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r
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K
ey
w
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s
:
C
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r
o
v
ascu
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ac
cid
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n
t
Dep
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Gh
an
a
Ma
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ag
em
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n
ce
Po
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p
atien
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So
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p
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CC B
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C
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L
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Yar
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Dep
ar
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ag
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Un
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ity
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I
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RO
D
UCT
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O
N
C
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r
o
v
ascu
lar
ac
cid
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t
(
C
VA)
o
r
s
tr
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k
e,
is
a
g
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co
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ce
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with
h
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m
o
r
tality
an
d
m
o
r
b
id
ity
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ates
wo
r
l
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wid
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[
1
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.
Mo
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an
1
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m
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ally
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Of
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6
.
5
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[
2
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Stro
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Or
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izatio
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[
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r
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7
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[
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[
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-
[
5
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.
A
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in
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Mid
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[
6
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.
Similar
ly
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PS
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at
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9
% [
8
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,
r
esp
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.
I
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Gh
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th
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r
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d
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in
Gh
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x
h
i
b
it
ea
r
ly
PS
D
f
r
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m
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
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8
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6
Dep
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,
s
o
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l su
p
p
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t a
n
d
ma
n
a
g
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t p
r
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s
a
mo
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g
Gh
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n
a
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p
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s
t
-
s
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ke
…
(
Lil
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Ya
r
n
ey
)
1553
o
n
e
to
n
in
e
m
o
n
th
s
af
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th
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v
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9
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[
1
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an
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ts
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x
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d
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[
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PS
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also
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an
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ts
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p
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1
1
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ically
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ts
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wh
o
d
id
n
o
t
h
av
e
s
tr
o
k
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[
1
2
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Ag
ain
,
p
ast
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tr
o
k
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d
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f
f
icu
lties
with
d
aily
ac
tiv
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,
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d
d
ep
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s
y
m
p
to
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s
ar
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m
ajo
r
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f
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s
f
o
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s
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in
s
tr
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k
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atien
ts
[
1
3
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Desp
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PS
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is
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f
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g
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ized
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esp
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ially
in
h
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f
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f
r
eq
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tly
v
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s
u
r
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ltin
g
in
g
ap
s
in
em
p
i
r
ical
ev
id
e
n
ce
r
e
g
ar
d
in
g
s
u
p
p
o
r
t
s
y
s
tem
s
an
d
m
an
ag
em
en
t
o
p
tio
n
s
tailo
r
ed
to
PS
D
am
o
n
g
C
VA
s
u
r
v
iv
o
r
s
in
Gh
an
a
[
1
4
]
.
E
x
is
tin
g
s
tu
d
ies
ex
p
lo
r
ed
o
n
ly
lim
it
ed
asp
ec
ts
o
f
PS
D,
co
v
er
in
g
r
is
k
f
ac
to
r
s
[
1
]
,
[
1
5
]
,
tr
ea
tm
en
t m
o
d
alities
[
1
6
]
,
an
d
th
e
im
p
ac
t o
f
PS
D
o
n
C
VA
s
u
r
v
iv
o
r
s
[
1
4
]
,
[
1
6
]
,
[
1
7
]
.
T
h
e
r
e
is
also
a
co
n
s
id
er
ab
le
g
ap
in
k
n
o
wled
g
e
a
b
o
u
t
th
e
co
n
n
ec
tio
n
b
etwe
en
m
e
d
icatio
n
p
o
ten
cy
an
d
PS
D
tr
ea
tm
en
t,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
f
u
r
th
er
in
v
esti
g
atio
n
in
to
th
e
p
r
ev
alen
ce
o
f
PS
D
am
o
n
g
C
VA
s
u
r
v
iv
o
r
s
an
d
s
u
r
v
iv
o
r
s
'
p
r
ef
er
en
ce
s
f
o
r
m
an
ag
e
m
en
t
an
d
t
r
ea
tm
en
t
o
p
tio
n
s
[
1
8
]
.
Un
d
er
s
tan
d
in
g
s
u
r
v
iv
o
r
s
'
p
r
ef
er
en
ce
s
in
th
is
ar
ea
is
ess
en
tial
f
o
r
d
ev
el
o
p
in
g
p
atien
t
-
ce
n
ter
ed
ap
p
r
o
ac
h
es
to
m
a
n
ag
in
g
PS
D
an
d
en
h
an
cin
g
tr
ea
tm
en
t
o
u
tc
o
m
es
[
1
5
]
.
Simi
lar
ly
,
d
esp
ite
th
e
h
ig
h
p
r
ev
ale
n
ce
o
f
s
tr
o
k
e
i
n
Gh
an
a
,
th
er
e
i
s
a
n
o
tab
le
lac
k
o
f
r
esear
ch
f
o
c
u
s
in
g
o
n
th
e
s
u
p
p
o
r
t
n
ee
d
s
o
f
C
VA
s
u
r
v
iv
o
r
s
[
1
5
]
,
[
1
9
]
,
h
in
d
er
in
g
th
e
d
ev
elo
p
m
en
t
a
n
d
im
p
lem
en
tatio
n
o
f
r
elev
a
n
t h
e
alth
p
o
licies to
ad
d
r
ess
th
e
co
n
d
itio
n
in
G
h
an
aian
h
o
s
p
itals
[
9
]
.
Ho
wev
er
,
g
iv
en
th
e
s
ig
n
if
ican
ce
o
f
s
cien
tific
e
v
id
en
ce
o
n
r
ec
o
v
e
r
y
f
r
o
m
PS
D
[
7
]
an
d
t
h
e
n
ee
d
f
o
r
s
u
s
tain
ed
m
en
tal
h
ea
lth
s
er
v
i
ce
s
f
o
r
p
o
s
t
-
s
tr
o
k
e
p
atien
ts
[
2
0
]
,
[
2
1
]
,
r
esear
ch
o
n
tr
ea
tm
en
t
p
r
ef
er
e
n
ce
s
an
d
s
u
p
p
o
r
t
s
y
s
tem
s
f
o
r
m
an
ag
i
n
g
p
o
s
t
-
s
tr
o
k
e
d
ep
r
ess
io
n
(
PS
D)
am
o
n
g
C
VA
s
u
r
v
iv
o
r
s
r
ec
eiv
in
g
h
ea
lth
ca
r
e
at
L
ed
zo
k
u
k
u
-
Kr
o
wo
r
M
u
n
icip
al
Ho
s
p
ital
(
L
E
KM
A
Ho
s
p
ital)
in
Acc
r
a
is
ess
en
tial.
