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  1. Effect of aqueous extract of Dicranopteris linearis leaves against paracetamol and carbon tetrachloride-induced liver toxicity in rats
    Ismail NA, Shamsahal-Din NS, Mamat SS, Zabidi Z, Wan Zainulddin WN, Kamisan FH, et al.
    Pak J Pharm Sci, 2014 Jul;27(4):831-5.
    PMID: 25015448
    The present study aimed to determine the hepatoprotective activity of Dicranopteris linearis L. (family Gleicheniaceae) leaf aqueous extract (DLAE) using two models of liver injury in rats. Rats were divided into ten groups (n=6) and received dH2O (negative control), 200 mg/kg silymarin (positive control) or DLAE (50, 250 and 500 mg/kg) orally once daily for 7 consecutive days and on the 8th day subjected to the hepatotoxic induction either using carbon tetrachloride (CCl4) or paracetamol (PCM). The bloods and livers were collected and subjected to biochemical and microscopical analysis. From the data obtained, only the highest dose of DLAE significantly (P<0.05) reduced the ALP, ALT and AST levels in CCl4-and PCM-induced hepatotoxic rats while the other doses caused significant (P<0.05) reduction only in the levels of ALT and AST. The histological results obtained were in line with the biochemical analysis wherein reduction in the CCl4- and PCM-induced tissue formation of necrosis, steatosis and inflammation occurred in a dose-dependent manner. In conclusion, the DLAE possesses hepatoprotective activity, which could be attributed to its free radicals scavenging and antioxidant activities, and high flavonoids content. Thus, in-depth studies regarding the hepatoprotective activity of DLAE are warranted.
    Matched MeSH terms: Drug-Induced Liver Injury/prevention & control*
  2. An outline of the need for psychology knowledge in health professionals: implications for community development and breast cancer prevention
    Ahmadian M, Samah AA, Saidu MB
    Asian Pac J Cancer Prev, 2014;15(12):5097-105.
    PMID: 24998591
    Knowledge of health and community psychology in health professionals influences psychosocial and community determinants of health and promoting participation in disease prevention at the community level. This paper appraises the potential of knowledge on psychology in health care professionals and its contribution to community empowerment through individual behavior change and health practice. The authors proposed a schematic model for the use of psychological knowledge in health professionals to promote participation in health interventions/disease prevention programs in developing countries. By implication, the paper provides a vision on policies towards supporting breast cancer secondary prevention efforts for community health development in Asian countries.
    Matched MeSH terms: Breast Neoplasms/prevention & control*
  3. Effects of wink glass on blink rate, nibut and ocular surface symptoms during visual display unit use
    Ang CK, Mohidin N, Chung KM
    Curr Eye Res, 2014 Sep;39(9):879-84.
    PMID: 25014251 DOI: 10.3109/02713683.2013.859273
    PURPOSE/AIM: Wink glass (WG), an invention to stimulate blinking at interval of 5 s was designed to reduce dry eye symptoms during visual display unit (VDU) use. The objective of this study is to investigate the effect of WG on visual functions that include blink rate, ocular surface symptoms (OSS) and tear stability during VDU use.
    MATERIALS AND METHODS: A total of 26 young and asymptomatic subjects were instructed to read articles in Malay language with a computer for 20 min with WG whereby their blink rate, pre- and post-task tear break-up time, and OSS were recorded. The results were compared to another reading session of the subjects wearing a transparent plastic sheet as a control.
    RESULTS: Non-invasive tear break-up time was reduced after reading session with transparent plastic sheet (pre-task = 5.97 s, post-task = 5.14 s, z = -2.426, p = 0.015, Wilcoxon), but remained stable (pre-task = 5.62 s, post-task = 5.35 s, z = -0.67, p = 0.501) during the reading session with WG. The blink rate recorded during reading session with plastic sheet was 9 blinks/min (median) and this increased to 15 blinks/min (z = -3.315, p = 0.001) with WG. The reading task caused OSS (maximum scores = 20) with median score of 1 (0-8) reduced to median score of 0 (0-3) after wearing WG (z = -2.417, p = 0.016).
