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UoA BDS 2 Sem 1 > Social concepts of dentistry and EBD > Flashcards

Social concepts of dentistry and EBD Flashcards

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1
Q

What are the social determinants of health?

A

The social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work live and age and the wider set of forces and systems shaping the conditions of daily life.

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2
Q

What are the examples of social determinants of health?

A

Income, education, unemployment, food security etc.

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3
Q

What do social determinants of health shape?

A

Social determinants of health shape the distribution of midstream factors, which, in turn shape individual’s health.

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4
Q

What are oral health inequalities?

A

It is when differentials in health are caused by social circumstances.

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5
Q

Discuss why health care access and utilisation are not at the root of oral health inequalities

A

Even if access to healthcare is given, it does not mean that a population may be educated enough to understand the scope of their diagnosis thus may lead to worst individual outcomes and worst population outcomes as well as the fact that a multitude of other factors that may impact the health outcomes (like availability of clean water, food etc.)

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6
Q

What is the concept of social gradient?

A

When an individual becomes more socially secure, they show a higher level of oral health literacy and oral health outcomes.

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7
Q

Why are targeted interventions among the most disadvantaged groups are unlikely to eliminate oral health inequalities?

A

Hyper individualistic approach to health care may treat the immediate problem in the individual, but does not change the social determinants that have affected the individual in the first place

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8
Q

Describe the social gradient in oral health-related behaviours.

A

Oral health-related behaviours are also socially patterned: across several indicators of socioeconomic disadvantage and behaviours.

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9
Q

What can you say about socioeconomic status and sugar consumption?

A

As household income increase – sugar consumption in beverages decreases.

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10
Q

What can you comment on other oral health-related behaviours and social gradient?

A

Behaviours like smoking, alcohol consumption, oral hygiene practices and dentist visits are worst among the disadvantaged

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11
Q

What is the direct pathway to behaviour?

A

The lack of resources causes certain behaviour to appear

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12
Q

What is the indirect pathway of behaviour?

A

Due to psychosocial factors – certain behaviour patterns occur

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13
Q

Discuss how decontextualizing health-related behaviours from the social determinants of health encourages blaming the victims of inequality for their unhealthy lifestyles.

A

It just creates a cycle of stigmatization and disadvantage and will not improve their oral health outcomes.

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14
Q

Provide examples of interventions that reduce and increase inequalities in behavioural outcomes.

A
  1. Media campaigns
  2. Taxation
  3. Policies
  4. Health warning
  5. Bans of advertising
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15
Q

Discuss the role of dental practitioners in reducing inequities in health-related behaviours.

A
  1. Self awareness
  2. Deliver evidence-based clinical prevention
  3. Advocacy skills
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16
Q

What is racism?

A

Racism is the unjust treatment of social groups on the basis of racial or ethnic background

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17
Q

What are different levels of racism?

A
  1. Interpersonal - between 2 people
  2. Intrapersonal - except ideologies by a single person
  3. Structural racism – laws, rules and practices
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18
Q

How would you describe the relationship between different types of racism?

A

Iceberg – interpersonal at the top and structural at the bottom

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19
Q

In which way does racism affect oral health?

A
  1. Through reduced access to resources that are required for health - Intersectionality - multiple other ideologies intersect to discriminate e.g. racism + sexism
  2. Through psychosocial factors – behaviours or embodiment
  3. Through the undermining of dental health service provider-patient relationships
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20
Q

How can structural racism affect oral health?

A

Structural racism reinforces implicit bias of people. An example: dental services are structured in a way which is not culturally sensitive to different racial minorities making said minorities to be less likely to attend dental services because THEY DO NOT FEEL WELCOME. Yet is statistics, it would just say “x racial minority is more likely not to attend their appointments”. Which leads the practitioners to make assumptions

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21
Q

What is implicit bias?

A

In social identity theory, an implicit bias or implicit stereotype, is the pre-reflective attribution of particular qualities by an individual to a member of some social out group.

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22
Q

What is intersectionality?

A

The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.

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23
Q

How can we fix racism?

A
  1. Structural changes – diversify racial makeup of training programs, increase the incentives for oral health personal to work in communities in which racially underpowered groups and many more
  2. Individual-level changes – speak up, support victims and take evidence
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24
Q

What is epidemiology?

A

The study of the distribution and determinants of health-related states and the application of this study to the control of health problems

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25
What is the life course approach to epidemiology?
Study of long term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood and later adult life. Exposures early in life are involved in initiating disease processes prior to clinical manifestation. models – exposures accumulate over the life – e.g. intersectionality
26
What are the two models in life course epidemiology?
1. Critical period models – exposure during a specific period has lasting impact – e.g. during gestation 2. Accumulation of risk
27
What is social-mobility?
It is shift in an individuals social status
28
What can you say about socio-economic circumstances and oral health?
Experiences of socio-economic disadvantage through the life course are related to various aspects of oral health. Socioeconomic factors may operate in critical windows of time, but also in cumulative and interactive ways over life. Models of critical period and accumulation of risk appear to collectively contribute to an understanding of oral health inequalities.
29
What is included in a health system?
1. Policy - a more upstream factor 2. Services - a more midstream factor
30
What is the role of policies?
1. Shift the distribution of social determinants of health – e.g. education, welfare, employment, progressive taxation, anti-racist legislation, wage capping and so on 2. Modify the mechanisms through which social determinants of health – e.g. health care access: increase availability of services, increasing accessibility of the services, increase accommodation of the services, increase affordability of the services, increase acceptability of the services. Behaviour: make healthier options the easier option, barriers, reinforce positive behaviour, oral health and nutrition policies in preschools, subsidize toothpaste and toothbrushes, subsidized healthy snacks, include oral health in mainstream messaging, promote oral health for children, taxation policies.
31
What can dentist do to help patients with their social-determinants of oral health?
At personal level: 1. Ask patients – social history is important! refer to them to local support services! 2. Connect patient with support resources – local groups, child protection, welfare 3. Advocate for patients – writing a letter, protest 4. Increasing awareness of your implicit bias 5. Understanding the social context of health-related behaviours At practice level: 1. Extend clinic hours 2. Offer payment plans 3. Offering a welcoming and culturally safe environment 4. Understand the main barriers to access care At community level: 1. Partnerships with community 2. Advocate for social change at community level
32
How can you describe the design of an evidence pyramid?
As we go up to the top of the pyramid – we reduce the amount of bias present in the studies – thus ouf findings are more representative to truth. NOTE: the higher you are on the pyramid does not determine the quality of results, you may have some poorly designed randomized controlled trials but well design cohort studies that may provide more accurate results.
33
What are Clinical Practice Guidelines?
They are created by a panel of experts with reference to systemic reviews of a particular subject. They summarise the evidence and provide clinical recommendations. These are at the top of Evidence Pyramid.
34
What are the main features of randomised control trials?
1. High level of evidence 2. Eandom assignment 3. Groups are exchangeable
35
What are the different types of RCTs?
1. Parallel-arm RCTs 2. Cross-over RCTs 3. N-of-1 'single patient' RCT
36
What is the structure of the parallel-arm RCTs?
1. Selection 2. Randomisation 3. Treatment and control group establishment and intervention 4. Follow up measures 5. Analysis
37
What is the structure of the Cross-over RCTs?
1. Selection 2. Randomisation 3. Treatment and control group and intervention 4. Washout period 5. Swap of control and treatment groups for second intervention 6. Outcomes of interventions 7. Analysis
38
What is the structure of the N-of-1 'single patients RCTs?
1. One patient is selected 2. They go through periods of treatment and non-treatments – the pattern is also random 3. Outcomes of interventions are recorded 4. Data is analysed
39
How can some factors affect the quality of RCTs?
1. Pre-specification of outcomes and trial registration 2. Quality of the randomisation process 3. Blinding 4. Analysis
40
How can pre-specification of outcomes and trial registration affect the quality of RCTs?
Outcomes need to be specified. If not, fishing for results may occur thus downplaying the negative outcomes. That is why we need pre-specification is needed to register a trial to reduce fishing. ALL TRIALS MUST BE REGISTERED PRIOR.
41
How does the quality of the randomisation process affect the quality of RCTs?
Appropriate randomisation generates an unbiased, unpredictable allocation sequence. The trial must also conceal the allocation sequence until after the participants have been recruited.
42
How does blinding affect the quality of RCTs?
Blinding protects randomisation schedule after it is implemented. We need to know who is blinded and how. Participants are less likely to be influences by physical and psychological responses. Investigators cannot influence participants. Analysis cannot include or exclude data
43
How does the analysis affect the quality of RCTs?
Using the ITT (intention-to-treat) or per-protocol approach to analysing data. Also remember why people drop out!
44
What is CONSORT?
CONSORT is a CONSOlidated Reporting of Trials, which is a tool that is used to judge the quality of RCTs. Think about it as a checklist. It is required by top journals. In general, using this tool the quality of trials have improved.
45
What is ROB-2?
ROB-2 is Risk of Bias 2 that is developed by Cochrane Collaboration. This will grade the bias in each RCTs.
46
What is the main objective of cohort studies?
Informing causal interference. What can we do to reduce the problem? It is set up to examine effects of many different sorts of exposures.
47
What are the strengths and limitations of a cohort study?
Limitations: 1. Not as much control as RCTs 2. Increase amount of bias 3. Influence of extrinsic factors Strengths: 1. Good preliminary studies 2. Cheaper 3. Effecient 4. Can collect different measures
48
What is the design of a cohort study?
1. Time baseline 2. Time goes on 3. We observe 4. Analysis 5. Outcome
49
What is the main objective of cross-sectional studies?
It is to describe health states. What is the nature of the problem?
50
How does a cross sectional study work?
1. Select a group 2. See if they were exposed or not 3. Analyse 4. Outcomes
51
Why do we do a cross-sectional study?
Have a snapshot and see the prevalence of health problems in a population
52
What is the limitation of cross-sectional study?
Cannot demonstrate temporal order!
53
What is a perspective study?
The study is conducted before data is gathered.
54
What is a retrospective study?
The study is conducted after the data is made available.
55
Why do we sample?
Reduce costs and it is more efficient
56
What are the steps to sampling?
1. Start with the question 'Why am I doing this study'? 2. Calculate the required sample size 3. Identify the eligible population and the 'sampling frame' 4. Decide on a method of sampling from the population 5. Execute the plan
57
What are some of the sampling methods?
1. Simple random sample – equal chance being selected 2. Stratified random sample – equal participation of sexes, races and other parameters 3. Systematic - non-random – a set process e.g. every tenth person 4. Clustered - geographic areas are selected, after the clusters of multiple people are selected 5. Convenience sampling – just recruit people where we actively recruit people with needed traits
58
What is the main objective of case control study?
It is causal interference. What can we do to reduce the problem.
59
What is the main objective of ecological study?
It is casual interference. What can we do to reduce the problem.
60
What is the design of a case control study?
It starts with a known outcome that is classified as a "case". Non-cases are treated as a control group.
61
What is the design of a case control study?
1. A group of people with a known disease are classified as cases 2. A group of people who are known not to have a disease are used as controls 3. Both groups are sampled and separated into exposed and none exposed 4. We get 4 groups thus 4 data steams 5. Odds are calculated
62
How do we select people for case-control study?
We select knowing they have the disease. We can get them from hospital, medical practices, registries, surveys and more.
63
What are some advantages of case control studies?
1. Faster and less costly than other study designs 2. Good for studying rare diseases 3. Can collect many different exposures 4. Can calculate a multitude of measures of effect
64
What are some of the disadvantages of cohort studies?
1. Selection bias 2. Recalll bias 3. Interview bias
65
What are ecological studies?
Ecological studies are epidemiological evaluations in which the unit of analysis is populations, or groups of people, rather than individuals. Example: Is the prevalence of dental caries lower in fluoridated areas?
66
What is an ecological fallacy?
It is a relationship between variables based on group characteristics is no necessarily reproduced between similar variables based on individual characteristics
67
What is a random error?
It is an error that occurs because the estimates we produce are based on samples and samples may not accurately reflect what is really going on in the population at large. This can be reduced by increasing the sample size.
68
What is a systematic error?
It relates to the way we conduct studies. It cannot be reduced by increasing sample size.
69
What is a confounding bias?
Confounding bias occurs when all or part of the apparent association between the exposure and the outcome is in fact accounted for by other variables that affect the outcome and are associated with the exposure. Example: higher coffee consumption results in higher rates of perio? No. Coffee consumption is caused by smoking just like perio!
70
What is non-differential misclassification of participants?
It is a misclassification that occurs if there is equal misclassification of exposure between subjects that have or do not have the health outcome. E.g.: Many studies ask if a patient has "ever used" a particular medications. As this question covers an extremely large time span, medication use might get erroneously linked to some disease.
71
In what ways can we avoid information bias?
1. Use control groups 2. Use questionnaires 3. Use self-administered questionnaire instead of an interviewer 4. If possible assess past exposure from biomarkers
72
What is a random error?
Random error occurs because the estimates we produce are on samples, and samples may not accurately reflect what is really going on in the population.
73
What are the two main factors that drive random error?
1. Sample size 2. Variability in the population
74
How can we measure and account for random error?
Using a confidence interval
75
What is a systematic review?
They are a way of reviewing all the data and results from studies about a specific question in a standardized systematic way
76
What is the benefit of systematic reviews?
By collating the evidence from a multitude of studies, systematic reviews are able to generate a more comprehensive and trustworthy picture of the topic than being studied than is possible from individual studies
77
What are the 9 steps of systematic reviews?
1. Formulating a well-defined question – PICO framework 2. Defining the eligibility criteria 3. Registering the protocol for a systematic review 4. Identifyin the evidence 5. Screening 6. Data extraction 7. Quality assessment 8. Data synthesis 9. Presenting the results

UoA BDS 2 Sem 1 (18 decks)

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