Algumas questões sobre a adoção na vida e obra de Marie Bonaparte / Algunas cuestiones sobre la adopción en la vida y obra de Marie Bonaparte / Some questions about adoption in the life and work of Marie Bonaparte

Nosso objetivo é demonstrar como a ossatura do conceito mãe morta na obra bonaparteana serve de fundamento teórico para se pensar a clínica da adoção. Essa inferência só é possível porque, a posteriori, a autora reconhece na moribunda Mimau, sua babá, uma mãe adotiva. Este trabalho analisa a maneira através da qual é decifrado o enigma intelectual do morrer (orfandade) e descoberto o segredo da mensagem (sexual) do outro (substituto materno). Em suma, nossos resultados apontam que a autora faz equivaler amor e morte entre os mecanismos do inconsciente na clínica da adoção, pois a "mãe morta" é o que se dá a pensar, e, da parte da mãe adotiva, é o que se deixa a desejar via enigma do sexual.

Nuestro objetivo es demostrar cómo el concepto de madre muerta en el trabajo bonaparteano sirve como base teórica para pensar en la clínica de adopción. Esa inferencia solo es posible porque, a posteriori, el autor reconoce en el moribundo Mimau, su niñera, una madre adoptiva. Este trabajo analiza la forma en que se descifra el enigma intelectual de morir (orfandad) y se descubre el secreto del mensaje (sexual) del otro (sustituto materno). En resumen, nuestros resultados indican que el autor hace que el amor y la muerte igualen los mecanismos del inconsciente en la clínica de adopción, porque la "madre muerta" es lo que uno piensa, y, por parte de la madre adoptiva, es lo que es deja algo que desear a través del enigma de lo sexual.

Our objective is to demonstrate how the framework of the concept of dead mother in Bonapartean work serves as a theoretical foundation for thinking about the clinic of adoption. This inference is only possible because, a posteriori, the author recognizes in the dying Mimau, her nanny, an adoptive mother. This work analyzes the way in which the intellectual enigma of dying (orphanhood) is deciphered and the secret of the (sexual) message of the other (maternal substitute) is discovered. In summary, our results indicate that the author makes love and death equate between the mechanisms of the unconscious in the adoption clinic, because the "dead mother" is what one thinks, and, on the part of the adoptive mother, is what is leaves to be desired via enigma of the sexual.

Challenges of developing a district child welfare plan in South Africa: lessons from a community-engaged HIV/AIDS research project.

The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework.

Percepção de risco como estratégia de convívio comensal com jovens órfãos pelo HIV/AIDS em São Paulo, SP, Brasil / Percepción de riesgo como estrategia de convivencia comensal con jóvenes huérfanos por VIH/SIDA en São Paulo, SP, Brasil / Commensal meetings strategies regarding youth orphaned by HIV/AIDS in São Paulo, SP, Brazil

No contexto do HIV/AIDS, estratégias comensais são acordadas pelas famílias para reduzir riscos. Com o objetivo de identificar percepções de risco nos convívios comensais desenvolveu-se estudo qualitativo com jovens órfãos pela AIDS. Os dados foram obtidos durante entrevista com questões sobre o cotidiano. Utilizou-se a proposta de Wright Mills do artesanato intelectual, na qual os sujeitos são considerados atores históricos e sociais. As estratégias mediante a percepção de risco ao HIV/AIDS foram consideradas acordos pactuados pela família para assegurar a interação social. Foi possível observar que as estratégias incluem a restrição do toque e do contato corporal; separação de utensílios e inutilização da comida tocada por soropositivos. A percepção de risco pode ser decorrente da inconstância dos achados científicos e de crenças que reforçam o processo de estigma e discriminação.(AU)

En el contexto del VIH/SIDA, las familias acuerdan estrategias comensales para reducir riesgos. Con el objetivo de identificar percepciones de riesgo en las convivencias comensales se desarrolló un estudio cualitativo con jóvenes huérfanos debido al SIDA. Los datos se obtuvieron durante entrevista con preguntas sobre el cotidiano. Se utilizó la propuesta de Wright Mills de la artesanía intelectual, en la cual los sujetos se consideran actores históricos y sociales. Las estrategias mediante la percepción de riesgo del VIH/SIDA se consideraron acuerdos pactados por la familia para asegurar la interacción social. Fue posible observar que las estrategias incluyen la restricción del toque y del contacto corporal, separación de utensilios e inutilización de la comida tocada por personas que son seropositivas. La percepción del riesgo puede ser consecuencia de la inconstancia de los hallazgos científicos y de creencias que refuerzan el proceso de estigmatización y discriminación.(AU)

Within the HIV/AIDS context, commensal strategies are agreed upon by the families aiming to reduce risks. With the objective of identifying risk perceptions in the commensal meetings, we developed a study with youth orphaned by AIDS. Interviews produced data through questions regarding daily life. The Wright Mills' proposal about intellectual craftsmanship was used for analysis. In this approachsubjects are considered historical and social actors. The strategies used from risk perception of HIV/AIDS were assumed as agreements by the families to ensure social interaction. It was observed that strategies include restrictions for touching and body contact; separation of dishes and disposal of food touched by the HIVpositive. The risk perception found may be due to variability of scientific findings and beliefs, thus reinforcing the process of stigma and discrimination.(AU)

Understanding grief in children who have lost a parent with cancer: How do they give meaning to this experience? Results of an interpretative phenomenological analysis.

Though the adjustment of bereaved children is increasingly investigated through quantitative studies, their intimate representations regarding the loss of their parent remain unknown. This qualitative study aims at exploring how they give meaning to this experience. Nondirective interviews with bereaved children were conducted and submitted to an interpretative phenomenological analysis. Fourteen children (8 boys, 6 girls, mean age = 8.5 years) were recruited. Seven major themes depicting their grief experience were identified. The importance of the surviving parent is critically highlighted. Findings suggest that the remaining parent could become a fundamental actor in providing grief support for the bereaved children.

Screening for PTSD symptoms in unaccompanied refugee minors: a test of the CRIES-8 questionnaire in routine care.

AIMS: The dramatic increase in the number of refugees in Europe presents a major public health challenge. The limited existing evidence indicates that the mental health needs of refugees are significant; unaccompanied refugee minors (URMs) constitute a particularly vulnerable group. In this study, we aimed to investigate whether a short questionnaire (Children's Revised Impact of Event Scale; CRIES-8) could be used as a screening tool for PTSD symptoms in URMs, 8-18 years old, during their routine health check-up. METHODS: Data were collected at the healthcare centre for asylum-seekers in Uppsala, Sweden. In total, 208 URMs completed the CRIES-8 during their health assessment. RESULTS: The CRIES-8 was feasible to use, showed good internal consistency and its factor structure was confirmed. Children with less than four years of education often had difficulties completing the questionnaire by themselves and needed help reading the questions. Almost all the respondents were male (98%), aged 9-18 years. The majority (81%) came from Afghanistan. About 76% scored above the cut-off and therefore were considered to be at risk of PTSD. The proportion of children who screened positive did not differ based on age, country of origin or current living arrangements. CONCLUSIONS: The CRIES-8 is a useful tool in clinical settings, however, children should be provided with reading support and instructions about how to complete the questionnaire. The high number of children who screened positive for PTSD symptoms indicates the need for a more thorough mental health assessment, and early prevention/intervention programmes to address URMs' mental health issues.

[Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany]. / Resilient oder Risikogruppe?

Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany Unaccompanied minors (umA in German) are considered as a risk group for psychological disorders. In international studies a high prevalence for trauma, anxiety, and depression were reported. A sample of N = 52 unaccompanied minors living in Germany was questioned on symptom severity as well as stress experience with the Refugee Health Screening-15. More than each second unaccompanied minor shows clinically relevant symptom severity and stress experience. In age-specific analyses the highest stress levels were found among the youngest unaccompanied minors. Therefore, specifically adapted settings for care should be applied for this high-risk group.

