Remote Australia Online

Purpose:To determine the prevalence and associations of cataract within the indigenous Australian population living in central Australia. Methods: 1884 individuals aged ≥20 years, living in one of 30 remote communities within the statistical local area of ‘central Australia’ were recruited for this study. This equated to 36% of those aged ≥20 years and 67% of those aged ≥40 years within this district. Slit-lamp examination was performed. The degree and subtype of cataract was graded using the Lens Opacities Classification System III criteria. A cataract was defined as a nuclear opalescence ≥4.0, a cortical opacity ≥3.0, a posterior subcapsular opacity ≥2.0, a visual acuity worse than 6/12 or a visual acuity worse than 6/60 due to cataract. The prevalence of cataract in one or both eyes was presented for each of the definitions. Results: Nuclear opalescence cataract was present in 13.5% (18.5% of those ≥40 years); cortical opacity cataract was present in 13.1% (17.7% of those ≥40 years); and posterior subcapsular cataract was present in 15.8% (21.0% of those ≥40 years). 12.6% of patients (17.3% of those ≥40 years) and 4.4% of patients (5.9% of those ≥40 years) had a cataract that resulted in a visual acuity of worse than 6/12 and worse than 6/60, respectively. All cataracts were associated with advancing age. Posterior subcapsular cataract was associated with self-reported diabetes. Conclusion: There is a higher prevalence of cataract among indigenous Australians living within remote central Australia compared with the non-indigenous population. Services for this population need to be designed with this in mind when planning resource allocation.

PURPOSE: To determine the distribution and associations of intraocular pressure (IOP) among the indigenous Australian population living in central Australia. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: 1884 individuals living in one of 30 remote communities within the statistical local area of 'Central Australia'. This equated to 36% of those aged >/=20 years and 67% of those aged >/=40 years within this district. METHODS: Participants aged 20 years or over were recruited as they presented to the eye clinic at each remote community. Of those recruited into the study, 1060 underwent IOP measurement using either a Perkins tonometer (Haag-Streit, Koeniz, Switzerland) or an ICare tonometer (Tiolat Oy, Helsinki, Finland) depending on the availability of equipment. Central corneal thickness (CCT) was also measured using ultrasound pachymetry. MAIN OUTCOME MEASURES: The distribution and associations of IOP from the right eye of each participant is presented. RESULTS: Mean IOP was 12.8 mmHg (SD 3.2 mmHg) and CCT was 512 microm (SD 36 microm). IOP was strongly associated with CCT (r(2) = 0.14, t = 3.87; P < 0.0001), showing an increase of 0.4 mmHg with every 10 microm increase in CCT. Furthermore, IOP was strongly associated with age, decreasing by 1.9 mmHg for every decade increase in age, but only for eyes with a CCT above the mean. CONCLUSION: IOP of indigenous Australians is lower than any other racial group previously published. This may relate to the low CCT readings found among this population. Clinicians will need to bear this in mind when examining indigenous Australians and make appropriate allowances for the measured IOP.

BACKGROUND: To determine the prevalence of pterygium within the indigenous Australian population living in central Australia. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: A total of 1884 individuals living in one of 30 remote communities within the statistical local area of 'Central Australia'. This equated to 36% of those aged >/=20 years and 67% of those aged >/=40 years within this district. METHODS: PARTICIPANTS aged 20 years or over were recruited as they presented to the eye clinic at each remote community. Slit-lamp examination was performed, and the presence of a pterygium or evidence of previous pterygium surgery was recorded. MAIN OUTCOME MEASURES: The prevalence of a pterygium in one or both eyes is presented. RESULTS: Pterygium was present in one or both eyes of 9.3% of individuals aged 40 years or older. Right and left eyes were affected equally (chi(2) = 0.19; P = 0.91). There was a significant association between the presence of a pterygium and age (t = 3.99; P < 0.0001). There was no association with gender (chi(2) = 1.06; P = 0.30). CONCLUSION: Pterygium was present in a significantly higher proportion of indigenous Australians compared with non-indigenous Australians. This is similar to previous findings of the National Trachoma and Eye Health Program and may be due to a difference in proportion of hours spent outdoors and consequent exposure to ultraviolet radiation.

