Статті в журналах з теми "Mouth Cancer South Australia Epidemiology"

Liver cancer (LC) ranks fifth in frequency in the world, with an estimated 437,000 new cases in 1990. The estimates are different when LC frequency is analyzed by sex and geographical areas. In developed areas, the estimates are 53,879 among men and 26,939 among women. In developing areas, the estimates are 262,043 in men and 93,961 in women. Areas of highest rates include Eastern and South Eastern Asia, Japan, Africa and the Pacific Islands (LC age-adjusted incidence rates [AAIRs] ranging from 17.6 to 34.8). Intermediate rates (LC AAIRs from 4.7 to 8.9 among men) are found in Southern, Eastern and Western Europe, Central America, Western Asia and Northern Africa. Low rates are found among men in Northern Europe, America, Canada, South Central Asia, Australia and New Zealand (LC AAIRs range from 2.7 to 3.2). In Europe, an excess of LC incidence among men compared with women is observed, and the age peak of the male excess is around 60 to 70 years of age. Significant variations in LC incidence among different countries have been described and suggest differences in exposure to risk factors. Chronic infection with the hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of LC is well established. In Europe, 28% of LC cases have been attributed to chronic HBV infection and 21% to HCV infection. Other risk factors such as alcohol consumption, cigarette smoking and oral contraceptives may explain the residual variation within countries. Interactions among these risk factors have been postulated. New laboratory techniques and biological markers such as polymerase chain reaction detection of HBV DNA and HCV RNA, as well as specific mutations related to LC, may help to provide quantitative estimates of the risk related to each these factors.

4 Background: Tyranny of distance in Australia has motivated oncologists to try innovations in oncology care to improve cost efficiency, access, and compliance. This is often done with little budget availability as health funds are metrocentric. The aim is to bring novel approaches to utilisation of oncology care and show its applicability to most countries even with financial constraints. Methods: Mt Gambier Hospital is a regional hospital in South Eastern South Australia (SE SA). The data collected from clinics was commenced in January 2016, to gain knowledge of epidemiology of cancer in the region, and numbers of patients seen. Despite gold standard cancer care being performed in consultations which are face-to-face, we rolled out telemedicine consultations. We also, implemented a Survivorship Care Model, and entered into a Teletrials Project which sets up a regional trials centre with support from a tertiary hospital, Flinders Medical Centre. Results: Telemedicine has been made in Mt Gambier Hospital’s cancer service a part of every day practice to save patients from unnecessary travel. From January 2016, until May 2019, there were 812 consultations with nurse practitioner, 2542 consultations with consultant in clinic, and 246 telemedicine consultations. Survivorship clinic has been implemented according to South Australian Framework for Survivorship with no extra funding. Since 2017, 49 patients were seen with curative therapy. A re-alignment of appointment scheduling will see 6 patients in the next 2 months, thus increasing clinic potential. Teletrials Project was born from collaboration with Flinders Medical Centre, and gained funding by Beat Cancer South Australia. We are now entering into final stages of Governance agreement for our 1st trial, 18 months from commencing the project. Since then, we also got 2 more collaboration grants from Beat Cancer SA. Conclusions: With limited resources, regional cancer centres are able to maximise their patient outcomes by applying novel strategies. These novel ways of doing things, may be able to be implemented on either existing budgets or through collaboration with metropolitan cancer centres to attract financial grants to improve patient outcomes.

IntroductionAdvances in systemic therapy for early and metastatic breast cancer (BC) over the last two decades have improved patients’ survival, but their impact on metastatic disease outcomes at a population level is not well described. The aim of this study is to investigate changes in the incidence, site and survival of metastatic disease for women with a first diagnosis of BC in 2001–2002 vs 2006–2007.Methods and analysisPopulation-based retrospective cohort study of women with first primary invasive BC registered in the New South Wales (NSW) Cancer Registry in 2001–2002 and 2006–2007. We will use linked records from NSW hospitals, dispensed medicines, outpatient services and death registrations to determine: women’s demographic and tumour characteristics; treatments received; time to first distant metastasis; site of first metastasis and survival. We will use the Kaplan-Meier method to estimate cumulative incidence of distant metastasis, distant recurrence-free interval and postmetastasis survival by extent of disease at initial diagnosis, site of metastasis and treatment-defined tumour receptor type (hormone receptor-positive, human epidermal growth factor receptor-2-positive, triple negative). We will use Cox proportional hazards regression to estimate the relative effects of prognostic factors, and we will compare systemic therapy patterns by area-of-residence and area-level socioeconomic status to examine equity of access to healthcare.Ethics and disseminationResearch ethics committee approval was granted by the Australian Institute of Health and Welfare (#EO2017/2/255), NSW Population and Health Services (#HREC/17/CIPHS/19) and University of Notre Dame Australia (#0 17 144S). We will disseminate research findings to oncology, BC consumer and epidemiology audiences through national and international conference presentations, lay summaries to BC consumer groups and publications in international peer-reviewed oncology and cancer epidemiology journals.

Background The incidence of gestational breast cancer (GBC) is increasing in high-income countries. Our study aimed to examine the epidemiology, management and outcomes of women with GBC in New South Wales (NSW), Australia. Methods A retrospective cohort study using linked data from three NSW datasets. The study group comprised women giving birth with a first-time diagnosis of GBC while the comparison group comprised women giving birth without any type of cancer. Outcome measures included incidence of GBC, maternal morbidities, obstetric management, neonatal mortality, and preterm birth. Results Between 1994 and 2013, 122 women with GBC gave birth in NSW (crude incidence 6.8/ 100,000, 95%CI: 5.6–8.0). Women aged ≥35 years had higher odds of GBC (adjusted odds ratio (AOR) 6.09, 95%CI 4.02–9.2) than younger women. Women with GBC were more likely to give birth by labour induction or pre-labour CS compared to women with no cancer (AOR 4.8, 95%CI: 2.96–7.79). Among women who gave birth by labour induction or pre-labour CS, the preterm birth rate was higher for women with GBC than for women with no cancer (52% vs 7%; AOR 17.5, 95%CI: 11.3–27.3). However, among women with GBC, preterm birth rate did not differ significantly by timing of diagnosis or cancer stage. Babies born to women with GBC were more likely to be preterm (AOR 12.93, 95%CI 8.97–18.64), low birthweight (AOR 8.88, 95%CI 5.87–13.43) or admitted to higher care (AOR 3.99, 95%CI 2.76–5.76) than babies born to women with no cancer. Conclusion Women aged ≥35 years are at increased risk of GBC. There is a high rate of preterm birth among women with GBC, which is not associated with timing of diagnosis or cancer stage. Most births followed induction of labour or pre-labour CS, with no major short term neonatal morbidity.

Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and the number of new hepatitis C infections. This paper updates estimates of HCV incidence between 1960 and 2005 and models long-term sequelae from infection. Outcomes among those with HCV were also recently assessed in a linkage study assessing cancer and causes of death following HCV diagnosis in New South Wales. Linkage study outcomes have been used here to calibrate modelled outcomes. Mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population. Model predicted endpoints that were calibrated against the NSW linkage data over the period 1995—2002 were: (i) incident hepatocellular carcinoma (HCC); (ii) opioid overdose deaths; (iii) liver-related deaths; and (iv) all-cause mortality. Modelled estimates and the linkage data show reasonably good calibration for HCC cases and all-cause mortality. The estimated HCC incidence was increased from 70 cases in 1995 to 100 cases in 2002. All-cause mortality estimated at 1000 in 1995 increased to 1600 in 2002. Comparison of annual opioid deaths shows some agreement. However, the models underestimate the rate of increase observed between 1995 and 1999 and do not entirely capture the rapid decrease in overdose deaths from 2000 onwards. The linkage data showed a peak of overdose deaths at 430 in 1999 compared to 320 estimated by the models. Comparison of observed liver deaths with the modelled numbers showed poor agreement. A good agreement would require an increase in liver deaths from the assumed 2 to 5% per annum following cirrhosis in the models. Mathematical models suggest that HCV incidence decreased from a peak of 14,000 infections in 1999 to 9700 infections in 2005, largely attributable to a reduction in injecting drug use. The poor agreement between projected and linked liver deaths could reflect differing coding of causes of deaths, underestimates of the numbers of people with cirrhosis following HCV, or underestimates of rates of liver death following cirrhosis. The reasonably good agreement between most of the modelled estimates with observed linkage data provides some support for the assumptions used in the models.

e21073 Background: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer characterized by high incidence of local recurrences, regional nodal metastases, distant metastases, and high mortality rates. It has no approved drug therapies and limited treatment options, especially to manage the metastatic disease. Our objective was to conduct a comprehensive review of MCC disease burden. Methods: We conducted a targeted literature review of studies published from 2010 to 2016 to assess epidemiology, patient burden, and unmet needs associated with MCC. An article was retrieved for full review if the abstract met each of the following criteria: reported incidence, natural morbidity or mortality of MCC; derived from a peer-reviewed journal; and reported in English-language published since January 2010. Results: The incidence of MCC (per 100,000 persons per year) is reported highest in Australia (0.82-1.60), followed by the US (0.6), Netherlands (0.35), Sweden (0.18-0.33), Finland (0.24-0.25), Spain (0.28), Denmark (0.22), South East Scotland (0.133), France (0.13). Inadequate data available from countries like Canada, UK, Germany and most part of Asia-Pacific. Typically, stage I-II MCC is observed in approximately 60% - 75% patients, stage III in 10% - 30% patients, and stage IV (metastatic) in 2% - 16% patients. The 5-year and 10-year survival is 0% - 68%, and 21% - 65% respectively, based on factors such as disease stage and gender. Although less than 20% patients progress to advanced metastatic stage IV MCC, they experience the highest unmet need due to lack of effective therapeutic options. Data on economic burden and humanistic burden (e.g., impact on patient quality of life) is not available. Conclusions: Epidemiological review indicates an increasing incidence of MCC; however, available estimates are at least 5 years old. Epidemiological data as well as data on clinical, economic and humanistic burden of MCC is lacking from several parts of the world. Further research is warranted to adequately quantify the burden-of-illness of MCC and assess comparative effectiveness of evolving treatment options to better inform patients, prescribers and payer organizations concerning optimal cost-effective modalities of disease management.

Abstract Background Australia has a relatively high level of alcohol consumption. Although alcohol consumption is known to increase the risk of several cancer types internationally, local evidence for Australia is limited. Methods Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to weekly alcohol consumption among 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident cancer cases were ascertained by linkage to the New South Wales Cancer Registry to December 2013 by the Centre for Health Record Linkage. Results Over a median 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of any cancer (HR per seven drink increase in weekly consumption: 1.02; 95% CI: 1.00-1.04), and cancers of the upper aerodigestive tract (1.19;1.10-1.29), mouth/pharynx (1.18;1.08-1.29), oesophagus (1.22;1.04-1.43), colorectum (1.09;1.04-1.15), colon (1.13;1.06-1.20), liver (1.22;1.04-1.44), breast (1.09;1.00-1.18), and melanoma (1.05;1.00-1.10); whereas an inverse association was observed for thyroid cancer (0.80;0.64-1.00). We estimated that by age 85 years, Australian men and women who consume >14 drinks/week increase their absolute risk of alcohol-attributable cancer by 4.4% and 5.4%, respectively, compared to non-drinkers. Conclusions We report relative risks of cancer incidence in relation to alcohol consumption that match the international evidence. In Australia, a nation with relatively high alcohol consumption, these risks may translate into a significant public health burden. Key messages We have generated estimates for the relationship between alcohol consumption and cancer risk in Australia.

