Sociodemographic and Clinical Characteristics of Child Sexual Abuse Reported to an Urban Public Hospital in Southern India, 2019-22

Objective: To describe the profile of child sexual abuse (CSA) reported to a tertiary care hospital. Methods: A retrospective analysis of CSA reported in children aged below 18 years from January, 2019 to June, 2022. Results: Out of the 231 cases of sexual abuse reported, 115 (49.8%) were children below 18 years. Most of the victims were children from 10 to 15 years (37.4%), and there were only two male victims. In 89.6%, the perpetrator was known to the victim. Revictimization was seen in 31%. The reported perpetrators were friends (27%), neighbors (34.8%), strangers (10.4%), or fathers (7.8%). Penetrative abuse was seen in 58.3% of reports. External injuries were seen in 6.96%. Eight victims were pregnant and HIV screening was positive in one victim. Conclusion: Early identification of CSA is important to prevent revictimization. Children from all age groups can be victims of CSA. Perpetrators can hail from all walks of life of the children.

Analysis of Forty-Two Psychoactive Substances in a Single Hair by Micro-Segmental Technique / 法医学杂志

OBJECTIVES@#To establish an LC-MS/MS method based on single hair micro-segmental technique, and verify the detection of 42 psychoactive substances in 0.4 mm hair segments.@*METHODS@#Each piece of single hair was cut into 0.4 mm segments and extracted by sonication and the segments were immersed in dithiothreitol-containing extraction medium. Mobile phase A was the aqueous solution containing 20 mmol/L ammonium acetate, 0.1% formic acid, and 5% acetonitrile. Mobile phase B was acetonitrile. An electrospray ionization source in positive ion mode was used for data acquisition in multiple reaction monitoring (MRM) mode.@*RESULTS@#The 42 psychoactive substances in hair had a good linear relationship within their respective linear ranges (r>0.99), the limits of detection were 0.2-10 pg/mm, the limits of quantification were 0.5-20 pg/mm, the intra-day and inter-day precisions were 1.5%-12.7%, the intra-day and inter-day accuracies were 86.5%-109.2%, the recovery rates were 68.1%-98.2%, and the matrix effects were 71.3%-111.7%. The method was applied to hair samples collected from one volunteer at 28 d after a single dose of zolpidem, with zolpidem detected in 5 hairs was 1.08-1.60 cm near the root tip, and the concentration range was 0.62-20.5 pg/mm.@*CONCLUSIONS@#The micro-segmental technique of single hair analysis can be applied to the investigation of drug-facilitated sexual assault cases.

¿En qué se diferencian las agresiones sexuales cometidas en solitario y en grupo? Una revisión sistemática / How are solo versus multiple perpetrator sexual assaults different? A systematic review

Resumen El estudio de las agresiones sexuales ha tenido una gran relevancia e interés en la literatura. Las agresiones sexuales en grupo representan una pequeña proporción de todas las agresiones sexuales cometidas, pero presentan unas características específicas. La presente revisión sistemática examinó las variables de los delitos de agresión sexual cometidos en solitario versus en grupo. Se realizó una búsqueda bibliográfica en las bases de datos Psycinfo, Academic Search (EBSCO) y Google Scholar, y se encontraron ocho documentos que cumplían las condiciones de inclusión. Los resultados muestran que existe evidencia de las diferencias cualitativas entre las agresiones sexuales cometidas según el número de infractores. Las dinámicas que se promueven en los grupos explican la participación de los sujetos en las agresiones sexuales en grupo. El comportamiento colectivo favorece las agresiones sexuales en grupo por los procesos inherentes a él. Los delincuentes son, en su mayoría, hombres. Los delincuentes solitarios tienen una mayor edad y, a medida que los grupos son más grandes, la edad de los agresores disminuye. En cuanto a las víctimas, son más jóvenes que los agresores, sobre todo en los casos perpetrados por múltiples sujetos, y ofrecen una mayor resistencia ante las agresiones en solitario. Se ha confirmado que en las agresiones en grupo se llevan a cabo más actos sexuales y se utiliza más la violencia. Por otro lado, no aparecen diferencias en cuanto al uso de alcohol y la presencia de armas en las agresiones. Estos resultados tienen implicaciones para la prevención del delito y el tratamiento de las víctimas.

