DPH (all stages) Flashcards
(51 cards)
What is epidemiology, and what studies and results need to be (valid etc.)
-studying diseases in populations - the distribution and determinants of disease frequency.
-Effectiveness of treatments, assessing need and demand in communities
-Needs to be reliable, valid, objective, simple, reproducible, quantifiable, sensitive and acceptable.
List study design in order of hierarchy triangle
- Lab and animal research
- Case report
- cross-sectional study
- cohort study
- case-control study
- randomised controlled trial
- systematic review
- Meta- analysis
Definition of case study. Uses. Weaknesses.
A report on a single patient with an outcome of interest. No control group. Used for investigating novel treatments, disease or hypotheses. Cannot suggest a causal relationship
-Cannot demonstrate valid statistical association. Lack of appropriate comparison group can obscure a relationship or suggest an association where none exists
Definition of cross-sectional study. Uses and cons
-Observation of a defined population at a point in time. Measures prevalence of a disease. Looks at potential risk factors.
-Don’t know when something happened. Cannot prove the cause. Group sizes may be unequal. Risk of recall bias
Definition of randomised control study. Pros and cons
-Participants randomly allocated to different interventions to evaluate effectiveness of an intervention. Compare to a control.
-Reduces selection bias
-Cost, ethical and compliance issues
Definitions of cohort study, uses and weaknesses
Identifying 2 groups, one who has received the exposure of interest and the other which did not. Not forced into groups, they are just maintaining what they already do. Looking prospectively to see if a disease develops. Common diseases for this method.
-Measuring incidence, cause of disease, prognosis, timing of events
-controls can be difficult to identify, Exposure may be linked to hidden confounder, Blinding is difficult. For rare diseases large sample size is often necessary (very small % of people actually have the disease)
Case-control study definition, uses, weaknesses
Patients with and without a disease, and looking retrospectively to work out the risk factors, causes, exposure of interest.
- Used for rare diseases
-Recall and selection bias. Exposure may be linked to hidden confounder. Difficult to establish time relationships between exposure to the risk factor and development of the disease
Systematic Reviews definition, uses, weaknesses
The evidence from lots of studies is gathered in one report which pools AND analyses all available data to assess the strength of the evidence.
-needs to answer a defined question and carried out with scientific rigour
-best at assessing strength of evidence than single studies
What is meta analysis
A meta-analysis is the statistical process of analyzing and combining results from several similar studies. So it can be involved within a systematic review
Definitions of prevalence, incidence, validity, reliability, sensitive, specificity
-Prevalence – proportion of individuals who have a disease at a specific instant. Provides an estimated probability that an individual will be ill at a point in time. Number of cases/ total population
-Incidence – number of new cases of a disease that develops in a population during a defined time period
-Validity –test faithfully records the test/disease it is presumed to identify. Measures what we want it to
-Reliability – consistent and repeatable at different times under same conditions
-Sensitive – picks up disease
-specificity- true negatives
-Acceptable – to patient. Safe
Definition of chance, bias, confounding factors
-Chance: a probability of something happening. All measurements are subject to some random variation.
-Bias: Inclination/prejudice in favour of a particular person, thing or viewpoint. To influence unfairly. A systematic error relating to the measurement of a variable. Measurement error.
-Confounding factor: due to error in interpretation of a measurement (even if measurement is accurate). Confounder factor is prognostically linked to the outcome of interest and is unevenly distributed between study groups
Limitations of DMFT index
-Lacks detail and based on assumption. M and F assumed to have been carious, but could be due to trauma
-Past treatment decisions could have been for preventative or restorative reasons
-Equal weighting to D, M and F, yet the implications for dental health are different.
Examples of barriers to behaviour change
Poor motivation and desire, lack of resources, socio-economic circumstances, lack of support, lack of education, busy lifestyle, disability,
List upstream and downstream interventions for disease prevention
-From downstream (chairside) to upstream (policies) :
- clinical prevention (eg. fluoride varnish), dental health education (chair side & schools), media campaigns, training other professional groups, community development, healthy settings (healthy food options in work places), fiscal measures to encourage healthier behaviour (sugar tax, bike lanes, fluoridation), legislation/regulation (laws), local/national policies (fluoridation)
-cannot only rely on downstream as many do not attend the dentist
Factors to consider when planning a health service in a particular area
- Need= what people could benefit from, the health gains. Look at the population (consider disease levels, age, gender, ethnicity, socio-economic factors, mobility, disablity) disease prevalence, current services
- Demand= what is asked for (better accessibility, wider range of treatment, better cost) Priorities, opinions
- Supply= what is provided. Available resources, policies
Ideally we want supply= demand
How to assess need
-surveys, data from dental practices/hospitals/social care
-assess current Provision- how well are providers performing. Is there any possibility of increasing capacity, providing mobile dental vans etc.
-Map and analyse to identify areas
-Look at Stakeholder views and patient views- how they perceive services, how oral health impacts them
-compare unmet needs and priorities
As price drops, demand increases. How to increase demand without dropping the price.
-Add adverts. Increase amount of complimentary goods
-Ideally we want supply = demand
Health needs of specific groups: disabled, frail, homeless, travellers, substance misusers, armed forces (factors that increase their risk of oral disease)
-Disability- poor access, mobility, need specialised equipment, compliance and consent
-Frail patients- poor access, mobility, dependant on others, poor mobility and dexterity, difficulty tolerating treatment, other health issues impacting treatment,
-Homeless- poor nutrition, poor access to services, cannot afford brushes, addiction to alcohol and drugs leads to further OH problems, mental health issues compound other problems
-Gypsies/ travellers – difficulty accessing services, cultural beliefs affect their trust in professionals, poor access to healthcare, poor general and health literacy
-Substance misusers- chaotic lifestyle means poor attendance, less likely to present in acute pain, methadone high in sugar (heroine replacement therapy)
-Armed forces- most recruited from low socioeconomic status. Role requires geographic placement away from standard primary care services. Oral fitness is an essential part of their overall medical fitness
What is unmet need and what it may be due to
-difference between what is required/ needed and the healthcare actually provided.
-Could be due to shortage of services, service not in right place, poor transport links, not enough people to run it, not the right service so doesn’t match the need and demographic of that community
Environmental and social factors that can contribute to dental disease
nutrition, genetics, sanitation, socio-cultural factors, healthcare services, income, dependents, geographical location, age, education, advertising, deprived areas, behavioral factors (parents taking children dentists) cultural beliefs (dental health not a priority), access to healthcare, stress, costs, disability, poverty, social exclusion/ solo living, unemployment, ethnicity, time, rurality, language barrier, poor knowledge, dental attendance, patient motivation, fluoridation, access to dentist
Benefits of fluoridation
-Fluoride slows demineralization, and increases remineralization. Fluoride hydroxyapatite is less soluble than HA so has slower demineralization
-Increases those caries free in children, decreases the mean dmft, reduces extractions, fewer fillings, reduces health inequality, benefits children and adults, doesn’t require behaviour change
-reduces the impact of high sugar diet or poor OH
Arguments against fluoridation
-expensive (but return of investment is higher than other fluoride programmes)
-intervening without consent.
-Against individual choice and human right [but there is no right to drink fluoride-free water as it occur naturally in some places and it is only a personal preference, it could be unethical to not fluoridate an area]
-it doesn’t work
-causes cancer, bone fractures, down’s syndrome, low intelligence etc. [there is no evidence of links with medical conditions]
-mass poisoning
Which study has highest recall bias
case-control study
Name indices of deprivation
index of multiple deprivation
Jarman index
Townsend index
