Remote Australia Online

Background Nurses are essential in global strategies to improve population health. However, there is a paucity of research that describes the application of primary health care from a nursing perspective. Australian remote area nurses work in primary health care clinics which are often the only health care service within the community. Services include acute care response as well as health promotion and public health activities. Question, Hypothesis or Aim To explore the meaning and application of primary health care principles from the perspective of nurses in Australian remote settings. Methods Telephone interviews were conducted with registered nurses and nurse practitioners working in Australian remote settings using constructivist grounded theory methods during 2014 and 2015. Findings Nurses in remote settings considered primary health care to be an holistic social model of care that included caring for the community as well as the individual. However, they were unable to provide care consistent with their intention due to the resource-poor nature of the remote setting. Inadequate physical resources, limited specialist health services, and a lack of time were found to impact on remote area nurses’ abilities to provide primary health care. Discussion This study is unique in its description of a cause of remote area nurse stress as being the inability to provide primary health care in line with their expectations. Conclusion Appropriate resourcing is essential for nurses to be able to provide a comprehensive array of holistic services in line with community-identified need that also reflect their own definitions of primary health care.

Objective: The over-reliance on overseas-trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas-trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance. Design: Qualitative interviews were undertaken with overseas-trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas-trained doctors. Setting: Migrant doctors working in general practice in rural and remote Australia. Participants: Overseas-trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group. Results: Overseas-trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas-trained doctors, policy-makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous-related health and cultural challenges. Conclusions: In the context of Australia's continuing reliance on overseas-trained doctors, this study revealed the need for improved communication and coordination between overseas-trained doctors, policy-makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.

Aims Early childhood anaemia due to iron deficiency is widespread in remote communities across northern Australia. Current recommendations for healthy food to complement breastfeeding at age 6 to 23 months include iron-rich and iron-enriched foods. An electronic nutrient analysis was undertaken to assess the iron content of hypothetical healthy diets for breastfed babies and young children aged 6 to 23 months in Australia, in comparison with their estimated requirements. Methods Hypothetical diets for 1 day were developed that were consistent with the Foundation Diets for breastfed infants 6 to 12 months and for toddlers 13 to 23 months. Nutrient content was derived using the Australian Food Composition database in FoodWorks 10. The iron content of these two diets were compared with Estimated Average Requirements (EARs) and Recommended Dietary Intakes (RDIs) for iron for infants aged 7 to 12 months and children aged 1 to 3 years. Results The iron content of the hypothetical diet for breastfed infants aged 6 to 12 months (5.8 mg) was less than the EAR (7 mg, 83%) and the RDI (11 mg, 53%). For young breastfed children aged 13 to 23 months, the iron content of the hypothetical diet was 4.4 mg; above the EAR (4 mg, 110%) but less than RDI (9 mg, 49%). Conclusions Breastfeeding has health and neurodevelopmental benefits for infants and young children that are particularly important in remote Australia where food insecurity and poor nutrition compromise health and wellbeing. Adequate iron intake is also important for neurodevelopment in early life but healthy diets for breastfed babies and young children may have insufficient iron content to meet requirements. The upcoming revision of the Australian Dietary Guidelines provides an opportunity to consider this issue.

Companion animal management in Australian remote Aboriginal communities (rAcs) is a complex problem, with multiple stakeholders involved with differing needs, knowledge, power and resources. We present our CoMM4Unity approach, a participatory systemic action research process designed to address such problems. In the first step, frame analysis is used to analyse stakeholders’ perspectives, knowledge types and power dynamics to determine their relative roles in animal management. Twenty individuals were interviewed from stakeholder groups involved in animal management in the remote, island rAc of Wurrumiyanga, Tiwi Islands. Frame analysis indicated that stakeholders aligned into four groups with distinct identity frames, knowledge types and power frames: Indigenous Locals, Indigenous Rangers, Non-Indigenous Locals and Animal Managers. All four groups shared overlapping perceptions about companion animals in Wurrumiyanga, and agreed that dog overpopulation was the primary issue. However, the groups differed in their strength of opinions about how dogs should be managed. Therefore, the situation is not one of diametrically opposing frames but more a misalignment of goals and values. Our application showed that frame analysis can reveal subtle variations in stakeholder groups’ identities, goals and values, and hence how they prioritise management measures.

Background Aboriginal children living in remote communities are at high risk of early and persistent otitis media. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are primary pathogens. Vaccines with potential to prevent early OM have not been evaluated in this population. We compared immunogenicity (ELISA and opsonophagocytic activity) of a combination of Synflorix™ (PHiD-CV10, 10 serotypes and protein D of NTHi) and Prevenar13™ (PCV13, 10 serotypes plus 3, 6A, and 19A), with recommended schedules. Methods This open-label superiority trial randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to PCV13 (P) at 2-4-6 months (_PPP), PHiD-CV10 (S) at 2-4-6 months (_SSS), or PHiD-CV10 at 1-2-4 plus PCV13 at -6 months (SSSP). Primary outcomes (blinded) were immunogenicity against PCV13-only serotypes 3, 6A, 19A, and PHiD-CV10-only protein D at 7 months. Secondary outcomes include immunogenicity against all serotypes at 2, 4 and 7 months. Findings Between 2011 and 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(141). An intention to treat approach including all available data was used. The SSSP group had superior immunogenicity against serotypes 3, 6A, and 19A compared to _SSS (OPA GMT ratios 8.1 to 59.5, p<0.001), and against protein D compared to _PPP (GMC ratio 11.9 (95%CI 9.7 to 14.6)). Immune responses to protein D and 3, 6A, and 19A in SSSP were not significantly lower (i.e. no harm) than either _SSS or _PPP. For ten common serotypes responses at 2, 4 and 7 months were superior for SSSP (following 1-, 2-, and 4- doses) than _SSS and _PPP (following 0-, 1-, and 3- doses). At 4 months, _SSS was superior to _PPP. Reactogenicity and hospitalisations were rare and unrelated to the intervention. Interpretation From two months, the 1-2-4-6-month combined schedule (SSSP) was safe and significantly more immunogenic than 2-4-6-month schedules. The earlier responses may be beneficial in high-risk populations.

Introduction: This rapid literature review aimed to inform the development of a new sustainable, evidence-based service delivery model for ear, nose and throat (ENT) services across Cape York, Australia. This work seeks to investigate the research question: 'What are the characteristics of successful outreach services which can be applied to remote living Indigenous children? Methods: A comprehensive search of three major electronic databases (PubMed, CINAHL and MEDLINE) and two websites (HealthInfo Net and Google Scholar) was conducted for peer-reviewed and grey literature, to elicit characteristics of ENT and hearing services in rural and remote Australia, Canada, New Zealand and the USA. The search strategy was divided into four sections: outreach services for rural and remote communities; services for Indigenous children and families; telehealth service provision; and remote ear and hearing health service models. A narrative synthesis was used to summarise the key features of the identified service characteristics. Results: In total, 71 studies met the inclusion criteria and were included in the review, which identified a number of success and sustainability traits, including employment of a dedicated ear and hearing educator; outreach nursing and audiology services; and telehealth access to ENT services. Ideally, outreach organisations should partner with local services that employ local Indigenous health workers to provide ongoing ear health services in community between outreach visits. Conclusion: The evidence suggests that sound and sustainable ENT outreach models build on existing services; are tailored to local needs; promote cross-agency collaboration; use telehealth; and promote ongoing education of the local workforce.

Purpose Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. Methods A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. Results From the participants? perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. Conclusion Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.

Objective To examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework.Design Cross-sectional.Setting Queensland non-for-profit cancer accommodation lodges.Participants Participants were patients with cancer who travelled for treatment from rural and remote Queensland to major urban centres (n=518; age mean=64.6, SD=11.18).Outcome measures Assessments included NCCI patient indicators, quality of life (QoL), psychological distress and unmet supportive care needs.Results The frequency at which NCCI indicators were met ranged from 37.5% for receiving an assessment and care plan to 97.3% for understanding explanations about diagnosis. Geographical considerations did not impact patient experience, whereas middle school educated participants were more likely than those with senior-level education or higher to receive an assessment and care plan (OR=1.90, 95% CI 1.23 to 2.91) and to report having their views on treatment taken into account (OR=2.22, 95% CI 1.49 to 3.33). Patients with breast or prostate cancer reported better communication and patient involvement and information and services provision (r=p<0.001) compared with those with skin and head and neck cancer. When compared with information and service provision, communication and patient involvement showed stronger positive associations with QoL (z=2.03, p=0.042), psychosocial (z=2.05, p=0.040) and patient care (z=2.00, p=0.046) outcomes.Conclusion The patient care experience varies across the NCCI indicators by sociodemographic and clinical factors that likely reflect healthcare system biases. Perceptions about communication and involvement appear most critical for optimal outcomes and should be a priority action area for cancer control.

