Remote Australia Online

Abstract Objective The aim of this study was to explore how interventions were provided to meet the needs of rural/remote residents who have had a traumatic hand injury, including the coordination of services between rural/remote and metro/regional therapists. Barriers to providing services, use of technology and professional support provided to therapists in rural/remote areas were also explored. Design Cross-sectional survey. Setting Metropolitan/regional and rural/remote public health facilities in Australia. Participants Occupational therapists and physiotherapists who provide hand therapy to rural/remote patients. Main outcome measure Quantitative and qualitative questionnaire responses analysed with descriptive statistics and inductive analysis. Results There were 64 respondents out of a possible 185. Over half of rural/remote respondents provided initial splinting and exercise prescriptions, and over 85% reported that they continued with exercise protocols. Videoconferencing technology for patient intervention and clinical review was used by 39.1% respondents. Barriers to providing services in rural/remote locations included transport, travelling time, limited staff, and lack of expert knowledge in hand injuries or rural/remote health care. Four major themes emerged from the open-ended questions: working relationships, patient-centred care, staff development and education, and rural and remote practice. Conclusion The use of technology across Australia to support rural/remote patient intervention requires attention to achieve equity and ease of use. Flexible and realistic goals and interventions should be considered when working with rural/remote patients. A shared care approach between metropolitan/regional and rural/remote therapists can improve understanding of rural/remote issues and provide support to therapists. Further research is recommended to determine the suitability of this approach when providing hand therapy to rural/remote residents.

Incursions of Japanese encephalitis (JE) virus into northern Queensland are currently monitored using sentinel pigs. However, the maintenance of these pigs is expensive, and because pigs are the major amplifying hosts of the virus, they may contribute to JE transmission. Therefore, we evaluated a mosquito-based detection system to potentially replace the sentinel pigs. Single, inactivated JE-infected Culex annulirostris Skuse and C. sitiens Wiedemann were placed into pools of uninfected mosquitoes that were housed in a MosquitoMagnet Pro (MM) trap set under wet season field conditions in Cairns, Queensland for 0, 7, or 14 d. JE viral RNA was detected (cycling threshold [CT] = 40) in 11/12, 10/14, and 2/5 pools containing 200, 1,000, and 5,000 mosquitoes, respectively, using a TaqMan real-time reverse transcription-polymerase chain reaction (RT-PCR). The ability to detect virus was not affected by the length of time pools were maintained under field conditions, although the CT score tended to increase with field exposure time. Furthermore, JE viral RNA was detected in three pools of 1,000 mosquitoes collected from Badu Island using a MM trap. These results indicated that a mosquito trap system employing self-powered traps, such as the MosquitoMagnet, and a real-time PCR system, could be used to monitor for JE in remote areas.

In this paper, we examine engagement with ‘the rural context’ in Australian education research, focussing on the implications of the signifier ‘rural’—in terms of its inclusion or absence. A review of Australian research literature in rural education indicates that the term ‘rural’ and its synonyms are more often used to denote assumptions of a generalised and predetermined ‘context’ for research than to think about its meaning. We present our findings here and discuss the implications of the signifier ‘rural’ in the Australian research literature to argue that while educational policy-makers must attempt to think differently about the 'problem of the rural’, the field itself also needs to more fully develop the capacity to do this.

1.8 In March 2018, the Senate referred an inquiry into the accessibility and quality of mental health services in rural and remote Australia to the Senate Community Affairs References Committee (committee).11 The terms of reference for the committee's inquiry are outlined below: (a) the nature and underlying causes of rural and remote Australians accessing mental health services at a much lower rate; (b) the higher rate of suicide in rural and remote Australia; (c) the nature of the mental health workforce; (d) the challenges of delivering mental health services in the regions; (e) attitudes towards mental health services; (f) opportunities that technology presents for improved service delivery; and (g) any other related matters.

The prevalence of youth-onset type 2 diabetes (T2D) and hyperglycaemia in pregnancy are increasing worldwide, disproportionately affecting First Nations populations. Early life represents a critical opportunity for prevention of later disease. Aims were to: 1) describe prevalence of T2D among Aboriginal and Torres Strait Islander youth aged ≤24 years; 2) explore associations of maternal hyperglycaemia in pregnancy (in this thesis defined as gestational diabetes (GDM) or T2D in pregnancy) with growth trajectories of offspring; 3) explore whether predominant breastfeeding at 6 months influences early growth in children exposed to hyperglycaemia; 4) describe associations of maternal hyperglycaemia with offspring anthropometry; and 5) describe associations of maternal hyperglycaemia with developmental risk of offspring. For Aim 1, an audit of primary health care records was undertaken across the northern Australia region. Aims 2-5 involved the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study, a birth cohort (n=1138 women, 1163 children). Glycaemic status was assessed in pregnancy, with detailed anthropometry at birth, and again at 18-60 months of age in a sub-group of children, along with developmental screening. This research identified a high prevalence of youth-onset T2D (6.7/1000 population), to our knowledge higher than recently reported internationally in any population of youth. Maternal hyperglycaemia was associated with offspring growth trajectories after adjustment for other factors, including maternal body mass index (BMI). Predominant breastfeeding to 6 months was protective against excess weight gain among infants of mothers with GDM. Both GDM and maternal BMI were associated with offspring anthropometry at 18-60 months of age. Both T2D and GDM were associated with developmental vulnerability and reduced head circumference of children. The findings have informed development of Australasian screening pathways for youth at risk of T2D. They have worldwide implications for policy and care of women with hyperglycaemia in pregnancy, their children, and youth with T2D.

Being a midwifery student through Charles Darwin University I had been hoping to experience a remote placement. Alas, due to COVID 19 my planned six weeks at Katherine Hospital in the NT was cancelled. I did not want to leave my family in the never-ending lockdown unsupported. I was hopeful that once again I would be offered the opportunity to understand more clearly and truthfully the experience of pregnancy and birth for women living remotely and a little of their cultural perspective too.

Over the last decade, scenario analysis increasingly has been used to explore the main drivers affecting global food supply and demand in the future. The aim of this study is to summarise, compare and evaluate global scenarios with a focus on global food security. We find that food security outcomes differ substantially and may be attributed to three main factors: (1) differences in scenario storylines and assumptions on drivers, (2) differences in the models that are employed to process the drivers and generate scenario outcomes, and (3) differences in the way and the extent to which results are reported. We also identify several ways how studies and models may be improved. This paper provides important and helpful suggestions for practitioners, but is also useful for policy-makers, who are usually the ultimate users of these scenario studies.

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

Objectives It is well known that there are associations between overall health, age, socioeconomic status and rural residency. The objective of this study was to determine the distribution of Australia's aged population by socioeconomic status, as well as remoteness. Methods The study employed the Australian Statistical Geography Standard (Statistical Area Level 1 and Remoteness Areas). The database of the geographic boundaries was integrated into the ageing population and socioeconomic data using the Geographic Information System. The socioeconomic data was analysed through the Index of Relative Socioeconomic Disadvantage. Results Over a decade, the older population in Australia has increased noticeably. In 2016, there was a high percentage of older people (≥65 years) in Tasmania (Tas), 19%, while the lowest percentage was recorded in the Northern Territory (NT), 7%. Across the country, Tasmania had the highest percentage of older citizens living in the most disadvantaged areas since 2006, with 48% recorded in 2016. There was an association between the remoteness areas and the education and income levels of the ageing cohort. However, this association differed between the states and territories. This socioeconomic gap becomes more evident in the very remote areas of the country. Conclusions The ageing population in Australia is increasing rapidly; this was associated with an evolving socioeconomic disparity among this ageing society. Our results demonstrated that socioeconomic inequalities were to be found among the older people based on their distribution over the remoteness areas in Australia. This information should be used to target healthcare and ageing policies that meet the specific needs of older people.

Purpose: In Australia, Aboriginal and Torres Strait Islander peoples (First Nations population) often have low overall cancer survival, as do all residents of geographically remote areas. This study aimed to quantify the survival disparity between First Nations and other Queenslanders for 12 common cancer types by remoteness areas. Methods: For all Queensland residents aged 20–89 years diagnosed with a primary invasive cancer during 1997–2016, we ran flexible parametric survival models incorporating age, First Nations status, sex, diagnosis time period, area-level socioeconomic status, remoteness categories and where appropriate, broad cancer type. Three survival measures were predicted: cause-specific survival, survival differences and the comparative survival ratio, each standardised to First Nations peoples’ covariate distributions. Results: The standardised five-year cause-specific cancer survival was 60% for urban First Nations and 65% for other Queenslanders, while remote residents were 54% (First Nations) and 58% (other). The absolute survival differential between First Nations and other Queenslanders was often similar, regardless of remoteness of residence. The greatest absolute difference in five-year standardised cancer survival was for head and neck cancers, followed by cervical cancer. The five-year comparative survival ratio (First Nations: other Queenslanders) for urban cancer patients was 0.91 (95% CI 0.90–0.93), similar to outer regional, inner regional and remote areas. The greatest comparative survival differential was for oesophageal cancer. Conclusion: First Nations’ survival inequalities are largely independent of geographical remoteness. It remains a priority to determine the contribution of other potential factors such as the availability of culturally acceptable diagnostic, management and/or support services.

INTRODUCTION: Consumer-driven community mental health services play an important role in rehabilitation, recovery, and advocacy in rural and remote Australia. The origins of services often lie in the need to provide options for people with mental illness and their carers when there is a lack of on-the-ground support. This article adds to the information about the strengths and limitations of consumer-driven mental health services by presenting the findings of an evaluation of The Station Inc. in rural South Australia. This consumer-driven mental health service provides a safe and supportive environment, social connections, and activities for its members (those with a lived experience of mental illness). Using a realist evaluation approach, the evaluation identified the contextual factors and the program mechanisms that produce positive outcomes for members. METHOD: The evaluation was conducted as participatory action research with The Station members, volunteers, management committee members, and staff involved in all phases of the research process. Because of the complexity of The Station's functioning a realist evaluation using qualitative data was conducted to identify how the program worked, for whom, and in what circumstances. Twenty-five in-depth interviews were conducted with participants who were randomly selected from within the groups identified above. Interviews focused on The Station's role in assisting recovery from mental illness, the limitations and strengths of the program, and relationships with the mental health system. The Station's goals, policies and procedures, and the role of stakeholders were analysed in order to identify any links among these contextual factors, program mechanisms, and program outcomes. Qualitative data were entered into descriptive categories in N6 software (QSR; <a href="http://www.qsr.international.com" target="_blank">www.qsr.international.com). Data from the stakeholder analysis were entered into Microsoft Excel. Using an iterative approach to include the three data sets, a model was developed that identified important contextual factors that linked with two groups of program mechanisms that produced positive outcomes for members. RESULTS: Program mechanisms are categorised by descriptive themes referred to as 'nurturing' and 'empowering'. Nurturing' is experienced as feeling of belonging and being accepted 'as one is' and 'empowerment' mechanisms engender a belief in oneself. Respondents identified features of The Station's program, policies, atmosphere, connections and networks, stakeholder relationships, and staff and volunteers that are nurturing and empowering. Five key contextual factors enable the program mechanisms to work. The Station's coordinators ensure that nurturing and empowerment processes are highlighted through careful facilitation. The governance arrangements, policies, and administrative systems at The Station are well developed but flexibly implemented so that they support the nurturing and empowerment processes. Support and legitimacy for the program is obtained from the mental health system at state and local levels. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate. CONCLUSIONS: Information about the benefits and limitations of consumer-driven mental health services in rural and remote Australia is in short supply. Increasing the available information about the contribution these services make may result in services being legitimised, understood, and resourced within mental health systems thus making the services sustainable. The benefits of consumer-driven services are that they provide flexibility and adaptation, an ability to capture the energy and passion of rural communities to improve the wellbeing of community members, and they overcome the power differential that exists between professionals and 'patients' or 'clients'.

Objective This cross-sectional study was done to determine the prevalence of blood-borne viruses and hepatitis B vaccination status in haemodialysis patients in Central Australia. Methods The study comprised nearly entirely of Aboriginal Australians except one Caucasian in Central Australia who had started haemodialysis between January 1996 and December 2019. Results Chronic hepatitis B infection was seen in 8.4% of patients and serological evidence of human T-lymphotropic virus 1 was seen in 28.3% of patients. The prevalence of human immunodeficiency virus and hepatitis C was less than 1%. The vaccine status of all 182 patients who had received hepatitis B vaccine was reviewed. Vaccine response was seen in 72.2% who received vaccine at birth or in early childhood. There were 99 patients aged 20 years and older who had received hepatitis B vaccines before their haemodialysis commenced. The vaccine response was observed in 88.9% of these patients. A seroconversion rate of 78.5% was achieved in vaccine naïve patients who received hepatitis B vaccine after their haemodialysis commenced. Conclusion The response to hepatitis B vaccine among haemodialysis patients in Central Australia was suboptimal and variable. The prevalence of chronic hepatitis B infection declined after the introduction of universal hepatitis B vaccination in 2000.

