p




  




Russell F. Bernabe, MD


 p 
ë. Health Care Provider
2. Social Mobilizer
3. Teacher
4. Administrator
5. Researcher
 

  







 

= the harmonious functioning of all parts of the body or the
physical ability of components of the body to self heal
 

= the well functioning biological state that provide the body
with physical capacities to fulfill all higher order task
!"
= is a state of complete physical, mental, and social well
being not merely the absence disease or infirmity.
 





#  $
%
= Types of stress
a. Eustress = helpful
b. Dystress = harmful
   &
= the ability of the individual to function in manner
acceptable to himself and to the group to which he is a part
 



& ' 

  
ë. Disease results from an imbalance between a disease agent
and man.
2. The nature and extent of the imbalance depends on the nature
of the host and agent.
3. The characteristics of the host and the agent are influenced
considerably by their environment.
 þ



  

Agent Host

Environment
 K (
#&
  


#&

= anything whose presence or absence can initiate or
perpetuate a disease process
(
 &

a. Biologic
b. Nutrient
c. Chemical
d. Physical
e. Mechanical
K

 

p 


= morphology
)&
*



= aerobic or anaerobic


 
+

, )



 

 
 

 


p &


= the ability of the agent when lodge in the body to set up
specific reaction.
), 


= severity of the reaction produced, measured in terms of
fatality
#&


 the ability to stimulate the host to produce antibodies.
 

 


 


 


= anything from which an is agent passes immediately to a host
)
 

= mechanisms by which an agent is transported from reservoir
to a susceptible host
,



 inanimate objects contaminated by the agent
,
 
 arthropods or other invertebrates which transmit infection

# ) 


 KK (
  


#&

= certain diseases have a predilection for specific age groups

-
= certain diseases are sex=linked



= certain diseases are peculiar to certain race
. )
  
&
= the presence or absence of certain diseases are influenced by
habits, customs, and religion.
/0-
 &

 



 



  
 



K


= resistance associated with antibodies
K


)
= ability to resist disease independently of antibodies
.

 

 include both immunity and inherent insusceptibility
/(


= a form of carrier state
1p


= refractoriness to further infection of already sick individual
2 
 
p 
 





a. Certain diseases have seasonal distribution
b. Distribution of vectors are adversely or favorably affected
c. Disease agents are adversely or favorably affected

 
= most vectors thrives best in higher humidity
3
& 
a. Geologic structure may facilitate transport of diseases
b. Fertility of the soil influence food habits
c. Topography affects the ability to utilize health care services
&
 


= All living things that may serve as reservoir, sources, and
vectors of diseases agents
a. Plants
b. Animals
c. Human beings



 


ë. Factors arising out of social environment aside from economic
status and its social stratification.
2. Factors that are essential concomitants and results of the
economic systems of the era.
3. Factors that are inherent in the nature of specific diseases
which are particularly subject to general as well as specific
economic and social conditions
4. Factors arising out of the maladjustments in the production and
distribution of curative and preventive services
5. Factors that essentially are psychological


*


 




ë. Conditions in the environment must be favorable to the
infectious agent or the agents must be able to adopt to the
environment
2. Suitable receivers must be present
3. The host must be susceptible and within reach
4. Satisfactory portal of entry into the host
5. Accessible portal of exit from the host
6. Appropriate means of dissemination and transmission to a new
host
     
 

 



 
ë. Characteristics and dosage of the agent, and the duration of
exposure of the host to it.
2. Reaction of the tissues of the host to the introduction of the
agents
3. Portal of entry tissues affected
 
 

 &

(

' 
 &

= by virtue of its natural resistance or weak agent
  

*) 

= host is a healthy carrier

)  
= very mild reactions that they escape detection but may lead to
carrier state.
.)'  

= cases may be typical or atypical
p 
þ


p 
3



a. Development of good habits and hygiene
b. Proper nutrition
c. Proper attitude toward sickness
d. Proper an prompt utilization of health and medical facilities

p 

a. Segregation of the reservoir or source of infection by
isolation or quarantine
b. Control of means of spread of disease agents
c. Increasing the resistance of host by specific immunization

 þ


0   &
= arrest disease process in its earliest possible state
p 



 


= give appropriate medicines to cases to eradicate human
reservoirs of disease agents
K

 

  



    


= animal reservoir should not be treated.
(
 þ


 )þ
 
= indicates failure of prevention
= requires treatment of more ore less advanced disease


 ) 
= maximizing the affected individual¶s remaining capacity
K


 '  



= done to prevent relapses
= to affect complete cure
p



  





Health Indicators
Russell F. Bernabe, MD


= a single number that represents the relative size of two number
= formula: a
______
(k)
b
= k´ is usually assigned a value of ë

 ë,


 ë
,


and so on
= the numerator in ratio may or may not be a subgroup or part of the
denominator

-

= Number of males X ë


Number of females
#&





= no. of persons aged
±ë4 y.o. + no. of persons aged 65 years and over X ë


no. of person ë5 ± 64 years old
p  
= a special type of ratio which the numerator is part of the denominator
= formula:
a
______
(k)
a+b
= Proportionate Mortality Ratio for Measles, which relate the number of deaths
from measles to the total deaths from all causes.



= =the frequency of occurrence of events over a given interval of time.
= it measures amount of changes
= categorized into:
K  
 

= the denominator is the total population
KK 
 

= events happening to a specified group are related only to the
corresponding segment of the population
= used when making comparisons between and among populations
which differ in distribution according to the different variables.
K 



ë. Crude Birth Rates
2. General Fertility Rates
3. Crude Death Rates
4. Cause=of=Death Rates
 
 


= measures how fast people are added to the population through births.
= formula:
no. of registered livebirths in a year

= ______________________________________________ X ë



midyear population

= can be made specific by computing for the different variables

= it is affected by:
a) fertility/marriage patterns and practices of a place
b) sex and age composition of a population
c) birth registration practices
3





= births are related to the segment of the population deemed to be capable of
giving birth
no. of registered livebirths in a year
_______________________________________________________________
3
= X ë



midyear population of women ë5 ± 44 years of age

= it can be made specific by computing it for different categories of maternal

variables
  




= gives the rate with which mortality occurs in a given population
no. of of deaths in a year

= __________________________________ X ë



midyear population

= it affected by:
a. peace and order situation
b. adverse environmental and occupational conditions
c. age and sex composition
. 




= gives the rate of dying secondary to specific causes
no. of of deaths from a certain causes in a year

= ___________________________________________________________ X ë



midyear population

= it can be made specific by relating the deaths from a specific cause and group
to the midyear population of that specified group
= it is affectd by:
a. completeness of registration of deaths
b. composition of the population
c. diseae ascertainment level in the community
KK




  


= shows the rate of dying in specific population groups.
= general formula:
no. of of deaths in a specified in a year

= ___________________________________________________________ X ë



midyear population of the same specified group

= much more valid to use than CDR when comparing mortality experiences
between groups.
= types:
ë. Infant Mortality Rates 4. Swaroop¶s Index
2. Maternal Mortality Rates 5. Case Fatality Rates
3. Proportionate Mortality Rates
K   



= a sensitive index of the level of health in a community

= it can be artificially lowered by improving the registration of births
= formula:
no. of deaths under ë year old in a specified in a year
K
= _____________________________________________________________________ X ë



number of livebirths in the same year
= affected by:
a. maternal and child health care c. environmental sanitation
b. malnutrition d. health service delivery
= subdivisions:
a. Neonatal Mortality Rate
b. Post=neonatal Mortality Rate
 4
    


= deaths are due to prenatal or genetic factor

no. of deaths among those under 28 days in a year

________________________________________________________________
4
= X ë



no. of live births in the same year
 )p
    


= deaths are due to environmental, genetic, nutritional and/or infectious factors.

no. of deaths among those 28 days to less than ë year of age in a year
_____________________________________________________________________________________
p
= X
ë



no. of live births in the same year
 
   



= measures the number of deaths due to diseases directly related to pregnancy,

delivery and puerperium per ë,


livebirth
= formula:
no. of deaths due to pregnancy, delivery, puerperium in a year

= ____________________________________________________________________________ X
ë



no. of livebirths in the same year
= affected by
a. maternal health practices
b. diagnostic ascertainment
c. completeness of registration of births
p   
  


= is the proportion of total deaths occurring in a particular population group or
from a particular cause
= formula:
no.of deaths from a particular cause or population group in a year
p
= _______________________________________________________________________________ X ë


total deaths in same year
.' 5K
-

= a special kind of proportionate mortality ratio

= a sensitive indicator of the standard oh health care
= formula:
no. of deaths among those 5
years and over in a year
K = ____________________________________________________________________ X ë


total number of deaths in the same year

= develop countries have higher Swaroop¶s Index than less developed ones
/ 
  


= is the proportion of cases which end up fatally
= it tells how much of the afflicted die from the disease
= formula:
no. of deaths from a specified cause

= ______________________________________________ X ë


number of cases of the same disease

= high CFR means more fatal disease

= it depends on :
a. nature of the disease itself
b. diagnostic ascertainment
c. level of reporting in the population
 ) 


K




p
 




K



6K


7
= measures the development of a disease in a group exposed to the risk of the
disease in a period
= useful than PR in determining etiologic factors of diseases.
= formula:
no. of new cases of a disease developing in a period of time
____________________________________________________________________________
IR = X ë


population at risk of developing the disease during the
same period of time
= 
 
K

 

= measures the proportion of persons in a population who are initially free of
the disease of interest and who develop the disease within specified time
interval
p
 




= measures the proportion of existing cases of a disease in a population
= more use than the incidence measure in describing the occurrence of chronic
conditions and as an indicator or basis for making decisions in the
administration of health services.
= formula:
no. of existing cases of a specified disease
PR = ________________________________________________________ X F
population examined
= influenced by:
a. diagnostic capabilities
b. levels of notifications
c. age and sex composition of the population
"




p)

þ
0-
 
= a very useful and commonly used method of describing a population trait.
= defined as the average of years an infant is expected to live under the
mortality conditions for a given year.
= life expectancy of a female child is always higher that her female counterpart
for the years indicated.

#

& 
 

= measures the mean length of time a specific group of patients spend in the
hospital continuously.
= computing by adding up the duration of stay of all patients dan dividing the
sum by the number of patients.

 

p




 




  p

 
Russell F. Bernabe, MD
 (
 

4
 
= represents name or identifiers of person¶s status, category, or attribute that
do not represent quantity or amount
"  
= represents an ordered series of relationship
K
  

= represents quantity, meaningful comparison of one number to the another
number is possible, no meaningful zero
4.
 

 represents quantity, meaningful comparison of one number to the another
number is possible, it has meaningful zero
(
,  )

,  )

= used interchangeably with attribute, are specific characteristics of anything
which can be assessed.
8  

= are attributes that yield observations that can be categorized according to
some characteristics or quality
8  

= are variables that yield observations that can be measured.


± expressed as integers
) ± expressed as fraction
(
  p

 
4 
p

 

( ) p

 

3  p

 

4 
p

 
= also known as the Textual Method of data presentation
= the data is simply narrated in a story like fashion
= tendency to get confused
= usually used as research abstract´ or summaries of study/research.
KK( ) p

   
= numerical data are presented in a logical fashion usually in
form of tables
= provide a compact and orderly way of presenting large sets of
detailed information
= can readily point out trends and comparison
= show the interrelationships among variables
 p  ( )

( )

)
= consecutively place on the left most potion of the
table,
(
= give the what´, who´, where´, and when´ of a table
= a 

may be placed as a secondary
caption and serves to clarify items in the main title or body


&= indicate the basis of classification of columns or
vertical series of figures
.
'
&= indicate the basis of classification of the rows or
horizontal series of figures
/  =composed of cell (intersection of a row and a column)
1
= placed immediately below the bottom rule of the table
2 
  = place immediately after the footnotes of unoriginal
data.
 
 p 
 
( )



= tables should exhibit a clean, professional and uniform look
 
= table should jive with the textual discussion
= can be achieved by:
i. clear, concise headings or captions
ii. uncluttered footnotes
iii. minimum variables present
iv. well spaced columns and rows



= implies that what is only necessary should be included in the
table
p
( )
 
#p&
 )

= a table should be placed immediately after the text where it was first
cited
9


= standardize a particular style of a table format for a single report
4
)
  )




= minimized the variables presented on a table.
= if data in a master table must be presented, it should be broken
down into simple tables with a maximum of 3 variables presented
0
 )
 )


-   
= the reader should be able to understand the content of the table
without referring to textual explanations.
p
 & 
0-   ( )

ë. Title must be complete but concise.
2. All units of measure should be indicated in the table.
3. Uncommon abbreviations should be explained in the footnote
4. Each row and column should have a clear and concise heading
5. Double rule lines should only be used in the top rule succeeding
rule lines should be single rule lines. Rule lines should always be
used for closely=spaced figures
   )
  &
)
  )

"
'  )

= a table which present distribution for a single variable
&
 )
6.Two= way table)
= a table which shows the distribution of two variables
'  )

= a table which shows the distribution of three or more variable
"
'  )

( )
 




  )


p
::2


 4
)
 

ë. Tuberculosis 24
,5

2. Influenza 574,748
3. Malaria 6,248
4. Diarrhea 8,4

5. Measles 37,857
6. Diphtheria 53
7. Malignant Neoplasm 4,723

Source:ë7 Annual Report of the Health Intelligence Center,

Department of Health
&
 )
6.Two= way/2 X 2)

Disease

E + =
x
p + a b
o
s = c d
u
r
e
 '  )
6 
;

7
( )
 ( 4
)
 <

 
#9" #<==2==>
#

  
 

 
 ? 

  ? 


