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  Background & Objective : Today, with changes in health care systems, most of the patients, receive occupational and special cares at home after being discharged from hospital . The aim of this study was to assess the effects of follow up on physical and emotional status of the patients with recent myocardial Infarction .

  Methods : This experimental study was done on 60 patients with acute myocardial infarction, who referred to Boali Hospital during 2000-2001.The patients were chosen randomly and were set in two different groups with 30 subjects in each group . Then, a home care program was designed for case group. but there was no intervention for control group . This home care program was completed and one week later the physical and emotional status of the patients in two groups were analyzed by Spilbergar and Beck tests and finally the results were compared in two groups using X² test.

  Results : The X² test showed that there is a significant difference between resting heart rate of two groups with P<0.05 but the difference among systolic and diastolic blood pressure, body weight, anxiety and depression was not statistically significant in two groups.

  Conclusions: Regarding the effects of follow-up on the physical and emotional status of the patients, nurses can improve the quality of the patienys life through active home - care and rehabilitation programs along with social supports.

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  Background & Objective : Regional anesthesia is a method of choice in cesarean section. But in emergency cesarean sections general anesthesia is usually preferred. On the other hand, intravenous sedative drugs used in general anesthesia induction rapidly crosses the placenta and result in fetal depression. Because of higher prevalence of general anesthesia in Iran it is reasonable to conduct more researches in this field. This study set out to compare the effects of Propofol and Thiopental-Na as induction agents on the neonatal Apgar score and maternal hemodynamic status.

  Methods: In this double blind clinical trial 60 pregnant women with ASA class I & II were studied. In a random way 30 patients received 2mg/kg Propofol and the rest of them were given 4mg/kg of Thiopental-Na. All these subjects had full term and normal fetus. Pre and post-induction status of the patients was monitored noninvasively after tracheal intubations and during 12 minutes after that. Also time intervals between induction and birth (cord clipping) and between uterus incision and birth were measured. Apgar score of neonates was evaluated through clinical examination in 1^st, 5^th, 10^th and 15^th minutes after birth. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test, chi-square and ANOVA.

 Results: Apgar score in different times (1.5,10&15 minute) had no significant difference between two groups. (In the 1^st minute Propofol was 7.1 ± 2.2 and Thiopental was 74 ± 1.8, in the 5^th minute Propofol was 9.2 ± 0.7 and Thiopental was 9.1 ± 0.9) Maximum variation of heart rate and blood pressure in two groups were not significantly different. The time intervals between induction and birth (less than 8 minutes) on the one hand and uterus incision and birth(less than 130 seconds) on the other were similar in two groups.

  Conclusions : Thiopental-Na and Propofol can be used with similar results for induction of general anesthesia in cesarean section.

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  Background & Objective: Flatulence is one of the most common postoperative disorders, which leads to abdominal distension, respiratory disorders and the openning of sutures. Some of the drugs used to alleviate the abdominal flatulence are associated with complications and harmful effects, which gives us a hint to adopt herbal medicine. The present study investigates the effect of supermint on the flatulence intensity after cesarean section.

  Methods: This double-blinded clinical trial study was conducted on 107 women (47 cases as placebo group and 60 cases as drug group) who had cesarean section in shahid Mobini hospital, Sabzevar. After stopping the administration of IV fluid, the subjects in both groups received 40 drops of drug and placebo every 20 minutes for 3 days.

  Results: The intensity of flatulence in the first 20 minutes (p=0.042), in second 20 minutes (p=0.001), in the third 20 minutes (p<0.001) and 120 minutes after intervention (p<0.001) was lower in drug group compared to before intervention.

  Conclusion: Supermint is effective in reducing the postoperative flatulence in cesarean section and is recommended to be used in these cases.

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 Background & Objectives: Considering the high prevalance of congenital obstruction of nasolacrimal ducts in infants and the importance of timely intervention and due to the lack of previous similar researches in Ardebil province, and regarding the discrepancies in the reports about the degree of successful accomplishment of the first probing, the researchers set out to design and perform the present research among the patients referring to ophthalmology ward.

  Methods: This descriptive and cross-sectional study was conducted on 84 children suffering from congenital nasolacrimal duct obstruction who had undergone pobing surgery in Alavi hospitaly between 2000 and 2002.

  Results: 70 eyes of 50 patients were examined. 27 (54%) were male and 23 (46%) were female. 20 of them (40%) had bilateral involvement and 30 (60%) had unilateral one. Involvement of right eye (60%) was more than left eye (40%) and was expected in first child (56%) more than subsequent offsprings. Clinical manifestation was epiphora in 44%, prulent discharge in 12% and epiphora with prulent discharge in 44%. 90% of the subjects were operated for the first time while 10% had had 2-3 operations before complete recovery was observed in 48% of the patients 46% of them had relative improvement and no recovery was witnessed in 6% of them.

 Conclusion: This study showed that the male infants were affected more than females, and the rate of involvement in right eye as well as in first children was relarively high. Also the rate of recovery among unilateral groups and infants under 1 year of age was considerably high, so it is recommended that the patients of this age group undertake a therapy with topical antibiotic and lacrimal sac massage and because of the low success of the surgery above 2 years of age, probing is recommended from 6 month to 18 months of age if medical treatment was unsuccessful.

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  Background and Objectives: The remarkable increase in the number of chronic diseases and failing in the definite treatment of these illnesses in order to meet the needs of these patients as well as the high costs of control and management of these diseases require special attention to the promotion of health in them. The first step in planning for this promotion is a study of the factors inflouencing health promotion in order to use them in planning to control and manage chronic diseases.

  Methods: Granded theory is a powerful research method to study social structures and processes. This method was employed in the present research to collect and analyze the data in chronic patients. Semi-Structured interviews were used to collect the data which were analyzed using continuous comparison method.

  Results: Six main themes including the meaning of health, life style, individual factors, spiritual beliefs, support and education emerged, all of which were effective in the process of health promotion in these patients.

  Conclusion: The findings indicated the concepts found in the research were interactively influencing each other to promote health in chronic patients. Support and education overshadowed other factors and had them under its influence. So, it is necessary to emphasise the role of these two factors in health-promoting activities in chronic patients and leading the patients towards health promotion through increasing self-reliance and creating a supportive environment.

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  Background & Objective: Depot-medroxyprogesterone acetate (DMPA) is an injectable contraceptive method that is widely used by 68 million women in over 114 countries and was reported Different medical and non medical reasons were reported for discontinuation of DMPA use. Due to little information about continuation rate and reasons for discontinuations of DMPA in this region and because of the different result of the research in other countries this study was designed. to evaluate the use of DMPA�including continuation rate and side effects.

  Methods: In this cross sectional retrospective study 396 DMPA user women referring to health care centers in Ardabil were selected through classified sampling. The data were collected by a questionnaire by interviewing the subjects and data were analyzed by SPSS software using analysis variance (ANOVA) and correlation and T-test.

  Results: The mean age of the study population was 32±7.8 years, 33.8% had primary education and the majority of the users were housewives (%95) and only20 (%5) were employed. 6, 9, 12 and 24 month cumulative continuation rate of DMPA were recorded as %44.5, %26.5, %18.2 and %2.3 respectively. The most common reason for discontinuation among all of groups was amenorrhea. The most common side effects were amenorrhea (%69.7), low back pain (%13.4), and weight gain (%13.4) and headache (%10.4). There was a significant corvelation belween education level and spouse's education level, spouse's job, family income, grariding, number of off spring, type of previous delivery and continuity of DMPA (p<0.05).

  Conclusion: The result of this study could help health authorities and care givers in term of correct counseling and follow up. This factor could result in more satisfaction and improve continuation rate of DMPA.

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 Background & Objectives: Toxoplasmosis is an important zoonosis parasitical disease. Infection with Toxoplasma gondii in transmission of parasite to fetus or its reactivation among immune-compromised persons can lead to server clinical symptoms. The aim of study was to determine immune level of Toxoplasmosis among women who were to get married and have referred to Health Center of Ardabil.

  Methods: In this study 272 blood samples of women who had referred to health center of Ardabil in 2007 were collected. Samples were tested with ELISA method to detect Anti-Toxoplasma IgM and IgG Antibodies.

  Results: The tests showed that 42.3% of women were IgG Positive, 57.2% were IgG negative and 2.6% women were IgM positive and also IgG positive. They have ( IgG positive women) 11.3% family history of abortion, 96.5% eating raw vegetables, 92.2% eating half cooked meat, 89.6% not washing the vegetables with disinfectants, 29.6% animal contact, 57.4% contact with raw meat and 94.8% used piped water.

  Conclusion: Since 57.7% of women who were to marry in Ardabil city were negative from the view point of Toxoplasmosis, health education for elimination of risk factors especially within pregnancy period seems mandatory.

