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[
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.
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[
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ased
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.
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Evaluation Warning : The document was created with Spire.PDF for Python.
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8806
I
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t.
J
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P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
4
,
Dec
em
b
er
2021
:
873
–
8
7
9
874
h
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in
v
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D
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2
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)
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t
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s;
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d
m
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s
t
r
a
t
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o
n
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t
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v
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t
i
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s;
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)
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e
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t
h
s
t
a
f
f
,
p
a
t
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n
t
a
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a
c
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;
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)
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l
l
b
e
i
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g
;
8
)
se
l
f
a
c
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u
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z
a
t
i
o
n
;
9
)
p
sy
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h
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o
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i
c
a
l
st
a
t
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;
1
0
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f
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*
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i
d
(
mi
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mu
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o
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d
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f
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s
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.
3
)
C
R
:
c
o
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st
r
u
c
t
r
e
l
i
a
b
i
l
i
t
y
.
R
M
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:
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me
a
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q
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ased
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ab
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1
,
th
er
e
ar
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f
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v
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d
icato
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s
b
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s
e
th
e
lo
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f
ac
to
r
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3
.
T
h
ese
f
i
v
e
in
v
alid
i
n
d
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r
s
ar
e:
i
)
A
v
ailab
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y
o
f
an
ad
v
er
s
e
e
v
en
t
r
ep
o
r
tin
g
f
o
r
m
;
ii
)
A
v
ail
a
b
ilit
y
o
f
d
i
s
cu
s
s
io
n
r
o
o
m
;
ii
i
)
R
e
g
u
lar
d
o
cto
r
r
ev
i
e
w
s
o
f
t
h
e
p
atie
n
t
m
ed
icatio
n
;
iv
)
R
ea
lis
tic
m
o
ti
v
atio
n
o
f
p
atien
ts
;
v
)
F
a
m
il
y
p
r
ep
ar
e
d
n
ess
f
o
r
p
atien
ts
’
d
iet
ar
y
r
es
tr
ictio
n
s
.
Fig
u
r
e
2
.
Fin
al
r
es
u
lt o
f
co
n
f
ir
m
ato
r
y
f
ac
to
r
an
al
y
s
i
s
test
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
4
,
Dec
em
b
er
2021
:
873
–
8
7
9
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3
.
3
.
Dis
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s
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ased
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tr
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v
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d
r
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ca
r
e
in
s
tr
o
k
e
p
atien
t
s
is
s
h
o
w
n
.
3
.
3
.
1
.
P
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s
o
na
l do
m
a
in
T
h
e
r
esu
lts
i
n
t
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i
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s
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Natio
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Dis
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r
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ac
h
is
k
e
y
ele
m
en
t f
o
r
i
m
p
r
o
v
in
g
q
u
alit
y
s
tr
o
k
e
s
er
v
ices
[
1
6
]
.
3.
3
.
2
.
Do
cu
m
ent
do
m
a
in
T
h
e
in
d
icato
r
s
o
f
av
ailab
ilit
y
o
f
ad
v
er
s
e
ev
e
n
t
r
ep
o
r
tin
g
f
o
r
m
s
o
f
tr
ea
t
m
e
n
ts
p
er
f
o
r
m
ed
ar
e
d
ec
lar
ed
in
v
a
lid
.
T
h
is
f
in
d
i
n
g
co
n
tr
as
ts
w
ith
a
r
etr
o
s
p
ec
tiv
e
co
h
o
r
t
s
t
u
d
y
i
n
C
an
ad
a
t
h
at
ai
m
s
to
d
e
tect
ad
v
er
s
e
e
v
e
n
ts
in
h
o
m
e
ca
r
e
s
etti
n
g
s
w
it
h
T
h
e
R
esid
e
n
t
Ass
e
s
s
m
e
n
t
I
n
s
tr
u
m
en
t
f
o
r
Ho
m
e
ca
r
e
(
R
A
I
-
H
C
)
[
1
7
]
.
Do
r
an
s
tu
d
y
s
h
o
w
ed
t
h
at
t
h
e
i
n
s
tr
u
m
en
t
f
o
r
ass
es
s
i
n
g
h
o
m
e
ca
r
e
q
u
ali
t
y
s
h
o
u
ld
co
n
tai
n
i
n
d
icato
r
s
t
h
a
t
ar
e
ab
le
to
d
etec
t
ad
v
er
s
e
ev
e
n
ts
i
n
h
o
m
e
ca
r
e
s
er
v
ices.
3.
3
.
3
.
Do
m
a
i
n o
f
pro
f
ess
io
n
a
l dev
elo
p
m
e
nt
Ho
m
e
ca
r
e
o
f
f
icer
s
m
u
s
t
b
e
s
k
ill
f
u
ll
at
p
r
ep
ar
in
g
th
e
m
s
elv
e
s
to
b
ec
o
m
e
p
r
o
f
es
s
io
n
al
o
f
f
icer
s
th
r
o
u
g
h
tr
ai
n
i
n
g
.
R
esear
c
h
b
y
Ko
s
ten
i
u
k
et
a
l.
s
tated
t
h
at
m
o
s
t
o
f
th
e
h
o
m
e
ca
r
e
o
f
f
icer
s
in
c
h
ar
g
e
w
h
o
f
u
l
l
f
ill
th
e
d
ail
y
n
ee
d
s
o
f
p
atien
t
s
,
ar
e
m
o
s
t
l
y
u
n
tr
ai
n
e
d
[
1
8
]
.
T
h
u
s
t
h
e
p
r
o
v
is
io
n
o
f
ed
u
ca
ti
o
n
in
th
e
f
o
r
m
o
f
w
o
r
k
s
h
o
p
s
,
ca
s
e
p
r
esen
ta
tio
n
s
,
s
e
m
i
n
ar
s
an
d
lect
u
r
es
(
f
ac
e
t
o
f
ac
e)
is
h
i
g
h
l
y
d
e
m
a
n
d
ed
b
y
h
o
m
e
ca
r
e
s
er
v
ic
e
p
r
o
v
id
er
s
[
1
8
]
.
3
.
3
.
4
Do
m
a
in o
f
s
up
po
rt
ing
f
a
cilit
ies
W
eig
h
t
s
ca
les
a
n
d
d
is
cu
s
s
io
n
r
o
o
m
s
ar
e
i
m
p
o
r
tan
t
s
u
p
p
o
r
tin
g
f
ac
il
ities
.
B
u
t
th
e
l
i
m
itatio
n
o
f
s
p
ac
e
an
d
ti
m
e
to
g
at
h
er
tea
m
s
m
a
k
es
th
e
d
i
s
cu
s
s
io
n
b
e
d
o
n
e
at
an
y
ti
m
e
an
d
i
n
an
y
w
a
y
s
p
o
s
s
ib
le
f
o
r
ex
a
m
p
le
s
th
r
o
u
g
h
s
o
cial
m
ed
ia
an
d
W
h
ats
A
p
p
g
r
o
u
p
.
W
eig
h
t
s
ca
le
s
ar
e
i
n
cl
u
d
ed
as
o
n
e
o
f
t
h
e
h
ea
v
y
eq
u
ip
m
e
n
t
to
ca
r
r
y
a
n
d
t
h
eir
u
s
e
w
a
s
d
i
f
f
icu
lt
esp
ec
iall
y
f
o
r
p
ati
en
t
s
w
h
o
w
er
e
b
ed
r
id
d
en
.
T
h
e
r
esu
lt
s
o
f
th
i
s
s
t
u
d
y
co
n
tr
as
t
w
it
h
t
h
e
o
th
er
r
esear
c
h
th
a
t
i
n
clu
d
e
w
ei
g
h
t
lo
s
s
as
o
n
e
i
n
d
icato
r
o
f
h
o
m
e
ca
r
e
[
1
1
]
,
[
18
]
,
[
19]
.
W
eig
h
t
lo
s
s
d
ata
w
o
u
ld
b
e
o
b
tain
ed
f
o
r
n
u
t
r
itio
n
al
ass
e
s
s
m
e
n
t f
o
r
s
tr
o
k
e
p
atien
t.
3.
3
.
5
.
Ad
m
i
nis
t
ra
t
iv
e
pro
ce
s
s
do
m
a
in
A
d
m
i
n
is
tr
ati
v
e
ac
ti
v
itie
s
f
o
cu
s
o
n
d
o
cu
m
e
n
ti
n
g
t
h
e
p
atien
t
's
co
n
d
itio
n
o
r
an
ac
tio
n
.
A
n
o
th
er
s
t
u
d
y
r
ev
ea
led
th
e
i
m
p
o
r
ta
n
ce
o
f
t
h
e
d
o
cu
m
en
tatio
n
p
r
o
ce
s
s
wh
ich
m
en
t
io
n
s
t
h
e
i
m
p
o
r
tan
c
e
o
f
d
o
cu
m
e
n
ti
n
g
p
atien
ts
w
h
en
tr
a
n
s
f
er
r
ed
to
s
u
b
-
ac
u
te
ca
r
e
[
2
0
]
.
Of
f
icer
s
w
h
o
w
er
e
n
e
g
li
g
e
n
t
in
d
o
cu
m
en
ti
n
g
t
h
e
co
n
d
itio
n
o
f
p
atien
t
s
at
d
is
c
h
ar
g
e
a
n
d
n
eg
l
ig
e
n
t
i
n
f
o
llo
w
in
g
u
p
o
n
th
e
co
n
d
it
io
n
o
f
p
atie
n
ts
w
er
e
v
er
y
s
tr
o
n
g
l
y
ass
o
ciate
d
w
ith
t
h
e
in
c
id
en
c
e
o
f
r
eh
o
s
p
italizatio
n
a
n
d
/o
r
d
ea
th
o
f
s
tr
o
k
e
p
atien
t
s
w
i
th
i
n
3
0
d
ay
s
a
f
ter
d
is
ch
ar
g
e
(
OR
:
1
.
5
1
.
9
5
%
C
I
1
.
0
7
-
2
.
1
2
)
[
2
0
]
.
T
h
is
s
h
o
w
s
th
at
th
e
in
d
icato
r
o
f
ad
m
i
n
i
s
tr
ativ
e
ac
ti
v
it
ies
i
s
in
d
ee
d
w
o
r
th
y
o
f
b
ei
n
g
o
n
e
o
f
th
e
in
d
icato
r
s
f
o
r
ass
es
s
i
n
g
t
h
e
q
u
alit
y
o
f
h
o
m
e
ca
r
e.
3.
3
.
6
.
Do
m
a
i
n o
f
hea
lt
h sta
f
f
inte
ra
ct
io
n w
it
h pa
t
ient
s
a
n
d f
a
m
ilie
s
Hea
lth
p
r
o
f
es
s
io
n
al
s
a
n
d
p
atien
t
an
d
f
a
m
il
y
i
n
ter
ac
tio
n
i
s
i
m
p
o
r
tan
t
b
ec
au
s
e
o
f
f
icer
s
i
n
p
r
i
m
ar
y
s
er
v
ices
a
n
d
co
m
m
u
n
it
y
h
ea
lt
h
s
er
v
ice
s
ca
n
p
r
o
v
id
e
ac
ce
s
s
to
s
er
v
ices
i
n
th
e
co
m
m
u
n
it
y
,
f
ac
ilit
ate
tr
a
n
s
f
er
to
s
p
ec
ialis
t
s
w
h
en
n
e
w
p
r
o
b
lem
s
ar
i
s
e,
p
r
o
v
id
e
tr
ain
i
n
g
,
an
d
id
en
tify
a
n
d
p
r
o
v
id
e
h
ea
lt
h
n
ee
d
s
to
ca
r
eg
iv
er
s
[
2
1
]
.
T
h
is
in
ter
ac
tio
n
is
n
ee
d
ed
to
f
o
s
ter
a
tr
u
s
ti
n
g
r
elatio
n
s
h
ip
as
w
ell
as
a
f
o
r
m
o
f
p
atien
t
a
n
d
f
a
m
il
y
in
v
o
l
v
e
m
en
t
in
h
o
m
e
ca
r
e
(
p
atien
t
an
d
f
a
m
il
y
ce
n
tr
ed
ca
r
e)
,
in
o
r
d
er
to
av
o
id
t
h
e
o
cc
u
r
r
en
ce
o
f
m
ar
g
i
n
aliza
t
io
n
[
2
1
]
,
[
2
2
]
.
Ma
r
g
in
al
izatio
n
i
s
th
e
f
ee
li
n
g
o
f
b
ein
g
m
ar
g
in
a
lized
b
y
s
tr
o
k
e
p
atien
t
s
an
d
ca
r
eg
iv
er
s
b
ec
au
s
e
t
h
e
y
f
ee
l
u
n
f
u
l
f
illed
p
r
o
m
i
s
es
an
d
f
r
u
s
t
r
ated
b
y
li
m
itat
io
n
s
o
r
late
ac
ce
s
s
a
n
d
a
lack
o
f
p
r
o
ac
tiv
e
f
o
llo
w
-
u
p
f
r
o
m
h
ea
l
th
w
o
r
k
er
s
a
f
ter
a
s
tr
o
k
e.
3.
3
.
7
.
Do
m
a
i
n o
f
ph
y
s
ica
l c
o
nd
it
io
n
A
cti
v
it
ies
o
f
d
ail
y
l
iv
i
n
g
(
ADL
)
ab
ilit
y
a
n
d
co
m
p
licatio
n
s
f
r
ee
ar
e
as
a
n
i
n
d
icato
r
o
f
h
o
m
e
ca
r
e
s
er
v
ices
[
1
1
]
,
[
18]
.
T
h
e
im
p
o
r
tan
ce
o
f
t
h
e
ADL
in
d
ep
en
d
e
n
ce
in
d
icato
r
ca
n
b
e
s
ee
n
f
r
o
m
th
e
e
x
p
er
t's
r
atin
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
252
-
8
806
V
a
lid
ity
a
n
d
r
elia
b
ilit
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test
in
g
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f h
o
me
ca
r
e
s
tr
o
ke
q
u
a
lity in
d
ica
to
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s
(
N
u
r
C
h
a
ya
ti
)
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an
d
th
e
h
i
g
h
s
co
r
e
o
f
lo
ad
in
g
f
ac
to
r
s
.
T
h
is
co
n
d
itio
n
is
i
n
ac
c
o
r
d
an
ce
w
it
h
Ma
s
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th
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ee
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s
as t
h
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m
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d
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ar
e
a
to
p
p
r
io
r
ity
t
h
at
m
u
s
t b
e
m
et
[
2
3
]
.
B
esid
es
attr
ib
u
ted
to
h
u
m
a
n
n
atu
r
e,
t
h
e
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if
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A
D
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d
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s
is
also
in
f
lu
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ce
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b
y
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lt
u
r
e;
esp
ec
iall
y
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av
an
e
s
e
cu
lt
u
r
e
(
I
n
d
o
n
esi
a)
.
I
n
ter
m
s
o
f
J
av
an
e
s
e
cu
lt
u
r
e,
w
h
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f
l
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i
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t
h
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ased
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s
o
m
e
o
n
e’
s
ab
ilit
y
to
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o
r
k
[
2
4
]
.
T
h
u
s
,
th
e
J
av
an
e
s
e
in
ter
p
r
et
th
e
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atie
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ex
tr
e
m
e
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ar
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ak
in
g
t
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e
m
u
n
ab
le
to
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k
in
d
ep
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e
n
tl
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Hen
ce
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ec
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h
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n
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it
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o
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d
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e
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th
e
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o
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t p
r
io
r
itized
g
o
al
h
ea
lt
h
ca
r
e
o
f
th
e
p
at
ie
n
ts
[
2
5
]
.
3.
3
.
8
.
Self
-
a
ct
ua
liza
t
io
n do
m
a
i
n
T
h
e
d
o
m
ain
o
f
s
el
f
-
ac
t
u
aliza
ti
o
n
is
clo
s
el
y
r
elate
d
to
th
e
m
e
an
in
g
o
f
f
a
m
il
y
f
o
r
p
atien
ts
.
F
a
m
il
y
f
o
r
th
e
J
av
a
n
ese
p
eo
p
le
an
d
I
n
d
o
n
esian
s
is
p
er
ce
iv
ed
as
a
p
lace
to
f
o
s
ter
a
s
e
n
s
e
o
f
m
u
t
u
al
as
s
is
ta
n
ce
s
p
o
n
tan
eo
u
s
l
y
.
T
h
er
ef
o
r
e
f
a
m
il
y
m
e
m
b
er
s
m
u
s
t
tr
u
s
t
ea
c
h
o
th
er
an
d
s
h
o
u
ld
n
ev
er
lea
v
e
ea
ch
o
th
er
[
2
6
]
.
T
h
is
p
er
ce
p
tio
n
h
as
i
m
p
licatio
n
s
o
n
h
ea
lt
h
asp
ec
t.
T
h
u
s
i
f
a
f
a
m
il
y
m
e
m
b
er
is
s
ic
k
o
th
er
f
a
m
il
y
m
e
m
b
er
s
an
d
th
e
co
m
m
u
n
it
y
w
i
ll
h
elp
ea
ch
o
th
er
to
ea
s
e
th
e
b
u
r
d
en
o
f
th
e
s
ic
k
p
er
s
o
n
.
Self
-
ac
t
u
aliza
tio
n
i
s
th
e
h
i
g
h
e
s
t
n
ee
d
in
h
u
m
a
n
s
[
2
3
]
.
T
h
u
s
w
h
en
p
ati
en
ts
ca
n
g
e
t
to
g
e
th
er
w
it
h
c
h
i
ld
r
en
an
d
g
r
an
d
c
h
ild
r
en
,
it
i
s
ex
p
ec
ted
th
at
t
h
e
y
w
il
l
r
ev
i
v
e
th
eir
l
if
e
s
p
ir
it
a
n
d
r
esto
r
e
th
e
r
o
le
o
f
p
atie
n
t
s
in
t
h
e
h
o
u
s
eh
o
ld
.
T
o
ac
h
iev
e
th
i
s
g
o
al,
h
ea
lt
h
w
o
r
k
er
s
ca
n
g
iv
e
ad
v
ice
to
f
a
m
il
y
m
e
m
b
er
s
to
s
p
en
d
as
m
u
ch
ti
m
e
as p
o
s
s
ib
le
to
ac
co
m
p
an
y
t
h
e
p
atien
ts
.
3.
3
.
9
.
P
s
y
cho
lo
g
ica
l st
a
t
e
do
m
a
i
n
T
h
e
d
o
m
ain
o
f
p
s
y
ch
o
lo
g
ical
co
n
d
itio
n
s
is
v
er
y
i
m
p
o
r
tan
t
asp
ec
t
in
s
tr
o
k
e
p
atien
t
s
b
ec
au
s
e
s
tr
o
k
e
p
atien
ts
o
f
ten
e
x
p
er
ien
ce
d
ep
r
ess
io
n
,
m
o
o
d
d
is
o
r
d
er
s
an
d
s
o
cial
is
o
latio
n
[
1
9
]
,
[
27
]
–
[
2
9
]
.
T
h
is
is
s
u
p
p
o
r
ted
b
y
a
n
o
th
er
s
t
u
d
ies
t
h
at
i
n
cl
u
d
e
n
eg
ati
v
e
m
o
o
d
s
as
a
n
i
n
d
icato
r
o
f
th
e
q
u
alit
y
o
f
h
o
m
e
ca
r
e
[
1
1
]
,
[
18
]
,
[
19]
.
I
n
ad
d
itio
n
,
it is
clea
r
l
y
e
x
p
lain
e
d
th
at
d
ep
r
ess
io
n
,
an
x
iet
y
an
d
s
ad
n
es
s
ar
e
p
ar
t o
f
p
s
y
ch
o
lo
g
i
ca
l in
d
icato
r
s
in
t
h
e
m
i
n
i
m
u
m
d
ata
s
et
-
h
o
m
e
ca
r
e
(
MD
S
-
HC
)
i
n
s
tr
u
m
e
n
t.
3
.
3
.
1
0
.
F
a
m
ily
in
depen
denc
e
a
nd
co
pin
g
do
m
a
i
n
T
h
e
d
o
m
ai
n
o
f
f
a
m
i
l
y
i
n
d
ep
en
d
en
ce
an
d
co
p
in
g
i
m
p
lies
t
h
at
f
a
m
i
l
y
d
u
tie
s
w
h
e
n
ca
r
in
g
f
o
r
p
atien
ts
ar
e
to
o
h
ea
v
y
.
Hen
ce
,
t
h
e
y
m
u
s
t
b
ala
n
ce
b
et
w
ee
n
ef
f
o
r
ts
/c
o
p
in
g
s
tr
ateg
ie
s
to
r
ed
u
ce
t
h
e
b
u
r
d
en
o
f
t
h
e
ta
s
k
.
R
esear
ch
o
n
2
0
5
ca
r
eg
iv
er
s
co
n
f
ir
m
ed
th
at
t
h
e
f
a
m
il
y
's
h
ea
v
y
d
u
t
y
o
f
te
n
ca
u
s
es
f
a
m
il
y
d
is
tr
es
s
d
u
e
to
p
h
y
s
ical
f
ati
g
u
e
b
ec
au
s
e
o
f
in
s
u
f
f
icie
n
t
ca
r
e
an
d
s
leep
tim
e
[
3
0
]
.
P
s
y
ch
o
lo
g
icall
y
,
t
h
e
f
a
m
il
y
o
f
te
n
co
m
p
lain
s
ab
o
u
t th
e
co
n
d
itio
n
o
f
p
ati
e
n
ts
w
h
o
d
o
n
o
t r
ec
o
v
er
i
m
m
ed
iat
el
y
t
h
at
lead
s
to
p
ess
i
m
i
s
m
a
n
d
d
esp
air
.
So
ciall
y
,
th
e
f
a
m
i
l
y
’
s
tas
k
to
tak
e
ca
r
e
o
f
th
e
p
atie
n
t
r
es
u
lts
i
n
a
la
ck
o
f
ti
m
e
to
g
a
th
er
w
it
h
f
r
ie
n
d
s
o
r
n
ei
g
h
b
o
u
r
s
.
Ma
k
i
n
g
t
h
e
m
u
n
ab
le
to
g
et
i
n
v
o
lv
ed
in
s
o
cial
ac
ti
v
ities
,
a
n
d
le
ad
s
to
ec
o
n
o
m
ic
p
r
o
b
lem
s
.
On
e
f
o
r
m
o
f
f
a
m
i
l
y
co
p
in
g
to
r
ed
u
ce
f
a
m
il
y
d
is
tr
e
s
s
i
s
b
y
t
ellin
g
s
to
r
ies
o
r
co
u
n
s
elli
n
g
w
it
h
h
ea
lt
h
w
o
r
k
er
s
ab
o
u
t
t
h
eir
p
r
o
b
lem
s
[
3
1
]
.
Fa
m
ilies
o
f
h
o
m
e
ca
r
e
p
atien
t
s
r
ea
ll
y
n
ee
d
h
ea
l
th
ed
u
c
atio
n
f
r
o
m
o
f
f
icer
s
[
3
2
]
.
Hea
lth
ed
u
ca
tio
n
w
o
u
ld
r
ed
u
ce
f
a
m
il
y
s
tr
es
s
[
3
3
]
b
e
ca
u
s
e
it
co
u
ld
i
m
p
r
o
v
e
s
e
lf
-
c
o
n
tr
o
l
an
d
f
a
m
il
y
co
m
p
ete
n
c
y
/k
n
o
w
led
g
e
i
n
h
o
m
e
ca
r
e
an
d
co
n
tr
o
l d
ep
r
ess
io
n
[
3
4
]
.
4.
CO
NCLU
SI
O
N
Ho
m
e
ca
r
e
as
a
f
o
r
m
o
f
ad
v
a
n
ce
d
h
ea
lt
h
s
er
v
ice
s
f
o
r
s
tr
o
k
e
p
atien
ts
r
eq
u
ir
es
i
n
d
icato
r
s
t
o
ascer
tain
th
e
q
u
a
lit
y
o
f
s
er
v
ices
p
r
o
v
i
d
ed
.
I
n
d
icato
r
s
o
f
g
o
o
d
h
ea
l
th
m
u
s
t
b
e
ex
a
m
i
n
ed
f
o
r
v
a
lid
it
y
.
T
h
is
s
t
u
d
y
su
cc
e
s
s
f
u
ll
y
p
r
o
v
ed
th
e
v
alid
it
y
o
f
6
2
i
n
d
icato
r
s
o
f
q
u
alit
y
h
o
m
e
ca
r
e
f
o
r
s
tr
o
k
e
a
p
atie
n
t
w
h
o
is
d
i
v
id
ed
in
to
1
0
d
o
m
ain
s
,
n
a
m
el
y
p
er
s
o
n
a
l,
d
o
cu
m
en
t,
p
r
o
f
ess
io
n
al
d
ev
elo
p
m
e
n
t,
s
u
p
p
o
r
tin
g
f
ac
ilit
ies,
ad
m
i
n
is
tr
ati
v
e
p
r
o
ce
s
s
,
h
ea
lth
s
taf
f
i
n
ter
a
ctio
n
w
it
h
p
ati
en
t
s
an
d
f
a
m
ilie
s
,
p
h
y
s
ical
co
n
d
itio
n
,
s
elf
-
ac
t
u
aliza
tio
n
,
p
s
y
ch
o
lo
g
ical
s
tate
a
n
d
f
a
m
il
y
in
d
ep
en
d
en
ce
an
d
co
p
in
g
.
T
h
e
in
d
icato
r
s
o
f
t
h
e
q
u
alit
y
o
f
h
o
m
e
ca
r
e
w
h
ic
h
ar
e
d
ev
elo
p
ed
in
clu
d
e
t
h
e
p
h
y
s
ical
an
d
p
s
y
ch
o
lo
g
ical
a
s
p
ec
ts
o
f
p
atie
n
ts
an
d
t
h
eir
f
a
m
ilie
s
,
t
h
e
m
a
n
ag
e
m
e
n
t
o
f
h
o
m
e
ca
r
e
p
r
o
v
id
er
s
in
v
o
lv
i
n
g
t
h
e
o
f
f
icer
s
also
t
h
e
co
m
p
lete
n
es
s
o
f
ad
m
i
n
is
tr
ativ
e
s
er
v
ice
s
.
T
h
e
ac
h
ie
v
e
m
e
n
t
o
f
t
h
e
s
e
in
d
ic
ato
r
s
is
ex
p
ec
ted
to
co
n
tr
ib
u
te
f
o
r
i
m
p
r
o
v
i
n
g
t
h
e
q
u
alit
y
o
f
h
o
m
e
ca
r
e
s
er
v
ices
f
o
r
s
tr
o
k
e
p
atien
ts
.
Fu
r
t
h
er
r
esea
r
ch
is
n
ee
d
ed
to
p
ilo
t p
r
o
j
ec
t th
is
in
d
icato
r
in
a
lar
g
er
ar
ea
o
f
h
o
m
e
ca
r
e
s
er
v
i
ce
s
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
e
au
th
o
r
s
ar
e
g
r
ate
f
u
l
to
t
h
e
A
ca
d
e
m
ic
W
r
itin
g
Staf
f
Un
i
v
er
s
ita
s
M
u
h
a
m
m
ad
i
y
a
h
Yo
g
y
a
k
ar
ta.
I
n
d
o
n
esia
f
o
r
lan
g
u
a
g
e
s
u
p
p
o
r
t to
th
ese
r
esear
ch
w
o
r
k
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
4
,
Dec
em
b
er
2021
:
873
–
8
7
9
878
RE
F
E
R
E
NC
E
S
[1
]
A
.
Ku
lsh
re
sh
th
a
,
L
.
M
.
A
n
d
e
rso
n
,
A
.
G
o
y
a
l,
a
n
d
N.
L
.
Ke
e
n
a
n
,
“
S
tro
k
e
in
S
o
u
t
h
A
sia
:
A
s
y
ste
m
a
ti
c
re
v
ie
w
o
f
e
p
id
e
m
io
lo
g
ic
li
tera
tu
re
f
ro
m
1
9
8
0
to
2
0
1
0
,
”
Ne
u
ro
e
p
id
e
mio
l
o
g
y
,
v
o
l.
3
8
,
n
o
.
3
,
p
p
.
1
2
3
–
1
2
9
,
2
0
1
2
,
d
o
i:
1
0
.
1
1
5
9
/
0
0
0
3
3
6
2
3
0
.
[2
]
M
.
P
.
L
in
d
sa
y
,
e
t
a
l.
,
“
W
o
rld
str
o
k
e
Org
a
n
iza
ti
o
n
(W
S
O):
g
lo
b
a
l
stro
k
e
f
a
c
t
sh
e
e
t
2
0
1
9
,
”
I
n
ter
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
S
tro
k
e
,
v
o
l.
1
4
,
n
o
.
8
,
p
p
.
8
0
6
-
8
1
7
2
0
1
9
,
d
o
i
:
1
0
.
1
1
7
7
/
1
7
4
7
4
9
3
0
1
9
8
8
1
3
5
3
.
[3
]
N
.
V
e
n
k
e
tas
u
b
ra
m
a
n
ian
,
BW
.
Y
o
o
n
,
J
.
P
a
n
d
ian
,
a
n
d
JC.
Na
v
a
rro
,
"
S
tro
k
e
e
p
id
e
m
io
lo
g
y
in
so
u
th
,
e
a
st,
a
n
d
so
u
t
h
-
e
a
st
a
sia
:
A
re
v
ie
w
,
"
J
o
u
rn
a
l
S
tr
o
k
e
,
v
o
l.
1
9
,
n
o
.
3
,
p
p
.
2
8
6
–
9
4
,
2
0
1
7
,
d
o
i:
1
0
.
5
8
5
3
/
jo
s.
2
0
1
7
.
0
0
2
3
4
.
[4
]
I
.
S
e
ty
o
p
ra
n
o
t
o
e
t
a
l
.
,
"
P
re
v
a
len
c
e
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f
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d
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iate
d
risk
f
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rs
in
sle
m
a
n
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istri
c
t
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f
Yo
g
y
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k
a
rt
a
S
p
e
c
ial
Re
g
io
n
,
In
d
o
n
e
sia
,
"
S
tro
k
e
Res
T
re
a
t
,
p
p
.
1
–
8
,
2
0
1
9
,
d
o
i:
1
0
.
1
1
5
5
/2
0
1
9
/
2
6
4
2
4
5
8
.
[5
]
L
.
T
ris
e
ti
a
w
a
ti
,
P
.
Yu
n
iar,
a
n
d
B
e
sra
l
.
"
Re
c
u
rre
n
t
S
tro
k
e
a
m
o
n
g
P
a
ti
e
n
ts
a
t
In
d
o
n
e
sia
’s
Na
ti
o
n
a
l
Bra
in
Ce
n
ter
Ho
sp
it
a
l:
C
o
n
tri
b
u
ti
n
g
F
a
c
to
rs,"
2
n
d
In
t
.
M
e
e
t.
o
f
Pu
b
li
c
He
a
l
.
2
0
1
6
wi
th
t
h
e
me
“
Pu
b
li
c
He
a
l.
Per
sp
e
c
t.
o
f
S
u
sta
in
a
b
le De
v
.
Go
a
ls
Ch
a
ll
e
n
g
e
s O
p
p
o
r,
Asia
-
P
a
c
if
ic R
e
g
.
,
2
0
1
8
,
p
.
1
9
–
2
6
,
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o
i:
1
0
.
1
8
5
0
2
/k
ls.
v
4
i
4
.
2
2
5
9
.
[6
]
IA
.
S
e
t
y
a
wa
n
,
T
M
.
A
n
d
a
y
a
n
i
,
a
n
d
RT
.
P
i
n
z
o
n
,
"
A
n
a
l
y
sis
o
f
Ha
e
m
o
rr
a
g
e
S
tro
k
e
Dise
a
se
a
t
Ho
sp
it
a
l
,
"
J
M
a
n
a
j
Da
n
Pela
y
a
n
a
n
Fa
rm
,
v
o
l
.
6
,
p
p
.
4
1
–
6
,
2
0
1
6
.
[7
]
H
.
F
a
d
h
i
lah
a
n
d
V
Y.
P
e
rm
a
n
a
sa
ri,
"
Eco
n
o
m
ic
Bu
rd
e
n
B
o
re
b
y
P
a
ti
e
n
ts
a
n
d
F
a
m
il
ies
b
e
c
a
u
s
e
o
f
stro
k
e
:
P
o
li
c
y
A
s
se
ss
m
e
n
t,
"
J
In
d
o
n
e
s He
a
l
P
o
li
c
y
Ad
m
.,
v
o
l.
5
,
n
o
.
3
,
p
p
.
9
1
–
5
,
2
0
2
0
,
d
o
i:
1
0
.
7
4
5
4
/
ih
p
a
.
v
5
i3
.
3
1
8
0
.
[8
]
M
.
F
.
W
a
lk
e
r,
K.
S
.
S
u
n
n
e
r
h
a
g
e
n
,
a
n
d
R.
J.
F
ish
e
r,
“
Ev
id
e
n
c
e
-
b
a
se
d
c
o
m
m
u
n
it
y
stro
k
e
re
h
a
b
il
it
a
ti
o
n
,
”
S
tro
k
e
,
v
o
l
.
4
4
,
n
o
.
1
,
p
p
.
2
9
3
–
2
9
7
,
2
0
1
3
,
d
o
i:
1
0
.
1
1
6
1
/S
T
ROK
EA
H
A
.
1
1
1
.
6
3
9
9
1
4
.
[9
]
Y.
M
a
h
e
n
d
r
a
d
h
a
ta
e
t
a
l.
,
"
P
r
o
v
isio
n
o
f
se
rv
ice
s.
Re
p
u
b
.
In
d
o
n
e
s.
H
e
a
l.
S
y
st.
Re
v
.
,
"
W
o
r
ld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
p
p
.
132
–
6
9
,
2
0
1
7
.
[1
0
]
S
.
Na
k
re
m
,
“
Un
d
e
rsta
n
d
in
g
o
r
g
a
n
iza
ti
o
n
a
l
a
n
d
c
u
lt
u
ra
l
p
re
m
i
se
s
f
o
r
q
u
a
li
ty
o
f
c
a
r
e
in
n
u
rs
in
g
h
o
m
e
s:
a
n
e
th
n
o
g
ra
p
h
ic stu
d
y
,
”
BM
C
He
a
lt
h
S
e
rv
.
Res
.
,
v
o
l.
1
5
,
n
o
.
1
,
2
0
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5
,
d
o
i:
1
0
.
1
1
8
6
/s1
2
9
1
3
-
0
1
5
-
1
1
7
1
-
y.
[1
1
]
N.
Ch
a
y
a
ti
,
C.
Eff
e
n
d
y
,
a
n
d
I.
S
e
ty
o
p
ra
n
o
to
,
“
M
o
d
if
ied
De
lp
h
i
Co
n
se
n
su
s
o
n
De
v
e
lo
p
i
n
g
Ho
m
e
Ca
re
S
e
r
v
ice
Qu
a
li
ty
In
d
ica
to
r
f
o
r
S
tro
k
e
S
u
rv
iv
o
r
in
Yo
g
y
a
k
a
rta,
In
d
o
n
e
sia
,
”
Op
e
n
Acc
e
ss
M
a
c
e
d
.
J
.
M
e
d
.
S
c
i.
,
v
o
l.
7
,
n
o
.
1
0
,
p
p
.
1
7
1
2
–
1
7
1
8
,
2
0
1
9
,
d
o
i:
1
0
.
3
8
8
9
/o
a
m
j
m
s.2
0
1
9
.
4
5
5
.
[1
2
]
A
.
Wag
n
e
r,
F
.
Zu
´
ñ
ig
a
,
P
.
Ru
¨e
s
c
h
,
R.
S
c
h
a
f
fe
rt,
a
n
d
J.
Dra
tv
a
,
“
S
e
lec
ti
n
g
h
o
m
e
c
a
re
q
u
a
li
ty
in
d
i
c
a
to
rs
b
a
se
d
o
n
th
e
Re
sid
e
n
t
A
ss
e
ss
m
e
n
t
In
stru
m
e
n
t
-
Ho
m
e
Ca
re
(R
A
I
-
HC)
f
o
r
S
w
it
z
e
rl
a
n
d
:
A
p
u
b
li
c
h
e
a
lt
h
a
n
d
h
e
a
lt
h
c
a
re
p
ro
v
id
e
rs’ p
e
rs
p
e
c
ti
v
e
,
”
PL
o
S
O
n
e
,
v
o
l.
1
5
,
n
o
.
1
2
,
p
p
.
1
–
1
7
,
2
0
2
0
,
d
o
i
:
1
0
.
1
3
7
1
/j
o
u
r
n
a
l.
p
o
n
e
.
0
2
4
4
5
7
7
.
[1
3
]
D.
W
.
V
it
u
ri
a
n
d
Y.
D.
M
.
Év
o
ra
,
“
Re
li
a
b
il
it
y
o
f
in
d
ica
to
rs
o
f
n
u
rsin
g
c
a
re
q
u
a
li
ty
:t
e
stin
g
in
tere
x
a
m
i
n
e
r
a
g
re
e
m
e
n
t
a
n
d
re
li
a
b
i
li
ty
,
”
Rev
.
L
a
ti
n
o
-
Am.
En
fer
m.
,
v
o
l.
2
2
,
n
o
.
0
2
,
p
p
.
2
3
4
–
2
4
0
,
2
0
1
6
,
d
o
i:
1
0
.
1
5
9
0
/
0
1
0
4
-
1
1
6
9
.
3
2
6
2
.
2
4
0
7
.
[1
4
]
J.
Zh
a
n
g
,
e
t
a
l
.
,
“
Re
li
a
b
il
it
y
a
n
d
v
a
li
d
it
y
o
f
a
n
in
d
ica
to
r
sy
ste
m
u
se
d
to
e
v
a
lu
a
te o
u
tp
a
ti
e
n
t
a
n
d
i
n
p
a
ti
e
n
t
sa
ti
sf
a
c
ti
o
n
in
Ch
in
e
se
h
o
sp
it
a
ls,
”
P
a
ti
e
n
t
Pre
fer
.
Ad
h
e
re
n
c
e
,
v
o
l.
1
2
,
p
p
.
2
5
2
7
–
2
5
3
6
,
2
0
1
8
,
d
o
i:
1
0
.
2
1
4
7
/
P
P
A
.
S
1
8
6
7
2
2
.
[1
5
]
Na
ti
o
n
a
l
I
n
stit
u
te
o
f
Ne
u
ro
l
o
g
ica
l
Diso
rd
e
rs
a
n
d
S
tro
k
e
,
"
P
o
st
-
S
tr
o
k
e
Re
h
a
b
il
it
a
ti
o
n
F
a
c
t
S
h
e
e
t,
"
2
0
1
8
,
[
On
li
n
e
]
.
Av
a
il
a
b
le:
h
tt
p
s://
w
ww
.
n
in
d
s.n
i
h
.
g
o
v
/Diso
r
d
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rs/P
a
t
ien
t
-
Ca
re
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iv
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r
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Ed
u
c
a
ti
o
n
/F
a
c
t
-
S
h
e
e
ts/P
o
st
-
S
tr
o
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e
-
Re
h
a
b
il
it
a
ti
o
n
-
F
a
c
t
-
S
h
e
e
t
[1
6
]
D.
J.
Clark
e
a
n
d
A
.
F
o
rste
r,
“
I
m
p
ro
v
in
g
p
o
st
-
stro
k
e
re
c
o
v
e
r
y
:
T
h
e
ro
le o
f
th
e
m
u
lt
id
isc
ip
li
n
a
ry
h
e
a
lt
h
c
a
re
tea
m
,
”
J
.
M
u
lt
id
isc
ip
.
He
a
lt
h
c
.
,
v
o
l
.
8
,
p
p
.
4
3
3
–
4
4
2
,
2
0
1
5
,
d
o
i:
1
0
.
2
1
4
7
/J
M
DH
.
S
6
8
7
6
4
.
[1
7
]
D.
M
.
Do
ra
n
,
J.
P
.
Hird
e
s,
R.
Blais,
G
.
R.
Ba
k
e
r,
J.
W
.
P
o
ss
,
a
n
d
X.
L
i,
“
A
d
v
e
rse
Ev
e
n
ts
As
so
c
iate
d
w
it
h
Ho
sp
it
a
li
z
a
ti
o
n
o
r
De
tec
ted
th
r
o
u
g
h
th
e
RA
I
-
HC
A
ss
e
ss
m
e
n
t
a
m
o
n
g
Ca
n
a
d
ian
Ho
m
e
Ca
re
Cli
e
n
ts
Év
é
n
e
m
e
n
ts
in
d
é
sira
b
les
a
ss
o
c
iés
à
l’
h
o
sp
it
a
l
isa
ti
o
n
o
u
d
é
t
e
c
tés
à
l’
a
id
e
d
u
R
A
I
-
HC
c
h
e
z
les
c
li
e
n
ts
q
u
i
re
ç
o
iv
e
n
t
d
e
s
so
i
n
s
à
d
o
,
”
He
a
l
Ca
re
P
o
li
c
y
,
v
o
l.
9
,
n
o
.
1
,
p
p
.
7
6
–
8
8
,
2
0
1
3
.
[1
8
]
J.
G
.
Ko
ste
n
iu
k
,
D.
G
.
M
o
rg
a
n
,
M
.
E.
O’Co
n
n
e
ll
,
V.
D.
Be
ll
o
-
H
a
a
s,
a
n
d
N.
J.
S
te
w
a
rt,
“
F
o
c
u
s
o
n
d
e
m
e
n
ti
a
c
a
re
:
Co
n
ti
n
u
i
n
g
e
d
u
c
a
ti
o
n
p
re
f
e
re
n
c
e
s
,
c
h
a
ll
e
n
g
e
s,
a
n
d
c
a
taly
sts
a
m
o
n
g
ru
ra
l
h
o
m
e
c
a
r
e
p
ro
v
id
e
rs,”
Ed
u
c
Ge
ro
n
to
l
,
v
o
l.
4
2
,
n
o
.
9
,
p
p
.
6
0
8
–
6
2
0
,
2
0
1
6
,
d
o
i:
1
0
.
1
0
8
0
/0
3
6
0
1
2
7
7
.
2
0
1
6
.
1
2
0
5
4
0
4
.
[1
9
]
A
.
D.
F
o
e
b
e
l
e
t
a
l.
,
“
Qu
a
li
ty
o
f
c
a
re
in
E
u
ro
p
e
a
n
h
o
m
e
c
a
re
p
ro
g
ra
m
s
u
sin
g
th
e
se
c
o
n
d
g
e
n
e
ra
ti
o
n
i
n
terRA
I
Ho
m
e
Ca
re
Qu
a
li
ty
In
d
ica
to
rs (HCQIs
),
”
BM
C
Ge
ria
tr
,
v
o
l.
1
5
,
n
o
.
1
,
p
p
.
1
-
1
0
,
2
0
1
5
,
d
o
i:
1
0
.
1
1
8
6
/s1
2
8
7
7
-
015
-
0
1
4
6
-
5.
[2
0
]
A
.
L
.
G
il
m
o
re
-
B
y
k
o
v
s
k
y
i,
Ke
n
n
e
lt
y
,
K.
A
.
,
Kin
d
,
E.
Du
G
o
f
f
,
a
n
d
A
.
J.
H.
Kin
d
,
“
Ho
sp
it
a
l
d
isc
h
a
rg
e
d
o
c
u
m
e
n
tatio
n
o
f
a
d
e
si
g
n
a
ted
c
li
n
icia
n
f
o
r
f
o
ll
o
w
-
u
p
c
a
re
a
n
d
3
0
-
d
a
y
o
u
tco
m
e
s
in
h
ip
f
ra
c
tu
re
a
n
d
stro
k
e
p
a
ti
e
n
ts
d
isc
h
a
rg
e
d
to
su
b
-
a
c
u
te
c
a
re
,
”
BM
C
He
a
l.
S
e
rv
Res
,
v
o
l.
1
8
,
n
o
.
1
0
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1
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M
.
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l.
,
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su
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[2
2
]
K.
M
.
S
c
h
a
rp
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E.
D.
H
a
ll
,
“
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a
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tary
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fa
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p
s,”
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.
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Co
mm
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.
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[2
3
]
A
.
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.
Av
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[2
4
]
D.
P
it
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a
a
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d
E.
Hs
ieh
,
“
He
a
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s
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m
issio
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ial
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sp
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ies
:
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Ja
v
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e
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iab
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tes
,
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a
l.
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Res
.
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0
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.
[2
5
]
J.
M
o
l
d
,
“
G
o
a
l
-
Dire
c
ted
He
a
lt
h
C
a
re
:
Re
d
e
f
in
in
g
He
a
lt
h
a
n
d
He
a
lt
h
Ca
re
in
th
e
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ra
o
f
V
a
l
u
e
-
Ba
se
d
Ca
re
,
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re
u
s
,
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l.
9
,
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.
1
,
p
p
.
1
–
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,
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0
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7
,
d
o
i:
1
0
.
7
7
5
9
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re
u
s.
1
0
4
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
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2
252
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8
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[2
6
]
N.
Y.
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y
a
n
ti
,
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[2
7
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.
v
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.
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.
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,
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:
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.
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te
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[2
8
]
E.
-
M
.
Ju
n
,
Y.
H
.
Ro
h
,
a
n
d
M
.
J.
Kim
,
“
T
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ts,
”
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Cli
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Nu
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.
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.
[2
9
]
N.
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ra
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,
"
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Dr M
Dja
m
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,
"
NER
S
J
.
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0
]
R.
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.
M
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ry
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M
.
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a
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ti
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.
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[3
1
]
K.
T
.
L
.
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a
n
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,
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.
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L
u
,
F
.
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.
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o
sta
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im
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[3
2
]
L
.
M
.
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t
a
l.
,
“
Qu
a
li
tativ
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s in
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re
,
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me
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.
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[3
3
]
JA
.
M
y
e
rs
-
W
a
ll
s,
"
F
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y
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i
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E
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A
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s:
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4
]
L.
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a
s
k
,
"
Ed
u
c
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ti
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f
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m
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y
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s
to
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:
W
h
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?
,
"
Ca
n
J
Psy
c
h
ia
try
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l.
5
8
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o
.
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,
p
p
.
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o
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10.
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0
5
8
0
0
8
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3
.
Evaluation Warning : The document was created with Spire.PDF for Python.