Remote Australia Online

Chapter 1: Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. Study design: Rapid review of articles published between January 2000 and May 2020. Data sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. Data synthesis: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. Chapter 2: Which interventions best support the health and wellbeing needs of rural populations experiencing natural disasters? Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. Study design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. Data sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. Data synthesis: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. Conclusion: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people?s health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. Chapter 3: The impact of bushfire on the wellbeing of children living in rural and remote Australia Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. Study design: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred eporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. Data sources: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. Data synthesis: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. Conclusion: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. Chapter 4: The role of national policies to address rural allied health, nursing and dentistry workforce maldistribution Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. Study design: Using scoping review methods, we included primary research ? published between 1 September 2009 and 30 June 2020 ? that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2. Data sources: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. Data synthesis: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). Conclusion: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. Chapter 5: Availability and characteristics of publicly available health workforce data sources in Australia Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. Study design: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. Data source : We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. Data synthesis: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources ? eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. Conclusion: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. Chapter 6: Rapid realist review of opioid tapering in the context of long term opioid use for non-cancer pain in rural areas Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. Study design: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. Data sources: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. Data synthesis: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. Conclusion: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers? concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Indigenous employment is a key point of engagement between Indigenous people and mining companies. Over the past two decades, research shows that the Australian mining industry has increased the numbers of Indigenous employees within the mining workforce. However, less is known about how well the industry is retaining Indigenous employees and what factors support retention. This article begins to fill this gap by presenting outcomes of qualitative research undertaken with both former and current Indigenous employees of a major employer of Indigenous people in the Pilbara region of Western Australia. We elucidate the main reasons for turnover intention as articulated by Indigenous employees and examine the strategies available to mining companies to address voluntary turnover within this cohort. The findings suggest that a culturally competent non-Indigenous workforce, culturally appropriate support mechanisms and access to professional development opportunities are key retention factors. The paper concludes by arguing that the mining industry will need to focus both on ensuring a culturally safe workplace for its Indigenous employees, and on increasing the regional Indigenous labour pool, if it is to contribute to more sustainable outcomes.

In this submission, Aboriginal Peak Organisations Northern Territory (APO NT) expresses their concern that the Northern Territory needs to be further included in government relations such as voter engagement, more accurate census data, and a significant presence in the House of Representatives. Key Recommendations: Aboriginal Peak Organisations Northern Territory (APO NT) supports the Bill and recommends that a minimum of two seats be provided for the Northern Territory (NT) in the House of Representatives. The Australian Electoral Commission’s determination to decrease the NT’s seat to one would not ensure sufficient and equitable representation to Territorians, especially Aboriginal and Torres Strait Islander people. The NT is Australia’s third largest jurisdiction, it would be extremely difficult and challenging for one MP to divide their time between Darwin, Alice Springs, Katherine, Tennant Creek, Nhulunbuy, Jabiru, outstations, 43 town camps, 96 major and minor communities and over 600 homelands, as well as Christmas Island and the Cocos Islands. All of these places deserve good representation in parliament. The suggested reason for the NT’s decrease in seats has been due to the decline in population. Given the remoteness, low literacy levels, high rates of homelessness and those not in the labour force, APO NT has concerns that the Census is not counting all Territorians, which could be an explanation for the low Territory population. The Territory currently has a population of 244,80013 people dispersed over the vast region, but according to the Northern Territory Department of Treasury and Finance, this will increase to 251,727 by 2021. There is great concern relating to the under-enrolment of eligible voters. While a five percent undercount has been incorporated into the population estimate the accuracy remains questionable. To protect the democratic right to vote in elections, governments must prioritise funding to enable well-resourced and thorough campaigns to educate, enthuse and enrol Aboriginal people in remote communities. There are many eligible young people living in remote areas that are not aware of their legal obligation to enrol to vote or understand how the electoral system works. Due to the diversity, language, cultural and geographical barriers in the NT, the Australian Government and the Australian Electoral Commission needs to reform and improve the electoral system in the NT to ensure every Australian citizen and Territorian has the right to vote and is equipped to fully participate in the democratic process.

In the journal article Did DI do it? The impact of a programme designed to improve literacy for Aboriginal and Torres Strait Islander students in remote schools, Guenther and Osborne () compare schoolwide NAPLAN reading scale scores for 25 Very Remote Indigenous schools implementing Direct Instruction through the Flexible Literacy for Remote Primary Schools Program (‘Flexible Literacy’ or ‘the program’) with those for 118 Very Remote Indigenous schools not involved with the program, to assert the program has not improved literacy outcomes. Good to Great Schools Australia (GGSA) undertook an analysis of the same school data for Reading, Writing, Spelling and Grammar and Punctuation scores. Our findings contradict theirs. In all areas, schools participating in the program show significant growth compared with all Australian and all Very Remote Indigenous schools. In Reading, schools involved in the program from 2015 to 2017 averaged 124% growth, while the average growth for comparable ages was 19 and 34% for Australian and Very Remote Indigenous schools, respectively. In Grammar and Punctuation schools involved in the program in the same period grew 180%, whilst growth for Australian schools was 15%, and for Very Remote Indigenous schools, 28%. These contrasting results illustrate the importance of evaluating growth to assess the impact of educational programs, rather than achievement alone, particularly in the case of Very Remote Indigenous schools where achievement levels are far below Australian grade levels. Guenther and Osborne's comparison of achievement across schools rather than measuring growth within schools obscures real gains and is misleading.

Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0–19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23–18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76–9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.

Remote communities often face a range of problems related to distance, service provision, high costs, and economic uncertainty. Many of these problems are structural and a direct result of their location on a periphery. In recent decades many remote settlements have looked to the tourism sector to supplement existing local economies. Numerous tools variously described in the literature as theories, models, and frameworks have been suggested as approaches for assisting local economies develop tourism. In searching for solutions, it is not unusual for researchers to advocate a standalone theory, model, or framework as a preferred approach. However, this method ignores the complexity of the real world and that solutions usually require a multidimensional approach based on combining various theoretical tools. This paper proposes an open architecture approach that utilizes a number of theories and models that can be selectively and collectively used to assist remote settlements develop a tourism sector. This approach was tested in Cooktown, Australia. One outcome was the identification of a range of deficiencies in the strategies currently used by the destination.

The Australian government has tasked the Commission with assessing the zone tax offset (ZTO), the remote area allowance (RAA) and the fringe benefits tax (FBT) remote area concessions. As a first step, the Commission held extensive consultations with communities and businesses in remote Australia. This draft report outlines some of the initial findings.

In this paper we review the professional learning and development (PLD) needs of teachers in rural and remote schools, focusing on the Australian context. We argue that online PLD is an emerging alternative to face-to-face arrangements for the continuing education of teachers, which can connect to rural contexts through attending to considerations of relevance, collaboration, and future focus. We describe challenges to the uptake of online PLD initiatives and exemplify online PLD approaches with potential in rural schools. There is support for the utility of online PLD comprising blended approaches, online coaching and mentoring, co-design by teachers, rich discussions and interactions, and longer-term online relationship building to support the needs of rural teachers.

Background: Diabetic retinopathy (DR) prevalence is higher in Indigenous Australians than in other Australians and is a major cause of vision loss. Consequently, timely screening and treatment is paramount, and annual eye screening is recommended for Indigenous Australians. Aims To assess the prevalence of DR, reduced vision, and DR treatment coverage among Indigenous Australian adults with diabetes attending Top End Indigenous primary care health services. Methods A cross-sectional DR screening study conducted from November 2013?December 2015 in two very remote Northern Territory Aboriginal primary healthcare services. Results In 287 subjects, the prevalence of non-proliferative DR, proliferative DR, and clinically significant diabetic macular oedema (CSMO) was 37.3%, 5.4% and 9.0%, respectively. Treatment coverage for PDR was 60% (of ten patients) and for CSMO was 17% (of 23 patients). Vision data were available from 122 participants at one site. The proportion with normal vision, reduced vision, impaired vision and blindness was 31.1%, 52.5%, 15.6% and 0.8%, respectively. Overall, ungradable monocular image sets (46%) were associated with poorer quality images and missing protocol images (both p < 0.001). Ungradable images for DR were associated with presence of small pupils/media opacities (p < 0.001). Ungradable images for diabetic macular oedema were associated with poorer image quality (p < 0.001), cataracts (p < 0.001), and small pupils (p = 0.04). Conclusions A high prevalence of DR, CSMO and impaired vision was noted in Indigenous Australians with diabetes. Screening in primary care is feasible, but more effective screening methods are needed. This article is protected by copyright. All rights reserved.

