Study guide cbp semester 2 tayang 12 maret 2015

2015

Community-Based Practice

Department of Community

and

Preventive Medicine

Study Program of Medicine

L I S T 0 F C O N T E N T

List of Module 2

Curriculum of Community Based Practice 3

Planners Team 7

Facilitators 8

Skill Lab Facilitators 9

Reserve Facilitators 9

Time Table 10

Skill Lab Time Table 22

Assessment Method 22

Introduction 23

Module 1 – 18 24

References 98

Annex 1 Film Summary “And the band played on” 99

Annex 2 Artikel Koran Bali Post 104

Annex 3 Artikel jurnal 109

Skill Lab (1-3) 110

L I S T O F M O D U L E

MODULE ~ 1 (Mausner & Bahn, p. 1-42) p. 26

Determinants of Health/Diseases, Natural; History of Diseases and Diseases Prevention

MODULE ~ 2 (Kirkwood and Sterne, chapter 2) p.32

Population, Sample, Data, and Variables

MODULE ~ 3 (Greenberg p. 15-28) p.35

Measurements of Morbidity and Mortality in a Population; Source of Error in Measurements

MODULE ~ 4 (Greenbergp. 51-53) p.40

Crude, Specific and Adjusted Rate

MODULE ~ 5 (Skill Lab Manual, Kirkwood & Sterne, Chapter 2) p. 43 Skill Lab: Data entry, Data Cleaning, and Data Transformation

MODULE ~ 6 (Greenberg, p. 29-43) p.45

Analysis and Interpretation of Descriptive Data

MODULE ~ 7 (Kirkwood & Sterne, Chap 3 &4) p.49

Data Presentation and Data Description

MODULE ~ 8 (Skill Lab Manual, Kirkwood & Sterne) p.54

Skill Lab Data Presentation and Data Interpretation

MODULE ~ 9 (Kirkwood & Sterne, Chap. 5-8, 10, 14, 15) p.55 Inferential Analysis and Interpretation of Analysis Results

(Hypothesis Test)

MODULE ~ 10 (Kirkwood & Sterne, Chap. 7, 9, 11, 16, 18, 19) p.59 Significance Test for Categorical and Interval Data

MODULE ~ 11 (Skill Lab Manual, Kirkwood & Sterne) p. 64 Correlation-Regression, Significance Test

For Categorical and Interval Data

MODULE ~ 12 (Greenberg, p. 45 – 73) p. 65

Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

MODULE ~ 13 (Greenberg) p. 72

Epidemiology Study to Determine Risk Factor of Disease

MODULE ~ 14 (Greenberg, p. 113-123) p.79

Epidemiology Study Design: Cohort Study

MODULE ~ 15 (Greenberg, p. 127-136) p.83

MODULE ~ 18 (Mausner & Bahn, p. 91-110, Greenberg 141-153) p. 95 Variability and Biases

CURRICULUM

Community Based Practice

Competency Statement

Instructional Goals

Learning Objectives Topics

Use community based-practices to conduct studies that improve diseases

prevention in the community

Demonstrate ability to apply health prevention principles based on risks and determinant factors of health problem

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 figures of the natural history of a certain disease.

e) Explain the applications of the natural history of a disease for prevention. f) Explain the severity of

diseases in a population and its implication to prevention.

g) Explain the Ice Berg phenomena and its implication in diseases prevention.

h) Describe the level of disease prevention based on determinants and natural history.

Determinants of Morbidity and Mortality in a Population, Natural History and Diseases Prevention

Competency Statement

Instructional Goals Learning Objectives Topics Demonstrate ability

to search, organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health

a) Explain

measurements of morbidity and mortality in a population. b) Describe the

definitions of population and sample.

c) Explain the conditions required for a

representative sample.

d) Explain several sampling methods. e) Describe types of data

and variables. f) Be able to prepare

software for data entry.

g) Differentiate

proportion, ratio, rate, prevalence and incidence.

h) Explain four types of incidence based on their denominators. i) Describe the source

of numerators and denominators for prevalence and incidence.

j) Explain types of errors in rate calculation.

Measurements of Morbidity and Mortality in a Population

k) Explain the differences, application, interpretation, and weaknesses of (slide) crude, specific, and adjusted rate. l) Be able to analyze,

and interpret crude, specific and adjusted rate.

Pattern of Morbidity and Mortality Based on Person, Place, and Time

Competency Statement

Instructional Goals Learning Objectives Topics m) Be able to analyze,

present, and interpret descriptive categorical and interval data. n) Be able to analyze

and present data using computers. Be able to interpret the measurements of morbidity and

mortality on samples descriptively.

o) Explain the method to determine disease prognosis from the population (survival analysis).

p) Be able to manage, analyze and interpret data inferentially. q) Describe the

definition,

requirements, types, and applications of surveillance.

r) Be able to conduct an epidemiologic

investigation of an outbreak.

Surveillance and Disease

Demonstrate ability to apply methods to determine risk factors of a disease and effectiveness of diseases intervention/ treatment/ prevention a. Describe epidemiological design, e.g.: cross-section, case-control, and cohort, to

determine risk factors of diseases.

b. Explain the advantages and disadvantages of cross-sectional, case-control and cohort design.

c. Describe the

application of clinical trials to determine the effectiveness of intervention, prevention, and treatment of diseases.

Methods to determine risk factors, effectiveness of treatment, prevention, and intervention of diseases in the community

Competency Statement

Instructional Goals Learning Objectives Topics d. Be able to describe

the differences between descriptive, cross-sectional, case-control, and clinical study design.

e. Describe the concept of patient variability, variability in medical research, variability of measurement, both in individual and

population level. f. Explain internal validity, external validity, selection bias, information bias, and confounding factors. g. Describe sources of

bias in descriptive research design, cross-sectional,

case-Analyze and interpret data of diseases screening in the community

a. Be able to apply the concept of sensitivity, specificity, and predictive value b. Describe the concept

of cut off points.

Screening of diseases in the community

~ PLANNERS TEAM ~

No Name Department Phone

1 Prof. dr. D.N. Wirawan, MPH _{(Coordinator)} Community/Preventive 0811394306

2 dr. A.A.Sg. Sawitri (Secretary) Community/Preventive 0817340145 3 dr. I.B. Wirakusuma, MOH Community/Preventive 08124696647

4 dr. Ayu Swandewi, MPH Public Health 088113677930

5 dr. Komang Ayu Kartika Sari, MPH Community/Preventive 082147092348 6 dr. Nyoman Sutarsa, MPH Community/Preventive 087860380028 7 dr. Ni Wayan Septarini, MPH Public Health 081353342409 8 dr. Putu Aryani, S. Ked Community/Preventive 081805664963 9 dr. Ni Luh Putu Ariastuti, MPH Community/Preventive 0818560008 10 dr. Gede Artawan Eka Putra, M. Epid Public Health 087860118004 11 Dr. Putu Cintya Denny Yuliatni Community/Preventive 081353380666

~ FACILITATORS ~

Regular Class (Class A)

No Name Department Phone Group Room

Number

1 Dr.rer.Nat. dr. Ni N. Ayu Dewi, M.Si Biochemistry 081337141506 A-1 A.3.09 2 dr. Ni Luh Putu Eka Diarthini,

S.Ked Parasitology 081353077733 A-2 A.3.10

3 Dr. I Gusti Nyoman Sri Wiryawan,

M.Repro Histology 082341768888 A-3 A.3.11

4 I.B. Putra Dwija, S.Si, M.Biotech Microbiology 08179747502 A-4 A.3.12 5 Drs. I Gede Made Adioka, Apt,

M.Kes Pharmacy 081999418471 A-5 A.3.13

6 dr. I Wayan Eka Sutyawan, Sp.M Opthalmology 081338538499 A-6 A.3.14 7 dr. I B Rangga Wibhuti, M.Biomed,

Sp.JP Cardiovascular 081237287888

A-7 A.3.15 8 dr. I Putu Kurniyanta, Sp.An Anaesthesiology 081805755222 A-8 A.3.16

No Name Department Phone Grou

p NumberRoom

1 Dr. I Putu Adiartha Griadi, M.Fis Phisiology 081999636899 B-1 A.3.09 2 Dr. Komang Ayu Kartika Sari, MPH Community/ Preventive 082147092348 B-2 A.3.10 3 dr. I Nyoman Sutarsa, MPH Community/ Preventive 087860380028 B-3 A.3.11 4 dr. I Nyoman Arcana, Sp.Biok Biochemistry 0811397960 B-4 A.3.12 5 dr. I Made Susila Utama, Sp.PD-KPTI Internal Med 08123815025 B-5 A.3.13 6 dr. I Made Suka Adnyana, Sp.BP Plastic Surgery 081236288975 B-6 A.3.14 7 dr. I Made Sudipta, Sp. THT-KL ENT 08123937063 B-7 A.3.15 8 dr. I Wayan Aryabiantara, Sp.An Anaesthesiology 08123822009 B-8 A.3.16 9 dr. I G Kamasan N. Arijana, M.Si.Med Histology 085339644145 B-9 A.3.17 10 dr. I Made Oka Negara, S.Ked Andrology 08123979397 B-10 A.3.19

Skill Lab Facilitators

No Name Department Phone

1 dr. G.N. Indraguna Pinatih, MSc. Com/Prev 08123816424

2 dr. Wayan Weta, MSc. Com/Prev 081337005360

3 dr. A.A.Sg. Sawitri, MPH Com/Prev 0817340145

4 dr.Putu Ayu Swandewi, MPH Public Health 081338996006 5 dr. Ni Luh Putu Ariastuti, MPH Com/Prev 0818560008 6 dr.I Wayan Gede Artawan EP, M.Epid Public Health 03617848123 7 dr. Komang Ayu Kartika Sari, MPH Com/Prev 082147092348

8 dr. Nyoman Sutarsa, MPH Com/Prev 087860380028

9 dr. Ni Wayan Septarini, MPH Public Health 081353342409 10 dr. Wulan Citra Sucipta, S.Ked Com/Prev 081805570772

Reserve Facilitators

No Name Department Phone

1 dr. A.A.Sg. Sawitri, MPH Com/Prev 0817340145

2 dr. I.B Wirakusuma, MOH Com/Prev 08124696647

3 dr. Putu Cintya Denny Yuliatni Com/Prev 081353380666 4 dr. Ni Wayan Septarini, MPH Public Health 081353342409

5 dr. Wulan Citra Sucipta, S.Ked Com/Prev 081805570772

6 dr. Ni Luh Putu Ariastuti, MPH Com/Prev 0818560008

~ TIME TABLE ~

English Class (B)

Days/date Time Activity Venue Conveyer

1 Thursday 12th _{of March}

08.00 –

09.00 Introductory

Theatre 4th Floor

dr. A.A.Sg. Sawitri, MPH

09.00 –

10.30 Movie

10.30 –

12.00 Discussion

12.00 –

13.00 Break/lunch 13.00 –

15.00

Independent

learning/Student Project (SP)

2 Friday

13th _{of March} 08.00 – 09.00

Introductory lecture 1 Determinants of morbidity and mortality in a population

Class Room (CR)

3.01 _{Prof. dr. D.N.} Wirawan,

10.30 – 11.30

Introductory lecture 3 Diseases prevention

11.30 –

12.30 Break/lunch

12.30 – 15.30

SGD : Determinants of morbidity and

mortality in a

population Discussion

Room (DR) SGD : Natural history

of diseases SGD : Diseases prevention

3 Monday 16th _{of March}

08.00 –

09.00

Student presentation and feedback : Determinants of morbidity and mortality in a population

CR 3.01

Prof. dr. D.N. Wirawan, MPH

dr. Ni Wayan Septarini, MPH 09.00 –

10.00

Student presentation and feedback : Natural history of diseases 10.00 –

10.30 Break

10.30 – 11.30

Student presentation and feedback : Diseases prevention

11.30 –

12.30 Break/Lunch

12.30 –

15.00 Independent Learning/SP 4

Tuesday

17th _{of March 08.00 –} 09.00

Introductory Lecture Population, Sample, Data, and Variables

CR 3.01 dr. Putu Ayu Swandewi, MPH

dr. Gd Artawan, M.Epid

09.00 – 10.00

Introductory Lecture Measurements of Morbidity and Mortality in A

Population; Source of Error dr. Ayu Kartika Sari, MPH dr. Sawitri, MPH

10.00 – 10.30

10.30 – 11.30

Introductory Lecture Crude, Specific and

Adjusted Rate

11.30 –

12.30 Break/Lunch

DR

12.30 – 15.30

SGD : Population, Sample, Data, and Variables

SGD : Measurements of Morbidity and Mortality in A

Population; Source of Error

SGD : Crude, Specific and Adjusted Rate

5 Wednesday

18th _of March

08.00 –

09.00

Student presentation and feedback :

Population, Sample, Data, and Variables

CR 3.01 dr. P. Swandewi, MPH dr. Gede Artawan Eka Putra, M. Epid

09.00 – 10.00

Student presentation and feedback : Measurements of Morbidity and Mortality in A

Population; Source of Error dr. Ayu Kartika Sari, MPH dr. Sawitri, MPH

10.00 –

10.30 Break

10.30 – 11.30

Student presentation and feedback : Crude, Specific and Adjusted Rate

11.30 –

12.30 Break/Lunch

12.30 –

15.30 Independent Learning/SP 6

Thursday

Skill lab Schedule

Skill Lab

Data Entry, Data

CR 3.01 Skill Lab Team

7 Monday

23th _of March 09.00 – 10.00 Introductory Lecture Analysis and Interpretation of Descriptive Data

CR 3.01 dr.

Wirakusuma, MOH dr. Ariastuti, MPH 10.00 – 11.00 Introductory Lecture Data Presentation and Data Description

dr. Putu Ayu Swandewi, MPH dr. Gede Artawan Eka Putra, M. Epid 11.00 –

12.00 Independent Learning/SP

12.00 –

13.00 Break/Lunch

13.00 – 15.00

SGD : Analysis and Interpretation of Descriptive Data

DR

SGD : Data

Presentation and Data Description

8 Tuesday

24th _of March

09.00 –

10.00

Student presentation and feedback Analysis and Interpretation of Descriptive Data CR 3.01 dr. Wirakusuma, MOH dr. Ariastuti, MPH 10.00 – 11.00

Student presentation and feedback : Data

Presentation and Data Description

dr. Putu Ayu Swandewi, MPH dr. Gede Artawan Eka Putra, M. Epid 11.00 –

12.00 Independent Learning/SP

12.00 –

13.00 Break/Lunch

13.00 –

15.00 Independent Learning 9

Wednesda y 25th _of

March

Skill lab Schedule

Skill Lab

Data Presentation and Data Interpretation

CR 3.01 Skill lab Schedule

10 Thursday

26th _of March

09.00 –

10.00

Introductory Lecture Inferential Analysis and Interpretation of Analysis Results (Hypothesis Test)

CR 3.01 dr. Putu Ayu Swandewi, MPH

dr. Gede Artawan Eka

Putra, M. Epid

10.00 –

11.00

Introductory Lecture Significance Test for Categorical and Interval Data

11.00 –

12.00 Independent Learning/SP

12.00 –

13.00 Break/Lunch

13.00 – 15.00

SGD : Inferential Analysis and Interpretation of Analysis Results (Hypothesis Test) DR SGD :

Significance Test for Categorical and Interval Data

11 Friday

27th _of March

09.00 –

10.00

Student presentation and feedback : Inferential Analysis and

Interpretation of Analysis Results (Hypothesis Test)

CR 3.01 dr. Putu Ayu Swandewi, MPH dr. Gede Artawan Eka Putra, M. Epid 10.00 – 11.00 Student presentation and feedback :

Significance Test for Categorical and Interval Data

11.00 –

12.00 Independent Learning/SP

12.00 – 13.00 Break/Lunch 13.00 – 15.00 Independent Learning/ SP

Days/date Time Activity Venue Lecturers

12 Monday 30th _{of March}

Skill lab Schedule

Skill Lab

Significance Test for Categorical & Interval Data

CR 3.01 Team Skill Lab

10.00 – 11.00

Introductory Lecture Epidemiologic studies to determine risk factors of diseases

dr. A.A.Sg. Sawitri, MPH Dr. dr. Gede Indraguna, SpGK 11.00 – 12.00 Independent Learning/ SP 12.00 –

13.00 Break/Lunch

13.00 – 15.00

SGD :

Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

DR

SGD:

Epidemiologic studies to determine risk factors of diseases

14 Wednesday

1st _{of April}

09.00 –

10.00

Student presentation and feedback

Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

CR 3.01 dr. Ayu Kartika Sari, MPH dr. Ariastuti, MPH 10.00 – 11.00

Student presentation and feedback Epidemiologic studies to determine risk factors of diseases

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Gd. Indraguna, Sp.GK 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch 13.00 – 15.00 Independent Learning/ SP 15 Thursday 2nd _{of April}

09.00 –

10.00

Introductory Lecture Epidemiology Study Design: Cohort Study

CR 3.01 dr. Nyoman Sutarsa, MPH dr. Ariastuti, MPH 10.00 – 11.00 Introductory Lecture Epidemiology Study Design: Case Control Study

CR 3.01 dr. Nyoman Sutarsa, MPH dr. Ariastuti, MPH 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch

13.00 – 15.00

SGD :

Epidemiology Study Design: Cohort Study

DR

SGD :

Epidemiology Study Design: Case Control Study

16 Monday 6th _{of April}

09.00 –

10.00

Student presentation and feedback Epidemiology Study Design: Cohort Study

CR 3.01 dr. Nyoman Sutarsa, MPH, dr. Ariastuti, MPH 10.00 – 11.00 Student presentation and feedback :

Epidemiology Study Design: Case Control Study CR 3.01 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch 13.00 – 15.00 Independent Learning/ SP 17 Tuesday 7th _{of April}

09.00 –

10.00

Introductory Lecture Applications of Clinical Trials to Determine the Effectiveness of Intervention, Prevention, and Treatment of Diseases

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Gd Indraguna, SpGK 10.00 – 11.00 Introductory Lecture Screening and Diagnostic Testing

CR 3.01 dr. Gede Artawan Eka Putra, M. Epid dr. Sawitri, MPH 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch

13.00 – 15.00

SGD:

Applications of Clinical Trials to Determine the Effectiveness of

Intervention, Prevention, and

Treatment of Diseases Epidemiology Study Design: Case Control Study DR SGD Screening and Diagnostic Testing DR 18 Wednesday

8th _{of April}

09.00 –

10.00

Student presentation and feedback: Applications of Clinical Trials to Determine the Effectiveness of Intervention, Prevention, and Treatment of Diseases

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna, SpGK 10.00 – 11.00

Student presentation and feedback : Screening and Diagnostic Testing

CR 3.01 dr. Gede Artawan Eka Putra, M. Epid dr. A.A.Sg. Sawitri, MPH 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch 13.00 –

15.00 Independent Learning

19 Thursday 9th _{of April}

09.00 –

10.00

Introductory Lecture Variability and bias

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna, SpGK 10.00 – 11.00

SGD: Variability and bias DR 11.00 – 12.00 Independent Learning/ SP 12.00 – 13.00 Break/Lunch 14.00 –

15.00 Independent Learning 20

Friday 10th _{of April}

09.00 –

10.00

Student presentation and feedback

Variability and bias

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna, SpGK 10.00 –

Team

13.00 –

14.00 Break/Lunch

14.00 –

15.00 Independent Learning 21

Saturday 11th _of

April

Preparation for Final Test

22 Monday

13th _of

April

09.00 – 11.00

Assessment Will be

arranged later

Team Resource Person And Facilitators

12th _of March

09.00 –

10.30 Movie

10.30 – 12.00

Independent learning / Student Project (SP)

12.00 –

13.00 Break/lunch 13.00 –

15.00 Discussion

2 Friday

13th _of March

08.00 –

11.30 Independent learning /SP

Class Room (CR) 3.01

Prof. dr. D.N. Wirawan, MPH

dr. Ni Wayan Septarini, MPH

11.30 –

12.30 Break/lunch

12.30 – 13.30

Introductory lecture 1 Determinants of morbidity and mortality in a population

13.30 – 14.30

Introductory lecture 2 Natural history of diseases

14.30 – 15.30

Introductory lecture 3 Diseases prevention 3

Monday 16th _of

March 08.00 –

11.00

SGD : Determinants of morbidity and

mortality in a population

Discussion Room (DR) SGD : Natural history

of diseases SGD : Diseases prevention

11.00 –

12.00 Break/Lunch 12.00 –

15.00

Student presentation and feedback :

Determinants of morbidity and mortality in a population

CR 3.01

Prof. dr. D.N. Wirawan, MPH

dr. Ni Wayan Septarini, MPH Student presentation

and feedback : Natural history of diseases Student presentation and feedback : Diseases prevention

4 Tuesday

17th _of March

08.00 –

11.30

Independent learning /SP

11.30 –

12.30

Break/lunch

12.30 – 13.30

Introductory Lecture Population, Sample, Data, and Variables

CR 3.01

dr. Putu Ayu Swandewi, MPH

dr.

G.Artawan, M.Epid

13.30 – 14.30

Introductory Lecture Measurements of Morbidity and Mortality in A

Population; Source of Error dr. Ayu Kartika Sari, MPH dr. Sawitri, MPH

14.30 – 15.30

Introductory Lecture Crude, Specific and

Adjusted Rate 5

Wednesda y18th _of

March

08.00 –

11.00

SGD : Population, Sample, Data, and Variables

DR

SGD : Measurements of Morbidity and Mortality in A

Population; Source of Error

SGD : Crude, Specific and Adjusted Rate

11.00 –

12.00 Break/lunch

12.00 – 13.00

Student presentation and feedback : Population, Sample, Data, and Variables

CR 3.01 dr. Putu Ayu Swandewi, MPH

dr. Artawan, MEpid

13.00 – 14.00

Student presentation and feedback : Measurements of Morbidity and dr. Ayu Kartika Sari, MPH dr. Sawitri,

14.00 – 15.00

Student presentation and feedback : Crude, Specific and Adjusted Rate

6 Thursday

19th _of March

Skill lab Schedule

Skill Lab

Data Entry, Data Cleaning, and Data Transformation

CR 3.01 Skill Lab Team

7 Monday

23th _of March 09.00 – 12.00 Independent Learning/SP 12.00 – 13.00 Break/lunch 13.00 – 14.00 Introductory Lecture Analysis and Interpretation of Descriptive Data

CR 3.01 dr.

Wirakusuma, MOH

dr. Ariastuti, MPH

14.00 – 15.00

Introductory Lecture Data Presentation and Data Description

dr. Putu Ayu Swandewi, MPH

dr. Gede Artawan Eka Putra, M. Epid

8 Tuesday

24th _of March

09.00 – 11.00

SGD : Analysis and Interpretation of Descriptive Data

DR

SGD : Data

Presentation and Data Description

11.00 –

12.00 Independent Learning/SP

12.00 –

13.00 Break/Lunch

13.00 –

14.00

Student presentation & feedback: Analysis and Interpretation of Descriptive Data CR 3.01 dr. Wirakusuma, MOH dr. Ariastuti, MPH

14.00 – 15.00

Student presentation & feedback: Data

Presentation and Data Description

dr. Putu Ayu Swandewi, MPH

dr. Gede Artawan Eka Putra, M. Epid

9 Wednesd ay 25th _of March

Skill lab Schedule

Skill Lab

Data Presentation and Data Interpretation

CR 3.01 Skill lab Schedule

10 Thursday

26th _of March

09.00 –

12.00 Independent learning /SP

CR 3.01 dr. Putu Ayu Swandewi, MPH

dr. Gede Artawan Eka Putra, M. Epid

12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture Inferential Analysis and Interpretation of Analysis Results (Hypothesis Test)

14.00 –

15.00

Introductory Lecture Significance Test for Categorical and Interval Data

11 Friday

27th _of March

09.00 – 11.00

SGD : Inferential Analysis and Interpretation of Analysis Results (Hypothesis Test) DR SGD :

Significance Test for Categorical and Interval Data 11.00 – 12.00 Independent Learning/SP 12.00 – 13.00 Break/Lunch 13.00 – 14.00

Student presentation and feedback : : Inferential Analysis and

Interpretation of Analysis Results (Hypothesis Test)

CR 3.01 dr. Putu Ayu Swandewi, MPH

dr. Gede Artawan Eka Putra, M. Epid 14.00 –

15.00

Student presentation and feedback : Significance Test for Categorical and Interval Data

31st _of March 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

CR 3.01 dr. Ayu Kartika Sari, MPH

dr. Sawitri, MPH

14.00 – 15.00

Introductory Lecture Epidemiologic studies to determine risk factors of diseases

dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna, SpGK 14 Wednesd ay 1st _{of April}

09.00 – 11.00

SGD :

Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

DR

SGD:

Epidemiologic studies to determine risk factors of diseases 11.00 – 12.00 Independent Learning /SP 12.00 – 13.00 Break/Lunch 13.00 – 14.00

Student presentation and feedback : Definition, Requirements, Types, and Applications of Surveillance and Outbreaks

CR 3.01 dr. Ayu Kartika Sari, MPH

dr. A.A.Sg. Sawitri, MPH

14.00 – 15.00

Student presentation and feedback : Epidemiologic studies to determine risk factors of diseases

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna, SpGK 15 Thursday 2nd _{of April}

09.00 – 12.00 Independent Learning /SP 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture Epidemiology Study Design: Cohort Study

