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1]
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c
l
ude
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7]
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t
i
nf
l
u
e
n
c
e
t
h
e
h
o
pe
o
f
t
h
e
c
a
r
e
[
9]
.
A
ge
,
ge
n
d
e
r
,
l
a
n
gua
ge
,
c
u
l
t
ur
e
,
e
duc
a
t
i
o
n
s
t
a
t
us
,
a
n
xi
e
t
y
a
n
d
pr
e
vi
o
us
h
o
s
p
i
t
a
l
i
z
a
t
i
o
n
i
nf
l
u
e
n
c
e
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
[
10]
.
P
a
r
t
i
c
i
pa
n
t
s
w
i
t
h
t
e
r
t
i
a
r
y
e
du
c
a
t
i
o
n
we
r
e
d
i
s
s
a
t
i
s
f
i
e
d
w
h
e
n
c
o
m
pa
r
e
d
w
i
t
h
i
ll
i
t
e
r
a
t
e
a
n
d
b
a
s
i
c
e
duc
a
t
i
o
n
[
11]
.
P
oo
r
wo
r
ki
n
g
c
o
n
d
i
t
i
o
n
s
,
h
e
a
vy
wo
r
k
l
o
a
ds
,
l
a
c
k
o
f
pa
r
t
i
c
i
pa
t
i
o
n
i
n
de
c
i
s
i
o
n
m
a
k
i
ng,
a
n
d
l
im
i
t
e
d
o
ppo
r
t
un
i
t
i
e
s
f
o
r
c
a
r
e
e
r
m
o
bil
i
t
y
.
C
o
n
s
e
que
n
t
l
y
,
l
a
c
k
o
f
r
e
s
o
ur
c
e
s
,
a
s
we
l
l
a
s
pr
o
f
e
s
s
i
o
n
a
l
,
e
nvi
r
o
nm
e
n
t
a
l
a
n
d
o
t
h
e
r
r
e
s
t
r
a
i
n
t
s
a
n
d
l
im
i
t
a
t
i
o
ns
[
12]
.
T
h
e
s
t
ud
y
r
e
ve
a
l
e
d
a
s
i
g
ni
f
i
c
a
n
t
a
s
s
o
c
i
a
t
i
o
n
a
m
o
n
g
pa
t
i
e
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t
a
ge
a
n
d
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
[
13]
.
A
s
t
ud
y
do
n
e
a
t
a
bl
a
c
k
l
i
o
n
h
o
s
p
i
t
a
l
s
h
o
we
d
t
ha
t
374
a
dul
t
pa
r
t
i
c
i
pa
n
t
s
w
i
t
h
a
100%
r
e
s
po
n
s
e
r
a
t
e
[
14]
.
L
a
n
gua
ge
b
a
r
r
i
e
r
we
r
e
de
t
e
r
m
i
n
i
ng
f
a
c
t
o
r
o
f
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
[
15]
.
T
h
e
p
a
t
i
e
n
t
un
a
bl
e
t
o
f
u
ll
y
e
x
p
r
e
s
s
t
h
e
i
r
f
e
ll
i
ng
to
t
h
e
n
ur
s
e
we
r
e
de
t
e
r
m
i
n
i
ng
f
a
c
t
or
s
f
o
r
pa
t
i
e
n
t
[
16]
.
Di
f
f
e
r
e
n
t
s
t
udi
e
s
h
a
ve
r
e
po
r
t
e
d
v
a
r
y
in
g
l
e
v
e
ls
o
f
i
npa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
i
n
d
if
f
e
r
e
n
t
l
e
v
e
l
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o
f
h
o
s
p
i
t
a
l
s
i
n
E
t
hi
o
p
i
a
.
A
s
t
ud
y
c
o
n
du
c
t
e
d
i
n
A
dd
i
s
Aba
b
a
,
67%
o
f
pa
t
i
e
n
t
we
r
e
s
a
t
i
s
f
i
e
d
[
17]
.
A
s
t
ud
y
do
ne
a
t
J
i
mm
a
U
ni
ve
r
s
i
t
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S
pe
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i
a
li
z
e
d
Ho
s
p
i
t
a
l
77.
