Remote Australia Online

This chapter draws on data from a large national study into the successful practices of schools in remote and very remote locations across Australia. These schools have significant proportions of Indigenous learners. To be part of the study, the schools must have at least 80% of their students identifying as Indigenous. The study seeks to identify the practices that contribute to the success in mathematics/numeracy in these schools. While there are many practices that have emerged from the study, this chapter focuses on the adoption of culturally responsive pedagogies that are linked to the issue of "shame". Shame is a cultural construct that is remarkably different from Western conceptions and is deeply embdedded in the cultural practices and dispositions of Indigenous Australians. Teachers in the study have developed a number of strategies to work with this notion and to bring about success for the learners. One of the key strategies creates opportunities for the students to be "proud" of their language and culture.

Using the papers of the Gibb Committee on the future of Aboriginal communities on pastoral properties in the Northern Territory (1970?72), this article contributes both theoretically and empirically to the history of self-determination policy. It reveals non-Aboriginal authorities? thinking at a crucial moment in the history of the governing of remote Aboriginal Australians: the dissolution of the ?pastoral-feudal? order under the impact of ?equal wages? and access to cash social security. The article argues that the state and pastoralists had to consider two modalities of Aboriginal empowerment: as individual citizen-workers whose labour time had now to be valued as a commodity; and as ?communities? aspiring to autonomy from the authority of pastoralists. The article concludes by arguing that the settler colonial state's imperatives are both ?capitalist? and ?custodial?.

Natural hazards cause sustained loss to the environment, yet the economic costs are largely not accounted for due to a lack of market measures. This research applies methods of global and national costing and proposes an integrated framework that incorporates marketable and non-marketable losses including those to the environment. These methods are applied to bushfires in the Northern Territory for estimating the cost of loss of ecosystem services as a surrogate. These fire events affect 20 per cent of the total land area annually (based on 18 years average from 2000–2018) and cost ~$150 million per annum. Losses were greatest on the Indigenous lands, followed by pastoral and conservation areas. It is calculated that the effect of bushfires on ‘loss of wellbeing’ for the remote Indigenous population is, conservatively, $272 million per year. An understanding of the costs of loss of environment is essential to develop emergency management policies that are effective in enhancing the resilience of communities.

Under a funding agreement contributed to by four Commonwealth Agencies and the State of Queensland, TSIRC was the proponent of and project managed the delivery of a $23.8M coastal defence project. The project effectively created at perimeter defence around the Saibai community from extreme tidal and storm impacts, and with provision to counter future sea level rise impacts. Additional works were undertaken at Boigu Island to improve seawall and bund wall integrity, in the first stage of the overall coastal defence works. Under a separate funding arrangement, coastal erosion protection works were undertaken by TSIRC staff with support from local indigenous persons at Poruma Island in 2018. Additional works on these and other islands are currently in the planning and design phase. This paper explores the threats and reviews the process that TSIRC has undertaken over the last few years to develop a positive way forward for these communities. It considers the roles and need for various expertise that was drawn into the work, including planners, community leaders, coastal engineers, council staff, agencies and contractors. It is hoped that the paper will lay bare how well-intentioned decisions in the past have led to issues today and highlight the way an integrated approach backed by government agencies can lead to good outcome.

Inclusive practices can be interpreted broadly as the ways in which we ensure that all students have an equitable education to optimise student learning outcomes, achievement and attendance. In this paper, Aboriginal pre-service teachers, all currently working towards their teaching degrees and all working as Aboriginal teaching assistants in Northern Territory (NT) classrooms, share their perceptions regarding barriers to inclusion for students in their schools and communities. The reflections were drawn from their university assignments in a unit on inclusive education, which focused on teaching all students including those with additional needs. Pre-service teachers were asked to name barriers to learning for their school-aged students and make suggestions about changes that would help students in/from their communities engage more successfully with school. This paper is intended to privilege the voices of this cohort of pre-service teachers who have significant insight into their schools, given many of them are working in the schools that they themselves attended as students. Using their assignments in the inclusive education unit as a basis for understanding their experiences with exclusion, identified barriers are examined along with their proposed solutions. This work calls for greater cultural inclusion of local languages and traditions. Inclusive and equitable education requires partnership with families and community members so that the education delivered, truly caters for students’ diverse learning needs.

Objective To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. Design and participants Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. Main outcome measure(s) Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. Results Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. Conclusion Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.

Objective: To investigate the association between hearing impairment (HI) and Year 1 school attendance in Aboriginal children in the Northern Territory (NT) of Australia. Methods: Observational cohort study (n=3,744) by analysing linked individual-level information for Aboriginal children from the NT Government school attendance records, NT Perinatal Register and Remote Hearing Assessment dataset, and community level data for relative remoteness, socioeconomic disadvantage and housing crowdedness. Results: Children with unilateral hearing loss, mild HI and moderate or worse HI had significantly lower Year 1 attendance than those with normal hearing, attending 5.6 (95%CI, −9.10 ∼−2.10), 4.0 (95%CI, −7.17 ∼−0.90) and 6.1 (95%CI, −10.71 ∼−1.49) days fewer, respectively. Other variables that yielded significant association were: male gender, having attended preschool less than 20% of available days, speaking English as second language, twin birth and average household size >5. Conclusions: Aboriginal children with any level of HI are likely to have lower school attendance rates in Year 1 than their peers with normal hearing. Implications for public health: In this population, where the prevalence of otitis media and accompanying HI remains extremely high, the early detection and management of hearing loss on entry into primary school should be included in the measures to improve school attendance.

Background: Previous studies have reported a high prevalence of chronic otitis media (OM) and hearing impairment (HI) in Aboriginal children in the Northern Territory (NT) of Australia. Children affected by these disorders are believed to be at increased risk for adverse outcomes in early childhood development, school attendance, academic performance, and child maltreatment and youth offending. However, to date, there have been no studies quantifying the association between HI and these outcomes in this population. Objective: This study will investigate the association between HI and the 5 outcomes in Aboriginal children living in remote NT communities. Methods: Individual-level information linked across multiple administrative datasets will be used to conduct a series of retrospective observational studies on selected developmental and school outcomes. The predictor variables for all studies are the results from audiometric hearing assessments. The outcome measures are as follows: Australian Early Development Census results, representing developmental readiness for school, assessed around 5 years of age; Year 1 school attendance rates; Year 3 school-based academic performance, assessed in the National Assessment Program—Literacy and Numeracy; incidence of child maltreatment events (including both notifications and substantiated cases); and incidence of a first guilty verdict for youth offenders. Confounding and moderating factors available for the analysis include both community-level factors (including school fixed effects, socioeconomic status, level of remoteness, and housing crowdedness) and individual-level factors (including maternal and perinatal health and hospital admissions in early childhood). Results: The study commenced in 2018, with ethics and data custodian approvals for data access and linkage. This has enabled the completion of data linkage and the commencement of data analysis for individual component studies, with findings expected to be published in 2019 and 2020. Conclusions: This study will provide first evidence of the impact of OM-related HI on the developmental, educational, and social outcomes of Australian Aboriginal children. The findings are expected to have significant implications for policy development, service design, and resource allocation. International Registered Report Identifier (IRRID): RR1-10.2196/15464

Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.

The expression ‘two-way’ teaching and learning has a long history in the Northern Territory in relation to remote Indigenous education. However, it is not applied with any degree of consistency; the term ‘two-way’ functions as a summary expression for a diverse array of pedagogical approaches. This article presents qualitative research from the remote, Yolŋu ‘homeland’ community at Gäwa in north-east Arnhem Land as Indigenous first-language, case-study data. It also aims to disambiguate ‘two way’ models as current community aspirations are compared with historical policies and applications of ‘two-way’ approaches from across the Northern Territory. These include Indigenous perspectives, Indigenous learning-style, team-teaching, bilingual education, ‘bothways’ education and domain separation.

In early 2019, Australia's Northern Territory (NT) government announced the $106 million funding and promotion of a new state-wide Territory Arts Trail featuring Indigenous art and culture under the banner 'The World's biggest art gallery is the NT'; Some of the destinations on the Arts Trail are Indigenous art centres, each one a nexus of contemporary creativity and cultural revitalisation, community activity and economic endeavour. Many of these art centres are extremely remote and contend with resourcing difficulties and a lack of visitor awareness. Tourists, both independent and organised, make their travelling decisions based upon a range of factors and today, the availability of accessible and engaging online information is vital. This makes the quality of the digital presence of remote art centres, particularly their website content, a critical determinant in visitor itineraries. This digital content also has untapped potential to contribute significant localised depth and texture to broader Indigenous arts education and comprehension. This article examines the context-based website content which supports remote Indigenous art centre tourism and suggests a strategic framework to improve website potential in further advancing commercial activities and Indigenous arts education.

Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention.

Background Rural and remote patients have reduced access to palliative care, often resulting in inter-hospital transfers and death a long way from home and family. Katherine Hospital (KH), a 50-bed hospital services a population with high Aboriginality who experience this issue. Aims To characterise trends in mortality and transfers at a remote hospital in reference to increasing capacity to provide palliative care. Methods Retrospective analysis of deaths in patients over 18 years of age, admitted between 2008 and 2018 at KH, Northern Territory. Outcome measures include number of deaths, aeromedical transfers to tertiary facility, palliative care episodes, demographics including Aboriginality, admission data and comorbidity. Statistical analysis included unpaired t-test, chi-square test and regression analysis. Results The number of deaths in KH increased from 23 (0.88% of inpatient admissions) in 2011 to 52 in 2018 (1.7%). During the same period, the proportion of all deaths classified as palliative increased from 51.4 to 66.0% (P = 0.001), with fewer deaths occurring in the emergency department (17.2–1.4% for the last 3 years, R = 0.75, P = 0.008). The number of aeromedical transfers of patients from KH to tertiary centres decreased from 769 (10.4% of all admissions) in 2011 to 434 (3.4%) in 2018 (P = 0.006). Conclusions Increasing the capacity of a remote hospital to provide palliative care allowed more patients to die closer to home and decreased inappropriate aeromedical retrievals. An increased in-hospital mortality rate should not be misinterpreted as reflecting suboptimal care if palliative intent, patients' wishes and non-clinical risk factors have not been ascertained.

As part of the Cape York Welfare Reform Trial (CYWRT), which has been running in the remote Aboriginal towns of Aurukun, Hope Vale, Mossman Gorge and Coen since 2008, Family Responsibilities Commissioners have the unprecedented ability to quarantine welfare payments. Critics claim these 'BasicCards,' which cannot be spent on alcohol, tobacco, pornography or gambling, brings shame to Aboriginal people - marking them as dependants, deemed incapable of responsible spending. Evaluations of the CYWRT paint a more complicated picture. While many of the 'spectators' of the CYWRT report 'welfare reform stigma,' the 'subjects' themselves are more positive. This paper draws on ethnographic research in Hope Vale to argue that these categories overlap with loosely defined, porous social groups that developed during the town's mission past, described as the 'engaged' and 'embedded' Hope Valers, respectively. The engaged group tends to be more aware of and sensitive to the views of the dominant society and to subscribe to its 'ideology of respectability.' Meanwhile, the latter group tends to adhere to a more egalitarian 'ideology of relatedness,' and do not experience the shame, even when their own welfare is quarantined, because the behaviours that trigger quarantining are normalised within their highly circumscribed domain.

Introduction Our study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.Methods In collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.Results More than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.Discussion We outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.

Objectives To evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.Design Retrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk.Setting The benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities.Participants None had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded.Intervention Aspirin at a dose of 75–162 mg/day.Outcome measures Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds.Results 8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding.Conclusion Aspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.

Phyllosticta cavendishii has been recorded in the Northern Territory (NT) of Australia occurring on non-Cavendish bananas since 1991. The race of P. cavendishii that infects Cavendish bananas is considered exotic to Australia and classified as an emergency plant pest. In July 2013, P. cavendishii was detected on Cavendish bananas near Darwin, NT. Here it is reported the diagnoses and field observations carried out during the Incident Definition Phase of the national biosecurity response, from July 2013 to October 2014. Of 1395 banana samples collected from 676 properties, 479 were positive for freckle disease, including 463 samples with P. cavendishii and 17 samples with P. maculata. Phyllosticta cavendishii was detected in 256 properties, including 62 properties where it was detected on Cavendish banana plants, within six distinct geographical zones across the NT. Phyllosticta cavendishii was detected on two cultivars within the Cavendish subgroup and six non-Cavendish. Multigene characterisation of Phyllosticta cultures showed that P. cavendishii was isolated from both Cavendish and non-Cavendish cultivars. Multiloci phylogeny analyses also revealed that the P. cavendishii strain in the outbreak have identical sequence similarity to the holotype (CBS H-20918), clade 2 P. cavendishii isolates which infect both Cavendish and non-Cavendish cultivars in South-east Asia and Oceania. The genetic data in this study shows that there is one P. cavendishii strain infecting both Cavendish and non-Cavendish cultivars in the outbreak. However, historical data and field observations provided anecdotal evidence for the existence of two races of P. cavendishii, including one that does not infect Cavendish bananas.

Objectives The aim of the study was to investigate the public health challenge to provide chronic disease management to Indigenous Australians who wish to remain on traditional lands and not cede tenure for health services. Study design Within the context of the United Nations (UN) Declaration on the Rights of Indigenous Peoples (DRIP), this research is intended to reveal health aspects requiring holistic consideration and thus enhance the resilience of Australia's First Nations Peoples. Methods Lead authorship was by an Australian Aboriginal author, using methods of an information and literature review. A case study of chronic kidney disease illustrates the challenges remaining with native title land tenure. Results Despite continuing land tenure challenges, Indigenous Australians have demonstrated resilience and resourcefulness to engage and secure improvements in health and other basic services. Conclusions The Australian Government needs to revisit its duty to respect, protect and fulfil its obligation to the country's First Nations people in a human rights–based approach towards improved, accessible and culturally appropriate health care for chronic diseases.

Australia is canine rabies free but free-roaming, domestic dog populations in remote northern communities are at risk of an incursion due to proximity to rabies-endemic south-east Asia. Unrestricted contact between dogs could facilitate rabies spread following an incursion, and increase the impact on both dogs and people. Whilst dog vaccination is the foundation of rabies prevention, control strategies could be enhanced by understanding the temporal pattern of roaming and associated risk factors, so that movement restrictions can be targeted. Global positioning system datasets from 132 dogs in eight Indigenous communities in the Torres Strait and Northern Peninsula Area (NPA) of Australia were analysed using regression methods. The influence of risk factors (including age, sex, location, season and hour of day) on dogs’ distance from their residences were assessed. Dogs roamed furthest in the NPA and during the dry season. Daily peaks in mean roaming distance were observed at 1000–1100 hrs and 1700–1800 hrs in the Torres Strait, and 1700–1800 hrs in the NPA. These findings demonstrate that understanding community-specific temporal roaming patterns can inform targeted movement restrictions during an outbreak of rabies in remote communities in northern Australia.

Objective To determine the population of owned dogs and cats in Indigenous communities in the Northern Territory (NT), and compare the data with those for the average Australian household. Methods Results of 20 Indigenous community animal health programs were analysed for species present and dog and cat numbers. The female breeding and puppy populations were also identified. Results The average dog population density was significantly higher than the average Australian household, with an average of 24.4 dogs per 10 households, but the average cat population density was similar (3.3 cats per 10 households). Numbers of other species were not determined. The average percentage of puppies in these communities was 17.6% of the treated canine population, the average percentage of breeding canine females was 18.6% of the treated canine population, and the average percentage of breeding feline females was 19.7% of the total feline population. Conclusions Dog populations in NT Indigenous communities were at least 6.3-fold higher per household compared with data for the rest of Australia. Cat populations per household were similar to the overall population. Factors contributing to the relatively high dog populations in remote Indigenous communities include a lack of veterinary presence, community remoteness, poor socioeconomic factors, poor house and yard designs, cultural reasons, communal beliefs, lack of community animal management and a lack of funding. We believe that animal health programs are an important way of addressing a number of these issues. Other elements that should be addressed include improving house and yard design, increasing education regarding animal health, care and welfare, and increasing the training and presence of health and animal professionals.

Objective To investigate the roaming of Indigenous community dogs and potential interaction with wild dogs and dingoes. Design Cross-sectional survey and longitudinal follow-up study. Methods Six remote Indigenous communities in Cape York Peninsula and Arnhem Land in northern Australia were selected. Hair samples were collected from community dogs and microsatellite DNA analyses were used to determine hybrid (>10% dingo DNA) status. Dogs were fitted with GPS collars and home range (ha) was estimated during monitoring periods of up to 3 days. Results In Cape York Peninsula, 6% of the 35 dogs sampled were dingo hybrids, whereas in Arnhem Land 41% of the 29 dogs sampled were hybrids. The median extended home range was estimated to be 4.54 ha (interquartile range, 3.40 − 7.71). Seven community dogs were identified with an estimated home range > 20 ha and home ranges included the bushland surrounding communities. No significant difference in home ranges was detected between hybrid and non-hybrid dogs. Conclusions Study results provide some evidence (dingo hybridisation, bushland forays) of the potential interaction between domestic and wild dogs in northern Australia. The nature of this interaction needs further investigation to determine its role in disease transmission; for example, in the case of a rabies incursion in this region.

