Circle:
Genogram:
Pedigree
Persepsi
Family
Lifecycle
Siklus
hidup-mati
Lifeline:
Kronologi
Family Lifeline
Minimal
emphasis
on family
Medical
information
and advice
Feeling and
support
Assessment
and
intervention
Family
therapy
Family Therapy
Dasar pemikiran dokter adalah dinamika keluarga dan kesehatan pasien saling mempengaruhi satu sama lainnya
dan pola ini perlu dirubah.
Perilaku dokter adalah bertemu secara teratur dengan keluarga pasien dan berusaha merubah dinamika keluarga
peraturan-peraturan yang tak tertulis dalam keluarga tersebut yang berhubungan dengan perkembangan fisik dan
mental pasien.
Dokter umummnya akan terlibat hingga level 4, level ini biasanya dibutuhkan kemampuan dalam konseling.
Sedangkan untuk melakukan peran hingga level 5 dibutuhkan satu pelatihan khusus.
Kelompok
Kelompok kecil: Diskusi, FGD, Role play, simulasi, dll
Kelompok besar:
Ceramah: pendidikan tinggi maupun rendah
Seminar: pendidikan menengah ke atas
Massa
Ceramah umum
Media elektronik, media cetak, billboard, dll
Berdasarkan
bentuk umum
penggunaan
Berdasarkan
cara produksi
Bahan bacaan
Bahan
peragaan
Media cetak
Media
elektronik
Media luar
ruang
modul, leaflet,
majalah, dll
poster, flip
chart, slide,
film, dll
Poster, flip
chart, leaflet,
pamflet,
majalah, koran
Reklame,
spanduk,
pameran,
banner
MEDIA ELEKTRONIK
Sifat
(+)
(-)
Leaflet
Film
Slide
Cukup efektif karena gambar atau materi dapat dilihat berkali-kali dan dibahas lebih
mendalam
Sasaran: kelompok
Imunisasi
Rutin
Bayi
Wanita subur
Anak SD
Tambahan
Imunisasi Tambahan
Back log fighting
Crash program
Outbreak response
immunization
PIN
SUB PIN
Catch up campaign
campak
Surveilans
Aktif
Datang langsung
Pasif
Laporan bulanan
Sentinel
Data
Surveilans
Metode
Khusus
Rutin
terpadu
Case Definition
Suspect
Probable
Definite
Susceptibility:
Risk factor
Presymptomatic
: Pathological
changes
Symptomatic:
Sign &
symptoms
Disability: Loss
of function
Outbreak
Outbreak
Endemic
The habitual presence of a disease within a given
geographic area; may also refer to the usual
prevalence of a given disease within such an area.
Epidemic
The occurrence in a community or region of a group
of illnesses of similar nature, clearly in excess of
normal expectancy, and derived from a common or
from a propagated source.
Pandemic
A worldwide epidemic.
Definitions by America Public Health Association (APHA)
PDCA
Pareto
Family
Nuclear (conjugal family)
Only the husband, the wife, and unmarried children
Blended (stepfamily)
Remarriage including step-siblings and parents.
Single-parent family
A lone parent and offspring living together as a family unit
Commune family
Several people living together, sharing responsibilities and resources
Incubatory carriers
are going to become ill, but begin transmitting their infection before their symptoms start (eg: HIV)
Healthy carriers
= inapparent infection. Never develop the illness, but are able to transmit their infection to others.
(eg: polio)
Convalescent carriers
continue to be infectious during and even after their recovery from illness (eg: typhoid)
Biological vector
Vector in whose body the infecting organism develops or multiplies before becoming infective to
the recipient individual. (eg: mosquito)
Mechanical vector
vector which transmits an infective organism from one host to another but which is not essential to
the life cycle of the parasite. (eg: house fly)
Preclinical
Clinical
Disability
Secondary
1. Health
promotion
2. Specific
protection
3. Early
detection
and prompt
treatment
Nutrition,
smoking
cessation
Vaccination,
protective
equipment
SCREENING
TertiaryTertiaryTertiary
4. Disabillity
limitation
5.
Rehabilitati
on
Mx
Physiotx
Susceptibility
Preclinical
Clinical
Disability
4. Disabillity
limitation
5.
Rehabilitati
on
Mx
Physiotx
1. Health
promotion
2. Specific
protection
3. Early
detection
and prompt
treatment
Nutrition,
smoking
cessation
Vaccination,
protective
equipment
SCREENING
Lokasi
Di tengah pemukiman penduduk
Kepadatan penduduk 3.000 5.000 penduduk
Jarak Pustu dengan sarana kesehatan lain = 3 5 km
Kriteria KLB
Penyakit menular baru
Peningkatan kejadian kesakitan terus-menerus selama 3 (tiga) kurun waktu
tertentu
Peningkatan kejadian kesakitan >2 x dibandingkan dengan periode
sebelumnya
Insidensi Prevalensi
Insidensi Prevalensi
x/y
Mortality Rate
Crude Death Rate
kematian/1000 penduduk
Infant Mortality
Rate
Neonatal
Mortality Rate
Maternal
Mortality Rate
kematian ibu
.