T
h
e
o
u
tco
m
e
o
f
f
er
s
em
o
tio
n
al
a
n
d
p
r
ac
tical
s
u
p
p
o
r
t
to
C
VA
s
u
r
v
iv
o
r
s
an
d
g
u
id
es
clin
ical
p
r
ac
tice
an
d
p
o
licy
f
r
am
ewo
r
k
s
aim
ed
at
im
p
r
o
v
in
g
th
e
lo
n
g
-
ter
m
we
ll
-
b
ein
g
o
f
C
VA
s
u
r
v
iv
o
r
s
[
2
2
]
.
2.
M
E
T
H
OD
2
.
1
.
Study
des
ig
n
W
e
ad
o
p
ted
th
e
d
escr
ip
tiv
e
ca
s
e
s
tu
d
y
d
esig
n
f
o
r
th
e
s
tu
d
y
.
T
h
e
r
esear
ch
ass
ess
ed
th
e
ex
p
er
ien
ce
o
f
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
am
o
n
g
C
VA
s
u
r
v
iv
o
r
s
in
Gh
an
a
an
d
ex
am
in
ed
th
eir
p
r
ef
er
r
ed
s
u
p
p
o
r
t a
n
d
m
an
ag
em
en
t
m
eth
o
d
s
.
T
h
is
d
esig
n
en
ab
led
th
e
d
etail
ed
an
d
in
-
d
e
p
th
in
v
e
s
tig
atio
n
o
f
PS
D
am
o
n
g
C
VA
s
,
en
s
u
r
in
g
th
at
th
e
o
u
tco
m
e
o
f
th
e
s
tu
d
y
p
r
o
v
id
e
s
a
v
iv
id
d
escr
ip
tio
n
o
f
th
e
d
y
n
am
ics
an
d
c
o
n
tex
t
o
f
th
e
p
h
en
o
m
e
n
o
n
with
o
u
t
ess
en
tially
s
ee
k
in
g
to
g
en
er
ali
ze
[
2
3
]
.
2
.
2
.
Study
a
re
a
a
nd
po
pu
la
t
io
n
L
ed
zo
k
u
k
u
-
Kr
o
wo
r
Mu
n
ici
p
a
l
Ass
em
b
ly
Ho
s
p
ital
(
L
E
KM
A
Ho
s
p
ital)
is
a
p
u
b
lic
h
o
s
p
ital
in
th
e
Gr
ea
ter
Acc
r
a
R
eg
io
n
o
f
Gh
a
n
a.
T
h
e
Ho
s
p
ital
is
th
e
lar
g
est
in
th
e
Ga
m
u
n
icip
ality
a
n
d
p
r
o
v
id
es
ac
ce
s
s
to
a
d
iv
er
s
e
p
atien
t
p
o
p
u
latio
n
[
2
4
]
.
I
t
h
as
a
1
0
0
-
b
ed
ca
p
ac
ity
with
o
v
e
r
2
0
0
n
u
r
s
es
an
d
an
av
er
ag
e
o
f
2
2
d
o
ct
o
r
s
[
2
4
]
.
T
h
e
f
ac
ilit
y
h
ad
an
ac
tiv
e
ce
r
eb
r
o
v
ascu
lar
ac
cid
e
n
t
u
n
i
t
en
s
u
r
in
g
t
h
e
av
ailab
ilit
y
o
f
e
lig
ib
le
p
ar
ticip
an
ts
f
o
r
th
e
s
tu
d
y
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
co
m
p
r
is
ed
6
8
C
VA
p
atien
ts
r
ec
eiv
in
g
ca
r
e
f
r
o
m
th
e
C
er
eb
r
o
v
ascu
lar
Acc
id
en
t
Un
it
o
f
L
E
KM
A
Ho
s
p
ital.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
was
lim
i
ted
to
C
VA
s
u
r
v
iv
o
r
s
wh
o
ar
e
r
esid
en
ts
o
f
th
e
L
E
KM
A
m
u
n
icip
ality
an
d
r
ec
eiv
in
g
ca
r
e
f
r
o
m
th
e
L
E
KM
A
h
o
s
p
ital
to
en
s
u
r
e
h
o
m
o
g
e
n
eity
,
r
ed
u
ce
p
o
ten
tial
co
n
f
o
u
n
d
in
g
v
ar
iab
les,
an
d
e
n
h
an
ce
t
h
e
in
ter
n
al
v
alid
it
y
o
f
th
e
s
tu
d
y
[
2
5
]
.
As
th
ese
in
d
iv
id
u
als
ar
e
d
ir
ec
tly
af
f
ec
ted
b
y
C
VA,
th
is
allo
wed
f
o
r
th
e
co
llectio
n
o
f
f
ir
s
th
an
d
e
x
p
er
ien
ce
s
an
d
in
s
ig
h
ts
[
2
3
]
.
O
n
ly
C
VA
s
u
r
v
iv
o
r
s
ab
o
v
e
1
8
y
ea
r
s
wh
o
r
ec
eiv
ed
c
ar
e
f
r
o
m
L
E
KM
A
h
o
s
p
ital
an
d
co
u
ld
co
n
s
en
t
to
p
ar
ticip
ate
i
n
th
e
r
esear
ch
wer
e
in
clu
d
ed
.
2
.
3
.
Sa
m
pli
ng
a
nd
s
a
m
ple size
A
p
u
r
p
o
s
iv
e
s
am
p
lin
g
tec
h
n
i
q
u
e
was
u
s
ed
to
s
elec
t
r
esp
o
n
d
en
ts
f
r
o
m
t
h
e
tar
g
et
p
o
p
u
l
atio
n
.
T
h
is
ap
p
r
o
ac
h
allo
wed
f
o
r
th
e
s
el
ec
tio
n
o
f
in
d
iv
i
d
u
als
wh
o
m
et
th
e
s
p
ec
if
ic
cr
iter
ia
r
elev
a
n
t
to
th
e
r
esear
ch
o
b
jectiv
es,
s
u
ch
as
a
g
e,
g
en
d
e
r
,
an
d
clin
ical
s
tatu
s
,
an
d
wer
e
willin
g
to
o
f
f
er
i
n
f
o
r
m
ed
c
o
n
s
en
t
f
o
r
p
ar
ticip
atio
n
in
th
e
s
tu
d
y
.
