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I
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Sci
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14
,
No
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3
,
Sep
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b
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20
25
:
1
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1130
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d
er
a
g
e
[
5
]
.
A
d
d
i
t
i
o
n
a
l
l
y
,
d
e
p
r
es
s
io
n
i
n
o
l
d
e
r
a
g
e
i
s
e
it
h
e
r
a
p
r
o
d
r
o
m
a
l
o
r
r
i
s
k
f
a
c
t
o
r
f
o
r
l
at
e
r
d
em
e
n
t
i
a
[
6
]
.
Dep
r
ess
io
n
is
f
r
eq
u
en
tly
lin
k
ed
with
c
o
g
n
itiv
e
d
ef
icit
s
,
wh
ich
ca
n
c
o
m
p
licate
t
h
e
clin
ical
m
an
ag
em
en
t
o
f
eld
er
ly
p
atien
ts
s
u
f
f
er
in
g
f
r
o
m
th
is
co
n
d
itio
n
.
Desp
ite
th
is
well
-
estab
lis
h
ed
ass
o
ciatio
n
,
th
er
e
is
lim
ited
k
n
o
wled
g
e
r
e
g
ar
d
in
g
th
e
p
r
ev
alen
ce
an
d
co
n
tr
ib
u
t
in
g
f
ac
to
r
s
o
f
co
g
n
itiv
e
im
p
ai
r
m
en
t
am
o
n
g
o
ld
er
ad
u
lts
with
d
ep
r
ess
io
n
in
Ma
lay
s
ia.
T
h
is
s
tu
d
y
aim
ed
to
f
ill
th
at
g
ap
b
y
ex
p
lo
r
in
g
t
h
e
f
ac
to
r
s
th
at
in
f
lu
en
ce
co
g
n
itiv
e
im
p
air
m
e
n
t
in
th
is
p
o
p
u
latio
n
.
Sp
ec
if
icall
y
,
it
is
h
y
p
o
th
esized
th
at
p
h
y
s
ical
ly
in
ac
tiv
e
eld
er
ly
in
d
iv
id
u
als
with
d
ep
r
ess
io
n
a
r
e
at
g
r
ea
ter
r
is
k
o
f
co
g
n
itiv
e
d
ec
lin
e,
an
d
th
o
s
e
with
lo
wer
lev
els
o
f
s
o
cial
s
u
p
p
o
r
t a
r
e
also
m
o
r
e
lik
el
y
to
ex
p
er
ien
ce
c
o
g
n
itiv
e
im
p
air
m
en
t.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
u
s
ed
d
at
a
s
et
o
n
th
e
h
ea
lth
o
f
o
ld
er
ad
u
lts
f
r
o
m
th
e
n
atio
n
wid
e
Natio
n
al
H
ea
lth
an
d
Mo
r
b
id
ity
Su
r
v
ey
2
0
1
8
(
NHM
S
2
0
1
8
)
co
n
d
u
cted
b
y
th
e
I
n
s
titu
te
f
o
r
Pu
b
lic
Hea
lth
,
N
atio
n
al
I
n
s
titu
tes
o
f
Hea
lth
,
Min
is
tr
y
o
f
Hea
lth
,
Ma
lay
s
ia.
T
h
e
NHM
S
2
0
1
8
was
a
n
atio
n
ally
r
ep
r
esen
tativ
e
h
ea
lth
s
u
r
v
ey
f
o
r
o
ld
er
p
o
p
u
latio
n
s
ag
ed
5
0
y
e
ar
s
an
d
ab
o
v
e
in
Ma
lay
s
ia.
I
t
was
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
u
s
in
g
a
two
-
s
tag
e
s
tr
atif
ied
clu
s
ter
s
am
p
lin
g
d
e
s
ig
n
.
T
h
e
f
ir
s
t
s
tag
e
was
th
e
en
u
m
er
atio
n
b
lo
ck
(
E
B
)
,
an
d
th
e
s
ec
o
n
d
s
tag
e
s
am
p
lin
g
u
n
it
was
th
e
liv
in
g
q
u
ar
ter
s
(
L
Q)
.
T
h
ese
E
B
s
co
n
s
titu
ted
th
e
s
am
p
lin
g
f
r
a
m
e
f
o
r
th
e
NHM
S
2
0
1
8
.
T
h
e
E
B
s
wer
e
s
elec
ted
in
d
ep
en
d
en
tly
f
r
o
m
1
3
s
tates
an
d
t
h
r
ee
f
e
d
er
al
ter
r
ito
r
ies
in
Ma
lay
s
ia
(
as
p
r
im
ar
y
s
tr
atu
m
)
an
d
with
in
u
r
b
an
o
r
r
u
r
al
ar
ea
s
(
as
s
ec
o
n
d
ar
y
s
tr
atu
m
)
.
T
h
e
Dep
a
r
tm
en
t
o
f
Statis
tics
,
Ma
lay
s
ia,
co
n
d
u
cte
d
a
s
elec
tio
n
o
f
s
am
p
les,
with
6
0
E
B
s
in
th
e
u
r
b
an
ar
e
as
an
d
5
0
E
B
s
in
th
e
r
u
r
al
ar
ea
s
.
T
h
e
allo
ca
tio
n
o
f
s
am
p
les
to
th
e
s
tate
an
d
s
tr
ata
was
d
o
n
e
p
r
o
p
o
r
tio
n
ally
to
th
e
p
o
p
u
la
tio
n
s
ize.
E
lig
ib
le
r
esp
o
n
d
en
ts
wer
e
th
o
s
e
s
tay
in
g
in
th
e
s
elec
ted
L
Q
f
o
r
th
e
p
ast
two
wee
k
s
,
ag
ed
m
o
r
e
th
an
5
0
y
ea
r
s
,
an
d
a
b
le
to
co
m
m
u
n
icate
o
n
th
eir
o
wn
o
r
th
r
o
u
g
h
a
p
r
o
x
y
.
T
h
e
d
etailed
s
am
p
lin
g
m
eth
o
d
s
o
f
NH
MS
2
0
1
8
h
a
v
e
b
ee
n
d
escr
ib
ed
in
th
e
m
eth
o
d
o
lo
g
y
an
d
g
e
n
er
al
f
in
d
in
g
s
r
ep
o
r
t
[
7
]
.
C
o
g
n
itiv
e
im
p
air
m
en
t
s
tatu
s
a
m
o
n
g
d
ep
r
ess
ed
eld
er
ly
was
th
e
o
u
tco
m
e
o
f
t
h
is
s
tu
d
y
.
T
h
e
co
g
n
itiv
e
s
cr
ee
n
o
f
id
en
tific
atio
n
an
d
i
n
ter
v
en
tio
n
f
o
r
d
em
en
tia
in
t
h
e
Af
r
ican
eld
er
l
y
(
I
DE
A)
h
as
b
ee
n
u
s
ed
as
a
co
g
n
itiv
e
ass
ess
m
en
t
to
o
l
to
s
cr
ee
n
f
o
r
d
em
en
tia
in
Ma
la
y
s
ia
[
8
]
,
[
9
]
.
Dep
r
ess
io
n
was
id
en
tifie
d
u
s
i
n
g
a
v
alid
ated
Ma
lay
v
e
r
s
io
n
o
f
th
e
Ger
iatr
ic
Dep
r
ess
io
n
S
ca
le
(M
-
GDS
-
1
4
)
,
with
t
h
o
s
e
wh
o
s
co
r
ed
≥
6
ca
teg
o
r
ized
as
h
av
i
n
g
d
e
p
r
es
s
io
n
.
T
h
is
s
cr
ee
n
in
g
to
o
l
h
as
b
ee
n
v
alid
ated
with
h
ig
h
s
e
n
s
itiv
ity
(
Sn
)
an
d
s
p
ec
if
icity
(
Sp
)
(
Sn
=
9
5
.
5
%,
Sp
=
8
4
.
2
%
f
o
r
clin
ic
ally
s
ig
n
if
ican
t
d
ep
r
ess
io
n
an
d
Sn
=
1
0
0
%,
Sp
=
9
2
.
0
%
f
o
r
m
ajo
r
d
ep
r
ess
io
n
)
[
1
0
]
.
T
h
e
in
d
ep
e
n
d
en
t
v
ar
iab
les
in
c
lu
d
ed
in
th
is
s
tu
d
y
wer
e
s
o
ci
o
d
em
o
g
r
ap
h
ic
v
ar
iab
les
co
m
p
r
is
in
g
ag
e
(
6
0
-
6
9
an
d
≥
7
0
y
ea
r
s
)
,
g
en
d
e
r
(
m
ale
an
d
f
em
ale)
,
eth
n
icity
(
Ma
lay
,
C
h
in
ese,
I
n
d
ian
,
B
u
m
ip
u
ter
a
Sab
ah
,
B
u
m
ip
u
ter
a
Sar
awa
k
an
d
o
th
e
r
s
)
,
ed
u
ca
tio
n
(
n
o
f
o
r
m
al
e
d
u
c
atio
n
,
p
r
im
ar
y
,
s
ec
o
n
d
ar
y
a
n
d
ter
tiar
y
ed
u
ca
tio
n
)
,
m
ar
ital
s
tatu
s
(
m
ar
r
ied
an
d
o
th
er
s
:
n
ev
er
m
ar
r
ied
/s
ep
ar
ate
d
/d
iv
o
r
ce
d
/wid
o
wed
)
,
o
cc
u
p
a
tio
n
(
p
r
iv
ate,
s
elf
-
em
p
lo
y
ed
,
r
etir
ee
,
h
o
m
em
a
k
e
r
an
d
u
n
em
p
l
o
y
ed
)
.
Facto
r
s
lik
e
p
h
y
s
ical
ac
tiv
ity
(
ac
tiv
e
an
d
in
ac
tiv
e)
an
d
s
o
cial
s
u
p
p
o
r
t
(
lo
w
-
f
air
an
d
h
ig
h
-
v
er
y
-
h
ig
h
)
wer
e
also
i
n
clu
d
ed
in
th
is
s
tu
d
y
.
Ph
y
s
ical
ac
tiv
ity
is
an
y
b
o
d
il
y
m
o
v
em
en
t
p
r
o
d
u
ce
d
b
y
s
k
e
letal
m
u
s
cles
th
at
r
eq
u
ir
es
en
er
g
y
e
x
p
en
d
itu
r
e
[
7
]
,
[
1
1
]
.
Ass
es
s
m
en
t
an
d
g
u
id
elin
es
o
f
p
h
y
s
ical
ac
tiv
ity
an
d
s
ed
en
tar
y
b
eh
av
i
o
r
a
r
e
ac
co
r
d
in
g
to
th
e
Glo
b
al
Ph
y
s
ical
Activ
ity
Qu
esti
o
n
n
air
e
(
GPAQ)
[
7
]
,
[
1
2
]
,
[
1
3
]
.
So
cial
s
u
p
p
o
r
t
is
an
ex
ch
a
n
g
e
o
f
r
eso
u
r
ce
s
b
e
twee
n
at
least
two
in
d
iv
id
u
als
p
er
ce
i
v
e
d
b
y
t
h
e
p
r
o
v
id
e
r
o
r
th
e
r
ec
ip
ien
t
to
b
e
in
ten
d
ed
t
o
en
h
a
n
ce
th
e
well
-
b
ein
g
o
f
th
e
r
ec
ip
ien
t
[
7
]
,
[
1
4
]
.
T
h
e
NHM
S
2
0
1
8
u
s
ed
Du
k
e
So
cial
Su
p
p
o
r
t
I
n
d
ex
(
DSSI)
with
11
-
i
tem
m
o
d
u
le
as
a
n
in
s
tr
u
m
en
t
to
m
ea
s
u
r
e
s
o
cial
s
u
p
p
o
r
t
in
t
h
e
eld
e
r
ly
[
7
]
,
[
1
5
]
–
[
1
7
]
.
T
h
e
DSSI
ex
am
in
es
f
o
u
r
s
ig
n
if
ican
t
d
im
en
s
io
n
s
: so
cial
n
etwo
r
k
,
s
o
cial
in
ter
ac
tio
n
,
s
u
b
jectiv
e
s
u
p
p
o
r
t,
a
n
d
in
s
tr
u
m
en
tal
s
u
p
p
o
r
t.
Descr
ip
tiv
e
s
tati
s
tics
wer
e
ap
p
lied
to
d
escr
ib
e
th
e
p
r
ev
alen
ce
o
f
s
o
cio
d
em
o
g
r
ap
h
ic
p
r
o
f
iles
,
p
h
y
s
ical
ac
tiv
ity
,
an
d
s
o
cial
s
u
p
p
o
r
t.
B
iv
ar
iate
an
aly
s
is
was
p
er
f
o
r
m
e
d
to
d
eter
m
i
n
e
th
e
ass
o
ciatio
n
b
etwe
en
co
g
n
itiv
e
im
p
air
m
en
t
s
tatu
s
an
d
ea
ch
p
o
s
s
ib
le
f
ac
to
r
u
s
in
g
a
co
m
p
le
x
s
am
p
le
lo
g
is
tic
r
eg
r
ess
io
n
.
A
ll
v
ar
iab
les
with
a
p
-
v
alu
e
less
th
an
0
.
2
5
o
r
v
ar
iab
les
with
clin
ically
s
ig
n
if
ic
an
t
v
alu
es
i
n
u
n
iv
ar
iate
an
al
y
s
is
,
an
d
v
ar
iab
les
k
n
o
wn
to
b
e
ass
o
ciate
d
with
co
g
n
itiv
e
im
p
ai
r
m
en
t
f
r
o
m
p
u
b
lis
h
ed
ar
ticles
will
b
e
i
n
c
lu
d
ed
f
u
r
th
e
r
with
m
u
ltip
le
lo
g
is
tic
an
aly
s
is
b
y
co
n
tr
o
llin
g
all
th
e
co
n
f
o
u
n
d
in
g
v
ar
iab
les.
T
h
e
r
is
k
esti
m
ati
o
n
was
ca
r
r
ied
o
u
t
u
s
in
g
th
e
o
d
d
s
r
atio
(
OR
)
an
d
9
5
%
co
n
f
id
e
n
ce
in
ter
v
als
(
C
I
)
,
an
d
th
e
p
-
v
alu
e
o
f
le
s
s
th
an
0
.
0
5
was
s
ig
n
if
ican
t.
I
n
ter
ac
tio
n
an
d
m
u
lti
-
co
llin
ea
r
ity
test
s
wer
e
ch
ec
k
ed
b
e
f
o
r
e
d
ec
is
io
n
s
wer
e
m
ad
e
o
n
th
e
f
i
n
al
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
Dep
r
ess
io
n
a
n
d
co
g
n
itive
imp
a
ir
men
t in
M
a
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ican
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3.
RE
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ically
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ip
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m
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am
o
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g
d
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eld
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ly
was
2
6
.
9
%.
I
t
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alm
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tim
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ig
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th
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ce
r
e
p
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d
in
I
r
a
n
,
9
.
5
%
[
1
9
]
.
I
t
is
also
h
ig
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er
t
h
an
7
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4
8
%
t
o
1
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g
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r
u
r
al
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r
u
r
b
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s
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in
I
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[
2
0
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,
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d
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C
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a
[
2
1
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.
T
h
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d
if
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er
e
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ce
m
a
y
b
e
b
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u
s
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ata
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tr
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r
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m
an
ex
ten
s
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e
n
atio
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wid
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s
u
r
v
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co
m
p
a
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to
p
r
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v
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u
s
s
tu
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ies
,
an
d
th
e
d
if
f
er
en
t
s
ca
les
u
s
ed
to
m
ea
s
u
r
e
co
g
n
itiv
e
im
p
air
m
en
t.
Ou
r
s
tu
d
y
s
h
o
we
d
n
o
s
ig
n
if
i
ca
n
t
ass
o
ciatio
n
s
b
etwe
en
ag
e,
g
en
d
e
r
,
m
ar
ital
s
tatu
s
,
ed
u
ca
tio
n
,
o
r
em
p
lo
y
m
e
n
t
with
co
g
n
itiv
e
im
p
air
m
en
t
in
d
ep
r
ess
ed
eld
er
ly
.
Pre
v
io
u
s
s
tu
d
ies
also
f
ailed
to
d
em
o
n
s
tr
ate
a
s
ig
n
if
ican
t
ass
o
ci
atio
n
b
et
wee
n
co
g
n
itiv
e
i
m
p
air
m
en
t
an
d
ag
e
[
2
0
]
–
[
2
2
]
,
g
e
n
d
er
,
a
n
d
m
a
r
ital
s
tatu
s
[
1
9
]
,
[
2
1
]
–
[
2
3
]
.
Mo
s
t
s
tu
d
ies
s
h
o
wed
a
s
ig
n
if
ica
n
t
ass
o
ciatio
n
b
etwe
en
l
o
w
ed
u
ca
tio
n
lev
els
a
n
d
u
n
em
p
lo
y
m
en
t.
Sti
ll,
o
u
r
r
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lt
was
s
im
ilar
to
o
th
e
r
r
esear
ch
b
y
B
o
m
f
im
et
a
l.
[
2
4
]
,
wh
ic
h
s
h
o
wed
a
lac
k
o
f
ass
o
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n
.
T
h
e
s
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ity
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e
to
m
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p
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ies d
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e
in
h
ig
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e
r
-
i
n
co
m
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c
o
u
n
tr
ies with
h
i
g
h
e
r
lev
els o
f
ed
u
ca
tio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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Sep
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20
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:
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1132
T
ab
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2
.
Facto
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C
l
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c
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3
%
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a
g
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k
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k
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R
s
q
u
a
r
e
:
9
.
3
%
3
.
1
.
So
cia
l
s
up
po
rt
a
nd
co
g
n
it
iv
e
im
pa
irm
ent
a
mo
ng
depress
iv
e
elderly
So
cial
s
u
p
p
o
r
t
h
as
b
ee
n
d
ef
i
n
ed
as
“th
e
s
u
p
p
o
r
t
ac
ce
s
s
ib
le
to
an
in
d
i
v
id
u
al
th
r
o
u
g
h
s
o
cial
ties
to
o
th
er
in
d
iv
id
u
als,
g
r
o
u
p
s
,
an
d
th
e
lar
g
e
r
co
m
m
u
n
ity
”
[
2
5
]
.
So
cial
s
u
p
p
o
r
t
h
as
b
ee
n
f
o
u
n
d
to
p
r
ed
ict
m
e
n
tal
h
ea
lth
,
h
ea
lth
-
r
elate
d
q
u
ality
o
f
life
,
an
d
d
aily
f
u
n
ctio
n
[
2
6
]
.
Ou
r
s
tu
d
y
f
o
u
n
d
th
at
th
e
d
e
p
r
ess
ed
eld
er
ly
with
lo
w
s
o
cial
s
u
p
p
o
r
t
h
a
d
alm
o
s
t
d
o
u
b
le
t
h
e
r
is
k
o
f
h
av
in
g
co
g
n
itiv
e
im
p
air
m
e
n
t
wh
en
c
o
m
p
ar
ed
to
d
ep
r
ess
ed
eld
er
ly
with
h
ig
h
s
o
cial
s
u
p
p
o
r
t.
T
h
er
e
is
in
cr
ea
s
in
g
e
v
id
e
n
ce
s
h
o
win
g
th
e
p
r
o
tectiv
e
r
o
le
o
f
s
o
cial
s
u
p
p
o
r
t
ag
ain
s
t
co
g
n
itiv
e
im
p
air
m
en
t.
Similar
f
in
d
in
g
s
wer
e
s
ee
n
in
Ma
cAr
th
u
r
Stu
d
ies
o
f
Su
cc
ess
f
u
l
Ag
in
g
,
wh
er
e
b
aselin
e
s
o
cial
s
u
p
p
o
r
t
p
r
ed
ict
ed
co
g
n
itiv
e
f
u
n
ctio
n
7
.
5
y
ea
r
s
later
[
2
7
]
.
A
m
eta
-
an
aly
s
is
r
ep
o
r
ted
th
at
s
o
cial
s
u
p
p
o
r
t
lo
wer
s
lev
els
o
f
s
tr
ess
wh
ich
in
t
u
r
n
is
ass
o
ciate
d
with
b
etter
g
l
o
b
al
c
o
g
n
itio
n
an
d
m
em
o
r
y
p
er
f
o
r
m
an
ce
i
n
h
ea
lt
h
y
o
ld
e
r
ad
u
lts
[
2
8
]
.
Ag
e
d
p
e
o
p
le
v
i
ew
co
g
n
itiv
e
im
p
air
m
en
t
a
s
a
th
r
ea
t
t
o
life
'
s
m
ea
n
in
g
,
id
en
titi
es,
an
d
o
v
er
a
ll
well
-
b
ein
g
.
Su
p
p
o
r
t
f
r
o
m
f
a
m
ily
at
th
is
p
o
in
t b
ec
o
m
es
c
r
u
cial
in
lo
wer
in
g
th
e
p
s
y
ch
o
s
o
cial
ef
f
ec
ts
ex
p
er
ien
ce
d
b
y
th
o
s
e
with
im
p
air
e
d
co
g
n
itio
n
[
2
9
]
.
He
n
ce
,
th
is
co
u
ld
e
x
p
lain
t
h
e
r
elatio
n
s
h
ip
b
etwe
en
s
o
cial
s
u
p
p
o
r
t a
n
d
co
g
n
itiv
e
im
p
ai
r
m
e
n
t seen
am
o
n
g
d
ep
r
ess
ed
eld
er
ly
in
Ma
lay
s
ia.
3
.
2
.
P
hy
s
ica
l
ac
t
iv
it
y
Ou
r
r
esu
lts
s
h
o
wed
th
at
b
ein
g
p
h
y
s
ically
in
ac
tiv
e
was
ass
o
ciate
d
with
th
e
p
r
esen
ce
o
f
co
g
n
itiv
e
im
p
air
m
en
t
in
o
ld
e
r
p
er
s
o
n
s
with
d
ep
r
ess
iv
e
s
y
m
p
t
o
m
s
.
T
h
e
p
r
e
v
io
u
s
s
y
s
tem
atic
r
e
v
iew
h
as
s
h
o
wn
th
at
s
ed
en
tar
y
b
e
h
av
io
r
is
ass
o
ciat
ed
with
r
ed
u
c
ed
co
g
n
itiv
e
f
u
n
ctio
n
[
3
0
]
.
Ph
y
s
ical
in
ac
tiv
ity
was
lis
ted
as
o
n
e
o
f
th
e
1
2
p
o
ten
tially
m
o
d
if
iab
le
r
is
k
f
ac
to
r
s
f
o
r
d
em
e
n
tia
in
th
e
2
0
2
0
r
ep
o
r
t
o
f
th
e
L
an
ce
t
C
o
m
m
is
s
io
n
[
3
1
]
.
Ma
in
tain
in
g
f
r
e
q
u
en
t
e
x
er
cise
in
cr
ea
s
es
an
d
m
ain
tain
s
c
o
g
n
itiv
e
r
eser
v
e.
Ph
y
s
ical
ac
tiv
ity
p
r
o
tects
b
r
ain
h
ea
lth
an
d
f
u
els
n
eu
r
o
p
last
icity
b
y
r
ed
u
cin
g
th
e
lik
elih
o
o
d
o
f
v
ascu
lar
d
is
ea
s
es
an
d
im
p
r
o
v
i
n
g
ce
r
eb
r
al
p
er
f
u
s
io
n
,
im
p
r
o
v
in
g
r
esp
ir
ato
r
y
f
u
n
ctio
n
,
s
tim
u
latin
g
g
r
o
wth
f
ac
to
r
s
,
p
ar
ti
cu
la
r
ly
b
r
ain
-
d
e
r
iv
ed
n
eu
r
o
tr
o
p
h
ic
f
ac
to
r
(
B
DNF)
an
d
in
s
u
lin
-
li
k
e
g
r
o
wth
f
ac
t
o
r
-
1
,
an
d
d
o
wn
r
eg
u
latin
g
o
x
i
d
ativ
e
s
tr
ess
an
d
in
f
lam
m
ato
r
y
r
esp
o
n
s
es.
I
t
also
r
ed
u
ce
s
th
e
b
r
ain
’
s
ex
p
o
s
u
r
e
to
n
e
u
r
o
to
x
ic
f
ac
to
r
s
,
in
clu
d
in
g
b
eta
-
am
y
lo
id
an
d
ex
ce
s
s
iv
e
g
lu
co
s
e
[
3
2
]
.
P
h
y
s
i
c
a
l
ac
t
i
v
it
y
a
n
d
e
x
e
r
c
is
e
h
a
v
e
al
s
o
im
p
r
o
v
e
d
c
o
g
n
i
t
i
o
n
i
n
p
a
t
i
e
n
ts
w
it
h
Al
z
h
e
i
m
e
r
’
s
d
i
s
e
as
e
[
3
3
]
.
A
m
et
a
-
a
n
a
l
y
s
is
h
a
s
s
h
o
w
n
t
h
a
t
e
x
e
r
ci
s
e
is
as
s
o
c
ia
t
e
d
w
i
t
h
t
h
e
i
m
p
r
o
v
e
d
m
o
o
d
i
n
o
l
d
e
r
p
e
r
s
o
n
s
[
3
4
]
.
3
.
3
.
Str
eng
t
h
a
nd
lim
it
a
t
io
n
T
h
is
r
esear
ch
s
tu
d
y
h
as
a
f
e
w
s
tr
en
g
th
s
an
d
lim
itatio
n
s
.
Usi
n
g
NHM
S
d
ata
d
er
iv
ed
f
r
o
m
a
lar
g
e
-
s
ca
le
p
o
p
u
latio
n
s
u
r
v
ey
en
s
u
r
es
th
e
v
alid
ity
o
f
th
e
r
esu
lts
in
g
en
e
r
alizin
g
it
to
th
e
Ma
lay
s
ian
p
o
p
u
latio
n
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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Hea
lth
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N:
2252
-
8
8
0
6
Dep
r
ess
io
n
a
n
d
co
g
n
itive
imp
a
ir
men
t in
M
a
la
ysia
n
eld
erly:
i
n
s
ig
h
ts
fr
o
m
a
…
(
A
z
lin
a
Wa
ti N
ikma
t
)
1133
in
ter
est
d
u
e
to
th
e
ap
p
r
o
p
r
iate
s
am
p
le
s
i
ze
an
d
h
i
g
h
r
esp
o
n
s
e
r
ate
o
b
tain
e
d
.
Usi
n
g
v
ali
d
ated
to
o
ls
co
u
p
led
with
tr
ain
ed
ev
alu
ato
r
s
in
m
ea
s
u
r
in
g
th
e
v
ar
iab
les
also
en
h
an
ce
d
th
e
v
alid
ity
o
f
th
e
d
ata
co
llected
.
T
h
e
m
u
ltiv
ar
iab
le
an
aly
s
is
o
f
im
p
o
r
tan
t
f
ac
t
o
r
s
,
in
clu
d
i
n
g
s
o
cio
d
em
o
g
r
ap
h
ic
,
p
h
y
s
ical
ac
t
iv
ity
,
an
d
s
o
cial
s
u
p
p
o
r
t,
f
u
r
th
e
r
s
tr
en
g
th
e
n
s
th
e
s
tu
d
y
.
Ho
wev
er
,
d
u
e
to
th
e
s
tu
d
y
'
s
cr
o
s
s
-
s
ec
tio
n
al
n
atu
r
e,
th
e
ca
u
s
al
r
elatio
n
s
h
ip
b
etwe
en
i
d
en
tifi
ed
f
ac
to
r
s
an
d
co
g
n
itiv
e
im
p
air
e
d
s
tatu
s
am
o
n
g
d
ep
r
ess
ed
eld
er
ly
ca
n
n
o
t
b
e
estab
lis
h
ed
.
Seco
n
d
l
y
,
ce
r
tain
v
a
r
iab
les,
s
u
ch
as
p
h
y
s
ical
ac
tiv
ity
a
n
d
s
o
cial
s
u
p
p
o
r
t,
wer
e
o
b
tai
n
ed
th
r
o
u
g
h
th
e
s
elf
-
r
ep
o
r
ted
m
ec
h
an
is
m
.
T
h
is
m
ec
h
an
is
m
ca
n
lead
t
o
r
ec
all
b
ias
o
r
s
o
cial
d
esira
b
ilit
y
r
es
p
o
n
s
e,
lead
i
n
g
t
o
o
v
er
o
r
u
n
d
er
esti
m
atio
n
o
f
th
e
lev
els
o
f
t
h
ese
v
ar
ia
b
les.
L
a
s
tly
,
u
s
in
g
s
cr
ee
n
in
g
to
o
ls
t
o
d
eter
m
in
e
t
h
e
co
g
n
itiv
e
a
n
d
d
ep
r
ess
io
n
le
v
el
with
o
u
t d
iag
n
o
s
tic
co
n
f
ir
m
ati
o
n
wo
u
ld
also
ex
p
o
s
e
th
e
f
in
d
i
n
g
s
to
m
is
class
if
icatio
n
b
ias to
a
ce
r
tain
ex
ten
t.
4.
CO
NCLU
SI
O
N
Hea
lth
ca
r
e
p
r
o
f
ess
io
n
als
m
u
s
t
lo
wer
th
eir
th
r
esh
o
ld
in
s
u
s
p
ec
tin
g
co
g
n
itiv
e
im
p
air
m
e
n
t
am
o
n
g
th
e
eld
er
ly
as
ea
r
ly
d
etec
tio
n
an
d
tr
ea
tm
en
t
will
h
elp
to
r
ed
u
ce
c
o
m
p
licatio
n
s
am
o
n
g
th
is
p
o
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DATA AV
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RE
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[
1
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W
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d
H
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t
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O
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g
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n
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.
[
2
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D.
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f
S
.
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,
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[
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R
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.
F
.
R
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.
,
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7
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N
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i
n
g
p
sy
c
h
o
l
o
g
ica
l
a
ss
e
ss
m
e
n
ts
a
n
d
p
sy
c
h
o
th
e
ra
p
y
t
o
b
o
t
h
c
h
il
d
a
n
d
a
d
u
lt
s.
He
r
re
se
a
rc
h
in
tere
s
t
in
v
o
l
v
e
s
q
u
a
li
t
y
o
f
li
fe
,
p
sy
c
h
o
lo
g
ica
l
we
ll
b
e
in
g
,
c
o
g
n
it
i
v
e
imp
a
irme
n
t,
a
u
ti
sm
a
n
d
a
g
e
d
c
a
re
.
F
o
ll
o
win
g
o
n
fro
m
h
e
r
P
h
.
D.,
sh
e
h
a
s
in
v
o
lv
e
d
i
n
fe
w
stu
d
ies
in
v
o
l
v
in
g
a
u
ti
sm
,
d
e
p
re
s
sio
n
a
n
d
l
o
n
e
li
n
e
ss
in
o
l
d
e
r
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d
u
lt
s
a
n
d
q
u
a
li
ty
o
f
l
ife
o
f
p
e
o
p
l
e
with
c
o
g
n
it
i
v
e
imp
a
irme
n
t
.
S
h
e
is
c
u
rre
n
tl
y
w
o
rk
in
g
o
n
fe
w
re
se
a
rc
h
p
ro
jec
ts
in
c
o
ll
a
b
o
ra
ti
o
n
with
o
t
h
e
r
fa
c
u
lt
ies
a
n
d
l
o
c
a
l
u
n
iv
e
rsi
ti
e
s
in
M
a
lay
sia
.
He
r
wo
rk
is also
re
c
o
g
n
ize
d
in
tern
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ti
o
n
a
ll
y
a
s sh
e
h
a
s b
e
e
n
a
p
p
o
in
ted
a
s a
n
e
d
it
o
rial
b
o
a
rd
m
e
m
b
e
r
fo
r
Jo
u
rn
a
l
o
f
P
a
ll
iativ
e
Ca
re
An
d
Nu
rsi
n
g
a
n
d
re
v
iew
e
r
b
o
a
rd
m
e
m
b
e
r
fo
r
Jo
u
rn
a
l
Of
Ag
i
n
g
An
d
Ag
e
Re
late
d
Dise
a
se
s
.
Sh
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
z
li
n
a
w
a
ti
@u
it
m
.
e
d
u
.
m
y
.
No
r
J
a
n
n
a
h
Na
suti
o
n
Ra
d
u
a
n
is
a
p
s
y
c
h
iatrist.
S
h
e
h
a
s
b
e
e
n
i
n
m
e
n
tal
h
e
a
lt
h
field
sin
c
e
1
2
y
e
a
rs
a
n
d
re
c
e
iv
e
d
h
e
r
m
e
d
ica
l
d
e
g
re
e
i
n
2
0
0
7
a
n
d
m
a
ste
r’s
d
e
g
re
e
in
P
s
y
c
h
iatry
in
2
0
1
6
a
n
d
is
re
g
istere
d
w
it
h
M
a
lay
sia
n
Na
ti
o
n
a
l
S
p
e
c
ialist
R
e
g
istry
.
S
h
e
is
a
Co
n
su
l
tan
t
P
sy
c
h
iatrist
i
n
UiT
M
P
ri
v
a
te
S
p
e
c
ialist
Ce
n
tre
(UPS
C)
a
n
d
S
e
n
io
r
Lec
tu
re
r
in
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
U
n
iv
e
rsiti
Tek
n
o
l
o
g
i
M
ARA
a
n
d
a
n
in
v
it
e
d
train
e
r
i
n
field
o
f
m
e
n
tal
h
e
a
lt
h
a
n
d
p
sy
c
h
o
lo
g
ica
l
w
e
ll
b
e
i
n
g
wo
r
k
sh
o
p
s
f
o
r
a
d
u
lt
s
&
c
o
r
p
o
ra
te
c
o
m
p
a
n
ies
.
S
h
e
wa
s
i
n
v
o
lv
e
d
i
n
p
sy
c
h
o
so
c
ial
su
p
p
o
r
t
p
r
o
g
ra
m
s
fo
r
M
H3
7
0
a
n
d
M
H1
7
c
a
tas
tro
p
h
e
.
He
n
c
e
with
m
a
n
y
p
ra
c
ti
c
e
s
a
n
d
e
n
c
o
u
n
ters
i
n
th
e
field
o
f
m
e
n
tal
h
e
a
lt
h
,
s
h
e
is
in
d
e
e
d
a
wa
rm
p
sy
c
h
iatrist
with
m
a
n
y
th
e
ra
p
e
u
ti
c
e
x
p
e
rien
c
e
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
o
rja
n
n
a
h
@u
it
m
.
e
d
u
.
m
y
.
Nurul
Az
r
e
e
n
H
a
shi
m
is
a
c
o
n
su
l
tan
t
p
s
y
c
h
iatrist
a
n
d
se
n
io
r
lec
tu
re
r
a
n
d
n
o
w
th
e
h
e
a
d
o
f
De
p
a
rtme
n
t
o
f
P
sy
c
h
iatry
,
F
a
c
u
lt
y
o
f
M
e
d
ici
n
e
a
n
d
H
o
sp
it
a
l
Al
-
S
u
l
tan
Ab
d
u
ll
a
h
Un
iv
e
rsiti
Te
k
n
o
lo
g
i
M
ARA
.
