In a case-control study in the Midlands of England, 195 subjects with superficial spreading or nodular melanoma were compared to age- and sex-matched controls chosen from all inpatients or outpatients in hospitals serving the defined source population. Significant increases in melanoma risk, after adjustment for other factors, were seen in association with total naevi on the arms (odds ratio (OR), for 15+ naevi compared to none = 3.8), intense freckling as an adult (OR = 6.2), and as a child (OR = 6.0), and higher social class (OR = 2.4). Positive single factor associations were also seen with light or red hair colour, tendency to sunburn easily, and a history of sunburn at ages 8-12, although these were not significant when adjusted for the other factors. No significant effect was seen with naevi greater than 6 mm, or with raised naevi, when adjusted for total number of naevi. Total arm naevi and density of freckling had independent effects, consistent with a multiplicative effect, the OR in those with 10+ naevi and heavy freckling being 20.8. The risk associated with red hair was independent of naevi, but associated with freckling. The strongest association with sunburn history was seen with a history of sunburn in childhood, with sunburn at later times, having smaller effects, or none. These results shows that freckling and social class as well as naevi are strong and independent risk indicators for melanoma. These associations were generally consistent by type of melanoma, sex, age, and extent of regular exposure of the body site affected, although the social class gradient was observed neither for nodular melanoma nor for melanomas occurring on the most exposed body sites.

No abstract

Six cases of pharyngeal leech (identified as Myxobdella africana) are reported from a highland area of North Kenya. Three patients were severely anaemic and one died. There have been sporadic reports of leech infestation of man in East and Central Africa but these reports lack correct identification of the leech. This paper includes a detailed account of the systematics of the leech and of its habitat. The leeches were ingested accidentally by drinking water from two infested water sources. The major symptoms were a feeling of something in the throat, epistaxis and haemoptysis. On examination, pharyngeal blood was a consistent feature although the leech was rarely seen on initial inspection. Examination under anaesthesia was usually successful in locating and removing the leech. Prompt blood transfusion was life-saving in two cases. The water sources were used by both cattle and man; the cattle may also be parasitized by leeches. Methods of improving the water sources were discussed with community leaders.

The effect on the detection and characteristics of melanoma, resulting from the Cancer Research Campaign's health education programme to promote the early detection of melanoma in the general population, was studied from 1987 to 1989. The seven study areas in England and Scotland yield a target population of 3.6 million. Data were collected from local clinic-based registers, pathology laboratories, and the cancer registries. The average annual incidence rates of melanoma were seven and 12 per 10(5) in males and females, respectively, age-standardized to England and Wales, 1988. These rates are similar to the national figures for Scotland, where there is a national melanoma register, but higher than those reported by the English and Welsh cancer registries. The incidence was significantly higher in females than males (P < 0.001), and increased with age. Fifty-three per cent and 65% of cases in males and females, respectively, were thin (Breslow thickness < or = 1.5 mm), similar to the national figures from Scotland. No significant decrease in the incidence of late-stage tumours was found in either sex as a result of the campaign. Because of difficulties with ascertainment of cases in England, the main evaluation will focus on future trends in mortality rates for melanoma.

The connections between men, masculinity and management remain understated if not largely concealed, despite a critical spotlight bein« increasingly cast on masculinity by many academic and other writers. In a similar vein, numerous commentators on organisation have charted the rise of new organisational forms and structures, and the management practices which flow from them. With few notable exceptions, however these bodies of work deny or downplay the complex linkages and inter connections between masculinity and the activities of management. B} drawing on the case of UK further education (FE), and more particu larly, the management practices therein, an aim of this article is to drav attention to this inter-relationship of masculinities and men managers. In so doing, we suggest that the term 'masculine subject' best exemplifies those men, and women, who seek to invest their sense of being in mas cuhnist discourses. The empirical basis is taken from research undertaker across a number of FE colleges wherein 24 men managers were inter viewed as part of a larger project concerned with the management ant regulation of the sector. In exposing the intensified and increasingly uncertain work conditions now typifying the new FE work culture, this article draws attention to practices of oppression and bullying by mac agers underplayed or overlooked by writers elsewhere.