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CC B
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C
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A
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Facu
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@
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th
1.
I
NT
RO
D
UCT
I
O
N
W
o
r
k
-
r
elate
d
m
u
s
cu
lo
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k
eleta
l
d
is
o
r
d
er
s
(
W
R
MD
s
)
ar
e
illn
ess
es
in
wh
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th
e
wo
r
k
p
lace
en
v
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n
m
en
t
an
d
h
o
w
th
e
wo
r
k
is
p
er
f
o
r
m
ed
p
lay
a
s
u
b
s
tan
tial
r
o
le
in
th
e
co
n
d
itio
n
,
p
o
s
s
ib
ly
co
n
tr
ib
u
tin
g
to
its
d
ev
elo
p
in
g
m
o
r
e
d
etr
im
en
tal
o
v
er
tim
e
[
1
]
.
W
R
MD
s
ar
e
ch
ar
ac
ter
ized
b
y
m
u
s
cu
lo
s
k
eleta
l
s
y
s
tem
ab
n
o
r
m
alities
an
d
co
m
m
o
n
m
ed
ical
is
s
u
es
th
at
s
ig
n
if
ican
tly
r
ed
u
ce
th
e
q
u
ality
o
f
life
,
in
cr
ea
s
e
s
ick
leav
e,
an
d
lead
to
d
is
ab
ilit
ies
[
2
]
.
T
h
ese
co
n
ce
r
n
s
af
f
ec
t
f
o
r
m
al
an
d
in
f
o
r
m
al
lab
o
r
s
ec
to
r
s
in
d
ev
elo
p
ed
an
d
d
ev
elo
p
in
g
in
d
u
s
tr
ial
n
atio
n
s
,
ad
v
er
s
ely
af
f
ec
tin
g
o
cc
u
p
a
tio
n
al
h
ea
lth
an
d
s
af
ety
,
an
d
th
e
ec
o
n
o
m
y
[
3
]
.
Glo
b
ally
,
th
e
d
ir
ec
t
an
d
in
d
ir
ec
t
co
s
ts
o
f
W
R
MD
s
am
o
u
n
t
to
2
7
0
m
illi
o
n
d
o
llar
s
an
n
u
ally
[
4
]
.
I
n
th
e
E
u
r
o
p
ea
n
Un
io
n
,
6
0
%
o
f
h
ea
lth
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r
elate
d
p
r
o
b
lem
s
am
o
n
g
th
e
wo
r
k
f
o
r
ce
ar
e
r
elate
d
to
W
R
MD
s
,
m
ak
in
g
th
em
th
e
m
o
s
t sev
er
e
is
s
u
es
an
d
p
o
s
in
g
p
er
s
o
n
al,
ec
o
n
o
m
ic,
an
d
s
o
cieta
l b
u
r
d
en
s
o
f
m
ed
ical
co
s
ts
,
m
ed
icatio
n
,
an
d
co
m
p
en
s
atio
n
[
5
]
.
I
f
th
e
n
u
m
b
er
o
f
af
f
ec
ted
in
d
iv
id
u
als
r
em
ain
s
h
ig
h
,
g
o
v
er
n
m
en
ts
m
ig
h
t
f
ac
e
an
in
cr
ea
s
ed
ec
o
n
o
m
ic
d
is
ad
v
an
tag
e
d
u
e
to
r
is
in
g
h
ea
lth
ca
r
e
ex
p
en
s
es
[
6
]
.
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
.
2
,
J
u
n
e
20
25
:
77
3
-
7
78
774
I
n
T
h
ailan
d
,
m
o
s
t
o
f
th
e
wo
r
k
f
o
r
ce
is
in
f
o
r
m
al
lab
o
r
,
wh
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f
ac
es
r
is
k
s
r
elate
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to
s
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welf
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in
co
m
e
in
s
tab
ilit
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,
an
d
u
n
clea
r
r
eg
u
latio
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s
[
7
]
.
W
ith
o
u
t
s
u
p
p
o
r
t
o
r
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p
p
o
r
tu
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ities
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g
r
o
u
p
o
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lab
o
r
er
s
lack
s
ad
eq
u
ate
p
r
o
tectio
n
an
d
b
en
ef
its
f
r
o
m
wo
r
k
an
d
ca
n
h
av
e
n
eg
ativ
e
s
o
cial
an
d
ec
o
n
o
m
ic
co
n
s
eq
u
en
ce
s
in
th
e
f
u
tu
r
e.
T
h
e
h
ea
lth
im
p
ac
t
o
f
wo
r
k
-
r
elate
d
is
s
u
es
was
r
ef
lecte
d
in
a
g
lo
b
al
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ep
o
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t
o
n
o
cc
u
p
atio
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al
d
is
ea
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es,
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h
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th
at
th
e
p
r
ev
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ce
o
f
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MD
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r
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f
r
o
m
5
5
.
6
to
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7
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2
%,
m
ak
in
g
it
th
e
m
o
s
t
co
m
m
o
n
o
cc
u
p
atio
n
al
illn
ess
[
8
]
.
T
h
ese
ab
n
o
r
m
alities
ar
e
r
elate
d
to
o
cc
u
p
atio
n
an
d
jo
b
ch
ar
ac
ter
is
tics
an
d
ar
e
o
f
ten
p
r
ev
alen
t
in
p
h
y
s
ically
d
em
an
d
in
g
lab
o
r
th
at
in
v
o
lv
es
h
ea
v
y
liftin
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,
r
ep
etitiv
e
m
o
v
em
en
ts
,
awk
war
d
p
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tu
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es,
an
d
im
p
r
o
p
er
u
s
e
o
f
eq
u
ip
m
en
t
[
9]
.
Kala
s
in
p
r
o
v
in
ce
is
a
s
ig
n
if
ican
t
s
ilk
-
p
r
o
d
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p
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v
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ce
in
th
e
n
o
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th
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s
ter
n
r
eg
io
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o
f
T
h
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en
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in
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icate
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ar
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r
o
ce
s
s
es
[
1
0
]
.
