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1.
PLoS One ; 17(12): e0275421, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36534649

RESUMO

BACKGROUND: Interpersonal violence damages mental health and frequently leads to aggressive defence strategies. If survivors are subsequently blamed for the events, both consequences worsen. Stigma flourishes, especially when survivors are silenced so that details of the trauma remain unknown. Breaking the secrecy both at the individual and collective level is key to enable the healing and reconciliation of individuals and communities living under continuous threat. METHOD: The NETfacts health system is a stepped care model with three components: (1) Narrative Exposure Therapy (NET), an evidence-based trauma therapy that includes survivor testimony (2) NET for Forensic Offender Rehabilitation (FORNET) acknowledges that perpetrators are frequently also victims and assists in reducing aggression and the attraction to violence, and (3) a community intervention disseminating and discussing Facts derived from NET treatment (NETfacts) to challenge the collective avoidance of atrocities and other traumatic material. The intervention was piloted in a community with 497 adult residents in Eastern Democratic Republic of Congo. The willingness of clients to consent to sharing their anonymised testimonies (with a focus on sexual violence survivors and ex-combatants) was investigated, together with other components of feasibility including security and clinical safety, extent of support of respected local authorities and participation rates. As secondary outcomes, clinical and social measures were assessed before and post NETfacts among 200 village residents of whom 160 self-enrolled and 40 had not participated in any form of treatment. RESULTS: Implementation was feasible with 248 clients from a partner project giving consent to use their testimonies and high support of respected local authorities and participation rates (56% of residents self-enrolled in NETfacts). Immediate beneficial effects were shown for posttraumatic stress and rejection of rape myths among NETfacts participants who experienced multiple traumatic events in their own past. Attitudes towards ex-combatants improved and the perceived lack of social acknowledgement after trauma increased independent from participation. No significant change was observed for depressive symptoms. CONCLUSION: NETfacts is a feasible and promising approach to challenge the culture of secrecy surrounding trauma, suppression and social exclusion. Long term effectiveness requires further evaluation.


Assuntos
Estupro , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Estudos de Viabilidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência/psicologia , Estupro/psicologia , Agressão/psicologia
2.
PLoS One ; 17(12): e0278859, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36508404

RESUMO

BACKGROUND: Rape is the most common act of violence against women during wartime which is considered interpersonal, social and political violence because survivors usually suffer from stigma and discrimination in the community. Sexual violence is a serious threat to women's health. The psychological and medical consequences of rape during the conflict period are not well documented. Therefore, this study investigated the psychological and medical consequences of rape among survivor in the northern Ethiopia conflict, which occurred since 2020-2022. METHODS: A retrospective cross-sectional survey supplemented with a qualitative data was conducted among survivors of rape recorded until June 2022. Health institutions that provide maternal and child health services in the study area were included. All rape victims who received medical care following the incident were included. Victims who were found in active war areas or rape care recorded before wartime were excluded. To understand the experience of raped women's psychological consequences related to sexual assault we conducted 23 in-depth interviews. Thematic analysis was used to conduct qualitative interpretation. RESULTS: The mean age of the participants was 31.66 (SD ± 20.95) years. One-third of 92(33.9%) of the survivors were diagnosed positive for sexually transmitted infections. Chlamydia 54(58.4%) and HIV 32(34.8%) were the most frequently diagnosed infections. Among the rape survivors, one-tenth 29(10.7%) of them were positive for pregnancy, and induced abortion was done for 13 (44.8%) women who got pregnant due to sexual assault. The armed groups not only have sexual interests but inhumane individuals and consider rape as their way of expressing abjection to civilians. Survivors of raped women are confronted with social rejection and exclusion in the community that aggravates the traumatic process. Because of shame and fear, rape survivors often do not seek help but have to be offered support proactively. The victims claimed that they didn't able to return to their previous life and considered their future in peril. CONCLUSION: Conflict has a multidimensional devastating life effect, especially on women's health. The victims experienced many physical and psychological consequences. Hence, resolving conflicts with peaceful discussion has numerous benefits for civilians.


Assuntos
Estupro , Delitos Sexuais , Criança , Gravidez , Feminino , Humanos , Adulto , Masculino , Estudos Transversais , Estudos Retrospectivos , Delitos Sexuais/psicologia , Sobreviventes/psicologia
3.
Evol Psychol ; 20(4): 14747049221141078, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36476056

RESUMO

Research on men's sexual exploitation of women has documented that men's psychology tracks cues associated with the ease of women's exploitability. In the current studies, we examined a different class of cues hypothesized to aid men's use of sexually exploitative strategies: environmental cues to the likelihood of discovery. We defined likelihood of discovery as the perceived probability of identification when engaging in exploitative behavior (e.g., presence of others). We test the hypothesis that men's likelihood to rape increases when their perception of the likelihood of discovery is low in three studies. In Study 1, we conducted a content analysis of individuals' responses (N = 1,881) when asked what one would do if they could stop time or be invisible. Besides the "other" category whereby there were no specific category for nominated behaviors, the most nominated category included sexually exploitative behavior-representing 15.3% of reported behaviors. Both Studies 2 (N = 672) and 3 (N = 614) were preregistered manipulations of likelihood of discovery surreptitiously testing men's rape likelihood to rape across varying levels of discovery. We found men, compared to women, reported a statistically higher likelihood to rape in both Studies 2 and 3: 48% compared to 39.7% and 19% compared to 6.8%, respectively. Across Studies 2 and 3, we found no statistical effect of the likelihood of discovery on participants' likelihood to rape. We discuss how the presence of one's peers may provide social protection against the costs of using an exploitative sexual strategy if a perpetrator is caught.


Assuntos
Estupro , Feminino , Humanos , Estupro/psicologia , Masculino
5.
Obstet Gynecol Clin North Am ; 49(4): 809-821, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36328682

RESUMO

Gender-based violence (GBV) affects more than 700 million women and girls, worldwide, manifesting systemically (eg, human trafficking) and at the interpersonal level (eg, rape, intimate partner violence) and conveying significant negative economic, social, mental, and physical health impacts. It is important for the clinician to be prepared for providing emergency, urgent, and longer-term care to women who are survivors of GBV. Panzi Hospital in the Democratic Republic of the Congo provides an example of person-centered, holistic care for survivors of GBV, including conflict-related and nonconflict-related sexual violence.


Assuntos
Violência por Parceiro Íntimo , Estupro , Delitos Sexuais , Feminino , Humanos , Sobreviventes
7.
Artigo em Inglês | MEDLINE | ID: mdl-36360787

RESUMO

Sexual violence is a common and under-reported form of violence that affects all categories of individuals. We sought to provide epidemiological data on men aged 15 years and over, victims of rape or suspecting a rape, and who reported it to the police. We conducted a retrospective study at the Department of Forensic Medicine of Hôtel-Dieu, Paris, France, between 2018 and 2021. Two-hundred men were included in the study, with an average age of 28.8 years. A vulnerability was mentioned for 17.5% of them. Most of the patients reported anal penetration, committed by a single male assailant, whom they met on the day of the assault. More than 60% of the patients reported the voluntary consumption of alcohol and/or illicit substances prior to the assault. Most patients were examined shortly after the assault (median 1 day). Anal lesions were found on examination in 37.0% of patients reporting anal penetration regardless of the time frame. The presence of anal lesions was statistically higher when patients were examined within 48 h. Our results reinforce the data in the literature on the risk factors associated with sexual violence among men, notably the consumption of alcohol and illicit substances, and psychological, economic, and social vulnerability.