Burns affect Australia’s First Nations children more than other Australian children, they also experience longer lengths of stay in tertiary burns units and face barriers in accessing burn aftercare treatment. Data sets from two studies were combined whereby 19 families, 11 First Nations Health Worker (FNHW) and 56 multidisciplinary burn team members from across Australia described the actual or perceived role of FNHW in multidisciplinary burn care. Data highlighted similarities between the actual role of FNHW as described by families and as described by FNHW such as enabling cultural safety and advocacy. In contrast, a disconnect between the actual experience of First Nations families and health workers and that as perceived by multidisciplinary burn team members was evident. More work is needed to understand the impact of this disconnect and how to address it.

Author summary As scabies control efforts continue to grow, scarcity of diagnostic options hinders success of elimination efforts in endemic areas. Efficiency in large-scale monitoring is further obstructed by invasive sample collection techniques, which are often uncomfortable for patients, and lack sensitivity. We have developed two PCR-based diagnostic assays targeting repetitive DNA elements. These were identified using new data on the S. scabiei genome. Targeting these elements by PCR improved the detection of scabies DNA. Enhanced sensitivity was demonstrated when tested against routine microscopy and a published PCR-based diagnostic assay. When combined with a non-invasive, effective FLOQ swab sampling method, the developed qPCR-based assays may provide a useful complementary tool for diagnosis of scabies, and its application will likely improve scabies control in target populations.

University Departments of Rural Health (UDRHs) facilitate clinical placements in rural and remote settings throughout Australia for students enrolled in tertiary health courses. UDRHs support students to travel to rural and remote regions, provide accommodation, and ensure clinical learning needs are met for students to complete these placements. In 2019, the 16 UDRHs across Australia supported over 16,500 placements (mostly in nursing, midwifery and allied health). Similar numbers of UDRH-facilitated placements were planned in 2020. However due to the risks of COVID-19, associated travel restrictions, biosecurity zones and the constraints within health services, many of these placements were altered, postponed or cancelled. This had repercussions for student progress through their university courses and the types of placements that were offered. As student responses to these placement changes were not well understood, UDRHs were interested in student experiences of their UDRH-facilitated rural or remote placement during 2020. All 16 UDRHs agreed to participate in a study of student perspectives among students who had a placement organised by a UDRH. The aims of the study were to: 1) identify student perspectives of impacts to UDRH-facilitated placements due to COVID-19; 2) identify student perspectives of UDRH-facilitated placements during COVID-19; 3) understand student experiences of UDRH-facilitated placements during COVID-19. A core project team of researchers from eight UDRHs lead the project, with involvement from all 16 UDRHs asking their students to participate. All students with a planned placement facilitated by any UDRH (regardless of whether or not the placement went ahead) between February and October, 2020 were invited by email to complete an online questionnaire. A total of 1,505 students completed the questionnaire. Of these, 84% identified as female, 4% as Aboriginal and/or Torres Strait Islander and 62% were under 25 years of age. Half were studying nursing or midwifery and half were studying medicine (9%) or one of19differentallied health disciplines. At the end of the questionnaire, all participants were asked if they were willing to be interviewed. Of those willing, 29 were randomly selected and interviewed. Interviewees included students who planned to undertake placements in all states and the NT. Of the1,505questionnaire participants, 20% did not complete their placement. Of students completing their placement, 60% indicated their placement was impacted by COVID-19 while 20%suggested their placement was not impacted. Where placements were impacted, students talked about their placement being changed to another service, another town, starting and completing the placement from ‘home,’ or the placement being undertaken from a metropolitan area via telehealth or in the form of a project relevant to a rural or remote location or service. Allied health students were more likely to report that their placement had been cancelled or changed to an online formator a placement model with less direct client contact than nursing students. The decision to cancel or postpone these placements was said to be made mostly by either the health service or the university where the student studied, rather than students choosing not to go rural. Importantly, 80% of respondents indicated they had completed a UDRH facilitated placement, of which 84% were satisfied with their placement. Given the travel restrictions in all states, UDRHs have, therefore, continued to provide placements in difficult times. While financial and mental health issues were identified, the key issues raised by students were concerns for their clinical learning and development of their skills involving direct patient care. Stemming from this, students were also concerned about graduating on time and securing employment in their area of study after graduation. The interviewees outlined the complexity of UDRH-facilitated rural and remote placements during 2020. Students who did not complete their placement talked about the cost of cancelled flights and travel. The students who did complete their rural or remote placement talked about restrictions preventing them from moving around the rural/remote area, being alone in student accommodation, and the restricted duties and activities during placement due to COVID-19 related issues (e.g., lack of personal protective equipment, changes in student tasks, etc.). The many changes and uncertainty of placements also contributed to students’ worry about their placement, progress through their course and clinical learning. Similar to the questionnaire respondents, interviewees also raised financial concerns, worries about graduation, fears about finding employment after graduation, mental health and resilience issues, and the many difficulties of juggling work, family, travel and uncertainty during the pandemic. Overall, most students wanted to go on their UDRH-facilitated rural or remote placement to gain experience and to progress through their course, and the majority of these students completed their UDRH-facilitated placement. While there were changes in placements, locations, accommodation and the types of placement, most students were grateful to complete their planned placement. The cancellation of, and changes to, placements appears to have contributed to student concerns about clinical learning and progression through their course. Many of these concerns are not likely to be specific to UDRH-facilitated placements, but to all placements required in their course. What was clear from this study was the complexity of students’ lives throughout COVID-19due to juggling financial issues, family concerns, seeking clinical experience, worrying about graduation and feeling insecure about future employment. This suggests that significant student support and flexibility is required for current and future cohorts of nursing and allied health students.

