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.

Adolescentes acolhidos em casa lar: narrativas de transtornos mentais e violência / Adolescentes y casas de acogida: narrativas de trastornos mentales y violencia / Adolescents housed in an orphanage: narratives of mental disorders and violence

Objetivo: conhecer a trajetória de adolescentes acolhidos que vivem em uma casa lar e os impactos para a sua saúde. Materiais e método: pesquisa qualitativa realizada em 2021, a partir de entrevista semiestruturada com 10 adolescentes, utilizando a Plataforma Google Meet®. Para a análise e categorização das enunciações, utilizaram-se a análise de conteúdo e o software de dados qualitativos gratuito Qualitative Data Analysis (QDA Miner Lite®). Resultados: as enunciações dos adolescentes revelam uma trajetória marcada por violências física, psicológica e sexual, praticada pela família de origem. Isso repercutiu em trauma, sofrimento psíquico e transtornos mentais, além de cuidados medicamentosos e acompanhamento de saúde. Conclusões: os adolescentes acolhidos requerem atenção, cuidado, rede intersetorial e atuação interprofissional. O acompanhamento especializado é fundamental, visto que os transtornos mentais e a violência estão presentes na trajetória desses adolescentes.

Objetivo: conocer la trayectoria de un grupo de adolescentes protegidos que residen en una casa de acogida e identificar los impactos para su salud. Materiales y método: investigación cualitativa realizada en 2021 a partir de una entrevista semiestructurada a 10 adolescentes, utilizando la plataforma Google Meet®. Para el análisis y categorización de los enunciados se utilizó el software gratuito de análisis de contenido y datos cualitativos Qualitative Data Analysis (QDA Miner Lite®). Resultados: las declaraciones de los adolescentes revelan una trayectoria marcada por violencia física, psicológica y sexual ejercida por la familia de origen. Esta realidad ha generado traumas, sufrimiento psíquico y trastornos mentales, dando además lugar a atención farmacológica y seguimiento en salud. Conclusiones: los adolescentes objeto de protección requieren atención, cuidado, una red intersectorial y acción por parte de un equipo interprofesional. El seguimiento especializado es fundamental, puesto que los trastornos mentales y la violencia han estado presentes en la trayectoria de vida de estos jóvenes.

Objective: To know the trajectory of sheltered adolescents living in foster homes and the impacts on their health resulting from this situation. Materials and method: Qualitative research conducted in 2021 via a semi-structured interview with 10 adolescents, using the Google Meet® Platform. Free Qualitative Data Analysis (QDA Miner Lite®) - content and qualitative data analysis software - was used for the analysis and categorization of utterances. Results: Adolescents' statements reveal a trajectory marked by physical, psychological, and sexual violence by the family of origin. This reality has had repercussions on traumas, psychic suffering, and mental disorders, in addition to medication care and health monitoring. Conclusions: Sheltered adolescents require attention, care, intersectoral network support, and interprofessional action. Specialized follow-up is fundamental since mental disorders and violence are present in the lifetime trajectory of these individuals.

Pakistani orphanage caregivers' perspectives regarding their caregiving abilities, personal and orphan children's psychological wellbeing.

BACKGROUND: Pakistan is home to 4.6 million children who have been orphaned. Limited data on caregiving in orphanages suggests that caregivers do not have specialized training and experience heavy workloads and high-stress levels. Supporting these caregivers to provide responsive and consistent caregiving can improve their well-being along with the psychological and physical development of children who have been orphaned. This research explored the main caregiving-related challenges faced by caregivers in orphanage settings, their professional and personal needs and perceived emotional and behavioural problems manifesting in children under their care. METHOD: This research adopted a qualitative research design with a thematic analysis approach. Semi-structured interviews were conducted with 14 caregivers who were currently caring for four to 12-year-old children in Pakistani orphanages. RESULTS: Five main themes: (1) religiosity, (2) economic relief, (3) caregivers' needs and well-being, (4) caring for children who have been orphaned and (5) need for context specific training, emerged from the data, which included several subthemes. Findings revealed the presence of positive religious views regarding the upbringing and care of children who have been orphaned. Work-provided accommodation was an important economic relief. Caregivers' psychological, physiological and personal lives were affected by job-related stress and demands. Many helpful and unhelpful parenting practices were documented, and challenges such as children's verbal and physical aggression, stealing, non-cooperation and poor social skills were reported. The main professional issues included low salary, high numbers of children in care and lack of context specific professional caregiving training provided. CONCLUSION: This study established the need for a tailored programme that suits the context specific caregiving needs in Pakistani orphanages to support the training and professional growth of caregivers and promote their wellbeing along with positive developmental outcomes in the children under their care.

