Two articles published Online First in The Lancet report that community support groups can reduce neonatal mortality. In addition, they can lower rates of maternal depression, provided that the population coverage is wide enough and the programs are suitably designed.

In trials in Nepal, participatory women’s groups have shown promise. Neonatal mortality was reduced by about one-third. Two research teams undertook to test this approach further. They carried out cluster-randomized controlled trials that were led by Anthony Costello, University College London Centre for International Health and Development, Institute of Child Health, London, UK.

Prasanta Tripathy, Ekjut, Chakradharpur, Jharkand, India and colleagues explain their work in the first article. They assigned clusters in a population of 228,186 people in Jharkand and Orissa in eastern India to either participating in women’s groups focusing on the reduction of maternal and newborn health problems, or not. A total of 19,030 births were monitored over 3 years. They found that neonatal mortality was 32 percent lower overall. It was 45 percent lower in years 2 and 3 for women who had been living in areas where women’s groups existed than for those who had not. Moderate maternal depression had fallen by 57 percent by the third year.

The authors explain: “Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices.”

They write in conclusion: “Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.”

Professor Kishwar Azad, Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh and colleagues describe their work in a second article. They monitored neonatal mortality for 36,113 births over 3 years in a population of 503,163. As with Tripathy et al’s study, the study population was divided into clusters. Some of which were assigned to support from women’s groups. Findings indicate that the community support made no difference to neonatal mortality rates.

They comment: “For participatory women’s groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.”

They note: “Women’s groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women’s group approach requires adequate human resources support for community mobilisation and appropriate coverage.”

“Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial”

Your average conversation down the pub on a Friday night could include topics such as ‘the kids are driving me mad this week’ or ‘the litter in our street is out of control’ and ‘have you seen that change 4 life advert on TV?’ – but the crucial research behind the topics rarely gets the same attention. Three events during the Economic and Social Research Council’s (ESRC) Festival of Social Science (12-21 March) provides a fascinating insight into how social science research influences our everyday lives.

An event hosted online by the Open University’s Institute for Social Marketing looks at how social marketing can influence our behaviour. Social marketing is a form of marketing that is used to influence behaviour for a ’social good’ such as obeying the speed limit or not to smoke in public areas. The event will have several interactive elements such as videos, a blogs and an online discussion aimed at introducing the general public to social marketing and the way it is used to influence behaviour.

Family policy and parenthood is an important yet complex issue and one which can make people react in very different ways. The Institute of Ideas is hosting ‘Standing up to Supernanny’ a debate in partnership with the Sunday Times Oxford Literary Festival on Sunday 21 March. The debate will focus on whether parents need counselling, parenting classes and policies backed by academic research in order to be good parents or whether parents should be standing up to ’supernanny’ policies, media and science.

Many people feel insecure when they drive in tunnels. However, their anxiety can be reduced.

“Driving in tunnels is actually twice as safe as driving in the open air, when all factors are taken into account,” says SINTEF scientist Gunnar Jensen.

However, a rough estimate suggests that as many as 10 – 20 percent of the population feel uncomfortable or very uncomfortable driving in tunnels. Older people in particular tend to feel insecure.

In a previous study carried out by SINTEF, as many as 40 percent of the older age-group said that they felt extremely insecure driving in tunnels. They spoke of walls and road lanes that seemed to shrink, and of a feeling of being completely exhausted when they eventually reached the end of the tunnel.

Gunnar Jenssen believes that this may be due to the fact that elderly people tend to have poorer vision than younger people. This means that lighting conditions in tunnels play a decisive role in determining how people experience tunnels, he believes.

Design can reduce discomfort

On this background, SINTEF transport researchers have been studying the use of various ranges of colour, lighting and patterns, as well as the use of cavern spaces in tunnels. The group’s driving simulator has been and still is a very aid in testing out lighting designs.

“The cavern in the tunnel is one measure that is high on our list. The trumpet-like widenings of the caverns’ entrances and exits are a way of breaking up the impact of long tunnels. The 24.5 km-long Lærdal Tunnel has three well-lit caverns designed according to proposals submitted by the Kadabra Produktdesign company, researchers and the artists Arild Juul and Brit Dyrnes.

Norwegian breathing spaces in Chinese tunnel

In 2007, the lighting design from Trondheim was exported to China, and Gunnar Jenssen was project manager for “Safety and Lighting Design” when that country inaugurated the world’s longest twin-tube tunnel, the Qinling Zhongnan Mountain Tunnel, in which the monotony is broken by huge caverns excavated at intervals of three to seven kilometres.

