BackgroundThe prognosis of breast and cervical cancer is relatively good if they are diagnosed at early stages.In Mongolia, however the survival rate of these cancers has been lower than in developed countries. Prevalence of late diagnoses of breast and cervical cancer is one of the most significant factors of the low survival rate of cancer patients in Mongolia. In this study, we sought to determine (1) the delay in diagnosing related with patient and (2) delay in treatment related with medical care including possible risk factors.GoalTo study the diagnosis delay of breast and cervical cancers related to medical care system.MethodsBreast and cervical cancer patients treated in the inpatient wards of National Cancer Center completed a study questionnaire on the first symptoms, timeline of medical care, and socio-demographic information. Diagnostic delay related with patient is indicated by extension of time interval of 30 days between the first symptoms and the first medical consultation. Diagnostic delay related with medical care system is indicated by extension of time interval of 30 days between the first medical the consultation and the first diagnosis. The delays of time were analyzed using the Mantel-Haenszel test.ResultsThe mean value of cervical cancer patient delay was 1.7 months. 40% of the patients were diagnosed later than 1 month failing to seek medical assistance as soon as the first symptom has been found (p=0.03). But the mean value of breast cancer patient delay was 2.1 months and 57% of patients were diagnosed later than 1 month. Diagnostic delay was associated with lack of diagnostic capacity of general practitioners and of province and district hospitals (p=0.001).ConclusionsDelays occur in all stages of the diagnostic process. Our results may represent an important tool in guiding the actions for an early diagnosis of cervical and breast cancers. There is a need for improving breast and cervical cancer awareness and training of general practitioners to reduce breast and cervical cancers mortality by promoting early detection.

Aim of this study was to evaluate the effectiveness of weight loss intervention in overweight and obese patients with newly diagnosed type 2 diabetes mellitus (T2D).92 overweight and obese subjects (42 men and 50 women), aged 32-56 years, with recently diagnosed type 2 diabetes were enrolled to the prospective cohort study. A 6-month counselingbased intervention was conducted between December 2011 and June 2012. Participants were Mongolian and received education sessions on healthy lifestyle guidelines including nutrition and physical activity in small groups. Before and after intervention, body weight (kg), body fat (%), waist and hip circumferences (cm), blood pressure (mm Hg), fasting blood glucose (mmol/l), HbA1C (%), total cholesterol (mmol/L) and triglyceride (mmol/L) were measured.80 out of 92 (86.9%) overweight and obese patients with T2D (BMI 31.57±4.2) completed weight loss intervention. Results of this study before and after the intervention showed mean body weight 84.41±13.08 vs 80.11±12.42, p<0.0001; BMI 31.57±4.2 vs 29.87±3.72, p<0.0001; waist circumference 104.18±10.51 vs 99.78±8.52, p<0.0001); hip circumference 107.04±8.66 vs 105.38±7.79, p<0.01; WHR 0.96±0.07 vs 0.94±0.05, p<0.0005; body fat 36.19±5.64 vs 34.26±6.57, p<0.0005; systolic blood pressure 133.03±22.5 vs 127.54±17.5, p<0.01; diastolic blood pressure 81.18±13.14 vs 77.61±11.03, p<0.05; fasting blood glucose 11.57±4.06 vs 7.99±2.64, p<0.0001; HbA1C 8.45±2.70 vs 5.95±1.70, p<0.0001; and total cholesterol 3.87±1.05 vs 3.15±0.96, p<0.0001 were improved significantly, except triglyceride 2.11±0.82 vs 1.73±1.8, p=0.0519. Thus results of the study showed an average weight loss of 4.3 kg and a significant decrease in BMI, percent body fat, and waist and hip circumferences, waist to hip ratio at 6 month. Significant reduction found in levels of fasting glucose, HbA1c and total cholesterol in blood after intervention, however no significant change found in blood level of triglyceride. Systolic and diastolic blood pressures were reduced significantly.Weight reduction of 5.1% of body weight in overweight and obese subjects with type 2 diabetes by the lifestyle intervention for 6 months resulted in significant reductions in total, abdominal and trunk adiposity and reduced blood pressure and improved glycemic control and dislipidemia.

Objective: To clear up of influence of society, economy family and mood of pregnant mother who gave stillbirth.Material and Methods: We chose 50 mother’s who gave stillbirth by case group, 50 mother’s who gave normal birth by control group by randomized method, research was conducted by specially prepared card and descriptive method, we compared placenta of mother’s who gave stillbirth and normal birth by pathologic analyse and working out was done by using SPSS 14.0 programme and difference between index was concluded by X 2 and F criteria.Results: Normal birth of mother’s who participated in the research is 19(16.7%) at the age 11(84.6%), at the age of 40-44 normal birth 1(50.0%), stillbirth 1(50.0%) stillbirth risk is increased under 19 and over 35, it has statistic probability (p=0.026). In 5(17.9%) of mother’s who gave normal birth, 23(82.1%) of mother’s who gave stillbirth. A member of her family smokes, in 45(62.5%) of mothers who gave normal birth, in 27(37.5%) of mothers who gave stillbirth a member of a family does not smoke .Seeing from this smoking of a family member affect to stillbirth and it has statistic probability (p=0.000).18(54.5%) of mothers who live in ger, 12( 35.3%) of mothers who live in a yard and a house, 20( 60.6) mothers who live in a flat gave normal birth. Seeing from this condition of living in a yard or in a house is worse that condition of living in a flat, it influence to stillbirth, it has probability for statistic (p=0.055). Conclusion: When women gives birth to a child under 19 and over 35 increases risk of stillbirth. It has statistic probability (p=0.026). Smoking of family member affects to stillbirth, it has statistic probability (p= 0.000). Condition of living in a yard and house is worse than living in a flat, it affect to stillbirth, it has probability for statistics (p=0.055).

Introduction.M.Colombo, W.Lange studies showed that 30-40% of people became chronic after suffering fromHepatitis B and C virus, about 50% of chronic cases transformed into primary liver cancer. There arefew studies in our country were conducted on hepatitis among healthcare professionals, particularnursing personnel.Goal.To identify antigens and antibodies of hepatitis B and C virus among nursesMaterials and Method.We carried out cross-sectional study among selected nurses, to determine surface antigen of hepatitisB virus and antibodies to hepatitis C virus. For identification of these antibodies and antigen, andvalidation of results Serodia tests from Fujinebo Company (Japan) and Beringnost (Germany) wereused respectively.Results.There were 598 nurses from the State Central Clinical Hospital, Shastin’s State Hospital, Hospitalof Military of Justice and Internal Affairs, and the National Center of Maternal and Child Health, whoparticipated in the study. From 5 hospitals a 598 nurses surveyed and revealed the hepatitis B virussurface antigen positive 18.9%, hepatitis C virus antibodies in 23.2%, B and C viruses detected by1.2% combined.Conclusion.The study identified that 43.2 percent of nurses surveyed on hepatitis B and C viruses were detected;it shows a high prevalence among the nurses. There is an urgent need to provide knowledge tomedical personnel regarding standards during procedures, concerning hepatitis infections, monitoringand improve technology used during procedures.

GoalAim of this study was to evaluate the effectiveness of weight loss intervention in overweight and obesepatients with newly diagnosed type 2 diabetes mellitus (T2D).Materials and Methods92 overweight and obese subjects (42 men and 50 women), aged 32-56 years, with recently diagnosedtype 2 diabetes were enrolled to the prospective cohort study. A 6-month counselingbased interventionwas conducted between December 2011 and June 2012. Participants were Mongolian and receivededucation sessions on healthy lifestyle guidelines including nutrition and physical activity in smallgroups. Before and after intervention, body weight (kg), body fat (%), waist and hip circumferences(cm), blood pressure (mm Hg), fasting blood glucose (mmol/l), HbA1C (%), total cholesterol (mmol/L)and triglyceride (mmol/L) were measured.Results80 out of 92 (86.9%) overweight and obese patients with T2D (BMI 31.57±4.2) completed weightloss intervention. Results of this study before and after the intervention showed mean body weight84.41±13.08 vs 80.11±12.42, p<0.0001; BMI 31.57±4.2 vs 29.87±3.72, p<0.0001; waist circumference104.18±10.51 vs 99.78±8.52, p<0.0001); hip circumference 107.04±8.66 vs 105.38±7.79, p<0.01;WHR 0.96±0.07 vs 0.94±0.05, p<0.0005; body fat 36.19±5.64 vs 34.26±6.57, p<0.0005; systolic bloodpressure 133.03±22.5 vs 127.54±17.5, p<0.01; diastolic blood pressure 81.18±13.14 vs 77.61±11.03,p<0.05; fasting blood glucose 11.57±4.06 vs 7.99±2.64, p<0.0001; HbA1C 8.45±2.70 vs 5.95±1.70,p<0.0001; and total cholesterol 3.87±1.05 vs 3.15±0.96, p<0.0001were improved significantly, excepttriglyceride 2.11±0.82 vs 1.73±1.8, p=0.0519. Thus results of the study showed an average weight lossof 4.3 kg and a significant decrease in BMI, percent body fat, and waist and hip circumferences, waist tohip ratio at 6 month. Significant reduction found in levels of fasting glucose, HbA1c and total cholesterolin blood after intervention, however no significant change found in blood level of triglyceride. Systolicand diastolic blood pressures were reduced significantly.ConclusionWeight reduction of 5.1% of body weight in overweight and obese subjects with type 2 diabetes bythe lifestyle intervention for 6 months resulted in significant reductions in total, abdominal and trunkadiposity and reduced blood pressure and improved glycemic control and dislipidemia.

Background: Glomerulonephritis (GN) remains a common cause of end stage kidney failure worldwide. The auto antibodies are useful in the patients prognosing, diagnose and treatment of GN. The aim of the study was to compare the prevalence and levels of auto antibodies in the sera of patients with GN in relation to the clinical activity of disease and auto antibodiesMethods: From a hospital-based population, 90 patients with GN (mean age 37.9±12.7) were recruited. Autoantibodies (C/P-ANCA, anti-dsDNA, anti-Sm, anti-SS-A/Ro, anti-SS-B/La, anti-Scl-70, anti-GBM) measured by Enzyme Immuno Assay (Germany, ORGENTEC Diagnostika GmbH). Renal function was evaluated by the eGFR using the Cockcroft-Gault formula.Results: Patients with GN was significantly younger and primary GN was more common in the male, but frequency of LN was 4 times higher among female. The prevalence of cANCA 2.9%, Sm 4.2%, dsDNA 5.7%, SSA 7.1%, SSB 1.4% were positive in primary GN group, the prevalence of Sm 16.7%, dsDNA 8.3%, SSA 25%, SSB 16.7% were positive in secondary GN group. A higher frequency of anti Sm 25%, anti-dsDNA 25%, anti-SS-A/Ro 75%, anti-SS-B/La 25% was observed in the lupus nephritis group. Conclusion: Lupus nephritis associated with several auto antibodies (anti Sm, anti-dsDNA, anti-SS-A/ Ro, anti-SS-B/La) and each of which are very useful in distinguishing patients with lupus nephritis from other secondary GN.

Introduction: The issue of meeting need of rehabilitation care service required to elders is one of determinants which influences in enabling quality of life of elderly people. In our country, we lack of survey on determining current need of long term care and one of its form rehabilitation care service for the elderly, so it became the background of the research. Goal: Reveal some needs of rehabilitation care service through determining the Activities of daily living and Instrumental Activities of daily living of Mongolian elderly people Materials and Method: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The research was conducted by using ADL and IADL tests as well as questionnaire to determine the needs of rehabilitation care service. Results: Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women, and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 473 elderly were from Ulaanbaatar city, 734 of them were from 4 regions of countryside. Among survey involved elderly, the mean of ADL ability was 87.4 percent, of which, the following abilities were better such as: continence (92.5%), toileting (91.3%), dressing (87.9%), while bathing ability was impaired mostly or 18.2 percent. Subsequently, the mean of IADL ability among survey involved elderly was found to be 29.9 percent. The health needs of elderly were differed. Due to extensive indicator, 24.8 percent of elderly wanted to admit in a hospital, 20.8 percent - home nursing care and 32.6 percent -involvement in rehabilitation care service. In terms of amount, the maximum needs were eight, while most of elderly requested 1-3 kinds of needs. Conclusions: 1. The impairment of Activity of Daily Living was found to be approximately 22.6 percent, while Instrumental Activity of Daily Living was 29.9 percent among Mongolian elderly people. 2. The impairment level of Activities of Daily Living and Instrumental Activities of Daily Living indicated the requirement of occupational and physical therapy in health care service for the elderly.

