Remote Australia Online

Health literacy is generally conceptualized as skills related to successfully navigating health ? ultimately linked to well-being and improved health outcomes. Culture, gender and age are considered to be influential determinants of health literacy. The nexus between these determinants, and their collective relationship with health literacy, remains understudied, especially with respect to Indigenous people globally. This article presents findings from a recent study that examined the intersections between masculinities, culture, age and health literacy among young Aboriginal and Torres Strait Islander males, aged 14?25 years in the Northern Territory, Australia. A mixed-methods approach was utilized to engage young Aboriginal and Torres Strait Islander males. The qualitative components included Yarning Sessions and Photovoice using Facebook, which are used in this article. Thematic Analysis and Framework Analysis were used to group and analyse the data. Ethics approval was granted by Charles Darwin University Human Research Ethics Committee (H18043). This cohort constructs a complex interface comprising Western and Aboriginal cultural paradigms, through which they navigate health. Alternative Indigenous masculinities, which embrace and resist hegemonic masculine norms simultaneously shaped this interface. External support structures ? including family, friends and community engagement programs ? were critical in fostering health literacy abilities among this cohort. Young Aboriginal and Torres Strait Islander males possess health literacy abilities that enable them to support the well-being of themselves and others. Health policymakers, researchers and practitioners can help strengthen and expand existing support structures for this population by listening more attentively to their unique perspectives.

This article reviews the way in which regional development is framed in a hyperlocal regional newspaper. It presents findings from detailed analysis of selected news articles published in a locally-based newspaper about the progress of a proposal by the Adani group to establish a mine in the Galilee Basin, Central Queensland, Australia (?the Adani project?). The area has a traditional association with mining, and had experienced an economic downturn due to a reduction in mining activity in the region. We expected that the newspaper would frame the Adani project positively, reflecting local support for the project to promote economic recovery. This was not the case. Environmental concerns about the project were dominant in coverage and themes of political responsibility and attribution of blame emerged. The findings add to limited existing knowledge about regional media in Australia operate, and challenge general assumptions that equate being local with being ?parochial?.

Neisseria meningitidis serogroup W has emerged as an increasingly common cause of invasive meningococcal disease worldwide; the average case-fatality rate is 10%. In 2017, an unprecedented outbreak of serogroup W infection occurred among the Indigenous pediatric population of Central Australia; there were 24 cases over a 5-month period. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis. The outbreak juxtaposed a well-resourced healthcare system against unique challenges related to covering vast distances, a socially disadvantaged population, and a disease process that was rapid and unpredictable. A coordinated clinical and public health response included investigation of and empiric treatment for 649 febrile children, provision of prophylactic antimicrobial drugs for 465 close contacts, and implementation of a quadrivalent meningococcal ACWY conjugate vaccine immunization program. The response contained the outbreak within 6 months; no deaths and only 1 case of major illness were recorded.

A qualitative study in the Northern Territory of Australia, among the Yolŋu people, traditional owners of large estates in the remote, isolated region of East Arnhem Land, sought to determine whether tobacco-control efforts utilizing denormalization had resulted in experiences of smoking-related stigma, as an unintended consequence. The role of Yolŋu smoke-free leaders was also investigated and the Tackling Indigenous Smoking program, ‘Yaka Ŋarali”, was evaluated to determine engagement and acceptance by Yolŋu smokers and their families.

Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children’s executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children’s behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children’s executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children’s exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.

Access to drug and alcohol treatment services is a particularly salient issue for Australia. The nation is paying considerable attention to risky drug and alcohol use. Indigenous Australians are particularly concerned about drug and alcohol related harms in their communities. Access to treatment is the most effective way of reducing drug related harm for disadvantaged populations. Primary health care is the optimal site for delivering drug and alcohol treatment. Semi-structured in-depth interviews with 47 primary health care, drug and alcohol and other health and welfare workers in rural and remote locations were conducted. Thematic analysis of interview data identified divergent perspectives according to a participant’s work role about drug and alcohol treatment, client needs and problems and service delivery approaches. Primary health care workers were conceptualised as locals. They tended to perceive that drug and alcohol interventions should quickly prevent individuals from on-going problematic use. Drug and alcohol workers were conceptualised as insiders. Most did not have knowledge or experience of the primary health care setting. Therefore they could not assist primary health care workers to integrate drug and alcohol interventions into their interactions with clients. Professional and organisational barriers constrain the primary health care worker role and limit the application of specialist interventions. Drug and alcohol work is only one of many competing demands in the primary health setting. The lack of understanding of the primary health care worker role and responsibilities is the most significant barrier to implementing specialist interventions in this role. Primary health care workers’ perceptions of substance misuse are more consistent with the individual moral or personal deficit philosophy of drug and alcohol treatment than harm minimisation approaches. This is a challenge for a specialist agency that is promoting harm minimisation and an adaptive approach to treatment within the primary care setting. Building the capacity of primary health care workers to do more varied tasks requires a good understanding of the pragmatic and practical realities of their day to day practice and the philosophies that underpin these.

