I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
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S)
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
,
p
p
.
1
54
8
~
1
55
3
I
SS
N:
2252
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DOI
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1
1
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J
o
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:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Preva
lence and
d
eter
mina
nts
as
so
cia
ted
wi
th
a
do
lesc
ent
idio
pa
thic
sco
lio
sis
:
resul
ts of scr
ee
ning
in
Sura
ka
r
ta, Indo
nesia
Alind
a
Nur
Ra
m
a
dh
a
ni
1
,
De
a
L
ini
a
Ro
m
a
dh
o
ni
1
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a
s
Awa
nis
2
1
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e
p
a
r
t
me
n
t
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y
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h
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a
p
y
,
U
n
i
v
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t
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s
‘
A
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sy
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a
h
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u
r
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k
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p
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p
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t
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l
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si
a
Art
icle
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nfo
AB
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T
RAC
T
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r
ticle
his
to
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y:
R
ec
eiv
ed
Oct
3
,
2
0
2
3
R
ev
is
ed
Feb
5
,
2
0
2
4
Acc
ep
ted
Feb
2
1
,
2
0
2
4
S
c
o
li
o
sis
is
d
e
fi
n
e
d
a
s
a
v
e
rte
b
ra
l
d
e
fo
rm
it
y
c
h
a
ra
c
teriz
e
d
b
y
a
late
ra
l
d
e
v
iatio
n
o
f
a
t
lea
st
1
0
°
with
v
e
rteb
ra
l
ro
tatio
n
.
Ad
o
les
c
e
n
t
id
io
p
a
th
i
c
sc
o
li
o
sis
is
g
e
n
e
ra
ll
y
fo
u
n
d
i
n
c
h
il
d
re
n
a
g
e
d
1
0
-
1
8
y
e
a
rs.
Ch
a
n
g
e
s
in
th
e
sc
o
li
o
sis
c
u
r
v
e
a
re
in
fl
u
e
n
c
e
d
b
y
v
a
rio
u
s
e
ti
o
l
o
g
ic
fa
c
to
rs
in
c
l
u
d
in
g
a
g
e
,
se
x
,
g
ro
wt
h
fa
c
to
rs,
c
u
r
v
e
l
o
c
a
ti
o
n
a
n
d
b
i
o
m
e
c
h
a
n
ica
l
fa
c
to
rs.
T
h
e
s
tu
d
y
wa
s
c
o
n
d
u
c
ted
to
d
e
term
in
e
t
h
e
p
re
v
a
len
c
e
o
f
a
d
o
les
c
e
n
t
i
id
o
p
h
a
t
ic
s
c
o
li
o
sis
in
sc
h
o
o
l
st
u
d
e
n
ts
a
g
e
d
1
2
-
1
5
y
e
a
rs
in
S
u
ra
k
a
rta
c
it
y
.
P
h
y
sic
a
l
e
x
a
m
in
a
ti
o
n
u
sin
g
Ad
a
m
'
s
fo
rwa
rd
b
e
n
d
i
n
g
tes
t
,
sc
o
li
o
m
e
ter
a
n
d
ris
k
fa
c
to
r
q
u
e
stio
n
n
a
ire.
Th
e
re
se
a
rc
h
su
b
j
e
c
ts
we
re
3
2
5
p
e
o
p
le
with
a
n
a
g
e
ra
n
g
e
o
f
12
-
1
5
y
e
a
rs.
Re
se
a
rc
h
su
b
jec
ts
a
re
in
c
lu
d
e
d
in
t
h
e
a
d
o
les
c
e
n
t
i
d
io
p
a
th
ic
sc
o
li
o
sis
c
a
teg
o
ry
if
t
h
e
Ad
a
m
'
s
fo
rwa
rd
b
e
n
d
i
n
g
tes
t
is
p
o
siti
v
e
a
n
d
th
e
sc
o
li
o
m
e
ter
v
a
lu
e
is
>
1
0
°.
