A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

Women bashing: An urban Aboriginal perspective

ABORIGINAL people in urbanised Australia experience violence on a daily basis. This violence ranges from the psychological (the covert hostility of the corner shop, the denial of the Aboriginality of fair-skinned or urban Blacks) through to the physical brutality of the criminal justice system. For Aboriginal women and children this daily violence is not only public but also has a private, B1ack-on-B1ack dimension. The Aboriginal home may be some refuge from the slights of white Australia but this is cold comfort to women for whom being 'flogged up' by their partners is so ordinary an event as to be unremarkable.

Being and Living in an Australian Urban Community

There is a limited evidence base which highlights the plight of Australian Aboriginal and Torres Strait Islander populations living in urban areas and the issues that impact on Indigenous achievements in education, health status, housing needs, rates of incarceration and the struggle for cultural recognition. This is despite over 70 % of all Aboriginal and Torres Strait Islander people in Australia now living in urban or regional urban areas (ABS 2008). The statistics demonstrate that living in urban centres is as much part of reality for Australian Aboriginal and Torres Strait Islander people as living in a remote discrete community. Using the capital city of Brisbane, Queensland as a case study, this paper will explore some of the issues that Aboriginal and Torres Strait Islander peoples face against a backdrop of the statistics and some of the current literature. It will additionally explore why there has been limited research with Aboriginal and Torres Strait Islander populations in urban areas and highlight some of the innovative research taking place which will begin to redress this gap. The research issues presented within this paper will resonate with some of the Native American and Indigenous movement patterns and associated issues additionally occurring in the United States of America, Canada and New Zealand.

Health, Death, and Indigenous Australians in the Coronial system

This paper details research conducted in Queensland during the first year of operation of the new Coroners Act 2003. Information was gathered from all completed investigations between December 2003 and December 2004 across five categories of death: accidental, suicide, natural, medical and homicide. It was found that 25 percent of the total number of Indigenous deaths recorded in 2004 were reported to, and investigated by, the Coroner, in comparison to 9.4 percent of non-Indigenous deaths. Moreover, Indigenous people were found to be over-represented in each category of death, except in death in a medical setting, where they were absent.

The failure of Australian legislation on indirect discrimination to detect the systemic racism which prevents Aboriginal people from fully participating in the workforce

Government figures put the current indigenous unemployment rate at around 23%, 3 times the unemployment rate for other Australians. This thesis aims to assess whether Australian indirect discrimination legislation can provide a remedy for one of the causes of indigenous unemployment - the systemic discrimination which can result from the mere operation of established procedures of recruitment and hiring. The impact of those practices on indigenous people is examined in the context of an analysis of anti-discrimination legislation and cases from all Australian jurisdictions from the time of the passing of the Racial Discrimination Act by the Commonwealth in 1975 to the present. The thesis finds a number of reasons why the legislation fails to provide equality of opportunity for indigenous people seeking to enter the workforce. In nearly all jurisdictions it is obscurely drafted, used mainly by educated middle class white women, and provides remedies which tend to be compensatory damages rather than change to recruitment policy. White dominance of the legal process has produced legislative and judicial definitions of "race" and "Aboriginality" which focus on biology rather than cultural difference. In the commissions and tribunals complaints of racial discrimination are often rejected on the grounds of being "vexatious" or "frivolous", not reaching the required standard of proof, or not showing a causal connection between race and the conduct complained of. In all jurisdictions the cornerstone of liability is whether a particular employment term, condition or practice is reasonable. The thesis evaluates the approaches taken by appellate courts, including the High Court, and concludes that there is a trend towards an interpretation of reasonableness which favours employer arguments such as economic rationalism, the maintenance of good industrial relations, managerial prerogative to hire and fire, and the protection of majority rights. The thesis recommends that separate, clearly drafted legislation should be passed to address indigenous disadvantage and that indigenous people should be involved in all stages of the process.

Conference on urban issues

Personal reflections and opinion on the Australian Aboriginal and Torres Strait Islander Studies (AIATSIS) National Indigenous Studies Conference, Perspectives on Urban life: Connections and Reconnections was held in Canberra from 28 September – 1 October 2009.

Examination of relationships between urban form, household activities, and time allocation in the Atlanta Metropolitan Region

A substantial body of research is focused on understanding the relationships between socio-demographics, land-use characteristics, and mode specific attributes on travel mode choice and time-use patterns. Residential and commercial densities, inter-mixing of land uses, and route directness in conjunction with transportation performance characteristics interact to influence accessibility to destinations as well as time spent traveling and engaging in activities. This study uniquely examines the activity durations undertaken for out-of-home subsistence; maintenance, and discretionary activities. Also examined are total tour durations (summing all activity categories within a tour). Cross-sectional activities are obtained from household activity travel survey data from the Atlanta Metropolitan Region. Time durations allocated to weekdays and weekends are compared. The censoring and endogeneity between activity categories and within individuals are captured using multiple equations Tobit models. The analysis and modeling reveal that land-use characteristics such as net residential density and the number of commercial parcels within a kilometer of a residence are associated with differences in weekday and weekend time-use allocations. Household type and structure are significant predictors across the three activity categories, but not for overall travel times. Tour characteristics such as time-of-day and primary travel mode of the tours also affect traveler's out-of-home activity-tour time-use patterns.

Indigenous Australians, vulnerability and the news media

This short article explores the ways in which the news media's reporting about Indigenous Australians can be improved. The article looks at how journalists predominantly portray Indigenous people in vulnerable circumstances. Journalists also often misrepresent Indigenous Australians in ways that can potentially harm individuals and communities. In forums about the media, it is common to hear Indigenous people say that they ignore non-Indigenous news services due to such problems, and they rely on community media instead. Even so, the non-Indigenous media has a huge impact on public understanding and government policies, which directly influence the living conditions of Indigenous people. Thus it remains important to consider how the performance of non-Indigenous media can be improved, and the article discusses the steps that are needed if this is to happen.

Transportation behaviours of older adults : an investigation into car dependency in urban Australia

Aim: Increased car dependency amongst Australia's ageing population may result in increased social isolation and other health impacts associated with the cessation of driving. While public transport represents an alternative to car usage, patronage remains low amongst senior cohorts. This study investigates the facilitators and barriers to public transport patronage and the nature of car dependence among older Australians. Method: Data was gathered from a sample of 24 adults (mean = 70.33 years) through a combination of quantitative (remote behavioural observation) and qualitative (interviews) investigation. Results: Findings suggest factors of relative convenience, affordability and health/mobility dictate choices of transport mode. The car is considered more convenient for the majority of suburban trips irrespective of the availability of public transport. Conclusion: Policy attention should focus on providing better education and information regarding driving cessation and addressing aged-specific social aspects of public transport including the accommodation of various health and mobility issues.

Reflecting on the ‘Dream Circle’ : urban Indigenous education processes designed for student and community empowerment

The ‘Dream Circle’ is a space designed by and operated through Indigenous educator footprints as a safe space for the school’s deadly jarjums (Indigenous children). The ‘Dream Circle’ uses a kinnected methodology drawing on the rich vein of Murri cultural knowledges and Torres Strait Islander supports within the local community to provide a safe and supportive circle. The ‘Dream Circle’ operates on a school site in the Logan area as an after school homework and cultural studies class. The ‘Dream Circle’ embodies practices and ritualises processes which ensure cultural safety and integrity. In this way the ‘Dream Circle’ balances the measures that Sarra (2005) purports are the stronger, smarter realities needed for positive change in Indigenous education.

Improving Indigenous women’s wellness through action research

Today in Australia, 75% of all Indigenous Australians reside in urban and peri-urban areas. In Brisbane, Indigenous Australians now number just over 45,000, and this number is rapidly increasing. Undertaking research with urban based Indigenous Australians is a relatively new phenomenon. Most past research with Indigenous people has been carried out in remote and regional areas. This paper focuses on a Participation Action Research project undertaken with Indigenous women in the highly urbanised area of North Brisbane. The project takes on the challenge of undertaking urban based Indigenous research. It opts not to centre on poor Indigenous women’s health statistics but instead centres on Indigenous women’s wellness and ways to talk about and work towards wellness. Through the cycles of dialogue with Indigenous women these concepts were teased out and manifested in two highly successful Women’s Wellness Summits. This paper will outline aspects of this project.

Realizing 'four comforts' in the urban fringe : the case of White Horse Lake Eco-creative City Project, Hangzhou, China

This article examines a cultural and creative industries park project – the White Horse Lake Ecocreative City on land outside the urban centre of Hangzhou, China, which uses an imaginary rural lifestyle as its key attraction. By analysing government policies and development plans, and through interviews with initiators, managers and creative practitioners, the article first assesses the geographical position, that is, the impact of locality with regard to both hard and soft infrastructure of the project; it then examines the synergies and tensions embedded in the strategic goals, that is, to build the right city for ‘four comforts’ (siyi, 四宜) – for residence, for business, for travel and for culture. The article concludes that Chinese-style cultural conversion remains locked in a top-down ideological framework, one that rural residents and the new ‘creative class’ are expected to respect.

A sociological quantitative study about Chineseness and Chinese heritage language for young Chinese Australian adults in urban Australia

The relationship between Heritage Language and ethnic identity has gained significant research ground in North America. However, there is a dearth of similar research conducted in other regions of the world. There seems to be little if any work investigating the link between Chinese Australians’ ethnic identity and their Chinese Heritage Language. This sociological quantitative study interpreted Chinese Australians’ “Chineseness” as their ethnic identity, linked this “Chineseness” to their Chinese Heritage Language, and did so by virtue of Bourdieu’s key concept ‘habitus’. 227 cases were analyzed by Structural Equation Modelling. The result demonstrated a statistically significant strong positive relationship between Chinese Australian urban young adults’ “Chineseness” and their self-perceptions of their Chinese Heritage Language proficiency (r=.73). This paper explained the findings in light of Bourdieu’s (1991) contention that people make choices about languages according to the habitus they have.