Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

Background: The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. Methods: The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Results: Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). Conclusions: This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study.

BACKGROUND: Several studies on various bariatric surgeries involving patients with type 2 diabetes mellitus (T2DM) showed an overall rate of remission of hyperglycemia. However, there is little known about predictive factors on remission after different types of surgeries. The aim of this study was to identify the T2DM remission rate and to determine the effects of preoperative factors characteristics of remission of type 2 diabetes in Iran. METHODS: We conducted a retrospective analysis of 1351 patients with T2DM operated by three different types of surgeries (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and One Anastomosis Gastric Bypass (OAGB)). Diabetes remission was defined according to the American Diabetes Association (ADA) criteria. Binary logistic regression analyses were employed. RESULTS: A total of 1351 patients, 675 patients (50.0%) undergoing OAGB, 475 (35.2%) RYGB, and 201 (14.9%) SG. 80.6%, 84.2% of OAGB, 81.7%, 82.6% of RYGB, and 77.1%, 81.5% of SG participants were in T2DM remission after 1 and 3 years, respectively. 1- and 3-year remission were associated with preoperative age, duration of T2DM, FBS and HbA1c, BMI, insulin therapy, and a family history of obesity (p < 0.05). CONCLUSION: The remission of T2DM after RYGB, SG, and OAGB surgery is dependent on various preoperative factors. Patients with younger age, shorter duration of T2DM, lower preoperative HbA1c and FBS, higher BMI, who were not on insulin therapy, and not having a family history of obesity were the best candidates to achieve a prolonged diabetes remission.

Health related quality of life in patient with type 2 diabetes: The role of household food insecurity on latent class membership.

BACKGROUND AND AIMS: Health related quality of life (HRQoL) is an important public health issue that mainly associated with a number of certain factors in medical sciences. This study, in particular, aimed to identify HRQoL latent subgroups among patients with type 2 diabetes and assess the role that household food insecurity (HFI) plays in classifying participants to each latent class. METHODS: At the present cross sectional study, all the diabetic patients of the rural regions of Neyshabur (a city in north-east of Iran) were recruited between April and July 2012 (N = 1847). Latent Class Analysis (LCA) was used to determine the latent subgroups of HRQoL. Finally, LCA was used to determine the effect of HFI on dedicating participants to each latent class after adjusting other covariates. RESULTS: Based on the subscales of HRQoL, three latent classes were identified, including: 1) poor HRQoL (34.6%), 2) moderate HRQoL (39.1%) and 3) good HRQoL (26.3%). After considering the possible confounders, having HFI decrease the odds of membership in latent class 2 (moderate HRQoL) (OR = 0.42, 95% CI: 0.29-0.60). Also having HFI show similar effect on latent class 3 (good HRQoL) and decrease the odds of membership in this class (OR = 0.13, 95% CI: 0.08-0.20) in compared to the first class (poor HRQoL). CONCLUSIONS: Results from the present study show that HFI plays an important role in decreasing the odds of membership in moderate and good HRQoL classes compared to poor HRQoL.

General health status in Iranian diabetic patients assessed by short-form-36 questionnaire: a systematic review and meta-analysis.

BACKGROUND: Diabetes mellitus is one of the most prevalent diseases worldwide. Diabetes is a chronic disease associated with micro- and macro-vascular complications and deterioration in general health status. Therefore, the aim of this study was to estimate general health status among Iranian diabetic patients through a systematic review and meta-analysis of study utilizing the Short-Form-36 questionnaire. METHODS: Searching the EMBASE, PubMed, ISI/Web of Sciences (WOS), MEDLINE via Ovid, PsycoINFO, as well as Iranian databases (MagIran, Iranmedex, and SID) from January 2000 to December 2017. The methodological quality of the studies was evaluated using the "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions" (ACROBAT-NRSI). Random-effect model was used and the means were reported with their 95% confidence interval (CI). To evaluate the heterogeneity between studies, I2 test was used. Egger's regression test was used to assess the publication bias. RESULTS: Fourteen studies were retained in the final analysis. The mean general health status using SF-36 in diabetic patients of Iran was 51.9 (95% CI: 48.64 to 53.54). The mean physical component summary was 52.92 [95% CI: 49.46-56.38], while the mean mental component summary was 51.02 [95% CI: 46.87-55.16]. CONCLUSION: The findings of this study showed that general health status in Iranian diabetic patients is low. Health policymakers should work to improve the health status in these patients and take appropriate interventions.

Estimation and Prediction of Avoidable Health Care Costs of Cardiovascular Diseases and Type 2 Diabetes Through Adequate Dairy Food Consumption: A Systematic Review and Micro Simulation Modeling Study.

BACKGROUND: Recent evidence from prospective cohort studies show a relationship between consumption of dairy foods and cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). This association highlights the importance of dairy foods consumption in prevention of these diseases and also reduction of associated healthcare costs. The aim of this study was to estimate avoidable healthcare costs of CVD and T2D through adequate dairy foods consumption in Iran. METHODS: This was a multistage modelling study. We conducted a systematic literature review in PubMed and EMBASE to identify any association between incidence of CVD and T2DM and dairy foods intake, and also associated relative risks. We obtained age- and sex-specific dairy foods consumption level and healthcare expenditures from national surveys and studies. Patient level simulation Markov models were constructed to predict the disease incidence, patient population size and associated healthcare costs for current and optimal dairy foods consumption at different time horizons (1, 5, 10 and 20 years). All parameters including costs and transition probabilities were defined as statistical distributions in the models, and all analyses were conducted by accounting for first and second order uncertainty. RESULTS: The systematic review results indicated that dairy foods consumption was inversely associated with incidence of T2DM, coronary heart disease (CHD) and stroke. We estimated that the introduction of a diet containing 3 servings of dairy foods per day may produce a $0.43 saving in annual per capita healthcare costs in Iran in the first year due to saving in cost of CVD and T2DM treatment. The estimated savings in per capita healthcare costs were $8.42, $39.97 and $190.25 in 5, 10 and 20-years' time, respectively. Corresponding total aggregated avoidable costs for the entire Iranian population within the study time horizons were $33.83, $661.31, $3,138.21 and $14,934.63 million, respectively. CONCLUSION: Our analysis demonstrated that increasing dairy foods consumption to recommended levels would be associated with reductions in healthcare costs. Further randomized trial studies are required to investigate the effect of dairy foods intake on cost of CVD and T2DM in the population.

Availability of outpatient rehabilitation facilities in 2015 in Iran: A nationwide study.

Background: Disability can involve many by diseases, injuries, or aging, and thus access to rehabilitation services has a key role in improving these patients' social life. Since 2008, Iran has improved the access to rehabilitation facilities along with the global convention. Yet, nationwide studies are required to evaluate the fair distribution of centres in each province. Thus, the present study aimed to evaluate the distribution of outpatient rehabilitation services in 32 provinces of Iran to help policymakers make more appropriate decisions. Methods: In this cross sectional study, which was conducted between April and October 2017, a master facilities list (MFL) of rehabilitation services that was developed in Iran was used to identify health facilities. Data were collected from the statistics of the Deputy for Rehabilitation of Social Welfare Organization offices and Red Crescent Organization in 32 provinces of Iran. Descriptive data were analysed by SPSS version 22 and reported by percentage and number in 1 000 000 population; distribution was drawn on Iran's map by the GIS software. Results: According to the MFL, outpatient rehabilitation services include physical medicine & rehabilitation, physiotherapy, occupational therapy, speech therapy, audiometry, and orthotics & prosthetics (90%); other rehabilitation centres include general rehabilitation centres, day care centres, and vocational centres (10%). The largest number of occupational therapy, physiotherapy, and audiology offices were found in Tehran, where general rehabilitation centres, day care centres, and vocational centres were less than 3 per 1 000 000 population. There were no rehabilitation centers in 14 provinces, and there were very few physical medicine and rehabilitation centres in most of the provinces. Conclusion: There was significant difference in the distribution of outpatient rehabilitation facilities in different provinces of Iran and some provinces required urgent attention of policymakers, as they had the least number or no rehabilitation facilities.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

BACKGROUND: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. OBJECTIVES: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. DESIGN: This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. RESULTS: The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. DISCUSSION: According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities' job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

The effectiveness of foot care education on people with type 2 diabetes in Tehran, Iran.

AIM: The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran. METHODS: One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20 min education session individually. The mode of the intervention was face-to-face. RESULTS: The applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care (P<0.0001 and P=0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI < or =25) rather than the obese ones. CONCLUSIONS: In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs.