Remote Australia Online

Our team was referred a 14-year-old, previously healthy, immunised aboriginal boy from a remote community in northern Western Australia. He had been admitted to the local community hospital 10 days previously and while there developed haemoptysis, fever and epigastric abdominal pain so was transferred to our care at the regional hospital for ongoing investigation and management.Haemoptysis is an uncommon presentation in adolescence. It can be caused by infection (eg, bronchiectasis, pneumonia, lung abscess or tuberculosis), trauma (eg, lung contusion, foreign body or inhalation injury), vascular disorders (eg, pulmonary embolus, arteriovenous malformation or haemangioma), late complications of congenital lung malformations, coagulopathy or one of the diffuse alveolar haemorrhage syndromes.1 Additionally, bleeding from the upper airway or gastrointestinal tract can mimic haemoptysis.Demographic considerations are important in this case. Bronchiectasis and rheumatic heart disease, both of which may present with haemoptysis, have increased prevalence in aboriginal children in Australia. In addition, Burkholderia pseudomallei is endemic and pulmonary infection can mimic tuberculosis.An infectious aetiology is favoured here in view of the history of fever.He had initially been admitted to the local hospital with presumed bacterial meningitis following presentation with headache, fever and meningism 10 days prior. Cerebrospinal fluid (CSF) prior to antibiotics demonstrated elevated white cell count (WCC) 550/mm3 (90% neutrophils) and protein (0.84 g/L), with negative microscopy and culture for bacteria, and negative PCR testing for bacteria and viruses. Intravenous ceftriaxone (ongoing) and dexamethasone 0.15 mg/kg four times a day (total 4 days) had been administered, with rapid resolution of symptoms.Following transfer to our care (day 1), examination showed normal respiratory rate and oxygen saturations (SaO2=98%); a productive cough with a moderate amount of blood-stained sputum was noted. The respiratory examination (including upper airway) was otherwise unremarkable. There was mild right upper quadrant abdominal tenderness …

Background: Indigenous residents living in remote communities in Australia’s Northern Territory experience higher rates of preventable chronic disease and have poorer access to appropriate health services compared to other Australians. This study compared health outcomes and costs at different levels of primary care utilisation to determine if primary care represents an efficient use of resources for Indigenous patients with common chronic diseases namely hypertension, diabetes, ischaemic heart disease, chronic obstructive pulmonary disease and renal disease. Methods: This was an historical cohort study involving a total of 14,184 Indigenous residents, aged 15 years and over, who lived in remote communities and used a remote clinic or public hospital from 2002 to 2011. Individual level demographic and clinical data were drawn from primary care and hospital care information systems using a unique patient identifier. A propensity score was used to improve comparability between high, medium and low primary care utilisation groups. Incremental cost-effectiveness ratios and acceptability curves were used to analyse four health outcome measures: total and, avoidable hospital admissions, deaths and years of life lost. Results: Compared to the low utilisation group, medium and high levels of primary care utilisation were associated with decreases in total and avoidable hospitalisations, deaths and years of life lost. Higher levels of primary care utilisation for renal disease reduced avoidable hospitalisations by 82-85%, deaths 72-75%, and years of life lost 78-81%. For patients with ischaemic heart disease, the reduction in avoidable hospitalisations was 63-78%, deaths 63-66% and years of life lost 69-73%. In terms of cost-effectiveness, primary care for renal disease and diabetes ranked as more cost-effective, followed by hypertension and ischaemic heart disease. Primary care for chronic obstructive pulmonary disease was the least cost-effective of the five conditions. Conclusion: Primary care in remote Indigenous communities was shown to be associated with cost-savings to public hospitals and health benefits to individual patients. Investing $1 in primary care in remote Indigenous communities could save $3.95-$11.75 in hospital costs, in addition to health benefits for individual patients. These findings may have wider applicability in strengthening primary care in the face of high chronic disease prevalence globally.

