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y
n
d
r
o
m
e
,
b
e
c
a
u
s
e
o
f
r
a
m
p
a
n
t
m
i
s
c
o
n
c
e
p
ti
o
n
s
a
b
o
u
t
t
h
e
i
r
ca
p
a
b
i
l
i
ti
e
s
[
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
:
14
89
-
1
49
8
1490
I
n
M
al
ay
s
i
a,
p
eo
p
l
e
wi
th
Do
wn
s
y
n
d
r
o
m
e
f
a
ce
u
n
iq
u
e
ch
al
len
g
es
in
f
in
d
in
g
e
m
p
lo
y
m
en
t.
I
t
h
a
s
b
ee
n
p
o
s
tu
l
at
ed
th
a
t,
d
es
p
i
t
e
th
e
g
r
e
at
p
o
t
en
t
ia
l
o
f
p
e
r
s
o
n
s
wi
th
Do
wn
s
y
n
d
r
o
m
e
to
wo
r
k
,
cu
r
r
en
t
em
p
lo
y
m
en
t
r
a
te
s
f
o
r
th
is
g
r
o
u
p
o
f
p
eo
p
le
r
em
a
in
r
a
th
e
r
lo
w
[
6
]
.
T
h
i
s
d
i
s
p
a
r
i
ty
i
s
o
f
ten
b
lam
ed
o
n
em
p
lo
y
er
s
'
at
ti
tu
d
e,
a
la
ck
o
f
awa
r
en
e
s
s
ab
o
u
t
wh
at
in
d
i
v
id
u
al
s
wi
th
Do
wn
s
y
n
d
r
o
m
e
ca
n
d
o
,
an
d
a
g
en
er
a
l
s
h
o
r
tag
e
o
f
s
u
it
ab
l
e
ed
u
c
at
io
n
al
an
d
t
r
ai
n
in
g
p
r
o
g
r
am
s
[
4
]
,
[
7
]
.
T
h
i
s
f
u
r
t
h
er
ex
p
la
in
s
th
at
th
e
cu
l
tu
r
a
l
an
d
s
o
c
ia
l
asp
ec
t
s
ad
d
to
th
e
d
i
f
f
i
cu
l
ti
es
o
f
g
et
tin
g
th
e
jo
b
[
8
]
,
[
9
]
.
T
h
u
s
,
th
i
s
s
tu
d
y
wo
u
ld
h
el
p
to
u
n
d
er
s
t
an
d
th
e
s
p
e
cif
ic
i
s
s
u
e
s
o
f
e
m
p
lo
y
ab
il
ity
f
o
r
p
er
s
o
n
s
wi
th
d
i
s
ab
il
it
ie
s
in
Ma
lay
s
ia.
T
h
is
i
s
a
h
u
g
e
b
ar
r
ie
r
in
em
p
lo
y
in
g
p
e
o
p
l
e
wi
th
D
o
wn
s
y
n
d
r
o
m
e,
wh
er
e
li
tt
le
e
f
f
e
ct
iv
e
in
te
r
v
en
tio
n
h
a
s
a
s
y
et
ta
k
en
p
la
ce
i
n
ei
th
er
in
c
lu
s
iv
e
p
r
ac
ti
ce
s
o
r
l
eg
i
s
la
ti
o
n
w
ith
in
Ma
lay
s
ian
wo
r
k
p
la
ce
s
[
4
]
,
[
1
0
]
.
Sev
er
al
s
tr
ateg
ies
h
av
e
b
ee
n
s
u
g
g
ested
to
a
d
d
r
ess
th
ese
is
s
u
es,
in
clu
d
in
g
ex
ten
s
iv
e
tr
ain
in
g
p
r
o
g
r
a
m
m
er
s
an
d
awa
r
e
n
ess
in
itiativ
es
tar
g
etin
g
em
p
lo
y
e
r
s
to
cr
ea
te
a
m
o
r
e
welc
o
m
in
g
wo
r
k
en
v
ir
o
n
m
e
n
t
f
o
r
p
eo
p
le
with
Do
wn
s
y
n
d
r
o
m
e.
T
h
ese
ef
f
o
r
ts
s
h
o
u
l
d
em
p
h
asis
e
ed
u
ca
tin
g
em
p
lo
y
e
r
s
ab
o
u
t
th
e
ab
ilit
ies
o
f
p
er
s
o
n
s
with
D
o
wn
s
y
n
d
r
o
m
e
an
d
th
e
ad
v
a
n
tag
es
o
f
in
clu
s
iv
e
r
ec
r
u
itm
en
t
p
r
ac
tices
[
1
1
]
.
M
o
r
e
o
v
er
,
th
e
p
u
b
lic
an
d
p
r
iv
ate
s
ec
to
r
s
m
u
s
t
wo
r
k
to
g
eth
er
to
estab
lis
h
a
s
u
p
p
o
r
tiv
e
f
r
a
m
ewo
r
k
f
o
r
e
m
p
lo
y
in
g
d
is
ab
led
in
d
iv
id
u
als
[
1
2
]
.
T
h
is
r
esear
ch
aim
s
to
in
v
esti
g
ate
th
e
cu
r
r
en
t
s
tatu
s
o
f
s
u
p
p
o
r
tiv
e
wo
r
k
en
v
ir
o
n
m
e
n
ts
f
o
r
p
eo
p
le
with
Do
wn
s
y
n
d
r
o
m
e
in
Ma
lay
s
ia,
ev
alu
atin
g
th
e
ef
f
icac
y
o
f
ex
is
tin
g
p
o
licies
an
d
p
r
ac
tices
wh
ils
t
id
en
tify
in
g
ar
ea
s
th
at
r
eq
u
ir
e
im
p
r
o
v
em
e
n
t.
B
y
ex
p
lo
r
in
g
th
ese
m
atter
s
,
th
e
s
tu
d
y
s
ee
k
s
to
co
n
tr
i
b
u
t
e
to
th
e
wid
er
d
is
cu
s
s
io
n
o
n
d
is
ab
ilit
y
in
clu
s
io
n
an
d
en
co
u
r
ag
e
s
u
s
tain
ab
le
jo
b
o
p
p
o
r
t
u
n
ities
f
o
r
in
d
iv
i
d
u
als
with
Do
wn
s
y
n
d
r
o
m
e
in
Ma
lay
s
ia.
2.
M
E
T
H
O
D
2
.
1
.
P
o
pu
la
t
io
n a
nd
s
et
t
ing
A
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
was
c
o
n
d
u
cte
d
am
o
n
g
wo
r
k
in
g
a
d
u
lts
ag
ed
1
8
y
ea
r
s
an
d
o
v
er
in
Ma
lay
s
ia
b
etwe
en
Ma
r
ch
2
0
2
2
an
d
Ap
r
il
2
0
2
3
.
Ma
lay
s
ia
is
a
d
ev
elo
p
in
g
co
u
n
t
r
y
in
So
u
th
ea
s
t
Asi
a,
with
an
esti
m
ated
p
o
p
u
latio
n
o
f
3
3
.
4
m
illi
o
n
in
2
0
2
3
[
1
3
]
.
I
n
Feb
r
u
ar
y
2
0
2
3
,
th
e
n
u
m
b
er
o
f
em
p
lo
y
ed
p
er
s
o
n
s
was
1
8
.
1
9
m
illi
o
n
(
6
7
.
4
%
o
f
th
e
to
tal
p
o
p
u
latio
n
)
.
Am
o
n
g
th
em
,
em
p
l
o
y
ee
s
co
n
s
is
ten
tly
co
m
p
r
is
e
th
e
lar
g
est
g
r
o
u
p
o
f
em
p
lo
y
ed
p
eo
p
le,
7
5
.
7
%
[
1
4
]
.
2
.
2
.
Sa
m
ple size
a
nd
s
a
m
pli
ng
pro
ce
du
re
Du
e
to
th
e
lack
o
f
a
r
ea
d
ily
a
v
ailab
le
s
am
p
lin
g
f
r
am
e,
th
is
s
tu
d
y
em
p
lo
y
ed
a
co
n
v
en
ien
c
e
s
am
p
lin
g
p
r
o
ce
d
u
r
e.