0
%
we
r
e
s
a
t
i
s
f
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e
d
[
18]
.
P
a
t
i
e
n
t
a
t
M
o
z
a
m
bi
que
Ho
s
p
i
t
a
l
,
55%
pa
t
i
e
n
t
we
r
e
s
a
t
i
s
f
i
e
d
[
19]
.
A
s
t
ud
y
c
o
n
du
c
t
e
d
i
n
Am
ha
r
a
r
e
g
i
o
n
s
a
t
i
s
f
a
c
t
i
o
n
l
e
v
e
l
we
r
e
22.
0%
t
o
50
%
[
20
]
.
S
t
udy
do
n
e
a
t
T
i
gr
a
y
z
o
n
a
l
h
o
s
p
i
t
a
l
s
s
a
t
i
s
f
a
c
t
i
o
n
l
e
v
e
l
wa
s
43
.
60%
[
21]
.
A
s
t
ud
y
do
n
e
a
t
De
b
r
e
M
a
r
ko
s
h
o
s
p
i
t
a
l
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
wa
s
56%
[
22]
.
T
o
i
m
pr
o
v
e
s
e
r
vi
c
e
s
qua
li
t
y
,
s
a
t
i
s
f
y
i
ng
p
a
t
i
e
n
t
s
i
s
t
h
e
pr
im
a
r
y
go
a
l
o
f
t
h
e
E
t
hi
o
p
i
a
n
go
ve
r
nm
e
n
t
's
t
r
a
n
s
f
o
r
m
a
t
i
o
n
a
ge
n
da
.
Ho
s
p
i
t
a
l
s
a
n
d
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
s
[
23,
24]
.
H
i
g
h
e
r
l
e
v
e
l
s
o
f
pa
t
i
e
n
t
c
a
pa
c
i
t
y
b
u
il
d
i
ng,
pr
o
m
i
s
e
to
c
a
r
e
a
n
d
a
d
he
r
e
n
c
e
t
o
r
e
c
o
m
m
e
n
de
d
m
a
n
a
ge
men
t
we
r
e
a
s
s
o
c
i
a
t
e
d
w
i
t
h
pa
t
i
e
n
t
o
u
t
c
o
m
e
[
25]
.
T
h
e
F
e
d
e
r
a
l
M
i
n
i
s
t
r
y
o
f
he
a
l
t
h
i
n
E
t
hi
o
p
i
a
s
e
t
36
n
a
t
i
o
n
a
l
ke
y
pe
r
f
o
r
m
a
n
c
e
i
nd
i
c
a
t
o
r
s
(
K
P
I
s
)
r
e
f
l
e
c
t
i
n
g
pr
o
c
e
s
s
e
s
a
n
d
o
ut
c
o
m
e
s
.
T
h
e
i
npa
t
i
e
n
t
s
e
r
vi
c
e
K
P
I
i
n
c
l
ude
s
:
a
d
m
i
s
s
i
o
n
s
,
m
o
r
t
a
l
i
t
y
,
s
ur
g
i
c
a
l
a
d
mi
s
s
i
o
n
t
i
me
l
i
ne
s
s
,
be
d
o
c
c
upa
n
c
y
,
t
h
e
a
ve
r
a
ge
l
e
n
gt
h
o
f
s
t
a
y
,
pr
e
s
s
ur
e
u
l
c
e
r
i
nc
i
de
n
c
e
,
s
ur
g
i
c
a
l
s
i
t
e
i
nf
e
c
t
i
o
n
a
n
d
c
o
m
p
l
e
t
e
n
e
s
s
o
f
i
n
p
a
t
i
e
n
t
m
e
d
i
c
a
l
r
e
c
o
r
ds
[
26]
.
L
a
c
k
o
f
hi
g
h
-
qua
li
t
y
e
qu
i
p
m
e
n
t
e
x
a
gge
r
a
t
e
d
t
h
e
pr
o
vi
s
i
o
n
o
f
qua
li
t
y
c
a
r
e
[
27]
.
