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Crowdsourcing is an emerging tool for collaboration and innovation platforms. Recently, crowdsourcing platforms have become a vital tool for firms to generate new ideas, especially large firms such as Dell, Microsoft, and Starbucks, Crowdsourcing provides firms with multiple advantages, notably, rapid solutions, cost savings, and a variety of novel ideas that represent the diversity inherent within a crowd. The literature on crowdsourcing is limited to empirical evidence of the advantage of crowdsourcing for businesses as an innovation strategy. In this study, Starbucks’ crowdsourcing platform, Ideas Starbucks, is examined, with three objectives: first, to determine crowdsourcing participants’ perception of the company by crowdsourcing participants when generating ideas on the platform. The second objective is to map users into a community structure to identify those more likely to produce ideas; the most promising users are grouped into the communities more likely to generate the best ideas. The third is to study the relationship between the users’ ideas’ sentiment scores and the frequency of discussions among crowdsourcing users. The results indicate that sentiment and emotion scores can be used to visualize the social interaction narrative over time. They also suggest that the fast greedy algorithm is the one best suited for community structure with a modularity on agreeable ideas of 0.53 and 8 significant communities using sentiment scores as edge weights. For disagreeable ideas, the modularity is 0.47 with 8 significant communities without edge weights. There is also a statistically significant quadratic relationship between the sentiments scores and the number of conversations between users.

This research examines deviant tourist behaviors that are posted online. Such behaviors result in value co-destruction as tourists who negatively interact with a service offering reduce value for p...

Resume L’obesite, definie par un exces de masse grasse, represente un probleme majeur de sante publique. Sa prevalence a fortement augmente a l’echelle mondiale depuis la seconde moitie du XXe siecle, a tel point que l’on parle « d’epidemie » d’obesite ou encore de « globesite ». Au vu des resultats souvent insuffisamment probants des mesures physiques et nutritionnelles, l’indication de chirurgie bariatrique peut etre posee des l’adolescence pour des cas d’obesite severe, apres echec d’autres strategies therapeutiques. L’indication de cette chirurgie pour les patients mineurs est encadree en France par les recommandations de la Haute Autorite de Sante publiees en 2016. Elle a pu montrer pour cette population son efficacite a court terme sur la reduction de l’Indice de Masse Corporelle, le traitement des comorbidites et une amelioration de la qualite de vie. Cependant la reussite a la chirurgie n’est pas systematique et des donnees de l’evolution a plus long terme de ces adolescents sont requises pour apprehender au mieux cette chirurgie. Il est primordial de reperer et renforcer des elements de motivation interne et de capacites d’adaptation du jeune, afin d’affiner la demande et d’ameliorer l’efficacite de la chirurgie. Elle s’integre dans une prise en charge pluridisciplinaire indispensable.

La haine est un affect qui traverse tous les individus et participe a la construction du sujet. Constitutive du psychisme, elle se manifeste sous diverses expressions des la toute petite enfance. L’histoire clinique de Manon, bebe tyrannique, illustre cette rencontre avec la haine. Le suivi psychotherapique permet de comprendre ce qu’il en est des possibles origines de cette haine et des mecanismes psychopathologiques qui la regissent.

Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one’s arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.

BackgroundMitochondrial disorders (MD) are metabolic diseases related to genetic mutations in mitochondrial DNA and nuclear DNA that cause dysfunction of the mitochondrial respiratory chain. Cognitive impairment and psychiatric symptoms are frequently associated with MD in the adult population. The aim of this study is to describe the neuropsychological profile in children and adolescents with MD.MethodsWe prospectively recruited a sample of 12 children and adolescents between February 2019 and February 2020 in the Reference Center for Mitochondrial Disorders of Angers (France). Participants and their parents completed an anamnestic form describing socio-demographic data and completed the WISC-V (Wechsler Intelligence Scale for Children, 5th edition) and the Parent and Teacher forms of the BRIEF (Behavior Rating Inventory of Executive Function).ResultsIn our sample, the mean IQ (Intellectual Quotient) score was 87.3 ± 25.3. The score ranged from 52 to 120. Concerning executive functions, a significant global clinical complaint was found for parents (six times more than normal) and to a lesser extent, for teachers (among 3 to 4 times more). Levels of intelligence and executive functioning were globally linked in our cohort but dissociation remains a possibility.ConclusionThe results of this study show that MD can be associated to neuropsychological disorders in children and adolescents, especially regarding the intelligence quotient and the executive function. Our study also highlights the need for regular neuropsychological assessments in individuals with MD and developing brains, such as children and adolescents.

