Remote Australia Online

As the expected age of survival increases, adults with CF will likely stay in the work force longer. Previous studies have reported that, in adults with CF, employment status is related to age and time spent in hospital, lung function and quality of life. While it is known that many (67%) engage in paid employment, to our knowledge there is minimal data available regarding the impact that CF has on work attendance (absenteeism) and performance (presenteeism). At Sir Charles Gairdner Hospital in Perth, we recently evaluated telehealth clinics for adults with CF living in rural and remote Western Australia (WA), and, as part of our study quantified absenteeism and presenteeism.

Objective Investigate the academic performance of medical students in rural and remote discipline rotations by rurality of placement. Design A retrospective cohort study. Setting Rural and remote clinical placement locations in Queensland, Australia. Participants University of Queensland third-year medical students. Main outcome measures In this study, student results for a range of assessments are the main outcome measures with rural area of student placement locations as categorised by the Australian Standard Geographical Classification – Remoteness Areas system the independent variable of interest. Results There was a significant effect of Australian Standard Geographical Classification – Remoteness Areas of placement on the health project, clinical case presentation, clinical participation assessment and overall grade, after controlling for the potential confounding impact of sex, age, students who attended the rural clinical school, cohort year, rotation during the year and type of health service where students were placed. No significant effect of rural placement level was identified for the written examination, poster or journal of achievement assessments. Conclusion Medical students’ academic achievement is associated with many factors, but this study shows that being placed in remote areas is one factor that either does not impede or can positively influence the learning and academic performance of medical students.

Our aim in this paper is to examine the ways in which electronic gaming machines (EGMs) redistribute resources to and from three remote towns in the Northern Territory (NT), namely Katherine, Tennant Creek and Nhulunbuy. We describe EGM expenditure levels in each town at the level of the individual venue, examine patterns of socioeconomic status within each town, explore the ways in which EGM markets are racialised through venue gate-keeping practices and spatially-based alcohol regulations, and examine the effects of resource redistribution mechanisms designed to return a proportion of EGM profits to host communities. The ability of venues to draw resources from extremely disadvantaged groups from the remote periphery is of central concern when attempting to assess the societal consequences of gambling in remote towns, both in terms of individual harm and the adequacy of resource redistribution. Existing mechanisms for resource redistribution are both selective and relatively meagre, pointing to a political and racial economy of EGM gambling that transfers resources from remote towns to sites of centralised ‘white’ power. We conclude that political economy in the context of remote NT towns may not be understood outside a consideration of racial economy and the way that constructed notions of race operate to legitimate existing processes of economic exploitation and resource redistribution.

Knowledge of the history of remote-area nursing in Australia is necessary if we are to truly understand the processes that have dictated the boundaries and reality of the scope of practice for today’s RANs (remote-area nurses). This paper briefly explores and discusses the social context and history of remote-area nursing in Australia and, in particular, Queensland during the 19th century.

Views of history often seem to be inextricably intertwined with assumptions about past and present political systems and the kind of pressure groups they generate. This fact is important when comparing the history of nursing across different time periods. This paper addresses the relevance of the historical comparative method for nurse historians as it applies to remote area nursing in Australia. The method is an under-utilized but legitimate and important methodological approach in health research, particularly when the research involves more than just content analysis of documents from the past. Specifically, when researching the history of nursing in Australia across different time periods, this method has much to contribute to our understanding of health-care practice and policy. Its contribution lies in allowing a student of nursing history to find the lessons from the past, which are many in health care. The historical comparative research method provides the way for comparisons of certain times and events as they relate to the scope of practice of nursing today.

Lower socioeconomic status has been linked to long-term stress, which can manifest in individuals as physiological stress. The aim was to explore the relationship between low socioeconomic status and physiological stress in Aboriginal and Torres Strait Islander Australians.

