Backgrond & Objective: In recent years, malaria has been a serious problem in Parsabad (a north-western town in Iran). A lot of health-care funding has been allocated to malaria campaign program in this area. The objective of this study was to investigate clinical epidemiology of malaria during 1999-2000.

 Methods: The data collected through epidemiology forms filled for 509 malaria positive cases during 1999- 2000 was analyzed by EPI2000 software. Frequency tables, X² test and one way ANOVA were used in this analysis.

 Results: All 509 Malaria cases diagnosed were P vivax. They belonged to the first seven-month of the year. 69.4% of malaria cases were related to the year 2000 and the others were related to 1999. The most frequent symptoms were chills in 488 cases (95.9%) and fever in 481 of them (94.5%). Sweating was found only in 3.9% of the reported cases. Mean age and standard deviation of patients was 22.9 + 15.6. There was no significant difference between men and women in terms of the distribution of fever and chills.

 Conclusions: The high prevalence of fever and chills was compatible with the findings of previous studies. If one of the two symptoms is positive in the residents of this area or those people traveling there, malaria should be suspected.

  Background & Objective : Several studies have introduced different methods to facilitate the fetal expulsion. One of these methods is episiotomy during the second stage of labor followed by instant repair of episiotomy incision. Perineal repair, its different methods and the outcomes have long been a matter of discussion and research. This study was performed in order to compare results of two different methods of perineal repair, namely standard (three stage) and two-stage method (leaving the skin unsutured).

  Methods : This study is a randomized clinical trial in which, 80 mothers were selected continuously and divided randomly into the two stage and three stage repair groups. A scaled pain ruler, a questionnaire and information checklist were used to collect the data. The setting of this study was the labor room, the postpartum unit and subjects’ homes.

  Results : The finding of this study showed no significant difference between the outcomes of the two groups in terms of perineal pain in the first 4-6 hours, the 2nd day, 15th and 21st day, incision recovery on the 15th and 21st day, dyspareunia and the first postpartum pain-free intercourse.

  Conclusions : The findings of this research indicated that the results obtained from the two above-mentioned methods are not significantly different. However, since the two stage method requires spending less time and energy and reduces the time that mothers should stay in labor room, it is suggested to be used as one of the perineal repair methods.

 Background & Objective: Hepatitis C Virus is the most common cause of post-transfusion hepatitis. This study was conducted to evaluate the prevalence of hepatitis C in multiply transfused patients.

 Methods: 45 patients with B- thalassemia major, 4 patients with hemophilia and 1 patient with aplastic anemia were studied prospectively during 2000. An initial questionnaire was used to collect the data regarding age, sex, duration and interval of at blood translation family history and the type of blood product received and the date of first infusion and then a blood sample was taken for detection of antibody against HCV.

 Results: 62% of the subjects were male and 38% of them were female with the age range of 6 months- 29 years old. 92% of the patients used packed red blood cells. 27 patients had a positive family history of thalassemia and two seropositive patients (4%) had thalassemia. Duration and mean amount of blood transfused were significantly higher in patients with HCV infection. Data analysis showed now significant relationship among variables of the study and hepatitis C cases.

 Conclusions: It is concluded that multiply transfused thalassemic patients are at high risk for HCV infection. Thus, routine screening of blood and anti- HCV test in these patients is necessary.

  Background & Objective : Breast cancer is the most common type of cancer among women worldwide and accounts for the majority of their deaths due to the cancer. Hence, diagnosing its risk factors is of great importance. In this study the association between abortion and breast cancer risk was investigated.

  Methods : In this Case- Control study in Mashhad, 105 patients with confirmed breast cancer were compared with 105 healthy women who were living in their neighborhood and were the same age. A questionnaire including demographic information as well as same questions regarding the factors associated with conception and emphasising abortion were used to collect the data, which then were analyzed using SPSS ver 9.

  Results : the findings indicated a relationship between breast cancer and history of abortion, compared to women with no history of abortion (OR=2.09 95% CI=1.18- 3.69). Also there was a significant relationship between the frequency of abortion and breast cancer (P=0.008 ). but odds ratio was not higher among women whose age at first abortion was less than 20 years. Also abortion before first full- term pregnancy increased breast cancer risk (OR= 5.97 95% CI=1.18-19.6). But the age at the time of abortion did not have any effect on the breast cancer risk.

  Conclusions : The findings suggested that the risk of breast cancer has a positive relationship with frequency of abortion and the risk is even higher if the abortion occurs before the first full-term pregnancy. Thus, health interventions seem to be necessary in this regard.

 Background & Objective: Stroke is a leading cause of death and disability worldwide. It is more common in men than in women, however more than half total stroke death occur in women. Several conditions and lifestyle factors have been well established as risk factors for stroke. The purpose of this study was to asses the magnitude of classic stroke risk factors and its pattern in women.

 Methods: A total of 62 patients with first-onset ischemic stroke were accrued from neurology unit of Alavi hospital during 2002 and compared with their age-matched controls from other units of same hospital. Information concerning potential risk factor exposure status was collected by structured questionnaire at interviews. Stroke risks were estimated by calculating the odds ratios.

 Results: Significantly increased risk of stroke was found among women with hypertension (OR=8.4 CI=3.7-1.8), current smoking (OR=4.2 CI=1.1-16), diabetes (OR=3.7 CI=1.4-9.7) and heart disease (OR=3.2 CI=1.2-8.4). Association of other factors (passive smoking, Hypercholestrolemia) with stroke was not significant.

 Conclusions: Hypertension, diabetes, current smoking and heart disease are major risk factors for stroke in women. Given that the majority of these factors are either correctable or modifiable, prevention strategies should be planned in accordance with this point in order to reduce the occurrence of stroke in women.

  Background & Objective : When a cesarean is necessary, it can be a life-saving technique for both mother and infant. In recent twenty years, the cesarean childbirth rate has increased dramatically. Moreover a cesarean costs nearly twice as much as a vaginal birth. The world Health organization states that a cesarean rate greater than 10-15% cannot be justified. The aim of this study was to determine the cesarean rates and its indications in social security hospital of Ardabil.

 Methods: In this cross-sectional study was conducted all of the deliveries (both cesarean and normal delivery) in Ardabil social security hospital were investigated using a questionnaire including the characteristics of indication. The data were analyzed using SPSS software.

  Results : 45.4% of the deliveries were done using cesarean and 54.6% of them with a normal procedure. 55.8% of all the cesareans had an accepted indication. 44.2% of cesareans were controversial or elective, 22.7% were repeated cesarean, 8.4% were breech presentation and 2.3% were golden baby and 10.8% of the cesareans did not have a clear indication.

 Conclusions: The cesarean section rates in this study were higher than world rates. As a result the rising cesarean birth rate must be stopped and reversed with health interventions.

  Background & Objective : Despite the ever increasing use of oral contraceptives there is uncertainty about the stroke risk associated with their use. Some cases of pulmonary Emboli and stroke have been reported among women taking these pills. The present research was conducted to investigate the relationship between taking contraceptive pills and the risk of ischemic stroke.

  Methods : In a case-control study, women with definite ischemic stroke were selected from Alavi Hospital in Ardabil who had no prior stroke. The control group was age-matched ( ± 3years) to cases and were selected from other wards of the same hospital. A questionnaire was administered to elicit information about prior exposure to various risk factors, including the oral contraceptive pill (OCP). The data were analyzed by SPSS software (Ver. 12) and statistical methods such as chi-square, multivariate regression and ANOVA. The risk factor were estimated by odds ratio.

 Results: OCP consumption was associated with an increased risk of ischemic stroke (OR=5.4 95% CI=1.1-5.3), and after adjustment for other risk factors of stroke it was OR=2.7 (95% CI=0. 95-7.2) with p=0.05.

 Conclusions: According to this study there was weak evidence for an association between ischemic stroke and OCP consumption. Extended studies are needed to clarify the relationship between risk of stroke and the present/ past use of OCP.

  Background & Objective : Promoting health has always been considered as one of the basic priorities in international, national, regional and local policies. Moreover, retention and promotion of individual health requires a good knowledge of essentials and priorities of the future. Consequently, determining heslth priorities and devising public health programs and policies is just one of the crucial issues to be considered and implemented by the organizations involved. So a fundamental revising of the health care services based on health promotion indices seems to be necessary in order to increase the influence of health interference programs, extend the quality of health care services and improve activities concerning public health.

