186 results on '"Nielsen BB"'
Search Results
2. Restricted Variance Interaction Effects: What They Are and Why They Are Your Friends
- Author
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Cortina, JM, Koehler, T, Keeler, KR, Nielsen, BB, Cortina, JM, Koehler, T, Keeler, KR, and Nielsen, BB
- Abstract
Although interaction hypotheses are increasingly common in our field, many recent articles point out that authors often have difficulty justifying them. The purpose of this article is to describe a particular type of interaction: the restricted variance (RV) interaction. The essence of the RV interaction is that, as the value of one variable in a system changes, certain values of another variable in the system become less plausible, thus restricting its variance. This, in turn, influences relationships between that variable and other variables. These types of interactions are quite common, even if they are not recognized as RV interactions, and they exist at every level of analysis. The advantage of the RV interaction is that, as compared with other interaction types, it is relatively simple to justify. The different forms of RV interaction do, however, contain complexities of which a researcher must be aware. This article explains and illustrates the forms that RV interactions can take and their often counterintuitive implications. It also describes how one should go about testing them. Our intention is to help researchers strengthen and focus their interaction arguments.
- Published
- 2019
3. Anaerobic fungi, their distribution and life cycle
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Trinci, APJ, Rickers, A, Gull, K, Davies, DR, Nielsen, BB, Zhu, WY, and Theodorou, MK
- Published
- 2016
4. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi‐experimental pre‐post study (The PartoMa study)
- Author
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Maaløe, N, primary, Housseine, N, additional, Meguid, T, additional, Nielsen, BB, additional, Jensen, AKG, additional, Khamis, RS, additional, Mohamed, AG, additional, Ali, MM, additional, Said, SM, additional, van Roosmalen, J, additional, and Bygbjerg, IC, additional
- Published
- 2017
- Full Text
- View/download PDF
5. Agonist binding, efficacy and domain closure of GluR2
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Frandsen, A, Pickering, DS, Vestergaard, B, Kasper, C, Nielsen, BB, Greenwood, JR, Campiani, G, Fattorusso, C, Gajhede, M, Schousboe, A, Kastrup, JS., Frandsen, A, Pickering, D, Vestergaard, B, Kasper, C, Nielsen, Bb, Greenwood, Jr, Campiani, G, Fattorusso, C, Gajhede, M, Schousboe, A, and Kastrup, Js.
- Published
- 2005
6. Top Management Team Nationality Diversity And Firm Performance: A Multilevel Study
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Nielsen, BB and Nielsen, S
- Subjects
Business & Management - Abstract
This research reexamines the equivocal relationship between top management team (TMT) diversity and firm performance. Combining upper echelons theory with insights from institutional theory, we establish a new, timely dimension of TMT diversitynationality diversityand develop an integrated multilevel framework explaining how its performance implications vary across contextual settings. We find that nationality diversity is positively related to performance; and this effect is stronger in (a) longer tenured teams, (b) highly internationalized firms, and (c) munificent environments. More generally, our research demonstrates that the consequences of TMT diversity depend on the (1) specific attributes of diversity being considered and (2) firm and industry conditions under which strategic decisions take place.
- Published
- 2013
7. Dynamic capabilities and performance: strategy, structure and environment
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Wilden, RM, Gudergan, S, Nielsen, BB, and Lings, IN
- Subjects
Business & Management - Abstract
Dynamic capabilities are widely considered to incorporate those processes that enable organizations to sustain superior performance over time. In this paper, we argue theoretically and demonstrate empirically that these effects are contingent on organizational structure and the competitive intensity in the market. Results from partial least square structural equation modeling (PLS-SEM) analyses indicate that organic organizational structures facilitate the impact of dynamic capabilities on organizational performance. Furthermore, we find that the performance effects of dynamic capabilities are contingent on the competitive intensity faced by firms. Our findings demonstrate the performance effects of internal alignment between organizational structure and dynamic capabilities, as well as the external fit of dynamic capabilities with competitive intensity. We outline the advantages of PLS-SEM for modeling latent constructs, such as dynamic capabilities, and conclude with managerial implications.
- Published
- 2013
8. 2012 Australian Census of Women in Leadership
- Author
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EOWA, EOFWITWA, Clarke, T, Nielsen, BB, Nielsen, S, Klettner, AL, and Boersma, M
- Abstract
A research book commissioned by the Australian Government Equal Opportunity Agency. This work reports the results of the 2012 Australian Census of Women in Leadership. The survey includes an analysis of the ASX 500 companies boards and executives gender diversity; gender diversity in public sector boards; and comparison with international initiatives in gender diversity in leadership positions. The work provides a detailed analysis of a large data base, and analytical commentary of the results. There is an assessment of remaining obstacles to achieving greater diversity, and analysis of what is required to create a better pipeline for the development of women for leadership.
- Published
- 2012
9. Exploration And Exploitation Fit And Performance In International Strategic Alliances
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Nielsen, BB and Gudergan, S
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Business & Management - Abstract
Exploration and exploitation constitute two separate, potentially conflicting strategic choices for firms engaged in international strategic alliances. Our empirical study challenges the ambidexterity argument and demonstrates that exploration and exploi
- Published
- 2012
10. A multilevel approach to understanding the multinationality-performance relationship
- Author
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Nielsen, BB, Nielsen, S, Devinney, T, Pedersen, T, and Tihanyl, L
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Business & Management - Abstract
This paper offers a discussion of the key multilevel issues pertaining to the multinationalityperformance (MP) relationship. Arguably, one of the most important areas of research in international business, firm internationalization and its consequences are multilevel phenomena, influenced by forces at different managerial and structural levels: from the executive, subsidiary and firm, to the country and industry. We suggest that accounting for important factors at each level and for their cross-level interactions may help reconcile inconsistent findings and advance our understanding of the MP relationship. Based on a critical review of the literature, we offer recommendations regarding the appropriate levels of theory, measurement, and analysis to guide future research
- Published
- 2010
11. Acupuncture for the induction of labour: a double-blind randomised controlled study
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Modlock, J, Nielsen, BB, and Uldbjerg, N
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Adult ,Male ,General Obstetrics ,Acupuncture Therapy ,Infant, Newborn ,Acupuncture ,labour induction ,Body Mass Index ,Parity ,prolonged pregnancy ,sham acupuncture ,Double-Blind Method ,Pregnancy ,Birth Weight ,Humans ,Female ,Pregnancy, Prolonged ,Labor, Induced ,Acupuncture Points - Abstract
Udgivelsesdato: 2010-Jun-24 Please cite this paper as: Modlock J, Nielsen B, Uldbjerg N. Acupuncture for the induction of labour: a double-blind randomised controlled study. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02647.x. Objective To investigate whether acupuncture is effective for the induction of labour in post-term pregnancies. Design A double-blind multicentre randomised controlled study. Settings Aarhus University Hospital and Herning Regional Hospital, Denmark. Population One hundred and twenty-five healthy women with uneventful pregnancies at gestational week 41(+6) were randomised into two groups. Methods The intervention group was given acupuncture twice on the same day at acupuncture point GV20 and bilaterally at points BL67, LI4 and SP6. The control group received sham acupuncture at the same points. Main outcome measures At effect evaluation, which was carried out 24 hours after randomisation, the primary endpoint was labour or delivery. Results The primary endpoint was achieved in seven women (12%) in the acupuncture group and eight women (14%) in the control group (P = 0.79). Stratification for parity and fetal gender did not alter the results. Conclusion Under the treatment regimen investigated in this study, acupuncture for the induction of labour in post-term women at gestational age 41(+6) weeks may not be effective.
