Students Book Block C.6 Lifestyle Related Diseases (2023)

Student’s Book
Block C.6
Lifestyle Related Diseases
Eighth Edition
2023
UNIVERSITAS GADJAH MADA

FACULTY OF MEDICINE, PUBLIC HEALTH AND NURSING
SCHOOL OF MEDICINE
YOGYAKARTA
Student’s Book Block C.6 | 1

Block C.6 Lifestyle Related Diseases
Student’s Book
Eighth Edition
© Faculty of Medicine, Public Health and Nursing

Universitas Gadjah Mada, 2023
Printed in Yogyakarta
Published by Faculty of Medicine, Public Health and Nursing

Universitas Gadjah Mada
All rights reserved
Copyright law protects this publication and permission should be obtained from publisher
prior to any prohibited reproduction, storage a retrieval system, or transmission in any form
by any means, electronic, mechanical, photocopying, and recording or likewise
2 | Student’s Book Block C.6

TEAM of BLOCK C.6
LIFESTYLE RELATED DISEASES
YEAR III COORDINATOR
Dr. dr. Hasanah Mumpuni, Sp.PD, Sp.JP

Department of Internal Medicine
BLOCK COORDINATION TEAM
CHAIRMAN
Dr. rer. nat. dr. BJ Istiti Kandarina
Department of BEPH
MEMBERS
dr. Yanri Wijayanti Subronto, PhD, Sp.PD-KPTI

dr. Silas Henry Ismanto, Sp.KJ(K)

Department of Psychiatry
Dr. dr. Zaenal Muttaqien, AIFM

Department of Physiology
dr. M. Robikhul Ikhsan, Sp.PD, KEMD


CONTRIBUTORS
Lastdes Cristiany Friday, S.GZ, MPH

Department of BEPH
dr. E. Henny Herningtyas, M.Si, PhD, Sp.PK

Department of Clinical Pathology
Dr. dr. Denny Agustiningsih, M.Kes, AIFM

Department of Phisiology
dr. Ronny Tri Wirasto, Sp.KJ

dr. Andrian Fajar K, Sp.KJ

dr. Irwan Supriyanto, PhD, Sp.KJ

SECRETARY
Berliana Tusilawati

CURRICULUM MAP
COMPETENCE-BASED CURRICULUM 2013
FACULTY OF MEDICINE UNIVERSITAS GADJAH MADA
Phase 3: Clinical Rotation - Becoming a Competent Doctor
Year 5
Exams 2
Compre
CLINICAL ROTATION
Phase 3: Clinical Rotation - Becoming a

Phase 2: Transition from Theory to Practice
Competent Doctor
Year 4: Emergency, Health System & Elective
Comprehensive
Year 4
Examination
Block D.1 Block D.2 Block D.3
Health
Emergency System & Elective
CLINICAL ROTATION
(6 weeks) Disaster (6 weeks)
(6 weeks)
V O
X X X
Year 3: Life Cycle and Diseases
Block C.1 Block C.2 Block C.3 Block C.4 Block C.5 Block C.6
Conception, Safe Childhood Adolescent & Elderly Lifestyle
Fetal Growth & Motherhood (6 weeks) Adulthood (6 weeks) Related
Holiday
Congenital & Neonates (6 weeks) Diseases
Anomaly (6 weeks) (6 weeks)
(6 weeks)
V V O
X X X X X X
Year 2: Human Body Structure & Function Problem, Basic Medical Practice and Research
Block B.1 Block B.2 Block B.3 Block B.4 Block B.5 Block B.6
Chest Limited Abdominal Sense Organ Basic Medical Research
Problems Movement & Problems Problems Practice (6 weeks)
Holiday
(6 weeks) Neurosensory (6 weeks) (6 weeks) (6 weeks)
Problems
(6 weeks)
V V O
X X X X X X
Phase 1: Foundation in Medicine
Year 1: Human Body Structure and Function
Block A.1 Block A.2 Block A.3 Block A.4 Block A.5 Block A.6
Being A Digestive Cardiorespiratory Genitourinary Nerve System Blood and
Medical System and System System & Sense Immune
Holiday
Students and Metabolism (6 weeks) (6 weeks) Organs System

Locomotor (6 weeks) (6 weeks) (6 weeks)
System
(6 weeks)
V V O
X X X X X X
X Block Examination
V Progress Test
O Clinical Skills Exams

OVERVIEW
GENERAL OUTLINE OF THE BLOCK CONTENT
This block aims to give the students understanding and problems management concerning
lifestyle-related diseases. Lifestyle is a characteristic bundle of behaviors that makes sense to
both others and oneself in a given time and place, including social relations, consumption,
entertainment, and dress. To achieve good health, a person should run healthy lifestyle.
According to WHO, healthy lifestyle is determined by physical fitness, balanced mental-social
health, and balanced nutrition. The theme of the block is lifestyle- related diseases.
The principles of biomedicine, clinical behavior and community health to problems
concerning lifestyle-related complaints will be outlined. In each module, the students will learn
aspects of selected, for prototypical convenience, diseases or health problems.
This block contains five learning units. The first unit is Risk Factors of Diseases, of which
consists of Socio-economic impact of illness, physical activities, nutrition and psychiatric
condition and diseases. Also, here we discuss about occupational diseases and food and
disease risk. The practical session will be physical fitness and exercise stress test, together
with conducting laboratory work on nutritional assessment and dietary program. The second
to fifth unit consist of various conditions related to conditions and diseases which maybe
related to an individual and community lifestyle. This may include (and not confined to)
Functional Syndrome, Diseases related to Metabolism, Addiction and HIV-STI, and Personality
and Malignancy.
In learning unit 2 is functional syndrome. The autonomic nerves are important in keeping
healthy stage of the body, and its imbalance may cause to several disorder and or diseases.
Mental health is as important as physical health, so that stress management is included in the
health life-style. Many people suffer from diseases that has psychological underlying
mechanism (psychosomatic diseases) such as Irritable Bowel Syndrome (IBS), (non-
anatomical) dyspepsia, etc. Management of these diseases is not merely by medication or
drugs, but it should also touch the psychological condition of the patients.
The topic in learning unit 3 is metabolic syndrome. Metabolic syndrome is one a cluster
of conditions — increased blood pressure, high blood sugar, excess body fat around the waist,
and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of
heart disease, stroke and diabetes. Indonesia is now facing a triple burden of disease, i.e.
infectious diseases, nutrition problem, and non-communicable diseases. Recent data showed
that cardiovascular disease and stroke are the two leading cause of death and morbidity in
Indonesia. High carbohydrate and calorie intake in the society leads to more than 5 millions
people suffer from Diabetes in the country, which is one of the main risk factor for
cardiovascular disease and stroke.
The topic in learning unit 4 is Addiction and HIV-STI. Addiction to drugs is one of the
main concern among youth and adult. Indonesia is estimated to be the house of 5 millions drug
addicts. Furthermore, it is estimated that there is more than 1 million HIV infection in Indonesia
with hundreds of thousands are infected by sexual-transmitted infections, many of which are
without symptoms and underdiagnosed. (Challenges and opportunity of pandemic Covid-19 to
new Normal Paradigm). Drug addiction and abuse, HIV and STI is a complex condition as it
involves social aspect of the disease such as working with marginalized and stigmatized
population, such as transgender, sex workers, drug abusers, etc.
The topic in learning unit 5 is Personality and Malignancy. Two most common known
life-style related malignancy are Lung and Colorectal Cancer. We know that cancer is a multi-
factorial disease, but many epidemiological studies have shown that smoking is one factor that
is strongly related to Lung and also Colorectal Cancer. Smoking is actually a modifiable risk
factor among men and women. Low fibre eating habit is also known to be related with the
higher incidence of colorectal cancer. This learing unit also consist of two recently described
conditions, i.e. culture-bound syndrome (several diseases that are confined and only known in
a particular culture or society) and violence in modern culture (violence which were recognised

or well-described before this modern era). Both of this conditions will affect the well-being of
individu and or society.
The topic tree of this block is presented to make the student easier in knowing,
understanding the objectives and determining subtopic of this block.
The scenario and the objectives of the scenario are used to create the problems which will
appear from the group discussion effected the scenario. When the problems arise the solutions
of the problems should be discussed and should be confirmed to the references, which are
available in the library or the internet. Finally, they are also used in order to enhance student’s
skills relevant to the module includes laboratory practice and skills labs.
FINAL OBJECTIVE
After completely and actively participate in learning activities of block, students are
expected to be able to understand the current updates of the epidemiology, etiology,
pathogenesis, diagnosis, prognosis, management and psychosocial aspect of lifestyle related
complaint of individuals, families and community in comprehensive, holistic, sustainable,
coordinative and collaborative manner and ‘the new normal paradigm’.

LEARNING OBJECTIVES
General objectives
Upon completion of block C.6, students should be able to:
1. apply the principles of biomedicine, clinical behavior and community health to problems
concerning lifestyle-related complaint.
2. compile and record accurately information relating to the understanding and management
of problems concerning life-style complaint.
3. conduct clinical procedure (simulation) according to problems, need, authority and
competence.
4. handle Lifestyle Related Diseases of individuals, families, and community in a
comprehensive, holistic, sustainable, coordinative and collaborative manner.
Spesific objectives
Upon completion of block C.6 are that students should be able to:
1. explain the principles of basic medical science that is related to life-style related diseases,
including pathogenesis, pathophysiology, and influencing factors.
2. utilize clinical reasoning when inquiring patient’s current illness history, past medical
history, family history, and social as well as other relevant history in a consecutive and
efficient manner (area 1, area 2).
3. conduct a rational physical examination in accordance to patient’s problem (area 2)
4. interpret clinical data and formulate it into a diagnosis and comparative diagnosis (area 4)
5. determine supporting examination in order to strain illness (include laboratory exam) (area
2).
6. explain results of diagnosis by giving reference to evidence-based medicine (area 3).
7. identify and explain various choices for intervention that may be undertaken, and then
determine an intervention in a rational/scientific manner for handling the illness.
intervention may be in the form of a surgery, pharmacology, diet, exercises, and/or
medical rehabilitation which includes change of behavior through counseling, and be
based on principle of quality control, budget control, benefit, and patient condition as well
as patient’s choice (area 1, area 3, area 4).
8. develop an effective strategy for halting source of illness, pathogenesis points and
pathophysiology, as well as determine consequences, and specific risks (area 3).
9. select and conduct therapeutic skill and conduct primary, secondary, and tertiary
preventive action in accordance to authority and competence (area 2).
10. explain changes in biochemical and pathophysiology process during and after intervention
(area 3).
11. identify various indicator of successful intervention, monitoring the progress of treatment,
improving and correctly adjusting therapy (area 3, area 4).
12. explain the benefit of therapy, diet, exercise, or change of behavior when handling
specific cases (area 3).
13. explain the purpose of follow up evaluation for handling illness (area 3).
14. identify, provide reasoning, and explain correct methods of primary, secondary, and
tertiary prevention, when communicating to patient, family members and community (area
4).
15. identify the role of patient’s family, patient’s occupation, and social surrounding as a risk
factor in the emergence of illness and factor that may influence therapy, as well as factor
that may influence prevention of illness (area 4).
16. keep updated with the latest scientific findings (area 6).
17. handle Lifestyle Related Diseases of individuals, families, and community in a
comprehensive, holistic, sustainable, coordinative and collaborative manner with
professional and ethical conduction (area 4, area 7).
RELATED DICIPLINES
Physiology, Bioethics, Psychiatry, Internal Medicine (Endocrinology, Gastroenterology,
Nephrology, Hematology, Pulmonology, Tropical Medicine), Pharmacology and Therapy,

Biochemistry, Public Health and Nutrition, Neurology, Clinical Pathology, Pathology,
Radiology
LINKEAGES TO OTHER BLOCK

Block C.6 Lifestyle Related Diseases related to block A.2 (Cardio Respiratory System), A.3
(Digestive System), A.4 (Genitourinary System), A.5 (Nervous System and Sense Organ),
A.6 (Blood and Immune System), B.1 (Chest Problems), B.2 (Neuromusculoskeletal
Problems), B.3 (Abdominal Problems), B.6 (Research), C.1 (Conception, Fetal Growth &
Congenital Anomaly), C.2 (Safe Motherhood & Neonate), C.3 (Childhood), C.4 (Adolescent &
Adulthood), C.5 (Elderly)

TOPIC TREE
Lifestyle
Individual & Family Community

Approaches Approach
Nutrition Physical Mental Spiritual Social Structural
Health
Problems
Risk Factor of Functional Metabolic Syndrome and its Malignancy

Addiction, HIV,
Diseases Syndrome related diseases STI
2018

Modules in Block C.6
Based on the above topic tree, Block C.6. is divided into two modules. The names of the
modules are:
Learning Unit 1 : Risk factor of Disease

Learning Unit 2 : Functional Syndrome
Learning Unit 3 : Metabolic Syndrome and its related diseases
Learning Unit 4 : Addiction, HIV, STI
Learning Unit 5 : Malignancy

LEARNING ACTIVITIES
The following learning activities are prepared to guide the students to obtain the learning
objectives of this block:
1. Group Discussion With Tutors

Group discussion with tutors or commonly called tutorial session is scheduled twice weekly
of two hours each. If the groups do not meet the tutors for some reason, they are
responsible to inform the secretariat immediately by calling: 631201. To get a life
discussion, the students should prepare the subject they are going to discuss. Prior
knowledge is also important to put during discussion. Members of the group should bring
some relevant notes taken from relevant learning resources. To achieve learning
objectives, the “seven-jumps” and multilevel scenario method will be used in the group
discussion.
Seven jumps method

In the seven jumps method, the underlying thoughts are basically asking the following
questions: What do we need to know? What do we already know? What more do we
wish to know?
The seven jumps are:

Step 1. Clarify terms and concepts
Step 2. Define the problem
Step 3. Analyze the problem
Step 4. Make a systematic inventory of the various explanations found in step 3
Step 5. Formulate learning objectives
Step 6. Collect additional information outside the group discussion
Step 7. Synthesize and test acquired information
Multilevel scenario method

Tutorial guide for multilevel scenario:
a. STEP 1 and 2 (100 minutes):
1) STEP 1: Patient's health problems discussion
2) STEP 2: Determine the purpose of learning
b. STEP 3: SELF STUDY

c. STEP 4 (100 minutes): explanation, analysis, synthesis, evaluation and demonstration
(role-play, drama, and etc) what have been learned and the possibility of having further
learning process. KNOWLEDGE-SKILLS ATTITUDE aspect can be achieved in this
tutorial process.
d. There is no chief in this scenario. Tutor is the discussion leader. But tutor does not
provide information, but facilitates learning function in the form of: 'Questioning'
(induces).
e. The critical thing is the need of lifelong learning efforts by:
1) LEARNING STAGES: To understand that learning process of diagnosis
comparison determination, diagnosis, as well as therapy in this stage of education
are the learning stages. Therefor, the results of students’ discussion do not have
to be correct. The tutors’ duty is to help directing students’ mindset/clinical logic so
they always have the will to learn.