T
h
e
d
iv
er
s
e
o
cc
u
p
atio
n
s
r
elate
d
to
g
ar
m
en
t
s
titch
in
g
p
lay
an
ess
en
tial
r
o
le
i
n
r
esid
en
ts
’
liv
elih
o
o
d
s
.
T
h
ese
o
cc
u
p
atio
n
s
ar
e
ce
n
tr
al
to
m
an
y
h
o
u
s
eh
o
ld
s
,
s
u
p
p
lem
en
tin
g
p
r
im
ar
y
in
co
m
e
s
o
u
r
ce
s
s
u
ch
as
f
ar
m
in
g
an
d
g
ar
d
en
in
g
[
1
1
]
.
T
h
e
wo
r
k
en
v
ir
o
n
m
en
t
an
d
p
o
s
tu
r
es
m
ay
n
o
t
b
e
er
g
o
n
o
m
ic,
p
o
ten
tially
lead
in
g
to
m
u
s
cu
lo
s
k
eleta
l
d
is
co
m
f
o
r
t
an
d
p
ain
[
1
2
]
.
Ho
wev
er
,
r
is
k
f
ac
to
r
s
f
o
r
W
R
MD
s
am
o
n
g
in
f
o
r
m
al
g
ar
m
en
t w
o
r
k
er
s
in
th
is
ar
ea
h
av
e
n
o
t b
ee
n
ad
d
r
ess
ed
.
Giv
en
th
e
is
s
u
e’
s
s
ig
n
if
ican
ce
,
th
is
s
tu
d
y
f
o
cu
s
ed
o
n
th
e
in
f
o
r
m
al
lab
o
r
f
o
r
ce
en
g
ag
ed
in
g
ar
m
en
t
s
titch
in
g
in
Kala
s
in
p
r
o
v
in
ce
.
T
h
e
o
b
jectiv
e
was
to
ass
ess
th
eir
ex
p
o
s
u
r
e
to
h
ea
lth
r
is
k
s
d
u
e
to
wo
r
k
-
r
elate
d
f
ac
to
r
s
.
T
h
is
s
tu
d
y
wo
u
ld
p
av
e
th
e
way
f
o
r
f
u
tu
r
e
s
o
lu
tio
n
s
in
th
is
ar
ea
.
I
f
n
o
t
ad
d
r
ess
ed
co
r
r
ec
tly
,
th
is
co
u
ld
lead
to
in
cr
ea
s
ed
h
ea
lth
ca
r
e
ex
p
en
s
es
an
d
r
ed
u
ce
d
wo
r
k
ef
f
ic
ien
cy
,
u
ltima
tely
im
p
ac
tin
g
th
e
q
u
ality
o
f
life
.
Her
e,
we
p
r
o
p
o
s
ed
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
to
s
u
r
v
ey
an
d
r
an
k
th
e
lev
els
o
f
r
is
k
f
ac
to
r
s
am
o
n
g
in
f
o
r
m
al
g
ar
m
en
t w
o
r
k
er
s
.
T
h
er
ef
o
r
e,
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
co
u
ld
s
er
v
e
as a
b
asis
f
o
r
d
ev
elo
p
in
g
h
ea
lth
p
r
o
m
o
tio
n
s
tr
ateg
ies
an
d
ef
f
ec
tiv
e
p
r
ev
en
tiv
e
m
ea
s
u
r
es to
ad
d
r
ess
W
R
MD
s
,
lead
in
g
to
s
u
s
tain
ab
le
s
o
lu
tio
n
s
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
em
p
lo
y
s
a
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
to
in
ter
v
iew
2
9
6
in
f
o
r
m
al
lab
o
r
er
s
en
g
ag
ed
in
g
ar
m
en
t
s
titch
in
g
in
Kala
s
in
Pro
v
in
c
e
f
r
o
m
1
3
v
illag
es.
Sam
p
le
s
ize
(
n
)
was e
s
tim
ated
u
s
in
g
th
e
f
o
r
m
u
la
g
iv
en
:
=
2
+
2
(
−
1
)
+
2
W
h
er
e
N
r
ep
r
esen
ts
th
e
to
tal
n
u
m
b
er
o
f
th
e
p
o
p
u
latio
n
,
wh
ich
was
6
,
7
8
8
,
z
=p
er
ce
n
ti
les
o
f
th
e
s
tan
d
ar
d
n
o
r
m
al
d
is
tr
ib
u
tio
n
co
r
r
esp
o
n
d
in
g
to
a
9
5
%
co
n
f
id
e
n
ce
lev
el,
wh
ich
is
1
.
9
6
,
p
=p
r
o
p
o
r
tio
n
o
f
th
e
p
o
p
u
latio
n
wo
r
k
in
g
as
in
f
o
r
m
al
g
a
r
m
en
t
wo
r
k
er
s
,
wh
ich
was
ass
u
m
ed
to
b
e
0
.
2
7
(
f
r
o
m
o
u
r
p
ilo
t
s
u
r
v
ey
)
,
q
=1
−
p
,
an
d
d
d
en
o
tes
m
ar
g
i
n
o
f
er
r
o
r
=5
at
9
5
%
co
n
f
i
d
en
ce
lev
el.
T
h
er
e
f
o
r
e,
u
s
in
g
th
e
f
o
r
m
u
la,
n
=6
,
7
8
8
(
1
.
9
6
)
2
×
0
.
2
7
×0
.
7
3
/(
0
.
0
5
)
2
(
6
,
7
8
8
-
1
)
+
(
1
.
9
6
)
2
×0
.
2
7
×0
.
7
3
=a
t le
ast 2
9
0
[
1
3
]
.
I
n
clu
s
io
n
cr
iter
ia
wer
e
i
)
in
f
o
r
m
al
lab
o
r
er
s
in
v
o
lv
ed
in
th
e
g
ar
m
en
t
s
titch
in
g
in
d
u
s
tr
y
with
≥
7
d
ay
s
o
f
ex
p
er
ien
ce
,
ii
)
ab
le
to
co
m
m
u
n
icate
in
T
h
ai,
an
d
iii
)
s
ig
n
ed
in
f
o
r
m
ed
co
n
s
en
t
f
o
r
m
s
.
