Remote Australia Online

Objective To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve antenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. Methods A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with 45 participants, including clinicians; regional policymakers and managers; and study implementation staff. Results Interviewees reported the early phase of the intervention had resulted in establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. Conclusion The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including development of a communication and engagement strategy.

This paper aims to provide insights on the association between exposure to rural general practice vocational training placements and subsequent rural practice location in Western Australia. We further explore the possibility that the observed associations might depend on an individual's rural upbringing and or an individual's exposure to general practice during medical school. To this end, a cross-sectional analysis of practice location of 353 general practitioners who completed their vocational training through WA General Practice Education and Training between 2010 and 2017 was conducted. The empirical analysis uses a fully recursive conditional mixed process estimator to jointly estimate the probabilities that a general practitioner (GP) completes their vocational training placement at a rural location and subsequently practices at a rural location. The results show that GPs who chose rural locations for their first and last vocational training placements are more likely to practice at a rural location compared to their counterparts choosing metropolitan locations. Also, the probability of subsequent rural practice is further strengthened by having a rural background and having exposure to general practice during medical school even after controlling for potential confounders. The results also indicate that GPs stay in rural locations for reasons linked to their career, family and lifestyles. This evidence underscores the importance of vocational training organisations in WA and reinforces the need for ongoing rural opportunities in training to ameliorate location-based disparities in the distribution of the GP workforce in Western Australia.

This study investigates how the digital divide in rural, agricultural Australia impacts women in significant and unexpected ways. Drawing on Marxist feminist perspectives on labour I ask, how do rural farming women access, use and manage digital connections and devices, and what role does gender play in the production of this 'digital labour'? Based on interviews conducted in Far North Queensland, I provide an account of digital labour in rural farming households showing that women often have more interaction with digital technologies than their male counterparts because they are responsible for domestic activities that are increasingly being conducted online. Women's consequent greater digital expertise enables them to forge pathways to digital inclusion and self-determination. Further analysis using Ursula Huws' ([2019]. Labour in Contemporary Capitalism: What Next? London: Palgrave Macmillan UK.) typology of labour confirms binary gender-based distribution of digital labour, but problematises how value is assigned to this work, in rural farming households. The research contributes to emergent understandings of digital labour and digital inclusion scholarship in rural contexts.

In this chapter, I focus on how young Aboriginal women find sexual partners, often with a view to marriage and child-bearing, in two communities. The first is a remote Aboriginal community that is restricted: non-residents must obtain a permit to enter (hereafter ‘the community’). I lived and worked as a nurse in the community for several years. The second is a town, in the sense that there is unrestricted movement of both Indigenous and non-Indigenous people, but it is still a remote community (hereafter ‘the town’). It is situated on the edge of Arnhem Land and is close to major mining developments. As such, the town has regular contact with non-Indigenous workers. A steady stream of non-Indigenous tourists also visit, attracted by fishing opportunities in the area. In contrast to the community, alcohol is readily available in the town. I visited the town regularly over a period of three years while researching my PhD thesis. Both places are connected through country and kinship relationships with family members travelling from one community to the other for funerals, ceremonies and social visits. In both, young Indigenous women appear to be growing up fast and forming sexual relationships in the early years of adolescence. Two bodies of evidence inform this chapter. The first is based on my experience as a nurse in the community, with responsibility (among many other things) for the sexual health of young people. During this period, my view of young people’s sexual relationships was narrow, confined to health education initiatives and point of care at the clinic. In terms of the numbers of teenage pregnancies and sexually transmitted infections, I was able to observe the scope of the issue, but I was not in a position to understand the motivation of young women and the decisions they made regarding their relationships. In 2012, I began my PhD research in the town of Boroloola. During this time, I lived in the town and was able to observe the lives and interactions of young women, as well as how their actions were perceived by older members of the community. My participant observation was supplemented by in-depth interviews with women and workshops exploring sexual decision-making. Many of the young women were reluctant to talk to me; therefore, explanations for some of the behaviours I observed were obtained from older women, whose perspectives may have been influenced both by their concern for, and propensity to critique, the younger generation. Early sexual experience can have significant effects on the sexual and reproductive health of young Indigenous women, including higher rates of underage pregnancy and sexually transmitted infections. Such women and their children often experience negative long-term outcomes (Stark and Hope 2007). Early sexual relationships can also influence developmental outcomes, as those who are sexually active can disengage from education. This is due to the late nights in which young people carve out their personal space and time away from the eyes of adults (Senior and Chenhall 2008). They may have minimal knowledge about life choices that are not linked to relationships and reproduction (McMullen 2015). Premature reproduction, generally, is associated with negative or less than optimal outcomes for children (Brumbach, Figueredo and Ellis 2009). Very little is known about how Indigenous youths negotiate relationships, define risk, conceptualise their sexuality and sexual decision-making, or how their views may be influenced by the culture and society in which they live (Senior 2003). Indigenous sexual and reproductive health has long been a priority with successive governments. Many interventions (Guy et al. 2012) have been designed to address this issue but, despite some success, particularly in the reduction of sexually transmitted diseases, young Indigenous women continue to bear a significant burden. Over the years, I have come to appreciate that young Indigenous women, living within a society at least partially governed by customary law, may experience a disconnection from the larger world and its social and cultural norms. Young Indigenous women living in the community and town examined in this chapter have many issues with which to contend. Remote Aboriginal communities have been severely tested by substance misuse and social disruption, a consequence of violent displacement from traditional lands and the introduction of welfare, alcohol and other drugs. Under such circumstances, young Aboriginal women trying to negotiate the perils of early adolescence appear to have no clear pathways (MacDonald and Boulton 2011; Burbank, Senior and McMullen 2015).

