I
n
t
e
r
n
at
ion
al
Jou
r
n
a
l
of
P
u
b
l
ic
Hea
l
t
h
S
c
ience
(
I
JP
HS
)
Vo
l
.
8
,
N
o
.
1
,
M
a
r
c
h
2019,
pp.
2
6
-
30
I
S
S
N:
2252
-
8806
,
DO
I
:
10
.
11591/i
j
p
h
s
.
v
8
i
1.
13461
26
Jou
r
n
al
h
o
m
e
page
:
ht
tps
:
//
w
w
w
.
iaes
c
or
e
.
c
om/
jou
r
nals
/i
nde
x
.
php/I
J
P
HS
M
od
e
l
t
o
p
r
e
d
ic
t
d
u
t
y
of
c
om
m
u
n
ity
n
u
r
se
s
in
p
r
o
m
ot
iv
e
a
n
d
p
r
e
ve
n
t
i
v
e
c
ar
e
S
is
m
u
l
yan
t
o
1
,
Nur
s
a
l
am
2
,
F
e
r
r
y
E
f
e
n
d
i
3
,
M
ad
e
M
ah
agu
n
a
P
u
t
r
a
4
,
A
d
it
h
a
Angga
P
r
at
am
a
5
1
Fac
u
l
t
y
o
f
H
e
a
l
t
h
,
U
n
i
v
e
rs
i
t
as
Q
am
ar
u
l
H
u
d
a
,
In
d
o
n
e
s
i
a
2
,3
Fac
u
l
t
y
o
f
N
u
rs
i
n
g
,
U
n
i
v
e
rs
i
t
as
A
i
r
l
an
g
g
a
,
I
n
d
o
n
e
s
i
a
4,
5
Se
k
o
l
ah
T
i
n
g
g
i
I
l
mu
K
e
s
eh
at
an
Bu
l
e
l
en
g
,
I
n
d
o
n
e
s
i
a
Ar
t
ic
l
e
I
n
f
o
AB
S
T
RA
CT
A
r
ti
c
le
h
is
tor
y
:
R
e
c
e
i
ve
d
M
a
y
27
,
201
8
R
e
vi
s
e
d
F
e
b
02
,
201
9
A
c
c
e
pt
e
d
F
e
b
27
,
2019
Co
mm
u
n
i
t
y
n
u
rs
e
s
h
a
s
i
m
p
o
rt
an
t
ro
l
e
i
n
p
ro
m
o
t
i
v
e
a
n
d
p
re
v
en
t
i
v
e
c
ar
e
i
n
c
o
mmu
n
i
t
y
.
A
i
m
o
f
t
h
e
s
t
u
d
y
w
as
t
o
m
a
k
e
mo
d
el
t
o
p
red
i
c
t
c
o
mmu
n
i
t
y
n
u
rs
e
s
ro
l
e
i
n
p
ro
m
o
t
i
v
e
an
d
p
re
v
en
t
i
v
e
c
ar
e
b
as
e
d
o
n
H
e
a
l
t
h
Pro
m
o
t
i
o
n
Mo
d
e
l
(H
PM)
.
D
e
s
i
g
n
o
f
t
h
e
s
t
u
d
y
w
as
u
s
e
d
e
x
p
l
an
at
o
r
y
w
i
t
h
C
ro
s
s
-
s
e
c
t
i
o
n
al
ap
p
ro
ach
.
S
u
m
o
f
p
art
i
ci
p
an
t
w
as
1
6
1
.
T
h
i
s
s
t
u
d
y
w
as
c
o
n
d
u
c
t
ed
i
n
1
1
Pu
b
l
i
c
H
e
al
t
h
C
e
n
t
e
r
i
n
Ban
y
u
w
an
g
i
at
1
J
an
u
ary
t
o
3
0
J
an
u
ar
y
2
0
1
8
.
Me
t
h
o
d
s
o
f
d
at
a
c
o
l
l
ec
t
i
o
n
w
as
c
l
u
s
t
e
r
s
am
p
l
i
n
g
.
T
h
e
d
at
a
w
as
an
al
y
s
e
d
u
s
i
n
g
s
m
art
P
LS
s
o
ft
w
ar
e
.
In
n
e
r
mo
d
el
:
p
e
rs
o
n
al
fa
c
t
o
rs
(t
=
1
.
9
8
1
),
i
n
t
e
rp
e
rs
o
n
a
l
i
n
fl
u
e
n
ce
s
(t
=
4
.
0
3
6
),
s
i
t
u
at
i
o
n
al
i
n
fl
u
e
n
ce
s
(5
.
7
2
0
),
c
o
mmi
t
men
t
(t
=
5
.
1
3
8
)
h
ad
affec
t
e
d
t
o
c
o
mmu
n
i
t
y
n
u
rs
e
s
d
u
t
y
i
n
p
ro
mo
t
i
v
e
an
d
p
re
v
en
t
i
v
e
c
ar
e
.
T
h
i
s
mo
d
el
co
u
l
d
p
red
i
c
t
co
mmu
n
i
t
y
n
u
rs
e
s
d
u
t
y
i
n
p
ro
m
o
t
i
v
e
a
n
d
p
rev
e
n
t
i
v
e
c
ar
e
in
h
i
g
h
l
e
v
el
(Q
=
0
.
9
9
8
)
.
T
h
at
w
as
i
m
p
o
rt
an
t
t
o
e
n
h
an
ce
of
co
mm
u
n
i
t
y
n
u
rs
e
s
d
u
t
y
t
h
ro
u
g
h
mo
d
i
f
y
i
n
g
c
o
mmi
t
men
t
o
f
n
u
rs
e
s
,
i
n
t
e
rp
e
rs
o
n
al
i
n
fl
u
e
n
ce
fa
c
t
o
rs
,
p
e
rs
o
n
al
fa
ct
o
rs
an
d
s
i
t
u
at
i
o
n
a
l
i
n
fl
u
e
n
ce
fa
c
t
o
rs
.
K
e
y
w
o
r
d
s
:
C
o
m
m
u
ni
t
y
n
ur
s
e
s
P
r
e
v
e
n
t
i
v
e
c
a
r
e
P
r
o
m
o
t
i
v
e
Co
p
yr
i
g
h
t
©
2
0
19
In
s
t
i
t
u
t
e
o
f
A
d
va
n
ced
E
n
g
i
n
ee
r
i
n
g
a
n
d
S
ci
e
n
ce
.
A
l
l
r
i
g
h
t
s
r
e
s
er
ved
.
C
or
r
e
s
pon
din
g
A
u
th
or
:
S
i
s
m
u
ly
a
n
t
o
,
F
a
c
u
l
t
y
o
f
He
a
l
t
h
,
Uni
ve
r
s
i
t
a
s
Qa
m
a
r
u
l
Huda
,
J
a
l
a
n
H.
B
a
da
r
udd
i
n
–
B
a
gu,
L
o
m
b
o
k
T
e
n
ga
h
,
K
e
c
a
m
a
t
a
n
P
r
i
n
gga
r
a
t
a
.
E
m
a
i
l
:
s
i
s
_
m
u
l
y
a
n
t
o
@y
a
h
o
o.
c
o
m
1.
I
NT
RODU
C
T
I
ON
T
h
e
i
nc
r
e
a
s
e
d
pr
e
v
a
l
a
n
c
e
o
f
c
h
r
o
ni
c
d
i
s
e
a
s
e
o
f
f
e
r
s
n
ur
s
e
s
t
h
e
c
h
a
ll
e
n
ge
o
f
h
o
w
to
h
e
l
p
i
nd
i
vi
du
a
l
s
m
a
ke
li
f
e
s
t
y
l
e
c
h
a
n
ge
s
a
n
d
m
a
n
a
ge
t
h
e
i
r
c
o
n
d
i
t
i
o
ns
[
1]
.
