Mobile teledermatology is a valid method to estimate prevalence of melanocytic naevi in children.

The prevalence of melanocytic naevi in children correlates with sun exposure and may serve as an objective population risk indicator of future melanoma incidence. The aim was to investigate if mobile teledermatology could offer a valid methodology compared with standard manual, face-to-face counting of naevi on the back of children. Ninety-seven children aged 7-16 years were enrolled. One dermatologist performed manual naevi counting and imaging of the child's back using an iPhone 4S comprising a safe-coded mobile application. Two other dermatologists independently counted naevi from the images. Cohen's weighted kappa (κw) coefficient demonstrated substantial agreement for both dermatologists: κw = 0.69 (0.57-0.81 [95% confidence intervals]) and κw = 0.78 (0.70-0.86), compared with the manual assessment. Inter-rater reliability was also substantial (κw = 0.80 [0.73-0.87]). Use of mobile teledermatology proved valid for estimating naevi prevalence on the back and could provide a more feasible methodology following trends in sun exposure in children.

Changes in body-site distribution of common melanocytic naevi among 7-year-old Swedish children between 2002 and 2007.

An observational population-based study conducted among 2 sets of 7-year-old children in Sweden in 2002 and 2007 revealed evidence of improved sun protection, also reflected in a significant reduction in the total number of melanocytic naevi. Based on these data-sets, the aim of the current study was to determine whether the overall reduction in naevi had impacted differently on body sites based on their main pattern of sun exposure. In 2002, median naevi counts/m2 were highest on intermittently sun-exposed sites: 13.8 (95% CI 8.0-22.7) compared with chronically sun-exposed sites: 11.0 (95% CI 0.0-20.5). In 2007, median naevi counts/m2 on intermittently sun-exposed body sites were significantly lower: 8.7 (95% CI 4.7-15.2), p < 0.0001, while on chronically exposed sites median naevi counts/m2 were unaltered: 10.3 (95% CI 0.0-14.4), p = 0.9313. Changes were most evident among boys. Future research can evaluate whether this shift in naevi distribution in Swedish children translates into a reduction in cutaneous melanomas on intermittently sun-exposed body sites.

Future reduction of cutaneous malignant melanoma due to improved sun protection habits and decreased common melanocytic nevi density among Swedish children?: A follow-up from 2002 to 2012.

We have previously demonstrated significant improvements in sun protection regimens and significantly fewer common melanocytic nevi (CMN) among 7-year-old children in southern Sweden when comparing year 2007 with 2002. The aim of this study was to investigate whether the observed decreasing trend also can be observed at age 10 and, in addition, to compare the CMN density change between 7 and 10 years of age during two periods of time. Two open cohorts were used, cohort I with schoolchildren investigated in 2002 at age 7 and in 2005 at age 10 and cohort II with schoolchildren investigated in 2009 at age 7 and in 2012 at age 10. A significant decrease in CMN density (number/m2 BSA) at age 10 from 2005 to 2012 was observed: 15.9 (14.7-17.2) and 11.4 (10.1-12.7), respectively. The density growth rate from 7 to 10 years was 2.8 (2.1-3.5) between 2002 and 2005 and decreased significantly to 0.9 (0.2-1.5) between 2009 and 2012. Significant increases were observed for 'often use of sunscreen', 'often staying in shade' and 'often staying indoors' from cohort I to cohort II: 65 vs 80%, 7.6 vs 13% and 7.3 vs 19%, respectively. The decrease in number of CMN among 10-year-old children confirms a current trend in Sweden. If this persists, a future reduction of cutaneous malignant melanoma incidence in Sweden might be anticipated. The results also indicate that CMN count could be used as an indicator of ultraviolet exposure.

Common melanocytic nevi in 7-year-old schoolchildren residing at different latitudes in Sweden.

