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er
s
e
r
a
n
g
e
o
f
eth
n
icities
an
d
cu
ltu
r
es,
m
ak
in
g
it
d
if
f
ic
u
lt
f
o
r
r
esid
en
ts
to
r
ec
eiv
e
eq
u
al
h
ea
lth
ca
r
e
[
9
]
.
T
h
is
d
ilem
m
a
im
p
ac
ts
m
a
n
y
ar
ea
s
o
f
h
ea
lth
ca
r
e,
m
o
s
t
n
o
t
ab
ly
o
n
h
o
w
SC
I
s
u
r
v
iv
o
r
s
a
r
e
m
an
ag
e
d
d
u
r
in
g
th
eir
r
eh
ab
ilit
atio
n
.
Facilities
with
s
p
ec
ialized
r
eh
ab
ilit
atio
n
u
n
its
ar
e
s
til
l
h
ar
d
to
co
m
e
b
y
in
I
n
d
o
n
esia.
On
ly
two
h
o
s
p
itals
p
r
o
v
id
e
SC
I
s
er
v
ices,
an
d
th
e
y
ar
e
lo
ca
te
d
o
n
J
av
a
I
s
lan
d
i
n
th
e
p
r
o
v
in
ce
s
o
f
J
ak
ar
ta
an
d
C
en
tr
al
J
av
a.
Alth
o
u
g
h
g
e
n
e
r
al
r
eh
ab
ilit
atio
n
s
er
v
ices
ca
n
b
e
p
r
o
v
id
ed
i
n
m
an
y
d
i
f
f
er
en
t
h
o
s
p
itals
,
th
e
d
if
f
icu
lty
f
o
r
SC
I
r
e
h
ab
ilit
atio
n
is
wo
r
s
en
ed
b
y
t
h
e
lack
o
f
s
k
illed
p
er
s
o
n
n
el.
T
r
a
n
s
p
o
r
tati
o
n
-
r
elate
d
o
b
s
tacle
s
f
u
r
th
er
im
p
air
th
e
s
itu
atio
n
b
y
m
ak
in
g
it
m
o
r
e
d
if
f
ic
u
lt
f
o
r
p
atien
ts
to
g
o
f
r
o
m
h
o
m
e
to
th
e
h
o
s
p
ital
[
1
0
]
.
B
ec
au
s
e
o
f
th
is
,
a
lar
g
e
n
u
m
b
er
o
f
SC
I
s
u
r
v
iv
o
r
s
ar
e
r
eq
u
ir
ed
to
r
ec
eiv
e
th
eir
ca
r
e
at
h
o
m
e
f
r
o
m
th
eir
r
elativ
es.
Prim
ar
y
ca
r
er
s
,
wh
ich
ar
e
f
r
eq
u
en
tly
f
am
ily
m
em
b
er
s
,
ar
e
u
n
p
aid
in
f
o
r
m
al
ca
r
e
r
s
wh
o
liv
e
with
th
e
p
atien
t
an
d
p
r
o
v
id
e
ca
r
e
[
4
]
.
Ho
wev
er
,
I
n
d
o
n
esia
is
am
o
n
g
n
u
m
er
o
u
s
Asi
an
co
u
n
tr
ies
wh
o
s
e
tr
ad
itio
n
s
v
al
u
es
ca
r
in
g
f
o
r
f
am
ily
m
em
b
er
s
as
a
s
ig
n
o
f
r
esp
ec
t
an
d
h
o
n
o
r
[
1
1
]
.
Mo
s
t
ca
r
er
s
ar
e
p
s
y
ch
o
lo
g
ically
an
d
em
o
tio
n
ally
in
ad
e
q
u
ate
to
p
e
r
f
o
r
m
d
e
m
an
d
in
g
an
d
c
o
m
p
le
x
ca
r
e
o
b
lig
atio
n
s
b
ec
a
u
s
e
th
ey
lack
th
e
p
r
o
p
er
k
n
o
wled
g
e
an
d
tr
ai
n
in
g
,
wh
ic
h
m
ig
h
t
r
esu
lt
in
t
h
e
in
c
r
ea
s
e
o
f
th
e
ca
r
e
r
’
s
lo
ad
[
4
]
.
T
h
e
s
h
o
r
tag
e
o
f
th
o
r
o
u
g
h
ep
id
em
io
lo
g
ical
d
ata
ab
o
u
t
th
e
ca
r
eg
iv
er
b
u
r
d
en
in
I
n
d
o
n
esia
h
ig
h
lig
h
ts
a
cr
u
cial
k
n
o
wle
d
g
e
g
ap
r
e
g
ar
d
in
g
th
e
co
m
p
lete
r
an
g
e
o
f
d
if
f
icu
l
ties
in
f
o
r
m
al
ca
r
eg
iv
er
f
ac
e.
T
h
is
s
ca
r
city
p
r
ev
en
ts
th
e
cr
ea
tio
n
o
f
th
e
f
o
c
u
s
ed
tr
ea
tm
en
ts
an
d
s
u
p
p
o
r
t
n
etwo
r
k
s
r
eq
u
ir
ed
to
s
u
cc
ess
f
u
lly
r
e
d
u
ce
t
h
e
s
tr
ain
o
n
ca
r
er
s
.
Giv
en
th
e
s
ig
n
if
ican
ce
o
f
r
eliab
le
ep
id
em
i
o
lo
g
ical
d
a
ta
in
s
h
ap
i
n
g
h
ea
lth
ca
r
e
p
o
lic
y
an
d
allo
ca
tin
g
r
eso
u
r
ce
s
,
f
ill
in
g
th
is
k
n
o
wled
g
e
v
ac
u
u
m
is
ess
en
tial in
im
p
r
o
v
i
n
g
th
e
h
ea
lth
o
f
I
n
d
o
n
esian
ca
r
er
s
an
d
ca
r
e
u
s
er
s
.
