I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
1
,
Ma
r
ch
2
0
2
5
,
p
p
.
85
~
93
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SS
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O
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l health:
sm
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ne discha
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Feb
19
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2
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2
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S
tro
k
e
is
a
d
ise
a
se
th
a
t
c
a
u
se
s
a
v
a
riet
y
o
f
p
h
y
sic
a
l
a
n
d
p
s
y
c
h
o
lo
g
ica
l
d
iso
rd
e
rs,
re
su
lt
i
n
g
in
li
m
it
a
ti
o
n
s
in
a
p
e
rso
n
'
s
li
fe
.
S
tro
k
e
p
a
ti
e
n
ts
o
fte
n
e
x
p
e
rien
c
e
p
sy
c
h
o
lo
g
ica
l
p
r
o
b
le
m
s
su
c
h
a
s
d
e
p
re
ss
io
n
,
a
n
x
iety
,
a
n
d
stre
ss
a
s
a
re
su
lt
o
f
c
h
a
n
g
e
s
i
n
th
e
ir
li
fe
a
c
ti
v
it
ies
.
Disc
h
a
rg
e
p
la
n
n
i
n
g
is
c
o
n
sid
e
re
d
a
n
in
ter
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e
n
ti
o
n
th
a
t
c
a
n
re
d
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c
e
c
o
m
p
li
c
a
ti
o
n
s
a
n
d
imp
r
o
v
e
t
h
e
q
u
a
l
it
y
o
f
l
ife
o
f
stro
k
e
p
a
ti
e
n
ts.
Ho
we
v
e
r,
th
e
re
a
re
stil
l
re
p
o
rts
th
a
t
th
e
imp
lem
e
n
tatio
n
o
f
d
isc
h
a
rg
e
p
lan
n
in
g
is
n
o
t
o
p
ti
m
a
l,
a
n
d
o
n
e
o
f
th
e
re
a
so
n
s
is
t
h
e
u
se
o
f
in
a
p
p
r
o
p
r
iate
m
e
th
o
d
s.
Th
e
a
im
o
f
th
e
st
u
d
y
wa
s
to
d
e
m
o
n
stra
te
t
h
e
imp
a
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t
o
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u
se
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isc
h
a
rg
e
p
lan
n
i
n
g
a
p
p
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c
a
ti
o
n
s
o
n
th
e
lev
e
ls
o
f
d
e
p
re
ss
io
n
,
a
n
x
iety
,
a
n
d
stre
ss
i
n
str
o
k
e
p
a
t
ien
ts.
T
h
e
re
se
a
rc
h
m
e
t
h
o
d
u
se
d
is
q
u
a
si
-
e
x
p
e
rime
n
tal
q
u
a
n
ti
tativ
e
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se
a
rc
h
with
a
o
n
e
-
g
ro
u
p
p
re
tes
t
a
n
d
p
o
sttes
t
d
e
sig
n
.
A
t
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tal
o
f
2
1
re
sp
o
n
d
e
n
t
s
u
se
d
p
u
r
p
o
si
v
e
sa
m
p
li
n
g
tec
h
n
i
q
u
e
s.
T
h
e
re
su
lt
s
sh
o
we
d
c
h
a
n
g
e
s
in
lev
e
l
s
o
f
d
e
p
re
ss
io
n
,
a
n
x
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a
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ss
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fter
a
p
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a
ti
o
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-
b
a
se
d
d
isc
h
a
rg
e
p
la
n
n
in
g
.
T
h
e
Wi
lco
x
o
n
sta
ti
stica
l
t
e
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re
su
lt
s
o
b
tai
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p
-
v
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o
f
0
.
0
0
0
(p
<
0
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0
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),
wh
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sts
th
a
t
th
e
re
is
a
n
in
flu
e
n
c
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o
f
a
p
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se
d
d
isc
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lan
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g
o
n
t
h
e
lev
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ls
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f
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e
p
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a
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x
iety
,
a
n
d
stre
ss
i
n
stro
k
e
p
a
ti
e
n
ts.
K
ey
w
o
r
d
s
:
An
x
iety
Dep
r
ess
io
n
Dis
ch
ar
g
e
p
lan
n
in
g
ap
p
licatio
n
s
Stre
s
s
Stro
k
e
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Dwi
R
etn
an
in
g
s
ih
Nu
r
s
in
g
Stu
d
y
Pr
o
g
r
am
,
Facu
lty
o
f
Nu
r
s
in
g
B
u
s
in
ess
an
d
T
ec
h
n
o
lo
g
y
,
W
id
y
a
Hu
s
ad
a
U
n
iv
er
s
ity
J
l.
Su
b
ali
R
ay
a
No
.
1
2
,
Kr
a
p
y
a
k
,
Sem
ar
an
g
B
ar
at,
Sem
ar
an
g
,
C
en
tr
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J
av
a
5
0
1
4
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,
I
n
d
o
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E
m
ail: d
wi.
r
etn
an
in
g
s
ih
@
u
wh
s
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Stro
k
e
is
th
e
lead
in
g
ca
u
s
e
o
f
d
is
ab
ilit
y
wo
r
ld
wid
e
an
d
th
e
n
u
m
b
er
two
ca
u
s
e
o
f
d
ea
th
[
1
]
.
A
s
tr
o
k
e
o
cc
u
r
s
wh
en
th
e
b
lo
o
d
v
ess
els
o
f
th
e
b
r
ain
ar
e
b
lo
ck
e
d
o
r
b
r
o
k
en
.
As
a
r
esu
lt,
s
o
m
e
p
ar
ts
o
f
th
e
b
r
ain
d
o
n
o
t
g
et
th
e
b
lo
o
d
s
u
p
p
ly
th
at
ca
r
r
ies
th
e
n
ec
ess
ar
y
o
x
y
g
en
,
r
es
u
ltin
g
in
th
e
d
ea
th
o
f
ce
lls
an
d
n
etwo
r
k
s
[
2
]
.
A
s
tr
o
k
e
ca
n
ca
u
s
e
m
an
y
clin
ical
m
an
if
estatio
n
s
,
b
o
th
p
h
y
s
ically
an
d
p
s
y
ch
o
lo
g
ically
.
Stro
k
es
r
esu
lt in
a
v
ar
iety
o
f
p
h
y
s
ical
d
is
o
r
d
er
s
th
at
ca
u
s
e
in
d
iv
id
u
als
to
e
x
p
er
ien
ce
li
m
itatio
n
s
in
th
eir
liv
es.
Patien
t
s
with
h
ig
h
e
r
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
h
av
e
a
lo
w
e
r
r
is
k
o
f
m
o
r
e
s
ev
er
e
s
tr
o
k
e
s
th
an
th
o
s
e
with
lo
wer
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
.
T
h
er
ef
o
r
e,
we
n
ee
d
to
f
o
cu
s
o
n
im
p
r
o
v
in
g
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
as
p
ar
t
o
f
s
tr
o
k
e
m
an
ag
e
m
en
t
[
3
]
.
A
s
tr
o
k
e
h
as
a
n
u
m
b
e
r
o
f
c
o
m
p
licatio
n
s
th
at
ca
n
ar
is
e,
o
n
e
o
f
wh
ich
is
a
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
.
Dep
r
ess
io
n
,
s
tr
e
s
s
,
an
d
an
x
iety
ar
e
p
s
y
c
h
o
lo
g
ical
p
r
o
b
lem
s
th
at
o
f
ten
o
cc
u
r
i
n
s
tr
o
k
e
p
atien
ts
.
I
n
s
tr
o
k
e
p
ati
en
ts
,
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
ca
n
ar
is
e
as a
r
esu
lt o
f
ch
an
g
es in
ac
tiv
ity
,
n
u
tr
itio
n
al
n
ee
d
s
,
m
o
b
ilizatio
n
,
an
d
o
t
h
er
n
ee
d
s
.
Fo
r
s
tr
o
k
e
p
atien
ts
,
d
is
ch
ar
g
e
p
lan
n
i
n
g
is
an
im
p
o
r
tan
t
c
o
m
p
o
n
en
t
in
o
r
d
er
to
m
in
im
ize
f
u
r
th
e
r
co
m
p
licatio
n
s
an
d
im
p
r
o
v
e
th
eir
q
u
ality
o
f
life
.
Alth
o
u
g
h
t
h
e
p
atien
t
h
as
r
ec
eiv
ed
g
o
o
d
ca
r
e
in
th
e
h
o
s
p
ital,
n
u
r
s
in
g
ca
r
e
ass
o
ciate
d
with
f
u
r
th
er
ca
r
e
s
h
o
u
ld
b
e
co
n
tin
u
ed
u
n
til
h
o
m
e
ca
r
e
s
o
th
at
t
h
e
r
ec
o
v
er
y
o
f
th
e
s
tr
o
k
e
v
ictim
ca
n
b
e
a
cc
eler
ated
[
4
]
.
E
f
f
ec
tiv
e
s
tr
o
k
e
d
is
ch
a
r
g
e
p
lan
n
in
g
f
o
r
h
o
s
p
italized
p
atien
ts
ca
n
r
ed
u
c
e
th
e
r
is
k
o
f
r
eh
o
s
p
italizatio
n
o
r
r
e
-
in
p
atien
t
tr
ea
tm
en
t.
I
n
d
icato
r
s
o
f
th
e
q
u
ality
o
f
ca
r
e
at
h
o
m
e
h
av
e
b
ee
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
1
,
Ma
r
ch
20
25
:
85
-
93
86
d
ev
elo
p
e
d
th
at
co
v
er
th
e
p
h
y
s
ical
an
d
p
s
y
ch
o
lo
g
ical
asp
ec
ts
o
f
p
atien
ts
an
d
th
eir
f
am
ilies
,
th
e
m
an
ag
em
e
n
t o
f
h
o
m
e
ca
r
e
p
r
o
v
id
er
s
in
v
o
lv
i
n
g
o
f
f
icer
s
,
an
d
th
e
av
ailab
il
ity
o
f
ad
m
in
is
tr
ativ
e
s
er
v
ices
[
5
]
.
Patien
ts
wh
o
s
u
r
v
iv
ed
an
ea
r
ly
s
tr
o
k
e
ar
e
at
r
is
k
o
f
h
a
v
in
g
r
e
cu
r
r
i
n
g
s
tr
o
k
e
s
o
f
th
e
s
am
e
o
r
a
d
if
f
e
r
en
t ty
p
e
[
6
]
.
B
u
t
at
th
e
m
o
m
en
t,
th
er
e
a
r
e
s
till
m
an
y
r
ep
o
r
ts
r
elate
d
to
th
e
n
o
t
-
o
p
tim
al
im
p
lem
en
tatio
n
o
f
d
is
ch
ar
g
e
p
la
n
n
in
g
in
s
tr
o
k
e
p
atien
ts
.
I
n
ad
eq
u
ate
m
eth
o
d
s
a
n
d
th
e
in
ac
tiv
ity
o
f
p
r
o
f
ess
io
n
als
in
im
p
lem
en
tin
g
d
is
ch
ar
g
e
p
lan
n
i
n
g
ar
e
th
e
m
ain
f
ac
to
r
s
ca
u
s
in
g
th
e
in
o
p
ti
m
al
im
p
lem
en
tatio
n
o
f
d
is
ch
ar
g
e
p
lan
n
in
g
[
7
]
.
I
n
ef
f
ec
tiv
e
im
p
lem
e
n
tatio
n
c
an
r
esu
lt
in
d
is
r
u
p
tio
n
o
f
co
n
tin
u
ity
o
f
ca
r
e
wh
e
n
th
e
p
ati
en
t
is
at
h
o
m
e
an
d
in
cr
ea
s
ed
p
atien
t
d
e
p
en
d
e
n
ce
o
n
tr
ea
tm
e
n
t
[
8
]
.
Sti
ll,
u
n
o
p
tim
al
d
is
ch
ar
g
e
p
lan
n
in
g
h
as
an
im
p
ac
t
o
n
th
e
in
cr
ea
s
e
in
th
e
n
u
m
b
er
o
f
h
o
s
p
italizatio
n
s
,
an
d
ev
e
n
tu
ally
p
atien
ts
b
ea
r
t
h
e
f
u
n
d
in
g
o
f
h
o
s
p
ital
co
s
ts
.
T
h
e
r
ec
u
r
r
en
ce
o
f
th
e
p
atien
t'
s
co
n
d
i
tio
n
o
r
r
e
-
h
o
s
p
italizatio
n
is
v
er
y
d
etr
im
en
tal
to
t
h
e
p
atien
t
an
d
h
is
f
am
ily
,
as
well
as
to
th
e
h
o
s
p
ital
[
9
]
.
Alth
o
u
g
h
p
atien
ts
an
d
f
am
ilies
h
av
e
alr
ea
d
y
r
ec
eiv
ed
ex
p
lan
ati
o
n
s
f
r
o
m
th
e
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
,
th
ey
ten
d
n
o
t
t
o
f
o
llo
w
th
e
in
s
tr
u
ctio
n
s
g
iv
en
b
ec
au
s
e
th
e
in
f
o
r
m
atio
n
p
r
o
v
id
ed
is
co
n
s
id
er
ed
in
ad
eq
u
ate,
s
o
p
atien
ts
an
d
f
a
m
ily
m
e
m
b
er
s
ar
e
less
awa
r
e
o
f
h
o
w
to
im
p
lem
en
t
it,
an
d
p
atien
ts
an
d
r
elativ
es
ar
e
n
o
t in
a
n
id
ea
l sit
u
atio
n
in
p
r
ep
ar
atio
n
f
o
r
r
ec
o
v
er
y
[
1
0
]
,
[
1
1
]
.
T
h
e
p
u
r
p
o
s
e
o
f
th
is
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
p
r
o
g
r
am
is
to
p
r
o
v
i
d
e
an
e
f
f
ec
tiv
e
s
o
lu
tio
n
to
th
e
u
s
e
o
f
d
is
ch
ar
g
e
p
lan
n
in
g
in
th
e
m
o
d
e
r
n
e
r
a
b
y
u
tili
zin
g
in
f
o
r
m
atio
n
tech
n
o
l
o
g
y
t
h
at
is
ea
s
ily
ac
ce
s
s
ib
le
b
y
p
atien
ts
an
y
tim
e
an
d
an
y
wh
er
e.
W
ith
th
e
av
ailab
ilit
y
o
f
th
is
ap
p
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
,
p
atien
ts
ca
n
im
p
r
o
v
e
th
eir
q
u
a
lity
o
f
life
as
well
as
r
ed
u
ce
a
n
x
iety
,
s
tr
ess
,
an
d
d
e
p
r
ess
io
n
.
T
h
e
r
esear
ch
aim
s
to
d
em
o
n
s
tr
ate
th
e
im
p
a
ct
o
f
th
e
ap
p
licatio
n
'
s
u
s
e
o
n
th
e
lev
els
o
f
d
ep
r
ess
io
n
,
an
x
iety
,
a
n
d
s
tr
ess
in
s
tr
o
k
e
p
atien
ts
.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
m
eth
o
d
u
s
ed
is
q
u
asi
-
ex
p
er
im
e
n
tal
q
u
an
titativ
e
r
esear
ch
with
a
o
n
e
-
g
r
o
u
p
p
r
etest
an
d
p
o
s
ttes
t
d
esig
n
[
1
2
]
.
T
h
e
r
e
s
ea
r
ch
was
co
n
d
u
cted
f
r
o
m
Au
g
u
s
t
2
0
2
3
to
Octo
b
er
2
0
2
3
.
T
h
e
DASS
-
42
q
u
esti
o
n
n
air
e
is
th
e
to
o
l
em
p
l
o
y
ed
[
1
3
]
.
T
h
e
s
am
p
le
p
o
p
u
la
tio
n
in
th
is
s
tu
d
y
was
th
e
en
tire
s
tr
o
k
e
p
o
p
u
latio
n
th
at
u
n
d
er
wen
t
h
o
s
p
italizatio
n
in
th
e
KR
MT
W
o
n
g
s
o
n
eg
o
r
o
d
is
tr
ict
o
f
Sem
ar
an
g
.
T
h
e
s
am
p
le
was
tak
e
n
u
s
in
g
p
u
r
p
o
s
iv
e
s
am
p
lin
g
,
w
ith
a
to
tal
o
f
2
1
r
esp
o
n
d
en
ts
.
T
h
e
4
0
r
esp
o
n
d
en
ts
wer
e
g
ath
er
ed
d
u
r
in
g
th
e
r
esear
ch
p
r
o
ce
d
u
r
e;
h
o
wev
er
,
d
u
r
in
g
t
h
e
d
ata
c
o
llectio
n
p
h
a
s
e,
s
o
m
e
o
f
th
e
r
esp
o
n
d
e
n
ts
h
ad
co
m
m
u
n
icatio
n
is
s
u
es,
lo
w
p
atien
t
awa
r
en
ess
,
an
d
o
th
er
g
en
e
r
al
ch
ar
ac
te
r
is
tics
th
at
m
ad
e
it
im
p
o
s
s
ib
le
to
co
n
d
u
ct
th
e
s
tu
d
y
.
C
o
n
s
eq
u
en
tly
,
2
1
r
esp
o
n
d
en
ts
s
atis
f
ied
th
e
in
clu
s
io
n
r
eq
u
ir
e
m
en
ts
.
B
ef
o
r
e
co
n
d
u
ctin
g
t
h
e
s
tu
d
y
,
r
esear
ch
er
s
ask
f
o
r
p
er
m
is
s
io
n
to
in
v
o
lv
e
r
esp
o
n
d
en
ts
in
th
e
s
tu
d
y
(
in
f
o
r
m
e
d
co
n
s
en
t)
an
d
s
h
o
w
th
eir
id
en
tity
an
d
p
u
r
p
o
s
e
o
f
th
e
r
esear
ch
s
o
th
at
r
esp
o
n
d
en
ts
u
n
d
er
s
tan
d
th
e
in
ten
tio
n
s
an
d
p
u
r
p
o
s
es
o
f
th
e
s
tu
d
y
.
W
h
en
r
esp
o
n
d
en
ts
ar
e
allo
wed
to
b
e
s
tu
d
ied
,
t
h
ey
ar
e
r
eq
u
ir
ed
to
s
ig
n
a
letter
o
f
co
n
s
en
t
th
at
h
as
b
ee
n
p
r
o
v
id
e
d
.
I
f
r
esp
o
n
d
en
ts
d
o
n
o
t
wan
t
to
,
th
e
r
esear
ch
er
s
ar
e
o
b
lig
ed
to
r
esp
ec
t
th
e
wis
h
es
o
f
r
esp
o
n
d
en
ts
an
d
n
o
t
co
n
tin
u
e
th
e
r
esear
ch
p
r
o
ce
s
s
;
i
)
T
h
e
r
esear
c
h
er
s
m
ea
s
u
r
ed
th
e
r
esp
o
n
d
en
t
'
s
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
s
tr
ess
p
r
i
o
r
t
o
th
e
d
is
ch
ar
g
e
p
lan
n
in
g
i
n
ter
v
en
ti
o
n
.
ii
)
R
esear
ch
er
s
p
r
o
v
id
e
d
d
is
ch
ar
g
in
g
p
la
n
n
in
g
u
s
in
g
an
An
d
r
o
id
-
b
ased
ap
p
licatio
n
.
T
h
e
in
ter
v
en
tio
n
w
as
g
iv
en
f
o
r
3
0
-
45
m
in
u
tes
ea
ch
s
ess
io
n
,
with
th
e
d
u
r
atio
n
o
f
th
e
in
ter
v
en
t
io
n
b
ein
g
g
iv
en
twice.
iii
)
T
h
e
r
esear
ch
er
r
e
-
m
ea
s
u
r
ed
th
e
lev
el
o
f
d
e
p
r
ess
io
n
an
d
s
tr
ess
o
f
r
esp
o
n
d
en
ts
af
ter
t
h
ey
wer
e
g
iv
e
n
d
is
ch
ar
g
e
p
l
an
n
in
g
th
r
o
u
g
h
th
e
ap
p
licatio
n
u
s
in
g
a
d
ep
r
ess
iv
e,
an
x
i
o
u
s
,
an
d
s
tr
ess
f
u
l
q
u
esti
o
n
n
air
e.
T
h
e
r
esear
ch
er
s
d
id
n
o
t
r
ev
e
al
th
e
id
en
titi
es
o
f
th
e
r
esp
o
n
d
en
ts
a
n
d
o
n
ly
u
s
ed
t
h
e
c
o
d
e
o
n
th
e
d
ata
co
llectio
n
s
h
ee
t
o
r
th
e
r
e
s
u
lts
o
f
th
e
r
esear
c
h
to
b
e
d
is
p
lay
ed
.
T
h
e
r
esear
ch
e
r
s
g
u
ar
an
tee
th
at
th
e
in
f
o
r
m
ati
o
n
th
at
h
as b
ee
n
cr
ea
ted
will r
em
ain
co
n
f
id
e
n
tial.
T
h
e
r
esear
ch
eth
ics
test
was
co
n
d
u
cted
at
KR
MT
W
o
n
g
s
o
n
eg
o
r
o
K
o
ta
Sem
ar
an
g
u
n
d
er
th
e
n
u
m
b
e
r
0
0
9
/Ko
m
.
E
tik
R
SW
N/I
X/2
0
2
3
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
O
v
er
v
iew
o
f
r
esp
o
nd
ent
s
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
e
n
ts
wer
e
eig
h
t
b
etwe
en
t
h
e
a
g
es
o
f
5
0
an
d
6
0
(
3
8
.
1
%),
a
n
d
eig
h
t
wer
e
o
v
er
60
y
ea
r
s
o
f
ag
e,
o
r
3
8
.
1
%.
Mo
s
t o
f
th
e
r
esp
o
n
d
en
ts
h
ad
a
s
tr
o
k
e,
5
2
.
4
%,
o
r
1
1
p
eo
p
le.
Mo
s
t h
ad
a
h
ig
h
s
ch
o
o
l
ed
u
ca
tio
n
,
with
1
0
p
e
o
p
le
h
a
v
in
g
4
7
.
6
%
.
T
h
e
h
is
to
r
y
o
f
h
y
p
er
ten
s
io
n
was
1
1
p
e
o
p
le
with
5
2
.
4
p
er
ce
n
t.
Mo
s
t
h
ad
s
tr
o
k
es
f
o
r
less
th
an
1
m
o
n
th
,
wh
ich
is
1
9
p
e
o
p
le
with
9
0
.
5
%
;
m
o
s
t
h
ad
a
f
ir
s
t
s
tr
o
k
e
o
f
1
8
p
eo
p
le,
o
r
8
5
.
7
%
as sh
o
wn
in
T
ab
le
1
.
T
h
e
r
esu
lts
in
d
icate
th
at
a
s
izab
le
p
o
r
tio
n
o
f
th
e
s
tr
o
k
e
p
atien
ts
in
th
e
n
u
r
s
in
g
r
o
o
m
ar
e
in
th
e
5
0
–
60
-
y
ea
r
-
o
ld
a
n
d
o
l
d
er
ag
e
g
r
o
u
p
s
.
Ph
y
s
ical
alter
atio
n
s
an
d
th
e
p
r
ev
alen
ce
o
f
h
ea
lth
is
s
u
es
in
th
e
s
en
io
r
p
o
p
u
latio
n
ar
e
s
o
m
e
o
f
th
e
p
r
im
ar
y
ca
u
s
es
o
f
o
ld
e
r
p
e
o
p
l
e's
in
cr
ea
s
ed
r
is
k
o
f
s
tr
o
k
e
[
1
4
]
.
I
t
im
p
lies
th
at,
g
iv
en
th
e
cir
c
u
m
s
tan
ce
s
o
f
t
h
i
s
in
v
esti
g
atio
n
,
ag
e
m
i
g
h
t
b
e
a
r
elev
an
t
r
is
k
f
ac
to
r
[
1
5
]
.
On
e
way
to
ex
p
lain
a
g
en
d
er
r
is
k
d
if
f
er
en
ce
in
s
tr
o
k
es
co
u
ld
b
e
t
h
e
h
ig
h
e
r
r
ate
o
f
s
tr
o
k
es
am
o
n
g
m
ales
(
5
2
.
4
%).
T
o
f
in
d
o
u
t
if
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
Op
timiz
in
g
p
a
tien
t m
en
ta
l h
ea
lth
o
u
tco
mes:
th
e
imp
a
ct
o
f sma
r
tp
h
o
n
e
-
b
a
s
ed
…
(
Dw
i R
etn
a
n
in
g
s
ih
)
87
p
ar
ticu
lar
ch
ar
ac
ter
is
tics
th
at
ar
e
m
o
r
e
p
r
ev
alen
t
in
m
e
n
r
aise
r
is
k
,
m
o
r
e
r
esear
ch
m
ay
b
e
r
eq
u
ir
ed
.
Acc
o
r
d
in
g
to
d
ata
in
I
n
d
o
n
esia
b
ased
o
n
g
en
d
er
c
h
ar
ac
ter
is
tics
,
m
en
ex
p
er
ien
ce
a
h
ig
h
e
r
r
ate
o
f
s
tr
o
k
e
v
ictim
s
th
an
wo
m
en
.
B
ec
au
s
e
o
f
th
e
h
o
r
m
o
n
e
estro
g
en
,
wh
ich
ac
ts
as
a
b
ar
r
ier
ag
ai
n
s
t
th
e
p
r
o
g
r
ess
io
n
o
f
ath
e
r
o
s
cler
o
s
is
,
wo
m
en
h
av
e
a
lo
wer
i
n
cid
e
n
ce
o
f
s
tr
o
k
es
th
an
m
e
n
.
Alth
o
u
g
h
wo
m
en
will
ex
p
er
ie
n
ce
a
s
tr
o
k
e
af
ter
m
en
o
p
a
u
s
e,
m
en
ar
e
m
o
r
e
lik
ely
th
an
wo
m
en
to
ex
p
er
ien
ce
o
n
e
at
an
ea
r
ly
ag
e.
W
o
m
en
wer
e
p
r
o
tecte
d
f
r
o
m
m
e
n
o
p
a
u
s
e
b
y
e
s
t
e
r
o
g
e
n
s
,
w
h
ic
h
c
o
n
t
r
i
b
u
t
e
d
t
o
a
n
i
n
c
r
e
as
e
i
n
h
i
g
h
-
d
e
n
s
i
t
y
l
i
p
o
p
r
o
t
e
i
n
(
HD
L
)
c
h
o
l
e
s
t
e
r
o
l
[
1
6
]
.
T
h
e
m
ajo
r
ity
o
f
p
atien
ts
ar
e
u
n
em
p
lo
y
e
d
an
d
h
av
e
a
h
ig
h
s
ch
o
o
l
ed
u
ca
tio
n
.
T
h
is
m
ay
in
d
icate
th
at
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
ca
n
p
l
ay
a
r
o
le
in
s
tr
o
k
e
in
cid
e
n
ce
i
n
th
is
p
o
p
u
latio
n
.
Fu
r
th
er
an
a
ly
s
is
o
f
th
e
s
o
cio
-
ec
o
n
o
m
ic
asp
ec
ts
m
ay
b
e
n
ee
d
ed
.
R
esp
o
n
d
en
ts
wh
o
h
a
v
e
a
h
ig
h
e
r
lev
el
o
f
ed
u
ca
tio
n
h
a
v
e
k
n
o
wled
g
e
an
d
in
f
o
r
m
atio
n
ab
o
u
t
h
ea
lth
co
m
p
ar
ed
to
th
o
s
e
with
l
o
wer
lev
els
o
f
e
d
u
ca
tio
n
.
T
h
e
lev
el
o
f
ed
u
ca
tio
n
d
ir
ec
tly
af
f
ec
ts
th
e
lev
el
o
f
k
n
o
wled
g
e
o
f
th
e
in
d
iv
id
u
al
[
1
7
]
.
T
h
e
least
k
n
o
wled
g
ea
b
le
p
eo
p
le
ar
e
lim
ited
to
r
em
em
b
er
in
g
,
d
e
f
in
in
g
,
an
d
s
tatin
g
f
ac
ts
;
th
ey
ar
e
u
n
a
b
le
to
d
em
o
n
s
tr
ate
co
m
p
r
eh
en
s
io
n
,
ap
p
licatio
n
,
an
aly
s
is
,
o
r
ap
p
r
aisal
o
f
th
eir
cu
r
r
en
t
a
b
ilit
ies.
Stro
k
e
wo
m
e
n
's
h
ig
h
r
ates
o
f
d
ea
th
,
m
o
r
b
i
d
ity
,
an
d
d
is
ab
ilit
y
u
p
s
et
th
e
d
elica
te
b
alan
ce
in
t
h
e
f
am
ily
u
n
it,
p
ar
ticu
lar
l
y
f
o
r
th
o
s
e
wh
o
tak
e
o
n
th
e
r
o
le
o
f
h
o
u
s
em
o
th
e
r
s
.
A
h
o
u
s
eh
o
ld
e
r
's
m
u
ltifa
ce
ted
d
u
ty
as
a
ca
r
eg
iv
er
f
o
r
ch
ild
r
en
,
a
h
u
s
b
an
d
,
an
d
an
ad
m
in
is
tr
ato
r
o
f
th
e
h
o
m
e
leav
es
h
er
o
p
en
to
th
e
d
am
ag
i
n
g
ef
f
ec
ts
o
f
s
tr
o
k
es.
Fu
r
th
er
m
o
r
e,
th
er
e
is
an
in
cr
ea
s
ed
r
is
k
o
f
s
tr
o
k
e
f
o
r
th
o
s
e
wh
o
ar
e
s
ed
en
tar
y
o
r
u
n
em
p
lo
y
ed
.
A
lack
o
f
p
h
y
s
ical
ex
er
ci
s
e
m
ay
b
e
th
e
ca
u
s
e
o
f
th
is
ill
n
ess
,
as
it
ca
n
lead
to
im
p
air
ed
b
lo
o
d
f
lo
w
th
r
o
u
g
h
o
u
t
th
e
b
o
d
y
an
d
a
lack
o
f
m
u
s
cu
lar
m
o
b
ilit
y
.
Fu
r
th
er
m
o
r
e,
a
c
o
r
r
elatio
n
h
as
b
ee
n
o
b
s
er
v
e
d
b
etwe
en
th
e
d
e
g
r
ee
o
f
wo
r
k
-
r
elate
d
s
tr
ess
an
d
an
elev
ated
r
is
k
o
f
h
ea
r
t
d
is
ea
s
e
in
two
d
is
tin
ct
d
em
o
g
r
a
p
h
ic
g
r
o
u
p
s
: m
id
d
le
-
a
g
ed
wo
m
en
an
d
m
en
a
g
ed
5
0
an
d
ab
o
v
e
[
1
8
]
.
T
h
e
s
ig
n
if
ican
ce
o
f
t
h
is
f
ac
to
r
in
r
elatio
n
to
s
tr
o
k
e
r
is
k
was
u
n
d
er
s
co
r
ed
b
y
th
e
h
i
g
h
p
r
e
v
alen
ce
o
f
h
y
p
er
ten
s
io
n
h
is
to
r
y
(
5
2
.
4
%)
.
Stra
teg
ies
f
o
r
p
r
ev
e
n
tin
g
s
tr
o
k
e
in
t
h
is
p
o
p
u
latio
n
m
ay
p
lace
a
s
ig
n
if
ican
t
em
p
h
asis
o
n
th
e
m
an
ag
e
m
en
t
an
d
p
r
ev
e
n
tio
n
o
f
h
y
p
er
ten
s
io
n
.
W
h
eth
er
it
is
an
i
s
ch
em
ic
o
r
h
em
o
r
r
h
a
g
ic
s
tr
o
k
e,
h
y
p
er
ten
s
io
n
is
a
s
u
b
s
tan
tial
r
is
k
f
ac
to
r
[
1
9
]
.
I
n
cr
ea
s
ed
p
er
ip
h
er
al
b
lo
o
d
p
r
ess
u
r
e
f
r
o
m
h
y
p
e
r
ten
s
io
n
r
esu
lts
in
a
f
au
lty
h
em
o
d
y
n
a
m
ic
s
y
s
tem
,
th
ick
er
b
lo
o
d
v
es
s
els,
an
d
h
ea
r
t
m
u
s
cle
h
y
p
er
tr
o
p
h
y
[
2
0
]
.
I
t
ca
n
b
e
m
ad
e
wo
r
s
e
b
y
th
e
p
atien
t's
h
ab
it
o
f
s
m
o
k
in
g
,
co
n
s
u
m
i
n
g
f
o
o
d
s
h
ig
h
i
n
f
at,
an
d
u
s
in
g
a
lo
t
o
f
s
alt,
all
o
f
wh
ich
ca
n
ca
u
s
e
p
laq
u
e
ath
e
r
o
s
cler
o
s
is
.
Ag
e,
g
en
d
er
,
an
ce
s
tr
y
,
r
ac
e,
d
iab
etes
m
ellitu
s
,
h
i
g
h
b
lo
o
d
p
r
ess
u
r
e,
h
ig
h
c
h
o
lest
er
o
l,
s
m
o
k
in
g
[
2
1
]
,
ath
er
o
s
cler
o
s
is
,
h
ea
r
t
d
i
s
ea
s
e,
o
b
esit
y
,
alco
h
o
l
in
ta
k
e,
s
tr
ess
,
f
av
o
r
a
b
le
s
o
cio
ec
o
n
o
m
ic
cir
c
u
m
s
tan
ce
s
,
p
o
o
r
ea
tin
g
h
ab
its
,
in
s
u
f
f
ici
en
t
p
h
y
s
ical
ac
tiv
ity
,
an
d
u
s
e
o
f
an
ti
-
p
r
eg
n
an
cy
m
ed
icatio
n
s
ar
e
s
o
m
e
o
f
th
e
f
ac
to
r
s
th
at
ca
n
in
f
lu
e
n
ce
th
e
r
is
k
o
f
s
tr
o
k
e
[
2
2
]
.
Stro
k
es
ca
n
b
e
ca
u
s
ed
b
y
a
v
ar
iety
o
f
co
n
d
itio
n
s
,
in
clu
d
in
g
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
[
2
3
]
.
M
o
s
t in
d
iv
id
u
als ex
p
er
ien
ce
th
ei
r
f
ir
s
t stro
k
e
with
in
a
m
o
n
th
o
r
less
.
I
n
o
r
d
er
to
le
s
s
en
th
e
ef
f
ec
ts
o
f
s
tr
o
k
es,
th
i
s
ca
n
f
o
cu
s
atten
tio
n
o
n
ea
r
ly
d
etec
tio
n
in
itiativ
es
an
d
ea
r
ly
t
r
ea
tm
en
ts
f
o
llo
win
g
th
e
in
itial a
s
s
au
lt.
T
ab
le
1
.
His
to
r
y
o
f
s
tr
o
k
e
a
n
d
r
esp
o
n
s
e
f
ea
tu
r
es
V
a
r
i
a
b
l
e
N
u
mb
e
r
(
%)
A
g
e
g
r
o
u
p
(
y
e
a
r
)
30
-
4
0
y
e
a
r
s
40
-
5
0
y
e
a
r
s
50
-
6
0
y
e
a
r
s
>
6
0
y
e
a
r
s
1
(
4
.
8
)
4
(
1
9
)
8
(
3
8
.
1
)
8
(
3
8
.
1
)
G
e
n
d
e
r
M
e
n
W
o
ma
n
1
1
(
5
2
.
4
)
1
0
(
4
7
.
6
)
Le
v
e
l
o
f
e
d
u
c
a
t
i
o
n
N
o
sc
h
o
o
l
El
e
m
e
n
t
a
r
y
s
c
h
o
o
l
Ju
n
i
o
r
h
i
g
h
sc
h
o
o
l
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
C
o
l
l
e
g
e
1
(
4
.
8
)
3
(
1
4
.
3
)
2
(
9
.
5
)
1
0
(
4
7
.
6
)
5
(
2
3
.
8
)
H
i
st
o
r
y
o
f
d
i
s
e
a
s
e
;
D
i
a
b
e
t
e
s m
e
l
l
i
t
u
s
H
y
p
e
r
t
e
n
si
o
n
D
i
a
b
e
t
e
s m
e
l
l
i
t
u
s
a
n
d
h
y
p
e
r
t
e
n
s
i
o
n
3
(
1
4
.
3
)
1
1
(
5
2
.
4
)
7
(
3
3
.
3
)
Lo
n
g
st
r
o
k
e
<
1
mo
n
t
h
6
m
o
n
t
h
s
-
1
y
e
a
r
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9
(
9
0
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2
(
9
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S
t
r
o
k
e
h
i
s
t
o
r
y
N
e
v
e
r
I
'v
e
n
e
v
e
r
b
e
e
n
1
8
(
8
5
.
7
)
3
(
1
4
.
3
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
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14
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1
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Ma
r
ch
20
25
:
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88
3
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2
.
Dis
t
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n o
f
depr
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o
n lev
els
Dep
r
ess
io
n
lev
els
b
ef
o
r
e
d
is
ch
ar
g
e
p
lan
n
i
n
g
wer
e
o
b
tain
ed
o
n
an
a
p
p
licatio
n
b
asis
.
T
h
e
1
2
p
atien
ts
,
o
r
5
7
.
1
%,
h
ad
n
o
r
m
al
d
ep
r
es
s
io
n
;
two
p
atien
ts
,
o
r
9
.
5
%,
h
ad
m
ild
d
ep
r
ess
io
n
;
one
p
atien
t,
o
r
4
.
8
%,
h
a
d
m
o
d
er
ate
d
ep
r
ess
io
n
;
t
h
r
ee
p
a
tien
ts
,
o
r
1
4
.
3
%,
h
ad
s
ev
er
e
d
ep
r
ess
io
n
;
an
d
th
r
ee
p
atien
ts
,
o
r
1
4
.
3
%,
h
ad
v
er
y
s
ev
er
e
d
e
p
r
ess
io
n
.
Dep
r
ess
io
n
r
ates
a
f
ter
g
iv
en
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
er
p
lan
n
i
n
g
wer
e
ac
h
iev
e
d
o
n
1
4
p
atien
ts
,
o
r
6
6
.
7
%,
wh
o
h
a
d
n
o
r
m
al
d
e
p
r
ess
io
n
s
;
f
o
u
r
p
atien
ts
,
o
r
1
9
%,
h
ad
m
ild
d
e
p
r
ess
io
n
s
;
th
r
ee
p
atien
ts
,
o
r
1
4
.
3
%,
h
ad
m
o
d
e
r
ate
d
e
p
r
ess
io
n
;
an
d
0
(
0
.
0
%)
p
atien
ts
h
ad
s
ev
er
e
an
d
v
er
y
s
er
io
u
s
d
ep
r
ess
io
n
as
p
r
esen
ted
in
T
ab
le
2
.
Fo
llo
win
g
th
e
im
p
lem
en
tatio
n
o
f
ap
p
licatio
n
-
b
ased
d
is
ch
a
r
g
e
p
lan
n
in
g
,
th
e
o
v
er
all
d
ep
r
ess
io
n
r
ate
am
o
n
g
s
tr
o
k
e
p
atien
ts
in
cr
ea
s
ed
[
2
4
]
.
T
h
e
p
er
ce
n
ta
g
e
o
f
p
at
ien
ts
wh
o
in
itially
h
ad
n
o
r
m
al
d
ep
r
ess
io
n
r
o
s
e
to
6
6
.
7
%
f
r
o
m
th
e
in
itial
5
7
.
1
%.
