Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health.

University departments of rural health are Commonwealth-funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements. We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted. Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences. Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice. Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.

Blood lead levels among Broken Hill children born 2009-2015: a longitudinal study to inform prevention strategies.

OBJECTIVES: To describe blood lead levels (BLLs) and their distribution among children in Broken Hill, New South Wales (NSW), at each of the scheduled testing points aligned with childhood immunisation and to determine how BLLs change over time for individual children. These data can inform action to prevent future lead exposure in Broken Hill children. STUDY TYPE: Retrospective longitudinal study. METHODS: Data were extracted from the Lead Management Program ACCESS database on children born between 2009 and 2015 and living in Broken Hill. BLLs were calculated using capillary blood collected via finger prick, classified according to specific blood lead thresholds and grouped according to the testing schedule. A subset of children tested at each of the first three annual testing points provided data to determine the blood lead trajectories for individual Broken Hill children. Data were analysed using SPSS and ArcGIS. RESULTS: At the first test at 12 months, around half the children recorded a BLL of <5 µg/dL, one in three had a BLL of 5-9 µg/dL and one in five had a BLL of ≥10 µg/dL. A similar pattern was observed for subsequent test points at 18 months, 2 years, 3 years and 4 years. Of the 336 children who had results recorded at each of the 12-month, 2-year and 3-year test points, BLLs in around one-third remained below the recommended threshold of 5 µg/dL. Another one-third of these children had at least one test result ≥10 µg/dL, and the BLL in the remainder did not exceed 5-9 µg/dL at any of the test points. The geospatial distribution of children with very high BLLs shows clustering of these children in some localities, as well as their widespread distribution throughout Broken Hill. CONCLUSIONS: It should be possible to keep BLLs below 5 µg/dL for the majority of young children in Broken Hill throughout their preschool years. This could be achieved by an integrated prevention strategy that includes population-level interventions such as targeted zonal remediation for high-risk areas and early intervention for individuals during the first 12 months and beyond, particularly for those who may not benefit directly from targeted zonal remediation. Routinely collected data could be used to guide the development, and monitor the effectiveness, of these interventions.

Is Time Spent Outside the Family Home a Risk Factor for Lead Exposure in Pre-School Children Living in Broken Hill?

Broken Hill is amongst a group of communities internationally that are at greater risk from lead due to active or historical lead industries. Current evidence suggests there is no safe level of lead for young children. This paper describes places outside the family home where young Broken Hill children spend time and considers the potential for this to contribute to lead risk. We interviewed 65 families of children 3 years old or younger and detailed the top five places children spent time at outside the family home. Exposure to private residences outside the family home was recorded for most (88%) young children. Nearly two thirds stayed there five or more hours per week. Most children went there on a weekly basis over many months (median, 12 months), increasing the likelihood of exposure to lead hazards. Further investigation of the lead hazard and risk behaviour of children at these residences would assist in developing guidelines for remediation of the lead hazard for all private residences in Broken Hill. This approach to elucidating the potential sources and pathways of lead and other heavy metal exposures for young children may have merit in other settings where comprehensive zonal remediation is not feasible or may not be warranted.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia.

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN: Rapid review of articles published between January 2000 and May 2020. DATA SOURCES: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN: Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing,deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Stemming the flow: how much can the Australian smartphone app help to control COVID-19?

OBJECTIVES: Our objective is to assess the potential contribution of the Australian Government's mobile smartphone tracing app (COVIDSafe) to the sustained control of coronavirus disease 2019 (COVID-19). STUDY TYPE: Development and analysis of a system dynamics model. METHODS: To define the pandemic context and specify model-building parameters, we searched for literature on COVID-19, its epidemiology in Australia, case finding processes, and factors that might affect community acceptance of the COVIDSafe smartphone app for contact tracing. We then developed a system dynamics model of COVID-19 based on a modified susceptible-exposed-infected-recovered compartmental model structure, using initial pandemic data and published information on virus behaviour to determine parameter values. We applied the model to examine factors influencing the projected trends: the extent of viral testing, community participation in social distancing, and the level of uptake of the COVIDSafe app. RESULTS: Modelling suggests that a second COVID-19 wave will occur if social distancing declines (i.e. if the average number of contacts made by each individual each day increases) and the rate of testing declines. The timing and size of the second wave will depend on the rate of decrease in social distancing and the decline in testing rates. At the app uptake level of approximately 27% (current at 20 May 2020), with a monthly 50% reduction in social distancing (i.e. the average number of contacts per day doubling every 30 days until they reach pre-social distancing rates) and a 5% decline in testing, the app would reduce the projected total number of new cases during April-December 2020 by one-quarter. If uptake reaches the possible maximum of 61%, the reduction could be more than half. CONCLUSIONS: Maintenance of a large-scale testing regimen for COVID-19 and widespread community practice of social distancing are vital. The COVIDSafe smartphone app has the potential to be an important adjunct to testing and social distancing. Depending on the level of community uptake of the app, it could have a significant mitigating effect on a second wave of COVID-19 in Australia.