- Published
- 2010
12. Strategic fit, contractual, and procedural governance in alliances
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Nielsen, BB
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Marketing - Abstract
This paper focuses on the simultaneous mediating and moderating effects of different governance mechanisms on the relationship between conditions for alliance formation and outcome. Alliance governance takes two distinct forms: contractual integration and procedural coordination. While contracts may help set the legal parameters of the alliance agreement, it is day-to-day coordination of activities and processes that determine the effectiveness of such contracts. The proposed framework explains how knowledge outcome of collaborative relationships may be determined by the match of partner motives, influenced by the mix of contractual and procedural governance. A series of testable propositions helps answer the following question. Do combinations of contractual and procedural governance mechanisms, given specific strategic fit, explain knowledge performance differentials?
- Published
- 2010
13. Collaborative capability in R&D alliances: exploring the link between organisational- and individual-level factors
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Knudsen, LG and Nielsen, BB
- Abstract
Utilising the dynamic capabilities perspective, this study examines the role of collaborative capability in R&D alliances with a focus on the interplay between organisational- and individual-level mechanisms. Collaborative capability has predominantly been conceptualised and analysed from a firm-level perspective, whereas the individual-level mechanisms that enable this ability to develop and flourish have been neglected. We explore the development of Novozymes' 'Partnering Project' and show how individual-level factors, such as competence development, work in concert with organisational-level strategic and structural mechanisms in creating collaborative capability. Based on an in-depth case study and a review of the literature, we propose a framework to explain the multi-dimensional nature of collaborative capabilities in R&D alliances. Our study shows how firms may benefit from increased attention to the interaction between individual- and organisational-level issues, captured via a partnering mindset, when designing R&D alliances.
- Published
- 2010
14. The impact of advanced life support in obstetrics training on post partum haemorrhage: XIX FIGO World Congress of Gynecology & Obstetrics, Cape Town
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Sorensen , BL, Rasch, Vibeke, Massawe , S, Nyakina , JD, Elsass , P, and Nielsen , BB
- Published
- 2009
15. Adaptive strategy making : The effects of emergent and intended strategy modes
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Andersen, TJ and Nielsen, BB
- Abstract
NA
- Published
- 2009
16. Determining international strategic alliance performance: A multidimensional approach
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Nielsen, BB
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Business & Management - Abstract
This paper considers the relationship between subjective, multidimensional measures of international strategic alliance (ISA) performance and predictors of success both before the alliance is formed (pre-alliance formation factors) and during the operation of the alliance (post-alliance formation factors). The empirical study, based on a web-survey, investigates a sample of Danish partner firms engaged in 48 equity joint ventures and 70 non-equity joint ventures with partners from around the world. A multi-dimensional operationalization of alliance performance measurement is utilized in order to capture both process and outcome aspects of alliance performance. The results show a significant relationship between alliance performance and host country risk as well as partner reputation preceding alliance formation. During the operation of the alliance, relationships between collaborative know-how, trust, protectiveness, complementarity, cultural distance and alliance performance were found.
- Published
- 2007
17. Knowledge management systems in multinational corporations : Typology and transitional dynamics
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Nielsen, BB and Michailova, S
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Business & Management - Abstract
The aim of this research is to (1) identify different types of MNC KMSs, based on these systems defining characteristics, (2) analyse the interdependencies between internal organisational factors and external environmental pressures that drive the adoption of a specific KMS, and (3) provide a better understanding of the processes underlying transitions between different types of KMS. In particular, we seek to advance the understanding of the dynamic nature ofKMprocesses in MNCs.Wemake MNC managers aware of the existence of different types of KMS and provide guidelines regarding the factors to consider when implementing a certain KMS type. Moreover, we outline some lessons in the management of transitions between different KMS types, and show the importance of timing and resource allocation for successful KMS implementation and change.
- Published
- 2007
18. Equity versus non-equity international strategic alliances involving Danish firms: An empirical investigation of the relative importance of partner and host country determinants
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Globerman, S and Nielsen, BB
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Business & Management - Abstract
A substantial literature has evolved focusing on the ownership structure of international strategic alliances (ISAs). Most of the relevant studies are theoretical in nature and concentrate on the conceptual factors that influence the choice between equity and non-equity structures. A smaller number of studies provide some empirical evidence on the importance of some of the conceptual factors. The theoretical literature highlights the potential influence of relational capital and transaction costs as determinants of ISA structure; however, there is little empirical evidence on the relative importance of these potential determinants. Moreover, there is only limited and indirect evidence bearing upon the impact of host country governance attributes on ISA ownership structure. In this study, we provide statistical evidence on the importance of potential determinants of governance mode choice for a sample of ISAs involving Danish firms. Our study documents how the determinants of governance mode choice vary in importance depending upon the quality of the governance infrastructure of the host country.
