Remote Australia Online

BACKGROUND: The Australian College of Rural and Remote Medicine (ACRRM) was funded by the Commonwealth Department of Health and Aged Care to set up a quality assurance and continuing medical education program for rural and remote general practitioners in radiology to begin in January 2001. An extensive literature search failed to uncover any previous publications on the specific educational or quality assurance needs for rural general practitioners in radiology. Broader educational needs assessments of rural general practitioners in Australia had identified radiology as an important skill for which improvement was desired. METHOD: A national steering committee consisting of four rural general practitioners and three radiologists, with the assistance of a program manager, developed and piloted a self-administered postal questionnaire to determine the educational and quality assurance needs of rural and remote general practitioners. The questionnaire was sent to all rural and general practitioners holding a remote radiology exemption using the Health Insurance Commission database. RESULTS: A total of 287 completed questionnaires were returned from all states in the country, except the Australian Capital Territory. The information gave a comprehensive picture of the self-reported radiology education needs of these doctors, who practice in isolation from radiologists and other specialists. The three areas in which the general practitioners were least confident in radiology were chest, cervical spine, and skull radiology. Their highest priority areas of need for education were chest radiology, film interpretation, and spinal radiology. The top preferred quality assurance activity was image review with a radiologist, followed by clinical audit, image review by peers, and measuring practice against guidelines. FINDINGS: Local ownership of education is important to successful program development and evaluation. Information obtained from the educational needs assessment was used to develop the Radiology Quality Assurance and Continuing Medical Education Program for Rural and Remote General Practitioners.

This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.

High prevalence rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been reported in Aboriginal people in remote and regional areas of Australia for well over two decades, and repeat positivity rates are high. To interrupt disease transmission and reduce the risk of complications, early diagnosis and treatment is important. However in many remote and regional areas there are long delays between testing for these curable sexually transmissible infections and providing treatment, due to both physical distance from laboratories and difficulties when recalling patients for subsequent management once results are available. Point-of-care (POC) tests have the potential to provide more timely diagnosis, to increase treatment and contact tracing, and in turn reduce CT and NG infection rates.

Objectives With accurate molecular tests now available for diagnosis of chlamydia and gonorrhoea (Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG)) at the point-of-care (POC), we aimed to explore the public health implications (benefits and barriers) of their integration into remote primary care in Australia.Methods Qualitative interviews were conducted with a purposively selected group of 18 key informants reflecting sexual health, primary care, remote Aboriginal health and laboratory expertise.Results Participants believed that POC testing may decrease community prevalence of sexually transmitted infections (STIs), and associated morbidity by reducing the time to treatment and infectious period and expediting partner notification. Also, POC testing could improve acceptability of STI testing, increase testing coverage and result in more targeted prescribing, thereby minimising the risk of antibiotic resistance. Conversely, some felt the immediacy of diagnosis could deter certain young people from being tested. Participants also noted that POC testing may reduce the completeness of communicable disease surveillance data given the current dependence on reporting from pathology laboratories. Others expressed concern about the need to maintain and improve the flow of NG antibiotic sensitivity data, already compromised by the shift to nucleic acid-based testing. This is particularly relevant to remote areas where culture viability is problematic.Conclusions Results indicate a high level of support from clinicians and public health practitioners for wider access to CT/NG POC tests citing potential benefits, including earlier, more accurate treatment decisions and reductions in ongoing transmission. However, the data also highlight the need for new systems to avoid adverse impact on disease surveillance.

Prevalence of dental caries in Australian aboriginal children resident in Carnarvon, Western Australia

Background: Despite the availability of testing and treatment, bacterial sexually transmissible infections (STIs) continue to occur at endemic levels in many remote Indigenous communities in Australia. New generation molecular point-of-care (POC) tests have high sensitivity, comparable with conventional diagnostic tests, and have the potential to increase the impact of STI screening. Methods: We developed mathematical models of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) transmission in remote Indigenous communities in Australia to evaluate screening and treatment strategies that utilise POC tests. Results: The introduction of POC testing with 95% sensitivity could reduce the prevalence of gonorrhoea and chlamydia from 7.1% and 11.9% to 5.7% and 8.9%, respectively, under baseline screening coverage of 44% per year. If screening coverage is increased to 60% per year, prevalence is predicted to be reduced to 3.6% and 6.7%, respectively, under conventional testing, and further reduced to 1.8% and 3.1% with the introduction of POC testing. Increasing screening coverage to 80% per year will result in a reduction in the prevalence of gonorrhoea and chlamydia to 0.6% and 1.5%, respectively, and the virtual elimination of both STIs if POC testing is introduced. Conclusions: Modelling suggests that molecular POC tests of high sensitivity have great promise as a public health strategy for controlling chlamydia and gonorrhoea. However, evaluation of the cost-effectiveness of POC testing needs to be made before widespread implementation of this technology can be considered.

