Página 1 dos resultados de 299 itens digitais encontrados em 0.023 segundos

Making reform work: institutions, dispositions, and the improving health of Bangladesh

Faguet, Jean-Paul; Ali, Zulfiqar
Fonte: Elsevier Publicador: Elsevier
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /01/2009 EN; EN
Relevância na Pesquisa
95.89%
We examine whether local governance can improve social development empirically, using good and bad cases of public health outcomes in Bangladesh. We explore the institutional underpinnings of service provision, digging down beneath the “rules of the game” to analyze the beliefs, understandings, and dispositions that drive social behavior. Changes in deep social attitudes led to improvements in social indicators. Regional variation in health outcomes is explained by the presence or absence of a dense web of relationships that enmeshed reformers in local systems of authority and legitimacy, strengthening their actions and making local society more susceptible to change.

Public health in Austria: an analysis of the status of public health

Fonte: World Health Organization Publicador: World Health Organization
Tipo: Book; NonPeerReviewed Formato: application/pdf
Publicado em //2011 EN; EN
Relevância na Pesquisa
115.94%
This book explores the key challenges facing Austria’s public health system. Set firmly in the context of the history, scope, functions and responsibilities of public health in developed countries, it examines how the Austrian system has developed and adapted over the last 50 years to the benefit of the population. It also looks at the challenges presented by life in the 21st century. The book draws on both national research and expert interviews to present a fully-rounded picture. This shows that the public health system in Austria is struggling to maintain essential services and develop policies for improvement, and the study proposes strategies and policies to tackle these developments, looking in particular at change within the fields of education, research and training. This book is essential reading for policy-makers, advisers and analysts interested in developing a public health strategy and competence in both developed and developing countries, as well as researchers interested in the Austrian health system.

Probability of an obese person attaining normal body weight: cohort study using electronic health records

Fildes, Alison; Charlton, Judith; Rudisill, Caroline; Littlejohns, Peter; Prevost, A. Toby; Gulliford, Martin C.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em //2015 EN; EN
Relevância na Pesquisa
115.92%
Objectives: Obesity is an increasing clinical and public health concern. This study aimed to answer the question: ‘What is the probability of an obese person attaining normal body weight?’ Methods: A sample of men and women aged 20 years and over was drawn from the Clinical Practice Research Datalink (CPRD). Participants who received bariatric surgery were excluded. The probability of attaining either normal weight, or 5% reduction in body weight, were estimated. Findings: Data were analysed for 278,982 participants including 76,704 obese men and 99,791 obese women. During a maximum of 9 years’ follow-up, 1,283 men and 2,245 women attained normal body weight. In simple obesity (BMI 30•0-34•9 Kg/m2), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with morbid obesity (BMI 40•0-44•9 Kg/m2). The annual probability of achieving a 5% weight reduction was 1 in 8 for men, and 1 in 7 for women with morbid obesity. Among participants who lost 5% body weight, 52•7% (95% confidence interval 52•4 to 53•0%) showed weight regain at two years and 78•0% (77•7 to 78•3%) at five years. Conclusions: The low probability of attaining normal weight...

Demography and public health

Grundy, Emily; Murphy, Michael J.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Book Section; NonPeerReviewed Formato: application/pdf
Publicado em 26/02/2015 EN; EN
Relevância na Pesquisa
95.9%
The health and health care needs of a population cannot be measured or met without knowledge of its size and characteristics. Demography is concerned with this and with understanding population dynamics - how populations change in response to the interplay between fertility, mortality and migration. This understanding is a pre-requisite for making the forecasts about future population size and structure which should underpin health care planning. Such analyses necessitate a review of the past. The number of very old people in a population, for example, depends on the number of births eight or nine decades earlier and risks of death at successive ages throughout the intervening period. The proportion of very old people depends partly on this numerator but more importantly on the denominator, the size of the population as a whole. The number of births in a population depends on current patterns of family building, and also on the number of women 'at risk' of reproduction - itself a function of past trends in fertility and mortality. Similarly, the number and causes of deaths are strongly influenced by age structure. Demography is largely concerned with answering questions about how populations change and their measurement. The broader field of population studies embraces questions of why these changes occur...

How do economic crises affect migrants’ risk of infectious disease? A systematic-narrative review

Kentikelenis, Alexander; Karanikolos, Marina; Williams, Gemma; Mladovsky, Philipa; King, Lawrence; Pharris, Anastasia; Suk, Jonathan E.; Hatzakis, Hatzakis; McKee, Martin; Noori, Teymur; Stuckler, David
Fonte: Oxford University Press on behalf of the European Public Health Association. Publicador: Oxford University Press on behalf of the European Public Health Association.
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /08/2015 EN; EN
Relevância na Pesquisa
95.89%
Background: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs. Methods: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research. Results: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases...

Public health coming home

Holland, Walter W.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Article; NonPeerReviewed Formato: application/pdf
Publicado em /06/2015 EN; EN
Relevância na Pesquisa
105.92%
The article on Public Health ‘Coming Home’ to English local government states that it provides a historical perspective.1 It is, however, limited and fails to address some of the issues that were important in 1974, when it joined the NHS. This letter gives the views of one ‘who was There’ and involved at both central and local level. Bevan is said to have favoured the future NHS to be based outside local government on ‘grounds of efficiency and quality’. But there was another reason. Most of the medical profession were opposed to governance by local authorities (LA), in particular those working in the voluntary hospital sector. Bevan was anxious to retain their willingness to serve in an NHS. There were some very innovative LA Health departments, such as those developing health centres and co-ordinated working with general practice.2 There were some outstanding public health practitioners, identified by Sir George Godber, the Chief Medical Officer at the time,3,4 but these were exceptions. In Counties, PH practitioners were usually treated as professionals, in urban authorities they were more likely to …

A tax on sugary drinks would not be a panacea but it would be a sensible step in the right direction for public health

Mytton, Oliver; Rayner, Mike
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 30/08/2012 EN; EN
Relevância na Pesquisa
95.88%
Oliver Mytton and Mike Rayner suggests that a 20 per cent tax on sugary drinks is necessary to encourage better consumption habits and tackle obesity, diabetes and heart disease. It is argued that such economic disincentives could be the most effective mechanism for improving public well-being.

"You cannot eat rights": a qualitative study of views by Zambian HIV-vulnerable women, youth and MSM on human rights as public health tools

Muzyamba, Choolwe; Broaddus, Elena; Campbell, Catherine
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /10/2015 EN; EN
Relevância na Pesquisa
95.88%
Background Human rights approaches now dominate the HIV prevention landscape across sub-Saharan Africa, yet little is known about how they are viewed by the populations they are designed to serve. Health interventions are most effective when they resonate with the worldviews and interests of target groups. This study examined local Zambian understandings of human rights approaches to HIV-prevention among three highly HIV-vulnerable groups: women, youth, and men-who-have-sex-with-men (MSM). Methods Focus groups included 23 women, youth, and MSM who had participated in activities organized by local non-governmental organizations (NGOs) using rights-based approaches, and interviews included 10 Zambian employees of these NGOs. Topics included participants’ experiences and views of the utility of these activities. Thematic analysis mapped out diverse ways participants viewed the concept of human rights in relation to HIV-prevention. Results Whilst NGO workers noted the need for human rights programs to address the complex drivers of the HIV epidemic, they struggled to tailor them to the Zambian context due to donor stipulations. Women program beneficiaries noted that the concept of human rights helped challenge harmful sexual practices and domestic abuse...