INTRODUCTION: Tobacco smoking has a range of known and predictable adverse outcomes, and across the world sustained smoking reduction campaigns are targeted towards reducing individual and public risk and harm. Conversely, more than 87 million women, mostly in low- and middle-income countries, use smokeless tobacco, yet the research examining the effect of this form of tobacco exposure on women is remarkably scant. In central Australia, the chewing of wild Nicotiana spp., a tobacco plant, commonly known as pituri and mingkulpa, is practised by Aboriginal groups across a broad geographical area. Until recently, there had been no health research conducted on the effects of chewing pituri. METHODS: This article reports on one component of a multidimensional pituri research agenda. A narrative approach utilising the methodology of the Learning Circle was used to interview three key senior central Australian Aboriginal women representative of three large geographical language groupings. The participants were selected by a regional Aboriginal women's organisation. With the assistance of interpreters, a semistructured interview, and specific trigger resources, participants provided responses to enable an understanding of the women's ethnobotanical pituri knowledge and practices around the use of pituri within the context of Aboriginal women's lives. Data were transcribed, and by using a constant comparison analysis, emergent themes were categorised. The draft findings and manuscript were translated into the participants' language and validated by the participants. RESULTS: Three themes around pituri emerged: (a) the plants, preparation and use; (b) individual health and wellbeing; and (c) family and community connectedness. The findings demonstrated similar participant ethnobotanical knowledge and practices across the geographical area. The participants clearly articulated the ethnopharmacological knowledge associated with mixing pituri with wood ash to facilitate the extraction of nicotine from Nicotiana spp., the results of which were biochemically verified. The participants catalogued the pleasurable and desired effects obtained from pituri use, the miscellaneous uses of pituri, as well as the adverse effects of pituri overdose and toxicity, the catalogue of which matched those of nicotine. The participants' overarching pituri theme was related to the inherent role pituri has in the connectiveness of people to family, friends and community. CONCLUSIONS: Central Australian Aboriginal women have a firmly established knowledge and understanding of the pharmacological principles related to the content of Nicotiana spp. and the extraction of nicotine from the plant. Widespread use of Nicotiana spp. as a chewing tobacco by Aboriginal populations in the southern, central and western desert regions of Australia is attested to by participants who assert that everyone uses it, with girls in these remote areas commencing use between 5 and 7 years of age. Central Australian Aboriginal people who chew Nicotiana spp. do not consider it to be a tobacco plant, and will strongly refute that they are tobacco users. Central Australian Aboriginal people do not consider that the Western health information regarding tobacco (as a smoked product) is applicable or aligned to their use of pituri. Nicotiana spp. users will deny tobacco use at health assessment. There is a requirement to develop and provide health information on a broader range of tobacco and nicotine products in ways that are considered credible by the Aboriginal population. Health messages around pituri use need to account for the dominant role that pituri occupies in the context of central Australian Aboriginal women's lives.<br /> Information for readers: A consultative organisation of Aboriginal women has as a strategic intent and operational agenda the improvement of Aboriginal women's and children's health across the research region. The group seeks opportunities to enhance their knowledge based on legitimate collaborative research; accordingly, they sought to participate in a range of research activities regarding the use of pituri and women's health outcomes. Of particular note, the group's participants chose to be identified by name in the publication of this research activity. In this article, the term 'Aboriginal' has been chosen by the central Australian women to refer to both themselves and the Aboriginal people in their communities; 'Indigenous' has been chosen to refer to the wider Australian Aboriginal and Torres Strait Islander people. The term Nicotiana spp. is used when referring to the plants from a Western perspective; pituri is used when referring to the plants, the tobacco quid, and the practice of chewing from a general Aboriginal perspective; and mingkulpa is used when the participants are voicing their specific knowledge and practices.

These guidelines and tools are to assist those working in regional communities achieve a more rewarding level of involvement in cultural activities. They show how to strengthen decisions, build productive partnerships and develop positive outcomes for both local hosts and visitors to rural, regional and remote Australia. Good practice enables strong participation in arts activities, saves time and money and achieves positive results regardless of the nature of the collaboration, the scale of the project, or the artform. Whether you are a visitor engaging in collaborative cultural projects or practices, or a host to partners in a collaboration, this document is designed to help you. It describes how to initiate, negotiate and conduct successful collaborative partnerships. It is designed for artists, arts organisations, community groups, venues, local government bodies, touring arts organisations, and other individuals or organisations whose work includes collaborating with others on arts or cultural projects in rural, regional and remote Australia. Case studies from around the country have been prepared to showcase good practice in cultural collaboration in regional Australia. They are referenced throughout the document. Existing guidelines and protocols are already available for related areas, including protocols for working with First Nations artists and volunteers. References and links to relevant resources can be found at the end of this document. This document is not intended to replicate or reinvent this information, nor does it aim to act as an exhaustive list. Rather, these guidelines and tools are provided to draw together the most important principles of good regional engagement and identify examples of them working successfully in practice.

Introduction There is a lack of neurodevelopmental assessment services in rural and remote locations in Australia that consider fetal alcohol spectrum disorder as a possible outcome. Methods Eighty-seven participants attended a workshop to support community-based professional development and co-design of a novel assessment approach. Qualitative data collection included video recording of the workshop, and small group discussions, for which a narrative analysis was utilised. Quantitative data collection included self-report questionnaires to understand current community practices and three key constructs: practitioner knowledge, attitudes, and intentions for future practice. Results The narrative analysis highlighted the ongoing impacts of colonisation, in terms of intergenerational trauma and alcohol use, experienced in the community today, and the potential high rates of fetal alcohol spectrum disorder. To address these issues, multiple strategies were discussed, including the recognition of First Nations knowledge and expertise and a focus on the next generation and community organisations working collaboratively. The pre-and post-questionnaires demonstrated that practitioners’ knowledge and attitudes were enhanced after attending the workshop, however practitioner intentions were not. The lack of significance for the intentions variable may have been due to the small number of available responses for that variable, in comparison to the other two constructs. Discussion The current study identified key learnings from workshop facilitators and participants. The findings call attention to the importance of a co-design approach, where collaboration is vital to support the appropriate adaption of evidence-based practice to suit the local context.

Remote and rural areas in Australia suffer from suicide rates significantly higher than those in metropolitan areas and the trend in suicide rates is increasing. In 2015, suicide was identified as one of the three leading causes of death outside metropolitan areas. This disturbing trend disproportionately affects men; death rates from suicide are 25to 40 per cent higher in rural-based men than those living in urban centres. Correspondingly, young men in regional areas between the ages of 15-24,were between 1.5and1.8 times more likely to commit suicide than men of the same demographic living in urban areas. Similar inter-regional comparison statistics have been reported for rural men aged between 25-44. Furthermore, two out of every three suicides in farmers over the age of 55,were male. Indigenous suicide rates outside urban areas are high; this suggests Indigenous and Torres Strait Islander rural and remote communities are disproportionately affected by suicide. In some remote areas, Indigenous suicide rates are up to seven times the national average. Reports indicate that, in 2017,suicide was the leading cause of death nationwide among Indigenous children between the ages of five and17.

There are numerous examples illustrating the integration of Aboriginal knowledge and participation in rangelands management. At the 2019 Australian Rangelands Conference we aimed to explore how Aboriginal culture and its core values have something deeper to contribute to rangelands management. We explore this through a Yungadhu (Malleefowl) cultural depiction and story. The depiction and story explain the often cited, but not well understood, concepts of Kinship, Country, Lore, and Dreaming. The story provides insight into Aboriginal people’s world view and is used in this paper to illustrate how well it aligns with current thinking about resilience in rangelands landscapes and communities. Significantly, we explain how the deep wisdom that resides in Aboriginal cultures has something meaningful to contribute to achieving the conditions for resilience.

Objective To examine the prevalence of dementia and problems associated with ageing in the Torres Strait. Methods The study was conducted across all 18 island and 5 mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland. Participants underwent a comprehensive health assessment and a Geriatrician assessment, which were used to establish consensus diagnoses. Results A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. The prevalence of dementia in the sample was 14.2%, which was 2.87 times higher than the wider Australian population. Conclusion Torres Strait Islander peoples share the increased risk of dementia seen in Aboriginal Australians compared to the wider community. This highlights the need for interventions to address this increased dementia risk for Aboriginal and Torres Strait Islander communities.

Electoral success of independents and minor parties is often interpreted as indicating a weakening of two-party systems of political competition. This paper, on all thirteen elections for the Northern Territory Legislative Assembly since 1974, observes that independents have enjoyed far more success than minor parties. It argues that independent success has reflected a continuing strong two-party system, not a weakening one. Six of ten successful independents in NTLA elections have been 'splitters' from the Country Liberal Party in times of intra-party turmoil. Their subsequent electoral success as independents in divisions previously very safe for the CLP leads to development of a 'lopsided seats' hypothesis; that independents succeed in electoral divisions where the two-party contest has become lopsided, with one major party attracting twice the votes of the other or more. Two successful 'non-splitter' independents in the 2016 election also contested such divisions - one lopsided to the CLP and one to Labor. This latter successful independent ran with the support of a Yolgnu First Nation organisation, which re-opens questions in the literature about Aboriginal candidates and Aboriginal voters, including turnout levels. A jurisdiction-wide graphic technique of 'proportionality profiling' is applied to all thirteen NTLA elections and contextualises the later division-level analysis.

Building on unique Indigenous advantages for people living in remote areas, this study offers insights for innovative land-based economic opportunities across northern Australia. These advantages—outside the mainstream economics—include peoples’ abilities to manage land and knowledge of ecosystems, culture, traditions/ceremonies which directly contribute towards peoples’ health, social relations, provisioning of a safe and secure environment, and learning constituents of well-being. To demonstrate, two representative remote communities, Maningrida and Borroloola in the Northern Territory, are used for revealing uncaptured, but valid, opportunities which, if realized, could help enhance Indigenous well-being—a much-needed agenda for the Australian Government. Moreover, innovative land-based opportunities will potentially save ~$49million/yr of government’s welfare costs. This study offers a detailed analysis of the existing socio-economic situation of the selected communities, outlines potential land-based economic opportunities, and advocates for a shift in policy planning from viewing remote communities as a problem to realising advantages of their unique prospects to develop the north. Applying an integrated approach to Indigenous development for supporting new economies can lead to diversification of north’s land sector which to date has been predominantly used for beef production causing threats to fragile ecosystems and hence their services to people living in the area.

Background: High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women’s experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care. Methods: Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015–2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed. Findings: Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles. Conclusions: The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.

This paper provides a first step at measuring and communicating progress in Queensland's discrete Indigenous communities. The framework in this paper is intended to illustrate an approach to measuring progress that can be further subdivided to provide a more detailed analysis of the key drivers of change. This staff research paper sets out an approach to measuring progress in Queensland's discrete Aboriginal and Torres Strait Islander communities (referred to in this paper as the discrete communities). The paper is intended to promote discussion on how to measure and monitor outcomes in the discrete communities. Key points: Assessing progress in Queensland's discrete Aboriginal and Torres Strait Island communities is important; however, there is a lack of publicly available information or an agreed framework for measuring and monitoring progress. The paper does not attempt to define Indigenous wellbeing or determine priorities for communities. Rather, it aims to demonstrate how progress could be measured using the Australian Bureau of Statistic's framework for measuring Indigenous wellbeing (which breaks wellbeing into nine domains). This framework adopts a broad view of wellbeing by combining a suite of statistical indicators, including traditional economic indicators such as income and employment, into a single composite measure of wellbeing. Estimates of progress are provided in this paper, however, they should be considered experimental. Our estimates of progress were constructed using publicly available information; they therefore omit some important indicators for which data were not publicly available—such as community level information relating to the health and family and kinship domains. Further, a simple weighting scheme has been applied to produce the composite measure and, as a result, weightings used in the construction of the estimates may not reflect community and stakeholder priorities.

