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BDS2 PMHP > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

epidemiology

A

is the study of populations in order to determine the frequency and distribution of disease.

both disease and health states

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2
Q

frequency of disease

A

burden of disease

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3
Q

what does epidemiology help identigy

A

risk factor for disease and determining optimal treatment approaches to clinical practice and preventative measures

  • Can study risk factors as well as health/disease outcomes
  • Can identify links, association and casualties
  • Development and evaluation of preventative medicine
    Cornerstone of evidence based practice
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4
Q

what is study in epidemiology

A

groups of people not individuals

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5
Q

first reported epidemiological case

A

John Snow and Broad St Pump cholera outbreak 1854

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6
Q

7 major role of epidemiology

A

Monitor infectious and non-infectious diseases
- Communicable and non-communicable diseases

Study natural history of diseases
- Prognosis and sequalae of disease

Investigation of disease risk factors

Health care needs assessment

Development of preventive programmes

Evaluation of interventions

Health Service planning

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7
Q

how are communicable diseases monitored

A

on a weekly basis e.g. flu

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8
Q

what is a consequence of a pandemic of an infectious disease e.g. flu

A

causes a number of deaths in elderly (linked to pneumonia) and additionally impact younger people too e.g. pregnant

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9
Q

how are non-communicable/chronic diseases monitored?

A

on a annual basis

e.g. cancer - incidence and death rates from cancer registries

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10
Q

oral example of self-limiting disease

A

ulcers

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11
Q

oral example of of chronic disease

A

chronic periodontal disease

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12
Q

oral example of fatal disease

A

oral cancer (50% will die in 5 year diagnosis)

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13
Q

oral example of unknown disease history

A

oral HPV

- unknown relationship with oropharyngeal cancer, need to carry out work to understand it

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14
Q

what is the purpose of epidemiologically studying the natural history of diseases?

A

sequalae of diseases (impact)

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15
Q

how can you epidemiologically investigate the risk factors (causes/determinants) of disease?

A

health needs assessment

  • What care services are required by particular population groups
  • Dependent on health status and demographics of population
  • Collective population needs

Analytical epidemiology – unpicking risk factors

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16
Q

what does analytical epidemiology do

A

unpick risk factors (causes/determinants) of disease

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17
Q

how are preventative programmes developed

A

Based on knowing risk factors of diseases and attempting to prevent exposure to these factors

E.g. distribution of decay in Scotland of whole population

  • 50% of 5-year-old in millennium
  • 70-75% in most deprived

Develop programme to communities
- Universal and targeted practice for deprived areas

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18
Q

what is the purpose of using epidemiology to evaluate interventions

A

has a new service/procedure made any difference

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19
Q

3 main types of epidemiological study

A

descriptive (observational)

analytical (observational)

  • case control
  • cohort

intervention/experimental
- randomised controlled trials

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20
Q

what is epidemiology necessary for

A

health service planning

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21
Q

prevalence

A

measurement of all individuals affected by the disease within a particular period of time or point in time
- period, point in time, proportion

Number of affected individuals (cases is numerator) divided by total number of persons in population (denominator)
- Expressed as a % or fraction

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22
Q

what are prevalence estimates obtained from

A

obtained from cross sectional studies or derived from registers

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23
Q

prevalences used for

A

estimate of how common a condition is within a population over a certain period of time (carry out multiple) or point in time

e.g. % of P1 Children in NHS Greater Glasgow & Clyde with no obvious caries experience, 2008 & 2010 (different areas over 2 times)

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24
Q

incidence

A

a measurement of the number of new individuals who contract a disease during a particular period of time
- per week, per year (need to have time window expressed with rates)

Number of new cases or events during a specific period of time in a defined population
- Same numerator of cases, denominator is population

e.g. 5 new cases per week, 10 cases of oral cancer per 100,000 population per annum

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25
Q

incidence rates obtained from

A

longitudinal studies or derived from registers

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26
Q

diabetes - incidence Vs Prevalence

A

chronic incurable disease like diabetes can have a low incidence but high prevalence, because the prevalence is the cumulative sum of past year incidence rates

  • Prevalence is cumulative sum of last year incidence rates
    How many patients need diabetic drugs/care
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27
Q

common cold - Incidence Vs Prevalence

A

short-duration curable condition such as the common cold can have a high incidence but low prevalence, because many people get a cold each year, but few people actually have the cold at any given time (so prevalence low)

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28
Q

use prevalence or incidence for chronic disease?

A

prevalence

29
Q

use prevalence or incidence for acute disease?

A

incidence

30
Q

use prevalence or incidence for cancer?

A

Can be chronic but want to know incidence as people die quite rapidly
- Trend over time

But depends on nature of chronic disease

31
Q

what are the 3 main variables in descriptive studies which partition individuals?

A

time (when)

place (where)

person (who)

32
Q

possible different time measurements

A 
dat
circadian 
weeks
months
yearly
33
Q

possible different place definitions

A

Globally (burden of disease – oral disease, caries),
countries,
MEDCs or LEDCs - Scottish Index of Multiple deprivation
towns,
communities/regions,

34
Q

possible different person definitions

A

age
gender
ethnicity

35
Q

3 aims of defined partitions in epidemiological studies

A

Identify changes in incidence or prevalence over time
OR
Determine incidence or prevalence of disease in different geographical areas
OR
Determine incidence/prevalence of disease in groups of individuals with different characteristics

Correlations may then be sought with other variables resulting in hypothesis of cause

36
Q

descriptive epidemiology measures

A

the burden of disease

37
Q

4 advantages of sample

A

reduces no. of individuals to be sampled
reduces cost
higher response rate
higher quality of information collected

38
Q

what must a sample of a population be

A

Sample must be representative of population being investigated.
- Aim is to avoid bias or being skewed

39
Q

why is sample size important

A

don’t need to ask everyone in population but must be representative so margins of error lie likely where true value is

40
Q

5 sampling techniques

A

simple random sample

systematic sample

stratified sample

cluster sample

multi-staging sample

41
Q

simple random sample

A

uses random number tables/generators

42
Q

systematic sample

A

individuals selected at regular intervals from population list (every 2nd, 3rd)
- logical

open to bias (how they are ranked)

43
Q

stratified sample

A

ensures small sub-groups adequately represented

e.g. Scottish index of multiple deprivation (into fifths)

44
Q

cluster sample

A

use of groups as sampling units, e.g. school classes

- more practicable

45
Q

multi-staging sampling

A

combines above techniques

- 20% of schools from each level of deprivation

46
Q

what can occur if sampling process isn’t clear

A

error and bias in survey methodology

47
Q

5 possibles errors that can occur due to unclear sampling techniques

A

Sampling bias / selection bias
- Skew data

Response bias / information bias
- Need to monitor who responds - could only be affluent educated (then miss a proportion)

Measurement error

Observer variation (intra- or inter-)
- needs to be Standardised

Loss to follow-up

48
Q

what are the 2 types of observer variation

A
  • Inta – minimal, sampler is consistent, repeatability

- Inter – between samplers

49
Q

what are indices used for

A

to measure disease need an appropriate index

Measuring for the purposes of epidemiological studies different from recording disease for patient treatment purposes
- More objective
- Not subjective description of decay
Standardised measurement

50
Q

9 properties of an ideal index

A

clear, unambiguous, not subjective

ideally correspond with clinically important stages of the disease

indicate treatment need

within the ability of examiners

reproducible

not time-consuming

acceptable to patient (no harm)

amenable to statistical analysis

allow comparison with other studies

51
Q

index for dental caries

A

DMF index
- first described in 1937

DMFT: decayed, missing & filled teeth (0-32)

DMFS: decayed, missing & filled surfaces (0-148)
- Distal, mesial, occlusal, buccal and lingual (incisors don’t have occlusal)

Deciduous teeth: dmf/def index
- dmf: deciduous decayed, missing and filled teeth (0-20)
- e = indicated for extraction / exfoliated
at age 6 (& over) only score “c, d, e”

52
Q

6 limitations of the DMF index

A

Teeth extracted for reasons other than caries
- Perio, trauma, missing naturally (M wrong), overestimation

Influenced by access, e.g. interproximal surface

Difficulty in differentiating fissure-sealant from restorations – underestimate caries

Influenced by past disease activity

  • Historical caries experience
  • Not necessarily at the time you examine

Threshold criteria of disease can vary (must specify)

Cannot be used for root caries

53
Q

level of decay used for DMF dental caries index

A

pulpal and decay in dentine
- both visible obvious decay

not enamel or sub-clincal decay

54
Q

national dental inspection programme NDIP

A

Scottish dental epidemiological programme of children
- Renamed from SHBDEP (Scottish Health Boards’ Dental Epidemiological Programme) (1987 – 2000) in 2002

Cross-sectional, descriptive dental surveys of school children

Larger samples than UK decennial surveys

Involve standard examination criteria and trained and calibrated examiners

Target groups: children in P1 and P7
- Basic inspection for all children in P1 &P7 every year

Detailed inspection (epidemiology) for a sample of children every year

  • Alternates each year between P1 and P7
  • NHS Board can add additional year groups
  • Sample more detailed DMFT sub-sample
55
Q

aims and goals of NDIP

A

Aims to inform:
- parents of their child’s dental health status (Basic NDIP)
- advise Scottish Government, NHS Boards, and other organisations of the oral disease prevalence in children in their area (Detailed NDIP – Epidemiology survey)
like a census

goals

  • to inspect a representative sample of the P1 or P7 LA school population in any year
  • to determine current levels of established tooth decay
  • to illustrate the impact of deprivation on the dental health of 5 & 11 year old children in Scotland
56
Q

basic NDIP procedure

A

Offered to every child in P1 and P7 classes of local authority schools every year

Proportion of school rolls inspected 85-90%

Generates letter to parent

  • Overall state of dental health of child
  • Conveys degree of urgency with which appointment for attendance at dentist suggested for child

Not a detailed examination of each surface of each tooth

57
Q

NDIP (detailed; epidemiology)

A

Detailed Inspection

  • more rigorous and comprehensive assessment
  • Calibration of examiners
  • records status of each tooth surface in accordance with international epidemiological conventions (i.e. d3mft: caries into dentine)- can be underestimate
  • Uses same clinical inspection criteria as SHBDEP - can therefore look at trends from 1987 re P1 children
58
Q

goals of NDIP

A
  • to inspect a representative sample of the P1 or P7 LA school population in any year
  • to determine current levels of established tooth decay
  • to illustrate the impact of deprivation on the dental health of 5 & 11 year old children in Scotland
59
Q

how is calibration of examiners performed for epidemiology surveys

A

Number of children e.g. 10 selected for calibration exercise
- High proportion should have caries

Potential dental epidemiology examiners then all examine and chart each child

Compare results

  • Assess inter-observer variation
  • Each child should have same level of decay from every examiner

Outlier dental examiners not able to participate in epidemiological programme

60
Q

index of orthodontic treatment (IOTN)

A

Assesses need and eligibility of children for NHS orthodontic treatment on dental health grounds (treatment need scale used on clinic for treatment planning)

Selects those children who will benefit most from treatment; fair way to prioritise limited NHS resources

Dental Health Component (DHC) has 5 Grades and Aesthetic Component (AC) has 1-10 scale

61
Q

aesthetic component of index of orthodontic treatment

A
  • scale of 10 colour photographs showing different levels of dental attractiveness
  • AC used for border-line cases with Grade 3 DHC. If high AC score, NHS treatment is permissible
62
Q

dental health component of index of orthodontic treatment

A

5 grades
- Grade 1: almost perfection, to
- Grade 5: for severe dental health problems
E.g. upper front teeth that protrude more than 9 mm

63
Q

plaque indices

A
  • Debris Index (Green & Vermillion, 1960)

- Plaque Index (Silness & Loe, 1964)

64
Q

gingivitis indices

A
  • Modified Gingival Index (Loe, 1967)

- Lobene Index (Lobene, 1986)

65
Q

periodontitis index

A

basic periodontal exam (BPE, CIPTN)

66
Q

3 indices used for periodontal disease

A
  • plaque indices
  • gingivitis indices
  • periodontitis indices
67
Q

types of fluorosis indices

A
  • Fluorosis Index (Dean, 1934)
  • TF Index (TFI) (Thylstrup & Fejerskov, 1978)
  • Tooth Surface Index of Fluorosis (TSIF) (Horowitz et al, 1984)
  • SCOTS Index (Scots HBs Child assessments of Opacities by tooth-Thirds & Symmetry) (Pitts & Stephen, 1991
68
Q

when can fluorosis be detected

A

when upper anterior teeth erupt

- blotchy - issue aesthetically

69
Q

is fluorosis a public health problem in Scotland?

A

Not considered a public health problem in Scotland

Low impact to patient and profession

Will be monitored through NDIP programme

  • Potential impact of childsmile programme
  • Due to increase in F in childsmile toothpaste (1450 ppm)

BDS2 PMHP (8 decks)

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