“The tunnel is 18×2 kilometres long, and to begin with it was a dry, monotonous tunnel, which was then developed in collaboration with Norwegian artists and designers into an oasis with palm-trees and clouds on the roof ,” says Jenssen.

Lighting for safety

The main point is to obtain a good distribution of light, in conjunction with the use of artistic lighting, which turns out to give drivers a feeling of space and of greater security. Modern lighting systems, with two rows of lamps, light sources that illuminate the opposite direction and driving lane, are beginning to be quite common in new Chinese tunnels, and they have also been installed in the tunnel that forms part of the Øresund Link between Denmark and Sweden.

President Barack Obama’s recent physical examination revealed that he is in generally good health and that he is still trying to quit smoking. His doctor’s advice: keep up his “smoking cessation efforts”; in other words, he should keep trying to kick the habit.

Susan Rausch, health educator at the Pat Walker Health Center and co-chair of the University of Arkansas’ FRESH campaign to promote the Tobacco Free Campus policy, says that stress is one of the reasons people give for not being able to quit smoking.

“Obviously, President Obama has a very stressful job,” she says. “But University of Arkansas students facing mid-term exams know something about stress, too. There are ways to deal with stress and quit smoking, too.”

Her advice for the president, and anyone with the same problem, and same goal, is a five-step plan.

1. Deal with your stress first! Stress by itself is bad for your health. Examine your day and identify the sources of your stress. Research stress reduction strategies and find ones that will work for you. Make physical activity that you enjoy a part of each day.

2. Ask yourself why you want to quit smoking. The key to success is personal choice: It has to be for you. Envision yourself as a non-smoker. Think of quitting as a gift you give yourself, not something that you are taking away.

3. Set a date for quitting.

4. Prepare for that quit date by cutting down and each time you smoke ask yourself how much you “needed” that cigarette. Freshen your surroundings: clean your home, car, clothes even your teeth. The spring season is a prime time for this.

5. On your quit date, plan to be somewhere smoking is not allowed, and reward yourself each day you don’t smoke.

Rausch says it’s also important to remember that relapse is not failure.

“Most smokers try several times before they achieve freedom. Each attempt teaches you something about the type of smoker that you are and the role of tobacco in your life. The better you understand yourself, the more likely you will succeed. The important thing is to keep trying. That’s true for a student, a professor, a staff worker or even the president of the United States.”

A Mailman School of Public Health study examining the effects of institutional discrimination on the psychiatric health of lesbian, gay and bisexual (LGB) individuals found an increase in psychiatric disorders among the LGB population living in states that instituted bans on same-sex marriage. The study, published in the March issue of the American Journal of Public Health, is available online.

Deborah Hasin, PhD, professor of clinical Epidemiology at the Mailman School of Public Health and senior author, and colleagues at the NYS Psychiatric Institute and Harvard University analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants were initially interviewed during 2001 – 2002 (Wave 1) and again during the period 2004-2005 (Wave 2), at which time participants’ sexual orientation was assessed.

“To address the impact of institutional discrimination on mental health, we examined whether LGB individuals living in states that instituted constitutional amendments banning gay marriage via the 2004-2005 elections evidenced increased rates of psychiatric disorders between Wave 1 and Wave 2 of the survey,” according to the authors.

Among LGB study participants living in these states, the prevalence of mood disorders, generalized anxiety disorder and alcohol use disorders increased significantly between Wave 1 to Wave 2, with the greatest increase, more than 200%, in generalized anxiety disorder. The prevalence of any psychiatric disorder also increased slightly among heterosexual respondents, but to a much lesser extent than their LGB counterparts.

“Before this study, little was known about the impact of institutional discrimination toward lesbian, gay and bisexual individuals in our society,” said Dr. Hasin. “The study highlights the importance of abolishing institutional forms of discrimination, including those leading to disparities in the mental health and well-being of LGB individuals.”

A survey of parents who had a child die of cancer found that one in eight considered hastening their child’s death, a deliberation influenced by the amount of pain the child experienced during the last month of life, report Dana-Farber Cancer Institute researchers in the March issue of Archives of Pediatrics & Adolescent Medicine.

The study, the first to explore this sensitive area, suggests that many parents worry that their children will suffer from uncontrollable pain, and that some parents might consider that an early death would be preferable. The researchers say the findings underscore the importance of managing patients’ pain, and of communicating with parents about the tools available for easing progressive pain.