Caracterización de la esfera socio-afectiva de preescolares sin amparo filial / Characterization of the sphere partner affective of kindergartens, without son-and-daughter protection

Introducción: la esfera socio-afectiva, desde las edades tempranas de la vida, incluye experiencias emocionales, socializadoras y motivacionales que permiten al niño relacionarse con los otros, respondiendo a determinadas costumbres, creencias, normas de convivencia y modelos de interacción. Objetivo: caracterizar la esfera socio-afectiva de preescolares sin amparo filial, pertenecientes al círculo interno Lu-Xun, de Arroyo Naranjo. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, durante el año 2014. La muestra la integraron 20 niños, con edades entre 3 y 5 años, a los que se les aplicó pruebas proyectivas, que permitieron valorar el estado actual de sus habilidades socio-afectivas. Resultados: el 100 por ciento reflejó, en sus dibujos, estados de ánimos desfavorables, pobreza en sus contenidos y escasa creatividad e imaginación. El 60 por ciento mostró dificultades en el control muscular. El 70 por ciento exhibió dificultades en las relaciones de intercambio, con pobre capacidad de socialización. El 95 por ciento mostró preferencias adecuadas a su edad, con gran inclinación hacia el juego y las flores, gustando de paseos y golosinas. El 50 por ciento mostró niveles de afectividad adecuados hacia determinada figura parental. El 45 por ciento mostró dificultades en las habilidades narrativas, con pobre vocabulario. El 95 por ciento transmitió, en las historias relatadas, conflictos en el área doméstica. Conclusiones: la esfera socio-afectiva se caracterizó, en el orden intrapersonal, por baja autoestima, necesidades insatisfechas, en especial la de abrigo y cuidados maternos, con proyección de miedos e inseguridad. En el orden interpersonal, existieron dificultades en el intercambio social y en la efectividad del aprendizaje(AU)

Introduction: The sphere partner affective, from the youths of life, he includes emotional experiences, socializadoras and motivational that they permit the little boy getting acquainted with others, answering to determined way of life, beliefs, standards of cohabitation and models of interaction. Objective: Characterizing the sphere partner affective of kindergartens, without son-and-daughter protection, pertenecientes to the internal Circle Lu Xun, of Arroyo Naranjo. Methods: The observational accomplished a study itself, descriptive, de transversal cut, during the year 2014. Sample was integrated by 20 children, with ages among 3 and 5 years, to the ones that were applied tests projective, the fact that they permitted appreciating the present-day status of his abilities partner affective. Results: The 100 percent reflected, in his drawings, states of unfavorable tempers, poverty in his contents and scarce creativity and imagination. The 60 % showed difficulties in muscular control. The 70 percent exhibited difficulties in exchange relationships with scant capability, of socialization. The 95 percent showed adapted preferences to his age, with great inclination toward the game and flowers, liking walks and sweets. The 50 percent showed levels of adapted affectivity toward determined to figure parental. The 45 percent showed difficulties in narrative abilities with scant vocabulary. The 95 percent transmitted conflicts in the area domestic, in related stories. Conclusions: The sphere partner affective characterized, in the order intrapersonal, for low self-esteem, unsatisfied needs itself, specially the one belonging to coat and maternal cares, with projection of fears and insecurity. In the interpersonal order, difficulties existed in the social interchange and in the effectiveness of learning(AU)

The impact of chronic disease on orphans' quality of life living in extended social care services: a cross sectional analysis.

BACKGROUND: Owing to a scarcity of data or other causes, patient research on the orphan population is lacking in most societies. Consequently, the primary goal of this study was to explore quality of life (QOL) and quality of care (QOC) among orphan patients (OPs) receiving tertiary healthcare services in Saudi Arabia (SA). METHOD: This study used a cross-sectional, quantitative survey design. Participants included 216 OPs either currently undergoing or who had undergone treatment for common chronic diseases (CDs) (e.g. cardiovascular disease, cancer, stroke and arthritis) during the past 12 months. The survey utilised the brief form from the World Health Organization Quality of Life (WHOQOL-BREF) tool and evaluated healthcare access and effectiveness domains to scrutinise the socio-medical patterns of OPs based on their current medical episodes. RESULTS: The descriptive analysis indicated that OPs' overall QOL reached a moderate level (M = 3.90). Similarly, participants reported relatively high levels of healthcare access and treatment effectiveness (M = 4.14 and M = 4.29, respectively). Stroke patients reported the highest QOL score (M = 3.95), and groups of patients with other CDs reported greater access to healthcare and more effective treatment maintenance compared to the other groups (M = 4.19 and M = 4.43, respectively). Regression analysis was conducted to predict overall QOL based on perceived QOC, and access explained only 6.5 % of the variance. An analysis of variance showed significant differences only between OPs with cardiovascular disease and cancer (P = .001), with the former reporting better access to tertiary healthcare services than the latter. CONCLUSIONS: Although some CD patients reported relatively acceptable levels of access to healthcare and receipt of effective treatment, the improvement of OPs' QOL and QOC poses a serious challenge for health policymakers.