Fo
r
h
y
p
er
g
e
o
m
et
r
ic
p
o
p
u
latio
n
s
,
co
m
p
r
is
in
g
f
in
ite
s
ets o
f
in
d
iv
id
u
als,
o
b
jects,
o
r
elem
en
ts
,
s
m
all
s
am
p
le
s
ize
s
o
f
≥
5
0
ar
e
ad
eq
u
ate
[
2
5
]
.
Alth
o
u
g
h
a
n
o
n
-
p
r
o
b
ab
ilit
y
s
am
p
lin
g
tech
n
iq
u
e
was
u
s
ed
,
an
d
n
o
r
ig
o
r
o
u
s
s
am
p
le
s
ize
ca
lcu
lati
o
n
was
n
ec
ess
ar
y
,
we
d
eter
m
in
ed
th
e
s
am
p
le
s
ize
b
y
u
tili
zin
g
a
f
o
r
m
u
la
f
o
r
s
am
p
lin
g
in
s
m
all
p
o
p
u
latio
n
s
[
2
5
]
:
=
2
(
2
(
−
1
)
+
2
)
(
1
)
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
.
3
,
Sep
tem
b
er
20
25
:
1
5
52
-
1
5
60
1554
W
h
e
r
e
:
n:
is
th
e
r
eq
u
ir
ed
s
am
p
le
s
i
z
e
.
N:
is
th
e
p
o
p
u
latio
n
s
ize
(N
=
68)
p:
an
d
q
ar
e
t
h
e
p
o
p
u
latio
n
p
r
o
p
o
r
tio
n
s
(
0
.
5
)
.
z:
is
th
e
lev
el
o
f
co
n
f
id
en
ce
at
9
5
%
(
1
.
9
6
)
.
E:
s
ets
th
e
ac
cu
r
ac
y
of
th
e
s
am
p
le
p
r
o
p
o
r
tio
n
.
E
is
s
et
to
0
.
0
5
.
B
ased
o
n
th
is
,
th
e
s
am
p
le
s
ize
f
o
r
th
e
s
tu
d
y
is
5
8
p
atien
ts
[
2
5
]
.
B
y
p
u
r
p
o
s
iv
ely
s
elec
tin
g
p
ar
ticip
an
ts
f
r
o
m
th
e
ce
r
eb
r
o
v
ascu
lar
a
cc
id
en
t
u
n
it
an
d
th
e
o
u
t
p
a
tien
t
d
ep
ar
tm
en
t,
th
e
s
tu
d
y
en
s
u
r
ed
ad
eq
u
ate
r
ep
r
esen
tatio
n
o
f
p
atien
ts
f
r
o
m
d
if
f
er
en
t
s
tag
es
o
f
r
ec
o
v
e
r
y
an
d
tr
ea
tm
en
t.
T
h
e
in
clu
s
io
n
cr
iter
ia
f
o
r
th
e
s
elec
tio
n
o
f
p
ar
ticip
an
ts
f
o
r
t
h
e
r
esear
ch
wer
e
p
ast
an
d
cu
r
r
en
t
C
VA
p
atien
ts
o
f
L
E
KM
A
Ho
s
p
ital
wh
o
ar
e
ad
u
lts
an
d
co
u
ld
p
r
o
v
id
e
in
f
o
r
m
ed
co
n
s
en
t
f
o
r
p
ar
ticip
atio
n
[
2
3
]
.
2
.
4
.
Da
t
a
c
o
l
l
e
c
t
i
o
n
Ov
er
al
l,
5
0
q
u
e
s
ti
o
n
n
a
ir
e
s
w
er
e
f
u
lly
co
m
p
le
ted
.
T
h
e
d
a
t
a
co
l
le
ct
io
n
t
o
o
l
wa
s
a
s
e
lf
-
s
t
r
u
c
tu
r
ed
q
u
es
t
io
n
n
a
ir
e
d
e
s
ig
n
ed
u
s
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le
R
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i
s
ed
(
C
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S
D
-
R
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)
s
c
al
e
[
2
2
]
,
[
2
6
]
.
I
t
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s
a
r
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i
ab
le
an
d
p
r
a
ct
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ly
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t
s
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d
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an
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t
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r
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ce
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o
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s
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h
e
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0
d
ep
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e
s
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n
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elf
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r
ep
o
r
t
s
c
al
e
[
2
6
]
w
a
s
u
s
ed
to
m
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s
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r
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s
p
o
n
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en
ts
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t
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h
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i
a)
,
ap
p
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te,
s
l
ee
p
,
th
i
n
k
in
g
/co
n
ce
n
tr
at
io
n
,
g
u
i
lt
(
wo
r
th
l
e
s
s
n
e
s
s
)
,
tir
ed
n
e
s
s
(
f
a
t
ig
u
e)
,
m
o
v
em
e
n
t
(
ag
it
a
t
io
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)
,
an
d
s
u
ic
id
a
l
id
ea
t
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.
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x
im
i
ty
to
th
e
h
o
s
p
i
ta
l
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ca
teg
o
r
iz
ed
as
e
ith
er
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e
ar
”
o
r
“f
ar
.
”
T
h
i
s
c
la
s
s
if
i
ca
tio
n
w
as
b
as
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o
n
tr
av
el
d
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s
tan
ce
aw
ay
f
r
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m
t
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ity
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ti
cip
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t
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wh
o
h
ad
a
tr
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el
tim
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l
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s
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th
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o
n
e
h
o
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cl
as
s
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ied
a
s
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ea
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”
wh
i
le
th
o
s
e
b
ey
o
n
d
th
i
s
r
an
g
e
w
er
e
c
o
n
s
id
er
ed
“f
a
r
”.
An
in
t
er
v
i
ew
er
-
as
s
i
s
t
ed
ap
p
r
o
ac
h
w
a
s
em
p
lo
y
ed
f
o
r
t
h
o
s
e
wh
o
co
u
ld
n
o
t
r
e
ad
o
r
u
n
d
er
s
tan
d
.
C
o
m
p
l
et
e
d
q
u
es
t
io
n
n
a
ir
e
s
w
er
e
p
er
s
o
n
a
l
l
y
r
ec
eiv
ed
.
