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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.

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., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there's little evidence and recommends further evaluation., Objective: The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia., Design: This study was a retrospective cohort study., Sample: This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018., Methods: Neonatal and maternal outcome was analyzed and compared between women receiving "walking" epidural anesthesia and women without an epidural anesthesia., Results: Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)"., Conclusion: Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery., (© 2023. The Author(s).)

The European Commission's current efforts to launch the largest proposal to restrict per- and polyfluoroalkyl substances (PFAS) in history reflect the dire global plight of PFAS accumulation in the environment and their health impacts. While there are existing studies on PFAS research, there is a lack of comprehensive analysis that both covers the entire research period and provides deep insights into global research patterns, incentives, and barriers based on various parameters. We have been able to demonstrate the increasing interest in PFAS research, although citation numbers are declining prematurely. Policy regulations based on proving and establishing the toxicity of PFASs have stimulated research in developed countries and vice versa, with increasing emphasis on ecological aspects. China, in particular, is investing increasingly in PFAS research, but without defining or implementing regulations - with devastating effects. The separation of industrial and environmental research interests is clear, with little involvement of developing countries, even though their exposure to PFAS is devastating. It, therefore, requires increased globally networked and multidisciplinary approaches to address PFAS contamination challenges., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Cannabis is a widely used drug like tobacco and alcohol. In the meantime, it is also prescribed for medical treatment in some countries. Tobacco smoke contains chemical carcinogens and particulate matter (PM) that are both harmful to health. Method: In this study, we investigated PM levels in second-hand smoke (SHS) of hand-tamped cannabis cigarettes compared to cigarettes with tubing tobacco and the 3R4F reference cigarette. Results: It could be demonstrated that the largest proportion of the particle mass is attributable to particles with a diameter of less than 1μm and that every tested cigarette emitted more PM than the 3R4F reference cigarette. In addition, our data clearly revealed that cannabis smoke contains higher PM levels in SHS than tobacco cigarettes. Compared to the reference cigarette, the PM 1 emissions of cannabis were 105% higher. Also, the cannabis mixed cigarettes had higher PM levels than the 3R4F cigarettes. For instance, the PM 10 emissions were 93% higher. Also, the Gauloises Mélange tubing tobacco also reached higher PM concentrations than the 3R4F cigarette. Discussion: Regardless of negative health effects, cannabis is seen as a harmless drug in the public eye. We found strong indications for potential health risks by PM from cannabis products and, therefore, the public should be educated about a potential harm.

Following the current outbreak, the mpox virus (formerly: monkeypox virus) is a highly threatening pathogen with public health significance, although mpox is still considered a neglected disease. Previously confined mainly to Africa, the virus spread globally in 2022. However, knowledge about mpox is limited, causing a distorted perception of the disease. Therefore, this study aimed to collect all information on scientific mpox publishing and to analyse them according to their chronological, geographical, and epidemiological patterns. It was not until the global outbreak that the relatively small number of publications was replaced by the immense increase in annual publication numbers. The most important player is the USA with a central role in international networking. They collaborated mainly with the Democratic Republic of Congo, a primary endemic country where the first viral clades were determined. Nigeria and other African countries were also represented, although mainly in the form of co-authorships. The fact that few of the first authors are from low- or middle-economic countries demonstrates the need to promote equitable networking at the global level and their support for surveillance and targeted immunization programmes.

Currently, West-Nile virus (WNV) is spreading worldwide to colder regions due to climate change. Human mortality and morbidity are prevalent and steadily increasing, associated with costs to public health systems. Therefore, the question of the impact of scientific engagement arises. What trends, barriers, and incentives for research related to global burdens are important in this context? To answer these questions, this study provides detailed insights into the publication patterns of WNV research and interprets them using several parameters, such as absolute and relative publication indices and socioeconomic and epidemiological characteristics. It is shown that national interests combined with regional outbreaks significantly influence publication intensity. Thus, a correlation between national publication volume and the number of WNV cases was observed. In contrast to most life science topics, the scientific interest in WNV significantly decreased after 2006. The USA, as the main actor in WNV research, is at the centre of international networking. Recently, European countries are also getting involved according to their new-emerging outbreaks. The results demonstrate national interest in research activities with a lack of globally focused approaches that are urgently needed to better understand and assess the distribution and characteristics of WNV.

Introduction: Studies have shown that pregnant women with COVID-19 have a higher risk of intensive care unit admission and invasive mechanical ventilation support than non-pregnant women. Pregnancy-associated physiological changes in respiratory function may contribute to the elevated risk. Alteration in lung volumes and capacities are attributed to the mechanical impediment caused by the growing fetus. Multiple pregnancies may therefore compromise functional lung capacity earlier than singleton pregnancies and contribute to severe respiratory symptoms of COVID-19., Materials and Methods: A total of 5514 women with a symptomatic SARS-CoV-2 infection during pregnancy registered in the COVID-19 Related Obstetric and Neonatal Outcome Study were included. The COVID-19-related adverse maternal outcomes were compared in 165 multiple versus 5349 singleton pregnancies. Combined adverse maternal outcome was defined as presence of COVID-19-related hospitalization and/or pneumonia and/or oxygen administration and/or transfer to ICU and/or death. Multivariate logistic regression was used to estimate the odds ratios and 95% confidence intervals were calculated., Results: The frequency of dyspnea, likelihood of developing dyspnea in a defined pregnancy week and duration of the symptomatic phase of the COVID-19 infection did not differ between the two groups. On average, COVID-19-related combined adverse outcome occurred earlier during pregnancy in women expecting more than one child than in singleton pregnancies. The overall incidence of singular and combined COVID-19-associated adverse maternal outcomes was not significantly different between groups. However, regression analysis revealed that multiple gestation, preconceptional BMI > 30 kg/m 2 and gestational age correlated significantly with an increased risk of combined adverse maternal outcome. Conversely, maternal age and medically assisted reproduction were not significant risk factors for combined adverse maternal outcome., Conclusion: Our data show that multiple gestation alone is a risk factor for COVID-19-associated combined adverse maternal outcome. Moreover, severe courses of COVID-19 in women expecting more than one child are observed earlier in pregnancy than in singleton pregnancies., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: With the increasing impacts of climate change, heatwaves are placing an enormous burden on health and social systems and threatening ecological diversity around the world. Heatwaves are increasing not only in frequency but also in severity and magnitude. They are causing the deaths of thousands of people. Research is needed on a multidisciplinary, supra-regional, and regional level., Methods: A detailed evaluation of the research conducted is not yet available. Therefore, this study provides a detailed insight into the publication landscape to identify key players, incentives, and requirements for future scientific efforts that are useful not only for scientists but also to stakeholders and project funders., Results: The number of publications on heatwaves is increasing, outpacing the trend of research indexed by the Science Citation Index Expanded. However, funding is lagging behind comparatively. Looking at absolute numbers, the USA, Australia, China, and some European countries have been identified as major players in heatwave research. If socio-economic numbers are included, Switzerland and Portugal lead the way. Australia and the UK dominate if the change in heatwave-exposed people is included. Nevertheless, exposure and economic strength of publishing countries were identified as the main drivers of national research interests. Previous heatwaves, in particular, have driven research efforts primarily at the national level., Conclusion: For an efficient monitoring or early detection system that also includes the economically weak regions, internationally networked efforts are necessary to enable preventive measures and damage limitation against heatwaves. Regardless of previous regional extreme heat events, research approaches should be focused to the global level., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Despite antagonizing attempts from the tobacco industry, passive inhalation of tobacco smoke is known to be cancerogenic and toxic to human health for decades. Nonetheless, millions of non-smoking adults and children are still victims of second-hand smoke. Accumulation of particulate matter (PM) in confined spaces such as the car are particularly harmful due to high concentrations. We here aimed to analyze the specific effects of ventilation conditions in the setting of a car. By the use of the measuring platform TAPaC (tobacco-associated particulate matter emissions inside a car cabin), 3R4F reference cigarettes, Marlboro red, and Marlboro gold were smoked in a car interior with a volume of 3.709 m 3 . Seven different ventilation conditions (C1-C7) were analyzed. Under C1, all windows were closed. Under C2-C7, the car ventilation was turned on power level 2/4 with the air directed towards the windshield. Only the passenger side window was opened, where an outer placed fan could create an airstream speed of 15.9-17.4 km/h at one meter distance to simulate a driving car. C2: Window 10 cm opened. C3: Window 10 cm opened with the fan turned on. C4: Window half-opened. C5: Window half-opened with the fan turned on. C6: Window fully opened. C7: Window fully opened with the fan turned on. Cigarettes were remotely smoked by an automatic environmental tobacco smoke emitter and a cigarette smoking device. Depending on the ventilation condition the cigarettes emitted different mean PM concentrations after 10 min under condition C1 (PM 10 : 1272-1697 µg/m 3 , PM 2.5 : 1253-1659 µg/m 3 , PM 1 : 964-1263 µg/m 3 ) under C2, C4, and C6 (PM 10 : 68.7-196.2 µg/m 3 , PM 2.5 : 68.2-194.7 µg/m 3 , PM 1 : 66.1-183.8 µg/m 3 ) C3, C5, and C7 (PM 10 : 73.7-139 µg/m 3 , PM 2.5 : 72-137.9 µg/m 3 , PM 1 :68.9-131.9 µg/m 3 ). Vehicle ventilation is insufficient to protect passengers from toxic second-hand smoke completely. Brand-specific variations of tobacco ingredients and mixtures markedly influence PM emissions under ventilation conditions. The most efficient ventilation mode to reduce PM exposure was achieved by opening the passenger´s window 10 cm and turning the onboard ventilation on power level 2/4. In-vehicle smoking should be banned to preserve innocent risk groups (e.g., children) from harm., (© 2023. The Author(s).)

