Remote Australia Online

BACKGROUND: People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners. OBJECTIVE: To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations. METHODS: We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants. RESULTS: A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns. CONCLUSIONS: CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities.

International evidence suggests that a key to improving health and attaining more equitable health outcomes for disadvantaged populations is a health system with a strong primary care sector. Longstanding problems with health workforce supply and turnover in remote Aboriginal communities in the Northern Territory (NT), Australia, jeopardise primary care delivery and the effort to overcome the substantial gaps in health outcomes for this population. This research describes temporal changes in workforce supply in government-operated clinics in remote NT communities through a period in which there has been a substantial increase in health funding.

In Australia, pancreatitis has been associated with gallstones in approximately 35% of cases and alcohol in approximately 25% of cases. The present study was performed to analyse the aetiology of pancreatitis in patients admitted to a remote Australian hospital that has a population base comprising both indigenous and non-indigenous people. A retrospective study was conducted of all cases of pancreatitis admitted to the Alice Springs Hospital from August 1993 to August 1999. One hundred and two patient records were examined, and 77% of these patients were Aboriginal. Alcohol was the most common aetiological factor (64%), with gallstone disease being the next most common. Aboriginal patients with pancreatitis were younger than non-Aboriginal patients ( P = 0.0304) and were also more likely to have alcohol as their cause of pancreatitis (P = 0.035), especially if they were male. In males, alcohol was implicated in at least 70% of cases. In females, the causes were gallstone disease (41%) and alcohol (49%). Patients with gallstone disease were significantly older than patients with other causes of pancreatitis (P = 0.000). There was an overall 30% increase in admission rate per year, which was primarily due to an increase in the number of Aboriginal admissions (36% per year) (P = 0.000). The present study highlights a difference in the aetiology of pancreatitis in Aboriginal and non-Aboriginal people from a remote Australian population.

Remote rural districts of Australia can continue to expect a loss of public services due to the low population density and migration loss. However allied health services such as physiotherapy, are cost-effective services that are in demand in remote Australia. This paper was derived from a report to the Rural Health Policy Unit of Queensland Health that granted funds for a mobile allied health team to visit the remote western shires of the Peninsula and Torres Strait health region. By presenting an outline of an unusual group of parochial occupational injuries it can be shown that there is indeed both a considerable demand for allied health services and these services can be provided to remote communities by a mobile remote outreach service for a reasonable cost.

Indigenous Australians suffer a disproportionate burden of kidney disease. Better understanding regarding how the disease and its treatments impact on indigenous patients, their families, and communities is important to provide effective services for this population. To investigate this issue, a large qualitative interview study was undertaken as part of the IMPAKT (IMProving Access to Kidney Transplants) research program. Indigenous (146) and non-indigenous (95) patients from nine hospital renal units and 17 associated dialysis satellite centers were interviewed. The study revealed that indigenous patients? experience of dialysis is strongly mediated by the social and situational circumstances of this population?specifically living in regional and remote communities, relative youth, late referral to nephrology care, language differences between patients and health providers, and low literacy. The dialysis regimen required dislocation of patients from their support networks, a situation exacerbated by pervasive miscommunication with healthcare providers, and a commonly reported sense of isolation and alienation. The implications of these findings for service delivery models are discussed.

For centuries, the residents of Blue Mud Bay, the Djalkiripuyngu, have encountered seafarers landing on their shores, and contacts with these visitors have varied in their regularity, intensity and amity. Currently, the most frequent non-indigenous seafarers are the professional crab and barramundi fishermen who extract resources from the local estuaries. The crab fishermen are recent migrants from Southeast Asia and some sign royalty contracts for access to Aboriginal land to transport their crabs, whilst the wealthy and politically powerful Anglo-Australian barramundi fishermen operate from large boats, do not need land access, and reject formal agreements. Djalkiripuyngu engagements with these respective visitors are shaped by Australian laws and by the different histories, ethnicities, access to power and depths of attachment to places between the various parties. The Djalkiripuyngu have consistently asserted ownership over the coastal seas adjacent to their lands and, in an important recent decision, have had one aspect of that ownership legally endorsed. Yet struggles for control over local seas demonstrate more than principles of indigenous and wider Australian law. They also reflect the wider history of Northern Australia, the pitfalls and possibilities of encounters between indigenous Australians and recent migrants, and an array of contemporary Australian identities.

Objective To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014. Design This is a retrospective analysis of publicly available datasets. Setting National Health and Medical Research Council Rural and Remote Health Research 2000–2014. Outcome measures ‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014. Results Of the 16 651 National Health and Medical Research Council-funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented. Conclusion Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.

