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[
2
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151
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5
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i
s
t
in
g
li
ter
at
u
r
e
em
p
h
a
s
iz
e
s
th
e
im
p
o
r
t
an
ce
o
f
ca
r
eg
iv
er
in
v
o
lv
em
en
t
an
d
f
a
m
ily
e
d
u
ca
t
io
n
in
en
h
an
c
in
g
d
ie
tar
y
co
m
p
l
ian
ce
an
d
s
e
lf
-
m
a
n
ag
em
en
t
b
eh
av
io
r
s
[
4
]
,
[
7
]
,
th
e
r
e
r
em
a
in
s
a
la
ck
o
f
n
u
an
c
ed
u
n
d
e
r
s
ta
n
d
in
g
r
eg
ar
d
in
g
h
o
w
f
am
ily
s
tr
u
c
tu
r
es
an
d
cu
ltu
r
al
n
o
r
m
s
in
f
lu
en
c
e
d
ia
b
e
te
s
ca
r
e
ac
r
o
s
s
d
if
f
er
en
t
p
o
p
u
la
tio
n
s
[
8
]
,
[
9
]
.
Fu
r
th
er
m
o
r
e,
in
ter
v
en
tio
n
s
s
u
ch
as
th
e
C
a
lg
ar
y
Fam
i
ly
I
n
te
r
v
en
tio
n
Mo
d
e
l
(
C
FIM
)
a
r
e
y
e
t
to
b
e
co
m
p
r
eh
en
s
i
v
el
y
ev
a
lu
a
ted
in
v
a
r
y
in
g
s
o
cio
c
u
l
tu
r
a
l
s
et
ti
n
g
s
,
wh
i
ch
m
ay
l
im
it
th
e
ap
p
li
ca
b
il
ity
o
f
f
in
d
in
g
s
d
er
iv
e
d
f
r
o
m
p
r
ed
o
m
in
an
t
ly
h
o
m
o
g
en
o
u
s
g
r
o
u
p
s
[
5
]
,
[
1
0
]
.
Ad
d
i
ti
o
n
a
lly
,
wh
i
le
s
o
ci
o
ec
o
n
o
m
ic
f
a
cto
r
s
h
av
e
b
ee
n
ac
k
n
o
wl
ed
g
ed
a
s
b
ar
r
ier
s
t
o
ac
h
iev
in
g
d
i
et
ar
y
ad
h
er
en
ce
,
th
e
s
p
ec
if
ic
m
ec
h
an
i
s
m
s
th
r
o
u
g
h
wh
i
ch
f
a
m
i
li
al
s
u
p
p
o
r
t
an
d
k
n
o
w
led
g
e
tr
a
n
s
f
er
o
c
cu
r
r
eq
u
ir
e
f
u
r
th
e
r
i
n
v
e
s
t
ig
at
io
n
to
o
p
ti
m
i
ze
in
t
er
v
en
t
io
n
s
t
r
a
teg
ie
s
f
o
r
d
iv
er
s
e
d
i
ab
e
t
ic
p
at
ien
t p
o
p
u
l
at
io
n
s
[
5
]
,
[
1
1
]
.
T
o
ad
d
r
ess
th
is
g
ap
,
we
p
r
o
p
o
s
e
a
s
tu
d
y
ai
m
ed
a
t
ev
alu
at
in
g
th
e
ef
f
ec
tiv
en
e
s
s
o
f
th
e
C
FI
M
in
im
p
r
o
v
in
g
d
ie
tar
y
ad
h
e
r
en
c
e
an
d
k
n
o
w
le
d
g
e
in
p
a
ti
en
t
s
wi
t
h
ty
p
e
2
d
ia
b
e
te
s
m
e
l
li
tu
s
.
Sp
ec
i
f
i
ca
lly
,
th
i
s
s
tu
d
y
aim
ed
to
m
ea
s
u
r
e
s
ig
n
if
ic
a
n
t
ch
an
g
e
s
in
d
i
et
ar
y
b
e
h
a
v
io
r
an
d
k
n
o
w
led
g
e
lev
e
l
s
r
eg
ar
d
in
g
d
iab
et
es
m
an
ag
em
en
t
f
o
llo
w
in
g
th
e
i
m
p
le
m
en
ta
tio
n
o
f
th
e
C
F
I
M
d
u
r
in
g
th
e
in
t
er
v
e
n
t
io
n
p
er
io
d
.
T
h
e
n
o
v
el
ty
o
f
th
i
s
s
t
u
d
y
f
u
n
d
a
m
en
ta
lly
r
e
s
id
e
s
i
n
th
e
a
p
p
l
ic
at
io
n
o
f
th
e
C
FI
M
,
wh
i
ch
u
n
d
er
s
co
r
e
s
th
e
im
p
o
r
tan
c
e
o
f
a
d
d
r
e
s
s
i
n
g
th
e
in
ter
s
ec
tio
n
o
f
f
a
m
i
l
i
al
d
y
n
am
i
c
s
an
d
ch
r
o
n
ic
i
ll
n
e
s
s
m
an
ag
em
en
t,
s
p
ec
if
ic
al
ly
in
p
at
ien
t
s
wi
th
ty
p
e
2
d
iab
et
es m
e
ll
itu
s
.
Un
lik
e
t
r
ad
i
tio
n
al
f
am
ily
-
b
a
s
ed
m
o
d
e
l
s
,
C
FIM
i
s
p
r
em
i
s
ed
o
n
a
co
m
p
r
e
h
en
s
iv
e
f
r
am
ew
o
r
k
th
a
t
in
teg
r
a
te
s
th
e
f
a
m
i
ly
's
r
o
le
s
,
b
el
ief
s
,
an
d
ad
ap
tiv
e
ca
p
ac
i
t
ie
s
,
th
er
eb
y
o
f
f
er
i
n
g
a
h
o
l
is
t
ic
p
e
r
s
p
ec
t
iv
e
o
n
d
i
s
ea
s
e
m
an
ag
e
m
en
t.
T
h
i
s
m
o
d
el
u
n
iq
u
e
ly
f
ac
il
i
tat
e
s
u
n
d
e
r
s
tan
d
in
g
th
e
p
s
y
ch
o
s
o
c
ia
l
i
m
p
l
ica
t
io
n
s
th
at
ex
t
en
d
b
ey
o
n
d
th
e
in
d
iv
id
u
al
p
a
ti
e
n
t,
m
ak
i
n
g
i
t
p
ar
t
icu
la
r
ly
r
e
lev
a
n
t
f
o
r
co
n
d
i
tio
n
s
l
ik
e
ty
p
e
2
d
iab
et
es
th
at
n
ec
e
s
s
it
at
e
o
n
g
o
in
g
m
an
ag
e
m
en
t
an
d
l
if
e
s
ty
l
e
ad
ju
s
tm
e
n
ts
.
T
h
e
q
u
a
s
i
-
ex
p
e
r
im
en
t
al
d
es
ig
n
en
h
an
ce
s
th
e
m
eth
o
d
o
lo
g
ic
al
r
ig
o
r
b
y
a
llo
win
g
f
o
r
co
m
p
ar
a
tiv
e
a
s
s
e
s
s
m
en
t
s
o
f
co
n
v
en
tio
n
al
ap
p
r
o
ac
h
e
s
v
e
r
s
u
s
C
FI
M
-
b
as
ed
i
n
t
er
v
en
ti
o
n
s
,
th
er
e
b
y
en
r
i
ch
in
g
th
e
ev
id
en
ce
b
a
s
e
i
n
th
i
s
d
o
m
a
in
.
T
h
ese
f
in
d
in
g
s
will
co
n
tr
ib
u
te
to
il
lu
m
in
a
tin
g
p
ath
way
s
f
o
r
n
u
r
s
in
g
p
r
a
ct
ic
es
an
d
h
ea
lt
h
p
o
li
ci
es
th
a
t
ad
v
o
ca
te
f
o
r
i
n
te
g
r
at
iv
e
c
ar
e
m
o
d
el
s
,
em
p
h
a
s
iz
in
g
th
e
n
ec
e
s
s
i
ty
o
f
f
am
i
ly
in
v
o
lv
em
en
t
in
ef
f
ec
tiv
e
d
i
ab
e
te
s
m
an
a
g
em
en
t
s
tr
a
te
g
ie
s
.
2.
ME
T
H
O
D
2
.
1
.
Desig
n
T
h
e
r
e
s
e
ar
ch
m
e
th
o
d
u
s
ed
w
a
s
q
u
an
ti
ta
tiv
e
wi
th
a
q
u
a
s
i
-
ex
p
er
im
en
ta
l
d
es
ig
n
u
s
in
g
a
t
wo
-
g
r
o
u
p
p
r
e
-
te
s
t
an
d
p
o
s
t
-
te
s
t a
p
p
r
o
ac
h
.
T
h
e
s
tu
d
y
w
as
co
n
d
u
ct
ed
a
t
th
e
B
o
lo
C
o
m
m
u
n
i
ty
He
al
th
C
en
ter
,
B
im
a
R
e
g
en
c
y
,
f
r
o
m
J
an
u
ar
y
to
O
ct
o
b
er
2
0
2
5
.
T
h
e
ch
o
ice
o
f
a
q
u
a
s
i
-
ex
p
e
r
im
en
ta
l
d
e
s
ig
n
f
o
r
th
i
s
s
tu
d
y
i
s
g
r
o
u
n
d
ed
in
i
t
s
p
r
ac
ti
ca
li
ty
an
d
e
th
i
ca
l
co
n
s
i
d
er
a
tio
n
s
in
a
co
m
m
u
n
ity
h
e
al
th
s
e
tt
in
g
.
Un
lik
e
r
a
n
d
o
m
iz
ed
co
n
tr
o
ll
ed
t
r
i
al
s
,
q
u
as
i
-
ex
p
er
im
en
t
al
d
e
s
ig
n
s
a
llo
w
r
e
s
ea
r
ch
er
s
to
e
v
a
lu
a
te
th
e
ef
f
ec
tiv
en
e
s
s
o
f
in
t
er
v
en
t
io
n
s
in
r
ea
l
-
wo
r
ld
co
n
t
ex
t
s
wh
er
e
r
a
n
d
o
m
a
s
s
ig
n
m
en
t
m
ay
n
o
t
b
e
f
e
as
ib
le
o
r
et
h
ica
l,
e
s
p
ec
ia
lly
in
v
o
lv
in
g
p
a
t
ien
ts
wi
th
ch
r
o
n
ic
co
n
d
i
tio
n
s
lik
e
ty
p
e
2
d
i
ab
e
te
s
m
e
ll
itu
s
.
T
h
i
s
ap
p
r
o
ac
h
en
a
b
le
s
co
m
p
ar
i
s
o
n
b
et
we
en
an
i
n
ter
v
en
t
io
n
g
r
o
u
p
an
d
a
co
n
tr
o
l
g
r
o
u
p
,
a
l
lo
w
i
n
g
f
o
r
o
b
s
er
v
ab
le
d
if
f
er
en
c
es
in
o
u
t
co
m
e
s
at
tr
ib
u
t
ab
l
e
to
th
e
ed
u
c
at
io
n
a
l
in
t
er
v
en
t
io
n
.
2
.
2
.
Set
t
ing
T
h
is
r
esear
ch
was
co
n
d
u
cte
d
at
th
e
B
o
lo
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
(
P
u
s
ke
s
ma
s
)
in
B
im
a
R
eg
en
cy
,
I
n
d
o
n
esia,
f
r
o
m
J
an
u
ar
y
to
O
cto
b
er
2
0
2
5
.
T
h
e
B
o
lo
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
was
ch
o
s
en
as
th
e
r
esear
ch
lo
ca
tio
n
b
ec
au
s
e
it
is
th
e
p
r
im
a
r
y
h
ea
lth
ca
r
e
f
ac
ilit
y
p
r
o
v
id
in
g
s
er
v
ices
f
o
r
p
atien
ts
with
ty
p
e
2
d
iab
etes
m
ellitu
s
in
th
e
ar
ea
.
T
h
e
r
esear
ch
co
n
tex
t
at
th
e
B
o
lo
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
is
im
p
o
r
tan
t
b
e
ca
u
s
e
it
p
r
o
v
id
es
a
f
ir
s
th
an
d
v
iew
o
f
th
e
c
h
allen
g
es a
n
d
n
ee
d
s
o
f
h
ea
lth
e
d
u
ca
ti
o
n
in
th
e
co
m
m
u
n
ity
.
2
.
3
.
P
a
rt
icipa
nts
T
h
e
p
o
p
u
la
tio
n
p
ar
t
ic
ip
a
t
in
g
i
n
th
i
s
s
tu
d
y
wa
s
p
at
ien
t
s
w
ith
ty
p
e
2
d
iab
et
es
m
el
l
itu
s
r
eg
i
s
t
er
ed
a
t
th
e
B
o
lo
C
o
m
m
u
n
i
ty
He
al
th
C
en
t
er
.
A
s
am
p
l
e
o
f
2
8
0
r
e
s
p
o
n
d
e
n
t
s
w
a
s
d
iv
id
ed
in
to
t
wo
g
r
o
u
p
s
:
1
4
0
r
e
s
p
o
n
d
e
n
t
s
in
th
e
in
t
er
v
en
t
io
n
g
r
o
u
p
wh
o
r
ec
e
iv
e
d
ed
u
ca
tio
n
u
s
in
g
C
FI
M,
an
d
1
4
0
r
es
p
o
n
d
en
t
s
in
th
e
co
n
tr
o
l
g
r
o
u
p
w
h
o
r
ec
e
iv
e
d
ed
u
c
at
io
n
a
l
m
ed
ia
in
th
e
f
o
r
m
o
f
a
b
o
o
k
le
t.
S
am
p
l
in
g
wa
s
c
ar
r
ied
o
u
t
u
s
in
g
a
p
u
r
p
o
s
iv
e
s
a
m
p
l
in
g
tech
n
iq
u
e,
wh
er
e
s
e
lec
t
io
n
w
as
b
a
s
ed
o
n
in
c
lu
s
io
n
c
r
i
ter
ia
,
n
a
m
e
ly
p
at
ien
t
s
ag
ed
o
v
er
1
8
y
e
ar
s
,
d
i
ag
n
o
s
e
d
wi
th
ty
p
e
2
d
ia
b
e
te
s
,
an
d
w
i
l
lin
g
to
p
ar
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in
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ca
t
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M,
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co
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l
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r
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s
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w
ith
tr
ad
it
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c
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m
at
er
i
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llo
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ap
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ch
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c
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a
s
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f
o
r
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to
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et
er
m
in
e
th
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s
am
p
l
e
s
i
ze
n
e
ce
s
s
ar
y
to
ad
eq
u
ate
ly
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et
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t
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ta
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ll
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ig
n
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i
ca
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t
d
i
f
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er
en
c
es
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et
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th
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e
n
t
io
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d
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o
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tr
o
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r
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p
s
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n
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er
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in
g
d
i
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ed
u
ca
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u
t
co
m
e
s
.
