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The Cashless Debit Card ('the card') is a stringent form of welfare quarantining targeting Aboriginal Australians. Select social security recipients have 80% of their fortnightly payments sequestered onto an electronic card that blocks the purchase of alcohol or gambling products. Advocates for the card envisage that its introduction will normalise Aboriginal family life. Analysis of the relationship between gender, care and the neo-paternalistic welfare state has been largely overlooked in research concerning the card. This article redresses that neglect, placing the lived complexities of everyday caregiving within the larger landscape of the neo-paternalistic welfare state's care. I craft three ethnographic portraits that exploire how the lived effects of the card are deeply shaped by culturally and historically conditioned caregiving practices. I then shift scales from everyday caregiving to the state's provision of care, arguing that a neo-paternalistic welfare state has effectively supplanted the post-war Australian welfare state's nurturance.

The health of Indigenous Australians is far poorer than non-Indigenous Australians, including an excess burden of infectious diseases. The health effect of built environmental (BE) features on Indigenous communities receives little attention. This study's objective was to determine associations between BE features and infectious disease incidence rates in remote Indigenous communities in the Northern Territory (NT), Australia. Remote Indigenous communities (n = 110) were spatially joined to 93 Indigenous Locations (ILOC). Outcomes data were extracted (NT Notifiable Diseases System) and expressed as ILOC-specific incidence rates. Counts of buildings were extracted from community asset maps and grouped by function. Age-adjusted infectious disease rates were dichotomised, and bivariate binomial regression used to determine the relationships between BE variables and infectious disease. Infrastructure Shelter BE features were universally associated with significantly elevated disease outcomes (relative risk 1.67 to 2.03). Significant associations were observed for Services, Arena, Community, Childcare, Oval, and Sports and recreation BE features. BE groupings associated with disease outcomes were those with communal and/or social design intent or use. Comparable BE groupings without this intent or use did not associate with disease outcomes. While discouraging use of communal BE features during infectious disease outbreaks is a conceptually valid countermeasure, communal activities have additional health benefits themselves, and infectious disease transmission could instead be reduced through repairs to infrastructure, and more infrastructure. This is the first study to examine these associations simultaneously in more than a handful of remote Indigenous communities to illustrate community-level rather than aggregated population-level associations.

Purpose We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Methods Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. Results CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). Conclusions The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.

‘Guḻarri (fresh water) has met the dhukun (metaphorically meaning confusion, doubt, misunderstandings or myths) and over the past three years become clear again, drinkable and nourishing.’ This story of freshwater, contamination and nourishment was told during a yarning circle by a community member. It was used to describe their research journey in a collaborative research project that sought to create, enact and evaluate a ‘bridge’ that early childhood education curriculum supported at one end by the strengths and content of local culture, and at the other by a proven pedagogy and learning strategy from the broader culture. This chapter draws on our experiences of implementing 3a (Abecedarian Approach Australia) in Families as First Teachers (FaFT) playgroups in two remote Indigenous communities in the Northern Territory (NT), Australia and explores the contextual realities and relational aspects of researching family practices and young children's early learning in remote communities. Specifically, we discuss the factors that shaped the implementation of the research and consider the approaches to grow research relationships of trust and collaboration. These partnerships within the research team (university and FaFT) enabled culturally appropriate adaptations and local language interpretations that ensured the strengths of Aboriginal identity, culture and language were upheld in the implementation of the programme. Insights from our efforts to collaboratively develop a culturally responsive Early Childhood Education and Care (ECEC) programme are discussed as design principles that might influence Indigenous early childhood educational research more broadly.

Using qualitative self-reported and observational evidence combined with a quantitative breakdown of linked administrative justice system data, this before-and-after study demonstrates the beneficial impacts of a First Nations community-controlled adult literacy campaign in six rural and remote communities in New South Wales, Australia. The most significant quantitative finding is a 50% reduction in reported serious offences in a sample of 162 campaign participants. Qualitative data from interviews found  an increased use of legal assistance services following the campaign. These findings are contextualised through the lived experiences and perceptions of First Nations campaign staff and participants, community leaders and government and non-government agency personnel.

Pre-service teachers are required to become reflective practitioners who can adapt their skills to a range of contexts and the diverse needs of learners. Many consider the practicum experience as critical to forming values and dispositions that are essential to a professional teacher identity. This article focuses on the experiences of five White pre-service teachers who volunteered to teach in remote Indigenous communities in South Australia, specifically the Anangu Pitjantjatjara Yankunytjatjara Lands, a desert environment in the far northwest of the state. As these pre-service teachers document their experiences, we draw upon Gee's work on identity to gain insights into how they understand the "rules" of their context and their own positionality. Our research reveals the ways privilege can foster possibilities and constraints, which afford certain subject positions for these pre-service teachers. We focus specifically on a prominent theme in their narratives - "authenticity" concerning their conception of teaching and learning.

Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-based decisionmaking regarding the allocation of rural services. We suggest that adopting a comprehensive definition of maternity services risk that considers both social and health services risks and their impact on clinical risk, could provide a solid basis for effective advocacy by professional bodies.

Aim Explore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7-year period. Methods Retrospective audit of all children (0?18?years) presenting to emergency from 1 January 2010 to 31 December 2016 with anaphylaxis, defined by Australasian Society of Clinical Immunology and Allergy definitions and doctor diagnosis. Results Seven hundred and twenty-four patients were identified with allergic diagnosis, 60% were diagnosed with non-anaphylaxis allergic reactions or unspecified urticaria and 40% with anaphylaxis (n =?286). Annual prevalence of anaphylaxis remained stable over the study period (M =?30.9/10 000 cases, range: 20.8?48.3/10 000). Gender distribution was equal, median age was 9.48?years (interquartile range = 4?15). Most (71%) arrived by private transport. 23% had a prior history of anaphylaxis. Food triggers (44%) were the most common cause of anaphylaxis. Insect bites/stings triggers occurred in 21%. Patients were promptly assessed (average wait time = 13?min), 16% received prior adrenaline injections. Adrenaline was administered in 26% and 20% were admitted to hospital. On discharge, 29% had a follow-up plan, 9% received an allergy clinic referral, 6% anaphylaxis action plan, 26% adrenaline autoinjector prescriptions and allergy testing performed in 6%. Conclusions We found a relatively low prevalence of overall childhood anaphylaxis in a regional area. The two most common causes of anaphylaxis in this population (food and bites/stings) recorded increased prevalence providing an opportunity for further study. Significant gaps in evidence-based care of anaphylaxis were noted, demonstrating the need for improved recognition and treatment guideline implementation in regional areas.

Introduction Otitis media (OM) starts within weeks of birth in almost all Indigenous infants living in remote areas of the Northern Territory (NT). OM and associated hearing loss persist from infancy throughout childhood and often into adulthood. Educational and social opportunities are greatly compromised. Pneumococcus and non-typeable Haemophilus influenzae (NTHi) are major OM pathogens that densely colonise the nasopharynx and infect the middle ear from very early in life. Our hypothesis is that compared to current single vaccine schedules, a combination of vaccines starting at 1 month of age, may provide earlier, broadened protection.Methods and analyses This randomised outcome assessor, blinded controlled trial will recruit 425 infants between 28 and 38 days of age and randomly allocate them (1:1:1) to one of three pneumococcal conjugate vaccine (PCV) schedules: Synflorix at 2, 4, 6 months of age, Prevenar13 at 2, 4 and 6 months of age, or an investigational schedule of Synflorix at 1, 2 and 4 months plus Prevenar13 at 6 months of age. The blinded primary outcomes at 7 months of age are immunogenicity of specific vaccine antigens (geometric mean concentration (GMC) and proportion of participants with above threshold GMC of 0.35 µg/L). Secondary outcomes at all timepoints are additional immunogenicity measures and proportion of participants with nasopharyngeal carriage of vaccine-type pneumococci and NTHi, and any OM, including any tympanic membrane perforation. Parental interviews will provide data on common risk factors for OM.Ethics and dissemination Ethical approval has been obtained from NT Department of Health and Menzies HREC (EC00153), Central Australian HREC (EC00155) and West Australian Aboriginal Health Ethics Committee (WAAHEC- 377-12/2011). Final trial results, data analyses, interpretation and conclusions will be presented in appropriate written and oral formats to parents and guardians, participating communities, local, national and international conferences, and published in peer-reviewed open access journals.Trial registration numbers ACTRN12610000544077 and NCT01174849.

Haemophilus haemolyticus can be misidentified as nontypeable Haemophilus influenzae (NTHi) due to their phenotypic similarities in microbiological culture. This study aimed to determine the prevalence of misidentified NTHi in respiratory specimens from children living in northern Australia.

Acute otitis media with perforation (AOMwiP) affects 40% of remote Indigenous children during the first 18 months of life. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the primary bacterial pathogens of otitis media and their loads predict clinical ear state. Our hypothesis is that antecedent respiratory viral infection increases bacterial density and progression to perforation.

Nontypeable Haemophilus influenzae (NTHi)-associated disease is a major health problem globally. Whole-genome sequence analysis identified the absence of hpd genes encoding Haemophilus protein D in 3 of 16 phylogenetically distinct NTHi isolates. This novel finding is of potential clinical significance, as protein D and hpd represent important NTHi vaccine antigen and diagnostic targets, respectively.