When a foreign adolescent orphan refuses to be treated: Considerations on a clinical case.

Providing medical treatment for unaccompanied foreign minors can prove particularly demanding when a patient is not fully compliant. This report describes the case of a 13-year-old boy from Sub-Saharan Africa brought to Italy to receive treatment for a neoplasm. Right from the start, he showed strong oppositional reactions, with aggressive and self-harming behavior. This made it necessary to activate various different psychological, psychiatric, and social-support resources, and to adapt the proposed treatments to the patient's willingness and ability to cooperate. Here we outline the assessments and actions (also from the economic and organizational standpoint) that need to be implemented in any scheme to bring young foreign orphans to Italy for specialist medical care.

Discordance of HIV and HSV-2 biomarkers and self-reported sexual behaviour among orphan adolescents in Western Kenya.

BACKGROUND: This paper examines the discordance between biological data of HIV and herpes simplex virus type 2 (HSV-2) infections and self-reported questionnaire responses among orphan adolescents in Western Kenya. METHODS: In 2011, 837 orphan adolescents from 26 primary schools were enrolled in an HIV prevention trial. At baseline, blood samples were drawn for HIV and HSV-2 infection biomarker testing, and participants completed an audio computer-assisted self-interviewing survey. RESULTS: Comparing biological data with self-reported responses indicated that 70% of HIV-positive (7 out of 10) and 64% of HSV-2-positive (18 out of 28 positive) participants reported never having had sex. Among ever-married adolescents, 65% (57 out of 88) reported never having had sex. Overall, 10% of study participants appeared to have inconsistently reported their sexual behaviour. Logistic regression analyses indicated that lower educational level and exam scores were significant predictors of inconsistent reporting. CONCLUSIONS: Our study demonstrates the discordance between infections measured by biomarkers and self-reports of having had sex among orphan adolescents in Kenya. In order to detect programme effects accurately in prevention research, it is necessary to collect both baseline and endline biological data. Furthermore, it is recommended to triangulate multiple data sources about adolescent participants' self-reported information about marriage and pregnancies from school records and parent/guardians to verify the information. Researchers should recognise potential threats to validity in data and design surveys to consider cognitive factors and/or cultural context to obtain more accurate and reliable information from adolescents regarding HIV/sexually transmitted infection risk behaviours. CLINICAL TRAIL REGISTRATION NUMBER: NCT01501864.

First evaluation of a population-based screen to detect emotional-behavior disorders in orphaned children in Sub-Saharan Africa.

Due to the HIV/AIDS pandemic which has left 12 million children orphaned in Sub-Saharan Africa, children are at increased risk for mental health problems. Currently, no validity data exist for any screening measure of emotional-behavior disorders in pre-adolescent children in Sub-Saharan Africa. The aims of the current study were to evaluate the construct validity of the caregiver-, teacher-, and self-report versions of the one-page Strengths and Difficulties Questionnaire (SDQ) in 466 orphans in South Africa between the ages of 7 and 11 (M age = 9.23 years, SD = 1.33, 51.93 % female) and to provide, for the first time, clinical cut-offs for this population. Findings demonstrated support for the caregiver SDQ, but not the teacher and self-report versions. We provide clinical cut-offs, but caution their use before further research is conducted. There remains a critical need for further psychometric studies of the SDQ in the developing world.

Comensalidade e cuidado: meninas-jovens-mulheres órfãs no contexto de HIV/Aids / Commensality and care: orphan girls and young women in the context of HIV/Aids / Comensalia y cuidado: chicas-jóvenes-mujeres huérfanas en el contexto del VIH/Sida

O "monopólio da cozinha", histórica e culturalmente, é atribuído às mulheres, mães. Para cuidar da família, elas elegem alimentos, compram, cozinham e os servem. Sustentam a comensalidade. Em contextos de HIV/Aids, onde há perda da mãe, as filhas tornam-se responsáveis por esses cuidados. O que pensam as meninas do papel de cuidadoras com o qual, prematuramente, deparam-se? O que dizem seus irmãos sobre isso? Realizamos entrevistas semidirigidas com 14 jovens órfãos. Os dados foram analisados pela proposta de Mills (2009). As jovens não demonstram insatisfação por executarem novas tarefas, mas deploram o fato de impedirem o estudo e a vida além-casa. Seus irmãos entendem a lida da cozinha como coisa de mulher e, por isso, dificilmente colaboram. Essas jovens necessitam de cuidados direcionados à situação vulnerável em que vivem. As políticas de Saúde Pública poderiam pleitear macroestruturas que atuassem sobre essa demanda.

"Monopoly of the kitchen" is historically and culturally attributed to women and mothers. To care for their families, they select and buy food, and cook and serve it. They sustain commensality. In contexts of HIV/AIDS, when mothers die, the daughters become responsible for such care. What do the girls think of the caregiver's role that they prematurely have to face? What do their brothers think about this? Semi-structured interviews were conducted with 14 young orphans. The data were analyzed as proposed by Mills (2009). The young women did not show any dissatisfaction with the new tasks that they were doing, but deplored the fact that this impeded them from studying and having a life beyond the home. Their brothers viewed dealing with the kitchen as women's business and rarely collaborated. These young women need care directed towards the vulnerable situation in which they live. Public health policies could seek macrostructures that would act on this demand.

Histórica y culturalmente, el "monopolio de la cocina" se atribuye a las mujeres, a las madres. Para cuidar de la familia eligen los alimentos, los compran, los cocinan y los sirven. Mantienen la comensalia. En el contexto del VIH/SIDA, cuando la madre muere, las hijas se hacen responsables de dichos cuidados. ¿Qué piensan las niñas del papel de cuidadoras? ¿Qué dicen sus hermanos al respecto? Realizamos entrevistas semi-estructuradas con 14 jóvenes huérfanos. Los datos fueron analizados por la propuesta de Mills (2009). Las huérfanas no mostraron descontento por desarrollar nuevas tareas, pero lamentaron el hecho de que esas tareas les impiden de estudiar y vivir una vida más allá del hogar. Sus hermanos conciben la cocina como cosa de mujeres y casi nunca colaboran. Estas jóvenes necesitan de atención por su situación de vulnerabilidad. Las políticas de Salud Pública podrían reclamar macro-estructuras para cubrir esa demanda.

AIDS orphans and vulnerable children in India: problems, prospects, and concerns.

This article reviews and discusses the problems, responses, and concerns of orphans and vulnerable children in India. The article shows that HIV/AIDS programs and interventions are vital for survival and welfare of orphan and vulnerable children, but they have reached only to a small fraction of the most vulnerable children. The article suggests a number of measures that government and civil society could take to address the problems and emphasizes the need to learn from other countries' experience and initiatives in developing appropriate policy and programmes for orphan and vulnerable children.

Adolescents living in orphanages in Ankara: psychological symptoms, level of physical activity, and associated factors.

AIM: Adolescents living in orphanages are at a disadvantage with respect to mental health. The aim of this study was to assess the distribution of psychological symptoms and their association with the level of physical activity (PA) in adolescents living in orphanages. METHOD: The study group consisted of 13-16-year-old adolescents (N=166) living in orphanages in Ankara, Turkey. Data were collected cross-sectionally in 2008 via questionnaires, including the Brief Symptom Inventory and Kiddo-KINDL Health-Related Quality of Life Questionnaire. Descriptive statistics were used to summarize data, whereas chi-square, ANOVA, Mann-Whitney U, Kruskal-Wallis, and t tests were used to compare groups. RESULTS: Median age of the participants was 16.0 years and 65.7% were male. Female gender, not going to school or work, dissatisfaction with school, contact with the family, chronic disease, chronic medication use, sleep problems, regular tobacco use, chronic disease in the family, and low quality of life score were associated with increased risk (GSI-Global Symptom Index>1 SD) for mental disorders. Physically active adolescents' use of tobacco, alcohol, other substances, and medications, as well as GSI and depression scores were lower and their quality of life scores were higher than those of their less active counterparts. CONCLUSION: Prevalence of psychological symptoms in adolescents living in orphanages were higher than in the general adolescent population. Physically active adolescents' mental health indices and abstinence behaviors with regard to tobacco, alcohol, and substances were more favorable. Encouraging adolescents to participate in sports and improving sports facilities in orphanages are interventions that can promote mental health.

Use of a brief standardized screening instrument in a primary care setting to enhance detection of social-emotional problems among youth in foster care.

