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]
.
An
alg
esics
,
an
tip
y
r
etics,
n
o
n
-
s
ter
o
id
al
an
t
i
-
in
f
lam
m
ato
r
y
m
e
d
icatio
n
s
,
an
d
a
n
t
ib
io
tics
ar
e
th
e
p
h
ar
m
ac
eu
ticals
th
at
ar
e
u
s
ed
m
o
s
t
f
r
eq
u
en
tly
f
o
r
s
elf
-
m
ed
icatio
n
[
6
]
.
Div
er
s
e
g
r
o
u
p
s
ex
h
ib
it
d
if
f
er
e
n
t
s
elf
-
m
ed
icatio
n
ten
d
en
cies,
wh
ich
ar
e
im
p
ac
te
d
b
y
a
v
ar
i
ety
o
f
v
ar
iab
les
,
in
clu
d
i
n
g
ag
e,
s
ex
,
wea
lth
,
a
f
o
cu
s
o
n
s
elf
-
ca
r
e,
an
d
m
e
d
ical
ex
p
er
tis
e
[
7
]
-
[
9
]
.
Par
ticu
lar
l
y
,
h
ea
lth
ca
r
e
wo
r
k
er
s
lik
e
d
o
ct
o
r
s
,
n
u
r
s
es,
an
d
p
h
ar
m
ac
is
ts
s
elf
-
m
ed
icate
m
o
r
e
o
f
ten
th
an
th
e
g
e
n
er
al
p
u
b
lic
[
4
]
.
W
HO
h
as
n
o
ted
th
at
ef
f
ec
tiv
e
s
elf
-
m
ed
icatio
n
co
u
ld
b
e
u
s
ef
u
l
in
th
e
tr
ea
tm
en
t
o
f
ac
u
te
illn
ess
es
th
at
d
o
n
'
t
n
ee
d
m
ed
ical
atten
tio
n
,
ca
n
r
ed
u
ce
t
h
e
v
is
itin
g
tim
e
to
a
d
o
cto
r
,
an
d
s
u
g
g
es
ts
a
less
ex
p
en
s
iv
e
alter
n
ativ
e
f
o
r
m
an
a
g
in
g
r
eg
u
lar
p
r
o
b
lem
s
[
4
]
.
Go
v
er
n
m
en
ts
in
n
u
m
er
o
u
s
n
atio
n
s
ar
e
also
p
r
o
m
o
tin
g
s
e
lf
-
m
ed
icatio
n
an
d
o
th
e
r
f
o
r
m
s
o
f
s
elf
-
ca
r
e
f
o
r
m
ild
ailm
en
t
s
.
W
h
en
p
er
s
o
n
s
s
af
ely
s
elf
-
m
ed
icate
,
tr
ea
tm
en
t
co
s
ts
,
tr
av
el
ex
p
en
s
es,
an
d
co
n
s
u
ltatio
n
tim
es
ar
e
all
d
ec
r
ea
s
ed
[
1
0
]
.
Yo
u
n
g
ad
u
lt
u
n
i
v
er
s
ity
s
tu
d
en
ts
ar
e
m
o
r
e
lik
ely
to
s
elf
-
m
ed
icate
d
u
e
to
th
eir
lim
ited
awa
r
e
n
ess
o
f
th
e
r
is
k
s
ass
o
ciate
d
with
d
r
u
g
u
s
e,
ea
s
y
ac
ce
s
s
to
th
e
in
ter
n
et,
in
cr
ea
s
ed
p
h
a
r
m
ac
eu
tical
ad
v
e
r
tis
in
g
,
an
d
t
h
e
ea
s
e
o
f
d
r
u
g
av
ailab
ilit
y
.
I
t
is
a
s
er
io
u
s
is
s
u
e
th
at
p
o
s
es
a
r
is
k
b
ec
au
s
e
s
ev
er
al
s
tu
d
en
ts
n
o
lo
n
g
er
ask
f
o
r
m
ed
ical
tr
ea
tm
en
t
,
i
n
s
tead
p
u
r
ch
ase
m
ed
ici
n
es
b
ased
o
n
th
e
in
f
o
r
m
atio
n
f
r
o
m
f
r
ien
d
s
,
f
a
m
ily
m
em
b
e
r
s
,
an
d
th
e
o
n
lin
e
[
1
1
]
.
Self
-
wid
esp
r
ea
d
u
s
e
o
f
m
ed
ic
atio
n
an
d
u
n
f
av
o
r
ab
le
ef
f
ec
ts
h
av
e
m
a
d
e
it
a
g
lo
b
al
h
ea
lth
ch
allen
g
e.
Ab
u
s
es
o
f
s
o
m
e
m
ed
icatio
n
s
an
d
p
o
o
r
u
s
ag
e
o
f
o
th
er
s
h
a
v
e
b
o
th
b
ee
n
lin
k
ed
to
n
eg
ativ
e
p
h
ar
m
ac
o
lo
g
ical
ef
f
ec
ts
[
1
2
]
,
[
1
3
]
.
Self
-
m
e
d
icatio
n
p
u
ts
o
n
e
at
r
is
k
f
o
r
d
r
u
g
ad
v
er
s
e
ef
f
ec
ts
,
co
n
tr
ib
u
tes
to
p
eo
p
le
d
elay
in
g
m
ed
ical
ca
r
e
to
o
l
o
n
g
,
wh
ich
m
ak
es
th
eir
illn
ess
wo
r
s
e,
an
d
is
o
n
e
o
f
th
e
ca
u
s
es.
Self
-
m
ed
icat
io
n
h
as
two
n
eg
ativ
e
ef
f
ec
ts
:
d
r
u
g
d
e
p
en
d
en
ce
an
d
h
id
in
g
s
ig
n
s
an
d
s
y
m
p
to
m
s
o
f
u
n
d
e
r
ly
in
g
illn
ess
[
1
4
]
,
[
1
5
]
.
Acc
o
r
d
in
g
to
s
ev
er
al
s
tu
d
ies,
m
an
y
u
n
iv
er
s
ity
s
tu
d
en
ts
f
r
o
m
d
if
f
er
e
n
t
ar
ea
s
wer
e
s
u
f
f
er
in
g
f
r
o
m
p
h
ar
m
ac
o
lo
g
ical
s
id
e
ef
f
ec
ts
,
s
u
ch
as
e
x
p
er
ien
ci
n
g
s
ev
er
e
d
is
ea
s
e
co
n
d
itio
n
s
lik
e
d
r
u
g
to
x
icity
an
d
lo
n
g
er
r
ec
o
v
er
y
tim
e
wh
ile
ap
p
ly
in
g
s
elf
-
m
ed
icatio
n
[
1
6
]
-
[
1
8
]
.
T
h
e
cu
r
r
en
t
s
itu
atio
n
in
B
an
g
lad
esh
d
e
m
o
n
s
tr
ates
th
at
m
o
s
t
p
eo
p
le
ch
o
o
s
e
to
ta
k
e
m
ed
icatio
n
s
o
n
th
eir
o
wn
in
itiativ
e
wh
en
th
e
y
b
ec
o
m
e
ill
r
ath
er
th
an
r
u
s
h
i
n
g
to
th
e
h
o
s
p
ital
o
r
d
o
cto
r
'
s
o
f
f
ice,
wh
ich
is
ty
p
i
ca
lly
af
f
ec
ted
b
y
s
ev
er
al
co
m
m
o
n
v
ar
iab
les
,
i
n
clu
d
in
g
a
d
v
ice
f
r
o
m
f
a
m
ily
o
r
f
r
ien
d
s
[
1
9
]
.
B
u
t
t
h
er
e
a
r
e
n
o
co
m
p
ar
ativ
e
d
ata
ab
o
u
t
th
e
p
r
ev
alen
ce
o
r
o
th
er
in
f
o
r
m
atio
n
o
f
s
elf
m
e
d
icatio
n
in
th
e
h
ea
lth
an
d
n
o
n
-
h
ea
lt
h
u
n
iv
er
s
ity
.
T
h
er
ef
o
r
e,
th
e
g
o
al
o
f
th
e
c
u
r
r
en
t
s
tu
d
y
wa
s
to
ascer
tain
th
e
p
r
ev
alen
ce
o
f
s
elf
-
m
ed
icatio
n
an
d
ass
ess
h
o
w
th
e
s
tu
d
y
y
ea
r
a
n
d
t
h
e
cu
r
r
icu
la
af
f
e
cted
s
elf
-
m
ed
icatio
n
am
o
n
g
Daf
f
o
d
il I
n
ter
n
atio
n
al
Un
iv
er
s
ity
s
tu
d
en
ts
.
2.
M
E
T
H
O
D
T
h
is
in
v
esti
g
atio
n
was
ca
r
r
ie
d
o
u
t
at
th
e
Dep
ar
tm
en
t
o
f
Ph
ar
m
ac
y
an
d
th
e
Dep
ar
tm
e
n
t
o
f
E
n
g
lis
h
,
Daf
f
o
d
il
I
n
ter
n
atio
n
al
Un
iv
er
s
ity
,
Dh
ak
a,
B
an
g
lad
esh
.
T
wo
d
if
f
er
en
t
d
e
p
ar
tm
en
ts
wer
e
s
elec
ted
d
u
e
to
h
ea
lth
an
d
non
-
h
ea
lth
is
s
u
es.
Data
w
er
e
co
llected
f
r
o
m
Octo
b
e
r
2
0
2
2
to
J
an
u
ar
y
2
0
2
3
.
Fo
llo
win
g
a
co
m
p
r
eh
e
n
s
iv
e
r
ev
iew
o
f
th
e
liter
atu
r
e,
a
d
escr
ip
tiv
e
cr
o
s
s
-
s
ec
tio
n
al
q
u
esti
o
n
n
air
e
was
cr
ea
ted
in
E
n
g
lis
h
.
T
h
e
q
u
esti
o
n
n
air
e
u
n
d
er
wen
t
v
alid
atio
n
an
d
p
r
et
esti
n
g
.
T
h
e
in
clu
d
ed
p
ar
ticip
a
n
ts
wer
e
all
s
tu
d
en
ts
o
f
t
h
e
Ph
ar
m
ac
y
an
d
E
n
g
lis
h
Dep
ar
tm
en
ts
o
f
Da
f
f
o
d
il
I
n
t
er
n
atio
n
al
Un
iv
e
r
s
ity
.
T
h
e
p
u
r
p
o
s
e
o
f
th
e
an
aly
s
is
was
ex
p
lain
ed
to
th
e
p
ar
ticip
an
ts
.
T
h
e
s
tu
d
e
n
ts
wh
o
d
en
ied
p
ar
ticip
atin
g
an
d
wh
o
r
ef
u
s
ed
to
s
h
ar
e
th
e
n
ec
ess
a
r
y
in
f
o
r
m
atio
n
wer
e
ex
clu
d
ed
f
r
o
m
th
e
s
tu
d
y
.
All
p
ar
ticip
an
ts
s
ig
n
ed
th
e
co
n
s
en
t
f
o
r
m
,
a
n
d
th
e
E
th
ical
R
ev
ie
w
C
o
m
m
ittee
o
f
th
e
F
ac
u
lty
o
f
Allied
Hea
lth
Scien
ce
s
ap
p
r
o
v
ed
th
e
s
tu
d
y
.
A
to
tal
o
f
2
4
0
u
n
d
er
g
r
ad
u
ate
s
tu
d
en
t
s
with
co
m
p
ar
ab
le
ag
es a
n
d
ed
u
ca
tio
n
al
b
ac
k
g
r
o
u
n
d
s
wer
e
g
iv
e
n
q
u
esti
o
n
n
air
e
s
an
d
in
clu
d
e
d
in
th
is
s
tu
d
y
[
2
0
]
.
An
aly
s
is
o
f
th
e
co
llected
d
ata
was
d
o
n
e
em
p
lo
y
in
g
th
e
SP
S
S
s
o
f
twar
e
(
v
er
s
io
n
1
6
.
0
)
.
T
h
e
d
escr
ip
tiv
e
s
tatis
tics
,
in
clu
d
in
g
f
r
eq
u
en
cy
,
cr
o
s
s
tab
s
,
ex
ac
t
,
an
d
C
hi
-
s
q
u
a
r
e
co
r
r
elatio
n
,
wer
e
u
s
ed
o
n
th
e
b
asis
o
f
d
i
f
f
er
en
t
v
ar
ia
b
les
.
T
h
e
d
at
a
was
p
r
esen
ted
in
th
e
f
o
r
m
o
f
ta
b
les,
tex
ts
,
an
d
f
ig
u
r
es.
*
(
p
<
0
.
0
5
)
,
*
*
(
p
<
0
.
0
1
)
,
an
d
*
*
*
(
p
<
0
.
0
0
1
)
wer
e
tak
en
as
s
tatis
ticall
y
s
ig
n
if
ican
t,
h
ig
h
ly
s
ig
n
if
ica
n
t
,
an
d
v
er
y
h
ig
h
ly
s
ig
n
if
ican
t
,
r
esp
ec
tiv
ely
,
wh
ile
co
r
r
elatio
n
was
co
n
s
id
er
ed
[
2
0
].
3.
RE
SU
L
T
S
Fro
m
th
e
to
tal
2
5
0
q
u
esti
o
n
n
air
es,
2
4
0
r
esp
o
n
d
en
ts
wer
e
in
clu
d
ed
as
th
ey
r
et
u
r
n
ed
t
h
e
f
illed
-
out
q
u
esti
o
n
n
air
e
,
an
d
th
e
r
em
ai
n
in
g
1
0
in
co
m
p
lete
q
u
esti
o
n
n
air
es
wer
e
ex
clu
d
ed
f
r
o
m
t
h
e
s
tu
d
y
.
He
r
e,
1
2
2
an
d
1
1
8
r
esp
o
n
d
en
ts
wer
e
u
n
d
er
g
r
ad
u
ate
m
ed
ical
an
d
n
o
n
-
m
ed
ical
s
tu
d
en
ts
,
r
esp
ec
ti
v
ely
.
Am
o
n
g
th
e
r
esp
o
n
d
en
ts
,
5
4
.
2
%
(
1
3
0
)
wer
e
f
em
ale
,
an
d
4
5
.
8
%
(
1
1
0
)
w
er
e
m
ale.
T
h
e
m
ax
im
u
m
r
esp
o
n
d
en
ts
wer
e
f
r
o
m
th
e
21
-
2
2
y
ea
r
s
ag
e
g
r
o
u
p
(
7
4
.
2
%;
1
7
8
)
,
wh
er
e
8
7
.
5
%
wer
e
Mu
s
lim
an
d
4
3
.
3
%
(
1
0
4
)
wer
e
s
tu
d
y
lev
el
-
4
r
esp
o
n
d
en
ts
(
T
a
b
le
1
)
.
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
in
d
icate
th
at
9
4
(
3
9
.
1
7
%)
o
f
t
h
e
h
ea
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
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I
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co
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ile
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ig
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3
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8
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6
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Fig
u
r
e
1
.
So
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r
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s
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2
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t
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N
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4
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0
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8
No
1
3
6
(
5
6
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7
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2
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9
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6
(
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9
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C
l
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r
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4
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2
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6
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7
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0
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2
0
0
No
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6
0
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6
6
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7
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8
8
(
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5
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0
0
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2
(
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5
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0
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B
a
se
d
o
n
t
e
st
i
m
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l
s re
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e
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d
f
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r
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y
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s
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8
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5
7
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5
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6
(
4
0
.
5
8
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8
2
(
5
9
.
4
2
%)
0
.
0
0
9
No
1
0
2
(
4
2
.
5
%)
6
6
(
6
4
.
7
1
%)*
*
3
6
(
3
5
.
2
9
%)
F
r
o
m
p
r
e
v
i
o
u
s
e
x
p
e
r
i
e
n
c
e
s
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s
1
7
8
(
7
4
.
2
%)
9
4
(
5
2
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8
1
%)
8
4
(
4
7
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1
9
%)
0
.
4
6
7
No
6
2
(
2
5
.
8
%)
2
8
(
4
5
.
1
6
%)
3
4
(
5
4
.
8
4
%)
S
e
l
f
-
me
d
i
c
a
t
i
o
n
i
s
l
e
ss
e
x
p
e
n
si
v
e
Y
e
s
1
4
4
(
6
0
.
0
%)
7
0
(
4
8
.
6
1
%)
7
4
(
5
1
.
3
9
%)
0
.
5
5
5
No
9
6
(
4
0
.
0
%)
5
2
(
5
4
.
1
7
%)
4
4
(
4
5
.
8
3
%)
B
e
c
a
u
s
e
o
f
l
o
n
g
w
a
i
t
i
n
g
t
i
m
e
i
n
t
h
e
h
o
sp
i
t
a
l
Y
e
s
1
4
6
(
6
0
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6
8
(
4
6
.
5
8
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7
8
(
5
3
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2
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.
2
4
9
No
9
4
(
3
9
.
2
%)
5
4
(
5
7
.
4
5
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4
0
(
4
2
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5
5
%)
B
e
c
a
u
s
e
o
f
h
a
v
i
n
g
e
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g
h
me
d
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n
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e
d
g
e
Y
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s
1
5
6
(
6
5
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0
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9
2
(
5
8
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9
7
%)*
6
4
(
4
1
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0
3
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0
.
0
1
5
No
8
4
(
3
5
.
0
%)
3
0
(
3
5
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7
1
%)
5
4
(
6
4
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2
9
%)
B
e
c
a
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s
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f
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a
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p
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si
b
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t
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f
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l
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Y
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s
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4
4
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8
(
3
5
.
8
5
%)
6
8
(
6
4
.
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5
%)
0
.
0
0
3
No
1
3
4
(
5
5
.
8
%)
8
4
(
6
2
.
6
9
%)*
*
5
0
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7
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1
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*
(
p
<
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.
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5
)
,
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(
p
<
0
.
0
1
)
,
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n
d
*
*
*
(
p
<
0
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0
0
1
)
w
e
r
e
c
o
n
si
d
e
r
e
d
t
o
b
e
s
t
a
t
i
s
t
i
c
a
l
l
y
s
i
g
n
i
f
i
c
a
n
t
,
h
i
g
h
l
y
s
i
g
n
i
f
i
c
a
n
t
,
a
n
d
v
e
r
y
h
i
g
h
l
y
si
g
n
i
f
i
c
a
n
t
,
r
e
sp
e
c
t
i
v
e
l
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
C
o
mp
a
r
a
tive
a
s
s
ess
men
t o
f k
n
o
w
led
g
e,
a
ttit
u
d
e,
a
n
d
p
r
a
ctice
to
w
a
r
d
… (
Md
.
Miz
a
n
u
r
R
a
h
ma
n
)
269
T
h
e
m
o
s
t
n
o
n
-
h
ea
lth
ca
r
e
p
ar
ticip
an
ts
u
s
ed
p
ain
k
iller
s
as
th
eir
p
r
im
ar
y
f
o
r
m
o
f
s
elf
-
m
ed
icatio
n
,
wh
ile
h
ea
lth
ca
r
e
s
tu
d
en
ts
ten
d
ed
to
u
tili
ze
an
tacid
s
(
F
ig
u
r
e
2)
.
I
n
th
e
ca
s
e
o
f
c
o
n
s
eq
u
e
n
ce
s
,
2
3
2
(
9
6
.
6
6
%),
p
ar
ticip
an
ts
ag
r
ee
d
ab
o
u
t
u
n
d
esire
d
s
y
m
p
to
m
s
o
f
s
elf
m
ed
icatio
n
;
1
1
8
(
4
9
.
2
%)
ag
r
e
ed
d
elay
r
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o
v
er
y
,
1
7
4
(
7
2
.
5
%)
a
g
r
ee
d
o
n
in
e
f
f
e
ctiv
en
ess
o
f
s
o
m
e
d
r
u
g
s
a
f
ter
lo
n
g
u
s
e,
1
3
4
(
5
5
.
8
%)
ag
r
ee
d
th
at
d
iag
n
o
s
is
o
f
illn
ess
tak
e
lo
n
g
er
d
u
e
to
s
elf
m
ed
icatio
n
,
an
d
1
5
8
(
6
5
.
8
%)
s
elf
m
ed
icatio
n
with
d
r
u
g
s
ca
n
r
esu
lt
in
d
is
ea
s
es
(
T
ab
le
3)
.
Fig
u
r
e
2
.
Dr
u
g
s
co
m
m
o
n
ly
ta
k
en
with
s
elf
-
m
ed
icatio
n
T
ab
le
3
.
Sh
o
win
g
th
e
e
f
f
ec
t o
f
s
elf
-
m
ed
icatio
n
S
t
a
t
e
me
n
t
C
a
t
e
g
o
r
i
e
s
N
u
mb
e
r
o
f
p
a
r
t
i
c
i
p
a
n
t
s
To
t
a
l
(
%)
H
e
a
l
t
h
sc
i
e
n
c
e
(
%)
N
o
n
-
h
e
a
l
t
h
s
c
i
e
n
c
e
(
%)
p
-
v
a
l
u
e
A
n
y
e
v
e
r
e
x
p
e
r
i
e
n
c
e
i
n
a
n
y
u
n
d
e
s
i
r
e
d
s
y
m
p
t
o
ms w
i
t
h
s
e
l
f
-
med
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c
a
t
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o
n
Y
e
s
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3
2
(
9
6
.
6
6
%)
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2
0
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0
.
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0
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1
1
2
(
4
6
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6
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0
.
4
0
6
No
8
(
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3
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2
(
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3
%)*
*
*
6
(
2
.
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R
e
c
o
v
e
r
y
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a
s
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e
l
a
y
e
d
b
y
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e
l
f
-
med
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c
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t
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o
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g
r
e
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i
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5
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8
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me
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r
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f
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se
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g
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e
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6
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6
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5
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1
.
0
0
0
D
i
sag
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e
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6
6
(
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7
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(
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4
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(
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3
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3
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D
i
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g
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o
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s
o
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l
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k
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o
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m
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c
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t
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n
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g
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e
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4
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4
6
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sag
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e
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e
l
f
-
me
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i
c
a
t
i
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i
t
h
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r
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su
l
t
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n
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i
se
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ses
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8
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5
.
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3
.
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3
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8
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5
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1
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i
sag
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2
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6
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*
(
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<
0
.
0
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*
*
(
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0
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d
*
*
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(
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w
e
r
e
c
o
n
si
d
e
r
e
d
t
o
b
e
s
t
a
t
i
s
t
i
c
a
l
l
y
s
i
g
n
i
f
i
c
a
n
t
,
h
i
g
h
l
y
s
i
g
n
i
f
i
c
a
n
t
,
a
n
d
v
e
r
y
h
i
g
h
l
y
si
g
n
i
f
i
c
a
n
t
,
r
e
sp
e
c
t
i
v
e
l
y
.
4.
DIS
CU
SS
I
O
N
Self
-
m
ed
icatio
n
is
th
e
wid
e
s
p
r
ea
d
p
r
ac
tice
f
o
r
s
elf
-
tr
ea
tm
en
t
b
y
i
n
d
iv
id
u
als
with
o
u
t
m
ed
ical
s
u
p
er
v
is
io
n
wh
ich
is
r
eg
ar
d
ed
as
a
f
o
r
m
o
f
s
elf
-
ca
r
e
[
3
]
.
S
elf
-
m
ed
icatio
n
also
in
clu
d
es
b
u
y
in
g
m
ed
icatio
n
s
f
r
o
m
th
e
p
h
a
r
m
ac
y
b
y
r
esu
b
m
itti
n
g
p
r
ev
io
u
s
p
r
escr
ip
tio
n
s
,
u
s
in
g
ex
tr
a
an
d
lef
to
v
er
m
e
d
ica
tio
n
s
at
h
o
m
e,
an
d
ask
in
g
f
r
ien
d
s
an
d
f
am
ily
f
o
r
g
u
id
an
ce
r
eg
ar
d
in
g
th
e
m
e
d
icati
on
[
3
]
.
T
h
e
p
r
esen
t
s
tu
d
y
a
im
ed
to
ass
ess
th
e
k
n
o
wled
g
e
an
d
p
r
ac
tices
r
elate
d
to
s
elf
-
m
ed
icatio
n
am
o
n
g
u
n
d
er
g
r
ad
u
ate
s
tu
d
en
ts
,
in
clu
d
in
g
b
o
th
h
ea
lth
ca
r
e
an
d
n
o
n
-
h
ea
lth
ca
r
e
r
esp
o
n
d
en
ts
.
T
h
e
s
tu
d
y
f
in
d
in
g
r
ev
ea
le
d
th
at
m
ajo
r
ity
o
f
s
tu
d
en
ts
wer
e
f
em
ale
an
d
a
g
e
g
r
o
u
p
(
2
1
-
2
2
)
;
n
ea
r
ly
s
am
e
ag
e
an
d
g
en
d
er
d
is
tr
ib
u
tio
n
t
o
th
o
s
e
in
a
s
tu
d
y
[
2
1
]
.
Am
o
n
g
th
e
2
4
0
v
alid
r
esp
o
n
s
es,
th
er
e
was
an
alm
o
s
t
eq
u
al
d
is
tr
ib
u
tio
n
b
etwe
en
h
ea
lth
ca
r
e
(
n
=
1
2
2
)
an
d
n
o
n
-
h
ea
lth
ca
r
e
(
n
=
1
1
8
)
s
tu
d
en
ts
.
T
h
e
m
ajo
r
ity
wer
e
a
g
ed
b
etwe
en
2
1
–
2
2
y
ea
r
s
(
7
4
.
2
%),
an
d
m
o
r
e
th
a
n
h
alf
wer
e
f
em
ale
(
5
4
.
2
%).
T
h
e
r
esu
lts
o
f
s
im
ilar
r
esear
ch
ca
r
r
ied
o
u
t
in
B
an
g
lad
esh
,
I
n
d
ia,
an
d
o
th
er
d
ev
elo
p
i
n
g
n
ati
o
n
s
ar
e
in
lin
e
with
th
e
p
r
e
v
alen
ce
o
f
s
elf
-
m
ed
icatio
n
f
o
u
n
d
in
t
h
is
s
tu
d
y
[
6
]
,
[
2
2
]
.
T
h
e
lev
el
o
f
k
n
o
wled
g
e
d
is
co
v
e
r
ed
in
th
is
s
tu
d
y
,
h
o
we
v
er
,
s
ee
m
s
to
b
e
q
u
ite
d
if
f
e
r
en
t
[
1
2
]
,
[
2
3
]
.
T
h
e
u
s
u
al
f
av
o
r
ab
le
attitu
d
es
o
f
s
tu
d
en
ts
o
n
s
elf
-
m
ed
icatio
n
ar
e
a
r
ef
lectio
n
o
f
th
ei
r
b
elief
th
at
it is
a
q
u
ick
an
d
ea
s
y
wa
y
to
tr
ea
t m
i
n
o
r
ailm
en
ts
[
2
4
]
.
A
s
u
b
s
tan
tial
k
n
o
wled
g
e
an
d
p
r
ac
tice
g
a
p
was
f
o
u
n
d
wh
e
n
h
ea
lth
-
r
elate
d
an
d
n
o
n
-
h
ea
l
th
-
r
elate
d
s
tu
d
en
ts
wer
e
co
m
p
ar
ed
.