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  Background & Objectives : Due to rapid population growth, many activities performed to find ways to prevent pregnancy around the world. Vasectomy is one of the most effective contraceptive methods but despite the benefits, it's using incidence is very low. It is important to involve men in order to population control. This study was aimed to describe the experiences of a group of men who had vasectomy and their sexual satisfaction after Vasectomy.

  Methods: A combination of qualitative and quantitative study (Triangulation method) was used on forty men who had been vasectomized in the city of Ardabil before 2006. The method the thematic oral history was used. Questionnaire about sexual satisfaction after vasectomy was prepared and completed by sample subjects (101 people). The results were analyzed by SPSS software.

  Results: The following three descriptive categories were developed from the men's experiences: influencing factors for doing vasectomy outcomes of vasectomy vasectomized men as advisers of the procedure for other men.

  Frequency of intercourses in 65.4%, sexual desire in 64.4%, sexual pleasure in 59.4%, duration of sexual intercourse in 66.3% and sexual ability in 68.3% of subjects did not change after sterilization.

  Conclusion: Family planning programmes must consider the clients sociocultural background. During explanations about vasectomy, the dissemination of the experiences of vasectomised men could improve the confidence and interest of the men to the method and may promote men’s involvement in reproductive health.

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Background & Objectives: Previous studies demonstrated that selected probiotic bacteria elicit beneficial effects in animals. Probiotic bacteria inhibit pathogens growth in the gut, improve lipid metabolism and activate immune system of animals. In the present study Enterococcus spp were isolated from Iranian traditional cheese and their effects on intestine pathogens (Shigella dysenteriae, Escherichia coli and Salmonella Typhimurium) growth, serum lipids level and activation of immune systems in mice were studied.

  Methods: Iranian cheese samples were collected from Ardabil province. Enterococci spp were isolated using selective culture mediums and identified using API kites. Inhibitory effects of isolated Enterococci on growth of Pseudomonas aeruginosa and intestine pathogens (Shigella dysenteriae, Escherichia coli and Salmonella typhimurium) were tested using agar well method . In order to study probiotic activities of isolated bacteria in live animals, NMRI mice were divided into different groups and Enterococci was administrated orally (1 ML/mouse) with doses equal to 2 (6×10⁸ cfu/ml) 3 (9×10⁸ cfu/ml) and 4 (12×10⁸ cfu/ml) MacFarland standard for 2 weeks. After two weeks continues treatment, blood samples were collected from retroorbital sinus and serum levels of cholesterol, triglycerides, LDL and HDL measured using enzymatic method. Interleukins (IL-2, IL-6 and IL-10) levels were measured using ELISA kites.

  Results: Results of this study demonstrated that treatment with faecium species decreases serum cholesterol and increases serum IL-10 level, while it has not showed significant effects on serum levels of glucose, triglycerides, IL-2 and IL-6 (p<0.05). Administration of faecalis species have no significant effects on lipid levels of serum ( p <0.05). Moreover, results revealed that treatment with faecalis species increased IL-6 and IL-10 ( p <0.05). None of the species affected pathogens growth significantly ( p <0.05).

  Conclusion: The results obtained from current study demonstrate that continues treatment with both species can affect immune functions of animal by altering the cytokines profile and treatment with faecium species decreases serum level of cholesterol.

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  Uterus leiomyomas are the most common benign tumors and usually are asymptomatic. This article is a report of an approximately large Myoma (12 × 12 × 21 cm). The subject was a 40-year-old woman with pelvic fracture. While examining, a large mass was found in the pelvic. The patient was transferred to the operation room to further examination. During the surgery an almost constant but stiff mass was found in hypogastrium that overextended to the umbilicus. For the last few months, the patient had some disorders such as constipation and oligomenorrhea but these disorders were not important and discomfortable complaining for the patient. Patient was clinically assumed to have ovarian tumor and referred for laparotomy. After surgery, pathological examination showed that it was a subserosal Myoma.

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  Background &Objectives :�Hyphema which commonly caused by the blunt trauma, is defined as blood accumulation in the anterior chamber of the eye. It is associated with several complications from which secondary hemorrhage is more important. This study was aimed to determine Tranexamic acid effect on reduction of the secondary hemorrhage in traumatic hyphema.

  Methods: This study was a randomized controlled trial in 54 patients with traumatic hyphema referred to ophthalmology clinic of Alavi Hospital in Ardabil during 2006-2008. The patients were divided into two groups. Half of the patients received Tranexamic acid and the rest used placebo. After examination of the eyes, the data were analyzed by using Chi-square^�and Student-t tests.

  Results : In this study 79.6% of patients were men and the rest were women. They had 19.8 ± 9.44 years old as mean. The vision for 33.3% of the individuals showed light perception, 29.6% hand motion and 35.2% of them indicated finger count. 1.9% of patients had grade I, 11.1% grade II, 38.9% grade III and 48.1% grade IV hyphema. The patients who received Tranexamic acid did not show secondary hemorrhage but five untreated individuals were undergone bleeding.

  Conclousion : Tranexamic acid reduced secondary hemorrhage in patients with blunt trauma-related hyphema. We suggest further studies of relationship between intra-ocular pressure and secondary hemorrhage rate.

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 Background & Objectives: Effects of new educational programs on health and physical fitness promotion is an important issue which needs regular evaluations. Physical fitness has many advantages such as cardio-respiratory health promotion, prevention of some diseases and improvement of quality of life. On the other hand, it has been shown that there is significant relationship between waterpipe smoking and cancer, cardiovascular as well as pulmonary diseases. The aim of this study was to evaluate the relationship between addiction to waterpipe smoking and cardio-respiratory fitness and body composition of physical education students in Islamic Azad University, Ardabil Branch.

 Methods: One hundred and eighty-one physical education students participated in this study. All subjects were selected by cluster sampling method. Cardio-Respiratory fitness (using Cooper test), Body Mass Index (BMI), Fat percent (using 2-point Lohman equation), addiction to waterpipe smoking, smoke exposure and awareness of waterpipe effects on athletic performance (using questionnaire) were evaluated.

 Results: The body composition of the most students was not suitable (50.3% extra fat), but the cardio-respiratory fitness of male students was better than that of female students.

 Furthermore, In spite of decrease in waterpipe smoking in comparison to last year (13.3% versus 35.6%), many non-smoking students are exposed to waterpipe smoke (21.0%) and some of them (48.1%) had little information about the harmful effects of waterpipe smoking on athletic performance.

 Conclusion: According to results of this study improvement in cardio-respiratory fitness and body composition of physical education students and enhancement of their information about side-effects of waterpipe smoking should be emphasized

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  Background & Objectives: Diarrhea is one the important causes of mortality among children in developing countries. The effect of zinc supplementation in reduction the rate of diarrhea is controversial. The aim of this study was to evaluate the effect of zinc supplementation on the severity and duration of diarrhea in children less than 5 years old hospitalized in Ali-Asghar hospital in Ardabil, 2005.

  Methods: This study was a double-blind, randomized, placebo-controlled trial including 228 children with acute diarrhea. The subjects randomly assigned into two placebo and experimental groups (114 patients in each group). The placebo group received glucose (5%), while the experimental group received 20 mg/day Zn sulfate. The severity and duration of diarrhea were assessed during the study. Data were analyzed using Chi-square, Pearson correlation coefficient tests and Students t-test by SPSS software.

  Results: Our findings showed that most of the patients in both groups were male (age range 1-12 months, weight range 3-11 kg, weight percentile 3-50). These children had breast feeding and complete vaccination. They were the first baby in their family and the majority of them were from urban area (Ardabil city). The severity of diarrhea in zinc supplemented children (74.6%) was less than placebo group (89.5 % ) (p=0.037). There was no significant difference between two groups in the duration of diarrhea (p=0.737). There also was no relationship between the severity of diarrhea and weight percentile (p= 0.085).

  Conclusion: Our data indicate that zinc supplementation reduces the severity of acute diarrhea and could be advised in children with acute diarrhea.

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  Background & Objectives: Myocardial infarction is one of the most common causes of mortality throughout the world. Utilization of thrombolytic drugs at the first hours upon MI leads to decrease in the rate of mortality. Streptokinase (SK) is commonly used because of its cost and availability. The golden time for maximum effect of SK appeared to be first hours after MI. The drug efficiency diminishes after 3 hours and it will be ineffective after 12 hours.

  This study was aimed to investigate interval between onset of the clinical symptoms and streptokinase receiving in patients with acute myocardial infarction�admitted for drug reception.

  Methods: This cross-sectional study was conducted in 150 patients with STEMI (ST elevation Myocardial Infarction ) who were attended to emergency room of Imam Khomeini hospital and fulfilled a questionnaire containing the data about age, sex, educational level, onset of symptoms, referring time to emergency room, SK utilization, past medical history of cardiac diseases, type and location of AMI, contraindications and side effects of SK.

  Results: In 111 men (74%) and 39 women (26%), the mean for interval between onset of symptoms and drug injection was 8 hour and 27 minutes ± 8 hour and 18 minutes .Only 41% of patients received streptokinase in less than 3 hours after chest pain. The main reasons for delaying in drug consumption were delayed decision to come to hospital in 61% of persons, long distance to hospital for 22% of individuals, delayed admission tor CCU for 13% of cases and delay in physician diagnosis for 0.043% of patients. To have a male sex and residency in city where the hospital was establilished were associated with less-delayed treatment start. However, the educational level, age and history of MI were not correlated with onset of treatment.

  Conclusions: Our results clearly show that the majority of patients receipt streptokinase more than 3 hours after chest pain. With considering the factors associated with delay to receive SK, teaching the patients with ischemic heart disease and giving information about golden time for thrombolytic therapy and its effect in prognosis as well as extending cardiac disease treatment centers in suburbs are recommended.

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  Background & Objectives: Coronary artery disease is the main cause of mortality in developing and industrial countries. Recently the involvement of infectious agents as a risk factor for Acute Coronary syndrome is drafted. So this study was designed to investigate the probable association between Acute Coronary syndrome and Helicobacter pylori infection.

  Methods: This case-control study was carried out on 300 hospitalized patients with the diagnosis of Acute Coronary syndrome (UA and MI) and 300 hospitalized patients without the history of coronary heart disease. Anti Helicobacter pylori Antibody level was determined by as an indicator of infection history. Using chi-square and t- test the results were analyzed in SPSS software.

  Results: Results showed that 79 patients (26.3%) in control group and 122 patients (40.6%) in case group were seropositive and the difference was significant. Relationship between cronory diseases risk factors and levels of IgG was not significant. Also the results showed that the rate of hypertension in seropositive patients in case group was significantly upper than control group.

  Conclusion: Regarding the findings of this study we can conclude that Helicobacter pylori infection probably is a risk factor for Acute Coronary Syndrome. Thus, further studies are needed to elucidate the association between Helicobacter pylori infection and Acute Coronary Syndrome.

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  Background & Objectives: Urinary stone disease is one of the common urinary tract complications that can lead to renal failure. It occurs usually in middle-aged and older men The aim of this study was to determine the association between types of urinary stones and risk factors for urinary stone formation in patients referred to Ardabil therapeutic centers.

  Methods : In this descriptive cross-sectional study, 150 patients with urinary stone were followed from March 2008 to July 2009 in therapeutic centers of Ardabil.

  Data were collected by a questionnaire include demographic factors such as age, gender, body mass index (BMI), Job and Habitation place. Data were analyzed by chi-square test and ANOVA in SPSS 16 software. The level of significance was p<0.05.

  Results: 116 of patients (77.3%) had calcium oxalate stone, 15 of patients (10%) had phosphate calcium stone, 10 of patients (6.7%) had acid uric and 9 of patients (6%) had phosphate ammonium stone. The mean age of patients was 41.90 + 14.41 years (48% of patients were 30-50 years old) and the mean body mass index (BMI) was 25.81+3.66. 91 of patients (60.66%) were male and 59 (39.4%) of them were female. There was no significant difference between types of urinary stones and factors including BMI the job of patient, (p=0.252), habitation place (p=0.173), history of previous illness (p=0.207) and history of drug use (p=0.247).

  Conclusion: The most common type of urinary stones was calcium oxalate (77.3%) in both men and women however ammonium phosphate (6%) is much less common.

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 Background & Objectives: Diabetes mellitus is recognized with severe metabolic complications. Many herbal medicines have been recommended for treatment of diabetes. In this study, the antidiabetic and analgesic effect of hexanic and alcohlic extract Trigonella-foenum graecum was investigated in normal and streptozotocin-induced diabetic rats.

 Methods: Present study was carried out in 2011 at Guilan University of Medical Sciences, 48 male Sprague Dawley rats (230-300 gr) were divided into six groups: control, type 1 diabetic, and 4 treat ed groups that received intraperitonealy hexanic and alcoholic extract of fenugreek (100, 200 mg/kg body weight) for 28 days. Two experimental models were used (acetic acid, and hot-plate tests) in order to characterize the analgesic effect. Blood glucose was measured with glucometer. Data analyzed with spss software 16 and one way ANOVA and Tukey tests. P<0.05 was statistically significant.