This article gives a detailed example of how action research theory can inform an innovative approach to education and training through its use as a curriculum design device within the both-ways philosophy of Indigenous education. This work was undertaken through a VET training program at the Batchelor Institute of Indigenous Tertiary Education in the Northern Territory (NT) of Australia. The specific target group was Indigenous people currently working in early childhood services in remote Indigenous communities in the NT where few hold the necessary qualifications. The curriculum development methodology described in this article embeds an iterative and reflexive approach to learning that is intended to support the empowerment and self-determination of the Indigenous early childhood workers while delivering a nationally recognized ‘mainstream’ qualification.

The Royal Australian College of General Practitioners’ (RACGP) 1998 Rural Quality Assurance and Continuing Education (QA & CE) Needs Assessment Project was designed to generate sufficient data to inform strategic planning for rural and remote GPs participating in the College’s QA & CE Program. Results indicated that the demand for QA & CE activities has changed over the past 12 years. Three distinct streams of continuing education emerged, where once only one was researched. This reflected a move towards continuing professional development (CPD) rather than purely continuing medical education (CME). However, differences between the CME needs identified suggested that national data could not be reduced to the local level. Data on CME in which rural and remote GPs felt underserviced, proved more useful in relation to other workforce variables such as age, length of service and gender. A broad ‘rural set’ of CPD topics was established, and the survey yielded information on learning format preferences that will be of use to providers of QA & CE activities for rural GPs across Australia.

Objective: Rural and remote health research has highlighted the many problems experienced in the bush. While attention to problems has raised awareness of the needs of rural and remote health, embedding a deficit perspective in research has stereotyped rural and remote health as poor environments to work in and as inherently problematic. The objectives of this paper are to challenge this thinking and suggest that a more balanced approach, acknowledging strengths, is beneficial. Design: This discussion identifies why the deficit approach is problematic, proposes a strengths-based approach and identifies some key strengths of rural and remote health. Results: This study suggests alternative ways of thinking about rural and remote practice, including the rewards of rural and remote practice, that rural and remote communities can act as change agents, that these disciplines actively address the social determinants of health, that rural and remote areas have many innovative primary health care services and activities and that rural and remote contexts provide opportunities for evaluation and research. It is proposed that rural and remote health can be viewed as problem-solving, thus dynamic and improving rather than as inherently problematic. Conclusion: Critical of a deficit approach to rural and remote health, this paper provides alternatives ways of thinking about these disciplines and recommends a problem-solving perspective of rural and remote health.

INTRODUCTION: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success. METHODS: A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically. RESULTS: Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment. CONCLUSIONS: Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.

The paper presents a comparative study of mobile technology adoption and use by two communities - one Aboriginal and the other non-Aboriginal - both located in a remote region of Australia, the Bloomfield River Valley of Cape York. Both communities have high levels of ownership of mobile phones relative to, on the one hand, the low uptake of other leT such as fixed-line phones by the Aboriginal community at Wujal Wujal and, on the other hand, the poor mobile coverage in the non-Aboriginal community at Bloomfield. For both groups communication is of paramount importance, followed by listening to music. In addition, the Aboriginal community make extensive use of other multimedia and Internet features of their devices. Key factors in the motivation to acquire mobile phones, in comparison to other ICT, are the superior cost management that mobiles offer for Aboriginal people and the convenience of being able to communicate while away from home for Bloomfield residents. The authors conclude that mobile technology needs to be taken seriously, even in areas of limited coverage such as the Bloomfield River Valley.

Aim: Aboriginal people living in remote communities experience high levels of chronic illness partly as a result of diet-related body mass index above 25 kg/m2. Remote stores are typically the only source of food and store nutrition policies are effective in enabling better health for community residents by changing product lines. The aim of the present study was to examine trends in purchasing patterns of sugar-sweetened water-based beverages in a remote Aboriginal community store following the implementation of a community-developed store nutrition policy. Methods: Documents outlining the objectives and strategies of the store policy were examined. Store sales data were quantified to determine changes in purchasing patterns, volume of beverages sold, sugar and energy purchased before and after the withdrawal of the three highest selling sugar-sweetened water-based beverages. Results: The community-developed policy was effective in implementing changes to product lines sold in the remote Aboriginal store. The withdrawal of the three top selling sugar-sweetened water-based beverages did not affect the total volume of all beverages sold but a shift in purchasing trends towards beverages with lower or zero sugar content resulted in a reduction in sugar and kilojoules consumed through water-based beverages. Conclusion: The approach of a community-driven store nutrition policy described here was successful and could be applied to other products in store that provide excess kilojoules with minimal nutritional benefit. The policy and aspects of implementation could also be applied in other remote Aboriginal communities.