BACKGROUND: Current epidemiologic research shows consistently that increased number of acquired common melanocytic nevi (CMN) is an important risk factor for cutaneous malignant melanoma. The purpose of this study was to investigate the number of CMN in relation to tanning habits and complexion among 7-year-old children residing at different latitudes in Sweden. METHODS: Two municipalities were chosen at latitude 65 degrees N to 68 degrees N in the north of Sweden and two at latitude 57 degrees N in the south. Children born in 1994 and registered in the municipalities were to be included (N = 1,676). A questionnaire was sent to their parents asking about the child's tanning habits. A body examination of CMN of size >or=2 mm was done by the same trained nurse in 1,380 (82.3%) of the children. RESULTS: CMN was significantly less prevalent among children living in the north with a prevalence of 5.6 [95% confidence interval (95% CI), 4.8-6.5] inland and 6.2 (95% CI, 5.3-7.2) coastal compared with the south with a prevalence of 9.5 (95% CI, 8.2-11.0) inland and 10.4 (95% CI, 8.9-12.0) coastal. In addition, blond hair, blue/gray/green eyes, holidays at seaside resorts abroad, more frequent sunburns, and parents fancying tanning were significant predictors of higher prevalence of CMN. CONCLUSIONS: These findings support previous evidence that the development of CMN is related to the level of sun exposure in childhood expressed as latitude of residence, holidays at seaside resort abroad, and number of sunburns. To reduce the incidence of cutaneous malignant melanoma, a change in attitude and behavior must start with young children and their parents.

A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that usually results in respiratory failure and death. Pirfenidone was approved as the first licensed therapy for IPF in Europe based on phase III trials where patients with a forced vital capacity (FVC) >50% of predicted were included. The aim of this study was to characterise patients treated with pirfenidone in Swedish clinical practice and to describe the adherence to the reimbursement restriction since reimbursement was only applied for patients with FVC below 80% of predicted. METHODS: This was a retrospective, observational chart review of IPF patients treated with pirfenidone from three Swedish university clinics. Patients initiated on treatment during the period 28 June 2012 to 20 November 2014 were included. Data on patient characteristics, basis of diagnosis, treatment duration, quality of life, and adverse drug reactions (ADRs) were collected from medical charts. RESULTS: Forty-four patients were screened and 33 were included in the study. The mean treatment duration from start of pirfenidone until discontinuation or end of study was 38 weeks. At the initiation of pirfenidone treatment, FVC was 62.7% (12.1) [mean (SD)], diffusion capacity (DLco) was 45.1% (13.8) of predicted, and the ratio of forced expiratory volume on 1 sec (FEV1) to FVC was 0.78 (0.1). The percentage of patients with an FVC between 50 and 80% was 87%. Ten of the patients had ADRs including gastrointestinal and skin-related events, cough and signs of impaired hepatic function, but this led to treatment discontinuation in only two patients. CONCLUSION: Data from this chart review showed that adherence to the Swedish reimbursement restriction was followed in the majority of patients during the study period. At the start of pirfenidone treatment, lung function, measured as FVC, was lower in the present cohort of Swedish IPF patients compared with other registry and real-life data. About a third of the patients had ADRs, but discontinuation of the treatment because of ADRs was relatively uncommon.

Similar anatomical distributions of childhood naevi and cutaneous melanoma in young adults residing in northern and southern Sweden.

BACKGROUND: Common melanocytic naevi are considered early biomarkers associated with risk of cutaneous malignant melanoma. We sought to investigate if residing at different latitudes in Sweden influences the population's anatomical distribution of naevi in children and melanoma in adults. METHODS: The nationwide Swedish Cancer Registry 1990-2012 gave cumulative number of invasive melanomas per body site, stratified by sex and age in northern (62-69 °N) (n=2823) and southern (55-58 °N) Sweden (n=24,115). A population-based cross-sectional study conducted in 2002 provided the allocation of naevi among 7-year-olds in northern (5695 naevi in 679 children) and southern Sweden (8392 naevi in 681 children). RESULTS: In 2012, northern Sweden had a two-fold lower melanoma incidence: 19.8/100.000 age-standardised population compared with 41.0/100.000 in the south. Similarly, a lower mean naevi density in children was demonstrated: 7.3 (standard deviation (SD) 5.4) in boys and 7.0 (4.7) in girls in the north versus 13.3 (8.4) in boys and 11.9 (8.5) in girls in the south. Across latitudes of residing, gender profiles and proportional body-site distributions of melanoma and naevi, respectively, were largely homogenous, but in southern Sweden slightly higher on the trunk; a body site associated with intermittent sun exposure. Childhood naevi distributions matched with melanomas in young and middle-aged adults. CONCLUSION: This large population-based study demonstrated that latitude of residing similarly affects the number and anatomical distribution of naevi in children and melanoma in adults. It supports a role of childhood naevi as predictors of overall and subsite risk of melanoma among young adults.

