[Abused child or suspected abused child: caregiving]. / La prise en soins de l'enfant victime ou suspecté victime de maltraitance.

Optimal care for abused children and their families can only be achieved through joint and committed endeavours from scientists, social workers and judiciary. The topic of child abuse and neglect will be introduced by a short account of the evolution of the status of the child in Western society. This clinic will be approached in its systemic dimension and will examine the place of the child in the family system and society in general. Clinical intervention intricacy as well as widely varying factors to be taken into account such as protection, ethics, therapy, way of life etc... will bring us to consider a number of precautionary guidelines for caregivers. By way of conclusion we will set out the FW-B caregiving system as put into practice by the teams of SOS Enfants.

Viser l'excellence dans la prise en soins de l'enfant maltraité et de sa famille ne peut se réaliser qu'avec un engagement entier et concerté des mondes scientifique, sociaux et judiciaire. Un bref historique de l'évolution du statut de l'enfance dans nos sociétés occidentales servira d'introduction au sujet de la maltraitance infantile. Cette clinique sera abordée essentiellement dans sa dimension systémique et interrogera la place de l'enfant dans le système familial et plus généralement sociétal. La complexité de l'intervention clinique liée à l'intrication de dimensions diverses, protectionnelles, déontologiques, thérapeutiques, culturelles, etc. nous amènera à prendre en compte certains principes de précaution utiles pour le soignant. Nous terminerons en présentant le dispositif de soins propre à la Fédération Wallonie-Bruxelles (FW-B) à savoir celui des équipes SOS Enfants et les modalités pratiques d'intervention de ces professionnels.

Hidden suppression of sex ratio distortion suggests Red queen dynamics between Wolbachia and its dwarf spider host.

Genetic conflict theory predicts strong selection for host nuclear factors suppressing endosymbiont effects on reproduction; however, evidence of these suppressors is currently scarce. This can either be caused by a low suppressor evolution rate, or if suppressors originate frequently, by rapid spread and concurrent masking of their activity by silencing the endosymbiont effect. To explore this, we use two populations of a dwarf spider with a similar female bias, caused by a Wolbachia infection. Using inter- and intrapopulation crosses, we determine that one of these populations demonstrates a higher suppressing capability towards Wolbachia despite having a similar population sex ratio. This suggests that spider and endosymbiont are locked in so-called red queen dynamics where, despite continuous coevolution, average fitness remains the same, hence hiding the presence of the suppressor. Finding different suppressor activity in populations that even lack phenotypic differentiation (i.e. similar sex ratio) further supports the hypothesis that suppressors originate often, but are often hidden by their own mode of action by countering endosymbiont effects.

Comparative genomic study of arachnid immune systems indicates loss of beta-1,3-glucanase-related proteins and the immune deficiency pathway.

Analyses of arthropod genomes have shown that the genes in the different innate humoral immune responses are conserved. These genes encode proteins that are involved in immune signalling pathways that recognize pathogens and activate immune responses. These immune responses include phagocytosis, encapsulation of the pathogen and production of effector molecules for pathogen elimination. So far, most studies have focused on insects leaving other major arthropod groups largely unexplored. Here, we annotate the immune-related genes of six arachnid genomes and present evidence for a conserved pattern of some immune genes, but also evolutionary changes in the arachnid immune system. Specifically, our results suggest that the family of recognition molecules of beta-1,3-glucanase-related proteins (ßGRPs) and the genes from the immune deficiency (IMD) signalling pathway have been lost in a common ancestor of arachnids. These findings are consistent with previous work suggesting that the humoral immune effector proteins are constitutively produced in arachnids in contrast to insects, where these have to be induced. Further functional studies are needed to verify this. We further show that the full haemolymph clotting cascade found in the horseshoe crab is retrieved in most arachnid genomes. Tetranychus lacks at least one major component, although it is possible that this cascade could still function through recruitment of a different protein. The gel-forming protein in horseshoe crabs, coagulogen, was not recovered in any of the arachnid genomes; however, it is possible that the arachnid clot consists of a related protein, spätzle, that is present in all of the genomes.

Flow cytometric sexing of spider sperm reveals an equal sperm production ratio in a female-biased species.

