Remote Australia Online

Central Australia is a human T-cell leukemia virus type 1c (HTLV-1c) endemic region and has the highest incidence of chronic kidney disease (CKD) in Australia. The factors associated with HTLV-1 seropositivity among Aboriginal Australian adults with CKD receiving hemodialysis (HD) were determined. A retrospective observational study of Aboriginal adults (≥ 18 years) who were receiving regular HD at the two main dialysis units in Alice Springs, December 1, 2010 to December 31, 2015. Demographic and clinical data before commencing HD were extracted from hospital records from the first presentation to Alice Springs Hospital (ASH) to HD commencement and associations were determined using logistic regression. Among 373 patients receiving HD, 133 (35.9%) were HTLV-1 infected. Identifiable factors associated with HTLV-1 status included increasing age, male gender, and diabetes before HD. The odds of diabetes mellitus were significantly higher among patients with HTLV-1 (adjusted odds ratio [aOR]: 2.76, 95% confidence interval [CI]: 1.19, 6.39; p=0.017). More than one-fifth of participants had an acute kidney injury, the risk of which was increased among those with a previous blood stream infection (aOR: 3.02, 95% CI: 1.71, 5.34, p<0.001). Men with a high HTLV-1 proviral load (≥500 copies per 105 peripheral blood leukocytes) had an increased risk of urinary tract infection (UTI) before HD (aOR: 5.15, 95% CI: 1.62, 16.40; p=0.006). A strong association between HTLV-1 and diabetes, and an increased risk of UTI among men with a high HTLV-1 PVL, suggest that interactions between HTLV-1 infection and conventional risk factors may increase the risk for CKD in this population.

Questions Buffel grass (Cenchrus ciliaris L.) is a drought-adapted invasive plant that has become a serious environmental weed in many arid and semi-arid systems. This paper examined whether eradication of buffel grass infestations: (i) increases frequency, richness and diversity of native vegetation and seed bank pools; and (ii) improves availability of seed resources for granivores. Location Alluvial ironwood/corkwood woodlands in arid central Australia. Methods We assessed differences in floristic and seed bank composition between buffel-infested sites and sites where buffel grass had been eradicated ca. 12 years previously. Plant species frequency data from nested-quadrat sampling were amalgamated into plant functional groups to examine their relationship to buffel treatment. A seed flotation method was employed to: (i) assess seed bank composition of functional groups at eradicated vs. infested sites; and (ii) test whether the mass of seeds available for granivores was higher at buffel-free sites. Results Buffel-eradicated sites supported richer and more diverse vegetation and seed banks across all functional groups except perennial grasses. The effect was strongest for perennial forbs, annual/short-lived forbs, and annual/short-lived grasses. The overall mass of seeds of non-buffel grass species was ca. 10-fold higher at buffel-removed sites. Numbers of seeds of species in the 0.001-0.009 9 g and 0.000 1-0.000 99 g size classes, both of which contain species with seeds consumed by granivores, were ca. 20- and 14-fold higher respectively at buffel-removed sites. Conclusions Buffel grass removal at localised scales provides islands of habitat with improved opportunities for native plant re-establishment and abundant foraging resources for granivores. Future research must disentangle the relative importance of dispersal vs. residual seed banks for community restoration after buffel grass invasion. Extended delays in eradication could allow seed bank reserves to deteriorate to a state that no longer permits regeneration.

