Remote Australia Online

In a world of continuous and fluid change, NT remote school organisations are caught within a social flux of patterned, structural educational inequality that models of Western-style leadership have largely been ineffective in altering. In this reform inertia I turn to the role that Indigenous leadership can play in breaking this cycle, and do so by reifying its legitimate and structural positioning against three core domains. These include: (1) what is Indigenous leadership and why does it matter, given schools are fundamentally about Western knowledge construction?; (2) in what ways does Indigenous leadership represent a strengthened reform plank in the navigation and development of NT remote school service provision, particularly given the impacts of structural turbulence that corrupts linear growth patterns?; and (3) what might a district education policy environment look like in enabling such policy trajectory?A key purpose of this paper is to identify and discuss the pivotal role that Indigenous leadership can play in moving NT remote schools along a continuum of development; a policy opportunity that has long existed nebulously connected, if not fully outside official NT Indigenous education policy settings. In this paper, NT Remote Indigenous Schools are sites of attention because they have consistently been the lowest performing of any jurisdiction in Australia. Of the 151 government schools in the NT, 110 are in remote and very remote contexts, with few validators to the structural placement of education. Of the 60,000 Indigenous members in the NT, 50,000 live in such contexts and Indigenous languages are the medium of economy and social/cultural life. From a pool of an approximate 1800 teachers in the NT, about 70 are Indigenous and most teach in urban contexts. What is behind this dichotomy and how can Indigenous leadership shift such patterned expressions of education inequality?

Diabetic retinopathy (DR) is the commonest cause of preventable blindness in working age populations, but up to 98% of visual loss secondary to DR can be prevented with early detection and treatment. In 2012, an innovative outreach DR screening model was implemented in remote communities in a state of Australia. The aim of this study was to explore the acceptability of this unique DR screening model to patients, health professionals and other key stakeholders.

A series of research projects conducted by the author in Australia in 2002–4 has thrown new light on the ways in which men in small rural towns do (or don’t) return to learn. This chapter summarises the evidence from some of these studies and places them in the context of a small but emerging literature on the distinctive and arguably different nature of men’s learning and their learning preferences. The research is timely in the light of concerns, both real and imagined, about men’s (McGivney, 1999a) and boys’ (Slade, 2002, House of Representatives 2002) differential rates of participation and attainment as compared with women and girls and changing discourses of gender and education (Lingard & Douglas, 1999). While there has been widespread historic gender segmentation of adult learning by field of study in most education sectors, segmentation involving men has not received sufficient or critical recent inquiry.

Australia’s Northern Territory (NT) has the country’s highest incidence and prevalence of kidney disease. Indigenous people from remote areas suffer the heaviest disease burden. Concerns regarding cost and sustainability limit the provision of dialysis treatments in remote areas and most Indigenous people requiring dialysis relocate to urban areas. However, this dislocation of people from their family, community and support networks may prove more costly when the broader health, societal and economic consequences for the individual, family and whole of government are considered.

This paper is the culmination of a research project involving four fieldtrips to the remote northwestern Australia town of Kununurra. The primary purpose of the research was to engage Kununurra’s visitors and residents in a participatory methodology for scenario based design to create a community-focused version of a professional fire mapping service, FireWatch. The research resulted in the development of MyFireWatch, a map based website which shows fire hotspots derived from satellite images across Australia, bringing this critical information to non-specialist users. The review of the take-up of MyFireWatch was conducted some 13 months after its launch in Kununurra, and the twelve interviewees involved were very positive overall. Their major concern was that visitors to Kununurra – especially backpackers and the senior self-drive tourists that Australians call ‘grey nomads’ – might not know about the service. A review of the tourist-focused sites in Kununurra reveals that organisations that promote tourism are reluctant to inform tourists about the potential dangers of their holiday destination. Thus, the culture and communication practices of tourism organisations are demonstrated to undermine the usefulness of otherwise valuable technological advances.

