Remote Australia Online

Identify trachoma knowledge, attitudes and practice of staff in clinics, schools and community workplace settings to optimise trachoma-elimination health-promotion programs in the Katherine West Health Board region of the Northern Territory. Prior to the introduction of a suite of health promotion resources the Indigenous Eye Health Unit and Katherine West Health Board conducted a baseline survey of open, multi-choice and closed questions regarding knowledge, attitudes and practices in relation to trachoma with 72 staff members over a 6-month period in 2010−11. Data were analysed for differences between settings. Two significant barriers and one enabling factor were identified. One in five staff members in clinics and 29% of staff members in schools were unaware they lived and worked in a trachoma-endemic area. One-third of school staff and 38% of clinic staff considered it normal for children to have dirty faces. However, the majority of participants felt comfortable talking about hygiene issues with others. The presence of dirty faces in young Indigenous children underpins the continuing prevalence of trachoma. Increasing the awareness of the health effects of children’s nasal and ocular secretions and changing community acceptance of dirty faces as the norm will reduce the risk of trachoma and other childhood infections. Staff in clinics, schools and community work settings can play a role in trachoma elimination by actively encouraging clean faces whenever they are dirty and by including face washing in holistic hygiene and health education. Staff in schools may need additional support. Trachoma-elimination health promotion should increase awareness of trachoma prevalence and encourage all who work and live in remote Indigenous communities to take action to promote facial cleanliness and good hygiene practices.

Conservation and environmental management have been reported as offering opportunities to substantially improve the wellbeing of Indigenous people. Using the holistic wellbeing impact evaluation (W-IE) approach – well suited for use in Indigenous communities – we interviewed 190 Indigenous Australians across four communities. All communities were involved in the Indigenous land and sea management programs (ILSMPs). Our study explored the conceptualisation of ‘wellbeing’ by participants. In particular, we were interested in the aspects of wellbeing perceived to be affected by ILSMPs. Out of the 26 wellbeing factors explored, ‘Health centres’; ‘Language’; ‘Schools’; and ‘Safe community’ emerged as being of highest importance to the largest percentage of the respondents. When grouped using principle components analysis (PCA), the ‘Community and society’ domain emerged as the most important; accounting for 52% of the overall importance of all wellbeing factors. The second most important domain was the ‘Country and culture’, contributing 31%. Lastly, ‘Economic aspects’ contributed only 17%. Respondents believed that ILSMPs have played a considerable causal role in improving wellbeing, by positively changing factors most important to them. Specifically, 73% of perceived causal links were related to improvements in the ‘Country and Culture’ and 23% to ‘Community and Society’ domain. We thus conclude that land management for Indigenous people is much more than ecological or environmental management with ILSMPs, perceived to cause a wide range of cultural and social benefits. We also propose ways in which the future design of such programs could be improved to further increase benefits.

After teaching Society and Culture since its introduction in NSW schools in 1987 I have always tried to put the course values of Social and Cultural Literacy into practice in my life and my teaching and demonstrate these as real and powerful to the students with whom I have worked. I have applied these in the classroom, on excursions in Sydney, in regional NSW and overseas. However, the most demanding and rewarding application of these values in my personal and professional experience has been in working with Anangu communities of Mutitjulu, Kaltukatjara (Docker River) and Imanpa in lands around Uluru in the Northern Territory.

Aims Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23?months with indicators of childhood development at school-age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Methods The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development?physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Results AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23?months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P?<?.001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P = .020) at school age. Conclusions Early childhood anaemia is a risk factor for developmental vulnerability at school-age in this setting. Interventions combining nutrition promotion and multi-micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement.