T
h
e
h
ig
h
e
st
p
re
v
a
len
c
e
o
f
a
d
o
les
c
e
n
t
i
d
io
p
a
th
ic
sc
o
li
o
sis
wa
s
fo
u
n
d
i
n
sc
h
o
o
l
c
h
il
d
re
n
a
g
e
d
1
4
y
e
a
rs.
Th
e
p
re
v
a
len
c
e
o
f
a
d
o
les
c
e
n
t
id
i
o
p
a
t
h
ic
sc
o
li
o
sis
is
h
ig
h
e
r
in
fe
m
a
le
(3
.
4
%
)
th
a
n
m
a
l
e
stu
d
e
n
ts
(0
.
3
%
).
D
e
term
in
i
n
g
fa
c
t
o
rs
th
a
t
m
ig
h
t
in
fl
u
e
n
c
e
th
e
o
n
se
t
o
f
a
d
o
l
e
sc
e
n
t
id
io
p
a
th
ic
sc
o
li
o
sis
in
c
l
u
d
in
g
a
g
e
,
g
e
n
d
e
r,
b
io
m
e
c
h
a
n
ica
l
fa
c
to
rs,
h
a
b
i
ts
o
r
li
fe
sty
les
fa
c
to
rs an
d
p
h
y
sic
a
l
a
c
ti
v
it
y
.
K
ey
w
o
r
d
s
:
Ad
o
lesen
t
id
io
p
ath
ic
s
co
lio
s
is
Dete
r
m
in
an
ts
Paed
iatr
ics
Pre
v
alen
ce
Sch
o
o
l
-
b
ased
s
cr
ee
n
i
n
g
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Alin
d
a
Nu
r
R
am
ad
h
a
n
i
Dep
ar
tm
en
t o
f
Ph
y
s
io
th
er
ap
y
,
Un
iv
er
s
itas
‘
Ais
y
iy
ah
Su
r
ak
ar
ta
Su
r
ak
ar
ta,
I
n
d
o
n
esia
E
m
ail:
alin
d
a.
r
am
ad
h
an
i@
ais
k
a
-
u
n
iv
e
r
s
ity
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Sco
lio
s
is
i
s
d
ef
in
ed
as
a
v
er
te
b
r
al
d
ef
o
r
m
ity
co
n
d
itio
n
ch
a
r
a
cter
ized
b
y
a
later
al
d
e
v
iatio
n
o
f
at
least
10
o
with
v
er
teb
r
al
r
o
tatio
n
[
1
]
.
Sco
lio
s
is
is
ca
u
s
ed
b
y
s
ev
e
r
al
f
ac
to
r
s
,
in
cl
u
d
in
g
id
io
p
ath
ic,
co
n
g
en
ital,
g
en
etic
f
ac
to
r
s
an
d
th
e
r
esu
lt
o
f
n
eu
r
o
m
u
s
cu
lar
d
is
o
r
d
er
s
[
2
]
,
[
3
]
.
I
d
io
p
ath
ic
s
co
lio
s
is
is
a
s
co
lio
s
is
co
n
d
itio
n
with
th
e
m
o
s
t p
r
ev
alen
ce
,
wh
ich
is
ar
o
u
n
d
8
5
% o
f
all
s
co
lio
s
is
ca
s
es
[
4
]
.
Ad
o
lescen
t
id
io
p
ath
ic
s
co
lio
s
is
is
g
en
er
ally
f
o
u
n
d
in
c
h
ild
r
en
a
g
ed
1
0
-
1
8
y
ea
r
s
.
Ad
o
lescen
t
id
io
p
ath
ic
s
co
lio
s
is
h
as
n
o
d
ef
in
ite
etio
lo
g
y
.
Sev
er
al
f
ac
to
r
s
ca
n
ca
u
s
e
th
e
co
n
d
itio
n
o
f
a
d
o
lescen
t
id
io
p
ath
ic
s
co
lio
s
is
in
clu
d
in
g
g
en
etic
f
ac
to
r
s
,
ab
n
o
r
m
alities
in
co
n
n
ec
tiv
e
tis
s
u
e
an
d
s
k
eleta
l m
u
s
cles
an
d
b
io
m
ec
h
an
ical
f
ac
to
r
s
.
