The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart

Background: The prevalence of small for gestational age (SGA) may vary depending on the chosen weight-for-gestational-age reference chart. An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA. Methods: Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003–2018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively. Results: The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGASTOPPAM of 14.2% and SGAIG21 of 18.0%, p < 0.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09–1.56], p < 0.01) than for Intergrowth-21 (aOR 1.19 [1.00–1.40], p = 0.04), particularly among paucigravidae (SGASTOPPAM aOR 1.36 [1.09–1.71], p < 0.01 vs SGAIG21 aOR 1.21 [0.97–1.50], p = 0.08). Conclusions: The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate

Configurational comparative methods in working life studies

Arbejdsmiljøproblemer opstår i et komplekst system af organisatoriske og arbejdsmarkedsmæssige forhold. Dette gør det vanskeligt at gennemføre og evaluere forebyggende tiltag på området, da der må tages højde for multikausale og gensidige påvirkninger. Det er derfor vigtigt at gennemføre forskning og evalueringer, som kan informere både praktikere og beslutningstagere om, hvornår og hvorfor tiltagene virker, og hvordan de kan forbedres, så de kan sikre den ønskede effekt. Konfigurationelle komparative metoder er en tilgang, der kan bidrage til at imødekomme disse behov. Formålet med artiklen er at introducere konfigurationelle komparative metoder i arbejdslivsforskningen og diskutere deres muligheder og udfordringer. Dette gøres gennem et eksempel, hvor metoderne har været anvendt i evalueringen af Arbejdstilsynets nye tilsynstilgang i store offentlige virksomheder. Vi konkluderer, at konfigurationelle komparative metoder (KKM) er brugbare til at undersøge effekter af arbejdsmiljøtiltag i arbejdslivsforskningen, og at metodernes fordel blandt andet er, at de kan afdække mulige kausale sammenhænge mellem flere betingelser og udfald, ligesom de kan anvendes på få cases. Metoderne stiller store krav til systematik og transparens i de metodiske valg. Vi håber med artiklen at skabe interesse for metoderne fra praktikere og forskere, der ønsker at bidrage til forsat metodeudvikling i kvalitativ og kvantitativ evaluering i arbejdslivsstudier.Work environment issues arise within a complex system of organizational and labour market related conditions. This makes it challenging to conduct and evaluate preventive initiatives, not least because the relations examined are multi-causal and interrelated. Consequently, there is a need for research that can inform practitioners and decision-makers on when and why such initiatives work and how they can be improved to bring about the desired effects. Configurational comparative methods represent an approach that can contribute to accommodating these needs. The objective of this paper is to introduce configurational comparative methods into the working life research and to discuss their possibilities and challenges. This is done through an example, in which these methods have been applied to an evaluation of the Danish work environment authorities’ new method for work inspections. We conclude that configurational comparative methods (CCM) are useful to investigate the effects of work environment initiatives in working life research, and that some of the advantages of the methods are that they can illuminate possible causal relations across several conditions and outcomes and that they are applicable on few cases. The methods demand systematics and transparency in the methodological choices. We hope with the article to create interest in the methods from practitioners and researchers who want to contribute to continued development in qualitative and quantitative evaluation methods within working life studies

Biosensor for Detecting Fetal Growth Restriction in a Low-Resource Setting

One strategy for improving detection of fetal growth restriction (FGR) is developing biosensors identifying placental dysfunction as a leading pathogenesis for FGR. The aim of this pilot study was to investigate the performance of a biosensor specified to detect placental dysfunction by means of maternal arterial turbulence acoustics in a low-resource setting. A cohort of 147 singleton pregnant women were prospectively followed with double-blinded biosensor tests, sonographic estimation of fetal weight (EFW) and Doppler flow at 26–28, 32–34 and 37–39 weeks of pregnancy. Full term live births with recorded birth weights (BWs) and without major congenital malformations were included. Outcomes were defined as (A) a solitary biometric measure (BW &lt; 3rd centile) and as (B) a biometric measure and contributory functional measure (BW &lt; 10th centile and antenatally detected umbilical artery pulsatility index &gt; 95th centile). Data from 118 women and 262 antenatal examinations were included. Mean length of pregnancy was 40 weeks (SD ± 8 days), mean BW was 3008 g (SD ± 410 g). Outcome (A) was identified in seven (6%) pregnancies, whereas outcome (B) was identified in one (0.8%) pregnancy. The biosensor tested positive in five (4%) pregnancies. The predictive performance for outcome (A) was sensitivity = 0.29, specificity = 0.97, p = 0.02, positive predictive value (PPV) was 0.40 and negative predictive value (NPV) was 0.96. The predictive performance was higher for outcome (B) with sensitivity = 1.00, specificity = 0.97, p = 0.04, PPV = 0.20 and NPV = 1.00. Conclusively, these pilot-study results show future potential for biosensors as screening modality for FGR in a low-resource setting

Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania

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

Unge forskere: Regeringens forskningsstrategi er som et afsnit af skærmtrolden Hugo

Universiteter er ikke virksomheder. Men uden politiske ambitioner ender forskningen som en aparte finansieret gren af erhvervslivet, advarer en stribe forskere med tilknytning til Det Unge Akademi