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s
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co
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Spirituali
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CC B
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li
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C
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A
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R
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Fik
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Dep
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tm
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Nu
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s
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Keseh
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p
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lan
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d
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m
ail: r
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f
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tik
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ala
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.
ac
.
i
d
1.
I
NT
RO
D
UCT
I
O
N
C
o
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
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(
C
HD
)
is
a
d
is
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th
at
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th
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m
ain
ca
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s
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d
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ce
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f
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HD
in
th
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ld
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7
2
%
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illi
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p
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p
le
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n
th
e
wo
r
ld
h
a
v
e
d
ied
f
r
o
m
C
HD
[
1
]
.
W
h
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ea
s
in
I
n
d
o
n
esia
t
h
e
p
r
ev
alen
ce
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f
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ac
co
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d
in
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to
th
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f
th
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2
0
1
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lth
R
esear
ch
was
f
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u
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d
to
b
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1
.
5%
[
2
]
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
in
d
icate
th
at
ef
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ts
to
p
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ev
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d
ea
th
in
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ts
wh
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h
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v
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b
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d
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n
o
s
ed
with
C
HD
m
u
s
t
r
ec
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atten
tio
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.
T
h
is
is
b
ec
au
s
e
th
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r
ec
u
r
r
en
ce
r
ate
in
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p
atien
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is
s
till
v
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h
ig
h
.
T
h
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s
tu
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y
f
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u
n
d
th
at
3
0
%
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f
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ati
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ts
ex
p
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ain
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ter
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ein
g
tr
ea
te
d
at
h
o
m
e
f
o
r
>
2
9
d
ay
s
[
3
]
.
I
n
ad
d
itio
n
,
s
tu
d
ies
wer
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also
f
o
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n
d
wh
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s
h
o
we
d
th
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t
ad
h
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en
ce
t
o
tr
ea
tm
en
t
b
eh
av
io
r
was
s
till
lo
w
[
4
]
.
T
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tm
en
t
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h
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n
ce
b
eh
av
io
r
in
C
HD
p
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wh
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ar
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till
lo
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ca
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h
av
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im
p
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th
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m
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s
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ca
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d
io
v
ascu
lar
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n
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(
MA
C
E
)
[
5
]
.
T
h
e
r
esu
lts
o
f
o
th
er
s
tu
d
ies
s
h
o
w
th
at
th
e
em
er
g
en
ce
o
f
a
h
ea
r
t
attac
k
in
s
o
m
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wh
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h
as
b
ee
n
d
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n
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s
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with
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HD
is
a
s
s
o
ciate
d
with
an
in
cr
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r
is
k
o
f
s
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d
d
en
ca
r
d
iac
ar
r
est
(
SC
A)
[
6
]
.
An
o
th
er
s
tu
d
y
also
illu
s
tr
ates
th
at
C
H
D
p
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in
I
n
d
o
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esia
h
av
e
a
h
ig
h
r
is
k
o
f
r
ec
u
r
r
en
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[
7
]
.
Th
e
r
ec
u
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r
en
ce
r
ate
in
th
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f
ir
s
t
y
ea
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af
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h
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s
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italizatio
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,
f
o
u
n
d
to
b
e
m
o
r
e
p
r
ev
alen
t
in
m
en
[
8
]
.
B
ased
o
n
th
is
,
p
r
ev
en
tiv
e
e
f
f
o
r
ts
ar
e
n
ee
d
ed
s
o
th
at
th
e
r
e
is
n
o
in
c
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ea
s
e
in
ca
s
es o
f
d
ea
th
d
u
e
to
h
ea
r
t
attac
k
s
[
1
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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E
ar
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Ap
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a
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s
[
1
0
]
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h
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ed
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in
g
h
y
p
er
ten
s
io
n
,
h
ig
h
ch
o
lest
er
o
l
an
d
d
iab
etes
m
ellitu
s
[
1
1
]
.
As
an
ef
f
o
r
t
to
im
p
r
o
v
e
th
is
h
ea
lth
y
life
s
ty
le,
g
o
o
d
s
elf
-
m
an
ag
em
en
t
s
k
ills
ar
e
n
ee
d
ed
.
Acc
o
r
d
in
g
to
I
n
d
iv
id
u
al
a
n
d
Fam
ily
Self
-
Ma
n
ag
em
en
t
T
h
eo
r
y
,
o
u
tco
m
e
ex
p
ec
tan
cy
,
p
lan
n
in
g
an
d
d
ec
is
io
n
m
ak
in
g
ar
e
p
ar
t
o
f
th
e
s
elf
-
m
an
ag
e
m
en
t
p
r
o
ce
s
s
.
T
h
ese
th
r
ee
c
o
m
p
o
n
e
n
ts
ar
e
v
er
y
im
p
o
r
tan
t
co
m
p
o
n
en
ts
th
at
ca
n
af
f
ec
t
th
e
im
p
r
o
v
em
en
t
o
f
h
ea
lth
s
tatu
s
,
q
u
ality
o
f
life
an
d
th
e
u
s
e
o
f
h
ea
lth
co
s
ts
n
ee
d
ed
f
o
r
h
ea
lth
ca
r
e
[
1
2
]
.