Abstract Background Survival improvement from breast cancer has been attributed mostly to treatment advances and earlier cancer detection. This study was to investigate cancer treatment and the association with survival. Methods A total of 13494 female patients with invasive breast cancer recorded on the South Australia Cancer Registry in 2000-2014 were included. Cancer treatments within 12 month following diagnosis were identified from linked cancer registry and other medical registries. Study factors included demo sociographic, tumour profile and comorbidity. Adjusted odds ratios and sub hazard ratios were reported on treatment and survival disparity respectively. Results 98% patients were treated with one or more treatment types. 56% had conserving surgery. Systemic treatment was received by 72%. Older patients with advanced cancer were less likely to have any treatment. Women in the most socioeconomically advantaged area were less likely to have combined mastectomy and conservative surgery (aOR 0.73, 95% CI 0.54-0.98), but more likely to have systemic treatment (aOR 1.44, 95% CI 1.26-1.64). Other factors such as country of birth, residential socioeconomic status, cancer differentiation, and diagnosis period differed in their associations with treatment type. Having conserving surgery predicted the lowest breast cancer death (adjusted SHR 0.31, 95% CI 0.26-0.36) compared to no surgery. Conclusions Breast cancer patients underwent varied treatment types with different impact on breast cancer mortality. Key messages Patients undergoing conserving surgery were at the lowest risk of the cancer death.

Abstract Background Lung cancer in never-smokers (LCINS), if considered as a distinct type, would rank as Australia’s eighth most deadly cancer. We investigated several demographic, lifestyle and health-related risk factors for LCINS in Australia. Methods Using the longitudinal 45 and Up Study cohort with 267,153 New South Wales (NSW) residents aged ≥45 years at recruitment (2006-2009), we quantified the relationship of 20 potential risk factors with LCINS. Self-reported never-smoking participants who were cancer-free at baseline were followed for incident lung cancer (LC), and adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case-control study including 10,781 NSW residents aged ≥18 years, was also used to examine 16 potential risk factors for LCINS. Adjusted odds ratios (OR) and 95% CI for LC were estimated using logistic regression. Results In the 45 and Up Study, there were 226 LC cases among 132,354 cancer-free never-smokers with a median follow-up of 5.41 years. In the CLEAR Study, there were 58 LCINS cases and 1316 cancer-free never-smoking controls. After adjusting for potential confounders, analyses of both datasets showed that Asian-born participants had a higher risk of LCINS than those born elsewhere: cohort HR = 2.83 (95% CI: 1.64-4.89) and case-control OR = 3.78 (95% CI: 1.19-12.05). Conclusions Our findings support the growing evidence that never-smokers born in Asia are at higher risk of developing LC than those born elsewhere. Key messages Region of birth could be considered when assessing potential LC risk among never-smokers.

AUSTRALIA – A New Skin Cancer Warning to the Over 60s AUSTRALIA – Joint Venture to Establish up to 12 ATOS Wellness Centers in Australia AUSTRALIA – New South Wales to Allow Cultivation of Genetically Modifed Canola CHINA – Nanodrug for Pig's Foot-and-Mouth Disease CHINA – Project for a Joint Biodiversity Lab in Yunnan Underway CHINA – New Plants for Biofuel INDIA – Texas Instruments — Indian Institute of Technology Pact INDIA – Ranbaxy and Department of Biotechnology Tie-up for R&D INDIA – Ayurvedic Association Agreement with American Herbal Association INDIA – Indo-Dutch Ties Set to Further Advance Agribiotech Research INDIA – Girl Undergoes Surgery in India to Gain Height INDIA – Bioserve to Set up New Facility in Hyderabad with US$2 Million Investment INDIA – Intas is Setting up India's First Plasma Fractionation Facility JAPAN – AnGes Launches Naglazyme in Japan KOREA – Health Institute Finds Needle-free Vaccination Method KOREA – Scientists Find Gene Promoting Liver Cancer Growth MALAYSIA – Dubai Group Invests in Southeast Asia's Largest Biodiesel Plant MALAYSIA – Malaysia on Track to Become Biotech Hub NEW ZEALAND – Blood Donors May Actually Become “Healthier” SINGAPORE – Scientifc Pioneer Davor Solter Joins A*STAR to Nurture Next Generation of Researchers and Clinician-Scientists SINGAPORE – Rockeby and National University of Singapore to Jointly Develop World's First Rapid Diagnostic Test Kit for Hand, Foot and Mouth Disease SINGAPORE – Singaporean Research Team Develops First Cytotoxic Antibody against Undifferentiated Stem Cells SINGAPORE – Singapore is Set to Promote Clinical Research in Public Hospitals SINGAPORE – Singapore Heart Foundation to Raise Awareness of Heart Disease among Women SINGAPORE – New Research Center Gets US$127 Million for Cancer Research SINGAPORE – Wyeth to Expand State-of-the-Art Nutritional Manufacturing Facility in Singapore TAIWAN – Taiwanese Patient Lives without Heart for 16 Days TAIWAN – Joint Canada-Taiwan Biofuel Development Project Announced TAIWAN – Researchers Find New Way to Probe Liver THAILAND – Thai Scientist Cracks Rice Gene

Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?

Asia-Pacific, the rising region for cancer vaccine clinical trials. Non-small cell lung cancer has largest number of clinical trials in Australia. Global dermatology pipeline to see shift towards increased usage of biologics. FDA approves first 0.1 mg auto-injector for life-threatening allergic reactions in infants and small children. FDA approves first two-drug regimen for certain patients with HIV. New early-breast cancer drug to be made available in Australia, New Zealand and South-East Asia. Multi-omic data analytics collaboration between the University of Oxford and Holmusk. NRGene’s genomic analysis project with Monsanto advances. Samsung BioLogics receives first FDA approval at world’s largest plant. TLC welcomes Mayor of Leiden and delegation to Taipei headquarter. Warren Wang appointed senior vice president and president of Asia Pacific of Boston Scientific. MiRXES reveals globalisation plans for 2018 and 2019. QuintilesIMS is now IQVIA. Quotient Sciences launches as the new global identity for Quotient Clinical. ESMO Asia 2017 Congress. More care is needed for cancer supportive care. ALEX study shows alectinib 600 mg more effective than crizotinib in Asian lung cancer patients. Study analyses mutations in cerebrospinal fluid in lung cancer with brain metastases. Study finds all Myanmar mouth cancer patients chew betel quid.

