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it
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s
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e
sp
e
c
ially
with
in
p
rima
ry
c
a
re
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e
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ss
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g
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ra
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IT)
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te
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li
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isk
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re
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th
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l
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re
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rd
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ters
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ial
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d
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fin
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l
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ly
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rimin
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ti
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p
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it
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f
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IT
wa
s
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ted
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ra
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teristic
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ly
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n
ts
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n
a
ly
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e
d
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we
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=
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s
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g
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w
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risk
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d
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u
a
ls.
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v
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ra
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TAG
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IT
d
e
m
o
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stra
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m
o
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te
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ty
a
s
a
p
re
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n
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re
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g
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m
e
n
t
in
p
rima
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h
e
a
lt
h
c
a
re
,
p
a
rti
c
u
larly
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n
ti
f
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in
g
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n
d
i
v
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d
u
a
ls
u
n
li
k
e
ly
to
h
a
v
e
p
re
d
iab
e
tes
.
K
ey
w
o
r
d
s
:
OGT
T
Pre
d
iab
etes
Prim
ar
y
h
ea
lth
ca
r
e
Scr
ee
n
in
g
T
AG
-
IT
T
h
is i
s
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o
p
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c
c
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ss
a
rticle
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n
d
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r th
e
CC B
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SA
li
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se
.
C
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s
p
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A
uth
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r
:
Yaltaf
it Ab
r
o
r
J
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m
Dep
ar
tm
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t o
f
Pu
b
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Hea
lth
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Facu
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Me
d
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Un
iv
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s
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tas I
s
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d
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St
.
Kaliu
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Km
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1
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5
,
Slem
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4
@
u
ii.a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Pre
d
iab
etes,
wh
ich
e
n
co
m
p
ass
es
im
p
air
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f
asti
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g
g
lu
c
o
s
e
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I
FG)
a
n
d
im
p
air
ed
g
lu
c
o
s
e
to
ler
an
c
e
(
I
GT
)
,
r
ep
r
esen
ts
an
in
ter
m
e
d
iate
m
etab
o
lic
s
tate
ass
o
ciate
d
with
a
s
u
b
s
tan
tially
in
cr
e
ased
lik
elih
o
o
d
o
f
d
ev
elo
p
in
g
ty
p
e
2
d
iab
etes
m
ellitu
s
(
T
2
DM
)
.
T
h
is
c
o
n
d
itio
n
h
as
b
ee
n
wid
ely
in
v
esti
g
ate
d
d
u
e
to
its
s
tr
o
n
g
p
r
ed
ictiv
e
v
alu
e
f
o
r
f
u
tu
r
e
d
ia
b
etes
an
d
its
o
cc
u
r
r
en
ce
ac
r
o
s
s
d
iv
er
s
e
p
o
p
u
latio
n
g
r
o
u
p
s
[
1
]
-
[
3
]
.
Acc
o
r
d
in
g
to
r
ec
en
t
esti
m
ates
f
r
o
m
th
e
I
n
te
r
n
atio
n
al
Diab
etes
Fed
er
atio
n
(
I
DF)
,
th
e
g
lo
b
al
a
g
e
-
s
tan
d
ar
d
ized
p
r
ev
alen
ce
i
n
2
0
2
1
was
ap
p
r
o
x
im
ately
9
.
1
%
f
o
r
I
GT
an
d
5
.
8
%
f
o
r
I
FG.
Pro
jectio
n
s
s
u
g
g
est
a
f
u
r
th
e
r
in
cr
ea
s
e
b
y
2
0
4
5
,
r
ea
ch
in
g
ab
o
u
t
1
0
.
0
%
f
o
r
I
GT
an
d
6
.
5
%
f
o
r
I
FG.
T
h
e
m
o
s
t
m
ar
k
ed
r
elativ
e
g
r
o
wth
is
a
n
ticip
ated
in
l
o
w
-
in
co
m
e
co
u
n
tr
ies
[
1
]
.
I
DF
r
ep
o
r
ts
also
h
ig
h
lig
h
t
th
at
I
n
d
o
n
esia
r
an
k
s
am
o
n
g
th
e
co
u
n
tr
ies
with
t
h
e
h
ig
h
est
n
u
m
b
er
o
f
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
E
va
lu
a
tin
g
t
h
e
p
erfo
r
ma
n
ce
o
f
TAG
-
I
T fo
r
p
r
ed
ia
b
etes d
etec
tio
n
in
I
n
d
o
n
esia
n
…
(
Ya
lta
fit
A
b
r
o
r
Je
em
)
33
ad
u
lts
liv
in
g
with
d
iab
etes,
b
o
th
cu
r
r
en
tly
an
d
in
f
u
t
u
r
e
p
r
o
j
ec
tio
n
s
f
o
r
2
0
5
0
,
a
n
d
r
em
ain
s
with
in
th
e
to
p
ten
n
atio
n
s
f
o
r
u
n
d
ia
g
n
o
s
ed
d
iab
e
tes in
2
0
2
4
,
with
an
esti
m
ated
7
3
.
2
% o
f
ca
s
es y
et
to
b
e
id
e
n
tifie
d
[
3
]
.
Pre
d
iab
etes
r
ep
r
esen
ts
a
r
ev
er
s
ib
le
m
etab
o
lic
s
tate
th
at
f
r
eq
u
e
n
tly
r
em
ain
s
u
n
d
iag
n
o
s
ed
in
c
o
m
m
u
n
ity
s
ettin
g
s
[
4
]
.
Ma
n
y
in
d
i
v
id
u
al
s
with
p
r
e
d
iab
etes
r
em
ai
n
u
n
d
iag
n
o
s
ed
b
ec
au
s
e
elev
ated
b
lo
o
d
g
lu
co
s
e
lev
els
ty
p
ically
d
o
n
o
t
p
r
o
d
u
ce
n
o
tice
ab
le
clin
ical
m
an
if
estatio
n
s
u
n
til
p
r
o
g
r
ess
io
n
to
ty
p
e
2
d
ia
b
et
es
m
ellitu
s
(
T
2
DM
)
o
cc
u
r
s
[
2
]
.
I
m
p
lem
e
n
tin
g
s
cr
ee
n
in
g
s
tr
ateg
ies
allo
ws
ea
r
lier
id
en
tific
atio
n
an
d
in
ter
v
en
tio
n
d
u
r
in
g
th
is
in
ter
m
ed
iate
m
etab
o
lic
s
tag
e,
wh
ich
is
s
till
p
o
ten
tially
r
ev
er
s
ib
le
an
d
th
er
ef
o
r
e
cr
itical
f
o
r
p
r
ev
en
tin
g
lo
n
g
-
ter
m
co
m
p
licatio
n
s
[
2
]
,
[
5
]
,
[
6
]
.
T
h
e
d
iag
n
o
s
is
o
f
p
r
ed
iab
etes
is
co
m
m
o
n
ly
estab
lis
h
ed
th
r
o
u
g
h
f
asti
n
g
p
lasm
a
g
lu
co
s
e
(
FP
G)
,
o
r
al
g
lu
co
s
e
to
ler
an
ce
test
in
g
(
OGT
T
)
,
o
r
m
ea
s
u
r
em
en
t
o
f
g
ly
ca
ted
h
em
o
g
l
o
b
in
(
Hb
A1
c)
[
5
]
,
[
7
]
.
Ne
v
er
th
eless
,
th
ese
d
iag
n
o
s
tic
ap
p
r
o
ac
h
es
d
ep
en
d
o
n
la
b
o
r
ato
r
y
f
ac
ilit
ies
an
d
en
tail
f
in
an
cial
an
d
lo
g
is
tical
co
n
s
tr
ain
ts
,
lim
itin
g
th
eir
f
ea
s
i
b
ilit
y
f
o
r
wid
esp
r
ea
d
ap
p
licatio
n
in
lar
g
e
p
o
p
u
latio
n
s
s
u
ch
a
s
I
n
d
o
n
esia.
T
h
er
e
is
a
clea
r
n
ee
d
f
o
r
s
cr
ee
n
in
g
in
s
tr
u
m
e
n
ts
th
at
ar
e
p
r
ac
tical,
n
o
n
in
v
asiv
e,
well
ac
ce
p
ted
b
y
t
h
e
co
m
m
u
n
ity
,
an
d
ec
o
n
o
m
ically
f
ea
s
ib
le
to
s
u
p
p
o
r
t
ea
r
ly
id
e
n
tific
atio
n
o
f
p
r
e
d
iab
etes.
An
ef
f
ec
tiv
e
to
o
l
s
h
o
u
ld
d
em
o
n
s
tr
ate
s
u
f
f
icien
t
s
en
s
itiv
ity
to
d
etec
t
in
d
iv
i
d
u
als
at
elev
ated
r
is
k
wh
ile
m
ain
tain
in
g
a
d
eq
u
ate
s
p
ec
if
icity
to
r
ed
u
ce
m
is
class
if
icatio
n
,
in
clu
d
in
g
b
o
th
f
alse
-
p
o
s
itiv
e
an
d
f
alse
-
n
eg
ativ
e
r
esu
lts
[
4
]
,
[
8
]
-
[
1
1
]
.
Sev
er
al
r
is
k
ass
ess
m
en
t
in
s
tr
u
m
en
ts
h
av
e
u
n
d
er
g
o
n
e
v
alid
at
io
n
in
th
e
I
n
d
o
n
esian
s
ettin
g
,
in
clu
d
in
g
th
e
I
n
d
o
n
esian
Pre
d
ia
b
etes
R
is
k
Sco
r
e
(
I
NA
-
PR
I
SC
)
an
d
th
e
Am
er
ican
Diab
etes
Ass
o
ciatio
n
(
ADA)
d
ia
b
etes
r
is
k
q
u
esti
o
n
n
air
e.
T
h
e
I
NA
-
PR
I
S
C
,
wh
ich
was
s
p
ec
if
ical
ly
d
ev
elo
p
ed
an
d
test
ed
with
in
th
e
I
n
d
o
n
esia
n
p
o
p
u
latio
n
,
d
em
o
n
s
tr
ated
a
s
en
s
itiv
ity
o
f
5
5
.
1
1
%
an
d
a
s
p
ec
if
icity
o
f
6
5
.
8
1
%
[
1
2
]
.
I
n
ad
d
itio
n
,
th
e
ADA
d
iab
etes
r
is
k
q
u
esti
o
n
n
air
e
h
as
b
ee
n
tr
an
s
lated
a
n
d
v
alid
ated
lo
ca
lly
,
y
ield
in
g
s
en
s
itiv
ity
a
n
d
s
p
ec
if
icity
v
alu
es
o
f
6
1
% a
n
d
7
1
%,
r
esp
ec
tiv
ely
[
1
3
]
.
T
h
e
to
o
l
to
ass
es
s
th
e
lik
elih
o
o
d
o
f
f
asti
n
g
g
lu
co
s
e
im
p
air
m
en
t
(
T
AG
-
I
T
)
was
o
r
ig
in
ally
in
tr
o
d
u
ce
d
in
th
e
Un
ited
State
s
as
a
b
r
ief
,
q
u
esti
o
n
n
air
e
-
b
ased
in
s
tr
u
m
en
t
d
esig
n
ed
to
esti
m
ate
th
e
p
r
o
b
ab
ilit
y
o
f
i
m
p
air
ed
f
asti
n
g
g
lu
co
s
e
u
s
in
g
d
em
o
g
r
ap
h
ic
an
d
clin
ical
r
is
k
in
d
i
ca
to
r
s
.