I
n
ad
d
itio
n
t
o
s
elf
-
m
a
n
ag
em
e
n
t
s
k
ills
,
m
ee
tin
g
s
p
ir
it
u
al
n
e
ed
s
is
an
im
p
o
r
tan
t
co
m
p
o
n
e
n
t
th
at
ca
n
af
f
ec
t
th
e
p
atien
t'
s
q
u
ality
o
f
l
if
e.
Sp
ir
itu
al
ex
p
er
ien
ce
s
ex
p
e
r
ien
ce
d
b
y
p
atien
ts
with
ch
r
o
n
ic
illn
ess
e
s
ca
n
b
e
a
p
ar
t
o
f
f
in
d
in
g
h
o
p
e
an
d
well
-
b
ein
g
e
v
en
th
o
u
g
h
th
e
y
ar
e
b
u
r
d
e
n
ed
b
y
th
eir
illn
ess
.
Ho
wev
er
,
if
th
e
p
atien
t
f
ee
ls
a
lack
o
f
i
n
n
er
p
ea
ce
,
an
in
ab
ilit
y
to
ac
ce
p
t
wh
at
h
as
h
ap
p
en
ed
to
h
im
o
r
h
er
,
t
h
en
th
is
ca
n
ca
u
s
e
s
p
ir
itu
al
d
is
tr
ess
wh
ich
will
al
s
o
im
p
ac
t
t
h
e
p
atien
t'
s
q
u
ality
o
f
life
[
1
3
]
.
T
h
e
d
im
en
s
io
n
o
f
o
n
e'
s
s
p
ir
itu
ality
ca
n
b
e
m
ea
s
u
r
ed
f
r
o
m
b
elief
in
Go
d
,
s
ea
r
ch
f
o
r
m
ea
n
i
n
g
,
m
in
d
f
u
ln
ess
an
d
f
ee
lin
g
o
f
s
ec
u
r
ity
[
1
4
]
.
Sev
er
al
s
tu
d
ies
h
av
e
b
ee
n
co
n
d
u
cted
o
n
co
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e
p
at
ien
ts
in
r
elat
io
n
to
ad
h
er
en
ce
to
tr
ea
tm
en
t
a
n
d
m
ed
icatio
n
.
Ho
wev
e
r
,
r
esear
c
h
th
at
ex
am
i
n
es
s
p
ir
itu
ality
with
s
elf
-
m
an
ag
em
en
t
o
f
c
o
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e
p
atien
ts
h
as
n
o
t
b
ee
n
wid
ely
ca
r
r
ied
o
u
t.
T
h
is
s
tu
d
y
aim
s
to
an
aly
ze
th
e
ef
f
ec
t
o
f
s
p
ir
itu
ality
o
n
s
elf
-
m
an
ag
em
en
t
o
f
co
r
o
n
a
r
y
h
ea
r
t
d
is
ea
s
e
p
atien
ts
'
ca
r
e
.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
d
esig
n
u
s
ed
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
.
T
h
e
r
esear
ch
s
am
p
le
was
1
4
5
p
at
ien
ts
with
co
r
o
n
a
r
y
h
ea
r
t
d
is
ea
s
e
wh
o
wer
e
v
is
itin
g
to
h
av
e
a
m
e
d
ical
ch
ec
k
-
u
p
at
th
e
h
o
s
p
ital'
s
h
ea
r
t
p
o
ly
clin
ic
in
Yo
g
y
ak
ar
ta
,
I
n
d
o
n
esia.
T
h
e
s
am
p
lin
g
tech
n
iq
u
e
was
ca
r
r
ie
d
o
u
t
b
y
c
o
n
s
ec
u
tiv
e
s
am
p
lin
g
tech
n
iq
u
e
.
T
h
e
r
esear
ch
v
ar
iab
le
b
ein
g
m
ea
s
u
r
ed
is
s
p
ir
itu
ality
wh
ich
in
clu
d
es f
o
u
r
d
im
en
s
io
n
s
,
n
am
ely
b
e
lief
in
G
o
d
,
s
ea
r
ch
f
o
r
m
ea
n
i
n
g
,
m
i
n
d
f
u
l
n
ess
an
d
f
ee
lin
g
o
f
s
ec
u
r
ity
.
I
n
ad
d
it
io
n
,
it
also
m
ea
s
u
r
es
s
elf
-
m
an
ag
em
en
t
v
a
r
iab
les
wh
ich
co
n
s
is
t
o
f
f
o
u
r
in
d
icato
r
s
,
n
am
ely
p
r
o
b
lem
r
ec
o
g
n
it
io
n
,
o
u
tco
m
e
ex
p
ec
tan
c
y
,
p
la
n
n
in
g
an
d
d
ec
is
io
n
m
ak
in
g
.
T
h
e
r
esear
ch
in
s
tr
u
m
e
n
t
u
s
ed
a
q
u
esti
o
n
n
air
e.
T
h
e
s
p
ir
itu
al
ity
q
u
esti
o
n
n
ai
r
e
was
ad
o
p
ted
f
r
o
m
th
e
s
p
ir
itu
ality
q
u
esti
o
n
n
air
e
[
1
4
]
.