CR 3.01 dr. Nyoman Sutarsa, MPH dr. Ariastuti,

MPH 14.00 –

15.00

Introductory Lecture Epidemiology Study Design: Case Control Study

16 Monday 6th _{of April}

09.00 – 11.00

SGD :

Epidemiology Study Design: Cohort Study

DR

SGD :

Epidemiology Study Design: Case Control Study 11.00 – 12.00 Independent Learning /SP 12.00 – 13.00 Break/Lunch 13.00 – 14.00

Student presentation and feedback :

Epidemiology Study Design: Cohort Study

CR 3.01 dr. Nyoman Sutarsa, MPH dr. Ariastuti, MPH

14.00 – 15.00

Student presentation and feedback :

Epidemiology Study Design: Case Control Study

CR 3.01

17 Tuesday 7th _{of April}

09.00 –

12.00 Independent learning /SP

12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture Applications of Clinical Trials to Determine the Effectiveness of Intervention, Prevention, and Treatment of Diseases

CR 3.01 dr. Sawitri, MPH

Dr. dr. Indraguna, SpGK

14.00 – 15.00

Introductory Lecture Screening and Diagnostic Testing

CR 3.01 dr. Artawan Eka Putra, M. Epid dr. Sawitri, MPH

18 Wednesday

8th _{of April}

09.00 – 11.00

SGD:

Applications of Clinical Trials to Determine the Effectiveness of

Intervention, Prevention, and

Treatment of Diseases

DR SGD Screening and Diagnostic Testing DR 11.00 –

12.00 Independent Learning/SP

12.00 –

13.00 Break/Lunch

13.00 –

14.00

Student presentation and feedback: Applications of Clinical Trials to Determine the Effectiveness of Intervention, Prevention, and Treatment of Diseases

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna P

14.00 – 15.00

Student presentation and feedback : Screening and Diagnostic Testing

CR 3.01 dr. Artawan Eka Putra, M. Epid dr. A.A.Sg. Sawitri, MPH 19 Thursday 9th _{of April}

09.00 –

12.00 Independent Learning/SP

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna P 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Introductory Lecture Variability and bias 14.00 –

15.00

SGD: Variability and bias

DR

20 Friday 10th _{of April}

09.00 –

12.00 Independent learning /SP

CR 3.01 dr. A.A.Sg. Sawitri, MPH Dr. dr. Indraguna P 12.00 – 13.00 Break/Lunch 13.00 – 14.00 Student presentation (SP) and feedback : Variability and bias

14.00 –

16.00

Presentation of student project and feed back 21

Saturday 11th _of

April

22 Monday

13th _of

April

09.00 – 11.00

Assessment Will be

arranged later

Team Resource Person And Facilitators

SKILL LAB TIME TABLE (Regular and English Class)

Date: 1. Thursday 19th _{March 2015} 2. Wednesday 25th _{March 2015} 3. Monday 30th _{March 2015}

No Class Group SGD Activity Time/Place

1 English I, II, III, IV, V Skill Lab/ pleno 08.00 – 09.30 / Class room 2 English VI, VII, VIII, IX, X Skill Lab/ pleno 09.30 – 11.00 / Class room

Break/Lunch 11.00 – 12.00 WITA

3 Regular I, II, III, IV, V Skill Lab/ pleno 12.00 – 13.30 / Class room

4 Regular VI, VII, VIII, IX, X Skill Lab/ pleno 13.30 – 15.00 / Class room

Guidance:

1. Each student is required to bring their own lap-top and has installed the SPSS program in to their laptop.

2. Data for practising will be provided before the first skill lab. Each head of the SGD have to contact dr. Putuariastuti or dr. Citra to ask for those files.

3. Skill Lab Guide is provided on the Anexes. Remember to bring your study guide every day.

ASSESSMENT METHOD

Student assessment of this block consists of:

1. a paper test with multiple choice questions at the end of block with proportion 80% of total score

2. a student project with proportion 15% of total score

3. evaluation of activity during the small group discussion with proportion 5% of total score

INTRODUCTION

A movie “And the Band Played On” will be played after introduction session in theatre room 4th _{floor. Every student should pay attention and carefully watch the movie because} proper understanding of the movie is needed to answer learning task question below. The summary of this movie can be seen in the Annex 1 of the Study Guide.

Learning task

Based on the movie “And The Band Played On”, you are required to discuss in your group the following questions:

1. Please explain about steps to discover the cause of AIDS based on this movie. Which one was started first, the lab investigation or epidemiology investigation to find out the cause of AIDS?

2. How were the roles of the following fields shown in the movie a. Statistic

b. Clinical c. Social

d. Epidemiology e. Virology

3. Please explain which part of the movie explained the types of social and political threats that influenced the investigation to find out the cause of that mysterious disease

4. Please explain which part of the movie showed ethics and professional aspects 5. Please explain which part of the movie that presented the threats/difficulties in

M O D U L E ~ 1

(Reference Maussner & Bahn, p. 1-42)

Determinants of Health/Diseases, Natural History of

Diseases and Diseases Prevention

Prof. dr. Dewa Nyoman Wirawan, MPH & dr. Ni Wayan Septarini, MPH

AIMS:

To be able to describe determinants, the natural history of diseases and death occurring in the population and diseases prevention

LEARNING OUTCOMES:

1.

Describe several determinants (models) of diseases and death occurring in the population.

2.

Explain the applications of understanding diseases and death determinants (models).

3.

Identify the strengths and weaknesses of diseases models.

4.

Draw figures of the natural history of a certain disease.

5.

Explain the applications of the natural history of a disease for prevention.

6.

Explain the severity of diseases in a population and its implication to prevention.

7.

Explain the Ice Berg phenomena and its implication in diseases prevention.

8.

Describe the level of disease prevention based on determinants and natural history

CURRICULUM CONTENTS:

1. Determinants (models) of diseases and death occurring in the population. 2. Natural history of certain disease and applications for prevention.

ABSTRACTS

In this lecture the difference approaches of community medicine and clinical medicine are discussed. In clinical medicine, concern is to individual patients who are visit health providers. In community or population medicine concern is to whole population, either sick or healthy in certain geographical area. Community medicine or public health focuses on prevention of diseasesin the population, whereas clinical medicine focuses on treating sick individual patients who come to health providers.

In order to provide appropriate treatments to individual patients, the diagnosis of her/his disease must be established. Similar approach must be established in community medicine. In order to provide appropriate preventions, determinants of health problems in the community must be understood.

To understand determinants or factors which influence the occurrence of diseases in the population, some epidemiological models or theories are discussed in this lecture. Each model has its strengths and weaknesses. There is no single model which is appropriate to explain determinants of all diseases occurrence. Triangle model which was first introduced, explained that the occurrence of diseases in the population is determine by agent, host and environments. Wheel model focused on intrinsic (host factors) and extrinsic (environments factors). Model which was introduced by Blum explained that the occurrence of diseases in the population determine by genetic, behaviour, health programs and environments. Web model explained that a determinant of diseases occurrence in the population is not simple but interrelated of many factors. There are many other models which explain determinants of diseases but not discussed in this lecture.

Beside determinants of diseases occurrence, appropriate prevention also depends on the natural history of the disease. For example, disease where the cause is well established such as HIV/AIDS, has long incubation period and fatal, the focus of prevention are primary prevention such as behavior change educations, secondary prevention such as voluntary HIV testing (VCT) and tertiary prevention such as care support and treatments of secondary (opportunistic) infections. On the other hand, if the cause of disease is not known such as cancers, focus of preventions is secondary and tertiary preventions. Other disease such as dengue fever, which is acute, no vaccine available and no treatments to kill the virus, the focus of prevention is on primary preventions.

SCENARIO& LEARNING TASKS

Guidelines:

a) During small group discussion (SGD), each group has to select a spokesperson, who will be presenting the results of discussions at the plenary

b) Prior to the plenary, the spokesperson of each group sits in front of the class c) Read carefully the learning tasks (1)and(2) below.

d) Each group have to discuss at least 4 (four) learning tasks below which are learning task (1) and three learning task(2) from (a) to (e)

e) Each group must present three learning tasks in the plenary.

f) Before the plenary start, every SGD has already put the file of the answer in the class’ computer/CPU

g) Learning task (3) is additional task, however, all of the students MUST watch the movie carefully in order to be able to answer learning task in day 2.

SGD : DETERMINANTS OF

HEALTH

/ DISEASES

Case 1.

Please watch carefully a short video clip on: (you can watch it at your home before the lecture)

http://www.youtube.com/watch?v=5Lul6KNIw_8 Learning Tasks 1:

After you carefully watch the video, please discuss the following questions: 1. What factors that influence health mentioned in this video clip?

2. Which model/s of disease morbidity is/are being use?

3. What interventions are being conducted in the two examples given on the clip? What are the focuses of the interventions for each case?