Rural and remote speech-language pathology service inequities: An Australian human rights dilemma.

Access to healthcare is a fundamental human right for all Australians. Article 19 of the Universal Declaration of Human Rights acknowledges the right to freedom of opinion and to seek, receive and impart information and ideas. Capacities for self-expression and effective communication underpin the realisation of these fundamental human rights. For rural and remote Australian children this realisation is compromised by complex disadvantages and inequities that contribute to communication delays, inequity of access to essential speech-language pathology services and poorer later life outcomes. Localised solutions to the provision of civically engaged, accessible, acceptable and sustainable speech-language pathology services within rural and remote Australian contexts are required if we are to make substantive human rights gains. However, civically engaged and sustained healthcare can significantly challenge traditional professionalised perspectives on how best to design and implement speech-language pathology services that seek to address rural and remote communication needs and access inequities. A failure to engage these communities in the identification of childhood communication delays and solutions to address these delays, ultimately denies children, families and communities of their human rights for healthcare access, self-expression, self-dignity and meaningful inclusion within Australian society.

Beginning the trajectory to ESKD in adult life: albuminuria in Australian aboriginal children and adolescents.

BACKGROUND: Globally, disadvantaged populations suffer a high burden of chronic kidney disease (CKD). The trajectory to CKD during childhood and adolescence remains unclear due to a paucity of longitudinal studies. METHODS: This was a prospective, population-based cohort study in which since 2002 we have followed 3418 children (1469 non-Aboriginal and 1949 Aboriginal) attending participating schools across New South Wales (NSW), Australia. The albumin:creatinine ratio was measured by dipstick every 2 years together with the body mass index (BMI) and blood pressure. We used multivariable logistic generalised estimating equation models to examine whether Aboriginal children had a higher prevalence of albuminuria compared with non-Aboriginal children with increasing age and to identify potential risk factors. RESULTS: The mean age at enrolment was 10.6 years, at which time 14.2 % of the children were obese and 16.0 % overweight, with 11.5 % found to have albuminuria. Over 8 years (11,387 participant-years) of follow-up the prevalence of albuminuria increased to 18.5 %, overweight to 16.1 % and obesity to 17.2 %. The BMI standard deviation score (SDS) was found to have a differential effect on the risk of albuminuria in Aboriginal and non-Aboriginal children (P interaction < 0.01). The prevalence of albuminuria decreased as the BMI SDS increased in both groups of children, but it increased more in non-Aboriginal children, leading to a 2.5 % higher prevalence of albuminuria in overweight Aboriginal children (95 % confidence interval 1.0-4.2 %). CONCLUSION: Compared with non-Aboriginal children, Aboriginal children are of higher risk of albuminuria when overweight or obese. We hypothesise that overweight and obesity are key contributors to the development of adult onset CKD among Aboriginal Australians, which needs further exploration in future studies.

Putting the genie back in the bottle: protecting children from lead exposure in the 21st century. A report from the field.

This paper highlights progress on an important public health issue which, despite significant progress, has now stalled and is in need of renewed investment. The objective is to describe the effectiveness of efforts to reduce childhood lead exposure in Broken Hill - a historic mining town in western NSW - and what is required to further reduce exposure. Lead has no known function in the human body, and emerging evidence suggests that no level of exposure is without health effects. A 1991 blood lead survey of 1-4-year-old children identified lead exposure as a significant public health issue in Broken Hill. A major NSW Government-funded program to reduce lead exposure began in 1994, and, by 2001, blood lead levels had reduced by two-thirds. The program was then integrated into other services and funding significantly reduced; blood lead levels have remained relatively unchanged since 2005. At present, 53% of children in Broken Hill have blood lead levels above the recently released National Health and Medical Research Council draft reference value for lead. Participation in annual blood lead screening declined from 52% to 38% after project funding decreased, but recent changes have doubled participation rates. A comprehensive abatement program is required to further reduce lead exposure in this community, and further research is required into how to maintain low blood lead levels and how best to engage the community about reducing individual lead risks. Findings from such studies would be relevant to the broader Australian community.

