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e
C
O
V
I
D
-
1
9
p
a
n
d
e
m
i
c
.
T
h
i
s
d
e
m
o
n
s
t
r
a
t
es
t
h
e
s
i
g
n
i
f
i
c
an
c
e
o
f
s
e
a
r
c
h
i
n
g
e
f
f
e
c
ti
v
e
p
r
o
te
c
t
i
v
e
f
a
ct
o
r
s
[
4
]
–
[
6
]
.
I
t
h
as
b
ee
n
f
o
u
n
d
t
h
a
t
n
u
r
s
es
w
h
o
w
o
r
k
i
n
s
p
i
r
it
u
a
l
l
y
f
u
l
f
i
l
lin
g
s
e
t
ti
n
g
s
h
a
v
e
a
l
o
w
e
r
r
is
k
o
f
b
u
r
n
o
u
t
a
n
d
t
h
e
i
r
e
m
o
t
i
o
n
a
l
s
ta
t
e
is
i
m
p
r
o
v
e
d
[
1
]
,
[
7
]
.
S
i
m
i
l
a
r
l
y
,
w
o
r
k
p
l
a
c
e
s
p
ir
i
t
u
a
l
it
y
i
s
g
a
i
n
i
n
g
i
n
c
r
e
a
s
e
d
s
i
g
n
i
f
i
c
a
n
c
e
i
n
e
n
h
a
n
c
i
n
g
j
o
b
s
a
t
i
s
f
a
ct
i
o
n
a
n
d
c
o
m
m
i
t
m
e
n
t
t
o
t
h
e
o
r
g
a
n
i
z
a
t
io
n
,
a
s
w
e
l
l
a
s
p
a
ti
e
n
t
-
c
e
n
t
e
r
ed
c
a
r
e
[
2
]
,
[
8
]
.
R
e
s
e
a
r
c
h
s
t
u
d
i
e
s
c
o
n
d
u
c
t
e
d
o
n
s
p
ir
itu
al
lead
er
s
h
ip
a
n
d
v
alu
e
co
n
g
r
u
en
ce
d
em
o
n
s
tr
ate
th
at
s
p
ir
itu
al
lead
er
s
h
ip
an
d
v
alu
e
c
o
n
g
r
u
en
ce
h
av
e
an
in
f
lu
en
ce
o
n
jo
b
s
atis
f
ac
tio
n
,
t
u
r
n
o
v
er
in
te
n
tio
n
,
a
n
d
s
u
b
jectiv
e
well
-
b
ein
g
.
I
t
im
p
lies
th
at
s
p
ir
itu
ally
o
r
ien
te
d
lead
er
s
h
ip
p
r
ac
tices a
llo
w
th
e
alig
n
m
en
t o
f
th
e
v
alu
es o
f
n
u
r
s
es to
th
e
m
is
s
io
n
o
f
th
e
o
r
g
an
izatio
n
[
9
]
–
[
1
1
]
.
Desp
ite
th
ese
im
p
r
o
v
e
m
en
ts
,
th
er
e
ar
e
ce
r
tain
is
s
u
es
with
t
h
e
ex
is
tin
g
b
o
d
y
o
f
ev
i
d
en
ce
.
T
o
b
eg
in
with
,
th
er
e
ex
is
t
co
n
s
id
er
a
b
le
v
ar
iatio
n
s
in
h
o
w
wo
r
k
p
lace
s
p
ir
itu
ality
m
ea
s
u
r
e
m
en
t
in
s
tr
u
m
en
ts
co
n
ce
p
tu
alize
th
e
n
o
tio
n
,
th
ei
r
p
s
y
ch
o
m
etr
ic
p
e
r
f
o
r
m
an
ce
,
an
d
th
eir
ap
p
licab
ilit
y
t
o
v
ar
i
o
u
s
c
u
ltu
r
es.
T
h
is
co
m
p
licates
th
e
p
o
s
s
ib
ilit
y
to
co
m
p
ar
e
s
tu
d
ies
[
2
]
,
[
1
2
]
.
Seco
n
d
,
o
th
er
in
ter
v
en
tio
n
a
l
s
tu
d
ies,
s
u
ch
as
m
in
d
f
u
ln
ess
p
r
o
g
r
am
,
r
ef
lect
iv
e
p
r
ac
tice,
an
d
s
p
ir
itu
al
le
ad
er
s
h
ip
tr
ain
in
g
,
h
a
v
e
d
em
o
n
s
tr
ated
p
o
te
n
tial
p
o
s
itiv
e
r
esu
lts
i
n
r
ed
u
cin
g
b
u
r
n
o
u
t
an
d
im
p
r
o
v
in
g
r
eten
tio
n
[
1
3
]
–
[
1
5
]
.
T
h
e
im
p
ac
t
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
o
n
t
h
e
p
s
y
ch
o
lo
g
ic
al
well
-
b
ein
g
o
f
n
u
r
s
es
h
as
b
e
en
s
tu
d
ied
in
p
r
i
o
r
s
y
s
tem
atic
r
ev
iews;
h
o
wev
er
,
th
e
s
tu
d
ies
h
av
e
s
er
io
u
s
f
laws
in
th
eir
m
eth
o
d
o
lo
g
y
.
As
an
ex
am
p
le,
th
e
g
lo
b
al
s
y
n
th
esis
b
y
[
1
6
]
r
ep
o
r
tin
g
in
cr
ea
s
ed
r
ates
o
f
d
ep
r
ess
io
n
,
an
x
iet
y
,
s
tr
ess
,
p
o
s
t
-
tr
au
m
atic
s
tr
ess
d
is
o
r
d
er
,
an
d
in
s
o
m
n
ia
ex
p
licitly
s
tated
th
at
th
e
m
en
tal
h
ea
lth
o
f
th
e
n
u
r
s
es wa
s
n
o
t e
v
alu
ated
p
r
e
-
p
a
n
d
em
ic,
th
u
s
,
p
r
ev
e
n
tin
g
th
e
q
u
an
tific
atio
n
o
f
th
e
in
cr
em
en
tal
p
s
y
ch
o
lo
g
ical
b
u
r
d
en
o
f
th
e
p
an
d
em
ic.
I
n
tu
r
n
,
th
ese
m
eth
o
d
o
l
o
g
ical
lim
itatio
n
s
d
id
n
o
t
allo
w
th
e
p
r
ev
i
o
u
s
r
e
v
iews
to
co
n
cl
u
d
e
o
n
h
o
w
th
e
p
s
y
ch
o
lo
g
ical
s
tate
o
f
n
u
r
s
es
ch
an
g
ed
a
f
ter
th
e
p
an
d
e
m
ic
en
d
ed
,
o
r
h
o
w
l
o
n
g
-
ter
m
wo
r
k
p
lace
d
eter
m
in
an
ts
s
u
ch
as
s
p
ir
itu
al
ity
,
lead
er
s
h
ip
,
a
n
d
v
alu
e
co
n
g
r
u
en
ce
d
eter
m
in
e
r
ec
o
v
er
y
an
d
r
esil
ien
ce
in
s
u
b
s
eq
u
en
t y
ea
r
s
.
T
h
e
i
n
t
e
r
n
a
t
i
o
n
a
l
s
t
u
d
i
e
s
b
y
[
1
7
]
c
o
n
d
u
c
t
e
d
o
n
w
o
r
k
p
l
a
c
e
s
p
i
r
i
t
u
a
l
i
t
y
w
e
r
e
w
i
d
e
l
y
i
n
c
l
u
s
i
v
e
o
f
v
a
r
i
o
u
s
t
y
p
e
s
o
f
o
c
c
u
p
a
t
i
o
n
s
,
w
h
i
c
h
d
i
d
n
o
t
i
n
c
l
u
d
e
n
u
r
s
i
n
g
.
T
h
e
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
e
d
e
a
r
l
i
e
r
l
i
m
i
t
e
d
p
a
s
t
r
e
v
i
e
w
s
o
f
n
u
r
s
i
n
g
r
e
s
e
a
r
c
h
t
o
2
0
1
8
a
n
d
d
i
d
n
o
t
i
n
c
o
r
p
o
r
a
t
e
t
h
e
l
a
t
e
s
t
q
u
a
n
t
i
t
a
t
i
v
e
d
a
t
a
[
1
8
]
.
S
u
c
h
r
e
v
i
e
w
s
f
a
i
l
e
d
t
o
c
o
n
s
i
d
e
r
o
u
t
c
o
m
e
s
o
f
t
h
e
p
s
y
c
h
o
l
o
g
i
c
a
l
c
o
n
s
e
q
u
e
n
c
e
s
o
f
t
h
e
p
a
n
d
e
m
i
c
a
n
d
e
x
a
m
i
n
e
d
h
o
w
e
f
f
e
c
t
i
v
e
s
p
i
r
i
t
u
a
l
l
e
a
d
e
r
s
h
i
p
w
a
s
i
n
i
m
p
r
o
v
i
n
g
t
h
e
w
e
l
l
-
b
e
i
n
g
o
f
n
u
r
s
e
s
i
n
m
o
d
e
r
n
h
e
a
l
t
h
c
a
r
e
.
E
a
r
l
i
e
r
a
n
a
l
y
s
e
s
m
i
s
s
e
d
t
h
e
y
e
a
r
2
0
2
5
a
n
d
c
o
u
l
d
n
o
t
p
r
o
v
i
d
e
a
s
y
s
t
e
m
a
t
i
c
a
n
a
l
y
s
i
s
o
f
t
h
e
d
e
t
e
r
m
i
n
a
n
t
s
o
f
o
c
c
u
p
a
t
i
o
n
a
l
w
e
l
l
-
b
e
i
n
g
b
a
s
e
d
o
n
s
p
i
r
i
t
u
a
l
i
t
y
a
f
t
e
r
t
h
e
e
p
i
d
e
m
i
c
.
T
h
e
r
e
a
r
e
s
e
v
e
r
a
l
n
e
w
c
o
n
t
r
i
b
u
t
i
o
n
s
i
n
t
h
i
s
i
n
t
e
g
r
a
t
i
v
e
r
e
v
i
e
w
.
I
n
t
h
i
s
a
n
a
l
y
s
i
s
,
i
t
s
u
m
m
a
r
i
z
e
s
q
u
a
n
t
i
t
a
t
i
v
e
i
n
f
o
r
m
a
t
i
o
n
(
2
0
1
5
-
2
0
2
5
)
i
n
p
a
r
t
i
c
u
l
a
r
w
i
t
h
r
e
f
e
r
e
n
c
e
t
o
r
e
g
i
s
t
e
r
e
d
n
u
r
s
e
s
,
w
h
i
c
h
h
a
s
n
o
t
b
e
e
n
d
o
n
e
i
n
p
r
ev
io
u
s
s
tu
d
ies.
T
h
is
is
th
e
f
ir
s
t
s
tu
d
y
th
at
co
n
tain
s
p
o
s
t
-
p
an
d
em
ic
f
i
n
d
in
g
s
a
b
o
u
t
th
e
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
o
f
n
u
r
s
es,
em
p
h
asizin
g
t
h
e
s
ig
n
if
ican
ce
o
f
s
p
ir
itu
ali
ty
in
th
e
p
o
s
t
-
C
OVI
D
-
1
9
r
ec
u
p
e
r
atio
n
,
a
n
d
n
o
s
u
ch
in
teg
r
ativ
e
r
ev
iew
s
tu
d
y
h
as
b
ee
n
d
o
n
e
b
e
f
o
r
e.
Un
lik
e
o
t
h
er
d
escr
ip
tiv
e
s
tu
d
ies,
it
c
r
itically
ass
es
s
es
th
e
p
r
o
ce
s
s
o
f
s
p
ir
itu
al
lead
er
s
h
ip
,
v
alu
e
co
n
g
r
u
e
n
ce
in
th
e
wo
r
k
p
lace
,
an
d
o
r
g
an
izatio
n
a
l
cu
ltu
r
e,
an
d
o
f
f
er
s
in
s
ig
h
ts
o
n
th
e
ef
f
ec
ts
o
f
wo
r
k
p
lace
s
p
ir
itu
ality
o
n
b
u
r
n
o
u
t,
s
atis
f
ac
tio
n
,
r
esil
ien
ce
,
m
o
tiv
at
io
n
,
an
d
r
eten
tio
n
.
T
h
e
an
aly
s
is
p
r
o
v
id
es
a
m
o
d
e
r
n
s
y
n
th
esis
ap
p
ly
in
g
th
e
W
h
i
ttem
o
r
e
an
d
Kn
af
l
f
r
am
ew
o
r
k
in
co
m
p
lia
n
ce
with
th
e
PR
I
SMA
2
0
2
0
p
r
in
ci
p
les,
wh
ich
m
ak
es it a
u
n
i
q
u
e
co
n
tr
ib
u
tio
n
o
f
n
u
r
s
in
g
in
th
e
p
o
s
t
-
p
an
d
em
ic
s
ettin
g
.
2.
M
E
T
H
O
D
E
x
p
l
a
i
n
i
n
g
t
h
e
r
es
e
a
r
c
h
c
h
r
o
n
o
l
o
g
i
c
a
l
l
y
,
i
n
cl
u
d
i
n
g
t
h
e
r
es
e
ar
c
h
d
e
s
i
g
n
,
r
es
e
a
r
c
h
p
r
o
c
e
d
u
r
e
s
(
i
n
t
h
e
f
o
r
m
o
f
t
h
i
s
i
n
t
e
g
r
a
ti
v
e
r
ev
ie
w
)
,
e
m
p
l
o
y
e
d
t
h
e
m
et
h
o
d
o
l
o
g
i
c
a
l
f
r
a
m
ew
o
r
k
i
n
t
r
o
d
u
c
e
d
b
y
[
1
9
]
,
t
h
u
s
,
h
a
v
i
n
g
a
s
y
s
te
m
a
t
i
c
a
n
d
r
i
g
o
r
o
u
s
m
e
t
h
o
d
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ev
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wh
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is
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id
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to
b
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2.
3
.
Scre
ening
a
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qu
a
lity
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l
A
to
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2
3
7
titl
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d
ab
s
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s
cr
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two
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ter
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Am
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8
6
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3
4
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ticles we
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ilt
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cr
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in
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ce
s
s
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ased
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n
:
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t
r
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lts
(
n
=
9
)
,
n
o
n
-
q
u
an
titativ
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d
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n
(
n
=
1
1
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,
n
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n
-
n
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r
s
e
p
o
p
u
latio
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(
n
=
6
)
,
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d
n
o
n
-
E
n
g
lis
h
lan
g
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ag
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(
n
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8
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.
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et
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ar
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q
u
alif
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d
to
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ak
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th
e
f
in
al
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th
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o
f
titl
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s
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C
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k
ap
p
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=
0
.
8
3
)
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n
d
r
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ly
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g
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n
f
u
ll
tex
t
s
cr
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n
in
g
(
k
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0
.
7
7
)
h
ad
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h
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ter
-
r
ater
r
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.
T
h
e
d
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cr
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ased
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Ap
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Sk
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Pro
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ig
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[
2
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ticles
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s
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e
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Fig
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ates
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An
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m
p
le
s
ize,
s
p
ir
itu
ality
at
wo
r
k
elem
en
t,
o
cc
u
p
atio
n
al
well
-
b
ein
g
o
u
tc
o
m
es,
k
ey
f
in
d
in
g
s
,
an
d
C
ASP
ap
p
r
aisal.
T
h
e
d
ata
wer
e
d
escr
ib
e
d
a
n
d
co
d
e
d
,
an
d
th
e
co
n
s
tan
t
co
m
p
ar
is
o
n
m
et
h
o
d
id
en
tifie
d
in
W
h
ittem
o
r
e
an
d
Kn
af
l a
n
aly
z
ed
th
e
d
ata.
P
a
t
t
e
r
n
s
,
c
o
n
v
e
r
g
e
n
c
e
s
,
a
n
d
d
i
v
e
r
g
e
n
c
e
s
w
e
r
e
f
o
u
n
d
a
n
d
r
e
p
e
a
t
e
d
l
y
n
a
r
r
o
w
e
d
d
o
w
n
i
n
t
o
g
r
e
a
t
e
r
o
r
d
e
r
t
h
e
m
a
ti
c
c
at
e
g
o
r
i
e
s
.
T
h
is
m
et
h
o
d
p
r
o
v
i
d
e
d
t
h
e
o
v
e
r
a
l
l
s
y
n
t
h
es
is
o
f
m
u
l
t
i
-
d
i
m
e
n
s
i
o
n
a
l
c
o
r
r
e
l
at
i
o
n
s
b
e
t
w
e
e
n
w
o
r
k
p
l
a
c
e
s
p
i
r
it
u
a
l
it
y
a
n
d
o
c
c
u
p
a
t
i
o
n
a
l
w
e
ll
-
b
e
i
n
g
o
f
n
u
r
s
e
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
Sco
p
u
s
:
3
8
8
,
ME
DL
I
NE
:
1
3
7
,
an
d
C
o
c
h
r
an
e:
1
1
y
ield
ed
5
3
6
r
ec
o
r
d
s
.
Af
ter
d
eletin
g
9
1
d
u
p
licates
an
d
f
ilter
in
g
1
8
5
e
n
tr
ies
b
y
p
u
b
licatio
n
y
ea
r
(
2
0
1
5
-
2
0
2
5
)
a
n
d
2
1
b
y
jo
u
r
n
al
tier
,
2
3
7
a
r
ticles
r
em
ain
ed
.
1
5
1
wer
e
ex
clu
d
ed
f
o
r
n
o
t
m
ee
tin
g
in
clu
s
io
n
s
tan
d
ar
d
s
.
5
3
f
u
ll
-
tex
t
ar
ticles
wer
e
av
ailab
le
f
r
o
m
8
6
r
ec
o
g
n
ized
ar
ticles.
1
9
p
ap
e
r
s
wer
e
s
elec
ted
af
ter
r
em
o
v
in
g
3
4
p
ap
e
r
s
d
u
e
to
ir
r
ele
v
an
t
f
in
d
in
g
s
:
9
,
n
o
n
-
q
u
an
titativ
e
d
esig
n
:
1
1
,
n
o
n
-
n
u
r
s
e
s
am
p
le
s
:
6
,
an
d
n
o
n
-
E
n
g
lis
h
lan
g
u
a
g
e
:
8
.
T
h
e
r
esear
ch
in
clu
d
e
d
1
2
0
to
1
,
2
5
0
n
u
r
s
es
f
r
o
m
Asi
an
,
Mid
d
le
E
aster
n
,
E
u
r
o
p
ea
n
,
an
d
Af
r
ican
s
ettin
g
s
in
cr
o
s
s
-
s
ec
tio
n
al
(
n
=
1
5
)
,
c
o
r
r
elatio
n
al
(
n
=
2
)
,
an
d
q
u
asi
-
ex
p
er
im
e
n
tal
(
n
=
2
)
m
et
h
o
d
s
.
Me
an
i
n
g
,
p
u
r
p
o
s
e,
co
n
n
ec
tio
n
,
s
p
ir
itu
al
lea
d
er
s
h
ip
,
an
d
v
al
u
e
al
ig
n
m
en
t
wer
e
ass
ess
ed
v
ia
wo
r
k
p
lace
s
p
ir
itu
ality
to
o
ls
.
B
u
r
n
o
u
t,
jo
b
s
atis
f
ac
tio
n
,
em
o
tio
n
al
r
esil
ien
ce
,
o
r
g
an
izatio
n
al
c
o
m
m
itm
en
t,
in
tr
in
s
ic
m
o
tiv
atio
n
,
a
n
d
th
e
d
esire
to
leav
e
wer
e
o
cc
u
p
atio
n
al
well
-
b
ein
g
o
u
tco
m
es.
T
ab
le
1
lis
ts
s
tu
d
y
ch
ar
ac
ter
is
tics
.
T
h
e
s
tu
d
ies r
ev
ea
led
f
iv
e
th
e
m
es.
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
Wo
r
kp
la
ce
s
p
ir
itu
a
lity a
n
d
n
u
r
s
es’
w
e
ll
-
b
ein
g
:
i
n
teg
r
a
tive
r
ev
iew
(
2
0
1
5
-
2
0
2
5
)
(
M
.
F
a
h
r
in
A
z
h
a
r
i)
163
3
.
1
.
T
hem
e
1
:
Sp
irit
ua
lity
a
nd
bu
r
no
ut
re
du
ct
io
n
T
h
e
s
y
n
th
esis
s
tu
d
ies
all
f
o
u
n
d
th
at
wo
r
k
p
lace
s
p
ir
itu
ality
n
eg
ativ
ely
co
r
r
elate
s
with
b
u
r
n
o
u
t,
a
n
d
th
e
m
o
s
t
s
ig
n
if
ican
t
co
r
r
elatio
n
s
wer
e
f
o
u
n
d
with
em
o
tio
n
al
ex
h
au
s
tio
n
an
d
d
ep
er
s
o
n
aliza
tio
n
.
I
n
m
o
s
t
o
f
th
e
s
tu
d
ies,
it
was
f
o
u
n
d
th
at
c
o
n
s
tr
u
cts
lik
e
m
ea
n
in
g
,
p
u
r
p
o
s
e,
an
d
co
n
n
ec
ted
n
ess
in
th
e
wo
r
k
p
lace
h
av
e
m
o
d
er
ate
to
s
tr
o
n
g
n
eg
ativ
e
r
elatio
n
s
h
ip
s
(
ap
p
r
o
x
im
ately
r
=
0
.
3
0
to
0
.
5
5
)
,
wh
ic
h
p
r
o
v
es
th
at
th
ese
asp
ec
t
s
ar
e
im
p
o
r
ta
n
t
p
s
y
ch
o
lo
g
ical
r
eso
u
r
ce
s
u
s
ed
b
y
n
u
r
s
es
[
1
6
]
,
[
2
1
]
–
[
2
3
]
.
Su
c
h
ass
o
ciatio
n
s
wer
e
o
b
s
er
v
e
d
i
n
v
ar
io
u
s
cu
ltu
r
al
co
n
d
itio
n
s
a
n
d
r
em
a
in
e
d
in
p
o
s
t
-
p
a
n
d
em
ic
co
n
d
itio
n
s
,
w
h
ich
test
if
ies
to
th
e
ap
p
licab
ilit
y
o
f
s
p
ir
itu
ality
in
th
e
e
n
v
ir
o
n
m
en
t
,
wh
ich
s
till
p
u
ts
s
ig
n
if
ican
t
e
m
o
tio
n
al
p
r
ess
u
r
e
[
1
]
,
[
5
]
,
[
2
4
]
At
th
e
s
am
e
tim
e
,
it
was
estab
lis
h
ed
th
at
s
u
ch
s
tr
u
ctu
r
al
jo
b
d
em
an
d
s
as
h
i
g
h
wo
r
k
lo
ad
,
in
a
d
eq
u
ate
s
taf
f
in
g
,
an
d
s
tr
ess
o
r
s
r
elate
d
t
o
eth
ics
h
av
e
a
s
ig
n
i
f
ican
t
co
n
n
ec
tio
n
with
em
o
ti
o
n
al
ex
h
au
s
tio
n
a
n
d
b
u
r
n
o
u
t
am
o
n
g
n
u
r
s
es
[
2
5
]
,
[
2
6
]
.
C
OVI
D
-
1
9
a
d
d
ed
t
o
th
ese
s
tr
ess
o
r
s
,
wh
ich
led
to
th
e
in
cr
ea
s
ed
m
o
r
al
an
g
u
is
h
an
d
p
s
y
ch
o
lo
g
ical
b
u
r
d
e
n
[
2
7
]
–
[
2
9
]
.
I
n
t
h
is
co
n
tex
t,
s
p
i
r
itu
ality
in
th
e
wo
r
k
p
lace
is
p
o
s
tu
lated
to
en
ab
le
th
e
em
o
tio
n
al
co
n
tr
o
l
p
r
o
ce
s
s
an
d
en
h
an
ce
r
esil
ien
ce
to
war
d
wo
r
k
p
r
ess
u
r
e
[
1
]
,
[
3
0
]
.
T
h
is
o
b
s
er
v
atio
n
r
elate
s
to
t
h
e
J
o
b
Dem
an
d
s
-
R
eso
u
r
ce
s
(
J
D
-
R
)
p
ar
ad
ig
m
,
wh
ich
s
u
g
g
ests
th
a
t
in
tr
in
s
ic
r
eso
u
r
ce
s
(
m
ea
n
in
g
,
s
o
cial
co
n
n
ec
tiv
ity
)
c
an
co
u
n
t
er
ac
t
th
e
n
e
g
ativ
e
ef
f
ec
ts
o
f
h
i
g
h
jo
b
d
em
a
n
d
s
o
n
b
u
r
n
o
u
t
[
3
1
]
.
T
h
e
y
ar
e
also
c
o
n
s
is
ten
t
with
th
e
h
y
p
o
t
h
esis
o
f
C
o
n
s
er
v
atio
n
o
f
R
eso
u
r
ce
s
(
C
OR
)
th
at
f
o
cu
s
es
o
n
th
e
p
r
o
tectiv
e
p
r
o
p
er
t
y
o
f
m
ea
n
in
g
f
u
l
an
d
r
elatio
n
s
h
i
p
r
eso
u
r
ce
s
to
av
o
id
em
o
tio
n
al
ex
h
au
s
tio
n
a
n
d
r
esil
ien
ce
to
r
eso
u
r
ce
lo
s
s
at
a
ce
r
tain
tim
e
[
3
2
]
.
T
h
e
em
p
i
r
ical
ev
i
d
en
ce
s
u
p
p
o
r
ts
th
e
id
ea
th
at
s
p
ir
itu
ality
im
p
r
o
v
es th
e
c
o
p
in
g
lev
el
an
d
m
en
tal
s
tr
en
g
th
o
f
n
u
r
s
es
[
3
3
]
.
Ho
wev
er
,
th
e
co
n
n
ec
tio
n
b
et
wee
n
s
p
ir
itu
ality
an
d
b
u
r
n
o
u
t
is
in
co
n
g
r
u
e
n
t
b
etwe
en
s
tu
d
ies.
I
n
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
o
n
1
1
8
T
u
r
k
is
h
n
u
r
s
es,
it
was
o
b
s
er
v
ed
th
at
wo
r
k
p
lace
s
p
ir
itu
ali
t
y
an
d
elem
en
ts
o
f
b
u
r
n
o
u
t
h
av
e
wea
k
p
o
s
itiv
e
co
r
r
elatio
n
s
,
esp
ec
ially
d
ep
er
s
o
n
aliza
tio
n
(
r
=
0
.
2
2
6
,
p
=
0
.
0
1
4
)
[
3
4
]
.
T
h
e
au
th
o
r
s
ex
p
lain
ed
t
h
is
tr
en
d
b
y
th
e
h
i
g
h
wo
r
k
lo
ad
r
elate
d
to
th
e
p
r
o
v
is
io
n
o
f
s
p
ir
itu
al
ca
r
e
in
th
e
en
v
ir
o
n
m
en
t
wh
er
e
th
er
e
is
a
lack
o
f
o
r
g
an
izatio
n
al
s
u
p
p
o
r
t
an
d
a
s
h
o
r
tag
e
o
f
p
er
s
o
n
n
el.
I
n
th
is
ca
s
e,
th
e
p
r
ac
tices
th
at
ar
e
co
n
n
ec
ted
with
s
p
ir
itu
ality
wer
e
v
iewe
d
as
an
o
th
er
b
u
r
d
en
o
f
wo
r
k
an
d
n
o
t
th
e
m
ea
n
s
o
f
p
r
o
tectio
n
.
T
h
is
o
b
s
er
v
atio
n
h
ig
h
lig
h
ts
th
e
co
n
tex
tu
al
s
en
s
itiv
ity
o
f
wo
r
k
p
lace
s
p
ir
itu
ality
,
wh
ich
im
p
li
es
th
at
its
im
p
ac
ts
r
eq
u
ir
e
o
r
g
an
izatio
n
al
ca
p
a
b
ilit
y
,
eth
ical
clim
ate,
an
d
cu
ltu
r
e
th
at
en
ab
le
em
p
lo
y
ee
s
to
ex
p
r
ess
th
eir
em
o
tio
n
s
an
d
s
p
ir
itu
ality
.
3
.
2
.
T
hem
e
2
:
O
rg
a
niza
t
io
na
l
co
mm
it
m
ent
a
nd
re
t
ent
io
n
Sp
ir
itu
ality
at
th
e
wo
r
k
p
lace
h
as
alwa
y
s
s
h
o
wn
p
o
s
itiv
e
r
elatio
n
s
h
ip
s
with
o
r
g
an
izatio
n
al
co
m
m
itm
en
t
an
d
lo
wer
tu
r
n
o
v
er
in
ten
tio
n
,
an
d
th
e
ef
f
ec
t
s
izes
h
av
e
b
ee
n
r
ep
o
r
te
d
to
r
an
g
e
b
etwe
en
ab
o
u
t
r
=
0
.
3
2
an
d
0
.
6
0
[
2
9
]
,
[
3
5
]
–
[
3
7
]
.
I
n
co
llectiv
is
t
cu
ltu
r
al
s
ettin
g
s
,
s
u
ch
r
elatio
n
s
wer
e
esp
ec
ial
ly
s
tr
o
n
g
,
an
d
s
u
ch
f
ac
to
r
s
as
s
h
ar
ed
m
ea
n
in
g
,
r
e
latio
n
s
h
ip
h
ar
m
o
n
y
,
a
n
d
co
m
m
o
n
v
alu
es
p
lay
th
e
k
e
y
r
o
le
o
f
an
tece
d
en
ts
o
f
p
r
o
f
ess
io
n
al
id
en
tity
an
d
lo
y
al
ty
[
1
0
]
,
[
3
8
]
.
R
ec
en
t
r
esear
ch
s
tu
d
ies
h
av
e
r
ea
f
f
ir
m
ed
th
e
r
o
le
p
lay
ed
b
y
v
alu
e
co
n
g
r
u
en
ce
at
th
e
wo
r
k
p
lace
,
also
k
n
o
wn
as
p
er
s
o
n
-
o
r
g
a
n
izatio
n
f
it,
as
a
p
r
ed
icto
r
o
f
r
eten
tio
n
o
u
tco
m
es.
A
n
in
cr
ea
s
ed
lev
el
o
f
alig
n
m
en
t
b
etwe
en
p
er
s
o
n
al
v
alu
es
o
f
n
u
r
s
es
an
d
o
r
g
an
izatio
n
al
c
u
ltu
r
e
was
ass
o
ciate
d
with
h
ig
h
e
r
em
o
tio
n
al
r
esil
ien
ce
,
h
i
g
h
er
jo
b
s
atis
f
ac
tio
n
,
an
d
r
e
d
u
ce
d
in
ten
tio
n
to
l
ea
v
e
[
39]
–
[
4
1
]
.
I
n
ad
d
itio
n
,
v
al
u
e
co
n
g
r
u
en
ce
s
t
r
en
g
th
en
e
d
em
o
tio
n
al
s
tab
ilit
y
an
d
o
r
g
an
izatio
n
al
c
o
m
m
it
m
en
t
th
r
o
u
g
h
o
u
t
th
e
cr
is
is
,
ev
en
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
a
n
d
em
ic
[
9
]
,
[
2
9
]
.
Ho
w
ev
er
,
th
e
s
ize
o
f
th
ese
im
p
ac
ts
was
d
if
f
er
en
t
in
t
h
e
r
eg
io
n
s
.
I
n
th
e
E
u
r
o
p
ea
n
an
d
o
th
er
in
d
iv
id
u
a
lis
tic
co
n
tex
ts
,
th
e
s
tu
d
ies
h
av
e
f
o
u
n
d
s
m
aller
ass
o
ciatio
n
s
,
in
d
icatin
g
th
at
o
r
g
an
izatio
n
a
l
co
m
m
itm
en
t
in
th
ese
lo
ca
tio
n
s
m
ig
h
t
b
e
b
etter
r
eg
u
l
ated
b
y
s
tr
u
ctu
r
al
em
p
lo
y
m
e
n
t
p
a
r
am
eter
s
,
in
cl
u
d
in
g
wo
r
k
l
o
ad
,
au
to
n
o
m
y
,
a
n
d
p
ay
m
en
t,
th
an
b
y
s
p
ir
itu
al
s
ig
n
if
ica
n
ce
its
elf
[
4
2
]
,
[
4
3
]
.
T
h
ese
r
esu
lts
m
ea
n
th
at
s
p
ir
itu
ality
at
th
e
wo
r
k
p
lace
p
lay
s
a
r
o
le
in
r
eten
ti
o
n
am
o
n
g
s
p
ec
if
ic
cu
ltu
r
al
an
d
o
r
g
a
n
izatio
n
al
co
n
tex
ts
,
b
u
t n
o
t
as
a
u
n
iv
e
r
s
al
f
ac
to
r
.
3
.
3
.