I
t
is
cr
itical
to
id
en
tify
f
ac
to
r
s
in
f
lu
en
cin
g
ca
r
eg
iv
e
r
b
u
r
d
e
n
in
I
n
d
o
n
esia
s
o
th
at
ap
p
r
o
p
r
iate
ac
tio
n
ca
n
b
e
tak
e
n
to
a
d
d
r
ess
th
em
.
T
h
is
s
tu
d
y
in
ten
d
s
to
an
aly
ze
ca
r
eg
iv
er
b
u
r
d
en
an
d
its
co
r
r
el
atio
n
with
th
e
Qo
L
o
f
ca
r
e
g
iv
er
s
an
d
d
eter
m
in
e
th
e
f
ac
to
r
s
th
at
in
f
lu
e
n
ce
th
e
m
.
T
h
e
co
m
m
u
n
al
n
at
u
r
e
o
f
I
n
d
o
n
esian
s
o
ciety
h
o
ld
s
f
am
ily
m
e
m
b
e
r
s
to
a
h
i
g
h
s
tan
d
ar
d
o
f
ca
r
e
a
n
d
co
m
m
itm
en
t
th
r
o
u
g
h
o
u
t
life
,
w
h
ich
co
u
ld
o
v
e
r
b
u
r
d
en
th
e
f
am
ily
as
ca
r
e
g
iv
er
s
[
1
2
]
.
W
e
h
y
p
o
t
h
esized
th
at
th
e
o
cc
u
p
atio
n
al
s
tatu
s
o
f
in
d
iv
id
u
als
with
SC
I
,
SC
I
lev
el,
SC
I
d
u
r
atio
n
,
h
ea
lth
in
s
u
r
an
ce
o
wn
er
s
h
ip
,
th
e
ca
r
e
g
iv
er
’
s
ed
u
ca
tio
n
le
v
el,
th
e
d
u
r
ati
o
n
o
f
ca
r
e,
an
d
th
e
len
g
th
o
f
in
ter
ac
tio
n
ea
c
h
d
a
y
wo
u
ld
b
e
ass
o
ciate
d
with
ca
r
e
g
iv
er
b
u
r
d
e
n
in
I
n
d
o
n
esia.
T
h
e
s
t
r
o
n
g
s
e
n
s
e
o
f
c
o
m
m
u
n
ity
i
n
I
n
d
o
n
e
s
i
a
n
s
o
ci
e
t
y
,
w
h
i
c
h
h
o
l
d
s
f
a
m
il
y
m
e
m
b
e
r
s
t
o
a
h
i
g
h
s
t
a
n
d
a
r
d
o
f
c
a
r
e
a
n
d
c
o
m
m
i
t
m
e
n
t
t
h
r
o
u
g
h
o
u
t
l
i
f
e
,
c
o
u
l
d
l
ea
d
t
o
a
n
o
v
e
r
b
u
r
d
e
n
i
n
g
o
f
t
h
e
f
a
m
i
l
y
a
s
ca
r
e
g
i
v
e
r
s
.
W
e
c
o
n
d
u
c
t
t
h
i
s
s
t
u
d
y
b
e
c
a
u
s
e
i
t
i
s
c
r
u
c
ia
l
t
o
c
o
n
d
u
c
t
r
es
e
a
r
c
h
o
n
c
a
r
e
g
i
v
e
r
s
i
n
I
n
d
o
n
e
s
ia
,
a
s
u
n
d
e
r
s
t
a
n
d
i
n
g
t
h
e
f
a
c
t
o
r
s
t
h
a
t
i
n
f
l
u
e
n
c
e
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
c
a
n
h
e
l
p
d
e
v
e
l
o
p
e
f
f
e
c
t
i
v
e
s
t
r
a
t
e
g
i
es
t
o
r
e
d
u
c
e
th
e
b
u
r
d
e
n
,
t
h
e
r
e
b
y
i
m
p
r
o
v
i
n
g
t
h
e
q
u
a
l
i
t
y
o
f
l
i
f
e
o
f
c
a
r
e
g
i
v
e
r
s
w
h
i
c
h
h
a
s
n
e
v
e
r
c
o
n
d
u
c
t
e
d
b
e
f
o
r
e
[
1
3
]
.
T
h
e
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
a
n
d
Q
o
L
s
h
o
w
e
d
a
s
t
at
i
s
t
i
c
al
l
y
s
i
g
n
i
f
i
c
a
n
t
a
n
d
s
u
b
s
t
a
n
t
i
a
l
n
e
g
a
tiv
e
c
o
r
r
e
l
a
t
i
o
n
.
A
h
i
g
h
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
c
a
n
h
a
v
e
n
e
g
a
t
i
v
e
i
m
p
a
ct
s
o
n
p
h
y
s
i
c
a
l
,
e
m
o
t
i
o
n
a
l
,
m
e
n
t
al
h
e
a
lt
h
,
a
n
d
s
o
c
i
a
l
l
i
f
e
,
w
h
i
c
h
l
o
w
e
r
s
t
h
e
Qo
L
o
f
t
h
e
c
a
r
e
g
i
v
e
r
[
3
]
,
[
5
]
,
[
1
3
]
,
[
1
4
]
.
T
h
e
c
o
n
d
i
t
i
o
n
o
f
f
a
m
i
l
y
c
a
r
e
g
i
v
i
n
g
is
o
n
e
e
x
a
m
p
l
e
o
f
h
o
w
c
u
l
t
u
r
e
s
a
r
e
a
s
o
r
t
o
f
i
n
t
e
r
g
e
n
e
r
a
t
i
o
n
a
l
i
n
h
e
r
i
t
a
n
ce
th
a
t
a
c
t
i
v
el
y
i
m
p
a
c
ts
p
e
o
p
l
e'
s
l
i
v
e
s
[
1
5
]
.
R
es
e
a
r
c
h
o
n
f
a
m
i
ly
c
a
r
e
r
s
p
a
r
ti
c
u
l
a
r
ly
I
n
d
o
n
e
s
i
a
,
is
e
s
s
e
n
ti
a
ll
y
r
e
q
u
i
r
e
d
b
e
c
a
u
s
e
b
y
r
e
c
o
g
n
i
zi
n
g
t
h
e
f
a
c
t
o
r
s
t
h
a
t
c
a
n
i
n
f
l
u
e
n
c
e
t
h
e
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
,
a
p
r
o
p
e
r
a
p
p
r
o
a
c
h
t
o
r
e
d
u
c
e
t
h
e
b
u
r
d
e
n
w
i
l
l
i
m
p
r
o
v
e
c
a
r
e
g
i
v
e
r
Q
o
L
t
h
a
t
a
ls
o
i
ts
i
m
p
ac
t
t
o
Q
o
L
o
f
S
C
I
p
a
ti
e
n
t
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
ad
o
p
ted
a
cr
o
s
s
-
s
ec
tio
n
al
an
aly
tic
d
esig
n
.
T
h
e
p
o
p
u
latio
n
o
f
th
is
s
tu
d
y
in
c
lu
d
ed
th
e
p
r
im
ar
y
ca
r
eg
iv
er
s
o
f
SC
I
p
atien
ts
at
th
e
p
h
y
s
ical
m
ed
icin
e
an
d
r
eh
a
b
ilit
atio
n
d
ep
a
r
tm
en
t
,
Dr
.
Hasan
Sad
ik
in
Ho
s
p
ital,
B
an
d
u
n
g
,
I
n
d
o
n
esia,
f
r
o
m
J
u
n
e
to
Au
g
u
s
t
2
0
2
1
.
A
co
n
s
ec
u
tiv
e
s
am
p
lin
g
p
r
o
c
ed
u
r
e
was
u
s
ed
to
s
elec
t
th
e
s
tu
d
y
p
ar
ticip
an
ts
.
A
s
am
p
le
s
ize
o
f
at
least
1
3
7
p
ar
ticip
an
ts
was
n
ee
d
e
d
to
ac
h
iev
e
a
s
ig
n
if
ican
ce
lev
el
o
f
0
.
0
5
,
a
p
o
wer
o
f
0
.
8
,
an
d
a
9
5
%
co
n
f
id
en
ce
in
ter
v
al.
T
h
e
s
tu
d
y
was
ap
p
r
o
v
ed
b
y
t
h
e
R
esear
ch
E
t
h
ics
C
o
m
m
ittee
o
f
Dr
.
Hasan
Sad
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t e
f
f
ec
t
o
n
ca
r
eg
iv
er
b
u
r
d
en
s
co
r
es.
T
o
s
ee
th
e
ef
f
ec
t
o
f
each
v
ar
ia
b
le
ex
am
in
ed
in
th
is
s
tu
d
y
o
n
th
e
ca
r
eg
iv
er
b
u
r
d
e
n
s
co
r
e
p
ar
tially
,
th
e
t
-
test
was
u
s
ed
with
th
e
r
esu
lt
s
as
s
h
o
wn
in
T
ab
le
4
.
Statis
tical
an
aly
s
is
,
as
s
h
o
wn
in
T
ab
le
4
,
s
h
o
wed
th
at
t
h
e
o
cc
u
p
atio
n
al
s
tatu
s
o
f
in
d
iv
i
d
u
als
with
SC
I
an
d
th
e
i
n
ter
ac
tio
n
len
g
t
h
p
er
d
ay
wer
e
f
o
u
n
d
to
h
av
e
a
s
ig
n
if
ican
t
ef
f
ec
t
o
n
th
e
ca
r
eg
iv
er
b
u
r
d
e
n
(
p
<0
.
0
5
)
.
T
h
e
f
in
d
in
g
s
in
d
icate
th
at
th
e
b
u
r
d
en
o
n
ca
r
eg
iv
e
r
s
an
d
em
p
lo
y
m
e
n
t
s
tatu
s
in
cr
ea
s
es
as
th
e
d
u
r
atio
n
o
f
d
aily
i
n
ter
ac
tio
n
in
cr
ea
s
es.
Ad
d
itio
n
ally
,
th
e
lack
o
f
o
cc
u
p
atio
n
am
o
n
g
in
d
i
v
id
u
als
with
SC
I
will
f
u
r
th
er
h
ei
g
h
te
n
th
e
b
u
r
d
en
o
n
ca
r
eg
iv
er
s
.
O
th
er
v
a
r
iab
les
s
u
ch
as
th
e
s
ev
er
ity
o
f
in
ju
r
y
,
d
u
r
a
tio
n
o
f
SC
I
,
p
r
esen
ce
o
f
h
ea
lt
h
in
s
u
r
an
ce
,
ca
r
e
g
iv
er
'
s
lev
el
o
f
ed
u
ca
tio
n
,
an
d
len
g
th
o
f
ca
r
e
g
iv
in
g
h
ad
n
o
s
ig
n
if
ican
t
co
r
r
elatio
n
with
ca
r
eg
iv
er
b
u
r
d
en
.
B
ased
o
n
Sp
ea
r
m
an
’
s
s
tatis
tical
an
aly
s
is
,
it
al
s
o
f
o
u
n
d
a
s
ig
n
i
f
ican
t,
s
tr
o
n
g
n
eg
ativ
e
c
o
r
r
ela
tio
n
(
r
ef
er
r
i
n
g
to
th
e
Gu
ilfo
r
d
cr
iter
ia)
b
etwe
en
ca
r
eg
iv
er
b
u
r
d
en
an
d
Qo
L
(
r
-
v
alu
e
−0
.
7
5
0
;
p
<0
.
0
0
1
)
as
illu
s
tr
ated
in
T
ab
le
5
.
I
t
s
h
o
ws
th
at
a
ca
r
eg
iv
er
'
s
q
u
ality
o
f
life
wo
u
ld
d
ec
lin
e
with
in
cr
ea
s
in
g
ca
r
eg
iv
i
n
g
b
u
r
d
en
.