Ut
i
li
zin
g
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ig
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if
ic
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(
α
)
o
f
0
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0
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an
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ip
a
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ed
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f
f
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ct
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(
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's
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)
d
r
a
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p
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ir
ed
,
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u
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g
in
a
to
ta
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es
t
im
a
ted
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am
p
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s
iz
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f
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s
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e
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li
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g
t
o
p
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in
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o
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s
en
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E
x
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cr
i
ter
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p
a
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a
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th
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p
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ig
n
if
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t
co
m
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id
co
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d
i
ti
o
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s
th
a
t
co
u
ld
in
ter
f
er
e
wi
th
d
ie
tar
y
p
r
ac
t
ice
s
,
p
r
eg
n
an
t
o
r
l
ac
t
at
in
g
wo
m
en
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an
d
th
o
s
e
ad
h
er
in
g
to
d
ie
tar
y
r
eg
im
en
s
u
n
r
e
la
ted
to
d
iab
et
es
m
an
ag
e
m
en
t,
th
u
s
en
s
u
r
in
g
a
h
o
m
o
g
en
eo
u
s
s
tu
d
y
p
o
p
u
la
ti
o
n
.
2
.
4
.
I
nte
rv
e
nt
io
n
T
h
e
in
ter
v
e
n
tio
n
p
r
o
ce
d
u
r
e
f
o
r
ed
u
ca
tio
n
o
n
ty
p
e
2
d
iab
et
es
m
ellitu
s
aim
s
to
im
p
r
o
v
e
p
atien
t
an
d
f
am
i
ly
u
n
d
er
s
tan
d
in
g
r
eg
a
r
d
in
g
th
e
m
a
n
ag
em
en
t
o
f
t
h
is
d
is
ea
s
e.
T
h
e
f
ir
s
t
s
tep
in
v
o
lv
es
an
in
-
d
ep
th
e
x
p
lan
atio
n
o
f
ty
p
e
2
d
ia
b
etes
m
ellitu
s
,
in
c
lu
d
in
g
p
o
ten
tial
co
m
p
licatio
n
s
an
d
th
e
im
p
o
r
tan
t
r
o
le
o
f
d
iet
in
its
m
an
ag
e
m
en
t.
Nex
t,
th
e
C
FIM
i
s
im
p
lem
en
ted
to
in
v
o
lv
e
f
am
ily
m
em
b
e
r
s
in
th
e
ed
u
ca
tio
n
p
r
o
ce
s
s
,
th
er
eb
y
cr
ea
tin
g
a
s
u
p
p
o
r
tiv
e
e
n
v
ir
o
n
m
en
t
th
at
r
ein
f
o
r
ce
s
b
eh
av
i
o
r
c
h
an
g
e.
I
n
ter
ac
tiv
e
d
is
cu
s
s
io
n
s
ar
e
a
k
ey
p
ar
t
o
f
th
is
p
r
o
ce
d
u
r
e,
wh
e
r
e
p
atien
ts
an
d
th
eir
f
am
ilies
ar
e
en
co
u
r
ag
e
d
t
o
ask
q
u
esti
o
n
s
an
d
s
h
ar
e
e
x
p
er
ien
ce
s
,
cr
ea
tin
g
a
p
o
s
itiv
e
atm
o
s
p
h
er
e
o
f
en
g
a
g
e
m
en
t.
T
h
e
tu
to
r
ial
also
in
clu
d
e
s
th
e
d
eliv
er
y
o
f
e
d
u
ca
tio
n
al
m
ater
ials
o
n
a
h
ea
lth
y
d
iet,
clea
r
ly
ex
p
lain
i
n
g
r
ec
o
m
m
en
d
ed
an
d
r
estricte
d
f
o
o
d
s
.
W
ith
th
is
ap
p
r
o
ac
h
,
it
is
h
o
p
e
d
th
at
p
atien
ts
will
d
ev
elo
p
a
b
etter
u
n
d
er
s
tan
d
i
n
g
o
f
m
an
ag
i
n
g
th
eir
d
iab
etes
th
r
o
u
g
h
an
ap
p
r
o
p
r
iate
d
iet
an
d
in
cr
ea
s
e
f
am
ily
s
u
p
p
o
r
t.
2
.
5
.
I
n
s
t
r
um
e
nt
s
a
n
d
m
ea
s
u
re
m
e
nt
s
Me
a
s
u
r
em
e
n
t
s
in
th
i
s
s
tu
d
y
wer
e
co
n
d
u
c
ted
u
s
in
g
a
q
u
e
s
t
io
n
n
a
ir
e
th
at
h
ad
b
e
en
te
s
ted
f
o
r
v
a
li
d
i
ty
an
d
r
e
l
iab
il
ity
t
o
ev
a
lu
at
e
t
w
o
m
a
in
d
im
en
s
io
n
s
:
p
a
ti
en
t
k
n
o
wl
ed
g
e
ab
o
u
t
d
iab
et
es
an
d
a
h
e
al
th
y
d
ie
t,
an
d
p
at
ien
t
ad
h
er
en
ce
to
th
e
r
ec
o
m
m
en
d
ed
d
ie
t.
T
h
e
f
ir
s
t
d
i
m
en
s
i
o
n
in
v
o
lv
ed
ev
alu
at
in
g
p
a
t
ien
t
k
n
o
wl
ed
g
e
b
ef
o
r
e
an
d
af
ter
th
e
in
t
er
v
en
t
io
n
(
p
r
e
-
t
e
s
t
an
d
p
o
s
t
-
te
s
t)
.
Da
ta
w
er
e
co
l
le
ct
ed
to
a
s
s
e
s
s
c
h
an
g
e
s
in
p
at
ie
n
t
u
n
d
er
s
t
an
d
in
g
o
f
d
iab
e
te
s
m
a
n
ag
em
en
t
an
d
th
e
im
p
o
r
tan
ce
o
f
a
h
e
al
th
y
d
ie
t.
T
h
e
s
ec
o
n
d
d
im
en
s
io
n
f
o
cu
s
ed
o
n
p
a
ti
en
t
ad
h
er
en
ce
to
th
e
r
ec
o
m
m
en
d
ed
d
ie
t,
al
s
o
m
e
a
s
u
r
ed
th
r
o
u
g
h
p
r
e
-
t
e
s
t
an
d
p
o
s
t
-
t
e
s
t.
T
h
r
o
u
g
h
th
i
s
ap
p
r
o
a
ch
,
i
t
i
s
h
o
p
e
d
th
a
t
th
er
e
wi
ll
b
e
an
an
aly
s
i
s
o
f
wh
e
th
er
th
e
r
e
i
s
an
in
cr
ea
s
e
in
p
a
ti
e
n
t
ad
h
e
r
en
c
e
af
ter
r
ec
e
iv
in
g
ed
u
ca
tio
n
ab
o
u
t
a
b
a
lan
ce
d
d
ie
t
an
d
d
i
ab
e
te
s
m
an
ag
e
m
en
t.
T
h
e
u
s
e
o
f
a
v
a
lid
an
d
r
e
li
ab
l
e
q
u
es
t
io
n
n
a
ir
e
p
lay
s
a
cr
u
c
ia
l
r
o
le
in
g
en
er
a
t
in
g
ac
c
u
r
a
te
an
d
ac
co
u
n
tab
le
d
a
ta,
s
o
th
a
t
r
e
s
e
ar
ch
f
in
d
in
g
s
c
an
p
r
o
v
id
e
v
a
lu
ab
le
in
s
ig
h
t
s
f
o
r
cl
in
i
ca
l p
r
ac
t
ic
e
an
d
d
iab
et
es
m
an
ag
em
en
t
in
th
e
co
m
m
u
n
i
t
y
.
2
.
6
.
Va
r
ia
bl
e
s
T
h
e
in
d
ep
en
d
en
t
v
ar
i
ab
l
e
an
aly
z
ed
w
a
s
h
ea
lth
ed
u
ca
t
io
n
u
s
in
g
th
e
C
FIM
c
h
r
o
n
i
c
ca
r
e
m
o
d
e
l
ap
p
r
o
a
ch
.
T
h
is
e
d
u
ca
t
io
n
ai
m
s
to
i
m
p
r
o
v
e
p
a
t
ien
t
u
n
d
er
s
ta
n
d
in
g
o
f
ty
p
e
2
d
i
ab
e
te
s
m
e
l
li
tu
s
m
an
ag
em
en
t,
wh
i
ch
s
h
o
u
ld
f
o
cu
s
o
n
b
eh
a
v
i
o
r
al
ch
a
n
g
e
s
an
d
p
at
ien
t
m
a
s
t
e
r
y
o
f
h
ea
lth
in
f
o
r
m
a
tio
n
.
T
h
e
d
ep
en
d
en
t
v
ar
iab
le
s
o
b
s
e
r
v
ed
in
c
lu
d
ed
d
ie
tar
y
co
m
p
li
an
c
e
o
f
ty
p
e
2
d
i
ab
e
te
s
m
el
li
tu
s
p
a
ti
en
t
s
,
wh
ich
i
s
a
k
ey
in
d
ic
ato
r
o
f
th
e
ef
f
e
ct
iv
en
e
s
s
o
f
p
a
ti
en
t
d
ie
t
an
d
h
ea
l
th
m
an
ag
e
m
en
t,
a
s
we
ll
as
p
at
ie
n
t
k
n
o
w
led
g
e
a
b
o
u
t
d
i
ab
e
te
s
an
d
ap
p
r
o
p
r
ia
te
d
ie
t,
wh
ich
r
ef
lec
t
s
th
e
ex
t
en
t
to
wh
ich
th
e
ed
u
ca
tio
n
p
r
o
v
id
ed
ca
n
in
f
lu
en
ce
p
a
ti
en
t
u
n
d
er
s
tan
d
in
g
an
d
a
wa
r
en
es
s
o
f
th
e
ir
h
e
al
th
co
n
d
i
tio
n
.
T
h
e
im
p
l
ica
t
io
n
s
o
f
th
i
s
s
tu
d
y
ar
e
ex
p
ec
ted
to
p
r
o
v
id
e
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[
1
2
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[
1
3
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.
I
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ly
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wh
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[
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[
1
4
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1
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[
1
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1
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ter
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n
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[
1
9
]
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[
2
0
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.
Pre
v
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th
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t
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ca
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in
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F
I
M
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ig
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tly
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io
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s
[
2
1
]
.
M
o
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v
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,
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ly
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ai
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d
ap
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ter
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im
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o
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t
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s
[
2
2
]
,
[
2
3
]
.
Mo
r
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v
er
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h
e
in
cr
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s
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t
h
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p
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en
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en
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if
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w
ith
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co
m
p
lia
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ce
in
th
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in
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g
r
o
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2
1
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%
r
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o
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t
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wo
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ld
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s
.
Fu
r
th
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u
p
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t
s
t
h
e
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o
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io
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tar
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to
s
af
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ty
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d
p
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a
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e
p
r
o
to
co
l
s
[
2
4
]
,
[
2
5
]
.
T
h
e
m
a
r
k
ed
im
p
r
o
v
em
en
t
s
in
b
o
th
k
n
o
wl
ed
g
e
an
d
co
m
p
li
an
c
e
w
ith
in
th
e
in
te
r
v
en
t
io
n
g
r
o
u
p
f
o
l
lo
w
in
g
th
e
C
FIM
ap
p
r
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h
s
u
g
g
e
s
t
th
at
s
t
r
u
ctu
r
ed
,
e
v
id
en
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
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6
C
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(
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ay
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li
t
y
am
o
n
g
h
ea
l
th
ca
r
e
p
r
o
v
id
er
s
[
2
6
]
-
[
2
8
]
.
I
n
th
e
in
te
r
v
en
tio
n
g
r
o
u
p
,
th
e
p
r
e
-
a
n
d
p
o
s
t
-
in
t
e
r
v
en
tio
n
p
-
v
alu
e
s
co
n
ce
r
n
in
g
k
n
o
w
led
g
e
(
0
.
0
0
0
p
r
e
-
te
s
t
an
d
0
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3
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o
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t
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te
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t)
s
u
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th
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C
FI
M
s
ig
n
i
f
ic
an
tl
y
en
h
an
ce
d
p
a
ti
en
t
a
war
en
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s
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n
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er
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an
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g
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f
d
i
ab
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te
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m
e
ll
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.
T
h
e
s
e
r
e
s
u
lt
s
ar
e
co
r
r
o
b
o
r
at
ed
b
y
f
in
d
in
g
s
f
r
o
m
Njo
ck
et
a
l.
[
2
9
]
,
wh
o
em
p
h
a
s
iz
e
th
e
cr
i
ti
ca
l
i
m
p
o
r
tan
ce
o
f
d
i
ab
e
te
s
ed
u
c
at
io
n
in
d
i
s
ea
s
e
m
an
ag
e
m
en
t
,
t
r
ea
tm
en
t
co
m
p
li
an
c
e,
a
n
d
im
p
r
o
v
in
g
h
e
al
th
o
u
tco
m
e
s
f
o
r
p
a
ti
en
t
s
w
it
h
ty
p
e
2
d
i
ab
e
te
s
m
e
l
li
tu
s
.
Fu
r
th
er
m
o
r
e,
Se
ty
o
ad
i
et
a
l
.
[
4
]
h
ig
h
l
i
g
h
t
h
o
w
ed
u
ca
tio
n
a
l
in
t
er
v
en
t
io
n
s
s
ig
n
if
i
ca
n
tly
b
o
l
s
te
r
d
i
eta
r
y
ad
h
er
en
ce
,
r
e
in
f
o
r
c
in
g
th
e
d
ir
e
ct
l
in
k
b
et
wee
n
im
p
r
o
v
ed
u
n
d
er
s
t
an
d
in
g
o
f
d
ia
b
et
e
s
an
d
co
m
p
li
an
c
e
w
i
th
d
ie
tar
y
r
ec
o
m
m
en
d
a
t
io
n
s
.
I
t
i
s
n
o
tab
le
th
at
th
e
co
n
t
r
o
l
g
r
o
u
p
a
l
s
o
ex
h
ib
i
ted
an
im
p
r
o
v
em
en
t
in
k
n
o
w
led
g
e
(
p
-
v
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lu
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f
0
.
0
0
0
)
.
T
h
i
s
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ai
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q
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e
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t
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ab
o
u
t
wh
e
th
er
o
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ex
te
r
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a
l
f
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ct
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r
s
,
s
u
ch
a
s
g
en
er
al
en
v
ir
o
n
m
en
ta
l
in
f
lu
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ce
s
o
r
p
as
s
iv
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in
f
o
r
m
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tio
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ab
s
o
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p
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,
p
l
ay
ed
a
r
o
le
in
th
i
s
im
p
r
o
v
em
en
t.
E
n
co
u
r
ag
in
g
ly
,
r
e
s
ea
r
ch
in
d
ic
at
e
s
th
at
m
er
e
ex
p
o
s
u
r
e
to
h
ea
lth
-
r
e
la
t
ed
i
n
f
o
r
m
at
io
n
ca
n
l
ea
d
to
in
cr
ea
s
ed
k
n
o
w
led
g
e,
alb
ei
t
to
a
l
e
s
s
er
ex
t
en
t
t
h
an
tar
g
et
ed
e
d
u
ca
t
io
n
a
l
p
r
o
g
r
am
s
,
r
ef
le
ct
in
g
th
e
co
m
p
lex
in
te
r
p
lay
o
f
s
tr
u
c
tu
r
ed
ed
u
ca
ti
o
n
v
er
s
u
s
s
p
o
n
t
an
eo
u
s
lea
r
n
in
g
in
p
a
ti
en
t
p
o
p
u
l
at
io
n
s
[
3
0
]
.
I
n
t
er
m
s
o
f
d
ie
ta
r
y
co
m
p
li
an
c
e,
b
o
th
th
e
in
t
er
v
e
n
t
io
n
g
r
o
u
p
a
n
d
th
e
co
n
tr
o
l
g
r
o
u
p
s
h
o
wed
s
i
g
n
if
ic
an
t
r
es
u
l
t
s
.