Improving participation by Aboriginal children in blood lead screening services in Broken Hill, NSW.

UNLABELLED: Lead poses a health risk to young children with detrimental effects on their intellectual development. Attendance rates for Aboriginal children at routine blood lead screening and at follow-up appointments in Broken Hill, NSW, have declined in recent years. This study sought to identify strategies to improve the participation of Aboriginal children aged 1-4 years in blood lead screening services in Broken Hill. METHODS: Attendance rates during the period 2000-2010 were determined using the Broken Hill Lead Management database. From June to August 2011, Aboriginal community members, service providers and public health staff were invited to interviews and focus groups to explore barriers, enablers and suggestions for improving participation. RESULTS: In 2009, 27% of Aboriginal children aged 1-4 years attended blood lead screening and 29% of these children with blood lead levels over 15 µg/dL attended follow-up appointments. Barriers to participation in lead screening services included community perceptions, reduced service capacity, socio-economic and interorganisational factors. Enablers included using a culturally acceptable model, linking lead screening with routine health checks and using the finger-prick method of testing. CONCLUSIONS: The final report for the study included recommendations to improve participation rates of Aboriginal children including using social marketing, formalising collaboration between health services, supporting disadvantaged families and employing an Aboriginal Health Worker.

New South Wales and Australian Capital Territory Researcher Development Program 2005-07: modest investment, considerable outcomes.

This evaluation of the Researcher Development Program (RDP) in NSW and ACT aimed to determine whether the RDP was effective in assisting novice researchers to undertake primary health care research. In mid-2008, 47 participants of the NSW and ACT RDP during 2005-07 were invited to participate in a postal survey. The survey included questions regarding previous research training and experience, outcomes during and after participation in the program, and organisational aspects of the program. Follow-up interviews were conducted with selected participants. Interview questions covered time in the program, supervision, organisational support and placement outcomes. Thirty-seven participants responded to the survey and 23 (62%) participants took part in the semi-structured interviews. Seventy-eight per cent of survey respondents felt that the RDP helped them move from novice to a more experienced researcher with effective supervision identified by participants as a key element in determining the success of the program. Many felt that time allocation was inadequate and 20% thought their capacity to maintain their workload was adversely affected by participating. Outcomes were considerable given the modest nature of the program. Notable outcomes were that most participants published their research and presented their research at a conference. Furthermore, one-fifth of survey respondents had enrolled in higher degrees. Several interviewees reported that their research led to changes in practice. Most respondents found the RDP valuable and considered that undertaking the program increased their research knowledge.

A cluster randomised controlled trial of vascular risk factor management in general practice.

OBJECTIVE: To evaluate the impact of a lifestyle intervention in Australian general practice to reduce the risk of vascular disease. DESIGN, SETTING AND PARTICIPANTS: Stratified cluster randomised controlled trial among 30 general practices in New South Wales from July 2008 to January 2010. Patients aged 40-64 years were invited to participate. The subgroup who were 40-55 years of age were included only if they had either hypertension or dyslipidaemia. INTERVENTION: A general practice-based health-check with brief lifestyle counselling and referral of high-risk patients to a program consisting of one to two individual visits with an exercise physiologist or dietitian, and six group sessions. MAIN OUTCOME MEASURES: Outcomes at baseline, 6 and 12 months included the behavioural and physiological risk factors for vascular disease - self-reported diet and physical activity, and measured weight, body mass index, waist circumference, blood lipid and blood sugar levels, and blood pressure. RESULTS: Of the 3128 patients who were invited, 958 patients (30.6%) responded and 814 were eligible to participate. Of these, 699 commenced the study, and 655 remained in the study at 12 months. Physical activity levels increased to a greater extent in the intervention group than the control group at 6 and 12 months (P = 0.005). There were no other changes in behavioural or physiological outcomes or in estimated absolute risk of cardiovascular disease at 12 months. Of the 384 enrolled in the intervention group, 117 patients (30.5%) attended the minimum number of group program sessions and lost more weight (mean weight loss, 1.06 kg) than those who did not attend the minimum number of sessions (mean weight gain, 0.73 kg). CONCLUSION: While patients who received counselling by their general practitioner increased self-reported physical activity, only those who attended the group sessions sustained an improvement in weight. However, more research is needed to determine whether group programs offer significant benefits over individual counselling in general practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12607000423415.