On the buses: a mixed-method evaluation of the impact of free bus travel for young people on the public health

Green, Judith; Steinbach, Rebecca; Jones, Alasdair; Edwards, Phil; Kelly, Charlotte; Nellthorp, John; Goodman, Anna; Roberts, Helen; Petticrew, Mark; Wilkinson, Paul
Fonte: National Institute for Health Research (NIHR) Publicador: National Institute for Health Research (NIHR)
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /02/2014 EN; EN
Relevância na Pesquisa
115.92%
Background In September 2005 London introduced a policy granting young people aged < 17 years access to free bus and tram travel. A year later this policy was extended to people aged < 18 years in education, work or training. This intervention was part of a broader environmental strategy in London to reduce private car use, but its primary aim was to decrease ‘transport exclusion’, and ensure that access to goods, services, education and training opportunities were not denied to some young people because of transport poverty. However, there were also likely to be positive and negative health implications, which were difficult to assess in the absence of a robust evidence base on the impact of transport policies on health and well-being. Objectives To evaluate the impact of free bus travel for young people in London on the public health. Specifically, to provide empirical evidence for the impact of this ‘natural experiment’ on health outcomes and behaviours (e.g. injuries, active travel) for young people; explore the effects on the determinants of health; identify the effects on older citizens of increased access to bus travel for young people and to identify whether or not the intervention represented value for money. Design Quasi-experimental design...

Book review: People-centred public health

Harris, Lindsay
Fonte: Blog post from London School of Economics & Political Science Publicador: Blog post from London School of Economics & Political Science
Tipo: Website; NonPeerReviewed Formato: application/pdf
Publicado em 23/07/2013 EN; EN
Relevância na Pesquisa
105.94%
"People-Centred Public Health." Jane South, Judy White and Mark Gamsu. Policy Press. December 2012. --- People-Centred Public Health examines how members of the public can be involved in delivering health improvement, primarily as volunteers or lay health workers. Drawing on a major study of lay engagement in public health, and using case studies and real life examples, this book aims to provide a comprehensive and accessible overview of policy, practice and research in this area. Lindsay Harris feels that a more international perspective would have added invaluable insight and broadened the audience for which this book will appeal.

Inequalities in self-reported health: a meta-regression analysis

Costa-i-Font, Joan; Hernández-Quevedo, Cristina
Fonte: LSE Health and Social Care, London School of Economics and Political Science Publicador: LSE Health and Social Care, London School of Economics and Political Science
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /03/2013 EN; EN
Relevância na Pesquisa
95.88%
There is a growing amount of health economics literature in Europe using standardised cross-country health inequality indexes. Yet, limited efforts have been put forward to examine the extent to which such evidence is subject to any specific methodological and publication biases despite studies relying upon different samples, heterogeneous health system institutions and which use different empirical strategies and data manipulation procedures. We draw upon appropriate statistical methods to examine the presence of publication bias in the health economics literature measuring health inequalities of self-reported health. In addition, we test for other biases including the effect of precision estimates based on meta-regression analysis (MRA). We account for a set of biases in estimates of income-related health inequalities that rely on concentration index-related methods and self-reported health measures. Our findings suggest evidence of publication bias that primarily depends on the cardinalisation of self-reported health and study-specific precision. However, no robust evidence of other publication biases has been identified.

Public health and fear of crime: a prospective cohort study

Jackson, Jonathan; Stafford, Mai
Fonte: Oxford University Press on behalf of the Centre for Crime and Justice Studies (ISTD) Publicador: Oxford University Press on behalf of the Centre for Crime and Justice Studies (ISTD)
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /11/2009 EN; EN
Relevância na Pesquisa
95.92%
Public insecurities about crime are widely assumed to erode individual well-being and community cohesion. Yet, robust evidence on the link between worry about crime and health is surprisingly scarce. This paper draws on data from a prospective cohort study (the Whitehall II study) to show a strong statistical effect of mental health and physical functioning on worry about crime. Combining with existing evidence, we suggest a feedback model in which worry about crime harms health, which, in turn, serves to heighten worry about crime. We conclude with the idea that, while fear of crime may express a whole set of social and political anxieties, there is a core to worry about crime that is implicated in real cycles of decreased health and perceived vulnerability to victimization. The challenge for future study is to integrate core aspects of the everyday experience of fear of crime with the more layered and expressive features of this complex social phenomenon.

