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Background: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them. Objective: To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting. Methods: The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review. Results: Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis. Conclusion: Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges and procedures involved in recognizing, managing, and reporting pediatric sexual abuse and assault, particularly in the emergency department setting. It outlines the importance of understanding the role of the Emergency Department in evaluating suspected abuse cases, the epidemiology of child sexual abuse, the variability in abuse types, and appropriate clinical approaches to assessment and reporting.

Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

Social support following a sexual assault (SA) may help minimize or prevent the myriad of negative sequelae impacting individuals who experience SA. Receiving a SA exam may provide initial support during the SA exam and set up individuals with needed resources and supports post-SA exam. However, the few individuals who receive a SA exam may not stay connected to resources or support post-exam. The purpose of this study was to understand individuals' post-SA-exam social support pathways including individuals' ability to cope, seek care, or accept support following a SA exam. Interviews were conducted with individuals who experienced SA and then received a SA exam through a telehealth model. The findings revealed the importance of social support during the SA exam and in the months that followed. Implications are discussed. [ABSTRACT FROM AUTHOR]

This study determined that the detection of spermatozoa could be improved by submitting sexual assault swabs directly for Differential Lysis extraction, whilst preserving the ability to conduct presumptive testing, eliminating the need to prepare a microscopic slide during initial examination. Analysis of semen from cotton swabs, rayon swabs, scrapings, tape-lifting and excisions from both thick and thin fabrics was conducted to ensure that the methodologies evaluated were tested on a range of exhibits and biological fluids typically seen in routine forensic casework. Results showed that microscopy slides created during Differential Lysis Extraction performed favourably in comparison with slides created during initial examination. A newly developed sexual assault process gave comparable detection levels to the traditional processing for Prostate Specific Antigen (p30) and Phadebas presumptive testing. It should be noted that the detection sensitivity for Acid Phosphatase (AP) was slightly better for traditional processing. The sensitivity of p30 was shown to be far superior to that of AP across most experiments. [ABSTRACT FROM AUTHOR]

Sexual assault is a form of violence disproportionately perpetrated against women by men; however, men also experience high rates of sexual victimization. While recent research exploring victimization of sexual assault among men does exist, little is known about situational characteristics and consequences surrounding men's assault experiences. Therefore, the current study examines narratives of men's sexual assault to further understand the unique experiences of men receiving a sexual assault medical forensic examination. To accomplish this, we conducted a retrospective medical chart review of sexual assault narratives from N = 45 men receiving a sexual assault medical forensic examination at a large academic medical institution in the southeastern United States. Three general constructs were identified within the records: a) Perpetrator use of coercive tactics, b) Memory loss, and c) Contextual factors. Nested within these constructs, five specific themes emerged, including: a1) Use of weapons and physical force; a2) Tactical administration of alcohol and drugs; b1) Difficulties remembering assault; c1) Consensual sexual activity turned non-consensual; c2) Incarceration. Findings from the present study common identified characteristics of sexual assaults among men receiving a sexual assault medical forensic examination, including coercive tactics used by perpetrators, consequences of sexual assault, and high-risk settings for male victimization. [ABSTRACT FROM AUTHOR]

In the United States, sexual assault survivors are advised to have a medical forensic exam and the collection of a sexual assault kit (SAK) to preserve biological evidence (e.g. semen, blood, saliva, hair) if they are considering reporting the assault to the police. Law enforcement personnel are supposed to submit the SAK (also known as a "rape kit") to a crime laboratory for forensic DNA testing, which can help identify or confirm the identity of the offender. However, police do not routinely submit SAKs for testing, and large stockpiles of untested kits have been found in police storage throughout the United States. Public outrage has prompted many cities to submit these older rape kits for DNA analysis, and this testing has identified thousands of suspected perpetrators. Police and prosecutors are re-opening these older sexual assault cases, which requires reestablishing contact with survivors who made the initial report years ago – a process referred to as "victim notification." In this study, we conducted qualitative interviews with survivors who received a SAK victim notification and participated in the re-investigation and prosecution of their cases. We explored how survivors reacted to this de facto admission of an institutional betrayal and the emotions they felt during and after the notification. Participants experienced considerable emotional distress (e.g. PTSD, anxiety, fear), anger and betrayal, and hope after they were recontacted by the police. Implications for making victim notifications more trauma informed are discussed. [ABSTRACT FROM AUTHOR]

In Crawford v. Washington, the United States Supreme Court held that if statements "were made under circumstances which would lead an objective witness reasonably to believe that the statements would be available for use at a later trial," then a defendant has the right to confront and cross examine the witness. However, the Court's subsequent retreat from this ruling and introduction of the primary purpose test in a later decision, created a flawed federal analysis, as seen in State v. Tsosie. In Tsosie, the New Mexico Supreme Court applied the primary purpose test to determine whether statements of the declarant, recorded in a sexual assault nurse examiner (SANE) report, required confrontation. Because the primary purpose test and federal confrontation clause jurisprudence is flawed, and because the New Mexico Constitution has been interpreted to provide defendants with stronger protections than the United States Constitution, through the interstitial approach New Mexico should adopt Massachusetts' iteration of the Crawford test. [ABSTRACT FROM AUTHOR]

Rape is a heinous crime that can have devastating effects on the survivor, The immediate medical examination and treatment of a rape survivor are crucial for their well-being and to-gather the necessary evidence to strengthen the case. Proper evidence collection is important for a successful legal prosecution. The earlier a survivor arrives for evaluation in the emergency department, the greater the chance of obtaining critical forensic evidence such as DNA samples. When patients delay presentation, or shower and change their clothes, relevant microscopic and macroscopic evidence is often lost. Evidence collection, including injury documentation, becomes less fruitful as time passes and tissue heals. Medical documentation has been shown to be positively associated with filing of charges and conviction. A Retrospective analysis of 67 cases of sexual assault examined at Department of Forensic Medicine at SMS medical college from 1st Jan to 31st Oct, 2020 was done, The clinical findings of the survivors were correlated to the time duration elapsed between incidence and medico-legal examination for all cases. 15 out of 67 cases (22%) were reported within 72 hrs; out of which 9 (60%) cases had corroborative clinical findings, 45 (67%) cases, who had reported later than 7 days only 1 (2%) had corroborative clinical findings. delayed reporting is most common hurdle for corroboration of material evidence and alleged accusation in these cases, The correlation of time of examination and clinical findings, in the present study, questions the relevance of mandatory medical examination in all cases. [ABSTRACT FROM AUTHOR]

Current estimates suggest there are 300,000–400,000 untested sexual assault kits (SAKs) in police department storage facilities throughout the United States. As these kits are being discovered and then submitted for forensic DNA testing, legal system personnel may recontact victims. These "victim notifications" involve informing survivors their kits were previously untested, sharing the results of new DNA testing, and asking for their engagement in reinvestigating and prosecuting the case. Typically, victim notifications are conducted by police, and survivors are connected with victim advocates soon thereafter. In this study, we interviewed survivors about their experiences of being notified by the police. We also interviewed about their work supporting survivors. Both survivors and advocates expressed strong concerns about police conducting notifications without an advocate present. [ABSTRACT FROM AUTHOR]

Background: People with learning disabilities are over‐represented amongst Sexual Assault Referral Centre service users. This work aims to explore the similarities and differences between service users with and without learning disabilities. Method: Medical notes of 52 service users likely to have a learning disability were compared with 52 service users not likely to have a learning disability (according to the Learning Disability Screening Questionnaire); all of whom attended Saint Marys SARC for a forensic medical examination during a 12‐month period. Results: Significant associations were found between the likelihood of learning disability and relationship to perpetrator; location of assault; alcohol use; time taken to present to SARC; domestic violence; self‐harm; suicide attempts and mental health service involvement. Conclusions: People with learning disabilities in the sexually assaulted population are more likely to present with intersecting vulnerabilities emphasising the need for timely, accessible and appropriate patient‐centred care for this group. [ABSTRACT FROM AUTHOR]

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. Trial registration: NCT01430624 [ABSTRACT FROM AUTHOR]

Idiographic script-driven imagery is core to both research and treatment related to posttraumatic stress disorder (PTSD), including among individuals with a history of sexual assault. However, there may be benefit in having alternatives to such idiographic techniques. The current study therefore examined multimodal responding to a standardized audio-recorded narrative of a sexual assault. In this experiment, 105 women (Mage = 19.09, SD = 2.24) were recruited from the community and randomly assigned to listen to a depiction of sexual assault (trauma condition) or a similar experience without sexual assault (control condition). As hypothesized, relative to the control group, participants in the trauma condition reported greater (a) increases in anxiety, anger, and disgust from pre- to post- manipulation, and (b) distress across the duration of the recording. In contrast to hypotheses, heart-rate did not differ across groups. Results suggest listening to a standardized sexual assault narrative, compared to a non-traumatic narrative, effectively increases negative affect. This indicates standardized sexual assault narratives have potential as a traumatic event cue presentation method both for trauma-focused treatment and studying reactions to sexual assault cues. [ABSTRACT FROM AUTHOR]