Peritoneal dialysis is usually considered a first-choice treatment for end-stage renal disease for patients living in remote areas. The advantages of peritoneal dialysis over haemodialysis are that peritoneal dialysis preserves the residual renal function for longer, provides patients with more independence and gives patients a greater opportunity to return home quickly. In Australia, Aboriginal people suffer end-stage renal failure at disproportionately higher rates than the general population. Given that many Aboriginal people live in remote communities a task of peritoneal dialysis units is to ensure the successful setting up and maintenance of peritoneal dialysis programmes in the outback. This paper examines how peritoneal dialysis units located in the city are able to deliver peritoneal dialysis to patients located often hundreds of kilometres and at times thousands of kilometres away in very remote communities. In preparing this paper interviews were conducted with renal and remote community-based health professionals in Western Australia and the Northern Territory, and with peritoneal dialysis patients in Western Australia. The success of remote peritoneal dialysis programmes relies on many elements, most importantly an integrated approach to care by all members of the peritoneal dialysis team. The peritoneal dialysis team included not just health professionals but also patients, their families, their communities and other support people such as those involved in the transport of peritoneal dialysis supplies to the outback. Careful communication, a willingness to participate, friendliness and delivering care and supplies with a smile are essential ingredients to a winning program. Without all of these ingredients dialysis in the bush may fail.

Objective:To establish a baseline of levels of Indigenous professional engagement in the health and community services sector in remote Northern Territory. Design:Analysis of data from 2001 and 2006 Census. Setting:Northern Territory – Balance Statistical Division. Participants:Persons employed in health and community services sector in 2006. Main outcome measures:Indigenous status, level of education, current education status, occupation type and residential mobility. Results:Indigenous employment grew by 137% between 2001 and 2006. In 2006, 42% of Indigenous employees were labourers and 9% professionals, in contrast to non-Indigenous workers of whom 41% were professionals and 5% labourers. Over 50% of workers who moved into the region between 2001 and 2006 were professionals, compared with 20% of those who had remained in the region. Indigenous in-migrants were twice as likely as Indigenous people who had stayed in the region to be professionals. Indigenous workers were much less likely to have post-school educational qualifications than non-Indigenous workers. Indigenous workers were also less likely to be studying for a post-school qualification. Indigenous in-migrants were three times as likely to have post-school qualifications than Indigenous people who had remained in the region and were also more likely to be enrolled in post-school education. Conclusions:The baseline is low Indigenous engagement as professional labour, and low Indigenous engagement in formal education. Mobile Indigenous people have higher levels of engagement. The situation might be addressed by increased formal education in remote areas and increased mobility of Indigenous health labour.

• Consensus recommendations for managing bronchiectasis in Indigenous children and adults living in rural and remote regions were developed during a multidisciplinary workshop and were based on available systematic reviews. • Successful diagnosis, management and prevention of bronchiectasis in Indigenous Australians requires access to comprehensive health care services, as well as improved housing, education and employment and reduced poverty levels. • Diagnosis of bronchiectasis requires a chest high-resolution computed tomography scan. Children who have bronchiectasis symptoms but non-diagnostic scans are described as having chronic suppurative lung disease (CSLD), rather than bronchiectasis. Untreated CSLD may progress to bronchiectasis. • Chronic wet cough (> 4 weeks) or recurrent wet cough (> 2 episodes/year) are important but often under-reported symptoms. Bronchiectasis is suspected when chronic cough is excessively prolonged (> 12 weeks) or if a chest radiographic abnormality persists despite appropriate therapy. • Intensive treatment aims to improve symptom control and quality of life while preserving lung function and reducing acute exacerbation frequency. • Antibiotics should be prescribed for acute infective episodes according to culture results of respiratory secretions, local susceptibility patterns and clinical severity. Patients not responding promptly to oral antibiotics should be hospitalised for more intensive treatment. • Ongoing care requires regular primary health care and specialist review, including monitoring for complications and comorbidities. Corticosteroids, bronchodilators and mucoactive agents may be used in individual cases, but routine use is not recommended. Physiotherapy and exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and immunisations maintained.

