Factors Associated with Prenatal Folic Acid and Iron Supplementation Among 21,889 Pregnant women in Northern Tanzania: A Cross-Sectional Hospital-Based Study.

Folate and iron deficiency during pregnancy are risk factors for anaemia, preterm delivery, and low birth weight, and may contribute to poor neonatal health and increased maternal mortality. The World Health Organization recommends supplementation of folic acid (FA) and iron for all pregnant women at risk of malnutrition to prevent anaemia. We assessed the use of prenatal folic acid and iron supplementation among women in a geographical area with a high prevalence of anaemia, in relation to socio-demographic, morbidity and health services utilization factors. We analysed a cohort of 21,889 women who delivered at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania, between 1999 and 2008. Logistic regression models were used to describe patterns of reported intake of prenatal FA and iron supplements. Prenatal intake of FA and iron supplements was reported by 17.2% and 22.3% of pregnant women, respectively. Sixteen percent of women reported intake of both FA and iron. Factors positively associated with FA supplementation were advanced maternal age (OR = 1.17, 1.02-1.34), unknown HIV status (OR = 1.54, 1.42-1.67), a diagnosis of anaemia during pregnancy (OR = 12.03, 9.66-14.98) and indicators of lower socioeconomic status. Women were less likely to take these supplements if they reported having had a malaria episode before (OR = 0.57, 0.53-0.62) or during pregnancy (OR = 0.45, 0.41-0.51), reported having contracted other infectious diseases (OR = 0.45, 0.42-0.49), were multiparous (OR = 0.73, 0.66-0.80), had preeclampsia/eclampsia (OR = 0.48, 0.38-0.61), or other diseases (OR = 0.55, 0.44-0.69) during pregnancy. Similar patterns of association emerged when iron supplementation alone and supplementation with both iron and FA were evaluated. FA and iron supplementation are low among pregnant women in Northern Tanzania, in particular among women with co-morbidities before or during pregnancy. Attempts should be made to increase supplementation both in general and among women with pregnancy complications

Reproductive and family planning history, knowledge, and needs: A community survey of low-income women in Beijing, China

10.1186/1472-6874-9-23BMC Women's Health923-BWHM

Recurrence of Preeclampsia in Northern Tanzania: A Registry-based Cohort Study.

Preeclampsia occurs in about 4 per cent of pregnancies worldwide, and may have particularly serious consequences for women in Africa. Studies in western countries have shown that women with preeclampsia in one pregnancy have a substantially increased risk of preeclampsia in subsequent pregnancies. We estimate the recurrence risks of preeclampsia in data from Northern Tanzania. A prospective cohort study was designed using 19,811 women who delivered singleton infants at a hospital in Northern Tanzania between 2000 and 2008. A total of 3,909 women were recorded with subsequent deliveries in the hospital with follow up through 2010. Adjusted recurrence risks of preeclampsia were computed using regression models. The absolute recurrence risk of preeclampsia was 25%, which was 9.2-fold (95% CI: 6.4 - 13.2) compared with the risk for women without prior preeclampsia. When there were signs that the preeclampsia in a previous pregnancy had been serious either because the baby was delivered preterm or had died in the perinatal period, the recurrence risk of preeclampsia was even higher. Women who had preeclampsia had increased risk of a series of adverse pregnancy outcomes in future pregnancies. These include perinatal death (RR= 4.3), a baby with low birth weight (RR= 3.5), or a preterm birth (RR= 2.5). These risks were only partly explained by recurrence of preeclampsia. Preeclampsia in one pregnancy is a strong predictor for preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies in Tanzania. Women with previous preeclampsia may benefit from close follow-up during their pregnancies

Causes of Perinatal Death at a Tertiary Care Hospital in Northern Tanzania 2000-2010: A Registry Based Study.

Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE). Overall perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths), perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000). The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths

Birth defects and cancer risk : Nordic population-based studies of cancer risk in children, adolescents, and adults with major birth defects and their siblings

Bakgrunn: Medfødte misdannelser og kreft er begge blant de ti vanligste årsakene til tapte leveår grunnet død eller helsetap for barn mellom 0 og 19 år (ulykker og perinatale sykdommer ekskludert). Årsakene til begge sykdommene er i stor grad ukjente. Alvorlige misdannelser er imidlertid etablert som risikofaktorer for kreft blant barn, noe som kan tyde på en felles etiologi. Hensikt: Vi undersøkte sammenhengen mellom det å ha en alvorlig misdannelse eller å ha et søsken med en alvorlig misdannelse og senere kreftutvikling; blant barn, ungdom og voksne, samt kjønnsforskjeller i denne sammenhengen blant barn. Metode: Vi gjennomførte tre populasjonsbaserte nøstede kasus-kontrollstudier hvor vi kombinerte registerdata fra Danmark, Finland, Norge og Sverige. Personer registrert i fødselsregistrene mellom 1967 og 2014 som utviklet kreft ble definert som kasus. Kontrollene ble matchet på land og fødselsår. Eksponeringene vi undersøkte var alvorlige misdannelser blant individene eller deres søsken. Den relative risikoen for kreft assosiert med eksponeringen ble estimert som oddsratio fra logistiske regresjonsmodeller. Resultat: Den relative risikoen for kreft blant personer med alvorlige misdannelser var 1,7 ganger høyere enn blant personer uten misdannelser. Den økte risikoen vedvarte inn i voksen alder (1,2 ganger høyere), spesielt gjaldt dette voksne med alvorlige misdannelser i hjerte, kjønnsorganer, nervesystemet, skjelettdysplasier og Down syndrom. Sammenhengene mellom alvorlige misdannelser og barnekreft var generelt sterkere blant jenter enn gutter. Blant personer som hadde søsken med alvorlige misdannelser, var risikoen for barnekreft (0 til 19 år) noe økt (1,09 ganger), mens den totale risikoen for kreft blant personer i alderen 0 til 46 år ikke var økt. Konklusjon: Våre resultater stemmer overens med hypotesen om felles bakenforliggende årsaker til alvorlige misdannelser og kreft: genetiske, miljømessige eller en kombinasjon. Arbeidet danner grunnlaget for videre forskning på de biologiske mekanismene som ligger bak begge sykdommene.Background: Globally, birth defects and childhood cancer are among the 10 most common causes of childhood disease burden (excluding perinatal diseases and injuries). There are few established risk factors for both diseases, but birth defects have consistently been associated with childhood cancer risk, suggesting a common aetiology. Given the large global public health impact of birth defects and childhood cancer, a broader understanding of the underlying causes is warranted. Objectives: We aimed to explore the associations between having a major birth defect or having a sibling with a major birth defect and cancer among children, adolescents, and adults, and to evaluate if the associations among children differed by sex. Methods: We performed three population-based nested case-control studies where we combined registry data from Denmark, Finland, Norway, and Sweden. Individuals registered in the birth registries between 1967 and 2014 who later developed cancer were defined as cases. Controls were frequency-matched on country and year of birth. The exposure of interest was major birth defects in the individuals or the siblings. The relative risk of cancer associated with the exposure was estimated as odds ratios from logistic regression models. Results: The relative risk of overall cancer in individuals with birth defects compared to individuals without birth defects was 1.7. The increased risk persisted into adulthood (1.2-fold), in particular for individuals with congenital heart defects, genital organ defects, chromosomal anomalies, nervous system defects, and skeletal dysplasia. The birth defect-childhood cancer associations were generally stronger in girls than boys. The risk of childhood cancer (0 to 19 years) was slightly elevated (1.09-fold) in individuals whose siblings had birth defects, but the overall risk of cancer in individuals aged 0 to 46 years was not increased. Conclusions: Our novel findings provide evidence consistent with common aetiologies of birth defects and cancer, such as shared genetic predisposition and environmental factors, and should motivate further research into possible biological mechanisms.Doktorgradsavhandlin

Contested legacies of early modern colonialism in Norway: A summary of the 2020 debates on Ludvig Holberg and Jørgen Thormøhlen

publishedVersio

Maternal outcome after complete uterine rupture

Introduction: Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures. Material and methods: This was a population‐based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967‐2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (OR s) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CI s). Results: We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3‐5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1‐5.0), parity ≥3 vs parity 1‐2 (AOR 2.8, 95% CI 1.2‐6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1‐4.8). Conclusions: Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture.acceptedVersio