Case 2

Please watch carefully as well:

http://www.youtube.com/watch?v=mMDUv2R6tHQ

Learning Tasks 2

1. What is the main topic of the conversation?

Learning Tasks 3

Discuss the following in your group:

a) The high morbidity and mortality due to dengue hemorrhagic fever (DHF) is influenced by many factors (determinants). Discuss these factorsusing Wheels Model. Explain also the most dominant factor.

b) 1. The high incidence of morbidity (morbidity rate) due to traffic accidents are influenced by many factors (determinants). Discuss in groups these factors using Web Model. Explain the most dominant factor.

2.The high mortality rate due to traffic accidents are also influenced by many factors (determinants). Discuss in groups these factors using Blum Model. Explain also the most dominant factor.

c) The high morbidity and mortality due to tuberculosis (TB) are influenced by many factors (determinants). Discuss in groups these factors using Triangle Model. Explain also the most dominant factor.

d) The high morbidity and mortality caused by HIV-AIDS are influenced by many factors (determinants). Discuss in groups these factors usingBlum and Triangle Model. Explain also the most dominant factor.

e) The high morbidity and mortality of children under 5 year olds in the community is influenced by many factors (determinants). Discuss these factors by using Mosley Model. Explain also the mechanisms between these factors by considering the direction of the lines in the Mosley Model.

Learning Tasks 4:

1. At the end of the lecture, each SGD group should give the lecturer a USB with capacity minimum 8 gb.

2. A movie “The Contagion” will be transfered to the USB and the USB will be returned during plenary. This movie will be discussed on the surveillance and disease’s outbreak topic

2. Prior to the plenary, the spokesperson of each group sits in front of the class 3. Read carefully the learning tasks (a) to (c) below.

4. Each group has to discuss all of the learning tasks below.

5. Before the plenary start, every SGD has already put the file of the answer in the class’ computer/CPU

LEARNING TASK

a) Discuss the natural history, primary, secondary and tertiary prevention of HIV-AIDS using a diagram.

b) Discuss the natural history, primary, secondary and tertiary prevention of denguehemorrhagic fever (DHF) using a chart.

Please refer to: http://www.medscape.com/viewarticle/725639_2

SGD :

DISEASES PREVENTION

Guidelines:

a) During small group discussion (SGD), each group has to select a spokesperson, who will be presenting the results of discussions at the plenary

b) Prior to the plenary, the spokesperson of each group sits in front of the class c) Read carefully the learning tasks (a) to (c) below.

d) Each group has to discuss all of the learning tasks below.

e) Before the plenary start, every SGD has already put the file of the answer in the class’ computer/CPU

LEARNING TASK

Please take a look this PDF file below before answering the following task:

http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf

All the answers for the following task must also refer/consider to “Ottawa Charter” as explained on the above file.

a) Discuss the natural history, primary, secondary and tertiary prevention of tuberculosis.

Please refer to the following website:

http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/iuatld_tb_manual_for_me dical_students.pdf

b) Discuss the natural history and primary, secondary and tertiary prevention of malnutrition in children age under 5 years.

Please refer to the following website:

http://www.jped.com.br/conteudo/00-76-s285/ing.pdf c) Please refer to the following website:

http://depts.washington.edu/epidem/Epi583/MockLancet.pdf

Please discuss the natural history, primary, secondary and tertiary prevention of traffic accident

Self assessment

1. Explain the determinant factor of diseases occurrence by using the Epidemiological Triangle, the Wheels and the Blum models!

2. A part of the Blum model is the health care factor. If you use the Wheel model, into which factor that factor should be included?

3. The other part of the Blum model is behaviour factor. If you use the Wheel model, that factor should be included into which factor? And if you use the Epidemiological Triangle model, how should you place the behaviour factor?

4. What are the differences between the natural history of HIV/AIDS, DHF, and coronary disease or stroke?

5. Why is it very important to understand the determinant and the natural history of certain diseases in a population?

6. The level of prevention consists of primary preventions, including health promotion (behaviour change & policy/regulation) and specific protection, secondary prevention (early detection and prompt treatment), and tertiary prevention (disability limitation and rehabilitation). Explain which prevention will be effective for the following diseases/incidents: DHF, HIV/AIDS, diarrheal, traffic accident, coronary heart disease, stroke, tuberculosis (TBC), and avian influenza.

7. The health promotion is actually “health education plus” which consists of health education (or behaviour intervention) and structural intervention (or policy/regulation). Give examples of behaviour intervention and policy/regulation to reduce death due to traffic accident, to decrease deficiency of energy and protein (under nutrition) and certain diseases caused by smoking behaviour.

8. Explain the definition of the iceberg phenomena and its consequences regarding the disease prevention in the community and regarding the accuracy of data available at service statistic (primary health services such as private midwives/ doctor, PHC, private clinics, secondary health care service such as district hospital, and tertiary health care service such as referral hospital).

M O D U L E ~ 2

(Reference Kirkwood and Sterne, chapter 2)

Population, Sample, Data, and Variables

dr. Putu Ayu Swandewi, MPH & dr. Gede Artawan Eka Putra, M.Epid

AIM:

Demonstrate ability to search, collect, organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health.

LEARNING OUTCOMES:

a) Describe the definitions of population and sample.

b) Explain the conditions required for a representative sample. c) Explain several sampling methods.

d) Describe types of data and variables. e) Describe several method of data collection

CURRICULUM CONTENTS:

Population, Sample, Data, and Variables

ABSTRACT

Population is a group in whom the result of certain study can be applied;while sample is part of the population that should represent its population. Two requirements for sample to be representative are concerning on samples size and sample selection.

Sample size are determined by indicators of measurements (mean, proportion) study design, alpha(α) and power(1-β), and tolerated deviation. Besides those above, sample selection also take important role. The recommended sample selection is non-random sampling (simple, systematic, stratified, multistage, etc). In clinic setting, we frequently used consecutive sampling which is a non random sampling and assumed to be represented its population.

Sample allocation can be used if we need more than one group of sample. The easiest way is block allocation. We can also use allocation of simple random sampling, stratified allocation, and systematic allocation.

SCENARIO:

Case 1.

Study on Maternal and Child Health

The study was conducted in two phase; 1) household survey to determine the under five years health status and 2) Quasi Experimental study to explore the effect of food supplementation program toward the improvement of nutritional status

First Phase

A household survey was conducted to explore under five years child’s health status at Desa Merdeka in 2011. The objective of the study was to determine several factors that associated with anemia and chronic malnutrition among children in the area. The area has two different characteristics which are easy to reach area (easy) and hard to reach area (hard). The condition of both areaswas suggested to be considered since there might be different characteristics of the family; hence, the samples were randomly selected from both areas.

The subjects of the study were all five under five years old children. Children from the family who are no longer residing in the area were excluded from the study and those with incomplete data were excluded during data analysis. List of the children were withdrawn from the register at the village leader office.

Data collection was performed by interview using structured questionnaire with the mothers and measurement of the children. The characteristics that were explored and measured include: mothers’ and children’s demographic characteristic, haemoglobin level and body weight. More specifically, the variables in the study were ID, name, area, mothers’ age, education, occupation; history of exclusive breastfeeding, parity; and children’s weight, age, hemoglobin level, body weight and height. The hemoglobin level measured with HemoCue, and body weight measured with digital scale. Anemia status was determined when Hb level less than 11 mg/dl and undernourished determined when BMI less than 11kg/m2

Second Phase

After the above data collection was completed, the second phase of the study was started. This phase aims to evaluate the impact of food supplementation program to

Learning Task 1:

You are required to discuss the following questions, based on the study:

1. Explain the definition of population (target population and sampled population) and sample!

From each study phase of the case above describe: 1. Target population of the study

2. Sampled population of the study

3. Discuss what are the different between target and sampled population

2. Discuss the reason of taking sample rather than observed all population and the requirement of a good sample?

3. Discuss several conditions for samples to represent the population (to be representative)!

4. Discuss the meanings and objective of inclusion criteria, exclusion criteria, and drop out criteria?

Base on the case study above, for each phase, describe: 1. What are the inclusion criteria for the study

2. What are the exclusion criteria for the study 3. What are the drop out criteria for the study

5. Explain the indication and the technique for sampling methods below

1. Simple random, stratified random, systematic random, multi-stage random, cluster,

2. Quota, convenience, purposive, and “snow-balling technique”

3. Based on the case study above, what is the sampling method of the study? 6. Based on the case above (phase 1), describe about sampling frame for the study.

What is the importance of constructing a sampling frame and when it is not possible to be constructed?

7. Explain several important parts in sample size calculation including variability, design, power (1-), level of significance (), effect size or precision or margin of error.

a. Draw the relationship between variables above b. Classify the variables based on their function

8. a. Explain the classification of variables based on the level of measurement

b. Among the variables on the study above, classify them based on the level of measurement

9. Describe method of data collection that have been applied on the case study above.

Self Assessments:

2.

What are the conditions required for a representative sample?

3.

Explain several sampling methods: simple random, proportional, multistage, stratified, systematic, cluster, quota, consecutive, incidental, purposive, and “snow-balling technique”!

4.

What is the meaning of exclusion criteria? What is the purpose of excluding some population characteristics?

M O D U L E ~ 3

(

Reference Greenberg p. 15-28 & Gordis, p. 37-83

)

Measurements of Morbidity and Mortality in a

Population; Source of Error in Measurements

dr. Ayu Kartika Sari, MPH & dr. A.A.Sg. Sawitri, MPH

AIMS

To demonstrate ability to search, collect, organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health.

LEARNING OUTCOMES:

At the end of the module, students should be able to:

1.

Explain measurements of morbidity and mortality in a population.

2.

Differentiate proportion, ratio, rate, prevalence and incidence.

3.

Explain four types of incidence based on their denominators.

4.

Describe the source of numerators and denominators for prevalence and incidence.

5.

Explain types of errors in rate calculation.

6.

Explain the differences, application, interpretation, and weaknesses of (slide) crude, specific, and adjusted rate.

1. Read previous lectures regarding the natural history of diseases.

2. Read Handout 1, p. 62–68, Greenberg, p. 47-53, Gordis, p. 37-83, and power point slides.

ABSTRACTS

As a medical doctor, either in a clinic or in a public health setting, we will face many problems in a field work which relate to rate, ratio, and proportion. A clinician will certainly consider rate in diagnosing and predicting the fatality or prognosis of a certain disease, a clinician will certainly use rate. Meanwhile, a public health doctor will apply rate, ratio, and proportion to either diagnose a community problem or to evaluate a health program.

Rate, ratio, and proportion, are measurements used to describe the situation, condition, or even a problem among population. Each measurement has specific characteristics and applications. Ratio which is a comparison between 2 independent numbers is usually used for management purpose. Proportion is a comparison between numerator and denominator in which the numerator is included in the denominator. Lastly, rate is a proportion which has population at risk as the denominator. The understanding on measurement characteristics is needed due to giving specific interpretation based on the situation and purpose of measurement.

SCENARIO & LEARNING TASK

Case 1.

The Jakarta Post, Jakarta | National | Tuesday, December 31 2013, 7:33 PM

http://www.thejakartapost.com/news/2013/12/31/36000-people-with-hivaids-receive-arv-therapy-throughout-2013.html

36,000 people with HIV/AIDS receive ARV therapy throughout 2013

As many as 36,483 people living with HIV/AIDS (ODHA) have received antiretroviral (ARV) treatment in 2013, up from 2,381 in 2005, a senior health official has said.

“The development of HIV/AIDS control in Indonesia has shown relatively good results. This can be seen from the increase in the number of people receiving antiretroviral therapy in 2013,” said the Health Ministry’s director general of disease control and environmental health, T, in Jakarta on Tuesday, as quoted by Antara news agency.

However, he said, the ministry also found that the number of early detected HIV cases had continuously increased. In 2013, 20,397 people were recorded as having been infected with HIV, up from 895 in 2005.

Meanwhile, the number of AIDS patients reached 2,763 as of September, down from 4,987 in 2005.

“The Case Fatality Rate (CFR) has also dropped to 0.85 percent as of September from

13.65 percent in 2004,” said T.

The Health Ministry has been intensively carrying out HIV/AIDS control and prevention programs by, among other measures, putting together a national guideline and training modules for health workers such as Training of Trainers (ToT) on Voluntary Counseling and Testing (VCT), which is followed up with VCT as well as Care and Support and Treatment (CST) training sessions.

Learning Task 1

You are required to discuss the following questions, based on the study above.

1.

What is the type of measurement underlined in the above case?

2.

What is the weakness of that measurement when it is applied to diagnose community health problem?

3.

Do you think that measurement is still important to be used in the above case? Please give a reason!

4.

Please interpret the data of case fatality rate mentioned in the above case! What is the importance of this rate to clinician?

5.

What are the differences between Case Fatality Rate and Cause Specific Death Rate?

Case

2

.

Mapping Injecting Drug Users Activity in Bali

A study was conducted by team of NGOs (Hatihati, Matahati, dan Yakeba) and Udayana University staff on June-December 2009. The objective of study was to determine the types of HIV risk behaviors among injecting drug users (IDUs) in Bali. Structured interviewed was done to 125 IDUs who randomly selected from a total of 550 reported active IDUs in Denpasar and Badung district. The findings showed that the types of drugs were varied, including heroin (97; 77.6%), buprenorphine (60; 48%) and ATS (1;

Learning Task 2

You are required to discuss the following questions, based on the study above 1. What is the type of measurement presented in the case above??

2. What is the weakness of that measurement when it is applied to diagnose community health problem? Explain your answer!

3. If you want to present the data in the form of relative number, which type will be most appropriate: proportion, prevalence, or incidence?

4. What is the interpretation of 77.6% at above?

5. When there was a total of 550 reported active IDUs, how many of them were possibly using tranquilizer?

6. What are the possibilities of biases of your estimation at number (5)? Provide your reasons!

Case

3

.

Survey of Tuberculosis in Bali, 2010

Bellow is the result of TB survey in Bali in the end of 2009 (Table 1) that was conducted by the team of Udayana University. The survey was conducted to total available public health centers (120 PHCs) in Bali and 3 main hospitals (RS Sanglah, RS Wangaya, and RS Buleleng). To complete the analysis of the study, researcher took data of population from the Bali Provincial Statistic Office (Table 2).

Table 1. Number of TB cases in Bali

No Sub-province Frequency Proportion Rate

1. Buleleng 165

2. Jembrana 73

3. Tabanan 57

4. Badung 119

5. Denpasar 312

6. Gianyar 73

7. Bangli 28

8. Klungkung 57

9. Karangasem 116

Total 1000

Source: HIV prevalence among TB patients in Bali, 2009

Table 2 Number of population in Bali, Based on District and Nationality at 2010

Regencies Indonesian Foreigners Total China Others

Male Female Male Female Male Female

1. Jembrana 136.063 136.757 4 1 2 1 272.828

2. Tabanan 214.260 216.884 0 0 19 9 431.172

3. Badung 197.167 195.619 0 1 161 72 393.020

4. Gianyar 199.973 199. 607 15 11 22 32 399.660

5. Klungkung 91.067 94.201 0 0 4 0 185.272

6. Bangli 107594 108.135 0 0 0 0 215.729

7. Karangasem 219.591 218.883 0 1 0 0 438.475

8. Buleleng 331.931 330.907 16 17 28 21 662.920 9. Denpasar 262.362 260.476 0 0 277 184 523.299

2010 1.760.008 1.761.469 35 31 513 319 3.522.375 Source: Bali Provincial Statistic Office, 2010

Learning Task

3

You are required to discuss the following questions, based on the study above

1. Fill in the proportion and the rate based on the above data. What is the interpretation?

2. What is the difference between the proportion and rate at the above? Which one is the appropriate to determine community health problem?

3. What is the rate you calculate: prevalence or incidence? Explain your answers! 4. What are the differences between incidence and prevalence?

5. If you want to calculate incidence of TB, draw the figure of incidence measurement based on the above data (take one sub-district as an example) 6. With regard to the source of data, what could be biases regarding the above

result?

Case 4 & Learning Task 4

Morbidity Cases on Newspaper

1. Read carefully the newspaper clipping provided at the annex with the title “Dipertanyakan, Pasien Kurang Mampu Masuk RSUP Denpasar”dan “Masalah Pasien Kurang Mampu, DPRD Pertanyakan Keluhan RSUP”. (Questioned: “Poor patients in Provincial Central Hospital” and “Problem with poor patients, Parliament asks the hospital complaints”).

2. Read thoroughly the clipping with title “Korban Kanker Terbanyak Penduduk Pedesaan, Tingkat Sosek Rendah”. (“Mostly cancer patients are from rural areas with low socio-economic status”)

Discuss in your group and give opinion or comments on that news. Write your comments on a paper and submit it to your lecturer by the next day.