The Australian Rural Health Research Collaboration: building collaborative population health research in rural and remote NSW.

The health problems faced by rural and remote communities are complex and not amenable to simple or short-term solutions. The Australian Rural Health Research Collaboration, which comprises rural research centres, area health services and policy makers in NSW, investigates these problems. Founded in 2002, it has grown to become the leading rural research collaboration in Australia. It aims to: conduct high quality research; build the capacity of researchers and clinicians; and encourage the translation of research evidence into practice for the benefit of rural and remote communities. The success of the Collaboration is illustrated by the increase in research outputs, funds generated, the strength of the relationships between partners and the ability to address complex research problems such as the mental health of rural and remote communities often deemed too difficult or expensive to include in metropolitan-based research. Keys to success have been the inclusive public health ethos, the participation of senior researchers and service managers, the critical mass of researchers achieved through collaboration and effective leadership and governance. This demonstrates the value of supporting cooperative research and capacity building in rural and remote areas where the size of research groups is small and where effective multi-disciplinary and co-operative research can pay dividends.

Evaluation of a mobile screening service for abdominal aortic aneurysm in Broken Hill, a remote regional centre in far western NSW.

OBJECTIVES: To evaluate the feasibility of a mobile screening service model for abdominal aortic aneurysm (AAA) in a remote population centre in Australia. DESIGN: Screening test evaluation. SETTING: A remote regional centre (population: 20 000) in far western NSW. PARTICIPANTS: Men aged 65-74 years, identified from the Australian Electoral roll. INTERVENTIONS: A mobile screening service using directed ultrasonography, a basic health check and post-screening consultation. MAIN OUTCOME MEASURES: Attendance at the screening program, occurrence of AAA in the target population and effectiveness of screening processes. RESULTS: A total of 516 men without a previous diagnosis of AAA were screened, an estimated response rate of 60%. Of these, 463 (89.7%) had a normal aortic diameter, 28 (5.4%) ectatic and 25 (4.9%) a small, moderate or significant aneurysm. Two men with AAA were recommended for surgery. Feedback from participants indicated that the use of a personalised letter of invitation helped with recruitment, that the screening process was acceptable and the service valued. CONCLUSIONS: It is feasible to organise and operate a mobile AAA screening service from moderate sized rural and remote population centres. This model could be scaled up to provide national coverage for rural and remote residents.

Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study.

OBJECTIVE: To examine activity patterns of the Royal Flying Doctor Service of Australia (RFDS) in far western New South Wales and to determine whether frequent use of RFDS services, particularly emergency evacuations, is a useful indicator of patients who may benefit from care planning and review. DESIGN, SETTING AND PARTICIPANTS: We conducted a retrospective audit of the RFDS South Eastern Section's Broken Hill patient database. Patients with a residential address in the study area who had accessed at least one RFDS medical service between 1 July 2000 and 30 June 2005 were included in the study. MAIN OUTCOME MEASURES: Number of evacuations, clinic consultations and remote consultations; clinic usage by frequent evacuees; number of primary diagnoses recorded for frequent evacuees; number of frequent users who might benefit from multidisciplinary care or specialist shared care. RESULTS: Between July 2000 and June 2005, the number of residents requiring evacuation or remote consultations declined by 26% and 19%, respectively, and the number of residents accessing clinics declined by 6%. (Over the same period, the population of the study area fell by about 24%.) Of the 78 patients who were identified as frequent users of the evacuation service (> or = 3 evacuations/year), 34 had three or more primary diagnoses recorded; 15 were infrequent or non-users of the clinics (< or = 3 attendances/year); 53 may have benefited from multidisciplinary care, and 41 from specialist shared care. CONCLUSIONS: Simple, practical clinical review systems can help health care organisations in rural and remote communities to achieve better outcomes by identifying patients who may benefit from planned care.

Natural history of chronic kidney disease in Australian Indigenous and non-Indigenous children: a 4-year population-based follow-up study.

