Week 4 Practice of Public Health PDF

DENT1006 PUBLIC HEALTH IN DENTISTRY Practice of Public Health/Health Education Assoc.Prof.Banu Öter banu.oter.bau.edu.tr Lecture 4: Practice of Public Health Critical Issues in Healthcare and Public Health Health Financing: Ensuring adequate funding for health servi...

DENT1006 PUBLIC HEALTH IN DENTISTRY Practice of Public Health/Health Education Assoc.Prof.Banu Öter banu.oter.bau.edu.tr Lecture 4: Practice of Public Health Critical Issues in Healthcare and Public Health Health Financing: Ensuring adequate funding for health services is a significant challenge. Human Resources for Health: There is a need for skilled health workers to deliver quality healthcare services. Mental Health: Mental health issues have been on the rise, and addressing them is a major challenge. Climate Change: Climate change poses one of the biggest threats to both the planet and the health of the people who live on it. Poverty: Poverty is a major barrier to access to healthcare services. Reproductive Health: Ensuring access to reproductive health services is a significant challenge. Infodemic: The spread of misinformation, especially during the COVID-19 pandemic, has been a major challenge. Humanitarian Crisis: Providing healthcare in conflict and crisis situations is a significant challenge.  Integrated Science Model: The integrated science model, is an interdisciplinary approach that combines insights from biological, behavioural, and social sciences to understand and address health and disease problems. Epidemiology: The basic principles and methods of epidemiology, which is the study of the distribution and determinants of health-related states or events in populations. The types of epidemiological studies; such as descriptive, analytical, and experimental studies, and how they can be used to investigate the causes and effects of diseases or health outcomes. Disease Measurement and Prevention: The studies are tools to measure disease frequency and magnitude using rates, ratios, proportions, incidence, and prevalence. It also delves into key epidemiological concepts, including the epidemiological triad, risk and prevention, stress and adaptation, and the biopsychosocial model of health and disease. Epidemiology The study of the distribution and determinants of health-related states or events in specified populations, and application of this study to control of health problems. Scientific Elements of Epidemiology Aetiology Pathogenesis Prevention Objectives of Epidemiology 1. To describe the distribution and magnitude of health and disease problems in the population. 2. To identify the determinants of aetiological factors and risk factors in the population. 3. To provide the data essential for planning, implementation and evaluation of services for prevention, control and treatment of disease or to setting up priorities for these services. In order to fulfil these objectives, descriptive studies, analytical studies, and experimental or interventional studies are undertaken. The ultimate aim of epidemiology is to promote and preserve health and eliminate or reduce morbidity and its consequences. EPIDEMIOLOGICAL METHODS The primary concern of an epidemiologist is to study disease occurrence among people. Factors and circumstances to which people are exposed may throw light on the cause of the disease. Epidemiologist employs carefully designed methods to find out the cause of disease occurrence. The methods he or she employs can be classified as: 1. Observational studies a. Descriptive studies b. Analytical studies Case-control studies Cohort studies 2. Experimental/interventional studies Randomized control studies, field trials-community trials. Descriptive Studies Descriptive studies are a type of observational research that involves collecting data to describe patterns of health or disease, without looking at cause-and-effect relationships. 1.Purpose: The main goal of descriptive studies is to observe and describe the distribution of a health condition or related events in a population. 2.Process: These studies involve measuring the frequency of the condition or event, as well as its patterns in relation to variables such as age, sex, and geographical location. 3.Outcome: The findings from descriptive studies can help identify patterns or trends, generate hypotheses, or provide information for further research. 4. Usage: Descriptive studies are often the first step in a research investigation. They can provide valuable information about the “who”, “what”, “where”, and “when” of health-related events. While descriptive studies can provide important information about health conditions or behaviours in a population, they do not provide evidence of a cause-and-effect relationship. Case-control Studies 1.Starting Point: Case-control studies begin by identifying individuals who have a specific disease or health condition (known as ‘cases’) and those who do not have the disease (known as ‘controls’). The goal is to investigate what might have caused the disease by looking into the past. 2.Selection: Cases are chosen because they have the disease or condition being studied. Controls, on the other hand, come from the same population but do not have the disease. To make sure cases and controls are similar in certain aspects (like age, sex, socioeconomic status), a process called ‘matching’is often used. 3.Exposure Measurement: Researchers look at the past exposure of both cases and controls to factors that are suspected to cause the disease. 4.Analysis: Researchers compare how often cases and controls were exposed to the suspected causes. They calculate something called an ‘odds ratio’to understand the relationship between the exposure and the disease. If the odds ratio is statistically significant, it suggests that there’s likely a relationship between the exposure and the disease. Cohort Studies 1.Starting Point: Cohort studies start by selecting a group of people who share a common characteristic or exposure. This group is then followed over time to see if they develop the disease or outcome being studied. 2.Selection: The study involves two groups: one that has been exposed to a certain factor (like a lifestyle habit or environmental exposure) and another that hasn’t been exposed. 3.Exposure Measurement: Researchers collect data on the exposure and other relevant variables from both groups. 4.Follow-up and Analysis: Both groups are followed over a specified period. The researchers then compared the incidence rates of the disease in the exposed and unexposed groups. They calculate measures like relative risk and attributable risk to evaluate the association between exposure and disease risk. These measures help estimate the impact of the exposure on disease occurrence. Randomized Controlled Trials (RCTs) Purpose: RCTs are the gold standard for establishing causation in epidemiology. Method: Individuals are randomly assigned to either an intervention group (receives a specific treatment or intervention) or a control group (does not receive the treatment). Goal: Assess the impact of the intervention on disease outcomes. Key Feature: Random assignment minimizes bias and helps establish a cause-and-effect relationship.  RCT on Dental Implants: This study evaluated the characteristics of RCTs regarding implant-supported single tooth or fixed partial dentures. The study assessed publication details, study characteristics, international collaboration networks, and characteristics related to the implant-supported treatment. RCT on Dental Anxiety: This trial examined the effect of perioperative propranolol against dental anxiety. The distributions of demographic variables and quantitative data were displayed in tables. RCT on Oral Health Education: This educational intervention used the health belief model for improving oral health behaviours. The Papillary bleeding index (PBI) was used as a measure in this study.  RCT on the Effect of Probiotics on Oral Health: This study aimed to evaluate the effect of probiotics on oral health. The study found that probiotics can be used as an adjunct to oral hygiene practices and may be effective in improving oral health. RCT on the Effect of Fluoride Varnish on Caries Prevention: This trial evaluated the effectiveness of fluoride varnish in preventing dental caries in children. The study found that fluoride varnish was effective in reducing the incidence of tooth decay in children. RCT on the Effect of Silver Diamine Fluoride on Caries Arrest: This study evaluated the effectiveness of silver diamine fluoride (SDF) in stopping dental caries. The study found that SDF is effective in stopping dental caries and can be used as an alternative to traditional restorative treatments. RCT on the Effect of Laser Therapy on Periodontal Disease: This trial evaluated the effectiveness of laser therapy in the treatment of periodontal disease. The study found that laser therapy effectively reduced pocket depth and improved clinical attachment levels in patients with periodontal disease. Field Trials/Community Trials Purpose: Assess the effectiveness of public health interventions in real-world community settings. Method: Researchers implement interventions in actual communities. Goal: Evaluate the impact of these interventions on reducing disease occurrence or improving health outcomes at the community level. Key Feature: Studies the practical effectiveness of interventions outside of controlled environments. Community Intervention Trial for Smoking Cessation: This trial aimed to evaluate the effectiveness of a community-based smoking cessation program. The study found that the program was effective in increasing smoking cessation rates among participants. Field Trial on Oral Health Promotion: This trial evaluated the effectiveness of an oral health promotion program in improving oral health outcomes in rural communities. The study found that the program was effective in improving oral health knowledge and behaviours among participants. Community-Based Intervention for Oral Cancer Prevention: This trial aimed to evaluate the effectiveness of a community-based intervention for oral cancer prevention. The study found that the intervention was effective in increasing oral cancer knowledge and screening rates among participants. Field Trial on Water Fluoridation: This trial evaluated the effectiveness of water fluoridation in reducing dental caries in children. The study found that water fluoridation was effective in reducing dental caries incidence among children. Clinical research designs  Clinical research is a scientific study that involves human subjects to evaluate the safety and effectiveness of new treatments, therapies, and interventions. Ethics in clinical research is essential to ensure that the rights, safety, and well-being of human subjects are protected. It also ensures that the research is conducted in a scientifically valid and socially responsible manner. Ethical Guidelines: Ethical guidelines are established for clinical research to protect patient volunteers and to preserve the integrity of the science. The ethical guidelines in place today were primarily a response to past abuses, such as the Tuskegee syphilis experiment, which was conducted from 1932 to 19721. Some of the influential codes of ethics and regulations that guide ethical clinical research include: Nuremberg Code (1947) Declaration of Helsinki (2000) Belmont Report (1979) CIOMS (2002) U.S. Common Rule (1991) Principles Guiding Ethical Research: Seven main principles have been described as guiding the conduct of ethical research: Social and clinical value Scientific validity Fair subject selection Favorable risk-benefit ratio Independent review Informed consent Respect for potential and enrolled subjects Ethical Issues in Clinical Research: Some of the ethical issues that arise in clinical research include informed consent, confidentiality, conflicts of interest, and vulnerable populations. External Validity: RCTs often have strict eligibility criteria, which makes it difficult to extrapolate their findings to other populations. Additionally, RCTs are conducted under ideal situations that do not simulate the “real” world settings. Surrogate Outcomes: In dentistry, only a small fraction of trials use clinically relevant outcomes (CROs), such as tooth loss, implant success, or retention of restorations. Most CROs in dentistry require many years to manifest and the number of events is usually very low, which makes the use of these outcomes particularly challenging1. Trial Design: Choosing a proper trial design is crucial for conducting an RCT. The choice of trial design depends on the research question, available resources, and time constraints. Data Management: Data management is another challenge in conducting RCTs. It’s important to ensure that data is collected accurately and efficiently and that it’s stored securely1. Financial Constraints: Conducting an RCT can be expensive, and funding can be a challenge. Communication of Findings: Communicating the findings of an RCT to the scientific community and the public can be challenging. It’s important to ensure that the findings are communicated accurately and effectively.  Systematic reviews and meta-analyses Systematic reviews and meta-analyses are important tools in clinical research. They allow researchers to synthesize the results of multiple studies and provide a more comprehensive understanding of the evidence. A systematic review is a comprehensive and structured approach to identifying, appraising, and synthesizing all relevant studies on a specific research question. A meta-analysis is a statistical technique used to combine the results of multiple studies. Purpose: The purpose of systematic reviews and meta-analyses is to provide a summary of the best available evidence on a specific research question. They can help identify gaps in knowledge, highlight areas for future research, and inform clinical practice guidelines. Process: The process of conducting a systematic review involves several steps, including developing a research question, searching for relevant studies, assessing the quality of the studies, extracting data from the studies, and synthesizing the results. The process of conducting a meta-analysis involves using statistical methods to combine the results of multiple studies. Advantages: Systematic reviews and meta-analyses have several advantages over individual studies. They can provide more precise estimates of treatment effects, identify sources of heterogeneity across studies, and help resolve conflicting results from individual studies. Limitations: Systematic reviews and meta-analyses also have some limitations. They are only as good as the quality of the studies included in the analysis, and they can be affected by publication bias. Additionally, they may not be appropriate for all research questions or study designs.