Remote Australia Online

Health and well-being are influenced by access and quality to safe drinking water, wastewater treatment, and hygiene practices and settings. This is recognised in the United Nations' Sustainable Development Goals for water and health. As a signatory to the UN Goals, Australia has a commitment to ensure the access and quality of these resources is attained for all, including Indigenous Australians living in remote communities. This research sought to identify the status of water, sanitation and hygiene services within remote communities on mainland Australia. Interviews were conducted with representatives of organisations providing water, sanitation and/or hygiene to communities. The quality and access of WASH services in remote Indigenous communities were revealed in this research as lacking at times in many communities. The qualitative results indicate that drinking water supplies can be contaminated by microbes or naturally occurring chemicals, wastewater treatment can be poorly maintained with irregular monitoring, and the health of residents is negatively impacted by crowding in houses, which affects residents' ability to maintain healthy hygiene levels of people, clothing, bedding and infrastructure. Effective responses require a collaborative and systemic approach by the respective government agencies responsible that effectively partner with – and adequately fund – Indigenous communities to provide options that are ‘fit for purpose, place and people’.

Reported here is a rare respiratory complication in a young primiparous woman in a remote community hospital in the Northern Territory, Australia. A Caucasian primiparous woman aged 23 years presented with chest pain following a very prolonged second stage of labour. On clinical examination a crunching and crackling sound was heard over the precordium, synchronous with the heartbeat (Hamman’s sign). A chest radiograph confirmed the presence of pneumomediastinum. Complete resolution of symptoms and signs was achieved with supportive management.

Objective: Shortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice. Methods: A comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers. Results: Twenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse’s transition is influenced by time. Conclusions: For successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase.

The 2002 NATSISS is the first national survey of Indigenous Australia that includes a transport module and, as such, provides a unique opportunity to examine Indigenous transport needs. The analysis of the transport data in this chapter is approached from an anthropological perspective, comparing this survey data with the ethnographic record. In doing so, I focus primarily on the findings of the remote area NATSISS but I also (as relevant) highlight comparative findings using the data from the non-remote NATSISS and the GSS. My focus reflects the concentration of ethnographic research in remote areas.

Objective: To estimate the magnitude of excess risk for proteinuria, high blood pressure and diabetes in Australian Aboriginal adults in three remote communities by comparing them with nationwide Australian data. Methods: Adult volunteers from three remote communities in the Northern Territory were screened for proteinuria, high blood pressure, and diabetes between 2000 and mid 2003. Rates for people age 25 to 74 years were compared with those from the AusDiab study conducted in 1999 and 2000. Results: Compared with AusDiab, rates of these conditions were elevated in all Aboriginal communities, but differed among them. With adjustment for age and sex, rates of proteinuria were elevated 2.5- to 5.3-fold, rates of high blood pressure were elevated 3.1- to 8.1-fold and rates of diabetes were elevated 5.4- to 10-fold (p<0.001 for all). The risk of having any condition ranged from 3.0- to 8.7-fold and the risk of having two or more conditions ranged from 5.8- to 14.2-fold. Discussion: The data are compatible with the excess morbidity and mortality from cardiovascular disease, diabetes and renal disease in these Aboriginal groups. They reflect the multitude of risk factors operating in these environments. They dictate urgent and systematic intervention to modify outcomes of established disease and to prevent their development. However, the resources required for effective secondary intervention will differ among communities according to the disease burden.

This chapter provides a critical analysis of a contemporary discourse on food, food systems and sustainability in Australia. It explores the apparent shift from food in a productive rural space, to food as a counterhegemonic discourse, frequently in, or linking urban spheres to a very limited subset of rural producers. The contemporary production of agriculture in rural Australia is driven by a paradigm of productivity, economic growth, efficiency, and technological innovation. Significant alternative visions of the food system cover a wide range of options with underpinning discourses of localisation, sustainability and social justice. Consumers, primarily in urban Australia, are increasingly driven by conscious consumption, including steady growth in organic food, interest in local food and shorter food supply chain products. Policy supporting alternative food is limited to local government where support of urban agriculture is increasing. Changing food preferences in urban centres drives decision-making in rural production systems. The core focus of this chapter is the fundamental changes or shifts in food production, and discourse, both in a rural and a urban context. The chapter questions the kind of binary that underpins a rural–urban dichotomy, exploring how the evolving food landscape engages, in particular with the predominantly urban population in Australia. In an Australian context, it asks the question of whether many rural producers are in danger of becoming invisible, in an increasing unsettled food sphere. This chapter argues the importance of broader and more equitable rural–urban linkages for sustainable food systems and for sustainable rural communities and landscapes.

Objectives Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal and Torres Strait Islander health services in Australia through exploring the strategies used by ‘high-improving’ Indigenous primary healthcare (PHC) services.Design, settings and participants This strengths-based participatory observational study used a multiple case study method with six Indigenous PHC services in northern Australia that had improved their performance in CQI audits. Interviews with healthcare providers, service users and managers (n=134), documentary review and non-participant observation were used to explore implementation of CQI and the enablers of quality improvement in these contexts.Results Services approached the implementation of CQI differently according to their contexts. Common themes previously reported included CQI systems, teamwork, collaboration, a stable workforce and community engagement. Novel themes included embeddedness in the local historical and cultural contexts, two-way learning about CQI and the community ‘driving’ health improvement. These novel themes were implicit in the descriptions of stakeholders about why the services were improving. Embeddedness in the local historical and cultural context resulted in ‘two-way’ learning between communities and health system personnel.Conclusions Practical interventions to strengthen responses to CQI in Indigenous PHC services require recruitment and support of an appropriate and well prepared workforce, training in leadership and joint decision-making, regional CQI collaboratives and workable mechanisms for genuine community engagement. A ‘toolkit’ of strategies for service support might address each of these components, although strategies need to be implemented through a two-way learning process and adapted to the historical and cultural community context. Such approaches have the potential to assist health service personnel strengthen the PHC provided to Indigenous communities.

Since 2015, many communities in regional and remote Australia have been subject to the Federal Government's so-called Community Development Program (CDP). In effect, the program itself is a targeted Work for the Dole program, except that participants in the communities it has been applied to are required to work 25 hours per week, all year round, in order to comply with this program and receive their basic unemployment payment.

Remote health professionals encounter many challenges associated with delivering care in poorly serviced remote locations and working across cultures. Despite an identified need for the assessment practices of health and social care professionals to accommodate cultural differences, and for staff training in the area, deficits in preparing the remote workforce for assessment remain. This paper combines the results of two qualitative studies to consider current and improved approaches to preparing and supporting staff for conducting assessments in remote and Indigenous settings. Study A focused on aged care assessment practices within the remote Aboriginal context of Central Australia, and Study B focused on the practice for assessing cognition among Aboriginal Australians in the Northern Territory. Our secondary analysis of these combined data sets provides valuable information to improve planning of approaches to preparing staff for assessments in these contexts. We report themes relating to three categories: the assessment workforce, current approaches to preparing assessment staff, and cross-cultural knowledge/skill. We discuss which areas require more detailed attention to prepare staff for this work – such as critical reflection and cultural safety – as well as how this may best be achieved – such as through the inclusion of cultural supervisors in practitioners' supervision models, and in follow-up components to workshop models.

Indigenous cultural tourism offers significant future opportunities for countries, cities and Indigenous communities, but the development of new offerings can be problematic. Addressing this challenge, this article examines contemporary Australian Indigenous art innovation and cultural entrepreneurship or culturepreneurship emanating from Australia’s remote Arnhem Land art and culture centres and provides insight into the future development of Indigenous cultural tourism. Using art- and culture-focused field studies and recent literature from the diverse disciplines of art history, tourism, sociology and economics, this article investigates examples of successful Indigenous artistic innovation and culturepreneurship that operate within the context of cultural tourism events. From this investigation, this article introduces and defines the original concept of Indigenous culturepreneurship and provides six practical criteria for those interested in developing future Indigenous cultural tourism ventures. These findings not only challenge existing western definitions of both culture and culturepreneurship but also affirm the vital role of innovation in both contemporary Indigenous art and culturepreneurial practice. Equally importantly, this investigation illuminates Indigenous culturepreneurship as an important future-making socio-political and economic practice for the potential benefit of Indigenous communities concerned with maintaining and promoting their cultures as living, growing and relevant in the contemporary world.