2) SELF-LIMITATIONS: To emphasize on 'uncertainty' and self-limitations is very
important, eventhough a physician feels that his diagnosis and therapy is correctly
upheld. Awareness on self-limitation and other possibilities, will be a physicians’
provision to always improve themselves, life-long learning process, to be initiative
on improving their knowledge, to ask their groups, seniors and to keep up with
medical science developments.
3) DOCTOR-PATIENT RELATIONSHIP: To emphasize on the
relationship/physician-patient relationship is very important so students would
understand that in the management of health problems, to uphold a diagnosis and
to give treatment are not enough for health outcomes. Good relationship between
physician and patient will boost patient’s healing process.
Assessment: 100% of tutorial attendance (except with permission based on faculty

regulation)
2. Independent learning (self study)

As adult learners, students are expected to perform independent learning, a skill that is
essential for future career and development. This skill includes discovering their own
interests, searching for more information from available learning resources, understanding
the information by different learning strategies and using various learning activities,
assessing their own learning, and identifying further learning needs. They will never be
satisfied to learn merely from the lecture notes or textbooks. Independent learning is an
important feature of the PBL approach and at some stage; learning will become a never-
ending journey without limits.
Students learn independently based on block’s objectives and scenario’s objectives,
nevertheless, it can be developed according to references which are already recommended
or the new comparative literature study getting from internet.
Self-study activities include searching related information and performing independent skills
training.
3. Lectures
Lectures are addressed to basic concepts of Lifestyle Related Diseases. Clinical
aspects of the lifestyle-related complaints will be taught to the student in order to enrich the
understanding as well as apply those basic concepts in clinical condition.
During block C.6 there will attend several lectures associated with the module topic. And
during tutorials, they are encouraged to deliver questions and ask for explanation of
unsolved problems.
Duration
Week Title Deparment
(Hour)
Block Coordinator
1 Introduction of Block C.6 1
Team
2 Socio-economic impact of illness HBESM 1
3 Food and disease risk BEPH 1
4 Malnutrition BEPH 1
1
5 Food Policy BEPH 1
Carpal tunnel syndrome, tarsal
6 Neurology 1
tunnel syndrome, paroneal palsy
7 Occupational Diseases HBESM 1
8 Exercise for management Diseases Physiology 1
The role of autonomic system in
9 Physiology 1
2 healthy life
10 Sexual dysfunction Physiology 1

Imbalance of autonomic nervous
11 Neurology 1
system
National and Global Psychosocial
12 Psychiatry 1
Problem
13 Psychosomatic Diseases Internal Medicine 1
Dyspepsia, gastritis, GERD, gastric -
14 Internal Medicine 1
duodenal ulcers, and Achalasia
Management of Metabolic
Syndrome
Diabetes Mellitus (Diagnosis and Internal Medicine-
16 1
Management) Endrocrin
17 Complication of Diabetes Internal Medicine 1
18 Stroke Neurology 1
Dietary (clinical nutrition) of chronic
diseases
20 Management of Obesity in Adult Health and Nutrition 1
3
21 Obesity in children Pediatric 1
Eating disorders (anoreksia nervosa,
22 Psychiatry 1
bulimia, pica)
Management (diagnosis and
Internal Medicine-
23 treatment) of Coronary Artery 1
Cardiology
Diseases
Prevention and Rehabilitation of Internal Medicine-
24 1
Cardiac Diease Cardiology
25 Gout, hyperurisemia, osteoporosis Internal Medicine 1
26 Substance Related Disorders Psychiatry 1
Diagnosis and Management NPS
27 (New Psychoactive Substance) Use Psychiatry 1
Disorder
Pharmacological aspect of addictive
28 Pharmacology 1
drugs
Human Immunodeficiency Virus
29 (HIV) / Acquired Immunodeficiency Internal Medicine 2
Syndrome (AIDS)
Comprehensive Management of HIV
Infections
4
HIV Team dr.
31 Counseling in HIV 2
Sardjito Hospital
Dermato and
32 Syndrome of Genital Discharge 1
Venerology
Dermato and
33 Syndroma of Genital Ulcer 1
Venerology
Syndrom of scrotal swelling & Dermato and
34 1
vegetation Venerology
Dermato and
35 STD-HIV 1
Venerology
36 STD and complication Obsgyn 1
Covid-19 Pandemic & Corona virus
related disease (Covid-19)
Standard & Transmission Based
Precaution
Public Health Management of Covid-
39 BEPH 1
19
Secondary Prevention in Infectious
Diseases

41 Lifestyle and malignancy Internal Medicine 1
42 Lung Cancer Internal Medicine 1
43 Colorectal Cancer Internal Medicine 1
44 Radiotherapy Radiology 1
5 Modern Culture Bound Syndrome
45 Psychiatry 1
and Behaviour Addiction
Adjustment Disorders (include
46 Psychiatry 1
PTSD)
47 Imaging of malignancy Radiology 1
4. Panel Discussions
There will be one topic in plenary discussion:
Week Title Deparment Duration
(Hours)
5 Panel Internal 2
discussion: Medicine
Lifestyle Related BEPH
Non Psychiatry
Communicable Physiology
Diseases
These panel discussions will present experts in their fields.
Assessment: 100% attendance
5. Practical Sessions
During block C.6, some departments will exercise practical sessions to improve and
enrich student’s inherent understandings with the module topic.
Duration
Week Title Dept
(Hours)
Physical Fitness Test
(P.O Astrand Physiology 2
Method)
1 Exercise Stress Test Physiology 2
Cardiocirculatory
fitness (independent Physiology -
practice)
Assessment Level of
Psychiatry 2
Distress
2
Nutritional
BEPH 2
Assessment
3 Dietary Program BEPH 2
Calcium and
Phospate Test &
Glucose Test (GOD-
PAP Method),
Glucose Challenge Clinical
5 2
Test, Oral Glucose Pathology
Tolerance Test,
Ketone Bodies –
Rothera’s Test,
HbA1c Test

6. Basic Clinical Competence Training (BCCT)
During block C.6 there will be five topics in Basic Clinical Competence Training that will be
distributed into each week.
Week Title Department Duration
(Hours)
1 Health Promotion Skills Lab 2
Integrated
Patient
2 Skills Lab 2
Management
(IPM)
Apusan Bakteri
3 Tahan Asam Microbiology 2
(AFB)
Sexually
Transmitted
4 Skills Lab 2
Diseases
Examination
Advance
5 Radiology and Skills Lab 2
Emergency
7. Field work (Friday Morning Aerobic Exercise)

Each student must follow Friday morning aerobic exercise (7 - 8 am at Basketball court)
Assessment: 100% attendance (5 times)

RESUME OF ASSESSMENT BLUE PRINT
Proportion of Block
Activities Examination Item Total
Questions
Laboratory of Psychiatry 6% (procedural
(1 topic) knowledge)
Laboratory of Physiology 12% (procedural
(2 topics) knowledge)
Practical Session 12% (procedural 36 %
Laboratory of BEPH (2 topics)
knowledge)
6%
Laboratory of Clinical Pathology Procedural
(1 topic) Knowlegde &
Skills
Block Examination 1 session consist of 100 items
(represent each Learning 50% 64%
Objective).
TOTAL 100%

WEEK-1
LEARNING UNIT 1: RISK FACTOR OF DISEASE
Scenario 1
Risk Factors of Disease
Nearly 90% of the world’s total disease burden occurs in developing countries, while only
10% of health expenditures are allocated there. The burden of non-communicable diseases
affects to the poor less than those who are better off; however these diseases also contribute
to the excess death and disability among the poor in terms of mortality and the loss of
disability.
Consumption of foods high in saturated and industrially produced trans fats, salt, and
sugar is the cause of at least 14 million deaths or 40% of all deaths every year from NCDs.
For example, over consumption of salt causes up to 30% of all cases of hypertension.
Physical inactivity causes about 3 million or 8% of all deaths per year from NCDs. Alcohol
consumption leads to 2·3 Million deaths each year, 60% of which are due to NCDs, and has
adverse health, social, and economic effects, and not just for the people who drink alcohol.
Changes in the social and economic environment have resulted in the risk factors for NCDs
becoming widespread.

MINI MAPING: HEALTHY LIFESTYLE
AUTONOMIC NERVE
SYSTEM
PHYSICAL FITNESS
BALANCED NUTRITION
BALANCED MENTAL HEALTH
HEALTHY LIFESTYLE HOMEOSTASIS UNHEALTHY LIFESTYLE
MAINTAIN HOMEOSTASIS DECREASE/LACK TO MAINTAIN HOMEOSTASIS

LIFESTYLE
ILNESS
WELLNESS
Created by dr. M. Robikhul Ikhsan

Lectures
1. Title : Introduction of Block C.6
Department : Block Coordinator Team
Duration : 1 hour
Content : Activities and learning objetives in
Block C.6
2. Title : Socio-economic impact of illness

Department : HBESM
Duration : 1 hour
Contents : the distribution of chronic
diseases, economic consequenes
-, the economic rationale for public
policy intervention against chronic
disease, cost-effectiveness of
interventions to prevent chronic
disease
3. Title : Food and disease risk

Department : BEPH
Duration : 1 hour
Contents : epidemiological food-related risk
factors, food diet reduce the risk of
developing chronic disease.
4. Title : Malnutrition
Department : BEPH
Duration : 1 hour
Contents : Management of Malnutrition,
malnutrisi energi protein, defisiensi
vitamin, defisiensi mineral
5. Title : Food Policy

Department : BEPH
Duration : 1 hour
Contents : preventing and controlling nutrition
related to non communicable
diseases
6. Title : Carpal tunnel syndrome, tarsal

tunnel syndrome, paroneal palsy
Department : Neurology
Duration : 1 hour
Contents : Diagnosis, Management,
rehabilitation
7. Title : Occupational Diseases

Department : HBESM
Duration : 1 hour
Contents : epidemiology, prevention,
management of occupational
diseases

8. Title : Exercise for Management
Diseases
Department : Physiology
Duration : 1 hour
Contents : Exercise for specific purposes
based on FITT principles, intensity
based on perceive exertion scale,
heart rate karvonen formula
Practical sessions
1. Title : Physical Fitness Test (P.O
Astrand Method - Ergocycle)
Duration : 2 hours
2. Title : Exercise Stress Test (Ergometry -

Ergocycle)
Duration : 2 hours
3. Title : Cardiocirculatory fitness

(independent practice)
BCCT
1. Title : Anthropometry For Health Risk
Screening (independent
practice)
Department : Skills Lab
2. Title : Health Promotion

Duration : 2 hours
Time allocation
Tutorial : 4 hours
Lecture : 8 hours
Practical : 4 hours
session
BCCT : 2 hours
Total 18 hours
Individual : 30-42 hours
Learning

References
1. American College of Sports Medicine., 2000. ACSM's Guidelines for Exercise Testing
and Prescription, 6th edition. Lippincott, Williams & Wilkins. Philadelphia
2. Corbin,B.; Lindsey, R; and Welk, G., 2000. Concepts of Physical Fitness and Wellness:
A Comprehensive Lifestyle Approach, 3rd edition. McGraw-Hill. Boston
3. Drossman DA. Functional abdominal pain syndrome. Clin Gastroenterol Hepatol
2004;2:353–365.
4. McArdle, WD.; Katch, FI.; and Katch, V L, 2001. Essentials of Exercise Physiology.
Philadelphia: Lea & Faber.
5. McGinnis, J. M., and Foege, W. H., 1993. "Actual Causes of Death in the United
States." Journal of the American Medical Association 270:2207–2212
6. Robbins, G; Powers, D; and Burgess., S (2002). A Wellness Way of Life, 5th edition.
McGraw-Hill. Boston
7. United States Department of Health and Human Services 1996. Physical Activity and
Health: A Report of the Surgeon General. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention. Atlanta
8. Wallace, J P., 2001. "Health Benefits of Exercise and Fitness." In Foundations of
Exercise Science, ed. Gary Kamen. Lippincott, Williams & Wilki. Philadelphia
9. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ 2013 Clinical Exercise physiology 3nd
ed. Human Kinetics Inc, Champaign II
10. The Lancet No. 377. 2011. Priority Action for non-communicable diseases. Health policy
11. Keith M. Diaz, John N. Booth III, David A. Calhoun, Marguerite R. Irvin, George Howard,
Monika M. Safford, Paul Muntner, Daichi Shimbo. Healthy Lifestyle Factors and Risk of
Cardiovascular Events and Mortality in Treatment-Resistant Hypertension. Hypertension.
2014;64:465-471
12. Nawi Ng. Hans Stenlund. Ruth Bonita. Mohammad Hakimi, Stig Wall & Lars Weinehall.
Preventable risk factors for non-communicable disease in rural Indonesia: prevalence
study using WHO STEPS approach. Bulletin of the World Health Organization 2006;
84:305-313.
13. IFPRI. 2016. Global Food policy Report.
14. World Health Organization. 2013. Global Action Plan for the Prevention and Control of
Non-communicable Diseases 2013-2020.
15. World Health Organization. 2014.Global Status Report.

WEEK - 2
LEARNING UNIT 2: FUNCTIONAL SYNDROME
Scenario 2
Physiological Defense Mechanism
After his wife passed a way, Abdallah (36 yo) experienced changes in the sleep and
defecation patterns. The passing of stool became irregular and his stomach sometimes
rejects food he consumed earlier. Moreover, he feels abdominal discomfort such as: pain,
bloating and intermittent diarrhea or obstipation. He noted that the urine color is yellowish.
After rising upright from lying position, he experiences palpitation and dizziness.
The medical doctor Abdallah sees, treats him with a holistic approach. This approach
includes the biological, psychological, social and spiritual aspect. His BP is 120/80 mmHg,
HR is 95 bpm and Respiratory rate is 24 x/minute and BMI is 19. He has no family history of
organic gastrointestinal diseases.

MINI MAPING FUNCTIONAL SYNDROME
Source:
Mayer EA. Emerging disease model for functional gastrointestinal disorders.
Am J Med 1999;107(5A):13S.

Lectures
1. Title : The role of autonomic system in healthy life
Duration : 1 hour
Content : how to maintain the function of autonomic system related to
physical activity and rest, exercise, and mental health
2. Title : Sexual dysfunction

Duration : 1 hour
Content : Management of Sexual Dysfunction (desire and sexual arousal
disorders, orgasmus disorders including ejaculation disorder,
sexual pain disorder including vaginismus, disparenia)
3. Title : Imbalance of autonomic nervous system

Duration : 1 hour
Contents : the interaction of neurological, physical, psychological, factors
in aetiology, diagnose, management, prevention
4. Title : National and Global Psychosocial Problem

Department : Psychiatry
Duration : 1 hour
Contents : management of psychiatric problems related to biological factors
(brain infection, chromosomal abnormalities, physical brain
trauma, hormonal), psychological factors (early age, frustration,
psychological trauma), social factors (social stress, social
discrimination, poverty), and spiritual factors (lack of spiritual
power source)
5. Title : Psychosomatic Diseases

Department : Internal Medicine
Duration : 1 hour
Contents : Clinical manifestation of psychosomatic diseases
6. Title : Dyspepsia, gastritis, GERD,gastric - duodenal ulcers, and

Achalasia
Duration : 1 hour
Contents : management: Dyspepsia, GERD and Gastritis, Akalasia,
Esofagitis refluks, gastro esofagus refluks), ulkus (gaster and
duodenum)
Practical sessions
1. Title : Assessment level of distress
Duration : 2 hours
2. Title : Nutritional Assessment

Department : BEPH
Duration : 2 hours

Skills laboratories
Title : IPM
Duration : 2 hours
Time allocation
Tutorial : 4 hours
Lecture : 6 hours
Practical Sessions : 4 hours
BCCT : 2 hours
Total : 16 hours
Learning
References
1. Bharucha AE, Camilleri M. Functional abdominal pain in the elderly. Gastroenterol Clin
North Am 2001;30:517–529.
2. Devor M. Neuropathic pain: what do we do with all these theories? Acta Anaesthesiol
Scand 2001;45:1121–1127.
3. Drossman DA. Functional abdominal pain syndrome. Clin Gastroenterol Hepatol
2004;2:353–365.
4. Edwards RR, Ness TJ, Weigent DA, Fillingim RB. Individual differences in diffuse
noxious inhibitory controls (DNIC): association with clinical variables. Pain
003;106:427–437.
5. Ohayon MM, Schatzberg AF. Using chronic pain to predict depressive morbidity in the
general population. Arch Gen Psychiatry 2003;60:39–47.
6. WHO, 2000, General Guidlines for Methodology on Research and Evaluation of
Traditional Medicine, WHO, Genewa
7. WHO, 2002, WHO Traditional Medicine Strategy 2002-2005, WHO, Geneva
8. Wong HY, Mayer EA. Gastrointestinal pain. In: McMahon S, Koltzenburg M, eds. Wall
and Melzack textbook of pain. 5th ed. New York: Elsevier, 2005.
9. Porges S.W. (2009). The Polyvagal Theory: New Insight int adaptive reactions of the
autonomic nervous system. Clev.Clin J.Med,76 (supl2)
10. Porges S.W. (2011). The Polyvagal Theory, Neurophysiological foundations of emotion,
attachment, communication, self regulation, W.W. Norton & company, New York.

WEEK - 3
LEARNING UNIT 3: METABOLIC SYNDROME AND ITS RELATED DISEASES
Scenario 3
COMMUNITY BASED SCENARIO

keyword: gadget addiction, coping stress, hoax (related to covid-19)

MINI MAPPING METABOLIC SYNDROME
Created by Andreanyta Meliala

Lectures
1. Title : Management of Metabolic Syndrome
Duration : 1 hour
Contents : diagnosis, management, related diseases of a risk factor
2. Title : Diabetes Mellitus (Diagnosis and Management)

Duration : 1 hour
Contents : diagnosis-, management-, and rehabilitation of acute and
complication of DM (ketosis- hiperosmoler, hipoglikemi)
3. Title : Complication of Diabetes Mellitus

Duration : 1 hour
Contents : Complication of Diabetes Mellitus
4. Title : Stroke
Duration : 1 hour
Contents : management, prevention and rehabilitation of stroke
5. Title : Dietary (clinical nutrition) of chronic diseases

Duration : 1 hour
Contents : dietary managemen for liver , renal, diabetes disease
6. Title : Management of Obesity in Adult

Department : Health and Nutrition
Duration : 1 hour
Contents : prevention- and body weight management of adolescent-
adulthood obesity
7. Title : Obesity in children

Department : Pediatric
Duration : 1 hour
Contents : epidemiology-, management-, prevention of children obesity
8. Title : Eating disorders (anoreksia nervosa, bulimia, pica)

Duration : 1 hour
Content : diagnosis-, management-, prevention of Eating disorders
(anoreksia nervosa, bulimia, pica)
9. Title : Management (diagnosis & treatment) of Coronary Artery

Diseases
Department : Internal Medicine Cardiology
Duration : 1 hour
Content : diagnosis, management, of cardiac diseases

10. Title : Prevention and Rehabilitation of Cardiac Diseases
Department : Internal Medicine Cardiology
Duration : 1 hour
Content : prevention and rehabilitation of cardiac diseases
11. Title : Gout, hyperurisemia, osteroporosis

Duration : 1 hour
Content : diagnosis-, managemen-, prevention -Gout, hyperurisemia,
osteroporosis
Practical sessions
1. Title : Dietary Program
Department : BEPH
Duration : 2 hours
BCCT
Title : Apusan Bakteri Tahan Asam (AFB)
Duration : 2 hours
Department : Microbiology
Time allocation
Tutorial : 4 hours
Lecture : 11 hours
Practical Session : 2 hours
BCCT : 2 hours
Total : 19 hours
Learning
References
1. American Diabetes Association. 2008. Standards of Medical Care in Diabetes. Diabetes
Care, Vol 31, Suppl 1, January.
2. Apridonidze T., Essah P.A., Iuorno M.J., Nestler J.E., 2004. Prevalence and
characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J
Clin Endocrinol Metab, 90:1929 –1935.
3. Franklin B.A., Kahn J.K., Gordon N..F, Bonow R.O., 2004. A cardioprotective “polypill”?
Independent and additive benefits of lifestyle modification. Am J Cardiol, 94:162–166.
4. Grundy S.M., Cleeman J.I., Daniels S.R., Donato K.A., Eckel R.H., Franklyn B.A.,
Gordon D.J., Krauss R.M., Savage P.J., Smith S.C., Spertus J.A., Costa F., 2005.
Diagnosis and Management of the Metabolic Syndrome: An American Heart
Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation,
112;2735-52.
5. Henry's Clinical Diagnosis and Management by Laboratory Methods, twenty-first
Edition. Edited by Richard A. Mc Pherson. Matthew R. Pincus
6. Mine Y, Miyashita K, Shahidi F. Nutrigenomics and Proteomics in Health and Disease
Food Factors and Gene Interactions. 2009. Wiley-Blackwell, USA.
7. PERKENI, 2011, Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di
Indonesia, PB Perkeni, Jakarta, Indonesia.
8. Rimbach G, Fuchs J, Packer L. Nutrigenomics. 2005 CRC Press. Boca Raton.
9. Sunarti. Interaksi polimorfisme genetic metilentetrahidrofolat reduktase dan metabolism
folat pada hipertensi esensial. 2007. Program Doktor Ilmu Kedokteran dan Kesehatan,
Fakultas Kedokteran, Universitas Gadjah Mada, Yogyakarta

10. International Diabetes Federation: The IDF consensus worldwide definition of the
metabolic syndrome, http://www.idf.org/metabolic-syndrome
11. Kaur, J. A Comprehensive Review on Metabolic Syndrome, Cardiology Research and
Practice Volume 2014
12. Balkau B1, Valensi P, Eschwège E, Slama G.A review of the metabolic syndrome,
Diabetes Metab. 2007 Dec;33(6):405-13

WEEK - 4
LEARNING UNIT 4: ADDICTION, HIV, STI
Scenario 4
Vaginal discharge (Multilevel Scenario)
Lectures
1. Title : Substance Related Disorders
Duration : 1 hours
Contents : Addiction and Substance Abuse (3A)
2. Title : Diagnosis and Management NPS (New Psychoactive Substance)

Use Disorder
Duration : 1 hour
Contents : diagnosis-, management-, prevention of New Psychoactive
Substance Addiction
3. Title : Pharmacological of addictive drugs

Department : Pharmacology
Duration : 1 hour
Contents : Pharmacological of addictive drugs
4. Title : Human Immunodeficiency Virus (HIV) / Acquired Immunedeficiency

Syndrome (AIDS)
Duration : 1 hour
Contents : Testing & Counseling HIV, Opportunistic Infections, Clinical Staging
of HIV, management of HIV, including Prevention of HIV and
Antiretroviral Therapy
5. Title : Comprehensive Management of HIV Infections

Duration : 1 hour
Contents : Tuberculosis in HIV patients
6. Title : Counseling in HIV

Department : HIV Team dr. Sardjito Hospital
Duration : 1 hour
Content : Counseling in HIV
7. Title : Syndrome of Genital Discharge

Department : Dermato and Venerology
Duration : 1 hour
Content : Vaginal & urethral discharge: introduction into sexually transmitted
diseases, patomechanism of STI, epidemiology of STI, syndromic
approach and syndromic management in STI
8. Title : Syndroma of Genital Ulcer

Duration : 1 hour

Content : Genital ulcer: introduction into sexually transmitted diseases,
patomechanism of STI, epidemiology of STI, syndromic approach
and syndromic management in STI
9. Title : Syndrom of scrotal swelling & vegetation

Duration : 1 hour
Content : diagnosis -, management-, prevention of STD etc.
10. Title : STD-HIV

Duration : 1 hour
Content : diagnosis -, management-, prevention of STD etc.
11. Title : STD and complication

Department : Obsgyn
Duration : 1 hour
Contents : salpingitis, abses tubo-ovarial abces, pelvic inflamatory disease
12. Title : Covid-19 Pandemic & Corona virus related disease (Covid-19)
Duration : 1 hour
Contents : Covid-19 Pandemic & Corona virus related disease (Covid-19)
13. Title : Standard & Transmission Based Precaution

Duration : 1 hour
Contents : Prevention and Control Of Infectious Diseases (Standard &
Transmission Based)
14. Title : Public Health Management of Covid-19

Department : BEPH
Duration : 1 hour
Contents : Epidemiology, Surveillance (risk factor - whole genome), Contact
Tracing Related to Covid-19 Pandemic, and Recording & Reporting
15. Title : Secondary Prevention in Infectious Diseases

Department : Guest Lecture
Duration : 1 hour
Contents : Secondary Prevention in Infectious Diseases (including vaccine)
Panel discussion
Title : Lifestyle Related Non Communicable Diseases
Lecturer : Block Coordinators Team
BEPH
Psychiatry
Physiology
Duration : 2 hours

BCCT
Title : Sexually Transmitted Diseases
Examination
Duration : 2 hour
Time allocation
Tutorial : 4 hours
Lecture : 15 hours
Panel Discussion : 2 hours
BCCT : 2 hours
Total : 23 hours
learning
References
1. A New Target for Tumor Therapy. Rakesh K. Jain, Ph.D. N Engl J Med 360;25: pg 269-
71.
2. Berkowitz AD. Applying the Social Norms Approach to Sexual Health & Sexual Assault
Prevention. The Peer ducator. November 2003. http://www.bacchusgamma.org/
pdf/PE/PE1103.pdf
3. Blume S B, Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment, 5th
ed. Am J Psychiatry 157:1894-1895, November 2000
4. Diamond D, Blatt S.J, Lichtenberg J D, Attachment and Sexuality, Psychoanalytic
Inquiry Book Series, The Analytic Press, New York, 2007, Vol 21
5. Drug Abuse and Dependencehttp://health.nytimes.com/health/guides/disease/drug-
abuse-and-dependence/overview.html
6. Guideline for the treatment of drug ddiction. http://www.drstp.drugeducation.com/
PDF/EstoniaSummaryEnglish.pdf acces in Feb.2010
7. Guideline for treatment Sexually Transmitted Infection. World Health Organization. 2003
8. Human sexual behavior. http://www2hu berlin.de/sexology/ ATLAS_EN/html/human_
sexual_behavior.html. accesed Feb 2010.
9. Induction Chemotherapy Followed by Concomitant Chemoradiotherapy for Non-Small
Cell Lung Cancer, Vokes EE The Oncologist 2001;6(suppl 1):25-27
10. Michael B. Rubens and Simon P. G. Padley. Tumors of the lung, Text Book of
Diagnostioc and Imaging volume1. Ed. David Sutton,Churchil Livingstone 2008
11. Mok TS, Wu Y-L, Thongprasert S, et al. Gefitinib or carboplatin–paclitaxel in pulmonary
adenocarcinoma. N Engl J Med 2009;361:947-57.
12. Preoperative Staging of Lung Cancer with Combined PET–CT. Fischer, B et al N Engl J
Med 2009;361:32-9.
13. Recent Clinical Trials in Non-Small Cell Lung Cancer. Suresh Ramalingam and
Chandra P. Belani. Current Cancer Therapy Reviews, 2006, 2, 81-99 81
14. Salvage Therapy for Advanced Non-Small Cell Lung Cancer: Factors Influencing
Treatment Selection. Suresh Ramalingam and Alan B. Sandler. Oncologist
2006;11;655-665
15. Silvia Ubillos, Darío Paez and José Luis González. Culture and sexual behavior.
http://www.psicothema.com/pdf/399.pdf. Psicothema 2000. Vol. 12, Supl., pp. 70-82
16. Simon Padley Sharyn L.S. MacDonald CHAPTER 18 – Pulmonary Neoplasms. Adam:
Grainger & Allison's Diagnostic Radiology, 5th ed.Churchil livingstone 2008
17. Travis, et al. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and
Heart. 2004. World Health Organization (WHO) Classification of Tumors. IARC Press.

18. Treatment of extensive-stage small cell lung carcinoma: current status and future
prospects.I.K. Demedts, K.Y. Vermaelen and J.P. van Meerbeeck. Eur Respir J 2010;
35: 202–215
19. Update on Second-Line Treatment Options in Advanced NSCLC: Cytotoxic and
Targeted Therapies. Biomarkers in Advanced NSCLC: Predicting Response to Second-
Line EGFR TKI Therapy. Thomas Lynch. www.peerviewpress.com/d/r385
20. WHO 2006 Report on Cancer Epidemiology
21. Galante, M; Kleber, HD; Brady, KT. 2015. Textbook of Substance Abuse Treatment, 5th
ed, The American Psychiatric Publishing, Washington DC.
22. Schuckit, MA: 2006. Drug and Alcohol Abuse, 6th ed, Springer, San Diego, CA.
23. American Psychiatric Association (APA). 2013. Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), 6th ed, Springer, San Diego, CA.

WEEK - 5
LEARNING UNIT 5: MALIGNANCY
Scenario 5
Cachexia (Multilevel Scenario)
Lectures
1. Title : Lifestyle and malignancy
Duration : 1 hour
Contents : epidemiology, prevention, management of lifestyle related
malignancy
2. Title : Lung Cancer

Duration : 1 hour
Contents : diagnosis, management, rehabilitation, paliative care
3. Title : Colorectal Cancer

Department Internal Medicine
Duration : 1 hours
Contents : diagnosis, management, rehabilitation, paliative care
4. Title : Radiotherapy
Department : Radiology
Duration : 1 hour
Contents : Radio imaging of malignancy etc.
5. Title : Modern Culture Bound Syndrome and Behaviour Addiction

Duration : 1 hour
Contents : diagnosis-, management-, prevention of Modern Culture Bound
Syndrome; behaviour addiction
6. Title : Adjustment Disorders (include PTSD)

Duration : 1 hour
Contents : Epidemiology-, diagnosis-, Management-, prevention of
Adjustment Disorders (include PTSD)
7. Title : Imaging of malignancy

Department : Radiology
Duration : 1 hour
Contents : Imaging of malignancy
Practical Session
1. Title : Glucose Test (GOD-PAP Method), Glucose Challenge Test, Oral
Glucose Tolerance Test, Ketone Bodies –Rothera’s Test, HbA1c
Test & Calcium and Phospate Test
Department : Clinical Pathology
Duration : 2 hours

BCCT
1. Title : Advance Radiology and Emergency
Duration : 2 hours
Time allocation
Tutorial : 4 hours
Lecture : 7 hours
Practical Session : 2 hours
BCCT : 2 hours
Total : 15 hours
Learning
References
1. Linda Feldman , Linda Shortt , Philippa Holowaty , Bart Harvey , Alykhan Jamal and
Katherine Rannie, 1997. A Comparison of the Demographic, Lifestyle and Sexual
Behaviour Characteristics of Virgin and Non-Virgin Adolescents The Canadian Journal
of Human Sexuality, Vol. 6
2. Definitions Related to the Use of Opioids for the Treatment of Pain. 2001.
http://www.painmed.org/pdf/definition.pdf. A consensus document from the American
Academy of Pain Medicine, the American Pain Society,and the American Society of
Addiction Medicine.
3. Human sexual behavior. http://www2hu berlin.de/sexology/ ATLAS_EN/html/human_
sexual_behavior.html. accesed Feb 2010.
4. Silvia Ubillos, Darío Paez and José Luis González. Culture and sexual behavior.
http://www.psicothema.com/pdf/399.pdf. Psicothema 2000. Vol. 12, Supl., pp. 70-82
5. Berkowitz AD. Applying the Social Norms Approach to Sexual Health & Sexual Assault
Prevention. The Peer ducator. November 2003. http://www.bacchusgamma.org/
pdf/PE/PE1103.pdf
6. Diamond D, Blatt S.J, Lichtenberg J D, Attachment and Sexuality, Psychoanalytic
Inquiry Book Series, The Analytic Press, New York, 2007, Vol 21
7. Djuanda A, Djuanda S, Hamzah M, Aisah S (eds) Penyakit Kelamin : Ilmu Penyakit Kulit
dan Kelamin.. FKUI. Edisi 2. 1993 p 301- 352
8. Drug Abuse and Dependence http://health.nytimes.com/health/guides/disease/drug-
abuse-and-dependence/overview.html
9. Opioid Abuse. Meehan, WJ http://emedicine.medscape.com/article/287790-overview
10. Brannon GE, History and Mental Status Examination http://emedicine.medscape.com/
article/293402-overview
11. Blume S B, Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment, 5th
ed. Am J Psychiatry 157:1894-1895, November 2000
12. Guideline for treatment Sexually Transmitted Infection. World Health Organization. 2003
13. Guideline for the treatment of drug ddiction. http://www.drstp.drugeducation.com/
PDF/EstoniaSummaryEnglish.pdf acces in Feb.2010
14. Fairburn C.G, Cooper Z., O’Connor, 2008, Eating Disorder Examination. In
FairburC.G.,Cognitive Behavior therapy and Eating Disorder, Guilford Press. New York
2008.
15. Hudsonahttp://www.journals.elsevierhealth.com/periodicals/bps/article/S0006-
3223%2806%2900474-4/abstract - cor1 James I., Eva Hiripib, Harrison G. Pope Jr.a,
Ronald C. Kesslerb, 2007, The Prevalence and Correlates of Eating Disorders in the
National Comorbidity Survey Replication, Society of Biological Psychiatry. Published by
Elsevier Inc Volume 61, Issue 3, Pages 348-358 (1 February 2007
16. Ipsen Angela, 2005, Eating Disorders: The Damage Seen and Unseen. Internet
resource available at URL:www.tiu.edu/cmx/seniors04/Ipsen.pdf. Copyright 2005
17. Kaplan, H.I., & Sadock, B.J. Comprehensive Textbook of Psychiatry, 7th ed. Williams .&
Wilkins, Baltimore, 2000.

18. National Institute for Clinical Excellence (NICE), 2004, Eating disorders : anorexia
nervosa, bulimia nervosa and related eating disorders, ISBN : 1-84257-497-3
19. Sadock, VA, Sadock BJ, 2007. Kaplan and Sadock’s Synopsis of Psychiatry, 10th Ed.
Philadelphia: Lippincott, Williams and Wilkins
20. Yager J., Devlin MJ., Halmi KA., Herzog DB, Mitchell JE., Powers PS., Zerbe KJ., 2005,
Eating Disorders, Focus The Journal of Lifelong Learning In Psychiatry, Vol 3 no 4 : 503-
510, American Psychiatric Association

PRACTICAL GUIDE
DEPARTMENT OF PHYSIOLOGY
Physical Fitness Test

P.O Astrand Method
Introduction
An aerobic capacitys highly expressing the ability to do activities for daily living (ADL),
which further very important in maintaining a healthy lifestyle. Aerobic capacity can be
measured by calculating the amount of oxygen required (VO2) in ml/kg/minute.
Aerobic capacity reflects the function-ability of the heart, blood, lungs, musclesto transport
and utilize O2 via the aerobic metabolic pathways; determining a person’s level of cardio-
respiratory fitness, has therefore both general and clinical applications.
To overcome the difficulties in performing a direct test, indirect measurement for VO2max
had been devised. There are several standarized test, i.e the Harvard Step Test, the Astrand
Bike Test, Physical Working Capacity (Exp: PWC-170), Young Men's Christian Association
(YMCA) Protocol and so on. These are called sub-maximal exercise-stress test and are based
on the linear relationship between heart rate (HR) and VO2.
Material
1. Bicycle Ergometer
2. Stethoscope
3. Sphygmomanometer
4. Electrocardiograph (ECG)
5. Metronome
6. Stopwatch
Procedure
1. Subject’s last meal at least 2,5 hour before test.
2. Measure body weight and examine the physical condition.
3. Record ECG in rest condition.
4. Subject sits on the Bicycle Ergometer; adjust the bike’s seat to the leg subject.
5. Place the chest electrode on the locations of V4, V5 and V6 and the extremities leads
place on the posterior thorax at the same level of precordial leads (V4, V5 and V6) and
using the rubber electrode strap.
6. Set the metronome at: 100
7. Set the work load started at number 1 (300 Kpm)
8. Subject start to pedal the bike as the metronome rhythm 50/ minute for 6 minutes.
9. In each stage, increasetheworkloadevery 6 minutes if a steady state has been reached,
formalesubject 300 Kpm (300, 600, 900 Kpmandsoon), forfemalesubject 150 Kpm (300,
450, 600, 750 Kpm).
10. Stop the pedal test if:
a. Heart rate reach 170 beat per minute, or
b. The subject feel tired,
c. Experience headache, dizzy, giddiness, faintness, etc
11. Measure the blood pressure and repeat every 5 minutes.
12. Record the heart rate and repeat every 1 minuteby using ECG.
Formulation
1. Enter the data according to the table 1 (men) or table 2 (woman) and read the maximal
O2 up take in liters/ minute for the mean heart rate achieved in two last minutes of the
last stage.
2. Matched with correction factor based on age (table 3)
3. Maximal O2 uptake (in ml/ minute) is divided by body weight in kilograms and the final
score on the test is expressed as ml O2/ kg/ minute.
4. Physical fitness level is measured according to Astrand (table 4).

Example Formulation:
Heart rate frequency used in this session is the last two minutes heart rate before
the paddle is stopped due to any reason.
Heartrate at the last two minutes is : n = 168

n-1 = 160
total = 328
mean frequency = 328/ 2 = 164
Load that can be achieved: 900 kpm (male)
From the Astrand table, the result = 2.7 L/min or 2,700 ml/min.
Matched withcorrection factor basedon age, i.e aged 18 years, the
resultcorrection factor: 1.10.
So the calculated VO2 max is 2,700 x 1.10 ml / min = 2,970 ml/min.
Simulated patient’s body weight = 50 kg, so VO2 max = 2,970 ml/min = 56,6 ml/kg/min
50 kg
If his physical fitness level is measured according toAstrand,

thenthe maximum aerobic power is very high.

Table 1.
Prediction of Maximal Oxygen Uptake from Heart Rate and
Work Load on Bicycle Ergometer
Applicable to men. The value should be corrected for age, using the factor given in Table 3.
Maximal Oxygen Uptake Liters/ min Maximal Oxygen Uptake Liters/ min
Heart 300 600 900 1200 1500 Heart 300 600 900 1200 1500
Rate kpm/ kpm/ kpm/ kpm/ kpm/ Rate kpm/ kpm/ kpm/ kpm/ kpm/
min. min. min. min. min. min. min. min. min. min.
120 2.2 3.5 4.8 148 2.4 3.2 4.3 5.4
121 2.2 3.4 4.7 149 2.3 3.2 4.3 5.4
122 2.2 3.4 4.6 150 2.3 3.2 4.2 5.3
123 2.1 3.4 4.6 151 2.3 3.1 4.2 5.2
124 2.1 3.3 4.5 6.0 152 2.3 3.1 4.1 5.2
125 2.0 3.2 4.4 5.9 153 2.2 3.0 4.1 5.1
126 2.0 3.2 4.4 5.8 154 2.2 3.0 4.0 5.1
127 2.0 3.1 4.3 5.7 155 2.2 3.0 4.0 5.0
128 2.0 3.1 4.2 5.6 156 2.2 2.9 4.0 5.0
129 1.9 3.0 4.2 5.6 157 2.1 2.9 3.9 4.9
130 1.9 3.0 4.1 5.5 158 2.1 2.9 3.9 4.9
131 1.9 2.9 4.0 5.4 159 2.1 2.8 3.8 4.8
132 1.8 2.9 4.0 5.3 160 2.1 2.8 3.8 4.8
133 1.8 2.8 3.9 5.3 161 2.0 2.8 3.7 4.7
134 1.8 2.8 3.9 5.2 162 2.0 2.8 3.7 4.6
135 1.7 2.8 3.8 5.1 163 2.0 2.8 3.7 4.6
136 1.7 2.7 3.8 5.0 164 2.0 2.7 3.6 4.5
137 1.7 2.7 3.7 5.0 165 2.0 2.7 3.6 4.5
138 1.6 2.7 3.7 4.9 166 1.9 2.7 3.6 4.5
139 1.6 2.6 3.6 4.8 167 1.9 2.6 3.5 4.4
140 1.6 2.6 3.6 4.8 6.0 168 1.9 2.6 3.5 4.4
141 2.6 3.5 4.7 5.9 169 1.9 2.6 3.5 4.3
142 2.5 3.5 4.6 5.8 170 1.8 2.6 3.4 4.3
143 2.5 3.4 4.6 5.7
144 2.5 3.4 4.5 5.7
145 2.4 3.4 4.5 5.6
146 2.4 3.3 4.4 5.6
147 2.4 3.3 4.4 5.5