100.000 kelahiran hidup
Mortality Rate
Crude Death
Rate
kematian/1000
penduduk
kematian/1000
penduduk
Infant
Mortality Rate
kematian
anak
usia <1
kematian
anak usia
<1 tahun
x K tahun
kelahiran
hidup
kelahiran
hidup
xK
Neonatal
Mortality Rate
kematian
anak
usia <1
kematian
anak usia
<1 bulan
x K bulan
kelahiran
hidup
kelahiran
hidup
xK
Maternal
Mortality Rate
kematian
ibu
kematianibu
xK
kelahiranhidup
kelahiran hidup
xK
IMR & MMR: K=1000 (kematian bayi/neonatal per 1000 kelahiran hidup)
MMR: K=100.000 (kematian ibu per 100.000 kelahiran hidup)
Biopsikososial
Promosi, prevensi, kurasi, rehabilitasi
Berkesinambungan. Follow up, kontrol, dll
Koordinatif
Kolaboratif
Decision-maker
Communicator
Community leader
Manager
RESEARCH
Variabel
What is Bias?
Any trend in the collection, analysis, interpretation,
publication or review of data that can lead to
conclusions that are systematically different from the
truth (Last, 2001)
A process at any state of inference tending to produce
results that depart systematically from the true values
(Fletcher et al, 1988)
Systematic error in design or conduct of a study (Szklo
et al, 2000)
Types of Bias
Selection bias
Unrepresentative nature of sample
Confounding bias
Distortion of exposure - disease relation by some
other factor
RESEARCH DESIGN
Laboratory
Experimental
Animal
Intervention
Human
Descriptive
NO group
comparison
Case report
Case series
Case study
Natural exposure
Observational
Group
comparison
Analytical
Cross-sectional
Case control
Cohort
Cross Sectional
Case Control
Cohort
Exposure
Disease
(+)
(-)
(+)
(-)
Exposure
Disease
(+)
(-)
(+)
90
180
(-)
30
300
RCT
Observasi
Observasi
Berdasarkan
Partisipasi
Partisipasi
Non
partisipasi
Berdasarkan
Keterbukaan
Terbuka
Tertutup
Efficacy vs Effectiveness
Efficacy
Effectiveness
real setting
Screening
MASS
SELECTIVE
Whole
population.
High risk
group.
Xray massal
HIV
CASE
FINDING
SINGLE
DISEASE
MULTIPHASE
Smaller
group.
Hereditary,
CRC
1 particular
disease.
Several test.
HBsAg
MCU
Diagnostic Test
Disease
T
e
s
t
True
positive
False
positive
False
negative
True
negative
Definition
Sensitivity
proportion of test positive result among diseased
group
Specificity
proportion of test negative result among non diseased
group
a+b
c+d
a+c
b+d
Test
result
Sensitivity = a / (a+c)
Specificity = d / (b+d)
PPV
NPV
= a / (a+b)
= d/ (c+d)
Sampling
RANDOM
Simple random
Stratified: karakteristik bertingkat (pendidikan rendah menengah tinggi)
Cluster: kelompok setara. (dari 1000 SMP diambil hanya 100 SMP)
Multistage: populasi besar, bertahap, agar mewakili seluruhnya (provinsi
kabupaten kecamatan kelurahan)
NON-RANDOM
Quota: ada kuota, ada kriteria karakteristik
Accidental: mirip kuota, tapi ga ada kriteria karakteristik
Judgemental/Purposive: sengaja milih sampel yg kira2 punya info yg
dibutuhkan
Snowball: sedikit sampel banyak (dgn network)
MIXED
STATISTICS
SIFAT
CONTOH
Kategorikal
Nominal
Bukan peringkat
Golongan darah
Jenis kelamin
Ordinal
Peringkat
Derajat penyakit
Status sosial ekonomi
Interval
Suhu tubuh
IQ
Rasio
Punya 0 alamiah
Kadar Hb
Penghasilan
Numerik
Uji Statistika
Variabel
Metode
Bebas
Nominal
Tergantung
Nominal
Nominal
dan/numerik (>2)
Nominal
Regresi Logistik
Numerik
Numerik
Numerik
Numerik >2
Numerik
T-test: - Berpasangan
- Independen
ANOVA
Regresi linier (AB)
Korelasi (A B)
Regresi multipel
Uji Proporchi
Stroke
Tidak Stroke
Merokok
Tidak Merokok
TIPS:
Uji Rerati
kadar GDS di 2 kelompok
T-Test INDEPENDEN Membandingkan
berbeda
TIPS:
Ingat uji RERATI (rerata-T test)
Jenis Hipotesis
Komparatif / Asosiatif (membandingkan / mencari
adanya hubungan)
2 kelompok
Berpasangan
Tidak
berpasangan
>2 kelompok
Berpasangan Tidak
berpasangan
Numerik
(interval
dan rasio)
Uji t
Uji t
Anova
berpasangan independen
Anova
Ordinal
Wilcoxon
KruskalWallis
Mann
Whitney
Friedman
= Bila sebaran data tidak normal (p<0.05 pada uji Kolmogorov Smirnov)
Asosiasi
Koefisien korelasi (r)
r > 0,7: asosiasi kuat
r 0,3-0,7: asosiasi sedang
r < 0,3: asosiasi ringan
SKDN
TERIMA KASIH