Prevalence of tuberculosis in homes for the aged and orphanages of a district in Kerala, India

BACKGROUND

India accounts for one fourth of the TB burden globally. One of the objectives of the National Strategic Plan is to achieve 90% notification rate of all TB cases. Screening of high risk groups is one of the important components towards achieving this objective. Inmates of homes for the aged and orphanages are at higher risk of having TB infection and disease. Hence this study was conducted with the objective of identifying the prevalence of TB among inmates of homes for the aged and orphanages.

METHODS

A cross sectional study was done in homes for the aged and orphanages of Kollam district of Kerala in India. Sample size was estimated as 466. Cluster sampling using probability proportionate to size was used. There were 32 homes for the aged, from which 5 were selected. Out of 43 orphanages 8 were selected. Inmates were screened using a questionnaire. Those with any of the symptoms suggestive of TB were examined by a pulmonologist in a camp conducted at the institute. Those who needed further evaluation were brought to Government Medical College, Kollam/other nearest government health setting. All those who were detected to be having tuberculosis, were guided and given the care as per the NTEP treatment protocol. Permission was taken from the Collector of Kollam district. Informed written consent from the study subjects/legally accepted representative and assent were taken.

RESULTS

533 inmates were assessed from homes for the aged. The mean age was 56.70 (SD - 17.40). Five new TB patients were identified during the study. Of this three patients had extra-pulmonary and two were pulmonary TB. Eight patients were receiving treatment for TB at the time of study already, seven of which were pulmonary and one was extra-pulmonary. So the prevalence of TB in homes for the aged was 13/533 ie 2.43% (95%CI - 1.36 to 4.03%) or 2430/lakh. A higher percentage of inmates with tuberculosis were females, stayed in dormitory, had only primary education, had history of contact with TB and were undernourished compared to inmates without tuberculosis. We screened 478 children in orphanages of Kollam district. There were no children less than 5 years. Most of the children were in the age group of 10-15 years (62.1%). Nine children (1.9%) had history of contact with TB. One child had a previous history of TB. There was only one child who was suspected to have Tuberculosis, She was evaluated by a pediatrician and Tuberculosis was ruled out.

CONCLUSION

The prevalence of TB in inmates of homes for the aged is much higher than the general population. This highlights the need for a more active case detection in such institutions, especially in the context of the country marching towards TB elimination. The absence of tuberculosis among children in orphanages is a positive indicator that the community is moving in the direction of TB elimination.

Healthcare Service Needs of Orphans and Vulnerable Children in Orphanages and Barriers Caregivers face in meeting their Healthcare Service Needs: A Mixed Method Research

Poor health and well-being among orphans and vulnerable children (OVC) in orphanages has been documented in literature, and evidence has shown an association between access to healthcare and well-being among this population. This study assessed the healthcare service needs of OVC and explored the barriers their caregivers face in meeting their healthcare service needs using a mixed method research approach. The study utilized a multi-stage sampling technique in selecting 384 OVC and 14 caregivers that participated in the study. Data were collected using pre-tested questionnaire and interview guide. The quantitative data were analyzed using Statistical Product and Service Solutions (SPSS) version 23, while the qualitative data were analyzed using thematic and content analysis. The result of the study shows that regular health assessment while in the orphanage tops the list of health services needed by OVC; this was followed by health assessment before or during admission into orphanages and facility visits for management of common illness by health professionals while health education for the children and caregivers ranked third. Mental healthcare was the least need reported by the children. From the caregivers' perspectives, financial, structural and psychological barriers emerged as major themes for barriers faced in meeting the healthcare service needs of OVC. The study concluded that OVC are mainly in need of regular health assessment and treatment of common ailments during facility visits by health professionals. The study further shows that caregivers face significant barriers in meeting the healthcare service needs of OVC.

Feasibility of Developing Audiovisual Material for Training Needs in a Vietnam Orphanage: A Mixed-Method Design

Disabled children living in orphanages in low-income countries may not have access to the therapy they need. The COVID-19 pandemic has complicated the situation dramatically, making online training activities a possible innovative option to meet the real needs of local staff. This study aimed to detect the training needs of the local staff of an orphanage in Vietnam, as well as develop an audiovisual training material and measure its feasibility. Training needs were identified through a focus group carried out by the volunteers of Fisios Mundi, a nongovernmental organization. The audiovisual training material was developed to meet these specific needs. Lastly, its feasibility was evaluated, in terms of both content and format, through an ad hoc questionnaire. Nine volunteers participated in the project. Twenty-four videos were created and structured around five themes. This study expands the body of knowledge on how an international cooperation project can be developed in a pandemic situation. The audiovisual training material content and format created in this project was considered by the volunteers as very feasible and useful for training the staff of a Vietnamese orphanage.

A comparison of caries experience among orphanage children with non-orphans attending government school of indore city

Introduction

Oral health is an imperative to general health. It is important in many aspects of child development, as poor oral health can lead to problems with nutrition, speech development and self-esteem. Children living in orphanage are considered vulnerable to oral diseases.

Objective

To identify and compare the caries experience of children between the ages of 6 and 15 living in orphanages with children attending school in the city of Indore.

Methods

A descriptive cross-sectional study was conducted among 6-15 years aged orphanage children and children studying in schools located in the same geographical area of the Indore city. A total of 200 children in each group were taken under the study. The data collected were oral hygiene practice and dentition status on WHO form 2013 for adults. The data was then analysed to determine mean DMFT and deft score.

Results

A statistically significant (p=0.001) difference in mean DMFT between orphans and non-orphans was observed. The decayed and missing component shows a statistically significant (p=0.001) difference between the orphans and non-orphans. For the primary dentition, the results show that the mean deft of orphans (0.28±0.84) was significantly higher (p=0.001) than non-orphans.

Conclusions

Based on the results of the present study, it can be concluded that the dental caries experience of orphans living in government-funded orphanage homes was found to be better than non-orphans studying in government school.

Severe deprivation in early childhood leads to permanent growth stunting: Longitudinal analysis of height trajectories from childhood-to-adulthood

BACKGROUND

Childhood institutional deprivation is associated with growth stunting in childhood but long-term effects in adulthood remain uncertain.

OBJECTIVE

To examine the impact of global institutional deprivation experienced in early childhood on subsequent growth with a special focus on final adult height and puberty timing.