This exploratory study examines the structure of cultural life scripts (CLS) and autobiographical memories in a group of 13 non-WEIRD (Western Educated Industrialized Rich Democratic) Nunggubuyu from Australia. Participants provided a CLS and reported the events’ expected timing and valence; and their seven most important memories, the age at the events and their valence. The CLS and important memories consisted mainly of positive events happening in early youth, but there was also a notable bump with positive events later in life. Results provide evidence for the important role of grandmothers in the Nunggubuyu culture, as both in the CLSs and in autobiographical memories, many events related to learning about Nunggubuyu culture as a child, and grandmothers teaching the community and especially children. Importantly, the results highlight that societal and cultural structures that differ from those in WEIRD communities may result in differences in CLS and in autobiographical memory recall.

The role of local government in improving public health has been given legislative recognition in some Australian states. There is growing evidence of the positive role this statutory recognition has given to align local government efforts with state government health policy. Health in All Policies (HiAP) is a comprehensive approach to integrating public health, promoting components into a range of traditional local policies such as those relating to housing, transport and water. While much of the work internationally in HiAP has focused on urban populations, we argue that there are opportunities for rural and remote Australian local governments to use HiAP to respond to disparities in health outcomes amongst rural and remote Australian communities. We examine the Australian experiences with HiAP, the role for local governments and the future challenges and opportunities around the use of a HiAP approach to improve community health outcomes in rural and remote Australian communities.

