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Fulltext Demographic and lifestyle determinants of time spent in physical activity among Malaysian adolescents

Cheah YK, Lim HK, Kee CC

Int J Pediatr Adolesc Med, 2018 Jun;5(2):49-54.
PMID: 30805533 DOI: 10.1016/j.ijpam.2018.02.001

Background and objectives: The objective of the present study is to examine factors affecting time spent in physical activity among adolescents in Malaysia.
Patients and methods: A nationally representative data of adolescents that consists of 25399 respondents is used. The demographic (age, gender, education) and lifestyle (fruits and vegetables consumption, carbonated soft drink consumption, cigarette smoking, alcohol drinking, sex behaviour, participation in physical education class, obesity) determinants of physical activity are assessed using binomial regression.
Results: The results show that age is negatively associated with time spent in physical activity. However, being male and education levels are positively related to time spent in physical activity. Having unhealthy lifestyle and being obese are associated with low levels of physical activity. Physical education seems to promote participation in physical activity.
Conclusion: In conclusion, demographic and lifestyle factors play an important role in determining levels of physical activity among adolescents. In order to reduce the prevalence of physically inactive adolescents, policy makers should focus primarily on late adolescents, females, adolescents who engage in unhealthy lifestyle and seldom attend physical education classes, as well as obese adolescents.

Matched MeSH terms: Life Style
Fulltext Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

J Prim Care Community Health, 2020 5 27;11:2150132720921738.
PMID: 32450747 DOI: 10.1177/2150132720921738

Objectives: Lowering the prevalence of mental health illness is one of the main public health concerns. The objective of the present study was to examine factors associated with depression and generalized anxiety disorder (GAD) among adults in Malaysia. Methods: Data were extracted from the National Health and Morbidity Survey 2011 (NHMS 2011), which is a nationally representative sample collected using a 2-stage stratified sampling method. A bivariate probit model was utilized to examine the influences of sociodemographic, lifestyle, and health factors on the likelihood of suffering from depression and GAD. Results: Age, gender, ethnicity, education, marital status, and self-rated health were significantly associated with depression and GAD. In particular, there were positive relationships between depression and GAD, and younger adults, females, Indian ethnic group, lower level of education, being unmarried, and self-rated poor health. Conclusions: Sociodemographic and health factors were associated with determining the risks of depression and GAD in Malaysia. With this information, future policies (eg, screening and treatment) could be targeted at those at most risk to develop depression and GAD.

Matched MeSH terms: Life Style
Factors influencing medication label viewing in Malaysia

Cheah YK, Chong YW

Glob Health Promot, 2018 Mar;25(1):63-72.
PMID: 27406823 DOI: 10.1177/1757975916649135

The misuse of medicine is a serious public health issue worldwide. An important factor that contributes to the misuse of medicine is the lack of medication label viewing by consumers. The objective of the present study is to examine the socio-economic, demographic and lifestyle factors associated with medication label viewing among Malaysian adults. The empirical analysis is based on a nationally representative data set of 30,992 respondents. An ordered probit model is used to examine different types of medication label viewers. The results of this study suggest that socio-economic (i.e. age, income level, education level, location of residence), demographic (i.e. gender, ethnicity, marital status) and lifestyle factors (i.e. physical activity, smoking) have significant effects on medication label viewing. It is found that age, low-income and low-education level reduce the likelihood of viewing medication label. Based on these findings, several policy implications are suggested. The present study provides policy makers with baseline information regarding which cohorts of individuals to focus on in efforts to increase the frequency of medication label viewing.

Matched MeSH terms: Life Style
Fulltext Association of suicidal ideation with demographic, lifestyle and health factors in Malaysians

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

East Asian Arch Psychiatry, 2018 Sep;28(3):85-94.
PMID: 30146496

OBJECTIVE: To determine the association of suicidal ideation with demographic, lifestyle, and health factors, using data from National Health and Morbidity Survey 2011 (NHMS 2011) of Malaysia.
METHODS: The NHMS 2011 included 10,141 respondents. Independent variables of suicidal ideation were income, age, household size, sex, ethnicity, education, marital status, smoking, physical activity, and self-rated health. The risk factors of suicidal ideation were determined using logistic regression analysis.
RESULTS: In the pooled sample, suicidal ideation was associated with age, sex, ethnicity, and self-rated health, but not associated with income, household size, education, physical activity, or smoking.
CONCLUSION: The likelihood of having suicidal ideation is positively associated with young adults, women, Indians, and those with poor self-rated health.
Study name: National Health and Morbidity Survey (NHMS-2011)

Matched MeSH terms: Life Style*
Sociodemographic, lifestyle and health determinants of suicidal behaviour in Malaysia

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

Psychiatry Res, 2018 03;261:319-324.
PMID: 29331849 DOI: 10.1016/j.psychres.2017.12.086

Suicide has become a serious matter in both developed and developing countries. The objective of the present study is to examine the factors affecting suicidal behaviour among adults in Malaysia. A nationally representative data which consists of 10,141 respondents is used for analysis. A trivariate probit model is utilised to identify the probability of having suicide ideation, suicide plan and suicide attempt. Results of the regression analysis show that to ensure unbiased estimates, a trivariate probit model should be used instead of three separate probit models. The determining factors of suicidal behaviour are income, age, gender, ethnicity, education, marital status, self-rated health and being diagnosed with diabetes and hypercholesterolemia. The likelihood of adopting suicidal behaviour is lower among higher income earners and older individuals. Being male and married significantly reduce the propensity to engage in suicidal behaviour. Of all the ethnic groups, Indian/others displays the highest likelihood of adopting suicidal behaviour. There is a positive relationship between poor health condition and suicide. Policies targeted at individuals who are likely to adopt suicidal behaviour may be effective in lowering the prevalence of suicide.

Matched MeSH terms: Life Style
Lifestyles and Sexual Behaviour Among School-Going Adolescents: A Mediational Role of Mental Health

Cheah YK, Zainuddin NH, Kee CC, Lim KH, Omar MA, Cheong YL

Clin Child Psychol Psychiatry, 2023 Oct;28(4):1341-1357.
PMID: 36428238 DOI: 10.1177/13591045221142497

Sexual behaviour and mental health among adolescents are major public health issues. This study examines how lifestyles affect sexual behaviour among school-going adolescents in Malaysia, and the potential mediational role of mental health. It is the first to our knowledge to explore the mediating effect of mental health on sexual behaviour with a focus on a fast-growing developing country. Data were obtained from the National Health and Morbidity Survey 2017 (n = 27,497). Structural equation modelling was utilized to examine depression and anxiety as mediators of the relationships between sexual behaviour and smoking, alcohol drinking and illicit drug use, controlling for sociodemographic factors. Results showed that adolescents who smoked, consumed alcohol, used illicit drugs, and had depression and anxiety were more likely to engage in sexual behaviour than others. Depression and anxiety partially mediated the relationships between sexual behaviour and smoking, and illicit drug use. The association between alcohol drinking and sexual behaviour was fully mediated by depression and anxiety. In conclusion, lifestyles may affect sexual behaviour through mediation of mental health. Therefore, policymakers should take mental health factors into consideration when designing adolescent sexual behaviour preventative interventions.

Matched MeSH terms: Life Style
Demographic, lifestyle, social, and psychological factors associated with worry-related sleep problems among school-going adolescents in Timor-Leste

Cheah YK, Kee CC, Lim KK, Cheong YL

J Child Adolesc Psychiatr Nurs, 2024 May;37(2):e12468.
PMID: 38654575 DOI: 10.1111/jcap.12468

OBJECTIVE: Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking.
DESIGN AND MEASURES: Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems).
RESULTS: School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems.
CONCLUSION: Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.

Matched MeSH terms: Life Style*
Fulltext Determinants of the demand for using preventive medical care among adults in penang, malaysia

Cheah YK

Malays J Med Sci, 2013 Jan;20(1):46-55.
PMID: 23613658 MyJurnal

In light of the fact that chronic diseases were becoming more prevalent recently, the primary objective of the study was to examine the socio-demographic, health, and lifestyle determinants of the use of preventive medical care in Penang, Malaysia.

Matched MeSH terms: Life Style
Fulltext Sociodemographic, lifestyle and health factors associated with depression among adults in Malaysia: an ethnic comparison

Cheah, Y.K., Azahadi, M., Phang, S.N., Abd Manaf, N.H.

JUMMEC, 2019;22(1):33-40.
MyJurnal

Background: Depression is a serious mental health illness worldwide. The purpose of the study was to
investigate the relationships between depression and its risk factors of sociodemography, lifestyle, and health
among the adults of the different ethnic groups in Malaysia.

Method: A nationwide database with 10141 observations was used. Multivariable logistic regression analyses
stratified by ethnicity were estimated.

Results: Ethnicity and gender, age, education, marital status and self-rated health were correlated to the
likelihood of having depression. Malay females and smokers (AOR: 2.083) were more likely to suffer from
depression than Malay males (AOR: 0.305) and non-smokers. Higher-income Chinese displayed higher odds of
having depression than lower-income Chinese (AOR: 1.009). Indians and others with secondary-level education
displayed a lower likelihood of developing depression compared to those with primary-level education (AOR:
0.587).

Conclusion: This study could contribute significantly to the formulation and development of an effective
policy directed towards reducing the prevalence of depression in the vulnerable. These were the adults, in
the younger age group, with lower education, with self-rated poor health, being female, unmarried, Malay
and Chinese, and Indians and others. A nationwide policy targeted towards the Malay females to reduce
their depression, with attention to the Chinese with a high income, and to the Indians and others with poor
educational background to improve their knowledge of mental health, would be worthy of consideration.

Matched MeSH terms: Life Style
Fulltext Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: a cross-sectional study

Cheikh Ismail L, Osaili TM, Mohamad MN, Al Marzouqi A, Jarrar AH, Zampelas A, et al.

Br J Nutr, 2021 Sep 14;126(5):757-766.
PMID: 33198840 DOI: 10.1017/S0007114520004547

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

Matched MeSH terms: Life Style*
Fulltext A Survey on Daily Activity Inclination and Health Complaints among Urban Youth in Malaysia

Chen AH, Rosli SA, Hovis JK

J Environ Public Health, 2020;2020:9793425.
PMID: 33376494 DOI: 10.1155/2020/9793425

Environmental influence is one of the attributing factors for health status. Chronic interaction with electronic display technology and lack of outdoor activities might lead to health issues. Given the concerns about the digital impact on lifestyle and health challenges, we aimed to investigate the daily activity inclination and health complaints among the Malaysian youth. A self-administered questionnaire covering lifestyle and health challenges was completed by 220 youths aged between 16 and 25. There were a total of 22 questions. Seven questions inspected the patterns of indoor and outdoor activities. Fifteen questions focused on the visual and musculoskeletal symptoms linked to both mental and physical health. The total time spent indoors (15.0 ± 5.4 hours/day) was significantly higher than that spent outdoors (2.5 ± 2.6 hours/day) (t = 39.01, p < 0.05). Total time engrossed in sedentary activities (13.0 ± 4.5 hours/day) was significantly higher than that in nonsedentary activities (4.5 ± 3.8 hours/day) comprised of indoor sports and any outdoor engagements (t = 27.10, p < 0.05). The total time spent on electronic related activities (9.5 ± 3.7 hours/day) was were higher than time spent on printed materials (3.4 ± 1.6 hours/day) (t = 26.01, p < 0.05). The association of sedentary activities was positive in relation to tired eyes (χ2 = 17.58, p < 0.05), sensitivity to bright light (χ2 = 12.10, p < 0.05), and neck pain (χ2 = 17.27, p < 0.05) but negative in relation to lower back pain (χ2 = 8.81, p < 0.05). Our youth spent more time in building and engaged in sedentary activities, predominantly electronic usage. The health-related symptoms, both visual and musculoskeletal symptoms, displayed a positive association with a sedentary lifestyle and a negative association with in-building time.

Matched MeSH terms: Life Style
Psychosocial factors and the health of the elderly Malaysian

Chen PC

Ann Acad Med Singap, 1987 Jan;16(1):110-4.
PMID: 3592576

Consequent to rapidly declining mortality and birth rates, developing countries, including Malaysia, can expect a rapid increase in the population aged 60 years and above. The health of the elderly is intimately tied up with both biophysical as well as psychosocial factors which include status loss, loneliness, fear of illness and death, poverty, harmful life-styles and deterioration of the quality of life. The effects of these psychosocial factors can manifest as sleep difficulties, worry and anxiety, depression, loss of interest, and a feeling of tiredness. In extreme cases, there may be auditory or visual hallucinations or paranoia. In the present paper, which is based upon a WHO sponsored study of 1001 elderly Malaysians, it is noted that 36% of the elderly have sleep difficulties, 47% "feel tired", 31% have a "loss of interest" and 22% are "worried tense". However 71% of the elderly are able to correctly perform at least 12 of 15 cognitive tests. 20% of elderly men smoke 15 or more cigarettes a day while 44% smoke at least one cigarette a day. 40% of elderly men indicate that their families complain about the amount of alcohol they drink. Undoubtedly primary health care programmes need to be re-oriented to the problems and needs of the elderly in countries such as Malaysia.

Matched MeSH terms: Life Style
Fulltext Life-styles and health-related behaviour

Chen PCY

Med J Malaysia, 1985 Jun;40(2):60-1.
PMID: 3834288
Matched MeSH terms: Life Style*
Developing primary health care for a nomad tribe: the Penans of the Baram

Chen PCY

Asia Pac J Public Health, 1987;1(1):34-7.
PMID: 3452377 DOI: 10.1177/101053958700100109

Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.

Matched MeSH terms: Life Style*
Pneumonia and diarrhoeas: killers of toddlers in developing countries

Chen ST

Trop Geogr Med, 1975 Mar;27(1):103-8.
PMID: 806152

Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.

Matched MeSH terms: Life Style
Fulltext Impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 and type 2 diabetes mellitus

Cheng HP, Wong JSL, Selveindran NM, Hong JYH

Endocrine, 2021 09;73(3):499-506.
PMID: 34244903 DOI: 10.1007/s12020-021-02810-1

AIMS: Malaysia implemented nationwide lockdown from 18th March till 3rd May 2020 to mitigate the spread of coronavirus disease (COVID-19). This study aimed to examine the impact of the lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 (T1DM) and 2 diabetes mellitus (T2DM) aged less than 18 years old.
METHODS: In this cross-sectional study, interviews and a standardised questionnaire comparing lifestyle changes before and during the lockdown were performed in follow-up clinic visits after the lockdown. Anthropometry measurements and glycated haemoglobin (HbA1c) values were compared 3 months prior and after the lockdown.
RESULTS: Participants were 93 patients with T1DM (11.08 ± 3.47 years) and 30 patients with T2DM (13.81 ± 2.03 years). Male gender, T2DM and pubertal adolescents were found to have a significant deterioration in glycaemic control. A significant increment of HbA1c was observed in patients with T2DM (8.5 ± 0.40 vs 9.9 ± 0.46%), but not in patients with T1DM (8.6 ± 0.28 vs 8.7 ± 0.33%). Contrarily, there was an improved glycaemic control in pre-pubertal T1DM children likely due to parental supervision during home confinement. Weight and BMI SDS increased in T1DM patients but surprisingly reduced in T2DM patients possibly due to worsening diabetes control. Reduced meal frequency mainly due to skipping breakfast, reduced physical activity level scores, increased screen time and sleep duration were observed in both groups.
CONCLUSIONS: Adverse impact on glycaemic control and lifestyle were seen mostly in patients with T2DM and pubertal adolescent boys.