Issue addressed Prevention approaches specific to prenatal alcohol exposure (PAE) and foetal alcohol spectrum disorder (FASD) have been identified as urgently needed in Australia, including in Aboriginal and Torres Strait Islander communities. However, very little work has aimed to describe and evaluate health promotion initiatives, especially those developed in rural and remote areas. Methods A series of television commercial scripts (scripts) were developed with health promotion staff at an aboriginal and Torres Strait Islander Community Controlled Health Service and piloted with 35 community members across six yarning sessions. Results Scripts evoked responses in line with two predominant themes: 'Strength' and 'Community resonance.' This process led to the development of a four-part television and radio campaign focusing on a life course approach to prevent prenatal alcohol exposure (PAE) 'Vision,' 'Future,' 'Cycle' and 'Effect.' Conclusions Intergenerational influences on PAE were key elements of scripts positively received by community members. Strengths of this work included a flexible approach to development, local aboriginal men and women coordinating the yarning sessions, and the use of local actors and familiar settings. So what? Preventing PAE is extraordinarily complex. Initiatives that are culturally responsive and focus on collective responsibility and community action may be crucial to shifting prominent alcohol norms. Future work is necessary to determine the impact of this campaign.

Objective: To describe the placental characteristics and neonatal outcomes of Central Australian Aboriginal women based on maternal self-report of tobacco use. Methods: Placental and neonatal variables were collected from a prospective maternal cohort of 19 smokeless tobacco chewers, 23 smokers and 31 no-tobacco users. Results: Chewers had the lowest placental weight (460 g) while the no-tobacco group had the heaviest placental weight (565 g). Chewers and the no-tobacco group had placental areas of similar size (285 cm2 and 288 cm2, respectively) while the placentas of smokers were at least 13 cm2 smaller (272 cm2). There were two stillbirths in the study and more than one-third (36%) of neonates (newborns) were admitted to the Special Care Nursery, with the chewers' neonates having a higher admission rate compared with smokers' neonates (44% vs. 23%). The cohort mean birthweight (3348 g) was not significantly different between the groups. When stratified for elevated maternal glucose, the chewers' neonates had the lowest mean birthweight (2906 g) compared to the neonates of the no-tobacco group (3242 g) and smokers (3398 g). Conclusions: This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Implications for public health: Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.

Social networks play a crucial role in linking poorly-resourced community-based Aboriginal land and sea management 'ranger' groups operating in remote Northern Australia with the resources and support required to fulfil natural and cultural resource management objectives. A lack of resources and piecemeal funding demands that a significant proportion of networks utilised are directed at creating capital to support land and sea management programs, in addition to networks created for undertaking land and sea management itself. Other networks have been created with neighbouring land managers to develop cooperative and collaborative management practices. The network structure of one ranger group in the west Arnhem region of the Northern Territory was analysed, and revealed a lack of resilience due to high dependence on the externally sourced coordinator. The reliance on a web of complex networks both to support the program and to undertake management activities raises questions about the viability of such programs. In particular, the time, level of skill and associated capacity required to negotiate social network construction with a range of actors brings into question the communities' capacity to maintain the functions of the program independently. Continued functionality of these land and sea management programs may depend on simplification and streamlining of funding, removal of intensive bureaucratic reporting requirements and more active skill development of participants in network creation, particularly with actors external to the community.

We examine the influence of drought and a variety of factors on agriculture in Northern Australia. Assuming constant prices, and using data collected from northern land managers, we estimate a Cobb-Douglas production function and use coefficients from the model to estimate the financial losses associated with drought. We find that drought-affected properties earn about half as much as other 'similar' properties. We then ask: How much does that 'cost' the industry, on average, and how would those costs change if droughts were to become more, or less widespread under climate change? Our estimates indicate that under the current climatic regime, the Northern Australian agricultural industry loses, on average, about 19% of output to drought each year: this could fall to 10% or rise to 40% under current climate projections. Although focused on Northern Australia, the findings have wider implications for management and adaption, given the magnitude of impacts and their likelihood to extend beyond the 'official' end of drought. Investments in climate-proof crops, on-farm management techniques and financial arrangements to help producers deal with a range of climatic risks, for example, should thus be priorities.

A main strategy of campaigns for 'smart' sustainable use of natural resources is to engage and educate local communities. Based on field research in the desert town of Alice Springs in central Australia, the article analyses how local residents variably resist, contest and support the kinds of values and forms of knowledge underpinning such campaigns. Taking the local implementation of a national Water Smart campaign as an example, the article draws on recent anthropology of place-making, belonging and meanings of water as part of cultural landscapes in order to illuminate how local dynamics of class-based values and associated historical patterns of education, occupation and Indigenous-settler relations are put into play as locals question increasingly dominant ontological and institutional assumptions about water in global discourses of environmental economics and natural resource management.

'Environmental values' form an increasingly important component of natural resource management, but use of the term 'value' is dominated by a narrow and limiting utility-based definition. In this paper I consider theories of value and practices of valuing water in the arid and semi-arid Lake Eyre Basin, central Australia. While value is the subject of diverse meanings - both within a range of academic disciplines and as understood by people in specific places - methods of valuing water in natural resource management are limited by reductionism, anthropocentrism and cultural specificity. This conceptualisation of value does not adequately capture what people in the Lake Eyre Basin value about water. I propose valuing variability as a new framework for valuing water that embraces diversity, change and complexity, and emphasises interconnections between water, humans and the non-human world. While physical variability is gaining acceptance in both the academy and management, the variability of social, cultural and ontological aspects of water has elicited less discussion. The theme of variability provides a useful framework for thinking about water, and for understanding relationships between water, place, people and the non-human world.

Purpose This two-year (2016-2018) study aimed to identify what a good life is for Aboriginal people with disability in remote Central Australia and how service providers can support them to achieve a good life. This paper presents the findings that relate to barriers to delivering services for Aboriginal people with disability. Methods In-depth interviews and focus groups were held with Aboriginal people with disability and their carers aged at least 18 years from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Lands and community organisations providing services there. The data were analysed using thematic analysis. Results There were 109 participants, of whom 47 were workers in service provider organisations and 62 were Aboriginal people. From the data, barriers to delivering services to support Aboriginal people to live a good life and solutions to overcome the barriers, were identified and described under the headings of environmental barriers and systemic issues. Conclusions We discuss the policy implications of these findings with regard to addressing Indigenous disadvantage and how governments, service providers, communities, and Aboriginal people with disability and their families can work in partnership to address these barriers. Implications for Rehabilitation Indigenous people with disability living in remote and very remote communities experience significant access and equity barriers to culturally responsive services that enable them to live a socially and culturally engaged life.Localised government and service provider disability policy approaches in Indigenous communities need to focus on both environmental and systemic issues. Greater investment in local remote communities is required to build the capacity of Indigenous families to support Aboriginal people with a disability to live a culturally and socially included life.

This paper describes and analyzes the model of care provided by the Ilpurla remote outstation rehabilitation program in Australia's Northern Territory. Reflections are offered about the cultural antecedents of the model, and how it addresses the needs of young Indigenous people. Data describing client numbers, length of stay, the underlying approach to rehabilitation, and the practices of the program are presented. The paper aims to promote an understanding of the outstation model of care, highlight difficulties between programs and their funding sources, and encourages recognition of its importance in the response to drug and alcohol use-related problems among Indigenous people.

Inhalation of petrol (gasoline) fumes has been prevalent in some Australian Indigenous communities since World War II, and has led to a continuing quest for an effective method of preventing the practice either by modifying the substance or by substituting nonharmful alternatives. This article traces the results of this search, beginning with the addition of ethyl mercaptan, then describing the substitution of aviation fuel for conventional vehicle fuel, and concluding with the staged introduction of Opal?a vehicle fuel containing low levels of aromatic hydrocarbons?throughout many communities from 2005. The article assesses the benefits and limitations of supply reduction methods.

