Case of Poliomyelitis Caused by Significantly Diverged Derivative of the Poliovirus Type 3 Vaccine Sabin Strain Circulating in the Orphanage.

Significantly divergent polioviruses (VDPV) derived from the oral poliovirus vaccine (OPV) from Sabin strains, like wild polioviruses, are capable of prolonged transmission and neuropathology. This is mainly shown for VDPV type 2. Here we describe a molecular-epidemiological investigation of a case of VDPV type 3 circulation leading to paralytic poliomyelitis in a child in an orphanage, where OPV has not been used. Samples of feces and blood serum from the patient and 52 contacts from the same orphanage were collected twice and investigated. The complete genome sequencing was performed for five polioviruses isolated from the patient and three contact children. The level of divergence of the genomes of the isolates corresponded to approximately 9-10 months of evolution. The presence of 61 common substitutions in all isolates indicated a common intermediate progenitor. The possibility of VDPV3 transmission from the excretor to susceptible recipients (unvaccinated against polio or vaccinated with inactivated poliovirus vaccine, IPV) with subsequent circulation in a closed children's group was demonstrated. The study of the blood sera of orphanage residents at least twice vaccinated with IPV revealed the absence of neutralizing antibodies against at least two poliovirus serotypes in almost 20% of children. Therefore, a complete rejection of OPV vaccination can lead to a critical decrease in collective immunity level. The development of new poliovirus vaccines that create mucosal immunity for the adequate replacement of OPV from Sabin strains is necessary.

Effectiveness of emotional intelligence therapy on suicide risk among adolescents in residential care

This study aimed to apply Emotional Intelligence Therapy (EIT) in a sample of adolescents in residential care and to examine its impact on three outcomes: suicide risk, perceived emotional intelligence (PEI), and basic psychological needs (BPN). Treatment consisted of 16 group sessions held on a weekly basis to develop the emotional skills of perception, facilitation of thinking, understanding and management. A clinical trial of repeated measures was conducted in which the study variables were evaluated at three time points: between three and four months prior to treatment, pre-treatment and post-treatment. Of the initial 65 participants, only 19 (73.68% were boys; Mage= 13.74) completed the three evaluations. The results showed a significant decrease in suicide risk after EIT, especially regarding levels of hopelessness and suicidal ideation. Participants also improved their perception of emotional clarity and of competence. No significant changes were noted in any of the variables when on the waiting list. EIT could be a good tool to prevent the emergence of factors that entail suicide risk among adolescents in residential care

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Comparison of Outcomes of Vision and Eye Screening of Children of Four Orphanages and School Children of Riyadh.

PURPOSE: The purpose was to compare vision and ocular disease among orphans to age-matched school children and determine the barriers they faced for ophthalmic care in Riyadh, Saudi Arabia. METHODS: Children of four orphanages of Riyadh (Gr1) were screened for vision refractive error (RE) and eye ailment on "World Sight Day-2019." They were compared to age-matched school children (comparison group; Gr2). The rates of RE, strabismus, amblyopia, and allergic conjunctivitis were estimated in two groups. The coverage of existing eye services for orphan children was reviewed. RESULTS: We screened 53 children of Gr1 and 106 school children of Gr2. The risk of RE was statistically significantly higher in school children compared to orphan children (odds ratio [OR] = 2.4 [95% confidence interval (CI) 1.2; 4.8] P = 0.01). The coverage of refractive services for Gr1 was significantly lower than for Gr2 (OR = 0.09 [95% CI 0.02; 0.4] P = 0.001). In Gr1, blurry vision (12 children), red eye (2), and itchy eyes (1) were the main symptoms. In Gr2, no child had eye complaints. In Gr1, amblyopia (1), strabismus (1), history of ocular trauma and surgery (1), eye medications needed (2), and systemic health problems were noted in 9 children. In Gr2, amblyopia (4), strabismus (4), and history of ocular surgery were noted in 2 children. CONCLUSION: Orphan children had less rate of myopia compared to school children. However, unattended ocular pathologies were detected during the screening campaign. The coverage of refractive services was low in these underprivileged children compared to school children.

Social Determinants of Health, the Family, and Children's Personal Hygiene: A Comparative Study.

Habits of personal hygiene are mostly acquired during childhood, and are, therefore, influenced by one's family. Poor hygiene habits are a risk factor for preventable disease and social rejection. Social Determinants of Health (SDH) consist of contextual factors, structural mechanisms, and the individual's socioeconomic position, which, via intermediary determinants, result in inequities of health and well-being. Dysfunctional family situations may, therefore, be generated by an unequal distribution of factors determining SDH. Little attention has been paid to the influence of the family on personal hygiene and the perception of social rejection in children. We designed a study to examine differences in personal hygiene and in the perception of social rejection between children in reception centers and children living in a family setting. A validated questionnaire on children's personal hygiene habits was completed by 51 children in reception centers and 454 children in normal families. Hygiene habits were more deficient among the children in reception centers than among the other children in all dimensions studied. Deficient hygiene habits were observed in the offspring of families affected by the main features of social inequality, who were more likely to perceive social rejection for this reason and less likely to consider their family as the greatest influence on their personal hygiene practices.

Skin diseases in rural Nyala, Sudan (in a rural hospital, in 12 orphanages, and in two refugee camps).

Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee camps (ORC) in Nyala, Sudan. χ2 test was used. The total prevalence of skin disorders in the sample was 92.6% (1670/1802). One thousand and fifty of 1182 (88.8%) people from ORC had a skin disorder. The most common skin diseases in this community were: fungal infections (32.6%), dermatitis/eczema (10.5%), bacterial skin infections (10.3%), disorders of skin appendages (8.7%), parasitic infestations (7.7%), atrophic skin disorders (7.4%), disorders of pigmentation (7.4%), hypertrophic skin disorders (6.4%), viral infections (5.8), benign neoplasm (1.9%), dermatoses due to animal injury (0.4%), bullous dermatoses (0.1%), and malignant neoplasm (0.1%). Hypertrophic and atrophic disorders of the skin were mainly lesions of scarification (mostly atrophic) (5.7%) and keloids (5.6%). Fungal infection, bacterial infection, and parasitic infestation were more common in the ORC group, while dermatitis and eczema, disorders of skin appendages, hypertrophic and atrophic disorders of the skin, disorders of pigmentation, and benign neoplasm were more common in the OC group. The prevalence of skin diseases in the rural Nyala was more than our expectation and was dominated by infectious skin diseases. In addition, infectious skin diseases were more common in ORC rather than OC.

A systematic scoping review of hygiene behaviors and environmental health conditions in institutional care settings for orphaned and abandoned children.

BACKGROUND: Adequate hygiene behaviors and environmental health conditions are fundamental to children's health, development, and well-being. They are especially important in institutional care settings for orphaned and abandoned children, a particularly vulnerable population whose basic needs are often not met. OBJECTIVES: We systematically reviewed the evidence about hygiene behaviors and environmental health conditions in institutional care settings for children and associated health outcomes; interventions to improve these behaviors, conditions, and outcomes; and obstacles to improvement. METHODS: PubMed, Web of Science, Scopus, and EBSCOhost were searched for studies in the peer-reviewed and grey literature. Studies were included if they reported primary data on one or more environmental health condition or hygiene behavior in an institutional care setting for orphaned and abandoned children. RESULTS: Forty-five publications reporting on over 500 institutions in 29 countries were included. The most documented concern was poor personal hygiene behaviors followed by inadequate water and sanitation infrastructure and overcrowding. Protozoan, helminthic, viral infections, and diarrheal illness among institutionalized children were the most commonly documented associated health outcomes. DISCUSSION: More studies documented the status of hygiene and environmental health in children's institutions than interventions to improve behaviors and conditions. Insufficient finances and expertise or involvement of caregivers are reported barriers to implementing improvements in children's institutions. The development of guidelines for essential environmental health standards in orphanages, monitoring of facility conditions, accountability for facility deficiencies, and implementation research to identify improvement opportunities would contribute to and promote the health and development of orphaned and abandoned children worldwide.

Stress and coping mechanisms among adolescents living in orphanages: An experience from Klang Valley, Malaysia.

INTRODUCTION: Health issues often differ from one population to another. Assessing different aspects of the health condition is a vital step toward developing and designing appropriate prevention and treatment programs to reduce health problems in any group or population. This study aimed to assess both the prevalence of stress and the coping mechanisms as well as identify the predictors of stress levels among adolescents in Malaysian orphanages. METHODS: Overall, 307 male and female adolescents (aged 13-18 y old) living in 9 private orphanages located in Klang Valley, Malaysia, participated in this cross-sectional study. Brief COPE scale and Depression, Anxiety and Stress Scale-21 were used as the main instruments in the current study. RESULTS: The results of the current study showed female adolescents and participants with a higher level of education were more likely to experience stress. The results also showed significant differences between boys and girls in using of coping mechanisms in self-distraction (t = -2.39, P = .01), substance use (t = 2.12, P = .03), use of emotional support (t = -2.70, P = .001), humor (t = 2.28, P = .02), and religion (t = -2.19, P = .02). Denial, venting, religion, humor, planning, and active coping were identified as predictors of stress among participants. DISCUSSION: The results showed a high prevalence of stress and a negative coping pattern among participants. The finding of the current study also showed the urgency of taking immediate action to reduce stress and improve coping methods among Malaysian institutional adolescents.