Assuntos
Vítimas de Crime , Estupro , Humanos , Masculino , Adulto , Estupro/psicologia , Estudos Retrospectivos , Paris/epidemiologia , Vítimas de Crime/psicologia , França/epidemiologia
8.
J Forensic Leg Med ; 92: 102448, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36334315

RESUMO

BACKGROUND: Sexual assault remains a highly prevalent crime worldwide and has the potential to cause a number of short and longer-term health sequelae. Complainants of recent sexual assault may undergo forensic and/or medical examinations for medical treatment or evidence collection, or both. However, the frequency and severity of acute health concerns requiring medical intervention in these patients at the time of examination is not well understood and has implications for their clinical care and safety. AIMS & OBJECTIVES: To examine the frequency and severity of acute concomitant health concerns at the time of forensic examination following an allegation of recent sexual assault in post-pubertal (age >13 years) individuals, through a review of existing literature. Concomitant health concerns considered in this review include ano-genital and extra-genital injury, and acute substance intoxication. METHODS: Four online databases (PubMed, Ovid Medline, CINAHL, Embase) were systematically searched with key terms regarding the topics of sexual assault, forensic examination, injury and intoxication. Articles were assessed for relevance based on inclusion and exclusion criteria. RESULTS: Of 562 titles, 53 full-text publications met the inclusion criteria. Frequency of ano-genital and extra-genital injury was highly variable across studies, and severity was inconsistently assessed and rarely reported. Medical treatment or transfer to acute care settings was more commonly required for extra-genital injuries. Non-fatal strangulation (NFS) was found to represent an increasingly frequent feature of sexual assault cases. NFS complainants often exhibit signs and symptoms of potentially lethal complications requiring urgent review in acute care settings. Substance use around the time of sexual assault was commonly reported by patients and detected in toxicological screens, and could have significant implications on patient and staff safety at the time of examination. CONCLUSION: The findings of this review highlight the clinical significance of acute concomitant health concerns following an allegation of recent sexual assault. Ano-genital and extra-genital injury, NFS and both voluntary and involuntary substance use may be more frequent and severe than previously understood. Further investigation into the assessment and management of these acute health needs is required to elucidate their clinical significance and inform evidence-based care for complainants of sexual assault.


Assuntos
Vítimas de Crime , Estupro , Delitos Sexuais , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adolescente , Medicina Legal , Asfixia
9.
Sci Justice ; 62(5): 621-623, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36336455

RESUMO

Many believe that an increase in the public confidence in the investigation of sexual crimes, and in conviction rates, will lead to an increase in the reporting of these crimes. Consequently, Forensic Science Providers are continually striving to make improvements in evidence recovery and examination and the subsequent interpretation of evidence. One development is in methods that enable an individual to self-sample. However, in cases where a complainant has self-sampled, questions of when the samples were taken, how they were stored and so on, can be legitimately raised. Additionally the continuity and integrity of evidential samples may be questioned resulting in them not being acceptable to the courts and potential evidence could therefore be lost. There is a large emotional and psychological impact of sexual assault and rape and no complainant who reports a sexual assault and recovers material should have that evidence inadmissible to a court. Specialised units for victims of alleged sexual violence are available and offer far more than the recovery of evidential samples. This commentary on behalf of the Faculty of Forensic & Legal Medicine (FFLM) and the Association of Forensic Science Providers Body Fluid Forum (AFSP BFF) highlights the need for after care for the victims of sexual assault and why all evidence recovered in cases of alleged sexual assault and sexual violence should be obtained in line with best practice protocols.


