Hyperarousal Symptom Severity in Women with Posttraumatic Stress Disorder Might Be Associated with LINE-1 Hypomethylation in Childhood Sexual Abuse Victims.

Introduction: Sexual assault and a history of childhood sexual abuse (CSA) are related to posttraumatic stress disorder (PTSD) development. Long interspersed nuclear elements (LINE-1) are transposable elements, and their methylation is used to infer DNA global methylation. DNA methylation can be affected by trauma exposition which in turn would be associated with PTSD. Thus, we investigated if the LINE-1 methylation pattern is related to PTSD symptoms in females with a history of CSA. Methods: This is a case-control study that examined, at baseline (W1), 64 women victims of sexual assault diagnosed with PTSD and 31 patients with PTSD who completed the 1-year follow-up (W2). Participants were categorized into two groups according to the presence of CSA (PTSDCSA+: NW1 = 19, NW2 = 10; PTSDCSA-: NW1 = 45, NW2 = 21). PTSD symptoms (re-experiencing, avoidance, hyperarousal, alterations in cognition/mood) were assessed using the Clinician-Administered PTSD Scale, and the history of CSA was assessed by the Childhood Trauma Questionnaire. LINE-1 methylation was measured in three sites (CpG1, CpG2, CpG3) located in the 5'UTR region using bisulfite conversion followed by pyrosequencing. Linear regression models were performed to test the relation between LINE-1 CpG sites methylation and PTSD symptoms. Results: We found a negative association between CpG2 methylation and hyperarousal symptoms among those in the PTSDCSA+ group in W1 (adjusted p = 0.003) compared to the PTSDCSA- group (p > 0.05). Still, no association was observed between other PTSD symptoms and other CpG sites. Further, in the longitudinal analysis, LINE-1 hypomethylation was no longer observed in PTSD participants exposed to CSA. Conclusion: Our findings suggest that LINE-1 methylation may help understand the relationship between trauma and PTSD. However, more studies are needed to investigate LINE-1 as an epigenetic marker of psychiatric disorders.

Symptoms of depression (not anxiety) mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in men

Objective: Childhood sexual abuse is associated with compulsive sexual behavior, depression, and anxiety in men. Furthermore, both depression and anxiety have been linked to compulsive sexual behaviors. However, whether anxiety and depression mediate the relationship between childhood sexual abuse and compulsive sexual behaviors has yet to be tested. We investigated whether symptoms of depression and anxiety mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in 222 men seeking treatment for such behaviors. Methods: Participants completed the Sexual Compulsivity Scale, Childhood Trauma Questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory. A cross-sectional parallel mediation analysis was conducted. Results: The prevalence of childhood sexual abuse in our sample was 57%. Significant correlations were found between childhood sexual abuse and compulsive sexual behaviors, depression, and anxiety. The results of the mediation analyses suggested that depression (B = 0.07, standard error [SE] = 0.03, 95%CI 0.02 to 0.15), but not anxiety (B = 0.02, SE = 0.02, 95%CI -0.2 to 0.07), mediated the link between childhood sexual abuse and compulsive sexual behaviors. The pattern of our results remained the same when controlling for other types of childhood trauma. Conclusions: Depression, not anxiety, appears to mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in men. Future research that tests our mediation analyses using a prospective longitudinal study would be highly informative.

Symptoms of depression (not anxiety) mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in men.

OBJECTIVE: Childhood sexual abuse is associated with compulsive sexual behavior, depression, and anxiety in men. Furthermore, both depression and anxiety have been linked to compulsive sexual behaviors. However, whether anxiety and depression mediate the relationship between childhood sexual abuse and compulsive sexual behaviors has yet to be tested. We investigated whether symptoms of depression and anxiety mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in 222 men seeking treatment for such behaviors. METHODS: Participants completed the Sexual Compulsivity Scale, Childhood Trauma Questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory. A cross-sectional parallel mediation analysis was conducted. RESULTS: The prevalence of childhood sexual abuse in our sample was 57%. Significant correlations were found between childhood sexual abuse and compulsive sexual behaviors, depression, and anxiety. The results of the mediation analyses suggested that depression (B = 0.07, standard error [SE] = 0.03, 95%CI 0.02 to 0.15), but not anxiety (B = 0.02, SE = 0.02, 95%CI -0.2 to 0.07), mediated the link between childhood sexual abuse and compulsive sexual behaviors. The pattern of our results remained the same when controlling for other types of childhood trauma. CONCLUSIONS: Depression, not anxiety, appears to mediate the relationship between childhood sexual abuse and compulsive sexual behaviors in men. Future research that tests our mediation analyses using a prospective longitudinal study would be highly informative.

Estudo descritivo dos casos notificados de violência sexual e dos serviços de atendimento especializado em Minas Gerais, 2019 / Estudio descriptivo de los casos notificados de violencia sexual y de los servicios de atención especializada en Minas Gerais, Brasil, 2019 / Descriptive study of reported cases of sexual violence and specialized care services in the state of Minas Gerais, Brazil, 2019

Objetivo: descrever o perfil sociodemográfico dos casos notificados de violência sexual (VS) e a distribuição dos serviços de atendimento ao agravo em Minas Gerais, Brasil, 2019. Métodos: estudo descritivo dos casos notificados no Sistema de Informação de Agravos de Notificação e dos serviços registrados no Cadastro Nacional dos Estabelecimentos de Saúde. Resultados: foram identificadas 4.418 notificações de VS no período, correspondendo a mais de 12 notificações/dia; houve maior frequência de notificações no sexo feminino (87,0%) e entre crianças e adolescentes (72,0%); a distribuição dos serviços mostrou vazios assistenciais em quatro das 14 macrorregiões de saúde do estado; as distâncias máximas percorridas para atendimento em serviços de referência variaram de 93 a 327 km. Conclusão: a escassez de serviços de atendimento a pessoas em situação de VS nas microrregiões e macrorregiões de Minas Gerais sinalizam a necessidade de planejamento de políticas públicas visando aumentar o acesso a esses serviços.

Objetivo: describir el perfil sociodemográfico de los casos notificados de violencia sexual (VS) y la distribución de los servicios para esta condición. Métodos: estudio observacional descriptivo basado en datos del Sistema de Información de Enfermedades de Declaración Obligatoria y servicios registrados en el Registro Nacional de Estabelecimientos de Salud, en Minas Gerais, Brasil, en 2019. Resultados: se identificaron 4.418 notificaciones de SV que representan más de 12 notificaciones por día; los registros se centraron en el sexo femenino (87,0%), niños y adolescentes (72,0%); la distribución de los servicios mostró brechas de atención en cuatro macrorregiones entre las 14 existentes; la distancia máxima recorrida para asistencia en un servicio de referencia osciló entre 93 y 327 km. Conclusión: la escasez de servicios de atención a personas en situación de SV en las micro y macro regiones, indican la necesidad de planificación de políticas públicas para ampliar el acceso.

Objective: to describe the sociodemographic profile of reported cases of sexual iolence (SV) and the distribution of care services for this health condition in the state of Minas Gerais, Brazil, 2019. Methods: this was a descriptive study of the cases of sexual violence reported on the Notifiable Health Conditions Information System and care services registered in the National Health Establishment Registry. Results: a total of 4,418 notifications of SV were identified during the study period, representing more than 12 notifications per day; the majority of notifications were among females (87.0%) and among children and adolescents (72.0%); the distribution of care services showed care gaps in four of the 14 health macro-regions of the state of Minas Gerais; the maximum distances traveled to access referral services ranged from 93 to 327 km. Conclusion: the scarcity of care services for people subjected to sexual violence in the micro-regions and macro-regions of Minas Gerais highlights the need for planning public policies aimed at increasing access to these services.

Condições sociais de crianças e adolescentes que sofreram violência sexual: percepções da equipe multiprofissional / Condiciones sociales de niños y adolescentes víctimas de violencia sexual: percepciones del equipo multiprofesional / Social conditions of sexually abused children and adolescents: Perceptions by a multiprofessional team

Objetivo: descrever as condições sociais de crianças e adolescentes vítimas de violência sexual na percepção da equipe multiprofissional de saúde. Materiais e método: estudo qualitativo realizado em 2019, com 30 membros da equipe multiprofissional de um hospital público localizado na Bahia, Brasil. As entrevistas foram interpretadas e analisadas de acordo com Bardin e categorizadas conforme marcadores de vulnerabilidade, à luz do interacionismo simbólico. Resultados: as profissionais atenderam crianças e adolescentes de 0 a 17 anos com relatos de vivência de violência sexual. As vítimas eram de ambos os gêneros, porém a maioria dos casos remete a crianças ou adolescentes do sexo feminino e afrodescendentes. Quanto à origem socioeconômica, na percepção das profissionais, as vítimas estavam submersas na pobreza e eram advindas de localidades periféricas. Conclusões: as interações entre profissionais e crianças ou adolescentes durante o atendimento embasaram as percepções das condições sociais das vítimas. A percepção é relevante, visto que serve para orientar cuidados como o acolhimento, tratamento e acompanhamento das vítimas e seus familiares.

Objetivo: describir las condiciones sociales de niños y adolescentes víctimas de violencia sexual desde la percepción de un equipo multiprofesional en salud. Materiales y método: estudio cualitativo realizado en 2019 con 30 integrantes del equipo multidisciplinario en salud de un hospital público ubicado en Bahía, Brasil. Las entrevistas fueron interpretadas y analizadas de acuerdo con los postulados de Bardin y categorizadas según marcadores de vulnerabilidad, a la luz del interaccionismo simbólico. Resultados: el equipo de profesionales atendió a niños y adolescentes de 0 a 17 años con relatos de experiencias de violencia sexual. Las víctimas eran de ambos sexos, aunque la mayoría de los casos se presentaron en menores de sexo femenino y afrodescendientes. En cuanto al origen socioeconómico, de acuerdo con la percepción de los profesionales, las víctimas estaban inmersas en condiciones de pobreza y provenían de localidades periféricas. Conclusiones: las interacciones entre profesionales y niños/adolescentes durante las jornadas de cuidado proporcionaron la línea base para establecer las percepciones en torno a las condiciones sociales de las víctimas. Estas percepciones son relevantes, puesto que permiten orientar cuidados como la recepción, el tratamiento y el acompañamiento a las víctimas y sus familiares.

Objective: To describe the social conditions of children and teenagers who were victims of sexual violence based on the perceptions of a multiprofessional health team. Materials and methods: Qualitative study conducted in 2019 with 30 members of the multidisciplinary team at a public hospital in Bahia, Brazil. The interviews were interpreted and analyzed according to Bardin and categorized using vulnerability markers, in the light of the symbolic interactionism approach. Results: The professionals treated children and teenagers aged 0 to 17 years with reports of experiencing sexual violence. Although victims were of both genders, most cases referred to female Afro-descendant infants. As for the socioeconomic profile of victims, from the perception of professionals, these were submerged in poverty and came from peripherical locations. Conclusions: Interactions between professionals and children and teenagers during treatment supported the perceptions about the victims and their social conditions. These perceptions are relevant since they allow guiding care actions such as the reception, treatment and monitoring of victims and their families.

Completitude, consistência e não duplicidade dos registros de violência sexual infantil no Sistema de Informação de Agravos de Notificação em Santa Catarina, 2009-2019 / Completitud, consistencia y no duplicación de registros de violencia sexual infantil en el Sistema de Información de Enfermedades de Declaración Obligatoria en Santa Catarina, Brasil, 2009-2019 / Completeness, consistency and non-duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System in the state of Santa Catarina, Brazil, 2009-2019

Objetivo: Avaliar a completitude, consistência e duplicidade de registros de violência sexual infantil no Sistema de Informação de Agravos de Notificação (Sinan) em Santa Catarina, Brasil, no período de 2009 a 2019. Métodos: Estudo transversal descritivo e analítico, para avaliar a qualidade dos dados do Sinan quanto à completitude, consistência e não duplicidade. Resultados: Foram notificados 3.489 casos de violência, observando-se aumento de 662,5% no número de notificações no período estudado, tendo o aumento do número de centros de referência ao atendimento das pessoas em situação de violência sexual no estado, explicado 46,7% da variação no número de casos, entre os anos estudados. A consistência foi excelente em 90,0% dos registros; e a completitude, entre excelente e boa em 92,3% deles. Para 14 variáveis, observou-se tendência de aumento da completitude no período. Não houve registro de duplicidades. Conclusão: Os dados do sistema de vigilância da violência sexual contra crianças foram considerados adequados nos quesitos avaliados.

Objetivo: Evaluar la completitud, consistencia y duplicidad de los registros de violencia sexual infantil reportados en el Sistema de Información de Enfermedades de Notificación (Sinan), en Santa Catarina, Brasil, de 2009 a 2019. Métodos: Se realizó un estudio de corte transversal descriptivo y analítico, para evaluar la calidad de los datos del Sinan. Resultados: Se reportaron 3.489 casos de violencia, observándose un aumento del 662,5% en el número de notificaciones, lo que se puede relacionar en el 46,7% de las veces, con el aumento del número de centros de referencia para la atención de personas en situación de violencia sexual en el estado. La consistencia fue excelente en 90,0%, la completitud se consideró de excelente a buena un 92,3%. Para 14 variables, la tendencia temporal de completitud aumentó. No hubo registros de duplicidad. Conclusión: Los datos del sistema de vigilancia de la violencia sexual contra la niñez se consideraron adecuados en las preguntas estudiadas.

Objective To evaluate the completeness, consistency and duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, between 2009 and 2019. Methods: This was a descriptive and analytical cross-sectional study aimed to assess the quality of SINAN data regarding completeness, consistency and non-duplicity. Results: 3,489 cases of violence were reported, with a 662.5% increase in the number of notifications in the period studied, with the increase in the number of referral centers for the care of people in situations of sexual violence in the state, explaining 46.7% of the variation in the number of cases, between the years studied. Consistency was excellent in 90.0% of the records; and completeness ranged between excellent and good in 92.3% of them. There was an increased trend in completeness for 14 variables in the period. There were no duplicate records. Conclusion: Data from the sexual violence against children surveillance system were considered adequate regarding the questions that were assessed in the study.

The Effects of Childhood Sexual Abuse: The Role of Anxiety and Alcohol Use among Haitian Women Living with HIV.

Childhood abuse has been linked to problematic drinking in adulthood. It is also documented that people living with HIV have higher rates of alcohol use than the general population. In Haiti, a total of 25% of women living with HIV have experienced childhood sexual abuse (CSA), which puts them at an increased risk for alcohol abuse. CSA has also been associated with anxiety disorders in adulthood. Therefore, it is critical to understand the relationship between CSA, anxiety, and alcohol use among women living with HIV. A total of 244 women living with HIV participated in this study, with 35% reporting CSA. Alcohol abuse was measured with the AUDIT, anxiety with the State-Trait Anxiety Inventory test, and sexual abuse with the Childhood Trauma Questionnaire. Compared to participants who did not experience childhood sexual abuse, participants who experienced childhood sexual abuse reported greater levels of alcohol use [(17.0, SD = 9.1) (11.9, SD = 8.6) p =.001] and anxiety [(55.8, SD = 9.8) (48.9 SD = 8.3) p =.001] respectively. The indirect effect of anxiety on the association between CSA and alcohol use was significant [(ß =.19 p =.05) 95% bootstrap CI.019 -.13] Thus, women who reported being sexually abused as children reported anxiety, which in turn, was associated with an increased risk for alcohol abuse. Results demonstrate that alcohol may be used as a negative coping mechanism to alleviate anxiety symptoms triggered by CSA. These findings elucidate the need for further research examining the impact that sexual trauma has on mental health.

Gender differences in the association between childhood sexual abuse and risk behaviors among people living with HIV in Haiti.

Research shows that in the Caribbean one-third of people living with HIV continue to engage in unprotected sexual practices. Childhood sexual abuse (CSA) and HIV-related risk behaviors have been found to play a contributory role in HIV transmission. We aimed to analyze gender differences in the association between CSA and substance use and sexual risk behaviors among Haitians living with HIV. A total of 276 HIV-positive individuals participated in this study with 56% experiencing sexual abuse during childhood. Results showed that participants who experienced CSA had increased odds of hazardous drinking compared to those who did not experience CSA; men (OR 2.9, 95% CI 1.2-7.3) and women (OR 2.5, 95% CI 1.2-5.6). While, marijuana use was only significantly associated in women (OR 5.2, 95% CI 2.1-13.5). For sexual risk behaviors, unprotected sex was significantly associated in both men (OR 3.0, 95% CI 1.3-7.1) and women (OR 2.0, 95% CI 1.5-7.7) who experienced CSA. Results of this study underscore the need for further research to better understand the role of gender in the relationship between CSA and risky behaviors among PLWH.

Interconsulta en maltrato infantojuvenil: Característica de la población con sospecha de maltrato infantojuvenil del Hospital de Pediatría Juan P. Garrahan / Consultation on child abuse: Characteristics of a population with a high level of suspicion of child abuse at Hospital de Pedatría Juan P. Garrahan

El maltrato infantojuvenil constituye un problema de salud pública, presenta consecuencias negativas en el adecuado desarrollo de los niños y adolescentes. Es consecuencia de una multiplicidad de factores individuales, sociales, psicológicos y culturales que puede incluso desembocar en la muerte del niño o adolescente. El objetivo fue realizar una descripción sociodemográfica e identificar posibles variables específicas de maltrato en la población que realizó alguna consulta al hospital y que fue derivada por el médico tratante al Consultorio Multidisciplinario de Protección Infantojuvenil (CMPIJ). Se trató de un estudio descriptivo, prospectivo de corte transversal, realizado entre julio de 2016 y mayo de 2017 en el Hospital de Pediatría Juan P. Garrahan. El criterio de inclusión fue la población que realizó alguna consulta al hospital, ya sea por sospecha de maltrato o por otros motivos y fue derivada por el médico tratante al CMPIJ. Se evaluaron 96 casos. el 67,7% de las sospechas fueron de abuso sexual infantil (ASI), el 22,9% de maltrato físico y el 9,4% de trastorno facticio aplicado a otro. En los casos de alta sospecha de ASI, el 75% de los pacientes eran de sexo femenino; en el 50% de los casos, el supuesto agresor era conviviente y el 50% de las madres refirió antecedentes de malos tratos en la infancia. En los casos de alta sospecha de maltrato físico, el 53% de los pacientes era de sexo masculino, en el 83,3% de los casos el supuesto agresor era conviviente y el 76,5% de las madres refirió antecedentes de malos tratos en infancia. Se concluye la importancia de contar con datos fidedignos en lo relativo al maltrato Infantojuvenil para permitir elaborar estrategias de prevención tanto a nivel asistencial como de Salud Pública (AU)

Child abuse is a public health problem with a negative impact on the adequate development of children and adolescents. It is a consequence of multiple individual, social, psychological, and cultural factors that may even result in the death of the child or adolescent. The aim of this study was to provide a sociodemographic description and to identify possible specific variables associated with abuse in the population that visited the hospital and was referred to the Multidisciplinary Child Protection Clinic (MDCPC). A prospective, descriptive, cross-sectional study was conducted between July 2016 and May 2017 at Hospital de Pediatría Juan P. Garrahan. The inclusion criterion was the population that visited the hospital, either for suspicion of abuse or for other reasons, who were referred to the MDCPC by the treating physician. Overall, 96 cases were evaluated; 67.7% of the suspicions were of childhood sexual abuse (CSA), 22.9% for child battering, and 9.4% for Munchausen syndrome by proxy. Among the cases with a high level of suspicion of CSA, 75% were female; in 50% of the cases the supposed aggressor lived in the household, and 50% of the mothers reported a history of child abuse. In the cases of a high level of suspicion of child battering, 53% of the patients were male, in 83.3% of the cases the aggressor was living in the household, and 76.5% of the mothers reported a history child abuse. In conclusion, trustworthy data on child abuse are necessary to develop prevention strategies at both the care and public health levels (AU)

"I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault.

The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.

Childhood Sexual Abuse and Indicators of Immune Activity: A Systematic Review.

Background: Childhood sexual abuse (CSA) is a prevalent subtype of early life stress associated with changes in immunological and neuroendocrine systems leading to inflammatory responses of the organism and increasing several inflammatory and immune markers. We aimed to conduct a systematic review concerning the association between CSA and indicators of immune activity. Methods: We conducted a search for articles in PubMed, Scopus, PsycINFO, and Web of Science, using the key words: ("Child sexual abuse" OR "childhood maltreatment" OR "sexual violence" OR "posttraumatic stress disorder" OR "rape") AND ("cytokines" OR "inflammatory markers" OR "interleukin" OR "tumor necrosis factor" OR "C-reactive protein"). PRISMA guidelines were used in order to improve the quality of this research, and MeSH terms were used in PubMed. Results: A total of 3,583 studies were found and, after application of the exclusion criteria, 17 studies were included in this review. Most studies reported an increase of inflammatory activity associated with the presence of early abuse. IL-6, TNF- α, and C-reactive protein were the most frequently analyzed markers and some studies showed higher levels in individuals that suffered CSA compared with controls, although the results were heterogeneous, as was the assessment of CSA, repeated trauma, and time of occurrence. It was not possible to perform a meta-analysis because the results were diversified. Conclusion: CSA is associated with changes in inflammatory markers levels. Improving the assessment of subtypes of trauma is important to further understand the complex correlations of CSA and its biological consequences such as psychiatric and physical illness in later life.

Anogenital warts in pediatric population

Abstract: The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

Elevated C-reactive Protein Levels in Women with Bipolar Disorder may be Explained by a History of Childhood Trauma, Especially Sexual Abuse, Body Mass Index and Age.

