Remote Australia Online

Background Inappropriate antimicrobial prescribing contributes to the emergence of antimicrobial resistance. Gaps exist in the understanding of antimicrobial prescribing in the remote setting. We aimed to assess adherence to guidelines and appropriateness of antimicrobial prescribing in Central Australia. Methods A retrospective study assessing antimicrobial prescriptions in ten Aboriginal clinics (three in remote communities and seven in regional centre) using a validated evaluation tool. Antimicrobials prescribed between 1 January—31 December 2018 were randomly selected for inclusion into the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing. Results A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines. Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory-tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively. Conclusion A quarter of antimicrobial prescriptions written in select remote central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.

While there is increasing international interest in approaching language analysis with the prism of repertoire, research on repertoire on the Australian continent is still very much in the shadow of “traditional” language-centric documentary work. This paper will explore the question of how users of Australian, English-lexified contact varieties exploit their multilingual repertoires to achieve local, conversation–organizational ends. Drawing upon a corpus of video recordings from Ipmangker, a Central Australian Aboriginal community, and using the analytical methods of interactional and comparative variationist linguistics, I examine the production of reported speech by four 6- to 7-year-old Alyawarr children in a play session at home. A set of prosodic, phonological, morphological and discourse-pragmatic features are shown to form a coherent set of linguistic elements with which these multilingual children can contrast reported speech from the surrounding talk. Moreover, the use of reported speech in play not only allows the children to organize their interaction, but responds to and constructs the epistemic landscape of play.

In May, 2017, an outbreak of rotavirus gastroenteritis was reported that predominantly impacted Aboriginal children ≤4 years of age in the Kimberley region of Western Australia. G2P[4] was identified as the dominant genotype circulating during this period and polyacrylamide gel electrophoresis revealed the majority of samples exhibited a conserved electropherotype. Full genome sequencing was performed on representative samples that exhibited the archetypal DS-1-like genome constellation: G2-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2 and phylogenetic analysis revealed all genes of the outbreak samples were closely related to contemporary Japanese G2P[4] samples. The outbreak samples consistently fell within conserved sub-clades comprised of Hungarian and Australian G2P[4] samples from 2010. The 2017 outbreak variant was not closely related to G2P[4] variants associated with prior outbreaks in Aboriginal communities in the Northern Territory. When compared to the G2 component of the RotaTeq vaccine, the outbreak variant exhibited mutations in known antigenic regions; however, these mutations are frequently observed in contemporary G2P[4] strains. Despite the level of vaccine coverage achieved in Australia, outbreaks continue to occur in vaccinated populations, which pose challenges to regional areas and remote communities. Continued surveillance and characterisation of emerging variants are imperative to ensure the ongoing success of the rotavirus vaccination program in Australia.

Hip-hop workshops have become a key feature of youth-focused community arts programmes in regional and remote Indigenous communities in Australia over the past twenty years with music videos being a primary output. While literature on Indigenous hip-hop in Australia has demonstrated that rap music provides a powerful medium of expression for representing identity, there has been little research on hip-hop workshops. In the early 2000s Indigenous hip-hop artists, many of whom co-facilitated the first hip-hop workshops, demonstrated an understanding of hip-hop as a new form of ceremony. This paper makes a case for hip-hop-as-ceremony as a framework for understanding what Indigenous communities might be utilising hip-hop workshops for, moving beyond lyrics and images to the collective public performance events that music videos depict. This article analyses two music videos produced through hip-hop workshops in the central Australian desert to point to the possibilities hip-hop culture provides for maintaining ceremonial practice.

