Biomedical subjects

E Kruger

Publications and source records attributed to E Kruger.

At least 19 recordsLinked to original sources

PubMed2006

Jaw fractures in the indigenous and non-indigenous populations of Western Australia: 1999-2003.

Little data exist on the analysis of jaw fractures in Australia, and none in Western Australia. This study was a retrospective analysis of all hospitalizations for jaw fractures in Western Australia between the years 1999-2000 and 2002-2003. The aims were to determine the incidence, distribution between males and females, different age groups, aboriginal and non-aboriginal groups, and rural and urban populations. The economic impact of jaw fracture hospitalizations was also determined. Males were more likely (80.4%) than females to be admitted for a jaw fracture. Fractures of the mandible were more common (61.9%) than maxillary fractures (38.1%). Aboriginal persons had nearly 10 times more hospitalization rate than that of non-aboriginal persons. Fracture rates were significantly (P<0.05) higher in rural (61.9 per 100,000) than in urban areas. Over the 4-year study period the total costs for all jaw fracture hospitalizations exceeded US$ 7.6 million. This study clearly indicates the burden of jaw fractures on the Western Australian population, in terms of physical and economic impact.

Adolescent↗

PubMed2006

Dental therapy in Western Australia: profile and perceptions of the workforce.

BACKGROUND: In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health workforce survey which indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the dental therapy workforce and analyse the perceptions of therapists. METHODS: In 2004, a postal questionnaire survey was undertaken amongst all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003. RESULTS: Valid information was obtained from 253 therapists (55 per cent response rate). The therapy workforce are almost exclusively female, have an average age of 40 years, are working in urban areas, obtained their qualification on average 20 years ago, work for the School Dental Service and qualified in Western Australia. More than a quarter no longer worked as therapists. Perceptions regarding the advantages and disadvantages of dental therapy as a career were identified. CONCLUSIONS: When trying to promote dental therapy and school dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia's National Oral Health Plan.

Adult↗

PubMed2006

Guided self diagnosis: an innovative approach to triage for emergency dental care.

BACKGROUND: The basic model of triage, developed more than 200 years ago by the French, is based on categorization of patient needs and thus the urgency and time required for care. This model in various forms is used in most hospitals throughout the world. METHODS: In this study, a fully computerized guided self-diagnosis system (based on a neural network design) was designed, prototyped, developed and trialled by front line non-clinically trained personnel in emergency dentistry. RESULTS: A total of 699 patients were seen as a result of the triage assessment within 14 days of their initial phone call and/or first contact. Patients categorized as requiring care on the day (Category 1) were provided more items of care (50 per cent of all items) and the greatest number of extractions (76 per cent) and endodontic treatments (78 per cent). Other categories were found to require less urgent care. CONCLUSIONS: The triage system developed in this study clearly holds significant promise in reducing the impact of emergency dental patients on dental health care systems. However, it is recognized that the system still requires some adjustment to ensure all Category 1 patients are examined before less urgent categories.

Dental Care↗

PubMed2006

Accessing government subsidized specialist orthodontic services in Western Australia.

BACKGROUND: In Australia there is growing demand for dental services. This leads to more pressure on the oral health service providers, and in particular government subsidized dental care. Against this backdrop it is important that government dental services (rationed to health care cardholders) are provided equitably on a basis of need, not access. The primary hypothesis investigated in this study was that there would be an even distribution of patients referred for government subsidized orthodontic care across Western Australia when regionally adjusted for socio-economic status. METHODS: Data were obtained as a de-identified waiting list for orthodontic treatment at The University of Western Australia. The data included all patients on the orthodontic waiting list as at December 2003. RESULTS: Significant differences between ARIA categories were detected when all waiting list entries were distributed. However, the trend was towards more entries (adjusted for population) in highly accessible areas. It was found that people from relatively wealthy areas tended to be more likely to be on the waiting list than those from more disadvantaged regions. CONCLUSION: In summary, the results of this study indicate that there is an uneven distribution of demand for orthodontics waiting list positions across Western Australian postcode areas by remoteness (ARIA) and by socio-economic disadvantage (IRSD). The results suggest that demand for subsidized orthodontic care may be influenced by the general demand for treatment of that region and not on what would be expected to be an even need for treatment across all health care cardholders.

Adolescent↗

PubMed2006

Hospitalization of Western Australian children for oral health related conditions: a 5-8 year follow-up.

BACKGROUND: This study investigated in-patient oral health care provision for children under 18 years of age in Western Australia. METHODS: Hospitalizations of children for oral health conditions over a four-year period were analysed using data obtained from the Western Australian Hospital Morbidity Data System (HMDS). This study followed a previously published study examining similar data for 1995. RESULTS: Between 1999-2000 and 2002-2003, a total of 26 497 episodes of care were attributed to oral health conditions among children aged 0-17 years. The cost of this care exceeded $40 million. Embedded and impacted teeth accounted for 33.2 per cent of oral health episodes, dental caries 28.3 per cent, pulp and periapical tissue conditions 7.1 per cent and dentofacial anomalies 6.1 per cent. With the exception of the infant age group (0-1 years), non-Aboriginal children had higher admission rates than Aboriginal children. In the 13-17 year age group a non-Aboriginal child was 31 times more likely to be admitted to hospital for an oral condition than an Aboriginal child. CONCLUSIONS: This study confirms the impact of oral health related conditions among children in Western Australia. It is also clear that there are differences between age and population groups in terms of access to in-patient dental services and exposure to risk factors for specific oral conditions.

Adolescent↗

PubMed2005

Accessing government subsidized specialist oral and maxillofacial surgery services in Western Australia.

BACKGROUND: In Western Australia the vast majority of government subsidized dental specialist services is provided through the University of Western Australia (UWA). With predicted expanding demand for services and the high cost of providing specialist services it is important that access to specialist care is targeted at need. In this study the waiting lists for oral surgery services at UWA was analyzed to test the hypothesis that demand for oral surgical care is distributed evenly across the eligible population of Western Australia. METHODS: Data were obtained from de-identified waiting lists for oral surgery at UWA. This data included all patients on the oral surgery waiting list from November 2001 to December 2003. RESULTS: Results indicated significantly less entries on the waiting list for people in remote and very remote postcode regions, and people living in postcode regions associated with a fixed government clinic were significantly more likely to be on the waiting list for oral surgery. CONCLUSIONS: The data presented identify that demand for specialist services is not driven through the expected factors of disease burden as indicated by socio-economic status, but by access to general dental services.

Analysis of Variance↗

PubMed2005

Fund allocation within Australian dental care: an innovative approach to output based funding.

BACKGROUND: Over the last 15 years in Australia the process of funding government health care has changed significantly. The development of dental funding models that transparently meet both the service delivery needs for data at the treatment level and policy makers' need for health condition data is critical to the continued integration of dentistry into the wider health system. METHODS: This paper presents a model of fund allocation that provides a communication construct that addresses the needs of both policy makers and service providers. RESULTS: In this model, dental treatments (dental item numbers) have been grouped into eight broad dental health conditions. Within each dental health condition, a weighted average price is determined using the Department of Veterans Affairs' (DVA) fee schedule as the benchmark, adjusted for the mix of care. The model also adjusts for the efficiency differences between sectors providing government funded dental care. In summary, the price to be applied to a dental health condition category is determined by the weighted average DVA price adjusted by the sector efficiency. CONCLUSIONS: This model allows governments and dental service providers to develop funding agreements that both quantify and justify the treatment to be provided. Such a process facilitates the continued integration of dental care into the wider health system.

Australia↗

PubMed2005

Pre-school child oral health in rural Western Australia.

BACKGROUND: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre-school children in a rural community in Western Australia. METHODS: The study was a cross-sectional oral health survey of pre-school children between the ages of 2 and 5 in Carnarvon, Western Australia. RESULTS: In total, 70 pre-school children (representing approximately 15 per cent of the total 2-5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non-Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks. CONCLUSIONS: This survey indicates that some pre-school children in rural areas, and especially Aboriginal pre-school children, are at high risk of developing dental caries. Effective oral health programmes commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.

Bottle Feeding↗

PubMed2004

A baseline study of the demographics of the oral health workforce in rural and remote Western Australia.

BACKGROUND: A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce. METHODS: A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia. RESULTS: Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums. CONCLUSIONS: The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.

Adult↗

PubMed2001

Growth responses of Populus tremuloides clones to interacting elevated carbon dioxide and tropospheric ozone.

The Intergovernmental Panel of Climate Change (IPCC) has concluded that the greenhouse gases carbon dioxide (CO2) and tropospheric ozone (O3) are increasing concomitantly globally. Little is known about the effect of these interacting gases on growth, survival, and productivity of forest ecosystems. In this study we assess the effects of three successive years of exposure to combinations of elevated CO2 and O3 on growth responses in a five trembling aspen (Populus tremuloides) clonal mixture in a regenerating stand. The experiment is located in Rhinelander, Wisconsin, USA (45 degrees N 89 degrees W) and employs free air carbon dioxide and ozone enrichment (FACE) technology. The aspen stand was exposed to a factorial combination of four treatments consisting of elevated CO2 (560 ppm), elevated O3 (episodic exposure-90 microl l(-1) hour(-1)), a combination of elevated CO2 and O3, and ambient control in 30 m treatment rings with three replications. Our overall results showed that our three growth parameters including height, diameter and volume were increased by elevated CO2, decreased by elevated O3, and were not significantly different from the ambient control under elevated CO2 + O3. However, there were significant clonal differences in the responses; all five clones exhibited increased growth with elevated CO2, one clone showed an increase with elevated O3, and two clones showed an increase over the control with elevated CO2 + O3, two clones showed a decrease, and one was not significantly different from the control. Notably. there was a significant increase in current terminal shoot dieback with elevated CO2 during the 1999-2000 dormant season. Dieback was especially prominent in two of the five clones, and was attributed to those clones growing longer into the autumnal season where they were subject to frost. Our results show that elevated O3 negates expected positive growth effects of elevated CO2 in Populus tremuloides in the field, and suggest that future climate model predictions should take into account the offsetting effects of elevated O3 on CO2 enrichment when estimating future growth of trembling aspen stands.

Air Pollutants↗

PubMed2001

Third molar outcomes from age 18 to 26: findings from a population-based New Zealand longitudinal study.

OBJECTIVE: The purpose of this study was to describe the presence and impaction status of people's third molars at age 18 years, as well as the observed changes in their clinical status between ages 18 and 26 years. STUDY DESIGN: Eight hundred twenty-one participants in a prospective cohort study were dentally examined at ages 18 and 26 years, and panoramic radiographs were taken at age 18 years but not at 26 years. For each tooth, its radiographic impaction status at age 18 years was compared with the clinical status by age 26 years. RESULTS: Of the 2857 third molars assessed at age 18 years, 92.8% were able to be followed up clinically at age 26 years. Approximately 54.9% of the teeth that were not impacted by age 18 had erupted by 26 years. Of the teeth that were impacted by age 18, 33.7% had fully erupted by age 26, 31.4% had been extracted, and 13.1% remained unerupted. Of the maxillary teeth that were categorized as "impacted" at age 18 years, 36.2% had fully erupted by age 26, whereas only 25.6% of the mandibular teeth had done so (P <.01). Fewer mandibular teeth than maxillary teeth remained unerupted by the time the patient was 26 years old (27.4% and 41.4%, respectively; P <.01), but there was no significant difference between the jaws in the proportion of impacted teeth at age 18 years that had been extracted by age 26 years (29.6% and 30.3%, respectively). For mesioangularly impacted third molars, 39.3% of maxillary teeth and 20.4% of mandibular teeth had fully erupted by age 26. Of the third molars that were mesioangularly impacted at age 18 years, 39.3% of maxillary teeth and 20.4% of mandibular teeth had fully erupted by age 26 years, whereas almost one-third of each had been extracted. Of the distoangularly impacted third molars, 20.4% of the maxillary teeth and one-third of the mandibular teeth had erupted by age 26, with 21.6% of the maxillary teeth and 31.6% of the mandibular teeth having been extracted. CONCLUSION: Other than horizontally impacted third molars, a substantial proportion of other impaction types do erupt fully, and radiographically apparent impaction in late adolescence should not be sufficient grounds for their prophylactic removal in the absence of other clinical indications.

Adolescent↗

PubMed2000

Endothelial monocyte activating polypeptide II induces endothelial cell apoptosis and may inhibit tumor angiogenesis.

Endothelial monocyte activating polypeptide II (EMAP-II) is a tumor-derived cytokine with potent effects on endothelial cells in vitro and in vivo including upregulation of tissue factor and the sensitization of human melanoma to systemic TNF treatment via its effects on the tumor vasculature. We investigated the effects of EMAP-II on tumor growth, angiogenesis, vasculogenesis, and apoptosis. EMAP-II inhibited endothelial cell proliferation, vasculogenesis, and neovessel formation. In vivo growth of human melanoma lines expressing high amounts of EMAP-II demonstrated slower growth, smaller tumors, and increased amounts of tumor necrosis than those expressing lower amounts of EMAP-II. EMAP-II induced endothelial-cell-specific apoptosis via a pathway that includes upregulation of the Fas-associated death domain and downregulation of Bcl-2. EMAP-II appears to have important effects on angiogenesis and may play a role in regulating tumor vascular growth.

3T3 Cells↗

PubMed1999

A prospective study of long-term health outcomes among Oklahoma City bombing survivors.

A follow-up study was conducted to identify long-term physical and emotional outcomes among Oklahoma City bombing survivors. Baseline data were gathered by the Oklahoma State Department of Health in 1995. Follow-up data were gathered by telephone interviews of survivors from 1-1/2 to 3 years after the bombing. The frequency of medical diagnoses, symptoms, medical cost, physical and social life changes, and services utilized since the bombing were assessed. A total of 494 persons were interviewed, 92 percent had been physically injured in the bombing. Seventy-nine percent of persons interviewed rated their general health status as "good," "very good," or "excellent." Overall, one-fourth to one-third of survivors reported being newly diagnosed with audiologic changes, anxiety, and depression since the bombing. One-third of persons reported preexisting medical conditions that had worsened since the bombing including depression (26%) and asthma/bronchitis (22%). The most frequently reported posttraumatic stress disorder symptoms were "being jumpy or easily startled" and "recurring distressful thoughts of the bombing." The most frequently utilized medical services were psychological counseling (63%) and audiology services (48%). Total costs were estimated of $ 5.7 million. Overall, persons who had been hospitalized with bombing injuries reported higher rates of diagnoses, symptoms, and services utilization. These findings suggest that a large proportion of survivors of a terrorist bombing, especially those seriously injured, will experience long-term physical and/or emotional outcomes and increased need for treatment for bombing-related medical conditions. All survivors should be carefully assessed over time for auditory damage, depression, anxiety, and posttraumatic stress disorder.

Adolescent↗

PubMed1999

The West Coast Study. I: Self-reported dental health and the use of dental services.

This study examined self-reported dental health and the use of dental services in a sample of the population of the West Coast of the South Island of New Zealand. The study differs from previous national surveys in that it provides a regional focus in a relatively remote area of the country; it provides an estimate of the prevalence and severity of dental anxiety among New Zealanders, using an instrument with a long history of use and validation; and it estimates the social impact of oral conditions. A questionnaire was mailed to 450 adult members of the population chosen at random from the electoral roll. The overall response rate was 76.6 percent. A dental check-up was the most commonly reported reason for the last visit to the dentist, although presentation for a specific problem accounted for 63 percent of all dental visits. Some 78.8 percent of the respondents described themselves as dentate, and episodic dental visiting was reported by 53 percent of that group. Higher proportions of episodic use of dental services were observed among beneficiaries, those on low incomes, and those who were classified as dentally anxious. Six percent of respondents had their last dentally treatment funded by public monies, and a further 3.6 percent did not have to pay. Beneficiaries and Community Services Cardholders were more likely to make up these groups. While public funding ensures access to care for a substantial number of individuals. West Coast dentists are supplementing this care by providing treatment without charge for a small number of people. Various adverse impacts of oral conditions were reported by up to 8.6 percent of respondents; more Community Cardholders reported feeling self-conscious or embarrassed than non-Community Cardholders. Geographic isolation and lack of choice of dental practitioner did not appear to be factors in determining utilisation. The two characteristics associated with poorer self-reported dental health and infrequent use of dental services were lower socio-economic status and self-reported dental anxiety. The findings of this study provide regional-level confirmation of the general findings of the 1976 and 1988 national studies.

Adolescent↗

PubMed1999

The West Coast Study. II: Dental anxiety and satisfaction with dental services.

Dental anxiety is common, and is a notable factor in the avoidance of dental care. The dental satisfaction of users is an important indicator of the quality of dental care. A postal survey (response rate 76.6 percent) was used to investigate dental anxiety and dental satisfaction among a representative sample of 249 dentate adults living on the West Coast of the South Island of New Zealand. Dental anxiety was reported by 20.8 percent of respondents, and was more prevalent among beneficiaries (individuals in receipt of a Social Welfare benefit) and younger people. Dental satisfaction was lower among younger people and those who were dentally anxious, and was higher among people with a tertiary education. Differences in consumers' expectations were considered responsible for the latter findings. Where appropriate, dentists should be prepared to adapt their manner of communicating with patients.

Adolescent↗

PubMed1999

Adnexal torsion. A clinicopathologic review of 31 cases.

OBJECTIVE: To evaluate the correlation between clinical parameters, intraoperative assessment of tissue viability and histopathology in adnexal torsion. STUDY DESIGN: A retrospective study of 31 patients undergoing surgical intervention for adnexal torsion was performed, and clinical and pathologic parameters were compared. RESULTS: Intraoperative evaluation of viability was confirmed in 10/12 cases. Impression of necrosis was confirmed in 18/19 cases. Fever was seen in 2/12 patients with viable adnexa and in 7/19 patients with necrosis. CONCLUSION: Intraoperative impression of tissue viability correlated well with histopathology. Fever was significantly associated with tissue necrosis.

Adnexa Uteri↗

PubMed1998

Dental caries and changes in dental anxiety in late adolescence.

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence.

Adolescent↗

PubMed1997

Good teeth, bad teeth and fear of the dentist.

Studies of dental fear and oral disease suggest that conditioning processes are important in the acquisition of dental fear. At this time, however, definitive conclusions are premature as all research on the etiology of dental fear has been retrospective in design, with most confined to analogue or clinic samples. This study redressed these limitations by prospectively investigating the relationship between oral health (i.e. caries experience) at age 5 and 15 yr and the report of dental fear at age 18 in a large, unselected birth cohort. Caries experience at age 5 was not related to the development of dental fear in late adolescence. In contrast, caries experience at age 15 was significantly, and specifically, related to the report of dental fear at age 18. A ratio of caries severity at age 15, indicating the extent of multi-surface involvement, was inversely related to dental fear at age 18. This intriguing finding suggests that relatively brief dental treatment occasioned by low levels of dental disease may result in the incubation of dental fear in some individuals and that longer episodes of treatment may facilitate fear habituation. Theoretical and practical implications of these findings are discussed.

Adolescent↗