Acolhimento institucional na voz de cuidadoras de crianças e adolescentes que vivem em Casa Lar / Acogimiento institucional en la voz de cuidadores de niños y adolescentes que viven en Casa Lar / Institutional foster care in the voice of caregivers of children and adolescents living in Casa Lar

Objetivo: conhecer o acolhimento institucional realizado por profissionais cuidadores que atuam com crianças e adolescentes que residem em Casa Lar. Método: estudo qualitativo, descritivo e exploratório, no qual participaram 11 profissionais que trabalham com crianças e adolescentes acolhidos. A coleta de dados aconteceu de agosto a novembro de 2021, a partir de entrevista semiestruturada, na Plataforma Google Meet®. As enunciações foram submetidas à análise temática de conteúdo. Resultados: os profissionais que atuam na Casa Lar desenvolvem um trabalho desafiador no acolhimento institucional, pautado na interação e relação afetiva, acolhimento humanitário, favorecimento de estratégias para a socialização e desenvolvimento pessoal, por meio do trabalho em equipe, com vistas às vulnerabilidades, demandas dos acolhidos e fortalecimento de vínculos. Conclusão: ao acolher as crianças e adolescentes, é indispensável que os profissionais ofereçam um cuidado que atenda as demandas de saúde desses indivíduos, e que contemple as singularidades presentes no processo de acolhimento institucional.

Objective: to know the institutional care provided by professional caregivers who work with children and adolescents living in Casa Lar. Method: qualitative, descriptive and exploratory study, in which 11 professionals who work with children and adolescents sheltered participated. Data collection took place from August to November 2021, from a semi-structured interview, on the Google Meet® Platform. The enunciations were submitted to thematic content analysis. Results: professionals working at Casa Lar develop a challenging work in institutional care, based on interaction and affective relationship, humanitarian reception, favoring strategies for socialization and personal development, through teamwork, with a view to vulnerabilities, welcoming demands and strengthening bonds. Conclusion: when embracing children and adolescents, it is essential that professionals offer care that meets the health demands of these individuals, and that contemplates the singularities present in the process of institutional care.

Objetivo: conocer la acogida institucional realizada por profesionales cuidadores que actúan con niños y adolescentes que residen en Casa Lar. Método: estudio cualitativo, descriptivo y exploratorio, en el cual participaron 11 profesionales que trabajan con niños y adolescentes acogidos. La recolección de datos tuvo lugar de agosto a noviembre de 2021, a partir de una entrevista semiestructurada, en la Plataforma Google Meet®. Las enunciaciones fueron sometidas al análisis temático de contenido. Resultados: los profesionales que actúan en la Casa Lar desarrollan un trabajo desafiante en la acogida institucional, pautado en la interacción y relación afectiva, acogida humanitaria, favorecimiento de estrategias para la socialización y desarrollo personal, por medio del trabajo en equipo, con vistas a las vulnerabilidades, demandas de los acogidos y fortalecimiento de vínculos. Conclusión: al acoger a los niños y adolescentes, es indispensable que los profesionales ofrezcan un cuidado que atienda las demandas de salud de esos individuos, y que contemple las singularidades presentes en el proceso de acogida institucional.

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.

Evaluation of physical and mental health status of orphan children living in orphanages in Sonitpur district of Assam: a cross-sectional study.

