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Articles 11551 - 11580 of 13354
Full-Text Articles in Entire DC Network
The Health Insurance Debate In Canada: Lessons For The United States?, Mary Anne Bobinski
The Health Insurance Debate In Canada: Lessons For The United States?, Mary Anne Bobinski
Faculty Articles
This Essay begins with an intentionally ambiguous title. Are comparisons to Canada relevant and useful for policy-makers in the United States and, if so, what lessons can we learn? Part II of this Essay highlights some of the risks and benefits of cross-border comparisons between the United States and Canada. In Part III, I analyze some of the key data points often cited in comparing the two health care systems. Part IV explores the current Canadian debate about private health insurance. Finally, in Part V, I focus on the lessons from Canada for the health insurance debate in the United …
Hiv-Positive Inmates Released From Nevada’S Prisons In 2001: Results From Matching Health Division And Corrections’ Databases, Paul G. Devereux, Kristen Clements-Nolle, Sharon Clodfelter, Jessey Bargmann-Losche, Miguel Feroro, Wei Yang
Hiv-Positive Inmates Released From Nevada’S Prisons In 2001: Results From Matching Health Division And Corrections’ Databases, Paul G. Devereux, Kristen Clements-Nolle, Sharon Clodfelter, Jessey Bargmann-Losche, Miguel Feroro, Wei Yang
Nevada Journal of Public Health
It is estimated that about one quarter of all HIV-infected individuals in the United States are released from a correctional facility each year. To better understand the needs of inmates with HIV exiting the prison system, a partnership with the Nevada State Health Division (NSHD), the Nevada Department of Corrections (DOC), and the University of Nevada, Reno School of Public Health was formed to examine this population using information contained in existing databases. An analysis of DOC data matched with the data from the HIV/AIDS Reporting System (HARS) maintained by the NSHD identified 2,802 HIV-negative inmates (2,451 males and 350 …
Évaluation De Tests De Dextérité Appliqués Aux Gants De Protection, Chantal Gauvin, Chantal Tellier, Renaud Daigle, Thierry Petitjean-Roget
Évaluation De Tests De Dextérité Appliqués Aux Gants De Protection, Chantal Gauvin, Chantal Tellier, Renaud Daigle, Thierry Petitjean-Roget
Rapports de recherche scientifique
Les gants de protection sont conçu pour protéger les mains, les doigts et les poignets. Cependant, plusieurs travailleurs choisissent de ne pas en porter et justifient ce choix principalement par le fait que les gants les empêchent d’effectuer leur travail correctement. Cette perception est confirmée par de nombreuses études qui ont démontré que les gants de protection affectent la dextérité, soit l’habileté d’un individu à manipuler des objets rapidement et avec précision.
L’effet des gants de protection sur la dextérité a été évalué, dans plusieurs études, par différents tests de dextérité, dont plusieurs ont été initialement développés pour d’autres applications …
Travail En Hauteur Et Protection Contre Les Chutes Pour Les Élagueurs, Jean Arteau, Yves Beauchamp, Ian Langlais, Frédéric Vachon
Travail En Hauteur Et Protection Contre Les Chutes Pour Les Élagueurs, Jean Arteau, Yves Beauchamp, Ian Langlais, Frédéric Vachon
Rapports de recherche scientifique
Problématique de santé et sécurité du travail et objectifs spécifiques :
Les élagueurs effectuent les travaux d'entretien des arbres. Leurs principales tâches sont l'émondage, l'élagage et l'abattage. Les méthodes d'accès à l'arbre sont les nacelles, les échelles, les grimpettes lors de l'abattage et les cordes. Les principaux risques sont les coupures par la scie à chaîne, les chutes de hauteur, la surdité, l'électrocution et les maux de dos. Les principaux employeurs sont les municipalités, les entreprises de distribution d'électricité (Hydro-Québec, Hydro-Sherbrooke, Hydro-Joliette, etc.) et les entreprises d'arboriculture qui sont souvent sous-traitantes des premières. Les travailleurs sont regroupés au sein de …
Concordance Interlaboratoire Des Tests De Prolifération Lymphocytaire Induite Par Le Béryllium (Belpt), Pauline Brousseau, Michel Rossignol, Chantal Dion, Nadine Sicard, Séverine Audusseau, Bruce Mazer, Nathalie Gravel, May Kafilmout, Stéphane Fortier, Mireille Varin, Thierry Petitjean-Roget
Concordance Interlaboratoire Des Tests De Prolifération Lymphocytaire Induite Par Le Béryllium (Belpt), Pauline Brousseau, Michel Rossignol, Chantal Dion, Nadine Sicard, Séverine Audusseau, Bruce Mazer, Nathalie Gravel, May Kafilmout, Stéphane Fortier, Mireille Varin, Thierry Petitjean-Roget
Rapports de recherche scientifique
L’exposition au béryllium peut mener à une réaction immunitaire de type cellulaire, la sensibilisation au béryllium (BeS) qui précèderait le développement de la bérylliose chronique dans les poumons. Cette sensibilisation peut être mise en évidence par un test de prolifération lymphocytaire induite par le béryllium (BeLPT), utilisé depuis une vingtaine d’années comme outil de dépistage précoce des effets du béryllium sur la santé.