C
lin
ical
m
an
if
estatio
n
s
th
at
ap
p
ea
r
i
n
s
co
lio
s
is
v
ar
y
f
r
o
m
asy
m
p
to
m
atic
to
clin
ical
s
y
m
p
to
m
s
s
u
ch
as
n
eu
r
o
m
u
s
cu
lar
an
d
ca
r
d
i
o
p
u
l
m
o
n
ar
y
d
is
o
r
d
er
s
[
5
]
.
Data
o
n
th
e
im
p
lem
en
tatio
n
o
f
s
cr
ee
n
in
g
a
n
d
th
e
p
r
e
v
alen
ce
o
f
s
co
lio
s
is
in
I
n
d
o
n
esia
is
s
till
lim
ited
.
Data
o
n
th
e
p
r
e
v
alen
ce
o
f
ad
o
lescen
t
id
io
p
ath
ic
s
co
lio
s
is
in
Su
r
ab
ay
a
was
r
ec
o
r
d
ed
at
2
.
9
3
%
in
ch
ild
r
en
a
g
ed
9
-
1
6
y
ea
r
s
[
5
]
.
Sch
o
o
l
-
b
ased
s
cr
ee
n
in
g
is
o
n
e
o
f
th
e
m
o
s
t
wid
ely
m
eth
o
d
to
d
eter
m
in
e
th
e
p
r
ev
alen
ce
o
f
ad
o
lescen
t
s
co
lio
s
is
.
Scr
ee
n
i
n
g
with
p
h
y
s
ical
ass
es
s
m
en
t,
Ad
am
’
s
f
o
r
war
d
b
en
d
in
g
te
s
t
an
d
s
co
lio
m
eter
m
ea
s
u
r
em
en
t
[
6
]
-
[
8
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
P
r
ev
a
len
ce
a
n
d
d
etermin
a
n
ts
a
s
s
o
cia
ted
w
ith
A
d
o
lescen
t I
d
i
o
p
a
th
ic
…
(
A
lin
d
a
N
u
r
R
a
ma
d
h
a
n
i
)
1549
C
h
an
g
es
in
t
h
e
s
co
lio
s
is
cu
r
v
e
ar
e
in
f
lu
en
ce
d
b
y
v
ar
io
u
s
et
io
lo
g
ical
f
ac
to
r
s
.
So
m
e
o
f
th
e
s
e
f
ac
to
r
s
in
clu
d
e
a
g
e,
g
en
d
er
,
g
r
o
wth
f
ac
to
r
,
cu
r
v
e
lo
ca
tio
n
an
d
b
io
m
ec
h
an
ical
f
ac
t
o
r
s
.
Sco
lio
s
is
is
r
elate
d
to
f
em
ale
g
en
d
er
an
d
ag
es
1
3
-
1
5
y
ea
r
s
[
9
]
.
T
h
is
is
r
elate
d
to
th
e
ea
r
l
y
ag
e
o
f
m
en
a
r
ch
e
a
n
d
p
ea
k
g
r
o
wth
in
wo
m
e
n
.
T
h
e
d
ev
elo
p
m
e
n
t o
f
ad
o
lescen
t id
i
o
p
ath
ic
s
co
lio
s
is
is
also
r
elate
d
to
g
r
o
wth
f
ac
to
r
s
[
1
0
]
.
Stu
d
y
r
ev
ea
led
th
at
th
er
e
is
a
p
o
s
itiv
e
r
elatio
n
s
h
ip
b
et
wee
n
h
eig
h
t
an
d
th
e
r
is
k
o
f
s
p
in
al
d
ef
o
r
m
ities
s
u
ch
as
id
io
p
ath
ic
s
co
lio
s
is
an
d
k
y
p
h
o
s
is
[
1
1
]
.
I
n
wo
m
e
n
,
th
e
tim
e
o
f
p
ea
k
g
r
o
wth
is
clo
s
ely
r
elate
d
to
m
e
n
ar
ch
e
[
1
0
]
.