A= 



 

 = 



 

 = 



 

@  



Footnote: Angeles University Foundation=School of Medicine
KKK3 p

  
#   &

ë. Simpler to read
2. Appeal to a greater number of people
3. Large complex masses of data can be presented in simpler language
4. Significant trends or patterns can be made to stand out more clearly
5. Offers a wider point of view of the data set, when precision is not
required
   &

ë. Can be used to misrepresent facts
2. Twist facts
3. Oversimplify situations
3

p 

ë. Should be completely self explanatory.
2. The scales should be properly labeled.
3. Trend lines and curves in the chart should be properly identified by labels or
a legend
4. Grid or guide rulings may be used in a graph to guide the eye, but they
should be kept at a minimum
5. Graphs should be simple, neat, and businesslike
6. Basis of classification is generally represented on the horizontal scale,
while, frequencies are placed along the vertical scale
7. The vertical scale should always start with zero.
8. Use color for emphasis or to differentiate between items in a diagram
. On an arithmetic scale, equal distances between tick marks on the axis
should represent equal numerical units


3 
p

 

 
ë. Bar Graph
2. Pie Chart
3. Component Bar Diagram
4. Histogram
5. Frequency Polygon
6. Line Graph
7.Scatterpoint Diagram
 3 
= for comparison of absolute or relative counts, rates, etc.
between categories of a qualitative or discrete
quantitative variable
= ualitative variables are represented using the horizontal
Bar graph
= Discrete quantitative variables are represented using the
vertical bar graph
  3 
  B        

   
  

 


 

 
 

 
 
   
 


 

   




  !!"!!!

p
 
= shows the breakdown of a group or total where the
number of categories of qualitative variable is not too
many
= the percentage of contribution of each component is
multiplied by 3.6
= the area of each sliced´ is proportional to the relative
contribution of the component to the whole pie
p
 
  

    
 p  
 

 C ¢

 
 





C

 C

C


  &

= shows the breakdown of a group or total where there are

several number of categories of qualitative variable


  &

&  )(
#
 4



&=:>.
==

:= Others

>= Hilot

2= Midwife

1= Nurse

/= Physician
.=

=

=

=
4


&=

Source: Health Intelligence Service, DOH, Philippine Health Statistics, ë84

.&

= graphic representation of the frequency distribution of a

continuous quantitative variable or measurement
including age group
= horizontal axis is a continuous scale showing the units of
measurement of variable under consideration
= vertical scale shows absolute or relative frequencies
= rectangle are drawn over the true limits of the groupings
= comparisons between groupings is made on the basis of
the areas of rectangle an not the height

*
 )
( )
.þ
&



>.K   
þ
&6
7 4K 
43 ë
44 3
45 6
46 ëë
47 ë2
48 ë6
4 ë4
5
8
5ë 6
52 4
53 2
54 ë
 .&

&.þ
&>.K   




2

ë8

ë6

4 ë4
K 
ë2

ë

=
. .../.1.2.>.:/=/// /. //
þ
&




/
*
p&
= same function as the histogram
= use to depict more than one distribution in a single graph
= the frequencies are plotted against the corresponding
midpoint of the classes
= can be constructed from a Histogram by simply
connecting the midpoints of the upper bases of each bar
and closing the figure
 /
*
p&
&/þ
&>.K   




2

ë8

ë6

4 ë4
K 
ë2

ë

=
. .../.1.2.>.:/=/// /. //
þ
&




 /
*
p&
&/þ
&>.K   




2

ë8

ë6

4 ë4
K 
ë2

ë

=
./. /.././/.1/.2/.>/.://=////// //./ ///
þ
&




1þ
 &

= shows trend data or changes with time or age with respect

to some other variable
= changes in growth of population, temperature readings,
birth and death rates morbidity and mortality rate are best
portrayed using Line graph
1þ
 &

&1   D
 

  




  

ss
 


ss
 ss
sss
 


ss 
ss 

ss
D



ss
s












2 
 &

= show correlation between two quantitative variables

= gives a rough estimate of the type and degree of
correlation between two variables
= usually made as a preliminary step towards more detailed
mathematical analysis
2 
 &

&2 
   &
     



&

V
       

 
Preventive, Family, and
Community Medicine
Sampling

Russell F. Bernabe, MD
 





&
= is a procedure of drawing a fraction or segment of a population
= purpose:
a) to determine certain characterisitics of the population.
b) to determine the occurrence of some events in the population
= advantages:
a) economy
b) greater speed in getting results
c) greater accuracy is achieved
d) more information can be obtained
e) more intensive and careful data collection and analysis can be done
 
 
&
K 4 p ) )
&
 
= the process of obtaining a sample where the probability of inclusion of a
unit is of known or specified, thus the reliability of a sample results can
not be assessed.

KK p ) )
&
 
= procedure of obtaining a sample where each unit of a population has a
known non=zero probability of being included.
= results using probability samples can be assessed for precision.
K4p ) )
&
 
  E ;#
 
&
= the inclusion into a sample of whatever units are at hand or available,
based on the assumption, often incorrect, that units picked this way are
typical of the population they came from.
= often used in the social and biological fields

F &

;p 

&
= inclusion or exclusion of units depends on an expert¶s´ judgment or
opinion.

8 
&
= process of picking units from various subgroups in proportion
corresponding to those of the population
KKp ) )
&
 
ë. Random Sampling
2. Systematic Sampling
3. Stratified Sampling
4. Cluster Sampling
5. Multistage Sampling
ë. Random Sampling
= Method of selecting a number of subjects from a population such that every
member has an equal chance of being drawn into the sample.

= The units are drawn unit by unit

2. Systematic Sampling
= This is a method where every Kth unit is selected from a population which is
arranged in some definite way to obtain a sample of units

= Complete enumeration or list of the sampling population is a prerequisite at the

start.
3. Stratified Sampling
= Population is divided into subpopulations or strata, then a samples from each
stratum are then selected either by random or systematic sampling as if each
strata is a ´population´ itself

= It ensures proportionate representation into the sample of the different classes

in the population.
4. Cluster Sampling
= Cluster sampling should be resorted to if
a. complete list of the sampling unit does not exist
b. an up=to=date list is not available
c. other sampling technique cannot be done

= The sampling unit consists of a group or cluster of similar units

5. Multistage Sampling
= Used only when dealing with extremely large population where complete list
of final sampling units are not available from the outset.

= process:
ë. Population is divided into first stage sampling units ( primary sampling
units) and a sample of these units is selected.
2. Each of these selected first stage sampling units is further subdivided into
a second stage units

= Different sampling methods may be used at any stage of the sampling

 


 #
* 


E

ë. Problems dealing with counts
a) Descriptive study or one population problem
K2pq
______________
n=
d2
where:
n = sample size
k = reliability coefficient based on the level of confidence
p = estimate of frequency of event
q=ë±p
d = maximum amount of deviation from true frequency
 


 #
* 


E

ë. Problems dealing with counts
b) Analytic study comparing two frequencies from different population
K22pq
______________
n=
d2
where:
n = sample size
k = reliability coefficient based on the level of confidence
p = ave. of estimates of frequencies of the event in the 2 population
q=ë±p
d = minimum difference between the frequencies to be detected
 


 #
* 


E

2. Problems dealing with measurements
a) Analytic study comparing two frequencies from different population

K22SD2
______________
n=
d2
where:
n = sample size
k = reliability coefficient based on the level of confidence
SD = estimate of standard error of difference
d = minimum difference between means to be detected.
Demography

Russell F. Bernabe, M.D.

Definition of Terms





= ratio of economically dependent part of the population to the
productive part
)&(


= number of years required for the population of an area to
double its present size given the current rate of population
growth

 
= physiological capacity of a woman, or couple to produce a live
child


= actual reproductive performance of an individual, a couple, a
group or a population.
Definition of Terms
3 '


= rate at which the population is increasing or decreasing at a
given time.
þ
0-
 
= average number of additional years a person would live if the
current mortality trends were to continue
þ
 
= maximum age that human beings could reach under optimum
condition

-

= the number of males per ë

females in a population multiplied
byë


p p

= special type of bar chart that shows age and sex composition of a
population.
Demography



& 
A. Focuses on 3 human phenomenon
ë. Population size
2. Composition of the population
3. Distribution of population in space
B. Seek reasons or explanations why such conditions are changing the
way they are, given the rate of change they exhibit.
Definition of Terms


& 
= the scientific study of human population including their E

,
 ), density and other demographic and socio=economic
characteristics and the causes and the consequences of changes in theses
factors.
Population Size

G  
 


ë. Natality
2. Mortality
3. Migration
Population Composition

 )
 

ë. Age
2. Gender
3. Marital status
4. Occupation
5. Education
Population Distribution
p 

= population per unit of land
= expressed as:
a) Person per square mile
b) Person per square kilometer
Uses of Demography
ë. Identify and characterize health problems.
2. Control and prevent health problems
3. Predict future developments and possible consequences
Sources of Demographic Data
 

= population information which includes, age, gender, ethnicity,
number of children ever born, literacy/educational attainment,
place of birth, occupation.
= de jure
= de facto
  

= information collected from only a subset of population
 , 
& 


= continuous recording of vital events such as birth, death,
stillbirth, marriages, divorces/annulments, and adoption
. &p 

&

= continuous recording of information about a population
Tools of Demography


= single number that represents the relative size of 2 numbers
= (a / b) x k
 p  
= special type of ratio in which the denominator is a part of the
denominator
= (a / a + b) x k



= frequency of occurrence over a given interval of time.
= e.g. Incidence Rate

 )&
p 

# 0H"p"K(K"4
number of males
 
-
I=========================== Hë


number of females

In ë
census of the Phils. 3
,443,ë87 males and 3
,ëë5,2 females

were enumerated. What is the sex ratio?
3
,443,ë87

-
I=================== Hë

= ë
ë
3
,ëë5,2

In ë
there were ë
ë males for every ë

females in the Philippines

 )&
p 

 
- 

( )
Population Distribution by Age and Gender,Cavite,ë

#&
 




- 
ë ë6,7
2 ë5,66ë ë
6.6
ë=4 5,48 56,7ë8 ë
5.7
5= 72,5
3 68,7ë8 ë
6.4
ë
=ë4 66,
3 64,432 ë
2.6
ë5=ë 5,4ë 5,238 ë

.4
2
=24 56,772 58,62 6.8
25=2 5
,63 53,232 5.ë
3
=34 45,476 45,463 ë

.

35=3 37,63 37,ë3ë ë
ë.4
4
=44 2,47 2,425 ë
ë.8
45=4 2
,586 2ë,257 6.8
5
=54 ë7,72 ë8, 4.6
55=5 ë3,38
ë4,832 
.2
6
=64 ,723 ë
,74 88.6
65=6 6,8ë5 8,32
8ë.
7
=74 4,42
5,6ë 74.ë
75 & > 6,
5
7,87 76.8
All ages 574,ë56 576,3
2 .6

 )&
p 

 #30"p"K(K"4
 #&


= in the Philippines the median age has been increasing from ë5.8
years inë7
to ë6.4 years in ë75 to ë8.6 years in ë8
and ë years in
ë
.
 #&





= index of age induced economic drain on manpower resources
= vital indicator of human resources and resource allocation

# of persons
=ë4 y.o. + 65 y.o. and over

#&




I
# of persons ë5=64 y.o.

 )&
p 

( )
Population Distribution the by Age Group Phils. ë

#&
&  4
)
p



= ë4 24,

4,586 3.5
ë5 = 64 34,62,5 57.ë
65 =
ver 2,
63,445 3.4
Total 6,67,4 ë

.

    
  &



ë. Fertility level
2. Peace and order situation
3. Urban=rural differences
 
 )&
p 

 #30#40H"p"K(K"46p p
 7
(
p 
 <&p 
= 45% of the population are children = median age is ë5 ± ë
= FR > 3
livebirths/ë,


= ë: ë dependency ratio

 
 p 
= 3
=4
% of the population are children = median age is 2
± 24
= FR = 25 = 3
livebirths/ë,


= 2: 3 dependency ratio

 " p 

= 3
% of the population are children = median age is 25 ± 2
= FR  2
livebirths/ë,


= ë: 2 dependency ratio
 p p


 & p
 
ë. Compute the percentage of the population in each age=sex group using the
total population as the denominator

2. Each age group is represented by a horizontal bar. The first bar representing
the youngest age group is drawn at the base of the pyramid.

3. The bars for males are traditionally presented on the left side of the central
vertical axis while bars for females are presented on the right side

4. The length of each bar corresponds to the percentage of the population

falling in the specific age and sex group being plotted
4
)
Jp

 )
p )#&
J
-  & 
::=

#&
3   




6
7 4
)
4
)


=4 6,8
6.6 ë,27ë 6.2
5= ,768 6.8 3,83 6.4
ë
=ë4 4,
3 6.4 88,62 6.

ë5=ë 82,7 5.6 78,26 5.4
2
=24 72,587 4. 6,24ë 4.7
25=2 58,66ë 4.
56,4ëë 3.8
3
=34 5
,732 3.4 4,523 3.4
35=3 43,3
7 2. 42,852 2.
4
=44 34,62 2.4 35,773 2.4
45=4 26,664 ë.8 28,26 ë.
5
=54 22,36
ë.5 24,373 ë.7
55=5 ë7,6ë3 ë.2 ë,85 ë.3
6
=64 ë3,6ë2
. ë5,82
ë.ë
65=6 ë
,
84
.7 ë3,226
.
7
=74 7,84
.5 ,5
.7
75=7
5,2
.4 7,48
.5
8
=+ 4,582
.3 6,6
5
.4
All Ages 742,7
8 5
.3 732,5ë5 4.7
Total Population= ë,475,223
 p )#&
J
- )  & ::=

 




8
=+
75=7
7
=74
65=6
5
=64
55=5
5
=54
45=4
4
=44
35=3
3
=34
25=2
2
=24
ë5=ë
ë
=ë4
5=

=4
8 6 4 2
PERCENT
2 4 6 8
, (
p

(

= broad base and gently sloping sides
= high rates of birth and death
= low median age and high dependency ratio

(

= broader base than type ëand sides bow in
= marked reduction in infant & child mortality but fertility is not yet
reduce
= median age is decreasing
, (
p

(

= beehive shape
= low birth rates
= median age is highest, dependency ratio is lowest, dependents are mostly
elders
(
.
= bell shape, a transitional one
= occurs after more than ë

years of declining birth and death rates
followed by reverse of the trend in fertility while maintaining low death rates
(
/
= pentagon shape
= marked and rapid decline in fertility
= low death rate

 )&
p  )
( )
 Percent Distribution of Population by Urban=Rural Residence by Region
Philippines,ë



& 9 ) 
  p
;*+

I 37.8 62.2 276.3
II 23.5 76.2 87.ë
III 6
.3 3.7 33.5
IV 5ë.ë 48. ë75.8
V 3ë.2 68.8 22ë.5
VI 35.8 64.2 266.3
VII 4
.4 5.6 3
6.5
VIII 3ë.2 68.8 ë42.3
IX 3
.7 6.3 ë6.ë
X 43.4 56.6 ë23.6
XI 47.4 52.6 ë4
.4
XII 25.4 74.8 ë36.

NCR ë

.

ë2,433.

CAR 3ë.2 68.7 62.4
Phils. 37.2 62.8 ëë.2
0
&p E

( )
.þ
)   ( 
p:2=:>1
  

'ear Number Crude Rate Number Crude Rate
ë7
66,762 26.4 234,
38 6.4
ë7ë 63,74 25.4 25
,ë3 6.6
ë72 68,385 24.8 285,76ë 7.3
ë73 ë,
4,2
26.2 283,475 7.ë
ë74 ë,
8ë,
73 26.2 283,75 6.
ë75 ë,223,837 2.ë 27ë,ë36 6.4
ë76 ë,3ë4,86
3
.3 2,86ë 6.
ë77 ë,344,836 3
.3 3
8,
4 7.