E
x
clu
s
io
n
cr
iter
ia
in
clu
d
ed
a
h
is
to
r
y
o
f
ac
cid
en
ts
in
th
e
m
u
s
cu
lo
s
k
eleta
l
s
y
s
tem
an
d
th
e
lab
o
r
er
s
wh
o
r
elo
ca
ted
d
u
r
in
g
th
e
s
tu
d
y
.
Data
co
llectio
n
to
o
ls
co
n
s
is
t
o
f
a
s
tr
u
ctu
r
ed
in
ter
v
iew
q
u
esti
o
n
n
air
e
d
iv
id
ed
in
to
f
o
u
r
s
ec
tio
n
s
:
i
)
g
en
er
al
in
f
o
r
m
atio
n
,
ii
)
wo
r
k
-
r
elate
d
in
f
o
r
m
atio
n
,
iii
)
p
o
s
tu
r
e
an
d
en
v
ir
o
n
m
en
tal
co
n
d
itio
n
s
at
wo
r
k
,
an
d
iv
)
a
s
tan
d
ar
d
ized
No
r
d
ic
q
u
esti
o
n
n
air
e
[
1
4
]
.
T
h
r
ee
o
cc
u
p
atio
n
al
h
ea
lth
an
d
s
af
ety
ex
p
er
ts
ap
p
r
o
v
ed
th
e
q
u
esti
o
n
n
air
e
o
n
en
v
ir
o
n
m
en
tal
r
is
k
f
ac
to
r
s
f
o
r
co
n
ten
t
v
alid
ity
.
T
h
e
co
n
ten
t
v
alid
ity
h
as
b
ee
n
co
n
f
ir
m
ed
b
y
th
e
in
d
ex
o
f
ite
m
o
b
jectiv
e
co
n
g
r
u
en
ce
(
I
OC
)
.
On
ly
th
e
item
s
with
I
OC
s
co
r
es
≥
0
.
5
wer
e
q
u
alif
ied
f
o
r
th
e
q
u
esti
o
n
n
air
e
(
an
av
er
ag
e
I
OC
o
f
0
.
8
9
)
.
T
h
e
item
s
with
C
r
o
n
b
ac
h
’
s
α
≥
0
.
7
wer
e
ac
ce
p
ted
an
d
u
s
ed
in
th
e
q
u
esti
o
n
n
air
e
(
an
av
er
ag
e
α
o
f
0
.
9
2
)
.
Data
an
aly
s
is
in
v
o
lv
es
d
esc
r
ip
tiv
e
s
tatis
tics
an
d
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
.
T
h
e
Hu
m
an
R
esear
ch
E
th
ics
C
o
m
m
ittee
o
f
Ma
h
asar
ak
h
am
Un
iv
er
s
ity
ap
p
r
o
v
ed
th
e
r
esear
ch
p
r
o
to
co
l (
n
u
m
b
er
2
8
6
-
1
9
3
/2
5
6
5
)
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
De
m
o
g
r
a
ph
ic
da
t
a
T
h
e
m
ajo
r
ity
o
f
th
e
p
ar
ticip
an
ts
co
n
s
is
ted
o
f
f
em
ales
(
8
6
.
5
%).
Mo
s
t
p
ar
ticip
an
ts
wer
e
in
th
e
ea
r
ly
ad
u
lt
ag
e
g
r
o
u
p
(
≤
5
0
y
ea
r
s
)
,
r
ep
r
esen
tin
g
5
2
.
7
%.
Ab
o
u
t
6
1
.
1
%
o
f
th
e
p
ar
ticip
an
ts
h
ad
a
b
o
d
y
m
ass
in
d
ex
with
in
th
e
s
tan
d
ar
d
r
an
g
e
(
1
8
.
5
-
2
4
.
9
)
.
Mo
s
t
h
ad
co
m
p
le
ted
p
r
im
ar
y
ed
u
ca
tio
n
(
6
3
.
2
%),
an
d
th
e
m
ar
ital
s
tatu
s
was
p
r
ed
o
m
in
an
tly
m
ar
r
ied
(
8
0
.
4
%).
Ov
er
h
alf
o
f
th
e
p
ar
ticip
an
ts
(
5
6
.
4
%)
ea
r
n
ed
less
th
an
5
,
0
0
0
b
ah
t
m
o
n
th
ly
f
r
o
m
g
ar
m
en
t
s
titch
in
g
.
R
eg
ar
d
in
g
wo
r
k
ch
ar
ac
ter
is
tics
,
4
5
.
6
%
o
f
th
e
s
am
p
le
u
s
ed
m
ac
h
in
e
-
b
ase
d
g
ar
m
en
t
s
titch
in
g
.
Ap
p
r
o
x
im
ately
5
4
.
1
%
h
ad
wo
r
k
ex
p
er
ien
ce
o
f
1
0
y
ea
r
s
o
r
m
o
r
e,
an
d
6
7
.
2
%
co
n
s
id
er
ed
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
R
is
k
fa
cto
r
s
fo
r
w
o
r
k
-
r
e
la
ted
mu
s
cu
lo
s
ke
leta
l d
is
o
r
d
ers
a
m
o
n
g
in
f
o
r
ma
l g
a
r
men
t
… (
Wip
a
C
h
u
p
p
a
w
a
)
775
g
ar
m
en
t
s
titch
in
g
as
a
s
u
p
p
lem
en
tar
y
o
cc
u
p
atio
n
,
wh
ile
6
0
.
5
%
p
r
im
ar
ily
id
en
tifie
d
as
f
ar
m
er
s
.
A
r
ep
r
esen
tativ
e
s
itti
n
g
p
o
s
tu
r
e
o
f
an
in
f
o
r
m
al
g
ar
m
en
t
wo
r
k
er
is
co
m
p
ar
ed
with
th
e
s
tan
d
ar
d
s
itti
n
g
p
o
s
tu
r
e
d
esig
n
i
n
F
i
g
u
r
e
1
[
1
5
]
.
I
n
Fig
u
r
e
1
(
a)
,
a
s
tan
d
ar
d
s
itti
n
g
p
o
s
tu
r
e
r
eq
u
ir
es
s
lig
h
t
ce
r
v
ical
f
lex
io
n
(
≤
2
5
)
with
p
r
o
p
er
b
ac
k
s
u
p
p
o
r
t
an
d
d
esk
h
eig
h
t.
Fig
u
r
e
1
(
b
)
s
h
o
ws
th
e
s
itti
n
g
p
o
s
tu
r
e
o
f
an
in
f
o
r
m
al
g
ar
m
en
t
wo
r
k
er
is
p
o
o
r
an
d
lack
s
ad
eq
u
ate
s
u
p
p
o
r
t.
(
a)
(
b
)
F
i
g
u
r
e
1
.
A
r
e
p
r
e
s
e
n
t
a
t
i
v
e
s
it
t
in
g
p
o
s
t
u
r
e
o
f
a
n
i
n
f
o
r
m
a
l
g
a
r
m
e
n
t
w
o
r
k
e
r
i
s
c
o
m
p
a
r
e
d
wi
t
h
t
h
e
s
t
a
n
d
a
r
d
s
i
t
ti
n
g
p
o
s
t
u
r
e
d
e
s
i
g
n
(
a
)
a
s
tan
d
ar
d
s
itti
n
g
p
o
s
tu
r
e
d
esig
n
ad
ap
te
d
f
r
o
m
[
1
5
]
an
d
(
b
)
a
r
e
p
r
esen
tativ
e
s
itti
n
g
p
o
s
tu
r
e
o
f
an
in
f
o
r
m
al
g
ar
m
e
n
t w
o
r
k
e
r
3
.
2
.
P
re
v
a
lence
o
f
wo
rk
-
re
la
t
ed
m
us
culo
s
k
elet
a
l dis
o
rder
s
a
m
o
ng
info
rm
a
l g
a
rm
ent
wo
rk
er
s
W
h
en
co
n
s
id
er
in
g
th
e
p
r
ev
alen
ce
o
f
W
R
MD
s
in
th
e
p
ast
s
ev
en
d
ay
s
an
d
1
2
m
o
n
th
s
,
s
elf
-
r
esp
o
n
s
es
to
th
e
s
tan
d
ar
d
ized
No
r
d
ic
q
u
esti
o
n
n
air
e
in
d
icate
d
a
p
r
ev
alen
ce
o
f
7
9
.
7
0
%
an
d
8
2
.
8
0
%,
r
esp
ec
tiv
ely
.
T
h
e
th
r
ee
m
o
s
t
co
m
m
o
n
af
f
ec
ted
ar
ea
s
in
th
e
p
ast
s
ev
en
d
ay
s
wer
e
th
e
s
h
o
u
ld
er
(
5
0
.
0
0
%),
n
ec
k
(
4
2
.
2
0
%),
an
d
k
n
ee
(
4
0
.
5
0
%).
Similar
ly
,
th
e
to
p
th
r
ee
af
f
ec
ted
ar
ea
s
in
th
e
p
ast 1
2
m
o
n
th
s
wer
e
th
e
s
h
o
u
ld
er
(
4
8
.
3
0
%),
k
n
ee
(
4
1
.
6
0
%),
an
d
h
ip
/leg
/b
u
tto
ck
(
3
3
.
4
0
%).
Deta
ils
ar
e
av
ailab
le
in
T
ab
le
1
.
T
ab
le
1
.
Pre
v
ale
n
ce
o
f
W
R
MD
s
am
o
n
g
in
f
o
r
m
al
g
a
r
m
en
t w
o
r
k
er
s
(
n
=
2
9
6
)
B
o
d
y
a
r
e
a
M
u
s
c
u
l
o
sk
e
l
e
t
a
l
d
i
so
r
d
e
r
s
B
o
d
y
a
r
e
a
M
u
s
c
u
l
o
sk
e
l
e
t
a
l
d
i
so
r
d
e
r
s
P
a
st
7
d
a
y
P
a
st
1
2
m
o
n
t
h
s
P
a
st
7
d
a
y
P
a
st
1
2
m
o
n
t
h
s
n
%
n
%
n
%
n
%
N
e
c
k
1
2
5
4
2
.
2
0
95
3
2
.
1
0
U
p
p
e
r
b
a
c
k
76
2
5
.
7
0
69
2
3
.
3
0
S
h
o
u
l
d
e
r
1
4
8
5
0
.
0
0
1
4
3
4
8
.
3
0
Lo
w
b
a
c
k
94
3
1
.
8
0
80
2
7
.
0
0
El
b
o
w
s
33
1
1
.
1
0
23
7
.
8
0
H
i
p
s
/
Th
i
g
h
s
/
B
o
t
t
o
m
1
1
5
3
8
.
9
0
99
3
3
.
4
0
W
r
i
st
s/
H
a
n
d
s
86
2
9
.
1
0
69
2
3
.
3
0
K
n
e
e
s
1
2
0
4
0
.
5
0
1
2
3
4
1
.
6
0
U
p
p
e
r
a
r
m
54
1
8
.
2
0
39
1
3
.
2
0
Le
g
s
64
2
1
.
6
0
56
1
8
.
9
0
Lo
w
a
r
m
47
1
5
.
9
0
36
1
2
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2
0
A
n
k
l
e
s
/
F
e
e
t
75
2
5
.
3
0
68
2
3
.
0
0
3
.
3
.
E
nv
iro
nm
ent
a
l
risk
f
a
c
t
o
rs
f
o
r
wo
r
k
-
re
la
t
ed
m
us
culo
s
k
elet
a
l
dis
o
rder
s
a
m
o
ng
i
nfo
rm
a
l
g
a
rm
ent
wo
rk
er
s
Ad
d
itio
n
al
an
aly
s
is
u
s
in
g
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
s
h
o
wed
th
at
th
e
m
o
s
t
s
ig
n
if
ican
t
f
ac
to
r
was
im
p
r
o
p
er
wo
r
k
s
tatio
n
s
(
ad
ju
s
ted
OR
=6
.
2
5
7
,
P=0
.
0
0
2
,
9
5
%
C
I
[
1
.
9
2
1
,
2
0
.
3
8
8
]
)
,
f
o
llo
wed
b
y
wo
r
k
-
r
elate
d
s
tr
ess
(
W
R
S)
(
ad
ju
s
ted
OR
=4
.
2
4
8
,
P=0
.
0
0
7
,
9
5
%
C
I
[
1
.
4
7
5
,
1
2
.
2
3
1
]
)
.
T
h
ese
d
ata
im
p
ly
th
at
im
p
r
o
p
er
wo
r
k
s
tatio
n
s
an
d
WRS
in
cr
ea
s
ed
th
e
r
is
k
s
f
o
r
m
u
s
cu
lo
s
k
eleta
l
in
ju
r
ies
b
y
ap
p
r
o
x
im
ately
6
an
d
4
tim
es,
r
esp
ec
tiv
ely
.
Po
o
r
lig
h
tin
g
an
d
p
r
o
lo
n
g
ed
r
ep
etitiv
e
task
s
last
in
g
3
-
5
m
in
u
tes
wer
e
o
th
er
f
ac
to
r
s
th
at
co
n
tr
ib
u
ted
to
th
e
W
R
MD
s
y
m
p
to
m
s
(
ad
ju
s
ted
OR
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.
6
9
3
,
p
=0
.
0
0
1
,
9
5
%
C
I
[
1
.
8
1
9
,
7
.
4
9
7
]
an
d
ad
ju
s
ted
OR
=2
.
6
8
6
,
p
=
0
.
0
2
3
,
9
5
% C
I
[
1
.
1
4
3
,
6
.
3
0
9
]
)
,
r
esp
ec
tiv
ely
as sh
o
wn
in
T
ab
le
2
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
5
2
-
8
8
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6
I
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t J Pu
b
lic
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l.
14
,
No
.
2
,
J
u
n
e
20
25
:
77
3
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7
78
776
T
ab
le
2
.
E
n
v
ir
o
n
m
en
tal
r
is
k
f
a
cto
r
s
f
o
r
W
R
MD
s
am
o
n
g
in
f
o
r
m
al
g
ar
m
e
n
t w
o
r
k
e
r
s
(
n
=2
9
6
)
F
a
c
t
o
r
s
C
r
u
d
e
O
R
A
d
j
u
st
e
d
O
R
p
-
v
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l
u
e
9
5
%
C
I
Lo
w
e
r
,
U
p
p
e
r
N
e
e
d
s t
o
b
e
n
d
d
u
r
i
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g
w
o
r
k
No
1
Y
e
s
2
.
0
1
9
2
.
6
8
6
0
.
0
2
3
1
.
1
4
3
,
6
.
3
0
9
I
n
a
d
e
q
u
a
t
e
l
i
g
h
t
i
n
g
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u
r
i
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g
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k
No
1
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e
s
2
.
7
5
4
3
.
6
9
3
<
0
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0
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1
1
.
8
1
9
,
7
.
4
9
7
I
n
a
p
p
r
o
p
r
i
a
t
e
a
r
r
a
n
g
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men
t
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e
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e
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t
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1
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e
s
2
.
4
6
1
6
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2
5
7
0
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0
0
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1
.
9
2
1
,
2
0
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3
8
8
S
o
c
i
a
l
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sp
e
c
t
s a
t
w
o
r
k
N
o
t
S
t
r
e
ssed
1
S
t
r
e
ssed
2
.
0
9
4
4
.
2
4
8
0
.
0
0
7
1
.
4
7
5
,
1
2
.
2
3
1
4.
CO
NCLU
SI
O
N
W
R
M
Ds,
ab
n
o
r
m
alities
in
t
h
e
m
u
s
cu
lo
s
k
eleta
l
s
y
s
tem
,
ca
u
s
e
a
s
u
b
s
tan
tial
h
ea
lth
r
i
s
k
d
u
e
to
escalatin
g
tr
en
d
s
in
d
is
ea
s
e
an
d
in
ju
r
y
.
T
h
is
s
tu
d
y
illu
s
tr
ates
th
at
W
R
MD
s
y
m
p
to
m
s
am
o
n
g
in
f
o
r
m
al
g
a
r
m
en
t
wo
r
k
er
s
in
Kala
s
in
ar
e
h
ig
h
l
y
p
r
ev
alen
t.
T
h
e
m
o
s
t
s
ig
n
if
ic
a
n
t
f
ac
to
r
s
ar
e
im
p
r
o
p
er
wo
r
k
s
tatio
n
s
an
d
s
tr
es
s
f
r
o
m
th
e
wo
r
k
p
lace
,
wh
ich
a
r
e
f
o
llo
wed
b
y
p
o
o
r
illu
m
i
n
atio
n
an
d
p
r
o
lo
n
g
ed
r
ep
etitiv
e
d
u
tie
s
.
I
t
h
as
b
ee
n
r
ep
o
r
ted
th
at
s
e
v
er
al
o
p
er
at
o
r
s
in
ass
em
b
ly
p
r
o
d
u
ctio
n
lin
es
r
u
n
t
h
e
r
i
s
k
o
f
p
o
o
r
wo
r
k
s
tatio
n
d
esig
n
s
[
1
6
]
.
I
n
th
is
s
tu
d
y
,
th
e
b
o
d
y
a
r
ea
s
th
at
m
an
if
est
th
e
m
o
s
t
W
R
MD
s
y
m
p
to
m
s
ar
e
th
e
s
h
o
u
ld
er
s
,
n
ec
k
,
k
n
ee
s
,
an
d
h
ip
s
,
f
o
llo
wed
b
y
th
e
lo
wer
b
ac
k
,
wr
is
ts
,
elb
o
ws,
an
d
an
k
les.
T
h
is
h
ig
h
p
r
ev
alen
ce
co
u
l
d
b
e
attr
ib
u
ted
to
th
e
n
atu
r
e
o
f
th
e
wo
r
k
,
wh
i
ch
in
v
o
lv
es c
o
n
s
tan
t f
o
r
war
d
h
ea
d
p
o
s
tu
r
e
(
FHP)
an
d
p
r
o
lo
n
g
e
d
h
u
n
ch
in
g
o
v
e
r
th
e
task
[
1
7
]
.
A
r
ec
en
t
p
iece
b
y
Nis
h
ik
awa
[
1
8
]
an
d
c
o
-
wo
r
k
er
s
m
ea
s
u
r
ed
th
e
ac
tiv
ity
o
f
th
e
tr
ap
ez
iu
s
(
a
l
ar
g
e
s
u
p
e
r
f
icial
b
a
ck
m
u
s
cle
ex
ten
d
i
n
g
f
r
o
m
th
e
o
cc
i
p
ital
b
o
n
e
to
th
e
lo
we
r
th
o
r
ac
ic
v
er
teb
r
ae
an
d
th
e
s
ca
p
u
la)
u
s
in
g
elec
tr
o
m
y
o
g
r
ap
h
y
(
E
M
G)
d
is
p
lay
ed
m
o
r
e
o
v
e
r
all
m
u
s
cle
ac
tiv
ity
an
d
s
u
b
jectiv
e
tire
d
n
ess
in
th
e
FHP
g
r
o
u
p
th
an
t
h
e
n
o
r
m
a
l
g
r
o
u
p
.
T
h
er
e
f
o
r
e,
th
e
FHP
m
ig
h
t
ex
p
lain
th
e
W
R
M
D
s
y
m
p
to
m
s
m
ain
l
y
o
n
th
e
s
h
o
u
l
d
er
s
an
d
n
ec
k
.
H
o
wev
er
,
a
s
tu
d
y
in
an
o
th
er
p
r
o
v
in
ce
o
f
T
h
ailan
d
s
h
o
wed
th
at
th
e
lo
wer
b
ac
k
was
wh
er
e
in
f
o
r
m
al
g
ar
m
en
t
wo
r
k
er
s
m
o
s
t
co
m
p
lain
ed
o
f
m
u
s
cle
p
ain
[
1
9
]
.
Fu
r
th
er
an
al
y
s
is
m
ay
b
e
r
eq
u
ir
ed
to
c
o
m
p
ar
e
o
th
e
r
p
o
s
s
ib
le
f
ac
to
r
s
f
o
r
th
is
d
is
cr
ep
an
cy
,
s
u
ch
as
p
h
y
s
ical
f
itn
ess
an
d
s
itti
n
g
tim
e
d
u
r
in
g
th
e
s
h
if
t.
T
h
e
ter
m
“
WRS
”
r
ef
er
s
to
a
p
atter
n
o
f
p
h
y
s
io
lo
g
ical,
co
g
n
it
iv
e,
em
o
tio
n
al,
a
n
d
b
e
h
av
io
r
al
r
esp
o
n
s
es
to
s
o
m
e
p
ar
ticu
lar
ly
d
em
a
n
d
i
n
g
ch
ar
ac
ter
is
tics
o
f
th
e
n
atu
r
e,
s
tr
u
ctu
r
e,
an
d
e
n
v
ir
o
n
m
en
t
o
f
th
e
wo
r
k
p
lace
[
2
0
]
.
T
h
e
W
R
S
h
as
n
eg
ativ
ely
af
f
ec
ted
em
p
lo
y
ee
s
’
h
ea
l
th
an
d
s
af
ety
a
n
d
th
ei
r
b
u
s
in
ess
es’
h
ea
lth
an
d
ef
f
ec
tiv
en
ess
[
2
1
]
.
W
o
r
k
p
lace
s
tr
ess
ca
n
lead
to
b
u
r
n
o
u
t,
w
h
ich
m
an
if
ests
as
ex
h
au
s
tio
n
an
d
ir
r
itab
ilit
y
.
I
t
is
lin
k
ed
to
s
ev
er
al
u
n
f
av
o
r
ab
le
r
ea
ctio
n
s
,
s
u
ch
as
jo
b
d
is
s
atis
f
ac
tio
n
,
a
lack
o
f
o
r
g
an
izatio
n
a
l
co
m
m
itm
en
t,
an
d
a
h
ig
h
in
clin
atio
n
to
q
u
it
[
2
1
]
.
I
n
ter
esti
n
g
ly
,
Ar
v
i
d
s
s
o
n
an
d
c
o
lleag
u
es
e
x
p
lain
ed
th
at
n
ec
k
an
d
u
p
p
er
ex
tr
em
ity
p
ain
d
ev
el
o
p
m
en
t
h
ad
b
ee
n
lin
k
ed
to
wo
r
k
p
l
ac
e
s
tr
ess
o
r
s
,
p
o
s
s
ib
ly
v
ia
i
n
cr
ea
s
in
g
s
u
s
tain
ed
m
u
s
cu
lar
ac
tiv
ity
[
2
2
]
.
T
h
is
p
er
s
p
ec
tiv
e
co
u
ld
ex
p
lain
wh
y
m
u
s
cle
d
is
co
m
f
o
r
t,
esp
ec
ia
lly
in
th
e
n
ec
k
an
d
s
h
o
u
ld
er
ar
ea
,
an
d
W
R
S c
o
-
ex
is
t.
Po
o
r
lig
h
tin
g
is
p
o
ten
tially
r
e
lated
to
W
R
MD
s
–
wo
r
k
er
s
m
ay
ad
o
p
t
u
n
n
at
u
r
al
p
o
s
itio
n
s
to
o
p
tim
ize
th
eir
v
is
io
n
in
in
ad
eq
u
ate
lig
h
tin
g
,
w
h
ich
r
aises
th
e
p
o
s
s
ib
ilit
y
o
f
in
ju
r
ies
[
2
3
]
.
Hea
d
an
d
ey
e
f
u
n
ctio
n
s
a
r
e
clo
s
e
ly
r
elate
d
to
n
ec
k
p
ain
.
