Rates of radiologically confirmed pneumonia as defined by the World Health Organization in Northern Territory Indigenous children

Objective To determine the burden of hospitalised, radiologically confirmed pneumonia (World Health Organization protocol) in Northern Territory Indigenous children. Design, setting and participants Historical, observational study of all hospital admissions for any diagnosis of NT resident Indigenous children, aged between >= 29 days and < 5 years, 1 April 1997 to 31 March 2005. Intervention All chest radiographs taken during these admissions, regardless of diagnosis, were assessed for pneumonia in accordance with the WHO protocol. Main outcome measure The primary outcome was endpoint consolidation (dense fluffy consolidation [alveolar infiltrate] of a portion of a lobe or the entire lung) present on a chest radiograph within 3 days of hospitalisation. Results We analysed data on 24 115 hospitalised episodes of care for 9492 children and 13 683 chest radiographs. The average annual cumulative incidence of endpoint consolidation was 26.6 per 1000 population per year (95% Cl, 25.3-27.9); 57.5 per 1000 per year in infants aged 1-11 months, 38.3 per 1000 per year in those aged 12-23 months, and 13.3 per 1000 per year in those aged 24-59 months. In all age groups, rates of endpoint consolidation in children in the arid southern region of NT were about twice that of children in the tropical northern region. Conclusion The rates of severe pneumonia in hospitalised NT Indigenous children are among the highest reported in the world. Reducing this unacceptable burden of disease should be a national health priority.

Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life

Objective To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life. Design A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Imm(u)nisation Register. Participants and setting All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age. Main outcome measures Incidence of ALRI and bronchiectasis (ICD-10-AM codes) and radiologically confirmed pneumonia (World Health Organization protocol). Results Data on 9295 infants, 8498 child-years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child-years (95% Cl, 416.2-437.2). Incidence rates were two times higher (relative risk, 2.12; 95% Cl, 1.98-2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6-7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child-years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child-years (95% Cl, 0.60-2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI. Conclusions Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

Successful application of a simple specimen transport method for the conduct of respiratory virus surveillance in remote Indigenous communities in Australia

Objective Surveillance programs and research for acute respiratory infections in remote Aboriginal communities are complicated by difficulties in the storage and transport of frozen samples to urban laboratories for testing. This study assessed the sensitivity of a simple method for transporting respiratory samples from a remote setting for viral PCR compared with frozen specimens. Methods We sampled every individual who presented to a remote Aboriginal community clinic in a non-epidemic respiratory season. Two anterior nasal swabs were collected from each participant. The left nare specimen was mailed to the laboratory via routine postal services. The right nare specimen was transported frozen. Testing for 16 viruses was undertaken using real-time multiplex PCR. Results A total of 140 participants were enrolled who contributed 150 study visits. Respiratory illnesses accounted for 10% of the reasons for presentation. Sixty-one viruses were identified in 50 (33.3%) presentations for 40 (28.6%) individuals; bocavirus and rhinovirus were the most common viruses identified (14.0% and 12.6% of episodes respectively). The sensitivity for any virus detected in mailed specimens was 67.2% (95%CI 55.4, 78.9) compared to 65.6% (95%CI 53.7, 77.5) for frozen specimens. Conclusion The mailing of unfrozen nasal specimens from remote communities does not compromise the viability of the specimen for viral studies.

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in indigenous infants in Australia

Objective To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) in preventing pneumonia, diagnosed radiologically according to World Health Organization (WHO) criteria, among indigenous infants in the Northern Territory of Australia. Methods We conducted a historical cohort study of consecutive indigenous birth cohorts between 1 April 1998 and 28 February 2005. Children were followed up to 18 months of age. The PCV7 programme commenced on 1 June 2001. All chest X-rays taken within 3 days of any hospitalization were assessed. The primary endpoint was a first episode of WHO-defined pneumonia requiring hospitalization. Cox proportional hazards models were used to compare disease incidence. Findings There were 526 pneumonia events among 10 600 children - an incidence of 3.3 per 1000 child-months; 183 episodes (34.8%) occurred before 5 months of age and 247 (47.0%) by 7 months. Of the children studied, 27% had received 3 doses of vaccine by 7 months of age. Hazard ratios for endpoint pneumonia were 1.01 for 1 versus 0 doses; 1.03 for 2 versus 0 doses; and 0.84 for 3 versus 0 doses. Conclusion There was limited evidence that PCV7 reduced the incidence of radiologically confirmed pneumonia among Northern Territory indigenous infants, although there was a non-significant trend towards an effect after receipt of the third dose. These findings might be explained by lack of timely vaccination and/or occurrence of disease at an early age. Additionally, the relative contribution of vaccine-type pneumococcus to severe pneumonia in a setting where multiple other pathogens are prevalent may differ with respect to other settings where vaccine efficacy has been clearly established.