This paper attempts to synthesise different bodies of literature relating to technology and inequality. The use of technology by minority groups has been studied, but in isolation. That is, it has been examined within particular marginalised communities rather than across them. For example, migrants and the ways that technologies are deployed to sustain connections between family members in different countries have been investigated extensively. Indigenous groups? appropriation of technologies to overcome distance in rural and remote areas has also been explored in depth. The role of technology in providing independence to people with disabilities has been scrutinised too, separately from that of older people. The findings from these studies of various minority groups generally sit in different disciplines, with little to no comparative analysis of them. In understanding commonalities between these minority groups in relation to access and affordability, the paper argues that these can no longer be considered ?minority? issues as they affect a significant proportion of the Australian population. Rather, affordability needs to be framed as part of a wider discussion about access and accessibility. Furthermore, notions of access and accessibility should be emphasised and clearly distinguished from mere availability.

Objectives To analyse incidence of prior emergency department presentations for interpersonal violence and demographics for a series of hospital admissions for interpersonal violence injuries. Design Retrospective analysis of trauma registry. Setting A tertiary hospital and primary referral centre for trauma in the Top End of the Northern Territory. Participants Patients hospitalised from 2010 to 2015 for injuries due to interpersonal violence with an injury severity score > 9. Main outcome measures Patient demographics, injury location, assault mechanism, alleged perpetrator, time/day of event, alcohol involvement, clinical outcome and prior emergency department presentations for interpersonal violence. Results A total of 248 admissions for patients with Injury Severity Score > 9 due to interpersonal violence were identified. Indigenous females over-represented non-Indigenous females (35.4% vs 5.0%, P < .001). The majority of victims had evidence of alcohol intake at presentation. Victims of single-punch head injuries were mostly male and non-Indigenous, whilst Indigenous persons experienced significantly more blunt and penetrating weapon injuries (66.7% and 68.1%). Forty-three per cent of patients had a preceding emergency department presentation for interpersonal violence; female gender, Indigenous ethnicity, evidence of alcohol intake, and urban location of injury were independent risk factors for prior interpersonal violence presentation. Conclusions Interpersonal violence is a recurring disease for a just under half of those presenting to a Top End hospital with moderate to severe injuries. Indigenous ethnicity, female gender and evidence of alcohol intake are predictive of prior interpersonal violence presentations. Patient under-reporting and incomplete data may underestimate the true prevalence of interpersonal violence presentations in rural and remote locales.

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider.

Objective: To evaluate the extent to which the current Pharmaceutical Benefits Scheme (PBS) guidelines for patient eligibility for lipid-lowering medication are applicable to Aboriginal people in Central Australia. Design, setting and participants: A 10-year cohort study of 659 Aboriginal people who participated in population-based cardiovascular disease (CVD) risk factor surveys in 1995 and who were free of CVD at baseline, for the period from 1995 to 2004-2005 or until first CVD event. Evidence of atherosclerotic CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) was sought from hospital, primary health care and death records. PBS eligibility was assigned according to the current PBS criteria, which were amended in 2006 to include Aboriginal-specific criteria, using participants' baseline (1995) and 10-year follow-up data. Main outcome measures: Proportions of PBS-eligible and PBS-ineligible participants who had CVD events during the study period; sensitivity and specificity of the criteria. Results: Of 42 participants who had CVD events during the study period, 35were PBS-eligible (incidence, 1130/100,000 person-years; relative risk compared with PBS-ineligible population, 4.87 [95% CI, 2.19-10.80]) and seven were PBS-ineligible. PBS eligibility was associated with older mean age (37 v 32 years) and male sex (48% v 37%), with 50.7% of participants (334/659) meeting eligibility criteria. The mean high-density lipoprotein cholesterol level at baseline was very low in both groups (0.81 v 0.87 mmol/L). The current PBS guidelines have low specificity (52%) in this population, which was found to improve (to 71%-82%) by incorporating additional non-lipid criteria (age and multiple non-lipid risk factors). Conclusion: The current PBS lipid treatment criteria, which include any Aboriginal person with diabetes and less stringent cholesterol thresholds than the previous version, identify a group at very high risk of CVD. Global risk assessment may better identify those at risk.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is a serious public health concern and in Australia, one that disproportionately affects Aboriginal people. Paralleling MRSA in human medicine, methicillin-resistant S. pseudintermedius (MRSP) is an increasingly prevalent pathogen in veterinary medicine. We aimed to characterize the carriage of MRSA and MRSP in dogs and cats from predominantly Aboriginal communities in a very remote region of New South Wales (NSW), Australia. Pets (303 dogs and 80 cats) were recruited from six communities in western NSW. Three swabs were collected from each animal (anterior nares, oropharynx and perineum) and from skin lesions or wounds (if present) and cultured on selective media for methicillin-resistant staphylococci. Human host-adapted community-associated MRSA representing four multilocus sequence types (ST1-IV, ST5-IV, ST72-IV, ST93-IV) were isolated from eight dogs (prevalence 2.6%, 95% confidence interval 1.3%–5.1%). Two ST5-IV isolates from a single dog were phenotypically trimethoprim-resistant, harbouring trimethoprim-resistant gene dfrG within the SCCmec type IVo mobile genetic element. MRSA was not isolated from any cats and MRSP was not isolated from any dogs or cats. This study estimated a high prevalence of human host-adapted community-associated MRSA carriage in dogs despite an absence of MRSP. This suggests MRSA carried by dogs in remote NSW originate from human hosts. The cycle of transmission between people, dogs and common environmental sources warrants further investigation. To our knowledge, this is the first report of trimethoprim-resistant ST5-IV in eastern Australia and the first report of trimethoprim-resistant ST5-IV from a dog.

