Health expenditure towards mental health is only 2% of all other health expenditure allocated to public health. Currently almost 64% of all that fraction xpendituregoesto hospital based care. It means that there is lack of resources or limitation for development of community basedmental health services in this country, where hospital based mental health system is still remain in place. Long term chronic patients occupied most hospital beds are usually homeless, have no caregivers, no family protection or have a families that could not support their mentally ill members. Traditionally National Center for Mental Health has been offering community based rehabilitation scheme in form of developing labor skills but its coverage and accessibility remains short. In other words it is open for those who admitted to an inpatient service only.For last years the center has been forged partnership with international NGO namely AIFO in cooperation to gradually expand its works toward development of community based rehabilitation programs for people with mental health problems. Study basis is a current need for an expansion and coverage of mental health care and services and priority development of community based services over inpatient care.To asses a current situation of long term chronic patients admitted to inpatient service, their inclusion to CBR programs, expansion possibility of mental health servicesTotal 450 cases of history were registered in an inpatient care in 2013. 170 cases of them were belong to long term patients (1 and over years) with 94 male (55.3% )and 76 female (44.7%) patients. From perspective of age: adult (30-49 years old) consists of main percentage (66.4%)of long term patients. 64 (57.1%)of that age group patients have diagnosis of schizophrenia. Age group of 10-19 years old consists of 0.6% with mental retardation diagnosis. Research shows that long term patients mostly have affective disorders, organic psychosis, mental retardation and schizophrenia. Schizophrenic patients consist of most percentage (52.9%) of long termpatients. Inpatient stay duration spans from 1 to 36 years for long term patients and 17 patients of them have been on permanent basis at the center. These inpatient care users usually have been re-admitting after from 2 weeks to 1 month of duration breaks and they all suffer fromschizophrenia.Currently 170 patients out 450 or 1 in 3 admitted to inpatient service department at NCMH are chronic patients. 80.6% of those frequent users consist of labor intensive 20-49 year olds. Need to develop and conduct community based rehabilitation programs at primary, secondaryand tertiary level of public health services, include chronic patients and also need to set up a nursery for chronic mental health patients.

In pathopsychology, one branch of mental analysis, recently we are using qualitative analyzing methods for mental phenomena. But improvement of professional methods of study, generalization of the new computer based technology, children’s psychology assessment and many other problems are becoming an urgent issue in this field.Our study involved 45 children from orphanage and the High School Personality Questionnaire (HSPQ) computer based questionnaire is used to measure the personality characteristics of orphan children. Spielberg-Hanin test is used to reveal anxiety. Study is analyzed by SPSS program.In total, 45 children (age from 9 to 18), 22 boys and 23 girls participated in our survey. 8.9% of them measured as a high intelligence, 91.1% measured as a lower and an average intelligence. Interestingly, 60% of children were good at controlling their emotions and behavior. Thus 55.6%had symptoms of flexible mind, imagining and probability of affect illness. Having more stress is due to introverted preference and self-blaming, also a feeling of self-blaming is due to not being bold. 51.1% of them assessed that they have dependent, emulative personality and submissive behavior which was very considerably. The anxiety of condition was high in 34.1% of children andlow in 12.2% of them, thus anxiety of individual was high in 36.6% and low in 7.3% of children. Therefore, it’s essential to help orphan children and consider reducing anxiety and improving their self-independence.

Acute lung injury and acute respiratory distress syndrome among children are clinical entities of multifactorial origin requiring intensive care. Pediatric acute respiratory distress syndrome is a devastating lung condition with high mortality being the end result of a wide variety of inciting events. The purpose of this article is to review recent evidence for the epidemiology, clinical signs, diagnosis and treatment of the acute respiratory distress syndrome in chidlren.

Introduction: The theory that usingmobile bearing (MB) design for total kneereplacementsurgeries can reduce the riskof tibial component loosening compared tofixed-bearing (FB) designs is still unclear.Arthroplastic surgeries developed rapidlywithin recent 10 years, but there is no similarstudy performed yet. This randomized studyinvestigated the impact of prosthesis design toloosening of components at 2 years for totalknee replacement surgeries.Materials and Methods: 479 patientswho underwent total knee arthroplastyin FirstCentral Hospital of Mongolia were allocated toeither FB or MB tibialarticulation.We comparedour results to similar studies which performedabroad due to there is no such a studyperformed before in Mongolia.Results: There is no significant differenceby age, sex, weight, height, body mass index,operation side (right or left) in both groups.Pre- and postoperative range of motionwasalmostsame for MB and FB groups.Butloosening complication was higher for the FBgroup (1.16%) than MB group (0%).Conclusion: Using MB design for total kneearthroplasty has less loosening complicationthan using FB design in Mongolians. Bonemineral density (dual energy absorptiometry)and radiostereometric analysis are necessaryfor widening studies in field of total kneereplacement surgeries in the future.

Mental health team includes a psychiatrist, a psychiatric nurse, psychologist and social workers. Mental health workers are more stressful than other sector’s workers. Mental workers are working with mental patients, who have chronic,severe and poor prognosis disorders for long time, and may have Work Burnout Syndrome (WBS). Worldwide, many researches are used Maslach Burnout Inventory (MBI) for assessing WBS. Our goal was to detect risk factors of WBS among mental health workers. We conducted the survey among workers mental (doctors, nurses and assistant nurses) and study design was a descriptive cross-sectional. We are used a questionnaire, is including MBI. Our subjects were 103 workers, who were 27 (26,2%) doctors, 32 (31,1%) nursesand 44 (42,75) nurse- assistant. They were 15 (14,6%) male and 88 (85,4%) female and average age was 38.21 (SD = 8.92). The worker’s average professional working year was 13.09 (SD = 9.76). Most of subjects (n=63 61.2%) were shift-workers and they (n=99 96.1%) have high workload. We determined 3 groups by level of MBS among mental workers, such as the group with EE’s high scale (n = 27; 27%), thegroup with DP’s high scale (n = 23; 22.8%) and the group with PA’s high scale (n = 50; 50.5%).MBS was high among NMHC’s workers. However their work time is low, but theyhave risk factors for MBI such as high workloads, shift work, number of patients. Workers of emergency department had termination burnout syndrome more than other acute departments. This was associated with working condition.

Children under 5 years of age in developing countries are particularly vulnerable to malnutrition. Malnutrition affects 50% of hospitalized children and 25–70% of the critically ill children. Malnutrition interferes with the appropriate response of the body to disease and predisposes to infection and to the onset of multiorgan failure, increasing morbidity and mortality, the mean length of hospital stay, and health costs. Aim: A prospective cohort study of children admitted to the tertiary pediatric ICU between January 2009 and January 2014 was carried out. To assess the malnutrition type, and impact of nutritional status on outcomes like mortality rate, disease, complication in critically ill children.To the study were enrolled 138 children admitted to the pediatric intensive care units of the NationalCenter for Maternal and Childrens Hospital. The study protocol was approved by the Ethics Committee of the MNUMS, and written informed consent was obtained from all study participants. Nutritional status was determined using Waterlow criteria.Total participants were 49.3% (n=68) of male, 50.7% (n=70) female. 138 children with a mean age 4.4 months ±3.6/ Std.Er/, min = 1 month, max = 12 months, mode = 1 month. n=70(50.7%) acute malnutrition, n=58(42%) chronic malnutrition by Waterlow criteria. In malnutrition group was assessed patient with ricket n=36 (26.1%), patient with anemia n=56(58.9%)While malnutrition is a major problem in pediatric intensive care units. Acute malnutrition moreoccurred in the pediatric intensive care.Malnutrition more occurring of intrauterine infection, genetic disorder, hematology disease’s patients.

Introduction: Orthopedic surgery is a highrisk of surgical formation of thromboemboliccomplications.Many researchers are exploringprevent surgical complications.Anticoagulanttreatment is the first choice to preventthromboembolic complications.Artificial jointreplacement surgery has been made in 2008,in National First Central Hospitals (NFCH).Wehave not guideline of anticoagulant treatmentafter surgery and have not principle of choisefollow-drug treatment and unclear testingschedule to monitor anticoagulant treatment,that has become the basis for this study. Westudied by comparing a comparative benefitfor anticoagulant treatment of unfractionatedand low molecular weight heparin results.And studied thromboembolic complications,monitoring test of anticoagulant treatment,fatal bleeding, changes hemostasis ofanticoagulant therapy in both groups. Thesurvey results in practice is doing researchaims to introduce and review the results of thelong-term results.Materials and Methods: Included in thesurvey about 1,400 patients, who had kneeand hip replacement surgery in 2008-2016, inJoint Center of NFCH. All patients are dividedin three group. The first group is control group,do not use anticoagulation treatment, in thesecond group used unfractionated heparin andin the third group used low-molecular-weightheparin.Each group studied comparativewhether thromboembolic complications anddeath caused by thromboembolic, fatalbleeding.Between surgical complication andanticoagulant therapy relationship to investigatethe relationship the correlation is likely trueof 95%. Caused by other thromboemboliccomplications detected cases were removedfrom the study.Results: Control groups has not hospitalmortality, but has 3 cases of sudden death ina after discharge.Hemostasis is longer (INR1,3-1,5) in the second group. There hospitalmortality occurred in 1 (cardiac infarction),and thromboembolic complications 1 (arterialthrombosis in the jugular) in the third group.Low molecular weight heparin are no changeshemostasis, it is strongly dependent (r=0,8).Also in this group there is no fatal bleeding.Conclusions: Orthopedic surgery isnecessary for prevention of thromboemboliccomplications are showing from in controlgroup has sudden death.2 groups have not fatalbleeding when used heparin in normal doses.Other countries researchers conclude lowmolecular-weight-heparin is more effectivethan unfractionated heparin, our study is notvisible correlation reliability.When used lowmolecularweight heparin, hemostasis is notchanged is showing a strong dependence.