  Methods: This project started in 2001 and was defined by precise planning of its organization chart. Its two basic concerns included the current status of health and determining its priorities. The first point, that is the current status of health was performed through investigating the previous researches as well as qualitative and field studies. In this phase of research 1000 urban and 1000 rural families were interviewed about different aspects of health including population characteristics, nutrition, risk factors, treatment habits and so forth. To measure the parameters such as hemoglobin, hematocrite, sugar and lipids, blood samples were taken from members of 200 families who were above 15. Weight, height and blood pressure of all the subjects who were above 15 years of age and weight, height and Mid Arm Circumference (MAC) of the children aged below 6 were measured. The data were collected and scored based on scientific indices and finally the research priorities in the field of health were determined. It should be noted that many people and organizations participated in this research.

  Results : The findings indicated that mortality of children under 5 years of age, casualties, accidents, etc. were among 34 most essential health priorities.

  Conclusions : Regarding the great experience of determining health priorities which was conducted through need assessment and wide cooperation of the public and organizations, it seems important to conduct such researches once in some years and transfer their findings to other sectors in order to prevent wastage of costs, time and labor. This will also lead the researches towards the real needs and necessary interference in order to promote public health.

 Background & Objective: World health organization (WHO) has paid a special attention to the reproduction health, which plays a crucial role in women health care and its promotion. The purpose of this study is to determine reproductive factors among Ashayer women in Ardabil province.

 Methods: Part of the plan entitled Investigating health and disease among Ashayer in Ardabil which was conducted in 2003 aimed at determining the reproduction indices using a structured questionnaire. The present research was a cross-sectional study in which the data regarding the reproductive status of the Ashayer women were extracted, collected and analyzed using SPSS software and descriptive statistics.

 Results: 268 women at the age of 10-49 completed the questionnaire. Mean age of marriage among women was 18.2, 8.6% of them had a history of stillbirth, 18.1% abortion and 38.19% unwanted pregnancy. 31.4% of the subjects did not have any reproductive health care, and 67.6% of those who did so were taken care less than four times.

 Conclusion: Improvement of reproductive indices among these women requires proper health care programs in order to enhance family planning services as well as reproductive health. This can prevent future outcomes such as unwanted pregnancy and other related complications.

  Background & Objective : The role of circulating lipids in the pathogenesis of ischemic stroke remains unclear despite 3 decades of research. Since ischemic stroke is one of the important causes of death or disability in the world. Finding its risk factors can play a crucial role in health interferences.This study was conducted to investigate the relationship between blood lipids and ischemic stroke.

  Methods : This was�a case-control study conducted in 2002. The case group were patients who were definitely diagnosed to have ischemic stroke for the first time. An equal number of control subjects (with the same age and sex) were selected from other hospital wards. These two groups were compared in terms of the blood lipids. The collected data were analyzed using SPSS software (release 12) and statistical methods such as ANOVA and multivariate regression.

  Results : In this research 132 cases were compared with equal number of control subjects. The subjects in both groups were 64.1 years old on average. The mean level of total cholesterol was significantly higher in case group (p=0.001). The mean level of Triglycerides had no significant difference in two groups.

  Conclusions: Regarding the findings of the present research, offering strategies to lower the chlestrol level through primary prevention as well as drug interferences especially in the groups with other risk factors of stroke, seems to have a significant role in the prevention of ischemic stroke.

 Background & Objective: Postpartum depression is a problematic and important disease and if not recognized and treated on time, it can be aggravated or chronic. Exercise is strongly recommended in this regard to prevent any family disorders and improve the health of mother, child and family. The aim of this study was to determine the effect of exercise on mild postpartum depression among women referring to Ardabil health centers.

  Methods : This study was a double blind clinical trial. About 50 subjects with normal vaginal delivery were selected. The subjects had referred to health canters in the second week after delivery and were diagnosed to have mild depression using Beck depression test. They were randomly divided into two groups (exercise and non-exercise). Then Beck test was done 6 weeks after delivery again and the results were compared in two groups.

  Results : The findings indicated that between mildly depressed mothers, 36% were 26-30 years old, 82% were housekeeper, 44% had under diploma education, 60% had two previous deliveries. 56% of exercise group and 32% of non-exercise group were treated. 8% of experimental subjects and 18% of control ones needed psychological consultation 6 weeks after delivery. T-test showed significant differences between two groups (p<0.05).

