Remote Australia Online

Globally, the value of integrating multiple knowledge systems is being recognised in ecosystem assessments, monitoring and management. This paper describes a participatory eco-cultural assessment of freshwater billabongs in the South East Arnhem Land Indigenous Protected Area, northern Australia, that drew on Indigenous ecological knowledge (IEK) and Western science using social and natural science research methods. IEK holders were concerned about feral ungulates trampling and consuming traditional bush food resources and reducing water quality, affecting eco-cultural values of billabongs. We recorded qualitative IEK and conducted a multivariate snapshot assessment of billabong physiochemical water quality, ground condition, yarlbun (water lily) cover and macroinvertebrate assemblage that showed distinct seasonal variation. Although both knowledge systems revealed indicators of seasonal change over 1 year, IEK also revealed longer-term changes and that degradation of billabongs in the late dry season was exacerbated by feral ungulates. This participatory research illustrates how the condition of freshwater systems can be assessed using cross-cultural techniques, how these techniques can reveal more nuanced understandings of eco-cultural condition and the value of including IEK for setting ecological baselines and recording long-term change.

Regular physical activity has multiple health benefits for both the prevention and management of disease, including for older adults. However, additional precautions are needed with ageing given physiological changes and the increasing prevalence of comorbidities. Hot ambient temperatures increase the risks of exercise at any age, but are particularly important given thermoregulatory changes in older people. This narrative review informs planning of physical activity programs for older people living in rural areas with very hot climates for a period of the year. A multi-database search of peer-reviewed literature was undertaken with attention to its relevance to Australia, starting with definitions and standard advice in relation to physical activity programming and the incremental limitations imposed by age, rurality, and extreme heat. The enablers of and barriers to increasing physical activities in older adults and how they can be modified for those living in extreme hot climates is described. We describe multiple considerations in program design to improve safety, adherence and sustaining physical activity, including supervision, simple instructions, provision of reminders, social support, encouraging self-efficacy. Group-based activities may be preferred by some and can accommodate special populations, cultural considerations. Risk management is an important consideration and recommendations are provided to assist program planning.

Drawn from a sample of 88 Indigenous young people in five locations in urban and remote Northern Australia, this research utilised a combination of qualitative approaches to encourage young people to discuss their ideas about sexual relationships and violence. Indigenous youth discussed highly public displays of violence, as well as violence within intimate settings and the interrelationships between these two arenas. A key finding of this research was that young people described violence as an accepted part of their sexual relationships and this normalisation led to significant tensions in their experiences and management of their everyday relationships. While violence around young people's relationships in remote communities was reported to some extent as being controlled through both the public and controlled form they take, we found that the increasing mobility of young people from remote to urban locations due to education opportunities and the impact of social media can lead to more serious forms of violence and tension in the maintenance of young people's sexual relationships. This contributes new findings to the literature on Indigenous young people's experiences in relationship forming and management, an area that has received little attention in the academic literature.

This article presents the results of a retrospective study that critically examines the development of a responsive parent?child program from conceptualisation to pilot implementation. The development of the Play to Connect program was a continuation of research translation work of the Let's Start parenting program which was delivered in remote Aboriginal communities across the Northern Territory, Australia from 2005-2016. The impetus for the Play to Connect program came from the community need for parenting support that could be delivered by local Aboriginal workers living in the community. The aim was to bring research and community together through the co-creation of contextually relevant knowledge directly useful for local Aboriginal facilitators. Embedded in a dynamic cycle of planning, delivery, observation and reflection, the team of local Aboriginal staff and visiting practitioners designed and piloted an innovative, user-friendly and adaptable parent-child program which was underpinned by the evaluation findings of an existing program, drawing on the framework of play therapy. The 2.5-year long process of development brought about action and change for the local Aboriginal staff. They valued the co-creation of the program and resources and reported increased knowledge of child development and confidence to deliver family support in their community. This study shows that the development of Play to Connect was more than 'tailoring' a parenting program - it was a way of creating sustainable support around a program to increase the chances of continuity of implementation and successful community engagement and development.

