Remote Australia Online

This paper further explores the importance of 'becoming-Aboriginal' as a postcolonial or decolonising strategy in terms of Australian national identity, specifically through the 'gateway' of Aboriginal tourism. Here, however, this strategy is tied particularly to Felix Guattari's work The Three Ecologies (1989) as part of a more urgent need to confront the crises presently facing humanity. Through focusing on one region in northern South Australia, initially visited in 1980 then again in 2020, I reflect upon my own experiences with Aboriginal culture and its ecologies in this area as a way to explore and expand upon not only my own identity and subjectivity but that of Australia's more generally. Considering Australia has always suffered something of an ?identity crisis? because of its often brutal white colonial history, the concepts of cultural transversality and ecosophy could provide a further turning point in the reconciliation process between Aboriginal and settler Australians.

Introduction Australians from regional, rural, and remote areas face diverse and complex challenges in accessing and utilising mental health services. Previous research has pointed to a range of individual, community, structural, and systemic barriers at play, however, limited literature has synthesised the knowledge on this topic. Parallel to this, information on the facilitators to accessing and utilising mental health services for this group is not well documented. This protocol describes the methodology to undertake a scoping review, which aims to explore the barriers and facilitators associated with accessing and utilising mental health services in regional, rural, and remote Australia. In addition, the scoping review aims to geographically map the identified barriers and facilitators. Methods This protocol is guided by Arksey and O’Malley’s methodological framework. A search strategy will be developed and implemented to identify relevant peer-reviewed and grey literature. Studies will be included if they report on the barriers and/or facilitators associated with accessing and/or utilising mental health services in regional, rural, and remote Australia. Two reviewers will independently screen the data at the title/abstract and full-text stage. One reviewer will extract the relevant data using a predetermined charting form and a second reviewer will validate the included data. A Geographical Information System program will be used to map the location of the studies; locations will be stratified according to the Modified Monash Model and relationships between barriers and facilitators will be analysed. Key findings will be presented in a narrative account and in text, tables, and maps. Discussion This scoping review will provide a contemporary account on the barriers and facilitators to accessing and utilising mental health services for regional, rural, and remote Australians. It is anticipated that the results of this scoping review will have national policy relevance and may be useful to healthcare providers.

Power doesn't come for free, but who should pay the cost? On the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in northwest South Australia, Anangu households have not historically been billed for domestic energy consumption. The state government has recently introduced a prepayment regime, ostensibly to curb supply costs. Yet extending the norms of customer payment for domestic energy requires significant administrative labour, with limited potential to recoup costs through billing. This article asks: why is enforced commensuration preferable to the status quo? It describes the invention of household energy insecurity via policy reform, including the establishment of a 'compensatory bureaucratic infrastructure' of customer policies, contracts, tariffs, and concessions designed to mitigate the harms produced by the introduction of prepayment. With the status quo deemed untenable and the transition to mainstreaming customer payment apparently inevitable, the article examines how geography and race operate as organising principles for the limits of difference among citizens under late liberal government in remote Australia.

This study evaluated the use of the Model of Engaging Communities Collaboratively (MECC) to guide the Jandu Yani U (For All Families) project, in which the Triple P – Positive Parenting Program was collaboratively adapted for use in very remote Aboriginal communities in Western Australia. The communities’ responses to the MECC processes were evaluated through interview-style or selfadministered surveys, semiformal interviews, focus group discussions and storytelling. The MECC processes were acceptable across all groups (mean score 3.86 on a 5-point acceptability scale). Qualitative data supported and gave context to the quantitative findings, demonstrating the acceptability and utility of the approach. The MECC provided a valuable framework for Aboriginal community engagement, program dissemination and implementation of research.

Purpose – The purpose of this paper is to describe the process of development and the pilot implementation of a preventive life skills curriculum for Indigenous middle school students in a very remote community college in the West Arnhem region of North Australia. The curriculum integrates proven educational and psychological techniques with culturally informed notions of relatedness and was developed as a contribution to efforts to prevent alarming rates of suicide among remote Indigenous youth. In this paper, the term, Indigenous refers to Australians of Aboriginal or Torres Strait Islander descent. Design/methodology/approach – Based on reviews of research literature on school-based suicide prevention and social and emotional learning in both general and Indigenous populations, and following detailed community consultations, a 12 week curriculum was drafted and implemented in two middle school classes (combined years 7-9). Lessons were videotaped and later analyzed and detailed commentary was sought from participating school staff. Findings – The pilot program has yielded important insights into requirements of a curriculum for young people with low English literacy levels and with variable school attendance patterns. It confirmed the need to adjust both pedagogical approach and curriculum content for the program to have resonance with students from this linguistic and cultural background and with varying levels of exposure to multiple stressors in disadvantaged community settings. Practical implications – The project has identified and resolved key questions for sustainable implementation of a preventive curriculum in challenging community circumstances. Originality/value – There are to date no examples of the systematic adaptation and design of a universal preventive intervention specifically for remote Australian Indigenous youth. The project is the first step toward the formal evaluation of the efficacy of a classroom-based approach to suicide prevention in remote community schools.

Introduction: Women's and men's health physiotherapy involve the assessment and management of pelvic floor dysfunction, incontinence, sexual dysfunction, pelvic pain, and specific areas related to each gender. Dysfunction with these areas has a large impact upon individuals and communities due to the cost of managing the conditions and their symptoms. Indigenous people have poorer health outcomes in Australia due to a lack of access to culturally responsive health care. The aim of this study was to explore if physiotherapists perceived that they could provide culturally responsive women's and men's health physiotherapy services to Indigenous people living in regional, rural, and remote Australia. Method: An online survey was distributed through social media Facebook sites to physiotherapists who provide women's and men's health physiotherapy services to people living in regional, rural, and remote Australia, from August to November 2020. An inductive approach to analysis was used, linking data to themes.Results: There were 33/54 responses to the question on culturally responsive care, with 29/54 respondents stating that they perceived that they provide culturally responsive women's and men's' physiotherapy services. Examples of services included a weekly clinic with a local Aboriginal medical service, working with aboriginal liaison officers, participating in cultural training and developing culturally sensitive handouts and presentations. A lack of inclusion of culturally responsive practice in postgraduate education was stated as a barrier to gaining knowledge of how to provide services. Low referrals and a low up take of women's and men's' physiotherapy services, lack of funding as well as a lack of culturally appropriate locations to provide services were described as limitations to providing women's and men's health physiotherapy services.Conclusion: Physiotherapists may provide culturally responsive, but they feel their knowledge of how to provide culturally responsive services is limited. A lack of referrals and funding also appears to limit their ability to provide women's and men's health physiotherapy to all people in regional, rural, and remote Australia.

Objectives: To co-create a culturally responsive student-implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service. Design: Co-creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed-method pre/postdesign. Setting: The service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia. Participants: Co-creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co-creation of the day-to-day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator. Findings: A reciprocal learning service model was co-created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community-based services. Conclusion: The co-created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required.

The Water Services Association of Australia initiated this review of remote water services to elevate the issues in the national conversation, and to recommend ways to close the gap in the delivery of safe drinking water, including water quality and water security. In 2021, WSAA commissioned Eric Vanweydeveld, who has spent many years working on water quality and First Nations engagement in the water industry, to research and document the arrangements for water servicing of remote communities across Australia. The focus is on Northern Territory, Western Australia, South Australia and Queensland. In Victoria, the Australian Capital Territory, Tasmania, and New South Wales (to a slightly lesser degree), First Nations communities are more commonly urban communities. Water services are generally supplied from well-established water networks, and the key recommendations are not necessarily applicable. A preliminary report was released in August 2022, at the inaugural Voices For The Bush conference in Alice Springs. Through extensive research and engagement with stakeholders and the communities themselves, Eric has developed a review which maps the complex and opaque arrangements in each jurisdiction, highlighting the linkages, differences and legacies. The more this issue is explored, the more nuances are revealed, and this will continue in the future phases. In this report, WSAA presents the most complete snapshot that we can of the information we have obtained at time of publication. Arising from Eric’s review, in this report WSAA and Eric propose findings and recommendations about how improving water servicing can help close the gap – and where we can start. We welcome the commitment of the new Commonwealth Government to implementing a renewed National Water Initiative. We believe it is the right vehicle through which governments can refine and embed these recommendations and initiatives, and steer meaningful progress, working with the urban water industry, WSAA, other stakeholders and most importantly, communities themselves. Also included is the summary report and key recommendations, as well as a case study prepared by Central Land Council.

Objectives: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community. Design: Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing. Setting: Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. Participants: Children aged 1-14 years; opportunistic screening of people aged 15 years or more. Main outcome measures: Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein. Results: During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15-years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies. Conclusions: Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.

Nyangatjatjara College is an independent Aboriginal school distributed across three campuses in the southern region of the Northern Territory. Since 2011, the College has conducted student and community surveys to obtain feedback regarding students’ educational experiences and their future aspirations. In 2016 Nyangatjatjara College funded a research project, Centring Anangu voices in Anangu education, to look more closely at Anangu educational aspirations to inform the development of a five-year strategic plan. Among other activities, interviewers conducted surveys by listening carefully to Anangu school students and community through sharing first-language narratives. This paper focuses on the most commonly discussed aspiration of students, their families and communities, namely, that school should enable young people to get a job. This finding parallels other research findings (Guenther et al., 2015) and the philosophical underpinnings of “red dirt thinking” on aspiration and success (Osborne & Guenther, 2013). Our examination of the data suggests that the theme of “work” is intertwined with aspects of the local community context. The paper concludes with an analysis of existing school-to-work transitions and opportunities, with suggestions for strengthening local participation in employment initiatives across the tri-state region at the intersection of the Northern Territory, South Australia and Western Australia.

Summary. The human rotavirus vaccine was evaluated during an outbreak of rotavirus G2P[4] infection in central Australia. No overall protective effect against hospitalization was demonstrated, raising concerns over the durability of vaccine protection against heterotypic strains. Background. Two and a half years after commencing routine vaccination with human rotavirus vaccine, an outbreak of rotavirus G2P[4] infection occurred in central Australia. Vaccine effectiveness against a P[8]-containing strain (G9P[8]) had been demonstrated previously in this setting. This subsequent outbreak provided the opportunity to evaluate vaccine effectiveness against hospitalizations for a non–vaccine-related genotype in the same population. Methods. A case-control study was nested within a cohort of vaccine-eligible children listed on a population-based immunization register. Children with rotavirus-confirmed gastroenteritis were individually matched by date of birth and Indigenous status with 4 control subjects. Results. Forty-one cases met the inclusion criteria, and 21 were severe cases among infants aged <12 months. Nineteen (46%) of 41 case patients had received 2 doses of human rotavirus vaccine, compared with 87 (53%) of 164 control subjects. Vaccine effectiveness against rotavirus-related hospitalization was 19% (odds ratio, .81; 95% confidence interval, .32–2.05) for 2 doses compared with none. On secondary analysis, there was evidence of a protective effect against disease complicated by acidosis in the subset of infants aged <12 months (odds ratio, .15; 95% confidence interval, .03–.84). Conclusions. Evidence was not found for an overall protective effect of human rotavirus vaccine against hospitalization for rotavirus disease in this setting. Post hoc analyses suggested a protective effect against severe disease in young infants.

The Menzies Ramaciotti Regional and Remote Health Sciences Training Centre (Menzies-Ramaciotti Centre) is located within the Menzies School of Health Research (Menzies) in Darwin, Northern Territory (NT). The Menzies-Ramaciotti Centre is contributing to the development of a local health workforce in the NT, including a strong biomedical workforce. The Centre facilitates health workforce career progression for regional and remote youth, with a focus on career development for Aboriginal and Torres Strait Islander (First Nations) youth. The Centre works in collaboration with a range of industry and education partners, who also have strong workforce development goals and a commitment to serving a vital community need to build pathways into work and study with First Nations peoples. Part of the Centre’s focus entails delivery of high-quality training in biomedical sciences, including theoretical and practical skill development in microbiology, laboratory techniques, immunology, public health, data science, allied health, and health research. The Centre uses a non-linear, strengths-based approach to training with a multiplicity of entry and exit points including high school work experience placements, traineeships, vocational placements, as well as undergraduate and postgraduate placements.