Table 2.
Prediction of Maximal Oxygen Uptake from Heart Rate and
Work Load on Bicycle Ergometer
Applicable to woman. The value should be corrected for age, using the factor given in Table
3.
Maximal Oxygen Uptake Liters/ min Maximal Oxygen Uptake Liters/ min
Heart 300 450 600 750 900 Heart 300 450 600 750 900
Rate kpm/ kpm/ kpm/ kpm/ kpm/ Rate kpm/ kpm/ kpm/ kpm/ kpm/
min. min. min. min. min. min. min. min. min. min.
120 2.6 3.4 4.1 4.8 148 1.6 2.1 2.6 3.1 3.6
121 2.5 3.3 4.0 4.8 149 2.1 2.6 3.0 3.5
122 2.5 3.2 3.9 4.7 150 2.0 2.5 3.0 3.5
123 2.4 3.1 3.9 4.6 151 2.0 2.5 3.0 3.4
124 2.4 3.1 3.8 4.5 152 2.0 2.5 2.9 3.4
125 2.3 3.0 3.7 4.4 153 2.0 2.4 2.9 3.3
126 2.3 3.0 3.6 4.3 154 2.0 2.4 2.8 3.3
127 2.2 2.9 3.5 4.2 155 1.9 2.4 2.8 3.2
128 2.2 2.8 3.5 4.2 4.8 156 1.9 2.3 2.8 3.2
129 2.2 2.8 3.4 4.1 4.8 157 1.9 2.3 2.7 3.2
130 2.1 2.7 3.4 4.0 4.7 158 1.8 2.3 2.7 3.1
131 2.1 2.7 3.4 4.0 4.6 159 1.8 2.2 2.7 3.1
132 2.0 2.7 3.3 3.9 4.5 160 1.8 2.2 2.6 3.0
133 2.0 2.6 3.2 3.8 4.4 161 1.8 2.2 2.6 3.0
134 2.0 2.6 3.2 3.8 4.4 162 1.8 2.2 2.6 3.0
135 2.0 2.6 3.1 3.7 4.3 163 1.7 2.2 2.6 2.9
136 1.9 2.5 3.1 3.6 4.2 164 1.7 2.1 2.5 2.9
137 1.9 2.5 3.0 3.6 4.2 165 1.7 2.1 2.5 2.9
138 1.8 2.4 3.0 3.5 4.1 166 1.7 2.1 2.5 2.8
139 1.8 2.4 2.9 3.5 4.0 167 1.6 2.1 2.4 2.8
140 1.8 2.4 2.8 3.4 4.0 168 1.6 2.0 2.4 2.8
141 1.8 2.3 2.8 3.4 3.9 169 1.6 2.0 2.4 2.8
142 1.7 2.3 2.8 3.3 3.9 170 1.6 2.0 2.4 2.7
143 1.7 2.2 2.7 3.3 3.8
144 1.7 2.2 2.7 3.2 3.8
145 1.6 2.2 2.7 3.2 3.7
146 1.6 2.2 2.6 3.2 3.7
147 1.6 2.1 2.6 3.1 3.6
Table 3.
Age Correction Factors

Table 4.
Norms for Maximum 02 Consumption (Aerobic Working Capacity)
WOMEN
Age Low Fair Average Good High
20-29 1.69 1.70-1.99 2.00-2.49 2.50-2.79 2.80+
28 29-34 35-43 44-48 49+
30-39 1.59 1.60-189 1.90-2.39 2.40-2.69 2.70+
27 28-33 34-41 42-47 48+
40-49 1.49 1.50-1.79 1.80-2.29 2.30-2.59 2.60+
25 26-31 32-40 41-45 42+
50-65 1.29 1.30-1.59 1.60-2.09 2.10-2.39 2.40+
21 22-28 29-36 37-41 42+
MEN
Age Low Fair Average Good High
20-29 2.79 2.80-3.09 3.10-3.69 3.70-3.99 4.00+
38 39-43 44-51 52-56 57+
30-39 2.49 2.50-2.79 2.80-3.39 3.40-3.69 3.70+
34 35-39 40-47 48-51 52+
40-49 2.19 2.20-2.49 2.50-3.09 3.10-3.39 3.40+
30 31-35 36-43 44-47 48+
50-59 1.89 1.90-2.19 2.20-2.79 2.80-3.09 3.10+
25 26-31 32-39 40-43 44+
60-69 1.59 1.60-1.89 1.90-2.49 2.50-2.79 2.80+
21 22-26 27-35 36-39 40+
Consumption (Aerobic Working Capacity)

*From Astrand, I., Acta Physiologica Scandinavica, 49 (suppl.169), 1960.
References
1. Astrand, P.O. & Rodahl, K. 1986. Textbook of Work Physiology: Physiological Bases of
Exercise, 3rd ed. McGraw-Hill, New York.
2. Astrand, P.O. Ergometry-test of Physical Fitness. Monark AB, Sweden.
3. Anonim, 1985. Petunjuk Tehnis Kesehatan Olahraga. Dep.Kes., Jakarta.

REPORT IN INDIRECT MEASUREMENT OF VO2 MAX
Group:
Students name:
Students number:
Sex:
Date of practical:
Name of probandus:
Date of birth/ age:
Sex:
Height:
Weight:
Time ECG during loading Blood

Work Load Heartrate Notes
(minutes) periode Pressure
Pretest (sits
on bicycle)
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
Workload to calculate maximum oxygen intake :......................................... pm/minute

Mean of heartrate in the last 2 minutes in mentioned workload : ......................................
times/minute
Maximum oxygen intake (prior to correction) :............................................L/minute
Age factor correction............. years-old :.............................................
Body weight : ...............................................kg
Maximum oxygen intake :..........L/minute:............ml/kg/minute
Classification : ................................(Astrand)

Description :
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Yogyakarta,.................................
Signature
Instructor Students,
(…………………………) (…………………………)

GRADED EXERCISE STRESS TEST
Aerobic activities, include walking, running, jogging, swimming, aerobic dancing, cycling,
are best suited to improving the efficiency of the heart and the vital capacity of the lungs. To
qualify as aerobic, an activity must be of sufficient duration to require oxygen consumption.
Any rhythmic activity that uses large muscle groups and can be maintained for an extended
period of time will increase the body's cardiovascular endurance if performed regularly. The
training effect of exercise depends on four variables: frequency (how often a person exercises);
intensity (how strenuously or, insome cases, at what speed); time (duration, how long);and
type (mode of exercise).
Graded exercise stress test is generally used for three main purposes:1) Measurement of
aerobic capacity 2) ECG observations and 3) evaluation the adequacy of physiologic
adjustments to metabolic demands that exceed the resting requirement. A stress test is
performed to assess how the heart responds to the demands of physical activity. It can help to
diagnose heart problems especially blockages in the coronary arteries that may not be
apparent when your heart is at rest. The inability of blood pressure to increase with exercise
can also reflect cardiovascular malfunction.
There are many different stress test protocols. The test can be a single-stage test such as
the Master two-step, or multistage test: bicycle and treadmill test. These tests are graded in
terms of physical work. Subject will start exercising on either a treadmill or stationary bicycle
at a low level of exercise. At specified lengths of time, the difficulty of the exercise is increased
by small amounts or in a step-like manner.
AIMS:
- to understand the physiological prosses during the exercise
- to observe the possible presence of heart function abnormalities during the exercise
- to know graded exercise stress protocol for aerobic capacity measurement
MATERIAL
1. Electrocardiograph
2. Stethoscope
3. Sphygmomanometer
4. Bicycle ergometer
5. Metronome
6. Electrode jelly
7. Rubber electrode strap
8. Stopwatch
PROCEDURE
1. Record the electrocardiogram and measure the blood pressure (at rest)
2. Seat the subject, place the 12 electrodes.
3. While the subject is seated, plug the input cable from the electrodes into the
electrocardiograph. Record the electrocardiogram.
4. The metronome should be set to make exactly 100 beats per minute. Have the subject
exercise either by pedaling the bicycle ergometer at 25 Watts. Continue the exercise task
for two minutes, and increase the load 25 Watts every two minutes until reaching maximal
exhaustion.
5. Measure the blood pressure every two minutes.
6. Record the electrocardiogram during the final ten secondo each minute. If at any time the
S-T segment deviated more than two small squares from the base line, or the T-wave
becomes negative, immediately discontinue the exercise. If the record very poor during
exercise, have the subject cease activity for the final ten seconds for each minute of exercise
and record the electrocardiogram under that condition. Marked the record so that each of
the exercise electrocardiograms can be differentiated.

7. The following guideline should be used for stopping a stress test:
a. Repeated presence of premature ventricular contraction (PVCs)
b. Progressive angina pain
c. Presence of S-T segment depression of2.00 mm or more
d. An extremely rapid increase in heart rate
e. Failure of heart rate or blood pressure to increase with progressive exercise or
progressive drop in systolic blood pressure with increasing work load
f. An increase in diastolic pressure of 20 mmHg or more, or rise above 110 mmHg
g. Headache, blurres vision, pale, clammy skin, faintness or extreme breathlessness.
Normogram for body surface area estimation
Height Body Weight

Surface
Area
Align the straight edge so it intersects at the subject’s height and weight. Doing so will create
an intersection in the body surface area scale.

Prediction of VO2max using exercise stress test based on body surface area

References
1. Astrand, P., Rodahl,K., Dahl. and Stromme, S.B., 2003, Textbook of Work Physiology ,
Physiological Bases of Exercise, Fourth Edition, Mc Graw Hill.
2. deVreis H.A, 1972, Laboratory Experiments in Physiology ofExercise, WM.C. Brown
Company
3. McArdle, W.D., Kath, F.I., Kath, V.L., 1986,Exercise Physiology , Second edition,
Philadelphia
4. Sofro, Z.M., 1999, Aplikasi Fisiologi Latihan Pada latihan Fisik, Fakultas Kedokteran
Universitas Gadjah Mada
5. Wackers, F.J., 1992, Heart Book: Exercise, Yale University School of Medicine, p: 85-94
6. Zauner, C.W., Stainsby, W.N. and Kaplan, H.M., 1972, Laboratory Experiments in Exercise
Physiology,Prencise Hall Inc

ERGOMETRY
Name: ……………………………………..
Age : ……………… ,Weigth (Kg) : …….. Height (CM): ………
Drugs used: ………………………………………
Rest E.K.G:
Blood Pressure EKG (rhythm,

Load (Watt) HR AP Symptom
Systolic. Diastolic. ES, ST. T)
Recorvery:
0
1
2
3
Conclusion:
Yogyakarta,.................................
Signature
Instructor Students,
(...............................)(...............................)

PANEL DISCUSSION GUIDE
DEPARTMENT OF PHYSIOLOGY
Physical Activity Level and Motivation Assesment
Introduction
Physical activity is an independent and important behavior factor for maintaining health
and well-being. However, almost one in three adults are not engaging in a recommended
amount of physical activity. Moreover, almost half of university students are lack of physical
activity. Since individuals will be more motivated to engage in physical activity if they are self-
determined, it is important to improve people’s intrinsic motivation toward physical activity. The
Global Physical Activity Questionnaire (GPAQ) and The Behavioural Regulations in Exercise
Questionnaire (BREQ-3) are feasible, acceptable and easy-to-implement tools for monitoring
physical activity and motivation level to evaluate the effectiveness of physical activity
intervention.
Material
1. Self-administered GPAQ
2. Self-administered BREQ-3
Procedure
1. Each student assess his/her own physical activity and motivation level before taking Block
C.6 and after taking Block C.6
2. To assess physical activity and motivation level before taking Block C.6, each student fills
the online form on June 11, 2020. The online form can be accessed at
https://forms.gle/DKJeqFf7XfJwrGa79. Having completed the form, individual data can be
accessed at https://rebrand.ly/before-taking-C6
3. To assess physical activity and motivation level after taking Block C.6 , each student fills the
online form on July 1, 2020. The online form can be accessed at
https://forms.gle/u57TppH49mtEkrin6. Having completed the form, individual data at
https://rebrand.ly/after-taking-C6
4. Observe and discuss your group’s level and change in physical activity and relative
autonomy index before and after taking Block C.6
Note:
- Meeting physical activity recommendation if total physical activity  600 MET.minutes
- The relative autonomy index is positively associated with the level of self-determination to
engage in physical activity.

PHYSICAL ACTIVITY LEVEL AND MOTIVATION REPORT
Programme:
Group:
Before taking Block After taking Block
C.6 C.6
Student Physical Activity Relative Physical Activity Relative
number (METs.minutes) autonomy (METs.minutes) autonomy
index index
Group
Average

Autonomic Function
Introduction
The autonomic function has been proposed to be an early predictor of health and
wellbeing. Its role as a predictor could be explained by the role of the autonomic nervous
system in regulating several physiologic processes. Schellong test is the active standing test
for assessing autonomic function by measuring heart rate and blood pressure. Either heart rate
alone, blood pressure alone, or a combination of both heart rate and blood pressure could
represent the autonomic function.
Material
Stop watch
Procedure
1. Conduct the Schellong test in the morning before getting out of bed
2. Lie down in a relaxed supine position for 5 minutes
3. Having lied down for 5 minutes, count resting heart rate in 10 seconds. Convert the heart
rate into beats per minute (Resting HR).
4. Having measured resting heart rate, stand up immediately. After standing up for 1 minute,
record heart rate in 10 seconds, then covert it into beats per minute (Standing HR).
5. Calculate the difference between Standing HR and Resting HR
6. Conduct the Schellong test 3 consecutive days before June 11, 2020 and 3 consecutive
days before July 1, 2020
7. Calculate the average of 3 days’ results and fill them into the online forms at
https://forms.gle/DKJeqFf7XfJwrGa79 (June 11, 2020) and
https://forms.gle/u57TppH49mtEkrin6 (July 1, 2020)
Note:
- Twenty beats or below in heart rate difference between two positions represents a healthy
autonomic function

AUTONOMIC FUNCTION REPORT
Programme:
Group:
Before taking Block C.6 After taking Block C.6
Student Day I Day II Day I Day I Day II Day I
Number
Resting Schellong Resting Schellong Resting Schellong Resting Schellong Resting Schellong Resting Schellong
Heart Test Heart Test Heart Test Heart Test Heart Test Heart Test
Rate (A) Rate (A) Rate (A) Rate (A) Rate (A) Rate (A)
Stan Stan Stan Stan Stan Stan
ding ding ding ding ding ding
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)
B-A B-A B-A B-A B-A B-A
Average Resting Heart Rate Average Resting Heart Rate
Average Difference in Schellong Test Average Difference in Schellong Test

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)

Number
HR HR HR HR HR HR
(B) (B) (B) (B) (B) (B)
Group Average Resting Heart Rate Average Resting Heart Rate

Average

PRACTICAL GUIDE
DEPARTMENT OF BIOSTATISTICS, EPIDEMIOLOGY AND POPULATION HEALTH
(Lastdes Cristiany Friday, S.Gz, MPH)
NUTRITIONAL ASSESSMENT
This flow chart helps you to understand this topic better
Anthropometrical data: Calculating and interpreting BMI

Body weight and body height • Underweight and normal: use actual
body weight
(data from skills lab practice)
• Overweight and obesity: use
adjusted body weight
Calculate total energy expenditure using

these steps:
▪ Calculate basal energy expenditure /
basal metabolic rate using Harris-
Benedict equation (BEE)
▪ Choose physical activity (PA) level
based on your behavior
▪ Calculate total energy expenditure
(TEE)
TEE = BEE x PA
Calculate daily requirement’s portions

based on manual table (excel sheet)
Develop daily menu using leaflet “food

stuffs exchanger / bahan makanan
penukar”
Figure 1.Nutritional Assessment flow chart