Background: Chronic suppurative otitis media (CSOM) affects many children in disadvantaged populations. The most appropriate topical antibiotic treatment in children with persistent disease is unclear. Methods: Children with CSOM despite standard topical treatment were randomized to 6–8 weeks of topical ciprofloxacin (CIP) versus topical framycetin-gramicidin-dexamethasone (FGD). Otoscopic, audiologic, and microbiologic outcomes were measured using standardized assessments and blinding. Results: Ninety-seven children were randomized. Ear discharge failed to resolve at the end of therapy in 70% children regardless of allocation [risk difference = −2%; (95% CI: −20 to 16)]. Healing of the tympanic membrane occurred in one of 50 children in the CIP group and none of 47 children in the FGD group. Severity of discharge failed to improve in more than 50% children in each group, and mean hearing threshold (38 dB and 35 dB) and proportion of children with greater than 25 dB hearing loss (98% and 88%) were not significantly different between the CIP and FGD groups. Side effects were rare. Conclusions: This study showed a similarly low rate of improvement or cure in children with persistent CSOM for both CIP and FGD topical therapies. Complications and side effects were insufficient to cease therapy or inform prescribing of either therapy.

In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM Pfizer) was replaced in the Northern Territory childhood vaccination schedule by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; Synflorix™ GlaxoSmithKline Vaccines). This analysis aims to determine whether the reduced prevalence of suppurative otitis media measured in the PHiD-CV10 era was associated with changes in nasopharyngeal (NP) carriage and middle ear discharge (ED) microbiology in vaccinated Indigenous children.

Introduction Otitis media (OM) is a common childhood illness, often resolving without intervention and acute and long-term complications are rare. However, Australian Aboriginal and Torres Strait Islander infants and children experience a high burden of OM and are at high risk of complications (tympanic membrane perforation and chronic infections). Bacterial OM is commonly associated with Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis. BIGDATA is a data asset combining over 25 years of microbiology and OM surveillance research from the Ear Health Research Program at Menzies School of Health Research (Northern Territory, Australia), including 11 randomized controlled trials, four cohort studies, eight surveys in over 30 remote communities (including data from Western Australia), and five surveys of urban childcare centers including Aboriginal and Torres Strait Islander and non-Indigenous children. Outcome measures include clinical examinations (focusing on OM), antibiotic prescriptions, pneumococcal vaccination, modifiable risk factors such as smoking and household crowding, and nasopharyngeal and ear discharge microbiology including antimicrobial resistance testing. Methods and Analysis The initial series of projects are planned to address the following key knowledge gaps: (i) otitis media prevalence and severity over pre pneumococcal conjugate vaccines (PCVs) and three eras of increasing PCV valency; (ii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics of pneumococcal serotypes, and antimicrobial resistance; (iii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics and antimicrobial resistance of other otopathogens; and (iv) serotype specific differences between children with acute OM and OM with effusion or without OM. These data will be utilized to identify research gaps, providing evidence-based prioritization for ongoing research. Ethics and Dissemination Data asset creation and priority analyses were approved by the Human Research Ethics Committee of Northern Territory Department of Health and Menzies School of Health Research (EC00153, 18-3281), the Child and Adolescent Health Service Human Research Ethics Committee and Western Australian Aboriginal Health Ethics Committee. Dissemination will be through peer review publication and conference presentations.

Objective This study explored the delivery of opioid maintenance treatment (OMT) from a specialist program in rural and remote New South Wales (NSW), focusing on the viability of the model and strategies for its improvement. Design Program evaluation examining configuration and delivery, client characteristics and trends in demand, using policy documents, service data and stakeholder consultations (n?=?28). Setting The Greater Western Area Health Service, a sparsely populated and large geographic area in NSW. Results There were four service hubs or primary sites. Three sites were co-located with hospitals and one within community health, with all sites providing assessment, prescribing, dispensing and limited case management. Staff were mainly trained nurses, while prescribers were visiting specialists or sessional GPs. There was minimal OMT provision by community prescribers and dispensers. In 2009, there were 638 clients. They were younger on average than those in OMT across Australia. The most common principal drug of concern was heroin (37?85% of clients), while around one-fifth of clients identified prescription opioids (18?23%). There was a substantial increase in OMT provision between 2006 and 2009 at three program sites. Staff at the sites had limited capacity to engage primary health services and thus reduce their client load. Conclusions Findings indicate the need to adjust funding to account for increased demand for OMT and to establish a financial incentive for GP prescribers. Dedicated resourcing is needed for a capacity building role to support the uptake of prescribing and dispensing in community services.

