Adoção tardia, filiação e devolução de crianças: uma realidade brasileira / Adopción tardía, filiación y devolución de niños: una realidad brasileña / Late adoption, filiation, and children devolution: a Brazilian reality / Adoption tardive, filiation et retour des enfants: une réalité brésilienne

O artigo trata da questão da adoção a partir da experiência de uma das autoras no Tribunal de Justiça do Rio de Janeiro. Apresenta as formas de adoção brasileiras, algumas em conformidade com as leis, outras realizadas de maneira informal. Examina as vicissitudes da adoção, entre as quais os casos de devolução. Procura, em seguida discutir suas consequências para o psiquismo, baseando-se nas interrogações sobre a filiação feitas pela psicanálise. Conclui com fragmentos da clínica, em que se trata de escutar os envolvidos ­trabalho a ser feito pela equipe de profissionais ­no intuito de facilitar caminhos pelos quais o sujeito venha a fazer para si um lugar e se exercer como sujeito de desejo

El artículo aborda el tema de la adopción a partir de la experiencia de una de las autoras en el Tribunal de Justicia de Rio de Janeiro. Presenta las formas de adopción brasileñas, algunas de acuerdo con las leyes, otras hechas de manera informal. Examina las vicisitudesde la adopción, incluso los casos de devolución. En seguida, busca discutir sus consecuencias para el psiquismo, basándose en las preguntas sobre la filiación planteadas por el psicoanálisis. Concluye con fragmentos de la clínica, en la cual se trata de escuchar a los implicados ­trabajo que debe realizar el equipe de profesionales ­para facilitar que lo sujeto venga a hacerse un lugar y se ejercer como sujeto de deseo

The article deals with the issue of adoption from the experience of one of the authors in the Court of Justice of Rio de Janeiro. It presents the Brazilian forms of adoption, some in accordance with the laws, others made informally. It examines the vicissitudes of adoption, including the cases of devolution. It then seeks to discuss its consequences for the psychism, based on the process of filiation as it is discussed by psychoanalysis. It concludes, using fragments of the clinic, in which it is about listening to those involved ­work to be done by the team of professionals ­,to facilitate the ways through which the subject will make himself a place and exercise himself as a subject of desire

L'article examine la question de l'adoption sur la base de l'expérience de l'un des auteurs de la Cour de Justice de Rio de Janeiro. Il présente les formes d'adoption brésilienne, certaines conformes aux lois, d'autres réalisées de manière informelle. Il examine les vicissitudes de l'adoption, y compris les cas de dévolution. Ensuite, il cherche à discuter ses conséquences sur le psychisme, à partir des questions d'affiliation posées par la psychanalyse. Il conclut, à partir de fragments de la clinique, qu'il s'agit d'écouter les personnes impliquées -travail à faire par l'équipe de professionnels -, facilitant ainsi les manières dont le sujet puisse faire un lieu pour soi et pour s'exercer en tant que sujet du désir

Prevalencia de sífilis en niños adoptados de Rusia / Prevalence of Syphilis in Children Adopted From Russia

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Auxological and endocrinological features in internationally adopted children.

In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.

Dermatoglyphic fluctuating asymmetry and total a-b ridge count as biomarkers of Foetal Alcohol Syndrome: Analysis in children adopted from Eastern Europe.

BACKGROUND: Dermatoglyphics, formed mainly during the second trimester of pregnancy have been used as markers of developmental disturbances. The aim of this study was to examine if dermatoglyphic variation in children adopted from Eastern European countries with differential prenatal alcohol exposure, could be associated with diagnosis of Foetal Alcohol Spectrum Disorder (FASD). METHODS: Total a-b ridge count (TABRC), total ATD angle (TATD), palpebral fissure asymmetry and fluctuating asymmetry of the a-b ridge count (FAABRC) and ATD angle (FAATD) were obtained from NO FASD (n = 40) and FASD (n = 145; FAS = 54, pFAS = 64; ARND = 13; ARBD = 14) individuals. NO FASD and FASD subgroups were statistically compared for dermatoglyphic variables. Correlations between dermatoglyphics and FASD diagnosis were also performed. RESULTS: TABRC showed significantly higher values in foetal alcohol syndrome (FAS, p = 0.006) and partial FAS (pFAS, p = 0.040) groups compared to NO FASD controls. Similar results were obtained for TATD (FAS, p = 0.015 and pFAS, p = 0.032) compared to controls. Significantly higher values in FAS, pFAS and alcohol-related neurodevelopmental disorders (ARND) groups were observed for FAABRC (p = 0.034, p = 0.007, p = 0.007 respectively) and for FAATD in FAS group (p = 0.014) compared to NO FASD. Additionally, FAS group with mean + 2SD in palpebral fissure asymmetry showed statistical significance compared to NO FASD (p = 0.018). Dermatoglyphic variables also correlated (rho, Spearman) significantly with FASD diagnosis. CONCLUSION: Dermatoglyphic pattern and FASD are related. The validation of dermatoglyphics as an associated marker with FASD together with the currently diagnostic tools would help clinicians to an early FASD diagnosis in children.

