Long-term effects of preeclampsia on maternal cardiovascular health and postpartum utilization of primary care: an observational claims data study

Purpose: Preeclampsia occurs in up to 15% of pregnancies and constitutes a major risk factor for cardiovascular disease. This observational cohort study aimed to examine the association between preeclamptic pregnancies and cardiovascular outcomes as well as primary and specialized care utilization after delivery. Methods: Using statutory claims data we identified women with singleton live births between 2010 and 2017. Main outcomes included the occurrence of either hypertension or cardiovascular disease after one or more preeclamptic pregnancies, number of contacts to a general practitioner or cardiologist after delivery and prescribed antihypertensive medication. Data were analyzed using Cox proportional hazard regression models adjusted for maternal age, diabetes, dyslipidemia, and obesity. Results: The study cohort consisted of 181,574 women with 240,698 births. Women who experienced preeclampsia once had an increased risk for cardiovascular (hazard ratio, HR = 1.29) or hypertensive (HR = 4.13) events. In women affected by recurrent preeclampsia, risks were even higher to develop cardiovascular disease (HR = 1.53) or hypertension (HR = 6.01). In the following years after delivery, general practitioners were seen frequently, whereas cardiologists were consulted rarely (0.3 and 2.4%). Conclusion: Women affected by preeclampsia experience an increased risk of developing chronic hypertension and cardiovascular disease, especially those with recurrent preeclampsia. Future medical guidelines should take this potential risk into account

Consideration of objective measures of performance and subjective assessments under background speech in open-plan offices

Short-term memory performance is important for activities in office environments and has effects on the efficiency of a company and employees' productivity. Negative effects of background speech on short-term memory performance have been shown in several laboratory studies (e.g. Banbury & Berry 1998). The Speech Transmission Index (STI) is considered to be a suitable physical set value to predict the decline of performance (Hongisto 2005). However, the impact on subjective aspects such as perceived workload is rarely considered. It already has been shown that subjective assessment like disturbance and objectively measured performance do not necessarily match (e.g. Schlittmeier et al. 2008). Employees may be able to compensate for performance effects by an increase of effort but in turn perceived workload may increase (e.g. Yeh & Wickens 1988). In addition, a lack of perceived privacy, caused by background speech (among other factors) can influence mental workload and pe rformance (e.g. Croon et al. 2005). This effect may not be immediately visible, but must be considered in the long term with respect to a decline of job dissatisfaction, which can cause absenteeism and even job termination. To avoid these consequences an exclusive focus on the loss of performance is not sufficient. Therefore the reported results consider both the effects of background speech varying in intelligibility (STI) to objective and subjective measures. It is shown that subjective assessments, e.g. of workload, disturbance, territoriality as well as privacy and objective measures of performance correlate with the STI

The relationship between the Speech Transmission Index and measures of cognitive performance

The presence of intelligible ambient speech is known to impair cognitive performance at silent, concentrated work. This experimental result is relevant to openplan offices, where individual task performance is assumed to be impaired by conversations of colleagues. This is a severe matter for the efficiency of companies. However, it has to be acknowledged that measures of cognitive performance in laboratory studies do not directly match real life office tasks and effects are expected to be task specific. The Speech Transmission Index (STI) is assumed to predict how much performance is reduced due to ambient speech in dependency of its intelligibility. A model in terms of an STIperformance-curve was proposed by Hongisto (2005) and target values for the acoustic quality of open-plan offices were defined. However, the model as well as the classification scheme still need to be elaborated. The reported studies systematically evaluate the proposed STI-performance-curve for STI values from 0.20 to 0.70, where the greatest performance effects are predicted. As a consequence of the results, new target values have to be discussed. Since the decline of performance due to ambient speech of varying intelligibility is expected to be task-sensitive, it needs to be investigated whether the model applies to different tasks. Therefore, experimental results are presented which address the issue of task sensitivity

Challenging the assumptions for thermal sensation scales

Schweiker M, Fuchs X, Becker S, et al. Challenging the assumptions for thermal sensation scales. Building Research & Information. 2016;45(5):1-18

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Abstract Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions