_Community Public Health outline.pdf

Outline Public Health Passcode: ?hQF9nSx Community Health Vs Private practice Community/Public Health...

Outline Public Health Passcode: ?hQF9nSx Community Health Vs Private practice Community/Public Health Private practice Survey and needs assessment * health history and exam Data analysis * Diagnosis Program planning * treatment planning Program operation * treatment Funding * payment Appraisal or evaluation * evaluation ADPIED: assessment, diagnosis, planning, implementation, evaluation and documentation Health for all people: protention, prevention, promotion Roles in public health can be as a clinician, educator, advocate, researcher, administrator Goals of Public Health Prevent epidemics and disease spread Protect against environmental hazards Prevent injuries Respond to disasters Assist communities in recovery Assure quality/accessibility to healthcare services Health education: education chair side or groups= verbal= leads to health awareness Health promotion informing and motivating; non-verbal= Examples Application of services Review fluoride systemic and topical discuss programs in school systems systemic is only helpful during the stages of tooth development ○ only affecting children topical can be from water supply; adults for everyone: toothpaste, mouth rinses, professionally applied fluoride, custom trays 2% neutral sodium fluoride rinse for 60 seconds once per week ○ not recommended for children under the age of 6 varnish program is the most effect at providing fluoride in a communit abscess of fluoride water fluoridation in schools ○ 4-5 times higher than in a community water supply Dental caries Prevention the most chronic childhood disease higher in lower economic social classes due to high sugar beverages root caries on the rise in elderly due to recession, polypharmacy, and not getting the care they need offer dental health education, dietary counseling, sealants (first 6 months after eruption) ○ helping children understand the acid production Periodontal disease Prevention affects 70% of the population bacteria/microbes is the number one cause tobacco is a risk factor; 2-6 times more likely to develop perio disease ○ if a pt quit smoking, still need to consider in grading process ○ damage has already been done men, low economic status and education Oral Cancer Prevention smoking and alcohol major risk factors 5 A’s for smoking cessation ○ ask, advise, assess, assist, arrange 80% start under the age of 18 years old Governmental levels of community health 1. International: looking at the treatment needs of EVERYBODY WHO: world health organization o CPITN: Community Perio of Index Treatment needs ▪ only used by WHO, use a WHO probe 2. Federal: focus on healthy problems of national population a. DHHS: Department of Health and Human services ( published Healthy people 2010) FDA: food and drug agency CDC: centers for disease control o recommendations o supplies funding NIH: national institute of health HRSA: healthy resources and services administration NIDCR: national institute of dental and craniofacial research AHRQ: agency for healthcare research and quality 3. State: local healthy department a. medicaid 4. Local: county, city, districts a. initiate the legislation for water fluoridation Terms-vocabulary Health: complete physical, mental, and social well-being Epidemiology: study of healthy and disease in a population data o Qualitative data: categorized, list ▪ categorical variable: no numeric representation= color or rating ▪ dichotomous variable: places subject into two groups= male/female, yes/no, pass/fail, true/false o Quantitative data: information that can be counted and expresses as a number ▪ graphs and charts ▪ continuous variable: large or infinite numbers or fractions= height weight ▪ distinct and separate units, whole numbers= number of children, DMFT Prevalence: EXISTING AND NEW cases in a population in a period of time Incidence: NEW cases and diagnosis at risk Epidemiology examines effects of Host factors: age, gender, race, immunity Biological cause: bacteria, viral, fungal Environmental: sun, pollutant, radiation Lifestyle: SES, drug and alcohol use, diet Epidemic: around a particular place and time; large number of people affected Endemic: occurs regularly within a population routinely Pandemic: outbreak of disease with a wide geographical area Types of preventative services: 1. Primary: no disease breakdown present a. arrest, prevent/promotion, reverse a disease process before tx is necessary i. ex: fluoride treats, immunization, education programs 2. Secondary: restore AFTER something has started a. intervention, termination b. treatment of disease and control of risk factors  i. ex: perio debridement, fluoride tx for demineralized enamel, simple restorations, education, physical and nutrition on OBESE individuals, screenings for early disease detection (looking for disease) 3. Tertiary: loss of something a. replace, rehabilitation b. prevent future loss i. ex: implans, dentures, partials, crowns *Examples in public health settings Rates Terms: Natality: number of LIVE births Morbidity: rate of illness; ratio of affected individuals to well individuals Mortality: rate if death Attack: single disease outbreak o occurs in a particular population Risk factors: can change it or you can't change it o identified in longitudinal study o smoking Risk indicators: suspected to cause a problem Risk markers: NOT modifiable o ex: race, gender, age, sex vital index: number of births in a given year divided by the number of deaths in a given year. Types of sampling bias: make a decision that is not completely without reason 1. Random: equal chance for everyone; best way to reduce bias 2. Stratified: sub-group; equal proportions from each group 3. Systematic: controlled by numbers, nth individual 4. Judgment: highest chance of causing bias; based on the person picking 5. Convenience: choose solely on convenience; easier to make decision, simple 6. Snow ball: I select a member and they select other people 7. Quota: amount until reaching limit Scales of measurement Nominal: order according to category but no rank; ethnic Ordinal: ranking order but not equal; gold-silver-platinum-bronze Interval: units that have a zero center, can be positive or negative; Fahrenheit Ration= their is a zero and you can only go up in equal measurements; height/weight Study types and research methods 1. Descriptive: describe and observe who, where, when, correlation to thinks; no manipulation; researchers may interact or they may not. Cross-sectional: snapshot in time, most common Longitudinal (retro or pro): group is observed over a long period of time and data is collected at certain intervals o retrospective: looking back and comparing now; only describing o prospective: watching to see what the future will be like 2. Analytical: analyzing to establish hypothesis; interventions, something is being added or taken away a. hypothesis b. Null Hypothesis: preferred research method of an analytical study; researcher tries to disprove or nullify Longitudinal: collect data at 2 or more interval in a group Cross-sectional: snapshop; single point in one time Retrospective (case-control method): comparing a past associated to now Prospective (cohort method): future; offering intervention along the way 3. Experimental: controlled in a lab, will be using controls and treatment groups a. control: treatment is being withheld, get placebo b. treatment: receiving the treatment c. blindness: researcher is unaware but the subject is aware what group they are in. d. double blindness: neither the researcher or subject are aware of what is going on e. variables: things we might add or take away  i. dependent variable:the outcome of interest AT THE END; what we want to happen; what gets measured for everybody. 1. DEPENDS ON INDEPENDENT ii. independent variable: what is manipulated to produce what we want iii. uncontrolled variable: not related to study and can not be controlled 4. Quasi experimental: no control group; unethical 5. Pilot study: small trial study IRB: Institutional Review Board: reviews the ethical implications of a study and that they are safe crossover study:treatment groups are reversed midway through the study, require a period for the groups to return to baseline levels (a washout period) before starting the other treatment Evaluation of results: Biostatistics is used 1. Descriptive statistics: Describe, present, summarize and organize numerical data on a graph or table; measures central tendency (middle) a. Data matrix: arrange scores from lowest to highest b. Determine frequency distribution Ungrouped: ascend or descending order and next to each other is the frequency of each number Cumulative: frequency of occurrence of the score up to including those about it are added Grouped: falling in between numbers that are group; similar to grades 1) Example: 96,96,92,91,96,92,88,91,96,89 2) Data matrix= 88,89,91,91,92,92,96,96,96,96 3) Ungrouped: 96=4 4) Cumulative: 96=4 92=2 92=6 (92 and higher) 91=2 91=8 89=1 89=9 88=1 88=10 5) Grouped: 91-96=8 (above 90 = A) 88-89=2 (between 80-90 =B) c. Measure of central tendency: middle Mean: average 927/10=92.7 o most common o affected by extreme values Median: midpoint 92 two number that are not the same: add and divide by 2 Mode/ peak: most frequent 96 d. Measure of Dispersion Range: subtract the lowest score from highest score in the number set; 96-88= 8 o least helpful Standard Deviation: square root of the variance; amount, have to be the same o most common and useful measure of dispersion o on a Normal, Bell, Gaussian curve most of the numbers are -1 to 1 because that is what the mode is o want small to make sure results are more precise Types of Curves: e. Normal, Bell, Gaussian curve = mean, median, mode all the same f. Positive skew: I am positive I will fall down this hill (left) i. mode is in the beginning -> median -> mean ii. mode is in the lowest number set g. Negative skew: I am negative about climbing this hill (right) i. mode is in the higher number set ii. mean -> median-> mode  2. Inferential statistics: Generalize findings; how do things relate between two things Terms: Validity: does the test really measure what is claims to be measuring; accuracy of data and the accuracy of methods and instruments used to collect data ▪ CAL is the best predictor of advanced periodontal disease ▪ internal validity: how accurate were the results; length of study, study size, and accuracy of statistics ▪ external validity: how well does the sample represent the population Reliability: consistently; reproducible easily ▪ Intra-examiner: same examiner every time ▪ Inter-examiner: difference examiner ▪ Calibration: best way to increase the reliability of inter-examination Sensitivity: identify the presence of disease; fewer cases are miss; number of true positives Specificity (no -en): ability to test for the absence of disease; show less false positive or negative test 1. Correlation coefficient: strength of the relationship between two variables (R-value) that can be measured; usually falls between -1 to 1 the closer the relationship; both can be strong; have to choose the one that is the closest to either -1 or 1! Positive correlation: when one goes up the other goes up ▪ direct association: positive skew Negative correlation: when one goes up the other goes down ▪ opposite: negative skew The tighter the cluster of # the stronger the relationship 2. Test used in inferential statistics: T-test: comparing two means; most common ANOVA (expressed in a F-value): 3 or more scores they are comparing P-value: probability that something will happen on its own (by chance) ▪ 1 out of 20 or