The Indigenous land and sea management (ILSM) movement in Australia is an Indigenous-led initiative based on strong and complex obligations to care for Country. Traditional Owners (TOs) and Ranger groups have achieved substantial support through government and non-government funding programs. As these programs mature, ILSM practitioners and their collaborators are grappling with how to evaluate success, a requirement necessary for ILSM to satisfy investment. To date, there has been little work describing the experience of monitoring and evaluation (M&E) from Indigenous perspectives. This thesis advances the discussion by providing accounts of how TOs and Rangers from two ILSM groups –in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia and at Ngukurr in the Northern Territory –are responding to the evaluation of their ILSM programs and collaborations. Both people-places have government-funded Ranger groups, Indigenous Protected Areas (IPAs), and non-government funded initiatives, each with requisite reporting requirements. The thesis has used background research, and collaborative investigations with TOs and Rangers to observe the activities undertaken and assess what was being achieved from their perspective. This work clarifies the problem –how to do M&E and strengthen Indigenous governance of Country without extending neoliberal governmentality. While there are tensions between funders, TOs and Rangers, the results show Indigenous agency in expressing priorities in ILSM programs, and through determining the activities and timing of work undertaken. TOs and Rangers gave a high priority to being on Country, performing ceremony, recounting and singing the Tjukurpa (APY Lands) or Drimin (Ngukurr), and maintaining language as integral components of ILSM –in addition to the more conservation-focused activities such as weed or feral animal control. However, the absence of local language words encompassing monitoring, management or success revealed that conventional M&E reporting may continue the disempowering colonial processes that ILSM aspires to reverse. Social, cultural, and environmental objectives are also not easily defined, for TOs, Rangers, or non-Indigenous funders. Nevertheless, Indigenous-focused M&E processes can provide further ‘proof of concept’ for Ranger and IPA programs, which have grown exponentially in recent decades. The research indicates that improved communication and understanding about the holistic objectives of ILSM, supported by collaborative governance of ISLM programs, could contribute to the development of fit-for-purpose M&E processes, which support and respect Indigenous evaluative methods and tools.

Situated in an arid desert environment at the centre of the Australian continent, MacDonnell Regional Council (MRC) is comprised of thirteen remote Aboriginal communities spanning across a region the size of Victoria. Out of the thirteen communities, only nine have access to 4G or mobile networks and out of this nine, six have received connection only in the last two years. In addition, during the last two years Northern Territory Public Libraries (NTPL) has established free Wi-Fi hotpots in eleven out of the thirteen communities. Use of mobile devices and interaction with the internet is still very new for many MRC residents.

Remote arid Australian towns already experience high summer temperature and are projected to have warmer future temperatures due to climatic changes. It is also home to many Indigenous women who prefer an outdoor lifestyle and have poor perinatal outcomes. Quantitative analysis of preterm birth and temperature data indicated higher risks to preterm births among Indigenous women in central Australia. This paper aims to report midwives’ observations on the effects of hot weather on poor perinatal outcomes in a central Australian town. Semi-structured interviews were conducted with 12 registered midwives providing perinatal services to families in central Australia. The interview responses were coded and classified against the major themes. None of the midwives perceived any direct relationship between heat exposure and preterm birth, but reported increased incidences of dehydration, exhaustion, discomfort and requests for induction among pregnant women which were often treated before further complications. A quarter of the respondents also mentioned that Indigenous pregnant women do not complain, even when symptoms of heat stress are evident. Quantitative analysis of perinatal and temperature data indicated increased risks to preterm births, but did not provide information on discomfort, dehydration, exhaustion or more requests to be induced. The study also shows that it is important for midwives and health practitioners to be culturally-sensitive to the fact that certain population groups tend not to complain, even if they are experiencing symptoms of heat stress. This research highlights the importance of cultural training for midwives and their role in alerting pregnant women to take precautionary measures during summer periods.

Vertical leakage (discharge to upper aquifers) is an important but poorly constrained component of water balance in the Great Artesian Basin (GAB), Australia. It ranges from negligible discharge where the GAB is overlain by aquitards, to high discharge where artesian water feeds the shallow unconfined aquifer (thereby raising the water table) causing elevated surface soil moisture and extensive surface salinisation. Adequately representing the temporal and spatial variability of vertical leakage is difficult due to the large scale over which the discharge occurs. An innovative method is presented that integrates a supervised classification of high-discharge zones using time-series Landsat data with landform mapping information to improve classification results. ‘Wetness persistence’ and ‘salt persistence’ classes, determined from the time series data, are related to groundwater discharge processes through a discharge framework that allows scaling up of field-based discharge estimates. The results show that using multi-image classification integrated with landform data will significantly reduce uncertainty by reducing false positives. No significant temporal trends were found in a time series assessment, with results featuring high variability, most likely due to image normalisation issues. The lack of a clear temporal signal suggests that an assumption of steady-state discharge is valid for estimating annual fluxes of vertical leakage. Supervised classification and landform outputs provide updated knowledge on GAB vertical leakage rates by providing useful lower and upper bounds of discharge rates respectively. Additionally, groundwater-dependent ecosystem classification, covering the full extent of the basin margins, is a new source of information resulting from the work.

OBJECTIVE: To assess primary care processes and clinical characteristics of adults with diabetes in remote northern Australian Indigenous communities. DESIGN: Clinical audit from diabetes registers in 21 remote primary healthcare centres in the Torres Strait Health Service District (n = 921), three in Cape York, Queensland (n = 252), and three in the Northern Territory (n = 194), between September 2002 and February 2003. PARTICIPANTS AND SETTING: Aboriginal and Torres Strait Islander adults with diabetes who were receiving their routine diabetes care in these 27 centres. MAIN OUTCOME MEASURES: Provision of regular checks for weight, blood pressure, glycaemia (HbA(1c)), proteinuria, lipid levels, renal function, eyes and feet, influenza and pneumococcal vaccination. Weight, blood pressure and glycaemic control. RESULTS: Most routine diabetes checks were delivered according to recommended schedules, except for eye and foot checks in the NT. There were uniformly high rates of appropriate treatment for hypertension and albuminuria, but low rates of insulin treatment and self-monitoring despite a high mean HbA(1c) level (8.9%). Vaccination rates were low in the NT. Torres Strait Islanders with diabetes were significantly heavier than Aboriginals, but had lower mean diastolic blood pressure (77.3 mmHg compared with 79.5 mmHg) and lower prevalence of albuminuria and smoking. CONCLUSION: A high proportion of Aboriginals and Torres Strait Islanders requiring treatment for high blood pressure and proteinuria are receiving it. However, there is dissonance between the relatively high rates of routine checks and apparent lack of therapeutic action on glycaemia. More intensive management of glycaemia, including improved nutrition, exercise and (probably) insulin, is required to reduce microvascular complications.

The No Germs on Me (NGoM) Social Marketing Campaign to promote handwashing with soap to reduce high rates of infection among children living in remote Australian Aboriginal communities has been ongoing since 2007. Recently three new television commercials were developed as an extension of the NGoM program. This paper reports on the mass media component of this program, trialling an evaluation design informed by the Theory of Planned Behaviour (TPB). Methods: A survey questionnaire taking an ecological approach and based on the principals and constructs of the TPB was developed. Surveys were completed in six discrete Aboriginal communities immediately before and on completion of four weeks intensive televising of the three new commercials. Results: Across the six communities access in the home to a television that worked ranged from 49 to 83 % (n = 415). Seventy-seven per cent (n = 319) of participants reported having seen one or more of the new commercials. Levels of acceptability and comprehension of the content of the commercials was high (97 % n = 308). Seventy-five per cent (n = 651) of participants reported they would buy more soap, toilet paper and facial tissues if these were not so expensive in their communities. For TPB constructs demonstrated to have good internal reliability the findings were mixed and these need to be interpreted with caution due to limitations in the study design. Conclusions: Cultural, social-economic and physical barriers in remote communities make it challenging to promote adults and children wash their hands with soap and maintain clean faces such that these behaviours become habit. Low levels of access to a television in the home illustrate the extreme level of disadvantage experienced in these communities. Highlighting that social marketing programs have the potential to increase disadvantage if expensive items such as television sets are needed to gain access to information. This trial of a theory informed evaluation design allowed for new and rich information to be obtained about community members’ beliefs, attitudes and intentions towards teaching and assisting children so safe hygiene behaviours become habit. Findings will support an evidence-based approach is taken to plan future NGoM program activities.

Indigenous fire management is experiencing a resurgence worldwide. Northern Australia is the world leader in Indigenous savanna burning, delivering social, cultural, environmental and economic benefits. In 2016, a greenhouse gas abatement fire program commenced in the savannas of south-eastern Arnhem Land in the Northern Territory, managed by the Indigenous Yugul Mangi rangers. We undertook participatory action research and semi-structured interviews with rangers and Elders during 2016 and 2019 to investigate Indigenous knowledge and obtain local feedback about fire management. Results indicated that Indigenous rangers effectively use cross-cultural science (including local and Traditional Ecological Knowledge alongside western science) to manage fire. Fire management is a key driver in the production of bush tucker (wild food) resources and impacts other cultural and ecological values. A need for increased education and awareness about Indigenous burning was consistently emphasized. To address this, the project participants developed the Yugul Mangi Faiya En Sisen Kelenda (Yugul Mangi Fire and Seasons Calendar) that drew on Indigenous knowledge of seasonal biocultural indicators to guide the rangers’ fire management planning. The calendar has potential for application in fire management planning, intergenerational transfer of Indigenous knowledge and locally driven adaptive fire management.

Introduction Rotavirus vaccines were introduced into the Australian National Immunisation Program in 2007. Despite this, Northern Territory Indigenous children continue to be hospitalised with rotavirus at a rate more than 20 times higher than non-Indigenous children in other Australian jurisdictions, with evidence of waning protection in the second year of life. We hypothesised that scheduling an additional (third) dose of oral human rotavirus vaccine (Rotarix, GlaxoSmithKline) for children aged 6 to &lt;12 months would improve protection against clinically significant all-cause gastroenteritis.Methods and analysis This Bayesian adaptive clinical trial will investigate whether routinely scheduling an additional dose of Rotarix for Australian Indigenous children aged 6 to &lt;12 months old confers significantly better protection against clinically important all-cause gastroenteritis than the current two-dose schedule at 2 and 4 months old. There are two coprimary endpoints: (1) seroconversion from baseline serum anti-rotavirus immunoglobulin A (IgA) titre &lt;20 U/mL prior to an additional dose of Rotarix/placebo to serum anti-rotavirus IgA titre &gt;20 U/mL following the administration of the additional dose of Rotarix/placebo and (2) time from randomisation to medical attendance (up to age 36 months old) for which the primary reason is acute gastroenteritis/diarrhoea. Secondary endpoints include the change in anti-rotavirus IgA log titre, time to hospitalisation for all-cause diarrhoea and for rotavirus-confirmed gastroenteritis/diarrhoea, and rotavirus notification. Analysis will be based on Bayesian inference with adaptive sample size.Ethics, registration and dissemination Ethics approval has been granted by Central Australian Human Research Ethics Committee (HREC-16-426) and Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC-2016-2658). Study investigators will ensure the trial is conducted in accordance with the principles of the Declaration of Helsinki and with the ICH Guidelines for Good Clinical Practice. Individual participant consent will be obtained. Results will be disseminated via peer-reviewed publication. The trial is registered with Clinicaltrials.gov (NCT02941107) and important modifications to this protocol will be updated.Trial registration number NCT02941107; Pre-results.

Many international bodies and agencies such as the UNDP and the World Bank are embracing IT, telecommunications and the Internet in particular as promising vehicles for development of the least developed countries. Internet and related technologies are being investigated as more efficient mechanisms for delivery of government services, health care and civil administration in remote areas. The paper is an analysis of the Local Government Association of the Northern Territory (LGANT) Internet Pilot Project?a trial project funded under the Regional Telecommunications Infrastructure Fund (RTIF) to implement e-mail and Internet capabilities in four remote communities in the Northern Territory of Australia. The pilot is a precursor to a much larger proposal which aims to provide similar capabilities to 66 community government councils throughout the Northern Territory. The paper concludes that Internet and e-mail have an important future in remote areas of the Northern Territory and, more importantly, that community councils are an appropriate, resilient locus for their development.

INTRODUCTION: Generations of Aboriginal people have been<strong> </strong>exposed to strings of traumatic events with devastating psychosocial health consequences, including psychiatric morbidities and mortalities, and medical complications. Posttraumatic Stress Disorder (PTSD) is a psychiatric morbidity directly linked to traumatic events. Despite research findings indicating traumatic exposure and resultant PTSD in Indigenous communities, little attention has been given to this condition in mental healthcare delivery. Consequently, clinical and psychosocial interventions are misguided and failed to deliver positive outcomes. The objective of this study is to explore the relationship between exposure to traumatic events, prevalence of PTSD and alcohol abuse in remote Aboriginal communities in Western Australia. METHODS: A combination of structured clinical interview and multiple survey questionnaires - Composite International Diagnostic Interview (CIDI), and Impact of Events Scale (IES), Alcohol Use Disorder Identification Test (AUDIT) and Indigenous Trauma Profile (ITP) - were administered to 221 Indigenous participants aged 18 to 65 years. RESULTS: The overwhelming majority, 97.3% (n=215) of participants were exposed to traumatic events. Analysis of CIDI results using DSM-IV diagnostic criteria shows a life time prevalence of 55.2% (n=122) for PTSD, 20% (n=44) for major depression (recurrent) and 2.3% (n=5) for a single episode. A total of 96% (n=212) participants reported consuming a drink containing alcohol and 73.8% (n=163) met diagnostic criteria for alcohol use related disorders, abuse and dependence. Of participants who met the PTSD diagnostic criteria, 91% (n=111) met diagnostic criteria for alcohol use related disorders. Other impacts of trauma such as other anxiety disorders, dysthymic disorder and substances abuses were also identified. CONCLUSION: The rate of exposure to traumatic events and prevalence of PTSD are disproportionately higher in the communities studied than the national average and one of the highest recorded in survivors of specific traumatic events in the world. A very high rate of alcohol abuse and dependence in participants who met diagnostic criteria for PTSD demonstrates correlation between alcohol abuse and PTSD. It also suggests that alcohol is used as self-medication.

