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s
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C
OVI
D‐
1
9
Gen
er
al
Hea
lth
Qu
esti
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n
n
air
e
Hea
lth
ca
r
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Hea
lth
wo
r
k
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s
Me
n
tal
h
ea
lth
T
h
is i
s
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n
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p
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n
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c
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ss
a
rticle
u
n
d
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r th
e
CC B
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-
SA
li
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se
.
C
o
r
r
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s
p
o
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ing
A
uth
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r
:
Ali K
ar
im
i
-
r
o
zv
eh
Dep
ar
tm
en
t o
f
Me
d
ical
-
Su
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g
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Nu
r
s
in
g
,
Sch
o
o
l
o
f
Nu
r
s
in
g
&
Mid
wif
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y
T
eh
r
an
Un
i
v
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s
ity
o
f
Me
d
ical
Scien
ce
s
T
eh
r
an
,
I
r
an
E
m
ail:
k
ar
im
ir
o
zv
e
h
@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
A
d
is
ea
s
e
k
n
o
wn
as
C
OVI
D
-
1
9
is
h
ig
h
ly
co
n
tag
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u
s
an
d
ca
u
s
ed
b
y
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in
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v
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s
ca
ll
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s
ev
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d
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(
SAR
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)
.
I
n
Ma
r
c
h
2
0
2
0
,
th
e
W
HO
d
e
clar
ed
th
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d
is
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a
g
lo
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p
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d
em
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ap
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Desp
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s
ap
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ly
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it
h
as
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ar
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f
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Mo
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e
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a
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1
6
7
m
illi
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p
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m
illi
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v
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s
[
1
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.
Ma
n
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co
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n
tr
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in
th
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wo
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l
d
ar
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u
f
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ic,
s
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cial,
an
d
h
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lth
ca
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tem
s
[
2
]
.
Sev
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p
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b
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lth
in
ter
v
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tio
n
s
ar
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9
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tiv
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C
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-
1
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,
h
as
h
elp
ed
to
a
g
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ea
t
ex
te
n
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in
th
e
r
ap
id
co
n
tain
m
en
t
o
f
t
h
e
ep
id
em
ic
[
3
]
,
[
4
]
.
T
h
er
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ar
e
m
an
y
s
y
m
p
to
m
s
ass
o
ciate
d
with
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s
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f
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in
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
1
,
M
ar
ch
20
26
:
1
-
7
2
d
if
f
icu
lties
.
As it b
ec
o
m
es m
o
r
e
s
ev
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e,
it c
an
r
esu
lt in
s
ev
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e
ac
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te
r
esp
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ato
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y
s
y
n
d
r
o
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,
p
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m
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k
id
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ailu
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d
e
v
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d
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th
if
lef
t
u
n
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ted
.
I
n
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d
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ca
n
ca
u
s
e
s
ec
o
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d
ar
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u
ts
m
o
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b
u
r
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n
o
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h
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lth
ca
r
e
s
ta
f
f
in
d
if
f
er
en
t
p
lace
s
[
5
]
.
Hea
lth
ca
r
e
p
r
o
v
id
e
r
s
ar
e
at
th
e
f
r
o
n
tlin
e
o
f
s
cr
ee
n
in
g
a
n
d
tr
ea
tin
g
th
is
d
is
ea
s
e.
Pu
b
lis
h
ed
s
tu
d
ies
f
r
o
m
v
ar
io
u
s
co
u
n
tr
ies
s
h
o
w
t
h
at
a
s
ig
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if
ican
t
p
er
ce
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tag
e
o
f
h
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lth
ca
r
e
wo
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k
er
s
,
esp
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ially
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th
e
b
e
g
in
n
in
g
o
f
th
e
e
p
id
em
ic,
h
av
e
b
ee
n
in
f
ec
ted
with
th
e
C
OVI
D
-
1
9
v
ir
u
s
,
wh
ich
h
as
ca
u
s
ed
a
n
in
cr
ea
s
e
in
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
am
o
n
g
th
em
[
6
]
.