Matched MeSH terms: Life Style
Fulltext Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial

Cheng SH, Ismail A, Anthony J, Ng OC, Hamid AA, Barakatun-Nisak MY

Evid Based Complement Alternat Med, 2015;2015:405615.
PMID: 26713097 DOI: 10.1155/2015/405615

Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (-1.16 versus +3.91), reduced HOMA-IR (-1.09 versus +1.34), and increased QUICKI (+0.05 versus -0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (-0.76% versus -0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes.

Matched MeSH terms: Life Style
Fulltext Anti-diabetic activity and microbial quality of ready-to-serve Momordica charantia (MC) drink

Chern, Pei Ern, Nor Ainy Mahyudin, Hazrina Ghazali, Norkhaizura Mahmud @ Ab Rashid

The Pertanika Journal of Scholarly Research Reviews, 2017;3(3):102-106.
MyJurnal

Diabetes mellitus has a high prevalence in Malaysia and is expected to rise in the future due to lifestyle changes. Thus, consumers are turning to alternative methods in the prevention and cure of the disease. The Momordica charantia has been studied for its anti-diabetic activity both in vitro and in vivo and is shown to be effective in inhibiting glucose absorption. Therefore, the MC is used as a main ingredient in the development of health beverages to offer alternatives for patients or the health conscious. The microbial quality of the product is examined to ensure the safety of the product and to find methods to enhance its shelf life.

Matched MeSH terms: Life Style
Fulltext Prehypertension: What is the current status?

Chia YC

Malays Fam Physician, 2008;3(2):72-6.
PMID: 25606120 MyJurnal

Cardiovascular disease (CVD) risk is a continuum across blood pressure. The term prehypertension was introduced because it is now recognized that blood pressure readings between what is deemed optimal and hypertension is associated with increased CVD risk. The prevalence of prehypertension is high and the progression to hypertension is also high. Prehypertension is also commonly associated with other CVD risk factors namely dyslipidaemia, dysgylcaemia and overweight/ obesity. Eighty-five percent of prehypertensives have one other or more CVD risk factor compared to normotensives. A recent study has shown a reduction in the development of hypertension from prehypertension with the use of an angiotensin receptor blocker. Unfortunately to date, the impact of treatment of prehypertension on CVD outcome is still unknown except in those with high CVD risk like diabetes or established CVD. However this does not mean nothing can be done for those with prehypertension. The aim of managing prehypertension is to lower the BP, prevent progression to hypertension and to prevent BP related CVD deaths. Lifestyle changes can reduce BP and this by itself can lower CVD risk. Until more evidence about other modalities of treatment become available this is a sensible and cost-effective way to manage prehypertension.

Matched MeSH terms: Life Style
May Measurement Month 2018: an analysis of blood pressure screening results from Malaysia

Chia YC, Ching SM, Devaraj NK, Chew BN, Ooi PB, Mohamed M, et al.

Eur Heart J Suppl, 2020 Aug;22(Suppl H):H83-H85.
PMID: 32884479 DOI: 10.1093/eurheartj/suaa035

Hypertension continues to be the top global killer, contributing to over 10 million deaths annually. As prevalence and unawareness of hypertension remain high in Malaysia, this study was aimed to screen more individuals to identify those with undiagnosed hypertension. Respondents aged ≥18 years were recruited through opportunistic sampling at various screening sites including health clinics, hospitals, student health centres, universities, community halls, shopping malls, as well as through other health screening campaigns. Each respondent completed a questionnaire on socio-demographic, environmental, and lifestyle data. Anthropometric measurements as well as three blood pressure (BP) measurements were obtained from all participants. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. The total number of participants was 4866. The mean age of the participants was 39.8 (17.6) years with 61.1% female participants. Of the 4866 participants, 1405 (28.9%) had hypertension. The proportion of those aware of their hypertension status was 76.3% (1073/1405). The proportion of those with hypertension on medication was 71% (998/1405). Of those receiving antihypertensive treatment, 62.4% (623/998) had controlled BP. The proportion of hypertension in this study was 28.9%. The awareness rate of 76.3% compares favourably to a previously reported national level of 43.2%. Hence, BP screening programmes may be effective at increasing awareness and should be conducted annually.

Matched MeSH terms: Life Style

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