Remote Australia Online

SummaryMuch of northern Australia’s tropical savannas are subject to annual intense and extensive late dry season wildfires, much of this occurring on Aboriginal land. Based on the successful West Arnhem Land Fire Abatement (WALFA) model, which has resulted in significantly reduced greenhouse gas emissions, fire abatement programmes are planned for other significant regions of northern Australia. This study offers an introduction to the ideas behind a proposed environmental and social benchmarking project that aims to evaluate the potential benefits of expanding the fire abatement program in northern Australia, under the leadership of NAILSMA and its partners. Gaining a better understanding of the biodiversity, social and cultural outcomes of these fire abatement activities is an important component of demonstrating multiple benefits of these programmes. We emphasize the role of both biodiversity and cultural mapping to establish benchmarks and baseline states, with the involvement of Indigenous communities being a key element to optimize social and biodiversity benefits. Consultation with Traditional Owners and ranger groups to establish an agreed set of targets, indicators and sampling protocols and methodologies are critical component of this process. Examples of preliminary work to date are provided.

Introduction Outcomes are reviewed with traumatic brain injury (TBI) involving intracranial haematomata (ICH) with patients in rural and remote areas of South Australia and adjacent states. Patients were referred to the Royal Adelaide Hospital (RAH), a level 1 trauma centre with a major neurosurgical service. Method From 2000 to 2013, 1107 multiple trauma cases included 162 with severe TBI. Local medical officers (LMOs) phoned a specific number to access resuscitative and neurosurgical advice. Onsite neurosurgical support was provided when requested. Specialist teams later retrieved these patients to RAH. Locations were coded according to the Accessibility/Remoteness Index of Australia (ARIA+). Injuries were coded using ICD 9 and 10. Results General surgeon LMOs drained nine clinically progressive ICHs. Neurosurgical attendance was provided in four instances. Eight patients survived. The remaining 153 patients had other injuries involving thoraco-abdominal organs, spine, pelvis and limbs. The overall mortality was 30%. Twenty-six had ICHs requiring surgical drainage later at the RAH, with 46% mortality. Average Injury Severity Score was 30 (range 9–66). Male/female ratio was 76/24. Motor vehicular accidents predominated (60%), followed by falls (26%) and assaults (10%). Those under 30 years were overrepresented. Patients were transported a mean distance of 283 km (maximum distance 2600 km). Conclusion LMOs in remote locations may consider immediate drainage of deteriorating traumatic ICH. Adequate support from a distant major trauma centre can help achieve acceptable outcomes. Effective communications are vital. The Royal Australasian College of Surgeons and Neurosurgical Society of Australasia guidelines based on the Early Management of Severe Trauma protocols can assist LMOs in making the decision to undertake emergency craniotomy.

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia.

Summary This chapter explores the adaptive capacity of Indigenous households using the case study area of the town camps of Alice Springs in central Australia. Jurisdictionally, Alice Springs is in the Northern Territory where, over the last 50 years, the frequency of extremely warm days and nights has increased and the average annual maximum temperature has increased by 0.12 °C per decade and the minimum temperature by 0.17 °C per decade. The town camps of Alice Springs comprise 18 communities of Aboriginal people located around this principal town in central Australia. Using social practices for comfort as a way of understanding how households adapt to changing climate and other dynamic factors around housing provision, a range of adaptive practices and vulnerabilities to climate change are revealed.

Public consultations had revealed that access to education was a significant concern in rural and remote areas of Australia, particularly in relation to ongoing economic decline. In response, the Australian Human Rights and Equal Opportunity Commission initiated the National Inquiry into Rural and Remote Education. The inquiry took evidence at formal public hearings in the capital cities of every state and territory and at less formal meetings with parents, students, educators, and community members in rural and remote areas of every state and the Northern Territory. The inquiry received 300 written and e-mailed submissions, including one from the government or education department in every state, the Northern Territory, and the Commonwealth. The inquiry also commissioned a survey from the Youth Research Centre at Melbourne University to which 3,128 individuals responded. This report describes the context of the inquiry (Ch2), the evaluation framework (Ch3), the policy framework (Ch4), the availability of school education (Ch5), the accessibility of school education (Ch6), the affordability of school education (Ch7), the acceptability of school education (Ch8) and the adaptability of school education (Ch9). Recommendations are given in each of chapters 3 to 9.

The Community Development Employment Projects (CDEP) scheme is an example of an Indigenous-specific program that combines community development and labour market program elements. This paper describes the nature of CDEP employment in 2008 and the extent to which it changed between 1994 and 2008. The paper also compares a selection of economic and social outcomes of CDEP participants with those of persons who were employed outside of CDEP, unemployed and not-in-the-labour-force (NILF) in 2008 and the extent to which these associations changed between 1994 and 2008. This paper also aims to assess the extent to which CDEP participation is consistent with the community development objectives of the scheme. The analysis shows that the nature of the jobs in which CDEP participants work and the experiences it provides to workers have changed little despite substantial changes in underlying policy settings. CDEP participation is associated with the maintenance of language and culture as well as facilitating an ongoing connection to traditional lands. Participation in the scheme is associated with better social and economic outcomes compared to those of the unemployed or those NILF, but much worse outcomes than those for people working in non-CDEP employment.

Objectives: Dental issues are more prevalent for Aboriginal Australians, especially those living in rural/remote locations, but distribution of clinicians is favoured towards metropolitan areas and are not always culturally competent. This study aimed to document the experiences of dental clinicians who relocated to rural/remote communities to provide dental services to Aboriginal communities in an effort to redress these gaps. Setting: Clinicians working in a new rural/remote dental service strategy to Aboriginal communities in Northern NSW. Design: Qualitative semi-structured face-to-face interviews and reflective diaries were analysed qualitatively. Participants: Relocating dental clinicians and their support team. Results: Three major themes emerged: Theme one: Mastering the clinical environment through professional experiences: Increasing professional capabilities, clinical environment, valuing team work and gaining community respect. Theme two: Development and growth of the individual through personal and social experiences: culture shock, developing cultural competence, social impact, economic cost and personal adjustments and growth. Theme three: An overarching sense of achievement and advice to new clinicians. Conclusion: Relocation to rural and remote communities to provide health services is a complex but rewarding process. Providing personal and professional support, to relocating clinicians resulted in an overall positive experience for the participants, where they increased their professional skills and developed personally. Living and working in the community increased their cultural competence. Barriers were overcome through effective communication, flexibility and teamwork. Funding for rural placements, such as these, is critical for rural and remote health services and should include long-term appropriate funding for mentoring and support.

The aim of this study was to explore rural and remote stroke survivors’ perspectives on their recovery journey, giving consideration to the diverse NWQ population. This study formed the first phase of a larger PhD project investigating the use of technology to enable stroke survivors to actively participate in their recovery in rural and remote areas. A qualitative study using semi-structured in-depth interviews was undertaken. Data was collected and analysed thematically using constructivist grounded theory principles. Adult stroke survivors living, working and travelling through NWQ were purposefully recruited.

My colleagues and I wish to convey the findings of a research project recently conducted in Far North Queensland (FNQ), Australia. Alcohol-related violence in FNQ Indigenous communities has been an issue for some time. This has prompted the Queensland Government in consultation with affected Indigenous communities to introduce the Making Choices, Meeting Challenges (MCMC) initiative. Specifically, the MCMC initiative introduced alcohol-management policies (AMPs) within these communities imposing certain restrictions on the sale, quantity and type of alcohol permitted in each community. AMPs and similar strategies have proven successful in other Indigenous communities, both nationally and internationally when struggling with alcohol-related violence. The AMPs came into effect in 2002 with a staggered implementation across affected communities. Penetrating and lacerating chest trauma (PLCT) secondary to interpersonal violence is a serious act and it is postulated that it could be used as a proxy-measure for underlying social unrest within a community. Since the introduction of AMPs, anecdotal observation by medical staff at Cairns Base Hospital (CBH) was that PLCTs secondary to interpersonal violence had noticeably decreased. It was hypothesised that with the introduction of AMPs had brought about a decrease in the level of violence within affected Indigenous communities. CBH is ideally suited to capture trends in PLCT by being the tertiary referral centre for FNQ, encompassing the affected communities and with serious chest traumas requiring retrieval. To support this hypothesis, a retrospective chart review, with appropriate human research ethics committee approval and Indigenous adviser input (special thanks to Dallas McKeown-Young for her ongoing assistance) commenced in 2008. This review examined all PLCTs referred to CBH from 2001 to 2006 and mortalities from the National Coroner's Information Service. Cases were identified by use of the ICD-10: Australian Modification codes, S21 to S29: Injuries of the Thorax. During this time 127 cases were identified with temporal trend patterns subjected to regression using Generalized Linear Models with significance set at p<0.05. The initial PLCT incidence rate for the FNQ region was 12.9/100,000 in 2001, falling to 6.9/100,000 in 2006, a statistically significant reduction (p=0.007). Examination of the MCMC communities revealed a very high 2001 PLCT incidence rate of 119.5/100,000, however, by 2006 this rate had fallen considerably to 18.7/100,000. Although these are small communities in absolute size, the reduction observed was statistically significant (p<0.0001). Our research demonstrated an almost two-fold decrease in the incidence of PLCT in FNQ from 2001 to 2006, thus confirming original anecdotal evidence. Further analysis of Indigenous communities with AMPs, to which much of the region's PLCT was attributed, showed a greater than six-fold reduction. This was a gradual but consistent decline over the six-year period, and would appear to correlate historically with the staggered introduction of AMPs in 2002. One limitation influencing these results, however, is the relatively small population of the communities reviewed, meaning that a small change in case numbers greatly influences incidence rates (Table 1). The trends, nevertheless, remained significant on statistical testing. The timeframe of the study was also relatively short, due to the paucity of electronic records and data indexing prior to 2001. The six-year census period nonetheless captured the formal implementation phase of the policy in question with the study design being basically correlational.

This paper reports on the preliminary findings of a qualitative project which aims to investigate ways to enable Aboriginal people with disabilities, their families and carers from the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara (NPY) lands in remote Central Australia to live the life that they choose. The study was informed by Indigenous research methodologies, and involved in-depth, semi-structured interviews with Anangu with disabilities and their families and service providers and other stakeholders. The data were collected in regional, remote and very remote regions. Interviews were by conducted by Aboriginal and non-Aboriginal staff in partnership with NPY Women’s council. This research has identified the perspectives of both Aboriginal people with disabilities and their families and service providers on the key barriers and facilitators to providing supports to enable Aboriginal people with disabilities and their families to live the life they choose.

Arts Nexus Inc. has a clear mission across all of Far North Queensland: growing creative people, communities and industries. Community Arts and Cultural Development (CACD) that builds capacity, values cultural diversity and fosters resilience, is essential in creating liveable communities. CACD is explained very well by the Australia Council: “Community arts and cultural development is distinct from other arts practice as it is the creative processes and relationships developed with community to make the art that defines it, not the art form or genre. What is at the core of this practice, however, is the collaboration between professional artists and communities to create art.” Today I would like to share with you some of the many examples of the work being done in the Far North Queensland region through the efforts of many members and partners of Arts Nexus, from community arts and cultural development (CACD) practitioners themselves to the many arts and community groups. Encompassing Cape York and the Torres Straits, our region has grown to have some of the most diverse cultures and lifestyles in the nation. These great examples demonstrate how arts and culture are the essential elements to ensure community wellbeing and resilience. “Arts with a health focus” has a real impact on the various social determinants that affect our ability to be resilience to challenges and change. Community Cultural development projects begin with your inner circle, starting from where you are, regardless of skills and resources. If success can be measured by personal growth and potential, then these are most inspiring and personally rewarding for everyone involved.

