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dph Flashcards

1
Q

define epidemiology

A
  • study of the distribution of (oral) diseases in a population
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2
Q

why is epidemiology important? (3)

A
  • helps population needs assessment to inform PH policies, planning, resource allocation
  • assesses impact of health promotion activities/policies
  • identifies changing patterns and population risk factors
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3
Q

define normative need

A
  • professionally defined health needs
  • assessed with clinical measures (eg indices for national surveys)
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4
Q

define felt/perceived need

A
  • lay person perception of their need, “wants”
  • assessed with self-rated questionnaires
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5
Q

define expressed need

A
  • felt/perceived need translated into action by utilising healthcare services or requesting information
  • “demand”
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6
Q

define comparative need

A
  • need is not evenly distributed among similar groups of people
  • assessed by comparing oral health needs between groups of people
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7
Q

what is an index? (3)

A
  • method of quantifying disease
  • relative numerical value (usually) describing a population on a scale
  • allows comparison with other populations
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8
Q

properties of an ideal index (8)

A
  • objectivity
  • acceptability
  • simplicity
  • amenable to statistical analysis and interpretation
  • reproducibility
  • validity
  • reliability
  • precision
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9
Q

give some examples of indices in oral health (up to 8)

A
  • DMFS/dmfs
  • ICDAS
  • gingival index, plaque index
  • IOTN
  • BEWE
  • BPE or CPI
  • trauma index
  • PUFA
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10
Q

define prevalence (of disease)

A

amount of disease present at a given point in time (often as a percentage)

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11
Q

define incidence (of disease)

A

change in disease in a given period of time (rate)

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12
Q

what are the advantages and limitations of using perceived need?

A

+:
- person-centred, accounts for psychological aspects and QoL
- cheaper, less complicated to assess
-:
- subjective, less reliable than normative need
- influenced by individual’s characteristics

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13
Q

what are the main two types of epidemiological studies?

A

observational and interventional

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14
Q

list different types of observational studies (4)

A
  • ecological
  • cross-sectional
  • case-control
  • longitudinal
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15
Q

list different types of interventional studies (3)

A
  • randomised controlled trials
  • non-randomised controlled trials
  • pre-post study
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16
Q

what is a observational study and its general pros/cons?

A
  • researcher collects information without influencing events
    • = cost-effective, quick, large samples
    • = cannot prove causality
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17
Q

what is a interventional study and its general pros/cons?

A
  • researcher deliberately influences events and investigates the effects of this
    • = can establish causality
    • = more expensive, dropout rate, ethical considerations, not applicable to all populations
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18
Q

what is an ecological study and its specific pros and cons?

A
  • observational study comparing trends in different populations
    • = generate hypothesis, able to compare
    • = no individual data, bias/ecological fallacy, difficult to control for confounders
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19
Q

what is a cross-sectional study and its specific pros and cons?

A
  • observational study where the population is assessed randomly at the same time point (eg ADHS)
    • = individual data and control of confounders, assess multiple outcomes, hypothesis generation
    • = cannot prove temporality or causality
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20
Q

what is a case-control study and its specific pros and cons?

A
  • observational study with pts assigned to case/control groups and matched by potential confounding factors
    • = efficient for rare diseases, individual data
    • = hard to do retrospectively, recall bias, rarely proves temporality
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21
Q

what is a longitudinal study and its specific pros and cons?

A
  • observational study with collection of data at different time points
    • = demonstrates temporality (establish RFs and disease incidence)
    • = long if prospective, may miss some confounders
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22
Q

what is a randomised controlled trial and its specific pros and cons?

A
  • interventional study with homogenous randomly assigned intervention/control groups +/- blinding
    • = causality
    • = may be long, risk of high dropout
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23
Q

what is a non-randomised controlled trial and its main disadvantage?

A
  • weak interventional study with non-random intervention and control groups
  • risks bias as it lacks randomisation
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24
Q

what is a pre-post study and its main disadvantage?

