laporan kelompok 1a konsep sehat sakit 201414

MODUL

HEALTH-SICK CONCEPT

PROBLEM BASED LEARNING

1st SCENARIO

Composed by:

Group 1A

Airlangga University

Faculty of Medicine

2014

TUTOR

Prof. Dr. Jusak Nugraha, dr, MS, SpPK (K)1

MODULE CHIEF

Dr. Pudji Lestari, dr, Mkes

SCENARIO COMPOSER

Margarita Maria Maramis, dr., SpKJ (K)

Dr. Florentia Sustini, dr, MS

Djohar Nuswantoro, dr, MPH

Siti Pariani, dr, MS, MSc, PhD

Samuel Nugraha, dr, Sp A

EDITOR

Dr. Pudji Lestari, dr, Mkes

HEALTH-SICK CONCEPT

1A GROUP PROBLEM BASED LEARNING

MEDICAL FACULTY OF AIRLANGGA UNIVERSITY

2

GROUP 1A

LEADER

Ottofianus Alvedo Hewick Kalangi/011311133063

SECRETARY

Putri Rahayu/011311133035

MEMBERS

Karisma Septari Idamusaga/011311133077

Kadek Novita Damayanti/011311133049

Haris Swastikoputra/011311133070

Anik Rahmatur Riza/011311133042

Ismi Ayu Putri Rahmadillah/011311133007

Anisah Adianti/011311133014

Ilham Wildan Ahmad/011311133021

Bella Patricia Simanjorang/011311133028

Ogiska Chaherfa Nadasya/011311133056

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CONTENTS

Cover............................................................................................................................................. 1

Tutors, Module Chief, Composer, and Editor.......................................................................... 2

Group Members.......................................................................................................................... 3

Contents........................................................................................................................................ 4

Acknowledgement…………………………………………………………………………........ 5

Instructional Objectives .…………………………………………………………………......... 6

I. Brain Storming and Cognitive Strategy................................................................................ 7

1.1 Scenario……………………………………………………………………………… 7

1.2 Main Problems .............................................................................................................. 7

1.3 Keywords ……………………………………………………………...…..…........... 7

1.4 Early Hypothesis.......................................................................................................... 7

1.5 Learning Issues and Additional Learning Issues......................................................... 8

1.6 Additional Information................................................................................................ 8

1.7 First Concept Mapping................................................................................................ 10

1.8 Additional Questions ………………………………………………………….......... 11

II. Problem Analysis ……………………………................................………………….......... 13

2.1 Learning Issues Answers ..…………………………………………………………... 13

2.2 Additional Learning Issues Answers…………....................................…………….. 41

III. Analysis and Conclusion…………………………………………………………………… 46

3.1 Analysis of Learning Issues …………………………………………………………. 46

3.2 Final Hypothesis …………………………………………………………………….. 49

3.3 Group Opinion ........................................................................................................... 49

3.4 Final Concept Mapping ............................................................................................. 50

3.3 Conclusion ................................................................................................................. 51

IV. Critical Appraisal …………………………………………………………………........ 52

4.1 References ............................................................................................................ 52

4.2 Appraisal .............................................................................................................. 74

V. Attachments ………………………………………………………………….................. 84

5.1 Sample of Journal Appraisal and Journal ............................................................. 84

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ACKNOWLEDGEMENT

First of all we want to thank God, so that we can finish our fourth moduule and we also

have special thanks to our beloved Tutor Prof. Dr. Jusak Nugraha, dr, MS, SpPK (K). for the

support and the guidance so we can understand this module better.

Moreover, the writer would like to thank the other groups for the support and especially to

all the PBL lecturers because of their contribution. Without them, right now we will not know about

learning how important the effective communication in everyday life and especially in the

professional atmosphere. In addition, we also want to thank the Ethic lecturers for their input to

make us understand the basic professionalism and ethic in the medical profession.

Our special thanks to Dr. Pudji Lestari, dr, Mkes Margarita Maria Maramis, dr., SpKJ (K) Dr.

Florentia Sustini, dr, MS Djohar Nuswantoro, dr, MPH Siti Pariani, dr, MS, MSc, PhD Samuel

Nugraha, dr, Sp A for giving the chance to us to make and solve this module because it gives a lot

of contribution to our knowledge and better understanding in the importance of interpersonal

communication and its barrier factors that regularly inhibit us to attain the effective communication.

We also ask for forgiveness if there are mistakes, mistyped-words, and words which are

incorrect.

Best Regards,

Writers,

Group 1A

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INSTRUCTIONAL OBJECTIVE

General Instructional Objective

After finishing this module, medical students from the 2nd semester able to explain the health-sick

concept as like spectrum, in physic, attitude, social dimension during human cycle life, and can be

pattern all stage of prevention to it dimension, in individually, families and communities, which

will become the foundation in carrying out its function as a provider of medical.

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CHAPTER 1

1st TUTORIAL

BRAIN STORMING

1.1 Scenario

Anton, 23 years old, an event organizer often being overworked, with irregular bedtimes and

eating. 2 months recently feels epigastric pain.

Anton, 23 tahun, seorang ‘event organizer’ sering sibuk bekerja tak kenal waktu, makan,

dan tidur tidak teratur. Dua bulan terakhir sering merasa nyeri di ulu hati.

1.2 Main Problems

Anton has an epigastric pain

1.3 Keywords

Being overworked

deviant life

Epigastric pain

1.4 Early Hypothesis

Anton has an epigastric pain which is caused by Helicobacter pylori infection due to deviant

lifestyle such as eating pattern, bedtimes, and work deadlines.

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1.5 Learning Issues and Additional Learning Issues

1. What is Epigastric pain?

2. What is the typhoid fever?

a. How is the typhoid fever spread?

b. How can you avoid typhoid fever?

c. What are the signs and symptoms of typhoid fever?

3. How relation between Helicobacter Pylori and Typhoid Fever?

4. How health-sick concept as like a spectrum?

5. How level of prevention epigastric pain in Anton?

6. What are the influence stamina drink to health?

7. How to treatment epigastric pain?

8. What are the factors that causing epigastric pain instead of infection?

9. How the influence of food menu that trigger epigastric pain?

10. How the influence of lifestyle factors in epigastric pain?

11. How is Mr. Anton’s condition based on health and illness spectrum?

12. How is the influence of social factor in epigastric pain of Mr. Anton’s cases?

13. How is the influence of mentally factor in epigastric pain of Mr. Anton’s cases?

14. How the influence of food and beverage and beverage sanitation in epigastric pain?

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1.6 Additional Information

Haven’t married

Very busy, so many time spend in the journey inside and outside of city

Human organyzing is so populer

Often consume stamina drink

1 year ago has typhoid fever

Eat whatever there is

Live in a nice boarding house

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1.7 First Concept Mapping

Picture 1.1 First Concept Mapping

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1.8 Additional Question

The first form additional questions

1. Question : Anton has been checked by a doctor?

Anamnesis : to determine the spectrum of healthy sick, sign or sympthoms.

Answer : Not yet.

2. Question : is there any other complaints besides Anton perceived gastric pain?

Anamnesis : to identify the risk factor.

Answer : Nothing.

3. Question : what is the dose used for Anton’s energy drinks?

Anamnesis : to know the effects of energy drinks to gastric pain.

Answer : do not remember.

4. Question : whether there is a habit of drinking alcohol, doping?

Anamnesis : to know the gastric pain effects.

Answer : Yes, Stamina Enhancher.

5. Question : is there any treatment performed Anton last 2 months?

Anamnesis : to determine the first aid and patient awareness.

Answer : Nothing.

6. Question : Anton feel stress or not?

Anamnesis : to determine whether there is an influence of stress on gastric pain and

increased gastric acid.

Answer : Anton pleased to work..

7. Question : what type of food eaten Anton? nutritionally balanced or not?

Anamnesis : to determine the sanitation of foods to gastric pain.

Answer : sober.

8. Question : is there any other complaints besides Anton perceived gastric pain?

The second form additional questions

1. Question :Is Anton feel worried about his job?

Anamnesis :to determine side effect of mental health to epigastric pain.

Answer :Anton pleased to work.

2. Question :Is Anton feel in a hurry when he finished his event Organizer?

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Anamnesis : to determine side effect of mental health to epigastric pain.

Answer :yes.

3. Question :How is the relationship between Anton and other people?

Anamnesis : to determine side effect of social to epigastric pain.

Answer :Good.

4. Question : How is the relationship between Anton and his family?

Anamnesis :to determine side effect of family to influence Anton in his job.

Answer :Good.

5. Question :Is there any influence of family to Anton’s job?

Anamnesis :because the influence of family help Anton and his illnes.

Answer :no.

6. Question :How is the food sanitation that Anton get?

Anamnesis :to determine the food hygine that Anton get.

Answer :Not certain.

7. Question :is the Anton’s food there is salmonella thypi bacteria?

Anamnesis : to determine side effect of physical aspect to epigastric pain.

Answer :Don’t know.

8. Question : is the Anton’s food there is Hellicobcter pylori bacteria?

Anamnesis :to determine side effect of disease spread through food.

Answer :Don’t know.

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CHAPTER 2

2nd TUTORIAL

PROBLEM ANALYSIS

2.1 Learning Issues’s Answers

1. What is Epigactric pain?

Epigastric pain is pain that is localized to the region of the upper abdomen

immediately below the ribs. Often, those who experience this type of pain feel it during

or right after eating or if they lie down too soon after eating. It is a common symptom of

gastroesophageal reflux disease (GERD) or heartburn. It may be associated with the

gastric contents moving upward into the back of the throat, causing inflammation and a

burning pain.

Learn More About Epigastric Pain

8 Simple Changes to Curb Heartburn

Do you also have nausea? Check possible causes.

Epigastric Pain? Join the Discussion

Epigastric pain may also occur with conditions that cause inflammation of

the digestive organs, such as gastritis and pancreatitis. Pregnant women may experience

epigastric pain due to increased abdominal pressure and hormonal changes that slow the

digestive process. Epigastric pain can also arise from conditions that impair the normal

digestive process, such as peptic ulcers, hiatal hernias, or gallstones. In these cases, it

may occur frequently after meals, and it may become chronic.

Some people have mild epigastric pain that occurs after eating and subsides

quickly, while others may have a severe burning feeling in the abdomen, chest and neck

that prevents sleep. Other symptoms that may accompany epigastric pain include

abdominal bloating, constipation, diarrhea, and vomiting, depending on the underlying

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http://www.bettermedicine.com/topic/heartburn-and-gerd/

http://www.localhealth.com/article/gallstones-1

http://www.localhealth.com/article/pancreatitis

http://forums.bettermedicine.com/forumdisplay.php/3153-Digestive-Conditions

http://www.bettermedicine.com/symptom-checker/

http://www.bettermedicine.com/digestive-health-center/8-simple-changes-to-curb-your-heartburn/

cause. In rare cases, epigastric pain is due to heart conditions such as heart attack and

angina (chest pain due to the heart not getting enough oxygen).

Epigastric pain is not a serious symptom on its own. However, if it occurs

with other life-threatening symptoms, it may be a sign of a condition that should receive

immediate medical treatment, such as a heart attack. Seek immediate medical care

(call 911) if you, or someone you are with, experience epigastric pain along with life-

threatening symptoms such as severe breathing problems; chest pain, pressure or

tightness; or vomiting blood or black material.

Seek prompt medical care if you are being treated for epigastric pain but mild

symptoms recur or are persistent.

SYMPTOMS

What other symptoms might occur with epigastric pain?

Epigastric pain may accompany other symptoms, which vary depending on

the underlying disease, disorder or condition. Frequently, symptoms that affect the

digestive tract may also involve other body systems.

What other symptoms might occur with epigastric pain?

Epigastric pain may accompany other symptoms, which vary depending on

the underlying disease, disorder or condition. Frequently, symptoms that affect the

digestive tract may also involve other body systems.

Gastrointestinal symptoms that may occur along with epigastric pain

Epigastric pain may accompany other symptoms affecting the digestive system such as:

Abdominal pain

Abdominal swelling, distension or bloating

Belching

Burning feeling in the abdomen or upper chest

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http://www.localhealth.com/article/belching

http://www.localhealth.com/article/abdominal-pain

http://www.localhealth.com/article/epigastric-pain/symptoms

http://www.bettermedicine.com/topic/angina/

Constipation

Diarrhea

Flatulence

Nausea with or without vomiting

Pain in the upper chest

In some cases, symptoms of epigastric pain can be a sign of a heart attack or

serious condition. Seek immediate medical care (call 911) if you, or someone you are

with, have any of these life-threatening symptoms including:

Chest pain, chest tightness, chest pressure, palpitations

Radiating pain down your shoulder and arm

Respiratory or breathing problems such as shortness of breath, difficulty breathing,

labored breathing, wheezing, not breathing, or choking

Vomiting blood or black material (resembling coffee grounds)

What causes epigastric pain?

Epigastric pain has many possible causes. Most commonly, epigastric pain is

the result of overeating, drinking alcohol while eating, or consuming greasy or spicy

foods. Epigastric pain can be caused by digestive conditions such as acid reflux or

lactose intolerance. Gastroesophageal reflux disease (GERD) is another possible cause

of epigastric pain. Inflammatory diseases or cancers affecting the gallbladder, pancreas

or stomach may result in epigastric pain. Pain in the epigastric region can also be a sign

of a cardiovascular problem such as a heart attack or angina (chest pain due to the heart

not getting enough oxygen).

Common causes of epigastric pain

Epigastric pain can be due to common causes including:

Dyspepsia (indigestion)

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http://www.localhealth.com/article/indigestion-1

http://www.localhealth.com/article/chest-pain-1

http://www.localhealth.com/article/shortness-of-breath

http://www.localhealth.com/article/nausea

http://www.localhealth.com/article/diarrhea

Gastritis (inflammation of the stomach lining)

Gastroesophageal reflux disease (GERD), a condition in which acidic stomach

contents flow back into the esophagus

Heartburn

Lactose intolerance

Pregnancy

Side effects to medications, such as aspirin and nonsteroidal anti-inflammatory drugs

(NSAIDs)

Other causes of epigastric pain

Epigastric pain may have other causes including:

Barrett’s esophagus (cellular changes in the esophagus that may lead to esophageal

cancer)

Esophagitis (inflammation of the esophagus)

Gallstones or gallbladder disease

Hiatal hernia (protrusion of the stomach into the chest through a hole in the

diaphragm)

Pancreatic cancer

Pancreatitis (inflammation of the pancreas)

Peptic ulcer or perforated peptic ulcer, resulting in stomach bleeding or an intestinal

ulcer

Stomach or esophageal cancer

Serious or life-threatening causes of epigastric pain

In some cases, epigastric pain may be a symptom of a serious or life-threatening

condition that should be immediately evaluated in an emergency setting. These include:

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http://www.localhealth.com/article/peptic-ulcer-1

http://www.bettermedicine.com/topic/pancreatic-cancer/

http://www.localhealth.com/article/gallstones-1

Angina (chest pain due to the heart not getting enough oxygen)

Heart attack (myocardial infarction)

Questions for diagnosing the cause of epigastric pain

To diagnose your condition, your doctor or licensed health care practitioner will ask you

several questions related to your epigastric pain including:

How long have you felt epigastric pain?

Are there certain times your epigastric pain is more severe?

Are you lactose intolerant?

Do you have angina or any other heart problems?

Do you have any other symptoms?

What medications are you taking?

Where precisely do you feel the pain?

What are the potential complications of epigastric pain?

Typically, epigastric pain on its own does not lead to serious complications.

However, it can affect your quality of life by causing distress and discomfort when you

eat. This may change your eating patterns and result in unintentional weight loss.

Further, epigastric pain can mimic serious heart symptoms. You can help minimize your

risk of serious complications by following the treatment plan you and your health care

professional design specifically for you. Complications of epigastric pain include:

Cancer of the esophagus, stomach, or other organs

Esophageal scarring and narrowing

Myocardial infarction (heart attack), if the pain is due to angina

Poor nutrition due to a decreased desire to eat

Poor quality of life

Spread of cancer

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http://www.bettermedicine.com/topic/angina/

http://www.bettermedicine.com/topic/heart-attack/

Spread of infection

2. What is the typhoid fever?

Typhoid fever is a disease caused by the bacterium Salmonella Typhi. This

disease is quite threatening if not treated promptly. Typhoid fever is still common in

developing countries and affects 21.5 million people each year. Typhoid fever is

common in the world, except in industrial countries like the United States, Canada,

Western Europe, Australia, and Japan. Typhoid fever can be prevented and can usually

be treated with antibiotics.

Distribution and Symptoms of Typhoid Fever

Salmonella Typhi lives only in the human body. Persons with typhoid fever

carry the bacteria in their intestinal tract and blood. In addition, the small percentage of

people who are called carriers, recover from typhoid fever or infected with these

bacteria but not ill, still carry the bacteria and still be able to infect the people around

him. Both ill persons and carriers of typhoid fever is Salmonella Typhi in their feces.

Typhoid fever can be obtained if you eat food or drink beverages that have

been touched by someone who has been infected with Salmonella Typhi or if the water

is consumed or water used to clean food contaminated with Salmonella Typhi bacteria.

Therefore, typhoid fever is more common in areas where hand washing is less popular

and the area where the water may be contaminated with sewage.

a Salmonella Typhi bacteria enter the body, they multiply and spread into the

bloodstream. The body reacts with sustained fever as high as 103° to 104° F (39° to 40°

C) as well as several other symptoms such as weakness, abdominal pain, headache, or

loss of appetite. In some cases, patients have a rash. The only way to know for sure if

the person is exposed to typhoid fever or not is by testing a stool sample or blood,

whether infected by Salmonella Typhi or not.

Two basic actions can protect themselves from typhoid fever:

1. Avoid risky foods and drinks. Avoiding risky foods will also help protect ourselves

from diseases such as diarrhea, cholera, dysentery, and hepatitis A.

2. in developed countries such as the United States, there is a vaccination against

typhoid fever.

With this it can be concluded that Mr. Anton had exposed to typhoid fever

due to the consumption of foods that are less clean. As a very busy event organizer,

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very reasonable if Mr. Anton buy food in any place that is easy to come by because he

felt he did not have much time to pick and choose for foods. In other words, the

consciousness of the importance of cleanliness of water and food consumed of Mr.

Anton is still not good.

3. How relation between Helicobacter Pylori and Typhoid Fever?

H. pylori infection occurs when a type of bacteria called Helicobacter pylori

(H. pylori) infects your stomach, usually during childhood. A common cause of peptic

ulcers, H. pylori infection is present in about half the people in the world. Most people

don't realize they have H. pylori infection, because they never get sick from it. If you

develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H.

pylori infection, because it can be treated with antibiotics.

Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare

in industrialized countries. However, it remains a serious health threat in the developing

world, especially for children. Typhoid fever spreads through contaminated food and

water or through close contact with someone who's infected. Signs and symptoms

usually include high fever, headache, abdominal pain, and either constipation or

diarrhea. When treated with antibiotics, most people with typhoid fever feel better

within a few days, although a small percentage of them may die of complications.

Vaccines against typhoid fever are available, but they're only partially effective.

Vaccines usually are reserved for those who may be exposed to the disease or are

traveling to areas where typhoid fever is common.

Evaluated the association between typhoid fever and Helicobacter pylori

infection, as the latter microorganism may influence gastric acid secretion and

consequently increase susceptibility to Salmonella typhi infection.

4. How health-sick concept as like a spectrum?

Concepts of health and illness

The words ‘health’ and ‘illness’ is have different meaning to everybody.

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When people get ill they usually develop symptoms. A symptom is

something that is noticeable to the affected person (e.g. itching or pain) and might be

noticeable to other people too (e.g. a rash or a lump).

After developing symptoms, people think of themselves as ill and decide to

take some action. It can be to buy some medication or to visit their GP. Then the GP

confirm that the person is ill and diagnose the disease.

However, sometimes this pattern is not followed because of some situations.

For example, people think of themselves as ill but a GP or a hospital consultant could

not detect any disorder. Sometimes, people might have a disease but not notice any

symptoms, or notice them but not think of themselves as ill. For example, a person catch

a cold, but ignore it and perform as normal.

Concept of Health

A holistic concept of health

A holistic concept of health is the belief that being healthy means being

without any physical disorders or diseases and being emotionally comfortable. For

example, according to this concept, a person who feels anxious or has low self-esteem

would not be well. People with this view are likely to label themselves as ill when they

experience unpleasant feelings, not just physical discomfort or pain. They are tend to

interpret minor discomforts, such as tiredness, as symptoms of illness.

A positive concept of health

A positive concept of health is the belief that being healthy is a state achieved

only by continuous effort. People with this belief take active steps to maintain their

health — through their choice of food, by taking exercise and other activities. Such

people are responsible for their own health. They will take credit for the continued

absence of disease and blame themselves if they develop symptoms. People who do not

take action to maintain their own health (for example, by ‘healthy eating’), according to

this view, cannot be healthy — even if there is nothing wrong with them.

A negative concept of health

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A negative concept of health is the view that being healthy is the absence of

illness — for example, not having any symptoms of disease, pain or distress. People

with this view are tend to believe that good health is normal and think that they are well.

They don't take any special actions to keep healthy because they think it’s not neccesary.

They don’t think of themselves as ill when they have minor discomfort caused by colds

or headaches, or when they feel tired or depressed.

Concepts of illness

Three different views or concepts of illness are ‘illness as illness’ (a

subjective sensation), ‘illness as disease’ (a set of symptoms) and ‘illness as a disorder’

(a malfunction of a body tissue, organ or system).

Illness as the subjective sensation of illness

A subjective sensation of illness means feeling ill. People might feel ill when

they have some disease symptoms; or when no symptoms are present. According to this

definition, illness exists when people decide that they feel ill or describe themselves as

being ill. People who are very anxious about, or sensitive towards, their health are likely

to think of themselves as ill even when there are no or very little symptoms. Otherwise,

some people refuse to think of themselves as ill even when there are obvious signs that

something is wrong.

Illness as having observable symptoms of disease

Disease refers to a diagnosable problem, which might be physiological (a

physical disorder) or psychiatric (a mental disorder). This view of illness is objective,

illness is something likely to be publicly available evidence— for example, two people

with medical knowledge agreeing that a patient has a disease.

Illness as a disorder

The word ‘disorder’ refers to some malfunction of a body tissue, organ or

system. This concept is based on the idea that body systems can go wrong. This

definition is the one that the writer of a medical textbook is likely to have in mind.

llness - Wellness Continuum

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The continuum bridged the relationship between wellness, medically driven

treatment models and high-level wellness. Individuals moving from the center or neutral

point to the left or treatment model moved to deteriorating states of health and finally

premature death. Individuals moving to the right of center increased their levels of

health and well-being through awareness, education and wellness growth. One of the

core concepts of the continuum was that the Treatment Paradigm could only take

individuals back to the neutral point, where the symptoms of disease have been

alleviated. The Wellness Paradigm, which could be utilized at any point on the

continuum, moved individuals toward higher levels of wellness.

Disease as a Process: Natural History and Clinical Course

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The clinical course of a disease, from the biomedical perspective

The dashed line in the centre of the diagram indicates that the disease

progression may be interrupted at any stage. And not all cases progress across all the

stages. After exposed with an infectious agent (or other physiopathologic event) there is

a theoretical point at which the disease process may begin. Symptoms appear after a

delay for seconds (as with anaphylaxis) to years (as with some cancers). The patient may

interpret their symptoms as indicating an illness and may seek professional care. After a

medical diagnosis, therapy is normally begun and short- and longer-term outcomes can

be recorded. If the outcome is unsatisfactory or unexpected there may be a loop back to

re-diagnose the condition and alter the therapy, as suggested by the pink curved line.

The move towards thinking of disease as a process, rather than a state, required new

concepts to describe the stages in this process.

* From the spectrums above we conclude that Mr. Anton is in the Symptoms/Symptoms

Appear level because he experience an epigastric pain which indicated an illness.

Factors that Affect Concepts of Health and Illness

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The Mandala of Health

This is a model of health and the community ecosystem that represents health

determinants as concentric nested influences, beginning with the person at the centre

(distinguishing body, mind, and spirit), then moving outwards to the social and physical

environment, and then moving further out to culture, economic, and societal influences.