T
h
is
s
u
g
g
ests
th
at
u
s
in
g
d
is
ch
ar
g
e
p
la
n
n
i
n
g
h
as
s
o
m
e
p
o
s
i
tiv
e
p
o
ten
tial.
T
h
e
d
ec
lin
e
in
th
e
p
r
ev
alen
ce
o
f
s
ev
er
e
an
d
v
er
y
s
ev
er
e
d
ep
r
es
s
io
n
d
eser
v
es
p
ar
ticu
lar
em
p
h
asis
.
T
h
e
1
4
.
3
%
o
f
p
atien
ts
h
ad
ex
t
r
em
ely
s
ev
e
r
e
d
ep
r
ess
io
n
,
an
d
1
4
.
3
%
h
ad
s
ev
er
e
d
ep
r
ess
io
n
b
e
f
o
r
e
th
e
in
ter
v
en
tio
n
.
Nev
er
th
eless
,
n
o
n
e
o
f
t
h
e
p
ati
en
ts
r
ep
o
r
ted
m
ajo
r
d
ep
r
ess
io
n
d
u
r
in
g
t
h
eir
d
is
ch
ar
g
e
p
lan
n
in
g
.
T
h
is
in
d
icate
s
th
at
th
e
in
ter
v
en
tio
n
was
s
u
cc
ess
f
u
l
in
lo
wer
in
g
g
r
ea
ter
lev
els
o
f
d
ep
r
ess
io
n
,
wh
ich
is
a
f
av
o
r
a
b
le
o
u
tco
m
e.
W
h
ile
th
er
e
h
as
b
ee
n
an
o
v
er
all
im
p
r
o
v
em
en
t,
it
s
h
o
u
ld
b
e
h
ig
h
lig
h
ted
th
at
1
9
%
o
f
p
ati
en
ts
s
til
l
h
av
e
m
ild
d
ep
r
ess
io
n
f
o
llo
win
g
tr
ea
tm
e
n
ts
.
I
t
im
p
lies
th
at,
in
o
r
d
er
to
d
ea
l
with
m
ild
er
ca
s
es
o
f
d
ep
r
ess
io
n
m
o
r
e
s
u
cc
ess
f
u
lly
,
th
e
in
ter
v
en
tio
n
m
ay
n
ee
d
to
b
e
m
o
d
if
ied
o
r
c
h
an
g
ed
.
Dep
r
ess
io
n
is
a
h
ig
h
ly
p
r
ev
a
l
en
t
clin
ical
s
ig
n
am
o
n
g
s
tr
o
k
e
v
ictim
s
[
2
5
]
.
M
o
o
d
d
is
o
r
d
e
r
s
,
s
u
ch
as
d
ep
r
ess
io
n
,
ar
e
em
o
tio
n
al
co
n
d
itio
n
s
th
at
p
er
s
is
t
an
d
im
p
ac
t
m
en
tal
f
u
n
ctio
n
s
,
in
clu
d
in
g
th
in
k
in
g
,
em
o
tio
n
s
,
an
d
b
e
h
av
io
r
[
2
6
]
.
T
h
is
is
a
r
e
s
u
lt
o
f
th
e
p
atien
t
's
ig
n
o
r
a
n
ce
ab
o
u
t
s
tr
o
k
e
tr
ea
tm
en
t.
A
f
ew
p
atien
ts
ex
p
r
ess
ed
th
eir
co
n
f
u
s
io
n
r
eg
ar
d
in
g
th
e
n
ex
t
c
o
u
r
s
e
o
f
tr
e
atm
en
t
if
t
h
ey
wer
e
r
ec
eiv
in
g
it
at
h
o
m
e.
I
n
ad
d
itio
n
,
th
e
p
atien
t
h
as
lo
w
s
elf
-
esteem
a
s
a
r
esu
lt
o
f
th
eir
s
tr
o
k
e
-
r
elate
d
in
ca
p
ac
ity
o
r
im
p
air
m
en
t
an
d
th
eir
n
eg
ativ
e
th
o
u
g
h
ts
,
wh
ich
tr
ig
g
e
r
th
e
s
tar
t
o
f
d
ep
r
ess
io
n
.
Dep
r
ess
io
n
tr
ea
tm
en
t
f
o
r
s
tr
o
k
e
v
ictim
s
in
v
o
lv
es
ex
p
ed
ited
r
eh
ab
ilit
atio
n
an
d
h
ea
lin
g
o
f
s
tr
o
k
e
-
r
elate
d
illn
ess
es
[
2
7
]
.
Po
s
t
-
s
tr
o
k
e
d
ep
r
ess
io
n
ca
n
b
e
b
r
o
u
g
h
t
o
n
b
y
a
n
u
m
b
er
o
f
th
in
g
s
,
s
u
ch
as
g
en
d
er
,
a
h
is
to
r
y
o
f
d
ep
r
ess
io
n
,
s
o
cio
ec
o
n
o
m
ic
cir
cu
m
s
tan
ce
s
in
th
e
f
am
ily
,
an
d
b
r
ain
i
n
ju
r
y
.
Stro
k
e
v
ictim
s
'
r
ates
o
f
d
ep
r
ess
io
n
m
ay
b
e
in
f
lu
en
ce
d
b
y
th
eir
f
am
ilies
'
p
r
o
v
is
io
n
o
f
b
o
th
m
ater
ial
an
d
m
o
r
al
s
u
p
p
o
r
t
[
2
8
]
.
Data
s
h
o
win
g
a
d
ec
lin
e
in
th
e
r
ate
o
f
d
ep
r
ess
io
n
wer
e
ac
q
u
ir
ed
b
ased
o
n
t
h
e
s
tu
d
y
's
f
in
d
in
g
s
.
T
h
is
is
d
u
e
t
o
t
h
e
f
ac
t
th
at
m
o
s
t
s
tr
o
k
e
p
at
ien
ts
s
ee
a
r
ed
u
ctio
n
in
th
eir
d
eg
r
ee
o
f
d
ep
r
ess
io
n
f
o
llo
win
g
d
is
ch
ar
g
e
p
lan
n
in
g
.
T
h
is
is
b
ec
au
s
e
ea
ch
p
atien
t
h
as
a
d
if
f
er
en
t
lev
el
o
f
awa
r
e
n
ess
wh
en
it
co
m
es
to
th
e
d
is
ch
ar
g
e
p
lan
n
in
g
t
h
at
h
as
b
ee
n
p
r
o
v
id
ed
f
o
r
th
eir
s
tr
o
k
e,
a
s
well
as
h
o
w
th
e
p
atien
t
h
as
r
esp
o
n
d
ed
t
o
co
p
in
g
with
is
s
u
es a
s
s
o
ciate
d
with
th
eir
s
tr
o
k
e
[
2
9
]
.
3
.
3
.
Dis
t
ributio
n o
f
a
nx
iet
y
l
ev
els
T
h
e
lev
el
o
f
em
er
g
e
n
cy
p
r
io
r
to
th
e
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
was
o
b
tain
ed
:
two
p
eo
p
le,
o
r
9
.
5
%,
h
ad
m
ild
a
n
x
iety
,
th
r
ee
p
eo
p
le,
o
r
1
4
.
3
%,
h
ad
m
o
d
er
ate
an
x
ieties,
two
p
e
o
p
le,
o
r
9
.
5
%,
h
ad
s
ev
er
e
an
x
ieties,
an
d
f
i
v
e
p
eo
p
le,
o
r
2
3
.
8
%,
h
a
d
v
er
y
s
ev
er
e
alar
m
s
as
p
r
esen
ted
in
T
ab
l
e
3
.
Fo
llo
win
g
th
e
im
p
lem
en
tatio
n
o
f
a
p
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
,
th
e
ty
p
ical
lev
el
o
f
em
er
g
en
cy
s
ig
n
if
ican
tly
in
cr
ea
s
ed
.
Fro
m
4
2
.
9
%
o
f
p
at
ien
ts
p
r
io
r
to
i
n
ter
v
en
tio
n
to
8
5
.
7
%
f
o
llo
win
g
in
ter
v
en
tio
n
,
th
is
in
d
icate
s
t
h
at
m
o
s
t
p
atien
ts
'
an
x
iety
le
v
els
h
av
e
b
ee
n
p
o
s
itiv
ely
im
p
ac
te
d
b
y
th
e
in
ter
v
en
tio
n
.
Prio
r
to
th
e
in
ter
v
en
tio
n
,
9
.
5
%
o
f
p
atien
ts
h
ad
s
ev
er
e
an
x
iety
,
2
3
.
8
%
h
ad
v
er
y
s
ev
e
r
e
an
x
iety
,
an
d
1
4
.
3
%
o
f
p
ati
en
ts
h
ad
m
o
d
er
ate
an
x
iety
.
T
h
is
im
p
lies
th
at
lo
w
er
in
g
an
x
ie
ty
lev
els
to
h
ig
h
e
r
lev
els
m
ay
b
e
ac
co
m
p
lis
h
ed
b
y
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
.
As
a
r
es
u
lt,
ad
d
itio
n
al
ass
ess
m
en
t
o
f
th
e
v
ar
iab
les
th
at
co
u
ld
lea
d
to
th
is
d
eg
r
ee
o
f
em
er
g
en
cy
is
r
eq
u
ir
ed
,
a
n
d
in
t
er
v
en
tio
n
tactics sh
o
u
ld
b
e
m
o
d
if
ied
as n
ee
d
e
d
[
3
0
]
.
Acc
o
r
d
in
g
to
th
is
s
tu
d
y
,
s
tr
o
k
e
p
atien
ts
f
ee
l
an
x
io
u
s
[
3
1
]
p
r
io
r
to
r
ec
eiv
in
g
ass
is
tan
ce
b
ec
au
s
e
th
ey
d
o
n
't
k
n
o
w
en
o
u
g
h
ab
o
u
t
h
o
w
a
s
tr
o
k
e
is
p
er
f
o
r
m
e
d
an
d
b
ec
au
s
e
th
er
e
c
o
u
ld
b
e
m
o
r
e
s
ig
n
if
ican
t
p
r
o
b
lem
s
.