Background: The majority of Germans see a deficit in information availability for choosing a physician. An increasing number of people use physician rating websites and decide upon the information provided. In Germany, the most popular physician rating website is Jameda.de, which offers monthly paid membership plans. The platform operator states that paid memberships have no influence on the rating indicators or list placement., Objective: The goal of this study was to investigate whether a physician's membership status might be related to his or her quantitative evaluation factors and to possibly quantify these effects., Methods: Physician profiles were retrieved through the search mask on Jameda.de website. Physicians from 8 disciplines in Germany's 12 most populous cities were specified as search criteria. Data Analysis and visualization were done with Matlab. Significance testing was conducted using a single factor ANOVA test followed by a multiple comparison test (Tukey Test). For analysis, the profiles were grouped according to member status (nonpaying, Gold, and Platinum) and analyzed according to the target variables-physician rating score, individual patient's ratings, number of evaluations, recommendation quota, number of colleague recommendations, and profile views., Results: A total of 21,837 nonpaying profiles, 2904 Gold, and 808 Platinum member profiles were acquired. Statistically significant differences were found between paying (Gold and Platinum) and nonpaying profiles in all parameters we examined. The distribution of patient reviews differed also by membership status. Paying profiles had more ratings, a better overall physician rating, a higher recommendation quota, and more colleague recommendations, and they were visited more frequently than nonpaying physicians' profiles. Statistically significant differences were found in most evaluation parameters within the paid membership packages in the sample analyzed., Conclusions: Paid physician profiles could be interpreted to be optimized for decision-making criteria of potential patients. With our data, it is not possible to draw any conclusions of mechanisms that alter physicians' ratings. Further research is needed to investigate the causes for the observed effects., (©Friedrich Aaron David Armbruster, Dörthe Brüggmann, David Alexander Groneberg, Michael Bendels. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.04.2023.)

The COVID-19 pandemic exemplified the importance of research on personal protective equipment. In specific, understanding how effective surgical masks or particulate filter respirators are at reducing the transmission of infectious diseases has suddenly become one of the most pressing issues for legislators, regulators, and everyday life. However, there was a lack of available scientific platforms to assess this issue. Therefore, we designed and built a system entitled MASC: measuring aerosol spreading during countermeasures. This platform allows the simulation of various everyday situations and evaluation of the efficacy of masks and respirators in reducing the amount of inhaled particulate matter from the air. Furthermore, MASC can be used to investigate how aerosols propagate in closed spaces, such as offices or classrooms. It can be used to generate aerosols on command and control the room temperature, humidity, and wind speed. Up to four laser aerosol spectrometers can be read simultaneously, and a camera can automatically take pictures to evaluate the efficacy of countermeasures to prevent the spread of aerosols. The aerosol generation, measurement periods, and the number of repetitions for an experiment can be configured digitally and are executed by a computer automatically. A website displays the data in real time and allows monitoring of the experiment. Upon completion, statistical values are calculated automatically to accelerate the evaluation of the gathered data. Codes and technical drawings in this present methodology publication are open source and can be used by the scientific community to establish similar systems., (© 2022. The Author(s).)

Background: The spread of ticks has also led to the emergence of regional, previously unknown tick-borne diseases (TBDs) that pose an immediate threat to public health systems worldwide. People who spend time or work outdoors are at risk without closer awareness of regional exposures. That is especially true for tourists, who very easily come into contact with ticks and get bitten while hiking and climbing. A regional lack of surveillance, lack of awareness, lack of scientific background, and misdiagnosis makes it hard to assess the actual threat properly., Methods: Therefore, this bibliometric study aims to assess the global research on ticks and some TBDs. Geographical and temporal patterns are elaborated under epidemiological and socioeconomic aspects. That will provide a factual basis for targeted action at the scientific, societal, and policy levels against the growing threat associated with ticks., Results: The USA and Brazil can be identified as the key players in tick research, followed by Russia and some Central European countries. The socioeconomic analysis points to epidemiologically relevant regions, as also shown by comparison with the TBD analysis. A correlation between countries' gross domestic product and publication performance was found. Lack of scientific resources limits the necessary research and surveillance programs., Conclusions: Many regions that are popular travel destinations are threatened by new tick species and thus new health risks. Therefore, outdoor activities in many locations may pose an unknown hazard that requires regionally differentiated scientific investigation and better, globally networked research strategies., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Unlike most other commodities, rare earth elements (REEs) are part of a wide range of applications needed for daily life all over the world. These applications range from cell phones to electric vehicles to wind turbines. They are often declared as part of "green technology" and, therefore, often called "green elements". However, their production and use are not only useful but also risky to the environment and human health, as many studies have shown. Consequently, the range of global research efforts is broad and highly variable, and therefore difficult to capture and assess. Hence, this study aims to assess the global parameters of global research on REE in the context of environment and health (REE eh ). In addition to established bibliometric parameters, advanced analyses using market driver and scientific infrastructure values were carried out to provide deep insight into incentives, necessities, and barriers to international research., Results: The focus of REE research is in line with national aspirations, especially from the major global players, China and the USA. Whereas globally, regional research interests are related to market interests, as evidenced by the inclusion of drivers such as electric vehicles, wind turbines, and permanent magnets. The topics receiving the most attention are related to gadolinium used for magnetic resonance imaging and the use of ceria nanoparticles. Since both are used for medical purposes, the medical research areas are equally profiled and mainly addressed in high-income countries. Nevertheless, environmental issues are increasingly in focus., Conclusions: There is still a need for research that is independent and open-ended. For this, market-independent technologies, substitutes and recycling of REEs need to be addressed scientifically. The results of this study are relevant for all stakeholders, from individual scientists to planners to funders, to improve future research strategies in line with these research mandates., (© 2022. The Author(s).)

The broad-spectrum insecticides in the neonicotinoid group are the most widely used worldwide because of their widely recognized advantages in the mode of action. Therefore, their use is growing on a large scale and, moreover, is often used preventively without considering the ecological impact. Studies demonstrated harmful effects on non-target organisms, which in turn negatively impact biodiversity and thus food production. The dramatic decline of honey bee colonies, for example, could be linked to the use of neonicotinoids. Ecologically sustainable solutions to this conflict must be focused by scientific research. The question arose whether the global research efforts meet these requirements on a global scale. Therefore, this review article aimed to analyze the global research landscape on neonicotinoids under ecological, economic, and temporal aspects. To this end, key players and incentives for investigations in this research field are identified. The increase in publications over time is significant and shows a dynamic citation pattern. It indicates a comparatively high interest in current research, with ecological issues becoming more and more the focus of international research. It has been shown that national publication performance and funding are in line with global market interests, with the most publishing country being China. In addition, the elevated status quo of the scientific infrastructure in high-economy countries and their willingness to support research can be linked to national research output. Lower economies are sparsely involved in published studies. The research performance accumulates with a high North-South divide. Therefore, future research projects must have a sustainable focus and take regional requirements worldwide into account. This requires greater involvement of developing countries as the most economically dependent regions with enormously increasing consumption rates. Solutions must be found to ensure sustainable food production against a backdrop of already declining biodiversity due to the large-scale use of neonicotinoids., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Particulate matter (PM) emission caused by tobacco combustion leads to severe health burdens worldwide. Second-hand smoke exposure is extraordinarily high in enclosed spaces (e.g., indoor rooms, car cabins) and poses a particular threat to the health of vulnerable individuals (e.g., children, elderly, etc.). This study aimed to establish a new measuring platform and investigate PM emissions under four different ventilation conditions inside a car cabin without exposing any person to harmful tobacco smoke., Methods: PM concentrations were measured during the smoking of 3R4F reference cigarettes in a Mitsubishi Space Runner (interior volume 3.709 m 3 ). The cigarettes were smoked with a machine, eliminating exposure of the researchers. Cigarettes were extinguished 4.5 min after ignition, and PM measurements continued until 10 min after ignition., Results: High mean PM concentrations were measured for cigarettes without ventilation after 4.5 min (PM 10 : 1150 µg/m 3 , PM 2.5 : 1132 µg/m 3 , PM 1 : 861.6 µg/m 3 ) and after 10 min (PM 10 : 1608 µg/m 3 , PM 2.5 : 1583 µg/m 3 , PM 1 : 1133 µg/m 3 ). 3R4F smoked under conditions with turned on ventilation resulted in reduction of PM compared to those smoked without ventilation after 4.5 min (PM 10 :-47.5 to -58.4%, PM 2.5 :-47.2 to -58%, PM 1 :-39.6 to -50.2%) and after 10 min (PM 10 :-70.8 to -74.4%, PM 2.5 :-70.6 to -74.3%, PM 1 :-64.0 to -68.0%). Cigarettes smoked without ventilation generated high PM peaks at 4.5 min (PM 10 : 2207 µg/m 3 , PM 2.5 : 2166 µg/m 3 , PM 1 : 1421 µg/m 3 ) and at 10 min (PM 10 : 1989 µg/m 3 , PM 2.5 : 1959 µg/m 3 , PM 1 : 1375 µg/m 3 ). PM peaks of cigarettes smoked under different ventilation modes varied at 4.5 min (PM 10 : 630-845 µg/m 3 , PM 2.5 : 625-836 µg/m 3 , PM 1 : 543 - 693 µg/m 3 ) and 10 min (PM 10 : 124 - 130 µg/m 3 , PM 2.5 : 124 - 129 µg/m 3 , PM 1 : 118 - 124 µg/m 3 )., Conclusion: The new measuring platform provides a safer way for researchers to investigate PM emissions of cigarettes. These data are comparable to published research and show that smoking in a parked vehicle with the windows closed generates harmful PM emissions even when the vehicle ventilation is in operation. Future studies should be carried out using the new measuring platform investigating PM exposure and PM distribution of in-vehicle smoking under a wide range of conditions., (© 2022. The Author(s).)

(1) Background: Guidelines on vaginal breech delivery require birth weight restrictions and neglect the impact of pelvic measurements despite contradicting evidence. There is a great need for more evidence on delivery outcome predicting factors for patients counselling. (2) Methods: We performed a prospective cohort study on 748 primiparous women intending vaginal breech birth and analyzed combined influence of fetal birth weight (BW) and the obstetric conjugate (conjugate vera obstetrica, CVO) on delivery outcome. (3) Results: We generated a BW/CVO ratio and devided our study cohort at median (257.8 g/cm) into a low ratio group (LR, with low birth weight and wide obstetric conjugate) and a high ratio group (HR, high birth weight and narrow obstetric conjugate). Cesarean section (CS) rate was significantly higher in HR (50.3%) as compared to LR (28.3%, p < 0.0001). Fetal morbidity was not different. In vaginally completed deliveries duration of birth was significantly longer in vHR (557 min) as in vLR (414 min, p < 0.001). Manual assistance to deliver the arms (‘Louwen maneuver’) positively correlated with birth weight (r2 = 0.215; p = 0.005) and the BW/CVO ratio (r2 = 0.0147; p = 0.02). (4) Conclusions: A high fetal birth weight combined with a tiny CVO predicts higher cesarean section probability, longer birth duration and the necessity to perform arm delivery assistance. Birth weight and pelvic measurements should be topics of great importance in patients counselling.

Background: After nearly a quarter-century of declining poverty, the numbers are rising again significantly. This is due not only to effects of climate change but also to the COVID-19 pandemics and armed conflict. Combined with the enormous health impacts, that will cause misery and health care costs worldwide. Therefore, this study provides background information on the global research landscape on poverty and health to help researchers, stakeholders, and policymakers determine the best way to address this threat., Results: The USA is the key player, dealing mainly with domestic issues. European countries are also involved but tend to be more internationally oriented. Developing countries are underrepresented, with Nigeria standing out. A positive correlation was found between publication numbers and economic strength, while the relationship between article numbers and multidimensional poverty was negatively correlated., Conclusions: These findings highlight the need for advanced networking and the benefits of cross-disciplinary research to mitigate the coming impacts., (© 2022. The Author(s).)

Background: In general, the prevalence of work-related musculoskeletal disorders (WMSD) in dentistry is high, and dental assistants (DA) are even more affected than dentists (D). Furthermore, differentiations between the fields of dental specialization (e.g., general dentistry, endodontology, oral and maxillofacial surgery, or orthodontics) are rare. Therefore, this study aims to investigate the ergonomic risk of the aforementioned four fields of dental specialization for D and DA on the one hand, and to compare the ergonomic risk of D and DA within each individual field of dental specialization., Methods: In total, 60 dentists (33 male/27 female) and 60 dental assistants (11 male/49 female) volunteered in this study. The sample was composed of 15 dentists and 15 dental assistants from each of the dental field, in order to represent the fields of dental specialization. In a laboratory setting, all tasks were recorded using an inertial motion capture system. The kinematic data were applied to an automated version of the Rapid Upper Limb Assessment (RULA)., Results: The results revealed significantly reduced ergonomic risks in endodontology and orthodontics compared to oral and maxillofacial surgery and general dentistry in DAs, while orthodontics showed a significantly reduced ergonomic risk compared to general dentistry in Ds. Further differences between the fields of dental specialization were found in the right wrist, right lower arm, and left lower arm in DAs and in the neck, right wrist, right lower arm, and left wrist in Ds. The differences between Ds and DAs within a specialist discipline were rather small., Discussion: Independent of whether one works as a D or DA, the percentage of time spent working in higher risk scores is reduced in endodontologists, and especially in orthodontics, compared to general dentists or oral and maxillofacial surgeons. In order to counteract the development of WMSD, early intervention should be made. Consequently, ergonomic training or strength training is recommended.