Development of success metrics can assist entrepreneurs achieve their goals more effectively, demonstrate achievements, attract new investment/partners and build public support. However, metrics of success are based on subjective worldviews. In Australia, indigenous peoples' 'performance' has usually been evaluated from the perspective of the dominant culture, rarely with reference to the views of the indigenous entrepreneurs themselves. This paper seeks first to outline the problematic nature of defining success, exploring the issue and potential options using three case studies of indigenous enterprises in remote Northern Australia that use wild harvested plants and animals commercially. Actors associated with each of these case studies were asked whether they thought they were successful and the reasons behind their self-appraisal. This research opens space to discuss alternative approaches to measuring indigenous enterprise success that acknowledge and respect cultural and contextual difference. Evaluations of the performance of indigenous entrepreneurs must start broad, embrace indigenous worldviews, consider context, be adaptive to changed circumstances and/or aspirations, see non-financial goals as legitimate and important, use shared definitions of success, and provide entrepreneurs and development agents (government, NGOs, corporates, etc.) with the training, tools and resources to evaluate and communicate their own success.

Children in regional, rural and remote areas have less access to services than those living in urban areas. Practitioners serving children with a hearing loss have attempted to address this gap, however there are few studies investigating service access and experiences of non-metropolitan families and professionals. This systematic review evaluates the literature on service provision to children with a hearing loss living in regional, rural and remote areas of Australia. A search of five databases, the gray literature and a prominent author located 37 relevant documents. The journal articles were rated for quality and the findings of all documents were themed. The evidence from this review indicates that children with a hearing loss living in regional, rural and remote Australia experience reduced quality and frequency of service. Further investigation is needed to identify the accessibility and suitability of services for children with a hearing loss in non-metropolitan areas.

Background: Lions Outback Vision has run a state-wide teleophthalmology service since 2011. In September 2015 the Australian federal government introduced a Medicare reimbursement for optometry-facilitated teleophthalmology consultations under specific circumstances. This audit demonstrates the first 12 months experience with this scheme. We aim to provide practical insights for others looking to embed a telemedicine program as part of delivering outreach clinical services. Methods: A 12-month retrospective audit was performed between September 2015 and August 2016, inclusive. A research officer used a specifically designed data extraction tool to record information from all teleophthalmology consultations performed in the time period. The primary outcome was the diagnosis at the end of the teleophthalmology consultation. Secondary outcome measures included the number of teleconsultations, cataract surgery rate, remoteness area of patients referred and imaging accompanying the referral. Results: In the 12-month period, 709 patients were referred resulting in 683 teleophthalmology teleconsultations. Cataract was the most frequent diagnosis (n = 287, 42.7 per cent), followed by glaucoma (n = 77, 11 per cent), age-related macular degeneration (n = 30, 4.4 per cent) and diabetic retinopathy (n = 26, 3.8 per cent). Of those who had teleconsultations, 98.6 per cent were from Outer Regional, Remote or Very Remote Australia. One or more accompanying images or investigations were part of 349 (49 per cent) teleconsultations, most commonly optical coherence tomography (215, 30 per cent) and fundus photography (148, 21 per cent). Face-to-face consultations were undertaken at an outreach clinic in 23 (3.4 per cent) cases, to determine the diagnosis. There were no statistically significant factors associated with attendance at teleophthalmology consultation, or for successfully undergoing cataract surgery. Conclusion: Teleophthalmology is a valuable adjunct to regional outreach ophthalmology services, providing patients with increased access to specialist care for a wide range of ophthalmic conditions, and more efficient access to surgical care.

