Remote Australia Online

Both Strongyloides stercoralis and hookworms are common soil-transmitted helminths in remote Australian communities. In addition to infecting humans, S. stercoralis and some species of hookworms infect canids and therefore present both environmental and zoonotic sources of transmission to humans. Currently, there is limited information available on the prevalence of hookworms and S. stercoralis infections in dogs living in communities across the Northern Territory in Australia. In this study, 274 dog faecal samples and 11 faecal samples of unknown origin were collected from the environment and directly from animals across 27 remote communities in Northern and Central Australia. Samples were examined using real-time polymerase chain reaction (PCR) analysis for the presence of S. stercoralis and four hookworm species: Ancylostoma caninum, Ancylostoma ceylanicum, Ancylostoma braziliense and Uncinaria stenocephala. The prevalence of S. stercoralis in dogs was found to be 21.9% (60/274). A. caninum was the only hookworm detected in the dog samples, with a prevalence of 31.4% (86/274). This study provides an insight into the prevalence of S. stercoralis and hookworms in dogs and informs future intervention and prevention strategies aimed at controlling these parasites in both dogs and humans. A “One Health” approach is crucial for the prevention of these diseases in Australia.

Summary Background The burden of acute lower respiratory infection (ALRI) in Indigenous children of Australia's Northern Territory is among the highest globally. No published data exists on the effect of pneumococcal conjugate vaccine (PCV) introduction on ALRIs in this population beyond 2005. The aim of this study was to describe the rates of ALRI admissions to hospital in Indigenous infants in the Northern Territory from 2006 to 2015, across three periods of different PCV use. We hypothesised that broader valency PCVs would be more effective against hospitalisations for pneumonia. Methods We did a retrospective population-based cohort study of Indigenous infants born in the Northern Territory followed up until age 12 months. Data were from administrative hospital and perinatal datasets. International classification of diseases codes (tenth revision, Australian modification; ICD-10AM) were used to identify respiratory hospitalisations of interest: all-cause ALRI, all-cause pneumonia, bacterial pneumonia, viral pneumonia, influenza-like illness (ILI), respiratory syncytial virus ALRI (RSV-ALRI), and pneumococcal ALRI. Incidence rates were compared between PCV eras (7-valent PCV [PCV7], 2006–09; 10-valent PCV [PCV10], 2009–11; and 13-valent PCV [PCV13], 2011–15) using interrupted time trend analysis and negative binomial regression. Findings For children born between Jan 1, 2006, and Dec 31, 2015, 4138 ALRI episodes (31% of all hospitalisations) occurred among 2888 (20%) of the 14 594 infants. The overall ALRI hospitalisation rate was 29·7 episodes per 100 child-years. Prominent risk factors associated with ALRI hospitalisation were living in a remote community or the Central desert region, being born preterm or with low birthweight. ALRI rates were lowest in the PCV13 era, in association with a significant reduction in bacterial pneumonia hospitalisations in the PCV13 era compared with the PCV10 (incidence rate ratio 0·68, 95% CI 0·57–0·81) and PCV7 (0·70, 0·60–0·81) eras. In contrast, RSV-ALRI rates were 4·9 episodes per 100 child-years in each era. Interpretation A 30% reduction in bacterial-coded pneumonia hospitalisations in the Northern Territory during the era of PCV13 immunisation supports its ongoing use in the region. Despite the reduction, one in five Indigenous infants born in the region continue to be hospitalised with an ALRI in their first year of life. Future gains require multifaceted environmental and biomedical approaches. Funding National Health and Medical Research Council of Australia.