A
s
t
ud
y
i
n
S
o
ut
h
Af
r
i
c
a
r
e
po
r
t
e
d
t
h
a
t
,
t
h
e
hi
g
h
e
s
t
wa
i
t
i
n
g
t
i
m
e
wa
s
a
s
s
o
c
i
a
t
e
d
w
i
t
h
pa
t
i
e
n
t
d
i
s
s
a
t
i
s
f
a
c
t
i
o
n
[
2
8]
.
T
he
r
e
we
r
e
d
i
f
f
e
r
e
n
t
f
a
c
t
o
r
s
t
h
a
t
de
l
a
y
t
h
e
h
e
a
l
t
h
c
a
r
e
pr
o
vi
d
e
r
to
a
tt
a
i
n
b
e
t
t
e
r
h
e
a
l
t
h
o
ut
c
o
m
e
s
[
29]
.
M
a
l
e
pa
t
i
e
n
t
h
a
d
hi
g
h
e
r
s
a
t
i
s
f
a
c
t
i
o
n
f
o
r
h
e
a
l
t
h
c
a
r
e
s
e
r
vi
c
e
s
,
ot
h
e
r
s
m
a
l
e
s
we
r
e
d
i
s
s
a
t
i
s
f
i
e
d
[
30,
31]
.
I
t
i
s
n
e
c
e
s
s
a
r
y
t
o
a
s
s
e
s
s
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
a
t
t
h
e
pr
i
m
a
r
y
h
o
s
p
i
t
a
l
l
e
v
e
l
s
.
M
o
s
t
o
f
t
h
e
pr
e
vi
o
us
s
t
ud
i
e
s
a
ddr
e
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s
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d
o
n
t
h
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ur
s
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n
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c
a
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s
pe
c
t
o
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o
s
p
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t
a
l
s
e
r
vi
c
e
.
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ut
a
c
c
o
r
di
n
g
to
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thi
o
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a
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o
s
p
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t
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vi
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e
t
r
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pa
t
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t
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o
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;
t
h
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c
t
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f
y
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ng
f
a
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t
or
s
.
2.
RE
S
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AR
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M
E
T
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h
e
s
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s
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o
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t
e
d
a
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r
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s
p
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t
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h
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t
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t
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f
r
o
m
M
a
r
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h
15
-
A
pr
i
l
25/2019.
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r
o
s
s
-
s
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t
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t
udy
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s
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pr
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T
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f
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pt
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s
we
r
e
m
a
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m
a
r
g
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n
o
f
e
r
r
o
r
(
d)
5%
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a
n
d
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95%
c
o
nf
i
de
n
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v
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,
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pr
o
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o
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t
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t
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e
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t
s
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t
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s
f
a
c
t
i
o
n
(
P
=
50%
)
,
10%
n
o
n
-
r
e
s
po
n
s
e
s
w
i
t
h
422
pa
r
ti
c
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pa
n
t
s
.
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h
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a
m
p
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wa
s
a
ll
o
c
a
t
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d
to
e
a
c
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h
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p
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z
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m
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e
d
pa
t
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e
n
t
s
.
T
h
e
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t
h
e
s
a
m
p
l
e
wa
s
d
i
s
t
r
i
b
ut
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to
t
h
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e
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wa
r
ds
(
m
e
d
i
c
a
l
,
s
ur
g
i
c
a
l
a
nd
g
y
ne
c
o
l
o
g
i
c
a
l
wa
r
ds
)
.
S
t
udy
pa
r
t
i
c
i
p
a
n
t
s
we
r
e
s
e
l
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c
t
e
d
e
v
e
r
y
t
wo
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[
32
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.
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
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N:
2252
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78
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ON
3.
1.
