Dental Public Health Flashcards
Define risk factor
A characteristic that has been directly shown to cause disease (e.g. sugar and dental decay, smoking and lung cancer)
Causal
Presence does not mean you WILL get a disease/a particular outcome, but the factor is CAUSALLY related
Define risk indicator
The behavioural and socioeconomic characteristics that are associated with disease but are not considered to cause the disease
(e.g. caries experience in the deciduous dentition, socioeconomic status and cancer).
Association – may be complex interactions with confounding factors (e.g ice cream and drowning)
Doesn’t mean they are not useful
Risk factor or risk indicator?
The presence of dental caries is seen in people who have a high frequency of sugar in their diet.
Frequent sugar intake a risk factor for dental caries
Risk factor or risk indicator?
The prevalence of periodontal disease is higher in the older generation than the younger generation.
Age is a risk indicator of periodontal disease
Risk factor or risk indicator?
The presence of dental caries is seen in children who have siblings who also have high caries rates.
Having siblings with a high caries rate is a risk indicator of having high caries rate
Risk factor or risk indicator?
The presence of dental erosion is seen in people with a high acid intake.
Acid intake a risk factor for dental erosion
Recall the Bradford Hill Criteria (9 points)
Some Canadians Say That Buying Big Cars Excites Americans:
- Strength (effect size): A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal
- Consistency (reproducibility): Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
- Specificity: Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship.
- Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
- Biological gradient (dose-response relationship): Greater exposure should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence.
- Biological plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge).
- Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that “… lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations”.
- Experiment:“Occasionally it is possible to appeal to experimental evidence”.
- Analogy: The use of analogies or similarities between the observed association and any other associations.
Define prevention
Actions aimed at eradicating, eliminating, or minimising the impact of disease and disability, or if none is feasible, retarding the progress of disease and disability
Define index and give 5 examples used in dentistry
An index is an instrument that enables the quantity of a disease or state to be measured
Examples:
- D3MFT/d3mft
- BPE
- IOTN
- Developmental defects in enamel (DDE)
- Thylstrup Fejekov index (fluorosis)
List 7 properties of an ideal index
Ideal index:
- Simple
- Objective
- Valid
- Reliable
- Quantifiable
- Sensitive
- Acceptable - volunteer and user
Recall the 3 levels of prevention
- Primary prevention - preventing disease initiation (e.g. immunisation)
Secondary prevention - identifying disease early and impeding progression and recurrence (e.g. screening)
- Tertiary prevention - reduce onset or impact of complications (e.g. rehabilitation)
What is screening?
National Screening Committee:
Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition.
They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.
A screening test is not intended to be diagnostic
It is to interrupt the natural history of a disease at its asymptomatic stage when it is treatable and progression can be halted
Based on the principle that there is a detectable preclinical phase or latent phase
Early detection and treatment of asymptomatic disease must offer some benefit in terms of reducing morbidity and mortality over later treatment
List 7 properties of a screening test
7 properties of a screening test:
- Cheap
- Easy to use
- Easy to interpret
- Safe
- Acceptable
- Reliable
- Valid
Define test sensitivity
Sensitivity – the ability of the test to identify those with the disease
What does high sensitivity mean?
The ability of the test to identify people with the disease
TP / (TP + FN) = N of people with the disease who test positive
We won’t miss many cases
However, this increases the chance of getting a false positive result
What does high specificity mean?
The ability of the test to identify people without the disease
TN / (TN + FP) = N of people without the disease who test negative
We won’t put too many people through unnecessary further tests and/or treatment
However, this increases the chance of getting a false negative result
What type of screening programme does this describe?
Large scale screening of population groups
Usually by invitation
Mass (population) screening
What type of screening programme does this describe?
Targeted screening of high-risk groups
Selective screening
What type of screening programme does this describe?
Examining individuals when they attend for some other, often unrelated, purpose
Opportunistic screening
List 10 important components of a screening programme
Important components of a screening programme:
- Test
- People to take the test
- Register to invite participants
- Infrastructure to invite (and re-invite) participants
- People and infrastructure to read the test
- People to record the test finding
- People and infrastructure to take and read further tests
- People and infrastructure to treat
- Support mechanisms
- Quality assurance mechanisms
List 4 advantages a screening programme
Screen programme advantages:
- Improved prognosis for some cases
- Less radical treatment which cures some early cases
- Resource savings
- Reassurance for those with negative test results
List 6 disadvantages of a screening programme
Screen programme disadvantages:
- Longer morbidity for cases whose prognosis is unaltered
- Overtreatment of questionable abnormalities
- Resource costs
- False reassurance for those with false-negative results
- Anxiety and sometimes morbidity for those with false positive results
- Hazard of screening test itself
List 10 criteria for a screening programme
Screening programme criteria
- The condition being screened for should be an important health problem
- The natural history of the condition should be well understood
- There should be a detectable early stage
- Treatment at an early stage should be of more benefit than at a later stage
- A suitable test should be devised for the early stage
- The test should be acceptable
- Intervals for repeating the test should be determined
- Adequate health service provision should be made for the extra clinical workload resulting from screening
- The risks, both physical and psychological, should be less than the benefits
- The costs should be balanced against the benefits
Based on screening programme criteria, should we have oral cancer screening?
20 criteria for screening programme (as per the up-to-date criteria; PHE, 2015).
Oral cancer meets many criteria
- Dentists are generally good at identifiying red and white patches (high sensitivity)
But lack of knowledge around:
- Which lesions will become cancerous (low specificity)
- A reliable test suitable for use in UK primary dental care
Should dentists be screening for diabetes?
No guidelines for this at present
Research in India and USA suggesting dentists can screen for type 2 diabetes
Opportunistic – use of blood from mouth or even finger prick test.
In this country more about other oral signs of diabetes (dry mouth, number of carious teeth, number of deep pockets, basic perio examination, denture stomatitis, angular cheilitis, geographic tongue, altered taste) in combination with a risk questionnaire looking at demographics and family history filled in prior to exam
Define epistemology
Epistemology - Greek epistēmē ‘knowledge’, from epistasthai ‘know, know how to do’.
‘The study of knowledge and justified belief.
What makes justified beliefs justified?
Is justification internal or external to one’s own mind?’
In other words, what is the source of your beliefs?
Would you accept that eating a lot of sugar causes dental caries? Why?
Define ontology
Ontology - modern Latin ontologia, from Greek ōn, ont- ‘being’ + -logy.
Ontology is a system of belief that reflects an interpretation by an individual about what constitutes a fact.
In other words, ontology is associated with a central question of whether social entities should be perceived as objective or subjective.
So, for your topic, what will you accept as a fact and from which source(s)?
Recall the hierarchy of quantitative research (7 points)
Levels I-IV
Recall the hierarchy of qualitative research (4 points)
Define inequality
The condition of being unequal
Define inequity
Injustice
Unfairness
Define health inequality
A health inequality is a descriptive term that refers to a variation in health status across groups of individuals within a population or differences between populations.
Tends to compare populations or communities rather than individuals.
What is the Marmot Review?
Marmot Review report - ‘Fair Society, Healthy Lives’
- Report produced in 2010 work started in 2008
- Chaired by Michael Marmot
- Strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities
- Focus on evidence base
- People taking control of their own lives
Recall the 6 policy objective of the Marmot Review
Martmot Review recommendations:
6 policy objectives:
- Giving every child the best start in life
- Enabling all children, young people and adults to maximize their capabilities and have control over their lives
- Creating fair employment and good work for all
- Ensuring a healthy standard of living for all
- Creating and developing sustainable places and communities
- Strengthening the role and impact of ill-health prevention
List 4 common methods of measuring social disadvantage
Most commonly used methods of measuring social disadvantage:
- Jarman Underprivileged Area Score
- The Townsend Index
- The Carstairs Index
- Index of Multiple Deprivation
Descrive English Indices of Multiple Deprivation (5 points)
English Indices of Multiple Deprivation:
- Measures relative deprivation not affluence
- Range of measures
- 7 domains
- About populations not individuals
- Small level data 32, 844 neighbourhoods
Recall the 5 levels of the Registrar General’s classification (1911).