PARTICIPANTS & SETTING

The study was originally set in the UK, though some adoptive families lived abroad by the time of the adult follow up. 165 individuals adopted by UK families before 43 months of age from Romanian orphanages after the fall of the Ceaușescu regime in the early 1990's were compared to 51 non-deprived UK adoptees, adopted before the age of 6 months.

METHODS

The English and Romanian Adoptees (ERA) study is a 20-year longitudinal natural experiment on the effects of institutional deprivation on development. Key growth milestones were extracted from growth curve modelling of height data collected at ages 4, 6, 11, 15 and 23 years using a Bayesian approach to fit the JPA2 model.

RESULTS

Deprivation effects on height were present at the take-off point of accelerating adolescent growth and persisted into adulthood - the largest effects being for individuals who experienced over six months of deprivation. Deprivation was associated with earlier take-off and achievement of peak height velocity of adolescent growth acceleration - an effect driven largely by females' data and correlated with parent ratings of pubertal development.

CONCLUSIONS

Early deprivation appears to reset tempo of growth early in development leading to permanent growth stunting in adulthood and accelerated onset of puberty, specifically in females.

[Pupil Mariela, what do an Orphanage and a Hospital have in common?]

In Argentina, the National Mental Health Law (No. 26.657), from 2010, indicates that a specific budget is available to carry out particularly significant changes in the institutions where patients are admitted for mental health reasons. Voluntary or involuntary hospitalization in general hospitals is promoted throughout the country, while the closure of specialized mental health hospitals is anticipated. However, some demographic characteristics and the marked lack of accessibility to specialized resources throughout the country allow to locate a well-founded doubt to said proposal, even if the indicated resources were available and even more so, if it is intended to preserve the valuable rights that are in the spirit of the Law. Especially with regard to clinically involuntary hospitalizations outside the big cities. This article aims to illustrate and substantiate this position clinically -with the case of the girl Mariela-, in relation to mental health patients of all ages and to criticize this aspect of the Law, pointing out the risk for users of not creating increasingly complex public mental health systems accessible to the entire population of the country.

What was learned from studying the effects of early institutional deprivation

The effect of experiences in infancy on human development is a central question in developmental science. Children raised in orphanage-like institutions for their first year or so of life and then adopted into well-resourced and supportive families provide a lens on the long-term effects of early deprivation and the capacity of children to recover from this type of early adversity. While it is challenging to identify cause-and-effect relations in the study of previously institutionalized individuals, finding results that are consistent with animal experimental studies and the one randomized study of removal from institutional care support the conclusion that many of the outcomes for these children were induced by early institutional deprivation. This review examines the behavioral and neural evidence for altered executive function, declarative memory, affective disorders, reward processing, reactivity to threat, risk-taking and sensation-seeking. We then provide a brief overview of the neurobiological mechanisms that may transduce early institutional experiences into effects on brain and behavior. In addition, we discuss implications for policy and practice.

Responding to orphanage trafficking from an information gathering perspective

Estimates suggest that close to 3 million institutionalized children internationally have some family to whom they could go home. A proportion of these children is recruited from their communities under false pretenses and has false documentation that describes them as legal orphans. The orphanages where they live exploit them on the basis of their orphanhood. These children are known as paper orphans. The aim of the current article is to provide a profile of their origins and networks based on current available evidence, from an investigative interviewing perspective. Increased discussion and research of this problem will assist in supporting efforts towards reunification of children with families, investigations by law enforcement into orphanages, and successful prosecution of orphanage trafficking. The article provides an overview of the orphanage trafficking context, followed by a comparison of orphanage trafficking victims with other child trafficking victims from the perspective of investigative needs. Investigative needs are outlined with respect to two primary groups who would interview paper orphans and other involved parties (e.g., birth parents, orphanage staff)-law enforcement and reunification officers. In the final section of the article, we encourage further research on orphanage trafficking and provide initial guidance for interviewing in this unique context. This paper serves as a step to raise further awareness of paper orphans, orphanage trafficking, and the specific characteristics of their cases that affect research and planning into how to identify and interview them and others involved.

Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

IMPORTANCE

In 2015, there were nearly 140 million orphaned children globally, particularly in low- and middle-income regions, and millions more for whom the street is central to their everyday lives. A total of 16.6 million children were orphaned because of deaths associated with HIV/AIDS, of whom 90% live in sub-Saharan Africa. Although most orphaned and separated children and adolescents in this region are cared for by extended family, the large number of children requiring care has produced a proliferation of institutional care. Few studies have investigated the association between care environment and physical health among orphaned and separated youths in sub-Saharan Africa.

OBJECTIVE

To examine the association of care environment with incident HIV and death among orphaned and separated children and adolescents who were living in charitable children's institutions, family-based settings, and street settings in western Kenya over almost 10 years.

DESIGN, SETTING, AND PARTICIPANTS

The Orphaned and Separated Children's Assessments Related to Their Health and Well-Being (OSCAR) project was an observational prospective cohort study conducted in Uasin Gishu County, Kenya. The cohort comprised 2551 orphaned, separated, and street-connected children from communities within 8 administrative locations, which included 300 randomly selected households (family-based settings) caring for children who were orphaned from all causes, 19 charitable children's institutions (institutional settings), and a convenience sample of 100 children who were practicing self-care on the streets (street settings). Participants were enrolled from May 31, 2010, to April 24, 2013, and were followed up until November 30, 2019.

EXPOSURES

Care environment (family-based, institutional, or street setting).

MAIN OUTCOMES AND MEASURES

Survival regression models were used to investigate the association between care environment and incident HIV, death, and time to incident HIV or death.

RESULTS

Among 2551 participants, 1230 youths were living in family-based settings, 1230 were living in institutional settings, and 91 were living in street settings. Overall, 1321 participants (51.8%) were male, with a mean (SD) age at baseline of 10.4 (4.8) years. Most participants who were living in institutional (1047 of 1230 youths [85.1%]) or street (71 of 91 youths [78.0%]) settings were double orphaned (ie, both parents had died). A total of 59 participants acquired HIV infection or died during the study period. After adjusting for sex, age, and baseline HIV status, living in a charitable children's institution was not associated with death (adjusted hazard ratio [AHR], 0.26; 95% CI, 0.07-1.02) or incident HIV (AHR, 1.49; 95% CI, 0.46-4.83). Compared with living in a family-based setting, living in a street setting was associated with death (AHR, 5.46; 95% CI, 2.30-12.94), incident HIV (AHR, 17.31; 95% CI, 5.85-51.25), and time to incident HIV or death (AHR, 7.82; 95% CI, 3.48-17.55).

CONCLUSIONS AND RELEVANCE

In this study, after adjusting for potential confounders, no association was found between care environment and HIV incidence or death among youths living in institutional vs family-based settings. However, living in a street setting vs a family-based setting was associated with both HIV incidence and death. This study's findings suggest that strengthening of child protection systems and greater investment in evidence-based family support systems that improve child and adolescent health and prevent youth migration to the street are needed for safe and beneficial deinstitutionalization to be implemented at scale.

Decrease of respiratory diseases in one social children welfare institute in Shanxi Province during COVID-19

Background

To assess the impact of disinfection measures on the incidence of common diseases in children welfare institute during the epidemic of Corona Virus Disease 2019 (COVID-19), and provide a basis for the daily disinfection management of children welfare institute.

Methods

This study surveyed and analyzed common diseases among children under the age of 14 in one social children welfare institute in Shanxi Province from January to May in 2018–2020 by the year-on-year method.

Results

The prevalence rate of respiratory diseases in 2020 was a significantly negative growth compared with 2018 and 2019. There was no obvious pattern of changes in digestive diseases group.

Conclusion

In view of the above anti-epidemic measures, it indicates that the children gathering institutions should strengthen effective personal protection and public health management to reduce infectious disease among children.

Selective inflammatory propensities in adopted adolescents institutionalized as infants

This study examined whether early life adversity (ELA) limited to infancy was associated with an increase in circulating levels of proinflammatory cytokines and cellular cytokine responses to three stimulants [lipopolysaccharide (LPS), phytohemagglutinin (PHA), and phorbol myristate acetate plus ionomycin (PMA/IO)]. Participants were previously institutionalized (PI) youth (N = 45, 56 % female) who had spent their first years in institutional care (e.g., orphanages, baby homes) before being adopted into well-resourced homes (median age at adoption = 13 mos) and non-adopted comparisons (NA; N = 38, 55 % female). Their age range was 13.3-21.2 years (M = 16.3 years). This analysis followed up an earlier report on these youth (Reid et al., 2019a) that identified an increase in terminally differentiated CD8 + CD57 T cells among the PI relative to the NA youth. Cytokine levels in circulation were not highly correlated and thus examined separately. PI youth had higher circulating levels of Tumor Necrosis Factor-alpha (TNFα), but not Interleukin-1β (IL-1β) or Interleukin-6 (IL-6). Cytokine responses to in vitro activation within each stimulant condition were highly correlated and were thus combined to generate an index of the inflammatory reaction to each stimulant. Using Multivariate Analysis of Covariance, there was a highly significant multivariate effect of group, which was carried primarily by the PMA/IO condition, with PI youth exhibiting a larger inflammatory response than NA youth. Tests of mediation showed that both the early rearing effects on circulating TNFα and the composite inflammatory index of PMA/IO responsiveness were mediated in the statistical model by the percentage of CD8 + CD57+ TEMRA cells in circulation, a marker of replicative senescence in T cells. Sex differences were also found in circulating levels of IL-6 and TNFα, with males having higher levels than females.

Prevention and control of COVID-19 in nursing homes, orphanages, and prisons

As the number of Coronavirus Disease (2019) (COVID-19) cases increase globally, countries are taking more aggressive preventive measures against this pandemic. Transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) include droplet and contact transmissions. There are also evidence of transmission through aerosol generating procedures (AGP) in specific circumstances and settings. Institutionalized populations without mobility and living in close proximity with unavoidable contact are especially vulnerable to higher risks of COVID-19 infection, such as the elderly in nursing homes, children in orphanages, and inmates in prisons. In these places, higher prevention and control measures are needed. In this study, we proposed prevention and control strategies for these facilities and provided practical guidance for general measures, health management, personal protection measures, and prevention measures in nursing homes, orphanages, and prisons, respectively.

A Systematic Review of the Outcome of Child Abuse in Long-Term Care

The aim of the systematic review described in this article was to determine the outcome of child maltreatment in long-term childcare and the scope of the evidence base in this area. Searches of 10 databases were conducted. Forty-nine documents describing 21 primary studies and 25 secondary studies were selected for review. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. Participants in the 21 primary studies included 3,856 abuse survivors and 1,577 nonabused controls. In six primary studies, survivors were under 18 years, and participants in the remaining primary studies were adults with a mean age of 54 years. Reviewed studies were conducted in the United Kingdom, the United States, Finland, Romania, Tanzania, Canada, Ireland, Australia, the Netherlands, Germany, Austria, and Switzerland. Participants were abused in religious and nonreligious residential care centers and foster care. There were significant associations between the experience of child abuse in long-term care and adjustment across the life span in the domains of mental health, physical health, and psychosocial adjustment. Evidence-based trauma-focused treatment should be offered to child abuse survivors. Future research in this area should prioritize longitudinal studies.

The home-self and out-of-home placement: The home concept among adults educated in their childhood at a residential care setting

This study proposes to examine the phenomenology of home among 46 Israeli adults who had been deemed "at-risk children" and removed from their home by court order in their childhood on the grounds of parental mistreatments, such as abuse and neglect. For a comprehensive understanding of the long-term impact of out-of-home placement, adults of different ages were interviewed. The research findings reflect the close connection between home concept and self-concept, a long-standing internal dialectic between the home that did not exist and the home (as an internal-emotional space) that the adults would have liked to have. Furthermore, our findings reveal what we term the life career of the home concept, that is, the various diachronic phenomenological definitions that adults grant to the home-self in childhood, anchored in the family home, during their time in a residential care setting, their adolescence, and their adulthood. The discussion addresses the unique self-concept and home concept of care leavers.

A Systematic Review of Reviews of the Outcome of Severe Neglect in Underresourced Childcare Institutions

The aim of the systematic review described in this article was to determine the outcomes for individuals exposed to severe neglect in congregate care institutions such as orphanages. In this context, severe neglect refers to failure to meet children's basic physical, developmental, and emotional needs due to inadequate resources. In this systematic review of previous systematic reviews and meta-analyses, searches of 10 databases were conducted, 18 papers that met inclusion and exclusion criteria were selected for review, their quality was assessed, and data were extracted and synthesized. The 550 primary studies included in the 18 systematic reviews and meta-analyses were relatively well designed, allowing confidence to be placed in their results. Severe neglect was associated with a wide range of problems in the domains of physical development, cognitive development, attachment, and mental health. The severity of adverse outcomes was partly influenced by the duration and severity of deprivation and a constellation of risk and protective factors. Prevention policies should aim to eliminate large underresourced congregate care institutions for infants. In taking steps toward this, policies should aim to adequately resource congregate care institutions to meet children's developmental needs for nutrition, stimulation, and attachment to a stable primary caregiver with adequate parenting skills and training. Early placement in adoptive or foster families, with access to routine physical and mental health-care service available in developed countries, is the most viable effective intervention for child survivors of severe neglect.

Global deficits in executive functioning are transdiagnostic mediators between severe childhood neglect and psychopathology in adolescence

BACKGROUND

Children reared in institutions experience profound deprivation that is associated with both heightened levels of psychopathology and deficits in executive functioning (EF). It is unclear whether deficits in EF among institutionally-reared children serve as a vulnerability factor that increases risk for later psychopathology. It is also unclear whether this putative association between EF and psychopathology is transdiagnostic (i.e. cuts across domains of psychopathology), or specific to a given syndrome. Thus, we examined whether global deficits in EF mediate the association between severe childhood neglect and general v. specific psychopathology in adolescence.

METHODS

The sample consisted of 188 children from the Bucharest Early Intervention Project, a longitudinal study examining the brain and behavioral development of children reared in Romanian institutions and a comparison group of never-institutionalized children. EF was assessed at age 8, 12, and 16 using a well-validated measure of neuropsychological functioning. Psychopathology was measured as general (P) and specific internalizing (INT) and externalizing (EXT) factors at age 12 and 16.

RESULTS

Institutionally-reared children had lower global EF and higher general psychopathology (P) at all ages compared to never-institutionalized children. Longitudinal path analysis revealed that the effect of institutionalization on P at age 16 operated indirectly through poorer EF from ages 8 to 12. No indirect effects involving EF were observed for INT or EXT at age 16.

CONCLUSIONS

We conclude that stable, global deficits in EF serve as a cognitive endophenotype that increases transdiagnostic vulnerability to psychopathology in adolescence among those who have experienced profound early neglect.

Prevalence and number of children living in institutional care: global, regional, and country estimates

BACKGROUND

Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care.

METHODS

In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE).

FINDINGS

Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3·18 million to 9·42 million children, with a median estimate of 5·37 million. When selecting the method with the lowest RMSE, the global estimate was 4·21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7·52 (95% CI 7·48-7·56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1·13 million), followed by Europe and central Asia (1·01 million), east Asia and Pacific (0·78 million), sub-Saharan Africa (0·65 million), Middle East and North Africa (0·30 million), Latin America and the Caribbean (0·23 million), and North America (0·09 million). North America consistently had the lowest estimates among all regions.

INTERPRETATION

Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations.

FUNDING

Lumos Foundation.

Improving emotional health and self-esteem of Malaysian adolescents living in orphanages through Life Skills Education program: A multi-centre randomized control trial

Generally speaking, institutionalised children and adolescents are at greatly increased risk of serious mental and behavioural problems, up to seven times more than their peers. Life skills- based interventions using peer enforcement have been introduced as effective program to improve adolescents' emotional and behavioral health. Therefore, the current randomized control study aimed to determine, if a life skills-based intervention could improve the emotional health and self-esteem among Malaysian adolescents in orphanages. Overall, 271 male and female adolescents (13-18 years old) from 8 orphanages in Klang valley, Malaysia participated in the study. Comparing the intervention to control group within 3 points of time, the finding of the study showed that immediately after finishing the interventional sessions (post-test), the mean scores of depression (F = 33.80, P<0.001, η2 = 0.11), anxiety (F = 6.28, P = 0.01, η2 = 0.02), stress (F = 32.05, P<0.001, η2 = 0.11) and self-esteem (F = 54.68, P<0.001, η2 = 0.17) were significantly decreased compared to the pre-test values. However, there was no significant difference between two groups in the depression mean scores (F = 2.33, P = 0.13). Regarding to the interaction between group and test a significant change was seen in the mean score of all 4 variables including depression (F = 31.04, P<0.001, η2 = 0.10), anxiety (F = 14.21, P<0.001, η2 = 0.05), stress (F = 15.67, P<0.001, η2 = 0.06) and self-esteem (F = 13.29, P<0.001, η2 = 0.05). Furthermore, except depression (Δmean = -1.37, P<0.001), no significant difference was seen between study variables' mean scores between post- and follow-up test (p>0.001). These results provide preliminary approve for LSE to enhance emotional health and self-esteem in orphanages.

Comparing Long-Term Placement Outcomes of Residential and Family Foster Care: A Meta-Analysis

This study presents findings from three separate meta-analyses investigating differences between children placed in residential care and in family foster care with regard to three outcomes: internalizing behaviors, externalizing behaviors, and perception of care. Based on publications from the last 20 years, a total of 23 studies were included. The total sample consisted of 13,630 children in care, with 7,469 from foster care and 6,161 from residential care. The results from this study indicated that children in foster care had consistently better experiences and less problems across the three outcomes as compared to children in residential care. Analyses did not reveal evidence of publication bias, and sensitivity analyses also suggested that results were not influenced by individual studies. Additionally, moderation analyses revealed that the differences between foster and residential care could vary depending on certain factors such as the publication year, the gross domestic product of the country, and the length of care. The implications of differences in outcomes between the two placements are discussed.

Externalizing trajectories predict elevated inflammation among adolescents exposed to early institutional rearing: A randomized clinical trial

BACKGROUND

There has been mounting interest in the pathophysiological relation between inflammation and psychopathology. In this paper, we examined associations between internalizing and externalizing psychopathology and inflammation in adolescents with a history of severe psychosocial deprivation and children reared in typical family contexts.

METHOD

The Bucharest Early Intervention Project is a longitudinal randomized trial of high-quality foster care as an alternative to institutional care. This report is based on 56 institutionalized children randomized to care as usual, 59 institutionalized children randomized to foster care, and 101 never institutionalized children who were recruited as an in-country comparison sample. Externalizing and internalizing behaviors were reported by parents and teachers at ages 8, 12, and 16. At age 16, C-reactive protein (CRP) was derived from blood spots in a subset of participants (n = 127). Multiple-group latent growth curve models were used to examine externalizing and internalizing trajectories and their associations with CRP.

RESULTS

Among children assigned to care as usual, higher levels of externalizing behaviors at age 8, as well as smaller decreases in these behaviors from 8 to 16 years predicted higher levels of CRP at age 16. In the same group of children, higher internalizing behaviors at age 8, but not the rate of change in these behaviors, also predicted higher levels of CRP. In contrast, these relations were not observed in the children assigned to foster care and never institutionalized controls.

CONCLUSIONS

Early institutional rearing is associated with a coupling of psychopathology and inflammation, whereas early placement into foster care buffers against these risks. These findings have implications for promoting healthy mental and physical development amongst institutionalized children.

Survivors of institutional abuse in long-term child care in Scotland

BACKGROUND

The Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland.

OBJECTIVE

To profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes.

PARTICIPANTS AND SETTING

225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI.

METHODS

Data were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements.

RESULTS

Survivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes.

CONCLUSIONS

Evidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.

Effects of early social deprivation on epigenetic statuses and adaptive behavior of young children: A study based on a cohort of institutionalized infants and toddlers

Early social deprivation (i.e., an insufficiency or lack of parental care) has been identified as a significant adverse early experience that may affect multiple facets of child development and cause long-term outcomes in physical and mental health, cognition and behavior. Current research provides growing evidence that epigenetic reprogramming may be a mechanism modulating these effects of early adversities. This work aimed to investigate the impact of early institutionalization—the immersion in an extreme socially depriving environment in humans—on the epigenome and adaptive behavior of young children up to 4 years of age. We conducted a cross-sectional study involving two comparison groups: 29 children raised in orphanages and 29 children raised in biological families. Genome-wide DNA methylation profiles of blood cells were obtained using the Illumina MethylationEPIC array; the level of child adaptive functioning was assessed using the Vineland Adaptive Behavior Scales-II. In comparison to children raised in families, children residing in orphanages had both statistically significant deficits in multiple adaptive behavior domains and statistically significant differences in DNA methylation states. Moreover, some of these methylation states may directly modulate the behavioral deficits; according to preliminary estimates, about 7–14% of the deviation of adaptive behavior between groups of children may be determined by their difference in DNA methylation profiles. The duration of institutionalization had a significant impact on both the adaptive level and DNA methylation status of institutionalized children.

Effects of early adversity on the brain: Larger-volume anterior cingulate cortex in AIDS orphans

Multiple studies have revealed that adolescent AIDS orphans have more psychosocial problems than healthy adolescents. However, little is known about whether and how the brain structures of adolescent AIDS orphans differ from those of healthy adolescents. Here, we used magnetic resonance imaging to compare adolescent AIDS orphans reared in institutions (N = 20) with a sex- and age-matched group of healthy adolescents reared in families (N = 20) in China using a voxel-based morphometry analysis. First, we found that both total gray- and white-matter volumes did not differ between groups. Second, after correcting for age, sex, and total gray-matter volume, the AIDS orphan group demonstrated smaller hippocampal volumes, larger anterior cingulate cortex (ACC) volumes, and no differences in the amygdala. Third, a whole-brain analysis identified higher gray-matter volume of the ACC in the AIDS orphan group than in the control group. The preliminary findings of this study highlight the need for future research to confirm the sensitivity of the hippocampus and ACC to early adversity.

Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial

OBJECTIVES

To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence.

STUDY DESIGN

This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized control children living in birth families (family care group) in Bucharest, Romania. Children were followed from baseline (21 months, range 5-31) through age 12 years for caregiving disruptions and growth trajectories and through age 14 years for pubertal development.

RESULTS

Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group. Tanner development was delayed in institutionalized group boys compared with foster care group and family care group boys at 12 but not 14 years. There were no differences in Tanner development and age of menarche among foster care group, institutionalized group, and family care group girls at ages 12 and 14 years. More disruptions in caregiving between 30 months and 12 years moderated decreases in growth rates of height in foster care group and weight in foster care group and institutionalized group across age. institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 vs institutionalized group and foster care group boys with <2 disruptions. foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 vs foster care group girls with <2 disruptions. Age of menarche was not affected by caregiving disruptions.

CONCLUSIONS

For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental.

TRIAL REGISTRATION

clinicaltrials.gov: NCT00747396.

The slope of cortisol from awakening to 30 min post-wake in post-institutionalized children and early adolescents

This study examined the association between early life adversity, in the form of early rearing in an institution (orphanage), and the slope of cortisol in the first thirty minutes after waking in 277 children, aged 7 through 15 years old, who had either been adopted between 6 and 60 months of age into well-resourced homes in the United States or born into similar homes. The adopted youth were divided at the median (age 16 months) into those adopted earlier (earlier-adopted, EA) and later (later-adopted, LA). The purpose of this study was to examine the post-waking slope in cortisol in post-institutionalized youth, predicting that it would be blunted, especially in later-adopted youth, when compared to the non-adopted (NA) youth. A secondary goal was to examine whether there would be some evidence of less blunting of the first 30 min of the cortisol awakening response among the children further along in pubertal development (i.e., Pubertal Recalibration Hypothesis). Pubertal stage was determined by nurse exam. Salivary cortisol was assessed at 0 and 30-min post-awakening on three days. The results showed that LA children had a blunted wake-30 min cortisol slope relative to NA and EA children. Neither the age by group nor pubertal stage by group analyses were significant. However, the majority of the sample were in early stages of puberty (56% in stages 1 & 2), thus the power was low for detecting such an interaction. This is the first year of a cohort-sequential longitudinal study examining early experiences and pubertal influences on the HPA axis, so it will be important to re-examine this question as the sample ages.

The effect of structured education on self-esteem and the suicide probability of male adolescents living in orphanages

AIM

This study aims to observe the effect of structured education provided to improve self-esteem and hope on the self-esteem and the suicide probability of male adolescents living in orphanages.

