Effects of the Islamic Revolution in Iran on medical education: the Shiraz University School of Medicine.

Some consequences of the Islamic Revolution in Iran on medical education were studied utilizing the Shiraz University School of Medicine. Of the 173 full-time faculty employed in 1978, 108 (63 per cent) had left the university by the end of 1982, and 81 (47 per cent) had left the country, aggravating the chronic shortage of medical personnel in Iran. Steps taken by the Iranian authorities to counteract these trends have not proven effective.

Acceptance of auxiliary health worker in rural Iran.

A pilot project to train and deploy low-level rural health auxiliaries is being carried out in southern Iran. This first group of 16 village health workers (VHW) went to work in the initial 16 project villages early in 1974. The group consisted of 11 men and 5 women ranging in age from 15 to 45. These workers are taught to treat simple medical conditions, to practice preventive health measures, and to conduct health education and visit programs. Six months after initial deployment to the villages, a sample survey of 226 villagers was carried out to determine what characteristics of the VHW and of the consumers were associated with greater acceptance of the VHW's work and his or her role in the village. The results indicated that both male and female health workers are accepted in an equivalent role, and that workers returning to their own villages are no more or no less likely to have difficulties in gaining acceptance than are those returning to a different village. It was found that experience with a VHW of a particular sex could significantly alter attitudes toward the preferred for the VHW. The age of the worker was the only variable closely associated with the villagers' confidence in the worker--the older the VHW, the higher the villagers tended to rate his or her knowledge. In Iran, as in many developing countries, the rural village tends to be a closed, male-dominated group. The experience of the VHWs in Iran makes it apparent that the health worker, regardless of sex, age, or village of origin, can gain the confidence and respect of the villagers.

Factors related to drug abuse among Iranian university students.

Questions related to the use of narcotics were administered to 607 students attending four Iranian universities: Pahlavi University, the University of Tehran, Isfahan University, and Aryamehr University. Twenty-four percent of the students reported that they have used drugs at some time, although only 11% of the students have used drugs more than three times in their lives. Hashish was the most frequently used drug, having been used by 54% of the students who have used narcotics. Ninty percent of the students prefer to ingest the drugs by smoking them. A majority of the students (59%) said that they use drugs for pleasure or to increase sociability. Use of drugs was found to be significantly related to sex, age, number of years of university attended, and father's education. Although proportionately more males than females use drugs, they do not appear to differ significantly from the females in the type of drugs used or the frequency of use. Drug use was not significantly related to the parents' socio-economic status or parents' use of drugs. Exposure to drug use in the university seems to be more closely related to drug use than does parental influence.

Physician migration to the U.S.--foreign aid for U.S. manpower.

Data were obtained from the American Medical Association on Iranian physicians practicing in the U.S., and from the Iranian Medical Registry on U.S.-trained Iranian physicians who have returned to practice in Iran. There were 2,066 Iranian physicians practicing in the U.S. in 1972, 1,234 (60%) of whom were not undergoing any training. Only 600 of Iran's 9,535 physicians in 1972 had been trained in the United States. Thus, less than one-third of the specialists who have completed training in the U.S. have returned to practice in Iran. The specialist group with the highest rate of return is the combined surgery subspecialties (neurosurgery, thoracic surgery, orthopedic surgery, and plastic surgery). The specialist groups with the lowest rates of return were pathology, anesthesiology, and psychiatry. A comparison is made of the manpower problems Iran faces and the American problems in the area of physician manpower.

Causes of physician migration: responses of Iranian physicians in the United States.

Each of the 2,270 Iranian physicians listed by the American Medical Association as residing in the United States in 1973 was sent a questionnaire in which he was asked whether or not he intended to return to Iran, his reasons for not returning if he did not intend to return and other questions concerning his history and present status. A total 760 questionnaires were returned. The results indicated that age, level of training, martial status, and previous practice in Iran were all related to intention to return, although whether or not the physician had returned to Iran on a visit was not an important factor. The most frequently cited reasons for not returning were professional reasons, particularly lack of medical facilities and equipment in Iran.

The front line health worker: selection, training, and performance.

Iranian villagers with basic literacy were recruited, selected, trained, and deployed as Village Health Workers (VHWs) to rural areas of Iran. VHW clinical visit records and activities logs were analyzed to determine levels and nature of effort achieved in the field. Within six months of deployment, the number of patient visits to VHW treatment services constituted 53% of the target population. Within ten months of deployment, the number of family planning acceptors rose from 8% to 21% of the population at risk. Improvements to water supplies have been effected in 50% of target villages. Sanitary improvements have been made to 35% of the houses and 88% of toilets in those villages. Demographic characteristics, class rank, and place of residence of VHWs appear unassociated with village differences in levels of achievement. However, availability of material resources and actual time spent by VHWs on the job may be factors influencing the differences in outcome between villages.

Radiological changes in pica.

The significance of pica and geophagia as a public health problem is well known. The objective radiographic diagnosis of geophagia depends on the abnormal opacification of the bowel as an immediate manifestitation of the condition. The chance of detectability of geophagia is highest in the colon and can be improved by using low penetration films, particularly for smaller amounts of ingested clay. Other radiologic changes frequently associated with the prolonged practice of geophagic are an atonic pattern of the colon, secondary radiographic changes due to iron-deficiency anemia and bone-age retardation. The occurrences of intestinal obstruction due to pica in the presence of preexisting bowel stricture is demonstrated.

Zinc deficiency occurring in females. Report of two cases.

The syndrome of dwarfism, hypogonadism, iron-deficiency anemia and geophagia, first reported in 1960 from Iran, was thought to be limited to males. In 1971-1972 two females with the same clinical features were observed over a 14-month period. The anemia responded rapidly to iron. Growth and sexual development occurred promptly when 120 mg of zinc sulfate was administered daily in conjunction with a well-balanced diet and iron supplement. This diet prior to the addition of zinc sulfate, resulted in gradual but much slower growth and sexual development. Observations in these two patients provide confirmation of the occurrence of human zinc deficiency in females, which responds to large doses of zinc salt.

Combined zinc and iron compared with iron supplementation of diets of 6- to 12-year old village schoolchildren in southern Iran.

The effects of supplementation of the diets of 6- to 12-year-old children in a village near Shiraz in Iran with zinc plus iron or iron alone, together with the indispensable amino acids in the form of egg white protein, vitamins, minerals, and corn oil have been evaluated. Initially 48 of 59 children had zinc concentrations below the minimum found in well-nourished persons. Eight months of supplementation with zinc plus iron (20 mg daily of elemental zinc as carbonate and 20 mg ferrous iron as fumarate) failed to stimulate growth or bone development or to bring about an increase in plasma zinc concentrations. However, supplementation with iron in the above amount was associated with an acceleration of growth in height and weight. The persistence of low concentrations of zinc in plasma and the failure of supplemental zinc to stimulate growth are attributed to the poor availability of both dietary and supplemental zinc resulting from sequestering action of fiber and phytate present in large amounts in the unleavened whole meal bread consumed by villagers. In addition, the results suggest that simultaneous administration of iron and zinc supplements may impair utilization of the metals.