Climate change and communicable and non-communicable disease / Монголын Анагаах Ухаан

Introduction@#The rate of global warming has accelerated over the past 50 years, with 2014 and 2015 being the earth’s warmest years on record. The prevailing scientific view is that increased ambient temperatures are changing rainfall patterns and cause extreme weather conditions. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens.</br> Annually, one out of every four deaths worldwide is due to environmental pollution and climate change-related diseases. </br> Greenhouse gases from human activities are the most significant driver of observed climate change since the mid-20th century.</br> These warming trends may have profound effects not only on the environment but also on human health directly and indirectly. In fact, climate change has been considered the biggest threat to global health in the 21st century.

Prevalence of construction worker injuries in the last 5 years and influencing factors of some years / Монголын Анагаах Ухаан

Background@#According to the International Labor Organization (ILO), 2.78 million workers are injured and killed each year as a result of occupational diseases, while 374 million are injured. Furthermore, work-related injuries cost the global economy 4% of its GDP. Construction workers are more likely than other workers to die and twice as likely to be injured. Construction accidents are frequently caused by a lack of knowledge and training, negligence, and inadequate safety equipment. Workers account for 70% of the factors influencing accidents, 49% of workplace problems, 56% of equipment shortages, 27% of material conditions, and 84% of risk management. Between 2009 and 2017, 3321 industrial accidents and acute poisoning cases were reported in Mongolia. 509 people died as a result of industrial accidents, 761 people became disabled as a result of injuries, and 2051 people temporarily lost their ability to work. As a result, determining the distribution, causes, and factors of accidents is reasonable. @*Purpose@#To detect the prevalence and influencing factors of accidents in the construction industry in the last 5 years.@*Material and Method@#Secondary data was collected using a quantitative research method based on a single-moment model of observational research from the "General Directorate of Professional Supervision" quantitative data on industrial accidents and acute poisoning by sampling 10 groups and 59 indicators of accident cases in the construction industry.@*Result@#The prevalence of accidents in the construction industry was calculated for 1000 workers in Ulaanbaatar's 21 provinces and 9 districts using the ARC GS program. For the calculation of influencing factors and injury causes at www.graphpad.com, P values less than 0.05 was considered significant. </br> Between 2017 and 2021, 134 accidents and injuries were reported in Mongolia's construction industry. All accidents were male in 123 cases (92%), and female in 11 cases (8%). </br> Accidents and injuries in the construction industry are distributed. In Mongolia, Ulaanbaatar had 66 cases, Umnugovi had 10, Orkhon had 10, and Khovd province had 12, all of which had more accidents than other provinces. Calculating the distribution per 1000 workers, Sukhbaatar has 20, Dornogovi has 15, Umnugovi has 12, and Khovd has 10.9.</br> The most important factors influencing construction accidents are the workplace environment and human factors. In terms of accident causes, falling, tripping, or slipping caused 55 or 41% of all accidents, falling objects caused 24 or 18%, being trapped by objects caused 19 or 14%, and 20 or 15% were remaining causes of injuries. In the last 5 years, 47 or 35.07% of all accidents were caused by workplace environment, 45 or 33.5% by human factors, 23 or 17.1% by management system, and 19 or 14.1% by technical and technological factors.@*Conclusions@#</br>1. In the last five years, the prevalence of accidents among construction workers is 16.3 per 1000. The prevalence is 42.9% (66) highest in Ulaanbaatar City, 20.1% (27) in Khan-Uul district, and 8.9% (12) in Khovd province. The prevalence per 1000 workers is 20 in Sukhbaatar, 15.7 in Dornogovi, 12 in Umnugovi, and 10.9 in Khovd, with a high prevalence of 1.07 in Ulaanbaatar. </br>2. Human factors, such as falling from a height due to noncompliance with safety rules, limited space in the workplace and environment, and falling into pits, wells, ditches, and excavated pits, are the leading causes of injuries and accidents. Closed fractures and head injuries are the most common.