METHOD

The study was conducted as an intervention study with pretest-posttest follow-up design. The study sample consisted of 30 adolescents living in the Ağrı Orphanage for Boys. Sessions of group education were conducted twice a week for 8 weeks, giving a total of 16 sessions; each session lasted for 60 to 90 minutes. Data were collected using a Personal Information Form, Rosenberg Self-Esteem Scale (RSES), and the Suicide Probability Scale (SPS). A repeated measures analysis of variance was used for data analysis. Three measurements were performed: the first at the pretest stage; the second at the posttest stage, and the third six weeks after the completion of the program.

FINDINGS

The SPS total scores and subscale scores of the study group were found to be statistically significantly lower in the second and the third measurements than in the first measurement. The RSES scores were found to be statistically significantly higher in the second and the third measurements than in the first measurement.

DISCUSSION

Because this group of adolescents is deemed at risk, it was suggested that the self-esteem and the suicide probability of the adolescents living in orphanages should be analyzed in more detail, and that preventive approaches should be considered.

Children and adolescents in institutional care versus traditional families: a quality of life comparison in Japan

BACKGROUND

A good quality of life (QOL) is important for the physical and mental well-being of all children. However, young people who live in an institutional setting may face different challenges than those who are raised in a traditional family. While a few quantitative studies of institutionalized children's QOL have been conducted, no research has investigated the QOL of young people living in Children's Homes (CHs) in Japan. This research compared the QOL of children and adolescents in Japan who live in CHs with that of children and adolescents living in traditional families.

METHODS

A cross-sectional study was conducted in July 2016 with 204 students (grades three through nine), 47 of whom lived in a CH, and 157 of whom lived in a traditional family. Ages ranged from 8 to 15 years (CH: 55.8% Female, 44.2% Male; Traditional: 54.1% Female, 45.9% Male). Participants answered the kid-Kinder Lebensqualität Fragebogen (Translated from German: Children's quality of life questionnaire; KINDL®) Japanese Version, which covers six subscales of QOL; they filled in the questionnaires at home. Analysis of variance was used to compare QOL between the two samples.

RESULTS

The total QOL score for all students (combined elementary school students and junior high school students) from CHs was statistically significantly lower than that for students from traditional families. Scores for the subscales, emotional well-being and family, were also significantly lower for CH young people than for those in traditional families. While elementary pupils in CHs reported lower QOL than those in traditional families, no significant differences in QOL were seen between junior high school students from CHs and their peers from traditional families.

CONCLUSIONS

The findings presented support previous research showing that the QOL of elementary school students living in CHs is significantly lower than that of their peers in traditional families. However, this difference was not observed among junior high school students. This contrast suggests that QOL changes with age. Future research is needed to evaluate the determinants of QOL among all generations and family contexts.

Survival, Signaling, and Security: Foster Carers' and Residential Carers' Accounts of Self-Harming Practices Among Children and Young People in Care

Research on clinicians' interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals' narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of "looked-after"; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people's social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.

Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care

Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.

The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.

[PHYSICAL DEVELOPMENT OF CHILDREN IN ORPHANAGES]

Aim - to define the parameters of physical development of children in orphanages. 72 children (45 boys, 27 girls) without chronic debilitating diseases and condition aged from 1 to 6 years from Tbilisi and Makhinjauri orphanages (Georgia) were assessed. Height and weight of all subjects were measured and BMI, height SDS (standard deviation score) and weight SDS were calculated. Data were compared to the normal values (national data). The retardation of the physical development were seen along almost all findings. The significant differences regarding age and gender were not revealed. The most expressed tendency to delay was expressed in the height of boys, particularly aged 3-5 years. Our data confirm that institution upbringing has a negative impact on the growth of children of 1-6 years of age. In children aged from 1 to 6 years who are healthy but live in orphanages there is a marked tendency to lag behind in physical development, mainly in height. The above-mentioned confirms the opinion about negative impact of upbringing in orphanages on the physical development of children.

[Oral Health attitude and Practices among children in boys' orphanage of Rabat, Morocco]

INTRODUCTION

Orphanages are a high-risk group of oral health diseases. The aim of this study was to evaluate oral hygiene attitudes among orphans living in Al Akkari orphanage in Rabat, Morocco.

MATERIALS AND METHODS

cross sectional study was conducted among 165 orphans aged between 6 and 15 years-old at the orphanage Al Akkari in Rabat, between December 2012 and February 2013. The information collect was realized by direct questioning of all the residents. The questions were asked by a dentist and concerned the attitudes of the residents towards principles of oral hygiene, the possession of toothbrush and dentifrice, tooth brushing frequency and methods and the existence or not of a previous oral hygiene instruction was also reported. Seizure and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 13.0 software.

RESULTS

The results showed that 94.5 % of the orphans' children have a toothbrush and 90.2% among them have toothpaste. 98.2% of residents brushed their teeth and 83.3% of those who brushed their teeth do it regularly (daily). 49.4% of the orphans' children brushed their teeth vertically while 88.5% of them had already oral hygiene instructions.

DISCUSSION

Attitudes of resident concerning tooth brushing regularity and the used method remains largely insufficient even if the orphans were informed of the importance of oral hygiene.

Early Psychosocial Neglect Adversely Impacts Developmental Trajectories of Brain Oscillations and Their Interactions

Rhythmicity is a fundamental property of neural activity at multiple spatiotemporal scales, and associated oscillations represent a critical mechanism for communication and transmission of information across brain regions. During development, these oscillations evolve dynamically as a function of neural maturation and may be modulated by early experiences, positive and/or negative. This study investigated the impact of psychosocial deprivation associated with institutional rearing in early life and the effects of subsequent foster care intervention on developmental trajectories of neural oscillations and their cross-frequency correlations. Longitudinally acquired nontask EEGs from three cohorts of children from the Bucharest Early Intervention Project were analyzed. These included abandoned children initially reared in institutions and subsequently randomized to be placed in foster care or receive care as usual (prolonged institutional rearing) and a group of never-institutionalized children. Oscillation trajectories were estimated from 42 to 96 months, that is, 1-3 years after all children in the intervention arm of the study had been placed in foster care. Significant differences between groups were estimated for the amplitude trajectories of cognitive-related gamma, beta, alpha, and theta oscillations. Similar differences were identified as a function of time spent in institutions, suggesting that increased time spent in psychosocial neglect may have profound and widespread effects on brain activity. Significant group differences in cross-frequency coupling were estimated longitudinally between gamma and lower frequencies as well as alpha and lower frequencies. Lower cross-gamma coupling was estimated at 96 months in the group of children that remained in institutions at that age compared to the other two groups, suggesting potentially impaired communication between local and long-distance brain networks in these children. In contrast, higher cross-alpha coupling was estimated in this group compared to the other two groups at 96 months, suggesting impaired suppression of alpha-theta and alpha-delta activity, which has been associated with neuropsychiatric disorders. Age at foster care placement had a significant positive modulatory effect on alpha and beta trajectories and their mutual coupling, although by 96 months these trajectories remained distinct from those of never-institutionalized children. Overall, these findings suggest that early psychosocial neglect may profoundly impact neural maturation, particularly the evolution of neural oscillations and their interactions across a broad frequency range. These differences may result in widespread deficits across multiple cognitive domains.

[Brain Bioelectrical Activity in Early Childhood Specific for Children Living in Orphanages]

We investigated whether the electroencephalogram (EEG) during visual fixation in institutionalized children shows the altered oscillation properties. EEG was recorded in the "eyes open" situation with visual attention fixed on a cartoon in 51 2-3.5 years old children living in Simferopol orphanage, Crimea and in 53 age-matched children living in families. Oscillation properties were measured using the relative power (RP) indices of theta-, alpha-, beta- and gamma-rhythms. Institutionalized children showed higher RP of alpha rhythm in seven loci (frontal polar, anterior temporal, posterior temporal and left occipital derivations), lower RP of theta rhythm in eight loci (frontal polar, frontal, anterior temporal and posterior temporal derivations). In addition, RP of beta- and gamma-rhythms were decreased in the left anterior temporal area. These results suggest that institutionalized children show impaired development of CNS, in particular development of limbic system and neocortex, probably are caused by early social deprivation.

The science of early adversity: is there a role for large institutions in the care of vulnerable children?

It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.

A pilot project to improve the oral health of orphans and of the elderly in residential care in Constanta, Romania

AIM

A pilot project to improve the oral health of Romanian orphans and elderly people in residential homes.

MATERIAL AND METHODS

The orphanage and old persons' home were in Constanta. After training, 50 fifth-year dental students made 14 weekly residential home visits to improve carers' oral health knowledge and oral hygiene (OH) procedures and to monitor progress in one orphan and one old person. At baseline and after 14 weeks a local dental school staff member examined each orphan and old person's oral health using WHO (1997) criteria and the Simplified Oral Hygiene Index (OHI-S). The carers' knowledge of OH and attitudes to providing and the students' knowledge and attitudes were assessed at baseline and again after 14 weeks with a questionnaire.

RESULTS

All 56 orphans (mean age 9.6 years, mean DMFT 2.39) living in the home participated and their mean OHI-S improved (1.40 to 0.80, p < 0.0001). Fifty old people (mean age 75.9 years) participated, of whom 22 (44%) were edentulous. There was no significant improvement in mean OHI-S (p < 0.10). The carers' oral health knowledge improved (mean scores from 65 to 88, p < 0.001) as did their attitude score (p < 0.013). Students noted changes in their understanding of the needs of the carers, orphans and elderly people. Their perception of their capability to provide OH education or train others to do so, or their inclination to do so remained substantially unchanged.

CONCLUSIONS

This pilot study met its aims suggesting that with suitable management, senior dental students can play a significant role in residential homes for orphans and old people by training carers and improving the residents' oral hygiene. Further similar studies in other settings are indicated.

The development of a feeding, swallowing and oral care program using the PRECEDE-PROCEED model in an orphanage-hospital in Guatemala

PURPOSE

The purpose of this study was to evaluate a long-term on-going international academic service-learning (I-ASL) intervention. Its goal was to improve swallowing, feeding and oral care technique of medical staff in an orphanage in Guatemala to children who are medically complex and have special needs.

METHOD

The PRECEDE-PROCEED model was used as the conceptual framework of the program. Five major target areas were identified during the diagnosis, assessment, implementation and evaluation phases of the model: knowledge and skills, feeding equipment, feeding and oral care technique, positioning and communication. Verbal instruction, modelling and small group training was provided by the research team across all visits. A five-day intervention designed to increase feeders' knowledge of feeding and oral care technique, signs and symptoms and complications of dysphagia and to improve their feeding, positioning and oral care technique was implemented and evaluated.

RESULT

Statistical analyses showed significant increases in knowledge and appropriate feeding, positioning and oral care technique.

CONCLUSION

As a consequence of the intervention, a trusting and mutually supportive relationship was built between the I-ASL team and the host organization.

Social communication difficulties and autism in previously institutionalized children

OBJECTIVE

To determine the risk of difficulties with social communication and restricted/repetitive behaviors as well as the rate of autism in children institutionalized in early infancy and to assess the impact of a foster care intervention on ameliorating this risk.

METHOD

Children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to a care-as-usual group (institutional care, CAUG), or placed in family-centered foster care (FCG) as part of the Bucharest Early Intervention Project (BEIP). At approximately 10 years of age, the Social Communication Questionnaire (SCQ) was administered to caregivers of children in both groups as well as to parents of a typically developing community sample (Never-Institutionalized group [NIG]) residing in Bucharest, Romania. Children scoring ≥12 on the SCQ underwent clinical evaluation for autism spectrum disorder (ASD).

RESULTS

Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never-institutionalized children on all subdomains of the SCQ (all p < 0.001). Children in the FCG had significantly lower scores on the SCQ than children in the CAUG (p < .001), particularly in the reciprocal social interaction domain, indicating that the intervention reduced problems in social communication. Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.

CONCLUSION

Early institutional rearing was associated with an increased risk of social communication difficulties and ASD. A family-centered foster care intervention improved social communication skills.

Anthropometric assessment of the nutritional status of children and adolescents residing in selected Polish orphanages based on their energy intake and physical activity level

BACKGROUND

Actions to the prevention of overweight and obesity should be first addressed to the youngest population and their parents, guardians as well as teachers. The major objectives of prevention and treatment of overweight and obesity programme should be focused on modification of nutritional habits and promotion of physical activity.