S
oc
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-
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m
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h
a
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r
is
t
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4
18
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89
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105
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30
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67
16
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11
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e
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l
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a
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in
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76
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d
16
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gi
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66
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r
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ta
nt
9
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r
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l
207
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c
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127
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a
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133
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16
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ta
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duc
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ti
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n
131
31.3
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r
im
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r
y
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h
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(
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115
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9
-
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)
63
15.1
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r
e
pa
r
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t
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y
(
11
-
12
)
14
3.3
di
pl
o
m
a
57
13.6
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e
gr
e
e
38
9.1
H
o
us
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h
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ld
M
e
a
n=
1633.65
<
1633.65=
258
61.7
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nc
o
m
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n E
th
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o
pi
a
n B
i
r
r
(
m
o
n
th
l
y
)
S
D
±2088.203
≥163
3.6
5=
160
38.3
P
a
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in
g s
ta
tu
s
F
r
e
e
151
36.1
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a
y
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g
124
29.7
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B
H
I
143
34.2
F
a
m
il
y
s
i
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e
<=5
338
80.9
>5
80
19.1
3.
2.
Adm
is
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ion
c
h
ar
ac
t
e
r
is
t
ic
s
of
r
e
s
p
on
d
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n
t
s
F
r
o
m
t
h
e
tot
a
l
4
18
i
n
pa
t
i
e
n
t
r
e
s
p
o
n
d
e
n
t
s
,
3
57
(
85
.
4
%
)
o
f
th
e
m
s
tay
e
d
l
e
s
s
or
e
qua
l
to
f
i
v
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da
y
s
i
n
t
h
e
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r
ds
a
n
d
m
or
e
th
a
n
h
a
l
f
o
f
t
h
e
r
e
s
pon
de
n
t
s
2
30
(
55
%
)
we
r
e
a
dm
i
tt
e
d
f
o
r
t
h
e
f
i
r
s
t
t
i
m
e
.
M
os
t
o
f
th
e
r
e
s
p
o
n
d
e
n
t
s
23
2
(
55
.
5
%
)
we
r
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a
d
m
i
tt
e
d
a
t
th
e
m
e
di
c
a
l
wa
r
d
a
n
d
1
53
(
36
.
6%
)
w
e
r
e
a
t
th
e
g
y
n
e
c
o
l
og
y
w
a
r
d
.
3.
3
.
Hos
p
it
al
f
ac
il
it
y
-
r
e
l
at
e
d
s
at
is
f
a
c
t
ion
F
r
o
m
a
ll
r
e
s
po
n
de
n
t
s
270
(
64.
6%
)
we
r
e
f
e
ll
c
o
mf
o
r
t
f
o
r
e
x
a
m
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o
n
r
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m
s
,
243
(
58.
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)
we
r
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i
n
t
e
r
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s
t
e
d
r
e
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r
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n
g
t
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nli
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t
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b
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n
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bl
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2
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3.
4
.
S
e
r
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ap
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M
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t
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r
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po
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n
t
s
289
(
71.
5
%
)
we
r
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s
a
t
i
s
f
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d
w
i
t
h
t
h
e
d
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a
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s
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c
e
.
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i
ke
w
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f
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t
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r
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a
t
m
e
n
t
292
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h
e
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ugs
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(
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4%
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,
by
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h
e
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y
m
e
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t
c
o
n
d
i
t
i
o
n
305
(
73.
0%
)
,
a
n
d
by
a
c
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s
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a
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o
r
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to
r
y
a
n
d
x
-
r
a
y
d
i
a
g
n
o
s
i
s
we
r
e
295
(
70
.
5%
)
.
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
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S
N:
2252
-
8
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P
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[
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[
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.
4.
CONC
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ON
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R
EF
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EN
C
ES
[1
]
Be
l
a
y
n
eh
,
M
.,
“
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p
at
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en
t
s
at
i
s
fac
t
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rt
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,”
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l
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b
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ed
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n
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d
p
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c
h
ea
l
t
h
,
.
v
o
l
.
5
,
n
o
.
3
,
2016
.
[2
]
D
o
n
ab
e
d
i
an
,
A
.,
“
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n
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xf
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3
.
[3
]
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ak
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,
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t
a
l
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MA
.
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n
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s
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.,
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l
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152
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o
.
9
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.
[6
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u
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ea
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h
,
vol.
4
,
n
o
.
8
,
pp
.