I
n
t
e
r
n
a
t
i
o
n
a
ll
y
t
h
e
r
e
h
a
s
b
e
e
n
gr
o
w
i
n
g
i
n
t
e
r
e
s
t
i
n
t
h
e
publi
c
h
e
a
l
t
h
r
o
l
e
o
f
pr
i
m
a
r
y
c
a
r
e
a
n
d
h
o
w
be
s
t
to
a
c
hi
e
v
e
a
s
t
r
o
n
ge
r
o
r
i
e
n
t
a
t
i
o
n
to
pr
e
v
e
n
t
i
o
n
a
nd
he
a
l
t
h
pr
o
m
ot
i
o
n
s
e
r
vi
c
e
s
f
o
r
pa
t
i
e
n
t
s
[2
-
4]
.
P
r
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
(
P
HC
)
f
o
c
us
e
s
o
n
t
h
e
o
r
ga
ni
s
a
t
i
o
n
a
n
d
de
li
ve
r
y
o
f
l
a
r
ge
ly
do
m
i
c
i
li
a
r
y
s
e
r
vi
c
e
s
[
5]
.
P
HC
i
s
c
o
n
s
i
de
r
e
d
to
b
e
vi
t
a
l
i
n
t
h
e
c
o
n
t
e
x
t
o
f
t
h
e
Na
t
i
o
n
a
l
He
a
l
t
h
S
e
r
vi
c
e
(
NH
S
)
a
s
i
t
r
e
pr
e
s
e
n
t
s
a
m
a
j
o
r
c
o
n
t
r
i
b
ut
o
r
to
wa
r
ds
a
c
a
r
e
s
t
r
a
t
e
gy
t
h
a
t
i
s
e
ffi
c
i
e
n
t
i
n
t
h
e
u
s
e
o
f
r
e
s
o
ur
c
e
s
a
n
d
i
n
t
h
e
e
ff
e
c
t
i
v
e
n
e
s
s
o
f
i
t
s
pr
a
c
t
i
c
e
s
.
P
HC
t
e
a
m
s
o
f
t
e
n
pr
o
vi
de
t
h
e
fi
r
s
t
c
o
n
t
a
c
t
wi
t
h
t
h
e
pa
t
i
e
n
t
a
n
d
a
r
e
i
n
t
e
gr
a
l
to
c
oo
r
di
n
a
t
i
n
g
d
i
ff
e
r
e
n
t
s
e
r
vi
c
e
s
i
nv
o
l
ve
d
i
n
c
a
r
e
[
6]
,
t
h
e
y
a
r
e
a
l
s
o
ke
y
pr
o
vi
d
e
r
s
o
f
a
d
vi
c
e
o
n
he
a
l
t
h
pr
o
m
ot
i
o
n
a
n
d
pr
o
t
e
c
t
i
o
n
.
Nur
s
e
s
wo
r
ki
n
g
w
i
t
hi
n
P
H
C
t
e
a
m
s
a
r
e
i
nv
o
l
ve
d
i
n
a
l
l
a
s
p
e
c
t
s
o
f
pr
im
a
r
y
c
a
r
e
,
f
r
o
m
s
t
r
a
t
e
gy
t
o
i
n
d
i
v
i
dua
l
pa
t
i
e
n
t
e
d
uc
a
t
i
o
n
a
nd
pr
e
v
e
n
t
i
o
n
[
6]
.
T
h
e
pr
i
n
c
i
p
l
e
s
o
f
P
r
i
m
a
r
y
He
a
l
t
h
C
a
r
e
(
P
HC
)
s
uc
h
a
s
e
f
f
i
c
i
e
nc
y
a
n
d
e
f
f
e
c
t
i
v
e
n
e
s
s
i
n
h
e
a
l
t
h
s
e
r
vi
c
e
de
li
ve
r
y
;
a
n
d
e
qu
i
t
a
bl
e
d
i
s
t
r
i
b
ut
i
o
n
o
f
h
e
a
l
t
h
s
e
r
vi
c
e
s
a
r
e
i
de
n
t
i
f
i
e
d
a
s
c
o
r
e
e
l
e
m
e
n
t
s
w
i
t
h
t
h
e
pot
e
n
t
i
a
l
t
o
c
o
n
t
r
i
b
ut
e
to
i
m
pr
o
v
e
d
c
o
m
m
u
ni
t
y
h
e
a
l
t
h
t
h
r
o
ugh
pr
o
pe
r
l
y
c
o
o
r
di
n
a
t
e
d
di
s
t
r
i
c
t
h
e
a
l
t
h
s
y
s
t
e
m
s
[
7]
.
T
h
e
r
o
l
e
a
n
d
s
c
o
pe
o
f
n
ur
s
i
ng
pr
a
c
t
i
c
e
h
a
s
e
v
o
l
v
e
d
i
n
r
e
s
po
n
s
e
t
o
t
h
e
d
y
n
a
mi
c
n
e
e
ds
o
f
i
nd
i
v
i
dua
l
s
,
c
o
m
m
u
ni
t
i
e
s
,
a
n
d
he
a
l
t
h
c
a
r
e
s
e
r
vi
c
e
s
[
8]
.
He
a
l
t
h
P
r
o
m
o
t
i
o
n
wa
s
a
n
e
f
f
o
r
t
o
f
c
o
m
m
u
ni
t
i
e
s
’
e
m
po
we
r
m
e
n
t
t
h
r
o
ugh
c
o
un
s
e
l
li
ng
t
he
c
o
m
m
u
ni
t
y
t
o
p
r
o
m
o
t
e
he
a
l
t
h
li
f
e
s
t
y
l
e
c
h
o
i
c
e
s
.
I
m
p
l
e
m
e
n
t
i
n
g
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
n
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
M
ode
l
to
pr
e
dict
duty
o
f
c
omm
unit
y
nur
s
e
s
in
pr
omotive
and
pr
e
v
e
nti
v
e
c
ar
e
(
Sis
mul
y
anto
)
27
b
e
h
a
vi
o
r
s
i
nc
l
ude
:
t
a
k
i
n
g
r
e
s
po
n
s
i
b
il
i
t
y
f
o
r
o
n
e
'
s
he
a
l
t
h
,
e
x
e
r
c
i
s
e
a
n
d
p
hy
s
i
c
a
l
a
c
t
i
vi
t
y
,
s
p
i
r
i
t
ua
l
i
nv
o
lv
e
m
e
n
t
,
pr
o
pe
r
n
ut
r
i
t
i
o
n
,
s
t
r
e
s
s
m
a
n
a
ge
m
e
n
t
,
t
e
c
hni
que
s
a
n
d
s
a
t
i
s
f
yi
ng
i
n
t
e
r
pe
r
s
o
n
a
l
r
e
l
a
t
i
o
n
s
hi
p
[
9]
.
M
e
a
n
w
hil
e
,
h
e
a
l
t
h
pr
e
ve
n
t
i
o
n
wa
s
a
k
i
n
d
o
f
he
a
l
t
h
c
a
r
e
s
e
r
vi
c
e
s
t
h
a
t
f
o
c
us
i
ng
o
n
d
i
s
e
a
s
e
pr
e
v
e
n
t
i
o
n
(
pr
i
m
a
r
y
,
s
e
c
o
n
da
r
y
a
n
d
t
e
r
t
i
a
r
y
l
e
v
e
l
)
t
h
r
o
ugh
i
m
p
l
e
m
e
n
t
i
n
g
o
f
h
e
a
l
t
hy
li
f
e
s
t
y
l
e
,
c
o
n
duc
t
i
n
g
e
a
r
ly
d
i
s
e
a
s
e
s
c
r
e
e
ni
ng,
e
a
r
l
y
d
i
s
e
a
s
e
t
r
e
a
t
i
n
g,
r
e
duc
i
n
g
i
m
pa
c
t
o
f
d
i
s
e
a
s
e
a
n
d
r
e
h
a
bil
i
t
a
t
i
o
n
[
10]
.
I
n
c
i
de
n
c
e
o
f
De
n
gue
Ha
e
m
o
r
a
g
i
c
F
e
ve
r
(
DH
F
)
i
n
B
a
ny
uwa
n
g
i
dur
i
n
g
t
h
e
pe
r
i
o
d
2016
r
e
a
c
h
e
d
1300
c
a
s
e
s
w
i
t
h
11
c
a
s
e
s
o
f
t
h
e
m
w
a
s
d
i
e
d.
