Effect of a motor skill-based intervention in the relationship of individual and contextual factors in children with and without Developmental Coordination Disorder from low-income families.

Contextual opportunities facilitate skill acquisition, and the interaction between individual and contextual factors is fundamental to enhancing health and social parameters in children with DCD. This study examined (1) the influence of Mastery Motivational Climate (MMC) and Exercise Play Climate (EPC) interventions on motor performance, physical activity, self-perceptions, BMI, engagement in the lessons, playtime, and screen time of children without and with DCD, (2) the relationship between motor performance, self-perceptions, BMI, engagement in the physical education lessons, playtime, and screen factors in the children's physical activity levels in the lessons (PA) pre-and post-test. Children (N = 255, 98 children with Developmental Coordination Disorder - DCD; 157 children without DCD) were randomly assigned to MMC and EPC. Physical Activity levels in the lessons, motor performance, self-perceptions of physical competence, body mass indexes, appropriate motor engagement with success in the lessons, and active play and screen time were assessed. Regarding intervention impact, from pre-to post-tests, the results showed increases (1) PA in children with DCD in the EPC group and without DCD in the MMC group; (2) locomotor and ball skills for children with DCD in both climates; (3) locomotor and ball skills for children without DCD in the MMC group; (4) self-perceptions of competence for children with DCD in the MMC group; and (5) engagement with success for all children in both climates. A slight decrease in BMI for children with DCD in both climates was found. Regarding the associations, at post-test, engagement with success explained (1) PA levels for children with DCD in the MMC group and children without DCD in the EPC group; (2) active playtime explained PA for children with DCD in the EPC group; (3) ball skills explained PA for children without DCD in the MMC group. The intervention promoted overall increases in motor performance and children's engagement in the lesson. The intervention strengthened the role of ball skills performance, engagement with success, and active play; however, these relationships were different across groups.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state.

INTRODUCTION: There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. MATERIALS AND METHODS: Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. RESULTS: Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). CONCLUSIONS: Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

Impact of a Simulation Exercise on Student Perceptions of Poverty and Interprofessional Socialization.

OBJECTIVE: This study aimed to evaluate the impact of an interprofessional poverty simulation exercise by determining if participating students demonstrated changes in attitude toward poverty (ATP) and perceptions of interprofessional socialization. METHODS: The Community Action Poverty Simulation from the Missouri Community Action Network was provided to 512 interprofessional health care students during 9 simulation exercises over a 3-year period. Primary participating professions were pharmacy, occupational therapy, and nursing. Student simulation roles were assigned to ensure a mix of professions in simulated families and debriefing groups. Debriefing sessions included questions related to interprofessional interactions. Students completed surveys before and following participation in the simulation, which included the ATP Short Form scale and the Interprofessional Socialization and Valuing Scale-9A. RESULTS: Statistically significant improvements in ATP were demonstrated for the overall score and 15 items of the 21-item ATP Short Form scale. The domains of stigma and structural perspective showed statistically significant improvement, while the personal deficiency domain did not. Statistically significant improvements in student perceptions related to interprofessional socialization were demonstrated for the overall score and 7 items of the 9-item Interprofessional Socialization and Valuing Scale-9A scale. CONCLUSION: This interprofessional poverty simulation positively altered student ATP and enhanced interprofessional socialization. The Community Action Poverty Simulation augmented with debriefing questions related to interprofessional interactions served as an effective interprofessional education experience for pharmacy, occupational therapy, and nursing students.

Overweight and Obesity in Finnish Children by Parents' Socioeconomic Position-A Registry-Based Study.