Grandparental Childcare for Biological, Adopted, and Step-Offspring: Findings From Cross-National Surveys.

Based on kin selection theory, amounts of grandparental investment should reflect the probability to share common genes with offspring. Adoption may represent a special case, however, yet grandparental investment in adopted children has previously been both theoretically misconstrued and little investigated. Here, we study for the first time how grandparental childcare provision is distributed between biological, adopted, and step-offspring. Using Generations and Gender Surveys (n = 15,168 adult child-grandmother and 12,193 adult child-grandfather dyads) and the Survey of Health, Ageing, and Retirement in Europe (n = 17,233 grandmother-adult child and 13,000 grandfather-adult child dyads), we find that grandparents were less likely to provide care to stepchildren than to adopted and biological children, but no difference between adopted and biological children. These findings were present in both data sets and for both grandmothers and grandfathers, after several potentially confounding factors were taken into account. The stepchild disadvantage is in line with kin selection theory. The congruent amounts of care provided to adopted and biological children may reflect similar levels of adult-child attachment, selection effects, and greater need in adoptive families, as well as some degree of genetical relatedness in the case of kin adoption. The study provides new evidence of biased kin investments in contemporary societies and stresses the importance of psychological motivation and attachment in evolutionary studies of kin investment.

Health status and nutritional development of adopted Ethiopian children living in southern Spain: A prospective cohort study.

OBJECTIVE: The first aim of this study was to evaluate the health status and anthropometrical development of adopted children from Ethiopia living in southern Spain. A second aim was to evaluate the association between these parameters and adherence to the Mediterranean dietary pattern. METHODS: The study sample included 53 adopted children from Ethiopia and a matched sample of 54 native-born children. A physical examination of the children, including height and weight, was conducted in Ethiopia at the time of entry into the adoption process. Height and weight were re-measured at the first day of adoption and 6, 12, and 24 mo after adoption. After 2 y of follow-up, another physical examination was performed, including the KIDMED test, to measure adherence to the Mediterranean diet. RESULTS: Skin and digestive conditions were the most prevalent disorders in Ethiopian children before adoption and at the end of follow-up. Baseline anthropometric characteristics indicated a low wasting prevalence (7.5%); however, stunted growth was more prevalent (35.8%). After 6 mo, the weight-for-age of Ethiopian children was restored (change from baseline P < 0.001), and not significantly different from the Spanish children at 1-y after adoption. Height-for-age also increased from baseline (P < 0.001. A higher KIDMED score was associated with increased weight-for-age (r = 0.279; P = 0.045) and height-for-age (r = 0.385; P = 0.004). CONCLUSIONS: This prospective study of adopted Ethiopian children confirmed a rapid growth development that occurred from the beginning of the adoption process and continued after the 2-y of follow-up. A higher adherence to the Mediterranean diet was associated with better growth development, which reinforces the importance of a balanced and adequate diet in growing children.

Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest. OBJECTIVE: To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children. DESIGN: Prospective observational cohort study SETTING: Western Sweden PARTICIPANTS: A population-based cohort of 37 adoptees diagnosed with FASD in childhood. OUTCOME MEASURES: Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist. RESULTS: Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18-28) and a mean follow-up time of 15.5 years (range 13-17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately -1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5-21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = 'severely ill'. CONCLUSION: Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

The place of environmental factors in multiple sclerosis: Genes, environment and the interactions thereof in the etiology of multiple sclerosis.