Calidad de vida y sintomatología depresiva en mujeres adolescentes vulnerables / Quality of life and depressive symptoms in vulnerable adolescent women

En este trabajo se analizó la relación entre calidad de vida y sintomatología depresiva en 230 mujeres adolescentes vulnerables, con una edad media de 12,5 años (DT= 2,1). Las adolescentes fueron evaluadas con el KIDSCREEN-27 y el "Inventario de depresión en niños". La presencia de sintomatología depresiva fue 20% y en la calidad todos los dominios de KIDSCREEN fueron mayores a 50 puntos. La salud física fue menor en las adolescentes con mayor escolaridad y anhedonia; la dimensión psicológica de la calidad de vida disminuye con la anhedonia, la autoestima, el ánimo negativo y los problemas interpersonales; la esfera familiar se impacta negativamente con la anhedonia y la autoestima negativa; el apoyo social decrece con los problemas personales y la ineficacia, mientras que la dimensión escolar se afecta negativamente por la anhedonia e ineficacia. Se concluye que la alta prevalencia de sintomatología depresiva en esta población y sus efectos negativos sobre la calidad de vida constituyen un recurso valioso para direccionar acciones sanitarias, implementar programas de prevención de la depresión y promoción de la salud mental

This paper analyzes the relationship between quality of life and depressive symptomatology in 230 vulnerable adolescent women, with mean age of 12.5 (SD= 2.1). The adolescents were evaluated with KIDSCREEN-27 and Children Depression Inventory. The prevalence of depressive symptomatology was 20 percent, and in the quality of life all domains of KIDSCREEN were greater than 50. Physical health was lower in adolescents with higher schooling and anhedonia; the psychological dimension of quality of life diminishes with anhedonia, negative self-esteem, mood, and interpersonal problems; the family sphere is impacted negatively by anhedonia and negative self-esteem; social support decreases with personal problems and ineffectiveness, while the school dimension of quality of life affected negatively by the presence of anhedonia and ineffectiveness. It is concluded that the high prevalence of depressive symptomatology in this population and its negative effects on the quality of life constitute a valuable input for directing subsequent health actions, implementing programs for the prevention of depression and promoting mental health

Remaking collective knowledge: An analysis of the complex and multiple effects of inquiries into historical institutional child abuse.

This article provides an overview and critical analysis of inquiries into historical institutional child abuse and examines their multiple functions and complex effects. The article takes a broadly international view but focuses primarily on Australia, the UK and Ireland, jurisdictions in which there have been major national inquiries. Drawing on sociological and other social science literature, it begins by considering the forms, functions, and purposes of inquiries. An overview of emergent concerns with institutional abuse in the 1980s and 1990s is then provided, followed by an examination of the response of many governments since that time in establishing inquiries. Key findings and recommendations are considered. The final sections of the article explore the evaluation of inquiries, both during their operation and in their aftermath. Policy change and legislative reform are discussed but the focus is on aspects often underplayed or overlooked, including an inquiry's credibility, its role in processes of knowledge production, and the part it plays in producing social and cultural shifts. In the context of growing numbers of inquiries across Western democracies, including the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, it is argued that grasping the complexity of the inquiry mechanism, with its inherent tensions and its multiple effects, is crucial to evaluating inquiry outcomes.

Risk Factors and Treatment Needs among Orphan School Children.