Abstract The study of sexual assault has had great relevance and interest in the literature. Group sexual assaults represent a small proportion of all sexual assaults committed, but they have specific characteristics. Internationally, it is established that between 10 and 33 % of sexual assaults have been committed by multiple authors. Describing the differences between individual versus group sexual assaults has been a challenge for researchers. The literature has concluded that there is a difference in the etiology of sexual assaults committed according to the number of authors. While in solo sexual assaults personal vulnerability factors may explain why these crimes are committed, in group assaults group behavior dynamics explain the interaction between more subjects. This systematic review examined the variables of sexual assault crimes committed alone versus in a group. A literature search was conducted on the Psycinfo, Academic Search (EBSCO) and Google Scholar databases. In the first analysis a total of 34 studies were initially identified, and after filtering the reasons for exclusion the analysis was performed with eight investigations. The results show that there is evidence of qualitative differences between sexual assaults committed according to the number of offenders. The dynamics promoted in the groups explain the subjects' participation in group sexual aggressions. Collective behavior favors sexual aggressions in groups because of the processes inherent to the group. The most common group was two subjects (dyad) although the average group was usually composed of three subjects. The offenders are mostly men; the lone offenders are older, and as the groups become larger, the age of the offenders decreases. Research has shown that the majority of victims are female, both in single and group assaults. Victims are also younger than the perpetrators, especially in multi-subject attacks, and they are more resistant to single-aggression attacks. The place where the crime is committed presents significant differences. Some authors found that offenders in groups of three or more people often commit the assault in an indoor space, although others found that lone offenders were more likely than group offenders to rape the victim indoors, especially in the bedroom. It has been confirmed that in group aggressions more sexual acts are carried out and more violence is used. Vaginal penetration is the most committed sexual assault, followed by anal and oral rape. In all cases, vaginal rape is more prevalent among group sexual assaults, even more so when the assaults are committed by groups of three or more subjects. Studies of multiple perpetrator sexual assaults show that this type of act increases the probability of suffering more injuries and long-term health problems. Another conclusion that can be drawn is that there are significant differences in the timing of stranger assault, with a higher likelihood of a stranger assault in group rapes. On the other hand, there is also a relevance in the presence of other instrumental factors such as alcohol and weapons. As for alcohol, it showed a significant relationship in sexual assaults. Although the presence of weapons in sexual assaults is not very common, some research has confirmed that groups tend to threaten victims with a weapon to a greater extent, and the knife is often the most common weapon. The results found are particularly relevant to understanding sexual assault crimes and have implications for crime prevention and the treatment of victims.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up / Violência sexual sofrida por mulheres na adolescência precoce e tardia: Cuidado dispensado e seguimento

Abstract Objective To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. Methods A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. Results The early group (n= 242) contained more adolescents who were enrolled in school (p< 0.001), suffered more daytime aggressions (p= 0.031), in their residences (p< 0.001), by an aggressor with whom they were acquainted (p< 0.001), had greater need of legal protection (p= 0.001), and took longer to seek care (p= 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n= 279), there was greater consumption of alcohol during the aggression (p= 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p= 0.033), sleep disorders (p= 0.003), symptoms of anxiety (p= 0.045), and feelings of anguish (p= 0.011); and had more prescriptions of psychotropics (p= 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. Conclusion The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Resumo Objetivo Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. Métodos Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. Resultados O grupo precoce (n= 242) continha maior número de estudantes (p< 0,001), que sofreram mais agressões diurnas (p= 0,031), em suas residências (p< 0,001), por agressor conhecido (p< 0,001), tiveram maior necessidade de proteção legal (p= 0,001), e demoraram mais a procurar atendimento (p= 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n= 279) houve maior consumo de álcool durante a agressão (p= 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p= 0,033), distúrbios do sono (p= 0,003), sintomas de ansiedade (p= 0,045), e sentimentos de angústia (p= 0,011); e receberam mais prescrições de psicotrópicos (p= 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. Conclusão Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Editorial: Agresión sexual en menores de 18 años / Editorial: Sexual assault in children under 18 years of age

El Estado panameño ratificó en el año 1990 la Convención sobre los Derechos del Niño y con ello asumió el compromiso de crear mecanismos para la protección de la niñez y la adolescencia, pero las actuales estadísticas señalan que los derechos de protección del menor siguen siendo vulnerados y van en aumento especialmente en las regiones comarcales indígenas en el país. Como vemos en el informe anual del Ministerio Público de Panamá para el año 2021 se registraron un total de 2,257 casos de "acceso sexual con una persona mayor de catorce (14) años y menor de dieciocho (18)" (artículo 176 del código penal) que representó un aumento del 18 % comparado a los 1,913 casos en 2020.