Da
ta
co
ll
ec
tio
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o
c
cu
r
r
ed
b
e
tw
ee
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an
u
ar
y
an
d
Ap
r
i
l 2
0
2
3
.
2
.
5
.
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t
h
ica
l c
o
n
s
id
er
a
t
io
n
s
Par
ti
ci
p
a
tio
n
wa
s
v
o
lu
n
t
ar
y
.
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h
er
e
wa
s
co
u
n
s
el
li
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g
s
u
p
p
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f
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d
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e
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p
ar
t
ic
ip
an
t
s
,
a
n
d
co
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id
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t
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l
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m
e
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m
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d
in
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lf
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tr
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t.
2
.
6
.
Da
t
a
a
na
ly
s
e
s
Da
ta
w
er
e
an
a
ly
z
ed
d
e
s
cr
ip
ti
v
ely
.
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h
e
a
cc
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r
ac
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d
co
m
p
le
ten
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o
f
ea
ch
q
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t
io
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n
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ir
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wer
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t
co
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f
ir
m
ed
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n
d
th
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a
ta
in
p
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to
M
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t
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x
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l
an
d
S
T
AT
A
v
er
s
i
o
n
1
7
f
o
r
o
r
g
an
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z
at
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d
an
a
ly
s
i
s
.
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h
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to
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n
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m
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e
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em
s
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le
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s
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[
2
5
]
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[
2
7
]
.
R
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/
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(
C
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=
0
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8
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)
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d
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es
t
-
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ity
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s
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4
5
–
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7
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.
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v
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l
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ty
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s
in
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t
h
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am
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cian
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Sca
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d
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th
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S
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(
0
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4
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to
0
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5
4
)
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em
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d
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p
e
r
s
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t
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d
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s
s
co
r
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a
t
l
ea
s
t
1
6
.
T
h
e
s
c
al
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d
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cr
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m
a
jo
r
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l
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u
f
f
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d
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ly
a
n
h
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o
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s
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h
o
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f
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m
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n
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s
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ti
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m
an
u
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(
DS
M)
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p
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m
s
d
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la
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t
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wo
we
ek
s
.
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b
ab
l
e
m
ajo
r
d
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r
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s
s
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e
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is
o
d
e
s
ar
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d
e
s
cr
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ed
a
s
ep
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s
o
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f
An
h
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o
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o
r
d
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s
p
h
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a
a
lm
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s
t
ev
er
y
d
ay
f
o
r
th
e
l
a
s
t
t
wo
w
ee
k
s
,
an
d
s
y
m
p
to
m
s
in
a
n
ex
tr
a
3
D
SM
s
y
m
p
to
m
c
at
eg
o
r
ie
s
r
ep
o
r
ted
to
h
av
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o
c
cu
r
r
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a
lm
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s
t
d
ai
ly
f
o
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th
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p
a
s
t
two
w
ee
k
s
.
Po
s
s
ib
le
m
a
jo
r
d
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r
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s
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ep
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s
o
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e
s
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a
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h
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o
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f
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d
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p
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s
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an
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p
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teg
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r
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s
th
a
t
h
ad
b
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n
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ep
o
r
t
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as
h
ap
p
en
in
g
e
ith
er
n
ea
r
ly
ev
er
y
d
ay
f
o
r
th
e
p
a
s
t
tw
o
we
ek
s
o
r
5
-
7
d
ay
s
in
th
e
p
r
ev
io
u
s
w
ee
k
.
Su
b
th
r
e
s
h
o
ld
d
ep
r
e
s
s
io
n
s
y
m
p
to
m
s
ar
e
th
o
s
e
wh
o
d
o
n
o
t
f
it
th
e
p
r
ev
io
u
s
r
e
q
u
ir
e
m
en
ts
b
u
t
h
ad
a
C
E
SD
-
s
ty
l
e
s
co
r
e
o
f
at
lea
s
t
1
6
.
Fin
al
ly
,
in
d
iv
id
u
a
l
s
w
ith
a
co
m
b
in
ed
C
E
S
-
D
s
co
r
e
o
f
le
s
s
th
an
1
6
ac
r
o
s
s
al
l
2
0
q
u
es
t
io
n
s
w
er
e
co
n
s
id
e
r
ed
t
o
h
av
e
n
o
c
li
n
i
ca
l
s
i
g
n
if
ic
an
c
e
.
I
n
d
iv
id
u
a
ls
wi
t
h
a
cu
m
u
la
tiv
e
C
E
SD
-
s
ty
le
s
co
r
e
o
f
le
s
s
th
an
1
6
in
al
l
2
0
q
u
e
s
t
io
n
s
w
er
e
co
n
s
id
e
r
ed
to
h
av
e
“n
o
c
lin
ic
al
s
ig
n
if
ica
n
ce
,
"
t
h
a
t
i
s
,
th
ey
wer
e
n
o
t
a
t
r
i
s
k
f
o
r
cl
in
ica
l
d
ep
r
e
s
s
i
o
n
.
S
co
r
e
s
b
et
wee
n
1
6
an
d
2
3
in
d
ic
at
ed
m
o
d
er
a
te
d
ep
r
es
s
io
n
,
an
d
a
s
c
o
r
e
o
f
2
4
o
r
ab
o
v
e
in
d
ic
at
ed
s
ev
er
e
d
ep
r
e
s
s
io
n
.
A
q
u
es
t
io
n
n
a
ir
e
w
as
em
p
lo
y
e
d
to
a
s
s
e
s
s
m
an
ag
em
e
n
t
p
r
ef
er
en
ce
s
am
o
n
g
p
ar
ti
cip
an
t
s
.
T
h
e
s
ca
le
p
r
o
v
id
ed
a
s
t
r
u
c
tu
r
ed
m
e
an
s
to
c
ap
t
u
r
e
th
e
s
tr
en
g
th
o
f
p
r
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e
r
en
c
e
f
o
r
d
if
f
er
e
n
t
m
an
ag
em
en
t
o
p
t
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o
n
s
,
r
an
g
in
g
f
r
o
m
p
h
ar
m
a
co
l
o
g
i
ca
l
to
n
o
n
-
p
h
ar
m
ac
o
lo
g
i
ca
l
tr
e
at
m
en
t
s
.
