TIME LAPSED BETWEEN SEXUAL AGGRESSION AND ARRIVAL AT THE BRAZILIAN HEALTH SERVICE

Background: We aimed to describe the social, demographic and medical characteristics of victims ofsexual violence and their association with the lapsed time between the aggression and the searchfor medical attention, and to identify the possible reasons for delay in access to hospital. Methods:We reviewed the records of 439 female cases of sexual violence, treated through the medical servicesin Sao Bernardo do Campo, Brazil, during an eight-year period, from 2000 to 2007. Results: Of the439 patients, 374 arrived at the hospital within 72 hours after the aggression. The average age was24.5 years; 45.1% completed or were finishing high school. The most common form of sexualaggression was vaginal penetration in 43.9% of the cases, followed by multiple forms of penetrationsuch as vaginal plus anal, or vaginal plus oral in 31.4% of the patients. Patients who did not sufferextra-genital injury and those who did not notify the authorities were significantly more likely topresent to care after 72 hours: OR = 2.58 (95%CI: 1.04; 6.38) and OR = 2.74 (95%CI: 1.58; 4.78)respectively. Patients who had prior knowledge of their aggressor were significantly less likely topresent after 72 hours (OR = 0.51; 95%CI: 0.28; 0.96). Conclusions: patients who suffered fromextra-genital trauma and those who notified the authorities were more likely to seek care within 72hours whereas patients who knew their aggressor were more likely to suffer the consequences ofseeking care later than 72 hours. Public policies and efforts to educate women about the seriousnessof this crime and encourage them to notify the authorities and seek care immediately following theaggression, may reduce the complications involving such crime.Objetivo: Descrever as características sócio-demográficas e clínicas de vítimas de violência sexuale sua associação com o tempo decorrido entre a agressão sexual e a chegada ao serviço desaúde. Método: Estudo retrospectivo de 439 casos de mulheres vítimas de agressão sexual,atendidas por serviço público de São Bernardo do Campo, São Paulo, Brasil, no período de 2000a 2007. Resultados: De 439 pacientes incluídas, 374 chegaram antes de 72 horas ao hospital.A média de idade foi de 24,5 anos; 45,1% cursava ou havia concluído o segundo grau. A penetração vaginal foi a ocorrência mais comum, sendo exclusiva em 43,9% dos casos, enquantoque a associação desta com penetração anal ou oral ocorreu em 31,4% dos casos. Foram estatisticamente significantes para a chegada após 72 horas da agressão: a ausência de traumanão genital (OR = 2,58; IC95%: 1,04; 6,38), a não realização de denúncia policial (OR = 2,74; IC95%: 1,58; 4,78) e o agressor conhecido (OR = 0,51; IC95%: 0,28; 0,96). Conclusões: Otraumatismo não genital e a denúncia policial foram protetores para as vítimas, trazendo-as aohospital dentro das primeiras 72 horas após a ocorrência; já o agressor conhecido foi fatordeterminante no atraso à chegada ao serviço de saúde. Políticas públicas para capacitação,divulgação e integração entre os setores envolvidos na abordagem deste tipo de violência podemreduzir as complicações dela decorrentes

Influence of forensic examination on the accountability of sexual violence authors in teenagers

OBJETIVO: avaliar a influência do exame médico-legal na responsabilização criminal de acusados de violência sexual contra adolescentes do sexo feminino. MÉTODO: foram analisados retrospectivamente 137 processos judiciais de estupro contra adolescentes matriculadas no Centro de Referência da Criança e do Adolescente entre janeiro de 1995 e dezembro de 2004. Os laudos do Instituto Médico Legal foram classificados como negativos ou positivos para a materialidade do crime sexual e confrontados com a sentença judicial, condenatória ou não para o acusado. Os dados foram informatizados em Programa EpiInfo e submetidos ao teste de Qui-quadrado para Tabelas de contingência, fixando-se em p &lt; 0,05 o nível de rejeição da hipótese de nulidade. RESULTADOS: em 30 casos (21,9%) o laudo foi concordante com a queixa de estupro. Em 107 casos (78,1%) o exame médico-legal não encontrou evidência material do crime sexual. Entre os exames positivos, 25 acusados (83,3%) foram condenados, enquanto nas perícias negativas ocorreram 68 condenações (63,5%). CONCLUSÕES: o exame médico-legal positivo se associou com maior probabilidade de condenação do acusado da violência sexual. A ausência de elementos comprobatórios materiais não impediu a responsabilização de parte expressiva dos acusados, indicando que outros meios de convencimento são admitidos pela justiça.OBJECTIVE: to evaluate the influence of forensic examination on the accountability of sexual violence criminal charges in adolescent girls. METHOD: retrospective study, it was analyzed 137 lawsuits rape in teenagers enrolled in the Reference Center for Children and Adolescents between January 1995 and December 2004. The awards of the Forensic Institute were classified as negative or positive for the materiality of sexual crimes and confronted with the judicial sentence, condemnatory or not. Data was computerized in EpiInfo Program and subjected to chi-square test for contingency tables, considering p < 0.05 the level of rejection of the hypothesis of nullity. RESULTS: in 30 cases (21.9%) the award was consistent with the complaint of rape. In 107 cases (78.1%) the forensic examination found no physical evidence of sexual crime. Among the positive cases, 25 accused (83.3 %) were condemned, while in the negative skills it was observed 68 condemnations (63.5 %). CONCLUSIONS: the positive forensic examination was associated with the most part of probability of condemnation of the accused of the sexual violence. The absence of corroborative material elements did not obstruct the accountability of expressive part of the accused subjects, indicating that other means of persuasion are accepted by the courts

Hydatidiform mole resulting from sexual violence

<p>Abstract</p> <p>Background</p> <p>Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteínicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report.</p> <p>Method</p> <p>Description of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Pérola Byington, São Paulo, from July 1994 to August 2011.</p> <p>Results</p> <p>The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection.</p> <p>Conclusion</p> <p>The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition.</p