BACKGROUND: Pseudoexfoliation syndrome (XFS) has been found to occur more commonly among indigenous Australians. This paper was designed to determine the prevalence of XFS within the indigenous Australian population living in central Australia. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: One thousand eight hundred eighty-four individuals living in one of 30 remote communities within the statistical local area of 'Central Australia' were recruited. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. METHODS: Participants aged 20 years or over were recruited as they presented to the eye clinic at each remote community. Slit-lamp examination was performed, and the presence of XFS in each eye was recorded and presented. MAIN OUTCOME MEASURE: Prevalence and associations of XFS. RESULTS: XFS was present in one or both eyes of 4.7% of the individuals recruited into the study. Prevalence increased with age (5.9% of those >/=40 years and 12.7% >/= 60 years). There was a significant association between the presence of XFS and climatic keratopathy (chi(2) = 240.13; P < 0.00001). Notably, none of those with XFS had ocular hypertension or glaucoma. CONCLUSION: XFS was present in a significantly higher proportion of indigenous Australians compared with previously reported prevalence estimates among non-indigenous Australians. The association found between XFS and climatic keratopathy may represent a common causal link between the two conditions. The lack of association of XFS with ocular hypertension and glaucoma appears to be a unique feature of the indigenous Australian population, and this merits further investigation.

Key nutrient densities of the diet of two remote northern coastal Aboriginal communities were measured using the store-turnover method during the periods that three store managers were responsible for each store respectively. Individual store managers were a greater determinant of nutrient density than the community itself. Furthermore, nutrient densities tended to be highest in both communities when their stores were administered by one particular store manager. The results support the notion that store managers wield considerable power over the food supply of remote Aboriginal communities, and raise questions concerning the ability of Aboriginal community members to influence their own food supplies in retail stores. However, the study also confirms that store managers can be important allies in efforts to improve Aboriginal dietary intake.

The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the 'store-turnover' method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three-monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B6 and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store-turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost-effectiveness and generalisability.

OBJECTIVE: To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang). DESIGN: Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community. SETTING: A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison. RESULTS: The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang "rebounded" in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang. CONCLUSIONS: The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.

The process of implementation and the effect of the nutrition policy of the Arnhem Land Progress Association (ALPA) were reviewed three years after implementation of the policy in five remote Aboriginal community retail stores in May 1990. In 1993, compliance with the policy varied among stores. Recommended foods were available regularly in most communities; however, promotional and educational components of the policy were not widely implemented. Dietary improvements were evident in those communities where stores most complied with the policy. Some aspects of the ALPA nutrition policy require modification, and renewed commitment to the policy is likely to improve further the diet in the Aboriginal communities involved. The ALPA nutrition policy is a potential model for the development of other local food and nutrition policies in remote Aboriginal communities.

Workforce issues present a major barrier to equitable access to health services for patients living in regional and remote areas. This article describes the development of a health centre to consolidate the major primary healthcare providers of a very remote community. The new health centre has resulted in measurable improvements in access to primary healthcare services in the region.

This study explores the knowledge and beliefs of diabetes in a group of Aboriginal people from a remote community in the Northern Territory. Information was gathered from participants through a combination of group discussions, semi-structured interviews and informal conversations. The four themes of explanation of diabetes were: worry, food, family and infections. The most common means of preventing or treating diabetes were stopping worry and changing one's diet. Significantly, few of the participants believed that medication was effective, and weight loss and exercise were not mentioned. The results highlight the miscommunication about diabetes that has occurred in this population. For effective communication and management of diabetes, health information must incorporate the contemporary health beliefs of the clients.

Summary Background In-utero exposures likely influence the onset and severity of obesity in youth. With increasing rates of type 2 diabetes mellitus (T2DM) and maternal adiposity in pregnancy globally, it is important to assess the impact of these factors on neonatal adipose measures. Objectives To evaluate the contribution of maternal ethnicity, body mass index (BMI), gestational weight gain, and hyperglycaemia to neonatal adiposity. Methods Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) is a longitudinal cohort study of Australian mother and neonate pairs. In this analysis, Indigenous (n = 519) and Europid (n = 358) women were included, of whom 644 had hyperglycaemia (type 2 diabetes [T2DM], diabetes in pregnancy [DIP], or gestational diabetes [GDM]). Associations between maternal ethnicity, hyperglycaemia, BMI and gestational weight gain, and the neonatal outcomes of length, head circumference, sum of skinfolds, total body fat, and percentage body fat were examined. Models were adjusted for maternal age, smoking status, parity, education, neonatal gender, and gestational age. Results Among those with hyperglycaemia in pregnancy, Indigenous women had a higher proportion of T2DM and DIP (36%, 13%) compared with Europid women (4%, 3%). In multivariate analysis, maternal T2DM (compared with no hyperglycaemia), BMI during pregnancy, and excess compared with appropriate gestational weight gain, were significantly associated with greater neonatal measures. DIP was associated with greater sum of skinfolds, total body fat, and percentage body fat. Indigenous ethnicity was associated with greater sum of skinfolds. Conclusions Maternal BMI, excess gestational weight gain, and hyperglycaemia operated as independent factors influencing neonatal adiposity. Interventions addressing these factors are needed to reduce neonatal adiposity.

BACKGROUND: The Australian Government's policies and programmes to redress the medical workforce shortage in rural and remote areas focus on recruitment of rural students and provision of rural clinical placements. The University of Notre Dame's Rural and Remote Health Placement Programme (RRHPP) uses an additional approach to address this issue. AIM: This article describes the RRHPP undertaken by all medical students in the first 2-years of their course and examines the educational worth of this approach. METHOD: Data were obtained from curricular documents, publications about the RRHPP and evaluation questionnaires administered to students and supervisors. RESULTS: The RRHPP provides students with opportunities to develop a patient- and community-centred perspective on the health issues of rural and remote populations by having them live and work with people in these areas prior to clinical placements. It is based on sound educational principles and underpinned by participation of rural/remote communities as experts and equal teaching partners. The RRHPP is valued and perceived by a majority of students and placement hosts as a useful strategy to develop medical students' understanding of the rural/remote community context and its impact on health. CONCLUSION: This community participatory approach benefits medical students and rural/remote communities.

Background: Despite Australia's wealth, poor growth is common among Aboriginal children living in remote communities. An important underlying factor for poor growth is the unhygienic state of the living environment in these communities. This study explores the physical and social barriers to achieving safe levels of hygiene for these children. Methods: A mixed qualitative and quantitative approach included a community level cross-sectional housing infrastructure survey, focus groups, case studies and key informant interviews in one community. Results: We found that a combination of crowding, non-functioning essential housing infrastructure and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children in this remote community. Conclusion: There is a need to address policy and the management of infrastructure, as well as key parenting and childcare practices that allow the high burden of infection among children to persist. The common characteristics of many remote Aboriginal communities in Australia suggest that these findings may be more widely applicable.

This article outlines the findings of a research project that examined how participation can be understood, and subsequently improved, within collaborative, co-creative media practices. As a case study, the research project looked at Pintubi Anmatjere Warlpiri Media and Communications (PAW Media), a remote Indigenous media organisation (RIMO) based in Yuendumu in Australia’s Northern Territory. By means of 13 in-depth interviews, grounded in participant observation, the project examined how Aboriginal participation was motivated, enabled and limited from the perspectives of Aboriginal and non-Aboriginal collaborators. The study revealed practices of Aboriginal participation at PAW Media that were highly valued by participants; nonetheless, limits to participation were noted and two conflicting views regarding improved practice expressed. Non-Aboriginal facilitators supported a transition towards greater Aboriginal autonomy over production, involving a handover of tasks and responsibility to their local Aboriginal counterparts; however, most Aboriginal media producers indicated that their participation was currently better served within a refined version of the existing co-creative structure.

Group A streptococci (GAS) cause several human diseases that differentially affect distinct host populations. Genotypes were defined by multilocus sequence typing and emm typing for 137 organisms collected from individuals in a remote aboriginal island community in tropical Australia and compared with >200 isolates obtained from sources elsewhere in the world. The majority of aboriginal-derived isolates shared emm types and housekeeping alleles with GAS isolates recovered from outside Australia, but these emm types and alleles were in novel combinations. There were many examples in which isolates from aboriginal and non-Australian subjects shared the same emm type, but for ~50% of emm types, the multilocus genotypes of isolates of the same emm type but from different regions were very different. A single emm type may typically define a single clone within the United States and on the remote island that is the focus of this study, but in many cases, these clones will be different, and this finding has implications for attempts to make global associations between emm types and certain disease manifestations.

There is a high incidence of nutrition-related diseases amongst Aborigines living in remote areas. An outline of the corporate food and nutrition policy of the Arnhemland Progress Association is given to demonstrate the potential for positive strategies in remote area stores. The Association is a retailer owned by Aboriginal groups and operates 11 remote community stores. Factors such as price, Aboriginal buying habits, seasonality, consumer demand and most importantly remote area stock management affect the supply of and demand for food items. Further, government policy on sales tax and private sector capital city pricing policies influence retailing in remote areas. The experience of the Arnhemland Progress Association illustrates the extent to which factors affecting supply of and demand for food lie outside the health sector and points to the need for an intersectoral policy on food and nutrition.

OBJECTIVE: Aboriginal people experience a higher burden of disease as a consequence of drug and alcohol (D&A) abuse. Although media campaigns can be a popular tool for disseminating health promotion messages, evidence of the extent to which they reduce the impact of substance abuse is limited, especially for rural Aboriginal communities. This paper is the first to examine the impact a locally designed D&A radio advertising campaign for Aboriginal people in a remote community in Western NSW. DESIGN: A post-intervention evaluation. SETTING: The radio campaign was implemented in Bourke, (population 2465, 30% Aboriginal). PARTICIPANTS: Fifty-three community surveys were completed. MAIN OUTCOME MEASURE(S): The self-reported level of awareness of the campaign and the number of self-referrals to local D&A workers in the intervention period. RESULTS: Most respondents (79%) reported they listen to radio on a daily basis, with 75% reporting that they had heard one or more of the advertisements. The advertisement that was remembered best contained the voice of a respected, local person. There was one self-referral to local health services during the intervention timeframe. CONCLUSION: The community-led radio advertising campaign increased community awareness of substance abuse harms, but had limited impact on formal help-seeking. This paper highlights the value of radio as a commonly used, trusted and culturally relevant health promotion medium for rural communities, especially when engaging local respected Aboriginal presenters.

Long distance commuting (LDC) impacts are difficult to generalize due to interactions between neighbouring communities. This paper explored resident perceptions and the nature of social capital in Kalgoorlie-Boulder to mediate LDC impacts. Group interview respondents reported a lack of linking social capital, they did not possess this type of social capital thus could not use it as a mediator between LDC impacts and wellbeing. There was a sense of helplessness based on a perceived inability to influence the scale of LDC (thus the size of the impact). Respondents were empathetic towards the local council (their linking social capital), however, participants perceived the council as powerless to influence the size of the LDC workforce in Kalgoorlie-Boulder. Respondents also identified structural limitations in LDC employment such as 12-h shifts, which impeded any attempt to build (bridging) social capital between residents and the LDC workforce.

Recent reforms to the Australian child-protection sector have widened its scope from solely a statutory child-protection system to a public-health model to increase the number of agencies involved in the provision of services for children who are deemed ‘vulnerable’ or ‘at risk’. Nevertheless, the number of Aboriginal children in the sector continues to increase. This paper argues that the reflective basis of social work practice in Australia contains a lack that evades consideration of the ‘projective identifications’ informing practice. Social workers are more likely to achieve safety outcomes for children when such projections are acknowledged and tendered to in their reflective practice.

