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Objective This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran. Methods The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17. Results Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants’ anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p  = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p  = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p  = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score ( P  = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p  < 0.001) compared to the group without specific service providers. Conclusion Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.

Among individuals with hypertension and without diabetes, those with specific service providers demonstrated higher SQ scores (b = 7.03; p < 0.001) compared to those without specific service providers. [...]individuals in rural areas with hypertension and without diabetes exhibited lower SQ scores (b = -6.07; p < 0.05) than their urban counterparts. Conclusion The results of the current study revealed that even though the primary health system has initiated delivering routine check-ups for patients with T2DM and/or hypertension in primary health centers a decade ago, there is a gap in the quality of services provided. Addressing these disparities requires targeted interventions such as patient and clinician education initiatives, as well as health system reforms to improve access to medication and disease management services in rural areas. Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Shabnam Iezadi & Kamal Gholipour 2.

Background: Iranian people have been celebrating the last Wednesday Eve Festival (Chaharshanbeh Soori) from Zoroastrian tradition (1725 BC). This ceremony, which had previously comprised a wide range of socially pleasant and well-accepted traditions, has now been changed into a scene of horror and danger by fireworks that threaten the physical, mental and social health of the community. Purpose: The purpose of this study was to investigate the epidemiological aspects of injuries due to Chaharshanbeh Soori in East Azerbaijan Province, Iran. Methods: This is a descriptive epidemiological study. Data on injuries caused by Chaharshanbeh Soori events were collected by using a national questionnaire in the emergency words of all public and private hospitals from March 15 to April 15, 2018. In this study, demographic and epidemiological variables including age, sex, education, the position of the injured person, living area, injured organ, the type of injury, and outcome of the injury were collected. Data were analyzed using Excel 2013 software for descriptive statistics. Results: A total of 318 injured people have been registered (incidence rate of 9 per 100,000 population). 80% of them were male and 20% were female. 53.8% of the injured people were under 20 years of age. 90% of the injured lived in urban areas, 7% in rural areas and 3% in suburban areas. 65% of injuries occurred during the use of firecrackers, 32% occurred for whom watching or passing, and 3% occurred during the construction of firecracker. 62% were uneducated or under diploma, 29% had diplomas or associate degree, and 9% had a bachelor or master degree. In terms of the type of injury, 57% suffered burns, and 43% had cuts or wounds. In total 289 outpatients were treated as outpatients, 28 were hospitalized as inpatients, one led to disability and death was not reported. Conclusion: Considering that most injuries are made by urban boys under the age of 20 who use the firecrackers as a means of happiness, effective interventional planning for them and their parents is necessary by health and safety officials of the community using the (successful and unsuccessful) past experiences.

Background: Traffic injuries are the third leading cause of death in Iran, accounting for more than 16000 death in 2016 (death rate of 20.5 per 100000 population). It was the first leading cause of premature death and disability in Iran in 2003. East Azerbaijan province is ranked eighth among the 31 provinces in terms of the number of deaths caused by traffic injuries. Purpose: To determine the epidemiological aspects of fatal traffic injuries in East Azerbaijan province, Iran. Methods: This cross-sectional descriptive study included 758 traffic-related deaths in East Azerbaijan province between March 2016 and March 2017. The data source was the Ministry of health and medical education death registry. According to this registry, all deaths should be recorded in this system. In this study, demographic and epidemiological variables including age, sex, education, occupation, death place, and living area were collected. Data were analyzed using Excel 2013 software. Results: Out of 758 people died in traffic injuries, 604 (80%) were male and 154 (20%) were female. The age distribution of death indicated that 354 (57%) aged 20-59 died from road traffic injuries. 667 (53.2%) road traffic death happened in the road and public places, 386 (30.3%) deaths happened in hospitals and day clinics, and 210 (16.5%) cases were unknown. In terms of living area 503 (66%) were living in urban areas, 242 (32%) in rural areas and it was unknown for 13 (2%) cases. 144 (19%) cases had primary education, 113 (14.9%) secondary education (Guidance school), 125 (16.5%) tertiary education (high school), 116 (15.3%) were uneducated, and 78 (10.3%) had academic education. In respect of occupation In terms of occupation, most jobs respectively were related to free job (36.7%) , unknown (22.8%), housekeepers (12.5%), farmers (7.4%), students (6.7%), employees/laborers (6.5%), unemployed (5%), retired (4.1%), children (2.4%), and professional drivers (1.8%). Conclusion: Considering that the most road traffic deaths occurred in roads, paying more attention to roads and vehicles safety should be taken into account. The high rate of death in men aged 20-59 who mostly are family breadwinners indicates the necessity of the effective behavioral interventions for this group.

Spiritual health is one of the basic concepts regarding how to deal with the problems caused by the disease. Anxiety and depression are common psychological consequences that affect the treatment process in cancer patients. Therefore, the present study has been conducted to explore relationship between spiritual well-being with anxiety and depression among cancer patients. A total of 200 eligible cancer patients were included in this cross-sectional survey. Questionnaires of the Hospital Anxiety and Depression Scale (HADS) and Spiritual Well-Being Scale (SWB) were provided to patients. The mean anxiety and depression scores were 9.98 ± 3.74 and 9.68 ± 3.32, respectively. Nearly half of the patients had anxiety and depression disorders. Age (β = -.300, P = .017) was a significant negative predictor for anxiety, and also education (β = -.885, P = .004) was a significant and negative predictor for depression. The mean score of patients' spiritual well-being was 76.61 ± 20.01, and its dimensions including existential well-being and religious well-being were 37.35 ± 9.78, and 39.27 ± 10.38, respectively. The majority of patients had a moderate level of spiritual well-being (81%). There was a statistically significant relationship between educational levels and spiritual well-being (P = 049), and religious well-being (P = 033). The spiritual well-being could significantly and negatively predict anxiety (β = -0.154, P < 0.001) and depression (β = -.134, P = < 0.001). There was a significant and inverse relationship between religious well-being with anxiety (rho = -.832, P < 0.001) and depression (rho = -.842, P < 0.001), and between existential well-being with anxiety (rho = -.830, P < 0.001) and depression (rho = -0.813, P < 0.001). There was a significant positive relationship between anxiety and depression (rho = 0.717, P < 0.001). The highest percentage of patients with depression disorder had more anxiety (75.6%). Spirituality can serve as a protective factor for psychological morbidity. Spirituality wellbeing-based care programs are suggested as a good method to promote mental health in cancerous patients.

Accurate and timely traffic flow prediction not just allows traffic controllers to evade traffic congestion and guarantee standard traffic functioning, it even assists travelers to take advantage of planning ahead of schedule and modifying travel routes promptly. Therefore, short-term traffic flow prediction utilizing artificial intelligence (AI) techniques has received significant attention in smart cities. This manuscript introduces an autonomous short-term traffic flow prediction using optimal hybrid deep belief network (AST2FP-OHDBN) model. The presented AST2FP-OHDBN model majorly focuses on high-precision traffic prediction in the process of making near future prediction of smart city environments. The presented AST2FP-OHDBN model initially normalizes the traffic data using min–max normalization. In addition, the HDBN model is employed for forecasting the traffic flow in the near future, and makes use of DBN with an adaptive learning step approach to enhance the convergence rate. To enhance the predictive accuracy of the DBN model, the pelican optimization algorithm (POA) is exploited as a hyperparameter optimizer, which in turn enhances the overall efficiency of the traffic flow prediction process. For assuring the enhanced predictive outcomes of the AST2FP-OHDBN algorithm, a wide-ranging experimental analysis can be executed. The experimental values reported the promising performance of the AST2FP-OHDBN method over recent state-of-the-art DL models with minimal average mean-square error of 17.19132 and root-mean-square error of 22.6634.

The purpose of this study was to introduce a new machine learning approach for differentiation of a pachychoroid from a healthy choroid based on enhanced depth-optical coherence tomography (EDI-OCT) imaging. This study included EDI-OCT images of 103 eyes from 82 patients with central serous chorioretinopathy or pachychoroid pigment epitheliopathy, and 103 eyes from 103 age- and sex-matched healthy subjects. Choroidal features including choroidal thickness (CT), choroidal area (CA), Haller layer thickness (HT), Sattler-choriocapillaris thickness (SCT), and the choroidal vascular index (CVI) were extracted. The Haller ratio (HR) was obtained by dividing HT by CT. Multivariate TwoStep cluster analysis was performed with a preset number of two clusters based on a combination of different choroidal features. Clinical criteria were developed based on the results of the cluster analysis, and two independent skilled retina specialists graded a separate testing dataset based on the new clinical criteria. TwoStep cluster analysis achieved a sensitivity of 1.000 (95-CI: 0.938–1.000) and a specificity of 0.986 (95-CI: 0.919–1.000) in the differentiation of pachy- and healthy choroid. The best result for identification of pachychoroid was obtained for a combination of CT, HR, and CVI, with a correct classification rate of 0.993 (95-CI: 0.980–1.000). Based on the relative variable importance (RVI), the cluster analysis prioritized the choroidal features as follows: HR (RVI: 1.0), CVI (RVI: 0.87), CT (RVI: 0.70), CA (RVI: 0.59), and SCT (RVI: 0.27). After performing a receiver operating characteristic curve analysis on the cluster membership variable, a cutoff point of 389 µm and 0.79 was determined for CT and HR, respectively. Based on these clinical criteria, a sensitivity of 0.793 (95-CI: 0.611–0.904) and a specificity of 0.786 (95-CI: 0.600–0.900) and 0.821 (95-CI: 0.638–0.924) were achieved for each grader. Cohen's kappa of inter-rater reliability was 0.895. Based on an unsupervised machine learning approach, a combination of the Haller ratio and choroidal thickness is the most valuable factor in the differentiation of pachy- and healthy choroids in a clinical setting.

Background/Aims Upper gastrointestinal bleeding (UGIB) is a frequent medical issue. The primary risk factors for bleeding peptic ulcers are Helicobacter pylori infection and non-steroidal anti-inflammatory drugs. The association between acute gastric/duodenal ulcer and opium use has been previously proposed; however, there is no available data on endoscopic findings of patients with acute UGIB who use opium. Materials and methods In the present descriptive cross-sectional study, endoscopic data of 50 consecutive patients with oral opium use and 50 consecutive patients without any opium use who were admitted for UGIB were recorded. The size (5–10 mm, 11–20 mm, or more than 20 mm), number (single, double, or multiple), and location of the ulcers (esophagus, gastric corpus including the fundus and body, antrum, angulus, or duodenum) were examined by endoscopy in both groups. Results Three or more ulcers were observed in 46% and 16% of patients with oral opium use and without opium use, respectively ( P -value = 0.001). The rate of giant ulcers (> 20 mm) was significantly higher in patients who used oral opium (40% vs. 12%; P -value = 0.007). Esophageal ulcers were also more common in oral opium users (30%) than non-users (8%) with UGIB ( P -value = 0.01). Nevertheless, the location of the ulcers between the two groups generally was not statistically different. Conclusions This study has demonstrated that multiple, large peptic ulcers in GIB are potential complications of oral opium use. This could aid the needed modifications in the treatment protocol for these patients.

Background and Aim Psoriasis is a prevalent chronic inflammatory skin condition, and the Mediterranean diet is often recommended for its health benefits, particularly its ability to mitigate chronic inflammation. This study sought to examine the extent to which psoriasis patients adhere to the Mediterranean diet and to explore its correlation with the severity of their condition Methods Seventy‐one psoriasis patients and 71 age‐ and sex‐matched healthy controls were enrolled the study and filled a standard questionnaire of adherence to the Mediterranean diet. The relationship between disease severity and adherence to the diet was also dealt with. Results The Mediterranean diet adherence score in the psoriasis group (5.25 ± 1.64) was significantly lower than the control group (6.28 ± 2.10) (p = 0.004). In addition, the consumption of fruit and fish in psoriasis patients was significantly lower than the control group and the consumption of red meat was significantly higher in the patient group. No significant relationship was found between the severity of the disease and the score of adherence to the Mediterranean diet (p = 0.42). Conclusion A significant difference between the two groups of psoriasis and the control group following the Mediterranean diet might be indicative of the relationship between diet and psoriasis and the potential benefits of this type of diet due to its anti‐inflammatory properties.

Rapid advancements in the internet and communication domains have led to a massive rise in the network size and the equivalent data. Consequently, several new attacks have been created and pose several challenging issues for network security. In addition, the intrusions can launch several attacks and can be handled by the use of intrusion detection system (IDS). Though several IDS models are available in the literature, there is still a need to improve the detection rate and decrease the false alarm rate. The recent developments of machine learning (ML) and deep learning (DL)-based IDS systems are being deployed as possible solutions for effective intrusion detection. In this work, we propose an arithmetic optimization-enabled density-based clustering with deep learning (AOEDBC-DL) model for intelligent intrusion detection. The presented AOEDBC-DL technique follows a data clustering process to handle the massive quantity of network data traffic. To accomplish this, the AOEDBC-DL technique applied a density-based clustering technique and the initial set of clusters are initialized using the arithmetic optimization algorithm (AOA). In order to recognize and classify intrusions, a bidirectional long short term memory (BiLSTM) mechanism was exploited in this study. Eventually, the AOA was applied as a hyperparameter tuning procedure of the BiLSTM model. The experimental result analysis of the AOEDBC-DL algorithm was tested using benchmark IDS datasets. Extensive comparison studies highlighted the enhancements of the AOEDBC-DL technique over other existing approaches.