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BDS2 PMHP > Introduction to Epidemiology > Flashcards

Introduction to Epidemiology Flashcards

1
Q

What is epidemiology

A

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

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2
Q

what does epidemiology help to identify

A

risk factors for disease and determining optimal treatment approaches to clinical practice and preventative medicine

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3
Q

what are the major roles of epidemiology

A

monitor infectious and non-infectious diseases
study natural history
investigations of disease risk factors
health care needs assessment
developing of preventative programs
evaluation of interventions and their effectiveness
health service planning

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4
Q

how is epidemiology used to monitor infectious diseases

A

monitor flue outbreaks which helps in planning for provision of flu

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5
Q

what is the natural history of disease

A

the course a disease takes in individual people from its pathological onset until its eventual resolution or death

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6
Q

what do we look at when studying natural history of diseases

A 
are they:
self limiting 
chronic 
fatal
unknown
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7
Q

what does investigations of disease factors consist of

A

o Looking at the causes/determinants of diseases

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8
Q

what does epidemiology help in health care needs assessments

A

o What care services are required by particular population groups

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9
Q

how does epidemiology help in development of preventative programs

A

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

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10
Q

what are the 3 main types of epidemiology studies

A

descriptive
analytic (observational)
intervention/experimental

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11
Q

what is descriptive epidemiology

A

measures of disease frequency and it is either prevalence or incidence

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12
Q

what is prevalence

A

o Measurement of all individuals affected by the disease within a particular period of time or point in time – a cross sectional point in the population

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13
Q

how is prevalence calculated

A

o Number of affected individuals (cases) divided by the total number of persons in population and is expressed as a percentage or fraction

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14
Q

what is prevalence obtained from

A

cross sectional studies or derived from registers

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15
Q

what is prevalence used as

A

an estimate of how common a condition is within a population over a certain period of time or point in time

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16
Q

what is incidence

A

a measurement of the number of new individuals who contract a disease during a particular period of time

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17
Q

how is incidence calculated

A

o Number of new cases or events during a specific period of time in a defined population

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18
Q

how is incidence estimates obtained

A

obtained from longitudinal studies or derived from registers

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19
Q

how is incidence expressed

A

o Expressed as a fraction

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20
Q

do we use incidence or prevalence for chronic incurable diseases

A

they have low incidence but high prevalence

we usually use prevalence - allows us to help in management

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21
Q

do we use incidence or prevalence for short duration curable conditions

A

they have high incidence but low prevalence because many people get a cold each year but few people actually have a cold at any given time so prevalence is low

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22
Q

what are the main variables for descriptive studies

A

Time, place, person OR when, where, who

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23
Q

what are the aims of time, place, person

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
24
Q

what are the advantages of sampling

A
  • Reduces number of individuals to be sampled
  • Reduces cost
  • Higher response rate
  • Higher quality of information collected
25
Q

what must samples be

A

The sample must be representative of population being investigated. The aim is to avoid bias.

26
Q

what are the sampling techniques

A 
simple random sample
systemic sample
stratified sample
cluster samples
multistage sampling
27
Q

what are simple random samples

A

o Use of a table of random numbers

28
Q

what is a systemic sample

A

o Individuals selected at regular intervals from population list

29
Q

what is a stratified sample

A

o Ensures small sub-groups adequately represented

30
Q

what is a cluster sample

A

o Use of groups as sampling units e.g school classes

31
Q

what is multi-stage sampling

A

o Combines above techniques

32
Q

what are the error

A
  • Sampling bias/selection bias
  • Response bias/information bias
  • Measurement error
  • Observer variation (intra- or inter-)
  • Loss to follow up
33
Q

what is response bias

A

o If you are not monitoring who is responding it could only be a certain group responding so you miss out groups in the population

34
Q

what is observer variation

A

o When examining it has to be the same

35
Q

how do we avoid measurement error when measuring disease

A

we use an appropriate index

36
Q

what are the properties of an ideal index

A
  • Clear, unambiguous, not subjective
  • Ideally correspond with clinically important stages of the disease
  • Indicate tx need
  • Within the ability of examiners
  • Reproducible
  • Not time consuming
  • Acceptable to patient
  • Amenable to statistical analysis
  • Allow comparison with other studies
37
Q

what are dental indices

A

DMF index

dmf/def index

38
Q

what are the limitations of the DMF index

A
  • teeth extracted for reasons other than caries
  • influenced by access e.g interproximal surface so could underestimate
  • difficulty in differentiating fissure sealant from restorations – underestimate caries
  • influenced by past disease activity
  • threshold criteria of disease can vary – must specify
  • cannot be used for root caries
39
Q

what is the study used for epidemiology of dental caries in children

A

Descriptive cross-sectional epidemiology

NDIP in scotland

40
Q

what does NDIP use

A

It uses cross sectional, descriptive dental surveys of school children
It has larger samples than UK decennial surveys
It involves standard examination criteria and trained and calibrated examiners

41
Q

what is the aim of NDIP

A

It aims to inform:

  • Parents of their child’s dental health status (basic NDIP)
  • Advise Scottish government, NHS boards and other organizations of the oral disease prevalence in children in their area
42
Q

what are the target groups for NDIP

A

p1 and 7

43
Q

what happens in NDIP

A
  • There is basic inspection for all children in p1 and p7 every year
  • There is detailed inspection (epidemiology) for a sample of children every year
    o Alternates each year between P1 and P7
  • NHS board can add additional year groups
44
Q

what is the basic inspection in NDIP

A
  • Offered to every child in p1 and p7 classes of local authority schools
  • Proportion of school rolls inspected = 85-90%
  • Generates letter to parent
    o Overall state of dental health of child
    o Coveys degree of urgency with which appointment for attendance at dentist suggested for child
  • Not a detailed examination of each surface of each tooth
45
Q

what does the detailed inspection consist of in NDIP

A
  • More rigorous and comprehensive assessment
  • Calibration of examiners
  • Records status of each tooth surface in accordance with international epidemiology conventions (i.e d3mft: caries into dentine)
  • Uses same clinical inspection criteria as SHBDEP
    o Can there look at trends from 1987 re P1 children
46
Q

what are the specific goals of the 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
47
Q

how are the NDIP epidemiology surveys calibrated

A
  • Number of children e.g 10 selected for calibration exercise
    o High proportion should have caries
  • Potential dental epidemiology examiners then all examine and chart each child
  • Compare results and assess inter-observer variation
  • Outlier dental examiners not able to participate in epidemiological programme
48
Q

what are the indices of fluorides

A
  • Fluorosis index
  • TF index
  • Tooth surface index of fluorosis
  • SCOTS index
49
Q

what does the index of ortho tx need do

A

Assesses need and eligibility of children for NHS ortho treatment
Selects those that will benefit most

50
Q

what are the 2 components of the index of orthodontic treatment need

A

dental health component

aesthetic component

51
Q

what is the dental health component

A

o Goes from grade 1 which is almost perfection to grade 5 which is severe dental health problems

52
Q

what is the aesthetic component

A

o Scale of 10 colour photographs showing different levels of dental attractiveness
o AC used for border-line cases with grade 3 DHC. If high AC score, NHS treatment is permissible

53
Q

what are the indices for periodontal disease

A

plaque indices
gingivitis index
periodontitis indices

54
Q

what are the plaque indices

A

o Debris index

o Plaque index

55
Q

what are the gingivitis indices

A

o Modified gingival index

o Lobene index

56
Q

what are the periodontitis indices

A

o Basic periodontal examiniation

BDS2 PMHP (10 decks)

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