This paper presents an in depth case study focussed on an aspect of a broader Australian Government Department of Education and Training, Higher Education Participation and Partnership Program (HEPPP) (2016-17). The Creative Industries (CI) Project: Creative Industries: Re-imagining Regional and Remote Students' Opportunities involved university academics and their creative industries university mentors mounting a CI Roadshow in regional and remote NSW secondary schools with low SES and Aboriginal and Torres Strait Islander representation. The projects two components are: the CI Roadshow travelling to schools with hands-on workshops and a national YOUTUBE video screenings of young Creative Industries Innovators and Entrepreneurs to supplement the mobile exhibition. A community centre requested that the HEPPP project be extended to an additional secondary school with a largely Indigenous population in a rural area. The rationale was that these students were unlikely to be included in such opportunities due to their location and that the students needed innovative learning opportunities to help them imagine new ideas for future careers. This request required additional funds, with the Wollotuka Institute of the University of Newcastle answering this request. Many Indigenous students do aim to go to university and attain higher education (Gale, et al., 2013; Harwood, et al., 2015; Nelson & Hay, 2010). However, the dearth of information about university and careers within Indigenous communities and schools (Oliver, et al, 2013) impacts on their significantly lower rates of access, retention and completion in higher education in comparison to non-Indigenous Australians (Behrendt, et al., 2012). The two components of the project support research affirming the importance of real life learning, "You Can't be what you can't see" (Wilks & Wilson, 2014) in order to offset the impact that rural/remote locations experience that limits the flow and restricts information regarding opportunities for higher education. In addition the project seeks to dispel the myths that CI technological employment opportunities are only located in cities and that innovative careers can occur within ones rural community. This paper reports specifically on the experience of these Indigenous secondary students and their interaction with the opportunities presented by the CI roadshow with a view to assess the benefits of this type of approach to broaden the future prospects of Indigenous students in rural/remote schools.

The Halsey Review made a recommendation to “Establish a national focus for RRR education, training and research to enhance access, outcomes and opportunities in regional Australia.” The propositions behind this recommendation are ones many would agree with: a focus on RRR education is important, as is the need to improve access, outcomes and opportunities. However, the way we approach these propositions is important too. In this presentation my focus will be on applying Halsey’s proposition and recommendation to rural and remote communities where First Nations people live. If we approach the propositions with an ‘about’ or ‘on’ or even a ‘for’ the response will probably perpetuate the metrocentric assumptions that define the rural and the remote. It also allows outsiders, whether First Nations or non-Indigenous outsiders, to set the agenda, and delimit the scope and framing of ‘access, outcomes and opportunities’. If we approach the proposition with an ‘in’, the possibilities of seeing solutions that are ‘out’ may be stymied. How we then see solutions from the perspectives of those who have benefited from the rural/remote but who have left that space is important as well. Finally, as researchers we can respond to the Halsey propositions using the ‘with’ perspective. This approach leaves open the possibilities of outsiders, who may be First Nations people or non-Indigenous, working in partnership alongside those who are insiders. The value of this approach can be seen in a shared understanding of issues and solutions and a more effective translation of the knowledge created through research. In the presentation I will share some examples of the ‘with’ approach in remote First Nations contexts which will probably also resonate with other rural, regional and remote contexts.

Boarding schools and residential facilities for remote Aboriginal and Torres Strait Islander students have long been part of the educational landscape in Australia. More recently, policy settings are giving considerably more attention to boarding schools and residential colleges as secondary schooling options for Indigenous students, particularly for those students from remote areas. Coupled with this, the contemporary Indigenous education milieu is seeing increased investment in scholarship programs, provision of transition support services and the establishment of national boarding standards. There is an emerging body of qualitative evidence about the experiences and outcomes of boarding for remote Aboriginal and Torres Strait Islander students. However, in Australia there are no publicly available studies showing quantitative impacts of boarding and there has been little attention applied to domestic or international experiences. In this paper, the authors consider boarding using three capital theory lenses: social/cultural capital (based on Bourdieu), human capital (based on Becker), and identity capital (based on Erikson). What light do these different theoretical perspectives shed on the development of boarding school policies and the operationalisation of processes designed to take young people away from their homes and communities for schooling? How do these theoretical lenses magnify, distort or clarify the assumptions that underpin boarding processes? Using these lenses we intend to go beyond an understanding of impact on individuals towards a more nuanced consideration of the possible social, cultural, health and wellbeing consequences of pursuing boarding as a strategic policy for Aboriginal and Torres Strait Islander students in Australia.

Over the last 10 years of 'Closing the Gap' considerable public investment has been made into programs designed to improve outcomes for First Nations students, particularly those who live in 'remote' communities. Some programs have targeted teaching and learning, or academic performance and attendance, or transitioning students into boarding schools. Others have focused on professional learning.However, it is difficult to determine to what extent these programs achieve their stated objectives. Very few interventions have been independently evaluated, and where they have, the results are often inconclusive. In 2014 the Australian Government announced $23.8 million in funding for the 'Flexible literacy for remote primary schools programme' which was designed to improve the literacy outcomes of students in remote schools, most of which had high proportions of First Nations students. A further $4.1 million was allocated to the program in 2017. The program uses either Direct Instruction or Explicit Direct Instruction--at October 2017 there were 34 schools participating in the Northern Territory, Queensland and Western Australia. An evaluation report covering the first two years of the program argued that there is 'little doubt that the program is having an impact on literacy levels' but with the confusing caveat that there was no significant difference between control and program schools.This paper takes a pragmatic methodological approach an analyses publicly available MySchool data for 'very remote' schools included in the program. It considers year 3 and 5 NAPLAN reading results and attendance averages for participating and non-participating schools in the three years before the program's rollout and compares them with results since. In framing the findings, consideration is given to outcomes of other programs that have an identifiable sample of schools (for example the Remote School Attendance Strategy and Connected Communities) and the array of strategies that have been used since Closing the Gap commenced in 2008, most of what have come and gone. The paper concludes by raising questions about the ethics of policy making and implementation and the role of evidence as a tool for accountability.

Background: Cardiac arrest occurs in over 25, 000 Australians every year. In the event of cardiac arrest, CPR alone has low rates of effectiveness. However, when provided in combination with defibrillation, survival rates increase significantly—reported to be up to 30%. Defibrillation needs to be administered quickly in the event of cardiac arrest, ideally within 3 minutes, but this is often not possible in rural and remote areas where there are limited health facilities. A contributor to cardiac arrest can be chronic heart disease (CHD). Australians in remote areas are 1.6 times more likely than those in major cities to be hospitalised for, and 1.3 times as likely to die from, CHD. Indigenous Australians are overrepresented in these statistics. This is further demonstrated in demand for our emergency aeromedical retrievals, via which 112 patients per week, or 16 patients per day, are transported to receive definitive care in a tertiary hospital. Aim: Responding to these research findings and interest from our communities, we commenced national roll-out of portable Automated External Defibrillators (AEDs), funded by corporate giving from a national partner. The primary aim of this AED project, the first of its kind in Australia, is to reduce the number of people who die from cardiac arrest in remote and rural Australia by improving access to AEDs for first responders. Method: Over two years of retrieval data was analysed to identify the locations most commonly attended in response to a patient experiencing cardiac arrest, along with national data relating to prevalence of CHD. We mapped these locations, and combined with local knowledge from our service managers, identified the best locations for provision of an AED. Results: Remote and rural locations in South Australia were identified as a high priority, and are the first for roll out of the portable AEDS through this program. It was determined that this program would most optimally be delivered in line with our medical chest program, which provides medications to approved custodians in areas where pharmacies are not easily accessible. To date, 80 AEDs have been provided in remote and rural South Australia, along with a self-developed training program to ensure people in those communities are confident to use the AEDs. This presentation will briefly explore the research that lead to the development of this program; the partnership approach leveraged to purchase the AEDS; the implementation methodology; and, results of the first year, including case studies.

Background:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Introduction: The causative agent of Q fever, Coxiella burnetti, is found in a wide variety of animals and does not require direct animal-to-human contact for infection. Q fever is contracted by inhaling contaminated dust particles or bacteria shed from infected animals. Q fever has traditionally been associated with rural workers in primary production, abattoirs and veterinary occupations; however cases linked to non-traditional sources are increasingly reported. The diversity of clinical symptoms and range of severity at presentation often leads to Q fever being misdiagnosed or not reported. Early identification, appropriate treatment and follow-up following acute Q fever are essential for the health and wellbeing of patients. Serious long-term complications occur in 5% of all acute Q fever cases yet there is no Australian guideline or global consensus on what follow-up should be provided to patients. Aim: This study explored the knowledge of Q fever, Q fever vaccination and usual clinical follow-up practices among rural general practitioners. Relevance: Rural practitioners are likely to have patients present with Q fever and assume responsibility for managing their short and long-term care. However there is little known about Australian rural general practitioners’ knowledge of Q fever and Q fever vaccination. Method: Far North Queensland rural general practitioners were invited to complete an anonymous survey either online or in hard copy. Descriptive analysis about knowledge of Q fever, recommendations for vaccination, post graduate education on Q fever and follow up practices was undertaken (IBM SPSSv22) on 16 responses (16/52, 31% response rate). Results: Nearly all respondents were aware of the traditional sources (contaminated livestock and soil) of Q fever and at-risk occupations (farmers, veterinarians, abattoir workers) requiring vaccination. Less obvious sources of infection (wildlife and domestic pets) were not as well recognized. Most respondents would consult with an Infectious Disease or Public Health colleague. Appropriate follow-up practices were described by a small number of respondents: treatment with doxycycline (n=4), follow-up over a period longer than one year (n=2), specific cardiac follow-up (n=3). Conclusion: This study identified a range of self-reported usual clinical practice and follow-up (if any) of Q fever cases by rural general practitioners, including consultation with a specialist. The lack of consensus found in this study reflects differing opinions about the best practice of Q fever management. These results further highlight the need for the development of evidence-based Q fever management guidelines.

For almost two decades, chlamydia and gonorrhoea diagnosis rates in remote Indigenous communities have been up to 30 times higher than for non-Indigenous Australians. The high levels of population movement known to occur between remote communities may contribute to these high rates.

Aboriginal suicide has emerged as an issue of public concern only within the recent past. Within the last decade there has been a substantial increase from levels that were previously low. Under the shadow of the Royal Commission into Aboriginal Deaths in Custody these increases, involving primarily young adult males, raise serious questions. Two years ago the author examined a series of suicides that had occurred in one area of remote Aboriginal Australia, the Kimberley region of Western Australia. This paper examines suicides that have occurred in the following two years, with comparisons both with the previous suicides, and with a group of age-matched Aborigines from the general Kimberley population drawn from a random sample survey.

In the preceding paper information was presented on a series of recent Aboriginal suicides in the Kimberley region of Western Australia. In this paper the author proceeds to an examination of the social and historical context of these events, which have occurred in conjunction with increases in other violent behaviours. Drawing from information generated by a survey of a stratified random sample of Aborigines from across the region, the rapidly changing environment of childhood is discussed, with particular attention to the structural and functional changes in caretaking roles. The inter-cultural context of these, as yet, largely intra-cultural manifestations of disadvantage, are emphasised.

Uptake of e-health, the use of information communication technologies (ICT) for health service delivery, in allied health appears to be lagging behind other health care areas, despite offering the potential to address problems with service access by rural and remote Australians. The aim of the study was to conduct a scoping review of studies into the application of or attitudes towards ehealth amongst allied health professionals conducted in Australia.

Excessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults.

