Biomedical subjects

M Tennant

Publications and source records attributed to M Tennant.

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

Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons.

BACKGROUND: Surgical extraction of third molars is one of the most common oral and maxillofacial surgical procedures performed and may have a number of associated complications. One of these complications is inferior alveolar nerve (IAN) dysaesthesia or impairment of sensory perception (including paraesthesia and/or anaesthesia). Previous studies assume that most clinicians use various combinations of nine radiologic criteria on panoramic radiographs as indicators of the relationship and, therefore, predictors of the risk of postoperative dysaesthesia. Our study assessed both the current radiologic modalities and assessment criteria used by Australian oral and maxillofacial surgeons when determining the proximity of mandibular canal to third molars. METHODS: A survey of all surgeon members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZOMS) practising in Australia was undertaken. RESULTS: Of the 105 questionnaires sent to surgeons, 72 responses (68 per cent) were returned. All surgeons reported using the panoramic radiograph but only 25 per cent considered it sufficiently accurate in determining the relationship between the mandibular canal (MC) and the third molar root, while 61 per cent of surgeons use CT for this purpose but the average frequency of use was very low (five per cent). This study also revealed that the nine radiologic criteria on a panoramic radiograph are used to varying extents by Australian surgeons. Nearly all surgeons use 'change in MC direction' and 'MC narrowing' to determine and close relationship. Thirty-one per cent used superimposition of the MC and the root of the third molar alone and 24 per cent used appearance of contact of the root with the MC alone in the absence of any other radiologic criteria to indicate close or intimate relationship. CONCLUSION: Further research is required to determine the accuracy and observer agreement or reliability of using the nine panoramic characteristics, to determine this relationship and whether the presurgical determination of proximity and position (buccal or lingual) of the canal utilizing CT has any usefulness in determining the surgical protocol or affect on postoperative morbidity.

Australia↗

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↗

PubMed2005

A concise review of the basic biology and pharmacology of local analgesia.

Local analgesics are the most commonly used group drugs in dental practice. However, due to their frequent use and high margin of safety, often dental practitioners neglect to properly understand the biology and pharmacology of these drugs. This article reviews the basic concepts of pain, pain pathways, the mode of action of local analgesics and factors which affect their usage. Specific details and properties of some currently available solutions are also outlined. A greater understanding of the biology and pharmacology of local anaesthetics will ultimately lead to safer and more effective use in everyday clinical practice.

Analgesia↗

PubMed2005

Discovery strategies in a BioPharmaceutical startup: maximising your chances of success using computational filters.

Small research-based pharmaceutical start-ups often lack the budget and do not have the infrastructure available to apply all possible techniques for compound selection. This review details our use of a range of techniques such as high-throughput docking and similarity searching to maximize the success rate when attempting to identify pharmaceutically relevant ligands in a resource-constrained environment.

California↗

PubMed2004

Differential modulation of energy balance by leptin, ciliary neurotrophic factor, and leukemia inhibitory factor gene delivery: microarray deoxyribonucleic acid-chip analysis of gene expression.

Most obese animal models, whether associated with genetic, diet-induced, or age-related obesity, display pronounced leptin resistance, rendering leptin supplement therapy ineffective in treating obesity. Ciliary neurotrophic factor (CNTF) has been recently used to invoke leptin-like signaling pathways, thereby circumventing leptin resistance. In the current study, we characterize immediate and long-term molecular events in the hypothalamus of rats exposed to the sustained ectopic expression of leptin, CNTF, or leukemia inhibitory factor, another neurocytokine of IL-6 family, all delivered centrally via a viral vector. The respective transgene-encoded ligands induced similar but not identical metabolic responses as assessed by the reduction in body weight gain and changes in food intake. To define molecular mechanisms of weight-reducing and anorexigenic action of cytokines, we have analyzed the gene expression profiles of 1300 brain-specific genes in the hypothalami of normal rats subjected to the prolonged cytokine action for 10 wk. We present evidence that constitutive expression of cytokines in the brain induces changes in gene expression characteristic of chronic inflammation leading to either temporal weight reduction (CNTF) or severe cachexia (leukemia inhibitory factor). Our results convey a cautionary note regarding potential use of the tested cytokines in therapeutic applications.

Animals↗

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

Evaluation of use of a single intravaginal swab to detect multiple sexually transmitted infections in active-duty military women.

The accuracy and suitability of use of a single intravaginal swab (SIS) for polymerase chain reaction detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and human papillomavirus infection was assessed in a cross-sectional study of 841 active-duty military women. The SIS, compared with standard diagnostic tests, allowed detection of more gonorrhea, more chlamydial infection, and more trichomoniasis. Sensitivity and specificity of SIS detection compared with adjudicated true-positive diagnoses were 95.8% and 97.8%, respectively, for gonorrhea, 94.6% and 99.3% for chlamydial infection, and 92.2% and 98.2% for trichomonal infection. Results with SISs were comparable to those with cervical swabs tested for human papillomavirus. Assay of clinician-collected and self-collected SISs yielded prevalences similar to those of standard diagnostic tests for all sexually transmitted infections. Therefore, the use of SISs is acceptable for the simultaneous diagnosis of multiple sexually transmitted infections and has potential for use as a self-administered diagnostic tool with widespread applicability among women.