R
esp
o
n
d
en
ts
r
ep
o
r
t
ex
p
e
r
ien
ci
n
g
a
v
ar
iety
o
f
s
y
m
p
to
m
s
,
s
u
ch
as
r
eg
u
lar
wo
r
r
y
,
f
ea
r
,
an
d
s
leep
d
if
f
icu
lties
.
A
s
ig
n
if
ican
t
co
n
tr
ib
u
tin
g
elem
en
t
to
an
x
iety
th
at
co
m
p
r
o
m
is
es
em
o
tio
n
al
s
tab
ili
ty
is
a
h
ig
h
f
ea
r
o
f
d
y
in
g
.
Mo
to
r
ab
n
o
r
m
alities
,
v
er
b
al
co
m
m
u
n
icatio
n
im
p
air
m
en
ts
,
p
er
ce
p
tu
al
im
p
air
m
en
ts
,
co
g
n
itiv
e
d
y
s
f
u
n
ctio
n
,
p
s
y
ch
o
s
o
cial
p
r
o
b
lem
s
,
an
d
b
l
ad
d
er
d
y
s
f
u
n
ctio
n
s
ar
e
all
b
r
o
u
g
h
t
o
n
b
y
s
tr
o
k
e
[
3
2
]
,
[
3
3
]
.
S
tr
o
k
es
ca
n
r
esu
lt
in
in
co
r
r
ec
t
r
o
u
te
p
atter
n
s
,
p
ain
an
d
s
u
b
lo
ca
tio
n
o
n
t
h
e
af
f
e
cted
p
o
r
tio
n
,
a
n
d
p
ar
aly
s
is
,
p
ar
ticu
lar
ly
o
n
th
e
af
f
ec
ted
s
id
e.
C
o
n
s
eq
u
e
n
tly
,
s
tr
o
k
e
v
ictim
s
ex
p
er
ien
ce
an
x
i
e
ty
as
a
r
esu
lt
o
f
a
d
ec
lin
e
in
b
o
d
ily
f
u
n
ctio
n
th
at
im
p
ac
ts
d
ay
-
to
-
d
ay
ac
tiv
ities
.
Acc
o
r
d
in
g
t
o
th
e
s
tu
d
y
's
f
in
d
in
g
s
,
s
tr
o
k
e
v
ictim
s
'
an
x
iety
d
ec
r
ea
s
ed
f
o
llo
win
g
in
ter
v
e
n
tio
n
.
Go
o
d
d
is
ch
ar
g
e
p
lan
n
in
g
ca
n
lo
wer
th
e
r
is
k
o
f
d
ea
th
,
lo
wer
tr
ea
t
m
en
t
co
s
ts
,
lo
we
r
th
e
lik
elih
o
o
d
o
f
r
ec
u
r
r
en
ce
o
r
r
elap
s
e,
b
o
o
s
t
p
atien
t
an
d
f
a
m
ily
s
atis
f
ac
tio
n
,
lo
wer
f
am
ily
wo
r
r
y
,
an
d
lo
wer
c
o
m
p
lica
tio
n
s
o
n
ce
p
atien
ts
r
etu
r
n
h
o
m
e
[
3
4
]
.
Acc
o
r
d
in
g
to
s
tu
d
y
f
in
d
in
g
s
,
s
tr
o
k
e
p
atie
n
ts
wh
o
r
ec
eiv
e
d
a
n
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
in
ter
v
en
tio
n
s
aw
a
r
e
d
u
ctio
n
in
th
eir
an
x
iety
.
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
Op
timiz
in
g
p
a
tien
t m
en
ta
l h
ea
lth
o
u
tco
mes:
th
e
imp
a
ct
o
f sma
r
tp
h
o
n
e
-
b
a
s
ed
…
(
Dw
i R
etn
a
n
in
g
s
ih
)
89
T
ab
le
2
.
Dep
r
ess
io
n
b
e
f
o
r
e
a
n
d
af
ter
in
ter
v
en
tio
n
D
e
p
r
e
ss
i
o
n
P
r
e
t
e
s
t
P
o
st
t
e
s
t
F
r
e
q
u
e
n
c
y
%
F
r
e
q
u
e
n
c
y
%
N
o
r
mal
12
5
7
.
1
14
6
6
.
7
M
i
l
d
2
9
.
5
4
19
M
o
d
e
r
a
t
e
1
4
.
8
3
1
4
.
3
S
e
v
e
r
e
3
1
4
.
3
-
-
V
e
r
y
s
e
v
e
r
e
3
1
4
.
3
-
-
T
o
t
a
l
21
1
0
0
21
1
0
0
T
ab
le
3
.
An
x
iety
lev
els b
e
f
o
r
e
an
d
af
ter
i
n
ter
v
en
tio
n
A
n
x
i
e
t
y
P
r
e
t
e
s
t
P
o
st
t
e
s
t
F
r
e
q
u
e
n
c
y
%
F
r
e
q
u
e
n
c
y
%
N
o
r
mal
9
4
2
.
9
18
8
5
.
7
M
i
l
d
2
9
.
5
-
-
M
o
d
e
r
a
t
e
3
1
4
.
3
3
1
4
.
3
S
e
v
e
r
e
2
9
.
5
-
-
V
e
r
y
s
e
v
e
r
e
5
2
3
.
8
-
-
T
o
t
a
l
21
1
0
0
21
1
0
0
3
.
4
.
Dis
t
ributio
n o
f
s
t
r
ess
le
v
els
F
o
u
r
teen
p
eo
p
le,
o
r
6
6
.
6
%,
h
ad
n
o
r
m
al
s
tr
ess
,
th
r
ee
p
eo
p
le
,
o
r
1
4
.
3
%,
h
ad
m
ild
s
tr
ess
,
o
n
e
p
er
s
o
n
,
o
r
4
.
8
%,
h
a
d
m
o
d
er
ate
s
tr
ess
,
th
r
ee
p
eo
p
le,
o
r
1
4
.
3
%,
h
ad
s
ev
er
e
s
tr
ess
.
No
r
esp
o
n
d
en
ts
ex
p
er
ien
ce
d
s
ev
er
e
s
tr
ess
af
ter
b
ein
g
g
iv
en
ap
p
l
icatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
as
s
h
o
wn
in
T
ab
le
4
.
N
o
r
m
al
s
tr
ess
lev
els
s
ig
n
if
ican
tly
in
cr
ea
s
ed
with
th
e
im
p
lem
en
tatio
n
o
f
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
i
n
g
.
T
h
e
9
5
.
2
%
o
f
p
atien
ts
f
o
llo
win
g
in
ter
v
en
tio
n
co
m
p
a
r
ed
to
6
6
.
6
%
b
ef
o
r
e
it.
T
h
is
im
p
lies
th
at
m
o
s
t
p
atien
ts
m
ay
b
en
ef
it
f
r
o
m
s
u
ch
in
ter
v
e
n
tio
n
s
in
ter
m
s
o
f
s
tr
ess
r
ed
u
ctio
n
.
T
h
e
1
4
.
3
%
o
f
p
atien
ts
r
ep
o
r
ted
lig
h
t
s
tr
es
s
,
4
.
8
%
r
ep
o
r
ted
m
o
d
er
ate
s
tr
ess
,
an
d
1
4
.
3
%
r
e
p
o
r
ted
s
ev
er
e
s
tr
ess
p
r
io
r
to
th
e
in
ter
v
en
tio
n
.
B
u
t
ju
s
t
4
.
8
%
o
f
p
atien
ts
h
ad
m
ild
s
y
m
p
to
m
s
f
o
llo
win
g
in
ter
v
e
n
tio
n
,
an
d
n
o
n
e
o
f
t
h
e
r
esp
o
n
d
en
ts
h
a
d
s
ev
er
e
o
r
ex
tr
em
ely
s
ev
er
e
s
y
m
p
to
m
s
.
T
h
is
d
em
o
n
s
tr
ates
h
o
w
well
th
e
in
ter
v
e
n
tio
n
w
o
r
k
ed
to
lo
we
r
s
tr
ess
lev
els
at
an
elev
ated
lev
el.
4
.
8
%
o
f
p
atien
ts
c
o
n
tin
u
e
d
to
ex
p
er
ie
n
ce
m
ild
s
tr
ess
f
o
llo
w
in
g
in
ter
v
en
tio
n
,
d
esp
ite
t
h
e
m
ajo
r
ity
o
f
p
atien
ts
ex
p
er
ien
cin
g
a
r
is
e
in
n
o
r
m
al
s
tr
ess
lev
els.
A
s
a
r
esu
lt,
it's
cr
itical
to
ass
ess
th
e
v
ar
iab
les
th
at
co
n
tr
ib
u
te
t
o
s
tr
ess
in
th
is
p
o
p
u
latio
n
an
d
th
in
k
ab
o
u
t m
o
d
if
y
in
g
o
r
e
x
p
an
d
in
g
th
er
a
p
eu
tic
tech
n
iq
u
es.
T
ab
le
4
.
Stre
s
s
lev
els b
ef
o
r
e
a
n
d
af
ter
i
n
ter
v
en
tio
n
S
t
r
e
ss
P
r
e
t
e
s
t
P
o
st
t
e
s
t
F
r
e
q
u
e
n
c
y
%
F
r
e
q
u
e
n
c
y
%
N
o
r
mal
14
6
6
.
6
20
9
5
.
2
M
i
l
d
3
1
4
.
3
1
4
.
8
M
o
d
e
r
a
t
e
1
4
.
8
-
-
S
e
v
e
r
e
3
1
4
.
3
-
-
V
e
r
y
s
e
v
e
r
e
-
-
-
-
T
o
t
a
l
21
1
0
0
21
1
0
0
Du
e
to
th
e
n
ee
d
to
ad
ju
s
t
to
t
h
e
p
h
y
s
ical
ch
an
g
es
b
r
o
u
g
h
t
o
n
b
y
th
e
s
tr
o
k
e,
s
o
m
e
p
atien
ts
ex
p
r
ess
co
m
p
lain
ts
ab
o
u
t
f
ee
lin
g
s
tu
f
f
ed
.