The Panamanian State ratified the Convention on the Rights of the Child in 1990 and thereby assumed the commitment to create mechanisms for the protection of children and adolescents, but current statistics indicate that the protection rights of minors continue to be violated and they are on the increase, especially in the indigenous regional regions of the country. As we see in the annual report of the Public Ministry of Panama for the year 2021, a total of 2,257 cases of "sexual access with a person over fourteen (14) years of age and under eighteen (18)" were registered (article 176 of the penal code ) which represented an increase of 18% compared to the 1,913 cases in 2020.

The development of a local sexual assault investigation kit: The Philippine experience

Objectives@#This paper presents the development of a local sexual assault investigation kit (SAK) that doctors in the Philippines could use to collect biological samples from victims of sexual abuse, including child patients, that would be used for DNA testing. The study also reports on a management system via courier service to protect the integrity of the samples that could be eventually used as evidence in court from the collection site to the laboratory with sufficient backup measures. @*Methods@#Women and Child Protection Units (WCPU) from Manila, Baguio, Cebu, and Davao partnered with the DNA Analysis Laboratory, Natural Sciences Research Institute of UP Diliman (NSRI-UPD) DNA Analysis Laboratory in testing the utility of a prototype SAK for the collection of biological samples from child patients. From January 2002 to March 2006, samples were collected from patients who went to WCPU within 72 hours post-contact and consented to participate in the study. WCPU doctors collected biological samples guided by the patient’s narratives and packaged the samples while following detailed documentation and chain of custody procedures. SAKs were then sent via a designated courier service from WCPU to the NSRI-UPD DNA Analysis Laboratory for DNA testing. The WCPU kept half of the samples collected, following recommendations made during sectoral consultations that included members of the Research Group of the Philippine Judicial Academy, prosecutors, and defense counsels. Case samples were packed well by the WCPU and received at the NSRI-UPD DNA Analysis Laboratory. Due to budget limitations, only the internal genitalia and patients’ reference buccal swabs were subjected to DNA tests as reported by Maiquilla et al.1 The remaining SAK components and case records were kept in a dedicated and secure storage facility. DNA testing reports were sent to the WCPU, which released them to the child patients and their legal guardians. @*Results@#One hundred fifty-four female children aged 2-18 years old and their legal guardians agreed to participate in the study. Based on the initial interviews of the social workers who conducted the evaluation, all the participants came from families with very low socioeconomic status. The WCPU doctors then complied with prescribed procedures. To date, NSRI-UPD DNA Analysis Laboratory records show that a subpoena for expert testimony had been issued in only one case out of the 63 cases (1.6%) that were positive for male DNA. No further information was available on the final decision in this case due to the absence of any order from the judge granting the laboratory access to court records. Likewise, WCPUs did not have any information on the remaining 62 cases that could have used the DNA test results as evidence if a case had been filed in court. @*Conclusion@#This study is the first to report the development and validation of a sexual assault investigation kit in the Philippines aimed at helping medical doctors in collecting and preserving critical biological samples for DNA testing. Using a dedicated courier service to send SAK from collecting agencies to the laboratory for DNA testing was successfully tested and resulted in faster delivery and significantly reduced overall cost. While DNA testing remains the most powerful tool for human identification and the technology has been available in the Philippines since 1997, certain factors have prevented it from being used routinely in sexual assault investigations, including those involving children.

Application Value and Research Progress of Human Microbiome in Sexual Assault Cases / 法医学杂志

In recent years, sexual assault cases have been on the rise, seriously infringing the legitimate rights and interests of women and children, causing widespread concern in society. DNA evidence has become the key evidence to prove the facts in sexual assault cases, but lack of DNA evidence or only DNA evidence in some sexual assault cases leads to unclear facts and insufficient evidence. With the emergence of high-throughput sequencing technology and the development of bioinformatics and artificial intelligence, new progress has been made in the study of human microbiome. Researchers have begun to use human microbiome for difficult sexual assault cases indentification. This paper reviews the characteristics of human microbiome, and its application value in the inferences of the body fluid stain origin, the sexual assault method, the crime time, etc. In addition, the challenges faced by the application of the human microbiome in practical case handling, the solutions and future development potential are analyzed and prospected.