Introduction: High prevalence of otitis media (OM) and hearing impairment (HI) in Aboriginal children in Australia’s Northern Territory (NT) is well documented. HI may be associated with poorer outcomes in early childhood development, school attendance and academic achievement. However, these associations have not been investigated in this population. Objectives and Approach: Retrospective cohort studies were conducted to investigate the association between HI and three education-related outcomes in Aboriginal children living in remote NT communities. The explanatory variable for all studies was audiometrically determined hearing levels. The outcome measures were Australian Early Development Census (AEDC) results, representing developmental outcomes at around age 5 years; Year 1 school attendance rates; and, National Assessment Program – Literacy and Numeracy (NAPLAN) results for Year 3 for academic achievement. Relevant confounding variables from available linked datasets were controlled for in the statistical analyses. Results: Compared with normal hearing children, after adjustment for selected confounding factors, children with HI had higher risk for being developmentally vulnerable in two or more of the five AEDC domains (adjusted odds ratio 1.69); lower AEDC domain score sum (-1.60~-2.40); scoring lower in Numeracy (by 15.2 points), Writing (by 13.4-15.6 points) and Spelling (by 5.0 points) domains of NAPLAN; and having lower attendance rates (attending 4.0-5.6 fewer days in Year 1). Severer HI categories generally yielded greater effect sizes. Notably, across the studies, some confounding variables included in the analysis yielded substantially greater effect sizes. Conclusion / Implications: OM-related HI has a negative impact on early childhood development, Year 1 school attendance and academic achievement in Year 3 in Aboriginal children living in remote NT communities. To improve the developmental and educational outcomes it is important to detect HI at an early age and provide effective educational support, in addition to clinical and audiometric management.

Objective: Clozapine is the most effective antipsychotic available for treatment-resistant schizophrenia. Unfortunately, it is often underutilised or administered late in the treatment course, if at all. This issue is further augmented in rural and remote regions where access to treatment is sparse. This study is the first of its kind to investigate the use of clozapine in a remote and regional area of Australia with a high proportion of Aboriginal and/or Torres Strait Islander individuals.Methods: This study includes all individuals who were commenced on clozapine between June 2013 and June 2018. Relevant clinical information was sourced from electronic medical records and descriptive statistical analysis performed.Results: A total of 3850 patients with psychotic disorders were reviewed over 5 years, of whom 63 were commenced on clozapine. The majority were male (n = 50, 79.4%) with a mean age of 33.9 years (standard deviation 11.0). A total of 34.9% (n = 22) identified as Aboriginal and/or Torres Strait Islander. The mean length of time between diagnosis and commencement of clozapine was 7.2 years (standard deviation ±4.6 years), while the mean number of antipsychotic medications tried prior to clozapine was 4.2 (standard deviation ±1.6 antipsychotics). Clozapine was discontinued in 57.1% of the individuals in this study (41% within the first 12 months). The most common cause for cessation was poor compliance (n = 19, 30.2%).Conclusion: While clozapine remains the most effective antipsychotic treatment, it is often commenced late in the treatment or ceased prematurely. Further work is required, particularly in remote and regional populations, to ensure treatment adherence for optimal patient outcomes.

Background: Culturally competent maternity care provision to Aboriginal and Torres Strait Islander women was identified as a priority area by Australia’s National Maternity Services Plan in 2011. While midwifery programs responded by including core Indigenous content and community placements in curricula, little is known about whether knowledge learned, and insights gained in response to these initiatives have endured and been applied in clinical practice. This follow-up study explores the impact of a compulsory Indigenous unit and a remote clinical placement on two cohorts of non-Indigenous midwives who were participants in an earlier 2012–14 study. Methods: Fourteen non-Indigenous participants who were either students or recent graduates in 2012–14 were located and re-interviewed in 2019–20. In-depth interviews based on a semi-structured interview guide were conducted by telephone or face-to face; recordings were transcribed and thematically analysed using standard qualitative procedures. Results: Exposure to Indigenous content and settings during training had an enduring impact on participants’ midwifery practice; most felt better prepared to provide culturally safe care, build respectful relationships and advocate for improved services for Aboriginal women. Despite this positive legacy, they also expressed apprehension about causing offence and recognised their own knowledge deficits with regard to Aboriginal cultural practices. Organisational constraints, including restrictions on the number of family members accompanying a birthing mother were identified as barriers to optimal care; some positive organisational initiatives were also described. Conclusions: This follow-up study provides encouraging evidence that well-designed and delivered Indigenous content and community placement opportunities in midwifery programs can have a lasting impact on service provision to Aboriginal women, contribute to a more informed, empathetic and culturally competent maternity workforce and help catalyse health service changes towards more culturally safe care.

Background Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant. Aims To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non-Indigenous patients, and identify major sources of delay. Methods We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between-group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1?year between commencement of dialysis and waitlisting were further analysed for major sources of delay. Results Twenty-five patients were included (20 Indigenous Australians and 5 non-Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264?days, P =?0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non-Indigenous) were waitlisted within 1?year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay. Conclusion Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation.

Background Severe community-acquired pneumonia (SCAP) has high mortality and morbidity. Aims To describe the epidemiology and microbiology of SCAP in Central Australia. Methods A retrospective epidemiological study describing the characteristics, incidence rates (IR) and microbiological aetiology of SCAP in Central Australia. Adult patients admitted to Alice Springs Hospital Intensive Care Unit (ICU) between 2011-2014 that fitted the IDSA/ATS definition of SCAP were included. Medical records were reviewed and compared between Indigenous and non-Indigenous patients. Primary outcomes were incidence rate and microbiological aetiology of SCAP. Secondary outcomes were 30-day mortality, and ICU and hospital length of stay (LoS). Results A total of 185 patents were included (156 Indigenous, 29 non-Indigenous). The overall SCAP IR per 1000 person-years was 3.24 (3.75 Indigenous and 1.87 non-Indigenous) with an IR difference of 2.71 after adjustment (p<0.001). Those aged ≥50 had an IR 74.8% higher than those younger. Male IR was 50% higher than females. There was a significant difference between Indigenous and non-Indigenous groups for age (48 vs. 64?years), but not for 30-day mortality (7.7% vs. 10.3%), ICU LoS (4.8 vs. 4.6?days) and hospital LoS (10.9 vs. 15.1?days), respectively. Likely causative pathogen(s) were identified in 117 patients; Streptococcus pneumoniae was the most common pathogen (28.2%), followed by Haemophilus influenzae (19.7%), Influenza A/B (16.2%) and Staphylococcus aureus (14.5%). Conclusion A high incidence of SCAP was observed in Central Australia, disproportionately affecting the Indigenous population. Prevention strategies are imperative, as well as early identification of SCAP and appropriate empiric antibiotic regimens. This article is protected by copyright. All rights reserved.

Aboriginal and Torres Strait Islander students can have their sense of belonging challenged by pursuing the education opportunity of attending a boarding school. This is exemplified in the current literature through reported experiences of loneliness, isolation, homesickness, and the feeling of being ‘between two worlds’. However, there is an absence of research that relates these issues with the established ability for architecture to influence occupant wellbeing. Few studies have focussed on the potential role of interior design in contemporary Aboriginal and Torres Strait Islander experiences of education. The aim of this doctoral thesis was to address this gap through a process of Participatory Action Research (PAR), in which data were collected by yarning and drawing with 27 current boarders (all Aboriginal people, 2 young men, 25 young women), 18 recent alumni (all Aboriginal people, 3 men, 15 women), and 7 boarding staff members (1 Aboriginal person, all women). Four major themes emerged that suggest a role for interior design in increasing student sense of belonging. These relate to the institutional characterisation of current boarding schools (Place Identity), an ‘all or nothing’ experience of social connectedness (Interior Architecture as a Social Atlas), the value of student participation in ongoing interior design actions (Spatial Voice), and the need for spaces that offer social and cultural relief (Third Space). From these themes, a new theoretical model for designing belonging is proposed - ‘the feedback model’. In this model, the built environment is conceptualised as a reciprocal storytelling tool for messages about identity and belonging. Although only a snapshot of voices is reported, it is proposed that the findings could have broader application to residential education settings.