Background Lung function in early adulthood has been shown to influence future morbidity and mortality. Its impact may vary across ethnic groups due to potential gene-environment interactions. There are limited data on risk factors for lung function deficits amongst the Australian Aboriginal population, particularly on early life exposures. The aim of our study was to investigate the association of perinatal and early life exposures on lung function in this population.Methods We used data from the Australian Aboriginal Birth Cohort (ABC), a birth cohort of 686 singleton babies born to a mother who self-identified as either Aboriginal and/or Torres Strait Islanders. Linear regression was used to evaluate the association between perinatal and early life exposures with FEV1, FVC, FEV1%predicted, FVC%predicted and FEV1/FVC ratio as individual outcomes in turn. Age, sex, height and smoking status were identified as a priori confounders for FEV1, FVC and FEV1/FVC. Smoking status was an a priori confounder for FEV1 and FVC% predicted. We used Directed Acyclic Graphs to identify minimally sufficient adjustment set of confounders.Results 459 (70.7%) participants were followed-up, of which spirometry undertaken on 312 but only 148 spirometry traces were deemed acceptable and included in subsequent analyses. The cohort mean age was 25.8 years (SD=1.1) and 74 (50%) were male. 62.8% were current smokers, 68.9% lived in remote communities and 58.8% depended on benefits as their main source of income. We found that 59 people (39.9%, 95%CI 31.9–48.2) had abnormal spirometry patterns (38 restrictive, 21 obstructive). Lung function parameters were strongly associated with maternal age, respiratory hospitalizations in early childhood and place of residence at birth (table 1).Conclusion Spirometry deficits are common in our cohort. Pre-school hospitalisations for respiratory infections and living remotely are risk factors for lower lung function in young Australian Aboriginal adults whilst increased maternal age is associated with better lung function. Studies evaluating perinatal and early life interventions that optimise attainment of normal lung function are required to minimise future morbidity and mortality in Aboriginal adults.View this table:Abstract P62 Table 1 Association between perinatal and early life exposures with FEV1, FEV1% predicted, FVC, FVC% predicted and FEV1/FVC ratio

Objectives To assess the risks of stroke and cardiovascular mortality for Aboriginal and non-Aboriginal Australians with atrial fibrillation. Design Retrospective data linkage cohort study. Setting, participants All people aged 20?84 years hospitalised with atrial fibrillation in Western Australia during 2000?2012. Main outcome measures Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10-year risks of stroke and of cardiovascular and all-cause mortality. Results Among 55 482 index admissions with atrial fibrillation, 7.7% of 20?59-year-old patients and 1.3% of 60?84-year-old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20?59 years had CHA2DS2-VASc scores of 2 or more (59.8% v 21.8%). In 20?59-year-old Aboriginal patients, the incidence during follow-up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5?4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9?8.9) were markedly higher than for non-Aboriginal patients. Stroke incidence was higher for 60?84-year-old patients, but the difference between Aboriginal and non-Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3?2.0). Cardiovascular mortality during follow-up was also higher for 20?59-year-old Aboriginal patients (IRR, 4.4; 95% CI, 4.3?5.9). The hazards of stroke (adjusted HR [aHR], 1.67; 95% CI, 1.22?2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18?1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA2DS2-VASc score were the most influential factors. Conclusion Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non-Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence-based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.

Two major forms of grassland are widespread in Australia. Those dominated by native species, the predominant harbours for many native insects, are of most conservation concern, whilst the pastures dominated by introduced alien grass species provide a rather different suite of resources. In many instances they are not an adequate substitute for the composition and variety of native flora that they replace. The variety of native grasslands, and the implications of changes from alien introductions are outlined below.