OBJECTIVE AND BACKGROUND: To evaluate whether increased levels of high-sensitivity C- reactive protein (hs-CRP) observed in individuals with bipolar disorder (BD) compared to healthy controls (HCs) could be influenced by a previous exposure to early life stress (ELS) independently from other explanatory or background variables, including age, body mass index (BMI), and the presence of cooccurring mental disorders. METHOD: In this case-control study, we included 142 healthy controls and 92 bipolar I and II patients. The Childhood Trauma Questionnaire was administered in a subset of 30 female patients with BD and 31 female HCs, and plasma hs-CRP was measured in all subjects. Multivariable models adjusted the data for the possible confounding variables. RESULTS: Serum hs-CRP levels were significantly higher in patients with BD compared to HCs. However, after controlling for BMI, these differences were no longer significant. Around 55% of the variance in hs-CRP was explained by cumulative and independent effects of age, BMI and childhood trauma, especially sexual abuse. CONCLUSION: Our results show that increased hs-CRP levels in BD patients are more related to childhood trauma, especially sexual abuse, age and BMI than to a diagnosis of BD per se. These data suggest that peripheral inflammation may underpin the well-known detrimental effects of childhood maltreatment and obesity in the course of BD. Hs-CRP data are difficult to interpret if they are not adjusted for effects of BMI and age.

Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis.

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

Correlates of Sexual Violence Among Men Who Have Sex With Men in Tijuana, Mexico.

Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.

Surviving sexual abuse in everyday life: forms of resistance used by children and adolescents / Sobreviviendo al abuso sexual en el cotidiano familiar: formas de resistencia utilizadas por niños y adolescentes / Sobrevivendo ao abuso sexual no cotidiano familiar: formas de resistência utilizadas por crianças e adolescentes

ABSTRACT Objective: to understand the forms of resistance used by children and adolescent victims of sexual abuse in the everyday family routine. Method: qualitative research developed at an Assistance Center to Women in Situations of Violence in the semi-arid region of Pernambuco, with data collected between June and November of 2014 through interviews with nine women. The analysis process was based on notions of Comprehensive Sociology and Everyday Life, with data organized by affinity, interpreted and categorized. Results: the emerged categories: ritualization of sexual abuse of children and adolescents in the family routine: acceptance of destiny through passivity; Camouflage to survive the experience of sexual abuse: silence, astuteness and acting/pretending in order to escape abuse, Between hidden sexual abuse and The revelation of sexual abuse. It can be seen that episodes of abuse occurred in secret and under the threat of abusers through intimidating gestures or words. Victims did not confront them or call attention or ask for help, they used tricks like metaphors, laughs and ironic words, as well as ridiculing them with excuses, hiding, pretending to be asleep or fleeing to the street. Conclusion: the underground centrality present in sexual abuse triggered forms of resistance in opposition to the oppression generated by the abuser in which, in accepting that way of life, the participants developed different survival mechanisms, as well as participating in voluntary work, music and sports, these vents alleviate the burden of concealing the abuse.

RESUMEN Objetivo: aprender formas de resistencia utilizadas por niños y adolescentes en un cotidiano familiar de abuso sexual. Método: investigación cualitativa desarrollada en un Centro de Atendimiento a la Mujer en Situación de Violencia en el Semiárido de Pernambuco, con datos recolectados entre junio y noviembre de 2014, por medio de entrevista con nueve mujeres. El proceso de análisis se fundamentó en nociones de la Sociología Comprensiva y del Cotidiano, con datos organizados por afinidad, interpretados y categorizados. Resultados: emergieron las categorías: ritualización del abuso sexual de niños y adolescentes en el cotidiano familiar: aceptación de la vida por la pasividad; camuflajes para sobrevivir a lo vivido sobre el abuso sexual: silencio, astucia y doble juego, y, entre lo oculto y la revelación del abuso sexual. Puede percibirse que los episodios de abuso ocurrían en secreto y bajo la amenaza de los abusadores a través de gestos o palabras intimidantes. Las víctimas no entraban en confrontación con ellos y para llamar la atención o pedir auxilio usaban artimañas como metáforas, risas y palabras irónicas, además de despistarlos con disculpas, escondiéndose, fingiendo dormir o escapándose para la calle. Conclusión: la centralidad subterránea presente en el abuso sexual desencadenó formas de resistencia en oposición a la opresión generada por el abusador en que, para la aceptación de la vida, las participantes desarrollaron diferentes mecanismos de sobrevivencia, además de encontrar en el trabajo voluntario, música y deporte, los respiraderos para aliviar el peso generado por la ocultación del abuso.

RESUMO Objetivo: apreender formas de resistência utilizadas por crianças e adolescentes em um cotidiano familiar de abuso sexual. Método: pesquisa qualitativa desenvolvida em um Centro de Atendimento à Mulher em Situação de Violência no semiárido de Pernambuco, com dados coletados entre junho e novembro de 2014 por meio de entrevista com nove mulheres. O processo de análise fundamentou-se em noções da Sociologia Compreensiva e do Cotidiano, com dados organizados por afinidade, interpretados e categorizados. Resultados: emergiram as categorias: ritualização do abuso sexual de crianças e adolescentes no cotidiano familiar: aceitação da vida pela passividade; camuflagens para sobreviver ao vivido de abuso sexual: silêncio, astúcia e duplo jogo; e, entre o oculto e a revelação do abuso sexual. Pode-se perceber que os episódios de abuso ocorriam em segredo e sob a ameaça dos abusadores através de gestos ou palavras intimidadoras. As vítimas não entravam em confronto com eles e para chamar a atenção ou pedir auxílio usavam artimanhas como metáforas, risos e palavras irônicas, além de despistá-los com desculpas, escondendo-se, fingindo dormir ou fugindo para a rua. Conclusão: a centralidade subterrânea presente no abuso sexual desencadeou formas de resistência em oposição à opressão gerada pelo abusador em que, para aceitação da vida, as participantes desenvolveram diferentes mecanismos de sobrevivência, além de encontrar no trabalho voluntário, música e esporte, os respiradouros para aliviar o peso gerado pela ocultação do abuso.

Vulnerability to Sexual Victimization in Female and Male College Students in Brazil: Cross-Sectional and Prospective Evidence.

Using both cross-sectional and prospective analyses, this study examined vulnerability factors for sexual victimization in 541 female and male Brazilian college students, of whom a subgroup of 250 took part in two measurements 6 months apart. Risk factors for sexual victimization (alcohol consumption, casual sex, and ambiguous communication) in participants' cognitive scripts for consensual sex were linked to sexual victimization via their translation into risky sexual behavior. Pornography use was indirectly linked to sexual victimization through its influence on risky sexual scripts and sexual behavior. Child sexual abuse predicted sexual victimization in the cross-sectional analysis, and victimization since age 14 predicted revictimization in the six months covered by the prospective period. Few gender differences were found. This study is the first prospective investigation of vulnerability factors for sexual victimization in Brazil, and similarities to evidence from North America are discussed.

Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires, Argentina.

This study sought to describe childhood sexual experiences with older partners (CSEOP) among men who have sex with men (MSM) in Buenos Aires, Argentina. MSM were recruited through respondent driven sampling. They responded to a computer administered self-interview with questions on CSEOP, operationalized as manual, oral, genital, or anal contact prior to age 13 with a partner at least 4 years older. Of the 500 respondents, only 25% identified as gay. Eighteen percent of the respondents reported CSEOP, the majority of whom did not feel they were hurt by the experience and did not consider it to be childhood sexual abuse (CSA). Over two-thirds of MSM who reported CSEOP said that their older partner was a female. Only 4% of those with a female partner felt their experience was CSA compared to 44% of those who had a male partner. Among all men reporting CSEOP, those who felt sexually abused were more likely to have been physically forced or threatened, physically hurt, and emotionally hurt than those who did not feel sexually abused. Having CSEOP, being hurt by the experiences, and perceiving the experiences as sexual abuse were not associated with current HIV sexual risk or substance use behavior. In this sample of MSM in Argentina, a substantial minority reported CSEOP. Those who felt they had been sexually abused were much more likely to have had an older male partner than an older female partner, and were more likely to report having been physically forced and threatened by their older partner.

Características epidemiológicas, consecuencias físicas y emocionales a corto y largo plazo en niños de 4 a 15 años con sospechas de abuso sexual. Hospital del Niño. Panamá 2009 al 2011