OBJECTIVE: To describe the natural history and risk of early chronic kidney disease (CKD) in Indigenous Australian populations. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort of 2266 Aboriginal and non-Aboriginal children enrolled from primary schools throughout New South Wales from February 2002 to June 2004 and followed for 4 years. MAIN OUTCOME MEASURES: Urinalysis, height, weight, blood pressure, birthweight and sociodemographic status at baseline and 2- and 4-year follow-up; CKD risk factors: haematuria, albuminuria, obesity, and systolic and diastolic hypertension. RESULTS: 2266 children (55% Aboriginal; 51% male; mean age, 8.9 years [SD, 2.0 years]) were enrolled at baseline. 1432 children (63%) were retested at 2-year follow-up, and 1506 children (67%) at 4-year follow-up. Prevalence of baseline CKD risk factors was frequent (2%-7%), but most abnormalities were transient. Besides persistent obesity (5.0%), persistence of CKD risk factors at final follow-up was low: haematuria (1.9%), albuminuria (2.4%), systolic hypertension (1.5%) and diastolic hypertension (0.2%). There was no difference in prevalence of persistent CKD risk factors between Aboriginal and non-Aboriginal children. CONCLUSIONS: Over 4 years of follow-up, Indigenous Australian children had no increased risk for early evidence of CKD. More than 70% of baseline risk factors were transient, and persistent risk factors were uncommon. Our findings suggest the increased risk for end-stage kidney disease seen in Indigenous adults is not yet manifest in these schoolchildren, and may be potentially preventable.

Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study.

AIM: Indigenous people have a two- to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non-Aboriginal Australian children. METHODS: Children were enrolled from primary schools throughout New South Wales, the state with the highest number of Aboriginal people. Associations between ethnicity, gender, birthweight, socio-demographic status and hypertension, obesity, baseline and persistent albuminuria were determined. RESULTS: A total of 2266 children (55% Aboriginal) were enrolled. Mean age was 8.9 years (+/-3.8 years). Obesity (body mass index >or=2 standard deviations) was detected in 7.1%, systolic hypertension (blood pressure >90th percentile) in 7.2%, diastolic hypertension in 5.9%, baseline albuminuria (albumin : creatinine >or=3.4 mg/mmol) in 7.3% and persistent albuminuria in 1.5% with no differences between Aboriginal and non-Aboriginal children. Hypertension was less common with increasing social disadvantage (trend P < 0.02). Increasing body mass index standard deviation was strongly associated with systolic and diastolic hypertension (both P < 0.0001). CONCLUSIONS: Many risk factors for cardiovascular disease are already common in young children but not more prevalent in Aboriginal than in non-Aboriginal children. In all children, overweight and obesity have the strongest association with hypertension, but social disadvantage appears protective for hypertension. Our findings suggest that risk for cardiovascular health disparities seen in indigenous adults manifests beyond childhood and that a window of opportunity exists to prevent some of these outcomes.

Managing environmental lead in Broken Hill: a public health success.

OBJECTIVES: To describe locality-specific changes in blood lead levels of 1-4-year-old children in Broken Hill, NSW between 1991 and 2007. METHODS: Annual age-sex standardised mean blood lead levels, blood lead screening clinic attendance rates and lead-dust levels for five lead-risk zones were calculated from routinely collected data. RESULTS: Blood lead levels were similar in all localities in 2002, 2003, 2005 and 2006, after having been consistently higher in localities with highest environmental lead since 1991. CONCLUSIONS: Combining health promotion with a targeted clean-up has reduced the effect of locality on blood lead levels. Results are consistent with reduced contamination due to effective soil stabilisation and storm-water control.

Addressing decreasing blood lead screening rates in young children in Broken Hill, NSW.

This paper outlines the findings of a review commissioned in response to concerns about declining attendance of young children for blood lead screening in Broken Hill, NSW. A review of the literature and feedback from the local community revealed that reasons for reduced screening attendance elsewhere can be applied here, but that any proposed response should take account of local conditions.

Influencing population health performance: feedback from managers, population health staff and clinicians on the NSW Population Health Standards for Area Health Services.

The NSW Population Health Standards for Area Health Services have recently been introduced in NSW to assist area health services assess and improve performance in population health. Greater Western Area Health Service was the pilot site for trialling the Standards as a self-assessment tool. Following self-assessment, managers, population health staff and clinicians were asked for feedback. Staff were either interviewed or participated in a group discussion. Consulting with staff who would be required to use the Standards in the long term was seen as important for facilitating implementation across the area health service. The Standards were seen as credible and potentially beneficial, especially in raising the profile of population health work and encouraging population-based and integrated approaches.