Objectives: To examine associations between parents' socioeconomic position (SEP) and child overweight and obesity, using registry data. Methods: Data (final n = 194,423) on children's height, weight and parents' SEP were drawn from the national Register of Primary Health Care Visits (Avohilmo) and Statistics Finland. Risk ratios for bernoulli-distributed overweight (RROW) and obesity (RROB) according to SEP were estimated using generalized linear models and using a log -link. Results: The risk for obesity was lower in boys from high-income families (RROB 0.76), for overweight and obesity was lower in boys (RROW 0.72, RROB 0.58) and girls (RROW 0.72, RROB 0.54) with highly educated fathers, in boys (RROW 0.79, RROB 0.58) and girls (RROW 0.78, RROB 0.56) with high-educated mothers and in boys (RROW 0.85, RROB 0.77) and girls (RROW 0.80, RROB 0.69) living in urban areas, as compared to low-income families, low-educated parents, and rural residence, respectively. Conclusion: The risk of overweight and obesity was increased in children with low SEP or rural residence. Administrative registers are a valid approach to monitor childhood obesity by parents' SEP.

Pubertal timing, neighborhood income, and mental health in boys and girls: Findings from the adolescent brain cognitive development study.

Early pubertal timing is associated with youth mental health problems, with association amplified or mitigated by characteristics of the residential neighborhood. Yet, limited research simultaneously examines the roles of neighborhood context and biological sex in this association. This study fills this research gap by examining sex-specific associations between pubertal timing and neighborhood income with youth mental health problems (internalizing and externalizing symptoms) in a longitudinal cohort of early adolescents in the United States (US). Participants were 9201 youth aged 9 or 10 years from the Adolescent Brain Cognitive Development Study. Pubertal timing was the average of parent- and youth-reported pubertal status standardized within sex and age. Outcome variables were youths' internalizing and externalizing symptoms assessed at 1-year follow-up via parent survey. We evaluated interaction effects between pubertal timing and neighborhood income in a series of sex-stratified linear mixed effect models, adjusted for family and personal sociodemographic characteristics. In girls, earlier pubertal timing was associated with more internalizing (ß = 0.06, p < 0.001) and externalizing problems (ß = 0.07, p < 0.001) at 1-year follow-up, not moderated by neighborhood income. In boys, earlier pubertal timing was associated with more externalizing problems among youth living in high-income neighborhoods, but not among those in low-income neighborhoods (interaction-p = 0.006). Results suggest that pubertal timing may affect youth mental health differentially in boys and girls, depending on the neighborhood contexts. These findings highlight the importance of both biological and social forces in shaping adolescent mental health and, thus, have public health and clinical implications for health promotion.

The Impact of Subjective Poverty on the Mental Health of the Elderly in China: The Mediating Role of Social Capital.

Reducing subjective poverty among the elderly is an important aspect of poverty governance and is a necessary part of implementing the healthy aging strategy in China. In both China and the majority of low- and middle-income countries, systematic research on the relationship between subjective poverty and the mental health of the elderly needs to be expanded. In this study, we aimed to examine how social capital, including bonding and bridging social capital, mediate the relationship between subjective poverty and mental health among the elderly in China. Relying on the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, we used ordered probit (oprobit) regression, propensity score matching (PSM), and instrumental variable (IV) regression to estimate the effects of subjective poverty on mental health. The results indicate that subjective poverty has a significant negative impact on the mental health of the elderly in China. More importantly, social capital, including bonding and bridging social capital, partially mediates the relationship between subjective poverty and mental health. We believe that, in the process of implementing the government's healthy aging strategy in China, society and government should recognize the importance and value of subjective poverty governance for the elderly. In particular, the construction of a social relationship network that centers on bonding and bridging social capital could be instrumental in dealing with subjective poverty among the elderly and safeguarding their mental health and wellbeing.

The heterogeneous relationship between public health expenditures and household medical expenditures: evidence from relative poverty households in China.

Exploring the heterogeneous relationship between public health expenditures and household medical expenditures from the perspective of relative poverty has positive significance for improving the ability of relative poverty households to cope with the risk of large rigid expenditures and optimizing the public health resource allocation. This paper uses the China Family Panel Studies (CFPS) from 2016 to 2020 to identify relative poverty standard from the perspective of medical needs, analyzes the impact of public health expenditures on medical expenditures of different household types, and evaluates the effect of public health expenditures on ensuring the medical needs of relative poverty households. The panel threshold regression result shows that 19.36% of the provinces per capita disposable where the household is located is the identification standard of relative poverty households. Public health expenditures have a crowding-in effect on household medical expenditures and have a stronger impact on relative poverty households, an effect that is also confirmed by two-stage least squares regression. In addition, ensuring household medical needs through public health expenditures focuses on the level of basic medical needs, and the role of household healthcare expenditures that reflects high-level medical needs is not obvious. In the future, the government should establish a monitoring mechanism for relative poverty households, ensure the basic medical needs of relative poverty households, and clarify the heterogeneity among different types of households, provide targeted public health services.

Socio-economic predictors of Inuit hunting choices and their implications for climate change adaptation.

In the Arctic, seasonal variation in the accessibility of the land, sea ice and open waters influences which resources can be harvested safely and efficiently. Climate stressors are also increasingly affecting access to subsistence resources. Within Inuit communities, people differ in their involvement with subsistence activities, but little is known about how engagement in the cash economy (time and money available) and other socio-economic factors shape the food production choices of Inuit harvesters, and their ability to adapt to rapid ecological change. We analyse 281 foraging trips involving 23 Inuit harvesters from Kangiqsujuaq, Nunavik, Canada using a Bayesian approach modelling both patch choice and within-patch success. Gender and income predict Inuit harvest strategies: while men, especially men from low-income households, often visit patches with a relatively low success probability, women and high-income hunters generally have a higher propensity to choose low-risk patches. Inland hunting, marine hunting and fishing differ in the required equipment and effort, and hunters may have to shift their subsistence activities if certain patches become less profitable or less safe owing to high costs of transportation or climate change (e.g. navigate larger areas inland instead of targeting seals on the sea ice). Our finding that household income predicts patch choice suggests that the capacity to maintain access to country foods depends on engagement with the cash economy. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

School-Based Health Centers, Access to Care, and Income-Based Disparities.

Importance: School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. Objective: To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. Design, Setting, and Participants: This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. Exposure: County-by-year SBHC adoption. Main Outcomes and Measures: Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. Results: This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). Conclusions and Relevance: In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya.

Background: Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya. Methods: This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted. Results: In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention. Conclusion: Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

Country-level institutional quality and financial system efficiency: An international evidence.

The optimum economic outcome of financial system development depends on its level of efficiency. The purpose of this study is to investigate the effect of institutional quality on financial system efficiency. For empirical analysis, we have used a panel dataset of 108 countries from 1996-2020 and employed fixed effect regression and two stages least squares (2SLS) regression methods. The empirical results show that institutional quality has a significant positive effect on financial system efficiency. Particularly all the constituting elements-voice and accountability, political stability and absence of violence, regulatory quality, government effectiveness, rule of law, and control of corruption-of institutional quality are found to have a significant positive impact on financial system efficiency. Moreover, we found that the effect of institutional quality is more pronounced in countries with low-income levels and strong institutional quality. These findings are robust across several robustness tests conducted using additional controls, alternative methodologies, an alternative measure of institutional quality, and financial system efficiency. The results of the study suggest that policy makers should prioritize both enhancing and sustaining institutional quality to promote the efficiency of the financial system, which is crucial for sustainable growth and development.

Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model.

BACKGROUND: Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR). METHOD: Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR. RESULTS: The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan. CONCLUSION: The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

COVID-19 economic stimulus packages, tourism industry and external debt: The influence of extreme poverty.

The COVID-19 outbreak has had a catastrophic effect on the tourism sector and poverty alleviation efforts. This is especially the case, given the crucial role the tourism sector plays in poverty alleviation and the generation of foreign exchange earnings. This study investigates the moderating influence of extreme poverty on the underlying link between the size of the tourism industry and COVID-19 Economic Stimulus Packages (ESPs) while accounting for the influence of external debt. The results show that tourism-dependent economies with a larger share of individuals living in extreme poverty introduced larger ESPs to cushion the impacts of the COVID-19 outbreak. In addition, economies with larger external debt have less fiscal and monetary leeway to alleviate the negative effects of the COVID-19 outbreak.

Outbreak of Multidrug-Resistant Tuberculosis - Kansas, 2021-2022.

An outbreak of multidrug-resistant (MDR) tuberculosis (TB) involved 13 persons in four households in a low-income, under-resourced urban Kansas community during November 2021-November 2022. A majority of the seven adults identified in the Kansas outbreak were born outside the United States in a country that had experienced an MDR TB outbreak with the same genotype during 2007-2009, whereas most of the six children in the Kansas outbreak were U.S.-born. Prompt identification, evaluation, and treatment of persons with MDR TB and their contacts is essential to limiting transmission.

Assessing and prioritizing biogas barriers to alleviate energy poverty in Pakistan: an integrated AHP and G-TOPSIS model.

Biogas is a promising renewable technology to alleviate energy poverty. Pakistan has a capacity of 5 million bio digesters that can be installed in different farming areas. However, this target has never been achieved because many barriers hamper the biogas industry development. In previous studies, some researchers have indicated these barriers in different geographical contexts: however, these barriers are rarely examined in Pakistan. To fulfill the research gap, this study prioritizes potential barriers. Using a literature review and a modified Delphi technique, we identify 25 sub-barriers and catalog them into 5 main categories. The analytical hierarchy process (AHP) prioritizes the main barriers and sub-barriers based on potential. Grey Technique for Order Preference by Similarity to Ideal Solution (G-TOPSIS) ranks the practical alternatives to combat these barriers. The study findings specify that the "financial barrier" is the top-ranked barrier among the main categories, followed by technical, socio-cultural, institutional and administrative, and environmental barriers. The overall ranking shows that the "high starting price tag" is ranked first among all sub-barriers in all categories. It has been proposed that "appropriate financial incentives" and "promotion of customized technology" would be feasible alternative solutions to combat the issues. Based on the research findings, some policy recommendations were suggested for biogas uptake in Pakistan. This study may assist policymakers, stakeholders, and government institutions in accelerating the potential of biogas energy to alleviate energy poverty in rural areas of Pakistan.

Managing household income and antiretroviral therapy adherence among people living with HIV in a low-income setting: a qualitative data from the HPTN 071 (PopART) trial in South Africa.

BACKGROUND: South Africa is reported to have the highest burden of HIV with an estimated 8.2 million people living with HIV (PLHIV) in 2021- despite adopting the World Health Organisation (WHO) universal HIV test and treat (UTT) recommendations in 2016. As of 2021, only an estimated 67% (5.5 million) of all PLHIV were accessing antiretroviral therapy (ART), as per recorded clinic appointments attendance. Studies in sub-Saharan Africa show that people living in low-income households experience multiple livelihood-related barriers to either accessing or adhering to HIV treatment including lack of resources to attend to facilities and food insecurity. We describe the interactions between managing household income and ART adherence for PLHIV in low-income urban and semi-urban settings in the Western Cape, South Africa. METHODS: We draw on qualitative data collected as part of the HPTN 071 (PopART) HIV prevention trial (2016 - 2018) to provide a detailed description of the interactions between household income and self-reported ART adherence (including accessing ART and the ability to consistently take ART as prescribed) for PLHIV in the Western Cape, South Africa. We included data from 21 PLHIV (10 men and 11 women aged between 18 and 70 years old) from 13 households. As part of the qualitative component, we submitted an amendment to the ethics to recruit and interview community members across age ranges. We purposefully sampled for diversity in terms of age, gender, and household composition. RESULTS: We found that the management of household income interacted with people's experiences of accessing and adhering to ART in diverse ways. Participants reported that ART adherence was not a linear process as it was influenced by income stability, changing household composition, and other financial considerations. Participants reported that they did not have a fixed way of managing income and that subsequently caused inconsistency in their ART adherence. Participants reported that they experienced disruptions in ART access and adherence due to competing household priorities. These included difficulties balancing between accessing care and/or going to work, as well as struggling to cover HIV care-related costs above other basic needs. CONCLUSION: Our analysis explored links between managing household income and ART adherence practices. We showed that these are complex and change over the course of treatment duration. We argued that mitigating negative impacts of income fluctuation and managing complex trade-offs in households be included in ART adherence support programmes.

Evaluating primary care networks in low-income and lower middle-income countries: a scoping review.

INTRODUCTION: Primary care networks (PCNs) are claimed to be an effective model to organise and deliver primary healthcare through collaborative relationships and effective coordination of primary care activities. Though increasingly implemented in different contexts, there is limited evidence on the effectiveness of PCNs in low-income and lower middle-income countries (LLMICs). OBJECTIVE: Our scoping review aims to understand how PCNs in LLMICs have been conceptualised, implemented and analysed in the literature and further explores the evidence of the effectiveness of these networks. METHODS: We structured our review using Arksey and O'Malley's framework for scoping reviews and recommendations by Levac et al. We also used the population, concept and context (PCC) guide of the Joanna Briggs Institute (JBI) methodology for scoping reviews to define the search strategy. The identified documents were then mapped, using Cunningham's evaluation framework for health networks, to understand how PCNs are conceived in LLMIC settings. RESULTS: We identified 20 documents describing PCNs in five LLMICs. The selected documents showed differing forms and complexities of networks, with a majority resourced by government, non-governmental and donor entities. Most networks were mandated, and established with defined goals, although these were not always understood by stakeholders. Unlike PCNs in developed settings, the scoping review did not identify integration of care as a major goal for the establishment of PCNs in LLMICs. Network evaluation relationships, outputs and outcomes also varied across the five networks in the identified documents, and perceptions of effectiveness differed across stakeholder groups. CONCLUSION: PCNs in LLMICs benefit from clearly stated goals and measurable outcomes, which facilitates evaluation. In order to maximise the benefits, careful attention to the aspects of network design and operation is required. Future research work could shed light on some of the missing pieces of evidence on their effectiveness by, for example, considering differential consequences of modes of network establishment and operation, including unintended consequences in the systems within which they reside, and evaluating long-term implications.

The Indivisibility of Parental and Child Mental Health and Why Poverty Matters.

PURPOSE: To ascertain to what extent parental and children's mental health wellbeing are inter-related over time. METHODS: We used a birth cohort study of 5,217 children in Scotland followed up from birth to adolescence. We fitted a Random Intercept Cross-lagged Panel Model for parental mental health and children's conduct problems and emotional symptoms. We included longitudinal patterns of poverty as the main covariate and some demographic control variables. RESULTS: The effects of parental mental health and child conduct problems and emotional symptoms on one another are roughly equal in early childhood. At younger ages, parents with poorer mental health tend to negatively affect their children's conduct and the conduct problems of a child seem to impact negatively on their parents' mental health. At older ages, it is children's emotional symptoms, but not conduct problems, that tend to have a reciprocal effect on parental mental health. Regarding structural inequalities, the effect of poverty on parents' and children's mental health is categorically the largest and continues to accrue throughout the whole period, intensifying mental health problems for both parents and children over time. DISCUSSION: Children's and parents' wellbeing is a bidirectional process. This interdependency needs to be acknowledged and addressed in policy. To foster children's wellbeing, we also need to foster parents' wellbeing. Furthermore, all interventions that address mental health and wellbeing in parents and children and that do not also tackle structural inequalities, such as poverty, will have limited success.