PMHP Flashcards
ottawa charter for health promotion (5)
- build healthy public policy
- create supportive environment
- strengthen community action
- develop personal skills
- reorient health services
different barriers to health which could cause inequality
- language
- lack of familiarity with health services
- culture
- racism
- incidence of unemployment
- tendency to reside in disadvantaged areas
self efficacy
patient’s belief that they can succeed at a particular task or behaviour & that is will result in a valued outcome
subjective norms
perceptions of social norms & expectations to comply with them e.g. what friends and family do
implementation intention
basically the planning of how a set goal will be achieved
locus of control
similar to self efficacy in that it is the patient’s belief that their dental health is under their own control - if they do not believe this then they are less likely to adhere to advice
steps of behavioural change
- precontemplators; those not interested
- contemplators; maybe in the future
- preparation; wanting to do it right now
- action; those doing it now
- maintenance; those keeping it up
how to aid behavioural change
establish rapport
set an agenda
assess readiness to change
exchange information
resistance - if misjudged their want to change back off & remind them it is their own personal choice
molecule used to fluoridate water
hydrofluorosilicic acid H2SiF6
or
sodium fluorosilicate Na2SiF8
best use of fluoride to reduce dental caries
topical fluoride i.e. varnish
community / individual based fluoride delivery methods
community - school water, salt, milk,
individual - varnish, rinses, supplements, toothpastes
fluoride varnish
applied 2-4 times per year
22,600ppmF
form of fluoride is sodium fluoride
dosage of fluoride supplements
0-6mths = 0mgF- daily
6mths - 3yrs = 0.25mgF- daily
3-6yrs = 0.5mgF- daily
6+ yrs = 1mgF- daily
amount of toothpaste for <2 & >2 years
<2yrs = 1000ppmF smear
>2yrs = 1000ppmF pea sized
childsmile nursey & school
targeted to nurseries & primary schools in higher priority areas (judged by SIMD); there will be 6 monthly fluoride varnish applications to children, fissure sealants & follow up of non regular dental attending children
units per week for men & women
max 14 units consumed over 2-3 days
alcohol management
part of SIGN 74
states that GPs & other primary care professionals should opportunistically identify hazardous & harmful drinkers then deliver a brief intervention
screening tools for alcoholism
AUDIT (alcohol use disorders identification test) is often seen as the gold standard but FAST (fast alcohol screen test) is often used as it is quicker
blood alcohol concentration
will peak 1hr after drinking on an empty stomach and will be removed at a rate of 15mg/100ml/hr
women have smaller blood volume & lower alcohol dehydrogenase in their stomach so more alcohol is absorbed before it is metabolised
levels of intoxication
- 80mg/100ml = current legal driving limit in UK (35mg/100ml on breath which is decreased to 22 in scotland)
nicotine replacement therapy
- reduces severity of withdrawal symptoms
- reduces desire to smoke
- can delay weight gain
- can reduce relapse
- can provide coping mechanism
nicotine patches
suit moderately dependent smokers (10-20 a day)
contraindications = widespread dermatological conditions
designed to be used over a 12wk period
last 16-24hrs
regular release throughout day so not suitable when urge to smoke is strong
nicotine gum
available in 2mg & 4mg strengths with higher one suiting >20 a day smoker
no more than 10 pieces per day should be chewed
suits irregular smokers
nicotine microtabs
small tablets placed sublingually & will suit both heavy & light smokers
should be in doses of 24 & 40 a day over 3 months
5 A’s for quitting
ASK
ADVISE
ASSESS
ASSIST
ARRANGE FOLLOW UP
contented smokers should be given advice on the 5R’s
emphasise relevant benefits of quitting
emphasise risks of continuing to smoke
list rewards of stopping
discuss roadblocks to quitting
emphasise that repeat attempts are more successful
2 main laws relating to drugs in UK
Medicines Act 1968
Misuse of Drugs Act 1971
oral complications of drug use
poor OH
xerostomia
sugar craving
high caries rate
poor perio
smoking
ANUG
low self esteem
trauma
poor attendance
dental anxiety
methadone
synthetics opiate analgesic
mixed with sugary green syrup; will continually occupy muscarinic opioid receptors which is thought to stabilise neurochemistry
epidemiology
helps determine frequency of a disease within certain risk factors and can assess people’s risk of disease
can be used to evaluate effects of any interventions that have been used and will help with evidence based approaches to health measures
prevalence
measure of all individuals affected by a certain disease (if divided by total it gives percentage affected)
it is used to show how common a certain disease actually is
incidence
number of new cases of a certain disease that are currently occurring