Objective To review the work-up and inpatient management of non-cystic fibrosis bronchiectasis exacerbations against best practice guidelines in Kimberley, a remote region of Western Australia, with the ultimate goal of improving treatment in the region. Design Retrospective cohort study and audit of remote adult bronchiectasis hospital admissions between 2011 and 2016. Setting Remote hospital inpatients. Participants Thirty-two patients and 110 hospital admissions were included. Patients were ≥15 years old, had computed tomography confirmed bronchiectasis and at least one hospital admission for acute respiratory illness prior to January 2011. Main outcomes measured The 5-year mortality and compliance to a Lung Foundation position statement on non-cystic fibrosis bronchiectasis which suggests investigating for an underlying cause at diagnosis and during exacerbations prolonged antibiotics (10–14 days) and prolonged hospital admissions (≥7 days) are required. Results The overall 5-year mortality was 21.8%, with the median age at death of 37 years (interquartile range, 27–63). The median duration of hospital admission was shorter than the recommended 3 days (interquartile range, 2–5) with 11 of 100 (11%) patients admitted for ≥7 days. The median duration of antibiotics was also shorter than the recommended 7 days (interquartile range, 4–10), with 31 of the 98 (32%) patients prescribed ≥10 days and 6 of the 98 (6%) prescribed ≥14 days of therapy. Conclusion We found under-treatment and under-investigation of non-cystic fibrosis bronchiectasis in the Kimberley region. Five-year mortality was highly consistent with other rural Australian Indigenous cohorts. Following this audit, a strategy to improve awareness, as well as update and promote regional guidelines has been developed.

Resource taxation is a key concern for resource-rich nations. An especially thorny public policy question revolves around how resource taxation translates into benefits for affected communities in which resource extraction occurs. This article considers the international and Australian experience with mineral resource taxes, the types of taxes employed, how they are collected and disbursed, and the extent to which they benefit regional and remote communities. It is argued that direct payments from mining companies to affected communities represent the most efficient form of transfer. However, payments alone will not improve the wellbeing of remote communities, which also require good governance and abundant transparency.

This Horizons report focuses on innovative models intended to reduce family violence on remote communities. It foregrounds the perspective of Aboriginal people who work within the family violence space or have had experience of family violence. The report is based on qualitative research in three sites in Australia: Fitzroy Crossing (Western Australia), Darwin (Northern Territory), and Cherbourg (Queensland). It supports the creation of a network of place-based Indigenous family violence strategies owned and managed by Indigenous people and linked to initiatives around alcohol reduction, inter-generational trauma, social and emotional wellbeing, and alternatives to custody. These initiatives may be constructed differently depending on context, but would ensure that responses to family violence reflect the needs of local women.

Objective Falls in older adults represent a significant challenge in Australia; however, the focus is often on urban-dwelling older adults. The aim of this review was to explore the literature on falls epidemiology and falls prevention interventions (FPI). Design A literature review was conducted searching Medline, Scopus, Social Sciences Citation Index, Google Scholar, Google and the Australian Institute of Health and Welfare publication catalogue. Setting Rural and remote Australia. Participants Rural and remote community dwelling Australians aged 50 years and older. Intervention Literature review. Main outcome measures Falls epidemiology and effective falls prevention interventions. Results Twenty references were identified: 14 related to falls epidemiology and 7 to FPI. No significant differences were found between rural, remote and major cities residents in relation to falls hospitalisation, falls mortality or fall-related injuries sustained. There are a wide assortment of health professionals and non-health professionals who are involved in providing FPI in rural and remote Australia. However, there was limited information on the effectiveness of these interventions in influencing falls outcomes. Conclusion Few studies explored falls and their prevention in rural and remote Australia. The limited literature on the topic suggests that a change in focus to one that utilises existing services and resources will be required to create sustainable outcomes. Four areas are proposed for concentrated effort to reduce the impact of fall-related injury in rural and remote Australia: integration and collaboration among health professionals, promotion of physical activity across the lifespan, community involvement and ownership of interventions, and evaluation and publication of findings.

Background: Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care. Aims: To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice. Methods: Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse. Results: Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending. Conclusion: In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.

Objective To demonstrate the usefulness of a conceptual framework to increase the understanding of rural and remote health by applying it to specific rural and remote health scenarios. Design A conceptual framework was applied to two case studies illustrative of key issues in rural health to reflect different contexts, issues and responses. Results Application of the framework to both case studies highlighted that changes in rural and remote health are diverse. While power was a key element of the framework, the interaction of all framework components underpinned changes. Conclusion The framework facilitated understanding of change in these rural scenarios and demonstrated that improvement in rural health requires change at both the local and structural levels.

