Background: Ensuring the quality of healthcare services relies heavily on the professional competence of nurses. This study aimed to assess the internal consistency and construct validity of a competency assessment questionnaire developed for nurses working in tertiary-level hospitals in Ulaanbaatar, Mongolia. Aim: The aim of this study is to determine the internal reliability and construct validity of the questionnaire used to assess nurses’ competency Materials and Methods: A cross-sectional study design was conducted among 390 nurses employed at tertiary hospitals in Ulaanbaatar. Data were analyzed using SPSS version 25.0. Internal reliability was evaluated using Cronbach’s alpha, and construct validity was assessed through exploratory factor analysis (EFA). Results: The 55-item questionnaire demonstrated excellent internal reliability (Cronbach’s alpha=0.981). The Kaiser-Meyer-Olkin (KMO) measure was 0.972, and Bartlett’s test of sphericity was significant (p<0.001), indicating the data were suitable for factor analysis Conclusions 1. The internal consistency of the questionnaire showed a Cronbach’s alpha coefficient of 0.981, indicating excellent reliability. In addition, the Cronbach’s alpha values for each of the seven subscales were all above 0.90, demonstrating strong inter-item correlations and stability of the measurement indicators. The developed questionnaire is a highly reliable and valid tool for assessing the competencies of nurses in Mongolia. Its strong psychometric properties support its use in both research and professional development contexts. 2. Factor analysis was conducted using the Varimax rotation method to evaluate the construct validity of the questionnaire. The Kaiser-Meyer-Olkin (KMO) measure was 0.972, and Bartlett’s Test of Sphericity was significant (p<0.001), indicating that the data were suitable for factor analysis. The analysis identified seven factors, each with a loading above 0.60, confirming the high construct validity of the measurement tool.

Background: The annual incidence of pulmonary thromboembolism is reported to be 39–115 cases per 100,000 population, with rates of 60–120/100,000 in Western countries and 10–20/100,000 in Asian countries. In Mongolia, few studies revealed the prevalence of risk factors and clinical manifestations of acute pulmonary embolism. Over the past 30 years, the incidence of risk factors for non-communicable diseases, which are mainly triggered by lifestyle and social parameters, has rose. Moreover, environmental conditions such as cold climate, hypoxia, and blood hyperviscosit may contribute to higher incidences of acute pulmonary embolism in high-altitude regions. This condition is potentially fatal and can become impair quality of life. Aim: We aimed to compare risk factors and clinical characteristics based on age and sex, and to evaluate laboratory findings and diagnostic tests among Mongolian patients diagnosed with acute pulmonary embolism. Materials and Methods: This retrospective research included total 232 patients meeting inclusion criteria. The information was collected from patient histories, including general demographics, risk factors, comorbidities, symptoms, and physical examination findings. Laboratory analyses included complete blood count, coagulation profile, and immunological markers (D-dimer, NT-proBNP, troponin, protein C, homocysteine, and C-reactive protein), as well as selected imaging parameters. We used Wells and Geneva scoring systems to assess probability of acute pulmonary embolism and Pulmonary Embolism Severity Index to determine disease severity. Differences by age and sex were analyzed using independent t-tests for continuous variables and chi-square tests for categorical variables. Results: Among participants with acute pulmonary embolism, the prevalence of tobacco and alcohol use was significantly higher among males (p<0.001). Among comorbidities, arterial hypertension and other pulmonary diseases were more common in males, whereas cardiac diseases were more frequent in females (p=0.028). Participants aged 65 years and older showed higher rates of comorbid conditions and regular medication use (p<0.001). The most common symptoms were dyspnea (90.9%), chest pain (74.2%), cough (70.5%), leg pain (38.9%), hemoptysis (20.7%), and cyanosis (9.3%). According to sPESI scoring, 69.8% (n=162) were at high risk of death within 30 days, with no significant difference by sex. However, mortality risk within 30 days was significantly higher in participants aged 65 years and above (p<0.001). As increasing age, the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were elevated, indicating an acute inflammatory response (p=0.001). Contrast-enhanced CT scans revealed that 95 participants (44.2%) had main pulmonary artery involvement, with no significant sex difference, though involvement of the main pulmonary artery was more frequent in those aged 65 and older. Conclusion Dyspnea, chest pain, and cough were the most common symptoms among patients diagnosed with acute pulmonary embolism. The 30-day mortality risk associated with it was higher among males and increased with advancing age.