    CONCLUSION: WG was found to increase post-task tear stability, increased blinking rate and reduced OSS during video display unit use among young and healthy adults. Although it may be considered as an option to improve dry eye symptoms among VDU users, further studies are warranted to establish its stability and its effect on subjects with dry eyes.
    KEYWORDS: Blink rate; Wink glass; non-invasive tear break-up time; visual display units
    Matched MeSH terms: Dry Eye Syndromes/prevention & control*
  4. Roux-en-Y gastric bypass for lower esophageal submucosal cancer in an obese diabetic patient
    Almulaifi AM, Lee WJ, Hong PE
    Surg Obes Relat Dis, 2014 Nov-Dec;10(6):e73-5.
    PMID: 25002323 DOI: 10.1016/j.soard.2014.04.013
    Matched MeSH terms: Diabetes Mellitus, Type 2/prevention & control
  5. Fulltext Does vitamin A supplementation protect schoolchildren from acquiring soil-transmitted helminthiasis? A randomized controlled trial
    Al-Mekhlafi HM, Anuar TS, Al-Zabedi EM, Al-Maktari MT, Mahdy MA, Ahmed A, et al.
    Parasit Vectors, 2014;7:367.
    PMID: 25127885 DOI: 10.1186/1756-3305-7-367
    Despite the intensive global efforts to control intestinal parasitic infections, the prevalence of soil-transmitted helminth (STH) infections is still very high in many developing countries particularly among children in rural areas.
    Matched MeSH terms: Helminthiasis/prevention & control*
  6. Fulltext The life and health challenges of young Malaysian couples: results from a stakeholder consensus and engagement study to support non-communicable disease prevention
    Norris SA, Anuar H, Matzen P, Cheah JC, Jensen BB, Hanson M
    BMC Public Health, 2014;14 Suppl 2:S6.
    PMID: 25080995 DOI: 10.1186/1471-2458-14-S2-S6
    BACKGROUND: Malaysia faces burgeoning obesity and diabetes epidemics with a 250% and 88% increase respectively between 1996 and 2006. Identifying the health challenges of young adults in Malaysia, who constitute 27.5 % of the population, is critical for NCD prevention. The aim of the study was two-fold: (1) to achieve consensus amongst stakeholders on the most important challenge impacting the health of young adults, and (2) to engage with stakeholders to formulate a NCD prevention framework.

    METHODS: The Delphi Technique was utilised to achieve group consensus around the most important life and health challenges that young adults face in Malaysia. Subsequently, the results of the consensus component were shared with the stakeholders in an engagement workshop to obtain input on a NCD prevention framework.

    RESULTS: We found that life stress was a significant concern. It would seem that the apathy towards pursuing or maintaining a healthy lifestyle among young adults may be significantly influenced by the broader distal determinant of life stress. The high cost of living is suggested to be the main push factor for young working adults towards attaining better financial security to improve their livelihood. In turn, this leads to a more stressful lifestyle with less time to focus on healthier lifestyle choices.

    CONCLUSIONS: The findings highlight a pivotal barrier to healthier lifestyles. By assisting young adults to cope with daily living coupled with realistic opportunities to make healthier dietary choices, be more active, and less sedentary could assist in the development of NCD health promotion strategies.

    Matched MeSH terms: Chronic Disease/prevention & control*
  7. Fulltext The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study
    Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R
    BMC Emerg Med, 2014;14:17.
    PMID: 25086638 DOI: 10.1186/1471-227X-14-17
    The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.
    Matched MeSH terms: Facial Injuries/prevention & control
  8. Fulltext Malaysia: empowering dentists into smoking cessation
    Nordin AS, Kadir RA
    Tob Control, 2014 Jul;23(4):284.