- Published
- 2007
19. MNCs and knowledge management : A typology and key features
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Michailova, S and Nielsen, BB
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Business & Management - Abstract
Purpose - In the literature there is inherent lack of process-oriented, evolutionary perspectives of organizational knowledge as it pertains to international business. To fill this gap, the aim of this paper is to draw on existing theories of the multinational corporation (MNC) and integrate it with knowledge management research to analyze key knowledge management features and dynamics of different types of MNCs. The paper aims at proposing a link between types of MNCs and knowledge management strategies applied by MNCs. Design/methodology/approach - The paper uses a series of examples from MNCs worldwide to propose a knowledge management based typology of MNCs and to illustrate how they exhibit different strategic dynamics related to knowledge management. Findings - An important stream of literature on MNCs distinguishes between two traditional models for established MNCs, originally described as ethnocentric and polycentric models. A common theme in these studies propose that dramatic changes in the competitive environment has reduced the effectiveness of traditional MNC approaches, highlighting the need to move toward network-based structures. Building on the evolutionary perspective of MNCs, the paper suggests a third type of MNC characterized by a virtual infrastructure based on an e-business model. The paper argues that this type may be more appropriate for organizing managerial activities across organizational and national boundaries in the new web-based knowledge economy. Practical implications - The paper suggests that whereas traditional MNCs invite for management interventions based on centralized economies of information, it makes more sense to manage networked MNCs as integrated learning organizations and e-business based MNCs as boundary-less virtual communities of practice.
- Published
- 2006
20. Global Cities And Multinational Enterprise Location Strategy
- Author
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Goerzen, A, Asmussen, C, Nielsen, BB, Goerzen, A, Asmussen, C, and Nielsen, BB
- Abstract
We combine the concept of location derived by economic geographers with theories of the multinational enterprise (MNE) and the liability of foreignness developed by international business scholars, to examine the factors that propel MNEs toward, or away from, global cities. We argue that three distinctive characteristics of global cities global interconnectedness, cosmopolitanism, and abundance of advanced producer services help MNEs overcome the costs of doing business abroad, and we identify the contingencies under which these characteristics combine with firm attributes to exert their strongest influence. Consistent with these arguments, our analysis of a large sample of MNE location decisions using a multilevel multinomial model suggests not only that MNEs have a strong propensity to locate within global cities, but also that these choices are associated with a nuanced interplay of firm- and subsidiary-level factors, including investment motives, proprietary capabilities, and business strategy. Our study provides important insights for international business scholars by shedding new light on MNE location choices and also contributes to our understanding of economic geography by examining the heterogeneous strategies and capabilities of MNEs the primary agents of economic globalization that shape the nature of global cities.
- Published
- 2013
21. The role of top management team international orientation in international strategic decision-making: The choice of foreign entry mode
- Author
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Nielsen, BB, Nielsen, S, Nielsen, BB, and Nielsen, S
- Abstract
By applying the upper echelons perspective to international strategic decision-making, we examine the impact of managerial characteristics on the choice of foreign entry mode. We distinguish between top management team (TMT) international experience and nationality diversity and propose the latter as a central yet understudied aspect of TMT composition that influences international decision-making with regard to choice of entry mode in a unique way. Our results show that while TMTs with international experience are more likely to choose full-control entry modes over shared-control entry modes, nationally diverse TMTs are more inclined to opt for shared-control over full-control entry modes when entering foreign markets. This highlights the need to treat TMT nationality diversity and international experience as two distinct characteristics influencing international strategic decision-making.
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- 2011
22. A multilevel approach to understanding the multinationality-performance relationship
- Author
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Devinney, T, Pedersen, T, Tihanyl, L, Nielsen, BB, Nielsen, S, Devinney, T, Pedersen, T, Tihanyl, L, Nielsen, BB, and Nielsen, S
- Abstract
This paper offers a discussion of the key multilevel issues pertaining to the multinationalityperformance (MP) relationship. Arguably, one of the most important areas of research in international business, firm internationalization and its consequences are multilevel phenomena, influenced by forces at different managerial and structural levels: from the executive, subsidiary and firm, to the country and industry. We suggest that accounting for important factors at each level and for their cross-level interactions may help reconcile inconsistent findings and advance our understanding of the MP relationship. Based on a critical review of the literature, we offer recommendations regarding the appropriate levels of theory, measurement, and analysis to guide future research
- Published
- 2010
23. Learning and innovation in international strategic alliances : An empirical test of the role of trust and tacitness
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Nielsen, BB, Nielsen, S, Nielsen, BB, and Nielsen, S
- Published
- 2009
24. Screening of anaerobic gut fungi for effective plant biomass degradation using gas production
- Author
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Zhu, W-y, Theodorou, Mk, Nielsen, Bb, Trinci, Apj, and Revues Inra, Import
- Subjects
[SDV.AEN] Life Sciences [q-bio]/Food and Nutrition ,[SDV.BDD] Life Sciences [q-bio]/Development Biology ,[SDV.BDLR] Life Sciences [q-bio]/Reproductive Biology - Published
- 1997
25. Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial
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Lund, S, primary, Hemed, M, additional, Nielsen, BB, additional, Said, A, additional, Said, K, additional, Makungu, MH, additional, and Rasch, V, additional
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- 2012
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26. Acupuncture for the induction of labour: a double-blind randomised controlled study
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Uldbjerg, N, primary, Modlock, J, additional, and Nielsen, BB, additional
- Published
- 2011
- Full Text
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27. Acupuncture for the induction of labour: a double-blind randomised controlled study
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Modlock, J, primary, Nielsen, BB, additional, and Uldbjerg, N, additional
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- 2010
- Full Text
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28. Infrared absorption study of a new dicarbon center in silicon
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Lavrov, EV, Nielsen, BB, Byberg, J, Lindstrom, JL, Lavrov, EV, Nielsen, BB, Byberg, J, and Lindstrom, JL
- Abstract
Infrared absorption measurements on n-type silicon doped with carbon and irradiated with electrons at room temperature have revealed new absorption lines at 527.4 and 748.7 cm(-1). The 748.7 cm(-1) line is observed only when the sample is cooled down in the dark and the spectra are measured through a low-pass filter with cut-off frequency below 6000 cm(-1). Light of frequency above 6000 cm(-1) removes this line and generates the 527.4-cm(-1) line. Spectra recorded on silicon doped with C-13 show that the two lines represent local vibrational modes of a carbon defect. The annealing behavior of the 748.7-cm(-1) line and of the EPR signal of two neighboring substitutional carbon atoms, (C-s-C-s)(-), are identical. The 527.4- and 748.7-cm(-1) modes are identified as the modes of C-s-C-s in neutral and negative charge states, respectively. The formation of C-s-C-s is investigated, and it is shown that the center may arise when a vacancy is trapped by the metastable substitutional carbon-interstitial carbon center, C-s-C-i. (C) 1999 Elsevier Science B.V. All rights reserved.