We present results of a systematic review of empirical research on racism and the schooling experiences of Aboriginal and Torres Strait Islander students, focussing on research published from 1989 to 2016. Our review is part of a series of systematic literature reviews on Aboriginal and Torres Strait Islander education in Australia. It attends to diverse manifestations of racism, from institutional and systemic discrimination to everyday microaggressions, and varying levels of analysis, from individual experiences to cohort approaches. This work adopts a critical perspective on disciplinary boundaries and the outcomes discourse within the broad field of education research. Additionally, we discuss the challenges inherent in systematic review inclusion/exclusion criteria related to racism in a field such as education in which racism and discrimination are frequently misrepresented or misreported, for example, as disciplinary and behaviour management issues, disadvantage or as regional and remote education challenges. The review discusses study types and locations, explores how racism is defined and understood and details the effects of racism on Aboriginal and Torres Strait Islander students.

Background/significance. Cardiac rehabilitation (CR) significantly reduces death, reoccurring cardiac events, hospital admissions while improving quality of life. However, it is still poorly attended with participation rates worldwide between 20-50%, worsened for rural and remote patients by the tyranny of distance, work responsibilities and transportation. Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance. Purpose. The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website. Methods. UX Design theoretical framework, using a co-design workshop, with thematic analysis, a survey, and the System Usability Scale was used to report outcomes. Results. Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 27 participants across 4 regional Local health Networks in SA. The median age of participants was 71.0 (IQR 58-78), 14 (51.9%) were female and 27 (100%) had completed a cardiac rehabilitation program. More than half used a smart phone (16; 59.3%) and Facebook (21; 77.8%). Overall usability remains low based on a mean SUS score of 63.4 (SD 21.1), however there was a tendency to usability improving over time. Conclusion. The co-design process has contributed to the development of the CR website, improving desired content and features. Improved usability scores can be achieved through further incorporating consumer feedback into the development of the CR website.

