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1.
Psychiatr Danub ; 31(4): 440-447, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698400

RESUMO

BACKGROUND: This study examined testimonies of women who were sexually assaulted multiple times by multiple unknown offenders. In these testimonial narratives, it is possible to detect specific modalities of traumatic event expression. This expression lacks any spatial, temporal, auditory or emotional determinants of the event. SUBJECTS AND METHODS: These fourteen women (out of 17) were imprisoned and forcefully isolated in detention camps or private houses in the occupied territories of Croatia and Bosnia and Herzegovina, during the war. At the same time, some of these women were raped by the offenders that were previously known to them. The average length of detention was 141 days among the seventeen victims (range of 7 to 395 days), while the average time from the first day of imprisonment to the first day of testimony was 311 days (range of 30 to 889 days). RESULTS: Based on the narrative descriptions of the events acquired from these testimonies, our analysis showed that these expressions differed when the offender was known to the victim, contrasted to the situation when the offender was completely unknown. This finding has a significant implication in victim's testimony at judicial hearings. Specifically, women that were raped by unknown perpetrator(s) were often unable to provide persuasive testimony and their recollection of the events was deemed insufficient for the further prosecution. Testimonies in these cases substantially lacked in vividness and were devoid of visuospatial determinants of the rape event. Consequently, this often resulted in the case's dismissal. CONCLUSION: The unusual and problematic expression of these traumatic memories might indicate that these events were not properly stored in the conceptual form of memory. Ultimately, victims could not make any coherent recollection or reconstruct the cascade of events by using perceptual information. We argue that this could be due to an aberrant mechanism of memory storage and difficulties that emerge on the level of sensory input. This problem needs to be further examined and correspondingly accounted for since it can exert significant influence on judicial outcomes in the domain of sexual assault cases worldwide.


Assuntos
Vítimas de Crime/psicologia , Rememoração Mental , Estupro/psicologia , Estupro/estatística & dados numéricos , Crimes de Guerra/psicologia , Bósnia e Herzegóvina , Croácia , Feminino , Humanos , Memória Episódica
2.
Praxis (Bern 1994) ; 108(13): 869-876, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31571536

RESUMO

Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice Abstract. Every now and then, physicians are challenged with date rape drugs. If there is a suspicion of substance administration, the question of involving forensic medicine is commonly raised. In obscure situations or questionable offences, however, patients may wish for an initial diagnosis in the emergency department or the private practice. The physicians are often greatly challenged by the variety of substances, the limited analytical methods and difficulties with the interpretion of results. The major goal of this article is to present diagnostic options including their limitations. An overview of frequently involved substances is provided. Particular focus will be placed on practical aspects, including questions regarding pre-analytics and health insurance coverage.


Assuntos
Preparações Farmacêuticas , Médicos , Detecção do Abuso de Substâncias , Anfetaminas/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Serviço Hospitalar de Emergência , Humanos , Estupro
4.
Emerg Med Clin North Am ; 37(4): 725-738, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563204

RESUMO

The diagnosis and treatment of sexually transmitted infections is a crucial component of providing evidence-based care in the emergency department. Understanding how to make the diagnosis and implement effective treatment is essential to maintaining and improving public health. Providers should also be adept at giving care to sexual assault survivors and seeking out the expertise of specially trained professionals within networks known as SANE, SAFE, or SART. These networks are critical to providing standardized care to sexual assault patients. Prophylaxis remains a key element for the prevention of sexually transmitted infections in all patients who are considered high risk.


Assuntos
Doenças Sexualmente Transmissíveis/diagnóstico , Serviço Hospitalar de Emergência , Infecções por HIV/prevenção & controle , Humanos , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Estupro , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/terapia
9.
East Mediterr Health J ; 25(4): 262-268, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31210347

RESUMO

Background: Violence against women is a global phenomenon. Aims: To estimate and forecast cognizable crime against women in New Delhi, India, from 2016 to 2020. Methods: Reported cognizable crime against women in New Delhi for 2009-2015 was extracted for statistical analysis, synthesis and modelling. The cognizable crimes reported are rape, attempt to commit rape, kidnapping and abduction, dowry deaths, assault on women with intent to outrage her modesty, insult to modesty of women, cruelty by husband or his relative, importation of girls from foreign countries, abetment of suicide of women and indecent representation of women. Results: The actual number of registered cases of crime against women ranged from 4251 (2009) to 17 104 (2015). The projected number of cases ranged between 18 991 [95% confidence interval (CI): 13 092-24 889) in 2016 to 28 663 (95% CI: 22 314-35 013)] in 2020. A rising trend in crime against women was noticed in New Delhi, ranging from 204.6 (2016) to 308.8 (2020) per 100 000 women. After witnessing a substantive increase (116.2%) in reported crime against women in New Delhi in 2013, the subsequent actual and projected rise appears to be incremental in nature, with an annual percentage point change ranging between 9% and 18%. Conclusion: Within limitations, it is concluded that the safety of women will continue to be a concern in the near future.