El abuso sexual se refiere a las conductas sexuales coercitivas , impuestas a una persona menor de edad, por otra persona, que puede ser físicamente superior, con más experiencia y recursos, que utiliza incorrectamente su poder o autoridad. Es un hecho significativo que cada día emerge con más fuerza e involucra la vulneración de los derechos humanos. Por esta razón ante el creciente interés en el tema a nivel mundial, ante las devastadoras consecuencias sobre el niño, su entorno, salud física, emocional y posterior desempeño escolar y social, hemos decidido abordarlo. Objetivo: Identificar las características sociodemográficas, consecuencias físicas en niños de 4 a 15 años con sospecha de abuso sexual, atendidos en el Hospital del Niño entre los años 2009 al 2011 y determinar si existe relación a corto y largo plazo entre la agresión y alteraciones psicoemocionales. Metodología: Se realizó un estudio en dos fases: La primera fase un estudio descriptivo retrospectivo simple y la segunda fase, analítica de seguimiento, en un periodo de 18 a 24 meses posterior a sufrir agresión sexual, de los casos referidos a los Juzgados de Niñez y Adolescencia del Distrito de Panamá, mediante la aplicación de La Escala Children's Depression Inventory y la Escala de Ansiedad de Spence. La muestra fue de 92 casos. Se analizaron los datos con Excel 2010. Resultados: El mayor número de casos de abuso sexual se encontró en la adolescencia temprana 36 %, con una media de edad de 9.6 años, encontrando un factor de asociación de ocurrencia en el ámbito extra familiar con 21 %; en donde el 79 % el agresor era conocido por las víctimas. Sólo un 45 % de los casos referidos se considero abuso según juzgados. Sólo un 26 % cumplió la ruta crítica de forma integral. Conclusiones: Encontramos la mayor afectación en el grupo de adolescencia intermedia. La agresión se realizó por un conocido de la víctima y el examen físico no fue concluyente para el dictamen de abuso. En los casos a quienes se aplicaron las herramientas de evaluación psicoemocionales se evidenció predominio de alteraciones de tipo emocionales.

The sexual abuse refers to coercive sexual behaviors imposed to a minor by another person who can be physically superior, with more experience, resources, using in a wrong way his authority. It is significant fact that every day more strongly emerges and involves the violation of human rights. For this reason at the global increase of the topic with devastating consequences for the child, their environment, physical and emotional health and subsequent school and social performance, we decide to address this issue. Objective: Identify the sociodemographic characteristics and physical consequences in children from 4 to15 years with suspected sexual abuse, attended in Hospital del Niño between years 2009-2011 and determine if there exists association in a short or long term between the aggression and psycho-emotional disorders. Methods: The study was conducted in two phases: the first one was a single retrospective study and the second phase was a follow-up analysis in a period from 18 to 24 months after the sexual attack, in those cases referred to the courts for Childhood and Adolescence Panama District, through the application of Children's Depression Inventory Scale and the Spence Anxiety Scale. The sample was 92 cases. Data were analyzed with excel 2010. Results: The most cases of child sexual abuse were in the middle adolescence (36%), with a mean age of 9.6 years. We found association of occurrence in the extra-familiar environment with 21%, where the 79% of the aggressors were known people from the victim. 45% of the cases were considered sexual abuse by the Tribunals. Just 26% complete the entire process (Critical Route). The psycho-emotional disturbances were seen in a short term with 16% in adolescents. Conclusions: the most affected group was the middle adolescence. The attack was done by a known person of the victim and the physical examination was not conclusive to determine sexual abuse. In the cases evaluated with the anxiety and depression scales the most resulted in emotional disturbances.

Una revisión acerca de la sintomatología del abuso sexual infantil / A review of the symptomatology of child sexual abuse

El abuso sexual infantil es un problema de gran impacto internacional y con una alta prevalencia. De acuerdo con la OMS, en el mundo al menos 150 millones de niñas y 73 millones de niños han sido víctimas de alguna forma de abuso sexual antes de cumplir los 18 años. La investigación, centrada principalmente en la sintomatología de esta problemática, pretende dar cuenta del estado del arte sobre el tema en el periodo del 2004 al 2010. Además, se muestra información valiosa y actualizada acerca de los factores de riesgo para comprender más a fondo el fenómeno. Se concluye que en las investigaciones se manifiesta la diversidad a nivel psicopatológico que reviste la vivencia y que aún se encuentran contradicciones entre los estudios, lo que podría señalar que el tema no ha sido suficientemente investigado.

Child sexual abuse is an issue with great international impact and a high prevalence - according to WHO. At present, at least 150 million girls and 73 million boys have been victims of some kind of sexual abuse before 18 years of age. This study, directed mainly towards the symptomatology of this issue, intends to present the state of the art about the subject in the period from 2004 to 2010, additionally, valuable and current information is presented regarding risk factors, in order to provide a better understanding of the phenomenon. It is concluded that research shows the psychopathological diversity involved in the experience and that contradictions between studies can still be found, which indicate that the subject has not been sufficiently studied.