T
h
e
in
ter
v
en
t
io
n
g
r
o
u
p
h
ad
a
p
-
v
a
lu
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o
f
0
.
0
0
0
b
ef
o
r
e
an
d
0
.
0
0
4
af
t
er
th
e
in
t
er
v
en
t
io
n
,
r
ef
le
ct
in
g
a
s
u
b
s
t
an
tia
l
in
cr
e
a
s
e
in
co
m
p
l
ian
t
ea
tin
g
b
eh
av
io
r
s
.
T
h
i
s
r
ein
f
o
r
ce
s
f
i
n
d
in
g
s
f
r
o
m
Han
e
t
a
l.
[
3
1
]
,
wh
i
ch
in
d
i
ca
te
t
h
at
in
d
iv
id
u
al
iz
ed
e
d
u
ca
tio
n
s
e
s
s
io
n
s
p
la
y
a
v
i
ta
l
r
o
le
in
s
y
n
th
e
s
iz
in
g
k
n
o
w
led
g
e
an
d
m
o
t
iv
at
in
g
ad
h
er
en
ce
to
r
ec
o
m
m
en
d
ed
d
ie
tar
y
g
u
id
e
l
in
e
s
.
T
h
e
c
o
n
tr
o
l
g
r
o
u
p
's
p
-
v
alu
e
o
f
0
.
0
0
2
,
wh
il
e
in
d
ic
at
in
g
s
o
m
e
im
p
r
o
v
em
en
t,
r
em
ai
n
s
w
ea
k
er
th
a
n
th
a
t
o
f
th
e
i
n
t
er
v
e
n
t
io
n
g
r
o
u
p
,
il
lu
s
tr
at
in
g
th
e
d
i
s
t
in
c
t
a
d
v
an
t
ag
e
p
r
o
v
id
ed
b
y
th
e
C
FI
M,
wh
ich
in
co
r
p
o
r
ate
s
t
ai
lo
r
ed
,
s
u
p
p
o
r
t
iv
e
i
n
te
r
v
en
t
io
n
s
th
a
t
f
o
s
te
r
a
d
ee
p
e
r
co
n
n
ec
t
io
n
b
et
we
en
k
n
o
wl
ed
g
e
an
d
b
e
h
av
io
r
a
l
ch
an
g
e.
E
v
id
en
c
e
in
d
ic
at
e
s
th
at
ta
ilo
r
ed
i
n
te
r
v
en
tio
n
s
,
s
u
ch
a
s
th
o
s
e
d
e
s
cr
i
b
ed
b
y
J
i
an
d
L
iu
[
3
2
]
,
c
an
ef
f
ec
t
iv
e
l
y
en
h
an
ce
d
i
et
ar
y
c
o
m
p
l
ian
ce
th
r
o
u
g
h
em
p
o
w
er
m
en
t
s
tr
a
te
g
ie
s
th
a
t f
o
s
ter
s
el
f
-
m
an
ag
em
en
t
.
T
h
e
f
in
d
in
g
s
ar
e
p
a
r
t
icu
lar
ly
s
ig
n
if
ic
an
t
g
iv
en
t
h
e
o
n
g
o
in
g
i
s
s
u
e
s
r
e
la
ted
to
p
a
t
ien
t
n
o
n
-
c
o
m
p
l
ian
c
e
in
d
iab
et
e
s
m
an
ag
em
en
t.
S
t
u
d
ie
s
h
av
e
s
h
o
wn
th
a
t
ed
u
ca
t
io
n
al
in
ter
v
en
tio
n
s
ca
n
p
r
o
m
o
t
e
b
et
ter
s
e
lf
-
m
an
ag
em
en
t,
l
ea
d
in
g
to
i
m
p
r
o
v
ed
h
ea
lth
o
u
tco
m
e
s
[
3
3
]
.
Ad
d
i
ti
o
n
a
lly
,
ad
h
er
en
c
e
to
d
i
eta
r
y
g
u
id
e
l
in
e
s
i
s
in
f
lu
en
c
ed
b
y
f
a
cto
r
s
s
u
ch
a
s
p
r
io
r
k
n
o
w
led
g
e
a
n
d
s
u
p
p
o
r
t
s
y
s
t
em
s
,
b
o
th
o
f
wh
i
ch
ar
e
ef
f
ec
tiv
ely
ad
d
r
e
s
s
ed
th
r
o
u
g
h
s
tr
u
ctu
r
ed
ed
u
ca
tio
n
[
3
4
]
.
Sam
i
et
a
l.
[
3
0
]
h
av
e
d
i
s
c
o
v
er
ed
th
a
t
d
ia
b
e
ti
c
p
at
ien
ts
wi
th
a
s
tr
o
n
g
u
n
d
er
s
t
an
d
in
g
o
f
d
ie
tar
y
n
ee
d
s
ex
h
ib
i
ted
n
o
tab
ly
b
e
tt
er
ad
h
er
en
c
e
to
n
u
tr
i
ti
o
n
a
l
g
u
id
el
in
e
s
an
d
m
an
ag
e
m
en
t
p
r
a
c
ti
ce
s
.
T
h
e
o
n
g
o
in
g
ch
al
len
g
e
s
r
el
at
ed
to
p
at
ien
t
n
o
n
-
co
m
p
li
an
c
e
in
d
iab
et
e
s
m
a
n
ag
em
en
t
h
ig
h
l
ig
h
t
th
e
n
e
ce
s
s
i
ty
f
o
r
ef
f
ec
t
iv
e
ed
u
c
at
io
n
a
l
in
t
er
v
en
t
io
n
s
.
E
v
id
en
ce
s
u
g
g
e
s
t
s
th
a
t
s
u
c
h
in
t
er
v
en
t
io
n
s
ca
n
en
h
an
c
e
s
e
lf
-
m
an
ag
em
en
t
s
k
il
l
s
am
o
n
g
d
iab
et
ic
p
at
ien
t
s
,
u
l
tim
at
el
y
r
e
s
u
lt
in
g
in
im
p
r
o
v
ed
h
ea
l
th
o
u
t
co
m
e
s
[
7
]
,
[
3
5
]
.
F
u
r
th
er
m
o
r
e
,
d
ie
tar
y
ad
h
er
en
c
e
i
s
c
lo
s
el
y
a
s
s
o
c
ia
te
d
w
i
th
a
n
in
d
iv
i
d
u
a
l
's
p
r
io
r
k
n
o
wl
ed
g
e
an
d
av
ai
lab
le
s
u
p
p
o
r
t
s
y
s
tem
s
,
a
s
p
ec
ts
th
at
s
t
r
u
c
tu
r
ed
ed
u
ca
tio
n
al
p
r
o
g
r
am
s
c
an
ef
f
e
ct
iv
e
ly
ad
d
r
e
s
s
[
6
]
,
[
3
6
]
.
S
p
ec
if
ica
l
ly
,
r
e
s
e
ar
ch
in
d
i
ca
te
s
th
a
t
d
iab
et
i
c
p
a
ti
en
ts
w
h
o
p
o
s
s
e
s
s
a
s
tr
o
n
g
u
n
d
er
s
tan
d
in
g
o
f
th
e
ir
d
ie
tar
y
n
ee
d
s
ex
h
ib
i
t
b
et
ter
ad
h
er
en
c
e
to
r
ec
o
m
m
e
n
d
ed
n
u
t
r
i
tio
n
al
g
u
id
el
in
e
s
[
3
6
]
.
T
h
e
s
e
f
i
n
d
in
g
s
em
p
h
a
s
ize
th
e
c
r
i
ti
ca
l
r
o
l
e
o
f
t
ai
lo
r
ed
ed
u
c
at
io
n
in
p
r
o
m
o
t
in
g
d
i
et
ar
y
co
m
p
li
an
c
e
an
d
m
an
ag
in
g
d
i
ab
e
te
s
ef
f
e
ct
iv
e
ly
.