Introduction: The mental and behavioral diseases affect in loneliness and discrimination of elderly people and mostly reduce the quality of life of elderly people compared to injury and accidence. Wulf Rossler, Switzerland mentioned that all kinds of mental diseases require long term care, especially rehabilitation. In our country, we lack of survey on determining psychosocial rehabilitation needs for the elderly, therefore it became the background of the research. Goal: Determine the psychosocial rehabilitation needs of Mongolian elderly people Method and materials: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The research was conducted by using Geriatric depression test, Spielberg Hanin test to reveal anxiety, Mini mental examination test to assess the cognitive status and AUDIT test to evaluate the alcohol usage. The diagnoses were put according to ICD-10 based on geriatric examination. Results: Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women, and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 473 elderly were from Ulaanbaatar city, 734 of them were from 4 regions of countryside. In terms of mental and behavioral diseases, anxiety and depression were prevailing among Mongolian elderly. Thirty eight point five percent of survey involved elderly investigated to have depression and 44 percent - anxiety. Moreover, dementia was found 36 and sleep disorder 28 per 1000 elders. Twenty three point six percent of elderly had slight cognitive impairment, 13.9 percent moderate cognitive impairment, while 2.1 percent had severe cognitive impairment. The cognitive impairment is differed in terms of region. The moderate cognitive impairment predominantly revealed in mountainous and eastern regions, while the severe cognitive impairment was prevailing in central and eastern regions. Due to classification of needs of elderly into medical, financial and other needs, found that, 37 percent of elderly required medical, 33 percent financial and 37 percent other needs. In terms of psychosocial needs, 30.4 percent wanted to have a place for spending free time, 23.9 percent to make new friends and 6.1 percent to hire a job. Also 4.4 percent of elderly had a need of having a caregiver. Conclusions: 1. Out of mental and behavioral diseases, anxiety (38.5 percent) and depression (44 percent) were prevailing among elderly. 2. Each Mongolian elderly had need of 1-2 psychosocial needs. 3. All kinds of psychosocial rehabilitation including the medical, adaptation enhancing and social rehabilitation are equally required for the elderly people.

Goal: The purpose of this study is to identify issues of current situation of the health information system in the health care facilities of Mongolia.Materials and Methods: A total 362 users as hospital directors, physicians, nurses, statisticians and IT workers of 105 health care facilities at primary, secondary and tertiary level participated in this study. Data collection methods were generated using a combination of questionnaires and in-depth interview of the users. The statistical analysis was carried out using the SPSS. Outcome measures were calculated with 95% confidence intervals (CI).Results: The survey results were shown that a vertical health information flow regulates in the health sector, internal networks set up and H-info 2.0 software as routine data processing and insurance claims are used in the hospitals of Mongolia. Regarding of e-health software as Computerized Physician Order Entry (CPOE), Drug Information System (DIS), Laboratory Information System (LIS) and Radiology Information System (RIS), 82.6% of the health care facilities used only CPOE. There 50% of the existed e-health software is not integrated in the health care facilities. In the data management, 27.0% of the health care facilities that used e-health applications had no backup solution. 45.5% of total users said that the information technology human resource is insufficient. 70.0% of users responded as there did not any continues training program in health information technology. The study was determined lack of functions and difficulty of using the existed software and inadequate software operation and not user-friendliness are the causes of the most of dissatisfactions. Conclusions: A vertical health information flow, internal networks, routine statistic processing set up and mainly CPOE used in the health care facilities. However there is no integration of e-health software and lack of its capacity. It is required modern integrated health information system in the health sector of Mongolia.

Background. There are at least 650 million people and one out or every 10 people worldwide has a disability. In Mongolia, around 128.000 people with disabilities and 12.000 are wheelchair users. Disabilities affect people in different ways. Causing trouble to their economy, their social life, mental and daily self care.The people with disabilities in Mongolia have much difficulties for their daily activities, have limited possibilities to be included in a health and social services equally and the status to become isolated from the society of them and their families are the invariable problem for them.Goal. To study and evaluate the daily embarrassments and problems of the disabled people and the standard medical environment for them.Results. The 55.8% were male and 4.2% were female of the participants in the survey 88.4% of them answered that they can use their wheelchairs in even land and square only. The 76.4% of the participants do not use public transportation and there is no road for the wheelchair users, no ramp is planned for the citizens with wheelchairs in service centers and organizations and so these are the facing problems for the disabled citizens in Mongolia.It demonstrates that the standard for the disabled citizens is not considered in the medical environmental standards seemingly from no ramp is planned for the citizens with wheelchairs in 92% of the hospitals, no elevator for the citizens with wheelchairs in 91% of the hospitals, 88% of the hospitals have not equipped their toilets with the equipments for the disabled citizens, and 91 % of the hospitals have not planned a room for the disabled citizens for the hospitals included in the surveys.Conclusions:1. Wheelchair users mostly dependent for daily and creative activities. Also they have limited social opportunities because there is no appropriate environment.2. Hospitals involved in the research showed that disabled people have limited health services, hospital environmental standard is not appropriate for them and 1,2 and 3 level of hospitals must setup infrastructure for the disabled people.