This paper reports on a collaborative qualitative study which explored education and communication practice related to chronic disease from the perspectives of Aboriginal people in a remote region of the Northern Territory, Australia, where the prevalence of chronic disease is extremely high. Most Yolngu (Aboriginal people of Northeast Arnhem Land) do not speak English as their first language and few health staff share the language and cultural background of their clients. Semi-structured interviews were conducted with Yolngu community members and health staff in their preferred language in small groups or individually, in an approach that was flexible and responsive to the concerns and priorities of Yolngu researchers and participants. As well, health education interactions were videotaped to facilitate more in-depth understanding of the strengths and challenges in communication (one video can be viewed at http://informahealthcare.com/doi/abs/10.3109/17549507.2012.663791). An iterative and collaborative process of analysis, interpretation, and verification revealed that communication and education related to chronic disease is highly ineffective, restricting the extent to which Yolngu can make informed decisions in managing their health. Yolngu participants consistently stated that they wanted a detailed and direct explanation about causes and management of chronic disease from health staff, and rarely believed this had been provided, sometimes assuming that information about their health is deliberately withheld. These serious limitations in communication and education have extensive negative consequences for individuals, their families, and health services. These findings also have broader relevance to all areas of healthcare, including allied health services, which share similar challenges in achieving effective communication. Without addressing the profound and pervasive inadequacies in communication, other interventions designed to close the gap in Indigenous health are unlikely to succeed.

Staphylococci are important opportunistic pathogens in human and veterinary medicine in addition to being part of the normal flora of the skin and mucous membranes of mammals and birds. The rise of antimicrobial resistance amongst staphylococci warrants closer investigation of the diversity of skin commensal organisms—including coagulase-negative staphylococci (CoNS)—due to their potential as a source of resistance genes. This study is aimed at characterising the commensal staphylococci—including methicillin-resistant Staphylococcus species (spp.)—from mucocutaneous sites of dogs and cats from remote New South Wales (NSW), Australia. Pet dogs and cats were recruited from participants in a community companion animal health programme in six communities in western NSW. Three swabs were collected from each animal (anterior nares, oropharynx, and perineum) and from skin lesions or wounds if present and cultured on selective media for Staphylococcus spp. In total, 383 pets (303 dogs, 80 cats) were enrolled. Staphylococcus spp. were isolated from 67.3% of dogs and 73.8% of cats (494 isolates). The diversity of CoNS was high (20 species) whilst only three coagulase-positive spp. were isolated (S. pseudintermedius, S. aureus, S. intermedius). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in dogs was high (2.6%) relative to other studies but was only a small proportion of overall commensal staphylococci. No cats carried MRSA and no MRSP was isolated from either species. Dogs were significantly more likely to carry coagulase-positive staphylococci than cats (P < 0.001). Amongst dogs, males and those with skin lesions were more likely to carry S. pseudintermedius. This study highlights important differences in the diversity and patterns of carriage of commensal staphylococci between dogs and cats in remote NSW, Australia.

The purpose of this study was to gain insight into what prevocational medical practitioners (PMPs) learnt during a six-month public health medicine and primary health care training program (the Program) in remote Aboriginal Australia in 2001-2002. The Program's curriculum objectives included clinical and public health management of sexually transmitted infections, immunization, clinical audit and quality improvement, primary health care in remote Aboriginal communities, and working as part of an interdisciplinary team with health and non-health professionals, and lay people. The mode and location of delivery of these objectives was determined by the healthcare needs of the Kimberley population, and availability of safe, supported workplaces. Qualitative data from a variety of sources, including PMPs' reflective journals, were examined in the context of the Program's curriculum objectives and by conducting a content analysis of journal notes. Findings are presented using the curriculum objectives and other comments that emerged while examining the data. Preliminary data indicated that PMPs gained knowledge and practical experience in clinical and public health management of sexually transmitted infections, immunization and primary health care in poorly resourced remote Aboriginal settings. Deeper understandings of health and illness in a cross-cultural setting also developed, along with professional and personal growth, as illustrated by the following quotations from PMPs: "I have learnt ... a different way of looking at people's health ... I was encouraged to think more deeply than before about the whys and wherefores of medical practice, and thus consider the most effective ways of influencing patients' behaviours for the better." "I was encouraged to examine the thought processes behind the ways ... healthcare was provided ... [after leaving the Kimberley] I am constantly questioning the reason why we are practising medicine in a certain way in the big city hospitals-much to the consternation of my colleagues ... ." The Program was successful in teaching its first four PMPs the basic tools of public health medicine and remote area primary health care.