Objectives Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. Methods In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Results Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection. Conclusions The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

BACKGROUND/AIM: Rural and remote health education during undergraduate training is a strategy to alleviate the shortage of rural health professionals. Undergraduate rural exposure can be beneficial in improving students' perceptions towards rural and remote practice as well as their decision to work rurally. This study examined James Cook University (JCU) final year occupational therapy students' perceptions towards rural and remote practice and if their perceptions had changed over the course of their study. METHODS: Questionnaires were administered to 58 final year occupational therapy students at JCU during a block class. Quantitative data analysis was performed on responses. RESULTS: The change in the students' career intentions from not considering to considering rural and remote practice over the duration of their study was found to be significant (exact P = 0.003). The influential factors identified in students considering rural employment included the rural location of their close family and friends (exact P = 0.006), the overall occupational therapy programme (U = 171.5, P = 0.045), good fieldwork experience (U = 144, P = 0.039) and inspiring fieldwork supervisors (U = 135.5, P = 0.01). The course curriculum was not found to influence the students' perceptual change. CONCLUSION: This study has found that students' perceptions towards rural and remote practice changed over the course of their university programme. A greater focus on the academic staff and fieldwork supervisors' perceptions towards rural and remote practice may be required in the development of rural undergraduate programmes. Identification of students who have family/close friends living in rural and remote areas may encourage occupational therapists to work in rural areas.

Objective: The oral health of Indigenous Australians, whether urban or rural, is significantly poorer than their non-Indigenous counterparts, and it would be expected that the oral health of rural and remote Indigenous Australians would be particularly poor, although the extent of this extra disadvantage has not been thoroughly documented. The aim of this study was to assess the oral health status and oral health needs in a sample of adult residents of selected towns and remote communities in the Kimberley region of North-west Australia. Design: A cross-sectional survey (dental examinations and oral health questionnaires) was carried out. Setting: Rural and remote communities in the Kimberley region of Western Australia. Participants: Adults in four selected communities. Results: The mean Decayed, Missing and Filled Teeth (DMFT) score for all participants was 9.8 (SD 8.3). The mean DMFT increased with increasing age. Only 7.3% of people were caries-free. A total of 13% of participants had periodontal pockets of 6 mm or more, and only 3% had no periodontal disease. More than a third (37%) of all participants had advanced periodontal disease. Only 21% of participants did not need any dental treatment. Conclusions: The oral health of Aboriginal and Torres Strait Islander people are listed as one of the priority areas of Australia's National Oral Health Plan. Based on the above results, oral health is clearly an important priority in the Kimberley.

Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease.

Background: Aboriginal Australians face significant disparities in oral health and this is particularly the case in remote communities where access to dental services can be difficult. Using volunteers to provide dental care in the remote Kimberley region of Western Australia is a novel approach. Methods: This study comprised an anonymous online survey of volunteers working with the Kimberley Dental Team (KDT). The survey had a response fraction of 66% and explored volunteer demographic characteristics, factors that motivated their involvement, perceptions of oral health among Aboriginal communities, and barriers and enablers to oral health in remote Aboriginal communities. Results: Volunteers were more likely to be female, middle-aged and engaged in full-time employment. The two most common reasons reported for volunteering were to assist the community and visit the Kimberley region. Education and access to reliable, culturally appropriate care were perceived as enablers to good oral health for Aboriginal people in the Kimberley while limited access to services, poor nutrition and lack of government support were cited as barriers. Conclusions: Volunteers providing dental services to remote areas in Western Australia had a diverse demographic profile. However, they share similar motivating factors and views on the current barriers and enablers to good oral health in remote Aboriginal communities.

INTRODUCTION: Most rural communities are too small and remote to sustain specialist services, and therefore some rural and remote doctors in Australia practice advanced procedural skills as part of their comprehensive care to underserved rural communities. The declining number of rural and remote procedural non-specialist doctors poses a problem in Australia. There is, at present, no comprehensive delineation of the obstacles Australian rural doctors face in trying to maintain their skills in the procedural areas of obstetrics, anaesthetics and surgery, nor of the solutions that may overcome the problems. This literature review addresses these two needs. METHODS: We interrogated the MEDLINE database to find articles about rural and remote medical education, with a specific focus on procedural skills. Other sources, including Google Scholar, were used to find relevant project and conference reports. RESULTS: The barriers to the maintenance of advanced procedural skills for rural and remote medical practitioners include: lack of opportunity; expense associated with remaining skilled in advanced procedural areas; lack of access to locum relief to attend educational sessions; lack of flexible options for education; lack of access to advanced procedural training; time constraints; multiple credentialing requirements from state health departments and joint consultative committees; family obstacles; and perceived medico-legal problems. Retention of rural doctors and the difficulties faced by them in maintaining advanced procedural skills are related. There is evidence that both these problems can be addressed, at least in part, by increased support for flexible continuing medical education and professional development such as specific skills rural training programs, the availability of group practice opportunities, improved hospital facilities, reasonable workloads, financial incentives, locum assistance, improved housing quality, and better educational support for families. We also noted a positive association between dedicated rural training programs and the recruitment of rural doctors. Factors associated with these successful training programs include: rural fellowships, explicit rural mission, rural location, rural program directors, and procedural orientation. CONCLUSION: The authors investigated the obstacles rural and remote doctors currently face in obtaining and remaining skilled in procedural medicine. The article describes the main barriers and presents some solutions from the literature. It also highlights the areas where work is being done and highlights the need for more quality research in this area.

Objectives A new molecular test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate as conventional nucleic acid amplification tests (NAAT), but performance has not been evaluated in routine primary care, performed at the point of care by clinicians. We aimed to examine its diagnostic performance when used by clinicians in remote community health services in Australia with high prevalences of CT and NG infection. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#12613000808741)Methods At 12 health services, training was provided to 99 clinicians in the use of the GeneXpert CT/NG assay who tested specimens from all patients undergoing STI screening. Specimens were also sent in parallel for conventional laboratory-based NAATs and the concordance of results was evaluated.Results Clinicians conducted 2486 tests: CT concordance was 99.4% (95% CI 99.1 to 99.7) with a positive concordance of 98.6% (95% CI 95.9 to 99.7) and negative concordance of 99.5% (95% CI 99.1 to 99.8); NG concordance was 99.9% (95% CI 99.7 to 100.0) with a positive concordance of 100.0% (95% CI 97.5 to 100.0) and negative concordance of 99.9% (95% CI 99.7 to 100.0).Conclusions In this first study reporting routine point-of-care use of GeneXpert CT/NG by primary care clinicians, we found excellent concordance with conventional NAATs. The use of the GeneXpert CT/NG at the point of care could potentially transform management and control of these infections in many endemic settings, including low/middle-income countries.

This research was conducted as a series of community-based discussions and workshops in the Northern Territory and north Queensland1. NAILSMA provided resources, logistics, backgrounding and other support to local Indigenous researchers and facilitators who ran the meetings on country. This was a Participatory Action Research (PAR) method, consistent with preceding research on community resilience and partnerships by ARPNet and NAILSMA under the Bushfire and Natural Hazards CRC project Developing effective partnerships in remote north Australian communities: Indigenous research and leadership in Ramingining and Galiwin’ku2. Inherent in this approach are direct benefits to Indigenous researchers and their communities from the process and from longer term outcomes influenced by their research and advocacy with EM agency leaders. The work found that gaps are evident within communities, within EM agencies and between them. Summary of the findings includes: • General lack of basic engagement by agencies – for example, not knowing who to talk to and how to start doing things differently. Limitations of local capability – governance, dedicated equipment and infrastructure, knowledge of EM systems and agency operations, restrictive laws etc. • Very little knowledge of social capital and other assets available in communities – local knowledge, equipment skills, communications, cross-cultural training, new generation recruitment, networks of obligation and care, nuanced knowledge of country and its seasons, use of fire. • Naivety from agencies about Indigenous culture and knowledge systems. • Lack of understanding about the costs and benefits of adopting new support and partnership models, tailored to regionally unique needs. • Lack of understanding of the impact across government agencies, particularly the lack of coordination of their functions, engagement and policy settings – often even within agencies. • Lack of clarity about resilience building at community level. • Poor recognition or knowledge of the impacts of climate change on different areas, and in relation to future planning • How land tenure effects Indigenous fire and land management activities • Performance criteria and stewardship of agency/community collaborations (cultural and EMA criteria) are undeveloped.

