Evaluation of the Ngaramura Program –Final Report

Since 2018 the Ngaramura “See the Way” Program has provided an alternative education service for Aboriginal young people suspended or risk of suspension from school in the Illawarra region of NSW. Ngaramura provides a unique educational and cultural learning environment that meets the needs of Aboriginal students facing challenges in their school and social environments. Four key concepts underlie Ngaramura: Re-connecting with education though culture and identity; Elders as holders of Indigenous cultural knowledge and history; culturally safe spaces for young people to learn and thrive; and Culture continuity through young people. Ngaramura operationalises these key concepts by: learning through Culture; adapting the Community setting as a cultural learning place; linking young people, families and schools; asserting Aboriginal identity in relationships with schools; connecting young people to services; and providing supportive pathways to address educational and employment disadvantage A total of 87 students (Years 7 to 12) from 5 local high schools, participated in Ngaramura over a 3 year evaluation period (2018-2020) which included lockdowns due to the COVID-19 pandemic. The Program met its key outcomes for Aboriginal young people, families, school and the Coomaditchie organisation. There is clear evidence of the program’s positive impact on the young Aboriginal people. Students reported experiencing school ‘differently’, more positively, following participation in Ngaramura. Parents and school staff witnessed a greater sense of pride, sense of belonging and self-worth, in students. school staff reported being able to build better relationships with students; while students appreciated that there were a team of people supporting them. Schools reported increased retention of Indigenous students, increased school attendance, greater cooperation. In the absence of Ngaramura, it is likely that many of the young Aboriginal participants would have left the education system, unable to keep up with schoolwork, or through expulsion. Ngaramura helped parents overcome barriers to supporting their children’s success at school, through the Family Support Worker, referral pathways, transport assistance and access to resources. Current policy acknowledges that valuing and respecting culture underlies effort to support Indigenous young people to thrive and reach their potential. Innovative programs such as Ngaramura are uniquely able to fill this much needed place-based cultural input, with local Indigenous knowledge from respected elders who know the Community and are experts in local Indigenous history. Coomaditchie is a place of cultural, environmental and historical significance for Aboriginal people in the Illawarra. The delivery of Ngaramura on Country at Coomaditchie is a key element to the success of the program. The two Cultural Workers who are well respected elders provided vital cultural leadership within the program Evidence shows that when supported by strengths-based, high-expectations approaches, Aboriginal and Torres Strait Islander children and young people can thrive in education and be supported to reach their potential. To enable this, school environments must be culturally safe and Aboriginal and Torres Strait Islander cultures must be valued, respected and visibly present. Ngaramura reflects these practices, providing a highly specialised program rich in culture and a place where the young Aboriginal people thrive in an educational environment

Monitoring travellers from Ebola-affected countries in New South Wales, Australia: what is the impact on travellers?

Background Amidst an Ebola virus disease (EVD) epidemic of unprecedented magnitude in west Africa, concerns about the risk of importing EVD led to the introduction of programs for the screening and monitoring of travellers in a number of countries, including Australia. Emerging reports indicate that these programs are feasible to implement, however rigorous evaluations are not yet available. We aimed to evaluate the program of screening and monitoring travellers in New South Wales. Methods We conducted a mixed methods study to evaluate the program of screening and monitoring travellers in New South Wales. We extracted quantitative data from the Notifiable Conditions Information Management System database and obtained qualitative data from two separate surveys of public health staff and arrivals, conducted by phone. Results Between 1 October 2014 and 13 April 2015, public health staff assessed a total of 122 out of 123 travellers. Six people (5%) developed symptoms compatible with EVD and required further assessment. None developed EVD. Aid workers required lower levels of support compared to other travellers. Many travellers experienced stigmatisation. Public health staff were successful in supporting travellers to recognise and manage symptoms. Conclusion We recommend that programs for monitoring travellers should be tailored to the needs of different populations and include specific strategies to remediate stigmatisation.JC was completing a placement as part of the Masters of Philosophy in Applied Epidemiology, Australian National University