Objectives: To compare the clinical outcomes and mortality rates of Aboriginal and Torres Strait Islander people of Kimberley origin receiving haemodialysis (HD) treatment with other subsets of Aboriginal and Torres Strait Islander HD patients (Northern Territory, Western Australia excluding the Kimberley region, the rest of Australia) and Australian non-Indigenous HD patients. Design, participants and setting: Retrospective identification of Aboriginal and Torres Strait Islander patients of Kimberley origin and analysis of secondary data from the Australia and New Zealand Dialysis and Transplant Registry; this group was compared with other Australian patients receiving HD treatment from 1 January 2003 to 31 December 2007. Main outcome measures: Clinical outcome measures; comorbid conditions; death rates per 100 patient-years, unadjusted and adjusted (for age, sex, comorbid conditions, late referral to nephrologist treatment). Results: Seventy per cent of HD treatments for Aboriginal and Torres Strait Islander patients of Kimberley origin was provided in the Kimberley. They had comparable adjusted mortality rates to non-Indigenous Australian patients (adjusted mortality rate ratio, 0.80; 95% CI, 0.51–1.23). Conclusions: This is the first report showing similar mortality rates for Aboriginal and Torres Strait Islander people exclusively from a remote area of Australia and non-Indigenous Australians receiving HD treatment. HD treatment delivered closer to home can be safe and effective in remote areas.

Rates of disabling conditions and the proportions of high care needs (PCAR and SCAR) were found to be high within the communities surveyed. Almost half of the survey participants (47%) reported having more than one disability. There were very high rates of physical disabilities recorded in this study, both in analysis of service provider data (77%) and by survey data (57%). This is likely to be at least in part reflective of the high prevalence of MJD in these communities. This study overwhelmingly reinforces the PC findings that there are very limited services available in remote communities above low level attendant care (PC, 2011).There were very limited options for day programs3and no community based overnight care options. One quarter (25%) of carers surveyed reported needing to provide 24/7 care which, with the incidence of profound and severe CARs are considered, points to a clear discrepancy between the services necessary and those currently available. The consequence of this discrepancy is a high reliance on informal carer networks. This is particularly relevant when the profile of carers is considered. Carers were almost always (80%) providing care to multiple people (people with disability and children under age of 15 years). Of those, 39% were providing care for 2 or more people with disability and at least one child. Almost half (46%) of all carers surveyed reported that they had a disability or chronic disease themselves and 77% lived in overcrowded housing. Consistent with other reported findings, understanding and conceptualisation of disability in western medical terms was found to be poor. There is evidence that a lack of awareness of cause and nature of disability has an impact on the capacity of people with disabilities and their carers to advocate for their needs and to engage with services. Amongst those surveyed, it was clear that where targeted information had been provided there was evidence of improved interaction with services, uptake of services and self advocacy.

The problem: Current education does not prepare health professionals for the very different context of remote Aboriginal health. This has negative effects on health services and causes an educationally generated recruitment-retention trap. A proposed solution: A new style of health service in remote Aboriginal communities is suggested, based on primary healthcare teams, in a biopsychosocial model which includes traditional healers. The proposed workforce will be predominantly Aboriginal and in a much wider range of positions and levels. They will work within and outside clinics and will assert their cultural and community knowledge as 'cultural brokers'. They will provide continuity of knowledge and practice for successive non-Indigenous health professionals. They will work with doctors in case conference mode to circumvent communication barriers and develop effective management strategies. Implications: Specific educational development is needed for preparation of Aboriginal health workers with leadership and health literacy skills to work effectively in teams of equals, and reciprocal preparation of non-Indigenous health professionals for working in and toward new relationships. New courses, curricula and delivery are needed for new and expanded Aboriginal roles, from community-based workers to graduate level in all disciplines of health and social sciences. Interdisciplinary teaching in context, in teams, in the remote community workplace, from a local (remote) education provider or hub, is the only feasible method of establishing and sustaining this paradigm.

Background. Australian Aborigines living in remote areas have exceedingly high rates of renal failure together with increased cardiovascular morbidity and mortality. To examine the basis of this association, we studied markers of renal function and cardiovascular (CV) risk in a coastal Aboriginal community in a remote area of the Northern Territory of Australia. End-stage renal disease (ESRD) incidence rates in that community are 15 times the national non-Aboriginal rate and CV mortality rates in the region are increased 5-fold.Methods. A cross-sectional community survey was conducted. Markers of early renal disease examined included urine albumin/creatinine ratio (ACR), serum creatinine concentration and calculated glomerular filtration rate (GFR). CV risk markers included blood pressure as well as measures of glycaemia, diabetes and serum lipids.Results. The study group included 237 people, 58% of the adult population of the community. The crude prevalence of microalbuminuria (urine ACR: 3.4–33.9 g/mol, 30–299 mg/g) was 31% and of overt albuminuria (urine ACR: ≥34 g/mol, ≥300 mg/g), 13%. The prevalence of overt albuminuria increased with age, but the prevalence of microalbuminuria was greatest in the 45–54 year age group. Microalbuminuria was associated with increasing body mass index, whereas overt albuminuria was associated with increasing glycated haemoglobin (HbA1c) and systolic blood pressure and a history of diabetes. The prevalence of elevated serum creatinine concentration (≥120 µmol/l) was 10%. GFR (calculated using the MDRD equation) was <60 ml/min/1.73 m2 in 12% and 60–79 ml/min/1.73 m2 in a further 36% of the study population. Although many people with albuminuria had well preserved GFRs, mean GFR was lower in people with higher levels of albuminuria.Conclusions. The high prevalence of markers of renal disease in this community was consistent with their high rates of ESRD. The distribution of microalbuminuria suggested a ‘cohort effect’, representing a group who will progress to overt albuminuria. The powerful association of renal disease markers with CV risk factors confirms a strong link between renal and CV disease in the early, asymptomatic stages of each. Thus, pathologic albuminuria, in part, might be a manifestation of the metabolic/haemodynamic syndrome and both conditions might arise out of a common menu of risk factors. Hence, a single agenda of primary and secondary intervention may benefit both.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

Managers of Indigenous Protected Areas (IPAs) may need to communicate the value provided by their protected area to indigenous and nonindigenous stakeholders, especially if a political focus on maximizing economic opportunities conflicts with traditional priorities. To facilitate this process, we used the latest Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services conceptual framework and the IPA plan of management to identify the diverse ways that nature contributes to people in the Yawuru IPA (Western Australia). 68 out of 144 of the IPA management objectives related directly to ecosystem goods and services of which 65 are nonmaterial, 35 material, and 24 regulating (some services overlap). As a guide for management to assess relevant contributions, we identified valuation methods applicable to the IPA's wetlands and found that a wide range of options are available to assess ecosystem value. We also performed a detailed assessment of fresh water flow over the IPA.

The Queensland Government welcomes the QPC Final Report and its Recommendations. We thank the QPC Commissioner Kim Wood and the Presiding Commissioner Professor Bronwyn Fredericks and the Inquiry team for their significant work to deliver this QPC Final Report.Communities, local councils, service providers and government agencies have undertaken extensive work to informthe QPC’s Inquiry. The Queensland Government thanks all who participated for their contribution.The Queensland Government expresses a long-term commitment to work with the 19 remote and discrete Aboriginal and Torres Strait Islander communities that include Indigenous Local Government Areas (Councils), their Mayors and community leaders,and other stakeholders to implement the intent ofthe proposedreform agenda.

Service delivery in remote and discrete communities is a complex ‘system’ of policy design, governance, funding and direct service provision, with responsibilities shared across all levels of government. The Queensland Government spends around $1.2 billion a year ($29,000 per person) on services to remote and discrete Aboriginal and Torres Strait Islander communities. Despite these expenditures, outcomes for Aboriginal and Torres Strait Islander people living in remote and discrete communities remain far behind the rest of the state, with most communities dependent on external resourcing. There is a strong commitment from government, service providers and communities to address the complex and longstanding issues facing remote and discrete communities, but the system they are operating under is fundamentally broken. There have been several past reform attempts, but they have not addressed the underlying incentives in the service delivery system that undermine outcomes and foster passive dependence. The key to achieving a sustained improvement is to enable Aboriginal and Torres Strait Islander communities to develop solutions for themselves. This means a change to the overall policy and service delivery architecture through three reforms: structural reform to transfer accountability and decision-making to communities, service delivery reform to better focus on the needs of individuals and communities, economic reform to facilitate economic participation and community development. The reforms will need to be underpinned by capability and capacity building within government, service providers and communities to support a new way of doing things, independent oversight, as well as timely and transparent data collection and reporting to ensure performance and accountability. The potential benefits are large, both in terms of improving wellbeing in communities and the savings that could be directed towards activities communities value most highly.