Background: The development and evaluation of nurse competency is an important research area that directly impacts the improvement of nursing quality and the optimization of the healthcare systems. Aim: To determine the psychometric properties, specifically the reliability and content validity, of the Mongolian version of the Competency Inventory for Registered Nurses. Materials and Methods: Research approval was obtained from the research ethics committee of the MNUMS (approval no. 2024/3-06), and adhering to ethical principles. Copyright owners granted permission to the principal investigator (PI) to use and translate the CIRN. Three bilingual experts were invited to be involved in the forward–backward translation process into the Mongolian language. Instrument reliability was pilot-tested with 30 nurses, who had similar characteristics with study sample. We collected data from 550 registered nurses, randomly selected and working in 11 reference-level and national centers in the capital city of Ulaanbaatar, and five Regional Diagnostic and Treatment Centers (RDTCs) of Mongolia. Results: The most of participants were female (96.9%); ages ranged from 20 to 63 ages with an average of 36.50. The internal consistency reliability of the CIRN was very high and Cronbach’s alpha coefficients were 0.97 respectively. The content validity indices (I-CVI≥0.78, S-CVI/Ave=0.98, S-CVI/UA=0.85) indicated satisfactory content validity. Factor analysis with Varimax rotation showed factor loadings ranging from 0.380 to 0.780. Conclusions 1. The Mongolian version of the Competency Inventory for Registered Nurses (CIRN) confirmed acceptable internal reliability. 2. The Mongolian version of the Competency Inventory for Registered Nurses (CIRN) was confirmed to be a valid instrument with appropriate content validity.

Background: Generation Z students, born after 1995, are characterized by their ability to multitask, low tolerance for traditional learning methods, impatience, short attention span, and preference for working independently rather than collaboratively. They are also considered more vulnerable to mental health challenges compared to previous generations. Aim: To assess the level of academic engagement among Generation Z students studying in the School of Nursing. Materials and Methods: This descriptive, cross-sectional quantitative study was conducted from February 1 to April 1, 2025. A total of 420 students majoring in nursing, midwifery, physical therapy, occupational therapy, and traditional medicine nursing at the School of Nursing, Mongolian National University of Medical Sciences, participated in the study. The Student Course Engagement Questionnaire (Handelsman, 2005) was used to evaluate students’ engagement levels. The reliability of the questionnaire was confirmed with a Cronbach’s α of 0.955. Statistical analysis was performed using SPSS version 25, and results were considered statistically significant at p<0.05. Results: Among the 420 participants, 91.9% were female and 8.1% were male. By major, 57.1% studied nursing, 22.6% midwifery, 8.8% physical therapy, and the remainder were from other disciplines. Student engagement was analyzed across three domains: academic involvement, personal responsibility and effort, and learning attitude and motivation. Pearson correlation analysis revealed strong positive correlations between academic involvement and personal responsibility/ effort (r=0.828), learning attitude and motivation (r=0.825), and between responsibility/effort and learning attitude/ motivation (r=0.903) (p<0.01). Age showed a weak positive correlation with year of study (r=0.381), while major and year of study had a weak negative correlation (r= -0.146) (p<0.01). Year of study and learning motivation also showed a weak negative correlation (r=-0.107, p<0.05). Conclusion The learning motivation and class engagement of Generation Z nursing students were found to be strongly correlated with their sense of responsibility, effort, and learning attitude (r=0.82–0.90, p<0.01). Most students demonstrated consistent participation and motivation to learn, showed less interest in traditional teaching approaches, and preferred practical training.