In the wet-dry tropics of Northern Australia, drinking water in remote communities is mostly sourced from bores accessing groundwater. Many aquifers contain naturally high levels of iron and some are shallow with surface water intrusion in the wet season. Therefore, environmental bacteria such as iron-cycling bacteria promoting biofilm formation in pipes or opportunistic pathogens can occur in these waters. An opportunistic pathogen endemic to northern Australia and Southeast Asia and emerging worldwide is Burkholderia pseudomallei. It causes the frequently fatal disease melioidosis in humans and animals. As we know very little about the microbial composition of drinking water in remote communities, this study aimed to provide a first snapshot of the microbiota and occurrence of opportunistic pathogens in bulk water and biofilms from the source and through the distribution system of three remote water supplies with varying iron levels. Using 16s-rRNA gene sequencing, we found that the geochemistry of the groundwater had a substantial impact on the untreated microbiota. Different iron-cycling bacteria reflected differences in redox status and nutrients. We cultured and sequenced B. pseudomallei from bores with elevated iron and from a multi-species biofilm which also contained iron-oxidizing Gallionella, nitrifying Nitrospira and amoebae. Gallionella are increasingly used in iron-removal filters in water supplies and more research is needed to examine these interactions. Similar to other opportunistic pathogens, B. pseudomallei occurred in water with low organic carbon levels and with low heterotrophic microbial growth. No B. pseudomallei were detected in treated water; however, abundant DNA of another opportunistic pathogen group, non-tuberculous mycobacteria was recovered from treated parts of one supply. Results from this study will inform future studies to ultimately improve management guidelines for water supplies in the wet-dry tropics.

The role of towns and small business is poorly understood, yet towns are vital for the long-term viability of communities in rural and remote Australia. This case study in the central western region of Queensland (CWQ) examines the impacts of drought on rural towns and how to build a resilient regional community and alleviate hardship. Evidence was collected during drought from town businesses through surveys, interviews and a public meeting in 2017.Towns in CWQ are especially exposed to the risks of drought, as approximately half of the businesses are directly linked to agriculture. Townspeople are major contributors to social cohesion and resilience in rural and regional communities, which are often service and maintenance centres of nationally important infrastructure such as roads for inter-state freight transport and tourism. Drought and declining grazier incomes have led to reduced spending in towns. Populations have dropped sharply, as itinerant agricultural workers leave the region. The complex economic and social flow-on impacts of drought have resulted in lower socioeconomic resilience. The majority of community members interviewed expressed a desire to build secure livelihoods, which echoes other research where existing and new rangelands livelihoods are seen as contributing to the success of the nation, a common global desire. Local organisations in CWQ display innovative business and community strategies. Future actions need to support and build on these initiatives.A framework with the acronym D.U.S.T. has been developed, with associated actions aimed at building resilience in these communities. D.U.S.T. is appropriate for this often-dusty region, and stands for: D. Decide to act; U. Understand the context; S. Support and develop local capacities and institutions; and T. Transform regional governance.The key for decision-makers is to work with local people who understand the contextual complexity and local needs. Actions need to be based on principles of adaptability, equity and inclusiveness, and working with the whole of the community. Building on existing collaborations and innovations as well as transforming governance and secure funding arrangements are needed. Lessons from the communities in CWQ may help other rural and remote regions build resilience to cope with the unpredictable financial, social and environmental future.

Across rural and remote Australia women are being relocated so that they can give birth at regional settings. Many of these women are Aboriginal and Torres Strait Islander Australians, who are birthing alone in a hospital where staff do not speak their language. They may have to wait weeks in a hostel where they are lonely and at times do not feel safe.

A traumatic hand injury can involve damage to a number of structures including skin, nerves, tendons, muscle bone, and soft tissue. Impairments such as pain or stiffness and loss of range of motion can last for many years and result in a moderate to extreme impact on a person’s day-to-day life. Work, leisure, financial security, and emotional well-being often most affected. This commentary provides an analysis of those factors that inhibit (barriers) and support (enablers) the provision of hand therapy rehabilitation in rural and remote areas. Providing a collaborative and flexible rehabilitation programme to rural and remote residents following a traumatic hand injury can be seen as a challenge due to issues such as a limited access to health care services. Established protocols that work in regional or metropolitan locations are unlikely to be effective and innovative and pragmatic strategies are required. The provision of a collaborative and flexible rehabilitation programme regardless of residential location is an important part of the therapist’s intervention plan.