This report provides an overview, including the north Australian bushfire and natural hazard (‘BNH’) context and the social background for the North Australian Bushfire and Natural Hazard Training project. The project has proceeded slowly (five years) and has changed dramatically as a result of engaging in Participatory Action Research (‘PAR’). This approach to researching the training needs of residents of remote north Australian communities encouraged these residents to participate in the framing of the enquiry as well as the generation of answers and training materials. Several desktop reviews were undertaken during the project. These examined the existing BNH training offerings as well as the opportunities that existed at the time for Indigenous community members to obtain leadership training. The reviews found that where training existed it largely omitted Indigenous perspectives, particularly in terms of strategic overviews and planning. For leadership training, it was found that where remote communities were able to access training for BNH it did not focus on leadership and that which focused on leadership did not include BNH management. In response to the views of project participants and the reviews, the project developed a set of training units that, taken together, drew together the essential elements of Indigenous and non-Indigenous BNH training in a Vocational Education and Training (‘VET’) style program. The program does however modify the ‘standard’ VET approach through the provision of flexible temporal arrangements for training and assessing. This need was identified as the project recognized the requirement to train ‘on Country1’ and to use local knowledge-holders in the preparations for and delivery of the training. Nine formal ‘engagements’ were held over the life of the project, including workshops and three training pilots. In each pilot, different components of the ten training units were presented and refined. A detailed and culturally appropriate evaluation was undertaken of each pilot and the feedback was incorporated into the next ‘round’ of pilot training.10 training units have been developed by the project. Some of these are entirely new while others are adaptations of existing training, albeit adapted sufficient to warrant a new unit descriptor. The 10 units have not yet been subject to National Accreditation, but are designed to map onto the Standards for VET Accredited Courses as set out by the Australian Skills Quality Authority. Each unit has been framed in terms of ‘Elements and Performance Criteria’, ‘Evidence Guide’, ‘Required Skills and Knowledge’ and a ‘Range Statement’.

Racism in health care undermines equitable service delivery, contributes to poorer health outcomes and has a detrimental effect on the Aboriginal workforce. In maternity care settings, Aboriginal women’s perceptions of discrimination are widespread, with the importance of cultural practices surrounding childbirth often not recognised. Efforts to build midwives’ cultural capabilities and address health disparities have seen Aboriginal content included in training programs but little is known about its application to clinical practice. This study reinterviewed midwives who had previously completed university midwifery training that aimed to increase understanding of Aboriginal people and cultural safety in health care. Participants were 14 non-Indigenous midwives and two Aboriginal midwives. Interviews explored the legacy of program initiatives on cultural capabilities and observations and experiences of racism in maternity care settings. Methods followed qualitative approaches for research rigour, with thematic analysis of transcribed interviews. Findings revealed the positive impact of well-designed content and placements, with non-Indigenous participants cognisant and responsive to casual racism but largely not recognising institutional racism. The Aboriginal midwives had experienced and were attuned to racism in all its guises and suggested initiatives to heighten awareness and dispel stereotypes. It is evident that greater attention must be paid to institutional racism in educational programs to increase its recognition and appropriate actions within health care settings.

It has been consistently highlighted in Australian research that Indigenous gifted students face many challenges in rural schools. Rurality presents its own advantages and challenges, while Indigeneity also accords additional challenges that non-Indigenous peoples would not encounter during their educational journey towards excellence. It appears that gifted Indigenous students in rural contexts often face misconceptions, inequitable identification practices, and inappropriate or non-existent programming for giftedness. This chapter will draw together research that focuses on the needs of gifted Indigenous students in rural settings, highlighting the potential problems and promising practices in identification and educational programming. We will also provide culturally sensitive recommendations for educators to support the academic potential of rural-based Indigenous gifted students.

INTRODUCTION: The Western Australia (WA) Acute TeleStroke Programme commenced incrementally across regional WA during 2016-2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs, including regional patient access to tertiary stroke specialist advice and reperfusion treatment; however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care and the drivers of cost-effectiveness has not been systematically evaluated. METHODS AND ANALYSIS: The aim of the case study was to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and transient ischaemic attack care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using state-wide administrative datasets will be used to run the base model. If sample size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in subgroup and sensitivity analysis. ETHICS AND DISSEMINATION: Ethics approval for this case study has been granted from the Western Australian Country Health Service Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development.

There is a growing burden of disease nationally and internationally from mental illness, both as a stand-alone problem and also comorbid with the growing epidemic of chronic, non-communicable diseases. The advent of the COVID-19 pandemic in early 2020 and ongoing climate change sequelae have exacerbated these mental health risks exponentially, creating massive service delivery dilemmas globally. In many countries, people in regional and particularly rural and remote areas, bear a greater disease burden from mental health conditions, due largely to the unique stressors inherent in rural life and inequitable access to appropriate services. This chapter canvases these issues and includes a brief discussion of optimally integrated care, risk factors and needs specific to rural people, the impact of Indigeneity, the role of socioeconomic factors in general and mental health, and inequity of access to primary mental healthcare services. These factors are illustrated by focusing on Australia as a case study, exemplifying both generic characteristics and those unique to that country that are relevant to service delivery in rural areas. The chapter was accepted for publication prior to Australia’s worst bushfires on record (in the summer of 2019–2020), subsequent floods in early 2020, and the advent of the COVID-19 pandemic in February–March 2020 (ongoing). Most of the highlighted factors, however, remain the same – albeit greatly exacerbated by these extraordinary events.

Loss of historical artefacts arising from colonisation and past social policy continue to cause disadvantage and distress for indigenous peoples all over the world and particularly so in Australia. Social efforts to improve community and family outcomes show little progress despite investment. The provision of culturally appropriate, high quality services could be enhanced through the use of technology, particularly in remote areas. One such application is the development of online options for family dispute resolution services. This study forms part of one example of community collaboration to ensure high quality, culturally appropriate services are available to some of the most disadvantaged groups in Australia. Using an organisational development approach via participatory action research, this chapter details an exercise in community engagement in planning for roll out of services. Data included both focus groups and researcher reflections which were pooled and analysed leading to the development of key themes. Participating communities appear ready and enthused by the concept of online service delivery; however, were wary of service provision that was not tailored to their needs or culturally insensitive. With ongoing modification and consultation with community reference groups, the service could be contextualised and adapted to better suit local needs.

The Sendai Framework of Action 2015-2030 calls for holistic Indigenous disaster risk reduction (DRR) research. Responding to this call, we synergized a holistic philosophical framework (comprising ecological systems theory, symbolic interactionism, and intersectionality) and social constructionist grounded theory and ethnography within a critical Indigenous research paradigm as a methodology for exploring how diverse individual and contextual factors influence DRR in a remote Indigenous community called Galiwinku, in the Northern Territory of Australia. Working together, Indigenous and non-Indigenous researchers collected stories in local languages using conversations and yarning circles with 20 community members, as well as participant observations. The stories were interpreted and analysed using social constructivist grounded theory analysis techniques. The findings were dialogued with over 50 community members. The findings deeply resonated with the community members, validating the trustworthiness and relevance of the findings. The grounded theory that emerged identified two themes. First, local Indigenous knowledge and practices strengthen Indigenous people and reduce the risks posed by natural hazards. More specifically, deep reciprocal relationships with country and ecological knowledge, strong kinship relations, Elders' wisdom and authority, women and men sharing power, and faith in a supreme power/God and Indigenous-led community organizations enable DRR. Second, colonizing practices weaken Indigenous people and increase the risks from natural hazards. Therefore, colonization, the imposition of Western culture, the government application of top-down approaches, infiltration in Indigenous governance systems, the use of fly-in/fly-out workers, scarcity of employment, restrictions on technical and higher education opportunities, and overcrowded housing that is culturally and climatically unsuitable undermine the DRR capability. Based on the findings, we propose a Community-Based DRR theory which proposes that facilitating sustainable Indigenous DRR in Australian Indigenous communities requires Indigenous and non-Indigenous partners to genuinely work together in two-directional and complementary ways.

This paper examines the potential for benefit-sharing from large-scale renewable energy projects in Australia on land held under customary ownership. I argue that the growing body of scholarship on accumulation by energy dispossessions needs to be balanced by attention to the opportunities for bene?t-sharing by Indigenous landholding interests. I remain open to the possibility that rent-seeking can create value for historically marginalised and formerly dispossessed Indigenous communities. Following a recent sustained period of Aboriginal repossession of land, benefits can flow to Aboriginal landholders and managers based on the strength and durability of traditional and novel property rights, and their capacity to negotiate benefits. Drawing on the extensive literature on mining negotiations in Australia, I focus on the significant role that the law plays in shaping benefit-sharing opportunities particularly through a procedural right of veto for Indigenous interests. Overall the legal procedural protections for Indigenous landholders are weaker for large scale renewable energy developments than for minerals extraction, and stronger under one legislative regime (Land Rights) than another (Native Title). This analysis shows how the law is both a site of struggle over benefit-sharing and can shape socio-spatially differentiated outcomes. I call for greater analysis of the relationship between rent-seeking, reparation and energy justice, with an emphasis on the distribution of benefits not just burdens.