The Better Internet for Rural, Regional & Remote Australia (BIRRR) group was founded in 2014 due to a lack of information, advocacy and support for bush broadband consumers. In particular, those requiring equitable telecommunications for their businesses and education of their children. There are now almost 11,000 active, engaged BIRRR members from every state and territory of Australia. BIRRR are a volunteer based advocacy group which operates entirely on the goodwill of its members. Rural, Regional & Remote (RRR) consumers are extremely reliant on effective communications, due to the nature of their geography, and this also heightens the need for effective representation. The BIRRR team has undertaken extensive large-scale research on regional telecommunication needs. Previously there have been few studies and limited research into this specific consumer group. BIRRR appreciates the opportunity to submit to the Regional Telecommunications Independent Review Committee (RTIRC). Equity of service is essential for RRR consumers, irrespective of where they choose to work and live. The contribution to the Australian economy made by RRR residents and businesses far outweighs the current infrastructure expenditure on telecommunications for these regions. To highlight, each person in the Quilpie Shire, Queensland contributes $250,000 to the economy, compared to Brisbane’s $70,000 per person ( RAPAD, 2016). To ensure RRR productivity and growth and to keep people living in RRR areas, voice and broadband services must be accessible, affordable, reliable and equitable. Essential services such as health, in RRR areas are already lacking. Mental and physical health, education, business productivity, tourism, economic growth and innovation would all benefit from improved telecommunications in our regions. The BIRRR team is on the ground in RRR areas every day, troubleshooting thousands of cases. The team is made up of six volunteers who are all rural women that have dedicated countless volunteer hours to ensure RRR telecommunications issues are resolved. The very reason for the existence of the BIRRR group is the reluctance of communication stakeholders to offer reliable services with efficient customer service and transparent information to RRR consumers. With over 250,000 website hits and hundreds of requests for help each month, BIRRR highlights the need for RRR consumers to be able to access user friendly telecommunications services that meet their specific needs. Every Australian, irrespective of where they live or work, should be confident they can access quality, reliable, accessible and affordable voice and broadband services with customer support guarantees. Numerous enquiries, reference groups and research have already been undertaken. BIRRR urges RTIRC to acknowledge that now it is the time to be proactive and solve the telecommunications issues raised in these reports, with a serious commitment policy and action, to ensure that RRR areas are not disadvantaged due to their population and postcode.

The life expectancy (LE) gap experienced by Aboriginal and Torres Strait Islander peoples in one of Australians most enduring health divides. Whilst there are many likely reasons, cardiovascular diseases (CVD) stand as the primary contributor. In particular, it is the almost ten-fold higher mortality from CVD at young ages that distinguishes this epidemic. The reasons for this disparity remain incompletely understood. Current research has focused on the likely contribution of traditional risk factor burdens in Aboriginal people, who demonstrate higher levels of smoking, obesity, hypertension and dyslipidaemia. Less attention has focused on the potential contribution of disadvantage and its interplay with psychosocial factors. Research on the psychosocial determinants of health, particularly in relation to CVD, has a long pedigree. Social context, particularly inequality between individuals, has assumed its rightful place at the forefront of our understandings of population levels of disease. Among them, socioeconomic position [SEP] and depression are the most robust, and most widely researched. They have not been adequately explored in the context of Aboriginal Australians, nor has the manner in which culture shapes, sustains or transforms disadvantage and psychosocial stress been outlined. The objective of the Men Hearts and Minds (MHM) Study was to identify the possible ways in which social disadvantage may lead to CVD in Aboriginal men in Central Australia and consider the role of psychosocial factors in modifying or mediating this relationship. This required a detailed and multi-disciplinary plan of research, covering the epidemiology of mental illness and chronic diseases, biomedical science, ethnographic field work and qualitative methodologies. Stage I required the development of measurement tools for exploring depression, stress, resilience, mastery and socioeconomic indicators that were valid and robust for use with Aboriginal men within Central Australia. This involved multi-stage qualitative techniques, engaging Aboriginal men, traditional healers (Ngangkari Tjuta) and mental health experts, to define the expressions and construction of mental illness in Aboriginal men. Depression existed, was recognizable, common, and had profound impacts on the social, emotional and physical well-being of Aboriginal men. ‘Worry’ was the most recognisable element, and the principle contributor to depression in Aboriginal men. Much of this was focused on the increasingly heavy and cumulative social and cultural burdens experienced throughout Aboriginal men’s lives, and manifest as a sense of inner turmoil and questioning of self, and of feelings of disconnectedness from all the things of critical importance within their lives. Kurunpa [spirit] was seen as the foundation of vitality and was critical to the physical, emotional and spiritual well-being of Aboriginal people. These findings were then used to interrogate existing psychological testing tools and develop novel measures to explore the interplay of SEP, stress and depression. These tools were then used in a community dwelling sample of Aboriginal men in Central Australia to explore the interaction of SEP, stress and depression and their potential contribution to CVD risk. In total 186 Aboriginal men across urban and remote community settings were assessed. Almost 40% of the sample had elevated depressive symptoms. Depression was highly correlated with standard measures of distress and inversely with mastery. Newly created measures, assessing Chronic Stress, the ‘Sense of Injury’ and deprivation, were highly correlated, reliable and fulfilled many validity criteria. There was a high level of cardiovascular risk, which was related to a number of psychosocial factors, particularly depression. Major depression was over 9 times as common in individuals with prevalent CVD. Cardiovascular risk was patterned across social strata, but not evident with the use of routine measures of SEP. Psychosocial factors modified the observed social gradient. In those with high chronic stress, the social gradient in CVD risk gradient was amplified. This pattern was mirrored in those who had been removed or had family forcible removed. Depression was correlated with a number of atherogenic pathways. Smokers were more likely to be depressed, and depression was strongly related to obesity. Individual with high depression scores were more than 20 times more likely to have a Body Mass Index >30. The interplay between the Autonomic Nervous System (ANS) (estimated with measures of Heart Rate Variability) and the Hypothalamic Pituitary Adrenal (HPA) axis (as measured according to obesity) highlights the interconnections across atherogenic pathways and may frame the cardiometabolic risk and psychosocial pathways to cardiovascular disease in this sample. The phenomenology of cumulative stress, distress and depression within the narratives of Aboriginal men constructed illness as a consequence of the ongoing fight to maintain balance - physically, emotionally and spiritually. From both a social and biological perspective, the construction of depression and heart disease as a consequence of cumulative chronic stress among Aboriginal men was supported in the findings of this work.

The archaeological record of Lower Laura (aka Boralga) Native Mounted Police camp, a longstanding base for Queensland?s frontier war in Cape York Peninsula, includes a diverse assemblage of culturally modified Erythophleum chlorastychys (Cooktown ironwood) trees. Analysis of cultural scar attributes and tool marks ? which were found to be variously associated with Aboriginal stone tools, tomahawks of different types, and long handled axes ? reveals a scenario of nineteenth century land use and technology that transcends the pre-conflict era of Aboriginal clan estates. As well as reflecting traditional patterns of Aboriginal tenure of prime waterfront land, the assemblage reveals innovations that occurred in Aboriginal technology in the lead-up to war. However, an unusual style of cultural scar cut using long handled axes appears to signal transformations in demography and land use following Native Mounted Police occupation. By integrating historical, oral history, spatial, typological, and botanical data this study provides evidence of demographic and environmental changes set in train by the gold-rush invasion. It also highlights the complexities of documenting Cooktown ironwood trees of advanced age and their fragile, deteriorating cultural modifications.

This study determines the optimal capacity of various components of an AC mini-grid hybrid power system in a remote area of South Australia. A range of generation and storage technologies, such as diesel generators, wind turbines, solar photovoltaic arrays, battery banks, and flywheels are considered. A minimum system operating reserve is maintained to ensure a certain degree of reliability. Four different configurations of hybrid power systems are analysed in hourly time-steps, over a year, using real data for system load, solar insolation, ambient temperature, and wind speed. Particle swarm optimisation approach is used to optimise the capacity of various components of each hybrid system to obtain the minimum net present cost (NPC) over a 20-year system lifespan. Suitable capital, operating, and maintenance costs in Australian context are considered in evaluating the system. Various simulation results, such as annual energy balances, NPCs, levelised cost of energy and cash flow analysis obtained for each optimised system are carefully analysed and discussed. The modelling and results confirms the feasibility and economical replacement of the diesel power system with those of hybrid power systems which use renewable energy supply.

The purpose of this guide is to raise awareness among persons conducting a business or undertaking (PCBUs), safety practitioners, managers, supervisors and workers of the hazards that may be present for people required to work remotely or in isolation. The guide is designed to assist in the identification, assessment and control of the hazards associated with remote or isolated work, and the development of appropriate policies and procedures to enable organisations to meet their legal obligations under the Work Health and Safety Act 2011 (Cth) (WHS Act), the Work Health and Safety Regulations 2011 (Cth) (WHS Regulations) and certain approved Codes of Practice. These include the Work Health and Safety Code of Practice 2011 (Cth)—Managing the Work Environment and Facilities, and the Work Health and Safety Code of Practice 2011 (Cth)—First Aid in the Workplace.

Spatial patterns of soil moisture and infiltration rate in a groved mulga woodland in arid central Australia are described. Infiltration rates within groves were measured with miniature cylinder infiltrometers set out in transects radiating from mulga stems, and extending into open sites beyond the plant canopy. Infiltration rates are highest close to stems, and decline rapidly with increasing distance, following a power-function relationship. This pattern of radially declining infiltration means that the soil surface within groves exhibits widely varying infiltration rates that are in some locations indistinguishable from those of intergrove soils. Contour-normal transects of surface soil moisture content and unconfined compressive strength were run across multiple wavelengths of the repeating mulga grove pattern. Soils within the lower intergroves were indistinguishable from those in the upper parts of groves in terms of these properties. Consequently, the position of the intergrove—grove boundary between these two locations could not readily be accounted for by the observed soil properties. Other factors (such as nutrient availability) may be involved in fixing the position of intergrove–grove boundaries, and this suggests the need for additional investigation of the mechanisms controlling the form of these patterned woodlands.

The Eremaean region, Australia’s arid biome and biogeographic region, has been discussed by botanists (and as the Eyrean, its counterpart for zoogeographers) for over 150 years, yet little progress was made in defining it as an area of endemism until the 2000s. As Australia’s largest biome and biogeographic region, the Eremaean has been defined in a climate sense, but is a historically composite biogeographic area. Taxa that inhabit the Eremaean (Eyrean) tend to display sister relationships to those outside the biome in temperate and monsoonal biome areas, indicating that two or more temporally discordant distributional patterns exist in the Australian flora and fauna. The future of Eremean and Eyrean bioregionalisation will need to incorporate these temporal patterns when constructing new bioregionalisations and historical and climate-based biogeographic models.

Habitat use by feral cats and dingoes was examined within a heterogeneous semi-arid woodland site in central Australia over 2 years. Density estimates of feral cats based on tracks were higher in mulga habitat than in open habitat. Isodar analysis implied that this pattern of habitat use by feral cats was consistent with the consumer-resource model of density-dependent habitat selection, which is an ideal free solution. The reason why mulga supported higher densities of feral cats was unclear. Foraging success of feral cats may be higher in the mulga because the stalk and ambush hunting tactics typically employed by felids are well suited to dense cover. Mulga may also have offered feral cats more protection from dingo predation. Dingo activity was distributed uniformly across habitats. The dingo isodar was statistically non-significant, suggesting that habitat selection by dingoes was independent of density.

Opportunities for the desert Aboriginal art centres have fallen like dominos in the wake of the coronavirus pandemic. The experiences are far from uniform, as each art centre is on its own life cycle. Some have been hit at a fragile moment, while others, in a more robust phase, have nonetheless had to swallow big disappointments. They are all adapting as best they can-as one manager said to me, "Aboriginal people have a history of adapting to change, they'll get through this." But, as for so many others around the world, the longer the restrictions and uncertainty last, the harder it will become.

Australia is currently free of canine rabies. Spatio-ecological knowledge about dingoes in northern Australia is currently a gap that impedes the application of disease spread models and our understanding of the potential transmission of rabies, in the event of an incursion. We therefore conducted a one-year camera trap survey to monitor a dingo population in equatorial northern Australia. The population is contiguous with remote Indigenous communities containing free-roaming dogs, which potentially interact with dingoes. Based on the camera trap data, we derived dingo density and home range size estimates using maximum-likelihood, spatially explicit, mark&–resight models, described dingo movements and evaluated spatial correlation and temporal overlap in activities between dingoes and community dogs. Dingo density estimates varied from 0.135 animals/km2 (95% CI = 0.127&–0.144) during the dry season to 0.147 animals/km2 (95% CI = 0.135–0.159) during the wet season. The 95% bivariate Normal home range sizes were highly variable throughout the year (7.95–29.40 km2). Spatial use and daily activity patterns of dingoes and free-roaming community dogs, grouped over ~3 month periods, showed substantial temporal activity overlap and spatial correlation, highlighting the potential risk of disease transmission at the wild–domestic interface in an area of biosecurity risk in equatorial northern Australia. Our results have utility for improving preparedness against a potential rabies incursion.

The Royal Flying Doctor Service (RFDS) provides medical care to populations without access to traditional health-care services. From 2014 to 2018 the RFDS conducted 6007 (≈1201/year) aeromedical retrievals for gastrointestinal (GI) disorders. More detailed research is needed to determine specific GI disorders that contributed to this caseload, and in particular inform whether the establishment of a GI specialist service is justified.

This article presents a history of left-wing ideas and activities in central Australia from the 1920s through to the 1970s. Although the central Australian region, and the Alice Springs district in particular, is now often associated with various Aboriginal rights struggles and other protest movements, little is known about the presence of left-wing influences prior to the 1970s. Working from archival sources, this paper begins to build up a picture of how leftists and, in particularly, those associated with the Communist Party of Australia struggled to make their presence felt in a predominantly conservative socio-economic milieu. The intent of this article is to sketch out the various historical figures, events and ideological contests that came to influence the political identity of Australia?s most isolated and scantily populated heartland over a number of decades. These vignettes also reveal how leftist politics did, and did not, have an effect on the Aboriginal rights campaigns that followed in the 1970s and onwards.

Globally, the agricultural sector is facing many challenges in response to climate change, unsustainable farming practices and human population growth. Despite advances in technology and innovation in agriculture, governments around the world are recognizing a need for transformative agricultural systems that offer solutions to the interrelated issues of food security, climate change, and conservation of environmental and cultural values. Approaches to production are needed that are holistic and multisectoral. In planning for future agricultural models, it is worth exploring indigenous agricultural heritage systems that have demonstrated success in community food security without major environmental impacts. We demonstrate how indigenous practices of customary harvest, operating in multifunctional landscapes, can be scaled up to service new markets while still maintaining natural and cultural values. We do this through a case analysis of the wild harvest of Kakadu plum fruit by Aboriginal people across the tropical savannas of northern Australia. We conclude that this system would ideally operate at a landscape scale to ensure sustainability of harvest, maintenance of important patterns and processes for landscape health, and incorporate cultural and livelihood objectives. Applied to a variety of similar native products, such a production system has potential to make a substantial contribution to niche areas of global food and livelihood security.

Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48-60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion.

Objective To identify barriers faced by Aboriginal people from remote communities in the Northern Territory (NT) when accessing hospital-based specialist medical services, and to evaluate the impact of the Specialist Outreach Service (SOS) on these barriers. Design Combined quantitative and qualitative study. Setting Remote Aboriginal communities in the ?Top End? of the NT, 1993?1999 (spanning the introduction of the SOS in 1997). Participants 25 remote health practitioners, patients and SOS specialists. Main outcome measures Numbers of consultations with specialists; average cost per consultation; perceived barriers to accessing hospital-based outpatient care; and perceived impact of specialist outreach on these barriers. Results Perceived barriers included geographic remoteness, poor doctor?patient communication, poverty, cultural differences, and the structure of the health service. Between 1993 and 1999, there were 5134 SOS and non-SOS outreach consultations in surgical specialties. Intensive outreach practice (as in gynaecology and ophthalmology) increased total consultations by up to 441% and significantly reduced the number of transfers to hospital outpatient clinics (P<0.001) Average cost per consultation was $277 for SOS consultations. compared with $450 at Royal Darwin Hospital and $357 at the closest regional hospital. Outreach has reduced barriers relating to distance, communication and cultural differences, and potentially bolsters existing primary healthcare services. Conclusions When compared with hospital-based outpatient services alone, outreach is a more accessible, appropriate and efficient method of providing specialist medical services to remote Aboriginal communities in the NT.

Summary Reasons for performing study: The distance travelled by Australian feral horses in an unrestricted environment has not previously been determined. It is important to investigate horse movement in wilderness environments to establish baseline data against which the movement of domestically managed horses and wild equids can be compared. Objectives: To determine the travel dynamics of 2 groups of feral horses in unrestricted but different wilderness environments. Methods: Twelve feral horses living in 2 wilderness environments (2000 vs. 20,000?km2) in outback Australia were tracked for 6.5 consecutive days using custom designed, collar mounted global positioning systems (GPS). Collars were attached after darting and immobilising the horses. The collars were recovered after a minimum of 6.5 days by re-darting the horses. Average daily distance travelled was calculated. Range use and watering patterns of horses were analysed by viewing GPS tracks overlaid on satellite photographs of the study area. Results: Average distance travelled was 15.9 ± 1.9?km/day (range 8.1?28.3?km/day). Horses were recorded up to 55?km from their watering points and some horses walked for 12?h to water from feeding grounds. Mean watering frequency was 2.67 days (range 1?4 days). Central Australian horses watered less frequently and showed a different range use compared to horses from central Queensland. Central Australian horses walked for long distances in direct lines to patchy food sources whereas central Queensland horses were able to graze close to water sources and moved in a more or less circular pattern around the central water source. Conclusions: The distances travelled by feral horses were far greater than those previously observed for managed domestic horses and other species of equid. Feral horses are able to travel long distances and withstand long periods without water, allowing them to survive in semi-arid conditions.

Background Strongyloides stercoralis is a soil-transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare but well-recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. Methods This retrospective case?control study measured the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. Records of primary healthcare presentations were reviewed for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. Results One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. Conclusion We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programs reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection. This article is protected by copyright. All rights reserved.

Background: Aboriginal and Torres Strait Islander Australians are disproportionately affected by Chronic Hepatitis B (CHB) with a prevalence of 6.08% in the Northern Territory (NT) and liver cancer rates 6 times higher than non-Indigenous Australians. Without appropriate care, overall 25% of those living with CHB will die from either liver failure or liver cancer, outcomes that can be minimised with regular follow up, antiviral treatment and hepatocellular carcinoma (HCC) screening. This care including antiviral treatment is publicly funded in the Australian setting however the care cascade still shows inequities in access to treatment for Aboriginal Australians. We describe the impact of a mobile care delivery model, “One Stop Liver Shop”, on the cascade of care for people living with CHB in a remote Australian setting. Methods: A retrospective analysis was performed for CHB care received between 2013 and 2018 in one very remote Northern Territory community, where the “One Stop Liver Shop” was iteratively developed with the community. Patients with positive Hepatitis B virus surface antigen (HBsAg) were identified through electronic medical records. Proportions of patients who are up-to-date with monitoring investigations and HCC screening were evaluated and compared to national guidelines and targets. Results: Eighty-three HBsAg positive patients were evaluated. Eighty-eight percent were engaged in care, 16% of whom were receiving antiviral treatment. Liver function tests (LFT) were up to date in 71% of patients in 2013 and 88% in 2018. Viral load (VL) monitoring was up to date for 61 (73%) of patients. There were 44 patients in whom HCC screening was indicated. Of these, 38 (86.4%) were up to date with 6 monthly alpha-fetoprotein (AFP), 35 (79.5%) were up to date with 6 monthly liver ultrasound scan (USS), and 34 (77.3%) were up-to-date for both. Conclusions: A “One Stop Liver Shop” developed with and including Aboriginal Health Practitioners bridges gaps in the availability of services to those living with CHB in a very remote community and improves the cascade of care.

This report presents an evaluation framework created for Tura New Music’s programs in regional and remote Australia and the findings of a summative evaluation of its work in the remote north-west region of Australia known as the Kimberley. Tura New Music has worked in the Kimberley since 2003, bringing cross-genre, contemporary live music and sound art to remote communities through an annual program of concerts, workshops and residencies, presented in partnership with local organisations. The study sought to develop a bespoke evaluation framework grounded in the experiences, priorities and aspirations of the communities of the Kimberley with whom Tura works. The dominant themes in the data gathered over three fieldwork engagements in the region were translated into the domains and subdomains of the framework. Monitoring tools were then developed and implemented in the field during the final fieldwork engagement (June 2019), using indicators drawn directly from the qualitative data. Across its three stages, the research incorporated mixed methods, including in-depth interviews, focus groups, participant observation and surveys. The resulting seven domains capture the diverse contributions of Tura’s work: Domain 1: Personal wellbeing Domain 2: Family and Community Domain 3: Identity and Culture Domain 4: Aesthetic enrichment Domain 5: Creativity stimulated Domain 6: Capacities and Connections Domain 7: Two-way Together with the subdomains, they offer an accessible schema of measurable or trackable outcomes within the specific music experiences that Tura offers. The findings show that Tura New Music brings distinctive musical opportunities to remote communities in terms of the instruments it features, the musical ideas and content, and its commitment to collaborations with First Nations musicians, including local and nationally-acclaimed artists. Its concerts, workshops and residencies can enhance feelings of place-connection and may help to strengthen community bonds, connecting new music and sound art with the local environment, providing a spotlight for local musicians, and even drawing people together across community boundaries. Its focus on contemporary and new music and sound art is highly valued, and its concerts promote relaxing and peaceful feelings for many people, while also being stimulating and challenging. In a context where many people live in the moment, Tura’s music events and residency activities in particular can ‘shift the energy’ of the town and create memorable experiences that the community continues to talk about after the tour or residency has concluded. Tura New Music is seen as a valued and reliable partner and collaborator. Trusted, respectful, and longstanding relationships between Tura personnel and the communities with which Tura New Music works are a critical component of Tura’s achievements in this work, central to its continued growth and therefore to any efforts to scale the work. A concern for communities is how Tura New Music’s activities and contributions can help to support the ongoing provision of music opportunities. The evaluation framework and monitoring tools have been designed to track the ways that capacities, resources, and connections for music and creativity evolve over time in tandem with (and therefore indirectly or directly connected to) Tura’s inputs. Tura’s flexibility of approach, engagement with local strengths and aspirations, and commitment to relationship building are important factors in its capacity to catalyse increased music provision, capacities, and resources for music in remote and regional communities. Mapping these developments over time will enable Tura to better understand its potential to strengthen the music capabilities of communities through its work.

This study describes the understanding, experiences and expectations of families living in rural and remote Australia regarding core concepts relating to disability service provision, including person-centred practice (PCP), family-centred practice (FCP), transdisciplinary practice (TDP), choice, control, inclusion, and equity. Thirteen parents or carers, each with a child with an intellectual disability aged between 6 and 16 years, living in rural and remote areas as described by the Australian Standard Geographical Classification ? Remoteness Area (ASGC-RA) and Modified Monash Model (MMM) ? were recruited through distribution of flyers (hard copies or by email) to clinicians, schools, and advocacy agencies. Semi-structured interviews were conducted with participants either in-person or via telephone between July and October 2015. Data were analysed using thematic analysis. Participants reported that their understanding of many of the disability principles (PCP, FCP, choice, control, inclusion, and equity) was different from providers, and that many providers struggled to understand families, and therefore they did not share meaning of the principles of best practice disability supports. Families did not identify transdisciplinary practice as a core issue or tenet of effective service delivery. Families also reported experiences of missing out on services, feeling a sense of isolation in their communities, struggling to access skilled therapists, and difficulty finding supports and goals that were relevant to their child. The quality of supports that these families accessed was often below the standard that they expected. They did not expect that support standards will change in rural and remote Australia, so many have very low expectations of the National Disability Insurance Scheme (NDIS) in the future. Although more data will need to be collected as the NDIS and its markets mature, these data show that many rural and remote participants and their supporters have a variety of concerns about how they will access quality allied health services through the Scheme.

BACKGROUND: Strongyloides seroprevalence is hyper-endemic in many Australian Aboriginal and Torres Strait Islander communities, ranging from 35-60%. We report the impact on Strongyloides seroprevalence after two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community. METHODS: Utilizing a before and after study design, we measured Strongyloides seroprevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined changes in serostatus. Serodiagnosis was undertaken by ELISA that used sonicated Strongyloides ratti antigen to detect anti-Strongyloides IgG. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 10-42 days if Strongyloides and/or scabies was diagnosed; others followed a standard alternative algorithm. A questionnaire on clinical symptoms was administered to identify adverse events from treatment and self-reported symptoms associated with serostatus. FINDINGS: We surveyed 1013 participants at the baseline population census and 1060 (n = 700 from baseline cohort and 360 new entrants) at month 12. Strongyloides seroprevalence fell from 21% (175/818) at baseline to 5% at month 6. For participants from the baseline cohort this reduction was sustained at month 12 (34/618, 6%), falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% (75/297) to 7% at month 18. Strongyloides positive seroconversions for the baseline cohort six months after each MDA were 2.5% (4/157) at month 6 and 1% at month 18, whilst failure to serorevert remained unchanged at 18%. At 12 months, eosinophilia was identified in 59% of baseline seropositive participants and 89% of seropositive new entrants, compared with 47%baseline seronegative participants and 51% seronegative new entrants. Seropositivity was not correlated with haemoglobin or any self-reported clinical symptoms. Clinical symptoms ascertained on the day of treatment and 24-72 hrs after, did not identify any adverse events. SIGNIFICANCE: Two community ivermectin MDAs delivered 12 months apart by trained Aboriginal researchers in collaboration with non-Indigenous researchers resulted in a sustained and significant reduction in Strongyloides seroprevalence over 18 months. Similar reductions were seen in the baseline cohort and new entrants.

INTRODUCTION: Australia's farmers constitute a heterogeneous group within the rural population. This literature review incorporates four broad areas: an understanding of farming communities, families and individuals and the contexts in which they live and work; an exploration of the challenges to morbidity and mortality that these communities face; a description of the patterns of suicide and accidental death in farming communities; and an outline of what is missing from the current body of research. Recommendations will be made on how these gaps may be addressed. METHODS: In developing this comprehensive literature review, a snowballing and saturation approach was adopted. Initial search terms included suicid*, farm*, accident*, fatal*, death, sudden death, rural OR remote, Australia and NOT Australia. Databases searched included SCOPUS, PubMed, Proquest and SafetyLit; research from 1995 onwards was examined for relevance. Earlier seminal texts were also included. Reference lists of retrieved articles were searched and citations explored for further relevant research material. The primary focus was on Australian peer-reviewed research with supplementary grey literature. International material was used as examples. RESULTS: The literature variously describes farmers as members of both rural farming communities and farming families, and as individuals within an occupational classification. Within each of these classifications, there is evidence of the cumulative impact of a multiplicity of social, geographical and psychological factors relating to work, living and social arrangements that impact the health and wellbeing of Australia's farmers and their families, particularly accidental death and suicide. Research consistently demonstrates traumatic death to be at a greater rate than in the general Australian population, with reductions found more recently in some modes of farming-related accidental death. Patterns of accidental death and suicide are commonly linked to the changing shape of contemporary farming. Suicide rates are also frequently described in relation to lethality and accessibility of means. The limitations of suicide and accidental death data are considerable. CONCLUSION: While there is consistent reporting of heightened levels of risk for suicide and accidental death in farming communities the limitations of the research remain significant. There are substantial gaps in current knowledge, and the body of research to date lacks clarity, inclusiveness and contextual specificity. Absent from the literature is any investigation of the impact of these frequently preventable deaths on the families and communities in which they occur. Recommendations for future research are suggested.

Objective To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. Methods The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004–2006 (retrospective cohort) and 2009–2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. Results The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Conclusions Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.