Economic outcomes in adulthood and their associations with antisocial conduct, attention deficit and anxiety problems in childhood.

BACKGROUND: Conduct disorder (antisocial conduct), attention deficit problems and anxiety in childhood have negative effects on individuals during their childhood, on their families, and often into adulthood. AIMS OF THE STUDY: To quantify the connections between childhood antisocial conduct, attention deficit and anxiety, and some adulthood economic consequences. METHODS: Data from a British birth cohort study were examined for links between behavioural and emotional problems in childhood, and occupational status and earnings in adulthood, after adjusting for individual and family covariates. RESULTS: The effects of antisocial conduct on adult labour market outcomes were complex. Results for males with antisocial conduct at age 10 showed a higher probability of being unemployed at age 30 (after adjustment for other factors). However, males with antisocial conduct at age 10 had higher earnings than those without such behaviour, again after adjusting for other factors. There were no such differences for females with antisocial conduct. Attention deficit problems at age 10 were associated with lower employment rates, worse jobs, lower earnings if employed, and lower expected earnings overall - for both males and females. Anxiety problems were associated with lower earnings. Other childhood factors associated with worse adulthood economic outcomes included cognitive attainment, living in a disadvantaged neighbourhood, mother's educational qualifications, family income and being looked after by a local authority. DISCUSSION: Links between antisocial conduct and attention deficit in childhood and high adulthood personal and societal costs support arguments for effective interventions to prevent and treat behavioural problems in childhood. However, the cost-effectiveness of such interventions still needs to be considered carefully. IMPLICATIONS FOR POLICY: Childhood mental health problems are strongly linked to adverse adulthood experiences across a number of domains. Early detection and intervention might head off many of these negative outcomes for children, their families and wider society. The positive impact of antisocial conduct on earnings needs further examination: it is not necessarily counter-intuitive, but it raises interesting policy questions. IMPLICATIONS FOR FURTHER RESEARCH: The long-term outcomes of childhood problems and interventions need further study, as do the pathways connecting childhood morbidity, adulthood outcomes and other potential intervening factors.

Primary Care 2030: Creating an Enabling Ecosystem for Disruptive Primary Care Models to Achieve Universal Health Coverage in Low- and Middle-Income Countries.

Background: Forty years after Alma Ata, there is renewed commitment to strengthen primary health care as a foundation for achieving universal health coverage, but there is limited consensus on how to build strong primary health care systems to achieve these goals. Methods: We convened a diverse group of global stakeholders for a high-level dialogue on how to create an enabling ecosystem for disruptive primary care innovation. We focused our discussion on four themes: workforce innovation and strengthening; impactful use of data and technology; private sector engagement; and innovative financing mechanisms. Findings: Here, we present a summary of our convening's proceedings, with specific recommendations for strengthening primary health care systems within each of these four domains. Conclusions: In the wake of the Astana Declaration, there is global consensus that high-quality primary health care must be the foundation for universal health coverage. Significant disruptive innovation will be required to realize this goal. We offer our recommendations to the global community to catalyze further discourse and inform policy-making and program development on the path to Health for All by 2030.

Linkages to care for newly diagnosed individuals who test HIV positive in nonprimary care settings.

Linkage services are an increasingly important component of the continuum of care for people living with HIV, particularly for individuals diagnosed in nonprimary care settings who are less likely than those identified in primary care settings to have a usual source of care. This study examines successful models used by hospital emergency departments, health department outpatient clinics, and other nonprimary care providers for testing, linking, and engaging newly diagnosed HIV-positive racial and ethnic minorities into medical care. Based on studies of five mature linkage-to-care (LTC) programs implemented in geographically and institutionally diverse settings, we identify five key characteristics that make them viable. Effective linkage programs are low cost, intensive, time limited, unique, and flexible. We also identify four core components of successful LTC protocols: directly employed linkage workers, active referral to medical care, person-centered linkage case management, and cultural and linguistic concordance. Finally, we develop a set of operational strategies to help providers address barriers at all levels of the health care system to help promote the effective linkage of newly diagnosed patients to care. We organize the strategies around four key areas: adherence to LTC protocols, selection of linkage workers, execution of linkage programs, and sustainability of linkage programs. The findings presented in this study provide a practical and operational guide for developing and implementing policies and procedures for linking newly diagnosed individuals who test HIV positive in nonprimary care settings into ongoing care for HIV infection.