BACKGROUND: Orphan children living in orphanages are often neglected. These children's physical and mental health status is essential as they are highly prone to malnourishment and psychosocial distress. We aim to evaluate the orphan children's physical and psychosocial status living in orphanages. METHODS: This study adopted a cross-sectional research design conducted with the children living in the orphanages using a pretested, predesigned schedule. A total of 83 children (aged 5 to 19 years) living in three different orphanages in the Sonitpur District of Assam were randomly selected for the study. Body Mass Index (BMI) for age and height were then determined using WHO standards. Thinness was defined as BMI for age below -2 SD (Standard Deviation) and thinness as height for age below -2 SD. The behavioural and mental status of children aged 10-19 years were evaluated using the Strengths and Difficulties Questionnaire (SDQ-21) with a cut-off value of SDQ score > 15 as the presence of emotional and behavioural distress. RESULTS: Almost 50% of orphans were in the age group of 10-14 years, 62.7% were females, and 42.2% had a primary level of education. 52.5% of orphans exhibited severe thinness for < -3 SD. Observed severe thinness more among the 5-9 years and 10-14 years (p-value < 0.05) group and among the male orphans (p-value < 0.05). Of 65 children aged 10-19, 18.5% had behavioural and mental distress. Emotional (32.3%) and poor conduct problems (23%) were observed significantly among male adolescents. CONCLUSIONS: Orphaned children, particularly those living in orphanages, are at risk of malnutrition and experience behavioural and psychosocial problems. Frequent assessments of their physical and mental health are advocated for early detection, prevention, and timely intervention.

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.

Psicologia na defesa dos direitos humanos de crianças e adolescentes / Psychology in the defense of children and adolescents' human rights / La psicología en la defensa de los derechos humanos de la niñez y la adolescencia

A propósito da história mais recente da Psicologia no Brasil, considerando o período a partir da Constituição Federal de 1988, tomada aqui como acontecimento que favorece a emergência da Psicologia como uma área comprometida com a garantia dos Direitos Humanos, este artigo traz para conhecimento e análise fragmentos de memórias de egressos de instituições totais, como os antigos orfanatos, manicômios e preventórios, como parte de uma política de assistência ao chamado menor abandonado. É possível identificar nas lembranças em questão, com bastante clareza, o entendimento da criança como sendo objeto das ações dos adultos e das instituições, inclusive sendo submetida a práticas de abuso sexual e exploração no trabalho, e não como um sujeito de direitos cuja vida deve ser mantida, reconhecida e valorizada em todas as suas dimensões. Este texto também procura relembrar os vários movimentos de resistências que lutaram pela modificação desse tipo de situação, para que se possa enfrentar os problemas da atualidade, muitos decorrentes da pandemia vivida pela população.(AU)

Regarding the most recent history of Psychology in Brazil, since the 1988 Federal Constitution, considered here as a favorable event for the emergence of Psychology as an area committed to guaranteeing Human Rights, this article analyzes fragments of memories of individuals held at total institutions - such as the old orphanages, asylums and preventive care centers -, as part of an aid policy to the so-called neglected minor. These memories clearly show the understanding of the child as an object of the actions of adults and institutions, including being subjected to sexual abuse and exploitation, and not as a subject of rights whose life must be preserved, recognized and valued in all its dimensions. It also evokes the several resistance movements that fought to change this scenario, so that we can face today's challenges, many of them resulting from the pandemic experienced by the population.(AU)

Considerando la historia más reciente de la Psicología en Brasil a partir de la Constitución Federal de 1988 tomada aquí como un acontecimiento que favorece el surgimiento de una Psicología comprometida con la garantía de los Derechos Humanos, este artículo expone y analiza fragmentos de memorias de egresados de instituciones totales como los antiguos orfanatos, asilos y centros de atención preventiva como parte de una política de asistencia al llamado menor abandonado. Se puede identificar claramente en estas memorias la comprensión del niño como objeto de las acciones de adultos e instituciones, incluso víctimas de abuso sexual y explotación en el trabajo, y no como sujeto de derechos cuya vida debe ser mantenida, reconocida y valorada en todas sus dimensiones. Además, se busca destacar los momentos de resistencia en la lucha por cambios en estas situaciones, llevados a cabo en la pandemia que afectó a la población.(AU)

Casais de genitores procuram o judiciário para entregar criança para adoção / Parental couples seek judiciary to consent their children's adoption / Parejas de padres buscan el poder judicial para entregar niños en adopción