Malgré que le test soit considéré comme étant efficace et performant pour identifier les individus à risque de développer une bérylliose, une controverse persiste autour du BeLPT. En effet, de nombreuses variables analytiques reliées aux standards du …
Senate Bill (Sb) 172: Governance Of Nutrition In Kentucky Public Schools: Implementation Analysis Final Report, Bill Brumbach
Senate Bill (Sb) 172: Governance Of Nutrition In Kentucky Public Schools: Implementation Analysis Final Report, Bill Brumbach
MPA/MPP/MPFM Capstone Projects
This report is intended to evaluate the implementation of Senate Bill (SB) 172 in Kentucky's public schools. This law requires that all schools in Kentucky implement strict nutrition standards that apply to all foods sold during the school day. This report highlights the different methods used by selected schools in implementing the requirements in SB 172. In performing my analysis, I traveled to different schools in central and southeastern Kentucky to assess how these select schools were meeting the requirements of the law. Site visits allowed me to discuss implementation strategies with school administrators and aided in my understanding of …
Snapshot 2007: Maine Workers With Disabilities, Maine’S Commission On Disability And Employment, Choices Ceo Project
Snapshot 2007: Maine Workers With Disabilities, Maine’S Commission On Disability And Employment, Choices Ceo Project
Disability & Aging
No abstract provided.
Evaluating If The Built Environment Has A Substantial Effect On Obesity In Fayette County, Kentucky, Will Warren
Evaluating If The Built Environment Has A Substantial Effect On Obesity In Fayette County, Kentucky, Will Warren
MPA/MPP/MPFM Capstone Projects
Background:
Obesity is a major health issue in the United States and Fayette County. As Fayette County has become increasingly obese, it too has had an issue of sprawl within its urban service area and beyond. Relationships between obesity and aspects of the built environment are continuing to be studied.
Objective:
To evaluate the impact certain factors may have on the body mass index of Fayette County residents, in particular whether urban sprawl has an overriding impact on the weight of residents.
