Self Evaluation in Department of Communicable Diseases, Faculty of Medicine, Tehran University of Medical Sciences

Introduction: Self evaluation is a process that defines and collects required data to judge about decision making issues at educational system on whether the educational department is fit to educate students? The objective of this study was determining the quality of the structural elements of the department of Communicable Diseases & determining the strengths, weaknesses, opportunities and threats to improve the quality of activities in the department under research. Materials and Methods: The employed method was Mixed methods (qualitative & quantitative research), on the basis of 10 procedural steps and within 8 sections dealing with evaluated factors;such as 1) organizational and management structure 2) scientific board members 3) students 4) Manpower 5) Space of educational research and health care 6) Equipment 7) curriculum 8) satisfaction of graduates, which were studied using 61 criteria and 172 indicators. Five-point Likert Scale was used for the responses in the questionnaire (1 - 1.75 = undesirable, to 4.2 - 5 completely desirable). Finally the data were analyzed using descriptive statistics indices and the assessment software of the Educational Development Center of TUMS. The instruments used in this method included assessment software, interview, observation and self-prepared questionnaire which consisted of 7 questionnaires and 2 check lists. Finding: The results of the research showed that general average of 8 investigating sections was 56.9% as a rather desirable research work. Conclusions: Therefore, it was concluded that function of the educational management in that group was directly in line with evaluation process, but continuing the process of evaluation seems necessary.

Teaching reproductive endocrinology in Iran: Pilot assessment of hospital-based clinical modules for medical students at Tehran University of Medical Sciences

This pilot study evaluated effectiveness and acceptance of a new hospital-based reproductive endocrinology curriculum among Iranian medical students. A voluntary, anonymous questionnaire was used to compare two teaching methods as applied to junior medical students at Tehran University of Medical Sciences. Students were randomly assigned to one of two clinical teaching settings;no student experienced both modules. Coursework for the pilot (experimental) group (n = 19) utilized a teaching approach comprising lectures, genetics laboratory, pelvic ultrasound, small group sessions, and opportunities to observe advanced reproductive technologies such as in vitro fertilization, ICSI, and embryo transfer. A control group (n = 34) received reproductive endocrinology instruction by the ‘traditional curriculum’, consisting mainly of lectures. Students were sampled at baseline and again atthe conclusion of their reproductive endocrinology session. Pre- and post-test data were analyzed for both groups;post-test differences between groups were also compared. No significant differences in mean age or gender mix were identified between the two study groups. Overall, the ques- tionnaire did not identify any significant intergroup differences for any parameter investigated. Although student acceptance rate appeared similar for both educational modules, the ratio of students having a “favorable regard” for reproductive medicine declined only among students randomized to the control group (41.2% vs. 32.3%). This report offers the first data on teaching reproductive endocrinology to medical students in Iran. Both traditional and innovative approaches to teaching reproductive endocrinology were well-accepted by students, although negative post-test responses were more common among students in the control group. While periodic quality assessments for existing clinical teaching methods are necessary, introduction of alternative teaching approaches is also important. Additional studies are planned to evaluate the impact this initiative may have on results on standardized tests measuring reproductive endocrinology knowledge, as well as election of further specialization in training.

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of non-medical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decision-making concerning type of delivery as well as to determine the appropriate medical indications of CS.

Prevalence of retinal pathologies in people over 60 years:the Tehran Geriatrics Eye Study

AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster sampling.After selecting subjects aged 60 and over,optometric,and ophthalmic examinations were done.For retinal examination,a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops.Biometry was done using the IOL Master for all participants.RESULTS:Of 3791 people that were invited through cluster sampling,3310 participated in the study(response rate=82%).The prevalence of retinal pigmented epithelium(RPE)change,drusen,geographic atrophy(GA),hypertensive retinopathy(HTR),nonproliferative diabetic retinopathy(NPDR),proliferative diabetic retinopathy(PDR),choroidal neovascularization(CNV),central retinal artery occlusion(CRAO),myopic retinopathy(MR),branch retinal vein occlusion(BRVO),and central retinal vein occlusion(CRVO)was 27.42%,11.08%,4.52%,3.03%,4.05%,0.54%,0.82%,0.39%,0.20%,0.49%,and 0.19%,respectively.After removing the effect of age,the odds of NPDR were 1.68 times higher in women compared to men(P=0.014).After removing the effect of sex,the odds of drusen,RPE change,GA,CNV,BRVO,and CRVO increased with age.CONCLUSION:There is a higher prevalence of RPE change,drusen,GA,CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values.Considering the correlation of most of the diseases with age and their effects on vision,attention should be paid to these diseases and the related screening programs to prevent vision impairment.