Background and objective: To evaluate the impact of a chronic lung disease management training programme, Breathe Easy Walk Easy (BEWE), for rural and remote health-care practitioners. Methods: Quasi-experimental, before and after repeated measures design. Health-care practitioners (n=33) from various professional backgrounds who attended the BEWE training workshop were eligible to participate. Breathe Easy Walk Easy, an interactive educational programme, consisted of a training workshop, access to online resources, provision of community awareness-raising materials and ongoing telephone/email support. Participant confidence, knowledge and attitudes were assessed via anonymous questionnaire before, immediately after and at 3 and 12 months following the BEWE workshop. At 12 months, local provision of pulmonary rehabilitation services and patient outcome data (6-min walk test results before and after pulmonary rehabilitation) were also recorded. Results: Measured knowledge (score out of 19) improved significantly after the workshop (mean difference 7.6 correct answers, 95% confidence interval: 5.8–9.3). Participants' self-rated confidence and knowledge also increased. At 12-month follow up, three locally run pulmonary rehabilitation programmes had been established. For completing patients, there was a significant increase in 6-min walk distance following rehabilitation of 48m (95% confidence interval: 18–70m). Conclusions: The BEWE programme increased rural and remote health-care practitioner knowledge and confidence in delivering management for people living with chronic lung disease and facilitated the establishment of effective pulmonary rehabilitation programmes in regional and remote Australian settings where access to such programmes is limited.

In December 2015, the WA Country Health Service (WACHS) began a one year pilot project across three of its regions to implement Patient Opinion, as an accessible, anonymous, and independently moderated online avenue for country consumers to share their health care stories: good and bad. Because of its public and "social" nature, the Patient Opinion platform also provided WACHS with the opportunity to enter into more personalised and open dialogue with consumers and publicly demonstrate how it listens to and acts on the experiences, insights and perspectives shared by consumers in this way. Using examples of stories shared by WACHS consumers on Patient Opinion, examples of WACHS responses to those stories, and project data, this presentation will explore the success of Patient Opinion as a tool for country consumers to share their health care experiences, and for our health service to listen, learn and improve from the experiences of our vastly dispersed consumer populations. The presentation will demonstrate the important role of our network of 21 District Health Advisory Councils (DHACS) - volunteer consumer representative/advocacy groups - in establishing and promoting the project. The DHACs have been strong advocates for the use of social media and other online technologies and innovations to engage with country consumers. If a health service is not engaged online, but its consumers are, it loses the ability to remain responsive to its consumers’ experiences in a timely way. It is important to have multiple avenues for consumers to have a voice and be heard within our organisation. The project has highlighted the role that patient stories can play in the evaluation of health services as well as engaging staff to understand the need for consumer-centred care. The human voice of the story can be a powerful motivator for service and culture change and can draw attention to what matters most to people about the care they receive. While our traditional, formal, and periodic feedback and evaluation methods such as annual patient surveys and complaints forms/systems are useful, they may not address the aspects of care that are most important to the consumer. Based on the success of the pilot project to date, the remaining five WACHS regions will join the project in early 2017.

Despite the emergence of decolonizing methods for the conduct of research involving Indigenous peoples since the 1990s, the field of Australian Indigenous studies remains characterized by the "spatial distance" that exists between professional academic researchers and the Aboriginal peoples and Torres Strait Islanders over whom they claim knowledge, understanding, and "expertise". This paper, written primarily as an opinion piece, describes what transpired when I decided to seek a deeper engagement with the Aboriginal community that is the focus of my research activity. Moving from southeastern Australia to the regional center of Alice Springs in the Northern Territory, this paper documents my efforts to close the spatial distance between researcher and researched through a series of vignettes. As the material outlined in the vignettes suggests, efforts to address the spatial distance proved only partially effective. Yet what emerged from this attempt was an ongoing engagement with inland remote Australia and a greatly enhanced understanding of the complex race relations between the Anangu (Aboriginal) peoples of the region and the non-Aboriginal population, as well as of the legacy of colonialism and the lingering impact the past continues to exert on the present.