T
hem
e
3
:
Wo
r
k
eng
a
g
e
m
ent
a
nd
j
o
b sa
t
is
f
a
ct
io
n
T
h
er
e
wer
e
also
co
n
s
is
ten
t
p
o
s
itiv
e
r
elatio
n
s
h
ip
s
b
etwe
en
h
ig
h
er
lev
els
o
f
wo
r
k
p
lace
s
p
ir
itu
ality
an
d
jo
b
s
atis
f
ac
tio
n
an
d
wo
r
k
e
n
g
ag
em
en
t,
r
ep
o
r
ted
to
b
e
ar
o
u
n
d
r
=
0
.
3
5
to
0
.
5
8
[
1
]
,
[
4
4
]
.
T
h
o
s
e
n
u
r
s
es
wh
o
f
elt
th
at
th
ey
en
g
a
g
ed
in
m
ea
n
i
n
g
f
u
l
an
d
v
alu
e
-
co
n
s
is
ten
t
wo
r
k
ex
p
e
r
ien
ce
d
a
h
ig
h
er
l
ev
el
o
f
en
th
u
s
iasm,
s
tr
o
n
g
er
p
r
o
f
ess
io
n
al
id
e
n
tity
,
an
d
in
c
r
ea
s
ed
in
tr
in
s
ic
m
o
tiv
atio
n
[
3
]
,
[
4
2
]
.
T
h
o
u
g
h
th
e
co
n
ce
p
t
o
f
s
p
ir
itu
ality
in
th
e
wo
r
k
p
lace
h
as
o
f
ten
b
e
en
d
is
cu
s
s
ed
in
p
ar
allel
with
o
th
er
p
s
y
ch
o
lo
g
ical
r
eso
u
r
ce
s
,
a
n
u
m
b
e
r
o
f
s
tu
d
ies
h
av
e
also
em
p
h
asized
th
e
r
o
le
o
f
s
p
ir
itu
ality
in
av
ailin
g
e
x
is
ten
tial
m
e
an
in
g
a
n
d
a
s
en
s
e
o
f
ca
llin
g
,
esp
ec
ially
in
th
e
em
o
tio
n
ally
-
d
em
an
d
i
n
g
ca
r
e
s
ettin
g
[
4
5
]
–
[
4
7
]
.
On
l
y
wh
en
th
e
s
tr
u
ctu
r
al
s
tr
ess
o
r
s
,
in
clu
d
in
g
ch
r
o
n
ic
u
n
d
er
s
taf
f
in
g
,
wo
r
k
o
v
er
lo
a
d
,
o
r
eth
ical
co
n
f
lict,
h
a
d
b
e
en
s
tatis
tically
co
n
tr
o
lled
,
th
e
d
ir
ec
t
ef
f
ec
t
o
f
s
p
ir
itu
ality
o
n
jo
b
s
atis
f
ac
tio
n
was
s
ig
n
if
ican
tly
r
ed
u
ce
d
[
2
6
]
,
[
4
8
]
.
T
h
e
tr
e
n
d
is
co
n
s
is
ten
t
with
J
D
-
R
th
eo
r
y
,
wh
ich
ar
g
u
es th
at
j
o
b
r
eso
u
r
ce
s
ca
n
n
o
t a
lway
s
b
e
u
s
ed
t
o
o
f
f
s
et
ex
tr
em
e
jo
b
d
e
m
an
d
s
[
3
1
]
.
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
60
-
1
70
164
3
.
4
.
T
hem
e
4
:
Sp
irit
ua
l
co
ng
ruence
a
nd
inte
rper
s
o
na
l c
a
re
T
h
is
s
y
n
th
esis
al
s
o
f
o
u
n
d
th
at
alig
n
m
en
t
b
etwe
en
th
e
s
p
ir
itu
al
p
r
in
cip
les
an
d
th
e
o
r
g
a
n
is
atio
n
al
m
o
r
al
clim
ate
in
n
u
r
s
es
in
cr
ea
s
ed
em
o
tio
n
al
s
tr
en
g
th
,
em
p
at
h
y
,
an
d
th
e
q
u
ality
o
f
in
te
r
p
er
s
o
n
al
s
er
v
ices.
T
h
is
r
elatio
n
s
h
ip
was
esp
ec
ially
p
r
o
n
o
u
n
ce
d
i
n
th
e
c
o
n
tex
t
o
f
th
e
Mid
d
le
E
ast
an
d
So
u
th
ea
s
t
Asi
a,
wh
er
e
th
e
co
llectiv
e
m
ea
n
in
g
an
d
th
e
h
ar
m
o
n
y
in
r
elatio
n
s
h
ip
s
ar
e
i
n
h
er
en
t
t
o
th
e
c
u
ltu
r
e
[
3
0
]
,
[
4
9
]
.
T
h
e
p
r
esen
ce
o
f
v
alu
e
co
n
g
r
u
en
ce
en
h
a
n
ce
d
t
h
e
ab
ilit
y
o
f
n
u
r
s
es
to
m
ain
tain
co
m
p
ass
io
n
ate
ca
r
e
in
t
h
e
f
ac
e
o
f
h
ig
h
em
o
tio
n
al
r
esp
o
n
s
e
[
2
5
]
,
[
3
9
]
.
I
n
lin
e
with
b
o
th
J
D
-
R
an
d
C
OR
v
iews,
s
p
ir
itu
al
co
n
g
r
u
en
ce
ac
ted
as
a
r
en
ewa
b
le
s
o
u
r
ce
t
h
at
f
ac
ilit
ated
th
e
r
eg
u
latio
n
o
f
e
m
o
tio
n
s
an
d
h
o
w
th
ey
co
p
e
d
with
p
r
ess
u
r
e
[
3
2
]
.