T
h
e
s
c
al
e
o
f
f
er
ed
r
ich
in
s
ig
h
ts
i
n
to
p
at
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en
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r
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.
T
h
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C
h
i
-
s
q
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ar
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te
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as
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Pu
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Hea
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Sci
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N:
2252
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8
8
0
6
Dep
r
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n
,
s
o
cia
l su
p
p
o
r
t a
n
d
ma
n
a
g
eme
n
t p
r
eferen
ce
s
a
mo
n
g
Gh
a
n
a
ia
n
p
o
s
t
-
s
tr
o
ke
…
(
Lil
y
Ya
r
n
ey
)
1555
3.
RE
SU
L
T
S
AND
D
I
S
C
US
SI
O
N
3
.
1
.
Resul
t
3
.
1
.
1
.
D
em
o
g
ra
ph
ic
cha
ra
ct
e
ristics a
nd
de
press
io
n a
m
o
ng
CVA
s
urv
iv
o
rs
T
h
e
f
in
d
in
g
s
r
ev
ea
led
a
h
ig
h
i
n
cid
en
ce
of
d
ep
r
ess
io
n
am
o
n
g
th
e
C
VA
s
u
r
v
iv
o
r
s
s
tu
d
ied
.
At
least
8
6
%
of
th
e
s
tu
d
y
p
o
p
u
latio
n
e
x
p
er
i
en
ce
d
d
e
p
r
ess
io
n
.
Ou
t
of
th
is
,
10%
h
ad
m
o
d
e
r
ate
d
ep
r
ess
io
n
an
d
7
6
%
h
ad
s
ev
er
e
d
ep
r
ess
io
n
.
Mo
s
t
o
f
th
e
C
VA
s
u
r
v
iv
o
r
s
r
ep
o
r
te
d
is
ch
em
ic
s
tr
o
k
e
(
8
0
%),
an
d
2
0
%
r
ep
o
r
te
d
h
em
o
r
r
h
ag
ic
s
tr
o
k
e
.
Ag
e
d
id
n
o
t
s
ig
n
if
ican
tly
c
o
r
r
e
late
with
PS
D
s
tatu
s
(
p
=
0
.
2
4
6
)
.
Ho
wev
er
,
th
e
s
ev
er
ity
o
f
PS
D
ten
d
ed
to
i
n
cr
ea
s
e
with
ag
e.
Similar
ly
,
th
er
e
wa
s
n
o
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
s
ex
an
d
PS
D
s
tatu
s
(
p
=
0
.
3
8
5
)
,
alth
o
u
g
h
f
em
ales
ten
d
ed
to
ex
p
er
ien
ce
more
s
ev
er
e
d
e
p
r
ess
io
n
.
Ma
r
it
al
s
tatu
s
s
h
o
wed
a
s
ig
n
if
ica
n
t
c
o
r
r
elatio
n
with
PS
D
s
tatu
s
(
p
=
0
.
0
1
8
)
.
Ho
wev
e
r
,
m
ar
r
ied
in
d
i
v
id
u
als
ex
p
e
r
ien
c
ed
m
o
r
e
s
e
v
er
e
d
ep
r
ess
io
n
c
o
m
p
ar
ed
to
u
n
m
a
r
r
ied
in
d
iv
id
u
als.
Ag
ain
,
n
eith
er
e
d
u
ca
tio
n
al
lev
el
nor
em
p
lo
y
m
e
n
t
s
tatu
s
s
h
o
wed
s
ig
n
if
ican
t
ass
o
ciatio
n
s
with
PSD
s
tatu
s
(p
=
0
.
8
3
1
an
d
0
.
1
9
7
)
.
L
ik
ewise,
th
e
n
u
m
b
er
of
ch
ild
r
en
an
d
p
r
o
x
im
ity
to
th
e
h
o
s
p
ital
d
id
n
o
t
co
r
r
elate
s
ig
n
if
ican
tly
with
PS
D
s
tatu
s
(
p
=
0
.
7
7
8
a
n
d
0
.
4
0
1
)
as sh
o
w
n
in
T
ab
le
1
.
T
ab
le
1
.
Dem
o
g
r
a
p
h
ic
ch
ar
ac
t
er
is
tics
an
d
PS
D
s
co
r
e
of
C
VA
s
u
r
v
i
v
o
r
s
V
a
r
i
a
b
l
e
PSD
s
c
o
r
e
C
h
i
-
s
q
u
a
r
e
p
-
v
a
l
u
e
No
PSD
n
(
%
)
M
o
d
e
r
a
t
e
n
(
%
)
S
e
v
e
r
e
n
(
%
)
A
g
e
7
.
8
9
6
0
.
2
4
6
40
–
49
4
(
3
6
.
4
)
1
(
9
.
1
)
6
(
5
4
.
5
)
50
–
59
1
(
8
.
3
)
2
(
1
6
.
7
)
9
(
7
5
.
0
)
60
–
69
2
(
1
0
.
0
)
2
(
1
0
.
0
)
1
6
(
8
0
.
0
)
70
a
n
d
a
b
o
v
e
0
(
0
.
0
)
0
(
0
.
0
)
7
(
1
0
0
.
0
)
S
e
x
1
.
9
0
7
0
.
3
8
5
M
a
l
e
5
(
2
0
.
0
)
3
(
1
2
.
0
)
1
7
(
6
8
.
0
)
F
e
m
a
l
e
2
(
8
.
0
)
2
(
8
.
0
)
2
1
(
8
4
.
0
)
M
a
r
i
t
a
l
s
t
a
t
u
s
1
5
.
3
2
0
0
.
0
1
8
S
i
n
g
l
e
1
(
1
6
.
7
)
3
(
5
0
.
0
)
2
(
3
3
.
3
)
M
a
r
r
i
e
d
4
(
1
5
.
4
)
0
(
0
.
0
)
2
2
(
8
4
.
6
)
W
i
d
o
w
e
d
1
(
7
.
7
)
1
(
7
.
7
)
3
(
8
4
.
6
)
D
i
v
o
r
c
e
d
/
s
e
p
a
r
a
t
e
d
1
(
2
0
.
0
)
1
(
2
0
.
0
)
3
(
6
0
)
Ed
u
c
a
t
i
o
n
a
l
l
e
v
e
l
1
.
4
7
3
0
.
8
3
1
P
r
i
m
a
r
y
4
(
1
7
.
4
)
2
(
8
.
7
)
17
(
7
3
.
9
)
S
e
c
o
n
d
a
r
y
1
(
7
.
1
)
1
(
7
.
1
)
1
2
(
8
5
.
7
)
T
e
r
t
i
a
r
y
2
(
1
5
.
4
)
2
(
1
5
.
4
)
9
(
6
9
.
2
)
Emp
l
o
y
me
n
t
s
t
a
t
u
s
8
.
6
0
9
0
.
1
9
7
U
n
e
m
p
l
o
y
e
d
1
3
(
1
2
.
0
)
5
(
2
0
.
0
)
1
7
(
6
8
.
0
)
P
r
i
v
a
t
e
e
m
p
l
o
y
e
d
0
(
0
.
0
)
0
(
0
.
0
)
9
(
1
0
0
.
0
)
G
o
v
e
r
n
m
e
n
t
e
m
p
l
o
y
e
d
1
(
2
5
.
0
)
0
(
0
.
0
)
3
(
7
5
.
0
)
S
e
l
f
e
m
p
l
o
y
e
d
3
(
2
5
.
0
)
0
(
0
.
0
)
9
(
7
5
.
0
)
N
u
mb
e
r
of
c
h
i
l
d
r
e
n
1
.
7
7
1
0
.
7
7
8
1
–
3
3
(
1
3
.
0
)
2
(
8
.
7
)
1
8
(
7
8
.
3
)
4
–
6
4
(
1
7
.
4
)
2
(
8
.
7
)
1
7
(
7
3
.
9
)
7
a
n
d
a
b
o
v
e
0
(
0
.
0
)
1
(
2
5
.
0
)
3
(
7
5
.
0
)
P
r
o
x
i
mi
t
y
to
H
o
s
p
i
t
a
l
1
.
8
3
0
0
.
4
0
1
F
a
r
5
(
2
0
.
8
)
2
(
8
.
3
)
1
7
(
7
0
.
8
)
N
e
a
r
2
(
7
.
7
)
3
(
1
1
.
5
)
2
1
(
8
0
.
8
)
T
o
t
a
l
7
(
1
4
.
0
)
5
(
1
0
.
0
)
3
8
(
7
6
.
0
)
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
2
0
2
3
3
.
1
.
2
.
So
cia
l
s
up
po
rt
f
o
r
CVA
s
u
r
v
i
v
o
rs
T
h
e
f
in
d
in
g
s
o
n
s
u
p
p
o
r
t
s
y
s
t
e
m
s
av
ai
lab
le
f
o
r
C
VA
s
u
r
v
iv
o
r
s
p
r
o
v
id
e
a
d
eta
i
led
u
n
d
e
r
s
t
an
d
in
g
o
f
th
e
s
o
u
r
ce
s
,
ty
p
e
s
,
f
r
eq
u
en
cy
,
an
d
b
en
ef
i
t
s
o
f
s
u
p
p
o
r
t
r
e
ce
iv
ed
.
Sp
o
u
s
e
s
o
r
p
ar
tn
e
r
s
an
d
c
h
ild
r
en
em
er
g
ed
as
th
e
to
p
t
wo
s
o
u
r
ce
s
,
ac
co
u
n
t
in
g
f
o
r
8
6
%
an
d
8
4
%
r
e
s
p
ec
t
iv
e
ly
,
f
o
llo
wed
b
y
r
e
la
tiv
e
s
(
6
0
%
)
,
ch
u
r
ch
m
e
m
b
er
s
(
3
6
%)
,
f
r
i
en
d
s
(
2
0
%
)
,
an
d
wo
r
k
a
s
s
o
c
ia
te
s
(
1
0
%).
T
h
e
ty
p
e
s
o
f
s
u
p
p
o
r
t
r
e
ce
iv
ed
in
c
lu
d
e
p
h
y
s
ica
l,
e
m
o
t
io
n
a
l,
f
in
an
ci
al
,
s
o
ci
al
,
m
en
ta
l,
an
d
s
p
i
r
i
tu
a
l
s
u
p
p
o
r
t.
Ac
tiv
it
ie
s
o
f
d
ai
ly
l
iv
in
g
,
in
c
lu
d
i
n
g
w
a
s
h
in
g
,
f
e
ed
in
g
,
an
d
d
r
e
s
s
in
g
,
w
er
e
th
e
p
r
im
ar
y
way
s
th
r
o
u
g
h
wh
i
ch
s
u
p
p
o
r
t
wa
s
g
iv
e
n
(
7
2
.
0
%
)
,
f
o
l
lo
w
ed
b
y
en
co
u
r
ag
em
en
t
(
6
8
.
0
%).
O
th
er
f
o
r
m
s
o
f
s
u
p
p
o
r
t
in
c
lu
d
ed
f
in
an
ci
al
a
s
s
i
s
t
an
ce
(
m
o
n
ey
,
b
i
ll
s
o
r
al
lo
w
a
n
ce
)
(
3
6
.
0
%),
v
i
s
it
s
(
1
6
.
0
%),
s
o
ci
al
in
t
er
a
ct
io
n
s
(
1
2
.
0
%)
,
an
d
p
r
ay
er
s
(
8
.
0
%).
T
h
e
b
e
n
ef
it
s
o
f
th
e
s
u
p
p
o
r
t
r
e
ce
i
v
ed
wer
e
m
an
if
o
l
d
.
Al
l
th
e
r
e
s
p
o
n
d
en
t
s
co
n
s
id
e
r
ed
p
h
y
s
i
ca
l
a
s
s
i
s
tan
c
e
an
d
im
p
r
o
v
ed
em
o
tio
n
a
l
we
l
l
-
b
ein
g
a
s
ex
tr
em
e
ly
b
en
ef
ic
ia
l.
R
ed
u
c
ed
f
e
el
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g
s
o
f
i
s
o
l
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io
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m
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t
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9
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in
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as
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f
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av
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lab
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ll
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
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Sep
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1556
T
ab
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2
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Su
p
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r
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s
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s
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ate
p
h
y
s
ical
r
ec
o
v
er
y
[
2
2
]
,
[
2
5
]
.