Assuntos
Vítimas de Crime , Estupro , Delitos Sexuais , Humanos , Vítimas de Crime/psicologia , Estupro/diagnóstico , Medicina Legal/métodos , Manejo de Espécimes
10.
Ecotoxicol Environ Saf ; 248: 114335, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36442399

RESUMO

Recently, there has been increasing concern about the health hazards of heavy metal-polluted farmlands. Recent findings suggest that intercropping could be effective remediation strategy for agricultural soils without affecting crop biomass yield. However, there are concerns on the heavy metal accumulation in plant organs in phytoremediation, emphasizing the need to develop an effective intercropping remediation model. In this study, we evaluated the effects of intercropping rape and wheat with different accumulation characteristics of cadmium (Cd), and crop growth and physiological characteristics. Intercropping significantly reduced the Cd content of rape shoot and root, with the rape-low Cd-accumulating wheat intercropping system yielding the best results. However, intercropping had no significant effect on Cd accumulation in wheat. Additionally, intercropping affected the root system configuration and structure, photosynthetic indicators, chlorophyll content, crop enzyme content, and rhizosphere enzyme activity of both species, but did not significantly affect the biomass of wheat and rape. Overall, our findings showed that intercropping rape with a low Cd-accumulating wheat variety could be an effective model for safe production of wheat and rape in weak alkaline soils without compromising biomass yield. The study demonstrates that similar innovative, effective, and judicious intercropping strategy can enrich the theory of contaminated soil remediation.


Assuntos
Estupro , Triticum , Cádmio , Solo , Biomassa
11.
Artigo em Inglês | MEDLINE | ID: mdl-36429806

RESUMO

A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the "Centro Soccorso Violenza Sessuale" (SVS) of the Sant'Anna Hospital in Turin between 1 January 2008, and 31 December 2017. Two hundred twenty-two patients were enrolled, 25 of which were minors, 141 were Italians, and most of them knew their aggressor and were raped in a private home. One hundred and fifty-five of them declared to the healthcare personnel to have taken alcoholic substances and/or drugs in conjunction with the event (86 reported having drunk alcohol, 36 having taken drugs and 33 disclosed both alcohol and drug abuse). If the woman knew her abuser, alcohol consumption was described as voluntary in more than 80% of cases, while in relation to drugs the consumption was equally voluntary or fraudulent. About 73% of women who reported having drunk alcohol just had amnesia or amnesia related to other symptoms, while amnesia was present in about 63% of women who reported only drug use. Physicians observed physical injuries on 156 women. Patients who reported to have assumed alcohol presented a significantly higher risk to suffer any physical injury and have a significantly increased risk to suffer injuries to their head and/or neck. The results obtained underline how even in Northern Italy alcohol intake represents the most widespread psychoactive substance in case of drug-facilitated sexual assault. There is therefore a need to promote education and prevention campaigns among citizens, especially among the youngest.


Assuntos
Intoxicação Alcoólica , Alcoolismo , Estupro , Assédio Sexual , Humanos , Feminino , Estudos Transversais , Etanol , Amnésia
12.
Proc Natl Acad Sci U S A ; 119(44): e2204698119, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36306329

RESUMO

War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.


Assuntos
Estupro , Delitos Sexuais , Transtornos de Estresse Pós-Traumáticos , Humanos , Estupro/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência
13.
West J Emerg Med ; 23(5): 672-677, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-36205671

RESUMO

INTRODUCTION: The emergency department (ED) is at the forefront for treatment of sexual assault patients. Many require treatment for injuries sustained during the assault, ranging from mild to severe. Our objective in this study was to characterize types of injuries associated with sexual assault and identify associated factors. METHODS: We reviewed ED charts from an inner-city trauma center and nearby community hospital from 2019-2020 for patients age ≥13 years with a chief complaint of sexual assault. We used descriptive statistics, chi square, and logistic regression to characterize demographics and identify factors associated with trauma. RESULTS: A total of 157 patients met inclusion criteria. The mean age was 27.9 years old (range 13-79 years) and 92.4% were female. Adult patients (age >18 years) comprised 77.5% of assaults vs adolescents (age 13-18 years) at 22.3%. Most patients presented to the trauma center compared to the community hospital (69.4% vs 30.6%). The assailants were reported as 61.2% acquaintance, 22.9% stranger, and 15.9% intimate partner. A forensic rape kit was performed in 92 (58.6%) cases. The patient was intoxicated with alcohol in 39 (24.8%) cases, and 22 (14%) patients reported drug-facilitated assault where an unknown substance was given to them. Alcohol (P = 0.95) and drug-facilitated assault (P = 0.64) did not change the occurrence of injuries. Fifty-seven (36.3%) patients exhibited physical trauma on presentation. Forty-five (28.6%) patients had minor injuries of abrasions, lacerations, or contusions. Major trauma was defined as fracture, brain injury, hemorrhage, strangulation, or injury requiring surgical consultation. There were 12 patients with major trauma consisting of fracture injury or nonfatal strangulation. None of the patients required admission. Sexual assault by an intimate partner (odds ratio [OR] 2.6; 95% CI: 1.1-6.5) and being an adult patient compared to adolescent (OR 3.0; 95% CI, 1.1-7.7) was significantly associated with physical trauma. Sexual assault by an intimate partner was also associated with nonfatal strangulation (OR 4.0; 95% CI, 1.1-15.4). CONCLUSION: Physical injuries that resulted from sexual assault were mostly minor and occurred in 36% of rape victims. Intimate partner violence was found to be associated with physical trauma as well as nonfatal strangulation. Overall, this study helps us to understand key factors associated with sexual violence.


Assuntos
Vítimas de Crime , Fraturas Ósseas , Violência por Parceiro Íntimo , Estupro , Delitos Sexuais , Adolescente , Adulto , Idoso , Asfixia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Int J Law Psychiatry ; 85: 101837, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36122514

RESUMO

Prior research has indicated that beliefs in rape myths can influence juror decision making in cases involving sexual assault, however, the phenomenon has been typically examined in relation to victim and defendant believability, as well as final verdicts. The current study observed mock jurors' evaluations of third-party witness evidence in alleged rape cases to determine whether these judgements were influenced by inherent rape myths. Participants (N = 196) took part in a mock juror experiment that included evidence from an eyewitness that was either in support of the defence, prosecution, or neutral. We found that males and individuals holding strong beliefs in rape myths were more likely to find defendants 'not guilty'. Additionally, participants endorsing rape myths were also more likely to view eyewitness evidence favourably, but only when it was in support of the defence. Our findings suggest that personal biases can influence the level of credence jurors place on case evidence, potentially through a confirmation bias.


Assuntos
Estupro , Masculino , Humanos , Função Jurisdicional , Julgamento , Culpa , Viés , Tomada de Decisões , Direito Penal
15.
Lancet ; 400(10354): 730-731, 2022 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-36058219
16.
Siglo cero (Madr.) ; 53(3): 95-115, septiembre 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-210808

RESUMO

Durante décadas, la violencia sexual que involucra a personas vulnerables se ha convertido en un tema de gran importancia social. Así mismo, las personas con discapacidad intelectual (DI) no son ajenas a la victimización de la violencia sexual. Los estudios efectuados sobre violencia sexual hacia personas con DI se han centrado en analizar la victimización cuando el agresor es uno solo y no se tiene conocimiento de la existencia de estudios que traten la violencia sexual cometida por la actuación de varios sujetos de manera grupal. Conocer las características de este tipo de violencia sexual es crucial para poder proteger a las personas con DI y poder prevenir estos delitos. Este artículo analiza las características de los sucesos de violencia sexual cometidos en grupo mediante un análisis descriptivo de las resoluciones judiciales en los últimos años en nuestro país. Se han encontrado 18 sentencias donde aparecen 47 autores, la mayoría hombres, y 18 víctimas. Los resultados del estudio permiten evidenciar la vulnerabilidad de las personas con DI y la necesidad de investigar este tipo de sucesos para intentar prevenir su victimización. (AU)


For decades, sexual violence involving vulnerable people has become an issue of great social importance. Likewise, people with intellectual disabilities (ID) are no strangers to sexual violence victimization. The studies carried out on sexual violence against people with ID have focused on analyzing victimization when the aggressor is only one and there is no knowledge of the existence of studies that deal with sexual violence committed by the actions of several subjects in a group. Knowing the charac-teristics of this type of sexual violence is crucial to protect people with ID and to prevent these crimes. This article analyzes the characteristics of group sexual offences by means of a descriptive analysis of court decisions in recent years in our country. Eighteen sen-tences were found in which 47 perpetrators appeared, most of them men, and 18 victims. The results of the study show the vulnerability of people with ID and the need to inves-tigate this type of events in order to try to prevent their victimization. (AU)


Assuntos
Humanos , Deficiência Intelectual , Delitos Sexuais , Violência , Estupro , Habilidades Sociais
17.
Artigo em Inglês | MEDLINE | ID: mdl-36011977

RESUMO

Previous studies have demonstrated the prevalence and negative consequences of rape myths in various social contexts, including their impact on jury decision-making. The current study adopted a mixed methods design to explore how educating jurors about rape myths via a judge's direction affected their decision-making regarding the guilt or innocence of a defendant in a rape case. Data were obtained from two mock trials and 12 questionnaire responses. The sample consisted of 12 women participants aged from 20 to 25. The thematic analysis indicated that participants who received rape myths education exhibited resistance to rape myths, increased scrutiny of the defendant as opposed to the complainant, and less disbelief of the complainant's alleged behaviours. Quantitative analysis suggested a strong positive correlation between the understanding of rape myths education and its influence on decision making; however, this was only found in the intervention group. Findings showed insights into the possible advantages of rape myths education for jurors that were delivered via the judge's direction. Future research directions and implications were discussed.


Assuntos
Estupro , Atitude , Escolaridade , Feminino , Culpa , Humanos
18.
Eur J Psychotraumatol ; 13(2): 2107820, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35992226

RESUMO

Background: Rape is a common traumatic event which may result in the development of posttraumatic stress disorder (PTSD), yet few studies have investigated risk biomarkers in sexually traumatised individuals. Adiponectin is a novel cytokine within inflammatory and cardiometabolic pathways with evidence of involvement in PTSD. Objective: This prospective exploratory study in a sample of female rape survivors investigated the association of single nucleotide polymorphisms (SNPs) in the adiponectin gene (ADIPOQ) and posttraumatic stress symptom (PTSS) severity, and the interaction of these SNPs of interest with childhood trauma in modifying the association with PTSS severity. Method: The study involved 455 rape-exposed black South African women (mean age (SD), 25.3 years (±5.5)) recruited within 20 days of being raped. PTSS was assessed using the Davidson Trauma Scale (DTS) and childhood trauma was assessed using a modified version of the Childhood Trauma Scale-Short Form Questionnaire. Eight ADIPOQ SNPs (rs17300539, rs16861194, rs16861205, rs2241766, rs6444174, rs822395, rs1501299, rs1403697) were genotyped using KASP. Mixed linear regression models were used to test additive associations of ADIPOQ SNPs and PTSS severity at baseline, 3 and 6 months following rape. Results: The mean DTS score post-sexual assault was high (71.3 ± 31.5), with a decrease in PTSS severity shown over time for all genotypes. rs6444174TT genotype was inversely associated with baseline PTSS in the unadjusted model (ß = -13.6, 95% CI [-25.1; -2.1], p = .021). However, no genotype was shown to be significantly associated with change in PTSS severity over time and therefore ADIPOQ SNP x childhood trauma interaction was not further investigated. Conclusion: None of the ADIPOQ SNPs selected for investigation in this population were shown to be associated with change in PTSS severity over a 6-month period and therefore their clinical utility as risk biomarkers for rape-related PTSD appears limited. These SNPs should be further investigated in possible gene-gene and gene-environment interactions.


Antecedentes: La violación sexual es un evento traumático común que puede resultar en el desarrollo del trastorno de estrés postraumático (TEPT); no obstante, pocos estudios han investigado biomarcadores de riesgo en personas sexualmente traumatizadas. La adiponectina es una citocina recientemente involucrada en vías inflamatorias y cardiometabólicas que tienen evidencia de compromiso en el TEPT.Objetivo: Este estudio prospectivo exploratorio, realizado en una muestra de mujeres sobrevivientes a violación sexual, investigó la asociación entre polimorfismos de nucleótido único (SNPs por sus siglas en inglés) en el gen de la adiponectina (ADIPOQ) y la severidad de los síntomas de estrés postraumático (SEPT), así como también cómo la interacción de estos SNPs sobre el trauma infantil modifica la asociación con la severidad de los SEPT.Método: El estudio incluyó a 455 mujeres sudafricanas de raza negra expuestas a una violación sexual (edad promedio de 25,3 años ± 5,5) reclutadas 20 días después de haber sido violadas sexualmente. Los SEPT se evaluaron empleando la Escala de Trauma de Davidson (DTS por sus siglas en inglés) y el trauma infantil se evaluó empleando una versión modificada de la Escala de Trauma Infantil ­ Cuestionario de versión corta. Se realizó la genotipificación de ocho SNPs del gen ADIPOQ (rs17300539, rs16861194, rs16861205, rs2241766, rs6444174, rs822395, rs1501299, rs1403697) empleando el KASP. Se emplearon modelos de regresión lineal para evaluar las asociaciones aditivas entre los SNPs del gen ADIPOQ y la severidad de los SEPT de base, a los tres y a los seis meses luego de la violación sexual.Resultados: El promedio del puntaje en la DTS luego de una violación sexual fue alto (71,3 ± 31,5) con una disminución en la severidad de los SEPT evidenciada a lo largo del tiempo para todos los genotipos. El genotipo rs6444174TT se encontró inversamente asociado a los SEPT de base en el modelo no ajustado (ß = −13.6, 95% CI [−25.1; −2.1], p = .021). Sin embargo, ningún genotipo mostró estar asociado significativamente con cambios en la severidad de los SEPT a lo largo del tiempo y, por tanto, ya no se investigó la interacción entre los SNPs del gen ADIPOQ y el trauma infantil.Conclusiones: Ninguno de los SNPs del ADIPOQ elegidos para esta investigación mostraron tener alguna asociación entre los cambios en la severidad de los SEPT en un periodo de seis meses y, por tanto, su utilidad clínica como marcadores de riesgo para el TEPT asociado a violación sexual es limitada. Se debería investigar más estos SNPs para evaluar las posibles interacciones gen-gen y gen-ambiente.


Assuntos
Adiponectina , Estupro , Transtornos de Estresse Pós-Traumáticos , Adiponectina/genética , Biomarcadores , Feminino , Humanos , Polimorfismo de Nucleotídeo Único/genética , Estudos Prospectivos , Estupro/psicologia , Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes
19.
Cien Saude Colet ; 27(9): 3689-3700, 2022 Sep.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36000655

RESUMO

The provision of abortion in pregnancies resulting from rape in Brazil is limited, restricted to a few facilities and concentrated in large urban centers. We aimed to estimate the potential for expansion of this service considering the installed capacity in the country's municipalities. From the data of June 2021 in the Cadastro Nacional de Estabelecimentos de Saúde (Brazilian National Registry of Health Facilities, CNES), three different scenarios of abortion provision provided by law in pregnancies resulting from rape were elaborated, and the percentage of female population of childbearing age living in the municipalities of each scenario was calculated by region. The first scenario included the municipalities with installed provision; the second, those with potential for provision considering the current regulations; and the third, those with potential for provision considering only the recommendations of the World Health Organization and the Penal Code of Brazil. The scenarios were composed of 55, 662 and 3,741 municipalities, respectively, and were home to 26.7%, 62.1%, and 94.3% of the country's females between the ages of 10 and 49. In all regions, there was installed capacity to expand provision, both in light of current regulations and international recommendations.