A
  • interventional study assessing a group before and after an intervention
  • any changes in disease outcome cannot fully be attributed to intervention
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25
Q

describe the reasoning behind a pilot study (3)

A
  • tests organisation of a study - identifies problems and adjustment of survey design
  • training and calibration of personnel
  • estimates level of disease and guides sample size
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26
Q

how is our population changing in the UK? (2)

A
  • generally increasing
  • > 65yo age group increasing faster than the rest of the population = aging population
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27
Q

what is the dominant age group in London?

A

16-64yo (working age)

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28
Q

what are the 7 domains of deprivation?

A
  • income
  • employment
  • education
  • health
  • crime
  • barriers to housing and services
  • living environment
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29
Q

define health inequalities

A

systematic, unjust differences in health between people/groups that may be considered unfair

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30
Q

list (categories of) social determinants of health (up to 6)

A
  • economic stability
  • neighbourhood and surroundings
  • education
  • food
  • community and social context
  • healthcare system
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31
Q

describe the social gradient of health (3)

A
  • lower socioeconomic position often leads to worse health
  • aggregation of unhealthy behaviours is socially patterned - lower SE classes more likely to engage in health-risk behaviours than health-promoting ones
  • often due to factors outside of individual’s control (social determinants) - not everyone has the same opportunities to live a healthy lifestyle
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32
Q

define health promotion (3)

A
  • positive concept
  • the process of enabling people to increase control over the determinants of health and thereby improve their health
  • making healthier choices easier and unhealthy choices more difficult
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33
Q

what are the basic requisites for health according to the Ottawa Charter? (8)

A
  • peace
  • shelter
  • education
  • food
  • income
  • stable eco-system
  • sustainable resources
  • social justice and equity
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34
Q

what is the Ottawa Charter for Health Promotion?

A
  • WHO 1986 consensus statement
  • identifies 5 components of health promotion action and basic prerequisites for health
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35
Q

what are the 5 components/action areas for public health? (Ottawa charter)

A
  • build healthy public policy
  • create supportive environments for health
  • strengthen community action for health (empowerment)
  • develop personal skills and social development
  • reorient health services
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36
Q

what is meant by “healthy public policy” and give examples (Ottawa Charter)

A
  • putting health on the agency for policy makers in all sectors and at all levels
  • investing in public transportation
  • tobacco taxation
  • age restrictions on certain products
  • advertisement and product placement restrictions
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37
Q

give examples of creating supportive environments for health (Ottawa Charter) (4)

A
  • availability of health-promoting resources at work/uni/school - eg gyms, cooking classes
  • playground and sport safety
  • addressing pollution (eg ULEZ)
  • no smoking areas
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38
Q

what are some issues with using health education/information to try and create behaviour change? (5)

A
  • assumes that having knowledge will lead to attitude/behaviour changes
  • “top-down” technique
  • paternalistic and prescriptive, often using threats and fear arousal
  • individualistic and victim blaming - ignoring the broader social context
  • assumes homogeneity among receivers - it is most effective on the most educated and economically advantaged
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39
Q

what are some barriers to behaviour change for health promotion? (7)

A
  • media advertisement (false advertising, unhealthy products)
  • social norms and peer pressure
  • financial factors (affordability)
  • availability and accessibility of healthy vs unhealthy choices
  • public policy
  • financial interest of industries
  • science manipulation by industries
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40
Q

is oral health education effective? (4)

A
  • increases knowledge but uncertain effects on behaviour/health
  • does not produce long term changes when used alone
  • most effective on those who have the resources = may increase health inequality
  • little evidence on cost-effectiveness
    (But should still be done by HCPs)
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41
Q

what are downstream PH interventions? (what, who, where)

A
  • treatments, prevention, health education for those ALREADY experiencing some disease/disability (small segment of population)
  • done in clinic
  • consumes most resources
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42
Q

what are midstream PH interventions? (what, who, examples)

