The outcome of children placed in a welfare center or foster care before the age of 4: Prognostic factors.

BACKGROUND: In child and adolescent psychiatry, many patients are placed in welfare institutions or foster care. OBJECTIVE: It is important to study their progress in the long term and to examine the psychological and social care arrangements as well as their impacts. POPULATION AND METHODS: This qualitative study designed to identify potential prognostic factors relating to the outcome of children placed in a welfare center or foster care before the age of 4 years was based on the analysis of 34 case histories of children placed in a welfare center or foster care in Angers. These records involved 129 cases collected for the "Saint Ex" study, a quantitative case study conducted from 1994 to 2001 designed to assess the outcome of children placed in a welfare center or foster care in Angers before the age of 4. The population sampling was purposive and was based on eight subgroups defined by three clinical criteria: Parent-Infant Relationship Global Scale assessment (PIR-GAS) at T1 (admission into welfare center or foster care), the status of a "infant at risk" at T1, and GAF (Global Assessment of Functioning) at T2 (exit from the welfare center or foster care). RESULTS: The study population included 11 girls and 23 boys. Factors contributing to adverse progression included problems with interactions at a very early age, failure to listen or respond to a child's request regarding his or her placement, long delays between establishing facts and implementing social measures, discontinuity and/or inconsistency regarding the placement arrangements, and sexual abuse. On the other hand, factors contributing to positive progress included the diagnosis and adapted treatment of a mental disorder in the case of one or both parents, early placement in a foster family, considering the child's requests regarding the placement, responsiveness of social services, and psychological or psychiatric follow-up. CONCLUSION: The analysis of these 34 cases sheds light on several prognostic elements, with the combination of all these factors as the background. Care based on prevention seems essential to protect early interactions and shorten the time that children are exposed to danger.

Factors associated with depression among homeless mothers. Results of the ENFAMS survey.

PURPOSE: Women are disproportionately likely to suffer from depression. This is especially true for those who experience socioeconomic hardship, such as homelessness. In France, among homeless mothers many are migrant. However, it is not clear whether risk factors associated with depression are specific for this group or the same as in the general population. Our objective was to describe socio-demographic, relational, living and housing conditions and health factors associated with depression among homeless mothers. METHODS: The ENFAMS survey, conducted via face-to-face bilingual interviews with a representative sample of homeless families in the Paris region (January-May 2013, n = 733 mothers). Mothers reported their socio-demographic characteristics, housing conditions including residential mobility, as well as physical and mental health. Depression was ascertained using the Composite International Diagnostic Interview (CIDI). Factors associated with mother's depression were studied in weighted Poisson regression models with robust error variance. RESULTS: The prevalence of depression among participating mothers was 28.8%. In multivariate analyses, depression was associated with fluency in French (PR = 1.88 95% CI 1.40; 2.51), suicide risk (PR = 2.26, 95% CI 1.82; 2.82), post-traumatic stress disorder (PR = 1.97, 95% CI 1.50; 2.60), and unmet health needs (PR = 1.68, 95% CI 1.09; 2.57). CONCLUSIONS: Homeless mothers have high levels of depression and associated psychiatric comorbidities. Associated risk factors appear to be both specific for this group and shared with mothers in the general population. Improvements in the monitoring of mental health difficulties as well as access to appropriate medical care in this vulnerable population may help improve health and social outcomes.

Emotional and behavioral difficulties in children growing up homeless in Paris. Results of the ENFAMS survey.

PURPOSE: Children growing up in homeless families are disproportionately more likely to experience health and psychological problems. Our objective was to describe social, environmental, individual and family characteristics associated with emotional and behavioral difficulties among homeless children living in the Paris region. METHODS: Face-to-face interviews with a representative sample of homeless families were conducted by bilingual psychologists and interviewers between January and May 2013 (n=343 children ages 4-13 years). Mothers reported children's emotional and behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), family socio-demographic characteristics, residential mobility, and parents' and children's physical and mental health. Children were interviewed regarding their perception of their living arrangements, friendships and school experiences. We studied children's SDQ total score in a linear regression framework. RESULTS: Homeless children had higher SDQ total scores than children in the general population of France, (mean total score=11.3 vs 8.9, P<0,001). In multivariate analyses, children's difficulties were associated with parents' region of birth (beta=1.74 for Sub-Saharan Africa, beta=0.60 for Eastern Europe, beta=3.22 for other countries, P=0.020), residential mobility (beta=0.22, P=0.012), children's health (beta=3.49, P<0.001) and overweight (beta=2.14, P=0.007), the child's sleeping habits (beta=2.82, P=0.002), the mother's suicide risk (beta=4.13, P<0.001), the child's dislike of the family's accommodation (beta=3.59, P<0.001) and the child's experience of bullying (beta=3.21, P=0.002). CONCLUSIONS: Children growing up homeless experience high levels of psychological difficulties which can put them at risk for poor mental health and educational outcomes long-term. Access to appropriate screening and medical care for this vulnerable yet underserved group are greatly needed.

[Course and progression of children admitted before 4 years of age in a French child welfare center]. / Parcours et devenir de 128 enfants admis avant l'âge de quatre ans en pouponnière sociale.

AIM: The purpose of this study was to determine the institutional trajectory and future of young children in child welfare. MATERIALS AND METHODS: A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant. RESULTS: We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2±4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures. CONCLUSION: The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.

Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium.

A rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.

Somatically acquired genetic alterations in flat colorectal neoplasias.

Somatically acquired mutations in several genes have been reported as playing an important role during colorectal tumorigenesis. Two alternative groups of carcinomas, termed LOH+ and RER+, have been defined on the basis of their genetic anomalies, a biallelic inactivation of the APC or the TGF-betaRII genes, occurring as an alternative, in LOH+ or RER+ tumors. It is a generally accepted hypothesis that most of colorectal cancers (CRC) develop from a pre-existing adenomatous polyp. Such benign lesions are usually exophytic polyps, a small proportion of adenomas having been described as flat lesions. The latter histological category has thus been proposed to bear specific genetic alterations. In order to examine this hypothesis, we have characterized a series of 44 flat colorectal neoplasias for their RER status and for somatic APC, KRAS and TGF-betaRII genes mutations. Flat colorectal neoplasias were found to be of the RER+ subtype in 22% of cases, all of them exhibiting a TGF-betaRII mutation. A mutation of the APC and KRAS genes has been found in 42% and 4% of tumors, respectively, none of these tumors being of the RER+ subtype. With the exception of a low KRAS mutation rate, flat adenomas appear to follow tumorigenesis pathways very similar to those identified in exophytic adenomas and carcinomas.

Canine leishmaniasis: identification of asymptomatic carriers by polymerase chain reaction and immunoblotting.

A major limitation to the study of the epidemiology of canine visceral leishmaniasis is the inability to identify and count asymptomatic carriers because classic diagnositc tests are insufficiently sensitive. We investigated the capacity of the polymerase chain reaction (PCR) to detect the parasite and immunoblotting to detect specific antibodies in samples from dogs living in an endemic area without any symptoms of leishmaniasis. Results of classic serologic tests (immunofluorescence and enzyme-linked immunosorbent assay) were negative. Two independent PCR assays detected the parasite in skin and conjunctival samples from 80% of the dogs. We found specific antibodies by immunoblot in 66% and 56% of the dogs had both specific antibodies and parasite DNA. As controls, samples from dogs with clinical manifestations of the disease before and after treatment were assayed. The frequency of positive PCR samples decreased after treatment, and although antibody levels decreased with cure of the disease, they remained detectable by immunoblot. Results showed that most of the dogs living in an endemic area had been exposed to Leishmania. Both PCR and immunoblot are sensitive enough to detect asyptomatic infection and could be valuable tools for studies monitoring the transmission of the disease and vaccination trials.

Tolfenamic acid in the control of ocular inflammation in the dog: pharmacokinetics and clinical results obtained in an experimental model.

Tolfenamic acid (TA) was tested in two studies to investigate its value in controlling ocular inflammation in the dog. First, TA was assayed within primary and secondary aqueous humour (AH) and in plasma 0, 4 and 24 hours after a 4 mg/kg subcutaneous injection. Secondly, an experimental ocular surgery model was set up in 10 dogs-five receiving TA two hours before surgery and five left untreated. TA was shown to diffuse into AH, reaching lower levels than in plasma: 1:126 ratio in primary AH and 1:43 in secondary AH. In the model, TA-treated dogs versus untreated dogs showed a significant reduction of miosis (P < 0.05) and a clear trend to a reduced ocular discharge and corneal oedema (P = 0.06). Prostaglandin E2 (PGE2) levels increased significantly less in AH after TA treatment (P < 0.05). These results show that TA, even if the whole concentration measured in AH is lower than in plasma, is able to limit the synthesis of the inflammatory mediator PGE2 in AH and to control ocular inflammatory symptoms induced by corneal surgery.

[The eye of birds of prey. Electroretinographic and histologic approach]. / L'oeil des rapaces. Approche électrorétinographique et histologique.

Birds are an excellent material for the study of retinal adaptation. In this work, the purpose of the authors is to analyse differences between electroretinograms of species of diurnal habits (Falconiformes) and electroretinograms of species of nocturnal habits (Strigiformes). The same is done on histology material about the two types of retina. The electroretinography answers and the retina histology can be correlated with the different species habits.