T
hi
s
n
u
m
b
e
r
wa
s
i
nc
r
e
a
s
i
ng
c
o
m
pa
r
e
d
t
o
2015,
whi
c
h
wa
s
9
00
c
a
s
e
s
w
i
t
h
9
c
a
s
e
s
o
f
w
hi
c
h
d
i
e
d
wo
r
l
dw
i
de
.
T
h
e
H
i
g
h
i
nc
i
de
n
c
e
o
f
De
n
gu
e
Ha
e
m
o
r
a
g
i
c
F
e
v
e
r
(
DH
F
)
i
n
c
o
m
m
u
ni
t
y
wa
s
c
a
u
s
e
d
by
f
a
il
ur
e
o
f
im
p
l
e
m
e
n
t
a
t
i
o
n
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
o
n
a
n
d
pr
e
v
e
n
t
i
o
n
i
n
c
o
m
m
u
ni
t
y
.
K
u
m
a
t
-
T
h
o
m
e
e
t
al
[
11]
r
e
po
r
t
e
d
t
h
a
t
f
a
il
ur
e
o
f
im
p
l
e
m
e
n
t
a
t
i
o
n
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
o
n
a
n
d
pr
e
v
e
n
t
i
o
n
i
n
c
o
m
m
u
ni
t
y
c
a
u
s
e
d
by
l
a
c
k
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
’
s
r
o
l
e
t
o
pr
o
m
o
t
e
h
e
a
l
t
h
li
f
e
s
t
y
l
e
be
h
a
vi
o
r
s
t
o
c
omm
u
ni
t
y
a
n
d
u
n
a
bl
e
t
o
c
o
n
duc
t
i
n
t
e
r
v
e
n
t
i
o
n
to
p
r
e
v
e
n
t
s
i
c
kn
e
s
s
.
W
hi
t
e
he
a
d
[
12]
pr
o
v
e
d
t
h
a
t
m
a
j
o
r
i
t
y
o
f
c
o
mm
u
ni
t
y
n
ur
s
e
s
w
h
o
g
i
vi
ng
h
e
a
l
t
h
pr
o
m
o
t
i
o
n
i
n
t
h
e
c
o
m
m
u
ni
t
y
d
i
d
n
o
t
b
e
s
uppo
r
t
e
d
by
a
va
i
l
a
bil
i
t
y
o
f
r
e
gu
l
a
t
i
o
n
f
r
o
m
r
e
g
i
o
n
a
l
go
v
e
r
nm
e
n
t
a
n
d
c
o
m
m
u
ni
t
y
.
L
e
a
k
o
f
s
o
pp
o
r
t
i
n
g
s
y
s
t
e
m
li
ke
po
or
o
f
t
i
m
e
,
poo
r
a
v
a
il
a
bil
i
t
y
o
f
f
a
c
il
i
t
i
e
s
li
ke
c
o
m
put
e
r
e
t
c
.
T
h
e
pur
po
s
e
o
f
t
h
e
s
t
udy
wa
s
t
o
a
n
a
l
y
s
e
s
o
f
(
1)
o
ut
e
r
m
o
de
l
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
pe
r
s
o
n
a
l
f
a
c
to
r
s
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
s
,
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
,
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
,
b
e
h
a
vi
o
r
,
c
o
m
m
u
ni
t
y
n
ur
s
e
s
dut
y
a
n
d
o
u
t
c
o
m
e
o
f
he
a
l
t
h
c
a
r
e
.
(
2
)
o
u
t
e
r
m
o
de
l
(
3)
G
o
dn
e
s
s
o
f
f
i
t
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
Th
i
s
s
t
udy
us
e
d
e
x
p
l
a
n
a
t
o
r
y
r
e
s
e
a
c
h
de
s
i
g
n
a
n
d
c
r
o
s
s
s
e
c
t
i
o
n
a
l
a
ppr
o
a
c
h
.
W
e
us
e
d
qu
e
s
t
i
o
nn
a
r
e
t
h
a
t
wa
s
de
ve
l
o
pe
d
upo
n
He
a
l
t
h
P
r
o
m
o
t
i
o
n
M
o
de
l
(
H
P
M
)
a
s
i
ns
t
r
um
e
n
t
to
m
e
a
s
ur
e
c
o
m
m
u
ni
t
y
nur
s
e
s
r
o
l
e
a
n
d
f
a
c
t
o
r
s
a
f
f
e
c
t
e
d
to
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
t
h
a
t
c
on
s
i
s
t
e
d
o
f
pe
r
s
o
na
l
f
a
c
t
o
r
s
,
b
e
h
a
vi
o
r
r
e
l
a
t
e
d
c
o
gn
t
i
o
n
a
n
d
e
f
f
e
c
t
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
s
,
s
i
t
ua
t
i
o
n
a
l
i
nf
l
u
e
n
c
e
s
,
a
n
d
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
.
1)
P
e
r
s
o
n
a
l
f
a
c
t
o
r
s
que
s
t
i
o
nna
r
e
c
o
n
s
i
s
t
e
d
o
f
a
ge
,
s
e
x
,
e
duc
a
t
i
o
n
l
e
ve
l
a
n
d
wo
r
ki
n
g
pe
r
i
o
d.
2)
B
e
h
a
vi
o
r
r
e
l
a
t
e
d
c
o
gni
t
i
o
n
a
n
d
e
f
f
e
c
t
que
s
t
i
o
nn
a
r
e
c
o
ns
i
s
t
e
d
o
f
c
o
gni
t
i
ve
a
s
pe
c
t
w
i
t
h
8
c
l
o
s
e
e
n
d
e
d
que
s
t
i
o
n
s
a
n
d
a
f
f
e
c
t
i
v
e
a
s
pe
c
t
w
i
t
h
10
c
l
o
s
e
e
n
de
d
que
s
t
i
o
ns
.
3)
I
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
s
que
s
t
i
o
nn
a
r
e
c
o
n
t
a
i
n
e
d
16
c
l
o
s
e
e
n
de
d
q
ue
s
t
i
o
ns
.
4)
S
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
que
s
t
i
o
nn
a
r
e
c
o
n
t
a
i
n
e
d
6
c
l
o
s
e
e
n
de
d
que
s
t
i
o
ns
.
5
)
C
o
m
mi
t
m
e
n
t
c
o
n
t
a
i
n
e
d
6
c
l
o
s
e
e
n
de
d
que
s
t
i
o
ns
,
6)
C
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
que
s
t
i
o
n
n
a
r
e
c
o
n
t
a
i
n
e
d
7
c
l
o
s
e
e
n
d
e
d
que
s
t
i
o
ns
.
I
n
J
a
n
ua
r
y
2018,
161
r
e
g
i
s
t
e
r
e
d
n
ur
s
e
s
wo
r
k
i
ng
a
t
11
P
ubli
c
He
a
l
t
h
C
e
n
t
e
r
i
n
B
a
ny
uwa
n
g
i
,
I
n
do
n
e
s
i
a
we
r
e
i
nv
i
t
e
d
to
pa
r
t
i
c
i
pa
t
e
t
h
i
s
s
t
ud
y
.
Que
s
t
i
o
nn
a
r
e
s
h
e
e
t
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
pe
r
s
o
n
a
l
f
a
c
t
or
s
,
b
e
h
a
vi
o
r
r
e
l
a
t
e
d
c
o
gni
t
i
o
n
a
n
d
e
f
f
e
c
t
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
,
s
i
t
ua
t
i
o
n
a
l
i
nf
l
ue
n
c
e
,
c
o
m
mi
t
m
e
n
t
a
n
d
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
we
r
e
d
i
s
t
r
i
b
ut
e
d
to
n
ur
s
e
s
a
f
t
e
r
wi
ll
i
ng
a
s
a
pa
r
t
i
c
i
p
a
n
t
.
A
pa
r
t
i
c
i
pa
n
t
m
us
t
be
m
e
t
t
h
e
i
nc
l
us
i
o
n
c
r
i
t
e
r
i
a
.
I
n
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
we
r
e
a
n
ur
s
e
wh
o
wor
ke
d
a
t
l
e
a
s
t
o
n
e
y
e
a
r
e
x
pe
r
i
e
n
c
e
i
n
P
u
bli
c
He
a
l
t
h
C
e
n
t
e
r
i
n
B
a
ny
uwa
n
g
i
a
n
d
h
a
vi
ng
a
h
e
a
l
t
h
p
hyi
s
i
c
a
n
d
m
e
n
t
a
l
c
o
n
d
i
t
i
o
n
.
De
s
c
r
i
pt
i
ve
a
na
l
y
s
i
s
wa
s
c
on
duc
t
e
d
by
d
i
s
p
l
a
yi
ng
f
r
e
que
n
c
y
d
i
s
t
r
i
b
ut
i
o
n
o
f
e
a
c
h
v
a
r
i
a
bl
e
o
n
t
h
e
t
a
bl
e
s
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
f
r
e
que
n
c
y
a
n
d
p
e
r
c
e
n
t
a
ge
o
f
e
a
c
h
v
a
r
i
a
bl
e
.
W
e
u
s
e
d
s
m
a
r
t
P
L
S
s
o
f
t
w
a
r
e
to
a
n
a
l
y
s
i
s
o
f
i
n
f
l
ue
n
c
e
o
f
i
nd
e
pe
n
d
e
n
v
a
r
i
a
bl
e
s
(
pe
r
s
o
n
a
l
f
a
c
t
or
s
,
b
e
h
a
vi
o
r
r
e
l
a
t
e
d
c
o
gni
t
i
o
n
a
n
d
e
f
f
e
c
t
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
nf
l
ue
n
c
e
,
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
u
e
n
c
e
,
c
o
m
mi
t
m
e
n
t
)
to
de
pe
n
de
n
v
a
r
i
a
bl
e
(
c
o
mm
u
ni
t
y
n
ur
s
e
s
r
o
l
e
i
n
he
a
l
t
h
pr
o
m
o
t
i
n
g
a
n
d
pr
e
v
e
n
t
i
n
g
s
e
r
vi
c
e
s
)
.
R
e
s
u
l
t
o
f
t
hi
s
a
n
a
ly
s
i
s
w
a
s
c
l
a
s
s
i
f
i
e
d
i
n
t
o
t
w
o
s
e
c
t
i
o
n
:
t
h
e
r
e
w
a
s
i
nf
l
ue
n
c
e
if
t
-
s
t
a
t
v
a
l
ue
wa
s
m
o
r
e
t
h
a
n
1
.
96,
t
h
e
r
e
wa
s
n
o
t
i
nf
l
ue
n
c
e
i
f
t
-
s
t
a
t
v
a
l
ue
wa
s
l
e
s
s
t
h
a
n
1
.
96.
Out
e
r
m
o
de
l
s
h
o
we
d:
1)
a
ge
,
s
e
x
,
a
n
d
l
o
n
g
o
f
wo
r
k
i
n
g
wa
s
v
a
li
d
a
s
i
nd
i
c
a
t
or
s
o
f
p
e
r
s
o
n
a
l
f
a
c
t
o
r
s
,
2)
kn
o
w
l
e
dge
a
n
d
a
t
t
i
t
ude
wa
s
v
a
li
d
a
s
i
n
d
i
c
a
t
or
s
o
f
b
e
h
a
vi
o
r
o
f
n
ur
s
e
s
,
3)
r
e
gul
a
t
i
o
n
a
n
d
a
v
a
il
a
bl
e
o
f
f
a
c
i
li
t
y
wa
s
va
l
i
d
a
s
i
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
s
,
4)
a
f
f
i
r
m
a
t
i
v
e
,
n
o
r
m
a
t
i
v
e
a
n
d
c
o
n
t
i
u
n
a
n
c
e
wa
s
va
l
i
d
a
s
i
n
d
i
c
a
to
r
s
o
f
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
,
5)
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
wa
s
v
a
li
d
a
s
i
nd
i
c
a
t
o
r
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
dut
y
,
6)
pr
e
v
e
n
t
i
n
g
a
n
d
t
r
e
a
t
i
n
g
wa
s
v
a
li
d
a
s
i
nd
i
c
a
t
o
r
o
f
o
u
t
c
o
m
e
o
f
h
e
a
l
t
h
c
a
r
e
.
T
hi
s
m
o
de
l
c
o
u
l
d
pr
e
d
i
c
t
c
o
m
m
u
n
i
t
y
n
ur
s
e
s
dut
y
i
n
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
i
n
hi
g
h
l
e
v
e
l
(
Q=
0
.
058
).
I
n
n
e
r
m
o
de
l
s
h
o
wn
i
n
T
a
bl
e
1
a
n
d
hy
pot
h
e
s
i
s
m
o
de
l
s
h
o
wn
i
n
T
a
bl
e
2.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
1
,
M
a
r
c
h
201
9
:
2
6
–
30
28
T
a
bl
e
1.
I
n
n
e
r
m
o
de
l
V
a
r
ia
bl
e
S
ub
v
a
r
ia
bl
e
L
o
a
di
ng
f
a
c
t
o
r
I
n
f
o
r
ma
ti
o
n
C
o
mp
o
s
it
e
r
e
li
a
bi
li
t
y
P
e
r
s
o
na
l
f
a
c
t
o
r
s
1.
A
ge
2.
S
e
x
3.
E
duc
a
ti
o
n
4.
W
o
r
ki
ng t
i
me
0.805
0.651
0.360
0.836
V
a
li
d
V
a
li
d
N
o
t
v
a
li
d
V
a
li
d
0.770
B
e
ha
v
i
or
r
e
la
t
e
d
c
o
gni
ti
o
n a
nd
e
f
f
e
c
t
1.
K
n
o
w
l
e
dge
2.
A
tt
it
ude
0.926
0.906
V
a
li
d
V
a
li
d
0.913
I
nt
e
r
pe
r
s
o
na
l
in
f
lu
e
n
c
e
s
1.
P
e
e
r
s
upp
o
r
t
2.
O
th
e
r
pr
of
e
s
s
i
o
ns
s
uppo
r
t
3.
C
ha
ir
ma
n of
pr
im
a
r
y
he
a
lt
h
c
a
r
e
s
uppo
r
t
4.
C
o
mm
uni
t
y
s
uppo
r
t
0.838
0.780
0.790
0.857
V
a
li
d
V
a
li
d
V
a
li
d
V
a
li
d
0.889
S
it
ua
ti
o
na
l
in
f
lu
e
n
c
e
s
1.
P
o
li
c
y
2.
F
a
c
il
it
y
0.949
0.946
V
a
li
d
V
a
li
d
0.946
C
o
mm
it
m
e
nt
1.
A
f
f
ir
ma
ti
ve
2.
N
o
r
ma
ti
ve
3.
C
o
nt
ui
na
nc
e
0.910
0.858
0.670
V
a
li
d
V
a
li
d
N
o
t
V
a
li
d
0.858
C
o
mm
uni
t
y
nur
s
e
s
dut
y
1.
P
r
o
m
o
ti
ve
2.
P
r
e
ve
nt
i
ve
0.961
0.959
V
a
li
d
V
a
li
d
0.959
T
a
bl
e
2
.
H
y
po
t
h
e
s
i
s
m
o
de
l
C
o
r
r
e
la
ti
o
n
b
e
tw
e
e
n
v
a
r
ia
bl
e
O
r
ig
in
a
l
s
a
mpl
e
S
a
mpl
e
X
S
ta
nda
r
d D
e
v
ia
ti
o
n
(
S
T
D
E
V
)
T
S
ta
ti
s
ti
c
I
n
f
o
r
ma
ti
o
n
P
e
r
s
o
na
l
f
a
c
t
o
r
s
-
>
be
ha
v
i
o
r
r
e
la
te
d
c
o
gni
ti
o
n a
nd
e
f
f
e
c
t
0.631
0.643
0.054
9.709
S
ig
ni
f
i
c
a
nt
P
e
r
s
o
na
l
f
a
c
t
o
r
s
-
>
c
o
mm
it
m
e
nt
0.631
0.643
0.054
2.430
S
ig
ni
f
i
c
a
nt
P
e
r
s
o
na
l
f
a
c
t
o
r
s
-
>
I
nt
e
r
p
e
r
s
o
na
l
I
n
f
lu
e
n
c
e
s
0.659
0.668
0.050
8.951
S
ig
ni
f
i
c
a
nt
P
e
r
s
o
na
l
f
a
c
t
o
r
s
-
>
S
it
ua
ti
o
na
l
I
n
f
lu
e
n
c
e
s
0.690
0.698
0.054
9.804
S
ig
ni
f
i
c
a
nt
P
e
r
s
o
na
l
f
a
c
t
o
r
s
-
>
C
o
mm
uni
t
y
nur
s
e
s
dut
y
0.096
0.096
0.048
2.115
S
ig
ni
f
i
c
a
nt
B
e
ha
v
i
or
r
e
la
te
d
c
o
gni
t
i
o
n a
nd e
f
f
e
c
t
-
>
c
o
mm
it
m
e
nt
0.399
0.400
0.166
4.447
S
ig
ni
f
i
c
a
nt
I
nt
e
r
pe
r
s
o
na
l
in
f
lu
e
n
c
e
s
-
>
c
o
mm
it
me
nt
0.257
0.267
0.150
2.554
S
ig
ni
f
i
c
a
nt
S
it
ua
ti
o
na
l
in
f
lu
e
nc
e
s
-
>
c
o
m
mi
tm
e
nt
0.248
0.241
0.093
5.548
S
ig
ni
f
i
c
a
nt
B
e
ha
v
i
or
r
e
la
te
d
c
o
gni
t
i
o
n a
nd e
f
f
e
c
t
-
>
C
o
mm
uni
t
y
nur
s
e
s
dut
y
-
0.121
-
0.126
0.068
2.875
S
ig
ni
f
i
c
a
nt
I
nt
e
r
pe
r
s
o
na
l
in
f
lu
e
n
c
e
s
-
>
C
o
mm
uni
t
y
nu
r
s
e
s
dut
y
0.307
0.304
0.075
6.417
S
ig
ni
f
i
c
a
nt
S
it
ua
ti
o
na
l
in
f
lu
e
nc
e
s
-
>
C
o
mm
un
it
y
nur
s
e
s
dut
y
0.437
0.448
0.077
9.667
S
ig
ni
f
i
c
a
nt
C
o
mm
it
m
e
nt
-
>
C
o
mm
uni
t
y
nur
s
e
s
dut
y
0.338
0.329
0.060
8.062
S
ig
ni
f
i
c
a
nt
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ON
S
t
udy
r
e
s
u
l
t
s
h
o
we
d
t
h
a
t
c
o
m
mi
t
m
e
n
t
a
f
f
e
c
t
e
d
to
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
.
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
a
l
s
o
s
h
o
we
d
o
n
t
h
e
po
s
i
t
i
ve
l
e
ve
l
,
t
h
a
t
m
e
a
n
c
o
m
m
u
ni
t
y
n
ur
s
e
s
h
a
d
a
po
s
i
t
i
v
e
c
o
m
mi
t
m
e
n
t
to
c
o
n
duc
t
t
h
e
i
r
r
o
l
e
o
n
h
e
a
l
t
h
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
t
o
t
h
e
c
o
m
m
u
ni
t
y
.
T
h
e
r
e
s
u
l
t
o
f
s
t
ud
y
w
a
s
r
e
l
e
v
a
n
c
e
w
i
t
h
pr
e
vi
o
us
s
t
ud
y
t
h
a
t
i
m
p
l
e
m
e
n
t
a
t
i
o
n
o
f
h
e
a
l
t
h
p
r
o
m
ot
i
n
g
s
e
r
vi
c
e
s
i
n
t
h
e
c
o
m
m
u
ni
t
y
w
a
s
i
n
f
l
ue
n
c
e
d
by
c
o
m
mi
t
m
e
n
t
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
a
n
d
s
uppo
r
t
e
d
by
o
r
ga
ni
z
a
t
i
o
n
c
u
l
t
ur
e
[
13]
.
C
o
m
mi
t
m
e
n
t
c
o
ul
d
e
n
c
o
ur
a
ge
a
pe
r
s
o
n
t
o
wo
r
k
f
u
l
ly
de
d
i
c
a
t
i
o
n
,
h
a
vi
ng
de
s
e
a
r
t
to
gi
v
e
hi
s
po
we
r
a
n
d
a
bil
i
t
y
t
o
w
o
r
k
f
u
ll
y
o
n
pu
r
po
s
e
o
f
o
r
ga
ni
z
a
t
i
o
n
s
o
t
h
a
t
c
o
ul
d
r
e
a
c
h
t
h
e
o
p
t
i
m
u
m
l
e
v
e
l
[
14]
.
P
o
gh
o
s
y
a
n
e
t
al
.
[
15]
a
l
s
o
s
h
o
we
d
t
h
a
t
c
o
m
m
i
t
m
e
n
t
o
f
n
ur
s
e
h
a
d
c
o
n
t
r
i
b
ut
e
to
a
c
hi
e
v
e
m
e
n
t
o
f
pr
o
m
ot
i
ve
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
i
n
c
o
m
m
u
ni
t
y
.
Nur
s
e
s
t
h
a
t
h
a
d
c
o
m
mi
t
m
e
n
t
to
t
h
e
i
r
s
e
lf
,
o
r
ga
ni
s
a
t
i
o
n
,
a
n
d
s
o
c
i
e
t
y
c
o
u
l
d
pr
e
s
e
n
t
a
goo
d
pr
o
m
ot
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
be
h
a
vi
o
r
.
C
o
m
mi
t
m
e
n
t
w
a
s
a
s
a
pa
r
t
o
f
im
po
r
t
a
n
c
e
r
o
l
e
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
i
n
g
i
v
i
ng
p
r
o
m
ot
i
ve
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
t
o
c
o
m
m
u
ni
t
y
.
S
o
th
a
t
wa
s
n
e
e
d
e
d
a
n
e
f
f
o
r
t
to
e
n
ha
n
c
e
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
.
S
t
udy
r
e
s
u
l
t
s
h
o
we
d
t
h
a
t
i
n
t
e
r
pe
r
s
o
n
a
l
i
nf
l
ue
nc
e
s
a
f
f
e
c
t
e
d
to
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
.
I
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
u
e
n
c
e
s
o
n
t
h
e
s
t
udy
a
l
s
o
s
h
o
we
d
o
n
t
h
e
m
o
de
r
a
t
e
l
e
v
e
l
,
t
h
a
t
m
e
a
n
c
o
m
m
u
ni
t
y
n
ur
s
e
s
h
a
d
a
c
h
a
n
c
e
to
c
o
n
duc
t
t
h
e
i
r
r
o
l
e
i
n
g
i
v
i
ng
h
e
a
l
t
h
pr
o
m
o
t
i
o
n
a
n
d
pr
e
v
e
n
t
i
o
n
s
e
r
vi
c
e
s
t
o
c
o
m
m
u
ni
t
y
be
c
a
us
e
t
h
e
y
wa
s
s
uppo
r
t
e
d
by
t
h
e
i
r
n
ur
s
e
s
c
o
l
l
e
gue
,
ot
h
e
r
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
,
c
hi
e
f
o
f
P
u
bli
c
He
a
l
t
h
C
e
n
t
e
r
a
n
d
c
o
m
m
u
ni
t
y
.
T
h
a
t
wa
s
r
e
l
e
va
n
c
e
w
i
t
h
P
e
n
de
r
[
16]
s
t
a
t
e
m
e
n
t
th
a
t
t
h
e
go
a
l
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
n
g
a
n
d
pr
e
v
e
n
t
i
n
g
e
f
f
o
r
t
s
we
r
e
de
pe
n
de
d
by
i
n
t
e
r
pe
r
s
o
n
a
l
i
nf
l
ue
n
c
e
s
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
s
uppo
r
t
i
n
g
o
f
c
o
l
l
e
a
gue
,
ot
h
e
r
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
a
n
d
c
o
m
m
u
ni
t
y
.
Gr
a
n
t
e
t
al.