Mo
r
eo
v
er
,
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
ar
e
f
ac
ed
with
a
n
ex
tr
e
m
ely
lar
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wo
r
k
l
o
ad
,
wh
ic
h
p
u
ts
th
em
at
a
h
ig
h
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is
k
o
f
in
f
ec
tio
n
,
p
o
llu
ti
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n
,
o
v
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tim
e,
f
r
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s
tr
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,
d
is
cr
im
in
atio
n
,
is
o
latio
n
,
an
d
jo
b
b
u
r
n
o
u
t
[
7
]
.
T
h
e
p
r
esen
ce
o
f
v
ar
io
u
s
s
o
u
r
ce
s
o
f
s
tr
ess
,
s
u
c
h
as
f
ea
r
o
f
co
n
tr
ac
tin
g
th
e
c
o
r
o
n
a
v
ir
u
s
,
lack
o
f
f
ac
ilit
ies,
co
n
tin
u
o
u
s
ch
an
g
es
in
th
e
wo
r
k
p
lace
,
in
s
o
m
n
ia,
f
ea
r
o
f
tr
an
s
m
itti
n
g
th
e
v
ir
u
s
t
o
f
am
ily
m
em
b
er
s
,
an
d
f
am
ily
r
esp
o
n
s
ib
ilit
ies,
m
ay
af
f
ec
t th
eir
m
en
tal
h
ea
lth
[
8
]
.
Sev
er
al
s
tu
d
ies
h
av
e
esti
m
ate
d
th
e
h
ig
h
p
r
ev
alen
c
e
o
f
p
s
y
c
h
o
lo
g
ical
d
is
tr
ess
as
C
O
VI
D
-
1
9
s
p
r
ea
d
.
Acc
o
r
d
in
g
to
th
e
r
esu
lts
o
f
th
ese
s
tu
d
ies,
ab
o
u
t
5
0
%
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
ex
p
o
s
ed
to
C
OVI
D
-
19
ex
p
er
ien
ce
d
s
y
m
p
to
m
s
o
f
an
x
iety
an
d
d
ep
r
ess
io
n
[
7
]
,
[
9
]
,
[
1
0
]
.
Acc
o
r
d
in
g
to
a
n
atio
n
al
s
u
r
v
ey
co
n
d
u
cte
d
in
C
h
in
a,
5
4
%
o
f
h
ea
lth
c
ar
e
p
r
o
v
id
er
s
r
e
p
o
r
ted
m
ed
i
u
m
to
s
ev
er
e
m
en
tal
h
ea
lth
ef
f
ec
ts
r
esu
ltin
g
f
r
o
m
th
e
C
OVI
D
-
1
9
o
u
tb
r
ea
k
,
2
9
%
r
e
p
o
r
ted
a
n
x
iety
s
y
m
p
to
m
s
,
an
d
1
7
%
r
ep
o
r
ted
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
[
1
1
]
.
As
a
r
esu
lt
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic,
Hu
an
g
an
d
Z
h
ao
[
1
2
]
r
ep
o
r
ted
h
ig
h
lev
els
o
f
an
x
iet
y
an
d
s
tr
ess
am
o
n
g
h
ea
lth
ca
r
e
wo
r
k
er
s
.
I
n
a
s
tu
d
y
o
f
1
2
5
7
h
ea
lth
p
r
o
f
ess
io
n
als
in
3
4
C
h
in
ese
h
o
s
p
itals
,
L
ai
e
t
a
l.
[
1
3
]
ev
al
u
ated
th
e
m
en
tal
h
ea
lth
o
f
s
taf
f
ex
p
o
s
ed
to
C
OVI
D
-
1
9
.
T
h
e
s
tu
d
y
f
o
u
n
d
th
at
5
0
.
4
%
o
f
s
taf
f
h
ad
s
y
m
p
to
m
s
o
f
d
ep
r
ess
io
n
,
7
1
.
5
% h
ad
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
,
3
4
% h
ad
in
s
o
m
n
ia,
an
d
4
4
.
6
% h
ad
s
y
m
p
to
m
s
o
f
an
x
iety
.
An
x
iety
an
d
s
tr
ess
am
o
n
g
n
u
r
s
es,
p
h
y
s
ician
s
,
an
d
h
ea
lth
ca
r
e
wo
r
k
er
s
wh
o
a
r
e
co
n
tactin
g
p
atien
ts
d
ir
ec
tly
ca
n
af
f
ec
t
th
eir
h
ea
lth
s
tatu
s
,
q
u
ality
o
f
life
,
an
d
wo
r
k
p
er
f
o
r
m
a
n
ce
[
1
4
]
.