Abstract Background Tobacco smoke is a known carcinogen and the magnitude of smoking-related cancer risk varies according to time and population. Local, contemporary evidence can drive appropriate tobacco control. We provide comprehensive cancer risk estimates related to smoking in the population-based, New South Wales (NSW) 45 and Up Study. Methods We estimated smoking-related hazard ratios (HR) for cancer using Cox proportional hazards regression using linked questionnaire (2006-2009) and incident cancer data (n ≥ 50 cases per cancer type), from the NSW Cancer Registry (to December 2013) (via CHeReL). Results Of 18,475 cancers among 229,028 participants aged ≥45 years, current smokers had significantly increased risks of cancers of the lung, larynx, head and neck, oesophagus, liver, bladder, pancreas, stomach, colorectum, and cancers with unknown primary site, compared to never-smokers; lung cancer risk was markedly elevated, including for current-smokers of 1-5 cigarettes/day (HR = 9.25, 95%CI=5.2-16.6), increasing to 38.39 (26.2-56.2) for current-smokers of > 30 cigarettes/day. Quitting substantively decreased cancer risk compared to continued smoking, with lung cancer risk decreasing with decreasing age at quitting (p(trend)<0.05), however risks remained elevated for those quitting aged >25 compared to never-smokers (1.73, 1.1-2.6 for age 26-30 years). An estimated 20% of current-smokers in Australia will get lung cancer during their lifetime versus 1.6% of never-smokers. Conclusions Smoking-attributable cancer risks in Australia are significant, comparable to contemporary risks from other developed nations. Key messages Smokers – including “light” smokers – are at high cancer risk, with ∼one-fifth of Australian lifetime smokers developing lung cancer. Quitting is beneficial. Continued investment in tobacco control is essential.

Abstract Background Environmental microbial exposure and human gut microbiota play a role in development of the immune system and susceptibility to food allergy. Pacifier use has been inconsistently associated with allergy, but the association between sanitization and food allergy is unknown. We investigated the association between infant pacifier use, with a consideration of sanitization, and food allergy at age 1 in the Barwon Infant Study (BIS). Methods Questionnaire data were collected prospectively from pregnant mothers from the Barwon region of south-east Australia at baseline and at infant ages 1, 6, and 12 months. Pacifier sanitization was defined as the joint exposure of a pacifier and cleaning methods (antiseptic, mouth, tap water, boiling). Challenge-proven food allergy was determined at age 1. Results Any pacifier use at 6 months was associated with food allergy (aOR, 1.94; 95% CI, 1.04-3.61), but not at other ages. This overall association was driven by the joint exposure pacifier-antiseptic use (aOR, 5.90; 95% CI, 2.18-15.97) compared to no pacifier use. Among pacifier users, pacifier-antiseptic was still associated with food allergy (aOR, 3.88; 95% CI, 1.55-9.72) when compared to pacifier-no antiseptic use. Further, increased use of pacifier-antiseptic at 0, 1 or 2 interviews over the first 6 months was associated with higher food allergy risk (ptrend=0.005). Conclusions Joint exposure to antiseptics and pacifiers at 6 months increased the odds of food allergy, showing a trend with increased use over time. Key messages This is the first report of pacifiers used with antiseptic being positively associated with challenge-proven food allergy.

Abstract Background Aboriginal people are known to be under-recorded in routinely collected datasets in Australia. This study examined methods for enhancing the reporting of cancer incidence among Aboriginal people using linked data methodologies. Methods Invasive cancers diagnosed in New South Wales (NSW), Australia, in 2010–2014 were identified from the NSW Cancer Registry (NSWCR). The NSWCR data were linked to the NSW Admitted Patient Data Collection, the NSW Emergency Department Data Collection and the Australian Coordinating Register Cause of Death Unit Record File. The following methods for enhancing the identification of Aboriginal people were used: ‘ever-reported’, ‘reported on most recent record’, ‘weight of evidence’ and ‘multi-stage median’. The impact of these methods on the number of cancer cases and age-standardised cancer incidence rates (ASR) among Aboriginal people was explored. Results Of the 204,948 cases of invasive cancer, 2703 (1.3%) were recorded as Aboriginal on the NSWCR. This increased with enhancement methods to 4184 (2.0%, ‘ever’), 3257 (1.6%, ‘most recent’), 3580 (1.7%, ‘weight of evidence’) and 3583 (1.7%, ‘multi-stage median’). Enhancement was generally greater in relative terms for males, people aged 25–34 years, people with cancers of localised or unknown degree of spread, people living in urban areas and areas with less socio-economic disadvantage. All enhancement methods increased ASRs for Aboriginal people. The weight of evidence method increased the overall ASR by 42% for males (894.1 per 100,000, 95% CI 844.5–945.4) and 27% for females (642.7 per 100,000, 95% CI 607.9–678.7). Greatest relative increases were observed for melanoma and prostate cancer incidence (126 and 63%, respectively). ASRs for prostate and breast cancer increased from below to above the ASRs of non-Aboriginal people with enhancement of Aboriginal status. Conclusions All data linkage methods increased the number of cancer cases and ASRs for Aboriginal people. Enhancement varied by demographic and cancer characteristics. We considered the weight of evidence method to be most suitable for population-level reporting of cancer incidence among Aboriginal people. The impact of enhancement on disparities in cancer outcomes between Aboriginal and non-Aboriginal people should be further examined.

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Background: Hand, Foot and Mouth Disease (HFMD) is a major public health concern in the Asia-Pacific region. Most recent HFMD outbreaks have been caused by enterovirus A71 (EV-A71), coxsackievirus A16 (CVA16), CVA10, and CVA6. There has been no report regarding the epidemiology and genetic diversity of CVA16 in Vietnam. Such knowledge is critical to inform the development of intervention strategies.Materials and Methods: From 2011 to 2017, clinical samples were collected from in- and outpatients enrolled in a HFMD research program conducted at three referral hospitals in Ho Chi Minh City (HCMC), Vietnam. Throat or rectal swabs positive for CVA16 with sufficient viral load were selected for whole genome sequencing and evolutionary analysis.Results: Throughout the study period, 320 CVA16 positive samples were collected from 2808 HFMD patients (11.4%). 59.4% of patients were male. The median age was 20.8 months (IQR, 14.96–31.41). Patients resided in HCMC (55.3%), Mekong Delta (22.2%), and South East Vietnam (22.5%). 10% of CVA16 infected patients had moderately severe or severe HFMD. CVA16 positive samples from 153 patients were selected for whole genome sequencing, and 66 complete genomes were obtained. Phylogenetic analysis demonstrated that Vietnamese CVA16 strains belong to a single genogroup B1a that clusters together with isolates from China, Japan, Thailand, Malaysia, France and Australia. The CVA16 strains of the present study were circulating in Vietnam some 4 years prior to its detection in HFMD cases.Conclusion: We report for the first time on the molecular epidemiology of CVA16 in Vietnam. Unlike EV-A71, which showed frequent replacement between subgenogroups B5 and C4 every 2–3 years in Vietnam, CVA16 displays a less pronounced genetic alternation with only subgenogroup B1a circulating in Vietnam since 2011. Our collective findings emphasize the importance of active surveillance for viral circulation in HFMD endemic countries, critical to informing outbreak response and vaccine development.

Abstract Background Ovarian cancer (OC) is the seventh most common malignancy worldwide and the most lethal gynaecological malignancy. We aimed to explore global geographical patterns and temporal trends from 1973 to 2015 for 41 countries in OC incidence and especially to analyse the birth cohort effect to gain further insight into the underlying causal factors of OC and identify countries with increasing risk of OC. Methods OC data were drawn from the Cancer Incidence in Five Continents databases and online databases published by governments. The joinpoint regression model was applied to detect changes in OC trends. The age–period–cohort model was applied to explore age and birth cohort effects. Results The age-standardized rate of OC incidence ranged from 3.0 to 11.4 per 100,000 women worldwide in 2012. The highest age-standardized rate was observed in Central and Eastern Europe, with 11.4 per 100,000 women in 2012. For the most recent 10-year period, the increasing trends were mainly observed in Central and South America, Asia and Central and Eastern Europe. The largest significant increase was observed in Brazil, with an average annual percentage change of 4.4%. For recent birth cohorts, cohort-specific increases in risk were pronounced in Estonia, Finland, Iceland, Lithuania, the United Kingdom, Germany, the Netherlands, Italy, Malta, Slovenia, Bulgaria, Russia, Australia, New Zealand, Brazil, Costa Rica, Ecuador, India, Japan, the Philippines and Thailand. Conclusions Disparities in the incidence and risk of OC persist worldwide. The increased risk of birth cohort in OC incidence was observed for most countries in Asia, Central and Eastern Europe, and Central and South America. The reason for the increasing OC risk for recent birth cohorts in these countries should be investigated with further epidemiology studies.

Abstract Background Patients with a primary melanoma may develop more than one in their lifetime. It is unclear whether mortality is worse after diagnosis of multiple primary melanoma (MPM) compared with single primary melanoma (SPM). Methods We analysed data from a population-based cohort of 3,869 patients diagnosed with primary in situ or invasive cutaneous melanoma in New South Wales, Australia in 2006-07 and followed up until 2018 (median 11.9 years) using linked mortality and cancer registry data. We compared overall mortality and melanoma-specific mortality for patients with SPM versus MPM, adjusting for other clinico-pathological prognostic indicators, using Cox proportional hazard models. The primary analysis was based on pathological features from the thickest tumour for MPM patients, however sensitivity analyses were performed using the first and last primary melanoma. Results The cohort consisted of 3,869 patients (2,929 SPM and 940 MPM) and 5,504 melanoma lesions (including 2,575 lesions from MPM patients). The primary multivariable analysis showed MPM was associated with lower mortality from all causes and melanoma compared with SPM with a hazard ratio of 0.62 (95% CI: 0.54-0.71, p < 0.001) and 0.37 (95% CI: 0.32-0.43, p < 0.001) respectively. These findings were also supported by the sensitivity analyses. Conclusions The diagnosis of MPM does not worsen mortality compared to a SPM, in fact it was associated with improved survival. This finding might be related to skin examination behaviours, biological or clinical factors. Key messages MPM patients have a better prognosis than SPM patients.

