Study of staff employee’s satisfaction / Монголын Анагаах Ухаан

Introduction@#Studies in many countries have found that the satisfaction of medical workers is closely linked to the quality and efficiency of medical services, as well as the satisfaction of patients. Satisfied employees will bring about satisfied clients. The satisfaction of employees remains a key factor linking the internal management and external management of an organisation. The World Health Organization (WHO) Global strategy on human resources on health workforce 2030 sets out the policy agenda to ensure a workforce that is ft for purpose to attain the targets of the Sustainable Development Goals (SDGs). Motivation of health care workers can initiate them to exert and maintain an efort towards organizational goals. Motivation depends up on many factors, and job satisfaction is one of the most important factors. Healthcare is a service industry where the overall service experience is important for customer satisfaction and quality of care (even if in different extents according to the professional at stake) and that the literature has been bringing about the pertinence of such a holistic approach, this research was conducted within this perspective. Likewise, it is also known that there is close correlation between the job satisfaction of health care staff and the total quality of health services. Different groups have reported differences between the job satisfaction of doctors and that of other health providers. Various satisfaction levels of health care workers, including general practitioners, nurses and midwives, have been reported previously. @*Materials and Methods@#This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree Maternity Hospital The study involved 480 employees of above mentioned hospitals. The short form of the Minnesota Satisfaction Questionnaire, with 20 items, was used to examine satisfaction with professional life. The self-administered questionnaire was distributed to all people at their workplaces. Responses of 4 (satisfied) or 5 (very satisfied) were classified as ‘satisfied’, those of 1 (very dissatisfied) or 2 (dissatisfied) as ‘dissatisfied’.@*Results@#The study recruited total 480 employees consisting of 220 employees working at Urguu Maternity Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and service assistants and 46 economic employees involved it. In table, 87.1% of total employees of maternity hospitals were female and 12.9% were male. While there had significantly difference for gender, occupation type and worked year in this sector and workplace between 3 maternity hospitals (p<.001), age and education level had no significantly difference between these 3 groups. The proportion of health care staff satisfied with their work was 80.7%. The chance to tell people what to do’ and ‘Being able to do things that do not go against my conscience’, and mostly dissatisfied with ‘The working conditions’ and ‘My pay and the amount of work I do’. There was no significant difference between satisfaction scores of health care staff according to age, gender, marital status, and experience of profession. When the 20 items constituting job satisfaction were examined specifically, the satisfaction score showed a difference related to profession. The midwives’ satisfaction score was significantly lower than that of the others. In table 4, to assess employee’s satisfaction of each maternal hospital: While the minimum satisfaction was assessed by employees of Urguu maternity hospital whether salary is equal for work performance, the maximum satisfaction was assessed by employees of Amgalan maternity hospital under scope of consistent workplace at 93.9 percent. @*Conclusion@#Maternity satisfy external and internal factors of employees are influenced. Maternity is different, depending on the satisfaction of other working areas of employment.

Risk factors and biomarkers of infection after Caesarean section / Монголын Анагаах Ухаан

Background@#The WHO recommends the ideal rate for cesarean section to be 15% of the total birth, but researchers are still attracting attention to the fact that in recent years this rate has been steadily increasing, and risk is not decreasing worldwide. Incidence of postcesarean section inflammation and infection are 8-10 times higher than vaginal birth. The determination of lactate levels in early diagnosis of sepsis is clinically significant and the higher the lactate level increases the risk of mortality. @*Objective@#The aim of the study is to improve early detection of inflammation and infection and prevention of serious complications by using risk factors of postcesarean section inflammation and infection, and detecting procalcitonin and lactate in maternal blood.@*Materials and Methods@#This research is conducted between 2015-2017 based at the “Urguu” Maternity Hospital, Obstetric Clinic of National Center for Maternal and Child Health of Mongolia. Factors affecting postcesarean section inflammation and infection are calculated based on multifactorial regression analysis. Procalcitonin was determined by enzyme binding assay while lactate, C-reactive protein, and lactate dehydrogenase were determined by “E-311” the fully automated analyzer.@*Results@#According to the results of the study, the probability of inflammatory and infectious complication is 2.4% when the duration of labor increases by one unit, 34.8% when the risk of amniotic fluid increases, 14.6% when the pregnancy process become more complicated. Whereas, excessive fetal weight statistically increases the risk of infection, but its impact is low. The result of the study shows that the procalcitonin sensitivity was 65%, and the specificity was 96%. Lactate resulted in sensitivity of 56%, but with only 67% specificity. C-reactive protein had a sensitivity of 65% and a specificity of 96%. Lactate dehydrogenase resulted in sensitivity of 95%, and specificity of 82% in the diagnosis of sepsis. @*Conclusion@#Postterm pregnancy, premature rupture of membranes, multifetal pregnancy, prolonged labor, placenta previa, pyelonephritis, chronic hepatitis, chronic hypertensive disorder, anemia, emergency cesarean section, preeclampsia are risk factors and it is statistically significant at (P<0.0001). The biomarkers have a direct correlation to all stages of inflammation and infections, which are important for the diagnosis.

Risk assessment for preeclampsia by biochemical and biophisycal markers at first trimester / Монголын Анагаах Ухаан

Introduction@#Preeclampsia, which affects about 2-8% of pregnancies, is major cause of maternal and perinatal morbidity and mortality, particularly in developing countries. In Mongolia, preeclampsia and eclampsia occurred among pregnancy complications about 25% in recent years. There is a percentage for a cause of maternal death was 17.7% in preeclampsia and eclampsia between 2012 and 2015 in Mongolia.</br> Effective prediction of preeclampsia can be achieved at 11-13 week’s gestation by combination of maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA PI), maternal serum placental growth factor (PlGF), and pregnancy-associated plasma protein-A (PAPP-A).@*Goal@#To investigate plasma concentration of PIGF and PAPP-A, in pregnant women at 11-13+6 of gestation for screening of preeclampsia, To examine the performance of first-trimester screening for preeclampsia based on maternal characteristics, MAP, and mUt.A-PI.@*Materials and Methods @#The study conducted among 393 single pregnant women at 11-13+6 weeks, who were visiting antenatal care services, between March, 2015 and June, 2017. The prospective Cohort research method was used for this study. Written informed consent was obtained from all participants. Maternal plasma PAPP-A, PlGF were determined using Perkin Elmer kits by fluoroimmunoassay.</br> Measurement of MAP was by validated automated devices (HEM-7120, Оmron, Japan). MAP was calculated from the formula DP + 1/3*(SP-DP), where DP represents diastolic blood pressure and SP- systolic blood pressure. Trans-abdominal ultrasound (Voluson E8, GE, USA) examination was carried out for Ut.A-PI.@*Results@#In the study population, there were 66 (16.8%) cases that experienced preeclampsia and 327 (83.2%) cases that were unaffected by preeclampsia. The result showed that the mean concentration of PlGF was 38.6±19.6 pg/ml in PE group whereas the mean was 45.1±24.0 pg/ml in normal pregnant women. Level of PAPP-A was 366.1±195.3 mU/L in group with PE, 633.6±496.9 mU/L in group without preeclampsia. </br> The best Youden’s index and area under the curve (AUC) for MAP and mUt.A-PI were as a predictor of PE. It can be shown that the cutoff point for MAP was 89.5 mmHg (sensitivity-71.2%; specificity-75.5% J-0.467; AUC-0.792; P<0.001). The cutoff point of mUt.A-PI was 2.34 (sensitivity-33.3%; specificity-77.7% J-0.12; AUC-0.577; P<0.001).@*Conclusions@#The concentration of PIGF and PAPP-A in pregnant women with preeclampsia at 11-13+6 of gestation was lower than normal pregnant women. The detection risk of PE by MAP is more accurate than the mUtA-PI measurement.

First-trimester detection of major cardiac defects with the use of biomarkers / Монголын Анагаах Ухаан

Background@#Congenital heart disease (CHD) is the most common congenital disorders in the newborn and about 25% of them are complex heart diseases which needs early intervention or open heart surgery in neonate period. The incidence of CHD is varies from 8-10 in 1000 live births and half of them are major heart diseases. Abnormal ductusvenosus blood flow at 110-136 weeks has also been described in association with fetal aneuploidy, cardiac defects and adverse perinatal outcome. In the last few years the clinicians are using the nuchal translucency, ductus-venosus regurgitation in fetus as a biomarker of congenital heart disease.@*Objective@#To assess the method of combining fetal nuchal translucency and ductusvenosus blood flow measurements in the detection of major cardiac defects in the first-trimester scan.@*Methods@#Prospective cohort study data was derived from first-trimester screening of pregnant women at National Center for Maternal and Child Health between March 2014 and May 2017. </br> A total of 318 patients at 110 to 136 weeks of gestation enrolled in the study. An ultrasonography scan was performed trans abdominally (using 3 to 7.5 MHz curvilinear transducers),first, to determine gestational age from the measurement of the fetal crown-rump length; second, to measure fetal nuchal translucency thickness; and third, to assess blood flow across in the ductus-venosus.@*Results@#During the study period, we carried out an ultrasonographic examination at 110-136 weeks in 318 singleton pregnancies with a live fetus and crown-rump length of 45-84 mm. The median age of women was 34 (range, 19-46 years). In our study 9(2,8%) of all singleton pregnancies were diagnosed with major heart defects and increased NT, ductus-venosus regurgitation was shown to be strongly associated with the CHD. The sensitivity of nuchal translucency to CHD was 83% (p-0.0001), dustus-venosus regurgitation was 75% (p-0.007), ductus-venosus PI was 80% (p-0.001). @*Conclusions@#First trimester biomarkers for fetal CHD screening can detect major heart defects. Increased NT, abnormal DV flow can be important indicators for echocardiography, which is favorablefor early prenatal diagnosis of CHD.