1
5
2
4
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5
3
7
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2
0
1
2
.
[7
]
Y
i
l
m
az
M.
,
“
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i
e
n
t
s
at
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fac
t
i
o
n
:
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al
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t
y
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e
Cu
m
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yet
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r
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n
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u
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a
l
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v
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l
.
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o
.
2
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p
p
.
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-
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2
0
0
1
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[8
]
Bay
i
n
,
G
.
,
Ö
n
d
e
r
,
R
Ö
.
,
“
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R
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l
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o
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2
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p
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[9
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v
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s
M,
Bo
n
d
,
M,
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rt
h
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r,
A
A
.
,
“
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at
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fy
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o
l
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?
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re
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M
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g
o
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Pat
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s
at
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s
fac
t
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o
n
,”
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u
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n
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f
A
d
v
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n
ce
d
Nu
r
s
i
n
g
,
v
o
l
.
22
,
n
o
.
2
,
pp.
316
-
3
2
2
,
1
9
9
5
.
[1
0
]
L
i
u
Y
W
,
G
.
,
“
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n
p
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s
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t
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o
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ar
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al
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n
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n
a
,”
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u
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a
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r
s
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n
g
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r
e
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a
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l
.
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o
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0
0
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1
]
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me
k
u
V
.
M
.
,
e
t
al
.
,
“
in
-
p
at
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e
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t
s
at
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s
fa
c
t
i
o
n
w
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t
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n
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n
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ar
e:
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c
as
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t
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k
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me
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s
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n
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t
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a
l
J
o
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R
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M
ed
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n
d
H
ea
l
t
h
S
ci
e
n
ces
,
v
o
l
.
2
,
no.
1
,
pp.
18
-
24
,
2
0
1
3
.
[1
2
]
Pal
e
s
e
A
,
T
M,
e
t
al
.
,
“
Su
rg
i
c
al
p
at
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en
t
s
at
i
s
fac
t
i
o
n
as
an
o
u
t
c
o
me
o
f
n
u
rs
e
s
’
c
ari
n
g
b
eh
av
i
o
rs
:
a
d
e
s
c
r
i
p
t
i
v
e
an
d
c
o
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el
at
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y
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n
s
i
x
E
u
r
o
p
e
a
n
co
u
n
t
ri
e
s
,”
J
.
Nu
r
s
.
S
ch
o
l
a
r
s
h
.,
v
o
l
.
43
,
n
o
.
4
,
p
p
.
341
-
3
5
0
,
2
0
1
1
.
[1
3
]
G
an
i
N
,
e
t
al
.
,
“
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s
s
e
s
s
m
en
t
o
f
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s
fac
t
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o
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.
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A
b
a
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a
,
2006
.
[2
2
]
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l
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S
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l
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2011.
[2
7
]
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k
au
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.
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23
-
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3
.
[2
8
]
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e
s
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a
w
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.
,
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al
.
,
“
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t
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.
4
,
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337
-
3
4
4
,
2
0
0
3
.
[2
9
]
W
H
O
.
,
“
W
o
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k
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n
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t
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e
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W
H
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at
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n
s
:
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h
e
W
o
rl
d
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e
al
t
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R
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p
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rt
,
2006.
[3
0
]
A
l
d
aq
al
SM
.
,
e
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al
.,
“
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d
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a
,”
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f
e
S
ci
en
ce
J
o
u
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n
a
l
,
v
o
l
.
9
,
n
o
.
1
,
p
p
.
277
-
2
8
0
,
2011
.
[3
1
]
G
h
o
s
e
S,
SV
.
A
.,
“
Pat
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e
n
t
s
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:
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ea
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l
.
34
,
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o
.
4
,
p
p
.
232
-
2
4
2
,
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0
1
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.
[3
2
]
O
k
afo
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u
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,
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.
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,
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3
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3
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.
[3
3
]
Mu
h
o
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.
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,
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.
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.
2
,
p
p
.
67
-
73
,
2
0
0
8
.
[3
4
]
Ch
en
H
.
,
e
t
al
.
,
“
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t
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