[
17]
a
l
s
o
r
e
po
r
t
e
d
s
uppor
t
i
n
g
f
r
o
m
c
o
l
l
e
a
gue
,
o
t
h
e
r
h
e
a
l
t
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
M
ode
l
to
pr
e
dict
duty
o
f
c
omm
unit
y
nur
s
e
s
in
pr
omotive
and
pr
e
v
e
nti
v
e
c
ar
e
(
Sis
mul
y
anto
)
29
pr
o
f
e
s
s
i
o
n
,
a
n
d
c
o
m
m
u
ni
t
y
c
o
u
l
d
o
pt
i
m
i
s
e
t
h
e
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
i
n
g
i
v
i
ng
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
to
c
o
m
m
u
ni
t
y
a
n
d
e
nh
a
nc
i
ng
o
f
c
o
m
m
u
ni
t
y
a
wa
r
e
n
e
s
s
t
o
i
m
p
l
e
m
e
n
t
h
e
a
l
t
h
l
if
e
s
t
y
l
e
b
e
ha
vi
o
r
s
[
11]
.
I
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
s
upp
o
r
t
i
n
g
f
r
o
m
c
o
l
l
e
a
gue
,
o
t
h
e
r
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
,
a
n
d
c
o
m
m
u
ni
t
y
wa
s
t
h
e
f
a
c
t
or
s
t
h
a
t
a
f
f
e
c
t
e
d
to
c
omm
n
i
t
y
n
ur
s
e
s
r
o
l
e
i
n
g
i
v
i
ng
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
to
c
o
m
m
u
ni
t
y
.
T
h
a
t
wa
s
i
m
po
r
t
a
n
t
to
e
n
c
o
ur
a
ge
c
o
m
m
u
ni
t
y
n
ur
s
e
s
a
l
wa
y
s
m
a
k
i
ng
go
o
d
r
e
l
a
t
i
o
n
s
hi
p
w
i
t
h
c
o
l
l
e
a
gu
e
,
ot
h
e
r
pr
o
f
e
s
s
i
o
n
a
n
d
c
o
m
m
u
ni
t
y
.
S
t
u
d
y
r
e
s
u
l
t
s
h
o
we
d
t
h
a
t
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
a
f
f
e
c
t
e
d
to
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
.
S
i
t
ua
t
i
o
na
l
i
nf
l
ue
n
c
e
s
o
n
t
h
e
s
t
ud
y
a
l
s
o
s
h
o
we
d
o
n
t
h
e
hi
g
h
c
a
t
e
go
r
y
,
t
h
a
t
m
e
a
n
t
he
r
e
we
r
e
r
e
gu
l
a
t
i
o
n
r
e
l
a
t
e
d
to
i
m
p
l
e
m
e
n
t
a
t
i
o
n
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
v
e
a
n
d
pr
e
ve
n
t
i
v
e
s
e
r
vi
c
e
s
i
n
t
h
e
c
o
m
m
u
ni
t
y
a
n
d
a
v
a
il
a
bil
i
t
y
o
f
f
a
c
i
li
t
i
e
s
t
h
a
t
s
upp
o
r
t
e
d
pr
o
m
o
t
i
n
g
a
n
d
pr
e
ve
n
t
i
n
g
e
f
f
o
r
t
s
.
P
r
i
m
a
r
y
he
a
l
t
h
c
a
r
e
,
o
n
t
h
e
o
t
h
e
r
h
a
n
d,
i
s
a
pu
bli
c
he
a
l
t
h
s
t
r
a
t
e
gy
de
r
i
ve
d
f
r
o
m
t
h
e
s
o
c
i
a
l
m
o
de
l
o
f
h
e
a
l
t
h
a
n
d
i
s
b
a
s
e
d
o
n
t
h
e
p
hil
o
s
o
phy
t
h
a
t
he
a
l
t
h
g
a
i
ns
a
r
e
be
tt
e
r
o
b
t
a
i
n
e
d
w
he
n
pe
o
p
l
e
’
s
b
a
s
i
c
n
e
e
ds
a
r
e
m
e
t
f
i
r
s
t
[
18]
.
T
h
e
f
u
n
d
a
m
e
n
t
a
l
pr
i
n
c
i
p
l
e
s
o
f
pr
i
m
a
r
y
he
a
l
t
h
c
a
r
e
a
t
t
h
e
o
pe
r
a
t
i
o
n
a
l
l
e
v
e
l
a
r
e
u
ni
que
t
o
t
h
e
s
pe
c
i
f
i
c
c
i
r
c
u
m
s
t
a
nc
e
s
o
r
s
y
s
t
e
m
.
T
h
us
t
h
e
un
de
r
lyi
ng
s
o
c
i
a
l
de
t
e
r
m
i
na
n
t
s
o
n
i
ll
-
he
a
l
t
h
s
uc
h
a
s
a
c
c
e
s
s
t
o
b
a
s
ic
l
i
vi
ng
c
o
n
d
i
t
i
o
n
s
,
une
m
p
l
o
ym
e
n
t
,
e
t
c
a
r
e
i
m
po
r
t
a
n
t
f
a
c
to
r
s
to
c
o
n
s
i
de
r
i
n
t
h
e
pr
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
s
t
r
a
t
e
gy
.
T
h
e
s
t
r
e
n
gt
h
o
f
pr
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
i
s
t
o
r
e
s
po
n
d
to
t
h
e
l
o
c
a
l
n
e
e
ds
o
f
i
n
d
i
v
i
dua
l
s
,
f
a
mi
l
i
e
s
a
n
d
po
pu
l
a
t
i
o
n
s
t
h
r
o
ugh
a
c
o
m
pr
e
h
e
n
s
i
ve
,
i
n
t
e
r
-
s
e
c
t
o
r
a
l
a
ppr
o
a
c
h
t
h
a
t
f
o
c
us
e
s
o
n
c
o
m
m
u
ni
t
i
e
s
a
s
t
h
e
u
ni
t
o
f
i
n
t
e
r
v
e
n
t
i
o
n
.
I
n
e
s
s
e
n
c
e
,
pr
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
pr
o
vi
de
s
a
c
o
n
ne
c
t
i
o
n
b
e
t
we
e
n
h
e
a
l
t
h
a
n
d
he
a
l
t
h
c
a
r
e
,
by
li
nk
i
ng
t
hi
s
to
s
o
c
i
a
l
a
n
d
e
c
o
n
o
m
i
c
s
y
s
t
e
m
s
.
T
h
e
pr
i
n
c
i
p
l
e
s
o
f
t
h
e
pr
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
a
ppr
o
a
c
h
i
nc
l
ude
e
qu
i
t
y
i
n
h
e
a
l
t
h
s
e
r
vi
c
e
de
l
i
ve
r
y
,
a
c
c
e
s
s
t
o
a
f
f
o
r
da
bl
e
a
n
d
a
ppr
o
pr
i
a
t
e
s
e
r
vi
c
e
s
,
e
m
po
we
r
m
e
n
t
o
f
pe
o
pl
e
,
a
n
d
s
us
t
a
i
na
bil
i
t
y
o
f
s
e
r
vi
c
e
pr
o
vi
s
i
o
n
[
19]
.
T
h
a
t
wa
s
r
e
l
e
va
n
c
e
w
i
t
h
P
e
n
de
r
[
16]
s
t
a
t
e
m
e
n
t
th
a
t
t
h
e
go
a
l
o
f
h
e
a
l
t
h
pr
o
m
o
t
i
n
g
a
n
d
pr
e
v
e
n
t
i
n
g
e
f
f
o
r
t
s
we
r
e
de
pe
n
de
d
by
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
a
v
a
il
a
bil
i
t
y
o
f
r
e
gu
l
a
t
i
o
n
a
n
d
f
a
c
i
li
t
i
e
s
.
T
h
o
m
a
s
e
t
al
.
[
10]
r
e
po
r
t
e
d
t
h
a
t
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
t
h
a
t
s
uppo
r
t
i
m
p
l
e
m
e
n
t
a
t
i
o
n
o
f
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
i
n
c
o
m
m
u
ni
t
y
wa
s
r
e
gu
l
a
t
i
o
n
a
n
d
a
v
a
il
a
bil
t
y
o
f
f
a
c
il
i
t
i
e
s
.