Ho
w
ev
er
,
f
in
d
in
g
s
f
r
o
m
th
is
r
esear
ch
h
ig
h
lig
h
t
a
c
o
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ce
r
n
in
g
tr
e
n
d
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e
g
ar
d
in
g
th
e
lim
it
ed
in
v
o
lv
e
m
en
t
o
f
f
r
ien
d
s
,
ch
u
r
ch
m
em
b
e
r
s
,
wo
r
k
ass
o
ciate
s
,
an
d
n
eig
h
b
o
r
s
in
th
e
s
u
p
p
o
r
t
n
etwo
r
k
s
o
f
C
VA
s
u
r
v
iv
o
r
s
[
3
3
]
.
T
h
is
s
u
g
g
ests
a
p
o
ten
tial
g
ap
in
s
o
cial
s
u
p
p
o
r
t
s
y
s
tem
s
,
with
im
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licatio
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s
f
o
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th
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v
er
all
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ein
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tco
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tr
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v
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s
wh
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ec
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ca
r
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f
r
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m
th
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L
E
KM
A
h
o
s
p
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T
h
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r
elu
ctan
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o
r
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ab
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y
o
f
in
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id
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m
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f
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cir
cles
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en
g
ag
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s
u
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tiv
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eh
av
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s
m
ay
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tem
m
ed
f
r
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m
v
ar
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d
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lack
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ab
o
u
t
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d
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o
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VA
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tig
m
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with
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r
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i
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Pu
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Hea
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Sci
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N:
2252
-
8
8
0
6
Dep
r
ess
io
n
,
s
o
cia
l su
p
p
o
r
t a
n
d
ma
n
a
g
eme
n
t p
r
eferen
ce
s
a
mo
n
g
Gh
a
n
a
ia
n
p
o
s
t
-
s
tr
o
ke
…
(
Lil
y
Ya
r
n
ey
)
1557
n
av
ig
atin
g
co
m
p
lex
ca
r
eg
iv
i
n
g
r
o
les
[
1
4
]
.
Ad
d
r
ess
in
g
th
is
g
ap
in
s
o
cial
s
u
p
p
o
r
t
n
et
wo
r
k
s
n
ec
ess
itates
m
u
ltifa
ce
ted
in
ter
v
en
tio
n
s
at
t
h
e
co
m
m
u
n
ity
lev
el.
C
o
m
m
u
n
ity
-
b
ased
in
itiativ
es
s
h
o
u
ld
b
e
d
ev
elo
p
e
d
to
f
o
s
ter
in
clu
s
iv
e
en
v
ir
o
n
m
e
n
ts
wh
er
e
in
d
iv
id
u
als
f
ee
l
em
p
o
wer
ed
to
aid
an
d
s
u
p
p
o
r
t
C
VA
s
u
r
v
iv
o
r
s
[
3
3
]
.
E
d
u
ca
tio
n
al
p
r
o
g
r
a
m
m
es
will
in
cr
ea
s
e
awa
r
en
ess
ab
o
u
t
s
tr
o
k
e
an
d
its
im
p
ac
t
o
n
s
u
r
v
iv
o
r
s
'
liv
es,
d
is
p
el
m
is
co
n
ce
p
tio
n
s
,
an
d
r
e
d
u
ce
s
tig
m
a.
T
h
is
will
en
co
u
r
ag
e
b
r
o
a
d
er
p
ar
ticip
at
io
n
in
c
ar
eg
iv
in
g
a
n
d
s
u
p
p
o
r
t
r
o
les
[
1
4
]
,
[
3
4
]
.
Ad
d
i
tio
n
ally
,
le
v
er
ag
in
g
tech
n
o
lo
g
y
an
d
s
o
cial
m
ed
ia
p
latf
o
r
m
s
ca
n
b
e
in
s
tr
u
m
en
tal
in
f
ac
ilit
atin
g
th
e
f
o
r
m
atio
n
o
f
v
ir
tu
al
s
u
p
p
o
r
t
n
etwo
r
k
s
to
o
f
f
er
o
p
p
o
r
tu
n
ities
f
o
r
C
VA
s
u
r
v
iv
o
r
s
to
co
n
n
ec
t
with
p
ee
r
s
f
ac
in
g
s
im
ilar
ch
allen
g
es a
n
d
ac
ce
s
s
v
alu
ab
le
r
eso
u
r
ce
s
an
d
in
f
o
r
m
atio
n
[
2
2
]
.
T
h
e
p
r
ef
e
r
en
ce
s
o
b
s
er
v
e
d
am
o
n
g
C
VA
s
u
r
v
iv
o
r
s
r
e
g
ar
d
in
g
p
h
ar
m
ac
o
lo
g
ical
an
d
p
s
y
ch
o
t
h
er
ap
eu
tic
in
ter
v
en
tio
n
s
,
as
ev
id
e
n
ce
d
b
y
o
u
r
f
in
d
i
n
g
s
,
r
eso
n
ate
with
th
e
n
o
tio
n
o
f
s
ee
k
in
g
co
m
p
r
e
h
en
s
iv
e
an
d
h
o
lis
tic
ap
p
r
o
ac
h
es to
m
an
ag
in
g
PS
D
[
1
7
]
,
[
3
4
]
.
T
h
e
ex
p
r
ess
ed
co
n
c
er
n
s
r
eg
ar
d
in
g
m
ed
icatio
n
s
id
e
ef
f
ec
ts
an
d
s
o
cio
-
cu
ltu
r
al
b
elief
s
u
n
d
e
r
s
co
r
e
th
e
im
p
o
r
tan
ce
o
f
p
er
s
o
n
alize
d
tr
e
atm
en
t
ap
p
r
o
ac
h
es
th
at
co
n
s
id
er
in
d
iv
id
u
al
n
ee
d
s
an
d
p
r
ef
e
r
en
ce
s
[
3
1
]
,
[
3
5
]
,
[
3
6
]
.
Mo
r
eo
v
e
r
,
f
in
an
cial
co
n
s
tr
ain
ts
an
d
p
er
ce
iv
ed
attitu
d
es
o
f
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
m
ay
s
ig
n
if
ican
tly
in
f
l
u
en
ce
tr
ea
tm
en
t
d
ec
is
io
n
s
,
in
d
icatin
g
th
e
n
ec
ess
ity
f
o
r
ac
ce
s
s
ib
le
ca
r
e
[
3
7
]
.
T
h
ese
f
in
d
in
g
s
h
ig
h
lig
h
t
s
ev
er
al
ch
all
en
g
es
in
ad
d
r
ess
in
g
PS
D
ef
f
ec
t
iv
ely
.
Firstl
y
,
th
e
n
ee
d
f
o
r
co
ll
ab
o
r
ativ
e
d
e
cisi
o
n
-
m
ak
in
g
b
etwe
en
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
an
d
C
VA
s
u
r
v
iv
o
r
s
i
s
p
ar
am
o
u
n
t
to
en
s
u
r
e
th
at
tr
ea
tm
en
t
p
lan
s
alig
n
with
p
atien
ts
'
g
o
als
an
d
v
al
u
e
s
[
1
7
]
.
W
e
also
f
o
u
n
d
p
atien
t
ed
u
ca
tio
n
p
r
o
g
r
am
s
to
b
e
c
r
u
cial
in
em
p
o
wer
in
g
in
d
iv
id
u
als.
Pro
v
id
i
n
g
co
m
p
r
e
h
en
s
iv
e
in
f
o
r
m
atio
n
ab
o
u
t
d
if
f
er
en
t
tr
ea
tm
en
t
o
p
tio
n
s
an
d
p
o
ten
tial
s
id
e
ef
f
ec
ts
will
en
ab
le
in
f
o
r
m
ed
d
e
cisi
o
n
-
m
ak
in
g
[
3
1
]
,
[
3
5
]
,
[
3
6
]
.
Acc
o
r
d
in
g
l
y
,
ef
f
o
r
ts
to
en
h
an
ce
c
u
ltu
r
al
co
m
p
eten
c
y
am
o
n
g
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
ar
e
ess
en
tial
to
ad
d
r
ess
th
e
s
o
cio
-
cu
ltu
r
al
f
ac
to
r
s
i
n
f
lu
en
cin
g
t
r
ea
tm
en
t
p
r
ef
er
en
ce
s
a
n
d
a
d
h
er
en
ce
[
3
7
]
.
B
y
f
o
s
ter
in
g
a
d
ee
p
er
u
n
d
er
s
tan
d
in
g
o
f
d
iv
er
s
e
cu
ltu
r
al
p
er
s
p
ec
tiv
es
an
d
b
elief
s
s
u
r
r
o
u
n
d
in
g
m
e
n
tal
h
e
alth
an
d
tr
ea
tm
en
t,
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
ca
n
b
etter
tailo
r
in
t
er
v
en
tio
n
s
to
m
ee
t
th
e
u
n
iq
u
e
n
ee
d
s
o
f
C
VA
s
u
r
v
iv
o
r
s
f
r
o
m
v
ar
io
u
s
cu
ltu
r
al
b
a
ck
g
r
o
u
n
d
s
.
I
n
ad
d
itio
n
,
r
e
d
u
ci
n
g
f
in
a
n
cial
b
ar
r
ier
s
to
ca
r
e
is
cr
u
cial
i
n
en
s
u
r
in
g
e
q
u
itab
le
ac
ce
s
s
to
ef
f
ec
tiv
e
tr
e
atm
en
ts
f
o
r
PS
D.
T
h
is
m
ay
in
v
o
lv
e
im
p
lem
en
tin
g
p
o
licies to
ex
p
an
d
in
s
u
r
an
ce
c
o
v
er
ag
e
f
o
r
m
en
ta
l h
ea
lth
s
er
v
ices o
r
estab
lis
h
in
g
s
u
b
s
id
y
p
r
o
g
r
am
s
to
allev
iate
th
e
f
in
an
cial
b
u
r
d
e
n
ass
o
ciate
d
with
tr
ea
tm
en
t [
3
7
]
.
Ad
d
r
ess
in
g
th
e
p
r
ef
e
r
en
ce
s
a
n
d
ch
allen
g
es
ass
o
ciate
d
with
p
h
ar
m
ac
o
l
o
g
ical
an
d
p
s
y
ch
o
t
h
er
ap
eu
tic
in
ter
v
en
tio
n
s
f
o
r
PS
D
r
eq
u
ir
e
s
a
m
u
ltifa
ce
ted
ap
p
r
o
ac
h
.
T
h
e
s
tr
ateg
y
m
u
s
t
p
r
io
r
itize
p
a
tien
t
-
ce
n
ter
ed
ca
r
e,
cu
ltu
r
al
s
en
s
itiv
ity
,
an
d
ac
ce
s
s
ib
ilit
y
to
p
r
im
ar
y
ca
r
e.
T
h
u
s
,
f
o
s
ter
in
g
co
llab
o
r
ati
o
n
b
etwe
en
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
an
d
p
atien
ts
,
en
h
an
cin
g
cu
ltu
r
al
c
o
m
p
eten
c
y
,
an
d
ad
d
r
ess
in
g
f
in
a
n
cial
b
ar
r
ier
s
,
q
u
ality
o
f
ca
r
e
an
d
o
u
tco
m
es f
o
r
C
VA
s
u
r
v
iv
o
r
s
with
PS
D
ca
n
b
e
im
p
r
o
v
ed
.
T
ab
le
3
.
Ma
n
a
g
em
en
t/tre
atm
e
n
t p
r
ef
er
e
n
ce
s
T
r
e
a
t
m
e
n
t
p
r
e
f
e
r
e
n
c
e
s
R
e
a
s
o
n
s
f
o
r
t
r
e
a
t
me
n
t
p
r
e
f
e
r
e
n
c
e
S
t
r
o
n
g
l
y
d
i
s
a
g
r
e
e
D
i
s
a
g
r
e
e
A
g
r
e
e
S
t
r
o
n
g
l
y
a
g
r
e
e
R
a
n
k
n
%
n
%
n
%
n
%
M
a
n
a
g
e
m
e
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t
/
t
r
e
a
t
m
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t
p
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f
e
r
r
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d
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y
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V
A
s
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r
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v
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M
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d
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t
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(
a
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s
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)
1
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P
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p
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R
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Q
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23.
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RE
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NC
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[
1
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S
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j
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N
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m,
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)
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.
4
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p
p
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1
0
–
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3
,
2
0
2
4
.
[
2
]
W
H
O
,
“
W
o
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d
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k
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O
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:
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[
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.
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[
3
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U
.
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A
.
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[
4
]
J.
W
h
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t
e
,
P
.
M
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A
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k
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s
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s
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T.
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L.
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M
.
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.
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[
1
8
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N
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