“The problem is that conversations about these family worries may not always happen,” said senior author Joanne Wolfe, MD, MPH, Division Chief of Pediatric Palliative Care at Dana-Farber and Director of Palliative Care at Children’s Hospital Boston. “Parents may not have the opportunity to express these feelings and considerations, and as clinicians, we may not be adequately enabling sufficient opportunity for them to talk about their concerns.”

Wolfe, along with first author Veronica Dussel, MD, MPH, a Dana-Farber research fellow, undertook the research to gain an understanding of why some parents would consider a measure as extreme as intentionally ending a child’s life.

The researchers interviewed 141 parents of children who had died of cancer and were treated at Dana-Farber, Children’s Hospital, or Children’s Hospitals and Clinics of St. Paul and Minneapolis, Minn.

The scientists queried parents about their behaviors and feelings leading up to their child’s death and at the time the survey was conducted, which was a year or more after the death. The parents were also presented with hypothetical vignettes involving a terminally ill child with uncontrolled excruciating pain or who was in an irreversible coma.

One in eight (13 percent) of parents had considered asking caregivers about the possibility of ending their child’s life, though only 9 percent reported having such a discussion. Five parents, or 4 percent, had requested that their child’s death be hastened, and 3 parents said it had been carried out, using morphine. Wolfe commented, however, that “this may not reflect what actually happened, because morphine is used in increasing doses to manage worsening pain without the intent or the effect of ending life.”

In response to the hypothetical vignettes, 50 percent of parents said they endorsed hastening death in situations of uncontrollable pain or if the child was in an irreversible coma. Parents were 40 percent more likely to approve hastening death for a child experiencing extreme pain than for a terminally ill child in a coma.

Wolfe said it is important to keep the findings in perspective. Only five parents reported having talked about hastening their child’s death, and 19 said they considered it. Wolfe said it is her experience that parents are comforted by having conversations about pain management and that most are reassured by knowing what will be done to ease their child’s suffering.

“We’ve come a long way, because we have a good palliative and supportive care program for children with cancer,” said Wolfe, who is also an assistant professor of pediatrics at Harvard Medical School.

But she acknowledged, “I can never promise that their child will be pain free. We still have quite a way to go in figuring out the best way to ease suffering at the end of life.” The gap exists in part, Wolfe said, because this area is not one given high priority for research funding agencies.

Oxygen for ethanol oxidation is supplied through breathing, the stomach, and the skin. There is a great deal of genetic and environmental variability in the pharmacokinetics of alcohol absorption, distribution, metabolism, and elimination. A new study has found that increasing dissolved oxygen concentrations in alcohol may help to reduce alcohol-related side effects and accidents.
“Ethanol is oxidized to acetaldehyde, then further oxidized to water and carbon dioxide in the body after consumption,” explained Kwang-il Kwon, a professor in the college of pharmacy at Chungnam National University and corresponding author for the study. “These oxidation reactions occur primarily via hepatic oxidation and are governed by the catalytic properties of alcohol-metabolizing enzymes, including the microsomal ethanol oxidizing system (MEOS), alcohol dehydrogenase (ADH), and aldehyde dehydrogenase (ALDH). Ethanol oxidation by ADH, ALDH, and MEOS requires oxygen, and a higher oxygen uptake increases the rate of ethanol oxidation.”

“Several studies have indicated that high-oxygen water can enhance the survival ability of mice, fatigue recovery, and anoxia endurance function,” added Hye Gwang Jeong, a professor in the department of toxicology in the college of pharmacy at Chungnam National University. “It can also increase energy storage. However, the influence of dissolved oxygen concentration on alcohol pharmacokinetics has not previously been described. This manuscript is the first to investigate the influence of dissolved oxygen concentrations on the pharmacokinetics of alcohol in healthy human subjects.”

Kwon and his colleagues performed three experiments with 49 healthy volunteers (30 men, 19 women), with a mean age of 27.2 years. Experiment one compared 8 ppm and 20 ppm dissolved oxygen concentrations in 240 ml of 19.5 percent alcoholic beverage. Experiment two compared 8 ppm and 20 ppm dissolved oxygen concentrations in 360 ml of 19.5 percent alcoholic beverage. Experiment three compared 8 ppm and 25 ppm dissolved oxygen concentrations in 360 ml of 19.5 percent alcoholic beverage.

