Remote Australia Online

The concept of birthing on country for Aboriginal people means having babies born on traditional lands, and more recently the term is used to indicate the desire of Aboriginal communities to have our babies born in our communities. Being born on country connects an Aboriginal person to the land and community in a deeply cultural way and affords life-long privileges such as hunting and fishing rights, as well as life long responsibilities for looking after country, both land and people. For Aboriginal women, birthing has moved from the personal to the political as governments provide policies about what is ?best? for Aboriginal women and their babies.

Corporate Social Responsibility (CSR) is an evolving concept that reflects various views and approaches regarding corporate relationships with broader society. This study examines the meanings and values attached to CSR within the Australian resource sector where various interests shape the implementation of CSR programs. The study was based on in-depth interviews with industry practitioners, business leaders, environmental and social specialists, government representatives and community leaders, including representatives from Indigenous groups. CSR was found to be a complex, multi-dimensional concept that was highly individualised with a variety of aspects highlighted during interviews. To make sense of this complexity, meanings of CSR were mapped according to Carroll’s four dimensions, namely Corporate, Legal, Ethical, and Philanthropic. However, a further CSR dimension was also required to capture the full spectrum of meanings. Referred to as ‘CSR interaction’, this dimension focuses on CSR meanings that align with the concept of CSR creating social change and improving the dynamics between companies and local communities and stakeholders. This study also identified some key social processes or drivers which helped explain how and why CSR meanings and approaches are adopted and delivered. These drivers also increased understanding of the wide diversity of CSR meanings and their distribution across the different stakeholder groups. Drivers included not only individual-level influences such as background, life experience, cultural and ethical values, but also broader influences such as organisational and institutional context. The implications of this for CSR practice were explored. The study sought to provide guidance for developing a working definition of CSR within the given context, through identifying the key integral requirements for CSR incorporating different perspectives and interests. The intent is that this can help support evaluation of the future success of CSR programs within the Australian resource sector.

As celebrations marking the 90th year of operations of the Royal Flying Doctor Service (RFDS) wind down, it is pertinent that we continue to look to the future, to ensure that our services remain competitive and efficient, optimally targeted and designed to meet the needs of a changing population in rural and remote Australia. This paper seeks to inform strategic planning and service design for the RFDS by answering the question: In 10 years’ time, as we mark our centenary, what services should the RFDS be providing? This is answered by analysing projected population, health status and health workforce trends in rural and remote Australia to identify key service gaps and inform recommendations for future RFDS service priorities. The findings of this paper also have a broader purpose and serve as an offering to the policy conversation on health service planning for rural and remote parts of Australia. The objective of this report is to determine the health service needs of Australians living in rural and remote regions in 2028, based on projected population, health status, demand and provision of healthcare services. Furthermore, this report aims to predict the future adequacy of the rural and remote health workforce and service provision as compared to metropolitan areas. As such, this report identifies the best areas for investment in future healthcare services by governments, service providers, communities and the RFDS.

Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation.

Access to microfinance alone cannot enable poverty alleviation and empowerment for Indigenous clients living in remote Australia. Providers must look beyond access and incorporate user-centred financial capability and resilience-building supports into their service provision. This paper discusses lessons from the field, citing practical examples drawn from two research projects, which describe culturally informed ways in which adopting this approach can empower Indigenous clients and communities to enhance their own financial resilience and wellbeing.

