In late 2023, an outbreak report of acute post-streptococcal glomerulonephritis (APSGN) in the Torres Strait documented seven confirmed cases and one probable case. This prompted an island-wide mass drug administration of oral trimethoprim/sulfamethoxazole to children aged 12 months to 17 years of age, possibly the first of its kind in response to an APSGN outbreak. In early 2024, an APSGN outbreak was declared with one confirmed and two probable cases, in the nearby Northern Peninsula Area of Cape York. The public health response to this outbreak included screening all children between 12 months and < 17 years of age for skin sores and sore throats, with treatment provided as deemed clinically appropriate. Both outbreaks reported nil further cases in the four months following each response. The relative merits of the different approaches will be discussed.

Understanding the genetic processes underlying divergence and connectivity among species is crucial for identifying evolutionary histories and informing conservation strategies. The Santalum genus exhibits distinct genetic variations across the complex geographic regions of Australia, Asia, and the Pacific Islands. This study leveraged genome-wide SNP markers to explore the genetic relationships within critically endangered and non-threatened species in an Austral-Pacific sandalwood complex, including Santalum lanceolatum, S. leptocladum, and S. macgregorii. Our findings revealed significant geographic partitioning and genetic divergence mostly aligned with current taxonomic classifications. However, notably, we showed S. macgregorii populations in Papua New Guinea (PNG) were divided into two distinct genetic groups: one in the Central and Gulf provinces and another in the Western Province, which shows a closer genetic relationship with S. lanceolatum from Australia's Northern Peninsula Area (NPA). This genetic connection suggests a history of secondary contact and potential hybridisation, influenced by historical land bridges and geological events. Our study highlighted that the sandalwood trees from the Western Province may represent a divergent lineage of S. lanceolatum; the S. macgregorii populations in the Central and Gulf provinces display vicariant divergence due to geographic isolation. These insights underscore the evolutionary complexity of sandalwoods and emphasise the need for tailored conservation strategies. Our results advocate for genetic rescue programs involving NPA S. lanceolatum to enhance reproductive success in threatened sandalwood populations, offering crucial guidance for conservation and management efforts in Australasia.

There is a growing body of literature around ageing well for Indigenous Peoples internationally. However, the perspectives of Torres Strait Islander Peoples, one of two First Nations groups in Australia, have not been documented. This qualitative study aims to explore what ageing well means to people living in the Torres Strait and Northern Peninsula Area (NPA) of Australia. Ten yarning circles were conducted with 45 participants from four island and five NPA communities across the region. Reflexive thematic analysis was used to identify seven themes of ageing well. A metaphor of a wongai tree-an endemic Torres Strait region tree-was used to describe those findings. The roots were used to represent the Torres Strait Islander way of life. The trunk represented practicing Torres Strait Islander identity. The branches represented a holistic approach to living a healthy lifestyle. The leaves represented strong leadership and role models. The fruit depicted passing on knowledge, tradition, and cultural practices. A cyclone, an adverse event, represented the challenges to ageing well, with the regrowth representing strong sustained life. Findings highlighted the importance of the cultural determinants of health, which significantly contribute to ageing well. These cultural determinants must be considered when addressing the health of First Nations Peoples, and as such, First Nations voices must be central in the design and implementation of practices and policies that affect them.

This study assessed the prevalence of suboptimal prescribing of medicines in First Nations older adults in the Torres Strait. Types of suboptimal prescribing included polypharmacy, over-prescribing, under-prescribing and anticholinergic burden. It also assessed any significant associations between suboptimal prescribing and common age-related problems such as falls, reduced function and cognition. Cross-sectional study (2015-2018) on 18 island and five mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland, Australia. Community-dwelling residents aged 45 years and older who identified as Torres Strait Islander and/or Aboriginal with complete medication histories were recruited in this study. Validated prescribing tools were used to identify suboptimal prescribing practises. There were 254 participants with complete medication histories. The mean age was 65.7 (SD ± 10.9, range 45-93), with 65% female. Suboptimal prescribing in this study was 74%. Of these, 49% of participants had polypharmacy, 44% were over-prescribed, and 36% were under-prescribed. Anticholinergic burden was identified in 26% of participants. Polypharmacy was more prevalent in participants who were dependent on instrumental activities of daily living (iADLs). The results demonstrate the importance of general practitioners, health-care workers or pharmacists, to monitor medication prescribing in this population. Frequent review of medications to reduce suboptimal prescribing practices within these communities may help to reduce adverse outcomes because of prescribing practices.

This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well-being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore. This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia. Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022. This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns. Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement. Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA.

ABSTRACT The wildlife-domestic interface is a key concept helping us to understand how diseases affect both wild and domestic animal populations, yet how to define and measure it remains a challenge. One tool which can contribute to our understanding of the wildlife-domestic interface is disease spread modelling. This can provide insight into how diseases spread within and between populations, and guide decision-making for disease control, response and surveillance programs. Specifically, quantitative estimation of contact rates permits such disease spread models to be developed and used confidently. Here we present a case study of the potential spread of rabies (an exotic disease in Australia) within the wild dog-domestic dog (Canis familiaris) ecosystem of northern Australia to illustrate the concept of the wildlife-domestic interface and disease transmission. We summarise a decade of research conducted to understand one such interface, the wild-domestic dog interface at one site in northern Australia, for the purposes of exploring the impact of one specific disease, rabies. Over a period of 10 years, free-roaming domestic dogs and wild dogs in the Northern Peninsula Area (NPA) of Cape York, Queensland were studied. Key findings included identification of a small but important group of domestic dogs which regularly roam in bushland areas; peri-urban wild dog activity, particularly in the dry season, likely driven by the availability of food sources; and the potential for interaction between hunting dogs and wild dogs in remote areas, particularly during the wet season. These observations can be used to inform disease spread models and identify strategies to mitigate the risks of disease transmission. However, the collection and incorporation of data into such models needs more consideration regarding what information is usable (such as contact rates) and the best ways to collect it. The scarcity of such models incorporating the wildlife-domestic interface suggests that integrated epidemiological-ecological studies are needed to fill this gap.

Tools screening depression and anxiety developed using the Western biomedical paradigm are still used with First Nations Peoples globally, despite calls for cross-cultural adaption. Recent work by this research team found that tools used to screen for depression and anxiety were inappropriate for use with Australian First Nations Peoples living in the Torres Strait and Northern Peninsula Area of Australia. The objective of this Delphi study, the second phase of a broader four-phase project, was to gain consensus from an expert mental health and/or social and emotional wellbeing (SEWB) panel to inform the development of an appropriate screening tool. This Delphi study took place between March and May 2023. Three sequential rounds of anonymous online surveys delivered using QualtricsTM were planned, although only two were needed to reach 75% consensus. The first round sought consensus on whether a new screening tool needed to be developed or whether existing tools could be used. The second round achieved consensus. Twenty-eight experts (47% response rate) participated across the two Delphi rounds. In the second round, 83% of these experts agreed or strongly agreed that a new screening tool, using the holistic First Nations concept of social and emotional wellbeing, be developed. Ninety-four percent of them agreed that it should take a Yarning approach. These findings enabled the development of a new SEWB screening tool that adopted a Yarning (narrative) approach designed for use in primary care and geriatric settings in the region. The new tool has four different Yarning areas: Community engagement and behaviour; Stress worries; Risk; and Feeling strong. Guidelines for tool use are integrated as well as Summary and Recommendation sections. At a macro-level this project responds to the need for new screening tools that are underpinned by First Nations worldviews.

The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.

Tools that screen for depression and anxiety developed using the Western biomedical paradigm are still used with First Nations peoples globally, despite calls for cross-cultural adaption. Recent work by the research team found that tools used to screen for depression and anxiety were not appropriate for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area (NPA). of Australia. Consequently, the objective of this Delphi study is to gain consensus from an expert mental health panel to inform the development of an appropriate depression and anxiety screening tool(s). A Delphi study with Australian expert panellists will be used to reach consensus about whether an existing screening tool should be used or whether adaption or new tool development should take place. Three sequential rounds of anonymous online surveys will be used to reach consensus. The first round will seek consensus about the tool(s). Subsequent rounds will seek consensus on the development of the tool(s) identified in round one. Panellists will be identified using a combination of authorship of related publications, established national clinical or research profile in First Nations mental health, and/or by peer referral. Consensus will be reached when 75% of the panel agree. When agreement is not reached suggestions will be taken to the next round. If agreement is not achieved by the third round, the Steering Committee will make any outstanding decisions. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Torres Strait Islander members of the research team.

Corrigendum to “Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions” [The Lancet Regional Health - Western Pacific 26 (2022) 100532

Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions

In July 2018, participants at a Waiben (Thursday Island) conference declared that it was time for a locally driven research agenda for the Torres Strait and Queensland Northern Peninsula Area. For decades, they felt exploited by outside researchers. They identified a lack of respect and consultation, with few benefits for their people. In response, the Australian Institute of Tropical Health and Medicine (Waiben Campus-Ngulaigau Mudh) invited a consultative group of elders and senior health providers to develop a research program based on local cultural and health needs. The aim was to promote research skills through a learn-by-doing approach. Four workshops were conducted over 2019. Key financial and in-kind support was provided by the Australian Institute of Tropical Health and Medicine, Hot North, and Queensland Health's Torres and Cape Hospital and Health Service. The first workshop attracted 24 people; none had previous research experience. The workshop format evolved over 2019, mainly guided by the participants. Overall, feedback was positive, and participant research proposals remain in various stages of development. Although suspended during the COVID-19 pandemic, this is a long-term investment in community-driven research that seeks to translate health benefits to the people. This model may apply to other communities, especially in rural and remote Australia. Warning: This article contains the names and/or images of deceased Aboriginal and Torres Strait Islander peoples.

Potentially Preventable Dementia in a First Nations Population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A Cross Sectional Analysis Using Population Attributable Fractions

Australian Aboriginal and Torres Strait Islander children experience unacceptably high rates of dental caries compared to their non-Indigenous Australian counterparts. Dental caries significantly impacts the quality of life of children and their families, particularly in remote communities. While many socioeconomic and lifestyle factors impact caries risk, the central role of the oral microbiota in mediating dental caries has not been extensively investigated in these communities. Here, we examine factors that shape diversity and composition of the salivary microbiota in Aboriginal and Torres Strait Islander children and adolescents living in the remote Northern Peninsula Area (NPA) of Far North Queensland. We employed 16S ribosomal RNA amplicon sequencing to profile bacteria present in saliva collected from 205 individuals aged 4–17 years from the NPA. Higher average microbial diversity was generally linked to increased age and salivary pH, less frequent toothbrushing, and proxies for lower socioeconomic status (SES). Differences in microbial composition were significantly related to age, salivary pH, SES proxies, and active dental caries. Notably, a feature classified as Streptococcus sobrinus increased in abundance in children who reported less frequent tooth brushing. A specific Veillonella feature was associated with caries presence, while features classified as Actinobacillus/Haemophilus and Leptotrichia were associated with absence of caries; a Lactobacillus gasseri feature increased in abundance in severe caries. Finally, we statistically assessed the interplay between dental caries and caries risk factors in shaping the oral microbiota. These data provide a detailed understanding of biological, behavioral, and socioeconomic factors that shape the oral microbiota and may underpin caries development in this group. This information can be used in the future to improve tailored caries prevention and management options for Australian Aboriginal and Torres Strait Islander children and communities.

Australia, home to the iconic dingo, is currently free from canine rabies. However northern Australia, including Indigenous communities with large free-roaming domestic dog populations, is at increased risk of rabies incursion from nearby Indonesia. We developed a novel agent-based stochastic spatial rabies spread model to evaluate the potential spread of rabies within the dingo population of the Northern Peninsula Area (NPA) region of northern Australia. The model incorporated spatio-temporal features specific to this host-environment system, including landscape heterogeneity, demographic fluctuations, dispersal movements and dingo ecological parameters—such as home range size and density—derived from NPA field studies. Rabies spread between dingo packs in nearly 60% of simulations. In such situations rabies would affect a median of 22 dingoes (approximately 14% of the population; 2.5–97.5 percentiles: 2–101 dingoes) within the study area which covered 1,131 km2, and spread 0.52 km/week for 191 days. Larger outbreaks occurred in scenarios in which an incursion was introduced during the dry season (vs. wet season), and close to communities (vs. areas with high risk of interaction between dingoes and hunting community dogs). Sensitivity analyses revealed that home range size and duration of infectious clinical period contributed most to the variance of outputs. Although conditions in the NPA would most likely not support a sustained propagation of the disease in the dingo population, due to the predicted number of infected dingoes following a rabies incursion and the proximity of Indigenous communities to dingo habitat, we conclude that the risk for human transmission could be substantial.

To examine the prevalence of dementia and problems associated with ageing in the Torres Strait. The study was conducted across all 18 island and 5 mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland. Participants underwent a comprehensive health assessment and a Geriatrician assessment, which were used to establish consensus diagnoses. A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. The prevalence of dementia in the sample was 14.2%, which was 2.87 times higher than the wider Australian population. Torres Strait Islander peoples share the increased risk of dementia seen in Aboriginal Australians compared to the wider community. This highlights the need for interventions to address this increased dementia risk for Aboriginal and Torres Strait Islander communities.

Interactions between dingoes and domestic dogs in Australia have implications for disease spread, but to understand the potential impact, better knowledge of the nature of this dingo-domestic dog interface is needed. Driven by a need to assess the risk of a rabies incursion in northern Australia and its likely impact, a field research program was initiated in 2012, focused on the Northern Peninsula Area (NPA) of Cape York, Queensland. There is scant information available on how and under what circumstances dingoes interact with domestic dogs, which is a gap in disease preparedness and response, and studies have been conducted on both domestic dogs and dingoes in this area. Here we describe one study that used camera-trap data to assess fixed and variable characteristics of NPA dingo populations. Because of the dingo-domestic dog interface and hybridisation in the NPA, we hypothesised that some dingo-type dogs might exhibit domestic dog traits. During 12 months of monitoring, 24 phenotypically-based dingo-type dogs were identified. Seven of these that were studied in more detail exhibited both dingo-like and domestic dog-like traits. Activity was concentrated at an unofficial waste site and mostly at night, and interactions between these seven dingo-like dogs were observed. Although interactions between this subset of highly active dingoes and domestic dogs were not observed, two such interactions were observed within the larger group of dingoes. Whilst this study provides baseline information about the role that the dingo-domestic dog interface could play in disease spread – such as in the event of a rabies incursion – it is a snapshot in a single region. To inform disease surveillance, control and management plans, multidisciplinary research involving ecologists, epidemiologists and veterinarians, together with indigenous communities, is needed to further define the dingo-domestic dog interface in Australia.

Dingo classification and management is complicated by hybridisation with domestic dogs. Northern Australia is a relatively high-risk zone for a rabies incursion, and in the event of an incursion, Aboriginal and Torres Strait Islander peoples who reside in this region would prioritise the protection of dingoes. Therefore, the classification of dingoes in this context is important. Twelve pictures of canids with features associated with both dingoes and domestic dogs from camera traps in the Northern Peninsula Area (NPA), northern Queensland, were shown to Aboriginal and Torres Strait Islander rangers (n = 3), biosecurity officers (n = 2), environmental health workers (n = 2), and residents (n = 39) in the NPA. Nearly all pictures (10/12) were classified as dingo or domestic dog (none as hybrid) and two were inconclusive (no overall agreement). Dingoes were consistently identified as medium to large-framed dogs, with a long nose, pointed ears, narrow abdomen, a bushy or feathered tail, and smooth coats of a single base colour. Some hybrid features were acceptable, including sable coats, lack of white tail tip or feet, and curled tail. These findings are a preliminary guide for identifying canids in the NPA region for whom management might be controversial. Building on this approach via further consultation with residents is needed to inform rabies response policy. Our approach using locally acquired camera trap pictures could also be extended to other regions in which dingoes have value but their management is controversial.

ABSTRACT A once-annual caries preventive (Intervention) treatment was offered to Aboriginal and Torres Strait Islander schoolchildren—a population with disproportionately poorer oral health than non-Indigenous Australian children—in the Northern Peninsula Area (NPA) of Far North Queensland (FNQ), which significantly improved their oral health. Here, we examine the salivary microbiota of these children (mean age = 10 ± 2.96 years; n = 103), reconstructing the bacterial community composition with high-throughput sequencing of the V4 region of bacterial 16S rRNA gene. Microbial communities of children who received the Intervention had lower taxonomic diversity than those who did not receive treatment (Shannon, p < 0.05). Moreover, the Intervention resulted in further decreased microbial diversity in children with active carious lesions existing at the time of saliva collection. Microbial species associated with caries were detected; Lactobacillus salivarius, Lactobacillus reuteri, Lactobacillus gasseri, Prevotella multisaccharivorax, Parascardovia denticolens, and Mitsuokella HMT 131 were significantly increased (p < 0.05) in children with severe caries, especially in children who did not receive the Intervention. These insights into microbial associations and community differences prompt future considerations to the mechanisms behind caries-preventive therapy induced change; important for understanding the long-term implications of like treatment to improve oral health disparities within Australia. Trial registration: ANZCTR, ACTRN12615000693527. Registered 3 July 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368750&isReview=true

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