Australian Aborigines Research Articles

The Religious Forms of the Elementary Life: Durkheim Revisited

In Durkheim’s view religion is advanced insofar as it has given way to the dictates of science and rationalism. I argue here that religion may well be defined by its emphasis on the sensational and imaginative rather than the mental or intellectual, and that it is in these terms that religious development should be measured. The article develops the view that Australian Aborigines, far from the least developed society and religion as Durkheim imagined, should be viewed as having the greatest development of religion, as well as an extraordinary form of organic solidarity based on their religion.

Indigenous People's Contribution to Food Systems Transformation

Across the world, there is an estimated 370-500 million indigenous people. They are distinct social and cultural groups that share collective ancestral ties to the lands and natural resources where they live, occupy, or from which they have been displaced. Indigenous peoples are often discriminated against, marginalized, and vulnerable. They include groups like the Maasai in East Africa, Pygmies of Central Africa, the San in Southern Africa, Berbers of North Africa, the Maya people of Central America, Australian Aboriginals, Maoris of New Zealand and many others

231The West Australian Burden of Disease Study 2015: mental health in Aboriginal West Australians

Abstract Background Mental disorders represent a growing health problem: an estimated 45% of Australians experience a mental disorder in their lifetime. The Western Australian (WA) Burden of Disease study 2015 produced detailed data for sub-populations within the state to inform policy and planning. Using this, we describe the burden of mental, substance use disorders and self-inflicted injuries in the WA Aboriginal population. Methods The study generated estimates for over 200 diseases to create ranked disease-level estimates of burden in the WA Aboriginal population for the first time. Eleven individual conditions in the mental disorders disease group, and suicide and self-inflicted injuries were analysed. Results Mental disorders contributed 18% of Aboriginal male and 16% of Aboriginal female DALYs in WA. Among Aboriginal males, alcohol use disorders ranked 3rd among all diseases (ASR: 33.6 DALYs per 1,000 males). Among Aboriginal females, anxiety disorders ranked 3rd (ASR: 17.3 per 1,000 females). Suicide and self-inflicted injuries ranked 2nd among all diseases among Aboriginal males (ASR: 39.8 DALYs per 1,000 males) and 5th among Aboriginal females (ASR: 10.8 per 1,000 females). Conclusions The study highlighted the high burden of disease from mental disorders and self-inflicted injuries among Aboriginal West Australians: self-inflicted injuries, alcohol use disorders and anxiety disorders ranked in the top 10 of all diseases. Key messages Mental disorders contribute substantially to the disease burden in WA among the Aboriginal residents. The findings can inform health policy and planning around mental health in the Aboriginal population, as well as informing social and liquor licensing policy.

559Health of Aboriginal children in Western Australia: Do grandparents matter?

Abstract Background Studies of select populations (e.g. pre-industrial or subsistence farming populations) suggest that children with living maternal grandmothers (MGMs) had improved survival. It is unknown if this holds for child health more generally or in Australian Indigenous communities, where care of children is commonly shared by family members. We examined associations between the health of young Aboriginal Western Australians and their grandparents. Methods Birth, death, inpatient and emergency department records of Aboriginal infants born 2000-2013 in WA and their grandparents were linked. Grandparents were classified as ‘healthy’ (alive with Charlson comorbidity index score of 0 or 1), ‘unhealthy’ (alive with a score of ≥ 2), or dead when the child was born. Results Among the 27,425 children, mortality by age 2 was lower with healthy grandparents (e.g. 11 deaths per 1000 live births with healthy MGMs; 22 with unhealthy; 16 with dead MGMs) and acute healthcare contacts were fewer (e.g. 13% with healthy MGMs spent ≥7 days in hospital by age 2 vs 19% with unhealthy or dead MGMs). However, healthcare contacts were generally unrelated to grandfathers. Outcomes were better for children with 2 living grandmothers (e.g. 1.5% with 2 grandmothers were discharged against medical advice in 2 years; 2.7% with 1 grandmother; 3.7% with none). Conclusions Children with healthy grandmothers had lower mortality and morbidity. These associations are unlikely to be due to genetic or environmental factors, as they are weaker/missing for grandfathers. Key messages Good health among older Aboriginal people may also benefit the health of subsequent generations.