Australia is underprepared for a rabies incursion due to a lack of information about how a rabies outbreak would spread within the susceptible canine populations and which control strategies would be best to control it. The aim of this study was to collect information to parameterize a recently developed dog rabies spread model as well as use this information to gauge how the community would accept potential control strategies. Such information–together with model outputs–would be used to inform decision makers on the best control strategies and improve Australia’s preparedness against a canine rabies incursion. The parameters this study focussed on were detection time, vaccination rates and dog-culling and dog movement restriction compliance. A cross-sectional survey of 31 dog-owners, using a questionnaire, was undertaken in the five communities of the Northern Peninsular Area (NPA) in northern Australia regarding community dog movements, veterinary visits, reporting systems, perceptions of sick dogs and potential human behaviours during hypothetical rabies outbreaks. It highlighted the significant shortfalls in veterinary care that would need to be vastly improved during an outbreak, who educational programs should be targeted towards and which dog movements should be restricted. The results indicate that men were significantly more likely than women to allow their dogs to roam and to move their dogs. The current low vaccination rate of 12% highlighted the limited veterinary services that would need to be substantially increased to achieve effective rabies control. Participation in mass vaccination was accepted by 100% of the respondents. There was lower acceptance for other possible rabies control strategies with 10–20% of the respondents stating a resistance to both a mass culling program and a ban on dog movements. Consequently, movement bans and mass dog culling would have limited effectiveness as a control strategy in the NPA community. More than half of the respondents said that they would report their sick dogs within a week. This would lead to a much more optimistic rabies detection time than observed in other regions with recent dog rabies outbreaks. Findings from this study can be used to parameterize a recently developed dog rabies spread model as well as to develop informed policies for managing a future rabies incursion, thus improving Australia’s preparedness against a canine rabies incursion.

Although Australia is canine rabies free, the Northern Peninsula Area (NPA), Queensland and other northern Australian communities are at risk of an incursion due to proximity to rabies infected islands of Indonesia and existing disease spread pathways. Northern Australia also has large populations of free-roaming domestic dogs, presenting a risk of rabies establishment and maintenance should an incursion occur. Agent-based rabies spread models are being used to predict potential outbreak size and identify effective control strategies to aid incursion preparedness. A key component of these models is knowledge of dog roaming patterns to inform contact rates. However, a comprehensive understanding of how dogs utilise their environment and the heterogeneity of their movements to estimate contact rates is lacking. Using a novel simulation approach – and GPS data collected from 21 free-roaming domestic dogs in the NPA in 2014 and 2016 – we characterised the roaming patterns within this dog population. Multiple subsets from each individual dog’s GPS dataset were selected representing different monitoring durations and a utilisation distribution (UD) and derived core (50%) and extended (95%) home ranges (HR) were estimated for each duration. Three roaming patterns were identified, based on changes in mean HR over increased monitoring durations, supported by assessment of maps of daily UDs of each dog. Stay-at-home dogs consolidated their HR around their owner’s residence, resulting in a decrease in mean HR (both core and extended) as monitoring duration increased (median peak core and extended HR 0.336 and 3.696ha, respectively). Roamer dogs consolidated their core HR but their extended HR increased with longer monitoring durations, suggesting that their roaming patterns based on place of residence were more variable (median peak core and extended HR 0.391 and 6.049ha, respectively). Explorer dogs demonstrated large variability in their roaming patterns, with both core and extended HR increasing as monitoring duration increased (median peak core and extended HR 0.650 and 9.520ha, respectively). These findings are likely driven by multiple factors that have not been further investigated within this study. Different roaming patterns suggest heterogeneous contact rates between dogs in this population. These findings will be incorporated into disease-spread modelling to more realistically represent roaming patterns and improve model predictions.

Globally, cardiovascular disease (CVD) accounts for millions of preventable deaths each year. Based on 2014–15 data, more than 11 million Australians (47%) have at least one chronic condition, with people living in rural and remote areas, and Indigenous Australians, having significantly increased chronic disease prevalence and risk. Access to health care in rural and remote areas is poor compared to metropolitan areas. This includes insufficient service provision for the needs of the population and the requirement of many rural and remote patients to travel long distances to access health care such as hospitals, general practitioners and emergency departments. As provision of primary health care is mainly located in urban and regional centres, it is of no surprise that secondary prevention services such as cardiac services, including cardiac rehabilitation (CR) programs, health services with cardiac capacity, and programs aimed at prevention, are mainly located in metropolitan and inner regional areas. This is concerning, as a leading reason for Royal Flying Doctor Service (RFDS) aeromedical retrievals is diseases of the circulatory system, with acute myocardial infarction (heart attack) being the leading diagnosis. Furthermore, many of the retrieval locations are in remote and very remote areas, with many of these locations having low primary care services per population. This is important, as rural and remote populations have higher levels of mortality and morbidity, related to delayed acute treatment (i.e. heart attack treatment delays), and limited access to chronic disease management. Furthermore, rural and remote populations have increased prevalence of smoking, overweight and obesity, mental health acuity, and alcohol and drug misuse, than people living in major cities. The RFDS currently provides extensive telehealth and primary healthcare support to patients in rural and remote communities across Australia including providing guidance on risk factors for CVD and evidence-based recommendations for treatment, although there are limited programs focusing on the rehabilitation of CVD patients. Participating in a CR program is a first critical step in a person’s recovery from their heart attack or heart event. Not only do these programs improve quality of life and risk factors, but people are 40% less likely to be readmitted to hospital and 25% less likely to die from another heart event if they have participated in CR. The reported barriers to participation in metropolitan and traditional hospital-based CR programs have included patient, provider, health system and societal-level barriers such as: older age, lower education level, a lack of perceived benefit, work or time constraints, transport difficulties, lack of referral, limited availability of programs and lack of patient financial reimbursement, as well as limited social or family support. In addition to these barriers, rural and remote patients face additional obstacles to participating in CR, including extensive travel time to access the few services that exist. To help overcome some of these barriers, there has been increasing availability of, and evidence for, alternative modes of delivery of CR, including phone-based, home-based and online CR. As such, there is an opportunity for rural and remote healthcare providers, such as the RFDS, to consider furthering the provision of innovative service developments to overcome these barriers to participation and address the significant treatment gap. For the RFDS, such an approach could consider telerehabilitation interventions in addition to the formulation and testing of an RFDS travelling CR service. Through geographical mapping, similar to the RFDS service planning operating tool (SPOT), this service could identify and visit communities in most need, via a locally-tailored program. Services, such as a travelling CR service, could potentially address the limitations of traditional CR program delivery, by removing attendance access barriers for rural and remote patients and providing continuity of care for CR.Regardless of the type of CR service the RFDS may develop or choose to implement in the future, it would ideally incorporate the Australian Cardiovascular Health and Rehabilitation Association (ACRA)’s CR guidelines of providing “equity and access to services”, utilise patient-centred telehealth and technology, and support and provide community-based CR. Further, the context of rural and remote healthcare provision must be carefully considered in service design. It is likely that the provision of co-designed, culturally appropriate CR services in rural and remote areas, that are understood, valued and supported by health professionals, would provide a much-needed service that would be highly utilised. The intended outcomes are likely to include improved quality of life, positive lifestyle modifications, and reductions in future CVD patient admissions to hospital and cardiac-related deaths.

This study elicited perceptions of nurses, doctors and allied health staff in rural and remote health facilities, about working with children and parents. This was a quantitative study using 'Working with Families', a validated and well-tested questionnaire, in the setting of seven rural and remote hospitals in North Queensland, Australia. The participants were 123 health professionals from the seven hospitals. The 'Working with Families' questionnaire consists of demographic characteristics and two questions about working with children and with their parents. Scores were compared and correlations sought with demographic characteristics. Scores were as follows (1=least positive, 5=most positive): working with children: 3.35 (95% confidence interval [CI] 3.22, 3.47), with parents 3.79 (95% CI 3.66, 3.92), mean difference -0.44 (95% CI -0.54, -0. 53; p < 0.001). No significant relationships occurred between scores and demographics. Family-centred care is the cornerstone of paediatric healthcare. People work in paediatrics and child health because they like children. Respondents were more positive about working with children than with parents. If staff find working with parents more difficult, the implementation of family-centred care may theoretically be negatively affected. Support and education about family-centred care and the newly emerging model, child centred care, may assist in overcoming less positive attitudes.