Evaluation of the Ngaramura “See the Way” Program - Community Report

Since 2018 the Ngaramura “See the Way” Program has provided an alternative education service for Aboriginal young people suspended or risk of suspension from school in the Illawarra region of NSW. Ngaramura provides a unique educational and cultural learning environment that meets the needs of Aboriginal students facing challenges in their school and social environments. Four key concepts underlie Ngaramura: Re-connecting with education though culture and identity; Elders as holders of Indigenous cultural knowledge and history; culturally safe spaces for young people to learn and thrive; and Culture continuity through young people. Ngaramura operationalises these key concepts by: learning through Culture; adapting the Community setting as a cultural learning place; linking young people, families and schools; asserting Aboriginal identity in relationships with schools; connecting young people to services; and providing supportive pathways to address educational and employment disadvantage A total of 87 students (Years 7 to 12) from 5 local high schools, participated in Ngaramura over a 3 year evaluation period (2018-2020) which included lockdowns due to the COVID-19 pandemic. The program met its key outcomes for Aboriginal young people, families, school and the Coomaditchie organisation. There is clear evidence of the program’s positive impact on the young Aboriginal people. Students reported experiencing school ‘differently’, more positively, following participation in Ngaramura. Parents and school staff witnessed a greater sense of pride, sense of belonging and self-worth, in students. School staff reported being able to build better relationships with students; while students appreciated that there were a team of people supporting them. Schools reported increased retention of Indigenous students, increased school attendance, greater cooperation. In the absence of Ngaramura, it is likely that many of the young Aboriginal participants would have left the education system, unable to keep up with schoolwork, or through expulsion. Ngaramura helped parents overcome barriers to supporting their children’s success at school, through the Family Support Worker, referral pathways, transport assistance and access to resources. Current policy acknowledges that valuing and respecting culture underlies effort to support Indigenous young people to thrive and reach their potential. Innovative programs such as Ngaramura are uniquely able to fill this much needed place-based cultural input, with local Indigenous knowledge from respected Elders who know the Community and are experts in local Indigenous history. Coomaditchie is a place of cultural, environmental and historical significance for Aboriginal people in the Illawarra. The delivery of Ngaramura on Country at Coomaditchie is a key element to the success of the program. The two Cultural Workers who are well respected Elders provided vital cultural leadership within the program Evidence shows that when supported by strengths-based, high-expectations approaches, Aboriginal and Torres Strait Islander children and young people can thrive in education and be supported to reach their potential. To enable this, school environments must be culturally safe and Aboriginal and Torres Strait Islander cultures must be valued, respected and visibly present. Ngaramura reflects these practices, providing a highly specialised program rich in culture and a place where the young Aboriginal people thrive in an educational environment

First reported outbreak of locally acquired hepatitis E virus infection in Australia

Objective: To determine the source and extent of a locally acquired hepatitis E virus (HEV) infection outbreak. Design, setting and participants: A cluster of notified cases of HEV infection linked to a single restaurant (X) was identified in May 2014. People with laboratory-confirmed HEV infection in New South Wales between January 2013 and December 2014 were interviewed about potential risk factors for HEV infection. Co-diners at restaurant X and patients with suspected but unexplained viral hepatitis were retrospectively tested. Foods eaten by the infected persons were compared with those of seronegative co-diners. HEV RNA detected in sera from infected persons was sequenced and genotyped. Implicated foods were traced back to their sources. Main outcome measures: Potential sources of infection, including overseas travel and foods eaten, and origin of implicated food products. Results: In 55 serologically confirmed cases of HEV infection, 24 people had not travelled overseas during their incubation periods. Of the 24, 17 reported having eaten at restaurant X, 15 of whom could be interviewed. All reported consuming pork liver pâté, compared with only four of seven uninfected co-diners (P < 0.05). The other seven people with locally acquired infections each reported consuming a pork product during their incubation periods. HEV RNA was detected in 16 of the 24 cases; all were of genotype 3. Sequencing indicated greater than 99% homology among restaurant X isolates. HEV RNA was isolated from pork sausages from a batch implicated in one of the locally acquired infections not linked with restaurant X. The pork livers used for pâté preparation by restaurant X were traced to a single Australian farm. Conclusions: This is the first reported HEV outbreak in Australia. HEV should be considered in patients presenting with a compatible illness, even without a history of overseas travel. Pork products should be thoroughly cooked before consumption

Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states.

BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake.MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage.ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates.ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage

School-level variation in coverage of co-administered dtpa and hpv dose 1 in three Australian states

Background:Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states.Methods:HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage.Results:Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0).Conclusion:The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome