14 mei 5level of prevention drg berni
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Concepts of Prevention
and Control
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The goals of medicine are to promote
health, to preserve health, to restorehealth when it is impaired, and tominimize suffering and distress.
These goals are embodied in the
word "prevention"
(I) Prevention
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Actions aimed at eradicating (mengakhiri),eliminating or minimizing the impact of
disease and disability, or if none of these
are feasible, retarding the progress of thedisease and disability.
Prevention; Definition and Concept
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Pencegahan penyakit adalah
Tindakan yang ditujukan untuk mencegah,menunda, mengurangi, membasmi,mengeliminasi penyakit dan kecacatanmdgn menerapkan sebuah atau sejumlahintervensi yg telah dibuktikan efektif.(Kleinbaum, et al., 1982; Last, 2001).
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The concept of prevention is best definedin the context of levels, traditionally called
primary, secondary and tertiary prevention.A fourth level, called primordial prevention,
was later added.
Prevention; Definition and ConceptDeterminants of PreventionDeterminants of Prevention
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Determinants of Prevention Successful prevention depends upon: a knowledge of causation,
dynamics of transmission, identification of risk factors and risk groups,
availability of prophylactic or early detection
and treatment measures, an organization for applying these
measures to appropriate persons or groups,
and
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Preventable Causes of Disease
BEINGS
Biological factors and Behavioral
FactorsEnvironmental factors
Immunologic factors
Nutritional factorsGenetic factors
Services, Social factors, and Spiritualfactors
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Levels of prevention
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
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Tingkat
pencegahan
Fase penyakit Kelompok target
primordial Kondisi normal kesehatan Populasi total dan
kelompok terpilih
Primary Keterpaparan factorpenyebab khusus
Populasi total dankelompok terpilih danindividu sehat
secondary Fase patogenesitas awal Pasien
Tertiary Fase lanjut (pengobatandan rehabilitasi)
Pasien
Tingkat pencegahan dan kelompoktargetnya menurut fase penyakit
Sumber : Beoglehole, WHO 1993
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Riwayat
penyakit
Tingkat pencegahan Upaya pencegahan
Pre-patogenesis Primordial prevention
Primary prevention
Underlying condition
Health promotion
Specific protection
patogenesis Secondary prevention
Tertiary prevention
Early diagnosis and prompt
treatment
Disability limitation
Rehabilitation
Hubungan kedudukan riwayat perjalanan penyakit, tingkat pencegahan
dan upaya pencegahan
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Fase sebelum sakit
Fasepre -pathogenes is dengantingkat pencegahan yang disebut
pencegahan primer (primaryprevention). Fase ini ditandaidengan adanya keseimbanganantara agent(kuman penyakit/
penyebab), host(pejamu) danenvirontment(lingkungan).
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Fase selama proses sakit
Fasepathogenes is , terbagi dalam 2tingkatan pencegahan yang disebut
pencegahan sekunder (secondaryprevention) dan pencegahan tersier(tertiary prevention). Fase inidimulai dari pertama kali seorang
terkena sakit yang pada akhirnyamemiliki kemungkinan sembuh ataumati.
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Primordial prevention
Primordial prevention consists ofactions and measures thatinhibit the emergence of riskfactors in the form ofenvironmental, economic, social,and behavioral conditions andcultural patterns of living etc.
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Primordial prevention
(cont.) It is the prevention of the emergenceor development of risk factors incountries or population groups inwhich they have not yet appeared
For example, many adult healthproblems (e.g., obesity, hypertension)have their early origins in childhood,
because this is the time when
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Primordial prevention (cont.)
In primordial prevention, efforts aredirected towards discouraging childrenfrom adopting harmful lifestyles
The main intervention in primordial
prevention is through individual and masseducation
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Primary prevention Primary prevention can be defined as
the action taken prior to the onset of
disease, which removes thepossibility that the disease will everoccur.
It signifies intervention in the pre-pathogenesis phase of a disease orhealth problem.
Primary prevention may be
accomplished by measures of
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Primary prevention (cont.)
It includes the concept of "positivehealth", a concept that encourages
achievement and maintenance of"an acceptable level of health thatwill enable every individual to lead
a socially and economicallyproductive life".
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Primary prevention (cont.)
Primary prevention may beaccomplished by measuresdesigned to promote generalhealth and well-being, andquality of life of people or by
specific protective measures.