A
d
is
r
u
p
tio
n
in
th
e
m
en
tal
h
ea
lth
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
m
ay
im
p
air
th
eir
in
tellectu
al
a
b
ilit
y
an
d
r
ea
s
o
n
in
g
,
as
well
a
s
th
eir
ab
ilit
y
t
o
p
a
y
atten
tio
n
an
d
co
o
r
d
in
ate
th
ei
r
ac
tio
n
s
.
T
h
e
p
e
r
f
o
r
m
an
ce
o
f
p
r
o
b
lem
-
s
o
lv
er
s
is
also
a
f
f
ec
ted
b
y
v
ar
io
u
s
em
o
tio
n
s
,
s
u
ch
as
an
x
iety
an
d
f
ea
r
.
I
t
is
p
o
s
s
ib
le
th
at
a
d
ec
r
ea
s
e
in
th
e
ab
ilit
y
to
s
o
lv
e
p
r
o
b
lem
s
ca
n
n
eg
ativ
ely
im
p
ac
t
th
e
ef
f
icien
cy
o
f
th
e
s
er
v
ices
p
r
o
v
id
ed
t
o
s
af
eg
u
ar
d
th
e
h
ea
lth
o
f
p
e
o
p
le
an
d
s
o
ciety
,
as
well
as
im
p
r
o
v
e
liv
in
g
co
n
d
it
io
n
s
[
1
0
]
,
[
1
1
]
.
Hen
ce
,
r
ec
o
g
n
izin
g
th
e
p
o
ten
tial
in
f
lu
en
ce
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
o
n
m
e
n
tal
h
ea
lth
s
tatu
s
,
co
n
d
u
ctin
g
a
co
m
p
ar
a
tiv
e
an
aly
s
is
o
f
th
e
m
en
tal
h
ea
lth
d
is
o
r
d
er
s
o
f
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
co
u
l
d
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
i
n
to
th
is
m
atter
.
T
h
is
s
tu
d
y
a
im
s
to
ad
d
r
ess
th
e
ex
is
tin
g
g
ap
in
r
esear
ch
b
y
co
m
p
ar
in
g
th
e
m
en
tal
h
ea
lth
s
tatu
s
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
in
b
o
th
C
OVI
D
-
1
9
an
d
non
-
C
OVI
D
-
1
9
war
d
s
at
DR
.
Sh
ar
iati H
o
s
p
ital
in
T
eh
r
an
.
2.
M
AT
E
R
I
AL
S AN
D
M
E
T
H
O
D
2
.
1
.
Resea
rc
h desi
g
n a
nd
s
a
m
pli
ng
m
et
ho
d
T
h
is
co
m
p
ar
ativ
e
-
d
escr
ip
tiv
e
s
tu
d
y
with
a
cr
o
s
s
-
s
ec
tio
n
al
a
p
p
r
o
ac
h
was
co
n
d
u
cted
in
2
0
2
1
.
T
h
e
p
o
p
u
latio
n
in
t
h
is
s
tu
d
y
was
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
in
Sh
a
r
iati
Ho
s
p
ital.
T
h
e
s
am
p
le
s
iz
e
in
th
is
s
tu
d
y
was
b
ased
o
n
th
e
m
ea
n
an
d
s
tan
d
ar
d
d
ev
iatio
n
o
b
tain
ed
f
r
o
m
th
e
m
en
tal
h
ea
lth
s
tatu
s
o
f
s
taf
f
in
C
OVI
D
-
1
9
an
d
non
-
C
OVI
D
-
1
9
war
d
s
in
th
e
s
tu
d
y
o
f
Qu
ch
a
n
et
a
l.
[
1
5
]
.
T
h
e
r
eq
u
ir
e
d
s
am
p
le
s
ize
wit
h
a
9
5
%
co
n
f
id
e
n
ce
lev
el
an
d
8
0
%
p
o
wer
was
2
2
3
.
T
o
p
r
e
v
en
t
th
e
p
o
s
s
ib
ilit
y
o
f
lo
s
in
g
th
e
s
am
p
le,
we
co
llect
ed
a
s
am
p
le
o
f
2
5
0
p
ar
ticip
an
ts
f
r
o
m
C
OVI
D
-
1
9
an
d
n
o
n
-
C
OVI
D
-
1
9
war
d
s
(
e
ac
h
g
r
o
u
p
co
m
p
r
is
ed
1
2
5
p
a
r
ticip
an
ts
)
.
A
lis
t
o
f
all
s
taf
f
was
p
r
e
p
ar
ed
f
ir
s
t,
an
d
th
en
th
e
y
wer
e
p
lace
d
in
d
if
f
er
en
t
cl
ass
es
b
ased
o
n
t
h
e
ty
p
e
o
f
jo
b
.
Af
ter
war
d
,
in
p
r
o
p
o
r
tio
n
to
t
h
e
to
tal
n
u
m
b
er
o
f
p
eo
p
le
in
ea
c
h
jo
b
class
,
r
esear
ch
s
am
p
les
wer
e
s
elec
t
ed
u
s
in
g
s
y
s
tem
atic
r
an
d
o
m
s
am
p
lin
g
.
T
h
e
in
clu
s
io
n
cr
iter
ia
in
th
is
s
tu
d
y
wer
e:
i
n
f
o
r
m
e
d
wr
itten
c
o
n
s
en
t;
at
le
ast
th
r
ee
m
o
n
th
s
o
f
jo
b
ex
p
er
ien
ce
at
Sh
ar
iati
Ho
s
p
ital;
an
d
at
least
th
r
ee
m
o
n
th
s
o
f
jo
b
ex
p
er
ien
ce
i
n
C
OVI
D
-
1
9
war
d
s
.
T
h
e
ex
clu
s
io
n
cr
iter
ia
wer
e:
p
ar
ti
cip
an
ts
with
d
r
awin
g
f
r
o
m
th
e
s
tu
d
y
f
o
r
a
n
y
r
ea
s
o
n
;
p
a
r
ticip
an
ts
s
u
b
m
itti
n
g
in
co
m
p
lete
q
u
esti
o
n
n
air
es;
p
r
ev
io
u
s
h
is
to
r
ies
o
f
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
s
s
u
ch
as
s
tr
ess
,
an
x
iety
,
a
n
d
d
ep
r
ess
io
n
th
r
o
u
g
h
s
elf
-
r
ep
o
r
t
; a
n
d
a
h
is
to
r
y
o
f
ta
k
in
g
p
s
y
ch
iatr
ic
d
r
u
g
s
th
r
o
u
g
h
s
elf
-
r
ep
o
r
t.
2
.
2
.
D
a
t
a
c
o
l
l
e
c
t
i
o
n
t
o
o
l
s
I
n
o
r
d
e
r
t
o
c
o
l
l
e
c
t
t
h
e
d
a
t
a
r
e
q
u
i
r
e
d
i
n
t
h
i
s
s
t
u
d
y
,
a
d
e
m
o
g
r
a
p
h
i
c
i
n
f
o
r
m
a
t
i
o
n
f
o
r
m
w
a
s
u
s
e
d
,
i
n
c
l
u
d
i
n
g
q
u
e
s
t
i
o
n
s
r
e
l
a
t
e
d
t
o
a
g
e
,
g
e
n
d
e
r
,
l
e
v
e
l
o
f
e
d
u
c
a
t
i
o
n
,
o
c
c
u
p
a
t
i
o
n
,
w
o
r
k
h
i
s
t
o
r
y
,
e
c
o
n
o
m
i
c
s
t
a
t
u
s
,
l
i
f
e
s
t
y
l
e
,
a
n
d
h
i
s
t
o
r
y
o
f
a
c
t
i
v
i
t
y
i
n
t
h
e
C
O
V
I
D
-
1
9
w
a
r
d
.
T
h
e
m
e
n
t
a
l
h
e
a
l
t
h
o
f
e
m
p
l
o
y
e
e
s
w
a
s
a
l
s
o
a
s
s
e
s
s
e
d
u
s
i
n
g
t
h
e
G
e
n
e
r
a
l
H
e
a
l
t
h
Q
u
e
s
t
i
o
n
n
a
i
r
e
(
G
H
Q
)
-
2
8
q
u
e
s
t
i
o
n
n
a
i
r
e
.
T
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
w
a
s
d
e
v
e
l
o
p
e
d
a
s
a
s
c
r
e
e
n
i
n
g
t
o
o
l
b
y
G
o
l
d
b
e
r
g
i
n
1
9
7
2
[
1
6
]
t
o
d
e
t
e
c
t
m
i
l
d
m
e
n
t
a
l
d
i
s
o
r
d
e
r
s
i
n
d
i
f
f
e
r
e
n
t
c
i
r
c
u
m
s
t
a
n
c
e
s
.
T
h
e
r
e
a
r
e
6
0
i
t
e
m
s
i
n
t
h
e
o
r
i
g
i
n
a
l
G
H
Q
a
n
d
3
0
,
2
8
,
2
0
,
a
n
d
1
2
i
t
e
m
s
i
n
t
h
e
s
h
o
r
t
e
r
v
e
r
s
i
o
n
s
.
I
n
t
h
i
s
s
u
r
v
e
y
,
t
h
e
G
H
Q
-
2
8
q
u
e
s
t
i
o
n
n
a
i
r
e
,
c
o
n
s
i
s
t
i
n
g
o
f
f
o
u
r
s
u
b
s
c
a
l
e
s
(
s
e
v
e
r
e
d
e
p
r
e
s
s
i
o
n
,
s
o
m
a
t
i
c
s
y
m
p
t
o
m
s
,
s
o
c
i
a
l
f
u
n
c
t
i
o
n
,
a
n
x
i
e
t
y
,
a
n
d
i
n
s
o
m
n
i
a
)
,
w
a
s
u
s
e
d
.
E
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.
Fu
r
th
er
m
o
r
e,
a
s
tu
d
y
in
I
r
a
n
em
p
l
o
y
in
g
th
e
GHQ
-
2
8
in
d
icate
d
th
at
4
8
.
2
%
o
f
s
taf
f
wo
r
k
in
g
in
C
OVI
D
-
1
9
r
ef
er
r
al
h
o
s
p
it
als
s
u
f
f
er
ed
f
r
o
m
m
e
n
tal
h
ea
lth
d
is
o
r
d
er
s
[
2
6
]
.
Ov
er
all,
th
e
r
esu
lts
o
f
th
e
p
r
esen
t
s
tu
d
y
s
u
g
g
est
th
at
d
u
r
i
n
g
th
e
C
OVI
D
-
1
9
p
an
d
em
ic,
th
e
p
r
ev
alen
ce
o
f
m
en
tal
h
ea
lth
d
is
o
r
d
er
s
am
o
n
g
h
ea
lth
ca
r
e
s
taf
f
was
s
im
ila
r
to
r
ep
o
r
ts
f
r
o
m
o
th
er
co
u
n
t
r
ies
an
d
tr
ea
tm
en
t
ce
n
ter
s
in
I
r
an
,
an
d
r
em
ain
ed
r
elativ
ely
h
ig
h
an
d
f
ar
f
r
o
m
o
p
tim
al
co
n
d
itio
n
s
.
T
h
e
r
ef
o
r
e,
ap
p
r
o
p
r
iate
in
ter
v
en
tio
n
s
tr
ateg
ies
ar
e
n
ec
ess
ar
y
to
im
p
r
o
v
e
th
e
m
en
tal
h
ea
lth
s
tatu
s
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
,
p
ar
ticu
lar
ly
th
o
s
e
ass
ig
n
ed
to
C
OVI
D
-
1
9
war
d
s
.
T
h
er
e
is
a
lo
wer
s
ev
er
ity
o
f
m
en
tal
h
ea
lth
d
is
o
r
d
er
s
in
t
h
e
p
r
esen
t
s
tu
d
y
th
an
in
Qu
c
h
an
et
a
l.
[
1
5
]
in
Sab
ze
v
az
h
o
s
p
itals
an
d
Far
o
k
h
n
ez
h
ad
et
a
l.
[
2
7
]
in
B
u
s
h
eh
r
Per
s
ian
Gu
lf
Ma
r
ty
r
s
Ho
s
p
ital.
I
t
s
ee
m
s
th
at
th
e
s
ev
er
ity
o
f
m
e
n
tal
h
ea
lth
d
is
o
r
d
er
s
am
o
n
g
m
ed
ica
l
s
taf
f
h
as d
ec
r
ea
s
ed
d
u
e
to
r
ea
s
o
n
s
s
u
ch
as
th
e
r
ed
u
ctio
n
o
f
th
e
leth
ality
o
f
th
e
d
is
ea
s
e,
th
e
u
n
iv
e
r
s
al
v
ac
cin
atio
n
p
r
o
g
r
a
m
,
an
d
th
e
in
cr
ea
s
e
in
t
h
e
lev
e
l
o
f
k
n
o
wled
g
e
an
d
awa
r
en
ess
o
f
m
e
d
ical
s
taf
f
in
d
ea
lin
g
with
t
h
e
d
is
ea
s
e
an
d
p
atien
ts
co
m
p
ar
ed
to
t
h
e
b
e
g
in
n
in
g
o
f
th
e
C
OVI
D
-
1
9
cr
is
is
.
I
n
ter
m
s
o
f
s
u
b
-
s
ca
l
es
o
f
m
e
n
tal
h
ea
lth
s
tatu
s
,
th
e
h
ig
h
est
m
ea
n
was
r
elate
d
to
an
x
iety
s
y
m
p
to
m
s
,
in
d
icatin
g
th
at
th
e
in
cid
e
n
ce
o
f
an
x
iety
an
d
s
leep
d
is
tu
r
b
an
c
e
d
u
r
in
g
t
h
e
C
OVI
D
-
1
9
p
an
d
e
m
ic
is
an
im
p
o
r
tan
t
p
ar
t
o
f
th
e
m
e
n
tal
h
ea
lth
d
is
o
r
d
er
s
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
in
h
o
s
p
itals
.
T
h
ese
f
in
d
in
g
s
we
r
e
in
lin
e
with
t
h
o
s
e
o
f
Dasty
ar
an
d
Kar
im
ian
k
ak
o
lak
[
2
8
]
,
wh
o
r
e
p
o
r
ted
th
at
a
n
x
iety
s
y
m
p
t
o
m
s
an
d
s
leep
d
is
tu
r
b
an
ce
h
a
d
th
e
h
ig
h
est
s
co
r
e
am
o
n
g
1
1
0
n
u
r
s
es
wo
r
k
in
g
i
n
I
m
am
R
ez
a,
Ah
v
a
z
Ho
s
p
ital.
I
n
two
o
t
h
er
s
t
u
d
ies
in
Nep
al
an
d
Po
lan
d
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
an
d
em
ic,
an
x
iety
an
d
s
leep
d
is
tu
r
b
an
ce
wer
e
m
o
r
e
s
ev
er
e
am
o
n
g
h
ea
lth
ca
r
e
wo
r
k
er
s
co
m
p
ar
e
d
to
o
th
er
as
p
ec
ts
o
f
m
en
tal
h
ea
lth
[
2
5
]
,
[
2
9
]
.
T
h
e
r
esu
lts
o
f
th
e
b
iv
ar
ia
te
an
aly
s
is
s
h
o
wed
t
h
at
s
taf
f
in
C
OVI
D
-
19
war
d
s
wer
e
in
wo
r
s
e
co
n
d
itio
n
in
ter
m
s
o
f
s
o
m
atic
s
y
m
p
t
o
m
s
,
an
x
iety
,
s
leep
d
is
tu
r
b
an
ce
,
an
d
to
tal
s
co
r
e
o
f
m
en
tal
h
ea
lth
co
m
p
a
r
ed
to
th
eir
p
ee
r
s
in
n
o
n
-
C
OVI
D
-
19
war
d
s
.
T
h
e
f
in
d
i
n
g
s
ar
e
in
lin
e
with
th
o
s
e
o
f
s
ev
er
al
p
r
ev
io
u
s
s
tu
d
ies
in
wh
ich
t
h
e
s
o
m
atic
s
y
m
p
to
m
s
o
f
s
taf
f
i
n
C
OVI
D
-
19
war
d
s
wer
e
s
ig
n
if
ican
tly
h
ig
h
er
th
a
n
th
o
s
e
o
f
th
eir
p
ee
r
s
in
o
t
h
er
w
ar
d
s
[
2
5
]
,
[
3
0
]
.