Objective: The relationship between psychosis and contact with the criminal justice system for Indigenous people living in rural and remote areas is not well understood. In this study, the authors examine patterns of incarceration among Indigenous people living with psychosis in Cape York and the Torres Strait over two decades. Methods: Data were collated from a clinical database of complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients with a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Corrections Service database. Descriptive statistics were calculated to compare characteristics between those incarcerated and those not incarcerated during the study period and to quantify patterns of incarceration including types of offences, time spent in custody and frequency of incarceration. Multivariate Cox regression analysis was used to assess associations between reported variables and 'first incarceration'.Results: Forty-five percent of Aboriginal patients (n=116) were incarcerated compared with 31% of Torres Strait Islanders (n=41) (p=0.008), and the proportion of males incarcerated (51%, n=141) was approximately twice that of females (24%, n=35; p=0.001). A cluster of first incarcerations were observed in close time proximity to diagnosis of psychosis. Individuals who had a history of both alcohol and cannabis use had approximately two times higher risk of being incarcerated following positive diagnosis compared to those without a history of substance use (hazard ratio=1.85; 95% confidence interval: [1.08, 3.17]; p=0.028). Males accounted for approximately 85% (n=328) of sentences. The most common most serious offence was causing physical harm to others (assault n=122, 31%). Conclusion: Our study found that for Aboriginal and Torres Strait Islander people with a psychotic disorder in North Queensland, criminal justice responses with resultant incarceration occurs frequently. Access to appropriate mental health services and diversion options for Indigenous Australians with psychosis should be a key public health and justice priority.

Background: Central Australia is a vast region of over 1,000,000 km2 that is sparsely populated by about 60,000 people, of whom approximately 40% are Indigenous Australians. The human T-cell lymphotropic virus (HTLV)-1c subtype is endemic to this region, where the Indigenous population is infected with diverse subtype c variants. HTLV-1-associated uveitis has been reported previously with other subtypes, but not HTLV-1c. Case Description: In this case series, we describe the first two cases of uveitis associated with HTLV-1c subtype infection. Uveitis was demonstrated in two Indigenous Central Australian men, one aged 39 y and the other, 48. Both had been referred to the Ophthalmology Department of Alice Springs Hospital, the referral centre for Central Australia, with subacute to chronic loss of visual acuity in their right eyes. Slit lamp examination revealed signs of uveitis. Other causes of uveitis were comprehensively excluded in the first patient and partially in the second, but both had positive HTLV-1 serology and high HTLV-1c proviral loads in peripheral blood. The second patient had an extremely high proviral load of >10% PBL indicating HTLV-1c infection as the most likely cause of uveitis, as proviral loads >1% PBL are associated with an increased risk of HTLV-1-associated inflammatory disease. Both received high-dose corticosteroids, but visual outcomes were poor in each case and they became blind in the affected eyes. They also lived in remote Aboriginal communities and had poor health literacy, complicating therapy and monitoring. Discussion: HTLV-1-associated uveitis is well-described in Japanese and Afro-Caribbean populations, but not in Australia, highlighting the novelty of our series. The HTLV-1c subtype is endemic to Central Australia where prevalence was >40% for Indigenous adults in one remote community. Clinicians should be aware of HTLV-1c infection as a cause of uveitis in Australia (and Melanesia, where HTLV-1c is also endemic), and HTLV-1 serology should be included in the basic uveitis work-up. They should also consider social determinants of health which may affect compliance and follow-up. Conclusion: A coordinated strategy to control the transmission of HTLV-1 among Indgenous Australians, who are generally not informed of the risks associated with this infection, is sorely needed.

The Human T-Lymphotropic Virus type 1 (HTLV-1) infects up to 20 million people worldwide who predominantly reside in resource-limited areas. The virus is associated with a haematological malignancy (adult T-cell leukaemia/lymphoma, ATL), and inflammatory diseases involving organ systems including the spinal cord, eyes and lungs. Determining the outcomes of infection in most HTLV-1 endemic areas is extremely difficult; however, the virus is highly endemic to central Australia where the Indigenous population has access to sophisticated medical facilities. We prospectively followed a large hospital-based cohort of Indigenous Australian adults that was well characterized with regard to base-line comorbid conditions, HTLV-1 serostatus and HTLV-1 proviral load (pVL). A higher baseline HTLV-1 pVL was strongly associated with an increased risk of airway inflammation (bronchitis/bronchiolitis and bronchiectasis) and death, which most often resulted from complications of bronchiectasis. Increased mortality due to an HTLV-1-associated inflammatory condition has not been demonstrated previously. The morbidity and mortality associated with HTLV-1 infection may therefore be substantially higher than has been assumed from an analysis of cohorts of subjects with adult T-cell leukaemia or HTLV-1-associated myelopathy. These findings have important implications for epidemiological research and for determining health care priorities in resource-limited settings.