T
h
e
n
u
cleu
s
r
eticu
lar
is
g
ig
an
t
o
ce
llu
lar
is
(
NR
G)
in
th
e
s
u
b
co
r
tical
ar
ea
o
f
th
e
b
r
ain
r
ec
ei
v
es
p
o
s
tu
r
e
a
n
d
v
is
io
n
in
f
o
r
m
atio
n
f
r
o
m
h
ea
d
an
d
ey
e
m
o
v
em
en
t,
s
tim
u
latin
g
th
e
ce
r
v
ical
m
u
s
cles
th
r
o
u
g
h
th
e
ce
r
v
ical
s
p
in
al
c
o
r
d
’
s
m
o
to
r
n
eu
r
o
n
s
an
d
r
esu
ltin
g
in
p
o
s
tu
r
al
s
tab
ilit
y
[
2
4
]
.
E
y
e
d
is
ea
s
es
lik
e
f
o
ca
l
v
is
io
n
d
is
o
r
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er
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d
d
o
u
b
le
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n
co
u
ld
co
-
e
x
is
t
in
th
o
s
e
with
n
ec
k
p
ain
an
d
th
e
d
y
s
f
u
n
ctio
n
o
f
v
er
teb
r
al
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r
ter
ies
(
ar
ter
ies
r
es
id
in
g
in
th
e
ce
r
v
ical
v
er
te
b
r
a
e)
[
2
5
]
.
As
a
r
esu
lt,
p
o
o
r
li
g
h
tin
g
in
th
is
s
tu
d
y
m
ig
h
t
in
ter
f
e
r
e
with
ey
e
m
u
s
cle
m
o
v
em
en
t
an
d
ca
u
s
e
p
o
o
r
n
ec
k
p
o
s
tu
r
e
an
d
m
u
s
cle
p
ain
.
I
t
h
as
b
ee
n
f
o
u
n
d
th
at
ac
tiv
e
b
r
ea
k
s
an
d
p
o
s
tu
r
e
ch
an
g
es
co
u
l
d
r
ec
o
v
e
r
h
ig
h
-
r
is
k
s
itti
n
g
wo
r
k
er
s
’
n
ew
o
n
s
e
t
o
f
n
ec
k
a
n
d
lo
w
-
b
ac
k
p
ain
[
2
6
]
.
Fu
r
th
e
r
s
tu
d
y
i
s
r
eq
u
ir
ed
to
im
p
lem
en
t th
is
in
ter
v
en
tio
n
in
in
f
o
r
m
al
g
ar
m
en
t w
o
r
k
er
s
.
Similar
ly
to
g
ar
m
en
t
wo
r
k
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s
,
m
an
u
al
lab
o
r
er
s
r
e
q
u
ir
e
h
ig
h
p
h
y
s
ical
d
em
an
d
s
,
in
clu
d
in
g
p
h
y
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ically
in
ten
s
iv
e
task
s
an
d
p
r
o
lo
n
g
e
d
r
ep
etitiv
e
d
u
ties
[
2
7
]
.
R
ep
etitiv
e
m
u
s
cle
in
ju
r
ies
ca
u
s
e
ex
tr
ac
ellu
lar
m
atr
ix
en
lar
g
em
e
n
t,
co
llag
e
n
ac
cu
m
u
latio
n
,
an
d
f
ib
e
r
n
ec
r
o
s
is
[
2
7
]
.
I
n
a
d
d
itio
n
,
d
ir
ec
t
d
a
m
a
g
e
to
ten
d
o
n
s
an
d
lig
am
en
ts
ca
n
also
p
r
o
d
u
ce
f
ib
r
o
s
is
an
d
ca
u
s
e
i
n
f
lam
m
at
io
n
an
d
c
o
llag
en
d
y
s
p
lasi
a
[
2
8
]
,
[
2
9
]
.
Du
e
t
o
r
ep
etitiv
e
h
an
d
an
d
ar
m
m
o
v
em
en
ts
an
d
s
u
b
o
p
tim
al
w
o
r
k
in
g
p
o
s
tu
r
es
th
at
n
ee
d
to
b
e
m
ain
tain
ed
f
o
r
ex
ten
d
ed
p
e
r
io
d
s
,
h
a
n
d
-
s
ewin
g
task
s
m
ay
b
e
ass
o
ciate
d
with
a
h
ig
h
p
r
ev
ale
n
ce
o
f
W
R
M
Ds
in
wo
r
k
er
s
,
esp
ec
ially
with
ex
ten
d
ed
p
er
io
d
s
wh
ile
s
ea
ted
at
a
d
esk
[
3
0
]
.
T
h
e
l
i
m
i
t
a
ti
o
n
s
o
f
t
h
i
s
s
t
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s
.
Fi
r
s
t
,
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cl
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ca
l
m
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f
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s
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at
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s
o
f
W
R
M
Ds
.
S
e
co
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l
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b
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p
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m
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8
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6
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s
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p
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Facu
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Hea
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Ma
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Un
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s
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.
T
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au
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s
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all
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f
o
r
th
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s
u
p
p
o
r
t.
RE
F
E
R
E
NC
E
S
[
1
]
A
.
P
a
l
,
A
.
D
a
s
g
u
p
t
a
,
S
.
k
.
S
a
d
h
u
k
h
a
n
,
L
.
B
a
n
d
y
o
p
a
d
h
y
a
y
,
B
.
P
a
u
l
,
a
n
d
D
.
P
o
d
d
e
r
,
“
H
o
w
c
o
mm
o
n
a
r
e
a
c
h
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s
a
n
d
p
a
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s
a
m
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g
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r
me
n
t
f
a
c
t
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y
w
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r
k
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s
?
a
w
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k
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r
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a
t
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m
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sc
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d
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s
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sses
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t
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t
h
r
e
e
f
a
c
t
o
r
i
e
s
o
f
S
o
u
t
h
2
4
P
a
r
g
a
n
a
s
D
i
st
r
i
c
t
,
W
e
st
B
e
n
g
a
l
,
”
J
o
u
rn
a
l
o
f
Fa
m
i
l
y
M
e
d
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c
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a
n
d
Pri
m
a
ry
C
a
re
,
v
o
l
.
1
0
,
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o
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2
,
p
p
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9
1
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2
1
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b
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2
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:
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j
f
m
p
c
.
j
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_
5
5
_
2
0
.
[
2
]
J.
S
.