methods used for sampling (4)
- simple random sample
- systemic sample - individuals selected at regular intervals from a population list
- stratified sample - ensures small sub groups are adequately represented in a sample
- cluster sample - use of groups as sampling units
requirements of an ideal index
- clear, unambiguous, non-subjective
- correspond with clinically important stages of disease
- indicate tx needed
- within examiner’s ability
- reproducible
- not time consuming
- acceptable to ptx
- amenable to statistical analysis
- allow comparison with other studies
indices used to measure disease
eg of index
DMFT - decayed, missing & filled teeth
limitations of DMFT
- if teeth XLA for reasons other than caries this is a misrepresentation
- can be difficult to visualise interproximal areas
- can be difficult differentiating fissure sealant from restorations
- can be influenced by past disease activity
- cannot be used for root caries
what is a risk factor
an environmental, behavioural or biological factor confirmed by temporal sequence usually increasing probability of disease occurring
if absent or removed it reduces probability
both causes & determinants are considered risk factors for disease development
cause
external agent which results in disease in susceptible individuals
determinant
attribute or circumstance which affects liability of an individual to be exposed, when they will be exposed and to develop the disease e.g. socio-economic status
confounding variable
particular type of extraneous variable which for some reason has been left uncontrolled. the result is that on looking at findings of an experimental study, rather than only one possible variable exerting influence on outcome, there are found to be others, which are said to be confounding the results
3 common indices of risk
- absolute
- attributable
- relative
absolute risk
most basic measure which gives incidence rates of a disease amongst people exposed to an agent, however it assumes no risk is incurred by those not exposed to the agent
attributable risk
this is the difference between the incidence rates of both exposed and non exposed groups; this represents the risks attributable to a factor being investigated
risk ratio
is a ratio of the incidence rate in the exposed group to the incidence rate in the non exposed group; this will measure the proportion of increase (or decrease) of disease in the exposed group while making allowances for the frequency of the disease amongst those not exposed to the harmful agent
cohort study
a prospective study where a group of people who have not yet got the disease are recruited for a
study and their risk factors are assessed. They will be observed over a period of time to measure the
frequency of occurrence of disease among those exposed to a risk factor and those not exposed
frequency of occurrence of disease
case control study
restrospective study in which people with a disease are compared to those free from disease and their histories traced to find out any exposure to suspect harmful agents
may be less robust that cohort studies as it depends on patient remember their risk factors
could be used for preliminary investigation of a hypothesis before being followed by cohort study if possible
risk ratio cannot be found so instead an odds ratio is found
main study providing risk factors for dental caries
vipeholm study
evidence levels for different types of studies in order from best to worst
- systematic cochrane review & RCT
- cohort
- case control
- case report / series
- narrative review, editorial
case report / series
this is a report on a single patient or series of patients with an outcome of interest however there is no control group involved
they should be used for identifying a new disease outcome & hypothesis generation but they cannot be used to demonstrate valid statistical associations due to their lack of control group
cross sectional study
observation of a defined population at a single point in time or time interval
this is where the exposure & outcome are determined at the same time
can be use for estimating prevalence of disease & investigating potential risk factors
disadv are that the causality may be vague & these factors can be easily confused with confounding factors; likely to be recall bias
case control study
study of people with a disease and a suitable control group without the disease; they will then be asked if they had a particular risk factor to see whether it played any part in their disease - useful when looking at potential causes of a disease
causes can be easily confused with confounding variables, there may be recall & selection bias and selection of controls may not be suitable, may be incorrect time relationships between the two so exposure may not have occurred before the disease
cohort study
group of individuals established then their exposure measured
they are followed up over a period of time & those that develop the disease are identified