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Primary prevention
Specific protectionHealth promotion
Achieved by
He alth educ ation
Environmental modifications
Nutritional interventions
Life style and behavioral changes
Immunization and seroprophylaxis
chemoprophylaxis
Use of specific nutrients or supplementations
Protection against occupational hazards
Safety of drugs and foods
Control of environmental hazards,
e.g. air pollution
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Health promotion
Health promotion is the process of
enabling people to increase control over
the determinants of health and thereby
improve their health.
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Approaches for Primary Prevention
The WHO has recommended the followingapproaches for the primary prevention ofchronic diseases where the risk factors
are established:
a. Population (mass) strategy b. High -risk strategy
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Population (mass) strategy
Population strategy" is directed at the wholepopulation irrespective of individual risk levels.
For example, studies have shown that even asmall reduction in the average blood pressure orserum cholesterol of a population would producea large reduction in the incidence of
cardiovascular disease
The population approach is directed towardssocio-economic, behavioral and lifestyle
changes
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High -risk strategy
The high -risk strategy aims to bring
preventive care to individuals atspecial risk.
This requires detection ofindividuals at high risk by theoptimum use of clinical methods.
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Secondary prevention It is defined as action which halts
the progress of a disease at itsincipient stage and prevents
complications.
The specific interventions are: early
diagnosis (e.g. screening tests, andcase finding programs.) andadequate treatment.
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Secondary prevention
Secondary prevention attempts toarrest the disease process, restore
health by seeking outunrecognized disease and treatingit before irreversible pathologicalchanges take place, and reverse
communicability of infectiousdiseases.
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Secondary prevention
It thus protects others from inthe community from acquiringthe infection and thus provide atonce secondary prevention forthe infected ones and primaryprevention for their potentialcontacts.
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Early diagnosis andtreatment
WHO Expert Committee in 1973defined early detection of health
disorders as the detection ofdisturbances of homoeostatic andcompensatory mechanism while
biochemical, morphological andfunctional changes are stillreversible.
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Early diagnosis andtreatment
The earlier the disease isdiagnosed, and treated the betterit is for prognosis of the case andin the prevention of the
occurrence of other secondarycases.
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Tertiary prevention It is used when the disease process
has advanced beyond its earlystages.
It is defined as all the measures
available to reduce or limitimpairments and disabilities, and topromote the patients adjustment toirremediable conditions.
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Disability limitation
disease
impairment
disability
handicap
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Impairment
Impairment is any loss orabnormality of psychological,physiological or anatomicalstructure or function.
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Disability
Disability is any restriction or lack of
ability to perform an activity in the manner
or within the range considered normal for
the human being.
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Handicap
Handicap is termed as a
disadvantage for a given individual,resulting from an impairment ordisability, that limits or prevents the
fulfillment of a role in the communitythat is normal (depending on age,sex, and social and cultural factors)for that individual.
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Rehabilitation
Rehabilitation is the combined
and coordinated use of medical,social, educational, andvocational measures for trainingand retraining the individual to
the highest possible level offunctional ability.
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Rehabilitation
Medical
rehabilitation
Vocational
rehabilitation
Social
rehabilitation
Psychological
rehabilitation
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Strategy for Prevention
AssessExposure
Identify
Populationsat High
Disease Risk(based on demography /
family history,
host factors..)
Conduct
Research on
Mechanisms(including the study ofgenetic susceptibility)
ApplyPopulation-Based
Intervention
Programs
Evaluate
Intervention
Programs
Modify Existing
Intervention
Programs
Inter
ven
tio
n
Assessment
Epidemiology Division
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(II) Control
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Control Concept of control:
The term disease control describes
ongoing operations aimed at
reducing:
The incidence of disease
The duration of disease and
consequently the risk of transmission
The effects of infection, including both
the h sical and s chosocial
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Control activities focus on primary
prevention or secondary prevention,
but most programs combine both.
control
elimination
eradication
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Disease Elimination Between control and eradication, an
intermediate goal has been
described, called "regionalelimination"
The term "elimination" is used to
describe interruption of transmissionof disease, as for example,elimination of measles, polio anddiphtheria from large geographic
regions or areas
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Disease Eradication
Eradication literally means to "tear out by roots".
It is the process of Termination of all transmission
of infection by extermination of the infectiousagent through surveillance and containment.
Eradication is an absolute process, an "all or
none" phenomenon, restricted to termination of aninfection from the whole world. It implies thatdisease will no longer occur in a population.
To-date, only one disease has been eradicated,
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Monitoring Monitoring is "the performance andanalysis of routine measurementsaimed at detecting changes in the
environment or health status ofpopulation" (Thus we havemonitoring of air pollution, waterquality, growth and nutritional
status, etc).