Auto-refraction versus subjective refraction in different phakic and pseudophakic conditions:the Tehran Geriatric Eye Study(TGES)

AIM:To compare the subjective refraction data with non-cycloplegic auto-refraction findings in the geriatric population above 60 years of age according to the different crystalline lens conditions.METHODS:This report is a part of the Tehran Geriatric Eye Study(TGES)that was conducted from January 2019 to January 2020 on elderly population 60 years of age and above in Tehran.The samples were selected by multistage stratified random cluster sampling.Of 3791 individual invitees,3310(response rate:87.3%)participated in this study.All study participants underwent non-cycloplegic autorefraction(auto-refractometer/keratometer Nidek ARK-510)and subjective refraction.RESULTS:Regarding the sphere,eyes with mixed cataract had the worst limits of agreement(LoA:-1.24 to 0.87)and the best agreement was related to the pseudophakic eyes(LoA:-0.83 to 0.54).The highest(0.27±0.31 D)and lowest(0.21±0.27 D)differences between the two methods regarding the cylinder power were observed in eyes with cortical cataract and normal eyes,respectively.The worst LoA between the two methods in measuring the cylinder power was related to the eyes with mixed cataract(LoA:-0.44 to 0.96).Regarding the J0(horizontal/vertical components of astigmatism),the mean values of J0 obtained by auto-refraction were tended more toward against the rule direction in all crystalline lens conditions,and the two methods had the greatest difference in cortical cataract cases(0.05±0.17 D).Regarding the J45(oblique components of astigmatism),the lowest(0±0.11 D)and highest(-0.01±0.12 D)differences were observed in normal eyes and eyes with cortical cataract,respectively.CONCLUSION:The auto-refractometer/keratometer Nidek ARK-510 results in the elderly with different phakic and pseudophakic conditions do not correspond well with subjective refraction findings.This discrepancy in spherical findings is more pronounced in individuals with mixed cataract than in other cases.

Distribution and associated factors of intraocular pressure in the older population:Tehran Geriatric Eye Study

AIM:To determine the distribution and associated factors of intraocular pressure(IOP) in an Iranian elderly population 60 years of age and above.METHODS:The present report is part of the Tehran Geriatric Eye study(TGES),a population-based cross-sectional study that was conducted on the residents of Tehran 60 years of age and above.The sampling was performed using multistage stratified random cluster sampling methods from 22 districts of Tehran,Iran.Demographic and history information,blood samples,and blood pressure were collected from all participants.Ocular examinations included measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,and slit-lamp biomicroscopy.The IOP was measured using Goldmann applanation tonometry(GAT).Corneal imaging and ocular biometry were performed using Pentacam AXL.RESULTS:The data of 3892 eyes of 2124 individuals were analyzed for this report.The mean age of the study participants was 66.49±5.31y(range:60 to 95y).The mean IOP was 15.2 mm Hg(95%CI:15.1 to 15.4),15.3 mm Hg(95%CI:15.1 to 15.5) and 15.1 mm Hg(95%CI:15.0 to 15.3) in all participants,males,and females,respectively.Of the study participants,1.3% had an IOP of ≥20 mm Hg.The mean IOP increased from 15.1 mm Hg in the age group 60-64y to 16.3 mm Hg in the age group ≥80y.According to the final multiple GEE model,the IOP was statistically significantly higher in men than in women.All the studied age groups,except for the 75-79-year-old age group,had significantly higher IOP compared to the 60-64-year-old age group.The IOP was significantly higher in underweight compared to other body mass index groups.Moreover,the IOP had a statistically significant direct relationship with the mean corneal power(mean CP),central corneal thickness(CCT),and systolic blood pressure.CONCLUSION:The present study presents the distribution of IOP in an Iranian elderly population.A higher IOP(within the range 14 to 17 mm Hg) is significantly associated with older age,male sex,high systolic blood pressure,increased mean CP,and CCT.These factors should be considered in the clinical interpretation of IOP.

Isoimperatorin alleviates acetic acid-induced colitis in rats

Objective:To investigate the effect of isoimperatorin on histopathological and biochemical changes in acetic acid-induced colitis rats.Methods:Colitis was induced by intracolonic administration of acetic acid solution(4%v/v)in rats.Rats were divided into six groups including the sham group,the negative control group,the dexamethasone-treated group,and the groups treated with isoimperatorin(0.1,1,and 10 mg/kg/d by gavage).The treatments were administered for three days and then colonic status was assessed by macroscopic,histopathological,and biochemical analyses.Results:Isoimperatorin significantly alleviated colonic damage in a dose-dependent manner and improved histological changes in rats with acetic acid-induced colitis.It also significantly reduced myeloperoxidase,TNF-α,IL-1β,and malodialdehyde levels.Conclusions:Isoimperatorin alleviates acetic acid-induced colitis in rats and may be a potential therapeutic agent for the treatment of colitis.

Late infection after peri-orbital autologous micro-fat graft:a case presentation and literature review

Citation:Pakdel F,Asadigandomani H,Arab Bafrani M,Nozarian Z,Abedinifar Z,Pirmarzdashti N,Jafari B,Siami Z.Late infection after peri-orbital autologous micro-fat graft:a case presentation and literature review.Int J Ophthalmol 2024;17(3):603-606.

Efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19:A randomized placebo-controlled trial

Objective: According to the high prevalence of COVID-19 and the subsequent risk of men's sexual health, we decided to investigate the efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19.Methods: In this study, 70 outpatients who were recovered from COVID-19 without acute respiratory distress syndrome with negative polymerase chain reaction test and a complaint of erectile dysfunction were divided into two groups: 35 patients who received tadalafil 5 mg daily and 35 who received placebo. For each patient, basic assessment of sexual function was performed using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Then, treatment was started from 2 months after complete recovery of COVID-19 with negative polymerase chain reaction test for 3 months. At the end of the treatments, the patients were re-evaluated for sexual function using the complete version of IIEF questionnaire. Finally, the results before and after treatment in the intervention group were compared with those of the control group.Results: Treatment with both tadalafil and placebo improved the patients' sexual function criteria compared to the baseline. However, this improvement was significantly higher in the intervention group with tadalafil than the control group with placebo (p<0.05).Conclusion: Daily administration of tadalafil 5 mg seems to be effective and safe for improvement of erectile dysfunction caused by COVID-19.

用机械涂层技术在Ti-6Al-4V基体表面沉积HA/Ti复合涂层与功能梯度涂层的表征、磨损行为和生物相容性

采用机械涂层技术在Ti-6Al-4V基体表面沉积HA/Ti复合涂层与功能梯度涂层(FGC),对涂层进行表征,对比其磨损行为和生物相容性。制备复合涂层所用初始粉末为50%Ti(质量分数)和50%HA(质量分数)的混合粉末,而FGC分为两层,分别为75%Ti+25%HA和25%Ti+75%HA(质量分数)。XRD结果表明在沉积过程中没有发生相变。此外,由于原始混合粉末中存在Ti颗粒,在涂层和基体之间形成了结合良好的连续界面,特别是在功能梯度涂层样品中。磨损实验结果显示,非梯度复合涂层的摩擦因数约为0.37,在界面处发生突变,而功能梯度涂层的摩擦因数从0.32增加到0.5,在界面处发生平缓变化。磨损表面的SEM像表明涂层的主要磨损机制为磨粒磨损。生物相容性评价结果显示,FGC样品具有更好的细胞黏附和增殖能力。

Insight into small eyes: a practical description from phenotypes presentations to the management

This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.

Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

Comprehensive analysis of the role of ubiquitin-specific peptidases in colorectal cancer:A systematic review

BACKGROUND Colorectal cancer(CRC)is the third most frequent and the second most fatal cancer.The search for more effective drugs to treat this disease is ongoing.A better understanding of the mechanisms of CRC development and progression may reveal new therapeutic strategies.Ubiquitin-specific peptidases(USPs),the largest group of the deubiquitinase protein family,have long been implicated in various cancers.There have been numerous studies on the role of USPs in CRC;however,a comprehensive view of this role is lacking.AIM To provide a systematic review of the studies investigating the roles and functions of USPs in CRC.METHODS We systematically queried the MEDLINE(via PubMed),Scopus,and Web of Science databases.RESULTS Our study highlights the pivotal role of various USPs in several processes implicated in CRC:Regulation of the cell cycle,apoptosis,cancer stemness,epithelial–mesenchymal transition,metastasis,DNA repair,and drug resistance.The findings of this study suggest that USPs have great potential as drug targets and noninvasive biomarkers in CRC.The dysregulation of USPs in CRC contributes to drug resistance through multiple mechanisms.CONCLUSION Targeting specific USPs involved in drug resistance pathways could provide a novel therapeutic strategy for overcoming resistance to current treatment regimens in CRC.

Efficacy and safety of bamlanivimab in patients with COVID-19:A systematic review and meta-analysis

BACKGROUND Monoclonal antibodies(mAbs)have shown clinical benefits against coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Several studies have reported the use of bamlanivimab as a promising treatment option for COVID-19.AIM To synthesize the latest evidence for the efficacy and safety of bamlanivimab alone in the treatment of adult patients with COVID-19.METHODS A literature search was conducted in PubMed,Cochrane Library,Web of Science,medRxiv,and Google Scholar using“SARS-CoV-2”,“COVID-19”,“LY-CoV555”,and“Bamlanivimab”keywords up to January 25,2023.The quality of included studies was assessed using the Cochrane bias tools.The Comprehensive Meta-Analysis software version 3.0 was used to analyze the data.RESULTS A total of 30 studies involving 47368 patients were included.A significant difference was observed between the bamlanivimab and standard of care/placebo groups in terms of mortality rate[risk ratio(RR)=50,95%confidence interval(CI):0.36-0.70],hospitalization rate(RR=0.51;95%CI:0.39-0.68),and emergency department(ED)visits(RR=0.69;95%CI:0.47-0.99);while the two groups exhibited no significant difference in terms of intensive care unit(ICU)admission(P>0.05).Compared to other mAbs,bamlanivimab was associated with a higher rate of hospitalization(RR=1.44;95%CI:1.07-1.94).However,no significant difference was detected between the bamlanivimab and other mAbs groups in terms of mortality rate,ICU admission,and ED(P>0.05).The incidence of any adverse events was similar between the bamlanivimab and control groups(P>0.05).CONCLUSION Although the results suggest the efficacy and safety of bamlanivimab in COVID-19 patients,further research is required to confirm the efficacy of this drug for the current circulating SARS-CoV-2 variants.

Prevalence of Anemia in Patients with Diabetes Mellitus:A Systematic Review and Meta-Analysis

Objective Anemia is a common public health concern in patients with type 2 diabetes worldwide.This study aimed to identify the prevalence of anemia among patients with diabetes.Methods Electronic databases,including PubMed,Scopus,Web of Sciences,and Google Scholar,were searched systematically for studies published between 2010 and 2021.After removing duplicates and inappropriate reports,the remaining manuscripts were reviewed and appraised using theNewcastleOttawa Scale(NOS)tool.A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17.Heterogeneity of the studies was assessed using the Q statistic.Results A total of 51 articles containing information on 26,485 patients with diabetes were included in this study.The articles were mainly from Asia(58.82%)and Africa(35.29%).The overall prevalence of anemia was 35.45%(95%CI:30.30–40.76),with no evidence of heterogeneity by sex.Among the two continents with the highest number of studies,the prevalence of anemia in patients with diabetes was significantly higher in Asia[40.02;95%CI:32.72–47.54]compared to Africa[28.46;95%CI:21.90–35.50](P for heterogeneity=0.029).Moreover,there has been an increasing trend in the prevalence of anemia in patients with diabetes over time,from[15.28;95%CI:9.83–22.21]in 2012 to[40.70;95%CI:10.21–75.93]in 2022.Conclusion Globally,approximately 4 in 10 patients with diabetes suffer from anemia.Therefore,routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.

