The Maternal Mortality Ratio is an important public health indicator that reflects both the quality of a health care system and the role of women within that society. In September 2000 the United Nations Millennium Declaration outlined the eight Millennium Development Goals (MDGs) that set targets to be achieved by 2015. MDG 5 focused on improving maternal health. It had two clear subgoals: to reduce maternal mortality globally by three quarters between 1990 and 2015 and to obtain universal access to reproductive health for women. Despite a global trend of declining maternal mortality only a handful of nations are currently 'on track' to achieve their MDG targets by 2015. The Islamic Republic of Iran is one of these nations. In just over three decades, Iran has undergone demographic transition with significant reductions in total fertility and population growth rates. In concert with this transition, Iran has achieved a dramatic decline in the maternal mortality ratio that has fallen to a rate comparable with developed nations. Significantly Iran has also experienced a paradigm shift in its major causes of maternal mortality from those characteristic of developing nations (postpartum haemorrhage, infection) to causes more commonly seen in developed nations (pulmonary embolus, stroke). There is no single explanation that may account for this transition, rather it is the product of a number of different initiatives that have incorporated family planning, grass roots focus and wider improvements within the health care system of Iran over the past three decades. However the experience of this nation may provide a useful example to other developing countries looking to reduce maternal mortality.
True aneurysm of the dorsalis pedis artery is rare. To our best knowledge, only 19 cases have been reported in the literature with one case of bilateral involvement. We describe an unusual case of simultaneous, bilateral true aneurysms of the dorsalis pedis arteries due to chronic mild trauma from dorsally positioned sandal straps with secondary atherosclerotic change. This is the first such case reported. Symptomatic aneurysms are at risk for thrombosis or embolization, and surgical management is recommended. In our case, both aneurysms were resected and repaired with interposition graft of saphenous vein. The patient was symptom free at 6-month follow-up.
Objective: Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design.Method: Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight kg/m 2 ), underweight kg/m 2 ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m 2 ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m 2 ) or non-weight restored (BMI < 18.5 kg/m 2 ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA).
Report of the results of 4 surgically treated epiphyseal injuries with progressing deformities in the lower extremities (3 injuries type V, 1 epiphyseal fracture type IV according to Salter and Harris). Our Surgical procedure consisted in a resection of the posttraumatic transphyseal bony bridge with a following interposition of a silastic block to prevent again transphyseal blocking. The indications for such a surgical procedure is explained possibilities leading to failures are discussed. The results of our experimental studies being the basis for such operations are reported.
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