The relative roles of genes and environment (not intra-familial environment) and interactions thereof continue to confound better understanding of the pathogenesis of multiple sclerosis (MS) and can also impact recurrence risks for family members as well as genetic family studies. Strong evidence for non-familial environmental factors is suggested by the change in the sex ratio (female:male) of MS patients over the last four decades.

Adopted children who kill their adoptive parents.

The killing of parents, frequently referred to as parricide, is a disturbing phenomenon that often generates widespread media coverage. Most of the scholarly literature on this topic has focused on biological offspring who kill mothers and fathers. Some analyses have examined juveniles and adults who kill their stepparents. To date, virtually no research exists on children who kill their adoptive parents because this type of victim-offender relationship has been absent from available homicide databases, thereby preventing such analyses. The present study is a content analysis of news reports of 46 cases of adopted children who killed their adoptive parents in several different countries. Data pertaining to offender and victim demographics, incident characteristics, and the processing of offenders from the initial charge through conviction and sentencing are examined. To the extent possible, media accounts are used to classify cases according to motives or circumstances leading to the killings. The article concludes with a comparison of profiles of children who kill adoptive parents in relation to those who kill biological parents, important observations that emerged from these news accounts, and discussion of possible explanations of parricide by adopted children, including adopted children syndrome, reactive attachment disorder, and biological risk factors. Limitations of this study and directions for future research are addressed.

Interaction of genetic vulnerability to schizophrenia and family functioning in adopted-away offspring of mothers with schizophrenia.

OBJECTIVE: The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. METHODS: The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. RESULTS: Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2-11.4) and LR (OR = 2.6, 95% CI 1.1-6.3) adoptees, but not to early parental death or divorce. CONCLUSIONS: The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning.

Postinjection abscesses and granulomas in children adopted from Russia.

Up to 1.3 million children from the former Soviet Union (fSU) and Eastern Europe have been placed in institutional care worldwide. With the hope of ensuring the child's health in the immediate post-adoption period, these children are known to receive many injections of vaccines, vitamins, and medications, many unnecessary and often administered with unsafe technique. This practice can lead to formation of suppurative granulomas in these children. Though rare, dermatologists should be aware of these conditions in adoptees from Eastern Europe.

Prevalence of fetal alcohol spectrum disorder among special subpopulations: a systematic review and meta-analysis.

AIM: To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use). DESIGN: Systematic literature review and meta-analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country-, disorder- [FASD and fetal alcohol syndrome (FAS)] and population-specific random-effects meta-analyses conducted. SETTING AND PARTICIPANTS: A number of service-defined subpopulations globally (see Findings). MEASUREMENTS: The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool. FINDINGS: We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10-40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9-11.7) global FASD prevalence in the general population. CONCLUSIONS: Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem.

Utility of tuberculin skin test and IGRA for tuberculosis screening in internationally adopted children: Retrospective analysis from a single center in Florence, Italy.

BACKGROUND: Most of internationally adopted children (IAC) come from countries in which tuberculosis (TB) is endemic. Interpretation of discordant Tuberculin Skin Test (TST) and Quantiferon-Gold In Tube (QFT) results is under debate. METHODS: Children consecutively referred to our IAC Center between 2009-2017 were prospectively evaluated and screened with protocol recommended by the America Academy of Pediatrics, including TST and QFT. TB infection prevalence was evaluated and possible risk factors associated with discordant TST/QFT results were investigated. RESULTS: 1775 IAC were enrolled (median age: 5.8; IQR:3.3-8.2; 1065 [60.0%] males). Most of the children came from a European country (715; 40.3%) and, among them, 428 (59.9%) from Russia. Active pulmonary TB was diagnosed in 7 (0.4%) children while LTBI was diagnosed in 255 (14.4%) children. Concordant TST-/QFT-result was observed in 1520 (85.6%) children, concordant TST+/QFT + result in 63 children (3.5%), while 169 children (9.5%) displayed TST+/QFT-result and the remaining 23 children (1.3%) TST-/QFT+. Factor significantly associated with discordant TST+/QFT-result was BCG vaccination (aOR:2.62; 95%CI. 1.12-6.12; P = 0.026) and age <5 years (aOR: 5.59; 95%CI:2.27-12.18; P < 0001). . No significant association was evidenced with, continent of origin, eosinophilia or gender. CONCLUSIONS: Our data suggest that QFT might be used as unique screening assay in IAC, but further studies are needed at this regard.