This guide provides advice for researchers in applying the principles in the AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research (the AIATSIS Code of Ethics or this Code). It is also useful for ethics review bodies to identify practical ways in which the principles should be evident in project design. The best ethical research practice occurs in the partnership, design and planning stages of a project. However, ethical practice permeates every stage of the research process and should be revisited regularly as research proceeds. In addition, where a researcher or community encounters a project that is already underway, it is important to take stock of the ethical underpinnings of the project and adjust as required. In acknowledging this, this Guide to Applying the AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research provides practical information on how you may apply the principles in four main stages of your research: 1. getting started 2. implementing your project 3. communicating research results 4. post-project. This Guide is designed to encompass a range of different project methodologies: • quantitative methods (surveys, big data, statistics) • qualitative methods (ethnographic, case studies, interview based) • mixed methods (participatory action, focus groups, workshops) • working with documents (historical, archival, discourse analysis). The Guide offers a range of best practices and ideas for any person engaging in ethical research. For more detailed information specific to particular types of research, for example large surveys, please refer to the supporting case studies on the AIATSIS Ethics webpage.2

The issue of food security is complex and requires capacity for often-unrelated groups to work together. We sought to assess the relevance and meaning of a commonly used set of community capacity development constructs in the context of remote Indigenous Australia and through this propose a model to support capacity.

Objective To consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians. Design Community-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP. Results All scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes. Conclusions The modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.

Fluoridation of public water supplies remains the key potential strategy for prevention of dental caries. The water supplies of many remote Indigenous communities do not contain adequate levels of natural fluoride. The small and dispersed nature of communities presents challenges for the provision of fluoridation infrastructure and until recently smaller settlements were considered unfavourable for cost-effective water fluoridation. Technological advances in water treatment and fluoridation are resulting in new and more cost-effective water fluoridation options and recent cost analyses support water fluoridation for communities of less than 1,000 people.

OBJECTIVE: To determine the educational needs of rural and remote non-specialist Australian doctors for obstetric ultrasound. DESIGN: Survey design. SETTING: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia. SUBJECTS: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men. RESULTS: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%). CONCLUSION: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non-specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program. WHAT IS ALREADY KNOWN: The authors could not find any published work on the educational needs of Australian non-specialist rural and remote doctors for obstetric ultrasound. There is research about the outcome of obstetric ultrasound education for urban family physicians in the USA, but no information about rural doctors' educational needs or education outcomes. The study needed to be done so that obstetric ultrasound professional development program of the Australian College of Rural and Remote Medicine could be based on the real needs of the target group. WHAT THIS PAPER ADDS: As a result of this research, there is now information on the educational needs of rural and remote Australian non-specialist medical practitioners that can be used by education providers to develop quality education programs in obstetric ultrasound.

In an era of a highly digitalized society, Australia's rural areas continue to be at a digital disadvantage. With the increasing penetration of information and communications technology (ICT) into all public and private realms, there is a need to examine the deeply rooted digital divide and how it is intertwined with issues of social exclusion in rural communities. This study focused on remoteness as an indicator of digital exclusion, and investigated its relationship with other dimensions of social exclusion. A secondary data analysis using Australian Bureau of Statistics (ABS) regional data revealed that remoteness was a strong predictor of home Internet and broadband connectivity, but digital divide was exacerbated by other socio-demographic factors such as educational levels and employment status. When implementing digital inclusion strategies, both supply (infrastructure) and demand (education levels, industry sector, employment opportunities, socio-demographics) factors must be considered.

Research data exists that highlight the discrepancy between the medical/dental status experienced by Aboriginal people compared with that of their non-Aboriginal counterparts. This, coupled with a health system that Aboriginal people often find alienating and difficult to access, further exacerbates the many health problems they face. Poor oral health and hygiene is an issue often overlooked that can significantly impact on a person's quality of life. In areas where Aboriginal people find access to health services difficult, the implementation of culturally acceptable forms of primary health care confers significant benefits. The Aboriginal community has seen that the employment and training of Aboriginal health workers (AHW), particularly in rural and remote regions, is significantly beneficial in improving general health. In the present study, an oral health training program was developed and trialed. This training program was tailored to the needs of rural and remote AHWs. The primary objective was to institute a culturally appropriate basic preventative oral health delivery program at a community level. It is envisaged that through this dental training program, AHWs will be encouraged to implement long-term preventive measures at a local level to improve community dental health. They will also be encouraged to pursue other oral health-care delivery programs. Additionally, it is considered that this project will serve to strengthen a trust-based relationship between Aboriginal people and the health-care profession.

