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Abstract In Japan, Mongolia, and Indonesia, dialysis care has been covered by national health insurance and social welfare programs as of 2022, which covers much of the cost burden. However, the proportion of this burden varies by country and Japan is the only one of these countries in which medical fees are fully covered for all dialysis patients. As systems for dialysis medical care coverage have been established, the number of dialysis patients has increased dramatically in each country. However, the cost of dialysis treatment itself is very high relative to personal income in all countries. This puts pressure on national healthcare budgets and gives rise to concerns about the sustainability of dialysis care in the future. Peritoneal dialysis (PD) is less expensive than hemodialysis (HD) in Mongolia and Indonesia, and a PD-first policy is considered effective in reducing costs. Nevertheless, an overwhelming number of patients still undergo HD. Despite the difficulties faced by these three countries in obtaining funds for dialysis treatment, among Asian countries, Mongolia and Indonesia are considered to have relatively advanced healthcare systems. It is considered that there has been progress in the provision of dialysis treatment subsidies to the citizens of these countries.

This study examines the reliability and validity of a Mongolian version of the Student Online Learning Readiness (SOLR) instrument in the Mongolian context. The instrument consists of 20 items used to evaluate technical competencies, social competencies with instructor, social competencies with classmates, and communication competencies. One thousand seven hundred and eight-six undergraduate students at the National University of Mongolia in Ulaanbaatar, Mongolia, participated in this study. Data were randomly split into two groups. The four-factor structure of the SOLR instrument explained 69.355% of the variance in the pattern of relationships among the items in the first half-sample. All four competencies had high reliabilities (all Cronbach's alpha values were 0.84 or higher). The validity of the four-factor structure of the Mongolian-language version of the SOLR model was confirmed with the deletion of one item that cross-loaded on multiple factors. Confirmatory factor analysis confirmed the validity of the hypothesised model of the 19-item structure of the Mongolian-language version of the SOLR instrument using the second half-sample.

Globally, the most common infectious cause of death among children 1-59 months of age is lower respiratory tract infection (1). Despite vaccine availability, Streptococcus pneumoniae causes a substantial proportion of [...]

We consider a continuous-time model of optimal consumption and pension insurance for a consumer with an uncertain lifetime. In the model, the consumer earns a stochastic wage income during her working life and optimally allocates her income between personal consumption, pension insurance, and securities with a deterministic dynamic return. Due to the weak development of the stock market in developing countries, employees' income comes mainly from wages and interest on savings from banks, that are discussed in this paper. The consumer's utility and bequest functions are constant absolute risk aversion (CARA). By characterizing the optimality condition of the consumer's problem using the Hamilton-Jacobi-Bellman equation, we find the optimal consumption and pension insurance as a function of wealth in closed form. We consider an application of the model while estimating its key elements using real-life data on age-specific population size, labor income, and interest rates. We show that as the absolute risk aversion for consumption increases, consumption and wealth move in the opposite direction. We also present a novel finding that wealth and consumption can be negatively related across consumers with different levels of consumption risk aversion.

Background/purpose: Oral health is related to general health and a person’s overall well-being. The aim of the present study was to explore the association between oral health status and bite force among young adults. Materials and methods: Maximum bite force (MBF) was measured using Dental Prescale II in conjunction with a pressure-sensitive film and bite force analyzer in 40 young adults aged 20 to 40. Supragingival dental plaque was collected and cultured. Plaque weight, pH, and colony counts were assessed. The decayed, missing, and filled teeth index (DMFT) and body mass index (BMI) were recorded. Results: Bite force was negatively correlated with the number of missing teeth and the sum of missing and filled teeth. When the filled-to-remaining-teeth ratio (F/R ratio) was less than 8%, the bite force was significantly higher compared to an F/R ratio of 8–25%. Additionally, the amount of total bacteria was positively correlated with total bite force, and the quantity of Streptococcus mutans (S. mutans) along with total bacteria was positively correlated with bite force in the molar region (∗P

BackgroundMicrovascular resistance reserve (MRR) is a recently introduced specific index of coronary microcirculation. MRR calculation can utilize parameters deriving from coronary flow reserve (CFR) assessment, provided that intracoronary pressure data are also available. The previously proposed pressure-bounded CFR (CFRpb) defines the possible CFR interval on the basis of resting and hyperemic pressure gradients in the epicardial vessel, however, its correlation to the Doppler wire measurement was reported to be rather poor without the correction for hydrostatic pressure.PurposeWe aimed to determine the pressure-bounded coronary MRR interval with hydrostatic pressure correction according to the previously established equations of CFRpb adapted for the MRR concept. Furthermore, we also aimed to design a prediction model using the actual MRR value within the pressure-bounded interval and validate the results against the gold-standard Doppler wire technique.MethodsHydrostatic pressure between the tip of the catheter and the sensor of the pressure wire was calculated by height difference measurement from a lateral angiographic view. In the derivation cohort the pressure-bounded MRR interval (between MRRpbmin and MRRpbmax) was determined solely from hydrostatic pressure-corrected intracoronary pressure data. The actual MRR was calculated by simple hemodynamic equations incorporating the anatomical data of the three-dimensionally reconstructed coronary artery (MRRp−3D). These results were analyzed by regression analyses to find relations between the MRRpb bounds and the actual MRRp−3D.ResultsIn the derivation cohort of 23 measurements, linear regression analysis showed a tight relation between MRRpbmax and MRRp−3D (r2 = 0.74, p

We present the first comprehensive review of 62 migratory shorebird species in Mongolia, covering their ecological status, IUCN assessments at regional or national levels, population trends, threats, and conservation measures. Mongolia hosts a total of 62 shorebird species from twenty-two genera and seven families, with six species classified as globally threatened: the Critically Endangered Sociable Lapwing, the Endangered Siberian Sandplover, the Far Eastern Curlew, the Great Knot, and the Vulnerable Sharp-Tailed Sandpiper. Both national and global IUCN Red List assessments highlight Mongolia’s significance as a breeding and passage migrating site for globally threatened and Near-Threatened shorebirds. Species richness is higher in northern regions compared to the south, with the highest diversity found in areas with complex aquatic ecosystems. Global population trends indicate a decline in 61% of species, with 18% remaining stable, 16% of unknown status, and 5% increasing. At the national level, most species are stable (61%), 34% status is unknown, and 5% are decreasing. Anthropogenic-induced threats, including habitat loss and degradation, pollution, disturbance, and harvesting, pose significant risks to 69% of species, while natural disasters affect 11%. Additionally, 8% of species are impacted by accidental mortality and intrinsic factors, and 5% by changes in native species. Despite these threats, no specific conservation action plans exist for shorebirds in Mongolia. However, general conservation measures are in place, such as environmental and fauna protection laws, regulations on foreign trade in endangered species, and the establishment of protected areas under governmental resolutions. Mongolia also participates in international conventions like the Convention on Biological Diversity (CBD), Ramsar, and Migratory Species (CMS), and has developed national red lists, red books, and publications such as “A Summary Conservation Action Plan for Mongolian Birds”, “Important Bird Areas” to support conservation efforts.

Assessing the impact of floods on crop cultivation is critical for ensuring food security and resilience in flood-prone regions. This study relied on cloud-free imagery from Landsat to construct six vegetation indices. These indices were used to conduct a comparative analysis of the flood disaster of 2022 in Pakistan. A random forest classifier was employed on pre-flood images to identify agricultural zones. A model was developed using two indices, Brightness (DBSI) and Wetness (TCW), along with the vegetative index of crop vigor (MSAVI), during the pre-flood months of 2021. The model’s accuracy was validated and exhibited an RMSE of 0.03 in predicting MSAVI values. The model was used to forecast MSAVI during post-flood periods. Spatial analysis identified approximately 30-47% of the study area as ‘Suitable’ and 46-64% as 'Highly suitable’ for early recultivation of Rabi Crops. The approach helps in planning for fast agricultural recovery in the aftermath of floods.