Mo
r
eo
v
er
,
i
t
m
u
s
t
b
e
a
ck
n
o
wl
ed
g
ed
th
at
e
d
u
ca
t
io
n
a
l
in
t
er
v
en
tio
n
s
y
ie
ld
b
et
ter
k
n
o
w
led
g
e
an
d
co
m
p
l
ian
ce
o
u
t
co
m
e
s
wh
ile
e
n
h
an
c
in
g
th
e
o
v
er
a
ll
q
u
a
li
ty
o
f
li
f
e
f
o
r
p
a
ti
en
t
s
w
ith
d
iab
et
e
s
.
Pro
g
r
am
s
lik
e
t
h
e
C
FIM
ar
e
cr
u
c
ia
l,
a
s
th
ey
f
o
s
t
er
p
r
o
ac
t
iv
e
en
g
ag
em
en
t
an
d
o
n
g
o
in
g
s
el
f
-
m
a
n
ag
e
m
en
t,
v
it
al
f
o
r
s
u
c
ce
s
s
f
u
l
d
iab
et
es
ca
r
e
[
3
7
]
.
T
h
e
d
y
n
a
m
ic
en
v
ir
o
n
m
en
t
cr
ea
ted
d
u
r
in
g
th
e
s
e
i
n
te
r
v
en
tio
n
s
h
elp
s
b
u
ild
a
s
u
p
p
o
r
t
iv
e
co
m
m
u
n
ity
am
o
n
g
p
a
t
ien
ts
,
wh
i
ch
C
h
ep
u
l
i
s
e
t
a
l.
[
3
8
]
i
n
d
ica
te
ca
n
f
u
r
th
e
r
en
h
a
n
ce
o
u
tco
m
e
s
f
o
r
a
t
-
r
is
k
p
o
p
u
la
ti
o
n
s
.
4.
CO
NCLU
SI
O
N
T
h
e
im
p
lem
en
tatio
n
o
f
th
e
C
FIM
s
ig
n
if
ican
tly
im
p
r
o
v
e
d
d
ietar
y
k
n
o
wled
g
e
an
d
ad
h
e
r
en
ce
in
p
atien
ts
with
ty
p
e
2
d
iab
etes
m
ellitu
s
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
.
T
h
e
r
esu
lts
f
r
o
m
T
ab
le
2
s
h
o
w
th
at
th
e
av
er
ag
e
k
n
o
wled
g
e
s
co
r
e
in
t
h
e
in
ter
v
en
tio
n
g
r
o
u
p
in
cr
ea
s
ed
f
r
o
m
4
.
8
4
±
1
.
2
3
5
to
8
.
9
8
±
2
.
8
5
1
,
wh
ile
th
e
co
n
tr
o
l
g
r
o
u
p
ex
p
er
ien
ce
d
a
s
m
aller
in
c
r
ea
s
e.
T
h
e
g
o
o
d
k
n
o
wled
g
e
ca
teg
o
r
y
also
i
n
cr
ea
s
ed
s
ig
n
if
ican
t
ly
f
r
o
m
2
1
.
4
3
%
t
o
50
.
7
1
%
i
n
th
e
in
te
r
v
en
tio
n
g
r
o
u
p
.
Fo
r
th
e
ad
h
e
r
en
ce
asp
e
ct,
th
e
av
er
a
g
e
s
co
r
e
i
n
th
e
i
n
ter
v
en
tio
n
g
r
o
u
p
in
cr
ea
s
ed
s
ig
n
if
ican
tly
f
r
o
m
2
7
.
0
0
±
6
.
5
1
8
to
6
1
.
3
8
±
7
.
1
7
1
,
with
th
e
g
o
o
d
ad
h
e
r
en
ce
ca
teg
o
r
y
in
cr
ea
s
in
g
f
r
o
m
2
1
.
4
3
%
to
5
4
.
2
9
%.
Statis
tics
s
h
o
w
th
at
th
e
p
-
v
al
u
es
f
o
r
k
n
o
wled
g
e
an
d
ad
h
er
en
ce
in
t
h
e
in
ter
v
en
tio
n
g
r
o
u
p
wer
e
0
.
0
0
0
an
d
0
.
0
0
4
,
r
esp
ec
ti
v
ely
,
in
d
icatin
g
s
tr
o
n
g
s
ig
n
if
ic
an
ce
.
Me
an
w
h
ile,
th
e
co
n
tr
o
l g
r
o
u
p
also
s
h
o
wed
an
in
cr
ea
s
e,
b
u
t
n
o
t
co
m
p
a
r
a
b
le
to
th
e
in
te
r
v
en
tio
n
.
T
h
ese
f
in
d
in
g
s
u
n
d
e
r
s
co
r
e
th
e
im
p
o
r
t
an
ce
o
f
u
s
in
g
t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
1
,
M
ar
ch
20
26
:
1
5
0
-
1
59
156
C
FIM
ap
p
r
o
ac
h
in
im
p
r
o
v
in
g
h
ea
lth
ed
u
ca
tio
n
o
u
tco
m
es
f
o
r
d
iab
etes
p
atien
ts
.
T
h
e
f
in
d
i
n
g
s
f
r
o
m
th
is
s
tu
d
y
ad
v
o
ca
te
f
o
r
h
ea
lth
ca
r
e
p
o
lic
y
m
ak
er
s
to
in
teg
r
ate
C
FIM
in
to
d
iab
etes
m
an
ag
em
en
t
p
r
o
g
r
am
s
,
em
p
h
asizin
g
p
atien
t
-
ce
n
ter
ed
in
ter
v
en
tio
n
s
th
at
ca
n
au
g
m
en
t
d
ietar
y
k
n
o
wled
g
e
an
d
ad
h
er
e
n
ce
,
u
ltima
tely
lead
in
g
t
o
b
etter
h
ea
lth
o
u
tco
m
es f
o
r
ty
p
e
2
d
ia
b
etes m
ellitu
s
p
atien
ts
.
T
h
e
n
e
ce
s
s
ity
f
o
r
r
eso
u
r
ce
allo
ca
tio
n
to
war
d
s
en
h
a
n
cin
g
f
am
ily
in
v
o
lv
em
e
n
t
in
d
iab
e
tes
ed
u
ca
tio
n
is
u
n
d
er
s
co
r
ed
,
s
u
g
g
esti
n
g
a
p
ath
way
to
s
u
s
tain
ab
le
h
ea
lth
im
p
r
o
v
em
e
n
ts
.
Fu
tu
r
e
r
esear
c
h
av
en
u
es
in
clu
d
e
in
v
esti
g
ati
n
g
th
e
lo
n
g
-
ter
m
im
p
ac
ts
o
f
t
h
e
C
FIM
o
n
d
ietar
y
p
r
ac
tices
b
ey
o
n
d
im
m
ed
iate
p
o
s
t
-
in
ter
v
en
tio
n
r
esu
lts
,
as
wel
l
as
i
ts
ef
f
ec
tiv
en
ess
ac
r
o
s
s
v
ar
io
u
s
d
em
o
g
r
a
p
h
ics
an
d
cu
ltu
r
al
co
n
tex
ts
.
L
o
n
g
itu
d
in
al
s
tu
d
ies
ar
e
r
ec
o
m
m
en
d
e
d
to
f
u
r
th
er
elu
cid
ate
th
e
e
n
d
u
r
in
g
ef
f
ec
ts
o
f
f
am
ily
-
ce
n
ter
ed
in
te
r
v
en
tio
n
s
.
No
tab
ly
,
th
is
s
tu
d
y
co
n
tr
i
b
u
tes
to
t
h
e
ex
is
tin
g
liter
atu
r
e
b
y
estab
lis
h
in
g
th
e
C
FIM
'
s
u
n
iq
u
e
ca
p
ac
ity
to
s
ig
n
if
ican
tl
y
im
p
r
o
v
e
d
ietar
y
k
n
o
wled
g
e
an
d
a
d
h
er
e
n
ce
,
t
h
er
eb
y
p
r
esen
tin
g
n
o
v
el
ev
id
en
ce
th
at
en
h
an
ce
s
o
u
r
u
n
d
er
s
tan
d
i
n
g
o
f
d
iab
etes
m
an
ag
e
m
en
t
an
d
ed
u
ca
tio
n
.
T
h
e
lim
itatio
n
o
f
th
e
s
tu
d
y
'
s
s
h
o
r
t
d
u
r
atio
n
o
f
f
o
llo
w
-
u
p
(
p
r
e
-
test
an
d
p
o
s
t
-
test
im
m
ed
iately
af
ter
in
ter
v
en
tio
n
)
r
est
r
icts
th
e
ass
e
s
s
m
en
t
o
f
th
e
lo
n
g
-
ter
m
s
u
s
tain
ab
ilit
y
o
f
k
n
o
wled
g
e
r
eten
tio
n
an
d
c
o
m
p
lian
ce
.
P
o
ten
tial
co
n
f
o
u
n
d
er
s
s
u
ch
as
e
x
ter
n
al
ed
u
ca
tio
n
al
in
f
lu
en
ce
s
o
r
v
ar
y
i
n
g
lev
els
o
f
f
am
ily
s
u
p
p
o
r
t
wer
e
n
o
t
co
n
tr
o
lled
f
o
r
,
wh
ich
m
a
y
h
av
e
in
f
lu
e
n
ce
d
th
e
o
u
tco
m
es.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
ex
t
en
d
o
u
r
h
ea
r
tf
e
l
t
g
r
a
ti
t
u
d
e
to
a
l
l
in
d
iv
i
d
u
a
ls
an
d
i
n
s
t
i
tu
t
io
n
s
th
at
co
n
t
r
ib
u
ted
to
t
h
e
s
u
c
ce
s
s
f
u
l
co
m
p
l
et
io
n
o
f
th
i
s
s
tu
d
y
o
n
th
e
C
F
I
M.
Sp
ec
ia
l
th
an
k
s
g
o
to
t
h
e
p
a
ti
en
t
s
at
th
e
B
o
lo
C
o
m
m
u
n
ity
H
ea
lth
C
en
ter
,
wh
o
s
e
p
ar
ti
ci
p
at
io
n
m
a
d
e
th
i
s
r
e
s
e
ar
ch
p
o
s
s
ib
le
.
W
e
ar
e
a
ls
o
g
r
at
ef
u
l
to
th
e
n
u
r
s
in
g
s
ta
f
f
f
o
r
th
e
ir
s
u
p
p
o
r
t
d
u
r
in
g
d
at
a
co
ll
ec
tio
n
an
d
i
m
p
le
m
en
ta
tio
n
o
f
th
e
in
t
er
v
e
n
tio
n
.
A
ck
n
o
wl
ed
g
m
e
n
t
i
s
d
u
e
to
o
u
r
a
ca
d
em
i
c
in
s
t
itu
ti
o
n
s
,
P
o
l
tek
k
es
Ke
m
en
k
es
Ma
tar
am
an
d
Un
iv
er
s
it
a
s
Ma
l
ah
ay
at
i,
f
o
r
p
r
o
v
id
in
g
th
e
n
ec
e
s
s
a
r
y
r
e
s
o
u
r
ce
s
an
d
en
v
i
r
o
n
m
e
n
t
co
n
d
u
c
iv
e
to
co
n
d
u
ct
in
g
th
i
s
r
e
s
e
ar
ch
.
Fin
al
ly
,
we
ap
p
r
ec
ia
te
o
u
r
c
o
ll
ea
g
u
es
f
o
r
th
e
ir
co
n
t
in
u
o
u
s
en
co
u
r
ag
e
m
en
t
a
n
d
v
al
u
ab
le
in
s
ig
h
t
s
th
r
o
u
g
h
o
u
t
th
i
s
s
tu
d
y
.
Yo
u
r
co
n
tr
i
b
u
tio
n
s
h
av
e
b
e
en
in
v
a
lu
a
b
le
,
an
d
we
h
o
p
e
th
at
o
u
r
f
in
d
in
g
s
w
i
ll
en
h
an
ce
h
e
a
lth
o
u
tco
m
e
s
f
o
r
in
d
iv
id
u
al
s
wi
th
ty
p
e
2
d
iab
et
es
m
el
li
tu
s
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
th
an
k
s
to
Min
is
tr
y
o
f
Hea
lth
f
o
r
th
e
f
u
n
d
in
g
g
i
v
en
(
Fu
n
d
in
g
Nu
m
b
er
: H
K.
1
2
/Po
ltek
k
es
Ma
tar
am
/2
0
2
5
/
1
9
8
2
2
)
.
M
o
n
i
t
o
r
in
g
in
v
o
lv
es
r
e
g
u
lar
c
h
ec
k
-
in
s
,
d
ata
co
llectio
n
ass
ess
m
e
n
ts
,
an
d
an
aly
s
is
to
ev
alu
ate
p
ar
ticip
an
t
r
eten
tio
n
an
d
s
tu
d
y
p
r
o
g
r
ess
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT
)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
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
Mu
h
tar
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
An
ih
ar
y
ati
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
J
u
lh
an
a
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Fad
lu
r
a
h
m
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Mu
h
am
m
ad
Ar
i
f
k
i
Z
ain
ar
o
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Ma
r
tin
in
g
s
i
h
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est
.
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
a
lg
a
r
y
fa
mily
in
terven
tio
n
mo
d
el
en
h
a
n
ce
s
d
ieta
r
y
co
mp
lia
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RE
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1]
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.
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4
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.
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5
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.
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8
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[
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[
3
6
]
T.
W
.
A
b
a
t
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e
t
a
l
.
,
“
Le
v
e
l
o
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a
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m
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i
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b
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s
p
o
p
u
l
a
t
i
o
n
i
n
Et
h
i
o
p
i
a
n
:
A
s
y
st
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mi
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v
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e
w
w
i
t
h
me
t
a
-
a
n
a
l
y
si
s
,
”
PLo
S
O
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e
,
v
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l
.
1
7
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n
o
.
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0
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p
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e
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.
[
3
7
]
E
.
A
.
Eme
k
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a
l
.
,
“
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ss
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p
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l
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o
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Me
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.
[
38]
L.
C
h
e
p
u
l
i
s
e
t
a
l
.
,
“
T
e
c
h
n
o
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o
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y
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n
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e
d
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c
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l
t
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y
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me
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p
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l
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v
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me
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t
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b
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o
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k
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t
s
w
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y
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2
d
i
a
b
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s
–
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p
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o
t
st
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”
J
o
u
r
n
a
l
o
f
Pr
i
m
a
ry
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e
a
l
t
h
C
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re
,
v
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l
.
1
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o
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1
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p
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4
,
d
o
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:
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0
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1
0
7
1
/
h
c
2
4
0
5
6
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Mu
h
ta
r
is
a
lec
tu
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r
in
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e
De
p
a
rtme
n
t
o
f
Nu
rsin
g
,
P
o
lt
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k
k
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s
Ke
m
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k
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s
M
a
tara
m
,
M
a
tara
m
,
NTB,
In
d
o
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sia
.
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h
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ld
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a
M
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d
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in
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g
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fiel
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.
M
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is p
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d
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o
imp
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.
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it
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to
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is
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ts.
M
u
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ti
v
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ly
p
a
rti
c
ip
a
tes
i
n
re
se
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rc
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p
ro
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ts
a
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d
w
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rk
sh
o
p
s
to
sta
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c
u
rre
n
t
with
t
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late
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c
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m
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ts
i
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n
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p
ra
c
ti
c
e
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
m
u
h
tarb
ima
9
9
8
@
g
m
a
il
.
c
o
m
.
Ani
h
a
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ti
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e
N
u
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g
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rtme
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lt
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k
k
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Ke
m
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n
k
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s
M
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tara
m
,
NTB,
In
d
o
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ry
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ti
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fro
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Qa
m
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ru
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d
a
Ba
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istratio
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p
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h
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a
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tac
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:
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ry
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ti
8
9
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m
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c
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.
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8
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159
J
u
lh
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p
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t
fig
u
re
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e
field
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siv
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s
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ica
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h
e
r
c
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d
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a
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su
c
h
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u
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h
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p
a
ti
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n
t
c
a
re
m
e
th
o
d
o
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g
ies
,
a
n
d
th
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n
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ra
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tec
h
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g
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ra
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s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
Ju
lh
a
n
a
2
7
@g
m
a
il
.
c
o
m
.
Fa
d
lu
r
a
h
m
i
is a d
e
d
ica
ted
sc
h
o
lar i
n
th
e
field
o
f
n
u
rsi
n
g
,
c
u
rre
n
tl
y
se
rv
i
n
g
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th
e
De
p
a
rtme
n
t
o
f
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rsin
g
a
t
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
M
a
tara
m
,
lo
c
a
ted
in
M
a
tara
m
,
NTB,
In
d
o
n
e
sia
.
Wi
th
a
f
o
c
u
s
o
n
a
d
v
a
n
c
i
n
g
n
u
rsi
n
g
e
d
u
c
a
ti
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n
a
n
d
p
ra
c
ti
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e
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sh
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s
c
o
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tri
b
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sig
n
ifi
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a
n
tl
y
t
o
th
e
d
e
v
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lo
p
m
e
n
t
o
f
c
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rr
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la t
h
a
t
a
li
g
n
with
c
o
n
tem
p
o
ra
ry
h
e
a
lt
h
c
a
re
n
e
e
d
s.
T
h
e
e
m
p
h
a
sis o
n
e
v
id
e
n
c
e
-
b
a
se
d
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ra
c
ti
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d
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it
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g
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r
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m
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h
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o
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m
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y
.
S
h
e
c
a
n
b
e
c
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n
tac
ted
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t
e
m
a
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tu
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m
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h
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rsit
y
,
Ba
n
d
a
r
Lam
p
u
n
g
,
In
d
o
n
e
sia
.
He
h
a
s
c
o
m
p
lete
d
h
is
f
o
rm
a
l
e
d
u
c
a
ti
o
n
i
n
n
u
rsi
n
g
a
n
d
c
o
n
ti
n
u
e
d
h
is
a
d
v
a
n
c
e
d
st
u
d
ies
t
o
stre
n
g
t
h
e
n
h
is
c
o
m
p
e
ten
c
y
i
n
n
u
rsi
n
g
p
ra
c
ti
c
e
a
n
d
e
d
u
c
a
ti
o
n
.
At
M
a
lah
a
y
a
ti
Un
i
v
e
rsity
,
he
is
in
v
o
lv
e
d
i
n
tea
c
h
in
g
,
re
se
a
rc
h
,
a
n
d
c
o
m
m
u
n
it
y
se
rv
ice
,
wit
h
a
fo
c
u
s
o
n
imp
r
o
v
i
n
g
th
e
q
u
a
li
t
y
o
f
h
e
a
lt
h
se
rv
ice
s
a
n
d
c
o
m
p
e
ten
c
y
-
b
a
se
d
lea
rn
in
g
stra
teg
ies
in
n
u
rsin
g
.
I
n
a
d
d
it
i
o
n
,
h
e
is ac
ti
v
e
i
n
c
o
n
fe
re
n
c
e
s a
n
d
sc
ien
ti
fic
p
u
b
li
c
a
ti
o
n
s th
a
t
h
a
v
e
a
n
imp
a
c
t
o
n
th
e
d
e
v
e
l
o
p
m
e
n
t
o
f
n
u
rsin
g
sc
i
e
n
c
e
in
I
n
d
o
n
e
sia
.
His
c
o
m
m
it
m
e
n
t
t
o
th
e
n
u
rsi
n
g
p
r
o
fe
ss
io
n
h
a
s
m
a
d
e
h
im
a
re
sp
e
c
ted
m
e
m
b
e
r
o
f
v
a
rio
u
s
p
r
o
fe
ss
io
n
a
l
o
r
g
a
n
i
z
a
ti
o
n
s
a
t
th
e
n
a
ti
o
n
a
l
a
n
d
in
tern
a
ti
o
n
a
l
le
v
e
ls.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
m
.
a
rifk
iz@
y
a
h
o
o
.
c
o
m
.
Ma
r
ti
n
in
g
sih
is
a
d
e
d
ica
ted
a
c
a
d
e
m
ic
a
ffil
iate
d
with
th
e
De
p
a
r
tme
n
t
o
f
Nu
rsi
n
g
a
t
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
M
a
tara
m
in
M
a
tara
m
,
Nu
sa
Te
n
g
g
a
ra
Ba
ra
t
(NTB),
I
n
d
o
n
e
sia
.
W
it
h
a
p
ro
f
o
u
n
d
c
o
m
m
it
m
e
n
t
to
a
d
v
a
n
c
in
g
n
u
rsi
n
g
e
d
u
c
a
ti
o
n
a
n
d
p
ra
c
ti
c
e
,
sh
e
h
a
s
c
o
n
tri
b
u
te
d
sig
n
ifi
c
a
n
t
ly
to
t
h
e
fiel
d
th
r
o
u
g
h
b
o
t
h
tea
c
h
in
g
a
n
d
re
se
a
rc
h
.
He
r
a
re
a
s
o
f
i
n
tere
st
e
n
c
o
m
p
a
ss
c
li
n
ica
l
n
u
rsin
g
,
h
e
a
lt
h
e
d
u
c
a
ti
o
n
,
a
n
d
c
o
m
m
u
n
it
y
h
e
a
lt
h
i
n
it
iati
v
e
s,
fo
c
u
sin
g
o
n
imp
ro
v
in
g
p
a
ti
e
n
t
o
u
tco
m
e
s
a
n
d
p
r
o
m
o
ti
n
g
h
o
li
stic
c
a
re
p
ra
c
ti
c
e
s.
M
a
rti
n
i
n
g
si
h
h
o
ld
s
a
re
lev
a
n
t
d
e
g
re
e
i
n
n
u
rsin
g
,
s
u
p
p
lem
e
n
ted
b
y
a
d
v
a
n
c
e
d
train
i
n
g
a
n
d
c
e
rti
fica
ti
o
n
s
th
a
t
b
o
lster
h
e
r
e
x
p
e
rti
se
.
S
h
e
a
c
ti
v
e
ly
e
n
g
a
g
e
s
i
n
p
ro
fe
ss
io
n
a
l
d
e
v
e
lo
p
m
e
n
t
a
n
d
is
a
m
e
m
b
e
r
o
f
v
a
rio
u
s
n
u
rsi
n
g
a
ss
o
c
iatio
n
s,
re
flec
ti
n
g
h
e
r
d
e
d
ica
ti
o
n
t
o
th
e
e
v
o
lu
ti
o
n
o
f
n
u
rsin
g
sta
n
d
a
r
d
s
in
In
d
o
n
e
sia
.
He
r
re
se
a
rc
h
e
n
d
e
a
v
o
rs
a
im
a
t
a
d
d
re
ss
in
g
c
o
n
t
e
m
p
o
ra
ry
c
h
a
ll
e
n
g
e
s
in
h
e
a
lt
h
c
a
re
,
with
a
n
e
m
p
h
a
sis
o
n
l
o
c
a
l
h
e
a
lt
h
issu
e
s
a
n
d
th
e
e
m
p
o
we
rm
e
n
t
o
f
n
u
rsin
g
p
ro
fe
ss
io
n
a
ls.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
in
g
th
a
h
ir@g
m
a
il
.
c
o
m
.
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