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Monitoring It also refers to on -going
measurement of performance of ahealth service or a healthprofessional, or of the extent towhich patients comply with oradhere to advice from healthprofessionals.
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Surveillance surveillance means to watch over
with great attention, authority and
often with suspicion
According to another, surveillance isdefined as "the continuous scrutiny(inspection) of the factors thatdetermine the occurrence and
distribution of disease and other
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Objectives of Surveillance The main objectives of surveillance are:
(a) to provide information about newand changing trends in the healthstatus of a population, e.g., morbidity,mortality, nutritional status or other
indicators and environmentalhazards, health practices and otherfactors that may affect health
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Objectives of Surveillance The main objectives of surveillance are:
(b) to provide feed-back which may be
expected to modify the policy and thesystem itself and lead to redefinition ofobjectives, and
(c) provide timely warning of publichealth disasters so that interventionscan be mobilized.
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Control of infectious diseases (the
4 CsControl
Cases Contacts Carriers Community
Diagnosisnotification
isolation
disinfection
treatment
follow up
release
observation detectionEpidemiological
Investigation &
containment
standard
strict
protective
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Evaluation of control Evaluation is the process by which
results are compared with theintended objectives, or more simplythe assessment of how well aprogram is performing.
Evaluation should always beconsidered during the planning andimplementation stages of a programor activity.
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Evaluation of control Evaluation studies may also be
carried out to generate informationfor other purposes, e.g., to attractattention to a problem, extension ofcontrol activities, training andpatient management, etc.
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Evaluation of control Evaluation can be useful
inidentifying performance difficulties.
Evaluation studies may also becarried out to generate information
for other purposes, e.g., to attractattention to a problem, extension ofcontrol activities, training andpatient management, etc.
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To summarize The goals of medicine are to promote
health, to preserve health, to restore
health when it is impaired, and tominimize suffering and distress.
These goals are embodied in theword "prevention"
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To summarize Successful prevention depends upon
a knowledge of causation, dynamics
of transmission, identification of riskfactors and risk groups, availability ofprophylactic or early detection andtreatment measures, an organizationfor applying these measures toappropriate persons or groups, andcontinuous evaluation of anddevelopment of procedures applied
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To summarize
The objective of preventive medicine
is to intercept or oppose the "cause"and thereby the disease process.
This epidemiological concept permitsthe inclusion of treatment as one of
the modes of intervention
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Thank You
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Pencegahan mengambil tindakan terlebihdahulu sebelum kejadian
Peran epidemiologi dalam pencegahan:
identifikasi faktor risiko yang dapatdimodifikasi konsep dasar penyakit
upaya pencegahan sesuai dengan riwayatalamiah penyakit r a p
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Riwayat alamiah penyakit
dan tingkat pencegahan
Periode prepatogenesis
Tingkat pencegahan primer
Promosi kesehatan
Perlindungan khusus
Periode patogenesis Tingkat pencegahan sekunder
Diagnosis dini dan pengobatan segera
Pembatasan ketidakmampuan (disability)Riwayat Alamiah Penyakit 58
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Tahap Pencegahan
Tingkat pencegahan disesuaikan denganriwayat alamiah penyakit:
1. Pencegahan primordial
2. Pencegahan primer
3. Pencegahan sekunder
4. Pencegahan tersier
h i di l
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1. Pencegahan Primordial
Tujuan: menghindari terbentuknya pola hidupsosial ekonomi dan kultural yang diketahuimempunyai kontribusi untuk meningkatkan
risiko penyakit Pencegahan primordial yang efektif
memerlukan adanya peraturan yang ketat dari
pemerintah Contoh:
P h i di l
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Pencegahan primordial
Fase penyakit
Misal: Kondisi yang mengarah penyebab
penyakit jantung koroner
Target
Populasi
kelompok terseleksi
Riwayat Alamiah Penyakit 61
2 P h P i
