Professional Documents
Culture Documents
SEMESTER I
1.
2.
3.
4.
SEMESTER II
1.
2.
3.
4.
5.
6.
Medical Professionalism
Community-Based Practice
Health System-Based Practice
Evidence-Based Medical Practice
Special Topic
Elective Study 1
SEMESTER III
1. The Hematologic System and Disorders
and Clinical Oncology
2. Immune System and Disorders
SEMESTER IV
1. The Musculoskeletal System and
Connective tissue Disorders
2. Neuroscience and Neurological Disorders
3. Behavior Change and Disorders
4. The Visual System and Disorders
SEMESTER V
1. The Alimentary and Hepatobiliary System
and Disorders
2. The Endocrine System, Metabolism, and
Disorders
3. Clinical Nutrition and Disorders
4. Special Topic
5. Elective Study 2
SEMESTER VI
1.
2.
3.
4.
SEMESTER VII
1. Medical Emergency
2. Special Topic: Travel Medicine
3. Elective Study 3
APPROCHES OF
CBP
Prevention (not
curative)
Community
(not individual)
Determinants
Genetic
Physical
Social, cultural
Biological, economical
Environment
Behavior
Health Services
Susceptible
(at risk)
Presymtomatic
stage
Clinical
stage
Stage
of
disability
Tertiary prev.
Primary prevention
Early detection
limitation
Health promotion & prompt
Rehabilitation
Specific protection treatment
TATA TERTIB
1.
Selama kuliah
HP dimatikan (bukan
silent)
2. Dalam pleno pagi bila
terlambat > 10 menit
(jam di
dinding ruang kuliah)
mahasiswa tidak
BLOCK CBP
RULE/REGULATIONS
Learning Outcomes:
a) Describe several determinants (models)
of diseases and death occurring in the
population
b) Explain the applications of
understanding diseases and death
determinants (models)
c) Identify the strengths and weaknesses of
diseases models
d) Draw figure of the natural history of a
certain disease
LEARNING SCHEDULE
(time table)
STUDY GUIDE PAGE 7 (CLASS B)
08.00-09.00: Introductory
lecture
09.00-11.00: Independent
learning
Reference 1 & 2
Learning tasks page 18-21
11.00-13.00: SGD
14.00-15.00: Student presentation &
feedback
LEARNING SCHEDULE
(time table)
STUDY GUIDE PAGE 11 (CLASS A)
09.00-10.00: Introductory
lecture
10.00-12.00: Independent
learning
Reference 1 & 2
Learning task-1 & 2 page 18-21
13.00-15.00: SGD
15.00-16.00: Student presentation &
feedback
APPROCHES OF
CBP
Prevention (not
curative)
Community
(not individual)
C. Everett Koop, MD
former U.S. Surgeon General
MODULE-1
Determinants of morbidity
and mortality in a
population
Natural history of the
disease
Diseases prevention
DAY 1
Determinants of
morbidity and
mortality in a
population
Model Blum
Model Mosley
HOST (intrinsic)
(age, sex, genotype, behaviour, nutritional
status)
AGENT
(biologic, physic, mechanical,
chemical, nutrient)
ENVIRONMENT
(Physical, Biological, Social)
AGENT
Biological, chemical, physical
Mechanical, Nutrient
HUMAN HOST
Age, race, sex, habit
Genetic, personality
Defense mechanism
ENVIRONMENT
Biological, chemical, physical
Mechanical, nutrient, social, psychologic
Triad epidemiologik
Homeostatic Balance
A
E
H
A
At equilibrium
Steady rate
A
E
Environmental changes that
favor the host
Biological
Environment
HOST
Genetic
Physical Environment
EXTERNAL (extrinsic)
INTERNAL
(intrinsic)
Social
politic,
economic
culture
Contoh
Kasus Kematian
Ibu
WEB MODEL
(SARANG
LABA-LABA)
BLUM MODEL
Genetic
Behavio
r
Morbidity and
mortality in
a population
Health
services
Environmental factors
(biological, physical, social, economical,
politic)
Socioeconomic determinants
Maternal
factors
Environmental
Contamination
Nutrient
deficiency
Healthy
Personal
Illness
control
Injury
Sick
Prevention
Treatment
Growth
faltering
Mortality
UNDERSTANDING
CAUSALITY
Disease
Step1
rarely happens
Step2
Disease
Disease
Disease
Disease
END OF DAY 1
Plenary day 1
Please refer to the plenary day 1 slides
MODULE-1
Determinants of morbidity
and mortality in a
population
Natural history of the
disease
Diseases prevention
DAY 2
Natural history of the
disease
Disease prevention
susceptibility (population at
pre symptomatic (asymptomatic)
clinical (symptomatic)
disability
PREPATOGENESIS
Agen
PATOGENESIS
Host
Fase klinis
Sembuh
Cacat
Fase penyembuhan
Lingkungan
Fase susceptible
Mati
Kronis
Fase subklinis
50
Clinical disease
Susceptible
host
Recovery
No infection
Incubation
Latentperiod
Exposure
Infectious
Onset
Non-infectious
Meninggal
Symptomatic
stage
Khronis
Carrier
Asymptomatic
stage
Sembuh
dengan cacat
Sembuh
tanpa cacat
Viral Load
Jumlah CD4
Jumlah CD4
200
Infeksi Akut
Infeksi asimtomatik
Window period
Serokonversi
5
Bulan 0 1 2 3 4 Tahun
Simptomatik/AI
DS
5
Secondary prevention
Early detection and
prompt treatment/action
Social
Economical
Physical
Social, cultural
Biological, economical
Environment
Behavior
Health Services
Susceptible
(at risk)
Presymtomatic
stage
Clinical
stage
Stage
of
disability
Tertiary prev.