- Published
- 1999
29. Local vibrational modes of a dicarbon-hydrogen center in crystalline silicon
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Hoffmann, L, Lavrov, EV, Nielsen, BB, Lindstrom, JL, Hoffmann, L, Lavrov, EV, Nielsen, BB, and Lindstrom, JL
- Abstract
Carbon-doped silicon irradiated with electrons at room temperature and subsequently implanted with protons has been studied by infrared absorption spectroscopy. Isochronal annealing in the temperature range from 400 degrees C to 800 degrees C has revealed an absorption line at 2967 cm(-1). When protons are substituted by deuterons, the line shifts down in frequency to 2211 cm(-1) and co-implantation of protons and deuterons gives rise to an additional line at 2218 cm(-1) Isotope shifts and similar annealing characteristics of the three lines show that the 2967 cm(-1) line represents a local vibrational mode of a defect, which contains two equivalent hydrogen atoms. In samples co-doped with C-12 and C-13, an additional mode is observed at 2963 cm(-1), which is about halfway between the modes involving only C-12 or C-13. From the relative intensities of the isotope-shifted modes in silicon co-doped with C-12 and C-13, it is concluded that the center contains two equivalent carbon atoms. The center is tentatively identified as two equivalent hydrogen atoms bound to two neighboring carbon atoms at substitutional sites. (C) 1999 Elsevier Science B.V. All rights reserved.
- Published
- 1999
30. Screening of anaerobic gut fungi for effective plant biomass degradation using gas production
- Author
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Zhu, W-Y, primary, Theodorou, MK, additional, Nielsen, BB, additional, and Trinci, APJ, additional
- Published
- 1997
- Full Text
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31. Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania.
- Author
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Sorensen BL, Elsass P, Nielsen BB, Massawe S, Nyakina J, and Rasch V
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- 2010
- Full Text
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32. Food and nutrient intakes among pregnant women in rural Tamil Nadu, South India.
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Andersen LT, Thilsted SH, Nielsen BB, Rangasamy S, Andersen, Lena Theilgaard, Thilsted, Shakuntala Haraksingh, Nielsen, Birgitte Bruun, and Rangasamy, Suguna
- Abstract
Objectives: To study pregnant women's diet at food and nutrient levels and how these match recommendations; to describe how factors such as education level, economy and folk dietetics influence the women's food choice; and to give suggestions for the improvement of nutrition education in the existing antenatal care systems.Design and Subjects: Thirty pregnant women in the last trimester were interviewed three times using a 24-hour dietary recall with weighing of foods and recipes of dishes. Interviews regarding health, nutrition and socio-economic status, and measurements of weight and height of the women, were conducted.Setting: Rural parts of Salem District, Tamil Nadu, South India.Results and Conclusion: The women's diet (without supplements) was insufficient in energy and all nutrients except fat, compared with the Indian recommendations. Aggravating low intakes of micronutrients were found which were reflected in low intakes of foods other than rice. Eating customs and economy appeared to influence the women's food choice negatively in relation to recommendations while factors such as education level, family type, pregnancy number and folk dietetics did not seem to have a negative effect. The amounts of foods recommended, especially green leafy vegetables, must be shown to the women. The nutrition advice given by all levels of health providers must be the same and based on cheap, local, commonly consumed foods. [ABSTRACT FROM AUTHOR]- Published
- 2003
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33. The Children's Global Assessment Scale (CGAS) and Global Assessment of Psychosocial Disability (GAPD) in clinical practice -- substance and reliability as judged by intraclass correlations.
- Author
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Dyrborg J, Larsen FW, Nielsen S, Byman J, Nielsen BB, and Gautré-Delay F
- Abstract
Studies on the inter-rater reliability on the Children's Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD) involving different subgroups of 145 outpatients from 4 to 16 years of age showed fair to substantial intraclass correlations of 0.59 to 0.90. Raters of different training levels participated. Interrater reliability was dependent on number of ratings per rater, training, available data sources and experience. A more detailed description of anchor points resulted in higher inter-rater agreement by psychiatrists training in child and adolescent psychiatry, but did not influence the inter-rater reliability among more (widely) experienced raters. Both the CGAS and the GAPD seem to be sufficiently reliable tools in clinical practice. The CGAS seems to be more sensitive to inter-rater variation than the GAPD. [ABSTRACT FROM AUTHOR]
- Published
- 2000
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34. Perceptions of the mammography experience.
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Baskin-Smith J, Miaskowski C, Dibble SL, Weekes D, and Nielsen BB
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- 1995
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35. The nurse's role in mammography screening.
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Nielsen BB
- Published
- 1989
36. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial.
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Lund SS, Tarnow L, Frandsen M, Nielsen BB, Hansen BV, Pedersen O, Parving H, and Vaag AA
- Subjects
PREVENTION of drug side effects ,INSULIN therapy ,OBESITY ,GLYCOSYLATED hemoglobin ,EVALUATION of medical care ,COMBINATION drug therapy ,INSULIN secretagogues ,ORAL drug administration ,TYPE 2 diabetes ,INSULIN ,HYPOGLYCEMIA ,METFORMIN ,PATIENT compliance - Published
- 2009
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37. Permanently infertile couples and family building-a cross-sectional survey in Denmark.