The mandala is intended to draw attention to the wide range of health determinants, and

to the need to address many levels in developing strategies for improving health.

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This diagram illustrates the phases in the natural history of a disease, and

links these to levels of prevention. Different groups, in different locations, will deliver

the different preventive strategies. Secondary prevention moves detection earlier (when

treatment may be more effective) by an amount known as the lead time.

Ideally, prevention occurs before people contract a disease, so preventive

programs are often delivered to currently healthy people in the general population. To

design such a programme, it necessary to understand the distribution of the condition in

the population and know how to identify future cases. The "iceberg of disease" metaphor

(a metaphor portraying the idea that clinicians only see a minority of cases of any given

disease) suggests that for every case that comes to a clinician, there are likely to be many

more people with pre-clinical disease in the community, and even more with risk factors

for the condition.

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5. How level of prevention epigastric pain in Anton?

In the science of epidemiology known three stages of prevention.

1. Primary prevention

Primary prevention seeks to reduce the frequency of new cases of disease occurring in a

population and this is most applicable to persons who are in the stage of susceptibility.

Primary prevention there are two strategies:

Health Promotion

These strategies include health education and health promotion programs designed to

foster healthier lifestyles and environmental health programs designed to improve

environmental quality. Specific examples of primary prevention include health

education, selective checks regularly, terms of adequate housing, recreation, and good

working conditions.

From Mr. Anton cases, in this stages effort of Mr. Anton is get more information about

health education as food sanitation, information how to ballance work and rest to save

helath.

Specific Protection

Specific protection is a specific effort to prevent the spread of certain diseases, such as

immunization, environment sanitation, skills of preventing an accident, specific

nutrition, avoid alergen, improved skills for preventing teen drug use and solicitation to

cope with stress etc.

2. Secondary Prevention

Secondary prevention attempts to reduce the number of existing cases in a population

and, therefore, is most appropriately aimed those in the stage of presymptomatec

disease or the early stage of clinical disease. Secondary prevention focuses on:

Early diagnosis and Prompt treatment

Early diagnosis include individual case detection and mass, screening for disease. The

aim of those level to recover and preventing dissease process, preventing spread of

infectious dissease, preventing complication and disability, shorten the disability.

Mr. Anton ought to check up to hospital or ather provider health if have get symptoms.

3. Tertiary Prevention

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Tertiary prevention tries to limit disability and improve functioning following disease or

its complications, often through rehabilitation. Tertiary Prevention strategies involve:

Treatment and rehabilitation

Providing hospital and health services to retraining extant ability maximally, promotion

in society and industry to employ who have been rehabilitated if possible a main

employee.

Limitation of disability

The aim of adequate treatment to stop dissease process and preventing further

complication and disability, to providing facility to decrese disability and preventing

mortality.

Social environment have big role in this stages to prevent the same symptoms in other

time.

Cited from: (Leavell RH, 1979)

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6. What are the influence stamina drink to health?

Energy drink is a type of beverage which contains stimulant drugs chiefly

caffeine and marketed as mental and physical stimulator. The main active constituents of

energy drinks include varying amounts of caffeine, guarana extract, taurine and ginseng.

Additional amino acids, vitamins and carbohydrates usually complete the list of

purportedly beneficial ingredients. The intended effects of energy drinks are to provide

sustenance and improve performance, concentration and endurance. Manufacturers pitch

their product to athletes, students and people in professions that require sustained

alertness.

These drinks are also commonly consumed at dance parties, which require

sustained energy for prolonged activity into late hours. In this setting, they may also be

combined with alcohol and recreational drugs such as ecstasy (MDMA; 3,4-

methylenedioxymethamphetamine) or other amphetamines. Young adults and

adolescents are particularly attracted to energy drinks because of effective product

marketing, peer influence and a lack of knowledge of the potential harmful effects. The

high sugar content in caffeinated energy drinks is similar to other soft drinks and is

known to contribute to obesity. Energy drinks usage has now become wide spread

people, particularly who want to meet both cognitive and physical performance demand.

High intake of energy drinks, particularly brand that contain high quantity of

caffeine can result in the slow downing the rate at which nutrient is absorbed into blood

stream; it also slow downs the rate of fluid absorption or dehydration during an exercise.

Excessive caffeine provides a blast of energy enabling the person to feel good initially

but when energy is burn up in 30–40 minutes, there is a sugar crash. Findings that

person who consumed energy drinks reported less sleepiness and increased alertness.

Approximately 15.3% person claim dehydrating effect of energy drinks on their body

which was consistent with past studies. It may be due to the fact that there were serious

consequences when a person substitute energy drinks for water during strenuous

physical activity, this is because caffeine act as diuretic agent and it removes extra fluid

from the body therefore if a person consume it while sweating, and it will result in

severe dehydration.

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In our setup prevalence of insomnia due to energy drinks was around 17%

which was much less than a study occur in Thailand. Most subject who reported

recreational use experience symptoms such as palpitation, tremors, seizures, inability to

focus, accelerated heart rate and gastrointestinal upset, the same as reported in past

studies. Elevation of blood pressure and heart rate was may be due to the press or effect

of caffeine which cause peripheral vasoconstriction rather than enhancement of cardiac

output.

Symptoms of caffeine withdrawal including fatigue, insomnia, muscle aches,

irritability, and depression begin in 12–24 hours after the last dose of Energy drinks; our

findings were consistent with past study. Recent research such as that reported a medical

journal Pediatrics reported online on March 14, 2014 states there is no safe limit in

consuming energy drinks for children, adolescents and young adults. Research on people

who consume excessive energy drinks can trigger heart palpitations, seizures, strokes

and sudden death events. The researchers identified the main causes that triggered it is

the health impact of excessive caffeine content. Effect of caffeine may become

increasingly more powerful when combined with various other ingredients in energy

drinks. So it seems that physicians should recommend to the parents that should prohibit

the use of the drinks on children, adolescents and young adult. Possible warnings and

recommendations were similar to the case of cigarettes, alcohol and narcotics.

In the study shows some of the ingredients contained in energy drinks

contain 14 times more caffeine than cola type beverages. This is the same as drinking

seven cups of coffee. The researchers examined 28 different energy drinks brands on the

market and the conclusion is surprising. An adult that has formed in the body can

tolerate the caffeine may be able to drink a few cups of coffee throughout the day with

no ill effects. However, the child or adolescent drinking the equivalent of seven cups in

one go is certainly cause serious health effects. Some reports say that the non-alcoholic

beverage when mixed with alcohol will have a negative impact, especially on the state of

certain health conditions. Some of the findings revealed a few deaths in Europe due to

teenagers or young adults drink energy drinks mixed with alcohol, or who had

conditions like epilepsy that may increase the risk. Energy drinks contain a variety of

stimulating substances, which when mixed can be harmful to the body. Consume too

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much caffeine, which is the main content in energy drinks can cause dehydration There

are few records of someone's death after drinking an energy drink to excess.

So far according to research energy drinks have no therapeutic benefit effect.

And some of the ingredients of the products are being researched and not get regulatory

approval. Pharmacological effects of the ingredients in energy drinks is known and not

known. When this effect is associated with reports of poisoning or toxicity improving

world health care associations to the potential for serious side effects in the use of

energy drinks. In the short term requires vigilance various parties about the possible

effects of energy drinks in the community to provide information and knowledge to

parents and families

The report revealed the American Academy of Pediatrics and used as a guide

for physicians that energy drinks. Dentist revealed that energy drinks also have damaged

teeth in australia teens. The Associated Press reported a total of 677 cases of overdose

and adverse effects recorded from October to December 2010 as tracked by the

American Association of Poison Control Centers. Reported so far in 2011 to 331 in

February and most of them involving children and adolescents most children under 6

years. Ingredients contained in stamina drinks, among others:

1. HFCS or other types of added sugar is a sweetener composition that does not have the

same benefits as a sweetener, not to mention low in calories but high in fat content. In

fact, the consumption of these products can lead to obesity, because it contains fat will

be stored the body. Indeed there are kinds of products low in sugar or sugar-free, but the

problem is they must incorporate other artificial sweeteners, which have to watch the

effect.

2. Caffeine; material contained in this coffee will not be able to give energy to the

drinker, just uplifting by stimulating the central nervous system. Most of the products

entering the composition of the caffeine content of soft drinks exceeded. Caffeine can

cause addiction, dizziness and headaches when excess consumption.