Stu
d
ies
h
av
e
p
r
o
v
e
n
th
at
d
elay
ed
p
u
b
e
r
ty
an
d
late
m
en
ar
ch
e
ar
e
ass
o
ciate
d
with
a
h
ig
h
er
p
r
ev
alen
ce
o
f
ad
o
lescen
t
id
io
p
ath
ic
s
co
lio
s
is
[
1
2
]
,
[
1
3
]
.
E
x
am
in
atio
n
t
o
estab
lis
h
th
e
d
iag
n
o
s
is
o
f
s
co
lio
s
is
ca
n
b
e
d
o
n
e
b
y
tak
i
n
g
th
e
p
atien
t'
s
h
is
to
r
y
an
d
p
h
y
s
ical
ex
am
in
atio
n
.
Patien
t
h
is
to
r
y
in
clu
d
in
g
h
is
to
r
y
o
f
p
r
o
b
lem
s
o
r
co
m
p
lain
ts
,
ag
e,
g
en
d
e
r
,
g
e
n
er
al
co
n
d
itio
n
o
f
th
e
p
atien
t
an
d
f
am
ily
h
is
to
r
y
.
Pre
n
atal,
n
atal
an
d
p
o
s
tn
atal
h
is
to
r
y
also
n
ee
d
s
to
b
e
o
b
tain
ed
if
th
e
s
u
b
jects
ex
am
in
ed
ar
e
ch
ild
r
en
.
T
h
e
p
h
y
s
ical
ex
am
in
a
tio
n
in
clu
d
es
g
ait,
p
ain
,
n
eu
r
o
lo
g
ical
s
y
m
p
to
m
s
,
p
h
y
s
ical
ex
am
in
atio
n
,
an
d
r
ad
i
o
lo
g
ical
ex
am
in
atio
n
[
2
]
,
[
6
]
,
[
1
0
]
.
Ob
s
er
v
atio
n
s
wer
e
m
ad
e
to
s
ee
an
d
f
in
d
o
u
t
th
e
asy
m
m
etr
ical
ch
an
g
es
i
n
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o
d
y
p
o
s
tu
r
e
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s
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y
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teb
r
al
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ef
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ities
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f
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f
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t
a
n
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ac
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Ob
s
er
v
atio
n
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wer
e
also
m
ad
e
in
a
f
o
r
wa
r
d
b
en
d
in
g
p
o
s
itio
n
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r
wh
at
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k
n
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as
th
e
Ad
a
m
'
s
f
o
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war
d
b
en
d
i
n
g
test
.
E
x
am
in
atio
n
is
ca
r
r
ied
o
u
t
to
d
ete
r
m
i
n
e
th
e
p
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esen
ce
o
f
p
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la
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n
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o
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th
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s
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i
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e.
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h
e
p
r
o
t
r
u
s
io
n
is
m
ea
s
u
r
ed
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y
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Sco
lio
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eter
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h
ich
g
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an
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le
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g
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t
o
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th
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p
r
o
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u
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io
n
d
ir
ec
tly
a
n
d
r
ec
o
r
d
e
d
in
ce
n
tim
eter
s
[
2
]
.
B
ased
o
n
th
is
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ac
k
g
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o
u
n
d
,
r
esear
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s
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e
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ter
ested
in
co
n
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u
ctin
g
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ch
to
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et
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r
ev
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ases
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2.
M
E
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H
O
D
T
h
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tu
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y
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cr
o
s
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-
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s
er
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tu
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n
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u
cted
f
r
o
m
Ma
r
c
h
to
Au
g
u
s
t
2
0
2
2
in
Su
r
ak
ar
ta
city
.
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h
e
s
tu
d
y
p
o
p
u
latio
n
was
ju
n
i
o
r
h
ig
h
s
ch
o
o
l
s
tu
d
en
ts
with
an
ag
e
r
an
g
e
o
f
1
2
-
1
5
y
ea
r
s
in
Su
r
ak
ar
ta.