Australia is a food secure nation that exports 60% of its total production. Yet, COVID-19 is having an impact on the ability of rural and remote communities to access sufficient, affordable nutritious food. Australia is not alone in experiencing pockets of food shortages. A recent joint statement from leading international food agencies highlighted the consequences that the restrictions have placed on movement within and between countries, disrupting food supply chains and the availability of food. During the early days of the outbreak of COVID-19 when panic buying began to take hold in Australia, the Alliance was regularly contacted by a member representative from a remote NSW town with a high Aboriginal population. He was concerned about the persistent and severe food supply shortages in his town that could impact household and community food security. Further media reports from other parts of the country indicated that a reduced food supply in rural areas was more general. The small, remote Aboriginal and Torres Strait Islander communities have been heavily affected, according to a media statement released from The Hon Ken Wyatt's office. Along with the apparent food shortages have come rising prices of staple foods, which creates additional anxiety amongst disadvantaged communities. Food security exists where ‘all people at all times have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.’ There are four pillars of food security: (a) food availability (b) food access, including both affordability and transport (c) food utilisation and (d) the stability of the food supply. Conversely, food insecurity is defined as a situation in which individuals, households and communities have limited or uncertain ability to meet these conditions that might or might not be accompanied by hunger. The outcome of food insecurity is poorer physical and mental health outcomes. The prevalence of food insecurity in Australia varies from 4% to 14%, but in disadvantaged populations it can be as high as 83%. Even at the lower end of this percentage, it means approximately 1 million Australians are experiencing food insecurity. The factors that impact on food insecurity are poverty, unemployment, low educational levels, social isolation, food literacy and time many of which put people living rural, regional and remote communities at greater risk. Additional challenges for those living in remote parts of Australia are being able to source good-quality fresh produce away from urban areas. Unemployment rates in rural areas are lower under usual conditions, so rising rates of unemployment during the coronavirus pandemic might precipitate higher prevalence of food insecurity, particularly for those regions that have been affected by drought and the recent bush fires, where agricultural and tourism businesses have taken a severe hit. In terms of solutions to addressing food insecurity in rural, regional and remote Australia, food relief charitable agencies play a key role in responding to the immediate needs of people experiencing food insecurity. However, while these services can help to reduce hunger and offer interventions to improve food knowledge and skills, they do not reduce the underlying causes of food insecurity. It is not reasonable to expect that lasting improvements to food insecurity come from individual and charity-led responses. Instead, governments at all levels—national, state and local—have critical roles to play in addressing food insecurity. Poverty is one of the main factors for a household being food insecure, so Australian government policies that improve household financial resources through fair welfare payments and potentially subsidised groceries will enable people to feed themselves in culturally appropriate ways. Since the Federal Government announced the stimulus package during COVID-19, JobSeeker allowances have been increased and other social security benefits have been boosted, which will provide some protection against food insecurity for vulnerable individuals, families and communities. Policies that are directed towards improving living and working conditions for disadvantaged people are also necessary to address the underlying causes of food insecurity. At the local level, strategies to improve food security in rural communities could include collaborative efforts between relevant stakeholders, such as state and local governments as well as private industry. The Alliance's virtual conversation on affordable and nourishing food for rural and remote communities considers policy and practical solutions. An initiative that has shown promise was a program funded by a local health district in two rural local government areas in Victoria, which improved access to fruit and vegetables through small store incentives. In the context of changing weather patterns and climate change, local governments are particularly well placed to use environmental sustainability principles to guide the development of food security programs in Australia. Under the Public Health and Wellbeing Act in Victoria, each local government has the responsibility for creating a health and well-being plan, which provides an opportunity to address the issues of climate change and food insecurity, while improving community capacity, building resilience and social cohesion. Shared principles for both food sustainability and food security are ecosystems' protection and biodiversity; food justice and fairness; and valuing local economies, local food systems and community resilience. It is at the local level where concerted responses to food insecurity are required, because this is where people experience food insecurity. Importantly, local strategies must be supported by the Australian Government and state governments that provide the other supports that people need.

INTRODUCTION:This article describes the process of mapping referral pathways to develop a localised resource to enhance the journey to diagnosis, treatment and support for foetal alcohol spectrum disorder (FASD) in a regional community setting. METHODS:Over a 6-month period, a research officer engaged service providers in Port and South Hedland, Western Australia, using participatory action research methods. An iterative process included a service environment scan, interviews with service leaders and refinement of progressive drafts of the pathway through the Hedland FASD Network. A community reference group advised on cultural issues. RESULTS:Referral pathways for interagency sectors (health, education, justice) were developed. Three pathway schematics and a companion four-page referral protocol were endorsed. The pathways were disseminated to all service providers and consensus was reached to trial the pathways within existing service systems. CONCLUSION:The process of referral pathway development provided a service mapping and gapping exercise to facilitate service integration. Evaluation of the resource will be conducted using the RE-AIM framework. The referral pathways template has been adapted and trialled by health and other professionals in several sites across Australia. The model developed for FASD can be applied to other neurodevelopmental disorders.

This is the story of suicide prevention in two remote Indigenous communities. The suicide prevention story from the Tiwi Islands (Northern Territory) and Yarrabah (Queensland) presented here is told by the communities themselves. It is a story of community empowerment in each place and as such supports the existing work of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP).

PricewaterhouseCoopers Indigenous Consulting (PIC) was appointed in February 2017 by the Department of the Prime Minister and Cabinet (the department) to undertake a review of Indigenous Advancement Strategy (IAS) funded secondary school scholarships.