Eating disorders (EDs) are common conditions that mainly affect women of reproductive age and have a major impact on fertility. Our systematic review focuses on the prevalence of EDs in patients in the process of assisted reproductive technique (ART) and describes the phenotypes of EDs identified.Our systematic review is based on the PRISMA criteria. Articles were collected using the Medline/Pubmed, Web Of Science and Cochrane databases. The articles chosen had to mention the prevalence of ED in infertile patients undergoing ART and be cohort or case-control studies assessing the prevalence of ED during fertility treatment.Fifteen articles were included in this review. The prevalence of active ED varied between 0.13 and 44% depending on the types considered in each study. The main phenotypes described were EDNOS (eating disorder not otherwise specified) and binge eating disorders (BED) occurring in women with a normal body mass index (BMI) and a history of ED. Mainly subthreshold forms with cognitive distortions were described.This review highlights a 6 times higher prevalence of EDs in infertile patients undergoing fertility treatment compared to regular pregnant women. However, diagnosing these conditions is complex. As a result, it is essential that professionals in contact with this population are alert to symptoms consistent with these conditions in order to refer them to specialized psychiatric care.RéSUMé: INTRODUCTION: les troubles des conduites alimentaires (TCA) sont des pathologies fréquentes affectant principalement les femmes en âge de procréer avec un impact majeur sur la fertilité. Notre revue de la littérature s’intéresse à la prévalence du trouble chez les sujets inscrits dans un processus d’assistance médicale à la procréation (AMP) et décrit les phénotypes des TCA repérés. MéTHODE: notre revue de la littérature se base sur les critères PRISMA. Les articles ont été collectés en utilisant les bases de données Medline/Pubmed, Web Of Science et Cochrane. Les articles sélectionnés devaient faire état de la prévalence des TCA chez les sujets infertiles recourant à une AMP, être des études de cohorte ou cas-témoins évaluant la prévalence des TCA au cours d’une AMP. RéSULTATS: quinze articles ont été inclus dans cette revue. Les prévalences de TCA actifs variaient entre 0,13 et 44% en fonction des formes considérées. Les principaux phénotypes décrits étaient les formes non spécifiques (EDNOS) et hyperphagiques (BED) survenant chez des femmes avec un indice de masse corporel (IMC) normal et présentant des antécédents de TCA. Il était décrit des formes subsyndromiques prédominées par des distorsions cognitives. CONCLUSION: cette revue met en évidence une prévalence de TCA supérieure chez les sujets infertiles recourant à une AMP par rapport aux femmes enceintes en population générales. Leur diagnostic est cependant complexe. Il est donc capital que les professionnels au contact de cette population soient vigilants aux symptômes évocateurs afin d’orienter vers une prise en charge spécialisée.Eating disorders are frequent pathologies that primarily affect women of childbearing age. Numerous articles reveal an increased risk for the mother and the child in case of an active disorder during pregnancy.We conducted a systematic review to determine the prevalence and phenotypes of eating disorders in infertile subjects undergoing fertility treatment.The results of the fifteen articles included show a prevalence six times higher than in pregnant women in the general population. Subjects with eating disorders have normal body mass indexes. The active forms are mainly characterized by episodes of binge eating disorders or other unspecified forms. Studies also describe incomplete forms characterized by the presence of dysfunctional thoughts around shape and weight without associated compensatory behavior.Professionals working in the field of reproductive medicine and providing fertility treatment have a major role to play in identifying and referring these subjects at risk to specialized care.

This study aims to explore the moderating roles of supervisor-subordinate guanxi and employee creativity in the perceived organizational support-organizational commitment-turnover intention link in the Chinese hotel organizations. Using a matched sample of 85 supervisors and 249 subordinates from 13 hotels in Shenzhen, China, we found that both supervisor-subordinate guanxi and employee creativity altered the relationships of perceived organizational support, affective commitment and employee prequitting behaviors. A significant conditional direct effect of perceived organizational support on prequitting behaviors was moderated by low supervisor-subordinate guanxi. Furthermore, a significant conditional indirect relationship between perceived organizational support and prequitting behaviors was found at high employee creativity. Moreover, interactive effect of affective commitment and employee creativity exerted a significant negative effect on prequitting behaviors. Findings shed light on the changing traditional values in modern management practices and the conditions under which organizations can improve employee retention. Theoretical and practical implications for talent management are discussed.

Patients with autoimmune encephalitis (AE) are likely to exhibit an acute onset of severe psychiatric features, including psychosis and/or catatonia. Based on the high prevalence of catatonia in AE and our clinical experience, we hypothesized that catatonia might be a marker of severity requiring more aggressive treatment approaches.To reach a sufficient number of cases with brain-autoimmune conditions, we pooled two samples (N = 58): the first from the French National Network of Rare Psychiatric diseases and the second from the largest Italian neuro-pediatrics center for encephalopathies. Autoimmune conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. We retrospectively compared patients with and without catatonia for psychiatric and non-psychiatric clinical features, biological and imaging assessments, type of immunotherapy used and outcomes.The sample included 25 patients (43%) with catatonia and 33 (57%) without catatonia. Forty-two patients (72.4%) had a definite AE (including 27 anti-NMDA receptor encephalitis) and 16 (27.6%) suspected autoimmune encephalitis. Patients with catatonia showed significantly more psychotic features [18 (72%) vs 9 (27.3%), p 0.001)] and more movement disorders [25 (100%) vs 20 (60.6%), p 0.001] than patients without catatonia. First line (corticoids, immunoglobulin and plasma exchanges) and second line (e.g., rituximab) therapies were more effective in patients with catatonia, with 24 (96%) vs 22 (66.7%) (p = 0.006) and 17 (68%) vs 9 (27.3%) (p = 0.002), respectively. However, those with catatonia received more combinations of first and second line treatments and had more relapses during outcomes.Despite its exploratory design, the study supports the idea that autoimmune catatonia may be a marker of severity and morbidity in terms of initial presentation and relapses, requiring the need for early and aggressive treatment.

International audience; The early recognition of ASD in adults is challenging, in particular due to the lack of appropriate and robust diagnostic tools. We performed a psychometric validation and diagnostic accuracy study of the French version of the RAADS-R on a sample of 305 adults: 105 with ASD without ID, 99 with psychiatric disorders, and 103 non-psychiatric control groups. The French version of the RAADS-R demonstrates good reliability and diagnostic validity, suggesting that it can help clinicians during the diagnostic process in adults with ASD without ID. However, the finding that a two-factor structure better fits the results requires further validation. This study point out the need of further study of RAADS in psychiatric disorders group due to the relatively high false positive rate (55.6%) of ASD.

Background: Mitochondrial disorders (MD) are a group of clinically heterogeneous genetic disorders resulting from dysfunction of the mitochondrial respiratory chain. Cognitive impairment is a common feature in adults with MD and psychiatric symptoms are associated with MD in up to 70% of the adult population. The aim of this study is to describe the psychiatric profile in children and adolescents with MD by focusing on the description of psychiatric symptoms.Methods: A cohort of 12 children and adolescents was prospectively recruited between February 2019 and February 2020 in the Reference Center for Mitochondrial Disorders of Angers (France). Participants and their parents completed an anamnestic form to provide socio-demographic data and completed the Global Assessment of Functioning scale, the Brief Psychiatric Rating Scale, the Child Depression Inventory, the Revised Children's Manifest Anxiety Scale, and the Conner's Rating Scale to evaluate the inattention/hyperactivity symptoms as well as the Quality of Life scale.Results: Four children (33.3%) were diagnosed with depressive symptoms. With regarding to anxiety, 6 children (50%) reported anxiety issues during the psychiatric interview and 3 children (25%) were suffering from anxiety according to the RCMAS scale. Compared to other children with chronic illnesses, the individuals in our cohort reported a lower overall quality of life score and lower scores in physical and social subscales.Conclusion: Our study shows that MD can lead to psychiatric disorders in children and adolescents, in particular anxiety and depression, as well as poor quality of life. This highlights the need for regular psychiatric assessments in individuals with developing brains, such as children and adolescents. We do not, however, have data regarding the neuropsychological profile of this population.

