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Iran in Transition Suppl.Pdf 2,400,000 1,600,000 All subjects Agriculture sciences Art fields Basic sciences Engineering Medical sciences Social sciences Female students (number) 800,000 0 2000 2002 2004 2006 2008 2010 2012 2014 A B Historical timeline of contemporary Iran Sanctions are intensified Anglo- Beginning Sanctions Constitutional revolution Soviet of Iran-Iraq are lifted and foundation of the first Occupation War Iranian parliament of Iran Sanctions End of Iran- Anglo- (WW II) are Iraq War American enforced Coup 1785 1850 1910 1925 1941 1951 1953 1979 1980 1988 2010 2016 Foundation of Pahlavi Islamic Amir Kabir Reforms Dynasty Nationalization Revolution of Iranian Oil 52 wks Industry Reign of Qajar Dynasty 45 wks First Pahlavi Era 23.8 wks Second Pahlavi Era Phase III Islamic Republic Period 6 4 Iran Middle East and North Africa World 2 Fertility rate, total (births per woman) 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Figure 1- Development of modern medical education system in Iran Dar al-Fonun is founded Foundation of the Faculty of Public Health is More than 50 public Department of Medicine is University of Tehran established at the University of medical schools are established at Dar al-Fonun Tehran founded in Iran operates independently 1851 1860 1918 1923 1928 1934 1950 1956 1966 1970 2012 2016 Department of Pharmacy Foundation of is established at Dar al- Shiraz, Tabriz, and Fonun Mashhad Medical Seven medical schools are The first Iranian tutors were Schools founded in different cities of employed at Dar al-Fonun A bill was passed to send Iran student abroad for education Faculty of Dentistry is founded at the University of Tehran Infection control timeline A leprosy rehabilitation center is founded in Khorasan Parliament National approves a Pasteur National malaria National smallpox free institute is A leprosarium is eradication institute of vaccination vaccination founded established in Tabriz program is public health is campaign program launched established 1850 1910 1921 1926 1933 1934 1939 1942 1947 1950 1952 1961 1965 1978 A vaccination Smallpox is official bill is passed Vaccination Institute of A plague eradicated by the department of Malariology A TB research in Iran parliament the Pasteur is founded sanitarium center is Institute is at the is founded formed by Institute of formed Pasteur in Tehran Institute the Pasteur parasitology Institute and Malariology is founded at Pasteur Institute A B 80 40,000 60 30,000 Female Female Male 40 Male 20,000 Life expectancy (at birth) expectancy Life 20 10,000 Population (number in thousands) (number Population 0 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 C D 200 600 150 450 Both Female 100 genders 300 Male 50 150 Adult Mortality Rate (per 1,000) Under−5 Mortality Rate (per 1,000) 0 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Figure Legends Figure 1. Prime Minister Mohammed Mosaddegh. (image may be subject to copyright) Figure 2. Tertiary education attainment rate in Iranian female university students (data from the online database of Statistical Center of Iran at https://www.amar.org.ir/english/Databases-Systems/Time-Series) Figure 3. Artificial eye back to 2800-2900 B.C. (A) and trepanned skull surgery for hydrocephalus from 4800 years ago (B) in Shahr-I Sokhta, (the permission to use these images is granted) Figure 4. Avicenna (image may be subject to copyright) Figure 5. Timeline of major sociopolitical events in Iranian history, 1785 – 2016 Figure 6. Total fertility rate in Iran, the Middle East and North Africa, and the world (data from the online database of the world bank available at https://data.worldbank.org/indicator/) Figure 7. Timeline of major events in medical education in Iran, 1951 – 2016 Figure 8. Timeline of major events in Iran to address public health challenges and infectious diseases, 1850 - 1978 Figure 9. Trends in population size (A), life-expectancy at birth (B), under-5 mortality (C), and adult mortality (D) in Iran, 1970 to 2015 (data from the Global Burden of Diseases 2015 study available at http://www.healthdata.org/gbd/data -A and B-, from the the National and Sub-National Burden of Diseases, Injuries, and Risk Factors, published in Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortalities at national and subnational levels from 1990 to 2015 Mohammadi, Younes et al. The Lancet Global Health, Volume 5, Issue 5, e537 - e544 -C-, and from the online database of the world bank available at https://data.worldbank.org/indicator/) Side panels Panel 1: The approach we followed in the development of this paper (methods) In the preparation of this manuscript, the following steps were designed and followed. We initially developed a preliminary conceptual framework based on the existing historical and well- documented facts about Iranian history of medicine, followed by a systematic review of Persian and English literature to identify sentinel events or breakthroughs for inclusion in this paper. We then identified relevant English and Persian material through searching available databases, including PubMed, Google Scholar, and Scientific Information Database (SID, a Persian database), without any time-period limitation and using different combinations of the relevant words, such as ‘Health’, ‘Medicine’, ‘Sciences’, ‘Research’, and ‘Education’, restricted to Iran. Subsequently, we expanded our search to the references of the manuscripts we found. We did not confine our search to any specific type of manuscript and included all relevant papers, books, and historical reports, both in English and Persian. Then we sorted the extracted milestones and breakthroughs to depict a timeline showing different time periods. We also developed a process to acquire feedbacks from renowned Iranian scholars, who are considered to be experts in the field of Iranian History of Medicine. Moreover, the progressing version of the manuscript was sent to the aforementioned scholars at different stages, and the contents were revised based on their comments and guidance. Furthermore, it was presented in several sessions and the comments of the invited experts were applied to the subsequent revisions of the manuscript. After drafting the main conceptual framework of the paper, using peer discussion interactive method, several rounds of expert peer review were followed to integrate the scientific evidence based on their opinions, to complete all of the pre-defined sections of the manuscript. Panel 2: Medical research and scientific productions From ancient times to the present day, Iran has witnessed formal and non-formal research structures carrying out medical research. However, it was only in recent years that research and scientific productions reached their climax in the country, [1-3] and the invention and production of high-tech products significantly increased. [4] During recent decades, Iranian researchers have been particularly productive in several fields, such as pharmacology, toxicology, chemistry, physics, computer sciences, engineering, and clinical medicine. [5, 6] This upsurge coincides with the introduction of one of the main national conventions in Iran; the ‘Health Innovation and Science Development Plan’, which has been developed based on the ‘2025 Vision of Iran’ document. Indeed, the ‘Comprehensive Scientific Map of Iran’ (which includes the ‘Health Innovation and Science Development Plan’) outlines a coordinated and dynamic collection of goals, policies, strategies, and requisites, which will direct the country toward being recognized as one of the leading nations in science in the region. At several junctures, scientific production was affected by different conditions such as the Islamic revolution, war and political instability. [6-8] Particularly, during the 1980s, as a result of war, embargo, and emigration of many skilled scholars, science production in Iran showed a significant decline. [1, 9] However, in the 1990s, different policies focused on supporting research activities and production of knowledge were adopted. Based on a report in 2010, Iranian science productions had the fastest growth rates in the world and expanded 11 times faster than the mean of world science production growth, only followed by Turkey, with a scientific publication growth rate five times faster than the global average. [3] Most of Iran’s scientific publications are done without research collaboration with the outside world. [10] This could be a major challenge as it may keep the scientists and academics away from the benefits of collaboration and partnership. The proportion of papers produced in collaboration with other countries decreased from 35% in 1996 to less than 20% in 2008. [1] Although this might mean that the country could continue to grow its products despite relative isolations and the difficulties the academics confronted in publishing articles and attending international conferences (due to costs and difficulties in obtaining visas), it calls for actions to reverse this trend. Moreover, limitations in research can be attributed to under-investment in Research and Development (R&D) systems in the country. [11] That aside, only a small fraction (about 0.5%) of these outputs are categorized into the highly cited publication group, i.e. have a notable impact on the academic community. [11] There are also signs that within the last couple of years the growth has slowed down, and hence, more investment is needed if the country hopes to reach leading countries in terms of scientific impact in the future. Panel 3: The national Iranian thalassemia prevention program Beta-thalassemia is one of the most common hereditary diseases in Iran, with 4.5% of the population carrying at least one of the genes (about 10% around the north and south). [12] The Thalassemia Prevention Program was established in 1995-1997 and was designed as a first example of controlling a genetic disease through the primary healthcare network with the main strategy of screening couples intending to get married.
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