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The Indonesian Journal of General Medicine
Published by International Medical Journal Corp. Ltd.
ISSN : -     EISSN : 3048104X     DOI : -
Core Subject : Health,
Dentistry Health Professions Medicine & Pharmacology Public Health Veterinary
ims: The Indonesian Journal of General Medicine aims to advance the field of medicine by disseminating high-quality research findings that are accessible to a broad audience of healthcare professionals, researchers, and policymakers. The journal is committed to supporting the development of medical knowledge and practice in Indonesia and globally, fostering innovative research and evidence-based clinical practices. Scope: The journal covers a wide range of topics within the general medical field, including but not limited to: Clinical studies in various medical disciplines Epidemiological research and public health issues Innovations in diagnostic techniques and treatments Reviews on current practices and emerging trends in medicine Case studies and clinical trials Health policy and medical education The Indonesian Journal of General Medicine welcomes submissions from all areas of medicine, particularly those that have significant implications for patient care, public health, and policy-making. The journal encourages submissions that offer new insights, propose novel approaches, or address challenges pertinent to the Indonesian and international medical communities.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 279 Documents
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Associations of The Gut Microbiota on Respiratory Disease in Children : A Systematic Review Indah Dwi Lestari; Rifah Zafarani Soumena; Vina Zakiah Latuconsina; Octovina Toressy; Rahma Dyahnissa
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/jmpfne38

Abstract

Background: The gut-lung axis represents a critical pathway linking early-life gut microbiota to pediatric respiratory diseases, but comprehensive synthesis of associations, mechanisms, and therapeutic evidence is lacking. Methods: This systematic review synthesized 80 studies (RCT, etc) examining gut microbiota associations with pediatric respiratory outcomes including asthma, allergic rhinitis, respiratory tract infections (RTIs), bronchiolitis, bronchopulmonary dysplasia (BPD), and cystic fibrosis (CF) lung disease. Results: Early-life gut dysbiosis during the first 100 days—characterized by reduced Lachnospira, Veillonella , Faecalibacterium , Rothia (FLVR taxa)—consistently associated with increased asthma risk (Arrieta et al., 2015). Short-chain fatty acids (SCFAs), particularly acetate and butyrate, emerged as central immunomodulatory mediators (Yang et al., 2025). Mendelian randomization confirmed causal roles for Collinsella and Ruminococcaceae UCG014 in childhood asthma (Li et al., 2023). In CF, Bifidobacterium - dominant gut microbiota associated with 45% fewer pulmonary exacerbations (Ray et al., 2022). Probiotics reduced RTI incidence (42% vs 59% in controls) and acute asthma exacerbations (RR 0.38) but showed no benefit for primary asthma prevention. Cesarean delivery, antibiotic exposure (HR for asthma 1.21), and breastfeeding cessation were key moderators. Apparent diversity–disease contradictions resolved when considering community composition rather than diversity metrics alone. Conclusion: Gut microbiota composition in early life is causally associated with pediatric respiratory disease risk through SCFA-mediated immune modulation, with the first 100 days as a critical window. Probiotics show strain-specific efficacy for RTI prevention and asthma treatment but not primary prevention.
Suicide Risk Management in Psychiatric Hospitals : A Clinical and Medico-Legal Approach in Indonesian Mental Health Services Bianda Adeti Patriajaya; Raden Wisnu Munazhat Akbar
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kg13tk43

Abstract

Suicide remains a major global public health concern, particularly among individuals with psychiatric disorders, and continues to present significant challenges in psychiatric hospital settings. In clinical practice, inadequate risk assessment, inconsistent monitoring, and unclear medico-legal responsibilities may compromise patient safety and increase potential liability. This study aims to analyze suicide risk management in psychiatric hospitals by integrating clinical experience with medico-legal perspectives to improve patient safety and healthcare accountability. A descriptive qualitative approach was used, based on clinical observations and a review of hospital protocols and relevant medico-legal frameworks in Indonesian mental health services. The findings suggest that effective suicide risk management requires not only comprehensive clinical assessment and continuous monitoring but also clear and consistent medico-legal guidance. Key challenges include variability in clinical practices, limited staff training, inadequate documentation, and ambiguity in legal accountability. Strengthening interdisciplinary collaboration, improving documentation practices, and aligning clinical protocols with legal standards are essential steps to enhance patient safety. In conclusion, an integrated clinical and medico-legal approach is crucial in managing suicide risk in psychiatric hospitals and in supporting safer and more accountable healthcare systems.
HUBUNGAN ASUPAN MIKRONUTRIEN MATERNAL SELAMA MASA KEHAMILAN DENGAN KEJADIAN STUNTING PADA ANAK: LITERATUR REVIEW Fachrul Maulana Azis; Armanto Makmum; Mayamariska Sanusi
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/p7j2pa65

Abstract

Stunting merupakan masalah gizi kronis yang masih menjadi tantangan kesehatan global, terutama di negara berkembang seperti Indonesia. Salah satu faktor penting yang berkontribusi terhadap kejadian stunting adalah asupan mikronutrien maternal selama masa kehamilan. Penelitian ini bertujuan untuk menganalisis hubungan asupan mikronutrien maternal selama kehamilan dengan kejadian stunting pada anak berdasarkan literatur terbaru. Metode yang digunakan adalah literature review dengan menelaah artikel nasional dan internasional tahun 2021–2025 yang diperoleh melalui database Google Scholar, PubMed, ScienceDirect, dan SpringerLink. Hasil telaah menunjukkan bahwa defisiensi zat besi, zinc, asam folat, vitamin D, vitamin A, dan iodium selama kehamilan berhubungan signifikan dengan gangguan pertumbuhan intrauterin, berat badan lahir rendah, prematuritas, dan peningkatan risiko stunting pada anak. Faktor lain seperti kurangnya keragaman pangan, rendahnya pengetahuan ibu, serta kondisi psikososial maternal juga berkontribusi terhadap kejadian stunting. Intervensi yang paling efektif meliputi suplementasi mikronutrien, edukasi gizi, diversifikasi pangan, dan optimalisasi antenatal care. Dengan demikian, pemenuhan kebutuhan mikronutrien maternal selama kehamilan merupakan langkah penting dalam pencegahan stunting dan peningkatan kualitas kesehatan ibu serta anak.
Comparing Single-Dose Versus Multi-Dose Benzathine Penicillin G for the Treatment of Late Latent Syphilis : A Systematic Review of Randomized Controlled Trials and Primary Studies Rielyana Lumban Gaol
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/764wp196

Abstract

Introduction: Late latent syphilis (LLS), defined as asymptomatic Treponema pallidum infection of >1 year duration, remains a global public health burden. Current guidelines recommend three weekly intramuscular (IM) doses of benzathine penicillin G (BPG) 2.4 million units (MU), yet adherence to this multi-dose regimen is suboptimal, and emerging evidence challenges its superiority over single-dose BPG. Methods: A systematic search adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines from inception to June 2026. We included randomized controlled trials (RCTs), prospective and retrospective cohort studies, and systematic reviews comparing single-dose versus multi-dose BPG in adults with LLS or syphilis of unknown duration. Risk of bias was assessed using Cochrane RoB 2 and Newcastle-Ottawa Scale. Results: Twenty studies (N>25,000 subjects) were included. The landmark NEJM RCT (Hook et al., 2025; N=249) demonstrated single-dose BPG was non-inferior to three-dose BPG for serologic response at 6 months (76% vs 70%; difference −6 percentage points, 90% CI −15 to +3). A large retrospective US study (Pugsley et al., 2026; N=18,027) examining late/unknown-duration syphilis found 4-fold titer decrease rates of 80% (1 dose) versus 75% (3 doses) at 24 months (no significant difference). Adherence to three-dose regimens ranged from 45–78% versus near-complete adherence to single-dose therapy. Jarisch-Herxheimer reaction occurred in 23.7% after the first dose; injection-site pain was lower in the single-dose group (76% vs 85%). No clinical relapse or tertiary progression was documented. Discussion: Across RCT and real-world evidence, single-dose BPG demonstrates equivalent serological efficacy to three-dose BPG for LLS with superior adherence. Factors independently associated with non-response include older age, low baseline RPR titer, female sex, and HIV co-infection. Pharmacokinetic rationale for three doses is challenged by pharmacodynamic modeling showing sustained treponemicidal concentrations with single-dose formulations. The serofast state (21–41%) is not reduced by additional BPG doses. Conclusion: Current evidence indicates single-dose BPG 2.4 MU is non-inferior to three-dose BPG for late latent syphilis regarding serological and clinical outcomes, with substantial advantages in adherence and tolerability. Guideline-revision bodies should consider revising treatment standards pending confirmatory RCT data in exclusively late latent populations.
Allergic Reactions to Residual Monomers in Acrylic Denture Bases: A Systematic Review of Randomized Controlled Trials and Primary Studies Junez Kanisa; Adethyan Wira Gama; Ayub Quisa
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/n8acfp80

Abstract

Introduction: Residual monomers — principally methyl methacrylate (MMA) and 2-hydroxyethyl methacrylate (2-HEMA) — persist in conventional polymethyl methacrylate (PMMA) denture bases following incomplete polymerization and are associated with a spectrum of adverse biological reactions, including Type IV contact hypersensitivity, allergic contact stomatitis, burning mouth syndrome (BMS), and occupational allergic contact dermatitis in dental personnel. Methods: he study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Two independent reviewers screened records using PRISMA 2020 methodology. Risk of bias was assessed with Cochrane RoB 2.0 and the Newcastle-Ottawa Scale. A minimum of 15 studies and 10 outcome domains were pre-specified. Results: Fifteen studies (n = 2,287 participants/specimens) met inclusion criteria. Autopolymerized resins harbored residual MMA of 2.2–7.5% w/w vs. 0.11–0.90% w/w for heat-cured PMMA and 0.02–0.12% w/w for CAD/CAM-milled PMMA. Patch-test positivity to MMA/2-HEMA among symptomatic denture wearers ranged from 4–27%. Ten pre-specified outcome domains were fully analyzed. GRADE certainty: HIGH for residual MMA quantification and cytotoxicity data; MODERATE for clinical sensitization prevalence and occupational exposure outcomes. Discussion: Evidence confirms a dose-dependent relationship between residual monomer elution and mucosal/immunological reactivity. Autopolymerized resins confer the greatest risk. Post-polymerization water immersion at 50°C for ≥60 minutes and use of CAD/CAM pre-polymerized PMMA substantially reduce allergenic burden. Conclusion: Residual monomers in acrylic denture bases constitute a clinically significant, preventable source of contact hypersensitivity. Clinicians should prioritize heat-cured or digitally fabricated PMMA, implement post-polymerization protocols, and employ standardized acrylate patch testing in symptomatic patients.
Efektivitas Program Pemberian Makanan Tambahan Lokal Terhadap Perbaikan Status Gizi Balita Underweight Berdasarkan Z-Score Berat Badan Terhadap Umur di Puskesmas Batu Cermin Maria Osvaldis Galus; Veronika Elfi Kefi
The Indonesian Journal of General Medicine Vol. 38 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/5zy11835

Abstract

Balita dengan status gizi underweight masih menjadi masalah kesehatan masyarakat di Indonesia, termasuk di tingkat pelayanan primer seperti puskesmas. Program Pemberian Makanan Tambahan (PMT) berbasis pangan lokal merupakan salah satu intervensi strategis untuk memperbaiki status gizi balita secara berkelanjutan. Penelitian ini bertujuan untuk menganalisis efektivitas program PMT lokal selama 28 hari terhadap perubahan status gizi balita underweight berdasarkan Z-score BB/U. Penelitian ini menggunakan metode kuantitatif dengan pendekatan quasi eksperimen pretest-posttest. Sampel sebanyak 59 balita underweight usia 6 – 59 bulan yang terdaftar di puskesmas dengan intervensi berupa pemberian PMT lokal selama 28 hari. Data status gizi diukur menggunakan Z-score berat badan terhadap umur (BB/U) sebelum dan setelah intervensi. Rata-rata Z-score BB/U sebelum intervensi adalah 8,98 ± 1,48 kg dan setelah intervensi meningkat menjadi 9,74 ± 1,55. Terdapat peningkatan signifikan status gizi setelah pemberian PMT lokal (p = 0,007). Program PMT lokal selama 28 hari efektif dalam meningkatkan status gizi balita underweight. Intervensi ini dapat dijadikan strategi berbasis komunitas yang berkelanjutan di puskesma yang efektif dalam perbaikan status gizi balita dengan kriteria berat badan kurang berdasarkan kriteria Z-score dengan dengan berat badan terhadap umur.
What is The Effectiveness of Virtual Reality Interventions On Upper Limb Motor Function Recovery In Stroke Survivors? : A Comprehensive Systematic Review Vania Florencia Susanto; Stella Vaniadewi
The Indonesian Journal of General Medicine Vol. 38 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/n9asy850

Abstract

Background: Stroke is a leading cause of long-term disability worldwide, with upper limb motor deficits affecting up to 85% of survivors and significantly impairing functional independence. Virtual reality (VR) has emerged as a promising technology for neurorehabilitation, offering task-specific, intensive, and engaging therapy. Methods: This systematic review synthesized evidence from 80 sources including randomized controlled trials (RCTs), etc examining VR interventions for upper limb recovery in stroke survivors. Primary outcomes included upper limb motor function measured by Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block Test (BBT), and activities of daily living (ADL). Results: Pooled meta-analyses demonstrated significant positive effects favoring VR over conventional therapy for upper limb function (SMD 0.20-0.63; moderate certainty evidence). The largest benefits occurred when VR was added to usual care (SMD 0.42, 95% CI 0.26-0.58) rather than replacing conventional therapy (SMD 0.20, 95% CI 0.12-0.28). Subacute stroke patients (1-6 months) showed the greatest ADL gains (SMD 0.52), while acute phase (<1 month) effects were non-significant (SMD 0.22). Immersive VR produced larger effects on FMA-UE (MD 6.33, 95% CI 4.15-8.50) compared to non-immersive systems. Dose-response analysis revealed interventions exceeding 15 total hours yielded superior outcomes (MD 9.67, 95% CI 4.19-15.15). Discussion: The therapeutic efficacy of VR is maximized in subacute stroke patients with moderate-to-severe impairment when delivered as an adjunct to conventional therapy for >15 hours over >4 weeks. Purpose-built rehabilitation VR systems demonstrate superiority over commercial gaming systems. Adverse events were minimal and transient. Conclusion: VR interventions are effective and safe for upper limb motor recovery in stroke survivors, with optimal benefits in subacute patients receiving sufficient dosing as an adjunctive therapy.
Efficacy of Anti-Amyloid Monoclonal Antibody Immunotherapy on Cognitive Progression in Alzheimer's Disease Patients : A Systematic Review of Randomized Controlled Trials and Primary Studies Luh Wayan Puspa Ningsih; Ida Bagus Kade Satyagraha
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/sdjae253

Abstract

Introduction: Alzheimer's disease (AD) is the leading cause of dementia worldwide, with the amyloid cascade hypothesis implicating amyloid-beta (Aβ) accumulation as a primary pathogenic driver. Anti-amyloid monoclonal antibodies (mAbs) represent the most advanced class of disease-modifying therapies, yet their cognitive efficacy, safety profile, and clinical meaningfulness remain subjects of ongoing debate. This systematic review synthesizes evidence from randomized controlled trials (RCTs) evaluating anti-amyloid mAb immunotherapy across all agents and disease stages. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Eligible studies comprised Phase II and III placebo-controlled RCTs evaluating anti-amyloid mAbs in patients with mild cognitive impairment or mild-to-moderate AD. Primary outcome was change in Clinical Dementia Rating-Sum of Boxes (CDR-SB). Risk of bias was assessed using Cochrane RoB 2.0. Results: Twenty publications representing 15 distinct trials (N>36,000 participants) evaluating seven mAbs were included. Second-generation mAbs (lecanemab, donanemab) demonstrated statistically significant CDR-SB slowing (lecanemab: Δ–0.45, 95% CI –0.67 to –0.23, p<0.001, 27% slowing; donanemab: Δ–0.67, 95% CI –0.95 to –0.40, p<0.001, 36% slowing) with corresponding amyloid PET reduction. First-generation agents (bapineuzumab, solanezumab, crenezumab, gantenerumab) failed to demonstrate clinically meaningful cognitive benefit despite variable amyloid clearance. Amyloid-related imaging abnormalities (ARIA) occurred in 12.6–41.3% of treated participants, with APOE ε4 homozygosity as the strongest risk factor. Quality-of-life and caregiver burden outcomes favored lecanemab and donanemab. Discussion: Divergent efficacy between mAb generations reflects differential Aβ species targeting, with second-generation agents selectively targeting pathogenic protofibrils and pyroglutamate-modified Aβ. The clinical meaningfulness of statistical differences remains debated as minimal clinically important differences may not be achieved within 18-month trial windows. ARIA necessitates mandatory MRI monitoring, and strict eligibility criteria limit real-world generalizability to <15% of AD populations. Conclusion: Second-generation anti-amyloid mAbs, particularly lecanemab and donanemab, represent the first disease-modifying therapies demonstrating statistically significant cognitive slowing in early AD. However, absolute benefit remains modest, safety monitoring is mandatory, and population eligibility is substantially restricted. Long-term evidence beyond 18 months and head-to-head trials are needed.
THE ANALYSIS STUDY OF DIAGNOSIS AND MANAGEMENT OF CONTACT DERMATITIS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND PRIMARY STUDIES Prety Pranitacitra; Ayu Dwi Mutia
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/79hhv885

Abstract

Introduction: Contact dermatitis (CD) encompasses allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), and occupational variants, representing the most prevalent occupational dermatosis globally. Despite substantial disease burden, diagnostic accuracy remains inconsistent and therapeutic strategies vary widely across clinical settings. This systematic review comprehensively evaluates current evidence regarding diagnostic modalities and therapeutic interventions for CD. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines (2003–2026). Inclusion criteria encompassed randomized controlled trials and primary studies assessing CD diagnosis or treatment in human subjects. Risk of bias assessment utilized Cochrane RoB 2.0 and Newcastle-Ottawa Scale. Results: Patch testing confirmed ACD in 50–87.5% of clinically suspected cases, yet utilization rates remained below 7.4% in insured populations. Nickel sulfate, fragrance mixes, and methylisothiazolinone constituted predominant allergens. Topical corticosteroids and calcineurin inhibitors demonstrated significant efficacy as first-line therapies. Dupilumab achieved Hand/Foot IGA 0/1 in 40.3% versus 16.7% placebo (P=0.003). Lipid-rich barrier preparations effectively prevented and treated ICD. Systemic agents including cyclosporine and JAK inhibitors showed improvement in refractory disease. Discussion: CD requires individualized diagnostic-therapeutic approaches integrating patch testing, allergen avoidance, barrier restoration, and targeted anti-inflammatory therapy. Significant barriers—sociodemographic, geographic, and systemic—limit diagnostic access. Novel biologics represent a paradigm shift for recalcitrant disease. Conclusion: Multimodal CD management incorporating accurate diagnosis, allergen avoidance, and appropriate pharmacotherapy achieves optimal outcomes. Future CD-specific RCTs and improved patch testing access are research priorities.
Karakteristik Pasien Nyeri Dada di Puskesmas Belawa Tahun 2025 Irma Rusnu
The Indonesian Journal of General Medicine Vol. 42 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/96w1vq91

Abstract

Latar belakang: Nyeri dada merupakan keluhan yang sering ditemukan di layanan kesehatan primer dengan spektrum etiologi yang luas dan potensi keterlibatan kondisi kardiovaskular. Informasi mengenai karakteristik pasien nyeri dada di fasilitas layanan primer pedesaan masih terbatas, padahal data tersebut diperlukan untuk menggambarkan pola kasus yang ditangani dalam praktik pelayanan rutin. Tujuan: Penelitian ini bertujuan untuk menggambarkan karakteristik demografi dan klinis pasien dengan keluhan nyeri dada di puskesmas pedesaan selama tahun 2025. Metode: Penelitian ini merupakan studi observasional deskriptif dengan desain potong lintang menggunakan data sekunder dari rekam medis elektronik. Seluruh pasien dengan diagnosis nyeri dada berdasarkan kode ICD-10 (I20.x dan R07.x) selama periode Januari–Desember 2025 diikutsertakan melalui metode total sampling. Variabel yang dianalisis meliputi usia, jenis kelamin, indeks massa tubuh, tekanan darah, faktor risiko perilaku, diagnosis klinis, serta penatalaksanaan awal. Analisis dilakukan secara deskriptif. Hasil: Sebanyak 19 pasien dianalisis dengan rerata usia 52,1 ± 18,6 tahun dan median 54,9 tahun (rentang 19,5–90,5 tahun), dengan 78,9% berusia ≥40 tahun. Distribusi jenis kelamin relatif seimbang antara laki-laki (52,6%) dan perempuan (47,4%). Sebagian besar pasien memiliki status gizi normal (68,4%) dan tekanan darah dalam batas normal (73,7%), sedangkan 21,1% termasuk kategori prehipertensi. Faktor risiko perilaku tidak tercatat dalam rekam medis. Sebagian besar diagnosis merupakan kondisi kardiak, yaitu angina pectoris atau unstable angina (63,2%), sedangkan 36,8% merupakan nyeri dada non-spesifik. Kesimpulan: Profil pasien nyeri dada di puskesmas pedesaan tahun 2025 didominasi oleh kelompok usia ≥40 tahun dengan proporsi diagnosis kardiak yang cukup besar. Temuan ini mencerminkan karakteristik kasus yang ditangani berdasarkan data pelayanan rutin di satu fasilitas layanan kesehatan primer. Interpretasi hasil perlu mempertimbangkan keterbatasan jumlah sampel, penggunaan data sekunder rekam medis, dan pelaksanaan penelitian pada satu fasilitas. Penelitian dengan cakupan yang lebih luas diperlukan untuk memperoleh gambaran yang lebih komprehensif.

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