This article revisits, analyzes and critiques Bruce Chatwin’s 1987 bestseller, The Songlines,1 more than three decades after its publication. In Songlines, the book primarily responsible for his posthumous celebrity, Chatwin set out to explore the essence of Central and Western Desert Aboriginal Australians’ philosophical beliefs. For many readers globally, Songlines is regarded as a—if not the—definitive entry into the epistemological basis, religion, cosmology and lifeways of classical Western and Central Desert Aboriginal people. It is argued that Chatwin’s fuzzy, ill-defined use of the word-concept “songlines”2 has had the effect of generating more heat than light. Chatwin’s failure to recognize the economic imperative underpinning Australian desert people’s walking praxis is problematic: his own treks through foreign lands were underpropped by socioeconomic privilege. Chatwin’s ethnocentric idée fixe regarding the primacy of “walking” and “nomadism,” central to his Songlines thématique, well and truly preceded his visits to Central Australia. Walking, proclaimed Chatwin, is an elemental part of “Man’s” innate nature. It is argued that this unwavering, preconceived, essentialist belief was a self-serving construal justifying Chatwin’s own “nomadic” adventures of identity. Is it thus reasonable to regard Chatwin as a “rogue author,” an unreliable narrator? And if so, does this matter? Of greatest concern is the book’s continuing majority acceptance as a measured, accurate account of Aboriginal belief systems. With respect to Aboriginal desert people and the barely disguised individuals depicted in Songlines, is Chatwin’s book a “rogue text,” constituting an act of epistemic violence, consistent with Spivak’s usage of that term?

Objective The incidence, presentation and outcomes of lupus nephritis (LN) varies with geography, ethnicity, socioeconomic status, and gender. There is relatively few data on LN in the non-Caucasian populations in Australia. This study describes the clinical presentation, histological features, natural history, and outcomes of a historical cohort of Aboriginal and Torres Strait Islanders people in Far North Queensland with biopsy-proven LN. Design Retrospective observational study. Setting Cairns and Hinterland Hospital and Health Service, Queensland, Australia. Participants Aboriginal and Torres Strait Islander patients with biopsy-proven LN treated between 1990 and 2013. Main outcome measures Renal replacement therapy and overall patient survival. Results Aboriginal and Torres Strait Islander people represented a substantial proportion (n=16/40, 40%) of all patients diagnosed with LN during the observation period. The frequency of nephrotic range proteinuria (n=11/14, 78.5%), eGFR <60 mL/min/1.73m2 (n=6/14, 42.8%) and proliferative LN (n=13/16, 81.25%) was high at the time of presentation. Despite use of multiple immunosuppressive agents, the overall rate of remission was poor (n=4/14, 28.5%), and incidence of ESKD (n=4/14, 28.5%) and death (n=5/16, 31.25%) was high. Conclusion The clinical presentation of LN in Aboriginal and Torres Strait Islanders in Far North Queensland is severe and the response to standard immunosuppressive therapy is unsatisfactory. Larger prospective multi-centre studies are required to better understand ethnic disparities in prognosis and response to immunosuppressive therapy in this specific population. This article is protected by copyright. All rights reserved.

Indigenous community governance in Australia is currently undergoing a change through an emerging economically rationalist approach, as promoted by Australian Federal, State and Territory Governments. This approach characterises outstation life as a lifestyle choice at the taxpayer’s expense (Martin & Owens, 2015). This change is manifested through increasing rhetoric about the withdrawal of funding for services to outstations and in some cases, the “closing” down of remote outstations (or homelands) due to their “unviability”(Altman, Kerins, Fogarty, & Webb, 2008; Kerins, 2009; Solonec, 2011). There are serious questions about the impacts of such closures on the residents themselves as well as the impacts on the larger communities and towns to which outstation people are re-settled. Such drastic measures have deep effects on Indigenous people, especially elders with a deep cultural need to maintain connection to country; yet this does not appear to be a consideration of policy under such an economically rationalist approach. This paper therefore reviews recent outstation policy at Federal, State and Territory levels and proposes some alternative ways to enable outstation people to live well on country. The points of view expressed in this paper are based on my experience working with people in remote indigenous communities between 1995 and 2008, and observation of the direction in Indigenous policy from then to the present.