ë78 ë,387,588 3
.5 27,
34 6.5
ë7 ë,42,8ë4 3
.3 3
6,427 6.6
ë8
ë,456,86
3
.3 28,

6 6.2
ë8ë ë,46ë,2
4 2.5 3
ë,ëë7 6.ë
ë82 ë,474,4ë 2.
3
8,758 6.ë
ë83 ë,5
6,356 28. 327,26
6.3
ë84 ë,478,2
5 27.7 3ë3,35 5.
ë85 ë,437,ë54 26.3 334,663 6.ë
ë86 ë,43,5 26.7 326,74 5.8
0
&p E

#4  K


= number of births = number of deaths


4  K


= Crude Birth Rate = Crude Death Rate
 #)
  

 
K


#)
K

± average number of people added to the
population per year.
pK p
#KI

where: p = population size at an initial time, o
p = population size at a latter time, t
 = number of years between time o and time t
0
&p E



 
K

± actual difference between the two census counts
expressed in percent relative to the population size during
the earlier census
pK p

KI H==
p

where: p = population size at an initial time, o

p = population size at a latter time, t
0
&  p G
&p 
K

 0


= any date intermediate to 2 census and take the results of these
censuses into account

p
 0


= any date in the past or during a current date following a census

p G

= any date following the last census for which no current reports
are available.

 p 0







= inflow=outflow method of projecting population size
= requires updated information regarding births, deaths, and
migration

pIpL6K 7L6KK =7
Where: B = number of births occurring during the interval
and t.
D = number of deaths occurring during the same interval.
I = number of immigrants between time
and t.
O = number of out=migrants between time
and t.

 p 0


 

 


 # 

0

K assumes an equal amount of absolute change
occurs in the population every year.

p Ip L)

where: p Ipopulation size for future date

p Iinitial population size
 = time interval
) = average population increase

 p 0

) 3


 0

± assumes a constant rate of
increase/decrease occurs over each unit of time, usually a year

p Ip 6L 7

where : p Ipopulation size for future date

p = initial population size
= rate of growth
 = time interval

 p 0

 0-
 0

± assumes that population size is
increasing continuously at very small amounts of time

p Ip
 

where : p Ipopulation size for future date

p = initial population size

= mathematical constant
= rate of growth
 = time interval
0
)&(


7# 



p
(I
)

)73


 

K67
(I
K6L 7

70-
 

K67
(I
  


Russell F. Bernabe, MD
 
p &   

ë. Identification of data to be collected
2. Determination of the possible sources of the data
3. Choosing the method appropriate for the study.
4. Preparation of the tools of data collection
5. Establishing the time frame of data collection
 p   

a. The data or information to be collected.
b. How the information are to be collected including the tools to be used.
c. How quality control is to be ensured and the different forms of bias are to be
eliminated.
d. Time table for the data collection including how it is estimated.
 K
   )



ë. Go back to the objectives
2. List down the variables and classify them
a) independent variables
b) dependent variables
c) confounding/extraneous variables.
  
 
 p 
 
= data or information are directly collected from the subjects of the study.

 
  
= data or information are collected from records of other institutions.
  
  




'þ


= simplest and most economical
= disadvantages are adequacy and accuracy of recorded information.
=   &

ë. Easy: data readily available
2. Maybe the only mean to study past events
3. Less expensive
=    &

ë. There may be different definitions of variables
2. Type of data may not be appropriate for the present study
3. Information needed may have not been recorder
  
  

 8

= a good way and frequently the only way to get information.
= can be conducted through personal interview, telephone interview, or
self=administered questionnaire.
=   &

ë. Cheap
2. Can be used to many persons simultaneously
3. Simple
4. Less time requirement
5. Bias are avoided
=    &

ë. Require respondent to be literate
2. Instructions can not be further explained
3. Low response and completion rate
4. Lose opportunity to probe further
  
  

 K

'
= this the method of actually determining the presence or absence of many
conditions and attributes in the study population.
   &
:
ë. Interest of the respondent can be stimulated
2. uestions can be repeated/clarified
3. Responses can be followed up/clarified
4. Actual observation
5. Interviews can be facilitated by visual aids
    &

ë. Expensive
2. Requires skilled interviewers
3. Subject to recall bias
4. Time consuming
5.
ë. Accuracy
2. Practicability
 
  #   

   

 # 
= getting the true value or measurement.
= characteristics related to accuracy
,  
= the ability to measure what it is supposed to measure.
a. Sensitivity
= label Positive those who have the condition
b. Specificity
= label negative those who do not have the condition
c. Positive Predictive Value
= the chance that a positive result is truly indicative of the
presence of the condition


  p
p

, 

Disease

T
Ò a
______
e Ò

Ò 
=
s a+c
t   Ò

Ò Ò d

= ______
b+d

p
a
______
p

=
, 
a+b
# 
")G


= ability of device to give the same or identical results when the
test is done on the same subject by different observers

p


 ) 
 )

= ability of the measuring device to give consistent results
p  )
= refers to the overall ease or difficulty in use of method.
= a practical method should:
a. require reasonable or available resources.
b. use procedures acceptable to the subjects.
c. enable coverage of the study population.
  
K  

&   
= true difference in test results or measurements which is either physiological
or pathological in origin
a. Interindividual variation
b. Intraindividual variation
0-


 
 
= variation inherent in the measuring instrument itself or its interpretation
a. Measuring device
b. Observer
i. Inter=observer variation
ii. Intra=observer variation


K
 

# ")
 
 




ë. Training of Observers
2. Definition and classification of events
3. Objective determination of events
4. Improvement of the measuring instrument or choice of more accurate
measuring device.
p
 8
 

#p 


 & *
 

ë. List the variables to be measured.
2. Formulate suitable questions that would measure the variables.
3. Decide on the sequence of the questions.
4. Prepare the draft of the questionnaire.
5. Make necessary modifications.
p
 8
 



*


 *
 

ë. Validity = it must be evident that the question will elicit an answer
that is a valid measure of the variable being measured.
2. The respondent can be expected to know the answers to the questions
3. Clear an unambiguous ± must be understood by all respondent
4. Not offensive ± should not embarrass respondent
5. Fair= questions should not suggest specific answer
Interpretation of Statistical data

Russell F. Bernabe, MD
 K

    

= Statistics is the basis of most proofs in the investigation sciences. The

proof of hypothesis in statistics is limited to the testing of hypothesis.
By statistical reasoning we are able to determine what proportion of the
time we will accept false hypothesis and what proportion of the time we
will reject a true hypothesis.

= requirements of scientific study is the correct interpretation of the

information or data.
 

0  





 
 



  
 
 
  


= statistics do not prove cause and effect, they merely show statistical
association.
= Statistical association may mean:
a) a causal relationship between the factor and disease.
b) an indirect association between the factor and the disease arising from a
factor common to the two.
c) spurious/artificial association

 #)


)




= this should not be done unless the populations from which the numbers
came are equal.
= comparison must be done in terms of proportion of rates.
 

0  





 
 



     

 
 &
  
= Inference of statistical association must be based on comparison of proportions.
= Statistical association exists when:
a) the disease rate in those with the factor differs from the disease rate in those
without the factor.
b) the prevalence of the factor in those with the disease differs from the
prevalence of the factor in those who are well.

. ! &  
-


= the conventional statistical indices have specific uses and significance and
therefore must be used accordingly
= Example:
The risk of dying in those with the disease is measured by the Case Fatality
Rate and not the Mortality Rate which measures the risk of dying in the population.´
 

0  





 
 



/ ! &
 


 

-
= every index has a specific formula for its computation.
= frequent error found in the literature is in determining Mortality Rate by dividing
the number of deaths from a disease by the total hospital admissions.

1 
      ' 



= except for factors under investigation all factors that may influence the outcome
should be equalized, otherwise such factors might be responsible for observed
difference.
= standardization or adjustments of rates may be done to correct´ this

.
 

0  





 
 



2 (
)
    
   ' 




= except for factors under investigation all factors that may influence the
outcome should be equalized, otherwise such factors might be responsible
for observed difference.

$#

0   )
#
)#
* 
p &  p
 



K
& 9
 +
%
Descriptive Epidemiology

Russell F. Bernabe, MD
 
 



&
Purpose:
To characterize the amount and distribution of disease within a population.

= To identify health problems and patterns of disease that exist.

= Descriptive studies generally precede analytic studies designed to investigate

determinants of disease.

= Descriptive studies often help to generate research hypotheses.

p

#&

= the most fundamental factor to consider when describing disease occurrence.
= the incidence of most chronic diseases increases with age.
= the incidence of many infectious diseases is highest in childhood.
3


= biological and non=biological factors related to gender may impact disease
risk.
= In all developed countries, life expectancy is higher in females and males ±
principally due to lower heart disease mortality.
= many chronic diseases occur more frequently in women
= as lifestyles continue to become more similar, a question is whether mortality
rates will become more similar (i.e. environment vs. biology).


;

 difficult to define, and to identify which characteristics may relate to disease
occurrence. Remarkable variation exists in rates of disease occurrence across
racial and ethnic groups. (Genetics, Socioeconomic status, etc)
p

  
= summarizing variable (SES), unreliably measured, that links:
Occupation, Education, Area of residence, Income, Lifestyle
= despite its unreliability, SES is consistently associated with mortality
in a gradient fashion.
p 

= Investigation by place includes:
= Across countries (international)
= Within country variation
= Urban/rural differences
= Localized areas
= Infectious and chronic diseases show great variation from one country to another.
= Some differences may be attributed to: Climate, Cultural factors, Diet, Genetics.
= Infectious and chronic diseases also show considerable variation within a country
= Some differences may be attributed to: Climate, Geology, Latitude,
Environmental pollution, and Race/ethnicity
= Some differences in disease occurrence between urban and rural locations may
be attributed to: Diet, Physical activity, Housing conditions (i.e. lead paint),
Crowding (i.e. spread of infection), Pollution
= Some localized differences in disease occurrence may be attributed to:
Carcinogenic exposure (i.e. radon), Geologic formations (i.e. water hardness),
and Lifestyle
(


The occurrence of health=relate events can vary by time:

 
 
= refer to gradual changes in disease occurrence over long periods of calendar time.
 
 refer to shorter=term increases and decreases in disease occurrence over a period
of years, or within a year.
p



 refers to increased disease occurrence among a group of people exposed almost
simultaneously to an etiologic factor (i.e. pathogen, contaminant).
. 


 long=term variation in disease occurrence among a group of persons who share
something in common.
/
&
= An unusual aggregation of health events grouped together in space or time.
#
0

&

Russell F Bernabe, M.D.

9
0

&
 
ë. Determine frequency and distribution of disease.
2. Determine disease occurrence/etiology
3. Investigate outbreaks/epidemics
4. Community diagnosis
 

 


 &


p )

= determine the current status of the problem (nature and extent)

a) trend
b) comparison with other countries
c) comparison with other disease
d) economic burden
i. economic burden without prevention
ii. economic burden with prevention
 

 


 &
70

'

:
þ 



= no. of deaths x (65 ± median age of death) x minimum wage x 5 x52
þ 
  )
= no. of cases x average duration of illness x minimum wage
þ 


= no. of cases x average cost of treatment
70

'


þ 



= no. of deaths x (65 ± median age of death) x minimum wage x 5 x52
þ 
  )
= no. of cases x average duration of illness x minimum wage
þ 


= no. of cases x average cost of treatment
p


= cost of prevention x no. of population to be protected
 

 


 &
#  0-& 
a) Facts:
i) etiologic agents
ii) mode of transmission
iii) incubation period
iv) duration of illness

b) Characterize the disease occurrence as to:

i) Person
ii) Place
iii) Time
 

 


 &

 

= Identification of factors, circumstance other probable determinants existing
in the country that could explain the present status of the problem
.(


= Cite evidences of relationship of the factor and the problem.
/
= summary of all the facts enumerated.
1



 
= strategies/steps to approach problem identified in the testing of hypothesis




 

Russell F. Bernabe, MD
 p )

K
     


p )


= central to research.
= the question to be answered or resolved.
= it is the issue to be settled.
= its identification and definition is the starting point of any research
activity
= it does not represent a moral or ethical position on an issue
= best stated in question form.



8

= in medicine, research question usually ask about
(
 
  
 

 



a. anatomic structure e. pharmacologic action
b. physiologic principle f. pathologic process
c. biochemical pathway g. disease pattern in population
d. clinical course of illness

(

 ' 

  )
 


a. precursor and product
b. exposure and outcome
c. cause and effect
d. factor and prognosis
e. intervention and result
f. process and reflections
 



p )





K

  
= most common source of research problem of medical practitioner who
is not a professional researcher´




= often the beginning of research when methodology was less developed
= something happens at the right time, right place, and to the right person
# 


 
 

= most common source of research problems for professional researcher´
." & E

 






 





  
   3



p )




 )
= the problem can be resolved through research
& 

= the problem is not over researched and the potential result is worth the effort, time
and resources that will be put into the research.
= it should have the following:
    ± should not be too specific and small in scope
)K

 ± there must be current interest in the problem area.

)
  p  
= should fulfill all the following
a. Adequate subjects can be gathered for the subjects
b. The procedures are technically possible
c. The information needed can be collected
d. Resources are available
e. The study can be completed within reasonable amount of time
 
  3 


p )









= identify the general area of interest then narrow down to a specific topic or subject.
Ex: General area ± health problem among factory workers
Specific topic ± exposure to chemicals and its effects





 )


'
a. Characteristics of an event
Ex: What are the adverse effects of working in a chemical factory?
b. Relationship of factor and event
Ex: Does exposure to chemical in the factory produce adverse effects?




p )

 



a. Write down the problem in question form.
b. Clarify what you really want to find out
= use clear terms
= be specific
 
    
p )


+ '
 )





 ) )


= for better understanding and clarification of the problem
= serve as guide in
a. setting more achievable or realistic goals
b. choosing appropriate methods
c. identifying variables and parameters for the study
d. interpreting results





) )




 )

= collective answers to the subproblems should be adequate in answering the main
question or resolving the main problem.
 
 )

)
a. review of literature
b. consultation with the expert


 it is the suggested or tentative answer to the research problem which
serves as guide in the development of the research plan

K
  


 
a. Hypothesis provides the basis for the testing of the significance of the
findings of the study
b. It helps the researcher in establishing the framework of with which to
approach the problem
c. Hypothesis is essential in the determination of sample size and
statistical testing
K
  


 
a. Hypothesis provides the basis for the testing of the significance of the
findings of the study
b. It helps the researcher in establishing the framework of with which to
approach the problem
c. Hypothesis is essential in the determination of sample size and
statistical testing
(


4

= assumes that an association does not exist.
a. sample is not different from the population
b. the independent variable (cause) is not associated with the dependent
variable (outcome)
c. An intervention is not effective or more effective than another intervention
= used for testing
a. the safety of drugs and other interventions
b. probing that health or medical belief is a myth or erroneous
Ex.
The serum uric acid level of diabetics is not elevated.´
Coffee drinking does not cause coronary artery disease´
Ligation of the internal mammary arteries does not improve coronary
circulation´
Metaproterenol and theophylline have equal efficacy in the treatment of asthma.´
(


#
 
 p


= it assumes that an association exists
= more useful and is preferrable in health and medical research
= used in testing:
a. suspected risk and prognostic factors
b. intervention
= types:
(' 
 4 
 
= does not indicate whether it is direct or inverse or which is greater when
two samples are being compared.
= used when there are conflicting findings on the subject shown in literatures
Ex.
Socio=economic conditions and I are associated´
The serum uric acid level of diabetics varies from the normal values.´
Metaproterenol and theophylline differ in efficacy in the treatment of asthma.´
(


)"
 
 
 
= gives the direction of the relationship, or states which is greater
when two samples are being compared.
Ex.
Socio=economic conditions and I are inversely associated´

The uric acid level of diabetics is higher than normal´

Metaproterenol is more efficacious than theophylline in the treatment of

asthma.´
 
  


  



= a factor can be suspected to have something to do with an outcome if the
factor is prevalent among those who have the condition than among those
who do not have the condition.

   &
= an outcome with similar pattern of occurrence another type of outcome,
and the factor of the former outcome is established, the same factor may be
the cause of the later outcome

 
   
= a factor that fluctuates when the occurrence of an outcome fluctuates or
vice=versa, such factor could be causally related to the outcome
.
  &




= factors that are similarly distributed as that of the outcome, are possible
causes of the outcome.
")G


= it is what the researcher expects to achieve or the outcome he hopes
would be produced by the study.
= it is the solution to the research problem
= its attainment will give affirmation or non=affirmation to the
hypothesis that has been formulated.
= derived from the statements of the problem and hypothesis and is
essentially a statement of the hypothesis as expected outcome
K
  
 &


)G


ë. they give an indication of the relevant variables to be considered in the
study
2. they guide the researcher in the choice of research design or methods
3. they tell the researcher what data to collect
4. they are helpful in planning the analysis of the results
5.they are bases for the interpretation of results.
 (
)G


3

")G


= the overall purpose of the research.
= derived from the broad problem and the hypothesis
= stated by transforming the problem statement from interrogative from
to a run=off declarative form introduced by phrase to determine´ or
similar phrases.
Ex.
To determine if there is a relationship between socio=economic
background and I.´
To establish the magnitude and pattern of STIs in Angeles City.´
To determine if continuous deworming can eradicate ascariasis´
To ascertain the accuracy of two=hour post glucose serum sugar level in
detecting DM.´
 (
)G



")G


= are statements of the specific outcome expected of the study.
= statements of the subproblems provide the basis for the formulation of the
specific objectives following the same process as in the formulation of the
general objective.
= Adequate specific objectives must be formulated before the researcher can
proceed with the study.
  
 
")G


 
#
* 




 

 
= collectively, they achieve the general objective

! 

  

'  




 

  )


0-



 )



= outcome is in quantitative form, preferably in terms of indicators
 ,  )

= are events, factors or characteristics which may vary from person to person, or in
the same person at different times.
= they are the tools and basis for clarification of subjects and indicators used to
measure the event or changes in the event under investigation.
Ex.
a. characteristics of the subjects
b. outcome or results of a process
c. factors that have some influence on the subject of inquiry.
 3

 
& 
,  )

8  
  )

= not expressed numerically (Sex, Civil status, Religion)
8  
  )

= are expressed numerically (age, height, weight)
= subtypes



= expressed as integers (number of children)
)
= can be expressed as integers or fractions (height, weight)
  
& 
,  )




K


  )

= the factor that affects the value of the dependent condition that produces the
outcome
= it is the cause in cause=effect relationship
= in an experiment, it is the factor that is manipulated or varies
K


  )

= the factor whose value is affected by the independent variable
= it is the effect in cause=effect relationship (change¶s indicator)
 &  )

= not the principal interest of the study but may distort the result of the study
because it is associated with both the independent and dependent variables
= if age and sex are not factors under investigation, they are usually confounding variables
because they are usually associated with both variables in the studies of relationship
 
,  )




,  )

= must be defined in operational terms (meaning in the research) to enable proper
classification and categorization of the subjects or any events
Ex.







A person has rheumatic heart disease if:
ë. he has stenosis or insufficiency , or both, of the mitral or aortic valve, or both.
2. He has history of rheumatic fever confirmed by the presence of carditis,
migratory polyarthritis, an elevated ASO titer, or all of the above.
")

ë. An individual shall be considered obese if the weight is at least ë
% in excess
of the Desired Body weight




&
ë. It is a plan or course of action the researcher takes to solve the research
problem.
2. It is the strategy or approach by which the research questions can be
answered.
  G   



&

 

= an inquiry into the nature of an unknown phenomenon or the occurrence of
an event.
= its aim is to infer to the reference population the findings from a sample
# 
= designed to test hypothesis
= sub classification:
")
  
= test hypothesis of relationship without artificial manipulation
of study factors
)0-


 
= involves artificial manipulation of study factors
  G   



&
")
  
  
  
= used to related the prevalence of the independent variable to the
prevalence of dependent variable.
= the objective is to determine the prevalence of the outcome in various
groups and/or to examine relationship between a factor and an outcome
based on prevalence data
  
  
= used to compare the frequencies of the independent variable in those
who have and those who do not the dependent variable
= objective is to test the hypothesis of relationship between variables and
there are not enough knowledge on the subject, or the outcome/effect is
rare
  G   



&
   
= used to compare the occurrence of the dependent variable between
those with and those without the independent variable
= the objective is to test hypothesis and there are enough evidence that
the hypothesis is likely to true
)0-


 
= strongest of all study designs
= they provide the most control over the study situation
= enable the researcher to isolate the observed effect of the study factor or
intervention
= objective is to evaluate the efficacy and/or effectiveness of an intervention
 

 
  
Choice of Population

Study Population

Classification of subjects and

Assessment of Variables

w/o factor w/o factor w/ factor w/ factor

and outcome but with but w/ and outcome
outcome outcome
Analysis
 

  
Choice of Population

Study Population

Classification of subjects exclude those with

outcome already

with factor without factor

Detection
of outcome
w/ outcome w/o outcome w/ outcome w/o outcome
Analysis
 

 
  
Choice of Population

Study Population

Classification of subjects

cases (/ outcome) controls (w/o outcome)

Assessment
of Factor
w/ factor w/o factor w/ factor w/o factor
Analysis
 

0-


  
Choice of Population

Study Population

Allocation of Intervention

Given Intervention Not Given Intervention

Detection
of Outcome

w/ outcome w/o outcome w/ outcome w/o outcome

Analysis
 





 




&
= is a procedure of drawing a fraction or segment of a population
= purpose:
a) to determine certain characterisitics of the population.
b) to determine the occurrence of some events in the population
= advantages:
a) economy
b) greater speed in getting results
c) greater accuracy is achieved
d) more information can be obtained
e) more intensive and careful data collection and analysis can be done
 #    K


= the assignment of subjects to the treatment and control groups whose mainobjective is
to ensure equal distribution of variables that can confound the relationship between the
treatment and the outcome
= Techniques
a) Random allocation
= each subject has equal change of being assigned to the treatment
group or the control group.
= offer equal distribution of confounding variables but often leads to
unequal number of subjects in different groups
b) Systematic Allocation
= each subject is alternately assigned to the treatment group or the control
group
= assures equal numbers in the groups.
 
p &   

ë. Identification of data to be collected
2. Determination of the possible sources of the data
3. Choosing the method appropriate for the study.
4. Preparation of the tools of data collection
5. Establishing the time frame of data collection
 p   

a. The data or information to be collected.
b. How the information are to be collected including the tools to be used.
c. How quality control is to be ensured and the different forms of bias are to be
eliminated.
d. Time table for the data collection including how it is estimated.
 K
   )



ë. Go back to the objectives
2. List down the variables and classify them
a) independent variables
b) dependent variables
c) confounding/extraneous variables.
  
 
 p 
 
= data or information are directly collected from the subjects of the study.

 
  
= data or information are collected from records of other institutions.
  
  




'þ


= simplest and most economical
= disadvantages are adequacy and accuracy of recorded information.
 8

= a good way and frequently the only way to get information.
= can be conducted through personal interview, telephone interview, or
self=administered questionnaire.
 ")
 
= this the method of actually determining the presence or absence of
many conditions and attributes in the study population.
  
  #   

   


ë. Accuracy
2. Practicability
# 
= getting the true value or measurement.
= characteristics related to accuracy
,  
= the ability to measure what it is supposed to measure.
a. Sensitivity
= label Positive those who have the condition
b. Specificity
= label negative those who do not have the condition
c. Positive Predictive Value
= the chance that a positive result is truly indicative of the
presence of the condition


  p
p

, 

Disease

T
Ò a
______
e Ò

Ò 
=
s a+c
t   Ò

Ò Ò d

= ______
b+d

p
a
______
p

=
, 
a+b
 

  p
p

, 

Syphilis
Ò 48
FTA Ò   
 
=
______
= :1
5


  5

  8



= ______ = :>/
5

p
48
______
p

= = .
, 
ë8
# 
")G


= ability of device to give the same or identical results when the
test is done on the same subject by different observers

p


 ) 
 )

= ability of the measuring device to give consistent results
p  )
= refers to the overall ease or difficulty in use of method.
= a practical method should:
a. require reasonable or available resources
b. use procedures acceptable to the subjects
c. enable coverage of the study population.
  
K  

&   
= true difference in test results or measurements which is either physiological
or pathological in origin
a. Interindividual variation
b. Intraindividual variation
0-


 
 
= variation inherent in the measuring instrument itself or its interpretation
a. Measuring device
b. Observer
i. Inter=observer variation
ii. Intra=observer variation


K
 

# ")
 
 




ë. Training of Observers
2. Definition and classification of events
3. Objective determination of events
4. Improvement of the measuring instrument or choice of more accurate
measuring device.
p
 8
 

#p 


 & *
 

ë. List the variables to be measured.
2. Formulate suitable questions that would measure the variables
3. Decide on the sequence of the questions
4. Prepare the draft of the questionnaire.
5. Make necessary modifications


*


 *
 

ë. Validity = it must be evident that the question will elicit an answer that is a
valid measure of the variable being measured.
2. The respondent can be expected to know the answers to the questions
3. Clear an unambiguous ± must be understood by all respondent
4. Not offensive ± should not embarrass respondent
5. Fair= questions should not suggest specific answer
   p 
&
= is a series of steps undertaken to put collected dat into form that is suitable
for statistical analysis

= it begins with the organization of raw data, by arranging the data in some
logical sequence or grouping.

= collected data must checked as to completeness, consistency, and

accuracy.
 


E
  p 
&
0 
= examination of completed forms or questionnaires by interviewers and
the field supervisor, to detect errors and omissions.
= completeness, consistency, and accuracy are ensured.


= the conversion of data into numbers or symbols which can be more easily
counted and tabulated, to make the data manageable and quantifiable
  

= storing of the data in memory tools for easy access.
.

E

 
= tabulate the data in cross=tabulations or dummy tables to enable the
researcher to have a preliminary overall view or the results
   # 
= consists of computations of the desired indicators stipulated in the specific
objectives of the study
= statistical analysis:

 
 
= used in descriptive studies as a means of describing the nature and \
characteristics of an event
)K

  
= used in analytic studies and consists of:
i. computation and comparison of indicators
ii. test for significance of observed differences
iii. determine degree of association


K   

  
 






 (


= the most useful are the mean and the median


,  
= these include the range, variance, standard error, etc.

*
 )
= this is the proportion of subjects found in the different classes of the
population
.

  

= these measures the frequency of occurrence of events out of the total
possible occurrenc3.
  (
&
")G

  
&
= to determine if an observed difference between a statistic from a sample
and the parameter is small enough as to be attributable to sampling
variation.
= interpretation of statistical results
a) p ==/ = statistically insignificant
b)  ==/ = statistically significant

   # 


 
ë The objective and research design
2 The scale of measurement/type of data

   # 

 
 

= use descriptive statistics, consists mainly of estimation of indicators which
are reflected in the objectives of the study
#  

= use inferential statistics for analysis of results
= Analysis consists of:
a. estimation/computation of indicators in the different study groups
similar to descriptive statistics.
b. test of significance of observed difference of values of indicators in the
groups
c. estimation of degree of association.
 

   # 
Objective To describe events/ to test
identify risk factor/causes Hypothesis/intervention

Research Descriptive/ Analytic

Design Cross sectional

Types of Descriptive Inferential

Analysis Statistics Statistics

Scale of Nominal/ Ordinal Interval/ Ratio Nominal/ Ordinal Interval/ Ratio

Measurement

Analysis of Computation of Computation of Computation of Computation of

Indicators Proportions Proportions Proportions Proportions
+ + +
Mean and Test of Mean and
Variance Significance Variance
+ +
Degree of Test of
Association Significance
+ Mean and
Degree of
Correlation
 
 
A. Computation of Indicators
ë. Mean
x
______
H=
n

where: _
X = mean
 = summation
x = observed values
n = total number of observation
 
 
2. Measures of Variation
a. Standard Deviation (SD) c. Standard Error of Difference

 (x ± x ) 2 0-- = (0ë72 + (0ë72

_____________________
=
(SE) = (ë72 + (ë72
në në
b. Standard Error

SDë
___________
0ë =
në
 
 
3. Range of Normal Values´
X + 2 SEë

4. Percent Distribution
Category Number Percent where:
A a a x ë

% a, b, & c are the number of observation
n falling w/in their respective categories

B b b x ë

% n = total number of observations

n

C c c x ë

%
n

Total n ë

%
 Statistical Tests to Determine Statistical Significance

Scale of Measurement
Type of Problem Interval/Ratio Ordinal Nominal
A. Comparison of
Parameters or indicators
ë. Single population z=test Kolmogorv Chi=square test
t=test Smirnov one=sample test
2. Two population
a. related samples paired t=test Wilcoxon matched pairs Mac Nemar¶s
Signed ranks=test
b. independent independent t=test Mann Whitney Fisher¶s Exact
samples U=test probability test
Chi=square test
3. Three or more groups
a. related samples F=test: two=way Friedman¶s two=way Cochran¶s =test
ANOVA ANOVA
b. independent F=test: two=way Kruskall Wallis one=way Chi=Square test
ANOVA ANOVA
B. Study of relationship Regression Spearman rank Kappa test
between variables Correlation correlation coefficient Contingency coefficient
test
 Measure of Degree of Association
  


 

+
= the ratio of the frequency of the disease among those exposed to the
frequency among those not exposed.
P2 where:
______
RR = Pë= frequency among the unexposed
Pë P2= frequency among the exposed

)# ) )

+
= the absolute frequency of the disease in the exposed individuals that can
be attributed to the exposure

AR = Pë = P2
 Measure of Degree of Association
2. Case=Control Study
a. Odds Ratio/ Cross=Product Ratio
= the rate of experiencing the outcome when an individual is exposed
relative to being unexposed.
F
`
  `
 
A
C Ò

T  
O
R
axd
_________
OR =
bxc
 Measure of Degree of Association
0-


 ;K

 
= the amount of reduction in the risk of experiencing the outcome when an
individual is given the intervention or protective measure/treatment.
Pë =P2
PV = ___________
Pë

where:
Pë = frequency among those not given the intervention
P2 = frequency among those given the intervention
 Measure of Degree of Association
4. Correlation and Regression Analysis
= correlation exist between two variables exists when there is concomitant
variation in the frequencies of the two variables.
= a regression problem considers the values of the measurement when another
is held fixed at each at several levels
the estimating equation formula is:

a. Linear relationship where: ' = dependent variable

' = a + bX X = independent variable
a = intercept constant
b = slope/rate of change
 Measure of Degree of Association
b. Non=linear
= variable depending on the configuration of the curve.
= the degree of association is measured by the coefficient of correlation the
formula for which is:

 (X ± x ) (' = y)
_____________________________________
=
 (X ± x ) 2  (' ± y) 2

Legend:
' = dependent variable
y = mean of the dependent variable
X = independent variable
x = mean of the dependent variable
Writing the Research Proposal and
Research Paper

Russell F. Bernabe, MD
p  


p  
K (

KK ")G


a) General objective
= statement of the overall objective
b) Specific objectives
= expected outcomes based on the specific questions
KKK


8

 clearly and adequately formulated, and researchable
K, 

    
  ) 

* 




'
, & 

= justification for the research proposal.
,K  +& 
= present state of knowledge regarding the problem
p  


p  
,KK 
 
a. Plan of Investigation
= research design and method of data collection
b. Subjects
= study population, source, size, and selection of subjects, groupings
c. Definitions in operational terms of disease categories and of variables
and parameters
d. Data processing and analysis
e. Interpretation and conclusion
p  


p  
,KKK (

( )

Duration of the Study
#(K,K(< 9
#(K"4
Development and pretest of research instruments ë month
Training of personnel ë month
Data collection 5 months
Data processing ë&ë/2 months
Data Analysis ë&ë/2 months
Report writing 2 months .
Total ë2 months

KH p

   


= type of personnel needed in the study, their start and termination
 p  


p  
H  &
6p
p
7
A. Personnel ±salaries ë32,



ë. Principal investigator/Co=principal investigator 48,



(2,


/month x ë2 months)
2. Two Assistants (2,


/month x ë2 months) 48,



3. Four Field workers (ë,8

/month x ë2 months) 36,



B. Operating Expenditure 5
,



ë. Office supplies 4
,



2. Transportation allowance ë
,



C. Contingency Cost ë2,



Total ë4,

HK p 
 
a) Position c) Experience in Research
b) Educational Background d) Publications
 p
 ! &


 

 
 
Review the process of the research according to the sequence the research was undertaken
a. What was the question or problem and how is it identified and clarified.
b. What step or course of action is taken to resolve the question.
c. What was found by the study.
d. What is the answer to the question, what is the solution to the problem

 :
Prepare a detailed outline of the report.
a. The problem
= statement of the problem and sub problem
= state of the art´
= Hypothesis to be tested
= Significance
b. The objectives
= General and specific objectives
= Variables
= Parameters/Statistics/Indicators
p
 ! &


 

 
c. The research methods
= Research design
= Subjects
= Operational definitions
= Data collection
= Data processing
= Data analysis
d. The Results
= Values of computed parameters/statistics/indicators
= Summary tables to be prepared
e. The interpretation of Results
= assessment of the findings of the study
= assessments of findings of the other studies
= answer to the questions
= generalization
= Graphs to be constructed
 p
 ! &


 

 
( : Determine the following:
a. Manuscript requirements
b. Title
c. Authorship
 
 3 
! &

' &
 is not literary writing, it should be simple and easy to understand, and it should
be direct to the point.
 it requires:
ë. Clarity in language rather than eloquence
2. Logical presentation of facts and inferences
3. Use of understood tables and graphs
4. Orderly presentation
5. No longer than necessary
p 



p 

A. Title
B. Authorship
C. Introduction
D. Methods
E. Results
F. Discussion
G. Conclusions
H. Abstract
I. Bibliography
p 



p 

# (

= it should describe the scope and content of the paper adequately with fewest
possible word.
= it should answer the questions what , who, where and when?

 # 
= it should give the names, positions, and professional addresses of the
investigators.
p 



p 

 K  
= it should not be too short or too long.
= it should explain why the study was undertaken.
= it should establish a frame of reference for the problem by providing:
I. Purpose of the study
= statement of the problem and background with reference to
pertinent literature
= question to be answered
= hypothesis
II. Aim of the study
= objectives of the study
= significance of the expected results
= it should not contain definitions of terms used in the title nor should explain
matters found in text books
p 



p 

 
 
= explains how the research was carried out.
= it should contain and describe the following
  
&
a. Type of study design
b. Subjects
i. sample population iv. exclusions
ii. sampling scheme v. Group assignment
iii. definitions and criteria for inclusion vi. interventions
   

a. sources of data c. data collected
b. methods of data collection d. tools for collection
    
&  # 
a. steps peerformed in data processing c. statistical design
p 



p 

0


= presentation of the findings of the research that will provide answer to
the questions which will enable the researcher to resolve the problem.

= starts with comparability of the characteristics of the subjects.


 
 

= determine if a representative sample has been drawn
)#  

= determine if comparability is achieved.

= if comparability is not achieved , extraneous variables have greatly

influenced the results.
p 



p 

 
= assessment of all evidences on the problems including the findings ob
other investigator whether they are in agreement or disagreement with
his findings
3 
= clear statement of the researcher¶s stand on the problem based on
all evidences available not only on the t present study¶s results.
 #) 
= a brief statement of the essential content of the original document
= it may be place after the authorship or after the conclusion
K )& 
= list of articles cited in the paper and are arranged according to the
sequence they are cited and are indicated by numbers
Healthy Lifestyle: Exercise

Russell F. Bernabe, MD
Exercise
= regular planned physical exertion aimed to achieved optimum cardio=
vascular health.


0-


ë. It tones and strengthens every organ and system of the body

2. It helps relax tensions, making sleep sounder.
3. It strengthens self=control, increases mental efficiency, and enhances feeling of well
being.
4. It decreases depression and anxiety
5. It lowers emotional stress
6. It lowers triglycerides and increases HDL
7. It decreases insulin resistance
8. It helps relieve constipation
. It provide some protection against osteoporosis
ë
. It increases endurance
ëë. It lengthens life expectancy
 (
0-


7#
)
-


= physical activity that primarily stimulate mitochondrial oxidative
metabolism
= involves repetitive movement of large muscle group that does not result in
progressive blood=stream lactic acid accumulation

7#
)
-


= activities resulting in accumulation of lactic acid that is produced when
blood flow is inadequate
= caused by muscle nonoxidative gylcogenolytic metabolism
Exercising Heart Rate (EHR)

 optimum heart rate that must be reached during exercise to achieved the
benefits of exercising.

$p 
5

M%


 
0
I{(22
= age in years) x 75%} + 5

0-


(22
= 2
years old) x 75% = ë5
+ 5 beats per minute
Components of an Exercise Program
 = frequency of exercise
= recommended frequency is 3 = 5 times week

K = intensity
= should increase the HR to the recommended EHR

( = time and duration of exercise

= each exercise session should be at least 6
minutes

(= tempo of the training program progression

Parts of Proper Exercise
ë) Warm up
2) Stretching/muscle conditioning
3) Exercise proper
4) Warm down
 3) Exercise

& &


 )
 
 =



#,
 

&

+G 
Badminton High Low Low
Basketball V. High Low Medium
Cycling V. High Medium Low
Dancing V. High Low Low
Golf Medium Low Low
Jogging V. High Low Medium
Swimming V. High Medium Low
Walking High Low Low
Weights Medium V. High Low
Limits/Over=exercising





-
&
 K

 

) chest pain e) pallor
b) lightheadedness/confusion f) cramps
c) breathlessness > ë
minutes g) palpitations
d) Nausea/vomiting
Limits/Over=exercising




-
&
 
 

a) Prolonged fatigue
b) insomnia
c) Weight gain
d) persistent rapid heart beat
Exercise Program Suspension
= development of any of the following:
ë) Persistent chest pain or progression of heart disease
2) Recurrent illness
3) Hypertension
4) Orthopedic problem
5) Dizziness
6) Swelling or sudden weight gain
Waste Management

Russell F. Bernabe, MD
 Waste
(a) any substance which constitutes a scrap material or an effluent or other unwanted
surplus substance arising from the application of any process

(b) any substance or article which requires to be disposed of as being broken, worn
out, contaminated or otherwise spoiled. However, this does not include a
substance, which is an explosive.
 Waste Classification
K  
! 

a) Household Waste
b) Industrial Waste
c) Commercial Waste
d) Clinical Waste
e) Hazardous Waste

KK 4 
! 

a) Agricultural Waste
b) Mines and uarries
Types of Waste

 = refuse
þ*  
' &
= water carried including human excreta
3 
 = air pollutants (e.g. CO)
T'PES of REFUSE
& ) &
 organic solid wastes that are putrescible wastes resulting from the
handling of food considered the most valuable component of refuse
because it is used for animal feeding, home feedings, fertilizers and soil
conditioners


)) = non=putrescible wastes except ashes
= both combustible (papers, woods, cardboard)and non=combustible
(cans, scrap metals)
= useful converted for packing materials

#
 = waste products that result from the use of coals or other fuels
.

'

& e.g. leaves, dirt, sand, animal manure
/
 

1    ' 

 Sources of human wastes
ë. Mouth=saliva
2. Respiratory system = mucus, phlegm, sputum, etc.
3. Skin= sweat
4. Genito=urinary= urine , secretions
5. Gastrointestinal= stools
WASTE MANAGEMENT
= works toward reduction, reuse and recycling of all resources.
a) reduction of energy consumption
b) water conservation
c) the purchase of reused and recycled products
d) the reusing and recycling of products
e) alternate transportation methods
Waste Hierarchy in Waste Management
ë. Waste reduction
2. Waste Re=use
3. Waste recovery
a. Recycling
b. Composting
c. Energy recovery from waste
4. Waste Disposal
ë. Waste reduction

 

' 
  
  
' 


 &



 
& 

+



' 
&


 

 &
   N
 

(
)G

' 



O 7





 
'
-&
 

 &&

 &


 

)7


 E 



    
')


' 

2. Waste Re=use
= involves putting an item to another use after its original function has been
fulfilled.
('



a) 
 


= products are used a number of times before they are discarded.
e.g. milk, bottles, cardboard craters, etc.

b) 
 



= uses are found for products once they have served their original
purpose.
e.g. discarded tyres used as boat fenders
3. Waste recovery
= the process by which waste is converted either into a usable form or energy is derived out
of the waste.
) 
& 



&
= involves processing waste to produce a usable raw material or product.
= Potential advantages
· ë. Extending the life and maximizing the value extracted from raw materials.
· 2. Energy savings
3. Reduced disposal impacts
) 
&
= aerobic processing of biologically degradable organic wastes to produce a reasonably
stable, granular material, usually also containing valuable plant nutrients
 0
&

 
' 

= is a process by which energy stored in the waste is extracted in the form of fuel or
electric power, which can then be used as power source for various applications
4. Waste Disposal
= the last option in the waste hierarchy
= disposal options :
i. Land Filling
ii. Incineration
iii. Permanent storage
 METHODS OF REFUSE DISPOSAL
ë. Burial = ëm x ëm pit

2. Open Burning = rural areas only

3. Feeding to Animals

4. Composting = aerobic and anaerobic decomposition

5. Sanitary Landfill = large scale burying, associated with problem of ground

water source

6. Incineration = controlled burning of refuse, associated with problem of air

pollution
 G (



 
 þ  &
(
' 
  )
  
 

= inert wastes , biodegradable waste, aqueous liquids (in limited quantities) ,
sludges , and certain special wastes
! 

' )
  

:
= Volatile liquids (solvents)
= Wastes which would introduce unacceptable contamination into leachate
= Wastes which would interfere with the biological processes in a landfill site
 E ' 
    :
Deep disposal = waste are placed in deep undergrounds in old mines until a
new use can be found.
Mono=landfill = no mixing of wastes and these are robustly designed engineered
barriers. they are not co=disposed with other wastes.
 G (



 

 K


= disposal of waste particularly clinical waste by exposing them to high
temperature that will render them sterilized.

 p


 &

= this is a last resort and it provides no amelioration of hazard. Any
hazardous wastes disposed by permanent storage will remain hazardous
indefinitely.
WASTE MANAGEMENT
= proper disposal of waste
= management of processes in order to achieve objectives
ë. to prevent contamination of :
=surface soil
=surface water
=ground water
2. to prevent the creation of breeding place
3. to prevent odors and unsightly conditions
4. to prevent contamination of fomites and other objects
 METHODS OF EXCRETA DISPOSAL
 
& K
= most acceptable form of excreta disposal
= disposal unit equipped with water and transport facilities
= advantages: ë) excellent health benefits
2) convenience
= Disadvantages ë) large water requirements
2) high construction and maintenance cost
= e.g. Cistern flush toilet connected to sewerage system
 METHODS OF EXCRETA DISPOSAL
 
& KK
= acceptable form of excreta disposal
= disposal unit equipped with water supply
= advantages: ë) excellent health benefits
2) convenience
= Disadvantages ë) large water requirements
2) moderate construction cost
3) requires dislodging every ë = 5 years
= e.g. Cistern flush toilet connected to septic tank, Aqua privy, Pour=flush
latrine, Vault privy
 METHODS OF EXCRETA DISPOSAL
 
& KKK
= unacceptable form
= disposal unit equipped with transport facilities only.
= advantages: ë) minimal water requirement
2) minimal construction cost
= Disadvantages ë) periodically emptied by night soil laborer/scavenger
3) problems of odor, insect, spillage
= e.g. Bucket Latrine
 METHODS OF EXCRETA DISPOSAL
 
& K,
= most unacceptable method of excreta disposal
= disposal unit not equipped with water nor transport facilities
= advantages: ë) convenience
2) very minimal construction cost
= Disadvantages ë) Associated with problem of environmental
contamination that can be detrimental to health
= e.g. Pit latrine, Bored=hole latrine, Compost Latrine
Methods of excreta disposal or water=carried waste
   

=pit privy e.g.. sanitary pit privy with water seal (recommended)
others: =bored=hole
=latrines e.g. trench latrines, overhung latrines
=box and carry
=can privy==>no chemical use like in chemical toilet
=flying saucer (not recommended)
 ) ) 
=septic tank
  ) 

=sewerage system (best or acceptable way of waste disposal)
=Imhoff tank
=chemical toilet= consists of a tank, containing 5 =ë
=ë5 gallons of
water with 25 lbs. of caustic soda
. 