Earthing Theology

Abstract The encounter of Aboriginal Australians with European settlers led to appalling injustices, in which Christian churches were in part complicit. At the root of these injustices was the failure to comprehend the Aborigines’ relationship to the land. In their mythic vision, known as The Dreaming, land is suffused with religious meaning and therefore sacred. It took two hundred years for this to be acknowledged in British-Australian law (Mabo judgement, 1992). This abrogated the doctrine of terra nullius (the land belongs to no-one) and recognized native title to land, based on continuous occupation and ritual use. But land disputes continue, and at a deeper level, there is little appreciation of the Indigenous spirituality of the land and the significance it could have for reconciliation with First Nations and the ecological crisis. Aboriginal theologies can help Christians to appreciate the riches of this spirituality and work towards justice.

Using web conferencing to engage Aboriginal and Torres Strait Islander young people in research: a feasibility study

BackgroundWhile web conferencing technologies are being widely used in communication and collaboration, their uptake in conducting research field work has been relatively slow. The benefits that these technologies offer researchers for engaging with hard-to-reach populations are beginning to be recognised, however, the acceptability and feasibility of using web conferencing technology to engage Aboriginal and Torres Strait Islander young people in research is unknown.ObjectiveThis study aims to evaluate whether the use of web conferencing to engage Aboriginal and Torres Strait Islander young people in research is an acceptable and feasible alternative to conventional face-to-face methods.MethodsAboriginal and Torres Strait Islander young people aged between 18 and 24 years were recruited via emails, flyers and snowballing to participate in an Online Yarning Circle (OYC) about wellbeing conducted via web conferencing. Five young Aboriginal and Torres Strait Islander Australians were trained as peer facilitators and each conducted one or more OYCs with support from an experienced Aboriginal and Torres Strait Islander researcher. The OYCs were recorded and the researchers conducted post-OYC interviews with the facilitators. OYC recordings, facilitator interviews and researchers’ reflections about the method were analysed to assess acceptability and feasibility for use with this population.Results11 OYCs were conducted with 21 participants. The evaluation focused on (a) acceptability of the method for participants and facilitators and (b) feasibility of data collection method and procedures for use in research. Our evaluation revealed good acceptability and feasibility of the method, with only minor challenges experienced, which were predominantly logistical in nature and related to scheduling, obtaining documentation of consent, and technical issues. These challenges were offset by the greater control over the level of engagement that was comfortable for individual participants and the greater ease with which they felt they could withdraw from participating. This shift in the traditional researcher-participant power dynamic was recognised by both participants and peer facilitators and was regarded as a support for Aboriginal and Torres Strait Islander young people’s participation in research.ConclusionsThe use of web conferencing to engage Aboriginal and Torres Strait Islander young people in research offers an acceptable and feasible alternative to face-to-face research methods. The benefits conferred by these technologies associated with yielding greater control and power to the research participant has broad relevance to research with marginalised populations.

Evaluation of an Aboriginal and Torres Strait Islander strengths based coaching program: a study protocol

BackgroundIncreasingly, strength-based approaches to health and wellbeing interventions with Aboriginal and Torres Strait Islander Australians are being explored. This is a welcome counter to deficit-based initiatives which can represent a non-Indigenous view of outcomes of interest. However, the evidence base is not well developed. This paper presents the protocol for evaluating a strengths-based initiative which provides life coaching services to Aboriginal and Torres Strait Islander community housing tenants. The study aims to evaluate the effect of life coaching on social and emotional wellbeing (SEWB) of tenants in three Victorian regions.MethodsThe More Than a Landlord (MTAL) study is a prospective cohort study of Aboriginal Housing Victoria tenants aged 16 years and over that embeds the evaluation of a life coaching program. All tenant holders in one metropolitan and two regional areas of Victoria are invited to participate in a survey of SEWB, containing items consistent with key categories of SEWB as understood and defined by Aboriginal and Torres Strait Islander peoples, and key demographics, administered by Aboriginal and Torres Strait Islander peer researchers at baseline, 6 and 18 months. Survey participants are then invited to participate in strengths based life coaching, using the GROW model, for a duration of up to 18 months. Indigenous life coaches provide tenants with structured support in identifying and making progress towards their goals and aspirations, rather than needs. The study aims to recruit a minimum of 200 survey participants of which it is anticipated that approximately 73% will agree to life coaching.DiscussionThe MTAL study is a response to Aboriginal and Torres Strait Islander community and organisational requests to build the evidence base for an initiative originally developed and piloted within an Aboriginal controlled organisation. The study design aligns with key principles for research in Indigenous communities in promoting control, decision making and capacity building. The MTAL study will provide essential evidence to evaluate the effectiveness of strengths-based initiatives in promoting SEWB in these communities and provide new evidence about the relationship between strengths, resilience, self-determination and wellbeing outcomes.Trial registrationThis trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.

Re-examining the gap: A critical realist analysis of eye health inequity among Aboriginal and Torres Strait Islander Australians

The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter ‘Aboriginal’) Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.

"We Have to Be Strong Ourselves": Exploring the Support Needs of Informal Carers of Aboriginal and Torres Strait Islander People with Cancer.

Informal carers provide an important role in supporting people with cancer. Aboriginal and Torres Strait Islander peoples experience higher cancer mortality than other Australians. To date, very little is known about the support needs of carers of Aboriginal and Torres Strait Islander adults with cancer. This article explored these needs through a qualitative study. Twenty-two semi-structured qualitative interviews and one focus group were conducted with carers of Aboriginal and Torres Strait Islander adults with cancer (n = 12) and Aboriginal and Torres Strait Islander cancer survivors (n = 15) from Queensland, Australia. Half of the carers interviewed were Aboriginal or Torres Strait Islander Australians. Interviews were transcribed, coded and thematically analysed following an interpretive phenomenological approach. Thematic analysis of carer and survivor interviews revealed four key themes relating to carers’ needs: managing multiple responsibilities; maintaining the carer’s own health and wellbeing; accessing practical support and information; and engaging with the health system. Within these overarching themes, multiple needs were identified including specific needs relevant for carers of Aboriginal and Torres Strait Islander peoples, such as advocating for the patient; accessing Indigenous support services and health workers; and ensuring that the cultural needs of the person are recognised and respected. Identifying the needs of informal carers of Aboriginal and Torres Strait Islander cancer patients will enable greater understanding of the support that carers require and inform the development of strategies to meet these areas of need.

"You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease.

Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital–community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.

Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review

BackgroundRacism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples.MethodsA systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary.ResultsOf total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism.ConclusionRacism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.

Prevalence and sites of pain in remote-living older Aboriginal Australians, and associations with depressive symptoms and disability.

Pain is a growing public health problem associated with significant health and functional implications. Limited data exist for Aboriginal Australians. To describe the prevalence, severity and sites of pain, analgesic use and associated factors, including depression and disability, in remote-living Aboriginal Australians. Cross-sectional study of 263 Aboriginal Australians aged ≥45 years from six remote Indigenous communities and the town of Derby in the Kimberley region of Western Australia between 2011 and 2013. Pain was assessed using a culturally adapted pain scale. Factors associated with pain were investigated with binary logistic regression. One hundred and seventy (64.6%) participants reported having pain and 53 (20.2%) reported persistent pain. Of those reporting pain, 61 (35.9%) rated it as moderate and 70 (41.2%) as severe. The most common sites of pain were back and knee, and 38 (22.4%) participants with pain indicated three or more sites of pain. Only 70 (41.2%) participants with pain were on some type of analgesic medication. After adjustment, poor vision (odds ratio (OR) = 2.21; 95% confidence interval (CI) 1.22-4.00), hypertension (OR=1.89; 95% CI 1.03-3.45) and heart problems (OR=2.05; 95% CI 1.01-4.14) were associated with pain. Higher depression scores were associated with more persistent pain, but pain was not significantly associated with clinically relevant depressive symptoms, or requiring assistance with two or more personal and/or instrumental activities of daily living. High levels of pain were reported, although the prevalence of persistent pain was comparable to the general population. Identifying risk factors, improving pain recognition and assessment and evaluating culturally tailored management approaches should be a priority.

A Pathway to Precision Medicine for Aboriginal Australians: A Study Protocol.

(1) Background: Genomic precision medicine (PM) utilises people’s genomic data to inform the delivery of preventive and therapeutic health care. PM has not been well-established for use with people of Aboriginal and Torres Strait Islander ancestry due to the paucity of genomic data from these communities. We report the development of a new protocol using co-design methods to enhance the potential use of PM for Aboriginal Australians. (2) Methods: This iterative qualitative study consists of five main phases. Phase-I will ensure appropriate governance of the project and establishment of a Project Advisory Committee. Following an initial consultation with the Aboriginal community, Phase-II will invite community members to participate in co-design workshops. In Phase-III, the Chief Investigators will participate in co-design workshops and document generated ideas. The notes shall be analysed thematically in Phase-IV with Aboriginal community representatives, and the summary will be disseminated to the communities. In Phase-V, we will evaluate the co-design process and adapt our protocol for the use in partnership with other communities. (3) Discussion: This study protocol represents a crucial first step to ensure that PM research is relevant and acceptable to Aboriginal Australians. Without fair access to PM, the gap in health outcome between Aboriginal and non-Aboriginal Australians will continue to widen.

Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ).

Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18–25, 26–44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.

Relevance of the Aboriginal Rethink Sugary Drink media campaign to Aboriginal and non‐Aboriginal audiences in regional Victoria

ObjectiveTo test the hypothesis that a culturally tailored sugar‐sweetened beverage (SSB) campaign designed specifically for the Victorian Aboriginal community will not only be valuable for Aboriginal Victorians but will also have cross‐over benefits for non‐Aboriginal Victorians. MethodsAn online survey was completed by 155 Victorians (78 Aboriginal, 77 non‐Aboriginal) four months after the Aboriginal Rethink Sugary Drink (RSD) advertisement was launched. Differences between Aboriginal and non‐Aboriginal respondents were assessed using χ2 and Wilcoxon rank‐sum tests. ResultsSeventy‐six per cent of Aboriginal respondents recalled seeing the advertisement compared to 56% of non‐Aboriginal respondents (p<0.05). A high proportion of respondents (59% for Aboriginal, 55% for non‐Aboriginal) who had seen the advertisement correctly identified the sugar content of a 600mL drink. The perceived relevance of the advertisement was high (78% for Aboriginal vs. 47% for non‐Aboriginal; p=0.003), as was the response that it motivated action to improve health (82% vs. 50%; p=0.001). ConclusionNotwithstanding the small sample size, the Aboriginal advertisement appeared to engage both Aboriginal and non‐Aboriginal Victorians and promote SSB knowledge and motivation to improve health, particularly among Aboriginal Victorians, who were the target population. Public health campaigns should be designed with Aboriginal Australians to ensure equitable reach and impacts across the whole population. Implications for public healthAboriginal‐led health promotion campaigns may be beneficial for both Aboriginal and non‐Aboriginal audiences.

Lung, breast and bowel cancer treatment for Aboriginal people in New South Wales: a population-based cohort study.

BackgroundAboriginal Australians have higher cancer mortality than non‐Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this.AimsTo investigate demographic, clinical and access factors associated with lung, breast and bowel cancer treatment for Aboriginal people compared with non‐Aboriginal people in New South Wales, Australia.MethodsPopulation‐based cohort study using linked routinely collected datasets, including all diagnoses of primary lung, breast or bowel cancer from January 2009 to June 2012. Treatment (surgery, radiotherapy or chemotherapy) within 6 months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer‐specific multidisciplinary team, visit to a specialist and possession of private health insurance. Logistic regression modelling was employed.ResultsThere were 587 Aboriginal and 34 015 non‐Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non‐Aboriginal people received surgery (odds ratio 0.46, 95% confidence interval 0.29–0.73, P < 0.001) or any treatment (surgery, chemotherapy or radiotherapy; odds ratio 0.64, 95% confidence interval 0.47–0.88, P = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 vs 33.3%, 2865/8597, P = 0.04) compared with non‐Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non‐Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities.ConclusionAboriginal people were significantly less likely to receive surgery for lung cancer than non‐Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways.

