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We aimed to assess the incidence and survival for all patients with invasive primary cutaneous malignant melanoma diagnosed in Scotland, UK, during 1979–98. The Scottish Melanoma Group obtained data for 8830 patients (3301 male and 5529 female) first diagnosed with invasive cutaneous malignant melanoma. Age-standardised incidence rose from 3·5 in 1979 to 10·6 per 10 5 population in 1998 for men, and from 7·0 to 13·1 for women, a rise of 303% and 187%, respectively. After 1995, the rate of increase levelled in women younger than 65 years at diagnosis. Melanoma incidence increased most in men on the trunk, head, and neck and in women on the leg. 5-year survival rose from 58% to 80% for men diagnosed in 1979 and 1993, respectively, and from 74% to 85% for women; improvements of 38% (p<0·001) and 15% (p<0·001), respectively. Most improvement was attributable to a higher proportion of thinner tumours. Male mortality from melanoma was 1·9/10 5 population per year at the start and end of the study, whereas mortality for men younger than 65 years at diagnosis rose from 1·2 to 1·35 (p=0·24). For all women, mortality fell slightly from 1·9 to 1·85/10 5 population per year (p=0·61), whereas for women younger than 65 years at diagnosis, mortality fell from 1·3 to 1·15 (p=0·62). Interventions aimed at both primary and secondary prevention of melanoma are justified. Specialist tumour registers for entire countries can be used to plan and monitor public health interventions. Published online June 25, 2002. http://image.thelancet.com/extras/01art7335web.pdf

Background: Socio-economic differences in survival from head and neck cancers are among the largest of any malignancies. Population-based data have been unable to explain these differences. Aims: To describe survival from head and neck cancers in a large cohort of patients for whom a range of socio-economic, demographic, behavioural and casemix data was available. Methods: Prospective cohort study using data from the Scottish Head and Neck Audit on all patients diagnosed with a head and neck cancer in Scotland between 1st September 1999 and 31st August 2001 linked to General Register Office for Scotland death records to 30th June 2006. Cox proportional hazards models were produced to describe adjusted hazards of death according to socio-economic circumstances, using validated area-based DEPCAT scores. Results: Data on 1909 patients were analysed. 71.0% were male and mean age was 64.3 (SD 12.2) years. Overall 5-year survival was 45.6% (95% CI: 43.4–47.8%). In order of strength of association in univariate regression, World Health Organisation Performance Status, disease stage, patient age, tumour site, smoking status, alcohol use, tumour differentiation, and deprivation were significant predictors of all-cause mortality but after multiple adjustment, deprivation was no longer an independent predictor of survival. Conclusions: Socio-economic differentials in survival from head and neck cancers are determined by a mixture of risk factors, some of which may be amenable to targeted earlier detection methods and lifestyle interventions. However, further research is needed to understand the impacts of performance status in more deprived patients.

We compared trends in melanoma incidence by body site in two populations exposed to different levels of sunlight and different approaches to melanoma prevention. We analysed site-specific melanoma incidence during the period 1982-2001 in Queensland, Australia (n=28 862 invasive melanomas; 2536 lentigo maligna melanomas) and the west of Scotland (n=4278 invasive melanomas; 525 lentigo maligna melanomas). Analyses were stratified by sex and age group (< 40 years, 40-59 years, ≥ 60 years). We estimated annual percentage change (APC) in melanoma incidence by regressing the logarithms of the rates and exponentiating the coefficients. Among men, overall melanoma incidence increased log-linearly in both settings, but significantly more rapidly in the west of Scotland (APC 2.8%) than Queensland (APC 1.4%). Rates of increase among Scottish men were higher for every body site and all ages than among Queensland men. Among women, overall melanoma incidence increased more rapidly among Scottish (APC 1.8%) than Queensland women (APC 0.7%). Most discrepant were trends in upper limb melanomas, which underwent large annual increases among Scottish women, but declined among younger Queensland women. Melanoma incidence continues to rise rapidly in all age groups in Scotland and among older people in Queensland. Rates of melanoma in younger people in Queensland are stabilizing, as might be expected if primary prevention campaigns were effective in reducing solar exposure. Variations in rates of change at different body sites warrant further monitoring.

To explore whether the anatomic distribution of melanoma differs with ambient sunlight levels, we compared age- and site-specific melanoma incidence in two genetically similar populations from different geographic regions. We ascertained all new cases of invasive cutaneous melanoma in the west of Scotland and Queensland 1982-2001. Melanoma incidence was calculated for four anatomic regions (head and neck, trunk, upper and lower limbs), standardized to the European population and adjusted for relative surface area of each site. Highest rates among males aged <40 years and 40-59 years were observed on the trunk, but on the upper limbs among Queensland females and lower limbs among Scottish females. After age 60, melanoma rates were highest on the head and neck in both sexes. In both sexes and at all ages, lower limb melanomas were more common in Scotland than expected from the Queensland population. These analyses indicate that while the overall distribution of melanoma is similar in populations with different levels of ambient sunlight, important differences remain. Identifying the causes of these differences is likely to provide better understanding of how sunlight causes melanoma.

