Remote Australia Online

Northern Territory (NT)-based clinical service data suggest substantial lung function impairment amongst First Nations adults as young as 18–40 years. Our objectives were to describe the burden of disease and lung function of adults living in regional-remote Queensland, identify determinants of lung function, and evaluate the impact of a specialist respiratory outreach service on lung function.

This article shines a light on a little-known cohort of higher education participants, mature-aged students in, and from, regional and remote Australia – the focus of a National Centre for Student Equity in Higher Education mixed-methods study. Notable patterns were found in the quantitative data; for instance, compared to their metropolitan counterparts, higher proportions of regional and remote students were older, female, from low socio-economic status areas, Aboriginal and Torres Strait Islander, and studied online and/or part-time. The presentation of four vignettes from the interviews uncovers the stories behind the numbers, revealing students’ diverse and complex circumstances; two of the students shared experiences of facing systemic obstacles, while the other two described receiving invaluable institutional support. The obstacles can be attributed to systems designed for “ideal”, “implied” and “traditional” students, and entrenched attitudes that privilege some “types” of students over others and limit the aim of full participation for all students.

Ideologies of language and of learning are local, underpinned and shaped by shared historical and current spiritual, cultural, social, and political understandings and experiences. We are keenly reminded of this in Henne–Ochoa et al.’s position paper. Contesting language ideologies that privilege language-as-code at the expense of social practices, the authors put forward alternative ideological frames to center Indigenous conceptions of language, learning, and language reclamation. They open our eyes wider to learning—and to learning in informal contexts. They draw our attention to ideologies dominant in formal schooling settings, and the colonizing practices they perpetuate, while acknowledging that schools have played, and will continue to play, a crucial role in Indigenous language revitalization (p. 487). In approaching this response, we learned of Leonard’s (2012) language reclamation frame- work: the larger effort by a community to claim its right to speak a language and the associated goals set in response to community needs and perspectives. In the larger effort of reclaiming language, identity, and power, schools may or may not be priority sites. With gratitude to the authors for sharing their thoughtful critique and practice from our positions as educators, in this short response we reflect on language ideologies and the challenges of decolonizing classrooms in Australia. We are Rosemary Narrurlu Plummer, a Warumungu educator and poet, Barbara Napanangka Martin, a member of the Warlpiri Education and Training Trust and retired Warlpiri educator, and Samantha Disbray, a non-Aboriginal education linguist. For more than a decade, we have worked individually and together in Central Australia on language teaching and learning in schools (Anderson et al., 2018; Disbray & Martin, 2018; O’Shannessy et al., 2019) and in informal con- texts (Disbray & Bauer, 2016; Disbray & Guenther, 2017; Disbray et al., 2019).

Indigenous educational disadvantage — compounded by complex and interrelated social, health, and employment outcomes — remains among the most pressing and persistent public policy challenges in Australia. By school-leaving age, the average Indigenous Australian student is around two and a half years behind the average non-Indigenous one — with achievement levels more comparable to developing nation school systems than those of the wider Australian population.1 This severely limits the future educational and employment opportunities of these young learners, condemning many to prolonged economic and social disadvantage. Truly ‘closing this gap’ is a moral, educational, and economic imperative. Dispiritingly poor education outcomes persist despite the best of intentions, considerable investment of resources, and countless programmes and policymaker initiatives.The bipartisan and intergovernmental commitment to ‘Closing the Gap’, spanning more than a decade, has done little to move the needle in education outcomes — meaning much work remains to address Indigenous educational disadvantage.

Introduction: Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies. Methods and analysis: This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. Ethics and dissemination: The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.

Background Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. Methods A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. Results There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Conclusions Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally–normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options.