  Conclusion : Results showed that exercise had a positive effect on the treatment of mild postpartum depression. As a result it is recommended strongly in postpartum care.

 Background & Objective: Studying the epidemiology and impact of headache can help improve patient care, estimation of burden of disease and classification systems. Migraine is common worldwide and has a geographically variable prevalence in the world. Moreover, its peak of incidence is the age of 20-30. The aim of this study was to determine the prevalence of migraine among the medical students in order to plan for future health interferences.

 Methods: In this cross-sectional study 631 students filled out a questionnaire designed according to the criteria of the international headache society. The data were analyzed using SPSS software (release 12) and descriptive statistics.�

 Results: 76.6% of the subjects were female and 23.4% of them were male. The females were 20.6 and males were 21.4 years old on average. The total prevalence of migraine was 7.3% (1.6% with aura, 5.4% without aura and 0.3% with both of them). Moreover, females, single subjects and students of medicine, except the migraine with aura that was more prevalent among students of associate degrees. A positive family history of headache was found in 45.6% of the students. 65.2% of those suffering from migraine had not referred to a physician and were unaware of their headache.

 Conclusions: Compared to similar researches there is a low prevalence of migraine among the students but most of the students do not take measures to cape with and treat them in the proper manner. This requires necessary health interferences.�

 Background & Objectives: Research has always been considered as a powerful tool in creating change and development and like any other process it demands careful planning, providing facilities and special resources. Investigating research trends can pave the way for systematic thinking in this regard. This study was conducted to examine trends in research methodology in order to promote the research quality in Ardabil University of Medical Sciences.

 Methods: In this cross-sectional descriptive study, data regarding research methodology and its administration was evaluated by a questionnaire during six years from 1997 to 2003. The data regarding the author of the research were collected through the interview. These data were then analyzed by SPSS software (release 12) using descriptive statistics.

 Results: Between 1997 and 2003, 196 research proposals were approved. The number of research designs increased from 3 to 45 during this period. Most of these studies (58.2%) had cross-sectional design. The experimental researches came second with 43 cases (21.9%). During this period the number of trials and analytic studies increased, but descriptive studies were still in the highest rank. Only 32% of the proposals were completed properly and in most of the cases they were not completed in the proper way and some subsections of the forms such as design, variable table, methods of data analysis, data collection procedures and administration problems were incomplete or missing in most of the designs. These problems were more evident before the establishment of research consultation office in 2001. 75% of the researchers had attended research workshop before conducting any research.

  Conclusion: The findings indicated a remarkable increase in the number of researches compared to the preceding years. Moreover, they have been more analytically-oriented. However, descriptive researches are in the top rank. Some necessary measures have to be taken in order to improve the present condition.

  Background & Objectives: Cesarean section is one of the most common surgeries in women. In developed countries the rate of cesarean section is reported to be 21.2%. In Iran, the rate of cesarean section is even higher than the international norms. In a study in Ardabil, in 2001, cesarean section rate came out to be 42.86%. Postoperative pain after cesarean is one of the complications that all mothers experience in one-way or another. Besides bothering mother it can disorder newborn feeding, ambulation of mother and bonding between newborn and mother if it is not controlled effectively. This study was conducted to compare the effect of intramuscular Methadone and Diclofenac suppository for pain relief after cesarean section in Alavi hospital, Ardabil.

  Methods: This study was a double blind clinical trial. 56 women who experienced cesarean section for the first time were randomly divided into two groups. Diclofenac suppository (100 mg every 8hr) was given to first group and Methadone (5 mg every 8hr) was injected to the second group for 24 hours. Then, the severity of pain was measured with numerical scoring in serial postoperative visits. The data were analyzed by SPSS software using descriptive and analytical statistics such as chi-square and ANOVA.

  Results: The findings indicated that the severity of pain in 2^nd, 3^rd and 4^th postoperative visits was significantly lower in patients who received Diclofenac suppositories than the other group (p<0.05). But overall, there was no statistically significant difference between the pain severity in Methadone receiving group (Mean & SD= 5.85 ± 3.5) and Diclofenac receiving group (Mean & SD= 6.46 ± 2.9).

  Conclusion: There was no significant difference between Diclofenac suppository and Methadone in terms of decreasing the postoperative pain after cesarean section. However, regarding the restrictions in the use of opioids, Diclofenac can be a suitable replacement for these drugs.