• This national assessment of Australia’s energy resources examines Australia’s identified and potential energy resources ranging from fossil fuels and uranium to renewables. It reviews and assesses the factors likely to influence the use of Australia’s energy resources to 2030 including the technologies being developed to extract energy more efficiently and cleanly from existing and new energy sources. • Australia has an abundance and diversity of energy resources. Australia has more than one third of the world’s known economic uranium resources, very large coal (black and brown) resources that underpin exports and low-cost domestic electricity production, and substantial conventional gas and coal seam gas resources. This globally significant resource base is capable of meeting both domestic and increased export demand for coal and gas, and uranium exports, over the next 20 years and beyond. There is good potential for further growth of the resource base through new discoveries. Identified resources of crude oil, condensate and liquefied petroleum gas (LPG) are more limited and Australia is increasingly reliant on imports for transport fuels. • Australia has a rich diversity of renewable energy resources (wind, solar, geothermal, hydro, wave, tidal, bioenergy). Except for hydro where the available resource is already mostly developed and wind energy where use is growing strongly, these resources are largely undeveloped and could contribute significantly more to Australia’s future energy supply. • Greater use of many energy sources with lower greenhouse gas emissions (especially renewable energy sources) is currently limited by the immaturity of technologies and the cost of electricity production. Advances in technology supported by industry and government actions are expected to result in commercial electricity production by 2030 from sources that are currently only at the demonstration stage. • Australia’s energy usage in 2030 is expected to differ significantly from that of today under the influence of the 20 per cent Renewable Energy Target and other government policies such as the proposed emissions reduction target. In addition the Government has established the Clean Energy Initiative which includes the Carbon Capture and Storage and Solar Flagship Programs, and the Australian Centre for Renewable Energy. • Australia’s long-term energy projections show total energy production nearly doubling due to strong export demand, primary energy consumption rising by 35 per cent, and electricity demand increasing by nearly 50 per cent by 2030. Whilst coal is expected to continue to dominate Australia’s electricity generation, a shift to lower-emissions fuels is expected to result in a significant reduction in coal’s share and increases in gas and renewable energy, particularly wind. • Australia’s energy infrastructure is concentrated in areas where energy consumption is highest and major fossil fuel energy resources are located. Greater use of new energy resources, particularly renewable energy sources, will require expansion of Australia’s energy infrastructure, including augmentation of the electricity transmission grid.

Background: Inequalities in the availability of maternity health services in rural Australia have been documented, but not the impact on aeromedical retrievals. This study aims to examine the prevalence of pregnancy-related aeromedical retrievals, the most common conditions (overall and in specific age groups), and their distribution according to operation area and demographic characteristics. Methods: Cross-sectional study using administrative data from the Royal Flying Doctors Service (RFDS) including all pregnant women aged 15–49 years retrieved by the RFDS between 2015 and 2019. All pregnancy-related aeromedical retrievals were classified according to the International Classification of Diseases, Tenth Revision (ICD-10, chapter XV). The distribution of pregnancy-related conditions was presented overall and stratified by age group (i.e. < 20 years, 20–34 years and 35+ years). Retrieval and receiving sites were geographically mapped with Tableau mapping software® based on postcode numbers of origin and destination. Results: A total of 4653 pregnancy-related retrievals were identified (mean age 27.8 ± 6.1 years), representing 3.1% of all RFDS transfers between 2015 and 18 and 3.5% in 2018–19 (p-value 0.01). The highest proportion of pregnancy-related retrievals (4.8%) occurred in Western operation. There was an apparent increase in pregnancy-related retrievals in South Australia and the Northern Territory (Central Operation) in 2018–19. Preterm labour/delivery was responsible for 36.4% of all retrievals (40.7% among women aged 15–19 years) and premature rupture of membranes for 14.9% (19.4% among women aged 35–49 years). Inter-hospital transfers represented 87.9% of all retrievals, with most patients relocated from rural and remote regions to urban hospitals; most retrievals occurred during the day, with a median distance of 300 km. Adolescents and Aboriginal and Torres Strait Islander were overrepresented in the sample (four and eight times higher than their metropolitan counterparts, respectively). Conclusions: The proportion of pregnancy-related aeromedical retrievals varies geographically across Australia. Overall, one-third of retrievals were related to preterm/delivery complications, especially among adolescents. Most retrievals performed by the RFDS are susceptible to public health strategies aimed at improving antenatal care and preventing unintended pregnancies among adolescents and Aboriginal and Torres Strait Islander women. Greater capacity to manage pregnancy conditions in rural hospitals could reduce the requirement for aeromedical inter-hospital transfers.

Disasters significantly reduce the accessibility of justice particularly in rural locations. The bushfires, which ravaged three states in the south-east of Australia in late 2019 and early 2020, have had catastrophic social and economic impacts on people, animals and places in rural areas. In the aftermath of disasters, people by necessity must inevitably avail themselves of legal advice and services: to negotiate new business contracts; re-mortgage property; access wills and testaments; attend court; and for a host of other matters. In rural communities, where access to legal services is already limited by distance and circumstance, disasters create increased demand, and access issues are accentuated. This chapter explores access to justice issues in post-disaster context and as they relate to rural, regional and remote communities. It draws upon post-disaster experiences nationally and internationally, outlining responses to improve access to legal services past and present, identifying effective responses. It argues that rurality creates additional barriers and reduces access to justice, and that disasters exacerbate existing access issues as well as creating new challenges.

Background: In Australia, it is projected that one in four individuals will be at the nominal retirement age of 65 or over by 2056; this effect is expected to be especially pronounced in rural areas. Previous findings on the effects of retirement on wellbeing have been mixed. The present study explores the effects of employment and retirement on health and wellbeing among a sample of rural Australians. Methods: Australian Rural Mental Health Study participants who were aged 45 or over (N = 2013) were included in a series of analyses to compare the health and wellbeing of individuals with differing employment and retirement circumstances. Self-reported outcome variables included perceived physical health and everyday functioning, financial wellbeing, mental health, relationships, and satisfaction with life. Results: Across the outcomes, participants who were employed or retired generally reported better health and wellbeing than those not in the workforce. Retired participants rated more highly than employed participants on mental health, relationships, and satisfaction with life. There was also a short-term benefit for perceived financial status for retired participants compared to employed participants, but this effect diminished over time. Conclusions: While retirement is a significant life transition that may affect multiple facets of an individual’s life, the direction and magnitude of these effects vary depending on the retirement context, namely the pre-retirement and concurrent circumstances within which an individual is retiring. Personal perceptions of status changes may also contribute to an individual’s wellbeing more so than objective factors such as income. Policies that promote rural work/retirement opportunities and diversity and address rural disadvantage are needed.

Background and objective Currently there is paucity of evidence in the literature in relation to normative values for diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC) among Indigenous Australians. Hence, in this study we assessed the DLCO and TLC parameters among Indigenous Australians in comparison to Australian Caucasian counterparts. Methods DLCO and TLC values were assessed and compared between Indigenous Australians and Australian Caucasians matched for age, sex and body mass index, with normal chest radiology. Results Of the 1350 and 5634 pulmonary function tests assessed in Indigenous Australian and Australian Caucasian adults respectively, a total of 129 Indigenous Australians and 197 Australian Caucasians met the inclusion criteria. Absolute DLCO and TLC values for Indigenous Australians were a mean 4.3 ml/min/mmHg (95% CI 2.86, 5.74) and 1.03 L (95% CI 0.78, 1.27) lower than Australian Caucasians (p<0.01). Percentage predicted values were 15.38 (95% CI 11.59, 19.17) and 16.63 (95% CI 13.59, 19.68) points lower for DLCO and TLC, respectively. Lower limit of normal (LLN) values did not significantly differ between groups, however a significantly greater proportion of Indigenous Australians recorded values below the LLN in comparison to Australian Caucasians for DLCO (64 vs. 25%, p<0.01) and TLC (66 vs. 21%, p<0.01). Significant differences for the interaction of sex on DLCO and TLC were noted in Australian Caucasians, with reduced or absent sex differentiation among Indigenous Australians. Conclusions There are significant differences in DLCO and TLC parameters between Indigenous Australian compared to Australian Caucasians. Appropriate DLCO and TLC norms need to be established for Indigenous Australians.

Drinking water security has been a neglected issue in Australian water reform. This article considers Australia?s chief water policy of the past two decades, the National Water Initiative, and its aim to provide healthy, safe, and reliable water supplies. Taking the Northern Territory as a case study, we describe how despite significant policy and research attention, the NWI has failed to ensure drinking water security in Indigenous communities in the NT, where water supply remains largely unregulated. The article describes shortcomings of legislated drinking water protections, the recent history of Commonwealth water policy, and areas where national reforms have not been satisfactorily undertaken in the NT. We aim to highlight key regulatory areas that require greater attention in NT water research and, more specifically, in the Productivity Commission?s ongoing inquiry process.

Access to timely behaviour support services for children and adolescents with a disability in rural and remote regions of Australia is problematic due to the inadequate supply of specialised staff providing complex behaviour support in their local area. Technology has the potential to provide a timely, quality, low-cost option that extends access to behaviour support services for these children and their support teams in rural and remote areas. The purpose of this narrative review was to explore policy and practice guidelines on the delivery of behaviour support via telepractice for children and adolescents with a disability in Australia, and more specifically for those on the autism spectrum. Secondly, the review aimed to establish the evidence base of this model of service for children and adolescents with autism, in order to reflect on how it aligns with current Australian policy and practice. Practice and policy documents were drawn from selected websites relevant to the delivery of behaviour support via telepractice in Australia. Peer-reviewed literature (2004?2019) on the delivery of behaviour support via telepractice was sourced via four databases. While telepractice appears to have promising utility for the provision of support for children and adolescents with autism who present with challenging behaviour, there was very little policy documentation or guidelines found that related specifically to the delivery of this support. There is a need for further rigorous research to inform policy, establish efficacy, and develop practice guidelines that ensure delivery of high quality telepractice behaviour supports under the National Disability Insurance Scheme.

Background Nurses in very remote areas of Australia (RANs), work in complex and isolated settings for which they are often inadequately prepared, and stress levels are high. This paper, based on the 'Back from the edge' project, evaluates the development and implementation of an intervention to reduce and prevent the impact of occupational stress in the RAN workforce in the Northern territory. Methods The methods involved a combined participatory action research/organisational development model, involving seven steps, to develop and implement system changes within the (then) Northern Territory Department of Health and Families (NTDH&F). The development, implementation and evaluation was informed via information from participants collected during workshops and interviews. Pre and post surveys were undertaken to evaluate the study. Results Occupational stress interventions developed by the workgroups were categorised into four main groups: (1) remote context, (2) workload and scope of practice, (3) poor management, and (4) violence and safety concerns. The main interventions centred on promoting a well educated, stable workforce. There were very few measurable changes as a result of the interventions as many were not able to be implemented in the time period of the study, but implementation is continuing. Conclusion While the outcome evaluations showed few effects, the study through consensus approaches, provides a blueprint for reducing stress among remote area nurses and evidence which should inform policy and practice with respect to service delivery in remote areas.

Background Although the burden of bronchiectasis is globally recognised, there is limited paediatric data particularly on trends over the years. There is also no published data on whether vitamin D deficiency/insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to relate with severe bronchiectasis in First Nations adults, is also important in children with bronchiectasis. Research Question Among children with bronchiectasis, has (a) the clinical and bronchoalveolar lavage (BAL) profiles changed between two 5-year periods (period-1=2007-11, period-2=2012-16); and (b) is vitamin D deficiency/insufficiency and/or HTLV-1 infection associated with radiological severity of bronchiectasis? Study Design and Methods We analysed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia at their first diagnosis i.e. no child was in both time-periods. Data collected include demographics, BAL, bloods and computed tomography chest scan evaluated using the Bhalla and modified Bhalla scores. Results The median age of the 299 children was 2.2 years (interquartile range 1.5-3.7), 168 (56%) males and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations more than tripled, but did not reach statistical significance. In period-2 compared to period-1, fewer First Nations children had chronic cough (period-1=61%, period-2=47%, p=0.03), were younger, less likely to have received azithromycin (period-1=42%, period-2=21%, p<0.001) and their BAL had lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 was not detected and vitamin D deficiency/insufficiency did not correlate with severity of bronchiectasis. Interpretation Bronchiectasis remains high particularly among First Nations children. Important changes that arguably reflect improvements were present, but overall, profiles remained similar. Although Vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 was non-existent and is unlikely to play any role in First Nations children with bronchiectasis.

Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top‐selling bread affected sales in 26 remote Indigenous community stores. After a 23‐week baseline period, 11 control stores received the regular‐salt bread (400 mg Na/100 g) and 15 intervention stores received the reduced‐salt version (300 mg Na/100 g) for 12‐weeks. Sales data were collected to examine difference between groups in change from baseline to follow‐up (effect size) in sales (primary outcome) or sodium density, analysed using a mixed model. There was no significant effect on market share (−0.31%; 95% CI −0.68, 0.07; p = 0.11) or weekly dollars ($58; −149, 266; p = 0.58). Sodium density of all purchases was not significantly reduced (−8 mg Na/MJ; −18, 2; p = 0.14), but 25% reduction across all bread could significantly reduce sodium (−12; −23, −1; p = 0.03). We found 25% salt reduction in a top‐selling bread did not affect sales in remote Indigenous community stores. If achieved across all breads, estimated salt intake in remote Indigenous Australian communities would be reduced by approximately 15% of the magnitude needed to achieve population salt targets, which could lead to significant health gains at the population‐level.

Objective: A high prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Aboriginal children in northern Australia is coupled with low understanding among families. This has negative impacts on children's health, limits opportunities for prevention and suggests that better health communication is needed. Methods: During an RHD echocardiography screening project, Aboriginal teachers in a remote community school created lessons to teach children about RHD in their home languages, drawing on principles of community-led development. Access to community-level RHD data, previously unknown to teachers and families, was a catalyst for this innovative work. Careful, iterative discussions among speakers of four Aboriginal languages ensured a culturally coherent narrative and accompanying teaching resources. Results: The evaluation demonstrated the importance of collective work, local Indigenous Knowledge and metaphors. As a result of the lessons, some children showed new responses and attitudes to skin infections and their RHD treatment. Language teachers used natural social networks to disseminate new information. A community interagency collaboration working to prevent RHD commenced. Conclusions and implications for public health: Action to address high rates of RHD must include effective health communication strategies that value Indigenous Knowledge, language and culture, collaborative leadership and respect for Indigenous data sovereignty.

Objective Trauma is reported by 70% of the global population and 4% of those exposed develop post-traumatic stress disorder (PTSD), but data from Indigenous populations are limited. We aimed to determine the prevalence, types and age of occurrence of traumatic events among community-living Indigenous Australians and associations with PTSD.Design Lifetime trauma and PTSD were quantified among a broadly representative sample of 544 Indigenous participants using a diagnostic clinical interview. Logistic regression examined predictors of PTSD.Setting Metropolitan, regional and remote areas of Southern Queensland and Northern New South Wales.Participants Indigenous Australians 18 years and older.Outcome measures Prevalence of traumatic life events and risk of PTSD.Results 64.9% of participants (standardised prevalence 62.6%) reported lifetime trauma, with more than one trauma category in 62.3%. Females reported 2.3 times more sexual violence, otherwise no gender differences existed. The prevalence of four common trauma categories were 1.7–3.0 times higher than in the Australian population; physical violence being the highest relative risk. Although overall childhood trauma was not increased, sexual or physical violence before age 15 was twice more common than in the Australian population.The standardised prevalence of 12-month PTSD was 13.3% (95% CI 10.4 to 16.1), 16.1% (95% CI 12.2 to 19.9) in females and 8.2% (95% CI 5.3 to 11.1) in males, three times the Australian rates. In multiple regression analysis, independent predictors of PTSD were female gender (OR 2.1), rural residence (OR 3.0), trauma under age 10 (OR 2.2), sexual (without physical) violence (OR 2.5), physical (without sexual) violence (OR 2.3), and both sexual and physical violence (OR 5.0).Conclusion Indigenous Australians are more likely to experience potentially harmful traumas and develop PTSD than other Australians. Mitigation of trauma among Indigenous Australians, particularly childhood exposure and sexual or physical violence, is essential to reduce their high burden of PTSD.Data are available on reasonable request. The University of Queensland (UQ) Human Ethics Committee imposes restrictions on the data. Anonymised data are available to researchers who meet the conditions of the ethics approval and research governance policy that applies to this study via UQ eSpace. Requests for the data may be sent to the Director of Research, Rural Clinical School, UQ (rcsrc@ uq.edu.au).

Introduction: While transient parathyroid insufficiency is not an uncommon complication of thyroidectomy, severe and prolonged hypocalcemia attributed to a combination of post-surgical hypoparathyroidism, hungry bone syndrome (HBS) and hypovitaminosis D is unusual.Clinical Case: A 17-year-old female from a remote community in Australia with Graves’ disease, complicated by exophthalmos and atrial flutter, underwent total thyroidectomy due to challenges with medication adherence leading to persistent thyrotoxicosis. FT4 was >150 pmol/L (normal 10–20 pmol/L) almost two years after diagnosis. Pre-operatively, she received Lugol’s iodine, carbimazole and beta-blockade. The operation was uncomplicated and three parathyroid glands were preserved. Within six hours of thyroidectomy, she developed symptomatic hypocalcemia with corrected calcium 1.9 mmol/L (7.6 mg/dL) (normal 2.2–2.65 mmol/L). PTH level was 0.8 pmol/L (normal 1.4–9.0 pmol/L). Magnesium and phosphate levels were initially normal but hyperphosphatemia developed the following day. 25-OH vitamin D was low (29 nmol/L, normal 50–150 nmol/L) and was corrected with high dose cholecalciferol.Despite use of continuous intravenous calcium gluconate in addition to oral calcium carbonate, as well as both intravenous and oral calcitriol and magnesium, urinary calcium excretion remained undetectable. Teriparatide 20 mcg BD was commenced on post-operative day 14 with no demonstrable improvement in serum calcium. Less than 48 hours after cessation of parenteral calcium on day 18 post-operation, corrected calcium and ionised calcium declined to 1.47 mmol/L (5.9 mg/dL) and 0.46 mmol/L (normal 1.15–1.33 mmol/L) respectively, prompting recommencement of calcium infusion.Her remarkably high requirement for calcium replacement with negligible urinary calcium excretion for at least one month in spite of parenteral calcium infusion for a total of three weeks’ duration is highly suggestive of HBS which became evident due to post-surgical hypoparathyroidism. She had elevated ALP (618 U/L, normal 35–140 U/L) and increased bone resorption marker (N-telopeptide/creatinine 262 nmol BCE/mmol, normal <100 nmol BCE/mmol), with osteopenia at lumbar spine (Z-score -1.7) and femur (Z-score -1.3). Additionally, vitamin D deficiency is likely to have contributed to the severity of hypocalcemia.60 days after surgery, she was still requiring calcium carbonate 2500 mg QID (4 g/day elemental calcium) and calcitriol 1 mcg TDS. Her phosphate level had normalised and ALP gradually declined to 241 U/L.Clinical Lesson: This case highlights the importance of attaining euthyroid status as early as possible pre-operatively to allow near-complete reversal of thyrotoxicosis-induced osteodystrophy, as indicated by normalisation of serum ALP, and ensuring vitamin D levels are replete prior to thyroidectomy for Graves’ disease.

The COVID-19 pandemic has prompted renewed attention among health professionals, Aboriginal community leaders, and social scientists to the need for culturally responsive preventative health measures and strategies. This article, a collaborative effort, involving Yanyuwa families from the remote community of Borroloola and two anthropologists with whom Yanyuwa have long associations, tracks the story of pandemics from the perspective of Aboriginal people in the Gulf region of northern Australia. It specifically orients the discussion of the current predicament of ?viral vulnerability? in the wake of COVID-19, relative to other pandemics, including the Hong Kong flu in 1969 and the Spanish flu decades earlier in 1919. This discussion highlights that culturally nuanced and prescribed responses to illness and threat of illness have a long history for Yanyuwa. Yanyuwa cultural repertoires have assisted in the process of making sense of massive change, in the form of past pandemics and the onset of sickness, the threat of illness with COVID-19 and the attribution of ?viral vulnerability? to this remote Aboriginal community. The aim is to centralise Yanyuwa voices in this story, as an important step in growing understandings of Aboriginal knowledge of pandemics and culturally relevant and controlled health responses and strategies for communal well-being.

Background: The use of methamphetamine or amphetamine stimulant drugs has been identified by authoritative public health bodies as a global health issue, with a worrying trend towards production and consumption of a higher purity crystalline form methamphetamine (ice) over the past decade. This trend has been well documented within Australia, resulting in a public perception of there being an 'ice' epidemic in regional/rural areas. Considering the illicit nature of ice, monitoring it is challenging and as such little information is available regarding the actual extent of methamphetamine use, harms and patterns in regional/remote Australia. Aim: To collate the available literature regarding methamphetamine use in regional/rural Australia and identify gaps in the literature. Methods: A literature search was conducted by searching 6 databases (PUBMED, Medline, CINAHL, EMBASE, PsycINFO and SCOPUS) following which exclusion/inclusion criteria were applied. Included papers were appraised with the Joanna Briggs Institute Critical appraisal tools and synthesised in light of the sociocultural, ethnic and geographic differences in methamphetamine use in Australia. Results: Regarding rural/regional Australia there is a significant lack of research into methamphetamine use, patterns and epidemiology since the rise of crystalline methamphetamine in 2013. The existing literature available suggests great variability in methamphetamine harms in rural communities. This can be a double-edged sword however, as the introduction of ice into a remote/rural community may result in greater harms if it becomes ingrained in local customs. Similarly, there is a lack of research into the specific factors within Indigenous communities leading to an increased rate of methamphetamine use amongst members. Recommendation: Future research should address the causes of variance in methamphetamine harms in rural/remote regions. Although the scope of this paper was the Australian context, a wider international approach may yield useful information.

On one level, motor vehicles might represent the possibility of unfettered freedom, escape (from government authority) and autonomy through providing work and leisure opportunities. On another level, in remote places, ‘hybridised’ and ‘Indigenised’ vehicles have been appropriated to speak to economic and cultural realities of everyday life. This chapter considers how night patrols may articulate expressions of decoloniality by enhancing Aboriginal social capital or what we refer to here as ‘collective efficacy’. It draws upon a subset of the findings from an evaluation of Indigenous Youth Programs in New South Wales to examine the effectiveness of night patrols operating in nine communities across the state. While the patrols were universally endorsed by the communities they served, some services were functioning at a high level while others had experienced periods of dysfunction and inactivity. The factors that impede effective service provision for night patrols in some communities were compared with other communities where services were functioning well. The chapter argues that night patrols can build and harness collective efficacy providing more than mere community policing functions.

Community engagement is often cited as a critical component of working within indigenous communities in Australia and other countries. Ideally, this involves engaging in community-led and community-informed methods and place-based approaches that scope, identify, and respond to individual, family, group, and community needs and aspirations in a culturally responsive way. Such processes recalibrate power relationships and ensure indigenous leadership and self-determination is a central focus. This chapter reflects on key learnings from the implementation of the Whole of Community Engagement (WCE) initiative led through the Office of Pro Vice-Chancellor – Indigenous Leadership at Charles Darwin University. This initiative used a combination of collaborative research, participatory action research, and developmental evaluation approaches to “inspire six remote Indigenous communities in the Northern Territory to include higher education as a normal expectation and milestone along the life journey.” Current education scholarship is used, alongside key findings from the WCE initiative, to identify and discuss 11 strategies for success to promote pathways into higher education for remote indigenous students. While these strategies are contextually bound, and specifically relate to the six remote communities involved in WCE, we encourage their use as a framework to examine their applicability in other settings.

