An Italian single-center retrospective analysis of 1106 consecutive cases of child and adolescent abuse: key elements of effective practices.

BACKGROUND: Child and adolescent maltreatment refer to several forms of abuse and neglect, with negative and harmful consequences on children's and adolescents' physical and psychological health. METHODS: This study aims to provide a wide perspective on child and adolescents maltreatment from a large, public, anti-violence center located in a university hospital (SVSeD, Sexual and Domestic Violence Service) and to suggest models of tailored therapeutic interventions and proposals for effective clinical practice. RESULTS: The sample study was obtained by analyzing 1106 medical records of victims aged 0 to 17 referring to SVSeD for all types of abuse. Our findings confirm that almost in one third (28.2%) of the cases children and adolescents are victims of multiple different types of violence. In our experience, sexual violence plays a leading role (66% of cases), being the most frequent type of child and adolescent abuse. CONCLUSIONS: This study confirms that child and adolescent abuse could manifest in many different ways, which are often not so easily detected, as the violence usually occurs inside the family. Institutional educational programs should be implemented to increase the health practitioners' skills and competence for detecting and reporting children and adolescents who are victims of abuse.

Similarity and Differences in Sexual Violence Against Adolescents and Adult Women: The Need to Focus on Adolescent Victims.

STUDY OBJECTIVE: To explore whether there are differences in characteristics, clinical findings and management in cases of sexual violence in adolescent and adult women. DESIGN: Retrospective study. SETTING: SVSeD-Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. PARTICIPANTS: Female victims of sexual violence aged 10 years and older. Two study groups were analysed: an adolescent group and an adult group. INTERVENTIONS: None; this was an observational study. MAIN OUTCOME MEASURES: Characteristics of the perpetrator, time spent between the episode of sexual violence and the access to SVSeD, presence of genital and/or extragenital injuries; tests for sexually transmitted diseases, spermatozoa research; and toxicological screening; RESULTS: Adolescent victims of sexual violence requested help later than the adult victims. The majority of the perpetrators were well known to the victims in both groups. In both groups, we observed genital injuries in 1 of 3 patients. We found a strong association between the presence of genital injuries and a positive screening test for sexually transmitted diseases, in particular with regard to the adolescent victims. CONCLUSION: Adolescents' delayed disclosure of sexual violence may affect the ability to properly manage these crimes. Prevention programs and public awareness campaigns should be implemented to highlight the importance of a prompt disclosure after sexual assault has occurred. Gynecologists should be made increasingly aware of this delicate issue, to better assist victims of sexual violence, especially adolescent victims.

A case report of lethal post-viral lymphocytic myocarditis with exclusive location in the right ventricle.

The inflammatory involvement of vital organs may represent a dangerous and life-threatening situation: in particular, the inflammation of the myocardial tissue of the heart may lead to severe consequences since the clinical history of the disease may be completely asymptomatic, any clinical sign may be lacking, thus preventing correct diagnosis and treatment. This may occur even in the case of myocarditis and may lead to unexpected death whose cause can be assessable only by means of a thorough histopathological examination. The article reports the case of 61-year old female who developed a flu-like syndrome with very few symptoms, followed by sudden death in three weeks. The autopsy and following histopathological investigations identified the cause of death in a post-viral lymphocytic myocarditis, probably related to the previous infectious disease, and alternative causes (as arrhythmic ventricular dysplasia, vasculitis, sarcoidosis and giant cell myocarditis) were excluded. The exclusive location in the right ventricle was a peculiar finding. The case highlights the importance of the myocardium of the right ventricle, a tissue which is often less considered even in histopathological surveys. The exclusive location of myocarditis in the right ventricle is a rare event but in this case fully responsible for death.

Death due to acute tetrachloroethylene intoxication in a chronic abuser.

Volatile substances are used widespread, especially among young people, as a cheap and easily accessible drug. Tetrachloroethylene is one of the solvents exerting effects on the central nervous system with experiences of disinhibition and euphoria. The case presented is that of a 27-year-old female, found dead by her father at home with cotton swabs dipped in the nostrils. She was already known for this type of abuse and previously admitted twice to the hospital for nonfatal acute poisonings. The swabs were still soaked in tetrachloroethylene. Toxicological and histological investigations demonstrated the presence of an overlap between chronic intake of the substance (with high concentrations in sites of accumulation, e.g., the adipose tissue, and contemporary tissue damage, as histologically highlighted) and acute intoxication as final cause of death, with a concentration of 158 mg/L in cardiac blood and 4915 mg/kg in the adipose tissue. No other drugs or medicines were detected in body fluids or tissues, and to our knowledge, this is the highest concentration ever detected in forensic cases. This peculiar case confirms the toxicity of this substance and focuses on the importance of complete histological and toxicological investigations in the distinction between chronic abuse and acute intoxication.

Can facial proportions taken from images be of use for ageing in cases of suspected child pornography? A pilot study.

The age of the victim plays a crucial role for the legal implications concerning pornography. Judges therefore often call on forensic experts to verify the age of individuals depicted on photographs or videos. However, there is no scientifically established protocol available for forensic practice in such cases. The conventional methods such as the evaluation of secondary sexual characteristics provide unsatisfactory results particularly when the legally relevant ages for child pornography (i.e. 14 and 18 years) are concerned. To overcome these limits, a European research group has explored the applicability of facial proportions as an age indicator on images. In this pilot study, standardized facial images of 353 females and 20 males from four age groups (6, 10, 14 and 18 years) were randomly selected for the metric analysis from a large data set including German, Italian and Lithuanian subjects. In this sample, several indices extracted from the frontal and lateral photographs were closely correlated to their respective indices taken from the living individuals. Furthermore, age-related changes were identified for indices taken from the photographs. The discriminant analysis showed that for the pooled sample, 60.3% of the cases were correctly classified into the respective age group. The percentage of correctly classified cases increased in the respective country samples as follows: 69.9% for Germany, 69.4% for Lithuania and 80.5% for Italy. The present study suggests that the metric assessment of the face may be used for age estimation on images. Nonetheless, more work needs to be done in order to verify the reliability of these findings on a large sample.