PXL01 in sodium hyaluronate for improvement of hand recovery after flexor tendon repair surgery: randomized controlled trial.

BACKGROUND: Postoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery. METHODS: This prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery. RESULTS: The most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p = 0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p = 0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p = 0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p = 0.021; PPAS: 76% vs. 35%, p = 0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p = 0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture. CONCLUSIONS: Treatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the most efficient dose and health economic benefits. TRIAL REGISTRATION: ClinicalTrials.gov NCT01022242; EU Clinical Trials 2009-012703-25.

Previous extensive sun exposure and subsequent vitamin D production in patients with basal cell carcinoma of the skin, has no protective effect on internal cancers.

BACKGROUND: It has been suggested that sunlight through production of vitamin D might have a protective effect on a number of internal cancers. Consequently, in spite of the well known skin cancer risks, some researchers advocate more exposure to ultraviolet radiation, supported by the solarium industry. We estimated the risk of internal cancer before the patient contracted a basal cell carcinoma (BCC) of the skin, the most common cancer in white populations and strongly associated with extensive sun exposure. METHODS: A nested case control study was undertaken in the whole Swedish population. 115,016 patients with BCC and 987,893 controls were linked to population based registers. FINDINGS: The cases had an increased risk of getting another form of cancer before the BCC diagnosis: odds ratio (OR)=1.84; 95% confidence interval (CI) 1.81-1.86. This risk was mainly due to skin cancer: OR=4.95; 95% CI 4.81-5.09 but also non-skin cancer risk was elevated: OR=1.37; 95% CI 1.35-1.39. We adjusted the estimates for age, level of income, occupational status in national censuses, place of living and sex, where appropriate. Of the cancers specifically suggested to be related to vitamin D status: colon, prostate, breast, and ovary cancer, all had slightly increased ORs whilst for pancreatic and gastric cancer no increased OR was found. INTERPRETATION: Patients with BCC, a proxy for extensive sun exposure, run an increased risk of other forms of cancer prior to the diagnosis of BCC. The findings in this study contradict that vitamin D production through extensive sun exposure has any protective effect on internal cancer but emphasise the increased risk for skin cancer.

Factors related to being sunburnt in 7-year-old children in Sweden.

BACKGROUND: Epidemiologic research shows that being sunburnt as a child is an important risk factor for cutaneous malignant melanoma (CMM). The purpose of this study was to investigate sunburn in relation to tanning habits and complexion among 7-year-old children living at different latitudes in Sweden. METHODS: Two municipalities were chosen at latitudes 65 degrees N and 68 degrees N in the north of Sweden and two at latitude 57 degrees N in the south. Children born in 1994 and registered in the municipalities were to be included (N=1676). A questionnaire was sent to their parents asking about their children's tanning habits, and the children were examined. The analysis set comprised 1360 children who participated in the examination and whose parents answered the questionnaire (81.1%). RESULTS: Twelve percent of all children had been sunburnt during the first 2 years of life compared to 44% between 2 and 4 years and 67% after 4. The children in the south at latitude 57 degrees N compared to Kiruna at latitude 68 degrees N and Piteå at 65 degrees N had a higher risk of ever being sunburnt during the first 2 years of life OR=1.87 (95% confidence interval (CI) 1.11-3.14) and 1.66 (0.95-2.90), respectively. The differences diminished with age. Sunscreen was an independent risk factor of being sunburnt between 2 and 7 years of age (not or seldom using sun screen was protective). Photosensitive skin type was the main risk factor for sunburns. CONCLUSION: Swedish children are frequently sunburnt and children living in the south are more sunburnt than those in the north. Sunscreens that were seldom used or not used at all were found to be protective. These results support previous reports that photosensitive skin type is an important risk factor for suffering sunburn as a child and therefore increases the risk of cutaneous malignant melanoma.