I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h
Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
,
p
p
.
1
57
6
~
1
58
4
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
14
i
3
.
2
4
9
8
0
1576
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Preva
lence and
h
ea
lth
lite
ra
cy
on
hig
h bloo
d pressu
re amo
ng
la
te
a
dulthoo
d in
div
idua
ls in Nort
hea
st Tha
ila
nd:
a
cros
s
-
section
a
l study
K
it
t
ipo
ng
So
rnlo
rm
1
,
Arunra
t
P
un
cha
G
lin
g
a
s
o
rn
2
1
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
K
h
o
n
K
a
e
n
U
n
i
v
e
r
s
i
t
y
,
K
h
o
n
K
a
e
n
,
T
h
a
i
l
a
n
d
2
F
a
c
u
l
t
y
o
f
Li
b
e
r
a
l
A
r
t
s
a
n
d
S
c
i
e
n
c
e
,
R
o
i
E
t
R
a
j
a
b
h
a
t
U
n
i
v
e
r
si
t
y
,
R
o
i
Et
,
T
h
a
i
l
a
n
d
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Ap
r
il 2
1
,
2
0
2
4
R
ev
is
ed
Dec
2
7
,
2
0
2
4
Acc
ep
ted
Ma
r
6
,
2
0
2
5
Hig
h
b
lo
o
d
p
re
ss
u
re
(HBP)
is
a
lea
d
in
g
ris
k
fa
c
to
r
fo
r
a
t
h
e
ro
sc
lero
ti
c
c
a
rd
io
v
a
sc
u
lar
d
ise
a
se
a
n
d
m
o
rt
a
li
ty
.
T
h
is
stu
d
y
a
ime
d
to
i
d
e
n
t
ify
h
e
a
lt
h
li
tera
c
y
a
n
d
o
th
e
r
c
h
a
ra
c
teristics
a
ss
o
c
iate
d
with
HBP
a
m
o
n
g
late
a
d
u
lt
s
i
n
Th
a
il
a
n
d
.
A
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
wa
s
c
o
n
d
u
c
ted
with
1
,
3
4
5
a
d
u
l
ts
a
g
e
d
3
5
-
5
9
y
e
a
rs
fro
m
He
a
lt
h
Ce
n
ters
7
,
8
,
9
,
a
n
d
1
0
in
No
rt
h
e
a
st
Th
a
il
a
n
d
.
De
sc
rip
ti
v
e
sta
ti
stics
a
n
d
a
g
e
n
e
ra
li
z
e
d
li
n
e
a
r
m
ix
e
d
m
o
d
e
l
(G
LM
M
)
we
re
u
se
d
to
d
e
term
in
e
th
e
a
d
j
u
ste
d
o
d
d
s
ra
ti
o
(Ad
j.
OR)
a
n
d
9
5
%
c
o
n
fid
e
n
c
e
in
terv
a
l
(CI).
Re
su
lt
s
sh
o
we
d
a
p
re
v
a
len
c
e
o
f
HBP
a
t
2
4
.
7
6
%
(9
5
%
CI
:
2
2
.
5
2
-
2
7
.
1
3
).
M
u
lt
i
v
a
riab
le
a
n
a
ly
sis
re
v
e
a
led
a
sig
n
if
ica
n
t
a
ss
o
c
iatio
n
b
e
twe
e
n
HBP
a
n
d
h
e
a
lt
h
li
tera
c
y
in
fi
n
d
i
n
g
h
e
a
lt
h
in
f
o
rm
a
ti
o
n
(A
d
j.
OR
=
1
.
5
9
,
9
5
%
CI:
1
.
2
8
-
1
.
9
6
,
p
-
v
a
lu
e
<
0
.
0
0
1
),
a
s
we
ll
a
s
ju
d
g
i
n
g
h
e
a
lt
h
i
n
fo
rm
a
ti
o
n
(Ad
j.
OR
=
1
.
3
4
,
9
5
%
CI:
1
.
0
4
-
1
.
7
3
,
p
-
v
a
l
u
e
=
0
.
0
2
4
).
Ad
d
it
i
o
n
a
ll
y
,
h
isto
r
y
o
f
sm
o
k
in
g
(Ad
j.
OR=
2
.
0
4
,
9
5
%
CI:
1
.
2
9
-
3
.
2
4
,
p
-
v
a
lu
e
=
0
.
0
0
2
),
c
o
m
o
r
b
id
i
ty
(Ad
j
.
OR
=
2
.
2
0
,
9
5
%
CI
:
1
.
7
6
-
2
.
7
4
,
p
-
v
a
l
u
e
<
0
.
0
0
1
),
p
h
y
sic
a
l
a
c
ti
v
it
y
(Ad
j.
OR
=
1
.
6
7
,
9
5
%
CI:
1
.
2
8
-
2
.
1
6
,
p
-
v
a
l
u
e
<
0
.
0
0
1
),
a
n
d
b
o
d
y
m
a
ss
in
d
e
x
(Ad
j
.
OR
=
2
.
2
1
,
9
5
%
CI:
1
.
1
4
-
4
.
2
6
,
p
-
v
a
lu
e
=
0
.
0
1
8
)
we
re
fo
u
n
d
to
b
e
a
ss
o
c
iate
d
with
HBP.
P
o
o
r
h
e
a
lt
h
li
tera
c
y
in
c
re
a
se
s
th
e
risk
o
f
HBP.
Re
lev
a
n
t
a
u
th
o
rit
ies
m
u
st
e
v
a
lu
a
te
th
e
g
ro
u
p
c
o
n
te
x
t
a
n
d
d
e
v
e
lo
p
a
su
it
a
b
le h
e
a
lt
h
li
tera
c
y
m
o
d
e
l.
K
ey
w
o
r
d
s
:
Hea
lth
liter
ac
y
Hig
h
b
lo
o
d
p
r
ess
u
r
e
Hy
p
er
ten
s
io
n
p
r
ev
alen
ce
L
ate
ad
u
lth
o
o
d
T
h
ailan
d
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Kittip
o
n
g
So
r
n
lo
r
m
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Kh
o
n
Kae
n
Un
iv
er
s
ity
Mu
an
g
Dis
tr
ict,
Kh
o
n
Kae
n
,
T
h
ailan
d
E
m
ail: k
itts
o
r
n
@
k
k
u
.
ac
.
th
1.
I
NT
RO
D
UCT
I
O
N
H
i
g
h
b
l
o
o
d
p
r
e
s
s
u
r
e
(
H
B
P
)
is
w
i
d
e
l
y
r
e
c
o
g
n
i
z
e
d
a
s
a
s
i
g
n
i
f
i
ca
n
t
r
i
s
k
f
a
c
t
o
r
f
o
r
c
a
r
d
i
o
v
a
s
c
u
la
r
d
i
s
e
a
s
e
s
[
1
]
,
[
2
]
.
I
t
s
p
r
e
v
a
l
e
n
c
e
i
s
o
n
t
h
e
r
i
s
e
g
l
o
b
a
ll
y
,
w
i
t
h
r
e
g
i
o
n
a
l
v
a
r
i
a
t
i
o
n
s
o
b
s
e
r
v
e
d
.
A
c
c
o
r
d
i
n
g
t
o
g
l
o
b
a
l
e
s
ti
m
a
t
es
,
b
y
2
0
2
5
,
a
p
p
r
o
x
i
m
a
t
e
l
y
3
1
.
1
%
(
1
.
3
9
b
i
l
l
i
o
n
)
o
f
t
h
e
l
at
e
a
d
u
lt
p
o
p
u
l
a
t
i
o
n
w
o
r
l
d
wi
d
e
is
p
r
o
j
ec
t
e
d
t
o
b
e
a
f
f
e
c
t
e
d
b
y
H
B
P
[
3
],
[
4
]
,
w
it
h
t
h
is
f
i
g
u
r
e
e
x
p
e
c
t
e
d
t
o
i
n
c
r
e
as
e
t
o
a
p
p
r
o
x
i
m
a
t
e
l
y
6
0
%
o
f
t
h
e
g
l
o
b
al
p
o
p
u
l
a
t
i
o
n
[
5
].
Acc
o
r
d
in
g
to
r
ec
en
t
g
l
o
b
al
an
aly
s
is
,
T
h
ailan
d
,
as
p
ar
t
o
f
th
e
E
ast
an
d
So
u
th
ea
s
t
Asi
a
r
eg
io
n
,
s
h
o
ws
m
o
d
er
ate
r
ates
o
f
h
y
p
er
ten
s
io
n
d
etec
tio
n
,
tr
ea
tm
e
n
t,
an
d
c
o
n
tr
o
l.
I
n
2
0
1
9
,
th
e
r
eg
io
n
al
d
ata
in
d
icate
d
th
at
5
4
%
(
4
6
-
6
2
%)
o
f
p
eo
p
le
wit
h
h
y
p
e
r
ten
s
io
n
h
ad
b
ee
n
d
ia
g
n
o
s
ed
,
4
1
%
(
3
2
-
4
9
%)
wer
e
r
ec
eiv
in
g
tr
ea
tm
en
t,
an
d
o
n
ly
1
7
%
(
1
3
-
2
5
%)
ac
h
i
ev
ed
a
d
eq
u
ate
b
lo
o
d
p
r
ess
u
r
e
co
n
tr
o
l.
W
h
ile
g
l
o
b
al
h
y
p
e
r
ten
s
io
n
p
r
ev
alen
ce
r
em
ain
ed
s
tab
le
f
r
o
m
1
9
9
0
to
2
0
1
9
at
ap
p
r
o
x
im
ately
3
2
-
3
4
%
in
a
d
u
lts
ag
ed
3
0
-
7
9
y
ea
r
s
,
s
ig
n
if
ican
t
im
p
r
o
v
em
e
n
ts
in
tr
ea
tm
en
t
an
d
co
n
tr
o
l
r
ates
h
av
e
b
ee
n
o
b
s
er
v
ed
in
m
a
n
y
m
id
d
le
-
in
co
m
e
co
u
n
tr
ies,
th
o
u
g
h
s
u
b
s
tan
tial
g
ap
s
r
em
ain
in
d
etec
tio
n
an
d
m
an
ag
em
e
n
t
ac
r
o
s
s
d
if
f
er
en
t
r
eg
io
n
s
[
6
]
.
T
h
e
n
u
m
b
er
o
f
d
ea
th
s
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
P
r
ev
a
len
ce
a
n
d
h
ea
lth
liter
a
c
y
o
n
h
i
g
h
b
l
o
o
d
p
r
ess
u
r
e
a
mo
n
g
la
te
a
d
u
lth
o
o
d
…
(
K
itti
p
o
n
g
S
o
r
n
lo
r
m
)
1577
attr
ib
u
tab
le
to
HB
P
ten
d
s
to
i
n
cr
ea
s
e
alo
n
g
s
id
e
t
h
e
r
is
e
in
t
h
e
n
u
m
b
er
o
f
p
atien
ts
[
7
]
.
He
alth
in
d
ices
r
ev
ea
l
th
at
th
e
n
o
r
th
ea
s
ter
n
r
eg
io
n
o
f
T
h
ailan
d
d
em
o
n
s
tr
ates
a
h
eig
h
ten
ed
r
is
k
o
f
HB
P,
ch
ar
ac
ter
ized
b
y
lo
w
lev
els
o
f
h
ig
h
-
d
en
s
ity
lip
o
p
r
o
tein
c
h
o
lest
er
o
l
(
HDL
-
C
)
an
d
h
ig
h
t
r
ig
ly
ce
r
id
es,
wh
ich
in
tu
r
n
ele
v
ate
th
e
lik
elih
o
o
d
o
f
d
ev
el
o
p
in
g
HB
P.
T
h
is
u
n
d
e
r
s
co
r
es a
n
o
tab
le
u
p
war
d
t
r
en
d
in
th
e
p
r
e
v
alen
ce
o
f
HB
P wit
h
in
th
e
r
e
g
io
n
[
8
]
.
W
h
ile
th
e
p
r
ev
alen
ce
an
d
f
ac
t
o
r
s
ass
o
ciate
d
with
HB
P
h
av
e
b
ee
n
ex
ten
s
iv
ely
s
tu
d
ie
d
in
t
h
e
eld
er
ly
p
o
p
u
latio
n
,
th
er
e
is
a
n
o
tab
le
g
ap
in
r
esear
c
h
f
o
c
u
s
in
g
o
n
l
ate
ad
u
lth
o
o
d
in
d
i
v
id
u
als
in
No
r
th
ea
s
t
T
h
ailan
d
.
T
h
is
g
ap
h
ig
h
lig
h
ts
th
e
n
ee
d
f
o
r
f
u
r
th
er
in
v
esti
g
atio
n
in
t
h
is
ar
ea
.
Giv
en
t
h
at
late
ad
u
lth
o
o
d
m
ar
k
s
th
e
o
n
s
et
o
f
h
y
p
er
ten
s
io
n
f
o
r
m
an
y
in
d
i
v
id
u
als,
it
is
im
p
er
ativ
e
to
d
ev
elo
p
b
lo
o
d
p
r
ess
u
r
e
d
is
ea
s
e
p
r
ev
en
tio
n
s
tr
ateg
ies
tailo
r
ed
to
th
is
d
em
o
g
r
ap
h
ic
i
n
T
h
ailan
d
.
W
ith
in
f
o
u
r
y
ea
r
s
,
two
-
th
ir
d
s
o
f
u
n
tr
ea
ted
ca
s
es
o
f
p
r
e
h
y
p
e
r
ten
s
io
n
m
ig
h
t
d
e
v
elo
p
i
n
to
h
y
p
er
te
n
s
io
n
[
9
]
.
T
h
e
late
ad
u
lt
p
o
p
u
latio
n
is
f
ac
in
g
life
s
ty
le
-
r
elate
d
r
is
k
f
ac
to
r
s
,
in
clu
d
in
g
im
p
r
o
p
e
r
d
iet,
lack
o
f
ex
er
cise,
s
tr
ess
,
h
ea
v
y
r
es
p
o
n
s
ib
ilit
ies,
an
d
in
ad
eq
u
ate
atten
tio
n
to
r
eg
u
lar
h
ea
lth
m
o
n
ito
r
i
n
g
.
S
i
g
n
i
f
i
c
a
n
t
r
e
s
e
a
r
c
h
h
as
r
e
v
e
al
e
d
t
h
a
t
i
n
a
d
d
i
t
i
o
n
t
o
h
e
r
e
d
i
ta
r
y
v
a
r
i
a
b
l
es
,
l
i
f
es
t
y
l
e
c
h
a
n
g
e
s
,
a
n
d
b
e
h
a
v
i
o
r
a
l
c
h
a
r
a
c
te
r
i
s
t
i
cs
a
r
e
p
r
i
m
a
r
y
c
a
u
s
e
s
o
f
H
B
P
[
10
]
,
l
a
c
k
o
f
e
x
e
r
c
is
e
,
b
ody
m
a
s
s
i
n
d
e
x
(
B
M
I
)
,
l
o
w
i
n
c
o
m
e
,
s
m
o
k
i
n
g
,
a
n
d
d
r
i
n
k
i
n
g
a
l
c
o
h
o
l
[
1
1
]
.
A
d
e
q
u
a
t
e
h
e
a
lth
l
i
t
e
r
ac
y
c
a
n
le
a
d
t
o
i
n
f
o
r
m
e
d
d
e
c
i
s
i
o
n
-
m
a
k
i
n
g
i
n
h
e
a
l
t
h
p
r
o
m
o
t
i
o
n
,
d
i
s
e
as
e
p
r
e
v
e
n
t
i
o
n
,
a
n
d
t
h
e
i
m
p
r
o
v
e
m
e
n
t
o
f
p
e
r
s
o
n
a
l
q
u
a
l
i
t
y
o
f
li
f
e
[
1
2
].
C
u
r
r
en
tly
,
th
er
e
is
lim
ited
em
p
ir
ical
r
esear
ch
f
o
cu
s
in
g
o
n
p
r
eh
y
p
e
r
ten
s
io
n
an
d
h
y
p
er
ten
s
i
o
n
in
late
ad
u
lth
o
o
d
,
o
f
ten
n
e
g
lectin
g
a
g
e
-
s
p
ec
if
ic
co
n
tex
ts
.
T
h
is
s
tu
d
y
in
v
esti
g
ates
h
ea
lth
liter
ac
y
f
ac
to
r
s
am
o
n
g
late
ad
u
lts
in
No
r
th
ea
s
t
T
h
ailan
d
to
g
u
id
e
c
o
n
tex
t
-
a
p
p
r
o
p
r
i
ate
h
ea
lth
p
r
o
m
o
tio
n
s
tr
a
teg
ies
an
d
m
itig
ate
h
y
p
er
ten
s
io
n
-
r
elate
d
co
m
p
licatio
n
s
.
T
h
er
ef
o
r
e
,
th
is
s
tu
d
y
aim
ed
to
d
eter
m
in
e
th
e
p
r
e
v
alen
ce
o
f
HB
P
an
d
ex
p
lo
r
e
t
h
e
h
ea
lth
liter
ac
y
an
d
f
ac
to
r
s
ass
o
ciate
d
with
HB
P
am
o
n
g
late
ad
u
lth
o
o
d
in
d
iv
id
u
als
r
esid
in
g
in
th
e
n
o
r
th
ea
s
ter
n
r
eg
io
n
o
f
T
h
ailan
d
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
T
h
is
is
a
p
ilo
t,
cr
o
s
s
-
s
ec
tio
n
al
,
an
d
d
escr
ip
tiv
e
s
tu
d
y
,
f
o
c
u
s
in
g
o
n
a
s
p
ec
if
ic
d
em
o
g
r
ap
h
ic
o
f
ad
u
lts
ag
ed
b
etwe
en
3
5
an
d
5
9
y
ea
r
s
o
ld
.
Data
wer
e
co
llected
at
R
eg
io
n
al
Hea
lth
C
en
ter
s
7
,
8
,
9
,
an
d
1
0
in
th
e
No
r
th
ea
s
ter
n
r
eg
i
o
n
o
f
T
h
ail
an
d
f
r
o
m
J
an
u
a
r
y
to
Ma
r
ch
2
0
2
3
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
was
late
ad
u
lts
in
No
r
th
ea
s
ter
n
T
h
ailan
d
with
an
ag
e
r
an
g
e
o
f
3
5
-
5
9
y
ea
r
s
.
T
h
e
s
tu
d
y
aim
s
to
in
v
esti
g
ate
th
e
v
ar
iab
les
ass
o
ciate
d
with
HB
P in
th
e
w
o
r
k
in
g
ad
u
lt p
o
p
u
latio
n
r
esi
d
i
n
g
in
No
r
th
ea
s
t T
h
ailan
d
.
T
h
e
r
e
s
e
a
r
c
h
e
r
s
e
m
p
l
o
y
e
d
p
r
o
b
a
b
i
l
i
t
y
s
a
m
p
l
i
n
g
t
o
s
el
e
c
t
p
a
r
ti
c
i
p
a
n
ts
f
r
o
m
n
o
r
t
h
e
a
s
t
e
r
n
T
h
ai
l
a
n
d
.
F
o
u
r
r
e
g
i
o
n
a
l
h
e
a
l
t
h
s
y
s
t
e
m
s
,
n
u
m
b
e
r
e
d
7
,
8
,
9
,
a
n
d
1
0
,
w
e
r
e
i
n
c
l
u
d
e
d
i
n
t
h
e
s
a
m
p
l
i
n
g
p
r
o
c
e
s
s
.
T
h
e
c
r
i
t
e
r
i
a
f
o
r
b
l
o
o
d
p
r
e
s
s
u
r
e
m
ea
s
u
r
e
m
e
n
ts
w
e
r
e
t
a
k
e
n
a
c
c
o
r
d
i
n
g
t
o
t
h
e
g
u
i
d
e
li
n
e
s
o
u
tl
i
n
e
d
i
n
t
h
e
s
e
v
e
n
t
h
r
e
p
o
r
t
o
f
t
h
e
J
o
i
n
t
N
a
t
i
o
n
a
l
C
o
m
m
i
tt
e
e
(
J
N
C
7
)
.
B
l
o
o
d
p
r
e
s
s
u
r
e
w
as
c
l
as
s
i
f
i
e
d
i
n
to
f
o
u
r
c
a
t
e
g
o
r
i
e
s
b
a
s
e
d
o
n
s
y
s
to
l
i
c
b
l
o
o
d
p
r
e
s
s
u
r
e
(
S
B
P
)
a
n
d
d
ia
s
t
o
l
i
c
b
l
o
o
d
p
r
e
s
s
u
r
e
(
DB
P
)
:
i)
N
o
r
m
a
l
b
l
o
o
d
p
r
e
s
s
u
r
e
(
SB
P
<
1
2
0
m
m
H
g
a
n
d
D
B
P
<
8
0
m
m
H
g
)
;
ii)
P
r
e
-
h
y
p
e
r
t
e
n
s
i
o
n
(
S
B
P
1
2
0
–
1
3
9
m
m
H
g
a
n
d
/
o
r
D
B
P
8
0
–
8
9
m
m
H
g
)
;
i
i
i
)
S
t
a
g
e
1
h
y
p
e
r
t
en
s
i
o
n
(
S
B
P
1
4
0
–
1
5
9
m
m
H
g
a
n
d
/
o
r
DB
P
9
0
–
9
9
m
m
H
g
)
;
a
n
d
i
v
)
S
ta
g
e
2
h
y
p
e
r
t
en
s
i
o
n
(
SB
P
≥
1
6
0
m
m
H
g
a
n
d
/
o
r
D
B
P
≥
1
0
0
m
m
H
g
)
.
T
h
e
n
,
H
B
P
w
as
c
o
n
s
i
d
e
r
e
d
wh
e
n
t
h
e
a
v
e
r
a
g
e
S
B
P
o
f
a
t
o
r
a
b
o
v
e
S
B
P
o
f
≥
1
4
0
m
m
H
g
a
n
d
/
o
r
D
B
P
o
f
≥
9
0
m
m
H
g
.
T
h
e
s
a
m
p
l
e
s
i
z
e
o
f
1
,
3
4
5
w
a
s
c
a
l
c
u
l
a
t
e
d
u
s
i
n
g
a
m
u
l
t
i
p
l
e
r
e
g
r
e
s
s
i
o
n
s
a
m
p
l
e
s
iz
e
f
o
r
m
u
l
a
[
1
3
]
,
b
a
s
e
d
o
n
p
r
e
v
i
o
u
s
r
e
s
e
a
r
c
h
t
h
a
t
i
d
e
n
ti
f
i
e
d
s
i
g
n
i
f
i
ca
n
t
a
s
s
o
c
i
at
i
o
n
s
b
e
t
w
e
e
n
h
e
a
l
t
h
l
i
t
e
r
a
c
y
a
n
d
h
y
p
e
r
t
e
n
s
i
o
n
a
s
d
e
m
o
n
s
t
r
a
t
e
d
i
n
F
i
g
u
r
e
1
[1
4
]
.
T
o
t
a
l
p
a
r
t
i
ci
p
a
n
t
s
=
r
i
s
k
g
r
o
u
p
o
f
P
r
e
-
HT
+
P
a
t
i
e
n
t
o
f
h
y
p
e
r
t
e
n
s
io
n
.
Fig
u
r
e
1
.
Flo
w
d
ia
g
r
am
s
h
o
wi
n
g
th
e
n
u
m
b
e
r
o
f
p
ar
ticip
an
ts
in
s
tu
d
y
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
57
6
-
1
58
4
1578
2
.
2
.
I
ns
t
rum
ent
s
o
f
t
he
s
t
ud
y
T
h
e
s
tu
d
y
em
p
lo
y
ed
clo
s
ed
-
en
d
ed
,
s
elf
-
ad
m
in
is
ter
ed
q
u
e
s
tio
n
n
air
es.
A
m
o
d
if
ied
v
er
s
io
n
o
f
th
e
q
u
esti
o
n
n
air
e
was
u
s
ed
,
co
m
p
r
is
in
g
s
ix
s
ec
tio
n
s
:
i)
d
em
o
g
r
a
p
h
ic
in
f
o
r
m
atio
n
,
i
n
clu
d
in
g
a
g
e,
g
en
d
er
,
in
co
m
e,
an
d
ed
u
ca
tio
n
lev
el
,
ii)
h
ea
lth
liter
ac
y
,
b
ased
o
n
th
e
HL
S
-
EU
-
Q4
7
s
elf
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
e
[
15
]
,
a
n
d
iii)
d
ep
r
ess
io
n
,
ad
ap
ted
f
r
o
m
th
e
Dep
ar
tm
en
t
o
f
Me
n
tal
Hea
lth
,
T
h
ailan
d
.
T
o
en
s
u
r
e
v
alid
ity
,
th
e
q
u
esti
o
n
n
air
e
was
r
e
v
iewe
d
b
y
f
iv
e
ex
p
e
r
ts
in
th
e
f
ield
,
ac
h
iev
in
g
a
n
item
-
o
b
jectiv
e
c
o
n
g
r
u
en
ce
s
co
r
e
o
f
0
.
9
2
.
Ad
d
itio
n
ally
,
t
h
e
s
tu
d
y
f
o
cu
s
ed
o
n
th
r
ee
co
n
s
tr
u
cts
—
h
ea
lth
liter
ac
y
an
d
d
e
p
r
ess
io
n
—
y
ield
in
g
C
r
o
n
b
ac
h
’
s
alp
h
a
co
ef
f
icien
ts
o
f
0
.
9
4
an
d
0
.
8
2
,
r
esp
ec
tiv
ely
.
Hea
lth
liter
ac
y
(
HL
)
in
th
is
s
t
u
d
y
was
ass
es
s
ed
th
r
o
u
g
h
a
c
o
m
p
r
eh
e
n
s
iv
e
4
5
-
item
test
co
v
er
in
g
f
o
u
r
ess
en
tial
co
m
p
o
n
en
ts
:
ac
ce
s
s
i
n
g
/o
b
tain
in
g
,
u
n
d
er
s
tan
d
in
g
,
ev
alu
atin
g
,
an
d
u
tili
zin
g
h
ea
lth
in
f
o
r
m
atio
n
.
E
ac
h
item
was
r
ated
o
n
a
f
o
u
r
-
p
o
in
t
o
r
d
in
al
s
ca
le,
r
an
g
in
g
f
r
o
m
"v
er
y
d
if
f
icu
lt"
to
"v
e
r
y
ea
s
y
.
"
Par
ticip
an
ts
wer
e
ca
teg
o
r
ized
in
to
f
o
u
r
g
r
o
u
p
s
—
in
ad
eq
u
ate,
p
r
o
b
lem
atic,
s
u
f
f
icien
t,
an
d
ex
ce
llen
t
—
b
as
ed
o
n
th
ei
r
s
co
r
es,
wh
ich
wer
e
ass
ig
n
ed
ac
co
r
d
in
g
to
p
r
e
d
ef
in
e
d
r
an
g
es a
n
d
c
o
r
r
esp
o
n
d
in
g
class
if
icatio
n
s
f
o
r
ea
ch
g
r
o
u
p
.
T
h
e
r
esear
ch
em
p
l
o
y
ed
th
e
s
ix
-
p
ar
t
p
atien
t h
ea
lth
q
u
esti
o
n
n
a
ir
e
-
9
(
PHQ
-
9
)
to
e
v
alu
ate
t
h
e
f
r
eq
u
e
n
cy
an
d
s
ev
er
ity
o
f
d
e
p
r
ess
iv
e
s
y
m
p
to
m
s
o
v
e
r
a
1
4
-
d
ay
p
er
io
d
,
as
well
as
to
d
eter
m
in
e
th
e
lik
elih
o
o
d
o
f
d
ep
r
ess
io
n
[
16
]
.
T
h
e
PHQ
-
9
u
tili
ze
s
a
4
-
p
o
i
n
t
L
ik
er
t
s
ca
le
,
r
an
g
i
n
g
f
r
o
m
0
(
in
d
icatin
g
th
e
ab
s
en
ce
o
f
a
n
ev
en
t)
t
o
3
(
i
n
d
icatin
g
an
ev
e
n
t
o
cc
u
r
r
in
g
n
ea
r
ly
ev
er
y
d
a
y
)
,
r
esu
ltin
g
in
a
to
tal
s
co
r
e
r
a
n
g
in
g
f
r
o
m
0
t
o
2
7
.
T
h
is
q
u
esti
o
n
n
air
e
is
wid
ely
r
ec
o
g
n
ized
a
n
d
r
esp
ec
ted
o
n
an
in
ter
n
atio
n
al
s
ca
le.
B
lo
o
d
p
r
e
s
s
u
r
e
m
ea
s
u
r
em
en
t
was
co
n
d
u
cted
u
s
in
g
au
to
m
atic
b
lo
o
d
p
r
ess
u
r
e
(
AB
P)
m
o
n
ito
r
s
.
Fin
al
b
lo
o
d
p
r
ess
u
r
e
r
ea
d
in
g
s
f
o
r
th
e
s
u
b
jects
wer
e
r
ec
o
r
d
e
d
as
th
e
m
ea
n
o
f
th
e
s
ec
o
n
d
an
d
th
ir
d
m
ea
s
u
r
em
en
ts
.
Hy
p
er
te
n
s
io
n
(
HB
P)
clas
s
if
icatio
n
was
d
eter
m
in
ed
ac
c
o
r
d
in
g
to
th
e
cr
iter
ia
o
u
tlin
ed
in
th
e
s
e
v
en
th
r
e
p
o
r
t
o
f
t
h
e
J
o
in
t
Nati
o
n
al
C
o
m
m
ittee
o
n
p
r
ev
en
tio
n
,
d
etec
t
io
n
,
ev
alu
ati
o
n
,
an
d
tr
ea
tm
en
t
o
f
h
i
g
h
b
l
o
o
d
p
r
ess
u
r
e
(
J
NC
7
)
[
17
].
2.
3
.
Da
t
a
a
nd
des
cr
iptiv
e
s
t
a
t
is
t
ics
Data
an
aly
s
es
wer
e
co
n
d
u
cted
u
s
in
g
STAT
A
s
tatis
t
ical
v
er
s
io
n
1
8
.
Descr
ip
tiv
e
s
tatis
tics
,
in
clu
d
in
g
p
er
ce
n
tag
es,
m
in
im
u
m
an
d
m
ax
im
u
m
v
alu
es,
m
ea
n
s
,
s
t
an
d
ar
d
d
ev
iatio
n
s
(
SDs
)
,
an
d
m
ed
ia
n
s
,
wer
e
em
p
lo
y
ed
to
an
aly
ze
d
em
o
g
r
a
p
h
ic
d
ata,
e
n
v
ir
o
n
m
en
tal
f
ac
to
r
s
,
h
ea
lth
liter
ac
y
,
an
d
d
e
p
r
ess
io
n
.
A
g
en
e
r
alize
d
lin
ea
r
m
ix
ed
m
o
d
el
(
GL
MM
)
was
u
tili
ze
d
to
ac
co
u
n
t f
o
r
r
an
d
o
m
e
f
f
ec
ts
an
d
co
r
r
elatio
n
s
with
in
clu
s
ter
s
[
18
]
.
I
n
th
is
m
o
d
elin
g
,
r
esid
e
n
tial
r
eg
io
n
al
h
ea
lth
was
d
esig
n
at
ed
as
th
e
r
an
d
o
m
e
f
f
ec
t.
B
iv
ar
iate
an
aly
s
is
was
in
itially
co
n
d
u
cte
d
to
e
x
p
lo
r
e
th
e
ass
o
ciatio
n
s
b
etwe
en
ea
ch
in
d
e
p
en
d
e
n
t
v
ar
iab
le
a
n
d
HB
P.
Var
iab
les
s
h
o
win
g
s
ig
n
if
ican
ce
i
n
th
e
b
iv
ar
iate
an
al
y
s
is
(
p
-
v
alu
e<
0
.
2
5
)
wer
e
th
e
n
in
clu
d
ed
in
th
e
m
u
ltiv
ar
ia
b
le
an
aly
s
is
.
I
n
th
e
f
in
al
m
o
d
el
u
s
in
g
b
ac
k
war
d
elim
in
atio
n
,
wh
i
ch
r
etain
ed
o
n
ly
s
ig
n
if
ican
t f
a
cto
r
s
,
th
e
o
u
tco
m
es
elu
cid
ate
th
e
ex
te
n
t
o
f
ass
o
ciatio
n
b
etwe
en
in
d
ep
en
d
en
t
v
ar
i
ab
les
an
d
HB
P,
p
r
ese
n
ted
as
a
d
ju
s
ted
o
d
d
s
r
atio
s
(
OR
s
)
alo
n
g
s
id
e
th
eir
co
r
r
esp
o
n
d
in
g
9
5
% c
o
n
f
id
en
ce
in
ter
v
als (
C
I
s
)
.
3.
RE
SU
L
T
S
3
.
1
.
So
cio
de
m
o
g
r
a
ph
ic
cha
ra
ct
er
is
t
ics,
hea
lt
h lit
er
a
cy
,
d
epre
s
s
io
n o
f
la
t
e
a
du
lt
ho
o
d wit
h
H
B
P
T
h
e
m
ajo
r
ity
o
f
t
h
e
1
,
3
4
5
p
ar
ticip
an
ts
wer
e
f
em
ale
(
6
7
.
0
6
%)
an
d
ag
ed
b
etwe
en
4
0
-
4
4
y
ea
r
s
.
Mo
s
t
p
ar
ticip
an
ts
wer
e
m
ar
r
ied
an
d
co
h
ab
itin
g
(
7
3
.
6
8
%),
with
4
3
.
7
9
%
h
a
v
in
g
p
r
im
ar
y
s
ch
o
o
l
ed
u
ca
tio
n
.
M
o
r
e
th
an
h
alf
(
5
3
.
0
%)
wer
e
en
g
ag
ed
in
ag
r
ic
u
ltu
r
e,
wh
ile
8
3
.
7
2
%
r
ep
o
r
ted
n
e
v
er
s
m
o
k
i
n
g
.
A
th
ir
d
o
f
th
e
p
ar
ti
cip
an
ts
h
ad
co
m
o
r
b
id
itie
s
(
2
0
.
7
4
%).
Am
o
n
g
all
p
ar
t
icip
an
ts
,
5
4
0
in
d
i
v
id
u
als
r
ep
o
r
ted
n
o
p
h
y
s
ical
ac
tiv
ity
(
4
0
.
1
5
%)
a
n
d
4
1
.
1
9
%
wer
e
o
b
ese.
Half
o
f
th
e
p
ar
ticip
an
ts
d
em
o
n
s
tr
ated
s
u
f
f
i
cien
t
h
ea
lth
liter
ac
y
(
6
1
.
1
2
%)
an
d
n
o
n
-
d
ep
r
ess
io
n
(
8
4
.
3
1
%)
as sh
o
wn
in
T
a
b
l
e
1
.
3
.
2
.
P
re
v
a
lences o
f
H
B
P
a
mo
ng
la
t
e
a
du
lt
ho
o
d ind
iv
idu
a
ls
in t
he
No
rt
hea
s
t
o
f
T
ha
ila
nd
T
ab
le
2
p
r
o
v
id
es
an
o
v
er
v
iew
o
f
th
e
p
r
ev
alen
ce
o
f
HB
P
am
o
n
g
late
ad
u
lth
o
o
d
in
d
iv
i
d
u
al
s
,
th
o
s
e
at
r
is
k
o
f
p
r
e
-
h
y
p
er
ten
s
io
n
(
Pre
HT
)
,
an
d
p
atien
ts
with
h
y
p
er
ten
s
io
n
.
Am
o
n
g
th
e
late
ad
u
l
t
p
o
p
u
latio
n
(
1
,
3
4
5
in
d
iv
id
u
als),
7
5
.
2
4
%
wer
e
ca
t
eg
o
r
ized
as
n
o
r
m
al,
wh
ile
2
4
.
7
5
%
wer
e
id
en
tifie
d
with
HB
P
(
≥
1
4
0
/≥
9
0
)
.
I
n
th
e
Pre
HT
r
is
k
g
r
o
u
p
(
1
,
2
0
2
in
d
iv
id
u
als),
8
2
.
9
4
%
wer
e
class
if
ied
as
n
o
r
m
al,
an
d
1
7
.
0
5
%
h
ad
HB
P.
Am
o
n
g
p
atien
ts
with
h
y
p
er
ten
s
io
n
(
1
4
3
in
d
iv
i
d
u
als),
6
2
.
2
4
%
wer
e
ca
teg
o
r
ized
as
n
o
r
m
al,
wh
ile
3
7
.
7
6
%
wer
e
id
en
tifie
d
with
HB
P.
E
ac
h
p
er
ce
n
tag
e
is
ac
co
m
p
an
ie
d
b
y
its
co
r
r
esp
o
n
d
in
g
9
5
% c
o
n
f
id
en
c
e
in
ter
v
al
(
C
I
)
.
3
.
3
.
B
iv
a
ria
t
e
a
na
ly
s
is
f
o
r
t
h
e
risk
f
a
ct
o
rs o
f
H
B
P
a
m
o
ng
la
t
e
a
du
lt
ho
o
d ind
iv
idu
a
ls
T
h
e
b
iv
ar
iate
an
aly
s
is
,
p
r
esen
ted
in
T
ab
le
3
,
o
u
tlin
es
th
e
f
ac
to
r
s
ass
o
ciate
d
with
H
B
P
am
o
n
g
p
ar
ticip
an
ts
.
I
n
t
h
e
in
itial
m
u
l
tiv
ar
iab
le
an
aly
s
is
m
o
d
el,
f
a
c
to
r
s
with
p
-
v
alu
es
less
th
an
0
.
2
5
wer
e
in
cl
u
d
e
d
.
T
h
ese
f
ac
to
r
s
co
m
p
r
is
ed
g
e
n
d
er
,
ag
e,
m
a
r
ital
s
tatu
s
,
o
cc
u
p
atio
n
,
s
m
o
k
in
g
h
ab
its
,
co
m
o
r
b
id
ities
,
p
h
y
s
ical
ac
tiv
ity
,
an
d
h
ea
lth
liter
ac
y
.
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
P
r
ev
a
len
ce
a
n
d
h
ea
lth
liter
a
c
y
o
n
h
i
g
h
b
l
o
o
d
p
r
ess
u
r
e
a
mo
n
g
la
te
a
d
u
lth
o
o
d
…
(
K
itti
p
o
n
g
S
o
r
n
lo
r
m
)
1579
T
ab
le
1
.
So
cio
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
,
h
ea
lth
liter
ac
y
,
d
ep
r
ess
io
n
(n
=
1
,
3
4
5
)
V
ar
i
a
b
l
e
N
u
m
b
er
Perce
n
t
a
g
e
(
%
)
G
en
d
er
Fema
l
e
9
0
2
6
7
.
0
6
Mal
e
4
4
3
3
2
.
9
4
A
g
e
35
-
39
2
4
8
1
8
.
4
4
40
-
44
3
3
6
2
4
.
9
8
45
-
49
2
9
5
2
1
.
9
3
50
-
54
2
5
1
1
8
.
6
6
55
-
59
2
1
5
1
5
.
9
9
St
a
t
u
s
Si
n
g
l
e
2
3
4
1
7
.
4
0
Marr
i
e
d
/
co
-
i
n
h
a
b
i
t
i
n
g
9
9
1
7
3
.
6
8
Sep
ara
t
e
d
/
d
i
v
o
r
ce
d
/
w
i
d
o
w
e
d
1
2
0
8
.
9
2
E
d
u
cat
i
o
n
al
Il
l
i
t
era
t
e
9
0
.
6
7
Pri
m
ar
y
s
c
h
o
o
l
5
8
9
4
3
.
7
9
H
i
g
h
s
c
h
o
o
l
3
8
6
2
8
.
7
0
D
i
p
l
o
ma
69
5
.
1
3
Co
l
l
eg
e
1
2
6
9
.
3
7
Mas
t
er'
s
d
e
g
re
e
o
r
h
i
g
h
e
r
1
6
6
1
2
.
3
4
O
cc
u
p
a
t
i
o
n
a
l
U
n
em
p
l
o
y
e
d
34
2
.
5
3
A
g
ri
cu
l
t
u
ri
s
t
73
5
3
.
0
1
Pri
v
a
t
e
b
u
s
i
n
e
s
s
1
3
0
9
.
6
7
G
o
v
er
n
me
n
t
e
mp
l
o
y
ee
2
7
0
2
0
.
0
7
O
ff
i
ce
r
55
4
.
0
9
H
o
u
s
e
w
i
fe
47
3
.
4
9
E
m
p
l
o
y
e
d
96
7
.
1
4
Cu
rr
en
t
s
m
o
k
i
n
g
N
e
v
er
1
,
1
2
6
8
3
.
7
2
Ex
-
s
m
o
k
er
73
5
.
4
3
Cu
rr
en
t
s
m
o
k
er
1
4
6
1
0
.
8
6
Co
m
o
r
b
i
d
i
t
y
No
1
,
0
6
6
7
9
.
2
6
Y
e
s
2
7
9
2
0
.
7
4
Ph
y
s
i
c
al
ac
t
i
v
i
t
y
Y
e
s
8
0
5
5
9
.
8
5
No
5
4
0
4
0
.
1
5
BMI
(
k
g
/
m
2
)
U
n
d
er
w
e
i
g
h
t
48
3
.
5
7
N
o
rma
l
4
6
5
3
4
.
5
7
O
v
er
w
e
i
g
h
t
2
7
8
2
0
.
6
7
O
b
e
s
i
t
y
5
5
4
4
1
.
1
9
H
ea
l
t
h
l
i
t
era
cy
(
t
o
t
a
l
)
In
a
d
e
q
u
a
t
e
(
0
-
5
0
%
)
34
2
.
5
3
Pro
b
l
ema
t
i
c
(5
1
-
6
6
%
)
2
7
1
2
0
1
5
Su
ff
i
c
i
e
n
t
(
6
7
-
8
4
%
)
8
2
2
6
1
.
1
2
E
x
ce
l
l
en
t
(≥
8
5
%
)
2
1
8
1
6
.
2
1
H
L
f
i
n
d
i
n
g
h
ea
l
t
h
i
n
f
o
rm
at
i
o
n
(F
H
I)
In
a
d
e
q
u
a
t
e
(
0
-
5
0
%
)
75
5
.
5
8
Pro
b
l
ema
t
i
c
(5
1
-
6
6
%
)
2
2
8
1
6
.
9
5
Su
ff
i
c
i
e
n
t
(
6
7
-
8
4
%
)
7
9
3
5
8
.
9
6
E
x
ce
l
l
en
t
(≥
8
5
%
)
2
4
9
1
8
.
5
1
H
L
u
n
d
ers
t
a
n
d
i
n
g
h
e
al
t
h
i
n
fo
r
ma
t
i
o
n
(
U
H
I)
In
a
d
e
q
u
a
t
e
(0
-
5
0
%
)
31
2
.
3
0
Pro
b
l
ema
t
i
c
(5
1
-
6
6
%
)
48
3
.
5
9
Su
ff
i
c
i
e
n
t
(
6
7
-
8
4
%
)
8
5
4
6
3
.
8
3
E
x
ce
l
l
en
t
(≥
8
5
%
)
4
1
2
3
0
.
7
9
H
L
j
u
d
g
i
n
g
h
e
al
t
h
i
n
fo
rma
t
i
o
n
(J
H
I)
In
a
d
e
q
u
a
t
e
(
0
-
5
0
%
)
28
2
.
0
8
Pro
b
l
ema
t
i
c
(5
1
-
6
6
%
)
1
5
7
1
1
.
6
7
Su
ff
i
c
i
e
n
t
(
6
7
-
8
4
%
)
8
7
9
6
5
.
3
5
E
x
ce
l
l
en
t
(≥
8
5
%
)
2
8
1
2
0
.
8
9
H
L
a
p
p
l
y
i
n
g
h
ea
l
t
h
i
n
f
o
rma
t
i
o
n
(
A
H
I)
In
a
d
e
q
u
a
t
e
(
0
-
5
0
%
)
15
1
.
1
2
Pro
b
l
ema
t
i
c
(5
1
-
6
6
%
)
85
6
.
3
2
Su
ff
i
c
i
e
n
t
(
6
7
-
8
4
%
)
8
3
6
6
2
.
1
6
E
x
ce
l
l
en
t
(≥
8
5
%
)
4
0
9
3
0
.
4
1
D
e
p
re
s
s
i
o
n
N
o
n
e
(
<
7
)
1
,
1
3
4
8
4
.
3
3
Mi
l
d
(
7
-
1
2
)
56
4
.
1
6
Mo
d
er
at
e
(
1
3
-
1
8
)
1
3
7
1
0
.
1
9
Sev
ere
(≥
1
9
)
18
1
.
3
4
*
B
M
I
w
a
s re
d
e
f
i
n
e
d
i
n
t
o
4
c
a
t
e
g
o
r
i
e
s
d
u
e
t
o
l
o
w
n
u
m
b
e
r
s
o
f
u
n
d
e
r
w
e
i
g
h
t
s
(
n
o
r
m
a
l
w
e
i
g
h
t
1
8
.
5
-
2
2
.
9
9
k
g
/
m
2
,
o
v
e
r
w
e
i
g
h
t
2
3
.
0
-
2
4
.
9
9
k
g
/
m
2
,
a
n
d
o
b
e
si
t
y
≥
2
5
.
0
k
g
/
m
2
T
a
b
l
e
2
.
P
r
e
v
a
l
e
n
c
e
o
f
H
B
P
a
m
o
n
g
l
a
t
e
a
d
u
l
t
h
o
o
d
i
n
d
i
v
i
d
u
a
l
s
Fact
o
r
s
N
u
m
b
er
(
%
)
9
5
%
CI
L
a
t
e
a
d
u
l
t
(
1
,
3
4
5
)
N
o
rma
l
1
,
0
1
2
(
7
5
.
2
4
)
7
2
.
8
6
-
7
7
.
4
7
H
BP
(
≥
1
4
0
/
≥
9
0
)
3
3
3
(
2
4
.
7
5
)
2
2
.
5
2
-
2
7
.
1
3
Ri
s
k
g
ro
u
p
o
f
Pre
H
T
(1
,
2
0
2
)
N
o
rma
l
9
9
7
(
8
2
.
9
4
)
8
0
.
7
0
-
8
4
.
9
7
H
BP
(
≥
1
4
0
/
≥
9
0
)
2
0
5
(
1
7
.
0
5
)
1
5
.
0
2
-
1
9
.
2
9
Pat
i
e
n
t
o
f
h
y
p
ert
en
s
i
o
n
(
1
4
3
)
N
o
rma
l
8
9
(
6
2
.
2
4
)
5
3
.
9
2
-
6
9
.
8
8
H
BP
(
≥
1
4
0
/
≥
9
0
)
5
4
(
3
7
.
7
6
)
3
0
.
1
1
-
4
6
.
0
7
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
57
6
-
1
58
4
1580
T
ab
le
3
.
T
h
e
b
iv
ar
iate
a
n
aly
s
is
ex
am
in
ed
th
e
r
is
k
f
ac
to
r
s
ass
o
ciate
d
with
HB
P a
m
o
n
g
late
ad
u
lth
o
o
d
in
d
iv
id
u
als (
n
=
1
,
3
4
5
)
V
a
r
i
a
b
l
e
s
N
u
mb
e
r
%
o
f
H
B
P
C
r
u
d
e
o
d
d
s
r
a
t
i
o
9
5
%C
I
p
-
v
a
l
u
e
G
e
n
d
e
r
0
.
0
9
1
F
e
mal
e
9
0
2
1
7
.
1
8
1
M
a
l
e
4
4
3
2
0
.
9
9
1
.
2
8
0
.
9
6
-
1
.
7
0
A
g
e
0
.
0
6
3
<
5
0
5
8
4
2
2
.
2
6
1
≥
5
0
7
6
1
2
6
.
6
8
1
.
2
7
0
.
1
4
-
0
.
3
4
S
t
a
t
u
s
*
0
.
0
1
9
S
i
n
g
l
e
23
2
0
.
5
1
1
M
a
r
r
i
e
d
/
C
o
-
I
n
h
a
b
i
t
i
n
g
9
9
1
2
6
.
6
4
1
.
4
0
1
.
0
0
-
1
.
9
9
S
e
p
a
r
a
t
e
d
/
D
i
v
o
r
c
e
d
/
W
i
d
o
w
e
d
1
2
0
1
7
.
5
0
0
.
8
2
0
.
4
6
-
1
.
4
5
Ed
u
c
a
t
i
o
n
a
l
*
0
.
0
0
2
C
o
l
l
e
g
e
/
m
a
st
e
r
's d
e
g
r
e
e
o
r
h
i
g
h
e
r
2
9
2
2
0
.
8
9
1
H
i
g
h
sc
h
o
o
l
/
d
i
p
l
o
m
a
4
5
5
2
1
.
3
2
1
.
0
2
0
.
7
1
-
1
.
4
7
I
l
l
i
t
e
r
a
t
e
/
p
r
i
mar
y
sc
h
o
o
l
5
9
8
2
9
.
2
6
1
.
5
6
1
.
1
2
-
2
.
1
8
O
c
c
u
p
a
t
i
o
n
a
l
0
.
0
7
2
U
n
e
m
p
l
o
y
e
d
/
h
o
u
s
e
w
i
f
e
81
2
4
.
6
9
1
A
g
r
i
c
u
l
t
u
r
i
st
7
1
3
2
7
.
4
9
1
.
1
5
0
.
6
7
-
1
.
9
6
P
r
i
v
a
t
e
b
u
si
n
e
s
s/
e
mp
l
o
y
e
d
2
2
6
2
2
.
5
7
0
.
8
8
0
.
4
9
-
1
.
6
0
G
o
v
e
r
n
m
e
n
t
e
mp
l
o
y
e
e
/
o
f
f
i
c
e
r
3
2
5
2
0
.
3
1
0
.
7
7
0
.
4
3
-
1
.
3
7
C
u
r
r
e
n
t
sm
o
k
i
n
g
*
<
0
.
0
0
1
N
e
v
e
r
7
5
6
2
2
.
7
4
1
Ex
-
sm
o
k
e
r
1
1
4
4
5
.
2
1
2
.
8
0
1
.
7
3
-
4
.
5
3
C
u
r
r
e
n
t
sm
o
k
e
r
4
7
5
3
0
.
1
4
1
.
4
6
1
.
0
0
-
2
.
1
4
C
o
m
o
r
b
i
d
i
t
y
*
<
0
.
0
0
1
No
1
,
0
6
6
2
1
.
4
8
1
Y
e
s
2
7
9
3
7
.
2
8
2
.
1
7
1
.
6
3
-
2
.
8
8
P
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
*
0
.
0
0
1
Y
e
s
8
0
5
2
1
.
6
1
1
No
5
4
0
2
9
.
4
4
1
.
5
1
1
.
1
7
-
1
.
9
4
B
M
I
*
<
0
.
0
0
1
N
o
r
mal
5
1
3
1
6
.
1
8
1
O
v
e
r
w
e
i
g
h
t
/
o
b
e
se
8
3
2
3
0
.
0
5
2
.
2
2
1
.
6
8
-
2
.
9
3
H
e
a
l
t
h
l
i
t
e
r
a
c
y
(
t
o
t
a
l
)
0
.
0
8
6
S
u
f
f
i
c
i
e
n
t
/
e
x
c
e
l
l
e
n
t
1
,
0
4
0
2
3
.
6
5
1
I
n
a
d
e
q
u
a
t
e
/
p
r
o
b
l
e
ma
t
i
c
3
0
5
2
8
.
5
2
1
.
2
8
0
.
9
6
-
1
.
7
1
H
L
f
i
n
d
i
n
g
h
e
a
l
t
h
i
n
f
o
r
m
a
t
i
o
n
(
F
H
I
)
*
0
.
0
0
1
S
u
f
f
i
c
i
e
n
t
/
e
x
c
e
l
l
e
n
t
1
,
0
4
2
1
9
.
8
0
1
I
n
a
d
e
q
u
a
t
e
/
p
r
o
b
l
e
ma
t
i
c
3
0
3
2
6
.
2
0
1
.
5
7
1
.
1
8
-
2
.
0
8
H
L
u
n
d
e
r
st
a
n
d
i
n
g
h
e
a
l
t
h
i
n
f
o
r
ma
t
i
o
n
(
U
H
I
)
0
.
0
9
3
S
u
f
f
i
c
i
e
n
t
/
e
x
c
e
l
l
e
n
t
1
,
2
6
6
2
4
.
2
5
1
I
n
a
d
e
q
u
a
t
e
/
pr
o
b
l
e
ma
t
i
c
79
3
2
.
9
1
1
.
5
3
0
.
9
4
-
2
.
4
9
H
L
j
u
d
g
i
n
g
h
e
a
l
t
h
i
n
f
o
r
ma
t
i
o
n
(
JH
I
)
0
.
8
2
6
S
u
f
f
i
c
i
e
n
t
/
e
x
c
e
l
l
e
n
t
1
,
1
6
0
2
4
.
6
6
1
I
n
a
d
e
q
u
a
t
e
/
p
r
o
b
l
e
ma
t
i
c
1
8
5
2
5
.
4
1
1
.
0
4
0
.
7
2
-
1
.
4
8
H
L
a
p
p
l
y
i
n
g
h
e
a
l
t
h
i
n
f
o
r
mat
i
o
n
(
A
H
I
)
0
.
0
8
9
S
u
f
f
i
c
i
e
n
t
/
e
x
c
e
l
l
e
n
t
1
,
2
4
5
2
4
.
1
8
1
I
n
a
d
e
q
u
a
t
e
/
p
r
o
b
l
e
ma
t
i
c
1
0
0
3
2
.
0
0
1
.
4
7
0
.
9
5
-
2
.
2
9
D
e
p
r
e
ss
i
o
n
0
.
3
8
8
N
o
n
e
/
m
i
l
d
1
,
1
9
0
2
4
.
7
1
1
M
o
d
e
r
a
t
e
1
3
7
2
3
.
3
6
0
.
9
2
0
.
6
1
-
1
.
4
0
S
e
v
e
r
e
18
3
8
.
8
9
1
.
9
3
0
.
7
4
-
5
.
0
4
N
o
t
e
:
*
S
i
g
n
i
f
i
c
a
n
t
l
y
a
ss
o
c
i
a
t
e
d
w
i
t
h
H
B
P
.
3
.
4
.
M
ultiv
a
ria
ble a
na
ly
s
is
o
f
f
a
ct
o
r
a
s
s
o
cia
t
ed
wit
h H
B
P
by
us
ing
t
he
G
L
M
M
T
h
e
m
u
ltiv
a
r
iab
le
an
al
y
s
is
f
o
r
ass
o
ciate
d
f
ac
to
r
s
o
f
HB
P
was
id
en
tifie
d
b
y
u
s
in
g
th
e
GL
MM
to
co
n
tr
o
l
th
e
clu
s
ter
in
g
ef
f
ec
t
o
f
th
e
s
am
p
lin
g
s
elec
tio
n
o
f
th
e
p
ar
ticip
an
ts
.
I
n
th
e
f
in
al
m
o
d
el,
HL
f
in
d
in
g
h
ea
lth
in
f
o
r
m
atio
n
,
HL
ju
d
g
in
g
h
ea
lth
in
f
o
r
m
atio
n
,
s
m
o
k
in
g
,
co
m
o
r
b
id
ity
,
p
h
y
s
ical
ac
tiv
ity
,
an
d
B
MI
r
em
ain
ed
s
ig
n
if
i
ca
n
tly
ass
o
ciate
d
with
HB
P.
Par
ticip
an
ts
wi
th
in
ad
eq
u
ate
an
d
p
r
o
b
lem
atic
HL
f
in
d
in
g
h
ea
lth
in
f
o
r
m
atio
n
wer
e
m
o
r
e
lik
el
y
to
h
av
e
HB
P
th
an
th
o
s
e
with
s
u
f
f
icien
t
an
d
ex
ce
llen
t
HL
in
th
is
ar
ea
(
Ad
j.
OR
=
1
.
5
9
,
9
5
%
C
I
:
1
.
2
8
-
1
.
9
6
,
p
-
v
al
u
e<
0
.
0
0
1
)
.
Similar
ly
,
p
a
r
ticip
an
ts
with
in
a
d
eq
u
ate
an
d
p
r
o
b
lem
atic
HL
ju
d
g
in
g
h
ea
lth
in
f
o
r
m
atio
n
wer
e
m
o
r
e
lik
ely
to
h
av
e
HB
P
th
an
th
o
s
e
with
s
u
f
f
icien
t
an
d
e
x
ce
llen
t
HL
ju
d
g
in
g
h
ea
lth
in
f
o
r
m
atio
n
(
A
d
j.
OR
=
1
.
3
4
,
9
5
%
C
I
:
1
.
0
4
-
1
.
7
3
,
p
-
v
alu
e
=
0
.
0
2
4
)
.
T
h
e
o
d
d
s
o
f
h
av
in
g
HB
P
wer
e
al
m
o
s
t
2
tim
es
h
ig
h
er
a
m
o
n
g
co
m
o
r
b
id
ity
p
ar
ticip
an
t
co
m
p
a
r
e
to
n
o
n
-
c
o
m
o
r
b
id
it
y
p
ar
ticip
a
n
t
(
Ad
j.
OR
=2
.
2
1
,
9
5
%
C
I
:
1
.
5
4
-
2
.
8
3
,
p
-
v
alu
e
=
0
.
0
1
8
)
,
Ov
er
wei
g
h
t
o
r
o
b
ese
p
ar
ticip
a
n
ts
wer
e
s
ig
n
if
ican
tly
m
o
r
e
lik
ely
to
s
u
f
f
er
f
r
o
m
HB
P
(
Ad
j.
OR
=
2
.
2
1
,
9
5
%
C
I
:
1
.
5
4
-
2
.
8
3
,
p
-
v
alu
e
=
0
.
0
1
8
)
.
