cbp 2013-lecture-1,2,3
TRANSCRIPT
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BLOCK CBPBLOCK CBP
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SEMESTER I
1. Stadium Generale and Humaniora
2. Medical Communication
3. The Cell as Biochemical Machinery
4. Groth and !e"elo#ment $renatal and
$ostnatal
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SEMESTER II
1. Medical $ro%essionalism
2. Community&Based $ractice
3. Health System&Based $ractice
4. E"idence&Based Medical $ractice
'. S#ecial To#ic(. Electi"e Study 1
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SEMESTER III
1. The Hematolo)ic System and !isorders
and Clinical *ncolo)y
2. Immune System and !isorders
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SEMESTER I+
1. The Musculos,eletal System and
Connecti"e tissue !isorders
2. -euroscience and -eurolo)ical !isorders
3. Beha"ior Chan)e and !isorders
4. The +isual System and !isorders
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SEMESTER +
1. The limentary and He#ato/iliary System
and !isorders
2. The Endocrine System0 Meta/olism0 and
!isorders
3. Clinical -utrition and !isorders
4. S#ecial To#ic
'. Electi"e Study 2
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SEMESTER +I
1. The Res#iratory System and !isorders
2. The Cardio"ascular System and !isorders
3. The rinary System and !isorders
4. The Re#roducti"e System and !isorders
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SEMESTER +II
1. Medical Emer)ency
2. S#ecial To#ic Tra"el Medicine
3. Electi"e Study 3
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Tahun lalu dilakukan perdebatan di Stasiun TV
Swasta Nasional dalam acara Indonesia Lawyers
Club (ILC) yang membahas UU embatasan
enggunaan Tembakau antara kelompok yang anti
dan yang pro
!ampir semua kelompok anti UU mengemukakan
alasan sbb" Ah, tidak benar merokok ada
kaitannya dengan kanker paru-paru. Buktinya,
saya dan teman-teman saya adalah perokok berat,
dan sudah merokok selama 30 tahun, toh sampaisaat ini tetap sehat-sehat saja.
Pertanyaan:sebagai calon dokter apa
komentar Sdr# dengan mengacu pada prinsip$
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APPROCHES OF
CBPPrevention (not
curative)Community
(not individual)
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Susceptible
(at risk)
Primary prevention
!ealth promotion
Speci&ic protection
Presym-
tomaticstage
Secondary prev.
'arly detection
prompt
treatment
Clinical
stage
Stageof
dis-
ability
Tertiary prev.
isability
limitation
*ehabilitation
Genetic
Environment
e!avior
"ealt! Services
P!ysical
Social# culturaliological# economical
Determinants
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1 Selama !ulia"HP dimati!an (#u!an
silent)
$A$A $ER$%B
& Dalam 'leno 'ai #ila terlam#at 1* menit(+am di dindin ruan !ulia")
ma"asis,a tida!
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B-OC. CBP(Community$based +edical ractice)
,# ! harus dimatikan selama kuliah dan S-
.# Study -uide dan semua re&erences agar selalu
dibawa saat kuliah/ S-/ indi0idual learning
1# 2ehadiran dan keakti&an saat S- dinilai
(34 dari nilai u5ian) IN-6T 6%S'N
7# 2ehadiran saat kuliah dan &eedback dihitung
(bila lebih dari .34 tidak ikut) tidak bisa u5ian
*UL'8*'-UL6TI9NS
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3# ada saat plenary mahasiswa presentasi
:# ;akil mahasiswa yang presentasi harus dipilih pada saat S- dan bukan di ruang kuliah
# Narasumber akan memberi &eedback
pada presentasi mahasiswa
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REFERE/CES 0 A/2A-
Study 3uide 0 Anne4es
Re5erence 167
anualPlease re5er to eac" daysession8module
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DA9 1 & ;: OD2-E61
C2RR%C2-2 S$2D9 32%DE1< OD2-ES
-EAR/%/3 A$ER%A-S:Re5erence 1 and & movie videocli' ,e#sites (it is advice to do,nload materials5rom t"e ,e#sites #e5ore t"e lecture)
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Learning 9utcomes"
a) escribe se0eral determinants(models)o& diseases and death occurring in the
population
b) '?plain the applications o&
understanding diseases and death
determinants (models)
c) Identi&y the strengths and weaknesseso&
diseases models
d) raw &igure o& the natural historyo& a
certain disease
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e) '?plain the applicationso& the natural
history o& a disease &or pre0ention
&) '?plain the se0erity o& diseasesin a
population and its implication to
pre0ention
g) escribe the le0el o& disease pre0ention
based on determinants and natural
history
h) '?plain the Ice %erg henomenomand
its implication in diseases pre0ention
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-EAR/%/3 SCHED2-E(time ta#le)
*=**6*>**: %ntroductory
lecture
S$2D9 32%DE PA3E < (C-ASS B)
*>**611**: %nde'endentlearninRe5erence 1 0 &-earnin tas!s 'ae1=6&1
11**61;**: S3D1?**61@**: Student 'resentation 05eed#ac!
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-EAR/%/3 SCHED2-E(time ta#le)
*>**61***: %ntroductory
lecture
S$2D9 32%DE PA3E 11 (C-ASS A)
1***61&**: %nde'endentlearninRe5erence 1 0 &-earnin tas!61 0 & 'ae 1=6&1
1;**61@**: S3D1@**617**: Student 'resentation 05eed#ac!
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APPROCHES OF
CBPPrevention (not
curative)Community
(not individual)
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Some of the people need health care
some of the time
BUT
All of the people need public health allof the time."
C. Everett $oop# %&
former '.S. Surgeon General
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Determinants o5 mor#idity and mortality in a
'o'ulation
/atural "istory o5 t"e
disease
Diseases 'revention
MODULE-1
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& *
Determinants o5
mor#idity andmortality in a'o'ulation
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$"e E'idemioloic $riad8 $rianle
($eori Sei $ia) 'ae &7 ;;
"eel odel ($eori Roda) 'ae ;@6;>e# odel ($eori Saran -a#a6la#a)'ae ;;odel Blum
Several models8conce't used toanalyed determinants o5
mor#idity and mortality in a'o'ulation
odel osley
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"+ST (intrinsic)(age# se,# genotype# be!aviour# nutritional
status)
GET(biologic# p!ysic# mec!anical#
c!emical# nutrient)
E/0+%ET(P!ysical# iological# Social)
odel Seitia (The 'pidemiologic Triad8Triangle)
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Triad e#idemiolo)i,
AGENTBiological, chemical, physicalMechanical, Nutrient
HUMAN HOSTAge, race, sex, habitGenetic, personalityDefense mechanism
ENVIRONMENTBiological, chemical, physicalMechanical, nutrient, social, psychologic
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Homeostatic Balance
E
H
t e1uilibriumSteady rate
E
H
T!e proportion of susceptibles
in population decreases
Environmental c!anges t!at
favor t!e agent
E
H
Environmental c!anges t!at
favor t!e !ost
EH
E
H
gent becomes more pat!ogenic
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Genetic
"+ST
'@T'*N6L (e?trinsic)
INT'*N6L
(intrinsic)
$hysical En"ironment
Social
#olitic0
economicculture
Biolo)ical
En"iron&ment
odel Roda ("eelodel)
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C t h ti I/;'% +9'L (S6*6N- L6%6 L6%6)
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Contoh asus ematian I/u
Modifikasi dari: FA Moeloek, 2010
;'% +9'L (S6*6N- L6%6$L6%6)
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B-2 ODE-
or#idity andmortality ina 'o'ulation
Environmental 5actors(#ioloical '"ysical social economical
'olitic)
Healt"services
3enetic
Be"avior
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C9NC'T (T!'9*A/ +9'L)INT*9UC' %A
*# +9SL'A;!IC! '@L6IN'
'T'*+IN6NTS 9B +9*%IITA 6N+9*T6LITA 9B C!IL*'N 6-'
UN'* 3 A'6*S IN 6 9UL6TI9N
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Socioeconomic determinants
+aternal
&actors
'n0ironmental
Contamination
Nutrient
de&iciencyIn5ury
!ealthy
ersonal
Illness
control
Sick
-rowth
&altering+ortality
PreventionTreatment
S9CI6L 'T'*+IN6NTS 9B !'6LT!
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S9CI6L 'T'*+IN6NTS 9B !'6LT!
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2"+ CS&" t l f k
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2"+- CS&" conceptual frame3ork
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-!ERST-!I-G
CS5IT6
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4our types of Causal relations!ips
1.-ecessary and Su%%icient2.-ecessary /ut not Su%%icient
3.Su%%icient /ut not -ecessary
4.-either Su%%icient nor -ecessary
-ecessary 7 ithout that %actor disease ne"erde"elo#s
Su%%icient 7 in the #resence o% that %actor disease alays
de"elo#s
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*. ecessary and Sufficient
&irect5
4actor &isease
/ndirect5
4actor Step* Step6 &isease
rarely !appens
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6. ecessary but not Sufficient
4actor
7
4actor &isease 7
4actor C
%ultiple factors re1uired5 initiator 8 promoter
(cancer# T)
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9. Sufficient but not ecessary
4actor
or
4actor &isease or
4actor C
:eukemia ; E,posure to radiation +0 ben
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=. eit!er sufficient nor necessary
(contributory causes)
4actor 7 4actor
or4actor C 7 4actor & &isease
or
4actor E 7 4actor 4
Most accurately re#resents causal relationshi#s in most
chronic diseases
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END OF DA !
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$lenary day 1
$lease re%er to the #lenary day 1 slides
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Determinants o5 mor#idity and mortality in a
'o'ulation
/atural "istory o5 t"e
diseaseDiseases 'revention
MODULE-1
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& 6
/atural "istory o5 t"e
diseaseDisease 'revention
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-atural History o% !isease
-atural history o% disease#ro)ression o% disease in an
indi"idual o"er time 8ITH*Tany inter"ention.
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/A$2RA- H%S$OR9 OF $HED%SEASE
Pae 76> re5erence &
Four staes
Stae o5 susce'ti#ility ('o'ulation atris!)Stae o5 're sym'tomatic (asym'tomatic) diseaseStae o5 clinical (sym'tomatic)
diseaseStae o5 disa#ility
Every disease "as dierencenatural
"istory (e4am'le: H%8A%DS DHF)
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$er9alanan lamiah $enya,it ':
PREPATOGENESIS PAT G N SIS
)en Host ;ase ,linis
Sem/uh
Cacat
5in),un)an ;ase #enyem/uhan Mati
ronis
;ase susce#ti/le ;ase su/,linis
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-atural history o% disease
Susceptible
!ost
T/%E
/ncubationperiod
&eat!
0ecovery
E,posure +nset
:atent /nfectious on-infectious
/nfection
o infection
Clinical disease
N6TU*6L !IST9*A ('*6L6N6N
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%eninggal
$!ronis
Carrier
Sembu!
dengan cacat
Sembu!tanpa cacat
6symptomatic
stage
Symptomatic
stage
N6TU*6L !IST9*A ('*6L6N6N
'NA62IT)
Contoh"hepatitis
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>>
6>>6>>
*>>>*>>>
> * 6 9 = ? * 6 9 = ? @ A> * 6 9 = ? * 6 9 = ? @ A
3340::: emer)encyroom "isits
> 1303(: hos#itali@ations
> 2: deaths
T!' V6*I6TI9N 9B SA+T9+6TIC
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T!' V6*I6TI9N 9B SA+T9+6TIC
IS'6S'S S'V'*ITA
,FF C6S'S
+ild (ringan) +oderateSe0ere
Batal
$"e lm 'resentation
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$"e lm 'resentations"o,ed to you
Contri#ution ('eran) o5: scienti&ic&oundations/ clinical skill/ communication
skill/ in&ormation management/ critical
thinking/ pro&essional 0alues and attitudes/community health
eneliti !ausa suatu 'enya!it(A%DS) dan 'encea"annya
D%FFERE/CES BE$EE/
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D%FFERE/CES BE$EE/
*. 4ocus5 population
6. 0esponsibilities5
all #eo#le in certain)eo)ra#hical area0 health andsic,0 those ho come andthose ho do not come to
health %acilities. They mustacti"ely #ro"ide diseases#re"ention to all #eo#le hoare at ris,
*. 4ocus5 individual
6. 0esponsibilities5all #eo#le ho come
to the health %acilities.They usually #assi"e.
P2B-%C HEA-$H
DOC$OR
C-%/%CA-
DOC$OR
P2B-%C HEA-$H C-%/%CA-
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P2B-%C HEA-$HDOC$OR
C-%/%CA-DOC$OR
9. 4unction5to mobili
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P2B-%C HEA-$HDOC$OR
C-%/%CA- DOC$OR
?. &iagnostic tools5
epidemiology#statistics# demograp!y
?. &iagnostic tools5
stet!oscope# ECG# labe,aminations kits # CTScan# etc
@. &iseasesmeasurements in t!ecommunity5
proportion# prevalence#incidence# ratio
@. &iseasesmeasurements forindividual patient5level
of blood pressure# bloodsugar# level of!emoglobin# etc
P2B-%C HEA-$H C-%/%CA-
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P2B-%C HEA-$HDOC$OR
C-%/%CA-DOC$OR
A. Treatment at t!ecommunity level(prevention)5public!ealt! program suc! as
education program#immuni
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P2B-%C HEA-$HDOC$OR
C-%/%CA-DOC$OR
D. /ndicators forevaluating community!ealt! program5percentdecrease of under
nutrition# percentincrease of contraceptiveuse for family planning#
etc
D. /ndicators for
evaluating t!e resultof patientstreatments5
decrease of bloodpressure of t!eindividual patient#increase of
!emoglobin
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GF%E S$ARS DOC$OR
(HO I orld Healt"Oraniation)Care 'rovider (clinical dr)
Communicator (clinical 0 PHdr)anaer (PH dr)
Community leader (PH dr)Decision ma!er (clinical 0 PHdr)
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S96L$S96L
'+6N6S6NS'%'LU+ UI6N
As sown in te -ilm And The Band Played n
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As sown in te -ilm And The Band Played n
wic was !resented to yo&$ tere were several
sciences involved in investi#ation te ca&se o- AI0S1
Tose sciences are.
A1 Social$ economic$ !olitic$ e!idemiolo#y$ statistic$
virolo#y$ clinical medicine
21 Social$ !olitic$ e!idemiolo#y$ statistic$ virolo#y$
clinical medicine$ ealt ed&cation
C1 Social$ e!idemiolo#y$ statistic$ virolo#y$
clinical medicine$ ealt ed&cation
01 Clinical medicine$ e!idemiolo#y$ statistic$ social$ !olitic
E1 Social science$ e!idemiolo#y$ statistic$
virolo#y$ clinical medicine
! l %il d 9 d l A d Th B d #l d
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!alam %ilm den)an 9udul And The Band #la$ed
On yan) telah Sdr. sa,si,an #ada a,tu
#ertemuan #ertama Blo, Community&Based$ractice0 ada /e/era#a metode yan) di#er)una,an
untu, men)un),a#an #enye/a/ I!S0 yaitu
1. Contact tracin)
2. Cohort
3. Case&control
4. Cross§ional
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Bila dilihat dari a,tunya0 urutan ca/an)
ilmu yan) mem/antu men)un),a#an#enye/a/ I!S0 yaitu
. $alin) aal "irolo)i0 lalu e#idemiolo)i dan tera,hir ilmu ,lini,
B. $alin) aal ilmu ,lini,0 lalu "irolo)i dan tera,hir e#idemiolo)i
C. $alin) aal ilmu ,lini,0 e#idemiolo)iAstatisti,Ailmu sosial0 lalu
"irolo)i
!. $alin) aal "irolo)i0 statisti,Ae#idemiolo)i lalu ilmu ,lini,E. $alin) aal statisti,Ae#idemiolo)i0 ilmu ,lini, lalu "irolo)i
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$ada Gam/ar&1 /eri,ut ini adalah ,om#etensi
,emam#uan yan) harus di,uasai oleh seoran)do,ter. om#etensi untu, memahami statisti,
,asus&,asus I!S dalam %ilm den)an 9udul
And The Band #la$ed OnD termasu,
1. Scienti%ic %oundations
2. In%ormation mana)ement
3. $ro%essional "alues
4. $o#ulation health
Cli i l
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Critical
t!inking
/nformation
management
Communication
skill
Community
"ealt!(Pu-blic
"ealt!)
Clinical
skill
Professional#
values#
attitudes
Scientific
foundations
CBP
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Sala! seorang ma!asis3a (inisial F) yang kulia! di
fakultas non-kese!atan mengatakan sebagai berikut5
Ah% tida& benar mero&o& ada &aitann$a den'an
&an&er paru(paru. Bu&tin$a% paman sa$a adalah
pero&o& berat% dan sudah mero&o& selama )* tahun%
toh sampai saat ini dia sehat(sehat sa+a.
Pertanyaan:#eri!an !omentar Sdrter"ada' 'ernyataan ma"asis,a GJse'erti 'ada soal di atas(dengan mengacupada prinsip-prinsip epidemiologi).
&alam suatu program interaktif yang
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,ho% &enapa pelacur $an' sudah +elas(+elasdi+umpai-/0tida& di&arantina. 1ere&a ..&an
den'an bebas masih menular&an -/(n$a pada
oran' lain. 2enapa pada saat ter+adi 3abahSA4S% $an' dicuri'ai sa+a sudah lan'sun'
diisolasi5
&alam suatu program interaktif yang
memba!as topik 3aba! "/B/&S di sebua!
stasiun radio di ali# banyak pendengar
dengan berapi-api mengatakan melalui
telepon sebagai berikut5
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An##ota 0PR0 Provinsi 2ali ta&n lal& men#ata"an
se,a#ai ,eri"&t. !ami sudah mengalokasikan
dana APB" yang #ukup besar untukpenanggulangan $%&'A%"( di Bali. !enapa jumlah
orang yang $%&)'A%"( kok terus bertambah
banyak. $arusnya kan berkurang. !alau begitu
per#uma dana yang kami alokasikan tersebut.
PERTAN(AAN. Seandainya Sdr1 men%adi !etas
"eseatan$ ,a#aimana Sdr1 men%awa, !ernyataanan##ota 0PR0 terse,&t
Pertanyaan 'endenar
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$em'at tidur 'asien demam
#erdara" yan dira,at di ruma"sa!it !o! tida! 'a!ai !elam#uK.alau 'asien diiit nyamu! Aedes
!an #isa menular!an 'enya!itnya!e'ada 'etuas di RS atau !e'ada'asien lainK
Pertanyaan 'endenardalam 'roram intera!ti5 di
se#ua" stasiun radio di Bali