The Whole of Community Engagement (WCE) initiative sought to identify barriers and enablers in Aboriginal students’ pathways to post-compulsory education, in six remote communities in Arnhem Land and central Australia. It identified known factors like colonial history, low English literacy, job prospects and cultural difference. Responses often focus on “both-ways” curriculum and pedagogy, and teachers’ cultural competence. Another factor found was interculturality, the fact of living and working at the intersections of Aboriginal and other socio-cultural worlds. The initiative found that students’ engagement with school and with pathways into further education were troubled by both cultural difference and intersection. The Aboriginal researchers involved in the initiative, living at the intersections in their own lives, exemplified the challenges of, and the capabilities needed to negotiate, cultural intersection. The authors propose an intercultural perspective as a refinement to the both-ways approach to remote education.

PURPOSE: To describe a virtual clinical pharmacy service as a model of care to support rural and remote Australian hospitals that otherwise would not have access to onsite pharmacists. SUMMARY: Many small hospitals in Australia do not have an onsite hospital pharmacist and struggle to support and optimize patient care. To increase access to a hospital pharmacist's specialized skills and medication knowledge, a virtual clinical pharmacy service was designed and implemented in 8 hospitals across rural New South Wales, Australia in 2020. The virtual clinical pharmacy service focuses on the core role of hospital pharmacists, including obtaining a best possible medication history, medication reconciliation at transitions of care, medication review, interprofessional team meetings, provision of patient-friendly medication lists, antimicrobial stewardship, and patient and clinician education. The model is aligned with recognized standards of practice for the delivery of clinical pharmacy services in Australian hospitals. This article details a model of care for translation across other settings. It provides the necessary details on clinical services, processes, supporting structures, an evaluation framework, and other important considerations for implementing virtual pharmacy services. CONCLUSION: This research provides policymakers, health service planners, and practitioners with a model for providing comprehensive clinical pharmacy services virtually to increase the safe and effective use of medicines. Future publication of the findings of a formal evaluation of the model's acceptability and effectiveness is planned.

Vector-borne diseases of dogs in Australian Aboriginal communities are relatively unexplored. These dogs represent a unique group with variable ecto- and endo-parasitic burdens, nutritional stresses and a general lack of veterinary intervention. We investigated haemoprotozoal and bacterial pathogen prevalences in relation to erythrocyte and platelet numbers in dogs from North-West New South Wales (N-W NSW) and the Northern Territory (NT; Central Australia).

Population-based studies have associated poor living conditions with the persistent disparity in the health of Aboriginal and non-Aboriginal Australians. This project assesses the applicability of the Health Community Assessment Tool and its role in improving the environment of a small community in the Midwest of Western Australia (WA). The action research cycles started with the initial reflection on the suitability of the HCAT version 2 for the local community context and whether it was fit-for-purpose. The researcher provided 'critical companionship', while the participants of the study were invited to be co-researchers (the Assessors) who critically examined the HCAT and assess the community. The relevant domains to the serviced town (an outer regional community) were pest control and animal management; healthy housing; food supply; community vibrancy, pride and safety; reducing environmental tobacco smoke; and promoting physical activity. The Assessors found the HCAT descriptors mostly aligned with their community context but found some of the items difficult to apply. Based on participant's suggestions, some of the original scoring scales were reformatted. School attendance and illicit drug use were identified as a key outcome indicator for youth but were missing from the HCAT. The HCAT domains applied helped streamlining core business of agencies in the local community. The face validity of HCAT items were confirmed in this research with minor adjustments to reflect local context. Youth engagement to education is of high community concern and the development of an item would create similar interagency collaborative dialogues.

'Education is the key' is often used as a metaphor in remote Australian First Nations communities to indicate the importance of learning to achieve some measure of socio-economic advantage - education is seen as a vehicle for advancement. First Nations people have enthusiastically bought into education and training vehicle. High school completion data suggest that 'gaps' are closing. But the vehicle appears to be breaking down as it heads along the road towards jobs and economic participation.This article presents an analysis of Census data to show trends in high school completion, employment and income. The data suggest growth in educational achievement. But a 'break down' of the data into non-Indigenous, First Nations Indigenous language speakers and First Nations English speakers shows little change in the economic fortunes of language speakers. In these latter findings a 'new narrative', built on QuantCrit propositions, takes shape and explains why the vehicle breaks down.

The aim of this project was to develop and enact appropriate approaches to support healthy lifestyle changes as part of longer-term diabetes prevention among younger Aboriginal people in Derby, Western Australia. Analysis of health care data showed a high diabetes prevalence and risk factors from an early age, with opportunities to enhance screening. Community members directed the creation of a comprehensive prevention program. The pilot program was found to be acceptable, appropriate and useful. This example of a localised, evidence based prevention program that can be run by a range of community members may be useful in other low-resource settings.

Objective Recruitment in research can be challenging in Australian Aboriginal contexts. We aimed to evaluate the SToP (See, Treat, Prevent skin infections) trial recruitment approach for Aboriginal families to identify barriers and facilitators and understand the utility of the visual resource used. Methods This qualitative participatory action research used purposive sampling to conduct six semi-structured interviews with staff and five yarning sessions with Aboriginal community members from the nine communities involved in the SToP trial that were audio recorded and transcribed verbatim before thematic analysis. Findings Community members valued the employment of local Aboriginal facilitators who used the flipchart to clearly explain the importance of healthy skin and the rationale for the SToP trial while conducting recruitment. A prolonged process, under-developed administrative systems and stigma of the research topic emerged as barriers. Conclusion Partnering with a local Aboriginal organisation, employing Aboriginal researchers, and utilising flip charts for recruitment was seen by some as successful. Strengthening governance with more planning and support for recordkeeping emerged as future success factors. Implications for public health Our findings validate the importance of partnership for this critical phase of a research project. Recruitment strategies should be co-designed with Aboriginal research partners. Further, recruitment rates for the SToP trial provide a firm foundation for building partnerships between organisations and ensuring Aboriginal perspectives determine recruitment methods.

Managed retreat is part of the planners’ analytical toolkit. It considers that human displacements driven by climate change will be more just if they are strategically managed by well-resourced authorities. In contrast to the contradistinction this discourse establishes between the status quo of ad hoc displacement and planned relocation, managed retreat disregards other policies that similarly encourage migration from places the state deems unviable. This article argues that slow withdrawal as managed retreat offers a framework for understanding policies that facilitate the reduction or discontinuation of services that settler colonial states formerly delivered to particular contexts. It does so through historical analysis of state support for housing and essential services infrastructure at Indigenous homelands and remote communities in the Northern Territory of Australia. Slow withdrawal as managed retreat emphasises the geographically differentiated character of state investment, highlights the reconfiguration of obligations for service provision between different levels of government, and considers whether and how ‘abandonment’ is appropriate ‘land back’ policy advancing Indigenous sovereignty. The article examines how the settler state withdraws specific supports while remaining present, and it considers the process of slow withdrawal as managed retreat in relation to contemporary demands for greater community control of Indigenous housing.

Research on the achievement of rural and remote students in science and mathematics is located within a context of falling levels of participation in physical science and mathematics courses in Australian schools, and underrepresentation of rural students in higher education. International studies such as the Programme of International Student Assessment (PISA), have reported lower levels of mathematical and scientific literacy in Australian students from rural and remote schools (Thomson et al, 2011). The SiMERR national survey of science, mathematics and ICT education in rural and regional Australia (Lyons et al, 2006) identified factors affecting student achievement in rural and remote schools. Many of the issues faced by rural and remote students in their schools are likely to have implications on their university enrolments in science, technology, engineering and mathematics (STEM) courses. For example, rural and remote students are less likely to attend university in general than their city counterparts and higher university attrition rates have been reported for remote students nationally. This paper examines the responses of a sample of rural/remote Australian first year STEM students at Australian universities to two questions. These related to their intentions to complete the course; and whether - and if so, why- they had ever considered withdrawing from their course. Results indicated that rural students who were still in their course by the end of first year were no more or less likely to consider withdrawing than were their peers from more populous centres. However, almost 20% of the rural cohort had considered withdrawing at some stage in their course, and their explanations provide insights into the reasoning of those who may not persist with their courses at university. These results, in the context of the greater attrition rate of remote students from university, point to the need to identify factors that positively impact on rural and remote students’ interest and achievement in science and mathematics. It also highlights a need for future research into the particular issues remote students may face in deciding whether or not to do science at the two key transition points of senior school and university/TAFE studies, and whether or not to persist in their tertiary studies. This paper is positioned at the intersection of two problems in Australian education. The first is a context of falling levels of participation in physical science and mathematics courses in Australian universities. The second is persistent inequitable access to, and retention in, tertiary education for students from rural and remote areas. Despite considerable research attention to both of these areas over recent years these problems have thus far proved to be intractable. This paper therefore aims to briefly review the relevant Australian literature pertaining to these issues; that is, declining STEM enrolments, and the underrepresentation and retention of rural/remote students in higher education. Given the related problems in these two overlapping domains, we then explore the views of first year rural students enrolled in STEM courses, in relation to their intentions of withdrawing (or not) and the associated reasons for their views.