T
h
o
s
e
wh
o
ev
er
s
m
o
k
ed
an
d
cu
r
r
en
t
s
m
o
k
er
co
n
s
u
m
p
tio
n
h
a
d
a
h
i
g
h
er
r
is
k
o
f
HB
P
th
an
p
ar
ticip
an
ts
wh
o
n
ev
er
s
m
o
k
ed
u
s
e
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
P
r
ev
a
len
ce
a
n
d
h
ea
lth
liter
a
c
y
o
n
h
i
g
h
b
l
o
o
d
p
r
ess
u
r
e
a
mo
n
g
la
te
a
d
u
lth
o
o
d
…
(
K
itti
p
o
n
g
S
o
r
n
lo
r
m
)
1581
(
Ad
j.
OR
=
2
.
0
4
,
9
5
%
C
I
:
1
.
2
9
-
3
.
2
4
,
p
-
v
alu
e
=
0
.
0
0
2
)
.
Ph
y
s
ical
ac
tiv
ity
was
s
ig
n
if
ican
t
ly
ass
o
ciate
d
with
HB
P.
(
Ad
j.
OR
=
1
.
6
7
,
9
5
% C
I
: 1
.
2
8
-
2
.
1
6
,
p
-
v
alu
e<
0
.
0
0
1
)
a
s
s
h
o
wn
in
T
ab
le
4
.
T
ab
le
4
.
Mu
ltiv
ar
ia
b
le
an
aly
s
i
s
o
f
f
ac
to
r
ass
o
ciate
d
with
HB
P b
y
u
s
in
g
th
e
GL
MM
F
a
c
t
o
r
s
N
u
mb
e
r
%
o
f
H
B
P
C
r
u
d
e
O
d
d
s
R
a
t
i
o
A
d
j
.
O
d
d
s
R
a
t
i
o
9
5
%C
I
p
-
v
a
l
u
e
H
L
f
i
n
d
i
n
g
h
e
a
l
t
h
i
n
f
o
r
m
a
t
i
o
n
(
F
H
I
)
<
0
.
0
0
1
S
u
f
f
i
c
i
e
n
t
/
E
x
c
e
l
l
e
n
t
1
,
0
4
2
1
9
.
8
0
1
I
n
a
d
e
q
u
a
t
e
/
P
r
o
b
l
e
m
a
t
i
c
3
0
3
2
6
.
2
0
1
.
5
7
1
.
5
9
1
.
2
8
-
1
.
9
6
H
L
j
u
d
g
i
n
g
h
e
a
l
t
h
i
n
f
o
r
ma
t
i
o
n
(
JH
I
)
0
.
0
2
4
S
u
f
f
i
c
i
e
n
t
/
E
x
c
e
l
l
e
n
t
1
,
1
6
0
2
4
.
6
6
1
I
n
a
d
e
q
u
a
t
e
/
P
r
o
b
l
e
m
a
t
i
c
1
8
5
2
5
.
4
1
1
.
0
4
1
.
3
4
1
.
0
4
-
1
.
7
3
C
u
r
r
e
n
t
sm
o
k
i
n
g
0
.
0
0
2
N
e
v
e
r
1
,
1
2
6
2
2
.
7
4
1
Ex
-
sm
o
k
e
r
/
C
u
r
r
e
n
t
sm
o
k
e
r
2
1
9
3
5
.
1
6
1
.
8
4
2
.
0
4
1
.
2
9
-
3
.
2
4
C
o
m
o
r
b
i
d
i
t
y
<
0
.
0
0
1
No
1
,
0
6
6
2
1
.
4
8
1
Y
e
s
2
7
9
3
7
.
2
8
2
.
1
7
2
.
2
0
1
.
7
6
-
2
.
7
4
P
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
Y
e
s
8
0
5
2
1
.
6
1
1
<
0
.
0
0
1
No
5
4
0
2
9
.
4
4
1
.
5
1
1
.
6
7
1
.
2
8
-
2
.
1
6
B
M
I
(
k
g
/
m
2
)
0
.
0
1
8
Lo
w
/
n
o
r
mal
(
<
2
3
)
5
1
3
1
6
.
1
8
1
O
v
e
r
w
e
i
g
h
t
(
2
3
-
2
4
.
9
9
)
/
O
b
e
s
i
t
y
(
≥
2
5
)
8
3
2
3
0
.
0
5
2
.
2
2
2
.
2
1
1
.
1
4
-
4
.
2
6
4.
DIS
CUSSI
O
N
T
h
e
s
tu
d
y
r
e
p
o
r
ted
a
2
4
.
7
5
%
p
r
ev
alen
ce
o
f
HB
P
am
o
n
g
lat
e
ad
u
lts
in
No
r
th
ea
s
t
T
h
ailan
d
,
a
f
ig
u
r
e
co
m
p
ar
ab
le
to
s
u
b
-
Sah
ar
a
n
Af
r
ica’
s
2
8
%
[
1
9
]
.
Ho
wev
er
,
th
is
r
ate
ex
ce
ed
s
th
at
f
o
u
n
d
in
So
u
th
Asi
a,
wh
er
e
HB
P
af
f
ec
ts
1
4
.
9
%
o
f
o
ld
er
a
d
u
lts
in
I
n
d
ia,
1
9
.
8
%
in
B
an
g
lad
esh
,
an
d
1
3
.
8
%
in
Nep
al
[
6
]
.
Su
ch
v
ar
iatio
n
m
ay
r
ef
lect
d
if
f
e
r
en
ce
s
in
lif
esty
le,
g
en
etic
p
r
ed
is
p
o
s
itio
n
,
o
r
h
ea
lth
ca
r
e
ac
ce
s
s
ib
ilit
y
ac
r
o
s
s
th
ese
r
eg
io
n
s
.
T
h
ese
f
in
d
in
g
s
u
n
d
e
r
s
co
r
e
a
s
ig
n
if
ican
tly
h
ig
h
er
p
r
e
v
ale
n
ce
in
T
h
ailan
d
co
m
p
ar
ed
t
o
p
r
ev
io
u
s
r
eg
io
n
al
s
tu
d
ies
an
d
h
ig
h
lig
h
t
th
e
u
r
g
en
t
n
ee
d
f
o
r
tar
g
eted
in
te
r
v
en
tio
n
s
.
I
n
th
e
r
ea
lm
o
f
h
ea
lth
liter
ac
y
co
n
ce
r
n
in
g
in
f
o
r
m
atio
n
u
tili
za
tio
n
,
it
h
as
b
ee
n
d
em
o
n
s
tr
ated
th
at
in
d
iv
i
d
u
als
with
in
a
d
eq
u
ate
o
r
p
r
o
b
lem
atic
in
f
o
r
m
atio
n
en
co
u
n
ter
d
if
f
icu
lties
in
ef
f
ec
t
iv
ely
m
an
ag
in
g
HB
P.
T
h
e
p
-
v
alu
e
o
f
<0
.
0
0
1
o
b
tain
e
d
in
th
i
s
s
tu
d
y
is
d
ee
m
ed
s
tatis
t
ically
s
ig
n
if
ican
t.
T
h
ese
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t
with
t
h
o
s
e
r
ep
o
r
ted
b
y
Su
n
d
ell
e
t
a
l.
[
2
0
]
in
d
icatin
g
a
co
r
r
elatio
n
b
etwe
en
ac
ce
s
s
to
p
er
s
o
n
al
h
ea
lth
in
f
o
r
m
atio
n
an
d
g
o
o
d
h
ea
lth
liter
ac
y
.
E
s
s
en
tially
,
in
d
iv
id
u
als
lack
in
g
ac
ce
s
s
to
h
ea
lth
in
f
o
r
m
atio
n
m
ay
s
tr
u
g
g
le
to
m
a
n
ag
e
th
eir
o
wn
h
ea
lth
ef
f
ec
t
iv
ely
.
Sp
ec
if
ically
,
in
ad
eq
u
ate/p
r
o
b
lem
atic
h
ea
lth
liter
ac
y
ju
d
g
in
g
h
ea
lth
in
f
o
r
m
atio
n
(
HL
J
HI
)
r
esu
lted
in
a
1
.
3
4
tim
es
h
ig
h
e
r
r
is
k
o
f
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
co
m
p
ar
ed
to
late
a
d
u
lts
with
ad
e
q
u
ate
o
r
e
x
ce
llen
t
h
ea
lth
liter
a
cy
lev
els.
No
tab
ly
,
late
ad
u
lth
o
o
d
in
th
e
No
r
th
ea
s
t
r
eg
io
n
e
x
h
ib
its
th
e
h
ig
h
est
p
r
o
p
o
r
tio
n
o
f
in
d
i
v
id
u
a
ls
with
less
th
an
a
b
ac
h
elo
r
'
s
d
eg
r
ee
,
p
o
ten
tially
lead
in
g
t
o
r
ed
u
ce
d
e
n
g
ag
em
en
t
in
h
ea
lth
-
r
elate
d
d
ec
i
s
io
n
-
m
ak
in
g
.
T
h
i
s
o
b
s
e
r
v
a
t
i
o
n
r
e
s
o
n
at
e
s
w
i
t
h
t
h
e
f
i
n
d
i
n
g
s
o
f
A
b
o
u
m
a
t
a
r
e
t
a
l
.
[
2
1
]
,
h
i
g
h
l
i
g
h
t
i
n
g
s
i
g
n
i
f
ica
n
t
d
i
f
f
e
r
e
n
c
e
s
i
n
t
r
e
a
t
m
e
n
t
d
e
c
is
i
o
n
p
a
r
t
i
ci
p
a
t
i
o
n
b
e
t
w
e
e
n
h
y
p
e
r
t
e
n
s
i
v
e
p
a
t
i
e
n
ts
w
i
t
h
l
o
w
e
d
u
c
at
i
o
n
a
n
d
h
e
a
l
th
l
i
t
e
r
a
c
y
l
e
v
e
ls
a
n
d
t
h
e
i
r
l
it
e
r
a
t
e
c
o
u
n
t
e
r
p
a
r
t
s
.
T
h
e
r
esu
lts
o
f
th
is
r
esear
ch
,
i
n
d
icatin
g
th
at
in
d
iv
id
u
als
w
h
o
cu
r
r
en
tly
s
m
o
k
e
o
r
h
a
v
e
e
v
er
s
m
o
k
e
d
ar
e
at
a
h
ig
h
er
r
is
k
o
f
d
ev
elo
p
in
g
HB
P,
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
f
in
d
in
g
s
r
ep
o
r
ted
b
y
E
s
tech
e
et
a
l
.
[
22
]
.
I
n
th
eir
s
tu
d
y
in
v
o
lv
in
g
3
9
1
h
y
p
er
ten
s
iv
e
p
atien
ts
,
s
m
o
k
i
n
g
was
f
o
u
n
d
to
b
e
ass
o
ciate
d
with
elev
ated
b
lo
o
d
p
r
ess
u
r
e
lev
e
ls
d
u
r
in
g
s
leep
[
23
]
.
C
o
n
v
er
s
ely
,
Gao
et
a
l.
[
2
4
]
f
o
u
n
d
n
o
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
in
h
y
p
er
te
n
s
io
n
r
is
k
b
etwe
en
cu
r
r
e
n
t
to
b
ac
co
u
s
er
s
an
d
n
o
n
-
s
m
o
k
er
s
.
Ho
wev
er
,
h
ea
v
y
m
ac
h
in
e
-
r
o
lled
cig
ar
ette
s
m
o
k
in
g
s
ig
n
if
ican
tly
in
cr
ea
s
ed
h
y
p
er
t
en
s
io
n
r
is
k
,
lik
ely
d
u
e
to
t
o
x
in
s
ca
u
s
in
g
v
ascu
lar
s
tiff
en
i
n
g
,
th
u
s
im
p
ac
tin
g
b
lo
o
d
p
r
ess
u
r
e
r
eg
u
latio
n
.
T
h
e
s
tu
d
y
r
ev
ea
led
t
h
at
p
ar
ti
cip
an
ts
with
co
m
o
r
b
id
d
is
ea
s
es
wer
e
m
o
r
e
s
u
s
ce
p
tib
le
to
d
ev
elo
p
in
g
HB
P
co
m
p
ar
ed
to
i
n
d
iv
id
u
als
with
o
u
t
an
y
co
m
o
r
b
id
ities
.
T
h
is
ass
o
ciatio
n
is
attr
ib
u
t
ed
to
t
h
e
ad
d
itio
n
al
s
tr
ain
p
lace
d
o
n
t
h
e
h
ea
r
t
a
n
d
ar
ter
i
es
d
u
e
to
u
n
d
e
r
ly
in
g
h
ea
lth
co
n
d
itio
n
s
.
As
a
r
esu
lt,
th
e
h
ea
r
t
m
u
s
t
wo
r
k
h
ar
d
er
,
lead
in
g
to
s
tiff
en
in
g
an
d
p
o
te
n
tial
r
u
p
t
u
r
in
g
o
f
ar
ter
ies,
t
h
er
eb
y
i
n
cr
ea
s
in
g
b
lo
o
d
p
r
ess
u
r
e.
T
h
ese
f
in
d
in
g
s
alig
n
wi
th
th
o
s
e
o
f
Das
et
a
l.
[
2
5
]
o
b
s
er
v
e
d
a
2
.
6
5
tim
es
in
cr
ea
s
ed
r
is
k
o
f
HB
P
in
in
d
iv
id
u
als
with
m
o
r
b
id
o
b
esit
y
.
Fu
r
th
er
m
o
r
e,
W
an
d
ile
em
p
h
asized
th
e
im
p
o
r
tan
ce
o
f
m
ai
n
tain
in
g
n
o
r
m
al
b
lo
o
d
p
r
ess
u
r
e
lev
els
to
p
r
ev
en
t sev
er
e
co
m
p
licatio
n
s
ass
o
ciate
d
with
co
m
o
r
b
id
c
o
n
d
itio
n
s
[2
6
].
T
h
e
s
tu
d
y
h
ig
h
lig
h
ts
th
e
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
p
h
y
s
ical
ac
tiv
ity
an
d
b
lo
o
d
p
r
ess
u
r
e
lev
els,
with
am
p
le
s
u
p
p
o
r
tin
g
ev
id
e
n
ce
s
u
g
g
esti
n
g
th
at
ex
er
cise
ai
d
s
in
d
ilatin
g
b
lo
o
d
v
ess
els,
a
co
n
s
is
ten
t
f
in
d
in
g
ac
r
o
s
s
p
r
ev
io
u
s
s
tu
d
ies.
Fo
r
in
s
tan
ce
,
Sy
au
q
i
[
2
7
]
o
b
s
er
v
ed
in
t
h
eir
s
tu
d
y
o
n
p
h
y
s
ical
ac
tiv
ity
am
o
n
g
h
y
p
er
ten
s
iv
e
p
atien
ts
th
at
it
led
to
a
r
ed
u
ctio
n
i
n
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e
(
SB
P)
lev
els
.
Ad
d
itio
n
ally
,
Gam
ag
e
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
57
6
-
1
58
4
1582
an
d
Sen
ev
ir
atn
e
[
2
8
]
id
e
n
tifie
d
lack
o
f
ex
er
cise
as
a
r
is
k
f
ac
to
r
f
o
r
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
am
o
n
g
em
p
lo
y
ee
s
.
Mo
r
eo
v
er
,
Yan
g
et
a
l
.
[
2
9
]
d
em
o
n
s
tr
ated
th
at
p
h
y
s
ical
f
itn
ess
s
er
v
es
as
a
p
r
ev
e
n
tiv
e
f
ac
to
r
a
g
ain
s
t
h
y
p
er
ten
s
io
n
in
ad
u
lts
,
r
ein
f
o
r
cin
g
th
e
p
r
o
tectiv
e
ef
f
ec
ts
o
f
e
x
er
cise.
T
h
e
p
o
s
itiv
e
ass
o
ciatio
n
s
o
b
s
e
r
v
ed
i
n
th
is
s
u
r
v
ey
b
etwe
en
H
B
P
an
d
a
B
MI
o
f
2
5
o
r
m
o
r
e
alig
n
with
f
in
d
in
g
s
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies.
Fo
r
ex
am
p
le,
R
ah
u
t
et
a
l
.
[
2
3
]
d
is
co
v
er
ed
th
at
o
v
er
weig
h
t
an
d
o
b
ese
g
r
o
u
p
s
in
B
an
g
lad
esh
h
a
d
a
h
i
g
h
er
r
is
k
o
f
d
e
v
elo
p
in
g
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
co
m
p
a
r
ed
to
th
o
s
e
w
ith
a
n
o
r
m
al
B
MI
.
Similar
ly
,
Ma
m
douh
et
a
l
.
[
3
0
]
f
o
u
n
d
t
h
at
th
e
o
v
er
weig
h
t
g
r
o
u
p
h
ad
a
2
.
5
6
tim
es
h
ig
h
er
lik
elih
o
o
d
o
f
d
ev
elo
p
in
g
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
th
an
th
e
n
o
r
m
al
weig
h
t
g
r
o
u
p
.
T
h
is
r
elatio
n
s
h
ip
b
etwe
en
i
n
cr
ea
s
ed
B
MI
a
n
d
HB
P
in
late
ad
u
lth
o
o
d
m
ay
b
e
attr
ib
u
ted
to
elev
ated
f
atty
tis
s
u
e
lev
els
in
o
b
ese
in
d
i
v
id
u
als,
wh
ich
ca
n
lead
t
o
in
cr
ea
s
ed
v
ascu
lar
r
esis
tan
ce
an
d
s
u
b
s
eq
u
en
tly
in
c
r
ea
s
e
th
e
wo
r
k
lo
ad
r
eq
u
ir
ed
f
o
r
th
e
h
e
ar
t
to
p
u
m
p
b
lo
o
d
th
r
o
u
g
h
o
u
t t
h
e
b
o
d
y
.
T
h
i
s
s
t
u
d
y
r
e
p
r
e
s
e
n
t
s
t
h
e
f
i
r
s
t
i
n
v
e
s
t
i
g
a
t
i
o
n
i
n
N
o
r
t
h
e
a
s
t
e
r
n
T
h
a
i
l
a
n
d
t
o
e
x
a
m
i
n
e
t
h
e
p
r
e
v
a
l
e
n
c
e
o
f
H
B
P
a
n
d
i
t
s
r
e
l
a
t
i
o
n
s
h
i
p
w
i
t
h
h
e
a
l
t
h
l
i
t
e
r
a
c
y
a
n
d
o
t
h
e
r
i
n
f
l
u
e
n
c
i
n
g
f
a
c
t
o
r
s
.
T
h
e
f
i
n
d
i
n
g
s
h
i
g
h
l
i
g
h
t
a
s
i
g
n
i
f
i
c
a
n
t
c
o
n
n
e
c
t
i
o
n
b
e
t
w
e
e
n
h
e
a
l
t
h
l
i
t
e
r
a
c
y
,
b
l
o
o
d
p
r
e
s
s
u
r
e
l
e
v
e
l
s
,
a
n
d
v
a
r
i
o
u
s
p
o
t
e
n
t
i
a
l
r
i
s
k
f
a
c
t
o
r
s
.
T
h
e
s
e
r
e
s
u
l
t
s
p
r
o
v
i
d
e
a
v
a
l
u
a
b
l
e
r
e
f
e
r
e
n
c
e
f
o
r
p
o
l
i
c
y
m
a
k
e
r
s
a
n
d
r
e
s
e
a
r
c
h
e
r
s
i
n
d
e
v
e
l
o
p
i
n
g
e
f
f
e
c
t
i
v
e
p
u
b
l
i
c
h
e
a
l
t
h
s
t
r
a
t
e
g
i
e
s
a
n
d
a
d
v
a
n
c
i
n
g
f
u
t
u
r
e
r
e
s
e
a
r
c
h
t
o
e
n
h
a
n
c
e
w
e
l
l
-
b
e
i
n
g
.
H
o
w
e
v
e
r
,
t
h
e
s
t
u
d
y
h
a
s
c
e
r
t
a
i
n
l
i
m
i
t
a
t
i
o
n
s
,
p
a
r
t
i
c
u
l
a
r
l
y
i
t
s
c
r
o
s
s
-
s
e
c
t
i
o
n
a
l
d
e
s
i
g
n
,
w
h
i
c
h
l
i
m
i
t
s
t
h
e
a
b
i
l
i
t
y
t
o
d
e
t
e
r
m
i
n
e
c
a
u
s
a
l
r
e
l
a
t
i
o
n
s
h
i
p
s
b
e
t
w
e
e
n
r
i
s
k
f
a
c
t
o
r
s
a
n
d
H
B
P
.
5.
CO
NCLU
SI
O
N
I
n
c
o
n
c
lu
s
io
n
,
th
e
s
tu
d
y
r
ev
e
als
a
co
n
ce
r
n
i
n
g
p
r
ev
al
en
ce
o
f
HB
P
a
m
o
n
g
la
te
a
d
u
lts
i
n
N
o
r
th
ea
s
t
T
h
ail
an
d
,
s
u
r
p
ass
i
n
g
r
a
tes
r
ep
o
r
te
d
in
n
ei
g
h
b
o
r
i
n
g
So
u
t
h
As
ian
c
o
u
n
t
r
ies
.
T
h
is
u
n
d
e
r
s
c
o
r
e
s
t
h
e
u
r
g
e
n
t
n
ee
d
f
o
r
tar
g
ete
d
in
te
r
v
e
n
ti
o
n
s
t
o
a
d
d
r
ess
t
h
e
m
u
lt
if
ac
e
te
d
d
ete
r
m
i
n
a
n
ts
o
f
HB
P
i
n
t
h
e
r
eg
io
n
.
E
n
h
a
n
ci
n
g
h
e
alt
h
lite
r
a
cy
,
p
a
r
t
ic
u
la
r
l
y
in
ac
ce
s
s
i
n
g
a
n
d
i
n
t
er
p
r
et
in
g
h
e
alt
h
in
f
o
r
m
ati
o
n
,
is
p
a
r
a
m
o
u
n
t
t
o
e
m
p
o
wer
in
g
in
d
i
v
i
d
u
a
ls
in
m
an
a
g
i
n
g
t
h
e
ir
h
ea
lt
h
ef
f
ec
tiv
el
y
.
E
f
f
o
r
ts
t
o
r
ed
u
ce
s
m
o
k
in
g
r
a
tes
a
n
d
p
r
o
m
o
te
h
e
alt
h
i
er
li
f
es
ty
le
c
h
o
ic
es,
s
u
c
h
as
r
e
g
u
la
r
p
h
y
s
ic
al
ac
ti
v
it
y
a
n
d
we
ig
h
t
m
a
n
a
g
e
m
e
n
t
,
a
r
e
c
r
u
c
ial
t
o
m
iti
g
ati
n
g
H
B
P
r
is
k
.
M
o
r
e
o
v
e
r
,
in
t
er
v
en
ti
o
n
s
ta
r
g
eti
n
g
c
o
m
o
r
b
id
i
ties
an
d
p
r
o
v
i
d
i
n
g
s
u
p
p
o
r
t
f
o
r
i
n
d
iv
id
u
a
ls
wi
th
e
x
is
ti
n
g
h
e
alt
h
c
o
n
d
iti
o
n
s
a
r
e
ess
e
n
ti
al
f
o
r
HB
P
p
r
e
v
e
n
ti
o
n
a
n
d
m
a
n
a
g
em
en
t.
B
y
ad
o
p
ti
n
g
a
c
o
m
p
r
e
h
e
n
s
i
v
e
a
p
p
r
o
a
ch
t
h
at
i
n
te
g
r
at
es
ed
u
c
ati
o
n
,
l
if
est
y
le
m
o
d
i
f
i
ca
t
i
o
n
,
a
n
d
h
e
alt
h
ca
r
e
s
u
p
p
o
r
t,
s
t
ak
eh
o
l
d
er
s
c
an
w
o
r
k
t
o
w
ar
d
s
r
e
d
u
ci
n
g
th
e
b
u
r
d
e
n
o
f
HB
P
a
n
d
i
m
p
r
o
v
i
n
g
ca
r
d
i
o
v
asc
u
la
r
h
ea
l
th
o
u
tc
o
m
es
a
m
o
n
g
lat
e
ad
u
l
ts
in
N
o
r
t
h
ea
s
t
T
h
ail
an
d
.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
s
in
ce
r
ely
ap
p
r
ec
iate
all
p
ar
ticip
an
ts
f
o
r
d
ed
icatin
g
th
eir
tim
e
an
d
c
o
n
tr
ib
u
tin
g
in
v
alu
ab
le
in
s
ig
h
ts
,
with
o
u
t w
h
ich
th
is
s
tu
d
y
wo
u
ld
n
o
t h
av
e
b
ee
n
f
ea
s
ib
le
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
s
tu
d
y
was
f
u
n
d
ed
b
y
t
h
e
2
0
2
3
R
esear
ch
Gr
an
t
f
r
o
m
th
e
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
wh
ich
s
u
p
p
o
r
ts
f
ac
u
lty
r
esear
ch
s
taf
f
.
T
h
e
g
r
an
t
is
p
ar
t
o
f
a
s
tr
ateg
ic
in
itiativ
e
o
f
th
e
Facu
lty
o
f
Pu
b
lic
Hea
lth
at
Kh
o
n
Kae
n
Un
i
v
er
s
ity
.
T
h
e
f
u
n
d
in
g
b
o
d
y
h
ad
n
o
i
n
v
o
lv
e
m
e
n
t in
an
y
asp
ec
t o
f
th
is
r
esear
c
h
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
t
h
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
K.
S
.
wa
s
r
esp
o
n
s
ib
le
f
o
r
co
n
ce
p
tu
aliza
tio
n
,
w
h
ile
K.
S.
an
d
A.
G.
jo
in
tly
co
n
d
u
cted
t
h
e
in
v
esti
g
atio
n
,
d
ata
cu
r
atio
n
,
an
d
th
e
wr
itin
g
an
d
ed
itin
g
p
r
o
ce
s
s
es.
K.
S.
s
ec
u
r
ed
th
e
f
u
n
d
in
g
,
v
er
if
ie
d
th
e
a
cc
u
r
ac
y
o
f
th
e
s
tu
d
y
,
an
d
p
r
o
v
id
e
d
g
u
id
an
ce
to
en
s
u
r
e
th
e
r
esu
lts
alig
n
ed
with
th
e
r
esear
ch
o
b
jectiv
es.
All
au
th
o
r
s
d
is
cu
s
s
ed
th
e
f
in
d
in
g
s
an
d
co
n
tr
i
b
u
ted
to
th
e
f
in
al
m
an
u
s
cr
ip
t
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Kittip
o
n
g
So
r
n
lo
r
m
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Ar
u
n
r
at
Pu
n
c
h
a
Glin
g
aso
r
n
✓
✓
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
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
P
r
ev
a
len
ce
a
n
d
h
ea
lth
liter
a
c
y
o
n
h
i
g
h
b
l
o
o
d
p
r
ess
u
r
e
a
mo
n
g
la
te
a
d
u
lth
o
o
d
…
(
K
itti
p
o
n
g
S
o
r
n
lo
r
m
)
1583
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
T
h
e
au
th
o
r
s
h
av
e
d
ec
lar
ed
th
at
n
o
co
m
p
etin
g
i
n
ter
ests
ex
is
t
.
I
NF
O
RM
E
D
CO
NS
E
N
T
W
e
h
av
e
o
b
tain
ed
in
f
o
r
m
ed
c
o
n
s
en
t f
r
o
m
all
in
d
iv
id
u
als in
c
lu
d
ed
in
t
h
is
s
tu
d
y
.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
e
r
esear
ch
r
elate
d
to
h
u
m
a
n
u
s
e
h
as
b
ee
n
co
m
p
lied
with
all
th
e
r
elev
an
t
n
atio
n
al
r
eg
u
l
atio
n
s
an
d
in
s
titu
tio
n
al
p
o
licies
in
ac
co
r
d
an
ce
with
th
e
te
n
ets
o
f
t
h
e
He
ls
in
k
i
Dec
lar
atio
n
an
d
h
as
b
ee
n
ap
p
r
o
v
e
d
b
y
th
e
au
th
o
r
s
'
in
s
titu
tio
n
al
r
ev
iew
b
o
ar
d
o
r
eq
u
iv
ale
n
t
co
m
m
i
ttee.
T
h
e
r
esear
ch
r
ec
eiv
ed
ap
p
r
o
v
al
f
r
o
m
th
e
I
n
s
titu
tio
n
al
R
ev
iew
B
o
ar
d
o
f
Kh
o
n
Kae
n
Un
iv
e
r
s
ity
(
HE
6
5
2
2
3
3
)
.
Par
ticip
an
ts
'
au
to
n
o
m
y
was
r
esp
ec
ted
,
with
ea
ch
in
d
iv
id
u
al
p
r
o
v
i
d
in
g
wr
itten
in
f
o
r
m
ed
co
n
s
en
t
.
T
o
p
r
o
tect
th
eir
p
r
iv
ac
y
,
p
s
eu
d
o
n
y
m
s
wer
e
ass
ig
n
ed
,
an
d
m
ea
s
u
r
es we
r
e
tak
en
to
e
n
s
u
r
e
th
e
c
o
n
f
id
e
n
tiality
o
f
th
e
c
o
llected
d
ata.