 Results: Compared to control rats, both of the aqueous - alcoholic and Hexan ic extract significantly reduced blood glucose level in all diabetics groups. This effect was stronger in groups that received Hexanic extract (p<0.05) . All groups received the aqueous - alcoholic and Hexan ic extract showed analgesic effect but this effect was more clear in the Hexanic 200 mg/kg group (p<0.05).

 Conclusion: Fenugreek extract possesses hypoglycemic , and analgesic effects .

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  Background & objectives: Heart failure is considered as a major cause of hospitalization. Many studies have shown association between sleep-related breathing disorders and heart failure. It has been shown that the relationship between nocturnal hypoxia and left ventricular dysfunction can cause significant morbidity and mortality in patients with congestive heart failure (CHF ). Accordingly, treatment of sleep related breathing disorders (SRBD) can give rise to improvement in CHF treatment too. This study surveys the prevalence of sleep disorder in stable heart failure patients regardless of ejection fraction.

  Methods : This study was a descriptive-analytical study. One hundred and eight patients with heart failure disease were studied. A questionnaire consisting of two parts (part I consistent of demographic information and part II consistent of sleep disorders) and clinical examination (pulse oximetery and echocardiography) were used for collection of data. The data were analyzed with SPSS statistical software using descriptive and analytical tests including the chi-square, Pearson correlation and ANOVA.

  Results: Fifty six persons (51.9%) of patients were female and 52 persons (48.1%) were male with mean age of 65.42 ± 11 years. In total sleep duration, 95 patients (88%) had nocturnal hypoxemia . There was correlation between arterial oxygen desaturation at night and ejection fraction .

  Conclusion : This study confirmed strong associations between nocturnal hypoxia and left ventricular dysfunction and SRBD should be considered in clinical treatment of systolic heart failure.

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  Background & objectives: Addiction is one of the problems in world threating the social, economic and culture factors. It is essential to have an accurate knowledge about the characteristics of drug users in order to diminish the high-risk behaviors of intravenous drug addicts. This research has been done to assess relationship between individual characteristics and high risk behavior in intravenous drug addicts.

  Method: In this descriptive-analytic research, 360 drug users were selected from different places in Ardabil city and interviewed by a prepared questionnaire. The data were analyzed using descriptive and analytical tests including t-test, Pearson correlation and ANOVA with SPSS statistical software.

  Results: The results showed that the age, gender, material status, job position, age of addiction start, age of injection start, injection frequency, injection frequency per day, syringe supply place and the partner’s gender during recent few months had no significant difference compared to drug users with needle sharing and without needle sharing. The educational level of drug users with needle sharing was lower (P=0.037) and the number of new syringe usage per month was also lesser (P=0.001). They predicted to be more likely infected with AIDS (P=0.001) and had a less argument with their partner about using condom, also mostly have not used condom at their last sexual relationship (P=0.001). The average number of their partners during last three months was high (P=0.003) and there was a meaningful relationship between true sense of peril and using condom in drug users with needle sharing group (p=0.001).

  Conclusion: There is a significant relationship between the true sense of danger and the using condom. It is necessary to have an appropriate advertising to increase using condoms among injecting drug users.

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  Background & objectives: Today, the concept of q uality of services is particularly important in health care and customer satisfaction can be defined by comparing the expectations of the services with perception of provided services. The aim of this study was to evaluate the quality of services provided for outpatients in clinic of Ardebil city based on the SERVQUAL model.

  Methods: This descriptive study was conducted on 650 patients referred to outpatient clinic since July to September 201 3 using a standardized SERVQUAL questionnaire (1988 ) with confirmed reliability and validity. The paired t-test and Friedman test were used for analysis of data by SPSS software.

  Results: 56.1 % of respondents were male and 43.9 % of them were female . The mean age of patients was 33 ± 11.91 , 68.9 % of patients were in Ardabil and 27.3 % of them had bachelor's or higher. The results showed that there is a significant difference between perceptions and expectations of the patients about five dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy) in the studied clinic (P< 0.001). The highest mean gap and minimum gap were related to empathy and assurance, respectively.

  Conclusion: Regarding to observed differences in quality , the managers and also planners have to evaluate their performance more accurately in order to have better planning for future actions. In fact, any efforts to reduce the gap between expectation and perception of patients result in greater satisfaction, loyalty and further visits to organizations.