Objective To propose a model of mentoring suitable for rural and remote health professionals. Design Given the rural and remote health workforce shortage, mentoring is proposed as a workforce retention strategy. Mentoring literature was reviewed; aspects of mentoring highlighted in the literature were considered to ascertain their suitability for rural and remote health professionals. Method A total of 39 mentoring papers were reviewed to outline key factors in mentoring rural and remote health professionals. Using this literature, key ways that rural and remote practice enhance or are barriers to mentoring were identified. From this, a model for mentoring rural and remote health practitioners, students and academics was developed. Results Four models of mentoring were identified: the cloning, nurturing, friendship and apprenticeship models. The apprenticeship model was identified as suitable for students, the nurturing model as suited to new health professionals to rural and remote settings and the friendship model for senior practitioners/academics. Factors more likely to enable mentoring in rural and remote settings were identified as feelings of obligation by senior practitioners, strong relationships between staff, blurred work/social boundaries, lack of hierarchy, inter-professional practice and technology. The barriers identified included workloads, access to mentors, fee-for-service system for some practitioners, conflicts which could jeopardise working and business relationships, and feelings of being judged. Conclusions A model of mentoring for rural and remote health professionals was presented. Given the potential to strengthen and increase the rural and remote health workforce, trialling such a model is worthwhile and evaluation would identify its impact.

Anthropologists have long attempted to come to grips with Indigenous Australian sorcery beliefs and especially with the idea that acts with no understandable efficacy bring about illness and death. In this ethnographic interpretation of sorcery beliefs in the remote community of Numbulwar, I follow those few who have attempted to find a link between these apparently harmless acts and real physiological consequences, arguing that the fear of sorcery that pervades Numbulwar contributes directly to the stress of daily life and indirectly to the premature morbidity and mortality of too many lives. Belief is posited as the mechanism whereby the human stress response is activated to a harmful extent, a process in which the projection of envious feelings may often be critical.

Background: Poor retention of health workers is a significant problem in rural and remote areas, with negative consequences for both health services and patient care. Objective: This review aimed to synthesise the available evidence regarding the effectiveness of retention strategies for health workers in rural and remote areas, with a focus on those studies relevant to Australia. Design: A systematic review method was adopted. Six program evaluation articles, eight review articles and one grey literature report were identified that met study inclusion/exclusion criteria. Results: While a wide range of retention strategies have been introduced in various settings to reduce unnecessary staff turnover and increase length of stay, few have been rigorously evaluated. Little evidence demonstrating the effectiveness of any specific strategy is currently available, with the possible exception of health worker obligation. Multiple factors influence length of employment, indicating that a flexible, multifaceted response to improving workforce retention is required. Conclusions: This paper proposes a comprehensive rural and remote health workforce retention framework to address factors known to contribute to avoidable turnover. The six components of the framework relate to staffing, infrastructure, remuneration, workplace organisation, professional environment, and social, family and community support. In order to ensure their effectiveness, retention strategies should be rigorously evaluated using appropriate pre- and post-intervention comparisons.

Objective To describe the personality (temperament and character traits) of remote Australian allied health professionals (AHPs). Recent research shows that health professionals can be differentiated by personality traits but little is known about the personality traits of AHPs. Design Cross-sectional (online) survey design with snowball sampling of participants. Setting and Participants Australian AHPs (N = 561; women, n = 502) classified into Remote (n = 266), Not Remote (n = 295). Main outcome measure(s) Demographic variables and the Temperament and Character Inventory (TCI R-140). Results Remote AHPs were higher in novelty seeking (P = 0.037) and self-transcendence (P = 0.042). Remote women were lower in harm avoidance (P = 0.042). Older remote AHPS were lower in reward dependence (P = 0.001); younger remote AHPs were lower in self directedness (P = 0.001) and higher in harm avoidance (P < 0.001). Women were more reward dependent (P < 0.001) and cooperative (P = 0.008) than men. Conclusions The sample demonstrated personality trait levels aligned with research on rural doctors and nurses and which might be advantageous for working in a challenging environment. Exploring the more stable nature of temperament traits coupled with the modifiable potential of character traits provides new insight into people who choose to work as a remote AHP. These findings might contribute to a better understanding of the personality trends in these AHPs which might provide clues to improve recruitment and retention strategies.