T
h
e
h
ig
h
e
r
in
ten
s
ity
o
f
s
o
m
at
ic
s
y
m
p
to
m
s
am
o
n
g
t
h
e
s
taf
f
o
f
th
e
C
OVI
D
-
19
war
d
s
m
ay
b
e
d
u
e
to
in
ten
s
iv
e
wo
r
k
in
s
tr
ess
f
u
l
s
itu
atio
n
s
an
d
th
e
r
ea
ctio
n
ca
u
s
ed
b
y
th
e
in
c
r
ea
s
ed
ac
tiv
ity
o
f
th
e
a
u
to
n
o
m
ic
n
er
v
o
u
s
s
y
s
tem
.
T
h
e
h
y
p
e
r
ac
t
iv
ity
o
f
th
e
a
u
to
n
o
m
ic
n
er
v
o
u
s
s
y
s
tem
d
o
es
n
o
t
af
f
ec
t
h
ea
lt
h
in
th
e
s
h
o
r
t
ter
m
,
b
u
t if
it c
o
n
tin
u
es f
o
r
a
l
o
n
g
ti
m
e,
it lea
d
s
to
f
atig
u
e,
d
ep
r
ess
io
n
,
a
n
d
o
th
er
ad
v
er
s
e
co
n
s
eq
u
en
ce
s
in
a
p
er
s
o
n
'
s
h
ea
lth
[
3
1
]
-
[
3
3
]
.
Fro
m
t
h
e
p
s
y
ch
o
d
y
n
am
ic
p
er
s
p
ec
tiv
e,
l
o
n
g
-
ter
m
em
o
tio
n
al
ten
s
io
n
s
i
n
h
ea
lth
ca
r
e
wo
r
k
er
s
m
ay
lead
t
o
s
o
m
atic
s
y
m
p
t
o
m
s
an
d
s
leep
d
is
o
r
d
er
s
,
w
h
ich
u
ltima
tely
lead
to
d
is
r
u
p
tio
n
s
in
t
h
eir
jo
b
p
er
f
o
r
m
an
ce
[
2
5
]
.
W
o
r
k
in
g
i
n
C
OVI
D
-
19
war
d
s
a
n
d
ca
r
i
n
g
f
o
r
C
OVI
D
-
19
p
atien
ts
ca
n
b
e
o
n
e
o
f
th
e
r
is
k
f
ac
to
r
s
f
o
r
ca
u
s
in
g
an
x
iety
an
d
s
leep
d
is
tu
r
b
an
ce
s
,
ac
c
o
r
d
in
g
to
th
e
p
r
esen
t stu
d
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
Men
ta
l h
ea
lth
s
ta
tu
s
o
f h
e
a
lth
ca
r
e
w
o
r
ke
r
s
in
C
OV
I
D
-
1
9
vs n
o
n
-
C
OV
I
D
-
19
…
(
A
b
d
o
lh
a
ki
m
Jo
r
b
o
n
ya
n
)
5
T
h
e
f
in
d
in
g
s
o
f
v
ar
io
u
s
s
tu
d
i
es
in
I
r
a
n
a
n
d
o
th
er
co
u
n
tr
ies
s
h
o
wed
t
h
at
th
e
an
x
iety
in
d
e
x
o
f
s
taf
f
wh
o
wer
e
in
d
ir
ec
t
co
n
tact
w
ith
p
atien
ts
with
C
OVI
D
-
19
was
at
a
h
ig
h
er
lev
el
co
m
p
ar
ed
to
th
eir
p
ee
r
s
in
o
th
er
n
o
n
-
C
OVI
D
-
19
war
d
s
[
1
5
]
,
[
3
4
]
-
[
3
7
]
.
T
h
e
r
esu
lts
o
f
T
an
et
a
l.
[
3
8
]
s
tu
d
y
o
n
m
ed
ic
al
s
taf
f
in
Sin
g
ap
o
r
e
d
u
r
in
g
th
e
o
u
t
b
r
ea
k
o
f
C
OVI
D
-
19
s
h
o
wed
th
at
h
ea
lth
ca
r
e
wo
r
k
er
s
wh
o
wer
e
in
clo
s
e
c
o
n
tact
with
p
atien
ts
in
f
ec
ted
with
C
OVI
D
-
19
h
ad
a
h
ig
h
er
an
x
iety
in
d
ex
th
a
n
t
h
o
s
e
wh
o
wer
e
n
o
t
in
co
n
tact
with
p
atien
ts
with
C
OVI
D
-
19
.
Pe
o
p
le
with
an
x
iety
d
is
o
r
d
er
s
ex
p
er
ien
ce
d
is
p
r
o
p
o
r
tio
n
ate
lev
els o
f
an
x
iety
,
w
h
ich
is
th
eir
b
o
d
y
'
s
n
atu
r
al
r
esp
o
n
s
e
to
s
tr
ess
[
3
9
]
.
An
x
iety
d
is
o
r
d
er
s
lead
to
e
x
ce
s
s
iv
e
n
er
v
o
u
s
n
ess
,
f
ea
r
,
a
p
p
r
eh
e
n
s
io
n
,
w
o
r
r
y
,
an
d
s
o
m
atic
s
y
m
p
to
m
s
in
a
p
er
s
o
n
[
4
0
]
.
Du
r
i
n
g
th
e
C
OVI
D
-
19
p
an
d
e
m
ic,
h
ig
h
lev
els
o
f
s
tr
ess
an
d
m
en
tal
h
ea
lth
p
r
o
b
lem
s
wer
e
co
m
m
o
n
am
o
n
g
f
r
o
n
tlin
e
h
ea
lth
p
r
o
f
ess
io
n
als,
an
d
f
o
r
th
is
r
ea
s
o
n
,
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
th
e
lev
el
o
f
an
x
iety
a
n
d
s
t
r
ess
am
o
n
g
h
ea
lth
ca
r
e
wo
r
k
e
r
s
was h
ig
h
er
th
an
in
th
e
g
e
n
er
al
p
o
p
u
l
atio
n
.
As
f
o
u
n
d
b
y
Qi
et
a
l.
[
4
1
]
r
es
ea
r
ch
in
C
h
in
a,
h
ea
lth
p
r
o
f
ess
io
n
als,
esp
ec
ially
th
o
s
e
wh
o
wer
e
o
n
th
e
f
r
o
n
tlin
e
o
f
th
e
tr
ea
tm
e
n
t o
f
C
OVI
D
-
19
,
h
a
d
s
ig
n
if
ican
tly
h
ig
h
er
r
ates o
f
an
x
iety
a
n
d
s
y
m
p
to
m
s
o
f
d
e
p
r
ess
io
n
th
an
th
eir
p
ee
r
s
,
wh
ic
h
was
c
o
n
s
is
ten
t
with
th
e
p
r
esen
t
s
tu
d
y
'
s
f
in
d
in
g
s
.
T
h
e
h
ig
h
er
lev
el
o
f
an
x
iety
in
th
e
h
ea
lth
ca
r
e
s
taf
f
o
f
th
e
C
OVI
D
-
19
war
d
s
,
as
r
ep
o
r
ted
in
th
e
o
th
er
s
tu
d
ies,
m
ay
b
e
d
u
e
t
o
r
ea
s
o
n
s
s
u
ch
as
wo
r
k
in
g
lo
n
g
h
o
u
r
s
,
f
ea
r
o
f
co
n
tr
ac
tin
g
th
e
d
is
ea
s
e
,
an
d
b
ein
g
af
r
aid
o
f
s
p
r
ea
d
i
n
g
it
to
f
am
ily
m
em
b
e
r
s
,
in
s
o
m
n
ia,
p
atien
t
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4
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,
h
o
s
p
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f
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ask
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to
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tify
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lth
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5.
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5
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[
6
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P.
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-
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t
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l
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[
7
]
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.
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o
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l
.
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[
8
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[
9
]
J.
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[
1
0
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J.
C
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t
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l
.
,
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[
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1
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.
P
.
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.
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o
,
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Me
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[
1
3
]
J.
La
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t
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l
.
,
“
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[
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4
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A
.
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[
1
5
]
A
.
D
.
M
.
Q
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.
Ta
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R
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[
1
6
]
D
.
P
.
G
o
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,
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q
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.
[
1
7
]
Z.
Z
a
ma
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A
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n
i
,
H
.
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i
,
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L.
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6
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4
7
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N
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w
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l
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[
4
8
]
W
.
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B
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RAP
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AUTH
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