[An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units]. / Évaluation des coûts directs de la prise en charge en urgence d'une victime de violences sexuelles.

BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures. METHODS: The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses. RESULTS: The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92€, of which 41.5 % (279.90€) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02€), attributable mainly to the biological screening tests for sexually transmissible infections (STIs). CONCLUSION: These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization "Medicine, medical specialties part time day or night common regime", allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations.

[Violence in schools: Prospective study conducted in an emergency reception center for victims of aggression]. / Violences en milieu scolaire : étude prospective dans un centre d'accueil en urgence des victimes d'agression.

INTRODUCTION: Although violence in schools is quite well conveyed in the media, the French literature data remain patchy, and the figures available arise mainly from surveys of victimization. This study had two main purposes: to add to the national epidemiological data on this phenomenon and to emphasize the actions that can be undertaken by the practitioner facing such events. MATERIAL AND METHODS: This was a prospective descriptive study that was conducted from September 1st, 2014, to June 30, 2015, in a single center, the CAUVA, an emergency center within the Bordeaux University Hospital for victims of assault. Included in the study was any person alleging acts of violence on the way to school, in the neighborhood, or within the school itself, and who was examined at the CAUVA following a judicial requisition. An anonymized questionnaire was distributed during the consultation. RESULTS: We collected 41 questionnaires over a 10-month period with 70.7% males (n=29) and 29.3% females (n=12), with a mean age of 14 years and 5 months (range, 7-49 years). The subjects included two teachers and 39 students. The time between the event and the forensic examination at CAUVA was mostly less than or equal to 7 days (n=18), between 7 and 15 days (n=14), 15 and 30 days (n=6), and more than 30 days (n=3). Twenty-six attacks (63%) took place inside the school - 21 middle schools - eight near the school, and seven between the student's home and the school. Inside the school, the events took place during a break (n=15), in the classroom (n=9), and during cultural outings (n=2). For one student out of two (n=25), the event reported was the first with acts of physical (n=37), psychological (n=20), or sexual violence (n=2). In 14.6% (n=6) of the cases, the assailant was a teacher and in almost 83% (n=34) of the cases it was another student, either from the same class (n=19) or another class (n=14), or a former student (n=1). CONCLUSION: This study brings out trends that can assist the practitioner during consultations related to violence. Screening, the description of the physical and psychological impact, and dispatching to a medical-legal unit for complex situations or sexual assaults contribute to making the general practitioner, the emergency physician, the pediatrician, and the school doctor key players in the treatment and management of violence.

[The contribution of legal medicine in child protection: Presentation of a multidisciplinary approach]. / Apport de la médecine légale à la protection de l'enfance : présentation d'un mode d'évaluation pluridisciplinaire.

INTRODUCTION: Maltreatment is a complex issue and therefore, requires a multidisciplinary approach, which has been commonly used in North America since the 1980s but remains unsystematic in France. Since 1999, the Centre d'Accueil en Urgence des Victimes d'Agression (emergency unit for victims of assault) of the Bordeaux University Hospital has brought together various medical, paramedical, and social actors on this issue. A standardized psychosocial assessment procedure has been introduced and is detailed in this paper, and was consistently conducted in all cases of suspicion of abuse on a minor. METHOD: The authors studied 74 cases of minors having undergone a psychosocial assessment following suspicions of maltreatment between 1 July 2014 and 30 June 2015 that were not referred to the courts. RESULTS: Forty-five girls and 29 boys, mean age 7 years, claiming mainly (75 %) to have been subjected to sexual violence, were addressed to us by internal partners (n=15) and external partners (n=37) and 22 who came to our unit by self-referral. Following our assessment, 35 returned to their home and 36 went to court following a police complaint (n=17) and a report filed to the public prosecutor of the Republic (n=19). Three of these cases were subjected to a report on matters of concern sent to the departmental council. CONCLUSION: Given the absence of a national consensus on the methodology used for assessing suspicions of maltreatment on minors, our psychosocial assessment can facilitate the task with its peer review as well as the detection and judicialization of the maltreatment. The authors also highlight the recent modification of article 226-14 of the Penal Code, which aims at protecting professionals reporting matters to legal authorities from any legal proceeding, except if it is established that the individual did not act in good faith.

[Aborting women social characteristics: a study in Maine-et-Loire region (France) in 2007]. / Caractéristiques sociodémographiques des femmes recourant à l'interruption volontaire de grossesse, et de sa prise en charge dans le Maine-et-Loire en 2007.

The number of voluntary termination of pregnancies (VTOP) in the district of Maine-et-Loire (France) has been slightly increasing in the last ten years but the rate of childbearing age seems to be stable as it is on a national or regional data. The aborting women in this district seem to be representative of French women terminating pregnancy regarding sociodemographical, gynaecological and contraception criteria. When they come to abort, the terms of the pregnant women are also representative. But if we compare the three family planning clinics of this department, we realise that the psycho-social interview is not equally carried out. In these three centres, there is the same proportion of medication abortion (as on a national and regional scale) but much less surgical abortion under general anaesthetic in Cholet (3.9%) than in Angers (27.7%) or Saumur (64.2%). The regional rate was of 30% and the national one of 65%. The explanation is the lack of time slot for general anaesthetics in Cholet and Angers. The majority of these women used a contraception method to avoid unwanted pregnancies but we observe a lot of failures due to natural methods and condoms (especially with young people). School prevention as well as prevention on a larger population of women and couples must be comprehensive and carried out seriously. It is essential to train doctors sufficiently and regularly on the questions of contraception in general (methods, instructions…).