A
  • preventive interventions targeting at-risk populations (but not all in the group will be at risk)
  • community level
  • eg:
    – community development
    – training other professional groups (carers, teachers)
    – media campaigns
    – school dental health education, FV, supervised toothbrushing
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43
Q

what are upstream PH interventions? (what, how, examples)

A
  • healthy public policy interventions (governmental, institutional, organisational) directed at ENTIRE populations
  • needs adequate support through tax structures, legal constraints and reimbursement mechanisms
  • eg:
    – sugar, tobacco taxation
    – age restrictions
    – national policy initiatives
    – legislation/regulation
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44
Q

define health advocacy

A

-informing and educating senior government, community leaders (decision-makers) about specific issues
- setting the agenda to obtain political decisions that improve the health of the population

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45
Q

how can dentists help with upstream and midstream interventions? (4)

A

(health advocacy)
- inform and educate decision-makers about specific oral health-related issues and how to minimise the root causes
- assess health determinants and community health needs and marshal resources/policy to respond to them (make healthy choices easier)
- supporting skills training of other professionals
- establish an evidence base on cost-effectiveness of interventions to support financing decisions

46
Q

what kinds of groups may be targeted by community-based programmes? (4)

A
  • prenatal, pregnant
  • children, young adults or older people (age)
  • culturally/linguistically diverse backgrounds
  • special care (homeless, LDs, mental health)
47
Q

why do we need to understand the local community (eg culture, religion, etc) for implementing community-based programmes? (2)

A
  • to ensure the programmes are culturally sensitive
  • improves acceptability and accessibility for community
48
Q

define evaluation (of oral health promotion intervention)

A

“the process of determining whether programmes or certain aspects of programmes are appropriate, adequate, effective, efficient for the purpose of the programme”

49
Q

what are the three different types of evaluation?

A
  • process evaluation
  • outcome evaluation
  • economic evaluation
50
Q

describe process evaluation (what, when, why)

A
  • assesses how well the programme is working:
    – extent to which it is being implemented
    – accessible and acceptable to target population?
  • starts as soon as programme is implemented and throughout operation
    • = gives early warning for any issues
51
Q

describe outcome evaluation (what, when, why)

A
  • measures effect of programme on target population:
    – progress in outcomes the programme addresses
    – target population behaviours
  • starts after programme has made contact with at least one person/group in target pop
    • = shows if programme is meeting objectives
52
Q

describe economic evaluation (what, when)

A
  • assesses value gained from vs costs of implementing an intervention (cost analysis)
    – resources used and costs
    – outcomes
  • at beginning and during programme operation
53
Q

give some examples of quantitative evaluation methods (3)

A
  • surveys and questionnaires
  • secondary data analysis
  • economic evaluation
54
Q

give some examples of qualitative evaluation methods (3)

A
  • interviews
  • focus groups
  • scenarios
55
Q

what does ROI mean?

A

return on investment - measure of cost-effectiveness of interventions

56
Q

what are the main principles of the NHS? (7)

A
  • comprehensive service available to all
  • access based on clinical need (not ability to pay)
  • high standards of excellence and professionalism
  • reflect needs and preferences of pt/family/carer
  • partnership working with other organisations/communities for pt interests
  • cost-effective and fair use of resources
  • accountable to public communities and pts
57
Q

what are the different types of dental services in England? (7)

A
  • general dental services
  • community dental services
  • out of hours, urgent care dental services
  • hospital dental services
  • domiciliary care
  • prison dentistry
  • private dental care
58
Q

where does most of the funding of dental services come from?

A
  • taxation mainly
  • NHS pt charges
59
Q

what is the dental quality and outcomes framework (DQOF)?

A
  • measures quality of care provided
  • 3 domains = clinical effectiveness, pt experience, safety
  • part of NHS contract value with a practice
60
Q

according to studies, why should we improve access to dental care? (2)

A
  • at any age, routine attenders have better-than-average oral health and lower DMFS scores
  • the longer routine attendance was maintained, the stronger the effect
61
Q

define access (to dental care)

A
  • timely use of personal health services to achieve the best outcomes
  • the “fit” between the patient and healthcare system
62
Q

what are the 5As affecting access to care?

