Hepatitis B, C, and D Virus Infections and AFP Tumor Marker Prevalence Among the Elderly Population in Mongolia: A Nationwide Survey / 예방의학회지

Objectives@#Infections with hepatitis B, C, and D virus (HBV, HCV, and HDV) are a major public health problem and lead to serious complications such as cirrhosis and hepatocellular carcinoma. We aimed to determine the seroprevalence of hepatitis B surface antigen (HBsAg), anti-HCV, anti-HDV immunoglobulin G, alpha-fetoprotein (AFP), and dual and triple hepatitis virus infections in Mongolia. @*Methods@#A total of 2313 participants from urban and rural regions were randomly recruited for this cross-sectional study. A questionnaire was used to identify the risk factors for hepatitis virus infections, and the seromarkers were measured using immunoassay kits. @*Results@#Among all participants, the prevalence of HBV, HCV, and HDV was 15.6%, 36.6%, and 14.3%, respectively. The infection rates were significantly higher in females and participants with a lower education level, rural residence, older age, and a history of blood transfusion. HBV and HCV co-infection was found in 120 (5.2%) participants and HBV, HCV, and HDV triple infection was detected in 67 (2.9%) participants. The prevalence of elevated AFP was 2.7%, 5.5%, and 2.6% higher in participants who were seropositive for HBsAg (p=0.01), anti-HCV (p<0.001), and anti-HDV (p=0.022), respectively. Elevated AFP was more prevalent in participants co-infected with HBV and HCV (5.8%, p=0.023), HBV and HDV (6.0%, p<0.001), and triple-infected with HBV, HCV, and HDV (7.5%) than in uninfected individuals. @*Conclusions@#Nearly half (49.8%) of the study population aged ≥40 years were infected with HBV, HCV, or HDV, and 22.4% had dual or triple infections.

A cohort study of chronic diseases for Mongolian people: Outline with baseline data of the Moncohort study.

Many Mongolian people suffer from non-communicable chronic diseases. In order to plan preventive strategies against such diseases, we designed a community-based prospective cohort study of chronic diseases, called the Moncohort study, in Mongolia. This is the first nationwide large-scale cohort study of chronic diseases. This paper describes the study's rationale, design and methods with baseline data. Mongolian residents aged ⩾40years were selected nationwide from many geographic regions in 2009. Data were collected on demographics, socioeconomic status, lifestyle, and anthropometric and biochemical measurements. In total, 2280 Mongolian residents were registered in the survey. Socioeconomic, lifestyle, anthropometric and biochemical characteristics were differentiated by gender and geographical area in descriptive data. Aging, low social class, physical inactivity and infrequent fruits intake were positively associated with histories of chronic disease in men, while aging was positively associated with histories of chronic disease in women. Factors associated with chronic diseases reveal gender-oriented strategies might be needed for their prevention. Detailed prospective analyses will illustrate the impact of risk factors on chronic diseases and lead to evidence for designing programs aimed at preventing chronic diseases and related disorders in Mongolia.

Ischemic heart disease among the general Mongolian population: a review of epidemiological studies.

Ischemic heart disease (IHD) is considered to be a pivotal health problem in Mongolia. To summarize the existing epidemiology of IHD in the general Mongolian population is crucial for primary prevention. The present review summarized population-based epidemiological data of IHD in Mongolia. When epidemiological studies were extracted from databases, very limited studies were available. The frequencies of IHD and IHD-attributable death rates appeared to be high and have an increased tendency in Mongolia. This could to be due to a gradually worsening state of potential IHD-related risk factors, such as smoking, hypertension, hypercholesterolemia, obesity and diabetes mellitus. This might indicate an urgent need of strategies for IHD and related risk factors. Anti-IHD strategies, such as more epidemiological studies and campaigns to increase awareness of IHD, at nationwide public health levels would be required in Mongolia for more effective prevention.

Epidemiologic features of metabolic syndrome in a general Mongolian population.

BACKGROUND: Although cardiovascular health is a crucial problem for Mongolian people, little information about metabolic syndrome, which is well known to be associated with the development of cardiovascular disease, is available in Mongolia. The aim of this study was to observe the epidemiological features of metabolic syndrome in a general Mongolian population. METHODS: This cross-sectional study was performed in 1911 general Mongolian subjects (717 men, 1194 women), who were ≥40 years old and free of ischemic heart disease, by using a dataset from a nationwide population-based cohort study in Mongolia. The prevalence of metabolic syndrome, as defined by International Diabetes Federation criteria, was determined. Alcohol consumption, smoking habits, and physical activity were evaluated. Education, marital status, income, and occupation were also examined as factors of socioeconomic status (SES). Their association with metabolic syndrome was determined by logistic regression models. RESULTS: The prevalence of metabolic syndrome was significantly higher in women (n=488, 40.6%) than in men (n=138, 19.4%). The prevalence of metabolic syndrome was high, especially in the Khangai region, in women. Moderate-to-high alcohol consumption was a significantly positively associated factor of metabolic syndrome in men [odds ratio (OR)=2.01; 95% confidence interval (CI) 1.15-3.51; adjusted odds ratio (AOR)=2.41; 95% CI 1.31-4.44] and widowed status was a significantly positively associated factor of metabolic syndrome in women (OR=1.61, 95% CI 1.18-2.18; AOR=1.49, 95% CI 1.07-2.08). CONCLUSIONS: Metabolic syndrome was prevalent in women compared with men among Mongolian adults. Preventive strategies aimed at men with a higher alcohol consumption and women with widowed status may help reduce metabolic syndrome, thereby improving cardiovascular health conditions in Mongolia.

[Satisfaction with hospital care among diabetic outpatients and its associated factors. Secondary use of official statistics].