Mitochondrial diseases (MDs) are a group of clinically heterogeneous genetic disorders that arise as the result of dysfunctional mitochondria. Only few medical articles deal with neuropsychological or psychiatric aspects of MDs. Aim: The present article aims to provide a systematic review of neuropsychological and psychiatric aspects of MDs. Methods: In order to identify all studies dealing with psychiatric and neuropsychological aspects of MDs in children and adolescents, we performed a search in the medical literature between April 2009 and April 2019 using PubMed, Cochrane and Web of Science and we defined inclusion and exclusion criteria. Results: We found only seven studies that satisfy the inclusion requirements and criteria. The main psychiatric aspects reported in MDs were depressive and behavioral disorders. With regard to the neuropsychological aspects of MDs, developmental analyses showed an overall deterioration, learning difficulties, and developmental delay. Interpretation: Children and adolescents with MDs may present psychiatric symptoms and neuropsychological impairment. A more systematic investigation of psychiatric and neuropsychological features of MDs is needed to foster a better understanding of the phenotype of these diseases and their links with the genotype, which may have significant implications for the developmental trajectories of patients.

The requesting of medical termination of pregnancy (MTP) for psychosocial reasons invites several questions concerning progress in medicine as well raising necessary and legitimate ethical questions. The law currently permits MTP for maternal reasons at any stage of pregnancy if the woman's health is at a significant risk. However, conceptions of mental health risks remain a grey area and present difficulties in terms of psychiatric assessment. When dealing with a patient suffering from a psychiatric disorder, questions must be asked on the reasons behind the request as well as questions concerning free and clear consent. It must also be taken into account that the progressive nature of pregnancy means patient care must be provided relatively quickly. These cases invite discussion on medical decisions, on both a moral and rational level, and the legitimacy of the basis on which the medical decision is taken in the context of MTP for psychosocial reasons.

This study examined the effects of hotel management leadership on employee innovative behavior in Chinese hotel organizations. Using a dyadic sample of 164 hotel supervisors and 603 service employees at 23 four-star and five-star hotels in 11 Chinese cities, we investigated whether organizational commitment mediated the effects of leadership on employee innovative behavior. We also examined how organizational tenure moderated leadership and innovative behavior through organizational commitment. Findings from our moderated-mediation model revealed that organizational commitment mediated the relationship between leadership and innovative behavior. Similarly, organizational tenure moderated the relationship between leadership and organizational commitment: there was a stronger relationship for long-tenured employees and a weaker relationship for short-tenured employees. However, the effect of higher leadership on organizational commitment was stronger for short-tenured employees than long-tenured employees. Our results spotlight the importance of fostering organizational commitment, which directly affects innovative behavior and through which supervisors can influence individual innovative behavior.

Background Despite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available. Objective To estimate the cost of abuse and neglect in children in placement before their 4th birthday in France. Participants and setting A cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care. Methods Child protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery. Results 129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors. Conclusion More research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.

Nous relatons l’histoire de Louise, une petite fille differente rencontree en consultation et pour qui les questions de transmission, sous toutes ses formes, sont au coeur de son histoire : entre transmission et determination (avec la question de l’inne et de l’acquis), transmission et prediction (et de certains enjeux du diagnostic prenatal), transmission et predestination (avec la question du diagnostic precoce), transmission et information au patient ou sa famille (sous-couvert de la loi de 2002), transmission et narration (dans la rencontre avec l’enfant). Dans ces debats, le pedopsychiatre de liaison en maternite et en service de pediatrie a une place fondamentale, en tant que praticien de l’inattendu et artisan de la rencontre avec l’enfant et ses parents.