I
n
its
in
itial
v
alid
atio
n
s
tu
d
y
,
T
AG
-
I
T
d
em
o
n
s
tr
ated
b
etter
d
is
cr
im
in
ativ
e
p
er
f
o
r
m
an
ce
th
a
n
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
alo
n
e,
ac
h
i
ev
in
g
a
n
a
r
ea
u
n
d
er
th
e
cu
r
v
e
(
AUC)
o
f
0
.
7
4
4
.
W
h
en
a
cu
t
-
of
f
s
co
r
e
o
f
≥
5
was
ap
p
lied
,
th
e
to
o
l
s
h
o
wed
h
ig
h
s
en
s
itiv
ity
(
8
7
.
0
%),
s
u
p
p
o
r
tin
g
its
u
s
e
f
o
r
lar
g
e
-
s
c
ale
s
cr
ee
n
in
g
p
u
r
p
o
s
es.
C
o
n
v
er
s
ely
,
ap
p
ly
in
g
h
ig
h
er
cu
t
-
o
f
f
v
alu
es
(
≥
8
an
d
≥
9
)
in
cr
ea
s
ed
s
p
ec
if
icity
to
7
8
.
8
%
an
d
8
7
.
9
%,
r
esp
ec
tiv
ely
,
t
h
er
eb
y
im
p
r
o
v
i
n
g
its
ab
ilit
y
t
o
co
r
r
ec
tly
id
en
tif
y
in
d
iv
id
u
als with
o
u
t th
e
co
n
d
iti
o
n
[
1
4
]
.
Alth
o
u
g
h
th
ese
f
in
d
in
g
s
in
d
icate
f
av
o
r
ab
le
p
er
f
o
r
m
a
n
ce
in
th
e
o
r
ig
in
al
s
tu
d
y
p
o
p
u
latio
n
,
ev
id
e
n
ce
r
eg
ar
d
in
g
its
ap
p
licab
ilit
y
an
d
d
iag
n
o
s
tic
ac
cu
r
ac
y
in
t
h
e
I
n
d
o
n
esian
co
n
tex
t
r
em
ain
s
l
im
ited
.
T
h
is
s
tu
d
y
was
co
n
d
u
cted
to
ass
ess
th
e
d
iag
n
o
s
tic
p
er
f
o
r
m
an
ce
o
f
th
e
T
AG
-
I
T
q
u
esti
o
n
n
air
e
i
n
id
en
tify
in
g
p
r
ed
iab
etes
am
o
n
g
ad
u
lts
v
is
itin
g
th
r
ee
p
r
im
ar
y
h
ea
lth
ca
r
e
(
PHC
)
ce
n
ter
s
in
Y
o
g
y
ak
a
r
ta,
with
th
e
o
r
al
g
lu
co
s
e
to
ler
a
n
ce
test
(
OGT
T
)
s
er
v
in
g
as
th
e
r
ef
er
e
n
ce
s
tan
d
ar
d
.
T
h
e
r
esu
lts
ar
e
in
ten
d
ed
to
p
r
o
v
id
e
ev
id
en
ce
th
at
m
ay
s
u
p
p
o
r
t
th
e
d
ev
elo
p
m
en
t
o
f
ef
f
icien
t
a
n
d
ec
o
n
o
m
ically
f
ea
s
ib
le
s
cr
ee
n
in
g
ap
p
r
o
ac
h
es
f
o
r
p
r
ed
iab
etes w
ith
in
PHC
s
er
v
ices.
T
o
th
e
b
est o
f
o
u
r
k
n
o
wled
g
e,
th
is
in
v
esti
g
atio
n
is
th
e
f
ir
s
t stu
d
y
to
e
x
am
in
e
th
e
v
alid
ity
o
f
T
AG
-
I
T
in
a
n
I
n
d
o
n
esian
p
o
p
u
latio
n
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
A
cr
o
s
s
-
s
ec
tio
n
al
d
iag
n
o
s
tic
a
cc
u
r
ac
y
s
tu
d
y
was
co
n
d
u
cted
to
d
eter
m
in
e
th
e
ab
ilit
y
o
f
th
e
T
AG
-
I
T
q
u
esti
o
n
n
air
e
to
d
etec
t
p
r
ed
iab
etes.
T
h
e
s
tu
d
y
r
ep
o
r
tin
g
ad
h
e
r
ed
to
th
e
STARD
2
0
1
5
g
u
i
d
elin
es
f
o
r
d
iag
n
o
s
tic
ac
cu
r
ac
y
r
esear
ch
.
E
th
ical
a
p
p
r
o
v
al
was
o
b
tain
ed
f
r
o
m
th
e
Facu
lty
R
esear
ch
E
th
ics
C
o
m
m
ittee
p
r
io
r
to
d
ata
co
llectio
n
.
2
.
2
.
Study
s
et
t
ing
T
h
e
r
esear
ch
was
ca
r
r
ied
o
u
t
in
th
r
ee
p
r
im
ar
y
h
ea
lth
ca
r
e
ce
n
ter
s
(
PHC
s
)
lo
ca
ted
in
Y
o
g
y
ak
a
r
ta,
I
n
d
o
n
esia.
Par
ticip
an
t
r
ec
r
u
it
m
en
t
an
d
d
ata
co
llectio
n
to
o
k
p
lace
b
etwe
en
J
u
n
e
-
Au
g
u
s
t
2
0
1
9
,
en
c
o
m
p
ass
in
g
in
itial scr
ee
n
in
g
,
ad
m
in
is
tr
atio
n
o
f
q
u
esti
o
n
n
air
es,
a
n
d
o
r
al
g
lu
co
s
e
to
ler
an
ce
test
in
g
(
OGT
T
)
.
2
.
3
.
P
a
rt
icip
a
nts a
nd
s
a
m
pli
ng
I
n
d
iv
id
u
als
ag
ed
2
0
y
ea
r
s
o
r
o
ld
er
wh
o
wer
e
r
e
g
is
ter
ed
at
th
e
s
elec
ted
PHC
s
wer
e
ap
p
r
o
ac
h
ed
u
s
in
g
PHC
r
ec
o
r
d
s
.
E
lig
ib
le
p
ar
ticip
an
ts
h
ad
n
o
p
r
e
v
io
u
s
d
ia
g
n
o
s
i
s
o
f
d
iab
etes
m
ellitu
s
,
wer
e
a
b
le
to
co
m
p
lete
th
e
T
AG
-
I
T
q
u
esti
o
n
n
air
e,
a
n
d
p
r
o
v
i
d
ed
wr
itten
in
f
o
r
m
e
d
co
n
s
en
t
to
u
n
d
er
g
o
OGT
T
ex
am
in
atio
n
.
E
x
clu
s
io
n
cr
iter
ia
co
m
p
r
is
ed
p
r
eg
n
an
cy
,
ac
u
te
o
r
s
ev
er
e
m
ed
ical
co
n
d
itio
n
s
,
cu
r
r
e
n
t
u
s
e
o
f
m
ed
icatio
n
s
k
n
o
wn
to
in
f
lu
en
ce
g
l
u
co
s
e
m
etab
o
lis
m
,
an
d
in
a
b
ilit
y
to
co
m
p
lete
b
o
th
th
e
q
u
esti
o
n
n
air
e
an
d
lab
o
r
ato
r
y
p
r
o
ce
d
u
r
es.
T
h
e
m
in
im
u
m
r
eq
u
ir
ed
s
am
p
le
s
ize
wa
s
e
s
tim
ated
at
3
0
7
p
ar
ticip
an
ts
,
ca
lcu
lated
b
ased
o
n
an
an
ticip
ated
s
en
s
itiv
ity
o
f
7
5
%,
a
p
r
ec
is
io
n
lev
el
o
f
5
%,
a
n
d
a
9
5
% c
o
n
f
i
d
en
ce
in
ter
v
al.
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.
15
,
No
.
1
,
M
ar
ch
20
26
:
32
-
42
34
2
.
4
.
T
AG
-
I
T
ins
t
rum
ent
a
nd
t
ra
ns
la
t
io
n
T
h
e
T
AG
-
I
T
q
u
est
io
n
n
air
e
in
clu
d
es
d
em
o
g
r
a
p
h
ic
a
n
d
clin
i
ca
l
r
is
k
in
d
icato
r
s
s
u
ch
as
a
g
e
,
s
ex
,
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
ca
teg
o
r
y
,
f
am
ily
h
is
to
r
y
o
f
d
iab
etes,
an
d
an
tih
y
p
er
te
n
s
iv
e
tr
ea
tm
en
t
s
tatu
s
.
T
h
e
o
r
ig
in
al
E
n
g
lis
h
v
er
s
io
n
was
tr
an
s
lated
in
to
B
ah
asa
I
n
d
o
n
esia
u
s
in
g
a
f
o
r
war
d
-
t
r
an
s
latio
n
ap
p
r
o
ac
h
,
f
o
llo
wed
b
y
r
ev
iew
b
y
ex
p
er
ts
to
e
n
s
u
r
e
lin
g
u
is
tic
clar
ity
an
d
cu
ltu
r
al
ap
p
r
o
p
r
iaten
ess
.
A
f
o
r
m
al
b
ac
k
-
tr
an
s
latio
n
p
r
o
ce
s
s
an
d
p
s
y
ch
o
m
etr
ic
e
v
alu
atio
n
wer
e
n
o
t p
er
f
o
r
m
e
d
.
T
h
e
tr
an
s
latio
n
p
r
o
ce
s
s
is
illu
s
tr
ated
in
Fig
u
r
e
1
.
2
.
5
.
O
G
T
T
pro
ce
du
re
All
en
r
o
lled
p
ar
ticip
an
ts
u
n
d
e
r
wen
t
a
s
tan
d
ar
d
7
5
-
g
o
r
al
g
l
u
co
s
e
to
ler
an
ce
test
in
ac
co
r
d
an
ce
with
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
r
ec
o
m
m
en
d
atio
n
s
[
1
2
]
.
Ven
o
u
s
b
lo
o
d
s
am
p
les
wer
e
o
b
tain
ed
af
ter
o
v
er
n
ig
h
t
f
asti
n
g
an
d
a
g
ain
t
wo
h
o
u
r
s
f
o
llo
win
g
g
lu
c
o
s
e
in
g
esti
o
n
.
Plas
m
a
g
lu
co
s
e
co
n
ce
n
tr
atio
n
s
wer
e
m
ea
s
u
r
ed
in
a
ce
r
tifie
d
lab
o
r
a
to
r
y
f
ac
ilit
y
.
Pre
d
ia
b
etes
was
d
ef
in
ed
as
im
p
air
e
d
f
asti
n
g
g
lu
co
s
e
(
I
FG;
f
asti
n
g
p
lasma
g
lu
co
s
e
1
0
0
–
1
2
5
m
g
/
d
L
)
,
im
p
air
e
d
g
lu
c
o
s
e
to
ler
an
ce
(
I
GT
;
2
-
h
o
u
r
p
lasma
g
lu
co
s
e
1
4
0
–
19
9
m
g
/
d
L
)
,
o
r
th
e
p
r
esen
ce
o
f
b
o
th
a
b
n
o
r
m
alities
[
1
3
]
.
S
am
p
les
af
f
ec
te
d
b
y
p
r
e
-
an
al
y
tical
is
s
u
es,
in
clu
d
in
g
h
em
o
ly
s
is
o
r
d
elay
ed
p
r
o
ce
s
s
in
g
,
wer
e
d
o
cu
m
en
ted
an
d
ex
clu
d
ed
wh
e
n
r
e
s
u
lts
wer
e
d
ee
m
ed
u
n
r
eliab
le.
2
.
6
.
Da
t
a
c
o
llect
io
n pro
ce
du
re
Par
ticip
an
ts
f
ir
s
t
co
m
p
leted
th
e
T
AG
-
I
T
q
u
esti
o
n
n
air
e,
f
o
llo
wed
b
y
an
th
r
o
p
o
m
et
r
ic
ass
ess
m
en
t
p
r
io
r
to
u
n
d
e
r
g
o
in
g
OGT
T
.
B
o
d
y
m
ea
s
u
r
em
en
ts
wer
e
o
b
tain
e
d
b
y
tr
ain
e
d
PHC
p
er
s
o
n
n
el
u
s
in
g
s
tan
d
ar
d
ized
p
r
o
ce
d
u
r
es.
T
h
e
o
v
er
all
s
tu
d
y
p
r
o
ce
s
s
is
p
r
esen
ted
in
th
e
f
lo
w
d
iag
r
am
in
Fig
u
r
e
2
.
2
.
7
.
St
a
t
is
t
ica
l a
na
ly
s
is
Diag
n
o
s
tic
ac
cu
r
ac
y
in
d
icato
r
s
wer
e
d
er
iv
ed
f
r
o
m
a
2
×2
co
n
tin
g
en
cy
tab
le
(
T
ab
le
1
)
,
in
clu
d
in
g
s
en
s
itiv
ity
,
s
p
ec
if
icity
,
p
o
s
itiv
e
p
r
ed
ictiv
e
v
alu
e
(
PP
V)
,
n
eg
a
tiv
e
p
r
ed
ictiv
e
v
alu
e
(
NPV)
,
p
o
s
itiv
e
an
d
n
eg
ati
v
e
lik
elih
o
o
d
r
atio
s
(
L
R
+
an
d
L
R
−)
,
an
d
o
v
er
all
ac
c
u
r
ac
y
.
R
ec
eiv
er
o
p
e
r
atin
g
ch
a
r
ac
ter
is
tic
(
R
OC
)
cu
r
v
e
an
aly
s
is
was p
er
f
o
r
m
ed
to
ass
ess
d
is
cr
i
m
in
ativ
e
ab
ilit
y
,
an
d
th
e
ar
ea
u
n
d
er
th
e
cu
r
v
e
(
AUC)
was in
ter
p
r
eted
ac
co
r
d
in
g
to
estab
lis
h
ed
b
en
ch
m
ar
k
s
.
T
h
e
o
p
t
im
al
cu
t
-
o
f
f
p
o
i
n
t
was
d
eter
m
in
ed
u
s
in
g
th
e
Yo
u
d
en
I
n
d
ex
,
as
r
ec
o
m
m
en
d
ed
in
d
iag
n
o
s
tic
v
alid
atio
n
s
tu
d
ies
[
1
5
]
.
T
h
e
p
r
ev
alen
ce
o
f
p
r
e
d
iab
etes
was
ca
lcu
lated
with
co
r
r
esp
o
n
d
in
g
9
5
%
co
n
f
id
en
c
e
in
ter
v
als.
Stati
s
tical
an
aly
s
e
s
wer
e
co
n
d
u
cted
u
s
in
g
SP
S
S
v
er
s
i
o
n
2
2
(
I
B
M
C
o
r
p
.
,
Ar
m
o
n
k
,
NY,
USA)
,
w
ith
two
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s
id
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v
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0
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0
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c
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s
id
er
ed
s
tatis
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s
ig
n
if
ican
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F
i
g
u
r
e
1
.
T
r
a
n
s
l
at
i
o
n
o
f
T
A
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T
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t
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e
s
i
a
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l
a
n
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a
g
e
F
i
g
u
r
e
2
.
R
es
e
a
r
c
h
w
o
r
k
f
l
o
w
f
o
r
T
A
G
-
I
T
v
a
l
i
d
a
ti
o
n
s
t
u
d
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
b
lic
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lth
Sci
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SS
N:
2252
-
8
8
0
6
E
va
lu
a
tin
g
t
h
e
p
erfo
r
ma
n
ce
o
f
TAG
-
I
T fo
r
p
r
ed
ia
b
etes d
etec
tio
n
in
I
n
d
o
n
esia
n
…
(
Ya
lta
fit
A
b
r
o
r
Je
em
)
35
T
a
b
l
e
1
.
C
r
o
s
s
-
t
a
b
u
la
t
i
o
n
o
f
T
A
G
-
I
T
v
s
OG
T
T
f
o
r
p
r
e
d
i
a
b
e
te
s
s
c
r
e
e
n
i
n
g
T
A
G
-
IT
O
G
T
T
(
G
o
l
d
s
t
a
n
d
a
r
d
)
P
o
s
i
t
i
v
e
(
P
r
e
d
i
a
b
e
t
e
s
)
N
e
g
a
t
i
v
e
(
N
o
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l
y
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)
T
A
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P
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t
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v
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TP
FP
T
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T
N
e
g
a
t
i
v
e
FN
TN
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
s
tu
d
y
was
ca
r
r
ied
o
u
t
in
two
r
eg
en
cies
with
in
th
e
Sp
ec
ial
R
eg
io
n
o
f
Yo
g
y
ak
ar
ta,
I
n
d
o
n
esia,
in
v
o
lv
in
g
th
r
ee
p
r
im
ar
y
h
ea
l
th
ca
r
e
ce
n
ter
s
(
p
u
s
ke
s
ma
s
)
:
Dep
o
k
I
I
an
d
Ng
a
g
lik
in
Slem
an
R
eg
en
cy
,
an
d
B
an
g
u
n
tap
an
I
I
in
B
an
tu
l
R
eg
en
cy
.
E
t
h
ical
clea
r
an
ce
was
g
r
an
ted
b
y
th
e
Me
d
ical
a
n
d
Hea
lth
R
esear
ch
E
th
ics
C
o
m
m
ittee,
Facu
lty
o
f
Me
d
ici
n
e,
Un
iv
er
s
itas
I
s
lam
I
n
d
o
n
esia.
I
n
itially
,
3
0
8
in
d
iv
i
d
u
als
co
n
s
en
ted
to
p
ar
ticip
ate
a
n
d
wer
e
en
r
o
lled
i
n
th
e
s
tu
d
y
.
Ho
w
ev
er
,
o
n
ly
pa
r
ticip
an
ts
with
co
m
p
lete
a
n
d
r
eliab
le
d
atasets
wer
e
in
clu
d
ed
in
th
e
f
i
n
al
an
aly
s
is
.
Par
ticip
an
t
attr
itio
n
o
cc
u
r
r
e
d
f
o
r
s
ev
er
al
r
ea
s
o
n
s
.
R
esp
o
n
d
en
t
-
r
elate
d
f
ac
to
r
s
in
clu
d
ed
f
ailu
r
e
to
atten
d
s
ch
ed
u
led
b
lo
o
d
ex
am
in
atio
n
s
an
d
n
o
n
-
ad
h
e
r
e
n
ce
to
f
asti
n
g
in
s
tr
u
ct
io
n
s
p
r
io
r
to
OGT
T
.
L
ab
o
r
ato
r
y
-
r
elat
ed
is
s
u
es
co
m
p
r
is
ed
h
em
o
ly
ze
d
s
am
p
les,
d
elay
ed
p
lasma
p
r
o
ce
s
s
in
g
,
im
p
r
o
p
e
r
tr
an
s
p
o
r
tatio
n
o
r
s
to
r
ag
e
co
n
d
i
tio
n
s
,
an
d
ex
ten
d
ed
tim
e
in
ter
v
als
b
etwe
en
s
p
ec
im
en
co
llectio
n
an
d
an
aly
s
is
.
Ad
d
itio
n
ally
,
r
esear
ch
-
r
elate
d
f
ac
to
r
s
s
u
ch
as
d
o
cu
m
e
n
tatio
n
e
r
r
o
r
s
an
d
s
u
b
o
p
tim
al
q
u
ality
c
o
n
tr
o
l
p
r
o
ce
d
u
r
es
co
n
t
r
ib
u
ted
to
d
ata
ex
clu
s
io
n
.
C
o
n
s
eq
u
e
n
tly
,
in
co
m
p
lete
o
r
u
n
r
eliab
le
r
ec
o
r
d
s
wer
e
r
em
o
v
e
d
f
r
o
m
th
e
f
in
al
d
ataset.
3
.
1
.
P
a
rt
icipa
nt
f
lo
w
a
nd
ch
a
ra
ct
er
is
t
ics
A
to
tal
o
f
9
3
p
ar
ticip
an
ts
m
et
all
s
tu
d
y
cr
iter
ia
an
d
wer
e
in
clu
d
ed
in
th
e
f
in
al
an
aly
s
is
.
T
h
e
d
e
m
o
g
r
a
p
h
ic
an
d
clin
ical
p
r
o
f
iles
ar
e
p
r
esen
te
d
in
T
ab
le
2
.
Am
o
n
g
th
e
p
ar
ticip
an
ts
,
2
7
(
2
9
.
0
%)
wer
e
m
ale
,
an
d
6
6
(
7
1
.
0
%)
wer
e
f
em
ale,
with
th
e
m
ajo
r
ity
b
elo
n
g
i
n
g
t
o
th
e
m
i
d
d
le
-
ag
e
d
ca
te
g
o
r
y
.
T
h
e
lar
g
est
ag
e
g
r
o
u
p
was 4
5
–
6
4
y
ea
r
s
,
r
ep
r
esen
tin
g
4
5
.
2
% o
f
th
e
s
am
p
le.
C
en
tr
al
o
b
esit
y
was
h
ig
h
ly
p
r
ev
alen
t,
o
b
s
er
v
ed
i
n
6
1
p
ar
ticip
an
ts
(
6
5
.
6
%),
w
h
ile
4
3
.
0
%
wer
e
ca
teg
o
r
ized
as
h
av
in
g
class
I
o
b
esit
y
.
B
ased
o
n
OGT
T
r
esu
lts
,
th
e
p
r
ev
alen
ce
o
f
p
r
e
d
i
ab
etes
was
2
4
.
7
%
(
2
3
o
u
t
o
f
9
3
p
ar
ticip
an
ts
)
.
Sp
ec
if
ically
,
7
.
5
%
wer
e
class
if
ied
as
h
av
in
g
im
p
air
e
d
f
asti
n
g
g
lu
co
s
e
(
I
FG)
,
an
d
1
7
.
2
%
h
a
d
im
p
air
e
d
g
lu
c
o
s
e
to
ler
an
ce
(
I
GT
)
.
Am
o
n
g
in
d
iv
i
d
u
als
id
en
tifie
d
with
p
r
ed
iab
et
es,
th
e
m
ea
n
f
asti
n
g
p
lasma
g
lu
co
s
e
lev
el
was
9
2
.
5
2
±
9
.
8
8
m
g
/d
L
,
an
d
t
h
e
m
ea
n
2
-
h
o
u
r
p
o
s
t
-
lo
a
d
g
lu
c
o
s
e
co
n
c
en
tr
atio
n
was
1
4
6
.
9
5
±
2
8
.
9
m
g
/d
L
.
T
ab
le
2
.
B
asic c
h
ar
ac
ter
is
tics
o
f
s
tu
d
y
p
ar
ticip
an
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
P
r
e
d
i
a
b
e
t
e
s (n
=
2
3
)
N
o
r
mo
g
l
y
c
e
mi
a
(
n
=
7
0
)
S
e
x
,
n
(
5
)
M
a
l
e
6
(
2
6
.
1
)
2
1
(
3
0
.
0
)
F
e
mal
e
1
7
(
7
3
.
9
)
5
0
(
7
0
.
0
)
A
g
e
(
y
e
a
r
s)
M
e
a
n
±
S
D
4
5
.
3
±
1
2
.
9
3
9
.
0
±
1
3
.
1
A
g
e
g
r
o
u
p
4
5
–
6
4
y
e
a
r
s,
n
(
%)
1
3
(
5
6
.
5
)
2
9
(
4
1
.
4
)
A
n
t
h
r
o
p
o
met
r
i
c
mea
s
u
r
e
s
B
o
d
y
w
e
i
g
h
t
(
k
g
)
,
m
e
a
n
±
S
D
6
1
.
5
±
1
3
.
0
6
5
.
1
±
1
5
.
1
H
e
i
g
h
t
(
c
m)
,
me
a
n
±
S
D
1
5
5
.
0
±
9
.
3
1
5
5
.
6
±
8
.
6
W
a
i
st
c
i
r
c
u
mf
e
r
e
n
c
e
(
c
m)
,
me
a
n
±
S
D
8
7
.
3
±
1
2
.
8
8
5
.
9
±
1
1
.
5
B
M
I
c
a
t
e
g
o
r
y
,
n
(
%)*
N
o
r
mal
o
r
u
n
d
e
r
w
e
i
g
h
t
(
<
2
3
k
g
/
m²
)
4
(
1
7
.
4
)
2
5
(
3
5
.
7
)
O
v
e
r
w
e
i
g
h
t
/
p
re
-
o
b
e
s
e
(
2
3
–
2
4
.
9
k
g
/
m²
)
2
(
8
.
7
)
8
(
1
1
.
4
)
O
b
e
si
t
y
(
≥
2
5
k
g
/
m²
)
1
7
(
7
3
.
9
)
3
7
(
5
2
.
9
)
M
e
a
n
B
M
I
(
k
g
/
m²
)
,
m
e
a
n
±
S
D
2
6
.
2
±
3
.
9
2
5
.
3
±
4
.
2
C
e
n
t
r
a
l
o
b
e
si
t
y
,
n
(
%)
Y
e
s
1
7
(
7
3
.
9
)
4
4
(
6
2
.
9
)
F
a
mi
l
y
h
i
st
o
r
y
o
f
d
i
a
b
e
t
e
s
,
n
(
%)
Y
e
s
4
(
1
7
.
4
)
0
(
0
.
0
)
B
l
o
o
d
p
r
e
ss
u
r
e
(
mm
H
g
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S
y
st
o
l
i
c
B
P
,
me
a
n
±
S
D
1
2
2
.
2
±
1
7
.
3
1
1
8
.
8
±
1
3
.
5
D
i
a
st
o
l
i
c
B
P
,
me
a
n
±
S
D
8
0
.
4
±
1
0
.
2
7
8
.
1
±
8
.
7
P
l
a
sma
g
l
u
c
o
se
l
e
v
e
l
s
(
m
g
/
d
L)
*
F
a
st
i
n
g
p
l
a
sma
g
l
u
c
o
s
e
,
mea
n
±
S
D
9
2
.
5
±
9
.
9
8
3
.
0
±
1
0
.
8
2
-
h
o
u
r
O
G
TT
g
l
u
c
o
s
e
,
m
e
a
n
±
S
D
1
4
7
.
0
±
2
8
.
9
1
0
3
.
2
±
1
7
.
0
3
3
.
2
.
Dia
g
no
s
t
ic
perf
o
rma
nce
o
f
T
AG
-
IT
T
h
e
p
e
r
f
o
r
m
an
ce
o
f
th
e
T
AG
-
IT
q
u
esti
o
n
n
air
e
in
d
etec
tin
g
p
r
ed
iab
etes
was
e
v
alu
ate
d
u
s
in
g
two
an
aly
tical
ap
p
r
o
ac
h
es:
r
ec
eiv
e
r
o
p
er
atin
g
ch
ar
ac
ter
is
tic
(
R
O
C
)
cu
r
v
e
an
aly
s
is
an
d
ca
lcu
la
tio
n
o
f
d
ia
g
n
o
s
tic
ac
cu
r
ac
y
m
ea
s
u
r
es
d
er
iv
ed
f
r
o
m
a
2
×2
c
o
n
tin
g
e
n
cy
tab
le
(
s
ee
T
ab
le
3
)
.
3
.
2
.
1
.
RO
C
cur
v
e
a
na
ly
s
is
As illu
s
tr
ated
in
Fig
u
r
e
3
,
R
O
C
cu
r
v
e
an
aly
s
is
p
r
o
d
u
ce
d
an
ar
ea
u
n
d
e
r
th
e
cu
r
v
e
(
AUC)
o
f
0
.
6
5
6
(
9
5
%
C
I
0
.
5
2
5
–
0
.
7
8
6
;
p
=
0
.
0
2
6
)
,
in
d
icatin
g
m
o
d
est
d
is
cr
im
in
ativ
e
ca
p
ac
ity
o
f
T
AG
-
I
T
in
d
if
f
er
e
n
tiatin
g
in
d
i
v
id
u
als
with
p
r
ed
iab
etes
f
r
o
m
th
o
s
e
with
n
o
r
m
al
g
lu
c
o
s
e
to
ler
an
ce
(
Fig
u
r
e
4
)
.
T
h
e
o
p
tim
al
cu
t
-
o
f
f
v
alu
e
d
eter
m
in
ed
u
s
in
g
Yo
u
d
en
’
s
in
d
e
x
d
e
m
o
n
s
tr
ated
co
m
p
a
r
ab
le
d
iag
n
o
s
tic
p
er
f
o
r
m
an
ce
to
th
e
p
r
ed
ef
i
n
ed
s
co
r
in
g
th
r
esh
o
ld
.
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.
15
,
No
.
1
,
M
ar
ch
20
26
:
32
-
42
36
Alth
o
u
g
h
th
e
AUC
r
ef
lects
lim
ited
ac
cu
r
ac
y
,
it
r
e
m
ain
ed
s
ig
n
if
ican
tly
ab
o
v
e
t
h
e
r
ef
er
e
n
ce
v
alu
e
o
f
0
.
5
0
,
s
u
g
g
esti
n
g
th
at
th
e
in
s
tr
u
m
en
t
p
er
f
o
r
m
s
b
etter
th
an
r
an
d
o
m
c
lass
if
icatio
n
.
Fig
u
r
e
3
.
AUC C
u
r
v
e
f
r
o
m
th
e
R
OC
Me
th
o
d
f
o
r
T
AG
-
I
T
V
alu
es.
Ar
ea
u
n
d
e
r
th
e
cu
r
v
e
(
A
UC
)
: 6
5
.
6
% (
9
5
%
C
I
: 5
2
.
5
%
–
7
8
.
6
%),
p
-
v
alu
e:
0
.
0
2
6
(
p
<
0
.
0
5
)
Fig
u
r
e
4
.
Sch
em
atic
c
o
m
p
ar
is
o
n
o
f
T
AG
-
I
T
co
m
p
ar
ed
with
OGT
T
-
b
ased
p
r
ed
ia
b
etes statu
s
3
.
2
.
2
.
Co
nting
ency
t
a
ble a
na
ly
s
is
T
o
p
r
o
v
id
e
a
clea
r
er
r
ep
r
ese
n
tatio
n
o
f
th
e
a
g
r
ee
m
e
n
t
b
et
wee
n
T
AG
-
I
T
class
if
icatio
n
an
d
OGT
T
-
co
n
f
ir
m
e
d
p
r
ed
iab
etes
s
tatu
s
,
Fig
u
r
e
4
p
r
esen
ts
th
e
d
is
tr
ib
u
tio
n
o
f
tr
u
e
p
o
s
itiv
e,
f
alse
p
o
s
itiv
e,
f
alse
n
eg
ativ
e,
an
d
tr
u
e
n
eg
ativ
e
r
esu
lts
d
er
iv
e
d
f
r
o
m
th
e
2
×2
co
n
tin
g
en
cy
tab
le
(
T
ab
le
3
)
.
Am
o
n
g
th
e
9
3
p
a
r
ticip
an
ts
an
aly
ze
d
,
2
3
wer
e
d
ia
g
n
o
s
ed
with
p
r
ed
i
ab
etes
b
ased
o
n
OGT
T
,
c
o
r
r
es
p
o
n
d
in
g
t
o
a
p
r
e
-
test
p
r
o
b
ab
ili
ty
o
f
2
4
.
7
%,
wh
ile
7
0
wer
e
class
if
ied
as
n
o
r
m
o
g
l
y
ce
m
ic.
T
AG
-
I
T
co
r
r
ec
tly
id
e
n
tifie
d
1
2
tr
u
e
p
o
s
itiv
e
an
d
4
7
tr
u
e
n
eg
ativ
e
ca
s
es;
h
o
wev
er
,
1
1
in
d
iv
id
u
als
with
p
r
ed
iab
etes
wer
e
m
is
clas
s
if
ied
as
lo
w
r
is
k
(
f
alse
n
eg
ativ
es),
an
d
2
3
n
o
r
m
o
g
ly
ce
m
ic
p
a
r
ticip
an
ts
wer
e
in
co
r
r
ec
tly
ca
teg
o
r
ize
d
as
h
ig
h
r
is
k
(
f
alse p
o
s
itiv
es).
T
h
ese
d
is
tr
ib
u
tio
n
s
co
r
r
esp
o
n
d
to
a
s
en
s
itiv
ity
o
f
5
2
.
2
%
an
d
a
s
p
ec
if
icity
o
f
6
7
.
1
%,
with
an
o
v
er
all
class
if
icatio
n
ac
cu
r
ac
y
o
f
6
3
.
4
%.
T
h
e
p
o
s
itiv
e
p
r
ed
ictiv
e
v
alu
e
was
3
4
.
3
%,
wh
er
ea
s
t
h
e
n
eg
ativ
e
p
r
ed
ictiv
e
v
alu
e
r
ea
ch
ed
8
1
.
0
%,
in
d
icati
n
g
b
etter
p
er
f
o
r
m
a
n
ce
in
ex
clu
d
in
g
in
d
iv
i
d
u
als
with
o
u
t
p
r
ed
i
ab
etes.
T
h
e
p
o
s
itiv
e
lik
elih
o
o
d
r
atio
(
L
R
+)
o
f
1
.
5
8
an
d
n
eg
ativ
e
lik
elih
o
o
d
r
atio
(
L
R
−)
o
f
0
.
7
1
f
u
r
th
e
r
s
u
g
g
est
m
o
d
est
s
h
if
ts
f
r
o
m
p
r
e
-
te
s
t to
p
o
s
t
-
test
p
r
o
b
ab
ilit
y
,
co
n
s
is
ten
t w
ith
th
e
m
o
d
er
at
e
d
is
cr
im
in
ativ
e
ab
ilit
y
o
b
s
er
v
ed
in
th
is
s
tu
d
y
.
T
o
f
u
r
t
h
er
illu
s
tr
ate
th
e
clin
ic
al
im
p
licatio
n
s
o
f
th
e
d
ia
g
n
o
s
tic
p
er
f
o
r
m
a
n
ce
o
f
T
AG
-
I
T
,
a
Fag
an
’
s
n
o
m
o
g
r
am
was
co
n
s
tr
u
cted
(
F
ig
u
r
e
5
)
.
T
h
is
g
r
ap
h
ical
to
o
l
d
e
m
o
n
s
tr
ates
h
o
w
th
e
lik
elih
o
o
d
r
atio
s
d
er
iv
e
d
f
r
o
m
th
e
s
tu
d
y
m
o
d
if
y
th
e
p
r
e
-
test
p
r
o
b
ab
ilit
y
o
f
p
r
ed
iab
etes
in
to
a
p
o
s
t
-
test
p
r
o
b
a
b
ilit
y
.
As
s
h
o
w
n
in
Fig
u
r
e
5
,
u
s
in
g
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
E
va
lu
a
tin
g
t
h
e
p
erfo
r
ma
n
ce
o
f
TAG
-
I
T fo
r
p
r
ed
ia
b
etes d
etec
tio
n
in
I
n
d
o
n
esia
n
…
(
Ya
lta
fit
A
b
r
o
r
Je
em
)
37
a
p
r
e
-
test
p
r
o
b
ab
ilit
y
o
f
2
4
.
7
%
,
a
p
o
s
itiv
e
T
AG
-
I
T
r
esu
lt (
L
R
+
=
1
.
5
8
)
in
cr
ea
s
es th
e
p
o
s
t
-
te
s
t p
r
o
b
ab
ilit
y
o
n
ly
m
o
d
estl
y
,
in
d
icatin
g
lim
ited
a
b
ilit
y
to
s
u
b
s
tan
tially
co
n
f
ir
m
p
r
ed
iab
etes.
C
o
n
v
er
s
ely
,
a
n
eg
ativ
e
T
AG
-
I
T
r
esu
lt
(
L
R
−
=
0
.
7
1
)
r
e
d
u
ce
s
th
e
p
r
o
b
ab
ilit
y
to
a
lo
wer
lev
el,
alt
h
o
u
g
h
th
e
r
ed
u
ctio
n
is
m
o
d
er
ate.
T
h
ese
f
in
d
in
g
s
s
u
g
g
est th
at
T
AG
-
I
T
h
as g
r
ea
ter
u
tili
ty
as a
n
in
itial
r
is
k
s
tr
at
if
icatio
n
to
o
l to
h
elp
ex
clu
d
e
i
n
d
iv
id
u
als at
lo
wer
r
is
k
r
ath
er
th
a
n
as a
d
ef
in
itiv
e
d
iag
n
o
s
tic
in
s
tr
u
m
en
t.
T
ab
le
3
.
Diag
n
o
s
tic
p
er
f
o
r
m
an
ce
o
f
T
AG
-
I
T
c
o
m
p
a
r
ed
with
OGT
T
-
b
ased
p
r
ed
ia
b
etes statu
s
TA
G
-
IT
r
e
su
l
t
P
r
e
d
i
a
b
e
t
e
s
N
o
r
mo
g
l
y
c
e
mi
a
To
t
a
l
P
o
si
t
i
v
e
12
2
3
35
N
e
g
a
t
i
v
e
11
47
58
To
t
a
l
23
70
93
Fig
u
r
e
5
.
Fag
a
n
’
s
No
m
o
g
r
am
o
f
T
AG
-
I
T
c
o
m
p
ar
e
d
with
O
GT
T
-
b
ased
p
r
e
d
iab
etes statu
s
3
.
3
.
I
nte
rpre
t
a
t
io
n
o
f
f
ind
ing
s
T
h
is
s
tu
d
y
was
co
n
d
u
cted
to
a
s
s
es
s
th
e
v
alid
ity
o
f
T
AG
-
I
T
a
s
a
s
cr
ee
n
in
g
in
s
tr
u
m
en
t
f
o
r
p
r
ed
iab
etes
in
I
n
d
o
n
esian
p
r
im
a
r
y
h
ea
lth
c
ar
e
s
ettin
g
s
.
T
o
th
e
b
est
o
f
o
u
r
k
n
o
wled
g
e,
t
h
is
r
ep
r
esen
ts
th
e
f
ir
s
t
attem
p
t
to
ex
am
in
e
th
e
p
er
f
o
r
m
an
ce
o
f
T
AG
-
I
T
with
in
an
I
n
d
o
n
esian
p
o
p
u
latio
n
.
T
h
e
f
in
d
in
g
s
in
d
ica
te
th
at
th
e
to
o
l
h
as
lim
ited
d
is
cr
im
in
ativ
e
ca
p
ac
ity
,
as
r
ef
lecte
d
b
y
a
r
elativ
el
y
m
o
d
est
ar
ea
u
n
d
er
th
e
R
OC
cu
r
v
e.
Alth
o
u
g
h
s
p
ec
if
icity
was
m
o
d
er
ate,
s
en
s
itiv
ity
r
an
g
ed
f
r
o
m
l
o
w
to
m
o
d
er
ate,
s
u
g
g
esti
n
g
th
at
a
co
n
s
i
d
er
ab
le
p
r
o
p
o
r
tio
n
o
f
in
d
iv
i
d
u
als
with
p
r
ed
ia
b
ete
s
m
ay
n
o
t
b
e
co
r
r
e
ctly
id
en
tif
ied
.
I
n
a
d
d
itio
n
,
th
e
ca
lcu
late
d
lik
elih
o
o
d
r
atio
s
p
r
o
d
u
ce
d
o
n
ly
s
m
all
s
h
if
ts
in
p
o
s
t
-
test
p
r
o
b
ab
ilit
y
,
lim
itin
g
its
v
alu
e
as
a
s
in
g
le,
s
tan
d
-
alo
n
e
s
cr
ee
n
in
g
m
eth
o
d
.
C
o
llectiv
ely
,
th
ese
r
esu
lts
im
p
ly
th
at
T
AG
-
I
T
m
ay
b
e
b
etter
u
tili
ze
d
f
o
r
p
r
elim
in
ar
y
r
is
k
s
tr
atif
icatio
n
r
ath
er
th
an
as a
r
ep
lace
m
e
n
t f
o
r
co
n
f
ir
m
ato
r
y
lab
o
r
ato
r
y
-
b
ased
g
lu
co
s
e
test
in
g
.
T
h
e
d
iag
n
o
s
tic
p
er
f
o
r
m
a
n
ce
o
b
s
er
v
ed
in
th
is
s
tu
d
y
ap
p
ea
r
s
lo
wer
th
an
th
at
r
e
p
o
r
ted
in
th
e
o
r
ig
in
al
d
ev
elo
p
m
e
n
t
an
d
v
alid
atio
n
r
e
s
ea
r
ch
co
n
d
u
cted
in
th
e
Un
ited
States
b
y
Ko
o
p
m
an
et
al.
,
wh
e
r
e
th
e
to
o
l
ac
h
iev
ed
an
AUC
o
f
ap
p
r
o
x
im
ately
0
.
7
4
f
o
r
d
etec
tin
g
im
p
air
e
d
f
asti
n
g
g
lu
c
o
s
e
an
d
p
r
e
v
io
u
s
ly
u
n
d
iag
n
o
s
ed
d
ia
b
etes
u
s
in
g
NHAN
E
S
p
o
p
u
latio
n
d
ata
[
1
4
]
.
A
later
m
o
d
if
icatio
n
d
esig
n
ed
f
o
r
ad
o
lescen
t
p
o
p
u
l
atio
n
s
(
T
AG
-
IT
-
A
)
d
em
o
n
s
tr
ated
r
ed
u
ce
d
d
is
cr
im
in
ativ
e
ab
ilit
y
,
with
a
n
AUC
o
f
ar
o
u
n
d
0
.
6
1
,
s
u
g
g
esti
n
g
d
im
in
is
h
ed
p
er
f
o
r
m
a
n
ce
wh
en
ap
p
lied
to
d
if
f
e
r
en
t a
g
e
g
r
o
u
p
s
[
1
6
]
.
C
o
m
p
ar
ed
with
t
h
ese
p
r
io
r
f
in
d
in
g
s
,
th
e
lo
wer
AUC an
d
s
en
s
itiv
ity
id
en
tifie
d
in
th
e
p
r
esen
t
s
tu
d
y
in
d
icate
th
at
T
AG
-
I
T
p
e
r
f
o
r
m
a
n
ce
m
ay
d
ec
r
ea
s
e
wh
en
im
p
lem
en
ted
in
p
o
p
u
latio
n
s
with
d
is
tin
ct
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
,
b
o
d
y
co
m
p
o
s
itio
n
p
atter
n
s
,
an
d
m
et
ab
o
lic
r
is
k
p
r
o
f
iles
.
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.
15
,
No
.
1
,
M
ar
ch
20
26
:
32
-
42
38
T
h
ese
r
esu
lts
u
n
d
er
s
co
r
e
th
e
im
p
o
r
tan
c
e
o
f
co
n
d
u
ctin
g
lo
ca
l
v
alid
atio
n
s
tu
d
ies
an
d
,
wh
en
n
ec
ess
ar
y
,
co
n
tex
tu
al
ad
ap
tatio
n
b
e
f
o
r
e
a
p
p
ly
in
g
r
is
k
p
r
ed
ictio
n
to
o
ls
ac
r
o
s
s
d
iv
e
r
s
e
p
o
p
u
latio
n
s
[
1
7
]
.
W
h
en
ev
alu
ated
alo
n
g
s
id
e
o
th
er
co
m
m
o
n
ly
u
s
ed
n
o
n
-
lab
o
r
at
o
r
y
r
is
k
ass
ess
m
en
t to
o
ls
,
th
e
d
iag
n
o
s
tic
acc
u
r
ac
y
o
f
T
AG
-
I
T
in
th
is
s
tu
d
y
ap
p
ea
r
s
co
m
p
ar
ativ
ely
lo
wer
.
Pre
v
io
u
s
in
v
esti
g
atio
n
s
h
av
e
s
h
o
wn
th
at
th
e
Fin
n
is
h
Diab
etes
R
is
k
Sco
r
e
(
FIN
DR
I
S
C
)
g
en
er
ally
ac
h
iev
es
m
o
d
er
ate
d
is
cr
im
in
ativ
e
p
er
f
o
r
m
an
ce
in
id
en
tify
in
g
p
r
e
d
iab
etes a
n
d
u
n
d
iag
n
o
s
ed
d
iab
etes,
with
r
ep
o
r
ted
AUC v
alu
es f
r
e
q
u
en
tly
r
an
g
in
g
b
etwe
en
0
.
7
0
an
d
0
.
8
0
i
n
d
iv
e
r
s
e
p
o
p
u
latio
n
s
[
1
8
]
-
[
2
3
]
.
A
s
y
s
tem
atic
r
ev
ie
w
in
clu
d
in
g
2
5
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
ies
d
o
cu
m
en
ted
AUC
esti
m
ate
s
s
p
an
n
in
g
0
.
6
4
9
to
0
.
7
5
5
,
s
en
s
itiv
ity
r
an
g
in
g
f
r
o
m
5
3
.
1
%
to
8
4
.
7
%,
an
d
f
alse
-
p
o
s
i
tiv
e
r
ates
b
etwe
en
2
1
.
8
%
an
d
5
4
.
8
%
[
2
4
]
.
C
o
m
p
a
r
ab
le
lev
els
o
f
d
is
c
r
im
in
atio
n
h
a
v
e
also
b
ee
n
r
e
p
o
r
ted
f
o
r
th
e
ADA
d
iab
etes r
is
k
test
,
wh
ich
h
as d
em
o
n
s
tr
ated
m
o
d
er
ate
AUC v
alu
es in
b
o
th
W
ester
n
an
d
Asi
an
p
o
p
u
latio
n
s
[
1
2
]
,
[
1
3
]
,
[
2
0
]
,
[
2
5
]
,
[
2
6
]
.
I
n
co
m
p
ar
is
o
n
,
th
e
AUC
o
b
tain
ed
f
o
r
T
AG
-
I
T
in
th
e
p
r
esen
t
s
tu
d
y
was
lo
wer
an
d
ac
co
m
p
an
ied
b
y
r
ed
u
ce
d
s
en
s
itiv
ity
,
s
u
g
g
esti
n
g
a
m
o
r
e
lim
ited
ca
p
ac
ity
to
d
if
f
er
en
tiate
in
d
iv
id
u
als
with
p
r
ed
iab
etes
f
r
o
m
th
o
s
e
with
n
o
r
m
al
g
lu
c
o
s
e
r
eg
u
latio
n
.
Alth
o
u
g
h
T
AG
-
I
T
,
FIN
D
R
I
SC
,
an
d
th
e
ADA
r
is
k
test
s
h
a
r
e
th
e
a
d
v
an
ta
g
e
o
f
b
ein
g
q
u
esti
o
n
n
air
e
-
b
ased
an
d
n
o
n
-
in
v
asiv
e,
th
e
f
in
d
i
n
g
s
in
d
icate
th
at
T
AG
-
I
T
m
a
y
o
f
f
er
less
d
is
cr
im
in
ato
r
y
s
tr
en
g
th
r
elativ
e
to
o
th
er
in
s
tr
u
m
en
ts
th
at
h
av
e
u
n
d
er
g
o
n
e
b
r
o
ad
er
v
alid
atio
n
an
d
,
i
n
s
o
m
e
ca
s
es,
ad
ap
tatio
n
to
s
p
ec
if
ic
p
o
p
u
latio
n
s
.
E
v
id
en
ce
f
r
o
m
Asi
an
co
u
n
tr
ie
s
,
in
clu
d
in
g
I
n
d
o
n
esia,
f
u
r
th
e
r
em
p
h
asizes
th
e
im
p
o
r
tan
ce
o
f
v
alid
atin
g
d
iab
etes
r
is
k
s
co
r
es
wi
th
in
lo
ca
l
co
n
tex
ts
.
R
esear
ch
co
n
d
u
cted
in
So
u
th
ea
s
t
Asi
a
h
as
d
em
o
n
s
tr
ated
co
n
s
id
er
ab
le
v
ar
iab
il
ity
in
t
h
e
p
e
r
f
o
r
m
an
ce
o
f
wid
ely
u
s
ed
to
o
ls
s
u
ch
as
FI
NDRIS
C
an
d
th
e
ADA
r
is
k
tes
t,
with
AUC
v
alu
es
r
an
g
in
g
f
r
o
m
m
o
d
er
ate
to
g
o
o
d
d
ep
en
d
in
g
o
n
p
o
p
u
latio
n
ch
ar
ac
ter
is
tics
an
d
m
etab
o
lic
r
is
k
p
r
o
f
iles
[
1
2
]
,
[
1
3
]
,
[
2
0
]
,
[
2
5
]
,
[
2
6
]
.
I
n
I
n
d
o
n
esia
,
v
alid
atio
n
s
tu
d
ies
o
f
th
e
A
DA
r
is
k
q
u
esti
o
n
n
air
e
an
d
m
o
d
if
ied
v
e
r
s
io
n
s
o
f
FIN
DR
I
S
C
h
av
e
ty
p
ically
s
h
o
wn
m
o
d
er
ate
d
is
cr
im
in
atio
n
,
y
et
co
n
s
is
ten
tly
h
ig
h
s
en
s
itiv
ity
o
r
s
p
ec
if
icity
h
as
n
o
t
b
ee
n
o
b
s
er
v
ed
ac
r
o
s
s
d
if
f
er
en
t
r
eg
io
n
s
[
1
9
]
,
[
2
5
]
.
W
ith
in
th
is
r
eg
io
n
al
p
er
s
p
ec
tiv
e,
t
h
e
p
er
f
o
r
m
an
ce
o
f
T
AG
-
I
T
id
en
tifie
d
in
th
e
p
r
esen
t
s
tu
d
y
d
o
es
n
o
t
ap
p
ea
r
to
ex
ce
ed
th
at
o
f
o
th
er
n
o
n
-
lab
o
r
a
to
r
y
s
cr
ee
n
in
g
to
o
ls
p
r
ev
io
u
s
ly
ev
alu
ated
in
I
n
d
o
n
esian
s
ettin
g
s
.
Ov
er
all,
th
ese
f
in
d
in
g
s
r
ei
n
f
o
r
ce
th
e
n
o
tio
n
th
at
th
e
ef
f
ec
tiv
en
ess
o
f
r
is
k
p
r
e
d
ictio
n
m
o
d
els
is
s
tr
o
n
g
ly
in
f
l
u
en
ce
d
b
y
d
em
o
g
r
ap
h
ic
an
d
ep
id
em
io
lo
g
ical
d
if
f
er
en
ce
s
,
u
n
d
er
s
co
r
in
g
th
e
n
ec
ess
ity
o
f
p
o
p
u
latio
n
-
s
p
ec
if
ic
v
alid
atio
n
p
r
io
r
to
la
r
g
e
-
s
ca
le
im
p
lem
en
tatio
n
in
p
r
im
ar
y
h
ea
lth
ca
r
e
s
er
v
ices.
Sev
er
al
m
eth
o
d
o
lo
g
ical
an
d
p
o
p
u
latio
n
-
s
p
e
cif
ic
co
n
s
id
er
atio
n
s
m
ay
ac
co
u
n
t
f
o
r
th
e
r
elativ
ely
lo
wer
AUC
an
d
s
en
s
itiv
ity
o
f
T
A
G
-
I
T
id
en
tifie
d
in
th
is
s
tu
d
y
.
First,
v
ar
iatio
n
s
in
d
em
o
g
r
a
p
h
ic
an
d
m
etab
o
lic
ch
ar
ac
ter
is
tics
,
s
u
ch
as
ag
e
d
i
s
tr
ib
u
tio
n
,
ce
n
tr
al
a
d
ip
o
s
ity
p
atter
n
s
,
an
d
g
en
etic
p
r
e
d
is
p
o
s
iti
o
n
,
m
ay
lim
it
th
e
tr
an
s
f
er
ab
ilit
y
o
f
a
r
is
k
s
co
r
e
o
r
ig
in
ally
d
er
iv
e
d
f
r
o
m
W
ester
n
p
o
p
u
latio
n
s
.
I
t
is
well
est
ab
lis
h
ed
th
at
Asi
an
p
o
p
u
latio
n
s
,
in
clu
d
in
g
I
n
d
o
n
e
s
ian
s
,
ten
d
to
d
ev
el
o
p
d
y
s
g
ly
c
em
ia
at
lo
wer
b
o
d
y
m
ass
in
d
e
x
(
B
MI
)
an
d
waist
cir
cu
m
f
er
en
ce
th
r
esh
o
l
d
s
co
m
p
ar
ed
with
W
ester
n
co
h
o
r
ts
,
p
o
ten
tially
r
ed
u
cin
g
th
e
d
is
cr
im
in
ativ
e
p
er
f
o
r
m
a
n
c
e
o
f
to
o
ls
th
at
ap
p
ly
co
n
v
en
tio
n
al
an
th
r
o
p
o
m
etr
ic
cu
t
-
o
f
f
s
[
2
7
]
-
[
2
9
]
.
Seco
n
d
,
th
e
m
o
d
er
ate
p
r
ev
al
en
ce
o
f
p
r
e
d
iab
etes
o
b
s
er
v
e
d
in
th
is
s
am
p
le
m
ay
h
av
e
in
f
lu
en
ce
d
p
r
ed
ictiv
e
m
ea
s
u
r
es
a
n
d
o
v
er
a
ll
test
p
er
f
o
r
m
an
ce
,
as
d
is
ea
s
e
p
r
ev
alen
ce
d
ir
ec
tly
a
f
f
ec
ts
p
r
ed
ictiv
e
v
alu
es
an
d
m
ay
in
d
ir
ec
tly
im
p
ac
t
s
en
s
itiv
ity
an
d
AUC
esti
m
ates.
T
h
ir
d
,
d
is
cr
ep
an
cies
in
th
e
r
ef
er
en
ce
s
tan
d
ar
d
u
s
ed
co
u
ld
also
co
n
tr
ib
u
te
to
p
e
r
f
o
r
m
an
c
e
v
ar
iatio
n
.
W
h
i
le
T
AG
-
I
T
was
in
itially
d
esig
n
ed
to
d
ete
ct
im
p
air
ed
f
asti
n
g
g
lu
co
s
e,
th
e
p
r
esen
t
s
tu
d
y
e
m
p
lo
y
ed
th
e
o
r
al
g
lu
co
s
e
to
l
er
an
ce
test
(
OGT
T
)
as
th
e
d
i
ag
n
o
s
tic
b
en
ch
m
ar
k
,
th
er
eb
y
i
d
en
tify
in
g
a
b
r
o
a
d
er
r
an
g
e
o
f
d
y
s
g
ly
ce
m
ic
co
n
d
itio
n
s
,
in
clu
d
in
g
is
o
lated
im
p
air
e
d
g
lu
c
o
s
e
to
ler
an
ce
.
C
o
llectiv
ely
,
th
ese
b
io
lo
g
ical
,
ep
id
em
io
l
o
g
ical,
a
n
d
m
eth
o
d
o
lo
g
ical
d
if
f
e
r
en
ce
s
lik
ely
co
n
tr
ib
u
ted
to
th
e
d
im
in
is
h
ed
p
er
f
o
r
m
an
ce
o
f
T
AG
-
I
T
in
th
is
co
n
tex
t
an
d
h
ig
h
lig
h
t
th
e
im
p
o
r
ta
n
ce
o
f
co
n
tex
tu
al
m
o
d
if
icatio
n
an
d
r
ec
alib
r
atio
n
b
ef
o
r
e
a
p
p
ly
in
g
th
e
to
o
l in
I
n
d
o
n
esian
p
r
i
m
ar
y
h
ea
lth
ca
r
e
s
ettin
g
s
.
Ov
er
all,
th
e
co
m
p
a
r
ativ
e
r
esu
lts
s
u
g
g
est
th
at
alth
o
u
g
h
T
AG
-
I
T
m
ay
h
a
v
e
u
tili
ty
f
o
r
p
r
elim
in
ar
y
r
is
k
ass
es
s
m
en
t,
it
s
h
o
u
ld
n
o
t
b
e
r
eg
ar
d
e
d
as
a
s
u
b
s
titu
te
f
o
r
l
ab
o
r
ato
r
y
-
b
ased
d
iag
n
o
s
tic
te
s
tin
g
in
I
n
d
o
n
esian
p
r
im
ar
y
ca
r
e.
T
h
is
in
ter
p
r
etat
io
n
alig
n
s
co
n
ce
p
tu
ally
with
ex
p
er
ien
ce
s
f
r
o
m
o
t
h
er
n
o
n
-
i
n
v
asiv
e
r
is
k
s
co
r
es,
s
u
ch
as
FIN
D
R
I
SC
,
wh
ich
d
em
o
n
s
tr
ated
im
p
r
o
v
ed
ac
cu
r
ac
y
in
Asi
an
p
o
p
u
latio
n
s
af
ter
ad
ju
s
tm
en
ts
to
an
th
r
o
p
o
m
etr
ic
th
r
esh
o
ld
s
an
d
r
ec
alib
r
at
io
n
o
f
r
is
k
weig
h
tin
g
[
3
0
]
.
I
n
co
n
tr
ast,
T
AG
-
I
T
h
a
s
n
o
t
y
et
u
n
d
er
g
o
n
e
s
y
s
tem
atic
m
o
d
if
icatio
n
f
o
r
I
n
d
o
n
esian
o
r
b
r
o
ad
e
r
Asi
an
p
o
p
u
latio
n
s
,
wh
ich
m
ay
ex
p
lain
its
lim
ited
d
is
cr
im
in
ativ
e
ca
p
ac
ity
in
th
e
cu
r
r
en
t
s
tu
d
y
.
T
h
ese
f
in
d
in
g
s
t
h
er
ef
o
r
e
p
r
o
v
id
e
em
p
ir
i
ca
l
ju
s
t
if
icatio
n
f
o
r
lo
ca
lly
r
ec
alib
r
atin
g
in
ter
n
atio
n
ally
d
ev
elo
p
ed
s
cr
ee
n
in
g
to
o
ls
p
r
io
r
to
i
n
teg
r
atio
n
in
to
n
atio
n
al
s
cr
ee
n
in
g
s
tr
ateg
ies.
Po
p
u
latio
n
-
s
p
ec
if
ic
ad
a
p
tatio
n
m
ay
en
h
a
n
ce
d
iag
n
o
s
tic
s
en
s
itiv
ity
an
d
clin
ical
ap
p
lica
b
ilit
y
,
en
s
u
r
in
g
th
at
s
cr
ee
n
in
g
ap
p
r
o
ac
h
es a
r
e
tailo
r
ed
to
lo
ca
l e
p
id
em
io
lo
g
ical
p
r
o
f
iles
an
d
h
ea
lth
ca
r
e
n
ee
d
s
.
W
ith
ap
p
r
o
p
r
iate
ad
ju
s
tm
en
ts
,
T
AG
-
I
T
m
ay
s
till
o
f
f
er
v
alu
e
as
a
co
m
p
lem
en
tar
y
s
cr
ee
n
in
g
i
n
s
tr
u
m
en
t
with
in
I
n
d
o
n
esian
p
r
im
a
r
y
h
ea
lth
ca
r
e
s
ettin
g
s
.
I
n
Pu
s
k
esm
as,
wh
er
e
ac
ce
s
s
to
lab
o
r
ato
r
y
e
x
am
in
atio
n
s
ca
n
b
e
co
n
s
tr
ain
ed
,
a
b
r
ief
a
n
d
n
o
n
-
i
n
v
asiv
e
q
u
esti
o
n
n
air
e
s
u
ch
as
T
AG
-
I
T
c
o
u
ld
h
elp
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
id
en
tify
in
d
iv
id
u
als
wh
o
war
r
an
t
f
u
r
t
h
e
r
b
io
ch
e
m
ical
ev
alu
atio
n
.
B
y
f
u
n
ctio
n
in
g
as
an
in
itial
tr
iag
e
t
o
o
l,
it
m
a
y
en
h
an
ce
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
E
va
lu
a
tin
g
t
h
e
p
erfo
r
ma
n
ce
o
f
TAG
-
I
T fo
r
p
r
ed
ia
b
etes d
etec
tio
n
in
I
n
d
o
n
esia
n
…
(
Ya
lta
fit
A
b
r
o
r
Je
em
)
39
th
e
ef
f
icien
cy
o
f
ca
s
e
d
etec
tio
n
an
d
o
p
tim
ize
th
e
allo
ca
tio
n
o
f
lim
ited
d
iag
n
o
s
tic
r
eso
u
r
ce
s
.
T
h
is
ap
p
r
o
ac
h
is
co
n
s
is
ten
t
with
n
atio
n
al
ef
f
o
r
ts
to
s
tr
en
g
th
en
ea
r
ly
id
e
n
tific
atio
n
o
f
n
o
n
-
co
m
m
u
n
icab
l
e
d
is
ea
s
es
th
r
o
u
g
h
Po
s
b
in
d
u
PTM
an
d
p
r
im
a
r
y
ca
r
e
–
b
ased
in
i
tiativ
es
p
r
o
m
o
te
d
b
y
th
e
Min
is
tr
y
o
f
Hea
lth
o
f
I
n
d
o
n
esia
[
3
1
]
,
[
3
2
]
.
W
ith
in
th
is
f
r
am
ewo
r
k
,
a
s
eq
u
en
tial scr
ee
n
in
g
m
o
d
el,
ap
p
l
y
in
g
a
r
is
k
s
co
r
e
as a
p
r
elim
in
ar
y
f
ilter
f
o
llo
wed
b
y
co
n
f
ir
m
ato
r
y
b
lo
o
d
g
lu
co
s
e
t
esti
n
g
,
m
ay
r
ep
r
esen
t
a
p
r
ac
ti
ca
l
an
d
ec
o
n
o
m
ical
ly
f
ea
s
ib
le
s
tr
ateg
y
t
o
e
x
p
an
d
p
r
ed
iab
etes d
etec
tio
n
w
h
ile
av
o
id
in
g
u
n
n
ec
ess
ar
y
lab
o
r
ato
r
y
p
r
o
ce
d
u
r
es.
Sev
er
al
co
n
s
id
er
atio
n
s
ar
e
im
p
o
r
tan
t
wh
en
in
ter
p
r
etin
g
th
e
p
r
esen
t
f
in
d
in
g
s
.
Alth
o
u
g
h
th
e
s
am
p
le
s
ize
was
in
itially
ca
lcu
lated
to
ac
h
iev
e
ad
eq
u
ate
s
tatis
tical
p
r
ec
is
io
n
,
th
e
f
in
al
n
u
m
b
er
o
f
p
ar
ti
cip
an
ts
in
clu
d
ed
in
th
e
an
aly
s
is
was
co
n
s
id
er
ab
ly
r
ed
u
ce
d
.
T
h
is
attr
itio
n
r
esu
lted
f
r
o
m
p
ar
ticip
an
t
n
o
n
-
c
o
m
p
li
an
ce
,
p
r
e
-
a
n
aly
tical
lab
o
r
ato
r
y
is
s
u
es
af
f
ec
tin
g
s
p
ec
im
en
q
u
ality
,
an
d
d
ata
m
an
ag
em
en
t
ch
allen
g
es
en
co
u
n
ter
ed
d
u
r
i
n
g
f
ield
im
p
lem
en
tatio
n
.
T
h
e
s
m
aller
an
aly
tical
s
am
p
le
m
ay
h
av
e
r
ed
u
ce
d
t
h
e
p
r
ec
is
io
n
o
f
d
iag
n
o
s
tic
ac
cu
r
ac
y
esti
m
ates,
as
r
ef
lecte
d
in
r
elativ
ely
wid
e
co
n
f
id
e
n
ce
in
te
r
v
als,
an
d
m
ay
h
av
e
in
f
lu
en
ce
d
s
en
s
itiv
ity
an
d
s
p
ec
if
icity
ca
lcu
latio
n
s
.
T
h
e
r
e
f
o
r
e,
t
h
is
s
tu
d
y
s
h
o
u
ld
b
e
r
eg
a
r
d
ed
as
a
p
r
elim
in
a
r
y
o
r
ex
p
lo
r
ato
r
y
v
alid
atio
n
o
f
T
AG
-
I
T
with
in
th
e
I
n
d
o
n
esian
p
r
im
ar
y
ca
r
e
co
n
te
x
t
r
ath
er
th
an
a
co
n
clu
s
iv
e
ev
al
u
atio
n
o
f
its
p
er
f
o
r
m
an
ce
.
W
h
ile
th
e
r
esu
lts
p
r
o
v
id
e
u
s
ef
u
l
in
itial
in
s
ig
h
ts
in
to
th
e
a
p
p
l
icab
il
ity
o
f
th
e
to
o
l,
f
u
r
th
e
r
co
n
f
ir
m
atio
n
t
h
r
o
u
g
h
lar
g
er
,
m
u
lti
-
ce
n
ter
in
v
esti
g
ati
o
n
s
with
s
tr
en
g
th
en
e
d
q
u
ality
co
n
tr
o
l p
r
o
ce
d
u
r
es is
war
r
an
te
d
.
4
.
CO
NCLUS
I
O
N
I
n
s
u
m
m
ar
y
,
th
is
s
tu
d
y
p
r
esen
ts
lo
ca
lly
g
en
er
ated
ev
i
d
en
ce
r
eg
ar
d
in
g
th
e
d
ia
g
n
o
s
tic
p
er
f
o
r
m
an
ce
o
f
T
AG
-
I
T
in
I
n
d
o
n
esian
p
r
im
ar
y
h
ea
lth
ca
r
e
s
ettin
g
s
,
in
d
icatin
g
th
at
its
ab
ilit
y
to
d
is
cr
im
in
ate
in
d
iv
id
u
als
with
p
r
ed
iab
etes
is
m
o
d
est
wh
en
a
p
p
lied
with
o
u
t
p
o
p
u
latio
n
-
s
p
ec
if
ic
m
o
d
if
icatio
n
.
As
th
e
f
ir
s
t
s
tu
d
y
to
ex
am
in
e
T
AG
-
I
T
in
an
I
n
d
o
n
esian
co
n
tex
t,
th
e
f
in
d
in
g
s
ad
d
to
th
e
b
r
o
ad
er
liter
atu
r
e
s
u
g
g
esti
n
g
th
at
in
ter
n
atio
n
ally
d
ev
elo
p
e
d
,
n
o
n
-
lab
o
r
ato
r
y
r
is
k
ass
ess
m
en
t to
o
ls
r
eq
u
ir
e
lo
c
al
v
alid
atio
n
b
ef
o
r
e
im
p
lem
en
tatio
n
.
R
ath
er
th
an
s
u
g
g
esti
n
g
im
m
ed
iate
wid
esp
r
ea
d
u
s
e,
th
e
r
esu
lts
em
p
h
asize
th
e
im
p
o
r
ta
n
ce
o
f
c
o
n
tex
tu
al
ad
ap
tatio
n
an
d
th
o
u
g
h
tf
u
l
in
teg
r
atio
n
o
f
r
is
k
-
b
ased
s
cr
ee
n
in
g
in
s
tr
u
m
en
ts
in
to
ex
is
tin
g
h
ea
lt
h
ca
r
e
s
y
s
tem
s
.
T
h
e
p
r
esen
t
f
in
d
in
g
s
th
er
ef
o
r
e
s
er
v
e
as
an
in
itial
r
ef
er
en
ce
p
o
in
t
f
o
r
im
p
r
o
v
in
g
p
r
ed
ia
b
etes
s
cr
ee
n
in
g
ap
p
r
o
ac
h
es
in
I
n
d
o
n
esia
an
d
s
u
p
p
o
r
t
o
n
g
o
in
g
ef
f
o
r
ts
to
r
ef
in
e
o
r
r
ec
alib
r
ate
to
o
ls
s
o
t
h
at
th
e
y
b
etter
r
ef
le
ct
th
e
ch
a
r
ac
ter
is
tics
an
d
r
is
k
p
r
o
f
iles
o
f
th
e
lo
ca
l p
o
p
u
latio
n
.
5
.
ST
UDY
L
I
M
I
T
A
T
I
O
N
S
Sev
er
al
lim
itatio
n
s
o
f
th
is
s
tu
d
y
m
er
it c
o
n
s
id
er
atio
n
.
First,
th
e
n
u
m
b
er
o
f
p
ar
ticip
an
ts
in
c
lu
d
ed
in
th
e
f
in
al
an
aly
s
is
was
co
n
s
id
er
ab
ly
lo
wer
th
an
th
e
in
itially
ca
l
cu
lated
m
in
im
u
m
s
am
p
le
s
ize,
wh
ich
m
ay
h
av
e
d
im
in
is
h
ed
s
tatis
tical
p
o
wer
an
d
r
ed
u
ce
d
th
e
p
r
ec
is
io
n
o
f
th
e
esti
m
ated
d
iag
n
o
s
tic
ac
cu
r
ac
y
m
ea
s
u
r
es.
Seco
n
d
,
as
th
e
r
esear
ch
was
co
n
d
u
cted
in
o
n
ly
th
r
ee
p
r
im
ar
y
h
ea
lth
ca
r
e
ce
n
ter
s
in
Yo
g
y
ak
a
r
ta,
th
e
f
in
d
in
g
s
m
ay
n
o
t
b
e
f
u
lly
r
ep
r
esen
tativ
e
o
f
o
th
er
r
eg
io
n
s
ac
r
o
s
s
I
n
d
o
n
esia.
T
h
ir
d
,
th
e
cr
o
s
s
-
s
ec
tio
n
al
n
atu
r
e
o
f
th
e
s
tu
d
y
co
n
f
in
es
in
ter
p
r
etatio
n
to
co
n
c
u
r
r
en
t
d
iag
n
o
s
tic
p
er
f
o
r
m
an
ce
a
n
d
d
o
es
n
o
t
p
er
m
it
ev
al
u
atio
n
o
f
t
h
e
to
o
l’
s
ab
ilit
y
to
p
r
ed
ict
f
u
t
u
r
e
p
r
o
g
r
ess
io
n
to
d
iab
etes.
Diag
n
o
s
tic
ac
cu
r
ac
y
s
tu
d
ies
m
ay
b
e
in
f
lu
en
ce
d
b
y
s
am
p
le
s
ize
co
n
s
tr
ain
ts
an
d
s
p
ec
t
r
u
m
b
ias,
p
ar
ticu
lar
ly
wh
en
co
n
d
u
cte
d
in
s
in
g
le
-
ce
n
ter
p
r
im
ar
y
ca
r
e
s
ettin
g
s
.
Ad
d
itio
n
all
y
,
r
is
k
s
c
o
r
e
p
er
f
o
r
m
an
ce
is
k
n
o
wn
to
v
ar
y
ac
r
o
s
s
p
o
p
u
l
atio
n
s
d
u
e
to
eth
n
ic
an
d
e
p
i
d
em
io
lo
g
ical
d
if
f
er
en
ce
s
[
4
]
,
[
1
5
]
,
[
1
7
]
.
T
h
ese
lim
itatio
n
s
m
ay
r
estrict
th
e
b
r
o
ad
er
ap
p
licab
ilit
y
o
f
th
e
s
tu
d
y
f
in
d
in
g
s
.
I
n
a
d
d
itio
n
,
p
o
ten
ti
al
p
r
e
-
an
aly
tical
an
d
an
aly
tica
l
ch
allen
g
es
in
b
lo
o
d
s
p
ec
im
en
p
r
o
ce
s
s
in
g
m
ay
h
a
v
e
in
f
lu
en
ce
d
OGT
T
m
ea
s
u
r
e
m
en
ts
,
d
esp
ite
th
e
im
p
lem
en
tatio
n
o
f
q
u
ality
co
n
tr
o
l
p
r
o
ce
d
u
r
es.
Fu
r
th
er
m
o
r
e
,
s
ev
er
al
r
is
k
f
ac
to
r
s
wer
e
o
b
t
ain
ed
th
r
o
u
g
h
s
elf
-
r
ep
o
r
t,
i
n
tr
o
d
u
cin
g
th
e
p
o
s
s
ib
ilit
y
o
f
r
ec
all
b
ias.
T
a
k
e
n
to
g
eth
er
,
th
ese
lim
itatio
n
s
s
u
g
g
est
th
at
th
e
r
esu
lts
s
h
o
u
ld
b
e
in
ter
p
r
eted
with
ca
u
tio
n
a
n
d
r
ein
f
o
r
ce
th
e
n
ee
d
f
o
r
lar
g
e
r
-
s
ca
le,
p
r
o
s
p
ec
tiv
e
s
tu
d
ies
to
v
alid
ate
an
d
ex
ten
d
th
e
p
r
esen
t f
in
d
in
g
s
.
6
.
F
UT
URE RE
SE
ARCH
T
h
e
lim
itatio
n
s
o
b
s
er
v
ed
in
th
is
s
tu
d
y
s
u
g
g
est
s
ev
er
al
av
en
u
es
f
o
r
s
u
b
s
eq
u
en
t
in
v
esti
g
ati
o
n
.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
f
o
c
u
s
o
n
tailo
r
in
g
T
AG
-
I
T
to
th
e
I
n
d
o
n
esia
n
p
o
p
u
latio
n
th
r
o
u
g
h
r
ec
alib
r
atio
n
o
f
r
is
k
f
ac
to
r
weig
h
tin
g
a
n
d
ad
ju
s
tm
en
t
o
f
an
th
r
o
p
o
m
etr
ic
t
h
r
esh
o
ld
s
,
p
ar
ticu
lar
l
y
f
o
r
b
o
d
y
m
ass
in
d
e
x
an
d
waist
cir
cu
m
f
er
en
ce
,
to
b
etter
r
ef
lec
t
lo
ca
l
m
etab
o
lic
r
is
k
p
atter
n
s
.
Su
ch
m
o
d
if
icatio
n
s
m
ay
en
h
a
n
ce
s
en
s
itiv
ity
an
d
im
p
r
o
v
e
o
v
er
all
d
is
cr
im
in
ativ
e
ca
p
ac
ity
in
Asi
an
p
o
p
u
latio
n
s
.
Mo
r
eo
v
er
,
p
r
o
s
p
ec
tiv
e
co
h
o
r
t
s
tu
d
ies
ar
e
n
ec
ess
ar
y
to
ev
al
u
ate
th
e
p
r
e
d
ictiv
e
v
alu
e
o
f
T
AG
-
I
T
in
id
en
tify
in
g
in
d
iv
id
u
als
at
r
is
k
o
f
p
r
o
g
r
ess
in
g
f
r
o
m
p
r
ed
ia
b
ete
s
to
o
v
er
t
d
iab
etes,
as
th
is
lo
n
g
itu
d
in
al
ass
ess
m
en
t
ca
n
n
o
t
b
e
ad
d
r
ess
ed
with
in
a
cr
o
s
s
-
s
ec
tio
n
al
f
r
am
ewo
r
k
.
Fu
r
th
er
s
tu
d
ies
co
u
l
d
also
ex
am
i
n
e
th
e
f
ea
s
ib
ilit
y
o
f
in
teg
r
atin
g
s
im
p
lifie
d
r
is
k
s
co
r
es
in
to
d
ig
ital
s
cr
ee
n
in
g
p
l
atf
o
r
m
s
,
f
ac
ilit
atin
g
lin
k
ag
e
with
ex
is
tin
g
n
o
n
-
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.
15
,
No
.
1
,
M
ar
ch
20
26
:
32
-
42
40
co
m
m
u
n
ica
b
le
d
is
ea
s
e
s
u
r
v
eillan
ce
s
y
s
tem
s
an
d
r
o
u
tin
e
p
r
im
ar
y
h
ea
lth
ca
r
e
s
er
v
ices.
Ad
v
an
cin
g
th
ese
r
esear
ch
d
ir
ec
tio
n
s
wo
u
ld
co
n
tr
ib
u
te
t
o
th
e
d
e
v
elo
p
m
e
n
t
o
f
s
ca
lab
le
an
d
co
n
tex
t
-
s
p
ec
if
ic
s
cr
ee
n
in
g
s
tr
ateg
ies,
th
er
eb
y
s
tr
en
g
th
en
in
g
th
e
im
p
lem
e
n
tatio
n
o
f
r
is
k
-
b
ased
ap
p
r
o
ac
h
es in
d
iab
etes p
r
e
v
en
tio
n
e
f
f
o
r
ts
a
cr
o
s
s
I
n
d
o
n
esia.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
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
t
r
ib
u
to
r
R
o
les
T
a
x
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
i
d
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Yaltaf
it Ab
r
o
r
J
ee
m
✓
✓
✓
✓
✓
✓
✓
✓
✓
R
ah
m
a
Yu
an
tar
i
✓
✓
✓
✓
✓
✓
✓
Haja
r
Ad
m
ir
a
W
id
iatn
in
d
a
✓
✓
✓
✓
✓
✓
✓
R
u
s
s
y
No
v
ita
An
d
r
ian
i
✓
✓
✓
✓
Sit
i So
lich
atu
l M
ak
k
iy
y
ah
✓
✓
✓
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
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g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
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:
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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
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
d
ec
lar
e
n
o
co
n
f
licts
o
f
in
ter
est,
af
f
ir
m
in
g
th
e
in
t
eg
r
ity
an
d
o
b
jectiv
ity
o
f
th
is
s
tu
d
y
.
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
i
v
id
u
als
in
c
lu
d
ed
i
n
th
is
s
tu
d
y
.
All
p
ar
tici
p
an
ts
wer
e
in
f
o
r
m
e
d
ab
o
u
t
th
e
s
tu
d
y
o
b
je
ctiv
es,
p
r
o
ce
d
u
r
es,
p
o
ten
tial
r
is
k
s
,
an
d
b
en
ef
its
,
an
d
th
ey
v
o
lu
n
tar
ily
ag
r
ee
d
to
p
ar
ticip
ate
b
y
s
ig
n
i
n
g
a
wr
itte
n
co
n
s
en
t f
o
r
m
p
r
io
r
t
o
d
ata
c
o
llectio
n
.
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
co
m
p
lied
with
all
r
elev
an
t
n
atio
n
al
r
eg
u
latio
n
s
an
d
in
s
titu
tio
n
al
p
o
licies
in
ac
co
r
d
an
ce
with
th
e
ten
ets
o
f
th
e
Helsin
k
i
Dec
lar
atio
n
.
T
h
is
s
tu
d
y
was
r
ev
iew
ed
an
d
ap
p
r
o
v
e
d
b
y
th
e
R
esear
ch
E
th
ics
C
o
m
m
ittee
o
f
th
e
Facu
lty
o
f
Me
d
icin
e,
Un
iv
er
s
itas
I
s
lam
I
n
d
o
n
e
s
ia
(
Ap
p
r
o
v
al
No
.
2
4
/Ka.
Ko
m
.
E
t/7
0
/KE
/VI
I
/
2
0
1
8
)
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
t
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
av
ailab
l
e
f
r
o
m
th
e
co
r
r
esp
o
n
d
i
n
g
au
th
o
r
,
[
Y
A
J
]
,
u
p
o
n
r
ea
s
o
n
a
b
le
r
eq
u
est.
Du
e
to
p
r
iv
ac
y
an
d
eth
ical
r
estric
tio
n
s
,
th
e
d
ataset
is
n
o
t
p
u
b
li
cly
av
ailab
le
as
it
co
n
tain
s
in
f
o
r
m
atio
n
th
at
c
o
u
l
d
co
m
p
r
o
m
is
e
th
e
co
n
f
id
en
tial
ity
o
f
r
esear
ch
p
ar
ticip
an
ts
.
RE
F
E
R
E
NC
E
S
[
1
]
L.
S
a
n
d
f
o
r
t
h
e
t
a
l
.
,
“
P
r
e
d
i
a
b
e
t
e
s
r
e
mi
s
si
o
n
t
o
r
e
d
u
c
e
t
h
e
g
l
o
b
a
l
b
u
r
d
e
n
o
f
t
y
p
e
2
d
i
a
b
e
t
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