    PMID: 25061647
    Matched MeSH terms: Smoking/prevention & control*
  9. The effect of facilitated tucking on procedural pain control among premature babies
    Lopez O, Subramanian P, Rahmat N, Theam LC, Chinna K, Rosli R
    J Clin Nurs, 2015 Jan;24(1-2):183-91.
    PMID: 25060423 DOI: 10.1111/jocn.12657
    To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants.
    Matched MeSH terms: Pain/prevention & control*
  10. Fulltext An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT)
    Tan PJ, Khoo EM, Chinna K, Hill KD, Poi PJ, Tan MP
    BMC Geriatr, 2014;14:78.
    PMID: 24951180 DOI: 10.1186/1471-2318-14-78
    Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults.
    Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.
    Discussion: Previous studies evaluating multifactorial interventions in falls have reported variable outcomes.
    Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that
    individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community.
    Trial registration: ISRCTN11674947
    Study: Malaysian Falls Assessment and Intervention Trial; MyFAIT
    Matched MeSH terms: Accidental Falls/prevention & control*
  11. The prospect of malaria elimination in the Arabian Peninsula: a population genetic approach
    Al-Hamidhi S, Mahdy MA, Idris MA, Bin Dajem SM, Al-Sheikh AA, Al-Qahtani A, et al.
    Infect Genet Evol, 2014 Oct;27:25-31.
    PMID: 24981966 DOI: 10.1016/j.meegid.2014.06.015
    In the Arabian Peninsula malaria control is progressing steadily, backed by adequate logistic and political support. As a result, transmission has been interrupted throughout the region, with exception of limited sites in Yemen and Saudi Arabia. Here we examined Plasmodium falciparum parasites in these sites to assess if the above success has limited diversity and gene flow.
    Matched MeSH terms: Malaria, Falciparum/prevention & control
  12. Empowering Malaysian dentists to tobacco dependence treatment conduct
    Nordin AS, Kadir RA, Yahya NA, Zakaria H, Rashid RA, Habil MH
    Int Dent J, 2014 Aug;64(4):206-12.
    PMID: 24835463 DOI: 10.1111/idj.12110
    As a signatory to the World Health Organisation 2003 Framework Convention on Tobacco Control, Malaysia has policies in place and funded 300 public Quit clinics. Unfortunately, government dentists are not included to run tobacco dependence treatment. A cross-sectional exploratory survey was carried out to seek Malaysian dentists' opinion on their knowledge, perception and willingness to conduct tobacco dependence treatment. Participation was voluntary from those who attended a specially designed one-day, four-module workshop on tobacco cessation intervention. Data were collected using the Audience-Response-System equipment which tracked immediate responses covering four domains namely: smoking as a public health problem, smoking as an addiction, the role of dentists in the programme and confidence in conducting smoking cessation in the clinic. Sample comprised more female dentists (73.5%), mean age 33.6 (SD 8.99) years and with more than 3 years working experience. Findings indicated that the majority agreed Malaysia has a rising problem in the prevalence of smoking (71.6%) and predicted that it will affect mostly the young (81.9%). Only half of the dentists surveyed (58.9%) routinely recorded their patients' smoking habits. The majority (71.6%) believed that dentists are effective in helping their patient to stop smoking and 76.3% agreed that dentists should discuss the smoking habit with their patients; however, 60% agreed that doing so is too time consuming. In addition, only 24.7% knew of more ways to treat a smoking habit. The majority felt comfortable giving advice to patients about changing their habits (76.5%) or discussing treatment options (60.5%): 75% would opt for a combined programme of counselling and use of medication if they have to do, 15% would choose to go on counselling only, while 8% did not want to treat. In conclusion, the findings suggest that dentists have a strong potential to contribute significantly to providing smoking cessation treatment if adequately trained.
    Matched MeSH terms: Smoking/prevention & control
  13. Fulltext Current insecticide susceptibility status of Malaysian Anopheles maculatus Theobald to malathion, permethrin, DDT and deltamethrin
    Rohani A, Aziz I, Zurainee MN, Rohana SH, Zamree I, Lee HL
    Trop Biomed, 2014 Mar;31(1):159-65.
    PMID: 24862056 MyJurnal
    Chemical insecticides are still considered as important control agents for malaria vector control. However, prolonged use of these chemicals may select mosquito vectors for resistance. In this study, susceptibility status of adult Anopheles maculatus collected from 9 localities in peninsular Malaysia, viz., Jeli, Temerloh, Pos Banun, Senderut, Jeram Kedah, Segamat, Kota Tinggi, Kluang and Pos Lenjang were determined using the standard WHO bioassay method in which the adult mosquitoes were exposed to standard insecticide impregnated papers malathion, permethrin, DDT and deltamethrin--at pre-determined diagnostic dosage. Deltamethrin was most effective insecticide among the four insecticides tested, with the LT50 of 29.53 min, compared to malathion (31.67 min), DDT (47.76 min) and permethrin (48.01 min). The effect of all insecticides on the laboratory strain was greater (with all insecticides demonstrated LT50 < 1 hour) than the field strains (deltamethrin 32.7, malathion 53.0, permethrin 62.0, DDT 67.4 min). An. maculatus exhibited low degree of resistance to all test insecticides, indicating that these chemical insecticides are still effective in the control of malaria vector.
    Matched MeSH terms: Malaria/prevention & control*
  14. Fulltext Bacteria as a source of oviposition attractant for Aedes aegypti mosquitoes
    Arbaoui AA, Chua TH
    Trop Biomed, 2014 Mar;31(1):134-42.
    PMID: 24862053 MyJurnal
    Since a safe and effective mass vaccination program against dengue fever is not presently available, a good way to prevent and control dengue outbreaks depends mainly on controlling the mosquito vectors. Aedes aegypti mosquito populations can be monitored and reduced by using ovitraps baited with organic infusions. A series of laboratory experiments were conducted which demonstrated that the bacteria in bamboo leaf infusion produce volatile attractants and contact chemical stimulants attractive to the female mosquitoes. The results showed that the female mosquitoes laid most of their eggs (59.9 ± 8.1 vs 2.9 ± 2.8 eggs, P<0.001) in bamboo leaf infusions when compared to distilled water. When the fresh infusion was filtered with a 0.45 μm filter membrane, the female mosquitoes laid significantly more eggs (64.1 ± 6.6 vs 4.9 ± 2.6 eggs, P<0.001) in unfiltered infusion. However when a 0.8 μm filter membrane was used, the female laid significantly more eggs (62.0 ± 4.3 vs 10.1 ± 7.8 eggs, P<0.001) in filtrate compared to a solution containing the residue. We also found that a mixture of bacteria isolated from bamboo leaf infusion serve as potent oviposition stimulants for gravid Aedes mosquitoes. Aedes aegypti laid significantly more eggs (63.3 ± 6.5 vs 3.1 ± 2.4 eggs, P<0.001) in bacteria suspension compared to sterile R2A medium. Our results suggest microbial activity has a role in the production of odorants that mediate the oviposition response of gravid mosquitoes.
    Matched MeSH terms: Dengue/prevention & control
  15. Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly?
    Mortaza N, Abu Osman NA, Mehdikhani N
    Eur J Phys Rehabil Med, 2014 Dec;50(6):677-91.
    PMID: 24831570
    Fall is a common and a major cause of injuries. It is important to find elderlies who are prone to falls. The majority of serious falls occur during walking among the older adults. Analyzing the spatio-temporal parameters of walking is an easy way of assessment in the clinical setting, but is it capable of distinguishing a faller from a non-faller elderly? Through a systematic review of the literature, the objective of this systematic review was to identify and summarize the differences in the spatio-temporal parameters of walking in elderly fallers and non-fallers and to find out if these parameters are capable of distinguishing a faller from a non-faller. All original research articles which compared any special or temporal walking parameters in faller and non-faller elderlies were systematically searched within the Scopus and Embase databases. Effect size analysis was also done to standardize findings and compare the gait parameters of fallers and non-fallers across the selected studies. The electronic search led to 5381 articles. After title and abstract screening 30 articles were chosen; further assessment of the full texts led to 17 eligible articles for inclusion in the review. It seems that temporal measurements are more sensitive to the detection of risk of fall in elderly people. The results of the 17 selected studies showed that fallers have a tendency toward a slower walking speed and cadence, longer stride time, and double support duration. Also, fallers showed shorter stride and step length, wider step width and more variability in spatio-temporal parameters of gait. According to the effect size analysis, step length, gait speed, stride length and stance time variability were respectively more capable of differentiating faller from non-faller elderlies. However, because of the difference of methodology and number of studies which investigated each parameter, these results are prone to imprecision. Spatio-temporal analysis of level walking is not sufficient and cannot act as a reliable predictor of falls in elderly individuals.
    Matched MeSH terms: Accidental Falls/prevention & control
  16. Fulltext The effects of α-tocopherol on bone: a double-edged sword?
    Chin KY, Ima-Nirwana S
    Nutrients, 2014 Apr 10;6(4):1424-41.
    PMID: 24727433 DOI: 10.3390/nu6041424
    Recent studies have found conflicting evidence on the role of α-tocopherol (αTF) on bone health. This nonsystematic review aimed to summarize the current evidence on the effects of αTF on bone health from cell culture, animal, and human studies in order to clarify the role of αTF on bone health. Our review found that αTF exerted beneficial, harmful or null effects on bone formation cells. Animal studies generally showed positive effects of αTF supplementation on bone in various models of osteoporosis. However, high-dose αTF was possibly detrimental to bone in normal animals. Human studies mostly demonstrated a positive relationship between αTF, as assessed using high performance liquid chromatography and/or dietary questionnaire, and bone health, as assessed using bone mineral density and/or fracture incidence. Three possible reasons high dosage of αTF can be detrimental to bone include its interference with Vitamin K function on bone, the blocking of the entry of other Vitamin E isomers beneficial to bone, and the role of αTF as a prooxidant. However, these adverse effects have not been shown in human studies. In conclusion, αTF may have a dual role in bone health, whereby in the appropriate doses it is beneficial but in high doses it may be harmful to bone.
    Matched MeSH terms: Osteoporosis/prevention & control
  17. Fulltext Cost-effectiveness analysis of HLA-B*5801 testing in preventing allopurinol-induced SJS/TEN in Thai population
    Saokaew S, Tassaneeyakul W, Maenthaisong R, Chaiyakunapruk N
    PLoS One, 2014;9(4):e94294.
    PMID: 24732692 DOI: 10.1371/journal.pone.0094294
    BACKGROUND: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), caused by allopurinol therapy, are strongly associated with the human leukocyte antigen (HLA), HLA-B*5801. Identification of HLA-B*5801 genotype before prescribing allopurinol offers the possibility of avoiding allopurinol-induced SJS/TEN. As there is a paucity of evidence about economic value of such testing, this study aims to determine the cost-effectiveness of HLA-B*5801 testing compared with usual care (no genetic testing) before allopurinol administration in Thailand.
    METHODS AND FINDING: A decision analytical and Markov model was used to estimate life time costs and outcomes represented as quality adjusted life years (QALYs) gained. The model was populated with relevant information of the association between gene and allopurinol-induced SJS/TEN, test characteristics, costs, and epidemiologic data for Thailand from a societal perspective. Input data were obtained from the literature and a retrospective database analysis. The results were expressed as incremental cost per QALY gained. A base-case analysis was performed for patients at age 30. A series of sensitivity analyses including scenario, one-way, and probabilistic sensitivity analyses were constructed to explore the robustness of the findings. Based on a hypothetical cohort of 1,000 patients, the incremental total cost was 923,919 THB (USD 29,804) and incremental QALY was 5.89 with an ICER of 156,937.04 THB (USD 5,062) per QALY gained. The cost of gout management, incidence of SJS/TEN, case fatality rate of SJS/TEN, and cost of genetic testing are considered very influential parameters on the cost-effectiveness value of HLA-B*5801 testing.
    CONCLUSIONS: The genetic testing for HLA-B*5801 before allopurinol administration is considered a highly potential cost-effective intervention in Thailand. The findings are sensitive to a number of factors. In addition to cost-effectiveness findings, consideration of other factors including ethical, legal, and social implications is needed for an informed policy decision making.
    Matched MeSH terms: Stevens-Johnson Syndrome/prevention & control*
  18. Fulltext Prophylactic effect of herbal-marine compound (HESA-A) on influenza A virus infectivity
    Mehrbod P, Ideris A, Omar AR, Hair-Bejo M
    BMC Complement Altern Med, 2014;14:131.
    PMID: 24708698 DOI: 10.1186/1472-6882-14-131
    Influenza virus is still a severe respiratory disease affecting human and other species. As conventional drugs are not recommended for long time because of side effects and drug resistance occurrence, traditional medication has been focused as alternative remedy. HESA-A is a natural compound from herbal-marine origin. Previous studies have reported the therapeutic properties of HESA-A on psoriasis vulgaris and different types of cancers and we also showed its anti-inflammatory effects against influenza A infection.
    Matched MeSH terms: Influenza, Human/prevention & control
  19. Fulltext PASS-predicted hepatoprotective activity of Caesalpinia sappan in thioacetamide-induced liver fibrosis in rats
    Kadir FA, Kassim NM, Abdulla MA, Kamalidehghan B, Ahmadipour F, Yehye WA
    ScientificWorldJournal, 2014;2014:301879.
    PMID: 24701154 DOI: 10.1155/2014/301879
    The antifibrotic effects of traditional medicinal herb Caesalpinia sappan (CS) extract on liver fibrosis induced by thioacetamide (TAA) and the expression of transforming growth factor β1 (TGF-β1), α-smooth muscle actin (αSMA), and proliferating cell nuclear antigen (PCNA) in rats were studied. A computer-aided prediction of antioxidant and hepatoprotective activities was primarily performed with the Prediction Activity Spectra of the Substance (PASS) Program. Liver fibrosis was induced in male Sprague Dawley rats by TAA administration (0.03% w/v) in drinking water for a period of 12 weeks. Rats were divided into seven groups: control, TAA, Silymarin (SY), and CS 300 mg/kg body weight and 100 mg/kg groups. The effect of CS on liver fibrogenesis was determined by Masson's trichrome staining, immunohistochemical analysis, and western blotting. In vivo determination of hepatic antioxidant activities, cytochrome P450 2E1 (CYP2E1), and matrix metalloproteinases (MPPS) was employed. CS treatment had significantly increased hepatic antioxidant enzymes activity in the TAA-treated rats. Liver fibrosis was greatly alleviated in rats when treated with CS extract. CS treatment was noted to normalize the expression of TGF-β1, αSMA, PCNA, MMPs, and TIMP1 proteins. PASS-predicted plant activity could efficiently guide in selecting a promising pharmaceutical lead with high accuracy and required antioxidant and hepatoprotective properties.
    Matched MeSH terms: Liver Cirrhosis/prevention & control*
  20. Elective proximal lower limb amputation in spinal cord injury patients with chronic pressure ulcers: improve quality of life, function, and shorten hospital stay. Case report
    Yusmido YA, Hisamud-Din N, Mazlan M
    Eur J Phys Rehabil Med, 2014 Oct;50(5):557-60.
    PMID: 24694951
    Pressure ulcers are common among patients with spinal cord injury and can be very challenging to treat. The treatment involves multidisciplinary approach and ranges from simple pressure relieve and wound dressings to a more radical treatment like proximal lower limb amputations, especially in chronic cases with potential detrimental effects to physical and mental health.
    Matched MeSH terms: Pressure Ulcer/prevention & control*
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