Customer satisfaction (CS) research traditionally focuses on large data sets collected over long periods of time across several business units. Business unit managers or property managers have a different focus in that they need to address dissatisfaction issues on a monthly basis and on a property basis. In search for zero defects, they are often confined to small samples lacking power where they cannot draw the relative importance of each variable responsible for the making of the overall perceived quality in their customer base. We propose to use a Bayesian approach to estimate the relative importance of predictors in the presence of small samples. Based on 12 consecutive months of CS survey data collected in a hotel, we show how the hotel manager can easily prioritize his or her quality management action plan on a monthly basis. The results of our study complement the current CS research methods while managing limited resources.

International audience; Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population.OBJECTIVE:The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients.METHODS:Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated.RESULTS:None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress.CONCLUSIONS:The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.Copyright © 2017 Elsevier Inc. All rights reserved.

Organic mental disorders are different and further revealed by increasingly advanced research. They are nevertheless misunderstood, without consensus, and raise clinical, diagnostic, and therapeutic questions. These disorders require effective collaboration between practitioners such as pediatricians and child psychiatrists. The subject should not disappear behind the complexity related to the clinical expression of these symptoms. Based on three cases of autoimmune encephalitis, we offer a reflection on the management and assessment of these diseases by a multidisciplinary team with the intention of providing optimal management. The aim of this paper is to override an initial divide posed by a particular clinical presentation. We would like to shed light on the place and legitimacy of child psychiatrists and their clinical expertise. This does not exclude the need for care of the symptoms, considering each subject and her experience. Follow-up is necessary because of the possible, often traumatic, functional and psychological consequences. Finally, the presence of each professional should be specified when the psychiatric symptoms appear to be the result of an organic disease in order to better support the subject in his suffering body.

Les attitudes d’opposition a l’adolescence constituent un motif de consultations de pedopsychiatrie de plus en plus frequent. Mais que sous-tendent ces attitudes d’opposition ? Nous presentons deux histoires d’adolescents. La premiere, celle de Franck, « le joueur », qui manifeste une opposition a tout ce qui lui est propose. L’agressivite est majeure mais elle fait lien. Elle s’inscrit dans une histoire developpementale, adaptative et apparait comme reactionnelle et structurante. La deuxieme, celle de Kevin, « le rebelle triste », un jeune qui exprime une opposition a tout ce qui le menace. La violence est extreme ; elle vise a rompre le lien. Elle est pathologique. Deux versants bien differents de cette expression d’opposition qu’il est classique de rencontrer et qu’il est important de differencier dans la clinique quotidienne de nos consultations avec des adolescents.

Resume L’etude des comorbidites, des facteurs de risque de pathologies organiques ou de la baisse de l’esperance de vie des patients atteints de pathologies mentales, notamment psychotiques, fait l’objet de nombreuses publications. La prise en charge, l’accompagnement, notamment en soins palliatifs, de ces patients, mais egalement le vecu tant des patients que des soignants dans ce type de situation sont plus rarement abordes. A partir de l’histoire de Pierre, patient suivi pour une schizophrenie paranoide et atteint d’un cancer du poumon au pronostic letal a court terme, nous evoquons l’accompagnement, la prise en charge de ces patients dans le cadre de soins palliatifs en secteur specialise psychiatrique et la complexite que cela peut representer, tant pour les patients que pour les equipes soignantes. Ainsi, le lieu de prise en charge mais egalement l’evaluation du comportement ou de la douleur s’averent a l’origine de reflexions complexes que nous discutons. Nous initions par la suite une reflexion autour des enjeux de cet accompagnement singulier avec les notions de travail du trepas et, plus generalement, des enjeux legaux et ethiques autour des refus de traitements dans ce cadre precis.

A partir de la rencontre avec un adolescent, Alban, âge de 13 ans, la notion d’ennui est developpee, tant dans ses aspects d’ennui de situation (notamment scolaire) que d’ennui existentiel. En effet, l’ennui est un symptome souvent evoque dans la clinique pedopsychiatrique, mais que revele-t-il ? Quel sens prend-il pour un enfant, ses parents, une institution ? Cette rencontre est l’occasion d’une reflexion autour des multiples facettes de l’ennui.