 Background & Objective: Each year thousands of children under five years old die due to acute respiratory infection and diarrheal diseases. A huge number of infants and children are hospitalized and visited by the physicians whereas most of these diseases can be prevented with timely treatment. Child health maintenance and improvement is one of the most important considerations in each society. Moreover, identifying child morbidity patterns should be a matter of concern in order to improve the health services. This study provides an overview of the leading causes of hospitalization among children with the aim of determining the most important causes of hospitalization and offering appropriate strategies to decrease them.

 Methods: This cross-sectional study was conducted in 2001 in Ardabil Ali-Asghar hospital. The subjects were randomly selected from the admission list on a daily basis. A questionnaire including demographic characteristics such as age, sex, time of admission and primary diagnosis was completed for each subject. The data were analyzed by SPSS software using descriptive statistics.

 Results: A total of 1945 patients were admitted almost half of which were studied. Febrile convulsion was found to be the most common cause of hospitalization (26%) while gastroenteritis (22.1%) and pneumonia (20%) were in the second and third order. Other causes included epilepsy, drug poisoning, meningitis, mumps, drug encephalitis, asthma, etc.

 Conclusion: According to the findings of this study, standard case management is necessary especially about febrile convulsion which is the most common cause of hospitalization. Since the present pattern is different from similar studies, further investigations are required to identify its causes.

 Background & Objective: Cardiovascular disease is a major global health problem. Countries with low to moderate income contribute significantly to the global burden of cardiovascular disease accounting for 78% of all deaths and 86.3% of all disabilities. This study was an attempt to determine the factors contributing to premature myocardial infarction among young adults in Ardabil city.

 Methods: In this Case-control study 52 subjects, under 45, with myocardial infarction, admitted to Buali hospital in 2003-2004, were compared with 52 age and sex matched population based controls. Odds ratio and confidence interval of 95% were used to evaluate the risk factors such as smoking, physical activity, family history, history of diabetes and similar factors. Analysis of variance was used to compare the means.

 Results: The mean age of the subjects was 37.2 and 96.2% of them were male. The positive family history of cardiovascular disease with odds ratio of 9.4 (95% CI=2.6-34.3) and current smoking with odds ratio of 2.8 (95% CI=1.3-6.2) associated with myocardial infarction. Mean of the body mass index and mean of concentration of FBS, LDL and HDL were different in case and control groups. Physical activity with odds ratio of 0.4 had protective effect. (95% CI= 0.2-0.8). There was no meaningful relationship between passive smoking, total cholesterol, education and job with myocardial infarction risk.

 Conclusion: Family history, smoking, high Fasting Blood Sugar, high LDL, Low HDL and physical inactivity are the most important factors associated with acute myocardial infarction. Proper health interventions should be considered in order to lower the risk factors among young adults especially those under 45 years of age with a positive family history of myocardial infarction.

 Background & Objectives: cervical dysplasia indicates the growth disorder of cervix and is characterized by the appearance of cancerous and precancerous cells in cervix. Cervical dysplasia often has no symptoms but can progress to cervical cancer in 5 % of the cases. Early diagnosis of these pre-invasive lesions with pap smear can prevent, to a great extent, the progress of lesion to cancer. The prevalence of cervical dysplasia is different in different parts of the world and depents, to a great extent, on its etiology. This study was an attempt to determine the prevalence and types of cervical dysplasia in 5000 cases of pap smears.

 Methods: This descriptive cross-sectional study was conducted on 5000 cases of pap smears selected randomly from among 8249 pap smears in the period between March 2003 to August 2004. Some samples were studied retrospectively and some others prospectively. The population of the study was composed of women referring to Ardabil health care centers for pop smear test. The data were collected with questionnaires and were analyzed using SPSS software (ver.11).

 Results: Cervical dysplasia was found in 56 cases (1.12%) 0.66% of which was CIN I, 0.3% CIN II and 0.16% CIN III.

 Conclusion: The total percentage of cervical displasia in this study was 1.12%. This prevalence in other similar studies varies between 0.4% in Scotland and 12% in USA. Nevertheless, the prevalence found in this study is in line with most of the similar researches.