Background Many women living in rural and remote Australia are required to travel large distances to birth in a hospital with maternity facilities, incurring considerable financial, social and emotional burden for them and their families. No studies to date have investigated the use of quantitative fetal fibronectin (qfFN) to predict term labour in asymptomatic pregnant women. A tool which is able to more accurately predict term labour has the potential to guide informed travel decision-making for women and healthcare professionals in rural and remote Australia. Aim The aim of this study is to determine if qfFN can reliably predict term labour in asymptomatic women from rural and remote areas. Materials and Methods Thirty-nine women from rural Australia provided 71 fFN samples between June 2016 and October 2018, from 37 weeks' gestation, with at least one week between samples for those providing multiple samples. Days from fFN sampling until spontaneous onset of labour were recorded. Using generalised estimating equation modelling we examined the utility of fFN as a predictor for onset of labour at term after adjusting for confounders. Results There was a small-to-moderate negative correlation (rs 0.27, P < 0.05) between time until labour and fFN. Quantitative fFN was observed to be a significant predictor of time until labour after adjusting for confounding variables (P < 0.001). Conclusion fFN levels may play a role in predicting term labour in rural women; however, future studies with a larger sample size are required to validate the findings of our pilot study.

In Australia, large-scale renewable energy projects are being developed or proposed on lands over which First Nations hold rights and interests. Our review of the literature on renewable energy and First Nations peoples globally indicates that renewable energy projects are likely to present risks in the distribution of socio-economic and environmental impacts, as well as significant opportunities for First Nation benefit. This paper explores the conditions under which First Nations people with communal property rights and interests in their traditional land are likely to derive benefit from large scale renewable energy projects. We examine ‘free, prior and informed consent’ (FPIC), a widely-recognised international human rights standard that sets out a consent, information and consultation framework for proposed developments on First Nation land. In calling for the just economic inclusion and participation of First Nation people in large-scale renewable energy projects we propose that ‘free, prior and informed consent’ offers a suitable framework for approaching the development of these projects. Furthermore, we detail what is best, and worst, practice in agreement making, based on previous First Nations agreement making experience, predominately with the resource extraction sector.

Barunga is an Aboriginal community in Jawoyn Country, in the Northern Territory of Australia. It is home to around 350 people, the vast majority of whom are Aboriginal. The Traditional Owners of the Barunga region have a rich cultural heritage, both tangible and intangible. Despite this resilient connection to country and culture, the community at Barunga is one of many Aboriginal communities subjected to the race-based and punitive government policy known as the Intervention. Designed to bring about change in remote Aboriginal communities, the Intervention has had a number of impacts upon Aboriginal lives. While the political situation in the Northern Territory, and beyond, has been interrogated from other points of view, little research has been conducted from an archaeological point-of-view. In fact, very little research has been conducted with respect to the contemporary entanglement between Aboriginal and non-Aboriginal Australians in regard to material culture. While material culture was used as a tool of cultural assimilation during early colonisation, it follows that it still plays a central role in reinforcing colonial attitudes in remote Aboriginal communities. Recent thinking in archaeology speaks to the deeply complex relationship between humans and things, and as such this thesis set out to investigate the situation in Barunga. This thesis explores material culture and graffiti in Barunga, in order to gain nuanced understandings of the ways in which material culture is used in remote communities. A theoretical model developed for this thesis is used in the interpretation of the material culture of Barunga. It can be used to explore the material culture of other communities as well. The model draws upon recent theoretical developments in the area of agency theory, entanglement, materiality and ‘assemblage thought’ to provide the intellectual tools with which material culture in Barunga can be understood as a cultural practice. The model consists of the themes, time and space; resistance and persistence, and memory and affect. The major result of this research is that the use of modern material culture by Aboriginal people in the Barunga community is informed by Aboriginal social and cultural practices, rather than reflecting some kind of assimilation with the dominant external society. Moreover, because the material culture itself is familiar, its use by Aboriginal people is interpreted by the mainstream society within a primarily European epistemology. This has led to government policy which is viewed by Aboriginal people as punitive and which is certainly ineffective, as demonstrated by the successive failure of the Federal government to ‘Close the Gap’ between Aboriginal and non-Aboriginal health, education, employment and lifespans.

Aim To explore chronic disease education, self-management and health literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings. Background Chronic disease management requires good health literacy abilities to manage long-term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people. Design A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines. Methods Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February-November 2017. Quantitative data (n = 200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data (n = 20) were collected via face-to-face interviews to examine chronic disease education and self-management experiences. Data were analysed separately then integrated to develop meta-inferences. Results Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in individuals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self-management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self-management were concurred with the low level of active engagement in health care. Conclusions Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self-management in contexts where health literacy abilities are challenged. Relevance to Clinical Practice Using yarning, and plain language visual aids, and teach-back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self-management.

Objective: To identify the specific risk factors for dementia in the Torres Strait. Methods: This research was conducted as part of a cross-sectional dementia prevalence study conducted in the Torres Strait. Participants underwent a comprehensive health assessment, where data on risk factors were collected, and a Geriatrician assessment, which was used to establish dementia diagnoses. Results: A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. Cerebrovascular disease, chronic kidney disease and older age were the most significant risk factors in this population. Once adjusted for age, cerebrovascular disease, chronic kidney disease, diabetes, low education and problems with mobility and incontinence were significantly associated with dementia. Conclusions Reducing dementia risk in the Torres Strait requires multifactorial interventions to address potentially modifiable risk factors with a particular focus on addressing the development of chronic midlife diseases.

This article examines crime prevention practices in the Torres Strait Region (TSR), where relatively low crime rates challenge the association of discrete Indigenous communities with crime 'problems' and also test other criminological assumptions around crime. Drawing on 27 interviews with justice professionals and social workers in the TSR, we account for the resilience of a 'shame culture' in the region, which provides for a high level of social integration and sustains crime prevention practices, such as cultural mediation. Thus, we argue that while economic indicators such as wealth and employment show high levels of disadvantage in the TSR, indicators of strong social capital provide an explanation for low crime rates. We conclude that social capital is translated into local crime prevention practices that are unique to the TSR and reinforce the importance of cultural continuity and autonomy.

Problem There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. Design: A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. Setting: Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. Key measures for improvement: Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. Strategies for change In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. Effects of change: Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. Lessons learnt: This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.

Community engagement is often cited as a critical component of working with Indigenous communities in both Australia and other countries. Ideally, this involves engaging in ‘bottom-up’ approaches that scope, identify and subsequently respond to community needs and aspirations. Community engagement is usually participatory and developmental in nature. It is often used as a means to shape policy and program development, scope research approaches and support enhanced service delivery in a range of settings, including the education sector. However, the physical, social, cultural, economic and political contexts in which community engagement occurs can be different. As such, there is no definitive approach to what community engagement both ‘looks’ and ‘feels’ like within different Indigenous education contexts. This chapter systematically explores what we already know about Indigenous community engagement, and how this relates to Indigenous education, and more specifically, Indigenous higher education contexts in Australia. We argue that there are four key factors that can impact on pathways into higher education for Indigenous students, which include ‘redefining community engagement from Indigenous standpoints’; ‘appropriately resourcing Indigenous community engagement activities’; ‘continuing to build an evidence base to learn from recent Indigenous community engagement investments’ and the need to ‘move beyond the rhetorical language used in many policy documents and frameworks.’ We conclude by suggesting that improvements in the quality and quantum of Indigenous community engagement work occurring in higher education in Australia will ultimately enhance opportunities for successful Indigenous pathways and transitions into university.

Objective: As cancer survival rates continue to increase, so will the demand for care from family and friends, particularly in more isolated settings. This study aims to examine the needs of cancer caregivers in regional and remote Australia. Methods: A total of 239 informal (i.e., non-professional) cancer caregivers (e.g., family/friends) from regional and remote Queensland, Australia, completed the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C). The frequencies of individuals reporting specific needs were calculated. Logistic regression analyses assessed the association between unmet needs and demographic characteristics and cancer type. Results: The most frequently endorsed needs were lodging near hospital (77%), information about the disease (74%), and tests and treatment (74%). The most frequent unmet needs were treatment near home (37%), help with economic burden (32%), and concerns about the person being cared for (32%). Younger and female caregivers were significantly more likely to report unmet needs overall (OR = 2.12; OR = 0.58), and unmet healthcare staff needs (OR = 0.35; OR = 1.99, respectively). Unmet family and social support needs were also significantly more likely among younger caregivers (OR = 0.35). Caregivers of breast cancer patients (OR = 0.43) and older caregivers (OR = 0.53) were significantly less likely to report unmet health and psychology needs. Proportions of participants reporting needs were largely similar across demographic groups and cancer type with some exceptions. Conclusions: Caregiver health, practical issues associated with travel, and emotional strain are all areas where regional and remote caregivers require more support. Caregivers’ age and gender, time since diagnosis and patient cancer type should be considered when determining the most appropriate supportive care.