In 2016 the death of remote area nurse (RAN) Gayle Woodford triggered widespread concern about the safety and security of nurses and midwives working in remote communities across Australia. In response to these events the Northern Territory (NT) Department of Health initiated a review into safety policies and practice across NT Health services. This paper will discuss the process followed and the recommendations of this important review. In April 2016 a project management team and steering group was established within the Department of Health (DoH) to oversight and direct the review process. External consultants were engaged to work collaboratively with the project team to conduct interviews with NT Health service staff employed in all 53 remote Primary Health Care (PHC) services across the NT. The external consultants provided an ‘arms’ length independence to the project. In addition the internal project team reviewed documentation including Work Health and Safety policies, callout practices, orientation/induction and equipment safety and quality checks. The review built on previous research and findings in the literature and considered contributors to staff safety such as cultural awareness and preparation for clinical practice in the remote environment with particular consideration of orientation and induction procedures in the context of high levels of staff turnover. Other major considerations in regard to staff security relate to clinical governance and policy development, safety equipment available and infrastructure issues. The presentation will also include progress to the time of the conference in the implementation of the review recommendations.

While a digital divide remains evident in many remote Indigenous Australian communities, individual and collective information and communication technologies practices have developed in accordance with broadband, satellite or WiFi availability. This article examines the ways in which Indigenous youth in remote Australia are ‘coming of age’ in contexts where digitally-mediated social interaction is a taken-for-granted aspect of social practice, communication and learning. While there are many positive aspects to this rapid development, it can also lead to intergenerational tensions as young people explore new patterns of behaviour, and older people come to terms with new cultural challenges. Drawing on long-term ethnographic observations in Central Australia, the impact of technology and the shift in perceptions, communication modes, and social and cultural practice across the generations in the Western Desert region are traced.

Objective: To study the demographic, rates and types of chronic respiratory conditions in Indigenous and non-Indigenous patients in regional and remote communities of Northern Territory Top End, who were referred to the specialist respiratory outreach service. Design: A retrospective, observational study over a 2 years period. Setting: Remote community health clinics within the Northern Territory Top End visited by the specialist respiratory outreach team. Participants: Only patients referred to respiratory specialist outreach team were included. There were 444 participants, with 210 males and 234 females. In total, 79.3% were Indigenous. Main outcome measures: The rates of chronic respiratory disease diagnoses and smoking status within the different communities and health district regions. Results: Chronic obstructive pulmonary disease (COPD) was the most common primary respiratory condition in our cohort of patients (50.5%) followed by sleep apnoea in (14.2%), bronchiectasis in (11.6%), asthma (11%), interstitial lung disease (2.5%), nodule/cancer (1.8%) sarcoidosis (0.2%) and others (9.2%). COPD, smoking status and bronchiectasis was more frequently noted among the Indigenous patients compared to non-Indigenous patients (56.3% versus 28.3%, P < 0.001), (52.6% versus 25.0%, P < 0.001), and (12.5% versus 3.3%, P = 0.01) respectively. Obstructive sleep apnoea was more commonly diagnosed in non-Indigenous patients. Conclusion: Indigenous patients of the remote and rural communities of the Top End have significantly higher rates of smoking and COPD compared to non-Indigenous patients. Bronchiectasis is also more common among Indigenous patients. Further efforts are warranted to develop strategies to address the disparity and optimise the respiratory outreach service to this population.

Objective: To describe the nursing workforce in very remote Australia, characteristics and key issues. Methods: Data were collected from four main sources: the refined CRANAplus database of remote health facilities; the 2006 census which provided population and percentage of Indigenous people in communities in very remote Australia; a national survey on occupational stress among nurses and an earlier study into violence and remote area nurses conducted in 1995. A descriptive analysis of the data was conducted. Setting: Health facilities in very remote Australia. Results: The registered nursing workforce in very remote Australia is mostly female (89%) and ageing, with 40.2% 50 years or over, compared to 33% nationally. Many (43%) are in remote Indigenous communities. Over the last decade, there has been a significant decrease in registered nurses with midwifery qualifications (55%) and in child health nurses (39%) in very remote Australia. Only 5% have postgraduate qualifications in remote health practice. Conclusion: The nursing workforce in very remote areas of Australia is in trouble. The workforce is ageing, the numbers of nurses per population has fallen and the numbers of midwives and child health nurses have dropped significantly over the last 15 years. As many of these nurses work in Indigenous communities, if these trends continue it is likely to have a negative effect on ‘closing the gap’ in Indigenous health outcomes.

