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l J
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ea
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I
J
P
H
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Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
,
p
p
.
1
7
9
7
~
1
8
05
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A
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ticle
his
to
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y:
R
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eiv
ed
Feb
8
,
2
0
2
5
R
ev
is
ed
Au
g
2
2
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2
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2
5
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No
v
3
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2
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2
5
Co
a
l
m
in
i
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g
v
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h
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o
p
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ra
to
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h
a
v
e
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a
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v
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se
q
u
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c
e
s
wi
th
h
e
a
lt
h
e
ffe
c
ts
su
c
h
a
s
fa
ti
g
u
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T
h
e
a
im
o
f
th
e
st
u
d
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wa
s
to
a
n
a
ly
z
e
t
h
e
r
isk
fa
c
to
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re
late
d
to
s
u
b
jec
ti
v
e
fa
ti
g
u
e
a
m
o
n
g
c
o
a
l
m
i
n
in
g
o
p
e
ra
to
rs
.
S
p
e
c
ifi
c
a
ll
y
,
i
t
se
e
k
s
to
e
x
a
m
in
e
th
e
re
lati
o
n
sh
ip
b
e
twe
e
n
wo
r
k
s
h
ift
,
wo
rk
in
g
p
e
rio
d
,
sle
e
p
q
u
a
n
t
it
y
,
sle
e
p
q
u
a
li
t
y
,
a
n
d
p
e
rso
n
a
l
c
h
a
ra
c
teristics
,
su
c
h
a
s
a
g
e
,
n
e
c
k
c
ircu
m
fe
re
n
c
e
,
a
n
d
b
o
d
y
m
a
ss
in
d
e
x
.
Da
ta
we
re
c
o
ll
e
c
ted
fr
o
m
a
c
o
a
l
m
in
in
g
site
i
n
S
o
u
th
Ka
li
m
a
n
tan
,
In
d
o
n
e
sia
in
2
0
2
2
with
p
rima
ry
q
u
e
stio
n
n
a
ires
.
A
t
o
tal
o
f
4
4
0
wo
rk
e
rs
wh
o
wo
r
k
e
d
in
th
e
m
i
n
in
g
a
n
d
h
a
u
li
n
g
a
re
a
fo
r
a
t
lea
st
o
n
e
y
e
a
r
we
re
re
c
ru
it
e
d
in
th
is
stu
d
y
.
T
h
is
wa
s
a
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
.
Qu
a
n
t
it
a
ti
v
e
d
a
ta
we
re
o
b
tain
e
d
to
d
e
sc
rib
e
th
e
lev
e
l
o
f
su
b
jec
ti
v
e
fa
ti
g
u
e
a
n
d
t
o
a
n
a
l
y
z
e
th
e
risk
fa
c
to
rs
a
ss
o
c
iate
d
with
th
e
wo
rk
fa
ti
g
u
e
i
n
c
o
a
l
m
in
i
n
g
v
e
h
icle
o
p
e
ra
to
rs.
T
h
e
fa
ti
g
u
e
wa
s
a
ss
o
c
i
a
ted
with
o
b
e
sity
(OR:1
.
7
7
7
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%
CI:1
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0
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t
(OR:1
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%
CI:1
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0
4
6
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3
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0
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),
n
e
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k
c
irc
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m
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re
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(OR:1
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1
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%
CI:1
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0
9
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2
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3
2
9
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,
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p
q
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li
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(OR:4
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5
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%
CI:2
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2
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),
a
n
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rk
i
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g
p
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rio
d
(OR:0
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4
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%
CI:1
0
.
3
6
0
-
0
.
8
2
5
)
(p
<
0
.
0
5
fo
r
a
ll
).
Ho
we
v
e
r,
fa
ti
g
u
e
d
i
d
n
o
t
sig
n
ifi
c
a
n
t
ly
a
ffe
c
t
fro
m
sle
e
p
q
u
a
n
ti
t
y
a
n
d
wo
r
k
sh
ift
.
E
n
su
ri
n
g
in
d
i
v
id
u
a
l
h
e
a
lt
h
is
e
ss
e
n
ti
a
l
f
o
r
p
re
se
rv
in
g
th
e
o
p
p
o
rt
u
n
it
y
t
o
sle
e
p
a
n
d
a
ll
o
win
g
th
e
b
o
d
y
t
o
re
c
o
v
e
r
fro
m
fa
ti
g
u
e
.
K
ey
w
o
r
d
s
:
C
o
al
m
in
in
g
Fatig
u
e
Ob
esit
y
Op
er
ato
r
s
R
is
k
f
ac
to
r
s
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
:
R
o
b
ian
a
Mo
d
jo
Dep
ar
tm
en
t o
f
Occ
u
p
atio
n
al
S
af
ety
an
d
Hea
lth
,
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Un
iv
er
s
itas
I
n
d
o
n
esia
Dep
o
k
,
W
est J
av
a
-
1
6
4
2
4
,
I
n
d
o
n
esia
E
m
ail: b
ian
@
u
i.a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Fatig
u
e
is
a
r
ec
o
g
n
ized
is
s
u
e
in
th
e
wo
r
k
p
lace
.
Fatig
u
e
h
as
b
ec
o
m
e
in
cr
ea
s
in
g
ly
c
o
m
m
o
n
in
r
ec
en
t
d
ec
ad
es
[
1
]
,
[
2
]
.
T
h
e
im
p
ac
t
o
f
in
d
u
s
tr
ial
p
r
o
g
r
ess
is
u
n
av
o
i
d
ab
le,
as
m
o
d
er
n
in
d
u
s
tr
ial
ci
v
ilizatio
n
d
em
an
d
s
q
u
ick
er
o
u
tp
u
t
f
o
r
a
m
u
ltit
u
d
e
o
f
r
ea
s
o
n
s
[
3
]
.
A
ty
p
ical
co
n
ce
p
tu
al
d
e
f
in
itio
n
o
f
f
atig
u
e
was
a
s
tate
o
f
ex
h
au
s
tio
n
,
d
r
o
wsi
n
ess
,
o
r
we
ar
in
ess
b
r
o
u
g
h
t o
n
b
y
in
s
u
f
f
ici
en
t
r
est,
eith
er
in
ter
m
s
o
f
q
u
a
n
tity
o
r
q
u
ality
[
4
]
.
T
h
is
af
f
ec
ts
th
e
v
is
ce
r
a,
o
r
th
e
ce
n
tr
al
n
er
v
o
u
s
s
y
s
tem
o
f
a
n
o
r
g
a
n
is
m
,
wh
ich
r
esu
lts
in
i
n
s
u
f
f
icien
t
ce
llu
lar
ca
p
ac
ity
o
r
s
y
s
tem
-
wid
e
en
e
r
g
y
to
m
ain
tain
t
h
e
o
r
ig
in
al
le
v
el
o
f
ac
tiv
ity
an
d
/o
r
p
r
o
ce
s
s
in
g
b
y
u
s
in
g
u
s
u
al
r
eso
u
r
ce
s
[
2
]
.
Fatig
u
e
m
a
n
if
e
s
ted
in
d
im
in
is
h
ed
ca
p
ac
ity
t
o
co
n
d
u
ct
ac
tiv
ities
at
th
e
d
e
s
ir
ed
lev
el
d
u
e
t
o
m
en
tal
an
d
/o
r
p
h
y
s
ical
lass
itu
d
e
o
r
ex
h
a
u
s
tio
n
[
5
]
,
[
6
]
.
T
h
e
r
e
ar
e
th
r
ee
m
ain
k
i
n
d
s
o
f
f
ati
g
u
e
-
r
elate
d
ef
f
ec
ts
:
p
h
y
s
ical
(
s
u
ch
a
s
b
r
ief
ly
an
d
s
u
d
d
en
ly
f
allin
g
asleep
,
o
r
"m
icr
o
s
leep
in
g
")
,
m
e
n
tal
(
s
u
ch
as
co
n
ce
n
tr
atio
n
lap
s
es),
an
d
em
o
tio
n
al
(
s
u
ch
a
s
ir
r
itatio
n
)
.
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
.
4
,
Dec
em
b
er
20
25
:
1
7
9
7
-
1
8
05
1798
R
ed
u
ce
d
lev
els
o
f
atten
tio
n
,
c
o
o
r
d
in
atio
n
,
ju
d
g
m
e
n
t,
an
d
m
o
tiv
atio
n
,
as
well
as
a
wo
r
s
en
ed
m
o
o
d
an
d
d
ec
r
ea
s
ed
jo
b
s
atis
f
a
ctio
n
,
ar
e
all
r
esu
lts
o
f
in
cr
ea
s
ed
lev
els o
f
f
atig
u
e.
J
o
b
s
atis
f
ac
tio
n
is
th
e
ter
m
u
s
ed
to
d
escr
ib
e
h
o
w
p
eo
p
le
f
ee
l
ab
o
u
t
th
eir
jo
b
s
.
I
n
ad
d
itio
n
to
in
cr
ea
s
in
g
th
e
n
ee
d
f
o
r
s
ick
d
ay
s
,
f
atig
u
e
is
lin
k
ed
to
lo
n
g
-
ter
m
h
ea
lth
is
s
u
es lik
e
s
t
r
ess
,
h
ea
r
t d
is
ea
s
e
,
m
en
tal
illn
ess
,
an
d
d
ig
esti
v
e
is
s
u
es [
7
]
.
I
n
g
en
er
al,
f
atig
u
e
in
th
e
wo
r
k
p
lace
m
a
y
b
e
d
escr
i
b
ed
b
y
th
e
q
u
an
tity
o
f
wo
r
k
co
m
p
ar
ed
t
o
th
e
len
g
th
o
f
ti
m
e,
as
well
as
th
e
wo
r
k
lo
ad
f
r
o
m
n
u
m
er
o
u
s
s
o
u
r
ce
s
,
s
u
ch
as
life
s
ty
le,
wo
r
k
s
ty
le,
h
ea
lth
p
r
o
b
lem
s
,
o
r
g
a
n
iza
tio
n
al
s
tr
u
ctu
r
e
,
wo
r
k
en
v
ir
o
n
m
e
n
t,
an
d
th
e
wo
r
k
its
elf
[
1
]
.
T
h
e
r
o
o
t
ca
u
s
es
o
f
f
atig
u
e
its
elf
ar
e
n
u
m
er
o
u
s
.
C
o
al
m
in
in
g
v
eh
icle
o
p
e
r
ato
r
s
p
lay
a
cr
u
cial
r
o
le
in
th
e
ex
tr
ac
tio
n
an
d
tr
an
s
p
o
r
ta
tio
n
o
f
co
al
f
r
o
m
m
in
i
n
g
s
i
tes,
co
n
tr
ib
u
tin
g
to
th
e
o
v
er
all
ef
f
ic
ien
cy
an
d
p
r
o
d
u
ctiv
ity
o
f
th
e
o
p
e
r
atio
n
.
Sh
if
t
p
atter
n
s
,
task
s
p
ec
if
icati
o
n
s
,
an
d
wo
r
k
an
d
en
v
ir
o
n
m
e
n
tal
co
n
d
itio
n
s
ar
e
ex
am
p
les
o
f
wo
r
k
-
r
elate
d
ca
u
s
es
[
7
]
.
Sh
if
t
wo
r
k
im
m
ed
iat
ely
r
esu
lts
in
f
atig
u
e,
i
n
cr
ea
s
ed
s
leep
in
ess
,
s
leep
d
is
tu
r
b
an
ce
s
,
an
d
p
o
o
r
c
o
g
n
i
t
io
n
.
Sh
if
t
wo
r
k
'
s
ef
f
ec
ts
o
n
s
leep
in
ess
an
d
f
atig
u
e
ca
n
af
f
e
ct
p
r
o
d
u
ctiv
ity
a
n
d
ac
cid
en
ts
[
8
]
.
C
h
r
o
n
ic
f
atig
u
e
is
lin
k
ed
to
a
v
ar
iety
o
f
h
ea
lt
h
p
r
o
b
lem
s
,
in
clu
d
in
g
m
u
s
cu
l
o
s
k
eleta
l
illn
ess
e
s
,
s
leep
d
is
r
u
p
tio
n
s
,
b
u
r
n
o
u
t,
p
o
o
r
well
-
b
ein
g
,
an
x
iety
,
an
d
d
e
p
r
es
s
io
n
[
9
]
.
T
h
e
m
in
in
g
in
d
u
s
tr
y
is
h
ig
h
ly
d
iv
er
s
if
ied
,
with
s
ig
n
if
ican
t
v
ar
iatio
n
s
in
d
ay
-
to
-
d
a
y
o
p
er
atio
n
s
ac
r
o
s
s
d
if
f
er
en
t
s
ec
to
r
s
.
E
s
p
ec
ially
f
o
r
co
al
m
in
in
g
v
eh
icle
wo
r
k
e
r
s
wh
o
o
p
er
ate
h
ea
v
y
m
ac
h
in
er
y
an
d
e
q
u
ip
m
e
n
t
u
s
ed
in
co
al
m
i
n
in
g
o
p
er
at
io
n
s
,
in
clu
d
i
n
g
co
n
ti
n
u
o
u
s
/lo
n
g
wall
co
al
m
ac
h
in
es,
d
r
il
l
r
ig
s
,
ex
ca
v
ato
r
s
,
b
u
lld
o
ze
r
s
,
lo
ad
er
s
,
p
o
wer
s
h
o
v
els,
an
d
h
a
u
l
tr
u
ck
s
.
An
o
th
er
im
p
o
r
tan
t
f
ac
to
r
is
m
in
e
s
i
ze
,
wh
ich
ca
n
r
an
g
e
f
r
o
m
less
th
an
1
2
wo
r
k
i
n
g
p
e
r
s
o
n
n
el
to
1
2
0
0
+
m
in
e
p
r
o
d
u
ctio
n
s
taf
f
.
Desp
ite
th
ese
v
ar
i
atio
n
s
,
o
n
e
co
m
m
o
n
ex
p
er
ien
ce
s
h
a
r
ed
b
y
m
i
n
ewo
r
k
er
s
is
wo
r
k
er
f
atig
u
e
[
1
0
]
.
T
h
e
s
co
p
e
o
f
th
ese
s
tu
d
ies
e
n
co
m
p
ass
ed
v
ar
io
u
s
p
er
f
o
r
m
an
ce
m
ea
s
u
r
es,
i
n
clu
d
in
g
ac
cid
en
ts
,
in
ju
r
ies,
r
ea
ctio
n
tim
es,
an
d
co
g
n
itio
n
[
1
1
]
.
Fatig
u
e,
p
ar
ticu
lar
ly
am
o
n
g
v
eh
icle
o
p
er
at
o
r
s
in
th
e
m
in
i
n
g
in
d
u
s
tr
y
,
p
r
esen
ts
its
elf
in
a
n
o
tab
l
y
d
is
tin
ct
m
an
n
er
co
m
p
a
r
ed
t
o
o
th
er
in
d
u
s
tr
ial
s
ec
to
r
s
.
Po
o
r
s
leep
in
g
h
ab
its
,
h
i
g
h
ly
r
ep
etiti
v
e
an
d
m
o
n
o
to
n
o
u
s
task
s
,
m
en
tal/p
h
y
s
ical
d
em
an
d
,
in
ten
s
e
n
o
is
e
lev
els,
v
ib
r
a
tio
n
,
elev
ated
tem
p
e
r
atu
r
e,
l
o
w
-
li
g
h
tin
g
lev
els,
s
leep
d
ep
r
iv
atio
n
,
an
d
ex
ten
d
ed
h
o
u
r
s
o
f
lab
o
r
ar
e
ex
am
p
l
es
o
f
m
in
in
g
-
s
p
ec
if
ic
d
u
ties
an
d
e
n
v
ir
o
n
m
en
tal
co
n
d
itio
n
s
th
at
m
ak
e
f
atig
u
e
a
m
ajo
r
is
s
u
e
af
f
ec
tin
g
th
e
s
ec
to
r
.