CORRELATION BETWEEN REPRODUCTIVE HORMONAL LEVEL AND OSTEOPOROSIS GENE POLYMORPHISMS AMONG POSTMENOPAUSAL WOMEN / Шинэ санаа Шинэ нээлт

Cervical cancer is commonly caused by infection with human papilloma virus(HPV) and some risk factors are involved in the etiology of it.1 All over the world 437000 people are diagnosed with cervical disorders and half of them die due to cervical cancer.2 Annually 12000 new cases of cervical cancer are detected and 5000 women die because of it. In Spain about 2000 women are determined in the 3rd and 4th stage of the disease per year.3 Over the period 2000-2008 cervical cancer rate is 8 %among all cancers in Mongolia. Approximately 16 % of women’s cancer is cervical cancer. 4 In developing nations prevalence rate of cervical cancer is higher because of malnutrition, quality and framework for early detection are not satisfying and some reproductive risk factors also influence on it. 5 Worldwide diagnosing early and rapid management of precancerous condition and cervical abnormalities turn into main issue. Therefore based on these detection of premalignant lesion of cervix by colposcopy the main objective of the study. The overall goal of the study is to detect the premalignant lesion of cervix by colposcopy and determine of some risk factors and study the results.A total of 71 women, who are treated in Women’s inflammatory disease unit, Infertility and Women’s endocrine disorder unit are recruited for the cross sectional study. The women, who conducted the study were selected by accidently and colposcopy was done. They also have completed special questionnaires. The data were analyzed using the SPSS 19.0, Windows Office. The average age of the women was 38±9.4. Colposcopy was done 90.1% (n=64) of women, 9.9% (n=7) of women had not colposcopy. Among the women who had colposcopy, biopsies were taken 56.3% (n=36). During colposcopy we analyzed condition of cervix then we took biopsy from suspected areas and sent it histology laboratory. We compared predictive diagnosis, histology results after colposcopy and 33.3% (n=12) were identified as normal, CIN I was 52.7%, (n=19), CIN II was 5.5% (n=2), CINIII was 2.7% (n=1), cervical cancer is confirmed in 5.5% (n=2). We studied risk factors that can influence the cervical disorders among the women recruited in the study and age of first sexual intercourse (r=0.356, p=0.033), number of abortion (r=0.412, p=0.029) were statistically significant. However age of the women, parity, usage of contraceptive pills, smoking, number of sexual partners were statistically not significant.(p>0.05) When women’s age of first sexual intercourse is younger, cervical cancer disorder occurs30% greater comparing to women having first sexual intercourse later, (p<0.05, R=0.3), when number of abortion increases cervical cancer disorder increases 40%(p<0.05, R=0.41). F-1 to recruit osteoprogenitor /mesenchymal stem cells in the bone regeneration process.

RISK FACTORS RELATED TO SEPSIS ASSOCIATED FROM CESAREAN SECTION / Шинэ санаа Шинэ нээлт

One of the important problems in obstetricians science is wound infection following cesarean deliveries.It occurs in 2-10%.In the obstetricians practice these disorders decline associated with the use of antibiotics but the last 10 years all countries of the world puerperal infection increases, obstetric causes sepsis purulent difficulties of 150 thousand women deaths per year. Objective: To identify risk factories for wound infection following cesarean delivery.A population – based study. To comparing women who have and have not developed a wound infection prior to discharge from First maternity hospital, Mother and Child National health Centre of Ulaanbaatar, between 2011-2013.Using a logistic regression model, the following risk factors were identified: Sepsis purulent difficulties were more likely to develop in women who have twin pregnancy (OR=4.5; 95% CI 2.4-8.6) and vaginal exam multiple times (OR=6.7; 95% CI 2.1-22). No significant differences between the 2 group who underwent cesarean delivery for indications such as induction of labor, falled induction of labor, presence of meconium – stained amniotic fluid, nonreassuring fetal heart rate patterns. Sepsis purulent difficulties (p=0.001) occurred more often in women who were older, multiple pregnancy and delivery, pre-eclampsia, emergency cesarean delivery. The risk to develop sepsis purulent difficulties following cesarean delivery is maternal age, pregnancy, recurrent abortion, gestation age, emergency cesarean delivery, premature rupture of membranes, twin pregnancy and labor complication. (p=0.001)