T
h
e
cl
u
s
ter
r
an
d
o
m
s
am
p
lin
g
m
eth
o
d
was
u
s
ed
to
o
b
tain
r
esear
ch
s
u
b
jects
as
d
em
o
n
s
tr
ated
in
Fig
u
r
e
1
.
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lu
s
ter
r
an
d
o
m
s
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p
lin
g
is
a
p
r
o
b
ab
ilit
y
s
am
p
lin
g
m
eth
o
d
i
n
wh
ich
we
d
ev
i
d
e
a
p
o
p
u
latio
n
i
n
to
clu
s
ter
s
,
s
u
ch
as
d
is
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icts
,
v
il
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e
o
r
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ch
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ls
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en
r
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d
o
m
ly
s
elec
t
s
o
m
e
o
f
th
ese
clu
s
t
er
s
as
s
am
p
le.
T
h
e
r
esear
ch
s
u
b
jects
wer
e
o
b
tain
ed
b
y
s
am
p
lin
g
1
s
u
b
-
d
is
tr
ict
f
r
o
m
5
s
u
b
-
d
is
tr
icts
in
S
u
r
ak
ar
ta
city
,
th
en
s
am
p
lin
g
5
s
ch
o
o
ls
f
r
o
m
1
s
elec
ted
s
u
b
-
d
is
tr
ict.
T
h
en
f
r
o
m
ea
ch
s
ch
o
o
l
th
e
r
esear
ch
s
u
b
jects
wer
e
tak
en
b
y
s
im
p
le
r
an
d
o
m
s
am
p
lin
g
.
T
h
e
r
esear
ch
s
u
b
ject
wer
e
3
2
5
ch
ild
r
en
ag
e
d
1
2
-
1
5
y
ea
r
s
o
l
d
.
T
h
is
r
esear
ch
h
as
r
ec
eiv
ed
an
eth
ical
s
tatem
en
t
f
r
o
m
t
h
e
Hea
lth
R
esear
ch
E
th
ics
C
o
m
m
is
s
io
n
o
f
Un
i
v
er
s
itas
‘
Ais
y
iy
ah
Su
r
ak
ar
ta,
No
: 1
0
2
/I
V/AUE
C
/2
0
2
3
,
Ap
r
il 2
0
2
2
.
Fig
u
r
e
1
.
C
lu
s
ter
r
an
d
o
m
s
am
p
lin
g
T
h
e
r
esear
ch
in
s
tr
u
m
e
n
t
u
s
ed
a
q
u
esti
o
n
n
air
e
,
Fig
u
r
e
2
s
h
o
ws
clin
ical
test
f
o
r
s
co
li
o
s
is
u
s
in
g
Ad
am
’
s
f
o
r
war
d
b
en
d
in
g
test
as
s
h
o
wn
in
Fig
u
r
e
2
(
a
)
a
n
d
a
s
co
lio
m
eter
as
p
r
esen
ted
in
Fig
u
r
e
2
(
b
)
.
V
e
r
t
e
b
r
a
l
i
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c
l
i
n
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ti
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8
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,
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1
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.
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T
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3.
RE
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D
D
I
SCU
SS
I
O
N
3.
1
.
Resul
t
s
T
h
e
r
esear
ch
s
u
b
jects
wer
e
3
2
5
p
eo
p
le
with
a
n
ag
e
r
an
g
e
o
f
1
2
-
1
5
y
ea
r
s
.
T
h
e
ch
a
r
ac
ter
is
tics
o
f
th
e
r
esp
o
n
d
en
ts
ar
e
d
escr
ib
ed
b
ased
o
n
a
g
e,
g
en
d
er
,
s
co
lio
m
et
er
d
eg
r
ee
an
d
th
e
r
esu
lts
o
f
t
h
e
Ad
am
'
s
f
o
r
war
d
b
en
d
in
g
test
.
T
ab
le
1
s
h
o
ws
th
at
r
esear
ch
s
u
b
jects
ag
ed
1
4
y
ea
r
s
h
ad
th
e
h
ig
h
est
f
r
eq
u
e
n
cy
o
f
2
7
8
ch
ild
r
e
n
.