A
  • available (geographical)
  • accessible (travel and physical)
  • acceptable (welcoming, quality, language, etc)
  • affordable (direct and indirect costs)
  • accommodating (flexible opening hours)
63
Q

briefly describe the access model (3)

A
  • environmental factors (availability, SE, etc) determine population characteristics (knowledge, resources and needs)
  • population characteristics affect utilisation of health services, affecting health outcomes and satisfaction
  • positive feedback loop - if pts are satisfied, they’ll return for further care
64
Q

what is the inverse care law?

A

those who most need care are less likely to utilise care services

65
Q

give some barriers to accessing dental care in the UK (9)

A
  • difficulty getting an NHS appointment
  • cost (varies by country)
  • anxiety
  • lack of perceived need
  • surgery/visit features and dentist characteristics (= satisfaction)
  • availability
  • knowledge of NHS services
  • MH - LDs, mobility limitations
  • others (transport, etc)
66
Q

how can we minimise barriers to access of dental care? (5)

A
  • address broader social determinants of health (reduce poverty, income inequalities)
  • improve education = increased average income and awareness
  • exempt status (financial)
  • improve information available with incentives to attend
  • outreach dental care - mobile caravans, domiciliary services, community initiatives
67
Q

what are health systems? (2)

A
  • all organisations/people/actions whose primary intent is to promote, restore or maintain health
  • efforts influencing determinants of health and direct health-improving activities
68
Q

what are the universal laws of healthcare systems (Cheng)? (3)

A
  • no matter how good the healthcare in a particular country, people will complain about it
  • no matter how much is spent on healthcare, doctors and hospitals will argue that it is not enough
  • the last reform always failed (always need a new reform)
    (no such thing as a perfect healthcare system)
69
Q

what is universal health coverage?

A

everyone, everywhere, able to access an essential package of quality health services without facing financial hardship as a result

70
Q

what are the 3 main dimensions of universal health coverage?

A
  • population = who is covered?
  • services = which interventions are included?
  • financial protection = what proportion of costs are covered by pooled funds?
71
Q

what are 3 challenges to universal health coverage?

A
  • availability of resources (not all technologies and interventions are available nationally and internationally) - what counts as essential?
  • over-reliance on direct payments at the time people need care (can lead to financial hardship) - when should payments be made?
  • inefficient and inequitable use of resources (20-40% wasted)
72
Q

what is the HRH: Workforce Strategy 2030?

A
  • global strategy aiming to progress towards universal health coverage and the UN sustainable development goals
  • by ensuring equitable access to health workers within strengthened health systems
73
Q

what is meant by “making every contact count”?

A
  • every time a HCP contacts a patient, it is an opportunity for health promotion and prevention, lifestyle improvement and reduction in health inequalities
74
Q

what are the steps of the rational planning model? (6)

A

1 identification of need
2 options
3 decisions of policy
4 identification of resources
5 implementation
6 evaluation
(and repeat)

75
Q

what information is needed for planning health services? (4)

A
  • population profile/demographics
  • disease levels (epidemiological data)
  • public concerns (priorities, demand)
  • existing service provision/use
76
Q

what are some barriers to providing fluoridated water nationally? (3)

A
  • safety concerns, risks of toxicity (although only 0.7ppm)
  • anti-fluoride associations
  • political will
77
Q

define proportionate universalism

A

resourcing and delivering of universal services at a scale and intensity proportionate to the degree of need

78
Q

pros and cons of upstream intervention

A

+ = addresses social determinants of health, higher ROI
- = influenced by political will, can enhance health inequalities

79
Q

pros and cons of midstream intervention

A

+ = more cost-effective than upstream, better uptake/targeted, fewer political issues
- = difficult to set target population, evidence base needed

80
Q

pros and cons of downstream intervention

A

+ = individualised
- = very few targeted, low ROI, patient cost

81
Q

describe trends in service utilisation by age and gender (4)