Fetal Alcohol Spectrum Disorder (FASD) is characterised by a range of lifelong disabilities caused by alcohol exposure during pregnancy (Mattson, Crocker, & Nguyen, 2011; Streissguth, Barr, Kogan, & Bookstein, 1996). Worldwide the estimated prevalence of FASD is 22.77 (0–176.77) cases per 1000 live births (Roozen et al., 2016). The average additional yearly cost associated with being born with FASD in four western countries has been estimated at USD $20,000 per year (Greenmyer, Klug, Kambeitz, Popova, & Burd, 2018). Furthermore, without appropriate support the social and emotional difficulties faced by children born with FASD and their families can seriously impact the whole family and community (Jonsson, 2019). While there are therapeutic approaches aimed at reducing the impact of FASD on children and families, these are difficult and costly to implement with variable efficacy (Reid et al., 2015). FASD is however preventable, and preventative measures are likely to yield the most positive outcomes for affected communities.

Current practice around, and challenges facing, energy provision in Australia?s Northern Territory (NT) remote communities are discussed: hydrogen energy is introduced as a solution to alleviate the challenges therein. Options for hydrogen supply in NT remote areas are economically evaluated and their feasibility is discussed. While current capital expenditure limits pose the main barrier to hydrogen supply in remote areas of the NT, it was found promising in terms of environmental effects, long-term economic return, reliability of energy supply, and community empowerment.

Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are a professional cadre of Australian health workers typically located in primary care clinics. The role is one of only two that is ‘identified’— that is, it must be occupied by an Aboriginal and/or Torres Strait Islander person — and holds specific responsibilities in relation to advocating for facility-level cultural safety. However, lack of understanding of the distinctive skills, scope and value associated with the A&TSIHW role remains pervasive in the broader health workforce. Positioned to represent the perspective of those working as A&TSIHWs, and drawing on 83 in-depth interviews with A&TSIHWs and others, this qualitative study reports on the core functions and distinctive orientation of the role, and seeks to articulate its distinctive value in the modern Queensland health service. Findings highlight the multifaceted (generalist) nature of the A&TSIHW role, which comprises three core functions: health promotion, clinical service and cultural brokerage. Underpinning these cross-cutting functions, is the role’s unique orientation, defined by client-centredness and realised through Indigenous strengths based ways of knowing, being and doing. The findings highlight how the A&TSIHW role is one of the only mechanisms through which Aboriginal and Torres Strait Islander knowledge can be brought to bear on context-specific adaptations to routine health service practices; and through which the impacts of lack of cultural or self-awareness among some non-Indigenous health professionals can be mitigated. The complexity of such work in a government health system where a dominant biomedical culture defines what is valued and therefore resourced, is under-recognised and undervalued and contributes to pressures and stress that are potentially threatening the role's long-term viability.No data are available. Data were collected under strict conditions of confidentiality and protection following human research ethics guidance for Aboriginal and Torres Strait Islander research provided by National Medical Research Council.

Australian Aboriginal youth experience significant morbidity but may find it difficult to access culturally appropriate health care, particularly in remote areas. The Derby Aboriginal Health Service (DAHS) provides care in this setting but experiences difficulties engaging with Aboriginal youth. The aim of this research was to improve access to health care for Aboriginal youth in remote Australia. Through interviews with Aboriginal youth and staff, it was established that the relationship between care provider and young people is key. Access is further facilitated through appropriate health staff providing expansive care, formation of partnerships and community outreach

The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis. A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement. Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.