I
f
th
e
p
atien
t
f
ee
ls
u
s
eless
an
d
is
u
n
ab
le
to
p
er
f
o
r
m
th
e
a
ctiv
ity
f
r
o
m
b
ef
o
r
e
th
e
s
tr
o
k
e,
th
ey
g
et
f
ea
r
f
u
l.
Du
e
to
a
n
x
iety
an
d
th
eir
p
h
y
s
ical
in
ca
p
ac
ity
to
ca
r
r
y
o
u
t
r
eg
u
lar
task
s
,
s
tr
o
k
e
v
ictim
s
ex
p
er
ien
ce
s
tr
ess
[
3
5
]
,
wh
ich
m
a
k
es
th
em
f
ee
l
wo
r
t
h
less
.
T
h
eir
q
u
ality
o
f
life
is
im
p
ac
ted
,
a
n
d
th
ey
f
ee
l
wo
r
th
less
as
a
r
esu
lt
o
f
th
is
s
tr
ess
.
S
tr
ess
-
r
elate
d
o
u
tco
m
es
f
r
o
m
ac
u
te
s
tr
o
k
e
ep
is
o
d
es
ca
n
in
clu
d
e
h
o
s
tili
ty
,
lo
w
s
elf
-
esteem
,
s
e
l
f
-
r
ejec
tio
n
,
s
tr
ess
,
m
alf
u
n
ctio
n
,
an
d
m
o
r
tality
.
Patien
ts
m
a
y
ex
p
er
ien
ce
s
tr
ess
d
u
e
to
th
eir
f
ea
r
a
n
d
lack
o
f
k
n
o
wled
g
e
a
b
o
u
t th
eir
illn
ess
[
2
7
]
.
T
h
e
s
tu
d
y
's
f
in
d
in
g
s
s
h
o
w
th
at,
af
ter
r
ec
eiv
in
g
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
,
2
0
r
esp
o
n
d
en
ts
,
o
r
9
5
.
2
%,
r
ep
o
r
ted
n
o
r
m
al
s
tr
ess
,
one
r
esp
o
n
d
en
t,
o
r
4
.
8
%,
ex
p
er
ien
ce
d
m
ild
s
tr
ess
,
an
d
0
%
o
f
r
esp
o
n
d
en
ts
,
o
r
n
o
n
e
at
all,
s
u
f
f
er
ed
s
ev
e
r
e
an
d
v
e
r
y
s
ev
er
e
s
tr
ess
.
Fo
llo
win
g
ap
p
licat
io
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
,
p
atien
ts
g
ain
k
n
o
wl
ed
g
e
o
n
h
o
w
s
tr
o
k
es
ar
e
im
p
le
m
en
ted
,
in
clu
d
in
g
wh
at
th
ey
n
ee
d
to
ea
t
an
d
h
o
w
m
u
ch
p
h
y
s
ical
ac
tiv
ity
to
d
o
[
3
6
]
.
So
m
e
p
atie
n
ts
h
ad
a
r
e
d
u
ctio
n
i
n
s
tr
ess
f
r
o
m
s
ev
e
r
e
to
m
ild
d
ep
r
ess
io
n
f
o
llo
win
g
an
a
p
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
i
n
g
in
ter
v
en
tio
n
,
wh
ile
th
o
s
e
wh
o
wer
e
al
r
ea
d
y
ex
p
er
ien
cin
g
s
tr
ess
s
aw
th
eir
s
tr
es
s
lev
els
d
r
o
p
to
m
ild
o
r
ev
e
n
n
o
r
m
al.
T
h
is
i
s
a
r
esu
lt
o
f
ea
ch
p
atien
t's
o
wn
lev
el
o
f
co
m
p
r
eh
e
n
s
io
n
o
f
th
e
s
tr
o
k
e
t
h
ey
h
av
e
ex
p
er
ien
ce
d
as
well
as
th
eir
r
ea
ctio
n
to
d
ea
lin
g
with
is
s
u
es
a
s
s
o
ciate
d
with
th
e
d
is
ea
s
e
[
3
7
]
.
3
.
5
.
E
f
f
ec
t
s
o
f
dis
cha
rg
e
pla
nn
ing
o
n lev
els o
f
depr
e
s
s
io
n
,
a
nx
iet
y
,
a
nd
s
t
r
ess
T
h
e
d
is
ch
ar
g
e
p
lan
n
i
n
g
in
ter
v
en
tio
n
r
ec
eiv
ed
a
n
eg
ativ
e
r
a
n
k
o
f
2
0
at
th
e
d
ep
r
ess
io
n
lev
el,
a
p
o
s
itiv
e
r
an
k
o
f
0
,
a
tie
v
alu
e
o
f
1
,
a
n
d
o
th
er
r
atin
g
s
th
at
in
d
icate
d
a
ch
an
g
e
in
th
e
r
esp
o
n
d
e
n
ts
'
d
ep
r
ess
io
n
lev
els
f
r
o
m
b
ef
o
r
e
an
d
af
ter
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
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p
lan
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in
g
.
On
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r
esp
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en
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p
o
r
t
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T
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T
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r
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t n
o
t c
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i
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g
it.
Evaluation Warning : The document was created with Spire.PDF for Python.
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I
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14
,
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1
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Ma
r
ch
20
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:
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90
B
ased
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ased
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n
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in
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e
was
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th
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ess
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e
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e
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icate
s
a
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ze
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p
o
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esis
(
Ho
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d
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ce
p
ta
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ce
o
f
th
e
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er
n
ativ
e
h
y
p
o
th
esis
(
Ha)
,
it
m
a
y
b
e
co
n
cl
u
d
ed
th
a
t
d
is
ch
ar
g
e
p
lan
n
in
g
h
as
an
i
m
p
ac
t
o
n
s
tr
o
k
e
p
atien
ts
'
lev
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ls
o
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tr
ess
,
an
x
iety
,
an
d
d
e
p
r
ess
io
n
as p
r
esen
ted
in
T
ab
le
5
.
T
ab
le
5
.
E
f
f
ec
ts
o
f
d
is
ch
ar
g
e
p
lan
n
in
g
o
n
lev
els o
f
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
s
tr
ess
F
r
e
q
u
e
n
c
y
D
e
p
r
e
ss
i
o
n
A
n
x
i
e
t
y
S
t
r
e
ss
p
-
v
a
l
u
e
N
e
g
a
t
i
v
e
r
a
n
k
s
20
20
19
0
.
0
0
0
*
P
o
si
t
i
v
e
r
a
n
k
s
0
0
0
T
i
e
s
1
1
2
N
o
t
e
s
:
*
me
a
n
s
p
-
v
a
l
u
e
≤
0
.
0
0
5
Patien
ts
wh
o
h
av
e
h
ad
a
s
tr
o
k
e
m
ay
f
ee
l
an
x
io
u
s
,
s
tr
ess
ed
,
o
r
d
ep
r
ess
ed
[
3
8
]
.
All
th
in
g
s
co
n
s
id
er
ed
,
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
h
as
b
ee
n
s
h
o
wn
to
b
e
s
u
cc
ess
f
u
l
in
lo
wer
in
g
s
tr
o
k
e
p
atien
ts
'
lev
els
o
f
s
tr
ess
,
an
x
iety
,
an
d
d
ep
r
ess
io
n
.
T
h
ese
f
in
d
in
g
s
b
ac
k
u
p
th
e
id
ea
o
f
in
c
o
r
p
o
r
atin
g
ap
p
-
b
a
s
ed
tech
n
o
lo
g
y
in
to
s
tr
o
k
e
p
atien
ts
'
r
ec
o
v
er
y
p
lan
s
to
en
h
a
n
ce
th
eir
m
en
tal
h
ea
lt
h
.
Fo
llo
win
g
im
p
lem
en
tatio
n
o
f
th
is
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
i
n
g
in
ter
v
en
tio
n
,
p
atien
ts
r
ep
o
r
t
in
c
r
ea
s
ed
co
m
p
r
eh
e
n
s
io
n
,
ze
al,
an
d
o
v
er
all
well
-
b
ein
g
.
T
h
e
q
u
ality
o
f
life
an
d
ev
e
r
y
d
ay
ac
tiv
ities
o
f
s
tr
o
k
e
p
atien
ts
will
im
p
r
o
v
e
with
p
r
o
p
er
d
is
c
h
ar
g
e
p
la
n
n
in
g
an
d
f
am
ily
p
r
e
p
ar
atio
n
to
ca
r
e
f
o
r
th
em
.
E
n
h
an
ce
d
p
h
y
s
ical
ac
tiv
ity
,
av
o
id
in
g
h
ea
lth
is
s
u
es,
m
e
d
icatio
n
ad
h
er
en
ce
b
y
p
atien
ts
,
an
d
r
eg
u
lar
illn
e
s
s
m
an
ag
em
en
t
ar
e
a
f
ew
ex
am
p
les.
I
n
o
r
d
e
r
to
d
ev
elo
p
a
tech
n
o
lo
g
y
-
d
r
i
v
en
d
is
ch
ar
g
e
p
lan
n
in
g
s
y
s
tem
th
a
t
f
ac
ilit
ates
th
e
f
am
ily
o
f
a
s
tr
o
k
e
p
atien
t's
ac
ce
s
s
to
in
f
o
r
m
atio
n
,
th
e
d
is
ch
ar
g
e
p
lan
n
er
n
ee
d
s
to
p
o
s
s
ess
s
tr
o
n
g
tech
n
ical
an
d
in
te
r
p
e
r
s
o
n
al
a
b
ilit
ies
[
3
9
]
.
Fam
ilies
an
d
p
atien
ts
ca
n
b
en
ef
it
f
r
o
m
r
elea
r
n
i
n
g
th
e
in
f
o
r
m
atio
n
b
y
u
s
in
g
au
d
io
v
is
u
al
m
ater
ials
d
u
r
in
g
t
h
e
d
is
ch
ar
g
e
p
lan
n
in
g
p
r
o
ce
s
s
[
4
0
]
.