Cervical cancer has caused substantial morbidity and mortality for millions of women over the past decades. While enormous progress has been made in diagnosis, prevention and therapy, the disease is still fatal for many women-especially in low-income countries. Since no detailed studies are available on the worldwide research landscape, we here investigated the global scientific output related to this cancer type by an established protocol. The "New Quality and Quantity Indices in Science" platform assessed all relevant cervical cancer research published in the Web of Science since 1900. A detailed analysis was conducted including country-specific research productivity, indicators for scientific quality, and relation of research activity to socioeconomic and epidemiologic figures. Visualization of data was generated by the use of density equalizing map projections. Our approach identified 22,185 articles specifically related to cervical cancer. From a global viewpoint, the United States of America was the dominating country in absolute numbers, being followed by China and Japan. By contrast, the European countries Sweden, Austria, and Norway were positioned first when the research activity was related to the population number. When the scientific productivity was related to annual cervical cancer cases, Scandinavian countries (Finland #1, Sweden #4, Norway #5, Denmark #7), the Alpine countries Austria (#2) and Switzerland (#6), and the Netherlands (#3) were leading the field. Density equalizing mapping visualized that large parts of Africa and South America were almost invisible regarding the global participation in cervical cancer research. Our data documented that worldwide cervical cancer research activity is continuously increasing but is imbalanced from a global viewpoint. Also, the study indicated that global and public health aspects should be strengthened in cervical carcinoma research in order to empower more countries to take part in international research activities., Competing Interests: The authors have declared that no competing interests exist.

Background: SARS-CoV-2 is one of the most threatening pandemics in human history. As of the date of this analysis, it had claimed about 2 million lives worldwide, and the number is rising sharply. Governments, societies, and scientists are equally challenged under this burden., Objective: This study aimed to map global coronavirus research in 2020 according to various influencing factors to highlight incentives or necessities for further research., Methods: The application of established and advanced bibliometric methods combined with the visualization technique of density-equalizing mapping provided a global picture of incentives and efforts on coronavirus research in 2020. Countries' funding patterns and their epidemiological and socioeconomic characteristics as well as their publication performance data were included., Results: Research output exploded in 2020 with momentum, including citation and networking parameters. China and the United States were the countries with the highest publication performance. Globally, however, publication output correlated significantly with COVID-19 cases. Research funding has also increased immensely., Conclusions: Nonetheless, the abrupt decline in publication efforts following previous coronavirus epidemics should demonstrate to global researchers that they should not lose interest even after containment, as the next epidemiological challenge is certain to come. Validated reporting worldwide and the inclusion of low-income countries are additionally important for a successful future research strategy., (©Doris Klingelhöfer, Markus Braun, Dörthe Brüggmann, David A Groneberg. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 08.09.2021.)

Purpose: The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality., Methods: This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA)., Results: The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10 - 5 ) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04., Conclusion: EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

Background: Vaginal breech delivery is becoming an extinct art although national guidelines underline its safety and vaginal breech delivery in an upright position has been shown to be a safe birth mode option. In order to spread clinical knowledge and be able to implement vaginal breech delivery into obstetricians' daily practice, we need to gather knowledge from facilities who teach specialized obstetrical management., Methods: We performed a prospective cohort study on 140 vaginal deliveries out of breech presentation solely-managed by seven newly-trained physicians and compared fetal outcome as well as rates of manual assistance in respect to preexisting experience., Results: Fetal morbidity rate measured with a modified PREMODA score was not significantly different in three sub-cohorts sorted by preexisting expertise levels of managing obstetricians (experience groups EG, EG0: 2, 5%; EG1: 3, 7.5%; EG2: 1, 1.7%; p = 0.357). Manual assistance rate was significantly higher in EG1 (low experience level in breech delivery and only in dorsal position) compared to EG0 and EG2 (EG1 28, 70%; EG0: 14, 25%; EG2: 21, 35%; p = 0.0008)., Conclusions: Our study shows that vaginal breech delivery with newly-trained obstetricians is a safe option whether or not they have advanced preexisting expertise in breech delivery. These data should encourage implementing vaginal breech delivery in clinical routine.

Glyphosate is a systemic broad-spectrum herbicide that is by now the most extensively used herbicide in the world and has been the source for a still heated controversy about its harmful effects on human health and the environment. The different weighting of scientific studies has led to different attitudes in most countries towards appropriate handling and their regulatory authorities. Therefore, an in-depth analysis of the global research landscape on glyphosate is needed to provide the background for further decisions regarding appropriate and careful use, taking into account the different regional conditions. The present study is based on established bibliometric methodological tools and is extended by glyphosate-specific parameters. Chronological and geographical patterns are revealed to determine the incentives and intentions of international scientific efforts. Research output grew in line with the exponential growth in consumption, with the field of research becoming increasingly multidisciplinary and shifting towards environmental and medical disciplines. The countries with the highest herbicide use are also the leading countries in glyphosate research: USA, Brazil, Canada, China and Argentina. The link between publication output and market parameters is as evident as the association with national grants. The research interest of the manufacturing company Monsanto could be shown as the second largest publishing institution behind the US Department of Agriculture, which interest is underscored by its position among the otherwise government-funded organizations. Developing countries are generally underrepresented in glyphosate research, although the use of glyphosate is increasing dramatically. In conclusion, the incentives are strongly linked to market and agricultural interests, with the scientific infrastructure of the countries forming the basis for financing and conducting research. The existing international network is important and needs to be expanded and strengthened by including the lower economies in order to take into account all regional and social needs and aspects of glyphosate use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Aims: Despite decades of effort, numerous aspects on ulcerative colitis (UC) remain unknown and require further investigation. Scientists experience numerous challenges to survey >40,000 items that have been published on UC since 1900, to evaluate their scientific impact or to identify collaborative networks publishing the most relevant work. Hence, no current, detailed and comprehensive knowledge regarding the worldwide research architecture of UC has been established until now., Methods: We conducted a scientometric study employing the previously validated NewQIS (New Quality and Quantity Indices in Science) platform to quantify the global research activity in the field of UC. Hereby, the total research productivity, scientific output of countries, individual institutions, authors, journals, their collaborative networks as well as semiqualitative aspects were assessed. Results were visualized via state-of-the-art density-equalizing mapping projections., Results: The United States, Germany, and the United Kingdom play leading roles regarding scientific activity, multilateral and bilateral cooperations. Within the past decades, research on UC diversified into a field covering numerous subject areas. Recently published studies predict that the scientific progress will be mainly depending on international cooperations; we can confirm that development by now., Conclusions: Scientometrics proofed to be a useful methodical approach to evaluate quantitative and semiqualitative aspects regarding UC. Also, we conclude that the influence of international cooperations on the scientific progress in the field of UC is constantly progressing., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Although the incidence and mortality of gastric cancer (GC) decreased in the last years, some countries remain highly affected. Especially in high-income economies the cases of cardia types are steadily increasing. Currently, GC is ranked third as cause for cancer death worldwide, whereby two-thirds of deaths still occur in low-income countries. But the global numbers are changing, and new regional challenges must be addressed., Methods: Therefore, this disease has been chosen for in-depth bibliometric analyses that combines the evaluation of publication meta-data with density equalizing visualization techniques. This study focuses on the chronological and geographical characteristics of GC research worldwide. Epidemiological and socio-economic parameters were analyzed and the influence of political framework conditions was examined. In addition, international collaborations and research priorities were evaluated., Results: In the last years, the publication numbers are rising more extensively in comparison to other cancer types. Albeit the usual leading positions, the United States is not the most publishing country on GC. It occupies the third position. Instead, China and Japan are the most publishing countries and together with South Korea also the key players as well as the most affected countries. These countries' governments are also the main donors for GC-research. The number of articles and the expenditures for research and development (R??D) as well as the incidence rate are correlated. Despite the scarce contribution of low-economic countries to the publication output, international collaborations lead to a modest output in those regions., Conclusion: This study pools background information for scientists, practitioners, funders and decision-makers by providing information on the development and priorities of GC research. Adaptive international approaches and partnerships are crucial to meet future changing epidemiological features worldwide., (© 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Introduction: Obesity is classified as a global epidemic and judged to be the greatest public health threat in Western countries. The tremendously increasing prevalence rates in children lead to morbidity and mortality in adults. In many countries, prevalence has doubled since the 1980s. Other countries show a continuous increase or stagnate at a very high level. Given these regional differences, this study aims to draw a global world map of childhood obesity research, including regional epidemiological characteristics, to comprehensively assess research influences and needs., Methods: In addition to established bibliometric parameters, this study uses epidemiological data to interpret metadata on childhood obesity research from the Web of Science in combination with state-of-the-art visualization methods, such as density equalizing map projections., Results: It was not until the 1990s that belated recognition of the dangerous effects of childhood obesity led to an increase in the number of publications worldwide. In addition, our findings show that countries' study output does not correlate with epidemiologic rates of childhood obesity. In contrast, the primary driver of the research efforts on childhood obesity appears to be largely driven government funding structures., Discussion/conclusion: The geographical differences in the epidemiological background of childhood obesity complicate the implementation of transnational research projects and cross-border prevention programs. Effective realization requires a sound scientific basis, which is facilitated by globally valid approaches. Hence, there is a need for information exchange between researchers, policy makers, and private initiatives worldwide., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

Background: Since mammography belongs to the most important preventive techniques in modern medicine, this study maps the related worldwide research output, which encompasses quantitative and qualitative aspects of the scientific activity and socio-economic features., Methods: The New Quality and Quantity Indices in Science (NewQIS) computing platform identified all mammography-specific articles in the Web of Science within two time periods, from 1900 to 2014 (P1) and from 2015 to 2020 (P2), a combination of density-equalizing mapping projections (DEMP) and socio-economic benchmarking was applied for analysis., Results: A total of 13,629 articles were retrieved. 8,744 articles were identified in P1 and 4,885 in P2. More than 100 articles were published annually since the 1980s. Regarding productivity and collaborative efforts, the United States was the leading nation in both evaluation periods. In our socioeconomic analysis, it was also ranked at the first place in P1 [72.68 mammography-related publications per GDP/capita (RGDP)]. The US was followed by the UK and Germany in P1 and by UK and India in P2. When population sizes were related to mammography research activities, Scandinavian countries and the Netherlands showed the highest research activity in P1 (e.g., Sweden: 31.89 publications per 1 million inhabitants). Gender analysis illustrated a relative dominance of female researchers in most countries with the exception of Japan., Conclusions: The global mammography research activity over the last century is paralleled by strong international collaborative efforts and follows largely economic figures and prevalence rates but displays distinct differences in comparison to the research landscape of other biomedical entities., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-19-774). The authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: The currently prevailing global threat of COVID-19 caused the publication numbers on coronaviruses to explode. The awareness of the scientific and public community is enormous. But what about the sense of all these undertakings and what can be learned about the future for a better understanding? These questions were answered with established bibliometric analyses of the time until the avalanche of publications unfolded., Methods: Chronological, geographical aspects of publication output on coronavirus were also evaluated under the influence of epidemiological and socio-economic parameters., Results: The trend in publication and citation numbers shows the strong influence of the past pandemics SARS and MERS with an untypical decline afterward. Research is becoming increasingly multidisciplinary over time. The USA and China, as the countries with the highest number of publications, are being displaced by other countries in the consideration of socio-economic and epidemiological aspects, which shows the effect of regional interest in corona research. A significant correlation was found between the number of SARS cases per country and related publications, while no correlation was found for MERS cases and articles., Conclusions: The results underline the need for sustainable and forward-looking approaches that should not end with the containment of COVID-19., Competing Interests: Conflict of interest. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2020 by the Journal of Global Health. All rights reserved.)

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.

Background: Needlestick injuries have caused a deleterious effect on the physical and mental health of millions of health-care workers over the past decades, being responsible for occupational infections with viruses such as HIV or hepatis C. Despite this heavy burden of disease, no concise studies have been published on the global research landscape so far., Methods: We used the New Quality and Quantity Indices in Science platform to analyze global NSI research (n = 2987 articles) over the past 115 years using the Web of Science and parameters such as global versus country-specific research activities, semi-qualitative issues, and socioeconomic figures., Results: Density-equalizing mapping showed that although a total of n = 106 countries participated in NSI research, large parts of Africa and South America were almost invisible regarding global participation in NSI research. Average citation rate (cr) analysis indicated a high rate for Switzerland (cr = 25.1), Italy (cr = 23.5), and Japan (cr = 19.2). Socioeconomic analysis revealed that the UK had the highest quotient Q GDP of 0.13 NSI-specific publications per bill. US-$ gross domestic product (GDP), followed by South Africa (Q GDP  = 0.12). Temporal analysis of HIV versus hepatitis research indicated that NSI-HIV research culminated in the early 1990s, whereas NSI-hepatitis research increased over the observed period from the 1980s until the last decade., Conclusion: Albeit NSI research activity is generally increasing, the growth is asymmetrical from a global viewpoint. International strategies should be followed that put a focus on NSI in non-industrialized areas of the world.

Background: From a global viewpoint, endometrial cancer belongs to the most common female cancers. Despite the heavy burden of diseases and numerous unanswered questions, no detailed pictures of the global structure of endometrial cancer research are available so far. Therefore, this malignancy was reviewed using the New Quality and Quantity Indices in Science (NewQIS) protocol., Methods: Using NewQIS, we identified endometrial carcinoma related research published in the Web of Science from 1900-2015 (P1) and from 2016-2020 (P2). Item analysis was performed with regard to research activity. Also, semi-qualitative aspects and socio-economic benchmarks were visualized using density equalizing mapping., Results: In total, 9,141 from 1900-2015 and 4,593 from 2016-2020 endometrial cancer related studies were identified with the USA having the largest numbers of publications, citations, institutions, as well as the highest country-specific h-Index concerning endometrial cancer research in both periods. In contrast to other fields of cancer research, the two East Asian countries Japan and China followed concerning total research activities until 2015. From 2016 until 2020, China was found in short distance to the USA and was ranked second. In the socio-economic analysis, European countries were in prominent positions. Greece published 579.83 endometrial carcinoma-related articles per billion US-$ GDP, Finland (527.29), Sweden (494.65), Israel (493.75), and Norway (367.85) followed in the ranking. Density equalizing mapping visualized that large parts of Africa, Asia and South America with a high burden of disease played almost no visible role in the endometrial cancer research activities., Conclusions: Endometrial cancer research activity is continuously increasing from a global viewpoint. However, the majority of original articles is published by authors based in high-income countries. Together with the finding that the research field of public health does only play a minimal role, our study points to the necessity that global health aspects should be introduced to endometrial cancer research.

Objective: Although breech presentations occur in 3-5% of term deliveries, the mode of delivery still remains a topic of debate. Hence, this study aimed to analyze the worldwide research output on breech presentation. All relevant publications issued in the Web of Science from 1900 to 2014 were assessed by an objective, standardized bibliometric procedure., Study Design: In this retrospective, descriptive study, we used the computerized NewQIS platform, to identify publications by a specific search term and to analyze them regarding quantitative parameters (e.g., countries of origin, journals) as well as qualitative characteristics (e.g., citation rate, country-specific H-index). In addition to geographical aspects, chronological developments and collaboration networks were investigated. In order to visualize the results, anamorphic maps were generated by the innovative "density equalizing map projections"(DEMP) technology., Results: A total of 1,438 original articles, reviews, "Letters" and "Abstracts" on breech presentation were identified. 86% of this work was written in English. The highest number and the most cited publications came from the US and Canada as well as Western European countries. Exceptions were Israel and South Africa that appeared among the leading countries. The collaboration network included 26 countries, dominated by the US and the UK. We also present a table of the 14 most cited publications in the world., Summary: This study underlines that the mere total of only 1,438 publications on breech do not do justice to this relevant and controversially discussed topic. The global research output was dominated by the industrialized world. Developing and emerging countries are largely excluded from research activities. To minimize this imbalance and to foster scientific collaborations, future research on this topic needs to be planned and funded according to these shortcomings., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: The best way to deliver a term breech infant is still a much discussed topic among obstetricians. The question whether nulliparity should be considered an exclusion criterion for an intended vaginal breech delivery is not fully answered., Objective: We compared maternal and neonatal outcome of intended vaginal breech deliveries of nulliparous versus multiparous women at term., Study Design: We conducted a prospective case-control study between January 2004 and December 2016. 1046 women expecting singletons at term with favorable pelvic measurements were enrolled in the study., Results: Neonatal morbidity and mortality was not significantly different in deliveries of nulliparous (n = 647) versus multiparous (n = 399) women. Nulliparous women had a significantly higher rate of a cesarean section during labor than multiparous women. Maternal birth-injury rates and the use of epidural anesthesia were significantly higher comparing vaginal births of nulliparous (n = 384) versus multiparous (n = 331) women., Conclusion: Nulliparity seems not be an exclusion criterion for intended vaginal breech birth at term. It is still important to inform the women of an increased risk of a cesarean section during labor. A clinical management built on this evidence might reduce negative implications for future pregnancies., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: 3-4% of pregnant women present with a fetal breech position at term. National societies regard vaginal breech delivery as a safe option, but only for a specific and thoroughly counseled group of patients. To avoid adverse outcome, many practitioners recommend elective cesarean section once their patients go past the estimated due date. Since encompassing evidence is missing, the evaluation on this common clinical practice is needed., Objective: This study compares the short-term maternal and fetal outcome in intended vaginally breech deliveries before the estimated due date (until 40 0/7 weeks of gestation) to the outcome of deliveries carried out past the estimated due date (later than 40 0/7 weeks of gestation)., Methods: This prospective cohort study includes 827 women who presented for an intended vaginal breech delivery of a singleton at our perinatal center between January 2010 and December 2016., Results: 447 patients (54%) delivered before or at their estimated due date, 380 (46%) of pregnancies continued after the estimated due date. Comparing both groups, no significant difference in maternal and neonatal short-term mortality and morbidity was found. The rate of caesarian sections was increased in the group of patients, who delivered later than 40 1/7 weeks of gestation. Here, the likelihood for delivery maneuvers was also increased., Conclusion: This study provides evidence, that an elective cesarean section for breech presentations at term is not obligatory when the estimated due date has passed in singleton pregnancy., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Fabry disease (FD), the second most prevalent lysosomal storage disorder, is classified as a rare disease. It often leads to significant quality of life impairments and premature death. Many cases remain undiagnosed due to the rarity and heterogeneity. Further, costs related to treatment often constitute a substantial financial burden for patients and health systems. While its epidemiology is still unclear, newborn screenings suggest that its actual prevalence rate is significantly higher than previously suspected., Methods: Based on well-established methodologies, this study gives an overview about the background of the development of FD-related research and provides a critical view of future needs., Results: On the grounds of benchmarking findings, an increasing research activity on FD can be observed. Most publishing countries are the USA, some European countries, Japan, Taiwan, and South Korea. In general, high-income countries publish comparably more on FD than low- or middle-income economies. The countries' financial and infrastructural background are unveiled as crucial factors for the FD research activity., Conclusions: Overall, there is a need to foster FD research infrastructure in developing and emerging countries with focus on cost-intensive genetic research that is independent from economic interests of big pharmaceutical companies., (© 2020 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.)

Objective: To compare the neonatal and maternal outcomes as well as the mode of delivery of intended vaginal breech deliveries in women with a prior cesarean section to primiparous patients., Study Design: The prospective monocenter cohort study was conducted among 604 women who presented for an intended vaginal singleton breech delivery at term between January 2007 and December 2016., Results: Out of 37 women with a prior cesarean 19 had a successful vaginal delivery. 344 of 567 primiparous women had a successful vaginal delivery. Neonatal morbidity and mortality as well as maternal outcome were not significantly different in successful vaginal deliveries of women with prior cesarean compared to primiparous patients. The cesarean section rate was not significantly higher in the group of women with a prior cesarean (49%) compared to the group of primipara (39%)., Conclusion: A prior cesarean should not be taken as an exclusion criterion for a planned vaginal delivery out of a breech presentation at term. Large multicenter, case-controlled studies are necessary to implement international guidelines., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Musculoskeletal disorders (MSD) are common among dental professionals. The most common areas affected are the trunk, neck, shoulders and wrists. Current evidence suggests that the causes of MSD can be found in the physical demands of the profession. Posture and movement during treatment is influenced by the arrangement of the treatment concept (patient chair, equipment and cabinets). It has not been investigated whether the ergonomic risk differs between the treatment concepts., Methods: To evaluate the prevalence of MSD in dental professionals, 1000 responses will be collected from a nationwide (Germany) online questionnaire (mod. Nordic Questionnaire and mod. Meyer questionnaire). In order to assess the ergonomic risk of the treatment techniques used in the four treatment concepts, 3D movement analyses are carried out with inertial sensors. For this purpose, 20 teams of dentists and dental assistants from four dental fields of specializations (generalists, orthodontists, endodontists and oral surgeons) and a student control group will be recruited. Each team will execute field specific standardized treatments at a dummy head. Measurements are carried out in each of the four treatment concepts. The data will be analyzed using the Rapid Upper Limb Assessment (RULA) which will be modified for the evaluation of objective data., Conclusions: On the basis of these investigations, a substantial gain of knowledge regarding work-related MSD in the field of dentistry and its potential biomechanical causes is possible. For the first time, objective and differentiated comparisons between the four treatment concepts are possible for different fields of dental specialization. Up to now, statically held positions of the trunk and proximal upper extremities, but also the repetitive movements of the hands have been considered a risk for MSD. Since both are included in the RULA, dental activities can be assessed in a detailed but also global manner with regard to ergonomic risks., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

The occupation of dental assistants (DAs) involves many health risks of the musculoskeletal system due to static and prolonged work, which can lead to musculoskeletal disorders (MSDs). The aim of the study was to investigate the prevalence of MSDs in DAs in Germany., Methods: For this purpose, an online questionnaire analyzed 406 (401 female participants and 5 male participants, 401w/5m) DAs. It was based on the Nordic Questionnaire (lifetime, 12-month, and seven-day MSDs' prevalence separated into neck, shoulder, elbow, wrist, upper back, lower back, hip, knee, and ankle), and occupational and sociodemographic questions as well as questions about specific medical conditions., Results: 98.5% of the participants reported complaints of at least one body region in their lives, 97.5% reported at least one complaint in the last 12 months and 86.9% affirmed at least one complaint in the last seven days. For lifetime, 12-month and seven-day prevalence, the neck was the region that was most affected followed by the shoulder, the upper back and the lower back., Conclusion: The prevalence of MSDs among German (female) DAs was very high. The most affected area is the neck, followed by the shoulder, the lower back, and the upper back. It, therefore, seems necessary to devote more attention to ergonomics at the working practice of DAs as well in education and in dental work.

Microplastics can be found all over the world, in the remotest regions and even in the Arctic snow. Primary microplastic is either produced as microparticles or enters the natural environment already as microparticles. Whereas secondary microplastic is generated by fragmentation or abrasion of other products in the natural environment. Both pollute the global ecospheres and even enter the human food chain. This study aims at the evaluation of the global publication output on both types of microplastic referring to absolute and contextual numbers. Only since 2006, the focus on the environmental burden led to an enormous increase of publications on MP. While China, USA and Germany are leading players regarding the absolute numbers, Portugal, Chile and Ireland are among the top countries when including socio-economic features and research expenditures. The responsibility for the big plastic waste producers can be shown by significantly correlating numbers of articles and the plastic waste generation, albeit here China and USA fall behind. However, the biggest producers are not the most affected countries. Despite the strong international interest, our study shows that many countries play no role at all in the publication landscape of MP. For future planning, it is necessary to extend the international collaborations to reach sustainable solutions for the whole planet earth., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Climate change is safe to be one of the biggest challenges of mankind. Human activities, especially the combustion of fossil fuels, contribute to the increase of greenhouse gases in the atmosphere and thus to the pace of climate change. The effects of climate change are already being felt, and the resulting damage will most likely be enormous worldwide. Because global impacts vary widely and will lead to very different national vulnerability to climate impacts, each country, depending on its economic background, has different options to ward off negative impacts. Decisions have to be made to mitigate climate consequences according to the preparedness and the vulnerability of countries against the presumed impacts. This requires a profound scientific basis. To provide sound background information, a bibliometric study was conducted to present global research on climate change using established and specific parameters. Bibliometric standard parameters, established socioeconomic values, and climate change specific indices were used for the analyses. This allowed us to provide an overall picture of the global research pattern not only in terms of general aspects, but also in terms of climate change impacts, its effects and regional differences. For this purpose, we choose representative indices, such as the CO 2 emissions for the responsibility of countries, the global climate risk index as a combination value for the different types of damage that countries can expect, the increase in sea level as a specific parameter as a measure of the huge global environmental impacts, and the readiness and vulnerability index for the different circumstances of individual countries under which climate change will take place. We hope to have thus made a comprehensive and representative selection of specific parameters that is sufficient to map the global research landscape. We have supplemented the methodology accordingly., Results: In terms of absolute publication numbers, the USA was the leading country, followed by the UK, and China in 3rd place. The steep rise in Chinese publication numbers over time came into view, while their citation numbers are relatively low. Scandinavian countries were leading regarding their publication numbers related to CO 2 emission and socioeconomic indices. Only three developing countries stand out in all analyses: Costa Rica, the Fiji Atoll, and Zimbabwe, although it is here that the climate impact will be greatest. A positive correlation between countries' preparedness for the impacts of climate change and their publication numbers could be shown, while the correlation between countries' vulnerability and their publication numbers was negative., Conclusions: We could show that there exists an inequity between national research efforts according to the publication output and the demands and necessities of countries related to their socioeconomic status. This inequity calls for a rethink, a different approach, and a different policy to improve countries' preparedness and mitigation capacity, which requires the inclusion of the most affected regions of the world in a strengthened international cooperation network., Competing Interests: Competing interestsAll authors declare that they have no competing interests., (© The Author(s) 2020.)

Systematic reviews represent the core and backbone of evidence-based medicine (EBM) strategies in all fields of medicine. In order to depict a first global sketch of the international efforts in the Cochrane database systematic reviews (CDSR), we analyzed the systematic reviews of the Cochrane database. Our global maps of systematic reviewing offer intriguing structural insights into the world of EBM strategies. They demonstrate that for the CDSR, the UK and Commonwealth countries take the lead position. Since patients, care providers and health systems all over the world benefit from systematic reviewing, institutions in other countries should increase their commitment., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Vaginal delivery out of a breech presentation in pregnancies at term are being re-implemented into clinical practice. Still, recommendations regarding exclusion criteria leading to caesarean sections are based on expert opinions, not on evidence-based guidelines. The difference in perinatal outcome and course of delivery in births with babies in frank breech position and babies in incomplete or complete breech presentation never has been investigated in a large patient cohort., Objective: To compare perinatal outcome of vaginally intended breech deliveries between births out of frank breech position and incomplete/complete breech presentation., Design: Prospective cohort study., Sample: 884 women at term with a singleton in frank breech presentation (FB) and 284 women with incomplete or complete breech presentation (CB) intending vaginal birth between January 2004 and December 2018., Methods: Maternal and fetal outcome was compared between groups using Pearson's Chi Square test. Birth duration parameters were analysed using logistic regression., Results: There were no differences in cesarean section rates (FB: 25.1%, CB 22.2%, p = 0.317). Short-term fetal morbidity did not differ between groups (FB: 2.5%, CB: 2.8%, p = 0.761). In vaginal deliveries the necessity to perform manual assistance was significantly more frequent in deliveries of infants in CB (FB: 39.9%, CB: 51.6%, p = 0.0013). Cord loops (FB: 10.1%, CB: 18.0%, p = 0.0004) and cesarean sections necessary because of cord prolapses (FB: 1.4%, CB 8.1%, p = 0.005) were significantly more often in deliveries with babies in CB., Conclusion: This study provides evidence, that perinatal morbidity is not associated with the fetal leg posture in vaginally intended breech deliveries. The higher risk for the need of manual assistance during vaginal birth in deliveries of babies out of complete or incomplete breech presentation suggests that obstetrical departments re-implementing the vaginal breech in their repertoire might start with births of babies out of frank breech presentation., Competing Interests: The authors have declared that no competing interests exist.

Background: Esophageal cancer (EC) is one of the deadliest cancers worldwide. The contemporary strong increase of the adenocarcinomas in Western countries and the high mortality rates require the intensification of prospective multinational studies., Methods: Therefore, this global health issue has been chosen for the bibliometric review of the global publication output. As source for meta and citation data, the Web of Science has been used and Density Equalizing Maps were applied for visualization., Results: 17,387 articles on EC could be identified. The years with publication and citation maxima correspond to the appearance of the most prolific articles. China is the most publishing country, followed by Japan and the USA. Germany and the UK ranked 4th and 5th. The analysis of the ratios articles and socio-economic parameters emphasizes the leading position of the Scandinavian countries and Japan. Here, the high-income countries come out on top. The high incidence regions are mainly represented by Chinese and Japanese research. The association of the publication output and the overall research funding could be shown., Conclusions: A strengthened international network increasingly consisting of the scientifically best positioned countries as well as more of the high incidence countries worldwide is mandatory for future research. The findings deliver scientists, clinicians and decision makers backgrounds for future decisions all over the world.