Comparison study colonic polypectomy / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. There are a lot of studies done on colonic polypectomy around the world, and mostly diagnosis with dysplasia change, so we consider to chose to study this topic.@*Aim@#In this study, we aimed to compare the between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of removing colon polyps. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2022 and 2023, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colon polyps less than 5mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result@#The average age of the 81 cases included in the study was 57.9 years, and the male-female ratio was 1:1.2.149 cases (75.6%) of slightly elevated type 0-IIa according to the Paris classification, according to the morphological structure revealed by endoscopy, while 79 cases (75.6%) were tubular adenoma according to histological analysis. (38.9%), low grade dysplasia 52 (25.6%) and high grade dysplasia 3 (1.5%) cases are noteworthy. Average polyp was 5-9 mm. Most of polyps removed was left side of colon especially in sigmoid colon. Bleeding rate was higher in hot snare method 11.5%. (1/149, 0.7%, 5/52, 9.6%; P = 0.6). There was no recurrent rate and no perforation in our study. @*Conclusions@#In our study, average size of 5-9 mm were removed and slightly elevated (0-IIa), sessile (0-Is) type of polyps were commonly found in the sigmoid colon. There is a higher risk of bleeding due to mucosal damage in hot snare polypectomy. A combination of hot and cold methods is equally effective for resection of colon pollyps up to 1 cm in size.

Assessment of renal function in chronic hepatitis C patients / Монголын Анагаах Ухаан

Background@#The association between hepatitis C virus (HCV) infection and chronic kidney disease (CKD) still remains controversial. We aimed to investigate whether HCV really affects renal function, and to analyze the association between clinical effects of CHC and decreased kidney function (assessed by glomerular filtration rate (eGFR) level).@*Aim@#Study of renal dysfunction in chronic hepatitis C virus infection@*Materials and Methods@#An estimated 222 patients with HCV infection and 222 age- and sex-matched community-based control individuals without HCV were enrolled (1:1, case and control ratio) in this study between from June 2022 to March 2023. We used the modification of diet in renal diseases to calculate eGFR. This study was approved by the review board of the Ethics Subcommittee of Ach Medical University and followed the Declaration of Helsinki. All statistical analysis was performed with SPSS version 26.0 software (SPSS Inc., Chicago, IL, USA), and a P value < 0.05 was considered statistically significant. Continuous variebles were presented as mean ± standard deviation, while categorical data was represented as numbers and percentages. Independent t-tests were used to compare the differences in parametric variables. The Mann-Whitney U test was performed to compare the follow-up period. Pearson’s chi-squared and Fisher’s exact tests were used to compare categorical variables. Multivariate logistic regression was used to identify the risk factors associated with recurrence. @*Results@#The median age of the respondents was 40 (range 21-70). In the case group, the speed of hanging judgment was 105.3±24.5, and in the control group, it was 118.7±18.5, which was a statistically significant difference (p<0.05, p<0.05). It was observed that the rate of filtration of the renal is below 90 or the loss of renal function increases with age (47.50±9.3 vs 40.21±11.1; p<0.01). In order to reduce the effect of age, when evaluating the renal function of participants over 45 years of age in the case-control group, the HCV was 99.69 in the case group and 111.05 in the control group, although there was an age effect on the decline in HCV in both groups, but it decreased more in the HCV-infected group. When comparing two groups (<3.25, >3.25) with liver fibrosis degree above and below 3.25, the higher degree of fibrosis affects the decrease in the rate of hepatic filtration (112.92±19.8 vs 105.23±27.1; p<0.01). The proportion of cryoglobulinemia was high when renal dysfunction was beginning or when the GFR was below 90 (<90). Logistic regression analysis showed that cryoglobulinemia had the greatest influence on the decrease in glomerular filtration rate (OR 4.22, 95% CI 1.97-9.00, p<0.05). The relationship between age and the decline in hanging judgment speed was statistically significant and directly moderate (r=0.95, p=0.009). On the other hand, there is a statistical relationship between gender and the decrease in the speed of hanging judgment, with a probable and weak correlation (r=0.07, p=0.01).@*Conclusion@#Our study found that the patients with HCV infection are associated with a low eGFR compared with non-HCV–infected patients. This association is consistent in age, gender, cryoglobulinemia and liver fibrosis patients.