Methods:
The study area used was Fayette County, which was broken down into its fourteen zip code areas …
Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips
Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips
Poverty, Gender, and Youth
The recent introduction of user fees for Vietnam’s primary healthcare services has generated concern that economic policies may adversely affect health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This Population Council working paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under age 5 recorded by the 2001–02 Vietnam National Health Survey. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Results suggest that social equity …
Tuko Pamoja: A Guide For Peer Educators, Program For Appropriate Technology In Health (Path)
Tuko Pamoja: A Guide For Peer Educators, Program For Appropriate Technology In Health (Path)
Reproductive Health
This guide was developed by Program for Appropriate Technology in Health (PATH) and is part of the Kenya Adolescent Reproductive Health Project’s Tuko Pamoja (We Are Together) series. Based on KARHP’s Adolescent Reproductive Health and Life Skills Curriculum, the guide is designed to help facilitate dialogue between adults and young people on issues related to adolescent reproductive health. It can be used to help peer educators share information and lead discussions with their peers on physical and emotional changes during adolescence, staying healthy, planning for the future, making good decisions, and preventing pregnancy and HIV and AIDS. The information can …
Grandir En Harmonie: Guide De L'Utilisateur, Population Council
Grandir En Harmonie: Guide De L'Utilisateur, Population Council
Reproductive Health
Ce guide de l’utilisateur fournit des informations pour aider les animateurs du programme « Grandir en harmonie » à jouer efficacement leur rôle d’éducateur pair. Le guide décrit la mission, les tâches et la cible des activités à faire avec les adolescent(e)s/jeunes. Ces activités leur permettent de renforcer leurs capacités à prendre des décisions afin de mieux se réaliser maintenant et dans le futur. Le guide aide les animateurs avec l’organisation, la méthodologie et le matériel de soutien pour les sessions.
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This user’s guide provides information to help “Growing in Harmony” curriculum facilitators effectively carry out their role of …
Mainstreaming Emergency Contraception In Ethiopia's Public Sector: Final Project Report, Jill Keesbury, Hailegiorgis Aytenfisu, Spike Bradford
Mainstreaming Emergency Contraception In Ethiopia's Public Sector: Final Project Report, Jill Keesbury, Hailegiorgis Aytenfisu, Spike Bradford
Reproductive Health
The Ethiopian Ministry of Health, the Ethiopian Society of Obstetricians and Gynecologists, and ECafrique launched a two-year project in 2004 to mainstream emergency contraception (EC) in the country’s public sector. The project aimed at improving reproductive health care among young women and reducing the country’s abortion rate by expanding access to EC. Overall, its goal was to demonstrate the feasibility of integrating EC within the public sector’s broader contraceptive mix and was guided by the following objectives: to scale-up and promote public sector EC services in five of Ethiopia’s most populated regions; to document the characteristics and use patterns of …
The Resolution Of Unintended Pregnancy Among Female Students At The University Of Ghana, Legon, Angela El-Adas
The Resolution Of Unintended Pregnancy Among Female Students At The University Of Ghana, Legon, Angela El-Adas
Reproductive Health
Little has been done to investigate the knowledge, attitudes, and practices of university students regarding unintended pregnancy likely because their middle-class status precludes their being considered a “deprived population.” Female students in tertiary institutions of higher learning are at an age and in a social context that makes them extremely susceptible to unintended pregnancy and the consequences of unsafe abortions. It is necessary to take steps to reduce the incidence of unwanted pregnancy and unsafe abortions among this group of “high risk” women. This study sought to investigate the extent of knowledge that female students at the University of Ghana, …
Bangladesh: Rh Curriculum Enhances Vocational Students' Knowledge And Behavior, Frontiers In Reproductive Health
Bangladesh: Rh Curriculum Enhances Vocational Students' Knowledge And Behavior, Frontiers In Reproductive Health
Reproductive Health
In 2004, the Population Council’s FRONTIERS Program and the Bangladesh Ministry of Youth and Sports collaborated on an intervention to introduce reproductive health education into government-run vocational-training courses. The training, offered to males and females aged 15–30, includes livestock husbandry, electronics, and secretarial work. The intervention built upon the positive results of the 1999 Bangladesh Youth Reproductive Health Study, which introduced a life-skills curriculum into secondary schools. The interactive reproductive health curriculum was modified to suit older adolescents and youth attending courses at vocational training centers. Topics included reproductive biology, family planning, pregnancy, sexually transmitted infections, critical thinking, and negotiation …
