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W
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v
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W
P
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h
a
s
b
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m
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a
g
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b
a
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y
a
n
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te
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iate
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u
p
a
ti
o
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a
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d
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e
a
lt
h
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tco
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n
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e
,
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e
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s
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ter
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m
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p
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a
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y
h
e
a
lt
h
c
a
re
w
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e
r
s.
A
c
ro
ss
-
s
e
c
ti
o
n
a
l
stu
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a
m
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g
a
str
a
ti
f
ied
ra
n
d
o
m
sa
m
p
le
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f
8
3
8
p
rim
a
r
y
h
e
a
lt
h
c
a
r
e
w
o
rk
e
rs
(H
CW
)
f
ro
m
th
e
n
in
e
d
istr
ict
h
e
a
lt
h
o
f
f
ice
s
u
n
d
e
r
th
e
S
e
lan
g
o
r
sta
te
h
e
a
lt
h
d
e
p
a
rtm
e
n
t.
Tw
o
sta
n
d
a
rd
i
z
e
d
se
lf
-
a
d
m
in
istere
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q
u
e
stio
n
n
a
ires
w
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re
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se
d
t
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o
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tain
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a
ta
o
n
W
P
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n
d
OSC
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o
g
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re
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m
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ls
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se
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te
th
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ss
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e
n
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a
n
d
W
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re
v
a
len
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e
o
f
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P
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a
s
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5
%
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h
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re
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y
v
e
rb
a
l
a
b
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se
wa
s
th
e
m
o
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o
m
m
o
n
t
y
p
e
(6
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%
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ll
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w
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d
b
y
b
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ll
y
in
g
(2
7
%
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p
h
y
si
c
a
l
v
io
len
c
e
(6
%
)
a
n
d
se
x
u
a
l
h
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ra
ss
m
e
n
t
(2
%
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9
.
7
%
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w
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re
th
e
m
o
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ff
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c
ted
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y
W
P
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h
e
m
a
in
p
e
rp
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trato
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we
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re
lativ
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s
o
f
p
a
ti
e
n
ts
(3
8
%
).
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o
w
lev
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l
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f
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wa
s
a
lso
a
ss
o
c
iate
d
w
it
h
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V
(OR=
3
.
0
4
,
9
5
%
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1
.
4
5
-
6
.
4
1
).
T
h
e
re
su
lt
s
o
f
th
is
stu
d
y
c
o
n
f
ir
m
e
d
t
h
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t
sa
f
e
t
y
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li
m
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te
is
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ss
o
c
iate
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w
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n
c
e
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terv
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ti
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n
d
e
f
f
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rts
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re
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e
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t
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HCW
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u
ld
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lu
d
e
im
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ro
v
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g
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rg
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n
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n
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l
sa
fe
t
y
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c
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ate
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lace
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T
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C
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p
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A
uth
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r
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n
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Dep
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So
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Me
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Fac
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Un
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s
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p
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r
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ail:
s
u
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@
g
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W
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p
lace
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(
W
P
V)
is
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f
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in
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p
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s
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t
h
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ass
a
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m
s
tan
ce
s
r
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ated
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k
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i
n
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u
d
in
g
co
m
m
u
ti
n
g
to
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d
f
r
o
m
w
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r
k
,
in
v
o
l
v
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n
g
ex
p
lici
t
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im
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licit
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h
allen
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s
to
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s
af
et
y
,
w
ell
-
b
ein
g
o
r
h
ea
lth
[
1
]
,
[
2
]
.
W
P
V
is
b
r
o
ad
ly
ca
teg
o
r
ized
in
to
t
w
o
,
i.e
.
,
phy
s
ical
(
Slap
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p
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n
ch
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n
g
a
n
d
P
u
n
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h
i
n
g
an
d
p
s
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h
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s
y
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h
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g
ical
v
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l
en
ce
ca
n
f
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r
t
h
er
b
e
class
i
f
ied
in
to
v
er
b
al
ab
u
s
e,
b
u
ll
y
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n
g
an
d
h
ar
ass
m
e
n
t
s
(
r
ac
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an
d
s
ex
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a
l)
[
3
]
.
W
P
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ca
n
also
b
e
class
if
ied
b
ased
o
n
th
e
p
r
ep
ar
ato
r
s
.
T
y
p
e
1
is
v
io
len
ce
w
it
h
cr
i
m
in
al
in
ten
t
s
u
c
h
as
r
o
b
b
er
y
,
h
o
m
icid
e.
T
y
p
e
2
is
v
io
len
ce
ca
u
s
ed
b
y
clie
n
ts
,
i
n
th
ese
in
s
t
a
n
ce
p
atien
t
s
a
n
d
t
h
eir
r
elati
v
es.
T
y
p
e
3
is
b
ein
g
v
io
len
ce
d
a
m
o
n
g
co
lleag
u
e
s
a
n
d
s
u
p
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io
r
s
.
T
y
p
e
4
is
b
ei
n
g
p
er
s
o
n
al
r
elati
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n
s
h
ip
v
io
len
ce
d
s
p
illi
n
g
o
v
e
r
to
w
o
r
k
p
lace
[
4
]
.
W
P
V
h
as
b
ec
o
m
e
a
g
lo
b
al
s
af
et
y
a
n
d
h
ea
l
th
co
n
ce
r
n
in
r
ec
en
t
ti
m
e
s
p
ar
ticu
lar
l
y
in
th
e
h
ea
lt
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ca
r
e
s
ec
to
r
g
lo
b
all
y
a
s
w
ell
a
s
r
eg
io
n
al
l
y
[
5
]
–
[
7
]
.
Hea
lth
ca
r
e
w
o
r
k
e
r
s
(
HC
W
)
in
cl
u
d
e
p
h
y
s
icia
n
s
,
n
u
r
s
es,
m
ed
ical
ass
is
tan
t
s
,
allied
m
ed
ical
w
o
r
k
er
s
,
p
u
b
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h
ea
lt
h
w
o
r
k
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s
,
lab
o
r
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r
y
tec
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ician
s
,
p
h
ar
m
ac
is
ts
,
an
d
ad
m
in
i
s
tr
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v
e
s
taf
f
[
8
]
.
A
s
t
u
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y
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n
w
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k
p
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v
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a
m
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g
Ho
s
p
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at
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p
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[
9
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ter
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n
th
er
e
is
n
o
p
h
y
s
ical
i
n
j
u
r
y
[
1
4
]
.
R
ea
s
o
n
s
f
o
r
u
n
d
er
r
ep
o
r
tin
g
o
f
W
P
V
a
m
o
n
g
H
C
W
i
n
clu
d
e
lack
o
f
a
r
ep
o
r
tin
g
p
o
lic
y
,
lack
o
f
f
ait
h
i
n
th
e
r
ep
o
r
tin
g
s
y
s
te
m
,
an
d
f
ea
r
o
f
r
etalia
tio
n
b
y
s
u
p
er
io
r
s
[
1
5
]
.
Ho
w
e
v
er
,
a
g
r
o
w
i
n
g
b
o
d
y
o
f
r
esear
ch
h
as
id
en
tifie
d
th
at
W
P
V
f
r
o
m
b
o
th
p
atien
t
s
an
d
co
lleag
u
es
ar
e
s
ig
n
i
f
ica
n
tl
y
a
s
s
o
ciate
d
w
it
h
p
s
y
ch
o
lo
g
ical
il
l
-
h
ea
lt
h
t
h
at
i
s
as
s
o
ciate
d
w
it
h
h
ig
h
lev
el
s
o
f
a
n
x
iet
y
,
f
ea
r
,
p
o
s
t
-
tr
au
m
atic
s
tr
es
s
d
is
o
r
d
er
(
PT
SD)
,
d
ep
r
ess
io
n
,
an
d
d
ec
r
ea
s
ed
w
o
r
k
s
ati
s
f
ac
tio
n
[
4
]
.
B
esid
es
a
f
f
ec
t
in
g
a
n
i
n
d
iv
id
u
al,
W
P
V
also
af
f
ec
t
s
an
o
r
g
an
iza
tio
n
v
ia
in
cr
ea
s
ed
ab
s
en
teeis
m
,
lo
w
er
p
r
o
d
u
ctiv
i
t
y
,
an
d
f
r
eq
u
e
n
t li
tig
a
tio
n
[
1
6
]
.
An
ex
te
n
s
i
v
e
r
ev
ie
w
o
f
e
x
is
t
in
g
li
ter
atu
r
e
s
h
o
w
ed
th
at
s
t
u
d
ies
co
n
ce
r
n
i
n
g
W
P
V
h
av
e
p
r
im
ar
il
y
f
o
cu
s
ed
o
n
in
d
i
v
id
u
al
f
ac
to
r
s
,
u
n
d
er
t
h
e
h
y
p
o
th
es
is
t
h
at
o
c
cu
r
r
en
ce
o
f
v
io
le
n
ce
is
g
en
er
all
y
d
eter
m
i
n
ed
b
y
p
er
s
o
n
al
ch
ar
ac
ter
is
t
ics
[
1
7
]
.
Hen
ce
,
t
h
er
e
is
a
n
i
n
cr
ea
s
ed
n
ee
d
f
o
r
a
m
u
ltid
i
m
en
s
io
n
al
ap
p
r
o
ac
h
to
W
P
V
r
elate
d
r
esear
ch
[
4
]
,
[
1
8
]
.
