1
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Kane D, Kennedy KM, Eogan M. The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review. Int J Legal Med 2024; 138:997-1010. [PMID: 37971512 DOI: 10.1007/s00414-023-03117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies. AIMS AND OBJECTIVES We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed. METHODS Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms. RESULTS Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized. CONCLUSIONS This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.
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Affiliation(s)
- D Kane
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland.
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland.
| | - K M Kennedy
- School of Medicine, University of Galway, Galway, Ireland
| | - M Eogan
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland
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2
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Stewart ML, Shackel R, Freedman E, Templeton DJ. Adult Sexual Assault Patients' Experience of the Physical Examination Component of the Medical Forensic Examination: A Scoping Review to Identify Gaps in the Research Literature. TRAUMA, VIOLENCE & ABUSE 2024; 25:663-679. [PMID: 36935572 DOI: 10.1177/15248380231158606] [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: 06/18/2023]
Abstract
We undertook a scoping review of published research literature that reported on adult sexual assault patients' experience of the physical examination component of the medical forensic examination (MFE). Eligible papers were those reporting data about the physical examination component of the MFE from the adult patient's perspective, published in the period January 2000 to March 2022 in peer reviewed journals and reports containing original research data published from a tertiary institution. Twelve papers were identified. The review identified a gap in the literature regarding the patient's experience of the physical examination component of the MFE. The existing literature is limited but suggests that some patients find the examination empowering and reassuring, restoring a sense of bodily control; however, for others it is an intrusive, violating experience that they endure. A more patient-centered sexual assault service appears to have a therapeutic value in itself, but more research is warranted as existing research is very limited and often from a proxy. In particular, more research on patients' self-reported experience of the MFE, including specific aspects of the examination and the experience of male and gender nonconforming victim-survivors, is needed. A better understanding, from the point of view of the patient, of the benefits of attending, may encourage victim-survivors to seek a health response and, possibly, report to police. It may also be time to assess the impacts of certain aspects of the forensic examination, rethink standard evidence collection processes, and consider enabling more acceptable options for victim-survivors including self-collection of intimate samples.
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Affiliation(s)
- Mary Louise Stewart
- The University of Sydney Law School, Sydney, NSW, Australia
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Rita Shackel
- The University of Sydney Law School, Sydney, NSW, Australia
| | - Eleanor Freedman
- Northern Sydney Local Health District, St Leonards, NSW, Australia
- New South Wales Health Education Centre Against Violence, Sydney, NSW, Australia
| | - David James Templeton
- Sydney Local Health District, Camperdown, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- The University of New South Wales, Sydney, NSW, Australia
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3
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Mognetti B, Bo M, Berta GN, Canavese A, Castagna P, Collini F, Santa V, Salomone A, Gino S. Sexual Harassments Related to Alcohol and Drugs Intake: The Experience of the Rape Centre of Turin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15090. [PMID: 36429806 PMCID: PMC9690951 DOI: 10.3390/ijerph192215090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Barbara Mognetti
- Department of Life Sciences and Systems Biology, University of Turin, via Accademia Albertina 13, 10123 Turin, Italy
| | - Marco Bo
- Hospital Medical Direction, Local Health Trust TO5, Piazza Silvio Pellico 1, 10023 Chieri, Italy
| | - Giovanni Nicolao Berta
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - Antonella Canavese
- Centro Soccorso Violenza Sessuale, Sant’Anna Hospital, City of Health and Science, Corso Spezia 60, 10126 Turin, Italy
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Paola Castagna
- Centro Soccorso Violenza Sessuale, Sant’Anna Hospital, City of Health and Science, Corso Spezia 60, 10126 Turin, Italy
| | - Federica Collini
- Department of Health Sciences, University of Eastern Piedmont, via Solaroli 17, 28100 Novara, Italy
| | - Veronica Santa
- Corso di Laurea Magistrale in Medicina e Chirurgia, Azienda Ospedaliera Universitaria San Luigi (Orbassano), University of Turin, v. Verdi 8, 10124 Turin, Italy
| | - Alberto Salomone
- Department of Chemistry, University of Turin, via Giuria 5, 10126 Turin, Italy
- Centro Regionale Antidoping, Regione Gonzole 10/1, 10043 Orbassano, Italy
| | - Sarah Gino
- Department of Health Sciences, University of Eastern Piedmont, via Solaroli 17, 28100 Novara, Italy
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Miziara ID, Miziara CSMG, Salguero Aguiar L, Alvez B. Physical evidence of rape against children and adolescents in Brazil: Analysis of 13,870 reports of sexual assault in 2017. SAGE Open Med 2022; 10:20503121221088682. [PMID: 35342626 PMCID: PMC8943547 DOI: 10.1177/20503121221088682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The medical literature reports child and adolescent maltreatment since the
8th century. Unfortunately, even today, the incomplete knowledge of this
event persists. Several forms of violence are applied to children and
adolescents, mainly sexual violence including rape and sexual assault.
Forensic medical examinations routinely include the genital area, anus, and
the body of the victims for signs of a recent or old injury. The main goal
of this study is to show the results of physical and sexual examinations
regarding confirmation of rape in children and adolescents, based on the
medicolegal reports. Methods: We made a descriptive cross-sectional study conducted by collecting data from
Medicolegal Institute (IML-São Paulo, Brazil) in 2017. We examined 13,870
reports of sexological examinations of victims of the alleged rape. The
variables analyzed were age; sex; physical examination; sexological
examination; and direct search for sperm in the vaginal, anal, or oral
cavity. We selected 11,725 reports from victims under 18 years. Results: As for the medical-legal findings, only 1735 reports (14.8%) confirmed sexual
abuse. The most affected ages were between 3 and 5 years in the male group
and 11 to 14 years in the female group. The most frequent injuries were
bruises and abrasions, fissures in the anal region. In 96.2% of the examined
males and 85.8% of the females under 14 years old, the examination was
inconclusive, and somebody cannot prove the alleged rape. Only 1735 reports
(113 from men and 1622 from women) concluded beyond any doubt the alleged
rape (14.8%). The search for sperm was positive in only 1582 cases
(13.5%). Conclusion: This study shows that the results of the medicolegal examinations were quite
limited in recording evidence. Sexual violence against children and
adolescents reaches mostly females under 13 years of age. Besides, it is a
complicated crime to prove, as 85.8% of female examinations and 96.2% of
male exams revealed: “no supporting elements” or “undetermined” to
characterize the felony. Therefore, to prevent it, the communication of the
alleged rape must be made as quickly as possible.
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Affiliation(s)
- Ivan Dieb Miziara
- Department of Legal Medicine, Ethics and Occupational Health, São Paulo University School of Medicine, São Paulo, Brazil
| | | | - Luan Salguero Aguiar
- Discipline of Legal Medicine and Bioethics, ABC School of Medicine, Santo André, Brazil
| | - Beatriz Alvez
- Discipline of Legal Medicine and Bioethics, ABC School of Medicine, Santo André, Brazil
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5
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Jakobsen LS, Jacobsen C, Asmussen IH, Lynnerup N, Banner J. The legal impact of forensic medical life-threatening danger assessment conclusions in cases of violent offense. Forensic Sci Int 2021; 329:111034. [PMID: 34688185 DOI: 10.1016/j.forsciint.2021.111034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between the legal outcome for suspected perpetrators and the forensic life-threatening danger assessments conducted as part of the clinical forensic medical examinations of victims with penetrating injuries. METHOD From the Danish Central Crime Register, we retrieved the legal outcomes for suspected perpetrators linked to victims with penetrating injuries in a six-year period and compared the proportional distribution of forensic life-threatening danger assessment conclusions - no life-threatening danger (NLD), could have been in life-threatening danger (CLD), and life-threatening danger (LD) - with the legal outcomes. RESULTS 326 victims were related to at least one identified suspected perpetrator with a legal outcome. When the forensic life-threatening danger assessments were more severe, an increased proportion of cases resulted in formal charges and, subsequently, conviction, than when the forensic life-threatening danger assessments were less severe. The percentage point differences between NLD, CLD, and LD were almost equal. CONCLUSION Our results indicate that the forensic life-threatening danger assessments are associated with the legal outcome, as both the proportion of cases with formal charges and the proportion of cases with a conviction increased with the severity of the forensic life-threatening danger assessment conclusions.
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Affiliation(s)
- Lykke Schrøder Jakobsen
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark.
| | - Christina Jacobsen
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
| | - Ida Helene Asmussen
- University of Copenhagen, Faculty of Law, Center for Interdisciplinary Studies of Law, Karen Blixen Plads 16, 2300 Copenhagen South, Denmark
| | - Niels Lynnerup
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
| | - Jytte Banner
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
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6
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Shi L, Lu T, Li Y, Deng ZH. Sexual Assault Against Women: A Retrospective Study of 292 Cases in Fujian Province, China. JOURNAL OF FORENSIC NURSING 2021; 17:210-218. [PMID: 34561403 DOI: 10.1097/jfn.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In China, rape is defined as forced sexual intercourse against a woman's will by violence, coercion, or any other means or intentionally having sexual intercourse with a girl under the age of 14 years who is legally incompetent of giving consent. METHOD A retrospective study of 292 cases of rape in Fujian Province, China, between the years 2014 and 2017 was conducted. Sociodemographic characteristics of victims and perpetrators, perpetration patterns of rape, and associated factors were reviewed and analyzed. RESULTS Over a quarter of rape victims were under the age of 18 years. In over half of cases, the perpetrators were known to the victims, which was more frequent in minors than in adult victims. Over half of perpetrators were within the age range of 18-30 years. Most perpetrators had received a low level of education and were from low-income populations. Nighttime has the highest occurrence of rapes: 39.9% of rapes occurred during late night; and 24.6%, during early night. Victim perpetrator relationship and the location were significantly related (χ2 = 23.667; df = 3, 266; p < 0.001). Risk evaluation showed that 30.8% and 28.1% of cases occurred under medium- and high-risk settings, respectively. Sexual motivation was present in over 95% of cases. Physical force was used in almost half of cases. Less than half of victims received forensic clinical examination after perpetration. CONCLUSIONS The findings provide population-based data to contribute to the future development of prevention strategies and to raise awareness of the urgent need for victim assistance services.
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Affiliation(s)
- Lei Shi
- Author Affiliation: West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University
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7
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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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8
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Friestad C, Vaskinn A. An exploration of theory of mind performance among men convicted of rape. Scand J Psychol 2021; 62:476-483. [PMID: 34085727 DOI: 10.1111/sjop.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/19/2021] [Indexed: 11/27/2022]
Abstract
Several of the known risk factors for sexual violence concern a lack of capacity for engaging in mutually satisfying interpersonal relationships. Socio-cognitive deficits may be approached from a theory of mind (ToM) perspective, where lack of ability to attribute mental states to others is seen as the core feature. This study focuses on imprisoned men (n = 26) convicted of rape against an adult. A video-based measure of ToM (MASC) was applied, depicting social interaction in a dynamic real-life setting. The results showed that the rape-convicted men have a markedly inferior ability to infer the mental states of others. Clinical as well as theoretical implications of the findings are discussed.