S
h
e
g
ra
d
u
a
ted
with
M
a
ste
r
in
P
s
y
c
h
o
l
o
g
ica
l
M
e
d
icin
e
fr
o
m
Un
iv
e
rsiti
M
a
lay
a
in
2
0
1
1
a
n
d
is
re
g
istere
d
with
M
a
lay
sia
n
Na
ti
o
n
a
l
S
p
e
c
ialist
Re
g
istry
.
He
r
sp
e
c
ial
in
tere
st i
s
i
n
th
e
field
o
f
R
e
h
a
b
il
it
a
ti
o
n
P
sy
c
h
iatry
.
S
h
e
h
a
s
p
u
b
li
sh
e
d
v
a
rio
u
s
a
rti
c
les
i
n
e
ste
e
m
e
d
p
sy
c
h
iatric
jo
u
rn
a
ls
a
n
d
h
a
d
g
iv
e
n
train
i
n
g
s
a
n
d
talk
s
i
n
th
e
field
o
f
p
sy
c
h
i
a
try
t
o
fe
ll
o
w
m
e
n
tal
h
e
a
lt
h
p
ro
fe
ss
io
n
a
ls
a
n
d
t
h
e
p
u
b
li
c
.
S
h
e
is
n
o
w
th
e
m
e
m
b
e
r
o
f
C
o
n
j
o
in
t
B
o
a
rd
o
f
P
s
y
c
h
iatry
wh
ic
h
i
n
v
o
lv
e
d
wi
th
c
o
o
rd
in
a
ti
o
n
a
n
d
su
p
e
rv
isio
n
o
f
p
o
st
g
ra
d
u
a
te
train
i
n
g
i
n
p
sy
c
h
iatr
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
z
re
e
n
@u
it
m
.
e
d
u
.
m
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N
:
2
2
5
2
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8
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I
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t J Pu
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l.
14
,
No
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3
,
Sep
tem
b
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20
25
:
1
1
2
9
-
1
1
3
6
1136
No
o
r
Az
lee
n
Ahm
a
d
T
a
r
m
izi
is
a
g
e
riatricia
n
a
n
d
i
n
tern
a
l
m
e
d
icin
e
p
h
y
sic
ian
i
n
F
a
c
u
lt
y
o
f
M
e
d
ici
n
e
a
n
d
Ho
sp
i
tal
Al
-
S
u
lt
a
n
A
b
d
u
ll
a
h
Un
iv
e
rsi
ti
Tek
n
o
lo
g
i
M
ARA
.
S
h
e
c
o
m
p
lete
d
h
e
r
u
n
d
e
r
g
ra
d
u
a
te
trai
n
in
g
in
Na
ti
o
n
a
l
Un
iv
e
rsity
o
f
Ir
e
lan
d
G
a
lwa
y
in
2
0
0
9
,
a
n
d
su
b
se
q
u
e
n
tl
y
c
o
m
p
lete
d
h
e
r
M
R
CP
UK
in
2
0
1
3
.
S
h
e
h
a
s
c
o
n
ti
n
u
e
d
to
fu
r
th
e
r
h
e
r
trai
n
in
g
in
g
e
riatric
m
e
d
icin
e
wh
ich
wa
s
c
o
m
p
lete
d
in
2
0
2
0
.
S
h
e
h
a
s
sin
c
e
se
rv
e
d
a
s
a
n
in
tern
a
l
m
e
d
icin
e
p
h
y
sic
ia
n
a
n
d
g
e
riatricia
n
i
n
UiTM
.
S
h
e
in
it
iate
d
th
e
g
e
riatric
s
e
rv
ice
a
n
d
fa
ll
s
p
re
v
e
n
ti
o
n
p
ro
g
ra
m
in
UiT
M
.
S
h
e
is
a
c
ti
v
e
l
y
in
v
o
l
v
e
d
in
t
h
e
g
e
riatric
fra
tern
it
y
i
n
c
lu
d
in
g
b
e
c
o
m
in
g
th
e
o
rg
a
n
izi
n
g
c
h
a
ir
f
o
r
M
a
lay
sia
n
C
o
n
g
re
ss
o
f
G
e
riatric
M
e
d
icin
e
2
0
2
4
.
S
h
e
c
o
n
t
in
u
e
s
to
p
r
o
v
i
d
e
a
wa
re
n
e
ss
a
n
d
k
n
o
wle
d
g
e
o
f
g
e
riatric
m
e
d
icin
e
to
h
e
a
lt
h
c
a
re
wo
rk
e
rs
a
n
d
t
h
e
p
u
b
li
c
b
y
v
a
rio
u
s
tal
k
s
a
n
d
c
o
m
m
u
n
it
y
e
n
g
a
g
e
m
e
n
ts.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
o
o
ra
z
lee
n
1
7
8
6
@u
it
m
.
e
d
u
.
m
y
.
No
r
Ani
ta
Affa
n
d
i
is
a
sta
t
isti
c
ian
with
a
d
e
g
re
e
in
sta
ti
stic
s
fro
m
Un
i
v
e
rsiti
Tek
n
o
lo
g
i
M
ARA
(UiTM
)
.
S
h
e
sta
rted
h
e
r
c
a
re
e
r
a
s
a
s
tatisti
c
ian
a
t
t
h
e
De
p
a
rtme
n
t
o
f
S
tatisti
c
s,
M
a
lay
sia
(DO
S
M
)
i
n
2
0
0
7
.
Ex
p
e
rien
c
e
d
i
n
th
e
p
ro
d
u
c
ti
o
n
o
f
p
rice
s
sta
ti
stics
a
n
d
b
u
sin
e
ss
te
n
d
e
n
c
y
sta
ti
stics
f
o
r
1
4
y
e
a
rs;
i
n
v
o
l
v
in
g
t
h
e
p
lan
n
in
g
,
c
o
m
p
il
in
g
,
p
r
o
c
e
ss
in
g
,
a
n
d
p
u
b
li
sh
i
n
g
p
r
o
c
e
ss
e
s
o
n
a
m
o
n
th
ly
a
n
d
q
u
a
rterly
b
a
sis
wh
il
e
se
rv
in
g
in
th
e
P
r
ice
,
In
c
o
m
e
&
Ex
p
e
n
d
it
u
re
S
tatisti
c
s
Di
v
is
io
n
(
DO
S
M
).
Cu
rre
n
tl
y
se
rv
in
g
a
t
t
h
e
Na
ti
o
n
a
l
I
n
stit
u
tes
o
f
He
a
lt
h
(NIH
)
u
n
d
e
r
th
e
S
e
c
to
r
f
o
r
Bio
st
a
ti
stics
&
Da
t
a
Re
p
o
sito
ry
si
n
c
e
2
0
2
1
,
p
ro
v
id
i
n
g
c
o
n
su
l
tan
c
y
re
late
d
to
re
se
a
rc
h
m
e
th
o
d
o
l
o
g
y
a
n
d
d
a
ta
m
a
n
a
g
e
m
e
n
t,
a
n
d
a
lso
p
a
rt
o
f
th
e
re
p
o
sit
o
ry
d
a
ta
tea
m
(
NIH
-
Da
RS
).
Sh
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
i
h
d
a
rs@
m
o
h
.
g
o
v
.
m
y
.
No
r
Fa
r
a
h
d
i
la
H
a
iro
m
a
n
is
a
sta
ti
sticia
n
with
a
d
e
g
re
e
in
Eco
n
o
m
ics
fro
m
th
e
Un
iv
e
rsity
o
f
M
a
lay
a
,
c
las
s
o
f
2
0
0
5
.
Afte
r
g
a
in
in
g
o
v
e
r
1
2
y
e
a
rs
o
f
e
x
p
e
rien
c
e
a
t
th
e
M
in
istry
o
f
I
n
ter
n
a
ti
o
n
a
l
Trad
e
a
n
d
In
d
u
st
ry
,
s
h
e
j
o
in
e
d
t
h
e
Bi
o
sta
ti
stics
a
n
d
Da
ta
Re
p
o
sit
o
ry
se
c
to
r
a
t
th
e
Na
ti
o
n
a
l
In
st
it
u
tes
o
f
He
a
lt
h
(NIH
)
in
2
0
2
0
.
S
h
e
h
a
s
a
p
a
ss
io
n
fo
r
wo
r
k
in
g
with
n
u
m
b
e
rs
a
n
d
e
n
jo
y
s
c
h
a
ll
e
n
g
i
n
g
h
e
rse
lf
with
i
n
fo
g
ra
p
h
ics
wh
il
e
p
re
p
a
ri
n
g
p
o
ste
rs
fo
r
p
u
b
l
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n
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g
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c
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n
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d
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g
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m
y
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n
d
g
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in
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d
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li
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x
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st
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o
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in
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0
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t
th
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Un
i
v
e
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f
M
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l
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y
a
.
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rre
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rv
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s
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li
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h
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lt
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m
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Op
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n
S
c
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c
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Alli
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n
c
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(M
OSA).
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p
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s
a
p
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le
in
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d
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c
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sy
ste
m
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t
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,
sp
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a
rh
e
a
d
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g
in
it
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s
su
c
h
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s
c
lo
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m
p
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g
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r
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se
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rs,
th
e
NIH
d
a
ta
re
p
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sito
r
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s
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ste
m
(NIH
-
Da
RS
),
a
n
d
p
ro
v
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d
in
g
trai
n
in
g
in
b
i
g
d
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ta an
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ly
ti
c
s
a
n
d
AI,
su
p
p
o
r
ti
n
g
th
e
m
in
istr
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'
s res
e
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rc
h
e
ffo
rts.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
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e
m
a
il
:
m
.
z
u
lf
a
d
li
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o
h
.
g
o
v
.
m
y
.
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n
g
k
u
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o
h
d
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a
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d
d
in
Te
n
g
k
u
K
a
m
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r
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l
b
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h
r
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is
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d
e
d
ica
te
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p
sy
c
h
iatrist
wh
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h
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s
m
a
d
e
sig
n
ifi
c
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n
t
c
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tri
b
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ti
o
n
s
to
th
e
fiel
d
o
f
m
e
n
tal
h
e
a
lt
h
in
M
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lay
sia
.
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c
o
m
p
lete
d
h
is
Ba
c
h
e
lo
r
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f
M
e
d
ici
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e
,
Ba
c
h
e
l
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r
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f
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rg
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BB
S
)
fr
o
m
th
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te
rn
a
ti
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a
l
Isla
m
ic
Un
i
v
e
rsity
M
a
lay
sia
(IIUM
),
wh
e
re
h
e
d
e
v
e
lo
p
e
d
a
st
r
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g
fo
u
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d
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ti
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n
in
m
e
d
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sc
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c
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s
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d
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p
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r
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tal
h
e
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lt
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c
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re
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u
rsu
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g
fu
rth
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r
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c
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He
u
n
d
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rt
o
o
k
p
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ra
d
u
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te
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d
ies
a
t
Un
iv
e
rsiti
Tek
n
o
l
o
g
i
M
ARA
(UiTM
),
e
n
h
a
n
c
in
g
h
is
e
x
p
e
rt
ise
a
n
d
sk
il
ls
in
p
s
y
c
h
iatry
.
His
rig
o
r
o
u
s
train
in
g
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n
d
c
o
m
m
it
m
e
n
t
to
t
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field
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v
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q
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ip
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d
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m
with
th
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k
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wle
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n
d
c
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b
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ro
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c
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l
m
e
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tal
h
e
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lt
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c
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re
.
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r
re
n
tl
y
,
h
e
se
rv
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s
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s
a
p
sy
c
h
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ist
a
t
Un
iv
e
rsiti
S
u
lt
a
n
Zain
a
l
A
b
id
i
n
(Un
iS
ZA),
wi
th
i
n
t
h
e
F
a
c
u
lt
y
o
f
M
e
d
icin
e
a
n
d
He
a
lt
h
S
c
ien
c
e
s
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
tg
sa
ifu
d
d
in
@
u
n
isz
a
.
e
d
u
.
m
y
.
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