AIM: The aim of the study was to identify risk factors and treatment needs of orphan children of Selangor, Kuala Lumpur, Malaysia. Ob ectives: (1) To identify the association between the frequency of snacking and caries among orphan schoolchildren, (2) To assess Streptococcus mutans and Lactobacilli (microbiological assessment) in saliva of orphan children, and (3) To formulate treatment needs for orphan children. MATERIALS AND METHODS: A cross-sectional study was done among 253 children of 5-, 12-, and 15-year-olds living in various orphanage houses of Selangor, Kuala Lumpur, Malaysia. Demographic data, and dietary and oral hygiene practices were collected through a structured questionnaire. Clinical examinations of children were conducted to assess oral health status and recorded in the World Health Organization oral health assessment form (1997). Stimulated saliva was collected for S. mutans and Lactobacilli levels. The statistical software, namely, Statistical Package for the Social Sciences version 19.0 was used for the analysis of the data. RESULTS: The final data analysis included 253 children of which 116 (45.8%) were boys and 137 (54.2%) were girls. Overall, 140 (55.33%) children were caries-free and 113 (44.66%) children presented with caries (decayed/missing/filled surface >0). High levels of salivary microbiological counts (S. mutans and Lactobacilli), i.e., ≥105, stress the importance of necessary preventive oral health services. Treatment needs among orphan children showed that most of the children, i.e., 58 (22.9%), need preventive or caries-arresting care followed by 49 (19.4%) who require two-surface filling as an immediate measure. CONCLUSION: From the results of our study, orphan children have low utilization of preventive and therapeutic oral health services. Urgent attention is required to plan a comprehensive dental health-care program to improve their oral health status. CLINICAL SIGNIFICANCE: Parents are the primary caretakers of children, but woefully some of them have to lead their lives without parents, the latter either being dead or incapable of bringing up their children. Such a group of children is known as orphans. As oral health is an integral part of general health, it is essential for health-care policy makers to address oral health needs of this underprivileged group of society. This article highlights the risk factors and treatment needs among orphan schoolchildren.

Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: examination of its clinical status and functional impact.

BackgroundEarly-life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation during, and their impact on, functioning in adulthood.AimsWe examine these issues in the young adult follow-up of the English and Romanian Adoptees study.MethodA total of 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceausescu's Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neurodevelopmental and mental health problems, and impairment between ages 2 and 25 years.ResultsYoung adult DSE behaviour was strongly associated with early childhood deprivation, with a sixfold increase for those who spent more than 6 months in institutions. However, although DSE overlapped with autism spectrum disorder and attention-deficit hyperactivity disorder symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood.ConclusionsDSE behaviour remained a prominent, but largely clinically benign, young adult feature of some adoptees who experienced early deprivation.

The impacts of institutional child sexual abuse: A rapid review of the evidence.

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse.

Toward a more comprehensive analysis of the role of organizational culture in child sexual abuse in institutional contexts.

This article draws on a report prepared for the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (Palmer et al., 2016) to develop a more comprehensive analysis of the role that organizational culture plays in child sexual abuse in institutional contexts, where institutional contexts are taken to be formal organizations that include children among their members (referred to here as "youth-serving organizations"). We begin by integrating five strains of theory and research on organizational culture from organizational sociology and management theory into a unified framework for analysis. We then elaborate the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations. We then use our unified analytic framework and our understanding of the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations to analyze the role that organizational culture plays in the perpetration, detection, and response to child sexual abuse in youth-serving organizations. We selectively illustrate our analysis with case materials compiled by the Royal Commission into Institutional Responses to Child Sexual Abuse and reports of child sexual abuse published in a variety of other sources. We conclude with a brief discussion of the policy implications of our analysis.

Clinical consequences of untreated dental caries assessed using PUFA index and its covariates in children residing in orphanages of Pakistan.

BACKGROUND: The purpose of this study was to determine the prevalence and clinical effects of untreated dental caries in Pakistani children residing in orphanages using the DMFT and PUFA index; association of decay and untreated dental caries with demographics including type of orphanage; behavioural and dental visiting pattern; and association of dental pain experience and type of orphanage with dental visiting. METHODS: A cross-sectional survey was conducted on a total of 753 orphan children belonging to 4-17 years of age group residing in twin cities of Rawalpindi and Islamabad, Pakistan. Clinical examination of children was performed using the DMFT and PUFA index for the assessment of dental caries and untreated decay, followed by questionnaire enquiring about eating and oral hygiene habits, dental visiting pattern and dental pain and swelling experience. Association between dental decay, child's dental visiting and pain as a consequence of untreated decay was carried out using chi square test and logistic regression analysis. RESULTS: The overall caries prevalence was 34.8% and overall prevalence of PUFA/pufa was 15.9%. The mean score of DMFT and dmft was 1.18 (SD 0.39) and 1.04 (SD 0.23), and mean PUFA was 1.18 (SD 0.57) and mean pufa score 1.14 (SD 0.35). Untreated caries ratio was found to be 49.1% indicating half the decay had progressed to involve the pulp. No significant association of gender was found with DMFT, dmft, PUFA and pufa (p > 0.05), however, when analysed individually, the 'D' component of DMFT was significantly associated with male gender (p = 0.05). Furthermore, no significant association of DMFT/dmft or PUFA/pufa in either dentition was found with behavioural characteristics such as dietary and oral hygiene habits. Also, 66.2% children who experienced pain had not been to the dentist in the past year (p = 0.013) and 52.6% children who mentioned experiencing pain at night had not been to the dentist in the past year (p = 0.009). Children with decay were more likely to have visited the dentist (OR 3.3, 95% CI 1.42-7.6, p = 0.006). However, children who reported to have experienced pain were less likely to have visited the dentist in the past year (OR 0.53, 95% CI 0.32-0.88, p = 0.014). CONCLUSIONS: Moderate levels of decay were found in the sample with 'd' component majorly responsible for the cumulative DMFT index. However, alarmingly almost half of the decay component (49.1%) had progressed to involve the pulp. Experiencing pain in teeth prompted dental visits. Initiation of preventive services for children residing in orphanages in Pakistan would help greatly towards reducing the burden of untreated decay.

Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings.

PURPOSE: This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. METHODS: We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. RESULTS: This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. CONCLUSIONS: Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.

Child violence experiences in institutionalised/orphanage care.

Institutions are not necessarily good environments for children. In the face of challenges such as HIV, Ebola, poverty, conflict and disaster the numbers have grown rather than reduced. Some countries have closed institutions down -driven by findings that cognitive developmental delay is associated with institutional care. Yet insight into abuse and violence within institutionalised settings is neglected. Maltreatment -violence and abuse -may be an issue. This systematic review series addresses violence and abuse experiences in institutionalised care, exploring firstly the frequency of abuse/violence in institutions, secondly any interventions to reduce such violence or abuse and thirdly the perpetrators of such violence or abuse. The final systematic review updates the findings on cognitive delay associated with institutionalised care. With a violence lens, cognitive delay may well be considered under the umbrella of neglect. Maltreatment and abuse may be a driver of cognitive delay. The keyword search covered several electronic databases and studies were included for data abstraction if they met adequacy criteria. Eight studies were identified on the prevalence of abuse in institutions and a further three studies reported on interventions. Only one study was identified documenting peer on peer violence in institutions. Sixty-six studies were identified examining cognitive development for institutionalised children. All but two of these record cognitive deficits associated with institutionalisation. Only two asked about violence or abuse which was found to be higher in institutionalised children. Overall the abuse experiences of children in institutions are poorly recorded, and in one study violence was associated with high suicidal attempts. The major intervention pathway for ameliorating cognitive challenge seems to be placement out of the institutions which shows benefits and redresses some cognitive outcomes - yet not a total panacea. The single study providing training and monitoring of harsh punishment and maltreatment showed immediate and decided reductions. This data suggest, despite the paucity of studies, violence and abuse, by commission or omission is prevalent in institutions, has an effect on child well-being and is amenable to intervention. Simple training or more complex structures to place children within conducive alternative environments (or to avoid institutionalised placements in the first place) seem to be the main pathway of intervention.

Chemical assessment of lead, cadmium, nitrate, and nitrite intakes with daily diets of children and adolescents from orphanages in Krakow, Poland.

The aim of this study has been to measure the level of lead, cadmium, nitrates, and nitrites in the daily diets of children and adolescents from orphanages located in Krakow (Poland). Diets were collected over four seasons of 2009. The content of cadmium and lead was measured with flameless atomic absorption spectrometry. Nitrates and nitrites in diets were measured using the Griess colorimetric method. In all orphanages, the average intake of lead with daily diets, regardless of the season, ranged from 1.11 ± 0.15 to 22.59 ± 0.07 µg/kg bw/week. The average cadmium intake by children and adolescents ranged between 3.09 ± 0.21 and 20.36 ± 2.21 µg/kg bw/week and, for all orphanages, exceeded the tolerable weekly intake (TWI) level. Daily intake of nitrates and nitrites ranged respectively from 27 to 289 % and from 9 to 99 % of the acceptable daily intake (ADI). The youngest children, with lower body mass, were particularly sensitive to the excessive intakes of cadmium and nitrates.

Early developmental milestones and age of independent walking in orphans compared with typical home-raised infants.

