Prevalence of child sexual abuse in Spain: a survey study / Prevalencia del abuso sexual infantil en España: un estudio de encuesta

Background/aim: Child sexual abuse (CSA) is a pervasive issue that affects children and adolescents worldwide, and Spain is no exception. Despite its high impact, there is a lack of comprehensive data on the prevalence of CSA in Spain. This study aims to update the current state of the prevalence of CSA, providing a comprehensive picture of the prevalence of sexual abuse from data using varying defining criteria. Method: A cross-sectional design was conducted, including a total of 1,323 participants, aged between 18 and 70 years (M = 28.40, SD = 10.31) responded to a measure of exposure to child sexual abuse. Results: The results exhibited that the prevalence of CSA was 9.2% for male and 22.1% for female participants, significantly higher for them. In terms of prevalence rate, females reported more frequently than males having suffered a more severe form of sexual abuse when they were 13 to 18 years old, with a large magnitude of the effect. Another notable finding was that the occurrence of global CSA with and without intercourse was significant, not a trivial effect. Conclusions: Consequently, there is a need for increased awareness, education, and resources to prevent and address CSA. The results of this study highlight the need for continued research to better understand the extent of CSA and to develop evidence-based interventions to protect children and adolescents from CSA victimization. (AU)

Antecedentes/objetivo: El abuso sexual infantil (ASI) es un problema generalizado que afecta a niños y adolescentes en todo el mundo, y España no es una excepción. A pesar de su gran repercusión, faltan datos completos sobre la prevalencia del ASI en España. El estudio pretende actualizar el estado actual de la prevalencia del ASI, proporcionando una imagen completa de la prevalencia del abuso sexual a partir de datos que utilizan diferentes criterios de definición. Método: Se realizó un diseño transversal, incluyendo un total de 1,323 participantes, en edades comprendidas entre 18 y 70 años (M = 28.40, DT = 10.31) respondieron a una medida de exposición a abuso sexual infantil. Resultados: Los resultados mostraron que la prevalencia de ASI fue del 9.2% para los hombres y del 22.4% para las mujeres, significativamente mayor para ellas. En cuanto a la tasa de prevalencia, las mujeres declararon con mayor frecuencia que los hombres haber sufrido una forma más grave de abuso sexual cuando tenían entre 13 y 18 años, con tamaño del efecto grande. Otro hallazgo a destacar fue que la existencia de ASI global con y sin coito resultó significativa, esto es, la prevalencia no es trivial. Conclusiones: Se concluye que hace falta una mayor concienciación, la educación y recursos para prevenir y abordar el ASI. Los resultados de este estudio ponen de relieve la necesidad de seguir investigando para comprender mejor el alcance del ASI y desarrollar intervenciones con fundamento empírico para proteger a los niños y adolescentes de la victimización de ASI. (AU)

Solicitation and Sexualized Interactions of Minors with Adults: Prevalence, Overlap with Other Forms of Cybervictimization, and Relationship with Quality of Life / [La solicitud sexual y las interacciones sexualizadas de menores con adultos: su prevalencia, solapamiento con otras formas de cibervictimización y relación con la calidad de vida]

Sexual solicitation and sexualized interaction with minors by adults constitute one of the most pernicious risks of the Internet. Little is known about the age range in which this phenomenon is most prevalent or the relationship and overlap of this problem with other risks, such as peer-to-peer cybervictimization and cyber dating abuse. Additionally, little empirical evidence exists on whether the overlap between these types of online victimization affects health-related quality of life (HRQoL). This study aimed to: 1) analyze the prevalence of sexual solicitation and interaction according to sex and stage of adolescence; 2) relate this problem to other forms of online victimization (cybervictimization and cyber dating abuse); 3) analyze the overlap between these forms of online victimization and differences in HRQoL scores. A cross-sectional and analytical study with 3,578 adolescents (52.7% girls) aged between 10-15 years was carried out. Of the adolescents in the study sample, 12.6% (n = 448) had received sexual requests and 6.4% (n = 230) had interacted sexually with adults. Sexual solicitation was most common among girls in middle adolescence. Of the participants, 33.9% (n = 1,216) had been involved in some form of online victimization. Peer cybervictimization and cyber dating abuse were positively and significantly correlated with sexualized solicitation/interactions with adults. Victims with the overlapping of all three types of online victimization (2.7%, n = 98) presented the lowest HQRoL scores (p < .001).(AU)