- Author
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Tanderup M, Vassard D, Nielsen BB, Pande A, Kroløkke C, Humaidan P, and Schmidt L
- Abstract
Study Question: Which decision-making factors influence family building among permanently infertile couples?, Summary Answer: Ethical, legal, and financial considerations outweigh genetic relatedness in decision-making, favouring domestic gestational surrogacy, if this were possible, over international options., What Is Known Already: Permanent infertility affects 4-5% of people in the fertile age. Their family-building options include adoption, surrogacy, uterus transplantation, foster care, and intentional multiple parenthood. However, in most countries, including Denmark, legal barriers constrain these methods due to surrogacy restrictions, suspended international adoptions, and the experimental status of uterus transplantation. Despite existing research on surrogacy, adoption, and specific causes of permanent infertility, a significant gap remains in our understanding of how couples with permanent infertility make family-building decisions within these limited frameworks., Study Design, Size, Duration: This cross-sectional study with 150 permanently infertile Danish participants was conducted from June to November 2023 using an online questionnaire. Multiple strategies, such as online forums, fertility clinics, hospital departments, and snowballing, were used to recruit a diverse sample., Participants/materials, Setting, Methods: The study included couples aged 26-50 years facing permanent infertility due to the following primary causes: women without a uterus (15%), women with a non-functional uterus (47%) or women for whom pregnancy would be life-threatening (9%), male couples (16%), transgender partner couples (2%), and other causes (11%). The survey collected data on demographics, reproductive history, family-building choices, and communication strategies. Closed questions were analysed using descriptive statistics., Main Results and the Role of Chance: Among 150 respondents, 41% had used transnational surrogacy, 27% adoption, 14% chose to remain childless, and 19% were undecided. Critical factors on family-building decisions were ethical, legal, and financial concerns which ranked higher than genetic relatedness. Despite the complexity of family building, most participants were open about their child's origin and received social support. If all family-building methods were legal and available in Denmark, domestic gestational surrogacy would be the preferred method, with uterus transplantation and remaining childless being least popular., Limitations, Reasons for Caution: The sample size is relatively small, despite the use of a variety of recruitment strategies. Nevertheless, this has ensured a diverse cohort representing the different reasons for infertility and family-building choices. It is important to note that the strategies may have favoured individuals achieving parenthood., Wider Implications of the Findings: The finding of our study reveals a notable gap between available family-building options in Denmark and the preferences of couples facing permanent infertility. These insights could be instrumental for organizations reviewing and developing family-building frameworks. Furthermore, for healthcare professionals guiding couples experiencing infertility issues in their attempts to build a family, an understanding of these preferences is essential to facilitate informed decisions about their future family plans., Study Funding/competing Interest(s): The project was financed by the Independent Research Fund Denmark. The authors have no conflict of interest to declare., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)
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- 2024
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38. Cancer in pregnancy - The obstetrical management.
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Storgaard L, Greiber IK, Pedersen BW, Nielsen BB, and Karlsen MA
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- Pregnancy, Female, Humans, Medical Oncology, Obstetrics, Pregnancy Complications, Neoplastic diagnosis, Pregnancy Complications, Neoplastic therapy
- Abstract
Cancer in pregnancy, defined as a cancer diagnosed during pregnancy, is a rare but severe condition presenting both clinical and ethical challenges. During the last two decades a paradigm shift has occurred towards recommending similar staging and treatment regimens of pregnant and non-pregnant cancer patients. This strategy is a result of an increasing number of reassuring reports on chemotherapy treatment in pregnancy after the first trimester. The management of cancer in pregnancy should be managed in a multidisciplinary team where staging, oncological treatment, social and mental care, timing of delivery, and follow-up of the infant should be planned. Due to the rarity, centralization is recommended to allow experience accumulation. Furthermore, national and international advisory boards are supportive when there is a lack of expertise., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
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- 2024
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39. Surrogacy as fertility treatment in Denmark.
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Tanderup M, Schmidt L, Kroløkke C, Nielsen BB, and Humaidan P
- Subjects
- Pregnancy, Female, Humans, Contracts, Denmark, Surrogate Mothers, Infertility
- Abstract
Gestational surrogacy, in which an infertile couple contracts with a woman to carry a foetus that the intended parents will raise, increases worldwide, and offers a route to parenthood for individuals and couples who otherwise have limited options. However, the situation in Denmark at present is that surrogacy with the help of healthcare professionals is illegal, and international adoption is no longer available. This review gives an overview of the legal situation of surrogacy in Denmark, the impact of the legislation, and medical issues to be aware of as healthcare professionals in the future., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)
- Published
- 2024
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40. Anaemia in the first trimester and poor physiological plasma expansion during pregnancy negatively impact foetal weight and newborn anthropometrics: An observational cohort study in Tanzania.
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Schmiegelow C, Møller SL, Yde AM, Nielsen BB, Hjort L, Theander TG, Lusingu JPA, Minja DTR, and Bygbjerg IC
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- Pregnancy, Female, Infant, Newborn, Humans, Pregnancy Trimester, First, Fetal Weight, Birth Weight, Prospective Studies, Tanzania epidemiology, Placenta, Pregnancy Outcome epidemiology, Hemoglobins, Cohort Studies, Pregnancy Complications, Hematologic epidemiology, Anemia epidemiology
- Abstract
Objectives: Anaemia during pregnancy is a major health challenge affecting pregnancy outcome worldwide. The objectives of this study were to investigate the impact of severe-moderate anaemia in the first trimester, as well as changes in haemoglobin during pregnancy among non-anaemic women, on foetal weight, placental blood flow and newborn anthropometrics., Methods: In a prospective cohort study, 346 women residing in rural Tanzania were followed throughout pregnancy with serial ultrasound and newborn anthropometrics assessed within 24 h of delivery. Associations between placental blood flow, foetal weight and newborn anthropometrics with either first trimester severe-moderate anaemia (haemoglobin≤9.5 g/dL) or changes in haemoglobin from the first to the third trimester among non-anaemic women, were assessed by mixed model regression and multiple linear regression, adjusting for maternal and foetal co-variables. Foetal weights and birthweight were converted to z-scores using a population based sex-specific weight reference., Results: Severe-moderate anaemia in the first trimester was associated with significantly reduced foetal weight z-scores (adjusted mean difference (aMD) -0.44 (95% CI -0.81, -0.07)) and newborn anthropometric indices (birth weight z-score aMD -0.55 (-0.9, -0.13), abdominal circumference aMD -11 mm (95% CI -20, -3)). There were no association between first trimester severe-moderate anaemia and placental blood flow. Among women who were non-anaemic in the first trimester, women with the least reduction in haemoglobin (Δ ≥ -0.3 g/dL) delivered significantly smaller newborns (birthweight z-score aMD -0.55 (-0.91, -0.20), abdominal circumference aMD -10 mm (95% CI -17, -3), compared to women with the greatest reduction (Δ haemoglobin ≤ -1.4 g/dL))., Conclusions: Severe-moderate anaemia in early pregnancy was associated with smaller newborn anthropometrics which was reflected in smaller mean foetal weights in the second and third trimester. Furthermore, among women who were non-anaemic in the first trimester, there was an association between smaller newborn anthropometrics and limited haemoglobin decrease during pregnancy, possibly reflecting insufficient plasma expansion., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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41. New expert advice on cancer in pregnancy.