Alth
o
u
g
h
th
is
m
et
h
o
d
i
n
t
r
o
d
u
ce
s
p
o
te
n
tial
b
iases
,
a
d
elib
er
ate
ef
f
o
r
t
was
m
a
d
e
to
e
n
s
u
r
e
g
r
ea
ter
p
r
ec
is
io
n
in
th
e
r
esu
lts
b
y
ai
m
in
g
to
co
llect
a
m
i
n
im
u
m
s
a
m
p
le
s
ize
o
f
2
0
0
in
d
i
v
id
u
als
f
o
r
ea
ch
o
f
th
e
th
r
ee
r
esp
o
n
d
en
t
ca
teg
o
r
ies:
em
p
lo
y
er
s
,
em
p
lo
y
ee
s
(
co
-
wo
r
k
er
s
)
,
an
d
co
m
m
u
n
ity
m
e
m
b
er
s
o
f
PW
D
s
.
Par
ticip
an
ts
wer
e
r
ec
r
u
ited
f
r
o
m
all
Ma
lay
s
ian
s
tates
th
r
o
u
g
h
v
ar
io
u
s
ch
an
n
els,
in
clu
d
in
g
em
ail
an
d
d
ig
ital
m
ed
ia
p
latf
o
r
m
s
s
u
ch
as
Face
b
o
o
k
,
I
n
s
tag
r
am
,
an
d
T
witter
.
T
o
b
e
elig
ib
le
f
o
r
p
ar
ticip
atio
n
,
in
d
i
v
id
u
als
h
ad
t
o
b
e
at
least
1
8
y
ea
r
s
o
ld
,
h
o
ld
Ma
l
ay
s
ian
citizen
s
h
ip
,
an
d
p
o
s
s
ess
b
asic
k
n
o
wled
g
e
ab
o
u
t
d
i
s
ab
ilit
ies,
in
clu
d
in
g
Do
wn
s
y
n
d
r
o
m
e
,
en
s
u
r
in
g
th
e
y
wer
e
leg
ally
ad
u
lts
,
co
n
n
ec
t
ed
to
th
e
Ma
lay
s
ian
co
n
tex
t,
an
d
f
am
iliar
with
th
e
s
tu
d
y
’
s
s
u
b
ject
m
atter
.
E
x
clu
s
io
n
cr
iter
ia
in
clu
d
ed
u
n
wi
ll
in
g
n
ess
to
p
ar
ticip
ate,
in
ab
ilit
y
to
u
n
d
er
s
tan
d
B
ah
asa
Me
lay
u
,
E
n
g
lis
h
,
o
r
M
an
d
ar
in
,
lac
k
o
f
m
en
tal
s
o
u
n
d
n
ess
,
an
d
h
av
in
g
Do
wn
s
y
n
d
r
o
m
e.
2
.
3
.
Da
t
a
c
o
llect
io
n ins
t
rum
ent
a
nd
da
t
a
co
llect
io
n pro
ce
du
re
W
e
u
s
e
d
a
q
u
e
s
t
i
o
n
n
a
i
r
e
t
o
o
b
ta
i
n
d
e
m
o
g
r
a
p
h
i
c
i
n
f
o
r
m
a
ti
on
ab
o
u
t
p
a
r
t
i
c
i
p
a
n
ts
,
i
n
c
l
u
d
i
n
g
r
esp
o
n
d
e
n
t
s
'
g
r
o
u
p
s
,
a
g
e
s
,
g
e
n
d
e
r
s
,
et
h
n
i
c
it
i
e
s
,
e
d
u
c
a
ti
o
n
a
l
le
v
e
ls
,
m
a
r
ita
l
s
t
a
t
u
s
e
s
,
a
n
d
r
e
li
g
i
o
n
s
.
T
h
e
q
u
e
s
ti
o
n
n
a
i
r
e
o
n
o
r
g
a
n
i
z
a
t
i
o
n
a
l
c
u
lt
u
r
e
w
as
a
d
ap
t
e
d
f
r
o
m
a
p
r
e
v
i
o
u
s
s
t
u
d
y
[
1
5
]
.
T
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
o
n
l
e
g
is
la
t
i
v
e
k
n
o
w
l
e
d
g
e
o
f
e
m
p
l
o
y
m
e
n
t
r
i
g
h
ts
a
n
d
at
t
it
u
d
e
s
t
o
w
a
r
d
s
d
i
s
a
b
i
l
it
y
i
n
t
h
e
wo
r
k
p
l
a
c
e
w
as
a
d
a
p
t
e
d
f
r
o
m
a
p
r
e
v
i
o
u
s
s
t
u
d
y
[
1
6
]
.
H
o
w
e
v
e
r
,
w
e
s
l
i
g
h
tl
y
m
o
d
i
f
i
ed
t
h
e
l
a
n
g
u
a
g
e
t
o
f
i
t
t
h
e
l
o
c
a
l
c
o
n
t
e
x
t
w
h
i
l
e
m
a
i
n
t
ai
n
i
n
g
t
h
e
o
r
i
g
i
n
a
l
c
o
n
t
e
n
t
.
B
e
f
o
r
e
d
a
t
a
c
o
l
le
c
t
i
o
n
,
t
h
e
q
u
es
t
i
o
n
n
a
i
r
e
wa
s
s
e
n
t
t
o
s
e
v
e
n
co
n
t
e
n
t
e
x
p
e
r
t
s
(
R
e
s
e
a
r
c
h
e
r
s
i
n
v
o
l
v
e
d
i
n
t
h
e
s
t
u
d
y
r
e
l
a
t
e
d
t
o
p
e
o
p
l
e
w
i
t
h
d
o
w
n
s
y
n
d
r
o
m
e
(
P
D
S
)
)
a
n
d
l
a
n
g
u
a
g
e
e
x
p
e
r
t
s
(
M
a
l
a
y
a
n
d
C
h
i
n
e
s
e
t
e
a
c
h
e
r
s
w
h
o
u
n
d
e
r
s
t
a
n
d
t
h
e
i
r
r
e
s
p
e
c
t
i
v
e
l
a
n
g
u
a
g
e
a
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T
h
e
in
s
tr
u
m
en
t
was
d
er
i
v
ed
f
r
o
m
th
e
q
u
esti
o
n
n
air
e
d
esig
n
ed
b
y
M
ea
g
e
r
et
a
l
.
[
1
6
]
o
f
t
h
e
I
n
s
titu
te
f
o
r
E
m
p
lo
y
m
e
n
t
Stu
d
ies
o
f
th
e
Un
ited
Kin
g
d
o
m
to
ass
ess
th
e
awa
r
en
ess
,
k
n
o
wled
g
e,
a
n
d
e
x
er
cise
o
f
em
p
l
o
y
m
en
t
r
ig
h
ts
.
T
h
e
1
4
-
item
q
u
esti
o
n
n
air
e
c
o
m
p
r
is
es
two
p
ar
ts
:
awa
r
en
ess
o
f
em
p
lo
y
m
en
t
r
ig
h
ts
(
1
0
item
s
)
a
n
d
atti
tu
d
e
to
war
d
s
leg
is
latio
n
(
4
item
s
)
.
T
h
e
m
etr
ics
f
o
r
ea
ch
item
ar
e
b
ase
d
o
n
a
5
-
p
o
in
t
L
ik
e
r
t
s
ca
le
f
r
o
m
s
tr
o
n
g
ly
d
is
ag
r
ee
to
s
tr
o
n
g
ly
ag
r
ee
.
