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Eg MB, Graesholt-Knudsen T, Madsen KB, Obel C, Charles AV, Ingemann-Hansen O. Distinct age-related differences among victims in cases of suspected child abuse. J Forensic Sci 2024; 69:252-263. [PMID: 37792506 DOI: 10.1111/1556-4029.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
Evidence describing age-related differences among children with suspected physical and sexual child abuse is lacking. We describe findings in severe cases of suspected abuse. Cases with 756 children <15 years old were included during 2001-2013 at the Department of Forensic Medicine, Aarhus University, using forensic evaluation documents, medical records, and court proceedings. Eight percent of children <4 years old died from child abuse, 36% through violence resulting in death, and 64% by manslaughter, whereas 1% > 4 years old died, solely by manslaughter. External injuries were mainly located to head and torso in children <4 years old, changing to the upper and lower extremities in older children. Child sexual abuse was suspected in 52% of cases with living children <4 years old, 83% of children 4-7 years of age, 88% of children 8-11 years of age, and 93% of children >12 years old. Anogenital findings were mainly caused by other medical conditions in children <4 years old, hymenal clefts in the superior half of the hymenal rim were almost exclusively found in children between 8 and 11 years of age, whereas both superficial and complete hymenal clefts in the inferior half of the hymenal rim were found in children >12 years old. The present study describes age-related differences in victims of suspected child abuse. Fatal versus nonfatal child physical abuse and the significance of hymenal findings in child sexual abuse could be studied further.
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Affiliation(s)
- Marlene Beyer Eg
- Department of Forensic Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Kathrine Bang Madsen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus V, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Blandino A, Maggioni L, Chiaffarino F, Parazzini F, Capano D, Florio EM, Margherita M, Bertelle GM, Franceschetti L, Amadasi A, Vignali G, Ciprandi B, Crudele GDL, Merelli VG, Collini F, Muccino EA, Nicolò P, Barbara G, Kustermann A, Cattaneo C, Gentilomo A. Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations. PLoS One 2021; 16:e0253980. [PMID: 34185821 PMCID: PMC8241090 DOI: 10.1371/journal.pone.0253980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. Methods It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor’s Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge’s final judgment. Results Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim’s deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. Conclusions Many factors seem able to influence the judge’s judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim’s statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.
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Affiliation(s)
- Alberto Blandino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
- * E-mail:
| | - Lidia Maggioni
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Francesca Chiaffarino
- Department of Woman, Newborn and Child, Gynaecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università Degli Studi, Milan, Italy
| | | | - Elena Maria Florio
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Manuela Margherita
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Gian Marco Bertelle
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Lorenzo Franceschetti
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Alberto Amadasi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Giulia Vignali
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Barbara Ciprandi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Vera Gloria Merelli
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Federica Collini
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Enrico Angelo Muccino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cattaneo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Andrea Gentilomo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
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Trosh LM, Sigvardsson BT, Sveinsdottir T, Gylfason HF, Sigurdsson JF. Children’s testimonies: What influences prosecutions and convictions in sexual abuse cases? NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.1894222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | - Jon Fridrik Sigurdsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Atreya A, Shrestha R, Nepal B, Nepal S, Shrestha D, Mahato S. When sexual offence is an unexpected diagnosis - exploration of medical, legal and social aspects in Nepalese scenario. Med Leg J 2020; 88:192-195. [PMID: 32716259 DOI: 10.1177/0025817220935878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In Nepal, following allegations of sexual assault, the survivor is taken by the police to a Government Hospital for medical examination and sample collection. To provide an integrated service to survivors of gender-based violence, a One-Stop Crisis Management Centre (OCMC) is established in many Government Hospitals. However, paediatric survivors of sexual abuse frequently seek initial care at the emergency department, as most present with a medical complaint rather than for sexual abuse. It is therefore important to train emergency physicians with the skills required to identify the features and diagnose a case of sexual assault. We present a case where the diagnosis of sexual assault of a child was an incidental finding and discuss the challenges faced in dealing with such cases in non-OCMC Hospital.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal
| | - Rijen Shrestha
- Department of Forensic Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Nepal
| | - Deepak Shrestha
- Department of Obstetrics and Gynecology, Lumbini Medical College, Palpa, Nepal
| | - Sweta Mahato
- Department of Obstetrics and Gynecology, Lumbini Medical College, Palpa, Nepal
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Rizzo A, Ricard D, La Harpe R, Fracasso T, Yaron M. Female Child and Adolescent Sexual Abuse Cases Reported at the Geneva University Hospitals Between 2006 and 2014: A Retrospective Study. J Pediatr Adolesc Gynecol 2020; 33:260-263. [PMID: 31726095 DOI: 10.1016/j.jpag.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/07/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To provide an objective quantification of the demographic characteristics and clinical findings related to female child and adolescent sexual abuse cases reported at the Geneva University Hospitals. DESIGN Retrospective study. SETTING Obstetrics and gynecology emergency unit. PARTICIPANTS Female children (0-12 years old) and adolescents (13-20 years old) seeking primary care after sexual assault. INTERVENTIONS None, observational study. MAIN OUTCOME MEASURES Delay from assault to time of presentation to primary care presentation, type of perpetrators, and the presence gynecological and bodily lesions. RESULTS Compared with children, a significantly higher proportion of adolescents presented to the hospital within 24 hours (134/289 (46.4%) vs 7/33 (21.2%); P = .006). Perpetrators were family members in 15/36 (41.7%) of children and in only 14/304 (4.6%) of adolescent patients (P < .00001); perpetrators were unfamiliar/nonrelated people in 8/36 (22.2%) of children and in 166/304 (54.6%) of adolescent patients (P < .0003). We did not find a significant difference between the 2 age groups with regard to the presence of gynecological lesions (15/35 (42.9%) of children and 91/298 (30.5%) of adolescent patients). However, we found a significant difference in the proportion of patients with bodily lesions such that 11/36 (30.6%) of children and 175/300 (58.3%) of adolescents (P = .002) were afflicted with bodily lesions. CONCLUSION To our knowledge this is the first study to evaluate child and adolescent sexual abuse cases on the basis of real-life data collected in Switzerland. Our results highlight important differences in child and adolescent sexual assault in terms of delay in presentation to primary care, perpetrator's relation to the victim, and presence of bodily lesions. This study confirms that gynecological findings alone are not consistently present in the patients who seek primary care after sexual assault.
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Affiliation(s)
- Annalisa Rizzo
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Dominique Ricard
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Romano La Harpe
- University Center of Legal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Tony Fracasso
- University Center of Legal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Michal Yaron
- Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland.
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A retrospective study of sexual offences in Zambia. J Forensic Leg Med 2018; 54:23-33. [PMID: 29306795 DOI: 10.1016/j.jflm.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
Abstract
Zambia has recently reported high incidences of sexual abuse against women and children. Zambian law categorises sexual offences into rape, defilement, incest and others, with defilement constituting the majority of the reported cases (>89%). Between 2010 and 2012, convictions of defilement cases were achieved in only 13% of cases reported to the police. DNA evidence has shown prominence in resolving crimes, specifically as an identification tool in sexual offences. Currently there is no empirical evidence describing the role of forensic evidence in sexual crimes in Zambia; as such a retrospective study was conducted to evaluate this between 2007 and 2014 (n = 1154). Only 14 (0.1%) of the cases had forensic samples collected in the form of a vaginal swab for semen analysis. In all cases where a suspect was identified (60%), identification was based on the witness/victim testimonies, and in no case, was forensic DNA evidence used to assist in identification or corroborate the testimonies. Overall, 28.1% of cases were taken to court and the conviction rate was 12.4%. These findings support the use of employing DNA evidence in sexual offence cases to aid the identification of suspects, which is hypothesised to increase the number of cases prosecuted in Zambia.
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Falligant JM, Fix RL, Alexander AA. Judicial Decision-Making and Juvenile Offenders: Effects of Medical Evidence and Victim Age. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:388-406. [PMID: 28441096 DOI: 10.1080/10538712.2017.1296914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse. A sample of 636 participants read vignettes and answered questions pertaining to the vignette. Participants also provided demographic information and responded to a series of items assessing participants' judicial decision-making strategies and outcomes. Broadly, the presence of medical evidence significantly influenced participants' decision-making across a variety of variables, including verdict outcome, verdict confidence, confidence that the victim was truthful, and determinations involving sex offender registration and notification requirements. The influence of medical evidence and victim age on perceptions and sentencing of juvenile sex offenders across these and additional outcome variables will be discussed.
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Affiliation(s)
| | - Rebecca L Fix
- a Department of Psychology , Auburn University , Auburn , Alabama , USA
| | - Apryl A Alexander
- b School of Professional Psychology , University of Denver , Denver , Colorado , USA
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Hornor G. Sexually Transmitted Infections and Children: What the PNP Should Know. J Pediatr Health Care 2017; 31:222-229. [PMID: 28215219 DOI: 10.1016/j.pedhc.2016.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 10/20/2022]
Abstract
Sexual abuse is a problem of epidemic proportions in the United States. In their practice, pediatric nurse practitioners will likely encounter children who have experienced sexual abuse-both those who have and have not previously been identified as victims. Sexually transmitted infections (STIs) are rare in sexually abused children and adolescents. However, when present, they can be crucial to making the diagnosis of sexual abuse and protecting children. This continuing education article will assist the pediatric nurse practitioner in interpreting the relationship between STIs and sexual abuse, correctly testing for STIs, and treating STIs in children and adolescents.
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