Background: The COVID-19 pandemic has grown to be a serious issue on a global scale. Dental care is one of the industries affected by COVID-19. The surveillance utilizing lifetime data, however, is still not clear. The purpose of this study was to use Google Trends (GT) analysis to examine symptom trends and challenges during the COVID-19 outbreak in Indonesia. Methods: Covid-19 cases retrieve from Our World in Data. The cases were collected between 1 April 2021-30 September 2021. The GT was used to discover Indonesian relative search volume (RSVs) covering the timeframe of the first outbreak covid-19 pandemic in Indonesia on 1 March 2020 until 13 February 2022. The duration of the search was chosen to reflect the relative popularity of the keywords 'symptoms and dentistry practice challenge-related terms' and 'coronavirus'. Results: We observed that there was a significant and positive correlation between the COVID-19 daily case using GT RSV data and the COVID-19 case from Our World in Data. The COVID-19 daily case had a strong correlation with search terms related to symptoms (such as fever, sore throat, flu, toothache, and cough), drugs (such as ibuprofen, paracetamol, demacolin, bodrex, and antibiotic), and health management (such as self-isolation and telemedicine). Conclusion: Using GT may be helpful to observe the current symptoms trends as well as its challenge tendencies as a surveillance tool for a continuing pandemic like COVID-19. GT should be considered and used as it has the potential to be a powerful digital epidemiology tool that can provide more insight into disease dynamics.

Mongolia, situated in central Asia and bordered by Russia to the north and China to the south, experiences a semi-arid climate across most of its territory. Grasslands are pivotal in Mongolia’s agricultural sustainability and food security, facing rapid changes in the last two decades that underscore the ongoing need for innovative approaches to assess vegetation conditions. This study aims to evaluate grassland biomass measurement and prediction through the analysis of high-resolution satellite data. By conducting a time series assessment of grazing-induced changes in vegetation dynamics at the long-term monitoring sites of the Botanic Garden and Research Institute, Mongolian Academy of Sciences, we seek to refine our understanding. The investigation covers biomass estimation across various Mongolian grassland landscapes, encompassing desert, steppe, and mountain regions. Spanning the grassland growing season from May 2020 to October 2023, the research leveraged diverse ground data types, including surface reflectance measurements, geographic coordinates for satellite data correction, and aboveground dry biomass. These components were instrumental in developing a biomass estimation model reliant on establishing correlations between the satellite-derived Normalized Difference Vegetation Index and biomass. The predicted biomass facilitated the time series map analysis and dynamic analysis. The PlanetScope surface reflectance correlates strongly at 0.97 with field measurements, indicating robust relations. Biomass and the Normalized Difference Vegetation Index show correlations of 0.82 for dry grassland, 0.80 for mountain grassland, and 0.65 for desert grassland, with a combined correlation coefficient of 0.62, revealing distinct characteristics across these grasslands. Time series dynamic analysis reveals rising biomass differences between grazed and ungrazed areas, suggesting potential grassland degradation. Variations in the slope coefficient of biomass differences among grassland types indicate differing degradation patterns, emphasizing the need for effective grazing management practices to sustain and conserve Mongolian grasslands. This highlights the potential of remote sensing in monitoring and managing grassland ecosystems.

Background: The COVID-19 pandemic has grown to be a serious issue on a global scale. Dental care is one of the industries affected by COVID-19. The surveillance utilizing lifetime data, however, is still not clear. The purpose of this study was to use Google Trends (GT) analysis to examine symptom trends and challenges during the COVID-19 outbreak in Indonesia. Methods: Covid-19 cases retrieve from Our World in Data. The cases were collected between 1 April 2021-30 September 2021. The GT was used to discover Indonesian relative search volume (RSVs) covering the timeframe of the first outbreak covid-19 pandemic in Indonesia on 1 March 2020 until 13 February 2022. The duration of the search was chosen to reflect the relative popularity of the keywords 'symptoms and dentistry practice challenge-related terms' and 'coronavirus'. Results: We observed that there was a significant and positive correlation between the COVID-19 daily case using GT RSV data and the COVID-19 case from Our World in Data. The COVID-19 daily case had a strong correlation with search terms related to symptoms (such as fever, sore throat, flu, toothache, and cough), drugs (such as ibuprofen, paracetamol, demacolin, bodrex, and antibiotic), and health management (such as self-isolation and telemedicine). Conclusion: Using GT may be helpful to observe the current symptoms trends as well as its challenge tendencies as a surveillance tool for a continuing pandemic like COVID-19. GT should be considered and used as it has the potential to be a powerful digital epidemiology tool that can provide more insight into disease dynamics.