A entrega de crianças para adoção por suas genitoras se tornou objeto de constantes normatizações, a exemplo da lei que alterou o Estatuto da Criança e do Adolescente, visando garantir à mulher o direito de não exercer a maternidade e à criança a possibilidade de ter seu direito à convivência familiar e comunitária preservado. Em 2009, a Segunda Vara da Infância e Juventude do Recife iniciou o atendimento a mulheres que manifestam o interesse em entregar sua criança para adoção, através do Programa Mãe Legal. Durante esses anos, verificou-se que, por vezes, é o casal de genitores que comparece para manifestar a intenção de entregar a criança para adoção. O objetivo geral desta pesquisa foi compreender as motivações dos genitores ao decidirem pela entrega ou desistência da colocação de uma criança para adoção, no âmbito do Programa Mãe Legal. Pretende-se analisar o processo pelo qual os genitores vivenciam a parentalidade e compreender o contexto vivido pelo casal que influenciou na sua decisão. A pesquisa foi de natureza qualitativa e teve como instrumental a análise de documentos do processo judicial. Cinco casos foram selecionados para o estudo, e os dados foram analisados por meio da análise de conteúdo temática. Os resultados apontaram que, além das questões subjetivas, as motivações têm suas raízes em fatores externos como o contexto em que o casal está vivendo; a violência e o desgaste da conjugalidade; a interrupção dos sonhos planejados; a falta de planejamento da gravidez; o desemprego e as dificuldades financeiras.(AU)

Mothers' consent to their children's adoption has become the subject of constant regulations, such as the law that changed the Children and Adolescents' Statute, aiming to guarantee to women the right to not exercise motherhood and to children the possibility of having their right to family and community life preserved. In 2009, the Second Childhood and Youth Court of Recife started assisting women who express an interest in consenting their child for adoption, by the Legal Mother Program. During these years, it was found that sometimes the couple of parents comes to express their intention to consent the adoption of a child. The general objective of this research was to understand the motivations of parents when deciding either on consenting or renouncing the placement of a child for adoption, within the scope of the Legal Mother Program. Analyzing the process by which parents experience parenting and to understanding the context experienced by the couple wich influenced their decision was the intention. The research had a qualitative nature and as instrument the analysis of judicial process documents. Five cases were selected for the study, and the data was analyzed by using thematic content analysis. The main results showed that, in addition to subjective issues, motivations have their roots in external factors such as the context in which the couple is living; the violence and the erosion of conjugality; the interruption of planned dreams; the lack of pregnancy planning; unemployment and financial difficulties.(AU)

La entrega de niños/as para la adopción por sus genitoras se ha transformado en objeto de continuas normativas, como la ley que cambió el "Estatuto da Criança e do Adolescente", con el objetivo de garantizar a la mujer el derecho de no ejercer la maternidad y al niño/a la posibilidad de tener su derecho a la convivencia familiar y comunitaria preservada. En el 2009, la "Segunda Vara da Infância e Juventude do Recife" ha iniciado la atención a las mujeres que desean dejar sus niños/as para adopción, a través del "Programa Mãe Legal". A lo largo de estos años se ha observado que, algunas veces, es la pareja de padres la que se presenta para manifestar el deseo de entregar el niño/a en adopción. El objetivo general de esta investigación fue comprender las motivaciones que llevan a los padres a decidir por la entrega o por la desistencia del acto de dejar el niño/a en adopción, en el marco del "Programa Mãe Legal". Se pretende analizar el proceso por el cual los padres vivencian la paternidad y comprender el contexto vivido por la pareja que ha influenciado la decisión. La investigación fue de naturaleza cualitativa y tuvo como herramienta el análisis de documentos del proceso judicial. Fueron seleccionados cinco casos para el estudio y los datos fueron analizados mediante la aplicación del método de análisis de contenidos temáticos. Los resultados señalaron que además de las cuestiones subjetivas, las motivaciones tienes sus raíces en factores externos, como el contexto en que vive la pareja, la violencia y el desgaste de la conyugalidad, la interrupción de los sueños, la falta de planificación del embarazo, el desempleo y la dificultad económica.(AU)

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.