A
h
ig
h
er
s
co
r
e
in
d
icate
s
a
h
ig
h
er
k
n
o
wled
g
e
o
f
em
p
lo
y
m
en
t
r
ig
h
ts
f
o
r
p
eo
p
le
with
d
is
ab
ilit
ies.
iii)
L
eg
is
lativ
e
k
n
o
wled
g
e
o
f
em
p
lo
y
m
en
t
r
ig
h
ts
r
ef
er
s
to
in
d
iv
id
u
al
awa
r
en
ess
an
d
u
n
d
e
r
s
tan
d
in
g
o
f
th
e
leg
al
r
ig
h
ts
an
d
p
r
o
tectio
n
s
a
f
f
o
r
d
e
d
to
p
eo
p
le
with
d
is
ab
il
ities
in
th
e
wo
r
k
p
lace
.
I
t
in
clu
d
es
k
n
o
win
g
s
p
ec
if
ic
laws,
r
eg
u
latio
n
s
,
an
d
p
o
licies
th
at
p
r
o
tect
th
e
r
ig
h
ts
o
f
in
d
iv
i
d
u
als
with
d
is
ab
ilit
ies,
in
clu
d
in
g
th
eir
r
ig
h
t
t
o
wo
r
k
,
s
ee
k
h
elp
o
r
ad
v
ice,
o
b
tain
in
f
o
r
m
atio
n
,
ad
d
r
ess
wo
r
k
-
r
elate
d
p
r
o
b
l
em
s
,
an
d
tak
e
leg
al
ac
tio
n
if
n
ec
ess
ar
y
.
I
t
also
in
v
o
lv
es
b
ein
g
in
f
o
r
m
ed
ab
o
u
t
th
e
r
elev
an
t
a
g
en
cies
o
r
au
th
o
r
ities
r
esp
o
n
s
ib
le
f
o
r
en
f
o
r
cin
g
t
h
ese
laws a
n
d
k
n
o
win
g
h
o
w
to
r
e
p
o
r
t v
io
latio
n
s
o
r
s
ee
k
h
elp
.
iv
)
Attitu
d
e
to
war
d
s
d
is
ab
ilit
y
i
n
th
e
wo
r
k
p
lace
r
ef
er
s
to
in
d
iv
id
u
al
b
elief
s
,
o
p
in
i
o
n
s
,
an
d
p
er
ce
p
tio
n
s
r
eg
ar
d
in
g
em
p
lo
y
m
e
n
t
r
ig
h
ts
an
d
tr
ea
tm
e
n
t
o
f
p
e
r
s
o
n
s
with
d
is
ab
ilit
ies
in
th
e
w
o
r
k
p
lace
.
I
t
in
v
o
lv
es
attitu
d
e
s
to
war
d
s
in
clu
s
iv
ity
,
non
-
d
is
cr
im
in
atio
n
,
f
air
n
ess
,
an
d
e
q
u
al
o
p
p
o
r
tu
n
ities
f
o
r
i
n
d
iv
id
u
als
with
d
is
ab
ilit
ies.
Po
s
itiv
e
attitu
d
es
in
clu
d
e
r
ec
o
g
n
izin
g
th
e
im
p
o
r
tan
ce
o
f
lear
n
in
g
ab
o
u
t
t
h
e
r
ig
h
ts
o
f
p
er
s
o
n
s
with
d
is
ab
ilit
ies,
ad
v
o
ca
tin
g
f
o
r
th
eir
em
p
lo
y
m
en
t
,
an
d
en
s
u
r
in
g
f
air
tr
ea
tm
e
n
t
an
d
o
p
p
o
r
tu
n
ities
f
o
r
tr
ain
in
g
a
n
d
p
r
o
m
o
tio
n
.
Neg
at
iv
e
attitu
d
es
m
ay
in
clu
d
e
th
e
b
elief
th
at
em
p
lo
y
er
s
s
h
o
u
ld
b
e
r
eq
u
ir
ed
to
em
p
lo
y
a
ce
r
tain
p
er
ce
n
ta
g
e
o
f
p
e
r
s
o
n
s
with
d
is
ab
ilit
ies
o
r
s
k
ep
ticis
m
ab
o
u
t
th
e
n
ee
d
t
o
lear
n
m
o
r
e
a
b
o
u
t d
is
ab
ilit
y
r
ig
h
ts
at
wo
r
k
.
2
.
5
.
St
a
t
is
t
ica
l a
na
ly
s
is
Sin
ce
th
e
d
ata
was
co
llected
t
h
r
o
u
g
h
an
o
n
lin
e
s
u
r
v
ey
,
it
was
en
ter
ed
d
ir
ec
tly
in
to
Mic
r
o
s
o
f
t
E
x
ce
l
f
o
r
th
e
in
itial
o
r
g
an
izatio
n
.
Su
b
s
eq
u
en
tly
,
d
ata
clea
n
in
g
was
p
er
f
o
r
m
ed
to
id
e
n
tif
y
an
d
a
d
d
r
ess
an
y
in
co
n
s
is
ten
cies
with
in
th
e
d
a
taset.
T
h
e
m
is
s
in
g
v
alu
es
we
r
e
th
en
ex
am
in
ed
,
an
d
m
is
s
i
n
g
d
ata
im
p
u
tatio
n
tech
n
iq
u
es
wer
e
em
p
l
o
y
ed
u
s
in
g
th
e
b
u
ilt
-
in
m
is
s
in
g
v
al
u
e
m
o
d
u
les
in
SP
SS
v
er
s
io
n
2
9
.
0
.
Descr
ip
tiv
e
s
tatis
t
ics
wer
e
g
en
er
ate
d
to
s
u
m
m
ar
ize
th
e
d
ata.
T
h
is
in
clu
d
ed
ca
lcu
latin
g
m
ea
n
s
a
n
d
s
tan
d
ar
d
d
e
v
iatio
n
s
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
:
14
89
-
1
49
8
1492
(
SD)
f
o
r
q
u
an
titativ
e
v
ar
iab
les
,
wh
ile
ca
teg
o
r
ical
v
ar
iab
les w
er
e
p
r
esen
ted
u
s
in
g
f
r
eq
u
en
cie
s
an
d
p
er
ce
n
tag
es.
A
o
n
e
-
way
an
aly
s
is
o
f
v
ar
ian
c
e
(
ANOV
A)
wa
s
p
er
f
o
r
m
ed
t
o
ex
p
lo
r
e
p
o
ten
tial
d
if
f
er
en
ce
s
in
m
ea
n
s
co
r
es
f
o
r
o
r
g
an
izatio
n
al
cu
ltu
r
e
,
k
n
o
w
led
g
e
o
f
d
is
ab
ilit
y
le
g
is
latio
n
,
an
d
wo
r
k
p
lace
attitu
d
e
t
o
war
d
p
eo
p
le
with
d
is
ab
ilit
ies
in
th
e
th
r
ee
r
esp
o
n
d
en
t
ca
teg
o
r
ies.
Sig
n
if
ican
t
f
in
d
in
g
s
o
f
ANOV
A
wer
e
f
u
r
th
er
in
v
esti
g
ated
u
s
in
g
p
o
s
t
h
o
c
co
m
p
ar
is
o
n
s
with
B
o
n
f
er
r
o
n
i
co
r
r
ec
tio
n
to
d
eter
m
in
e
t
h
e
g
r
o
u
p
s
th
at
d
if
f
er
ed
.
Fin
ally
,
m
u
ltip
le
lin
ea
r
r
eg
r
ess
io
n
an
a
ly
s
es
wer
e
p
er
f
o
r
m
e
d
f
o
r
ea
c
h
d
o
m
ain
to
e
x
am
in
e
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
s
o
cio
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
an
d
th
e
v
ar
io
u
s
d
o
m
ain
s
o
f
o
r
g
a
n
izatio
n
al
c
u
ltu
r
e.
J
AM
OVI
v
er
s
io
n
2
.
3
.
2
8
,
an
o
p
en
-
s
o
u
r
ce
s
tatis
tical
s
o
f
twar
e,
d
id
th
is
p
ar
t
o
f
th
e
d
ata
an
aly
s
is
.
A
s
ig
n
if
ican
ce
l
ev
el
o
f
p
<.
0
5
was
ad
o
p
ted
t
h
r
o
u
g
h
o
u
t th
e
an
al
y
s
is
to
id
en
tify
s
tatis
tically
s
ig
n
i
f
ican
t r
elatio
n
s
h
ip
s
.
2
.
6
.
E
t
hica
l
co
ns
idera
t
io
ns
T
h
is
s
tu
d
y
ad
h
er
ed
t
o
eth
ica
l
p
r
in
cip
les
th
r
o
u
g
h
o
u
t.
T
h
e
d
ig
ital
in
f
o
r
m
ed
c
o
n
s
en
t
en
s
u
r
ed
th
at
p
ar
ticip
an
ts
wer
e
f
u
lly
in
f
o
r
m
ed
b
ef
o
r
e
p
ar
ticip
atio
n
.
Data
co
n
f
id
en
tiality
was
m
ain
tain
ed
,
an
d
a
n
o
n
y
m
ity
was
g
u
ar
an
teed
to
p
r
o
tect
p
ar
ticip
an
t
p
r
iv
ac
y
.
Par
ticip
an
ts
wer
e
also
in
f
o
r
m
ed
o
f
t
h
eir
r
i
g
h
t
to
with
d
r
aw
at
an
y
tim
e,
an
d
all
d
ata
was p
r
o
tecte
d
with
p
ass
wo
r
d
s
to
p
r
e
v
e
n
t u
n
au
t
h
o
r
ized
ac
ce
s
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
t
he
r
esp
o
nd
ent
s
T
ab
le
1
p
r
esen
ts
th
e
d
e
m
o
g
r
a
p
h
ic
ch
ar
ac
ter
is
tics
o
f
5
9
5
r
es
p
o
n
d
e
n
ts
in
a
s
tu
d
y
o
n
em
p
l
o
y
m
en
t
f
o
r
in
d
iv
id
u
als with
Do
wn
s
y
n
d
r
o
m
e
in
Ma
lay
s
ia.
T
h
e
s
am
p
le
h
ad
a
m
ea
n
ag
e
o
f
3
6
.
3
y
ea
r
s
(
SD
=
1
1
.
9
)
an
d
was
p
r
ed
o
m
i
n
an
tly
f
em
ale
(
5
9
.
8
%).
R
esp
o
n
d
en
ts
wer
e
ca
teg
o
r
i
ze
d
as
em
p
lo
y
er
s
(
2
9
.
4
%),
e
m
p
lo
y
ee
s
(
5
3
.
1
%)
,
an
d
m
em
b
er
s
o
f
th
e
co
m
m
u
n
i
ty
o
f
p
er
s
o
n
s
with
d
is
ab
ilit
ies
(
PW
D
s
)
(
1
7
.
5
%).
T
h
e
m
ajo
r
i
ty
h
eld
p
er
m
an
en
t
em
p
lo
y
m
e
n
t
(
8
2
.
9
%),
wer
e
o
f
C
h
in
ese
eth
n
icity
(
7
2
.
3
%),
a
n
d
h
a
d
h
i
g
h
er
s
ec
o
n
d
ar
y
e
d
u
ca
t
io
n
(
5
8
.
2
%).
Mo
s
t
r
esp
o
n
d
en
ts
wer
e
s
in
g
le
(
5
2
.
4
%)
an
d
C
h
r
is
tian
(
5
7
.
0
%).
T
h
e
n
atu
r
e
o
f
jo
b
s
was
d
iv
er
s
e,
with
th
e
s
er
v
ice
s
ec
to
r
b
ein
g
th
e
m
o
s
t c
o
m
m
o
n
(
4
4
.
0
%),
f
o
llo
wed
b
y
o
f
f
icial
(
2
8
.
7
%)
a
n
d
m
a
n
u
al
jo
b
s
(
2
7
.
2
%).
3
.
2
.
Descript
iv
e
s
t
a
t
is
t
ics
T
h
e
s
t
u
d
y
i
n
v
o
l
v
i
n
g
5
9
5
p
a
r
t
i
c
i
p
a
n
t
s
r
e
v
e
a
l
e
d
a
m
o
d
e
r
a
t
e
o
r
g
a
n
i
z
a
t
i
o
n
a
l
c
u
l
t
u
r
e
t
h
a
t
s
u
p
p
o
r
t
s
t
h
e
e
m
p
l
o
y
m
e
n
t
o
f
p
e
o
p
l
e
w
i
t
h
d
i
s
a
b
i
l
i
t
i
e
s
(
P
W
D
)
,
w
i
t
h
a
n
o
v
e
r
a
l
l
m
e
a
n
s
c
o
r
e
o
f
5
3
.
9
3
%
(
S
D
=
1
8
.
3
9
%
)
.
A
m
o
n
g
t
h
e
v
a
r
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)
=
6
.
0
7
2
,
p
=.
0
0
2
,
η
²=
.
0
2
0
)
.
Po
s
itiv
e
attitu
d
es
ar
e
ess
en
tial
f
o
r
f
o
s
ter
in
g
an
in
clu
s
iv
e
wo
r
k
p
l
ac
e
cu
ltu
r
e,
as
th
ey
ca
n
m
itig
ate
p
er
ce
p
tu
al
an
d
attitu
d
in
al
b
ar
r
ier
s
th
at
o
f
ten
h
in
d
er
th
e
em
p
lo
y
m
en
t
an
d
in
teg
r
atio
n
o
f
PW
D
[
2
1
]
,
[
2
2
]
.
Alth
o
u
g
h
s
ig
n
if
ica
n
t
ANOV
A
r
esu
lts
em
er
g
ed
f
o
r
‘
Dis
ab
ilit
y
HR
M
-
Fit
’
(
F
(
2
,
5
9
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=4
.
3
0
9
,
p
=
.
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4
,
η
²=
.
0
1
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a
n
d
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n
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u
ltu
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,
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t
-
h
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with
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p
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t
th
e
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p
ec
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p
s
r
esp
o
n
s
ib
le
f
o
r
th
ese
d
if
f
er
en
ce
s
.
T
h
is
s
u
g
g
ests
th
at
wh
ile
th
er
e
ar
e
v
ar
iatio
n
s
in
p
er
ce
p
tio
n
s
,
th
e
d
if
f
er
en
ce
s
ar
e
n
o
t
s
tr
o
n
g
en
o
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g
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t
o
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u
te
d
to
s
p
ec
if
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p
s
c
o
n
cl
u
s
iv
ely
.
T
h
is
f
in
d
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g
u
n
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er
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r
e
s
th
e
co
m
p
lex
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h
iev
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g
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h
esiv
e,
in
clu
s
i
v
e
cu
ltu
r
e
with
in
o
r
g
a
n
izatio
n
s
[
2
5
]
.
I
n
ter
esti
n
g
l
y
,
n
o
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
wer
e
f
o
u
n
d
in
th
e
p
er
ce
p
tio
n
o
f
‘
T
o
p
Ma
n
a
g
em
en
t
C
o
m
m
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en
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(
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9
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7
0
3
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5
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0
0
2
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.
T
h
is
lack
o
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s
ig
n
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ican
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d
if
f
e
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ce
m
ig
h
t
in
d
icate
a
g
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er
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n
s
en
s
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s
o
r
u
n
if
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ity
in
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p
m
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ag
em
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t
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m
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cr
o
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s
d
if
f
er
en
t
g
r
o
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p
s
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h
ig
h
lig
h
tin
g
a
p
o
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ea
f
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o
r
g
an
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al
im
p
r
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e
n
t to
en
s
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m
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em
en
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s
ac
tiv
e
a
n
d
v
is
ib
le
co
m
m
itm
en
t to
in
cl
u
s
iv
ity
[
1
8
]
,
[
1
9
]
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
th
e
r
esp
o
n
d
en
ts
(
N
=
5
9
5
)
C
h
a
r
a
c
t
e
r
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s
t
i
c
s
N
%/
M
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n
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s
d
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n
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r
s
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6
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3
(
1
1
.