Many Australians living in rural and remote areas of Australia need to travel hundreds of kilometres for health care service, or to wait for health service providers, such as the Royal Flying Doctor Service (RFDS), to visit them. The levels of acute and subacute hospital services in rural and remote areas are reported to be inadequate, as is, to a lesser extent, access to aged care services. The need to travel long distances is a major barrier for people in remote locations, particularly older people, seeking health care. National data on health care for older Australians are available, but we do not have a clear picture of the specific problems of older people living in rural and remote areas who require aeromedical retrieval for treatment. We therefore briefly describe in this report the health characteristics of older Australians who have been retrieved at least once by the RFDS and the primary health care services accessible to them within 60 minutes by road. We undertook a cross-sectional review of prospectively collected routine patient data for older Australians (Indigenous patients aged 55 years or more; non-Indigenous patients aged 65 years or more) retrieved by the RFDS from anywhere in Australia between 1 July 2014 and 31 June 2017. To assess population health service coverage, we entered the locations of available health services (source: Health Direct; https://about.healthdirect.gov.au) into the RFDS Service Planning and Operational Tool (SPOT), and then overlaid 2016 census data provided by the Australian Bureau of Statistics.

Students from regional and remote areas remain significantly under-represented in higher education despite decades of equity policy designed to encourage participation. One explanation is that policy initiatives often overlook the realities in local rural contexts that can make higher education less desirable. Applying the theoretical lens of ‘doxic’ and ‘habituated’ aspirations, this paper analyzes interviews with 13 students, 10 parents/carers, and 4 teachers from one regional and one remote community in NSW, Australia. We document the emotional and material realities shaping young people’s imagined futures in these communities, highlighting the commitment to a rural lifestyle in one, and the desire to escape the other community in decline. We argue that developing successful initiatives to address equitable participation in higher education requires a departure from hegemonic discourses of ‘rurality’ and greater recognition of and respect for the diverse needs and desires of regional and remote students.

Objective To assess whether outcomes of peripheral artery disease (PAD) were related to remoteness from the treating tertiary vascular centre. Setting and Participants Participants with a variety of types of occlusive and aneurysmal diseases were recruited from a tertiary hospital in North Queensland, Australia. Remoteness was assessed by residence outside Townsville and estimated distance to the vascular centre. Cox proportional hazard analyses were used to examine the association of remoteness with outcome. Design Cohort study. Main outcome measures The primary outcome was requirement for surgery to treat PAD. Secondary outcomes were major adverse cardiovascular events (MACE) and all-cause mortality. Results Of 2487 patients recruited, 1274 (51.2%) had at least one PAD surgery, 720 (29.0%) at least one MACE, and 909 (36.6%) died during a median of 4.2 (inter-quartile range 1.3-7.7) years. Compared to Townsville residents (n = 1287), those resident outside Townsville (n = 1200) had higher rates of PAD surgery (hazard ratio, HR 1.55, 95% confidence intervals, CI, 1.39, 1.73) but no increased risk of MACE (HR 1.00, 95% CI 0.86, 1.16) or death (HR 1.03, 95% CI 0.90, 1.17). This association was attenuated when adjusting for distance from the vascular centre (HR 1.31, 95% CI 1.14, 1.51). Patients in the highest quartile of distance presented with lower ankle-brachial pressure index, more severe carotid artery disease and larger aortic diameter. Conclusions People with PAD in North Queensland residing furthest from the tertiary hospital presented with more severe artery disease and had greater rates of PAD surgery.

Objective: Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. Design: Registry-based cohort study. Setting Binational clinical quality registry. Participants: Burn-injured patients admitted to a specialist Australian burn service. Main outcome measures: Receiving gold standard first aid following a burn injury. Results: Approximately two-thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. Conclusions: Nearly two-thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required.