3
.
2
.
Dis
cus
s
io
n
T
h
is
s
tu
d
y
s
h
o
wed
th
at
m
o
s
t
SC
I
ca
r
eg
iv
er
s
ex
p
er
ien
ce
a
m
ild
to
m
o
d
er
ate
b
u
r
d
en
.
I
t
m
ay
b
e
in
f
lu
en
ce
d
b
y
I
n
d
o
n
e
s
i
a
n
cu
ltu
r
e,
wh
ich
b
eliev
es c
ar
in
g
f
o
r
t
h
e
in
f
ir
m
m
em
b
er
s
o
f
th
e
f
am
i
ly
is
co
n
s
id
er
ed
an
o
b
lig
atio
n
an
d
is
also
co
n
s
is
te
n
t w
ith
r
elig
io
u
s
v
alu
es [
1
7
]
,
[
18
]
.
I
n
h
er
e
n
t f
am
ily
v
alu
es,
s
u
ch
as
co
m
m
itm
en
t,
s
o
lid
ar
ity
,
p
r
o
tectio
n
,
an
d
co
n
ce
r
n
f
o
r
o
th
er
s
,
ar
e
cu
ltu
r
al
f
a
cto
r
s
.
Ho
wev
er
,
in
m
an
y
cu
lt
u
r
es,
esp
ec
ially
in
n
atio
n
s
with
p
atr
iar
c
h
al
cu
ltu
r
es
lik
e
I
n
d
o
n
esia,
th
ese
s
o
ci
al
s
tan
d
ar
d
s
ar
e
d
etr
im
en
tal
t
o
wo
m
en
.
C
ar
in
g
d
u
ties
h
av
e
a
p
r
o
f
o
u
n
d
im
p
ac
t
o
n
ca
r
eg
iv
e
r
s
'
q
u
ality
o
f
life
.
C
ar
eg
iv
er
s
,
in
p
ar
ticu
lar
,
f
r
e
q
u
en
tly
en
c
o
u
n
te
r
p
h
y
s
ical
an
d
h
ea
lth
-
r
elate
d
ch
allen
g
es,
r
esu
ltin
g
in
a
r
ed
u
ctio
n
in
th
eir
p
er
ce
iv
ed
q
u
alit
y
o
f
life
[
1
9
]
,
[
2
0
]
.
T
h
e
wo
r
k
lo
ad
a
n
d
r
esp
o
n
s
ib
ilit
ies
o
f
wo
m
en
in
th
e
h
o
m
e
ca
u
s
e
v
ar
io
u
s
is
s
u
es,
in
clu
d
in
g
f
am
ilial
co
n
f
lict,
f
in
an
cial
s
tr
ess
,
an
d
a
d
ec
lin
e
in
th
e
h
ea
lth
o
f
f
em
ale
ca
r
e
g
i
v
er
s
.
T
h
e
s
tr
ess
th
at
co
m
es
with
ca
r
in
g
f
o
r
o
t
h
er
s
also
im
p
ac
ts
wo
m
en
's
m
en
tal
h
ea
lth
[
2
1
]
.
T
h
ese
ch
ar
ac
ter
is
tics
m
ay
alter
f
o
r
f
am
ily
ca
r
eg
iv
er
s
in
d
ev
elo
p
ed
co
u
n
tr
ies,
wh
er
e
ed
u
ca
tio
n
lev
els
ar
e
h
ig
h
er
,
ac
ce
s
s
to
h
ea
lth
ca
r
e
f
ac
ilit
ies
i
s
b
etter
,
a
n
d
a
p
r
ef
er
e
n
ce
f
o
r
p
r
o
f
ess
io
n
al
ca
r
eg
i
v
er
s
ex
is
ts
.
I
n
W
ester
n
co
u
n
tr
ies,
ca
r
i
n
g
f
o
r
a
f
am
ily
is
n
o
t a
cu
ltu
r
al
n
o
r
m
[
22
].
I
n
r
esear
c
h
b
y
Sin
h
a
et
a
l.
[
7
]
,
th
e
m
aj
o
r
ity
o
f
p
ar
ticip
an
ts
in
d
icate
d
a
m
o
d
er
ate
-
to
-
s
ev
er
e
l
o
ad
.
T
h
is
co
u
ld
b
e
d
u
e
to
a
h
ig
h
er
in
ter
ac
tio
n
d
u
r
atio
n
ea
ch
d
ay
(
>
1
2
h
)
th
an
r
ep
o
r
ted
in
t
h
is
s
tu
d
y
,
an
d
th
e
v
alu
e
o
f
tak
in
g
ca
r
e
o
f
th
e
f
am
ily
is
a
n
atu
r
al
co
n
d
itio
n
i
n
I
n
d
o
n
e
s
ia.
C
lo
s
e
r
elatio
n
s
h
ip
s
am
o
n
g
ex
ten
d
ed
f
am
ily
m
em
b
er
s
in
I
n
d
o
n
esia
m
a
y
r
ed
u
ce
th
e
s
tr
ess
o
n
ca
r
etak
er
s
[
2
3
]
.
Oth
er
r
esear
ch
h
as
f
o
u
n
d
t
h
at
th
e
m
ain
d
o
m
ain
o
f
ca
r
e
g
iv
er
b
u
r
d
en
in
af
f
lu
e
n
t
co
u
n
tr
ies
is
ti
m
e
-
d
ep
en
d
en
t
[
3
]
,
[
2
4
]
.
T
h
e
d
u
r
atio
n
o
f
d
aily
en
g
ag
em
e
n
t
b
etwe
en
ca
r
eg
i
v
er
s
an
d
p
eo
p
le
with
SC
I
h
ad
a
s
u
b
s
tan
tial
im
p
ac
t
o
n
ca
r
e
g
iv
er
b
u
r
d
en
.
T
h
e
m
ajo
r
ity
o
f
ca
r
etag
iv
er
s
wer
e
in
th
eir
p
r
o
d
u
ctiv
e
y
ea
r
s
,
wi
th
a
m
ea
n
ag
e
o
f
4
0
.
7
±
1
1
.
2
y
ea
r
s
.
B
y
p
r
o
v
id
in
g
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
Un
r
a
ve
lin
g
s
p
in
a
l c
o
r
d
i
n
ju
r
y
ca
r
eg
iver b
u
r
d
en
in
I
n
d
o
n
esia
(
V
itr
ia
n
a
B
ib
en
)
1637
lo
n
g
-
ter
m
ca
r
e,
ev
en
life
lo
n
g
ass
is
tan
ce
m
ig
h
t
in
ter
f
er
e
with
th
e
ca
r
e
g
iv
er
'
s
d
aily
ac
tiv
ities
an
d
life
s
ty
le,
in
cr
ea
s
in
g
m
u
ltip
le
r
esp
o
n
s
ib
ilit
ies
co
n
f
lict,
lim
it
in
g
th
eir
s
o
cial
ac
tiv
ities
,
an
d
in
cr
ea
s
i
n
g
th
eir
lo
ad
[
2
5
]
,
[
2
6
]
.
T
h
e
ca
r
e
g
iv
er
'
s
b
u
r
d
en
g
r
o
ws in
p
r
o
p
o
r
tio
n
to
th
e
a
m
o
u
n
t o
f
tim
e
s
p
e
n
t p
r
o
v
id
in
g
ca
r
e
[
7
]
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
in
d
iv
id
u
als with
s
p
in
al
co
r
d
i
n
ju
r
y
an
d
ca
r
eg
iv
er
s
Ch
a
rac
t
er
i
s
t
i
c
s
SCI
i
n
d
i
v
i
d
u
a
l
s
(
n
=
1
3
7
)
Care
g
i
v
e
rs
(
n
=
1
3
7
)
G
en
d
er,
n
(
%
)
Mal
e
6
6
(
4
8
.
2
)
4
3
(
3
1
.
4
)
Fema
l
e
7
1
(
5
1
.
8
)
9
4
(
6
8
.
6
)
A
g
e
(
y
e
ar
s
),
mea
n
(S
D
),
ra
n
g
e
4
3
.
7
(
1
4
.
6
),
1
9
-
69
4
0
.
7
(
1
1
.
2
),
2
1
-
67
O
cc
u
p
a
t
i
o
n
,
n
(
%
)
W
o
r
k
i
n
g
3
9
(
2
8
.
5
)
4
7
(
3
4
.
3
)
N
o
t
w
o
r
k
i
n
g
9
8
(
7
1
.
5
)
9
0
(
6
5
.
7
)
E
d
u
cat
i
o
n
,
n
(
%
)
E
l
eme
n
t
ar
y
s
c
h
o
o
l
1
6
(
1
1
.
7
)
7
(
5
.
1
)
J
u
n
i
o
r
h
i
g
h
s
c
h
o
o
l
3
8
(
2
7
.
7
)
4
5
(
3
2
.
8
)
Sen
i
o
r
h
i
g
h
s
c
h
o
o
l
8
1
(
5
9
.
1
)
8
4
(
6
1
.
3
)
Bac
h
el
o
r
/
D
i
p
l
o
ma
2
(
1
.
5
)
1
(
0
.
7
)
Mar
i
t
a
l
s
t
a
t
u
s
,
n
(
%
)
Marr
i
e
d
1
1
6
(
8
4
.
7
)
1
3
0
(
9
4
.
9
)
Si
n
g
l
e
1
9
(
1
3
.
9
)
8
(
5
.
1
)
W
i
d
o
w
/
w
i
d
o
w
er
2
(
1
.
5
)
0
(
0
)
H
ea
l
t
h
i
n
s
u
ra
n
ce
,
n
(
%
)
H
a
s
h
ea
l
t
h
i
n
s
u
ra
n
ce
1
3
7
(
1
0
0
)
N
o
h
ea
l
t
h
i
n
s
u
ra
n
ce
0
(
0
)
L
e
v
e
l
o
f
i
n
j
u
r
y
,
n
(
%
)
Para
p
l
eg
i
c
1
2
1
(
8
8
.
3
)
T
e
t
ra
p
l
e
g
i
c
1
6
(
1
1
.
7
)
A
SI
A
cl
as
s
i
fi
ca
t
i
o
n
,
n
(
%
)
A
IS
A
3
5
(
2
5
.
5
)
A
IS
B
1
4
(
1
0
.
2
)
A
IS
C
3
4
(
2
4
.
8
)
A
IS
D
5
3
(
3
8
.
7
)
A
IS
N
D
(
n
o
t
d
e
t
e
rm
i
n
ed
)
1
(
0
.
7
)
E
t
i
o
l
o
g
y
,
n
(
%
)
T
ra
u
m
at
i
c
3
8
(
2
7
.
7
)
N
o
n
t
ra
u
mat
i
c
9
9
(
7
2
.
3
)
D
u
ra
t
i
o
n
o
f
SCI
(m
o
n
t
h
s
),
me
an
(S
D
)
,
r
an
g
e
1
3
.
4
(
8
.
4
)
,
3
-
60
Rel
a
t
i
o
n
s
h
i
p
s
t
a
t
u
s
,
n
(
%
)
Pare
n
t
2
0
(
1
4
.
6
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Ch
i
l
d
2
8
(
2
0
.
4
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Si
b
l
i
n
g
2
(
1
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5
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Sp
o
u
s
e
8
6
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6
2
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8
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O
t
h
er
1
(
0
.
7
)
Care
g
i
v
i
n
g
d
u
r
at
i
o
n
(m
o
n
t
h
s
),
me
an
(S
D
),
ra
n
g
e
In
t
era
ct
i
o
n
d
u
r
at
i
o
n
i
n
a
d
a
y
(
h
)
,
m
ea
n
(
SD
)
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ra
n
g
e
1
3
.
4
(
8
.
3
)
,
3
-
60
7
.
7
(
2
.
8
)
,
4
-
20
Care
g
i
v
e
r
b
u
rd
en
s
co
re
Med
i
a
n
3
4
Ran
g
e
1
7
-
62
Care
g
i
v
e
r
b
u
rd
en
c
l
a
s
s
i
f
i
ca
t
i
o
n
,
n
(
%
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L
i
t
t
l
e
o
r
n
o
b
u
r
d
e
n
(6
.
6
)
Mi
l
d
t
o
m
o
d
era
t
e
7
5
(
5
4
.
7
)
Mo
d
er
at
e
t
o
s
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ere
4
9
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3
5
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Sev
ere
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)
A
meric
a
n
sp
i
n
a
l
i
n
j
u
r
y
a
ss
o
c
i
a
t
i
o
n
(
A
S
I
A
)
;
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meric
a
n
sp
i
n
a
l
i
n
j
u
r
y
a
ss
o
c
i
a
t
i
o
n
i
mp
a
i
r
m
e
n
t
s
c
a
l
e
c
l
a
ssi
f
i
c
a
t
i
o
n
(
A
I
S
)
;
sp
i
n
a
l
c
o
r
d
i
n
j
u
r
y
(
S
C
I
)
;
Za
r
i
t
B
u
r
d
e
n
I
n
t
e
r
v
i
e
w
(
Z
B
I
)
.
T
ab
le
2
.
Qu
ality
o
f
life
s
co
r
e
i
n
ca
r
eg
iv
e
r
s
V
ar
i
a
b
l
e
Mea
n
(S
D
)
Med
i
a
n
Ran
g
e
Care
g
i
v
e
r
q
u
al
i
t
y
o
f
l
i
f
e
s
c
o
re
(
W
H
O
Q
o
L
-
B
RE
F)
5
0
.
4
5
(
8
.
6
2
)
49
35
-
71
W
H
O
Q
o
L
-
BR
E
F,
W
o
rl
d
H
eal
t
h
O
r
g
a
n
i
zat
i
o
n
Q
u
al
i
t
y
o
f
L
i
f
e
-
B
RI
E
F
T
ab
le
3
.
T
h
e
ef
f
ec
t
o
f
in
d
ep
en
d
en
t v
ar
iab
les to
ca
r
eg
iv
er
b
u
r
d
en
Su
m
o
f
s
q
u
a
re
s
df
Mea
n
s
q
u
a
re
F
Si
g
.
Reg
res
s
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o
n
re
s
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d
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a
l
t
o
t
a
l
1
2
0
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5
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9
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0
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7
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3
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4
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3
1
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6
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N
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t
e
:
d
f
,
d
e
g
r
e
e
o
f
f
r
e
e
d
o
m;
F
,
F
r
a
t
i
o
:
S
i
g
,
si
g
n
i
f
i
c
a
n
c
e
.
T
ab
le
4
.
L
in
ea
r
r
eg
r
ess
io
n
an
a
ly
s
is
o
f
f
ac
to
r
s
in
f
lu
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ca
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co
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V
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a
b
l
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e
r
b
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res
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o
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c
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eff
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n
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s
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p
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v
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l
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e
O
cc
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p
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t
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o
n
a
l
s
t
at
u
s
o
f
SCI
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n
d
i
v
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d
u
a
l
s
-
4
.
4
4
5
2
.
1
5
7
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L
e
v
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l
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f
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j
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6
6
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ra
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n
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(
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Evaluation Warning : The document was created with Spire.PDF for Python.
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I
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4
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Dec
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b
er
20
24
:
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3
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40
1638
T
ab
le
5
.
C
o
r
r
elatio
n
an
aly
s
is
b
etwe
en
ca
r
eg
iv
e
r
b
u
r
d
en
s
co
r
e
an
d
ca
r
e
g
iv
er
q
u
ality
o
f
life
s
co
r
e
V
a
r
i
a
b
l
e
C
o
r
r
e
l
a
t
i
o
n
r
p
-
v
a
l
u
e
C
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
sco
r
e
a
n
d
c
a
r
e
g
i
v
e
r
q
u
a
l
i
t
y
o
f
l
i
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e
sc
o
r
e
S
p
e
a
r
m
a
n
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7
5
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o
t
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a
l
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0
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5
:
st
a
t
i
st
i
c
a
l
l
y
si
g
n
i
f
i
c
a
n
t
;
r
:
c
o
r
r
e
l
a
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
.
T
h
e
f
in
an
cial
b
u
r
d
e
n
is
in
cr
ea
s
in
g
,
wh
ich
m
ay
b
e
ca
u
s
ed
b
y
th
e
I
n
d
o
n
esian
h
ea
lth
s
y
s
tem
its
elf
.
T
h
e
s
y
s
tem
n
o
w
co
n
s
is
ts
o
f
p
u
b
lic
an
d
p
r
iv
ate
p
r
o
v
i
d
er
s
an
d
f
in
an
cin
g
[
2
7
]
,
[
2
8
]
.
T
h
e
o
n
l
y
s
tu
d
y
ab
o
u
t
th
is
s
y
s
tem
s
h
o
wed
th
at
th
e
g
o
v
er
n
m
en
t
s
h
ar
e
o
f
to
tal
h
ea
lth
ex
p
en
d
itu
r
e
also
r
em
ain
s
l
o
w,
at
o
n
ly
3
9
%,
w
h
er
ea
s
p
r
iv
ate,
p
r
im
a
r
ily
o
u
t
-
of
-
p
o
ck
et
ex
p
en
d
itu
r
e
,
is
6
0
%.
T
h
e
I
n
d
o
n
esian
g
o
v
er
n
m
en
t
h
as
im
p
lem
en
ted
d
if
f
e
r
en
t
h
ea
lth
-
ca
r
e
s
o
cial
in
s
u
r
an
ce
s
y
s
tem
s
,
alth
o
u
g
h
th
e
em
p
h
asis
is
o
n
cu
r
ativ
e
ca
r
e
s
er
v
ices
an
d
h
ea
lth
in
f
r
astru
ctu
r
e
th
at
s
u
p
p
o
r
ts
m
ed
ical
ca
r
e
[
2
9
]
,
[
30
]
.
T
h
is
m
ea
n
s
th
at
ca
r
in
g
f
o
r
SC
I
p
atien
ts
at
h
o
m
e
n
ee
d
s
o
th
er
ec
o
n
o
m
ic
s
u
p
p
o
r
t
s
o
u
r
ce
s
.
E
v
en
if
r
eh
ab
ilit
atio
n
s
er
v
ices
ar
e
c
o
v
er
e
d
b
y
s
o
cial
in
s
u
r
an
ce
,
tr
an
s
p
o
r
tatio
n
t
o
d
is
tan
t
h
ea
lth
f
ac
ilit
ies
ca
u
s
es
o
th
er
f
in
an
ci
al
b
u
r
d
e
n
s
f
o
r
th
e
ca
r
e
g
iv
er
[
31
]
,
[
32
]
,
[
3
3
]
.
T
h
is
s
tu
d
y
s
h
o
wed
th
at
h
ea
lth
in
s
u
r
an
ce
h
ad
n
o
s
tatis
tical
ly
s
i
g
n
if
ican
t
ef
f
ec
t
o
n
ca
r
e
g
iv
er
b
u
r
d
e
n
s
co
r
es.
T
h
is
m
ig
h
t
b
e
b
ec
au
s
e
ca
r
eg
iv
er
s
s
h
o
u
ld
s
till
f
u
n
d
th
e
ad
d
itio
n
al
co
s
ts
a
s
s
o
ciate
d
w
ith
p
r
o
v
id
in
g
ca
r
e,
s
u
ch
as
tr
an
s
p
o
r
tatio
n
,
o
v
e
r
-
th
e
-
c
o
u
n
t
er
m
ed
icatio
n
s
,
an
d
m
ed
ical
e
q
u
ip
m
en
t
th
at
is
n
o
t
co
v
er
ed
b
y
h
ea
lth
in
s
u
r
a
n
ce
[
34
]
.
T
o
f
u
lf
ill
t
h
eir
n
u
m
er
o
u
s
co
m
p
le
x
task
s
,
ca
r
eg
iv
er
s
in
I
n
d
o
n
esia
r
eq
u
ir
e
s
u
p
p
o
r
t.
T
h
ese
in
v
o
lv
e
p
lan
n
in
g
a
n
d
p
r
o
v
i
d
in
g
h
a
n
d
s
-
o
n
ca
r
e,
k
ee
p
in
g
tr
ac
k
o
f
an
d
m
an
a
g
in
g
s
y
m
p
to
m
s
,
p
r
o
v
id
in
g
e
m
o
tio
n
a
l
s
u
p
p
o
r
t,
tak
i
n
g
ca
r
e
o
f
an
d
i
n
ter
ac
tin
g
with
th
e
lar
g
e
r
f
a
m
ily
,
ac
ce
s
s
in
g
r
eso
u
r
ce
s
an
d
m
an
ag
in
g
f
in
an
ce
s
,
ac
tin
g
as
th
e
p
atien
t'
s
ad
v
o
ca
te,
n
av
ig
atin
g
th
e
h
ea
lth
ca
r
e
s
y
s
tem
,
as
well
as
p
r
ep
ar
i
n
g
f
o
r
an
u
n
ce
r
tain
f
u
tu
r
e
[
35
].
T
h
e
lim
itatio
n
s
o
f
t
h
is
s
tu
d
y
wer
e
th
at
it
was
co
n
d
u
cted
with
in
a
s
m
all
g
r
o
u
p
at
o
n
e
lo
ca
tio
n
;
th
er
ef
o
r
e,
th
e
s
tu
d
y
’
s
r
esu
lts
co
u
ld
n
o
t
b
e
a
p
p
lied
to
th
e
o
v
e
r
all
p
o
p
u
latio
n
in
I
n
d
o
n
esia.
F
u
r
th
er
m
o
r
e,
we
d
id
n
o
t
co
n
s
id
er
o
t
h
er
f
ac
to
r
s
p
r
e
d
icted
to
af
f
ec
t
th
e
ca
r
e
g
iv
er
b
u
r
d
e
n
,
s
u
ch
as
m
ed
ical
r
eh
a
b
ilit
atio
n
p
r
o
g
r
am
s
;
th
e
ca
r
eg
iv
er
’
s
k
n
o
wled
g
e,
s
k
ills
,
h
ea
lth
p
r
o
b
lem
s
,
an
d
c
o
p
in
g
m
ec
h
an
is
m
s
;
s
o
cial
s
u
p
p
o
r
t;
an
d
k
in
s
h
ip
r
elatio
n
s
h
ip
s
with
in
d
iv
id
u
al
s
with
SC
I
.
As
a
r
esu
lt,
m
o
r
e
r
esear
ch
in
t
o
th
e
ass
o
ciat
io
n
b
etwe
en
t
h
ese
v
ar
iab
les an
d
ca
r
e
g
iv
er
l
o
ad
is
r
eq
u
ir
e
d
.
4.
CO
NCLU
SI
O
N
T
h
e
ca
r
eg
iv
er
b
u
r
d
en
ca
n
be
i
n
f
lu
en
ce
d
b
y
s
o
m
e
f
ac
to
r
s
.
T
h
is
s
tu
d
y
s
h
o
wed
th
e
o
cc
u
p
ati
o
n
al
s
tatu
s
o
f
in
d
iv
id
u
als
with
S
C
I
an
d
th
e
d
u
r
atio
n
o
f
in
ter
ac
tio
n
p
er
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"
Th
e
As
so
c
iatio
n
o
f
Vitam
in
D
S
e
ru
m
S
tat
u
s
a
n
d
Vitam
in
D
Re
c
e
p
to
r
G
e
n
e
s
P
o
ly
m
o
r
p
h
ism
with
sa
rc
o
p
e
n
ia
in
In
d
o
n
e
sia
Co
m
m
u
n
it
y
-
Dw
e
ll
i
n
g
El
d
e
rl
y
.
"
S
h
e
is
a
lso
th
e
He
a
d
o
f
t
h
e
P
M
R
De
p
a
rtme
n
t
a
t
Dr.
Ha
sa
n
S
a
d
i
k
in
Ho
sp
it
a
l
Ba
n
d
u
n
g
a
n
d
h
a
s
b
e
e
n
a
c
o
n
su
l
tan
t
f
o
r
Ne
u
ro
m
u
sc
u
lar
Re
h
a
b
il
it
a
t
io
n
.
He
r
re
se
a
rc
h
in
tere
sts
in
c
lu
d
e
d
y
s
p
h
a
g
ia
re
h
a
b
il
it
a
ti
o
n
,
stro
k
e
re
h
a
b
il
it
a
ti
o
n
,
a
n
d
q
u
a
li
ty
o
f
l
ife.
S
h
e
i
s
a
P
M
R
I
n
d
o
n
e
sia
C
o
ll
e
g
i
u
m
c
o
m
m
it
tee
m
e
m
b
e
r,
se
c
re
tary
o
f
th
e
F
a
c
u
lt
y
S
e
n
a
te,
a
u
t
h
o
r
o
f
se
v
e
ra
l
in
tern
a
ti
o
n
a
l
p
e
e
r
-
re
v
iew
e
d
p
u
b
li
c
a
ti
o
n
s
a
n
d
e
d
it
o
r
o
f
Ne
u
ro
Re
h
a
b
il
it
a
ti
o
n
Jo
u
r
n
a
l
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
v
it
rian
a
@u
n
p
a
d
.
a
c
.
id
.
No
v
itri
S
u
m
a
r
d
i
is
a
p
h
y
sia
tr
ist
wh
o
g
ra
d
u
a
ted
i
n
2
0
0
8
fro
m
t
h
e
Un
i
v
e
rsity
o
f
In
d
o
n
e
sia
.
Cu
rre
n
tl
y
wo
r
k
in
g
a
s
m
e
d
ica
l
sta
ff
a
t
th
e
m
a
in
tea
c
h
in
g
h
o
sp
i
tal
in
Wes
t
Ja
v
a
p
ro
v
in
c
e
a
s
o
n
e
o
f
t
h
e
m
a
in
re
fe
rra
l
h
o
sp
it
a
ls.
He
r
m
a
in
in
tere
st
is
n
e
u
ro
re
h
a
b
il
it
a
ti
o
n
wit
h
tec
h
n
o
l
o
g
y
d
e
v
e
lo
p
m
e
n
t
in
c
l
u
d
i
n
g
g
a
it
a
n
a
ly
sis
a
n
d
r
o
b
o
ti
c
r
e
h
a
b
il
it
a
ti
o
n
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
o
v
i
tri
@u
n
p
a
d
.
a
c
.
id
.
Ar
y
a
Wij
a
y
a
is
a
p
h
y
sia
tri
st
a
t
th
e
In
d
ra
m
a
y
u
d
istri
c
t
g
e
n
e
ra
l
h
o
sp
i
tal.
He
is
a
g
ra
d
u
a
te
o
f
t
h
e
P
h
y
sic
a
l
M
e
d
ici
n
e
a
n
d
Re
h
a
b
il
i
tatio
n
(P
M
R)
m
e
d
ica
l
e
d
u
c
a
ti
o
n
p
ro
g
ra
m
a
t
P
a
d
jad
jara
n
Un
i
v
e
rsity
,
Ba
n
d
u
n
g
,
In
d
o
n
e
sia
.
He
is
a
n
a
d
m
in
istrato
r
o
f
th
e
In
d
o
n
e
sia
n
As
so
c
iatio
n
o
f
P
M
R
in
Wes
t
Ja
v
a
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
ry
a
ra
y
5
0
0
0
@
g
m
a
il
.
c
o
m
.
S
e
p
ta
n
i
a
Elfi
r
a
S
im
a
tu
p
a
n
g
is
a
p
h
y
sia
tri
st
a
t
t
h
e
Ka
li
d
e
re
s
d
istri
c
t
g
e
n
e
ra
l
h
o
sp
i
tal
in
Ja
k
a
rta.
S
h
e
is
a
g
ra
d
u
a
te
o
f
th
e
P
h
y
sic
a
l
M
e
d
icin
e
a
n
d
Re
h
a
b
il
i
tatio
n
(P
M
R)
m
e
d
ica
l
e
d
u
c
a
ti
o
n
p
ro
g
ra
m
a
t
P
a
d
jad
jara
n
Un
iv
e
rsity
,
Ba
n
d
u
n
g
,
In
d
o
n
e
sia
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
se
p
tan
ia
1
8
0
0
1
@m
a
il
.
u
n
p
a
d
.
a
c
.
id
.
S
itti
Ay
u
H
e
m
a
s
Nur
a
r
ifa
h
is
a
g
e
n
e
ra
l
p
ra
c
ti
ti
o
n
e
r
a
t
P
h
y
si
c
a
l
M
e
d
icin
e
a
n
d
Re
h
a
b
il
it
a
ti
o
n
(P
M
R)
P
a
d
ja
d
jar
a
n
Un
iv
e
rsit
y
,
Ba
n
d
u
n
g
,
In
d
o
n
e
sia
.
He
r
m
a
in
in
tere
st
is
n
e
u
ro
re
h
a
b
il
it
a
ti
o
n
a
n
d
p
a
i
n
m
a
n
a
g
e
m
e
n
t.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
y
u
h
e
m
a
s@
g
m
a
il
.
c
o
m
.
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