Displaying publications 221 - 240 of 562 in total

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  1. Khairani, O., Norazua, R., Zaiton, A.
    Medicine & Health, 2007;2(1):80-85.
    MyJurnal
    Smoking in adolescence is a great health concern as it is related to many chronic diseases and mortality in later life. It is also associated with other high-risk behaviours among adolescents. The objective of this study was to determine the prevalence and reasons for smoking among upper secondary schoolboys. This was a cross-sectional study conducted among Form 4 and Form 5 students. Three schools in the District of Hulu Langat were identified and students from these schools were selected randomly. The students were given a self-administered questionnaire. A total of 343 students were included in the study. The prevalence of smoking among the schoolboys was 37%. Although the majority of them initiated smoking between 13-15 years old (67%), 21% of them began smoking below 12 years of age (primary school). There was a significant association between adolescent smoking and smoking among family members (p<0.05). The common reasons reported for
    initiating smoking were curiosity (69%) and peer pressure (51%). However, the common reasons for continuing smoking were stress (70%) and addiction (49%). Schoolwork was reported as the most important factor which contributed to their stress. Smoking prevention programmes should begin early in primary schools. Adolescents should be educated on effective coping strategies in managing stress and learning to be assertive.
    Keywords: smoking, adolescents, secondary school, reasons.
    Matched MeSH terms: Chronic Disease
  2. Rathor MY, Mohammad Fauzi AR, Omar AM
    MyJurnal
    Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinions.
    Matched MeSH terms: Chronic Disease
  3. Cheah YK, Su TT
    JUMMEC, 2012;15(2):1-7.
    MyJurnal
    The objective of the present study is to investigate the impact of socio-demographic factors on the acquisition of health information on Non-Communicable Diseases (NCDs) among Malaysian adults. A robust analysis was conducted on cross-sectional survey data obtained from 398 respondents in Penang (Malaysia) between August to October 2010. An ordered probit model was applied to examine the factors affecting the scale of health information. The results suggest that old individuals, rural dwellers, having chronic disease and history of serious family illnesses are 0.19%, 2.39%, 2.2% and 2.71% less likely to acquire poor health information on NCDs than others, whereas Malays, Chinese, males and those of low educated are 8.76%, 6.22%, 2.94% and 21.62% more likely to acquire poor health information on NCDs than others. Based on these findings, several intervention measures toward increasing the health knowledge among the population are recommended, which include the use of language-based mass media to advertise the information on diseases, designing health awareness campaigns in urban areas and introducing more basic health related subjects and courses into primary and secondary schools.
    Matched MeSH terms: Chronic Disease
  4. Saloma, P., Chan, K.G., Ong, M.F.
    MyJurnal
    Owing to reduced inpatient stays, people with mental illness (PMI) were often discharged from the hospital in ‘acute’ conditions. During this transition period of fragility, the relocation of care from hospital to home has tremendous impact on every aspect of a family’s life as they need to face a challenging task of caring especially when they are ‘not ready’ and ‘ignorant’ about the chronicity and severity of the illness. Furthermore, where economic and psychological support is concerned, those who are undertaking this task may require significant professional guidance. Aims: This study examines the experiences of 100 families in caring for people with mental illness in the community. Methods: Qualitative interviews were conducted in their homes within three Malaysian states of Sabah, Sarawak and Johor in year 2013. Results: Three themes emerged from the findings of ‘care demands related concerns’ of these families. These include theme (1): care provision related concerns of families which were related to the needs of people with mental illness for continuing care provision, their non-compliance with medication and relapse, altered sleep pattern, limited self-care ability, behavioral problems and also social isolation. Theme (2): perceived availability of resources of service provision/support which were related to activities planned for the families before the discharge of the people with mental illness and theme (3): family members perceived service needs whereby they informed of their needs such as continual health care through home visit, provision of financial aid, job coach service, centre for care provision of PMI and rehabilitative programs.
    Matched MeSH terms: Chronic Disease
  5. Sazlina SG
    Malays Fam Physician, 2015;10(1):2-10.
    PMID: 26425289 MyJurnal
    The world population of older people is on the rise with improved health services. With longevity, older people are at increased risk of chronic non-communicable diseases (NCDs), which are also leading causes of death among older people. Screening through case finding in primary care would allow early identification of NCDs and its risk factors, which could lead to the reduction of related complications as well as mortality. However, direct evidence for screening older people is lacking and the decision to screen for diseases should be made based on comorbidity, functional status and life expectancy, and has to be individualised.
    Matched MeSH terms: Chronic Disease
  6. Kamath S, Omar M, Wah LT
    Med J Malaya, 1970 Dec;25(2):123-7.
    PMID: 4251133
    Matched MeSH terms: Chronic Disease
  7. Johari HH, Mohamad I, Sachlin IS, Aziz ME, Mey TY, Ramli RR
    Auris Nasus Larynx, 2018 Dec;45(6):1183-1190.
    PMID: 29880289 DOI: 10.1016/j.anl.2018.04.010
    OBJECTIVE: This study was done to determine frontal recess anatomy cell variations and its association with frontal sinusitis. The incidence of frontal recess cells in the population, the presence of frontal recess cell variations in chronic rhinosinusitis and non-chronic rhinosinusitis and the association of frontal recess cell variation in the development of frontal sinusitis were also assessed.

