IDENTIFICATION OF OSTEOPOROSIS RISK FACTORS / Шинэ санаа Шинэ нээлт

@#BACKGROUND: According to International osteoporosis foundation report, osteoporosis is a multifactorial condition associated with an increased risk of fracture and is caused by social, behavioral and physiological factors. Overall incidence is increasing in every country due to people’s life style changes, diet and increased life expectancy. OBJECTIVES: To evaluate the some hormonal effects in bone mineral density among Mongolian population. METHODS: Bone density was measured in the distal one third of radius using the Sunlight Omnisense (Sunlight Medical, Rehovot, Israel) and classified into 3 groups according to WHO osteoporosis criteria. Normal participants were selected into control group and osteoporotic participants were selected into control group. We have evaluated PTH, calcitonin, 25-hydroxy vitamin D in case-control group. RESULT: The prevalence of osteoporosis was 25.7% and 25.3% of participants were osteopenic. It was clear that PTH elevated group (>30.3pg/ml) had more risk of osteoporosis. CONCLUSION: The prevalence of osteoporosis was 25.7% and 25.3% of participants were osteopenic. PTH elevation is risk factor in men.

Self-evaluation of practical skills of nurses during pre- and postoperative care / Шинэ санаа Шинэ нээлт

@#BACKGROUND The study was based on the facts that high patient satisfaction and good health indicators are common in countries where quality of nursing care and organization has reached high level and skill level of these professionals is the main factor for the improvement of health care service quality. OBJECTIVE Evaluate practical skill levels of nurses who are responsible for pre- and post-operative care in the National First Central Hospital (NFCH). METHOD Using cross-sectional design, we have conducted 120 questions questionnaire, which was developed by Canadian Nursing Association and Kwantlen Polytechnic University in 2008, to determine 4 levels of skill (never done – did independently) among 41 nurses who work in the Department of Surgery of NFCH. Data was analyzed using social studies statistics software SPSS 21. RESULT Average age and average work years of the 41 nurses who work in the Department of Surgery were 29.9±8.6 and 7.7±9.1, respectively. In terms of specialty, 4 were anesthesiology and intensive care nurse (9.8%) and 17 were surgical nurse (41.5%) while almost half of them (20, 48.8%) did not have specialty certification. During the evaluation of practical skill levels of participants in regards to pre- and post-operative care, for checking readiness of respiratory apparatus, there were 9 (22%) nurses who had never done it, 11 (27%) nurses who did it with assistance, 9 (22%) nurses who did it under guidance, and 12 (29%) nurses who did it independently, for checking neurologic function, there were 4 (11%) nurses who had never done it, 3 (7%) nurses who did it with assistance, 7 (17%) nurses who did it under guidance, and 27 (65%) nurses who did it independently, for operation wound care, there were 5 (12%) nurses who had never done it, 2 (5%) nurses who did it with assistance, 11 (27%) nurses who did it under guidance, and 23 (56%) nurses who did it independently, for using nasal and tracheal intubation, there were 10 (24%) nurses who had never done it, 4 (10%) nurses who did it with assistance, 10 (24%) nurses who did it under guidance, and 17 (42%) nurses who did it independently. There was correlation between average work years and skill level (p<0.001). CONCLUSION Varying skill levels (never done it 17.25%, with assistance 12.25%, under guidance 22.5%, and independently 48%) of surgical nurses who are responsible for pre- and post-operative care show that there is a need for improving practical skills of nurses in the Department of Surgery of NFCH.

DIFFERENCES IN ATTITUDES ON PATIENT SAFETY CULTURE BETWEEN PHYSICIANS AND NURSES / Шинэ санаа Шинэ нээлт

@#BACKGROUND Patient safety has become a matter of interest to healthcare professionals, governments and researchers worldwide. During the last decade, many studies have been conducted to assess the prevalence, severity and causes of a large variety of different types of adverse events in hospitals, as well as the effectiveness of various approaches to enhance safety. In Mongolia, it is also an arguable point, mistakes and errors associated with physicians, hospital staffs and healthcare organizations has been occurring frequently in recent years. Our main aim is to find difference between physicians and nurses’ attitude on patient safety culture. METHODS The study included 3 tertiary hospitals from Ulaanbaatar city, Mongolia with a total of 122 respondents; all hospital staff. The Hospital Survey on Patient Safety Culture (HSOPSC) Questionnaire from AHRQ (Agency for Healthcare Research and Quality) was used. AHRQ methods, Pearson’s Chi-squared test, pairwise proportion test (p≤ 0,05) were used for statistical analysis. RESULTS Patient safety in hospitals was evaluated as positive by 62.3% of healthcare workers. The highest scores were obtained in specific dimensions as teamwork within unit (77.3%), unit’s team learning from occurred adverse events (71%). Per our survey, health care workers considered non-punitive response to error (20.6%) and communication openness (27.7%) as being weak areas. In surveyed hospitals, physicians and nurses had a significantly different outlook at communication, adverse events reporting and management support. Physicians reported fewer errors than nurses. CONCLUSION Doctors rated safety culture less positively than nurses in some dimensions of patient safety culture- feedback and communication about error, transition and handoffs, management support for patient safety and teamwork across units. This result could indicate a need for more intensive interventions in certain areas of patient safety culture and is certainly an area for future research inquiry.

Geographical variations of osteoporosis rate in Mongolian adults / Монголын Анагаах Ухаан

IntroductionOsteoporosis is becoming an increasingly important economic and public health problem as ourpopulation ages. Different results are reported about osteoporosis rate among various geographicalzones and ethnic groups even in same country. These differences cannot be attributed to hormonalstate or to the dietary intake of calcium, but do accord in general with the living standards of the differentcountries and the degree of physical activity undertaken by the different populations and sexes.GoalTo determine the osteoporosis rate among Mongolian adults and evaluate the geographical distributionsof osteoporosis rateMaterials and MethodsOur study group was 1990 adults who are over 18 years and participated from Uvs, Arkhangai, Dundgovi,Sukhbaatar province and Ulaanbaatar. We have evaluated serum PTH, 25-hydroxyvitamin D level andbone mineral density via bone sonometer (Sunlight Mini-Omni, Beammed, USA). Lifestyle risk factorswere evaluated through a specific questionnaire.ResultsThe osteoporosis rate is 25.5% (n=507) among Mongolian adults and 2 times higher in women thanmen in all age group. SOS was inversely correlated with age in both sexes (men: r=-0.286, p<0.01,women: r=-0.513, p<0.01). Osteoporosis rate was lowest in Ulaanbaatar but highest in Arkhangai(male osteoporosis) and Dundgovi province (female osteoporosis). Of 25-hydroxyvitamin D values 29%were below 20ng/ml (deficient), 39.8% ranged from 20-29.9ng/ml (insufficient) and 31.2% were above30ng/ml (sufficient). In addition, 25-hydroxivitamin D concentrations were not related to bone density.Serum 25-hydroxivitamin D level was highest in Dundgovi province in both sexes. Mean PTH level was26.0±17.7pg/ml and inversely correlated with T-score (r=-0.248, p<0.01) in men.ConclusionOsteoporosis rate among Mongolian adult is lowest in Ulaanbaatar comparing to other rural areas. Andserum 25-hydroxivitamin D deficiency is 68.8% in Mongolian adults.

Correlation between serum parathyroid hormone, 25-hydrohyvitamin D and bone mass density / Шинэ санаа Шинэ нээлт

Osteoporosis is a disease in which the density of bone is decreased with consequent increase in bone fragility and susceptibility to fracture risk. Vitamin D deficiency may cause secondary hyperparathyroidism and low bone mineral density. Our study was aimed to assess relation between vitamin D status and parathyroid hormone and bone density in adults.Relatively healthy 369 participants aged between 20-60 were randomly selected from Ulaanbaatar city. Specially designed questionnaire was used in the survey. Bone mass density was diagnosed according to the WHO criteria by the T-score. Respondents serum calcium and phosphorus levels were described by the fully automated analyzer (Cobas Integra 2800, Germany). Serum parathyroid hormone and 25-hydroxivitamin D levels were described by using ELISA kit (Eucardio Laboratory, Inc. USA) at the Molecular biology laboratory of MNUMS.The statistical result was analyzed by SPSS 21 program.The subjects mean age was 47.61±12.92, with a range of 20-83. The mean T-score was -0.60±2.17. Our study showed that negative correlation between bone mass density values at parathyroid hormone (r=-0.58, p<0.05), 25-hydroxyvitamin D (r=-0.48, p<0.05) and serum calcium (r=-0.21, p<0.05).Our study showed increased serum parathyroid hormone led the releasing calcium from bone and decreasing bone mass density.

Needs assessment of faculties’ development on teaching methodology at MNUMS / Шинэ санаа Шинэ нээлт

Regardless the possession of any graduation and qualifications anywhere in order to train the doctors and medical professionals with the capabilities to work in any places there are the needs of the knowledgeable mentors to teach their knowledge, abilities and trends to the students in national, regional and international levels. This survey was started to determine the needs of the skills development of the mentors of the Mongolian National University of Medical Sciences under the mission to make it as one of the best 100 medical universities in the Asia-Pacific region and in order to create the favorable environment to accelerate the development of the university and creating a team consists from qualified mentors and researchers by improving the trainings, researches and clinical favorable environment including the quality improvement of the activities.The total of 333 mentors from the 5 structures and 3 branches of the Mongolian National University of Medical Sciences were surveyed to be developed by the University of Michigan including the use of the widely used questionnaires in the universities consisting from 7 groups and 81 questions to determine the needs of the mentors.The working range of the best medical mentors including their needs of the skills was studied. The 55.7% (50.4-61.0%) of the mentors included in the survey were told that the facilitation of the learning needed, 82.4% (78.3-86.5%) as the role models needed, 79.9% (75.6-84.2%) as the provision of the information is needed, 76.3% (71.7-80.9%) as 82.8% (78.8-86.9%) as the planning needed and 81.0% (76.8-85.2%) as the assessment of the training is needed.There is a need to develop the skills related to the 6 frameworks as the learning facilitation for the mentors, role model providers, information providers, resource developers, planners and assessors.

Current Status of Public-Private Partnership in Mongolian Health Sector / Шинэ санаа Шинэ нээлт

State that the private sector partnership is a general concept that encompasses formal legal relationships between government entities and the private sector to use private sector resources and expertise to ensure delivery of public services and property. This is because public services to improve the capacity for sustainable use of private sector skills and modernization of technology andfinancial resources, capacity building and increased capacity necessary to wait for the budget cost ofthe current economic situation of our country. Public-private partnership noted that the assessment made by international organizations to take place very effectively in our country. Therefore, the evaluation of the current public-private partnership in the health sector in order toimprove these conditions and to improve the quality and accessibility of care and identify ways of involvement in the implementation of a basis for the work of the study. The purpose of the study is to assess the state of public-private partnership conditions in the Mongolian health sector.We conducted overall 20 focus group interviews with 180 participants, including doctors and health care professionals. 17 out of 20 were from Ulaanbaatar and 3 were out of 20. From them, six interviews in the Aimag’s and district’s Complex Hospital represented for the secondary health care organizations, 8 interviews in the Family Clinic represented for primary health care organizations.3 interviews in the third health care organizations. Also 3 interviews in the private health care organizations.Is not known the advantages of public and private medical practitioners and medical specialists partners and do not have experience in working partner. But running has partnered with medical doctors, specialists increased support service types currently provided as a partnership between the hospital and doctor finds that your experience is improving and increasing the quality of service.For flip side is that partners can expand partnership working poor accountability. Future doctors and medical experts believe is necessary to strengthen the increasing awareness of the Partnership through the provision of secondary education, advocacy and policy.Doctors and medical experts believe that public-private partnerships Mongolian international health industry groups have developed expanding significantly. It believes that the lack of knowledge about the partnership, due to be implemented in a realistic policy document.