Achieving Synergies In Prevention Through Linking Sexual And Reproductive Health And Hiv Services, Ian Askew
Achieving Synergies In Prevention Through Linking Sexual And Reproductive Health And Hiv Services, Ian Askew
Reproductive Health
Integration, linkages, and synergies are widely used terms among those interested in strengthening the relationship between sexual and reproductive health services and HIV prevention. These conference proceedings explore the terms conceptually and review the wide range of combinations of SRH and HIV prevention services that have been linked or integrated. Several different combinations have proven feasible and acceptable in pilot situations, but there remains a lack of evidence as to their effectiveness in changing behaviors, including preventing HIV transmission. There is also limited experience with scaling up successful models and a need to move beyond a focus on services to …
Hiv/Aids Programming And Sexuality Of Young People Perinatally Infected With Hiv, Harriet Birungi
Hiv/Aids Programming And Sexuality Of Young People Perinatally Infected With Hiv, Harriet Birungi
Reproductive Health
These conference proceedings draw on preliminary data from an ongoing project implemented by TASO Uganda and the Population Council that contributes to the promotion of sexual and reproductive health rights of young people aged 10–19 years perinatally infected with HIV. The key argument is that HIV/AIDS programming in Uganda and elsewhere in Africa will need to acknowledge that the population of young people perinatally infected with HIV is growing and to specifically target that population. HIV/AIDS programming will also address the sexual desires of young people perinatally infected with HIV by providing them with information and practical support to understand …
Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Bagh District, Munir Afridi, Saman Naz, Nayyer Munir
Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Bagh District, Munir Afridi, Saman Naz, Nayyer Munir
Reproductive Health
The Primary Healthcare Revitalization, Integration, and Decentralization in Earthquake-affected Areas (PRIDE) program is designed to improve primary health-care services and health outcomes for populations in Bagh and Mansehra districts in northern Pakistan that were affected by the devastating earthquake that struck on October 8, 2005. The project aims to strengthen the financial and human resource management capacities of district health authorities and primary health-care providers. Access to and quality of primary health-care services will be improved through an essential package of health services and improved skills of primary health-care personnel. Community demand for quality services will be improved through an …
Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Mansehra District, Munir Afridi, Saman Naz, Nayyer Munir
Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Mansehra District, Munir Afridi, Saman Naz, Nayyer Munir
Reproductive Health
The Primary Healthcare Revitalization, Integration, and Decentralization in Earthquake-affected Areas (PRIDE) program is designed to improve primary health-care services and health outcomes for populations in Bagh and Mansehra districts in northern Pakistan that were affected by the devastating earthquake that struck on October 8, 2005. The project aims to strengthen the financial and human resource management capacities of district health authorities and primary health-care providers. Access to and quality of primary health-care services will be improved through an essential package of health services and improved skills of primary health-care personnel. Community demand for quality services will be improved through an …
Increasing Dual Protection Among Rickshaw Pullers In Bangladesh, Ismat Bhuiya, Mizanur Rahman, Ubaidur Rob, M.E. Khan, K.M. Zahiduzzaman
Increasing Dual Protection Among Rickshaw Pullers In Bangladesh, Ismat Bhuiya, Mizanur Rahman, Ubaidur Rob, M.E. Khan, K.M. Zahiduzzaman
Reproductive Health
The main objective of this study, conducted in six urban clinics of Dhaka, Bangladesh was to increase contraceptive use among rickshaw pullers, with special emphasis on condom use. The study tested two strategies to increase access to family planning and reproductive health (RH) information and services: a) an educational campaign together with improved availability of condoms; and b) an educational campaign alone. Findings show that rickshaw pullers’ knowledge on contraceptive methods increased significantly in both the experimental sites compared to the control site. Use of any contraceptive method increased significantly in the experimental sites, and condom use increased significantly in …
Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon
Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon
Reproductive Health
The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed …
Provision Of Emergency Contraceptive Services Through Paraprofessionals In India, Shiv Kumar, Chander Shekhar, N.K. Gupta, Malabika Roy, M.E. Khan, Mary Philip Sebastian, Rukma Idnani, Ardash Bhargava, Vinita Salvi
Provision Of Emergency Contraceptive Services Through Paraprofessionals In India, Shiv Kumar, Chander Shekhar, N.K. Gupta, Malabika Roy, M.E. Khan, Mary Philip Sebastian, Rukma Idnani, Ardash Bhargava, Vinita Salvi
Reproductive Health
In 2004, with funding for technical assistance provided by USAID, the Indian Council of Medical Research funded and collaborated with the Frontiers in Reproductive Health (FRONTIERS) program of the Population Council on a two-year study to assess the usefulness and effectiveness of using paraprofessionals in educating and providing emergency contraception (ECP) services to potential users. Based on the findings and advocacy efforts, the Indian Ministry of Health and Family Welfare introduced ECP as an over-the-counter medication beginning in September 2005. This made it possible for paraprofessionals in the National Family Planning Program to provide ECP services, making the method widely …
Assessing The Feasibility, Acceptability And Cost Of Introducing Postabortion Care In Health Centres And Dispensaries In Rural Tanzania, Monica Wanjiru, Ian Askew, Nzoya Munguti, Saumya Ramarao, Rick Homan, Reheme Kahando, John M. Pile
Assessing The Feasibility, Acceptability And Cost Of Introducing Postabortion Care In Health Centres And Dispensaries In Rural Tanzania, Monica Wanjiru, Ian Askew, Nzoya Munguti, Saumya Ramarao, Rick Homan, Reheme Kahando, John M. Pile
Reproductive Health
The EngenderHealth ACQUIRE Project has been supporting the Tanzanian Ministry of Health (MOH) since early 2005 to decentralize the management of postabortion care (PAC) services to primary healthcare facilities (health centers and dispensaries), with the intention of bringing services closer to women who are unable to access them at district hospitals. Findings from this study were provided to the MOH and ACQUIRE to address issues arising from introduction of the intervention; and in September 2006, to assess the feasibility, cost, and effectiveness of the intervention. Findings show that the intervention appears to have broadened service providers’ range of clinical skills …
Testing The Effectiveness Of The Men As Partners Program (Map) In Soweto, South Africa, Prudence Ditlopo, Saiqa Mullick, Ian Askew, Ricardo Vernon, Edwin Maroga, Sgidi Sibeko, Mokgethi Tshabalala, Rabbuh Raletsemo, Dean Peacock, Andrew Levack
Testing The Effectiveness Of The Men As Partners Program (Map) In Soweto, South Africa, Prudence Ditlopo, Saiqa Mullick, Ian Askew, Ricardo Vernon, Edwin Maroga, Sgidi Sibeko, Mokgethi Tshabalala, Rabbuh Raletsemo, Dean Peacock, Andrew Levack
Reproductive Health
This project was conducted to evaluate the effectiveness of the Men as Partners (MAP) program in South Africa in terms of: changing men’s gender attitudes, norms and behaviors; changing aspects of gender dynamics in relationships; reducing the prevalence of unwanted pregnancy risk behaviors at individual and community levels; and increasing male involvement in gender based violence (GBV) and HIV prevention and in HIV care and support activities. The intervention activities implemented were MAP workshops, public demonstrations, and participation in community action teams. The evaluation of the interventions showed that about 30% of the workshop participants had also attended other MAP …
Young People's Sexual And Reproductive Health In India: Policies, Programmes And Realities, K.G. Santhya, Shireen J. Jejeebhoy
Young People's Sexual And Reproductive Health In India: Policies, Programmes And Realities, K.G. Santhya, Shireen J. Jejeebhoy
Reproductive Health
This paper presents an overview of key policies and government programmes intended to reduce HIV vulnerability and improve sexual and reproductive health among young people in India, and identifies the extent to which these policies and programmes have addressed the gamut of unique sexual and reproductive needs of young women and men. It also explores the extent to which programmes have been adapted to accommodate state-level differences in the sexual and reproductive vulnerability of youth; the review takes the examples of two states, namely, Andhra Pradesh, characterised by both early marriage and high HIV prevalence, and Madhya Pradesh, characterised by …
Download The Pdf Of The Entire Issue: Pehc Vol. 1, Issue 2
Download The Pdf Of The Entire Issue: Pehc Vol. 1, Issue 2
Prescriptions for Excellence in Health Care Newsletter Supplement
No abstract provided.
Factors Associated With Atypical Moles In New Hampshire, Usa, L Titus-Ernstoff, J Ding, A. E. Perry, S. K. Spencer, B. F. Cole, M. S. Ernstoff
Factors Associated With Atypical Moles In New Hampshire, Usa, L Titus-Ernstoff, J Ding, A. E. Perry, S. K. Spencer, B. F. Cole, M. S. Ernstoff
Dartmouth Scholarship
Only a few studies, conducted in Sweden, assessed factors associated with the presence of atypical moles in the general population. We conducted a population-based, case-control study in New Hampshire, USA, to identify factors associated with atypical moles. In our study, atypical moles affected 14% of the study population. The adjusted odds ratio (OR) was 0.34 (95% confidence interval (CI)=0.14-0.80) for those with the highest adulthood recreational sun exposure, relative to the lowest. The OR for any freckles, compared to none, was 2.24 (95% CI=1.18-4.25). We found a linear relationship between the number of benign moles and the presence of atypical …
Impact Of Combat Stress On Mental Health Outcomes: Brfss Survey Data 2006, Emily Pedneau
Impact Of Combat Stress On Mental Health Outcomes: Brfss Survey Data 2006, Emily Pedneau
Theses and Dissertations
Objectives: This study sought to determine the relationship between combat experience and mental health outcomes. The study sought to determine whether age was a significant factor in poor mental health outcomes. Methods: Multiple logistic regression (n = 195,048) and multiple linear regression (n = 264,154) were performed on the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. Veteran status and a host of demographic and health status questions were analyzed in relation to diagnosis of anxiety or depressive disorder (multiple logistic regression) and to number of days poor mental health (multiple linear regression). Results: Diagnosis of anxiety or depression was …
Sexual Violence And Correlates Among Women In Hiv Discordant Union, Uganda, Donath Emusu
Sexual Violence And Correlates Among Women In Hiv Discordant Union, Uganda, Donath Emusu
All ETDs from UAB
We sought to estimate the prevalence of sexual violence and sexually transmitted diseases (STDs), identify risk factors for sexual violence and STDs among women in Human Immunodeficiency Virus (HIV) discordant unions, and investigate the lived experiences of sexual violence among women in HIV discordant unions attending post-test club services at AIDS Information Centers (AICs) in Uganda. We carried out a prospective cohort study of women in HIV discordant and HIV negative concordant unions after disclosure of their HIV serostatus. We estimated prevalence of STDs in the two study cohorts and compared them for occurrence of risk factors for sexual violence …
Titania Coated Hollow Glass Microspheres For Environmental Applications, Mark C. Koopman
Titania Coated Hollow Glass Microspheres For Environmental Applications, Mark C. Koopman
All ETDs from UAB
The potential applicability of titania coated hollow glass microspheres (HGMs) to the photocatalytic degradation of microbiological and organic chemical water pollutants could have dramatic positive effects on improving the quality of industrial wastewaters that empty into rivers and streams, as well as potential use in economically improving the quality of drinking water. Heterogeneous photocatalysis using titania has been extensively studied since the 1990’s because of its non-toxic nature, its high quantum yield of electrons and photo-holes, and its ability to use ambient solar radiation as a power source. Although titania embodies extraordinarily attractive properties for a range of environmental applications, …
Delayed Childbearing, Pregnancy Spacing And Impact On Subsequent Pregnancy Outcomes: Missouri Resident Mothers 1978-1997, Sarah K. Nabukera
Delayed Childbearing, Pregnancy Spacing And Impact On Subsequent Pregnancy Outcomes: Missouri Resident Mothers 1978-1997, Sarah K. Nabukera
All ETDs from UAB
Introduction The main objective of the study was to examine reproductive health issues among women delaying initiation of childbearing until age 30 or older. Specifically, it examined pregnancy spacing patterns, relationship between pregnancy spacing and subsequent perinatal outcomes as well as racial differences in spacing and adverse perinatal outcomes. Methods A retrospective cohort study was conducted using the Missouri maternally linked live birth, fetal death and infant death files 1978-1997. The study sample was limited to mothers residing in Missouri during the study period, having first pregnancy at age 20-50 years, as well as a subsequent second pregnancy. Final study …