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government?s 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world.Methods:A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period.Results:Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87?6.42%) and 5.45% (4.68?6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23?3.46%; suicide deaths: 4.38%, 95% interval 3.78?5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning.Conclusion:Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.

Australia is the only developed country to suffer trachoma and it is only found in remote Indigenous communities. In 2009, trachoma prevalence was 14%, but through screening, treatment and health promotion, rates had fallen to 4% in 2012. More work needs to be done to sustain these declining rates. In 2012, 25% of screened communities still had endemic trachoma and 8% had hyperendemic trachoma. In addition, only 58% of communities had reached clean face targets in children aged 5–9 years. Australian Football League (AFL) players are highly influential role models and the community love of football provides a platform to engage and strengthen community participation in health promotion. The University of Melbourne has partnered with Melbourne Football Club since 2010 to run trachoma football hygiene clinics in the Northern Territory (NT) to raise awareness of the importance of clean faces in order to reduce the spread of trachoma. This activity supports Federal and state government trachoma screening and treatment programs. Between 2010 and 2013, 12 football clinics were held in major towns and remote communities in the NT. Almost 2000 children and adults attended football clinics run by 16 partner organisations. Awareness of the football clinics has grown and has become a media feature in the NT trachoma elimination campaign. The hygiene station featured within the football clinic could be adapted for other events hosted in remote NT community events to add value to the experience and reinforce good holistic health and hygiene messages, as well as encourage interagency collaboration.

In Western Australia, Aboriginal people comprise approximately 24% of offences and 18% of all offenders appearing in the Western Australian Magistrates Courts. The high rate of Indigenous contact with the justice system is generally a reflection of the high rate of Indigenous involvement in crime. Research on the relationship between substance use and crime is overwhelmingly supportive of the hypothesis that alcohol and other drugs (AOD) use increases the risk of involvement in crime. Illicit drug use increases the rate of involvement in crime, at least in part because of the high costs associated with funding illicit drug use. The current evaluation focuses on the following adult court drug diversion programs that are part of the WADP: the Pre-Sentence Opportunity Program (POP), Indigenous Diversion Program (IDP) and the metropolitan and regional Supervised Intervention Treatment Regime (STIR).

Australians generally have good health and an effective health system. How do we know this? We use a range of measures, such as life expectancy, mortality and morbidity, to monitor Australia’s health over time and to compare it with that of other countries. For instance, we use the Australian Health Performance Framework to assess the health of our population and the performance of our health system. Since 1988, Australia’s health has reported biennially on national indicators across the domains of health status, determinants of health, and the health system. Trend assessment for indicators across these three domains show mixed results:• We have seen some favourable trends in the health status domain, including a decline in the incidence rate of heart attacks, bowel cancer and the prevalence of severe or profound core activity limitation. However, there have been unfavourable trends too: hospitalisations for injury and poisoning have been increasing.• The proportion of adults who are daily smokers, who are at risk from long-term harm from alcohol and who have an educational attainment of a non-school qualification or above have all been trending favourably over the last 10 years. However, not all news in the determinants of health domain is positive: the proportion of people who are obese and overweight has been increasing over the past 20 years.• Assessment of the health system domain shows favourable progress for a number of indicators, including immunisation rates for 1- and 5-year-olds and potentially avoidable deaths. There has been no change over the last 10 years in some measures, such as wait times for emergency departments, however, the wait time for elective surgery has increased (an unfavourable trend).

