DPH Flashcards
What is epidemiology, and what studies and results need to be (valid etc.)
-studying diseases in populations - the distribution and determinants of disease frequency
-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
Definitions of case study, cross-sectional survey and randomised control trial
Case studies: 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
Cross-sectional Surveys: 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.
Randomised controlled trials: Participants randomly allocated to different interventions to evaluating effectiveness of an intervention. Compare to a control. Cost and compliance issues
Definitions of cohort study, case-control study, and systematic review
Cohort study: 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, looking forward to see if a disease develops. Common diseases for this method.
Case-control studies: Patients with and without a disease, and looking retrospectively back in time to work out what the risk factors and causes could have been. Used for rare diseases. Complicated, time-consuming.
Systematic Reviews: 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. Combines findings to end confusion
Definitions of prevalence, incidence, validity, reliability, sensitive
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 at risk, 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
Acceptable – to patient
Definition of chance, bias, confounding
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.
How many units of alcohol is low, medium and high risk
-Low: < 14 units per week. Spread evenly over 3 days or more.
-Medium: >14 units a week
-High: >35 for women. >50 units for men
Young people should be alcohol-free. Pregnant women (or planning) not to drink at all
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,
How many units in small/ standard/ large glass of wine, bottle of wine, bottle of beer/ cider (330ml), can of beer (440ml), pint of low/ high strength beer, glass of champagne
-small glass= 1.5 units
-standard glass= 2.1
-large glass= 3
-bottle= 10 units
-bottle of beer= 1.7 units
-can of beer= 2.4 units
-pint of lower strength= 2
-pint of higher strength= 3
-champagne=2 units
List upstream and downstream interventions for disease prevention
clinical prevention (eg. fluoride varnish), dental health education (chair side, schools, campaigns), laws and policies (eg. sugar tax), healthy food options in work places, reduced gym prices, bike lanes
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 (age, gender, ethnicity, socio-economic, mobility, disabled) disease prevalence, current services
- Demand= what is asked for (better accessibility, wider range of treatment, better cost)
- Supply= what is provided
Health needs of specific groups: disabled, frail, homeless, travellers, substance misusers
-Disability- poor access, need specialised equipment, compliance and consent
-Frail patients- poor access, 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- high caries risk, chaotic lifestyle means poor attendance, less likely to present in acute pain, may demand opiate based analgesics, methadone (heroine replacement therapy) cariogenic so suggest sugar-free
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