Myelopathy as a Presentation of Cervical Spine Metastasis: A Case Report

Cervical myelopathy is a consequence of spinal cord compression in the cervical spine. Degenerative cervical spondylosis, osteophytes, discosteophyte complex, degenerative spondylolisthesis and hypertrophy of ligamentum flavum are the main etiologies of cervical myelopathy. Metastasis to cervical spine could be a rare cause of cervical myelopathy. The present study is a case report;presented a 36-year-old male with severe pain in cervical region, gait disability and impairment in sensory and motor function of upper left extremity. The patient had a history of thyroidectomy and cervical lymph node dissection due to follicular thyroid carcinoma (FTC) with improper follow-ups. He was diagnosed with metastatic cervical myelopathy and underwent surgical treatment. Cervical myelopathy due to metastasis is a rare condition and only few cases have been reported so far. So myelopathies can be a complication of metastatic cancers, and it should be considered by health professionals.

Antibiotic resistance and carriage class 1 and 2 integrons in clinical isolates of Acinetobacter baumannii from Tehran,Iran

Objective:To investigate antibiotic resistance and carriage class 1 and 2 integrons in clinical isolates of Acinetobacter baumannii(A.baumannii)from Tehran,Iran.Methods:Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute.The presence of integrons was investigated by PCR using specific primers.Results:Among isolated A.baumannii strains,82%were multidrug resistant,27 samples(54%)were resistant to three or more than three antibiotics and 16 samples(32%)showed resistance to two antibiotics.Integrons were detected from 44 of 50 isolates(88%),with classes 1 and 2 being observed in 42%(21/50)and 82%(41/50)of isolates,respectively.Integron-positive A.baumannii isolates showed higher antibiotic resistance than integron-negative isolates and all showed a multidrug-resistant phenotype.Conclusions:Our findings show that classes 1 and 2 integrons,and especially classes 2 integrons are widely disseminated among A.baumannii strains isolated from Tehran and these structures are playing a major role in the acquisition of multidrug resistance in these strains.So monitoring of drug resistance with investigating carriage class 1 and 2 integrons is very important to plan specific infection control measures due to multidrug resistance A.baumannii in Iran hospitals.

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

Objective:To identify the frequency of syphilis among Iranian HIV-positive patients.Methods:A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital,Tehran,Iran.The lab tests including CD4 cell count,cerebrospinal fluid,veneral disease research laboratory(VDRL),fluorescent treponema antibody-absorption(FTA-Abs)and viral load were performed for all the patients.Data regarding medical history and their demographics were also collected.Results:Of all 450 HIV-positive patients,24(5.3%)had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45%of them had a definite co-infection of syphilis.65.3%of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%.We did not find any patient with neurosyphilis.Conclusions:Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations,the diagnosis of syphilis should be timely established using screening tests among such patients.

Estimating the Outdoor Recreational Value of Lavizan Jungle Park of Tehran Using Contingent Valuation Method (CV)

Natural resources and its condition have always had a key role in economic and social developments of different societies around the world and these resources are considered as natural capital and bankroll of economic growth and development for every country. In the present study, we have evaluated the outdoor recreational value of Lavizan Jungle Park of Tehran and its visitors’ willingness to pay per visit (WTP) by using Contingent Valuation method (CV) and two-dimensional choice questionnaires. We used 125 questionnaires and logit model in order to evaluate the WTP. The purpose of this study is to measure individuals’ willingness to pay for visiting and preserving the environment of Lavizan Park as well as indicating the relationship between influential factors on their WTP. Estimating the value of natural resources is very important in making environmental preservation policies because preserving these natural attractions, as a part of ecotourism, is highly important. JEL Classification: Q29, Q51, C25.

Prevalence of HIV infection and the correlates among homeless in Tehran,Iran

Objective:To determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran,Iran.Methods:In 2007-2008,Tehran municipality stacked up 10657 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS(IRCHA)departments to conduct HIV infection prevalence surveys in homeless populations.The results were analyzed for associations with demographic information,family support,status of drug abuse and relation with family and friends.Results:Overall HIV prevalence was 1.7%(95%confidence interval 1.4-1.9).Factors independently associated with HIV infection included history of using drugs[AOR 8.15(4.86-13.67)].older age[AOR1.80(1.08-2.99)for 40-55 yr],occupation[AOR 1.64(1.19-2.24)for unemployed],and no relation with family[AOR 1.82(l.30-2.54)|.Conclusions:This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless.Harm reduction programs should be expanded,particularly among homeless injection drug users.