T
h
e
I
n
ter
n
atio
n
al
L
ab
o
u
r
Or
g
an
iza
tio
n
(
I
L
O)
g
u
id
eli
n
es
f
o
r
d
ev
elo
p
in
g
co
m
p
r
e
h
en
s
iv
e
W
P
V
p
r
ev
en
t
io
n
m
ea
s
u
r
es
p
r
o
p
o
s
e
th
is
s
t
r
ateg
y
,
w
h
ich
i
n
cl
u
d
es
in
d
i
v
id
u
al
tr
ain
i
n
g
an
d
co
u
n
s
e
lli
n
g
as
w
ell
as
i
m
p
r
o
v
e
m
en
ts
in
s
a
f
et
y
an
d
h
ea
lt
h
-
r
e
lated
o
r
g
an
is
atio
n
a
l
cu
lt
u
r
e
as
w
ell
as
p
o
lic
y
[
1
9
]
.
Desp
ite
t
h
e
f
ac
t
th
a
t
o
r
g
an
i
s
atio
n
al
i
s
s
u
es
s
u
ch
a
s
u
n
d
er
s
taf
f
i
n
g
,
i
n
ad
eq
u
ate
s
u
p
er
v
is
o
r
s
u
p
p
o
r
t,
p
o
o
r
w
o
r
k
g
r
o
u
p
r
elatio
n
s
h
ip
s
,
a
n
d
j
o
b
o
v
er
lo
ad
h
av
e
b
ee
n
li
n
k
ed
to
in
cr
ea
s
ed
w
o
r
k
p
lace
v
io
le
n
ce
,
m
o
r
e
r
e
s
ea
r
ch
o
n
o
r
g
an
i
s
atio
n
al
s
af
et
y
f
ac
to
r
s
is
s
til
l
h
i
g
h
l
y
r
eq
u
ir
ed
[
4
]
.
On
e
o
f
t
h
e
m
ai
n
o
r
g
a
n
izatio
n
al
f
ac
to
r
af
f
ec
t
in
g
h
ea
lt
h
an
d
s
af
et
y
r
el
ated
o
u
tc
o
m
e
s
in
t
h
e
h
ea
lt
h
ca
r
e
en
v
ir
o
n
m
e
n
t
i
s
s
af
et
y
cli
m
ate
–
th
e
s
h
ar
ed
ass
es
s
m
en
t
s
o
f
s
af
et
y
p
o
licies,
p
r
o
ce
d
u
r
es,
an
d
p
r
ac
tices,
an
d
th
e
p
er
ce
p
tio
n
s
an
d
ex
p
ec
tatio
n
s
w
o
r
k
er
s
h
av
e
o
f
w
o
r
k
p
lace
s
af
et
y
[
2
0
]
.
T
h
e
co
n
ce
p
t
o
f
OSC
e
n
co
m
p
as
s
es
t
h
e
f
o
llo
w
i
n
g
:
m
an
a
g
e
m
en
t
an
d
o
r
g
a
n
izatio
n
a
l
p
r
ac
tices
(
ad
eq
u
ac
y
o
f
tr
ai
n
i
n
g
,
p
r
o
v
is
io
n
o
f
s
af
et
y
eq
u
ip
m
en
t,
q
u
alit
y
o
f
s
a
f
et
y
m
a
n
a
g
e
m
e
n
t
s
y
s
te
m
)
m
an
a
g
e
m
en
t
v
alu
e
s
(
m
a
n
a
g
e
m
en
t
co
n
ce
r
n
f
o
r
e
m
p
lo
y
ee
w
e
ll
-
b
ei
n
g
)
,
em
p
lo
y
ee
i
n
v
o
l
v
e
m
en
t
in
w
o
r
k
p
lace
h
ea
lt
h
a
n
d
s
af
et
y
a
s
w
el
l
as
e
m
p
lo
y
er
e
m
p
lo
y
ee
co
m
m
u
n
icatio
n
o
n
o
f
s
a
f
et
y
a
n
d
h
ea
lth
[
2
1
]
.
T
h
e
p
r
esen
ce
o
f
h
ig
h
s
af
et
y
cli
m
ate
le
v
els a
s
b
ee
n
li
n
k
ed
to
a
r
ed
u
ctio
n
i
n
o
cc
u
p
at
io
n
all
y
r
elate
d
h
ea
lth
h
az
ar
d
s
[
2
2
]
.
Hen
ce
,
th
e
o
b
j
ec
tiv
e
o
f
t
h
is
s
tu
d
y
to
es
ti
m
ate
th
e
p
r
ev
alen
ce
o
f
W
P
V
in
r
elatio
n
to
s
o
cio
-
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tic,
j
o
b
ch
ar
ac
ter
is
tics
a
n
d
OSC
r
is
k
f
ac
to
r
s
a
m
o
n
g
p
r
i
m
ar
y
h
ea
lth
ca
r
e
w
o
r
k
er
s
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n,
s
t
ud
y
lo
ca
t
io
n a
nd
s
a
m
pli
ng
T
h
i
s
w
as
a
c
r
o
s
s
-
s
e
c
t
i
o
n
al
s
tu
d
y
c
o
n
d
u
c
t
e
d
am
o
n
g
H
C
W
a
t
g
o
v
e
r
n
m
en
t
p
r
im
a
r
y
h
ea
l
th
c
a
r
e
f
a
ci
l
it
i
es
in
th
e
s
t
a
t
e
o
f
S
el
an
g
o
r
,
M
a
l
ay
s
ia
.
