1.Assessing children with disabilities using who international classification of functioning (ICF)
Norovnyam P ; Tserendulam N ; Oyunkhand E ; Tuul O ; Amarjargal O ; Baljinnyam B ; Nasantogtokh E ; Altantuya Sh ; Enkhmaa D
Mongolian Journal of Obstetrics, Gynaecology and Pediatrics 2022;31(1):2265-2271
Assessing children with disabilities using who international classification of functioning (ICF)
Background: In 2021, according to the World Health Organization (WHO), over 1 billion people are estimated to experience disability. The number of children with disabilities globally is estimated at almost 240 million, according to a new UNICEF report. There are approximately 43 million children with disabilities in East Asia and the Pacific. In the 2020 population and housing census of Mongolia, a total of 106.4 thousand people with disabilities were counted, of which 7.6 percent or 8.1 thousand children aged 0-14 were counted. People with disabilities lose some of their ability to labor. WHO recommended that assessment of children with disabilities using both ICD and ICF. Thus, we aim to assess children with disabilities who have neurological disease using International Classification of Functioning and evaluate the validity of this classification.
Materials and methods: This was a cross sectional analytical study based on NCMCH. Study materials were collected from children and guardians through standard questionnaires. The questionnaire consisted of 2 groups: general information of the participant and indicators of the scope of the D code of the "ICF" to assess the childhood disability. According to the indicators of the D code range, activity limitations and participation restriction, disabilities were evaluated. Each question in the questionnaire was measured on a 5-point Likert scale from 0 to 4. The statistical analysis was performed using R 3.5.1 program. Validity was assessed using the Rasch model for each question. Questionnaire reliability was assessed by Cronbach's alpha test.
Results: The study included 32 children aged 2-15 years. Male children were 62.5% of participants, the mean age was 8±3.1 years. Correlation between questions was high (r = 0.79) and reliability was adequate (α=0.94). As a result of Rasch analysis, the mean and standard deviation of the 36 selected parameters were not significantly different from the standardized mean. 3 indicators that did not meet the analysis criteria were removed, and a total of 33 indicators were used to measure childhood disabilities. Mean infit MNSQ was 1.06, mean outfit MNSQ was 0.93. MNSQ of all participants were 1.0 – 2.0. As a result of Rasch analysis, the mean of 33 indicators of disability is -1.6, the standard deviation is 1.2, the upper limit of the mean is 3.6, and the lower limit is -3.4, and the indicator of D code was stable enough to measure disability. The mean code scores were 2.45±1.3. The mean score of disability level of children diagnosed with cerebral palsy was 2.9±1.09, and children hospitalized with seizures and meningitis was 0.5±0.3. Also, the total mean score was 2.61±1.2 in the group with disability and receiving care, and 1.8±0.21 in the group not receiving care, which was a statistically significant difference.
Conclusions: Inter-indicator correlation was good and reliability of the questionnaire was adequate in field use of the 38 indicators of the activity limitations and participation restriction of the International Classification of Functioning, Children's Version (ICF-CY) code range “D”. When evaluated by Rasch analysis, 33 questions were evaluated as structural and stable. The International Classification of Functioning can be used to assess children's disabilities.
Discussions: Niels Ove Illum et al. (2015) found that The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders. Results were similar to our study.
2.Effects of Storage Conditions on Complete Blood Cell Count Parameters
Batchimeg N ; Oyunkhand L ; Altankhuyag E ; Gantulga D ; Uranbaigali E ; Munkhtulga L
Health Laboratory 2020;11(1):18-23
Introduction:
The complete blood count (CBC) is a frequently performed laboratory test today. This study evaluated the effects of temperature and sample storage time on parameters of CBC which could produce misleading results of clinical significance.
Methods:
In a cross-sectional study, CBC was checked in 20 randomly selected out-patients and baseline measurements were analyzed using the XN-2000 (Sysmex, Kobe, Japan) fully automated hematology analyzer. CBC was done all samples of storage at room temperature. Values were checked at time intervals of 0, 6, and 24 hr.
Results:
Among CBC parameters, white blood cell, red blood cell, hemoglobin, mean cell hemoglobin (MCH), neutrophils and lymphocytes were stable at time up to 6 h. Hematocrit increased between 0 and 24 hours, averaging 41.5% and 45.2%, respectively. MCV, RDW-SD, and RDW-CV increased between 0 and 24 hours. The mean value was statistically significant. There were 85.6fL/ 93.4fL (p<0.001), 40.7fL /48.2fL (p<0.001), 13.1% and 14.2% (p<0.05), respectively.
However, the MCHC was affected by time differences. (p <0.001 at 0 and 24 hours, p <0.001 at 3 and 24 hours). Platelet PDW, MPV, and P-LCR values increased between 0 and 24 h, respectively.
Conclusion
Whole blood samples were stored at room temperature for 24 hours for CBC tests, there were statistically significant differences in the size of red blood cells and platelets.
3.The assessment of the reason and type among disabled older Mongolians
Byambasuren E ; Purevsuren E ; Enkhbayar M ; Oyunkhand R
Mongolian Medical Sciences 2012;160(2):35-40
Introduction: Findings of study on disability types among Mongolian population confirm that 16631 (15.4) refers to visual impairment, speech and language disability 5999 (5.6), hard of hearing 12633 (11.7), mobility impairment 31265 (28.9), intellectual impairment 20898 (19.3) and other disabilities 20645 (19.1). There is no other study which assessed disability prevalence and some determinant factors which lead to disability and health status among older (ages women 55+, men 60+) disabled Mongolians. Goal: To assess the reason and type among disabled older Mongolians Materials and methods: This study was conducted on a random sample of disabled elderly people residing in Ulaanbaatar, Mongolia. Study is based on questionnaire and interview to indicate some health conditions. We used formal methods to assess activities of daily living and instrumental activities of daily living of disabled older people.Result: The sample represented 46.2% of men and 53.8% women in respondents. Median age of respondents was 75.2±10.5 (men 74.2±8.7, women 76.2±11.8). While 72.3% of respondents did physical work, 25.4% respondents did intellectual work and only 2.3% respondents had physical-intellectual work. According to the types of disability, 36.7% of respondents had mobility impairment, 16.7% of elder people had visual disability and 12.2% of respondents had hearing impairment. While 94.6% respondents had acquired disability, 4.6% respondents had congenital disability. In terms of activities of daily living, 76.2% of respondents had difficulty in bathing independently, 38.5% with dressing, and 62.3% had moving limitations at home.Conclusions:1. Mobility disability is higher (36.7%) than other types of disability among disabled older people.2. About 76.2% respondents had disability because of some diseases, about 8.5% about 8.5% from occupational disease, about 3.1% respondents from industrial injuries and about 11.5% respondents because of home injuries.3. Disability with activities of daily living is about 48% among disabled older people and the highest disabled daily activity is bathing, about 76.2%. Disability with instrumental activities of daily living is about 66% in disabled older people and the highest disabled instrumental activity is about 90%, is walking in long distance.4. According to this conclusion, disabled older people will greatly increase to demand health and social care assistance.
4.Results of determining some needs of rehabilitation care requirred to elderly of Mongolia
Oyunkhand R ; Byambasuren E ; Zandi N ; Batsereedene B ; Chimedsuren O ; Byambasuren S
Mongolian Medical Sciences 2011;157(3):37-40
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.
5.Results of determining psychosocial rehabilitation needs of Mongolian elderly
Oyunkhand R ; Byambasuren E ; Zandi N ; Batsereedene B ; Chimedsuren O ; Byambasuren S
Mongolian Medical Sciences 2011;157(3):41-44
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.
6.Result of survey on determining the cognitive ability among mongolian elderly
Oyunkhand R ; Byambasuren B ; Batsereedene E ; Byambasuren S
Mongolian Medical Sciences 2011;172(2):78-80
Background: In our country, the survey on mental condition of Mongolian elderly, in particularly on assessing the cognitive status has not provided yet. Goal: To determine the cognitive status of elderly and find out some factors which affect on it. Objectives:1. Determine the cognitive ability of Mongolian elderly2. Find out some factors which affect the cognitive ability of elderlyMaterials and Methods: In this cross sectional study, we had chosen randomizily 1 cluster from each 4 economic and geographic regions of Mongolia and Ulaanbaatar city, and totally comprised of 1207 elderly, of which 60 and over for male and 55 and over for female. The cognitive status of survey involved elderly was evaluated by mini mental examination test (MMET).Results: The mean age of survey involved elderly was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 60.3(728) percent of elderly people were normal, 39.7(479) percent of them estimated to have cognitive decline. Out of elderly with cognitive decline, 59.5 percent had slight cognitive impairment, 35.1 percent moderate cognitive impairment and rest 5.4 percent had severe cognitive impairment. The cognitive impairment predominantly revealed in female and prevailed more in elderly who live in countryside compared to elderly who live in the city (P<0.001). The cognitive impairment was related to educational background of elderly who had cognitive decline. Along the decline of education estimated higher level of cognitive impairment, as well as 47.5 percent of male and 53.8 percent of female, who had lower education, shared most percentage of cognitive impairment, compared to other educational levels.The cognitive impairment is directly correlated to decline of Activity of daily living and Instrumental activity of daily living of elderly (p<0,0001).Conclusions:1. The decline of cognitive status of elderly is correlated to gender. The educational background, income and family are related to their cognitive impairment.2. Activity of daily living and Instrumental activity of daily living have direct correlation to cognitive impairment of elderly.
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