Public Health Service Needs of Pharmacy Customers / Шинэ санаа Шинэ нээлт

Although all the pharmacy programs (1 public and 2 private) in Mongolia comply with the national standard for pharmacy higher education D 723400 (MNS 5323-126: 2012), competence based learning has not been introduced yet. Also, pharmaceutical public health service needs have not been assessed in community pharmacies of Mongolia. Our goal was to assess the learning needs of pharmacists’ public health competencies and link pharmacy education with the health needs of populations.This cross-sectional, in-pharmacy survey was conducted in a simple random sample of community pharmacies in 6 districts of Ulaanbaatar city central region, which provide price discount on selected drugs through national health insurance. The survey was developed with evidence for reliability and validity and focused on two main needs assessment: pharmaceutical public health (PPH) serviceprovision and PPH competencies learning. Open ended and 3 point scale (1=great benefit; 2=some benefit; 3=no benefit) questions were used to obtain: general information, public health service knowledge, and needs of learning PPH competencies. Descriptive statistics and comparisons using STATA 13 were performed.A total of 248 surveys were obtained (pharmacists n=82; customers n=166). Pharmacist knowledge/skills greatly impacted the public’s decision to use expanded services. The customers reported high levels (75.3%) of needs with pharmacists providing advice on health promotion and healthy life style. 47.6% of the pharmacists replied having knowledge on health promotion and disease prevention is a great benefit to their practice.Our findings indicate that the public is very interested in pharmaceutical public health services and believe they will benefit. Also pharmacists need to be trained ecessary competencies.

Correlation between serum parathyroid hormone, 25-hydrohyvitamin D and bone mass density / Шинэ санаа Шинэ нээлт

Osteoporosis is a disease in which the density of bone is decreased with consequent increase in bone fragility and susceptibility to fracture risk. Vitamin D deficiency may cause secondary hyperparathyroidism and low bone mineral density. Our study was aimed to assess relation between vitamin D status and parathyroid hormone and bone density in adults. Relatively healthy 369 participants aged between 20-60 were randomly selected from Ulaanbaatar city. Specially designed questionnaire was used in the survey. Bone mass density was diagnosed according to the WHO criteria by the T-score. Respondents serum calcium and phosphorus levels were described by the fully automated analyzer (Cobas Integra 2800, Germany). Serum parathyroid hormone and 25-hydroxivitamin D levels were described by using ELISA kit (Eucardio Laboratory, Inc. USA) at the Molecular biology laboratory of MNUMS.The statistical result was analyzed by SPSS 21 program. The subjects mean age was 47.61±12.92, with a range of 20-83. The mean T-score was -0.60±2.17. Our study showed that negative correlation between bone mass density values at parathyroid hormone (r=-0.58, p<0.05), 25-hydroxyvitamin D (r=-0.48, p<0.05) and serum calcium (r=-0.21, p<0.05). Our study showed increased serum parathyroid hormone led the releasing calcium from bone and decreasing bone mass density.

Relationship between bone density, and hormonal and mineral healthy aging of Mongolians / Шинэ санаа Шинэ нээлт

To measure hardness of bone density, and study its relationship with serum calcium, phosphorus, Calcitonin levels and urine calcium level.Pre-designed questionnaire is used to reveal any risk factors associated with osteoporosis and also BMI is evaluated based on measurements of weight, height, bust and waist circumference. Study participants were measured their bone mass density of wrist and shin by ultrasound ( Sunlight MiniOmni, Beammed, USA). Serum calcium and phosphorus levels were analyzed by automatedbiochemical analyzer, Integra 800, according to the adhered protocol to the machine. New, clean urine containers were distributed to participant a day before urine test day and middle part of urine is collected into the container. The urine calcium level was analyzed by automated biochemical analyzer, Cobas Integra 800, according to the machine protocol. Calcitonin level was analyzed by ELISA kit by Eu cardio company of United States.Total of 80 people ages 26 to 87 from Ulaanbaatar were participated for this study. 29 (36.3%) ofthem were males whereas, 51 (63.8%) of them were females. Serum calcium average level was2.0+-0.2mmol/L, serum phosphorus average level was 0.8+-0.1mmol/L while urine calcium level was 3.9+-2.5mmol/L. According to our result, bone mass density was related to age (r=-0.495), serum calcium level has statistically important relationship (p<0.05) with bone mass density (r=-0.326), age(r=0.277), serum phosphorus (r=0.351), and urine calcium level (r=-0.316). Measurement above did not have statistically important relationship with Calcitonin level.Osteoclast might be dominating in osteoporosis since bone mass density is decreasing while serum calcium level is increasing along with aging.

Assessment of contents of the “Community based rehabilitation” curriculum / Шинэ санаа Шинэ нээлт

In our country for developing these services closer to the population, providing home care and treatment can be conducted in order to get the patient’s health care refer to the family and sum based health centers should be carried out. At the family and sum hospitals are working graduators of medical university, who assisting health care of Community based rehabilitation. In those cases adoctor have a role to give health care services, and to mediate between disabled people and other health care services as physical therapy, speech therapy, prosthesis and orthotics care, disability surgery and other professional cares. Therefore, there is needs to determine training needs of Community based rehabilitation and to accommodate with study curriculum.To evaluate the curriculum content, retrospective databases and descriptive research method were used and research data was collected by previous data analysis, interview and surveillance.In the result, contents of the “Community based rehabilitation” curriculum in different medicaluniversities are generally the same. But the curriculum was more attached to the disease and its drug medications rather than reflecting to proper guidance and advice for patients and main idea of “Community based rehabilitation”. Availability of specific textbooks and handbooks is limited, hence the trainings are held using international declaration, annual report or guidelines. Also the specialists who teach the subject were inadequate. Relating the due subjects, teaching methods were various, such as problem solving and small group discussion, case study etc., and students were evaluated bytest, case solving, essay writing and for School of Medicine, MNUMS they use OSCE. In conclusion, content of the “Community based rehabilitation” curriculum in undergraduate medical education is not adequate, indefinite, and discordant and there is lack of specialized teachers. Additionally, the curriculum content was not applied to the WHO guidance. Therefore we developed“Community based rehabilitation” curriculum in each medical disciplines, available to be used in undergraduate medical education in further.

Support for smoke-free policy among restaurant owners and managers in Ulaanbaatar, Mongolia.

OBJECTIVES: Exposure to second-hand smoke (SHS) is widespread in restaurants in Ulaanbaatar, the capital city of Mongolia. While a smoke-free policy is the most effective way of protecting restaurant workers and customers from SHS, this has not been well accepted in Mongolia. Furthermore, little is known about restaurants' attitude toward the smoke-free policy. METHODS: A cross-sectional survey directed to restaurant owners or managers was conducted in 475 representative restaurants in Ulaanbaatar. Face-to-face interviews using a questionnaire and on-site observation were performed. RESULTS: Only 29.3% of the restaurants claimed to prohibit smoking; none of the remaining had any protection toward SHS, and half of the restaurants estimated that more than 20% of customers would smoke inside. None of them had visible "no smoking" signs and the majority never received complaints about SHS. Despite the generally high level of knowledge of the health effects of SHS, of the 336 restaurants that were not smoke free, only 25.9% expressed that they planned to take action in the near future. By contrast, 87.8% of restaurants would support the government if it asked all restaurants to ban smoking. Multivariate analysis identified that restaurants having menus in foreign languages, selling cigarettes and predicting business decline were less likely to support the government smoke-free policy. CONCLUSIONS: This survey demonstrates that restaurants owners and managers were reluctant to take action on their own, but would support government policy. The government can assume a stronger role first by revising the law on tobacco control following the Framework Convention on Tobacco Control guideline.

Доод мөчний артер венийн судасны эмгэг сүлжээрлийг бөглөж эмчилсэн нь / Шинэ санаа Шинэ нээлт

INTRODUCTION More attention is paid recently following the increase in vascular diseases which 1MH3jnr is affecting the disability rate of the population at working age. Arteriovenous - malformation can occur at any place of human body and cause different levels of complaints and disability. OBJECTIVE Main goal was to make complete diagnosis of the AVM of lower extremity and to identify necessary coil for the treatment after to analyze the treatment result after the procedure. METHOD The treatment procedure of Lower extremity AVM was accomplished on 29 year old female at Angiography department of Shastin's Central Hospital. AVM was created by the anastomosis made between a. glutca superior, a.glutca inferior, a.obturatoria dextra and v.glutca superior, v.glutea inferior, v.obturatoria dexstra which have created pulsatile, pain at m.gluteus major et minor level. In control picture after the M.Coli embolization treatment the filling of the malformation have disappeared expressing the successful result. CONCLUSION Having previous experience of M.Coli embolization of brain vessel malformation we need to improve the skill and perform the procedure for different caliber vessels of the brain. It is preferable that we perform embolization treatment prior to surgical treatment and analyze the result.