This study evaluates the feasibility of an emerging technology – a concentrated solar multi-effect distiller (CSMED) – to supply high quality water for beneficial use at Eromanga, which is located in a remote and dry region of Australia. Produced water from the Kenmore oil field is the only reliable water source at Eromanga and has been approved for livestock watering. The process utilises concentrated solar technology to drive a multi-effect distiller, making the process ideal for the Australian outback. Historical water parameters of the produced water were assessed against the water guidelines for irrigation, livestock watering, municipal and potable use. The proposed treatment will further improve key water quality parameters to exceed guideline requirements for unrestricted water uses mentioned above. The CSMED produces a high-quality distillate (i.e. treated water) free of all mineral salts that can be mixed with the produced water to increase the final product water volume. An Excel based model was developed to determine suitable blending ratios while maintaining the water quality for each beneficial use. For production of livestock watering and potable use, a blending ratio (of at least 19% v/v) between the CSMED distillate and produced water can be applied, significantly increasing the final water volume. The Excel based model could also indicate chemical addition for adjustment of sodium absorption ratio in the case of irrigation application. The brine from the CSMED can potentially be used to prepare drilling mud for oil field operation. An on-site performance study of the CSMED system has been planned to validate these results.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people. METHODS: Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people. RESULTS: Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services. CONCLUSION: The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed.

Background: There is growing recognition of the contribution of the social determinants of health to the burden of many infectious diseases. However, the relationship between socioeconomic status and the incidence and outcome of melioidosis is incompletely defined. Methods: All residents of Far North Queensland, tropical Australia with culture-proven melioidosis between January 1998 and December 2020 were eligible for the study. Their demographics, comorbidities and socioeconomic status were correlated with their clinical course. Socioeconomic status was determined using the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage score, a measure of socioeconomic disadvantage developed by the Australian Bureau of Statistics. Socioeconomic disadvantage was defined as residence in a region with a SEIFA score in the lowest decile in Australia. Results: 321 eligible individuals were diagnosed with melioidosis during the study period, 174 (54.2%) identified as Indigenous Australians; 223/321 (69.5%) were bacteraemic, 85/321 (26.5%) required Intensive Care Unit (ICU) admission and 37/321 (11.5%) died. 156/321 (48.6%) were socioeconomically disadvantaged, compared with 56603/269002 (21.0%) of the local general population (p<0.001). Socioeconomically disadvantaged patients were younger, more likely to be female, Indigenous, diabetic or have renal disease. They were also more likely to die prior to hospital discharge (26/156 (16.7%) versus 11/165 (6.7%), p = 0.002) and to die at a younger age (median (IQR) age: 50 (38–68) versus 65 (59–81) years, p = 0.02). In multivariate analysis that included age, Indigenous status, the presence of bacteraemia, ICU admission and the year of hospitalisation, only socioeconomic disadvantage (odds ratio (OR) (95% confidence interval (CI)): 2.49 (1.16–5.35), p = 0.02) and ICU admission (OR (95% CI): 4.79 (2.33–9.86), p<0.001) were independently associated with death. Conclusion: Melioidosis is disease of socioeconomic disadvantage. A more holistic approach to the delivery of healthcare which addresses the social determinants of health is necessary to reduce the burden of this life-threatening disease.

Introduction: Community aged care services provide support to older adults living in their own homes. Cognitive impairment may increase the complexity of the support required. There is a need to ensure suitable brief screening tools are available to community aged care providers to assess possible cognitive impairment. This study aimed to examine the agreement between 2 validated cognitive impairment screening tools, the Mini-Cog, and Abbreviated Mental Test Score (AMTS), and the perceptions the individuals case manager of Case Manager's. Methods: A cross-sectional survey study was undertaken with clients of a community aged care provider. Clients were administered both the screening tools via an electronic survey by their Case Manager. Results: In total, 158 (54%) eligible participants consented to participate. There was a 70% agreement between the Mini-Cog and AMTS measures, indicating a moderate agreement which was not statistically different from chance (Kappa 0.08, 95% CI 0.04-0.19). Case Managers identified 37% (n=48/130) of participants as possibly having cognitive impairment, of which, 15% (n=20) were also identified via a screening tool. Conclusions: The findings indicate poor agreement across the 3 measures. To ensure adequate supports are offered to those with cognitive impairment, the use of validated tools that can be administered by non-medical staff in a community setting is a priority. This study highlights a need for further work to determine the most suitable tool for use by community-based aged care services.