S
e
la
n
g
o
r
h
as
a
p
o
p
u
la
t
i
o
n
o
f
6
.
5
3
m
il
l
i
o
n
an
d
i
s
th
e
m
o
s
t
p
o
p
u
l
a
te
d
s
t
a
t
e
in
M
a
l
ay
s
i
a
.
T
h
e
g
o
v
e
r
n
m
en
t
p
r
im
a
r
y
h
e
a
l
th
ca
r
e
f
ac
i
l
it
i
es
l
o
c
at
e
d
i
n
th
e
n
in
e
d
i
s
t
r
i
c
ts
in
S
ela
n
g
o
r
r
e
c
e
iv
es
t
h
e
h
ig
h
es
t
p
a
ti
en
t
v
i
s
it
in
M
a
l
ay
s
i
a
.
S
tu
d
y
p
a
r
t
i
ci
p
an
ts
w
e
r
e
s
e
l
ec
t
e
d
f
r
o
m
th
e
n
in
e
d
is
t
r
ic
t
s
i
n
S
el
an
g
o
r
v
ia
p
r
o
p
o
r
t
i
o
n
a
t
e
s
t
r
a
t
if
i
e
d
r
a
n
d
o
m
s
am
p
l
in
g
m
et
h
o
d
.
T
h
e
in
c
lu
s
i
o
n
c
r
i
t
e
r
ia
w
e
r
e
M
a
l
ay
s
i
an
ci
t
i
z
en
,
ag
e
d
b
e
tw
e
en
2
1
a
n
d
6
0
y
ea
r
s
o
l
d
.
B
e
s
i
d
es
th
a
t
,
p
a
r
ti
c
i
p
an
ts
m
u
s
t
h
av
e
h
ad
a
t
l
e
a
s
t
o
n
e
y
e
a
r
o
f
w
o
r
k
in
g
e
x
p
e
r
i
en
ce
i
n
o
n
e
o
f
t
h
e
g
o
v
e
r
n
m
en
t
d
i
s
t
r
i
c
t
h
e
a
lth
f
a
c
i
li
t
i
es
in
S
e
la
n
g
o
r
.
C
o
n
tr
a
c
t
w
o
r
k
e
r
s
,
p
a
r
t
-
t
im
e
w
o
r
k
e
r
s
a
n
d
a
tt
a
ch
m
en
t
s
tu
d
en
ts
w
e
r
e
ex
c
lu
d
e
d
.
I
n
a
d
d
i
t
i
o
n
,
p
a
r
t
i
c
i
p
an
t
s
w
e
r
e
a
ls
o
r
a
n
d
o
m
ly
s
el
e
c
te
d
f
r
o
m
th
e
em
p
l
o
y
e
e
li
s
t
p
r
o
v
i
d
e
d
b
y
th
e
d
is
t
r
i
ct
h
e
a
lt
h
d
e
p
a
r
tm
en
ts
u
s
i
n
g
S
PS
S
S
t
at
i
s
t
i
cs
s
o
f
tw
a
r
e
E
d
i
t
i
o
n
2
4
.
T
o
e
n
s
u
r
e
an
a
d
e
q
u
a
t
e
s
am
p
l
e
s
i
z
e
a
n
d
p
o
w
er
o
f
th
e
s
tu
d
y
,
th
e
c
o
n
f
i
d
en
ce
in
t
e
r
v
al
(
C
I
)
w
as
s
e
t
at
9
5
%
,
a
n
a
l
p
h
a
(
α
)
o
f
5
%
an
d
8
0
%
p
o
w
e
r
o
f
s
tu
d
y
.
H
en
ce
,
s
am
p
l
e
s
i
z
e
w
as
d
e
t
e
r
m
in
e
d
b
y
tw
o
m
e
a
n
s
,
o
n
e
b
y
u
s
i
n
g
p
o
p
u
l
a
t
i
o
n
s
u
r
v
ey
s
in
s
im
il
a
r
p
r
e
v
i
o
u
s
s
tu
d
i
es
an
d
u
s
in
g
th
e
m
ea
s
u
r
e
o
f
a
s
s
o
c
ia
t
i
o
n
[
1
]
,
[
2
]
.