Australia’s rural and remote health practitioners must be armed with information to help reduce risk of mental health problems in individuals with issues of gender dysphoria and sexual orientation, according to Australia’s Human Rights Commissioner Tim Wilson.

Aims To elucidate key considerations for effective health promotion with Aboriginal and Torres Strait Islander males in remote Northern Territory. Context Despite the significant disparities in health outcomes amongst Aboriginal and Torres Strait Islander males, particularly in remote Northern Territory, investment in health promotion policy and practice has been inadequate. Progressing towards self-determination with Aboriginal and Torres Strait Islander males, and to meet the unique health and well-being needs of this marginalised demographic, consideration for staff retention and training, strengths-based approaches, and implications of divergent masculinities must be considered when devising and delivering culturally responsive and appropriate health promotion interventions. Health promotion needs to be conducted in a collaborative manner, and in less conventional settings, to better engage Aboriginal and Torres Strait Islander males. Approach This commentary draws on the author's reflections about working in remote Aboriginal and Torres Strait Islander health policy, practice and research contexts in Northern Australia. It brings together diffuse strands of scholarship about Aboriginal and Torres Strait Islander male health; Aboriginal and Torres Strait Islander health promotion; and health promotion in rural and remote contexts. In doing so, we identify and discuss strategies that have potential to strengthen Aboriginal and Torres Strait Islander male health promotion in rural and remote Australia. Conclusion Health services and professionals in remote Northern Territory must leverage the inherent strengths of Aboriginal and Torres Strait Islander males to imbue service delivery with both meaning and capacity for self-determination. In doing so, this might ultimately help to alleviate the marginalisation of this demographic.

The System of Environmental-Economic Accounting Ecosystem Accounting (SEEA-EA) is widely promoted in environmental and economic policy and management. Unfortunately, the SEEA-EA has not substantively addressed the aspects of accounting that may be of interest to, or used by, Indigenous peoples. We investigate an Indigenous perspective on the potential of the SEEA-EA to support cultural and environmental management through collaborative workshops with managers of Nyamba Buru Yawuru, the Prescribed Body Corporate representing the Yawuru Traditional Owners in Western Australia. Our discussions highlight that while the SEEA-EA may be a valuable tool for empowering Indigenous people and supporting the management of their lands and seas, there are areas where the SEEA-EA needs to be broadened to better reflect cultural values, and the services to ecosystems provided by Indigenous peoples. Embedding Indigenous perspectives into the SEEA-EA would mean that it is of greater use to Indigenous peoples and their representative organisations and ensure that these values are better recognised in the policymaking of government.

AIM: COVID-19 rapidly transformed how Australians access health care services. This paper considers how the inability for urban patients to access in-person care expediated the introduction of virtual solutions in health service delivery thus creating a new access paradigm for rural and remote Australians. CONTEXT: 'Physical distancing' is a phrase synonymous with public health responses to COVID-19 in Australia, but distance is a decades-long problem for rural health access. Counterintuitively, the pandemic and associated restrictions on mobility have reduced in real terms the distance from, and therefore the time taken to access, critical public services. 'Lockdowns' have unlocked health access for rural and remote Australians in ways that had been rejected prior to 2020. The pandemic has disrupted traditional delivery models and allowed the piloting of novel solutions, at the same time as stress-testing current delivery systems. In the process, it has laid bare a myopia we term 'urban paternalism' in understanding and delivering rural health. APPROACH: This commentary outlines how the COVID-19 operating environment has challenged traditional urban-dominated policy thinking about virtual health care delivery and how greater availability of telehealth appointments goes some way to reducing the health access gap for rural and remote Australians. CONCLUSION: Australian Commonwealth Government policy changes to expand the Medical Benefit Scheme (MBS) to include telephone or online health consultations are a positive initiative towards supporting Australians through the ongoing public health crisis and have also created access parity for some rural and remote patients. Although initially announced as a temporary COVID-19 measure in March 2020, telehealth has now become a permanent feature of the Medicare landscape. This significant public health reform has paved the way for a more flexible and inclusive universal health care system but, more importantly, taken much needed steps towards improving access to primary health care for patients in rural and remote areas. Now the question is: Can the health care system integrate this virtual model of delivery into 'business as usual' to ensure the long-term sustainability of telehealth services to rural and remote Australia?

Transcribing speech for primarily oral, local languages is often a joint effort involving speakers and outsiders. It is commonly motivated by externally-defined scientific goals, alongside local motivations such as language acquisition and access to heritage materials. We explore the task of ‘learning through transcription’ through the design of a system for collaborative speech annotation. We have developed a prototype to support local and remote learner-speaker interactions in remote Aboriginal communities in northern Australia. We show that situated systems design for inclusive non-expert practice is a promising new direction for working with speakers of local languages.

This chapter presents the second of four case studies exploring contemporary practices of community performance. Big hART’s practical methodology engages a multilayered approach holding in tension individual experiences of exclusion, assets-based community development, the creation of ‘exquisite’ art and national policy change. These dimensions animate Big hART’s dynamic and iterative practice. The chapter examines the final creative development process for Hipbone Sticking Out before the performance premiered at a mainstage theatre in Canberra, the capital city of Australia, in July 2013. Hipbone was produced as part of the Yijala Yala project based in Roebourne, a town of approximately 1000, mostly Indigenous inhabitants in north-western Western Australia. The chapter focuses on the articulation of big hART’s cultural rights-based approach within what anthropologist, Mary Edmunds, refers to as “the hard demands of an overwhelming Pilbara development trajectory [in which] both government and resource companies are essential players in determining what the extent, and the limits, of [Indigenous] self-determination might be” (2012, p. 51). The case study provides detailed examples of a way of working that enables individuals and communities that have experienced social exclusion to stake a claim in mainstream spaces, to call for a response to systematic injustice and to create vital cultural livelihoods.

Housing in Australia’s Northern Territory (NT) remote areas has remained a challenge despite many years of attempts by policy makers and engineers. Community engagement has been found a major factor in success of remote projects and one way to attract local engagement and reduce construction cost in remote areas is using locally available materials in construction. In this paper technical feasibility of using mudbrick made from local soil is studied through standard compressive and erosion resistance tests. Results show that both compressive strength and erosion resistance of the mudbricks made in the study meet the requirements recommended by HB 195 – Australia earth building handbook. Findings suggest that mudbrick could be considered as an alternative construction material to the current common practice of using block work in NT remote areas. Inclusion of a low amount of high lime content Portland cement was found significantly effective in improving mudbrick erosion resistance properties.

Background Machado-Joseph Disease (MJD), or Spinocerebellar Ataxia Type 3 (SCA3), is a genetic disorder that causes progressive muscle weakness, loss of motor control, ataxia and permanent physical disability. Sleep disturbances are associated with MJD but remain poorly understood. Objective To investigate frequency and characteristics of sleep disorders and their association with health-related quality of life and psychosocial wellbeing for Aboriginal Australians living with MJD. Methods A convenience sample of MJD participants n = 24 participated in a semi-attended, ambulatory diagnostic sleep study to capture polysomnography, actigraphy and sleep diary data. Self-report measures collected were the Pittsburgh Sleep Quality Index (PSQI), STOP-BANG Questionnaire for Obstructive Sleep Apnoea (OSA), International Restless Legs Syndrome Study Group rating scale (IRLS), Kessler-5 (K5) and EuroQoL-5 Dimension (EQ5D). Caregivers (n = 22) reported EQ-5D, K5 and bed partners’ sleep behaviour (Mayo Sleep Questionnaire-Informant). Environmental factors were measured. Results We observed Nocturia, Sleep Related Leg Cramps, OSA, REM Behaviour Disorder, and RLS, respectively in 100%, 71%, 47%, 43%, and 33% of participants with a significant positive correlation between Body mass index (BMI) and Apnoea hypopnea index (AHI). The majority of sleep was spent in non-rapid eye movement sleep (NREM)-N2 stage (77.8% (67.7, 81.6)). Overcrowding (92%) and overnight care needs (42%) interrupted sleep. MJD participants and caregivers reported high psychological distress (K5 median 12.5 IQR 7, 16.5 & 8 IQR 6, 12 respectively). Conclusion Poor sleep quality and sleep disturbances are prevalent among this cohort. Disease manifestations and environmental factors are driving factors. Larger sample sizes are required to predict risk factors and confirm observed associations.

While Computer Assisted Language Learning (CALL) is being superseded by an integrated approach to language learning and technology, it still has great potential to assist indigenous peoples in becoming print-literate in their own languages. This can also help to combat the disempowerment experienced by indigenous people as their world is penetrated by others with radically different backgrounds. This paper reports on research on an application of CALL implemented among the Kunib dji, a remote, indigenous Australian community. It focuses on the use of talking books in Ndjebbana, a language with only 200 speakers; the books were displayed on touch-screens at various locations in the community. Investigations into the roles of the computer to support language learning and cultural understanding are also reported. The computer was found to be a useful tool in promoting Kunib dji collaboration and cultural transformation.