Summary Climate change adaptation is influenced by local histories, social structures and cultural norms, economic factors and political relations, which includes how people construct their relationships with the environment and with other people. This chapter proposes that the effectiveness of adaptive responses is underpinned by cultural values, and that culture can enable, constrain or limit adaptation. This chapter discusses the role that traditional ecological knowledge (TEK) plays in shaping Indigenous individuals' and communities' understandings of and responses to climatic and ecological changes in the East Kimberley region of North West Australia. It provides a brief overview of the geographical and social contexts of this case study, and then provides an overview of some of the environmental knowledge of Miriwoong seasonal calendar. The chapter also discusses how TEK includes both detailed knowledge of environmental conditions and natural resource management practices.

Objective: To explore the role art centres in remote communities play for Aboriginal and Torres Strait Islander Australians living with dementia. Methods: A comprehensive literature search was undertaken, with no restrictions on articles regarding year of publication. Results: Art programmes have been found to be of benefit to both people living with dementia and their carers, particularly when programmes are administered in environments that are culturally revered. Findings indicate remote art centres play a key role in maintaining traditions, culture and practices unique to Aboriginal and Torres Strait Islanders, but there is a gap in knowledge regarding how they cater for the needs of people with dementia. Conclusion: Addressing this gap will be helpful in remote areas where prevalence of dementia is up to five times that of non-Aboriginal people, and there are limited health and support services. Further research is required to explore strengths and gaps of current practices.

This demographic study of the Northern Territory’s German born population identifies factors that have contributed to their attraction and retention as long-term residents. Policymakers are concerned with growing the Territory’s population by attracting more long-term residents, especially skilled workers and females. German born migrants are significant in this context as they have been present in the Northern Territory(NT) since the 1800s, there have been many more females than males arriving in recent years, and the German born NT workforce, especially the women, is highly skilled and educated. This study profiles German born residents using ABS Census data and presents results from a recent online survey. Germans were found to represent a diverse migrant group that had moved to the NT for a variety of personal and work-related reasons, seeking work and lifestyle opportunities, a sunnier climate, counter-urban lifestyles and adventure in this peripheral, northern region of Australia. Germans were found to be ‘sticky’ as a result of overall satisfaction with life and work in the NT.

Objective: To describe the epidemiology of invasive pneumococcal disease (IPD) in the Kimberley and examine whether cases could have been prevented by vaccination. Design: Prospective case series of IPD cases from 1 January 1995 to 31 December 2001. Setting: The Kimberley region of far north-western Australia. Subjects: Seventy IPD cases in 37 men and 33 women aged 5 months to 90 years. Aboriginal people comprised 90% (63/70) of cases. Main outcome measures: Demographic, clinical and microbiological characteristics of IPD cases. Proportion of cases caused by vaccine-preventable serotypes. IPD incidence in the Kimberley. Results: Pneumonia and bacteraemia were the commonest clinical presentations. Of IPD cases, 15% (children) and 67% (adults) had a risk factor for IPD. The case fatality rate was 13%. Of cases, 46% (95% confidence interval (CI) 35–58%) were caused by serotypes covered by an age-appropriate vaccine. Of the 26 cases eligible for pneumococcal vaccination, only 4 (16%) had been appropriately vaccinated. IPD incidence in Aboriginal people aged 15 years and over declined from 97.8/100 000 person years (95% CI 56.5–139.1) in 1997 to 38.1/100 000 person years (95% CI 22.5–53.9) in 2001. Conclusions: The significant proportion of cases caused by vaccine-preventable serotypes and that was, therefore, preventable underscores the importance of pneumococcal vaccination. What this paper adds: What is already known? IPD is a major cause of morbidity and mortality worldwide, and especially in Indigenous Australian populations; however, there is little published information about the epidemiology of this illness in the Kimberley region of Western Australia, which has a large Indigenous population. What does this study add? Many Kimberley IPD cases are caused by vaccine-preventable serotypes and are, therefore, potentially preventable. Following the introduction of an adult pnuemococcal vaccination program in 1996, IPD incidence in Kimberley Aboriginal adults fell significantly.

The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccination program conducted in 1991–1993 could show whether the program was effective; and (ii) to describe the epidemiology of invasive pneumococcal disease using laboratory surveillance data. As part of quality assurance, we undertook a retrospective cohort study to compare the hospitalisation and mortality rates of a pneumococcal-vaccine-vaccinated and an unvaccinated group and a correlational study to compare the before- and after-vaccination hospitalisation rates for the vaccinated and unvaccinated groups. We used laboratory data to describe the epidemiology of invasive pneumococcal disease. The cohort study consisted of 815 subjects (306 vaccinated, 509 comparison). No significant differences were observed in the admission rates for pneumonia and lower respiratory tract infection between the two groups. By using a correlational study, we examined before- and after-vaccination hospitalisation rates and this also failed to reveal any differences, except for persons aged 50 years and older. Laboratory surveillance of invasive disease demonstrated that children younger than 6 years and adults younger than 50 years with alcohol-related problems accounted for most of the cases. Despite the study's limitations, it supports the use of pneumococcal vaccine in persons aged older than 50 years, while at the same time highlighting the ongoing need for better vaccines, especially for children and those aged younger than 50 years with medical conditions predisposing to pneumococcal disease.

Objective: To document rates of serious injuries in relation to government alcohol restrictions in remote Australian Indigenous communities. Design and setting: An ecological study using Royal Flying Doctor Service injury retrieval data, before and after changes in legal access to alcohol in four remote Australian Indigenous communities, Queensland, 1 January 1996 – 31 July 2010. Main outcome measures: Changes in rates of aeromedical retrievals for serious injury, and proportion of retrievals for serious injury, before and after alcohol restrictions. Results: After alcohol restrictions were introduced in 2002–2003, retrieval rates for serious injury dropped initially, and then increased in the 2 years before further restrictions in 2008 (average increase, 2.34 per 1000 per year). This trend reversed in the 2 years after the 2008 restrictions (average decrease, 7.97 per 1000 per year). There was a statistically significant decreasing time trend in serious-injury retrieval rates in each of the four communities for the period 2 years before the 2002–2003 restrictions, 2 years before the 2008 restrictions, and the final 2 years of observations (2009–2010) (P < 0.001 for all four communities combined). Overall, serious-injury retrieval rates dropped from 30 per 1000 in 2008 to 14 per 1000 in 2010, and the proportions of serious-injury retrievals decreased significantly for all four communities. Conclusion: The absolute and the proportional rates of serious-injury retrievals fell significantly as government restrictions on legal access to alcohol increased; they are now at their lowest recorded level in 15 years.

Aims: To assess the impact of supply reduction through Alcohol Management Plans (AMP) on the rate of serious injuries in four indigenous communities in remote Australia. Methods: An ecological study used the database of the Royal Flying Doctor Service (RFDS) to calculate trauma retrieval rates for 8 years pre- and 2 years post-AMP in four remote communities covering a period from 1 January 1995 to 24 November 2005. All serious injuries in these communities required aero-medical retrieval. Results Serious injury resulted in a total of 798 retrievals during the observation period. One-sided analysis of variance for repeated measurements over the 10 years demonstrated a significant (P = 0.021) decrease of injury retrieval rates after the introduction of the AMP. Similarly, a comparison of linear trends of injury retrieval rates pre- and post-AMP also resulted in a significant decrease (P = 0.022; one-sided paired t-test). Comparisons of injury retrieval rates of just the 2 years pre- and post-AMP also revealed a significant reduction (P = 0.001; paired t-test), with an averaged 52% decline. Identical comparisons of retrieval rates for causes other than injury revealed no significant changes. Conclusion This impact evaluation provides evidence that AMP was effective in reducing serious injury in the assessed indigenous communities.