Administration, Intravaginal↗

PubMed2001

Cellular survival in rat vein-to-artery grafts. Extensive depletion of donor cells.

Microsurgical models of vein-to-artery graft surgery have been developed in rats as a means of assessing vein graft adaptation and neo-intimal hyperplasia. Neo-intimal hyperplasia in these grafts is often attributed, at least in part, to an adaptive response by venous smooth muscle cells to the increased intraluminal pressure of the arterial pressure. However, considerable evidence suggests complete or near-complete cellular replacement in these grafts. A series of experiments were undertaken in which male vein or artery grafts were placed into either allogeneic female nude rat hosts or into syngeneic WKy female hosts as a means of determining donor cell survival. Grafts were removed at postsurgery week 2 or week 6 and the fate of the donor male cells assessed by PCR amplification of the testis-determining gene Sry. The Sry gene was undetectable in 2-week male to female vein grafts. When left for 6 weeks, donor cells were detectable in vein grafts only after multiple 50-cycle PCR analyses. Minimal donor cell survival was not due to an allograft response, as donor male cells were readily detectable in WKy male to female nude rat artery-to-artery grafts. These data were not nude rat specific, as poor donor cell survival was also evidenced in syngeneic male to female vein-to-artery grafts. In conclusion, we demonstrate only marginal survival of donor cells in rat vein-to-artery grafts. Neo-intimal hyperplasia in these grafts was not a consequence of donor venous smooth muscle cell proliferation.

Animals↗

PubMed2001

Development of oral health training for rural and remote aboriginal health workers.

Research data exists that highlight the discrepancy between the medical/dental status experienced by Aboriginal people compared with that of their non-Aboriginal counterparts. This, coupled with a health system that Aboriginal people often find alienating and difficult to access, further exacerbates the many health problems they face. Poor oral health and hygiene is an issue often overlooked that can significantly impact on a person's quality of life. In areas where Aboriginal people find access to health services difficult, the implementation of culturally acceptable forms of primary health care confers significant benefits. The Aboriginal community has seen that the employment and training of Aboriginal health workers (AHW), particularly in rural and remote regions, is significantly beneficial in improving general health. In the present study, an oral health training program was developed and trialled. This training program was tailored to the needs of rural and remote AHWs. The primary objective was to institute a culturally appropriate basic preventative oral health delivery program at a community level. It is envisaged that through this dental training program, AHWs will be encouraged to implement long-term preventive measures at a local level to improve community dental health. They will also be encouraged to pursue other oral health-care delivery programs. Additionally, it is considered that this project will serve to strengthen a trust-based relationship between Aboriginal people and the health-care profession.

Adult↗

PubMed2001

The first structure of a microsomal P450--implications for drug discovery.

Although numerous microbial, soluble P450 structures have been known for some time, it is only recently that the first crystal structure of a microsomal, membrane-associated P450 has been determined. The structure gives an increased understanding of the membrane, substrate and reductase binding surfaces, and has enabled the modeling of other P450s with greater accuracy. Other milestones include the first determination of a true P450 drug target, CYP51, the determination of a thermophilic P450 and the structures of cryogenically trapped intermediates of the P450 reaction cycle.

Animals↗

PubMed2000

Rural and remote oral health, problems and models for improvement: a Western Australian perspective.

Oral healthcare in rural communities shares many of the dilemmas faced by medicine in providing services to large geographical areas with dispersed populations. This study examined the population data and service provision data relevant to the geographical distribution of oral health care in Western Australia (WA). Of the 1.7 million people resident in WA, 72% were resident in the five major urban centres with only 13% in rural and remote regions. Of the 320 postcode regions, 186 had a population of less than 2500, 31 had a population from 2500 to 5000, 42 from 5000 to 10,000, 37 from 10,000 to 20,000, and 24 had a population greater that 20,000. Almost 80% of postcode regions with a population less than 2500 are in non-urban regions. Of the total of 690 dentists who were analysed in this study, it was found that the vast majority (greater than 85%) worked in practices in postcode regions within metropolitan Perth or the major urban centres. A total of 43 postcode regions did not have a dental practice within their bounds. In order to address this disparity in service availability, strategies including the development of training for medical practitioners and auxiliaries, the use of modern technology, school-based programs and the development of interdisciplinary links should be implemented. These strategies would also facilitate the development of closer links between medical and dental practitioners and the development of skills within the medical fraternity that would facilitate improved oral health in rural and remote communities.

Dentistry↗