T
h
ese
f
ac
to
r
s
,
alo
n
g
with
th
e
m
in
in
g
in
d
u
s
tr
y
'
s
lo
n
g
h
o
u
r
s
an
d
s
h
if
t
-
wo
r
k
s
ch
ed
u
le,
m
a
k
e
f
atig
u
e
a
m
ajo
r
co
n
ce
r
n
[
1
1
]
,
[
1
2
]
.
T
h
e
p
r
esen
t
s
tu
d
y
aim
s
to
ex
p
lo
r
e
t
h
e
r
is
k
f
ac
t
o
r
s
r
elate
d
to
s
u
b
jectiv
e
f
atig
u
e
am
o
n
g
co
al
m
i
n
in
g
o
p
er
at
o
r
s
.
Sp
ec
if
ically
,
it
s
ee
k
s
to
ex
am
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
wo
r
k
s
h
if
t,
w
o
r
k
in
g
p
er
io
d
,
s
leep
q
u
an
tity
,
s
leep
q
u
ality
,
a
n
d
p
er
s
o
n
al
ch
ar
ac
te
r
is
tics
,
s
u
ch
as a
g
e,
n
ec
k
cir
c
u
m
f
er
e
n
ce
,
an
d
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
.
2.
M
E
T
H
O
D
2
.
1
.
S
t
u
d
y
d
e
s
i
g
n
,
s
e
t
t
i
n
g
s
,
a
n
d
p
a
r
t
i
c
ip
a
n
t
s
T
h
i
s
c
r
o
s
s
-
s
e
ct
i
o
n
a
l
s
t
u
d
y
w
as
c
o
n
d
u
c
t
e
d
a
t
a
c
o
al
m
i
n
i
n
g
s
it
e
i
n
S
o
u
t
h
K
al
i
m
a
n
t
a
n
,
I
n
d
o
n
e
s
i
a
,
i
n
2
0
2
2
,
i
n
v
o
l
v
i
n
g
4
4
0
w
o
r
k
e
r
s
w
h
o
h
a
d
b
e
e
n
e
m
p
l
o
y
e
d
i
n
t
h
e
m
i
n
i
n
g
a
n
d
h
a
u
l
i
n
g
a
r
e
a
s
f
o
r
a
t
l
ea
s
t
o
n
e
y
e
a
r
.
Q
u
a
n
t
i
t
at
i
v
e
d
a
t
a
w
e
r
e
u
s
e
d
to
d
e
s
c
r
i
b
e
l
e
v
el
s
o
f
s
u
b
j
e
c
ti
v
e
f
a
t
i
g
u
e
a
n
d
t
o
a
n
a
l
y
z
e
t
h
e
r
is
k
f
a
c
t
o
r
s
as
s
o
c
ia
t
e
d
w
i
t
h
w
o
r
k
f
a
t
i
g
u
e
a
m
o
n
g
c
o
a
l
m
i
n
i
n
g
v
e
h
i
c
l
e
o
p
e
r
a
t
o
r
s
.
2
.
2
.
I
n
s
t
r
u
me
n
t
s
T
h
e
q
u
e
s
ti
o
n
n
a
i
r
e
s
w
e
r
e
s
e
p
a
r
a
t
e
d
i
n
t
o
t
h
r
e
e
s
e
ct
i
o
n
s
.
T
h
e
f
i
r
s
t
s
ec
t
i
o
n
c
o
n
ta
i
n
s
q
u
e
s
t
i
o
n
s
a
b
o
u
t
t
h
e
r
e
s
p
o
n
d
e
n
t'
s
p
e
r
s
o
n
a
l
d
a
t
a
,
s
u
c
h
a
s
a
g
e
,
we
i
g
h
t
,
h
ei
g
h
t
,
n
e
ck
c
i
r
c
u
m
f
e
r
e
n
c
e
,
h
e
al
t
h
c
o
m
p
l
a
i
n
ts
,
a
n
d
m
e
d
ic
a
l
h
i
s
t
o
r
y
.
I
n
a
d
d
i
t
i
o
n
,
t
h
is
q
u
e
s
tio
n
n
a
i
r
e
a
l
s
o
c
o
n
t
a
i
n
s
m
a
tt
e
r
s
r
e
l
a
t
e
d
t
o
t
h
e
r
es
p
o
n
d
e
n
t'
s
w
o
r
k
,
s
u
c
h
a
s
w
o
r
k
a
r
e
a
,
w
o
r
k
i
n
g
p
e
r
i
o
d
,
w
o
r
k
s
h
i
f
t
s
,
a
n
d
c
o
m
m
u
t
i
n
g
t
i
m
e
.
T
h
e
s
e
c
o
n
d
s
e
ct
i
o
n
o
f
t
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
w
as
a
b
o
u
t
t
h
e
d
e
s
c
r
i
p
t
i
o
n
o
f
f
a
t
i
g
u
e
i
n
w
o
r
k
e
r
s
u
s
i
n
g
t
h
e
f
a
t
i
g
u
e
as
s
ess
m
e
n
t
s
c
al
e
(
F
AS
)
q
u
e
s
t
i
o
n
n
a
i
r
e
t
o
m
e
as
u
r
e
th
e
l
e
v
e
l
o
f
s
u
b
j
ec
t
i
v
e
f
a
t
i
g
u
e
s
y
m
p
t
o
m
s
,
w
h
i
ch
c
o
n
t
a
i
n
s
1
0
q
u
es
t
i
o
n
s
[
1
3
]
.
T
h
e
F
AS
is
a
c
h
r
o
n
i
c
f
a
t
i
g
u
e
ass
e
s
s
m
e
n
t
q
u
e
s
t
i
o
n
n
a
i
r
e
c
o
n
s
i
s
t
in
g
o
f
1
0
q
u
e
s
t
i
o
n
s
r
e
g
a
r
d
i
n
g
f
a
t
i
g
u
e
s
y
m
p
t
o
m
s
.
T
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
u
s
e
s
a
L
i
k
er
t
s
ca
l
e
o
f
1
t
o
5
,
w
i
t
h
q
u
e
s
tio
n
s
4
a
n
d
1
0
u
s
i
n
g
r
e
v
e
r
s
e
ass
e
s
s
m
e
n
t
.
I
n
f
o
r
m
a
t
i
o
n
o
n
a
L
i
k
e
r
t
s
c
a
l
e
o
f
1
t
o
5
is
a
s
f
o
l
l
o
ws
:
“
n
e
v
e
r
”
(
n
e
v
e
r
f
elt
s
y
m
p
t
o
m
s
)
wi
t
h
a
s
c
o
r
e
o
f
1
,
“
o
c
c
a
s
i
o
n
a
l
l
y
”
(
f
e
el
i
n
g
s
y
m
p
t
o
m
s
f
o
r
o
n
c
e
a
m
o
n
t
h
o
r
l
e
s
s
)
w
i
t
h
a
s
c
o
r
e
o
f
2
,
“
s
l
i
g
h
t
l
y
f
r
e
q
u
e
n
t”
(
f
e
e
l
i
n
g
s
y
m
p
t
o
m
s
s
e
v
e
r
a
l
t
i
m
e
s
a
m
o
n
t
h
)
w
i
t
h
a
s
c
o
r
e
o
f
3
,
o
f
t
e
n
(
f
e
e
l
i
n
g
s
y
m
p
t
o
m
s
e
v
e
r
y
w
e
e
k
)
w
i
t
h
a
s
c
o
r
e
o
f
4
,
“
a
lw
a
y
s
”
(
f
e
e
li
n
g
s
y
m
p
t
o
m
s
al
m
o
s
t
e
v
e
r
y
d
a
y
)
w
i
t
h
a
s
c
o
r
e
o
f
5
.