Pensamentos de risco de um adulto autor de violência sexual / Risk thoughts of an adult perpetrator of sexual violence / Pensamientos de riesgo de un adulto autor de violencia sexual

Trata-se de pesquisa qualitativa sobre os pensamentos de risco (fantasias sexuais) de um adulto ofensor sexual (55 anos, cumpriu pena restritiva de liberdade) atendido em uma instituição pública de saúde. Buscou-se, por meio de pesquisa documental, conhecer o desenvolvimento das fantasias sexuais em relação ao assédio sexual. O contexto foi o de uma instituição de saúde, e o foco foi o assédio a três vítimas meninas (oito, nove e 10 anos). As informações foram coletadas em uma entrevista que teve a duração de duas horas. Realizou-se a leitura das informações sobre os pensamentos/fantasias que surgem diante de um possível assalto sexual a uma criança e/ou adolescente. A discussão versou sobre: o pensamento de risco; as reações da vítima; e o processo de justificativa para a ação violenta. O conhecimento dos pensamentos de risco devem fazer parte de qualquer intervenção com essa população de ofensores sexuais adultos e ser visto como parte do circuito protetivo de crianças e adolescentes.

This is a qualitative research (documentary analysis) on the risk thoughts (sexual fantasies) of an adult sexual offender (55 years old, who served a restrictive sentence of freedom) attended in a public health institution. We sought, through documentary research, to know the development of sexual fantasies concerning the behavior of sexual harassment. The context was in a health institution, and the focus was the harassment of three female victims (eight, nine and 10 years old). The information was collected in an interview that lasted two hours. Information about the thoughts/fantasies that came up in the face of a possible sexual assault on a child and/or adolescent was carried out. The discussion dealt with: risk thinking; the victim's reactions; and the process of justification for violent action. Knowledge of risk thoughts should be part of any intervention with this population of adult sexual offenders and be seen as part of the protective circuit of children and adolescents.

Se trata de una investigación cualitativa (análisis documental) sobre los pensamientos de riesgo (fantasías sexuales) de un adulto ofensor sexual (55 años, cumplió una pena restrictiva de libertad) atendido en una institución pública de salud. Se buscó, por medio de la investigación documental, conocer el desarrollo de las fantasías sexuales con relación a la conducta del acoso sexual. El contexto fue de una institución de salud, y el enfoque fue el acoso de las tres niñas víctimas (ocho, nueve y 10 años). La información fue recogida en una entrevista que tuvo una duración de dos horas. Se realizó la lectura de las informaciones sobre los pensamientos/fantasías que surgen ante un posible asalto sexual a un niño y/o adolescente. La discusión versó sobre: el pensamiento de riesgo; las reacciones de la víctima; y el proceso de justificación para la acción violenta. El conocimiento de los pensamientos de riesgo debe formar parte de cualquier intervención con esa población de ofensores sexuales adultos y ser visto como parte del circuito protector de niños y adolescentes.

Genital injuries: Are they telling us something about sexual violence?

Abstract Genital injury has a forensic relevance after a sexual assault and it has been discussed and investigated among professionals who work in this field. To analyze the studies published in the last decades, the present review examines different factors that may influence this finding, first clarifying terms of the forensic field, such as the peculiarity of the legal medical examination, and the distinction of the terms "legal" and "anatomical" vagina. Finally, it analyses if it is possible that the existence of these injuries in victims explain the lack of consent in sexual contact, and to clarify the meaning of the absence of injuries.

The incidence, pattern and management of sexual assault in a tertiary hospital in North-western Nigeria

Background: Sexual assault is any sexual act performed by one person on another without the person’s consent or on a victim who is incapable of giving consent. It is a violation of basic human rights, a gender-based issue and a violent crime against both the individual and the society. The objectives of the study were to determine the incidence, pattern and management of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.Methods: This was a 10 - year retrospective study. Case records of sexual assault from 1st January, 2007 to 31st December, 2016 were retrieved and relevant data extracted and analyzed using the SPSS for windows version 20.0Results: The incidence of sexual assault was 0.8%. Majority, 88 (85.4%) occurred in children and adolescents. Peno-vaginal penetration was the most common form of assault 65 (63.1%) and the assailants were known to the victims in 74 (71.9%) of the cases. Involvement of psychiatrists/psychologists in the management of the victims was poor as psychiatrists were involved in only 13 (12.6%) of the cases. Most of the victims were lost to follow up.Conclusions: Sexual assaults occurred mostly in children and adolescents in this study. Increased public awareness and preventive interventions are required especially among the at-risk age groups to enhance their safety. Training of relevant persons in the institution to offer counselling to the victims is recommended as referral for psychiatrists’ consultation was poor. It is important to institute a good tracking system to follow up the victims as most are lost to follow up.

