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R
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2
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2
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Ma
r
1
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6
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Dia
b
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tes
m
e
ll
it
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s
(DM)
is
a
m
a
j
o
r
n
o
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c
o
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m
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v
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h
e
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lt
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ra
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y
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h
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a
y
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ffe
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t
t
h
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ir
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g
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n
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lf
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m
a
n
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g
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e
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h
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y
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ime
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n
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ly
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th
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re
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ti
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n
d
k
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g
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a
b
o
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t
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m
o
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g
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h
e
e
ld
e
rly
in
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n
d
u
n
g
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y
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t
Ja
v
a
.
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d
e
sc
rip
ti
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e
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ro
ss
-
se
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ti
o
n
a
l
stu
d
y
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s
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o
n
d
u
c
t
e
d
o
n
1
5
0
e
ld
e
rli
e
s
with
ty
p
e
2
DM
u
si
n
g
p
u
r
p
o
siv
e
sa
m
p
li
n
g
a
t
p
rima
ry
h
e
a
lt
h
c
a
re
fa
c
il
it
ies
with
h
ig
h
DM
c
a
se
s.
Da
ta
we
re
c
o
ll
e
c
ted
th
ro
u
g
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c
tu
re
d
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terv
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si
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a
d
e
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o
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ra
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h
ic
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e
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ire
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n
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it
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m
m
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lt
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le
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h
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ice
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u
e
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ire
o
n
DM
k
n
o
wle
d
g
e
th
a
t
h
a
d
b
e
e
n
tes
ted
fo
r
v
a
l
id
it
y
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n
d
re
li
a
b
il
it
y
p
re
v
i
o
u
sl
y
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a
d
a
p
ted
fr
o
m
a
n
In
d
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n
e
sia
n
d
iab
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tes
se
lf
-
m
a
n
a
g
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m
e
n
t
in
stru
m
e
n
t.
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n
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wle
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g
e
sc
o
re
s
we
re
c
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teg
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rize
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in
to
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o
d
a
n
d
p
o
o
r.
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ta
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re
a
n
a
ly
z
e
d
u
sin
g
t
h
e
C
h
i
-
sq
u
a
re
tes
t.
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st
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sp
o
n
d
e
n
t
s
h
a
d
a
n
e
lem
e
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tary
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r
h
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g
h
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sc
h
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o
l
e
d
u
c
a
t
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n
.
Th
e
m
a
jo
rit
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o
f
th
e
e
l
d
e
rly
w
it
h
h
ig
h
e
r
e
d
u
c
a
ti
o
n
lev
e
ls
h
a
d
g
o
o
d
k
n
o
wle
d
g
e
a
b
o
u
t
D
M
,
wh
il
e
th
o
se
with
l
o
we
r
e
d
u
c
a
ti
o
n
lev
e
ls
ten
d
e
d
to
h
a
v
e
p
o
o
re
r
k
n
o
wle
d
g
e
.
T
h
e
re
wa
s
a
s
tatisti
c
a
ll
y
sig
n
ifi
c
a
n
t
a
ss
o
c
iati
o
n
b
e
twe
e
n
e
d
u
c
a
ti
o
n
lev
e
l
a
n
d
e
ld
e
rl
y
k
n
o
wl
e
d
g
e
a
b
o
u
t
DM
(p
<
0
.
0
0
1
).
E
d
u
c
a
ti
o
n
le
v
e
l
is
sig
n
ifi
c
a
n
t
ly
a
ss
o
c
iate
d
with
DM
k
n
o
wle
d
g
e
a
m
o
n
g
th
e
e
ld
e
rl
y
i
n
Ba
n
d
u
n
g
.
Th
e
se
fi
n
d
i
n
g
s
h
i
g
h
li
g
h
t
t
h
e
n
e
e
d
fo
r
a
tail
o
re
d
c
o
n
t
in
u
it
y
o
f
c
a
re
d
iab
e
tes
p
r
o
g
ra
m
,
e
sp
e
c
ially
fo
r
th
e
e
ld
e
rl
y
with
lo
we
r
e
d
u
c
a
ti
o
n
a
l
a
tt
a
in
m
e
n
t,
in
o
r
d
e
r
to
imp
ro
v
e
se
lf
-
m
a
n
a
g
e
m
e
n
t
a
n
d
g
ly
c
e
m
ic co
n
tr
o
l.
K
ey
w
o
r
d
s
:
Diab
etes m
ellitu
s
E
d
u
ca
tio
n
lev
el
E
ld
er
ly
Hea
lth
liter
ac
y
Kn
o
wled
g
e
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
C
itra
W
in
d
an
i M
am
b
an
g
Sar
i
Do
cto
r
al
Pro
g
r
a
m
,
Facu
lty
o
f
Me
d
icin
e,
Un
iv
er
s
itas
Pad
jad
jar
an
Su
m
ed
an
g
,
W
est J
av
a
4
5
3
6
3
,
I
n
d
o
n
esia
E
m
ail: c
itra
.
win
d
an
i@
u
n
p
ad
.
a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Diab
etes
m
ellitu
s
is
a
g
r
o
win
g
p
u
b
lic
h
ea
lth
p
r
o
b
lem
in
I
n
d
o
n
esia,
p
ar
ticu
lar
ly
am
o
n
g
o
ld
er
ad
u
lts
.
T
h
e
I
n
ter
n
atio
n
al
Diab
etes
Fe
d
er
atio
n
(
I
DF)
esti
m
ated
th
at
I
n
d
o
n
esia
is
am
o
n
g
th
e
co
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n
tr
ies
with
th
e
lar
g
est
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u
m
b
er
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lts
liv
in
g
with
d
iab
etes,
with
a
p
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r
o
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d
1
1
%
in
r
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y
ea
r
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m
o
r
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th
an
1
9
–
2
0
m
illi
o
n
af
f
ec
ted
ad
u
lts
[
1
]
.
T
h
e
I
n
d
o
n
esian
B
asic
Hea
lth
R
esear
ch
also
s
h
o
ws
an
in
cr
ea
s
in
g
tr
en
d
in
DM
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
-
8
8
0
6
A
s
s
o
cia
tio
n
b
etw
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ed
u
ca
tio
n
a
l le
ve
l a
n
d
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ia
b
etes
kn
o
w
led
g
e
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mo
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…
(
C
itr
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Win
d
a
n
i
Ma
mb
a
n
g
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r
i
)
371
p
r
ev
alen
ce
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ased
o
n
b
l
o
o
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g
l
u
co
s
e
m
ea
s
u
r
em
en
ts
a
n
d
p
h
y
s
ician
d
iag
n
o
s
is
,
co
n
f
ir
m
in
g
t
h
at
DM
is
a
m
ajo
r
an
d
g
r
o
win
g
p
u
b
lic
h
ea
lth
p
r
o
b
lem
i
n
I
n
d
o
n
esia
[
2
]
.
Am
o
n
g
o
ld
er
a
d
u
lts
,
th
e
r
i
s
k
o
f
DM
an
d
its
co
m
p
licatio
n
s
is
e
v
en
h
ig
h
er
d
u
e
to
ag
e
-
r
elate
d
p
h
y
s
io
lo
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ical
c
h
an
g
es,
m
u
ltip
le
co
m
o
r
b
i
d
ities
,
an
d
lim
itatio
n
s
in
ac
ce
s
s
in
g
an
d
u
n
d
er
s
tan
d
in
g
h
ea
lth
in
f
o
r
m
ati
o
n
[
3
]
-
[
5
]
.
K
n
o
w
l
e
d
g
e
a
n
d
h
e
a
lt
h
l
it
e
r
a
c
y
s
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g
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f
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c
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ct
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f
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m
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f
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c
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r
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[
6
]
.
I
n
c
o
n
t
r
a
s
t
,
l
i
m
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t
e
d
h
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a
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y
c
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m
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c
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t
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l
[
7
]
,
[
8
]
.
O
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r
a
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t
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w
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n
t
k
n
o
w
l
e
d
g
e
an
d
lo
w
h
ea
lth
liter
ac
y
f
ac
e
p
o
o
r
er
clin
ical
r
esu
lts
an
d
co
m
p
licat
io
n
s
,
in
f
lu
en
ce
d
b
y
s
o
cio
-
d
em
o
g
r
a
p
h
ic
f
ac
to
r
s
[
9
]
.
Stu
d
ies
i
n
So
u
th
ea
s
t
an
d
E
ast
Asi
a,
p
ar
ticu
lar
ly
i
n
Vietn
am
an
d
T
h
ailan
d
,
r
ev
e
al
th
at
o
l
d
er
a
d
u
lts
with
ty
p
e
2
d
iab
etes
d
e
m
o
n
s
tr
ate
m
o
d
er
ate
d
iab
etes
-
r
e
lated
k
n
o
wled
g
e,
with
l
o
wer
ed
u
ca
tio
n
lev
els
n
eg
ativ
e
ly
af
f
ec
tin
g
th
is
k
n
o
w
led
g
e
[
1
0
]
,
[
1
1
]
.
Ad
d
itio
n
ally
,
th
er
e
is
a
s
tr
o
n
g
lin
k
a
g
e
b
etw
ee
n
h
ea
lth
liter
ac
y
,
s
elf
-
ef
f
icac
y
,
s
elf
-
ca
r
e
b
eh
av
i
o
r
s
,
an
d
g
ly
ca
em
ic
co
n
tr
o
l a
m
o
n
g
th
ese
p
o
p
u
latio
n
s
[
1
2
]
,
[
1
3
]
.
Ho
wev
er
,
e
v
id
en
ce
o
n
th
e
r
e
latio
n
s
h
ip
b
etwe
en
ed
u
c
atio
n
l
ev
el
a
n
d
d
iab
etes
k
n
o
wled
g
e
am
o
n
g
I
n
d
o
n
esian
o
ld
er
ad
u
lts
r
em
ai
n
s
lim
ited
.
A
n
atio
n
ally
r
ep
r
es
en
tativ
e
an
aly
s
is
(
I
n
d
o
n
esia
Fam
ily
L
if
e
Su
r
v
e
y
)
s
h
o
wed
th
at
lo
wer
e
d
u
ca
tio
n
al
lev
els
wer
e
ass
o
ciate
d
with
a
h
ig
h
er
p
r
ev
alen
ce
o
f
d
iab
etes
[
1
4
]
.
On
e
s
tu
d
y
in
I
n
d
o
n
esia
r
ep
o
r
ted
th
at
d
iab
etes
k
n
o
wled
g
e
its
elf
was
a
s
ig
n
if
ican
t
p
r
ed
icto
r
,
b
u
t
th
is
s
tu
d
y
h
ig
h
lig
h
ts
ed
u
ca
tio
n
an
d
k
n
o
wled
g
e
as
k
ey
d
eter
m
in
an
ts
o
f
s
elf
-
m
a
n
a
g
em
en
t
[
1
5
]
.
I
n
ad
d
itio
n
,
h
ig
h
er
d
iab
etes
liter
ac
y
is
p
o
s
itiv
ely
ass
o
ciate
d
with
b
etter
s
elf
-
m
an
ag
e
m
en
t a
m
o
n
g
o
ld
er
ad
u
lts
[
1
6
]
.
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
ed
u
ca
tio
n
lev
el
an
d
d
iab
etes
k
n
o
wled
g
e
s
h
o
ws
in
co
n
s
is
ten
cy
ac
r
o
s
s
s
tu
d
ies.
Har
to
n
o
an
d
E
d
iy
o
n
o
[
1
7
]
f
o
u
n
d
n
o
s
ig
n
if
ican
t
lin
k
b
etwe
en
ed
u
ca
tio
n
an
d
k
n
o
wled
g
e
o
f
d
iab
etes
m
an
ag
em
en
t
am
o
n
g
ty
p
e
2
DM
p
ati
en
ts
in
W
est
Kalim
an
tan
,
wh
ile
d
u
r
atio
n
o
f
illn
ess
was
s
ig
n
if
ican
t.
C
o
n
v
er
s
ely
,
a
s
tu
d
y
i
n
C
im
ah
i
in
d
icate
d
th
at
d
ia
b
etes
k
n
o
wled
g
e
v
ar
ied
b
y
ed
u
ca
tio
n
al
lev
el,
ag
e,
an
d
g
en
d
er
[
1
8
]
.
R
esear
ch
o
n
p
r
e
-
el
d
er
ly
p
o
p
u
latio
n
s
s
u
g
g
ests
h
ig
h
er
ed
u
ca
tio
n
co
r
r
elate
s
with
b
etter
d
iab
etes
k
n
o
wled
g
e
an
d
p
r
ev
e
n
tiv
e
ac
tio
n
s
[
1
9
]
.
Alth
o
u
g
h
th
e
in
f
lu
e
n
ce
o
f
e
d
u
ca
tio
n
o
n
d
iab
etes
k
n
o
wled
g
e
is
well
d
o
cu
m
en
ted
,
m
o
s
t
r
esear
ch
in
I
n
d
o
n
esia
h
as
f
o
cu
s
ed
o
n
r
u
r
al
p
o
p
u
latio
n
s
o
r
r
elied
o
n
b
r
o
ad
n
atio
n
al
s
u
r
v
ey
s
.
Fo
r
ex
am
p
le,
th
e
2
0
1
8
I
n
d
o
n
esian
B
asic
Hea
lth
Su
r
v
ey
r
ev
ea
led
clea
r
u
r
b
an
–
r
u
r
al
d
if
f
er
en
ce
s
in
d
iab
etes
-
r
elate
d
r
is
k
f
ac
to
r
s
,
s
u
c
h
as
p
h
y
s
ical
ac
tiv
ity
,
o
b
esit
y
,
an
d
d
iet,
alth
o
u
g
h
it
d
id
n
o
t
d
elv
e
i
n
to
k
n
o
wled
g
e
o
r
ed
u
ca
tio
n
lev
els
s
p
ec
if
ically
[
2
0
]
.
Oth
er
s
tu
d
i
es,
lik
e
th
e
a
n
aly
s
is
o
f
th
e
I
n
d
o
n
esian
B
asic
Hea
lth
Su
r
v
ey
,
f
u
r
th
er
h
ig
h
lig
h
t
u
r
b
an
–
r
u
r
al
d
is
tin
ctio
n
s
in
p
r
e
d
iab
etes d
eter
m
in
an
ts
b
u
t sti
ll d
o
n
o
t a
s
s
ess
h
ea
lth
liter
ac
y
o
r
ed
u
ca
tio
n
’
s
d
i
r
ec
t
im
p
ac
t o
n
d
iab
etes k
n
o
wled
g
e
[
2
1
]
.
W
ith
in
cr
ea
s
in
g
u
r
b
an
izatio
n
,
cities
s
u
ch
as
B
an
d
u
n
g
ar
e
e
x
p
er
ien
cin
g
s
ig
n
if
ican
t
ch
a
n
g
es
in
th
eir
d
em
o
g
r
a
p
h
ic
an
d
h
ea
lth
p
r
o
f
iles
.
T
h
e
u
r
b
a
n
en
v
i
r
o
n
m
e
n
t
in
t
r
o
d
u
ce
s
u
n
iq
u
e
f
a
cto
r
s
,
s
u
ch
a
s
g
r
ea
ter
ac
ce
s
s
to
ed
u
ca
tio
n
,
h
ea
lth
ca
r
e
s
er
v
ices,
an
d
d
ig
ital
in
f
o
r
m
atio
n
.
T
h
a
t
m
ay
s
h
a
p
e
h
ea
lth
liter
ac
y
d
i
f
f
er
en
tly
co
m
p
a
r
ed
to
r
u
r
al
ar
ea
s
.
Alth
o
u
g
h
d
ir
e
ct
s
tu
d
ies
o
n
d
iab
etes
k
n
o
wled
g
e
am
o
n
g
th
e
el
d
er
ly
i
n
B
an
d
u
n
g
ar
e
s
ca
r
ce
,
r
eg
io
n
al
r
esear
ch
(
So
u
t
h
J
ak
ar
ta)
h
as
d
em
o
n
s
tr
ated
th
at
s
tr
u
ctu
r
ed
ed
u
ca
tio
n
al
in
ter
v
en
tio
n
s
ca
n
s
ig
n
if
ican
tly
im
p
r
o
v
e
k
n
o
wled
g
e
ab
o
u
t
ty
p
e
2
d
iab
etes a
m
o
n
g
o
l
d
er
ad
u
lts
[
2
2
]
.
As
o
n
e
o
f
I
n
d
o
n
esia’
s
lar
g
est
an
d
m
o
s
t
d
y
n
am
ic
cities,
B
an
d
u
n
g
o
f
f
er
s
a
v
alu
ab
le
co
n
tex
t
f
o
r
ex
p
lo
r
in
g
th
ese
d
is
p
ar
ities
.
T
h
e
city
’
s
d
iv
er
s
e
s
o
cio
ec
o
n
o
m
ic
lan
d
s
ca
p
e
a
n
d
r
a
p
id
u
r
b
a
n
d
ev
elo
p
m
en
t
p
r
esen
t
b
o
th
o
p
p
o
r
tu
n
ities
an
d
ch
alle
n
g
es
f
o
r
d
iab
etes
ed
u
ca
tio
n
a
m
o
n
g
t
h
e
eld
er
l
y
.
Mo
r
eo
v
er
,
d
ietar
y
an
d
en
e
r
g
y
in
tak
e
p
atter
n
s
d
if
f
er
b
etwe
en
u
r
b
an
B
an
d
u
n
g
an
d
r
u
r
al
ar
e
as
lik
e
Su
m
ed
an
g
,
wh
er
e
e
d
u
ca
tio
n
lev
el
is
o
n
ly
co
r
r
elate
d
with
v
eg
etab
le
an
d
leg
u
m
e
i
n
tak
e
in
th
e
r
u
r
al
s
ettin
g
.
T
h
is
s
tu
d
y
s
u
g
g
ests
t
h
at
ed
u
ca
tio
n
m
ay
in
f
lu
en
ce
h
ea
lth
b
eh
av
io
r
s
d
i
f
f
er
en
tly
ac
r
o
s
s
co
n
te
x
ts
[
2
3
]
.
T
h
is
s
tu
d
y
s
ee
k
s
to
f
ill
a
cr
itical
g
ap
in
th
e
liter
atu
r
e
b
y
in
v
esti
g
atin
g
t
h
e
co
r
r
elatio
n
b
etwe
en
e
d
u
ca
t
io
n
lev
el
a
n
d
d
iab
etes
k
n
o
wled
g
e
am
o
n
g
o
ld
e
r
ad
u
lts
in
u
r
b
an
B
an
d
u
n
g
.
T
h
e
f
in
d
in
g
s
m
ay
in
f
o
r
m
u
r
b
an
h
ea
lth
p
o
licies
an
d
tar
g
eted
in
t
er
v
en
tio
n
s
,
n
o
t
o
n
ly
f
o
r
B
an
d
u
n
g
b
u
t a
ls
o
f
o
r
o
th
e
r
r
ap
id
ly
g
r
o
win
g
I
n
d
o
n
esian
ci
ties
u
n
d
er
g
o
i
n
g
s
im
ilar
tr
an
s
itio
n
s
.
2.
M
E
T
H
O
D
W
e
co
n
d
u
cted
a
d
escr
ip
tiv
e
c
r
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
at
s
ix
p
r
i
m
ar
y
h
ea
lth
ce
n
tr
es
in
B
an
d
u
n
g
C
ity
.
A
p
u
r
p
o
s
iv
e
s
am
p
le
o
f
1
5
0
o
l
d
er
ad
u
lts
with
p
h
y
s
ician
-
d
iag
n
o
s
ed
ty
p
e
2
DM
was
r
ec
r
u
ited
.
E
lig
ib
ilit
y
r
eq
u
ir
e
d
in
d
ep
en
d
en
ce
in
d
aily
liv
in
g
(
B
ar
th
el
I
n
d
e
x
)
an
d
n
o
r
m
al
/m
ild
co
g
n
itiv
e
f
u
n
ctio
n
(
M
MSE
)
.
Data
wer
e
co
llected
u
s
in
g
a
s
tr
u
ctu
r
e
d
q
u
esti
o
n
n
air
e
co
n
s
is
tin
g
o
f
two
p
ar
ts
.
T
h
e
f
ir
s
t
p
ar
t
r
ec
o
r
d
e
d
s
o
cio
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
(
ag
e,
s
ex
,
eth
n
i
city
,
m
ar
ital
s
tatu
s
,
ed
u
ca
tio
n
lev
el,
o
cc
u
p
atio
n
,
an
d
d
u
r
atio
n
o
f
d
iab
etes)
.
T
h
e
s
ec
o
n
d
p
ar
t
ass
ess
ed
d
iab
etes
k
n
o
wled
g
e.
T
h
e
d
iab
etes
k
n
o
wled
g
e
s
ec
tio
n
was
ad
ap
ted
f
r
o
m
th
e
d
iab
etes
k
n
o
wled
g
e
test
(
DKT
2
)
d
ev
el
o
p
ed
an
d
v
alid
ated
b
y
Fit
zg
e
r
ald
et
a
l.
[
2
4
]
an
d
f
r
o
m
an
I
n
d
o
n
esian
d
iab
etes
s
elf
-
m
an
ag
em
en
t
i
n
s
tr
u
m
en
t
u
s
ed
p
r
e
v
i
o
u
s
ly
b
y
Ku
r
n
iawa
n
an
d
Yu
d
ian
to
[
2
5
]
.
T
h
e
in
s
tr
u
m
en
ts
wer
e
cu
ltu
r
ally
a
d
ap
ted
15
-
item
d
iab
etes
k
n
o
wled
g
e
q
u
esti
o
n
n
ai
r
es
,
v
alid
ated
b
y
e
x
p
er
t
r
ev
ie
w
an
d
p
ilo
t
test
in
g
(
C
r
o
n
b
ac
h
’
s
alp
h
a
=
0
.
7
2
)
.
E
a
ch
co
r
r
ec
t a
n
s
wer
was sco
r
ed
as 1
,
g
en
er
atin
g
a
to
tal
s
co
r
e
o
f
0
–
1
5
.
Kn
o
wled
g
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
.
2
,
J
u
n
e
20
26
:
37
0
-
37
7
372
was
ca
teg
o
r
ized
in
to
‘
g
o
o
d
’
a
n
d
‘
p
o
o
r
’
b
ased
o
n
p
ilo
t
d
is
tr
ib
u
tio
n
.
Ass
o
ciatio
n
s
b
etwe
en
ed
u
ca
tio
n
lev
el
a
n
d
k
n
o
wled
g
e
we
r
e
test
ed
u
s
in
g
C
h
i
-
s
q
u
ar
e
an
aly
s
is
(
p
<
0
.
0
5
)
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Resul
t
s
A
s
tu
d
y
in
v
o
lv
in
g
1
5
0
o
ld
er
ad
u
lts
with
ty
p
e
2
d
iab
etes
m
ellitu
s
r
ev
ea
led
d
em
o
g
r
ap
h
ic
d
etails
in
d
icatin
g
th
at
m
o
s
t
p
ar
tici
p
an
ts
wer
e
ag
ed
6
0
–
7
4
,
p
r
ed
o
m
in
an
tly
f
em
ale,
an
d
o
f
Su
n
d
a
eth
n
icity
.
Ap
p
r
o
x
im
ately
h
alf
h
ad
lo
w
e
d
u
ca
tio
n
al
attain
m
e
n
t,
with
o
n
e
-
f
if
th
h
av
in
g
co
m
p
leted
h
i
g
h
er
ed
u
ca
tio
n
.
M
o
s
t
wer
e
m
ar
r
ied
,
wh
ile
o
th
er
s
wer
e
wid
o
wed
o
r
s
in
g
le.
T
ab
le
1
d
etails
th
e
s
o
cio
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
.
T
ab
le
2
d
etails
th
e
r
esp
o
n
d
e
n
ts
'
life
s
ty
le
an
d
clin
ical
ch
a
r
ac
ter
is
tics
.
Mo
s
t
h
ad
n
ev
er
s
m
o
k
ed
o
r
co
n
s
u
m
ed
alco
h
o
l,
p
r
im
ar
ily
en
g
a
g
ed
in
h
o
u
s
eh
o
ld
c
h
o
r
es,
an
d
r
ep
o
r
ted
walk
in
g
as
th
eir
m
ain
f
o
r
m
o
f
ex
er
cise.
L
ess
th
an
h
alf
m
ain
tain
ed
a
r
e
g
u
lar
d
iet,
b
u
t
m
o
s
t
atten
d
ed
m
e
d
ical
ch
ec
k
-
u
p
s
.
Ab
o
u
t
two
-
th
ir
d
s
ex
p
er
ien
ce
d
f
o
o
t
co
m
p
lain
ts
,
in
clu
d
in
g
n
u
m
b
n
ess
,
p
ain
,
o
r
tin
g
lin
g
,
a
n
d
a
s
im
ilar
p
r
o
p
o
r
tio
n
h
a
d
r
ec
eiv
e
d
d
iab
etes e
d
u
ca
tio
n
.
T
ab
le
3
illu
s
tr
ates
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
b
etwe
en
ed
u
ca
tio
n
lev
el
an
d
d
ia
b
etes
k
n
o
wled
g
e,
r
ev
ea
lin
g
th
at
r
esp
o
n
d
en
ts
wi
th
lo
wer
ed
u
ca
tio
n
le
v
els
ten
d
to
s
co
r
e
b
elo
w
a
v
er
ag
e
in
d
iab
etes
k
n
o
wled
g
e.
C
o
n
v
er
s
ely
,
th
o
s
e
with
s
en
i
o
r
h
ig
h
s
ch
o
o
l
a
n
d
c
o
lleg
e/u
n
iv
er
s
ity
ed
u
ca
tio
n
g
en
er
ally
s
co
r
ed
ab
o
v
e
a
v
er
ag
e.
T
h
e
C
h
i
-
s
q
u
ar
e
test
co
n
f
ir
m
e
d
th
is
ass
o
ciatio
n
as
s
tati
s
tica
lly
s
ig
n
if
ican
t
(
p
<
0
.
0
0
1
)
,
in
d
icatin
g
th
at
h
ig
h
er
ed
u
ca
tio
n
c
o
r
r
elate
s
with
b
ette
r
d
iab
etes k
n
o
wled
g
e
am
o
n
g
e
ld
er
ly
d
iab
etes p
atien
ts
in
B
an
d
u
n
g
.
T
ab
le
1
.
So
cio
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
(
n
=
150)
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
n
%
A
g
e
(
y
e
a
r
s)
60
–
74
1
3
3
8
8
.
6
7
75
–
90
17
1
1
.
3
3
S
e
x
M
a
l
e
48
3
2
.
0
F
e
mal
e
1
0
2
6
8
.
0
Et
h
n
i
c
i
t
y
S
u
n
d
a
1
0
2
6
8
.
0
Jav
a
n
e
se
12
8
.
0
O
t
h
e
r
36
2
4
.
0
Ed
u
c
a
t
i
o
n
l
e
v
e
l
Ev
e
r
a
t
t
e
n
d
e
d
p
r
i
mar
y
s
c
h
o
o
l
b
u
t
d
i
d
n
o
t
g
r
a
d
u
a
t
e
5
3
.
3
3
P
r
i
mary
sc
h
o
o
l
43
2
8
.
6
7
Ju
n
i
o
r
h
i
g
h
sc
h
o
o
l
28
1
8
.
6
7
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
43
2
8
.
6
7
C
o
l
l
e
g
e
/
u
n
i
v
e
r
si
t
y
31
2
0
.
6
7
M
a
r
i
t
a
l
s
t
a
t
u
s
S
i
n
g
l
e
/
n
e
v
e
r
m
a
r
r
i
e
d
5
3
.
3
3
M
a
r
r
i
e
d
43
5
6
.
6
7
W
i
d
o
w
e
d
28
4
0
.
0
T
ab
le
2
.
C
lin
ical
an
d
h
ea
lth
b
e
h
av
io
r
c
h
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
(
n
=
1
5
0
)
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
n
%
S
mo
k
i
n
g
h
i
st
o
r
y
N
e
v
e
r
1
0
1
6
7
.
3
F
o
r
mer,
b
u
t
q
u
i
t
33
2
2
.
0
C
u
r
r
e
n
t
l
y
sm
o
k
i
n
g
16
1
0
.
7
A
l
c
o
h
o
l
c
o
n
s
u
m
p
t
i
o
n
h
i
st
o
r
y
N
e
v
e
r
1
3
7
9
1
.
3
F
o
r
mer,
b
u
t
q
u
i
t
10
6
.
7
C
u
r
r
e
n
t
l
y
d
r
i
n
k
i
n
g
3
2
.
0
R
o
u
t
i
n
e
d
a
i
l
y
a
c
t
i
v
i
t
y
W
o
r
k
i
n
g
9
6
.
0
S
c
h
o
o
l
1
0
.
7
H
o
u
s
e
h
o
l
d
c
h
o
r
e
s
1
0
5
7
0
.
0
O
t
h
e
r
35
2
3
.
3
Ty
p
e
o
f
e
x
e
r
c
i
s
e
N
e
v
e
r
11
7
.
3
W
a
l
k
i
n
g
1
0
7
7
1
.
3
R
u
n
n
i
n
g
3
2
.
0
G
y
mn
a
st
i
c
s
/
e
x
e
r
c
i
se
c
l
a
ss
25
1
6
.
7
C
y
c
l
i
n
g
4
2
.
7
R
e
g
u
l
a
r
d
i
e
t
Y
e
s
59
3
9
.
3
No
90
6
0
.
0
R
e
g
u
l
a
r
c
h
e
c
k
-
up
Y
e
s
1
3
3
8
8
.
7
No
17
1
1
.
3
F
o
o
t
c
o
m
p
l
a
i
n
t
s
(
n
u
m
b
n
e
ss/
p
a
i
n
/
t
i
n
g
l
i
n
g
)
Y
e
s
1
0
2
6
8
.
0
No
48
3
2
.
0
H
i
st
o
r
y
o
f
d
i
a
b
e
t
e
s e
d
u
c
a
t
i
o
n
Y
e
s
97
6
4
.
7
No
53
3
5
.
3
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
A
s
s
o
cia
tio
n
b
etw
ee
n
ed
u
ca
tio
n
a
l le
ve
l a
n
d
d
ia
b
etes
kn
o
w
led
g
e
a
mo
n
g
…
(
C
itr
a
Win
d
a
n
i
Ma
mb
a
n
g
S
a
r
i
)
373
T
ab
le
3
.
Ass
o
ciatio
n
b
etwe
en
ed
u
ca
tio
n
lev
el
a
n
d
d
iab
etes k
n
o
wled
g
e
am
o
n
g
th
e
eld
er
ly
(
n
=
1
5
0
)
Ed
u
c
a
t
i
o
n
l
e
v
e
l
P
o
o
r
k
n
o
w
l
e
d
g
e
G
o
o
d
k
n
o
w
l
e
d
g
e
To
t
a
l
(
n
)
p
-
v
a
l
u
e
n
%
n
%
Ev
e
r
a
t
t
e
n
d
e
d
p
r
i
mar
y
s
c
h
o
o
l
4
8
0
.
0
1
2
0
.
0
5
<
0
.
0
0
1
P
r
i
mary
sc
h
o
o
l
30
6
9
.
8
13
3
0
.
2
43
Ju
n
i
o
r
h
i
g
h
sc
h
o
o
l
18
6
4
.
3
10
3
5
.
7
28
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
16
3
7
.
2
27
6
2
.
8
43
C
o
l
l
e
g
e
/
u
n
i
v
e
r
si
t
y
8
2
5
.
8
23
7
4
.
2
31
To
t
a
l
76
5
0
.
7
74
4
9
.
3
1
5
0
3
.
2
.
Dis
cus
s
io
n
T
h
is
s
tu
d
y
r
ev
ea
led
a
s
tatis
tically
s
ig
n
if
ican
t
co
r
r
elatio
n
b
etwe
en
ed
u
ca
tio
n
al
attain
m
en
t
an
d
d
iab
etes
k
n
o
wled
g
e
am
o
n
g
o
l
d
er
p
er
s
o
n
s
with
ty
p
e
2
d
iab
et
es
m
ellitu
s
in
B
an
d
u
n
g
C
ity
.
E
ld
er
ly
in
d
iv
i
d
u
als
with
g
r
ea
ter
ed
u
c
atio
n
al
lev
els
ex
h
ib
ited
s
u
p
er
io
r
u
n
d
e
r
s
tan
d
in
g
of
d
iab
etes,
wh
ile
th
o
s
e
with
less
er
ed
u
ca
tio
n
al
attain
m
e
n
t
d
em
o
n
s
tr
ated
in
f
er
io
r
k
n
o
wled
g
e
.
T
h
e
C
h
i
-
s
q
u
ar
e
an
aly
s
is
r
ev
ea
led
a
s
ig
n
if
ican
t
ass
o
ciatio
n
(
p
<
0
.
0
0
1
)
,
d
e
m
o
n
s
tr
atin
g
th
at
f
o
r
m
al
e
d
u
ca
t
io
n
s
ig
n
if
ican
tly
i
n
f
lu
en
ce
s
d
iab
etes
k
n
o
wled
g
e
a
m
o
n
g
o
ld
er
p
er
s
o
n
s
.
T
h
e
d
is
co
v
e
r
y
alig
n
s
with
th
e
th
eo
r
etica
l
p
r
em
is
e
th
at
e
d
u
c
atio
n
af
f
ec
ts
a
n
in
d
iv
id
u
al'
s
ca
p
ac
ity
to
ac
q
u
ir
e,
a
n
aly
ze
,
a
n
d
c
o
m
p
r
eh
en
d
ess
en
tial
h
ea
lth
i
n
f
o
r
m
atio
n
n
ec
ess
ar
y
f
o
r
m
ak
in
g
in
f
o
r
m
ed
h
ea
lt
h
d
ec
is
io
n
s
[
6
]
,
[
7
]
.
Prio
r
r
esear
ch
in
d
icate
s
th
at
in
d
iv
id
u
als
with
elev
ated
ed
u
ca
tio
n
lev
els
an
d
h
ea
lth
liter
ac
y
p
o
s
s
ess
s
u
p
er
io
r
ca
p
ab
ilit
ies
in
in
ter
p
r
etin
g
p
h
y
s
ician
d
i
r
e
ctiv
es,
co
m
p
r
e
h
en
d
in
g
lab
o
r
a
to
r
y
f
i
n
d
in
g
s
,
a
n
d
ex
ec
u
tin
g
a
d
v
is
ed
life
s
ty
le
m
o
d
if
icatio
n
s
,
s
u
ch
as
d
ietar
y
ad
ju
s
tm
en
ts
,
p
h
y
s
ical
ex
er
cis
e,
an
d
a
d
h
er
e
n
ce
to
p
r
escr
ip
tio
n
r
eg
im
en
s
[
6
]
-
[
1
0
]
.
I
n
o
ld
er
p
er
s
o
n
s
,
in
ad
e
q
u
ate
h
ea
lth
liter
ac
y
a
n
d
in
s
u
f
f
icien
t
k
n
o
wled
g
e
co
r
r
elate
with
ad
v
er
s
e
clin
ica
l
o
u
tco
m
es
an
d
a
n
in
cr
ea
s
ed
r
is
k
o
f
p
r
o
b
lem
s
[
9
]
,
[
2
6
]
.
T
h
e
cu
r
r
e
n
t
r
esu
lts
co
r
r
o
b
o
r
a
te
ex
is
tin
g
f
i
n
d
in
g
s
,
in
d
icatin
g
th
at
ed
u
ca
tio
n
al
at
tain
m
en
t
is
a
cr
u
cial
f
ac
to
r
in
f
lu
en
cin
g
d
iab
etes
awa
r
en
ess
in
later
life
.
T
h
e
f
in
d
i
n
g
s
o
f
th
is
s
tu
d
y
a
lig
n
with
r
esear
ch
c
o
n
d
u
cted
in
o
th
er
Asi
an
n
atio
n
s
.
I
n
Vietn
am
,
Ng
u
y
en
et
a
l.
[
1
1
]
f
o
u
n
d
th
at
s
en
io
r
o
u
tp
atien
ts
with
ty
p
e
2
d
iab
etes m
ellitu
s
h
ad
o
n
ly
m
o
d
est k
n
o
wled
g
e
a
n
d
p
r
ac
tices,
with
lo
wer
ed
u
ca
tio
n
al
attain
m
en
t
ad
v
er
s
ely
co
r
r
elate
d
with
d
iab
etes
k
n
o
wled
g
e
.
On
g
-
Ar
tb
o
r
ir
ak
et
a
l.
[
2
7
]
s
h
o
wed
t
h
at
in
T
h
ai
c
o
m
m
u
n
ities
,
h
ea
lth
liter
ac
y
,
s
elf
-
ef
f
i
ca
cy
,
an
d
s
elf
-
ca
r
e
b
eh
av
io
r
s
am
o
n
g
o
ld
er
p
e
r
s
o
n
s
with
ty
p
e
2
d
iab
etes
m
elli
tu
s
wer
e
in
ter
co
n
n
ec
ted
an
d
s
ig
n
if
ican
tly
im
p
ac
ted
g
ly
ce
m
ic
co
n
tr
o
l.
R
ec
en
t
r
esear
ch
f
r
o
m
E
g
y
p
t
an
d
o
th
er
co
n
tex
ts
r
ev
ea
ls
th
at
o
ld
er
p
e
r
s
o
n
s
with
r
estricte
d
h
ea
lth
liter
ac
y
an
d
in
s
u
f
f
icie
n
t
k
n
o
wled
g
e
ar
e
m
o
r
e
p
r
o
n
e
to
ex
h
ib
it
in
a
d
eq
u
ate
s
elf
-
ca
r
e
b
eh
av
i
o
r
s
an
d
in
f
er
io
r
o
u
tco
m
es
[
8
]
,
[
9
]
,
[
1
3
]
.
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
s
ig
n
if
ican
ce
o
f
tailo
r
e
d
ed
u
ca
tio
n
al
an
d
h
ea
lt
h
liter
ac
y
in
itiativ
es f
o
r
eld
er
ly
in
d
iv
id
u
als with
d
iab
etes.
I
n
I
n
d
o
n
esia,
d
iab
etes
am
o
n
g
o
ld
er
ad
u
lts
is
a
s
ig
n
if
ica
n
t
p
u
b
lic
h
ea
lth
is
s
u
e
d
u
e
t
o
its
r
is
in
g
p
r
ev
alen
ce
an
d
th
e
n
u
m
er
o
u
s
r
is
k
f
ac
to
r
s
en
c
o
u
n
ter
e
d
b
y
th
e
a
g
ed
.
N
u
m
er
o
u
s
s
tu
d
ie
s
h
av
e
in
v
esti
g
ated
k
n
o
wled
g
e,
p
r
e
v
en
tiv
e
b
eh
av
io
r
s
,
an
d
s
elf
-
m
an
ag
em
e
n
t
ac
r
o
s
s
v
ar
i
o
u
s
ag
e
d
em
o
g
r
a
p
h
i
cs.
Ku
r
n
iawa
n
a
n
d
Yu
d
ian
to
[
2
5
]
in
d
icate
d
th
at
d
iab
etes
s
elf
-
m
an
ag
em
e
n
t
in
ad
u
lt
p
atien
ts
with
ty
p
e
2
d
iab
etes
m
ellitu
s
co
r
r
elate
d
with
e
d
u
ca
tio
n
a
n
d
f
am
ilial
s
u
p
p
o
r
t.
R
ian
to
et
a
l.
[
1
8
]
d
is
co
v
er
e
d
th
at
p
atien
ts
'
u
n
d
er
s
tan
d
i
n
g
an
d
p
er
ce
p
tio
n
o
f
d
ia
b
etes
m
ellitu
s
wer
e
co
r
r
elate
d
with
th
eir
a
ttit
u
d
es
to
war
d
s
d
is
ea
s
e
m
an
ag
em
en
t
in
p
r
im
ar
y
ca
r
e
en
v
ir
o
n
m
en
ts
.
A
s
tu
d
y
i
n
Sem
ar
an
g
r
ev
ea
led
t
h
at
o
ld
er
ad
u
lts
with
ty
p
e
2
d
iab
etes
m
ellitu
s
ex
h
ib
ited
d
iv
er
s
e
lev
els
o
f
k
n
o
wled
g
e
an
d
b
e
h
av
io
r
c
o
n
ce
r
n
in
g
d
ia
b
etes,
with
s
ev
er
al
in
d
iv
id
u
al
s
s
till
en
g
ag
in
g
in
s
u
b
o
p
tim
al
b
eh
av
io
r
s
.
R
esear
ch
co
n
d
u
cte
d
in
a
n
u
r
s
in
g
h
o
m
e
in
C
im
ah
i
r
e
v
ea
led
th
at
o
ld
er
p
e
r
s
o
n
s
'
u
n
d
er
s
tan
d
i
n
g
o
f
d
iab
etes m
el
litu
s
v
ar
ied
ac
co
r
d
in
g
to
a
g
e,
e
d
u
ca
tio
n
al
attain
m
en
t,
a
n
d
g
en
d
er
[
1
8
]
.
R
esear
ch
in
co
m
m
u
n
ity
co
n
te
x
ts
h
as in
d
icate
d
th
at
p
r
e
-
eld
e
r
ly
p
o
p
u
lat
io
n
s
with
elev
ated
ed
u
ca
tio
n
al
attain
m
en
t e
x
h
ib
it
s
u
p
er
io
r
k
n
o
wled
g
e
a
n
d
p
r
e
v
en
tativ
e
b
e
h
av
io
r
s
ab
o
u
t
d
iab
etes
m
ellitu
s
(
DM
)
[
1
9
]
.
No
n
eth
eless
,
n
o
t
all
r
esear
ch
h
as
id
en
tifie
d
a
s
u
b
s
tan
tial
co
r
r
elatio
n
b
etwe
en
ed
u
ca
tio
n
al
attain
m
en
t
a
n
d
d
iab
etes
k
n
o
wled
g
e.
Har
to
n
o
a
n
d
E
d
iy
o
n
o
[
1
7
]
,
o
p
er
atin
g
in
a
p
r
im
a
r
y
ca
r
e
e
n
v
ir
o
n
m
en
t
i
n
W
est
Kalim
an
tan
,
in
d
icate
d
th
a
t
ed
u
ca
tio
n
al
attain
m
en
t
d
id
n
o
t
s
ig
n
if
ican
tly
co
r
r
elate
w
ith
k
n
o
wled
g
e
o
f
th
e
f
iv
e
p
illar
s
o
f
d
iab
etes
m
an
ag
em
en
t,
alth
o
u
g
h
th
e
d
u
r
atio
n
o
f
illn
ess
was
s
ig
n
if
ican
tly
lin
k
ed
to
k
n
o
wled
g
e
.
T
h
ese
v
ar
iatio
n
s
in
d
icate
th
at
alth
o
u
g
h
ed
u
ca
ti
o
n
is
s
ig
n
if
ican
t,
its
in
f
l
u
en
ce
o
n
k
n
o
wled
g
e
m
ay
b
e
m
o
d
er
a
ted
b
y
f
ac
to
r
s
s
u
ch
as e
x
p
o
s
u
r
e
to
h
ea
lth
ed
u
ca
tio
n
,
d
is
ea
s
e
d
u
r
atio
n
,
s
o
cial
m
ilieu
,
an
d
th
e
s
tr
u
ctu
r
e
o
f
p
r
im
ar
y
ca
r
e
f
ac
ilit
ies.
T
h
is
s
tu
d
y
co
n
tr
ib
u
tes
to
th
e
e
x
is
tin
g
ev
id
en
ce
b
y
co
n
ce
n
tr
at
in
g
o
n
el
d
er
ly
in
d
iv
id
u
als
with
d
iab
etes
in
an
u
r
b
an
I
n
d
o
n
esian
co
n
tex
t.
T
h
e
co
r
r
elatio
n
b
etwe
en
e
d
u
ca
tio
n
lev
el
an
d
d
iab
etes
awa
r
en
ess
s
u
g
g
ests
th
at
o
ld
er
p
e
r
s
o
n
s
with
lo
wer
ed
u
ca
tio
n
al
attain
m
en
t
m
a
y
n
e
ce
s
s
itate
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
an
d
cu
s
to
m
ized
ed
u
ca
tio
n
al
ass
is
tan
ce
.
Ho
wev
er
,
lim
ited
f
o
r
m
al
e
d
u
ca
tio
n
d
o
es
n
o
t
in
h
er
e
n
tly
p
r
ev
en
t
o
ld
er
p
e
r
s
o
n
s
f
r
o
m
co
m
p
r
eh
e
n
d
in
g
d
iab
etic
i
n
f
o
r
m
atio
n
.
R
esear
ch
in
I
n
d
o
n
esia
h
as
d
em
o
n
s
tr
ated
t
h
at
o
r
g
a
n
ized
a
n
d
co
n
tex
tu
ally
r
elev
an
t
e
d
u
ca
tio
n
ca
n
e
n
h
an
ce
k
n
o
wled
g
e
a
n
d
s
elf
-
m
an
ag
em
e
n
t
b
eh
a
v
io
r
s
,
ev
en
in
i
n
d
iv
id
u
als
with
lo
wer
ed
u
ca
tio
n
al
attain
m
en
t
[
2
4
]
,
[
2
5
]
.
Gr
o
up
-
b
ased
d
iab
etes
s
elf
-
m
an
ag
em
en
t
ed
u
ca
tio
n
(
DSME
)
f
o
r
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
.