Background: One-third of people with epilepsy have drug-resistant epilepsy, making surgical treatment necessary. Comprehensive pre-surgical evaluations, including long-term video-electroencephalographic (VEEG) monitoring, magnetic resonance imaging (MRI), and neuropsychological testing, are essential components of epilepsy presurgical evaluation. The Epilepsy Center at the Mongolian-Japanese Hospital of MNUMS was established in September 2022 and introduced long-term video-EEG monitoring in May 2023. This marked the first time in Mongolia that comprehensive evaluation for epilepsy surgery became available. Aim: To evaluate the role and outcomes of long-term video-EEG monitoring in the pre-surgical assessment of epilepsy patients Materials and Methods: A prospective cohort study was conducted at the Epilepsy Center of the Mongolian-Japanese Hospital from May 2023 to March 2025. Patients who underwent VEEG and comprehensive pre-surgical evaluation were included. Data included demographic information, seizure history, imaging findings, and neurophysiological assessments (routine, sleep-deprived, and long-term video EEG). Patients were divided into two groups based on whether they met criteria for epilepsy surgery, and surgical outcomes were compared between these groups. Results: A total of 297 patients (104 children and 193 adults) participated in the study. Of these, 96 (32%) were diagnosed with temporal lobe epilepsy and underwent pre-surgical evaluation. The mean age of this group was 33±9.2 years; male-to-female ratio was 1:1. Age of seizure onset was 20±10.9 years, and the mean duration of epilepsy was 14.8±10.3 years. Etiologies included meningitis (21.7%), febrile seizures (15.2%), birth complications (12.5%), and traumatic brain injury (12.5%). The average duration of VEEG monitoring was 1.45±0.68 days, during which 161 seizures were recorded (average 2.64 per patient). No seizures were captured in 35 patients. Among the 96 patients, 29 met the criteria for surgical intervention, and 11 underwent temporal lobe epilepsy surgery. Surgical outcomes were significantly better compared to the non-surgical group (p<0.05). Conclusion Long-term video-EEG monitoring plays a critical role in precisely localizing the epileptogenic zone, identifying seizure types, establishing differential diagnoses, and optimizing surgical candidacy. It is confirmed as an essential diagnostic tool in the pre-surgical evaluation for epilepsy surgery.

Background: Mining is a major source of income, economic benefits, and job creation; however, it remains one of the most hazardous occupations in terms of health. Physically demanding, labor-intensive, hot, humid, noisy, and dusty work environments have a negative impact on the physical and psychological health of mine workers. Several factors, including age, gender, years of service, workload, stress, and fatigue, can affect sleep quality. Lack of sleep can lead to poor concentration, reduced alertness, impaired decision-making, and an increased risk of workplace injuries. While many studies have explored sleep quality and its risk factors in the general population, few have focused specifically on miners. This gap is the primary motivation for conducting the present study. Aim: To examine the risk factors affecting the sleep quality of dayshift workers at Baganuur Joint Stock Company. Materials and Methods: This cross-sectional study included 129 day-shift workers from Baganuur Joint Stock Company and was conducted between October and November 2023. Sleep quality was assessed using the 19-item Pittsburgh Sleep Quality Index (PSQI) questionnaire. Data were analyzed using SPSS version 26.0, with statistical significance set at p < 0.05. Results: Among the study participants, 86% (n = 111) were male. A total of 58.9% had been employed for less than 10 years, and 86% were always on call during non-working hours. Overall, 51.2% of the participants had poor sleep quality. Female gender (55.0%, p = 0.032) and being always on call during non-working hours (93.9%, p = 0.008) were significantly associated with poor sleep quality. Logistic regression analysis revealed that being female increased the risk of poor sleep quality (OR = 0.315, 95% CI = 0.105–0.944, p = 0.039). Conclusions 1. The majority of participants (51.2%) reported poor sleep quality, 2. Gender and being on call during non-working hours were significantly associated with reduced sleep quality among day-shift miners.

