The rate of birth trauma in the US has been reported to range between 0.2 and 37 birth traumas per 1000 births. Because of the minimal number of population-based studies and the inconsistencies among the published birth trauma rates, the rate of birth trauma in the US remains unclear. This is a cross-sectional study that was conducted using 890 582 in-hospital birth discharges from the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database. A neonate was defined as having birth trauma if their hospital discharge record contained an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code from 767.0 to 767.9. Weighted data were used to calculate rates for all birth traumas and specific types of birth traumas, and rates and odds ratios by demographic, hospital and clinical variables. Weighted data represented a national estimate of 3 920 787 in-hospital births. Birth trauma was estimated to occur in 29 per 1000 births. The three most frequently diagnosed birth traumas were injuries to the scalp, other injuries to the skeleton and fracture of the clavicle. Significant univariable predictors for birth trauma included male gender, Asian or Pacific Islander race, living in urban or wealthy areas, being born in Western, urban and/or teaching hospital, a co-diagnosis of high birthweight, instrument delivery, malpresentation and other complications during labour and delivery. Birth trauma risk factors including those identified in this study may be useful to consider during labour and delivery. In conclusion, additional research is necessary to identify ways to reduce birth trauma and subsequent infant morbidity and mortality.

PURPOSE Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. MATERIALS AND METHODS A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. RESULTS The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. CONCLUSIONS TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Abstract Objective To assess the adequacy of periconceptional intake of key micronutrients for perinatal health in relation to regular cereal consumption of pregnant women. Design, setting and subjects Low-income pregnant women (n 596) in Pittsburgh, Pennsylvania, USA, who enrolled in a cohort study at <20 weeks’ gestation. These women reported usual dietary intake in the three months around conception on an FFQ. Cereal consumers were women who reported consuming any dry cereal at least three times per week. High risk for nutrient inadequacy was defined as intake less than the Estimated Average Requirement. Results About 31 % of the women regularly consumed cereal. After adjusting for energy intake, race/ethnicity, marital status, breakfast consumption and supplement use, cereal eaters had significantly higher intakes of folate, Fe, Zn, Ca, fibre and vitamins A, C, D and E (all P < 0·01) and were approximately two to six times more likely to have intakes in the highest third of the distribution for folate, Fe, Zn, Ca, vitamins A and D, and fibre (all P < 0·01) than cereal non-eaters. Cereal consumption was also associated with reductions of 65–90 % in the risk of nutrient inadequacies compared with non-consumption (all P < 0·01). Conclusions Encouraging cereal consumption may be a simple, safe and inexpensive nutrition intervention that could optimize periconceptional intake for successful placental and fetal development.

This background note will be updated to include any new developments on the formal negotiations are taking place within the meetings and working groups that have been established under the United Nations Framework Convention on Climate Change and Kyoto Protocol framework. The Rudd Government has emphasised that a major part of Australia’s efforts to control global greenhouse gas (GHG) emissions would be Australia’s participation in international negotiations leading to a global agreement on this issue. Domestically, the government proposed an Emissions Trading Scheme, which is currently being debated in Parliament.Australia participates in a number of bilateral and multilateral climate change partnerships. It is party to both the United Nations Framework Convention on Climate Change (UNFCCC) and the Kyoto Protocol. The main feature of the Kyoto Protocol is that it contains legally binding GHG emissions targets for developed countries that are parties to the Protocol. The Australian Government is currently participating in international meetings intended to shape a future global response to tackling climate change.The formal negotiations are taking place within the various meetings and working groups that have been established under the UNFCCC and Kyoto Protocol framework. This background note will be a ‘living’ document, updated to include any new developments on this front.

In the recent Carbon Pollution Reduction Scheme Green Paper the Rudd Government emphasised that a major part of its efforts to control global gas emissions would be its participation in international negotiations leading to a global agreement on this issue. Australia is party to the Kyoto Protocol, the United Nations Framework Convention on Climate Change, the Asia-Pacific Partnership on Clean Development and Climate, and has a number of bilateral and other international climate change partnerships. There are many forthcoming international meetings that will have a bearing on the creation of a post-2012 international agreement to reduce greenhouse gas emissions. However, not all of them are important for the negotiation of the eventual agreement itself. The purpose of the following paper is to outline the main international forums where this agreement is to be negotiated and to present a timetable of major Australian and international events and meetings leading up to these final negotiations. It also provides an outline of leading organisations which are likely to influence international climate change negotiations. This paper will be a ‘living’ document, updated to include any new developments regarding domestic or international climate change negotiations.