B
a
s
e
d
o
n
th
e
s
am
p
l
e
s
i
z
e
c
al
cu
l
a
ti
o
n
a
b
o
v
e
,
t
h
e
la
r
g
es
t
s
am
p
l
e
s
i
z
e
r
e
q
u
i
r
e
d
f
o
r
th
is
s
tu
d
y
is
5
3
0
.
G
i
v
en
an
e
s
t
im
a
te
d
5
3
-
9
1
%
r
e
s
p
o
n
s
e
r
a
te
[
1
]
–
[
3
]
,
a
m
i
n
im
u
m
o
f
1
,
0
0
0
[
(
1
0
0
÷
5
3
)
x
5
3
0
=
1
,
0
0
0
]
q
u
e
s
ti
o
n
n
ai
r
e
s
w
e
r
e
d
i
s
t
r
i
b
u
te
d
.
T
h
i
s
s
tu
d
y
a
d
h
e
r
e
d
t
o
th
e
H
e
ls
in
k
i
D
e
c
l
a
r
at
i
o
n
s
[
2
3
]
w
h
ich
r
e
q
u
i
r
e
s
a
p
r
o
t
o
c
o
l
ex
p
l
a
in
in
g
t
h
e
s
tu
d
y
'
s
g
o
al
s
,
d
at
a
c
o
l
l
e
c
ti
o
n
t
e
ch
n
i
q
u
es
,
d
a
t
a
u
s
es
,
a
n
d
p
a
r
t
i
ci
p
a
n
t
p
r
i
v
ac
y
g
u
a
r
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6
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iii
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2
6
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.
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8
7
[
26]
.
A
p
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2
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2
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3
.
St
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B
M
SP
SS
Statis
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Ver
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2
4
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t
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RE
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S AN
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ict
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r
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eir
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J
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Hea
lth
Sci
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2252
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8806
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u
p
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me
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:
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r
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d
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g
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a
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e
r
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.
11
,
No
.
1
,
M
ar
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20
22
:
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.
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re
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4
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8
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5
%)
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p
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ticip
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ts
s
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id
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e
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p
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s
ed
to
at
least
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n
e
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f
th
e
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teg
o
r
ies
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T
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11
,
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20
22
:
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p
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th
e
p
r
in
cip
le
ter
tiar
y
h
o
s
p
ital
i
n
Ma
la
y
s
ia
lo
ca
ted
at
th
e
h
e
ar
t
o
f
th
e
d
en
s
el
y
p
o
p
u
lated
Ku
ala
L
u
m
p
u
r
a
n
d
th
ese
f
ac
to
r
s
w
er
e
id
e
n
ti
f
ied
p
r
ev
io
u
s
l
y
to
b
e
s
i
g
n
i
f
i
ca
n
t
i
n
p
r
ed
icti
n
g
w
o
r
k
p
lace
v
io
le
n
ce
[
3
2
]
.
I
n
co
m
p
ar
is
o
n
to
t
h
e
HU
KM
s
tu
d
y
w
h
ic
h
o
b
s
er
v
ed
a
s
ig
n
if
ican
t
l
y
lo
w
er
p
r
ev
alen
ce
,
it
is
b
ec
au
s
e
th
a
t
s
tu
d
y
o
n
l
y
m
ea
s
u
r
ed
th
r
ee
m
o
n
th
s
p
r
ev
alen
ce
o
f
W
P
V
u
s
i
n
g
a
d
i
f
f
er
e
n
t
s
t
u
d
y
in
s
tr
u
m
en
t i
n
co
n
tr
ar
y
to
th
e
p
r
esen
t st
u
d
y
w
h
ic
h
m
ea
s
u
r
ed
o
n
e
-
y
ea
r
p
r
ev
alen
ce
.
T
h
e
m
o
s
t
co
m
m
o
n
t
y
p
e
W
P
V
o
b
s
er
v
ed
in
th
i
s
s
t
u
d
y
w
a
s
v
er
b
al
ab
u
s
e
(
6
5
%),
f
o
llo
w
ed
b
y
b
u
ll
y
i
n
g
(
2
7
%),
n
ex
t
w
as
p
h
y
s
ical
v
io
len
ce
(
6
%)
an
d
th
e
lea
s
t
co
m
m
o
n
b
ei
n
g
s
ex
u
al
h
ar
ass
m
e
n
t
(
2
%).
T
h
ese
r
esu
l
t
s
ar
e
s
i
m
ilar
w
it
h
m
u
ltip
le
o
th
er
s
tu
d
ies
[
3
3
]
,
[
3
4
]
.
Ver
b
al
ab
u
s
e
is
u
s
u
all
y
r
ep
o
r
ted
f
ar
m
o
r
e
co
m
m
o
n
th
a
n
o
th
er
s
b
ec
au
s
e
it
is
k
n
o
w
n
to
p
r
ec
e
d
e
s
u
b
s
eq
u
en
t
p
h
y
s
i
ca
l
v
io
len
ce
an
d
b
u
ll
y
in
g
.