La solicitación e interacción sexual con menores por parte de adultos constituyen uno de los riesgos más perniciosos de Internet. Se sabe poco sobre la franja de edad en el que es más frecuente o sobre la relación y el solapamiento de este problema con otros riesgos, como la cibervictimización entre iguales y el abuso online en la pareja. Además, existen pocas evidencias empíricas sobre si el solapamiento entre estos tipos de victimización afecta a la calidad de vida relacionada con la salud (CVRS). Los objetivos de este estudio fueron: 1) analizar la prevalencia de la solicitación/interacción sexual en función del sexo y la etapa de la adolescencia, 2) relacionar esta problemática con la cibervictimización entre iguales y el abuso online en la pareja, 3) analizar el solapamiento entre estas formas de victimización online y sus diferencias en las puntaciones de CVRS. Se trata de un estudio transversal y analítico con 3,578 adolescentes (52.7% chicas) entre 10-15 años. El 12.6% (n = 448) habían recibido solicitaciones sexuales y el 6.4% (n = 230) había interactuado sexualmente con adultos. La solicitación sexual fue más frecuente en chicas en la adolescencia media. Un 33.9% (n = 1,216) había sufrido algún tipo de victimización online. La cibervictimización entre iguales y el abuso online en la pareja correlacionaron positiva y significativamente con solicitaciones/interacciones sexualizadas con adultos. Las víctimas que solaparon los tres tipos de victimización online (2.7%, n = 98) presentaron las puntuaciones de CVRS más bajas (p < .001).(AU)

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.

Violência sexual contra mulheres: uma análise das notificações no Espírito Santo, Brasil / Violencia sexual contra las mujeres: un análisis de las notificaciones en Espírito Santo, Brasil / Sexual violence against women: an analysis of notifications in Espírito Santo, Brazil

Resumo Objetivo Estimar a frequência e os fatores associados à violência sexual contra mulheres no Espírito Santo. Métodos Estudo transversal realizado a partir de dados notificados entre 2011 e 2018 no Sistema de Informação de Agravos de Notificação. A análise multivariada foi conduzida por meio da regressão de Poisson, com variância robusta. Resultados A frequência de violência sexual foi de 15,6%, sendo maior a ocorrência em crianças; pessoas sem deficiências e/ou transtornos; residentes em área urbana; com agressor único, desconhecido, do sexo masculino e sem suspeita de uso de álcool. A residência foi o local de maior ocorrência e o caráter de repetição esteve presente. Conclusão e implicações para a prática A violência sexual contra mulheres apresentou alta frequência no estado. Os resultados reforçam a associação desse agravo com características da vítima, do agressor e do evento, evidenciando a vulnerabilidade das crianças e o espaço doméstico como um cenário de grande frequência desse agravo.

Resumen Objetivo Estimar la frecuencia y los factores asociados con la violencia sexual contra la mujer en Espírito Santo. Métodos Estudio transversal realizado a partir de datos notificados entre 2011 y 2018 en el Sistema de Información de Enfermedades de Declaración Obligatoria. El análisis multivariado se realizó mediante regresión de Poisson, con varianza robusta. Resultados La frecuencia de violencia sexual fue del 15,6%. La prevalencia fue mayor en niñas; personas sin discapacidades y/o trastornos; residentes en áreas urbanas; con un único agresor, desconocido, del género masculino y sin sospecha de consumo de alcohol. La residencia fue el lugar de mayor ocurrencia y el carácter de repetición estuvo presente. Conclusión e implicaciones para la práctica La violencia sexual contra las mujeres fue altamente prevalente en el estado. Los resultados refuerzan la asociación de esa condición con las características de la víctima, del agresor y del evento, evidenciando la vulnerabilidad de las niñas y el espacio doméstico como escenario de alta frecuencia de esa condición.

Abstract Objective To estimate the frequency and factors associated with sexual violence against women in Espírito Santo. Methods Cross-sectional study based on data reported between 2011 and 2018 in the Notifiable Diseases Information System. Multivariate analysis was conducted using Poisson regression, with robust variance. Results The frequency of sexual violence was 15.6%, being the prevalence higher among children; people without disabilities and/or disorders; urban areas residents; with a sole, male, unknown aggressor and without suspicion of alcohol use. The residence was the place with the highest occurrence and the character of repetition was present. Conclusion and implications for practice Sexual violence against women was highly prevalent in the state. The results reinforce the association of this condition with the characteristics of the victim, the aggressor and the event, evidencing the vulnerability of children and the domestic space as a scenario of high frequency of this harm.

Estupro na primeira macrorregião do estado de Alagoas: resultados da pesquisa DVEAL, 2016-2018 / Rape in the first macro-region of the state of Alagoas: results from DVEAL survey, 2016-2018

Objetivos: apresentar resultados do eixo 2 do projeto Diagnóstico da Violência Fatal e Não Fatal no Estado de Alagoas (DVEAL). Neste artigo é comparado o padrão epidemiológico do estupro de crianças e adolescentes em relação aos adultos. Métodos: delineou-se uma investigação observacional e retrospectiva incluindo 380 registros de violência sexual no Instituto Médico Legal, entre 2016 e 2018. Por meio de regressão logística binária e múltipla calculou-se a chance de violência por faixa etária, associando os possíveis fatores relacionados. Resultados: metade das vítimas estupradas possuíam até 13 anos de idade, com média de 14 anos, e 9 em cada 10 casos eram de mulheres/meninas vitimadas. O padrão do estupro identificado foi de vítimas: em situação conjugal solteira; estudantes, abusadas por conhecidos; que realizaram exame pericial entre 1-7 dias; abusadas durante a madrugada; e em região genital. Cerca de 8 em cada 10 casos foram estupros confirmados pela perícia, o restante foi via relato oral. O modelo final identificou dois fatores mais associados à violência sexual em crianças/adolescentes. Conclusão: o padrão de vitimização sexual no estado impacta significativamente crianças e adolescentes e, principalmente, o gênero feminino

Aims: to present the results of axis 2 of the Diagnosis of Fatal and Non-Fatal Violence in the State of Alagoas (DVEAL) project. This article compares the epidemiological pattern of rape involving children/adolescents in relation to adults. Methods: an observational and retrospective investigation was designed, including 380 records of sexual violence at the Instituto Médico Legal, between 2016 and 2018. Through binary and multiple logistic regression, the chance of violence by age group was calculated, associating the possible related factors. Results: half of the raped victims were up to 13 years old, with an average of 14 years old, and 9 out of 10 cases were victimized women/girls. The pattern of rape identified was of victims: single marital status; students, abused by acquaintances; who underwent an expert examination between 1-7 days; abused during the dawn; and in the genital region. About 8 out of 10 cases were rapes confirmed by forensics, the rest were via oral report. The final model identified two factors most associated with sexual violence in children/adolescents. Conclusions: the pattern of sexual victimization in the state significantly impacts children and adolescents, especially the female gender

Epidemiología de los niños, niñas y adolescentes derivados a un equipo de referencia en violencia basado en género y generaciones durante la pandemia por el COVID-19: diferencias con el año 2016: CASMU-IAMPP / Epidemiology of children and adolescents referred to a gender violence reference team during the COVID-19 pandemic as compared to 2016: CASMU-IAMPP / Epidemiologia de crianças e adolescentes referidos a uma equipe de referência em violência baseada em gênero durante a pandemia do COVID-19: diferenças com o ano de 2016: CASMU-IAMPP

El maltrato y el abuso sexual infantil constituyen una violación de los derechos humanos y un importante problema de salud mundial. La situación ya era grave y compleja previamente. El aislamiento social por el COVID-19 la volvió una crisis. En marzo de 2020 se tomaron medidas preventivas para mitigar los efectos de la enfermedad. El confinamiento fue una de ellas. El maltrato infantil durante 2020 ascendió de 20% a 32%. Objetivo: conocer las características epidemiológicas de los niños, niñas y adolescentes víctimas de situaciones de maltrato y de probable abuso sexual infantil, asistidos en el Equipo de Referencia en Violencia Basado en Género y Generaciones de una institución, entre el 1 abril de 2020 al 31 julio de 2020, en comparación con el mismo período en 2016. Se realizó un estudio observacional, descriptivo, con los usuarios menores de 18 años derivados a dicho equipo. El total de consultas fue 28 en 2016, y 17 en 2020. Los motivos de consulta en 2016 fueron: 24,5% abuso sexual, 3,5% negligencia y 72% maltrato emocional en el contexto de violencia doméstica. En 2020 fueron 41%, 6% y 53%, respectivamente. En 2016 82% de los casos fueron derivados por el sector de salud, de ellos 36% por el pediatra tratante. En 2020 fueron 76% y 46%, respectivamente. A pesar de existir a nivel internacional múltiples reportes y publicaciones que apuntan a un estado de emergencia infantil por la pandemia del COVID-19, esto no se vio reflejado.

Summary: Child and sexual abuse involve a breach of human rights and a major global health problem. The situation was already serious and complex before the Covid 19 Pandemic, but it has turned it into a crisis. In March 2020, preventive measures were taken to mitigate the effects of the disease, the lockdown was one of them. Child abuse rose from 20% to 32% in 2020. Objective: learn about the epidemiological characteristics of children and adolescent victims of abuse and probable sexual abuse, assisted by the Gender Based Violence Reference Team at one institution, between April 1, 2020 and 31 July 2020, compared to the same period in 2016. An observational, descriptive study was carried out with users under 18 years of age referred to team mentioned above. The total number of consultations was 28 in 2016, and 17 in 2020. The reasons for consultation in 2016 were: 24.5% sexual abuse, 3.5% neglect and 72% emotional abuse within the framework of domestic violence. In 2020 they were 41%, 6% and 53%, respectively. In 2016, 82% of the cases were referred by the health sector, 36% of them by the treating pediatrician. In 2020 76% and 46%, respectively. Despite the multiple global reports and publications that suggest a state of emergency for the case of children and adolescents due to the Covid-19 pandemic, this was not reflected in our figures.

O abuso infantil e o abuso sexual constituem uma violação dos direitos humanos e um grande problema de saúde global. A situação já era grave e complexa antes da pandemia do Covid-19 e o isolamento social transformou ela em uma crise. Em março de 2020, foram tomadas medidas preventivas para mitigar os efeitos da doença. O confinamento foi um deles. O abuso infantil em 2020 aumentou de 20% para 32%. Objetivo: conhecer as características epidemiológicas de crianças e adolescentes vítimas de abuso e provável abuso sexual infantil, atendidos pela Equipe de Referência em Violência Baseada no Gênero numa instituição de saúde entre 1º de abril de 2020 a 31 de julho de 2020, em comparação para o mesmo período de 2016. Foi realizado um estudo observacional, descritivo com usuários menores de 18 anos de idade que tinham sido encaminhados à referida equipe. O número total de consultas foi de 28 em 2016 e 17 em 2020. Os motivos de consulta em 2016 foram: 24,5% abuso sexual, 3,5% negligência e 72% abuso emocional em contexto de violência doméstica. Em 2020 foram 41%, 6% e 53%, respectivamente. Em 2016, 82% dos casos foram referudis pelo setor de saúde, 36% deles pelo pediatra responsável. Em 2020 foram 76% e 46%, respectivamente. Apesar da existência de vários papers e publicações a nível gobal que sugerem um estado de emergência para as crianças devido à pandemia de Covid-19, isso não se refletiu nos nossos dados.

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.

Stigma as a barrier to addressing childhood trauma in conversation with trauma survivors: A study in the general population.

Victims of childhood trauma report shame and anticipation of stigma, leading to non-disclosure and avoidance of help. Stigma is potentially aggravating the mental health consequences of childhood trauma. So far there is no comprehensive study examining stigma toward adult survivors of various forms of childhood trauma, and it is unclear whether stigma interferes with reaching out to affected individuals. In a vignette study based on a representative sample of the German general population (N = 1320; 47.7% male) we randomly allocated participants to brief case vignettes pertaining to past childhood sexual/physical abuse or accidents, and adult physical abuse. Stigma was elicited by applying the Social Distance Scale, assessing respondents' attitudes/stereotypes toward the persons in the vignette and their reluctance to address the specific trauma in conversation. While one aim was to establish the prevalence of stigma toward persons with CT, we hypothesized that attitudes differ according to type of trauma. Of the respondents, 45% indicated they were unlikely to reach out to a victim of childhood sexual abuse, 38% to a victim of childhood physical abuse, 31% to someone reporting a childhood accident and 25% to someone reporting adult physical abuse. Contrary to our expectations, childhood sexual abuse did not consistently elicit more stigma than childhood physical abuse in Krukall-Wallis tests. Equally, childhood interpersonal trauma did not consistently elicit more stigma than childhood accidental trauma. Structural equation modeling revealed social distance as mediator of the relationship between negative stereotypes and reluctance to address childhood trauma in conversation. Our analyses further revealed an ambiguous role of negative stereotypes in addressing childhood trauma in conversation with trauma victims, which has yet to be examined. There is evidence for stigma associated with having survived childhood trauma, which is interfering with offering help.

The Association of Childhood Maltreatment with Adulthood Mental Disorders and Suicidality in Korea: a Nationwide Community Study.

BACKGROUND: Although childhood maltreatment is a known risk factor for adulthood mental health, the impact of different types of childhood maltreatment on mental disorders is not yet clear. This study explored the association of each type of childhood maltreatment with adulthood mental disorders and suicidality in South Korea. METHODS: A total of 5,102 individuals from the general populations over the age of 18 responded to the Korean version of the Composite International Diagnostic Interview and questions about childhood maltreatment (emotional neglect, psychological abuse, physical abuse, and sexual abuse). To evaluate the odds ratio for mental disorders and suicidality associated with each type of childhood maltreatment, we used logistic regression analysis. RESULTS: About 17.0% of the respondents reported having experienced a type of maltreatment in childhood. According to the type, 9.4% reported physical abuse, 9.3% reported emotional neglect, 7.9% reported psychological abuse, and 3.8% reported sexual abuse. Exposure to each type of childhood maltreatment was associated with most types of mental disorders after adjusting for sociodemographic factors. Each type of childhood maltreatment victim was associated with suicidality (suicidal ideations, suicide plans, and suicide attempts). Dose-response patterns for suicide attempts were observed in all types of victims. Moreover, the respondents who experienced frequent childhood emotional neglect were 14 times more likely to have attempted suicide. CONCLUSION: Childhood maltreatment was associated with mental health in adulthood. The findings show the need for early detection and intervention of victims of childhood maltreatment to minimize its negative impact on adult mental health.

Sexual Abuse and Sexually-Transmitted HIV/AIDS in Jamaican Children and Adolescents Aged 6-19 Years.

INTRODUCTION: Risk factors and outcomes of sexually-acquired human immunodeficiency virus infection were characterized in Jamaican children and adolescents. METHODOLOGY: Management was carried out by multidisciplinary teams in Infectious Diseases clinics during August 2003 through February 2019 using modified World Health Organization HIV criteria. RESULTS: There were 78 clients, aged 6 to 19 years, with females:males = 4:1 (p < 0.05). Sexual-initiation occurred in 60%, 47 before < 16 years (median 13 years, with four < 10 years; females:males = 7:1). Sexual-initiation preceded HIV diagnosis in all cases (median 2 years). Secondary education 93% (69/77) and living with non-parental relatives 17% (13/78) were associated with early sexual-initiation (p < 0.042); as was later imprisonment in 6% (3/52). Other sexually transmitted infections 36% (19/53) were associated with sexual-initiation ≥ 16 years (p < 0.01). Risks for ongoing HIV-transmission included infrequent condom use 74% (39/53), body-piercings 50% (24/48), illicit drug use 37% (28/76), tattoos 36% (19/52), transactional sex 14% (7/53) and pregnancy 56% of girls. 77% (59/77) had Centres for Diseases Control's Category A HIV infection; 82% (61/75) initiated anti-retroviral therapy; 75% (56/75) had first-line drugs, with helper T lymphocyte counts ≥ 500 cells/µL in 61% (48/78) and HIV viral load of < 1,000 copies/µL in 63% (40/64). Complications included dermatological 39% (20/52), respiratory 25% (13/52) and neurological 15% (8/52). Early sexual initiation was associated with depression 43% (33/76; p < 0.004) and suicidal attempt or ideation 23% (18/77; p < 0.096). Four (5%) died. CONCLUSIONS: Sexually transmitted HIV/AIDS in children and adolescents should preempt prompt medical, legal and psychosocial interventions.

Hypothalamic-pituitary-adrenal axis attenuation and obesity risk in sexually abused females.

BACKGROUND: Childhood sexual abuse (CSA) confers elevated risks for obesity in females. Mechanisms that explain this link remain unclear. This study tracked serum basal cortisol levels with body mass index (BMI) from childhood into adulthood to test whether hypothalamic-pituitary-adrenal (HPA) axis attenuation accounts for elevated obesity risks for sexually abused females. METHODS: Data drew from six timepoints of a longitudinal study of the impact of CSA on development. Participants were females aged 6-16 years at time of study enrollment with substantiated CSA and demographically matched non-abused peers. Analyses included only participants who did not have obesity at study enrollment. Main outcomes were BMI growth trajectories across ages 6-27 (n = 150; 66 abused, 84 comparisons) and early adulthood obesity status (ages 20-27; n = 133; 62 abused, 71 comparison). HPA axis functioning indicators were intercept and linear slope parameters extracted from multilevel growth trajectories of serum basal cortisol levels across development. Racial-ethnic minority status, parity, steroid medication use, depression history and disordered eating history were covaried. RESULTS: While controlling for covariates, multilevel modeling indicated that high initial serum basal cortisol levels in childhood and attenuated cortisol growth rate over time (i.e., HPA axis attenuation) were associated with accelerated BMI accumulation (p < .01). Attenuated cortisol growth rate mediated the effect of CSA on accelerated BMI accumulation and on elevated adulthood obesity rates (p < .05). CONCLUSION: This work establishes a mechanistic association between HPA axis attenuation and obesity, suggesting that trauma treatments for abuse survivors should include interventions that reduce health consequences associated with dysregulated stress physiology.

[Epidemioclinical and legal aspects of sexual abuse among minors in Monastir, Tunisia]. / Aspects épidémiocliniques et suites judiciaires des abus sexuels chez les mineurs à Monastir, Tunisie.

INTRODUCTION: Child sexual abuse is a disturbing reality and a major public health problem. Indeed, it is a subject that has long been treated as taboo, with dramatic consequences on physical and mental health as well as on social wellbeing of the victims. The purpose of this study was to highlight the epidemiological and clinical features as well as the legal aspects of child sexual abuse. METHODS: we conducted a retrospective descriptive study at the psychiatric outpatient service of the University Hospital of Monastir over a period of 12 years and 6 months. All children younger than 18 years diagnosed with suspected or confirmed sexual assault were included. RESULTS: a total of 93 children, victims of sexual abuse were enrolled. The average age of patients was 10 years, with a standard deviation of 3.9 years. Sex-ratio M/F was 0.9. The most common sexual contact was touching (47,3% of cases). The majority of abusers were male (93,5%). In more than half of the cases (53,8%) they were relatives of the child and in 28% of cases intra-familial abuse was reported. Initial psychiatric assessment showed mental disorders in 70% of cases. CONCLUSION: sexual abuse is a very broad field of violence which varies widely in nature and intensity. Although, in some types of sexual abuse occasionally there is a lack of physical traces, the emotional and psychological impact is ubiquitous and characterized by numerous clinical manifestations.

Sexual Violence Against Children.

Sexual violence against children is a gross violation of children's rights during their formative years and will likely interfere with their developmental trajectory and long-term quality of life. As a result, this form of violence includes commercial sexual exploitation of children, sexual abuse, child marriages, and female genital mutilation. The evidence shows that violence prevention is worth the investment; however, prioritizing this agenda to ensure funding through government spending remains low. Despite funding realities, research and advocacy efforts need to continue, with a focus on promoting effective practices for mitigation.

Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

BACKGROUND: Population-level prevalence estimates for a broad range of adverse childhood experiences (ACEs), which are known to affect health across the lifespan, are currently unavailable in Canada. The purpose of this study was to estimate the prevalence of individual ACEs by sociodemographic factors among middle-aged and older adults. METHODS: Data for this cross-sectional analysis were obtained from the first follow-up (2015-2018) of the Canadian Longitudinal Study on Aging (baseline recruitment from 2011 to 2015). Participants included individuals aged 45-85 years and residing in the community in the 10 Canadian provinces. Exposure to ACEs was assessed using a retrospective, self-report questionnaire. Logistic regression was used to obtain the adjusted prevalence estimates of ACEs within groups formed by the sociodemographic characteristics and each variable was adjusted for all other sociodemographic variables. RESULTS: Of the 44 817 participants in the first follow-up, 61.6% (weighted) reported exposure to at least 1 ACE. Exposure to physical abuse (weighted prevalence of 25.7%), intimate partner violence (22.4%) and emotional abuse (21.8%) were the most prevalent types of ACEs. Individuals younger than 65 years (born in 1950-1969), with no postsecondary education or education below a bachelor's degree, or with annual household income less than $20 000 reported greater exposure to ACEs. Reporting for many ACEs was higher among women and those of nonheterosexual orientation. Overall, British Columbia, Alberta, Manitoba, Ontario and Quebec reported relatively higher prevalence for several examined categories of ACEs. INTERPRETATION: Adverse childhood experiences were highly prevalent across all demographic groups with substantial heterogeneity in the distribution among the middle and older age population. The high prevalence of ACEs and their potential negative consequences on health and well-being emphasize the need to develop and promote trauma-informed care to assist individuals affected by ACEs.

[Protection Against Violence and Abuse in Medical Institutions - Reasons, Prevalence and Implications for Practice]. / Schutz vor Gewalt und Übergriffen in medizinischen Institutionen ­ Ursachen, Häufigkeiten und Implikationen für die Praxis.

Protection Against Violence and Abuse in Medical Institutions - Reasons, Prevalence and Implications for Practice Reported cases of (sexual) abuse in institutions as well as the results of surveys show that violence against children and adolescents, but also against adults, occurs also in medical institutions. There are still few studies on the frequency of these cases. However, the cases that have come to public attention show that medical institutions bear systemic risk factors for such assaults. On the other hand, medical institutions also play an important role in child protection, since many children and adolescents affected by maltreatment including sexual abuse come into contact with the medical system. It is necessary that medical institutions deal with this problem and develop respective institutional protection concepts. A protection concept is a system of measures that ensure better protection against assaults within an organisation. Important steps are analysis of risk factors, structural changes, the creation of plan of procedures and the development of an institutional attitude that assaults are not tolerated. Although the development of protection concepts takes time and resources, it has many advantages for institutions, such as an increased sense of security for professionals, because they know how to proceed in such situation. Now that the obligation to draw up protection concepts is anchored in the quality management guideline of the Federal Joint Committee (G-BA), all hospitals and practices must set out to develop appropriate concepts.

Descriptive analysis of the context of child sexual abuse reportedly perpetrated by female suspects: Insights from Saint Mary's Sexual Assault Referral Centre.

BACKGROUND: Determining the prevalence and characteristics of female-perpetrated child sexual abuse (CSA) is fraught with difficultly. There is a historical lack of empirical research and a discrepancy between the number of cases that reach the attention of the authorities and its suspected prevalence in society. It is also noted that for a myriad of reasons many CSA reports do not progress through the criminal justice process so many remain as allegations rather than proven or disproven crimes. OBJECTIVES: The study set out to answer the research questions: 'What are the characteristics and context of CSA reportedly perpetrated by females, and what are the similarities and differences in the context of alleged CSA committed by male and female suspects?' PARTICIPANTS AND SETTING: This study presents data from all service users aged 0-17 years (n = 986) that attended Saint Mary's Sexual Assault Referral Centre (SARC) for a forensic medical examination over a three-year period. METHODS: Data collection was performed retrospectively from the paper case files recorded at the time of attendance. Due to the small number of female suspects, analysis was restricted to frequency calculations. RESULTS: Results show females were reportedly involved in the alleged abuse of less than 4% of the children attending SARC. Females appeared more likely to be associated with the alleged abuse of younger children and abuse occurring within the child's home. CONCLUSIONS: This study's most arresting feature is that despite the large number of CSA cases examined, it was rare to have a female suspect. This study demonstrates how much is still unknown about female-perpetrated CSA.

The Cumulative and Differential Relation of Adverse Childhood Experiences and Substance Use During Emerging Adulthood.

Adverse childhood experiences (ACEs) have far-reaching effects on a wide range of health outcomes in adulthood, however, less is known about their consequences in emerging adulthood or in a geographically distinct sample. We examined the cumulative and individual relation of ACEs and two risky behaviors: alcohol and illegal drugs consumed by 490 Spanish emerging adults (mean age = 18.9). Participants answered the ACEs questionnaire, and two items about alcohol and illegal drugs consumption. Results showed that the overall experience of suffering different ACEs was a significant predictor of drug but not of alcohol consumption. Moreover, ACEs subtypes presented differential effects on substance use. Whereas some increased the likelihood of either drug or alcohol use, others reduced it. This study supports the importance of examining specific adverse experiences rather than only using an overall measure and provides some counterintuitive results that may be linked to resilient mechanisms.

Child Sexual Abuse by Catholic Priests, Deacons, and Male Members of Religious Orders in the Authority of the German Bishops' Conference 1946-2014.

This study explores the extent of sexual abuse of minors by members of the Catholic Church in Germany. It is the first comprehensive study to examine this extent in a European country. The goals of this study are as follows: (a) to analyze whether the extent and characteristics of sexual abuse in a European country are comparable to those in the United States and Australia and (b) how discrepancies can be explained. The personnel files of 38,156 Catholic Priests, deacons, and male members of religious orders in the authority of the German Bishops' Conference were analyzed. The study period lasted from 1946 to 2014. All 27 German dioceses took part in this study. A total of 4.4% of all clerics (N = 1,670) from 1946 to 2014 were alleged to have committed sexual abuse, and 3,677 children or adolescents were identified as victims. These results are similar to those from comparable studies in the United States. Sexual abuse of minors within the authority of the Catholic Church seems to be a worldwide phenomenon.