Par
ad
o
x
ically
,
h
ea
lth
s
cien
ce
s
tu
d
en
ts
r
ep
o
r
ted
h
ig
h
e
r
r
ates
o
f
s
elf
-
m
ed
icatio
n
d
esp
ite
g
en
er
ally
h
a
v
in
g
a
b
et
ter
awa
r
en
ess
o
f
p
h
ar
m
ac
o
lo
g
ical
in
d
icatio
n
s
an
d
s
id
e
ef
f
ec
ts
.
Ov
er
co
n
f
id
en
ce
in
p
h
ar
m
ac
o
lo
g
ical
ex
p
er
tis
e
an
d
th
e
b
elief
th
at
o
n
e
is
ca
p
ab
le
o
f
s
elf
-
tr
ea
tin
g
co
u
ld
b
e
th
e
ca
u
s
e
o
f
th
is
[
2
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.
15
,
No
.
1
,
M
ar
ch
20
26
:
2
6
6
-
273
270
[
2
6
]
.
No
n
-
h
ea
lth
s
tu
d
e
n
ts
,
o
n
t
h
e
o
th
e
r
h
a
n
d
,
m
ig
h
t r
ely
m
o
r
e
o
n
o
n
lin
e
r
eso
u
r
ce
s
,
p
r
io
r
p
r
escr
ip
tio
n
s
,
o
r
p
ee
r
co
u
n
s
el,
s
u
g
g
esti
n
g
a
lack
o
f
u
n
d
er
s
tan
d
in
g
o
f
p
o
s
s
ib
le
h
az
ar
d
s
.
Acc
o
r
d
in
g
to
th
is
s
tu
d
y
'
s
n
o
tewo
r
th
y
f
in
d
in
g
s
,
s
elf
-
m
ed
icati
o
n
ac
tiv
ities
wer
e
co
m
m
o
n
a
m
o
n
g
b
o
th
h
ea
lth
ca
r
e
an
d
n
o
n
-
h
ea
lth
ca
r
e
s
tu
d
en
ts
.
T
h
e
W
HO
d
ef
in
es
s
elf
-
m
ed
icatio
n
as
u
s
in
g
o
v
er
-
t
h
e
-
co
u
n
ter
o
r
n
o
n
-
p
r
escr
ip
tio
n
p
h
a
r
m
ac
eu
ticals
with
o
u
t
a
p
r
escr
ip
tio
n
,
an
d
3
9
.
1
7
%
o
f
h
ea
lth
ca
r
e
s
tu
d
en
ts
ag
r
ee
d
with
th
is
d
escr
ip
tio
n
,
c
o
m
p
ar
e
d
to
1
8
.
3
3
%
o
f
n
o
n
-
h
ea
lth
ca
r
e
s
tu
d
e
n
ts
.
Giv
en
th
at
h
ea
lth
ca
r
e
s
tu
d
en
ts
ex
h
i
b
it
m
o
r
e
awa
r
en
ess
,
it
p
o
i
n
ts
to
a
k
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o
wled
g
e
g
a
p
b
etwe
en
th
e
two
g
r
o
u
p
s
.
Similar
f
i
n
d
in
g
s
wer
e
r
ep
o
r
ted
in
a
2
0
1
6
s
tu
d
y
[
2
7
]
,
w
h
ich
s
h
o
wed
th
a
t
m
ed
ical
s
tu
d
en
ts
h
a
d
a
b
etter
u
n
d
er
s
tan
d
in
g
o
f
s
elf
-
m
ed
ic
atio
n
co
m
p
ar
ed
to
non
-
m
e
d
ical
s
tu
d
en
ts
.
Self
-
m
ed
icatio
n
h
a
b
its
ar
e
ca
u
s
ed
b
y
a
n
u
m
b
er
o
f
v
ar
iab
l
es,
s
u
ch
as
ea
s
y
ac
ce
s
s
to
d
r
u
g
s
,
p
r
io
r
ex
p
er
ien
ce
with
s
im
ilar
co
n
d
i
tio
n
s
,
f
in
an
cial
lim
itatio
n
s
,
a
n
d
a
lack
o
f
tim
e
to
s
ee
d
o
cto
r
s
.
Peer
r
ef
er
r
als,
co
m
m
er
cials,
an
d
th
e
m
ed
ia
all
h
av
e
a
s
ig
n
if
ican
t
im
p
ac
t.
T
h
ese
elem
en
ts
a
r
e
c
o
n
s
is
ten
t
with
b
e
h
av
i
o
r
al
th
eo
r
ies
th
at
in
d
icate
y
o
u
n
g
a
d
u
lts
'
h
ea
lth
-
s
ee
k
in
g
b
eh
av
io
r
s
ar
e
s
ig
n
if
ican
tly
in
f
lu
en
ce
d
b
y
p
er
ce
iv
e
d
co
n
tr
o
l
an
d
co
n
v
en
ien
ce
[
2
6
]
,
[
2
8
]
.
T
h
e
s
u
r
v
ey
p
r
o
jecte
d
th
at
th
e
m
o
s
t p
r
ev
alen
t o
n
es we
r
e
p
r
i
o
r
ex
p
er
ien
ce
(
7
4
.
2
%),
lack
o
f
tim
e
(
4
3
.
3
%),
an
d
th
e
p
er
ce
p
tio
n
o
f
lo
n
g
h
o
s
p
ital
waitin
g
tim
es
(
6
0
.
8
%).
A
d
d
itio
n
ally
,
m
o
r
e
th
a
n
h
alf
(
5
7
.
5
%)
o
f
th
e
r
esp
o
n
d
en
ts
wer
e
in
f
lu
en
ce
d
b
y
f
r
ien
d
s
an
d
f
am
ily
,
an
d
6
0
%
b
eliev
e
d
s
elf
-
me
d
icatio
n
was
m
o
r
e
ec
o
n
o
m
ical.