T
h
e
m
o
s
t
co
m
m
o
n
p
er
p
etr
ato
r
s
o
f
W
P
V
w
er
e
r
el
ativ
es
f
o
llo
w
ed
b
y
p
atie
n
ts
,
c
o
lleag
u
e
s
,
s
u
p
er
io
r
s
an
d
p
u
b
li
c.
T
h
is
is
co
n
s
is
te
n
t
w
it
h
t
h
e
s
t
u
d
y
d
o
n
e
i
n
HK
L
as
w
ell
[
1
0
]
.
T
h
e
p
r
ev
alen
ce
o
f
w
o
r
k
p
la
ce
v
io
len
ce
w
a
s
h
i
g
h
er
in
h
ea
lth
ca
r
e
f
ac
ilit
ies
i
n
lar
g
er
d
is
tr
ict
s
(
6
5
.
8
%)
co
m
p
ar
ed
to
s
m
a
ller
d
is
tr
icts
(
3
4
.
2
%).
Ma
j
o
r
ity
o
f
v
io
le
n
t
i
n
cid
en
ts
o
cc
u
r
i
n
s
id
e
t
h
e
h
ea
lt
h
f
ac
ilit
y
co
m
p
ar
ed
to
o
u
ts
id
e
(
h
o
m
e
v
is
iti
n
g
,
co
m
m
u
t
in
g
to
an
d
f
r
o
m
w
o
r
k
)
.
T
h
is
i
s
d
u
e
to
t
h
e
b
i
g
g
er
wo
r
k
f
o
r
ce
in
b
ig
g
er
d
is
tr
icts
as
w
ell
a
s
th
e
d
en
s
it
y
o
f
p
atien
ts
a
n
d
p
atien
t
lo
ad
at
th
e
f
ac
i
liti
es
[
1
0
]
.
Mu
ltip
le
l
o
g
is
tic
r
eg
r
e
s
s
io
n
s
co
n
tr
o
llin
g
f
o
r
co
n
f
o
u
n
d
er
s
f
o
u
n
d
th
at
o
d
d
s
f
e
m
ale
s
h
a
v
e
a
h
ig
h
er
5
.
5
ti
m
es
o
d
d
s
o
f
r
ep
o
r
tin
g
ex
p
o
s
u
r
e
to
W
P
V
co
m
p
ar
ed
to
m
ale
s
.
T
h
is
f
i
n
d
in
g
is
s
i
m
ilar
to
o
th
er
s
t
u
d
ies
[
3
4
]
–
[
3
6
]
alth
o
u
g
h
m
u
lt
ip
le
o
t
h
er
s
tu
d
ies
d
o
r
ep
o
r
t
n
o
d
if
f
er
en
ce
i
n
th
e
p
r
ev
alen
ce
b
et
w
ee
n
m
ale
s
an
d
f
e
m
ales
[
9
]
,
[
1
0
]
.
Mo
s
t
s
tu
d
ies
r
ep
o
r
t
th
at
th
e
lo
w
er
th
e
ag
e
t
h
e
h
i
g
h
er
t
h
e
o
d
d
s
o
f
ex
p
er
i
en
ci
n
g
W
P
V
[
1
0
]
,
h
o
w
e
v
er
,
th
is
s
tu
d
y
i
t
w
a
s
n
o
te
d
th
e
m
id
d
le
-
a
g
ed
g
r
o
u
p
o
f
3
1
-
5
0
h
ad
h
ig
h
er
o
d
d
s
co
m
p
ar
ed
to
th
e
y
o
u
n
g
er
H
C
W
.
T
h
is
p
r
o
v
es
th
at
all
ag
e
g
r
o
u
p
ar
e
eq
u
all
y
at
r
is
k
o
f
W
P
V
in
-
ter
m
s
o
f
p
r
i
m
ar
y
h
ea
l
th
ca
r
e
s
etti
n
g
.
T
h
e
o
t
h
er
s
ig
n
i
f
ica
n
t
f
ac
t
o
r
s
w
er
e
r
ac
e
an
d
m
ar
ital sta
tu
s
,
o
d
d
s
w
er
e
h
i
g
h
er
a
m
o
n
g
C
h
i
n
ese
co
m
p
ar
ed
to
Ma
lay
s
a
n
d
b
ein
g
I
n
d
ian
w
as
a
p
r
o
tect
iv
e
f
ac
to
r
.
B
esid
es
d
iv
o
r
ce
es a
n
d
w
id
o
w
s
also
h
a
d
h
ig
h
er
o
d
d
s
co
m
p
ar
ed
to
s
in
g
le
HC
W
.
I
n
ter
m
s
o
f
w
o
r
k
-
r
elate
d
f
ac
t
o
r
s
,
th
e
s
ig
n
i
f
ica
n
t
f
ac
to
r
s
wh
ich
i
n
cr
ea
s
e
t
h
e
o
d
d
s
o
f
ex
p
er
ien
cin
g
W
P
V
af
ter
ad
j
u
s
t
m
e
n
t
w
er
e
w
o
r
k
i
n
g
in
lar
g
er
d
is
tr
ict
f
ac
il
ities
as
w
ell
as
w
o
r
k
in
g
w
it
h
≤
1
0
HC
W
d
u
r
in
g
a
n
o
r
m
al
w
o
r
k
i
n
g
h
o
u
r
.
P
r
o
f
ess
io
n
w
a
s
n
o
t
s
i
g
n
i
f
ican
t
alth
o
u
g
h
t
h
e
p
r
ev
alen
ce
w
a
s
h
i
g
h
am
o
n
g
n
u
r
s
e
s
.
I
n
th
e
Un
ited
States
,
lo
n
g
w
aiti
n
g
h
o
u
r
s
,
n
o
t
s
ati
s
f
ied
w
i
th
tr
ea
t
m
e
n
t,
u
n
d
er
s
taf
f
i
n
g
an
d
p
o
o
r
w
aiti
n
g
ar
ea
s
an
d
tr
ea
t
m
e
n
t
r
o
o
m
s
w
er
e
id
en
ti
f
i
ed
as
r
is
k
f
ac
to
r
s
o
f
W
P
V
a
m
o
n
g
HC
W
[
3
7
]
.
Sim
i
lar
l
y
,
i
n
Ma
la
y
s
ia
W
P
V
is
ex
p
lain
ed
b
y
lo
n
g
w
a
iti
n
g
p
er
io
d
o
f
m
o
r
e
t
h
an
2
0
m
i
n
u
tes
,
r
ef
u
s
al
o
f
r
ef
er
r
al
to
ter
t
iar
y
ce
n
tr
es,
p
er
s
i
s
te
n
t
an
d
u
n
tr
ea
ted
p
ain
,
p
atie
n
t
s
’
a
n
x
ie
t
y
an
d
m
is
u
n
d
er
s
tan
d
i
n
g
s
d
u
e
to
la
n
g
u
a
g
e
b
ar
r
ier
o
r
in
v
ie
w
o
f
d
if
f
er
e
n
ce
in
tr
ad
itio
n
,
o
r
u
n
co
n
d
u
ci
v
e
wo
r
k
en
v
ir
o
n
m
e
n
t
[
1
0
]
.
F
in
a
l
ly
,
in
t
e
r
m
s
o
f
OS
C
,
a
l
o
w
l
ev
el
o
f
s
af
e
ty
c
l
im
at
e
w
a
s
s
t
r
o
n
g
ly
ass
o
c
i
a
te
d
w
ith
h
ig
h
e
r
p
r
e
v
a
l
en
c
e
o
f
a
l
l
s
o
u
r
ce
s
o
f
v
e
r
b
al
a
b
u
s
e
.
W
h
i
l
e
d
if
f
e
r
en
c
es
in
th
e
a
s
s
ess
m
en
t
o
f
s
af
e
ty
c
lim
a
t
e
m
ay
ex
is
t
,
th
e
f
in
d
in
g
s
in
t
h
is
s
tu
d
y
a
r
e
c
o
n
s
i
s
t
en
t
w
i
th
p
r
e
v
i
o
u
s
ev
i
d
en
c
es
s
h
o
w
in
g
a
s
t
r
o
n
g
l
in
k
b
e
t
w
e
en
s
af
e
ty
c
l
im
a
t
e
f
a
c
t
o
r
s
an
d
w
o
r
k
-
r
e
l
at
e
d
i
n
ju
r
i
e
s
[
3
8
]
an
d
p
h
y
s
i
c
a
l
an
d
p
s
y
c
h
o
l
o
g
i
c
a
l
jo
b
a
b
u
s
e
[
3
9
]
.
I
n
a
s
tu
d
y
o
f
o
r
g
an
i
z
a
ti
o
n
al
d
e
t
e
r
m
in
an
t
s
o
f
s
af
e
ty
cl
im
a
te
i
n
n
u
r
s
in
g
h
o
m
es
,
a
m
o
r
e
p
o
s
i
t
iv
e
s
af
e
ty
c
lim
a
t
e
r
e
d
u
c
e
d
n
u
m
b
e
r
o
f
w
o
r
k
p
l
a
c
e
e
r
r
o
r
s
w
h
i
ch
l
ea
d
t
o
a
v
i
o
l
en
t
e
v
en
t
[
4
0
]
.
T
h
is
p
r
o
v
i
d
e
s
s
o
m
e
s
u
p
p
o
r
t
f
o
r
th
e
f
a
c
t
th
at
OS
C
w
e
r
e
s
ig
n
if
i
c
an
t
i
n
v
e
r
s
e
d
e
te
r
m
in
an
ts
o
f
W
PV
i
n
th
e
cu
r
r
en
t
s
tu
d
y
.
