Melanoma epidemiology, prognosis and trends in Latvia

Background Melanoma incidence and mortality rates are increasing worldwide within the white population. Clinical and histological factors have been usually used for the prognosis and assessment of the risk for melanoma. Objectives The aim of the study was to describe the clinical and histopathological features of the cutaneous melanoma (CM) in the Latvian population, to test the association between melanoma features and patient survival, and to assess the time trends for melanoma incidence. Methods We undertook a descriptive, retrospective analysis of archive data of 984 melanoma patients treated at the largest oncological hospital of Latvia, Riga East University Hospital Latvian Oncology Centre (LOC), between 1998 and 2008. Cox proportional hazards model was used to analyse patient survival and autoregressive models were applied to detect trends in melanoma incidence over time for various categories of melanoma. Results The study showed a significant ascending trend in melanoma incidence in Latvia during the time period from 1998 to 2008 (ß = 1.83, 95% CI = 1.15-2.91, P = 0.011). Nodular melanoma was the most common tumour subtype with a frequency of 39.2%. Ulceration was present in 45.2% of melanomas. The mean Breslow thickness was 6.0 mm (6.8 mm) and no significant decline in median Breslow thickness was observed during the study period (P = 0.609). A better overall prognosis was detected for females in comparison with males (HR = 1.49; 95% CI = 1.22-1.81; P < 0.001). Conclusions There is a steady increase in melanoma incidence in Latvia with the majority of melanomas diagnosed at late stages with poor prognosis for survival.publishersversionPeer reviewe

Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0–3-Year-Old Children Suffering from Trauma and Chronic Stress

Adverse childhood experiences are an important societal concern. Children aged 0-3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0-3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0-3

Germline MC1R status influences somatic mutation burden in melanoma

The major genetic determinants of cutaneous melanoma risk in the general population are disruptive variants (R alleles) in the melanocortin 1 receptor (MC1R) gene. These alleles are also linked to red hair, freckling, and sun sensitivity, all of which are known melanoma phenotypic risk factors. Here we report that in melanomas and for somatic C>T mutations, a signature linked to sun exposure, the expected single-nucleotide variant count associated with the presence of an R allele is estimated to be 42% (95% CI, 15-76%) higher than that among persons without an R allele. This figure is comparable to the expected mutational burden associated with an additional 21 years of age. We also find significant and similar enrichment of non-C>T mutation classes supporting a role for additional mutagenic processes in melanoma development in individuals carrying R alleles

Reconstruction of palaeovegetation and sedimentation conditions in the area of ancient Lake Burtnieks, northern Latvia

Palaeobotanical investigations were carried out with the aim of reconstructing the development of palaeovegetation and formation of sediments in the northeastern area of ancient Lake Burtnieks. Pollen and plant macroremain studies provide information on vegetation development in the surroundings of the lake, including Stone Age settlements of Braukšas I and Braukšas II. Results of the investigations indicate that the development of vegetation together with sedimentation conditions in the palaeolake have changed since the Younger Dryas until today. Vegetation composition varies in different parts of the ancient Lake Burtnieks area due to past changes in lake water level which reached different sites at different times. Data from the northern part of ancient Lake Burtnieks indicate its gradual overgrowing since the Preboreal. Deposition of minerogenic lacustrine sediments (silt, clayey silt and sand) lasted until the Boreal or the Atlantic time, depending on the water depth of the lake locality. Clastic sediments were overlain by gyttja, which in turn was later covered by well-decomposed fen (sedge, sedge–grass) peat that started to form at the end of Atlantic time. Pollen and plant macroremain composition of lacustrine sediments and fen peat sequences suggests that people have inhabited the area since Preboreal–Boreal times. However, weak traces of possible presence of people are found already at the very end of the Younger Dryas.Fluctuating curves of broadleaved tree pollen, a significant amount of pollen of cultivated plants and charcoal dust in sediments indicate activities of an early man and refer to start of crop growing in the area in the second half of the Atlantic chronozone

Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review.

BACKGROUND/OBJECTIVES: Cachexia affects ∼ 80% of pancreatic cancer patients. An international consensus defines cachexia as an ongoing loss of skeletal muscle mass (sarcopenia) with or without loss of fat, which impairs body functioning and cannot be reversed by conventional nutritional measures. Weight loss percentage and elevated inflammation markers have been employed to define this condition earlier. This review aimed to assess the prevalence and consequences of cachexia and sarcopenia on survival in patients with pancreatic ductal adenocarcinoma. METHODS: The systematic review was performed by searching the articles with preset terms published in PubMed and Cochrane Database until December 2013. After identifying relevant titles, abstracts were read and eligible articles data retrieved on preformatted sheets. The prevalence and impact of sarcopenia/cachexia on survival was evaluated. RESULTS: In total 1145 articles were retrieved, only 10 were eligible. Definitions of cachexia and sarcopenia were heterogeneous. In patients with normal weight (BMI 18.5-24.9 kg/m(2)) the prevalence of sarcopenia ranged from 29.7 to 65%. In overweight or obese patients (BMI >25 kg/m(2)) were 16.2%-67%. Sarcopenia alone was not demonstrated to be an independent factor of decreased survival, although obese sarcopenic patients were shown to have significantly worse survival in two studies. CONCLUSIONS: Impact of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma is currently understudied in the available literature. Definitive association between cachexia and survival cannot be drawn from available studies, although weight loss and sarcopenic obesity might be considered as poor prognostic factors. Further prospective trials utilizing the consensus definition of cachexia and including other confounding factors are needed to investigate the impact of cachexia and sarcopenia on survival in pancreatic adenocarcinoma

Trauma-informed care in childcare organisations to support children exposed to child maltreatment: Joint conclusions of four European countries

Trauma-informed care is emerging as a promising good practice to recognise, treat and prevent trauma in young children. The use of trauma-informed care in childcare organisations might have a positive impact on children who suffer from child maltreatment. The current study organised desk research and focus group discussions with professional experts in Latvia, Italy, Hungary and Belgium to assess if trauma-informed care is known, applied or taught. The joint conclusions of the desk research and the focus group discussions demonstrated that childcare professionals currently lack the knowledge, skills and attitude to engage in trauma-informed care. Even though they have ways to prevent and tackle trauma, these ways are often based on gut feeling or experience and are not formalised or explicitly addressed. This lack of conscious knowhow is an issue that possibly leads to underreporting of situations of child maltreatment and a lack of attuned responses to children suffering from child maltreatment. Overall, there were no training initiatives focused on trauma-informed care for childcare professionals, which might explain why these good practices do not reach the sector