In high-burden settings, guidelines recommend antibiotic treatment for all suspected group A Streptococcus (GAS) infections to prevent rheumatic fever and poststreptococcal glomerulonephritis. Highly sensitive rapid GAS tests could reduce unnecessary antibiotic use in these settings.This was a prospective study of the Xpert Xpress Strep A (Cepheid) molecular test compared with culture of throat swab samples collected at a referral hospital in northern Australia. Demographic and clinical data and results of streptococcal serology and culture were collected.Of 164 throat swab samples, 145 (88%) were eligible for inclusion; 49 (34%) were molecular test positive and 24 (17%) were culture positive for GAS. The sensitivity, specificity, and positive and negative predictive values for the molecular test versus culture were 100.0%, 79.3%, 48.8%, and 100.0%, respectively. Among 25 samples testing positive with the molecular test and negative with culture, group C or G streptococci were cultured in 2, and a plausible clinical explanation, such as pharyngotonsillitis, or rheumatic fever with positive results of streptococcal serology, was apparent in 19 instances. In 25 patients with rheumatic fever or poststreptococcal glomerulonephritis diagnoses, molecular testing nearly trebled the detection of GAS in throat swab samples, from 3 (12%) detected with culture to 8 (32%) detected with molecular testing. Reasons for “false-positive” molecular test results could include the presence of GAS below the threshold of culture detection or persistence of nonviable organisms after infection.Implementation of molecular testing could improve antibiotic use in this high-burden setting. The incremental yield in poststreptococcal syndromes, by which time cultures are negative, has high potential in the diagnostic workup of autoimmune poststreptococcal syndromes and warrants further investigation.

Objective To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children. Design A prospective 3-year cohort study of children in 10 remote Aboriginal communities in South Australia with (n = 4) or without (n = 6) swimming pools. Setting Outback Australia. Participants Eight hundred and thirteen school-age children residing in remote South Australia. Main outcome measures Prevalence of open and closed middle ear disease and prevalence of hearing loss. Results About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non-pool communities (P = 0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non-pool communities in the frequency of either inactive (19.4% pool vs 22.6% non-pool; P = 0.232) or active (19.8% pool vs 17.8% non-pool; P = 0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non-pool communities in the frequency of type B tympanometry (P = 0.465). Conclusions Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.

This paper analyses the development of an Aboriginal ?workfore? program which operates in remote communities, the Community Development Employment Projects (CDEP) scheme, from its conception back in the mid 1970s through to the present day. It identifies a number of distinct periods in the development of the program; a period of debate surrounding its conception, an initial pilot period of operation beginning in 1977 in which the scheme endured both significant criticism and severe budgetary and administrative problems, a period of review and hesitation from 1980 to 1983 and a period of expansion and success since 1984. These changing fortunes of the CDEP scheme are explained through reference to three underlying forces which have contributed to the development of the program over the years; bureaucratic politics, Aboriginal community politics in remote areas and the the rising levels of unemployment in the Australian community more generally.

Despite frequent exposure to bushfires, cyclones and floods, remote Indigenous communities across northern Australia typically have little involvement in managing, mitigating or planning for such events. This scenario planning project explored how people in remote communities, through Indigenous ranger groups, can contribute effectively to the mitigation and delivery of emergency services. This research revealed the importance of developing effective partnerships between emergency management agencies and members of remote communities to integrate and assess the resources and services needed for responsible agencies in the Northern Territory. Using three remote communities as case studies, the potential engagement opportunities with ranger groups was explored to identify solutions to deliver efficient, cost-effective and culturally appropriate emergency services. A collaborative policy framework involving emergency services organisations and Indigenous communities is proposed to mitigate and manage incidents while meeting Indigenous cultural protocols. This recognises and takes advantage of community networks and knowledge of local socio-cultural and natural systems. This research offers practical insights into the delivery of cost-effective and improved emergency services to empower north Australian remote communities.