    METHODS: This was an observational, retrospective cross-sectional study of computed tomography (CT) scan of paranasal sinus that had been performed on patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah done from January 2009 until December 2016. The presence of frontal recess cells variation was compared with other populations.

    RESULTS: A total of 312 sides from 156 patients' CT scan images were analyzed. Left and right sinuses were considered individually. A total of 63 sides showed evidence of frontal sinusitis, 37 were male and 26 were female, whereas 249 sides were clear from frontal sinus disease. It was not much difference in mean age for frontal sinusitis patient (46.51±14.00) and patients without frontal sinusitis (48.73±16.44). The percentage was almost equal for CRS and non-CRS groups regardless of side and gender. In our study, the frontal recess cell such as agger nasi cell was found in almost all patients 98.1%, frontal ethmoidal cell type 1, type 2, type 3 and type 4 comprised of 28.8%, 31.1%, 14.4% and 0% respectively. Whereas, suprabullar cell can be seen in 40.3%, supraorbital ethmoid cells 16.7%, frontal bullar cell 33.0% and inter-frontal sinus septal cells 10.8%. There was a statistically significant association between the presence of frontal bullar cell and the development of frontal sinusitis (p value<0.001).

    CONCLUSION: The frontal recess cells variation in Malaysian subjects were almost similar to those reported in other Asian populations such as Japanese, Taiwanese, Chinese and Korean. Our study found that frontal bullar cells had a significant association with the development of frontal sinusitis than other frontal recess cells. The understanding of the frontal recess anatomical structures was very important as this would lead to a successful treatment of CRS and at the same time it helped the surgeon to have a better plan of endoscopic sinus surgery to prevent the disease recurrence and surgical complication.

    Matched MeSH terms: Chronic Disease
  8. Wan Amir Nizam, W.A., Ng, S.H., Wan Rosli, W.I.
    MyJurnal
    Discovery of novel dietary fibre (DF)-rich food ingredient is of great interest to meet the rising consumer demand for healthy food. Intake of DF-enriched food has been positively associated with a decreased risk of chronic diseases. Pleurotus sajor-caju (PSC), one of the prominent edible mushrooms widely cultivated in Malaysia, is useful for its culinary and medicinal purpose. This study aimed to determine the nutritional, physical, colour and sensorial properties of cinnamon biscuit formulated with PSC powder as partial replacement (0, 4, 8 and 12%) for wheat flour. Results indicated that elevated incorporation levels of PSC powder significantly (P
    Matched MeSH terms: Chronic Disease
  9. Huijin, Lau, Nor Fadilah Rajab, Arimi Fitri Mat Ludin, Suzana Shahar
    Jurnal Sains Kesihatan Malaysia, 2015;15(22):97-102.
    MyJurnal
    The expansion of ageing population has gained much public attention on the importance of healthy and successful ageing,
    which is absence of major chronic diseases, preserved physiological and cognitive functioning and active engagement
    with life. Previous studies have found there was a significant correlation between physical fitness with cognition. However,
    the relationship between physical fitness with successful and unsuccessful cognitive ageing groups are very limited. This
    study was aimed to identify the significant physical fitness components that contribute in reducing risk of cognitive decline
    represented as different cognitive ageing groups. A total of 300 community-based elderly aged 60 and above from the
    states of Selangor, Perak and Kelantan were recruited using multistage random sampling method in this cross-sectional
    study. Cognitive function of subjects was categorized into three groups, namely Mild Cognitive Impairment (MCI) (n
    = 100), Usual Ageing (UA) (n = 100) and Successful Ageing (SA) (n = 100) based on defined criteria. Senior Fitness
    Tests included 2-minute step, handgrip strength, chair stand, chair sit-and-reach, 8 foot up-and-go and back scratch
    were measured to determine the cardiorespiratory fitness; muscle strength; agility and flexibility of subjects. SA group
    had significantly better performance than non-SA groups in all fitness components, except for chair sit-and-reach. After
    controlling for age, gender, education years and smoking status, handgrip strength and chair stand tests were associated
    with a reduced risk of MCI by 7% [OR: 0.93, 95% C.I: 0.88-0.99, p < 0.05] and 15% [OR: 0.85, 95% C.I: 0.75-0.95, p <
    0.01], respectively. These findings suggest that older adults with higher upper and lower body muscular strength could
    serve as protective factors for cognitive impairment. Further research is warranted to evaluate the mechanism of physical
    and cognitive decline such as Motoric Cognitive Risk Syndrome (MCR) in more detailed for the purpose for promoting
    healthy and successful ageing.
    Matched MeSH terms: Chronic Disease
  10. Padzil, F., Mariatulqabtiah, A. R., Abu, J.
    Jurnal Veterinar Malaysia, 2017;29(2):9-13.
    MyJurnal
    Avian polyomavirus disease is among the most common viral diseases of domesticated exotic birds as such in psittacine families. Caused by avian polyomavirus (APV) which possess a circular, double-stranded DNA which encodes for major structural virus protein 1 (VP1) and minor structural proteins VP2, VP3 and VP4, the disease is also known as Budgerigar fledgling disease polyomavirus (BFPyV), Papovavirus, and Psittacine polyomavirus. Infections from APV may lead to cutaneous haemorrhage, abdominal distension, feather abnormalities and even death. The APV virus has a broad avian host range and is known to cause acute chronic disease in several psittacine birds such as parrot, cockatoo, macaw, and budgerigar. The current status of APV epidemiology globally has not been fully recorded. Only the studies of the virus and disease caused within several countries are used as references, and few were done together with detection of beak and feather disease virus. Despite the common occurrence of APV among bird breeders in Malaysia, a very limited study has been done to evaluate the prevalence status of APV in Malaysia. In this review, we wish to disseminate knowledge, particularly to pet owners and bird breeders, on APV characterisations, its updated occurrence worldwide and prevention strategies. This information may be useful to trigger in depth study on the epidemiology of disease and better management practises among breeders.
    Matched MeSH terms: Chronic Disease
  11. Albahri AS, Zaidan AA, Albahri OS, Zaidan BB, Alsalem MA
    J Med Syst, 2018 Jun 23;42(8):137.
    PMID: 29936593 DOI: 10.1007/s10916-018-0983-9
    The burden on healthcare services in the world has increased substantially in the past decades. The quality and quantity of care have to increase to meet surging demands, especially among patients with chronic heart diseases. The expansion of information and communication technologies has led to new models for the delivery healthcare services in telemedicine. Therefore, mHealth plays an imperative role in the sustainable delivery of healthcare services in telemedicine. This paper presents a comprehensive review of healthcare service provision. It highlights the open issues and challenges related to the use of the real-time fault-tolerant mHealth system in telemedicine. The methodological aspects of mHealth are examined, and three distinct and successive phases are presented. The first discusses the identification process for establishing a decision matrix based on a crossover of 'time of arrival of patient at the hospital/multi-services' and 'hospitals' within mHealth. The second phase discusses the development of a decision matrix for hospital selection based on the MAHP method. The third phase discusses the validation of the proposed system.
    Matched MeSH terms: Chronic Disease
  12. Khan Y, Pandy V
    Front Pharmacol, 2016;7:352.
    PMID: 27729866
    Phytotherapy is an emerging field successfully utilized to treat various chronic diseases including alcohol dependence. In the present study, we examined the effect of the standardized methanolic extract of Morinda citrifolia Linn. unripe fruit (MMC), on compulsive ethanol-seeking behavior using the mouse conditioned place preference (CPP) test. CPP was established by injections of ethanol (2 g/kg, i.p.) in a 12-day conditioning schedule in mice. The effect of MMC and the reference drug, acamprosate (ACAM), on the reinforcing properties of ethanol in mice was studied by the oral administration of MMC (1, 3, and 5 g/kg) and ACAM (300 mg/kg) 60 min prior to the final CPP test postconditioning. Furthermore, CPPs weakened with repeated testing in the absence of ethanol over the next 12 days (extinction), during which the treatment groups received MMC (1, 3, and 5 g/kg, p.o.) or ACAM (300 mg/kg, p.o.). Finally, a priming injection of a low dose of ethanol (0.4 g/kg, i.p.) in the home cage (Reinstatement) was sufficient to reinstate CPPs, an effect that was challenged by the administration of MMC or ACAM. MMC (3 and 5 g/kg, p.o.) and ACAM (300 mg/kg, p.o.) significantly reversed the establishment of ethanol-induced CPPs and effectively facilitated the extinction of ethanol CPP. In light of these findings, it has been suggested that M. citrifolia unripe fruit could be utilized for novel drug development to combat alcohol dependence.
    Matched MeSH terms: Chronic Disease
  13. Ulaganathan V, Kandiah M, Mohd Shariff Z
    J Gastrointest Oncol, 2018 Aug;9(4):650-663.
    PMID: 30151261 DOI: 10.21037/jgo.2018.04.01
    Background: Metabolic syndrome was linked with various chronic diseases, including cancer. The study on the effect of metabolic syndrome on colorectal cancer (CRC) was not conducted in Malaysia. Therefore, this study aims to determine the association between metabolic syndromes and its components with CRC, based on the three established definitions.

    Methods: A multi-centred matched case control study was conducted in five local hospitals. A total of 140 histologically confirmed CRC cases were matched with 280 cancer free controls. Mean value and prevalence of the components of metabolic syndrome between cases and controls were measured based on the three definitions. A multiple variable analysis using Cox regression was conducted to measure the strength of the association between the definitions of MetS, components of MetS and risk of CRC.

    Results: Multiple variable analyses showed that metabolic syndrome significantly and independently increased the risk of CRC, with an odds ratio ranging from 1.79 to 2.61. This study identified that the definition of metabolic syndrome by the International Diabetes Federation is the most sensitive in predicting the risk of CRC, compared to metabolic syndrome as defined by the World Health Organization and National Cholesterol Education Program Adults Treatment Panel III. Abdominal obesity, low HDL-cholesterol, and hypertension were identified as the three core risk factors, which promote inflammatory signals that contribute to metabolic syndrome and an increased risk of CRC.

    Conclusions: These data hypothesized that simple measurement of abdominal obesity, abnormal BP and HDL-cholesterol especially using International Diabetes Federation (IDF) definition of MetS for South Asians for to detect individuals at CRC risk may have higher clinical utility than applying other universal complex MetS definitions.

    Matched MeSH terms: Chronic Disease
  14. Ulaganathan V, Kandiah M, Shariff ZM
    J Carcinog, 2018;17:4.
    PMID: 30294246 DOI: 10.4103/jcar.JCar_2_18
    BACKGROUND: Obesity has frequently been associated with the dyslipidemic state and with the risk of various chronic diseases.

    OBJECTIVE: The objective of this study was to determine the relationship between obesity and blood lipids with a risk of colorectal cancer (CRC).

    METHODOLOGY: Histologically confirmed CRC patients from five local hospitals were matched with cancer-free controls for age, gender, and ethnicity (n = 140: 280). The study participants underwent physical assessment for the presence of obesity and 10 mL of fasting blood was drawn for blood lipid analysis.

    RESULTS: In this study, abdominal obesity significantly doubled the risk of CRC (adjusted odds ratio [AOR] =1.69, 95% confidence interval [CI] = 1-2.83). Hypercholesterolemia and low high-density lipoprotein cholesterol (HDL) increased the risk of CRC more than twofolds (AOR = 2.6, 95% CI = 1.7-3.9 and AOR = 3.8, 95% CI = 2.3-6.3, respectively). Abdominal obesity and hypercholesterolemia synergically doubled the risk of CRC (AOR = 2.0, 95% CI = 1-4). Low-HDL has shown no synergic association with other dyslipidemic states with an increased CRC risk.

    CONCLUSION: Improving abdominal obesity, hypercholesterolemia, and low HDL may be a clinically relevant strategy to reduce the risk of CRC among Malaysians.

    Matched MeSH terms: Chronic Disease
  15. Safurah Khairul Fadzil, Marhanis Salihah Omar, Noorlaili Mohd Tohit
    Int J Public Health Res, 2018;8(2):998-105.
    MyJurnal
    Introduction The use of dietary supplements had risen over the years among chronic
    disease patients with most of it were of patients' own initiative. This study
    aimed to describe the supplements use, assess the knowledge and attitude
    towards supplements and its interaction with prescribed medication, and
    determine whether knowledge and attitude towards supplements could
    influence treatment adherence in chronic disease patients.
    Methods A cross-sectional study was conducted among chronic disease patients in
    Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur from
    September to November 2016 upon their written informed consent. This
    study consists of a collection of validated instruments that measured the use
    of dietary supplements and its reason; the knowledge and attitude on dietary
    supplements and supplements-drug interaction and medication adherence.
    Results A total number of 250 respondents were interviewed and 72.4% was found to
    use supplements of own initiatives. Most of the respondents were using
    supplements to maintain health (78.8%), prevent health problems (72.4%)
    and improve overall health (63.2%). It was found that respondents'
    knowledge on supplement-drug interactions were not at the satisfactory level.
    The treatment adherence was found not to be associated with knowledge and
    attitude towards supplements nor numbers of supplements use.
    Conclusions Chronic disease patients mainly knew on the purpose of supplements for
    health and wellness, but had less knowledge on supplement-drug interactions,
    warranting patients' education on that particular field.
    Matched MeSH terms: Chronic Disease
  16. Saeidi A, Zandi K, Cheok YY, Saeidi H, Wong WF, Lee CYQ, et al.
    Front Immunol, 2018;9:2569.
    PMID: 30473697 DOI: 10.3389/fimmu.2018.02569
    T-cell exhaustion is a phenomenon of dysfunction or physical elimination of antigen-specific T cells reported in human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections as well as cancer. Exhaustion appears to be often restricted to CD8+ T cells responses in the literature, although CD4+ T cells have also been reported to be functionally exhausted in certain chronic infections. Although our understanding of the molecular mechanisms associated with the transcriptional regulation of T-cell exhaustion is advancing, it is imperative to also explore the central mechanisms that control the altered expression patterns. Targeting metabolic dysfunctions with mitochondrion-targeted antioxidants are also expected to improve the antiviral functions of exhausted virus-specific CD8+ T cells. In addition, it is crucial to consider the contributions of mitochondrial biogenesis on T-cell exhaustion and how mitochondrial metabolism of T cells could be targeted whilst treating chronic viral infections. Here, we review the current understanding of cardinal features of T-cell exhaustion in chronic infections, and have attempted to focus on recent discoveries, potential strategies to reverse exhaustion and reinvigorate optimal protective immune responses in the host.
    Matched MeSH terms: Chronic Disease
  17. AlQarni K, AlQarni EA, Naqvi AA, AlShayban DM, Ghori SA, Haseeb A, et al.
    Front Pharmacol, 2019;10:1306.
    PMID: 31787894 DOI: 10.3389/fphar.2019.01306