S
i
l
v
a
-
Ju
n
i
o
r
,
M
.
C
.
M
a
r
t
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n
e
z
,
F
.
S
.
S
e
k
i
y
a
,
C
.
B
.
d
e
M
i
r
a
n
d
a
,
a
n
d
F
.
M
.
F
i
s
c
h
e
r
,
“
R
e
t
u
r
n
t
o
w
o
r
k
a
f
t
e
r
s
i
c
k
l
e
a
v
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d
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sc
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k
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l
e
t
a
l
d
i
s
o
r
d
e
r
o
r
i
n
j
u
r
y
:
a
l
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l
st
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d
y
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d
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B
r
a
z
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l
,
”
BM
C
Pu
b
l
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c
H
e
a
l
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v
o
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.
2
3
,
n
o
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1
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p
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1
8
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2
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3
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8
6
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s1
2
8
8
9
-
0
2
3
-
1
6
7
8
9
-
z.
[
3
]
N
.
N
a
i
c
k
e
r
,
F
.
P
e
g
a
,
D
.
R
e
e
s,
S
.
K
g
a
l
a
m
o
n
o
,
a
n
d
T.
S
i
n
g
h
,
“
H
e
a
l
t
h
ser
v
i
c
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s
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se
a
n
d
h
e
a
l
t
h
o
u
t
c
o
mes
a
m
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n
g
i
n
f
o
r
mal
e
c
o
n
o
my
w
o
r
k
e
r
s
c
o
mp
a
r
e
d
w
i
t
h
f
o
r
m
a
l
e
c
o
n
o
my
w
o
r
k
e
r
s:
a
s
y
st
e
ma
t
i
c
r
e
v
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e
w
a
n
d
me
t
a
-
a
n
a
l
y
si
s,
”
I
n
t
e
rn
a
t
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l
J
o
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rn
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En
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R
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l
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,
v
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l
.
1
8
,
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o
.
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p
.
1
–
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5
,
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r
.
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o
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.
3
3
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0
/
i
j
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p
h
1
8
0
6
3
1
8
9
.
[
4
]
A
.
A
r
a
t
i
k
a
t
l
a
,
N
.
M
a
f
f
u
l
l
i
,
H
.
C
.
R
o
d
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i
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B
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RAP
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S O
F
AUTH
O
RS
Wip
a
Chu
p
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li
c
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a
h
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h
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m
Un
iv
e
rsity
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Th
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il
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n
d
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(
P
u
b
li
c
He
a
lt
h
)
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t
Na
re
su
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Un
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e
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n
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n
d
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S
c
.
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c
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p
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ty
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t
S
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ra
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re
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Un
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h
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g
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il
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d
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S
h
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tere
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d
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g
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m
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su
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Th
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tal
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H
e
c
a
n
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c
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n
tac
ted
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t
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m
a
il
:
wisit.
t@m
su
.
a
c
.
th
.
Witta
y
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Yo
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suk
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n
As
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ro
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th
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F
a
c
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lt
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Alli
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lt
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S
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s,
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ra
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ra
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In
stit
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Th
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d
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n
d
h
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s
a
D.
En
g
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rin
g
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ro
c
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En
g
in
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e
r)
fro
m
th
e
S
a
v
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ie
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ll
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g
e
,
F
ra
n
c
e
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M
.
En
g
.
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a
n
it
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ry
e
n
g
in
e
e
rin
g
)
a
t
Ch
u
lalo
n
g
k
o
rn
Un
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e
rsity
,
Th
a
il
a
n
d
,
a
n
d
B.
S
c
.
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c
u
p
a
ti
o
n
a
l
h
e
a
lt
h
a
n
d
sa
fe
ty
)
a
t
M
a
h
id
o
l
Un
iv
e
rsity
,
Th
a
il
a
n
d
.
As
a
re
se
a
rc
h
e
r,
h
is
sk
il
ls
a
n
d
e
x
p
e
rti
se
e
n
c
o
m
p
a
ss
e
n
g
in
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rin
g
,
o
c
c
u
p
a
ti
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n
a
l
h
e
a
lt
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a
n
d
sa
fe
ty
,
e
n
v
iro
n
m
e
n
tal
h
e
a
lt
h
,
a
n
d
h
e
a
lt
h
a
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d
sa
fe
ty
tec
h
n
o
lo
g
y
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
witt
a
y
a
.
y
o
o
@m
a
h
id
o
l.
a
c
.
th
o
r
witay
a
.
y
@m
su
.
a
c
.
th
.
K
u
k
ia
t
T
u
d
p
o
r
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n
As
sista
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t
P
r
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fe
ss
o
r
a
t
t
h
e
F
a
c
u
lt
y
o
f
P
u
b
li
c
He
a
lt
h
,
M
a
h
a
sa
ra
k
h
a
m
Un
iv
e
rsity
,
T
h
a
il
a
n
d
.
He
re
c
e
iv
e
d
a
P
h
.
D.
in
M
e
d
ica
l
S
c
iec
n
e
fro
m
Ra
d
b
o
u
d
Un
iv
e
rsity
,
t
h
e
Ne
t
h
e
rlan
d
s
,
a
m
a
ste
r’s
in
P
h
y
sio
l
o
g
y
fr
o
m
M
a
h
i
d
o
l
Un
i
v
e
rsity
,
a
n
d
a
c
li
n
ica
l
p
ro
fe
ss
io
n
a
l
in
P
h
y
sic
a
l
T
h
e
ra
p
y
fro
m
Kh
o
n
Ka
e
n
Un
i
v
e
rsity
,
T
h
a
il
a
n
d
.
His
re
se
a
rc
h
in
c
l
u
d
e
s
m
u
sc
u
lo
sk
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leta
l
d
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o
rd
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rs,
o
c
c
u
p
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ti
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n
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l
m
e
d
icin
e
,
a
n
d
n
o
n
-
c
o
m
m
u
n
ica
b
le
d
ise
a
se
s,
fro
m
m
o
lec
u
les
to
c
li
n
ica
l
a
p
p
l
ica
ti
o
n
s.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
Ku
k
iat.
t@m
su
.
a
c
.
th
.
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