Vulvar cancer is a serious condition that requires a range of specialist treatments including surgery, chemotherapy, and radiation. In Australia, such treatments are only available in major metropolitan hospitals. Thus, women diagnosed with this condition in rural and remote areas must relocate to the metropolitan specialist centers for treatment. The focus of this article is on the experience of relocation for specialist care for Indigenous women diagnosed with vulvar cancer from East Arnhem Land, Northern Territory, Australia. The findings presented in this article explore a range of issues that affect the experience of relocation such as community concerns, cultural distress, loneliness, fear, worry, and physical concerns associated with the condition.

Background Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Methods Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012-2018. Population data for the same time period provided rates. Results Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re-admission rate was 3.8% and all-cause mortality was 0.03%. Conclusion The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non-Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

Leprosy is now very rarely acquired in Australia, but it is still diagnosed; Indigenous Australians in remote locations bear the greatest burden of disease. Historically, its incidence has been highest in the Northern Territory, but cases are also diagnosed in Far North Queensland (FNQ), a region that adjoins Papua New Guinea (PNG), where leprosy remains endemic. Since 1985, Torres Strait Islander Australians and PNG nationals have been able to move freely across the border to pursue traditional activities in the Torres Strait Protected Zone. This arrangement acknowledges the importance of their shared cultural history, but also means that FNQ clinicians may encounter conditions that are rare in temperate Australia. The potential public health implications are also clear. To evaluate the epidemiology of leprosy in FNQ, we retrospectively reviewed all laboratory-confirmed cases diagnosed in the region during 1989–2018. The Far North Queensland Human Research and Ethics Committee provided ethics approval for the study (reference, HREC/18/QCH/107). Twenty cases of leprosy were identified in the Queensland Health Notifiable Conditions Register (Box 2). The median age of the patients was 26 years (interquartile range, 16–36 years); 11 patients had been born in Australia, including seven of nine Torres Strait Islanders (but no Aboriginal Australians). Apart from 1989 (six cases) and 2017 (three cases), no more than two cases had been notified in a single year. The most recent Australian-born patient was a 28-year old Torres Strait Islander woman diagnosed in 2009; she had had close contact with a person with leprosy born in PNG.

Australian Aboriginal and Torres Strait Islander people continue to experience significant disparities in oral health and there remains an urgent need to improve services to rural and remote communities. Quantitative research has typically been used to highlight the disease burden and severity experienced by those living in remote communities, but this data does little to explore the lived reality and psychosocial nuances that impact on care. The Kimberley region of Western Australia is home to over 150 Aboriginal communities spread out across 400,000 square kilometres. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discussions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities.

Current research suggests that Aboriginal-controlled organizations should play a larger role in developing and implementing sports-based programmes for Aboriginal young people. In this paper, we explore the influence of an Aboriginal-controlled organization and its government-funded remote sports-based programme on Aboriginal participants and non-Aboriginal stakeholders. We consider whether this sports-based programme is meeting the needs of a remote community in Northern Territory, Australia, and argue that the influence of the Aboriginal controlled organization is somewhat minimized, due to the constraints of government policy and associated funding, which focus on the socioeconomic agenda of reducing gaps between Aboriginal and non-Aboriginal Australians in health, education and employment. The Aboriginal community members and youth would appreciate the Aboriginal-controlled organization working more closely with them to improve the influence of the programme by paying respect to the local Aboriginal culture, social systems and knowledge.

Whose values matter when considering which environment is healthier for a child whose guardianship is contested? The biological mother from a remote Australian Aboriginal community, who voluntarily relinquished her but has now requested her return? The foster mother who has cared for her in a metropolitan centre in another State of Australia, thousands of kilometres away? The welfare professionals who also live in that city? Or the child herself, who left her birth home and community five years earlier at the age of two? Drawing on a case study of a seven-year old Aboriginal girl, the authors argue that non-Indigenous values trumped Indigenous values without the realisation of key players who were empowered to make such determinations. The article uses Manuel DeLanda's neo-assemblage theory to consider the range of processes that exert themselves to shape place-values and social identity in colonised nations. It will also draw on Erik Erikson's and Lev Vygotsky's theories of psychosocial development to consider competing sets of values that raised feelings of dissonance within the child. Beliefs about what makes a place health-giving are revealed to be complex in colonised nations. Despite policy and legislative changes to better support Aboriginal people and their right to difference, non-Indigenous professionals can continue to be driven by an unrecognised systemic racism. While place-values are not, of course, the only (or perhaps even the most significant) consideration in guardianship determinations, this article will argue they can play a significant and covert role.

This paper argues that the advent of Township Leasing has made some progress towards more inclusive economic and political institutions on ALRA land in the Northern Territory. It is likely this has led, and will lead, to better socio-economic outcomes for the people living there. However, Township Leasing is not an end unto itself and should only be viewed as a worthy stepping-stone to full Traditional Owner autonomy and control over their own land. To that end, the final section of the paper makes some recommendations to enhance Township Leasing. These include: continuing to increase support for Community-Entity Township Leasing; streamline the negotiation process; extend the sc ope of Township Leasing; and upgrade the monitoring and evaluation of its impact.

Co-production across scientific and Indigenous knowledge systems has become a cornerstone of research to enhance knowledge, practice, ethics, and foster sustainability transformations. However, the profound differences in world views and the complex and contested histories of nation-state colonisation on Indigenous territories, highlight both opportunities and risks for Indigenous people when engaging with knowledge co-production. This paper investigates the conditions under which knowledge co-production can lead to improved Indigenous adaptive environmental planning and management among remote land-attached Indigenous peoples through a case study with ten Traditional Owner groups in the Martuwarra (Fitzroy River) Catchment in Western Australia’s Kimberley region. The research team built a 3D map of the river and used it, together with an interactive table-top projector, to bring together both scientific and Indigenous spatial knowledge. Participatory influence mapping, aligned with Traditional Owner priorities to achieve cultural governance and management planning goals set out in the Fitzroy River Declaration, investigated power relations. An analytical framework, examining underlying mechanisms of social learning, knowledge promotion and enhancing influence, based on different theories of change, was applied to unpack the immediate outcomes from these activities. The analysis identified that knowledge co-production activities improved the accessibility of the knowledge, the experiences of the knowledge users, strengthened collective identity and partnerships, and strengthened Indigenous-led institutions. The focus on cultural governance and management planning goals in the Fitzroy River Declaration enabled the activities to directly affect key drivers of Indigenous adaptive environmental planning and management—the Indigenous-led institutions. The nation-state arrangements also gave some support to local learning and decision-making through a key Indigenous institution, Martuwarra Fitzroy River Council. Knowledge co-production with remote land-attached Indigenous peoples can improve adaptive environmental planning and management where it fosters learning together, is grounded in the Indigenous-led institutions and addresses their priorities.

OBJECTIVES: The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). METHODS: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. RESULTS: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. CONCLUSIONS: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.

INTRODUCTION: Aboriginal* children in rural and remote communities in Australia have a higher burden of dental decay and poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience six times the rate of untreated dental decay of non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers who participated in a project that tested the minimally invasive atraumatic restorative treatment and the Hall technique approaches (ART-HT) to manage early childhood dental caries among Australian Aboriginal preschool children. METHODS: The core study design was a stepped-wedge, cluster-community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement; the early intervention group was offered dental treatment using the ART-HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up, children in both groups were re-examined and offered care using the minimally invasive model of care, and parents and carers were invited to take part in focus group or one-to-one interviews. Semistructured interviews, guided by the yarning approach, were conducted with consenting parents and carers in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio-recorded with permission and transcribed by an independent agency. Thematic analysis was undertaken, the transcripts were coded by NVivo software, and emergent themes were identified and developed. RESULTS: One-to-one interviews were conducted with 29 parents and carers (10 from five test communities; 19 from eight control communities). Interview participants consisted of 3 males and 26 females. Following thematic analysis, three main themes (and subthemes) were identified: (1) access to care (barriers, service availability, impact on family due to lack of access); (2) experience of care (cultural safety, child-centred care, comprehensiveness of care); (3) community engagement (service information, engagement, oral health education). Structural and system factors as well as geography were identified as barriers by parents and carers in accessing timely and affordable dental care in culturally safe environments; parents and carers also identified the impacts from lack of access to care. They valued comprehensive care delivered within community, underpinned by child- and family-centred care. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships. CONCLUSION: A high level of satisfaction was reported by parents and carers with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and that were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable and should be considered in delivering oral health services for young children in rural and remote locations. * The term Aboriginal is inclusive of Aboriginal and Torres Strait Islander peoples.