Abstract Herein, we theoretically demonstrate that simple metal (Ga and Al) substitutional atoms, rather than the conventional transition metal substitutional elements, not only stabilize the ThMn12-type SmFe12 and Sm(Fe,Co)12 phases thermodynamically but also further improve their intrinsic magnetic properties such that they are superior to those of the widely investigated SmFe11Ti and Sm(Fe,Co)11Ti magnets, and even to the state-of-the-art permanent magnet Nd2Fe14B. More specifically, the quaternary Sm(Fe,Co,Al)12 phase has the highest uniaxial magnetocrystalline anisotropy (MCA) of about 8 MJ m−3, anisotropy field of 18.2 T, and hardness parameter of 2.8 at room temperature and a Curie temperature of 764 K. Simultaneously, the Al and Ga substitutional atoms improve the single-domain size of the Sm(Fe,Co)12 grains by nearly a factor of two. Numerical results of MCA and MCA-driven hard magnetic properties can be described by the strong spin-orbit coupling and orbital angular momentum of the Sm 4f-electron orbitals.

Background: Medicine-related problems are common in older people living in residential aged care facilities (RACFs). Recognising the significant medicine-related problems, the Australian government has announced a $345 million funding package to employ on-site pharmacists in RACFs starting in 2023. The new on-site pharmacists are to provide a range of clinical services to reduce medicine-related adverse events, promote quality use of medicines, and improve clinical governance and education. Underpinning these services, the authors argue that pharmacists play the critical role as resident advocates. Objective: This study aims to demonstrate how pharmacists can enhance their advocacy responsibility within and beyond the clinical environment to not only reduce medicine-related adverse events but also improve residents' overall health and quality of life. Methods: This study uses a case series methodology to demonstrate pharmacists' diverse roles in advocating for residents and their families. The case studies were based on participants enrolled in the Reducing Medicine-Induced Deterioration and Adverse Reactions (ReMInDAR) trial, a randomised controlled trial testing the effects of a regular pharmacist service across the Australian RACFs. Results: Pharmacists' advocacy ranged from persistence in follow-up with a resident's general practitioner (GP) to ensure the GP was aware that a patient was experiencing bleeding and bruising while on an anticoagulant, to advocating for a new bed for a resident with peripheral oedema who had been sleeping in his chair due to fear of falling out of his current bed. Conclusions: Our trial focussed on pharmacists serving as the residents' advocate to improve their overall health and quality of life, rather than just addressing a list of medicine-related problems. The pharmacist model used in the ReMInDAR trial supports pharmacists to work to their full scope of practice, helps guide the Australian government's new on-site pharmacist program, and serves as an exemplar pharmacist in aged care model internationally.

No abstract in English

Objectives: Needlestick and sharps injuries are a major cause of transmission of blood borne pathogens in health-care workers. The present study aims to examine the yearly incidence and causes of sharps injuries and assess the prevalence of blood-borne infection in provincial healthcare workers in Mongolia. Methods: A cross-sectional study enrolling 21 province hospitals across Mongolia was conducted from 2015 to 2019. Descriptive data presented as absolute numbers with percentage and a multivariate analysis was employed to identify the association between risk factors and occupational exposure to blood-borne factors. Results: Of the 20546 health care workers, 12.5% (n = 2566) employees were infected with hepatitis. Approximately 4.4% were infected with hepatitis B; 7.5% with hepatitis C; and 0.6% with hepatitis B, C or B, D. Among health care workers detected with hospital-acquired infection, most were women (n = 84.1%), aged between 41-55 years old (58.9%). Having sharp needlestick injuries, blood and body liquids splash, and a dental service was found to be associated with hospital-acquire infection in the study. Conclusion: Our study results demonstrated that 12 out of 100 health care workers were infected with HAI in Mongolia. This indicates that there be might serious occupational hazards. Public health authorities should consider increasing provision of public health programs such as vaccination, safety equipment and adjusted workload. Health care workers in Mongolia should be informed about the risks and consequences, as well as undertake preventive measures.