Evaluation is a driving concern for arts organizations the world over, and a growing requirement from philanthropic, government, and corporate funders. There is increasing recognition of the need for evaluations of socially engaged arts programs to be appropriate for the communities, cultural contexts, participants, and stakeholders involved in their activities. This article directly addresses this need, and outlines the process of developing a bespoke framework for evaluating the social impact of a music program in the Kimberley region of far north-west Australia, a region with a majority First Nations’ population. It describes the methods used to develop this evaluation framework and indicators that were grounded in community perspectives on the difference that this music program makes to community life. It situates the methods chosen within a theoretical orientation towards a capability approach and an ecological understanding of externally provided arts activities. The authors argue that this methodology offers a culturally relevant, holistic way to track and measure the direct and indirect outcomes that engagement with the arts can bring.

Introduction: We have previously showed that albuminuria was associated with low birthweight in young adults in a remote Australian Aboriginal community that has high rates of kidney disease. Here we describe the association of birthweight with incidence and progression of kidney disease over time. Methods: Among 695 members of an Aboriginal community with recorded birthweights, urine albumin creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were measured at ages 5 to 40 years, and follow-up values were measured or imputed again a median of 11.6 years later. Prevalence of markers on each occasion and change over time were evaluated in the context of birthweights and other potentially significant factors. Results: On the second screen, ACR was inversely and significantly correlated with birthweight and eGFR was directly correlated with birthweight. Increases in ACR and in proportions of persons who developed new-onset (incident) albuminuria between screens were higher in those of lower birthweights (<2.5 kg). Proportions of persons who lost ≥20% of their baseline eGFR were higher in the lower birthweight groups. Lower birthweights also amplified elevations of ACR associated with other risk factors, specifically higher body mass indexes (BMIs) and a prior history of poststreptococcal glomerulonephritis (PSGN). At both screens, progressively higher levels of ACR beyond the mid-microalbuminuria range were correlated with lower levels of eGFR. Conclusions: Lower birthweight contributes to an excess of kidney disease and its progression in this population. Because an excess of low birthweight and episodes of PSGN are eminently preventable, substantial containment of kidney disease is feasible.

This article reports the process of identifying a well-being monitoring and evaluation approach for a community development programme with Aboriginal Native Title Holders in Northern Australia. The process involved the use of an empowerment-based Aboriginal Family Well-Being framework to enable Native Title Holders to articulate domains of value to their local community. These domains aligned with an existing culturally sensitive Aboriginal well-being survey tool which the Native Title Holders saw as relevant for their use. The attempts to provide Aboriginal people with a broader and more long-term perspective from which to judge the value of short-term projects is a different approach to traditional programme assessment (monitoring and evaluation). It aims to provide Aboriginal people with a more relevant frame from which they can make judgements about the worth of any programme or project in their location, supporting local control and decision-making. Potentially it provides Aboriginal people with the information from which to advocate for other supports and to assess the value of Government and other projects.

Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. Objective The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers (AHWs) and registered nurses (RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. Design The design used a qualitative approach and discussion schedule to elicit responses. Setting The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. Participants The participants were experienced diabetes educators (RNs and AHWs), managers and students currently enrolled in the course (n=17). Results The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. Conclusion The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues.