In the recent Carbon Pollution Reduction Scheme Green Paper the Rudd government emphasised that a major part of its efforts to control global gas emissions would be its participation in international negotiations leading to a global agreement on this issue. Australia is party to the Kyoto Protocol, the United Nations Framework Convention on Climate Change, the Asia-Pacific Partnership on Clean Development and Climate, and has a number of bilateral and other international climate change partnerships. There are many forthcoming international meetings that will have a bearing on the creation of a post-2012 international agreement to reduce greenhouse gas emissions. However, not all of them are important for the negotiation of the eventual agreement itself. The purpose of the following paper is to outline the main international forums where this agreement is to be negotiated and to present a timetable of major Australian and international events and meetings leading up to these final negotiations. It also provides an outline of leading organisations which are likely to influence international climate change negotiations. This paper will be a ‘living’ document, updated to include any new developments regarding domestic or international climate change negotiations.

AIM To present the prevalence of dental caries in Bosnia and Herzegovina (BH), to estimate the levels of salivary mutans streptococci and lactobacilli and compare them with caries prevalence in 12-years-old children from different socioeconomic backgrounds. STUDY DESIGN AND METHODS A survey was carried out in 8 cantons of the Federation of BH (FBH) and in Republic Srpska (RS) in 2004. The final sample included 560 12-year-olds. The clinical examinations focused on dental status, expressed as DMFT index, and they were carried out by one examiner, following WHO standard methodologies. Additionally, the study involved 109 12-years old children from Sarajevo, divided in three groups, based on their socioeconomic background. For measuring lactobacillus and mutans streptococci (MS) count in saliva Dentocult LB and Dentocult SM-Strip Mutans were used. Levels of MS and lactobacilli were expressed as a score between 0 and 3, indicating very low to very high levels of SM and lactobacilli. RESULTS The average DMFT of the 12-year-olds was 4.16+/-2.92. On average, 91% of the 12-year-olds were affected with dental caries. The SiC Index was 7.41+/-3.31. Investigating the relationship between caries associated microflora and caries experience in children of different socioeconomic status showed the following: significant difference in caries prevalence was found in children with different living conditions, where children with high socioeconomic status had better oral health compared to the other two groups. For mutans streptococci, 25.7% of the children had mutans class 0, 24.8% class 1, 34.9% class 2 and 14.6% class 3. The mean DMFT for mutans class 0 was 3.50, for class 1 was 4.30, for class 2 was 5.62 and for class 3 was 6.0. For lactobacilli, 38.5% of the children had lactobacilli class 0, 25.7% class 1, 23.9% class 2 and 11.9% class 3. The mean DMFT for lactobacilli class 0 was 4.3, for class 1 was 4.9, for class 2 was 4.8 and for class 3 was 6.0. No significant differences in the level of mutans streptococci and lactobacilli were found between the groups. CONCLUSION There is moderate caries prevalence among BH 12-year-olds (DMFT 4.16+/-2.92). Caries experience varies between children with different living condition but no relation between levels of salivary mutans streptococci and lactobacilli and socioeconomic status of children could be found.

Introduction: Genetic variants of the angiotensinogen gene have been linked to both hypertension and preeclampsia. The M235T polymorphism is more common in hypertension and preeclampsia in some populations. A polymorphism in the angiotensinogen basal promoter region of AGT -217 is more common in African Americans with hypertension. The authors investigated the frequency of M235T and AGT -217 in Caucasian and African American women with and without preeclampsia. Methods: The study was a nested case—control study of primiparous women with singleton pregnancies. Genomic DNA from preeclamptic and control subjects underwent polymerase chain reaction amplification and restriction digestion. Results: The M235T and AGT -217 polymorphisms were both more common in African American women; however, the variants were not more common in preeclampsia. Conclusion: The frequency of angiotensinogen polymorphisms M235T and AGT -217 is different by race; however, these polymorphisms are not associated with an incre ased risk of preeclampsia.