C
u
ltu
r
al
n
o
r
m
s
b
ased
o
n
et
h
ical
o
b
lig
atio
n
,
r
elatio
n
al
in
ter
c
o
n
n
ec
ted
n
ess
,
an
d
s
h
ar
ed
m
o
r
al
v
alu
es
d
eter
m
in
ed
th
e
o
b
s
er
v
ed
b
e
n
ef
its
an
d
ac
ce
n
tu
ated
th
e
s
ig
n
if
ica
n
ce
o
f
th
e
co
n
te
x
tu
al
in
ter
p
r
etatio
n
.
3
.
5
.
T
hem
e
5
:
T
he
ef
f
ec
t
o
f
s
piritua
l le
a
dersh
i
p o
n we
ll
-
b
eing
Sp
ir
itu
al
lead
er
s
h
ip
b
ec
am
e
a
s
tr
o
n
g
i
n
d
icato
r
o
f
t
h
e
p
s
y
ch
o
lo
g
ical
h
ea
lth
a
n
d
c
o
m
m
itm
en
t
o
f
n
u
r
s
es
,
as
well
as
t
h
eir
r
esil
ien
ce
in
v
ar
io
u
s
s
tu
d
ies
[
1
0
]
,
[
3
8
]
,
[
5
0
]
.
Vis
io
n
,
p
u
r
p
o
s
e,
co
m
p
ass
io
n
,
an
d
altr
u
is
tic
lead
er
s
cr
ea
ted
a
f
av
o
r
ab
le
wo
r
k
en
v
ir
o
n
m
en
t
th
at
co
n
tr
ib
u
ted
to
th
e
r
is
e
o
f
in
tr
i
n
s
ic
m
o
tiv
atio
n
an
d
em
o
tio
n
al
s
af
ety
am
o
n
g
n
u
r
s
es
[
5
1
]
.
T
h
e
im
p
o
r
tan
ce
o
f
s
p
ir
itu
al
an
d
tr
a
n
s
f
o
r
m
atio
n
al
lead
er
s
h
ip
th
at
f
ac
ilit
ates
t
h
e
estab
lis
h
m
en
t
o
f
p
s
y
ch
o
lo
g
ical
s
af
ety
was
em
p
h
asized
in
r
ec
e
n
t
r
esear
c
h
as
well,
allo
win
g
n
u
r
s
es
to
v
o
ice
t
h
eir
co
n
ce
r
n
s
an
d
en
g
a
g
e
in
a
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
with
o
u
t
th
e
th
r
ea
t
o
f
p
er
s
ec
u
tio
n
[
5
2
]
,
[
5
3
]
.
T
h
ese
lead
er
s
h
ip
b
eh
av
io
r
s
wer
e
r
elate
d
to
less
b
u
r
n
o
u
t a
n
d
less
tu
r
n
o
v
e
r
in
ten
t
io
n
[
3
7
]
,
[
5
4
]
,
[
5
5
]
.
No
d
if
f
er
en
ce
s
wer
e
f
o
u
n
d
b
et
wee
n
th
e
r
eg
io
n
s
,
an
d
th
e
m
e
d
i
atio
n
ef
f
ec
ts
wer
e
s
tr
o
n
g
er
in
Asi
an
an
d
Mid
d
le
E
aster
n
co
n
d
itio
n
s
th
an
in
E
u
r
o
p
ea
n
o
n
es
d
u
e
to
th
e
cu
ltu
r
al
d
iv
er
s
ity
in
lead
er
s
h
ip
ex
p
ec
t
atio
n
s
an
d
s
p
ir
itu
al
m
an
if
estatio
n
[
4
2
]
,
[
4
3
]
.
All
in
all,
wo
r
k
p
lace
s
p
ir
itu
ali
ty
ac
ts
as
a
m
u
ltid
im
en
s
io
n
al
p
s
y
ch
o
lo
g
ical,
e
m
o
tio
n
al,
a
n
d
r
elatio
n
al
r
eso
u
r
ce
to
h
elp
n
u
r
s
es
in
o
c
cu
p
atio
n
al
well
-
b
ei
n
g
in
a
v
a
r
iety
o
f
h
ea
lth
ca
r
e
s
ettin
g
s
.
Stro
n
g
er
em
o
tio
n
al
en
d
u
r
a
n
ce
,
r
ed
u
ce
d
b
u
r
n
o
u
t,
in
cr
ea
s
ed
wo
r
k
en
g
ag
em
e
n
t,
a
n
d
in
cr
ea
s
ed
o
r
g
an
izatio
n
al
l
o
y
alty
wer
e
alwa
y
s
lin
k
ed
to
m
ea
n
in
g
,
p
u
r
p
o
s
e,
c
o
n
n
ec
ted
n
ess
,
an
d
v
alu
e
co
n
g
r
u
en
ce
[
1
6
]
,
[
2
2
]
,
[
5
6
]
–
[
5
8
]
.
T
h
ese
tr
en
d
s
ca
n
b
e
well
ex
p
lain
ed
b
y
th
e
JD
-
R
f
r
am
ewo
r
k
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[
64]
Y
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Li
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AP
P
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NDI
X
F
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g
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r
e
1.
P
R
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f
l
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am
B
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O
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RAP
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RS
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.
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h
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s
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jarm
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sin
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m
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Un
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rsity
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.
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c
a
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tac
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upl
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,
Re
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[T
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hra
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t
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t
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due
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ve
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= 33)
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t
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A
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N
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n
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g
l
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s
(
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evi
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(
n
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9
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t
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s
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f
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e
l
i
g
i
b
i
l
i
t
y
(
n
=
5
3
)
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