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.

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.

Lifetime post-traumatic stress disorder in older individuals with a history of institutional upbringing in childhood: the role of social acknowledgement and stressful life events.

Background: Child maltreatment (CM), particularly in institutional contexts, can affect the development of post-traumatic stress disorder (PTSD). Research suggests that factors during CM (e.g. severity, variety, duration) and in the aftermath of CM (e.g. stressful life events, and social acknowledgement, i.e. the degree to which an individual feels validated and supported following a traumatic event) can explain some of the heterogeneity in PTSD development. However, there is a lack of research on long-term correlates of CM and mitigating factors, with only a few studies having been conducted with older survivors of institutional upbringing. Such research is relevant, given the long-term associations between CM and the older age status of many survivors. Objective: The current study examined the link between CM and PTSD in older individuals with a history of institutional upbringing (risk group; RG) and a matched control group (CG). Differences in stressful life events and social acknowledgement were also investigated. Method: Participants were n = 116 RG (Mage = 70.25 years, 41% female) and n = 122 CG (Mage = 70.71 years, 51% female). Data was assessed using self-report questionnaires and a clinical interview. Results: The RG reported higher levels of exposure to CM. Lifetime PTSD showed a bigger association with the level of exposure to CM, compared to having an institutional upbringing. Participants with higher CM levels reported more stressful life events. High levels of social acknowledgement mediated the relationship between CM and PTSD in the CG. Conclusions: Exposure to CM had a stronger association with PTSD than a history of institutional upbringing. In the CG, the survivors' perception of social acknowledgement ameliorated lifetime PTSD to a small extent. A critical issue for policy makers should be to enhance safeguarding measures against CM exposure, not only in institutional contexts, but also more generally, given the link to PTSD.

Antecedentes: El maltrato infantil (MI), particularmente en contextos institucionales, puede incidir en el desarrollo del trastorno de estrés postraumático (TEPT). La investigación sugiere que los factores durante el MI (ej. gravedad, variedad, duración) y en el periodo posterior al MI (ej. eventos estresantes de la vida y reconocimiento social, es decir, el grado en que un individuo se siente validado y apoyado después de un evento traumático) pueden explicar en parte la heterogeneidad en el desarrollo del TEPT. Sin embargo, hay una falta de investigación sobre los correlatos a largo plazo del MI y los factores atenuantes, y solo se han realizado unos pocos estudios con personas mayores que han sobrevivido a la crianza institucional. Dicha investigación es relevante, dadas las asociaciones a largo plazo entre MI y el estado a mayor edad de muchos sobrevivientes.Objetivo: El presente estudio examinó el vínculo entre MI y TEPT en personas mayores con antecedentes de crianza institucional (grupo de riesgo; GR) y un grupo de control emparejado (GC). También se investigaron las diferencias en los eventos vitales estresantes y el reconocimiento social.Método: Los participantes fueron N = 116 en GR (edad promedio = 70,25 años, 41% mujeres) y N = 122 en GC (edad promedio = 70,71 años, 51% mujeres). Los datos se evaluaron mediante cuestionarios de auto-reporte y una entrevista clínica.Resultados: El GR reportó niveles más altos de exposición a MI. El TEPT durante la vida mostró una mayor asociación con el nivel de exposición a MI, en comparación con la crianza institucional. Los participantes con niveles más altos de MI reportaron más eventos vitales estresantes. Altos niveles de reconocimiento social mediaron la relación entre MI y TEPT en el GC.Conclusiones: La exposición a MI tuvo una asociación más fuerte con el TEPT que el historial de crianza institucional. En el GC, la percepción de reconocimiento social de los sobrevivientes mejoró en pequeña medida el TEPT durante la vida. Una cuestión fundamental para los responsables de la formulación de políticas debería ser mejorar las medidas de protección contra la exposición a MI, no solo en contextos institucionales, sino también de manera más general, dado el vínculo con el trastorno de estrés postraumático.