OBJECTIVES: Generalizable data on current satisfaction levels are required to establish a scientific basis for the political advancement of measures to improve satisfaction with hospital care among patients with diabetes. The present study made secondary use of existing official statistics in order to demonstrate the range of satisfaction levels with hospital care among diabetic outpatients and to closely examine related factors. METHODS: Data sets that consolidated the Patient Survey, the Survey of Medical Care Institutions, and the Patient Behavior Survey (all from 2008) were created. Shared medical institution survey reference numbers were used to consolidate the data from the Patient Survey and the Survey of Medical Care Institutions, and in addition, sex and date of birth were used to consolidate the Patient Behavior Survey data. The range of satisfaction levels with hospital care among diabetic outpatients was investigated along with any relationship with the following potentially related factors: visitation status (first or repeat examination); waiting time until examination; examination duration; care-seeking status (any use of other medical facilities, etc.); diabetic complications; other complications; coverage under the Public Assistance Act; smoking cessation outpatient services; hospitals that specialized in treating diabetes (metabolic medicine); medical care on Saturday, Sunday, and public holidays; and provision of health checkups. RESULTS: Overall, 62.3% of diabetic outpatients were either fairly or extremely satisfied with their hospital care, whereas 5.6% expressed dissatisfaction. Satisfaction levels with hospital care were found to be significantly related to visitation status, waiting time until examination, examination duration, care-seeking status, and Saturday medical care. Multivariate analysis with the factors demonstrated to be significantly related to satisfaction revealed significant relationships between high satisfaction levels and repeat examinations, short waiting times, no use of any other medical facilities, and long examinations. CONCLUSION: Consolidating official statistics from multiple sources indicated the range of satisfaction levels with hospital care among diabetic outpatients and facilitated the clarification of factors affecting satisfaction. Reducing waiting times and ensuring sufficient time spent on examinations are important for increasing satisfaction levels with hospital care among patients with diabetes. It is hoped that official statistics can be further applied to many future public health policy studies.

Hypertension in Mongolia: an overview.

OBJECTIVES: Although hypertension is the primary cause of morbidity and mortality from cardiovascular diseases in Mongolia, reviews about hypertension in this country have not been reported, to our knowledge. Information on the overview of this disease may be useful to establish measures and policy to prevent hypertension and its related complications. The aim of our article is to summarize the current situation vis-à-vis hypertension in Mongolia. METHODS: Population-based studies that provided relevant information on hypertension in Mongolia were searched through PubMed, abstract books of the Mongolian Medical University resources from cardiologists, epidemiological databases and reliable websites of national organizations. Available articles from 1970 to present were selected. RESULTS: A high prevalence of hypertension, which varied according to geographic location, exists among Mongolian people. The prevalence of hypertension may be influenced by nutritional factors, sedentary lifestyle, socioeconomic status and environmental factors in particular. CONCLUSIONS: The high prevalence of hypertension among Mongolian people can be a serious health problem in this country. Defining ethnic features of hypertension and related conditions will be the initial step that may lead to prevention of this disease. Further research and positive efforts to prevent hypertension appear necessary for Mongolians.

Ischemic heart disease and its related factors in Mongolia: a nationwide survey.

Ischemic heart disease (IHD) remains one of the most important disorders associated with disability and mortality worldwide, and is one of the major causes of cardiovascular diseases in Mongolia. The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia. We conducted a nationwide cross-sectional survey between March and September, 2009. General participants were recruited from urban to rural regions in a multistage random cluster sampling method. The diagnosis of IHD was based on the Rose questionnaire (World Health Organization) and electrocardiographic findings. A total of 369 (16.2 %) subjects with IHD were diagnosed among 2,280 participants. The prevalence of subjects with IHD was significantly increased by age: from 9.9 % in individuals age 40-44 years compared to 17.7 % in those over 60 years. Smoking habits (former and current) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men, while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women. IHD was found to be prevalent, especially among people aged over 40 years, in Mongolia. Statistical factors related to IHD were found to be significantly different based on sex. The current data may provide relevant information to prevent IHD in the Mongolian population.

The effect of prepregnancy body mass index on singleton cesarean delivery among term nulliparous women in Japanese population.

PURPOSE: Overweight or obesity is a known risk factor for cesarean delivery although there is minimal data among Japanese women. The aim of the study was to examine the effect of prepregnancy body mass index (BMI) on singleton cesarean delivery among term nulliparous women using a national sample from the Human Milk Survey. METHODS: Data from the Human Milk Survey between 1998 and 2008 were used for the secondary analysis. Women were categorized as underweight (BMI < 18.5 kg/m(2)), normal weight (18.5 ≤ BMI < 25.0), or overweight (BMI ≥ 25.0) based on their prepregnancy BMI. The association between maternal prepregnancy BMI and cesarean delivery was assessed using logistic regression models. RESULTS: A total of 915 women were included in the analysis. The proportion of cesarean section was 10.1%. Overall, 17.1% of the women were underweight while 6.0% were overweight. After adjusting for maternal age, smoking status, pregnancy complications, and infant birthweight, overweight women were 2.7 times more likely to have a cesarean delivery compared to normal weight women (adjusted odds ratio [adjusted OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4), and underweight women were half as likely to have a cesarean delivery compared to normal weight women (adjusted OR = 0.5, 95% CI = 0.2-1.1). CONCLUSIONS: Being overweight before pregnancy more than doubled the risk of cesarean delivery independent of age, smoking, pregnancy complications, and infant birthweight among term nulliparous women. Overweight Japanese women should be advised to achieve normal prepregnancy BMI in their preconception period to prevent cesarean delivery.