Globally, since the latter part of the 20th Century, maternal and neonatal mortality rates have continued to reduce. However, in high-income countries (HICs), rates are still higher for women living in rural and remote locations compared to those in living metropolitan areas6. Pregnant women residing in Indigenous communities in the Northern Territory of Australia must relocate from home at 36-38 weeks gestation to wait near a hospital for the birth of their baby and remain in that place until given medical clearance to return home. The situation is similar for non-Indigenous women but they do have more choices available to them regarding the place, date and time of relocation. HICs, such as Australia, provide advanced primary and secondary health services which are available to all residents, whether free or by payment. Reports from the World Health Organization (WHO) and the World Bank show improvements in maternal and neonatal health outcomes over time and that the Millennium Development Goals (MDGs) were being largely met. Missing from these reports are data on the inequalities of health outcomes within HICs for people who live in geographically isolated areas. This study discusses current policies and practices in maternal health care around the world and particularly in the remote Northern Territory of Australia (NT). I sought to identify evidence of any effect on maternal and neonatal health from the requirement for pregnant women, with low-risk pregnancies, to relocate from home at 36-38 weeks gestation to stay near a maternity facility. The study was undertaken as a review of literature in three different styles comprising systematic, grey, and narrative and culminated in an umbrella view of the overall results. This work contributes to the current range of literature by showing that there has been no rigorous research directly applicable to the primary research question. This study highlights the need for further research into what women want in relation to birthing choices. In order that women can be free to choose the place of birth of their baby, research must be conducted which unequivocally demonstrates whether planned early relocation from their local community to near a major birthing centre, at 36-38 weeks gestation, has any effect on the health of the mother or baby. These choices will need to be balanced against increasing costs for the provision of health services to remote areas and the lack of midwives, nurses and doctors able (or willing) to work away from urban settings.

Background: Advances in cancer treatment have not benefited all patients equally, underscoring the need for a personalised approach to care. Objective: The aim of this article is to outline the key elements of personalised cancer care, including delivery of goal-directed care, self-management and self-management support, care integration, focus on access and equity, reduction in cost and promotion of health literacy and e-health literacy. Discussion: Achievement of personalised cancer care requires a system-wide approach that targets the patient, healthcare provider and healthcare system with data informing practice. Primary care providers, including general practitioners (GPs) and practice nurses, play an important and growing part in the provision of personalised cancer care through support, advocacy, coordination, holistic care and health promotion. Cancer care systems can facilitate GPs’ involvement in care through early input into multidisciplinary management, timely communication, rapid access to acute care and training opportunities.

Background: Among Aboriginal children, the burden of acute respiratory tract infections (ALRIs) with consequent bronchiectasis post-hospitalisation is high. Clinical practice guidelines recommend medical follow-up one-month following discharge, which provides an opportunity to screen and manage persistent symptoms and may prevent bronchiectasis. Medical follow-up is not routinely undertaken in most centres. We aimed to identify barriers and facilitators and map steps required for medical follow-up of Aboriginal children hospitalised with ALRIs. Methods: Our qualitative study used a knowledge translation and participatory action research approach, with semi-structured interviews and focus groups, followed by reflexive thematic grouping and process mapping. Findings: Eighteen parents of Aboriginal children hospitalised with ALRI and 144 Australian paediatric hospital staff participated. Barriers for parents were lack of information about their child's condition and need for medical follow-up. Facilitators for parents included doctors providing disease specific health information and follow-up instructions. Staff barriers included being unaware of the need for follow-up, skills in culturally responsive care and electronic discharge system limitations. Facilitators included training for clinicians in arranging follow-up and culturally secure engagement, with culturally responsive tools and improved discharge processes. Twelve-steps were identified to ensure medical follow-up. Interpretation We identified barriers and enablers for arranging effective medical follow-up for Aboriginal children hospitalised with ALRIs, summarised into four-themes, and mapped the steps required. Arranging effective follow-up is a complex process involving parents, hospital staff, hospital systems and primary healthcare services. A comprehensive knowledge translation approach may improve the follow-up process. Funding State and national grants and fellowships.

Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action.

Introduction: Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers. Methods: This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia. Results: The mean age of carers was 38.3±14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up. Conclusion: A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies.

OBJECTIVE: To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared to normoglycemia. METHODS: Data were from 1,102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction. RESULTS: A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% vs. 22%; p<0.001). Compared to non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were (OR=1.83 [95%CI: 1.11-3.02] and 1.72 [0.99-3.00] after age adjustment, 1.84 [1.06-3.19] and 1.33 [0.70-2.54] after adjustment for school education and delivery mode, and 1.62 [0.95-2.77] and 0.99 [0.53-1.86] after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. CONCLUSION: The significantly higher rates of PPH experienced by Indigenous compared to non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.