Cardiotocography (CTG), introduced in the 1960s, was initially expected to prevent hypoxia-related deaths and neurological injuries. However, more than five decades later, evidence supporting the evidence of intrapartum CTG in preventing neonatal and long-term childhood morbidity and mortality remains inconclusive. At the same time, shortcomings in CTG interpretation have been recognised as important contributory factors to rising caesarean section rates and missed opportunities for timely interventions. An important limitation is its high false-positive rate and poor specificity, which undermines reliably identifying foetuses at risk of hypoxia-related injuries. These shortcomings are compounded by the technology's significant intra- and interobserver variability, as well as the subjective and complex nature of fetal heart rate interpretation. However, human factors and other environmental factors are equally significant. Advancements in fetal heart rate monitoring are crucial to support clinicians in improving health outcomes for newborns and their mothers, while at the same time avoiding unnecessary operative deliveries. These limitations highlight the clinical need to enhance neonatal outcomes while minimising unnecessary interventions, such as instrumental deliveries or caesarean sections. We believe that achieving this requires a paradigm shift from subjective interpretation of complex and nonspecific fetal heart rate patterns to evidence-based, quantifiable solutions that integrate hardware, engineering and clinical perspectives. Such transformation necessitates an international, multidisciplinary effort encompassing the entire continuum of pregnancy care and the broader healthcare ecosystem, with emphasis on well-defined, actionable health outcomes. Achieving this will depend on collaborations between researchers, clinicians, medical device manufacturers and other relevant stakeholders. This expert review paper outlines the most relevant and promising directions for research and strategic initiatives to address current challenges in fetal heart rate monitoring. Key themes include advancements in computerised fetal heart rate monitoring, the application of big data and artificial intelligence, innovations in home and remote monitoring and consideration of human factors.

Objective: To measure and determine the occupational cardiovascular workload and cardiovascular fitness among older employees (50 +) in four physically demanding occupational groups. Methods: Health investigations, including aerobic capacity, were performed on 120 construction and kitchen workers, cleaners, and assistant nurses. Cardiovascular load was assessed over three working days using heart rate (HR) measurements. Data was processed for average loads (HR and Relative HR reserve (%HRR)) and measures describing variations in loads, such as time spent in different heart rate intensities. Results: Participants’ mean age was 57 (SD 4.1) years, and 63% of the participants were female. The mean %HRR over occupational groups was 24.9% (SD 6.8). Of the participants, 43% had an average cardiovascular load above 24.5%HRR and 11% over 33%HRR. Depending on the work sector, 22–37% of the worktime was spent in intensities over 30%HRR, and 2–4% was spent in cardiovascular intensities over 50%HRR. The average VO<inf>2</inf>max was 33.2 (SD 8.2) ml/kg/min for all, for men 39.0 (SD 7.0), and for women 29.8 (SD 6.9). Conclusion: We found a high mean cardiovascular load at work among the senior workers in all four work sectors, but low proportions of the worktime were spent in high intensity levels. Despite a high mean cardiovascular load at work, a high proportion of the workers had low cardiovascular fitness. Given the possible negative effects of occupational physical activity and to meet future demographic challenges, future interventions should aim to reduce physical loads and increase physical fitness in the workforce.

Introduction: Intraamniotic infection (IAI) is one of the main possible complications of preterm prelabor rupture of membranes (PPROM) and can lead to severe consequences for the neonate, such as early onset neonatal sepsis (EONS). Available diagnostic tools for IAI have poor diagnostic performance, which may result in both over- and underdiagnoses of IAI. In a search for better diagnostic tools, we have examined short-term variation (STV) in fetal heart rate. We have previously shown that in IAI exposed pregnancies, the STV was more than 20% lower in the last cardiotocography trace before the start of labor, as compared to those not exposed to IAI. The association between IAI and STV needs further evaluation and we therefore continued by examining the longitudinal change in STV in association with IAI. Material and methods: We performed a historical cohort study on 628 singleton pregnancies with PPROM, delivering between 24 + 0 to 33 + 6 gestational weeks. The main exposure of the study was IAI, using EONS as a proxy as no easily available method exists for confirming IAI antepartum, and IAI and EONS are strongly associated. The main outcome was STV in fetal heart rate. At least two available cardiotocography traces per fetus were required as a minimum, from PPROM or from seven days before birth, whichever came later, until the start of labor or planned cesarean birth. A total of 9 690 cardiotocography traces were analyzed. Results: Fetuses exposed to IAI had a 26.5% steeper decline in their STV during the last 24 h before the start of labor when compared to fetuses not exposed (95% CI -32.9% to -19.4%; p < 0.001). After adjustment for antenatal corticosteroids, the decline remained significant. The decline became less prominent but the significance remained when also adjusting for the baseline frequency (-12.7% [95% CI -19.3% to -5.5%], p < 0.001). In the IAI-exposed group, the baseline frequency increased by 11.1 bpm during the last 12 h before the start of labor, beyond those who were not exposed (95% CI 8.3 bpm to 13.8 bpm; p < 0.001). Conclusions: In pregnancies affected by IAI the STV declines steeper in the last 24 h before the start of labor as compared to pregnancies not affected by IAI, even after adjustment for increasing baseline frequency. The association of STV in relation to IAI needs to be further studied in order to evaluate and establish STVs usefulness in monitoring patients for IAI. [GRAPHICS]

Proton pump inhibitors (PPIs) are widely used to treat acid-related disorders, yet concerns persist regarding their association with adverse cardiovascular (CVAE), renal outcomes, and all-cause mortality. We leveraged real-world longitudinal data from the Stockholm CREAtinine Measurements (SCREAM) project to investigate trajectories linking PPI use with chronic kidney disease (CKD), CVAE, and all-cause mortality using a process mining approach. We identified 294,734 new users of PPIs or H2 blockers (H2Bs) with a baseline eGFR ≥ 60 mL/min/1.73 m² and followed them for up to 15 years using a process-mining approach to discover disease trajectories. The association of PPI and CVAE is not significant after accounting for death as a competing event. However, PPI use is significantly associated with a higher subdistribution hazard of CKD and all-cause mortality compared to H2B. Our findings indicate that CKD may act as a mediator in the trajectory PPI→CKD→CVAE, underscore the importance of monitoring renal function in long-term PPI users, and emphasise the need for future prospective trials to clarify cardiovascular risks.

INTRODUCTION: Early-onset neonatal sepsis (EONS) is an important cause of neonatal morbidity and mortality and is strongly associated with intra-amniotic infection. The risk of intra-amniotic infection increases after preterm prelabor rupture of membranes (PPROM). Better tools are needed for monitoring women with PPROM for intra-amniotic infection and identifying those at high risk of EONS so that intervention can be made timely. This study aimed to identify antepartum risk factors for EONS in a PPROM population and develop a risk-indicating model.

MATERIAL AND METHODS: We performed a historical cohort study on PPROM pregnancies delivering between gestational weeks 24 + 0 and 33 + 6 in Stockholm, Sweden. Using logistic regression, we evaluated the risk of the outcome EONS associated with maternal background characteristics, symptoms and signs, and cardiotocography. We combined variables associated with high risk into a risk-indicating model and estimated its performance by calculating its sensitivity, specificity, accuracy, positive and negative predictive values, positive likelihood ratio, and area under the ROC curve.

RESULTS: We included 709 women and their neonates, out of which 29 developed EONS. Variables most strongly associated with EONS were maternal diabetes (OR 4.37, 95% CI 1.41-13.56), maternal temperature ≥ 38°C (OR 6.42, 95% CI 2.94-14.02), positive urinary or vaginal/cervical culture (OR 2.62, 95% CI 1.14-6.03), and cardiotocography parameters. Fetal baseline frequency above 160 bpm was associated with a 3.75 times increased risk of EONS (95% CI 1.51-9.33). Meanwhile, short-term variation was negatively associated with EONS risk, and a value below 4 ms had a 4.17 times increased risk of EONS (95% CI 1.77-9.83). A risk-indicating model for EONS combining the mentioned variables had an area under the ROC curve of 0.7348. This model performed better at indicating risk for EONS than the clinicians' suspicion of intra-amniotic infection.

CONCLUSIONS: Maternal diabetes, maternal fever, positive urinary or vaginal/cervical culture, fetal tachycardia, and decreasing short-term variation were associated with an increased risk for EONS in a PPROM population. A risk-indicating model combining these risk factors performed better than the clinicians' suspicion of intra-amniotic infection in identifying high-risk pregnancies for EONS.

To better connect the needs of industrial stakeholders and technology development in smart wearables for ergonomics, the DiPMaS project uses a co-design methodology to develop a digital platform to support manufacturing staff to improve health, safety and quality. This conference contribution aims to provide an overview of the results of the project so far, and present the results from the user survey on the prioritized functionalities of the digital platform. The findings can contribute to the development of future digital platforms for ergonomics applications and facilitate the implementation of such platforms within the industry.

Hand-intensive work is strongly associated with work-related musculoskeletal disorders (WMSDs) of the hand/wrist and other upper body regions across diverse occupations, including office work, manufacturing, services, and healthcare. Addressing the prevalence of WMSDs requires reliable and practical exposure measurements. Traditional methods like electrogoniometry and optical motion capture, while reliable, are expensive and impractical for field use. In contrast, small inertial measurement units (IMUs) may provide a cost-effective, time-efficient, and user-friendly alternative for measuring hand/wrist posture during real work. This study compared six orientation algorithms for estimating wrist angles with an electrogoniometer, the current gold standard in field settings. Six participants performed five simulated hand-intensive work tasks (involving considerable wrist velocity and/or hand force) and one standardised hand movement. Three multiplicative Kalman filter algorithms with different smoothers and constraints showed the highest agreement with the goniometer. These algorithms exhibited median correlation coefficients of 0.75–0.78 for flexion/extension and 0.64 for radial/ulnar deviation across the six subjects and five tasks. They also ranked in the top three for the lowest mean absolute differences from the goniometer at the 10th, 50th, and 90th percentiles of wrist flexion/extension (9.3°, 2.9°, and 7.4°, respectively). Although the results of this study are not fully acceptable for practical field use, especially for some work tasks, they indicate that IMU-based wrist angle estimation may be useful in occupational risk assessments after further improvements.

IntroductionIntraamniotic infection (IAI) and subsequent early-onset neonatal sepsis (EONS) are among the main complications associated with preterm prelabor rupture of membranes (PPROM). Currently used diagnostic tools have been shown to have poor diagnostic performance for IAI. This study aimed to investigate whether the exposure to IAI before delivery is associated with short-term variation of the fetal heart rate in pregnancies with PPROM. MethodsObservational cohort study of 678 pregnancies with PPROM, delivering between 24 + 0 and 33 + 6 gestational weeks from 2012 to 2019 in five labor units in Stockholm County, Sweden. Electronic medical records were examined to obtain background and exposure data. For the exposure IAI, we used the later diagnosis of EONS in the offspring as a proxy. EONS is strongly associated to IAI and was considered a better proxy for IAI than the histological diagnosis of acute chorioamnionitis, since acute chorioamnionitis can be observed in the absence of both positive microbiology and biochemical markers for inflammation. Cardiotocography traces were analyzed by a computerized algorithm for short-term variation of the fetal heart rate, which was the main outcome measure. ResultsTwenty-seven pregnancies were categorized as having an IAI, based on the proxy diagnosis of EONS after birth. Fetuses exposed to IAI had significantly lower short-term variation values in the last cardiotocography trace before birth than fetuses who were not exposed (5.25 vs 6.62 ms; unadjusted difference: -1.37, p = 0.009). After adjustment for smoking and diabetes, this difference remained significant. IAI with a later positive blood culture in the neonate (n = 12) showed an even larger absolute difference in STV (-1.65; p = 0.034), with a relative decrease of 23.5%. ConclusionIn pregnancies with PPROM, fetuses exposed to IAI with EONS as a proxy have lower short-term variation of the fetal heart rate than fetuses who are not exposed. Short-term variation might be useful as adjunct surveillance in pregnancies with PPROM. [GRAPHICS] .

Previous studies have suggested an association between Proton Pump Inhibitors (PPIs) and the progression of chronic kidney disease (CKD). This study aims to assess the association between PPI use and CKD progression by analysing estimated glomerular filtration rate (eGFR) trajectories using a process mining approach. We conducted a retrospective cohort study from 1 January 2006 to 31 December 2011, utilising data from the Stockholm Creatinine Measurements (SCREAM). New users of PPIs and H2 blockers (H2Bs) with CKD (eGFR < 60) were identified using a new-user and active-comparator design. Process mining discovery is a technique that discovers patterns and sequences in events over time, making it suitable for studying longitudinal eGFR trajectories. We used this technique to construct eGFR trajectory models for both PPI and H2B users. Our analysis indicated that PPI users exhibited more complex and rapidly declining eGFR trajectories compared to H2B users, with a 75% increased risk (adjusted hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.49 to 2.06) of transitioning from moderate eGFR stage (G3) to more severe stages (G4 or G5). These findings suggest that PPI use is associated with an increased risk of CKD progression, demonstrating the utility of process mining for longitudinal analysis in epidemiology, leading to an improved understanding of disease progression.

Process mining holds promise for analysing longitudinal data in clinical epidemiology, yet its application remains limited. The objective of this study was to propose and evaluate a methodology for applying process mining techniques in observational clinical epidemiology. We propose a methodology that integrates a cohort study design with data-driven process mining, with an eight-step approach, including data collection, data extraction and curation, event-log generation, process discovery, process abstraction, hypothesis generation, statistical testing, and prediction. These steps facilitate the discovery of disease progression patterns. We implemented our proposed methodology in a cohort study comparing new users of proton pump inhibitors (PPI) and H2 blockers (H2B). PPI usage was associated with a higher risk of disease progression compared to H2B usage, including a greater than 30% decline in estimated Glomerular Filtration Rate (eGFR) (Hazard Ratio [HR] 1.6, 95% Confidence Interval [CI] 1.4–1.8), as well as increased all-cause mortality (HR 3.0, 95% CI 2.1–4.4). Furthermore, we investigated the associations between each transition and covariates such as age, gender, and comorbidities, offering deeper insights into disease progression dynamics. Additionally, a risk prediction tool was developed to estimate the transition probability for an individual at a future time. The proposed methodology bridges the gap between process mining and epidemiological studies, providing a useful approach to investigating disease progression and risk factors. The synergy between these fields enhances the depth of study findings and fosters the discovery of new insights and ideas.