Sexual Assault of Nigerian Female Adolescents: A Review of the Trend and Effects

ntroduction: Adolescent sexual assault is a huge public health problem with physical, reproductive health and psycho-social consequences.Methods: A literature review was carried out on its prevalence, forms,risk factors and effects using multiple databases, namely MEDLINE, Web of Science Core Collection, and Google Scholar Google search. Additional information was from medical textbooks and journals.Results: The estimated prevalence of sexual aggression among adolescents varied widely in different studies in Nigeria, ranging from 6 to 74%. Broad variation may be due to different incident reporting rates at multiple locations.Conclusion: The solution to this problem involves the mobilization and active co-operation of all stakeholders in the society such as parents, guardians, teachers, non-governmental organizations, religious leaders, political leaders and government. Sex education should be given at home, school and other settings to both males and from other formal sources.Review Article

Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature

Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD). Methods: Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape. Results: We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong. Conclusion: In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.

Identification of New Designer Benzodiazepine Diclazepam in Drug Facilitated Sexual Assault / 法医学杂志

OBJECTIVES@#To identify the new designer drugs which are totally unknown and not in the routine testing list by the technologies such as high-resolution mass spectrometry in drug facilitated sexual assault, in order to solve the problem in actual cases.@*METHODS@#The milky fluid from an actual case was extracted and analyzed using LC-QE, ¹H-NMR and GC-MS, respectively. The accurate masses and cluster ions isotope patterns of unknown compound were obtained by LC-QE. The molecular formula was confirmed as C₁₆H₁₂C₂N₂O based on the protons number of ¹H-NMR. The isomers diclazepam and 4-chlorodiazepam were separated and detected with GC-MS.@*RESULTS@#The new designer benzodiazepine as diclazepam in the milky fluid was identified. The results provided direct evidence for the investigation and qualitative analysis of such cases.@*CONCLUSIONS@#The combined application of various methods, including LC-QE, ¹H-NMR and GC-MS, can be used to detect unknown new psychoactive substances.

Virginia Woolf, neuroprogression, and bipolar disorder

Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhood trauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhood trauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf’s biography and art can provide clinicians with important insights about the course of bipolar disorder.

Violência sexual: da denúncia à criminalização do agressor / Sexual violence: from complaint to criminalization of offenders / Violencia sexual: de la denuncia a la penalización del agresor

Objetivo: caracterizar as ocorrências policiais e dimensionar a realização do exame pericial nas vítimas de violência sexual. Método: estudo retrospectivo que analisou ocorrências de violência sexual contra mulheres com idade igual ou superior a 18 anos, registradas em uma Delegacia da Mulher. Utilizou-se um instrumento adaptado ao Aplicativo Microsoft Excel® para a coleta e a estatística descritiva para a análise dos dados. Resultados: o tempo transcorrido entre a violência e a denúncia variou de horas a 14 meses. Os principais agressores foram homens desconhecidos. Entre as vítimas que realizaram o exame pericial, a maioria era branca, jovem, com ensino médio. Os agressores eram mais velhos e com menor escolaridade. Mulheres vitimadas por homens de seu convívio desistiram da denúncia. Conclusão: para um atendimento efetivo e resolutivo, não basta a implementação de ações interdisciplinares; é preciso que a mulher seja acolhida com base numa assistência humanizada.

Objective: to characterize police complaint reports and establish the dimensions profile the forensic medical examination of victims of sexual violence. Method: this retrospective study analyzed occurrences of sexual violence against women 18 or more old, recorded at a Special Police Service for Women. Data were collected using a tool adapted to Microsoft Excel®, and analyzed using descriptive statistics. Results: time between assault and complaint ranged from hours to fourteen months. Most victims who underwent forensic examination were young, white and had attended middle school. Most offenders were unknown, older men with less schooling than their victims. Women abused by men they knew withdrew the complaint. Conclusion: for effective care that offers a solution, it is not enough to implement interdisciplinary actions; services must accept and support women on the basis of humanized care.

Objetivo: caracterizar las denuncias policiales y dimensionar la realización del examen forense en las víctimas de violencia sexual. Método: estudio retrospectivo que analizó denuncias de violencia sexual contra las mujeres con edad igual o mayor a dieciocho años, registradas en la Comisaría de Defensa de la Mujer. Se ha utilizado un instrumento adaptado a la Aplicación Microsoft Excel® para la recolección y la estadística descriptiva destinadas al análisis de datos. Resultados: el tiempo transcurrido entre la violencia y la denuncia osciló entre horas a catorce meses. Los principales agresores eran hombres desconocidos. Entre las víctimas que realizaron el examen forense, la mayoría era mujeres blancas, jóvenes y tenían nivel de estudio secundario. Los agresores eran de hombres mayores y con nivel de escolaridad más bajo. Mujeres, víctimas de hombres que hacen parte de su ambiente de convivencia, abdicaron de la denuncia. Conclusión: para una atención eficaz y resolutiva no basta con implementar acciones interdisciplinarias, es necesario que se reciba a la mujer con una atención humanizada.

Valoración médico legal de la víctima de delito sexual / Legal medical assessment of the victim of sexual crime

La atención médica de las víctimas de delitos sexuales constituye un desafío para el personal de salud. Supone el abordaje integral del paciente, buscando no sólo el resguardo de su salud física y mental, sino también la adecuada ejecución de una valoración pericial de las posibles lesiones y la correcta obtención de evidencia y material biológico. Todas las personas que intervengan en este proceso deben saber reconocer cuál es su función, cuál es el momento ideal para realizar la valoración, el espacio más adecuado, así como qué debe incluir, de modo que la información recabada sirva de herramienta en la resolución del proceso judicial posterior.

The medical care of victims of sexual assault is a challenge for healthcare professionals. It entails a comprehensive approach, looking not only to safeguard the patient's physical and mental health, but also to properly carry out an expert assessment of all possible injuries and obtain evidence and biological material. Every individual involved in this process needs to recognize what their role is, what is the ideal time to perform the assessment, the most suitable space and what they should include in the evaluation, so that the information collected will serve as a tool in resolving the subsequent prosecution.

Femicidio sexual, a propósito de dos casos / Sexual femicide, concerning two cases

Este trabajo describe los hallazgos de la escena y necropsia de dos casos de femicidio sexual ocurridos entre Diciembre del año 2013 y Julio del 2014, en la República de Panamá.

This paper describes the findings of the scene and autopsy of two cases of sexual femicide that occurred between December 2013 and July 2014, in the Republic of Panama.

Binge drinking: conductas sexuales de riesgo y drogas facilitadoras del asalto sexual en jóvenes españoles / Binge drinking: Risky sexual behaviors and drug facilitated sexual assault in spanish youths

El uso de drogas -alcohol incluido- como facilitadoras del asalto sexual y las conductas sexuales de riesgo son dos fenómenos relevantes desde una perspectiva sociosanitaria. El objetivo de la presente investigación es comparar las actitudes hacia estas variables en una muestra de 164 jóvenes en condiciones de intoxicación etílica frente a sobriedad. La muestra está compuesta por 82 varones y 82 mujeres. Su media de edad era 27.50 ± 63.72. Contestaron un cuestionario en el que se recogen datos sociodemográficos, información del consumo de drogas y la Escala de Conductas Sexuales; además, se emplearon varios etilómetros Digital Zaphir Deluxe para determinar la alcoholemia. Se trata de un estudio cuasiexperimental realizado sobre un diseño intraindividual. El muestreo es no probabilístico de tipo "bola de nieve". Los resultados muestran unas actitudes más positivas y una mayor intencionalidad hacia el empleo de drogas como facilitadoras del asalto sexual y hacia las conductas sexuales de riesgo de los sujetos que se encuentran bajo el efecto del alcohol en contextos recreativos, independientemente del sexo de la muestra. Se destaca, por un lado, la importancia de investigar sobre el uso de drogas como facilitadoras del asalto sexual (tema ampliamente ignorado en España) y se profundiza en cómo el consumo de drogas afecta al uso de métodos anticonceptivos, y por otro, la necesidad de incluir información en los programas preventivos sobre cómo el consumo de alcohol (y otras drogas) está relacionado con la actividad sexual.

Drug use (alcohol included) as a sexual-assault facilitator and risky sexual behavior are two important issues from a social and health perspective. This study aims to compare the attitudes towards these variables in a sample of 164 young people in conditions of intoxication vs sobriety. The sample consisted of 82 men and 82 women. Their mean age was 27.50 (SD = 3.72). Participants answered a sociodemographic questionnaire, a drug information questionnaire, and the Sexual Behaviors Scale. and moreover, Several Zaphir Deluxe Digital breathalyzers were also used to monitor alcohol level. This is a quasiexperimental study conducted using a within-subject design. Non-probabilistic snowball sampling was used. The results showed more positive attitudes and greater intentions towards the use of drugs as facilitators of sexual assault and risky sexual behaviors in those who are under the influence of alcohol in recreational contexts, regardless of the sex of the sample. These results showed, on the one hand, the importance of studies into the use of drug facilitated sexual assault -a largely ignored issue in Spain- and to determine how drug use affects the use of contraceptive methods. On the other hand, the results show the need to include information in preventive programs about the way alcohol (and other drugs) use is related to sexual activity.

Antecedente de agresión sexual y su asociación con conductas de riesgo en adolescentes consultantes en un centro de atención en salud sexual y reproductiva / History of sexual aggression and its association with risk behavior in adolescents consulting a focus on sexual and reproductive health

Antecedentes: La mayoría de los programas de salud reproductiva en Chile operan bajo la premisa de que todas las mujeres y en especial las adolescentes están o han estado comprometidas en relaciones sexuales consensuales, y no consideran que muchas de ellas pueden ser sobrevivientes de agresión sexual y pueden presentar necesidades diferentes en salud sexual y reproductiva. Objetivo: Examinar cuáles conductas de riesgo y variables sociodemográficas y familiares están asociadas al antecedente de agresión sexual en adolescentes consultantes en un centro de atención en salud sexual y reproductiva. Método: Estudio analítico de corte transversal. La información fue recolectada en la primera consulta a 3.064 adolescentes mujeres entre 12 y 19 años, atendidas en un centro de salud sexual y reproductiva en el período 2003-2010. Se usó regresión logística para identificar los factores asociados a la agresión sexual. Resultados: Un 22,7 por ciento reportó antecedente de agresión sexual. Las conductas de riesgo asociadas al antecedente de agresión sexual fueron: inicio de la actividad sexual bajo coerción o bajo efectos del alcohol, mayor número de relaciones afectivas y parejas sexuales, menor edad al inicio de la actividad sexual, menor promedio de notas, mayor consumo de cigarrillo, de alcohol y drogas, y menor edad al inicio del consumo de drogas. Conclusión: El antecedente de agresión sexual deja a las mujeres expuestas a riesgos en la salud sexual y reproductiva, por lo que los equipos de salud debieran ser capaces de detectar estas problemáticas para poder intervenir en forma adecuada y eficaz.

Background: Most of reproductive health programs in Chile operate under the premise that women and adolescent girls in particular, are or have been engaged in consensual sex and do not consider that many of them may be survivors of sexual abuse, and may have different needs in sexual and reproductive health. Objective: Determine which risk behaviors and familial variables are associated with sexual aggression history in adolescents consulting at sexual and reproductive health center. Method: Cross-sectional analytical study. The information was gathered from a structured interview applied in the first consultation to 3,064 adolescent girls between 12 and 19 years, who attended a sexual and reproductive health centre for the period 2003-2010. Logistic regression was used to identify factors associated with sexual assault. Results: A 22.7 percent reported sexual assault history. Risk behaviors associated with sexual aggression were: onset of sexual activity forced or under influence of alcohol, as many relationships and sexual partners, younger age at onset of sexual activity, lower grade point average, cigarette smoking, alcohol and drug use and younger age at onset of drug use. Conclusion: A history of sexual aggression leaves women at risk for sexual and reproductive health, so health teams should be able to detect these problems in order to intervene appropriately and effectively.

Examining an Accused of Sexual Assault - Some Practical Aspects.

Rape or Sexual Assault victim examination is one important medicolegal procedure, but examining an accused of sexual assault - is not any less important task and it is one of the commonest responsibilities a medico encounters generally when posted at any Government Hospital. But it has been observed that this type of case has always been a headache for them because of mainly two reasons – firstly - how to conduct the cases with clear-cut concept, and secondly - for a fear to face the court. It has also been seen that at so called standard books, views on minute practical problems during conduction of such cases they are lacking at several aspects which are really necessary. This discussion is with the motto of highlighting those specific portions as much as possible to enable an easier proceeding of such medicolegal works.