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Affiliation(s)
- Christine Friestad
- Department of Mental Health and Addiction, Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Lillestrom, Norway
| | - Anja Vaskinn
- NORMENT Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Vik BF, Rasmussen K, Schei B, Hagemann CT. Three groups of suspects in police reported rape cases: First-time suspects, recidivists and unidentified suspects. A comparative study. J Forensic Leg Med 2020; 71:101771. [PMID: 32342899 DOI: 10.1016/j.jflm.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/30/2018] [Accepted: 02/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies show that reported suspects in adult rape cases often have a criminal record, and that many are rape recidivists. Annual numbers of police reported rapes have dramatically increased but the proportion of rapes being prosecuted and numbers of convictions are low. To increase knowledge about the suspects in cases of police reported rapes; whether they have committed the crime before or not may inform preventive measures. AIMS To compare suspect, victim, and assault related characteristics among different groups of police-reported rape suspects (first-time suspects, recidivist suspects and unidentified suspects). METHODS Retrospective, descriptive study of suspects in cases of rape or attempted rape reported by women ≥16 years of age in the Sør-Trøndelag police district, Norway, from 2003 to 2010. RESULTS Among the 356 suspects included, 207 (58%) were first-time suspects, 75 (21%) were recidivists and 74 (21%) were unidentified. Being a first-time suspect was significantly associated with victim being <18 years, recidivist suspect was significantly associated with victim being a partner, both suspect- and victim unemployment, and suspect reporting intake of other drugs than alcohol. When suspects were unidentified, victims were more likely to have consumed alcohol prior to assault, and reporting the suspect being of non-Western origin. Also, the reporting of a public venue was more frequent when unidentified suspect. CONCLUSIONS The study shows different patterns in groups of suspects as to victim and assault characteristics. Detection and description of such differences can provide valuable information for future prevention programs, police investigation methods and health care guidelines.
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Affiliation(s)
- Bjarte Frode Vik
- Norwegian University of Science and Technology (NTNU), Department of Clinical and Molecular Medicine, P.B. 8905, N-7491, Trondheim, Norway; St. Olavs Hospital, Department of Neuropsychiatry, P.B. 3250 Sluppen, N-7006, Trondheim, Norway.
| | - Kirsten Rasmussen
- Norwegian University of Science and Technology (NTNU), Department of Psychology, 7491, Trondheim, Norway; St. Olavs Hospital, Forensic Research Unit, Brøset, P.B. 1803 Lade, 7440, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.B. 8905, N-7491 Trondheim, Norway; Department of Obstetrics and Gynecology St. Olavs Hospital, P.B. 3250 Sluppen, N-7006, Trondheim, Norway
| | - Cecilie Therese Hagemann
- Norwegian University of Science and Technology (NTNU), Department of Clinical and Molecular Medicine, P.B. 8905, N-7491, Trondheim, Norway; Department of Obstetrics and Gynecology St. Olavs Hospital, P.B. 3250 Sluppen, N-7006, Trondheim, Norway
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10
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Vik BF, Rasmussen K, Schei B, Hagemann CT. Is police investigation of rape biased by characteristics of victims? Forensic Sci Int Synerg 2020; 2:98-106. [PMID: 32412007 PMCID: PMC7219117 DOI: 10.1016/j.fsisyn.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
Aim To explore differences in police investigations between cases of rape against women with and without vulnerability factors. Methods Retrospective, descriptive study of cases of rape against women ≥16 years of age. Cases involving victims with and without vulnerability factors were compared regarding the quality of police investigation. Results Vulnerability was present among 68% of the victims. Cases with vulnerable victims had an adjusted odds ratio for a low-quality police investigation of 2.1 (95% CI [1.0-4.4]) compared to cases where victims were non-vulnerable. Conclusions Our results do not prove that rape myths existed among police officers. Our findings show a trend indicating that vulnerable victims may have been less prioritized compared to non-vulnerable victims. More studies are needed regarding how the police respond to rape complaints and to what degree police investigations are influenced by different characteristics of victims.