Social class I-V
Registrar General’s classification (1911):
I. Professional
II. Intermediate
III N. Skilled non-manual
III M. Skilled manual
IV. Semi-skilled manual
V. Unskilled manual
Define social class
A status hierarchy in which individuals and groups are classified on the basis of esteem and prestige acquired mainly through economic success and accumulation of wealth.
Social class may also refer to any particular level in such a hierarchy.
Businessdictionary.com
http://www.businessdictionary.com/definition/social-class.html
Recall the determinants of health (5 levels)
List 3 possible explanations for health inequalities
Possible explanations for health inequalities:
- Artefact
- Selection – people with poor health slide down the social scale
- Lifestyle
List 4 possible explanations for deprivation
Possible explanations for deprivation:
- Linked to education levels which reflects through to health behaviour
- Lifestyle factors
- Dietary habits
- Possible barriers to access to treatment and health services: Language, cultural, under-provided community
List 6 possible explanations for health inequalities among those people with learning disabilities
6 possible explanations for health inequalities for those people with learning disabilities
- May be dependant on others for help with health care
- May be dependant on others for health care visits
- May have problems accessing health care
- May not be able to communicate effectively
- Health may be low priority
- Material barriers
Define health promotion
Health promotion
‘It is the process of enabling people to increase control over and improve their health’
List the fundamental conditions and resources for health, as stated in the Ottawa Charter.
Prerequisites for health (Ottawa charter)
The fundamental conditions and resources for health are:
- peace,
- shelter,
- education,
- food,
- income,
- a stable eco-system,
- sustainable resources,
- social justice, and equity.
List 5 action areas for health promotion identified in the Ottawa charter (1986)
5 action areas for health promotion: Batman Can Save Dying Robin
- Building healthy public policy
- Creating supportive environments
- Strengthening community action
- Developing personal skills
- Re-orientating health services
Recall the tannahill model of health promotion (3 points)
Tannahill model of health promotion:
- Health education
- Health protection
- Prevention
Define health education
A communication activity which provides the individual, the family, the community with the information and skills with which to make informed decisions
e.g. health education in schools, media campaigns.
Define disease/ill health prevention
The activities and services which contribute to the reduction of the risk or occurrence of a disease, injury or illness
e.g. includes immunisation services, family planning and screening with targeting of resources where needed.
Define health protection
Comprises legal or other regulations and policies aimed at the enhancement of health and the improvement of the environment in order to make healthy choices easy choices
e.g. non-smoking policies, food legislation, taxation on goods, seatbelts, alcohol legislation in Scotland.
List and describe 3 dimensions of social class
Dimensions of social class:
Wide-ranging, multi-dimensional concept - the three most significant:
- Economic dimension - measured using indicators such as income, wealth and occupation.
- Political dimension - measured using indicators such as status and power.
- Cultural dimension - measured using indicators such as education level, values, beliefs, lifestyle, norms, consumption patterns, etc.
List 8 variables of the Jarman Deprivation Score (1991)
Jarman Deprivation Score:
- Unemployment - unemployed residents aged 16+ as a proportion of all economically active residents aged 16+.
- Overcrowding - persons in households with 1 and more persons per room as a proportion of all residents in ouseholds.
- Lone pensioners - lone pensioner households as a proportion of all residents in households.
- Single parents - lone ‘parents’ as a proportion of all residents in households.
- Born in New Commonwealth - residents born in the New Commonwealth as a proportion of all residents.
- Children aged under 5 - children aged 0-4 years of age as a proportion of all residents .
- Low social class - persons in households with economically active head of household in socio-economic group 11 (unskilled manual workers) as a proportion of all persons in households.
Recall the 4 variables of the Townsend Index
A measure of material deprivation within a population. The measure incorporates four variables:
- Unemployment (as a percentage of those aged 16 and over who are economically active);
- Non-car ownership (as a percentage of all households);
- Non-home ownership (as a percentage of all households)
- Household overcrowding.
Recall the 7 domains of the Index of multiple deprivation (IMD) score
IMD 7 domains:
- Income
- Employment
- Education
- Health
- Crime
- Barriers to housing and services
- Living environment
