5 Flashcards
descriptive epidemiology
Describes the problem
trends / prevalence
- global
- UK / Scotland
analytical epidemiology
- Analyses the risk factors
- biomedical -> social determinants
epidemiology
is the study of the distribution and determinants of diseases in populations
distruibution
burden
widespread
determinants
cause or risk factor
population
groups of indiviudals geographic/ area/ community of interest
what determines population size?
births, deaths, inward and outward migration determines population size
what makes up a populations demographics?
- Births
- deaths
- age-structure
- gender
- migration
counts
number of people affected by a particular condition (at a particular time, and area)
limited – need denominator
- i.e. how many possibly could be affected
monitor changes over time, between groups and populations
prevalence
is the proportion (%) of population with a disease at any given point (point prevalence) or period (period prevalence in time)
diseases quite stable and chronic e.g. caries, diabetes
- not necessarily cancer – there is more new cases which is incidence
incidence
is the number of new cases of a disease in a defined population over a defined period of time (rate)
divide count by population to get rate over a time period
standardised data
takes into account population age-structure
needed to have a fair comparison
how many people are affected by oral diseases worldwide?
estimated 3.58 billion of 7 billion people total
what disease is the most prevalent of 328 conditions that were assessed in a study?
caries of the permanent teeth
how many people suffer from caries globally?
estimated 2.4 billion suffer caries of the permanent teeth
486 million children suffer caries of primary teeth
3 ways to measure and record dental caries
- DMF/dmf index
- ICDAS International Caries Detection and Assessment System
- Significant Caries Index
DMF/dmf index
used to measure and record dental caries
number of decayed, missing, filled teeth (or surfaces)
ICDAS International Caries Detection and Assessment System
used to measure and record dental caries
restorative status and caries status scores
- enamel level decay and dentine level decay
Significant Caries Index
used to measure and record dental caries
takes into account skewed distribution of caries in population
e.g. tenth with the most decay has more than one decayed surface
what has been the main driver in improvement in dental caries incidences since the 70s?
fluoride toothpaste use
but complex range of factors (inc. public awareness)
3 strategies for preventing cares in populations
- High risk individual approach (clinical risk assessment)
- Targeted population approach (targeting on areas of deprivation / communities)
- Whole population approach (universal ie / eg. a founding principle of the NHS)
what is a proportionate-universal approach?
universal Vs targeted
- high deprivation needs more effort to improve than lower deprivation
- shifting the whole population into a lower risk category benefits more individuals than shifting high risk individuals into a lower risk category
e.g. Childsmile levels
3 strategies for delivering fluordie
toothpaste
water fluoridation
community fluoride schemes
upstream actions to help improve oral health inequalities
socioeconomic and political context (structure and systems)
- macroeconomic policies
- social & welfare policies
- food policies
- education policies
- health system & policies
midstream actions to help improve oral health inequalities
community context
- community assets and workforce
- schools and nurseries
- voluntary/NGO sector
- social and physical environment
downstream actions to help improve oral health inequalities
behaviour and biological factors
- age, biolfilm, behaviours (diet, toothbrushing, parenting)
Physiological factors
- stress
- perceived control
- social support
health services
- quality of care
childsmile health improvement approaches are….
- Theory-based
- Evidence-based
- Common risk factor approach
- Community engagement
- Multi-agency working
- Proportionate universalism
when was Childsmile incorproated into NHS primary care payment system?
2011
Childsmile oral health improvement advice
- Demonstrate and observe hands-on brushing instruction
- Tailored advice on diet and nutrition
- Action plan
Childsmile fluoride varnish (2-5 years)
for children from 2 years apply varnish twice a year
additional 2 times a yer in nursery/primary schools
Childsmile - changed dental contract (statement of renumeration)
change in payment for dentists
got prevention items added