R
e
gu
l
a
t
i
o
n
c
o
u
l
d
g
u
i
de
t
h
e
c
o
m
m
u
ni
t
y
n
ur
s
e
s
a
b
o
ut
t
h
e
s
c
o
pe
t
h
a
t
s
h
o
u
l
d
b
e
do
n
e
a
n
d
e
ns
ur
e
t
h
e
c
o
m
m
u
ni
t
y
n
ur
s
e
s
f
r
o
m
m
a
ny
k
i
n
d
s
o
f
dut
y
a
c
c
i
de
n
t
[
20]
.
W
hi
t
e
he
a
d
[
12]
a
l
s
o
pr
o
v
e
d
t
ha
t
a
v
a
il
a
bil
i
t
y
o
f
r
e
gu
l
a
t
i
o
n
a
n
d
f
a
c
il
t
i
e
s
h
a
d
i
n
f
l
u
e
n
c
e
d
to
im
p
l
e
m
e
n
t
a
t
i
o
n
o
f
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
i
n
c
o
m
m
u
ni
t
y
.
S
i
t
ua
t
i
o
na
l
i
nf
l
ue
n
c
e
s
t
h
a
t
c
o
n
s
i
s
t
e
d
o
f
r
e
gu
l
a
t
i
o
n
a
n
d
f
a
c
il
i
t
i
e
s
wa
s
a
pa
r
t
o
f
i
m
po
r
t
a
n
c
e
r
o
l
e
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
i
n
pr
o
m
ot
i
v
e
a
n
d
pr
e
ve
n
t
i
ve
c
a
r
e
.
T
o
e
n
h
a
n
c
e
a
f
f
e
c
t
e
d
o
f
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
u
e
n
c
e
s
,
c
o
u
l
d
b
e
do
ne
by
e
ns
ur
e
o
f
a
v
a
il
a
bi
t
y
o
f
r
e
gu
l
a
t
i
o
n
a
n
d
f
a
c
il
i
t
i
e
s
.
4.
CONC
L
USI
ON
C
o
m
m
u
ni
t
y
n
ur
s
e
s
o
f
P
r
i
m
a
r
y
He
a
l
t
h
C
a
r
e
i
n
B
a
ny
uwa
n
g
i
c
o
n
duc
t
e
d
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
ve
c
a
r
e
to
c
o
m
m
u
ni
t
y
go
o
dl
y
e
n
o
ugh
.
C
o
m
mi
t
m
e
n
t
o
f
nur
s
e
s
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
n
f
l
ue
n
c
e
s
,
a
n
d
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
ue
n
c
e
s
we
r
e
f
a
c
t
o
r
s
t
h
a
t
a
f
f
e
c
t
e
d
to
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
i
n
pr
o
m
o
t
i
v
e
a
n
d
pr
e
v
e
n
t
i
v
e
c
a
r
e
.
I
t
wa
s
c
o
n
s
id
e
r
e
d
to
e
nh
a
nc
e
o
f
c
o
m
m
u
ni
t
y
n
ur
s
e
s
r
o
l
e
c
a
p
a
c
i
t
y
t
h
r
o
ugh
m
o
d
if
yi
ng
c
o
m
mi
t
m
e
n
t
o
f
n
ur
s
e
s
,
i
n
t
e
r
pe
r
s
o
n
a
l
i
nf
l
ue
n
c
e
f
a
c
t
o
r
s
a
n
d
s
i
t
ua
t
i
o
n
a
l
i
n
f
l
u
e
n
c
e
f
a
c
t
o
r
s
.
AC
K
NOWL
E
DGE
M
E
NT
S
T
h
e
a
ut
h
o
r
s
w
o
ul
d
l
i
ke
t
o
t
h
a
n
k
t
o
a
l
l
pa
r
t
i
c
i
p
a
n
t
s
wh
o
pa
r
t
i
c
i
p
a
t
e
d
i
n
t
hi
s
s
t
ud
y
.
RE
F
E
R
E
NC
E
S
[1
]
K
.
D
av
i
e
s
,
“
W
h
at
i
s
e
ffec
t
i
v
e
i
n
t
e
rv
e
n
t
i
o
n
?
-
u
s
i
n
g
t
h
eo
ri
e
s
o
f
h
e
al
t
h
p
ro
m
o
t
i
o
n
,
”
B
r
.
J.
Nu
r
s
.
,
v
o
l
.
1
5
,
n
o
.
5
,
p
p
.
252
–
2
5
6
,
2
0
0
6
.
[2
]
W
o
rl
d
H
e
al
t
h
O
rg
a
n
i
zat
i
o
n
,
P
r
i
m
a
r
y
ca
r
e:
n
o
w
m
o
r
e
t
h
a
n
ever
.
G
e
n
ev
a:
W
H
O
,
2
0
0
5
.
[3
]
W
o
rl
d
H
e
al
t
h
O
rg
a
n
i
zat
i
o
n
,
D
ecl
a
r
a
t
i
o
n
o
f
A
l
m
a
A
t
a
.
In
t
e
r
n
a
t
i
o
n
a
l
co
n
f
er
e
n
ce
o
n
p
r
i
m
a
r
y
ca
r
e
.
A
l
m
a
A
t
a:
U
S
SR,
1
9
7
8
.
[4
]
S.
P
ec
k
h
am,
A
.
H
an
n
,
S.
K
en
d
a
l
l
,
an
d
S.
G
i
l
l
a
m,
“
H
e
a
l
t
h
p
ro
m
o
t
i
o
n
an
d
d
i
s
e
as
e
p
rev
e
n
t
i
o
n
i
n
g
en
e
ral
p
rac
t
i
ce
an
d
p
ri
m
ar
y
c
ar
e
:
a
s
co
p
i
n
g
s
t
u
d
y
,
”
P
r
i
m
.
H
ea
l
.
Ca
r
e
R
es
.
D
ev.
,
v
o
l
.
1
8
,
n
o
.
6
,
p
p
.
5
2
9
–
5
4
0
,
2
0
1
7
.
[5
]
R.
K
u
s
ch
n
i
r
an
d
A
.
H
.
Ch
o
rn
y
,
“
Red
al
y
c
R
ed
e
s
d
e
at
e
n
ção
à
s
aú
d
e
:
co
n
t
e
x
t
u
al
i
za
n
d
o
o
d
e
b
at
e
H
e
a
l
t
h
care
n
e
t
w
o
rk
s
:
c
o
n
t
e
x
t
u
al
i
zi
n
g
t
h
e
d
e
b
at
e
,
”
Ci
en
.
S
a
u
d
e
Co
l
et
.
,
v
o
l
.
1
5
,
n
o
.
5
,
2
0
1
0
.
[6
]
C.
R.
D
a
l
l
a
N
o
ra,
R.
S
ch
a
e
f
e
r,
a
n
d
J
.
N
e
v
e
s
-
A
m
a
d
o
,
“
N
u
rs
e
s
’
p
rac
t
i
ce
s
i
n
t
h
e
c
o
n
t
e
x
t
o
f
p
ri
m
ar
y
h
e
a
l
t
h
c
ar
e
i
n
Po
rt
u
g
al
,
”
J.
R
es
.
Nu
r
s
.
,
v
o
l
.
2
3
,
n
o
.
6
,
p
p
.
5
2
0
–
5
3
2
,
2
0
1
8
.
[7
]
N
.
Ph
as
w
a
n
a‐Mafu
y
a
et
a
l
.
,
“
Pri
m
ar
y
h
e
a
l
t
h
c
ar
e
s
e
r
v
i
ce
d
el
i
v
e
r
y
i
n
So
u
t
h
A
fr
i
c
a,
”
In
t
.
J.
H
ea
l
t
h
C
a
r
e
Q
u
a
l
.
A
s
s
u
r
.
,
v
o
l
.
2
1
,
n
o
.
6
,
p
p
.
6
1
1
–
6
2
4
,
Se
p
.
2
0
0
8
.
[8
]
S.
Ran
d
a
l
l
,
T
.
Cra
w
f
o
rd
,
J
.
Cu
rr
i
e
,
J
.
Ri
v
e
r,
a
n
d
V
.
B
et
i
h
av
as
,
“
I
m
p
a
c
t
o
f
co
mm
u
n
i
t
y
b
as
ed
n
u
rs
e
-
l
ed
c
l
i
n
i
c
s
o
n
p
at
i
e
n
t
o
u
t
co
m
e
s
,
p
at
i
en
t
s
at
i
s
fac
t
i
o
n
,
p
at
i
en
t
a
cce
s
s
an
d
co
s
t
e
ff
ec
t
i
v
en
e
s
s
:
A
s
y
s
t
em
at
i
c
r
e
v
i
ew
,
”
In
t
.
J.
N
u
r
s
.
S
t
u
d
.
,
v
o
l
.
7
3
,
n
o
.
Ma
y
,
p
p
.
2
4
–
3
3
,
2
0
1
7
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
1
,
M
a
r
c
h
201
9
:
2
6
–
30
30
[9
]
S.
Fu
l
l
e
r,
“
I
l
l
n
e
s
s
p
re
v
en
t
i
o
n
i
n
t
h
e
N
H
S
fi
v
e
y
e
ar
fo
r
w
ar
d
v
i
ew
,
”
Nu
r
s
.
M
a
n
a
g
e.
,
v
o
l
.
2
2
,
n
o
.
3
,
p
p
.
2
0
–
2
6
,
May
2
0
1
5
.
[1
0
]
J
.
J
.
T
h
o
m
as
,
A
.
M.
H
art
,
an
d
M.
E
.
Bu
r
m
an
,
“
I
m
p
ro
v
i
n
g
H
e
al
t
h
Pro
mo
t
i
o
n
an
d
D
i
s
e
as
e
Pr
e
v
en
t
i
o
n
i
n
N
P
-
D
el
i
v
e
r
e
d
Pri
m
ar
y
Car
e
,
”
J
.
Nu
r
s
e
P
r
a
ct
.
,
v
o
l
.
1
0
,
n
o
.
4
,
p
p
.
2
2
1
–
2
2
8
,
2
0
1
4
.
[1
1
]
E
.
K
u
rn
at
-
T
h
o
m
a,
M.
E
l
-
Ba
n
n
a
,
M.
O
ak
c
ru
m
,
a
n
d
J
.
T
y
ro
l
e
r,
“
N
u
rs
e
s
’
h
e
a
l
t
h
p
ro
m
o
t
i
n
g
l
i
f
e
s
t
y
l
e
b
e
h
av
i
o
rs
i
n
a
c
o
mmu
n
i
t
y
h
o
s
p
i
t
al
,
”
A
p
p
l
.
Nu
r
s
.
R
es
.
,
v
o
l
.
3
5
,
p
p
.
7
1
–
8
1
,
2
0
1
7
.
[1
2
]
D
.
W
h
i
t
e
h
e
a
d
,
“
T
h
e
r
o
l
e
o
f
c
o
mmu
n
i
t
y
-
b
as
e
d
n
u
rs
e
s
i
n
h
e
al
t
h
p
ro
mo
t
i
o
n
,
”
B
r
.
J.
Co
m
m
u
n
i
t
y
Nu
r
s
.
,
v
o
l
.
5
,
n
o
.
1
2
,
p
p
.
6
0
4
–
6
0
9
,
2
0
0
0
.
[1
3
]
B.
G
arry
et
a
l
.
,
“
Pro
m
o
t
i
o
n
o
f
o
ral
h
e
al
t
h
b
y
c
o
mmu
n
i
t
y
n
u
rs
e
s
,
”
B
r
.
J.
Co
m
m
u
n
i
t
y
Nu
r
s
.
,
v
o
l
.
2
2
,
n
o
.
1
0
,
2
0
1
7
.
[1
4
]
V
.
Mai
j
al
a
,
K
.
T
o
s
s
av
ai
n
en
,
an
d
H
.
T
u
ru
n
e
n
,
“
H
e
a
l
t
h
p
ro
m
o
t
i
o
n
p
ra
c
t
i
ce
s
d
e
l
i
v
e
r
ed
b
y
p
ri
m
ar
y
h
e
al
t
h
c
are
n
u
rs
e
s
:
E
l
eme
n
t
s
fo
r
s
u
cce
s
s
i
n
Fi
n
l
a
n
d
,
”
A
p
p
l
.
Nu
r
s
.
R
es
.
,
v
o
l
.
3
0
,
p
p
.
4
5
–
5
1
,
2
0
1
6
.
[1
5
]
L
.
Po
g
h
o
s
y
a
n
,
J
.
L
i
u
,
an
d
A
.
A
.
N
o
rf
u
l
,
“
N
u
rs
e
p
ra
c
t
i
t
i
o
n
e
rs
as
p
ri
m
ar
y
c
ar
e
p
ro
v
i
d
e
rs
w
i
t
h
t
h
e
i
r
o
w
n
p
at
i
e
n
t
p
an
e
l
s
a
n
d
o
rg
a
n
i
zat
i
o
n
a
l
s
t
ru
c
t
u
r
e
s
:
A
c
r
o
s
s
-
s
e
c
t
i
o
n
a
l
s
t
u
d
y
,
”
In
t
.
J.
Nu
r
s
.
S
t
u
d
.
,
v
o
l
.
7
4
,
n
o
.
D
ecem
b
e
r
2
0
1
6
,
p
p
.
1
–
7
,
2
0
1
7
.
[1
6
]
N
.
J
.
P
en
d
e
r,
C
.
L
.
Mu
r
d
au
g
h
,
an
d
M.
A
.
Pars
o
n
s
,
H
ea
l
t
h
p
r
o
m
o
t
i
o
n
i
n
n
u
r
s
i
n
g
p
r
a
ct
i
ce
.
Pe
ars
o
n
,
2
0
1
1
.
[1
7
]
A
.
J
.
G
ran
t
,
L
.
L
i
n
e
s
,
P
.
D
arb
y
s
h
i
r
e
,
Y
.
Parr
y
,
L
.
L
i
n
es
,
an
d
P
.
D
arb
y
s
h
i
r
e
,
“
H
o
w
d
o
n
u
rs
e
p
rac
t
i
t
i
o
n
e
rs
w
o
r
k
i
n
p
ri
m
ar
y
h
e
a
l
t
h
c
ar
e
s
e
t
t
i
n
g
s
?
A
s
co
p
i
n
g
r
e
v
i
ew
,
”
In
t
.
J.
Nu
r
s
.
S
t
u
d
.
,
2
0
1
7
.
[1
8
]
H
.
K
el
e
h
e
r,
“
W
h
y
Pri
m
ar
y
H
e
al
t
h
Car
e
O
ff
e
rs
a
m
o
r
e
C
o
m
p
re
h
en
s
i
v
e
A
p
p
ro
ach
t
o
T
ack
l
i
n
g
H
e
al
t
h
In
e
q
u
i
t
i
e
s
t
h
an
Pri
m
ar
y
Car
e
,
”
A
u
s
t
.
J.
P
r
i
m
.
H
ea
l
t
h
,
v
o
l
.
7
,
n
o
.
2
,
p
.
5
7
,
2
0
0
1
.
[1
9
]
C.
v
an
W
ee
l
a
n
d
J
.
D
e
Mae
s
e
n
ee
r,
“
N
o
w
mo
r
e
t
h
an
ev
e
r
:
W
o
rl
d
H
e
al
t
h
A
s
s
em
b
l
y
rev
i
s
i
t
s
p
ri
m
ar
y
h
e
al
t
h
c
a
re
,
”
P
r
i
m
.
H
ea
l
t
h
Ca
r
e
R
es
.
D
ev.
,
v
o
l
.
1
1
,
n
o
.
0
1
,
p
.
1
,
J
an
.
2
0
1
0
.
[2
0
]
W
.
T
i
n
g
v
o
l
l
,
T
.
Sæt
e
rs
t
ran
d
,
an
d
L
.
M.
M
ccl
u
s
k
y
,
“
T
h
e
c
h
a
l
l
en
g
e
s
o
f
p
ri
m
ar
y
h
e
a
l
t
h
c
ar
e
n
u
rs
e
l
e
ad
e
rs
i
n
t
h
e
w
ak
e
o
f
N
ew
H
e
a
l
t
h
Car
e
R
e
f
o
r
m
i
n
N
o
r
w
a
y
,
”
B
M
C
Nu
r
s
.
,
p
p
.
1
–
8
,
2
0
1
6
.
Evaluation Warning : The document was created with Spire.PDF for Python.