OBJECTIVES

The aim of this study was to evaluate the nutritional status, intake of energy and macronutrients as well as the physical activity of students from orphanages in Krakow.

MATERIAL AND METHODS

Study was performed in 5 orphanages located in Krakow (Poland), which were under control of Social Welfare Centre in Krakow. The study involved 153 students, 67 girls and 86 boys, aged from 7 to 20 years. Nutritional status was assessed by anthropometric measurements. The protein and total fat content in diets was measured by chemical analyses and carbohydrates were calculated by difference. Physical activity level of children and adolescents was assessed by questionnaire.

RESULTS

Over 80% of boys and about 90% of girls had a normal body mass. Students have spent their free time on additional physical activity from 1h 34 min/day to 5 h 12 min/day. They also have spent their free time on sedentary activities on average 4 h/day. Daily diets of students did not met recommendations for energy, carbohydrates and fats. Intake of protein was too high and exceeded the estimated average requirement even over three times.

CONCLUSIONS

Despite the insufficient intake of fat and carbohydrates, students generally showed a proper BMI value. This suggests that excess intake of protein was used for maturation process and was additional source of energy. Reported additional physical activity was satisfactory.

Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving

BACKGROUND

To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit.

METHODS

An assessment was completed of 134 children between 1.5-12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move.

RESULTS

28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care.

CONCLUSIONS

These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.

[The placement courses and the subjective quality of life of 6- to 11-year-old children living in child welfare institutions]

BACKGROUND

Besides diseases, the concept of quality of life is increasingly used to account for the consequences of other vulnerability situations that may be encountered by individuals, including young children. However, very few studies have examined children's perception of their quality of life in the context of child welfare and protection, and they yielded mixed results.

OBJECTIVES

The objectives of this study were (1) to compare the subjective quality of life of children placed in institution with that of children living in their families, by controlling for child sex, age, socioeconomic and familial status, and (2) to examine its relations with their placement course in the child welfare system.

METHOD

The sample of this study was composed of 56 children aged 6 to 11, 28 of which were placed in a child welfare institution. Information about the placement course of institutionalized children was given by their social workers and the quality of life of all participants was assessed with the AUQUEI questionnaire. This self-report, which is based on children's conception of their quality of life, allows assessment of four distinct dimensions in addition to the overall score: leisure, performances, relations and family life, and separation.

RESULTS

According to the results, the quality of life of children placed in institutions did not differ from that of children living in their families. However, its perception was closely related to the placement course of institutionalized children in the child welfare system. Whereas maltreated children obtained lower overall and performance scores than their neglected peers, children placed in foster families before institution had a poorer perception of their quality of life in the domains of family life and separations.

DISCUSSION

These results are interpreted in light of attachment research and theory. Indeed, the relations between children's quality of life and their placement course could be explained by their high level of attachment disorganization. Finally, the results of this study suggested that children were well aware of their difficulties and that they can easily be identified by directly assessing the children's quality of life.

[Risk of introduction and spread of polioviruses in closed-type child-care facilities]

AIM

Compare frequency of isolation of polioviruses in children living in closed-type facilities (orphanages) before and after the change in poliomyelitis vaccination scheme.

MATERIALS AND METHODS

Feces samples of 207 children from 5 orphanages during immunization with oral poliomyelitis vaccine (OPV) and of 259 children from 4 orphanages during vaccination with inactivated poliomyelitis vaccine (IPV) were studied. Isolation and identification of polioviruses was carried out according to WHO recommendations.

RESULTS

In orphanages, where children were immunized with the oral vaccines, 21 polioviruses were isolated. In orphanages, where only inactivated vaccine was used, 10 polioviruses were isolated, the presence of polioviruses in these facilities is associated with their introduction from the outside. The percentage of poliovirus detection in children immunized with OPV was shown to be 16.9 ± 3.4% and was significantly higher than in children vaccinated with IPV (6.1 ± 1.9%). Polioviruses isolated from children immunized with OPV belonged to serotypes 1, 2 and 3 in 19.0, 14.3 and 66.7% of cases, respectively. Polioviruses detected in children immunized with IPV belonged to serotypes 1, 2 and 3 in 30, 40 and 30% of cases, respectively. All the isolated polioviruses turned out to be Sabin vaccine strains.

CONCLUSION

Implementation of strict prophylaxis measures in orphanages is necessary in order to prevent the possibility of introduction, transmission and circulation of polioviruses. Improvement of control in children from closed-type facilities will ensure maintenance of Russian Federation status as the country free of poliomyelitis.

Incidence and risk factors of Giardia duodenalis infection in an orphanage, Thailand

A cohort study was performed to evaluate the incidence and risk factors of Giardia duodenalis infection in an orphanage in suburban area outside Bangkok, central Thailand. Stool specimens were examined for the presence of G. duodenalis in January 2007, May 2007 and January 2008. Of 892 stool specimens from 481 individuals, simple wet preparation, PBS ethyl-acetate sedimentation and PCR amplification of the SSU-rRNA gene were performed to detect G. duodenalis. Using PCR of the glutamate dehydrogenase gene and sequence analysis, G. duodenalis assemblages were identified. Associated risk factors were analysed using Fisher's exact test which revealed significant infection of G. duodenalis in boys and specific rooms where orphans aged 25-48 months old lived. Genotypic characterization of G. duodenalis revealed that assemblage A subtype AII was the most predominant found in orphans living in the specific rooms, thus the transmission was likely to occur via person-to-person. Other modes of transmission were less likely to occur. This study showed that the incidence rate of Giardia infection gradually decreased significantly after the implementation of health education and appropriate treatment of infected orphans.

Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya

OBJECTIVE

The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) among orphaned and separated children in Uasin Gishu County, western Kenya.

METHODS

A total of 1565 (55.5% male) orphaned and separated adolescents aged 10-18 years (mean 13.8 years, sd 2.2), were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children's Institutions (CCIs), and 73 on the street. Posttraumatic stress symptom (PTSS) scores and PTSD were assessed using the Child PTSD Checklist.

RESULTS

Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%), then households (15.0%) and CCIs (11.5%). PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse.

CONCLUSION

This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households. Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support.