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Storgaard L, Brix-Tange U, Colmorn LB, Ejlertsen B, Greiber IK, Gørløv JS, Hansen DL, Hjortshøj CM, Holm HS, Loft A, Ketabi Z, Kroman N, Leth-Miller D, Macklon KT, Mosgaard B, Nielsen BB, Nielsen HM, Pedersen BW, Rosendavl M, Smedegaard H, and Svane IM
- Subjects
- Pregnancy, Female, Humans, Netherlands, Neoplasms, Physicians
- Abstract
Cancer in pregnancy is rare, and most physicians lack knowledge in handling pregnant cancer patients. This review summarises the present knowledge on this condition. In the Netherlands, an Advisory Board on Cancer in Pregnancy was established in 2012. The board supports Dutch physicians' decisions in the management of pregnant patients with cancer. In 2021 the International Advisory Board on Cancer in Pregnancy was established, and in continuation, the Danish Advisory Board on Cancer in Pregnancy (DABCIP) has now been founded. DABCIP consists of 22 members from 13 different medical disciplines., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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- 2024
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42. Impact of the war in Ukraine and the COVID-19 pandemic on transnational surrogacy - a qualitative study of Danish infertile couples' experiences of being in 'exile'.
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Tanderup M, Pande A, Schmidt L, Nielsen BB, Humaidan P, and Kroløkke C
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- Female, Humans, Pregnancy, Denmark epidemiology, Mothers, Pandemics, Surrogate Mothers, Ukraine epidemiology, Male, COVID-19, Infertility therapy
- Abstract
Research Question: How did Danish permanently infertile couples experience surrogacy when going abroad and what impact did the war in Ukraine and the COVID-19 pandemic have on this?, Design: A qualitative study was performed between May and September 2022. The in-depth semi-structured interviews were conducted with 14 permanently infertile couples across Denmark who were in different stages of using surrogacy. The interviews were transcribed and analysed using systematic text condensation., Results: All except one couple went abroad, mainly to Ukraine, to have an enforceable transparent contract, professionals to advise them and the possibility of using the eggs of the intended mother. They did not feel that this was a 'choice' but rather the only option they had to have the longed-for child. According to current Danish legislation, the intended mother could not obtain legal motherhood over the child, not even through stepchild adoption, and this increased the feeling of not being a 'worthy mother'. This study expanded on the term 'reproductive exile' by identifying four different forms of exile: the exiled Danish couple, the gestational carrier in exile, exile at home and, finally, the reproductive body in exile., Conclusions: Understanding infertile couples' experiences when crossing borders is important for several reasons. It may, among others, assist politicians and authorities in developing a sound Danish legal policy on surrogacy to address the current issues of legal parenthood and avoid missing reproductive opportunities for permanently infertile couples., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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43. Falling Insulin Requirement in Pregnant Women With Diabetes Delivering Preterm: Prevalence, Predictors, and Consequences.
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Søholm JC, Do NC, Vestgaard M, Ásbjörnsdóttir B, Nørgaard SK, Pedersen BW, Storgaard L, Nielsen BB, Holmager P, Ringholm L, Damm P, and Mathiesen ER
- Subjects
- Asphyxia, Female, Humans, Infant, Newborn, Insulin therapeutic use, Placenta, Pregnancy, Pregnancy Outcome epidemiology, Pregnant Women, Prevalence, Prospective Studies, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 epidemiology, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology, Premature Birth epidemiology
- Abstract
Context: Falling insulin requirements often lead to considerations of whether a pregnancy can continue safely or if delivery is indicated., Objective: To evaluate prevalence and predictors of falling insulin requirements in pregnant women with preexisting diabetes delivering preterm and to explore the relationship to fetal asphyxia and neonatal morbidity., Methods: A prospective cohort study of 101 consecutive singleton pregnant women with preexisting diabetes delivering preterm < 37 weeks (68 type 1 and 33 type 2 diabetes) where the prevalence of falling insulin requirements (≥20%) before delivery was recorded., Results: In total, 27% (27/101) experienced falling insulin requirements of median 30% (interquartile range 24-40) before delivery. In all women with type 1 diabetes, the prevalence was 37% (25/68), whereas it was 43% (24/56) in those with indicated preterm delivery and 6% (2/33) among women with type 2 diabetes. In women with type 1 diabetes and indicated preterm delivery, falling insulin requirements were first identified at 34 + 5 (33 + 6-35 + 4) weeks + days and delivery occurred 3 (1-9) days later. Gestational age at delivery, prevalence of suspected fetal asphyxia, and neonatal morbidity were similar in women with and without falling insulin requirements. Neither glycemic control, nausea, or preeclampsia was associated with falling insulin requirement., Conclusion: Falling insulin requirements often preceded preterm delivery in women with type 1 diabetes, foremost when preterm delivery was indicated, but was not related to fetal asphyxia or neonatal morbidity. Whether falling insulin requirements in late pregnancy are a warning sign of placental insufficiency or mainly reflects variations in normal physiology needs further investigation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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44. Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes.
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Søholm JC, Vestgaard M, Ásbjörnsdóttir B, Do NC, Pedersen BW, Storgaard L, Nielsen BB, Ringholm L, Damm P, and Mathiesen ER
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- Female, Fetal Macrosomia epidemiology, Humans, Infant, Newborn, Pregnancy, Prospective Studies, Risk Factors, Diabetes Mellitus, Type 2 epidemiology, Diabetes, Gestational epidemiology, Pre-Eclampsia epidemiology, Premature Birth epidemiology
- Abstract
Aims/hypothesis: We aimed to identify potentially modifiable risk factors and causes for preterm delivery in women with type 1 or type 2 (pre-existing) diabetes., Methods: A secondary analysis of a prospective cohort study of 203 women with pre-existing diabetes (117 type 1 and 86 type 2 diabetes) was performed. Consecutive singleton pregnancies were included at the first antenatal visit between September 2015 and February 2018., Results: In total, 27% (n = 55) of the 203 women delivered preterm at median 36 + 0 weeks. When stratified by diabetes type, 33% of women with type 1 diabetes delivered preterm compared with 20% in women with type 2 diabetes (p = 0.04). Women delivering preterm were characterised by a higher prevalence of pre-existing kidney involvement (microalbuminuria or diabetic nephropathy) (16% vs 3%, p = 0.002), preeclampsia (26% vs 5%, p < 0.001), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (2.7% vs -1.6% from the mean, p = 0.008), higher gestational weight gain (399 g/week vs 329 g/week, p = 0.01) and similar HbA
1c levels in early pregnancy (51 mmol/mol [6.8%] vs 49 [6.6%], p = 0.22) when compared with women delivering at term. Independent risk factors for preterm delivery were pre-existing kidney involvement (OR 12.71 [95% CI 3.0, 53.79]), higher gestational weight gain (per 100 g/week, OR 1.25 [1.02, 1.54]), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (% from the mean, OR 1.07 [1.03, 1.12]) and preeclampsia (OR 7.04 [2.34, 21.19]). Two-thirds of preterm deliveries were indicated and one-third were spontaneous. Several contributing factors to indicated preterm delivery were often present in each woman. The main indications were suspected fetal asphyxia (45%), hypertensive disorders (34%), fetal overgrowth (13%) and maternal indications (8%). Suspected fetal asphyxia mainly included falling insulin requirement and abnormal fetal haemodynamics., Conclusions/interpretations: Presence of preeclampsia, higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks and higher gestational weight gain were independent potentially modifiable risk factors for preterm delivery in this cohort of women with pre-existing diabetes. Indicated preterm delivery was common with suspected fetal asphyxia or preeclampsia as the most prevalent causes. Prospective studies evaluating whether modifying these predictors will reduce the prevalence of preterm delivery are warranted., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)- Published
- 2021
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45. Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry-based study.
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Groth KA, Nielsen BB, Sheyanth IN, Gravholt CH, Andersen NH, and Stochholm K
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- Adult, Aortic Diseases epidemiology, Aortic Diseases physiopathology, Female, Fetal Death, Humans, Marfan Syndrome epidemiology, Pregnancy, Pregnancy Complications, Cardiovascular epidemiology, Pregnancy Outcome, Registries, Marfan Syndrome physiopathology, Maternal Health, Pregnancy Complications, Cardiovascular physiopathology
- Abstract
In Marfan syndrome (MFS), pregnancy is considered as high risk due to the deficiency of fibrillin in the connective tissue and increased risk of aortic dissection. The objective was to demonstrate the consequences on maternal health, in women with diagnosed and undiagnosed MFS at the time of pregnancy and childbirth. By using national health care registries, we identified all pregnancy related outcomes, from women with MFS (n = 183) and an age-matched background population (n = 18,300). We found 91 pregnancies during follow-up. Significantly fewer women with MFS gave birth, compared to the background population. No women with known MFS had a pregnancy related aortic dissection but complications related to the cervix were increased (HR:19.8 [95% CI:2.2-177.5]). Fifty women with MFS were undiagnosed at the time of their first pregnancy and/or childbirth. Among these, there were more birth canal related complications HR:27.2 (95% CI: 2.3-315.0), preeclampsia (HR:2.25 [95% CI: 1.11-4.60]), fetal deaths (HR:12.3 [95% CI: 1.51-99.8]), and all delivery-related dissections came from this subgroup. In conclusion, undiagnosed women with MFS experienced more pregnancy and childbirth related complications including fetal death, birth canal issues, preeclampsia, and aortic disease, which emphasizes the need for an early MFS diagnosis and special care during pregnancy and childbirth., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
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46. High Prevalence of Gestational Diabetes Mellitus in Rural Tanzania-Diagnosis Mainly Based on Fasting Blood Glucose from Oral Glucose Tolerance Test.
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Grunnet LG, Hjort L, Minja DT, Msemo OA, Møller SL, Prasad RB, Groop L, Lusingu J, Nielsen BB, Schmiegelow C, Bygbjerg IC, and Christensen DL
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- Adult, Cohort Studies, Female, Glucose Tolerance Test, Humans, Pregnancy, Prevalence, Rural Population, Tanzania epidemiology, Young Adult, Blood Glucose analysis, Diabetes, Gestational diagnosis, Diabetes, Gestational epidemiology
- Abstract
Gestational diabetes mellitus (GDM) is associated with poor pregnancy outcomes and increased long-term risk of metabolic diseases for both mother and child. In Tanzania, GDM prevalence increased from 0% in 1991 to 19.5% in 2016. Anaemia has been proposed to precipitate the pathogenesis of GDM. We aimed to examine the prevalence of GDM in a rural area of Tanzania with a high prevalence of anaemia and to examine a potential association between haemoglobin concentration and blood glucose during pregnancy. The participants were included in a population-based preconception, pregnancy and birth cohort study. In total, 538 women were followed during pregnancy and scheduled for an oral glucose tolerance test (OGTT) at week 32-34 of gestation. Gestational diabetes mellitus was diagnosed according to the WHO 2013 guidelines. Out of 392 women screened, 39% (95% CI: 34.2-44.1) had GDM, the majority of whom (94.1%) were diagnosed based solely on the fasting blood sample from the OGTT. No associations were observed between haemoglobin or ferritin and glucose measurements during pregnancy. A very high prevalence of GDM was found in rural Tanzania. In view of the laborious, costly and inconvenient OGTT, alternative methods such as fasting blood glucose should be considered when screening for GDM in low- and middle-income countries.
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- 2020
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47. Research methods in international business: The challenge of complexity.
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Eden L and Nielsen BB
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International business (IB) research is designed to explore and explain the inherent complexity of international business, which arises from the multiplicity of entities, multiplexity of interactions, and dynamism of the global economic system. To analyze this complexity, IB scholars have developed four research lenses: difference, distance, diversity, and disparity. These four lenses on complexity have created not only unique research opportunities for IB scholarship but also unique research methodological challenges. We therefore view complexity as the underlying cause of the unique methodological challenges facing international business research. We offer several recommendations to help IB scholars embrace this complexity and conduct reliable, interesting, and practically relevant research., (© Academy of International Business 2020.)
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- 2020
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48. FOETAL for NCD-FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life: a prospective preconception study in rural Tanzania.