Our journey, our story: a study protocol for the evaluation of a co-design framework to improve services for Aboriginal youth mental health and well-being.

IntroductionMainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation.Methods and analysisRelationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers’ knowledge and understanding of local, place-based cultural practices. Once relationships are developed, co-design workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement.Ethics and disseminationThe study has approval from the Kimberley Aboriginal Health Planning Forum Kimberley Research Subcommittee, the Western Australian Aboriginal Health Ethics Committee, and the Curtin University Human Research Ethics Committee. Transferability of the outcomes across the youth mental health sector will be directed by the co-researchers and is supported through Aboriginal and non-Aboriginal organisations including youth mental health services, peak mental health bodies and consumer groups. Community reports and events, peer-reviewed journal articles, conference presentations and social and mainstream media will aid dissemination.

Surgical and percutaneous management of Aboriginal Australians with rheumatic heart disease: Timeliness and concordance between practice and guidelines

BackgroundRheumatic heart disease (RHD) affects over 40 million people globally who are predominantly young and from impoverished communities. The barriers to valvular intervention are complex and contribute to the high morbidity and mortality associated with RHD. The rates of guideline indicated intervention in patients with significant RHD have not yet been reported. MethodsFrom 2007 to 2017, we used the Australian Northern Territory Cardiac Database to identify patients with RHD who fulfilled at least one ESC/EACTS guideline indication for mitral valve intervention. Baseline clinical status, comorbidities, echocardiographic parameters, indication for intervention, referral and any interventions were recorded. Results154 patients (mean age 38.5 ± 14.6, 66.1% female) were identified as having a class I or IIa indication for invasive management. Symptoms, atrial fibrillation and pulmonary hypertension were the most common indications for surgery (74.5%, 48.1%, 40.9%). From the onset of a guideline indication the actuarial rates of accepted referral and intervention within two-years were 66.0% ± 4.0% and 53.1% ± 4.4% respectively. Of those who were referred and accepted for intervention, 86% received it within 2 years. The rates of accepted referral for patients with class I indications were 72.5% ± 4.2% while class IIa indications were 42.5% ± 9.0% (p<0.001). ConclusionsApproximately half of Aboriginal patients with significant rheumatic mitral valve disease who met ESC/EACTS guideline indications for intervention received surgery or valvuloplasty within two-years. A significant difference in referral rates was found between Class I and Class IIa indications for valvular intervention.

‘Without uniform I am a community member, uncle, brother, granddad’: Community policing in Australia’s Torres Strait Region

As a palpable legacy of violent colonialism, Aboriginal and Torres Strait Islander (‘Indigenous’) Australians are the most incarcerated peoples in the world. Community policing, which hinges on the development of trusting community–police partnerships, is frequently proposed as a means of reducing this over-representation, but approaches vary and produce divergent outcomes. This article draws on interview data to explore policing in Australia’s Torres Strait Region – a remote archipelago situated off the northern tip of Queensland. A strong commitment to community and hybridised policing approaches likely provide a partial explanation for relatively low crime in the region. However, under-reporting of some offences (e.g. domestic violence) suggests a possible need to overlay alternative approaches that improve access to justice for all victims, especially women. Overall, the Torres Strait Region experience holds possible lessons for policing in Australia’s other remote Indigenous communities, again demonstrating that decolonisation is a critical starting point for addressing over-representation.

Extinction, Inscription and the Dreaming: Exploring a Thylacine Connection

ABSTRACT The thylacine, commonly associated with its Tasmanian extinction, also existed on the Australian mainland up until 3000–3500 years ago and is depicted in rock art sites in various locations around Australia. This lengthy period since extinction means we know little about Aboriginal Australians’ connections with this animal. This paper draws on available evidence to explore these thylacine connections. This exploration highlights the role that inscriptions, traces and narratives may play in facilitating continuing relationships with long extinct species. It also suggests that in these cosmologies, the material absence of a species does not necessarily correlate with ontological finality (of the kind generally considered central to the idea of extinction). The comparative perspective offered here complements work detailing extinction as a concept that has its own historical origins and developments, one that emerges as a specific cultural understanding about the nature of the world and its inhabitants.