Introdução: O câncer bucal é referido como um dos maiores problemas de saúde pública no mundo, sendo dever do cirurgião-dentista estar preparado para utilizar estratégias de detecção precoce de tal condição, atentando-se aos fatores predisponentes como o tabaco e o álcool. Objetivo: Avaliar a percepção dos acadêmicos dos 9º e 10º períodos do curso de Odontologia sobre o câncer bucal. Metodologia: A pesquisa foi desenvolvida nas dependências do referido curso com amostra correspondente a 74 participantes, de ambos os sexos e maiores de idade. Como instrumento de coleta de dados foi utilizado um questionário, contendo 13 questões objetivas relacionadas aos objetivos do estudo. Resultados: A maioria dos participantes afirmou ter conhecimento sobre o problema com informações adquiridas na graduação e grande parte afirma procurar identificar câncer bucal na primeira consulta do paciente. Daqueles que não o fazem, 28,57% não sabem e 21,43% consideram desnecessário esse exame, a maioria considera o cirurgião-dentista de alta importância na prevenção e detecção do câncer bucal. Conclusão: Dado o exposto, se faz necessário a orientação aos acadêmicos sobre a importância da participação do cirurgião-dentista na prevenção e diagnóstico precoce do câncer bucal para que este profissional conquiste maior confiança da população com maior qualidade e resolutividade no atendimento, melhorando prognóstico da doença.Descritores: Neoplasias Bucais; Odontologia; Diagnóstico.ReferênciasBrasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Análise dos dados de mortalidade de 2001. Brasília, jan. 2004. Acesso em: 02 de abril de 2019. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/ mortalidade%202001.pdf.Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of mouth cancer: a review of global incidence. 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Rev Bras Cancerologia. 2010;56(2):195-205.Morais TMN. Câncer de boca: avaliação do conhecimento dos cirurgiões-dentistas quanto aos fatores de risco e procedimentos diagnósticos [dissertação]. São Paulo: Faculdade de Odontologia. Universidade de São Paulo; 2003.Garbin D. Conhecimento dos cirurgiões-dentistas sobre câncer bucal: um estudo de caso na rede pública de Florianópolis – SC [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2007.Horowitz AM, Siriphant P, Sheikh A, Child WL. Perspectives of Maryland dentists on oral cancer J Am Dent Assoc. 2001;132(1):65-72.Dib LL, Souza RS, Tortamano N. Avaliação do conhecimento sobre câncer bucal entre alunos de Odontologia, em diferentes unidades da Universidade Paulista. Rev Inst Ciênc Saúde. 2005;23(4):287-95.Dib LL. Nível de conhecimento e de atitudes preventivas entre universitários do curso de odontologia em relação ao câncer bucal: desenvolvimento de um instrumento de avaliação. Acta Oncol Bras.2004;24(2):628-43.Cannick GF, Horowitz AM, Drury TF, Reed SG, Day TA. Assessing oral cancer knowledge among dental students in South Carolina. J Am Dent Assoc. 2005;136(3):373-78.Clovis JB, Horowitz AM, Poel DH. Oral and pharyngeal cancer: knowledge and opinions of dentists in British Columbia and Nova Scotia. J Can Dent Assoc. 2002;68(7):415-20.Greenwood M, Lowry RJ. Primary care clinicians’ knowledge of oral câncer: a study of dentists and doctors in the north east of England. Br Dent J. 2001;191(9):510-12.Patton EE, Zon LI. Taking human cancer genes to the fish: a transgenic model of melanoma in Zebrafish. Zebrafish. 2005;1(4):363-68.Syme SE, Drury TF, Horowitz AM. Maryland dental hygienists' knowledge and opinions of oral cancer risk factors and diagnostic procedures. Oral Dis. 2001;7(3):177-84.Vasconcelos EM. 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Music from Another Time – One Perth Night in 2009The following extract is taken from fieldwork notes from research into the enduring Northern Soul dance scene in Perth, Western Australia.It’s 9.30 and I’m walking towards the Hyde Park Hotel on a warm May night. I stop to talk to Jenny, from London, who tells me about her 1970s trip to India and teenage visits to soul clubs in Soho. I enter a cavernous low-ceilinged hall, which used to be a jazz venue and will be a Dan Murphy’s bottle shop before the year ends. South West Soul organiser Tommy, wearing 34-inch baggy trousers, gives me a Northern Soul handshake, involving upturned thumbs. ‘Spread the Faith’, he says. Drinkers are lined up along the long bar to the right and I grab a glass of iced water. A few dancers are out on the wooden floor and a mirror ball rotates overhead. Pat Fisher, the main Perth scene organiser, is away working in Monaco, but the usual suspects are there: Carlisle Derek, Ivan from Cheltenham, Ron and Gracie from Derby. Danny is back from DJing in Tuscany, after a few days in Widnes with old friends. We chat briefly mouth to ear, as the swirling strings and echo-drenched vocals of the Seven Souls’ 45 record, ‘I still love you’ boom through the sound system. The drinkers at the bar hit the floor for Curtis Mayfield’s ‘Move on up’ and the crowd swells to about 80. When I move onto the floor, Barbara Acklin’s ‘Am I the Same Girl?’ plays, prompting reflection on being the same, older person dancing to a record from my teenage years. On the bridge of the piano and conga driven ‘’Cause you’re mine’, by the Vibrations, everybody claps in unison, some above their heads, some behind their backs, some with an expansive, open-armed gesture. The sound is like the crack of pistol. We are all living in the moment, lost in the music, moving forward and backward, gliding sideways, and some of us spinning, dervish-like, for a few seconds, if we can still maintain our balance.Having relocated their scene from England south to the Antipodes, most of the participants described on this night are now in their sixties. Part of the original scene myself, I was a participant observer, dancing and interviewing, and documenting and exploring scene practices over five years.The local Perth scene, which started in 1996, is still going strong, part of a wider Australian and New Zealand scene. The global scene goes back nearly 50 years to the late 1960s. Northern Soul has now also become southern. It has also become significantly present in the USA, its place of inspiration, and in such disparate places as Medellin, in Colombia, and Kobe, in Japan.The feeling of ‘living in the moment’ described is a common feature of dance-oriented subcultures. It enables escape from routines, stretches the present opportunity for leisure and postpones the return to other responsibilities. The music and familiar dance steps of a long-standing scene like Northern Soul also stimulate a nostalgic reverie, in which you can persuade yourself you are 18 again.Dance steps are forward, backward and sideways and on crowded dancefloors self-expression is necessarily attenuated. These movements are repeated and varied as each bar returns to the first beat and in subcultures like Northern Soul are sufficiently stylised as to show solidarity. This solidarity is enhanced by a unison handclap, triggered by cues in some records. Northern Soul is not line-dancing. Dancers develop their own moves.Place of Origin: Soul from the North?For those new to Northern Soul, the northern connection may seem a little puzzling. The North of England is often still imagined as a cold, rainy wasteland of desolate moors and smoky, industrial, mostly working-class cities, but such stereotyping obscures real understanding. Social histories have also tended to focus on such phenomena as the early twentieth century Salford gang members, the “Northern Scuttlers”, with “bell-bottomed trousers … and the thick iron-shod clogs” (Roberts 123).The 1977 Granada television documentary about the key Northern Soul club, Wigan Casino, This England, captured rare footage; but this was framed by hackneyed backdrops of mills and collieries. Yet, some elements of the northern stereotype are grounded in reality.Engels’s portrayal of the horrors of early nineteenth century Manchester in The Condition of the Working Class in England in 1844 was an influential exploration of the birth pains of this first industrial city, and many northern towns and cities have experienced similar traumas. Levels of social disadvantage in contemporary Britain, whilst palpable everywhere, are still particularly significant in the North, as researched by Buchan, Kontopantelis, Sperrin, Chandola and Doran in North-South Disparities in English Mortality 1965–2015: Longitudinal Population Study.By the end of the 1960s, the relative affluence of Harold Wilson’s England began to recede and there was increased political and counter-cultural activity. Into this social climate emerged both skinheads, as described by Fowler in Skins Rule and the Northern Soul scene.Northern Soul scene essentially developed as an extension of the 1960s ‘mod’ lifestyle, built around soul music and fashion. A mostly working-class response to urban life and routine, it also evidenced the ability of the more socially mobile young to get out and stay up late.Although more London mods moved into psychedelia and underground music, many soul fans sought out obscure, but still prototypical Motown-like records, often from the northern American cities Detroit and Chicago. In Manchester, surplus American records were transported up the Ship Canal to Trafford Park, the port zone (Ritson and Russell 1) and became cult club hits, as described in Rylatt and Scott’s Central 1179: The Story of Manchester's Twisted Wheel.In the early 1970s, the rare soul fans found a name for their scene. “The Dave Godin Column” in the fanzine Blues and Soul, published in London, referred for the first time to ‘Northern Soul’ in 1971, really defining ‘Northern’ directionally, as a relative location anywhere ‘north of Watford’, not a specific place.The scene gradually developed specific sites, clothes, dances and cultural practices, and was also popular in southern England, and actually less visible in cities such as Liverpool and Newcastle. As Nowell (199) argues, the idea that Northern Soul was regionally based is unfounded, a wider movement emerging as a result of the increased mobility made possible by railways and motorways (Ritson and Russell 14).Clubs like the Blackpool Mecca and Wigan Casino were very close to motorway slip roads and accessible to visitors from further south. The initial scene was not self-consciously northern and many early clubs, like the ‘Golden Torch’, in Tunstall were based in the Midlands, as recounted by Wall (441).The Time and Space of the DancefloorThe Northern Soul scene’s growth was initially covered in fanzines like Blues and Soul, and then by Frith and Cummings (23-32). Following Cosgrove (38-41) and Chambers (142), a number of insider accounts (Soul Survivors: The Wigan Casino Story by Winstanley and Nowell; Too Darn Soulful: The Story of Northern Soul by Nowell; The In-Crowd: The Story of the Northern & Rare Soul Scene by Ritson & Russell) were followed by academic studies (Milestone 134-149; Hollows and Milestone 83-103; Wall 431-445). The scene was first explored by an American academic in Browne’s Identity Scene and Material Culture: The Place of African American Rare Soul Music on the British Northern Soul Scene.Many clubs in earlier days were alcohol-free, though many club-goers substituted amphetamines (Wilson 1-5) as a result, but across the modern scene, drug-taking is not significant. On Northern Soul nights, dancing is the main activity and drinking is incidental. However, dance has received less subtle attention than it deserves as a key nexus between the culture of the scene and black America.Pruter (187) referred to the earlier, pre-disco “myopia” of many music writers on the subject of dance, though its connection to leisure, pleasure, the body and “serious self-realization” (Chambers 7) has been noted. Clearly Northern Soul dancers find “evasive” pleasure (Fiske 127) and “jouissance” (Barthes v) in the merging of self into record.Wall (440) has been more nuanced in his perceptions of the particular “physical geography” of the Northern Soul dance floor, seeing it as both responsive to the music, and a vehicle for navigating social and individual space. Dancers respond to each other, give others room to move and are also connected to those who stand and watch. Although friends often dance close, they are careful not to exclude others and dancing between couples is rare. At the end of popular records, there is often applause. Some dance all night, with a few breaks; others ‘pace’ themselves (Mercieca et al. 78).The gymnastics of Northern Soul have attracted attention, but the forward dives, back drops and spins are now less common. Two less noticed markers of the Northern Soul dancing style, the glide and the soul clap, were highlighted by Wall (432). Cosgrove (38) also noted the sideways glide characteristic of long-time insiders and particularly well deployed by female dancers.Significantly, friction-reducing talcum powder is almost sacramentally sprinkled on the floor, assisting dancers to glide more effectively. This fluid feature of the dancing makes the scene more attractive to those whose forms of expression are less overtly masculine.Sprung wooden floors are preferred and drink on the floor is frowned upon, as spillage compromises gliding. The soul clap is a communal clap, usually executed at key points in a record. Sometimes very loud, this perfectly timed unison clap is a remarkable, though mostly unselfconscious, display of group co-ordination, solidarity and resonance.Billy from Manchester, one of the Perth regulars, and notable for his downward clapping motion, explained simply that the claps go “where the breaks are” (Mercieca et al. 71). The Northern Soul clap demonstrates key attributes of what Wunderlich (384) described as “place-temporality in urban space”, emerging from the flow of music and movement in a heightened form of synchronisation and marked by the “vivid sense of time” (385) produced by emotional and social involvement.Crucially, as Morris noted, A Sense of Space is needed to have a sense of time and dancers may spin and return via the beat of the music to the same spot. For Northern Soul dancers, the movements forwards, backwards, sideways through objective, “geometric space” are paralleled by a traversing of existential, “conceived space”. The steps in microcosm symbolise the relentless wider movements we make through life. For Lefebvre, in The Production of Space, these “trialectics” create “lived space”.A Sense of Place and Evolving IdentitySpaces are plastic environments, charged with emerging meanings. For Augé, they can also remain spaces or be manipulated into “Non-Places”. When the sense of space is heightened there is the potential for lived spaces to become places. The space/place distinction is a matter of contention, but, broadly, space is universal and non-relational, and place is particular and relational.For Augé, a space can be social, but if it lacks implicit, shared cultural understandings and requires explicit signs and