Producing equal amounts of male and female offspring has long been considered an evolutionarily stable strategy. Nevertheless, exceptions to this general rule (i.e. male and female biases) are documented in many taxa, making sex allocation an important domain in current evolutionary biology research. Pinpointing the underlying mechanism of sex ratio bias is challenging owing to the multitude of potential sex ratio-biasing factors. In the dwarf spider, Oedothorax gibbosus, infection with the bacterial endosymbiont Wolbachia results in a female bias. However, pedigree analysis reveals that other factors influence sex ratio variation. In this paper, we investigate whether this additional variation can be explained by the unequal production of male- and female-determining sperm cells during sperm production. Using flow cytometry, we show that males produce equal amounts of male- and female-determining sperm cells; thus bias in sperm production does not contribute to the sex ratio bias observed in this species. This demonstrates that other factors such as parental genes suppressing endosymbiont effects and cryptic female choice might play a role in sex allocation in this species.

[Clinical evaluation of adherence to antiretroviral therapy in adolescents infected by HIV since infancy]. / Évaluation clinique de l'adhésion au traitement antirétroviral chez des adolescents infectés par le VIH depuis la petite enfance.

OBJECTIVE: To assess the adherence to antiretroviral therapy in adolescents infected by HIV since early childhood and to determine its medical and psychosocial determinants. METHODS: The study was based on patient interviews to administer 2 adherence questionnaires. The medical charts were reviewed for the record of the latest CD4 counts, viral load, and sociodemographic characteristics. RESULTS: Thirty-two HIV-infected adolescents were enrolled in the study. Only 15 of 32 of them (47%) claimed adherence greater than 95%, whereas 26 of 32 (81%) had a viral load less than 50 copies/mL. The adolescents with an undetectable viral load had a median adherence rate significantly higher than adolescents with virological failure (100 versus 83.5%; P=0.01). Among the latter, 5 out of 6 patients acknowledged adherence less than 95% versus 12 of 26 patients with an undetectable viral load. Having forgotten was the main reason reported for skipping medication doses. Fear of being seen while taking the pills differentiated adolescents with adherence less than 95% from the others (79 versus 33%; P=0.01). CONCLUSION: The self-reported adherence rate evaluated by questionnaire was associated with control of the viremia. However, the significance of these rates and the thresholds used have to be interpreted taking into account the characteristics of the drugs as well as the patients' treatment history. The reasons for skipping treatment doses are related to the adolescent process and the representations that the adolescent has of his illness.

[The out-of-home care of HIV-infected children]. / L'accueil de l'enfant infecté par le VIH dans le milieu scolaire et résidentiel.

OBJECTIVE: To improve the conditions of out-of-home care of HIV-infected children. METHODS: Group discussions including staff members of 28 institutions having cared for an HIV-infected child with the objective to share 4 points of view: those of the HIV-infected child, of his parents, of the medical staff and of the out-of-home care professionals. RESULTS: Care professionals are uncomfortable with the confidentiality surrounding the diagnosis. The feeling of better controlling the risks justifies their wish to obtain medical information, although these risks are ill-defined. The contributions of the parents of HIV-infected children shed a light on the link between the disclosure of the child's diagnosis and their intimacy and family history. Role-playing games with constructed scenarios revealed fixed and absurd aspects of certain beliefs and the difficulties to put in practice the acquired knowledge. The legitimacy of desire of parenthood in HIV-infected adults was questioned by some of the care professionals and their social representation of the person living with HIV appeared ambiguous, reminding the stigma these families are still victims of. CONCLUSION: Improving the conditions of out-of-home care of HIV-infected children requires ethical, legal and scientific counseling and discussions in the setting that should occur independently of the presence of a child with HIV. The disclosure of the diagnosis should only occur, if necessary, for their well-being, with their or their parents' agreement.

[The beaten child: psychological aspects]. / L'enfant battu: aspects psychologiques.

Well beyond its effects on the body, physical abuse spoils a child's future by jeopardizing its living "tools" to become a woman, a man, a parent. Several clinical vignettes will illustrate the various psychosocial damages of physical abuse as well as the coping strategies the child will use to outlive these threatening situations. We will then thouroughly explore the process that underlies these situations of abuse and stress the importance of the dynamics the abusive family is engaged in. The identification of risk factors completes the global assessment of these critical situations. Taking charge of these problems requires to address the difficult question of the child protection as well as the emotional burden the helping staff is facing. This stresses the need for specialized teams and therapeutical networks to handle these difficult situations. The hospitalization of the child, when not medically justified, may not be useful but its negative effects must not be underestimated. We will end this paper with some comments about the future of these children, which is not necessarily as dark as some might forecast.