An individual’s nutrition status reflects the degree to which physiologic needs for nutrient
are being met. Nutrient intake depends on actual food consumption, which is influenced by
factors such as economic situation, eating behavior, emotional climate, cultural influences,
effects of various disease states on appetite, and the ability to consume and absorb adequate
nutrients. Nutrient requirements are also influenced by many factors, including physiologic
stressors such as infection, acute or chronic disease processes, fever, or trauma; normal
anabolic states of growth such as pregnancy or rehabilitation; body maintenance and well-
being; and psychological stress. The balance between nutrient intake and nutrient
requirements is the nutrition status.
When adequate nutrients are consumed to support the body’s daily needs and any
increased metabolic demands, the person moves into optimal nutrition status. This status
promotes growth and development, maintains general health, supports activities of daily living,
and helps protect the body from disease and illness. Appropriate assessment techniques can
detect a nutritional deficiency in the early stages of development, allowing dietary intake to be
improved through nutrition support and counseling before a more severe condition develops.
A nutrition status assessment should be performed routinely for any individual.
However, the type of assessment for those who are basically healthy differs from assessments
for those who are critically ill. Persons at nutritional risk can be identified on the basis of
screening information that is routinely obtained at the time of admission to a hospital or nursing
home or after returning to home-based care. Information obtained in the nutrition assessment
is used to design an individual nutrition care plan. A thorough nutrition assessment increases
the effectiveness of nutrition intervention, education, and counseling.
Nutrition assessment is a comprehensive evaluation carried out by a registered dietitian
for defining nutrition status using medical, social, nutritional, and medication histories; physical
examination; anthropometric measurement; and laboratory data. Nutrition assessment
involves interpretation of data from the nutrition screen and incorporates additional information.
The purpose of assessment is to gather adequate information in which to make a professional
judgment about nutrition status (ASPEN, 2002). The nutrition assessment is the first step in
the nutrition care process (Lacey, 2003).
Information gathered depends on the particular setting, present health status of the
individual or group, how data is related to particular outcomes, whether it is an initial or follow-
up assessment, and recommended practices (ADA, 2005). Once the nutrition assessment
process is complete and a nutrition diagnosis made, the nutrition plan of care can be
developed. Once interventions are chosen, they can be implemented as tailored for the
appropriate setting (e.g., hospital, clinic, home). The goal of nutrition assessment are to identify

individuals who require aggressive nutrition support, restore or maintain an individual’s nutrition
status, identify appropriate MNT, and monitor the efficacy of these interventions.
Nutritional assessment can be done using the ABCD methods. These refer to the following:
A = Anthropometry
B = Biochemical/biophysical methods
C = Clinical methods
D = Dietary methods.
Energy requirement calculationfor a person with normal BMI using an actual body
weight (weight from measurement). If someone has a lower BMI (BMI <18.5) the calculation of
its energy requirement using actual body weight. Meanwhile, the calculation of the energy
requirement of a person with excess BMI (BMI ≥23) using adjusted body weight. The formula
for calculating adjusted body weight is as follows:
Adjusted Body weight = {(ABW - IBW) x 0.25} + IBW
ABW = Actual body weight

Normal Weight = (Height-100)
IBW = Ideal body weight = Normal Weight x 90%
CALCULATION OF NUTRIENT REQUIREMENT
Here are the following steps to calculate daily energy requirement:
1. Basal Energy Expenditure (BEE) usingHarris Benedict equation

• Men: 66 + (13.7 x Weight) + (5 x height) – (6 x Age)
• Women: 655 + (9,6 x Weight) + (1.8 x Height) – (4,7 x Age)
• Note: Weight in kg, Height in cm, Age in year
2. Physical activity level

Estimated physical activity level for 19 Years or Older :
Intensity constant
Sedentary (PAL estimatedtobe 1,0 - 1,4) 1.0 – 1.2
Mild / Low Active (PAL estimatedtobe 1,4 – 1,6) 1.2 – 1.4
Moderate / Active (PAL estimatedtobe 1,6 - 1,9) 1.4 – 1.6
Severe / Very Active (PAL estimatedtobe 1,9 – 2,5) 1.6 – 1.9
Source : Institute of Medicine, Food, and Nutrition Board, 2002.

• Estimated energy expenditure (EER) is the average dietary energy intake that is
predicted to maintain energy balance in a healthy adult of a defined age
• Physical activity level (PAL) is the physical activity level that is the ratio of the total energy
expenditure to the basal energy expenditure. PAL is the sum of each constant of each
activity below.
• METs (Metabolic equivalents) are multiples of an individual's resting oxygen
uptakes,defined as the rate of oxygen (O2) consumption of 3.5 ml of O2/min/kg body
weight in adults.
• The ∆ PAL is the allowance made to include the delayed effect of physical activity in
causing excess post-exercise oxygen consumption (EPOC) and the dissipation of some
of the food energy consumed through the thermic effect of food (TEF).
3. Total Energy Expenditure (TEE) = BEE x Physical Activity Level

Arrange a right portion of daily energy requirement into a right calculation for each
macronutrient. Here are the proportions of each macronutrient:
a. Protein Requirement:
• 15% of TEE
• Note: 1 g protein produce 4 kcal
b. Fat Requirement:
• 25% of TEE
• Note: 1 g fat produce 9 kcal
c. Carbohydrate Requirement:
• 60% of TEE
• Note: 1 g carbohydrate produce 4 kcal
Energy Protein Fat Carbohydrate

No
(Kcal) (Gram) (Gram) (Gram)
1. Dailyneed plan
2. TEE
3. % FULFILLMENT
*) use excel table to make a better calculation and attach that result on your report

DEVELOP DAILY MENU BASED ON ENERGY REQUIREMENT
After you know exactly your energy expenditure and macronutrient’s apportionment,
develop daily menu using leaflet contained of household measures and nutritional value of
each food group. A good daily menu is a menu contained 90 - 110% fulfillment of each
macronutrient and having food diversity.
DAILY MENU ACCORDING TO PERSONAL REQUIREMENT
No. Mealtime Menu Householdmeasure Amount Energy Protein Fat Carbo-

(g) hydrate
andingredients (kcal) (g) (g)
(g)
1. Breakfast
2. Mid-daybreak
3. Lunch
4. Afternoonbreak
5. Dinner
6. Endoftheday

REVIEW NUTRIENT INTAKE USING FOOD RECORD
Dietary methods of assessment include looking at current intakes of nutrients from food
by individuals or a group to determine their nutritional status. You can record the foods and
drinks that have eaten in one day and use this data to calculate the dietary diversity
score.Dietary diversity is a measure of the number of food groups consumed over a reference
period, usually 24 hours. Generally, there are six food groups that our body needs to have
every day, which are carbohydrate, animal-based protein, plant-based protein, fruit, sugar and
oil or fat.
Principle
The purpose of the food record is to provide information on the personal exact food intake
during one day.
Stage 1: Record of Foods and drinks consumed

The food record should commence with the first food and/or drink consumed in the morning.
Stage 2: Description of foods and drinks consumed

During this stage, write for more specific descriptions of all the foods and drinks consumed,
including cooking methods and (if possible) brand names.
Stage 3: Estimation of amounts

Quantities can be recorded by the interviewer as volumes such as L, cc or mL, pints, cups,
etc.; or as weights-gram, pounds, ounces, etc. Then convert all amounts to the equivalent
number of grams.
Stage 4: Review the data

At the end, you have to ensure that all the items have been recorded correctly.

References
1. Acheson K.J, Campbell I.T, Edholm O.G, Miller D.S, Stock M.J (1980). The measurement
of food and energy intake in man-an evaluation of same techniques. American Journal of
Clinical Nutrition 33: 1147-1154.
2. American Dietetic Association. 2005. Nutrition Assessment. In ADA Nutrition Care Manual
On-line, Chicago, American Dietetic Association.
3. ASPEN Board of Directors. 2002. Guidelines for the Use of Parenteral and Enteral Nutrition
in Adults and Pediatric Patients,JPEN J Parenter Enteral Nutr, 26(supl l):ISA.
4. Gersovitz M, Madden J.P, Smiciklas-Wright H (1978). Validity of The Twenty-four-hour
DietaryRecall and Seven-day Record for GroupComparisons. Journal of the American
Dietetic Association 73: 48-55.
5. Health and Welfare Canada (1973). Nutrition Canada National Survey. Health and Welfare,
Ottawa.
6. Institute of Medicine, Food and Nutrition Board .2002. Dietary Reference Intakes: for Energy,
Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington
DC, The National Academies Press.
7. Irsan, M., Wahyuningsih, I., & Hasibuan, O. C. (2015). Aplikasi Pedoman Gizi Seimbang
Dan Kalkulator Kesehatan Berbasis Mobile. In Konferensi Nasional Sistem & Informatika
(pp. 9–10). Bali
8. Lacey K, Pritchett E. 2003. Nutrition Care Process and model: ADA Adopts Road Map to
Quality Care and Outcomes Management, J Am Dietetic Assoc 103(8):1061.
9. Mahan LK, Stump SE. 2008. Krause’s Food & Nutrition Therapy 12th ed. Canada, Elsevier.
10. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO (1990). “A new predictive
equation for resting energy expenditure in healthy individuals”. The American Journal of
Clinical Nutrition. 51 (2) :241 – 7.PMID 2305711
11. Rosalind F Gibson, 1993, Nutritional Assessment, a laboratory manual.
12. Samuelson G (1970). An Epidemiological Study of Child health and nutrition in a northern
Swedish county. 2. Methodological study of the recall technique. Nutrition and Metabolism
12: 321-340.

FOOD RECORD FORM
Name :
Day/date of record :
Body weight :
Body height :
TEE :
No. Mealtime Menu Amount of portion Amount Energy Protein Fat Carbo-
andingredients and (g) (kcal) (g) (g) hydrate
Householdmeasure (g)
1. Breakfast
2. Mid-daybreak
3. Lunch
4. Afternoonbreak
5. Dinner
6. Endoftheday

DIETARY PROGRAM (CALCULATION OF NUTRIENT INTAKE)
Principle
Nutrient intakes can be calculated from food consumption data collected by quantitative or
semi-quantitative methods.
In this module, students are expected to use software for calculation of nutrient intake.
NutriSurvey
This software is the friendly-use soft-ware which has function for nutrient analysis
and calculation of energy requirements, planning of diets, diet history, food frequency,
searching of nutrients in foods, handling of recipes, etc. NutriSurvey is the English
translation of a Professional Germany nutrition software (EBISpro). It gives very helpful
information with no expenses (free).
NutriSurvey was developed by Dr. Juergen Erhardt and supported by Dr. Rainer
Gross.The latest version of this softare was updated in 2007. This software can be
downloaded freely in this site http://www.nutrisurvey.de/index.html
Figure 1Nutrisurvey Display

A. Download and Install
1. Download Software Nutrisurvey 2007
• Click http://www.nutrisurvey.de/
• Click Nutrisurvey2007.exe and make sure you know location of the file, type of the
file .exe
• Click link database
• Click link Indonesian and make sure you know location of the file, type of the file .zip
2. Software Installation
• Find location the file and click Nutrisurvey2007.exe
• Click next and wait until the process has been complete
• Click OK – nutrisurvey is ready to use but database still in English (file location: in
C:/)
3. Upload Indonesian Food Database
• Extract file Indonesian
• Copy file INDO.FTA to folder Nutrisurvey 2007
• Open program Nutrisurvey 2007
• Click menu Food
• Click menu Include more foods from other database
• Click menu INDO.FTA then OK – wait until the process is complete
• Click ALL – SAVE – CLOSE – YES
B. Introduction (Nutri-Survey display)
Figure 2Nutrisurvey Display

Figure 2. is the display when you open the program. In this display you can open, edit,
and save your file, modify intake recommendation, make a new recipe, calculate intake
requirement, and modify food data base report using menu bar. You also can see the result in
display of the result- i.e., total nutrient, proportion of each nutrients per 100 grams
You can enter name and amount of food consumption in the worksheet. Enter the name
of the food by typing the name in the ‘Food’ column. Then enter the amount of it in the ‘Amount’
column. So the nutrient ingredient of the food will show automatically in the ‘Food Ingredient
From Each Food’ Section. Here the example on Figure 3.
Figure 3 Display of Entered Name and Amount of Food
Nutrisurvey also provide the button for another function such as insert empty line, in
case you want to insert a new food between the two of entered line. Then delete the content
line bottom for delete the line that already entered the food. There are also buttons available
on program function to show chart of percent fulfillment of the recommended nutrient from the
food record, search the food, choose the selected nutrient to show in the nutrient ingredient of
each food page and help page.
Figure 4 Insert Empty Line and Delete Content Line
Figure 5 Chart, Food Lookup, Nutrient Selection and Help Button

C. Energy requirement using Nutrisurvey
In this step, you can figure out whether your food intake has been sufficient or not
(less than or more than recommendation). We have to use appropriate reference for
recommendation in order to get correct analysis. This program can facilitate you to change
reference for individual recommendation. For example, we want to analyze intake
requirement for a teenager aged 18 years old, female, named Anisa. Nutrisurvey will use
RDA recommendation to calculate nutrient sufficiency automatically. We know that RDA
can’t be used for Indonesian people because reference for Indonesian people is AKG
(Angka KecukupanGizi – Nutrient Intake Recommendation for Indonesian People). AKG
has not been in nutrisurvey yet. Thus, we have to modify the reference by these steps:
• Open folder where we install the application

• Copy and paste rda.rcd, then rename with akg.rcd
• Go to nutrisurvey application
• Click extras, choose read, then change recommendation
• Choose AKG
• Fill in with nutrient requirement based on AKG
• Click OK
• In display, choose recommendation for women aged 18 years old
Select AKG
Please select
the appropriate
group
Please fill in
based on AKG
Figure 6 Change Recommendation

You can add your own requirements by these steps:
• Click extras, choose read, then change recommendation
• Choose AKG
• Write you energy requirement in the bottom and click OK
• Close the application
• Please select your name as your reference for energy recommendation
Figure 7 Make an Individual Recommendation
Nutrisurvey can calculate your own energy requirement based on your own condition.
Please follow these steps:
• Click calculation in menu bar

• Click energy requirement
• Input data – i.e. name (example: Anissa), age, sex, weight, and height