INTRODUCTION: This research was undertaken to gain insight into what remote area nurses perceived were enablers and barriers to being involved in delivering care to an Aboriginal person with a terminal diagnosis passing away on their traditional lands. It is hoped that this gives remote area nurses, Aboriginal Australians and service providers a glimpse into what is happening in the remote areas of Australia. Remote area nurses often work in isolated and in extreme geographical locations. This also means that a significant proportion work alongside and with Aboriginal Australians. In addition, remote area nurses are often left to support people in the communities they work in under extreme and often under-resourced conditions. METHODS: A literature review was undertaken on this subject and a four-section questionnaire was then developed based on the literature. This included demographic questions and two sections using an ordinal Likert scale. The Likert scale questions asked remote area nurses about the skills they felt they used to deal with particular situations and the capacity of the health service to deal with the situations. The fourth section comprised open-ended questions. Thematic analysis was undertaken on the open-ended questions. Categories and themes were developed, and the results discussed. The four-part questionnaire was designed to be anonymous, and it formed part of the questionnaire distributed to students enrolled with the School of Indigenous and Remote Health Alice Springs, Flinders University by email, and to not-for-profit membership organisation CRANAplus for distribution through their networks. RESULTS: Remote area nurses felt that the barriers to supporting an Aboriginal Australian with a terminal diagnosis passing away on their traditional lands were a lack of support around the delivery of culturally appropriate end-of-life care, lack of a stable workforce, insufficient cultural knowledge and understanding, and a lack of guidance and support from family. They felt the enablers were effective communication with the family and Aboriginal elders providing advice to staff and direction on how they can support the family, willingness of staff to participate in care, and input from Aboriginal health practitioners. CONCLUSION: Remote area nurses perceived they lacked support and knowledge from several different areas, both from within their communities and outside of their communities. Despite the barriers, it was evident that remote area nurses can be very resourceful at enabling the processes of supporting Aboriginal people with a terminal diagnosis passing away on their traditional lands.

Introduction Measuring self-reported alcohol use is challenging in any population, including when episodic drinking may be common. Drinking among Indigenous Australians has been shown to vary greatly within and between communities. However, most survey methods assume 'regular' patterns of drinking. National estimates have also been shown to underestimate alcohol use among this group. This paper describes drinking patterns in two representative community samples (urban and remote). Methods Indigenous Australians (aged 16+ years) in two South Australian sites were recruited to complete the Grog Survey App. The App is a validated, interactive tablet-based survey tool, designed to help Indigenous Australians describe their drinking. Drinking patterns were described using medians and interquartile ranges; gender and remoteness were compared using Wilcoxon rank-sum tests. Spearman correlations explored the relationship between drinking patterns and age. Logistic regressions tested if beverage or container preference differed by remoteness or gender. Results Three-quarters of participants (77.0%, n = 597/775) were current drinkers. Median standard drinks per occasion was 7.8 (78 g), 1.3 drinking occasions per month (median). Three-quarters of current drinkers (73.7%) reported a period without drinking (median: 60 days). Remote drinkers were more likely to drink beer. Improvised containers were used by 40.5% of drinkers. Discussion and Conclusions Episodic drinking with extended 'dry' periods and from non-standard drinking containers was common in this representative sample of Indigenous Australians. The diversity of container use and beverage preference, by gender and remoteness, illustrates nuances in drinking patterns between communities. It shows the importance of community-level data to inform local strategies addressing alcohol misuse.

Bauxite mining operations are increasingly sited on Indigenous-owned land, particularly in tropical areas, including northern Australia. The environmental impacts of bauxite mining are significant. Native vegetation, including commercially valuable forests, is cleared and typically windrowed and burnt. For many Indigenous Australians, mining of their land creates much concern about biocultural, community health and livelihood impacts from the loss of access to traditional lands and resources, and the ability to ‘care for country’. Improved pre-mining utilisation of forest resources and effective mine rehabilitation can mitigate some of these impacts and it is important to Indigenous communities that they are engaged in these processes. But Indigenous peoples' expectations are rarely considered or adequately addressed in site clearing activities or mine completion criteria, and there is limited guidance on how their expected outcomes can be monitored and evaluated for mine closure and relinquishment. This paper reports on a case-study of the Western Cape York Peninsula bauxite mining region in northern Australia. The paper reviews mine rehabilitation in the case-study region, including related Indigenous forest livelihoods initiatives, presents local Indigenous peoples' expectations for pre- and post-mining forest and landscape management as an integrated mining-community forestry ‘vision’, and discusses implications for mine completion criteria, mine closure and relinquishment. The findings highlight the need for Indigenous peoples' full and transparent free, prior and informed consent participation in all aspects of mine closure planning, and for further research to trial the development and assessment of mine completion criteria linked to local biocultural landscape restoration and Indigenous livelihoods. The findings can inform mining policymakers, regulators and industry professionals on the design, implementation and monitoring of mine completion criteria and associated pre- and post-mining management that will improve environmental outcomes and socio-cultural benefits for Indigenous communities impacted by mining.

