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P
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Vo
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14
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20
25
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1
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//
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s
.
ia
esco
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e.
co
m
Co
rrelatio
n be
tw
een j
e
t
la
g
sy
ndro
me a
nd air
trav
el
fatig
ue
K
ha
er
ul Am
ri,
I
m
elda
Av
ia
,
Azis F
a
hruji
N
u
r
si
n
g
D
e
p
a
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t
m
e
n
t
,
F
a
c
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y
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e
a
l
t
h
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c
i
e
n
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e
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M
a
r
s
e
k
a
l
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u
r
y
a
d
a
r
ma
A
e
r
o
sp
a
c
e
U
n
i
v
e
r
si
t
y
,
E
a
st
Ja
k
a
r
t
a
,
I
n
d
o
n
e
si
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Oct
1
,
2
0
2
4
R
ev
is
ed
Dec
1
6
,
2
0
2
4
Acc
ep
ted
Ma
r
6
,
2
0
2
5
Lo
n
g
-
d
ista
n
c
e
a
ir
trav
e
l
c
a
u
se
s
trav
e
lers
to
e
x
p
e
rien
c
e
trav
e
l
fa
ti
g
u
e
.
Je
t
lag
sy
n
d
r
o
m
e
is o
n
e
o
f
th
e
fa
c
t
o
rs t
h
a
t
e
x
a
c
e
rb
a
te fatig
u
e
fr
o
m
a
ir
tra
v
e
l.
F
a
ti
g
u
e
c
a
n
se
rio
u
sly
imp
a
c
t
trav
e
lers
wi
th
a
h
isto
r
y
o
f
il
l
n
e
ss
.
He
a
lt
h
e
m
e
rg
e
n
c
ies
re
su
lt
in
g
fr
o
m
trav
e
l
fa
ti
g
u
e
c
a
n
e
v
e
n
lea
d
to
d
e
a
th
.
A
c
ro
ss
-
se
c
ti
o
n
a
l
st
u
d
y
wa
s
c
o
n
d
u
c
ted
to
i
d
e
n
ti
f
y
th
e
re
l
a
ti
o
n
sh
i
p
b
e
twe
e
n
jet
lag
sy
n
d
r
o
m
e
a
n
d
a
ir
trav
e
l
fa
ti
g
u
e
.
T
h
e
1
1
7
p
e
o
p
le
w
h
o
h
a
d
trav
e
led
i
n
th
e
p
a
st
y
e
a
r
h
a
d
jet
lag
sy
n
d
r
o
m
e
a
n
d
d
i
d
n
o
t
m
e
e
t
th
e
e
x
c
lu
sio
n
c
rit
e
ria
we
re
se
le
c
ted
.
Th
e
q
u
e
stio
n
n
a
ires
u
se
d
th
e
c
irca
d
ian
ty
p
e
i
n
v
e
n
to
r
y
a
n
d
t
h
e
fa
ti
g
u
e
sc
a
le
,
a
n
d
v
a
li
d
it
y
a
n
d
re
li
a
b
il
it
y
we
re
tes
ted
.
M
u
lt
ip
le
lo
g
isti
c
re
g
re
ss
io
n
wa
s
p
e
rfo
rm
e
d
to
d
e
term
in
e
th
e
v
a
riab
les
in
flu
e
n
c
in
g
a
ir
trav
e
l
fa
ti
g
u
e
.
Th
e
re
latio
n
sh
ip
b
e
twe
e
n
jet
lag
sy
n
d
r
o
m
e
a
n
d
a
ir
t
ra
v
e
l
fa
ti
g
u
e
wa
s
a
n
a
ly
z
e
d
u
sin
g
Ch
i
-
s
q
u
a
re
a
n
a
ly
sis.
Re
su
lt
s
o
f
th
e
stu
d
y
i
d
e
n
t
ifi
e
d
th
a
t
5
3
.
8
%
o
f
re
sp
o
n
d
e
n
ts
e
x
p
e
rien
c
e
d
se
v
e
re
fa
ti
g
u
e
,
a
n
d
5
4
.
7
%
e
x
p
e
rien
c
e
d
se
v
e
re
jet
lag
sy
n
d
ro
m
e
.
Je
t
lag
sy
n
d
r
o
m
e
c
o
rre
late
d
wit
h
a
ir
t
ra
v
e
l
fa
ti
g
u
e
sig
n
ifi
c
a
n
tl
y
(
p
=
0
.
0
0
1
)
.
Re
sp
o
n
d
e
n
ts
wit
h
se
v
e
re
jet
la
g
sy
n
d
r
o
m
e
e
x
p
e
rien
c
e
d
se
v
e
re
fa
ti
g
u
e
.
Th
e
fin
d
i
n
g
s
fro
m
t
h
is
stu
d
y
e
m
p
h
a
siz
e
th
a
t
a
d
d
re
ss
in
g
jet
lag
sy
n
d
ro
m
e
is
n
e
c
e
ss
a
ry
to
re
d
u
c
e
a
ir
tra
v
e
l
fa
ti
g
u
e
fo
r
o
v
e
ra
ll
h
e
a
lt
h
.
K
ey
w
o
r
d
s
:
Air
tr
av
el
C
ir
ca
d
ian
Fatig
u
e
J
et
lag
s
y
n
d
r
o
m
e
T
r
av
el
f
atig
u
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
:
Kh
ae
r
u
l A
m
r
i
Nu
r
s
in
g
Dep
ar
tm
en
t,
Facu
lty
o
f
Hea
lth
Scien
ce
,
Ma
r
s
ek
al
S
u
r
y
ad
a
r
m
a
Aer
o
s
p
ac
e
Un
i
v
er
s
ity
Halim
Per
d
an
a
Ku
s
u
m
a,
E
ast
J
ak
ar
ta,
I
n
d
o
n
esia
E
m
ail:
kh
ae
r
u
lam
r
i2
8
@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
L
o
n
g
-
d
is
tan
ce
air
t
r
av
el
m
a
k
es
tr
av
eler
s
f
ee
l
p
s
y
ch
o
lo
g
ically
an
d
p
h
y
s
io
lo
g
ically
d
is
tu
r
b
ed
.
Ps
y
ch
o
lo
g
ical
an
d
p
h
y
s
io
lo
g
i
ca
l
d
is
tu
r
b
an
ce
s
o
cc
u
r
d
u
e
to
th
e
lo
n
g
d
u
r
atio
n
o
f
tr
av
el
e
x
ce
ed
in
g
4
h
o
u
r
s
,
ch
an
g
es in
air
p
r
ess
u
r
e
with
a
n
air
cr
af
t a
ltit
u
d
e
o
f
8
,
0
0
0
-
1
2
,
0
0
0
f
ee
t,
an
d
p
ass
in
g
th
r
o
u
g
h
d
if
f
er
en
t tim
e
zo
n
es
[
1
]
,
[
2
]
.
T
h
e
p
s
y
c
h
o
lo
g
ical
an
d
p
h
y
s
io
lo
g
ical
d
is
tu
r
b
an
ce
s
th
a
t
o
cc
u
r
a
r
e
ca
lled
jet
lag
s
y
n
d
r
o
m
e.
Ps
y
ch
o
lo
g
ical
s
y
m
p
to
m
s
o
f
jet
lag
s
y
n
d
r
o
m
e
in
clu
d
e
an
x
iety
,
s
tr
ess
,
m
o
o
d
s
win
g
s
,
f
ea
r
,
em
o
tio
n
al
ex
h
a
u
s
tio
n
,
an
d
ten
s
io
n
.
Ph
y
s
io
lo
g
ical
s
y
m
p
to
m
s
in
clu
d
e
in
cr
ea
s
ed
s
leep
d
is
tu
r
b
an
c
es,
d
ig
esti
v
e
d
is
o
r
d
er
s
,
b
lo
o
d
p
r
ess
u
r
e,
h
y
p
o
x
ia,
h
y
p
er
v
en
tilatio
n
,
an
d
p
h
y
s
ical
f
atig
u
e
[
3
]
.
T
h
e
s
y
m
p
to
m
s
ex
p
er
ien
ce
d
m
ay
v
a
r
y
in
ce
r
tain
i
n
d
iv
id
u
als.
Fatig
u
e
is
a
co
m
m
o
n
c
o
m
p
lex
e
m
o
tio
n
f
elt
o
n
ai
r
tr
av
el.
Fatig
u
e
is
d
escr
ib
ed
as
e
x
tr
em
e
tire
d
n
ess
an
d
s
tr
ess
d
u
e
to
s
leep
d
is
tu
r
b
a
n
ce
s
ca
u
s
ed
b
y
th
e
s
tr
ess
o
f
f
lig
h
t.
T
h
e
f
atig
u
e
ex
p
er
ien
ce
d
co
n
s
is
ts
o
f
s
h
o
r
t
-
ter
m
f
atig
u
e
an
d
lo
n
g
-
ter
m
f
atig
u
e
[
4
]
.
Sh
o
r
t
-
ter
m
f
atig
u
e
is
ass
o
ciate
d
w
ith
lack
o
f
s
leep
o
r
r
est,
p
h
y
s
ical
o
r
m
en
tal
o
v
er
l
o
ad
,
lo
n
g
wo
r
k
in
g
h
o
u
r
s
,
an
d
j
et
lag
.
Me
an
wh
ile,
lo
n
g
-
ter
m
f
atig
u
e
is
k
n
o
wn
as
ch
r
o
n
ic
f
atig
u
e
d
u
e
to
v
ar
io
u
s
f
ac
to
r
s
s
u
ch
as
s
tr
ess
an
d
w
o
r
k
in
g
co
n
d
itio
n
s
.
Fatig
u
e
d
escr
ib
es
as
co
g
n
itiv
e
d
ec
lin
e,
d
ec
r
ea
s
e
d
co
n
ce
n
tr
at
io
n
,
em
o
tio
n
al
c
h
an
g
es,
an
d
af
f
ec
tiv
e
d
ec
lin
e
[
5
]
,
[
6
]
.
T
h
e
s
y
m
p
to
m
s
o
f
jet
lag
s
y
n
d
r
o
m
e
ar
e
n
o
t
ju
s
t
a
tem
p
o
r
ar
y
in
co
n
v
en
ien
ce
.
Mild
h
ea
lth
p
r
o
b
lem
s
ca
n
b
e
ex
ac
er
b
ated
wh
en
p
ass
en
g
er
s
ex
p
er
ie
n
ce
jet
la
g
s
y
n
d
r
o
m
e
.
T
r
av
eler
s
e
x
p
er
ie
n
cin
g
jet
la
g
s
y
n
d
r
o
m
e
with
a
m
ed
ical
h
is
to
r
y
s
u
ch
as
h
y
p
e
r
ten
s
io
n
,
ca
n
m
ak
e
m
atter
s
wo
r
s
e,
h
y
p
e
r
ten
s
io
n
ca
n
in
c
r
ea
s
e
b
ef
o
r
e,
d
u
r
in
g
,
o
r
af
ter
tr
av
el
[
7
]
.
Stu
d
ies
o
n
tr
av
el
d
u
r
atio
n
an
d
atm
o
s
p
h
er
i
c
p
r
ess
u
r
e
o
n
b
lo
o
d
p
r
ess
u
r
e
s
h
o
w
a
s
ig
n
if
ican
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
0
6
C
o
r
r
ela
tio
n
b
etw
ee
n
jet
la
g
s
yn
d
r
o
me
a
n
d
a
ir
tr
a
ve
l fa
tig
u
e
(
K
h
a
eru
l A
mri
)
1533
r
elatio
n
s
h
ip
[
8
]
.
T
h
e
lo
n
g
f
lig
h
t
d
u
r
atio
n
cr
ea
tes
d
is
co
m
f
o
r
t
an
d
s
tr
ess
,
wh
ile
th
e
atm
o
s
p
h
er
ic
p
r
ess
u
r
e
m
ak
es
th
e
b
o
d
y
h
y
p
o
x
ic
.
Pro
lo
n
g
ed
s
tr
ess
an
d
h
y
p
o
x
ia
ca
u
s
e
an
in
c
r
ea
s
e
in
b
lo
o
d
p
r
ess
u
r
e.
A
s
tu
d
y
was
co
n
d
u
cte
d
o
n
2
0
h
ea
lth
y
in
d
iv
id
u
als
wh
o
e
x
p
er
ien
ce
d
jet
lag
s
y
n
d
r
o
m
e
d
u
e
t
o
air
t
r
av
el
to
id
en
tif
y
b
r
ain
a
n
d
n
eu
r
o
en
d
o
cr
in
e
c
h
an
g
es
[
9
]
.
T
h
e
s
tu
d
y
s
h
o
wed
ch
a
n
g
es
d
u
r
in
g
jet
la
g
r
elativ
e
to
r
ec
o
v
e
r
y
,
in
clu
d
in
g
d
ec
r
ea
s
ed
co
n
n
ec
ti
v
ity
in
th
e
b
asal
g
an
g
lia
-
th
a
lam
o
co
r
tical
n
etwo
r
k
an
d
in
cr
ea
s
ed
f
u
n
ctio
n
al
co
n
n
ec
tiv
ity
b
etwe
en
t
h
e
m
ed
ial
tem
p
o
r
al
lo
b
e
s
u
b
s
y
s
tem
a
n
d
m
ed
ial
v
is
u
al
co
r
tices.
L
o
wer
m
elato
n
in
lev
els
an
d
h
i
g
h
lev
els o
f
th
y
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o
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d
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o
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m
o
n
es d
u
r
in
g
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lag
e
x
h
ib
ited
s
im
ilar
tr
en
d
s
to
b
r
ain
ac
tiv
it
y
in
th
e
r
ig
h
t lin
g
u
al
g
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u
s
.
T
h
e
s
tu
d
y
co
n
clu
d
e
d
th
at
b
r
ain
an
d
n
e
u
r
o
en
d
o
cr
i
n
e
ch
an
g
es
d
u
r
in
g
jet
lag
ar
e
ass
o
ciate
d
with
jet
lag
s
y
m
p
to
m
s
.
Oth
er
s
tu
d
ies
h
av
e
in
d
icate
d
th
at
ch
an
g
es
in
th
e
b
o
d
y
'
s
cir
ca
d
ian
r
h
y
th
m
r
esu
lt
in
ch
an
g
es
in
co
r
tis
o
l
lev
els [
1
0
]
.
J
et
lag
s
y
n
d
r
o
m
e
ca
n
in
ter
f
er
e
with
a
p
er
s
o
n
's
p
er
f
o
r
m
an
ce
at
wo
r
k
o
r
ev
en
d
is
r
u
p
t
d
aily
ac
tiv
ities
i
f
th
e
s
y
m
p
to
m
s
ar
e
s
ev
er
e.
J
e
t
lag
an
d
f
atig
u
e
ca
n
also
s
er
io
u
s
ly
im
p
ac
t
s
o
m
e
o
n
e
w
h
o
wo
r
k
s
with
h
ig
h
co
n
ce
n
tr
atio
n
an
d
h
i
g
h
s
af
ety
r
is
k
s
[
1
1
]
.
Dec
r
ea
s
ed
c
o
n
ce
n
t
r
atio
n
d
u
e
to
jet
lag
s
y
n
d
r
o
m
e
an
d
tr
av
el
f
atig
u
e
ca
n
also
p
u
t
tr
av
eler
s
at
r
is
k
o
f
ac
cid
en
ts
[
1
2
]
.
T
r
av
eler
s
wh
o
d
r
iv
e
p
o
s
t
-
f
lig
h
t
will
b
e
at
h
ig
h
r
is
k
o
f
in
ju
r
y
a
n
d
d
ea
th
o
n
th
e
r
o
a
d
.
E
v
en
tr
a
v
eler
s
cr
o
s
s
in
g
th
e
s
tr
ee
t
ca
n
b
e
at
h
ig
h
r
is
k
.
L
ac
k
o
f
a
wa
r
en
ess
o
r
f
ailu
r
e
to
r
ec
o
g
n
ize
th
e
ef
f
ec
ts
o
f
jet
la
g
s
y
n
d
r
o
m
e
ex
p
o
s
es tr
av
eler
s
to
f
atal
r
o
a
d
tr
af
f
ic
ac
ci
d
en
ts
.
T
h
e
ad
v
er
s
e
ef
f
ec
ts
th
at
ca
n
o
c
cu
r
d
u
e
to
jet
lag
s
y
n
d
r
o
m
e
ar
e
an
im
p
o
r
tan
t
f
o
cu
s
f
o
r
p
r
e
v
e
n
tio
n
.
Pre
-
f
lig
h
t
h
ea
lth
ch
ec
k
s
ar
e
n
ec
ess
ar
y
.
Ho
wev
er
,
p
r
e
-
f
lig
h
t
h
ea
lt
h
ch
ec
k
s
ar
e
o
n
l
y
ca
r
r
ied
o
u
t o
n
at
-
r
is
k
g
r
o
u
p
s
o
r
in
th
e
ev
en
t
o
f
a
p
an
d
em
ic
o
r
s
p
r
ea
d
o
f
d
is
ea
s
e.
T
h
e
lack
o
f
p
ass
en
g
er
k
n
o
wled
g
e
r
e
g
ar
d
in
g
th
e
im
p
ac
t
o
f
jet
lag
s
y
n
d
r
o
m
e
d
u
e
to
t
r
av
el
is
a
m
ajo
r
f
ac
to
r
i
n
th
e
f
ailu
r
e
o
f
e
f
f
o
r
ts
to
p
r
e
v
en
t
jet
lag
s
y
n
d
r
o
m
e.
Var
io
u
s
s
tu
d
ies
h
av
e
b
ee
n
c
o
n
d
u
cted
to
o
v
er
c
o
m
e
th
is
jet
lag
b
u
t
h
av
e
n
o
t
f
o
u
n
d
a
tr
u
l
y
s
ig
n
if
ican
t
ef
f
o
r
t
in
o
v
er
co
m
i
n
g
jet
lag
b
o
th
p
h
ar
m
ac
o
lo
g
ically
an
d
n
o
n
-
p
h
ar
m
ac
o
lo
g
ically
[
1
3
]
.
Pas
s
en
g
er
s
wh
o
tr
av
eled
in
d
if
f
er
en
t
zo
n
es
a
n
d
ex
p
er
ien
ce
d
jet
lag
s
y
n
d
r
o
m
e
d
id
n
o
t
m
ak
e
ef
f
o
r
ts
to
o
v
er
co
m
e
jet
lag
s
y
n
d
r
o
m
e
p
r
o
p
er
ly
[
1
4
]
.
Pas
s
en
g
er
s
wh
o
ex
p
er
ien
ce
f
atig
u
e
an
d
jet
lag
s
y
n
d
r
o
m
e
h
av
e
a
life
s
ty
le
th
at
is
n
o
t
g
o
o
d
f
o
r
th
eir
h
ea
lth
,
n
a
m
ely
ir
r
eg
u
la
r
s
leep
p
atter
n
s
,
n
o
t
u
s
in
g
r
elax
atio
n
t
ec
h
n
iq
u
es,
an
d
d
o
in
g
e
x
er
cise th
at
ca
n
in
cr
ea
s
e
f
atig
u
e.