Retreat from Alma Ata?: the WHO's report on task shifting to community health workers for AIDS care in poor countries

Campbell, Catherine; Scott, Kerry
Fonte: Routledge Publicador: Routledge
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /03/2011 EN; EN
Relevância na Pesquisa
95.9%
This paper examines the potential of community health worker (CHW) programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to tackle health worker shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous CHW experiences. The WHO has taken account of five key lessons learnt from past CHW programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the 'community embeddedness' of CHWs, found to be of critical importance to the success of past CHW programmes. We have no doubt that the WHO plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness, CHWs will be unable to successfully perform the socially oriented tasks assigned to them by the WHO, such as health education and counselling. We locate the WHO's neglect of community embeddedness within the context of a broader global public health trend away from community-focused primary healthcare towards biomedically focused selective healthcare.

Diabetes in Algeria and challenges for health policy: a literature review of prevalence, cost, management and outcomes of diabetes and its complications

Lamri, Larbi; Gripiotis, Erofile; Ferrario, Alessandra
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /02/2014 EN; EN
Relevância na Pesquisa
95.89%
Background Diabetes has become an increasingly prevalent and severe public health issue in Algeria. This article investigates the prevalence, the cost and the management of this disease. Its first objective is to better understand the burden (both from an epidemiological and economic perspective) and management of diabetes. The second objective is to understand the health policy strategy adopted by Algeria in order to respond to the disease. Methods We conducted a literature review of prevalence, costs, management and outcomes of diabetes and its complications. This was complemented by data compilations and results of expert consultations. Results The epidemiology of diabetes is continually evolving and is becoming more problematic. The national evidence suggests that the prevalence of diabetes in Algeria has increased from 6.8% in 1990 to 12.29% in 2005, but is quite higher among certain groups and areas of the country. This disease affects all population groups, especially 35-70 year olds, who constitute a large segment of the working population. There are very few estimates of the cost of diabetes. These include a 1998 study on the total cost of type 1 diabetes (USD 11.6 million, which, inflated to 2013 value, totals to USD 16.6 million)...

A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

Wennberg, David E.; Sharp, Sandra M.; Bevan, Gwyn; Skinner, Jonathan S.; Gottlieb, Daniel J.; Wennberg, John E.
Fonte: BMJ Publishing Group and the Health Foundation Publicador: BMJ Publishing Group and the Health Foundation
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em 10/04/2014 EN; EN
Relevância na Pesquisa
95.91%
Objective:- To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Setting:- Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design:- Cross sectional analysis. Participants:- 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n=5 153 877). Main outcome measures:- The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services—Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare’s administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Results:- Estimated variation in age...

Health effects of unemployment benefit program generosity

Cylus, Jonathan; Glymour, M. Maria; Avendano, Mauricio
Fonte: American Public Health Association (APHA) Publicador: American Public Health Association (APHA)
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em /02/2015 EN; EN
Relevância na Pesquisa
105.91%
Objectives: Unemployment has been linked to poorer health, but few studies identify policies that mitigate the negative health consequences of joblessness. Unemployment benefit programmes might protect health through several pathways, but a key methodological challenge is accounting for the fact that individuals who receive unemployment benefits differ from those who do not receive benefits. Methods: We link US state law data on maximum allowable unemployment benefit levels between 1985 and 2008 to individual self-rated health for heads of households in the Panel Study of Income Dynamics and implement state and year fixed effect models. Results: Unemployment is associated with increased risk of reporting poor health among men in both linear probability (Beta =0.0794, 95% CI[Confidence Interval]: 0.0623, 0.0965) and logistic models (Odds ratio[OR] =2.777, 95%CI 2.294, 3.362), but this effect is lower when the generosity of state unemployment benefits is high (Beta for interaction between unemployment and benefits=-0.124, 95% CI: -0.197, -0.0523). A 63% increase in benefits completely offsets the impact of unemployment on self-reported health. Conclusions: Results suggest that unemployment benefits may significantly alleviate the adverse health effects of unemployment among men.