Rural and remote community pharmacies service large areas of rural Queensland, and because of the distances involved often do not meet the patients for whom they provide medication. Telepharmacy would improve the quality of pharmaceutical services provided in rural and remote areas, by allowing community pharmacists to have realtime contact with dispensing doctors, aboriginal health workers and patients via a video-phone. We used commercial (analogue) videophones to connect community pharmacists to dispensing doctors, patients in depot pharmacies (i.e. those with no pharmacist) and aboriginal health workers. However, various problems occurred and only 10 video-phone interactions were recorded during the six-month project. In all of the recorded interactions, the video-phone was actually used as a conventional telephone because a video-connection could not be established at the time of the call. (This may have been due to telephone network problems in the rural areas.) Despite these problems, all project participants showed great enthusiasm for the potential benefits of such a service.

Western Australia (WA) has been able to prevent methicillin-resistant Staphylococcus aureus (MRSA) strains from outside of the state from becoming established in its hospitals. Recently, a single-strain outbreak of MRSA occurred in a WA metropolitan teaching hospital following admission of an infected patient from a remote community. The strain responsible for the outbreak was unrelated to any imported strains and spread rapidly in the hospital. Screening of two remote communities in the region from which the index case came revealed that 42% of the people in one community and 24% in the other carried MRSA. Isolates were typed by resistance pattern, plasmid analysis, contour-clamped homogeneous electric field electrophoresis, bacteriophage pattern, and coagulase gene restriction fragment length polymorphism. It was found that of the people carrying MRSA, 39% in the former community and 17% in the latter community were carrying an MRSA strain which was indistinguishable from the strain that caused the hospital outbreak.

Background: The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia’s rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia’s universal health insurance scheme, called Medicare. Findings: Despite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s–1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005–2009. Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia’s rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia’s rural medical workforce. Conclusion: It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.

OBJECTIVE: The aim of this study is to examine management practices that support the wellbeing of health professionals working in remote regions, which may improve workforce retention. METHOD: An online questionnaire was distributed to health professionals working in remote regions of the Kimberley and North Queensland. A response rate of 20% was achieved. RESULTS: The findings suggest that, for health professionals working in remote regions of northern Australia, accessing adequate support is one of the most challenging aspects of working in remote regions. Hence, in remote regions where turnover is high, retention of competent health professionals may benefit from management practices that provide improved personal and professional support. CONCLUSIONS: Health professionals working in remote Australia face unique pressures due to their geographical and professional isolation. Therefore, providing support improves their professional competence and personal wellbeing, and promotes workforce stability, which benefits the remote community through better access to health services.

Timothy O'Rourke reports on a current study investigating Indigenous perceptions and experiences of healthcare design in order to increase the efficacy of cross-cultural design in healthcare architecture.

Omega-3 fatty acids are essential for brain function. We recruited 409 children aged 3-13 years (M=8.27, SD=2.17) for a randomised controlled trial supplementing with placebo or fish oil capsules (providing 750mg docosahexaenoic plus eicosapentaenoic acids, and 60mg gamma linolenic acid/school day) for 20 school weeks (Phase 1) followed by one-way crossover to fish oil (Phase 2). Children undertook assessments of reading, spelling and non-verbal cognitive development (Draw-A-Person) at baseline, 20 and 40 weeks. Teachers completed Conners Behaviour Rating Scales (CBRS). The treatment group showed improvements in Draw-A-Person compared with the placebo during Phase 1 (p=0.029), with strongest effects in Indigenous 7-12 year olds (p=0.008). The placebo group showed significant within-group improvements after switching to treatment (p<0.001). There was no treatment effect for reading or spelling, and CBRS data were unable to be analysed. These findings may be understood in the context that sustained school attendance and nutrition interact to produce school-related achievement.