R
esear
ch
o
n
jet
lag
s
y
n
d
r
o
m
e
an
d
air
tr
av
el
f
atig
u
e
h
as
b
ee
n
th
e
f
o
cu
s
o
f
atten
tio
n
in
r
ec
en
t
y
ea
r
s
,
b
u
t
th
er
e
is
s
till
a
lack
o
f
co
m
p
r
eh
en
s
iv
e
s
tu
d
ies.
Mo
s
t
p
r
ev
io
u
s
s
tu
d
ies
h
a
v
e
f
o
cu
s
ed
o
n
an
aly
zin
g
th
e
p
h
y
s
io
lo
g
ical
e
f
f
ec
ts
o
f
jet
la
g
s
y
n
d
r
o
m
e
o
n
th
e
b
o
d
y
,
s
u
c
h
as
s
leep
d
is
tu
r
b
an
ce
s
an
d
d
ig
esti
v
e
p
r
o
b
lem
s
,
with
o
u
t
ex
p
lo
r
in
g
th
e
ac
co
m
p
an
y
in
g
p
s
y
ch
o
lo
g
ical
im
p
ac
ts
.
Fo
r
e
x
am
p
le,
o
n
e
s
tu
d
y
f
o
u
n
d
th
at
lo
n
g
-
d
is
tan
ce
air
tr
av
el
ca
n
ca
u
s
e
p
h
y
s
ical
an
d
e
m
o
tio
n
al
d
is
tr
ess
,
b
u
t
d
id
n
o
t
in
v
esti
g
ate
in
d
ep
th
h
o
w
f
a
tig
u
e
is
ex
p
er
ien
c
ed
d
u
r
in
g
tr
av
el.
W
ith
th
e
in
cr
ea
s
in
g
n
u
m
b
er
o
f
in
ter
n
atio
n
al
tr
i
p
s
an
d
awa
r
e
n
ess
o
f
tr
a
v
el
f
ati
g
u
e,
it is
im
p
o
r
tan
t
to
co
n
d
u
ct
m
o
r
e
c
o
m
p
r
eh
en
s
iv
e
r
esear
ch
th
at
n
o
t
o
n
l
y
ass
ess
es
p
h
y
s
io
lo
g
ical
asp
ec
ts
b
u
t
al
s
o
ass
o
ciate
s
jet
lag
s
y
n
d
r
o
m
e
with
p
s
y
c
h
o
lo
g
ical
f
atig
u
e.
T
h
is
s
tu
d
y
is
ex
p
ec
ted
to
p
r
o
v
id
e
n
ew
an
d
in
-
d
ep
th
in
s
ig
h
ts
in
to
th
e
r
elatio
n
s
h
ip
b
etwe
en
jet
lag
s
y
n
d
r
o
m
e
a
n
d
tr
av
eler
f
atig
u
e,
a
n
d
its
im
p
licatio
n
s
f
o
r
p
ass
en
g
er
h
ea
lth
.
T
h
er
e
f
o
r
e
,
it
is
im
p
o
r
tan
t
to
u
n
d
er
s
tan
d
air
tr
av
el
f
atig
u
e
to
p
r
e
v
en
t
th
e
ad
v
er
s
e
ef
f
ec
ts
o
f
jet
lag
s
y
n
d
r
o
m
e
.
T
h
is
s
tu
d
y
aim
s
to
d
eter
m
in
e
wh
eth
er
th
e
r
e
is
an
ass
o
ciatio
n
b
etwe
en
jet
lag
s
y
n
d
r
o
m
e
an
d
air
tr
a
v
el
f
a
tig
u
e
f
r
o
m
Octo
b
er
2
0
2
3
t
o
J
an
u
ar
y
2
0
2
4
.
2.
M
E
T
H
O
D
2
.
1
.
S
t
u
d
y
de
s
i
g
n
a
nd
p
a
r
t
i
c
ip
a
n
t
s
T
h
is
cr
o
s
s
-
s
ec
tio
n
al
o
b
s
er
v
ati
o
n
al
s
tu
d
y
was
co
n
d
u
cted
in
ar
o
u
n
d
Un
iv
e
r
s
itas
Dir
g
an
tar
a
Ma
r
s
ek
al
Su
r
y
ad
ar
m
a
,
E
ast
J
ak
ar
ta,
I
n
d
o
n
esia,
b
etwe
en
Octo
b
er
2
0
2
3
u
n
til
Ma
r
c
h
2
0
2
4
.
T
h
e
s
elec
tio
n
o
f
r
esear
c
h
tim
e
is
b
e
ca
u
s
e
in
th
at
m
o
n
th
m
an
y
p
eo
p
le
tr
av
el
b
y
air
p
lan
e.
T
h
e
q
u
esti
o
n
er
s
d
is
tr
ib
u
ted
f
o
r
s
taf
f
an
d
s
tu
d
en
t
Un
iv
er
s
itas
Dir
g
an
tar
a
Ma
r
s
ek
al
Su
r
y
ad
ar
m
a.
R
esear
ch
er
s
s
elec
ted
r
esp
o
n
d
en
ts
wh
o
f
it
th
e
in
clu
s
io
n
cr
iter
ia
th
at
h
av
e
tr
av
eled
b
y
air
p
lan
e
with
in
th
e
last
1
y
ea
r
an
d
h
av
e
s
y
n
d
r
o
m
jet
lag
.
E
x
clu
s
io
n
cr
iter
ia
is
n
ev
er
tr
av
eled
b
y
air
p
lan
e.
T
h
is
s
tu
d
y
was
co
n
d
u
cte
d
o
n
1
1
7
p
e
o
p
le,
th
e
r
esu
lt
o
f
s
am
p
le
s
ize
ca
lcu
latio
n
f
r
o
m
L
em
esh
o
w’
s
f
o
r
m
u
la.
T
h
is
r
e
s
ea
r
ch
h
as
eth
ics
ap
p
r
o
v
al
f
r
o
m
r
esear
ch
a
n
d
co
m
m
u
n
ity
s
er
v
ice
in
s
titu
tio
n
,
Un
iv
er
s
itas
Dir
g
an
tar
a
Ma
r
s
e
k
al
Su
r
y
a
d
ar
m
a
(
KE
T
/UNSUR
YA/0
9
/I
I
I
/2
0
2
3
)
.
T
h
e
in
d
ep
en
d
en
t
v
ar
iab
le
is
jet
lag
s
y
n
d
r
o
m
e
a
n
d
th
e
d
ep
e
n
d
en
t
v
ar
iab
le
is
air
tr
av
el
f
atig
u
e.
R
esp
o
n
d
en
t
c
h
ar
ac
te
r
is
tic
v
ar
iab
les
as
co
n
f
o
u
n
d
er
s
a
r
e
ag
e,
g
en
d
er
,
ed
u
ca
tio
n
,
r
ea
s
o
n
f
o
r
t
r
av
el,
d
u
r
atio
n
o
f
air
tr
av
el,
f
r
eq
u
e
n
c
y
o
f
air
tr
av
el,
an
d
d
u
r
atio
n
o
f
jet
lag
s
y
n
d
r
o
m
e.
2
.
2
.
M
e
a
s
u
r
e
me
n
t
s
2
.
2
.
1
.
J
e
t
l
a
g
s
y
n
d
r
o
me
qu
e
s
t
i
o
n
n
a
i
re
T
h
is
r
esear
ch
u
tili
ze
s
a
q
u
esti
o
n
n
air
e
d
esig
n
ed
t
o
id
en
tif
y
j
et
lag
s
y
n
d
r
o
m
e,
wh
ic
h
is
m
o
d
if
ie
d
f
r
o
m
th
e
C
ir
ca
d
ian
T
y
p
e
I
n
v
en
to
r
y
q
u
esti
o
n
n
air
e
[
1
5
]
.
T
h
e
q
u
esti
o
n
n
air
e
d
escr
ib
es
h
o
w
d
is
r
u
p
tiv
e
jet
lag
s
y
n
d
r
o
m
e
is
to
d
aily
ac
tiv
ities
an
d
th
e
s
ev
er
ity
o
f
th
e
s
y
n
d
r
o
m
e
ex
p
er
i
en
ce
d
.
I
t
co
n
s
is
ts
o
f
1
0
s
tatem
en
t
item
s
,
ea
ch
r
ate
o
n
a
L
ik
er
t
s
ca
le
r
a
n
g
in
g
f
r
o
m
1
to
4
.
T
h
e
s
ca
le
u
s
es
th
e
f
o
ll
o
win
g
r
atin
g
s
:
1
=
n
ev
er
,
2
=
r
ar
ely
,
3
=
o
f
ten
,
a
n
d
4
=
alwa
y
s
.
R
e
s
p
o
n
d
en
ts
with
h
ig
h
s
co
r
e
in
d
icate
a
m
o
r
e
s
ev
er
e
ex
p
er
ien
ce
o
f
jet
l
ag
s
y
n
d
r
o
m
e
.
T
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
53
2
-
1
53
9
1534
ca
teg
o
r
izatio
n
f
o
r
th
is
q
u
esti
o
n
n
air
e
is
a
f
o
llo
w:
a
s
co
r
e
o
f
l
ess
t
h
an
1
9
(
m
ed
ia
n
)
in
d
icate
s
a
m
ild
ca
s
e
o
f
jet
lag
s
y
n
d
r
o
m
e,
wh
ile
a
s
co
r
e
o
f
1
9
o
r
m
o
r
e
(
m
ed
ian
)
in
d
icat
es
a
s
ev
er
e
ca
s
e.
T
h
e
q
u
esti
o
n
n
air
e
was
v
alid
ated
,
an
d
th
e
m
ea
s
u
r
em
en
t in
s
tr
u
m
e
n
t sh
o
ws
r
eliab
ilit
y
with
a
C
r
o
n
b
ac
h
’
s
Alp
h
a
c
o
ef
f
icien
t
o
f
0
.
8
0
8
.
2
.
2
.
2
.
T
he
a
ir
t
ra
v
el
f
a
t
ig
ue
qu
estio
nn
a
ire
T
h
e
f
atig
u
e
s
ca
le
q
u
esti
o
n
n
air
e
m
ea
s
u
r
es
air
tr
av
el
f
atig
u
e
wh
ich
is
m
o
d
if
ied
f
r
o
m
a
to
u
r
is
m
f
atig
u
e
s
ca
le
[
3
]
.
T
h
is
q
u
esti
o
n
n
air
e
ass
ess
es
f
iv
e
d
if
f
er
e
n
t
ty
p
es
o
f
f
atig
u
e:
p
h
y
s
ical
f
atig
u
e,
co
g
n
itiv
e
f
atig
u
e,
af
f
ec
tiv
e
f
atig
u
e,
a
n
d
m
o
tiv
ati
o
n
al
f
atig
u
e.
I
t
co
n
s
is
ts
o
f
1
5
s
tatem
en
t
item
s
,
ea
ch
r
ate
o
n
a
L
ik
er
t
s
ca
le
r
a
n
g
in
g
f
r
o
m
1
to
4
.
T
h
e
s
ca
le
u
s
es
th
e
f
o
llo
win
g
r
atin
g
s
:
1
=
d
id
n
o
t
f
ee
l,
2
=
s
lig
h
tly
f
elt,
3
=
m
o
d
er
ately
f
elt,
an
d
4
=
s
tr
o
n
g
ly
f
elt.
R
esp
o
n
d
en
t
s
with
h
ig
h
s
co
r
e
in
d
icate
a
m
o
r
e
s
ev
er
e
ex
p
e
r
ien
ce
o
f
air
tr
av
el
f
atig
u
e.
T
h
e
ca
teg
o
r
izatio
n
f
o
r
th
is
q
u
esti
o
n
n
air
e
is
a:
a
s
co
r
e
o
f
less
th
a
n
2
0
(
m
e
d
ian
)
in
d
icate
s
a
m
ild
ca
s
e
o
f
a
ir
tr
av
el
f
atig
u
e,
wh
ile
a
s
co
r
e
o
f
2
0
o
r
m
o
r
e
(
m
ed
ian
)
in
d
icate
s
a
s
ev
er
e
ca
s
e.
T
h
e
q
u
esti
o
n
n
air
e
was
v
alid
ated
,
a
n
d
th
e
m
ea
s
u
r
em
en
t in
s
tr
u
m
e
n
t sh
o
w
s
r
eliab
ilit
y
with
a
C
r
o
n
b
ac
h
’
s
Alp
h
a
co
ef
f
icien
t o
f
0
.
9
4
3
.
2
.
3
.
R
e
s
e
a
r
ch
a
n
a
l
y
s
i
s
T
h
e
d
escr
ip
tio
n
an
aly
s
is
ex
a
m
in
es
th
e
ag
e,
g
en
d
e
r
,
ed
u
ca
t
io
n
,
r
ea
s
o
n
f
o
r
tr
av
el,
d
u
r
atio
n
o
f
tr
av
el,
f
r
eq
u
e
n
cy
o
f
tr
a
v
el,
a
n
d
d
u
r
a
tio
n
o
f
jet
lag
s
y
n
d
r
o
m
e.
C
ateg
o
r
ical
v
a
r
iab
les
wer
e
p
r
esen
ted
as
co
u
n
ts
an
d
p
er
ce
n
tag
es,
wh
ile
co
n
tin
u
o
u
s
v
ar
iab
les
u
s
in
g
m
ea
n
,
s
tan
d
ar
d
d
ev
iatio
n
,
m
in
im
u
m
,
m
ax
im
u
m
,
a
n
d
9
5
%
co
n
f
id
en
ce
in
ter
v
al.
W
e
u
s
ed
C
h
i
-
s
q
u
ar
e
an
aly
s
is
to
ass
ess
th
e
co
r
r
elatio
n
b
etwe
en
jet
la
g
s
y
n
d
r
o
m
e
an
d
air
tr
av
el
f
atig
u
e.
Ad
d
itio
n
ally
,
w
e
p
er
f
o
r
m
ed
m
u
ltip
le
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
es to
id
en
tif
y
th
e
p
r
im
ar
y
f
ac
to
r
s
in
f
lu
en
c
in
g
air
tr
a
v
el
f
atig
u
e.
A
p
-
v
alu
e
o
f
less
th
an
0
.
0
5
was
co
n
s
id
er
ed
s
tatis
tical
ly
s
ig
n
if
ican
t.
T
h
e
s
tatis
tical
p
ac
k
ag
e
f
o
r
th
e
s
o
cial
s
cien
ce
s
(
SP
SS
)
v
er
s
io
n
2
7
.
0
was u
til
ized
f
o
r
a
n
aly
s
is
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
On
e
h
u
n
d
r
ed
an
d
s
ev
e
n
teen
p
ar
ticip
ated
in
th
is
s
tu
d
y
.
Ma
le
p
ar
ticip
an
ts
wer
e
s
lig
h
tly
o
u
t
n
u
m
b
er
e
d
f
em
ales,
co
m
p
r
is
in
g
6
4
.
1
%
o
f
th
e
to
tal.
Mo
s
t
p
ar
ticip
an
ts
we
r
e
ac
ad
em
y
o
f
lev
els
e
d
u
ca
tio
n
(
6
7
.
5
%).
T
h
e
m
o
s
t
co
m
m
o
n
r
ea
s
o
n
f
o
r
tr
av
elin
g
is
to
v
is
it
f
am
ily
(
2
3
.
9
%).
T
ab
l
e
1
s
h
o
ws th
e
ch
ar
ac
ter
is
tic
s
o
f
th
ese
r
esp
o
n
d
en
t.
T
ab
le
2
s
h
o
ws
th
e
m
ea
n
s
co
r
e
s
o
f
ag
es,
d
u
r
atio
n
o
f
air
tr
av
e
l,
f
r
eq
u
e
n
cy
o
f
air
tr
av
el,
a
n
d
d
u
r
atio
n
o
f
jet
la
g
s
y
n
d
r
o
m
e.
T
h
e
av
e
r
ag
e
a
g
e
o
f
th
e
p
ar
ticip
an
ts
is
3
6
.
9
1
±
9
.
6
8
y
ea
r
s
o
ld
.
T
h
e
p
ar
ticip
an
ts
ar
e
in
th
e
ad
u
lt
s
tag
e,
with
a
m
in
im
u
m
ag
e
o
f
2
1
.
T
h
e
av
er
ag
e
d
u
r
atio
n
o
f
air
tr
a
v
el
is
4
.
4
±
4
.
1
2
h
o
u
r
s
,
th
e
av
er
a
g
e
f
r
eq
u
e
n
cy
o
f
air
tr
av
el
is
3
.
4
6
±
6
.
6
6
tim
es p
er
y
ea
r
,
an
d
t
h
e
av
er
a
g
e
d
u
r
atio
n
o
f
jet
lag
s
y
n
d
r
o
m
e
is
7
.
2
9
±
1
2
.
2
7
h
o
u
r
s
.
T
ab
le
3
p
r
esen
ts
th
e
lev
els
o
f
jet
lag
s
y
n
d
r
o
m
e
an
d
air
t
r
a
v
el
f
atig
u
e.
T
h
e
m
aj
o
r
ity
o
f
p
a
r
ticip
an
ts
ex
p
er
ien
ce
d
s
ev
er
e
jet
la
g
s
y
n
d
r
o
m
e
(
5
4
.
7
%).
T
h
e
m
ajo
r
ity
o
f
p
a
r
ticip
an
ts
ex
p
er
ie
n
ce
d
s
e
v
er
e
air
t
r
av
el
f
atig
u
e
(
5
3
.
8
%).
T
ab
le
4
s
h
o
ws
th
e
r
e
latio
n
s
h
ip
b
etwe
en
jet
lag
s
y
n
d
r
o
m
e
a
n
d
air
tr
a
v
el
f
atig
u
e
u
s
in
g
th
e
C
h
i
-
s
q
u
ar
e
test
.
T
h
e
f
in
d
in
g
s
in
T
ab
le
4
r
ev
ea
led
a
s
ig
n
if
ican
t
co
r
r
elatio
n
b
etwe
en
jet
lag
s
y
n
d
r
o
m
e
a
n
d
air
tr
av
el
f
atig
u
e
(
p
<0
.
0
0
1
)
.
Par
ticip
an
ts
with
m
ild
jet
lag
s
y
n
d
r
o
m
e
e
x
p
er
ien
c
ed
m
ild
f
atig
u
e
(
6
9
.
8
%),
wh
ile
th
o
s
e
with
s
ev
e
r
e
jet
lag
s
y
n
d
r
o
m
e
ex
p
e
r
ien
ce
d
s
ev
er
e
air
tr
av
el
f
atig
u
e
(
7
3
.
4
%).
T
ab
le
1
.
R
esp
o
n
d
e
n
t c
h
ar
ac
ter
is
tics
: g
en
d
er
,
ed
u
ca
tio
n
,
an
d
r
ea
s
o
n
s
f
o
r
tr
av
el
(
N
=
1
1
7
)
V
a
r
i
a
b
l
e
N
%
G
e
n
d
e
r
M
a
l
e
75
6
4
.
1
%
F
e
mal
e
42
3
5
.
9
%
Ed
u
c
a
t
i
o
n
H
i
g
h
sc
h
o
o
l
38
3
2
.
5
%
A
c
a
d
e
m
y
79
6
7
.
5
%
R
e
a
s
o
n
s f
o
r
t
r
a
v
e
l
W
o
r
k
55
4
7
%
F
a
mi
l
y
28
2
3
.
9
%
Tr
a
v
e
l
16
1
3
.
7
%
O
t
h
e
r
s
18
1
5
.
4
%
T
ab
le
2
.
R
esp
o
n
d
e
n
t c
h
ar
ac
ter
is
tics
: a
g
e,
d
u
r
atio
n
o
f
tr
av
el,
f
r
eq
u
en
c
y
o
f
tr
av
el,
an
d
d
u
r
ati
o
n
o
f
jet
lag
s
y
n
d
r
o
m
e
(
n
=
1
1
7
)
V
a
r
i
a
b
l
e
M
e
a
n
±
S
D
M
a
x
i
m
u
m
M
i
n
i
m
u
m
9
5
%
C
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
A
g
e
(
y
e
a
r
)
3
6
.
9
1
±
9
.
6
8
64
21
3
5
.
1
3
3
-
3
8
.
6
8
D
u
r
a
t
i
o
n
o
f
a
i
r
t
r
a
v
e
l
(
h
o
u
r
)
4
.
4
±
4
.
1
2
20
0
3
.
6
4
-
5
.
1
5
F
r
e
q
u
e
n
c
y
o
f
a
i
r
t
r
a
v
e
l
i
n
o
n
e
y
e
a
r
(
t
i
mes)
3
.
4
6
±
6
.
6
6
45
0
2
.
2
4
-
4
.
6
8
D
u
r
a
t
i
o
n
o
f
j
e
t
l
a
g
sy
n
d
r
o
m
e
(
h
o
u
r
)
7
.
2
9
±
1
2
.
2
7
72
0
5
.
0
5
1
-
9
.
5
4
5
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
8
0
6
C
o
r
r
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tio
n
b
etw
ee
n
jet
la
g
s
yn
d
r
o
me
a
n
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a
ir
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a
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l fa
tig
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(
K
h
a
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mri
)
1535
T
ab
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5
s
h
o
ws
th
e
r
esu
lt
o
f
m
u
ltip
le
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
.
T
h
e
r
esu
lts
s
h
o
w
th
at
th
e
Od
d
s
R
atio
(
OR
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o
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m
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8
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1
9
with
9
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I
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n
am
ely
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7
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to
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1
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ea
n
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g
th
at
s
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e
r
e
jet
lag
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y
n
d
r
o
m
e
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av
e
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ch
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ce
o
f
r
esp
o
n
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e
n
ts
ex
p
er
ien
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er
e
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tr
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v
el
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atig
u
e,
n
am
ely
8
.
5
1
9
tim
es
co
m
p
ar
ed
to
m
ild
jet
lag
s
y
n
d
r
o
m
e.
T
h
e
v
a
r
iab
l
e
d
u
r
ati
o
n
o
f
jet
lag
s
y
n
d
r
o
m
e
h
as
an
OR
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alu
e
o
f
1
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0
3
8
with
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5
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I
0
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9
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ea
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g
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at
r
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e
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ts
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o
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e
l
o
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g
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d
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r
atio
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t
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s
y
n
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r
o
m
e
will
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av
e
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c
h
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ce
o
f
r
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o
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en
ts
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er
ien
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g
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e
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atig
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e
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1
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m
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ar
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o
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e
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o
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e
s
h
o
r
t
d
u
r
atio
n
o
f
jet
lag
s
y
n
d
r
o
m
e.
T
h
e
v
a
r
iab
le
g
en
d
e
r
h
as
a
n
OR
v
al
u
e
o
f
0
.
2
7
9
wit
h
9
5
%C
I
0
.
1
0
9
t
o
0
.
7
3
0
,
m
ea
n
in
g
th
e
r
esp
o
n
d
en
ts
wh
o
ar
e
f
e
m
ale
will h
av
e
a
ch
an
ce
o
f
r
esp
o
n
d
e
n
ts
ex
p
er
ien
c
in
g
s
ev
er
e
air
tr
a
v
el
f
atig
u
e
.
T
ab
le
3
.
Dec
r
ip
tiv
e
o
f
jet
lag
s
y
n
d
r
o
m
e
an
d
air
tr
av
el
f
atig
u
e
(
N
=
1
1
7
)
V
a
r
i
a
b
l
e
N
%
Jet
l
a
g
s
y
n
d
r
o
me
l
e
v
e
l
M
i
l
d
53
4
5
.
3
%
S
e
v
e
r
e
64
5
4
.
7
%
A
i
r
t
r
a
v
e
l
f
a
t
i
g
u
e
l
e
v
e
l
M
i
l
d
54
4
6
.
2
%
S
e
v
e
r
e
63
5
3
.
8
%
T
ab
le
4
.
T
h
e
co
r
r
elatio
n
tet
la
g
s
y
n
d
r
o
m
e
with
air
tr
a
v
el
f
ati
g
u
e
(
N
=
1
1
7
)
V
a
r
i
a
b
l
e
A
i
r
t
r
a
v
e
l
f
a
t
i
g
u
e
To
t
a
l
O
d
d
s
r
a
t
i
o
(
9
5
%
C
I
)
P
v
a
l
u
e
M
i
l
d
S
e
v
e
r
e
N
%
N
%
Jet
l
a
g
s
y
n
d
r
o
me
6
,
3
9
3
0
.
0
0
1
*
M
i
l
d
37
6
9
.
8
%
16
2
8
.
5
%
53
(
2
.
8
5
2
-
1
4
.
3
3
2
)
S
e
v
e
r
e
17
2
6
.
6
%
47
7
3
.
4
%
64
*
p
<
0
.
0
5
s
i
g
n
i
f
i
c
a
n
c
e
T
ab
le
5
.
T
h
e
r
esu
lts
o
f
m
u
ltip
le
r
eg
r
ess
io
n
an
aly
s
is
V
a
r
i
a
b
l
e
B
SE
W
a
l
d
p
-
v
a
l
u
e
O
d
d
s
R
a
t
i
o
9
5
%
C
I
Jet
l
a
g
s
y
n
d
r
o
me
2
.
1
4
2
0
.
4
7
2
2
0
.
5
8
9
0
.
0
0
1
8
.
5
1
9
3
.
3
7
7
-
2
1
.
4
9
1
G
e
n
d
e
r
-
1
.
2
7
5
0
.
4
9
0
6
.
7
7
1
0
.
0
0
9
0
.
2
7
9
0
.
1
0
7
-
0
.
7
3
0
D
u
r
a
t
i
o
n
o
f
j
e
t
l
a
g
sy
n
d
r
o
m
e
0
.
5
0
7
0
.
6
5
1
0
.
4
3
6
0
.
0
7
5
1
.
0
3
8
0
.
9
9
6
-
1
.
0
8
2
C
o
n
st
a
n
t
0
.
5
0
7
0
.
6
5
1
0
.
4
3
6
0
.
4
3
6
1
.
6
6
1
T
h
e
r
esu
lts
s
h
o
wed
th
at
th
er
e
was
m
o
r
e
m
ale
p
ar
ticip
atio
n
in
th
is
s
tu
d
y
co
m
p
ar
ed
to
f
em
ales.
Ma
le
an
d
f
e
m
ale
g
en
d
er
d
if
f
er
e
n
ce
s
in
s
tu
d
ies
r
elate
d
to
jet
lag
s
y
n
d
r
o
m
e
ap
p
ea
r
i
n
th
e
s
leep
d
is
tu
r
b
an
ce
s
ec
tio
n
,
wo
m
en
a
r
e
m
o
r
e
s
en
s
itiv
e
to
s
leep
d
is
tu
r
b
an
ce
s
i
n
th
e
f
ir
s
t
f
iv
e
d
ay
s
o
f
jet
lag
s
y
n
d
r
o
m
e
[1
6
]
.
Few
s
tu
d
ies
h
av
e
ev
alu
ated
th
is
p
ar
am
ete
r
.
T
h
e
g
en
d
er
lin
k
to
th
e
jet
lag
s
y
n
d
r
o
m
e
is
b
io
lo
g
ical
clo
ck
d
is
r
u
p
tio
n
o
r
cir
ca
d
ian
r
h
y
th
m
d
is
r
u
p
tio
n
.
Gen
d
er
-
s
p
ec
if
ic
d
if
f
er
en
ce
s
in
jet
lag
ar
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
af
f
ec
ted
h
ea
lth
p
r
o
b
lem
s
s
u
ch
as d
iab
et
es,
wh
ile
in
wo
m
e
n
,
it is
ass
o
ciate
d
with
s
leep
d
is
o
r
d
e
r
s
,
p
s
y
ch
o
p
ath
o
lo
g
y
,
an
d
m
etab
o
lic
s
y
n
d
r
o
m
e
[
1
7
]
.
T
h
is
r
esear
ch
s
h
o
ws
th
at
g
en
d
e
r
s
s
u
f
f
er
f
r
o
m
jet
lag
s
y
n
d
r
o
m
e
an
d
air
tr
a
v
el
f
ati
g
u
e.
T
h
e
r
esear
ch
in
d
icate
s
th
at
wh
ile
m
o
s
t
air
tr
av
eler
s
ar
e
ad
u
lts
,
th
er
e
ar
e
also
r
esp
o
n
d
en
ts
wh
o
ar
e
eld
er
ly
,
a
r
o
u
n
d
6
4
y
ea
r
s
o
ld
.
I
t’
s
im
p
o
r
tan
t
to
p
ay
ex
tr
a
atten
tio
n
to
th
e
h
ea
lth
co
n
d
itio
n
s
o
f
eld
e
r
ly
tr
a
v
eler
s
.
Alth
o
u
g
h
th
e
s
tu
d
y
d
o
esn
’
t
s
h
o
w
d
ir
e
ct
lin
k
b
etwe
en
a
g
e
a
n
d
f
atig
u
e
f
r
o
m
air
tr
a
v
el,
t
h
e
eld
er
ly
s
h
o
u
ld
s
till
tak
e
p
r
ec
au
tio
n
s
an
d
p
r
ep
a
r
e
a
cc
o
r
d
in
g
l
y
.
Fatig
u
e
f
r
o
m
air
tr
av
el
ca
n
wo
r
s
en
th
e
h
ea
lth
o
f
eld
er
ly
in
d
i
v
id
u
als
with
ex
is
tin
g
h
ea
lth
is
s
u
es.
J
et
lag
an
d
tr
av
el
f
atig
u
e
ca
n
also
wo
r
s
en
s
leep
d
is
o
r
d
er
s
in
eld
er
ly
,
s
o
it’s
s
u
g
g
ested
to
p
r
o
v
id
e
p
s
y
ch
o
lo
g
ical
ex
am
in
atio
n
s
o
r
h
ea
lth
co
n
s
u
ltati
o
n
s
f
o
r
at
-
r
is
k
g
r
o
u
p
[
1
8
]
.
E
ld
er
ly
in
d
iv
id
u
als
with
a
h
is
to
r
y
o
f
illn
ess
s
h
o
u
ld
p
lan
th
eir
tr
av
el
ca
r
e
f
u
lly
to
m
in
i
m
ize
p
o
ten
tial iss
u
es d
u
r
in
g
ai
r
tr
av
el.
I
t
is
im
p
o
r
tan
t
t
o
co
n
s
id
er
h
a
v
in
g
a
d
o
cto
r
o
r
m
ed
ical
p
e
r
s
o
n
n
el
ac
co
m
p
an
y
th
e
tr
ip
an
d
e
n
s
u
r
e
th
at
n
ec
ess
ar
y
m
ed
icatio
n
is
p
r
o
v
id
ed
[
1
2
]
.
E
ld
er
in
d
iv
id
u
als wit
h
a
h
is
to
r
y
o
f
illn
ess
m
ay
ex
p
er
ien
ce
ex
ac
er
b
ate
d
jet
lag
s
y
n
d
r
o
m
e
an
d
air
tr
av
el
f
atig
u
e,
o
r
th
eir
p
r
e
-
ex
is
tin
g
c
o
n
d
itio
n
m
a
y
wo
r
s
en
.
Me
d
ical
p
er
s
o
n
n
el
d
ev
o
te
s
ig
n
if
ican
t
ed
u
ca
tio
n
al
e
f
f
o
r
ts
,
esp
ec
ially
d
u
r
in
g
p
ea
k
air
tr
av
el
s
ea
s
o
n
s
s
u
ch
as
r
elig
io
u
s
f
esti
v
als
o
r
lo
n
g
h
o
lid
ay
s
,
wh
e
n
p
eo
p
le
tak
e
tim
e
o
f
f
to
v
is
it f
am
ily
in
d
is
tan
t p
lace
s
b
y
ai
r
p
la
n
e.
M
o
s
t a
ir
t
r
av
el
is
f
o
r
p
er
s
o
n
al
r
ea
s
o
n
s
r
ath
er
th
an
w
o
r
k
-
r
elate
d
,
esp
ec
ially
to
v
is
it
f
am
ily
.
I
n
I
n
d
o
n
esia,
wh
er
e
th
e
r
e
ar
e
n
u
m
er
o
u
s
r
elig
io
u
s
h
o
lid
ay
s
an
d
an
n
iv
e
r
s
ar
ies,
m
an
y
p
e
o
p
le
u
s
e
co
llectiv
e
leav
e
to
tr
av
el
lo
n
g
d
is
tan
ce
s
to
v
i
s
it f
am
ily
.
Re
s
p
o
n
d
en
ts
with
a
h
is
to
r
y
o
f
p
ast
an
d
cu
r
r
e
n
t
illn
ess
es
ar
e
at
h
ig
h
r
is
k
o
f
ex
p
er
ie
n
c
in
g
h
ea
lth
p
r
o
b
lem
s
d
u
r
in
g
th
ei
r
tr
av
els.
Go
o
d
p
lan
n
in
g
f
o
r
lo
n
g
-
d
is
ta
n
ce
air
b
y
air
tr
a
v
el
f
o
r
at
-
r
is
k
g
r
o
u
p
s
.
R
esear
ch
h
as
s
h
o
wn
th
at
air
tr
av
el
is
p
ar
t
o
f
th
e
r
is
k
f
o
r
p
eo
p
le
with
a
h
is
to
r
y
o
f
asth
m
a,
as
air
tr
av
el
ca
n
wo
r
s
en
co
n
d
itio
n
s
s
u
ch
as
h
y
p
er
b
ar
ic
h
y
p
o
x
ia,
in
cr
ea
s
ed
h
ea
r
t
r
ate,
an
d
ev
en
h
y
p
er
te
n
s
io
n
[
1
9
]
,
[
2
0
]
.
T
r
a
v
eler
s
with
asth
m
a
m
ay
ex
p
e
r
ien
ce
jet
lag
an
d
tr
a
v
el
f
atig
u
e,
wh
ic
h
ca
n
ex
ac
e
r
b
ate
asth
m
a
s
y
m
p
to
m
s
.
O
p
tim
al
asth
m
a
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.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
53
2
-
1
53
9
1536
co
n
tr
o
l
b
e
f
o
r
e
air
tr
av
el
is
e
s
s
en
tial.
B
ef
o
r
e
tr
av
elin
g
,
th
e
asth
m
a
m
an
ag
em
e
n
t
p
lan
s
h
o
u
ld
b
e
r
ev
iewe
d
.
Patien
ts
s
h
o
u
ld
ca
r
r
y
asth
m
a
m
ed
icatio
n
s
s
u
ch
as
o
r
al
c
o
r
t
ico
s
ter
o
id
s
an
d
in
h
ale
r
s
.
T
r
av
eler
s
with
asth
m
a
s
h
o
u
ld
h
av
e
a
s
elf
-
m
an
a
g
em
en
t
p
lan
in
th
e
ev
en
t
o
f
an
ex
ac
er
b
atio
n
o
cc
u
r
r
in
g
d
u
r
in
g
tr
a
v
el.
Oth
er
r
is
k
g
r
o
u
p
s
,
s
u
ch
as
tr
av
eler
s
with
ch
r
o
n
ic
h
ea
r
t
d
is
ea
s
e
,
ar
e
at
h
ig
h
r
is
k
o
f
i
n
-
f
lig
h
t
d
ec
o
m
p
en
s
atio
n
with
s
u
d
d
en
ca
r
d
iac
ar
r
est
o
r
d
ea
th
[
2
1
]
.
T
r
a
v
el
f
a
tig
u
e
an
d
p
o
s
t
-
f
lig
h
t
jet
lag
s
y
n
d
r
o
m
e
also
th
r
ea
ten
to
wo
r
s
e
n
th
e
d
is
ea
s
e.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
in
th
is
s
tu
d
y
d
id
n
o
t
m
ak
e
ef
f
o
r
ts
to
p
r
ev
en
t
jet
lag
s
y
n
d
r
o
m
e
b
e
f
o
r
e
tr
av
elin
g
,
b
u
t
m
ad
e
ef
f
o
r
ts
to
r
e
d
u
ce
jet
lag
s
y
n
d
r
o
m
e
wh
en
th
e
y
f
elt
it.
T
h
er
ef
o
r
e
,
th
e
r
e
n
ee
d
s
to
b
e
g
o
o
d
p
lan
n
in
g
r
elate
d
to
h
ea
lth
b
ef
o
r
e
tr
a
v
elin
g
,
i
n
clu
d
in
g
t
h
e
co
n
s
u
m
p
tio
n
o
f
m
e
d
icin
es.
Go
o
d
tr
av
el
p
lan
n
in
g
is
im
p
o
r
tan
t
n
o
t
o
n
ly
f
o
r
th
e
eld
er
ly
b
u
t
also
f
o
r
o
th
er
h
i
g
h
-
r
is
k
g
r
o
u
p
s
s
u
ch
as
ch
ild
r
en
a
n
d
i
n
f
an
ts
.
Par
en
ts
an
d
f
lig
h
t
cr
ew
o
r
air
c
r
af
t
m
e
d
ical
p
er
s
o
n
n
el
n
ee
d
to
c
o
n
s
id
er
th
e
p
r
esen
ce
o
f
ch
ild
p
ass
en
g
er
s
o
r
in
f
an
ts
w
h
o
m
ay
ex
p
e
r
ien
ce
jet
lag
s
y
n
d
r
o
m
e
an
d
tr
av
el
f
atig
u
e.
P
ar
en
ts
with
y
o
u
n
g
ch
ild
r
en
ca
n
t
ell
th
e
f
lig
h
t
cr
e
w
to
p
r
o
v
id
e
g
o
o
d
f
o
o
d
f
o
r
th
eir
ch
ild
,
co
n
s
id
er
f
o
o
d
aller
g
ies,
m
an
ag
e
h
ea
lt
h
p
r
o
b
lem
s
d
u
e
to
air
p
r
ess
u
r
e
at
h
ig
h
altitu
d
es
f
r
o
m
g
r
o
u
n
d
le
v
el,
an
d
esp
ec
ially
m
an
ag
e
jet
lag
s
y
n
d
r
o
m
e
af
ter
th
e
tr
ip
[
2
2
]
.
A
ch
ild
o
r
i
n
f
a
n
t
with
a
h
ea
lth
c
o
n
d
itio
n
m
ay
r
eq
u
ir
e
m
ed
ical
atten
tio
n
d
u
r
in
g
t
h
e
tr
ip
an
d
n
ec
ess
ar
y
m
ed
icatio
n
.
E
m
er
g
e
n
cies
d
u
r
in
g
tr
av
el
m
a
y
o
cc
u
r
d
u
e
to
o
v
er
e
x
er
tio
n
o
f
th
e
ch
ild
.
T
h
e
s
y
m
p
to
m
s
o
f
illn
ess
ex
p
er
ien
ce
d
b
y
c
h
ild
r
en
d
u
r
in
g
th
e
tr
i
p
ar
e
g
en
e
r
ally
f
ev
e
r
an
d
th
e
em
er
g
e
n
cy
t
h
a
t
o
cc
u
r
s
is
ep
ilep
s
y
[
2
3
]
.
C
h
ild
r
en
n
ee
d
to
b
e
well
-
p
r
ep
ar
e
d
f
o
r
tr
av
el
esp
ec
ially
th
o
s
e
with
ce
r
tain
d
is
ea
s
es o
r
co
n
g
en
ital
d
is
ea
s
es
s
u
ch
as a
u
tis
m
,
atten
tio
n
d
ef
ic
it h
y
p
er
ac
tiv
ity
d
is
o
r
d
er
(
ADHD
)
,
asth
m
a,
h
ea
r
t d
is
ea
s
e,
o
r
d
is
ab
ilit
ies.
R
esp
o
n
d
en
ts
in
th
is
s
tu
d
y
h
av
e
all
ex
p
er
ien
ce
d
jet
lag
d
u
r
in
g
air
tr
av
el.
T
h
e
m
ajo
r
ity
o
f
th
e
s
y
m
p
to
m
s
f
elt
wer
e
m
o
r
e
th
an
o
n
e
s
y
m
p
t
o
m
an
d
s
o
m
e
e
v
en
ex
p
er
ie
n
ce
d
m
o
r
e
th
an
two
s
y
m
p
to
m
s
.
S
y
m
p
to
m
s
o
f
jet
lag
s
y
n
d
r
o
m
e
th
at
h
av
e
b
ee
n
ex
p
er
ien
ce
d
b
y
r
esp
o
n
d
en
ts
in
clu
d
e
f
atig
u
e,
d
r
o
wsi
n
ess
,
im
p
air
ed
co
n
ce
n
tr
atio
n
,
m
o
o
d
s
win
g
s
,
h
ea
d
ac
h
es,
n
a
u
s
ea
,
d
if
f
icu
lty
s
leep
in
g
,
co
n
s
tip
atio
n
,
an
d
o
th
er
s
.
So
m
e
o
n
e
wh
o
h
as
h
y
p
er
ten
s
io
n
an
d
d
ia
b
etes
wh
en
e
x
p
er
ien
cin
g
s
y
m
p
to
m
s
o
f
jet
lag
s
y
n
d
r
o
m
e
will
b
e
at
r
is
k
o
f
in
cr
ea
s
in
g
b
lo
o
d
p
r
ess
u
r
e
an
d
b
lo
o
d
s
u
g
ar
[
1
]
,
[
2
4
]
,
[
2
5
]
.
T
h
e
s
tu
d
y
ex
p
lain
s
th
at
a
p
e
r
s
o
n
wh
o
h
as
a
d
is
ea
s
e
will
b
e
at
h
ig
h
r
is
k
o
f
d
eter
io
r
atin
g
h
ea
lth
wh
e
n
ex
p
er
ien
cin
g
jet
lag
s
y
n
d
r
o
m
e
s
o
p
r
ev
en
tio
n
is
b
etter
th
an
cu
r
e.
T
h
u
s
,
air
tr
av
el
p
r
ep
ar
atio
n
s
n
ee
d
to
b
e
ca
r
ef
u
lly
d
esig
n
ed
f
o
r
h
i
g
h
-
r
is
k
g
r
o
u
p
s
.
T
h
e
av
er
a
g
e
tr
ip
d
u
r
atio
n
wa
s
4
.
4
h
o
u
r
s
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
4
.
1
1
5
h
o
u
r
s
.
R
e
s
p
o
n
d
en
ts
r
ep
o
r
ted
h
av
in
g
tr
a
v
eled
b
y
ai
r
f
o
r
m
o
r
e
th
an
8
h
o
u
r
s
.
T
h
e
d
u
r
atio
n
o
f
tr
av
el
ac
co
r
d
in
g
t
o
r
esear
ch
is
o
n
e
o
f
th
e
f
ac
to
r
s
th
at
af
f
ec
t
f
atig
u
e
[2
6]
.
Ho
wev
er
,
in
th
is
s
tu
d
y
,
t
h
e
d
u
r
atio
n
o
f
th
e
tr
ip
h
ad
n
o
ef
f
ec
t
b
ec
au
s
e
th
e
av
er
ag
e
r
esp
o
n
d
e
n
t
d
id
n
o
t
tr
av
el
lo
n
g
d
is
tan
ce
s
.
T
h
e
av
er
ag
e
f
r
eq
u
en
cy
o
f
tr
av
el
was
3
.
4
6
tim
es
p
er
y
ea
r
,
in
d
icatin
g
th
at
m
o
s
t
r
esp
o
n
d
e
n
ts
wer
e
tr
av
eler
s
.
All
r
esp
o
n
d
en
ts
wh
o
e
x
p
er
ien
ce
d
jet
lag
r
ep
o
r
ted
an
a
v
er
ag
e
jet
lag
d
u
r
atio
n
o
f
7
.
2
9
8
h
o
u
r
s
af
ter
air
tr
av
el.
T
h
e
r
esu
lts
o
f
th
e
an
aly
s
is
s
h
o
wed
an
ass
o
ciatio
n
b
etwe
en
th
e
d
u
r
atio
n
o
f
jet
lag
an
d
f
atig
u
e
d
u
e
to
air
tr
a
v
el.
T
h
is
is
d
u
e
to
th
e
s
ig
n
if
ican
t
v
ar
iatio
n
in
jet
lag
ex
p
er
ien
ce
am
o
n
g
r
esp
o
n
d
en
ts
.
R
esp
o
n
d
e
n
ts
wh
o
ex
p
er
ien
ce
lo
n
g
e
r
jet
lag
will
b
e
at
r
i
s
k
o
f
ex
p
er
ien
cin
g
f
atig
u
e
d
u
e
to
h
ea
v
ier
air
tr
av
el
[
2
7
]
.
Alth
o
u
g
h
th
e
s
ev
er
ity
o
f
jet
lag
s
y
n
d
r
o
m
e
ex
p
er
ie
n
ce
d
b
y
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
e
n
ts
was lo
w,
th
er
e
wer
e
s
till
r
es
p
o
n
d
en
ts
wh
o
e
x
p
er
ien
ce
d
h
ig
h
j
et
lag
s
y
n
d
r
o
m
e
s
ev
er
ity
.
J
et
lag
s
y
n
d
r
o
m
e
h
as
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
with
air
tr
av
el
f
atig
u
e.
R
esp
o
n
d
en
ts
wh
o
e
x
p
er
ien
ce
d
jet
lag
s
y
n
d
r
o
m
e
with
h
i
g
h
s
ev
er
ity
ex
p
e
r
ien
ce
d
air
tr
a
v
el
f
atig
u
e
with
h
ig
h
le
v
els
o
f
f
atig
u
e.
T
h
e
jet
lag
s
y
n
d
r
o
m
e
ca
u
s
es
f
atig
u
e
to
wo
r
s
en
.
Air
tr
av
el
f
atig
u
e
is
ca
u
s
ed
b
y
th
e
lo
n
g
d
u
r
ati
o
n
o
f
th
e
t
r
ip
an
d
o
th
er
tr
a
v
el
af
ter
war
d
s
,
an
d
s
o
m
e
ev
en
g
o
s
tr
aig
h
t
to
wo
r
k
with
o
u
t
ta
k
in
g
a
b
r
ea
k
.
Air
tr
av
el
f
atig
u
e
ex
p
e
r
ien
ce
d
ca
n
in
clu
d
e
b
o
d
y
d
is
co
m
f
o
r
t,
ac
h
es,
h
ea
d
ac
h
es,
lack
o
f
ap
p
etite,
d
if
f
ic
u
lty
s
leep
in
g
,
n
au
s
ea
,
an
d
v
o
m
itin
g
,
an
d
in
d
ig
esti
o
n
[
2
8
]
.
A
h
ig
h
ly
in
f
l
u
en
tial
f
ac
to
r
in
air
tr
av
el
f
atig
u
e
is
jet
lag
s
y
n
d
r
o
m
e.
J
et
lag
s
y
n
d
r
o
m
e
o
cc
u
r
s
d
u
e
to
th
e
cir
ca
d
ian
d
is
r
u
p
tio
n
ca
u
s
ed
b
y
air
tr
a
v
el
in
d
if
f
e
r
en
t
tim
e
zo
n
es.
T
h
is
f
atig
u
e
ca
n
h
u
r
t
h
ea
lth
,
d
ec
r
ea
s
e
p
er
f
o
r
m
an
ce
,
d
ec
r
ea
s
e
d
ec
is
io
n
-
m
ak
in
g
,
an
d
d
ec
r
ea
s
e
co
n
ce
n
tr
atio
n
p
o
we
r
,
wh
ich
ca
n
b
e
at
r
is
k
o
f
ac
cid
en
ts
at
wo
r
k
o
r
wh
ile
tr
av
elin
g
[
2
9
]
,
[
3
0
]
.
T
h
e
ef
f
ec
t
o
f
jet
lag
s
y
n
d
r
o
m
e
o
n
ai
r
tr
av
el
f
atig
u
e
i
s
s
ig
n
if
ican
t.
E
f
f
o
r
ts
to
r
ed
u
ce
jet
lag
s
y
n
d
r
o
m
e
ar
e
n
ec
ess
ar
y
b
ec
a
u
s
e
th
ey
ca
n
s
ig
n
if
ican
tly
r
ed
u
c
e
jet
lag
s
y
n
d
r
o
m
e
an
d
r
ed
u
ce
f
atig
u
e
d
u
e
to
air
tr
a
v
el.
