Introduction: Aging is a complex process, where all organ systems can be affected at different stages, with different speed. There are many external and internal factors influencing to the aging and some parameters are changing during aging. These parameters are called as biomarkers of aging. One of potential biomarkers is blood red cell count and its indices. Aim of the study: To study the dynamic features of red blood cell indices during aging of Mongolians. Materials and methods: To the study were enrolled 338 healthy people aged 35-88 years. Present research was implemented at HSUM and district health centers geriatric cabinets. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. Venous blood was flown in EDTA containing tube, after which hematology indices were analyzed by cell counter Humacount. In this paper we introduced the red cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and platelet cell count. Results and discussion: Red blood cell count was higher in man than women, like hemoglobin concentration (150.5535.3g/l for man, 131.4432.58g/l for women). Red blood cell count increases with aging until 65 against hemoglobin concentration which decreases with aging (r=-0.275, =0.001). Mean corpuscular volume of erythrocyte were 85.024.73fL in man, 83.055.2fL in women and it was significantly increasing with aging in both sexes. The main reasons for the increase of hematocrit are increased number of erythrocyte and MCV, but it has sex different features. In man the MCV was strong factor, where erythrocyte count had higher influence on hematocrit increase of female. MCH and MCHC were higher in man, but has stronger inverse correlation with aging (r=-0.556, p=0.000). In discussion were mentioned that the red blood cell indices had specific dynamic features correlated with aging, especially in man, which was explained by testosterone secretion and its decline during aging. Biologically women have higher adaptation capacity during aging due to physiological processes like menstruation, pregnancy and menopause. Platelet number was decreasing in both sexes, which can be a major cause of hemorrhagic syndrome in geriatric practice. Conclusion: Red blood cell indices (RBC count, hemoglobin, hematocrit, MCV, MCH, MCHC and platelet) have an age specific features during aging and results of this study could be an useful information for geriatricians and medical professionals who work or intend to work with elderly.

Introduction: Biological aging is defined as a process or group processes that originate from progressive decrement of viability and increment of vulnerability of the organism with the passage of time. Biological age can be viewed as an objective measure for the assessment of ones biological vigor which is inevitably declined with advancing chronological age. Materials and methods: The individuals biological age scores (BAS) were estimated from 5 variables: forced expiratory volume in 1.0 sec (FEV1), systolic blood pressure (SBP), blood glucose, albumin, other proteins ratio and mean corpuscular hemoglobin (MCH). The study was composed on study design, based on E. Nakamuras developed method. Using above mentioned parameters was calculated biological age score (BAS), by which were assessed the aging rate of each individual. Results: We investigated a trend for the rate of aging changes in adults aged above 35. Variables used as a biomarkers of aging are significantly correlated with aging, where the systolic blood pressure was strongest one. Biological age score was calculated for every individual and it has strong correlation with chronological age (r=0.331, p=0.01). The rate at which ageing process relatively faster were 45-55 and 55-66 age intervals for females, against which aging rate of man was slower than women in above mentioned age groups. Conclusion: Variables used in calculation of BAS had significant cross sectional correlation with age and the aging rate was faster in man than in women in later age groups. In younger and older age groups (35-45 and above 65) individuals of both sexes had similar aging rate.

Background: Several researchers had been previously done the health professional workload study,however, because of the lack of studies of the relationship between physicians’ volume and outcome, wedid not have enough evidence of the resource allocation, the surgery outcome and quality improvementin our country.Goal: The study was aimed to study general surgeon volume and surgery outcome.Materials and Methods: We randomly selected 1147 patients diagnosed with gallbladder disease whounderwent laparoscopic cholecystectomy (LC) and acute appendicitis from 2012-2013 at the First andThird Clinical hospital and Khovd province Regional Diagnostic and Treatment Center were included.Patient demographics and clinical information, such as drug cost, duration of surgery, and name ofsurgeons were derived from patient medical records. Surgeons’ information, such as age, gender,professional and academic degree, and work experience were derived from hospital human resourcedepartment and correlation analysis was performed to examine the association between surgeryduration, surgeon experience and drug cost.Results: Hospitals LC was done 51,3±32,8 minutes with 24900,70 tugriks, appendectomy was done52,7±31,4 minutes with 18361,00 tugriks of drug cost. The Third Clinical hospital surgeons operatedhigher costs (28631,34±16985,86tugriks) and shorter time (39,86±39,54 ìèí) of an appendectomy. Butthe First Clinical hospital surgeons incurred lower cost (8460,82±13231,40 tugriks) of appendectomy.However, there were no significant differences in operation time and drug average cost in appendectomyin terms of positive and weak correlation(r<0.5, p>0.05). Conclusion: General surgeon volume was notassociated with surgery outcome.

Introduction Managers in the service sector are under increasing pressure to demonstrate that their services are customerfocused and that continuous performance improvement is being delivered. Given the financial and resource constraints under which service organizations must manage it is essential that customer expectations are properly understood and measured and that, from the customers ’perspective, any gaps in service quality are identified. Goal • SERVQUAL instrument in order to ascertain any actual or perceived gaps between customer expectations and perceptions of the service offered. • To point out how management of service improvement can become more logical and integrated with respect to the prioritized service quality dimensions and their affections on increasing/decreasing service quality gaps. Model of Service Quality Gaps There are seven major gaps in the service quality concept and three of them important gaps, which are more associated with the external customers are Gap1, Gap5 and Gap6. Gap1: Customers’ expectations versus management perceptions Gap2: Management perceptions versus service specifications Gap3: Service specifications versus service delivery Gap4: Service delivery versus external communication Gap5: The discrepancy between customer expectations and their perceptions of the service delivered Gap6: The discrepancy between customer expectations and employees’ perceptions Gap7: The discrepancy between employee’s perceptions and management perceptions According to this model, five dimensions are stated as follows 1) Tangibles. Physical facilities, equipments and appearance of personnel. 2) Reliability. Ability to perform the promised service dependably and accurately. 3) Responsiveness. Willingness to help customers and provide prompt service. 4) Assurance (including competence, courtesy, credibility and security). Knowledge and courtesy of employees and their ability to inspire trust and confidence. 5) Empathy (including access, communication, understanding the customer). Caring and individualized attention that the firm provides to its customers. The SERVQUAL approach contains a questionnaire that evaluates five generic service dimensions or factors through 27 questions, evaluating both expectation and performance using a seven point Likert scale. This approach evaluates service quality by calculating difference (gap) between customer expectations and perceptions (service quality= P – E). ‘P’ denotes customer perception of service or performance and ‘E’ denotes expectations before a service encounter deliver the actual. If the answer is negative, then dissatisfaction occurs. This equation is usually called gap analysis, but as it was emphasized, this approach only measures gap 5.

Introduction:Cardiovascular disease morbidity has been continuously increased among the population of Khangai region in the last 10 years - as of year 2010 for instance the rate was 1.5 more in Arkhangai aimag and 1.2 more in Khuvsgul aimag compared to the average rate nationwide. This research study was conducted due to the higher rates listed above in the region and the need to clarify various issues related to the medical care being provided with respect to the illness.Goal:It was deemed necessary to analyze the existing situation of early detection, monitoring and treatment of arterial hypertension among the population of the chosen province and to develop improved methodology.Objectives:1. To study the early detection of arterial hypertension2. To examine whether or not the clients are being given the needed recommendations related to the arterial hypertension monitoring and medicine treatmentMaterials and Methods:Cross sectional, organization based survey with 52 questions was carried out among 87 doctors/professionals of 17 soum and 100 family and aimag's general hospital of Orkhon, Bulgan, Arkhangai, Huvsgul and Selenge aimag. SPSS-17 program and Fisher test was used to generate and develop information.Results:Each soum, inter - soum and provincial doctor is responsible for checking/measuring the arterial pressure of their respective registered number of population by the percentage listed below: Soum doctor-56%, inter-soum doctor-50%, aimag's doctor-46,9% (p=0.19). Body weight and height are being irregularly measured on each chosen level (52.9%-62.5% p=0.67). Similarly the BMI is also being irregularly determined (42, 9% - 54, 5% p=0.07).From all the patients who have an arterial hypertension, 54.3%-55.6% are being monitored by dispensary and 11.1%-14.3% (p=0.53) are being regularly monitored in the chosen medical organizations. Although it is required to repeatedly measure and monitor the arterial pressure depending on its level the result shows that no planned monitoring is being done for the 77.8% of the patients. It is not sufficient for a sound and family doctor to recommend the regular use of antihypertensive the 48.6%, inter- sound doctor 43% and aimer's doctor 29% ( p= 0.40).Conclusions:1. The arterial hypertension - early detection practice is shown to be inadequate at the Chosen health care level (p=0.19).2. For the most clients with the arterial hypertension (59.9% p= 0.40), recommendations on regularly using antihypertensive is not being done - half the clients (54.3% - 55.6%) with the arterial hypertension are not being monitored.

Varieties of plants and lyophilized bovine bile have been used for increase secretion of bile in traditional systems of medicine of various countries. Following many articles note on the benefi cial effects of lyophilized bovine bile particularly on the wound healing and gastric protection effects, there is paucity of reports in literature on its effects on a bile secretion, a bile bilirubin, bile cholesterol and a plasma cholesterol levels. Sillichol contains lyophilizedbovine bile, liver hydrolisate, yarrow extract and silymarin. The aim of this study was to find out the effect of bile fl ow, bile bilirubin concentration bile cholesterol level and hepatoprotective of Sillichol. Sixteen adult male wistar rats (weighing between 200-250 gr) were used in the study. They were randomly assigned into control and sillichol group comprising 4 in each group. Thereafter, they were weighed and anaesthetized with ketamine (2ml/200gr body weight) muscle leg and quickly pinned to a dissecting board. Laparotomy was performed and liver lobes were defl ected anterolaterally to expose the common bile duct. The common bile duct was cannulated with a portex cannula (0.5 mm diameter) after a semitransection was made on the bile duct. The cannuls was held in place with thread tied over it and around the bile duct.The bile was collected for 8 hours from each rat studied according to method of Rozuet Jousse. The rate of bile fl ow was noted, the volume of bilirubin, bile cholesterol levels were determined in the control and test groups. Moreover, total of 18 wistar rats (200-250 gr) were obtainedfrom laboratory house of Drug research institute and acclimated for 10 days before starting the experiment. Liver toxicity was induced by the subcutaneous injection of carbon tetrachloride (CCL4, 0.4 ml/100gr), 1:1 diluted with paraffi n oil, for four successive days of the experiment (N.P.Scakun et al, 1983). The rats were divided randomly into 3 groups comprising 6 rats in each group and fed the same diet throughout the experimental period. Mean values of bile cholesterol and bilirubinlevels, rate of bile secretion in the control and sillichol group. Bile cholesterol levels were signifi cantly decreased in the sillichol group compared with the control group (60.3±0.88 mg/dl vs 62.6±1.21mg/dl, p<0.05). Rate of bile secretion was signifi cantly increased in the experimental compared with the control group(10.21±0.25 ml/8hr vs 4.18±0.25 ml/8hr, p<0.05). Total bilirubin, conjugated and unconjugatedbilirubin concentrations in both sillichol and control groups were not signifi cantly different (p<0.01). The activities of GOT, GPT and ALP were estimated in serum samples as the liver function biomarkers using biochemical diagnostic test. The CCL4 treatment markedly affected the liverspecifi c enzymes. It was found that a signifi cant (p<0.05) increase in serum GOT, GPT and ALP activities of CCL4 treated rats. After the treats, hepatic biomarkers were elevated in the serum due to release of the enzymes from damaged liver. GOT (69.8±1.5), GPT (103.9±1.2), ALP (23.8±0.2) and Cholesterol (67.7±13.6) andtriglyceride (64.0±3.3) levels weredecreasedsignifi cantly (p<0.05) in the sillichol groupcompared with the control group. Silichol is decreasing concentration of cholesterol and bilirubin’s level in bile, constantly after administration of drug. Also, liverpreparation is increasing bile acid secretion in hepatocytes and a speed of secretion.From the results of pharmacological study concluded that involves CCL4 induced acute toxic hepatitis, liver preparation has hepatoprotective effect by protecting the liver cells from injury, improving the regeneration process and by correcting metabolic functions of the liver.

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.

BACKGROUND: Children’s development and childhood disability are a public health issues to their consequences on quality of life and productivity not only for affected children but also for families and populations as a whole. WHO and the World Bank estimate that more than a billion people live with some form of disability, which equates to approximately 15% of the world’s population (1). Citing the Global Burden of Disease study of 2004, the World Report further estimates that amongst those aged 0-14 years, roughly 5.1% of all children (93 million) live with a ‘moderate or severe’ disability and 0.7%, or 13 million children, live with severe difficulties. Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and other risks, which are affect their cognitive, motor, and social emotional development. There are few research result and national statistics on the childhood disabilities of under 5 years children in Mongolia. OBJECTIVES:The objective of the screening was to determine the rate of disabilities in children aged 9 months to 5 years in Ulaanbaatar. MATERIALS AND METHODS: Population based cross-sectional study design used childhood disabilities screening among under 5 years children in Ulaanbaatar. TQ-(ten questions) screening method used to determine childhood disabilities. The structured interview checklist (TQ) and a guide to collect background and risk factors information were administered in a face-to-face interview of the child’s caregivers. The screening covered 8838 children from 6 districts, Ulaanbaatar. RESULTS: The study covered totally 8838 children (50.4 %) were male and 193 (48.4 %) were female. Over 81 % of the persons responding to the questions were mothers of the children, 10 % fathers. 9 % were the child’s relative and child’s sibling. Based on the ‘ten questions’ screen, 1960 out of 8838 children were positive (disabled). CONCLUSIONS: The positive rate of disabilities by TQ was a higher. At the post verification stage there is need to estimate sensitivity, specificity and negative predictive value of TQ. The second step of evaluation among positive cases should take diagnosis by comprehensive evaluation and clinical assessment.

The increasing proportions of aged persons have been accompanied in the world. NCDs are often associated with older age groups. High blood glucose levels and unhealthy diet increase the risk of or cause most NCDs. In this study we aimed to determine correlation between the older people (60<) blood glucose level and food consumption. 1563 healthy elder people participated in this research. We measured blood glucose level in all subjects at the Nursing school’s Training and Research Center of health science university of Mongolia. Ulaanbaatar city, Orkhon aimag, Khovd aimag, Khentii aimag, Bulgan aimag, Dornogovi aimag, Tov aimags represented urban areas, while the rest of aimags and soums represented rural areas. The questionnaire was used to collect data on respondent’s social-economic status, fruit and vegetable consumption, physical activity, and their causes. In order to assess the diet pattern of the surveyed population, the respondents were asked about frequency of fruit and vegetable consumption, type of oil used in food, and amount of salt consumed daily. Simple regression analysis was performed to shown that significantly positive correlations between blood glucose and salt intake (р<0.001), The other composition are no significantly changes.

Background: Over the past 20 years, world wide scale social and economic reforms, technological breakthroughs, and the population growth (increased by 1.64 billion), especially in urban areas, have had a negative impact on human health; changes in living and working conditions (environmental and air pollution), population density, traffic jam, unhealthy lifestyles, workload, and work stress – all contribute to non-communicable diseases – are increasing. According to researchers from Stanford University in the United States, “Stress plays a key role in the development of behavioral disorders such as poor diet, lack of exercise, alcohol and tobacco use, and addiction. Furthermore, these behavioral disorders play a major role in the development of metabolic disorders and cancer, such as hypertension, cardiovascular disease such as myocardial infarction, and diabetes and obesity. “Stress, in particular, depends on the type of workplace, work environment, and occupation in which the person spends most of their life. Materials and Methods: The study is covered 473 nurses from the specialized tertiary level hospitals in Mongolia. We determined their perceived work stress by the WPS (3 parts 57 questions) questionnaire of American scientist Rice. The work stress results were analytically analyzed with the cross-sectional method regarding the nurses’ arterial blood pressure. Results: Totally 473, or 121, 89, 146, and 117 nurses participated from NCTO (1), NCMH (3), NCID (4), and NCC (4). In present study, 34 or 7.2% of 18-24 year olds, 139 or 29.4% of 25-30 year olds, 99 or 20.9% of 31-40 year olds, 169 or 35.7% of 41-50, and 32 or 6.8% over 51 year olds. The study was conducted by collecting an age group similar to the age pyramid of nurses working in the hospital. The participants illustrated low levels of work stress in 7.6%, medium levels in 27.1%, and high levels of work stress in 65.3%, respectively. When we examine whether the level of stress exposure of nurses differs between the groups by high, medium, and low levels of workplace stress, the analysis of one factor variance confirms the statistical real difference (F = 3.071), (p = 0.028). The study results revealed that long lasted accumulated work stress trigger the hypertention. Conclusion The onset of stress in a nurse’s workplace depends on many different social factors, such as age, gender, organizational characteristics, organization, place of work, and years of experiences. In conclusion, we agreed with Spruil Tanya et al., that chroronic stress at work can be the reason for the high blood pressure.