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3. Vitamin B; artificial Vitamin B is helpful and will not be directly excreted through

urine, because vitamin B is useful only when aided by the presence of several vitamins

and substances in the body support. Especially for vitamin B12, may cause interference

to the nervous system if consumed regularly.

4. For the long term, mixing alcohol with energy drinks can cause hepatitis, tumors, and

cirrhosis. This is due to two drinks before going to react when mixed and the body will

not be able to process the results of earlier reactions.

5. Drink 2 or 3 cans let alone more can cause poor concentration, a sense of panic and

worry.

6. Mixing energy drinks with drugs is dangerous, because it can increase the likelihood

of cardiovascular disease such as stroke.

7. Drinking energy drinks while sweating more than 1 can moreover can cause

dehydration, because it contains caffeine which can cause the kidneys to work more

drain fluids from your body. Imagine, when athletes consume these drinks before the

match, instead of added energy obtained even dehydration.

8. Taurine is an amino acid. Based on research, it is not clearly known benefits of taurine

in the brain, even said taurine or anesthetic sedative influence on the brain. Taurine also

cause unstable heartbeat.

9. Sodium citrate usually put in energy drinks as a preservative. The effects of these

chemicals is to accelerate the process of conversion of glucose to lactic acid, thus

speeding up the decline in stamina.

10. Energy drinks are very dangerous for people with hypertension, because your heart

rate will be driven by these drinks. Some other ingredients such as inositol and niacin

are harmless, but also does not bring any benefit, since the dose is very small.

In conclusion drinks energy drinks are low in nutrients but high in fat plus some

substances which have some side effects, especially caffeine.

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7. How to treatment epigastric pain?

Treatment of Epigastric

Epigastric pain can be regarded as a symptom of pain in the upper abdomen.

Epigastric This often occurs due to gastritis. Therefore, treatment for this epigastric

same as treatment for gastritis.

Treatment of gastritis depends on the specific cause. Gastritis can becaused

by NSAIDs or alcohol and by H. pylori infection. In treating this disease, in addition to

the action of active, passive action is also required. The point here is, treatment of

gastritis (include epigastric) can be divided into 2 Personal Treatment and Medication.

Personal treatment ( Non-pharmacologic therapy) :

Diet - (+/-) - except coffee and alcohol, which must be excluded.

Avoidance of agents injurious to the mucosal barrier, e.g., unbuffered aspirin

( NSAIDs)

Alleviation of emotional stress, anxiety, etc.

Stop smoking.

Medications used to treat gastritis include:

Anti-anxiety to kill the anxiety.

Diazepam is used to relieve anxiety, muscle spasms, and seizures and to

control agitation caused by alcohol withdrawal. Diazepam comes as a tablet, extended-

release (long-acting) capsule, and concentrate (liquid) to take by mouth. Do not open,

chew, or crush the extended-release capsules; swallow them whole. It is usually taken 1

to 4 times a day and may be taken with or without food. Follow the directions on your

prescription label carefully, and ask your doctor or pharmacist to explain any part you

do not understand. Take diazepam exactly as directed. Diazepam can be habit-forming.

Do not take a larger dose, take it more often, or for a longer time than your doctor tells

you to. Tolerance may develop with long-term or excessive use, making the drug less

effective. This medication must be taken regularly to be effective. Do not skip doses

even if you feel that you do not need them. Do not take diazepam for more than 4

months or stop taking this medication without talking to your doctor. Stopping the drug

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suddenly can worsen your condition and cause withdrawal symptoms (anxiousness,

sleeplessness, and irritability). Your doctor probably will decrease your dose gradually.

Beside that, some examples are included in the class of anti-anxiety are Kalmag and

Spasmium.

Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive

tract, your doctor may recommend a combination of antibiotics to kill the bacterium.

Antibiotic regimens are different throughout the world. In the United States, antibiotics

prescribed for treatment of H. pylori include amoxicillin, clarithromycin (Biaxin),

metronidazole (Flagyl) and tetracycline. You'll likely need to take antibiotics for two

weeks, depending on their type and number.

Medications that block acid production and promote healing. Proton pump

inhibitors reduce acid by blocking the action of the parts of cells that produce acid.

These drugs include the prescription and over-the-counter medications omeprazole

(Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium),

dexlansoprazole (Dexilant) and pantoprazole (Protonix). Long-term use of proton pump

inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine

fractures. Ask your doctor whether a calcium supplement may reduce this risk.

Medications to reduce acid production. Acid blockers — also called histamine

(H-2) blockers — reduce the amount of acid released into your digestive tract, which

relieves gastritis pain and encourages healing. Available by prescription or over-the-

counter, acid blockers include ranitidine (Zantac), famotidine (Pepcid), cimetidine

(Tagamet) and nizatidine (Axid).

Antacids that neutralize stomach acid. Your doctor may include an antacid in your

drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain

relief. Side effects can include constipation or diarrhea, depending on the main

ingredients.

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8. What are the factors that causing epigastric pain instead of infection?

External Factors

Eating Pattern.

People who eat a heavy meal and then lie on their back or bend over from the

waist are at risk for an attack of heartburn. Anyone who snacks at bedtime is also at

high risk for heartburn.

Pregnancy

Pregnant women are particularly vulnerable to GERD in their third trimester,

as the growing uterus puts increasing pressure on the stomach. Heartburn in such cases

is often resistant to dietary interventions and even to antacids.

Obesity

A number of studies suggest that obesity contributes to GERD, and it may

increase the risk for erosive esophagitis (severe inflammation in the esophagus) in

GERD patients. Studies indicate that having excess abdominal fat may be the most

important risk factor for the development of acid reflux and associated complications,

such as Barrett's esophagus and cancer of the esophagus. Researchers have also reported

that increased BMI is associated with more severe GERD symptoms. Losing weight

appears to help reduce GERD symptoms. However, gastric banding surgery to combat

obesity may actually increase the risk for, or worsen symptoms of GERD.

Respiratory Diseases

People with asthma are at very high risk for GERD. Between 50% and 90%

of patients with asthma have some symptoms of GERD. People with chronic

obstructive pulmonary disease (COPD) are also at increased risk for GERD, and having

GERD may worsen pre-existing COPD.

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Smoking

Increasing evidence indicates that smoking raises the risk for GERD. Studies

suggest that smoking reduces LES muscle function, increases acid secretion, impairs

muscle reflexes in the throat, and damages protective mucus membranes. Smoking

reduces salivation, and saliva helps neutralize acid. It is unknown whether the smoke,

nicotine, or both trigger GERD. Some people who use nicotine patches to quit smoking,

for example, have heartburn, but it is not clear whether the nicotine or stress produces

the acid backup. In addition, smoking can lead to emphysema, a form of COPD, which

is itself a risk factor for GERD.

Alcohol Use

Alcohol has mixed effects on GERD. It relaxes the LES muscles and, in high

amounts, may irritate the mucus membrane of the esophagus. Small amounts of alcohol,

however, may actually protect the mucosal layer. It should be noted that a combination

of heavy alcohol use and smoking increases the risk for esophageal cancer.

Hormone Replacement Therapy.

Symptoms of GERD are more likely to occur in postmenopausal women who

receive hormone replacement therapy. The risk increases with larger estrogen doses and

longer duration of therapy.

Pills

If you use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

or naproxen, it’s possible that you’ll be more prone to heartburn along with frequent

headaches. Apart from NSAIDs, other prescription drugs can trigger heartburn too.

These include:

Antibiotics

calcium channel blockers (for hypertension)

bronchodilators like albuterol (for COPD and asthma)

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drugs for osteoporosis

Genes

Like other ailments, heartburn can also run in the family. In other words, if you have a

family member suffering from this condition, you are also at risk of having it yourself.

Experts are not sure yet how they can explain the hereditary nature of GERD, but it can

be because of:

inherited abnormalities in stomach function

hypersensitivity to acids inside the stomach

Chocolate

If you have GERD and you love chocolates, you’re going to mourn over this

fact: chocolates cause reflux more than any other food. It’s a triple threat. For one, it

contains caffeine and other stimulants like theobromine that can cause reflux. It is also

high in fat (particularly white and milk chocolate) and that can also cause reflux.

Finally, it’s rich in cocoa, and yes you guessed it right, that can cause reflux too.

Soda

Soda is another culprit. The bubbles in soda and other carbonated drinks

expand inside the stomach. This brings increased pressure that can up the risk of reflux.

Soda that contains caffeine and acidic ingredients are much worse. There was a study

done on the acidity of several cola brands and it was found that Coke, Diet Pepsi, and

Tab were the most acidic of all. If you have GERD, it’s best to stay away completely

from all types of soda drinks.

Fried Food

Fried food is bad for another reason – it increases bad cholesterol in the

body, shoots up risk for heart disease, and makes you more prone to high blood pressure

among others. Other than that, it’s also a major cause of reflux. Next to chocolate, it’s

the next food that is most commonly linked to heartburn. Deep fried foods are the worst

of their kind. Buttered chicken, French fries, and doughnuts are just few of the many

examples.

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Other external factors that may increase your chance of heartburn :

Exercising or strenuous activity immediately after eating

Age

Employment status

Marital status

Educational level

Economic level

Lying down, bending over, or straining after eating

Prior surgery for heartburn such as vagotomy

Certain nervous system disorders

In-dwelling nasogastric tube

Foods and beverages associated with heartburn include:

Caffeine drinks such as coffee or carbonated soft drinks

Citrus fruits

Spicy foods

Foods made with tomatoes, such as pizza, chili, or spaghetti sauce

Medications and supplements associated wtih heartburn include:

Anticholinergics

Calcium channel blockers

Theophylline, bronchial inhalers, and other asthma medications

Nitrates

Sildenafil

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Bisphosphonates

Internal Factor

Psychosomatic Factors

Functional heartburn coexists with other functional gastrointestinal disorders.

GERD symptoms are also more common in patients with irritable bowel syndrome.

Exposure of severe sustained stress has been associated with increased heartburn.

Although no controlled trials have shown benefits of behavioral therapy in functional

heartburn patients, relaxation training in a small number of patients with GERD has

been shown to reduce the symptom ratings and esophageal acid exposure.

9. How the influence of food menu that trigger epigastric pain?

The term 'prevalence' of Epigastric pain usually refers to the estimated

population of people who are managing Epigastric pain at any given time. The term

'incidence' of Epigastric pain refers to the annual diagnosis rate, or the number of new

cases of Epigastric pain diagnosed each year. In industrialized countries like United

State, England, France, etc, 20 to 50 population may be affected by epigastric pain.

Rates of Epigastric pain infection are higher in areas with late mealtime, food menu,

poor sanitation, and etc. And infection rates may be higher than 80 percent in some

Developing countries. In 2004 the epigastric pain ranks number 9 out of 50 major

rankings outpatients in hospitals throughout Indonesia with 218,500 cases (RI Health

Department Medical Care Data).

This is caused by food menu that unbalanced so that become unhealthy

pattern/diet food. Before this, the late of mealtime trigger the epigastric pain. The late

mealtime encourage people to consume various food menu. Food menu will determine

the amounts of nutrients obtained for doing activities. Sufficient balance according to

needs of providing nutrients that enough to carry out physical activities, if the intake is

less it will affect the health and quality life.

Statistical testing was not accomplished for age comparisons because of the

small numbers available after stratification by age groups, but was done for analyses

comparing frequent vs infrequent heartburn status. A hectic day at work, business

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travel, a week of long work hours, and a week with numerous deadlines were reported

less by the older age groups as causes of heartburn. Heartburn before, during, and

immediately after exercise or sports was reported more frequently as a cause of

heartburn by the younger age groups. Because the hectic day, many people reported

eating a higher percentage of heartburn-promoting foods, including fatty foods,

chocolate, peppermint, citrus fruits or juices, and tomato products. Men were 64% more

likely than women to report drinking alcoholic beverages as a cause of heartburn (OR,

1.64; 95% CI, 1.29-2.09).

The hectic and late mealtime for people who always have bussines travel

makes them consume the fast, easy, delicious such as citrus fruits or juices, tomato

products, spicy foods, chocolate, peppermint, fatty and fast food (high fat), caffeinated,

carbonated, and alcoholic beverages. All that food menu that mentioned, direct and

indirect trigger the common of epigastric pain

Chocolate seems to cause more reflux than any other food. It’s a triple whammy:

1. Chocolate contains caffeine and other stimulants such as theobromine, which cause

reflux.

2. Chocolate is high in fat, and fat causes reflux.

3. Chocolate is also high in cocoa, and cocoa causes reflux.

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Soda and other carbonated beverages are some of the main causes of acid

reflux. The bubbles of carbonation expand inside the stomach, and the increased

pressure contributes to reflux. Sodas with caffeine and those that are acidic (almost all)

are even worse. Fried food is the single most recognized cause of reflux. It is also the

food most often associated with heartburn, which is chest pain from esophageal

reflux. Deep-fried foods are on the "bad list" because of their high fat content.

Beer, liquor, and wine are believed to contribute to reflux. Many alcoholic

beverages are not very acidic. However, alcohol is believed to relax the valve at the

bottom of the esophagus (where it joins the stomach), leading to reflux.Otherwise, have

only one cocktail or glass of wine a day, and completely avoid acidic mixers like orange

juice or soda. Similarly all high-fat foods cause reflux. There is no reason to believe that

one high-fat butter or cheese is better than another in this regard. If you have reflux and

a serious cheese habit, something has to give.Acid reflux is caused by high-fat cuts of

meat beef, pork, lamb which stay longer in the stomach and increase the chance of acid

reflux.

Coffee or espresso a day is fine, but people who drink coffee all day long are

courting reflux. For instance, some patients report that coffee consumption causes their

heartburn, while other patients are not affected by the consumption of this beverage.

Coffee is a beverage that consists of various types of materials and chemicals : including

fats, carbohydrates, amino acids, vegetable acid called phenols, vitamins and minerals.

Coffee is known to stimulate the stomach to produce gastric acid thereby creating more

acidic environment and could irritate the stomach. There are two elements that can affect

the health of the stomach and the stomach lining, namely caffeine and chlorogenic acid.

The study, published in Gastroenterology found that various factors such as

acidity, caffeine or other mineral content in coffee can trigger high stomach acid. So that

no single component should be responsible.

Caffeine stimulates of the central nervous system (brain), respiratory system

and cardiovascular system. Therefore, no wondered that every reasonable amounts of

coffee drinking (1-3 cups), our bodies feel refreshed, excited, not easily tired after

drunk. Caffeine stimulates of the central nervous system so that it can increase activity

and gastric secretion hormones and pepsin in the stomach. Gastrin hormone released by

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the stomach has the effect of gastric secretion from the highly acidic gastric fundus.

Increased acid secretion that can cause irritation and inflammation of the gastric mucosa.

Thus, digestion disorders are vulnerable owned by people who frequently

drink coffee is epigastric pain (inflammation of the stomach lining). Some people who

have had indigestion and discomfort in the abdomen or stomach usually advise you to

avoid or limit drinking coffee so that the condition does not get worse.

10. How the influence of life style factors in epigastric pain?

Lifestyle factors such as chronic stress, drinking coffee, and smoking were

long believed to be primary causes of ulcers, it is now thought that they only increase

susceptibility to ulcers in some H. pylori carriers.Shift Work and Other Causes of

Interrupted Sleep. People who work the night shift and get a very busy schedule have a

significantly higher incidence of ulcers than day workers.Irregular sleeping patterns may

also cause acidity in the stomach. Researchers suspect that frequent interruptions of

sleep may weaken the immune system's ability to protect against harmful

bacteria.Consumption of spicy foods and oily foods increases the amount of acid

produced in the stomach.Consumption of foods those are very rich in fiber content.

The mean duration of meal timing deviation was 8 years for the HP and

gastritis groups. No significant differences were found in subjects who skipped meals or

had inconsistent amount of food.Frequent deviation from the regular meal timing for a

prolongedperiod of time seemed to be associated with increased risk of HP and gastritis.