Results showed that elevated, dissolved oxygen concentrations in alcoholic drinks can accelerate the metabolism and elimination of alcohol. For example, the time to reach 0.000 percent blood alcohol concentration (BAC) for the 240 ml of 19.5 percent alcoholic beverage with 20 ppm dissolved oxygen concentration was 20.0 min faster than with 8 ppm (257.7 min). The time to reach 0.000 percent BAC for the 360 ml of 19.5 percent alcoholic beverage with 20 ppm (334.5 min) and 25 ppm (342.1 min) dissolved oxygen concentration was 23.3 min and 27.1 min faster than with 8 ppm, respectively.

“The oxygen-enriched alcohol beverage reduces plasma alcohol concentrations faster than a normal dissolved-oxygen alcohol beverage does,” said Kwon. “This could provide both clinical and real-life significance. The oxygen-enriched alcohol beverage would allow individuals to become sober faster, and reduce the side effects of acetaldehyde without a significant difference in alcohol’s effects. Furthermore, the reduced time to a lower BAC may reduce alcohol-related accidents.”

Both Kwon and Jeong noted that alcoholic drinks with a higher oxygen concentration already exist in Korea, but they lack scientific support. “It seems that these drinks can maintain a high dissolved-oxygen concentration for about 10 to 20 days before the stopper is removed, and for 70 minutes after removing the stopper, respectively, at room temperature,” said Kwon.

Identifying the public health and safety needs of children from low-income communities may be best accomplished through art, report University of Pittsburgh researchers in the current online issue of Progress in Community Health Partnerships: Research, Education and Action. In their paper, researchers describe the success of Visual Voices, an arts-based program that engages community members as partners in research.

The study was based on Visual Voices programs conducted with 22 children ages 8 to 15 in two low-income and predominantly African-American communities in Baltimore and Pittsburgh. During the Visual Voices sessions, participants created paintings and drawings to share their perceptions, both positive and negative, of community safety and violence, as well as their hopes for the future. Afterward, they combined their individual art projects into two “visual voice” exhibits that were publicly displayed in each city.

Michael A. Yonas, Dr.P.H., Visual Voices creator and assistant professor, Department of Family Medicine, University of Pittsburgh School of Medicine, and colleagues at Pitt and the Johns Hopkins Center for Injury Research and Policy, used qualitative research methods to review and code the participants’ art projects for themes. Factors that participants identified as important to safety included school and social networks – family, friends and the local community. Places that they identified as unsafe were corner stores, streets and alleys with poor lighting, and abandoned houses. Other contextual factors identified as unsafe were drugs, smoking, drinking, gambling, guns and violence.

“Community members are experts in their own lives much more so than those who reside outside their communities,” said Dr. Yonas. “Visual Voices helps incorporate residents’ unique expertise into the research process in a non-intrusive and fun way, and creates valuable data about their life experiences.”

Visual Voices is different than surveys or focus groups because it uses tools – crayons, paint and markers – that are familiar to children, and it can lead to in-depth discussions, encourage self-efficacy and help build trusting relationships between academic researchers and the communities they serve, added Dr. Yonas. It also can help experts prioritize public health interventions.

In Pittsburgh, for example, findings were shared with the local police department to develop potential intervention opportunities and to increase law enforcement’s understanding of young peoples’ perceptions of safety.

“The heart of Visual Voices is to ask and listen,” said Jessica G. Burke, Ph.D., study co-author and assistant professor, Department of Behavioral and Community Health Sciences, Pitt’s Graduate School of Public Health. “You need to first ask what it is people care about in order to develop public health interventions that are appropriate for specific communities.”

Two experts on bmj.com today say that further research is needed before consumers can be reassured that electronic cigarettes (also known as e-cigarettes) are safe.

“Our knowledge on the acute and long term effects of e-cigarette use is, at best, very limited”, say Andreas Flouris and Dimitris Oikonomou, from the Institute of Human Performance and Rehabilitation in Greece.

Interest in alternative smoking products is augmenting since anti-smoking policies are becoming more widespread. Electronic cigarettes or e-cigarettes are one of the most newly introduced products on the market. These are battery operated devices that allow users to inhale a nicotine vapor. They are meant to substitute normal cigarettes and help smokers quit.

There are a number of doubts regarding the safety of e-cigarettes. The US Food and Drug Administration (FDA) had expressed serious concerns. Three reports have been undertaken on the product: one by the FDA, one by a private body called Health New Zealand (HNZ) and another by Demokritos, a publicly-funded Greek research institute.