• To make it more accurate, please input data activity by mention minutes of
your activity
• You can click weight reduction program or weight gain program to figure out
time to achieve ideal weight adjusted by food intake
• You can input your energy requirement from this calculation into your own
recommendation
Figure 8 Calculate an Individual Requirement
D. Making new recipe in database

Even though there are specific food database that unavailable in nutrisurvey, we can
still made it manually. Ways to create new recipe in nutrisurvey:
• Open nutrisurvey window

• Type all needed ingredients and proportion in
• Click bar “Food”, the choose “Safe Food as Recipe”
• Put name of new recipe
• Choose “OK”

Figure 9 Create New Recipe
In creating new recipe, we should consider nutrition loss due to food
processing. For example, nutrition in grilled fish-basil will be different with steam fish-
basil and also will be different compared with fried fish-basil. Step to modify our recipe:
• Click bar “Food”

• Choose “Change a Recipe”
• Select our recipe in upper left column
• Click ingredient that we want to change in “food” column
• Change food processing that we want in bottom right/ “value” column
• Repeat process point 4-5 as you want
• (If needed) add/delete ingredient in upper right column
• When it’s done click “Save”
Figure 10 Change a recipe

E. Adding new nutrition fact database
Nutrisurvey allowed us to modify nutrition databased that exist in food either
adding nutrition fact which unavailable yet. Food database that unavailable in
nutrisurvey could be added by another sources from TabelKomposisiPangan
Indonesia (TKPI) or from nutritional fact that include in food labels.
Steps to modify food database:
• Click bar “Food”

• Choose “Modify Food Database”
• Choose “Add food”
• Fill the nutrition fact
Figure 11 Adding a new nutrition fact
F. Calculate food Nutrient

Main function of nutrisurvey is calculate food nutrient. First, you have to input all of
your food intake in worksheet. Please follow this step to input your food intake:
• Move your pointer into worksheet

• Click headings to separate time consumption – i.e. breakfast, lunch, and dinner
• Write name of food intake, for example: rice 200 gram Click enter
after write rice
• Choose what kind of “rice” that you eat when the display appear
• Input amount of the food
Repeat the step for all food consumption

Figure 12 Input and Calculate Food Nutrient
G. Exporting file to document form (ready to print)

After finish inputing all ingredient that we were consuming, we can see the
report form by clicking icon “Report” in bar. You can see total nutrient intake in the
right side after you input all of your food intake. In addition, you can also analyze
percentage of sufficiency intake, nutrient per 100 gr of food, and nutrient per time
consumption. Display that will show up:
Figure 13 Final Report
References
Arab L. (1988). Analyses, presentation and interpretation of result. In: Cameron M E,

Staveren W. Avan (eds), Manual on Methodology for Food Consumption Studies.
Oxford University Press, pp. 145-169.

Consumer and Food Economic Institute (1976-1992). Composition of foods-raw,
processed, and prepared. Agriculture Handbook 8 Nos. 1-21, US Government
Printing Office, Washington, DC.
Health and Welfare Canada. Nutrient Value of some Common Foods. Health Services
and Promotion Branch and Health Protection Branch, Health and Welfare Canada,
Ottawa, 1988.
Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT (1991). McCance
and Widdowson’s The Composition of Foods. Fifth revised and extended edition.
The Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food,
Cambridge, UK.
Holland B, Unwin ID, Buss DH (1992a). Fruit and Nuts. The First Supplement to the Fifth
Edition of McCance and Widdowson’s The Composition of Foods, Royal Society
of Chemistry and Ministry of Agriculture, Fisheries and Food Cambridge, UK.
Holland B, Welch AA, Buss DH (1992b). Vegetable Dishes. The Second Supplement to
the Fifth Edition of McCance and Widdowson’s The Composition of Foods, Royal
Society of Chemistry and Ministry of Agriculture, Fisheries and Food Cambridge,
UK.
Perisse J (1982). The heterogeneity of food composition tables. In: Hautvast J G A J,

Klaver W (eds) The Diet Factor in Epidemiological Research. Euronut Report 1,
Wageningen, pp. 100-105.
Rosalind F Gibson, 1993, Nutritional Assessment, a laboratory manual.
Stumb, Phyllis. Considerations For Selecting A Dietary Assessment System. J Food

Compost Anal. 2008 February 1; 21(Suppl 1): S13–S19.
doi:10.1016/j.jfca.2007.07.011

PRACTICAL REPORT
DEPARTMENT OF BIOSTATISTICS, EPIDEMIOLOGY AND
POPULATION HEALTH
BLOCK C.6 LIFE STYLE RELATED DISEASES

2022
By:
(insert your name)
(insert your student number
Instructor :
Group :
Date of Practical Sessio :
FACULTY OF MEDICINE, PUBLIC HEALTH AND NURSING

UNIVERSITAS GADJAH MADA

REPORT GUIDELINE
Layout: HVS A4, times new roman, 12, line spacing 1.5, margin 4-4-3-3 (top-left-
right-bottom)
Cover certainty:
• Practical session title
• UGM logo
• Full name, student number, group, regular/international
• Day and date of practical session
• Name of instructor
• Affiliation address and year
The content of the report:

A. Nutritional Assessment
1. Calculate BMI and interpretation
2. Calculate total energy expenditure
3. Macronutrient’s apportionment
4. Arrange food portion based on excel table
5. Develop daily menu
B. Dietary Program
1. Day 1 (report +food photo+ interpretation)
2. Day 2 (report + food photo +interpretation)
3. Day 3 (report + food photo+ interpretation)
4. Discussion and recommendation
5. Attachment: Food record form (3 days)

A. BMI Classification
B. Calculation of Energy Requirement
1. BEE
2. TEE
C. Macronutrient Requirement
1. Protein
2. Fat
3. Carbohydrate
D. Portion Size Nutrition
Portion calorie Carbo(g) protein(g) fat(g)

Carbohydrate
Animal based protein
Vegetable based
protein
Vegetable b
Vegetable a
Oil /fat
Sugar
Milk
Fruit
Total
Requirement
% fulfillment

D. Develop Daily Menu
No Meal time Menu and Household Amount Energy Protein Fat Carbo-
ingredients measure (g) (kcal) (g) (g) hydrate
(g)
1. Breakfast
2. Mid-day
break
3. Lunch
4. Afternoon
break
5. Dinner
6. End of the
day
E. Discussion
F. Recommendation

DIETARY PROGRAM
A. Day 1 (report + interpretation)

B. Day 2 (report + interpretation)
C. Day 3 (report + interpretation)
D. Discussion and recommendation
E. Attachment: 24 hours recall form (3 days)
FOOD RECORDFORM
Name :
Day/date of record :
Body weight :
Body height :
TEE :
No. Meal time Menu and Amount of Amount Energy Protein Fat Carbohy
ingredients portion and (g) (kcal) (g) (g) drate
Household (g)
measure
1. Breakfast
2. Mid-day
break
3. Lunch
4. Afternoon
break
5. Dinner
6. End of
the day

Rubric of Report Assessment C6 2022
No. component Point

1. Approriatecoverandgeneral format (5)
Kriteria penilaian
a. Layout, font 1
b. Title and date 1
c. Instructor’s name 1
d. Ordered numbering (point) 1
e. On time submission 1
2. Report content (95)
A. Nutritional Assessment
a. Re-writetheidentiti: BW, Height, age, sex and activity level 2
a. Calculatethe BMI andintepretation 5
b. Calculate BEE usig Harris Benedict formula ( actual BW or 5
adjusted BW)
c. Calculate TEE 5
d. Macronutritiondistribution 10
e. Portion distribution (excel) 5
f. Approriatemacronutrienportion (90-110% of TEE) and display the 3
complete table
g. make sense portion distribution 10
h. make a simple one day menu based on planning 10
i. Discussion 5
j. Recommendation 5
B. Dietary Program
a. Reportnutrisurveyday 1 +foodphoto + intepretation 5
b. Reportnutrisurveyday 2 + foodphoto +intepretation 5
c. Reportnutrisurveyday 3 + foodphoto +ntepretation 5
d. Attachment: Food Record form (3 days) 5
e. Discussion 5
f. Recommendation 5
TOTAL 100
Score reduction:
1. Late submission: -1/day
2. Plagiarism suspect: -20 point

PRACTICAL GUIDE
DEPARTMENT OF PSYCHIATRY
ASSESSMENT LEVEL OF DISTRESS
INTRODUCTION
Practical work of Psychiatry of block C.6 is focusing on measuring level of distress using
Self-Reporting Questionnaire (SRQ)-Adaptation from WHO 1994.
TOPIC
1. What is Distress
2. How to Measure distress
3. How to use SRQ
1. DISTRESS
The definition of distress is ambiguous. Distress is a part of stress which has a negative
effect to human body. Stress is your mind and body’s response or reaction to a real or imagined
threat, event or change. The threat, event or change are commonly called stressors. Stressors
can be internal (thoughts, beliefs, attitudes or external (loss, tragedy, change).
Eustress or positive stress occurs when your level of stress is high enough to motivate you
to move into action to get things accomplished. Distress or negative stress occurs when your
level of stress is either too high or too low and your body and/or mind begin to respond
negatively to the stressors. Using “distress” word is to describe unpleasant feelings or emotions
that may cause problems for people.
Clinical Manifestation
a. Cardiac - increased heart rate
b. Respiratory - increased respiration
c. Skin - decreased temperature
d. Hormonal - increased stimulation of adrenal genes which produce an adrenal rush.
Emotional Manifestation
a. Tearfulness
b. Fear
c. Anxiety
d. Panic
e. Guilt
f. Agitation
g. Depression
h. Overwhelmed
2. HOW TO MEASURE DISTRESS

Many instruments used to recognize distress (stress) level. Distress can be measured
with assessing 2 specific conditions of physical symptoms and psychological symptoms. Self
reporting questionnaire (SRQ) which is adapted from WHO is a tool to help understanding
distress in life and measure the distress.
3. HOW TO USE SRQ-20

Research has shown that mental disorders are common among general medical patients.
The self reporting questionnaire (SRQ) was developed as an instrument wich was designed to
screen for psychiatric disturbance in primary health care settings, especially in developing
countries (Harding et al., 1984 cit WHO., 1994).
The SRQ is a screening instrument. This screening focuses only in consisting of the neurotic
items.
The SRQ consists 20 item questions assessed a neurotic symptom.

English version
SRQ -20
A copy of the English version of the Self Reporting Questionnare-20 is shown below
1. Do you often have headace? Yes/ No
2. Is your appetite poor? Yes/ No
3. Do you sleep badly? Yes/ No
4. Are you easily frightened? Yes/ No
5. Do your hands shake? Yes/ No
6. Do you feel nervous, tense or worried? Yes/ No
7. Is your digestion poor? Yes/ No
8. Do you have trouble thinking early? Yes/ No
9. Do you feel unhappy? Yes/ No
10. Do you cry more than usual? Yes/ No
11. Do you find it difficult to enjoy your daily activities? Yes/ No
12. Do you find it difficult to make decisions? Yes/ No
13. Is your daily work suffering? Yes/ No
14. Are you unable to play a useful part in life? Yes/ No
15. Have you lost interest things? Yes/ No
16. Do you feel that you are worthless person? Yes/ No
17. Has the thought of ending your life been on your mind? Yes/ No
18. Do you feel tired all the time? Yes/ No
19. Do you have uncomfortable feelings in your stomach? Yes/ No
20. Are you easily tired? Yes/ No
Indonesian version
Apakah (NAMA) sering Apakah (NAMA) merasa sulit untuk
F01  F11 
menderita sakit kepala? menikmati kegiatan sehari-hari?
Apakah (NAMA) tidak Apakah (NAMA) sulit untuk
F02  F12 
nafsu makan? mengambil keputusan?
Apakah (NAMA) sulit Apakah pekerjaan (NAMA) sehari-
F03  F13 
tidur? hari terganggu?
Apakah (NAMA) tidak mampu
Apakah (NAMA) mudah
F04  F14 melakukan hal-hal yang bermanfaat 
takut?
dalam hidup?
Apakah (NAMA) merasa
Apakah (NAMA) kehilangan minat
F05 tegang, cemas atau  F15 
pada berbagai hal?
kuatir?
Apakah tangan (NAMA) Apakah (NAMA) merasa tidak
F06  F16 
gemetar? berharga?
Apakah pencernaan
Apakah (NAMA) mempunyai pikiran
F07 (NAMA) terganggu/  F17 
untuk mengakhiri hidup?
buruk?
Apakah (NAMA) sulit Apakah (NAMA) merasa lelah
F08  F18 
untuk berfikir jernih? sepanjang waktu?
Apakah (NAMA) merasa Apakah (NAMA) mengalami rasa
F09  F19 
tidak bahagia? tidak enak di perut
Apakah (NAMA)
F10  F20 Apakah (NAMA) mudah lelah? 
menangis lebih sering?
The SRQ-20 adaptation was used in RISKESDAS (riset kesehatan dasar) Indonesian
Ministry of Health in 2007

SCORING
Each of the 20 items is score 0 or 1. A Score of 1 indicates that the symptom was
present during the past month; a score of 0 indicates that the symptom was absent. The
maximum score is therefore 20.
SRQ USAGE
It is important that if a decision is taken that the SRQ will be interviewer administered in a
study, that all interviewers follow exactly the same procedure. Screening of patients in
general health clinics in the participating countries within the collaborative study showed that
a significant proportion of mental symptoms were reported by patients but were not being
picked up by the health workers.
There are 3 clear discriminations within SRQ usage for neurotic scale.
1. Cognitive items 3. Somatic Symptom
2. Anxiety and depression

PRACTICAL GUIDE
DEPARTMENT OF CLINICAL PATHOLOGY AND LABORATORY
MEDICINE
BLOCK C6
Contributor:
dr. Elizabeth Henny Herningtyas, MD., M.Si., Ph.D., SpPK(K)
dr. Fuad Anshori, M.Sc, Sp.PK
TOPICS:
1. Glucose Test (GOD-PAP method)
2. Glucose Challenge Test
3. Oral Glucose Tolerance Test
4. Keton Bodies (Rothera’s test)
5. HbA1c
2022