Tuberculosis among migrant populations in the European Union and the European Economic Area

Odone, Anna; Tillmann, Taavi; Sandgren, Andreas; Williams, Gemma; Rechel, Bernd; Ingleby, David; Noori, Teimur; Mladovsky, Philipa; McKee, Martin
Fonte: Oxford University Press on behalf of the European Public Health Association Publicador: Oxford University Press on behalf of the European Public Health Association
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em //2015 EN; EN
Relevância na Pesquisa
95.88%
Background: Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report ‘Key Infectious Diseases in Migrant Populations in the EU/EEA’ commissioned by The European Centre for Disease Prevention and Control. Methods: We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012. Results: In 2010, of the 73 996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers. Conclusion: This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan...

From "retailers" to health care providers: transforming the role of community pharmacists in chronic disease management

Mossialos, Elias; Courtin, Emilie; Naci, Huseyin; Benrimoj, Shalom; Bouvy, Marcel; Farris, Karen; Noyce, Peter; Sketris, Ingrid
Fonte: Elsevier Publicador: Elsevier
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em //2015 EN; EN
Relevância na Pesquisa
95.9%
Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs—particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes.

Do you have to win it to fix it?: a longitudinal study of lottery winners and their health care demand

Cheng, Terence C.; Costa-i-Font, Joan; Powdthavee, Nattavudh
Fonte: Centre for Economic Performance (CEP), LSE Publicador: Centre for Economic Performance (CEP), LSE
Tipo: Monograph; NonPeerReviewed Formato: application/pdf
Publicado em /03/2015 EN; EN
Relevância na Pesquisa
95.9%
We exploit lottery wins to investigate the effects of exogenous changes to individuals' income on health care demand in the United Kingdom. This strategy allows us to estimate lottery income elasticities for a range of health care services that are publicly and privately provided. The results indicate that lottery winners with larger wins are more likely to choose private health services than public health services from the National Health Service. For high-income individuals without private medical insurance, the larger their winnings, the more likely they are to obtain private overnight hospital care. For privately insured individuals, the larger their winnings, the more likely they are to obtain private care for dental services and for eye, blood pressure, and cervical examinations. We find that medium to large winners ( $500) are more likely to have private health insurance. Larger winners are also more likely to drop coverage earlier, possibly after their winnings have been exhausted. The elasticities with respect to lottery wins are comparable in magnitude to the elasticities of household income from fixed effect models.

Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian register data

Grundy, Emily; Kravdal, Øystein
Fonte: BMJ Publishing Group Publicador: BMJ Publishing Group
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em //2014 EN; EN
Relevância na Pesquisa
95.91%
Background Short and very long interbirth intervals are associated with worse perinatal, infant and immediate maternal outcomes. Accumulated physiological, mental, social and economic stresses arising from raising children close in age may also mean that interbirth intervals have longer term implications for the health of mothers and fathers, but few previous studies have investigated this. Methods Discrete-time hazards models were estimated to analyse associations between interbirth intervals and mortality risks for the period 1980–2008 in complete cohorts of Norwegian men and women born during 1935–1968 who had had two to four children. Associations between interbirth intervals and use of medication during 2004–2008 were also analysed using ordinary least-squares regression. Covariates included age, year, education, age at first birth, parity and change in coparent since the previous birth. Results Mothers and fathers of two to three children with intervals between singleton births of less than 18 months, and mothers of twins, had raised mortality risks in midlife and early old age relative to parents with interbirth intervals of 30–41 months. For parents with three or four children, longer average interbirth intervals were associated with lower mortality. Short intervals between first and second births were also positively associated with medication use. Very long intervals were not associated with raised mortality or medication use when change of coparent since the previous birth was controlled. Conclusions Closely spaced and multiple births may have adverse long-term implications for parental health. Delayed entry to parenthood and increased use of fertility treatments mean that both are increasing...