  Background & Objectives: In modern civilization, community participation is considered to be the most important way of development in different parts of the society. Establishing social development and health promotion centers (SDHPC) is the first step which is taken in this regard. In these centers, social development is implemented along with health promotion. During some planned activities people practice participation and having sense of responsibility while they move towards development and health. They understand that the key for solving majority of health problems are in their own hands.

  Methods: In the framework of an action research, interventions based on dynamic, reevaluation activities, were done in two parts: Formation of activity committees and establishment of population laboratory. SDPHC set its programs based on a planned approach to community health and community mobilization was the first practical action in this plan.

  Aiming at presentation and evaluation of community mobilization model, different activities consisting of mobilization of heath volunteers, raising participation of regional stake holders, recognizing social literature to ensure effective and pervasive communication with people, propagation and call for participation along with general enumeration of society was done to find authoritative people.

  Results: Health volunteers helped to recognize 60 key persons. 53 of them accepted participation. Objectives of the center were explained to them in three meetings, and their opinions were collected. A study of community literature showed that this region had a moderate to high cultural behaviors, and moderate to low income level and education with suitable interest in participation. The Evaluation of provincial broadcasting organization, municipality and other organizations was not desirable except for education organization. Publishing a newsletter was not welcomed by people but it created a bright perspective among governmental authorities. 287 persons accepted invitations voluntarily and took membership. After regional census, it was found that 4355 households with a total population of 19652 were living in this region 9305 (48%) of whom were females. Mean age of population was 26 and mean household dimension was 4.5. 8352 persons (42%) were married. Majority of women were house wives and majority of men had self managed job.

  Conclusion : The process of community mobilization in this project was evaluated to be successful but for establishment and continuation of activities in SDHPC most of the organizations and different groups of people should be encouraged to participate.

 Background & Objectives : Providing health services for all population subgroups of a community is a major hallmark for health administration. Little is known about health status of Ashayer population in Iran. This study aims at evaluating health status and quality of health service delivery to them.

 Methods: In a cross-sectional research 320 households (1800 persons), entered the study. Moreover, blood samples from 458 dogs were taken and studied with both Direct Aglutination Test (DAT) and a newly presented dipstick test . All children under 12 were also studied with DAT. In computing the sample size the generalizability for 63 variables with a minimum and maximum probability level of 90% and 97% respectively were taken into account and since the cluster sampling was employed, the Design Effect would be at least 1.56 and for different variables in the first sample it would be at most 4.

 Results: Only 30 households(9.7%) used piped water supply inside their houses while most of the other families (41%) obtained their water from mobile water tanks. Residual water chlorine was measured to be zero in 88.7% of the samples taken from drinking water of Ashayer. 89 (27.8%) households had lavatories and 22 (7%) households had bathrooms inside their houses. 90.4% of those using raw vegetables washed them only with plain water. Monthly incidence rate for accidents was 230 per 10000. 18.1% of women in reproductive age had a history of abortion. Unwanted pregnancy rate was 38.9%. 47.1% of women with a labor history in past three years had never been visited by any person legally allowed to do so. Women in reproductive age had a poor knowledge about contraceptive methods. The minimum delay for vaccination was 16.9 (SD= 19.26) days regarding the third dose of OPV and the highest delay in vaccination was 46.44 (SD=60.7) days belonging to the third dose of HBV. From all 503 persons above 12 years old, 77 cases had hypertension. Periodontal easy bleeding was observed in 13.7 % and pyorrhea in 19.3%. 10.2 % had aching neck, 18.7% had backache and arthralgia was shown in 13.5%. The unmet need for physician's visit was 64.8%. The frequency of positive cases of leshmaniasis was 3.4% and 3.06% for boys and girls respectively. 28 male and 6 female dogs were positive in DAT test making an overall positive rate of 7.4%. Sensitivity of dipstick test was higher than 80 percent only when golden standard was considered to be DAT ≥ ¹ /₆₄₀.

  Conclusion: Many of the health indices of Ashayer except for vaccination were suitable. This requires further attemps on the part of govermental and health outhorities. Kale-azar disease can spread to the north of the province as well as the neighboring provinces due to the migration of these tribes. It is predicted that Bilesavar and Parsabad cities will be added to the andemic regions of this disease in coming years. Using dipstick test recently offered by WHO is recommended to be used to screen the infected dogs.