    Objective: Medication adherence is defined as taking medications as advised and prescribed by health care professionals for stated duration. Diabetes mellitus (DM) is one of the most common chronic illnesses in Saudi Arabia. This study aimed to document medication adherence in Saudi patients with type 2 diabetes. Methods: A quantitative cross-sectional study was conducted in Saudi out-patients with type 2 DM in the city of Khobar, Saudi Arabia. The study used the General Medication Adherence Scale (GMAS) to document medication adherence in this population. Data was analyzed through SPSS version 23. Study was ethically approved. Results: Data was collected from 212 patients. Few patients (35.8%) had high adherence to anti diabetic medications. The correlation between HbA1c level and adherence score was negative and significantly strong (ρ = -0.413, p < 0.0001). Most patients (N = 126, 59.4%) modified their medication therapy during month of Ramadan and on Eid occassion. Education level was not a determinant of adherence in this population. Conclusion: This study highlighted that medication adherence is influenced by religious and social factors. Patient counseling is required to improve patient beliefs and increase awareness of adhering to prescribed anti diabetic pharmacotherapy. A pharmacist can play constructive role of a disease educator and patient counselor.
    Matched MeSH terms: Chronic Disease
  18. Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, et al.
    Front Public Health, 2019;7:268.
    PMID: 31620419 DOI: 10.3389/fpubh.2019.00268
    This study aimed to assess the uptake of recommended vaccines and to identify the factors associated with the vaccines' uptake among Malaysian Hajj and Umrah pilgrims. A cross-sectional survey among Malaysian Hajj and Umrah pilgrims in 2018. The uptake of the recommended vaccines was surveyed through an anonymous self-administered questionnaire to pilgrims attending a pre-departure Hajj/Umrah orientation course. Descriptive statistics were used for elaborating the demographic characteristics and vaccines uptake of the respondents. Multiple logistic regression was used for predicting the factors associated with the vaccines' uptake. A total of 1,274 pilgrims participated in the study with a mean age (standard deviation) of 42.42 (15.6). A total of 833 (65.4%) participants were females and 232 of the participants (18.2%) had at least more than one chronic disease. The uptake of influenza and pneumococcal vaccines were 28.6% (364/1,274) and 25.4% (324/1,274), respectively. Among the 527 pilgrims who were "at increased risk" of infections, 168 (31.9%) and 184 (34.9%) received influenza and pneumococcal vaccines, respectively. Gender, marital status and occupation were the common predictors associated with vaccines uptake. The vaccination uptake among Malaysian Hajj and Umrah pilgrims is low and declining from previous years. Educating the pilgrims toward vaccine uptake is essential and exploring the barriers for vaccination.
    Matched MeSH terms: Chronic Disease
  19. Mohd Sidik S, Mohd Zulkefli NA, Mustaqim A
    Asia Pac Fam Med, 2003;2(4):196-199.
    Introduction: Depression is the most common psychiatric disorder among the elderly. The hallmark of depression in the elderly is its comorbidity with medical illness. Aim: To determine the prevalence of depression and its association with chronic illness among the elderly in a rural community setting. Methods: A cross sectional study design was used. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Results: The prevalence of depression was higher among elderly with chronic illness (9.0%) compared to elderly without chronic illness (5.6%). Depression among the elderly was signi.cantly associated with ischemic heart disease. Conclusion: The prevalence of depression among the elderly with chronic illness in the community is high. Primary care providers need to be vigilant when treating elderly patients in their care as depression is commonly found in this group.
    Matched MeSH terms: Chronic Disease
  20. Bauman A, Phongsavan P, Schoeppe S, Chey T
    ISBN: 978-92-9061-474-6
    Citation: Bauman A, Phongsavan P, Schoeppe S, Chey T. Noncommunicable disease risk factors and socioeconomic inequalities – what are the links? A multicountry analysis of noncommunicable disease surveillance data. Report to the WHO Regional Office for the Western Pacific. Geneva: World Health Organization; 2010

    Malaysia as contributing authors and in full text.
    Matched MeSH terms: Chronic Disease
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