Life after the Norwegian cluster program

Masteroppgave i innovasjon og entrepenørskap. Fakultet for ingeniør- og naturvitskap/ Mohnsenteret for innovasjon og regional utvikling/ Høgskulen på Vestlandet, campus Bergen.GCE Ocean Technology er i dag en av tre klynger med GCE-status, global center of expertise, i det norske klyngeprogrammet Norwegian Innovation Clusters. Klyngen ble etablert i Bergen, i 2006, og fremmer industri innen havteknologi. GCE Ocean Technology er nå en moden klynge i det norske klyngeprogrammet, hvor de har vært medlem siden de ble etablert. Ved utgangen av 2025 må de ut av klyngeprogrammet og dermed mister de sin grunnfinansiering, tilsvarende 10 millioner per år. Parallelt med deres strategiarbeid for den kommende utgangen av NIC-programmet, har de engasjert oss studenter til å komme med innspill. I denne masteroppgaven vil vi se nærmere på hvordan GCE Ocean Technology kan utvikle seg de neste årene, for å være en levende klynge selv etter klyngeprogrammet. Dette innebærer blant annet å kartlegge hva medlemmene betrakter som hovedverdien med klyngen, samt kartlegge klyngens markedssegmenter. I tillegg undersøker vi muligheter for økt samarbeid med andre, hvor vi relaterer klyngens videreføring til grønn omstilling og stiavhengighet. I teoridelen går vi nærmer inn på hva som kjennetegner en klynge, fordeler med å være medlem av en klynge, klyngetyper og klyngedynamikk. Dette for å gi et teoretisk grunnlag om hva klyngen kan bety for sine medlemmer, og hvordan klyngen henger sammen og driftes i dag. Videre ser vi på klyngedannelse og omorganisering av klyngen, med tanke på ulike utviklingsbaner og grønn omstilling. Her belyses viktige faktorer som må tas hensyn til ved en eventuell omorganisering og videreføring av klyngen. For å kunne besvare hovedproblemstillingen og forskningsspørsmålene, har vi benyttet flere ulike metoder for datainnsamling. Vi har gjennomført kvalitative semistrukturerte dybde-intervjuer, og fått tilgang til data fra en kvantitativ spørreundersøkelse. Samlet sett har dette gitt bred og dyp innsikt i hva de ulike bedriftene og organisasjonene mener. Det er også gjennomført et intervju av en representant fra klyngeadministrasjonen til Maritime CleanTech, for å kunne sammenligne hvordan den tidligere NCE-klyngen håndterte sin utgang fra klyngeprogrammet. Analysen viser at GCE Ocean Technology er en relativ differensiert klynge kjennetegnet av et sterkt fagmiljø innen havteknologi, med mye samarbeid og nettverksdeling. Vi konkluderer med at det er mange aspekter som kan være styrende for videreføring av klyngen, men at man uansett bør etterstrebe en grønnere, mer internasjonal fremtid. Til tross for at dette kan være både komplisert og utfordrende. Samtidig mener vi at klyngen bør holde sin brede retning for å ivareta de forskjellige markedssegmentene innen havteknologi, og være et innovasjon-mekka for sine medlemsbedrifter.GCE Ocean Technology is currently one of three clusters with GCE status, Global Center of Expertise, in the Norwegian cluster program Norwegian Innovation Clusters. The cluster was established in Bergen in 2006 and promotes the ocean technology industry. GCE Ocean Technology is now a mature cluster within the Norwegian cluster program, having been a member since its establishment. At the end of 2025, they must exit the cluster program, resulting in the loss of their core funding, equivalent to 10 million Norwegian kroner per year. In parallel with their strategic work for the upcoming exit from the NIC program, they have engaged us as students to provide input. In this master's thesis, we will delve into how GCE Ocean Technology can evolve in the coming years to remain a thriving cluster even after the cluster program. This includes mapping out what the members consider to be the primary value of the cluster and identifying the cluster's market segments. Additionally, we will explore opportunities for increased collaboration with others, relating the cluster's continuation to green transition and path dependency. In the theoretical section, we delve into the characteristics of a cluster, the advantages of being a cluster member, cluster types, and cluster dynamics. This provides a theoretical foundation for understanding what the cluster can mean for its members and how the cluster is interconnected and operated today. Furthermore, we examine cluster formation and cluster reorganization, considering different development paths and the green transition. This sheds light on important factors that need to be considered in a potential reorganization and continuation of the cluster. To address the main research question and research objectives, we have utilized various data collection methods. We conducted qualitative semi-structured in-depth interviews and gained access to data from a quantitative survey. Together, these methods have provided broad and deep insights into the perspectives of different companies and organizations. Additionally, we conducted an interview with a representative from the cluster administration of Maritime CleanTech to compare how the former NCE cluster handled its exit from the cluster program. The analysis reveals that GCE Ocean Technology is a relatively differentiated cluster characterized by a strong technical community within ocean technology, with extensive collaboration and network sharing. We conclude that there are multiple aspects that can influence the continuation of the cluster, but regardless, we should strive for a greener, more international future, despite the potential complexities and challenges. Simultaneously, we believe the cluster should maintain its broad direction to accommodate the various market segments within ocean technology and remain an innovation hub for its member companies.INN59

OPS som innovasjonsfremmende gjennomføringsmodell : en litteraturstudie

Masteroppgave i økonomi og administrasjon – Universitetet i Agder 2014Rapporten søker å gjøre rede for Offentlig Privat Samarbeid som innovasjonsfremmende gjennomføringsmodell. Dette gjør den ved å stille fire forskningsspørsmål: 1. Er offentlig privat samarbeid en mer innovasjonsfremmende gjennomføringsmodell sammenliknet med tradisjonelle modeller? 2. Kan tidligere erfaringer ifra gjennomførte OPS-prosjekter i Norge fortelle noe om OPS som innovasjonsfremmende gjennomføringsmodell? 3. Kan erfaringer ifra England, hvor metoden har vært benyttet lengre, fortelle noe om OPS som innovasjonsfremmende gjennomføringsmodell? 4. Hvordan bør OPS brukes/utvikles videre for at den skal virke innovasjonsfremmende? Nærmere undersøkelse av disse fire problemstillingene viser at det er momenter ved OPSmodellen som gjør den til et godt verktøy og virkemiddel for å fremme innovasjon, men at modellen i seg selv ikke er innovasjonsfremmende

Photographs in burn patient diaries: A qualitative study of patients’ and nurses’ experiences

Objective: To explore burn patients’ and burn intensive care nurses’ experiences of the photos in patient diaries. Design: A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20–77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38–61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ). Setting: A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades. Findings: Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery. Conclusion: Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients’ pathway of treatment, care and recovery. Implication for clinical practice: Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients’ entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.publishedVersio