Ho
wev
e
r
,
th
e
r
esu
lts
o
f
th
e
s
y
s
tem
atic
r
ev
ie
w
s
h
o
w
th
at
jet
lag
s
y
n
d
r
o
m
e
h
as
n
o
t
r
ec
eiv
ed
a
g
o
o
d
tr
ea
tm
en
t
s
tr
ateg
y
,
f
o
r
ex
a
m
p
le,
s
leep
t
h
er
ap
y
an
d
h
ea
lth
y
f
o
o
d
.
T
h
e
r
e
is
n
o
ev
id
en
ce
o
f
ap
p
r
o
p
r
iate
p
h
ar
m
ac
o
lo
g
ical
an
d
n
o
n
-
p
h
ar
m
ac
o
l
o
g
ical
in
ter
v
e
n
tio
n
s
in
m
an
a
g
i
n
g
jet
lag
s
y
n
d
r
o
m
e
an
d
f
atig
u
e
d
u
e
to
air
t
r
av
el
[
1
]
,
[
3
1
]
.
Fatig
u
e
m
a
n
ag
em
en
t
i
n
clu
d
es
p
r
e
v
e
n
tio
n
an
d
co
n
tr
o
l
s
tr
ateg
ies
s
u
ch
as
g
ettin
g
en
o
u
g
h
s
leep
b
ef
o
r
e
th
e
n
ex
t
ac
tiv
ity
a
n
d
tak
i
n
g
m
e
d
icatio
n
s
th
at
ca
n
im
p
r
o
v
e
s
lee
p
an
d
m
ed
icatio
n
s
th
at
ca
n
im
p
r
o
v
e
p
er
f
o
r
m
a
n
ce
an
d
s
tam
in
a
[
3
0
]
.
T
h
e
s
y
s
tem
atic
r
ev
iew
s
tu
d
y
s
h
o
wed
th
at
tr
av
eler
s
r
ep
o
r
ted
im
p
o
r
tan
t
k
n
o
wled
g
e
ab
o
u
t
je
t
lag
s
y
n
d
r
o
m
e
an
d
t
r
av
el
f
ati
g
u
e,
h
a
d
ex
p
e
r
ien
ce
d
jet
lag
s
y
n
d
r
o
m
e
an
d
tr
av
el
f
atig
u
e,
a
n
d
r
ep
o
r
ted
m
an
ag
e
m
en
t
s
tr
ateg
ies
u
s
ed
to
r
ed
u
ce
jet
lag
s
y
n
d
r
o
m
e
an
d
tr
a
v
el
f
ati
g
u
e
[
3
2
]
.
T
h
er
ef
o
r
e
,
it is
v
er
y
im
p
o
r
ta
n
t in
tr
av
el
m
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I
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Hea
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Sci
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2252
-
8
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6
C
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co
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d
r
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m
e
a
n
d
f
atig
u
e
ca
u
s
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b
y
air
tr
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I
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als
ex
p
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cin
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jet
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ten
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atig
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lth
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a
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ticu
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o
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ch
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ic
illn
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s
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ch
as
h
y
p
er
ten
s
io
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an
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d
iab
etes.
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h
is
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
ca
r
ef
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l
tr
av
el
p
lan
n
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g
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d
th
e
im
p
lem
en
tatio
n
o
f
p
r
ev
en
tiv
e
s
tr
ateg
ies,
s
u
ch
as
m
ain
tain
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g
r
eg
u
la
r
s
leep
p
atter
n
s
,
co
n
s
u
m
in
g
h
ea
lth
y
f
o
o
d
,
an
d
u
s
in
g
ap
p
r
o
p
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ia
te
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ed
ic
atio
n
to
r
ed
u
ce
th
e
n
eg
ativ
e
e
f
f
ec
ts
o
f
jet
lag
.
T
h
is
r
esear
ch
h
as
b
r
o
ad
im
p
licatio
n
s
f
o
r
th
e
air
lin
e
i
n
d
u
s
tr
y
an
d
h
ea
lth
ca
r
e
p
r
o
f
ess
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n
als,
p
ar
ticu
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ly
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n
ter
m
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o
f
ef
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o
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ts
to
p
r
ev
e
n
t
an
d
m
an
ag
e
jet
lag
.
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lin
es
ca
n
p
r
o
v
id
e
p
ass
en
g
er
s
with
m
o
r
e
d
etailed
in
f
o
r
m
atio
n
o
n
jet
lag
m
an
ag
em
en
t,
wh
il
e
h
ea
lth
ca
r
e
p
r
ac
titi
o
n
er
s
ca
n
o
f
f
er
m
o
r
e
f
o
cu
s
ed
ad
v
ice
to
p
atien
ts
with
ch
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ic
co
n
d
itio
n
s
r
e
g
ar
d
in
g
th
e
m
a
n
ag
em
en
t o
f
tr
av
el
f
atig
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e.
Ho
wev
er
,
th
is
s
tu
d
y
also
h
as
s
ev
er
al
lim
itatio
n
s
.
T
h
e
d
ata
u
s
ed
is
lar
g
e
ly
b
ased
o
n
s
el
f
-
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ep
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r
ted
tr
av
eler
ex
p
e
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ien
ce
s
,
wh
ich
m
ay
co
n
tain
s
u
b
jectiv
e
b
ias.
Oth
er
f
ac
to
r
s
s
u
ch
as
th
e
t
y
p
e
o
f
f
lig
h
t,
c
ab
in
co
n
d
itio
n
s
,
an
d
th
e
lo
n
g
-
ter
m
ef
f
ec
ts
o
f
jet
lag
h
av
e
n
o
t
b
e
en
f
u
lly
in
v
esti
g
ated
.
T
h
e
r
ef
o
r
e,
f
u
tu
r
e
r
esear
ch
s
h
o
u
ld
b
r
o
a
d
en
its
s
co
p
e
b
y
in
co
r
p
o
r
atin
g
o
b
jectiv
e
d
a
ta,
s
u
ch
as
b
io
lo
g
ical
m
ea
s
u
r
em
en
ts
o
f
s
leep
d
is
tu
r
b
an
ce
s
an
d
f
atig
u
e
.
Fu
r
t
h
er
s
tu
d
ies
s
h
o
u
ld
also
co
n
s
id
er
o
th
er
f
ac
to
r
s
th
at
m
ay
i
n
f
lu
en
ce
jet
lag
,
s
u
c
h
as
f
lig
h
t
d
u
r
atio
n
,
ca
b
in
p
r
ess
u
r
e,
an
d
th
e
im
p
ac
t
o
n
tr
av
eler
s
with
d
iv
er
s
e
h
ea
lth
co
n
d
itio
n
s
.
Su
ch
s
tep
s
ar
e
ex
p
ec
ted
to
p
r
o
v
id
e
a
d
ee
p
e
r
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
r
elatio
n
s
h
ip
b
etwe
en
jet
la
g
an
d
tr
av
el
f
atig
u
e,
as
well
as
th
eir
im
p
ac
t o
n
h
ea
lth
.
ACK
NO
WL
E
DG
E
M
E
NT
S
T
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t
h
o
r
s
wo
u
ld
lik
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atitu
d
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to
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e
R
esear
ch
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d
C
o
m
m
u
n
ity
Ser
v
ices
I
n
s
titu
tio
n
,
Ma
r
s
h
al
Su
r
y
ad
ar
m
a
Aer
o
s
p
a
ce
Un
iv
er
s
ity
,
J
ak
ar
ta,
I
n
d
o
n
e
s
ia,
f
o
r
p
r
o
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id
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n
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u
p
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t.
Sp
ec
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th
an
k
s
to
th
e
Facu
lty
o
f
Hea
lth
Scien
ce
,
Nu
r
s
in
g
Scien
ce
p
r
o
g
r
am
Stu
d
y
,
U
n
iv
er
s
itas
Dir
g
an
tar
a
Ma
r
s
ek
al
Su
r
y
ad
ar
m
a,
f
o
r
g
r
a
n
tin
g
eth
ical
p
e
r
m
is
s
io
n
to
co
n
d
u
ct
th
is
s
tu
d
y
.
L
astl
y
,
th
e
a
u
th
o
r
s
wo
u
l
d
lik
e
to
th
an
k
all
th
e
p
ar
ticip
an
ts
wh
o
willin
g
ly
to
o
k
p
ar
t in
th
is
s
tu
d
y
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
s
ec
tio
n
s
h
o
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l
d
d
escr
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e
s
o
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r
ce
s
o
f
f
u
n
d
i
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ag
en
c
y
th
a
t
h
av
e
s
u
p
p
o
r
te
d
th
e
wo
r
k
.
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t
h
o
r
s
s
h
o
u
ld
s
tate
h
o
w
th
e
r
esear
ch
d
escr
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ed
in
th
eir
ar
ticle
was
f
u
n
d
ed
,
in
clu
d
in
g
g
r
an
t
n
u
m
b
er
s
if
ap
p
licab
le.
I
n
clu
d
e
t
h
e
f
o
llo
win
g
(
o
r
s
im
ilar
)
s
tatem
en
t if
th
er
e
is
n
o
f
u
n
d
in
g
in
v
o
l
v
ed
: A
u
th
o
r
s
s
tate
n
o
f
u
n
d
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n
g
i
n
v
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lv
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d
.
AUTHO
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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.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
53
2
-
1
53
9
1538
DATA AV
AI
L
AB
I
L
I
T
Y
Data
av
ailab
ilit
y
is
n
o
t a
p
p
lica
b
le
to
th
is
p
ap
er
as n
o
n
ew
d
at
a
wer
e
cr
ea
ted
o
r
an
aly
ze
d
in
t
h
is
s
tu
d
y
.
RE
F
E
R
E
NC
E
S
[
1
]
Y
.
S
.
B
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.
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