Background Embedding research capabilities and workforce development activities with clinical service entities promotes the development of sustainable, innovative, quality-focused oral health care services. Clinical and strategic governance is an important area of consideration for rural and remote dental services, posing particular challenges for smaller service structures. Sustaining remote area dental services has some significant complexities beyond those involved in urban service models. Methods This study describes the sustaining structure of a remote area dental service with a decade of history. Results In the current climate, chief among these challenges may be those associated with dental workforce shortages as these impact most heavily in the public sector, and most particularly, in remote areas. As sustained workforce solutions come from developing a future workforce, an essential element of the workforce governance framework for remote dental service provision should be the inclusion of a student participation programme. Collaborative partnership approaches with Aboriginal health services promote the development and maintenance of effective, culturally sensitive dental services within rural and remote Aboriginal communities. Having sustained care for 10 years, this collaborative model of integrated research, education and service has demonstrated its effectiveness as a service model for Aboriginal communities in Western Australia. Conclusions This descriptive study finds the core values for this success have been communication, clinical leadership, mentorship within effective governance systems all linked to an integrated education and research agenda.

Background In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom live in regional and remote areas. Compared with the general Australian population, rates of pre-existing type 2 diabetes in pregnancy are 10-fold higher and rates of gestational diabetes are 1.5-fold higher among Indigenous women. Current practices in screening for diabetes in pregnancy in remote Australia are not known. Aims To assess current health service delivery for NT women with diabetes in pregnancy (DIP) by surveying healthcare professionals' views and practices in DIP screening and management. Materials and Methods A cross-sectional survey of NT healthcare professionals providing clinical care for women with DIP was conducted based on pre-identified themes of communication, care-coordination, education, orientation and guidelines, logistics and access, and information technology. Results Of the 116 responders to the survey, 78% were primary healthcare professionals, 32% midwives and 25% general practitioners. High staff turnover was evident: of Central Australian professionals, only 33% (urban) and 18% (regional/remote) had been in their current position over 5 years. DIP screening was conducted at first antenatal visit by 66% and at 24–28-week gestation by 81%. Only 50% of respondents agreed that most women at their health service received appropriate care for DIP, and 41% of primary care practitioners were neutral or not confident in their skills to manage DIP. Conclusions It is promising that many healthcare professionals report following new guidelines in conducting early pregnancy screening for DIP in high risk women. Several challenges were identified in healthcare delivery to a high risk population in remote Australia.

Unions, community, work and family influence each other in striking ways in one of Australia's key export sectors, iron ore mining. The nature of these relationships cannot be understood outside of the history and geography that has shaped them, not least the enduring legacy of Australia's founding as a settler society and the uneven nature of the economy today. The Pilbara is the pre-eminent site of the iron ore industry, a site at once remote and integrated, an exemplar of Australia's long-standing dependence on external markets. When export production began 50 years ago, workers, their families and unions developed strong social networks and political agendas in which industrial and social demands overlapped. The Pilbara was a union place. From the 1980s, the conditions which had allowed strong unions and which had underpinned a particular set of family and community relationships around those unions changed. State-sanctioned employer antagonism and the rise of the 'fly-in-fly-out' workforce transformed social relationships. With that set of changes, unionism all but collapsed. Today, increased automation is changing the nature of work, unsettling the gender division of labour and throwing open questions about the geography of mining. There are now 'mining families' and maintenance workers in metropolitan communities and there are workers in urban computer centres controlling operations at the mine sites. Unions are struggling to find a place for themselves not least because of the control that the companies exercise over the very issues examined here - community, work and family.

