Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3–17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6–66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33–2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.

A Novel Approach for Healthcare Information System using Cloud

The main objective of this paper is to outline a Cloud Computing based Healthcare Information System that helps bridge the gap between various hospitals, patients and clinics by creating a central hub of patient details and health care history that is accessible via two interfaces- either the mobile app or the web application.

Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices

Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.

Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature

Background. Although lumbar isthmic spondylolisthesis is frequent in the Caucasian population, its association with spondylodiscitis is extremely rare. Case Description. The authors reported the case of a 44-year-old patient affected by pyogenic spondylodiscitis on previously documented isthmic spondylolisthesis at the L5-S1 level. The patient was surgically treated by circumferential arthrodesis combining anterior lumbar interbody fusion (ALIF), followed by L4-S1 percutaneous osteosynthesis using the same anesthesia. Appropriate antibiotherapy to methicillin-susceptible Staphylococcus aureus, found on the intraoperative samplings, was then delivered for 3 months, allowing satisfactory evolution on the clinical, biological, and radiological levels. Discussion. This is the first case report of spondylodiscitis affecting an isthmic spondylolisthesis surgically treated by circumferential arthrodesis. In addition to providing large samplings for analysis, it confirms the observed evolution over the past 30 years in modern care history of spondylodiscitis, increasingly including surgical treatment with spinal instrumentation, thus avoiding the need of an external immobilization. Care must nonetheless be exercised in performing the ALIF because of the inflammatory tissue increasing the risk of vascular injury. Conclusion. Spondylodiscitis occurring on an L5-S1 isthmic spondylolisthesis can be safely managed by circumferential arthrodesis combining ALIF then percutaneous osteosynthesis in the same anesthesia, obviously followed by appropriate antibiotherapy.

The looked-after child in time: Creating and analysing longitudinal data on placement history and educational outcomes

Background with rationaleThe Scottish government collects data on Looked-after-children (LAC) from the 32 local authorities (LAs) in Scotland. Since 2008, the LAs have provided individual data on a yearly basis that covers every child who was looked after at any time during the year up to the Census date. These data have been linked to data on educational outcomes for these children. Cross-sectional analysis by the Scottish Government show that the educational outcomes for these children are much poorer than for other children in Scotland. This presentation will discuss methods to create a longitudinal data set from these data and thus infer how a child’s lifetime history of care relates to their educational outcomes. Main AimTo relate the children’s educational outcomes (school attendance and exclusion) to their history of being in care. Features of their care history include, age a start of care, number and type of care episodes (e.g. at home, with relatives, in foster care or residential care) as well as their legal reasons for being in care. Methods/ApproachThese data present a number of challenges to achieving the aim. The process of creating longitudinal records from nine cross-sectional samples revealed many data problems. A child’s history in care can potentially last from birth to aged 16, or even older, but the data available was for a nine-year window (2008 to 2017) along with some details of episodes that started before 2008 for those in care later. Individual histories were either right-censored or left-truncated. The latter posed a bigger problem for our analyses since most of the early history is missing for a large proportion of the children. The methods used involved using multiple imputation methods to infer the age at start of care and the number of previous episodes for these children. ResultsWe will compare the results from the longitudinal analyses with those obtained from cross-sectional results. ConclusionLongitudinal data provides the opportunity to understand which patterns of care are associated with the poorest educational outcomes.

Foster care, syndemic health disparities and associations with HIV/STI diagnoses among young adult substance users

ObjectivesFoster care history is associated with many health and social problems, including sexual risk behaviours, HIV and other sexually transmitted infections (STIs). This cross-sectional study compares sexual risk behaviours among a sample of young adult substance users in Miami (N=602) with and without foster care histories.MethodsParticipants completed a comprehensive assessment which included sections on foster care, sexual risk behaviours and related health and social problems. Logistic regression was used to examine the relationship between foster care history, associated syndemic vulnerabilities and increased likelihood of having a prior HIV/STI diagnosis.ResultsBivariate analyses indicated that foster care alumni were more likely to report a prior HIV/STI diagnosis, higher condomless sex frequencies, being high on alcohol or drugs during sex, sexual victimisation and a history of homelessness compared with other participants in the sample (p<0.05). Multivariate analyses revealed that foster care history, sexual victimisation and group sex participation are associated with a prior HIV/STI diagnosis (p<0.05). Group sex participation doubled the odds of a prior HIV/STI diagnosis for foster care alumni, compared with other participants (p<0.5).ConclusionsThis exploratory study identifies characteristics that distinguish foster care alumni from non-alumni and signals the need to better serve the sexual and related health needs of individuals with foster care histories. Clinicians and healthcare providers should provide foster care alumni with detailed HIV/STI risk reduction information and resources and services to address related syndemic vulnerabilities (eg, victimisation and homelessness).