Objective: The aims of this study are to assess nursing student satisfaction with their Northern Territory clinical placement; describe the characteristics of these students; and examine the relationship between student placements and future rural/remote work intentions. Background: Positive clinical placement experiences in a rural or remote setting can encourage student nurses to consider working in rural and remote locations after graduation. Study design and methods: The study is a cross-sectional survey of nursing students, and a review of placement data. Participants were studying a pre-registration Bachelor of Nursing course from a variety of Australian universities who undertook a clinical placement of usually four or more weeks in the Northern Territory from 2017-2019. The main outcome measures are overall satisfaction with their placement, and consideration of living and working in a rural or remote location after graduating. Logistic regression analyses examined the relationship between student placements and future rural or remote work intentions. Results: One hundred and sixty three undergraduate nursing students responded to the online survey. The majority (70%) of placements were undertaken in remote or very remote (18%) locations. Satisfaction with the placement was very high (94%), and 88% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. Satisfaction with educational resources and prior interest in working remotely were associated with overall placement satisfaction (p<0.10). Overall satisfaction with the placement and prior consideration of working regionally, rurally, or remotely were significantly associated with feeling encouraged to consider working rurally or remotely (p<0.05). Conclusion: This study supported the logical pathway of providing a satisfying clinical nursing placement in the Northern Territory to contribute to a higher likelihood of the student considering working in a remote or rural setting after graduation. Providing satisfying remote clinical placements is a strategy for growing a nursing workforce for remote and rural settings. Implications for research, policy and practice: Ongoing investment in remote clinical nursing placements is needed to ensure nursing students are satisfied with their placement. In particular, the educational resources and support during the placement need to be of high quality. Actively recruiting students who had a prior interest in working in a regional, rural or remote setting will likely lead to high satisfaction with the placement and contribute to an interest in working in a rural or remote setting post-graduation.

Objective The objective of this study was to apply a strength-based approach to examine the relation of cultural and social determinants to high family functioning for Aboriginal people in Central Australia. Design Cross-sectional study involving a quantitative analysis of survey data. Prevalence rate ratios (PRs) and 95% CIs were calculated from binomial regressions, adjusted for gender and age. Qualitative data from workshops with Aboriginal leaders in Central Australia supported the interpretation of the research findings. Participants The study involved 639 Aboriginal people in Central Australia who participated in the Mayi Kuwayu Study. Result Overall, 57.9% (370/639) of participants reported high/very high family functioning, 16.9% (108/639) reported moderate and 13.3% (85/639) reported low. The adjusted prevalence of family functioning was similar across gender, age groups and household sizes. Family functioning was associated with lower family financial status (aPR=0.74, 95% CI=0.60 to 0.91) and receiving welfare (0.88, 0.77 to 1.00). Family functioning was greater with high community cohesion (2.72, 1.68 to 4.39), high individual agency in community (2.15, 1.63 to 2.85); having an Aboriginal language as a first language (1.20, 1.04 to 1.37); speaking your Aboriginal language a lot (1.37, 1.12 to 1.68); high exposure to cultural practice and knowledge (1.45, 1.28 to 1.65); and multigenerational or extended family households (1.19, 1.02 to 1.38). Conclusion High family functioning is a strength in Central Australia and is intrinsically connected with culture. Healthcare providers and programmes that build on the foundations of culture and family are an important approach to improving wellbeing. Data may be obtained from a third party and are not publicly available. The Mayi Kuwayu dataset is governed by senior Aboriginal people based on principles of Indigenous data sovereignty. Requests on data access can be made to the Mayi Kuwayu Data Governance group.

Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.

Abstract Aims To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes mellitus (GDM). Methods PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C] or fasting plasma glucose) were assessed for women with GDM (n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C, fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. Results Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12?weeks, and 23% vs. 37% at 6 months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6-month HbA1C compared to non-Indigenous women (16% vs. 2%, p < 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. Conclusions Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.