This thesis presents a comprehensive analysis of the gambling activities of Aboriginal people living in remote areas of the Northern Territory, Australia. Extended fieldwork was carried out in the remote community of Maningrida, Arnhem Land. The research focused on card games played in the community. In addition, research was conducted in a large urban gambling venue in Darwin, the capital of the Northern Territory, that examined remote Aboriginal people’s access to, and use of, poker machines (electronic gaming machines). The findings describe complex social, economic and political processes at work within both community card games and the urban gambling venue from an anthropological perspective. The findings suggest that Aboriginal people in Maningrida benefit socially, economically and politically through membership in the informal regulatory structures that existed within card games. However, the community also identified problems relating to card games, particularly in relation to the impact of card games on children. This research also found that, although playing poker machines in an urban gambling environment was an activity that remote Aboriginal people engaged in and enjoyed, it did not offer the same social and economic opportunities as card games. There was a distinct reliance on social relationships within the urban gambling venue, and the efforts and attempts made by people to continue to gamble in groups (despite the individualised nature of poker machines) was significant. Aside from winning a large sum of money, the economic benefits for remote Aboriginal people attending the venue were minimal. The information gathered through this fieldwork has significant implications in terms of the development of relevant harm-minimisation strategies. Finally, the research found that the Aboriginal people involved in this research defined ‘problem gambling’ differently from mainstream definitions. The research found that Aboriginal people defined ‘problem gambling’ as a person neglecting or rejecting social relationships and obligations as a result of gambling. The findings from this research identify a significant need for the development of a national strategy in Australia to address the issues that Aboriginal people face in relation to gambling.

Conceptualisation and theoretical understanding of slow journalism has developed over more than a decade in reaction to the fast-paced journalism so prevalent in contemporary, mainstream media. Articulated in 2007 by Susan Greenberg, the slow journalism movement encompasses attributes such as deep, non-sensational storytelling, transparency, participatory involvement, community service and ethical practice. The Australian Broadcasting Corporation?s (ABC) foray into slow journalism over the last several years via the Remote Communities Project (RCP) enables reporters to spend up to two weeks in a remote or rural community and find what the project management team call ?the untold stories?. As part of a research project investigating the RCP, 15 journalists, producers and managers from the ABC were interviewed. When these participants were asked to reflect upon their understanding of slow journalism, several themes emerged: this form entails a change in practice; the importance of community engagement; and the ability to invest time in finding and developing stories. This article reports on those themes through the lens of participant reflection and Pierre Bourdieu?s cultural production model to develop a better understanding of how reporters who undertook projects for the RCP view the process of slow journalism and implications for journalistic practice.

Free-roaming domestic dogs in Indigenous communities of northern Australia have the potential to spread diseases at the wild?domestic dog interface. Hunting activities with domestic dogs, commonly practiced in Indigenous communities, also create opportunities for wild?domestic dog interactions in the bush, providing pathways for potential disease spread. Data from a camera-trap study conducted in remote Indigenous communities of northern Australia were used to explore spatial and seasonal opportunities for interactions between dingoes and unsupervised domestic dogs. For each type of dog, activity indices, based on detection events per camera station with an adjustment for sampling effort, were mapped across the study area and plotted against distance to communities. Unsupervised domestic dogs were mostly active in proximity (<1?km) to the communities. However, there was a noticeable peak of activity further in the bush away from the communities, especially in the wet season, coinciding with areas commonly used for hunting activities. In contrast, the activity of dingoes was more homogeneous within the study area, with a higher peak of activity around the communities during the dry season, and in bush areas distant (>10?km) to communities during the wet season. Overall, our findings suggest that interactions between dingoes and unsupervised community dogs are more likely to occur around the communities, particularly during the dry season, whereas in the wet season, there is increased opportunity for interactions in distant areas in the bush between dingoes and, presumably, hunting dogs.

Background: To determine the prevalence of enteric infections in Aboriginal children aged 0–2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth. Methods: Cross-sectional analysis of Aboriginal children (n = 62) residing in a remote community in Northern Australia, conducted from July 24th - October 30th 2017. Stool samples were analysed for organisms by microscopy (directly in the field and following fixation and storage in sodium-acetate formalin), and by qualitative PCR for viruses, bacteria and parasites and serology for Strongyloides-specific IgG. Child growth (height and weight) was measured and z scores calculated according to WHO growth standards. Results: Nearly 60% of children had evidence for at least one enteric pathogen in their stool (37/62). The highest burden of infection was with adenovirus/sapovirus (22.9%), followed by astrovirus (9.8%) and Cryptosporidium hominis/parvum (8.2%). Non-pathogenic organisms were detected in 22.5% of children. Ten percent of children had diarrhea at the time of stool collection. Infection with two or more pathogens was negatively associated with height for age z scores (− 1.34, 95% CI − 2.61 to − 0.07), as was carriage of the non-pathogen Blastocystis hominis (− 2.05, 95% CI - 3.55 to − 0.54). Conclusions: Infants and toddlers living in this remote Northern Australian Aboriginal community had a high burden of enteric pathogens and non-pathogens. The association between carriage of pathogens/non-pathogens with impaired child growth in the critical first 1000 days of life has implications for healthy child growth and development and warrants further investigation. These findings have relevance for many other First Nations Communities that face many of the same challenges with regard to poverty, infections, and malnutrition.

This paper argues that inappropriate government policies cause of low remote Indigenous labour force participation and high unemployment. This paper is a submission to the Remote Participation and Employment Services Engagement Panel (0), responding to the Discussion Paper released 16 August 2011.

Rheumatic heart disease (RHD) is almost entirely preventable, but the incidence in indigenous Australians remains one of the highest in the world. A community-based echocardiogram screening program of 862 Torres Strait Islander children identified 25 (2.9%) new cases of RHD. Among these 25 children, 5/7 (71%) prior acute rheumatic fever presentations had not been recognized. There was a history of microbiologically confirmed group A <span class="jp-italic">Streptococcus</span> infection in 17/25 (68%) children with RHD compared with 9/25 (36%) controls (odds ratio [OR] [95% CI]: 3.78 [1.17–12.19], <span class="jp-italic">P</span> = 0.03). This was more likely to be a skin swab (16/25 [64%] cases versus 6/25 [24%] controls) than a throat swab (1/25 [4%] cases versus 3/25 [12%] controls) (OR [95% CI]: 5.33 [1.51–18.90] [<span class="jp-italic">P</span> = 0.01]), supporting a role for skin infection in RHD pathogenesis. Household crowding and unemployment were common in the cohort, emphasizing the need for prioritizing strategies that address the social determinants of health. This study explores the burden of rheumatic heart disease diagnosed during an echocardiogram screening program in the Torres Strait Islands in tropical Australia and highlights the importance of primordial and primary prevention.

Aims Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions

This paper reports on a study that aimed to understand how remote area nurses implemented primary health care principles in the Australian remote health care setting. Twenty-four Registered Nurses and Nurse Practitioners who worked in remote health services without inpatient facilities were interviewed using constructivist grounded theory methods. Findings revealed that nurses in this study aimed to practice in a way that was guided by Indigenous empowerment and social justice. However, some nurses questioned elements of their practice such as ‘chasing’ people for appointments or routine screening required by clinical guidelines that may not reflect the values of Indigenous peoples. Nurses expressed concern that they may be reinforcing past colonising practices and their actions may be considered paternalistic rather than empowering. Nurses in this study wanted to develop partnerships and provide nursing care that aligned with the health and wellbeing expectations of communities. However, ways of communicating the needs of communities and the development of partnerships between health providers and communities need to be developed. The present study calls for further research from the perspective of remote community members in order to develop ways of sharing knowledge about health and wellbeing between remote area nurses and communities.

Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings.

Critical inquiry into sensitive social problems requires risk-taking by researchers and research participants alike. Detailed in this chapter are insights into risks as experienced by the scholar within a study involving Aboriginal participants in remote Australia. Research is both personal and political, requiring researchers to move deftly between each realm as they negotiate their legitimacy as agents of social change through this medium. Rather than avoiding personal vulnerability, the scholar can navigate personal and professional risks positively. Arguably, through actively embracing the knot of discomfort associated with risk-taking, researchers open themselves to deeper engagement with Aboriginal participant voice and expertise, thereby discovering innovative solutions to complex problems.