A oferta do aborto em gestações decorrentes de estupro é limitada no Brasil, restrita a poucos estabelecimentos e concentrada em grandes centros urbanos. Objetivou-se estimar o potencial de expansão da oferta do serviço considerando a capacidade instalada nos municípios país. A partir dos dados de junho de 2021 no Cadastro Nacional de Estabelecimentos de Saúde foram elaborados três diferentes cenários de oferta de aborto previsto em lei em gestações decorrentes de estupro, e calculado o percentual da população do sexo feminino em idade fértil residente nos municípios de cada cenário por região. No primeiro cenário foram incluídos os municípios com oferta instalada, no segundo aqueles com potencial de oferta considerando as normativas vigentes, e no terceiro aqueles com potencial de oferta considerando apenas as recomendações da Organização Mundial de Saúde e o Código Penal brasileiro. Os cenários foram compostos, respectivamente, por 55, 662 e 3.741 municípios, sendo residência de 26,7%, 62,1% e 94,3% das pessoas do sexo feminino entre 10 e 49 anos do país. Em todas as regiões havia capacidade instalada para ampliação da oferta tanto à luz das normativas vigentes quanto das recomendações internacionais.


Assuntos
Aborto Induzido , Estupro , Adolescente , Adulto , Brasil/epidemiologia , Causalidade , Criança , Cidades , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
20.
Cien Saude Colet ; 27(9): 3715-3728, 2022 Sep.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36000657

RESUMO

The objective was to characterize the cases of sexual violence (SV) against women in Minas Gerais state, associating the care provided in cases of rape with the type of health service that provided the care (specialized or not). The Notifiable Diseases Information System was used for data referring to the notification of SV among women (age ≥10 years old), which occurred in 2017, and the National Registry of Health Facilities for information on the type of health service. The SV occurred mainly among women under 29 years old (77.1%), blacks (61.1%), singles (69.7%), and with low education (42.4%). Rape was the most frequent SV (73.5%), with the majority being notified within 72 hours of the occurrence. For all the procedures recommended for acute situations of SV, there was an association between attendance at a specialized service and a greater chance of carrying out the planned procedures. The only exception was abortion permitted by law. The results demonstrated the importance of continuing investment in the qualification and expansion of the SV care network and the importance of a better territorial distribution of reference services in Minas Gerais.


Objetivou-se caracterizar os casos de violência sexual (VS) contra mulheres, em Minas Gerais-MG, investigando a associação entre a atenção prestada nos casos de estupro, ao tipo de unidade de saúde que realizou o atendimento (especializada ou não). Utilizou-se o Sistema Nacional de Agravos de Notificação, para dados referentes à notificação de VS entre mulheres (idade≥10 anos), ocorridos em 2017, e o Sistema Nacional de Estabelecimentos de Saúde, para informações sobre o tipo de unidade de saúde. A VS ocorreu, principalmente, entre mulheres abaixo de 29 anos (77,1%), negras (61,1%), solteiras (69,7%) e de baixa escolaridade (42,4%). O estupro foi a VS mais frequente (73,5%), sendo a maioria notificado até 72h após ocorrência. Para todos os procedimentos preconizados para situações agudas de estupro, houve associação entre o atendimento em unidade especializada e a maior chance de realização dos procedimentos previstos. Única exceção foi o aborto previsto em lei. Os resultados demostraram a importância da continuidade do investimento na qualificação e ampliação da rede de atenção à VS, e, também, a importância da melhor distribuição territorial das unidades de referência em MG.


Assuntos
Estupro , Delitos Sexuais , Adulto , Brasil , Criança , Feminino , Serviços de Saúde , Humanos
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