T
h
e
q
u
esti
o
n
n
air
e
o
n
b
elief
in
Go
d
,
s
ea
r
ch
f
o
r
m
ea
n
in
g
,
m
in
d
f
u
ln
ess
an
d
f
ee
lin
g
o
f
s
ec
u
r
ity
ea
ch
p
r
es
en
ts
f
iv
e
q
u
esti
o
n
s
with
f
iv
e
an
s
wer
ch
o
ices
co
n
s
is
tin
g
o
f
s
tr
o
n
g
ly
d
is
ag
r
ee
(
s
co
r
e
1
)
,
d
is
ag
r
ee
(
s
co
r
e
2
)
,
d
o
n
o
t
h
esit
ate
(
s
co
r
e
3
)
,
ag
r
ee
(
s
co
r
e
4
)
an
d
s
tr
o
n
g
l
y
ag
r
ee
(
s
co
r
e
5
)
.
Me
an
wh
ile,
th
e
p
r
o
b
lem
r
ec
o
g
n
itio
n
q
u
esti
o
n
n
air
e
p
r
ese
n
ts
f
iv
e
m
o
d
if
ied
s
tatem
en
ts
f
r
o
m
th
e
p
r
o
b
lem
r
ec
o
g
n
izin
g
q
u
esti
o
n
n
ai
r
e
.
T
h
e
p
r
o
b
lem
r
ec
o
g
n
itio
n
in
d
icat
o
r
co
n
s
is
ts
o
f
an
in
tr
o
d
u
ctio
n
to
th
e
f
ac
to
r
s
th
at
p
r
ec
ip
itate
r
ec
u
r
r
e
n
c
e
an
d
an
in
tr
o
d
u
ctio
n
to
tr
ea
tm
en
t
ass
is
tan
ce
.
T
h
e
an
s
wer
ch
o
ices
c
o
n
s
is
ted
o
f
s
tr
o
n
g
ly
d
is
ag
r
ee
,
d
is
ag
r
ee
,
u
n
d
ec
i
d
ed
,
ag
r
ee
an
d
s
tr
o
n
g
ly
ag
r
ee
.
T
h
e
o
u
tco
m
e
ex
p
ec
tan
c
y
q
u
esti
o
n
n
air
e
was m
o
d
if
ied
f
r
o
m
th
e
o
u
tco
m
e
ex
p
ec
tan
c
ies
by
b
eh
av
io
r
c
h
an
g
e
q
u
e
s
tio
n
n
air
e
[
1
5
]
.
T
h
e
s
ix
s
tatem
en
ts
r
ef
lect
th
e
r
esp
o
n
d
en
ts
'
ex
p
ec
tatio
n
s
in
t
er
m
s
o
f
p
h
y
s
ical
ac
tiv
ity
,
d
ie
t,
s
tr
ess
m
an
ag
em
en
t,
d
r
u
g
c
o
n
s
u
m
p
tio
n
,
h
ea
lth
ch
ec
k
-
u
p
s
,
h
ea
lth
ca
r
e.
T
h
e
an
s
wer
ch
o
ices
u
s
ed
a
L
ik
er
t
s
ca
le
with
th
e
ch
o
ices
s
tr
o
n
g
ly
d
is
ag
r
ee
,
d
is
ag
r
ee
,
u
n
d
ec
id
e
d
,
ag
r
ee
an
d
s
tr
o
n
g
l
y
ag
r
ee
.
T
h
e
p
la
n
n
in
g
q
u
esti
o
n
n
air
e
p
r
esen
ts
f
iv
e
m
o
d
if
ied
s
tatem
en
ts
f
r
o
m
th
e
Plan
n
in
g
-
HAPA
I
n
v
en
to
r
y
[
1
6
]
.
Plan
n
in
g
i
n
d
icato
r
s
in
clu
d
e
co
m
m
itm
en
t,
p
lan
n
in
g
h
ea
lt
h
ch
ec
k
s
,
p
lan
n
in
g
d
iet
p
atter
n
s
,
p
lan
n
i
n
g
p
h
y
s
i
ca
l
ac
tiv
ity
,
p
lan
n
in
g
p
s
y
c
h
o
lo
g
ical
h
ea
lth
.
T
h
e
an
s
wer
c
h
o
ices
p
r
o
v
id
e
th
e
ch
o
ices
n
ev
er
,
s
o
m
etim
es,
o
f
ten
an
d
alwa
y
s
.
T
h
e
d
ec
is
i
o
n
-
m
ak
i
n
g
q
u
esti
o
n
n
air
e
m
o
d
if
ies
th
e
Fli
n
d
er
s
Dec
is
io
n
Ma
k
in
g
Qu
esti
o
n
n
a
ir
e
[
1
7
]
b
y
p
r
esen
tin
g
ten
s
t
atem
en
ts
.
Dec
is
io
n
m
ak
in
g
i
n
d
icato
r
s
co
n
s
is
t
o
f
v
ig
ilan
ce
,
h
y
p
er
v
ig
ilan
ce
,
d
e
f
en
s
iv
e
av
o
id
an
c
e,
b
u
c
k
-
p
as
s
in
g
,
p
r
o
cr
asti
n
atio
n
,
a
n
d
r
a
tio
n
aliza
tio
n
.
T
h
e
an
s
wer
ch
o
ices
u
s
e
f
o
u
r
ch
o
ices,
n
am
ely
n
ev
er
(
s
co
r
e
1
)
,
s
o
m
etim
es
(
s
co
r
e
2
)
,
o
f
ten
(
s
co
r
e
3
)
an
d
alwa
y
s
(
s
co
r
e
4
)
.
Pre
s
en
tatio
n
o
f
r
esear
ch
d
ata
o
n
ea
c
h
v
a
r
iab
le
is
d
o
n
e
b
y
p
r
esen
tin
g
th
e
f
r
eq
u
en
cy
d
is
tr
ib
u
tio
n
.
T
h
e
ca
teg
o
r
izatio
n
o
f
s
p
ir
itu
ality
v
ar
iab
les
co
n
s
is
ts
o
f
h
ig
h
(
to
tal
s
co
r
e>
8
0
%),
m
ed
iu
m
(
to
tal
s
co
r
e
o
f
4
1
%
-
8
0
%)
an
d
lo
w
(
to
tal
s
co
r
e
o
f
1
-
4
0
%
)
.
T
h
e
s
elf
-
m
an
ag
em
e
n
t
v
ar
ia
b
le
ca
teg
o
r
izatio
n
co
n
s
is
ts
o
f
g
o
o
d
(
s
co
r
e>
8
0
%),
s
u
f
f
icien
t
(
s
co
r
e
5
6
%
-
8
0
%)
an
d
less
(
1
%
-
5
5
%).
Me
an
wh
ile,
an
aly
zin
g
th
e
ef
f
ec
t
o
f
s
p
ir
itu
ality
o
n
s
elf
-
m
an
ag
em
en
t
was
ca
r
r
ied
o
u
t
u
s
in
g
a
lin
ea
r
r
eg
r
ess
io
n
an
aly
s
is
te
s
t
with
a
s
ig
n
if
ican
ce
l
ev
el
o
f
9
5
%.
Data
wer
e
an
aly
ze
d
u
s
in
g
th
e
SP
SS
f
o
r
W
in
d
o
ws
2
3
p
r
o
g
r
a
m
.
R
esear
ch
was
ca
r
r
ied
o
u
t
g
u
id
ed
b
y
eth
ica
l
p
r
in
cip
les.
All
r
esp
o
n
d
en
ts
h
a
v
e
p
r
o
v
id
ed
in
f
o
r
m
ed
c
o
n
s
en
t
.
T
h
e
r
esear
c
h
im
p
lem
en
tatio
n
h
as
b
ee
n
ad
ju
s
ted
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
S
p
ir
itu
a
lity a
n
d
s
elf
-
ma
n
a
g
e
men
t in
co
r
o
n
a
r
y
h
e
a
r
t d
is
ea
s
es p
a
tien
t (
R
iz
a
F
ikri
a
n
a
)
345
to
th
e
r
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5
2
5
T
h
e
ex
is
ten
ce
o
f
d
is
o
r
d
er
s
a
p
er
s
o
n
'
s
m
en
tal
h
ea
lth
ca
n
b
e
lo
wer
ed
b
y
m
ee
tin
g
th
e
n
ee
d
s
o
f
s
p
ir
itu
ality
[
2
1
]
.
Sp
ir
itu
ality
is
ab
le
to
o
v
er
co
m
e
s
u
f
f
e
r
in
g
ex
p
e
r
ien
ce
d
s
u
ch
as
f
ea
r
an
d
d
ea
t
h
[
2
2
]
.
I
n
s
o
m
eo
n
e
wh
o
ex
p
er
ien
ce
s
ex
c
ess
iv
e
f
atig
u
e,
th
e
s
elec
tio
n
o
f
co
p
in
g
m
ec
h
an
is
m
s
with
a
s
p
ir
itu
ality
ap
p
r
o
ac
h
ca
n
r
ed
u
ce
th
e
b
u
r
d
en
o
f
f
atig
u
e
ex
p
er
ien
ce
d
[
2
3
]
.
I
n
p
atien
t
s
u
n
d
er
g
o
in
g
p
alliativ
e
ca
r
e,
s
p
ir
itu
ality
b
ec
o
m
es
an
im
p
o
r
tan
t
d
o
m
ain
th
at
ca
n
im
p
r
o
v
e
q
u
ality
o
f
life
[
2
4
]
.
Sp
ir
itu
al
h
ea
lth
is
n
o
t
o
n
ly
a
n
ec
ess
ity
f
o
r
a
d
u
lt
h
ea
lth
,
b
u
t
also
p
lay
s
an
im
p
o
r
tan
t
r
o
le
in
ch
ild
h
ea
lth
[
2
5
]
.
T
h
e
ex
i
s
ten
ce
o
f
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
s
th
at
o
cc
u
r
i
n
a
p
er
s
o
n
will
n
o
t
au
t
o
m
atica
lly
b
e
ab
le
t
o
d
ec
r
ea
s
e
with
o
n
e'
s
s
p
ir
itu
ality
,
b
u
t
th
er
e
s
till
n
ee
d
s
to
b
e
s
u
p
p
o
r
t a
v
ailab
ilit
y
[
2
6
]
.
Plan
n
in
g
f
o
r
th
e
av
ailab
ilit
y
o
f
s
p
ir
itu
al
s
u
p
p
o
r
t is ess
en
tial f
o
r
p
atien
ts
with
ch
r
o
n
ic
illn
ess
es
[2
7]
.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
also
s
h
o
wed
th
at
s
elf
-
m
an
ag
e
m
en
t
in
C
HD
p
atien
ts
o
b
tain
ed
all
in
d
icato
r
s
b
o
th
p
r
o
b
lem
r
ec
o
g
n
itio
n
,
o
u
t
co
m
e
ex
p
ec
tan
cy
,
p
lan
n
i
n
g
an
d
d
ec
is
io
n
m
a
k
in
g
,
m
o
r
e
th
an
h
alf
o
f
th
e
p
atien
ts
wer
e
in
th
e
g
o
o
d
ca
teg
o
r
y
.
E
v
en
o
n
th
e
d
ec
is
io
n
-
m
a
k
in
g
in
d
icato
r
s
,
it
was
f
o
u
n
d
th
at
al
m
o
s
t
all
p
atien
ts
h
ad
g
o
o
d
d
ec
is
io
n
-
m
ak
i
n
g
ab
ilit
ie
s
.
T
h
is
s
tu
d
y
s
h
o
ws
th
at
p
atien
ts
h
av
e
r
ea
lized
th
at
ca
r
e
an
d
tr
ea
tm
en
t
th
at
is
ca
r
r
ied
o
u
t
p
r
o
p
er
ly
an
d
co
r
r
ec
tly
will
b
en
e
f
it
th
eir
h
ea
lth
an
d
h
a
v
e
a
n
im
p
ac
t
o
n
im
p
r
o
v
in
g
th
e
p
atien
t'
s
q
u
ality
o
f
life
.
Plan
n
in
g
f
o
r
th
e
s
ch
ed
u
le
f
o
r
th
e
m
ed
ical
ex
am
in
atio
n
th
at
h
as
b
ee
n
ca
r
r
ie
d
o
u
t
in
d
icate
s
t
h
at
th
e
p
atien
t h
as a
h
ig
h
co
m
m
itm
en
t to
m
o
n
ito
r
in
g
h
is
h
ea
lth
s
tatu
s
an
d
to
g
et
g
o
o
d
ca
r
e
an
d
tr
ea
tm
en
t so
th
at
a
r
elap
s
e
d
o
es
n
o
t
o
cc
u
r
i
n
h
im
.
Ho
wev
er
,
th
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
d
if
f
er
e
n
t
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies
wh
ich
s
h
o
wed
th
at
s
elf
-
m
an
ag
em
en
t
ab
ilit
ies
in
C
HD
p
atien
ts
af
t
er
r
ec
eiv
in
g
p
er
c
u
tan
eo
u
s
co
r
o
n
ar
y
in
ter
v
en
tio
n
(
PC
I
)
in
ter
v
en
tio
n
wer
e
i
n
t
h
e
m
o
d
e
r
ate
an
d
lo
w
ca
t
eg
o
r
ies
[
2
8
]
.
Go
o
d
s
elf
-
m
an
a
g
e
m
en
t
is
n
ee
d
ed
f
o
r
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
S
p
ir
itu
a
lity a
n
d
s
elf
-
ma
n
a
g
e
men
t in
co
r
o
n
a
r
y
h
e
a
r
t d
is
ea
s
es p
a
tien
t (
R
iz
a
F
ikri
a
n
a
)
347
s
o
m
eo
n
e
wh
o
h
as
b
ee
n
d
iag
n
o
s
ed
with
C
HD.
T
h
is
is
b
ec
a
u
s
e
s
elf
-
m
an
ag
em
en
t
is
p
o
s
itiv
ely
co
r
r
elate
d
with
th
e
q
u
ality
o
f
life
o
f
C
HD
p
atien
ts
[
2
9
]
.
G
o
o
d
s
elf
-
m
a
n
ag
em
en
t r
ed
u
ce
s
th
e
r
is
k
o
f
c
o
m
p
li
ca
tio
n
s
[
3
0
]
.
Self
-
m
an
ag
em
en
t
o
f
p
atien
ts
is
in
f
lu
en
ce
d
b
y
s
ev
er
al
f
ac
to
r
s
.
Stu
d
ies
f
o
u
n
d
th
at
a
p
er
s
o
n
'
s
s
e
lf
-
m
an
ag
em
en
t
ca
n
b
e
ass
o
ciate
d
with
n
eg
ativ
e
attitu
d
es,
n
o
n
-
co
m
p
lian
ce
a
n
d
th
e
p
r
esen
ce
o
f
m
en
tal
illn
ess
[
3
1
]
.
I
n
a
d
d
itio
n
,
s
elf
-
m
an
ag
e
m
en
t
is
r
elate
d
to
illn
ess
p
er
c
ep
tio
n
an
d
th
is
is
m
ed
iated
b
y
co
p
in
g
s
ty
les
[
3
2
]
As
an
ef
f
o
r
t
to
im
p
r
o
v
e
p
atie
n
t
s
elf
-
m
an
ag
em
en
t,
g
o
o
d
h
ea
lth
liter
ac
y
an
d
k
n
o
wled
g
e
a
r
e
n
ee
d
ed
[
3
3
]
,
[
3
4
]
.
So
ed
u
ca
tio
n
is
v
er
y
i
m
p
o
r
ta
n
t,
b
ec
au
s
e
s
elf
-
m
an
ag
e
m
en
t
ed
u
ca
tio
n
ca
n
i
n
cr
ea
s
e
s
elf
-
ef
f
icac
y
[
3
5
]
.
W
h
ile
h
ig
h
s
elf
-
e
f
f
icac
y
is
also
ab
l
e
to
i
n
cr
ea
s
e
s
elf
-
m
an
a
g
em
e
n
t
ab
ilit
y
[
3
6
]
,
[
3
7
]
.