DATA AV
AI
L
AB
I
L
I
T
Y
All r
elev
an
t d
ata
ar
e
with
in
t
h
e
p
ap
er
a
n
d
its
s
u
p
p
o
r
tin
g
in
f
o
r
m
atio
n
f
iles
.
RE
F
E
R
E
NC
E
S
[
1
]
M
.
D
.
S
a
j
u
,
K
.
P
.
A
l
l
a
g
h
,
L.
S
c
a
r
i
a
,
S
.
J
o
se
p
h
,
a
n
d
J.
A
.
T
h
i
y
a
g
a
r
a
j
a
n
,
“
P
r
e
v
a
l
e
n
c
e
,
a
w
a
r
e
n
e
ss
,
t
r
e
a
t
m
e
n
t
,
a
n
d
c
o
n
t
r
o
l
o
f
h
y
p
e
r
t
e
n
si
o
n
a
n
d
i
t
s
a
ss
o
c
i
a
t
e
d
r
i
s
k
f
a
c
t
o
r
s
:
R
e
su
l
t
s
f
r
o
m
b
a
s
e
l
i
n
e
su
r
v
e
y
o
f
S
W
A
D
ES
f
a
m
i
l
y
c
o
h
o
r
t
s
t
u
d
y
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
H
y
p
e
rt
e
n
s
i
o
n
,
v
o
l
.
2
0
2
0
,
p
p
.
1
–
7
,
A
p
r
.
2
0
2
0
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
2
0
/
4
9
6
4
8
3
5
.
[
2
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
G
l
o
b
a
l
H
e
a
l
t
h
O
b
s
e
r
v
a
t
o
r
y
d
a
t
a
r
e
p
o
si
t
o
r
y
:
P
r
e
v
a
l
e
n
c
e
r
a
t
e
o
f
h
y
p
e
r
t
e
n
s
i
o
n
i
n
a
d
u
l
t
s
a
g
e
d
3
0
-
79
y
e
a
r
s
,
”
2
0
2
4
.
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
d
a
t
a
/
g
h
o
(
a
c
c
e
sse
d
J
a
n
.
0
3
,
2
0
2
5
)
.
[
3
]
K
.
T
.
M
i
l
l
s
e
t
a
l
.
,
“
G
l
o
b
a
l
d
i
s
p
a
r
i
t
i
e
s
o
f
h
y
p
e
r
t
e
n
si
o
n
p
r
e
v
a
l
e
n
c
e
a
n
d
c
o
n
t
r
o
l
,
”
C
i
r
c
u
l
a
t
i
o
n
,
v
o
l
.
1
3
4
,
n
o
.
6
,
p
p
.
4
4
1
–
4
5
0
,
A
u
g
.
2
0
1
6
,
d
o
i
:
1
0
.
1
1
6
1
/
C
I
R
C
U
LA
TI
O
N
A
H
A
.
1
1
5
.
0
1
8
9
1
2
.
[
4
]
B
.
Z
h
o
u
e
t
a
l
.
,
“
W
o
r
l
d
w
i
d
e
t
r
e
n
d
s
i
n
h
y
p
e
r
t
e
n
si
o
n
p
r
e
v
a
l
e
n
c
e
a
n
d
p
r
o
g
r
e
ss
i
n
t
r
e
a
t
me
n
t
a
n
d
c
o
n
t
r
o
l
f
r
o
m
1
9
9
0
t
o
2
0
1
9
:
a
p
o
o
l
e
d
a
n
a
l
y
si
s
o
f
1
2
0
1
p
o
p
u
l
a
t
i
o
n
-
r
e
p
r
e
s
e
n
t
a
t
i
v
e
st
u
d
i
e
s
w
i
t
h
1
0
4
mi
l
l
i
o
n
p
a
r
t
i
c
i
p
a
n
t
s
,
”
T
h
e
L
a
n
c
e
t
,
v
o
l
.
3
9
8
,
n
o
.
1
0
3
0
4
,
p
p
.
9
5
7
–
9
8
0
,
S
e
p
.
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
2
1
)
0
1
3
3
0
-
1.
[
5
]
P
.
M
.
K
e
a
r
n
e
y
,
M
.
W
h
e
l
t
o
n
,
K
.
R
e
y
n
o
l
d
s,
P
.
M
u
n
t
n
e
r
,
P
.
K
.
W
h
e
l
t
o
n
,
a
n
d
J.
H
e
,
“
G
l
o
b
a
l
b
u
r
d
e
n
o
f
h
y
p
e
r
t
e
n
si
o
n
:
a
n
a
l
y
si
s
o
f
w
o
r
l
d
w
i
d
e
d
a
t
a
,
”
T
h
e
L
a
n
c
e
t
,
v
o
l
.
3
6
5
,
n
o
.
9
4
5
5
,
p
p
.
2
1
7
–
2
2
3
,
Ja
n
.
2
0
0
5
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
0
5
)
1
7
7
4
1
-
1.
[
6
]
B
.
Z
h
o
u
e
t
a
l
.
,
“
W
o
r
l
d
w
i
d
e
t
r
e
n
d
s
i
n
h
y
p
e
r
t
e
n
si
o
n
p
r
e
v
a
l
e
n
c
e
a
n
d
p
r
o
g
r
e
ss
i
n
t
r
e
a
t
me
n
t
a
n
d
c
o
n
t
r
o
l
f
r
o
m
1
9
9
0
t
o
2
0
1
9
:
a
p
o
o
l
e
d
a
n
a
l
y
si
s
o
f
1
2
0
1
p
o
p
u
l
a
t
i
o
n
-
r
e
p
r
e
s
e
n
t
a
t
i
v
e
st
u
d
i
e
s
w
i
t
h
1
0
4
mi
l
l
i
o
n
p
a
r
t
i
c
i
p
a
n
t
s
,
”
T
h
e
L
a
n
c
e
t
,
v
o
l
.
3
9
8
,
n
o
.
1
0
3
0
4
,
p
p
.
9
5
7
–
9
8
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
2
1
)
0
1
3
3
0
-
1.
“
H
e
a
l
t
h
D
a
t
a
C
e
n
t
e
r
.
”
h
t
t
p
s:
/
/
h
d
c
ser
v
i
c
e
.
m
o
p
h
.
g
o
.
t
h
(
a
c
c
e
ss
e
d
Ja
n
.
1
0
,
1
B
C
)
.
[
7
]
D
e
p
a
r
t
me
n
t
o
f
D
i
se
a
se
C
o
n
t
r
o
l
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
a
t
:
h
t
t
p
s
:
/
/
d
d
c
.
mo
p
h
.
g
o
.
t
h
/
d
i
se
a
se
_
d
e
t
a
i
l
.
p
h
p
.
A
c
c
e
sse
d
J
a
n
u
a
r
y
1
st
,
2
0
2
3
.
[
8
]
W
.
A
e
k
p
l
a
k
o
r
n
,
“
Th
a
i
n
a
t
i
o
n
a
l
h
e
a
l
t
h
e
x
a
mi
n
a
t
i
o
n
su
r
v
e
y
5
t
h
(
N
H
ES)
i
n
2
0
1
4
h
e
a
l
t
h
s
y
st
e
ms
r
e
s
e
a
r
c
h
i
n
st
i
t
u
t
e
(
H
S
R
I
)
,
”
N
o
n
t
a
b
u
r
i
P
u
b
l
i
sh
e
rs
,
p
.
1
6
6
,
2
0
1
4
.
[
9
]
S
.
Ju
l
i
u
s
e
t
a
l
.
,
“
F
e
a
s
i
b
i
l
i
t
y
o
f
t
r
e
a
t
i
n
g
p
r
e
h
y
p
e
r
t
e
n
si
o
n
w
i
t
h
a
n
a
n
g
i
o
t
e
n
si
n
-
r
e
c
e
p
t
o
r
b
l
o
c
k
e
r
,
”
N
e
w
En
g
l
a
n
d
J
o
u
rn
a
l
o
f
Me
d
i
c
i
n
e
,
v
o
l
.
3
5
4
,
n
o
.
1
6
,
p
p
.
1
6
8
5
–
1
6
9
7
,
A
p
r
.
2
0
0
6
,
d
o
i
:
1
0
.
1
0
5
6
/
N
EJ
M
o
a
0
6
0
8
3
8
.
[
1
0
]
E.
G
r
o
ssm
a
n
,
“
A
m
b
u
l
a
t
o
r
y
b
l
o
o
d
p
r
e
ssu
r
e
mo
n
i
t
o
r
i
n
g
i
n
t
h
e
d
i
a
g
n
o
si
s
a
n
d
man
a
g
e
me
n
t
o
f
h
y
p
e
r
t
e
n
si
o
n
,
”
D
i
a
b
e
t
e
s C
a
r
e
,
v
o
l
.
3
6
,
n
o
.
S
u
p
p
l
e
me
n
t
_
2
,
p
p
.
S
3
0
7
–
S
3
1
1
,
A
u
g
.
2
0
1
3
,
d
o
i
:
1
0
.
2
3
3
7
/
d
c
S
1
3
-
2
0
3
9
.
[
1
1
]
R
.
M
.
C
a
r
e
y
,
P
.
M
u
n
t
n
e
r
,
H
.
B
.
B
o
sw
o
r
t
h
,
a
n
d
P
.
K
.
W
h
e
l
t
o
n
,
“
P
r
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
o
f
h
y
p
e
r
t
e
n
s
i
o
n
,
”
J
o
u
rn
a
l
o
f
t
h
e
Am
e
r
i
c
a
n
C
o
l
l
e
g
e
o
f
C
a
rd
i
o
l
o
g
y
,
v
o
l
.
7
2
,
n
o
.
1
1
,
p
p
.
1
2
7
8
–
1
2
9
3
,
S
e
p
.
2
0
1
8
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
a
c
c
.
2
0
1
8
.
0
7
.
0
0
8
.
[
1
2
]
K
.
S
ø
r
e
n
se
n
e
t
a
l
.
,
“
H
e
a
l
t
h
l
i
t
e
r
a
c
y
i
n
Eu
r
o
p
e
:
c
o
mp
a
r
a
t
i
v
e
r
e
s
u
l
t
s
o
f
t
h
e
E
u
r
o
p
e
a
n
h
e
a
l
t
h
l
i
t
e
r
a
c
y
s
u
r
v
e
y
(
H
LS
-
EU
)
,
”
T
h
e
Eu
r
o
p
e
a
n
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
5
,
n
o
.
6
,
p
p
.
1
0
5
3
–
1
0
5
8
,
D
e
c
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
9
3
/
e
u
r
p
u
b
/
c
k
v
0
4
3
.
[
1
3
]
F
.
Y
.
H
s
i
e
h
,
D
.
A
.
B
l
o
c
h
,
a
n
d
M
.
D
.
L
a
r
sen
,
“
A
s
i
mp
l
e
me
t
h
o
d
o
f
s
a
mp
l
e
s
i
z
e
c
a
l
c
u
l
a
t
i
o
n
f
o
r
l
i
n
e
a
r
a
n
d
l
o
g
i
st
i
c
r
e
g
r
e
ss
i
o
n
,
”
S
t
a
t
i
st
i
c
s
i
n
M
e
d
i
c
i
n
e
,
v
o
l
.
1
7
,
n
o
.
1
4
,
p
p
.
1
6
2
3
–
1
6
3
4
,
Ju
l
.
1
9
9
8
,
d
o
i
:
1
0
.
1
0
0
2
/
(
S
I
C
I
)
1
0
9
7
-
0
2
5
8
(
1
9
9
8
0
7
3
0
)
1
7
:
1
4
<
1
6
2
3
:
:
A
I
D
-
S
I
M
8
7
1
>
3
.
0
.
C
O
;
2
-
S.
[
1
4
]
K
.
T.
S
e
l
c
u
k
,
Y
.
M
e
r
c
a
n
,
a
n
d
T
.
A
y
d
i
n
,
“
U
n
c
o
n
t
r
o
l
l
e
d
b
l
o
o
d
p
r
e
ssu
r
e
i
n
p
a
t
i
e
n
t
s
w
i
t
h
h
y
p
e
r
t
e
n
s
i
o
n
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
:
T
h
e
r
o
l
e
o
f
l
o
w
h
e
a
l
t
h
l
i
t
e
r
a
c
y
,
”
Er
c
i
y
e
s
T
ı
p
D
e
rg
i
si
/
Er
c
i
y
e
s
Me
d
i
c
a
l
J
o
u
r
n
a
l
,
v
o
l
.
4
0
,
n
o
.
4
,
p
p
.
2
2
2
–
2
2
7
,
D
e
c
.
2
0
1
8
,
d
o
i
:
1
0
.
5
1
5
2
/
e
t
d
.
2
0
1
8
.
1
8
1
0
2
.
[
1
5
]
K
.
S
ø
r
e
n
se
n
e
t
a
l
.
,
“
H
e
a
l
t
h
l
i
t
e
r
a
c
y
i
n
Eu
r
o
p
e
:
c
o
mp
a
r
a
t
i
v
e
r
e
s
u
l
t
s
o
f
t
h
e
E
u
r
o
p
e
a
n
h
e
a
l
t
h
l
i
t
e
r
a
c
y
s
u
r
v
e
y
(
H
LS
-
EU
)
,
”
T
h
e
Eu
r
o
p
e
a
n
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
5
,
n
o
.
6
,
p
p
.
1
0
5
3
–
1
0
5
8
,
D
e
c
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
9
3
/
e
u
r
p
u
b
/
c
k
v
0
4
3
.
[
1
6
]
M
.
L
o
t
r
a
k
u
l
,
S
.
S
u
mr
i
t
h
e
,
a
n
d
R
.
S
a
i
p
a
n
i
s
h
,
“
R
e
l
i
a
b
i
l
i
t
y
a
n
d
v
a
l
i
d
i
t
y
o
f
t
h
e
Th
a
i
v
e
r
s
i
o
n
o
f
t
h
e
P
H
Q
-
9
,
”
BM
C
Psy
c
h
i
a
t
r
y
,
v
o
l
.
8
,
n
o
.
1
,
p
.
4
6
,
D
e
c
.
2
0
0
8
,
d
o
i
:
1
0
.
1
1
8
6
/
1
4
7
1
-
2
4
4
X
-
8
-
4
6
.
[
1
7
]
A
.
V
.
C
h
o
b
a
n
i
a
n
e
t
a
l
.