Active immunization status against measles, mumps, rubella, hepatitis B in internationally adopted children, surveyed at the university hospital of Palermo, Sicily.

INTRODUCTION: The internationally adopted child is a fragile subject who often shows an incomplete health documentation, which hinders the complete assessment of health status. MATERIALS AND METHODS: Between January 2010 and June 2016, at the University Hospital "AOUP P. Giaccone" of Palermo, we reviewed the health documentations of 111 children recently arrived in Italy following the conclusion of the international adoption procedure. 62.2% of the children were male, of various nationalities and with an average age of 7 years (± 3.4). This study aims to detect, in the observed sample, the reliability of the vaccinal documentation and the real acquired immunization. We intend to estimate the presence of IgG against Measles, Mumps, Rubella and Hepatitis B viruses. RESULTS: Percentages of subjects with a complete correspondence between documentation attesting the successful vaccination and the effective immunization were: 78% for measles, 66% for mumps, 84% for rubella, 71% for hepatitis B. Percentages of subjects without vaccinal documentation but with positive evidence of IgG were: 50% for measles, 38% for mumps, 71% for rubella, 50% for hepatitis B. CONCLUSIONS: The partial correspondence found between vaccinations performed and real immune status can be attributed to several reasons: poor reliability of the received health documentation, the complex economic situation of the health services in the countries of origin, the incorrect vaccines storage or the administration beyond the expiration date, the poor immunological response due to concomitant diseases or severe malnutrition, the probable non-administration of the expected booster dose. Particular attention needs to be paid to this population, which may represent a risk group susceptible to vaccine-preventable diseases.

Epidemiology and risk factors of hypovitaminosis D in a cohort of internationally adopted children: a retrospective study.

BACKGROUND: Predictors of hypovitaminosis D were extensively studied in the adult population, leading to an approximately complete understanding of them, while there is a lack of studies in the pediatric population, especially in migrant and internationally adopted children. In this retrospective study, we tried to identify the major laboratory predictors of hypovitaminosis D in a cohort of internationally adopted children. METHODS: Data were extracted from the database of the "Ethnopediatrics Outpatient Clinic" of the "A. Gemelli" Foundation University Hospital in Rome, Italy. Our study included 873 children evaluated from March 2007 to May 2016. Analysis of variance, chi square test, t test and multivariate logistic regression were performed, a "p" value < 0.05 was considered significant, with a confidence interval of 95%. RESULTS: We did not find any significant correlation between Vitamin D and Calcium, Phosphates or Magnesium levels within the population we examined. Moreover, parathyroid hormone is not a good predictor of Vitamin D Status. CONCLUSIONS: Considering the strong influence Vitamin D status has not only on bone health, but also on general well-being, it is due to perform a vitamin D assessment as soon as possible, especially in internationally adopted children.

Internationally adopted children: not only infectious diseases!

Information on prevalence of special needs in internationally adopted children (IAC) is incomplete. We reviewed data from 422 IAC screened at a single Centre in Italy in 2015-16. Prevalence of special needs reached 17.1% (n = 72). Among these children, the most frequent conditions were fetal alcohol spectrum disorders (FASD; n = 30; 7.1%), cleft lip palate (n = 8; 1.9%) and other congenital malformations (n = 20; 4.7%). Worrisomely, 25 out of 52 (48.1%) Russian children presented with FASD.

Adult psychosocial outcomes of men and women who were looked-after or adopted as children: prospective observational study.

OBJECTIVE: To investigate whether men and women who were looked-after (in public care) or adopted as children are at increased risk of adverse psychological and social outcomes in adulthood. DESIGN, SETTING: Prospective observational study using the Avon Longitudinal Study of Parents and Children, which recruited pregnant women and their male partners in and around Bristol, UK in the early 1990s. PARTICIPANTS: 8775 women and 3654 men who completed questionnaires at recruitment (mean age: women 29; men 32) and 5 years later. EXPOSURE: Childhood public care status: looked-after; adopted; not looked-after or adopted (reference group). OUTCOMES: Substance use (alcohol, cannabis, tobacco) prepregnancy and 5 years later; if ever had addiction; anxiety and depression during pregnancy and 5 years later; if ever had mental health problem; social support during pregnancy; criminal conviction. RESULTS: For women, 2.7% were adopted and 1.8% had been looked-after; for men, 2.4% and 1.4%, respectively. The looked-after group reported the poorest outcomes overall, but this was not a universal pattern, and there were gender differences. Smoking rates were high for both the looked-after (men 47%, women 58%) and adopted (men 44%, women 40%) groups relative to the reference group (both 28%). The looked-after group were at increased risk of a high depression score (men: 26% vs 11%, OR 2.9 (95% CI 1.5 to 5.6); women: 24% vs 9%, 3.4 (2.2 to 5.0)). A high anxiety score was reported by 10% of the reference women, compared with 26% of those looked-after (3.0 (2.0 to 4.5)) and 17% of those adopted (1.8 (1.2 to 2.6)). Looked-after men and women reported the lowest social support, while criminal convictions and addiction were highest for looked-after men. Adjustment for adult socioeconomic position generally attenuated associations for the looked-after group. CONCLUSIONS: The needs of those who experience public care as children persist into adulthood. Health and social care providers should recognise this.

Glucose-6-phosphate dehydrogenase deficiency in internationally adopted children.

There are conflicting guidelines about screening of internationally adopted children for glucose-6-phosphate dehydrogenase (G6PD) deficiency, a common genetic disorder. In a multi-ethnic population of 2,169 internationally adopted children, we found that the prevalence of G6PD deficiency was 1.6% overall and 2.2% in males. Prevalence differed by country or region of origin, ranging from 0 to 13% overall and 0 to 22% in males. The prevalence in females was 1%. A diagnosis of G6PD deficiency informs the treatment of malaria and enables education and counseling to prevent morbidity and mortality from G6PD deficiency. Screening for G6PD deficiency should be strongly considered for internationally adopted children.

Susceptibility to allergy in adoptive children: a cross-sectional study at "Bambino Gesù Children's Hospital".

BACKGROUND: Prevalence of allergy has steeply increased during the past few decades, particularly in high-income countries. The development of atopy could present different characteristics in internationally adopted children with regard to incidence, specific patterns of allergies and timing of occurrence. We aimed to investigate the occurrence of allergic diseases among adopted children in Italy. METHODS: We collected demographic information, preadoption immunization data, infectious diseases screening results, immunological status, and performed hematological and biochemical tests according to a standardized protocol in 108 adopted children. RESULTS: At initial visit (mean age was 5.7 ± 3.2 years), 48 children displayed elevated total serum IgE levels with a prevalence of 56.5% (95%CI: 0.45; 0.67). The prevalences of children screened positive for one or more food allergens and inhalants were 30.1% (95%CI: 19.9%; 42.0%) and 34.3% (95%CI: 23.3%; 46.6%) respectively, only 9 children exhibited abnormal absolute eosinophil counts, 23 (21.3%) had a parasitic infection and 60 (55.6%) had received at least one dose of vaccine. CONCLUSIONS: Children without medical records or with a past medical history suggestive of atopy should perform a thorough allergy evaluation at the time of adoption. Our study offers also a glimpse at the vaccination status and immune-allergic profiles of recent migrant children in Italy.

Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study.

Ferrara P, Cutrona C, Guadagno C, Amodeo ME, Del-Vescovo E, Ianniello F, Petitti T. Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study. Turk J Pediatr 2018; 60: 464-466. Internationally adopted infants experienced profound institutional deprivation in early infancy. Adoption may have a positive effect on child development, providing a massive catch-up growth in the developmental parameters. In this preliminary study we examined the effect of family deprivation on abandoned children placed in high quality foster care during infancy. We also investigated the presence of a growth delay in Italian domestic adoptees at the time of family placement and the potential physical recovery after adoption. Anthropometric measures (weight, length or height /head circumference) and Body Mass Index (BMI) were measured on arrival (T0) and 6 (T1), 12 (T2) and 24 months (T3) after adoption. The results show moderate delays in physical growth on the children`s arrival into the adoptive family and a significant catch-up growth in all auxological parameters from T < sub > 0 < /sub > to T < sub > 3 < /sub > . This is one of few Italian studies that points out a positive change in trajectories of growth after child adoption.