News & Analysis
Clinical Trials Update
Breastfeeding Rates Improved
With Financial Reward
Financial incentives modestly improved
breastfeeding rates in areas of England with a
baselineprevalenceoflessthan40%,accord-
ing to a study published in JAMA Pediatrics.
The trial included 10 010 new mothers
who were randomly assigned to usual care
following the United Nations Children’s Fund
(UNICEF) Baby Friendly Initiative, or to an in-
tervention group that financially rewarded
women for breastfeeding. Intervention
group participants received usual care in ad-
dition to a $50 shopping voucher each time
they stated in writing that their infants were
receiving breast milk at ages 2 days, 10 days,
6 to 8 weeks, 3 months, and 6 months.
Women who received the financial incen-
tive for breastfeeding had a significantly
greater prevalence of breastfeeding at 6 to
8 weeks (the primary outcome measure):
37.9% vs 31.7% of the usual care group. The
trial was limited by the lack of independent
verification that women were breastfeeding.
Air Pollution May Limit Health Benefits
of Walking
Short-term exposure to traffic pollution ne-
gates the cardiopulmonary benefits of walk-
ing for healthy individuals, those with chronic
obstructive pulmonary disease (COPD), and
those with ischemic heart disease, accord-
ing to a trial published in The Lancet.
Study participants were age 60 years or
older and included 40 healthy volunteers,
40 individuals with stable COPD, and 39 with
stable ischemic heart disease. Participants
were randomly assigned to walk for 2 hours
along a traffic-polluted commercial street
in London or through a traffic-free park. The
walk was repeated 3 to 8 weeks later.
Walking in the park led to an increase in
lungfunctionandadecreaseinarterialstiffness
up to 26 hours after the walk for all partici-
pants.Walkingonapollutedstreetattenuated
these benefits, a finding associated with in-
creasedexposuretoairpollutantssuchasblack
carbonandultrafineparticles.Thosetakingcar-
diovascular medications had less arterial stiff-
ness than the other groups, perhaps because
these medications have protective effects
against air pollution, suggested the authors.
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High-Intensity Exercise Safe
in De Novo Parkinson Disease
Clinicians can safely prescribe high-intensity
exercise to patients with Parkinson disease
who are not yet taking medication, found a
phase 2 trial published in JAMA Neurology.
The 128 participants with de novo
Parkinson disease were randomized to
engage in high-intensity exercise (4 times
per week at 80%-85% of maximum heart
rate), moderate-intensity exercise (4 times
per week at 60%-65% of maximum heart
rate), or to a control group on a wait list for
6 months.
Adherence to the prescribed exer-
cise regimen was 2.8 days per week at
80.2% maximum heart rate in the high-
intensity group and 3.2 days per week at
65.9% maximum heart rate in the moderate-
intensity group. The mean change in Uni-
fied Parkinson Disease Rating Scale motor
score in the high-intensity group was 0.3
compared with 3.2 in the control group; in-
tense exercise led to less change in motor
symptoms. Adverse musculoskeletal events
were not severe.
Internet-Accessed STI Test
Complements Face-to-Face Services
Internet-accessed sexually transmitted in-
fection testing (e-STI testing) increased
uptake of STI testing, according to a study
published in PLOS Medicine.
The 2072 participants aged 16 through
30 years were randomly assigned to re-
ceive a text message with the web link of an
e-STI testing service (intervention) or to re-
ceive a text message with a link to a site list-
ing locations and websites of 7 local sexual
health clinics (control). Participants in the in-
tervention group could order free test kits
for STIs over the internet and return their
samples to a laboratory. Test results were de-
livered by text message or telephone, and
those with positive results were directed to
local clinics for treatment.
Uptake of STI testing was significantly
greater in the intervention group than in the
control group at 6 weeks (50% vs 26.6%).
The proportion of participants diagnosed
and treated was 2.8% and 1.1% in the inter-
vention group vs 1.4% and 0.7% in the con-
(Reprinted) JAMA February 27, 2018 Volume 319, Number 8
Financial reward may modestly improve
breastfeeding rates.
trol group, respectively. A larger study will be
necessary to better evaluate the effect of
e-STI on diagnosis and treatment, accord-
ing to the authors.
Stem Cell Transplantation Improves
Scleroderma Outcomes
Myeloablative autologous hematopoietic
stem cell transplantation resulted in signifi-
cantly better long-term clinical outcomes—
although greater toxicity–in patients with
scleroderma than did cyclophosphamide,
found a trial published in the New England
Journal of Medicine.
The 75 participants with severe sclero-
derma were randomly assigned to undergo
myeloablative autologous stem cell trans-
plantation or to receive cyclophosphamide.
In the intention-to-treat population, the
global rank composite score of disease
features at 54 months demonstrated the su-
periority of transplantation (67% of 1404
pairwise-participant comparisons favored
transplantation and 33% favored cyclophos-
phamide). In the per-protocol population,
event-free survival at 54 months was 79%
in the transplantation group and 50% in the
cyclophosphamide group. Mortality re-
lated to treatment in the transplantation
group was 3% at 54 months and 6% at 72
months compared with 0% in the cyclo-
phosphamide group. − Anita Slomski, MA
Note: Source references are available through
embedded hyperlinks in the article text online.
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