B
es
i
d
es
f
i
n
d
in
g
s
o
f
th
is
s
tu
d
y
is
al
s
o
in
l
in
e
w
i
th
p
r
ev
i
o
u
s
r
e
s
e
a
r
ch
in
a
p
s
y
ch
i
a
t
r
i
c
s
e
tt
i
n
g
b
y
I
s
ak
e
t
a
l
.
w
h
e
r
e
em
p
l
o
y
e
e
p
o
s
it
iv
e
p
e
r
c
e
p
t
i
o
n
s
o
f
m
an
ag
em
en
t
’
s
c
o
m
m
itm
en
t
t
o
s
a
f
e
ty
w
er
e
s
ig
n
if
ic
an
t
ly
a
s
s
o
c
i
at
e
d
w
ith
f
ew
e
r
p
a
t
i
en
t
p
e
r
p
e
t
r
a
t
e
d
a
g
g
r
ess
iv
e
in
c
i
d
en
ts
[
4
1
]
.
I
n
a
d
d
i
t
i
o
n
,
th
e
i
r
s
tu
d
y
w
a
s
d
o
n
e
i
n
a
v
e
r
y
h
ig
h
-
r
i
s
k
en
v
i
r
o
n
m
en
t
w
h
e
r
e
l
ik
el
ih
o
o
d
o
f
a
v
i
o
l
en
t
i
n
ci
d
e
n
t
o
c
cu
r
r
in
g
i
s
h
ig
h
.
Po
s
i
t
iv
e
c
l
im
at
e
r
at
in
g
s
f
o
r
v
i
o
l
en
c
e
p
r
e
v
e
n
t
i
o
n
in
d
ica
t
e
d
a
l
o
w
e
r
r
is
k
o
f
b
e
in
g
ex
p
o
s
e
d
t
o
v
i
o
l
en
c
e
o
v
e
r
t
h
e
c
o
u
r
s
e
o
f
s
ix
m
o
n
th
s
in
lo
n
g
i
tu
d
in
a
l
r
e
s
e
a
r
ch
.
H
o
w
ev
er
,
t
h
e
t
o
o
l
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[
4
2
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A
l
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a
ct
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ly
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a
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ly
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th
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s
[
4
3
]
.
G
i
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4.
CO
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SI
O
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h
is
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at
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HC
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.
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b
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ab
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Ma
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f
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to
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ter
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in
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p
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ter
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p
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f
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ate
f
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to
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ad
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to
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e
x
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t
in
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p
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ev
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n
tio
n
s
tr
ateg
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s
w
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f
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cu
s
e
s
m
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o
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co
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it
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ce
.
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n
te
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in
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l
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d
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l
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at
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ies
s
h
o
u
ld
b
e
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o
p
ted
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ev
elo
p
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g
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n
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g
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m
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g
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.
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h
e
ap
p
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s
h
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ld
in
cl
u
d
e
tr
ai
n
in
g
an
d
co
u
n
s
elli
n
g
at
th
e
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n
d
iv
id
u
al
le
v
el.
I
m
p
r
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v
e
m
en
t
o
f
p
h
y
s
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s
a
f
et
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t
u
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t
h
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a
n
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a
s
w
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w
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n
ess
a
n
d
p
o
licies
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e
g
ar
d
in
g
o
r
g
an
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n
al
s
a
f
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y
cl
i
m
ate
an
d
its
p
o
s
iti
v
e
r
o
le
in
p
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en
ti
n
g
v
io
len
ce
a
n
d
n
e
g
ati
v
e
w
o
r
k
-
h
ea
lt
h
r
elate
d
o
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tco
m
e.
F
u
t
u
r
e
s
t
u
d
ies
m
u
s
t
b
e
co
n
d
u
cted
u
s
in
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a
p
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s
p
e
ctiv
e
d
e
s
ig
n
,
s
i
m
u
ltan
eo
u
s
l
y
e
v
alu
ati
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n
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al
t
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o
f
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le
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ce
a
n
d
it
s
p
o
ten
tial
r
i
s
k
f
ac
to
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s
.
Sp
ec
ial
atten
tio
n
s
h
o
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ld
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e
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v
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o
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g
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ter
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t
h
e
r
is
k
o
f
v
io
len
ce
.
RE
F
E
R
E
NC
E
S
[
1
]
V
.
D
i
M
a
r
t
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n
o
a
n
d
M
.
M
u
sr
i
,
G
u
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n
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v
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t
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w
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p
l
a
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e
.
M
i
n
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st
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H
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ma
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R
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so
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M
a
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n
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K
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,
2
0
0
1
.
[
2
]
C
.
M
e
n
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Evaluation Warning : The document was created with Spire.PDF for Python.
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Evaluation Warning : The document was created with Spire.PDF for Python.