T
h
e
s
c
o
r
e
g
e
n
e
r
a
t
e
d
o
n
e
a
c
h
q
u
es
ti
o
n
is
t
h
e
n
a
d
d
e
d
u
p
t
o
g
e
t
a
t
o
t
a
l
s
co
r
e
,
w
h
i
c
h
w
i
l
l
d
e
t
e
r
m
i
n
e
t
h
e
l
e
v
e
l
o
f
s
u
b
j
e
ct
i
v
e
f
a
ti
g
u
e
i
n
th
e
r
e
s
p
o
n
d
e
n
t
.
T
h
e
t
o
t
a
l
s
c
o
r
e
t
o
b
e
o
b
t
ai
n
e
d
i
s
1
0
t
o
5
0
.
T
h
e
t
o
t
a
l
s
c
o
r
e
o
f
e
a
ch
r
e
s
p
o
n
d
e
n
t
i
s
ca
t
e
g
o
r
i
z
e
d
i
n
to
“
n
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2
N
i
g
h
t
sh
i
f
t
2
1
9
4
9
.
8
C
o
mm
u
t
i
n
g
t
i
me
(
mi
n
u
t
e
)
3
5
.
3
±
1
5
.
8
T
h
e
av
e
r
ag
e
ag
e
o
f
th
e
4
4
0
r
e
s
p
o
n
d
en
ts
was
3
4
.
6
±
6
.
9
,
r
an
g
in
g
f
r
o
m
2
1
to
5
3
y
ea
r
s
.
T
h
e
av
er
ag
e
o
f
th
e
b
o
d
y
m
ass
in
d
ex
o
f
t
h
e
r
esp
o
n
d
en
ts
was
2
4
.
3
±
3
.
3
.
T
h
e
av
er
ag
e
n
ec
k
cir
cu
m
f
er
en
ce
o
f
t
h
e
p
a
r
ticip
an
ts
was
3
4
.
5
±
2
.
5
ce
n
tim
eter
s
.
T
h
e
av
er
ag
e
s
leep
d
u
r
atio
n
o
f
th
e
p
ar
ticip
an
ts
was
6
.
3
±
0
.
6
h
o
u
r
s
.
T
h
e
s
leep
q
u
ality
s
co
r
e
m
ea
n
was
4
.
1
±
1
.
8
.
T
h
e
av
er
ag
e
wo
r
k
in
g
p
er
io
d
o
f
th
e
p
ar
ticip
an
ts
was
5
.
7
±
5
.
1
r
an
g
i
n
g
f
r
o
m
1
to
2
0
y
ea
r
s
.
T
h
e
p
ar
ticip
an
ts
’
av
er
ag
e
co
m
m
u
tin
g
tim
e
was 3
5
.
3
±
1
5
.
8
m
in
u
tes
,
as sh
o
wn
i
n
T
ab
le
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
9
7
-
1
8
05
1800
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
s
u
b
jectiv
e
f
atig
u
e
with
s
leep
q
u
ality
an
d
s
leep
q
u
a
n
tity
,
as
well
a
s
p
ar
ticip
an
ts
’
ch
ar
ac
ter
is
tics
,
s
u
ch
as
ag
e,
B
M
I
,
an
d
n
ec
k
ci
r
cu
m
f
er
e
n
ce
.
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ein
g
o
v
er
weig
h
t
(
OR
1
.
7
8
3
,
p
=
0
.
0
3
4
)
an
d
o
b
ese
(
OR
1
.
7
7
7
,
p
=
0
.
0
2
7
)
wer
e
ass
o
ciate
d
with
m
o
r
e
s
u
b
jectiv
e
f
atig
u
e
s
y
m
p
to
m
s
th
an
p
ar
ticip
an
ts
o
f
o
th
er
B
MI
(
i.e
.
,
s
ev
er
e
u
n
d
e
r
weig
h
t,
u
n
d
er
weig
h
t,
an
d
n
o
r
m
al)
.
Par
ticip
an
ts
with
n
e
ck
s
ize
m
o
r
e
th
an
3
4
ce
n
tim
eter
s
m
o
r
e
co
m
m
o
n
ly
ex
h
ib
it
s
u
b
jectiv
e
f
atig
u
e
s
y
m
p
t
o
m
s
th
an
th
o
s
e
with
a
s
ize
le
s
s
th
an
3
4
ce
n
tim
eter
s
(
OR
1
.
5
1
3
,
p
=
0
.
0
7
5
)
.
Par
ticip
an
ts
with
p
o
o
r
s
leep
q
u
ality
m
o
r
e
co
m
m
o
n
ly
e
x
h
ib
it
s
u
b
jectiv
e
f
atig
u
e
s
y
m
p
to
m
s
t
h
an
th
o
s
e
with
g
o
o
d
s
leep
q
u
a
lity
(
OR
4
.
5
9
7
,
p
=
0
.
0
0
0
)
.
I
n
th
is
s
tu
d
y
,
wo
r
k
in
g
p
er
io
d
s
wer
e
f
o
u
n
d
t
o
b
e
ass
o
ciate
d
with
s
u
b
jectiv
e
f
atig
u
e
lev
el
am
o
n
g
o
p
er
at
o
r
s
(
OR
0
.
5
4
5
;
p
=
0
.
0
0
5
)
.
T
h
er
e
was
n
o
s
tatis
tical
d
if
f
er
en
ce
in
s
u
b
jectiv
e
f
atig
u
e
s
y
m
p
to
m
s
in
r
elatio
n
to
p
ar
t
icip
an
ts
’
ag
e
,
s
leep
q
u
an
tity
,
a
n
d
wo
r
k
s
h
if
t
,
as sh
o
wn
in
T
ab
le
2
.
T
ab
le
2
.
C
o
r
r
elatio
n
b
etwe
en
f
ac
to
r
s
r
elate
d
to
s
u
b
jectiv
e
f
atig
u
e
am
o
n
g
m
i
n
in
g
o
p
er
ato
r
s
V
a
r
i
a
b
l
e
s
S
u
b
j
e
c
t
i
v
e
f
a
t
i
g
u
e
p
-
v
a
l
u
e
O
R
v
a
l
u
e
(
9
5
%
C
I
)
Y
e
s
No
n
%
n
%
A
g
e
(
Y
e
a
r
)
≤
3
4
61
2
6
.
9
1
6
6
7
3
.
1
0
.
2
4
4
0
.
7
6
7
(
0
.
5
0
9
-
1
.
1
5
6
)
1
.
0
0
0
>
3
4
69
3
2
.
4
1
4
4
67
.
6
B
o
d
y
mas
s i
n
d
e
x
(
B
M
I
)
O
b
e
se
34
37
58
63
0
.
0
2
7
1
.
7
7
7
(
1
.
0
6
7
-
2
.
9
6
0
)
O
v
e
r
w
e
i
g
h
t
30
37
51
63
0
.
0
3
4
1
.
7
8
3
(
1
.
0
4
6
-
3
.
0
4
0
)
U
n
d
e
r
w
e
g
h
t
3
2
7
.
3
8
7
2
.
7
0
.
8
5
3
1
.
1
3
7
(
0
.
2
9
3
-
4
.
4
1
7
)
S
e
v
e
r
e
u
n
d
e
r
w
e
i
g
h
t
0
0
2
1
0
0
0
.
9
9
9
0
.
0
0
0
(
0
.
0
0
0
)
N
o
r
mal
63
2
4
.
8
1
9
1
7
5
.
2
1
.
0
0
0
N
e
c
k
C
i
r
c
u
mf
e
r
e
n
c
e
(
c
m)
≥
3
4
88
3
2
.