Primary prevention
Early detection
limitation
Health promotion & prompt
Rehabilitation
Specific protection treatment
58
Periode Prepatogenesis
Kerusakan
Penyakit
awal jaringan
lanjut
Periode Patogenesis
Konvalesens
Promosi kesehatan
Pendidikan kesehatan
Perlindungan khusus
Imunisasi
Kebersihan perorangan
Perkembangan kepribadian
Sanitasi lingkungan
Skrining
Pemeriksaan khusus
Genetika
Tujuan:
Menyembuhkan dan mencegah
penyakit berlanjut
Rehabilitasi
Pembatasan ketidakmampuan
Pencegahan primer
Pencegahan sekunder
Tingkat Penerapan Upaya Pencegahan
Pencegahan tertier
ICE-BERG PHENOMENA
SEVERITY OF DISEASES
TWO CONSEQUENCIES
(DUA KONSKUENSI)
Semakin lebar dasar gunung es:
Semakin sulit penanggulangan penyakit
(control of the disease)
Bila memakai data sekunder, data
(statistik penyakit) akan semakin tidak
akurat
CONTOH: DBD dan RABIES
Epidemiological Iceberg
Only the tip of the iceberg is
easily observable
Dog bite example
3.73 dog bites annually
451,000 medically
treated
334,000 emergency
room visits
13,360 hospitalizations
20 deaths
Mild (ringan)
Moderate
Severe
Fatal
DIFFERENCES BETWEEN
PUBLIC HEALTH
DOCTOR
CLINICAL
DOCTOR
1. Focus: individual
2. Responsibilities:
all people who come
all people in certain
geographical area, health and to the health facilities.
They usually passive.
sick, those who come and
those who do not come to
health facilities. They must
actively provide diseases
prevention to all people who
are at risk
1. Focus: population
2. Responsibilities:
PUBLIC HEALTH
DOCTOR
CLINICAL
DOCTOR
3. Function:
to cure and to
increase the
patients quality
of life
4. Place of works:
private practices,
hospitals, etc
PUBLIC HEALTH
DOCTOR
CLINICAL DOCTOR
6. Diseases
measurements in the
community:
proportion, prevalence,
incidence, ratio
6. Diseases
measurements for
individual patient: level
of blood pressure, blood
sugar, level of
hemoglobin, etc
5. Diagnostic tools:
5. Diagnostic tools:
epidemiology,
stethoscope, ECG, lab
statistics, demography examinations kits , CT
Scan, etc
PUBLIC HEALTH
DOCTOR
7. Treatment at the
community level
(prevention): public
health program such as
education program,
immunization program,
nutrition program,
family planning
program, etc
CLINICAL
DOCTOR
7. Treatment for
individual patient
(diagnosis and
care):
medical
treatments,
surgery,
radiation,
physiotherapy,
etc
PUBLIC HEALTH
DOCTOR
8. Indicators for
evaluating community
health program: percent
decrease of under
nutrition, percent
increase of contraceptive
use for family planning,
etc
CLINICAL
DOCTOR
8. Indicators for
evaluating the result
of patients
treatments:
decrease of blood
pressure of the
individual patient,
increase of
hemoglobin
(clinical & PH
SOAL-SOAL
PEMANASAN
SEBELUM UJIAN
Contact tracing
Cohort
Case-control
Cross-sectional
Clinical
skill
Critical
Community thinking
Health
(Pu-blic
Health)
CBP
Information
management Scientific
Communication
skill
Professional,
values,
attitudes
foundations
Pertanyaan pendengar
dalam program interaktif di
sebuah stasiun radio di Bali
Tempat tidur pasien demam
berdarah yang dirawat di rumah
sakit kok tidak pakai kelambu?
Kalau pasien digigit nyamuk Aedes
kan bisa menularkan penyakitnya
kepada petugas di RS atau kepada
pasien lain?