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14]
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18]
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e
d
i
t
e
d
w
i
t
h
n
e
c
e
s
s
a
r
y
m
o
d
i
f
i
c
a
t
i
o
n
.
Que
s
t
i
o
nn
a
i
r
e
s
we
r
e
pr
e
pa
r
e
d
i
n
E
n
g
l
i
s
h
s
i
nc
e
t
h
e
s
t
ud
y
po
pul
a
t
i
o
ns
we
r
e
e
duc
a
t
e
d
a
n
d
c
a
n
r
e
a
d
&
u
n
de
r
s
t
a
n
d
t
h
e
c
o
n
c
e
pt
o
f
t
h
e
que
s
t
i
o
ns
t
hi
s
wa
s
mi
n
i
mi
z
e
t
h
e
r
i
s
k
r
e
l
a
t
e
d
w
i
t
h
que
s
t
i
o
ne
r
tr
a
n
s
l
a
t
i
o
n
.
Da
t
a
wa
s
a
na
l
y
z
e
d
us
i
ng
S
P
S
S
v
e
r
s
i
o
n
20
s
o
f
t
wa
r
e
pa
c
ka
ge
.
T
h
e
da
t
a
wa
s
c
r
o
s
s
c
h
e
c
ke
d
pr
i
o
r
to
a
c
t
ua
l
a
n
a
ly
s
i
s
.
T
h
e
da
t
a
we
r
e
pr
e
s
e
n
t
e
d
u
s
i
n
g
m
e
a
n
,
s
t
a
n
da
r
d
de
vi
a
t
i
o
n
,
p
e
r
c
e
n
t
a
ge
,
gr
a
ph
s
a
n
d
t
a
bl
e
s
.
A
dd
i
t
i
o
n
a
ll
y
o
n
e
wa
y
a
na
ly
s
i
s
o
f
v
a
r
i
a
n
c
e
wa
s
do
n
e
t
o
c
o
m
pa
r
e
t
h
e
m
e
a
n
k
n
o
w
l
e
dge
s
c
o
r
e
o
f
t
h
e
s
t
udy
s
u
bj
e
c
t
s
.
2.
7.
E
t
h
ical
c
on
s
id
e
r
at
ion
s
E
t
hi
c
a
l
c
l
e
a
r
a
n
c
e
w
a
s
o
b
t
a
i
n
e
d
f
r
o
m
i
ns
t
i
t
ut
i
o
n
a
l
E
t
hi
c
a
l
r
e
vi
e
w
c
o
m
m
i
t
t
e
e
o
f
H
a
r
a
r
He
a
l
t
h
S
c
i
e
nc
e
C
o
l
l
e
g
e
b
e
f
o
r
e
t
h
e
s
t
a
r
i
n
g
o
f
t
h
e
f
i
e
l
d
wo
r
k.
R
e
s
p
o
n
de
n
t
s
we
r
e
i
n
f
o
r
m
e
d
a
b
o
ut
t
h
e
o
bj
e
c
t
i
v
e
a
n
d
pu
r
po
s
e
o
f
t
h
e
s
t
udy
a
n
d
v
e
r
b
a
l
c
o
n
s
e
n
t
wa
s
o
b
t
a
i
n
e
d
f
r
o
m
e
a
c
h
r
e
s
po
n
de
n
t
.
M
or
e
o
v
e
r
,
a
l
l
t
h
e
s
t
ud
y
pa
r
t
i
c
i
pa
n
t
s
we
r
e
i
n
f
o
r
m
e
d
t
h
a
t
t
h
e
y
ha
v
e
a
f
u
ll
r
i
g
h
t
to
pa
r
t
i
c
i
pa
t
e
o
r
de
c
l
i
ne
f
r
o
m
pa
r
t
i
c
i
pa
t
i
n
g
i
n
t
h
e
s
t
ud
y
a
n
d
t
h
e
s
t
ud
y
pa
r
t
i
c
i
pa
n
t
s
we
r
e
a
s
s
ur
e
d
f
o
r
a
n
a
tt
a
i
nm
e
n
t
o
f
c
o
nf
i
de
n
t
i
a
li
t
y
f
o
r
t
h
e
i
nf
o
r
m
a
t
i
o
n
o
b
t
a
i
n
e
d
f
r
o
m
t
h
e
m
.
2.
8.
Op
e
r
at
ion
al
d
e
f
in
it
ion
s
Goo
d
K
n
o
w
l
e
dge
:
w
h
e
n
o
v
e
r
a
ll
k
n
o
w
l
e
dg
e
s
c
o
r
e
o
f
s
t
ud
y
pa
r
t
i
c
i
pa
n
t
’
s
i
s
a
b
o
v
e
m
e
a
n
.
