Predictors of malignancy in melanocytic lesions presenting as new lesions compared to baseline total body photography: A case-control study.

BACKGROUND: Only a small per cent of new melanocytic lesions developing in adults are expected to represent melanomas. Total body photography (TBP) has been widely incorporated in clinical practice, especially for follow-up of high-risk individuals with multiple naevi. However, dynamic changes detected with TBP need to be interpreted with caution to avoid unnecessary excisions. OBJECTIVES: To identify clinical and dermoscopic predictors of malignancy in melanocytic lesions presenting clinically as new lesions on TBP. METHODS: Melanomas and melanocytic naevi excised from a high-risk cohort and presenting as new lesions on TBP were retrospectively included. Naevi were arbitrarily collected up to approximately twice the number of melanomas. Melanomas were categorized as 'unequivocal' or 'borderline' on histopathology review. RESULTS: Sixty melanomas and 110 naevi were included. Median age (range) of cases (55; 27-83) was 9 years older than controls (46; 24-77) (p < 0.0001). Median diameter (IQR) of naevi was 2.6 mm (1.8-3.8) and of melanomas 4.2 mm (2.7-7.0) (p < 0.0001). On histopathology, 40% of the melanomas were 'borderline'. A positive 7-point checklist was reported in 12.5% of 'borderline' melanomas and 33.3% of 'unequivocal' melanomas (p = 0.005), while 18.3% of melanomas were completely featureless. Blue-whitish veil, atypical vascular pattern and shiny white lines were exclusively found in melanomas. The main predictors of malignancy were (OR; 95% CI) regression structures (7.13; 1.88-27.06; p = 0.004); hypo/amelanotic colour (6.00; 1.17-30.73; p = 0.03); irregular pigmentation (3.89; 1.36-11.13; p = 0.01); asymmetrical peripheral dots/globules (3.50; 1.11-11.00; p = 0.03); and asymmetry in pattern and/or colour (2.5; 1.3-4.9; p = 0.007). All invasive melanomas detected in patients younger than 50 years presented at least one dermoscopic predictor of malignancy. CONCLUSIONS: Melanomas presenting as new lesions are frequently featureless or feature poor on dermoscopy and difficult-to-diagnose on histopathology. In high-risk patients, the presence on any of the dermoscopic predictors of malignancy identified should prompt excision; however, the remaining lesions should be closely monitored.

Is the Utility of the GLIM Criteria Used to Diagnose Malnutrition Suitable for Bicultural Populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ).

OBJECTIVES: To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Maori and non-Maori of advanced age. DESIGN: A longitudinal cohort study. SETTING: Bay of Plenty and Lakes regions of New Zealand. PARTICIPANTS: 255 Maori; 400 non-Maori octogenarians. MEASUREMENTS: All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. RESULTS: 56% of Maori and 46% of non-Maori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Maori and non-Maori (15% and 19% of all participants). Approximately one-third of participants (37% Maori and 32% non-Maori) died within the five-year follow-up period. The odds of death for both Maori and non-Maori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Maori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Maori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Maori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Maori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. CONCLUSION: Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Maori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Maori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework.

Assessment of Dietary Intake in Three Cohorts of Advanced Age in Two Countries: Methodology Challenges.

OBJECTIVES: Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described. PARTICIPANTS: The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006-7. LiLACS NZ recruited a 10-year birth cohort of Maori (indigenous New Zealanders) aged 80-90 years and a single year birth cohort of non-Maori aged 85 years in 2010. MEASUREMENTS: Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Maori contexts. Detailed methods are described. RESULTS: In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Maori and 353 (90%) non-Maori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Maori and 39 minutes for non-Maori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83-94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake. CONCLUSIONS: Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Maori and non- Maori). The 24hr-MPR is an acceptable method of dietary assessment in this age group.

Potentially modifiable determinants of malnutrition in older adults: A systematic review.

BACKGROUND & AIMS: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

Pulsed Entanglement of Two Optomechanical Oscillators and Furry's Hypothesis.

A strategy for generating entanglement between two separated optomechanical oscillators is analyzed, using entangled radiation produced from down-conversion and stored in an initiating cavity. We show that the use of pulsed entanglement with optimally shaped temporal modes can efficiently transfer quantum entanglement into a mechanical mode, then remove it after a fixed waiting time for measurement. This protocol could provide new avenues for testing for bounds on decoherence in massive systems that are spatially separated, as originally suggested by Furry not long after the discussion by Einstein-Podolsky-Rosen and Schrödinger of entanglement.

Health and Social Factors Associated with Nutrition Risk: Results from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

OBJECTIVES: To establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Maori and non-Maori in advanced age. DESIGN: A cross sectional analysis of inception cohorts to LiLACS NZ. SETTING: Bay of Plenty and Lakes region of the North Island, New Zealand. PARTICIPANTS: 255 Maori and 400 non- Maori octogenarians. MEASUREMENTS: Nutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15. RESULTS: Half (49%) of Maori and 38% of non-Maori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Maori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Maori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002). CONCLUSION: Traditional risk factors apply to both Maori and non-Maori whilst education as indicative of low socioeconomic status is an additional risk factor for Maori. High nutrition risk impacts health related quality of life for non-Maori. Interventions which socially facilitate eating are especially important for women and for Maori to maintain cultural practices and could be initiated by routine screening.

The BRIGHT Trial: what are the factors associated with nutrition risk?

OBJECTIVES: To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). DESIGN: A cluster randomised controlled trial. SETTING: Three main centres in New Zealand. PARTICIPANTS: A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Maori). MEASUREMENTS: Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. RESULTS: Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Maori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. CONCLUSION: Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Variation in malariometric and red cell indices in children in the Mount Cameroon area following enhanced malaria control measures: evidence from a repeated cross-sectional study.

BACKGROUND: Following enhanced malaria control measures, such as nationwide free distribution of insecticide-treated bed nets (ITN) by the government of Cameroon, its impact on malariometric and red cell indices in children ≤14 years in Muea, in the Mount Cameroon area was evaluated. METHODS: Two cross-sectional studies were conducted during the malaria transmission season (March-July) in 2006 (baseline) and 2013 (follow-up), respectively. The investigative methods included the use of a questionnaire to assess ITN use and coverage, clinical evaluation and laboratory investigations. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and density as well as full blood count determination using standard procedures and also an automated haematology analyzer. RESULTS: The majority of children (81.5%) possessed an ITN in 2013. The proportion of effective users of ITN increased significantly from 20.9% (CI = 17.3-25%) in 2006 to 35.2% (CI = 31-39.7%) in 2013. The highest relative risk reduction in prevalence during the follow-up study was observed in malaria anaemia (79%, CI = 58.0-69.1% [69.1 to 14.5%]), followed by gametocytaemia (71.6%, CI = 58.9-80.3% [25.6 to 7.3%]), anaemia (64%, CI = 58.0-69.1% [80.1 to 28.9%]), and malaria parasitaemia (57.2%, CI = 51.4-62.3% [85.4 to 36.6%]). In the baseline survey, the prevalence of splenomegaly was significantly highest (χ2 = 18.3, P <0.001) in the youngest group of children while in the follow-up study, it was highest in the oldest (χ2 = 6.03, P = 0.049). The overall prevalence of mild, moderate and severe anaemia in the study population at baseline (59.6, 14.9, 6.3%) decreased significantly (P <0.001) to 24.4, 2.7 and 1.3%, respectively during the follow-up with the highest relative risk reduction in prevalence occurring in moderate anaemia (82.1%, CI = 67.3-90.2% [14.9 to 2.7%]). Microcytic anaemia also decreased significantly (P <0.001) from 56 to 7.7% during the follow-up survey. CONCLUSION: Following interventions, anaemia (moderate to severe) was a more sensitive measure to changes in malaria exposure and children between 11-14 years of age experienced a significant increase in malaria-related morbidity.

Mycobacterium mimicking metastatic melanoma.

We present three patients with lung nodules with an antecedent history of primary cutaneous melanoma or metastasis of melanoma to extrathoracic lymph nodes. Based on radiological findings, it was suspected that these patients had metastatic disease. Subsequent investigations confirmed the cause of the nodules was non-tuberculous mycobacterial infection. We discuss the similarities in symptoms and radiological features between atypical mycobacterial infections and metastatic disease and why a biopsy is important prior to planning a patient's treatment.

What is associated with nutrition risk in very old age?

OBJECTIVES: To identify factors associated with nutrition risk among a purposive sample of those in advanced aged. DESIGN: A cross sectional feasibility study. SETTING: Three North Island locations in New Zealand. PARTICIPANTS: One hundred and eight community-living residents aged 75- 85 years. MEASUREMENTS: Nutrition risk was assessed using a validated questionnaire, Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II). A Physical Activity Scale for the Elderly (PASE) was used to determine level of physical activity. Markers of body composition, grip strength and fasting blood samples were collected. RESULTS: Fifty-two percent of participants were at high nutrition risk (SCREEN II score < 50; range 29-58; out of maximum score 64). The mean score for SCREEN II was higher for older people who lived with others (50.3 ± 5.1) compared to those who lived alone (46.4 ± 5.8) p=0.001. The SCREEN II score was positively correlated with the total PASE score r= 0.20 (p=0.042), grip strength r=0.20 (p=0.041), and muscle mass percentage r=0.31 (p=0.004). Lower levels of haemoglobin, serum zinc and physical activity were associated with higher nutrition risk. CONCLUSION: Half the participants were at high nutrition risk. They tended to be widowed or live alone and had lower levels of haemoglobin and serum zinc. Those at lower nutrition risk had greater muscle mass and strength, lower body fat, consumed alcohol more frequently and engaged in more physical activity. Strategies which encourage older people to eat meals and be physically active with others may assist to improve their health.

How is the risk of undernutrition associated with cardiovascular disease among individuals of advanced age?

BACKGROUND: The oldest old (85+) are the fastest growing population segment in New Zealand. Cardiovascular disease (CVD) is the main cause of death and is associated with various risk factors including risk of undernutrition. OBJECTIVES: To determine if there is an association between CVD and nutrition risk in advanced age. SETTING: Three North Island locations (rural and urban areas) in New Zealand. PARTICIPANTS: 108 participants aged 85 years (75-79 for Maori). MEASUREMENTS: Comprehensive health assessments were undertaken. Clinically manifest CVD was pre-defined and ascertained from interviews and hospitalisation records. Nutrition risk was assessed using a validated questionnaire-Seniors in the Community: Risk evaluation for eating and nutrition, Version II (SCREEN II). RESULTS: 72 participants (67%) had CVD (49% men); 52% of participants had a SCREEN II score < 50. Those with CVD had lower HDL level [median(IQR)] [1.4(0.7) vs. 1.6(0.6)] (p=0.041), and higher waist circumference [97.5(19.1) vs. 89.3(20.6)] (p=0.043) compared to those without CVD. Those with CVD were at no greater nutrition risk than those without CVD (SCREEN II score: [49(7) vs. 51(10)] (p=0.365). Using logistic regression controlling for confounders, SCREEN II scores trended towards an inverse association with CVD (p=0.10). CONCLUSION: Two thirds of the study participants had CVD and half were at risk of undernutrition. Nutrition risk was mildly associated with CVD. This study provides further evidence that those in advanced age are at risk of undernutrition. Further research is needed to establish how the causes and consequences of CVD are related to nutrition risk.