Socio-economic determinants of attendance at diabetes self-management education program: using Andersen's behavioral model.

BACKGROUND: Diabetes self-management education is an effective factor for improving outcomes and quality of life in patients with diabetes. However, little information is available on the factors associated with participation or non-participation in self-management education programs in people with diabetes. The aim of this study was to explore the factors affecting on the attendance of patients with diabetes in the diabetes self-management education program. METHODS: A cross-sectional study was conducted in 2019 on 384 patients with diabetes referred to the main comprehensive health centers of Mashhad, Iran. All patients were linked with a diabetes self-management education program that lasted three months and involved 12 sessions. We explore the factors affecting on attending in diabetes self-management education program using Andersen's behavioral model. Data for independent variables (predisposing, enabling, and need factors) were gathered at the beginning of the training program using registration forms. Dependent variable (attendance of patients with diabetes in the training program) was checked at the end of the program. Univariate and multivariate analysis were done with SPSS v.25. RESULTS: The results of this study showed that women were less likely to participate in the self-management education program than men (OR=0.414; P<0.05). Also, age, travel time, health status and years with diabetes have negative significantly correlated with participation in the education program (P<0.05). The study showed that patients with diabetes aged≥65 were less participated in the training program than those ≤40 (OR=0.159; P<0.05). Also, patients who lived farther than 40 min away from training center were less likely to participate for this program than patients that live in an area<20 min away from training center (OR=0.196; P<0.05). Odds of attending in training program for patients with poor health status was less than patients with excellent health status (OR=0.282; P<0.05). Participation in training program were low in patients with more than 5-year diabetes duration compared to less than 1 year (OR=0.176; P<0.05). CONCLUSION: The implementation of the classes at the right time and online, Reduce the distance between people and the place of the class, providing facilities and providing infrastructure may be appropriate to involve women and the elderly.

Reasons for non-participation in a self-care training program for diabetic patients: a qualitative study.

INTRODUCTION: Self-care behaviors in diabetic patients is considered an important factor for controlling the diabetes. Therefore, diabetic patients need training the self-care behaviors to control this disease. This study aims to investigate the reasons for diabetic patients' non-participation in a self-care training program. METHOD: This qualitative study was carried out between 1 April to 1 July 2019. We used in-depth semi-structured interviews with 30 diabetic patients who did not participate in the self-care training program. Data analysis was conducted using content analysis with MAXQDA software. FINDINGS: The results of this study showed that there are 5 themes and 14 sub-themes for patients' non-participation in self-care training program. Themes included access; individual, familial and social factors; attitude and awareness; motivator factors and need Factors. Also sub-themes were physical access, time access, physical abilities, social-familial responsibilities, attitude to disease, attitude to education, attitude to health, awareness, incentive, communication, teaching methods, perceived risk, access to other educational resources and self-efficacy. CONCLUSION: According to the results of this study, simple physical and time access, offering high-quality education, providing virtual and distant training, organizing and designing modern training methods can lead to increase participation in self-care training programs.

Practicing patients' rights in Iran: a review of evidence.

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights' practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights' charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

The Factors Associated With Direct Medical Costs in Patients With Gastric Cancer: Quantile Regression Approach Compared With Gamma Regression.

OBJECTIVES: Evaluating the costs of illness can provide evidence to improve performance at all levels of health organizations. This study aimed to identify the relationship between the costs of diagnosing and treating patients with gastric cancer and their explanatory variables, using quantile and gamma regressions and comparing the results of the two models. METHODS: This was a cross-sectional and descriptive-analytic study carried out in 2016. In total, 449 patients with gastric cancer were selected at a hospital affiliated with Mashhad University of Medical Sciences. Direct costs and other variables were collected from medical documents. Data were analyzed using the STATA 12 software, using quantile and gamma regression analysis, and the results were compared. RESULTS: The highest average cost per patient was related to hospitalization costs in both metastatic (20 911 034 Iranian Rials) and nonmetastatic patients (20 738 062 Iranian Rials). The lowest average cost was related to biopsy services in nonmetastatic patients. The results of the study also showed that quantile regression is an appropriate substitute for gamma regression and, in some cases, can provide more information for the analysis of disease costs. Based on the results of the quantile regression, being a male and having a shorter stay had a positive effect on cost and the age of the patient had a significantly negative effect. CONCLUSIONS: Examining the cost of a common illness, such as gastric cancer, is an important economic tool for policy makers and decision makers. It provides evidence-based decision making about resource allocation that they can use for future planning and cost control.

Polymeric nanoparticles as carrier for targeted and controlled delivery of anticancer agents.

In recent decades, many novel methods by using nanoparticles (NPs) have been investigated for diagnosis, drug delivery and treatment of cancer. Accordingly, the potential of NPs as carriers is very significant for the delivery of anticancer drugs, because cancer treatment with NPs has led to the improvement of some of the drug delivery limitations such as low blood circulation time and bioavailability, lack of water solubility, drug adverse effect. In addition, the NPs protect drugs against enzymatic degradation and can lead to the targeted and/or controlled release of the drug. The present review focuses on the potential of NPs that can help the targeted and/or controlled delivery of anticancer agents for cancer therapy.