=(e.g. airplane)=chemical toilet
Sewerage System
p 
;




  &
 

&6) 7



 
 +
#
)


 +
.#
)

 +&

/ & &
  &
)

1





)

   
   
Solid Waste Disposal

 


) & 

) &     

& 
&
Housing Sanitation

Russell F. Bernabe, MD
HOUSING SANITATION
 


ë. Shelter
2. Secure place
3. Center of family activity
4. Decent place for caring and rearing
5. Satisfies physiological and psychological needs of man
HOUSING SANITATION
 p 
  &
I Fundamental Physiologic needs
II Fundamental Psychologic needs
III Protection against Contagion
IV Protection against accidents
I Fundamental Physiologic needs
ë) Maintenance of appropriate temperature that will allow Adequate heat
loss or prevent undue heat loss from the human body.
2) Provision of unpolluted environment
3) Provision of adequate natural illumination
4) Provision of adequate artificial illumination and avoidance of glare
5) Protection from excessive noise
6) Provision of adequate space for exercise and play of children
II Fundamental Psychologic needs
ë) Provision of adequate privacy
2 Provision of opportunities for normal family life
3) Provision of opportunities for normal community life
4) Provision of facilities that will enable performance of household task with
adequate ease.
5) Provision of facilities for maintenance of cleanliness
6) Concordance with the prevailing social standard of the local community
III Protection against Contagion
ë) Provision of a safe and sanitary water supply
2) Protection of the water supply systems against pollution
3) Provision for toilet facilities
4) Protection against sewage contamination of the interior surface
5) Avoidance of unsanitary condition
6) Exclusion of the dwelling area from vermin
7) Provision of sufficient space in sleeping areas
8) Provision for sanitary food storage
IV Protection against accidents
ë) Construction of house should conform with the prevailing standards to
prevent/avoid accidents:
a) falls
b) electrocution
c) fire
d) vehicular accidents

2) Provision of adequate emergency exit

 0
 &
ë) #
 
  
* 
' 
at least 2
gallons/person/day
2) p 
' 
  (refuse and excreta)
3) p 
 & 

 
4)  minimum of 2 egress should be constructed
5) 

   0*


a) Food preparation, storage and cooking b) Bathroom, Toilet and Lavatory
6) 

  
a) Light ± for general lighting 5=ë
foot candle, for reading ë4 foot candle
b) Ventilation= for adequate air circulation (air movement within ë
to ë5 min)
c) Temperature ± 2
to 3
Celsius
d) Noise insulation ± maintain sound level to 2
dB in sleeping quarters
7) ,

 &a)Safe storage for drugs and poisons.
8) #
* 
 
=ë5
square feet of space for first occupant
=ë

square feet additional space for each succeeding occupant
=minimum of 7 feet floor to ceiling clearance
 Types of Dwelling units
7 &

K single dwelling unit in one lot and one roof
7 
- two dwelling units in one lot under one roof
7 # 

K several dwelling units in one lot under one roof
7  

;('
 several dwelling units on several levels in one big lot under
one roof
.7 (

  '
&
a) Hotel/Motel
b) Lodge/Inn
c) Dormitories
/7 
  '
&
a) Camps
b) Convents/seminaries
c) Institutional hospitals
Food Sanitation

Russell F. Bernabe, MD
Food Sanitation
Control measure employed in food handling, preparation and storage to
ensure the safeness of food from contamination of poisonous substances and
invasion of disease causing microorganisms.
OBJECTIVES:
ë. To educate each individual, the family and community on proper way of
handling, preparing and storing of foods.
2. To provide protective measures on foods against unrelated agents that alter it's
value.
3. To ensure consumption of safe wholesome food.
4. To prevent sale of food of poor quality or offensive to purchaser.
5. To protect consumer against adulteration and misrepresentation.
6. To cut down spoilage and wastage.
Aspects/Areas of Consideration
ë. Food Control
2. Food Management
3. Food Technology
4. Food Handling/Handlers
Primary Health Significance
ë. Transmit pathogens
2. Transfer parasites
3. Incite allergic reactions
Occurrence of Food Contamination
ë. Production/Processing
2. Transport Storage
3. Distribution and Retailing
Food=borne Diseases
""p"K"4K43
Ingestion of food that contains toxins that are produced by microbial
growth or toxins that are cause by substances that contaminated the food

"""
40K40(K"4
The contaminating microorganisms infects the person who ingests
contaminated food. As the pathogen grow in the host , it produces
damaging toxins.
Prevention
ë. healthy food handlers
2. care in food handling
3. clean environment
4. sufficient amount of clean water
5. proper storage/refrigeration of perishable food
6. don't keep cooked food too long under warm temperature
  

 ) 
 


 

a. ingredients used
b. freshness
c. source
d. methods of preparation, preservation and storage.
   

a. Free from infection and disease.
b. Cleanliness and personal hygiene.
30 

; 0 )


a. Cleanliness
b. Sanitary maintenance of the equipment, utensils and the area where the
food is being prepared.
#&
 &' 
 
  



A. Animal parasites = pork and beef tapeworm

B. Bacteria = Salmonella
C. Bacterial toxins = food intoxication due to toxins of streptococcus, staphylococcus
and botulism.
D. Poisons = deliberately added to food as preservatives, coloring or
accidentally added by mistake.
E. Poisonous animals, fish or plants
F. Chemically decomposed foods.
G. Idiosyncrasies to certain foods.
H. Dietary indiscretions, eating too little or too much.
METHODS OF FOOD PROCESSING:
 
&
 

 
a. High Temperature
b. Pasteurization
c. Blanching
d. Canning
e. Freezing
f. Drying
g. Fermentation and Pickling


 p

 
ë. Food cleaning
p 
= removal of visible soil
)

 
= use of chemical substances to remove chemical residues.
 
& 
= to eliminate organism

& 
= treat with UV or IR rays
2. Food preservation
&(




= best method by cooking
)p 
 E 
= utilizes mild heat with sufficient holding time to destroy pathogens
responsible for fermentation and spoilage
Methods of Milk Pasteurization:
 þ'(

 &(


= use ë4
= ë53 oF for 3
minutes
= cool rapidly to 5
oF
 &

 (


= flush method
= use ë6ë oF for ë5 seconds then cool rapidly to 5
oF
Continuation of Food preservation
 &
= scalding with hot/boiling water
 &
= food put in cans, sterilized and sealed under pressure
= Signs of unsatisfactory canning process
i leaks
ii Swelling/lid puffers
iii Springer/flicker
= causes : iii.ë overfilling
iii.2 insufficient vacuum
Continuation of Food preservation



E&
= not effective as high temperature
= storage of food at 2
= 3
oF
 &
= dehydration of food to reduce moisture content to ë
= ë5%
which will inactivate enzymes that produces putrefaction.

&


   p+&
= alcoholic fermentation
= vinegar and sugar immersion of food
3. Chemical Preservation
= the addition of chemicals additives to food as preservatives
(
# 

K
 
= added to enhance food value
= e.g. vitamins, mold inhibitors, bactericides, emulsifiers, minerals,
flavors, etc
)p



= added to protect the nutrient in food, add flavor, and improve
physical qualities
= e.g. anti=oxidants and sequestrants
p )

= preservatives such as formaldehyde, salicylates, boric acid
Food Adulteration
ë. Mixing/addition of substance that lowers the quality food.
2. Substitution of a cheaper additive in place of a more expensive but effective
additives
3. Abstraction of valuable constituents of food
4. Food coloring to conceal inferiority of food
5. Addition of poison
6. Misbranding and mislabeling
Water Sanitation

Russell F. Bernabe, MD
Water
 

' 
= colorless, transparent, odorless and palatable neutral pH, very
good solvent
) )
' 
=free from harmful substances, chemicals and
organisms

9

a. drinking e. laundry
b. cooking f. cleaning
c. bathing g. recreation
d. power generation h. means of transportation
 Water Diseases´
' 
) 
 diseases that occur due to ingestion of contaminated water
e.g. cholera, typhoid
' 
' 
  diseases that occurs due to insufficient hygiene
secondary to insufficient water supply
e.g. scabies
' 

 
 diseases transmitted by vectors whose life cycle is
partially dependent on water
e.g. malaria, dengue
' 
) 
  diseases transmitted by vector that lives in water
e.g. schistosomiasis
' 
 

 diseases which are spread by water
e.g. leptospirosis
 Water Impurities
(
 þ )    


 p 


ë.   = solids ë. physical exam = pH, thresh= ë. coagulation = sedimentation and

colloids hold odor number, cloudiness & filtration

2

  (dissolved) 2. chemical exam 2. for hardness = filtration
= permissible process ion exchange
(Na+, Ca, Mg
but not in excess)
= non=permissible

3. )&  3. microscopic exam 3. filtration aeration

(planktons)
= algae
= small animals

4.
  & 
4. bacterial exam: 4. chlorination
= bacteria, virus E. coli
= protozoa

5.  
5. test for radioactivity 5. elimination of source

UALIT' OF WATER

# 
 +&' 
 


'&
K(0
K#
 #

* 
 & * 
 

 * 
AESTHETIC UALIT'
The aesthetic quality requirements are in respect of substances and
characteristics affecting the acceptability of water for domestic use.

ë.  = transparent
2.   = odorless
3.  
= tasteless
4. 



(turbidity) = clear
5. 
6. 

These aesthetic quality standards are made to ensure the acceptability of

water for domestic use and should „
be regarded as a basis for rejection of a
water supply.
 BIOLOGICAL UALIT'6
(
&

 &
  +&' 

 )
' &

 ' 

ë. use of coliform bacteria as indicator organisms.

2. presumptive test for coliform organisms indicative of fecal pollution.

If coliform organisms are found in water sample, then it is presumed that the water is

'
' &
 
 ' 


3. Confirmatory test for E.coli = undoubtedly of fecal origin.

If E.coli is not found, a further test for streptococous faecalis is carried out.

4. Bacterial quality for drinking water

The proper and efficient treatment of a raw water with chlorination or disinfection should
ensure the absence of any coliform organisms.
WHO: International Standards for Drinking Water

= treated & chlorination water should have a zero count of Coliform organism in any ë

ml.
sample

 ' 

  )

!"


  

a) 5% of water samples collected from the distribution system should not contain any
coliform organisms in ë

ml. throughout the year.

b) no sample should contain E. coli in ë

ml.

c) no sample should contain more than ë
coliform organism in ë


ml.

d) coliform organisms shall not be detectable in ë

ml of any 2 consecutive samples.

 3. CHEMICAL UALIT':
ë. (- ) 

ë.ë Arsenic (As)
.
5 mg/L ë.4 Lead (Pb)
.
ë
ë.2 Cadmium (Cd)
.
ë ë.5 Mercury (Hg)
.

ë
ë.3 Cyanide (Cn)
.
5 ë.6 Selenium (Se)
.
ë
2. p


= Insecticides Ex. chlorinated hydrocarbon (DDT, Aldrin, Lindane)
= Herbicides
= Fungicides
3.  

= may occur naturally in water
= they may cause FLUOROSIS and skeletal damage to humans.
= Fluoride =
.6 =
.8 mg/l with a temperature range of 26.3oC= 32.6oC
4. 4 

= > 45 mg/l (NO3) may cause methemoglobinemia in infants
SOURCES OF WATER
K 
  
' 

ë. Rain water
2. Ground water
3. Surface water
KK4
  
' 

ë. Desalinated water
2. Reclaimed waste water
ë. RAIN WATER

= collected from roof and artificial catchment areas and stored in cisterns and
tanks
= soft and of high quality
= has been a traditional source of water supply for rural areas
= not a very reliable source of supply because:
ë. the rainfall pattern for any one area is seldom constant
2. the area of catchment can be extensive and costly for large
populations
2. GROUND WATER
= from springs, wells and infiltration galleries

= cool, uncontaminated and of good quality due to the percolation and passage
of water through various geological strata in the ground, there can be
undesirable minerals in solution such as Ca++, Mg++, Fe, Mn

`

and ++, ions cause hardness in water.

 and „ forms tiny particles of iron rust & oxide of manganese

= usually requires very little treatment other than chlorination.

= a good source for both urban and rural water supplies.

3. SURFACE WATER
= from streams, rivers, ponds, and lakes

= usually contaminated with various organic and inorganic impurities and

will require treatment to render it suitable and safe for drinking

= treated by slow sand filtration and chlorination

II. NON=CONVENTIONAL SOURCES OF WATER
7 
  
' 

= demineralization and removal of salts specially from brackish or salty water
= Demineralization processes include:
ë.ë distillation ë.3 electrodialysis
ë.2 ion exchange ë.4 reverse osmosis
= Disadvantages
ë. costly
2. requires complicated equipment and highly trained personnel
II. NON=CONVENTIONAL SOURCES OF WATER
7

 

' 
' 

= the reuse of treated waste water like sewage effluents after treatment
processes and disinfection
= additional treatment processes include:
2.ë rapid filtration
2.2 use of activated carbon to reduce further the fine suspended and dissolved solids
and disinfected with chlorine
= Uses of reclaimed waste water
2.2.ë for industrial processes and as industrial cooling water
2.2.2 for flushing toilets
 WATER TREATMENT
Objective of Water treatment: To provide a potable water supply
A. 
 

= boiling, filtration and/or chlorination
B.  
= purification system
  ! 
(


p 

ë. Coagulation
2. Flocculation
3. Sedimentation
4. Filtration: a. sand filter
b. pressure filter
5. Disinfection: a. Chlorine
b. Iodine
 WATER PROTECTION

! 
p 

ë. Watershed (catchment area) = protection from human habitation
2. Proper waste disposal
3. Proper construction and protection of wells and springs
4. Proper distribution
Factors affecting the quantity of water required for domestic
purposes:

ë. its availability
2. the water pressure in the distribution system
3. the number of plumbing fixtures in the house




' 
 +  

ë. Residential area: ë
= ë5 gal/day
2. Industrial area: ë

= ë5
gal/day

(
'& 
' 
 &






ë. For urban areas = ë8
liters/person/day
2. For rural areas:
a) water from public taps = 25 liters/person/day
b) in households with water pipe connection = ë5
liters/person/day
Health Education

Russell F. Bernabe, MD
Health Education
= a compound word, Health and Education
= should be viewed within
a. the changing context of health and disease
b. the changing health picture where lifestyles play an important role
c. accepted definition of health
 Health Education
= it is leading out what people already know and believe and do about their
health modifying those that are undesirable, and developing desirable
behaviors that are conducive to health.

= it is a process of providing experiences to people in order that they may be

able to define their health problems, personal, family and community=and
to take the needed actions for solving these problems

= plays an important role in the Primary level of prevention and is an

essential part of the other levels of prevention
 Other definitions
p






0  

= a  
 that bridges the gap between health information and health
practices.



 
= a  
 of bringing about behavioral changes individuals, groups and
larger populations from behavior that are presumed to be detrimental to
health, to behaviors that are conducive to present and future health.
 Other definitions
3


= any 
)  of learning experiences
&
  

    of behavior conducive to health

.4  ( + 

p
   p 

0   

= the  
 of assisting individuals, acting separately or collectively to
make informed decisions about matters affecting personal health and that
of others
 Health Behavior
= central concern of Health Education
= 3 categories
p




 
= for preventing or detecting illness in an asymptomatic
state
K

 
= define state of health and to discover suitable remedy
+


 
= perception of illness and how to get well
= generally involves a whole range of dependent
behaviors and leads to some degree of exemptions of
one¶s usual responsibilities
Foundations of Health Education
p  
= serves as proper guide for health educators



  
= provides content of health education programs


  

 

= theories or methods to bring about behavioral changes
 ë. Philosophical Foundation
ë. Health Education should bring about improved health and well being for all through
promotion of healthful lifestyle, community actions for health and conditions that
make it possible to live healthful lives
2. While health is obviously the goal, ultimately the end should be human
development.
3. Health education is working with´ rather than for´ the people.
4. Intervention strategy should be tailored to address the circumstances of a given
population, person or situation
5. Effective health education planning and application involves anticipation of the
emerging challenges of the future not just understanding the current health
challenges
6. The most effective health education is planned and developed by both the health
educator and the people involved.
7. Appropriately planned health education program yield results.
 ë. Philosophical Foundation
8. Requirements of successful health education includes:
a. financial, political and management support
b. careful planning, monitoring and evaluation
c. intersectoral collaboration
d. application of multiple theories and methods
e. participant involvement and qualified personnel
. 3 principal strategies to effectively achieved health education:
a. Advocacy
b. empowerment
c. social support
 2. Biomedical Foundation
= explains illness in terms of biological malfunction rather than multifactorial
causes

 #

a. The definition of disease as deviation from normal biologic functioning.

b. The doctrine of specific etiology.

c. The conception of generic diseases, that is the universality of disease

taxonomy.

d. The scientific neutrality of medicine.

 Contributions of Biomedical Foundation
ë. Identification and repair of biological problems using surgery or medicine

2. Reduction of deaths from infectious diseases

3. Increased life expectancy because of discoveries of sophisticated

technologies
 3. Behavioral Science Foundation
= attributes the decline in mortality to rising standard of living which gave rise
to better nutrition and improved environment or personal hygiene.
= it includes
a. The socio=economic and cultural factors associated with health and disease
b. The psychological factors associated with health behavior
i. learning process
ii. Communication process
iii. Change process
c. Strategies/interventions to bring about change to include individual,
interpersonal and group intervention models
Processes of Health Education
I. Learning Process
II. Communication Process
III. Change Process
 I. Learning Process
0


þ
&
3 = must be relevant to the needs and concern of the person



= require physical, mental, and emotional preparedness
 = provide the learner with viable alternatives
.K

 = acceptance or rejection depends on previous experience
/


= actions depends on the perception and expectation of best results
1
*

= result of the response would either be a confirmation or contradiction of
expectations
2

' &= unfavorable consequences leads to exploration of other
alternatives (changes in behavior) or lose hope (give up)
 Theories of Learning
ë. Behaviorist theories
2. Cognitive theories
3. Humanist theories
 ë. Behaviorist theories
= Learning results from the association between stimuli and
responses.
Example:
p 5   &
= pairing of natural stimulus with neutral stimulus will
result to a conditioned response
)(  +
5þ '0-

  þ '0

þ '0-

= > frequency of stimulus=response
connection is used > the association and vice=versa
þ '0
 ± stimulus connection is strengthened
with reward and weakened with punishment
+
5"
 &
= learning takes place when it is followed by reinforcement
 2. Cognitive theories
= A reorganization of a number of perceptions percolating in the mind of the
learner

Example:
(
5&
 &
= learning is goal directed and needs a semblance of structure
 3. Humanist theories
= While some form of stimulus=response is also present, they feature the
analyses of the nature of personality and society
= Active role of the learner is highlighted

Example:
   5 &
(
 
= reciprocital determinism of individual and environment
 Parts of Learning Process


= relevant and meaningful issues are quickly learned
þ
& 
= learning is easy in an appropriate circumstances


= learning is effective if real learning situations or those
which closely resemble them are provided for.
.p


= learning is effective if the individual participation is
enhanced by identifying motivations and skillful usage of
motivations of the learner
 II. Communication Process


ë. The process by which information is exchanged and understood by two or
more people (Daft)
2. The creation or exchange of understanding between and a receiver both
verbal and nonverbal. (Rackick)
3. A process by which people attempt to share meaning via transmission of
symbolic message. (Porter and Roberts)
 Elements of Communication Process
 
;


= initiates the process of communication

 &

= physical form into which the information/idea are encoded
 

= mode of transmission of the information/idea
.




= target of the sender¶s message
/

) +
= reaction of the receiver
 Steps in the Communication Process
(+&
= framing of ideas in sender¶s mind
0 &
= putting thought into some form
( 
&
= broadcasting the message via some medium
.p

&
= incoming communication sensed by senses
/
 &
= incoming communication transform into some form
19
  &
 Communication Theories
ë. The Two Step Flow Theory

2. The Diffusion Process

3. Communication=Behavior Change Model

 Communication Theories
(
('
'(
 
= ideas are disseminated through mass media are received mostly opinion
leaders in the community, who in turn play relay or reinforcement roles
to influence others and spread ideas through their interpersonal
relationship.
 Communication Theories
(
p 

= acceptance of an idea goes through five stages:
a. Awareness
b. Interest
c. Evaluation
d. Trial
e. Adoption
 Communication Theories


 
   &



 based on an input output factors relevant for communication
programs in health

a. Input factors
i. awareness
ii. interest
iii. evaluation
iv. trial
v. adoption
 Communication Theories


 
   &



a. Output factors
i. exposure to the message
ii. Attending to it
iii. liking, becoming interested in it
iv. comprehending it
v. skill acquisition
vi. acceding to it
vii. memory stage of content or agreement to both
viii. information search and retrieval
ix. deciding on basis of retrieval
x. behaving in accord with decision
xi. reinforcement of desired acts
xii. post behavioral consolidating
 Principles of Communication
ë. People select what they see or hear.
2. Interpret selectively what they see and hear.
3. Choose what they want to remember and what they want to
forget.
4. Words do not have meanings
5. Meanings are in the people.
6. Meaning are in contexts
7. Meanings are in relationship
Barriers to Communication
0 

  

i. noise
ii. competition for attention
iii. time
)(

&  

-

 &

= Familiar terminology tend to minimize misunderstanding
= more complex message the greater the misunderstanding
p
  

 encoding and sending or decoding and receiving message
depends on:
i. frame of reference
ii. Beliefs
iii.selective perception
 Ways to Overcome Barriers to Effective
Communication
a. Regulate the flow of information
b. Encourage feedback
c. Simplify message language
d. Listen actively
e. Restrain emotions
f. Use nonverbal cues
 III. Change Process
& &

= a change in knowledge and/or perception of a person

)#
 &

= a change in individual¶s belies, predispositions, intentions
and tendencies


   &

= an alteration in an individual/group¶s knowledge, attitude
and practices
 Levels of Change Occurrence
K   
= a change in knowledge , attitudes, values and behavior of
the individual

)3 
= a change in normative beliefs, values and behaviors of the
group.



= can be accomplished by a major or pervasive change,
such as legislation, technical innovations and massive
movements.
 Elements of Change Occurrence
K 
= idea, behavior, new technology to affect change
)( &
 &

= an individual, group of people, or a community
 &
 &

= a person or group of person introducing the innovation
 
&
 &

= deliberate actions, set of activities, approaches, tactics, or
processes designed to effect change
 Motivation to Change


 p
&

= emulation of behavior of prestigious individuals
)

 0
3 
= economic gain is the most important consideration



 
= competition motivates change
")&  
 
= usually a friend cannot be turn down

p  
= satisfaction is derived from innovation in the form of play


&#

= provide emotional attachment to it as sacred undertaking
 Strategies/Methods of Health Education

 


0  


 

 
    &

= environmentalist places emphasis on the structural factors
= individualist place emphasis on the responsibility of the
individual


& +   
'
 

'

 +



= emphasize the prevention paradox: a large number of people at small risk
may give rise to more cases of disease than a small number who are at high
risk
 Classification of Strategies/Methods of Health
Education

 


0  


 

 
    &

= environmentalist places emphasis on the structural factors
= individualist place emphasis on the responsibility of the
individual


& +   
'
 

'

 +



= emphasize the prevention paradox: a large number of people at small risk
may give rise to more cases of disease than a small number who are at high
risk
Family Medicine

Russell F. Bernabe, MD
Family Medicine
= a discipline in Medicine with 
+'
&
  
 

which refers to    
  


P

=  with


    
 

  

 

Characteristic Family Medicine Care
 p 


= first contact
 &

= chronologically
= geographically
= interdisciplinary
= interpersonal
 




= ecologic factors
Characteristic Family Medicine Care
. p


= emphasis on health education
/  

= relieve symptoms through early diagnosis and prompt treatment
1

 ) 

= enable highest possibility for the patient to return to their usual
routine.
Family Medicine as a Specialty
 & )
) +'
&

= integration of biological, clinical, and behavioral sciences
= curricular framework integrates the elements of traditional clinical
disciplines
= emphasis on :
a. prevention
b. modern epidemiology
c. physiological medicine
d. socio=cultural factors
Family Medicine as a Specialty
 9*

  
= patients¶ cases are undifferentiated and not categorized
= encompasses:
a. all ages
b. both genders
c. each organ systems
Family Medicine as a Specialty
 #




= Potential areas for research
a. Clinical
= Epidemiology of common diseases
= Screening for diseases
= Alternative treatment for common
diseases
b. Health Care Delivery
= Cost effectiveness of care
= Utilization of health services
Family Medicine as a Specialty
c. The Family in Family Medicine
= Family epidemiology
= Impact of Illness in the family
= Effect of family on illness

d. Family Practice Approach

= Family therapy
= Patient education
Family Medicine as a Specialty
. K

 &  &
= emphasis on continuity
= multi= and/or inter= disciplinary orientation of training
Family Medicine
   

 
:
ë. centered on the family as a basic social unit.
2. it is health oriented



 E

ë. disease prevention.
2. health maintenance
3. curative medicine
 Requisites for a Family Medicine
Practitioner
= personal attributes of Family Medicine practitioner are perhaps of equal
importance to scientific knowledge

ë. Interest in people 7. Sensitivity

2. Good judgment 8. Thinker and doer
3. Broad interest . Flexibility
4. Decisiveness ë
.Ease w/ interpersonal relationship
5. Assume responsibility ëë.Comprehensive
6. Stability
 Misconceptions on Family Medicine
ë. Field of Family Practice
a. Family practice is what any family=oriented´ practice specialist does
b. Patients usually prefer a super specialist when they get sick
c. The Family Medicine Practitioner is not well=respected by other
specialists
d. Anyone can practice good family medicine without residency training.
c. Degrading attitude in university medical center towards primary and
comprehensive care
 Misconceptions on Family Medicine
ë. Field of Family Practice

a. Family practice is what any family=oriented´ practice specialist does

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Misconceptions on Family Medicine
b. Patients usually prefer a super specialist when they get sick.

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Attributes patients look for in a Physician (4 C¶s)

ë. Compassion 3. Competence
2. Convenience 4. Cost
Misconceptions on Family Medicine
c. The Family Medicine Practitioner is not well=respected by other
specialists

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   *
%

d. Anyone can practice good family medicine without residency training.

c. Degrading attitude in university medical center towards primary and

comprehensive care
Reflects:
ë. lack of awareness on major objective of medicine
2. relative isolation from the needs of the community
Misconceptions on Family Medicine
2. Nature of Family Practice
a. Family Medicine physician spends all his time with minor illness
and has to refer the patient who really get sick
b. The Family Medicine Physician will not be given hospital
privileges
c. It would be too busy in Family Medicine practice
d. The Family Medicine Physician is for rural areas and not for larger
communities
e. Family Medicine Physician earn income below other specialist.
 #Kþ<þK0<þ0
= represents:
a. composite of the individual developmental changes of the family
members
b. evolution of the marital relationship
c. the cyclic development of the evolving family unit.
= it provide a predictable, chronologically oriented sequence of events in
family life.
= it involves a sequence of stressful changes that requires compensating or
reciprocal readjustments by the family if it is to maintain viability.
(#30"(0#Kþ<þK0<þ0
I. Unattached 'oung Adult
II. The Newly Married Couple
III. The Family With 'oung Children
IV. The Family With Adolescents
V. Launching Family
VI. Family In Later 'ears




Russell F. Bernabe, MD
 p
 
0-
 
p
 
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= a group of tasks designed either to determine the risk of subsequent diseases
or to identify disease in its early, symptomless state
= based on the premises that
ë. asymptomatic individuals can harbor disease
2. examination can detect disease can decrease morbidity
and mortality
 p
 
0-
 p 
= :
  

ë. Physical Examination = every 5 years
2. Blood Pressure = annually
3. Cholesterol = every 5 years
4. Breast & Pelvic Exam = every 3 years
5. Pap Smear = every 3 years (after 2 yearly negatives)
6. Mammography = baseline at 35 years old
7. Immunizations = Tetanus/Diphtheria ± every ë
years
 p
 
0-
 p 
.=/=
  

ë. Physical Examination = every 3 years
2. Blood Pressure = annually
3. Cholesterol = every 5 years
4. Breast & Pelvic Exam = annually
5. Pap Smear = every 3 years (after 2 yearly negatives)
6. Mammography = every 2 years
7. Occult Blood in stool = every 3 years
 p
 
0-
 p 
/1:
  

ë. Physical Examination = every 2 years
2. Blood Pressure = annually
3. Cholesterol = every 5 years
4. Breast and Pelvic Exam = yearly
5. Pap Smear = every 3 years (after 2 yearly negative)
6. Mammography = annually
7. Occult Blood in stool = annually
8. Proctosigmoidoscopy = every 3 years (after 2 yearly negative)
. Immunizations = a) Influenza = yearly after age 65 years
b) Pneumovax ± at age 65
 p
 
0-
 p 
2=
   
 

ë. Physical Examination = annually
2. Blood Pressure = annually
3. Cholesterol = every 5 years
4. Breast & Pelvic Exam = yearly
5. Pap Smear = every 3 years after 2 yearly negative
6. Mammography = annually
7. Occult Blood in stool = annually
8. Proctosigmoidoscopy = every 3 years after 2 yearly negative
 



= A process encompassing:
a. screening for abnormalities
b. early detection of disorders
c. prevention of ill=health
p  ")G





ë. To alert and educate individuals about their roles and responsibilities in
maintaining their own health.
2. To detect disease at an early stage to alter its progression.
3. To provide entry into health care system
4. To improve health care especially among socially disadvantage
5. To gain understanding of disease trends both in population and in
individuals.
6. To make the best use of proven, cost=beneficial techniques, especially in
screening and early detection.






I. Prevention
II. Screening
III. Periodic Health Examination/Early Detection
 p


 
& 
p


ë. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
 p 
p


 Clinical manifestation of disease is prevented through health promotion and
specific disease protection.

ë. Life style
= healthy diet = basic living habits
= non=addictive behavior = leisure activity
2. Health maintenance
= screening activities = immunizations
3. Family life education
= sexuality = marriage
= prenatal care = problems of aged members
= personal hygiene and sanitation
 
 p


= Implies early intervention to detect and treat asymptomatic disease
ë. Monitoring of well=being by physician and patient.
2. Encouraging sick members to sick appropriate help
3. Compliance monitoring regarding specific management.
 (
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= Consists of intervention in the setting of established disease to avoid
complications and disability and to assist in rehabilitation.
ë. Balanced support between compliance monitoring and the appropriate
independent activity of members with chronic illness.
2. Adjustment of all members to changes necessitated by chronic illness in one
member.
3. Coping with crisis created by a serious illness such as congenital anomaly or
by a dying family member.
 

+
ë. Health behavior
a. Tobacco use e. Injuries/accidents
b. Alcohol f. Exercise
c. Caffeine g. Infectious disease
d. Nutrition, diet, and obesity h. Stress
2. Family determinants
= family history can help predict future problems
3. Environmental and Community determinants
a. Socio=economic factors
b. Sanitation
 

&
= Patients are well or asymptomatic individual.

