Remote Australia Online

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

Objective: To detect Anaplasma platys and Babesia canis vogeli infection, using polymerase chain reaction (PCR)-based assays, in free-roaming dogs associated with eight Aboriginal communities in remote areas of Australia and to determine the impact of infection through the assessment of platelet numbers. Procedures: Blood samples from 215 dogs were screened by PCR for A platys and B canis vogeli using established genus-specific DNA primers for the 16S and 18S rRNA genes respectively. Both A platys DNA and B canis vogeli DNA were confirmed from the screening PCR either by sequencing or by the use of species-specific primers. Peripheral blood films from 92 of the 215 dogs were used to estimate platelet numbers through an indirect method. Results: Of 215 dogs, 69 (32%) were positive for A platys, 22 (10%) for B canis vogeli and 24 (11%) for both. The two organisms were detected singularly and as coinfection in all communities. For the 92 dogs in which peripheral blood films were examined, the mean estimated platelet counts for the non-infected dogs was 318 x 10 9/L, those infected with A platys alone was 256 ? 109/L, those with B canis vogeli alone was 276 x 10 9/L and those infected with both parasites was 169 x 10 9/L. In young dogs, infection produced significantly decreased mean platelet counts when compared to uninfected dogs. Thrombocytopenia (< 200 x 10 9/L) was detected in 18 (51%) dogs infected with A platys alone, 3 (33%) dogs infected with B canis vogeli alone, 13 (72%) dogs coinfected, and 8 (27%) uninfected dogs. Conclusions: A platys and B canis vogeli infection, either singularly or together, was widespread in free roaming dogs associated with remote Aboriginal communities in the Northern Territory and north-western New South Wales. Moreover, both A platys and B canis vogeli infections were associated with a reduction in mean platelet numbers in dog populations, particularly in young dogs. The fact that 51% of dogs infected with A platys alone and 72% dogs coinfected were thrombocytopenic compared to 27% of uninfected dogs suggests that the organism alone or in combination with B canis vogeli has the potential to cause thrombocytopenia and perhaps contribute to a clinical bleeding disorder in infected dogs.

Objective Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time. Design A cross-sectional survey of students and a review of student placement data. Setting Northern Territory, Australia. Participants Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019. Main outcome measure(s) Agreement with the statements ?This placement has encouraged me to consider living and working in a rural or remote location after I graduate? and ?Overall, I was satisfied with my placement.? The administrative record review examined student numbers, and placement length over time. Results A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%). Conclusions The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings.

There is a robust body of work highlighting distinctive challenges encountered by leaders of small schools in pursuit of school improvement but this work has focused on the school as the unit of change and neglects the role of the district. As the district potentially influences what principals know and how they use their knowledge, this article examines how districts provide professional support for principals of small schools in rural or remote environments. The article identifies from the literature features of effective districts in supporting change and improvement in their schools. A case study is then presented of one district in Western Australia. This district's magnitude and remoteness yield rich insights into strategies assisting principals to enhance performance and vitality of rural or remote schools and their communities. Finally, suggestions are made for strengthening these strategies referring to the new model of supporting schools on the cusp of its implementation in Western Australia.

Background: University students’ mental wellbeing is increasingly “on the radar” of universities in Australia and internationally. In this climate, this one-year 2019/20 NCSEHE Equity Fellowship research investigated university students’ perspectives on mental wellbeing and their insights into proactive approaches that they found supportive during their university studies. In particular, the research focused on mature-aged students who live in, or come from, regional and remote areas in Australia. Regional and remote students are in the national spotlight as attested by recent national reports. However, the focus of improving access and participation in higher education has been on school leavers. Mature-aged students are largely missing from the discussion, yet they make up a sizeable proportion of the regional and remote cohort. In focusing on the mature-aged sub-group within the regional and remote cohort, this project responded to calls for deeper understanding of the diversity and complexity of equity group cohorts, as well as the need to understand more about how universities can proactively support students’ mental wellbeing. Research approaches and methods: This Fellowship research investigated two overarching research questions: i) “What factors impact on the mental wellbeing of mature-aged undergraduate university students in, and from, regional and remote Australia?”; and ii) “What are proactive approaches that support the mental wellbeing of mature-aged undergraduate university students in, and from, regional and remote in Australia?” The sub-research question, “who are mature-aged university students in, and from, regional and remote Australia?” was a necessary starting point for approaching the two overarching questions. This research followed a concurrent transformative mixed-methods design (Creswell, 2014). It was informed by multiple conceptualisations of mental wellbeing (detailed in Section 2.2.1. of the Report). In brief, adapting the WHO’s (2014) definition, mental wellbeing was understood as managing the “normal” stresses of university and life in order to thrive and reach one’s academic goals and potential. The research also drew on Bronfenbrenner’s ecological systems theory to demonstrate that students are located within multiple interacting microsystems (for example: university, family, work and local community) that impact positively and negatively on their mental wellbeing, and which are also influenced by other layers of the broader ecosystem. Three methods of data collection (detailed in Section 3) were employed: i) national higher education student data (specifically, the 2018 Domestic Undergraduate Participation data); ii) a student survey; and iii) student interviews. Descriptive statistical analyses of the national student data and the quantitative survey data were undertaken. Specific questions in the latter were investigated for associations between variables using cross tabulations and tested for significant differences using Chi-square tests. The p<0.05 significance level was used for all tests. The open-ended survey questions and the interview data were analysed qualitatively. The approximately 1,800 survey participants and 51 interviewees were from regional and remote areas all over Australia, in all states and territories; they studied in a range of fields and were spread across the year levels. The majority of participants were from 15 universities. Key findings: In response to the research questions, findings are detailed in Sections 4, 5 and 6 in the Report and summarised here. Notable patterns in the regional and remote student cohort were found from an analysis of the national higher education student data. The more remote the geographical location, the higher the proportion of students who were female, studying online and studying part-time. The proportion of Aboriginal and Torres Strait Islander students increased with remoteness. The proportion of students from low socioeconomic status (SES)areas was far higher for the regional and remote locations compared to the metropolitan areas. All of these patterns were even more pronounced for older students: that is, for students who were aged 21 or older at the commencement of their degree. The majority of survey respondents (82.0%) remained in their regional/remote location for their university studies; 41.1 per cent of the respondents had children under 18years of age living at home, and 81.3 per cent of respondents were in paid employment. Further statistical analysis of the survey data revealed that the students who studied online were more likely to study part-time, work full-time, and live in outer regional, remote and very remote areas; in addition, the students who were the first in their family to attend university were more likely to study online. Mature-aged students in, and from, regional and remote Australia were found to be a diverse cohort with varying circumstances. Large numbers of the survey and interview respondents undertook their studies fully online in their regional or remote locations. Smaller numbers relocated from regional or remote areas to major cities, but with the intention of returning home upon completion of their studies. Many students had busy lives balancing their studies with parenting, work and community responsibilities. These students, typically women, carved out the space and time for study in snippets between their other commitments. Other students were less time poor and studying was “their time”. Some of these students found that study helped them in their recovery from or management of major life events or situations, such as divorce, retirement and, in some cases, homelessness, or physical or mental ill-health (including anxiety, depression and post-traumatic stress disorder). A variety of factors impacted on students’ mental wellbeing, both within the context of their daily learning and interactions with their university course, curriculum, peers and staff, and outside of the university environment, such as practical issues (for example, unreliable internet) and financial challenges. Several aspects of the students’ learning experiences were revealed in the qualitative analyses and highlight the importance of teaching and learning for student mental wellbeing. Mature-aged students in certain sub-groups within the regional and remote cohort—such as students who studied online and part-time, and students with children—experienced compounding challenges and impacts. Almost half of the survey respondents(47.7%)considered deferring/withdrawing from their university course. The top two reasons why students considered deferring/withdrawing were: i) stress (65.6%); and ii) feeling overwhelmed by their university study-load (55.4%). The survey responses to a series of statements that focused on the different periods within the cycle of a semester highlighted the temporal nature of stress with some periods of time within a semester being more stressful than others. Unsurprisingly, the most stressful periods were the time just before assignments were due and the final weeks of semester. School holiday periods were a stressful time for a large minority of students, as were the pre-semester/orientation periods and the first week of semester. While more than half of the respondents (54.7%) agreed or strongly agreed that they had at least one person (staff member or student) they could turn to at university for support, of concern is that nearly one third (31.1%) of the respondents did not. Also of concern is that 46.7 per cent of respondents reported not having a supportive peer group (whether it be face-to-face or online) at university. The finer-grained analysis found that specific sub-groups of students (that is, students who studied online or part-time or were aged 31-40) not only had no one to turn to for support at university, but they were also likely not to have support with their university studies from people close to them outside of university; for example, they were more likely to report that their family and friends had a negative or extremely negative impact on their mental wellbeing. There is a discrepancy between universities’ provision of Student Support Services and students’ awareness of them. The quantitative analysis of the survey results revealed a lack of awareness of wellbeing/health events and online resources on university websites about mental health and wellbeing. On a more positive note, 72.4 per cent of survey respondents were aware that they could access counselling services at university. Comments from some interviewees highlighted that they were unaware of their university’s Student Support Services until they needed them and were introduced to them by a staff member, such as a lecturer, tutor or librarian. It illustrates the importance of small actions by staff, which ultimately assisted these students in seeking support from their university’s Student Support Services. The majority of students in this study indicated that they knew how to look after their mental wellbeing. However, students reported that it was not always possible to implement self-care and other “healthy” strategies whilst juggling multiple commitments. For many students in this study, there was a mismatch between the academic demands and the time that students had available to meet them, along with other commitments vital to maintaining their general health, their families and their finances.

It's been 30 years since the tabling of the Royal Commission into Aboriginal Deaths in Custody and for Indigenous people things are worse than they have ever been when dealing with the justice industry.

Death by suicide is always a difficult topic to discuss. It affects those left behind like no other death. Suicide of a non-Indigenous person is no less tragic than the suicide of an Indigenous person, but best available statistics show that Indigenous people are far more likely to take their own lives, and so it warrants additional attention. Recent data from the Australian Bureau of Statistics found that there were 27.1 Indigenous suicide deaths per 100,000 persons in 2019, compared with 12.9 non-Indigenous suicides per 100,000 people in the same time period. A reduction in the suicide rate among Indigenous Australians was included as a specific target area when the Closing the Gap initiative was updated in July 2020. The most recent Productivity Commission report on mental health stated that “suicide is the fifth leading cause of death for Aboriginal and Torres Strait Islander people, compared with the twelfth for non-Indigenous people”. The situation is even more dire for younger males (15–44 years), as shown in the Figure below taken from the report. In documenting the problem of suicide among the Indigenous population, particularly youth, a 2019 systematic review argued that the term “crisis” is appropriate, given that young Indigenous Australians not only die by suicide at significantly higher rates than their non-Indigenous peers, but also do so at an increasingly younger age, particularly in remote areas.

Background: Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants. Methods: Aboriginal women aged 25–69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model. Results: In total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n = 46) were never-screened and one-third (n = 69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (> 92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them. Conclusions: A community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

Aims To assess the feasibility and metabolic effects of once weekly supervised injection of exenatide-LAR in addition to standard care in Indigenous Australians with type 2 diabetes. Methods Two communities in Central Australia with longstanding specialist clinical outreach services were allocated by random coin toss to receive once-weekly exenatide-LAR injection with weekly nurse review and adjustment of medication for 20?weeks (community with exenatide-LAR) or to weekly nurse review in addition to standard care over 20?weeks (community without exenatide-LAR). The primary outcome was the feasibility of the intensive diabetes management model of care with and without weekly supervised exenatide-LAR. Secondary outcomes included change in HbA1c. Results 13 participants from community with exenatide-LAR and 9 participants from the community without exenatide-LAR were analysed. 85% of individuals in the community with exenatide-LAR and 67% in the community without exenatide-LAR attended more than half of clinic visits. Median difference in the change in HbA1c from baseline to final visit, adjusted for baseline HbA1c, between the community with exenatide-LAR and the community without exenatide-LAR was -3.1%, 95% CI (-5.80%, -0.38%; p = 0.03). Conclusions Weekly exenatide-LAR combined with weekly nurse review demonstrated greater improvements in HbA1c, highlighting its potential for use in remote communities.

Objective To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients? choice of service. Design A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. Setting A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. Participants Patients attending the emergency department with lower urgency problems. Interventions ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. Main outcome measures The proportion of patients attending the ED with GP-appropriate problems and influences on their decisions to attend the ED. Results About 48% of all attendances met the agreed definition of GP-appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. Conclusion Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.

Introduction: If the invitation to research is not delivered in a way that is understood, or acknowledges that participants may come from a different world-view, it may affect participation rates, and research findings and research relationships with Indigenous communities. Reflections on the consent process and community engagement for research with Indigenous populations are rarely documented as shown in our systematic review.1 In response, The Picture Talk Project was initiated by leaders of remote Aboriginal communities of the Kimberley to have a ‘Yarn’ about the research process.2 Methods: Aboriginal leaders formed a partnership with researchers from Sydney and Darwin. Locally respected Aboriginal people were employed to work as Community Navigators and interpret language, provide cultural guidance and learn Western research approaches. Community leaders were interviewed (research topic yarning) and focus groups (collaborative yarns) were held with Aboriginal community members comprising of parents or carers about their understanding of research, the consent process and their preference of how communities should be engaged and how information should be presented.2 Focus group participants were also given the option to draw pictures on paper during the focus group in order to divert focus to a mutual activity.3,4 Transcripts are analysed using NVivo10 qualitative software and coded using inductive and deductive coding with grounded theory.5 Major Themes are synthesised and supporting quotes from participants were identified. Results: Participants were from different age groups, both males and females and from main local language groups of the Fitzroy Valley, namely Bunuba, Gooniyandi, Walmajarri, Wangkatjungka and Nykina. Interview analysis reveals five main themes: Research – finding knowledge; Showing respect for Aboriginal people, working on country and being flexible with time; Working together with good communication; Reciprocity – learning two ways and Reaching consent. Themes emerging from the focus group data include: Research – your knowledge; Communication – ‘Milli Milli’ (written word) versus Pictures; Community Research Relationships – ‘Checking in’; and Future Directions: What to research next? Conclusion: Aboriginal communities want researchers to change their approach to community engagement.1 Specific feedback is given on how to communicate in a way that is embraced by remote Aboriginal communities leading to better recruitment rates and more meaningful research outcomes and forming relationships which embody respect for Aboriginal culture.

In northern Australia, wild dog populations potentially interact with domestic dogs from remote communities, which would create opportunities for disease transmission at the wild?domestic interface. An example is rabies, in the event of an incursion into northern Australia. However, the likelihood of such wild?domestic interactions is ambiguous. Hybridisation analyses based on 23 microsatellite DNA markers were performed on canine-origin scats collected in bushland areas around remote Indigenous communities in the Northern Peninsula Area, Queensland. Sufficient DNA was extracted from 6 of 41 scats to assess the percentage of dingo purity. These scats most likely originated from two 'pure' domestic dogs (0% dingo purity), one hybrid (20% dingo purity) and three 'pure' dingoes (92%?98% dingo purity). The two domestic dog samples were collected in the vicinity of communities. The location of two of the dingo-origin samples provides genetic evidence that dingoes are present in areas close to the communities. The availability of anthropogenic food resources likely creates opportunities for interactions with domestic dogs in the region. The hybrid sample demonstrates the occurrence of antecedent contacts between both populations by means of mating and supports the likelihood of a spatio-temporal overlap at the wild?domestic interface. This represents the first genetic survey involving a wild dog population of equatorial northern Queensland, with evidence of dingo purity. Our results have implications for potential disease transmission within a priority area for biosecurity in northern Australia.

Giftedness has long been recognised as a cultural construct. Further, the processes and practices for developing talents are culturally influenced. Yet, there is little existing research into Australian Aboriginal understandings of giftedness and talent. There is a need to move beyond pan-Aboriginality when considering Australian Aboriginal views, and with this in mind, this paper reports the findings of an investigation into Yolngu conceptions of giftedness, talent, and talent development. Importantly, for the Yolngu participants in this study, these constructs are grounded in their foundation law (Djalkiri Rom). It follows that identification of giftedness relies on observation of traits and behaviours that, when harnessed, will serve these cultural priorities. It also follows that the practices and processes used by the Yolngu to develop talents will be mediated by their cultural milieu. This has implications for young people from cultural minority backgrounds, including Australian Aboriginal students, who often find their approaches to giftedness and talent sidelined at school.

Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations.

Boarding schools have played an important role for much of Australia’s colonised history. But in recent years attention has shifted to the role of boarding schools particularly for rural and remote Aboriginal and Torres Strait Islander students. The Northern Territory Government’s 2014 Review of Indigenous Education (The Wilson Review) supported boarding options ahead of local secondary provision for rural and remote students. Scholarship programs are often touted as the solution and while articulated policy on boarding is hard to find, financial support for boarding is not so hard to find. But what has been the impact of this growth in demand? How can it be that so little policy has resulted in so much activity and so much evidence of potential harm? This chapter argues from a theoretical position that the high hopes for boarding have often not materialised because of the hegemonic policy paradigms (or belief systems), which fail to take account of evidence, and which in turn have the potential to create ethically questionable policy. We also challenge researcher ethics in the ‘site’ of boarding. The lessons from this discussion extend to other sites or places and it could be that boarding is one place among many in the rural/remote context where these tensions occur. The chapter concludes by suggesting that critical consideration of the consequences of potentially unethical policy is the first step in moving towards ethically sound boarding provision.

Reforms to the delivery of housing services to remote Aboriginal communities in Australia have resulted in radical changes to housing management. Commencing in 2008, the National Partnership Agreement on Remote Aboriginal Housing (NPARIH) was a 10-year, AU$5.5-billion housing management and capital works program of new housing, and refurbishment of existing housing, in remote Indigenous communities. As well as increasing the quality and quantity of housing stock, the reforms included the transfer of housing from Indigenous Community Housing Organisations (ICHOs) to state and territory governments, with the goal of improving the standard of housing and housing maintenance by bringing tenancy management up to public housing standards (COAG 2008).Drawing on Sanders’ (2009) framework for analysing policy principles in Australian Indigenous affairs, this chapter argues that as the process of implementing NPARIH rolled out, remote housing delivery became a site in which competing policy principles of guardianship, equality and choice were played out. Equality was evident in NPARIH’s goal of normalising remote Aboriginal communities so that housing standards are comparable to those that apply in other regions of Australia. There were also elements of adaptation that resulted in some principles of choice and recognition. But these tendencies were accompanied by coercive measures that reflect policy principles of guardianship: first, in their requirement for Aboriginal people to give up some of their land rights by agreeing to government leases over their land; and second, in the emphasis on individual behavioural change and self-responsibility in meeting the same tenancy obligations as apply in mainstream public housing. The analysis concludes that, despite evidence that an adaptive approach that recognises Aboriginal life worlds works best in Aboriginal service delivery, the normalising imperatives of the neoliberal state overwhelmingly support the continuation of the colonising project and the transformation of remote Aboriginal Australia along white ‘settler’ lines. As argued by others in this volume (Eatock, Chapter 3, Sanders, Chapter 6, Howard-Wagner, Chapter 12), this shows that although neoliberal governance may allow some lacunas of difference, it is fundamentally aligned with the overarching, enduring and continuing project of colonisation.

Safe drinking water provision in remote Australian Indigenous communities can raise many challenges. An initiative to enhance drinking water treatment was piloted in Australia?s remote Torres Strait Islands. It was co-designed through close involvement of Torres Strait Islander local government officers and water operators. Data collection and analysis was undertaken independent researchers to assess the effectiveness of the pilot, drawing on both quantitative and qualitative sources, including field visits to the two Torres Strait Islands. The findings identified three key features for an effective programme of safe water delivery: appropriate infrastructure that is ?fit for purpose, place and people?; mentoring and technical support for remotely located water operators, and cooperation across relevant state and local government agencies. The pilot initiative has adaptive potential for other remote communities and for other basic services, including wastewater treatment and solid waste management.

There is considerable literature documenting the peripatetic preferences of Australians for leisure, lifestyle and work purposes, and the paucity of reliable data that would provide insights to why people have multiple bases and the impact on local markets and service delivery (McKenzie et al. 2008 p. 4; Nicholas and Welters 2017; Nicholas and Welters 2016). There have been numerous requests and submissions to the Australian Bureau of Statistics (Productivity Commission 2014; Productivity Commission 2019; ABS 2007; McKenzie et al. 2008) to systematically record population mobility, and to not limit the Place of Usual Residence to just one location in the quinquennial census. To date, these have been unsuccessful. This paper focuses specifically on long distance commuting (LDC) for work purposes in rural, regional and remote areas, but the principles and benefits of recording labour force mobility (requiring multiple nights away from the place of usual residence), apply equally for other forms of population mobility such as for education, lifestyle and other seasonal vacation work. Specifically, this paper shows how the lack of data about workforce mobility undermines prescient planning and informed regional economic development for local government authorities whose capacity to raise revenue is limited. This is particularly the case in mining regions where local governments and other planning authorities are constrained by State Agreements which absolve large multinational mining companies from paying local government rates and other taxes for local infrastructure and services (Horsley 2013).

Aims: To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women. Methods: Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn. Results: Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8–88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03–4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy. Conclusions: Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.

The school of social vulnerability in disaster sciences offers an alternative perspective on the current COVID-19 (coronavirus) pandemic crisis. Social vulnerability in general can be understood as a risk of exposure to hazard impacts, where vulnerability is embedded in the normal functioning of the society. The COVID-19 pandemic has exposed systemic (political and health care systems), demographic (aging, race) and,based on the results of our approach, spatial (spatial isolation and connectivity) yvulnerabilities as well. In this paper, we develop a risk prediction model based on two composite indicators of social vulnerability. These indicators reflect the two main contrasting risks associated with COVID-19, demographic vulnerability and, as consequences of the lockdowns, economic vulnerability. We conceptualise social vulnerability in the context of the extremely uneven spatial population distribution in Australia. Our approach helps extend understanding about the role of spatiality in the current pandemic disaster.

Objective To investigate the experiences of audiologists and audiometrists working in regional and remote areas of Australia. Design A qualitative design, using telephone and videoconference semi-structured interviews and thematic analysis. Setting Regional and remote locations across Australia Participants 5 audiologists and 2 audiometrists, 6 female and one male. Interventions None. Main outcome measures Insights into the experiences of audiologists and audiometrists working in rural Australia. Results Core themes that emerged from analysis were (a) professional isolation and increased scope of practice, (b) the importance of social and professional networks, (c) variable access to professional support, (d) challenges in the recruitment and retention of clinicians, and (e) tensions between service provision and profitability. Conclusion This study provides valuable insights into both the rewarding and challenging aspects of working as an audiologist or audiometrist in regional and remote areas. This study emphasised the need to address these challenges in order to attract more audiological professionals to work and stay in regional and remote areas of Australia.

Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia’s Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019.

Objective To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. Design Cross-sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/Setting Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. Main outcome measure(s) Career preference in primary care after graduation. Results The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4-42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P = .004). Conclusion Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like-minded peers and clinicians to preserve the career interest of these students.

Background Supporting a child?s healthy development is determined, in part, by a parent?s ability to seek, access, interpret and effectively utilize health information. This aspect of parenting draws on a set of skills referred to as health literacy. Objective To assess the level of health literacy among parents/carers in a regional South Australian community. Methods Parents/carers of primary school-aged children, residing in Whyalla, South Australia, were invited to complete the 13-item All Aspects of Health Literacy Survey. Results 155 parents/carers completed the survey (79% mothers). Most participants were English-speaking (97%), employed (62%) and had 2-3 children (62%), with 52% completing tertiary education. Median total health literacy scores were mostly in the moderate-high range (median 27, IQR 26,27), as were critical health literacy scores (median 7, IQR 6,8). Higher scores were reported for functional health literacy (median 8, IQR 7,9), communicative health literacy (median 9, IQR 8,9) and empowerment health literacy (median 4, IQR 3,5). Conclusions Our findings reveal modest levels of health literacy among a sample of parents/carers of primary school-aged children in a regional South Australian community. Further work is needed to understand the differential effect of parental health literacy on child health outcomes, and the types of strategies that may mitigate the impact of these barriers on a child's healthy development.

Knowledge co-production enabled via decolonised research approaches can support indigenous leaders to respond to the challenges and opportunities that result from their natural and cultural resource management obligations and strategies. For knowledge co-production to be realised, such research interactions must provide space for Indigenous peoples to position themselves as research leaders, driving agendas and co-designing research approaches, activities, and outputs. This paper examines the role that positionality played in supporting an Indigenous-led research partnership, or knowledge-action system, that developed between indigenous, industry, and research project partners seeking to support development of the Indigenous-led bush products sector in northern Australia. Our chosen conceptualisation of positionality informs sustainability science as a way for scientists, practitioners, and research partners to consider the power that each project member brings to a project, and to make explicit the unique positioning of project members in how they influence project processes and the development of usable knowledge. We locate the research in northern Australia and then articulate how selected research methodologies supported the partnership that resulted in knowledge co-production. We then extend the literature on decolonising methodologies and positionality by illuminating how the positionality of each research partner, and the partnership itself, influenced the research and knowledge co-production processes. In culmination, we reveal how an interrogation of post-project benefits and legacies (e.g., usable knowledge) can enable a fuller understanding of the lasting success of the project and partnership, illustrated with examples of benefits derived by project partners since the project ended.