9
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e
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r
s
G
e
n
d
e
r
F
e
mal
e
3
5
6
5
9
.
8
M
a
l
e
2
3
9
4
0
.
2
R
e
s
p
o
n
d
e
n
t
s
Emp
l
o
y
e
r
1
7
5
2
9
.
4
Emp
l
o
y
e
e
3
1
6
5
3
.
1
C
o
mm
u
n
i
t
y
o
f
P
W
D
s
1
0
4
1
7
.
5
Emp
l
o
y
me
n
t
st
a
t
u
s
P
e
r
man
e
n
t
4
9
3
8
2
.
9
Te
mp
o
r
a
r
y
/
p
a
r
t
-
t
i
me
86
1
4
.
5
V
o
l
u
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t
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e
r
16
2
.
7
Et
h
n
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t
y
M
a
l
a
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74
1
2
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4
C
h
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n
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se
4
3
0
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2
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3
O
t
h
e
r
s (I
b
a
n
,
B
i
d
a
y
u
h
,
a
n
d
o
r
a
n
g
u
l
u
)
91
1
5
.
3
Le
v
e
l
o
f
e
d
u
c
a
t
i
o
n
P
r
i
mary
e
d
u
c
a
t
i
o
n
33
5
.
5
S
e
c
o
n
d
a
r
y
e
d
u
c
a
t
i
o
n
1
4
2
2
3
.
9
H
i
g
h
e
r
s
e
c
o
n
d
a
r
y
3
4
6
5
8
.
2
G
r
a
d
u
a
t
e
a
n
d
a
b
o
v
e
74
1
2
.
4
M
a
r
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t
a
l
s
t
a
t
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s
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g
l
e
3
1
2
5
2
.
4
M
a
r
r
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e
d
2
6
3
4
4
.
2
O
t
h
e
r
s (S
e
p
a
r
a
t
e
d
,
w
i
d
o
w
e
d
o
r
d
i
v
o
r
c
e
d
)
20
3
.
4
R
e
l
i
g
i
o
n
I
sl
a
m
87
1
4
.
6
C
h
r
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st
i
a
n
3
3
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5
7
.
0
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u
d
d
h
i
sm
1
3
1
2
2
.
0
O
t
h
e
r
s
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f
r
e
e
t
h
i
n
k
e
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s
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n
d
H
i
n
d
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i
sm)
38
6
.
4
N
a
t
u
r
e
o
f
t
h
e
j
ob
O
f
f
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c
i
a
l
1
7
1
2
8
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7
M
a
n
u
a
l
j
ob
1
6
2
2
7
.
2
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e
r
v
i
c
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e
c
t
o
r
2
6
2
4
4
.
0
S
e
r
v
i
c
e
sec
t
o
r
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n
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l
u
d
e
s
h
e
a
l
t
h
,
sal
e
a
n
d
mar
k
e
t
i
n
g
,
a
r
t
,
a
n
d
e
n
t
e
r
t
a
i
n
m
e
n
t
T
ab
le
2
.
Descr
ip
tiv
e
s
tatis
tics
o
f
th
e
o
r
g
an
izatio
n
al
cu
ltu
r
e
t
o
em
p
lo
y
a
p
er
s
o
n
with
d
is
ab
i
liti
es (
N
=
595)
D
o
ma
i
n
s
#
i
t
e
m
s
M
e
a
n
%
Sd
9
5
%
C
I
C
r
o
n
b
a
c
h
a
l
p
h
a
C
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r
r
e
c
t
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d
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t
e
m
-
t
o
t
a
l
c
o
r
r
e
l
a
t
i
o
n
O
r
g
a
n
i
z
a
t
i
o
n
a
l
c
u
l
t
u
r
e
To
p
ma
n
a
g
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me
n
t
c
o
mm
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t
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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t J Pu
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lth
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14
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No
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3
,
Sep
tem
b
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20
25
:
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89
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8
1494
T
ab
le
3
.
On
e
-
way
an
aly
s
is
o
f
v
ar
ian
ce
o
f
d
o
m
ain
s
o
f
o
r
g
an
i
za
tio
n
al
cu
ltu
r
e,
k
n
o
wled
g
e
an
d
attitu
d
e
to
war
d
s
th
e
em
p
lo
y
m
en
t o
f
a
p
er
s
o
n
w
ith
d
is
ab
ilit
ies b
y
ca
teg
o
r
y
o
f
r
esp
o
n
d
en
ts
(
N
=
5
9
5
)
V
a
r
i
a
b
l
e
s
Emp
l
o
y
e
r
s (
n
=
1
7
5
)
Emp
l
o
y
e
e
(
n
=
3
1
6
)
Emp
l
o
y
e
e
(
n
=
1
0
4
)
p
-
v
a
l
u
e
2
To
p
ma
n
a
g
e
me
n
t
c
o
mm
i
t
m
e
n
t
4
8
.
2
(
2
2
.
6
)
4
9
.
9
(
2
1
.
4
)
5
1
.
1
(
1
4
.
8
)
p
>
.
0
5
.
0
0
2
I
n
c
l
u
s
i
v
e
c
u
l
t
u
r
e
5
7
.
4
(
2
0
.
0
)
*
5
5
.
2
(
2
0
.
5
)
5
1
.
7
(
1
5
.
2
)
p
=
.
0
5
8
.
0
1
0
S
u
p
p
o
r
t
i
v
e
W
o
r
k
p
l
a
c
e
6
2
.
2
(
1
9
.
5
)
*
5
8
.
7
(
1
9
.
2
)
*
7
3
.
1
(
1
9
.
8
)
*
p
<
.
0
0
1
.
0
6
8
D
i
sab
i
l
i
t
y
H
R
M
f
i
t
3
9
.
8
(
1
8
.
8
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4
1
.
4
(
1
8
.
6
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*
4
6
.
3
(
1
6
.
9
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*
p
=
.
0
1
4
.
0
1
4
K
n
o
w
l
e
d
g
e
of
t
h
e
l
e
g
i
sl
a
t
i
o
n
7
1
.
7
(
1
5
.
1
)
*
7
4
.
6
(
1
4
.
0
)
*
8
1
.
0
(
1
3
.
5
)
*
p
<
.
0
0
1
.
0
4
5
A
t
t
i
t
u
d
e
5
4
.
6
(
1
9
.
6
)
*
5
8
.
3
(
1
6
.
2
)
6
2
.
1
(
1
7
.
8
)
*
p
=
.
0
0
2
.
0
2
0
Th
e
f
i
g
u
r
e
i
n
p
a
r
e
n
t
h
e
ses
i
n
d
i
c
a
t
e
s sa
mp
l
e
s
i
z
e
;
a
n
a
s
t
e
r
i
s
k
s
i
g
n
i
n
d
i
c
a
t
e
s
p
o
st
h
o
c
d
i
f
f
e
r
e
n
c
e
s
.
3
.
4
.
F
a
ct
o
rs a
s
s
o
cia
t
ed
wit
h
t
he
do
m
a
ins
o
f
o
r
g
a
niza
t
io
n
a
l c
ulture
:
m
ultiple linea
r
re
g
re
s
s
io
n a
na
ly
s
is
T
h
e
m
u
ltip
le
lin
ea
r
r
e
g
r
ess
io
n
an
aly
s
is
co
n
d
u
cted
in
T
a
b
le
4
aim
ed
to
id
en
tif
y
p
r
e
d
icto
r
s
ass
o
ciate
d
with
d
if
f
er
en
t
d
o
m
ai
n
s
o
f
o
r
g
an
izatio
n
al
cu
ltu
r
e,
s
p
ec
if
ically
f
o
cu
s
in
g
o
n
th
e
co
m
m
itm
en
t
o
f
to
p
m
an
ag
em
en
t,
in
cl
u
s
iv
e
cu
ltu
r
e,
s
u
p
p
o
r
tiv
e
wo
r
k
p
lace
,
an
d
H
R
M
f
it
f
o
r
d
is
ab
ilit
y
.