The authors remark that the interpretations of the three reports diverge significantly. The FDA detected a number of toxins in e-cigarettes and “carefully raises caution on potential harmful effects of e-cigarettes.”On the other hand, HNZ recommends e-cigarettes as they are safer than normal tobacco products. DRI takes a neutral position.

In conclusion, the authors note that while “alternative smoking strategies are always welcome in an effort to reduce the threat to public health caused by the tobacco epidemic”, further research is necessary in order to inform consumers about the safety of these e-cigarettes.

As Atlanta officials aim to tackle the city’s safety problems this year, some of their toughest criminals to stop maybe young offenders whose desires to commit crimes are being fueled by an anticipation of dying early.

Georgia State University Criminal Justice experts Timothy Brezina, Volkan Topalli and economist Erdal Tekin, have released a unique study that indicates that although young criminals are aware of the risks of violent injury, death or punishment, the possibility of a shorter life span encourages them to focus more on the “here and now.”

“It turns out that if you boil it all down the more you think you are going to die young the more likely it is that you are going to engage in criminality and violence,” Topalli said. “This is the opposite of what most people think, because most people think that if you think you’re going to die soon you become depressed and you wouldn’t commit crimes.”

The research “Might not be a Tomorrow”, is among the first Criminal Justice studies to simultaneously include one-on-one offender interviews with an econometric analysis of nation-wide adolescent data to provide a better understanding of why young people tend to pursue high-risk behaviors associated with immediate rewards, which include crime and violence.

The professors interviewed more than 30 young offenders in some of Atlanta’s toughest neighborhoods, specifically focusing on Central West Atlanta, a community that has suffered high rates of drug trafficking, serious street crime and youth violence. Those interviews, which lasted from 45 to 120 minutes, focused on the participants’ perception of risk, with an emphasis on the risk of future injury, early death and the extent to which these perceptions influenced their attitudes and behaviors related to offending.

“Many had been shot or stabbed and bore visible scars of physical trauma,” Brezina said. “They also expressed what criminologists refer to as a “coercive” worldview; in their eyes, they occupy a dog-eat-dog world where it is acceptable if not necessary to use force to intimidate others and to prevent victimization.”

The bleak outlook on life and sense of “futurelessness” of young offenders has been shaped by some of their earliest memories and reinforced by other people in their lives and the witnessing of violence, Topalli said. Prior research has found that when young people believe they have no future, it is argued, they have little to lose by engaging in crime or violence.

“They live in neighborhoods that are kind of like war zones,” Topalli said. “They grew up hearing gun shots, seeing people die and hearing ambulances and police cars. Just about every young person we talked to had seen a dead body, and either has fired a weapon or has been fired upon in some context. Over 70 percent of them have been victimized themselves, which is far greater than the larger population. The majority of them won’t die early, but the illusion is that you will and it’s reinforced by the culture.”

The professors also analyzed data from the National Longitudinal Study of Adolescent Health, also known as Add Health, which was specifically designed to investigate adolescents’ health and risk behaviors and is considered the largest and most comprehensive survey of adolescents ever undertaken. The data includes responses from more than 20,000 adolescents between seventh and 12th-grade and their parents. Detailed questions were included about the delinquent behavior of adolescents, like whether they had committed crimes such as theft, robbery or shooting in the nine to 12 months prior to the interview and whether they thought they will live to 35 or be killed by the age of 21.

The study’s finding state that when the perceived chance of being killed by age 21 is greater than 50 percent, the probability of offending behavior increases by 3.3 percent. The probability of offending behavior increases by 3.4 percent when the perceived chance of living to age 35 is less than 50 percent.

“The results from the Add Health study mirrored the results from the interviews,” Topalli said.

Georgia State researchers say the finding have implications for public policy. And not only do the researchers have plans to expand the research, Georgia State University is establishing a Center for Crime and Violence Prevention Policy, to deal with issues like youth/gang violence, urban drug markets and crime trend forecasting.

“It seems unlikely that threats of harsher criminal justice penalties will deter these fearless offenders. They assume life is short anyway and willingly accept the risks associated with a criminal lifestyle – even death,” Brezina said. “An alternative approach is to confront the pervasive violence and other social ills that so many inner-city children confront in their daily lives – conditions that deflate hope and breed crime in the first place.”