An estimated twenty per cent of Australia, almost all of which lies in remote regions, is legally owned by Indigenous people (Altman et al. 2007). Over the last few decades, many Indigenous communities have established land and sea management organisations (known as ranger groups) to fulfil cultural responsibilities for ‘looking after country’; to create jobs and manage environmental threats (Blanch 2008). In support of these community-based initiatives, governments, non-government agencies and the private sector have increasingly developed programmes to assist Indigenous Australians living and working on country to maintain conservation and cultural values. However, financial support is often coupled with expectations and demands for increased accountability (a ‘Western’ notion) and incorporation of monitoring programmes that demonstrate outcomes of cultural and natural resource management (NCRM) activities, for example, through the federal government’s Monitoring, Evaluation, Reporting and Improvement framework. The limited implementation of environmental outcome monitoring is not specific to the Indigenous land management sector, but is a broader concern of the conservation sector in Australia and internationally. However, to enable monitoring of work outcomes, baseline data, information about environmental threats and technical capacity to monitor and report are needed.

Objectives: To describe the epidemiology of invasive pneumococcal disease in children under 5 years of age in Far North Queensland and to examine the potential impact of a seven- and 11-valent conjugate pneumococcal vaccine. Methods: A review of all cases of invasive pneumococcal disease in children under 5 years of age in Far North Queensland over a 9 year period (1992–2000). The distribution of the serotypes of isolates causing invasive pneumococcal disease was compared with the serotypes contained in the two vaccines. Results: The annual incidence in indigenous and non-indigenous children under 5 years of age was 163 (95% confidence interval (CI) 122–213) and 42 (95% CI 31–55) cases per 100 000 children, respectively. For children under 2 years of age, these figures were 297 (95% CI 208–411) and 71 (95% CI 49–100), respectively. There was a greater variety of serotypes isolated from indigenous children (n = 17) than from non-indigenous children (n = 9; P < 0.01). The serotypes within the seven-valent vaccine accounted for 62% (95% CI 46–75%) and 88% (95% CI 76–95%) of the isolates from indigenous and non-indigenous children, respectively (P < 0.01). Serotypes within the 11-valent vaccine accounted for 72% (95% CI 57–84%) of the isolates from indigenous children under 5 years of age, but did not account for any extra isolates from non-indigenous children. Conclusion: Although the seven- and 11-valent conjugate pneumococcal vaccines cover only approximately 60 and 70%, respectively, of the isolates that cause invasive disease in indigenous children in Far North Queensland, they nevertheless have the potential to prevent much morbidity in and hospitalization of these children. It will be essential to maintain surveillance following the introduction of conjugate pneumococcal vaccines so as to monitor changes in the incidence of invasive pneumococcal disease, particularly in high-risk children.

Alcohol restrictions have been implemented in many Indigenous communities internationally, with the aim to reduce alcohol-related harm. Whilst a range of reviews have evaluated such restrictions using different measures, drink driving has been described in several reviews as increasing. Presently, this remains anecdotal; with limited empirical evidence to corroborate these reports. In Australia, the Queensland government introduced alcohol management plans in remote Indigenous communities, during 2002-2003, with total alcohol prohibition commencing in 2008 in some communities. Given road crashes are one of the leading causes of injuries for Indigenous peoples, this study aims to identify if the restrictions have been successful in reducing drink driving or have increased such behaviour. We examine this by reviewing changes in conviction rates and in offender and offence characteristics following the 2008 restrictions. Using de-identified Queensland court drink driving conviction data (2006-2011), from four Indigenous communities, Robust Poisson regression models compared counts of drink driving convictions pre (2006-2008) versus post SRS (2009-2011). Changes in offender characteristics and conviction details (blood alcohol concentration (BAC) and sentencing severity), were examined using chi-squares. Results indicate a decline in convictions after the 2008 SRS in three communities. However, a significant increase in convictions was identified in one study community. Community-level disparity included significant decline in BAC in one community (χ2=5.58, p=0.02) compared with the three other communities that did not indicate change and a significant increase the number of women convicted in two ommunities (χ2=17.36, p<0.01; χ2=5.79, p=0.04). Alcohol restrictions may have important implications in road safety with these reductions in convictions and BAC in some communities. However, an increase in the number of women convicted and limited changes in BAC for other communities demonstrate the complex relationship between alcohol use, remoteness and driving. Greater focus on demand reduction strategies may be necessary to address alcohol misuse.