Northern Territory Of Australia Research Articles

Association between maternal mental health-related hospitalisation in the 5 years prior to or during pregnancy and adverse birth outcomes: a population-based retrospective cohort data linkage study in the Northern Territory of Australia

Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes. We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations. From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births. Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services. The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.

Validating APSIM for the Northern Territory of Australia: An environment with challenging weather and soils

Validating APSIM for the Northern Territory of Australia: An environment with challenging weather and soils

What are the impacts of alcohol supply reduction measures on police-recorded adult domestic and family violence in the Northern Territory of Australia?

BackgroundDuring 2017-18, the Northern Territory (NT) introduced a Banned Drinker Register (BDR) and Minimum Unit Price (MUP) NT-wide; Police Auxiliary Liquor Inspectors (PALIs) in three regional towns; and restrictions on daily purchases/opening hours (DPOH) in one regional town. The BDR is an individual-level alcohol ban; MUP is a pricing policy; and PALIs enforce bans on restricted areas at takeaway outlets. This study examines the impact of these policies on adult domestic and family violence (DFV). MethodsWe examined DFV assaults and breaches of violence orders from January 2014 – February 2020 using interrupted time series models for NT, Greater Darwin, Katherine, Tennant Creek, and Alice Springs. To account for increasing numbers of individuals on the BDR we tested two timepoints (Sept 2017, March 2018). FindingsFollowing DPOH, assaults (78 %) and alcohol-involved assaults (92 %) decreased in Tennant Creek. After PALIs, assaults (79 %) in Tennant Creek, and breaches (39 %) and alcohol-involved breaches (58 %) in Katherine decreased. After MUP, assaults (11 %), alcohol-involved assaults (21 %) and alcohol-involved breaches (21%) decreased NT wide. After MUP/PALIs in Alice Springs, alcohol-involved assaults (33 %), breaches (42 %), and alcohol-involved breaches (57 %) decreased. BDR (Sept 2017) found increases in assaults (44 %) and alcohol-involved assaults (39 %) in Katherine and assaults (10%) and alcohol-involved assaults NT-wide (17 %). There were increases of 21 %-45 % in breaches NT-wide, in Darwin, Katherine, and Alice Springs. Following March 2018 found increases in assaults (33 %) and alcohol-involved assaults (48 %) in Katherine. There were increases - from 20 % to 56 % - in breaches in NT-wide, Katherine, and Alice Springs. ConclusionPALIs and DPOH were associated with some reductions in DFV; the BDR was associated with some increases. The upward trend commences prior to the BDR, so it is also plausible that the BDR had no effect on DFV outcomes. Although MUP was associated with reductions in the NT-wide model, there were no changes in sites without cooccurring PALIs.

Application of P-TOPALS for Smoothing Input Data for Population Projections ‘At the Edge’

Sparsely populated areas of developed countries are regions of great demographic diversity and dynamism. While they remain strategically and economically important, trends in urbanization and technology have increased their relative sparsity and isolation making centralized government, service delivery and planning a challenge. Populations of their sub-jurisdictions are small and often exhibit significant heterogeneity in key demographic characteristics, not least between their Indigenous first residents and non-Indigenous citizens. Development of projection models for these areas is challenged by significant input data paucity, biases and structural issues related to the data collection and estimation architectures in place to gather input data across diverse and small populations. While this is the case, the demand for and importance of projections is no less for sparsely populated areas than elsewhere. Variants of the cohort component model are important tools for population projections for SPAs, with their grounding in the demographic accounting equation and modest input requirements. Nevertheless, to attain fit-for-purpose input data requires demographers to consider and select from a growing number of methods for smoothing issues with input data for projections for these regions. In this article we analyze the contributions of recent advances in methods for estimating fertility, mortality, and migration rates for small and diverse populations such as those in SPAs, focusing on the very sparsely populated jurisdiction of the Northern Territory of Australia. In addition to the contributions of our method itself, results at the detailed level demonstrate how abnormal and challenging ‘doing’ projections for sparsely populated areas can be.

Melioidosis Knowledge Awareness in Three Distinct Groups in the Tropical Northern Territory of Australia.

Melioidosis is a potentially life-threatening infection. This study aimed to assess the melioidosis knowledge among distinct participant groups in the tropical Top End of the Northern Territory (NT) of Australia. Participants were categorised into three groups: NT medical students and health research staff (Group 1: Hi-Ed), Aboriginal Rangers and Aboriginal Healthcare Workers (Group 2: Rangers/AHWs), and patients with a history of melioidosis infection (Group 3: Patients). A questionnaire was developed to collect data on demographics, risk and protective factor awareness, and knowledge acquisition sources. We used responses to calculate indices for risk knowledge (RKI), protective knowledge (PKI), overall melioidosis knowledge (MKI), and information sources (ISI). We found that 93.6% of participants in Group 1 (Hi-Ed) said that they had heard of melioidosis, followed by 81.5% in Group 3 (Patients), and 72.0% in Group 2 (Rangers/AHWs). Group 1 (Hi-Ed) participants demonstrated greater knowledge of risk-increasing behaviours but had gaps in knowledge of clinical risks like diabetes. Multiple regression revealed that the number of resources used was the only significant predictor of MKI. There are varying melioidosis knowledge levels across different NT participant groups. Targeted educational interventions are needed to enhance melioidosis awareness. A weblink with an interactive summary of our analysis can be found under Results part.

Significance of lung nodules detected on chest CT among adult Aboriginal Australians - a retrospective descriptive study.

There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia. Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules. Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow-up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow-up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection. Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.

Psychosocial Hazards in the Northern Territory Building and Construction Industry: A Profile of Job Demands and Job Resources in a Jurisdiction and Industry with High Rates of Suicide.

The work environment for building workers in Australia's Northern Territory (NT) is characterised by concerningly high rates of distress and suicide at both a jurisdictional and an industry level. Work-related psychosocial hazards are known antecedents of work-related distress and suicide, and more research is required to understand how these hazards impact workers in this unique building context. This paper examines the unique work environment in the NT building industry by comparing psychosocial hazards in the NT with those in the broader Australian building and construction industry. When comparing 330 NT self-report survey responses about psychosocial hazards in the workplace to 773 broader Australian building industry responses, supervisor task conflict for NT workers was more concerning, at 10.9% higher than the broader Australian cohort. Within the NT sample, comparisons between fly-in and fly-out/drive-in and drive-out (FIFO/DIDO) workers and non-FIFO/DIDO workers were also performed to determine specific local psychosocial hazards. When comparing FIFO/DIDO workers' responses to their NT peers, role overload and supervisor task conflict were significantly higher, and co-worker and supervisor support were lower. In FIFO/DIDO environments, praise and recognition, procedural justice, and change consultation were at concerningly lower averages than the broader NT building and construction industry. These results suggest that the NT building and construction industry, and particularly FIFO/DIDO operations, require greater resourcing, investment, and focus on workplace mental health initiatives to improve the work environment and wellbeing of this workforce and mitigate hazards that can lead to distress and the high rates of occupational suicide found in this jurisdiction and industry.

Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis – a ten-year retrospective cohort study

BackgroundThis study assessed hospitalisation frequency and related clinical outcomes among adult Aboriginal Australians with bronchiectasis over a ten-year study period.MethodThis retrospective study included patients aged ≥ 18 years diagnosed with bronchiectasis between 2011 and 2020 in the Top End, Northern Territory of Australia. Hospital admissions restricted to respiratory conditions (International Classification of Diseases (ICD) code J) and relevant clinical parameters were assessed and compared between those with and without hospital admissions.ResultsOf the 459 patients diagnosed to have bronchiectasis, 398 (87%) recorded at least one respiratory related (ICD-J code) hospitalisation during the 10-year window. In comparison to patients with a recorded hospitalisation against those without—hospitalised patients were older (median 57 vs 53 years), predominantly females (54 vs 46%), had lower body mass index (23 vs 26 kg/m2) and had greater concurrent presence of chronic obstructive pulmonary disease (COPD) (88 vs 47%), including demonstrating lower spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) (median FVC 49 vs 63% & FEV1 36 vs 55% respectively)). The total hospitalisations accounted for 3,123 admissions (median 4 per patient (IQR 2, 10)), at a median rate of 1 /year (IQR 0.5, 2.2) with a median length of 3 days (IQR 1, 6). Bronchiectasis along with COPD with lower respiratory tract infection (ICD code-J44) was the most common primary diagnosis code, accounting for 56% of presentations and 46% of days in hospital, which was also higher for patients using inhaled corticosteroids (81 vs 52%, p = 0.007). A total of 114 (29%) patients were recorded to have had an ICU admission, with a higher rate, including longer hospital stay among those patients with bronchiectasis and respiratory failure related presentations (32/35, 91%). In multivariate regression model, concurrent presence of COPD or asthma alongside bronchiectasis was associated with shorter times between subsequent hospitalisations (-423 days, p = 0.007 & -119 days, p = 0.02 respectively).ConclusionHospitalisation rates among adult Aboriginal Australians with bronchiectasis are high. Future interventions are required to explore avenues to reduce the overall morbidity associated with bronchiectasis among Aboriginal Australians.

Brackish groundwater desalination by constant current membrane capacitive deionization (MCDI): Results of a long-term field trial in Central Australia

A long-term field trial of membrane capacitive deionization (MCDI) was conducted in a remote community in the Northern Territory of Australia, with the aim of producing safe palatable drinking water from groundwater that contains high concentrations of salt and hardness ions and other contaminants. This trial lasted for 1.5 years, which, to our knowledge, is one of the longest reported studies of pilot-scale MCDI field trials. The 8-module MCDI pilot unit reduced salt concentration to below the Australian Drinking Water Guideline value of 600 mg/L total dissolved solids (TDS) concentration with a relatively high water recovery of 71.6 ± 8.7 %. During continuous constant current operation and electrode discharging at near zero volts, a rapid performance deterioration occurred that was primarily attributed to insufficient desorption of multivalent ions from the porous carbon electrodes. Performance could be temporarily recovered using chemical cleaning and modified operating procedures however these approaches could not fundamentally resolve the issue of insufficient electrode performance regeneration. Constant current discharging of the electrodes to a negative cell cut-off voltage was hence employed to enhance the stability and overall performance of the MCDI unit during the continuous operation. An increase in selectivity of monovalent ions over divalent ions was also attained by implementing negative voltage discharging. The energy consumption of an MCDI system with a capacity of 1000 m3/day was projected to be 0.40∼0.53 kWh/m3, which is comparable to the energy consumption of electrodialysis reversal (EDR) and brackish water reverse osmosis (BWRO) systems of the same capacity. The relatively low maintenance requirements of the MCDI system rendered it the most cost-efficient water treatment technology for deployment in remote locations. The LCOW of an MCDI system with a capacity of 1000 m3/day was projected to be AU$1.059/m3 and AU$1.146/m3 under two operational modes, respectively. Further investigation of particular water-energy trade-offs amongst MCDI performance metrics is required to facilitate broader application of this promising water treatment technology.

Ten-year (2009–2019) epidemiological study of head and neck, salivary glands and upper aerodigestive tract cancers, and overall survival outcomes in the Northern Territory of Australia

BackgroundHead and neck, salivary glands and aerodigestive tract cancers (HNACs) rank sixth in cancer incidence in Australia, posing significant public health and economic challenges. However, data on HNACs in the...

Indigenous Housing Rights and Colonial Sovereignty: Self-Determination and Housing Rights beyond a White Possessive Frame

Through the lens of Aileen Moreton-Robinson's ‘white possessive logics’, this article addresses a series of legal cases concerning inhumane Aboriginal housing in the Northern Territory of Australia. It critiques successive government policies in relation to First Nations people since the colonisation of the Northern Territory in the nineteenth century, setting the cases in their historical context of ongoing subordination of First Nations people to the interests of white possession of land and governance. We argue that domestic law pertaining to First Nations housing rights manifests white possessive logics. Such control can only be overcome through affording First Nations communities self-determination over housing in accordance with international law and First Nations claims. Self-determination and sovereignty are antidotes to the colonial histories that underlie inadequate housing for Indigenous peoples not only in Australia but across settler colonies. In developing this argument, we draw on international law and honour the advocacy of Northern Territory Aboriginal communities who have struggled for community-control over housing and homelands over successive generations.

"Putting the power back into community": A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia's Northern Territory.

Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia's Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe "Managing hepatitis B" training course for the Aboriginal health workforce. Here, we present an evaluation of the course. 1. To improve course participants CHB-related knowledge, attitudes, and clinical practice. 2. To evaluate the "Managing hepatitis B" training course. 3. To enable participants to have the skills and confidence to be part of the care team. We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our "Managing hepatitis B" training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick's training evaluation framework. Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams. The "Managing hepatitis B" training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment.

Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare.

First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.

Predicting child development and school readiness, at age 5, for Aboriginal and non-Aboriginal children in Australia's Northern Territory.

Positive early development is critical in shaping children's lifelong health and wellbeing. Identifying children at risk of poor development is important in targeting early interventions to children and families most in need of support. We aimed to develop a predictive model that could inform early support for vulnerable children. We analysed linked administrative records for a birth cohort of 2,380 Northern Territory children (including 1,222 Aboriginal children) who were in their first year of school in 2015 and had a completed record from the Australian Early Development Census (AEDC). The AEDC measures early child development (school readiness) across five domains of development. We fitted prediction models, for AEDC weighted summary scores, using a Partial Least Square Structural Equation Model (PLS-SEM) considering four groups of factors-pre-pregnancy, pregnancy, known at birth, and child-related factors. We first assessed the models' internal validity and then the out-of-sample predictive power (external validity) using the PLSpredict procedure. We identified separate predictive models, with a good fit, for Aboriginal and non-Aboriginal children. For Aboriginal children, a significant pre-pregnancy predictor of better outcomes was higher socioeconomic status (direct, β = 0.22 and indirect, β = 0.16). Pregnancy factors (gestational diabetes and maternal smoking (indirect, β = -0.09) and child-related factors (English as a second language and not attending preschool (direct, β = -0.28) predicted poorer outcomes. Further, pregnancy and child-related factors partially mediated the effects of pre-pregnancy factors; and child-related factors fully mediated the effects of pregnancy factors on AEDC weighted scores. For non-Aboriginal children, pre-pregnancy factors (increasing maternal age, socioeconomic status, parity, and occupation of the primary carer) directly predicted better outcomes (β = 0.29). A technical observation was that variance in AEDC weighted scores was not equally captured across all five AEDC domains; for Aboriginal children results were based on only three domains (emotional maturity; social competence, and language and cognitive skills (school-based)) and for non-Aboriginal children, on a single domain (language and cognitive skills (school-based)). The models give insight into the interplay of multiple factors at different stages of a child's development and inform service and policy responses. Recruiting children and their families for early support programs should consider both the direct effects of the predictors and their interactions. The content and application of the AEDC measurement need to be strengthened to ensure all domains of a child's development are captured equally.

Permeable Housing

This article explores how water acts on permeable housing and the documentary infrastructures that mitigate its impact and enable its flows. It does so through consideration of ongoing litigation brought by public housing tenants at the remote communities of Ltyentye Apurte (Santa Teresa) and Laramba in the Northern Territory of Australia for incomplete repairs and unsafe drinking water. I offer a distinction between pragmatist and functionalist housing, as competing concepts for framing, respectively, the impact of entrenched low expectations on remote housing performance and management and the minimum amenity that contemporary housing should provide. The litigation by Ltyentye Apurte and Laramba householders is notable for challenging the habitability standard that remote community housing must meet and for introducing the provision of safe drinking water as a matter of habitable housing. While water searches out cracks and refuses expulsion from the housing assemblage, necessitating repairs and maintenance, such mobility provides a challenge for allocating specific obligations to various settler colonial authorities that are collectively involved in maintaining house function. Drawing on close analyses of a series of legal decisions, the article examines how legal frameworks and intra-governmental funding arrangements are employed to eschew responsibility for safe drinking water inside remote community housing.

Natal origin and dispersal of problem saltwater crocodiles in the Darwin Harbor, Australia

AbstractManagement programs that successfully recovered wild saltwater crocodile (Crocodylus porosus) populations in the Northern Territory of Australia did so with an expanding commitment to maintaining public safety. One aspect of the program is the ongoing removal of resident and immigrant crocodiles within Darwin Harbor (since 1979), the main urban center. We determined the likely sources of crocodiles caught as problem animals between 2015–2017 by comparing recently developed methods for population assignment. Depending on the assignment model used, we estimated that between 30% and 50% of crocodiles in Darwin Harbor originated from the Adelaide and Mary rivers, and the Kakadu region east of Darwin, and between 20% and 30% of crocodiles originated from the Finniss, Reynolds, and Daly rivers southwest of Darwin. Saltwater crocodiles occur at particularly high densities in these catchments. The remainder came from a mixture of different sources across the Northern Territory. The most common animals captured were immature (150–180 cm) males that have traveled 100–200 km. We did not identify any relationships between the distance from the inferred origin to Darwin Harbor and the size and sex of the crocodiles, or the year of capture. The targeted removal of crocodiles from specific sites such as Darwin Harbor, near where most people live, improves public safety in the highest risk areas, without compromising abundant source populations in most areas.

Investigating the correlation between extreme temperature events and the increasing frequency of power outages in the Northern Territory of Australia

It has been claimed that the grid of the Northern Territory of Australia suffers from more frequent blackouts because of the increasing occurrence of extreme events. However, the temperature oscillations have not changed since the time measurements started to be collected at the end of 1800. The time series of the monthly maximum and highest temperatures for the two locations of the Northern Territory of Australia which are spanning 140 years shows temperature extremes are not worsening, being the records detrended. The increasing power outages have many other causes. Some are natural such as cyclones, winds, or lightning. Others are human such as equipment failure, animal or human interference, overload, and maintenance or upgrade. One reason for the more frequent power outages is the reduced resilience of the grid forced to accept a growing share of non-dispatchable, intermittent, and irregular solar energy without appropriate energy storage. Their occurrence may be lessened by improving the resilience of the grid by providing adequate energy storage. The study contributes to the understanding of the complex factors influencing power outages and highlights the importance of resilient grid infrastructure.

Making Waves: The Role of Indigenous Water Beings in Debates about Human and Non‐Human Rights

ABSTRACTRejecting nature‐culture dualism, contemporary anthropology recognises the mutually constitutive processes that create shared human and non‐human lifeworlds. Such recognition owes much to ethnographic engagement with diverse indigenous cosmologies many of which have, for millennia, upheld ideas about indivisible worlds in which all living kinds occupy a shared ontological space and non‐human species and environments are approached respectfully, with expectations of reciprocity and partnership. As many societies confront the global chaos caused by the anthropocentric prioritisation of human interests, anthropologists and indigenous communities are therefore well placed to articulate alternative models in which the non‐human domain is dealt with more equitably and inclusively. This paper is located comparatively in long‐term ethnographic research with indigenous communities in Australia, alongside the Mitchell River in North Queensland and the Brisbane River in South Queensland. It draws more specifically on involvement in legal claims for water rights by Māori iwis in New Zealand; in land claims by the Kunjen language group in Cape York; and in a recent ‘sea country’ case brought against a major multi‐national by the Tiwi Islanders in Australia's Northern Territory. It also makes use of a major comparative study of water beings in diverse cultural and historical contexts, and considers the central importance of water beings such as Māori taniwha and the Australian Rainbow Serpent in such legal conflicts, and in broader debates about human and non‐human rights. Like other water deities around the world, these beings personify the generative (and potentially punitive) powers of water and its co‐creative role in shaping human and non‐human lives. They are resurfacing today with an important representational role in contemporary conflicts over land and water.

Cystic lung disease in adult Indigenous Australians in the Northern Territory of Australia.

Indigenous Australians have a high prevalence of chronic lung diseases. However, no previous studies have reported on cystic lung disease in an Indigenous patient cohort. This report describes 20 adult Indigenous patients noted to have incidental lung cysts on chest computed tomography (CT) while being referred to undergo lung function tests in the Northern Territory of Australia. Of the total 20 Indigenous patients demonstrating presence of pulmonary cysts on chest CT scan, 13/20 (65%) were males with a mean age of 49.9 years (range 24-74 years), with no significant difference in age between males and females. The majority reported a smoking history and spirometry demonstrated moderate reduction in lung function parameters. While there was no pattern in the size or location of cysts, most demonstrated multiple cysts (55% had ≥5 cysts) with bilateral involvement (65%), alongside a range of concurrent pulmonary radiological abnormalities. The aetiology for lung cysts was largely unknown. This is the first report to illustrate cystic lung disease within an Indigenous population. Further radiology studies are required to investigate the causes and prognostications of cystic lung disease in Indigenous patients.

Antiphospholipid syndrome in rural, remote, and First Nations peoples in the Top End of the Northern Territory, Australia

BackgroundThe Northern Territory of Australia has a high proportion of First Nations peoples living in remote communities and a high burden of chronic autoimmune diseases. The epidemiology and clinical outcomes of antiphospholipid syndrome (APS) in First Nations Australians are poorly characterized. ObjectivesTo determine the epidemiology, presenting features, and outcomes of patients with APS using an 18-year retrospective cohort of newly diagnosed patients presenting to Royal Darwin Hospital (2002-2020). MethodsPatients admitted to Royal Darwin Hospital with a new incident diagnosis of APS between January 2002 and December 2020 were identified and followed until December 2022, with data on baseline demographics, clinical and laboratory features, and overall survival extracted from electronic and paper medical records. ResultsFifty-three patients with APS were included, of whom 40 (75%) were First Nations and 46 (87%) were female. Thirty (75%) of First Nations patients with APS resided in very remote Australia vs 0 (0%) non–First Nations patients. Eighteen cases (34%) had primary APS, and 35 cases (66%) had secondary APS, most in association with lupus. Eight (15%) cases developed catastrophic APS (CAPS), all in First Nations patients. There were 13 deaths (of which 11 were among First Nations patients). Patients with CAPS had significantly shorter median overall survival (8.3 years from diagnosis), with median survival in non-CAPS patients not reached (P = .003). ConclusionThere is a high prevalence of APS in First Nations patients living in very remote Australia admitted for tertiary care in the tropical north of the Northern Territory, Australia. The rate of CAPS in First Nations patients was high, and CAPS was associated with significantly shorter survival. Larger prospective studies are required to inform improved models of care for First Nations and remote Australians living with APS.