AIM: Early gross motor development is a major indicator of global milestones in the first year of life, affecting the walking ability of a child. There has been limited research reporting on early motor development and the age of independent walking of orphaned infants compared to typical home-raised infants. The purpose of this study was to compare the mean scores of early gross motor movement at 4, 6 and 8months of age and at the age of walking attainment of typically raised infants and orphaned infants. In addition, we looked to compare the walking age between these same infants. MATERIALS AND METHODS: This cross-sectional study recruited 59 typical home-raised infants and 62 orphans. Their gross motor development was assessed using the Alberta Infant Motor Scale (AIMS). The age of walking attainment was also prospectively monitored and ascertained. The Student's independent t-test was used to analyse the differences of the AIMS scores at 4, 6 and 8months of age and at the age of independent walking between the two groups. RESULTS: The orphans showed significantly lower AIMS scores at 4, 6 and 8months of age and the age of independent walking (P-value<0.05). The orphan group had a 5-month older mean age of walking attainment (15.0±4.2months) compared with typical home-raised infants (9.9±1.4months). CONCLUSION: Orphans have delays in early gross motor development and walk independently at an older age, compared with home-raised infants.

Diseminación de cepas Staphylococcus aureus sensible a meticilina (SASM) relacionadas genéticamente, pertenecientes al CC45, entre portadores nasales sanos de hogares infantiles de Medellín, Colombia / Spread of genetically related methicillin-susceptible Staphylococcus aureus belonging to CC45, in healthy nasal carriers in Child Day Care Centers of Medellin, Colombia

INTRODUCCIÓN: La colonización por Staphylococcus aureus desempeña un papel importante en la epidemiología y patogénesis de las infecciones que causa. La población infantil es una de las más susceptibles a colonizarse; sin embargo, en Colombia los estudios en comunidad y en población infantil son escasos. OBJETIVO: Determinar la relación clonal de aislamientos colonizantes de S. aureus en menores de 8 hogares infantiles de Medellín y describir las características epidemiológicas presentes en esta población. MÉTODOS: Se realizó un estudio observacional transversal donde se seleccionó una muestra de 200 menores entre los 6 meses y los 5 años de edad, provenientes de 8 hogares infantiles de Medellín, Colombia, durante 2011. Las muestras fueron tomadas de fosas nasales. Los aislamientos de S. aureus y la resistencia a meticilina se confirmaron molecularmente, empleando los genes nuc y mec. La genotipificación incluyó tipificación del SCCmec, tipificación de spa, PFGE y MLST. La información epidemiológica fue obtenida de los padres y analizada en SPSS® 21.0. RESULTADOS: La frecuencia de colonización en los hogares varió entre el 16,7% (n = 3) y el 53,6% (n = 15). En el interior de 4 hogares infantiles se identificaron aislamientos de S. aureus relacionados entre sí. Adicionalmente, el 50% de todos los aislamientos de S. aureus sensible a meticilina se agruparon en 3 clúster, que pertenecían a los complejos clonales CC45, CC30 y CC121. CONCLUSIÓN: La tipificación molecular de los aislamientos de los menores colonizados y el análisis realizado en el interior de los hogares permitió describir la diseminación de las cepas colonizantes en el interior de los hogares infantiles de la ciudad de Medellín, principalmente del CC45, un clon exitoso en colonización

INTRODUCTION: Colonization plays a major role in the epidemiology and pathogenesis of Staphylococcus aureusinfections. The child population is one of the most susceptible to colonization; however, community and children studies are limited in Colombia. OBJECTIVE: To assess the clonal relationship of S. aureus strains isolated from colonized children in eight day care centers (DCCs) from Medellin and to determine the presence of epidemiological characteristics in these populations. METHODS: An observational cross-sectional study was conducted on a sample of 200 children aged from 6 months to 5 years attending eight DCCs in Medellin, Colombia, during 2011. Nasal samples were collected from each nostril. The isolates species and methicillin resistance were molecularly confirmed using nuc and mec genes. Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. Epidemiological information was obtained from the parents and analyzed using the statistics program SPSS 21.0 RESULTS: The colonization frequency in DCCs ranged from 16.7% (n = 3) to 53.6% (n = 15). Genetically related isolates were identified inside four DCCs. Half (50%) of the isolates were grouped in 3 clusters, which belonged to the clonal complexes CC45, CC30, and CC121. CONCLUSION: Molecular typing of isolates from colonized children and comparison among DCCs showed the spread of colonizing strains inside DCCs in Medellin; predominantly the CC45 clone, a successful child colonizer

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

BACKGROUND: Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. METHODS: The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. RESULTS: Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). CONCLUSION: Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.