4.epidemiology tutorial (realtioonship of epidemiology biostatistics & dph ) sept 25th 2014(edited)
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Transcript of 4.epidemiology tutorial (realtioonship of epidemiology biostatistics & dph ) sept 25th 2014(edited)
Dr Tin Myo Han
Department of Community Dentistry
Kulliyyah of Dentistry, International Islamic University, Malaysia
Epidemiology Biostatistics Public Health/ Dental Public
Health
25/9/2014
25/9/2014
IIUM
Epidemiology of Dental Caries & Periodontal Disease - Magnitude (prevalence of Dental Caries & PD) - Analysis of Epidemiological Data: *Comparison between clinic’s register and community survey - Applicability of Epidemiological Data analysis
25/9/2014
• Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
• Public Health Activities: -Prevention & Promotion of Oral Health: Action Plan to reduce Periodontal Disease burden
EPIDEMIOLOGY
Bio-stat
• Assignment for Students
DPH
25/9/2014
A public dental Clinic
(KK-Gigi, Kuantan)
In accordance with clinic’s register,
Period : from 1st January 2013 to 31st December 2013
Total dental Patients : 500 patients
-Adult dental caries : 220 cases
-Periodontal diseases : 110 cases
-Pediatric dental caries : 70 cases
-Dentures : 20 cases
- Dental check-up : 30 cases
- Oral surgical cases : 45 cases
- Orthodontics & other : 5 cases
25/9/2014
A Community Oral
Health Survey
- Community dentistry department, KOD, IIUM,
conducted a community survey in Kuantan to
estimate the magnitude of common oral health
problems in 2013
-Total 350 dental caries cases
-250 periodontal cases
-25 newly diagnosed oral ulcer cases and
-15 dental injury cases (old + new)
- were identified from 5000 persons under the study
Epidemiology of Dental Caries & Periodontal Disease - Magnitude (prevalence of Dental Caries & PD) - Analysis of Epidemiological Data: *Comparison between clinic’s register and community survey - Applicability of Epidemiological Data analysis
25/9/2014
• Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
• Assignment for Students
25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Rate,Ratio, Proportion, Prevalence and Incidence)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey? Q3. What is your conclusion on the epidemiological data analysis ? Q4. What should you do to get more understanding on the situation ? Why ?
Public Dental Clinic Community Survey
Proportion of dental caries (adult + Child) in 2013 = ( 220 +70)/500 *100 = 58% of patients /year Proportion of PD in 2013 = 110/500 *100 = 22% of patients/year Ratio of Dental Caries
and Periodontal cases = 290:110 = 29:11 ~ 3:1
Prevalence of Dental caries ( 2013)
= 70 cases per 1000 population
Prevalence of PD ( 2013) = 50 cases per 1000 population
25/9/2014
Public Dental Clinic Community Survey
Proportion of dental caries (adult + Child) = ( 220 +70)/500 *100 = 58% of patients Proportion of PD = 110/500 *100= 22% of patients
Prevalence of Dental caries ( 2013)
= 70 cases per 1000 population
Prevalence of PD ( 2013) = 50 cases per 1000
population
25/9/2014
Prevalence Dental Caries = 58% or 580 cases per 1000 patients per year
Prevalence of PD = 220 cases per 1000 patients per year
Ratio of Dental Caries & PD
= 290:110 (or) 58 :22 = 29:11 ~ 3:1
Ratio of Dental Caries & PD
= 350:250 (or) 70:50
= 7:5 =1.4 :1~ 1.5 :1
RATIO
25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Proportion, Prevalence and Ratio)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey ? Q3. What is your conclusion on the epidemiological data analysis ? Q3. What should you do to get more understanding on the situation ? Why ?
25/9/2014
“We have more dental caries cases than PD! (3:1)” ……” Prevalence of dental caries in the clinic higher than that of PD” ! (Clinic attendance rate)
“In our community survey also more dental caries cases than PD! (1.4:1)” …”Prevalence of dental caries is also higher than that of PD in community”…
..” However, PD cases were found more in the community survey than clinics “ ……………
(3:1) vs (1.4:1)
25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD (epidemiological measurement)? ( Proportion, Prevalence and Ratio)? Q 2. Which epidemiological measurement will be used to compare these epidemiological data between the public dental clinic and the community survey ? Q3. What is your conclusion on the epidemiological data analysis ? Q4. What should you do to get more understanding on the situation ? Why ?
25/9/2014
..” However, PD cases were found more in the community survey than clinics “ ……………
(3:1) vs (1.4:1)
..” We want to know why PD cases were found more in the community survey than in the clinic “
“ Which factors are influencing on it?
“Epidemiological question (or) starting point for Epidemiological study “
1. Trend study 2. Community diagnosis 3. Health services evaluation 4. To know the individual risks and chances 5. Syndrome identification 6. Completing the clinical picture 7. Searching for causes / risk factors for
establishing causal relationship (New diseases or existing diseases)
15
25/9/2014
Why PD cases were found more in the community survey than in the clinic“ “ Which factors are influencing on it?
25/9/2014
TIME
PLACE PERSON
Agent
Host Environment
Causation Triads Distribution Triads
MOT
25/9/2014
TIME
PLACE PERSON
Agent
Host Environment
Causation Triad Distribution Triad
Epidemiology of Dental Caries & Periodontal Disease - Magnitude (prevalence of Dental Caries & PD) - Analysis of Epidemiological Data: *Comparison between clinic’s register and community survey - Applicability of Epidemiological Data analysis
25/9/2014
• Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to Combat Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
• Assignment for Students
“Role of Biostatistics in Epidemiological Investigation “
25/9/2014
25/9/2014
Community Survey: December 1st -31st,2013
Clinic: Klinik Kasiharan Balok
“Distribution of disease (Distribution Triad)”
Clinic register:1st January to December 31st,2013
Community: Sungi Lembing
Survey: 250 PD cases
/5000 person
Clinic: 110 PD cases/500
Patients
TIME PERSON
PLACE
25/9/2014
Community Survey: December 1st -31st,2013
“Distribution Triad: TIME
Balok Clinic register: 1st January to December 31st,2013
Distribution: endemic pattern Distribution: epidemic/outbreak pattern
25/9/2014
“Distribution Triad: PLACE
Residence:
Out of 110,
-108 patients
(Balok community)
-2 patients (Beserah)
•* *
* * •* *
* *
*
KK Balok Dental Clinic Community Survey: December 1st -31st,2013
Residence:
Out of 250,
-108 cases
(Sungai Lembing )
-142 patients
(Flood Relief Center
Sungai Lembing)
•* *
* *
•* *
* *
•* *
* *
Epidemiological Mapping
25/9/2014
Community Survey: December 1st -31st,2013
“Distribution of disease (Distribution Triad)”
TIME
3rd to 7th December 2013
25/9/2014
“Distribution Triad: PERSON (Age,Gender,Race,Edu & Occupation)
Age Groups
Periodontal Cases
Significant test & “p” Value
Community Survey Sungai Lembing
(n=250) n(%)
Public Dental Clinic (Balok) (n=110)
n(%)
< 20 years 10 (4) 6 (6)
X2 test “p” >0.05
21-40 years 63(25) 28 (25)
41-60 years 127(51) 61 (55)
>60 years 50(20) 15(14)
Total 250 110
Summary descriptive statistics
Minimum = 18 Maximum = 67 Mean(±SD )= 43(± 5.1)
Minimum =17 Maximum = 65 Mean(±SD )= 44(± 4.9)
“ t” Test “p” >0.05
Based on distribution triad analysis,
- unexpected increase in number of PD cases was found 2 weeks after Flood (time) - 56.8%(146/250) of them were from Flood relief
centers (place) - 51% ( 127/250) were 41-60 years old ( Person) - Thus, more PD cases in Community survey may be more occurrence of PD among Persons from flood relief centers
25/9/2014
Hypothesis of Distribution
25/9/2014
AGENT
ENVIRONMENT
HOST
25/9/2014
AGENT
Ref: Basic Epidemiology assignment answered by dental students (2014-2015)
29
?P
D K
no
wle
dg
e
Diet/Sweet
?S
tres
s
AGENT
Most likely causes of PD in Community Survey in Kuantan 2013
25/9/2014
Risk factors
Periodontal Cases Significant
test & “p” Value
Community Survey Sungai Lembing
(n=250) n(%)
Public Dental Clinic (Balok) (n=110)
n(%)
Yes No Yes No
X2 test “p”
Poor Oral Hygiene 67% 33% 42% 58%
Stress (+) 70% 30% 30% 70%
DM (+) 47% 53% 27% 73%
-Significant Association between “(Poor oral hygiene & PD)”
(Stress & PD ) were found in community survey
25/9/2014
HOST
25/9/2014
HOST
More severe PD cases were seen among:
- more than 41 years old (60%),
- female (67%) and
- DM patients ( 76%)
25/9/2014
ENVIRONMENT
Macro environment : -weather (flood) -Social status ( flood relief centre) - OH materials and supply -Other factors
Micro environment : -Oral flora changes because of Oral hygiene practices , Stress, Underlying Medical disease (DM)
Based on causal triad analysis, Causes of more PD cases
were :
- Poor OH practices , Stress, and underlying medical
disease (DM) (Agent)
- Severe PD were above 41 years old, female, DM (Host)
- flood in Kuantan and changing oral flora (environment)
25/9/2014
Causal Hypothesis
25/9/2014
EPIDEMIOLOGY
Descriptive Hypothesis
Descriptive
Statistics
Age , sex,
occupation,
( Minimal ,
Maximum age,
Frequency ( %)
Causal Hypothesis
Inferential
Statistics
Significant Association
b/t age, sex , risk factors & occurrence of disease
( X2, ANOVA)
Epidemiology of Dental Caries & Periodontal Disease - Magnitude (prevalence of Dental Caries & PD) - Analysis of Epidemiological Data: *Comparison between clinic’s register and community survey - Applicability of Epidemiological Data analysis
25/9/2014
• Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
• Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
• Assignment for Students
Prevention & Promotion of Oral Health: Action Plan to reduce burden of
Periodontal
25/9/2014
Primary prevention : -Screening PD among community & risk populations
(self-reported questionnaires & professional screening (BPE)
Secondary prevention : - Early diagnosis and prompt treatment to reduce loss
of teeth ( avoidable ) Tertiary prevention (Rehabilitation) : Quality of life of PD patients!
25/9/2014
25/9/2014
Oral health care in unusual situation ( eg. flood) :
25/9/2014
More
PD cases in Community survey
Public Dental Clinic vs Community
Survey
(Case findings of caries and PD)
( 270 vs 350 in dental caries) &
(110 vs 250 in PD)
Dental Caries vs Periodontal Disease
( 3:1 in Public Clinics & 1.4 :1 in Community survey
25/9/2014
25/9/2014
In the scenario, Ratio of Dental Caries &
PD, Dental caries ceases are higher than PD in both private dental clinics data and community survey.
Q-1 : Give reasons for attending less PD at
public dental clinics and finding less PD in community survey comparing with dental caries?
Dental Caries vs Periodontal Disease?
Answers 1:
Nature of diseases (Overt caries vs hidden PD
cases)
Knowledge of patients on PD
Awareness of patients on PD & Dental services
Oral health seeking behavior ( peer )
Other unknown factors (!!! Research)
25/9/2014
25/9/2014
In the scenario, more Dental caries and PD cases were found in community survey than public dental clinic
Q-2 : Give reasons for finding more Dental
caries and PD cases in community survey?
Community survey data vs Public dental clinic data?
Answers 2:
Active case finding (community survey) vs passive case
finding ( public dental clinic)
Iceberg phenomenon
Socio-economic and cultural factors
( communication, financial support, value and norm on
oral health)
Knowledge of patients on OH care & services
Other factors (unknown )!! Research
25/9/2014
25/9/2014
25/9/2014 47
“ Oral Health Manpower & Trends of common oral health problems in
“MALAYSIA ” comparing with Japan, & Singapore )
4th Year Dental Students ( 2014-2015)