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Background: Hypertension is a serious health hazard and an important factor in disability and mortality. Regarding the importance of effective preventive and control measures, this study was carried out with the aim of determining the effect of family counseling on controlling blood pressure in women suffering from hypertension in Nimavar (a village in Zanjan province) 2004. Materials and Methods: This quasi-experimental study was conducted on women suffering from hypertension who were selected through convenience sampling access method. Blood pressure of all married women of the village was measured according to international league of blood pressure standard and women with blood pressures over or equal to 140/90 mmHg within three measures, entered the research. To confirm the validity of the questionnaire, we used the content validity method and to confirm the reliability we used test retest method. Then, the counseling plan was performed on patients’ families for a month (almost 10 sessions for each family according to the requirements) and blood pressure of the suffering women was measured on a weekly basis. Mean blood pressures of samples were recorded a month before, during the counseling and two months after counseling. Difference in blood pressure before and after counseling was analysed using variance analysis and t-test. Results: The survey of 41 women suffering from hypertension results revealed that the mean systolic blood pressure of the patients declined from 166.3±18.2 mmHg before counseling to 141.2±12.9 mmHg after counseling. Besides, the mean diastolic blood pressure declined from 102.9±7.49 mmHg before counseling to 90±26.2 mmHg three months following counseling (P=0.0001) there was a significant difference in systolic and diastolic pressure between the first month, the second month and the third month before and after counseling (p=0.0001) Conclusion: The results indicated that family counseling could be an effective way of controlling hypertension. Thus, regarding the research society and sample size, efficacy of the procedure should be tested in urban societies using more extensive studies.

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Background: BPD is generally observed in premature neonates needing oxygen (direct or ventilated), and to reduce its effects various studies have been carried out with different results. In this study the effect of vitamin A in prevention of chronic lung disease in premature neonates under 2500 gr was investigated in Zanjan within the years 2003-2004. Materials and Methods: In this double blind clinical trial premature neonates under 36 weeks of age and birth weight of under 2500 gr were included in the study in case of need to oxygen during first three days of birth and neonates who died during three days of birth and those with congenital disorders and distinct heart condition were excluded from the study. At first 66 neonate were selected of whom 12 cases were excluded from the study. The survivors were randomly categorized into two groups: a control (28 cases) and a treatment (26 cases). Treatment group received 10000 IU vitamin A intramuscularly on the 4th and the 8th days. The variables need to complementary oxygen – neonate weight on 28th day, and mortality rate up to 28th day – were considered as outcome indices. The results were analyzed through statistical tests , relative risk and 95% confidence interval in community. Results: 54 neonates were followed up to 28 days following birth. One case from treatment group and 3 cases from control group died before reaching the 28th day. Of 50 survivors 6 cases in treatment and 12 cases in control group were found to be oxygen dependent (Oxygen Saturation <95%). On the 28th day no significant difference was observed between the two groups in weight gain (p=96%) need to oxygen (p=77%) and mortality rate (p=336%). Conclusion: Although the results of this study show no decline in BPD rate, mortality rate and no gain in weight of neonates, we can not reject the effect of vitamin A with higher doses. Thus, further research with higher sample size and higher dose of vitamin A specially in neonates under 1500 gr of weight is recommended.

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Background & Objectives: Water - related diseases are among the most important public health problems in developing countries and providing the people with safe water is a key factor in health promotion. Thus, the present study was conducted to investigate the effect of adolescents' participation on drinking water habits of Rostam Abad village in Bouin Zahra in 2004.
Materials & Methods: This research is a quasi - experimental study with 36 adolescent cases that covered 102 families. At first, training sessions were held for the adolescents and then each of them took charge of a few families (average 3 families) for education and control. Ultimately, the percentage of rural families who used healthy water (chlorinated or boiled) before and after adolescents' participation was compared. To compare the mean consumption of safe water pre and post intervention t-test was used.
Results: The results showed that none of the rural families consumed healthy water before intervention. However, 68.8% of the families used healthy water after intervention. Paired t-test showed a significant difference between mean consumption of safe water pre and post intervention (P=0.001). Conclusion: Adolescent participation affects the index of providing and consumption of healthy water in rural areas. Thus, it is suggested that this approach be applied as a practical means to increase the healthy water consumption in rural areas.

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Background & Objective: Nurses form the most significant sector of the health care provision and play a fundamental role in providing on-going quality care for patients. To attain clinical competency, it is essential to understand the factors influencing it. Due to the fact that clinical competency is directly affected by specific features of the educational and health care system and the medical training within each country, it is necessary to assess the factors influencing clinical competency.
Materials & Methods: This study was based on the Grounded Theory method. The sample of 36 comprised of clinical nurses, as well as trainers and managers within the Ministry of Health and Medical Training, Nursing and Midwifery faculties, hospitals and members of the Nursing Council in Tehran. Data was obtained through semi-structured interviews, which were recorded and subsequently transcribed. The analysis was carried out by the Straus and Corbin method.
Results: In this study, personal factors were identified as one of the contextual factors affecting clinical competency. The respondents branded this category as “the internal and personal factors”. This included a significant number of sub-categories such as education and skill, moral values, consciousness responsibility and accountability. Another category was identified as “the external and organizational factors” which included categories such as educational and clinical environments, work license, control and supervision and effective educational system.
Conclusion: The clinical competency process resulted from the interaction between three factors ethics, effective experience and environmental factors.

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Background & Objective: Studies have reported a relationship between serum ferritin and some components of insulin resistance, as well as an increased risk for type 2 diabetes. Therefore, it is probable for the dietary content of iron to have an influence on the development of diabetes. In this study, the iron intake in first-degree relatives of type2 diabetic patients with normal or impaired glucose tolerance was investigated.
Materials & Methods: Based on the results of OGTT, 210 first-degree relatives of type 2 diabetic patients were divided into 2 groups with normal and impaired (diabetic, IGT) glucose tolerance. Using a 3-day food questionnaire, the daily intake of energy, red meat, fish and poultry meat, magnesium, iron, zinc, and chromium was calculated and compared between the 2 groups.
Results: The mean age and BMI were 48.9 ± 5.2 years and 43.7 ± 6.7 years (P=0.373) and 29.3 ± 0.7 kg/m2 and 28.7 ± 0.8 kg/m2 (P=0.654) in impaired and normal groups, respectively. Iron intake was significantly higher in impaired group in comparison with normal subjects. (P=0.015), however, no significant differences were observed between the two groups concerning the intake of other nutrients.
Conclusion: Keeping the role of other risk factors in mind, the higher iron intake observed among subjects of the impaired group shows a probable relationship between an increased intake of iron and a higher risk in developing type2 diabetes.

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Background & objective: FMF is an autosomal recessive genetic disorder characterized by acute episodes of fever accompanied by severe abdominal pain, pleurisy, arthritis, and skin rashes. Clinical symptoms of the disease vary considerably in patients, and little is known about the origin of this variation. This study investigates a male patient suffering from severe FMF and his parents.
Materials & Methods: The subject was a six-month-old boy with recurrent fever accompanied by severe abdominal pain and skin rashes. Molecular screening was conducted through polymerase chain reaction (PCR) and sequencing exon10 of MEFV gene.
Results: The investigation to indentify common mutations، using ARMS-PCR and exon 10 sequencing revealed an M697/M680I compound heterozygote mutation in exon 10 of the related gene. Patient′s father and mother were heterozygote for mutations M680I and M694V, respectively without having the history of FMF attacks.
Conclusions: It seems that accompaniment of mutations M680I and M694V even in compound heterozygote form might lead to severe phenotype FMF. This is the first report of early onset and severe phenotype FMF case associated with a 694V/680I compound heterozygote mutation in Iran.

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Background and Objective: Although there are several methods of treatment of osteoporosis, prospective studies to compare their effect on bone density in Iranian population are rare. This study was designed to compare the effect of alendronate and hormone replacement therapy on bone mineral density of postmenopausal Iranian women living in Zanjan.

 Materials and Methods: We treated 115 women (mean age 54/8±9 years). Twenty four women were treated with conjugated equine estrogen (0.625 mg), 5 mg medroxyprogesterone, and 1000 mg elemental calcium with 400 IU vitamin D daily. Forty four subjects received 10 mg/d alendronate plus calcium and vitamin D in the same dose and 37 women were taken placebo with 1000 mg/d calcium and 400 IU/d vitamin D. Their bone mineral densities (BMD) were measured at the lumbar spine, hip and mid radius every 12 months for three years. All cases with secondary osteoporosis were excluded from the study.

Results: Significantly a higher percentage increases in BMD at the lumbar spine (P< .008, 2-way analysis of variance) were found in the alendronate group than in the HRT and calcium + vitamin D groups throughout the 36-month study period. However, there was no difference in BMD at the femoral neck and mid-radius between alendronate and HRT groups. Treatment with alendronate resulted in a 11% increase at the L-spine BMD (P: 0/00). A non significant reduction of about 4% at the femoral neck BMD was detected in alendronate group at the end of the 3-year study period. Although there was no significant change in the femoral neck, lumbar spine or mid-radius BMD with HRT, a significant decline (about 9%) in the BMD of the femoral neck was observed in the placebo group (P: 0.004). There was no difference in upper gastrointestinal or drug-related side effects between the groups.

 Conclusion: Our data suggest that the use of alendronate was well tolerated for 3 years and significantly increased BMD at the L-spine. It also can reduce the rate of BMD reduction at the femoral neck as was seen in the placebo group in postmenopausal Iranian women. Although HRT can inhibit BMD reduction at the femoral neck and lumbar spine, this regimen can not increase BMD in postmenopausal Iranian women.

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Background and Objectives: Thalassemia is a hereditary hemolytic anemia requiring life-long transfusion treatment. The frequent blood transfusion has some side effects, including immunologic reaetions and non-immunologics such as iron overload and transmission of some infections such as HBV, HCV and HIV. This cross-sectional study was aimed to investigate the transfusion effects in patients referred to the Adult Thalassemia Clinic, Tehran.
Materials and Methods: For data collection, the patients were asked for the history of transfusion reactions, their files of medical records were surveyed with concern to transfusion status and reactions, and some laboratory data including serum ferritin and TTI were also collected. The results were analyzed using SPSS software.
Results: Foun hundreds and forty one patients comprises of 53% males and 47% females with mean age of 22.6 years were studied. They consisted of 362 (82.1%) thalassemia major and 79 (17.9%) thalassemia intermediate. The mean of ferritin level was 1856.4 ng/dl. From the studied subjects, 7 (1.6%) had history of delayed hemolytic disorder, 25 (6.1%) presented with allergy and 41 (9.9%) showed febrile transfusion reaction. The remaining 368 subjects (82.4%) showed no evidence of transfusion reactions. The records showed that 117 patients (28.4%) were HCV Ab positive, 369 (88.7%) were HBsAb positive and 80 (19.2%) were HBcAb positive, 3(0.7%) HBsAg positive. According to this results, 300 patients (70.3%) were vaccinal positive; 66 (15.5%) were immune to HBV from past infections; 40 (9.4%) were negative and 3 (0.7%) were carrier of HBV. Totally, 366 (85%) patients were immune to HBV. We had no case of HIV positive.
Conclusion: Transfusion reaction and their documentation are very important for blood transfusion services and programming. Unfortunately, there is no statistic records of these reactions in the hospitals or there may be some unclassified data in the patients’ files. Regular co-operation between hospitals and blood transfusion centers is required for collecting the information and finding total incidence of transfusion reactions. Hemovigilance or computerized network between blood bank centers in hospitals and Iran transfusion organization is the best way for collecting such data.

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Recognition and Frequency Determination of Common Allergens in Allergic Patients of Zanjan City by Skin Prick Test Ahmadiafshar A1, Sepehri S2, Moosavinasab SN3, Torabi SZ1 1 Dept of Pediatric, Ayat-ul-Alah Moosavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran 2 Zanjan University of Medical Sciences, Zanjan, Iran 3 Dept of Social Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Corresponding Author's Address: Dept of Pediatric, Ayat-ul-Alah Moosavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran E-mail: akefeh45@zums.ac.ir Received: 13 Jan, 2008 Accepted: 24 Nov, 2008 Background and Objective: Recognition of various environmental allergens is of great importance. Since contact with them may cause or accelerate sympotoms in allergic patients. Our purpose of this study was to determine sensitivity to common allergens by skin prick test. Materials and Methods: Patients with allergic rhinitis, asthma and atopic dermatitis referred to Allergy Clinic of Valie Asr Hospital of Zanjan City, 2003-2005, were submitted to skin prick test with a series of indoor, outdoor and food allergens. Results: Two hundred patients (111 females and 89 males) 4-60 years of age were recruited. Eighty three percent of subjects showed at least one positive skin prick test. The skin prick tests were positive for grass (Rye grass 41%), weed (pigweed 27%, Herb 21%), Tree (olive 22%, Ash 20%, Butirytis 19.5% ), Mites (D.P 16%, D.F 16%), Cockroach 14.5%, feather11%, Mold (Aspergillus 11.5%, Alternaria 7.5%), Food (Wheat 9%, Pepper7.5%, Egg 6.5%). Conclusion: According to the freguency of positive skin tests to pollens in our patients, it seems that avoiding contanct with these agents in related seasons, treatment ineluction, drug dose acceleration and desensitization procedures would be of great help in allergic patients.

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Background and Objective: Conflicts among health care personnel including nursing personnel who require extensive interaction with different people, is common and almost inevitable. As there is not sufficient information about the causes, types, and dimensions of interpersonal conflicts among clinical nurses and the adverse effects of these conflicts on the function of nursing team in Iran, we aimed to perform this study in order to find out causes of different inter-group or inter personal conflicts among nurses using qualitative research method and Grounded Theory Approach (GT). Materials and Methods: The data was collected through interviews. Constant comparison method was used in order to perform qualitative analysis. Results: Open coding process resulted in emergence of causal conditions and different types of conflicts within the nursing society. Exposure to imposed conditions, confronting with opposition, disagreement and destructive behaviors were indicative of characteristics of conflicting events and tasks, process, relational and marginal conflicts which were major categories of conflict in clinical settings. Feeling threats towards benefits was recognized as the main apprehension of participants. This core variable can explain how conflicts occur and develop within nursing society according to conflicts of benefits. Conclusion: The findings showed that individual factors and intra as well as extra-organizational factors were major and/or contextual causes of inter-group conflicts among nurses. One of the significant and interesting findings in this study was that the conflicts did not affect the occupational function of nurses despite the significant effect on marginal issues in their work environment. The study also showed that these conflicts are part of simulation process in nursing tasks. Key words: Occupational Conflicts, Interpersonal Conflict, Nursing, Clinical Environment.

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Background and Objective: Spoligotyping is a method based on 36bp Direct Repeat (DR) chromosomal loci polymorphism which is connected to one or two 35-41 bp spacer sequences. There are 94 different intra DR spacer sequences which are identified so far and only 43 of them are used as usual. Mycobacterium tuberculosis complex strains can be identified based on lacking or having these sequences. Materials and Methods: Spoligotyping test was carried out on 238 TB smear positive patients. Primary separation of mycobacterium strains was done through Petrof 4% method and Lowenstein Jensen (LJ) media. Biochemical tests such as Niacin test/Catalase activity/Nitrate reduction were done in order to identify the strains. Drug sensitivity to INH (0.2Mg/ml)/ RIF (40Mg/ml)/ STM (10Mg/ml) and ETBl (2Mg/ml) identified by proportional method and according to that, the strains were divided into three groups: sensitive, multi drug resistance (MDR) and non MDR. Then DNA was extracted by CTAB method from the positive colonies. Sequences were amplified by PCR and after denaturizing, hybridization with Streptavidine peroxidase enzyme was performed by Line reverse blot method. Radiography was done after adding the Luminoscense and membrane onto the X-ray films. Results: Serotypes were divided into 9 groups (Beijing/ CAS1/ Haarlem / U/ T2/ T1/ EAI3/ EAI2 and CAS2). Most of the strains were from Haarlem (27%) and CAS1 (25%) groups. Two strains were also identified in this method that belonged to Mycobacterium bovis. Conclusion: Spoligotyping method is an easy, rapid and sensitive test in order to identify Mycobacterium tuberculosis complex strains.