Myeloperoxidase (MPO) is a hemoprotein normally released from activated monocytes and neutrophils. Traditionally viewed as a microbicidal enzyme, MPO also induces low-density lipoprotein oxidation, activates metalloproteinases, and oxidatively consumes endothelium-derived NO. The elevated plasma MPO level is a risk factor for myocardial events in patients with coronary artery disease. Patients with preeclampsia display evidence of the inflammation and endothelial dysfunction associated with oxidative stress in the circulation, vasculature, and placenta. We hypothesized that MPO levels in the circulation and placental extracts from women with preeclampsia would be greater than levels in women with normal pregnancies. Placental extracts were prepared from placental villous biopsies from preeclamptic (n=27) and control (n=43) placentas. EDTA plasma samples were obtained from gestationally age-matched preeclamptic and control normal pregnancies. MPO concentrations were measured by ELISA. Immunohistochemistry was used to determine MPO localization in the placenta. MPO levels in placental extracts from women with preeclampsia were significantly higher than the levels in normal control subjects (546±62 versus 347±32 ng/mL; P=0.025). MPO was found in the floating villi and basal plate of placentas with a greater staining in the basal plates from preeclampsia placentas compared with normal pregnancies. Plasma MPO levels were 3-fold higher in patients with preeclampsia compared with normal control subjects (36.6±7.6 versus 11.0±3.1 ng/mL; P=0.003). In conclusion, MPO levels are significantly increased in the circulation and placenta of women with preeclampsia. We speculate that MPO may contribute to the oxidative damage reported in the endothelium and placenta of women with preeclampsia.

for an Invited Paper for the MAR08 Meeting of The American Physical Society Balancing academic career and children: a personal perspective NINA MARKOVIC, Johns Hopkins University For women in academia, the tenure review and the desire to have children often happen around the same time. How does one cope with the challenges of an academic career while raising small children? From a personal perspective of an assistant professor and a mother, I will discuss the great challenge of efficient time management and the practical strategies to deal with it.

The authors compared postpartum adiponectin levels among women with prior pregnancy-induced disturbances and assessed their association with homeostasis model assessment for insulin resistance (HOMA-IR), the metabolic syndrome (MS), and the Framingham risk score (FRS). Women delivering in 1998 through 2001 and who had gestational diabetes mellitus (n=22), gestational hypertension (n=32), or preeclampsia (n=34) were examined 1 to 2 years after delivery and were grouped-matched to controls (n=29) by age and prepregnancy body mass index. HOMA-IR was increased, adiponectin values were decreased, and there was a higher MS prevalence in women with prior gestational diabetes mellitus (all P<.05). Adiponectin levels were inversely related to HOMA-IR (r=-0.45; P<.0001) and FRS (r=-0.25; P=.007), and a significant trend for decreasing adiponectin values with increased number of MS components was noted (P trend <.0001). Adiponectin concentration remained a significant correlate of FRS and MS irrespective of pregnancy history; a concentration <10.5 microg/mL provided the optimal cutoff to distinguish those with or without MS. Thus, a lower postpartum adiponectin concentration identifies women at increased cardiovascular risk regardless of pregnancy history.

Objectives: We hypothesized that TNF-α would be higher in obese versus lean women with preeclampsia. Methods: Total plasma TNF-α was measured in a nested case-control study of 123 nulliparous lean and obese control women and women with preeclampsia. Results: Adjusted mean TNF-α concentrations were 0.97 ± 0.11 (pg/mL ± SEM) in lean controls, 1.01 ± 0.10 in obese controls, 1.43 ± 0.11 in lean women with preeclampsia and 1.16 ± 0.11 in obese women with preeclampsia. Pregnancy outcome was the single predictor of TNF-α concentration in the general linear regression model (p = 0.04). Conclusion: TNF-α concentration was higher in preeclampsia compared with control subjects. Obesity was not associated with higher TNF-α concentrations in either preeclampsia or control subjects.