8
1
8
0
6
7
.
2
0
.
0
7
5
1
.
5
1
3
(
0
.
9
8
3
-
2
.
3
2
9
)
1
.
0
0
0
<
3
4
42
2
4
.
4
1
3
0
7
5
.
6
S
l
e
e
p
q
u
a
n
t
i
t
y
≤
6
h
o
u
r
s
1
9
m
i
n
u
t
e
s
73
3
2
.
2
1
5
4
6
7
.
8
0
.
2
5
6
1
.
2
9
7
(0
.
859
-
1
.
9
5
8
)
1
.
0
0
0
>
6
h
o
u
r
s
1
9
m
i
n
u
t
e
s
57
2
6
.
8
1
5
6
7
3
.
2
S
l
e
e
p
q
u
a
l
i
t
y
P
o
o
r
46
5
8
.
2
33
4
1
.
8
0
.
0
0
0
4
.
5
9
7
(
2
.
7
6
2
-
7
.
6
5
0
)
1
.
0
0
0
G
o
o
d
84
2
3
.
3
2
7
7
7
6
.
7
W
o
r
k
sh
i
f
t
N
i
g
h
t
sh
i
f
t
65
2
9
.
7
1
5
4
7
0
.
3
1
.
0
0
0
1
.
0
1
3
(
0
.
6
7
3
-
1
5
2
6
)
1
.
0
0
0
M
o
r
n
i
n
g
s
h
i
f
t
65
2
9
.
4
1
5
6
7
0
.
6
W
o
r
k
i
n
g
p
e
r
i
o
d
≤
5
y
e
a
r
s
62
2
4
.
2
1
9
4
7
5
.
8
0
.
0
0
5
0
.
5
4
5
(
0
.
3
6
0
-
0
.
8
2
5
)
1
.
0
0
0
>
5
y
e
a
r
s
68
37
1
1
6
63
T
h
e
p
r
esen
t
s
tu
d
y
ex
am
in
es
th
e
co
r
r
elatio
n
b
etwe
en
s
leep
q
u
ality
an
d
th
e
s
u
b
jectiv
e
f
atig
u
e
lev
els
ex
p
er
ien
ce
d
b
y
m
in
in
g
o
p
er
a
to
r
s
.
Pre
v
io
u
s
r
esear
ch
h
as
i
n
d
icate
d
th
at
p
o
o
r
s
leep
q
u
al
ity
ca
n
s
er
v
e
as
a
p
r
ed
icto
r
o
f
ele
v
ated
f
atig
u
e
l
ev
els
[
1
9
]
.
On
e
s
tu
d
y
r
ep
o
r
te
d
a
s
ig
n
if
ican
t
i
n
v
er
s
e
r
elatio
n
s
h
ip
b
etwe
en
s
leep
q
u
ality
an
d
g
en
er
al
f
atig
u
e
(
p
<0
.
0
0
1
)
[
2
0
]
,
[
2
1
]
.
Simi
lar
ly
,
o
u
r
f
in
d
in
g
s
alig
n
with
ea
r
lier
r
esear
ch
d
em
o
n
s
tr
atin
g
a
s
tr
o
n
g
co
r
r
el
atio
n
b
etwe
en
s
leep
q
u
ality
a
n
d
f
atig
u
e
lev
els
am
o
n
g
h
ea
lt
h
ca
r
e
p
r
o
f
ess
io
n
als
[
2
0
]
.
T
h
ese
r
esu
lts
h
ig
h
lig
h
t t
h
e
cr
itical
r
o
le
o
f
s
leep
q
u
ality
in
o
cc
u
p
atio
n
al
f
atig
u
e,
s
u
g
g
e
s
tin
g
th
at
d
is
r
u
p
ted
o
r
in
ad
eq
u
ate
s
leep
m
ay
s
ig
n
if
ican
tly
im
p
air
aler
tn
ess
,
c
o
n
ce
n
tr
atio
n
,
an
d
p
h
y
s
ical
en
d
u
r
an
ce
.
T
h
er
ef
o
r
e,
im
p
r
o
v
in
g
s
leep
q
u
ality
th
r
o
u
g
h
tar
g
eted
in
ter
v
e
n
tio
n
s
s
u
ch
as
s
leep
h
y
g
ien
e
e
d
u
ca
tio
n
,
r
est
b
r
ea
k
p
o
licies
,
an
d
wo
r
k
s
ch
ed
u
le
a
d
ju
s
tm
en
t
s
s
h
o
u
ld
b
e
co
n
s
id
er
ed
a
n
ess
en
tial c
o
m
p
o
n
en
t o
f
f
atig
u
e
r
is
k
m
an
ag
e
m
en
t.
R
eg
ar
d
in
g
B
MI
,
it
was
o
b
s
er
v
ed
th
at
th
er
e
was
an
ass
o
ciati
o
n
b
etwe
en
b
ein
g
o
b
ese
(
p
=
0
.
0
2
7
)
an
d
o
v
er
weig
h
t
(
p
=
0
.
0
3
4
)
with
s
u
b
jectiv
e
f
atig
u
e.
T
h
e
co
n
s
is
ten
t
ass
o
ciatio
n
b
etwe
en
o
b
esit
y
s
tatu
s
an
d
h
eig
h
ten
ed
lev
els
o
f
f
atig
u
e
h
as
b
ee
n
well
-
estab
lis
h
ed
.
Sy
s
tem
ic
in
f
lam
m
atio
n
m
ay
p
lay
a
k
ey
r
o
le
in
m
ed
iatin
g
f
atig
u
e
in
in
d
i
v
id
u
als
with
o
b
esit
y
,
as
th
o
s
e
with
g
r
ea
ter
a
d
ip
o
s
ity
h
a
v
e
d
em
o
n
s
tr
ated
in
cr
ea
s
ed
c
o
n
ce
n
tr
atio
n
s
o
f
i
n
f
lam
m
at
o
r
y
m
a
r
k
er
s
s
u
c
h
as
C
-
r
ea
c
tiv
e
p
r
o
tein
,
T
NF
-
α
,
I
L
-
6
,
l
ep
tin
,
an
d
r
esis
tin
.
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
n
a
lysi
s
o
f ris
k
fa
cto
r
s
a
s
s
o
ci
a
ted
w
ith
s
u
b
jective
fa
tig
u
e
s
y
mp
to
ms a
mo
n
g
…
(
R
o
b
ia
n
a
M
o
d
jo
)
1801
Ad
d
itio
n
ally
,
a
r
ec
ip
r
o
ca
l
r
e
latio
n
s
h
ip
h
as
b
ee
n
id
en
tifie
d
b
etwe
en
o
b
esit
y
an
d
s
leep
d
is
o
r
d
er
s
,
f
u
r
th
e
r
co
n
tr
ib
u
tin
g
to
f
atig
u
e
[
2
2
]
.
I
n
th
is
p
a
r
ticu
lar
i
n
v
esti
g
atio
n
,
a
g
r
ea
ter
n
u
m
b
er
o
f
wo
r
k
e
r
s
r
ep
o
r
tin
g
f
atig
u
e
wer
e
f
o
u
n
d
in
t
h
e
g
r
o
u
p
wit
h
ab
n
o
r
m
al
n
u
tr
itio
n
al
s
tatu
s
,
co
m
p
ar
e
d
to
th
o
s
e
class
if
ied
as
h
av
in
g
n
o
r
m
al
s
tatu
s
[
2
3
]
.
T
h
ese
f
in
d
in
g
s
h
ig
h
lig
h
t
th
e
co
m
p
lex
in
ter
p
la
y
b
etwe
en
m
etab
o
lic
h
ea
lth
,
s
leep
q
u
ality
,
an
d
p
er
ce
iv
ed
f
atig
u
e.
Fro
m
a
p
r
a
ctica
l
p
er
s
p
ec
tiv
e,
th
is
s
u
g
g
est
s
th
at
in
ter
v
en
tio
n
s
aim
ed
at
weig
h
t
m
an
ag
em
en
t
an
d
m
etab
o
lic
h
ea
lth
im
p
r
o
v
em
en
t
m
ay
b
e
ef
f
ec
tiv
e
s
tr
ateg
ies
f
o
r
r
ed
u
cin
g
f
atig
u
e
a
m
o
n
g
w
o
r
k
er
s
i
n
p
h
y
s
ically
d
e
m
an
d
in
g
i
n
d
u
s
tr
ies
s
u
c
h
as
m
in
i
n
g
.
I
n
ad
d
itio
n
to
B
MI
,
n
ec
k
cir
cu
m
f
e
r
en
ce
,
a
co
m
m
o
n
ly
o
v
er
lo
o
k
ed
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
em
en
t,
s
er
v
es
as
an
o
th
er
im
p
o
r
tan
t
in
d
icato
r
o
f
o
b
esit
y
an
d
r
elate
d
h
ea
lth
r
is
k
s
,
an
d
m
ay
p
r
o
v
id
e
f
u
r
t
h
er
in
s
ig
h
t
in
to
t
h
e
r
elatio
n
s
h
ip
b
etwe
en
b
o
d
y
co
m
p
o
s
itio
n
an
d
f
atig
u
e
.
Nec
k
cir
cu
m
f
er
en
ce
is
an
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
em
en
t
th
at
r
ef
le
cts
u
p
p
er
b
o
d
y
s
u
b
cu
tan
e
o
u
s
f
at
an
d
is
k
n
o
wn
to
co
r
r
elate
with
o
b
esit
y
,
m
etab
o
lic
d
is
o
r
d
er
s
,
an
d
o
b
s
tr
u
ctiv
e
s
leep
ap
n
ea
[
2
4
]
,
[
2
5
]
.
B
MI
h
as
b
ee
n
s
h
o
wn
to
p
r
ed
ict
n
ec
k
cir
cu
m
f
e
r
en
c
e,
w
ith
h
ig
h
e
r
B
MI
v
alu
es
g
en
er
al
ly
ass
o
ciate
d
with
la
r
g
er
n
ec
k
s
izes
[
2
6
]
.
I
n
t
h
is
s
tu
d
y
,
a
n
ec
k
cir
cu
m
f
e
r
en
ce
g
r
ea
ter
th
an
3
4
ce
n
tim
eter
s
was
f
o
u
n
d
to
co
r
r
elate
wit
h
o
b
esit
y
an
d
was
ass
o
ciate
d
with
in
cr
ea
s
ed
f
atig
u
e
am
o
n
g
p
ar
ticip
an
ts
(
p
=
0
.
0
7
5
)
.
T
h
is
s
u
g
g
ests
th
at
in
d
iv
id
u
als
with
lar
g
er
n
ec
k
cir
c
u
m
f
er
e
n
ce
s
ar
e
m
o
r
e
lik
ely
to
ex
p
er
ien
ce
f
atig
u
e
d
u
r
in
g
d
aily
ac
tiv
ities
[
2
7
]
.
A
d
d
itio
n
ally
,
f
atig
u
e
h
as
b
ee
n
id
e
n
tifie
d
as
a
co
n
tr
ib
u
tin
g
f
ac
t
o
r
to
m
u
s
cu
lo
s
k
el
etal
d
is
o
r
d
er
s
,
m
a
k
in
g
t
h
e
m
e
asu
r
em
en
t
o
f
n
ec
k
cir
cu
m
f
er
en
ce
an
im
p
o
r
ta
n
t
co
n
s
id
er
atio
n
i
n
o
cc
u
p
atio
n
al
h
ea
lth
ass
ess
m
en
ts
[
2
8
]
.
T
h
ese
f
in
d
in
g
s
h
a
v
e
m
ea
n
in
g
f
u
l
im
p
licatio
n
s
f
o
r
wo
r
k
p
lace
h
ea
lth
m
o
n
ito
r
in
g
.
Nec
k
cir
cu
m
f
er
e
n
ce
,
as
a
s
im
p
l
e
an
d
n
o
n
-
i
n
v
asiv
e
m
ea
s
u
r
e,
ca
n
s
er
v
e
as
an
ea
r
ly
in
d
icato
r
o
f
f
atig
u
e
r
is
k
,
p
ar
ticu
lar
ly
in
p
h
y
s
ically
in
t
en
s
iv
e
o
cc
u
p
atio
n
s
.
L
ar
g
er
n
ec
k
cir
cu
m
f
er
en
ce
m
ay
also
p
o
in
t
to
u
n
d
ia
g
n
o
s
ed
co
n
d
itio
n
s
s
u
c
h
as
o
b
s
tr
u
ctiv
e
s
leep
ap
n
ea
,
wh
ich
ca
n
im
p
air
s
leep
q
u
ality
an
d
lead
to
p
er
s
is
ten
t d
ay
tim
e
f
atig
u
e.
T
h
e
len
g
t
h
o
f
tim
e
p
ar
ticip
a
n
ts
h
ad
wo
r
k
ed
i
n
m
in
in
g
was
s
ig
n
if
ican
tly
ass
o
ciate
d
with
s
u
b
jectiv
e
f
atig
u
e
lev
els.
T
h
is
f
in
d
in
g
s
u
p
p
o
r
ts
p
r
io
r
r
esear
ch
in
d
ic
atin
g
a
lin
k
b
etwe
en
e
m
p
lo
y
m
en
t
d
u
r
atio
n
an
d
cu
m
u
lativ
e
w
o
r
k
-
r
elate
d
f
atig
u
e
[
2
9
]
.
A
p
r
ev
io
u
s
s
tu
d
y
r
e
v
ea
led
th
at
th
e
le
n
g
th
o
f
em
p
l
o
y
m
en
t
is
c
o
r
r
elate
d
with
f
atig
u
e
lev
els.
W
o
r
k
e
r
s
with
lo
n
g
e
r
em
p
l
o
y
m
en
t
d
u
r
atio
n
s
ten
d
t
o
ex
p
er
ien
ce
h
ig
h
er
f
atig
u
e
lev
els
,
p
ar
ticu
lar
ly
d
u
e
to
th
e
cu
m
u
l
ativ
e
ef
f
ec
ts
o
f
p
r
o
l
o
n
g
e
d
ex
p
o
s
u
r
e
to
d
em
a
n
d
in
g
wo
r
k
co
n
d
itio
n
s
[
3
0
]
.
T
h
ese
r
esu
lts
u
n
d
er
s
co
r
e
th
e
im
p
ac
t
o
f
lo
n
g
-
ter
m
o
cc
u
p
atio
n
al
s
t
r
ess
o
n
wo
r
k
er
well
-
b
ein
g
,
e
s
p
ec
ially
in
lab
o
r
-
in
ten
s
iv
e
an
d
h
ig
h
-
r
is
k
i
n
d
u
s
tr
ies
s
u
ch
as
m
in
in
g
.
Ov
er
tim
e,
r
ep
ea
ted
p
h
y
s
ical
s
tr
ain
,
ex
p
o
s
u
r
e
to
en
v
ir
o
n
m
en
tal
s
tr
ess
o
r
s
(
e.
g
.
,
h
ea
t,
n
o
is
e,
v
ib
r
atio
n
)
,
an
d
m
en
tal
wo
r
k
l
o
ad
ca
n
lead
to
ch
r
o
n
ic
f
atig
u
e,
r
ed
u
ce
d
p
h
y
s
ical
r
esil
ien
ce
,
an
d
ev
en
b
u
r
n
o
u
t.
T
h
is
s
u
g
g
ests
th
e
im
p
o
r
tan
ce
o
f
im
p
le
m
en
tin
g
p
r
ev
en
tiv
e
s
tr
ateg
ies th
at
ad
d
r
ess
th
e
n
ee
d
s
o
f
lo
n
g
-
s
er
v
in
g
em
p
lo
y
ee
s
.
