Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.
Background High-quality bowel preparation is essential for accurate and safe colonoscopy. Demographic, medical, and socio-cultural factors may influence bowel preparation adequacy, particularly in regional and remote populations in Central Australia. Methods A retrospective cohort study was conducted on consecutive colonoscopies performed between March and August 2025 at Alice Springs Hospital. The primary outcome was mean Boston Bowel Preparation Scale (BBPS) score. Secondary outcomes included predictors of inadequate bowel preparation (BBPS < 6) using multivariable logistic regression. Results A total of 125 colonoscopies were included (35 First Nations and 90 non–First Nations patients). Mean BBPS was significantly lower among First Nations patients (6.0 ± 1.8 vs 7.8 ± 1.6; p < 0.001). Inadequate bowel preparation occurred in 28.6% of First Nations patients and 7.8% of non–First Nations patients (p = 0.002). Independent predictors of inadequate preparation included First Nations status, inpatient status, chronic kidney disease, travel distance greater than 200 km, and hospital-based preparation. Conclusion First Nations patients were significantly more likely to experience inadequate bowel preparation for colonoscopy. Addressing communication barriers, logistical challenges, and culturally appropriate education may improve preparation quality in remote healthcare settings. Clinical Trial Registration Not applicable.
Introduction Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS).Methods This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated.Results Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05).Conclusion This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes.Trial registration number ACTRN12613000793718.
The purpose of this document is to provide a summary of the current expert opinion and recent literature for clinicians, Indigenous health workers and patient advocates interested in Kidney Supportive Care (KSC) in Australia and New Zealand. Our purpose is not to duplicate the recently released International Society of Nephrology (ISN) KSC/Conservative Kidney Management (https://academy.theisn.org/products/kidney-supportive-care-and-conservative-kidney-management-curriculum#tab-product_tab_overview), but to present an Australian and New Zealand perspective on this emerging field. A key focus of this document is to highlight patients' perspectives on this topic. The document refers to adult patients living with advanced kidney disease (Stages IV and V chronic kidney disease).
BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) cause significant morbidity and mortality. In Australia's Northern Territory (NT), MRSA BSI prevalence is disproportionately high. Vancomycin remains standard therapy despite toxicity and complex monitoring requirements. AIM:To evaluate demographics, clinical management and outcomes of patients with MRSA BSI in the NT, with a focus on health inequities. METHODS:This multi-centre retrospective observational study analysed MRSA BSI episodes in hospitalised adults between 2017 and 2022 at the Royal Darwin and Alice Springs Hospitals. Key data were extracted from electronic medical records. Composite treatment failure was defined as follows: outcome of all-cause 90-day mortality, persistent bacteraemia (>7 days) or 90 day relapse. RESULTS:Of 182 identified episodes, MRSA accounted for 40% of all S. aureus BSIs. First Nations Australians were disproportionately affected, representing 69% of episodes, with an incidence rate 3.3 times higher than non-Indigenous residents. The composite treatment failure rate was 18%, and 90-day mortality was 13%. Age ≥ 50 years was the only independent variable associated with treatment failure. Notably, 19% of patients required an antimicrobial switch from vancomycin, frequently due to adverse drug reactions. Vancomycin minimum inhibitory concentration (MIC) testing showed high discordance between VITEK2 and E-Test. CONCLUSION:MRSA bloodstream infections remain a significant challenge in the NT, largely due to social and structural factors disproportionately affecting First Nations Australians. While strategies to prevent invasive bloodstream infections should be prioritised, the high incidence of vancomycin-related adverse events and MIC discordance underscores the urgent need for stable, effective oral antimicrobial alternatives and culturally safe, community-led prevention strategies.