,
“
S
e
v
e
n
t
h
r
e
p
o
r
t
o
f
t
h
e
j
o
i
n
t
n
a
t
i
o
n
a
l
c
o
mm
i
t
t
e
e
o
n
p
r
e
v
e
n
t
i
o
n
,
d
e
t
e
c
t
i
o
n
,
e
v
a
l
u
a
t
i
o
n
,
a
n
d
t
r
e
a
t
m
e
n
t
o
f
h
i
g
h
b
l
o
o
d
p
r
e
ss
u
r
e
,”
H
y
p
e
rt
e
n
s
i
o
n
,
v
o
l
.
4
2
,
n
o
.
6
,
p
p
.
1
2
0
6
–
1
2
5
2
,
D
e
c
.
2
0
0
3
,
d
o
i
:
1
0
.
1
1
6
1
/
0
1
.
H
Y
P
.
0
0
0
0
1
0
7
2
5
1
.
4
9
5
1
5
.
c
2
.
[
1
8
]
C
.
E
.
M
c
C
u
l
l
o
c
h
a
n
d
S
.
R
.
S
e
a
r
l
e
,
G
e
n
e
r
a
l
i
ze
d
,
L
i
n
e
a
r,
a
n
d
M
i
x
e
d
M
o
d
e
l
s
.
W
i
l
e
y
,
2
0
0
0
.
d
o
i
:
1
0
.
1
0
0
2
/
0
4
7
1
7
2
2
0
7
3
.
[
1
9
]
P
.
Jee
m
o
n
e
t
a
l
.
,
“
W
o
r
l
d
h
e
a
r
t
f
e
d
e
r
a
t
i
o
n
r
o
a
d
ma
p
f
o
r
h
y
p
e
r
t
e
n
s
i
o
n
–
A
2
0
2
1
U
p
d
a
t
e
,
”
G
l
o
b
a
l
H
e
a
r
t
,
v
o
l
.
1
6
,
n
o
.
1
,
S
e
p
.
2
0
2
1
,
d
o
i
:
1
0
.
5
3
3
4
/
g
h
.
1
0
6
6
.
[
2
0
]
E.
S
u
n
d
e
l
l
,
J.
W
å
n
g
d
a
h
l
,
a
n
d
Å
.
G
r
a
u
ma
n
,
“
H
e
a
l
t
h
l
i
t
e
r
a
c
y
a
n
d
d
i
g
i
t
a
l
h
e
a
l
t
h
i
n
f
o
r
ma
t
i
o
n
-
see
k
i
n
g
b
e
h
a
v
i
o
r
–
a
c
r
o
ss
-
sec
t
i
o
n
a
l
st
u
d
y
a
m
o
n
g
h
i
g
h
l
y
e
d
u
c
a
t
e
d
S
w
e
d
e
s
,
”
BM
C
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
2
,
n
o
.
1
,
p
.
2
2
7
8
,
D
e
c
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
8
9
-
0
2
2
-
1
4
7
5
1
-
z.
[
2
1
]
H
.
J.
A
b
o
u
ma
t
a
r
,
K
.
A
.
C
a
r
s
o
n
,
M
.
C
.
B
e
a
c
h
,
D
.
L.
R
o
t
e
r
,
a
n
d
L.
A
.
C
o
o
p
e
r
,
“
T
h
e
i
m
p
a
c
t
o
f
h
e
a
l
t
h
l
i
t
e
r
a
c
y
o
n
d
e
s
i
r
e
f
o
r
p
a
r
t
i
c
i
p
a
t
i
o
n
i
n
h
e
a
l
t
h
c
a
r
e
,
me
d
i
c
a
l
v
i
s
i
t
c
o
mm
u
n
i
c
a
t
i
o
n
,
a
n
d
p
a
t
i
e
n
t
r
e
p
o
r
t
e
d
o
u
t
c
o
m
e
s
a
m
o
n
g
p
a
t
i
e
n
t
s
w
i
t
h
h
y
p
e
r
t
e
n
s
i
o
n
,”
J
o
u
rn
a
l
o
f
G
e
n
e
ra
l
I
n
t
e
rn
a
l
M
e
d
i
c
i
n
e
,
v
o
l
.
2
8
,
n
o
.
1
1
,
p
p
.
1
4
6
9
–
1
4
7
6
,
N
o
v
.
2
0
1
3
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
1
6
0
6
-
0
1
3
-
2
4
6
6
-
5.
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
57
6
-
1
58
4
1584
[
2
2
]
V
.
T.
Est
e
c
h
e
,
P
.
S
p
o
s
i
t
o
,
C
.
A
c
o
st
a
,
M
.
P
e
r
e
d
a
,
a
n
d
E.
S
o
t
o
,
“
A
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
sm
o
k
i
n
g
a
n
d
h
y
p
e
r
t
e
n
si
o
n
c
o
n
t
r
o
l
:
d
e
scr
i
p
t
i
v
e
a
n
d
a
n
a
l
y
t
i
c
a
l
s
t
u
d
y
,
”
i
n
T
o
b
a
c
c
o
,
sm
o
k
i
n
g
c
o
n
t
r
o
l
a
n
d
h
e
a
l
t
h
e
d
u
c
a
t
i
o
n
,
S
e
p
.
2
0
2
1
,
p
.
P
A
2
4
4
3
.
d
o
i
:
1
0
.
1
1
8
3
/
1
3
9
9
3
0
0
3
.
c
o
n
g
r
e
ss
-
2
0
2
1
.
P
A
2
4
4
3
.
[
2
3
]
D
.
B
.
R
a
h
u
t
,
R
.
M
i
s
h
r
a
,
T.
S
o
n
o
b
e
,
a
n
d
R
.
R
.
Ti
mi
l
si
n
a
,
“
P
r
e
v
a
l
e
n
c
e
o
f
p
r
e
h
y
p
e
r
t
e
n
si
o
n
a
n
d
h
y
p
e
r
t
e
n
si
o
n
a
m
o
n
g
t
h
e
a
d
u
l
t
s
i
n
S
o
u
t
h
A
si
a
:
A
mu
l
t
i
n
o
m
i
a
l
l
o
g
i
t
m
o
d
e
l
,
”
Fr
o
n
t
i
e
rs
i
n
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
0
,
J
a
n
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
8
9
/
f
p
u
b
h
.
2
0
2
2
.
1
0
0
6
4
5
7
.
[
2
4
]
N
.
G
a
o
e
t
a
l
.
,
“
A
ssess
i
n
g
t
h
e
a
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
s
mo
k
i
n
g
a
n
d
h
y
p
e
r
t
e
n
si
o
n
:
S
m
o
k
i
n
g
s
t
a
t
u
s
,
t
y
p
e
o
f
t
o
b
a
c
c
o
p
r
o
d
u
c
t
s,
a
n
d
i
n
t
e
r
a
c
t
i
o
n
w
i
t
h
a
l
c
o
h
o
l
c
o
n
s
u
mp
t
i
o
n
,
”
Fr
o
n
t
i
e
rs
i
n
C
a
rd
i
o
v
a
sc
u
l
a
r
M
e
d
i
c
i
n
e
,
v
o
l
.
1
0
,
F
e
b
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
8
9
/
f
c
v
m.
2
0
2
3
.
1
0
2
7
9
8
8
.
[
2
5
]
S
.
D
a
s,
M
.
D
e
b
n
a
t
h
,
S
.
D
a
s,
S
.
S
a
r
k
a
r
,
a
n
d
A
.
S
.
R
u
ma
n
a
,
“
A
ss
o
c
i
a
t
i
o
n
o
f
o
v
e
r
w
e
i
g
h
t
a
n
d
o
b
e
s
i
t
y
w
i
t
h
h
y
p
e
r
t
e
n
s
i
o
n
,
d
i
a
b
e
t
e
s
a
n
d
c
o
m
o
r
b
i
d
i
t
y
a
mo
n
g
a
d
u
l
t
s
i
n
B
a
n
g
l
a
d
e
s
h
:
e
v
i
d
e
n
c
e
f
r
o
m
n
a
t
i
o
n
w
i
d
e
d
e
mo
g
r
a
p
h
i
c
a
n
d
h
e
a
l
t
h
s
u
r
v
e
y
2
0
1
7
–
2
0
1
8
d
a
t
a
,
”
BM
J
O
p
e
n
,
v
o
l
.
1
2
,
n
o
.
7
,
p
.
e
0
5
2
8
2
2
,
J
u
l
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
3
6
/
b
mj
o
p
e
n
-
2
0
2
1
-
0
5
2
8
2
2
.
[
2
6
]
P
.
M
.
W
a
n
d
i
l
e
,
“
H
y
p
e
r
t
e
n
si
o
n
a
n
d
c
o
mo
r
b
i
d
i
t
i
e
s
:
A
s
i
l
e
n
t
t
h
r
e
a
t
t
o
g
l
o
b
a
l
h
e
a
l
t
h
,
”
H
y
p
e
r
t
e
n
si
o
n
a
n
d
C
o
m
o
rb
i
d
i
t
i
e
s
,
v
o
l
.
1
,
n
o
.
1
,
p
p
.
1
–
7
,
2
0
2
4
,
d
o
i
:
1
0
.
4
6
4
3
9
/
h
y
p
e
r
t
e
n
si
o
n
.
1
.
0
0
1
.
[
2
7
]
K
.
R
.
S
y
a
u
q
i
,
“
P
h
y
si
c
a
l
a
c
t
i
v
i
t
y
e
f
f
e
c
t
o
n
b
l
o
o
d
p
r
e
ss
u
r
e
o
f
h
y
p
e
r
t
e
n
si
v
e
p
a
t
i
e
n
t
s
i
n
K
a
l
i
d
e
r
e
s,
J
a
k
a
r
t
a
,
”
J
o
u
rn
a
l
o
f
H
y
p
e
rt
e
n
si
o
n
,
v
o
l
.
3
9
,
n
o
.
S
u
p
p
l
e
m
e
n
t
2
,
p
p
.
e
4
–
e
5
,
M
a
y
2
0
2
1
,
d
o
i
:
1
0
.
1
0
9
7
/
0
1
.
h
j
h
.
0
0
0
0
7
5
2
4
1
2
.
7
2
1
5
2
.
d
5
.
[
2
8
]
A
.
U
.
G
a
m
a
g
e
a
n
d
R
.
d
e
A
.
S
e
n
e
v
i
r
a
t
n
e
,
“
P
h
y
s
i
c
a
l
i
n
a
c
t
i
v
i
t
y
,
a
n
d
i
t
s
a
s
so
c
i
a
t
i
o
n
w
i
t
h
h
y
p
e
r
t
e
n
si
o
n
a
m
o
n
g
e
mp
l
o
y
e
e
s
i
n
t
h
e
d
i
s
t
r
i
c
t
o
f
C
o
l
o
m
b
o
,
”
B
MC
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
1
,
n
o
.
1
,
p
.
2
1
8
6
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
8
9
-
0
2
1
-
1
2
0
1
3
-
y.
[
2
9
]
J.
Y
a
n
g
e
t
a
l
.
,
“
A
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
p
u
s
h
-
u
p
e
x
e
r
c
i
s
e
c
a
p
a
c
i
t
y
a
n
d
f
u
t
u
r
e
c
a
r
d
i
o
v
a
sc
u
l
a
r
e
v
e
n
t
s
a
m
o
n
g
a
c
t
i
v
e
a
d
u
l
t
m
e
n
,
”
J
AM
A
N
e
t
w
o
rk
O
p
e
n
,
v
o
l
.
2
,
n
o
.
2
,
p
.
e
1
8
8
3
4
1
,
F
e
b
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
0
1
/
j
a
m
a
n
e
t
w
o
r
k
o
p
e
n
.
2
0
1
8
.
8
3
4
1
.
[
3
0
]
H
.
M
a
m
d
o
u
h
e
t
a
l
.
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
a
ss
o
c
i
a
t
e
d
r
i
sk
f
a
c
t
o
r
s
o
f
h
y
p
e
r
t
e
n
si
o
n
a
n
d
p
r
e
-
h
y
p
e
r
t
e
n
si
o
n
a
mo
n
g
t
h
e
a
d
u
l
t
p
o
p
u
l
a
t
i
o
n
:
f
i
n
d
i
n
g
s
f
r
o
m
t
h
e
d
u
b
a
i
h
o
u
se
h
o
l
d
su
r
v
e
y
,
2
0
1
9
,
”
J
o
u
r
n
a
l
o
f
H
y
p
e
rt
e
n
s
i
o
n
,
v
o
l
.
4
0
,
n
o
.
S
u
p
p
l
1
,
p
.
e
2
2
9
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
9
7
/
0
1
.
h
j
h
.
0
0
0
0
8
3
7
8
1
6
.
8
0
2
3
6
.
5
3
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
K
itti
p
o
n
g
S
o
r
n
l
o
r
m
is
a
lec
t
u
re
r
o
f
Bi
o
sta
ti
stics
a
n
d
G
e
o
in
fo
rm
a
ti
c
s
in
F
a
c
u
lt
y
o
f
P
u
b
li
c
He
a
lt
h
Kh
o
n
Ka
e
n
Un
iv
e
rsity
.
He
h
a
s
p
u
b
li
s
h
e
d
o
v
e
r
t
e
n
p
e
e
r
-
re
v
iew
e
d
sc
ien
ti
fic
a
rti
c
les
in
m
a
jo
r
j
o
u
r
n
a
ls
o
n
t
h
e
su
b
jec
ts
o
f
p
u
b
li
c
h
e
a
lt
h
a
n
d
s
p
a
ti
a
l
d
istri
b
u
ti
o
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
k
i
tt
so
r
n
@k
k
u
.
a
c
.
th
.
Ar
u
n
r
a
t
Pu
n
c
h
a
G
li
n
g
a
so
r
n
is
a
lec
tu
re
r
o
f
p
u
b
li
c
h
e
a
lt
h
i
n
F
a
c
u
lt
y
o
f
L
ib
e
ra
l
Arts
a
n
d
S
c
ien
c
e
,
Ro
i
Et
Ra
jab
h
a
t
U
n
iv
e
rsit
y
.
He
r
re
c
e
iv
e
d
h
e
r
P
h
.
D
.
fro
m
K
h
o
n
Ka
e
n
Un
iv
e
rsity
.
S
h
e
a
lso
c
o
m
p
lete
d
h
e
r
m
a
ste
r’
s
d
e
g
re
e
in
p
u
b
li
c
h
e
a
lt
h
a
d
m
i
n
istratio
n
p
ro
g
ra
m
a
t
Kh
o
n
Ka
e
n
Un
i
v
e
rsity
.
He
r
re
se
a
rc
h
fo
c
u
se
s
o
n
p
u
b
li
c
h
e
a
lt
h
a
n
d
trad
i
ti
o
n
a
l
m
e
d
icin
e
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
ru
p
u
n
c
h
a
7
@g
m
a
il
.
c
o
m
.
Evaluation Warning : The document was created with Spire.PDF for Python.