Beginning in the first decade of the 21st centruy, there was a growing disregard for the benefits of the German medical system concerning the junior obstetricians/gynecologists (OB/GYN) job situation. As in other fields of medicine, numerous colleagues left Germany to work in other countries such as the United Kingdom, Noway, Sweden, or Switzerland. According to studies, financial factors represent one of the reasons for the discontent. We here present a practical descriptive approach to assess/review the actual compensation of single work tasks of OB/GYNs on the basis of previously published, existing data. Using the workflow data from the Medical work Assessment in German hospitals (MAGRO) platform of twenty junior OB/GYNs with an average workday of 9:24:35 h (SD = 01:05:07 h), a large scale data analysis of 2,325,556 different time points was performed to calculate the financial valuation of single work tasks. In order to assess the evolution over the past years, different modern and historic (e.g. AiP) pay scales were used and analysed in relation to the actual work on a weekly, monthly and per annum basis. Our review shows that there has been a dramatic increase in the financial reward of the practical work tasks of junior OB/GYN physicians in German hospitals in comparison to the situation of the early 2000s years. In this respect, it can not be further argued that the German system has large disadvantages concerning the payment of junior doctors in comparison to other European countries., Competing Interests: not applicable.not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objectives: The purpose of this study was to investigate the role of the maternal pelvis, assessed by MRI pelvimetry in nulliparous women expecting a term fetus in breech presentation, to predict a successful and safe vaginal birth., Study Design: In this monocentric and anonymized cohort study, we enrolled 367 nulliparous women with breech presentation at 39 +0 to 41 +0 weeks of gestation during a period of 8 years at the University Women's Hospital in Frankfurt/Main. Pelvic measurements were obtained by standard MRI imaging. We correlated the obstetric conjugate, the pubic angle and the distance between the ischial tuberosities (intertuberous distance) with the maternal and fetal outcomes of vaginally intended breech births. The data was evaluated using logistic regression analysis., Results: 241 of 367 participants (65.7%) experienced a successful vaginal delivery whereas 126 patients (34.3%) were subjected to secondary cesarean section. An increasing obstetric conjugate was significantly associated with an increasing rate of successful vaginal deliveries. No significant correlation of the intertuberous distance and the pubic angle with the mode of delivery could be shown. Although statistically not significant, we were able to define cut-off values of 10.9 cm in the intertuberous distance and 70° in the pubic angle; below these values, no successful vaginal delivery was recorded. No significant differences in the short-term outcomes were seen between the neonates of the vaginal delivery and the cesarean section groups. Inter- and intraobserver variability showed excellent reproducibility for all MRI parameters., Conclusion: The obstetric conjugate correlates with the rate of vaginal deliveries in nulliparous women at term and can be used as a useful criterion for pre-selection and counseling of women with breech presentation and the desire for a vaginal delivery., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Strategies employing information science and scientometric approaches were introduced to science policy and management over the past decades. As a rapidly evolving field, new bibliometric parameters are proposed and discussed continuously and the fields also benefits from the introduction of novel visualization techniques. The present article summarizes the experiences with a platform that combines geographical mapping with scientometrics. It was established between 2005 and 2008 at the Charité in Berlin and termed "New Quality and Quantity Indices in Science" (NewQIS), consisting of the integration of common scientometric parameters such as the h-index and novel visualization techniques including density equalizing mapping. NewQIS was used to assess socio-economic important fields of medicine and sciences. Within NewQIS studies, research activities, citation patterns and their relation to socio-economic figures were analyzed with regard to time periods, countries, continents or even single cities. Within the decade after its establishment, more than 80 NewQIS articles were peer-reviewed and published. Being a non-funded low budget project, it was used by many medical students to conduct their MD thesis. The narrow technical frame led to the chance of a comparison of research output between different fields of science. This article summarizes NewQIS 1.0 activities, discusses its limits and gives a look into the future of NewQIS 2.0 with a target of 200 evaluated entities of the biomedical field of sciences., Competing Interests: Conflict of interestsThe authors declare that they have no competing interests., (© Akadémiai Kiadó, Budapest, Hungary 2019.)

Introduction: On a global scale, the malignant growth of mammary gland is the most common type of cancer in women. In the progress of mammary carcinoma, osseous metastatic invasion has a pivotal significance because it is a frequent complication occurring at an early stage of the disease., Background: Bone metastases in breast cancer patients lead to increased mortality and decreased health-related quality of life. Therefore, early diagnostic assessment and treatment is requested. Meanwhile the progress of the disease should be monitored closely. Regarding health-related quality of life and lifetime prolongation, osseous metastases should be early diagnosed, therapied, and monitored. Up to date the gold standard is the whole-body scintigraphy. This kind of bone imaging features has high sensitivity but shows loss of specificity., Aim: This study aims to investigate the diagnostic versatility of bone markers in its resorption and formation function to detect bone metastases in patients with breast cancer., Patients, Materials, and Methods: For this purpose, the concentration of competing bone processing tumor markers in serums of 78 patients was detected and analyzed. Two groups of women with mammary carcinoma with and without osseous metastases were built to examine the presence (or absence) of statistically significant disparity of tumor marker concentration. The tumor markers employed in this study were the carboxyterminal collagen type I telopeptid (CTX), known as beta-crosslaps (β-CTx), the alkaline phosphatase (AP), and its isoenzymes (especially the bone-specific AP [B-AP]). Additionally, the tumor markers for breast cancer (CA 15-3 and CEA) were analyzed in both groups., Results: Our results provide evidence that in both groups, tumor markers such as β-CTx and B-AP were a promising tool for the detection and exclusion of bone metastases in breast cancer. This comprehensive investigation shows both β-CTx and B-AP are able to fulfill the conditions of a competent appliance to detect osseous metastases of patients with mammary carcinoma., Conclusion: Concerning the urgency of early and frequent detection, staging, and disease monitoring of mammary carcinoma with osseous metastases, this study renewed and underlined the importance of biochemical tumor markers - especially β-CTx and B-AP - and laid a clinical-based cornerstone to build up on a prospective research., (© 2019 S. Karger AG, Basel.)

Introduction: The clinical management of breech presentations at term is still a controversially discussed issue among clinicians. Clear predictive criteria for planned vaginal breech deliveries are desperately needed to prevent adverse fetal and maternal outcomes and to reduce elective cesarean section rates. The green-top guideline considers an estimated birth weight of 3.8 kg or more an indication to plan a cesarean section despite the lack of respective evidence., Objective: To compare maternal and neonatal outcome of vaginal intended breech deliveries of births with children with a birth weight of 2.5 kg- 3.79 kg and children with a birth weight of 3.8 kg and more., Design: Prospective cohort study., Sample: All vaginal intended deliveries out of a breech position of newborns weighing between 2.5 kg and 4.5 kg at the Obstetrics department at Goethe University Hospital Frankfurt from January 2004 until December 2016., Methods: Neonatal and maternal outcome of a light weight group (LWG) (< 3.8 kg) was compared to and a high weight group (HWG) (≥ 3.8 kg) using Pearson's Chi Square test and Fishers exact test. A logistic regression analysis was performed to detect an association between cesarean section rates, fetal outcome and the birth weight., Results: No difference in neonatal morbidity was detected between the HWG (1.8%, n = 166) and the LWG (2.6%, n = 888). Cesarean section rate was significantly higher in the HWG with 45.2% in comparison to 28.8% in the LWG with an odds ratio of 1.57 (95% CI 1.29-1.91, p<0.0001). In vaginal deliveries, a high birth weight was not associated with an increased risk of maternal birth injuries (LWG in vaginal deliveries: 74.3%, HWG in vaginal deliveries: 73.6%; p = 0.887; OR = 1.9 (95% CI 0.9-1.1))., Conclusion: A fetal weight above 3.79 kg does not predict increased maternal or infant morbidity after delivery from breech presentation at term. Neither the literature nor our analyses document evidence for threshold of estimated birth weight that is associated with maternal and/or infant morbidity. However, patients should be informed about an increased likelihood of cesarean sections during labor when attempting vaginal birth from breech position at term in order to reach an informed shared decision concerning the birth strategy. Further investigations in multi center settings are needed to advance international guidelines on vaginal breech deliveries in the context of estimated birth weight and its impact on perinatal outcome., Competing Interests: The authors have declared that no competing interests exist.