The article analyses Joint Defence Facility Pine Gap in Australia that is used by the United States to controls satellites pinpoint airstrikes around the world. The Joint Facility rises political controversy in Australia (especially after Edward Snowden’s revelations) as many doubt if it is in Australia’s best interests to contribute data for drone assassinations and targeting US nuclear weapons. Considering Australia’s policy towards Joint Defence Facility Pine Gap the author raises the question whether national security can be “outsourced” to save budget funds. The article concludes that in Australia it is noticeable that human intelligence potential in financial terms is less valued than some construction, manual jobs. Considering that Russia and China, which are in the focus of Pine Gap intelligence gathering do not outsource its national security and were more successful in preventing major information leaks, moreover in preventing major terrorist attacks on their soil, is indicating that national security should not be privatized.

Objective: To investigate the effectiveness of the Northern Territory Women's Cancer Prevention Program in improving cervical screening participation for Indigenous women. Design: Descriptive longitudinal period prevalence study. Participants: All NT resident women aged 20?69?years who had at least one Pap smear recorded on the NT Pap Smear Register between 1997?and 2004. Main outcome measures: Indirectly estimated percentage of NT Indigenous women in rural and remote areas with a predominantly Indigenous population (accounting for 55% of the NT Indigenous population) who participated in screening, in biennial periods between 1997?and 2004. Participation by all eligible NT women (both Indigenous and non-Indigenous) is also reported by region for the same period. Results: In 1997?1998, estimated participation for Indigenous women was about half the national rate (33.9% [95% CI, 32.6%?35.2%] v 63.9% [95% CI, 63.8%?63.9%]). Participation increased to 44.0% (95% CI, 42.7%?45.4%) in 1999?2000, and changed little thereafter; participation was higher in the Top End compared with Central Australia, and varied from 16.6% to 75.0% between remote areas. Participation rates for all women living in rural/remote regions were lower than those in urban regions. Conclusions: Recruitment of Indigenous women for cervical screening has improved since 1999. This may have partly contributed to the fall in their cervical cancer incidence and mortality in recent years. Although in most areas Indigenous participation is lower than national levels, in one area it was considerably higher. Improvements can be achieved by learning from these communities, to further close the gap in morbidity and mortality between Indigenous and non-Indigenous women.

Poor dog health and overpopulation is a concern in many remote aboriginal communities (RACs) in central and northern Australia, with implications for both animal welfare and public health.

Dog health in rural and remote Australian Indigenous communities is below urban averages in numerous respects. Many Indigenous communities have called for knowledge sharing in this area. However, dog health education programs are in their infancy, and lack data on effective practices. Without this core knowledge, health promotion efforts cannot progress effectively. This paper discusses a strategy that draws from successful approaches in human health and indigenous education, such as dadirri, and culturally respectful community engagement and development. Negotiating an appropriate education program is explored in its practical application through four case studies. Though each case was unique, the comparison of the four illustrated the importance of listening (community consultation), developing and maintaining relationships, community involvement and employment. The most successful case studies were those that could fully implement all four areas. Outcomes included improved local dog health capacity, local employment and engagement with the program and significantly improved dog health.

Background: Australian public policy prioritises the development of evidence-based and culturally appropriate oral health promotion to improve the oral health of Aboriginal people, including children. Aim: This thesis aims to identify themes of effective and culturally appropriate oral health promotion targeting Indigenous children in high-income nations; develop, implement and evaluate oral health promotion for Aboriginal children in rural and remote communities in NSW and determine if these strategies are effective and sustainable. Methods: A collaboration took place with three Aboriginal communities in Central Northern NSW, Australia, in 2014 to collect baseline oral health status of Aboriginal children and inform potential oral health promotion strategies. In 2015, a suite of oral health promotion strategies were co-designed with Aboriginal communities in Central Northern NSW including in-school toothbrushing, installation of refrigerated and filtered water fountains, water bottle program, distribution of fluoride toothpaste and toothbrushes; dental health education and a structured fluoride varnish program. These strategies were implemented in three schools in the region in 2016. The fluoride varnish program was also implemented in seven schools in NSW in 2017 piloting Aboriginal dental assistants to apply fluoride varnish. Oral health promotion was evaluated to determine feasibility, sustainability and impact. Results: Community-led oral health promotion strategies significantly reduced dental caries among children, increased positive oral hygiene behaviours and were considered sustainable. School fluoride varnish programs are feasible and Aboriginal dental assistants can safely provide children with at least three fluoride varnish applications per year using this approach. Discussion and Conclusion: Co-designed and community-led oral health promotion is effective and sustainable and may be a solution to improving the oral health of Aboriginal children.