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Affiliation(s)
- Bjarte Frode Vik
- Norwegian University of Science and Technology (NTNU), Department of Clinical and Molecular Medicine, P.B. 8905, N-7491, Trondheim, Norway.,Department of Research and Development, Psychiatry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,St. Olavs Hospital, Department of Neuropsychiatry, P.B. 3250 Torgarden, N-7006, Trondheim, Norway
| | - Kirsten Rasmussen
- Norwegian University of Science and Technology (NTNU), Department of Psychology, 7491, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway.,St. Olavs Hospital, Forensic Research Unit, Brøset, P.B. 1803 Lade, 7440, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.B. 8905, N-7491, Trondheim, Norway.,Department of Obstetrics and Gynecology St. Olavs Hospital, P.B. 3250 Sluppen, N-7006, Trondheim, Norway
| | - Cecilie Therese Hagemann
- Norwegian University of Science and Technology (NTNU), Department of Clinical and Molecular Medicine, P.B. 8905, N-7491, Trondheim, Norway.,Department of Obstetrics and Gynecology St. Olavs Hospital, P.B. 3250 Sluppen, N-7006, Trondheim, Norway
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11
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Piccinini A, Vignali G, Bailo P, Barbara G, Gennari G, Di Candia D, Albertini V, Kustermann A. Management of DNA evidence collected on adolescents in sexual assault investigations: A 10-year review from a large Italian rape centre. MEDICINE, SCIENCE, AND THE LAW 2019; 59:232-239. [PMID: 31248321 DOI: 10.1177/0025802419858538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little research is available on the actual forensic use of genetic analyses performed in sexual violence cases, despite their relevant role in legal processes. The present retrospective study aimed to contribute to filling this gap in research, evaluating the actual number of serological/DNA analyses that followed medical examination of female adolescent victims of sexual violence. The study was performed in a large rape centre in Milan (North Italy) by analysing all medical records of female victims of sexual violence aged 13–19 years in the period from January 2006 to December 2015. The total number of sexual assault victims examined aged 13–19 years was 599. In 473 of the cases, biological evidence had been collected. The gathering of biological evidence was accurately performed (double swab technique) in multiple anatomical regions on the victims’ bodies, and clothes were acquired when biological stains were present or could be present. Proper handling under chain of custody for all the items collected followed in every case. Despite all of this, serological/DNA analyses were requested in only 9/473 (1.9%) cases. Procedural issues possibly affecting the magistrates’ decisions not to use DNA extensively as an investigative tool are also discussed.
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Affiliation(s)
- Andrea Piccinini
- Forensic Genetics Laboratory, Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giulia Vignali
- Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Paolo Bailo
- Forensic Genetics Laboratory, Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Giussy Barbara
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | | | - Domenico Di Candia
- Department of Biomedical Sciences for Health - Università degli Studi di Milano, Italy
| | - Valentina Albertini
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Alessandra Kustermann
- Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
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Valentine JL, Sekula LK, Cook LJ, Campbell R, Colbert A, Weedn VW. Justice Denied: Low Submission Rates of Sexual Assault Kits and the Predicting Variables. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:3547-3573. [PMID: 29294625 DOI: 10.1177/0886260516681881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Following sexual assaults, victims are advised to seek health care services with forensic evidence collected and packaged in sexual assault kits (SAKs). This large (N = 1,874), retrospective study examined rates of SAK submissions by law enforcement to the state crime laboratory for analysis from 2010 to 2013 at four sites in a Western state in the United States with established sexual assault nurse examiner (SANE) programs. Variables of legal and extralegal characteristics in sexual assault cases were explored through generalized estimating equations (GEE) modeling to determine what factors statistically predicted SAK submissions. For submitted SAKs, the length of time between the dates of assault and dates of submission was categorized, and bivariate and multivariate analyses were calculated to discover legal and extralegal characteristics affecting time of submission. The study sites represented 40% of the state's law enforcement agencies and 65% of the state's population. Out of the 1,874 SAKs in the study, only 38.2% were submitted by law enforcement to the state crime laboratory for analysis. When SAK submissions were examined based on time between assaults and submission dates, 22.8% were submitted within a year of the assault and 15.4% were submitted more than a year after the assault following media and community pressure for law enforcement agencies to submit SAKs in storage. Significant variability of SAK submission rates and the time submitted from the assault dates were found between the sites. Site location was found to be the main determinant of whether or not SAKs were submitted. The lack of SAK submissions for analysis results in justice denied for victims and raises public safety concerns. The finding that the location in which the sexual assault occurred was the primary factor on SAK submissions represents an inequity of justice.
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Kjærulff MLBG, Bonde U, Astrup BS. The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends. Forensic Sci Int 2019; 297:90-99. [PMID: 30797159 DOI: 10.1016/j.forsciint.2019.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape. METHODS All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included. RESULTS The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015. CONCLUSION The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.
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Affiliation(s)
- Mette Louise B G Kjærulff
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløws Vej 17, Odense C, Denmark
| | - Ulla Bonde
- Department of Gynecology and Obstetrics, Odense University Hospital, Kløvervænget 23, -55, Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J.B. Winsøwsvej 19, 3., Odense C, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Birgitte Schmidt Astrup
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløws Vej 17, Odense C, Denmark.
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La Harpe R, Burkhardt S, Ricard-Gauthier D, Poncet A, Yaron M, Fracasso T. Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault. J Forensic Sci 2018; 64:1119-1124. [PMID: 30556905 DOI: 10.1111/1556-4029.13971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.
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Affiliation(s)
- Romano La Harpe
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Sandra Burkhardt
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Dominique Ricard-Gauthier
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Antoine Poncet
- Hôpitaux Universitaires de Genève, unité d'appui méthodologique, 4 rue G. Perret-Gentil, 1211, Genève 14
| | - Michal Yaron
- Hôpitaux Universitaires de Genève, Service de Gynécologie et Obstétrique, 30 bd de la Cluse, 1205, Genève
| | - Tony Fracasso
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
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Nielsen LH, Hansen M, Ingemann-Hansen O. Predicting charges and convictions for rape suspects in Denmark: characteristics associated with the notion of the ‘credible criminal’. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/14043858.2018.1526469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L. H. Nielsen
- The Research group on Interpersonal Violence Europe, Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - M. Hansen
- The Research group on Interpersonal Violence Europe, Department of Psychology, University of Southern Denmark, Odense, Denmark
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Forr C, Schei B, Stene LE, Ormstad K, Hagemann CT. Factors associated with trace evidence analyses and DNA findings among police reported cases of rape. Forensic Sci Int 2018; 283:136-143. [PMID: 29301113 DOI: 10.1016/j.forsciint.2017.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/10/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between victim, suspect and assault characteristics and (1) forensic analysis of trace evidence, (2) detection of spermatozoa and (3) DNA match in police-reported cases of rape/attempted rape. In addition, we explored whether DNA findings were associated with legal outcome. METHODS We conducted a retrospective, descriptive study based on police-reported rapes and attempted rapes of women ≥16 years of age in Sør-Trøndelag Police District throughout 1997-2010. Police data were merged with information from the Sexual Assault Centre (SAC) at St. Olavs University Hospital, Trondheim, Norway. We used binary and multivariable logistic regression for the comparisons. RESULTS We identified 324 victims (mean age 24 years). The police requested analysis in 135 (45%) of the 299 collected victim samples. The police decision to analyze was after adjustment associated with the victim being employed or under education, and a public venue, but not with interval from assault to sampling. Spermatozoa were detected in 79 (61%) of the analyzed cases, of which 71 were collected from victims within 24h. Interval from assault being <24h and reporting a penetrative assault remained associated with the findings of spermatozoa after adjustments. Forensic analyses of trace evidence collected from victim, suspect and/or venue disclosed matching DNA profiles in 57 (40%) of a total of 143 analyzed cases. Matching DNA profiles were associated with suspect being known to the victim and with the venue being private. A higher proportion of cases with a DNA match were prosecuted in court: 20 of the 29 cases prosecuted. However, despite a DNA match 35 cases were anyway dismissed because of insufficient evidence. CONCLUSIONS Although many of the associations in our study were expected, it is still important to report the actual numbers to gain insight into the importance of a DNA match in legal proceedings. A substantial proportion of cases with DNA match was dismissed because of insufficient evidence. To strengthen the justice response to sexual assault, it is essential to generate knowledge about the role of medico-legal evidence in such cases, and there are obviously other non-medical factors influencing the legal decisions.
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Affiliation(s)
- Camilla Forr
- Helse Nord-Trøndelag, P.B. 333, N-7601 Levanger, Norway.
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.B. 8905, N-7491 Trondheim, Norway; Department of Gynecology St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Sluppen, N-7006 Trondheim, Norway.
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Gullhaugveien 1-3, NO-0484 Oslo, Norway.
| | - Kari Ormstad
- Department of Forensic Medicine, Oslo University Hospital HF Rikshospitalet, P.B. 4950 Nydalen, 0424 Oslo, Norway.
| | - Cecilie Therese Hagemann
- Norwegian University of Science and Technology (NTNU), Department of Clinical and Molecular Medicine, P.B. 8905, N-7491 Trondheim, Norway; Department of Gynecology St. Olavs Hospital, Trondheim University Hospital, Postbox 3250 Sluppen, N-7006 Trondheim, Norway.
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Sathirareuangchai S, Phobtrakul R, Phetsangharn L, Srisopa K, Petchpunya S. Comparative study of spermatozoa detection using the genital swab versus bedside smear slide technique in sexual assault patients. J Forensic Leg Med 2015; 35:69-72. [PMID: 26344463 DOI: 10.1016/j.jflm.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/26/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Specimen collection from sexual assault victims is an essential part of practice in forensic medicine. Semen analysis is a forensic test used to confirm sexual contact. Two methods of specimen collection were compared in this study: the genital swab and bedside slide smear. MATERIALS AND METHODS A retrospective chart review was performed in the Division of Clinical Forensic Medicine, Siriraj Hospital, Thailand. Data were collected on microscopic spermatozoa detection in the external and internal genitalia, the time interval from assault to visit, and the history of condom use and genital cleansing. McNemar's test was used for comparison between the genital swab and bedside slide smear techniques. RESULTS In total, 724 case files from 2009 to 2013 were reviewed. The genital swab technique yielded a higher detection rate than did the bedside slide smear technique in both the external genitalia (37.0% vs. 31.8%, respectively) and internal genitalia (40.8% vs. 34.1%, respectively). Collection of a genital swab only missed positive cases in 4%-6% of negative swabs. When considering both the external and internal genitalia, the genital swab still yielded a higher rate of positive results than did the slide smear (45.9% vs. 39.0%, respectively). Examination of the victim within the first 3 days produced the highest spermatozoa detection rate (46.3%). CONCLUSIONS The genital swab is the preferred specimen collection method for spermatozoa detection in adult sexual assault victims. However, collection of both a swab and slide specimen may be considered in some cases. Collection of specimens later than 3 days after the assault greatly decreases the rate of spermatozoa detection.
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Affiliation(s)
- Sakda Sathirareuangchai
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Rattana Phobtrakul
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Ladda Phetsangharn
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Kamontip Srisopa
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Saowarat Petchpunya
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Genito-anal injury patterns and associated factors in rape survivors in an urban province of South Africa: a cross-sectional study. BMC WOMENS HEALTH 2015; 15:29. [PMID: 25887051 PMCID: PMC4396864 DOI: 10.1186/s12905-015-0187-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022]
Abstract
Background The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries. Methods In a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins. Results In the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age. Conclusions This study found that being a virgin, multiple perpetration rape and the examiner’s qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.
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Mont JD, White D. Barriers to the effective use of medico-legal findings in sexual assault cases worldwide. QUALITATIVE HEALTH RESEARCH 2013; 23:1228-1239. [PMID: 23935160 DOI: 10.1177/1049732313502396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Despite the increasing implementation of standardized rape kits across jurisdictions, the medico-legal findings generated by these tools are often not related to positive criminal justice outcomes. Given that there has been no global investigation of the factors that might impede their successful use in cases of sexual assault, we conducted a review of relevant scholarly and "grey" literature from industrialized and less-developed regions. One key theme to emerge from the analysis concerned certain problematic practices and behaviors of professional groups involved in the various stages of the post-sexual assault process. We found that a lack of competence in handling sexual assault cases, contempt for women who have been victimized, and corruption among some forensic examiners, police, scientists, and legal personnel often have shaped the collection, processing, analysis, and use of medico-legal evidence. We discuss recent initiatives and future directions for research that might serve to address these issues.
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Hagemann CT, Helland A, Spigset O, Espnes KA, Ormstad K, Schei B. Ethanol and drug findings in women consulting a Sexual Assault Center--associations with clinical characteristics and suspicions of drug-facilitated sexual assault. J Forensic Leg Med 2013; 20:777-84. [PMID: 23910880 DOI: 10.1016/j.jflm.2013.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 04/17/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
The purpose of the study was to describe toxicological findings among women seeking health care after sexual assault, and to assess the relationship with so-called proactive DFSA (drug facilitated sexual assault). We also explored associations between ethanol in blood/urine and background data, assault characteristics, and clinical findings. We conducted a retrospective, descriptive study of female patients ≥ 12 years of age consulting the Sexual Assault Center at St. Olavs University Hospital, Trondheim, Norway. They were examined between July 1, 2003 and December 31, 2010, and urine and/or blood were analyzed for ethanol and selected medicinal/recreational drugs. Among the 264 patients included, ethanol and/or drugs were detected in 155 (59%). Of the 50 patients (19%) testing positive for drugs other than ethanol, benzodiazepines/benzodiazepine-like drugs were found in 31, central stimulants in 14, cannabinoids in 13 and opioids in nine. None tested positive for gamma-hydroxybutyrate (GHB). In total, 57 patients (22%) suspected proactive DFSA, but only five had findings of sedative drugs that were not accounted for by self-reported voluntary intake. No cases could unequivocally be attributed to proactive DFSA. Among the 120 patients tested for ethanol within 12 h after the assault, 102 were positive. The median estimated blood alcohol concentration (BAC) at the time of assault was 1.87 g/L. Patients testing positive for ethanol more often reported a public place of assault and a stranger assailant. Higher estimated BAC at the time of assault was associated with higher frequency of suspecting proactive DFSA. Ethanol was the most prevalent toxicological finding in urine/blood from victims of sexual assault, and high ethanol concentrations were often detected. Among the patients suspecting proactive DFSA, very few had sedative drug findings not explained by voluntary intake. It seems like opportunistic DFSA, rather than proactive DFSA dominate among the sexually assaulted attending our SAC.
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Affiliation(s)
- Cecilie T Hagemann
- Department of Public Health and General Practice, Norwegian University of Science and Technology, P.O. Box 8905, N-7491 Trondheim, Norway.
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Greger HK, Jozefiak T, Myhre AK. Child Abuse Management Units: How can Mental Health Services be Further Improved? Scand J Child Adolesc Psychiatr Psychol 2013; 1:51-62. [PMID: 37869708 PMCID: PMC10586204 DOI: 10.21307/sjcapp-2013-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Child abuse is a broad term that includes physical, sexual, and emotional (e.g., psychological, verbal) abuse. There are huge variations with regard to the level of severity and the consequences of abuse. Because child abuse is such a sensitive topic, it is a challenging task to conduct studies concerning this subject. OBJECTIVE The aim of the study was to identify areas that could be improved to offer better health care services to patients. Therefore, routine assessments, the characteristics of the cases, and the types of follow up were emphasized. METHOD The Norwegian Ministry of Health and Care Services provided an exception from the principle of informed consent so that this study could be conducted. We had access to the medical records of all children between the ages of 0 and 14 years old who were referred to the regional child abuse management unit in 2006 and 2007. A descriptive, cross-sectional study was performed. RESULTS One hundred and six children were referred to the child abuse management unit. For the majority of these patients (80.2%), sexual abuse was the only concern. The children presented diverse psychological and somatic symptoms and problems. Psychosocial functioning was in general not properly described in the records. Four out of five of the children were referred to services for follow up after the first examination in the child abuse management unit. Only 36% of the children were referred to child protective services. CONCLUSION This study revealed that psychosocial functioning is seldom documented and that psychological symptoms could be described more reliably and in more detail. A systematic approach may be helpful for health care providers, and we suggest the implementation of valid evidence-based instruments, such as the Child Behavior Checklist and the Children's Global Assessment Scale.
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Affiliation(s)
- Hanne K. Greger
- Department of Child and Adolescent Mental Health, St. Olav’s University Hospital, Trondheim, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Jozefiak
- Department of Child and Adolescent Mental Health, St. Olav’s University Hospital, Trondheim, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne K. Myhre
- Children’s Clinic, St. Olav’s University Hospital, Trondheim, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology and Regional Resource Center, St. Olav’s University Hospital, Trondheim, Norway
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