Sev
er
a
l
p
r
ed
icto
r
v
ar
iab
les
wer
e
in
clu
d
ed
in
th
e
a
n
aly
s
is
,
s
u
ch
as
ag
e,
ca
teg
o
r
y
o
f
r
esp
o
n
d
en
ts
,
g
e
n
d
er
,
eth
n
ic
g
r
o
u
p
,
lev
el
o
f
e
d
u
ca
tio
n
,
m
ar
ital statu
s
,
r
elig
io
n
,
leg
is
lativ
e
k
n
o
wled
g
e,
an
d
attitu
d
e.
T
h
e
m
u
l
t
i
p
l
e
l
i
n
e
a
r
r
e
g
r
es
s
i
o
n
m
o
d
e
l
e
x
p
l
a
i
n
e
d
2
6
%
o
f
t
h
e
v
a
r
i
a
n
c
e
i
n
t
o
p
m
a
n
a
g
e
m
e
n
t
c
o
m
m
i
t
m
e
n
t
t
o
w
a
r
d
s
d
is
a
b
i
li
t
y
i
n
c
l
u
s
i
o
n
(
R
²
=
0
.
2
6
,
a
d
j
u
s
t
e
d
R
²
=
0
.
2
3
9
,
F
(
1
6
,
5
7
8
)
=
1
2
.
7
,
p
<
.
0
0
1
)
.
T
h
i
s
f
i
n
d
i
n
g
u
n
d
e
r
s
c
o
r
e
s
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
v
a
r
i
o
u
s
f
a
c
t
o
r
s
i
n
s
h
a
p
i
n
g
m
an
a
g
e
m
e
n
t
'
s
c
o
m
m
it
m
e
n
t
t
o
f
o
s
t
e
r
i
n
g
a
n
i
n
c
l
u
s
i
v
e
w
o
r
k
p
l
a
c
e
f
o
r
p
e
o
p
l
e
w
i
t
h
d
i
s
a
b
i
l
i
ti
e
s
(
PW
D
)
.
Si
g
n
i
f
i
c
a
n
t
p
r
e
d
i
c
t
o
r
s
o
f
t
o
p
m
a
n
a
g
e
m
e
n
t
c
o
m
m
i
t
m
e
n
t
i
n
c
l
u
d
e
d
t
h
e
c
a
t
e
g
o
r
y
o
f
e
m
p
l
o
y
e
r
s
(
β
=
.
3
7
,
p
<
.
0
0
1
)
a
n
d
e
m
p
l
o
y
e
e
s
(
β
=
.
3
0
,
p
<
.
0
0
1
)
,
w
h
o
d
e
m
o
n
s
t
r
a
t
e
d
h
i
g
h
e
r
p
e
r
c
e
i
v
e
d
c
o
m
m
i
t
m
e
n
t
t
h
a
n
m
e
m
b
e
r
s
o
f
t
h
e
d
i
s
a
b
i
l
i
t
y
c
o
m
m
u
n
i
t
y
.
T
h
i
s
s
u
g
g
e
s
ts
t
h
a
t
t
h
o
s
e
w
i
t
h
i
n
t
h
e
o
r
g
a
n
i
z
a
t
i
o
n
a
l
s
t
r
u
c
t
u
r
e
,
s
u
c
h
a
s
e
m
p
l
o
y
e
r
s
a
n
d
e
m
p
l
o
y
e
e
s
,
m
a
y
h
a
v
e
a
m
o
r
e
f
a
v
o
r
a
b
l
e
v
i
e
w
o
f
t
o
p
m
a
n
a
g
em
e
n
t
'
s
c
o
m
m
it
m
e
n
t
c
o
m
p
a
r
e
d
t
o
t
h
o
s
e
f
r
o
m
t
h
e
d
i
s
a
b
i
li
t
y
c
o
m
m
u
n
i
t
y
.
T
h
i
s
a
li
g
n
s
w
i
t
h
t
h
e
l
it
e
r
a
t
u
r
e
i
n
d
i
ca
t
i
n
g
t
h
a
t
i
n
t
e
r
n
al
s
t
a
k
e
h
o
l
d
e
r
s
o
f
t
e
n
p
e
r
c
e
i
v
e
o
r
g
a
n
i
z
a
t
i
o
n
a
l
e
f
f
o
r
ts
m
o
r
e
p
o
s
i
ti
v
e
l
y
d
u
e
t
o
d
i
r
e
c
t
i
n
v
o
l
v
e
m
e
n
t
a
n
d
c
o
m
m
u
n
i
c
a
t
i
o
n
[
1
5
]
.
E
t
h
n
i
c
C
h
i
n
e
s
e
p
a
r
t
i
ci
p
a
n
t
s
w
e
r
e
n
e
g
a
t
i
v
el
y
a
s
s
o
c
i
a
te
d
w
i
t
h
p
e
r
c
e
i
v
e
d
t
o
p
m
a
n
a
g
e
m
e
n
t
c
o
m
m
i
t
m
e
n
t
(
β
=
-
.
3
3
,
p
<
.
0
1
)
.
T
h
i
s
m
a
y
r
e
f
l
e
c
t
c
u
lt
u
r
a
l
o
r
s
y
s
t
e
m
i
c
b
a
r
r
ie
r
s
t
h
a
t
n
e
e
d
t
o
b
e
a
d
d
r
e
s
s
e
d
t
o
e
n
s
u
r
e
e
q
u
i
t
a
b
le
i
n
c
l
u
s
i
o
n
a
c
r
o
s
s
d
i
v
e
r
s
e
e
t
h
n
ic
g
r
o
u
p
s
[
2
6
]
.
A
d
d
i
t
i
o
n
a
l
l
y
,
h
i
g
h
e
r
s
e
c
o
n
d
a
r
y
e
d
u
c
a
t
i
o
n
(
β
=
-
.
3
6
,
p
<
.
0
1
)
a
n
d
g
r
a
d
u
a
t
e
-
l
e
v
e
l
e
d
u
c
at
i
o
n
(
β
=
-
.
4
7
,
p
<
.
0
1
)
w
e
r
e
a
ls
o
n
e
g
a
t
i
v
ely
a
s
s
o
ci
a
t
e
d
w
i
t
h
c
o
m
m
i
t
m
e
n
t
.
T
h
i
s
c
o
u
l
d
i
n
d
i
c
a
te
t
h
a
t
i
n
d
i
v
i
d
u
a
l
s
w
it
h
h
i
g
h
e
r
e
d
u
c
a
t
i
o
n
l
e
v
e
ls
m
a
y
h
a
v
e
h
i
g
h
e
r
e
x
p
e
c
t
at
i
o
n
s
o
r
m
o
r
e
c
r
i
ti
c
a
l
v
i
e
ws
o
f
m
a
n
a
g
e
m
e
n
t'
s
e
f
f
o
r
t
s
i
n
d
is
ab
i
l
i
t
y
i
n
c
l
u
s
i
o
n
[
2
7
]
.
I
n
t
e
r
es
ti
n
g
l
y
,
a
t
ti
t
u
d
e
s
t
o
wa
r
d
s
PW
D
w
e
r
e
p
o
s
it
i
v
e
l
y
a
s
s
o
ci
a
t
e
d
w
i
t
h
h
i
g
h
e
r
s
e
c
o
n
d
a
r
y
e
d
u
c
a
t
i
o
n
(
β
=
.
4
1
,
p
<
.
0
0
1
)
,
s
u
g
g
e
s
ti
n
g
t
h
a
t
e
d
u
c
a
ti
o
n
p
l
ay
s
a
r
o
l
e
i
n
s
h
a
p
i
n
g
p
o
s
i
t
i
v
e
p
e
r
c
e
p
ti
o
n
s
a
n
d
a
t
t
itu
d
e
s
t
o
w
a
r
d
s
d
is
a
b
i
li
t
y
i
n
c
l
u
s
i
o
n
.
T
h
i
s
f
i
n
d
i
n
g
i
s
c
o
n
s
is
te
n
t
w
i
t
h
r
e
s
ea
r
c
h
h
i
g
h
l
i
g
h
t
i
n
g
t
h
e
r
o
l
e
o
f
e
d
u
c
a
tio
n
i
n
f
o
s
t
e
r
i
n
g
i
n
c
l
u
s
i
v
e
a
tt
i
t
u
d
e
s
a
n
d
r
e
d
u
c
i
n
g
s
ti
g
m
a
[
1
8
]
.
I
n
t
e
r
m
s
o
f
c
r
e
a
t
i
n
g
a
n
i
n
c
l
u
s
i
v
e
c
u
l
t
u
r
e
,
t
h
e
r
e
g
r
e
s
s
i
o
n
m
o
d
e
l
e
x
p
l
a
i
n
e
d
2
2
%
o
f
t
h
e
v
a
r
i
a
n
c
e
(
R
²
=
0
.
2
2
1
,
a
d
j
u
s
t
e
d
R
²
=
0
.
2
0
0
,
F
(
1
6
,
5
7
8
)
=
1
0
.
3
,
p
<
.
0
0
1
)
.
E
m
p
l
o
y
e
r
s
(
β
=
.
7
5
,
p
<
.
0
0
1
)
a
n
d
e
m
p
l
o
y
e
e
s
(
β
=
.
5
1
,
p
<
.
0
0
1
)
p
e
r
c
e
i
v
e
d
a
s
i
g
n
i
f
i
c
a
n
t
l
y
g
r
e
a
t
e
r
l
e
v
e
l
o
f
i
n
c
l
u
s
i
v
i
t
y
t
h
a
n
c
o
m
m
u
n
i
t
y
m
e
m
b
e
r
s
w
i
t
h
d
i
s
a
b
i
l
i
t
i
e
s
.
L
e
g
i
s
l
a
t
i
v
e
k
n
o
w
l
e
d
g
e
(
β
=
.
1
6
,
p
<
.
0
0
1
)
a
n
d
a
t
t
i
t
u
d
e
s
t
o
w
a
r
d
s
P
W
D
(
β
=
.
3
2
,
p
<
.
0
0
1
)
w
e
r
e
p
o
s
i
t
i
v
e
l
y
a
s
s
o
c
i
a
t
e
d
w
i
t
h
p
e
r
c
e
i
v
e
d
i
n
c
l
u
s
i
v
e
c
u
l
t
u
r
e
,
r
e
i
n
f
o
r
c
i
n
g
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
a
w
a
r
e
n
e
s
s
a
n
d
p
o
s
i
t
i
v
e
a
t
t
i
t
u
d
e
s
i
n
p
r
o
m
o
t
i
n
g
i
n
c
l
u
s
i
v
i
t
y
[
2
8
]
.
Fo
r
p
er
ce
p
tio
n
s
o
f
a
s
u
p
p
o
r
ti
v
e
wo
r
k
p
lace
,
th
e
m
o
d
el
ex
p
l
ain
ed
2
0
.
3
%
o
f
th
e
v
ar
ian
ce
(
R
²=
0
.
2
0
3
,
ad
ju
s
ted
R
²=
0
.
1
8
1
,
F(1
6
,
5
7
8
)
=9
.
2
2
,
p
<.
0
0
1
)
.
C
o
m
m
u
n
ity
m
em
b
er
s
with
d
is
ab
ilit
ies
p
er
c
eiv
ed
th
e
wo
r
k
p
lace
to
b
e
s
ig
n
if
ican
tly
less
s
u
p
p
o
r
tiv
e
(
β=
-
.
4
2
,
p
<.
0
0
1
)
,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
m
o
r
e
r
o
b
u
s
t
s
u
p
p
o
r
t
s
tr
u
ctu
r
es.
Hig
h
er
lev
els
o
f
ed
u
ca
tio
n
wer
e
also
n
eg
ativ
ely
ass
o
ciate
d
with
p
er
ce
p
tio
n
s
o
f
s
u
p
p
o
r
t
(
β=
-
.
3
2
,
p
<.
0
5
)
,
wh
ich
m
ay
r
ef
lect
h
ig
h
er
e
x
p
ec
tatio
n
s
o
r
cr
itical
ev
alu
atio
n
s
b
y
m
o
r
e
ed
u
ca
ted
in
d
i
v
id
u
a
ls
[
2
9
]
.
I
d
en
tify
i
n
g
as
Mu
s
lim
was
p
o
s
itiv
ely
ass
o
ciate
d
with
a
s
u
p
p
o
r
tiv
e
wo
r
k
p
lace
(
β=.7
0
,
p
<.
0
0
1
)
,
s
u
g
g
est
in
g
th
at
c
u
ltu
r
al
o
r
r
elig
io
u
s
v
alu
es m
ay
i
n
f
lu
en
ce
p
er
ce
p
tio
n
s
o
f
s
u
p
p
o
r
t
[
3
0
]
.
Fin
ally
,
th
e
m
o
d
el
ex
p
lain
e
d
2
2
.
1
%
o
f
th
e
v
a
r
ian
ce
in
HR
M
d
is
ab
ili
ty
f
it
(
R
²=
0
.
2
2
1
,
ad
ju
s
ted
R
²=
0
.
1
9
9
,
F(1
6
,
5
7
8
)
=1
0
.
2
,
p
<.
0
0
1
)
.
Po
s
itiv
e
attitu
d
es
to
war
d
s
PW
D
(
β=.3
6
,
p
<.
0
0
1
)
an
d
leg
is
lativ
e
k
n
o
wled
g
e
wer
e
s
ig
n
if
ican
t
p
r
ed
icto
r
s
o
f
a
s
tr
o
n
g
er
p
e
r
ce
iv
e
d
HR
M
f
it
f
o
r
d
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[
1
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Ou
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CO
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DATA AV
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d
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to
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tain
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estrictio
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RE
F
E
R
E
NC
E
S
[
1
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
D
i
sa
b
i
l
i
t
y
a
n
d
H
e
a
l
t
h
.
”
h
t
t
p
s:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
h
e
a
l
t
h
-
t
o
p
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c
s/
d
i
sa
b
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l
i
t
y
(
a
c
c
e
ss
e
d
M
a
r
.
1
3
,
2
0
2
4
)
.
[
2
]
U
n
i
t
e
d
N
a
t
i
o
n
s
,
“
Tr
a
n
sf
o
r
m
i
n
g
o
u
r
w
o
r
l
d
:
T
h
e
2
0
3
0
a
g
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d
a
f
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r
s
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st
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l
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d
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v
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l
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p
me
n
t
,
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e
p
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r
t
m
e
n
t
o
f
Ec
o
n
o
m
i
c
a
n
d
S
o
c
i
a
l
Af
f
a
i
rs
S
u
s
t
a
i
n
a
b
l
e
D
e
v
e
l
o
p
m
e
n
t
,
2
0
1
5
.
[3
]
I
n
t
e
r
n
a
t
i
o
n
a
l
L
a
b
o
u
r
O
r
g
a
n
i
z
a
t
i
o
n
,
“
W
o
r
l
d
E
m
p
l
o
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m
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n
t
a
n
d
S
o
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i
a
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O
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k
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n
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r
O
r
g
a
n
i
z
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t
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n
,
2
0
2
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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u
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viro
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p
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in
Ma
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:
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(
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1497
[
4
]
S
.
L
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a
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.
C
a
g
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o
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N
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i
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[
5
]
B
.
G
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k
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.
P
.
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n
tl
y
wo
r
k
in
g
in
Co
m
m
u
n
it
y
M
e
d
icin
e
a
n
d
P
u
b
li
c
He
a
lt
h
De
p
a
rtme
n
t.
He
r
sp
e
c
i
a
li
z
a
ti
o
n
s
in
c
lu
d
e
fa
m
il
y
h
e
a
lt
h
,
one
h
e
a
lt
h
a
n
d
field
e
p
i
d
e
m
io
lo
g
y
.