Su
b
jects
with
m
ale
g
en
d
er
wer
e
2
4
4
ch
ild
r
en
an
d
f
em
a
le
as
m
an
y
as
8
1
ch
ild
r
e
n
.
T
h
e
r
esu
lts
o
f
th
e
s
co
lio
m
eter
ex
am
in
atio
n
s
h
o
wed
th
at
3
.
7
%
o
f
all
s
u
b
ject
s
h
ad
a
v
er
teb
r
al
in
clin
atio
n
an
g
le
o
f
>1
0
°.
T
h
e
r
esu
lts
o
f
th
e
Ad
am
'
s
f
o
r
war
d
b
en
d
test
s
h
o
wed
th
at
1
0
.
2
%
o
f
all
s
u
b
jects e
x
p
er
ien
ce
d
tr
u
n
k
r
o
tatio
n
.
T
ab
le
2
s
h
o
wed
th
e
r
esu
lts
o
f
th
e
p
o
s
itiv
e
Ad
am
'
s
f
o
r
war
d
b
en
d
in
g
test
b
ased
o
n
g
en
d
er
o
f
th
e
s
u
b
jects
an
d
m
ea
s
u
r
em
en
t
o
f
th
e
tr
u
n
k
in
clin
atio
n
an
g
le
u
s
in
g
a
s
co
lio
m
eter
>1
0
°.
T
h
e
p
r
ev
alen
ce
o
f
s
co
lio
s
is
was
3
.
7
%
o
f
th
e
to
t
al
s
u
b
jects.
T
h
e
h
ig
h
est
p
r
ev
a
len
ce
o
f
s
co
lio
s
is
in
ch
ild
r
e
n
ag
ed
1
4
y
ea
r
s
was
3
.
7
%
an
d
f
em
ale
was
3
.
4
%.
T
h
e
r
esu
lts
o
f
th
e
s
co
lio
m
eter
e
x
am
in
atio
n
to
d
eter
m
in
e
t
h
e
d
eg
r
ee
o
f
v
e
r
teb
r
a
l
in
clin
atio
n
s
h
o
wed
th
at
t
h
e
h
i
g
h
est p
r
ev
alen
ce
o
f
v
er
teb
r
al
i
n
clin
atio
n
an
g
le
was 1
1
°
-
1
5
° (
2
.
5
%).
T
ab
le
1
.
Su
b
ject
c
h
ar
ac
ter
is
tics
A
g
e
G
e
n
d
e
r
A
d
a
m’
s
f
o
r
w
a
r
d
b
e
n
d
i
n
g
t
e
s
t
S
c
o
l
i
o
me
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1
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[
1
0
]
,
[
1
7
]
,
[
2
2
]
.
An
o
th
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f
ac
t
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th
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th
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f
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.
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s
ab
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m
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(
AI
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s
o
th
at
m
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p
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r
f
o
r
m
an
ce
is
n
o
t
o
p
tim
al
[
2
3
]
,
[
2
4
]
.
T
h
e
n
ex
t
f
ac
to
r
th
at
we
en
co
u
n
ter
e
d
in
s
o
m
e
liter
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r
e
r
elate
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to
b
ag
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s
e
is
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e
im
p
ac
t
o
f
u
s
in
g
a
s
lin
g
o
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n
e
-
s
id
ed
b
ag
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B
y
weig
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tin
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o
n
e
s
id
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t
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b
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k
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with
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m
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b
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atic.
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tly
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in
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a
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in
th
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cid
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ce
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f
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co
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is
[
2
5
]
,
[
2
6
]
.
T
h
e
s
o
lu
tio
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ca
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f
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is
n
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a
b
ac
k
p
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a
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le
-
s
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.
T
h
e
s
tu
d
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n
ts
ca
n
u
s
e
a
b
ag
with
wh
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ls
to
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th
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s
p
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is
h
ig
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ly
r
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m
m
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Alth
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u
g
h
in
d
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th
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h
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h
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s
k
ca
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b
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d
b
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h
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f
th
e
p
ar
av
er
teb
r
al
p
o
s
tu
r
al
m
u
s
cles
is
n
o
t
o
v
er
u
s
ed
.
No
r
m
ally
,
th
e
weig
h
t
o
f
a
s
tu
d
en
t’
s
b
ac
k
p
ac
k
is
n
o
m
o
r
e
th
an
1
0
%
o
f
th
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ch
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'
s
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d
y
w
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h
t.
I
f
o
v
e
r
weig
h
t
o
f
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ag
,
th
er
e
will b
e
a
r
is
k
o
f
a
b
n
o
r
m
alities
in
th
e
c
h
ild
'
s
p
o
s
t
u
r
e,
leg
s
h
a
p
e
an
d
g
ait
in
th
e
f
u
tu
r
e
[
2
3
]
,
[
2
7
]
.
Sev
er
al
s
tu
d
ies
h
av
e
f
o
u
n
d
th
e
ev
id
en
ce
th
at
tr
u
n
k
asy
m
m
etr
y
an
d
p
o
o
r
p
o
s
tu
r
e
in
c
h
ild
r
en
ar
e
ass
o
ciate
d
with
AI
S.
T
h
is
co
n
d
itio
n
is
r
elate
d
to
th
e
p
r
esen
ce
o
f
asy
m
m
etr
ic
an
d
im
b
alan
ce
d
p
ar
asp
in
al
m
u
s
cle
ac
tiv
ity
.
Po
o
r
p
o
s
tu
r
e
ca
n
ca
u
s
e
im
b
alan
ce
d
p
ar
asp
i
n
al
m
u
s
cle
ac
tiv
ity
.
Stu
d
y
f
o
u
n
d
a
h
ig
h
er
av
e
r
ag
e
r
o
o
t
-
m
ea
n
-
s
q
u
ar
e
(
R
MS)
o
f
s
u
r
f
ac
e
elec
tr
o
m
y
o
g
r
ap
h
y
(
s
E
MG
)
v
alu
es
o
n
th
e
c
o
n
v
e
x
s
id
e
o
f
th
e
af
f
ec
ted
g
r
o
u
p
m
u
s
cles.
T
h
is
in
d
icate
s
an
asy
m
m
etr
y
o
f
m
u
s
cle
ac
ti
v
ity
b
etwe
en
th
e
lef
t
an
d
r
ig
h
t
s
id
es
o
f
th
e
u
p
p
er
tr
ap
ez
iu
s
an
d
latis
s
im
u
s
d
o
r
s
i
in
h
ab
itu
al
s
itti
n
g
p
o
s
itio
n
[
2
8
]
,
[
2
9
]
.
So
m
e
s
tu
d
ies
s
u
g
g
est
th
at
asy
m
m
etr
y
in
p
ar
asp
in
al
m
u
s
cle
ac
tiv
ity
m
a
y
p
r
ed
icto
r
o
f
cu
r
v
e
p
r
o
g
r
ess
io
n
in
AI
S
[
2
9
]
-
[
3
1
]
.
An
o
th
er
f
in
d
i
n
g
th
at
m
ay
in
f
l
u
en
ce
th
e
in
cid
en
ce
o
f
s
co
lio
s
is
i
s
s
cr
ee
n
tim
e
f
o
r
d
ay
.
Su
ch
as,
h
o
w
lo
n
g
ch
ild
r
e
n
s
p
en
d
in
g
tim
e
t
o
elec
tr
o
n
ic
p
r
o
d
u
cts
s
u
ch
as
co
m
p
u
ter
s
,
T
Vs,
an
d
ce
ll
p
h
o
n
es.
So
m
e
s
tu
d
ies
m
en
tio
n
th
at
o
v
er
tim
e
with
g
ad
g
et
will
m
ak
e
ch
ild
r
en
d
o
l
ess
p
h
y
s
ical
ac
tiv
ity
,
s
o
m
u
s
cle
f
itn
ess
an
d
b
o
n
e
h
ea
lth
will
d
ec
r
ea
s
e.
