Longitudinal study of melanocytic nevi in adolescents.

BACKGROUND: Although melanocytic nevi are the strongest known risk factors for melanoma, their etiology is not well understood. OBJECTIVES: This study was performed to assess the roles of constitutional pigmentary factors and sun exposure in the development of new nevi in adolescents. METHODS: A cohort of 111 school children, aged 12 and 13 years at baseline, were followed up for 5 years. Whole-body counts of nevi of all sizes and detailed sun exposure histories were updated each year. Analyses of full-body nevus counts and of nevus counts on the face and neck region and on the shoulder and back region were undertaken by means of log-linear regression, allowing for repeated measures. RESULTS: Mean whole-body nevus counts were 130.1 (SD = 69.9) in 1990 and 215.5 (SD = 127.1) in 1994. Shoulder and back counts were consistently higher than face and neck counts. Subjects with heavy shoulder freckling had increased nevus counts on all sites investigated, with a means ratio for whole-body counts of 1.11 (95% CI, 1.03-1.19), compared with those with no freckling. Those who spent all of their school lunch times in the midday sun had a means ratio of 1.62 (95% CI, 1.15-2.29) compared with those who spent very little time in the sun during the lunch period. Summer holiday sun exposure was not significantly associated with development of nevi in this adolescent cohort. CONCLUSION: The degree of freckling, especially on the shoulders, and habitual midday sun exposure, rather than holiday sun exposure, are significant determinants of melanocytic nevi in Queensland adolescents.

Evolution of melanocytic nevi on the faces and necks of adolescents: a 4 y longitudinal study.

All melanocytic nevi on the faces and necks of a cohort of students, initially aged 12-14 y, were mapped and photographed annually for 4 y. The features of each nevus were charted yearly noting changes in size and profile, and the appearance or disappearance of any nevi on a student's face and neck was recorded. Nevi were classified by size (small, < 2 mm; medium, 2-5 mm; large, > 5 mm), and by profile (flat, raised). Data from 20 adolescents selected randomly from the cohort for detailed analysis showed males had about twice as many nevi as females, but there was little difference between sexes in their patterns of nevus development. Approximately half the nevi were small in all years; under 5% were large. Over the 4 y of follow-up the proportion of flat nevi dropped from 70% to 57%, whereas nevus numbers increased by 47% in year 1, with smaller increases in older students. Most new or disappearing nevi were small and flat, although both incident and disappearing nevi could be larger and/or raised. Of the existing nevi that altered in the follow-up period, the tendency was towards an increase in size among raised but not among flat nevi; a lowering of profile among small nevi; and a raising of profile among larger nevi; but there were many exceptions to this pattern. Among several host factors examined, inability to tan after sun exposure was found to be significantly negatively associated with the propensity of nevi to change size over the study period. Overall our findings indicate that, contrary to conventional belief, there is a measurable turnover among melanocytic nevi even in early life.

Hospitalization in HIV in Chicago.

BACKGROUND: Reduction in HIV-related morbidity and mortality in the highly active antiretroviral therapy (HAART) era has been unevenly distributed in the United States, and its impact on hospitalizations in urban minority populations in the public sector has been poorly characterized. METHODS: We conducted a retrospective analysis of clinical and administrative data sets of an urban public hospital HIV clinic from 1997 and 1998 to identify the correlates of hospitalization early in the HAART era. RESULTS: 2,647 unduplicated HIV-infected patients were seen in 1997 and 1998 at the CORE Center. There were 31.7 percent women, 71 percent African-Americans and 12 percent Hispanics, and the mean age was 38 years. Men who had sex with men (MSM), injection drug users (IDU), and heterosexuals each made up one third of the population. A majority of the patients had no health insurance, and 27 percent had Medicaid. The median CD4 T cell count was 266 cells/microL, and the median viral load was 1,901 copies/ml. Hospitalizations declined significantly from 1997 (1,579) to 1998 (1,160). Admissions were confined to 25 percent of clinic patients, and 16 patients (range 8-15) had eight or more admissions. African-Americans and Hispanics had significantly more and longer hospitalizations than whites, but there was no difference by gender. IDUs had significantly more admissions than non-IDUs (28 percent vs. 21 percent respectively). On multivariate analysis, lower CD4 T cell count and higher viral load predicted risk of admission in all periods. Unexpectedly, hospitalization rates were high in patients in the highest baseline CD4 T cell stratum, > 500 cells/ml (45 of 353, 13 percent), and lowest viral load stratum, < 500 copies/ml (103 of 675, 15 percent), and rose from 1997 to 1998. HAART (i.e., 1 or 2 drug regimens) predicted fewer hospitalizations compared to 1 or 2 drug regimens. In a subset of patients who filled prescriptions on site, HAART increased from 72 percent to 85 percent and 1-2 drug regimens fell from 28 percent to 15 percent from 1997 to 1998. Regular care was associated with more frequent hospitalization and more hospital days per admission than no regular care. Hospitalized patients had significantly higher mortality than patients not hospitalized (12 percent vs. 2 percent respectively). CONCLUSION: HIV-related hospitalizations were frequent in the HAART era and decreased over time. Older age, lack of HAART, lower CD4 T cell count, higher viral load, and minority race predicted hospitalization, while gender did not. However, patients with extremely favorable CD4 T cell and viral load counts also had higher than expected hospitalization rates. Three quarters of patients had no hospitalizations, and clustering of hospitalizations in a small number of patients may enable targeted programs to reduce recidivism.