I
n
ad
d
itio
n
to
p
r
o
v
id
in
g
d
ir
ec
tio
n
s
o
n
h
o
w
to
r
ec
eiv
e
tr
ea
tm
en
t
in
th
e
h
o
s
p
ital
f
r
o
m
th
e
tim
e
o
f
h
o
s
p
italizatio
n
u
n
til
th
eir
d
is
ch
ar
g
e,
it
ca
n
aid
in
th
eir
co
m
p
r
eh
en
s
io
n
an
d
h
elp
th
em
r
etain
th
e
in
f
o
r
m
atio
n
t
h
at
was
p
r
esen
ted
[
4
1
]
.
Oth
er
r
esear
ch
also
s
h
o
wed
th
at
p
a
tien
ts
'
an
d
f
am
ilies
'
ass
es
s
m
en
ts
o
f
th
eir
d
eg
r
ee
o
f
co
n
f
id
e
n
ce
af
ter
h
o
s
p
ital
d
is
ch
ar
g
e
wer
e
p
o
s
itiv
ely
im
p
ac
ted
b
y
th
e
in
tr
o
d
u
ctio
n
o
f
d
is
ch
ar
g
e
p
lan
n
in
g
e
d
u
ca
tio
n
.
R
esear
ch
h
as
d
em
o
n
s
tr
ated
t
h
at
d
eliv
er
i
n
g
d
is
ch
ar
g
e
p
lan
n
i
n
g
ed
u
ca
tio
n
in
a
co
n
s
is
ten
t,
p
r
o
g
r
ess
iv
e,
an
d
co
n
tin
u
o
u
s
m
an
n
er
h
as
an
im
p
ac
t
o
n
p
ati
en
ts
'
an
d
f
am
ilies
'
co
m
p
r
eh
e
n
s
io
n
an
d
ea
s
e
o
f
r
e
ac
tio
n
[
4
2
]
.
I
n
ter
m
s
o
f
k
n
o
wled
g
e,
q
u
al
ity
o
f
life
,
an
d
d
aily
ac
tiv
ities
,
s
tr
o
k
e
p
atien
ts
wh
o
ar
e
e
x
p
o
s
ed
to
d
is
ch
ar
g
e
p
lan
n
in
g
f
o
r
s
tr
o
k
e
h
av
e
b
etter
av
e
r
ag
e
s
co
r
es
[
4
3
]
.
Dis
ch
ar
g
in
g
s
tr
ateg
y
af
f
ec
ts
h
o
w
a
f
am
ily
h
an
d
les
a
s
tr
o
k
e
p
atien
t
in
th
e
h
o
s
p
ital
[
4
4
]
.
Patien
ts
,
f
am
ilies
,
an
d
ca
r
eg
iv
er
s
u
r
g
en
tly
n
ee
d
th
e
ap
p
licatio
n
f
o
r
d
is
ch
ar
g
e
p
la
n
n
in
g
o
f
p
ati
en
ts
with
s
tr
o
k
e
d
u
r
in
g
h
o
m
e
ca
r
e
in
o
r
d
e
r
to
lo
wer
tr
ea
tm
en
t
co
s
ts
an
d
o
f
f
er
in
f
o
r
m
atio
n
o
n
h
o
w
to
tr
ea
t
a
s
tr
o
k
e
p
atien
t
[
4
5
]
.
As
s
tr
o
k
e
p
atien
ts
g
ain
m
o
r
e
awa
r
e
n
ess
,
th
ey
will
b
e
m
o
r
e
co
n
f
id
en
t
to
p
u
r
s
u
e
p
o
s
t
-
s
tr
o
k
e
tr
ea
tm
en
t
an
d
lead
n
o
r
m
al
l
iv
es.
I
n
d
i
v
id
u
als
wh
o
h
av
e
ex
p
er
ien
ce
d
a
s
tr
o
k
e
an
d
ar
e
u
n
ab
le
to
ca
r
r
y
o
u
t
th
eir
r
eg
u
lar
task
s
o
n
th
eir
o
wn
r
eq
u
ir
e
p
s
y
ch
o
l
o
g
ical
s
u
p
p
o
r
t
wh
en
th
ey
n
o
tice
b
eh
av
io
r
al
ch
a
n
g
es
in
th
em
s
elv
es
[
4
6
]
.
E
lev
ated
s
elf
-
wo
r
th
will
ex
p
ed
ite
th
e
r
ec
o
v
er
y
f
r
o
m
a
s
tr
o
k
e,
en
h
an
ce
b
o
d
ily
ca
p
ab
ilit
ies,
an
d
elev
at
e
o
n
e's
s
tan
d
ar
d
o
f
liv
in
g
[
4
7
]
.
Stro
k
e
p
atien
ts
b
e
n
ef
it
f
r
o
m
th
e
s
u
p
p
o
r
t
o
f
th
eir
f
am
ilies
b
ec
au
s
e
th
ey
f
ee
l le
s
s
alo
n
e
an
d
h
av
e
a
h
ig
h
er
q
u
ality
o
f
life
wh
en
th
e
y
ar
e
well
-
ca
r
ed
f
o
r
[
4
8
]
.
4.
CO
NCLU
SI
O
N
Stro
k
e
p
atien
ts
at
K
R
MT
W
o
n
g
s
o
n
eg
o
r
o
Ko
ta
Sem
ar
an
g
R
SD
ex
p
er
ien
ce
s
ig
n
if
ican
tly
lo
wer
lev
els
o
f
s
tr
ess
,
an
x
iety
,
a
n
d
s
ad
n
ess
wh
en
ap
p
licatio
n
-
b
ased
d
is
ch
ar
g
e
p
lan
n
in
g
tech
n
iq
u
es
ar
e
u
s
ed
.
T
h
e
im
p
licatio
n
is
th
at
b
y
o
f
f
er
i
n
g
a
m
o
r
e
cr
ea
tiv
e
a
n
d
m
e
th
o
d
ical
ap
p
r
o
ac
h
t
o
r
ec
o
v
e
r
y
p
lan
n
in
g
,
t
h
ese
ap
p
licatio
n
s
m
ay
b
e
a
u
s
ef
u
l
t
o
o
l
f
o
r
en
h
a
n
cin
g
t
h
e
q
u
ality
o
f
life
f
o
r
s
tr
o
k
e
v
ictim
s
.
As
a
r
esu
lt,
u
s
in
g
th
is
ap
p
r
o
ac
h
ca
n
b
e
a
d
v
is
ed
as
a
co
m
p
o
n
en
t
o
f
a
t
h
er
ap
y
p
lan
f
o
r
s
tr
o
k
e
p
atien
ts
in
o
r
d
er
to
a
d
d
r
ess
p
s
y
ch
o
lo
g
ical
is
s
u
es a
n
d
e
n
h
a
n
ce
o
v
er
all
r
ec
o
v
er
y
r
esu
lts
.
RE
F
E
R
E
NC
E
S
[
1
]
C
.
A
.
N
o
r
t
h
u
i
s,
C
.
J
.
C
r
a
n
d
a
l
l
,
K
.
L.
M
a
r
g
o
l
i
s,
S
.
J.
D
i
e
m,
K
.
E
.
En
sr
u
d
,
a
n
d
K
.
La
k
s
h
mi
n
a
r
a
y
a
n
,
“
A
sso
c
i
a
t
i
o
n
b
e
t
w
e
e
n
p
o
st
-
st
r
o
k
e
d
i
sa
b
i
l
i
t
y
a
n
d
5
-
y
e
a
r
h
i
p
-
f
r
a
c
t
u
r
e
r
i
sk
:
t
h
e
w
o
m
e
n
’
s
h
e
a
l
t
h
i
n
i
t
i
a
t
i
v
e
,
”
J
o
u
rn
a
l
o
f
S
t
ro
k
e
a
n
d
C
e
r
e
b
ro
v
a
scu
l
a
r
D
i
s
e
a
s
e
s
,
v
o
l
.
2
9
,
n
o
.
8
,
p
p
.
1
–
9
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
st
r
o
k
e
c
e
r
e
b
r
o
v
a
s
d
i
s
.
2
0
2
0
.
1
0
4
9
7
6
.
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
Op
timiz
in
g
p
a
tien
t m
en
ta
l h
ea
lth
o
u
tco
mes:
th
e
imp
a
ct
o
f sma
r
tp
h
o
n
e
-
b
a
s
ed
…
(
Dw
i R
etn
a
n
in
g
s
ih
)
91
[
2
]
B
.
W
h
i
t
e
h
e
a
d
,
D
.
C
o
r
b
i
n
,
A
.
A
l
b
o
w
a
i
d
e
y
,
N
.
Z
h
a
n
g
,
K
.
K
a
r
e
l
i
n
a
,
a
n
d
Z.
M
.
W
e
i
l
,
“
M
i
l
d
t
r
a
u
m
a
t
i
c
b
r
a
i
n
i
n
j
u
r
y
i
n
d
u
c
e
s
p
e
r
i
c
y
t
e
d
e
t
a
c
h
m
e
n
t
i
n
d
e
p
e
n
d
e
n
t
o
f
st
r
o
k
e
v
u
l
n
e
r
a
b
i
l
i
t
y
,
”
N
e
u
ro
sci
e
n
c
e
L
e
t
t
e
rs
,
v
o
l
.
8
1
8
,
n
o
.
S
e
p
t
e
m
b
e
r
2
0
2
3
,
p
.
1
3
7
5
5
2
,
2
0
2
4
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
n
e
u
l
e
t
.
2
0
2
3
.
1
3
7
5
5
2
.
[
3
]
N
.
Y
a
m
a
n
i
e
e
t
a
l
.
,
“
H
i
g
h
s
o
c
i
o
e
c
o
n
o
mi
c
s
t
a
t
u
s
i
s
a
sso
c
i
a
t
e
d
w
i
t
h
st
r
o
k
e
se
v
e
r
i
t
y
a
mo
n
g
s
t
r
o
k
e
p
a
t
i
e
n
t
s
i
n
t
h
e
N
a
t
i
o
n
a
l
B
r
a
i
n
C
e
n
t
r
e
H
o
s
p
i
t
a
l
,
J
a
k
a
r
t
a
,
I
n
d
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[
1
6
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