Towards growing Indigenous culturally competent legal professionals in Australia

The Review of Australian Higher Education (Bradley Review: 2008) identified the need for tertiary institutions to incorporate Indigenous knowledges into curriculum to improve educational outcomes for Indigenous Australians and to increase the cultural competency of all students. It recommended that higher education providers ensure that the institutional culture, the cultural competence of staff and the nature of the curriculum supports the participation of Indigenous students, and that Indigenous knowledge be embedded into curriculum so that all students have an understanding of Indigenous culture. While cultural competency has been recognised as an essential element of professional practice in health services internationally, and legal practice in the United States, very little work has been done to promote the cultural competency of legal professionals in the Australian context. This paper will discuss a pilot cultural competency professional development program for legal academics at Queensland University of Technology (Brisbane) developed with the assistance of a Faculty of Law Teaching and Learning Grant in 2011-2012, and tell one Murri’s journey to foster Indigenous cultural competency in an Australian law school.

Promising interventions for reducing Indigenous juvenile offending

Indigenous juveniles (those aged 10 to 16 years in Queensland and 10 to 17 years in all other jurisdictions) are over-represented at all stages of the criminal justice system, and their over-representation becomes more pronounced at the most severe end of the system (ie in detention). Recent figures show that Indigenous juveniles are 24 times as likely to be detained in a juvenile correctional facility as non-Indigenous juveniles (Richards & Lyneham 2010). A variety of explanations for this over-representation have been proposed, including: • lack of access or disparate access to diversionary programs (Allard et al. 2010; Cunneen 2008; Snowball 2008); • systemic discrimination against Indigenous juveniles (eg police bias against Indigenous juveniles) (Cunneen 2008; Kenny & Lennings 2007); • inadequate resourcing of Aboriginal legal services (Cunneen & Schwartz 2008); and • genuinely higher levels of offending by Indigenous juveniles (Kenny & Lennings 2007; Weatherburn et al. 2003). A range of measures (including diversion and juvenile conferencing programs) has recently been implemented to reduce the over-representation of Indigenous juveniles in detention, and minimise the contact of juveniles with the formal criminal justice system. Diversionary measures can only have a limited impact, however, and reducing offending and reoffending have been identified as critical factors to address if the over-representation of Indigenous juveniles is to be reduced (Allard et al. 2010; Weatherburn et al. 2003). While acknowledging that other measures designed to reduce the over-representation of Indigenous juveniles are important, this paper reviews the evidence on policies and programs that reduce offending by Indigenous juveniles in Australia. Where relevant, research from comparable jurisdictions, such as New Zealand and Canada, is also discussed.

Re-imagining youth justice

Persistent high levels of recidivism among young offenders (Luke and Lind 2002; Weatherburn et al. 2012) and the over‐representation of Indigenous young people (Cunneen and White 2011; Snowball 2008; Tauri 2012) have long been features of youth justice in Australia. Other problems – such as the increased rates of young people committing sex offences (Dwyer 2011; O’Brien 2010), increasing numbers of young people criminalised for new offences such as ‘sexting’ (Lee and McGovern 2013), and increasing numbers of young female offenders being drawn into youth justice systems (Carrington 2006; Carrington and Pereira 2009) – have emerged more recently. In this paper, we draw on the concept of ‘imaginary penalities’ (Carlen 2010) to argue these chronic problems are partly informed by ‘imaginary’ understandings of how and why young people (re)offend; reflect ‘imaginary’ understandings of what works to address young people’s (re)offending; and reflect ‘imaginary’ ideals about the primary purposes of the youth justice system. We acknowledge up front that answers to these questions require a great deal of new empirical research. This paper is only a beginning that sets out exactly what such an ambitious project might look like.

Submission to the inquiry into the high level of involvement of Indigenous juveniles and young adults in the criminal justice system

Introduction • The Australian Institute of Criminology (AIC) is Australia's national research and knowledge centre on crime and justice. • The Institute seeks to promote justice and reduce crime by undertaking and communicating evidence-based research to inform policy and practice. • The AIC is governed by the Criminology Research Act and has been in operation since 1973. • The AIC is pleased to have the opportunity to contribute to the Committee's Inquiry into the high level of involvement of Indigenous juveniles and young adults in the criminal justice system. • There is a great deal of evidence to demonstrate that Indigenous young people are significantly over-represented at every stage of the criminal justice system in Australia.

Negotiating disability and colonisation : the lived experience of Indigenous Australians with a disability

Disability among Indigenous Australians lies at a nexus between the ongoing impact of European settlement from 1788 and the social effects of living with a disability. Colonisation, with its political, social, economic and cultural concomitants, continues to impact on Indigenous experience, extending to the institutions and services concerned with disability. There is little attention paid to Indigenous Australian disability in general, and the need to decolonise disability has recently been emphasised. Ethnographic research in Brisbane, Australia among Indigenous people with a disability (mostly related to diabetes) confirms the ongoing impact of colonisation. While this experience pervades all aspects of their lives, it also moderates their experience of living with a disability in positive ways. However, while individuals can negotiate their personal experience of disability, the decolonisation of disability services presents challenges that need to be addressed.

Sexualities and sensitivities: Queer(y)ing the ethics of youth research in the field

In contemporary Western societies, the years between childhood and young adulthood are commonly understood to be (trans)formative in the reflexive project of sexual self-making (Russell et al. 2012). As sexual subjects in the making, youthful bodies, desires and sexual activities are often perceived as both volatile and vulnerable, thus subjected to instruction and discipline, protection and surveillance. Accordingly, young people’s sexual proximities are closely monitored by social institutions and ‘(hetero)normalising regimes’ (Warner 1999) for any signs that may compromise the end goal of development—a ‘normal’ reproductive heterosexual monogamous adult...

Footprints to pathways : reconciliation action planning in industry to sustain Indigenous employment in Queensland

This paper provides an introductory discussion to a study focusing on industry Reconciliation Action Plans (RAP) and sustaining Indigenous employment in Queensland. Indigenous people continue to experience deep and persistent disadvantage in employment, which limits their life prospects (McLachlan, Gilgillan & Gordon, 2013). A major contributing factor to this detriment is irregular employment and or unemployment. A reasonable standard of living has been found to be determined by access to economic resources such as income and wealth. Denial of this access, denies access to income streams, social status, and engagement in meaningful activities. Hence, job loss and joblessness are triggers of disadvantage (McLachlan, et al., 2013). For young Indigenous people, lack of access has lasting effects particularly if they have multiple characteristics that place them at risk of disadvantage. The project aims to develop knowledge and understanding of Industry RAPs mediate employment opportunities for Indigenous people and how young Indigenous people conceive of their employment options and the processes by which employers can best support Indigenous people. It adopts two theoretical frameworks to investigate the aim of the study : (1) Lave and Wenger’s (1991) theory of communities of practice and, (2) Sen’s (1993) capability approach which provides a structure for examining individual well-being in the context of societal inequality. This paper discusses the first research question of the study: What are Industry Reconciliation Action Plans? What is included in RAPs? Why do Industries develop RAPs? How do RAPs attract, recruit, retain, and tenure Indigenous people? The project’s significance rests with its focus on Industry, employers, policies and practices that aid the attraction and retention of Indigenous people in employment.

Governing young people’s drug use: Crime, harm and contemporary drug use practices

Since the nineteenth century, drug use has been variously understood as a problem of epidemiology, psychiatry, physiology, and criminality. Consequently drug research tends to be underpinned by assumptions of inevitable harm, and is often directed towards preventing drug use or solving problems. These constructions of the drug problem have generated a range of law enforcement responses, drug treatment technologies and rehabilitative programs that are intended to prevent drug related harm and resituate drug users in the realm of neo-liberal functional citizenship. This paper is based on empirical research of young people’s illicit drug use in Brisbane. The research rejects the idea of a pre-given drug problem, and seeks to understand how drugs have come to be defined as a problem. Using Michel Foucault’s conceptual framework of governmentality, the paper explores how the governance of illicit drugs, through law, public health and medicine, intersects with self-governance to shape young people’s drug use practices. It is argued that constructions of the drug problem shape what drug users believe about themselves and the ways in which they use drugs. From this perspective, drug use practices are ‘practices of the self’, formed through an interaction of the government of illicit drugs and the drug users own subjectivity.