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Background: The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk. Methods: In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting. Results: This study included 10992 women who delivered vaginally between 2008–2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 p value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 p value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort. Conclusions: Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss. PLAIN LANGUAGE SUMMARY: An episiotomy is a cut between the vagina and the anus that may be performed by an obstetrician during childbirth and can result in increased blood loss or severe birth tears. In this study, we investigated the risks of both bleeding and severe tears caused by a highly selective local practice of episiotomies below 2% and compared the results with statewide data. The study included 10992 women who delivered between 2008–2018, 171 of whom underwent episiotomies according to the hospital's protocols. Having an episiotomy did not increase the likelihood of severe birthing tears but was associated with an increase in estimated blood loss. Therefore, although highly selective use of episiotomy is unlikely to cause more severe tears, it has the potential to worsen the mother's health by increasing blood loss. [ABSTRACT FROM AUTHOR]

Author(s): Jan Bauer [sup.1], Dörthe Brüggmann [sup.1], Doris Klingelhöfer [sup.1], Werner Maier [sup.2], Lars Schwettmann [sup.2] [sup.3], Daniel J. Weiss [sup.4], David A. Groneberg [sup.1] Author Affiliations: (1) grid.7839.5, 0000 [...], Purpose The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = - 0.57; p < 0.001). Conclusion Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.

Introduction: Tobacco companies conduct and fund research. They are not always interested in open-ended research. They promote their interests through public relations campaigns. It's a proven fact that they influence the scientific community by impairing scientific reputation, especially in the case of health-related research. Methods: To obtain a comprehensive picture of research and funding activities of the tobacco industry as well as studies about the tobacco industry, respective scientific articles were analyzed in terms of temporal aspects, research areas, networking, and funding sources using established and advanced bibliometric methods. Results: We found the foci of publications with tobacco industry involvement or funding were mainly in chemistry, toxicology, pharmacology, and agricultural sciences. Health-related scopes occurred much less frequently. In contrast, health and medical sciences were the main focus of publications on the tobacco industry. The Chinese state-owned CNTC was the most research-involved tobacco company and often networked with Chinese academic institutions. Whereas, Western universities, on the other hand, collaborated with tobacco companies to a much lesser extent. Conclusion: Conflicts of interest of researchers or academic institutions with the tobacco industry occur repeatedly. That is highly problematic and should not be ignored by the scientific community. The science and the public should be skeptical about tobacco industry-supported research. [ABSTRACT FROM AUTHOR]