We conducted qualitative research exploring the treatment experience of people with DR-TB. We held nine focus group discussions with 57 adults undergoing/recently completed treatment for DR-TB in Georgia, Mongolia and South Africa. Translated transcripts were analysed using thematic analysis. We identified three higher order themes: (1) Treatment experience and the role of good relationships with healthcare providers: Treatment duration, pill burden and side-effects were challenging aspects of treatment. Side-effects/symptoms that were visible signs of illness were particularly troubling. Good relations with clinical staff helped combat fear and uncertainty regarding treatment. (2) Mental distress and opportunities for wellbeing: The shame, stigma and isolation people experienced as a result of their DR-TB diagnosis was an important cause of mental distress. No longer being infectious enabled people to resume work and socialising. Positive emotions emerged with good treatment outcomes. (3) Fear and worry along the treatment journey: Participants expressed fears about TB: infecting others; whether they would be able to endure treatment; side-effects; health consequences of treatment. Worries mostly disappeared with successful treatment. Alongside measuring side-effects, time to culture conversion and cure rates, future trials of DR-TB treatments should capture how quickly visible symptoms resolve, quality of life measures, and mental health outcomes.

ObjectivesLarge population-based studies examining frailty trajectory found a linear increase in frailty over time. The pattern in which frailty changes over time for an individual person is less well-described. We examined the frailty trajectory of older adults living in aged-care in Australia.Materials and methodsThis secondary study used data from a randomised controlled trial involving 39 aged-care facilities in Australia. The trial intervention was an on-going pharmacist-led intervention occurring every 8 weeks over 12 months aimed at preventing medicine-induced deterioration and adverse reactions. Frailty was assessed using the Frailty Index. Participants were categorised as non-frail, pre-frail and frail. Individual frailty trajectory over 12 months was visualised using the alluvial plot. Case notes were examined to explore reasons for any rapid transitions in frailty status.ResultsA total of 248 participants was included. At baseline, 40.3% were non-frail and 59.7% were pre-frail. The proportion of participants who were non-frail and pre-frail decreased over time; 15.7% were frail at 6 months and 23.4% were frail at 12 months. Overall, twenty different combinations of frailty transitions were identified over 12 months. Retrospective analysis of case notes suggest that death or transition from non-frail to frail was often preceded by hospitalisation, falls, medication change or clinically significant deterioration in grip strength or cognition.ConclusionThe degree of frailty increased over time, but there were variations in the individual trajectories. Regular monitoring of events that precede changes in frailty status is needed to identify strategies to prevent further deterioration in residents’ conditions.

Abstract Background High prevalence of falsified, counterfeit and substandard medicines pose a threat to public health and treatment failure. This study aimed to investigate the quality of selected essential medicines available in Mongolia. Methods A cross-sectional study collected essential medicines from pharmacy outlets in Mongolia, during June and July, 2017. These products were then submitted for pharmacopoeial analysis and registration status. Results A total of 1770 samples from 118 pharmacy entities were purchased from wholesalers in urban and rural areas. Pharmacopoeial analysis found 179 (10.1%) samples or eleven product groups were unacceptable. The prevalence of substandard locally produced medicines (n = 105, 5.9%) was higher than imported equivalents [(n = 74, 4.17%, p = 0.0001)]. Approximately one-third of all unacceptable tests were related to assay (n = 73, 30.8%) and weight variation. Of 1770 samples, 76 (4.3%) were unregistered and the prevalence of unregistered samples was 3.8% in Ulaanbaatar city and 5.8% in rural areas, respectively. Conclusions This study has indicated that falsified and substandard medicines are prevalent in Mongolia. Considerable effort is required by regulatory authorities, private manufacturers, as well as importers to increase the quality of essential medicines in Mongolia.