Health Impact Assessment of the Mining Industry / Монголын Анагаах Ухаан

@#Health impact assessment is a means of evidence-based policy-making for improvement in health. It is a combination of methods whose aim is to assess the health consequences to a population of a policy, project, or program that does not necessarily have health as its primary objective. It is described as being “the leading global network on best practice in the use of impact assessment for informed decision-making regarding policies, programs, plans and projects”. In recent years, much evidence was revealed that the mining, metal mining, and processing industry has a greatly impact on humans. Residing population has affected directly and indirectly influenced to the health and wellbeing of human. </br>The mining, metal mining and processing industries play an important role in the economic and social development of Mongolia. With the rapid development of the mining industry in Mongolia, environmental protection and environmental rehabilitation have become a priority. Currently, there are 27 laws governing environmental legal acts in our country, and chapter 3 of the Hygiene Law covers environmental and health impact assessment. As stated the implementation of the law shall be financed from the state and local budgets, the central state administrative organization and the Governor at the appropriate level shall order the relevant professional organizations to carry out environmental research and analysis work and to develop projects, and in addition to financing with budget funds, as well as conducting research with their funds for interested citizens, enterprises, and organizations were are arrangements to support the implementation of the laws and its regulation. </br>However, Within the scope of the Law on Environmental Protection and Detailed Environmental Impact Assessment Procedures, the negative impact on the environment is identified but in the area of health impact, it is a lack of information on how the activities are conducted, and health impact assessments are not conducted according to procedures and methods. Thus, there are need to conduct health impact assessments of the mining area and its affected population.

Lung cancer is a public health dilemma / Монголын Анагаах Ухаан

@#Lung cancer has the highest mortality rate in the world and is the most common cancer type in Asiancountries. In developed countries, new cases and lung cancer among women tend to increase, while in less developed countries, the death rate of this cancer is high and its prevalence is higher among males. </br>Moreover, in many studies conducted in recent years worldwide, a sample of the studies containing early detection, diagnosis, and treatment that can be implemented at the national level was translated and compiled. </br>Improvement of public health education, availability of health care services, an increase of human resource capacity, implementation of early detection programs among the public, and early detection with a reduced dose of KTG among the target group are expectations of the public health sector. </br>Special attention should be paid to issues such as reducing smoking among the people of Mongolia, immediately solving the problem of air pollution in central areas, assessing and reducing the risk factors of occupational diseases of mining workers, and introducing modern methods of treatment and diagnosis in health care services. The time has come to take multifaceted measures to prevent lung cancer, which has a high global disease burden and economic burden, with public participation.

Results of the study of citizens’ attitudes toward public health care and services / Монголын Анагаах Ухаан

Introduction@#Among the population of Mongolia, cardiovascular diseases (34.2%), cancer (24.3%), accidents and external causes (16.9%) are highly prevalent, and risk factors such as alcohol and tobacco use, unhealthy diet, lack of exercise have increased dramatically, and more than half of people aged 45-64, or 53.2% are at high risk of contracting non-communicable diseases. When comparing the demand for health care and services according to the level of healthcare institutions, it was determined that 70% of the demand is in the primary healthcare institution, 20% at the secondary level, and 10% at the tertiary level. Therefore, in order to prevent these diseases and provide health education to the population, it is necessary to study the attitude of the citizens who visit primary healthcare institutions about public health care and services.@*Material and Methods@#In this study, a cross-sectional research design was used to determine citizens’ attitudes toward public health care and services. In collecting data, a total of 291 people from each of Dornod and Khovd provinces, from the capital of provinces, and 3 soums were included in the target sampling method. When evaluating the attitudes of the respondents, they were rated on a scale of 1-5 for each question. 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 the 30th of June, 2022 (Decision #22/05/04).@*Results@#51% (148) of respondents rated their health status as good and 42.1% (122) rated it as moderate, and 57.6% (167) of all respondents answered that they visit the primary health center when they have symptoms. Also, the status of visiting a primary health center for prevention is better in the following groups: 45-54 age group, among people with complete secondary and higher education, and soum healthcare center. </br>The attitudes of the participants towards public health care and services were evaluated in 4 groups, which are the demand for organizing preventive measures, the dependence of health on the individual, and the dependence of health on social and economic conditions, with an average of 4 points which means the demand is great. In addition, the healthcare institution’s organization of measures to promote and prevent the health of citizens is an average of 3.87 points, and the general score of the respondents’ attitude is 3.98 points, which indicates that there is a great demand for public health care and services. @*Conclusions@#Despite the low number of visits to primary health centers for preventive purposes among the respondents, attitudes toward public health care and services were good.

A comparative study of cold snare and hot snare resection of colon polyps / Монголын Анагаах Ухаан

Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aimed to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy was performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2020 and 2022, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colonoscopy with a high-performance Olympus EVIS EXERA III brand NBI from Japan. In this study, we selected only hyperplastic polyps and adenomas <10 mm in size. Polyps less than 5 mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result @#According to the results of the study, in terms of age, the percentage of people having a polyp removed was relatively low among 15-39 year olds compared to the other age groups, while it was higher in those aged >65 years. In terms of body mass index, 75% of the total number of people who had a tumor removed were overweight, indicating that overweight or obese people are at higher risk of developing a colorectal polyps. In terms of gender, 63% of people who had a polyp removed were male, indicating a male predominance in polyp prevalence. The percentage of tumor questionnaires in the total study population was 0% or absent. Early detection of adenomas and hyperplastic polyps, which are precursors of tumor, is the main way to prevent the development of cancer. A slightly raised polyp was present in 53 or 79.1% of the polyps, while a broad-based polyp occurred in 13 or 19% of the polyps, indicating the predominance of the slightly raised polyp in the population. In terms of location, polyps occurred more often in the descending colon and the sigmoid colon, and complications (perforation, bleeding) related to the anatomical structure and location are more likely to occur in these parts of the colon. However, the likelihood of relapse is very low. The procedure time was 17.6 minutes on average, and in 14 cases, hemostatic clamps were placed to prevent the risk of bleeding, and in 5 cases, epinephrine was injected for hemostasis. Early detection of colorectal diseases (endoscopy), changes in the lifestyle of clients, and regular preventive examinations are the main factors to reduce the risk of cancer development, and early start of treatment as well as complete removal of adenoma, an antecedent to cancer, will have a significant impact on cancer prevention and mortality reduction.@*Conclusions@#</br>1. Left sided polyps were commonly diagnosed among study participants. </br>2. Correlation between the probability of recurrence and the anatomical location of the polyps was very low. </br>3. Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4–10mm colorectal polyps. Moreover, there was no significant difference between CSP and HSP in terms of overall complications.

Associated factors to lower renal glomerular filtration rate in chronic hepatitis C patients / Монголын Анагаах Ухаан

Introduction@#Studies have shown that hepatitis C virus (HCV) infection not only causes hepatitis, but also pathological changes in other organ systems. Therefore, it is necessary to study the relationship between chronic HCV and chronic kidney disease.@*Objective @#To determine the factors influencing renal glomerular function in chronic hepatitis C patients@*Materials and methods@#Patients with chronic hepatitis C virus were referred to Third Central Hospital, Tegsh Huslen Medical Center, two regional 2020 from August to October. Data on morbidity of patients with chronic hepatitis C were analyzed. The results were processed using SPSS-23 software. Statistical probabilities were determined by checking whether there were statistically significant differences between the groups, using logistic regression analysis and chi-square methods.@*Results @#There were 54 (46.9%) individuals whose renal glomerular filtration rate was reduced to less than 90 ml/min. In a linear regression analysis, a decrease in renal glomerular filtration rate with age was a significant correlation. Renal glomerular filtration rate is decreased in 37% patients by age-related manner (r2 = 0.37). To determine other causes, no significant correlations were observed when grouped by diabetes, cirrhosis, BMI, and hepatic steatosis (p>0.005). The older age of the patient and the high blood pressure were at 6.4 times higher risk to decrease the glomerular filtration rate in patients with chronic hepatitis C (OR 6.4 (95% CI 1.3-31.4), p=0.021) than the patients who have young age and normal blood pressure by multiple logistic regression analysis.@*Conclusion@#The age of the patient and high blood pressure are contributing factors to the decline in the incidence of low glomerular filtration rate in patients with chronic hepatitis C.

A comparative study of the complications between hot snare and cold snare polypectomy / Монголын Анагаах Ухаан

@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aim to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy will be performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This will help us to investigate which of the two methods is most prevalent for polypectomy.

Assessment of secondary school indoor air quality / Монголын Анагаах Ухаан

Introduction@#During this pandemic, overcrowding in classroom caused by a lack of educational facilities and poor indoor air quality are the main causes of respiratory diseases among children and adolescents. Therefore, it is essential to measure and assess the indoor air quality where children spend extended periods of time such as school. @*Materials and methods@#This study covered four schools with old buildings and four schools with new buildings in Bayanzurkh, Sukhbaatar, Khan-Uul, Chingeltei district of Ulaanbaatar. We collected PM10 and PM2.5, carbon dioxide, air temperature, humidity, and microbiological count from chosen classrooms and compared to the MNS4585:2016 standard. SPSS-24 was used to do statistical analysis on the information gathered during the evaluation.@*Results and Discussion@#The 24-hour average PM2.5 concentration was 64.3 (95% CI: 64.1-64.5) mcg/m3, which was 4.3 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016 standard. The 24-hour average PM10 concentration was 85.3 (95 % CI: 85.1-85.6) mcg/m3, which is 1.9 times higher than WHO guideline value. In older school buildings, the 24-hour average PM2.5 concentration was 5.6 times higher than the WHO guideline value and 1.7 times higher than the MNS4585:2016; the average PM10 concentration was 2.8 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016. The air temperature and carbon dioxide concentration in classroom was met the MNS4585: 2016. The average relative humidity of all schools is 24.2±6.5%, which is 14-16% lower than the MNS4585: 2016. @*Conclusion@#The indoor air quality of the school in new and old buildings was similar poor, therefore a variety of steps are needed to improve it.

Determination of concentrations of indoor air pollutants emitted from briquette combustion / Монголын Анагаах Ухаан

Introduction@#This field assessment was performed to ensure the effective implementation of Order No. A/142 of the Deputy Prime Minister of Mongolia dated 30^th December 2021 and Order No. A/01 of the Head of the National Committee for Reducing Environmental Pollution dated 3^rd January 2022 and to monitor the level of indoor air pollutants emitted from traditional stoves and standard stoves. @*Purpose@#To determine the level of indoor air pollutants emitted from briquette combustion and to develop recommendations by comparing various types of stoves and dwellings. @*Materials and Methods@#Through analytical cross-sectional designs, three households from Songinokhairkhan district and one household from Chingeltei district were selected to participate in this assessment as they use briquettes for heating, vary in their dwelling types (ger (traditional Mongolian tent), house) and their stove types (traditional, standard), stay home during the day and chose to participate in the assessment. 24-hour continuous measurements were conducted for each dwelling and before taking measurements, we calibrated and adjusted the air suction velocity of the measuring instrument at the Central Metrology Laboratory. The monitor was placed at a distance of 0.5m from the stove and a height of 0.5-1.0m from the floor. The results were then compared with the Mongolian National Standard “General air quality and technical requirements MNS4585:2016” and WHO Guidelines for Indoor Air Quality 2021. Statistical analysis was performed using SPSS 24.0 software, mean, ANOVA test, and if the p-value is less than 0.05, our results are statistically significant.@*Results@#The concentration level of SO₂ in houses with “Dul” stoves was within the level specified in the Mongolian standard MNS4585: 2016 and WHO Guidelines for Indoor Air Quality 2021, while 24-hour SO₂ concentration in gers and houses with traditional stoves was 1.3-2.92 times higher than the standards. The 24-hour average concentration of nitrogen dioxide in houses with traditional stoves was 1.73 times higher than the Mongolian air quality standard MNS4585: 2016. There were statistically significant differences in the emission levels of SO₂ and NO₂ depending on dwelling and stove types (df=4, f=4.04, p=0.008 and df=4, f=17.17, p=0.001, respectively.). The 8-hour average (10,000 μg/m3) CO concentration was statistically significant for various types of dwellings and stoves (df=4, f=45.17, p=0.001), whereas there was a statistically significant difference in CO concentrations in gers with traditional stoves and gers with standard stoves in terms of morning, afternoon, and evening hours (df=3, f=33.17, p=0.001). @*Conclusion@#Indoor air pollutants in the households except for houses with “Dul” stoves have been determined to exceed the air quality standards set by the Mongolian air quality standards and WHO Guidelines for Indoor Air Quality 2021.

Some results of the study on knowledge, attitudes and practices of risk factors for non-communicable diseases among graduate students of secondary school / Монголын Анагаах Ухаан

Introduction@#Globally, deaths from NCDs increased by 15% between 2010 and 2020 (44 million deaths), with an estimated 10.4 million deaths in Southeast Asia (WHO, 2020). </br> In this regard, a research was conducted to assess the knowledge, attitudes and practices of graduate students of secondary school about risk factors for non-communicable diseases. @*Purpose@#To assess the knowledge, attitude and practice of secondary school graduate students of the about the risk factors for non-communicable diseases.@*Material and Method@#In the research, one school from the rural and four school from the urban settings were selected in the Ulaanbaatar city using a purposive deliberate sampling method. A total of 350 students were involved. The information was examined using questionnaires with 4 chapters and 65 questions, which were specifically designed to knowledge, attitudes and practice regarding risk factors for non-communicable diseases. </br>The research was discussed and approved at the meeting of the Ethics Subcommittee of the “Ach” University on April 13, 2021. After providing detailed information about the research through the “Introductory Permit Form”, we contacted with the social worker in charge of the high school students to obtain permission to include students in the research and received formal confirmation via Gmail. @*Result@#30.3 percent of the respondents said that they allow smoking in the ger, but 18.9 percent do not. 42% of the respondents said that the reason for not eating fruits and vegetables is that they are expensive and do not believe in the quality of imported fruits and vegetables, while 77.8 % have a negative habit of adding salt to their food. 29.4% do not know how to be active, 29.4% do not like to be active, when asking how many hours a day do you exercise, 46.6 percent answered 15 minutes, 37.4 percent 30 minutes, 8.9 percent 45 minutes and 6.4 percent 60 minutes. When answering a question to clarify knowledge about the use of the Internet, 50.9% percent said it was 1-2 hours, 6.4 percent - 30-45 minutes and when asking to find out how much time they use the Internet per day, 35.4% said 3-4 hours, 30% answered 5-6 hours, which have a negative habit.@*Conclusion@#</br>1. 80% of students involved in the research have sufficient knowledge about the risk factors for NCDs. </br>2. 70% have a positive attitude towards risk factors for NCDs. </br>3. 60% lead a healthy behavior, but the remaining 40% need to be developed and habituate healthy behaviors and practice.

The comparison of ambient air quality with raw coal and improved fuel consumption, Ulaanbaatar, 2018-2020 / Монголын Анагаах Ухаан

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.

Distribution of tick-borne diseases at Bulgan province, Mongolia / Монголын Анагаах Ухаан

Background@#Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2]. </br>In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3]. </br>Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5]. </br>During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD. </br>Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province. </br>Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. @*Purpose @#Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections.@*Material and Method@#Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens. </br>Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites.@*Result and conclusion@#Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis. </br>Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province. </br>247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%). </br>By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

Incidence of type 1 and type 2 diabetes among children 0-19 of age in 2014-2020 in Mongolia / Монголын Анагаах Ухаан

Background@#Diabetes mellitus prevalence increased year to years in Mongolia similar to other countries. Prevalence of Type 1 and type 2 diabetes is increasing showed many literature sorces (M. Lönnrot et al, 2000; H.Viskari et al, 2005; Francesco Dotta et al, 2007; Shoichiro Tanaka et al, 2009; Lars C. Stene et al, 2010; Wing-ChiG Yeung et, 2011; Maarit Oikarinen Sisko Tauriainen et, 2012; Teresa Rodriguez-Calvo et, 2015).</br> Several studies on prevalence, risk factors and complications of type 2 diabetes have been conducted in Mongolia (J.Suvdaa, 1988; Kh.Altaisaikhan, 2002; Bayarchimeg B, 2004; U.Tsolmon, 2005; Myagmartseren D., 2009; Sainbileg S., 2011; Erdenechimeg D., 2012; Enkhjaragal Ya., 2012; Otgonbayar D., 2015). </br> Currently, there is no conducted study on incidence of type 1 and type 2 diabetes among children and youth in Mongolia. @*Goal @#To study of incidence of type 1 and type 2 diabetes among children and youth@*Material and Method@#We used to data from Health Development Center and calculated incidence of 1 and type 2 diabetes among children 0-19 years of age per 10000 populations. This study methodology approved Research ethics committee of “Ach” Medical University (2019-6-24, Decision #19/02/04). @*Result @#Incidence in aimag level were in 2014-2020 0-4 year age group 0,00 (2016, 2017)-0.20 (2020); 5-9 age group 0,00 (2015, 2016)-0.32 (2017), 10-14 age group 0,22 (2015, 2016)-0,83 (2020); and 15-19 age group 0,13 (2015)-1,02 (2019). </br> In Ulaanbaatar 2014-2020: 0-4 age group 0,00(2015, 2016)-0.33 (2019); 5-9 age group 0,00(2015)- 0.74 (2019); 10-14 age group 0,00 (2015, 2016)-1,91(2019); and 15-19 age group 0,34(2017)- 1.41(2019).@*Type 2 diabetes in 2014-2020@#In aimag level (rural): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2018, 2020)-0.05 (2019); 5-9 age group 0.00 (2016, 2018, 2020)-0.16 (2017); 10-14 age group 0.00(2019)-0.12(2020); 15-19 age group 0.07 (2015)-0.43(2019). </br> In Ulaanbaatar (Urban): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2019, 2020)-0.11 (2018); 5-9 age group 0.00 (2014, 2015, 2016, 2018, 2020)-0.07 (2017); 10-14 age group 0.00(2014, 2016, 2018)-0.58(2019) and 15-19 age group 0.11 (2015)-1,52(2019) per 10000 pop.@*Conclusion@#Type 1 diabetes incidence in l increased in regard to age of children, there is little differences between rural and urban area but in last 2 years there is noted increasing. Type 1 diabetes incidence in 2014- 2018 more than the incidence of type 2 diabetes, in 2019-2020 among 15-19 age group increased especially in Ulaanbaatar.

Incidence and mortality of stroke in Ulaanbaatar and its last 20 years’ trend / Монголын Анагаах Ухаан

Background@#Globally the incidence of stroke is not decreasing, and the deaths and disabilities caused by stroke is increasing every year, especially in low and low-middle income countries.</br> Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance.</br> Having reliable data on stroke morbidity and mortality, as well as periodic identification of long-term trends will be important information for proper prevention planning in the population, monitoring the disease and further improving the quality of health care. @*Material and Method@#A prospective cohort study has been conducted in adult citizens (972409 in 2019, 925367 in 2020) of 6 districts of Ulaanbaatar from the 1st of January, 2019 to 31st of December, 2020. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and some private hospitals. Information of stroke death was obtained from forensic institute and state registration office of the capital city.</br> The trends of stroke incidence and mortality was compared to data between 1998-1999 and 2019- 2020 in UB. @*Results@#The age-standardized crude incidence rate per 100.000 person-years of stroke were 209.0/100.000 (n=1934) in 2019 and 194.0/100.000 (n=1821) in 2020 among adults of UB city. The above results were compared to 1998-1999 studies and the incidence rate declined by 94.0/100.000 in 2019-2020, whereas mortality rate increased by 10.0/100.000 in women aged 16-34. Stroke mortality was 11.6% in 1998 and 26.5% in 1999, while in our study it was 33.87% in 2019 and 29.71% in 2020. Although the incidence of stroke rates has decreased in 1998-1999, the mortality rate has not decreased significantly. @*Conclusion@#Morbidity and mortality rates among the population of Ulaanbaatar citizen remain highest in the world, compared to 20 years ago with overall morbidity declining but mortality has not decreased. </br> In recent years, the Government of Mongolia has been focused on reducing non-communicable diseases, but the primary and secondary prevention and control of stroke in the general population, as well as the acquisition of knowledge attitudes, practices and access to health care still need to be improved.

Risk factors for noncommunicable diseases and adolescents / Монголын Анагаах Ухаан

@#More than 150 million young people worldwide smoke; 81% of adolescents do not get enough exercise; 11.7% of adolescents drink alcohol and 41 million children under the age of 5 are overweight or obese. There were read and reviewed the 2011 and 2019 international and domestic literatures on prevalence and risk factors for non-communicable diseases among adolescents. We tried to summarise the risk factors for noncomminiable disease among adolescents.

Relationship between meteorological parameters and some intestinal infectious diseases / Монголын Анагаах Ухаан

Introduction@#Mongolia is one of the most vulnerable countries to climate change due to its geographical location, climate conditions, level of development and lifestyle of the population.</br> The “Impact of Climate Change on Drinking Water, Health and Adaptability” study report has shown that climate change is affecting the quality and composition of drinking water, drying up many rivers and lakes and reducing groundwater levels.</br> There was a strong positive correlation between precipitation and air temperature and dysentery, diarrhea and salmonellosis, while there was a strong negative correlation between precipitation, air temperature and viral hepatitis. @*Goal@#The goal of the study was to reveal correlation between meteorology parameters and some intestinal infectious diseases and human health in Mongolia.@*Material and Methods@#We evaluated climate and certain morbidity (intestinal infections) indicators for the last 15 years (2005-2019) using descriptive survey methods. The methodology of the survey has developed and discussed at the Scientific Council meeting of NCPH, 12th of Oct, 2020. The methodology of the survey has developed and discussed at Medical Ethics Reviews Committee of MOH on 23rd. of June, 2021.@*Results@#On the other hand, the average air temperature has intensively risen for the last three decades since 1990 with the warmest average temperature between 2001-2010, whereas the coldest average temperature has been observed between 1951-1960. In 2005-2009, the prevalence of intestinal infections per 10.000 population was 0.8 cases of salmonellosis, 11.2 cases of dysentery, 0.2 cases of diarrhea, and 39.0 instances of hepatitis A. Throughout 2015 and 2019, the prevalence of salmonellosis fell by 0.1 per 10.000 population, dysentery by 2.9, diarrhea by 0.1, and hepatitis A by 0.1.@*Conclusion@#A seasonal trend in intestinal infections was observed (p<0.001). Strong positive correlation was found between high temperature and some intestinal infections (hepatitis А, dysentery, salmonellosis) respectively.