Dating app facilitated sexual assault (DAppSA) is a concerning phenomenon with minimal published research. This retrospective study explored if DAppSAs were different than other sexual assaults (SAs) committed by acquaintances through a review of 3,413 sexual assault medical forensic examination (SAMFE) charts from 2017 to 2020 in a Mountain West state in the United States. Routine Activities Theory and Confluence Model of sexual aggression provided the theoretical framework for the study. Inclusion criteria for DAppSA cases included (1) victim was 14 years of age or older; (2) victim indicated meeting the perpetrator on a dating app; (3) SA occurred at initial in-person meeting; and (4) victim had a SAMFE with SA kit evidence collection. DAppSAs (n = 274) represented 8.02% of overall cases and 13.92% of acquaintance SAs (n = 1,968). DAppSA victims had unique characteristics including a higher percentage of male victims (7.5%), college students (22.2%), and victims with self-reported mental illness (MI) (59.6%). Victims were less likely to fight back during the assault with lower percentages of kicking (5.8%) and hitting (9%). DAppSA victims and perpetrators were less likely to use drugs or alcohol before or during the assault. DAppSAs were found to be more violent SAs with increased strangulation (32.4%); assaultive/penetrative acts; and victim injuries, especially anogenital and breast injuries. Unique and troubling differences were found in DAppSA cases than other SAs committed by acquaintances. Due to the increased violent nature of DAppSAs, the researchers propose that sexual predators use dating apps as hunting grounds for vulnerable victims. Recommendations to address dating app safety concerns, influence dating app usage policies, and improve care to survivors are discussed through systems-based and trauma-informed approaches. [ABSTRACT FROM AUTHOR]

Child sexual abuse is a prevalent phenomenon worldwide. However, a gap exists between its incidence and its disclosure rate. Furthermore, assessment tools and techniques capable to identify the source of symptoms are lacking. This study investigates the extent to which the validated Medical Somatic Dissociation Questionnaire (MSDQ) can differentiate between sexually and non-sexually abused children. A total of 794 children and youth between the ages of 8 and 18 (mean age: 12.2 (SD = 2.3); 42% female, 58% male) were recruited from the general population; other participants were residents of boarding schools and children who were referred to medical treatment. The anonymous online questionnaire included queries about demographics, a condensed version of the Traumatic Life Events Questionnaire, and the MSDQ. Findings indicate strong internal consistency, reliability, incremental validity, and predictive validity of the instrument, indicating the superiority of the MSDQ's ability to predict sexual abuse compared to physical abuse or the loss of a family member. It is concluded that the MSDQ can be integrated into the evaluation process performed by healthcare professionals in the diagnosis of minors with unexplained symptomatology. [ABSTRACT FROM AUTHOR]

Child sexual abuse affects millions of children globally but in Nigeria, hospital-based studies continue to report few cases, making it difficult to assess the magnitude and quality of care. This study aimed to overcome this challenge by reviewing police medical reports instead of hospital records. A total of 420 reports were retrieved from one police area command in Kaduna State, Northwestern Nigeria, between 2018 and 2021. The majority of the victims were females (65.5%), 5–14 years (70.2%), and familiar with their assailants (71.4%). Most of the assailants were men (99.0%), 20–40 years (29.1%), who acted alone (86.7%). Most of the reports contained history (79.3%), physical examination (49.6%), and laboratory results (>90%). Among female victims, the commonest genital findings were absent hymen (25.6%) and normal findings (17.6%). Among male victims, the commonest anal findings were normal findings (41.7%) and anal dilatation (23.6%). The victims tested positive for HIV (0.5%), hepatitis B (4.7%), hepatitis C (1.0%), and syphilis (0.8%). Higher positivity rates were noted among assailants. Treatments offered to the victims included antibiotics (30.2%), analgesics (11.9%), emergency contraception (6.7%), and psychotherapy (67.4%). The review calls for improved reporting, use of comprehensive treatment guideline, and training of service providers to improve the quality of care. [ABSTRACT FROM AUTHOR]

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma. [ABSTRACT FROM AUTHOR]

Although police organizations have devoted considerable effort to training investigators in evidence-based witness interviewing techniques, there is some suggestion that current practices do not meet the multifaceted requirements of sexual assault cases. Here, we assessed the specific challenges inherent in conducting interviews with adult sexual assault complainants, by conducting in-depth interviews with 21 experienced investigators from both Australia and New Zealand. The challenges that investigators identified fell into three broad themes: meeting the evidential needs of sexual assault investigations, establishing credibility, and managing complainant vulnerabilities. We discuss how the investigative interview process might be modified in line with these challenges. [ABSTRACT FROM AUTHOR]

Prompt and better primary examination of victims accompanied by meticulous note-taking in cases of suspected child sexual abuse are needed to improve both conviction rates and to avoid inappropriate criminal investigations and proceedings. The majority of child sexual abuse victims are female. More training is needed for gyaecologists in this field. [ABSTRACT FROM AUTHOR]

This study examined how the COVID-19 pandemic affected sexual assault healthcare services in a predominately African American U.S. city. In mixed methods research design, we used quantitative interrupted time series modeling to evaluate changes in service rates for three core post-assault healthcare services—medical forensic exams (MFEs), medical advocacy MFE accompaniment, and counseling—from January 2019 through June 2021. We also conducted qualitative interviews with 12 sexual assault advocates to understand how their clients were impacted by COVID and how their agency adapted services to respond to the needs of their community. Both the quantitative and qualitative data revealed marked disruptions in service provision. The number of MFEs, medical advocacy accompaniments, and counseling sessions significantly decreased during the pandemic's initial surge, and survivors feared seeking hospital-based health care due to concerns that they might contract COVID-19 in hospital emergency departments. The number of MFEs performed by program staff did not return to pre-pandemic levels during this study's observation period, but the number of medical advocacy accompaniments and counseling sessions did significantly rebound. Counseling services eventually exceeded pre-pandemic levels as agency staff supported clients with both assault- and COVID-related trauma and loss. These results underscore the need for community-based sexual assault healthcare services, so that if public health emergencies limit the availability, accessibility, and safety of hospital emergency department care, sexual assault survivors have other settings for obtaining post-assault health care. [ABSTRACT FROM AUTHOR]

Rape survivors who submit to a medical forensic exam generally expect the resulting rape kit to be tested, but hundreds of thousands of rape kits have been left untested in police storage facilities nationwide. The current study sought to understand what the experience of having an untested rape kit was like for survivors. Using Interpretive Phenomenological Analysis, this study examined narratives of 15 survivors whose rape kits had been part of the rape kit backlog. Analysis suggested that survivors experience an extreme sense of betrayal and loss of faith in the criminal justice system when their kits are not tested. For these survivors, the rape kit was more than just evidence in a box; it was part of them. Implications are discussed. [ABSTRACT FROM AUTHOR]

Keywords: Sex offenses; Social media; Mobile applications; Child abuse; Forensic medicine EN Sex offenses Social media Mobile applications Child abuse Forensic medicine 506 508 3 06/20/23 20230615 NES 230615 Shining a light on technology-facilitated sexual assault - the "why" behind the research As a forensic physician, you are exposed to some of the most terrible actions humans can inflict on one another. Social media, Sex offenses, Child abuse, Mobile applications, Forensic medicine A story suggesting that the assaults could be medically high risk, with a large proportion involving penetration and a low proportion reporting condom use. [Extracted from the article]

Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures. [ABSTRACT FROM AUTHOR]

Despite consensus that the forensic medical examination is an integral component to a comprehensive response to child sexual abuse (CSA), concerns have been expressed about the impact of these examinations on children and young people. A small‐scale survey was conducted with a group of CSA professionals (n = 19), followed by semi‐structured interviews with six adolescents, accessed through CSA specialist units in Ireland. While concerns were expressed about the examination, overall, professionals were in favour of it as part of a holistic therapeutic response to CSA. Five themes were identified from the interviews with adolescents: the experience of the examination as an imposition, the unknown nature of the examination, the focus on the body itself, feeling exposed and having a say. Findings highlight how a trauma‐informed approach, with emphasis on information sharing and supporting the autonomy of the young person's voice and choice throughout the process, could provide a transformative experience for young people, helping them integrate their psychological and physical sense of themselves. The forensic medical examination can facilitate the healing and recovery process by bringing into awareness many of the anxieties that, due to shame or inability to tolerate associated emotional pain, remain unspoken and unspeakable following CSA. [ABSTRACT FROM AUTHOR]

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability. [ABSTRACT FROM AUTHOR]

Body fluid identification through messenger RNA (mRNA) has been proposed as a useful supplement to presumptive and confirmatory tests by previous laboratory studies; however, its application in routine clinical forensic examination was rare. We report a case of sexual assault in which body fluid identification by mRNA profiling was used. Vaginal secretions mRNA markers (MUC4, HBD1, and CYP2B7P1) were used to test the sample, being obtained positive results. This case demonstrates that mRNA profiling of body fluids could be applied to routine case examinations as an aid, acting as a scientific collaborative evidence to strengthen the medicolegal opinion. [ABSTRACT FROM AUTHOR]

Background: Sexual anal assault is an important and critical issue worldwide. Usually the clinical examination reveals subtle findings to prove the incident of sexual anal assault. Thus for approaching a proper diagnosis, the victim needs to be examined by a trained and experienced forensic physician who is officially involved in dealing with such issues. Methods: Prospective study of 82 victims of sexual anal assault transferred by the local prosecutor to the forensic medicine department. Results: The majority of victims were females (82%), most of them were younger than 18 years (53.8%). The findings obtained by other clinical positions regarding the distribution of anal cutaneous folds revealed that (82%) of victims showed normal distribution, and (18%) showed abnormal distribution of the folds. While after chest-knee positioning (33.3%) of victims showed normal distribution of the anal cutaneous folds and (38.5%) showed abnormal distribution along with (28.2%) of victims showed absence of folds. Regarding inspection of anal sphincter by other clinical positions; (84.6%) of victims showed normally contracted sphincter and (15.4%) showed less contractility of the sphincter, whilst by chest-knee positioning (35.9%) of victims showed normally contracted sphincter with the majority of victims (64.1%) showed abnormal contraction. Concerning injuries in the anal region represented mainly by contusions and abrasions; they were noticed only in (12.8%) of victims by other clinical positions, while were present in (29%) of victims examined with chest-knee position. Conclusions: During the clinical examination of victims of sexual anal assault, and in comparison with other clinical positions used, the application of chest-knee position showed overall more conspicuous physical findings, especially regarding the distribution of anal cutaneous folds, the inspected degree of contractility of anal sphincter, and the presence of injuries in the anal region represented mainly by contusions and abrasions. [ABSTRACT FROM AUTHOR]

Despite the widespread use of sexual assault medical forensic exams (SAMFEs), practitioners and researchers continue to debate the role of SAMFEs and the evidence they provide in the investigation and prosecution of sexual assault cases. Using data from a review of sexual assault cases reported to police between 2015 and 2017 in two jurisdictions (n = 534), we use logistic regression examine whether the presence of a SAMFE predicts the likelihood of achieving criminal case processing outcomes and whether the relationship of the SAMFE with criminal case processing outcomes is moderated by other legal and extralegal case characteristics. We did not find evidence that the presence of a SAMFE in a case significantly predicts whether a suspect will be identified, arrested, or convicted overall, but we did find evidence of the SAMFE's injury documentation value for arrest. Researchers and practitioners should account for the multiple ways SAMFEs can influence decision-making in future research and policymaking. [ABSTRACT FROM AUTHOR]

This study reported a sexual assault case where Y-STR DNA profile was tested for the confirmation of male DNA. Within the DNA profile of the sample of accused, a tri-allelic pattern was detected at locus DYF387S1. Since this locus doesn't exist in any of the commercially available Y-STR amplification kits, So, the confirmation of this tri-allelic pattern was done by re-extracting and amplifying the extracted DNA by using Y-Filer Plus amplification kit (Thermo Fischer Scientific, CA, USA--Thermo) followed by separation of amplicons on Genetic Analyzer 3500xl.The allelic patterns of case sample belong to Type-2 pattern of tri-allelic outcome because peak heights were in balanced manner. This region is very much prone towards any structural mutation which could be either addition or deletion of allele, so for the forensic point of view this locus should be used carefully for kinship analysis. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to investigate the frequency of specific signs and symptoms following sexual assault-related non-fatal strangulation (NFS) and to explore the interaction between assault characteristics and physical exam findings. Methods: This retrospective observational study included all adults (>18 years) reporting strangulation during sexual assault who presented for a forensic sexual assault exam at one of six urban community hospitals contracted with a single forensic nurse agency. Demographic information, narrative elements, and physical exam findings were abstracted from standardized sexual assault reporting forms. We analyzed data with descriptive statistics and compared specific variables using chi-square testing. Results: Of the 580 subjects 99% were female, with a median age of 27 (interquartile range 22-35 years). The most common injury location was the neck (57.2%), followed by the mouth (29.1%). We found that 19.1% of the victims had no injuries evident on physical exam and 29.8% reported a loss of consciousness. Eye/eyelid and neck findings did not significantly differ between subjects who reported blows to the head in addition to strangulation and those who did not. The time that elapsed between assault and exam did not significantly correlate with the presence of most head and torso physical exam findings, except for nose injury (P = 0.02). Conclusion: Slightly more than half of the victims who reported strangulation during sexual assault had visible neck injuries. Other non-anogenital findings were present even less frequently, with a substantial portion of victims having no injuries documented on physical exam. The perpetrators' use of blows to the head may account for many of the non-anogenital injuries observed, but not for the neck and eye/eyelid injuries, which may be more specific to non-fatal strangulation. More research is needed to definitively establish strangulation as the causal mechanism for these findings, and to determine whether any long-term neurologic or vascular sequelae resulted from the observed injuries. [ABSTRACT FROM AUTHOR]

The article focuses on psychiatric evaluation of victims and offenders of sexual assault in view of current laws.

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011–2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p =.001). Patients who were not students were more likely to report than students (OR = 3.24; p =.002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p =.007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p =.008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p =.056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting. [ABSTRACT FROM AUTHOR]

This article aims to define and describe female genital anatomy, the changes that occur in the genitalia during growth and puberty, and during sexual response and intercourse. It elaborates the reasons for normal genital examination findings in most female children who have been sexually abused and explains why the absence of findings of genital trauma should not be used to challenge the credibility of the child's history of sexual abuse. [ABSTRACT FROM AUTHOR]

Child sexual abuse is the most challenging type of abuse to detect. Moreover, there are difficulties in gathering evidence, apprehending, and prosecuting the perpetrator. The trial is often based on the contradiction of the suspect's and the child's statements. The aim of this study is to identify the difficulties encountered during the entire trial in cases of sexual assault against the child in Turkey starting from the investigation phase, to determine the auditability of taking a child's statement, which is the basis of the judicial decision, and to evaluate the effectiveness of the principles set by the Supreme Court, which oversees the local court decision. It was determined that the trial was continued on abstract allegations, the Supreme Court's approval of the decision of the local court was based on "the slander of a person who wants to harm another person over the sexuality of a minor is contrary to the usual flow of life." Furthermore, the reason wassuggestive of subjective interpretations rather than material truths. This study, which is a master's thesis, has been submitted to the Turkish Ministry of Justice. [ABSTRACT FROM AUTHOR]

This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13-17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies. [ABSTRACT FROM AUTHOR]

Casual sex, although common in college culture, can increase the risk of sexual victimization, which in turn can lead to posttraumatic stress disorder (PTSD). This study examined sexual victimization, self-esteem, and social support as relative predictors of PTSD and risky casual sex (RCS) in a sample of 229 female undergraduates. Results suggested that enhancing self-esteem may have a greater relative impact on PTSD symptoms compared with social support, even after accounting for the impact of sexual victimization. Moreover, a reduction in PTSD symptoms may have the potential to minimize RCS. Future research is needed to determine temporal relations among these variables. [ABSTRACT FROM AUTHOR]

This study examined the recorded interviews of 132 children between 3 and 16-years of age who were involved in a forensic investigation evaluating allegations of sexual and/or physical abuse. As part of this investigation, two interviews were conducted over a 5-day period. The interviews were analyzed to examine how frequently these children disclosed substantiated allegations of abuse when asked directly about these experiences in one or both interviews. Results revealed that 39.2% of children with substantiated sexual abuse and 55.6% of those with substantiated physical abuse denied these experiences in one or both interviews. The denial rate was highest among school aged children (6- to-10-year- olds), as over a third of the girls and more than half of the boys in this age group denied the substantiated allegations in one or both interviews. Recantations were also relatively common, as 24% of the children who disclosed sexual and/or physical abuse prior to the assessment denied the allegations in one or both interviews. The youngest children (3- to 5-year-olds) were most likely to be inconsistent in their denials/disclosures across interviews. Custody status and relation to the perpetrator also predicted denials/disclosures of sexual, but not physical abuse. Overall, the data suggest that denials of both sexual and physical abuse are quite common and higher than rates found in most archival file reviews. [ABSTRACT FROM AUTHOR]

Background: Sexual assault (SA) is common, but Black individuals might be at higher risk of SA and negative health sequalae. Racial differences in SA characteristics and health care utilization after SA are largely unknown. Materials and Methods: We reviewed medical records of 690 individuals (23.9% Black; 93.6% women) who received a SA medical forensic exam (SAMFE) at a southeastern U.S. hospital. We examined bivariate racial differences in SA characteristics and used zero-inflated Poisson regressions to estimate racial differences in mental health outpatient visits at the SAMFE hospital. Results: Among survivors of SA, Black survivors were more likely than White survivors to have been victimized by an intimate partner (odds ratio [OR] = 1.77, confidence interval [95% CI] = 1.02–3.07) and they had more post-SA outpatient mental health visits at the SAMFE hospital (incidence rate ratio [IRR] = 2.05, 95% CI = 1.70–2.47). Black survivors were less likely to report alcohol or drug use before the SA (OR = 0.42, 95% CI = 0.28–0.62). In multivariable models, Black survivors trended toward more mental health visits than White survivors (IRR = 1.63, 95% CI = 0.82–2.44), but intimate partner violence (IPV) significantly moderated that association (IRR = 0.01, 95%CI = ≤0.001–0.03). Black survivors assaulted by an intimate partner were less likely to access mental health care than White IPV survivors. Conclusions: The hospital setting of a SAMFE could be a unique opportunity to serve Black survivors and reduce racial disparities in mental health sequelae, but additional support will be needed for Black survivors experiencing IPV. An intersectional, reproductive justice framework has the potential to address these challenges. [ABSTRACT FROM AUTHOR]

Violence against social workers and other social service practitioners is prevalent across countries and service delivery settings, often accepted as implicit in working with vulnerable clients. A corresponding scholarly focus on workplace violence, and the factors that affect it, is, however, still developing. This is particularly stark in the domestic and family violence (DFV) and sexual assault (SA) sectors. To address this gap, this article explores the extent and impact of practitioners' exposure to workplace violence, and the mix of work and organisational factors that predict it. Analysis of survey data from Australian DFV and SA practitioners (N  = 903) enables a focus on the two main sources of workplace violence: violence from clients and violence from colleagues. Both types of violence were found to be prevalent, gendered and associated with emotional strain and intention to leave. We argue that in DFV and SA sectors, which respond to multiple forms of gendered violence, understanding the multifaceted nature of workplace violence, and the structural arrangements that underpin it, is necessary for planning strategies to prevent and address it. [ABSTRACT FROM AUTHOR]

Sexual assault is a major public health concern associated with significant mental health and medical symptoms. Follow-up screening post-sexual assault medical forensic examination (SAMFE) can be one method of determining needs and providing targeted prevention of mental health and medical symptoms among individuals who experienced a recent sexual assault. However, the factors associated with engagement in post-SAMFE follow-up screening have not been identified. The current study examined the association between intimate partner violence victimization and sexual assault–related characteristics and engagement in post-SAMFE follow-up screening. Participants were 193 individuals who received a SAMFE and indicated at the time of SAMFE that they were interested in follow-up by the hospital. It was found that individuals were less likely to engage in follow-up screening if the assault was perpetrated by an intimate partner. These findings suggest that other resources are needed to reach individuals who experience sexual assault perpetrated by an intimate partner due to the unique needs of that population. [ABSTRACT FROM AUTHOR]

Emerging research has shown that experiences of sexual violence are associated with cancer screening behaviors. However, to date, little attention has been given to the impact of sexual assault on cancer screening behaviors, particularly among men. To address this, we used data from the 2014 Kansas Behavioral Risk Factor Surveillance System. This survey is conducted annually via telephone. Logistic regressions were used to calculate odds of ever engaging (i.e., lifetime) in specific screening behaviors (clinical breast exam [CBE], mammogram, Pap test, colonoscopy/sigmoidoscopy, fecal occult blood test and prostate-specific antigen [PSA] test) and current compliance with cancer screening recommendations (CBE, mammogram, Pap test, colorectal cancer screening, and PSA test), with lifetime sexual assault as the independent variables. Colorectal cancer screening models were stratified by gender. All models adjusted for confounders. Sexual assault was associated with lower odds of ever receiving a PSA test and, for women, higher odds of ever receiving a colonoscopy or sigmoidoscopy. Sexual assault was associated with lower odds of current compliance with CBE, mammogram, Pap test, and PSA test screening recommendations. A history of sexual assault was associated with lower odds of current compliance with cancer screening procedures, with the notable exception of colorectal cancer screening. Less consistent patterns were seen for lifetime screenings. Results suggest that alternatives to currently recommended procedures (like self-collection of HPV [human papilloma virus] DNA) or modified screening procedures may be a promising route to increase current compliance with cancer screening among a population that may avoid these procedures due to pain or fear of retraumatization. [ABSTRACT FROM AUTHOR]

We present a case study of a researcher–reporter collaboration that formed from an initiative to address thousands of previously untested rape kits in one Midwestern (U.S.) jurisdiction. We explore this symbiotic partnership by examining (a) how and why it formed; (b) the outcomes, including extensive and public dissemination and a unique project that surveyed 294 Ohio law enforcement agencies to see what happened after the rape kits were tested (Ohio Rape Kit Survey Project); and (c) the impact that the partnership, dissemination, and larger initiative had in sparking demonstrable change in how the justice system and the general public responded to and engaged with the issue of untested rape kits and with victims of sexual assault. We conclude with larger takeaways from this collaboration for researchers and reporters but also provide a framework for how this type of collaboration can be leveraged to produce change for the greater good. [ABSTRACT FROM AUTHOR]

Little prior research has explored how prosecutors perceive and utilize biological and injury evidences in sexual assault cases. In this qualitative study, semistructured interviews were conducted with assistant district attorneys (ADAs) working in an urban district attorney's office in the northeastern United States. ADAs were asked to describe how biological and injury evidences could be probative and their strategies for using this evidence. The interviews suggest that prosecutors perceive the probative value of biological and injury evidences on a continuum, varying based on case characteristics. Prosecutors felt that undergoing a forensic medical examination in itself supported victims' credibility. Biological evidence bolstered victims' credibility if it matched the victim's account better than the defendant's. They perceived DNA evidence as helpful when it identified unknown suspects, confirmed identification of suspects by other means, or rebutted defendants' denial of sexual contact. DNA evidence was also helpful when victims were incapacitated, too traumatized to recall or talk about the assault, or too young to identify assailants, and when police used the information in interrogating suspects. The biggest limitation to biological evidence prosecutors cited was overcoming the consent defense. The ADAs reported they used DNA evidence even when it was not particularly probative, because it confirms the correct person is being prosecuted, it communicates the victim's and prosecution's seriousness, and it meets jury expectations in trials. Prosecutors found injury evidence useful because it corroborated victims' accounts and helped refute defendant claims of consensual sex. The findings may assist in educating others about biological and injury evidences in these cases, and could inspire professionals and advocates to work to develop and support a broad range of investigative methods. [ABSTRACT FROM AUTHOR]

Introduction: Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as "alleged." Methods: This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample. Results: Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault. Conclusion: Implications of this coding are discussed. [ABSTRACT FROM AUTHOR]

The article examines what nurses should know about caring for a patient who has been sexually assaulted and working with a sexual assault nurse examiner (SANE). Topics discussed include the sexual violence problem in the U.S., the possible collaboration of the nurse with the SANE to make sure that appropriate reporting is done, and questions that the SANE must ask to the patient.

Purpose: Sexual assault care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. Upon completion of SANE training, nurses can demonstrate their experience and expertise by obtaining SANE certification. Availability of nurses with SANE training or certification is often limited in rural areas, and no studies of rural certified SANEs exist. The purpose of this study is to describe rural SANE availability. Methods: We analyze both county‐level and hospital‐level data to comprehensively examine SANE availability. We first describe the geographic distribution of certified SANEs across rural and nonrural (ie, urban or suburban) Pennsylvania counties. We then analyze hospital‐level data from semistructured interviews with rural hospital emergency department administrators using qualitative content analysis. Findings: We identified 49 certified SANEs across Pennsylvania, with 24.5% (n = 12) located in 8 (16.7%) of Pennsylvania's 48 rural counties. The remaining 37 certified SANEs (75.5%) were located in 13 (68.4%) of Pennsylvania's 19 nonrural counties. Interview data were collected from 63.9% of all eligible rural Pennsylvania hospitals (n = 63) and show that 72.5% (n = 29) have SANEs. Of these, 20.7% (n = 6) have any certified SANE availability. A minority of hospitals (42.5%; n = 17) have continuous SANE coverage. Conclusions: Very few SANEs in rural Pennsylvania have certification, suggesting barriers to certification may exist for rural SANEs. Though a majority of hospitals have SANEs, availability of SANEs was limited by inconsistent coverage. A lack of certified SANEs and inconsistent SANE coverage may place rural sexual assault victims at risk of receiving lower quality sexual assault care. [ABSTRACT FROM AUTHOR]