Background: Heavy cannabis use in remote Indigenous Australian communities potentially contributes to existing health disparities. Community members’ perceptions of cannabis harms will support harm-minimization in these settings. Objective: To describe perceived cannabis harms reported by a cohort of Indigenous Australians living in small, isolated communities as an indication of their existing resources for change. Method: Inductive thematic analysis of 407 semi-structured interviews with participants in a cohort study in three remote communities in Cape York in far north Queensland (Australia) revealed major areas of concern about cannabis. Three attitudinal categories were defined according to reported cannabis impacts and urgency for change: 1- 'LOW CONCERN' said cannabis was a low priority community issue; 2- 'SOME CONCERN' tolerated cannabis use but identified personal or community-level concerns; and 3- 'HIGH CONCERN' expressed strong aversion to cannabis and identified serious personal or community-level harms. The characteristics and the patterns of concerns were summarized across the groups. Results: ‘Category 1- LOW CONCERN’ (n = 107), mostly current users, emphasized personal ‘financial impacts’ and ‘stress.’ ‘Category 2 ‘ SOME CONCERN’ (n = 141) perceived community level impacts warranting systematic action, particularly on ‘employment’; and ‘Category 3 ‘ HIGH CONCERN’ (n = 159), most of the never users, emphasized concerns for families and youth. Irrespective of use history, the cohort reported financial and abstinence-related stress, overlapping alcohol issues and generally endorsed alleviating impacts on children and youth. Conclusion: Nearly ubiquitous experience with cannabis harms and impacts in this cohort suggests resources for harm reduction including family and cultural obligation, stress relief, financial management, and engagement are available across all community members, not just users.

Between 1923 and 1925, tropical medicine specialist, Cecil Cook, conducted a field survey of leprosy in Australia. The disease, once largely confined to the east, had infiltrated the north of the continent. Mostly, Indigenous people were afflicted but endemicity was present among white Australians in regions of interracial contact. Cook criticised state government control measures and recommended the standardisation of policy under federal government authority. Drawing from international precedents and biomedicine, adapted to local epidemiology, Cook and his colleagues in Australian health bureaucracies determined leprosy policies in the interwar period. As white settlement of the north expanded, a major aim was to protect white Australians from the presumed threat posed by Indigenous people with infectious diseases. Concomitantly, concern for the health and welfare of remote Indigenous Australians found expression among humanitarians, Indigenous activists, missionaries, and anthropologists, with their agitation for change and giving relief and protection at missions, sometimes subverting leprosy laws. Resultant inquiries did little to lessen harsh leprosy policy. Between 1931 and 1940, leprosaria for Indigenous patients opened in the Northern Territory, north-west Western Australia, and northern Queensland—Channel Island, Derby, and Fantome Island, respectively—supported by funded field surveys and stronger legal powers for examination and detention.

Background Lower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse. Objectives The primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the sample and to explore associations between HL and emergency department representation and discharge against medical advice. Methods This was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview. Results In a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study. Conclusion Trends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.

Aim To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction. Background Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services. Design Christmals and Gross’s integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings. Findings Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role. Discussion Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community. Conclusion The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions.

In Arnhem Land, northern Australia, speakers of the Burarra language live and communicate within a highly multilingual and multilectal language ecology. This paper explores how regional ideologies of socio-cultural distinctiveness and unity are projected into the linguistic space at the level of the language (within Maningrida's language ecology), as well as at the level of the lect (in terms of dialects and sociolects within the Burarra language). Drawing from current ethnography, naturalistic interactional and elicited language data, and other existing materials, the paper considers how speakers reproduce and evaluate language-internal variation within a linguistically diverse region. These processes are contextualised within the dynamics of long-term ‘egalitarian’ multilingualism which continue to shape contemporary practices and contemporary means of social meaning-making.

On Australia’s north-central coast, the regional hub of Maningrida is distinguished by a highly diverse language ecology, with local linguistic repertoires taking in elements of multiple traditional languages as well as localised Englishes, Kriol (an English-lexified creole), and a local alternate sign language system. Texts and talk in Maningrida are rarely monolingual. Youth culture in Maningrida is char-acterised by the interacting demands of traditional cultural life and an emergent urban subculture that increasingly connects to global phenomena. Young speak-ers are more, and differently, mobile compared to earlier generations, and their language practices are fundamentally implicated in community language change. While some elders are concerned that young people are connecting less deeply to their languages’ traditional heartlands, young speakers themselves have differ-ent perspectives to offer. This chapter explores the language practices of Manin-grida youth and centralises local Indigenous perspectives on this phenomenon. Drawing on data collected through collaborative community language research, we consider the emergence of a restructured urban variety of the Burarra language, a process of “linguistic urbanisation” in which youth are central. We further con-sider examples of the creative multilingual practices of young Maningrida speak-ers/signers, such as the recent success of an all-female band from the community who sing in five local languages. This chapter aims to illustrate how Maningrida youth create affordances within the diverse multilingual resources of their com-munity, and the ways in which they draw on tradition and modernity to create new forms of meaning making.

BACKGROUND: There is increased interest in building research capacity in rural health research in Australia and internationally. In Australia, the Primary Health Care Research Evaluation and Development program funded by the Australian Government has supported this move. Overall this program aims to build the quantum of primary healthcare research to underpin clinical practice, health systems improvement, and policy. In order to achieve this objective, one strand of the program aims to build research capacity among practitioners. In implementing this program in rural and remote areas of the west of South Australia, the Spencer Gulf Rural Health School has identified methodological and research design issues faced by practitioners who are researching in their communities. These issues include problems encountered in living and researching in the same location and accessing small-scale statistical information. We were interested to know whether there was interest in a formal course (Rural Research and Evaluation) that would address these issues and provide information about community-based research designs. METHODS: A cross-sectional anonymous survey was designed and sent to 141 organisations in the health, human service, and local government sectors in regional South Australia. Respondents were asked to evaluate the demand and interest for a new course--Rural Research and Evaluation. The term 'rural' was used to refer to both rural and remote locations. Information was sought on the respondent's role in the organisation, current level of research participation, views about the proposed course content, and factors that the respondent thought would facilitate or inhibit their participation. The majority of questions were close-ended. RESULTS: Sixty surveys were returned giving a 42.5% response rate. Data were analysed using descriptive statistics. A high level of research and evaluation activity was reported with 80% of respondents undertaking research or evaluation as part of their professional role. There was also agreement that all the proposed topics were important to be included in a course. Each of the topics was ranked at four or five on a five-point scale by at least 58% of respondents. The topic 'understanding evaluation methodologies' was ranked at four or five by 85% of respondents, making it the most highly ranked topic. There was also consensus about the features respondents thought would make the course attractive for them to study. Over half (62%) of the respondents ranked having lecturers with a broad rural research background at five, very important, on a five-point scale. Almost half (48%) of the respondents ranked online delivery at five, a very important factor in making the course attractive to study. CONCLUSIONS: Those interested in research and evaluation may have been more likely to return the survey and there may have been respondent bias in this regard. Therefore the results must be interpreted with caution. However, the level of agreement with the proposed course topics may suggest that these reflect important issues in undertaking research and evaluation in rural and remote locations. If this is the case there is value in discussion about how these issues are dealt with in different contexts in order to overcome some of the barriers to effective research.

This chapter explores how speakers in Maningrida, a linguistically diverse Indigenous community in northern Australia, negotiate and evaluate their language practices within ‘hybrid spaces’ (i.e. spaces shaped by the interaction of diverse groups, institutions and ways of speaking). The analysis draws on data from two settings – a public school event, and a football match – and I consider the ways in which a translanguaging lens may provide insights into the interactional and socio-psychological realities of lived multilingualism in Maningrida. The major focus of the chapter pertains to Burarra/English mixing. I discuss the nature and functions of this language practice, and note that while speakers appear to ‘soft assemble’ their linguistic resources to fit the communicative situation at hand, there are also observable constraints exerted by the morphosyntax of the contributing codes. This practice are situated against the backdrop of long-standing multilingualism and language ideologies in the Arnhem Land region. The chapter evaluates translanguaging as a possible useful addition to the nomenclatural and analytical toolbox of researchers in the Australian Indigenous context, and as an important step towards decolonising understandings of local language practice, and further provides critiques and suggestions for strengthening the model’s descriptive potential.

Rural and remote communities in Australia are characterised by small but widely dispersed populations. This has been proven to be a major hurdle in access to medical care services with screening and treatment goals repeatedly being missed. Telemedicine in ophthalmology provides the opportunity to increase the availability of high quality and timely access to healthcare within. Recent years has also seen the introduction of artificial intelligence (AI) in ophthalmology, particularly in the screening of diseases. AI will hopefully increase the number of appropriate referrals, reduce travel time for patients and ensure timely triage given the low number of qualified optometrists and ophthalmologists. Telemedicine and AI has been introduced in a number of countries and has led to tremendous benefits and advantages when compared to standard practices. This paper summarises current practices in telemedicine and AI and the future of this technology in improving patient care in the field of ophthalmology.

