In patients undergoing major abdominal surgery, a colloid-based (with hydroxyethyl starch [HES] 130/0.4) and a crystalloid-based (with lactated Ringer's solution [RL]) volume replacement regimen was compared regarding tissue oxygen tension (ptiO(2)) measured continuously by microsensoric implantable catheters. The ptiO(2) increased in the HES-treated (+59%) but decreased in the RL-treated (-23%) patients. Improved microcirculation may be the mechanism for the better ptiO(2) in the HES group.

OBJECTIVES:To evaluate a multi-method approach to postdischarge sur veillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.DESIGN: Cross-sectional sur vey. SETTING: Academic tertiar y-care obstetric and gynecology center with 54 beds.PATIENTS: All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.METHODS: Infections were identified during hospital stay or by postdischarge sur vey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Sur veillance System. RESULTS:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence inter val [CI 95 ], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge sur veillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI 95 , 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI 95 , 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI 95 , 1.2-11.8; P = .02). CONCLUSIONS:The high response rate validated the effectiveness of this kind of sur veillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454). ABSTRACTThe single most important risk factor for postpartum maternal infection is delivery by cesarean section.1 Maternal morbidity related to infections has been shown to be eightfold higher after cesarean section than after vaginal delivery.2 Reducing the number of deliveries by cesarean section and identifying risk factors for post-cesarean surgical-site infections (SSIs) could contribute to a decrease in maternal morbidity.

Both traumatic experiences in their birth families and multiple placement histories lead to increased mental health problems in foster children. The formation of secure attachments to new caregivers could be a protective factor for foster children. The current study focused on the associations between foster parents' sensitivity, parenting stress and foster children's attachment behavior as well as behavior problems. The sample consists of 48 children (aged from 1 to 6 years) and their foster caregivers. Attachment behavior and sensitivity were observed during home visits. Furthermore, caregiver reports were used to assess parenting stress and children's behavior problems. Compared to normative data, foster children showed lower levels of attachment security and more behavior problems. Foster children's attachment security and behavior problems were predicted significantly or marginally by foster parents' stress and supportive presence.

Birth cohort studies of developmental defects of enamel (DDE) and early childhood caries (ECC) in very low birthweight (VLBW) and normal birthweight (NBW) infants are rare. In this birth cohort of 234 VLBW and 234 NBW infants, we report the incidence of ECC and DDE at 8 and 18-20 mos of corrected age. Infant medical and maternal socio-demographic data were abstracted from medical records at birth. Dental assessments for ECC and DDE (enamel hypoplasia, demarcated and diffuse opacities) were completed at 8 and 18-20 mos. The incidence of hypoplasia was significantly higher in VLBW compared with NBW infants (8 mos, 19% vs. 2%; 18 mos, 31% vs. 8%). The incidence of ECC (International Caries Detection and Assessment System: ICDAS ≥ 2) was 1.4% (8 mos) and 12% (18-20 mos) and was similar between the VLBW and NBW groups. At both ages, using a beta-binomial regression model to control for potential confounders (maternal and infant characteristics), we found increased risk for enamel hypoplasia among the VLBW infants compared with the NBW infants. African Americans had a lower risk for enamel hypoplasia at 18-20 mos. The VLBW infants should be monitored for ECC due to the presence of enamel hypoplasia.

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