DDPH Flashcards
What does proportionate universalism mean? What review highlighted this?
All pts should be given the benefit of advice and support to change behaviour regarding their general and dental health but with a scale and intensity that is proportionate to the level of disadvantage faced
The Marmot review
What does grade I evidence mean? DBOH
Strongest, from at least 1 systematic review of multiple well designed RCTs
What does grade II evidence mean? DBOH
Strong evidence from at least 1 properly designed RCT of appropriate size
What does grade III evidence mean? DBOH
Evidence from well designed trails without randomisation - cohort, time series etc
What does grade IV evidence mean? DBOH
Evidence from well designed non experimental studies from more than 1 centre or research group
What does grade V evidence mean? DBOH
Opinions of respected authorities based on clinical evidence or descriptive studies
What groups in DBOH are referred to as those giving concern to their dentist?
- Likely to develop caries
- Special needs
- Dry mouth
- Obvious current active caries
- Ortho appliances
- Other predisposing factors
What is the reference in the key systematic review (2012) to demonstrate that oral health professionals increased quit rates within the dental setting?
West and Brown
What is the name of a quick screening tool for alcohol identification/misuse?
AUDIT-C
What is this study design:
Well participants are chosen on the basis of a different exposure. Wait to see if they develop disease.
Cohort study
What is this study design:
A representative sample of people are surveyed to answer a question
Cross-sectional survey design
What is this study design:
Participants randomly allocated to different interventions then followed and outcomes assessed
Randomised Control Trial
What is this study design:
People with a disease are matched to those without it and earlier exposure to different environmental factors compared
Case-control study
What is this study design:
Description of the MH of one or more patients
Case study/ series
What is this study design:
Critical assessment, evaluation and synthesis of multiple high quality research studies to answer a single specific question
Systematic review
Rank the study designs from highest quality to lowest quality
1) Systematic reviews and meta analysis of RCTs
2) RCTs
3) Cohort studies
4) Case-control studies
5) Cross-sectional studies/surveys
6) Case reports
7) Mechanistic studies
8) Expert opinions and editorials
When was Oral Health Surveillance established?
60s
What is needs assessment and what are its risks?
Local data for local services
Small scale surveys so poor sampling and no wider comparison group
What is used for policy advice?
What is used for research into disease?
Cross sectional data but risk of misinterpretation
Comprehensive data set but expensive
When was the last adult dental health survey?
How many households and what was the response rate?
2009
13,400 and 60% response
What are the issues with using the following sampling frameworks
a) Postcode address files
b) GP lists
c) Dentist lists
a) From census, need consent
b) wont show where they live
c) do not use due to dental access/ not registered
What do you need to have a good sample?
- Inclusion and exclusion criteria
- Meaningful response rate
- Big enough sample to increase confidence
- Know what proportion of those sampled agreed to take part
- Stratified
Where is the Health Promotion emblem from?
The Ottowa Charter 1986
What is health promotion?
Starts with health, seeks to develop community and individual measure to help develop lifestyles that can maintain and enhance state of wellbeing
What is disease prevention?
Begins with threat to health. Disease or environmental hazard and seeks to protect as many people form the harmful consequences of that threat
What is upstream prevention and what is downstream prevention?
Upstream = national policy, legislation Downstream = chairside health education, schools, clinical prevention
What is the Tannahill Model of Health Promotion?
- Prevention
- Health protection
- Health education
What is primary prevention?
- Attempt to prevent onset of disease
- Carried out on healthy populations
- Health promotion and specific protection
What is secondary prevention?
- Aim to terminate a disease process and prevent complication e.g. WSL and fluoride varnish
- Restorative care - restore tissues to as normal as possible
What is tertiary prevention?
- Replace lost tissues in an attempt to reduce or limit impairment, disability and death
- Reconstructive and rehabilitative
When evaluating oral health interventions what is meant by effectiveness?
Ability of an intervention to meet its intended effect in the real world
When evaluating oral health interventions what is meant by efficacy?
Ability of an intervention to meet its intended effect under optimal conditions ie the ideal world
In disease prevention evaluation, what is meant by considering process measures?
Assess if the intervention has been implemented as planned e.g. levels of pt satisfaction/quality assurance
In disease prevention evaluation, what is meant by considering outcome measures?
Assess the long term effects ie did it achieve its goal
In disease prevention evaluation, what is meant by considering process evaluation?
Intervention acceptability, integrity, quality and reach (include the people we wanted it to)
In disease prevention evaluation, what is meant by considering outcome evaluation?
Were the objectives met, what was achieved, outcome measures appropriate
Why should we challenge the high risk approach with caries prevention?
Majority of new lesions in lower risk >50% in initial DMFS scores of 0
Should be population or directed population approach
Why do diseases fall before medical model intervention?
- Efficacy overplayed, nutrition sanitation and reproduction more important
- Material circumstances/ social circumstance
- Subjective nature of illness
- Ignores other forms of healing
What classification did the CDH survey 2013 use for socioeconomic circumstances?
2011 ONS Output area classification - groups together similar geographic areas according to characteristics common to the population
Statistical neighbours CIPFA - compares local authorities with similar demographic profiles
What classifications are there for social groups?
Registrar Generals Occupational Social Class index 1911 (I-V)
Revised Socioeconomic classification
In what social class is smoking in pregnancy, edentulism and caries experience greater?
Social Class V (unskilled)
What are the 3 ways of measuring deprivation to target regeneration policies to the most deprived areas?
- Jarman Index
- Townsend Index
- Index of Multiple Deprivation (IMD)
Summarise the findings of the Marmot Review (2010)
The lower a person’s socio-economic status the poorer their health is likely to be (die earlier and live with disability longer)
Health inequalities are largely preventable and occur from a complex interaction of many factors e.g. housing income education social isolation disability