2
,
J
u
n
e
20
26
:
37
0
-
37
7
374
o
ld
er
p
er
s
o
n
s
h
as
b
ee
n
s
h
o
wn
to
im
p
r
o
v
e
s
elf
-
ca
r
e
p
r
ac
tice
s
,
en
co
m
p
ass
in
g
f
o
o
d
,
p
h
y
s
ical
ac
tiv
ity
,
a
n
d
f
o
o
t
ca
r
e
[
2
4
]
.
C
h
an
g
es
i
n
s
elf
-
ca
r
e
b
e
h
av
io
r
s
we
r
e
r
ec
o
r
d
e
d
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
an
d
e
m
ic
,
s
u
b
s
eq
u
e
n
t
t
o
f
o
cu
s
ed
tr
ea
tm
en
ts
in
p
r
im
ar
y
ca
r
e
[
2
5
]
.
Dig
ital
ed
u
ca
tio
n
a
n
d
co
u
n
s
elin
g
h
av
e
b
ee
n
s
h
o
wn
to
en
h
a
n
ce
s
elf
-
ca
r
e
b
eh
av
io
r
s
an
d
tr
ea
tm
e
n
t
ad
h
er
en
ce
in
in
d
i
v
id
u
als
with
ty
p
e
2
d
iab
etes
m
ellitu
s
[
2
8
]
.
A
s
y
s
tem
atic
s
tu
d
y
d
eter
m
in
ed
th
at
e
d
u
ca
tio
n
al
i
n
ter
v
en
tio
n
s
s
ig
n
if
ican
tly
en
h
an
ce
s
elf
-
ca
r
e
m
an
a
g
em
en
t
i
n
d
iab
etes
m
ellitu
s
,
p
ar
ticu
lar
ly
wh
e
n
tailo
r
ed
t
o
p
atien
ts
'
liter
ac
y
lev
els an
d
s
o
cio
-
cu
ltu
r
al
c
o
n
tex
ts
[
2
9
]
.
Self
-
ca
r
e
m
an
ag
em
e
n
t
in
o
ld
e
r
p
er
s
o
n
s
with
d
iab
etes
m
ellitu
s
is
f
u
r
th
er
co
m
p
licated
b
y
f
u
n
cti
o
n
al
lim
its
,
v
ar
io
u
s
co
m
o
r
b
id
ities
,
an
d
en
v
i
r
o
n
m
e
n
tal
in
f
lu
e
n
ce
s
.
R
esear
ch
in
r
em
o
te
r
e
g
io
n
s
in
d
icate
s
th
at
eld
er
ly
in
d
iv
id
u
als
m
a
y
en
c
o
u
n
ter
s
u
p
p
lem
en
tar
y
o
b
s
tacle
s
to
s
elf
-
ca
r
e,
s
u
ch
as
r
estricte
d
ac
ce
s
s
to
h
ea
lth
ca
r
e
f
ac
ilit
ies,
elev
ated
tr
an
s
p
o
r
tatio
n
ex
p
en
s
es,
an
d
d
im
in
is
h
ed
o
p
p
o
r
tu
n
ities
f
o
r
o
r
g
a
n
iz
ed
in
s
tr
u
ctio
n
[
3
0
]
.
Stu
d
ies
co
n
d
u
cte
d
in
I
r
a
n
a
n
d
E
u
r
o
p
e
in
d
icate
a
s
u
b
s
t
an
tial
co
r
r
elatio
n
b
etwe
en
f
u
n
ctio
n
al
ca
p
ac
ity
,
m
ed
icatio
n
ad
h
er
en
ce
,
s
elf
-
c
ar
e
b
eh
a
v
io
r
s
,
an
d
g
ly
ce
m
ic
co
n
tr
o
l
i
n
o
ld
e
r
p
e
r
s
o
n
s
wit
h
ty
p
e
2
d
iab
etes
m
ellitu
s
.
Gu
p
ta
et
a
l.
[
3
0
]
i
d
en
tifie
d
th
at
in
r
u
r
al
I
n
d
ia,
p
atien
ts
an
d
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
r
eg
ar
d
ed
ec
o
n
o
m
ic
lim
itatio
n
s
,
d
is
tan
c
e
to
m
ed
ical
f
ac
ilit
ies,
an
d
a
d
ef
icien
t
h
ea
lth
s
taf
f
as
s
ig
n
if
ican
t
o
b
s
tacle
s
to
ef
f
ec
tiv
e
s
elf
-
ca
r
e.
R
esear
ch
f
r
o
m
B
an
g
lad
esh
an
d
C
an
ad
a
d
em
o
n
s
tr
ates
th
at
s
o
cio
ec
o
n
o
m
ic
p
o
s
itio
n
s
ig
n
if
ican
tly
m
ed
iates
th
e
r
el
atio
n
s
h
ip
b
etwe
en
h
ea
lth
liter
ac
y
,
s
elf
-
ca
r
e,
an
d
g
ly
ca
em
ic
m
an
ag
e
m
en
t
[
3
1
]
,
[
3
2
]
.
T
h
ese
d
ata
in
d
icate
th
a
t
ed
u
ca
tio
n
-
f
o
c
u
s
ed
tr
ea
tm
en
t
s
s
h
o
u
ld
b
e
s
u
p
p
lem
en
ted
w
ith
co
m
p
r
eh
en
s
iv
e
in
itiativ
es
th
at
tack
le
s
tr
u
ctu
r
a
l
an
d
s
o
cio
ec
o
n
o
m
ic
o
b
s
tacle
s
,
p
ar
ticu
la
r
ly
f
o
r
lo
w
-
in
c
o
m
e
eld
er
ly
in
d
iv
id
u
als.
I
n
I
n
d
o
n
esia,
o
n
e
s
tu
d
y
d
em
o
n
s
tr
ates
th
at
s
tr
u
ctu
r
ed
ed
u
ca
t
io
n
s
ig
n
if
ican
tly
im
p
r
o
v
es
b
o
th
k
n
o
wled
g
e
an
d
s
elf
-
ca
r
e
b
eh
av
i
o
r
s
,
em
p
h
asizin
g
th
at
ed
u
ca
tio
n
al
f
o
r
m
at
an
d
s
u
p
p
o
r
t m
atter
[
3
3
]
.
Fam
i
lia
l
s
u
p
p
o
r
t
is
a
v
it
al
e
le
m
e
n
t
f
o
r
el
d
e
r
l
y
i
n
d
i
v
i
d
u
als
m
a
n
a
g
i
n
g
c
h
r
o
n
ic
i
ll
n
ess
es.
R
esea
r
c
h
i
n
I
n
d
o
n
esi
a
h
as
d
em
o
n
s
t
r
at
ed
t
h
at
t
h
e
k
n
o
wle
d
g
e
an
d
e
n
g
a
g
em
e
n
t
o
f
f
a
m
i
ly
m
e
m
b
er
s
co
r
r
el
ate
w
it
h
p
ati
en
ts
'
s
elf
-
m
a
n
a
g
e
m
e
n
t
a
n
d
q
u
a
lit
y
o
f
lif
e
[
3
4
]
.
A
r
e
ce
n
t
c
o
m
p
r
e
h
e
n
s
i
v
e
r
e
v
i
ew
d
ete
r
m
i
n
e
d
th
at
f
am
ili
al
p
a
r
ti
ci
p
at
io
n
ca
n
e
n
h
a
n
c
e
a
d
h
er
en
ce
t
o
d
ia
b
eti
c
s
el
f
-
m
an
ag
em
e
n
t
m
e
th
o
d
s
,
e
n
c
o
m
p
ass
i
n
g
n
u
t
r
i
ti
o
n
,
p
h
y
s
i
ca
l
ex
er
cise
,
an
d
m
ed
ica
ti
o
n
c
o
m
p
l
ia
n
c
e
[
3
5
]
.