When an endangered or minority language is spoken by children and taught in schools, both oral and literacy skills are crucial for continued language maintenance. In school settings, literacy skills are often prioritised to support the transition to second language literacy, and rich oral language development is overlooked. This paper presents a transdisciplinary collaboration between a language researcher, curriculum support staff and educators in Warlpiri schools, designed to address this. In the project, language documentation research was re-purposed to support professional learning for oral first language development. Educators increased their metalinguistic knowledge and understandings of children's oral language development. They planned programs to meet the learning needs identified from children?s data and mapped these to curriculum documents. They enhanced their capacity to develop the Warlpiri language skills of their students and promote children?s bilingual, and potentially biliterate, language development. The process and practice described are transferable to other minority, Indigenous and endangered language teaching and learning contexts.

Importance Indigenous communities of Far North Queensland (FNQ) have one of the highest incidences of alcohol-related ocular trauma globally. Background To review the epidemiology of closed- and open-globe trauma admitted to Cairns Hospital from FNQ health districts following the implementation of alcohol restrictions in Indigenous communities. Design Retrospective study of cases from January 2014 to December 2018. Participants A total of 142 cases identified from ICD-10 clinical-coding data. Methods Records were reviewed to determine demographics, clinical details and outcomes. Main Outcome Measures Annual incidence by demography and ethnicity (Indigenous vs non-indigenous). Results Estimated annual incidence was 10.4/100000 population (Open-globe: 3.6/100000, Closed-globe: 6.8/100000 population). Incidence rate ratio was 2.8x higher in Indigenous (22.8/100000 population) compared to non-indigenous populations. Injury from assault was 8.2x higher in the Indigenous population. Alcohol was involved in 76% of assaults. Paediatric injuries comprised 20.4% of the cohort, with Indigenous children over-represented (44.8% of children). Visual acuity (VA) at presentation ranged from ?0.08logMAR to No-Perception of Light (NPL), with 41.8% poorer than +1.00logMAR. Final VA ranged from ?0.18logMAR to NPL. Mean final VA was significantly better for closed- than open-globe injuries (+0.43 vs +1.01logMAR). Ruptures had the poorest outcomes (mean + 1.65logMAR). Conclusions The overall incidence of severe ocular trauma in FNQ has decreased compared to that reported from 1995-2002. The extremely high incidence observed in the Indigenous communities of Cape York has decreased dramatically since the introduction of Alcohol Management Plans. Nevertheless, the Indigenous population still experiences significantly higher rates of severe ocular trauma, particularly from assault. This article is protected by copyright. All rights reserved.

Extract from a paper presented by the Educational Determinants of Aboriginal Health group from Flinders University, a collaborative group of Indigenous and non-Indigenous academics, teachers and community members at the Educational Determinants of Aboriginal Health workshop of the Cooperative Research Centre for Aboriginal Health.

Purpose.?Community-based rehabilitation (CBR) developed in response to delivery of rehabilitation services to people with disability in developing countries, and appears appropriate to address rehabilitation needs of rural and remote populations, including Australian Aboriginal People with acquired brain injury (ABI). This article will describe participatory action research (PAR) as a vehicle for exploring and translating the CBR model within a mainstream brain injury rehabilitation service in Queensland, Australia.Method.?PAR was conducted with two self-selected remote Aboriginal communities in Far North Queensland. Key components to this project were the employment of a local Aboriginal worker, facilitating community engagement and consultation. PAR elements of planning, action and review were conducted through individual and group meetings and activities within the communities across a 3-year period.Results.?The project has facilitated expansion and change within the current brain injury rehabilitation service model in line with CBR philosophical foundations, including community development and partnership as a desirable way of engaging with key stakeholders.Conclusions.?The focus on community consultation through PAR and the development of community partnerships has increased the cultural competency of the rehabilitation service, the capacity of participating communities and of the sector to respond in ways that are valued and owned by Aboriginal People with brain injury, their families and communities.

In 2010, the population of the Northern Goldfields Health District was 40,992 people (1.8% of the state's population). The age-structure differs from that of the WA population by having a larger percentage of people aged less than 45 years, and a lower proportion of adults above this age. By 2020, the size of the population of the Northern Goldfields Health District is expected to increase by 19.9%, to 49,139 people In 2009, Aboriginal people accounted for 12.3% of the population of the Northern Goldfields Health District, which was greater than the state average (3.3%). Seven lifestyle and psycho-social risk factors were significantly higher in the Northern Goldfields Health District compared with the state. These were: current smoking, insufficient fruit and vegetable consumption, drinking at risky/high risk levels for short-term and long-term harm, insufficient physical activity and obesity There were no self-reported doctor-diagnosed health conditions that were significantly higher in the Northern Goldfields Health District compared with the state, although some were significantly lower Some health services were used significantly less in the Northern Goldfields Health District compared to the state, but there was no significantly higher useage of health services in the last year.

Across the world’s rangelands, livelihoods of millions of people are dependent on customary and commercial use of wildlife. Many Australian Aboriginal communities also aspire towards developing natural resource-based enterprises but there is a unique combination of historical, legislative and cultural factors that make this process complex. Typically, government support for Indigenous enterprise development has focussed largely on development of ‘social enterprise’, with subsidies coming from various government community development programs. This has resulted in some increase in participation and employment, but often inadequate attention to economic aspects of enterprise development leading to low levels of business success. This paper will examine historical, legislative and institutional dimensions in business development in Aboriginal communities. It does this through a case study of business enterprise development of the Kakadu Plum products by the Indigenous people of the Thamarrurr Region of the Northern Territory, Australia, using a participant observation research method. We found that attention on important economic criteria was subsumed by a focus on social enterprise priorities during the development of this natural resource-based enterprise. This resulted in a very slow transition of the ‘social enterprise’ to the ‘financial enterprise’, due largely to fragmented business decisions and inefficient value chains. We call for a refocus of natural resource-based enterprise development programs in remote Australian Aboriginal townships to incorporate greater emphasis on business acumen within the complex social, cultural and political fabric.

Human-induced climate change in Australia is affecting the frequency and intensity of extreme events, including bushfires, cyclones and drought. Human health is affected by these climate impacts through direct impacts which include injuries and death from extreme events; indirect impacts through natural system changes such as impacts on water, food and air; and indirect impacts on human systems including mental health, productivity, and damage to housing and health-care facilities. Remote settlements are vulnerable to these climate impacts and associated health impacts due to isolated location, quality of the infrastructure, economic resources, limited transport, and existing health vulnerabilities that enable resilience or vulnerability. Remote Indigenous communities are particularly vulnerable. This research sought to identify vulnerabilities of human health of residents in remote Indigenous communities to human-induced climate change to contribute to adequate responses of prevention and preparation.

Objectives: To identify maternal and perinatal risk factors associated with childhood anaemia. Methods: A retrospective cohort study was conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004–2014 in Community A and 2010–2014 in Community B and C, and their respective mothers were recruited into the study. Maternal and child data were linked to provide a longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was the prevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6 months. Results: Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6 months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08–9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21–5.70) were associated with an increased risk of childhood anaemia at 6 months of age. Conclusions for Practice: This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

The article presents a case analysis of the work regime at a uranium mine, located on indigenous land in northern Saskatchewan, Canada. All the miners are flown in and out (FIFO), and with nearly half the workforce coming from different indigenous communities. We ask how the miners participate in and experience life as FIFO workers, and enrol the community concept in the analysis. Defining community as not merely a group of people or a place but also, in the wake of Tönnies’ classic work, as a matter of attitude, the case analysis reveals a community at work but fragmentation of indigenous communities off work.

For generations, Aboriginal housing policy in remote communities has revolved around making up a housing deficit without regard to the viability of those communities or the effect of Government supplied housing on the future economic and social development of their residents. Public expenditure on remote community housing programs has been generous and well targeted but despite the generosity it has produced wrecked houses and dependent communities. This is because policy makers have failed to acknowledge the link between housing and economic opportunity. Remote communities are in transition. Aboriginal people, especially the young, are moving from these communities to find better lives and better economic opportunities elsewhere. This transition presents governments with an opportunity to reassess the housing priorities of these communities. This paper, which comes at the time the Rudd Government’s National Policy Commission is inquiring into the future of Aboriginal housing in remote communities, recommends a policy of linking housing to employment.