M O D U L E ~ 4

(Greenbergp. 51-53)

Crude, Specific and Adjusted Rate

dr. Ayu Kartika Sari, MPH & dr. A.A.Sg.Sawitri, MPH

___________________________________________________________________

ABSTRACTS

The other principal topic of morbidity and mortality measurements is the terms of crude, specific, and adjustment. These measurements are often being applied to those rate, ratio, and proportion. Crude, specific and adjustment are relative measurements. Crude means, generally, if the numerator and the denominator use total incident in a population (ex. CDR, CBR). While specific measurement is when the numerator and the denominator are comes from certain sub-populations. For instances the specific mortality on delivered women and the specific morbidity on tuberculosis. The adjustment is adjusting a certain incident among a group of population to a standard population for comparison purpose.

Case 1

Sero prevalence of HIV among TB patients in Bali

Study of HIV-TB was conducted in 2009 by research team of Udayana University to find out the HIV prevalence among TB patients who visit health services (puskesmas, Sub-province and hospitals) in Bali. Each newly TB diagnosed patients were having short counselling for examination for their HIV status in anonymously unlinked manner. One thousand TB patients (580 male and 420 female) were visiting clinics on June to December 2008. HIV was found to be positive among 39 TB patients (30 male and 9

female), while the distribution based on sub-provinces is presented in the following table. (Report of Sero-Survey of HIV Co Infection among TB patients in Bali, 2009)

Distribution of TB and HIV Patients Based on Sex and Sub-province

Number Disctric Freq. of TB patients (m; f) Freq of HIV patients (m; f)

1. Buleleng 165 (101; 64) 19 (16; 3)

2. Jembrana 73 (45; 28) 1 (1; 0)

3. Tabanan 57 (31;26) 1 (1; 0)

4. Badung 119 (68; 51) 0

5. Denpasar 312 (171; 141) 16 (11; 5)

6. Gianyar 73 (43; 30) 0

7. Bangli 28 (18; 10) 0

8. Klungkung 57 (31; 26) 0

9. Karangasem 116 (75; 41) 2 (1; 1)

Total 1000 (580; 420) 39 (30; 9)

Learning Task 1

1. What is the crude HIV infection among TB patients in Bali? What is the interpretation of that number?

2. What is the specific HIV infection among TB patients in Bali, based on sex? What is the interpretation of that number? Is the number confounded by area or sub-province?

3. What is the specific HIV infection among TB patients in Bali, based on sub-province? What is the interpretation of that number? Is the number confounded by sex?

4. What is the specific HIV infection among TB patients in Bali, based on sex and sub-province? What is the interpretation of that number? Is the number confounded by sex and sub-province?

5. Regarding the above results, explain the weaknesses of crude and specific rate. 6. If you are the Head of Bali Province, what will you do with regard to the above

result (number 1, 2, and 3)?

7. If you are the Head of Puskesmas in Buleleng area, what will you do if you diagnose patient as a TB in Puskesmas?

Graphic Comparison of CBR and CDR at Canada and Alberta

Learning Task 2

1. First summary: the health status at Canada is better than Alberta. Is that correct? Explain your answer!

2. In order to make fair comparison between those states, what should you do? What data do you need?

3. Second summary: Number of deaths at Canada is greater than Alberta. Is that correct? Explain your answer!

4. Third summary: If adjusted death rate for Canada is 7 per 1000 persons, when the total population of Canada is 33,476,688. The total number of death was 234,339. Is that correct? Explain your answer!

Self Assessment

1. How do you differentiate absolute, ratio, proportion and rate?

2. Incidence and prevalence are not similar in many ways. Explain that! 3. In how many ways can you calculate incidence rate?

4. What are denominators that can be applied for calculating incidence? What is the most ideal enumerator?

5. Which measurement can be used to predict prognosis or trend of mortality for suffering from disease?

M O D U L E ~ 5 (SKILL LAB I)

(Reference Skill Lab Manual, Kirkwood & Sterne, Chapter 2)

DATA ENTRY, DATA CLEANING AND DATA

TRANSFORMATION

dr. Putu Ayu Swandewi, MPH & dr. Gede Artawan Eka Putra, M.Epid

AIMS:

To demonstrate ability to search,organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health.

LEARNING OUTCOMES:

1. To make structure of data with SPSS application 2. To do data entry

2. Data entry 3. Data cleaning 4. Data transformation

SCENARIO & LEARNING TASKS

Case.

A population study was done in two sub villages in Desa Merdeka. This study’s purpose was to determine several factors that associated with anaemia and chronic malnutrition among children in the area. The area has two different characteristics which are easy to reach area (easy) and hard to reach area (hard). The condition of both areas was suggested to be considered since there might be different characteristics of the family; hence, the samples were randomly selected from both areas.

First Phase

Data collection was performed by interview using structured questionnaire with the mothers and measurement of the children (see questionnaire in the skill lab guide). The characteristics that were explored and measured include: mothers’ and children’s demographic characteristic, haemoglobin level and body weight. More specifically, the variables in the study were ID, name, area, mothers’ age, education, occupation; parity; and children’s age, haemoglobin level, body weight and height. The haemoglobin level measured with HemoCue, and body weight measured with digital scale. Anaemia status was determined when Hb level less than 11 mg/dl and undernourished determined when BMI less than 11kg/m2

Second Phase

After the above data collection was completed, the second phase of the study was started. This phase aims to evaluate the impact of food supplementation program to improve nutritional status among undernourished children. All undernourished children were involved in the study, expect those with severe illness. The children were allocated into two groups; first group received food supplementation and second groups continue with the prior daily consumption. The supplementation was provided up to 2 months and at the end of two month the nutritional status (the body weight)were measured again.

Learning Tasks:

See the sheet of data collection and raw data. The data were analysed by computer with software of SPSS. Discuss and analyse the tasks bellow:

1. Explain the types of variables in relation to construction of data entry: variable name (name), type, width, decimal, labels, value labels, missing values!

2. Number (No) consists of 3 numbers (hundreds), name of its field is: number (5 characters, not more than 8 characters for SPSS V.12 or bellow). Fill in the following field structure: type of field: . . . ; Width: . . . ; Decimal: . . . , Labels: . . . , Value labels: . . . ; Missing values: . . .

3. Generally, how can you determine errors in data entry? 4. Explain how you can search and fix the errors!

5. Explain the methods of classifying interval and categorical data!

6. Explain how to calculate composite index of Mass Body Index based on body height and body weight.

Self Evaluation

1. A haemoglobin value consists of 2 numbers and 1 decimal (example: 13.6 gr%). What is its field width?

2. Explain the limits of values that can be used as indicators of error in data entry. 3. Explain the types of variables based on their functions. Give an example of each

variable.

4. Explain the types of variables based on measurements scale. Give an example of each.

5. Explain with an example, what is the meaning of ratio variable? 6. Explain some methods to control a variable!

7. Explain the differences between formal education and IQ variables!

M O D U L E ~ 6

(Reference Greenberg, p. 29-43)

Analysis and Interpretation of Descriptive Data

dr. Ida Bagus Wirakusuma, MOH & dr. Putu Ariastuti, MPH

AIMS:

To demonstrate ability to search, collect, organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health.

LEARNING OUTCOMES:

2. Rate comparison 3. Data interpretation

ABSTRACT

Descriptive in epidemiology begins with the assumption that disease do not occur in random. Typically three standard questions are posed to characterize the non random distribution of disease: Who get the disease? Where does the disease occur? and When does the disease occur? These questions concern the element of person, place and time, respectively.

At the minimum, the personal attributes examined in relation to disease occurrence are the distribution by age, race and sex. The place of occurrence of the disease may be studied at international, regional and local level. Temporal pattern can be examined across year, month, or days, depending on the time course of the disease in question.

SELF DIRECTING LEARNING:

Basic knowledge and its application that students must know include: 1. Variables of person, place and time

2. Rate comparison and interpretation

SCENARIO & LEARNING TASKS

Case 1.

Look at the following figure carefully:

Fig 1

Total deaths by broad cause group, by WHO Region,

World Bank income group and by sex, 2008

(Source: Global status report on non communicable diseases 2010)

Learning Tasks 1:

Carefully look at the figure above, and discuss the following questions:

1.

What are the interpretations of the figure? How many conclusions could you drawn from the figure?

2.

When you are living at Indonesia on 2008, what is your risk of death by injuries?

Case 2.

Carefully look at the figure below, and discuss the following questions:

(Source: Global status report on non communicable diseases 2010)

Learning Tasks 2:

1. The figures are data of cancer worldwide based on 1) ………; 2) ……….; 3) ………… 2. Could we conclude that risk of lung cancer among male is higher than liver cancer

among female?

3. Could we conclude that risk of breast ca among female is higher than cervix ca? 4. Could we conclude that risk of lung cancer in Indonesia is higher than in India?