La recherche Saint-Exupery. 2011-2014 decrit le devenir sur 20 ans de 129 enfants ayant beneficie, avant l’âge de 4 ans, d’un placement dans un etablissement de l’Aide sociale a l’enfance (ASE) du departement de Maine-et-Loire (49). Les biographies exhaustives de ces enfants ont ete reconstituees depuis leur naissance jusqu’a leur majorite. La morbidite personnelle a l’admission est tres forte (mauvais etat general, souffrance psychique) dans un climat familial souvent tres perturbe (nombreux enfants places dans la fratrie, troubles psychiatriques parentaux). Tous les enfants progressent ensuite, mais en ordre disperse. Les enfants dont la gravite de l’etat a l’admission est importante et pour lesquels les decisions de placement ont ete prises apres un long delai, progressent le moins bien. La recherche met en evidence plusieurs determinants pejoratifs du devenir, notamment la gravite et la duree de l’exposition au risque. A l’âge adulte, un quart des enfants conservent un handicap psychique et une inadaptation sociale et sont dependants des prestations sociales. A l’oppose, un autre quart evolue favorablement ; il s’agit d’enfants pris en charge suffisamment tot, avec des troubles somatiques et psychologiques encore reversibles. La recherche met aussi en evidence des facteurs protecteurs, notamment une prise en charge precoce. Les evolutions pejoratives paraissent donc pouvoir etre reduites en ameliorant le depistage et en developpant cette prise en charge precoce.

Resume Objectif Le but de cette etude etait de connaitre la trajectoire institutionnelle et le devenir de jeunes enfants admis dans une structure d’aide sociale a l’enfance (ASE). Materiel et methodes Une etude catamnestique des dossiers archives de 1994 a 2001 a ete menee par un pedopsychiatre et une psychologue clinicienne. Elle a porte sur l’evolution clinique des enfants admis avant l’âge de 4 ans au village Saint-Exupery, foyer de l’enfance du departement du Maine-et-Loire. Les donnees administratives medicales, judiciaires et educatives (developpement, sante physique, situation familiale, parcours a l’ASE) ont ete recueillies et analysees a l’aune de leur evolution au sein de la structure. Le recueil a ete fait en respectant l’ordre chronologique d’admission afin d’obtenir un recul optimal, tout en completant par l’interview de referents ASE et des familles d’accueil les informations recueillies sur dossier. Resultats Cent vingt-huit enfants ont ete inclus. Les delais avant placement avaient ete longs (13,1 mois en moyenne apres la premiere alerte) pour un et l’âge moyen d’admission etait de 17 mois. La situation sanitaire, physique et psychique des enfants a l’admission etait mauvaise : grossesses mal suivies, troubles psychiatriques frequents, cas de maltraitance averee dont 7 cas de syndrome de Silverman. tiers des enfants presentait un retard de croissance a l’admission qui a recupere dans la moitie des cas. La duree moyenne du parcours au sein du dispositif ASE avait ete de 13,2–4,6 annees. A echeance, 24 mesures « jeune majeur », 8 mesures de protection des majeurs et 9 mesures allocation adulte handicape (AAH) avaient ete prises. Des troubles psychiatriques avaient ete notes chez 116 enfants a l’entree et chez 98 a la sortie du dispositif. Une progression significative du fonctionnement social et scolaire de l’enfant (evalue par l’echelle CGAS pour Children's Global Assessment Scale) a ete notee. A l’issue du suivi, un adulte jeune sur deux presentait des difficultes d’insertion sociale, avec parcours chaotique dans de nombreuses familles d’accueil, echecs de restitution et echecs scolaires. Conclusion La situation clinique des enfants pris en charge a l’ASE et son evolution a long terme confirment les hypotheses de depart sur le retard de prise en charge de ces enfants provenant, dans leur grande majorite, de familles connues et suivies par les services sociaux. Si le placement a permis une amelioration de l’etat physique et psychique de ces enfants, avec notamment une recuperation staturo-ponderale, nous avons note a l’issue de cette prise en charge la persistance de troubles psychiques graves necessitant des mesures de protection sociale ou d’AAH pour un adulte jeune sur cinq.