rules, as with an airport or supermarket, it is a non-place. It is not relational. It lacks history. Time cannot be stretched or temporarily suspended. As non-places proliferate, urban people spend more time alone in crowds, ”always, and never, at home” (109), though this anonymity can still provide the possibility of changing identity and widening experience.Northern Soul as a culture in the abstract, is a space, but one with distinct practices which tend towards the creation of places and identities. Perth’s Hyde Park Hotel is a place with a function space at the back. This empty hall, on the night described in the opening, temporarily became a Northern Soul Club. The dance floor was empty as the night began, but gradually became not just a space, but a place. To step onto a mostly empty dance floor early in the night, is to cross liminal space, and to take a risk that you will be conspicuous or lonely for a while, or both.This negotiation of space is what Northern Soul, like many other club cultures has always offered, the promise and risk of excitement outside the home. Even when the floor is busy, it is still possible to feel alone in a crowd, but at some stage in the night, there is also the possibility, via some moment of resonance, that a feeling of connection with others will develop. This is a familiar teenage theme, a need to escape bonds and make new ones, to be both mobile and stable. Northern Soul is one of the many third spaces/places (Soja 137) which can create opportunities to navigate time, space and place, and to find a new sense of direction and identity. Nicky from Cornwall, who arrived in Perth in the early 1970s, felt like “a fish out of water”, until involvement in the Northern Soul scene helped him to achieve a successful migration (Mercieca et al. 34-38). Figure 1: A Perth Northern Soul night in 2007. Note the talcum powder on the DJ table, for sprinkling on the dancefloor. The record playing is ‘Helpless’, by Kim Weston.McRobbie has argued in Dance and Social Fantasy that Northern Soul provides places for women to define and express themselves, and it has appealed to more to female and LGBTQIA participants than the more masculine dominated rock, funk and hip-hop scenes. The shared appreciation of records and the possibilities for expression and sociality in dance unite participants and blur gender lines.While the more athletic dancers have tended to be male, dancing is essentially non-contact, as in many other post-1960s ‘discotheque’ styles, yet there is little overt sexual display or flirtation involved. Male and female styles, based on foot rather than arm movements, are similar, almost ungendered, and the Soul scene has differed from more mainstream nightlife cultures focussed on finding partners, as noted in Soul Survivors: The Wigan Casino Story by Winstanley and Nowell. Whilst males, who are also involved in record buying, predominated in the early scene, women now often dominate the dance floor (Wall 441).The Perth scene is little different, yet the changed gender balance has not produced more partner-seeking for either the older participants, who are mostly in long-term relationships and the newer, younger members, who enjoy the relative gender-blindness, and focus on communality and cultural affinity. Figure 2: A younger scene member, ‘Nash’, DJing in Perth in 2016. He has since headed north to Denmark and is now part of the Nordic Northern Soul scene.In Perth, for Stan from Derby, Northern Soul linked the experiences of “poor white working class kids” with young black Americans (Mercieca et al. 97). Hollows and Milestone (87-94) mapped a cultural geographic relationship between Northern Soul and the Northern cities of the USA where the music originated. However, Wall (442) suggested that Northern Soul is drawn from the more bi-racial soul of the mid-1960s than the funky, Afro-centric 1970s and essentially deploys the content of the music to create an alternative British identity, rather than to align more closely with the American movement for self-determination. Essentially, Northern Soul shows how “the meanings of one culture can be transformed in the cultural practices of another time and place” (Wall 444).Many contemporary Australian youth cultures are more socially and ethnically mixed than the Northern Soul scene. However, over the years, the greater participation of women, and of younger and newer members, has made its practices less exclusive, and the notion of an “in-crowd” more relaxed (Wall 439). The ‘Northern’ connection is less meaningful, as members have a more adaptable sense of cultural identity, linked to a global scene made possible by the internet and migration. In Australia, attachment seems stronger to locality rather than nation or region, to place of birth in Britain and place of residence in Perth, two places which represent ‘home’. Northern Soul appears to work well for all members because it provides both continuity and change. As Mercieca et al. suggested of the scene (71) “there is potential for new meanings to continue to emerge”.ConclusionThe elements of expression and directional manoeuvres of Northern Soul dancing, symbolise the individual and social negotiation of direction, place, space, identity and time. The sense of time and space travelled can create a feeling of being pushed forward without control. It can also produce an emotional pull backwards, like an elastic band being stretched. For those growing older and moving far from places of birth, these dynamics can be particularly challenging. Membership of global subcultures can clearly help to create successful migrations, providing third spaces/places (Soja 137) between home and host culture identities, as evidenced by the ‘Southern’ Northern Soul scene in Australia. For these once teenagers, now grandparents in Australia, connections to time and space have been both transformed and transcended. They remain grounded in their youth, but have reduced the gravitational force of home connections, projecting themselves forward into the future by balancing aspects of both stability and mobility. Physical places and places and their connections with culture have been replaced by multiple and overlapping mappings, but it is important not to romanticise notions of agency, hybridity, third spaces and “deterritorialization” (Deleuze and Guattari in Anti-Oedipus: Capitalism and Schizophrenia). In a globalised world, most people are still located geographically and labelled ideologically. The Northern Soul repurposing of the culture indicates a transilience (Richmond 328) “differentially available to those in different locations in the field of power” (Gupta and Ferguson 20). However, the way in which Northern Soul has moved south over the decade via migration, has arguably now provided a stronger possible sense of resonance with the lives of black Americans whose lives in places like Chicago and Detroit in the 1960s, and their wonderful music, are grounded in the experience of family migrations in the opposite direction from the South to the North (Mercieca et al. 11). In such a celebration of “memory, loss, and nostalgia” (Gupta and Ferguson 13), it may still be possible to move beyond the exclusion that characterises defensive identities.ReferencesAugé, Marc. Non-Places: An Introduction to Supermodernity. Trans. John Howe. London: Verso, 2008.Barthes, Roland. The Pleasure of the Text. Trans. Richard Miller. New York: Hill and Wang, 1975Browne, Kimasi L. 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