 
  

&6

   7
ë. The condition must have a significant effect on quality and quantity of life.
2. Acceptable methods of treatment must be available.
3. The condition must have an asymptomatic period during which detection and
treatment significantly reduce morbidity and mortality.
4. Treatment in asymptomatic phase must yield a therapeutic result superior
to that obtained by delaying treatment until symptom appear.
5. Tests that are acceptable to patients must be available at reasonable cost to
detect the condition in the asymptomatic period.
6. The incidence of the conditions must be sufficient to justify cost of screening,
 
  #   
 

&
ë. Hypertension
2. Hypercholesterolemia
3. Glaucoma
4. Hearing deficit
5. Carcinomas
a. Breast e. Prostatic
b. Cervical f. Endometrial
c. Lung g. Ovarian
d. Colon h. Testicular
6. Infectious Diseases
a. Rubella c. Hepatitis
b. Tuberculosis d. STI¶s
 0 


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ë. Case finding by survey and selective examination
2. use of all available laboratory procedures
3. use of consultant specialist in communicable disease
4. adequate notification of cases
5. examination of contacts
K
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Russell F. Bernabe, MD
 


K




= primary biologic and psycho=physiologic disorder.

K

= includes the sufferer¶s experience of the disease and the
broad range of dislocations felt by both the sufferer and
his family.
= deeply embedded in the social, cultural and family context
of the person who is ill.
K
 K

ë. Sickness of patient causes suffering and severe disruption for the
patient¶s family.

2. Particular illness sets in motion processes that are disruptive of family

life and hazardous to health of family member.

3. Patient¶s disease is embedded in a whole matrix of difficult family

problems that contribute to the disease process itself.
 
&K
 


= To discover the meaning of illness:
K
& 



± examining of the clinical and laboratory evidences of
biologic and psycho=physiologic dysfunction.
K
& 

 ± exploring the meaning of illness to the patient and
patient¶s family
a. patient¶s understanding of etiology of his disease
b. its pathophysiology and appropriate treatment
c. trajectory and outcome of his illness
 (

K
( G
 
= normal course of the psychosocial aspects of disease for the patient and the
family
9

ë. Allows Family physician to predict, anticipate, and deal with a family¶s
response to illness.
2. Indicates normal and pathologic responses thus enabling family physicians to
formulate special therapeutic plan.
(
 &

K
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I. Onset of Illness
II. Impact Phase
III. Major Therapeutic Effects
IV. Recovery Phase
V. Adjustment to the Permanency of the Outcome
 K"
K

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ë. Nature of Onset
= rapid and clear onset
2. Characteristics of Experience
a. provide little time for physical and
psychological adjustment
b. short period between onset,
diagnosis and treatment leaves
little time to remain in a state of
uncertainty
3. Impact on Family
= caught up in suddenness to deal
with immediate decision.
 


ë. Nature of Onset
= gradual and insidious onset
2. Characteristics of Experience
= suffer from state of uncertainty over
meaning and symptom
3. Impact on Family
= vague apprehension, anxiety and
fearful fantasies over denial of
seriousness of
symptom and possible implication
 



ë. Mistrust and Hostility toward the medical profession
2. Issue on legitimacy of sufferer¶s symptoms

Corrective measure:
ë. Explore routinely the explanatory model and fear that patients bring to the
clinic visits
2. With inappropriate label of illness, acknowledge and explore conflict the
patient may be suffering.
3. Explore several aspects of pre=diagnostic phase of patients and families.
KK

 &K
 p 

p 



ë. Emotional Plane
a. Initial phase ± denial, disbelief, and anxiety
b. Succeeding phase ± anger, anxiety, and depression
c. Last phase ± accommodation and acceptance
2. Cognitive Plane
a. Initial phase ± tension and confusion
b. Succeeding phase ± exacerbation of tension and distress
c. Last phase = acceptance
KKK  G (

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p 
ë. Psychologic states of the patients and family determine the choice of therapeutic
plans as well as the alternative choices.
2. Assumption of responsibility for care early in the treatment plan.
3. Economy of treatment plan.
4. Lifestyle and cultural characteristics of a family
5. Effects of hospitalization, surgery and other therapeutic methods
a. Father ± special economic burden
b. Mother ± greatest impact on other family members
c. Children ± special syndrome of emotional problems
i. children ± hostility, abandonment
ii. Parents ± helpless, guilt, frustrated, hurt
d. Geriatric ± vulnerable to fears of death, rejection, abandonment, loneliness
KKK  G (

0 

)

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ë. Openness of the Attending Physician to the family.
2. Deal with multiple variables
3. Work with harmony with patient and family
4. Coordinate all aspects of therapy
5. Anticipate pathologic response which occurs
K, 0 # G

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  &



  

ë. Return to full health
= simplest outcome
= gains from illness experience
= patient nurtured and allowed to take over abandoned obligation, new
responsibilities and privileges when sick.
2. Partial Recovery
= constant sense of vulnerability due to long period of waiting.
3. Recovery is quite different if it requires acceptance of known permanent
disability
K, 0 # G

"





#   


#
 &p 
ë. Deal with the immediate effect of trauma.
2. Alleviate anxiety and assure adequate rest
3. Provide psychologic support through understanding and repeated reassurance
4. Explore level of understanding of patient and family (labeling)
, # G


p



"


ë. The family¶s adjustment to the initial crisis.
2. The second crisis occurs as family realizes that they have to accept and adjust
to permanency of disability.
3. Finally, the family begin and gives up hope for the patient¶s full return to
health and have to accept that life must go forward and the pattern believed to
be temporary must be accepted as permanent.
0
K
 K

ë. Emotional trauma
2. Social dislocation
3. Economic catastrophe

 
= Family is in crisis when it moves into a state of disequilibrium in response to
any situation or event that it can not resolve by the use of available problem
solving skills, behavior or response.
0  &
 
 #

 &' )

 
 
= boiling point at which crisis response is set in motion
a. affected by uniqueness of internal and external factors
b. stresses are sufficient in number or intensity to disturb family equilibrium
c. family psychosocial history provides information regarding capacity of
family to cope with illness and other missions
d. quality of family life
0  &
 
 











a. Anticipatory guidance issue
b. timeliness of illness or problem



 



a. Member providing financial support
b. Member plays a critical role in family emotional life

.  & 
  

a. assesses and monitors effects of role disruption
b. identifies gap in the family that exists or has resulted from illness
c. sick role as perceived by patient and family
0  &
 
/ 4 
K

a. For acute illness
= potential for crisis especially when family routines are suspended
b. For chronic illness
= prolonged fear and anxiety leads to higher incidence of illness in other
members of the family
c. For terminal illness
= highly emotional and devastating
d. Hospitalization
= conflict between the family and hospital staff (intrusion)
e. Family reaction to death
= initially denial , then anger, after which there is bargaining, then
depression, finally acceptance
 
&

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0
 p 
&
p 

"
K state of response of protective p 
K = tension may be observed
denial, disbelief and numbness objectively
)0
 
 K strong emotion p 
KK = result from proven method of
alternately express anxiety or rage, tension reduction
sadness, depression p 
KKK = increasing assessment and
#

  
± emotional receptivity of the family to new

climate moves towards hopefulness approach for relief of distress
and acceptance p 
K, = quality of family reorganization
(
#




Russell F. Bernabe, MD
 (
#





ë. Recognize Family Structure
2. Understanding Normal Family Function
3. Learn to Assess Family Structure and Function in Clinical Practice
 
#




K 
K
 
a. Composition
b. Social History
c. Community and Neighborhood
KK K   
 
a. Health History
b. Family Dynamics
i. Techniques
ii. Recording
"9p#(K"4#þ0KK40



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þ
 
"  



 
EE
= father of Industrial Medicine (Occupational Medicine)

3
& E
= father of Occupational Medicine in the Philippines
Important Conditions in O.H.
KG 
= a condition which has occurred after a short/single period of exposure
to an unsafe act or condition.

K

= a condition which has occurred as a consequence of long exposure to
unsafe act or condition.
 Definitions
"  

= concerned with the promotion and maintenance of highest degree of
physical, mental as well as the social well being of workers in all
occupations.

"  


= a branch of Preventive Medicine concerned with adaptation of man to
his job and the job to each man.
 "  &


= the applied science concerned with
ë. Identification risk factors
2. Measurement risk factors
3. Appraisal of risk and control to acceptable standards of physical well
being
4. Chemical biological factors arising in or from the workplace
Basic Components of Occupational Medicine
ë. Treatment of occupational injuries and illnesses
2. Conduction of pre=placement and fitness=for=duty examinations
3. Performing executive health maintenance examinations
4. Periodical Assessment of workers¶ health
5. Ocular inspection of workplace
6. Consultation with and counseling employees
7. Participation in management teams
 3 "  


ë) Promotion of Health

2) Prevention of Disease

3) Control of work environment and work condition

4) Rehabilitation


)

"  

p 

ë) Knowledge of the work environment
2) Pre=placement, periodic, special examinations
3) Administrative responsibility
4) Treatment/rehabilitation
5) Health education/advice
6) Efficient record keeping
7) Surveillance of High risk groups
8) Liaison with outside organizations
) Reassurance of workers
 ! +
 


 

)!".
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  ;"  


= diseases that exclusively affect the working population
= factors in the work environment are essential and predominant in the disease causation
 ! +
 



= disorders other than and in addition to recognized occupational diseases that occur
among working populations
= where work environment and performance contribute significantly, but in varying
magnitude.
a) occupation as one of the causal factors
b) occupation as a contributing factor
c) occupationally aggravated pre=existing disease
73




= diseases among the general population which workers may be equally or more
susceptible
ë
Leading Occupational Diseases and Injuries
ë. Occupational Lung diseases
2. Musculoskeletal injuries
3. Occupational cancers (other than lung)
4. Severe traumatic injuries
5. Cardiovascular diseases
6. Reproductive disorders
7. Neurotoxic disorders
8. Noise=induced hearing loss
. Dermatologic conditions
ë
. Psychological disorders
    
  "  


7 K 
= genetics
= personality
= Socioeconomic class
= Age
= Sex
= Nutrition
= Susceptibility
 7 0- 0 


7& 
= infectious diseases agents
= reservoirs
= vectors
= fomites
)7 
= social customs
= organizational set up
7p 
= Noise
= Extremes of temperature
= Pressure
= Vibration
 

"  &


ë) Recognition of Health Hazards

2) Evaluation of Workplace

3) Control
 K   &

 
 

ë) Substitution

2) Changing the process

 &&
 

ë) Isolation
2) Wet method
3) General ventilation
4) Personal Protective Equipment
5) Personal hygiene
6) Housekeeping/Maintenance
7) Waste Disposal
8) Special Control Method
) Medical Control
ë
) Education and Training
 _
_  

_
_



Russell F. Bernabe, MD
4  
K 
p &
64Kp7
= formerly Medicare now popularly known as the National Health
Insurance Act of ë5

= instituted in March 4, ë5 by virtue of R.A. 7875

= it is the Philippine's largest and premiere social health insurance

program
 #
4Kp
= to effectively provide health care services that is
ë. accessible
2. affordable
3. acceptable
4. adequate (accredited ë574 hospitals and 2



MDs)
 p

K 
  6p
7

= a government owned and controlled corporation mandated by the NHIP

= Functions of PhilHealth:
ë. to administer and manage a sustainable program

2. to extend quality and relevant health care services to a broader

membership.
 4Kp
ë. Accelerate Universal Coverage

2. Enhance and expand the benefits to include more outpatient services

3. Consolidate the Medicare program

4. Ensure a sustainable National Health Insurance Program for All

 
&
4Kp
ë. Employed sector

2. Individually=paying members

3. Non=paying members
a) Retirees and pensioners
b) Permanent and partial disability pensioners and death pensioners

4. Indigent members
 0-

&

ë. Legitimate spouse not an NHIP member

2. Children below 2ë years old, unmarried and unemployed

3. Children over 2ë years old suffering from congenital or acquired debilitating

diseases

4. Dependent Parents > 6
years old

 
 


Mëa = used by employed members

Mëb = used by Individually=paying members

Mëc ± used by indigent/sponsored members

 p
 




p + &

Inpatient hospital care:
ë. Room and board (45 days for the insured and another 45days to be shared
by the extensions per year)
2. Services of health care professionals
3. Diagnostic, laboratory, and other medical examination services
4. Use of surgical or medical equipment and facilities
5. Prescription drugs and biologicals, subject to the limitations stated in
Section 37 of RA 7875
6. Inpatient education packages.
7. Maternal Care Package for the 3rd NSD
8. Newborn Care Package
 p
 




p + &

Outpatient care:
ë. Services of health care professionals
2. Diagnostic, laboratory, and other medical examination services
3. Personal preventive services
4. Prescription drugs and biologicals, subject to the limitations described in
Section 37 of RA 7875
5. Emergency and transfer services
6. HIV/AIDS Benefit package
7. Malaria Benefit Package
 

 )
" 



ë. Chemotherapy
2. Radiotherapy
3. Cataract Extraction
4. Hemodialysis
5. Minor surgical procedures done in operating room complex
5. TB DOTS
 4

 )



ë. Non=prescription drugs and medicines
2. Outpatient psychotherapy and counselling for mental illness
3. Drug and alcohol abuses and dependency treatment
4. Cosmetic Surgery
5. Home and rehabilitation services
6. Optometric services
7. 4th Normal Spontaneous Deliveries of women
8. Other cost ineffective procedures as defined by NHIP
 9





4Kp


K

   
& 
p 
 
  (
 


   2

3

4


 &  


Ordinary case ë,5

ë,7

3,



Intensive 2,5

4,


,



Catastrophic
8,



ë6,



H þ )  


Ordinary 35
85
ë,7


Intensive 7

2,


4,



Catastrophic
4,


ë4,



 p 
 



4Kp
General Practitioner = Php ë5
.

/day Specialist= Php 25
.

/day

"   p 
 
  (
 
General practitioner 6

6

6


Specialist ë,


ë,


ë,



K


General Practitioner 






Specialist ë,5

ë,5

ë,5


2,5


   
General Practitioner 






Specialist ë,5

ë,5

2,5


 p 
 



4Kp
"
"
&


a. RVU 3
and below 385 67
ë,
6

b. RVU 3ë to 8

ë,ë4
ë,35

c. RVU 8ë and above
2,ë6
3,4

 &
 Maximum of ë6,

#

& Maximum of 5,




,95


 


p
"09
0
,9
Mastectomy, partial 75
Mastectomy, simple, complete 

Mastectomy, radical (Urban type operation) 2


Appendectomy ë


Ruptured appendix w/ abscess or generalized peritonitis ë5

Cholecystectomy w/ exploration of common duct 3


Dilation and curettage 4

T.A.H.B.S.O 25

Vaginal hysterectomy 2


Vaginal delivery only (w/ episiotomy) 5

Breech extraction 8

Caesarian delivery ë5

 
p &p 


p 
 
  (
 

, 

 





() þ&  ë,ë25 ë,ë25 ë,ë25

 

0



ë. Paid 3 monthly contribution within the immediate 6 month prior to the month of
confinement

2. Confinement to any accredited hospital for not less than 24 hours

3. The 45 days allowance for room and board has not been consumed yet
 4Kp

 


ë. Confinements in non=accredited hospitals except in emergency cases
2. Confinements less than 24 hours except:
a) Case is emergency
b) Patient is transferred to better equipped hospital
c) Patient expired during confinement
 0

Finish