GLUCOSE TEST (GOD-PAP METHOD)
Objective:
To determine the glucose concentration in human samples
Principle:
Glucose concentration is determined after enzymatic oxidation by glucose oxidase. The
colorimeteric indicator is quinoneimine, which is generated from 4-aminoantipyrine and
phenol by hydrogen peroxide under the catalytic action of peroxidase (Trinder’s reaction).
The reaction is as follow:
GOD
Glucose + O2 Gluconic acid + H2O2
POD
2 H2O2 + 4-Aminoantipyrine + Phenol Quinoneimine + 4 H2O
Samples:
Serum, heparinized plasma or EDTA plasma, spinal fluid
Separate at the latest 1h after blood collection from cellular contents.
Glucose concentration in the blood that deproteinated and centrifuged immediately after the
collection, will be stable for 5 days in temperature 15°C up to 25°C or in 4°C
Glucose concentration in serum or plasma that had been prepared 30 minutes after
collection will be stable for 24 hours in 4°C.
Glucose stability after addition of a glycolytic inhibitor (NaF, KF): 1 day at 20-25°C or 7 days
at 4-8°C.
Reagents:
Components and Concentration in the test
Phosphate buffer pH 7.5 250 mmol/L

Phenol 5 mmol/L
4-Aminoantipyrine 0.5 mmol/L
Glucose oxidase (GOD) 10 kU/L
Peroxidase (POD) 1 kU/L
Standard: 100 mg/dL (5.55 mmol/L)
Storage Instructions and Reagent Stability

The reagent is stable up to the end of the indicated expired date, if stored at 2-8°C, protected
from light and avoided from contamination. Do not freeze the reagents!
Note: It has to be mentioned, that the measurement is not influenced by occasionally
occurring color changes, as long as the absorbance of the reagent is < 0.3 at 546 nm. The
standard is stable up to the end of the indicated expired date, if stored at 2-25°C
Warnings and Precautions

1. The reagent contains sodium azide (0.95 g/L) as preservative. Do not swallow. Avoid
contact with skin and mucous membranes
2. Take the necessary precautions for the use of laboratory reagents
Addition reagent:
Trichloroacetic acid solution 300 mmol/L, for deproteination, stable at 15°C up to 25°C

Assay Procedure:
Wavelength 500 nm, Hg 546 nm
Optical path 1 cm
Temperature 20-25°C or 37°C
Measurement against Blank
Calculation
With standard or calibrator
A Sample x Concentration Standard/ Cal (mg/dL)

Glucose (mg/dL) =
A Standard/Cal
Conversion factor
Glucose (mg/dL) x 0.05551 = Glucose (mmol/L)
Normal range:
Fasting 70 - 100 mg/dL (whole blood)
70 - 115 mg/dL (serum)
35 -50 mg/dL (spinal fluid)
References:
1. PK FK UGM, 2002, TuntunanPraktikumPatologiKlinik, LaboratoriumPatologiKlinik FK UGM
Yogyakarta
2. WHO, 2000, Guidelines on Standard Operating Procedures for Clinical Chemistry, Regional
Office for South-East Asia, New Delhi

GLUCOSE CHALLENGE TEST
Objective:
To know the body responses after glucose loading and to screen diabetes mellitus among
pregnant women
Principle:
The patient body is forced to respond to glucose loading and the blood glucose is monitored.
Abnormal result can be obtained after the loading (challenge). The test is generally done
between weeks 24 and 28 of pregnancy.
Samples: Serum or plasma
Reagents:
1. Glucose 50 g
2. Reagent kit for glucose assay (GOD-PAP method)
Assay Procedure:
The patient is not fasting before test
The patient is given 50 g glucose loading dissolved in 200 ml water. The glucose should be
drink within 5 minutes
The patient’s venous blood sample is taken one hour after loading.
The glucose concentration is measured from the sample.
Interpretation:
The venous plasma glucose concentration 140 mg/dL or higher indicate gestational diabetes.
Reference:
WHO, 2000, Guidelines on Standard Operating Procedures for Clinical Chemistry, Regional

ORAL GLUCOSE TOLERANCE TEST
Objective:
To know the body responds after glucose loading and to screen diabetes mellitus among
suspected person
Principle:
The patient’s body is forced to respond to glucose loading and the blood glucose are
monitored every hour for 2 hours after loading.
Samples: Serum or plasma
Reagents:
1. Glucose 75 g
2. Reagent kit for glucose assay (GOD-PAP method)
Assay Procedure:
• The patient should fast or no intake calory for 8-12 hours before test
• In fasting condition, the blood sample is taken and the glucose concentration is
measured.
• The patient is given 75 g glucose loading in appropriate amount of water (approximately
200 mL).
• The blood samples are taken again at one hour and two hours after loading
• The glucose concentration is measured for those paired samples
Result and Interpretation

Based on National Diabetes Data Group and World Health Organization, the results are
interprete as:
Venous Plasma Glucose (mg/dL)

Diagnosis
Fasting 2 hours
Normal <110 <140
Impaired Fasting Glycemia ≥110 - <126 <140
Impaired Glucose <110 ≥140
Tolerance
Diabetes Mellitus ≥126 ≥200
Reference:
WHO, 2000, Guidelines on Standard Operating Procedures for Clinical Chemistry, Regional

KETONE BODIES - ROTHERA’S TEST
Objective:
To determine the ketone bodies existence in urine sample.
Introduction
Ketone bodies are intermediary products of fat metabolism and their presence in blood
and then in urine indicate that the metabolism is disordered or incomplete. In condition when
fat becomes the primary energy source (e.g. poorly controlled diabetes mellitus, starvation,
low-carbohydrate diet, high-fat diet, exercise, alcohol excess and severe illness) will cause
a rise in ketones. Diabetic ketoacidosis (DKA) is an abnormal metabolic state caused by a
build-up of ketones in the body and decrease blood pH. It is characterized by hyperglycemia,
acidosis and ketonemia. It is usually the result of an absolute or relative insulin deficiency.
Principle:
The three main ketone bodies are acetone, acetoacetic acid (diacetic acid) and beta-
hydroxybutyric acid.
Acetone and acetoacetic acid react with sodium nitropruside in the presence of saturated
alkali to produce a purple color. This test cannot detect beta-hydroxybutyric acid. No
interference of most drugs and metabolic products.
Sample: freshly voided urine
Rothera modified by Joshlin Clinic

Rothera’s reagent: Dry mixture
Combine 5 g sodium nitropruside with 200g ammonium sulfate. Store in a clean amber
bottle at 25-35°C. Stable for 6 months.
Ammonia concentrated, specific gravity 0.91
Positive control: 1-2 drops of acetone is added to 5 ml of urine
Negative control: distilled water
Assay Procedure:
Take about 5 ml urine in an 18 x 150 mm glass tube, add about one teaspoon of the mixture,
mix well, and then add 0.5 to 1.0 ml of concentrated ammonia down to the side of the tube
so that it layers on top of the urine. Observe for any color change within 30-60 seconds.
Positive standard:
Right to left: tube 1: negative, tube 2 positive 1 (1 drop of acetone), tube 3 positive 2 (2 drops
of acetone, tube 4 positive 3 (3 drops of acetone)
Result
If acetone and diacetic acid are present, then a purple (permanganate calomel red) color
will form at the junction of the two layers within 30-60 seconds. The result can be graded
from trace to 3+ based on the intensity of the color formed, as detailed below
No change in color (- / negative)
Pinkish ring (+) = 5 mg acetoacetic acid or 20 mg aceton per 100 ml urine
Red ring (++) = 30 mg acetoacetic acid or 250 mg aceton per 100 ml urine
Deep purple ring (+++) = 80 mg acetoacetic acid or 800 mg aceton per 100 ml urine

Interpretation:
Normal urine does not contain methyl ketone. Weak false positive reaction may occur it the
urine contains L-dopa and phenyl pyruvic acid.
If there is suspicion of a false positive test, heat the urine in a test tube in a Bunsen burner
flame for one minute, and allow cooling and repeating the Rothera’s test. Heated urine will
not give a positive Rothera’s due to ketone bodies
References:
1. PK FK UGM, 2002, Tuntunan Praktikum Patologi Klinik: Analisis Urin, Laboratorium Patologi
Klinik FK UGM Yogyakarta
2. WHO, 2000, Guidelines on Standard Operating Procedures for Clinical Chemistry, Regional
3. Comstock JP, Garber AJ. Chapter 140. Ketonuria. NCBI Bookshelf. Page 1-42.

HbA1c TEST
Objective
To determine the HbA1c percentage in human blood.
Principle
Gycation of hemoglobin occur during erythrocyte exposure to glucose, to form labile
the stabile binding. In HbA, labile binding fraction normally comprises 10% from total glucose
binding. The amount of HbA, influenced by glycosilation depends of the degree and duration
of glucose exposure. HbA1 comprises of three HbA1aA1b dan A1c.HbA1c comprise about 70%
of the glycated, and the others less than 20% of the glycated Hb..HbA1c comprise about
60%-70% of the total HbA1.
HbA1c test is a boronate affinity assay. Measurement of total glycoHb by boronic acid
chromatography also measure the abnormal glycatedHb such as glycated HbA and the
results are not influenced by renal failure, aspirin, or temperature fluctuation. When blood is
added to the reagent, erythrocyte immediately lyses. All hemoglobins are precipitated. The
boronic acid conjugate binds to cis-diols of glycated hemoglobin. An aliquot of the reaction
mixture is added to the test device, and all the precipitated hemoglobin, conjugate-bound
and unbound, remains on top of the filter. Any excess of colored conjugate is removed with
the washing solution. The precipitate is evaluated by measuring the blue (glycated
hemoglobin) and the red (total hemoglobin) color intensity respectively with the reader, the
ratio between them being proportional to the percentage in the sample.
Samples
Capillary blood and venous blood with or without anticoagulants (EDTA, heparin and NaF)
can be used.
Reagents
TD/Test Device 1x 24 units
Plastic device containing an uncoated membrane filter
R1/Reagent
Glycinamide buffer containing Zn ions, dye-bound boronic acid and detergents
R2/Washing solution
Morpholine buffered NaCl solution and detergents
Assay Procedure
1. Precipitation of hemoglobin
Add 5 mL whole blood to the test tube pre-filled with R1/Reagent. Mix well. Leave the tube
for minimum 2 minutes, maximum 3 minutes. Note: make sure that the capillary tube is
completely empty after mixing.
2. Application of sample
Remix to obtain a homogenous suspension. Apply 25 mL of the reaction mixture to a
TD/Test Device by holding the pipette approximately 0.5 cm above the test well. Empty the
pipette quickly into the middle of the test well. Allow the reaction mixture to soak completely
into the membrane. Wait for 15-20 seconds. Note: Avoid air bubbles.
3. Application of R2/Washing Solution

Apply 25 mL R2/Washing Solution to the TD/Test Device. Allow the washing solution to soak
completely into the membrane. Wait for 10 seconds.
Note: Avoid air bubbles.
4. Test result measurement
Read the test result within 5 minutes using the reader.

Picture 1. HbA1c Assay Procedure
Interpretation:
Normal value less than 5.6%
Prediabetes state 5.7-6.4% and indicate diabetes mellitus if ≥6.5%
This method measures the total glycated hemoglobin (GHb),but reports a standardized
HbA1c value. Standardization is carried out according to the European Reference
Laboratory recommendations for Glycohemoglobin.
References:
1. Nycocard HbA1c Manual Procedure.
2. Ravel, R. 1995, Clinical Laboratory Medicine, Chicago Book Medicine Publisher


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Student’s Book

UNIVERSITAS GADJAH MADA

Student’s Book Block C.6 | 1

© Faculty of Medicine, Public Health and Nursing

Published by Faculty of Medicine, Public Health and Nursing

2 | Student’s Book Block C.6

YEAR III COORDINATOR

Dr. dr. Hasanah Mumpuni, Sp.PD, Sp.JP

BLOCK COORDINATION TEAM

dr. Yanri Wijayanti Subronto, PhD, Sp.PD-KPTI

dr. Silas Henry Ismanto, Sp.KJ(K)

Dr. dr. Zaenal Muttaqien, AIFM

dr. M. Robikhul Ikhsan, Sp.PD, KEMD

Student’s Book Block C.6 | 3

Lastdes Cristiany Friday, S.GZ, MPH

dr. E. Henny Herningtyas, M.Si, PhD, Sp.PK

Dr. dr. Denny Agustiningsih, M.Kes, AIFM

dr. Ronny Tri Wirasto, Sp.KJ

dr. Andrian Fajar K, Sp.KJ

dr. Irwan Supriyanto, PhD, Sp.KJ

4 | Student’s Book Block C.6

Phase 3: Clinical Rotation - Becoming a

Students and Metabolism (6 weeks) (6 weeks) Organs System

Student’s Book Block C.6 | 5

GENERAL OUTLINE OF THE BLOCK CONTENT

6 | Student’s Book Block C.6

Student’s Book Block C.6 | 7

8 | Student’s Book Block C.6

LINKEAGES TO OTHER BLOCK

Student’s Book Block C.6 | 9

Individual & Family Community

Nutrition Physical Mental Spiritual Social Structural

Risk Factor of Functional Metabolic Syndrome and its Malignancy

Student’s Book Block C.6 | 10

Learning Unit 1 : Risk factor of Disease

Student’s Book Block C.6 | 11

1. Group Discussion With Tutors

Seven jumps method

The seven jumps are:

Multilevel scenario method

b. STEP 3: SELF STUDY

12 | Student’s Book Block C.6

Assessment: 100% of tutorial attendance (except with permission based on faculty

2. Independent learning (self study)

Student’s Book Block C.6 | 13

14 | Student’s Book Block C.6

Student’s Book Block C.6 | 15

7. Field work (Friday Morning Aerobic Exercise)

16 | Student’s Book Block C.6

Student’s Book Block C.6 | 17

Risk Factors of Disease

Student’s Book Block C.6 | 19

HEALTHY LIFESTYLE HOMEOSTASIS UNHEALTHY LIFESTYLE

MAINTAIN HOMEOSTASIS DECREASE/LACK TO MAINTAIN HOMEOSTASIS

Created by dr. M. Robikhul Ikhsan

20 | Student’s Book Block C.6

2. Title : Socio-economic impact of illness

3. Title : Food and disease risk

5. Title : Food Policy

6. Title : Carpal tunnel syndrome, tarsal

7. Title : Occupational Diseases

Student’s Book Block C.6 | 21

2. Title : Exercise Stress Test (Ergometry -

3. Title : Cardiocirculatory fitness