Q
u
a
lit
ati
v
e
r
esea
r
c
h
f
r
o
m
C
h
i
n
a
a
n
d
o
t
h
e
r
co
n
t
e
x
ts
h
as
d
e
m
o
n
s
tr
ate
d
t
h
a
t
f
am
i
ly
d
y
n
a
m
ics
,
p
s
y
c
h
o
lo
g
i
ca
l
f
a
ct
o
r
s
,
a
n
d
s
el
f
-
p
e
r
c
ei
v
e
d
l
o
a
d
s
u
b
s
ta
n
ti
all
y
a
f
f
e
ct
lo
n
el
in
ess
a
n
d
s
e
lf
-
c
a
r
e
e
x
p
e
r
i
en
ce
s
i
n
o
l
d
e
r
p
e
r
s
o
n
s
wit
h
t
y
p
e
2
d
i
ab
etes
m
el
lit
u
s
[
3
6
]
,
[
3
7
]
.
T
h
es
e
f
i
n
d
i
n
g
s
h
i
g
h
li
g
h
t
t
h
e
n
e
ed
t
o
i
n
c
o
r
p
o
r
at
e
a
f
am
il
y
-
ce
n
t
er
ed
a
p
p
r
o
a
ch
i
n
t
o
d
i
ab
etes
e
d
u
ca
ti
o
n
p
r
o
g
r
a
m
s
f
o
r
o
ld
e
r
in
d
i
v
i
d
u
als
.
T
h
e
co
m
b
in
ed
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
an
d
p
r
io
r
s
tu
d
ies
in
d
icate
m
u
ltip
le
im
p
licatio
n
s
f
o
r
n
u
r
s
in
g
p
r
ac
tice
an
d
p
r
im
ar
y
h
ea
lth
ca
r
e.
Old
er
p
er
s
o
n
s
with
litt
le
ed
u
ca
tio
n
s
h
o
u
ld
b
e
p
r
io
r
itized
f
o
r
d
iab
etes
ed
u
ca
tio
n
.
E
d
u
ca
tio
n
al
m
ater
ials
m
u
s
t
em
p
lo
y
ac
ce
s
s
ib
le
lan
g
u
ag
e,
v
is
u
al
aid
s
,
an
d
cu
ltu
r
ally
p
er
tin
en
t
ex
am
p
les
to
ad
d
r
ess
liter
ac
y
an
d
s
en
s
o
r
y
co
n
s
tr
ain
ts
.
Seco
n
d
ly
,
DSME
o
u
g
h
t
to
b
e
in
clu
d
ed
in
cu
r
r
en
t
ch
r
o
n
ic
illn
ess
p
r
o
g
r
am
s
f
o
r
o
ld
er
p
er
s
o
n
s
with
in
p
r
im
ar
y
ca
r
e
en
v
ir
o
n
m
e
n
ts
,
u
tili
zin
g
g
r
o
u
p
-
b
ased
an
d
in
ter
ac
tiv
e
ap
p
r
o
ac
h
es
th
at
h
av
e
d
em
o
n
s
tr
ated
ef
f
icac
y
[
2
9
]
,
[
3
8
]
.
T
h
ir
d
,
f
am
ily
m
em
b
er
s
an
d
ca
r
eg
iv
e
r
s
o
u
g
h
t
to
e
n
g
ag
e
ac
tiv
ely
in
e
d
u
ca
tio
n
al
ac
tiv
ities
to
p
r
o
v
i
d
e
s
u
p
p
o
r
t
f
o
r
e
v
er
y
d
ay
s
elf
-
ca
r
e
at
h
o
m
e
[
3
5
]
.
Fo
u
r
,
b
ased
o
n
o
u
r
r
esear
ch
ab
o
u
t
t
h
e
e
v
alu
atio
n
p
r
o
g
r
am
in
I
n
d
o
n
esia,
o
ld
er
ad
u
lts
n
ee
d
in
ter
v
en
tio
n
t
o
en
h
an
ce
th
eir
k
n
o
wled
g
e
,
s
u
c
h
as
co
n
tin
u
ity
o
f
ca
r
e
[
3
9
]
,
[
4
0
]
.
Fu
t
u
r
e
r
esear
ch
s
h
o
u
ld
u
tili
ze
lo
n
g
itu
d
in
al
d
esig
n
s
to
in
v
esti
g
ate
h
o
w
e
d
u
ca
tio
n
lev
el
an
d
c
u
s
to
m
ize
d
co
n
tin
u
ity
o
f
ca
r
e
p
r
o
g
r
am
s
af
f
ec
t
ch
an
g
es
in
k
n
o
wled
g
e,
s
elf
-
ca
r
e
b
e
h
av
io
r
s
,
an
d
g
ly
ce
m
ic
co
n
tr
o
l
o
v
er
t
im
e,
wh
ile
also
ex
am
in
i
n
g
th
e
m
ed
iatin
g
r
o
les
o
f
s
o
cio
ec
o
n
o
m
ic
p
o
s
itio
n
,
f
am
il
y
s
u
p
p
o
r
t,
an
d
h
ea
lth
liter
ac
y
.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
s
h
o
wed
a
s
ig
n
if
ica
n
t
ass
o
ciatio
n
b
etwe
en
ed
u
ca
ti
o
n
lev
el
an
d
d
iab
etes
k
n
o
wled
g
e
am
o
n
g
th
e
eld
er
ly
in
B
an
d
u
n
g
C
ity
.
Old
er
ad
u
lts
with
h
ig
h
er
ed
u
c
atio
n
al
attain
m
en
t
wer
e
m
o
r
e
lik
ely
to
h
av
e
g
o
o
d
k
n
o
wled
g
e
a
b
o
u
t
d
iab
etes
an
d
its
m
an
ag
em
en
t,
wh
er
ea
s
t
h
o
s
e
with
lo
wer
ed
u
ca
tio
n
te
n
d
ed
to
h
av
e
p
o
o
r
er
k
n
o
wled
g
e.
T
h
ese
f
in
d
in
g
s
u
n
d
er
lin
e
th
e
im
p
o
r
ta
n
ce
o
f
p
r
o
v
id
in
g
s
tr
u
ctu
r
ed
an
d
s
im
p
le
d
iab
etes
ed
u
ca
tio
n
tailo
r
ed
to
th
e
n
ee
d
s
o
f
t
h
e
el
d
er
ly
with
lo
w
ed
u
ca
tio
n
,
i
n
v
o
lv
in
g
f
a
m
ily
m
em
b
e
r
s
an
d
p
r
im
ar
y
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
.
Stre
n
g
th
e
n
in
g
h
ea
lt
h
ed
u
ca
tio
n
p
r
o
g
r
am
s
f
o
r
o
ld
er
ad
u
lts
is
ex
p
ec
ted
,
wh
ich
i
s
co
n
tin
u
ity
o
f
ca
r
e
o
f
th
e
el
d
er
ly
with
d
iab
etes
,
t
o
im
p
r
o
v
e
d
iab
etes
s
elf
-
m
an
a
g
em
en
t
an
d
co
n
tr
ib
u
te
t
o
b
ett
er
g
ly
ce
m
ic
c
o
n
tr
o
l
an
d
p
r
e
v
en
tio
n
o
f
f
u
tu
r
e
co
m
p
licatio
n
s
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
ap
p
r
ec
iated
all
r
esp
o
n
d
en
ts
an
d
th
e
U
n
iv
er
s
itas
Pad
jad
jar
an
,
B
an
d
u
n
g
,
W
est
J
av
a
,
I
n
d
o
n
esia,
f
o
r
s
u
p
p
o
r
tin
g
an
d
f
ac
ilit
atin
g
th
e
d
atab
ase
s
ea
r
c
h
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
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8
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6
A
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