Introduction: This study highlights the importance of access to treatment services and medicines. Research has shown that a significant portion of direct expenses for individuals who are not covered by health insurance is allocated to treatment, diagnostics, and medication costs, indicating issues with the accessibility and quality of health services.
According to the World Health Organization recommendations, if out-of-pocket health expenses exceed 25% of total health financing, it heightens the risk of deepening poverty and creates inequalities related to income.
Although policies and programs aimed at increasing access to subsidized medicines are being implemented, the expected outcomes and actual implementation of these initiatives have not fully met the health needs of the entire population.
Therefore, addressing these issues is essential. For instance, improving the regulation of medicine prices, ensuring adequate supply, and enhancing the subsidy system may be necessary steps moving forward. Methods: This study was conducted using a cross sectional design, employing methods such as document analysis, comparative study, and synthesis.
The list of discounted medicines provided by the health insurance fund includes 650 items from 161 manufacturers across 40 countries. Among these medicines, 7% have expired registration, 9% have been removed from registration, 11% are out of stock, and 73% are supplied normally. Of the medicines listed, 7% are domestic, and 93% are imported, with 39% coming from Asian countries and 54% from European countries, indicating a high reliance on imports for medicine supply and accessibility. A study of the medicines supplied by the pharmaceutical supply organizations shows that 16.5% of the prices are above the maximum price set by the health insurance fund, indicating the need for establishing medicine prices based on research and evidence. Conclusion Out of the 650 types of medicines registered in the list of subsidized medicines, 27% are in a status of expired, removed, or out of stock. The price from the pharmaceutical supply organizations exceeds the upper limit of the subsidized medicine prices set by the insurance fund, covering 83.5% of the total group of medicines.
Therefore, it is necessary to update the list of subsidized medicines from the health insurance fund based on research and evidence.

Background: Cancer is not only a physiological disease but also a complex condition that profoundly affects an individual’s psychological well-being and social relationships. Misconceptions about cancer within the public, including its association with death and the tendency to attribute blame to patients as being “personally responsible,” contribute to the development of social stigma among cancer survivors. This stigma negatively impacts patients’ engagement in treatment and their quality of life, highlighting the need to assess societal attitudes based on survivors’ lived experiences. Aim: To examine the everyday lived experiences of cancer survivors, measure perceived social stigma, and identify psychological challenges as well as sources of support. Materials and Methods: A mixed-methods design was employed. In the quantitative component, the Cancer Stigma Scale (CASS) and the Attitudes Toward Cancer Questionnaire (ATCQ) were translated and their content validity was evaluated by an expert panel using the Content Validity Index (CVI), followed by pilot testing to confirm feasibility (FVI). In the qualitative component, focus group discussions were conducted with cancer survivors, and coping ability was assessed using psychological assessment tools. Result: A total of 207 participants (68% female; mean age 33.82±13.7 years) were included in the quantitative study. Participants experienced a moderate level of cancer-related stigma, with negative attitudes most strongly associated with perceptions of disease severity and individual responsibility. Qualitative findings revealed that physician communication and family support played a decisive role in psychological responses at the time of diagnosis disclosure. Excessive sympathy or social distancing increased psychological distress, whereas normal interpersonal interaction and realistic encouragement were identified as the most effective forms of support. Conclusion To improve psychosocial support for cancer survivors, it is essential to enhance healthcare professionals’ communication skills, promote accurate public understanding of cancer, and strengthen the sustainability of survivor support group activities.

Background: In recent years, as the demand for orthodontic treatment has increased, the need to thoroughly investigate the causes of dental and skeletal malocclusions has become more important. In skeletal Class II malocclusion, mandibular deficiency prevalence for 70–80% of cases, maxillary excess for 10–20%, and a combination of both for approximately 15% (Figure 1). In cases associated with mandibular deficiency, clinical features include severe dental crowding, deep overbite, and reduced lower facial height. These conditions negatively affect facial profile, occlusion, masticatory function, and airway. Therefore, accurate diagnosis and appropriate treatment planning are essential. Diagnosis: Skeletal Class II malocclusion, deepbite, and severe crowding. Treatment: in August 2025, using self-ligating brackets with posterior bite up placed on the molars. After 4 months, a temporary anchorage device (TAD) was inserted, and anterior retraction was performed along with vertical elastics. Within 7 months, the overjet was decreased from 7 mm to 3 mm, and the overbite decreased from 7.5 mm to 4.5 mm. Midline deviation and arch form were corrected, and molar and canine relationships improved to Angle Class I. The facial profile also showed noticeable improvement. Conclusion Within a relatively short period after treatment initiation, severe crowding was resolved, and both sagittal and vertical relationships of the anterior teeth improved to normal values. Molar and canine relationships were significantly improved, along with facial esthetics. This case demonstrates that with proper planning, TAD-supported orthodontic treatment can be an effective non-extraction approach for certain cases of skeletal Class II malocclusion with severe crowding.

Background: Adolescence is a critical period for physical, psychological, and social development. However, traditional school bullying and cyberbullying have emerged as major public health issues adversely affecting adolescent mental health. Aim: To estimate the prevalence of school bullying and cyberbullying among Mongolian adolescents, evaluate their impacts on psychosocial difficulties, self-harm, and suicidal ideation, and identify protective factors. Materials and Methods: A cross-sectional study was conducted under the international Global Child and Adolescent Mental Health Study (GCAMHS) framework. A randomized sample of 2936 adolescents aged 11–17 years was recruited from public schools across Ulaanbaatar, provincial, and rural areas. Psychosocial difficulties were assessed using the Strengths and Difficulties Questionnaire (SDQ). Statistical analyses included Chi-square tests, independent t-tests, and multivariable logistic regression modeling to compute adjusted odds ratios (aOR). Results: Overall, 24.2% (n=710) of adolescents reported school bullying victimization, while 15.4% experienced cyberbullying victimization. Boys experienced higher rates of traditional school victimization than girls (28.5% vs. 20.4%, p < 0.001), whereas girls were significantly more vulnerable to cyberbullying victimization (17.4% vs. 13.1%, p=0.001). Bullied students showed significantly higher total SDQ difficulty scores compared to non-victims (18.08±6.15 vs. 10.86±5.20, p < 0.001). Multivariable logistic regression analysis revealed that cyberbullying victimization was the strongest predictor for suicidal ideation (aOR=3.62, 95% CI: 2.79–4.69) and self-harm behavior (aOR=3.08, 95% CI: 2.41–3.93). School bullying victimization also increased suicidal ideation (aOR=2.79), while school safety perception served as an independent protective factor against suicidal ideation (aOR=0.64, 95% CI: 0.53–0.76). Conclusion Traditional and cyberbullying remain prevalent among Mongolian adolescents, with cyberbullying exerting a particularly strong negative impact on psychosocial distress, self-harm, and suicidal ideation. Enhancing school safety and implementing targeted psychosocial and digital safety interventions tailored to gender-specific needs are essential.

Background: Globally, gastric cancer accounts for 1,089,000 new cases and 769,000 deaths annually, ranking fifth in overall cancer incidence and third in cancer-related mortality. The aim to determine HER2 expression in patients with gastric cancer and to evaluate its correlation with clinical and immunological biomarkers, as well as the need for further laboratory diagnostics. Aim: To determine HER2 expression in patients with gastric cancer and to evaluate its association with clinical and immunological biomarkers, as well as the potential need for further laboratory diagnostics. Materials and Methods: A retrospective study was conducted using archived materials from patients with gastric cancer at the Clinical Pathology, Molecular Genetics, and Pathology Laboratories of the National Cancer Center of Mongolia, covering the period from 2019 to June 2025. HER2 protein expression in tumor tissue was assessed using immunohistochemistry (IHC), and chromogenic in situ hybridization (CISH-HER2) was employed to confirm gene amplification. Statistical analysis was performed using the Prisma-10 software. Results: In our study, among 210 cases of gastric cancer evaluated by IHC for HER2, 46 (21.9%) were HER2-positive and 164 (78.1%) were HER2-negative. When comparing patients with gastric cancer stratified into HER2 1+ (negative) and HER2 3+ (positive) groups, no statistically significant differences (p < 0.05) were observed in age, sex, tumor location (surgically resected tissue), morphology, or disease stage. However, a higher proportion of males was noted in the HER2 3+ group (80.9%), though this did not reach statistical significance (p = 0.0879). Significant associations were found with tumor markers. Elevated serum CA-72-4 (>5 ng/mL) was more frequent in the HER2 3+ group (58.8%; p = 0.0069). In contrast, elevated CA-19-9 (>35 U/mL) was more common in the HER2 1+ group (93.5%; p = 0.0117), and elevated CEA (>6.9 U/mL) was also predominant in the HER2 1+ group (90.6%; p = 0.002). These findings suggest that HER2 3+ status predominates in cases with elevated CA-72-4, which may influence diagnostic strategies and HER2-targeted therapies (e.g., trastuzumab). Conversely, elevated CA-19-9 and CEA were more associated with HER2 1+ status, indicating a need for further detailed investigation of these markers in relation to HER2 expression. In patients evaluated by CISH for HER2 expression, stratification into HER2-positive and HER2-negative groups revealed no statistically significant differences (p < 0.05) in age, sex, tumor location, morphology, stage, or serum tumor markers (CA-72-4, CA-19-9, CEA). This suggests that HER2 status (positive/negative) may be independent of these variables. Although HER2 positivity was higher in poorly differentiated tumors (48% vs. 30.6% negative; p=0.1414) and in stage IV disease (50% vs. 39.3% negative; p=0.2607), these differences were not statistically significant. Elevated serum markers (CA-72-4, CA-19-9, CEA) were observed but showed no significant correlation with HER2 status. Conclusion Determining the molecular profile of gastric cancer patients can significantly contribute to refining clinical diagnosis, developing treatment strategies, enhancing therapeutic outcomes, and improving patients’ quality of life.

Background Varicose veins, or chronic venous insufficiency, become visibly noticeable from the second stage when veins start appearing on the surface of the skin. Symptoms include severe itching, pain, swelling, and inflammation. Chronic venous insufficiency is a common condition in countries such as China, South Korea, Japan, Mongolia, and Kazakhstan. Diagnosis of varicose veins relies on blood flow studies, coagulation tests, contrast-enhanced magnetic resonance imaging (MRI), and Doppler ultrasound of the venous system. Patient B, a 43-year-old male, has experienced pain and swelling in the right lower limb vein for the past two years, especially when exposed to heat. Coagulation tests show PT and PT INR within normal range. Doppler ultrasound of the venous system revealed that the perforating vein is dilated to 0.45 cm and has valve insufficiency. In the deep veins, a width of 0.68 cm was measured, while superficial veins ranged between 0.46–0.59 cm. After receiving appropriate treatment from the Department of Fire Acupuncture, the patient’s symptoms have improved.

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient’s scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a “manual pressure-cooker technique.” The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

Introduction: Air pollution is one of the greatest environmental risk to health. Ambient air pollution accounts for an estimated 4.2 million deaths per year due to stroke, heart disease, lung cancer and chronic respiratory diseases. Approximately 46% of the population resides in Ulaanbaatar, and over half of the population living in ger (traditional yurt dwelling) areas consumes raw coal, which leads to an increase in ambient air pollutants. The Government of Mongolia took a series of actions to reduce air pollution; one was the ban on the consumption of raw coal beginning on 15 May 2019. The aim of this study is to describe the Ulaanbaatar air quality related to briquettes usage during cold seasons. Material and Methods: We used ecological research design in this study. Quantitative data about air quality of Ulaanbaatar city during the cold seasons (Oct, Nov, Dec, Jan, Feb, Mar, Apr) in 2018-2020 years were analyzed from Department of air quality. These 5 indicators such as sulfur dioxide, nitrogen dioxide, particles (PM_2.5, PM₁₀) and carbon monoxide were selected for statistical analysis. The SPSS-20 software was used to analyze the data. Ethics: The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on 5^th of February, 2021. Results: The average sulfur dioxide, nitrogen dioxide concentrations in the air have increased in October 2019–April 2020 compared to the previous five years. But carbon oxide, particular matter concentrations have decreased in the selected years. Sulfur dioxide (p <0.0001), nitrogen dioxide (p =0.001), PM₁₀(p <0.0001), and PM_2.5 (p <0.0001) are differentiated before and after the use of improved fuels by Wilcoxon signed rank test. However, the CO content did not differ from that of the briquette’s consumption (p =0.412). Conclusions During the cold seasons, the concentration of sulfur dioxide and nitrogen dioxide has increased in air of Ulaanbaatar after used briquettes, while the concentration of particulate matter has decreased during the cold seasons.

Clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years Background: In worldwide, 176190 children infected with SARS-CoV-2 during April of 2020. According 01/09/2021, 46019 children had diagnosed with COVID-19 in Mongolia, were 19.5% of all cases. During COVID-19 infection, respiratory and digestive symptoms were commonly presented in children. Although the symptoms of coronavirus disease in children and adults are similar, in general, it was relatively mildly than adults, but from clinical observations reported that the infection occurs more severely in children and leads to death. During the coronavirus pandemic, it has been reported that children have Kawasaki syndrome, cardiac myopathy, coronary artery changes, and digestive system problems. Cardiac dysfunction in children may have recovered without sequelae, and further long-term follow-up studies are necessary. We aimed study clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years. Materials and methods: The study was conducted Children hospital of NCMCH from October 01, 2021 to April 01, 2022, participated 594 inpatients with COVID-19 and influenza, and studied clinical characteristics, laboratory and functional diagnostic changes, treatment, and complications of the coronavirus disease and influenza. Results: The study included 450 children aged 0-18 years with confirmed COVID-19 infection and 144 children with influenza. In social-demographic indicators, the mean age of children is 4±4.8 years, and 58.6% are male. Children age group included 0-4 ages, 5-9 ages, 10-15 ages and over 15 ages (62.4%, 17.5%, 16.2%, and 3.7%), respectively. As for influenza, 39.7% were children aged 0-9. In 8 cases, they received the COVID-19 vaccine but became ill with COVID-19. As for the variants of COVID-19 infection, 231(41.8%) alpha, 219(48.0%) delta, and 144(24.2%) influenza according to the wave period and clinical differentiation. In severity of diseases, 2(0.4%) were mild, 312(69.3%) were moderate, 117(26.0%) were severe, and 17(3.8%) were critical severe. There is a statistically significant difference in the severity of the disease between COVID-19 and influenza. 1 death (0.4%) occurred in cases of COVID-19. The mean days of inpatients with COVID-19 was 12.4±5.5 and mean days of inpatients with influenza 8.6±3.64. When assess signs of children, fever, cough and food aversion were main signs among both group of alpha and delta varientin COVID-19. Specifically, 67.3% had fever, 63.3% cough, 16.4% runny nose, 8% chest pain, 10.2% headache, 15.5% fatigue, and 0.9% decreased sense of taste and smell. There is a statistically significant difference (p<0.000) in the symptoms of cough, chest pain, general toxication symptoms and decreased sense of taste and smell in the case of COVID-19 and influenza. During influenza, symptoms of chest tightness and respiratory distress were observed in 10 (7.4%) children during severe illness. 0.5% of all cases of COVID-19 with sinus arrhythmia, and atrioventricular block were detected 0.9% of all cases by electrocardiogram analysis. When studying the underlying medical conditions of children in relation to the complications of COVID-19 and influenza, children diagnosed with heart defects, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases have a greater impact on the severity of the disease of COVID-19 than those with influenza. In the study of the factors affecting the severity of the COVID-19 infection, the child's age and gender did not have an effect, while the presence of a heart defect in the child increased the risk of complications by 5 times (p<0.001). Conclusions: Among 0-4 aged children with COVID-19 are occurred more hospitalization, brightly presented symptoms in children with chronic diseases, are being more severe and hospitalization days are more than in children with influenza. Symptoms of fever, cough, and runny nose are more common in children during flu and influenza, while headache, abdominal pain, dehydration, and reduced sense of taste and smell are significantly more common in the case of COVID-19. On the other hand, symptoms of chest pain, weakness, and fatigue were found in the 2 groups. The comorbidities (congenital cardiac anomalies, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases) are being risk factors for the severity of coronavirus disease.

Early detection of bronchial asthma in children and establishment of a national continuous monitoring system Introduction: Bronchial asthma - a chronic inflammatory disease with recurrent allergic reactions characterized by increased sensitivity of the bronchi to various factors, swelling of the bronchial mucosa, excessive mucus secretion, and narrowing of the airways due to severe muscle contraction. Early detection of bronchial asthma in childhood, its prevalence, and the establishment of a continuous monitoring system to assess the effectiveness of follow-up treatment Materials and methods: It is mild in children, but is ready to be severe. If left untreated for a long time, the structure of the bronchi changes irreversibly and becomes ineffective. There are cases of death due to risk factors for irritability and asthma. In the first objective of the study, the National Center for Maternal and Child Health (NCMCH) Children's Counseling Polyclinic, Respiratory Pathology Department, and the Children's Department of the General Hospital of 21 aimags and 9 districts were used to determine the prevalence of Acute respiratory infections, implemented outpatient (2019-2021). Within the scope of objectives 2 and 3 of the study, a self-controlled case-control study model was used to assess the diagnosis of asthma in the case group based on the GINA-2018 guideline evaluation and clinical and laboratory tests based on the GINA protocol treatment. The parameters were taken, the pre-treatment parameters were recorded and compared in the control group, and the results were calculated. Results: When the prevalence was determined by the Acute respiratory infections level, there were 11 cases per 1,000 children. 80.8% of cases of asthma were caused by asthma 1-5 times a year, and the majority or 96.5% were aged 0-9 years. Allergies include plant (42.9%), food (25.4%), and pet (14.3%) allergies under the age of 4, all types of allergies between the ages of 5-14, and plant allergies 15-19 years, (9%), food (21.4%), pet (14.3%), environmental moisture and mold allergies (14.3%). Among the 89 children treated according to GINA guidelines, 64.0% used spices or allergenic foods, 13.5% used antibiotics, 6.7% used paracetamol, and 13.5% used other drugs. Children with asthma were assessed according to GINA guidelines and monitored and treated for 1 year (0.0001), the number of cases of asthma (p = 0.035) and the number of people receiving emergency care (p = 0.042) decreased statistically. There was a statistically significant difference of 2%, nocturnal cough decreased by 15.2%, and whooping cough decreased by 1.4%. Conclusions: The prevalence of asthma was 11 cases per 1,000 children. The main causes of allergies are plants, food and pets. The number of coughs, hospitalizations and emergency room visits decreased with GINA treatment.