T
h
ese
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t
with
p
r
ev
i
o
u
s
r
esear
ch
[
2
5
]
,
[
2
8
]
,
wh
ich
h
ig
h
lig
h
ted
co
n
v
en
ie
n
ce
,
af
f
o
r
d
ab
ilit
y
,
a
n
d
ac
ce
s
s
ib
ilit
y
as
co
m
m
o
n
m
o
tiv
atio
n
s
f
o
r
s
elf
-
m
e
d
icatio
n
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
.
Acc
o
r
d
in
g
to
b
eh
a
v
io
r
al
an
al
y
s
is
,
n
o
n
-
h
ea
lth
s
tu
d
en
ts
f
r
eq
u
en
tly
d
ep
en
d
e
d
o
n
p
r
io
r
p
r
esc
r
ip
tio
n
s
o
r
g
u
id
an
ce
f
r
o
m
class
m
ates
an
d
f
am
ily
,
b
u
t
p
h
ar
m
ac
y
an
d
m
ed
ical
s
tu
d
en
ts
wer
e
m
o
r
e
lik
ely
to
u
tili
ze
o
v
er
-
th
e
-
co
u
n
te
r
p
h
a
r
m
ac
eu
ticals
ap
p
r
o
p
r
iately
[
2
9
]
.
C
o
n
ce
r
n
s
ar
e
also
r
aised
b
y
t
h
e
in
f
o
r
m
atio
n
s
o
u
r
ce
s
u
s
ed
p
r
io
r
to
s
elf
-
m
ed
icatio
n
.
A
s
ig
n
if
ican
t
p
o
r
tio
n
o
f
th
e
r
esp
o
n
d
en
ts
(
5
0
%)
r
elied
o
n
f
am
ily
m
em
b
er
s
,
f
o
llo
wed
b
y
p
h
ar
m
ac
is
ts
(
1
7
%),
o
ld
p
r
e
s
cr
ip
tio
n
s
(
1
7
%),
an
d
d
r
u
g
lea
f
lets
o
r
in
ter
n
et
s
o
u
r
ce
s
(
6
%).
On
ly
a
v
e
r
y
s
m
all
p
er
ce
n
tag
e
(
1
.
6
7
%)
c
o
n
s
u
lted
p
h
y
s
ician
s
.
T
h
is
p
atter
n
h
as
also
b
ee
n
o
b
s
er
v
e
d
in
ea
r
lier
r
e
s
ea
r
ch
[
3
0
]
,
w
h
ich
f
o
u
n
d
th
at
s
tu
d
en
ts
wh
o
s
el
f
-
m
ed
icate
m
o
s
t
f
r
eq
u
e
n
tly
o
b
tain
d
r
u
g
in
f
o
r
m
atio
n
f
r
o
m
class
m
ates
an
d
p
h
ar
m
ac
is
ts
,
r
ef
lectin
g
lim
ited
r
elian
ce
o
n
o
f
f
icial
m
e
d
ical
g
u
id
an
ce
.
C
o
m
m
o
n
ailm
e
n
ts
lead
in
g
to
s
elf
-
m
ed
icatio
n
wer
e
m
in
o
r
co
n
d
itio
n
s
s
u
c
h
as
h
ea
d
ac
h
e
(
4
9
.
1
7
%),
f
ev
er
(
2
3
.
3
3
%),
an
d
co
m
m
o
n
co
ld
/f
lu
(
1
6
.
6
%),
co
n
s
is
ten
t
with
p
r
io
r
liter
atu
r
e
[
2
4
]
.
T
h
ese
s
y
m
p
to
m
s
ar
e
o
f
ten
p
er
ce
iv
ed
as
n
o
n
-
s
er
i
o
u
s
an
d
ar
e
lik
ely
to
p
r
o
m
p
t
in
d
i
v
id
u
als
to
av
o
id
s
ee
k
in
g
p
r
o
f
ess
io
n
al
co
n
s
u
ltatio
n
.
A
co
m
p
ar
is
o
n
o
f
d
r
u
g
s
u
s
ed
r
ev
ea
le
d
th
at
n
o
n
-
h
ea
lth
ca
r
e
s
tu
d
en
ts
p
r
ed
o
m
i
n
an
tly
u
s
ed
p
ain
k
iller
s
,
wh
ile
h
ea
lth
ca
r
e
s
tu
d
en
ts
s
h
o
wed
a
p
r
ef
er
en
ce
f
o
r
an
tacid
s
.
T
h
is
in
d
icate
s
s
o
m
e
v
ar
iatio
n
in
d
r
u
g
ch
o
ices
,
p
o
s
s
ib
ly
b
ased
o
n
p
e
r
ce
iv
ed
m
ed
ical
k
n
o
wled
g
e
,
co
n
s
is
ten
t w
ith
a
s
im
ilar
f
in
d
in
g
[
3
1
]
.
Desp
ite
th
e
wid
esp
r
ea
d
p
r
ac
ti
ce
,
a
co
n
s
id
er
ab
le
m
aj
o
r
ity
(
9
6
.
6
6
%)
o
f
th
e
r
esp
o
n
d
en
ts
ac
k
n
o
wled
g
ed
th
e
p
o
ten
tial
n
eg
ativ
e
ef
f
e
cts
o
f
s
elf
-
m
ed
icatio
n
.
C
o
n
ce
r
n
s
in
cl
u
d
ed
d
elay
ed
r
ec
o
v
er
y
(
4
9
.
2
%),
in
ef
f
ec
tiv
en
ess
o
f
d
r
u
g
s
af
te
r
p
r
o
lo
n
g
ed
u
s
e
(
7
2
.