Background: A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce. Methods: A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia. Results: Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums. Conclusions: The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.

INTRODUCTION: This paper describes an action research process (in which the researchers are active participants throughout the process of development, testing and refinement) to develop a framework for clinical risk assessment and management in the context of rural and remote medicine. The framework is needed to support educational, medicolegal and quality improvement processes in rural and remote medical practice. METHODS: The research process included identifying a problem and gradually developing a research question, developing a potential model for application in a specific context, refining the tool and piloting the tool in a limited context. The research question and framework were developed during a series of teleconferences under the aegis of the Censorial Panel of the Australian College of Rural and Remote Medicine (ACRRM). After the framework was developed and refined, it was tested at a workshop in conjunction with the ACRRM Scientific Forum in Alice Springs, Australia, in July 2004. Workshop participants were principally but not exclusively rural medical practitioners from across Australia. The main outcome measure was a working framework for risk management broadly applicable in rural and remote medicine. RESULTS: The process clarified differences between safety and quality approaches in metropolitan and rural and remote medical practice, culminating in an appropriate clinical risk management framework. CONCLUSION: The action research as undertaken resulted in a workable risk management framework that is worthy of further development and that may be a valuable educational tool, both for existing practitioners and for future rural doctors. Further, it has potential as a means of providing legal protection to rural practitioners when actual rural practice is at odds with "best practice" as defined by a metropolitan group of experts.

Objective: To describe oral health in the Anangu Pitjantjatjaraku lands in South Australia and to compare with earlier surveys and national data. Design: Descriptive. Setting: Data were collected at the time of dental care service provision, according to World Health Organization protocols, at the request of the Nganampa Health Council on optical mark reader forms. Participants: There were 356 Anangu adults and 317 children surveyed. Results: The mean number of teeth affected by dental caries in the deciduous dentition in young children, aged 5-6 years, was double (mean 3.20) that of the overall Australian child population aged 5-6 years (mean 1.44). In contrast to the decline in deciduous caries in Australian children generally, Anangu children aged 5-9 years had a 42% increase in the mean number of teeth affected since 1987. Adults experienced low levels of dental caries, but severe periodontal disease was more prevalent among diabetics (79%) compared with-non-diabetics (13.8%). Tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53). Conclusions: Oral health promotion strategies, in association with general health strategies, need to be developed to improve oral health in this remote Aboriginal population. What this paper adds: Recent studies have shown that oral health of Indigenous children is worsening, but there has been little documentation of the changing oral health status of Indigenous adults. This study notes the deterioration of oral health in both children and adults since 1987/88. The relationship between glycaemic control, periodontal diseases and tooth loss in Indigenous adult populations needs to be further investigated.

The Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Code of Ethics for Aboriginal and Torres Strait Islander Research is informed by the recognition of and respect for the rights of Indigenous1 peoples as articulated in the United Nations Declaration on the Rights of Indigenous Peoples.2 As such, AIATSIS recognises that Aboriginal and Torres Strait Islander peoples have the right to be fully engaged in any processes, projects and activities that may impact on them. The AIATSIS Code outlines four principles that underpin ethical Australian Indigenous research; these are: Indigenous self-determination, Indigenous leadership, impact and value, and sustainability and accountability. Each principle frames a set of responsibilities for researchers, institutions and review bodies when conducting Aboriginal and Torres Strait Islander research. Aboriginal and Torres Strait Islander research includes all research that impacts on or is of particular significance to Aboriginal and Torres Strait Islander peoples, including the planning, collection, analysis and dissemination of information or knowledge, in any format or medium, which is about, or may affect, Indigenous peoples, either collectively or individually. The AIATSIS Code sets national standards for the ethical and responsible conduct of all Aboriginal and Torres Strait Islander research, across all disciplines and methodologies. It is for use by those undertaking research, reviewing research or funding research, including individuals, universities, governments, industry and community organisations. This Code is consistent with and supports the Australian Code for the Responsible Conduct of Research and the National Statement on Ethical Conduct in Human Research.3 It provides guidance on the application of those standards in Aboriginal and Torres Strait Islander research. The AIATSIS Code is issued pursuant to AIATSIS’ legislative function to provide leadership in ethics. Compliance with this Code is required for all research funded by or undertaken under the auspices of AIATSIS, the Australian Research Council (ARC) and the National Health and Medical Research Council (NHMRC), and other institutions or bodies that have adopted the AIATSIS Code.