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2. Pencegahan Primer
Adl Upaya pencegahan yg dilakukan saatproses penyakit belum mulai (pd periodepre-patogenesis) dengan tujuan agar tidakterjadi proses penyakit
Tujuan: mengurangi insiden penyakit dengancara mengendalikan penyebab penyakit danfaktor risikonya
Upaya yang dilakukan adalah untuk memutusmata rantai infeksi agent host -environment
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Terdiri dari:
1. Health promotion
2. Specific protection
Dilakukan melalui 2 strategi: populasi danindividu
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Tingkat pencegahan primer
Perlindungan khusus
Imunisasi
Kebersihan perorangan
Sanitasi lingkungan
Perlindungan thdp kecelakaan akibat
kerja
Riwayat Alamiah Penyakit 64
Ti k t h i
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Tingkat pencegahan primer
Perlindungan khusus
Penggunaan gizi tertentu
Perlindungan terhadap zat yang dapatmenimbulkan kanker
Menghindari zat-zat alergenik
Riwayat Alamiah Penyakit 65
P h i
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Pencegahan primer
Fase penyakit
Faktor-faktor penyebab khusus
Target Total populasi
kelompok terseleksi
Individu sehat
Riwayat Alamiah Penyakit 66
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Tingkat pencegahan primer
Promosi kesehatan
Pendidikan kesehatan, penyuluhan
Gizi yang cukup sesuai dengan
perkembangan
Penyediaan perumahan yg sehat
Rekreasi yg cukup
Pekerjaan yg sesuai
Konseling perkawinanRiwayat Alamiah Penyakit 67
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3. Pencegahan Sekunder
Adl Upaya pencegahan yg dilakukan
saat proses penyakit sudah berlangsung
namun belum timbul tanda/gejala sakit(patogenesis awal) dengan tujuan
proses penyakit tidak berlanjut
Tujuan: menghentikan proses penyakit lebihlanjut dan mencegah komplikasi
Bentuknya berupa deteksi dini dan
pemberian pengobatan (yang tepat)
P h k d
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Pencegahan sekunder
Fase penyakit
tahap dini penyakit
Target pasien
Riwayat Alamiah Penyakit 69
Tingkat pencegahan sek nder
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Tingkat pencegahan sekunder
Diagnosis dini dan pengobatan segera
Penemuan kasus (individu atau masal)
Skrining Pemeriksaan khusus dengan tujuan
Menyembuhkan dan mencegah penyakit berlanjut
Mencegah penyebaran penyakit menular Mencegah komplikasi dan akibat lanjutan
Memperpendek masa ketidakmampuan
Riwayat Alamiah Penyakit 70
Tingkat pencegahan sekunder
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Tingkat pencegahan sekunder
Pengobatan yang cukup untuk
menghentikan proses penyakit
mencegah komplikasi dan sekuele yg
lebih parah
Penyediaan fasilitas khusus untuk
membatasi ketidakmampuan dan
mencegah kematianRiwayat Alamiah Penyakit 71
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Contoh PMS kultur rutin bakteriologis utk
infeksi asimtomatis pd kelompok
risti
Sifilis tes serologis utk infeksi
preklinis pd kelompok risti
Kanker leher rahim hapusan pap
Kanker payudara skrining dgn
mammografi
4 P h T i
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4. Pencegahan Tersier
Adl Pencegahan yg dilakukan saat prosespenyakit sudah lanjut (akhir periodepatogenesis) dengan tujuan untukmencegah cacad dan mengembalikanpenderita ke status sehat
Tujuan: menurunkan kelemahan dan kecacatan,memperkecil penderitaan dan membantu
penderita-penderita untuk melakukanpenyesuaian terhadap kondisi yang tidak dapatdiobati lagi
Terdiri dari:
Pencegahan tersier
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Pencegahan tersier
Fase penyakit
penyakit tahap lanjut (pengobatan dan
rehabilitasi)
Target
pasien
Riwayat Alamiah Penyakit 74
Tingkat pencegahan tersier
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Tingkat pencegahan tersier
Rehabilitasi
Penyediaan fasilitas untuk pelatihan hingga
fungsi tubuh dapat dimanfaatkan sebaik-
baiknya
Pendidikan pada masyarakat dan
industriawan agar menggunakan mereka
yang telah direhabilitasi
Riwayat Alamiah Penyakit 75
Tingkat pencegahan tersier
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Tingkat pencegahan tersier
Rehabilitasi
Penempatan secara selektif
Mempekerjakan sepenuh mungkin
Terapi kerja di Rumah Sakit
Menyediakan tempat perlindungan khusus
Riwayat Alamiah Penyakit 76
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Contoh Peny vaskuler diabetik pd kaki
perawatan kaki (podiatric cure) rutin
pasien diabetes Fraktura & cedera memasang rel
pegangan tangan (handrails) di
rumah orang yg mudah jatuh
Ulserasi kulit kronis penyediaan
matras khusus utk penyandang
cacat berat
Latihan
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Latihan
Seorang ibu membawa bayinya untuk
diimunisasi Polio.
Tindakan imunisasi Polio tersebut termasuk
pencegahan apa?
Tahap yang mana dari riwayat alamiah
penyakit yang akan dicegah dengantindakan imunisasi tersebut? Mengapa?
Jelaskan!
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