5
%),
d
i
f
f
icu
lty
in
ac
cu
r
ate
d
iag
n
o
s
i
s
(
5
5
.
8
%),
an
d
th
e
p
o
s
s
ib
ilit
y
o
f
in
d
u
ci
n
g
n
ew
d
is
ea
s
es
(
6
5
.
8
%).
T
h
ese
co
n
ce
r
n
s
ec
h
o
th
e
f
in
d
in
g
s
o
f
s
tu
d
i
es
[
3
]
,
[
3
1
]
,
wh
ich
em
p
h
asized
th
e
r
is
k
s
ass
o
ciate
d
with
in
ap
p
r
o
p
r
iate
d
r
u
g
u
s
e
with
o
u
t
p
r
o
f
ess
io
n
al
s
u
p
er
v
is
io
n
.
T
h
e
r
ef
o
r
e
,
h
ea
lth
s
cien
ce
s
tu
d
en
ts
p
r
o
p
er
ly
u
n
d
er
s
to
o
d
th
e
p
r
ac
tice
o
f
s
elf
-
m
ed
icatio
n
as
co
m
p
ar
ed
to
n
o
n
-
h
ea
lth
s
cien
ce
s
tu
d
en
ts
.
T
h
e
cu
r
r
en
t
r
esu
lts
h
ig
h
lig
h
t
th
e
cr
itical
n
e
ed
f
o
r
f
o
cu
s
ed
h
ea
lth
ed
u
ca
tio
n
in
itiativ
es
at
th
e
u
n
iv
er
s
ity
lev
el
in
o
r
d
er
to
en
co
u
r
a
g
e
n
o
n
-
h
ea
lth
s
tu
d
e
n
ts
to
u
s
e
d
r
u
g
s
s
en
s
ib
ly
a
n
d
p
er
h
ap
s
lo
wer
in
ap
p
r
o
p
r
iate
s
elf
-
m
ed
icatio
n
.
Fu
r
th
er
m
o
r
e,
ca
m
p
aig
n
s
to
r
a
is
e
awa
r
en
ess
o
f
th
e
r
is
k
s
o
f
r
esis
tan
ce
an
d
m
o
r
e
s
tr
in
g
en
t
r
eg
u
latio
n
o
f
a
n
tib
io
tic
s
ales
ar
e
ess
en
tial
leg
is
la
tiv
e
in
ter
v
en
tio
n
s
.
T
h
e
s
elf
-
r
e
p
o
r
ted
d
ata
o
f
th
is
s
tu
d
y
ar
e
o
n
e
o
f
its
lim
itatio
n
s
.
Ad
d
itio
n
ally
,
th
e
p
o
ll
was
c
o
n
d
u
cte
d
at
a
s
in
g
le
s
ch
o
o
l,
w
h
ich
m
ay
n
o
t
f
air
ly
r
ef
lect
th
e
b
eh
a
v
io
r
s
o
f
o
th
er
c
o
lleg
e
s
tu
d
en
ts
n
atio
n
wid
e.
5.
CO
NCLU
SI
O
N
Self
-
m
ed
icatio
n
is
co
m
m
o
n
a
m
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
B
an
g
lad
esh
f
o
r
b
o
th
h
ea
lth
an
d
n
o
n
-
h
ea
lth
s
cien
ce
Dep
ar
tm
en
ts
.
Hea
d
ac
h
e
was
th
e
m
o
s
t
f
r
eq
u
en
tly
tr
ea
ted
d
is
o
r
d
e
r
,
with
a
n
tacid
s
b
ein
g
th
e
m
o
s
t
p
r
ac
ticed
m
e
d
i
ca
tio
n
,
an
d
f
a
m
ily
m
em
b
e
r
s
wer
e
th
e
m
ain
s
o
u
r
ce
o
f
in
f
o
r
m
atio
n
.
R
ea
s
o
n
o
f
s
elf
-
m
ed
icatio
n
wer
e
p
r
ev
io
u
s
ex
p
er
ien
ce
s
,
a
n
d
id
en
tifie
d
ef
f
ec
ts
an
d
co
m
p
licatio
n
s
wer
e
u
n
d
esire
d
s
y
m
p
to
m
s
,
d
elay
ed
r
ec
o
v
er
y
,
in
ef
f
ec
tiv
e
n
ess
o
f
d
r
u
g
s
,
an
d
a
d
ia
g
n
o
s
is
o
f
illn
ess
ta
k
es
lo
n
g
er
.
T
h
e
h
ea
lth
s
ci
en
ce
s
tu
d
en
ts
h
av
e
co
m
p
ar
ativ
ely
p
o
s
itiv
e
k
n
o
wled
g
e,
attitu
d
es
,
an
d
awa
r
e
n
ess
of
th
e
ef
f
ec
tiv
en
ess
o
f
s
elf
-
m
ed
icatio
n
as
co
m
p
ar
ed
to
n
o
n
-
h
ea
lth
s
cien
ce
s
tu
d
en
ts
.
Fu
r
th
er
r
esear
c
h
is
n
ee
d
ed
to
e
x
am
in
e
s
elf
-
m
ed
icatio
n
ac
r
o
s
s
d
em
o
g
r
a
p
h
ic,
s
o
cio
ec
o
n
o
m
ic,
an
d
g
e
o
g
r
ap
h
ic
g
r
o
u
p
s
o
f
m
as
s
p
eo
p
le
in
B
an
g
lad
esh
.
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
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6
C
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Md
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271
F
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Au
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Md
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Ms
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Evaluation Warning : The document was created with Spire.PDF for Python.