Introduction: We performed more than1200 arthroplasty surgeries at National FirstCentral Hospitalfrom 2008, so we haveour surgical technique and experiences.Thepurpose of this study is to assess our surgicalresults and complications after surgery forfemoral neck fracture made in Joint Center,National First Central Hospital, and tocomparingsimilar studies in other countries,and to develop the best optionsurgicaltherapy.Materials and Methods: Between 2008-2015, hip replacement surgery accountedatotal of 168 cases, that was 13.9% allof replacement surgery. A retrospectiveanalysis of patient database based onhospital discharge data and medical recordswas performed. The medical records ofthese patients were reviewed to confirmthe presence of a surgical site infection asdescribed by the Centers for Disease Control(CDC)/NNIS guidelines.Results: Between 2008-2015, in theJoint Center,National First Central Hospital,are seeing increasing number of patientswith hip replacement surgery each year.The cause for hip replacement surgery isaseptic necrosis (42%), at second is femoralneck fractures (22%). Joint Center,NationalFirst Central Hospital currently not providedemergency trauma care center. Therefore,younger patient with femoral neck fracturewas not to happen duringresearch. Olderthan 60 year patients with osteoporosis and,in some cases with nonunion, was doneforhip replacement surgery. The averageage of 75.7 (61-87).Bipolar hip arthroplastywas 14 cases all of 36 patients with femoralneck fracture.9 (5,31%), complications ariseall of hip replacement surgery (168 cases).Including: Infection - 1 (0.59%), sliding - 1(0.59%), dislocation - 2 (1.78%), fracture- 2 (1,18%), nerve injury - 2 (1,18%) andpostoperative mortality - 1 (0.59%).Conclusion: Internal Fixation- for patientage under 60 andgood bone quality. Thatoperation complication is femoral headnecrosis, not healing /nonunion/ delivery ofa lot of research that shows focus. Further,most surgery for femoral neck fracture is hipreplacement that is expected to be widelyavailable.

Introduction: Artificial joint replacementsurgery started in 2008, in Joint centerof National First Central Hospital. Hasexperienced a variety of post-surgicalcomplications.Postoperative infectiouscomplications, prevent and investigate thecauses of the research is carried out todetermine whether the opportunity.Materials and Methods: Facilitiesrandomly selected cases difficult patientswith postoperative septic, and analyzedby descriptive method. In all cases,Bacteriological analysis of the clinicallaboratory department of joint fluidsamples received. We determined artificialjoints causes of postoperative infectiouscomplications and artificial joints determinethe factors of postoperative infectiouscomplications. Calculate the treatment ofinfectious complications.Results: Since 2008, done a total1200 with an artificial joint replacementsurgery. Each year, a surgical number isincreasing. 82% of all cases were kneeartificial joint replacement surgery and18% were hip artificial joint replacementsurgery. There are 20 cases of postoperativeinfectious complications.Most suppurativecomplications (14 cases, 70%) are earlycomplications, that directly related to thesurgery and hospital infections are likelyto be. Pathogenic bacterial samples weredetected 10 cases. An assay blanks dependon laboratory capacity and the number ofsamples. Open surgery is 83,3% effective,when early infectious period. No mortalitydue to infectious complications in our center.Conclusion: The main reason of thepostoperative infectious complications ofartificial joint surgery is S. Aureus (99%).14 cases (70%) of all postoperativecomplications are early complications, thatdirectly related to the surgery and hospitalinfections are likely to be. The main factorsaffecting disinfection of the surgical roomand trauma.