Background: Harms from cannabis use among Indigenous populations in Australia, New Zealand, Canada and the United States may be magnified by poorer health and heavy use. However, little direct evidence is available to evaluate cannabis’ impacts. In communities in remote northern Queensland (Australia) where cannabis has become endemic, opportunities to support change were investigated. Methods: Participants (aged 15-49 years) were asked about their cannabis use history in interviews in two waves of population sampling in Cape York (Queensland). Wave 1 included 429 people (235 males and 194 females); and wave 2 included 402 people (228 males and 174 females). Current users (used cannabis during the year before interview) described frequency of use, amount consumed, expenditure and dependence symptoms. Other substance use was recorded for 402 people at wave 2. Results: Wave 1: 69% reported lifetime use and 44% current use. Males (55%) were more likely than females (30%) to be current users (P<0.001). Most (96%) current users described at least weekly use; nearly half (48%) were ‘heavy’ users (≥6 cones/session at least once/week) and 77% met cannabis dependence criteria. Overall, three communities spent up to $AUD14,200/week on cannabis, around $AUD2.0 million/year, or around 9% of community people’s total income on cannabis. The majority (79%) of current users wanted to quit or reduce their cannabis use. Wave 2: no difference was observed in the proportion of lifetime (69%, |z|=0.04, P=0.968) or current cannabis users (39%, |z|=1.39, P=0.164); nor current use among males (71%, |z|=0.91, P=0.363) or females (62%, |z|=0.36, P=0.719). However, a significant reduction in current users by 15% (|z|=2.36, P=0.018) was observed in one community. Of 105 wave 1 current users reinterviewed or assessed by proxy at wave 2, 29 (27%) had ceased use. These participants reported cost and family commitments as reasons to change and that social support and employment enabled abstinence. Current and lifetime cannabis use were closely associated with all other substance use, particularly tobacco and alcohol (both P>0.001). Conclusions: High rates of heavy cannabis use in remote Australian Indigenous communities warrant further action. Successful cessation in a number of individuals suggests that significant opportunities are available

Background Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. Methods In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16–29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory-based sexually transmissible infection testing for 12 months followed by 12 months of intervention with molecular point-of-care testing, or the reverse sequence. The primary outcome was the proportion of people (aged 16–29 years) found to have C trachomatis or N gonorrhoeae who had a positive result at retesting 3 weeks to 3 months after treatment, and a secondary outcome was treatment within 7 days, both in those aged 16–29 years and at the cluster level. We did these analyses using data from all participants who had a positive result at testing, by point-of-care of laboratory testing (ie, the intention-to-treat population). The trial is registered with Australian and New Zealand Clinical Trials Registry (ACTRN12613000808741). Findings Between June 1, 2013, and Feb 29, 2016, 12 health services were enrolled and randomly assigned to standard care followed by intervention (six) and the reverse sequence (six). After randomisation, one health service that was initially assigned to standard care was excluded because it no longer met the inclusion criteria. 455 individuals tested positive for C trachomatis or N gonorrhoeae infection in the intervention group, and 405 tested positive in the standard care group. In the intervention group, 12 (19%) of 63 individuals retested had a positive test result, compared with nine (13%) of 67 with positive retests in the standard care group (relative ratio [RR] 1·42, 95% CI 0·64–3·13; p=0·405), and 347 (76%) were treated within 7 days in the intervention group, compared with 191 (47%) in the standard care group (RR 1·66, 1·41–1·93; p<0·0001). Interpretation Retesting rates were too low to draw conclusions on the effect of the intervention on repeat infections. Further research will be needed to determine whether point-of-care tests have an effect on reinfection rates, and the sustainability of using this technology. However, our findings show that time to treatment of C trachomatis or N gonorrhoeae infections in primary care clinics in remote areas in Australia with a high prevalence of sexually transmissible infections could be substantially reduced by the use of molecular point-of-care tests. Funding The National Health and Medical Research Council, Australia

Project: Explore what it means to create classroom dialogue in a context where the teacher and students begin with little shared understanding of the topic, or of the academic purposes implicit in the curriculum goals. Material for the enquiry was drawn from a series of four Mathematics lessons about telling the time, which took place in a remote Aboriginal school. Authors Matt Lotherington is a teacher and curriculum coordinator in the school, while Helen Harper and Bronwyn Parkin are researchers. All three were interested in studying teacherled classroom talk, and how this talk could be used to support students to appropriate new language and concepts. Setting The context for this study is a school in the town of Maningrida, in the Northern Territory. At least 11 Aboriginal languages are spoken in this town. The school has an enrolment of about 700 students from Preschool to Year 12, and almost all (95%) are Aboriginal. School attendance fluctuates greatly, averaging around half (50%), particularly during the dry season when many people in the town move back to traditional country. The official language of instruction is English, although many children have minimal English knowledge when they first come to school. Literacy and numeracy levels as measured by the National Assessment Program Literacy and Numeracy (NAPLAN) are low. For example, in 2016, 94% of Maningrida Year 7 students scored in the lowest Band 4 for Reading, compared with 3% nationally (ACARA, 2016). For the past five years, the school has implemented a scaffolded approach to English instruction through the Accelerated Literacy (AL) program (Cowey, 2007; Gray, 2007). The AL approach is a source of Matt's experience in scaffolding pedagogy. Matt's class, at the time of this study, comprised 12 students across Years 5 and 6. All were Aboriginal, and all spoke English as an additional language or dialect. A high-attending class, they averaged strong (91%) attendance. However, their generally low levels of literacy and mathematics created some challenges for building age-appropriate content.

AIM: To identify factors that affect rheumatic fever prophylaxis for remote-living Aboriginal patients, and to determine the proportion who received adequate prophylaxis. DESIGN AND SETTING: Interview (with analysis based on principles of grounded theory) of patients with a history of rheumatic fever or rheumatic heart disease and their relatives, and health service providers in a remote Aboriginal community; audit of benzathine penicillin coverage of patients with rheumatic heart disease. PARTICIPANTS: 15 patients with rheumatic heart disease or a history of rheumatic fever, 18 relatives and 18 health care workers. RESULTS: Patients felt that the role of the clinic was not only to care for them physically, but that staff should also show nurturing holistic care to generate trust and treatment compliance. Differing expectations between patients and health care providers relating to the responsibility for care of patients absent from the community was a significant factor in patients missing injections. Neither a biomedical understanding of the disease nor a sense of taking responsibility for one's own health were clearly related to treatment uptake. Patients did not generally refuse injections, and 59% received adequate prophylaxis (> 75% of prescribed injections). CONCLUSION: In this Aboriginal community, concepts of being cared for and nurtured, and belonging to a health service were important determinants of compliance.

There is increased awareness of the need to balance multiple societal values in land use and development planning. Best practice has promoted the use of landscape-level conservation planning and application of the ‘mitigation hierarchy’, which focuses on avoiding, minimizing or compensating for impacts of development projects. However, environmental impact assessments (EIA) typically focus in a reactive way on single project footprints with an emphasis on environmental values and specifically biodiversity. This separation may miss opportunities to jointly plan for and manage impacts to both environmental and social values. Integrated approaches may have particular benefit in northern Australia, where Indigenous people have native title to as much as 60% of the land area and cultural values are closely linked with natural values. Here, we present a novel framework for integrating biodiversity and cultural values to facilitate use in EIA processes, using the Nyikina Mangala Native Title Determination Area in the Kimberley, Western Australia, as a case study. We demonstrate 1) how social and cultural values can be organized and analyzed spatially to support mitigation planning, 2) how social, cultural, and biodiversity values may reinforce each other to deliver better conservation outcomes and minimize conflict, and 3) how this information, in the hands of Indigenous communities, provides capacity to proactively assess development proposals and negotiate mitigation measures to conserve social, cultural, and biodiversity values following the mitigation hierarchy. Based on values defined through a Healthy Country Planning process, we developed spatial datasets to represent cultural/heritage sites, freshwater features, common native animals and plants represented by biophysical habitat types, and legally-protected threatened and migratory species represented by potential habitat models. Both cultural/heritage sites and threatened species habitat show a strong thematic and spatial link with freshwater features, particularly the Fitzroy River wetlands. We outline some of the challenges and opportunities of this process and its implications for the Northern Australia development agenda.

Nurses are key providers of health care in remote Indigenous communities throughout Australia. Evidence of nurses? actual practice and the outcomes of their care for clients in this context, however, is lacking. This exploratory research describes how nursing is practised in a remote Aboriginal community and reveals many anomalies. The overall theme, termed amorphous practice, defines the changeable character of practice from nurse to nurse and from situation to situation. The themes underlying amorphous practice are termed detachment, diffusion, and beyond the nursing domain. Each theme is described by way of its characteristics, the strategies nurses use to deal with the situation, and the consequences. The significance of these findings raise concerns for the accountability of nursing and most of all for the rights of Indigenous people in remote areas to basic standards of safe health care.

Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.

This paper explores the case of an Aboriginal woman from Central Australia who has in recent years experienced a radical shift in her life circumstances. It pursues a writerly approach that makes the variety of forces and relationships legible that she now navigates, including that of the anthropologist-friend. ‘Journeying with’ is proposed as an ethnographic method as well as an ethical stance well attuned to the turbulent circumstances of the present—in the Warlpiri life sketched here, and globally. Destabilization and displacement are increasingly common features of contemporary experience, and this paper proposes that ethnography anchored at the level of the individual person is well placed to engage unsettling transformations in the world at large, in social relationships, and modes of personhood, as well as in anthropological production.

Objective This article describes the rationale for, and development of, an evidence-based rural typology as the basis for an incentive scheme to improve medical workforce retention. This case study describes the key factors associated with ensuring that research evidence is translated into rural health policy and program implementation. Design Case study. Setting Rural and remote Australia. Results The development and implementation of the Modified Monash Model in Australia demonstrates some of the key facilitators of knowledge exchange. These include: sound evidence based on good empirical data and rigorous methodology; transparency to peers and stakeholders; the importance of long-term commitment to rural health research; the credibility of the researcher; multiple modes of communication of results; real world validation and amplification of results; patience and persistence underscored by the commitment of researchers to achieving more equitable outcomes for rural and remote doctors; serendipity in terms of timing; and a governmental culture that values evidence-based outcomes. Conclusion The knowledge exchange process is neither easy nor simple and rarely rapid. It often requires the engagement of communities, professional associations, health care providers, researchers, policy-makers and funders. Implementation of evidence into rural health policies and programs benefits all parties through significant improvements in efficiency, effectiveness and equity.

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient?practitioner relationships.

Background: Regional and remote areas are often disadvantaged in terms of access to palliative care services. The impact of reduced access to services on people living in regional or remote areas of Australia is poorly understood.Objective: Identify and examine current literature relating to the palliative care experiences of adults living in regional and remote areas of Australia.Methods: CINAHL, Medline, PubMed, Cochrane Review Library and grey literature were searched using a combination of keywords. A thematic analysis was applied.Results: Thirteen articles were included in the final review. Poor access, relocation and hardship were identified as issues affecting participants.Conclusion: Limited literature was available addressing the palliative care experiences of adults living in regional and remote areas of Australia. To identify and address any inequities in palliative care provision and access, the experiences of palliative care patients living outside major cities need to be examined.

Culture can be viewed as an integral part of Aboriginal and Torres Strait Islander health and wellbeing. This study explores the association between caring for country, through participation in a Ranger program, and wellbeing. We analyzed cross-sectional data collected in Central Australia in 2017, comparing health and wellbeing (life satisfaction, general health, psychological wellbeing and family wellbeing) among Aboriginal and Torres Strait Islander peoples employed as Rangers (n = 43) versus not employed as Rangers (n = 160). We tested if any differences in outcomes were explained by differences in key demographic or health factors. Ranger participation was significantly associated with very high life satisfaction (PR = 1.69, 95% CI: 1.29, 2.20) and high family wellbeing (PR = 1.47, 95% CI: 1.13, 1.90); associations remained significant after individual adjustment for education, income, employment, health risk factors and health conditions. The magnitude and direction of associations were similar for very good general health, but results were not significant. We did not identify an association between Ranger participation and psychological wellbeing. While based on a small sample, these findings support the assertion that participation in the Ranger program is associated with positive health and wellbeing outcomes. This supports the continuation of cultural participation and practice through the Ranger program and has implications for funding, program and policy development.

Importance Epidemiological data on visually significant ocular trauma in the Top End of the Northern Territory. Background Our main objective is to determine whether Indigenous patients are disproportionately affected by visually significant ocular trauma as compared to non-Indigenous patients. Design This was a retrospective audit at the Royal Darwin Hospital (RDH) in the Top End of the Northern Territory during January 2013 – June 2015. Participants 104 ocular trauma patients were included. 43 were Indigenous and 61 were non-Indigenous Methods Medical records of patients with ocular trauma between Jan 2013 – June 2015 (except simple, non-penetrating corneal foreign bodies and abrasions) were reviewed. Vision loss was defined by visual acuity: mild ≥6/18, moderate 6/18- 6/60, severe ≤6/60 following WHO standards. Main outcome measures Included the incidence of ocular trauma patients by ethnicity (Indigenous vs non-Indigenous). Our secondary outcome included vision loss, mechanism of injury, open vs closed injury, age, remoteness, and alcohol involvement Results 104 patient charts reviewed. 43 (41%) were Indigenous and 61 (59% were non-Indigenous). Alleged assault was the greatest contributor to ocular trauma in both groups (74% in Indigenous vs 39% non- Indigenous). Severe vision loss was more prevalent in the Indigenous vs non-Indigenous patients (30% vs 16%). Conclusion and Relevance Indigenous patients were disproportionately affected by visually significant ocular trauma compared to non-Indigenous patients. This research provides important data on ocular trauma in the Northern Territory. Further prevention strategies are needed to reduce vision loss in this population.

Earthquake Environmental Effects (EEEs) identified in the source region of the 20th May 2016 intraplate moment magnitude (Mw) 6.1 Petermann earthquake in Central Australia are described and classified using the Environmental Seismic Intensity (ESI-07) scale. EEEs include surface rupture, ground fissures and cracks, vegetation damage, rockfalls, and displaced (jumped) bedrock fragments. The maximum ESI intensity derived from EEEs is X, consistent with previous observations from some moderate Mw crustal earthquakes. Maximum ESI isoseismals correlate with the location of the surface rupture rather than epicentre area due to the dipping geometry of the reverse source fault. ESI isoseismals encompass a larger area of the hanging-wall than the footwall, indicating stronger ground motions on the hanging-wall due to increased proximity to the rupture source and ground motion amplification effects. The maximum areal extent of secondary (seismic shaking-induced) EEEs (300 km2) is significantly smaller than expected using the published ESI-07 scale (approx. 5000 km2). This relates to the low topographic relief and relatively homogeneous bedrock geology of the study region, which (i) reduced the potential for site response amplification of strong ground motions, and (ii) reduced the susceptibility of the landscape to EEE such as landsliding and liquefaction. Erosional degradation of the observed EEE features and decreasing confidence with which they can be uniquely attributed to a seismic origin with increasing time since the earthquake highlight challenges in using many of the natural features observed herein to characterise the locations and attributes of paleo-earthquakes.

Background: The postpartum period is a critical time to improve health outcomes for Aboriginal women, particularly for those who have chronic conditions. Aims: To assess enhanced support methods (for women following diabetes in pregnancy (DIP)) to improve completion rates of recommended postpartum health checks. Materials and Methods: Fifty-three Aboriginal women in the Northern Territory (NT) were contacted in the postpartum period to encourage medical check-ups. Messages were delivered through phone (call or text messages) or other methods (Facebook or email). The primary outcome was postpartum blood glucose testing (oral glucose tolerance testing (OGTT), random or fasting glucose and HbA1c). Results: Establishing contact with women was difficult. Of 137 messages sent to 52 women, 22 responded (42%). Phone was the most common contact method with successful contact made from 16 of 119 (13%) attempts. Rates of postpartum OGTT completion were higher in the group successfully contacted (32% vs 7%). However, for any postpartum glucose testing (including OGTT and HbA1c) rates were 25 of 42 (60%) and neither success in making contact nor the contact method was associated with higher rates. Conclusions: The small sample size limits our conclusions; however, results highlight that engaging remote women postpartum is difficult. While rates of postpartum OGTT completion differed according to successful contacts, rates of any postpartum blood glucose testing did not. Further research is needed to explore feasible intervention methods to improve postpartum screening after a pregnancy complicated by diabetes.

Drawing on campaigns waged and administrative burdens managed by the Gundjeihmi Aboriginal Corporation (GAC) in Kakadu National Park to manage the effects of existing uranium mining and further proposed mining, this article draws attention to some of the techniques and coalitions that GAC has created to manage its would-be managers. It uses the case of monitoring the operations and particularly the rehabilitation of the Ranger Uranium mine and of halting the opening of a second mine, known as Jabiluka, to consider the less conspicuous paperwork battles that take place amid and in the aftermath of these public battles. In considering these contests, we argue that the double valency of holding to account needs to be considered, to avoid dichotomising Indigenous people as either co-opted by or opposed to administration, a bifurcation which fails to recognize the complexity and inevitability of contemporary Indigenous management regimes. This is neither a celebration of Indigenous counter-administration, nor a false positing of Aboriginal alternatives to institutionalized worlds. Concluding, we note that when the organizational toil of drawing the locus of power in decision-making towards Aboriginal interests is made apparent, the notion that there is an alternative to institutionalized forces of settler colonialism, represented by Indigenous resistance, is complicated. We mark this organizational work as evidencing the unrelenting nature of administrative violence under active colonization.

Background: The permeatal cartilage ‘push through’ tympanoplasty is a safe and effective technique that has previously been shown to be beneficial in a variety of settings. This study examines its efficacy in a population with high proportions of Indigenous Australians who live in remote areas and have a high burden of chronic suppurative middle ear pathology. Methods: Multi-centre prospective case series. Two hundred and forty-one patients underwent transcanal “push-through” myringoplasty in the Northern Territory of Australia between January 01, 2012 and January 01, 2014. Graft integrity, air-bone gap closure and pure-tone average (PTA) thresholds were recorded at 1–5 months post operatively and after 12 months. Results: At 1–5 months, 87.2% of patients had successful grafts and intact tympanic membranes. Beyond 12 months, 84.4% of patients continued to have intact grafts and tympanic membranes. Less than 20% of patients had a residual hearing loss of more than 30 dB after the surgery. The air-bone gap was significantly lower after surgery (P<0.001). Conclusions: ‘Push Through’ myringoplasty has a favourable success rate when compared to conventional methods employed in the Aboriginal population (30–64%) and provides the patient with a safe ear and improved hearing.

This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10 years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers – half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.

Objective To report that prevalence rates of osteoporosis and osteopenia differ according to different levels of remoteness in Queensland, Australia. Design Retrospective analysis of bone mineral density scans undertaken between April 2015 and April 2016. Setting Mobile laboratory housing a dual energy X-ray absorptiometry in rural and remote Queensland. Participants Four-thousand-four-hundred-and-twenty-seven referred individuals 70 years of age or older. Main outcome measures Bone mineral density (g cm−2) at two sites was used to measure the level of bone health as per the World Health Organization criteria for osteoporosis. Results A slightly higher percentage of women was screened and the percentage screened in both men and women decreased as levels of remoteness increased. Women in outer regional areas had significantly higher odds of having osteopenia over normal bone mineral density, compared to women in an urban setting. Conclusion As the level of remoteness increased, there was a decrease in the percentage of men and women being screened to determine their risk of osteoporosis. Furthermore, the current data suggest that women in more remote areas have significantly lower bone density, compared to an urban female population. Finally, men and women have similar levels of osteopenia across Queensland, Australia.

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health -36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.