All
c
o
r
r
e
c
t
a
ns
we
r
s
we
r
e
c
o
de
d
a
s
1
w
hi
l
e
t
h
e
i
nc
o
r
r
e
c
t
o
n
e
we
r
e
c
o
de
d
a
s
0,
t
h
e
n
t
h
e
s
u
m
a
n
d
m
e
a
n
o
f
t
h
e
s
u
m
o
f
o
b
s
e
r
v
a
t
i
o
ns
wa
s
c
a
l
c
u
l
a
t
e
d
to
de
f
i
ne
t
h
e
kn
o
w
l
e
d
ge
c
ut
o
f
f
po
i
n
t
.
S
i
mi
l
a
r
ly
po
or
kn
o
wl
e
dge
wa
s
de
f
i
ne
d
a
s
o
v
e
r
a
l
l
k
n
o
w
l
e
dge
s
c
o
r
e
b
e
l
o
w
t
h
e
m
e
a
n
kn
o
w
l
e
d
ge
s
c
o
r
e
o
f
t
h
e
s
a
m
p
l
e
[
19]
.
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ON
3.
1.
S
oc
io
d
e
m
ogr
ap
h
ic
c
h
a
r
ac
t
e
r
is
t
ics
A
t
ot
a
l
o
f
132
n
ur
s
e
s
w
e
r
e
i
nc
l
ude
d
i
n
t
hi
s
s
t
ud
y
.
Out
o
f
t
hi
s
75
(
57%
)
we
r
e
f
e
m
a
l
e
s
wo
r
k
i
n
g
i
n
d
i
f
f
e
r
e
n
t
uni
t
s
o
f
t
h
e
Ho
s
p
i
t
a
l
.
M
a
j
o
r
i
t
y
(
42.
4%
)
we
r
e
i
n
t
h
e
a
ge
b
e
l
o
w
30
y
e
a
r
s
.
T
h
e
m
e
a
n
a
g
e
o
f
t
h
e
n
ur
s
e
s
we
r
e
32.
2
y
e
a
r
s
(
32.
2
y
e
a
r
s
±
5
y
e
a
r
s
)
.
Only
f
e
w,
11
(
8.
3%
)
h
a
s
l
e
s
s
t
h
a
n
o
n
e
y
e
a
r
s
wo
r
k
i
n
g
e
x
p
e
r
i
e
n
c
e
,
whil
e
63
(
47.
7%
)
h
a
d
1
-
5
y
e
a
r
s
wo
r
ki
n
g
e
x
pe
r
i
e
n
c
e
,
40
(
30.
3%
)
h
a
s
6
-
10
y
e
a
r
s
wo
r
k
i
n
g
e
x
pe
r
i
e
n
c
e
a
n
d
a
b
o
ut
13
%
h
a
d
wor
k
e
x
pe
r
i
e
n
c
e
a
b
o
v
e
t
e
n
y
e
a
r
s
i
t
i
s
pr
e
s
e
n
t
e
d
i
n
T
a
bl
e
1.
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
.
2
,
J
un
e
201
9
:
21
9
–
22
8
222
T
a
bl
e
1
.
S
o
c
i
o
de
m
o
gr
a
phi
c
c
ha
r
a
c
t
e
r
i
s
t
i
c
s
o
f
n
ur
s
e
s
V
a
r
ia
bl
e
s
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
(
%
)
S
e
x
M
a
le
75
57
F
e
ma
l
e
57
43
A
ge
19
-
28
y
e
a
r
s
56
42.4
29
-
38
y
e
a
r
s
45
34.1
39
-
48
y
e
a
r
s
23
17.4
49
-
58
y
e
a
r
s
8
6.1
W
o
r
k
E
x
pe
r
ie
n
c
e
s
<
1
y
e
a
r
11
8.3
1
-
5
y
e
a
r
s
63
47.7
6
-
10
y
e
a
r
s
40
30.3
A
bove
t
e
n
y
e
a
r
s
18
13.7
Am
o
n
g
132
s
t
ud
y
pa
r
t
i
c
i
pa
n
t
s
,
39
(
29.
5%
)
we
r
e
us
e
d
W
HO
gu
i
d
e
l
i
ne
t
o
t
r
e
a
t
S
A
M
,
27
(
20.
5%
)
us
e
d
U
ni
t
e
d
N
a
t
i
o
n
I
n
t
e
r
n
a
t
i
o
n
a
l
C
hi
l
dr
e
n
E
duc
a
t
i
o
n
F
u
n
d
(
UN
I
C
E
F
)
gu
i
de
li
ne
s
t
o
t
r
e
a
t
S
A
M
.
I
n
a
dd
i
t
i
o
n
,
o
nl
y
39
(
29.
5%
)
r
e
p
o
r
t
e
d
to
us
e
E
t
hi
o
p
i
a
n
S
AM
m
a
n
a
ge
m
e
n
t
pr
oto
c
o
l
s
w
hil
e
,
27
(
20.
5%
)
d
i
d
n
o
t
us
e
d
a
ll
.
M
a
j
o
r
i
t
y
o
f
t
h
e
m
,
108
(
81.
8%
)
n
ur
s
e
s
c
o
v
e
r
e
d
a
c
ut
e
m
a
l
nut
r
i
t
i
o
n
i
n
t
h
e
i
r
a
c
a
de
mi
c
s
t
a
y
w
hil
e
,
m
o
r
e
t
h
a
n
h
a
lf
,
59
(
44.
7%
)
c
o
v
e
r
e
d
i
n
t
h
e
i
r
s
e
c
o
n
d
y
e
a
r
o
f
s
t
udy
.
A
t
ot
a
l
o
f
101
(
76.
5%
)
o
f
n
ur
s
e
s
we
r
e
e
v
e
r
inv
o
l
v
e
d
i
n
m
a
n
a
g
e
m
e
n
t
o
f
S
A
M
.
Al
s
o
,
117
(
88.
6%
)
o
f
nur
s
e
s
pe
r
c
e
i
ve
t
ha
t
t
h
e
t
i
m
e
de
v
o
t
e
d
to
c
hil
d
h
o
od
s
e
v
e
r
e
a
c
ut
e
m
a
l
nut
r
i
t
i
o
n
s
e
c
t
i
o
n
wa
s
a
de
qua
t
e
(
T
a
bl
e
2)
.
M
a
j
o
r
i
t
y
o
f
t
h
e
n
ur
s
e
s
,
98
(
74.
2
%
)
h
a
d
r
e
c
e
i
v
e
d
tr
a
i
n
i
ng
o
n
S
e
ve
r
e
A
c
ut
e
M
a
l
nut
r
i
t
i
o
n
,
a
n
d
i
n
t
e
r
e
s
t
i
n
g
ly
S
A
M
d
i
s
p
l
a
y
s
(
po
s
t
e
r
s
)
a
r
e
d
i
s
p
l
a
y
e
d
a
t
t
h
e
v
a
r
i
o
us
wo
r
k
p
l
a
c
e
o
n
pe
d
i
a
t
r
i
c
s
,
i
n
pa
t
i
e
n
t
a
n
d
o
u
t
pa
t
i
e
n
t
wa
r
ds
o
r
c
o
n
s
u
l
t
a
t
i
o
n
r
oo
m
,
i
t
i
s
pr
e
s
e
n
t
e
d
i
n
T
a
bl
e
2.
T
a
bl
e
2
.
S
A
M
m
a
n
a
g
e
m
e
n
t
r
e
l
a
t
e
d
b
e
h
a
vi
o
r
s
a
m
o
n
g
n
ur
s
e
s
V
a
r
ia
bl
e
s
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
(
%
)
W
a
s
a
c
ut
e
ma
ln
ut
r
it
i
o
n /
N
ut
r
it
i
o
n/
c
ove
r
e
d
in
y
o
ur
c
u
r
r
i
c
ul
um /
pr
e
v
i
o
us
l
y
/
?
Y
e
s
108
81.8
No
24
18.2
I
n w
hi
c
h
y
e
a
r
of
s
tu
d
y
, i
t
is
a
ddr
e
s
s
e
d?
F
ir
s
t
y
e
a
r
26
19.7
S
e
c
o
nd
y
e
a
r
59
44.7
T
h
ir
d Y
e
a
r
40
30.3
F
o
u
r
th
Y
e
a
r
7
5.3
I
nvo
l
ve
m
e
nt
i
n ma
na
g
e
m
e
nt
of
s
e
ve
r
e
a
c
ut
e
ma
ln
ut
r
it
i
o
n.
Y
e
s
101
76.5%
No
31
23.5%
A
f
t
e
r
b
e
in
g
e
mpl
oy
e
d ha
ve
y
ou e
ve
r
a
tt
e
nde
d
in
-
s
e
r
v
ic
e
or
o
ut
-
s
e
r
v
ic
e
tr
a
in
in
g/
s
o
n S
A
M
?
Y
e
s
98
74.2
No
34
25.8
3.
2.
Nur
s
e
s
`
k
n
ow
l
e
d
ge
on
S
AM
m
an
age
m
e
n
t
Ab
o
ut
h
a
l
f
o
f
n
ur
s
e
s
,
49.
2%
c
o
r
r
e
c
t
l
y
i
de
n
t
i
f
i
e
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