Assuntos
Violência de Gênero/tendências , Saúde da Mulher , Tráfico de Pessoas/estatística & dados numéricos , Humanos , Índia/epidemiologia , Estupro/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos
10.
BMC Womens Health ; 19(1): 76, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200696

RESUMO

BACKGROUND: Rape, unintended pregnancy, and abortion are among the most controversial and stigmatized topics facing sexual and reproductive health researchers, advocates, and the public today. Over the past three decades, public health practicioners and human rights advocates have made great strides to advance our understanding of sexual and reproductive rights and how they should be protected. The overall aim of the study was to understand young women's personal experiences of unintended pregnancy in the context of Nicaragua's repressive legal and sociocultural landscape. Ten in-depth interviews (IDIs) were conducted with women ages 16-23 in a city in North Central Nicaragua, from June to July 2014. CASE PRESENTATION: This case study focuses on the story of a 19-year-old Nicaraguan woman who was raped, became pregnant, and almost died from complications resulting from an unsafe abortion. Her case, detailed under the pseudonym Ana Maria, presents unique challenges related to the fulfillment of sexual and reproductive rights due to the restrictive social norms related to sexual health, ubiquitous violence against women (VAW) and the total ban on abortion in Nicaragua. The case also provides a useful lens through which to examine individual sexual and reproductive health (SRH) experiences, particularly those of rape, unintended pregnancy, and unsafe abortion; this in-depth analysis identifies the contextual risk factors that contributed to Ana Maria's experience. CONCLUSIONS: Far too many women experience their sexuality in the context of individual and structural violence. Ana Maria's case provides several important lessons for the realization of sexual and reproductive health and rights in countries with restrictive legal policies and conservative cultural norms around sexuality. Ana Maria's experience demonstrates that an individual's health decisions are not made in isolation, free from the influence of social norms and national laws. We present an overview of the key risk and contextual factors that contributed to Ana Maria's experience of violence, unintended pregnancy, and unsafe abortion.


Assuntos
Aborto Induzido/psicologia , Estupro/psicologia , Direitos Sexuais e Reprodutivos/psicologia , Direitos da Mulher , Feminino , Humanos , Nicarágua , Gravidez , Gravidez não Planejada/psicologia , Saúde Reprodutiva , Fatores de Risco , Saúde Sexual , Adulto Jovem
12.
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 254-259, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185007

RESUMO

Objective: To study the characteristics of patients attended for sexual assault in the Emergency Department of Miguel Servet Maternity Hospital. Material and methods: Descriptive cross-sectional study of sexual assaults managed between October 2016 and April 2018 at Miguel Servet Maternity Hospital. Results: We attended 52 cases of sexual assault in 50 women. Patients were generally young women with an average age of 28 years (24% were minors), had been assaulted by penetration (57.7%) by a single assailant (80.8%), and had received no observable physical lesions on the genitals (86.5%) or other parts of the body (65.4%). Fifty percent of the assaults took place during the weekend, and 63.5% of the patients came to the emergency department within 24 hours of the incident. In 75% of cases, the women reported the assault to the police. In 48% of cases, the patient did not undergo serology testing after visiting the emergency department; of those who did, 81% did not undergo repeat testing 3 months later. Conclusions: We observed a lack of agreement between the overall rate of sexual assault and the number of patients who came to the Emergency Department for this reason. Patients were mostly young, with no secondary physical lesions, and had been assaulted by penetration by a single assailant. Patients' adherence to medical indications was poor. Appropriate coordination between health workers, the police, and forensic experts is essential for appropriate management of sexual assaults are