Regular meal timing may play an important role in the prevention of HP infection and

gastritis

According to Ms Lim Su Lin, the chief dietician at NUH, people who often

eat meals at irregular times are at greater risk of developing Helicobater Pylori (HP)

infection and gastritis. Her study found that someone who deviates from his regular meal

times for more than an hour, at least twice a week, increased his risk of getting an HP

infection and gastritis by three times. HP is a bacteria that lives in the mucous lining of

the stomach and is known to be the main cause of chronic, long-term gastritis, and can

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41

lead to complications like ulcers and stomach cancer in some people. If a person delays

his meal for two or more hours at least twice a week, he puts himself at 6.3 times the

risk of getting HP and 3.5 times the risk of getting gastritis. She also found that subjects

with either HP or gastritis habitually delayed meals for about eight hours, compared with

4½ hours for the control group.

Based on study at Brazilians or Japanese, the consuming of rice or diet of

rice can include in the step of Pylori who infect the gastritis. The prevalence of atrophic

gastritis was 31.9% (95% confidence intervals, 26.6%–37.6%). The proportion of

subjects with atrophic gastritis increased with age, but there were no significantly

marked differences in the proportions of subjects with atrophic gastritis among the three

generations studied (first generation [Issei], second generation [Nisei], and third

generation [Sansei]) for any 10-year age group. The associations with smoking and

alcohol drinking were not significant. Length of education was inversely associated with

gastric atrophy, while infrequent rice intake was preventive; the odds ratio relative to

everyday rice intake was 0.13 (95% confidence intervals, 0.39–0.46) on multivariate

analysis.

2.2 Additional Learning Issues

11. How is Mr. Anton’s condition based on health and illness spectrum?

We decide to choose Symptoms as Mr. Anton’s position on Illness-Wellnes Spectrum

above. The reason why we choose Symptoms is caused Mr. Anton has experience

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epigastric pain and based on data there is some problems on physic, mental and social

dimension. From the physic dimension, such as drinking energy drink, eat carelessly,

and having an irregular pattern of sleep. From the mental dimension, such as

workaholic which caused him to forget his own health, working with hurry and anxiety

because of job deadline. From the social dimension, such as being single which mean

there is no nearest person to care for his life pattern, and job demands to do the best for

his job. Epigastric pain experienced by him is a symptom of an illness which need some

curative and prevention solution as soon as possible, so it will not move to worse

condition.

12 . How is the influence of social factor in epigastric pain of Mr. Anton’s cases?

SOCIAL FACTORS

Social factors are factors that are influenced by people around us.

Components included in it are the reference group, the family, the role of fiber and

social status. This factor has a close mutual relationship with other factors, like physical

and mental.

In Anton's case, he has a problem in his social aspects, that causing epigastric

in Anton. From the scenarios we know that Anton is a very busy event organizer. While

he was single and living away from his family. So, we will look at the social aspects of

Anton's in terms of his status and job demands.

Status

The lack of social support . That is , the stress will tend to appear in workers

who do not have the support of their social environment . Social support here could be

the support of the work environment and family environment . Many cases show that ,

workers who experiencing job stress is not receiving the support ( especially moral ) of

the family , such as parents , in-laws , children , friends and the like . Likewise, when a

person does not have the support of fellow workers ( both leaders and subordinates )

will tend to be more susceptible to stress . This is caused by a lack of social support that

causes inconvenience of carrying out the work and duties . In this case , Anton spelled

not have a wife and stay juh from family . So the possibility of Anton lack of support

from loved ones . Then it will return the stress arising Anton body figure though happy

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to work . Stress is what triggers the onset of gastrointestinal diseases such as gastritis ,

epigastric , and others .

Job Demands

In the world of work , it must be a sense of competition . A worker will strive

to be the best that can still exist in the world of work . Competition is what will give

birth to their own anxiety because they get many preassure , so this will be a direct

psychological impact on workers themselves . Psychologically, job dissatisfaction arises

followed by pressure on emotions such as anxiety, irritability or irritability, bad mood,

moody, bored and rude attitude. Stress can also result in changes in workers' behavior,

such as decreased productivity, attendance and commitment to the organization. It also

generates behaviors such as smoking or excessive alcohol consumption, aggressiveness

in speech or act, to do things that interfere in the workplace, often found sleeping or at

work. Stress experienced continuous and uncontrolled, can lead to burn-out is a

combination of exhaustion physically, psychologically and emotionally. . When this

disorder is received in a long time can cause psychosomatic diseases such as gastritis

( automatically result in epigastric ) , stress , fatigue , and others .

13. How is the influence of mentally factor in epigastric pain of Mr. Anton’s cases?

Mentally influenced by psychological factors and emotions that exist in a

person. This factor has a strong reciprocal relationship with the physical and social

factors. Psychological and emotional factors can affect the function of the

gastrointestinal tract and lead to changes in gastric acid secretion, motility and affects

vascularization of the gastric mucosa and lower threshold of pain stimuli (Mudjaddid,

2006). In the case of Anton, he had problems in the mental aspect. From the scenarios

we know that Anton is an event organizer that is very busy with his work. Organizing

an event is certainly a lot of work to be done includes all the purposes of an event. So,

we'll see the mental aspects of anxiety as Anton in terms of working time deadlines that

must be completed and work in a spirit of self-Anton, Anxiety as working time

deadlines. As an organizing events that demand a lot of people, making Anton should

get the job done on time and in accordance with customer expectations.

Demands professionalism, and timeliness of work at stake for both events

organizing his name. That's why it's anxiety arises in Anton, anxious because of the

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time, worried that demands professionalism make changes to acid secretion. Supported

by Anton who spends a lot of time on the road, resulting in irregularity lifestyle. Such is

not exactly the time to eat and sleep Anton. Coupled with the Anton potluck. Allows for

Anton eating unhygienic food, inadequate sanitation, and nutrition perfection. Thus

emerged the pain in the pit of the stomach Anton. The spirit at work in Anton really

enjoy the job, he worked from morning till night and did not know the time, because

very excited, Anton emotions to work can not be obstructed. This causes the doings of

eating and sleeping Anton dissipated. Frequent eating Anton Matchless on time

accompanied by Anton who likes drinking stamina to maintain stamina. Because this

can affect gastric acid secretion increased with continuous pain in the gut Anton.

14. How the influence of food and beverage and beverage sanitation in epigastric

pain?

A food and beverage sanitation is needs of the people, because the food and

beveragewho safe will protect and prevent the occurrence of disease or other health

problems. In sanitation there are essential effort to reach it. There are sanitary food and

beverage hygiene, nutrition and safety.

We will discuss about the sanitary hygiene in this part. Epigastric pain also

happened because the lack of sanitation food and beverage. In addition to the food and

beverage menu and quality of food and beverage, epigastric pain can also occur due to

the cleanliness of food and beverage. The poor sanitation of food and beverage are the

main factor in the appearance of disease. Bacterial infections cause epigastric pain is the

most common bacterium Helicobacter pylori infection as a result. H. pylori infection is

most likely acquired by ingesting contaminated food and beverage (water contaminated)

and through person to person contact. Over half the world's population is colonized by

H. pylori. In developing countries, prevalence is approximately 70-90% and most

people are infected as Infants or young children and adult.

Numerous epidemiological studies have reported positive associations

between untreated or fecally contaminated drinking water and incidence of H. pylori

infection. However, viable cells have not been cultured from water samples. When

suspended in water, H. pylori cells change morphologically from mostly spiral shapes to

mostly coccoid or U-shapes and enter a viable but nonculturable state. Some

HEALTH-SICK CONCEPT



45

experiments with animals, but not all, indicate that these coccoid forms are still

infective. It appears that the morphological change is aresponse to stress, and coccoid

cells die after some time, depending on environmental conditions .Genes specific to H.

pylori have been detected by molecular methods in drinking water and surface waters,

including sea water, and experiments indicate that H. pylori can survive up to several

weeks in water, depending on temperature, salt content, and nutrient

Simillary to Klein et al. reported earlier that the municipal water supply

seems to be an important source ofH. pylori infection among children from families of

both low and high socioeconomic status. Consumption of uncooked vegetables has also

been described as a mode for transmission of H. pylori. Goodman et al. also reported

that children swimming in rivers or pools as did using streams as a drinking water

source and those who frequently consumed raw vegetables were more likely to have the

infection.