We present tangible design non-proposals as a technique for establishing and growing relationships in community-based co-design projects, particularly with Australian Aboriginal and Torres Strait Islander communities. Prior tangible design products from our research group were used to introduce our capabilities and interests and as tangible provocations to understand potential community interests for co-design. We describe how the non-proposals supported initial conversations and imagination, forming relationships, formalising an official relationship, understanding the scope and scale of community aspirations, artful appropriation, and how they morphed into a research prototype aligned to the community's needs and vision. We describe the ways that tangibles supported a mutual sensitisation process and realising project limits, bounds and misalignments. We contribute a framework for design non-proposals with both general characteristics and dimensions salient to our collaborative work with Aboriginal communities. We evaluate our own design non-proposals using the framework to present implications for seeding co-design processes.

This article posits the development of a healthier food choice app as a means of contributing to facilitating nutritionally superior food selection among indigenous Australians living in remote communities. A significant health gap exists between indigenous and non-indigenous people in Australia. Further, indigenous Australians living in remote communities carry a significant and disproportionate share of this gap. One contributor to poor health is poor nutrition: current food consumption in remote communities is a diet dominated by highly processed foods and characterized by high levels of sugar, refined cereals, and low intake of fruit and vegetables coupled with excessive sodium intake and deficiency in a number of micronutrients. Employing two marketing-based concepts, the dual processing model of nutritional labeling and habit, as the basis for the development of a healthier food app, we contend that a food choice app has the potential to disrupt habitual behavior and generate new learning about healthier food choices in remote indigenous communities. The app would be based on the George Institute?s FoodSwitch app, which enables users to scan barcodes of food products at the point of purchase and determines if the food item is a healthy choice and otherwise suggests healthier alternatives. The proposed app would utilize existing imagery used by the Jimmy Little Foundation, a not-for-profit organization working in remote indigenous communities promoting healthier food and lifestyle practices, and would provide information in a culturally appropriate and clearly communicated form.

Gasoline (petrol) sniffing is a form of volatile substance misuse that is particularly prevalent within Australian indigenous communities. Although epidemiological studies have shown that gasoline sniffing has decreased over recent years, rates of gasoline sniffing deaths have not been widely reported. Therefore, a study was undertaken to assess the association between the implementation of low aromatic fuel (LAF) and gasoline sniffing deaths. All cases of fatal gasoline sniffing in South Australia between 2000 and 2019 were identified from the Toxicology Database and autopsy reports at Forensic Science South Australia. Furthermore, previous studies of gasoline sniffing deaths were assessed to provide historical context and approximate rates of gasoline sniffing deaths before the current study. The rate of gasoline sniffing deaths decreased significantly (P = 0.039) over the study period concomitant to an increase in the number of LAF sites nationally. Although not supported by findings of statistical significance because of the small number of cases, this study provides further supportive evidence for the effectiveness of LAF by showing a significant associated decrease in local rates of gasoline sniffing deaths.

OBJECTIVE: Determine how very-remote Indigenous community (RIC) food and beverage (F&B) turnover quantities and associated dietary intake estimates derived from only stores, compare with values derived from all community F&B providers. METHODS: F&B turnover quantity and associated dietary intake estimates (energy, micro/macronutrients and major contributing food types) were derived from 12-months transaction data of all F&B providers in three RICs (NT, Australia). F&B turnover quantities and dietary intake estimates from only stores (plus only the primary store in multiple-store communities) were expressed as a proportion of complete F&B provider turnover values. Food types and macronutrient distribution (%E) estimates were quantitatively compared. RESULTS: Combined stores F&B turnover accounted for the majority of F&B quantity (98.1%) and absolute dietary intake estimates (energy [97.8%], macronutrients [≥96.7%] and micronutrients [≥83.8%]). Macronutrient distribution estimates from combined stores and only the primary store closely aligned complete provider estimates (≤0.9% absolute). Food types were similar using combined stores, primary store or complete provider turnover. CONCLUSIONS AND IMPLICATIONS: Evaluating combined stores F&B turnover represents an efficient method to estimate total F&B turnover quantity and associated dietary intake in RICs. In multiple-store communities, evaluating only primary store F&B turnover provides an efficient estimate of macronutrient distribution and major food types.