useful for estimating incidence of a disease, investigating causes of disease, determining prognosis, timing & direction of events of disease
issues with cohort study (5)
- controls often difficult to identify
- confounding variables likely to interfere
- blinding is difficult
- large samples are needed for rarer diseases
- very expensive & time consuming
4 key design elements of RCT
- specification of participants (so the inclusion / exclusion criteria)
- comparison (control group)
- randomisation
- blinding
specification of participants
must be unambiguous i.e. not open to interpretation e.g. ptx age / severity of disease
comparison
RCT must have control group which gets the placebo
randomisation
describes how subjects are allocated to treatments - researcher & participant must not be the ones to do the allocation as there would be bias involved
this means any participant has an equal chance of being in the placebo group as being in the drug group - this should be done via computer
blinding
RCT should be double blinded - this means participant & researcher must not be aware of treatment given to patients; if they were aware this may influence the results
risk ratio
aka relative risk
can be devised once RCT undertaken & will describe whether there is a change between the placebo group or not, and by how much of a change there is
e.g. drug group was 63% but placebo was 18% so 63/18 means risk ratio = 3.42
confidence intervals
95% confidence interval used
if the final confidence interval contains 1 then there is insufficient evidence of a difference but if it doesn’t there is sufficient evidence there is a difference between the two
e.g. if risk ratio was 3.42 and confidence interval was 1.52-7.73 there was sufficient evidence the drug was effective
systematic review
different RCTs pooled together to realise the risks or benefits of a particular treatment
explicit search strategy to include all papers without prejudice then removing those with a low quality of evidence
highlights where more evidence is needed & when enough has been produced
will also identify flawed studies
meta analysis
optional part of systematic review; it combines the statistical results of studies for a pooled estimate of treatment effect across the studies
6 dimensions of quality in healthcare
- person centred
- safe
- efficient
- effective
- equitable
- timely
what SIGN guidelines we should know about
SIGN 43 - management of unerupted & impacted 3rd molar teeth 2000
SIGN 47 - preventing dental caries in children at high caries risk 2000
SIGN 87 - prevention and management of dental decay in pre school child 2005
SIGN 90 - diagnosis and management of head and neck cancer 2006
SDCEP
scottish dental clinical effectiveness programme
recommendations based on:
- current legislation or professional regulations
- group consensus after critical evaluation of evidence
- group consensus after considering expert opinion
6 factors of clinical governance
- education & training
- clinical audit
- clinical effectiveness
- research & development
- openness
- risk management
capacity
A - act
M - make decision
C - communicate
U - understand
R - retain
legislation regarding capacity
Adults with Incapacity (Scotland) Act 2000
what information must be given to patient to allow them to make decisions
- diagnosis
- treatment options
- risks & complications
- treatment plan and cost
- impact of no treatment
legislation for equality in dentistry
equality act 2010
protected characteristics
age
disability
gender reassignment
marriage & civil partnership
pregnancy & maternity
race & ethnicity
religion & belief
sex
sexual orientation
diversity
acknowledgement of alterity amongst people in terms of their community, culture, beliefs, life experiences & individuality
equality v equity
equality = fairness of opportunity and observing the rights of people so their alterity is not discriminated against
equity = to treat equals equally and unequals unequally i.e. certain inequalities demand special measures to ensure fairness
4 main communication skills for guiding style
OARS
O - open questions
A - affirmation (appreciation for patient efforts)
R - reflective listening
S - summary
types of domestic abuse
- verbal
- emotional
- physical
- sexual
- financial
who is most at risk of domestic abuse
- women aged 16-24
- men aged 16-19
- long term illness / disability
- mental health problems
- women who are separated / separating
- pregnancy
signs of domestic abuse
repeated injuries
bruises at different stages of healing
dental injuries
unlikely explanations for injury
facial bruising
strangle marks around the neck
delay in seeking help for injuries
soft tissue bruising
AVDR intervention for domestic violence
ASK, VALIDATE, DOCUMENT, REFER
Ask - about abuse in a private setting
Validate - show concern, removes blame & shows that you believe them & taking it seriously
Document - be specific & detailed, use ptx own words & clinical notes
Refer - means ‘signposting’ to appropriate services i.e. scottish domestic abuse helpline