Ho
we
v
e
r
,
s
elf
-
m
an
a
g
em
en
t
k
n
o
wled
g
e
is
in
f
lu
e
n
ce
d
b
y
e
m
o
tio
n
al
q
u
ality
o
f
life
as
well
as
s
o
cial
s
u
p
p
o
r
t
[
3
8
]
.
T
h
e
in
cr
ea
s
e
in
ex
is
tin
g
s
tig
m
a
ca
n
r
ed
u
ce
s
elf
-
m
an
a
g
em
en
t
ab
ilit
y
[
3
9
]
.
So
f
o
r
h
ea
lth
wo
r
k
er
s
,
it
is
v
er
y
im
p
o
r
tan
t
to
co
n
d
u
ct
m
o
tiv
atio
n
al
in
ter
v
iewin
g
as p
ar
t o
f
ef
f
o
r
ts
to
im
p
r
o
v
e
p
atien
t self
-
m
an
ag
em
e
n
t
[
4
0
]
.
T
h
e
s
tu
d
y
also
s
h
o
ws
s
p
ir
itu
ality
in
th
e
b
elief
in
Go
d
d
im
en
s
io
n
h
as
a
s
ig
n
if
ican
t
ef
f
ec
t
o
n
s
elf
-
m
an
ag
em
en
t
o
f
C
HD
p
atien
ts
o
n
th
e
in
d
icato
r
s
o
f
p
r
o
b
lem
r
ec
o
g
n
itio
n
,
o
u
tc
o
m
e
ex
p
ec
tan
cy
an
d
p
lan
n
i
n
g
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
i
n
lin
e
with
p
r
ev
io
u
s
s
tu
d
ies
wh
ich
ex
p
lain
th
er
e
is
a
s
tr
o
n
g
co
r
r
elatio
n
b
etwe
en
s
p
ir
itu
ality
an
d
s
elf
-
m
an
ag
e
m
en
t,
r
esil
ien
ce
as
a
m
ed
iato
r
[
4
1
]
.
B
elief
in
Go
d
is
clo
s
ely
r
ela
ted
to
o
n
e'
s
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
an
d
r
ed
u
ce
s
th
e
in
cid
en
ce
o
f
d
e
p
r
ess
io
n
th
r
o
u
g
h
th
e
p
r
o
ce
s
s
o
f
m
ea
n
in
g
in
life
,
f
ee
lin
g
co
m
f
o
r
ta
b
le
with
Go
d
,
th
e
em
er
g
en
ce
o
f
r
elig
i
o
u
s
co
p
in
g
,
p
o
s
itiv
e
r
ea
p
p
r
aisal
an
d
welf
ar
e
.
B
esid
es
th
at,
th
at
is
r
elate
d
to
o
n
e'
s
an
x
iety
.
So
m
eo
n
e
wh
o
h
as
g
r
ea
ter
th
at
d
i
m
en
s
io
n
,
s
h
o
ws
lo
wer
an
x
iety
th
an
s
o
m
eo
n
e
wh
o
d
o
esn
'
t
b
eliev
e
in
th
e
ex
is
ten
c
e
o
f
G
o
d
,
a
h
a
p
p
ier
life
,
m
o
r
e
s
atis
f
ied
with
h
is
life
,
b
etter
p
h
y
s
ical
h
ea
lth
an
d
co
n
s
id
er
s
f
am
ily
an
d
f
r
ie
n
d
s
to
b
e
an
im
p
o
r
ta
n
t p
ar
t
o
f
th
eir
s
o
cial
life
[
4
2
]
,
[
4
3
]
.
Sp
ir
itu
ality
also
in
f
lu
en
ce
s
h
ea
lth
o
u
tco
m
es
an
d
g
e
n
er
al
well
-
b
ein
g
o
f
p
atien
ts
with
ter
m
in
al
illn
ess
.
Sp
ir
itu
ality
en
co
u
r
ag
es
p
atien
ts
t
o
b
e
ab
le
to
ac
ce
p
t
th
eir
illn
ess
an
d
ca
n
p
r
o
v
id
e
a
s
en
s
e
o
f
p
r
o
tectio
n
,
in
s
till
h
o
p
e
i
n
th
em
an
d
h
elp
p
atien
t
s
to
b
e
a
b
le
to
m
ain
tain
a
p
o
s
itiv
e
attitu
d
e
s
o
th
e
y
ca
n
co
n
tin
u
e
th
eir
liv
es
s
o
th
at
it
wil
l
h
av
e
a
p
o
s
itiv
e
i
m
p
ac
t
o
n
th
eir
h
ea
lth
an
d
we
ll
-
b
ein
g
[
4
4
]
.
I
n
d
i
v
id
u
als
wh
o
ex
p
er
ien
ce
h
ea
lth
p
r
o
b
lem
s
g
en
er
ally
s
ee
k
m
ed
i
ca
l
ass
is
tan
ce
to
o
v
e
r
co
m
e
th
ese
p
r
o
b
le
m
s
.
Ou
tco
m
e
ex
p
ec
tan
cy
is
c
o
n
s
id
er
ed
as
s
o
m
eth
in
g
th
at
ca
n
m
o
tiv
ate
s
o
m
eo
n
e
to
m
a
k
e
ch
a
n
g
es
in
h
ea
lth
b
eh
a
v
io
r
f
o
r
th
e
b
etter
.
Ou
tco
m
e
ex
p
ec
tan
cy
is
a
c
o
n
s
eq
u
e
n
ce
th
at
ca
n
b
e
an
ticip
ate
d
b
o
th
p
o
s
itiv
e
a
n
d
n
eg
ativ
e
as
a
r
esu
lt
o
f
a
p
e
r
s
o
n
'
s
b
eh
av
io
r
,
s
u
ch
as
b
eh
av
i
o
r
i
n
m
ain
tain
in
g
a
h
ea
lth
y
life
s
ty
le,
in
clu
d
in
g
co
n
s
u
m
p
tio
n
o
f
alc
o
h
o
l,
s
m
o
k
in
g
a
n
d
weig
h
t
m
an
ag
e
m
en
t.
Patien
ts
will
b
e
m
o
r
e
o
b
ed
ie
n
t
to
th
ei
r
tr
ea
tm
en
t
p
lan
if
th
e
p
atien
t
f
ee
ls
th
at
th
is
will
h
av
e
a
p
o
s
itiv
e
im
p
ac
t
an
d
p
r
o
v
id
e
b
en
e
f
its
to
th
eir
h
ea
l
th
.
Patien
ts
wh
o
ar
e
ab
le
t
o
r
ec
o
g
n
ize
o
u
tco
m
e
ex
p
ec
tan
cy
well
will
tr
y
to
m
ak
e
ch
an
g
es
to
th
ese
p
r
o
b
l
em
atic
b
eh
av
io
r
s
s
o
th
at
b
etter
h
ea
lth
g
o
als
ar
e
ex
p
ec
ted
to
b
e
ac
h
iev
ed
[
4
5
]
.
Hig
h
o
u
tc
o
m
e
e
x
p
ec
tan
cy
co
u
p
led
with
th
e
av
ailab
ilit
y
o
f
g
o
o
d
s
o
cial
s
u
p
p
o
r
t
ca
n
im
p
r
o
v
e
h
ea
lth
b
eh
av
i
o
r
a
n
d
af
f
ec
t t
h
e
q
u
ality
o
f
life
o
f
p
at
ien
ts
[
4
6
]
–
[
4
8
]
.
Sp
ir
itu
ality
an
d
r
elig
io
n
p
lay
a
r
o
le
in
o
n
e'
s
d
ec
is
io
n
m
ak
in
g
.
Me
d
ical
d
e
cisi
o
n
m
ak
i
n
g
is
o
f
ten
n
ee
d
ed
f
o
r
p
atien
ts
wh
o
a
r
e
i
n
th
e
h
o
s
p
italizatio
n
p
h
ase,
b
o
th
m
ak
i
n
g
d
ec
is
io
n
s
to
u
n
d
e
r
g
o
tr
ea
tm
e
n
t
an
d
m
ak
in
g
d
ec
is
io
n
s
in
s
to
p
p
in
g
tr
ea
tm
en
t
o
r
ac
tio
n
.
R
elig
io
n
is
o
f
ten
a
g
u
id
e
f
o
r
s
o
m
eo
n
e
in
m
a
k
in
g
th
at
d
ec
is
io
n
,
co
n
tr
o
llin
g
an
d
b
eli
ev
in
g
in
d
ea
th
an
d
d
ea
th
[
4
9
]
.
Patien
ts
with
lo
w
h
ea
l
th
liter
ac
y
h
av
e
lim
ited
k
n
o
wled
g
e
ab
o
u
t
th
e
d
is
ea
s
e.
So
in
ter
v
en
tio
n
is
n
ee
d
ed
s
o
t
h
at
th
er
e
is
an
in
cr
ea
s
e
in
h
ea
lth
liter
ac
y
an
d
in
th
e
en
d
p
atien
ts
ar
e
ab
le
to
m
ak
e
g
o
o
d
d
ec
is
io
n
s
[
5
0
]
.
I
n
d
ec
is
io
n
m
ak
i
n
g
,
it
i
s
v
er
y
im
p
o
r
ta
n
t
to
p
a
y
atten
tio
n
to
p
atien
t
v
alu
es a
n
d
ex
p
ec
ted
g
o
als
[
5
1
]
.
T
h
e
lim
itatio
n
o
f
th
is
s
tu
d
y
is
th
e
s
tu
d
y
was
ca
r
r
ied
o
u
t
o
n
l
y
in
a
n
in
tr
a
h
o
s
p
ital
s
ettin
g
,
n
am
ely
o
n
p
atien
ts
wh
o
ca
r
r
ied
o
u
t
h
ea
l
th
ch
ec
k
s
at
th
e
h
o
s
p
ital.
T
h
e
s
tu
d
y
d
id
n
o
t
s
am
p
le
p
atien
ts
in
a
co
m
m
u
n
ity
s
ettin
g
.
T
ak
in
g
th
e
r
es
p
o
n
d
en
t's
s
ettin
g
o
n
ly
in
th
is
h
o
s
p
ital
s
h
o
ws
th
at
th
e
r
esp
o
n
d
en
t
h
a
s
g
o
o
d
b
eh
av
io
r
to
co
n
d
u
ct
a
m
ed
ical
e
x
am
in
atio
n
to
th
e
h
o
s
p
ital.