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Hjort L, Lykke Møller S, Minja D, Msemo O, Nielsen BB, Lund Christensen D, Theander T, Nielsen K, Larsen LG, Grunnet LG, Groop L, Prasad R, Lusingu J, Schmiegelow C, and Bygbjerg IC
- Subjects
- Adult, Child Development, Epidemiological Monitoring, Epigenomics, Female, Health Services Needs and Demand, Humans, Infant, Newborn, Preconception Care methods, Preconception Care standards, Preconception Care statistics & numerical data, Pregnancy, Risk Assessment, Risk Factors, Tanzania epidemiology, Women's Health standards, Women's Health statistics & numerical data, Anemia diagnosis, Anemia epidemiology, Malaria epidemiology, Malaria prevention & control, Noncommunicable Diseases epidemiology, Noncommunicable Diseases prevention & control, Pregnancy Complications, Hematologic diagnosis, Pregnancy Complications, Hematologic epidemiology, Prenatal Exposure Delayed Effects diagnosis, Prenatal Exposure Delayed Effects epidemiology, Prenatal Exposure Delayed Effects prevention & control
- Abstract
Purpose: Low-income and middle-income countries such as Tanzania experience a high prevalence of non-communicable diseases (NCDs), including anaemia. Studying if and how anaemia affects growth, placenta development, epigenetic patterns and newborns' risk of NCDs may provide approaches to prevent NCDs., Participants: The FOETALforNCD (FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life) Study is a population-based preconception, pregnancy and birth cohort study (n=1415, n=538, n=427, respectively), conducted in a rural region of North-East Tanzania. All participants were recruited prior to conception or early in pregnancy and followed throughout pregnancy as well as at birth. Data collection included: maternal blood, screening for NCDs and malaria, ultrasound in each trimester, neonatal anthropometry at birth and at 1 month of age, cord blood, placental and cord biopsies for stereology and epigenetic analyses., Findings to Date: At preconception, the average age, body mass index and blood pressure of the women were 28 years, 23 kg/m
2 and 117/75 mm Hg, respectively. In total, 458 (36.7%) women had anaemia (haemoglobin Hb <12 g/dL) and 34 (3.6%) women were HIV-positive at preconception. During pregnancy 359 (66.7%) women had anaemia of which 85 (15.8%) women had moderate-to-severe anaemia (Hb ≤9 g/dL) and 33 (6.1%) women had severe anaemia (Hb ≤8 g/dL). In total, 185 (34.4%) women were diagnosed with malaria during pregnancy., Future Plans: The project will provide new knowledge on how health, even before conception, might modify the risk of developing NCDs and how to promote better health during pregnancy. The present project ended data collection 1 month after giving birth, but follow-up is continuing through regular monitoring of growth and development and health events according to the National Road Map Strategic Plan in Tanzania. This data will link fetal adverse event to childhood development, and depending on further grant allocation, through a life course follow-up., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2019
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49. Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania.
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Schmiegelow C, Msemo OA, Møller SL, Nielsen BB, Paulsen CB, Ødum L, Theander TG, Kavishe RA, Lusingu JPA, Minja DT, and Bygbjerg IC
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- Adult, Anemia blood, Anemia diagnosis, Anthropometry, Female, Health Status, Humans, Iron blood, Iron Deficiencies, Linear Models, Malaria complications, Pregnancy, Pregnancy Complications blood, Pregnancy Complications diagnosis, Pregnancy Outcome, Risk Factors, Rural Population, Social Class, Tanzania, Women's Health, Young Adult, Anemia etiology, Erythrocytes, Fertilization, Gestational Age, Hemoglobins metabolism, Pregnancy Complications etiology, Pregnancy Trimester, First
- Abstract
Objective: Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy., Methods: In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status., Results: Mean Hb was 123 and 119 g/l before conception and during early pregnancy (median gestational age 53 days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration., Conclusions: Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy., (© 2019 John Wiley & Sons Ltd.)
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- 2019
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50. Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania.
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Paulsen CB, Nielsen BB, Msemo OA, Møller SL, Ekmann JR, Theander TG, Bygbjerg IC, Lusingu JPA, Minja DTR, and Schmiegelow C
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- Adult, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Infant Mortality trends, Infant, Newborn, Infant, Premature, Diseases epidemiology, Male, Pregnancy, Prevalence, Retrospective Studies, Survival Rate trends, Tanzania epidemiology, Anthropometry methods, Infant, Premature, Diseases diagnosis, Infant, Small for Gestational Age, Rural Population
- Abstract
Background: Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper arm circumference (MUAC) of the newborn have previously been shown to be reasonable methods for detecting low birth weight (< 2500 g) and prematurity (gestational age < 37 weeks). The aim of this study was to investigate if the three anthropometric measurements could also correctly identify SGA newborns., Methods: In the current study from a rural area of northeastern Tanzania, 376 live newborns had foot length, chest circumference, and MUAC measured within 24 h of birth. Gestational age was estimated by transabdominal ultrasound in early pregnancy and SGA was diagnosed using a sex-specific weight reference chart previously developed in the study area. Receiver operating characteristic curves were generated for each of the anthropometric measurements and the area under the curve (AUC) compared. Operational cutoffs for foot length, chest circumference, and MUAC were defined while balancing as high as possible sensitivity and specificity for identifying SGA. Positive and negative predictive values (PPV and NPV) were then calculated., Results: Of the 376 newborns, 68 (18.4%) were SGA. The AUC for detecting SGA was 0.78 for foot length, 0.88 for chest circumference, and 0.85 for MUAC. Operational cut-offs to detect SGA newborns were defined as ≤7.7 cm for foot length, ≤31.6 cm for chest circumference and ≤ 10.1 cm for MUAC. Foot length had 74% sensitivity, 69% specificity, PPV of 0.35 and NPV of 0.92 for identifying SGA. Chest circumference had 79% sensitivity, 81% specificity, PPV of 0.49 and NPV of 0.95 for identifying SGA. Finally, MUAC had 76% sensitivity, 77% specificity, PPV of 0.43 and NPV of 0.94 for identifying SGA., Conclusion: In a setting with limited availability of an accurate gestational age, all three methods had a high NPV and could be used to rule out the newborn as being SGA. Overall, chest circumference was the best method to identify SGA newborns, whereas foot length and MUAC had lower detection ability., Trial Registration: Clinicaltrials.gov ( NCT02191683 ). Registered 2 July 2014.
- Published
- 2019
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