Aboriginal residency of Australia began over 50,000 years ago. This landscape has sustained many Aboriginal communities, whilst witnessing major geological and climate transformations. Aboriginal custodians have navigated a vast spectrum of new and changing food sources to sustain themselves through their integration of custodial responsibilities with traditional ecological knowledge (TEK). Contemporary Australia is intrigued by Aboriginal bush foods, although this is only part of the larger body of Indigenous knowledge that concerns the protocols and foraging patterns that have sustained Aboriginal populations, while accommodating large food harvesting and sharing at celebratory events. This chapter surveys the unique Aboriginal food-security paradigm by providing an overview of Aboriginal ethno-botany, TEK, and foraging protocols. It examines food-sharing events and describes key food types that were harvested. The chapter offers an alternate ethno-ecological insight as to how this generational Indigenous knowledge could be applied today in Australian landscape architecture, planning, and landscape management practice.

Objective: The present paper aims to provide an overview of the Medical Specialist Outreach Assistance Programme (MSOAP) and its implementation in South Australia with particular reference to the expansion of visiting psychiatric services to rural and remote areas. Included is a discussion of a number of the practical issues and challenges experienced by the author in the development of a visiting psychiatric service to the remote community of Coober Pedy in northern South Australia. Conclusions: There has been much success to date with the expansion of visiting psychiatric services to rural and remote areas within South Australia under MSOAP. MSOAP appears to have considerable merit, particularly for psychiatrists working in private practice. There are several practical issues to be considered in taking on this type of work. The professional rewards are substantial.

The aim of this paper is to demonstrate the utility of Goal Attainment Scaling (GAS) as an effective, multidisciplinary measure of client outcomes for rural and remote health services. Goal Attainment Scaling was adopted by the Spinal Outreach Team (SPOT) as a client-focussed evaluation tool, as it is sensitive to the individual nature of clients' presenting issues and the multidisciplinary focus of the team. It enables individualised goals to be set on a five-point scale. Goal Attainment Scaling was introduced to the SPOT service after a pilot trial established guidelines for its effective implementation. An ongoing review process ensures that goal scaling remains realistic and relevant. Service outcomes can be effectively summarised using a frequency distribution of GAS scores. One of the important benefits of GAS is its facilitation of collaborative goal setting between clinician and client. Goal Attainment Scaling is recommended to rural and remote multidisciplinary health services because of its ability to summarise outcomes from heterogeneous service activities.

Many children in the remote Fitzroy Valley region of Western Australia have prenatal alcohol exposure (PAE). Individuals with PAE can have neurodevelopmental impairments and be diagnosed with one of several types of Fetal Alcohol Spectrum Disorder (FASD). Fine motor skills can be impaired by PAE, but no studies have developed a comprehensive profile of fine motor skills in a population-based cohort of children with FASD. We aimed to develop a comprehensive profile of fine motor skills in a cohort of Western Australian children; determine whether these differed in children with PAE or FASD; and establish the prevalence of impairment.

Sexually transmitted infections (STIs) pose a significant health problem for many Aboriginal and Torres Strait Islander populations across Australia. A fundamental aspect of an STI control strategy is the availability and quality of clinical sexual health services. This paper looks at the sexual health services delivered to screen diagnosed cases of chlamydia, gonorrhoea and syphilis, and to their contacts, in primary health care centres in remote areas of Far North Queensland. It describes the prevalence of sexual health symptoms, aspects of partner notification and the level of infection diagnosed in contacts. Ninety two per cent of women and 96% of men with chlamydia and/or gonorrhoea denied any symptoms at screening. One hundred and sixty one clients named 206 contacts, giving a contact tracing ratio of 1.28. Twenty per cent of female and 18% of male index cases named no contacts. The number of contacts an index case named in this setting was similar across gender and age groups, but there were significant differences in the numbers of contacts named according to health care provider. Of the 88 contacts of chlamydia and/or gonorrhoea patients for whom there is follow up information, 32 of 47 (68%) female contacts and 23 of 41 (56%) male contacts returned a positive diagnosis. For 48% of the female and 32% of the male infected contacts, the final diagnosis was either for both infections or for the infection for which they were not named as a contact. The implications of these findings for treatment guidelines in this setting are identified.