Case 3:

Figure 3. Age-standardized incidence of all cancers (excluding non-melanoma skin cancer), by type, per 100 000 population for both sexes, by WHO Region, 2008

Learning Tasks 3:

Based on the above figure, please answer the following questions:

1. The figures are data of cancer worldwide based on 1) ……….; 2) ………….. 2. Could we conclude that highest risk of lung cancer was in AMR and EUR? 3. Could we conclude that risk of breast ca among female is higher than cervix ca? 4. Could we conclude that risk of cervix uteri cancer in SEAR is higher than in

AFRICA?

5. What are the difference between data provided at figure 2 and 3?

Self Assessments:

1.

What is the definition of specific rate?

2.

What are the differences between specific and crude rate?

3.

Which variables are usually used as a base for specific rate calculation?

4.

What is the use/benefit of calculating specific rate?

5.

Describe the method to diagnose an undernourish problem among under-five- year old children in one area?

6.

A clinician needs to understand the variation (pattern) of diseases based on Who, Where, and When. Why?

M O D U L E ~ 7

(Reference Kirkwood & Sterne, Chap 3 &4)

Data Presentation and Data Description

dr. Putu Ayu Swandewi, MPH & dr. Gede Artawan Eka Putra, M.Epid

AIM:

Demonstrate ability to search, collect, organize and interpret information/data from different sources in order to assist in diagnostic, therapeutic and health.

LEARNING OUTCOME:

Be able to perform data presentation and data description.

CURRICULUM CONTENTS:

Data presentation and data description

ABSTRACT

Presenting and describing data are closely related with data classification based on their function, which are: interval (numeric or quantitative), discrete, continue, categorical (qualitative), and ordinal data.

Qualitative data is divided into two categories (dichotomies) and more than two categories (multi-chotomies). Important aspect of qualitative data is the number for each category. The analysis can be made is, either frequency distribution or cross-tab frequency distribution. In the table of frequency distribution, we can calculate incidence, prevalence, and ratio, both for crude and specific measurements based on place, time and person. To summarize the data we can use highest and lowest frequencies and or mode. While for cross-tab frequency distribution, we can make percentage based on column, row, dan total percentages. For specific cross-tab 2x2 (four-fold table), we can calculate some important indicators such as Odds Ratio (OR), Risk Ratio (RR), Specificity (Sp), and Sensitivity (Se). Besides table, we can present this data by graphic, which is most appropriate, is bar chart

Presenting numeric/quantitative data looks more simple than presenting categorical/nominal data. The important aspect to be understood is how to determine appropriate data presentation, either as a single variable or in relation with other variable. Measurements which are used is central tendency (Average) and dispersion.

Student Project

SEARCHING, ANALYSIS, AND

INTERPRETING STUDY RESULT

T O P I C S :

Descriptive longitudinal, cross sectional

Analitic cross sectional

Case Control

Cohort

Clinical & Community Trial

Diagnostic Test

STUDENT PROJECT

Abstract

Epidemiologic approaches are utilised to understand the distribution and risk factor of disease, also to know the effectiveness of an intervention. The understanding of these concepts assist doctors in diagnosing, developing evidence based therapy and determining the prognosis of the disease. In community, a doctor is expected to utilise these concepts to tackle health problems.

This student project aims to help student to gain better understanding about epidemiologic approaches and the specific attributes in each approach.

Learning task:

1. Each group need to conduct search on scientific publication that using one of the epidemiology approach (see assignment table for each group).

2. Pay attention on the timeline of this student project

3. Each group need to consult and get approval from the planners on the topic 4. Pay attention on the specific tasks for each approach. Discuss it with your group. 5. Develop short report, maximum 10 A4 pages

6. Make 8 copies of your group reports and submit them to dr. Citra timely

7. Presentation of the student project will be conducted randomly on day 20th _{of CBP}

block, at the PLENARY SESSION (See the presentation guide)

8. Assessment will be conducted based on several criteria (See evaluation guide) a. Appropriateness of the answer to the task

b. Participation in group work will be proved by clear job description for each group member. (dominated work will receive negative mark)

c. Student project will contribute 15% of total CBP block mark.

Table 1. Group assign and epidemiologic approach

No SGD Class Approach Planners

1 I, II Regular

English

Study Descriptive Cross Sectional

Dr. AyuKartika/dr. Citra

2 III Regular

English

Study Descriptive Longitudinal Dr.AyuKartika/dr. Citra

3 IV Regular

English

Study Analytic Cross Sectional Dr.Septarini

4 V Regular

English

Study Case Control Dr.Sutarsa

5 VI Regular

English

Study Case Control (Matched Pair)

Dr.Sutarsa

6 VII Regular

English

Study Cohort Prospective Dr.Ariastuti

English

8 IX Regular

English

Study Clinical Trial Dr.Sawitri

9 X Regular

English

Study Community Trial Dr.Sawitri

10 XI Regular

English

Uji Diagnostik Dr.Artawan

Table 2. Student Project Timeline

No Date/week Activities Penanggungjawab 1 Week II Searching and consultation with Planners Planners

2 Week II Discussion with group The chief of SGD

3 Week III Report writing The chief of SGD

4 Week IV Report submission to IKK-IKP The chief of SGD & dr. Ariastuti

5 Week IV Develop presentation slide The chief of SGD

6 Week IV Presentation The chief of CBP block

Table 3. Task for each approach

No Design Task

1 Observational study: cross sectional, case control, cohort (source: STROBE Statement) Introduction  Explains the study background

 Explains the specific objective of the study

 Explains the study hypothesis (if available)

Method  Explains the study design and describe important element of the study

 Develops study profile

 explains the setting, location, relevant date include recruitment period, exposure, follow up and data collection method

 Participant:

(a) Cohort study—describes eligibility criteria, sources, and selection

method. Explain the follow up method

(b) Case-control study—describes eligibility criteria, sources and

method to select case and control. Explain the rational in selecting case and control.

© Cross-sectional study— describes eligibility criteria, sources, and

selection method

(d)Cohort study— For matched studies, explains the matching criteria,

the number of exposed and unexposed group.

(e) Case-control study—For matched studies, explains the matching

 Explains the definition of outcome, exposure, predictor, potential confounder and effect modifier. Explain the diagnostic criteria (if available)

 Explains how to determine sample size

 Explains all statistical methods including methods to control confounding variables

Cohort study—if available, explains how to resolve loss to follow-up

Case-control study—if available, explains how to match between case

and control that was done

Cross-sectional study—if available, explains analytical method that

have done related to sample selection Result  Explains main result of the study

2 Clinical Trial : (source: CONSORT Statement)

Introduction _ Explains the background of the study

 Explains the specific purpose of the study

 Explains the hypothesis

Methods  Describe the trial design and the attributes including ration allocation

 Developa study profile completely including the attributes

 Explains the criteria of eligibility for the participant

 Explains the settings and location where data collected

 Explains the intervention given to each group, including the possibility of repetition and real of the intervention

 Explains specific measurement from primary and secondary outcome

 Explains how to determine sample size

 If available, explains about analytical interim that was done

 Explains the randomization methods

 Explains the randomization type and details of the restrictions if available

 Described the procedure that was done until intervention given

 Explains who did the randomization, who did the subject inclusion and and who determine subject allocation for intervention/placebo? Was it done blinded?

 Explains the statistical method used to compare the primary and secondary outcome

Result &

Discussion  For every primary and secondary outcome, explains the result and significance

 Explains the study limitation, how to resolve bias source, whether any precision problems

 Explains about generalisability (external validity, applicability) of the result; if available

3 Diagnostic Test

Introduction _ Explains the background of the study

 Explains about the special purpose of the study

Method  Explains the study design and important part related to the study design

 Develop the study profile

 Explains about the relevant setting, location, and date including recruitment period, exposure, follow up and data collection

 Participant: explains the eligibility criteria, source and selection method

 Explains the definition of gold standard and diagnostic test. Please explains the diagnostic criteria if available.

 Explains how to determine the sample size

Presentation guideline:

1. Presentation slides:

 Maximum 10 slides

 Maximum 12 sentences/point per slide, minimum font size 20, font type ARIAL/TIMES NEW ROMAN/CALIBRI

 Minimum animation, simple background

2. Presentation time maximum 12 minutes, followed by 10 minutes discussion

3. Each group will have chance to present their SP as planners will chose presenters randomly.

4. Please ensure to input all group slides to the computer before the presentation session begin, and name them as SGD 1, SGD 2 and so on, and put them in to one folder namely: Student Project Community Based Practice – English/Regular Class

Assesment guideline

No Assesment items Maximum mark

1 Appropriate answer 60

2 Group work 20

3 The ability to answer questions 20

Total mark 100

The mark for study project is an average of marks from planners who assess every SGD groups. The study project mark contribute 15% of total CBP evaluation.