Pressupostos para a escuta psicanalítica em instituição de acolhimento de crianças e adolescentes / Assumptions for psychoanalytic listening in a children's and adolescents' hostelling institution / Presupuestos para la escucha psicoanalítica en una institución de acogida para niños y adolescentes

Partimos do trabalho em uma instituição de acolhimento para crianças e adolescentes propondo uma escuta orientada pela psicanálise. Considerando as tensões entre instituição e psicanálise, a questão que nos orienta é de que forma a transferência pode contribuir para uma instauração de escuta, que permitirá a elaboração da situação de vulnerabilidade desses sujeitos. Utilizamos como método de pesquisa a revisão bibliográfica associada à psicanálise aplicada e recorremos aos fragmentos de recordação das situações vividas no cotidiano institucional. Concluiu-se que há um lugar de escuta sob transferência a ser considerada na instituição e que o Plano Individual de Atendimento (PIA) necessita ser efetivado sob transferência, para que seja implementado como instrumento que valorize o surgimento das singularidades dos acolhidos.

We started from work at a host institution for children and adolescents, proposing a listening guided by psychoanalysis. Considering the tensions between institution and psychoanalysis, the question that guides us is how the transfer can contribute to establishing a listening that will allow the elaboration of the situation of vulnerability of these subjects. We used as a research method the bibliographic review associated with applied psychoanalysis and we also used fragments of remembrance of the situations experienced in the institutional daily life. It was concluded that there is a place of listening under the transfer to be considered in the institution and that the Individual Assistance Plan needs to be carried out under the transfer in order to be implemented as an instrument that values the emergence of the singularities of the sheltered.

Partimos desde el trabajo en una institución de acogida para niños y adolescentes proponiendo una escucha orientada por el psicoanálisis. Considerando las tensiones entre institución y psicoanálisis, la cuestión que nos orienta es de qué forma la transferencia puede contribuir al establecimiento de un escuchar que permitirá la elaboración de la situación de vulnerabilidad de esos sujetos. Utilizamos como método de investigación la revisión bibliográfica asociada al psicoanálisis aplicado y recurrimos a los fragmentos de recuerdos de las situaciones de la vida cotidiana institucional. Concluimos que hay un lugar de escucha bajo transferencia a ser considerado en la institución y que el Plan Individual de Atención necesita ser efectivado bajo transferencia para que sea implementado como un instrumento que valore el surgimiento de las singularidades de los acogidos.

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.

[Pupil Mariela, what do an Orphanage and a Hospital have in common?] / Niña Mariela ¿qué tienen en común un Hogar y un Hospital?

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.

A pilot project: handwashing educational intervention decreases incidence of respiratory and diarrheal illnesses in a rural Malawi orphanage.

Children who live in orphanages represent a population particularly vulnerable to transmissible diseases. Handwashing interventions have proven efficacy for reducing the rate of transmission of common infectious diseases. Few studies have analyzed the delivery of health interventions for children in orphanages in sub-Saharan Africa. To address this gap, we conducted an ecological assessment and piloted a handwashing intervention in an orphanage in rural Malawi, focusing on caregiver knowledge and behaviors, child handwashing behaviors, and disease incidence. A secondary study aim was to demonstrate program feasibility for a future randomized controlled trial. Orphanage caregivers participated in a three-module educational intervention on handwashing based on WHO recommendations and workshops on how to teach the curriculum to children. Seventeen orphanage caregivers and 65 children were monitored for handwashing behavior and child disease incidence. Friedman's tests were conducted to compare changes in caregiver knowledge and behaviors. Child handwashing behaviors and surveillance of child disease incidence were measured pre- and post-intervention. There were significant increases in caregiver hand hygiene knowledge. At six months post-intervention, handwashing with soap increased significantly among caregivers (p < 0.001) and was observed in children. The incidence of acute respiratory infections decreased from 30% to 6% post-intervention, resulting in an 80% decrease. The incidence of diarrhea decreased from 9.2% to 6.2% post-intervention, resulting in a 33% decrease. A brief educational intervention may improve handwashing knowledge and behaviors and help to decrease the incidence of common infectious diseases in an orphanage in rural Malawi. In addition, the caregiver uptake of the intervention demonstrated feasibility for future studies.