Objective: This paper describes the implementation and selected outcomes of the Young Person Check (YPC), a high-coverage screening program in far north Queensland targeting remote youth aged 15–24 years for sexually transmissible infections (STI) and chronic disease risk. The YPC was conducted 19 times in eight discrete remote communities and one community cluster between 2009 and 2012. Methods: Narrative description of consultation processes, YPC planning, recruitment strategies, logistics, screen design, additional costs and data management; analysis of coverage by location, age group and gender, selected STI management outcomes, and clinic-based STI testing separate from YPCs. Results: A total of 3,686 episodes of care were delivered, including 3,083 to Indigenous youth aged 15–24 years. Overall coverage of the 15–24 population was 73% for females and 72% for males. Median time to treatment for chlamydia/gonorrhoea cases was 13 days and 63% of cases had at least one contact treated. Clinic-based STI testing did not decrease. Conclusions: Positive outcomes of the YPC program, including satisfactory participation, rest on a rigorous approach to planning, recruitment and implementation; provision for STI follow-up; and data management. Implications: Testing and treatment strategies form an important element of efforts to address endemic STI and reduce HIV risk in remote Australian populations. Complementary population testing strategies will continue to be utilised and may contribute, if coverage is satisfactory. Programs such as the YPC should be considered in settings where the conditions outlined here can be met.

Objective: The aim of this report is to discuss a needs analysis conducted with rural and remote nurses in Queensland undertaking supply of medications in public hospitals without a pharmacist. Design: Survey questionnaire. Methods: A questionnaire was faxed to 65 Queensland Health rural and remote hospitals using supply nurses. It contained six closed questions regarding previously identified medication ‘supply’ issues, and three open questions to determine additional information. Results: Of the surveys, 42 (65%) were returned. Major areas of interest included a safety checklist for medication supply (90%, 38/42), more information on medication labelling requirements (83%, 35/42) and timing of medications with regard to food (86%, 36/42). Requirements for patient counselling, increased access to consumer medication information (CMI) (76%, 32/42), and resources regarding doses, indications, interactions and adverse effects also rated highly (73%, 31/42). Thirty-three supply nurses highlighted at least one issue in the open questions: more information on the legal requirements of repackaging medications (39%, 13/42), increased access to CMI and counselling tools (36%, 12/42) and an efficient stock control system (30%, 10/42). Conclusions: This report highlights the need to broaden current support services available to nurses undertaking the supply of medications. It is vital that support programs, and the laws and guidelines related to supplying medications in rural and remote hospitals, support health care professionals providing quality use of medicines (QUM) and reflect the realities of rural and remote health care.

The dingo (Canis dingo or C. familiaris, including hybrids with feral dogs) is the apex carnivore on mainland Australia. Fifteen non-native ungulate species have established wild populations in Australia. Dingoes are managed to reduce impacts on domestic ungulates, and introduced wild ungulates are managed to reduce impacts on natural ecosystems and to minimise competition with domestic ungulates. There is speculation about the extent to which (1) dingoes limit the abundances of introduced wild ungulates, and (2) introduced wild ungulates sustain dingo populations. We reviewed the literature to identify potential ecological interactions between dingoes and introduced wild ungulates, and to synthesise evidence for interactions between dingoes and each ungulate species (including the percentage frequency occurrence (%FO) of ungulates in dingo diets). Eleven of the 15 ungulate species were recorded in the diet of dingoes, with the highest %FO occurrences reported for feral goats (73%) and cattle (60%). Two studies concluded that dingoes reduced ungulate abundances (feral goat (Capra hircus) and feral donkey (Equus asinus)), and two studies concluded that dingoes did not regulate feral pig (Sus scrofa) abundances. A fifth study concluded that dingoes exhibited a Type III functional response to increasing sambar deer (Cervus unicolor) abundances. A sixth study concluded that dingoes made relatively little use of hunter-shot sambar deer carcasses. We propose that interactions between dingoes and introduced wild ungulates depend on the sex–age classes vulnerable to dingo predation, dingo pack sizes, the availability of escape terrain for ungulates and the availability of alternative foods for dingoes. The interplay between environmental conditions and the population growth rate of ungulates, and hence their ability to sustain losses from predation, could also be important. We predict that dingoes will have most impact on the abundance of smaller ungulate species and neonates.

This paper draws on a consultation with 200 stakeholders about a mental health plan in the most remote region of South Australia to discuss primary mental healthcare improvement strategies. In rural and remote environments, a lack of services means that it is more difficult to deal with a mental illness or provide assistance for circumstantial life problems. The authors’ consultations revealed difficulties with service access, acceptability and teamwork. They also found that the availability of local human service workers leads to their use as first-level mental health contacts, but these workers are neither skilled nor supported for this. These difficulties will require attention to the boundaries between different service providers which can otherwise create inflexibility and service gaps. The regional mental health plan that is being rolled out will develop collaboration through regional interagency task groups, networking groups for local human service workers and the position of a regional mental health coordinator in order to overcome these difficulties and to operationalise service partnerships.