A
  • ADHS 2009 = 3/4 report attending every 2 years, increases with age then decreases
  • CDHS = 1/3 attend before 2yo (constant)
  • females more likely to be regular attenders and attend for preventative care
  • males more symptomatic
82
Q

describe trends in service utilisation by ethnicity (3)

A
  • inequality in use and for specific procedures (tend to favour extractions)
  • BAME visits more likely to be symptomatic
  • ADHS 2009 = all ethnic minorities less likely to visit regularly
83
Q

describe trends in service utilisation by SE class (2)

A
  • routine and manual occupation households less likely to be regular attenders, more likely to be symptomatic
  • middle classes visit earlier and more frequently for preventative tx
84
Q

describe general trends in caries epidemiology (and DBOH-specific) (up to 9)

A
  • decline in prevalence and severity over past 30-40years in all ages
  • most have low/no carious cavities, small percentage have higher levels
  • progression of early lesions is less frequent and slower
  • lesions are generally smaller and cavitation tends to occur at a later age
  • more common among the least affluent and least educated
  • more common in Asian children in England (diet?)
  • most lesions are pit and fissure lesions rather than smooth surfaces
  • most caries occurs in adults now instead of children

DBOH = root caries increases with age

85
Q

upstream interventions for caries (4)

A
  • water fluoridation (also salt fluoridation in Europe, milk fluoridation in Blackpool)
  • public health policies - sugar tax
  • nutritional guidelines emphasising low sugar intake, balanced diet
  • education and awareness campaigns on OH and dental checkups
86
Q

midstream interventions for caries (4)

A
  • school-based programmes - FV, toothbrushing lessons, OHI
  • affordable dental care - subsidised preventive and restorative tx for low-income families
  • community oral health promotion programmes - free dental checkups, workshops
  • targeted health communication
87
Q

downstream interventions for caries (5)

A
  • OHI
  • FV
  • fissure sealants
  • regular dental check ups
  • diet advice and risk factor discussion
88
Q

what conditions is excess sugar a risk factor for? (5)

A
  • obesity
  • diabetes
  • CVD
  • cancers
  • caries
89
Q

describe epidemiological trends relating to sugar (and DBOH-specific) (5)

A
  • 1/8 of adults achieve 5% sugar of dietary energy recommendation
  • highest sugar intake in children (4-18yo)
  • sugar-sweetened drinks providing 30% of free sugars in 11-18yo

DBOH:
- intake of free sugars decreasing over time in children but still above recommendations
- fewer children and young people report drinking sugar-sweetened beverages, and those drinking them are consuming less

90
Q

upstream interventions for diet and sugar intake (5)

A
  • food policies and legislation - decrease fat/sugar/salt in processed food, mandatory food labelling
  • agricultural subsidies towards fruits and vegetables - more affordable and accessible than unhealthy food options
  • urban planning - easy access to supermarkets, farmers’ markets
  • taxation and pricing policies - sugar, salt, subsidise healthier options
  • labelling and menu board information in restaurants and on food
91
Q

midstream interventions for diet and sugar intake (5)

A
  • food banks
  • free school meals for 20% most deprived individuals
  • community-led gardens and cooking classes
  • health promotion campaigns for healthy eating
  • community support group for those making dietary changes
92
Q

downstream interventions for diet and sugar intake (4)

A
  • diet advice and pt education
  • behaviour change programmes
  • mobile health applications (trackers, recipes, tips)
  • pt education materials (brochures, flyers, online resources)
93
Q

describe epidemiological trends relating to oral cancer (and DBOH-specific) (5)

A
  • risk increases with age
  • RFs = low SE background, alcohol, poor diet, pollution, genetics, (chewing) tobacco

DBOH:
- Scotland - lower SE groups 3x greater risk
- SE Asian groups in London have higher risk
- oropharyngeal cancer >3x higher in men

94
Q

upstream interventions for oral cancer (5)

A
  • tobacco control policies - taxation, advertising bans, smoke-free areas, age restrictions
  • alcohol regulation - taxation, minimum legal age restrictions, limits on hours of sale
  • HPV vaccination to vaccinate everyone (not current)
  • PH campaigns to raise awareness on risk factors
  • nutritional policies - promoting good balanced diet, 5/day
95
Q

midstream interventions for oral cancer (4)

A
  • screening programmes - at risk populations
  • HPV vaccinations currently in schools
  • community outreach programmes - education on RFs, importance of early detection
  • workplace health initiatives, esp where workers are exposed to carcinogens
96
Q

downstream interventions for oral cancer (3)

A
  • smoking cessation advice/referral (VBA)
  • advising alcohol reduction
  • discuss risk factors, pt education
97
Q

what conditions is tobacco use a risk factor for? (4)

A
  • lung cancer and other cancers
  • respiratory disease
  • heart disease
  • periodontal disease and peri-implantitis
98
Q

describe epidemiological trends relating to tobacco use (and DBOH-specific) (3)

A
  • most take up smoking in teens or early twenties
  • decreasing in the UK but still high, more men than women
  • DBOH - 2.5x higher prevalence in routine and manual occupations
99
Q

upstream interventions for tobacco specifically (3)

A
  • tobacco control policies - taxation, advertising bans, smoke-free areas, age restrictions
  • plain packaging +/or health warnings on packaging
  • agricultural subsidies for alternative crops and farmer education
100
Q

midstream interventions for tobacco specifically (4)

A
  • campaigns - educating on risk, Stoptober
  • school-based programmes
  • workplace smoking cessation programmes - counselling, medications
  • community-led initiatives and support groups
101
Q

downstream interventions for tobacco specifically (4)

A
  • smoking/paan cessation advice/referral (VBA)
  • pt education, discussing RFs
  • GP referrals
  • digital health interventions (apps, texts, online resources)
102
Q

what conditions is alcohol consumption a risk factor for? (4)

A
  • hypertension
  • liver cirrhosis
  • CVD
  • cancers
    (social problems - family violence, crime, trauma)
103
Q

describe epidemiological trends relating to alcohol consumption (and DBOH-specific) (3)

A
  • 2x males than females drank >14u/wk
  • managerial and professional occupations most likely to drink alcohol
  • DBOH = adults living in least deprived areas more likely to drink >14 units in a normal week
104
Q

upstream interventions for alcohol specifically (4)

A
  • pricing policies - minimum unit pricing, taxation
  • regulation of availability - restricting to certain hours
  • marketing restrictions - advertising, sponsorships, promotions
  • legal drinking age law
105
Q

midstream interventions for alcohol specifically (5)

A
  • education and awareness campaigns, dry January
  • school and workplace programmes for prevention and support
  • community-led initiatives
  • offer screening and brief interventions for risky alcohol use in primary care settings
  • training other HCPs on recognising alcohol misuse
106
Q

downstream interventions for alcohol specifically (4)

A
  • referral to rehabilitation services
  • behaviour change methods with patients
  • mental health support referral if appropriate
  • pt education, discussing RFs
107
Q

describe epidemiological trends relating to the aging population (and DBOH-specific) (3)

A
  • the number of >65yo is increasing faster than the rest of the population
  • people are retaining more of their natural teeth and for longer
  • DBOH - root caries increases with age and amongst independently-living older adults
108
Q

upstream interventions relating to health of older and elderly people (3)

A
  • public health policies - access to dental care, inc those in long-term care facilities (insurance coverage expansion, funding)
  • community water fluoridation to help reduce caries incidence
  • free dental check ups (legislation)
109
Q

midstream interventions relating to health of older and elderly people (4)

A
  • regular oral health assessments in community settings - eg care homes, disabilities or severe illness
  • mobile dental services
  • interprofessional collaboration - dental and general health
  • education for caregivers and families
110
Q

downstream interventions relating to health of older and elderly people (2)

A
  • regular dental check up - xerostomia, root caries, periodontal
  • pt education and discussing RFs

other bds5 things (5 decks)

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