It is January 2014, I encounter a 34-year-old Luritja woman in Central Australia and she recognises me. A flood of memories wash over me as I recall this young woman as a 7-year-old child at Yipirinya School where I worked as a teacher and teacher linguist from 1987-1991. Pivoting off this experience, in this chapter I trace the stories of some of the Yipirinya school children whose idealistic parents and grandparents devoted themselves to ensuring that their youngsters would have access to bilingual education in order to maintain language and culture. I situate this account within the policy era of self-determination that gave rise to this community-controlled bilingual education initiative and then trace the impact of changing policy environments over the decades. By analysing the life course trajectories of some of the first generation of Yipirinya school children I focus on the formative experiences as well as the socio-political factors that have enabled individuals to shape life directions. I conclude by arguing that for some it has been a complex of factors including language and culture maintenance and seeing their elders in leadership positions have enabled some in this group to develop the resilience and strength of identity to establish satisfying life course directions, while for others the barriers of poverty and marginalisation have proved insurmountable.

In rural health and other health service development contexts, there is frustration with a reliance on pilot projects as a means of informing policy and service innovation. There is also an emerging recognition that existing research methods do not draw lessons from the failed sustainability that characterises many of these pilots and demonstration projects.

Objective: This paper describes the implementation of the 'Maga Barndi' pilot project while highlighting certain issues relevant to delivering psychiatric services to Aboriginal people.Method: The process of developing and implementing the project is described with an emphasis on those aspects which seem to enhance accessibility and acceptability to the Aboriginal community.Results: Over the 2-year period of the project, a caseload of 61 Aboriginal patients was established within Geraldton. A further 22 Aboriginal patients were managed at a variety of regional centres and another 52 at the Regional Prison. This represented a marked increase in service utilisation by local Aboriginal people. Psychiatric admissions for Aboriginal patients to the local hospital were reduced by 58% in the year following service commencement. Location of the project within an Aboriginal-controlled health centre with access to Aboriginal health workers and a flexible assertive community management approach were key factors in facilitating patient access to the service.Conclusions: The project succeeded in its objective of pioneering a culturally sensitive psychiatric service for Aboriginal people in Geraldton and the Midwest. Lessons learnt during the development of the project may be useful to other services seeking to improve their accessibility and acceptability to Aboriginal people.

Type 2 diabetes (T2DM) is increasing in prevalence in Indigenous Australian children and adolescents. High rates of diabetes in pregnancy (DIP) in Indigenous Australians increases the risk of diabetes for the next generation. DIP is associated with neonatal adiposity, which correlates with long-term risk of obesity and diabetes. Indigenous Australians have high rates of low birth weight and increasingly, large for gestational age associated with DIP. The aims are: 1. To evaluate adiposity in babies born to Indigenous mothers and those of European background with DIP in the Northern Territory; 2. To evaluate the relationship between maternal factors and neonatal birth weight and body composition. Thus far 266 mothers and neonates from the PANDORA cohort (Pregnancy and Neonatal Outcomes in Remote Australia) have been assessed. Neonatal anthropometrics were performed on all neonates, including skin fold measures. Calculations of fat mass were made using a validated equation (fat mass=0.39055(birth weight)+0.0453(flank skinfold)-0.03237(length)+0.54657). Significant differences were found in maternal characteristics between Indigenous and European background participants, including diabetes type (T2DM 14.7% vs 1.1%, p<0.001), smoking in pregnancy (26.5% vs 9.1%, p<0.001) and location of residence (regional/remote 41.4%vs 9.8% p<0.001). Gestational age at birth was significantly different (38.2 vs 39 weeks p<0.001), however birth weight was not significantly different (3380 vs 3428g). Indigenous neonates had greater subscapular (4.69 vs 4.20mm, p=0.003) triceps (4.75 vs 4.22mm, p=0.004) and flank skin folds (4.08 vs 3.60mm, p=0.006). This difference remained significant for the flank skin fold only, after adjustment for diabetes type and maternal body mass index (BMI). There was no significant difference in calculated fat mass. On regression analysis, maternal BMI, smoking, nulliparity and T2DM were each independently associated with birth-weight z-score. Recruitment to PANDORA is ongoing. Preliminary data reveals higher skin fold measures, indicative of adiposity, in Indigenous neonates. There was no significant difference in fat mass. Smoking, BMI, nulliparity and T2DM were independently associated with birth-weight z-score, ethnicity was not independently associated.