News & Analysis Clinical Trials Update Breastfeeding Rates Improved High-Intensity Exercise Safe With Financial Reward in De Novo Parkinson Disease Financial incentives modestly improved Clinicians can safely prescribe high-intensity breastfeedingratesinareasofEnglandwitha exercise to patients with Parkinson disease baselineprevalenceoflessthan40%,accord- who are not yet taking medication, found a ingtoa study published in JAMA Pediatrics. phase 2 trial published in JAMA Neurology. The trial included 10 010 new mothers The 128 participants with de novo who were randomly assigned to usual care Parkinson disease were randomized to followingtheUnitedNationsChildren’sFund engage in high-intensity exercise (4 times (UNICEF) Baby Friendly Initiative, or to an in- per week at 80%-85% of maximum heart tervention group that financially rewarded rate), moderate-intensity exercise (4 times women for breastfeeding. Intervention per week at 60%-65% of maximum heart group participants received usual care in ad- rate), or to a control group on a wait list for dition to a $50 shopping voucher each time 6 months. they stated in writing that their infants were Adherence to the prescribed exer- receiving breast milk at ages 2 days, 10 days, cise regimen was 2.8 days per week at Financial reward may modestly improve 6 to 8 weeks, 3 months, and 6 months. 80.2% maximum heart rate in the high- breastfeeding rates. Womenwhoreceivedthefinancialincen- intensity group and 3.2 days per week at tive for breastfeeding had a significantly 65.9%maximumheartrateinthemoderate- trolgroup,respectively.Alargerstudywillbe greater prevalence of breastfeeding at 6 to intensity group. The mean change in Uni- necessary to better evaluate the effect of 8 weeks (the primary outcome measure): fied Parkinson Disease Rating Scale motor e-STI on diagnosis and treatment, accord- 37.9% vs 31.7% of the usual care group. The score in the high-intensity group was 0.3 ing to the authors. trial was limited by the lack of independent compared with 3.2 in the control group; in- verification that women were breastfeeding. tense exercise led to less change in motor Stem Cell Transplantation Improves symptoms. Adverse musculoskeletal events Scleroderma Outcomes were not severe. Myeloablative autologous hematopoietic Air Pollution May Limit Health Benefits stem cell transplantation resulted in signifi- of Walking Short-term exposure to traffic pollution ne- cantly better long-term clinical outcomes— Internet-Accessed STI Test although greater toxicity–in patients with gates the cardiopulmonary benefits of walk- Complements Face-to-Face Services ingforhealthyindividuals,thosewithchronic Internet-accessed sexually transmitted in- scleroderma than did cyclophosphamide, found a trial published in the New England obstructive pulmonary disease (COPD), and fection testing (e-STI testing) increased those with ischemic heart disease, accord- uptake of STI testing, according to a study Journal of Medicine. The 75 participants with severe sclero- ingtoa trial published in The Lancet. published in PLOS Medicine. Study participants were age 60 years or The 2072 participants aged 16 through derma were randomly assigned to undergo myeloablative autologous stem cell trans- older and included 40 healthy volunteers, 30 years were randomly assigned to re- 40individualswithstableCOPD,and39with ceive a text message with the web link of an plantation or to receive cyclophosphamide. In the intention-to-treat population, the stable ischemic heart disease. Participants e-STI testing service (intervention) or to re- were randomly assigned to walk for 2 hours ceive a text message with a link to a site list- global rank composite score of disease features at 54 months demonstrated the su- along a traffic-polluted commercial street ing locations and websites of 7 local sexual in London or through a traffic-free park. The health clinics (control). Participants in the in- periority of transplantation (67% of 1404 pairwise-participant comparisons favored walk was repeated 3 to 8 weeks later. tervention group could order free test kits Walking in the park led to an increase in for STIs over the internet and return their transplantation and 33% favored cyclophos- phamide). In the per-protocol population, lungfunctionandadecreaseinarterialstiffness samplestoalaboratory.Testresultswerede- up to 26 hours after the walk for all partici- livered by text message or telephone, and event-free survival at 54 months was 79% in the transplantation group and 50% in the pants.Walkingonapollutedstreetattenuated those with positive results were directed to these benefits, a finding associated with in- local clinics for treatment. cyclophosphamide group. Mortality re- creasedexposuretoairpollutantssuchasblack Uptake of STI testing was significantly lated to treatment in the transplantation group was 3% at 54 months and 6% at 72 carbonandultrafineparticles.Thosetakingcar- greater in the intervention group than in the diovascularmedicationshadlessarterialstiff- control group at 6 weeks (50% vs 26.6%). months compared with 0% in the cyclo- phosphamide group. − Anita Slomski, MA nessthantheothergroups,perhapsbecause The proportion of participants diagnosed these medications have protective effects and treated was 2.8% and 1.1% in the inter- Note: Source references are available through embedded hyperlinks in the article text online. against air pollution, suggested the authors. vention group vs 1.4% and 0.7% in the con- jama.com (Reprinted) JAMA February 27, 2018 Volume 319, Number 8 761 © 2018 American Medical Association. All rights reserved.
JAMA – American Medical Association
Published: Feb 27, 2018
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