Background Indigenous Australians are significantly burdened by chronic kidney disease (CKD). Elevated levels of C-reactive protein (CRP) have been associated with diabetes and cardiovascular incidence in previous studies. Elevated CRP has been associated with albuminuria and reduced eGFR in cross-sectional studies. This study investigated the long-term predictive association between CRP measured at a baseline exam and the incidence of a CKD-related hospitalization. Methods Health screening examinations were conducted in individuals of a remote indigenous Australian community between 1992 and 1998. The risk of subsequent CKD hospitalisations, documented through Northern Territory hospital records up to 2010, was estimated with Cox proportional hazard models in people aged over 18 years at the baseline screen and who had albumin-creatinine ratios (ACRs) less than 34g/mol. Results 546 participants were eligible for our study. Individuals in the highest CRP tertile at baseline had increased levels of traditional cardiovascular risk factors. They also had almost 4 times the risk of a CKD-related hospitalisation compared with participants in the lowest CRP tertile (HR=3.91, 95%CI 1.01-15.20, P=0.049) after adjustment for potential confounding factors. Participants with CRP concentrations greater than 3mg/L had almost 3 times the risk of CKD hospitalisations than those ≤3mg/L (HR=2.84, 95%CI 1.00-8.00, P=0.049). Furthermore, risk of CKD hospitalisations increased 34% per doubling of baseline CRP (HR=1.34, 95%CI 1.04-1.74, P=0.024). Conclusion In individuals in this remote indigenous community without overt albuminuria at baseline the risk for incident CKD related hospitalisations was predicted by elevated C-reactive protein levels almost a decade earlier. Further research is needed to understand the roles that CRP and systemic inflammation play in CKD risk.

Background: Tick-borne haemoparasites Babesia vogeli and Anaplasma platys are common among the free-roaming canine populations associated with Aboriginal communities in Australia, whilst the prevalence of haemoplasmas, which are also suspected to be tick-borne, remained unexplored. The aim of this study was to determine the prevalence of haemoplasma infection in these populations, and to identify any correlation with other haemoparasites. Blood was collected from 39 dogs associated with four Aboriginal communities and screened for infection using PCR and serology. DNA was purified and PCR analyses for piroplasms, Anaplasmataceae family bacteria and haemoplasmas performed. Serum was analysed using a commercial haemoparasite ELISA. Prevalence of infection was compared between communities. Results: Seventeen dogs (44%) were infected (PCR positive) with Mycoplasma haemocanis, eight (21%) with ‘Candidatus Mycoplasma haematoparvum’, 20 (51%) with A. platys, and 17 (44%) with B. vogeli. Two dogs were infected with a novel haemoplasma as determined by DNA amplification and sequencing. Two dogs (5%) were serologically positive for Dirofilaria immitis antigens, one (3%) was positive for Ehrlichia canis antibodies and nine (24nbsp;%) were positive for A. platys antibodies. Co-infections were frequent. Haemoplasma prevalence was highest (73%, 16/22) in Central Australia and lowest (22%, 2/9) in Western Australia (p = 0.017). In contrast, B. vogeli prevalence was low in Central Australia (18%, 4/22) but higher (78%, 7/9) in Western Australia (p = 0.003). Conclusions: This is the first time haemoplasma infections, including a novel species, have been molecularly documented in Australian dogs. The wide regional variation in prevalence of some of the haemoparasite infections detected in this study warrants further investigation.