Royal Darwin Hospital

A key determinant of diet quality in outer regional to very remote areas is the higher cost of food. This systematic scoping review aims to identify evidence gaps on drivers of the cost of food, to guide future research and policy development to improve food security across outer regional to very remote areas of Australia. The Joanna Briggs Institute three step literature search was utilised and the review was conducted in accordance with PRISMA guidelines. Five electronic databases (Ovid MEDLINE, CINAHL, Informit, Embase, Scopus) were systematically searched in September 2024. Peer-reviewed literature set in outer regional to very remote regions of Australia were included if they were on the topic of food and food price and the drivers influencing these. Title and abstract screening were performed by two authors, as well as double screening of full texts by two authors. Data were extracted from included articles regarding remoteness category, aims, sampling, methodology, drivers influencing food price, outcomes and implications on policy, as well as author commentary on the drivers of food price. The CREATE tool for research involving Aboriginal and Torres Strait Islander communities was completed by two authors, with guidance from two First Nations authors and the senior author. Twenty articles published between 1987 to 2022 met the inclusion criteria. Most studies reported on remoteness itself as the determinant of high food price. Other drivers of food price included freight, high operating costs of smaller stores and weather events. Those living in outer regional to very remote Australia pay more for food, however there is a lack of empirical detailed evidence on the drivers of higher food price. To effectively address the higher cost of food in outer regional, rural, and remote Australia and promote food security in these areas, empirical evidence on system determinants could complement existing expert evidence for targeted policy and government support.

Nontyphoidal Salmonella bacteria are an important global cause of gastrointestinal disease. In Australia, it is estimated that salmonellosis costs approximately 140 million Australian dollars per year in illness, pain and suffering, and other productivity losses. The Northern Territory (NT) of Australia is a sparsely populated tropical environment, with 31% of the population being Aboriginal Australians. We described the epidemiology of salmonellosis in the NT by analyzing routinely notified salmonellosis cases diagnosed between 2005 and 2024. We performed descriptive, univariate, and multivariate analyses. We used exact logistic regression to explore associations with severe disease (hospitalization or death). We performed negative binomial regression analysis to explore associations with length of hospitalization. There were 9628 salmonellosis notifications equating to a mean annual notification rate of 203 per 100,000 persons-the highest reported in the world; 51% of cases were male; 25.3% had severe disease (2432 hospitalizations and 18 deaths); and 50% were aged <5 years. The most commonly reported serotypes were S. Saintpaul (1125/9628, 11.7%), S. Virchow (1002/9628, 10.4%), and S. Typhimurium (936/9628, 9.7%). Aboriginal people were notified at 1.2 times (95% confidence interval [CI] 1.1-1.2, p < 0.001) the rate of non-Aboriginal people, were 3.7 times (95% CI 3.3-4.1, p < 0.001) more likely to experience severe disease, and were hospitalized for 1.6 times longer (95% CI 1.5-1.8, p < 0.001) than non-Aboriginal people. There was no difference in salmonellosis notification rates in 2005-2014 compared with 2015-2024; however, S. Typhimurium notifications decreased. The tropical climate, abundant wildlife, and contamination of the household environment with Salmonella contribute to high rates of salmonellosis in the NT. Credible interventions are needed to decrease the incidence of salmonellosis, particularly among young children exposed to contaminated tropical environments.

Background: Otocariasis, the infestation of the external auditory canal (EAC) by ticks, is a common presentation in endemic regions and an emerging clinical consideration in Australia. Conventional agents, including local anaesthetics and oils, often fail to rapidly inactivate hard ticks, potentially prolonging patient discomfort and increasing the risk of infectious complications. Dimethicone, a low-toxicity, low-viscosity organosilicon compound, has demonstrated efficacy against arthropods but has not been formally evaluated for hard tick otocariasis. This study aims to investigate whether dimethicone outperforms conventional agents in inactivating hard ticks. Methods: In a laboratory-based experiment, 48 Rhipicephalus haemaphysaloides ticks were randomly allocated into four treatment groups (n=12 per group): dimethicone, olive oil, coconut oil, and 2% xylocaine. Ticks were submerged in the test agent and observed under magnification, with time to complete inactivity recorded. Inactivity was defined as cessation of all leg movement despite stimulation. Data were analysed using Statistical Package for Social Sciences (SPSS), with between-group comparisons performed to assess differences in time to inactivity. Results: Time to inactivity was significantly shorter in the dimethicone group (75.0±10.4 s) compared with olive oil (753.3±78.3 s), coconut oil (1,056.6±122.8 s), and 2% xylocaine, in which no inactivity was observed within the 1,800-second observation period (all comparisons P<0.001). Conclusions: Dimethicone rapidly and reliably inactivated hard ticks in vitro, outperforming commonly used agents. This effect is likely mediated by its ability to penetrate the tick spiracular system and impair respiration. Given its favourable safety profile and rapid action, dimethicone may represent a practical option for managing otocariasis in outpatient and emergency settings. Further in vivo studies are warranted to confirm clinical applicability in the Australian context.

Melioidosis occurs in both humans and animals following exposure to and infection with Burkholderia pseudomallei in environmental soil and water. However, it should not be seen as a zoonosis, as transmission from animals to humans is exceptionally rare, as is transmission from person to person. In humans, melioidosis and severe disease are usually seen in people with clinical risk factors, most notably diabetes. Similarly, for animals, melioidosis is rarely seen in healthy species native to endemic regions, presumably reflecting co-evolution with B. pseudomallei over millennia. On the other hand, there is differential susceptibility among farm and grazing animals of non-tropical origins. Sheep, alpacas, and camels are especially susceptible, while with good animal husbandry, goats and pigs are farmed in some melioidosis-endemic regions. Melioidosis is seen in companion animals such as dogs and cats, mostly those in poor health. Melioidosis outbreaks have occurred in exotic animals imported into zoos in tropical cities, with tragic consequences for some iconic, critically endangered primate species. The clinical and pathological features seen in animals with melioidosis from natural exposure have been very informative for understanding the spectrum of disease in humans, including different clinical patterns reflecting whether the mode of infection was inhalational, percutaneous, or from ingestion of B. pseudomallei . There is a rapidly expanding global footprint of melioidosis, reflecting both unmasking of endemic disease with improved diagnostics and evolving spread of B. pseudomallei to new receptive locations, attributed to anthropogenic factors. In addition, case numbers in endemic regions have been on the rise and will likely continue to rise because of the triad of increasing numbers of people living with diabetes, environmental disturbance from construction activities with increasing urbanization, and climate change. It is hoped that over the next decade, the global map of the biogeographical boundaries of B. pseudomallei in the environment will be much further refined, enabling targeted support for the specific diagnostics and therapeutics required to minimize mortality from melioidosis. • Melioidosis is expanding globally due to both the unmasking of previously unknown endemic foci and the spread to new locations. • Humans and animals develop melioidosis from environmental exposure; zoonotic infection is exceedingly rare. • Pathology in animal melioidosis informs human disease. • Melioidosis can kill endangered primates imported to zoos in the tropics. • Increasing diabetes, urban construction, and climate change will drive increased cases of melioidosis.

To characterise the clinical, microbiological, radiological and operative features of Xanthogranulomatous Pyelonephritis (XGP) in a 10-year retrospective case series from the Top End of the Northern Territory (NT) of Australia. We retrospectively reviewed all histopathologically confirmed XGP cases managed at Royal Darwin Hospital (2014-2024). Inclusion criteria were adults undergoing nephrectomy with a final histopathological diagnosis of XGP. Data included demographics, comorbidities, microbiology, imaging and surgical details. Descriptive analysis was performed. Ten cases were identified, 90% were female and 70% identified as Aboriginal and/or Torres Strait Islander. Mean age was 43.5 years overall, but lower among Aboriginal and/or Torres Strait Islander patients at 39 years. Most resided in remote or very remote areas. Recurrent urinary tract infections and staghorn calculi occurred in 80% of cases. Escherichia coli was the most isolated organism. Three patients experienced delays to care due to discharge against medical advice or loss to follow-up; two had encrusted ureteric stents insitu for over 5 years. All patients underwent nephrectomy; one laparoscopic case was converted to open. Three procedures were elective. All patients required postoperative ICU admission. No deaths occurred, although one patient developed necrotising fasciitis in the wound. This first Australian case series of XGP highlights an overrepresentation of Aboriginal and/or Torres Strait Islander patients. Findings align with global patterns in presentation and management, but underscore regional challenges including delayed care, advanced disease and surgical complexity in the context of chronic health inequities. Culturally safe and community-informed strategies are essential to improve outcomes in this high-risk population.

Bronchiolitis is the leading cause of hospitalisation in infants under one year. While evidence-based guidelines exist, including the updated Australasian Bronchiolitis Guidelines (2025), variations in care persist. Improving care in regional and rural hospitals is challenging due to limited access to paediatric expertise and evidence-based resources, contributing to continued use of low-value interventions. This mixed methods study will use a human-centred design approach to co-design and evaluate the usability of the Regional and Rural Translation Bronchiolitis (RART-Bronch) platform, an interactive online tool targeted at non-metropolitan settings. The platform will feature bronchiolitis educational resources, implementation support, a benchmarking and feedback tool, and family education materials. Participants will be regional and rural clinicians and parents of infants hospitalised with bronchiolitis in these settings. Data will be collected through co-design meetings, usability surveys, semi-structured interviews, and think aloud methods. Engagement with the co-design process will also be evaluated. We will develop a user-friendly, evidence-based platform specific to regional and rural contexts that supports bronchiolitis guideline adherence and enhances clinical decision-making. Effectiveness will be evaluated in a future cluster randomised controlled trial and may inform future implementation strategies for improving care, quality and equity across regional and rural healthcare. This study aims to reduce variation in bronchiolitis care by co-designing an interactive online platform, RART-Bronch, with clinicians and parents from regional and rural settings. The platform aims to support sustainable reductions in low-value care and improve outcomes for infants with bronchiolitis. It will deliver evidence-based guidance to clinicians working in regional and rural hospitals with limited paediatric expertise. Findings will inform future implementation of tailored education, audit and feedback strategies in acute care. This work aims to enhance paediatric care quality in under-resourced settings and contribute to scalable, equitable improvements in bronchiolitis management across Australia.

BackgroundPrenatal Alcohol Use (PAU) has detrimental effects on mothers and their children. Robust estimates of the prevalence of PAU and associated risk factors are critical for informing interventions to reduce adverse health impacts. This study aimed to estimate the prevalence and risk factors of PAU among Aboriginal and non-Aboriginal mothers in the Northern Territory of Australia.MethodsWe used linked individual-level records from the NT perinatal register, hospital admissions, and emergency department presentations to estimate the prevalence of PAU for all 19,588 births to NT-resident women from 2013 to 2017. Permutation analysis was used to create four PAU categories: no PAU, early PAU (alcohol use in early pregnancy only), continued PAU (alcohol use in early and late pregnancy), and extreme PAU (hospital admissions/ presentations for alcohol-related diagnosis during pregnancy). Multinomial logit models explored the associations between sociodemographic and clinical factors and degrees of PAU. A relative risk ratio (RRR) with a 95% confidence interval (CI) was used to measure associations.ResultsThere were 19,588 births to 16,199 women during the study period (6,310 births to 5,207 Aboriginal women). The mean gestational age at birth for Aboriginal women was 37.8 (95% CI: 37.7, 37.9) weeks and 38.7 (38.6, 38.8) weeks for non-Aboriginal women. The overall PAU prevalence for births to Aboriginal women was 13.1% (95% CI: 12.2, 14.0), including 5.9% (95% CI: 5.2, 6.5) early PAU, 4.3% (95% CI: 3.8, 4.8) continued PAU, and 2.8% (95% CI: 2.4, 3.3) “extreme” PAU. The overall prevalence for non-Aboriginal women was 2.3% (95% CI: 2.1, 2.6), including 1.7% (95% CI: 1.5, 1.9), 0.53% (95% CI: 0.4, 0.7) and 0.1% (95% CI: 0.02, 0.1) for each category, respectively. Age, smoking, and substance misuse-related hospitalisation were associated with an increased risk of PAU among both populations. Being a victim of violence was an additional risk among Aboriginal women. More than five antenatal care (ANC) visits were associated with less PAU. However, 17.9% (n = 3520) of births had missing records related to PAU.ConclusionThe study provides refined prevalence estimates for PAU across groups with increasing risk of harm. Early identification and effective engagement with women at risk of PAU are critical for improving outcomes for mothers and their children. Targeted interventions like enhanced services that support cessation of alcohol and other drugs (AOD), strengthening families, and sustained engagement with culturally safe, trauma-informed maternity care may aid in reducing PAU. The study also highlights the critical need to enhance both the quality and completeness of the routine recording of alcohol use during pregnancy.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08216-5.