Alison Rodriguez

New research suggests that living near major roads or highways is associated with incidence of non-Alzheimer dementia, Parkinson disease (PD), Alzheimer disease (AD), and multiple sclerosis (MS).

, the study involved a data analysis of approximately 678,000 residents of Metro Vancouver, Canada. The researchers aimed to investigate associations between exposures and non-AD dementia and PD. Additionally, associations with AD and MS were assessed in nested case-control analyses.

According to the results, road proximity was associated with all outcomes for living less than 50 meters from a major road or less than 150 meters from a highway. Furthermore, a link was also found between air pollutants and incidence of PD and non-AD dementia.

"For the first time, we have confirmed a link between air pollution and traffic proximity with a higher risk of dementia, PD, AD, and MS at the population level," Weiran Yuchi, the study's lead author and a PhD candidate in the UBC school of population and public health, said in a 

. "The good news is that green spaces appear to have some protective effects in reducing the risk of developing 1 or more of these disorders. More research is needed, but our findings do suggest that urban planning efforts to increase accessibility to green spaces and to reduce motor vehicle traffic would be beneficial for neurological health."

The researchers also noted that noise was not associated with any outcomes, however, associations with greenness suggested protective effects for PD and non-AD dementia, the findings explained.

"For people who are exposed to a higher level of green space, they are more likely to be physically active and may also have more social interactions," said senior study author Michael Brauer, professor in the UBC school of population and public health. "There may even be benefits from just the visual aspects of vegetation."

The authors suggested that these findings emphasize the importance of city planners, including greenery and parks when developing residential neighborhoods.

Yuchi W, Sbihi H, Davies H, et al. Road proximity, air pollution, noise, green space and neurologic disease incidence: a population-based cohort study [published online January 21, 2020]. 

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Air Pollution From Major Roads, Highways Linked With Incidence of Parkinson Disease

In the United States, transgender women are disproportionately affected by 

, suggesting the need for additional efforts that address the social and structural barriers unique to the population, according to a recent 

The report shows that 18.8% of transgender women have HIV, based on studies conducted in the United States between 2006 and 2017. The CDC explained that this could be due to the stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors (eg, sex work, injection drug use).

 initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States,” the report said. “HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services.”

The CDC analyzed HIV partner services data submitted by 61 health departments during 2013 to 2017 and found of 208,304 index persons (persons with HIV diagnosis), 1727 (0.8%) were transgender women. Furthermore, this analysis revealed that 71.5% of index transgender women were interviewed for partner services—lower than for all index persons combined (81.1%).

These results indicate a need for additional outreach to the transgender community, especially by addressing concerns that include fear and loss of confidentiality, distrust of the medical community, abandonment, and abuse.

The CDC funded the implementation of comprehensive HIV prevention programs in 61 state and local health departments, including partner services, from 2013 to 2017. The report revealed that 71.2% of transgender women partners were notified of their potential HIV exposure, 46.5% were tested for HIV, and 18.6% received a new diagnosis of HIV.

“Full and effective implementation of partner services programs is important to identify persons who are unaware of their HIV status. Partner services is a successful strategy for identifying persons with undiagnosed infection with HIV,” the report concluded. “HIV prevention programs tailored to the needs of transgender women, particularly transgender women who are black, aged ≤35 years, and residing in the South, could help to reduce onward HIV transmission, increase linkage to HIV medical care and prevention, reduce HIV-related health disparities, and contribute to ending the HIV epidemic in the United States.”

The CDC noted that it conducts prevention research for identifying evidence-based interventions that focus on transgender women, as well as funds HIV prevention projects that prioritize the transgender population.

Because this report was on results seen in programs funded by the CDC, the authors note their results may not be generalizable to transgender women across the United States.

Song W, Mulatu MS, Rao S, Wang G, Kudon HZ, O’Connor K. HIV partner service delivery among transgender women—United States, 2013—2017. 

. 2020;69(2):35-39. doi: 10.15585/mmwr.mm6902a3.

There is a great need for additional outreach to the transgender community, especially by addressing concerns that include fear and loss of confidentiality, distrust of the medical community, abandonment, and abuse.

HIV Disproportionately Affects Transgender Women, CDC Reports

Individuals with headache who use smartphones may be more likely to use more pain medication and find less relief than those who do not use smartphones, reported a study investigating the association of smartphone use with occurrence of new-onset headache.

 involved 400 patients who were categorized in 2 groups: smartphone users (SUs) and non-smartphone users (NSUs).

 The researchers administered a questionnaire that assessed the participants’ headache characteristics and treatment taken.

Of the 400 patients, 194 were NSUs and 206 were SUs. According to the results, the NSUs were older and had lower education level and lower socioeconomic status. Additionally, the SUs were more likely to take pain-relieving drugs for their headaches than non-users, with 96% of smartphone users taking drugs while 81% of non-users did.

Headache characteristics were similar in both groups, except for the higher occurence of aura in the NSU group compared with the SU group (15

"While these results need to be confirmed with larger and more rigorous studies, the findings are concerning, as smartphone use is growing rapidly and has been linked to a number of symptoms, with headache being the most common," study author Deepti Vibha, DM, of All India Institute of Medical Sciences in New Delhi and a member of the American Academy of Neurology, said in a 

The study also evaluated pill count, finding that smartphone users took an average of 8 pills per month compared with non-users who took an average of 5 pills per month, according to the results.

In an editorial accompanying the study, Heidi Moawad, MD, and Elaine Jones, MD, suggested that in order to reduce the association of medication use, patient dependence on mobile internet devices must change.

 "Is it reasonable to expect a patient with headache to cut back on smartphone use if the alternative is feeling disconnected and inefficient?" they asked. Certain features, such as hands-free settings, voice activation, and audio functions could help alleviate some of these possible effects of phone use. But more research is needed to find potential solutions.

1. Uttarwar P, Vibha D, Prasad K, et al. Smartphone use and primary headache: A cross-sectional hospital-based study [published online March 4, 2020]. 

2. Moawad H, Jones E. Smartphone use and headaches: Are we ready to accept a link? [published online March 4, 2020]. 

Using a smartphone was associated with higher usage of acute medication, but less relief, in individuals with new-onset headache or increased severity of headache.

Study Links Smartphone Use to Greater Need for Medication Among People With Headache

 pay-for-performance (P4P) programs may reduce all-cause mortality in patients with type 2 diabetes (T2D), according to a recent 

 assessed the effect of a diabetes P4P program on all-cause mortality in patients with newly diagnosed T2D. The researchers recruited 5478 patients with T2D enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010. Patients not enrolled in the P4P program were also recruited as the control group.

In P4P payment models, providers, care organizations, and other healthcare stakeholders are given incentives for achieving performance objectives. Programs within the model, also known as value-based purchasing, are supported by leading insurance providers in Medicare and Medicaid as it promotes a culture that rewards providers for efficiency and penalizes high costs, poor patient outcomes, and medical errors.

“Previous studies have reported that patients enrolled in P4P programs had better adherence to the guideline-recommended examinations, had better clinical processes of care (e.g. HbA1c) and intermediate outcomes, decreased diabetes-related hospitalizations and inpatient costs, but increased rates of severe hypoglycemia requiring emergency medical care and increased outpatient expenses due to more regular follow-up visits,” the authors said. “Patients with type 2 diabetes are associated with a two-fold increase in mortality and a reduction in life expectancy by about 6 years compared with individuals without diabetes.”

The effect of the P4P program and adherence on all-cause mortality was evaluated using multivariate Cox proportional hazard models analysis, showing that a total of 250 patients had died in the P4P program group, compared with 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, 

 < .0001). Additionally, the control group had more comorbidities.

Of those in the P4P program, the researchers observed better adherence and a greater reduction in mortality. Also, participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality; this effect was particularly pronounced in the patients with better adherence to the P4P program.

Adjusted hazard ratio (aHR) for all-cause mortality was 0.58 (95% CI, 0.48-0.69). In those with a minimum 1-year and 2-year good P4P adherence, there was a greater reduction in mortality, with aHRs (95% CI) of 0.48 (0.38-0.62) and 0.36 (0.26-0.49), respectively.

“The positive effects of the P4P program existed across age- and disease-specific groups except for those with stroke, cancer and psychosis, which may be explained by high competing mortality of these diseases and poor compliance due to the underlying diseases and conditions that can lead to a diminished P4P effect,” the authors stated. “In the subgroup analysis, the patients with a longer regular adherence to the P4P program had a greater reduction in mortality rate. Hence, both participating in and adhering to the P4P program played an important role in contributing to the reduction of mortality in the patients with newly diagnosed type 2 diabetes.”

The authors suggested that future efforts should focus on promoting P4P programs in patients with newly diagnosed T2D for long-term survival benefits.

Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. 

2020;99(7):e19139. doi: 10.1097/MD.0000000000019139.

Diabetes pay-for-performance programs may reduce all-cause mortality in patients with type 2 diabetes (T2D).

Author | Alison Rodriguez

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