Objective Out-of-hospital cardiac arrest is an event with an extremely poor prognosis. There is limited literature on the outcomes for regional Australia, with none specifically addressing remote populations. We aimed to assess out-of-hospital cardiac arrest outcomes in the aeromedical retrieval population of the Top End Medical Retrieval Service. Design We retrospectively identified all cardiac arrests, deaths and patients who had cardiopulmonary resuscitation within the aeromedical retrieval database for a 5-year period from January 2012 to December 2016. Setting Retrieval patients across the Top End of the Northern Territory, Australia. Participants All patients within the cohort with a non-traumatic out-of-hospital cardiac arrest. Main outcome measures Data were collected on outcomes as per Utstein definitions, along with patient demographics, retrieval timings and interventions. Results Seventy-five patients suffering cardiac arrest were identified, with 58 having a non-traumatic arrest in an out-of-hospital setting. The median age of the cohort was 40 years, and 53% had an initial shockable rhythm. Return of spontaneous circulation was achieved in 55% and 43% survived to hospital. The survival to hospital discharge and 28 days were 31% and 29%, respectively. Conclusions Although the study has a small sample size and limitations on generalisability due to the restricted nature of the cohort selection, the results suggest a 28-day survival rate is potentially comparable to other regions of Australia and the rest of the world. Further research needs to be undertaken in out-of-hospital cardiac arrest in remote regions to establish a true population?based cohort and ascertain where improvements can be made.

Screen-printed textiles from Aboriginal art centers are more than just commercial products. Closely connected with Aboriginal 'ways of being,' they carry profound and often ancient stories from the world's oldest continuous culture and offer consumers a glimpse into a different world. Their creation supports remote livelihoods and culturally affirming practises which contribute to social and emotional wellbeing. But as this paper shows, the recent enthusiasm for Aboriginal textiles in the fashion industry pits the enduring cultural narratives embodied in the textiles against the transient and unpredictable forces of the fashion market. There have been many positive translations to fashion; however, the accessible and reproducible aspects of cloth render a vulnerability to exploitation in the mass fashion world. It is now time for all parties to establish transparent business principles and a clear code of ethics to guide commercial partnerships and guarantee artist control over their ancestral heritage. Fashion displays and promotes Indigenous cultural heritage in a unique way, but for these textiles, there are a range of alternative iterations that portray a timelessness beyond fashion.

Objective: To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. Methods: The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. Results: Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Conclusions: Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills.

In line with findings throughout Australia, rural, remote and Indigenous Western Australians suffer from a higher burden of oral disease and have less access to dental practitioners and care than their urban and non-Indigenous counterparts. With workforce projections indicating an increase in the shortage of dental practitioners, especially in rural and remote areas, the Centre for Rural and Remote Oral Health (CRROH) in Western Australia set out to establish a sustainable programme to service such increasingly disadvantaged populations. Via the vertical integration of education, service and research CRROH pioneered a sustainable model to deliver much needed oral health services to some of Western Australia's most remote areas, while primarily focused on addressing the oral health needs of Indigenous Australians. One of the key lessons from the programme has been the development of a strong clinical governance framework and a support network to sustain services in remote locations. This study offers one way to provide and sustain dental care for those most in need, yet largely left out.