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Purpose: Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health., Methods: We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level., Results: We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty., Discussion: More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Background: The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States., Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system., Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems., Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes., (© 2020 Wiley Periodicals LLC.)

Objective: To compare cause-specific UK mortality in children and young people (CYP) with EU15+ countries (European Union countries pre-2004, Australia, Canada and Norway)., Design: Mortality estimates were coded from the WHO World Mortality Database. Causes of death were mapped using the Global Burden of Disease mortality hierarchy to 22 cause groups. We compared UK mortality by cause, age group and sex with EU15+ countries in 2015 (or latest available) using Poisson regression models. We then ranked the UK compared with the EU15+ for each cause., Setting: The UK and EU15+ countries., Participants: CYP aged 1-19., Main Outcome Measure: Mortality rate per 100 000 and number of deaths., Results: UK mortality in 2015 was significantly higher than the EU15+ for common infections (both sexes aged 1-9, boys aged 10-14 and girls aged 15-19); chronic respiratory conditions (both sexes aged 5-14); and digestive, neurological and diabetes/urological/blood/endocrine conditions (girls aged 15-19). UK mortality was significantly lower for transport injuries (boys aged 15-19). The UK had the worst to third worst mortality rank for common infections in both sexes and all age groups, and in five out of eight non-communicable disease (NCD) causes in both sexes in at least one age group. UK mortality rank for injuries in 2015 was in the top half of countries for most causes., Conclusions: UK CYP mortality is higher than a group of comparable countries for common infections and multiple NCD causes. Excess UK CYP mortality may be amenable to health system strengthening., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Universal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC., Methods: We followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not., Results: Overall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1-4 years) and primary school (5-9 years) children, respectively. Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79-2.00) and vaccine-preventable admissions (HR 4.41, 2.59-7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55-4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17-1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77-2.04, HR 11.43, 8.48-15.39, and HR 4.82, 3.93-5.91, respectively). These associations were modified in children who consulted more in primary care., Conclusions: A high uptake of preventive primary care from birth is associated with fewer unplanned and ACS admissions in children. However, the clustering of poor health, a lack of preventive care uptake, and social deprivation puts some children with comorbid conditions at very high risk of admission. Strengthening immunisation coverage and preventive primary care in countries with poor UHC could potentially significantly reduce the health burden from hospital admission in children.

Background: The Countdown for UK Child Survival tracks recent UK child mortality trends and makes recommendations for improvement., Methods: We used data from the WHO World Mortality Database to calculate mortality from 1970 to 2014 for 0-19 year olds in the UK and a comparable group of wealthy countries (the EU15+). We used Poisson regression models to assess the significance of apparent differences. We extrapolated model coefficients to estimate future disparites between the UK and the EU15+ to 2030. We proposed goals and intermediate indicators to track UK mortality in keeping with the UN Sustainable Development Goals., Results: UK infant mortality continues to track in the worst decile of EU15+ mortality with 1-4 year mortality in the worst quartile. Annual reductions in total UK mortality have been significantly lower than the EU15+ since 1990 for infant, postneonatal and 1-4 year mortality. If current trends persist, by 2030 UK infant mortality and 1-4 year mortality could be respectively 180% and 145% of EU15+ median mortality. UK non-communicable disease (NCD) mortality among 1-4 years and 15-19 years persists in the worst quartile. UK injury mortality continues in the best quartile. A framework of goals and indicators for UK child survival and health is presented., Discussion: UK mortality among under 10 years of age continues to diverge from the EU15+ median, and UK NCD mortality remains persistently poor. We propose a set of goals to improve UK childhood survival by 2030 and an annual Countdown mechanism to monitor progress towards these targets., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)