Geographic modelling of jaw fracture rates in Australia: a methodological model for healthcare planning

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Fracture Fixation Technique and Chewing Side Impact Jaw Mechanics in Mandible Fracture Repair

Lower jaw (mandible) fractures significantly impact patient health and well‐being due to pain and difficulty eating, but the best technique for repairing the most common subtype—angle fractures—and rehabilitating mastication is unknown. Our study is the first to use realistic in silico simulation of chewing to quantify the effects of Champy and biplanar techniques of angle fracture fixation. We show that more rigid, biplanar fixation results in lower strain magnitudes in the miniplates, the bone around the screws, and in the fracture zone, and that the mandibular strain regime approximates the unfractured condition. Importantly, the strain regime in the fracture zone is affected by chewing laterality, suggesting that both fixation type and the patient's post‐fixation masticatory pattern—ipsi‐ or contralateral to the fracture— impact the bone healing environment. Our study calls for further investigation of the impact of fixation technique on chewing behavior. Research that combines in vivo and in silico approaches can link jaw mechanics to bone healing and yield more definitive recommendations for fixation, hardware, and postoperative rehabilitation to improve outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Patterns of Mandibular Fractures in South Australia: Epidemiology, Treatment, and Clinical Outcomes

INTRODUCTION

The mandible is one of the most common facial bones to be injured with great clinical variability across countries caused by assaults, road traffic accidents, and falls.

METHODS

A retrospective review was conducted for adult mandibular fractures from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. Our aim was to describe epidemiological trends of mandibular fractures, differences for sex and age, and clinical outcomes.

RESULTS

Five hundred sixty five adult patients presented with a mandibular fracture with a male predominance (4.5:1). The mean age was 34.2 years with men 11.9 years younger than females (32.0 versus 44.1 years, P < 0.001). Assaults represented 58.2% of cases. A quarter of the cohort reported alcohol use. Assaults commonly resulted in angle and symphyseal fractures, whereas almost all falls and road traffic accident resulted in condylar or coronoid fractures. Young men were 1.9 times more likely to have mandibular fractures compared to women, whereas elderly men were 11.8% less likely (P < 0.001). The most common fracture was the angle (33.6%) and the angle/symphyseal (14.2%). Men were 2.5 times more likely to have surgery. The complication rate was 10.8% and the re-operative rate was 5.0%. Women had a significantly longer admission of 1.6 days compared to men (4.4 versus 2.8 days, P = 0.003).

CONCLUSIONS

Young men are more likely to have mandibular fractures from assaults and have surgery. Young women and elderly females are more likely to have animal and fall-related injuries resulting including in condylar fractures with associated injuries and extended length of stay.

Ten years of hospitalisation for oral health-related conditions in Western Australia: an unjust dichotomy

The objective of this study was: (1) to examine the demographics of in-patient oral health care by Aboriginal status; (2) to identify the mix of oral conditions by Aboriginal status; and (3) to describe trends over a 10-year period, comparing Aboriginal and non-Aboriginal groups. Hospitalisation data were obtained from the Western Australian Morbidity Data System (HMDS). The principal diagnosis, as classified by the International Classification of Disease (ICD-10AM), was obtained for every episode for adult patients who were discharged from all hospitals in Western Australia (WA) for the financial years 1999-2000 to 2008-09. Results indicated that more than 130000 persons were admitted to hospitals in WA over 10 years, for oral health-related conditions, at a direct cost of more than $400million. Most of those admitted were younger than 30 years, and 2.8% of all those admitted were Aboriginal people. Aboriginal people were admitted at significantly higher rates, for a very different mix of conditions, they were mostly from younger age groups, were mostly from very remote and the most disadvantaged areas and were almost all uninsured, compared with non-Aboriginal people. Hospital admissions for oral health-related conditions, as well as the mix of conditions that drive these hospitalisations, are strongly divided across social, racial and geographic variables, and remain a burden to the health-care system.

Role of public transport in accessibility to emergency dental care in Melbourne, Australia

The aim of this study was to develop a method for the analysis of the influence of public transport supply in a large city (Melbourne) on the access to emergency dental treatment. Geographic Information Systems (GIS) tools were used to associate the geographical distribution of patients (and their socioeconomic status) with accessibility (through public transport supply, i.e. bus, tram and/or train) to emergency dental care. The methodology used allowed analysis of the socioeconomic status of patient residential areas and both spatial location and supply frequency of public transport by using existing data from patient records, census and transport departments. In metropolitan Melbourne, a total of 13 784 patients met the inclusion criteria for the study sample, of which 95% (n = 13 077) were living within a 50 km radius of the Royal Dental Hospital of Melbourne. Low socioeconomic areas had a higher demand for dental emergency care in the Royal Dental Hospital of Melbourne. Public transport supply was similar across the various socioeconomic strata in the population, with 80% of patients having good access to public transport. However, when considering only high-frequency bus stops, the percentage of patients living within 400 m from a bus stop dropped to 65%. Despite this, the number of patients (adjusted to the population) coming from areas not supplied by public transport, and from areas with good or poor public transport supply, was similar. The methodology applied in the present study highlights the importance of evaluating not only the spatial distribution but also the frequency of public transport supply when studying access to services. This methodology can be extrapolated to other settings to identity transport/access patterns for a variety of services.

Closing the Gaps: competing estimates of Indigenous Australian life expectancy in the scientific literature

Objective: Closing the gap in life expectancy between Indigenous and other Australians within a generation is central to national Indigenous reform policy (Closing the Gap). Over time, various methods of estimating Indigenous life expectancy and with that, the life expectancy gap, have been adopted with differing, albeit non-comparable results. We present data on the extent of the gap and elucidate the pattern of use and interpretations of the different estimates of the gap, between 2007 and 2012.

Methods: An extensive search was conducted for all peer-reviewed health publications citing estimates of and/or discussing the life expectancy of Indigenous Australians, for the period 2007–2012.

Results: Five predominant patterns of citation of the gap estimates were identified: 20 years, 17 years, 15–20 years, 13 years, and 11.5 years for males and 9.7 years for females. Some authors misinterpret the most recent estimates as reflecting improvement from the 17-year figure, rather than the result of different methods of estimation. Support for the direct methods used to calculate Indigenous life expectancy is indicated.

Conclusions and Implications: A specific estimate of the life expectancy gap has not been established among stakeholders in Indigenous health. Agreement on the magnitude of the gap is arguably needed in order to evaluate strategies aimed at improving health outcomes for Indigenous Australians. Moreover, measuring progress towards ‘closing the gap’ depends on the availability of comparable estimates, using the same techniques of measurement to assess changes over time.