Objective To examine unintentional drowning by remoteness in Australia. Design A systematic review of both peer-reviewed and grey literature published between January 1990 and December 2019 (inclusive). Method Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, MEDLINE (Ovid), PubMed, EMBASE, Scopus, PsycINFO (ProQuest), SPORTDiscus and Google Scholar were searched for studies exploring fatal and non-fatal unintentional drowning by remoteness. Epidemiological data, common factors and prevention strategies were extracted and mapped to Australian standard geographical classifications (major cities, inner regional, outer regional, remote and very remote). Level of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation and prevention strategies aligned to the hierarchy of control. Result Thirty-two studies satisfied inclusion criteria (66% reporting epidemiology; 59% risk factors; and 44% prevention strategies). All (100%) included studies were assessed very low against Grading of Recommendations Assessment, Development and Evaluation. Findings indicate rural populations (ie, excluding major cities) have higher rates of drowning positively correlated with increasing remoteness. Common factors included age (child), natural water bodies, undertaking boating and watercraft activities and alcohol consumption. While a range of prevention strategies has been proposed, only one study outlined a rural drowning prevention strategy which had been implemented and evaluated. Strategies were generally low on the hierarchy of control. Conclusion Rural populations are proportionately overrepresented in drowning statistics. Proposed prevention strategies have unknown efficacy. Greater research into rural drowning of Australians is needed especially exploring behavioural motivations, program delivery, cost-effectiveness and evaluation. Development and use of a standard definition for remoteness are recommended. Rural populations use water extensively; therefore, there is an urgent need to keep them safe.

Background/Objectives There is a paucity of research available regarding the epidemiology of patients attending dermatology outpatient services in Australia. Our objective was to analyse who was attending public dermatology outpatient clinics in a Northern Territory tertiary hospital, with a particular focus on Indigenous and rural patients. Methods This is a retrospective cohort study of patients who attended dermatology outpatient clinics between 1 January 2016 and 31 December 2016. Outcome measures included patient demographics (age, gender, ethnicity and postcode) and referrer details. Results Over the 12 month study period, 923 appointments were scheduled for 500 patients. Of the appointments scheduled, 667 were attended. Twelve per cent of patients were Indigenous, and of the total appointment attendances, 10% were by Indigenous patients. Of the 923 appointments, 28% were not attended, with a higher non-attendance rate for Indigenous patients at 36%. The majority of patients seen were adults, for both groups, but a larger proportion of Indigenous children were seen. Nine per cent of patients with a recorded address were from a remote region. Conclusion Dermatology outpatient services are likely under-utilised by Indigenous, and remote patients. If we are to improve skin health in Australia, barriers such as limited access to dermatological services in remote regions must be addressed.

Introduction Little is known about the prevalence of current alcohol dependence in Indigenous Australian communities. Here we identify the frequency of reported symptoms, estimate the prevalence and describe the correlates of current alcohol dependence. Methods A representative sample of Indigenous Australians (16+ years) was recruited from an urban and remote community in South Australia. Data were collected between July and October 2019 via a tablet computer-based application. Participants were likely dependent if they reported two or more dependence symptoms (ICD-11; in the last 12?-months), weekly or more frequently. Chi-square tests described the relationship between demographics, remoteness and alcohol dependence. Spearman correlations estimated the relationship between symptoms of dependence, consumption characteristics and demographics. Results A total of 775 Indigenous Australians participated. The most frequently reported symptoms were prioritising alcohol over other things and loss of control. Overall, 2.2% were likely dependent on alcohol (n =?17/775). Prevalence did not vary by remoteness. Participants who drank more and more frequently tended to report more frequent symptoms of dependence. In the urban site, men tended to report more frequent symptoms of dependence than women. Age, income and schooling were not linked to dependence. Discussion and Conclusions The prevalence of current alcohol dependence in this representative sample was similar to that of the general Australian and international estimates. Understanding risk factors for current alcohol dependence will be useful to inform the allocation of funding and support. Accurate estimates of the prevalence of current alcohol dependence are important to better identify specialist treatment needs.

Objective: This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters. Introduction: Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management. Methods: A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol. Results: Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care. Conclusion: Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.