For the general population, it appears that the most likely mode of

transmission is direct contact, by either the oral-oral route (through vomitus and saliva)

or perhaps the fecal-oral route. Waterborne transmission, probably due to fecal

contamination, may also be an important source of infection, especially in parts of the

world in which untreated water is common. Overall, inadequate sanitation practices,

low socioeconomic status and overcrowded or high-density living conditions seem to be

related to higher prevalence of H. pylori infection.

Recent faecal-oral mode of transmission is strengthened by the fact that the

source of drinking water, such as well water or river water has been contaminated by

germs proven H. pylori. Although the culture of H. pylori in water present in the

environment, such as river water or well water never made it but the PCR was found

that the water obtained in the genome of the bacteria H. pylori.

The existence of environmental H. pylori reservoirs has been suggested and

epidemiological studies indicate that water can be a source of H. pylori infection.

Studies have shown that there is a significant link between people who have Epigastric

Pain.

Besides the infection of H. pylori helicobacters , there are other infection

bacteries, like H. suis were reportedly detected in raw pork. H. pullorum has been

HEALTH-SICK CONCEPT



46

detected in cecal contents of turkeys and chickens and in raw chickenThere is a need

for a systematic survey of environmental and potable (fit to drink) waters for the

presence of Helicobacter pylori, as its presence in source or treated waters has profound

public health and epidemiological implications. The potential presence of the organism

in source water necessitates the documentation of treatment and disinfection procedures

to prevent the infection of drinking water consumers.

CHAPTER 3

3rd TUTORIAL

ANALYSIS AND CONCLUSION

3.1 Analysis of Learning Issues

Epigasthric pain can cause by gastritis. Gastritis is an inflammation,

irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually

(chronic). Gastritis can be caused by irritation due to excessive alcohol use, chronic

vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory

drugs. It may also be caused by any of the following: Helicobacter pylori (H. pylori): A

bacteria that lives in the mucous lining of the stomach. Without treatment the infection can

lead to ulcers, and in some people, stomach cancer. Pernicious anemia: A form of anemia

that occurs when the stomach lacks a naturally occurring substance needed to properly

absorb and digest vitamin B12. Bile reflux: A backflow of bile into the stomach from the

bile tract (that connects to the liver and gallbladder). Infections caused by bacteria and

viruses.

Typhoid fever is a disease caused by the bacterium Salmonella Typhi.

Typhoid fever can be obtained if you eat food or drink beverages that have been touched by

someone who has been infected with Salmonella Typhi or if the water is consumed or water

used to clean food contaminated with Salmonella Typhi bacteria.

H. pylori infection occurs when a type of bacteria called Helicobacter pylori

(H. pylori) infects the stomach, but most people don't realize they have H. pylori infection,

HEALTH-SICK CONCEPT



47

because they never get sick from it. This is what Mr. Anton experienced before. Evaluated

the association between typhoid fever and Helicobacter pylori infection, as the latter

microorganism may influence gastric acid secretion and consequently increase susceptibility

to Salmonella Typhi infection so Mr. Anton experienced the typhoid fever. And then, the

gastric acid secretion of Mr. Anton stomach increasing and the gastritis happened, caused

the epigasthric pain.

When people get ill they usually develop symptoms. A symptom is

something that is noticeable to the affected person (e.g. itching or pain) and might be

noticeable to other people too (e.g. a rash or a lump). After developing symptoms, people

think of themselves as ill and decide to take some action. So from all of these criteria, we

decide to choose Symptoms as Mr. Anton’s position on Illness-Wellnes Spectrum above.

Based on data, there are some problems on physic, mental and social

dimension. From the physic dimension, it can be concluded that Mr. Anton had exposed to

typhoid fever due to the consumption of foods that are less clean. As a very busy event

organizer, very reasonable if Mr. Anton buy food in any place that is easy to come by

because he felt he did not have much time to pick and choose for foods. In other words, the

consciousness of the importance of cleanliness of water and food consumed of Mr. Anton is

still not good. Then, food menus that consumed by Mr. Anton was unbalanced so it become

unhealthy pattern/diet food. Before this, the late of mealtime trigger the gastritis that may

cause the epigasthric pain. The late mealtime encourage people to consume various food

menus, whereas food menus will determine the amounts of nutrients obtained for doing

activities. Sufficient balance according to needs of providing nutrients that enough to carry

out physical activities, if the intake is less it will affect the health and quality life. Mr. Anton

does not realize the importance of food menus yet.

HEALTH-SICK CONCEPT



48

Next, Mr. Anton has a behavior to drink energy drinks, which is not good for

his body, so it worsened his health state. There are many ingredients in energy drinks that

are not too good if consumed everyday like caffeine, guarana extract, HFCS (sweetener),

taurine and ginseng. He is having an irregular pattern of sleep too.

From the mental dimension, such as workaholic cause him to forget his own

health, working with hurry, anxiety because of job deadline, and he really enjoy the job so

he worked from morning till night and did not know the time, because very excited, Anton

emotions to work can not be obstructed. This influence the doings of eating and sleeping of

Mr. Anton. From the social dimension, such as being single which mean there is no nearest

person to care for his life pattern, and job demands to do the best for his job.

Actually, Mr. Anton condition still can be prevented or treated. In the science

of epidemiology, known the three stages of prevention. In Mr. Anton case, for primary

prevention, there are health promotion which including health education, selective checks

regularly, terms of adequate housing, recreation, and good working conditions as well as

specific protection such as environment sanitation, skills of preventing an accident, specific

nutrition, improved skills for preventing teen drug use and solicitation to cope with stress.

And for secondary prevention, we can do the early diagnosis include individual case

detection and mass, screening for disease.

But, for Mr. Anton, we can treat the gastritis first. Treatment of gastritis

depends on the specific cause. Acute gastritis caused by NSAIDs or alcohol may be relieved

by stopping use of those substances. Chronic gastritis caused by H. pylori infection is

treated by eradicating the bacteria. Most gastritis treatment plans also incorporate

medications that treat stomach acid in order to reduce signs and symptoms you're

experiencing and promote healing in your stomach.

HEALTH-SICK CONCEPT



49

3.2 Final Hypothesis

Anton suffers an epigastric pain as a symptom of disease due to

problems in physics, mental, and social aspects.

3.3 Group Opinion

We’re all agree that the symptom felt by Anton happened because of his behavior to

work hard and timeless and the resulting fatigue both physically and mentally, as well as

his habit of drinking energy drinks and eating irregularly.

HEALTH-SICK CONCEPT



50

3.4 Final Concept Mapping

Picture 3.1 Final Concept mapping about Mr. Anton’s cases

51

3.4 Conclusion

Because of the irregular pattern of life, often consume energy drink, food sanitation are less guarded, and heavy work demands accompanied

by anxiety and tension caused Anton felt pain in the gut(epigastric pain). The solution is Personal Treatment and Medication, while persuasive

consisting of Primary, Secondary, and Tersiery. Primary maintain a healthy lifestyle and regular. Secondary is effective and efficient

treatment. Tersiery is the role of family and social environment in preventing the occurrence of disease symptoms.

HEALTH-SICK CONCEPT



52

REFFERENCESS

HEALTH-SICK CONCEPT



53

HEALTH-SICK CONCEPT



Source

For

Answering

Question

Searching

Method

Information

Type

Validity Importance Applicability

Foundation Result Foundation Result Foundation Result

Heartburn Risk

Factors,

Knowledge, and

Prevention

Strategies A

Population-

Based Survey of

Individuals With

Heartburn

8

Open

<http://archinte.ja

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Digital Book

(*.pdf)Idea Yes Idea Yes Idea Yes

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work.com/

article.aspx?

articleid=485088

[ accessed at

march 15, 2014 :

3.00 PM ]

9

http://

archinte.jamanet

work.com/

journal.aspxkeyw

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epigastric pain or

heartburn”

Online

JournalIdea Valid

Content of

information YesIs it

applicable?Yes

http://

repository.unhas.

ac.id/handle/

123456789/3934

[ accessed at

march 15, 2014 :

7.35 PM ]

9

www.google.com

keyword:

“mealtime and

stress affect

epigastric pain or

Online

JournalIdea Valid

Content of

informationYes

Is it

applicable?Yes

54

http://www.google.com/

http://archinte.jamanetwork.com/article.aspx?articleid=485088



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