OBJECTIVE: To determine whether systematic use of a validated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care. METHODS: Before-and-after study design, following a practice intervention to screen all youth in foster care for psychosocial problems using the Strengths and Difficulties Questionnaire (SDQ), a validated instrument with 5 subdomains. After implementation of systematic screening, youth aged 11 to 17 years and their foster parents completed the SDQ at routine health maintenance visits. We assessed feasibility of screening by measuring the completion rates of SDQ by youth and foster parents. We compared the detection of psychosocial problems during a 2-year period before systematic screening to the detection after implementation of systematic screening with the SDQ. We used chart reviews to assess detection at baseline and after implementing systematic screening. RESULTS: Altogether, 92% of 212 youth with routine visits that occurred after initiation of screening had a completed SDQ in the medical record, demonstrating high feasibility of systematic screening. Detection of a potential mental health problem was higher in the screening period than baseline period for the entire population (54% vs 27%, P < .001). More than one-fourth of youth had 2 or more significant social-emotional problem domains on the SDQ. CONCLUSIONS: Systematic screening for potential social-emotional problems among youth in foster care was feasible within a primary care setting and doubled the detection rate of potential psychosocial problems.

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China.

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.

The impact of the HIV/AIDS epidemic on kinship resources for orphans in Zimbabwe.

The extended family has been recognized as a major safety net for orphans in sub-Saharan Africa. However, the mortality crisis associated with HIV/AIDS may drastically reduce the availability of relatives and thus undermine traditional forms of mutual support. In this article, the microsimulator SOCSIM is used to estimate and project quantities such as the number of living uncles, aunts, siblings, and grandparents available to orphans. The model is calibrated to the setting of Zimbabwe, using data from demographic and Health Surveys and estimates and projections of demographic rates from the United Nations. The article shows that there is a lag of more than ten years between the peak in orphanhood prevalence and the peak in scarcity of grandparents for orphans. The results indicate that a generalized HIV/AIDS epidemic has a prolonged impact on children and orphans that extends well beyond the peak in mortality. A rapid increase in the number of orphans is followed by a steady reduction in the number of living grandparents for orphans. Consequently, the burden of double orphans (both of whose parents have died) is likely to shift to uncles and aunts. In Zimbabwe, the number of living uncles and aunts per double orphan decreased between 1980 and 2010, but it is expected to increase progressively during the next few decades. Changes in kinship structure have important social consequences that should be taken into account when seeking to address the lack of care for orphans.

The prebereavement psychological needs of AIDS-affected adolescents in Uganda.

INTRODUCTION: In Sub-Saharan Africa, adolescents who live with dying parents are recognized as vulnerable but research into their psychological needs is limited. AIM: A small qualitative retrospective study was undertaken in Uganda to gain insight into the prebereavement experiences of AIDS-affected adolescents. METHOD: Unstructured interviews with ten parentally-bereaved adolescents were conducted and recorded. Following transcription, the narrative data were thematically analysed. FINDINGS: The adolescents' level of awareness concerning the parent's illness affected their psychological needs. Four variations of awareness were identified and then categorized as concealed reality, disguised reality, discerned reality and disclosed reality. CONCLUSION: Most adolescents discerned that their parent was dying as the illness advanced, but they remained psychologically isolated and unprepared. Disclosure is advocated but must include ongoing emotional support and future care arrangements.

A devolução de crianças adotadas: ruptura do laço familiar

A partir da pesquisa de mestrado da autora, este trabalho ressalta alguns aspectos da subjetividade dos pais adotivos envolvidos com a experiência da adoção que podem culminar na devolução da criança adotada. Analisa as repercussões da infertilidade e o contexto da adoção sobre pais e filhos, compreendendo que a possibilidade da adoção vir a ser ou não uma experiência criativa depende da dinâmica do casal e da família. As motivações subjetivas dos pais para a adoção, a infertilidade e a alteridade da origem da criança são fatores dentre outros que, somados, tendem a intensificar os conflitos já existentes na relação e, em alguns casos, podem levar à devolução da criança adotada. O estudo conclui sobre a necessidade dos adotantes superarem as dores relacionadas à ausência do filho concebido biologicamente e da elaboração dos conflitos gerados pelas origens do filho adotivo para que possam assegurar-se nos lugares da paternidade/maternidade.