Incidência de violência sexual em crianças e adolescentes em Recife/Pernambuco no biênio 2012- 2013

O corpo da criança como receptáculo da violência física: análise dos dados epidemiológicos do Viva/Sinan

RESUMO A alta incidência da violência física contra a criança e o adolescente no Brasil aponta a necessidade urgente de elaboração de políticas públicas para enfrentar e prevenir esse problema. Objetivou-se estudar o perfil da violência física doméstica contra a criança e o adolescente no Brasil e regiões, no período de 2009 a 2019. Estudo descritivo, epidemiológico, baseado em dados secundários obtidos no Sistema de Informação de Agravos de Notificação (Sinan-NET) e sistema TabWin. A maior taxa de violência física doméstica se refere a meninas de 10 a 14 anos (248 por 100 mil habitantes). Em relação a crianças e adolescentes do sexo masculino, a faixa etária com maior taxa de violência física é de zero a 4 a anos (232 por 100 mil habitantes). A população indígena possui as maiores taxas de violência em todas as regiões. Pai e mãe são os agressores mais frequentes (41,13% e 39,84% respectivamente). Meninos são mais suscetíveis à violência física doméstica na infância, e meninas, na adolescência. A faixa etária mais acometida por violência física doméstica é de zero a 4 anos, e as raças mais acometidas são a indígena e a parda. Na maior parte das vezes, a violência aconteceu dentro de casa.

Nicht nur Doktorspiele – (rechts)medizinische Aspekte von Sexualdelikten an Kindern durch Kinder

Hintergrund

Sexualisierte Handlungen zwischen gleichaltrigen Kindern sind in der Regel Ausdruck eines normalen, altersgerechten Verhaltens. Doch auch zwischen Minderjährigen gibt es sexualisierte Gewalt, die über das altersentsprechende Interesse hinausgeht und in der medizinischen Literatur bislang wenig Beachtung fand.

Methode

Es wurde eine selektive Literaturrecherche in der Datenbank PubMed sowie mithilfe des Suchdienstes Google Scholar durchgeführt. Außerdem wurde eine retrospektive Analyse eigener Fälle durchgeführt.

Ergebnisse

Die erfassten Studien ergaben Prävalenzen von 6 bis 50,7 % für unerwünschte sexuelle Kontakte. SchülerIn an einer Highschool und weiblich zu sein oder einen Migrationshintergrund zu haben, wurde als Risikofaktor für sexuelle Übergriffe identifiziert. Mehr als die Hälfte (54 %) der Täterinnen und bis zu 16 % der Täter waren zuvor selber von Missbrauch und/oder Vernachlässigung betroffen. In der eigenen Erhebung gaben 37 % der Mädchen an, penovaginal penetriert worden zu sein, während 60 % der Jungen eine penoanale Penetration angaben. In keinem Fall konnten objektivierbare Verletzungen festgestellt werden.

Schlussfolgerung

Auch wenn bei der medizinischen Untersuchung von minderjährigen Geschädigten nach Sexualdelikten nur äußerst selten eindeutige Befunde festzustellen sind, sollte jede/jeder MedizinerIn Kenntnis über die Wertigkeit und Bedeutung von kindlichen Genitalbefunden haben. Weiterhin gilt es, den fließenden Übergang von „Doktorspielen“ zu sexualisierter Gewalt zwischen Minderjährigen korrekt zu erkennen.

The prevalence of sexual violence against female children: A systematic review and meta-analysis

BACKGROUND

Sexual violence against female children is considered an important public health problem. However, there are currently no clear prevalence rates across the globe on which to base measures to protect these children. The objective of this study is to systematically summarize the prevalence of sexual violence against female children.

METHODS

We conducted a comprehensive search of the PubMed, Embase and Web of Science databases from their inception through April 2021 for pertinent studies reporting the prevalence of sexual violence against female children. The prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I² statistic. Differences by study-level characteristics were estimated through subgroup analysis and meta-regression.

RESULTS

A total of 28 cross-sectional studies were included (a total of 30,524 participants). The pooled sexual violence rate against female children was 0.24 (95 % CI = 0.20-0.27). Groups comparisons revealed that sexual violence rates obtained from 1981 to 2000 (0.28, 95 % CI = 0.21-0.36) were higher than those obtained from 2001 to 2020 (0.21, 95 % CI = 0.16-0.25), that rates were higher for female children from developed countries (0.25, 95 % CI = 0.20-0.29) than for those from developing countries (0.21, 95 % CI = 0.14-0.27), the rates for surveyed adults (0.22, 95 % CI = 0.17-0.28) than for surveyed female children (0.18, 95 % CI = 0.10-0.26), and that rates for those ≤15 years of age (0.10, 95 % CI = 0.01-0.20) were much lower than those for older children.

CONCLUSIONS

Nearly a quarter (24 %) of female children have been victims of sexual violence. Prevention strategies should be developed urgently to protect female children from aggression.

Prevalence and Factors Associated with Sexual Violence against Children in a Brazilian State

Sexual violence is one of the forms of violence against children worldwide. Understanding its magnitude and its associated factors is essential to promote effective protection policies to childhood. The objective was to verify the prevalence and analyze the factors associated with sexual violence against children in a Brazilian state. This is a cross-sectional study analyzing data from reported cases of violence against children in the state of Espírito Santo, Brazil, between 2011 and 2018. The characteristics of the victim, perpetrator and aggression were studied, and the associations were analyzed using Poisson regression. The frequency of sexual violence was 41.8% and was more prevalent in girls, in the age groups 3 to 5 and 6 to 9 years old, in white ethnicity/color and in the urban area. The offenders were mainly men, known to the victim and occurred mainly in the residence. Sexual violence was the most reported violence among children in Espírito Santo, occurring within their circle of trust, demonstrating the need to provide support for families and to advance public policies to guarantee children's rights.

The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study

OBJECTIVES

Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims.

METHODS

This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed.

RESULTS

Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old.

CONCLUSIONS

Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

A Meta-Analytic Framework for Developing Protocols to Attend Child and Adolescent Victims of Sexual Violence

Violence against children and adolescents is a global public health problem. In Brazil, there are challenging boundaries for professionals in the protection network in general and for health professionals in particular. Moreover, among other factors, there is the challenge of referral, due to weaknesses in decision making, given the nature of sexual violence and how it is managed by healthcare services. This study aims to propose a Meta-Analytic framework to support the referral of young victims of sexual violence, considering levels of severity, independent of factors such as how protection systems are structured and managed and the local laws in force. We propose a Meta-Analytic approach, developed using the fundamentals of Delphi and DPSIR (Drivers, Pressures, State, Impact, and Response Model of Intervention), from the perspective of Value-Focused Thinking. The Delphi method was structured in two stages: the first stage aimed to identify and classify typical cases of sexual violence; the second stage used the DPSIR model, with the aim of identifying the decision criteria for typical cases that occur in a given municipality. The main outcomes are: (i) the application of the modified Delphi participatory method within the context of local social policies; (ii) the construction of a value tree based on Value-Focused Thinking; and (iii) the identification and systematization of criteria that most interfere with the evaluation of cases of sexual violence, which can be used for multi-criteria decision making.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up

OBJECTIVE

 To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided.

METHODS

 A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%.

RESULTS

 The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups.

CONCLUSION

 The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

A Violência Mora ao Lado? Violência Familiar e Comunitária entre Adolescentes

Resumo Para descrever a ocorrência de situações de violência contra adolescentes na família e na comunidade, foi conduzido estudo transversal em escolas públicas de municípios do Brasil. O Questionário da Juventude Brasileira Versão Fase II foi utilizado. Participaram 2.860 adolescentes, sendo 58,5% do sexo feminino. Cerca de um terço dos participantes sofreram violência física na família. Na comunidade, 32,7% dos adolescentes reportaram ter sofrido situações de violência psicológica. Situações de violência física ocorreram mais entre meninos, em participantes de 15 a 19 anos e nos que experimentaram álcool ou drogas ilícitas. Considera-se como importante que ações preventivas contra violência de naturezas distintas sejam contínuas e abrangentes, incluam diferentes subgrupos e garantam o suporte necessário.

Sexual Violence against Children and Adolescents Taking Place in Schools: An Integrative Review

Sexual violence against children and adolescents is considered a public health problem of worldwide scope. The objective is to analyze the findings in the literature that address the phenomenon of sexual violence against children and adolescents in the school environment; is an integrative literature review that has as its element-problem of interest children and adolescent victims of sexual violence in schools. The research filters used were: the availability of the text (free full text) and publication date (in the last five years); Initially, 1199 studies were identified, then, after application of filters and the removal of duplicated studies, a total of 175 studies was reached. Subsequently, the selection of articles occurred with the sieve of the titles, resulting in 20 studies. From these, 13 proceeded to the eligibility stage, with three being excluded after a full reading. Therefore, nine studies composed the final sample. One of the factors related to the occurrence of sexual violence against children and adolescents in schools is the absence of educational spaces on the subject, being the main parameter for approaching the outline of identification and prevention strategies, with the insertion of sexual education on the school routine, with the participation of the family.

Violence against adolescents: analysis of health sector notifications, Brazil, 2011-2017

INTRODUCTION

Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit.

METHODS

Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables.

RESULTS

The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors.

CONCLUSIONS

Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Challenges for the implementation of the chain of custody for rape victims in the Federal District

Abstract Chain of Custody implies adequate collection, recording, and storage of the vestige of sexual violence, guaranteeing the reliability of the material that will be forwarded as expert evidence. Its implementation in the Unified Health System has faced challenges. Objective: To know the attendance to victims of sexual violence in the public maternity of Federal District and evaluate the knowledge of the team about the legislation on a chain of custody. Method: Cross-sectional, quantitative, and descriptive study with 134 medical and nursing professionals working in the obstetric emergency, who answered a questionnaire, submitted to descriptive statistical analysis and the Qui-Square Test. Results: Of the 78.95% of professionals who reported attending to victims of sexual violence, 25.71% consulted in 10 minutes, and 14.18% received specific training. The situational diagnosis reveals that the care is superficial, centered on medical issues, and the collection of vestiges is non-existent. Conclusion and implications to nursing practice: A generalized change of posture is necessary so that it is possible to implant the chain of custody in the maternity studied. It is essential to develop care beyond medical issues, and which includes forensics. It is suggested a collaborative action between physicians and nurses, with nursing as the epicenter of this process.

Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares

RESUMO A presente pesquisa objetivou apresentar perspectivas de conselheiros tutelares sobre a atuação nos casos de violência contra a criança. Para tanto, foram entrevistados 16 profissionais atuantes no município de Palmas (TO), Brasil. Os dados foram submetidos à análise de conteúdo. Identificou-se que interferem no enfrentamento da violência infantil, por esses atores, a falta de conhecimento e habilidades para identificar crianças em risco ou situação de violência, o envolvimento das famílias nos casos, a precariedade de recursos materiais, o quantitativo insuficiente de profissionais, falhas na rede de proteção à criança, estereótipos culturais, a desvalorização profissional e a impunidade do agressor. Sendo assim, para que o Conselho Tutelar consiga exercer plenamente suas funções e contribuir para a interrupção do ciclo de violência infantil, são necessários investimentos em diversas áreas, tais como a qualificação dos conselheiros tutelares, por meio da oferta de cursos periódicos, e a implantação de ambientes de trabalho com recursos material e humano suficientes, de modo a contribuir para que se exerçam ações integradas, intersetoriais e resolutivas.