With Financial Reward in De Novo Parkinson Disease Financial incentives modestly improved Clinicians can safely prescribe high-intensity breastfeeding rates in areas of England with a exercise to patients with Parkinson disease baselineprevalenceoflessthan40%,accord- who are not yet taking medication, found a ing to a 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 following the United Nations Children’s Fund 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. Women who received the financial incen- intensity group and 3.2 days per week at tive for breastfeeding had a significantly 65.9% maximum heart rate in the moderate- trol group, respectively. A larger study will be 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 Air Pollution May Limit Health Benefits were not severe. Myeloablative autologous hematopoietic of Walking stem cell transplantation resulted in signifi- Short-term exposure to traffic pollution ne- Internet-Accessed STI Test cantly better long-term clinical outcomes— gates the cardiopulmonary benefits of walk- Complements Face-to-Face Services although greater toxicity–in patients with ing for healthy individuals, those with chronic Internet-accessed sexually transmitted in- scleroderma than did cyclophosphamide, obstructive pulmonary disease (COPD), and fection testing (e-STI testing) increased found a trial published in the New England those with ischemic heart disease, accord- uptake of STI testing, according to a study Journal of Medicine. ing to a trial published in The Lancet. published in PLOS Medicine. The 75 participants with severe sclero- Study participants were age 60 years or The 2072 participants aged 16 through derma were randomly assigned to undergo older and included 40 healthy volunteers, 30 years were randomly assigned to re- myeloablative autologous stem cell trans- 40 individuals with stable COPD, and 39 with ceive a text message with the web link of an plantation or to receive cyclophosphamide. stable ischemic heart disease. Participants e-STI testing service (intervention) or to re- In the intention-to-treat population, the 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 along a traffic-polluted commercial street ing locations and websites of 7 local sexual features at 54 months demonstrated the su- in London or through a traffic-free park. The health clinics (control). Participants in the in- periority of transplantation (67% of 1404 walk was repeated 3 to 8 weeks later. tervention group could order free test kits pairwise-participant comparisons favored Walking in the park led to an increase in for STIs over the internet and return their transplantation and 33% favored cyclophos- lungfunctionandadecreaseinarterialstiffness samples to a laboratory. Test results were de- phamide). In the per-protocol population, 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% pants.Walkingonapollutedstreetattenuated those with positive results were directed to in the transplantation group and 50% in the 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 carbonandultrafineparticles.Thosetakingcar- greater in the intervention group than in the group was 3% at 54 months and 6% at 72 diovascular medications had less arterial stiff- control group at 6 weeks (50% vs 26.6%). months compared with 0% in the cyclo- ness than the other groups, perhaps because The proportion of participants diagnosed phosphamide group. − Anita Slomski, MA these medications have protective effects and treated was 2.8% and 1.1% in the inter- Note: Source references are available through against air pollution, suggested the authors. vention group vs 1.4% and 0.7% in the con- embedded hyperlinks in the article text online.
jama.com (Reprinted) JAMA February 27, 2018 Volume 319, Number 8 761