T
h
e
u
s
i
n
g
o
f
g
ad
g
ets
is
n
o
t
with
o
u
t
r
ea
s
o
n
,
b
ec
au
s
e
o
f
p
an
d
em
ic
C
OVI
D
-
1
9
,
m
an
y
ch
ild
r
en
tak
e
o
n
lin
e
class
es
an
d
u
s
in
g
co
m
p
u
ter
s
,
ce
llp
h
o
n
es
o
r
tab
lets
to
co
m
p
lete
h
o
m
ewo
r
k
.
So
,
t
h
is
r
esu
lt
in
in
cr
ea
s
e
o
f
s
cr
ee
n
tim
e
an
d
r
ed
u
cin
g
tim
e
s
p
en
t
o
n
o
u
t
d
o
o
r
ac
tiv
ities
.
No
r
m
ally
,
d
aily
s
cr
ee
n
tim
e
f
o
r
ch
ild
r
en
an
d
ad
o
lescen
ts
ag
ed
6
-
1
7
y
ea
r
s
is
two
h
o
u
r
s
d
ay
[
2
4
]
,
[
3
2
]
-
[
3
4
]
.
I
n
c
o
n
clu
s
io
n
,
d
eter
m
in
in
g
f
ac
to
r
s
th
at
m
ig
h
t
i
n
f
lu
en
ce
th
e
o
n
s
et
o
f
ad
o
lescen
t
id
io
p
at
h
ic
s
co
lio
s
is
in
clu
d
in
g
ag
e,
g
e
n
d
er
,
b
io
m
ec
h
an
ical
f
ac
to
r
s
,
h
ab
its
o
r
life
s
ty
les f
ac
to
r
s
an
d
p
h
y
s
ical
ac
tiv
ity
.
4.
CO
NCLU
SI
O
N
T
h
e
h
ig
h
est
p
r
ev
ale
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ce
o
f
a
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lescen
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in
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m
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I
t
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o
p
e
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at
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ly
d
etec
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r
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r
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wth
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f
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r
m
ity
a
n
d
r
ed
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th
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clin
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m
an
if
estatio
n
s
t
h
at
ar
is
e
as a
r
esu
lt o
f
s
co
lio
s
is
.
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[
1
]
A
.
G
r
a
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s,
E.
Ei
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a
r
s
d
o
t
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i
r
,
a
n
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.
G
e
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m,
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c
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p
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p
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4
5
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1
3
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1
3
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1
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-
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1
0
5
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8.
[
2
]
C
.
F
u
sc
o
,
F
.
Za
i
n
a
,
S
.
A
t
a
n
a
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.
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N
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g
r
i
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i
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n
d
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e
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,
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P
h
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h
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e
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e
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t
i
d
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o
p
a
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h
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s
c
o
l
i
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si
s:
A
n
u
p
d
a
t
e
d
s
y
st
e
mat
i
c
r
e
v
i
e
w
,
”
Ph
y
si
o
t
h
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r
a
p
y
T
h
e
o
r
y
a
n
d
Pr
a
c
t
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e
,
v
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l
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2
7
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n
o
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1
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p
p
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8
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2
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5
9
3
9
8
5
.
2
0
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0
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5
3
3
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4
2
.
[
3
]
S
.
R
.
K
i
k
a
n
l
o
o
,
S
.
P
.
Ta
r
p
a
d
a
,
a
n
d
W
.
C
h
o
,
“
Et
i
o
l
o
g
y
o
f
a
d
o
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e
sc
e
n
t
i
d
i
o
p
a
t
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c
s
c
o
l
i
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s
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s:
A
l
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t
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r
a
t
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r
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r
e
v
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w
,
”
Asi
a
n
S
p
i
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e
J
o
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rn
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v
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1
3
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3
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.
L
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,
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[
5
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I
.
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.
K
o
ma
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-
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g
u
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.
B
.
D
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o
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d
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c
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i
s:
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[
6
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A
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N
.
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.
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,
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C
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re:
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[
7
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J.
R
,
A
.
R
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Th
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