He
r
re
se
a
rc
h
i
n
tere
st
i
n
c
lu
d
e
s
a
d
o
les
c
e
n
t
h
e
a
lt
h
,
m
e
n
tal
h
e
a
lt
h
,
sp
e
c
ial
n
e
e
d
s
c
h
il
d
re
n
,
a
n
d
c
o
m
m
u
n
ica
b
le
d
ise
a
se
.
S
h
e
can
be
c
o
n
tac
ted
at
e
m
a
il
:
sra
z
it
a
sh
a
m
@u
n
ima
s.m
y
.
Ro
sa
li
a
S
a
i
m
o
n
is
a
se
n
io
r
le
c
tu
re
r
a
t
th
e
F
a
c
u
lt
y
o
f
M
e
d
icin
e
a
n
d
He
a
lt
h
S
c
ien
c
e
s,
UN
IM
AS.
He
r
P
h
.
D
.
i
n
S
o
c
ial
a
n
d
P
re
v
e
n
ti
v
e
M
e
d
icin
e
(He
a
lt
h
P
ro
m
o
ti
o
n
)
f
o
c
u
se
s
o
n
th
e
b
io
-
p
sy
c
h
o
-
so
c
ial
n
e
e
d
s
o
f
i
n
d
i
v
id
u
a
ls
a
n
d
c
o
m
m
u
n
it
ies
wit
h
in
d
y
n
a
m
ic
e
n
v
ir
o
n
m
e
n
ts
wit
h
p
sy
c
h
o
so
c
ial
stim
u
li
t
h
a
t
p
r
o
m
o
te
h
e
a
lt
h
a
n
d
we
ll
-
b
e
in
g
.
He
r
re
se
a
r
c
h
in
tere
sts
in
c
lu
d
e
a
d
o
les
c
e
n
t
h
e
a
lt
h
,
e
l
d
e
rly
h
e
a
lt
h
,
m
e
n
tal
h
e
a
lt
h
,
a
n
d
sa
lu
t
o
g
e
n
ic
b
u
il
t
e
n
v
iro
n
m
e
n
t
a
sp
e
c
ts.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
at
e
m
a
il
:
sro
sa
li
a
@u
n
i
m
a
s.m
y
.
Yo
k
e
Yo
n
g
Chen
is
a
se
n
io
r
le
c
tu
re
r
a
t
t
h
e
F
a
c
u
lt
y
o
f
M
e
d
icin
e
a
n
d
He
a
lt
h
S
c
ien
c
e
s,
UN
IM
AS.
in
th
e
M
a
lay
sia
n
M
in
i
stry
o
f
He
a
lt
h
.
He
r
P
h
.
D
.
in
P
s
y
c
h
o
l
o
g
y
(He
a
lt
h
)
fo
c
u
se
s
o
n
th
e
re
latio
n
sh
i
p
b
e
twe
e
n
tra
u
m
a
ti
c
e
x
p
e
rien
c
e
s
a
n
d
p
o
st
-
trau
m
a
ti
c
stre
s
s
d
iso
r
d
e
r
a
m
o
n
g
p
a
ti
e
n
ts
wit
h
c
a
rd
io
v
a
sc
u
lar
c
o
n
d
it
i
o
n
s.
He
r
re
se
a
rc
h
a
d
d
re
ss
e
s
th
e
h
o
li
sti
c
b
i
o
-
p
sy
c
h
o
-
so
c
ial
n
e
e
d
s
o
f
in
d
i
v
id
u
a
ls
i
n
b
o
th
c
o
m
m
u
n
i
ty
a
n
d
h
e
a
lt
h
c
a
re
se
tt
in
g
s.
He
r
w
o
rk
i
n
c
lu
d
e
s
i
n
terv
e
n
t
io
n
st
u
d
ies
a
n
d
re
se
a
rc
h
o
n
re
h
a
b
il
it
a
ti
o
n
stra
teg
i
e
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
at
e
m
a
il
:
y
y
c
h
e
n
@u
n
ima
s.m
y
.
S
h
a
r
ifa
Ez
a
t
b
i
n
ti
W
a
n
Pu
te
h
is
a
se
n
io
r
lec
tu
re
r
a
t
t
h
e
De
p
a
rtme
n
t
o
f
P
u
b
li
c
He
a
lt
h
M
e
d
icin
e
,
F
a
c
u
l
ty
o
f
M
e
d
icin
e
,
Un
i
v
e
rsiti
Ke
b
a
n
g
sa
a
n
M
a
lay
sia
.
He
r
P
h
.
D.
i
n
P
u
b
li
c
He
a
lt
h
-
He
a
lt
h
Eco
n
o
m
ics
fo
c
u
se
s
o
n
HPV
v
a
c
c
in
e
c
o
st
-
e
ffe
c
ti
v
e
n
e
ss
,
sh
a
p
in
g
M
a
lay
sia
’s
v
a
c
c
in
a
ti
o
n
p
o
l
icy
.
S
h
e
h
a
s
h
e
l
d
k
e
y
a
c
a
d
e
m
ic
a
n
d
a
d
m
in
istrati
v
e
ro
les
,
in
c
lu
d
in
g
De
a
n
o
f
t
h
e
Ce
n
tre
fo
r
Cit
ra
S
tu
d
ies
(P
P
CU
),
De
p
u
ty
De
a
n
,
a
n
d
He
a
d
o
f
Ca
se
M
ix
&
Co
d
in
g
.
Ac
ti
v
e
l
y
in
v
o
lv
e
d
in
h
e
a
lt
h
p
o
li
c
y
,
re
se
a
rc
h
,
a
n
d
c
o
n
su
lt
a
n
c
y
,
s
h
e
c
o
ll
a
b
o
ra
tes
with
m
in
istri
e
s,
u
n
iv
e
rsiti
e
s
,
a
n
d
i
n
tern
a
ti
o
n
a
l
b
o
d
ies
o
n
h
e
a
lt
h
fi
n
a
n
c
in
g
,
sm
o
k
i
n
g
c
o
n
tro
l
,
a
n
d
p
u
b
li
c
h
e
a
lt
h
re
fo
rm
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
at
e
m
a
il
:
s
h
_
e
z
a
t@h
c
tm.u
m
.
e
d
u
.
m
y
.
Abg
S
a
fu
a
n
Adena
n
is
a
r
e
c
e
n
t
g
ra
d
u
a
te
in
P
u
b
l
ic
He
a
lt
h
fro
m
th
e
F
a
c
u
lt
y
o
f
M
e
d
icin
e
a
n
d
He
a
lt
h
S
c
ie
n
c
e
s,
UN
IM
AS.
His
p
o
stg
ra
d
u
a
te
re
se
a
rc
h
wo
rk
fo
c
u
se
s
o
n
e
x
p
lo
r
in
g
th
e
b
a
rriers
a
n
d
e
n
h
a
n
c
e
rs
o
f
e
m
p
lo
y
m
e
n
t
fo
r
p
e
rso
n
wit
h
Do
wn
sy
n
d
r
o
m
e
in
M
a
lay
sia
.
Hi
s
re
se
a
rc
h
in
tere
st
in
c
l
u
d
e
s
s
o
c
ial
a
n
d
p
re
v
e
n
ti
v
e
m
e
d
icin
e
,
d
isa
b
i
li
t
y
st
u
d
ies
,
a
n
d
e
p
i
d
e
m
io
lo
g
y
.
At
th
e
ti
m
e
o
f
writi
n
g
,
h
e
is
c
u
rre
n
tl
y
a
h
o
u
se
o
ffice
r
se
rv
in
g
u
n
d
e
r
th
e
M
in
istry
o
f
He
a
lt
h
,
M
a
lay
sia
.
He
c
a
n
b
e
c
o
n
tac
ted
at
e
m
a
il
:
a
b
g
sa
fu
a
n
0
8
@
g
m
a
il
.
c
o
m
.
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