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Background: Women with one lifetime singleton pregnancy have increased risk of cardiovascular disease (CVD) mortality compared with women who continue reproduction particularly if the pregnancy had complications. Women with twins have higher risk of pregnancy complications, but CVD mortality risk in women with twin pregnancies has not been fully described. Objectives:We estimated risk of long-term CVD mortality in women with naturally conceived twins compared to women with singleton pregnancies, accounting for lifetime number of pregnancies and pregnancy complications.Methods: Using linked data from the Medical Birth Registry of Norway and the Norwegian Cause of Death Registry, we identified 974,892 women with first pregnancy registered between 1967 and 2013, followed to 2020. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for maternal CVD mortality were estimated by Cox regression for various reproductive history (exposure categories): (1) Only one twin pregnancy, (2) Only one singleton pregnancy, (3) Only two singleton pregnancies, (4) A first twin pregnancy and continued reproduction, (5) A first singleton pregnancy and twins in later reproduction and (6) Three singleton pregnancies (the referent group). Exposure categories were also stratified by pregnancy complications (pre-eclampsia, preterm delivery or perinatal loss).Results: Women with one lifetime pregnancy, twin or singleton, had increased risk of CVD mortality (adjusted hazard [HR] 1.72, 95% confidence interval [CI] 1.21, 2.43 and aHR 1.92, 95% CI 1.78, 2.07, respectively), compared with the referent of three singleton pregnancies. The hazard ratios for CVD mortality among women with one lifetime pregnancy with any complication were 2.36 (95% CI 1.49, 3.71) and 3.56 (95% CI 3.12, 4.06) for twins and singletons, respectively. Conclusions:Women with only one pregnancy, twin or singleton, had increased longterm CVD mortality, however highest in women with singletons. In addition, twin mothers who continued reproduction had similar CVD mortality compared to women with three singleton pregnancies.

Various interventions to prevent occupational injuries in the construction industry have been proposed and studied. This continuing updated Cochrane review systematically summarizes the most current scientific evidence on the effectiveness of interventions to prevent injuries associated with construction work. Search terms that covered the concepts of 'construction workers', 'injury', 'safety' and 'study design' were used to identify intervention studies in five electronic databases up to April 2017. Acceptable study designs included randomized controlled trials (RCT), controlled before-after studies (CBA) and interrupted time series (ITS). In total 17 studies, 14 ITS and three CBA studies, from the US (6), UK (2), Italy (3), Denmark (1), Finland (1), Austria (1) Germany (1) Spain (1), Belgium (1) met the inclusion criteria. Most studies were at high risk of bias. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very lowquality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers.

Evaluation of interventions to reduce occupational injuries in the construction industry are relatively scarce. Various interventions to prevent occupational injuries have been proposed and studied. In a Cochrane review we systematically summarise the most current scientific evidence on the effectiveness of interventions to prevent injuries associated with construction work. Most of these studies are analysed with an interrupted time series design, which are characterised by a higher risk of bias.We use the GRADE (Grades of Recommendations, Assessment, Development and Evaluation) approach that systematically represents the factors important in interpretating evidence and results in a current update of our review. While the evidence can be different for each outcome, GRADE considers the evidence for each outcome and takes into account the magnitude of effect and ensures the process is systematic and transparent.Rating of the evidence was done as follows: with RCTs we started at high quality and with observational studies we started at low quality. Then we downgraded if one of the following criteria were met: study limitations, inconsistency, indirectness, imprecision and publication bias. We upgraded observational studies if there have been dose-response, large effect size or an opposite effect of confounding. We constructed tables for every comparison for our interventions and our two primary outcomes fatal and non-fatal injuries because these were our inclusion criteria for the studies.Applying GRADE and the difference with strength of association will be discussed based on the above mentioned update of our review. Also the differences in clarity of the conclusions with and without GRADE will be discussed.