Objetivo: estudiar las características de las pacientes atendidas en el Servicio de Urgencias del Hospital Maternal Miguel Servet por agresión sexual. Material y métodos: estudio descriptivo de las agresiones sexuales entre octubre de 2016 hasta abril de 2018 en el Hospital Maternal Miguel Servet. Resultados: se atendieron 52 urgencias de 50 pacientes diferentes. El perfil de la paciente fue: mujer joven, con una edad media de 28 años (el 24% fueron menores de edad), mediante penetración (57,7%), por un agresor único (80,8%) y sin lesiones físicas objetivables en genitales (86,5%) ni otras partes del cuerpo (65,4%). El 50% de agresiones se produjeron durante el fin de semana y el 63,5% acudió al Servicio de Urgencias en las primeras 24 horas tras la agresión. El 75% denunció los hechos a la policía. El 48% de las pacientes no se realizó serologías tras la visita al Servicio de Urgencias, y de las que lo hicieron, el 81% no repitió la determinación a los 3 meses. Conclusiones: existe una discordancia entre la tasa de agresión sexual global y el número de mujeres que acudió a Urgencias por este motivo. Las pacientes fueron en su mayoría jóvenes, sin lesiones físicas secundarias y agredidas mediante penetración por un agresor único. Fue observada una baja adherencia a las indicaciones médicas por parte de las pacientes. Una adecuada coordinación entre profesionales sanitarios, policía y especialistas en Medicina Legal y Forense es fundamental para un correcto manejo de la situación


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Delitos Sexuais/estatística & dados numéricos , Estupro/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Transversais , Ciências Forenses/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Epidemiologia Descritiva , Distribuição por Idade
13.
Eur. j. psychol. appl. legal context (Internet) ; 11(1): 1-7, ene.-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-183537

RESUMO

Research findings suggest that sex offenders show worse performance than the general population in neuropsychological tests. Nevertheless, moderators such as age of the victim, use of antisocial control groups, and characteristics of administered measures have been highlighted. Here, 100 participants completed a battery of cognitive measures tapping fluid reasoning, verbal ability, and three basic executive processes (inhibition, switching, and updating). They were matched by educational level and classified in four groups: controls, non-sex offenders, rapists, and child abusers. The analyses revealed that rapists showed lower fluid reasoning scores than controls and child abusers. Furthermore, rapists and child abusers showed lower executive updating performance than controls and non-sex offenders. Importantly, child abusers did show fluid reasoning scores on a par with controls (controlling for updating differences), but their executive updating performance was equivalent to the one revealed by rapists (controlling for fluid intelligence differences). Implications of these findings for the design of efficient intervention programs are discussed


Los datos de investigación empírica sugieren que los delincuentes sexuales presentan un peor desempeño que la población general en las pruebas neuropsicológicas. Aun así, se ha resaltado la influencia de variables moderadoras como la edad de la víctima, el uso de grupos control que incluyan individuos antisociales y las características de las medidas utilizadas. En este estudio cien participantes completaron una batería de pruebas cognitivas que evalúan razonamiento fluido, capacidad verbal y tres funciones ejecutivas básicas (inhibición, cambio y actualización). Los participantes estaban igualados en su nivel educativo y divididos en cuatro grupos: controles, delincuentes no sexuales, agresores sexuales con víctimas adultas y abusadores de menores. Los análisis revelaron que los agresores sexuales con víctimas adultas presentaban puntuaciones menores que los controles y los abusadores de menores en razonamiento fluido. Más aún, los agresores con víctimas adultas y los abusadores tenían peor desempeño que los controles y los delincuentes no sexuales en actualización ejecutiva. Es destacable que los abusadores de menores mostraran puntuaciones en razonamiento fluido equiparables a las de los controles (controlando estadísticamente las diferencias en actualización), pero su desempeño en actualización ejecutiva fue equivalente al mostrado por los agresores con víctimas adultas (controlando estadísticamente las diferencias en inteligencia fluida). Finalmente se discuten las implicaciones de estos resultados para el diseño de programas de intervención efectivos


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Estupro/psicologia , Delitos Sexuais/psicologia , Abuso Sexual na Infância/psicologia , Função Executiva , Psicologia Criminal/métodos , Criminosos/psicologia , Comportamento Criminoso , Testes Neuropsicológicos/estatística & dados numéricos , Estudos de Casos e Controles
15.
J Trauma Dissociation ; 20(3): 288-303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31072268

RESUMO

Hundreds of thousands of previously untested sexual assault kits (SAKs) have been uncovered in police property storage facilities across the United States, representing a national failure in institutional response to sexual assault. Faced with this discovery, jurisdictions must now decide if and how they should test these kits. Some stakeholders have suggested prioritizing kits for testing by victim, offender, or assault characteristics, based on the belief that these characteristics can predict the likely utility of DNA testing. However, little research has examined the empirical merits of such prioritization. To address this gap in the literature and inform SAK testing policies, we randomly sampled 900 previously untested SAKs from Detroit, MI. The sampled SAKs were submitted for DNA testing, and eligible DNA profiles were entered into Combined DNA Index System (CODIS), the federal DNA database. Police records associated with each SAK were coded for victim, offender, and assault characteristics, and logistic regression analyses were conducted to test whether these characteristics predict which SAKs yield DNA profiles that match ("hit") to other criminal offenses in CODIS. Testing this sample of previously-untested SAKs produced a substantial number of CODIS hits, but few of the tested variables were significant predictors of CODIS hit rate. These findings suggest that testing all previously-unsubmitted kits may generate information that is useful to the criminal justice system, while also potentially addressing the institutional betrayal victims experienced when their kits were ignored.


Assuntos
Vítimas de Crime , Criminosos , Ciências Forenses/estatística & dados numéricos , Estupro , Manejo de Espécimes/estatística & dados numéricos , Direito Penal , Bases de Dados de Ácidos Nucleicos , Feminino , Humanos , Aplicação da Lei , Michigan , Alocação de Recursos , Estados Unidos
16.
Maturitas ; 124: 39-42, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097177

RESUMO

OBJECTIVE: We previously conducted an audit of the care provided for survivors of sexual violence seen at our emergency department and observed that 90% of them did not receive optimal care. This study analysed whether the implementation of a new protocol and educational sessions for staff increased the proportion of such patients who received optimal medical care. METHODS: A computerized chart detailing a new care protocol was developed specifically for rape survivors. Educational sessions focusing on the use of the new protocol were organized for healthcare providers. We then conducted another audit that reviewed retrospectively the charts of all survivors of sexual violence who were cared for at a public university hospital. MAIN OUTCOME MEASURE: Optimal medical care was defined as including systematic investigations for sexually transmitted diseases, and the provision of prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow-up. RESULTS: We analysed the charts of 362 survivors of sexual violence and observed that all of the required procedures were completed for 337 patients (93%) and the required preventive measures were provided to 325 patients (90%). CONCLUSION: After the implementation of the new protocol and educational sessions, the proportion of survivors who received optimal medical care increased from 10% to 90%. Nevertheless, optimal management also implies social, psychological and legal support. We hope that the establishment of specialist sexual assault centres will further improve management.


Assuntos
Pessoal de Saúde/educação , Assistência ao Paciente/métodos , Estupro , Sobreviventes , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Protocolos Clínicos , Anticoncepção Pós-Coito , Serviço Hospitalar de Emergência , Feminino , Humanos , Pessoa de Meia-Idade , Assistência ao Paciente/normas , Testes de Gravidez , Estudos Retrospectivos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Adulto Jovem
18.
Perspect Biol Med ; 62(1): 153-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031302

RESUMO

In this essay, a medical student reflects on her experience as part of a service trip to rural Honduras. Although she feels proud of the work the group does and the impact that they are able to make, she is also forced to grapple with the vast amount of unremitted suffering that she will inevitably leave behind.


Assuntos
Neoplasias do Colo do Útero/diagnóstico , Feminino , Honduras , Humanos , Programas de Rastreamento , Estupro/psicologia , População Rural , Maus-Tratos Conjugais
20.
Epidemiol Psychiatr Sci ; 28(6): 598-602, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30977461

RESUMO

To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors' needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and meaning; 'power over' relational approaches which can prevent compassionate responses and result in staff having to develop their own coping strategies; and poorly addressed and reported experiences of sexual violence within psychiatric settings. We argue that these multiple forms of silencing have arisen in part because of biomedical dominance, a lack of support and training in sexual violence for staff, inconsistent access to structured, reflective supervision, and the difficulties of facing the horror of sexual violence and abuse. We then describe community-based and grassroots responses, and consider the potential of trauma-informed approaches. Whilst this paper has a UK focus, some aspects will resonate globally, particularly given that Western psychiatry is increasingly being exported around the globe.


Assuntos
Serviços de Saúde Mental , Estupro/psicologia , Delitos Sexuais/psicologia , Pesquisa sobre Serviços de Saúde , Humanos
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