T
h
is
ca
n
also
b
e
th
e
ca
u
s
e
o
f
th
e
r
esu
lts
o
f
th
is
s
tu
d
y
w
h
er
e
m
o
s
t r
esp
o
n
d
e
n
ts
h
av
e
g
o
o
d
s
elf
-
m
an
ag
em
e
n
t sk
ills
.
4.
CO
NCLU
SI
O
N
Sp
ir
itu
ality
in
th
e
b
elief
in
Go
d
d
im
en
s
io
n
in
f
l
u
en
ce
s
th
e
s
elf
-
m
an
ag
em
e
n
t
o
f
C
HD
p
atien
ts
o
n
th
e
in
d
icato
r
s
o
f
p
r
o
b
lem
r
ec
o
g
n
i
tio
n
,
o
u
tco
m
e
e
x
p
ec
tan
cy
a
n
d
p
lan
n
in
g
.
Hig
h
B
elief
in
Go
d
will
in
cr
ea
s
e
th
e
ab
ilit
y
o
f
C
HD
p
atien
ts
to
r
ec
o
g
n
ize
th
e
p
r
o
b
lem
s
th
ey
ar
e
f
ac
in
g
,
in
c
r
ea
s
e
ex
p
ec
tatio
n
s
f
o
r
th
e
d
esire
d
r
esu
lts
f
r
o
m
th
e
in
ter
v
en
tio
n
s
to
b
e
ca
r
r
ie
d
o
u
t
a
n
d
im
p
r
o
v
e
th
e
d
eter
m
in
atio
n
o
f
ac
tio
n
p
l
an
s
f
o
r
ca
r
r
y
in
g
o
u
t
ca
r
e
an
d
tr
ea
tm
en
t.
T
h
e
p
r
ac
tical
im
p
licatio
n
o
f
th
e
r
esu
lts
o
f
th
is
s
tu
d
y
is
th
a
t
h
ea
lth
wo
r
k
er
s
,
b
o
th
d
o
cto
r
s
an
d
n
u
r
s
es,
m
u
s
t
tr
y
to
b
e
in
v
o
lv
ed
in
m
ee
tin
g
t
h
e
s
p
ir
itu
al
n
ee
d
s
o
f
C
HD
p
atien
ts
wh
ile
in
th
e
tr
ea
tm
en
t
p
h
ase.
T
h
is
aim
s
to
im
p
r
o
v
e
t
h
e
ab
ilit
y
o
f
s
elf
-
m
a
n
ag
em
e
n
t
o
f
p
atien
ts
s
o
th
at
it
is
ex
p
ec
t
ed
to
im
p
r
o
v
e
th
eir
h
ea
lth
b
eh
av
io
r
an
d
p
r
e
v
en
t
r
ec
u
r
r
en
ce
o
f
C
HD
p
atien
ts
.
Pre
v
en
tio
n
o
f
r
ec
u
r
r
en
ce
o
f
C
HD
p
atien
ts
i
s
ex
p
ec
ted
to
im
p
r
o
v
e
th
e
p
atie
n
t'
s
q
u
ality
o
f
life
.
T
h
e
f
u
tu
r
e
r
ec
o
m
m
en
d
ati
o
n
o
f
th
is
s
tu
d
y
is
th
e
n
ee
d
f
o
r
a
m
o
r
e
in
-
d
ep
th
s
tu
d
y
o
f
t
h
e
f
ac
to
r
s
th
at
af
f
ec
t
t
h
e
s
p
ir
itu
ality
o
f
co
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e
p
atie
n
ts
s
o
th
at
th
is
ca
n
b
e
u
s
ed
as
a
b
asis
in
ef
f
o
r
ts
to
im
p
r
o
v
e
a
n
d
m
ee
t
th
e
s
p
ir
itu
al
n
ee
d
s
o
f
p
atien
ts
in
th
e
h
o
p
e
th
at
th
er
e
will
b
e
im
p
r
o
v
e
d
b
etter
s
elf
-
m
a
n
ag
em
en
t in
co
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e
p
atien
ts
.
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.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
3
4
3
-
350
348
RE
F
E
R
E
NC
E
S
[
1
]
M
.
A
.
K
h
a
n
e
t
a
l
.
,
“
G
l
o
b
a
l
e
p
i
d
e
mi
o
l
o
g
y
o
f
i
sc
h
e
mi
c
h
e
a
r
t
d
i
s
e
a
s
e
:
r
e
s
u
l
t
s
f
r
o
m
t
h
e
g
l
o
b
a
l
b
u
r
d
e
n
o
f
d
i
sea
s
e
st
u
d
y
,
”
C
u
r
e
u
s
,
v
o
l
.
1
2
,
n
o
.
7
,
p
.
e
9
3
4
9
,
J
u
l
.
2
0
2
0
,
d
o
i
:
1
0
.
7
7
5
9
/
c
u
r
e
u
s.
9
3
4
9
.
[
2
]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
I
n
d
o
n
e
s
i
a
,
“
B
a
s
i
c
h
e
a
l
t
h
r
e
se
a
r
c
h
2
0
1
8
,
”
(
i
n
I
n
d
o
n
e
si
a
n
)
,
L
e
m
b
a
g
a
Pe
n
e
rb
i
t
B
a
l
i
t
b
a
n
g
k
e
s
.
I
n
d
o
n
e
si
a
n
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
,
Jak
a
r
t
a
,
p
p
.
1
–
1
5
6
,
2
0
1
8
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
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2
3
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4
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5
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6
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2
7
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[
2
8
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