Carbon monoxide poisoning, 2016-2020, Mongolia / Монголын Анагаах Ухаан

Rationale@#Carbon monoxide (CO) is a colorless, odorless gas produced by carbon-containing substances, most commonly incomplete fuel and biomass combustion. Carbon monoxide deprives the human body of oxygen, leads to severe poisoning and death. In 2017, there were 137 new cases of carbon monoxide poisoning per 1,000,000 people worldwide, and 4.6 deaths per 1,000,000. The global incidence of carbon monoxide poisoning has remained steady over the previous 25 years, while mortality has decreased by 36-40%. Every year in Mongolia, 700-840 persons are hospitalized for carbon monoxide poisoning. Also, there has been a lack of study into the prevalence and causes of carbon monoxide poisoning and death.@*Goal@#Study the dynamics of morbidity and mortality cases caused by carbon monoxide poisoning in Mongolia.@*Objectives@#</br> To analyze the carbon monoxide poisoning morbidity recorded in Mongolia between 2016-2020. </br> To analyze the carbon monoxide poisoning mortality reported in Mongolia between 2016-2020.@*Material and Methods@#The survey was conducted utilizing data from outpatient and inpatient poisoning and deaths reported in 2016-2020 with the goal of studying carbon monoxide poisoning and mortality in Mongolia. Workplace exposure poisoning was excluded from quantitative data on carbon monoxide poisoning (fires, suicidal, accidental and domestic explosions, accidents, external effects).The statistics analysis was performed using 23 versions of the SPSS program, to estimate a distribution of new cases and fatalities per 10,000 population depended on age, sex, average number of hospital days, and standard error. ArcGIS version 10.8 was used to map the locations.@*Results@#Acute carbon monoxide poisoning. Carbon monoxide poisoning was 0.01-0.31 cases per 10,000 population during 2016 and 2018. Between 2019 and 2020, it increased to 1.5-1.9 cases per 10,000 population, with up to 37% of those admitted to hospitals. In the last five years, carbon monoxiderelated deaths have been reported in 0.1-0.3 cases per 10,000 population. The amount of hours firing of the households increases every year in September, when the colder season begins. Incidences of death and intentional poisoning were reported in Arkhangai, Uvurkhangai, Khuvsgulaimags, and Ulaanbaatar. The average age of poisoning patients admitted to the hospital was 33 ± 19.5 years old (minimum 2 months, maximum 81). In terms of gender, women registered for 58.4 (734) percent of all cases. The average number of days spent in the hospital was 3.4± 3.7 days.</br> Carbon monoxide poisoning-related mortality. During the previous five years (2016-2020), 353 people died in Mongolia as a result of carbon monoxide poisoning, although 1.4 percent, or five people, died in hospitals, one case in Bayan-Ulgii, Zavkhan, and Uvs aimags, and two cases in Ulaanbaatar. However, 98.6 percent of them died prematurely at home or in poisoned places due to a lack of access to health care. The average age of carbon monoxide poisoning deaths cases was 35 ± 19.9 years old, and 71.7 (253) percent were male. The Ulaanbaatar, Selenge, Uvs, and Dornod aimags had the lowest death rate of 0.08-0.21 per 10,000 population, while Khuvsgul and Arkhangai aimags had the highest death rate of 0.96-1.57 per 10,000 population.@*Conclusions@#Carbon monoxide poisoning among the population rises during the winter season, however, in the previous five years, 96.5 percent of cases have been poisoned accidentally, particularly 82.6 (1035) percent of cases reported in Ulaanbaatar. According to socioeconomic factors, 41.6 (529) of the cases were male, with an average age of 36.5±15.4 years.</br> During the preceding five years, carbon monoxide-related mortality in Mongolia was between 0.2 per 10,000 people. Without medical attention, 99.2% of cases died at the exposed location or area. The death rate in Khuvsgul aimags was low, whereas it was high in Ulaanbaatar city. The average age of premature deaths was 35±19.9 years, and 71.7 (253) percent were male.