Background: The learning outcomes of a program are defined by the knowledge, skills, and attitudes that students are expected to acquire by the end of the curriculum. For occupational therapy professionals, it is essential to successfully implement both pre-graduation and post-graduation programs and to assess the effectiveness of the curriculum by clearly identifying the competencies expected of graduates in society. Aim: To identify the core competencies required for training occupational therapists at both pre-graduation and post-graduation levels. Materials and Methods: A modified Delphi method combined with Nominal Group Technique (NGT) was employed. The study was conducted in three phases from April 2022 to May 2024. In the initial online survey, a total of 83 participants were involved, including occupational therapy students, graduates, and members of the Mongolian Association of Occupational Therapists. A nominal group consisting of four experts held several focus group discussions to review and vote on the proposed competencies, forming a revised list. In the final phase (second-round Delphi), the updated list was distributed online again to collect additional feedback. Results: A total of 136 individuals participated in the online surveys throughout the study. The final list of competencies was synthesized based on three main international standards: the World Federation of Occupational Therapists (WFOT) Minimum Standards for Education (2016), the Canadian Association of Occupational Therapists (CAOT) Profile of Occupational Therapy Practice (2012), and the TUNING Educational Competencies in Europe. Through five rounds of NGT meetings, one online scoring session, and a final Delphi round, a total of 12 program learning outcomes (PLOs), 198 core competencies for the pre-graduation level, and 86 competencies for the post-graduation level were identified. Conclusion By applying consensus techniques, we developed a structured list of core competencies at both the basic and advanced levels aligned with the 12 program learning outcomes (PLOs) of the occupational therapy curriculum. This list can serve as a practical reference framework for future curriculum design and professional training programs in the occupational therapy.

Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: Obesity, especially central obesity, is a risk factor for non-communicable chronic diseases such as dyslipidemia, type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and metabolic syndrome (MetS). Aim: Study the association between the subcutaneous fat area (SFA) and visceral fat area (VFA) with lipid metabolism parameters in adults with MetS. Materials and Methods: Data from 1511 participants who visited the ‘NURA Mongolia’ Ai Health screening center between September 2023 and February 2024, including general information, DEXA (Dual X-ray Absorptiometry), and biochemical analysis results, were used. Metabolic syndrome (MeS) was assessed based on the harmonizing criteria 2009 (≥3 criteria). VFA and SFA were categorized into four groups using quartiles (Q1-Q4). Statistical analysis was performed using SPSS v26, including T-tests, multiple logistic regression (OR, 95% CI), and ROC (AUC) analysis. Results: The average age of the participants was 30.5±3.9 years, with a BMI of 25.1 kg/m², and 49.5% were male. The group with MetS (n=531) had significantly higher levels of VFA and SFA compared to the group that rated their health as relatively healthy and had no clinical diagnosis (n=979) (control group) (p<0.0001), with males showing higher VFA and females showing higher SFA (p<0.0001). The Q4 group for VFA had a significant association with MetS in males (4.611, 95% CI=2.394–9.591) and females (2.253, 95% CI=1.097-3.912) (p<0.001). Logistic regression analysis showed that increased VFA was more strongly associated with MetS in males (β=0.325, p<0.0001) and females (β=0.338, p<0.003) than BMI. The AUC for predicting MetS was 0.790 (95% CI=0.750-0.831) for VFA and 0.401 (95% CI=0.351-0.451) for SFA, with all results being statistically significant (p<0.001). VFA had a higher predictive value compared to other markers. Conclusion In healthy men with metabolic syndrome, VFA is more prominently defined, while SFA is higher in healthy women. Since VFA is a better predictor of metabolic syndrome than SFA, it increases the risk of diseases such as cardiovascular diseases and type 2 diabetes in men, whereas SFA in women serves as a protective factor.