With increasing numbers of baby boomers retiring and taking to the road in rural and remote Australia, often for extended periods, this review aimed to identify the characteristics of these ‘grey nomads’ travelling across Australia, their experiences in relation to their health and social needs and their access to health care. To this end, an integrative literature review with narrative analysis was conducted. Studies of Australian grey nomad travellers published from 1999 to January 2020 were sourced from Ovid Emcare, Medline/PreMedline, Embase, PsychINFO, Academic Search Complete and Google Scholar. Fourteen records based on 11 studies described grey nomads as predominantly older heterosexual couples who defied the conventional view of aging by seeking adventure and new experiences. Many planned for their health needs while travelling, and their health was overwhelmingly reported to improve with the nomadic lifestyle. This review demonstrates the paucity of data about grey nomads. Information on travellers’ health care needs and service usage is a significant gap, undermining regional and rural service planning and the provision of healthcare services, and represents a considerable challenge for healthcare providers such as GPs, pharmacies and emergency departments.

Participation in sport and physical activity can improve academic outcomes and has been identified as a potential mechanism for addressing educational disadvantage and ‘closing the gap’ in Australian Indigenous communities. To explore this possibility in relation to sport and lifestyle we performed a cluster analysis on data from the Footprints in Time study (also known as the Longitudinal Study of Indigenous Children), using data from Waves 3–6 (2010–2013, ages 5–9 years) of this cohort study. Cluster inputs were organised according to not only sports participation, but also screen time, sleep duration and unhealthy food intake, as reported in parent surveys. Associations between lifestyle cluster membership and academic outcomes from standardised tests from 2014-5 (Progressive Achievement Tests [PATs] for Maths and Reading, and National Assessment Program for Literacy and Numeracy [NAPLAN]) were examined using linear models. Analyses were adjusted for age, sex, remoteness and parental education. Three clusters were identified: Low Sport (36% of sample), characterised by low sports participation and low sleep duration; Junk Food Screenies (21% of sample), with high screen time and high intake of unhealthy foods; and High Sport (43% of sample), showing high sports participation and low screen time. Cluster membership was associated with academic performance for NAPLAN Literacy and Numeracy, and for PAT Maths. The High Sport cluster consistently performed better on these tests, with effect sizes (standardised mean differences) ranging from 0.10 to 0.38. We discuss the ecological dynamics potentially contributing to lifestyle cluster membership and ways in which policy can support healthier High Sport lifestyles associated with better academic performance.

Vowel elision is common in Pitjantjatjara and Yankunytjatjara connected speech. It also appears to be a locus of language change, with young people extending elision to new contexts; resulting in a distinctive style of speech which speakers refer to as muṯumuṯu (‘short’ speech). This study examines the productions of utterance-final past tense suffixes /-nu, -ɳu, -ŋu/ by four older and four younger Pitjantjatjara speakers in spontaneous speech. This is a context where elision tends not to be sociolinguistically or perceptually salient. We find extensive variance within and between speakers in the realization of both the vowel and nasal segments. We also find evidence of a change in progress, with a mixed effects model showing that among the older speakers, elision is associated with both the place of articulation of the nasal segment and the metrical structure of the verbal stem, while among the younger speakers, elision is associated with place of articulation but metrical structure plays little role. This is in line with a reanalysis of the conditions for elision by younger speakers based on the variability present in the speech of older people. Such a reanalysis would also account for many of the sociolinguistically marked extended contexts of elision.

Tropical Cyclone Monica is one of the most intense Australian cyclones in recorded history, and threatened several Indigenous communities in April 2006. It prompted the evacuation of the remote island community of Warruwi, and caused considerable damage to the mainland township of Maningrida. The evacuation of Warruwi went smoothly as emergency services personnel, the community and the airline cooperated to airlift some 350 people to designated safe areas on the mainland. We show that local institutions culturally embedded in Indigenous ways of understanding and responding to the world were important in providing essential but ?unofficial? services during the emergency. Recognizing and respecting the resilience of the local process involved in everyday Indigenous life is revealed as central to ensuring local cooperation and effective involvement of state and national institutions in delivering effective measures during emergencies. Ensuring that local, state and national authorities offer recognition and understanding of these Indigenous institutions, and develop strong relationships with them, should be a priority in developing approaches that limit conflict and trauma where emergency services risk overriding local protocol.

This article considers how Indigenous peoples in Central Australia share and keep digital records of events and cultural knowledge in a period of rapid technological change. To date, research has focused upon the development of digital archives and platforms that reflect Indigenous epistemologies and incorporation of protocols governing access to information. Yet there is scant research on how individuals with little access to such media share and hold?or not, as the case may be?digital cultural information. After surveying current enabling infrastructures in Central Australia, we examine how materials are held and shared when people do not have easy access to databases and the Internet. We analyze examples of practices of sharing materials to draw out issues that arise in managing storage and circulation of cultural records via Universal Serial Bus (USB) flash drives, mobile phones, and other devices. We consider how the affordances of various platforms support, extend, and/or challenge Indigenous socialities and ontologies.

Scarce literature comprehensively captures the transition to solid foods for children in remote Aboriginal Australian communities, a population expected to be especially vulnerable to nutritional inadequacy for largely socio-economic reasons. This study describes the dietary intake of children aged 6–36 months in a remote Aboriginal community during the years of solids introduction and establishment. Specifically, we aimed to explore milk feeding practices, major sources of nutrition and traditional food consumption, dietary patterns and nutrient and food group intakes, and compare these to national and international recommendations.

Issue addressed: National smoking prevalence is decreasing among Aboriginal and Torres Strait Islander people. In remote areas, Aboriginal and Torres Strait Islander smoking prevalence remains higher than in nonremote areas and is not improving. Methods: We analysed data from 539 daily and weekly smokers from remote areas who completed baseline surveys at either Wave 1 (April 2012-October 2013) or Wave 2 (August 2013-August 2014), including 157 from Wave 1 who also completed Wave 2, from the Talking About The Smokes project. We assessed associations between baseline predictor measures and having made any quit attempt in the past year and, among those who did, having sustained the last quit attempt for one month or more. Results: More smokers had made a quit attempt if they were younger or reported being unable to buy essentials due to money spent on smokes, being more stressed, having several pro-quitting motivations and attitudes, having an effective smoke-free home, or being encouraged to quit by a health professional or by family/friends. Of these, more had sustained their last quit attempt for one month or more if they reported being more socially advantaged, no smoking-induced deprivation, being less dependent, chewing pituri or an having effective smoke-free home. Conclusions: Health staff should consider the quite different factors associated with starting and then sustaining a quit attempt. SO WHAT?: Our findings support continued attention in remote areas on smoke-free homes and health staff providing regular encouragement to all smokers to quit and more use of smokers' friends and family for support.

The South East Gulf of Carpentaria’s coastal and marine zone is not widely recognized for its outstanding biodiversity; however it contains unique ecosystems of global significance. Among such assets one can find breeding marine turtle populations, submerged patch reefs and extensive sea grass beds. The ecosystem also includes a significant proportion of the world’s dugong population, endangered sawfish, river sharks and three species of rare inshore dolphin. The coast comprises nationally important coastal wetlands, and is host for internationally recognised migrating shore birds and nationally significant breeding populations of water birds. The health and productivity of the coastal and marine zone is also reflected in traditional, recreational and commercial fisheries that produce over $50m of crab, prawn and finfish product whilst supporting a growing tourist industry and providing material and cultural sustenance for Indigenous people. Given a small population and limited intensive land use or industrial development, the status of most natural assets within the South East Gulf’s coastal and marine zones are relatively well preserved. In fact, many such ecosystems are considered to be ‘near pristine’ when compared to more developed regions of Australia. However, what we know is far outweighed by what we don’t know about the Gulf’s coastal and marine zone due to limited scientific investigations and data collected in the region. The condition of these valuable ecosystems is being negatively affected by grazing along the coastal zone, pests, weeds and an unmanaged fire regime. For marine areas, the most significant impacts are associated with commercial fishery catch including non-target bycatch species, disturbance of the environment via trawling and marine debris from Asia. Locally, port operations and recreational fishing tourism engender significant impacts. More educational material regarding fisheries regulations and marine sustainability may be needed to target visiting anglers. There is also an emerging issue due to the influence of turbid flood waters in big wet seasons, from erosion in Gulf river basins and elevated sediment loads impacting on the marine environment. Given the Gulf region’s naturally varied climate and its low lying coastline, projected climate change and sea level rise poses significant impact risks to the coastal zone and communities. Some impacts brought about by a rise in sea level are already evident as eroded beaches and salt water incursion into coastal wetlands. Coastal areas will experience further changes in response to sea level rise. More extreme cyclones and storm surges with major disruption to coastal, near shore, marine and estuarine ecosystems are expected. To be effective Natural resource managers, a much greater and integrated understanding of river basin, coastal and marine ecosystems is required. Currently, there is a lack of coordinated or ongoing system scale monitoring within the Gulf’s coastal and marine environment. This is in stark contrast to other coastal areas of Queensland with high value marine biodiversity assets. Obvious examples include the Great Barrier Reef and Moreton Bay catchments. The influence of sea grass meadows and catchment scale water quality on marine environments are priority for ongoing research.

Euro-Western perspectives dominate visual communication design education in Australia. This paper examines how the ?8 Aboriginal Ways of Learning? pedagogical framework transformed the learning and teaching of design within high school contexts in two Aboriginal communities ? Ntaria in the Northern Territory and Warmun in Western Australia. Known as 8 Ways, this model facilitates a culturally safe space for knowledge sharing, encourages teachers to engage with Indigenous pedagogies within the classroom, and emphasizes relational learning. Multiple participatory methods informed our approaches, including the development of place-based design curricula to embed and evaluate 8 Ways. These case studies reveal how Indigenous pedagogical approaches to design education can create value and meaning for Indigenous young people through the enactment and expression of cultural identity, while reinforcing connection to land, family, and community. We argue that non-Indigenous educators can draw upon Indigenous pedagogies to decolonize their teaching strategies and to engage Indigenous students in meaningful culture-centered, intergenerational, and on-Country learning experiences. This research paves the way for participatory and place-based models of design education that reinforce and return the knowledge systems, land stewardship practices, and cultural values of Australia?s First Nations peoples to the classroom.

Aboriginal and Torres Strait Islander people may be disproportionately affected by COVID-19 and despite isolation remote communities have an increased risk of COVID-19 transmission due to overcrowding and frequent travel over long distances for family, cultural or community events. The response to an outbreak in remote settings will be logistically challenging requiring a coordinated multiagency response. The provision of timely COVID-19 diagnostic testing is central to this response.

Strongyloides stercoralis, a parasitic roundworm, is endemic in many countries world-wide. In Australia, groups at risk for strongyloidiasis include Aboriginal and/or Torres Strait Islander people, who acquired this parasite locally, and immigrants and returned travellers who acquired the infection outside Australia. We obtained deidentified results of ELISA IgG antibody tests for Strongyloides from diagnostic pathology laboratories during 2012 to 2016 and calculated the number of people who were positive at least once and the number who never had a positive result. We drew maps showing the number positive per 100,000 of population, the percent positive of those tested, and the number tested/100,000 for each region and the number positive in each suburb of residence according to the Australian Bureau of Statistics. The highest seropositivity (260-996/100,000 of population) was in Northern Australia, north-west South Australia and north-east New South Wales where many Aboriginal and Torres Strait Islander people live in remote communities. There were also some regions in Greater Capital Cities with a high number of people positive per 100,000 of population (112-188/100,000), likely reflecting higher populations of immigrants and returned travellers who were infected outside Australia.

Natural Hazard-induced Disasters (NHD) cause a wide range of losses to built and natural environments, the latter often beyond standard measures. Precise accounting and characterisation of the losses can assist in developing effective management policies that help to build resilient communities. This study applies trans-disciplinary approaches to assess total, monetary and non-monetary, NHD-related losses, estimated at AUD 156 million per year (2010–2019 average), for Australia’s Northern Territory where bushfires, cyclones, storms and floods are destructive and frequent events. Non-monetary losses, often overlooked or omitted, were estimated at AUD103 million per year, accounting for two-thirds of total disaster-related losses. Marketable losses, estimated at AUD 53 million per year, were inferred, using standard and non-standard datasets, from the Australian Government’s Natural Disaster Relief and Recovery Arrangements, insurance costs (Insurance Council of Australia database), and other relevant sources. Non-monetary losses were accounted for by the loss of ecosystem services from natural systems caused by cyclones and bushfires only, applying ecological economics approaches, but without considering long-term losses over the duration of recovery. This study informs disaster management policies to invest in collective emergency and environmental management planning for reducing NHD risk and building resilience of local communities to manage and prepare for rapidly changing climates. Such an accounting approach is essential in contexts where NHDs disproportionately affect the lives and well-being of disadvantaged remote communities.

OBJECTIVE: To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. DESIGN: This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011. SETTING AND PARTICIPANTS: The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007. INTERVENTION: Cancer care delivery to rural sites via Townsville teleoncology model. MAIN OUTCOME MEASURES: The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration. RESULTS: Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty-three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville. CONCLUSION: Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.

Welfare conditionality, whereby eligibility for income support payments is linked to prescribed forms of behaviour or values, is intended to encourage responsible behaviour in marginalised populations. However in practice, it may have consequences that worsen rather than improve their life chances. One of the most invasive forms of conditional welfare is income management (IM), involving the quarantining of up to 90 per cent of income that cannot be spent on excluded items in order to reduce substance abuse and gambling and enhance financial management and parenting capacity. This qualitative study examines the views of IM participants and community stakeholders in the regional community of Ceduna, Australia. Its findings are presented – pertaining to practical experiences of IM, the impact of IM on participant wellbeing, and community divisions around IM – and the study discusses whether or not it has advanced key program objectives. It is concluded that the negative effects of IM exceed any perceived benefits.

Background: The external auditory canal?s unique anatomical characteristics made the presence of foreign bodies (FBs) a clinical challenge, particularly in rural settings without ready access to tertiary care and specialist intervention. Aims: Our study surveys the experience in aural FBs surgical management in a rural Australian tertiary center. It proposes a safe, easy, and affordable technique to remove stones from the ear canal. Methods: We have completed a 10-year retrospective surgical chart review, including 474 patients (52 adults and 428 children) requiring surgical management to remove aural FBs at the Royal Darwin Hospital, Northern Territory, Australia. We surveyed for patient demographics, foreign-body description, complications, location, and removal attempts. We identified what factors determine the need for surgical management and propose a technique for a safe, uncomplicated, and affordable removal of stones from the ear canal after applying this method in a small subgroup. Results: The most common FBs requiring surgery in children were stones. A predominance in the Aboriginal population from remote communities was found, leading to a nasal bridle magnet technique to remove stones in rural settings. This method reduces the number of extraction attempts of the most frequent FB found in children?s ears, aiming to minimize complications, negative experiences, and health cost. Conclusion: Contrary to international literature, stones were found to be the most common FB in remote aboriginal populations. The proposed technique reduces the number of extraction attempts of the most frequent FB found in children?s ears, aiming to minimize complications, negative experiences, and health cost.

Aim To evaluate an automated retinal image analysis (ARIA) of indigenous retinal fundus images against a human grading comparator for the classification of diabetic retinopathy (DR) status. Methods Indigenous Australian adults with type 2 diabetes (n = 410) from three remote and very remote primary-care services in the Northern Territory, Australia, underwent teleretinal DR screening. A single, central retinal fundus photograph (opportunistic mydriasis) for each eye was later regraded using a single ARIA and a UK human grader and national DR classification system. The sensitivity and specificity of ARIA were assessed relative to the comparator. Proportionate agreement and a Kappa statistic were also computed. Results Retinal images from 391 and 393 participants were gradable for ?Any DR? by the human grader and ARIA grader, respectively. ?Any DR? was detected by the human grader in 185 (47.3%) participants and by ARIA in 202 (48.6%) participants (agreement =88.0%, Kappa = 0.76,), whereas proliferative DR was detected in 31 (7.9%) and 37 (9.4%) participants (agreement = 98.2%, Kappa = 0.89,), respectively. The ARIA software had 91.4 (95% CI, 86.3?95.0) sensitivity and 85.0 (95% CI, 79.3?89.5) specificity for detecting ?Any DR? and 96.8 (95% CI, 83.3?99.9) sensitivity and 98.3 (95% CI, 96.4?99.4) specificity for detecting proliferative DR. Conclusions This ARIA software has high sensitivity for detecting ?Any DR?, hence could be used as a triage tool for human graders. High sensitivity was also found for detection of proliferative DR by ARIA. Future versions of this ARIA should include maculopathy and referable DR (CSME and/or PDR). Such ARIA software may benefit diabetes care in less-resourced regions.

In remote Indigenous communities, people with end stage kidney disease have limited access to dialysis services and the vast majority of patients contend with urban displacement in order to access treatment. Through ethnographic encounters with Yolngu renal patients and other actors in Northern Territory healthcare systems, this paper explores how the threats posed by end stage kidney disease are multiply conceptualised and imbued with different forms of moral and political value. Drawing on Mary Douglas' cultural theory of risk, I consider how Yolngu, health professionals and health policymakers construct topographies of safety and danger. I argue that medical risk is deployed in Northern Territory healthcare systems to perform the 'dirty work' of governing uncertainties and threats to renal patients' health and of distributing treatment amongst patients and over space. The 'dirty work' of medical risk recasts questions of value and the distribution of resources into matters of safety and liability.

Introduction. The evolving SARS-CoV-2 coronavirus pandemic presents a series of challenges to clinical diagnostic services. Many proprietary PCR platforms deployed outside centralised laboratories have limited capacity to upscale when public health demands increase. We set out to develop and validate an open-platform mobile laboratory for remote area COVID-19 diagnosis, with a subsequent field trial. Gap Statement. In regional Western Australia, molecular diagnostic support is limited to near point-of-care devices. We therefore aimed to demonstrate open-platform capability in a rapidly deployable format within the context of the COVID-19 pandemic. Methodology. We compared, selected and validated components of a SARS-CoV-2 RT-PCR assay in order to establish a portable molecular diagnostics laboratory. The optimal combination of PCR assay equipment, reagents and consumables required for operation to national standards in regional laboratories was identified. This comprised RNA extraction and purification (QuickGene-480, Kurabo, Japan), a duplex RT-PCR assay (Logix Smart COVID-19, Co-Diagnostics, USA), a Myra liquid handling robot (Biomolecular Systems, Australia) and a magnetic induction thermal cycler (MIC, Biomolecular Systems). Results The 95 and 99% limits of detection were 1.01 copies μl−1 (5.05 copies per reaction) and 2.80 copies μl−1 (14.00 copies per reaction) respectively. The Co-Diagnostics assay amplified both SARS-CoV-1 and −2 RNA but showed no other cross reactivity. Qualitative results aligned with the reference laboratory SARS-CoV-2 assay (sensitivity 100% [95 % CI 96.48–100%], specificity 100% [95% CI 96.52–100%]). In field trials, the laboratory was operational within an hour of arrival on-site, can process up to 36 samples simultaneously, produces results in two and a half hours from specimen reception, and performed well during six consecutive runs during a 1 week deployment. Conclusion. Our mobile laboratory enables an adaptive response to increased test demand, and unlike many proprietary point-of-care PCR systems, rapid substitution with an alternative assay if gene targets change or reagent supply chains fail. We envisage operation of this RT-PCR assay as a standby capability to meet varying regional test demands under public health emergency operations guidance.

Objectives:This study aimed to explore the impact of early health risks on young Aboriginal children?s attendance in playgroups and their early learning outcomes.Design:The study used a cross-sectional design to identify associations between children?s early health characteristics, their attendance at a Families as First Teachers (FaFT) playgroup and their early learning outcomes.Setting:A total of 128 Aboriginal children from two remote Northern Territory (NT) communities attending FaFT playgroups participated in the study.Method:Health data were coded as risk factors and associated with children?s attendance and learning outcome data.Results:Children in the cohort experienced relatively high rates of health risks: ear infections (otitis media, 57%), anaemia (37%), skin infections (28%), low birthweight (22%), low weight for age (19%) and a high proportion were born to teenage mothers (26%). However, these rates were lower than previously recorded rates for Aboriginal children in remote NT communities. Despite the presence of multiple health risks, low weight for age was the only risk factor found to be negatively associated with children?s learning outcomes (language skills) and only two health risks (teenage motherhood and lower child haemoglobin levels) were negatively associated with children?s attendance at playgroup. Most children (65%) experienced one or two health risks during the study and no significant associations were found between the number of health risks experienced and children?s attendance or learning outcomes.Conclusion:The study highlights the importance of culturally responsive, evidence-based and integrated health and education programmes within remote Aboriginal Australian communities as a means to mitigate risks to poor learning and development outcomes.

This study of a remote Aboriginal community in Australia’s Northern Territory in 2014 sought to understand diabetes from a local Aboriginal perspective. Participants drew on a variety of holistic healing methods in the absence of an individual or individuals identified as holding a healing role in the community. The study offers an alternative to the common assumption that all communities can identify specific individuals as Aboriginal healers who are central to maintaining Aboriginal beliefs and wellbeing who contribute to holistic health (Clarke 2008; Maher 1999; McDonald 2006; Seathre 2013; Williams 2011). This research found the seven adult Aboriginal diabetes patients participating in the longitudinal ethnographic study actively engaged in self-healing strategies. Moreover, diabetes clinicians could combine local remedies and biomedical treatment to heal diabetes within the clinic, as well as actively engaging the patient in their own treatment, effective to reduce the symptoms and prevalence of diabetes in Aboriginal populations.

Modelling social capital in a remote Australian Indigenous community

Introduction: Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region in the Northern Territory, Australia. Bronchiectasis is a heterogenous disease that features among these chronic respiratory conditions in this population. However, there are sparse comparative data between Aboriginal and non-Aboriginal patients with bronchiectasis from this region. Methods: In this retrospective study, demographics, clinical characteristics and relevant laboratory parameters were compared among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017. Resuts: A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Aboriginal. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 v 67 years), the majority lived in rural and remote communities (80% v 9 %), had higher rates of self-reported smoking (52% v 19%), alcohol consumption (29% v 12%) and co-occurrence of chronic obstructive pulmonary disease (65% v 38%) and other chronic co-morbidities. Sputum microbiology was also different between the groups with Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis being more common in Aboriginal patients, while Pseudomonas aeruginosa, Aspergillus species and non-tuberculous mycobacteria were higher in non-Aboriginal patients. Further, Aboriginal patients had poorer lung function compared to non-Aboriginal patients (forced expiratory volume after 1 second predicted 33% v 53%, forced vital capacity predicted 49% v 60% respectively), higher exacerbation rates (29% v 18%) and poorer overall outcomes (age at death 60 v 76 years). Conclusion: Within a single health service, Aboriginal patients with bronchiectasis have significantly poorer outcomes with differing manifestations and higher comorbidities than non-Aboriginal patients. This warrants further studies to identify feasible interventions to reduce this inequity.

Adnyamathanha is one of the Thura-Yura languages, spoken in the northern Flinders Ranges of South Australia. It has a rather large inventory of consonant sounds, the analysis of which presents some challenges. We show that, in the most recently spoken variety of the language, there is a contrast between two series of obstruents, phonetically voiced and voiceless, in intervocalic position. There are also four phonetically distinct rhotic sounds, two of which we analyse as major allophones of the voiced apical stops. We also analyse a full series of contrastive pre-stopped nasals and a full series of contrastive pre-stopped laterals and we give reasons for preferring this analysis over one of stop + sonorant clusters. We show that there are three contrasting vowel qualities in Adnyamathanha, with no clear evidence to support a fourth, open-front unrounded phoneme. Apparently-contrastive long vowels can almost all be analysed as V+V sequences separated either by glides or morpheme boundaries. The phonetically long vowels resulting from the latter case do not appear to be stressed, although the increased duration may give this impression to English ears. We conclude, however, that a ‘once-a-phoneme-always-a-phoneme’ approach does not provide a satisfactory account of Adnyamathanha phonology. It is more helpful to recognise that, between the robust phonemic contrasts and the clearly marginal sounds, there may be a ‘cline of contrast’ with a number of intermediate phonological relationships.