T
h
is
s
tu
d
y
h
as
u
n
co
v
er
e
d
t
h
at
th
e
c
o
r
r
elatio
n
b
etwe
en
th
e
a
g
e
o
f
lab
o
r
er
s
a
n
d
t
h
eir
s
u
b
jectiv
e
lev
el
o
f
f
atig
u
e
was
f
o
u
n
d
to
b
e
s
tatis
tically
in
s
ig
n
if
ican
t.
Nev
er
th
eless
,
th
is
o
u
tco
m
e
is
co
n
s
is
ten
t
with
a
p
r
io
r
s
tu
d
y
th
at
h
as
d
em
o
n
s
tr
ated
t
h
at
th
er
e
ex
is
ts
n
o
ass
o
ciatio
n
b
etwe
en
ag
e
an
d
o
cc
u
p
atio
n
al
f
atig
u
e
am
o
n
g
s
t
em
p
lo
y
ee
s
in
th
e
tex
tile
in
d
u
s
tr
y
[
3
1
]
.
T
h
ese
f
in
d
in
g
s
s
u
g
g
e
s
t
th
at
ag
e
alo
n
e
m
a
y
n
o
t
b
e
a
r
eliab
le
p
r
e
d
icto
r
o
f
f
atig
u
e
in
p
h
y
s
ically
d
em
an
d
in
g
o
cc
u
p
atio
n
s
s
u
ch
as
m
in
in
g
.
Fatig
u
e
lev
els
ar
e
lik
ely
in
f
lu
en
ce
d
m
o
r
e
b
y
f
ac
to
r
s
s
u
ch
as
wo
r
k
lo
ad
,
s
h
i
f
t
p
att
er
n
s
,
s
leep
q
u
ality
,
p
h
y
s
ical
f
itn
ess
,
an
d
i
n
d
iv
id
u
al
c
o
p
in
g
m
ec
h
a
n
is
m
s
r
ath
er
th
an
ch
r
o
n
o
lo
g
ical
ag
e.
T
h
is
s
tu
d
y
r
ev
ea
led
th
at
th
er
e
was
n
o
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
s
u
b
jectiv
e
f
atig
u
e
l
ev
els
an
d
s
leep
q
u
an
tity
.
Par
ticip
a
n
ts
wh
o
r
e
p
o
r
ted
s
leep
in
g
le
s
s
th
an
7
h
o
u
r
s
p
e
r
n
i
g
h
t
ex
p
er
ien
ce
d
m
o
d
er
ate
f
atig
u
e
co
m
p
lain
ts
[
3
2
]
.
T
h
is
r
esu
lt
is
n
o
t
co
n
s
is
ten
t
with
p
r
io
r
r
esear
ch
,
wh
ich
attr
ib
u
ted
f
atig
u
e
to
in
s
u
f
f
icien
t
r
est,
o
f
ten
ca
u
s
ed
b
y
p
r
o
lo
n
g
ed
w
o
r
k
in
g
h
o
u
r
s
an
d
d
is
tu
r
b
an
ce
s
in
s
leep
p
atter
n
s
r
elate
d
to
s
tr
ess
,
an
x
iety
,
an
d
en
v
ir
o
n
m
en
tal
f
ac
to
r
s
s
u
ch
as
n
o
is
e
[
7
]
.
T
h
e
lack
o
f
a
s
tr
o
n
g
co
r
r
elatio
n
in
th
is
s
tu
d
y
s
u
g
g
ests
th
at
s
leep
q
u
an
tity
alo
n
e
m
ay
n
o
t
f
u
lly
e
x
p
lain
s
u
b
jectiv
e
f
atig
u
e
i
n
th
e
m
in
in
g
wo
r
k
f
o
r
ce
.
Oth
er
f
a
cto
r
s
,
s
u
ch
as
s
leep
q
u
ality
,
wo
r
k
d
e
m
an
d
s
,
p
h
y
s
ical
ex
er
tio
n
,
an
d
in
d
iv
id
u
al
r
esil
ien
ce
,
m
ay
p
lay
a
m
o
r
e
p
r
o
m
in
en
t
r
o
le
.
I
t'
s
p
o
s
s
ib
le
th
at
wo
r
k
er
s
ar
e
ac
cu
s
to
m
ed
to
s
h
o
r
ter
s
leep
d
u
r
atio
n
s
o
r
h
av
e
ad
ap
ted
co
p
in
g
s
tr
ateg
ies
th
at
m
itig
ate
th
e
ef
f
ec
ts
o
f
r
ed
u
ce
d
s
leep
tim
e.
T
h
e
f
in
d
in
g
s
o
f
t
h
is
s
tu
d
y
r
e
v
ea
led
th
at
th
er
e
was
n
o
s
ig
n
if
ican
t
co
r
r
elatio
n
b
etwe
en
s
u
b
jectiv
e
f
atig
u
e
lev
els
a
n
d
wo
r
k
s
h
if
t.
T
h
is
o
u
tc
o
m
e
c
o
n
tr
asts
with
p
r
io
r
r
esear
ch
th
at
i
d
en
ti
f
ied
a
s
ig
n
i
f
ican
t
ass
o
ciatio
n
b
etwe
en
c
u
m
u
lati
v
e
f
atig
u
e
an
d
s
h
if
t
wo
r
k
am
o
n
g
m
ed
ical
p
r
o
f
ess
io
n
als
(
p
<0
.
0
5
)
[
3
3
]
.
I
t
also
co
n
tr
ad
icts
a
p
r
ev
io
u
s
s
tu
d
y
th
at
r
ep
o
r
ted
s
h
if
t
wo
r
k
as
a
co
n
tr
ib
u
tin
g
f
ac
t
o
r
to
f
ati
g
u
e
am
o
n
g
m
in
in
g
o
p
er
ato
r
s
[
5
]
.
M
o
r
eo
v
er
,
ea
r
li
er
r
esear
ch
h
as
s
h
o
wn
th
at
s
h
if
t
wo
r
k
ca
n
n
eg
ativ
el
y
af
f
ec
t
wo
r
k
er
s
'
p
er
s
o
n
al
an
d
f
am
ily
life
s
atis
f
ac
tio
n
[
3
4
]
.
T
h
e
lack
o
f
ass
o
ciatio
n
in
th
is
s
tu
d
y
m
ay
r
ef
lect
d
if
f
er
en
ce
s
in
s
h
if
t
s
tr
u
ctu
r
es,
wo
r
k
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ib
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r
o
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g
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izatio
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atig
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ag
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m
en
t
p
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ac
tices
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t
h
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y
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ite.
I
t
is
p
o
s
s
ib
le
th
at
th
e
m
in
in
g
co
m
p
an
y
in
q
u
esti
o
n
h
as
im
p
le
m
en
t
ed
ef
f
ec
tiv
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co
u
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ter
m
ea
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r
es,
s
u
ch
as
r
eg
u
late
d
s
h
if
t
len
g
th
s
,
ad
eq
u
ate
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est
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er
io
d
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,
o
r
s
h
if
t
r
o
tatio
n
s
ch
ed
u
les
th
at
m
itig
ate
th
e
n
e
g
ativ
e
ef
f
ec
ts
ty
p
icall
y
ass
o
ciate
d
with
s
h
if
t
wo
r
k
.
Ad
d
itio
n
ally
,
in
d
iv
id
u
al
d
if
f
e
r
en
c
es
in
ad
ap
tatio
n
to
s
h
if
t
wo
r
k
,
in
c
lu
d
in
g
life
s
ty
le
h
ab
its
an
d
s
leep
m
an
ag
em
en
t stra
teg
ies,
m
ay
in
f
lu
en
ce
h
o
w
f
atig
u
e
is
p
er
ce
iv
ed
an
d
r
e
p
o
r
t
ed
.
T
h
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
s
h
if
t
wo
r
k
alo
n
e
m
ay
n
o
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u
n
i
v
er
s
ally
p
r
e
d
ict
f
a
tig
u
e,
an
d
th
at
c
o
n
tex
tu
al
w
o
r
k
p
lace
f
ac
to
r
s
m
u
s
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
5
2
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0
6
I
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t J Pu
b
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Hea
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Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
9
7
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1
8
05
1802
b
e
co
n
s
id
er
ed
.
E
m
p
lo
y
er
s
s
h
o
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ld
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o
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e
to
m
o
n
ito
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s
h
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elate
d
f
atig
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e
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is
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s
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ls
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r
ec
o
g
n
izin
g
t
h
e
r
o
le
o
f
s
u
p
p
o
r
tiv
e
wo
r
k
p
lace
p
r
ac
tices in
r
ed
u
cin
g
its
im
p
ac
t.
A
r
ec
en
t
s
tu
d
y
h
as
h
i
g
h
lig
h
t
ed
th
e
s
ig
n
if
ica
n
t
im
p
ac
t
o
f
m
in
er
f
atig
u
e
o
n
p
e
r
f
o
r
m
an
c
e.
Fatig
u
e
r
em
ain
s
p
r
e
v
alen
t
in
m
in
in
g
o
p
er
atio
n
s
d
u
e
to
th
e
p
h
y
s
ically
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em
an
d
in
g
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atu
r
e
o
f
th
e
wo
r
k
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d
th
e
ch
allen
g
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g
en
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ir
o
n
m
e
n
tal
co
n
d
itio
n
s
u
n
iq
u
e
to
th
e
in
d
u
s
tr
y
.
I
t
is
f
r
eq
u
en
tly
id
en
tifie
d
as
a
co
n
tr
ib
u
tin
g
f
ac
to
r
in
n
u
m
er
o
u
s
h
ea
lth
an
d
s
af
ety
i
n
cid
en
ts
with
in
m
in
es
[
3
5
]
.
Mo
r
e
o
v
er
,
f
atig
u
e
ca
n
im
p
air
co
g
n
itiv
e
f
u
n
ctio
n
s
s
u
ch
as
atten
tio
n
,
d
ec
is
io
n
-
m
ak
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g
,
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d
r
ea
ctio
n
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e,
th
er
e
b
y
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eg
ativ
ely
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f
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tin
g
o
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er
atio
n
al
p
er
f
o
r
m
an
ce
at
m
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e
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ites
[
3
6
]
.
T
h
ese
f
in
d
i
n
g
s
em
p
h
asize
t
h
e
cr
itical
n
ee
d
f
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r
p
r
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f
atig
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e
m
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ag
em
en
t
s
tr
ateg
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in
m
in
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.
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d
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ess
in
g
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atig
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e
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o
t
o
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ly
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u
p
p
o
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ts
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n
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ib
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ac
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4.
CO
NCLU
SI
O
N
T
h
e
r
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lts
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f
th
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tu
d
y
in
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icate
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at
th
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jectiv
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ati
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e
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ien
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b
y
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al
m
in
in
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ato
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s
is
p
r
im
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ily
attr
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tab
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to
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eir
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leep
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ality
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m
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ce
,
b
o
d
y
m
ass
in
d
ex
,
a
n
d
wo
r
k
in
g
p
er
io
d
s
.
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o
m
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ate
th
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as
s
o
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s
af
ety
r
is
k
s
,
it
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o
m
m
e
n
d
ed
th
at
p
r
ev
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n
tativ
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m
ea
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r
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e
im
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lem
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ted
th
r
o
u
g
h
th
e
ass
ess
m
en
t
an
d
im
p
r
o
v
em
en
t
o
f
o
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er
ato
r
s
leep
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u
ality
,
as
well
as
th
e
p
r
o
m
o
tio
n
o
f
o
p
tim
al
b
o
d
y
weig
h
t t
h
r
o
u
g
h
h
ea
lth
an
d
s
af
ety
in
itiativ
es th
at
in
clu
d
e
f
atig
u
e
m
an
a
g
em
en
t c
o
m
p
o
n
en
ts
.
I
n
ad
d
itio
n
,
it
is
r
ec
o
m
m
en
d
ed
th
at
m
in
i
n
g
c
o
m
p
an
ies
in
co
r
p
o
r
ate
r
o
u
tin
e
h
ea
lth
s
cr
e
en
in
g
s
th
at
in
clu
d
e
m
ea
s
u
r
em
en
ts
o
f
B
M
I
an
d
n
ec
k
cir
c
u
m
f
er
e
n
ce
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n
g
s
id
e
r
eg
u
lar
e
v
alu
atio
n
s
o
f
s
leep
p
atter
n
s
an
d
f
atig
u
e
lev
els.
T
ailo
r
e
d
in
ter
v
en
tio
n
s
—
s
u
ch
as
s
leep
h
y
g
ien
e
ed
u
ca
tio
n
,
s
h
if
t
s
ch
ed
u
l
in
g
s
tr
ateg
ies,
an
d
welln
ess
p
r
o
g
r
am
s
tar
g
etin
g
n
u
tr
itio
n
a
n
d
p
h
y
s
ical
ac
tiv
ity
—
s
h
o
u
ld
b
e
d
e
v
elo
p
e
d
to
a
d
d
r
ess
th
e
s
p
ec
if
ic
n
ee
d
s
o
f
h
i
g
h
-
r
is
k
wo
r
k
er
s
.
T
h
ese
co
m
b
in
ed
ef
f
o
r
ts
ca
n
s
u
p
p
o
r
t
a
h
ea
lth
ier
wo
r
k
f
o
r
ce
,
e
n
h
an
ce
o
p
er
atio
n
al
p
er
f
o
r
m
an
ce
,
a
n
d
r
e
d
u
ce
th
e
lik
elih
o
o
d
o
f
f
atig
u
e
-
r
elate
d
in
c
id
en
ts
in
th
e
m
in
in
g
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ec
to
r
.
ACK
NO
WL
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DG
M
E
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S
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e
au
th
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r
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ac
k
n
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ce
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atitu
d
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o
Ad
ar
o
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d
o
n
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o
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th
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s
u
p
p
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t
in
p
r
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v
id
i
n
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en
tial
d
ata,
f
ac
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ies,
an
d
in
f
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astru
ctu
r
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at
co
n
tr
ib
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ig
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ican
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s
u
cc
ess
f
u
l
co
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p
letio
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o
f
th
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esear
ch
.
F
UNDING
I
NF
O
R
M
A
T
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h
is
s
tu
d
y
r
ec
eiv
ed
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o
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x
ter
n
a
l f
u
n
d
in
g
.
AUTHO
R
CO
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B
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h
is
jo
u
r
n
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u
s
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th
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C
o
n
tr
ib
u
to
r
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les
T
ax
o
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m
y
(
C
R
ed
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to
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ec
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g
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ize
in
d
iv
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al
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th
o
r
co
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ib
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tio
n
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,
r
ed
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ce
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th
o
r
s
h
ip
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p
u
tes,
an
d
f
ac
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llab
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atio
n
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Aut
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Vi
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Desy
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Hap
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wati
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Did
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C
:
C
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p
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ter
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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
n
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s
y
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to
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(
R
o
b
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M
o
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1803
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NF
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DATA AV
AI
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AB
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L
I
T
Y
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h
e
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ata
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at
s
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p
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,
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R
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.
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w
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estrictio
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RE
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NC
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[
1
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S
.
A
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,
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[
2
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[
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[
5
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[
6
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[
7
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[
8
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A
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[
9
]
I
.
K
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[
1
0
]
T.
J.
B
a
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[
1
1
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.
A
.
D
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.
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.
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1
2
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3
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1
4
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C
.
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4
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s
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
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c
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.
Evaluation Warning : The document was created with Spire.PDF for Python.