The balance between degradation and preservation of sedimentary organic carbon (OC) is important for global carbon and oxygen cycles 1 . The relative importance of different mechanisms and environmental conditions contributing to marine sedimentary OC preservation, however, remains unclear 2 – 8 . Simple organic molecules can be geopolymerized into recalcitrant forms by means of the Maillard reaction 5 , although reaction kinetics at marine sedimentary temperatures are thought to be slow 9 , 10 . More recent work in terrestrial systems suggests that the reaction can be catalysed by manganese minerals 11 – 13 , but the potential for the promotion of geopolymerized OC formation at marine sedimentary temperatures is uncertain. Here we present incubation experiments and find that iron and manganese ions and minerals abiotically catalyse the Maillard reaction by up to two orders of magnitude at temperatures relevant to continental margins where most preservation occurs 4 . Furthermore, the chemical signature of the reaction products closely resembles dissolved and total OC found in continental margin sediments globally. With the aid of a pore-water model 14 , we estimate that iron- and manganese-catalysed transformation of simple organic molecules into complex macromolecules might generate on the order of approximately 4.1 Tg C yr −1 for preservation in marine sediments. In the context of perhaps only about 63 Tg C yr −1 variation in sedimentary organic preservation over the past 300 million years 6 , we propose that variable iron and manganese inputs to the ocean could exert a substantial but hitherto unexplored impact on global OC preservation over geological time. Catalysis of simple organic carbon molecules into complex macromolecules by Fe and Mn may play a fundamental role in organic carbon preservation, to a degree that could substantially affect the Earth’s carbon and oxygen cycles.

The coprecipitation of organic carbon with iron minerals is important for its preservation in soils and sediments, but the mechanisms for carbon-iron interactions and thus the controls on organic carbon cycling are far from understood. Here we coprecipitate carboxylic acids with iron (oxyhydr)oxide ferrihydrite and use near-edge X-ray absorption fine structure spectroscopy and wet chemical treatments to determine the relationship between sequestration mechanism and organic carbon stability against its release and chemical oxidative remineralisation. We show that organic carbon sequestration, stabilisation and persistence increase with an increasing number of carboxyl functional groups. We suggest that carboxyl-richness provides an important control on organic carbon preservation in the natural environment. Our work offers a mechanistic basis for understanding the stability and persistence of organic carbon in soils and sediments, which might be used to develop an overarching relationship between organic functional group-richness, mineral interactions and organic carbon preservation in the Earth system.

Background Provision that aims to promote the social, emotional, and mental wellbeing of children and young people (including their mental health) is increasingly implemented in education settings. As researchers, policymakers, and practitioners explore the complexities of promotion and prevention provision in practice, it is critical that we include and amplify children and young people’s perspectives. In the current study, we explore children and young people’s perceptions of the values, conditions, and foundations that underpin effective social, emotional, and mental wellbeing provision. Methods We engaged in remote focus groups with 49 children and young people aged 6–17 years across diverse settings and backgrounds, using a storybook in which participants constructed wellbeing provision for a fictional setting. Analysis Using reflexive thematic analysis, we constructed six main themes presenting participants’ perceptions: (1) recognising and facilitating the setting as a caring social community; (2) enabling wellbeing to be a central setting priority; (3) facilitating strong relationships with staff who understand and care about wellbeing; (4) engaging children and young people as active partners; (5) adapting to collective and individual needs; and (6) being discreet and sensitive to vulnerability. Conclusions Our analysis presents a vision from children and young people of an integrated systems approach to wellbeing provision, with a relational, participatory culture in which wellbeing and student needs are prioritised. However, our participants identified a range of tensions that risk undermining efforts to promote wellbeing. Achieving children and young people’s vision for an integrated culture of wellbeing will require critical reflection and change to address the current challenges faced by education settings, systems, and staff.

With the cancer burden rising in sub-Saharan Africa, countries in the region need surveillance systems to measure the magnitude of the problem and monitor progress in cancer control planning. Based on the national estimates built from data provided by cancer registries in sub-Saharan Africa, we summarise key patterns of the regional burden and argue for investments in locally produced data. To present national estimates of the cancer incidence and mortality burden in sub-Saharan Africa countries, new cancer cases and deaths were extracted from International Agency for Research on Cancers' GLOBOCAN database for the year 2020. Given weak vital statistics systems, almost all of the information on the cancer burden in sub-Saharan Africa was derived from population-based cancer registries. Of the 48 countries included in GLOBOCAN (national populations must be larger than 150 000 inhabitants in 2020), relatively recent cancer registry data (up to 2019) were directly used to produce national incidence estimates in 25 countries, while the absence of such data for 16 meant that estimates were based on data from neighbouring countries. Tables and figures present the estimated numbers of new cases and deaths, as well as age-standardised (incidence or mortality) rates per 100 000 person-years and the cumulative risk of developing or dying from cancer before the age of 75 years. 801 392 new cancer cases and 520 158 cancer deaths were estimated to have occurred in sub-Saharan Africa in 2020. Cancers of the breast (129 400 female cases) and cervix (110 300 cases) were responsible for three in ten of the cancers diagnosed in both sexes. Breast and cervical cancer were the most common cancers, ranking first in 28 and 19 countries, respectively. In men, prostate cancer led in terms of incidence (77 300 cases), followed by liver cancer (24 700 cases) and colorectal cancer (23 400 cases). Prostate cancer was the leading incident cancer in men in 40 sub-Saharan Africa countries. The risk of a woman in sub-Saharan Africa developing cancer by the age of 75 years was 14·1%, with breast cancer (4·1%) and cervical cancer (3·5%) responsible for half of this risk. For men, the corresponding cumulative incidence was lower (12·2%), with prostate cancer responsible for a third of this risk (4·2%). Cervical cancer was the leading form of cancer death among women in 27 countries, followed by breast cancer (21 countries). Prostate cancer led as the most common type of cancer death in 26 countries, with liver cancer ranking second (11 countries). The estimates indicate substantial geographical variations in the major cancers in sub-Saharan Africa. Rational cancer control planning requires capacity to be built for data production, analysis, and interpretation within the countries themselves. Cancer registries provide important information in this respect and should be prioritised for sustainable investment in the region. None.