Ancylostoma ceylanicum is the common hookworm of domestic dogs and cats throughout Asia, and is an emerging but little understood public health risk in tropical northern Australia. We investigated the prevalence of A. ceylanicum in soil and free-ranging domestic dogs at six rainforest locations in Far North Queensland that are Indigenous Australian communities and popular tourist attractions within the Wet Tropics World Heritage Area. By combining PCR-based techniques with traditional methods of hookworm species identification, we found the prevalence of hookworm in Indigenous community dogs was high (96.3% and 91.9% from necropsy and faecal samples, respectively). The majority of these infections were A. caninum. We also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7%) and soil (55.6%) in an Indigenous community. A. ceylanicum was present in soil samples from two out of the three popular tourist locations sampled. Our results contribute to the understanding of dogs as a public health risk to Indigenous communities and tourists in the Wet Tropics. Dog health needs to be more fully addressed as part of the Australian Government's commitments to “closing the gap” in chronic disease between Indigenous and other Australians, and encouraging tourism in similar locations.

Objectives: The use of innovative information technology is now well established in health. However, while the gap in health status between Indigenous and other Australians is both significant and unchanging, there is limited application of these new approaches to addressing this national health priority. This may in part reflect the ?digital divide?, which is another facet of Indigenous disadvantage. This paper describes an approach to address both issues in remote Indigenous settings.Results: The Health Interactive Technology Network began as a proof-of-concept study of touchscreen technology in two Indigenous health settings. It has subsequently expanded to a number of remote Indigenous communities and developed new platforms and applications to respond to emerging health issues. In creating narrative, interactive approaches to address choices in relation to health behaviours, the community development and engagement effects of the creative process have been highlighted. These findings suggest that these approaches will be suited to further expansion in the area of mental health.

The following report documents the growing up stories provided by people in the Torres Strait and Northern Peninsula Area during the trial phase of the Longitudinal Study of Indigenous Children. The trial is designed to assist the Australian Government Department of Families, Community Services and Indigenous Affairs (FaCSIA) develop a national ‘Footprints in Time’ Longitudinal Study of Indigenous Children.

Many observers feel that current social policy, and particularly the payment of welfare to the unemployed, needs to be fundamentally rethought. It is notable that advocates of change include both the government-appointed McClure Committee and influential Indigenous spokespersons, most notably Noel Pearson. In their publications Participation Support for a More Equitable Society (McClure 2000) and Our Right to Take Responsibility (Pearson 2000b) both these parties adopt the language of mutual obligation and, on the face of it, appear to agree with the general principle. The central tenet of mutual obligation in the context of current debates is the problem of how to shift individuals from being 'passive' welfare dependents into active engagement with the 'real' economy. The model is predicated on the forging of new partnerships between governments, business, the community, and the individual. Both the McClure Committee and Pearson recognise that many Indigenous communities face major structural and systemic barriers to full economic participation, particularly in rural and remote regions. Both only make passing reference to the CDEP scheme that was first established in 1977 as Australia's prototype mutual obligation program. While the wages component of the scheme is covered by notional welfare equivalent payments, additional amounts are also provided with which to administer the scheme and purchase capital equipment. At 1 July 2000, there were nearly 31 000 participants in the scheme across Australia. The CDEP scheme, as a model, meets many of the principles of mutual obligation as ennunciated by McClure and Pearson as well as by academics like Yeatman (1999) and Saunders (see Ch. 3, this volume). In the discussion that follows, I first define the boundaries of remote Australia, noting that about 70 per cent of the 265 CDEPs that existed at the time of the 1996 Census fall within this jurisdiction. On the basis of joint research with Matthew Gray (Altman & Gray 2000), I then provide a very brief assessment of the economic impact of the CDEP scheme in this region. McClure's and Pearson's prescriptions for facilitating Indigenous engagement with the 'real' economy are then examined and subjected to some reality checks; and finally I set out my own views on how the CDEP scheme, with modification, could be used as an institutional framework for Indigenous economic development.

“Food and nutrition security exists when all people at all times have physical, social and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life.” (FAO 2012). This report was prepared by the Reference Group to collate current knowledge and perceptions surrounding food security in Alice Springs as the first step in developing a community-wide approach to addressing the issue. Its intent is to bring food security to the attention of local decision makers for discussion and consideration. It is well recognised that collective action needs to occur as a cross-sectional approach across systems including government, non-government organisations and community members to see positive change. As stated by the NRHA (2016): “Failure to address food insecurity affects a national budget from both ends. It results in increased health and welfare costs for decades to come, and also means lost taxation revenue and societal contribution from people unable to take their place in the paid workforce.” Fundamentally, food and nutrition security is influenced by the social determinants of health and the specific dimensions of availability, access, utilisation and stability over time. Influences at a local level have been interpreted at a household and community level within this report. Key Findings: Alice Springs is home to a large proportion of groups identified at high risk of facing food insecurity, inclusive of Aboriginal (17.6%) and other Culturally and Linguistically Diverse (23.4%) peoples. This highlights the importance of working in the food security space to address the unjust disadvantage faced by these populations. Alice Springs sits close to the median relative disadvantage compared to other parts of Australia (396 of 543) and the NT (13 of 18). However, we have severely disadvantaged pockets within the Alice Springs local government area. Key determinants of food insecurity are present in Alice Springs. Housing availability and affordability are a prominent issue resulting in high levels of overcrowding and other forms of homelessness, especially for at-risk groups. For Aboriginal people, transport and utility access and affordability is lower than the rest of the NT population. The NT faces greater health disparity compared to the rest of Australia in many areas including life expectancy (4.9 years lower), and greater burdens of disease (1.4x higher) particularly in kidney and urinary (4.5x higher), blood and metabolic (2.4x higher), and cardiovascular diseases (2.0x higher). Dietary risk factors contribute 7.3% to this disease burden. Some of these disease are well correlated with food insecurity, especially Type 2 diabetes and obesity. Food and Nutrition programs within Alice Springs are plethoric (113 identified) but are uncoordinated across providers and focus mainly on Emergency Food Relief and Education of individuals, with large gaps in the Access dimension and Promotion determinant. The food system within Alice Springs is not tailored towards healthy eating behaviours. Mapping reveals that there is an abundance of outlets selling majority unhealthy items that are easier to access than outlets selling majority healthy items, especially in lower socioeconomic areas; and food deserts (where no food outlets are within 500m) exist in entire suburbs, especially outside of town limits, and in extremely disadvantaged locations. Some public transport infrastructure is adequate and affordable to access, however improvements to frequency of services, communication of services, spread of bus stops in disadvantaged areas are recommended as the current system as whole may not meet the needs of the most vulnerable community members of which it aims to serve i.e. the elderly, young people or those with mobility impairments. Healthy food costs less than unhealthy/current food choices in Alice Springs and is comparable with Darwin prices. However, current data does not reflect the extra costs that may be incurred when utilising healthy food. These costs need to be investigated in greater detail to establish true affordability indices. Research has been conducted with service providers who described determinants, coping mechanisms and impacts of food security for Alice Springs community members. They also reported on current activities addressing food security and where they would like to see further action. For reasons described in this report, these have not been reported here but are considered in the recommendations and have been reported back to participants. They are planned to be published at a later date following research into community perspectives of food security in Alice Springs.

In recent years, the native food industry in Australia has increased in both value and volume due to the discovery of a wide range of phytochemicals (e.g. vitamin C, polyphenols) that have potential health benefits. Thus, plant organs and tissues of these native plants are used in a wide range of applications. In particular, the kernel of a native plum, the Kakadu plum (Terminalia ferdinandiana, Combretaceae) is considered to be rich in lipids and other phytochemical compounds. The aim of this study was to evaluate the use of NIR spectroscopy to analyse and characterise kernel samples and tissues of wild harvest fruit samples. The FT-NIR reflectance spectra of cracked kernels, seeds cover tissues, and dry powder Kakadu plum kernels were acquired. Both principal component analysis and partial least squares discriminat analysis were used to analsye and interpret the spectral data. A correct classification rate of 93%, 86% and 80% was achieved for the identification of kernel provenance using all tissues, seed coats and the whole nuts, respectively. The results of this study reported for the first time the analysis of Kakadu plum kernels and their tissues using NIR spectroscopy.

In the mid-1980s the AUSSAT satellite brought television and radio to remote Australia for the first time. There was concern amongst Aboriginal communities that the imposition of mass media without consultation could result in permanent damage to culture and language. However, over the years, the Warlpiri people have adopted modern communication technology including radio, video making, locally produced television, and more recently on-line services. This paper examines why the Warlpiri have adopted modern communication technology and whether there have been social changes as a result. It also looks at the pioneering media work by the Pitjantjatjara people at Ernabella in the far north of South Australia.

Background: The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions. Objective: The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing. Methods: This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions. Results: This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment. Conclusions: This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/21832