À la suite du dévoilement d’une agression sexuelle, l’examen médical est l’une des étapes importantes qui sont recommandées pour les enfants victimes, mais seulement certains d’entre eux le complètent. L’objectif de la présente étude est de vérifier si les enfants qui font l’examen anogénital à la suite du dévoilement d’agression sexuelle sont différents de ceux qui n’en font pas ainsi que de documenter les variables, notamment les caractéristiques de l’enfant, de la famille, de l’agresseur et de l’agression, qui pourraient prédire le fait de compléter cet examen. L’échantillon est composé de 211 enfants âgés de 6 à 13 ans recevant des services au Centre d’expertise Marie-Vincent. Une régression logistique binaire révèle que l’absence d’emploi de la mère (RC = 6,15), être victime d’une agression sexuelle très sévère (RC = 6,02), être victime d’un agresseur adulte (RC = 3,43) et provenir d’une famille monoparentale (RC = 2,89) contribuent à prédire si l’examen anogénital est réalisé ou pas à la suite du dévoilement. Les résultats confirment que les enfants complètent l’examen surtout afin de trouver des éléments de preuves et que parmi ceux qui pourraient en bénéficier pour leur bien-être, plusieurs ne sont pas rencontrés. / Following the disclosure of sexual assault, the medical examination is one of the most important steps recommended for child victims, but only some of them undergo the examination. The objective of this study was to determine whether children who undergo an anogenital examination following a disclosure of sexual assault are different than those who do not, as well as to document the variables, particularly, the characteristics of the child, the family, the aggressor and the assault, that could predict whether or not an anogenital examination is conducted. The study group was composed of 211 children within between the ages of 6 to 13 years old receiving services at the Centre d’expertise Marie-Vincent. A binary logistic regression reveals that when the mother is unemployed (RC = 6.15), being a victim of a very violent sexual assault (RC = 6.02), being a victim of an adult aggressor (RC = 3.43) and coming from a single-parent family (RC = 2.89) contribute to predicting if the anogenital exam is given or not following the disclosure. Results confirm that the primary goal of the anogenital examination is to find elements of proof and that many children who could benefit from this test for their wellbeing are not being examined.

Made available in DSpace on 2017-07-10T17:11:48Z (GMT). No. of bitstreams: 1 Dissertacao Jefferson Tales Oliva 2.pdf: 8591439 bytes, checksum: 6970719a05f60fc1f4fccba9893f38d5 (MD5) Previous issue date: 2014-04-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In the health area, large amounts of data from different sources, such as clinical examinations and procedures, are stored in hospitals and medical clinics databases. Characteristics observed in these examinations and procedures are described in textual medical reports. These findings are indispensable for professionals of any medical specialty, as they are used to maintain the clinical history of the patients. The data contained in these reports can be analyzed, in a more complete manner, through the use of computational resources, such as the Data Mining process supported by computational intelligence techniques. However, for the application of such process, it is essential that the data is represented in a structured format, as Computational Data Bases. In this sense, the Laboratory of Bioinformatics from the West Paraná State University in partnership with the Coloproctology Service of the Faculty of Medical Sciences from the State University of Campinas, developed the Mapping Medical Digital Findings Process (PMLM) using ontologies with the aim of providing support for the transformation of unstructured textual medical reports into a structured representation. Nevertheless, the techniques employed in PMLM must be performed manually and separately by means of computer instructions, hampering its use by professionals who are not from the computational area. The objective of this work is to automate and optimize PMLM using ontologies by integrating its preprocessing methods in a computational tool. For this purpose, a Collaborative Computer System (SCC) was built using the prototyping development model, which is applied in five stages: communication, fast plan, modeling, prototype construction, and evaluation and feedback. The developed computational system was evaluated in conjunction with domain experts, confirming that SCC meets the required specifications and presents a great value for the extraction and the study of patterns that may be discovered in medical findings. SCC was also evaluated experimentally, using a set of 100 artificial medical reports that simulate the Upper Digestive Endoscopy (EDA), showing good results. Thus, the automated PMLM using ontologies, implemented in the SCC, enables the performance of more complete and detailed studies, contributing to the generation of new knowledge. / Na área da saúde, grandes quantidades de dados provenientes de diversas fontes, como exames clínicos e de procedimentos, são armazenadas em bases de dados de hospitais e clínicas médicas. As características observadas nesses exames são descritas em laudos médicos textuais. Esses laudos constituem ferramenta indispensável para profissionais de qualquer especialidade médica para a manutenção do histórico clínico de pacientes. Os dados contidos nesses laudos podem ser analisados, de modo mais completo, através de recursos computacionais, como o processo de Mineração de Dados apoiado por técnicas de Inteligência Computacional. No entanto, para a aplicação desse processo, é imprescindível que os dados estejam representados em formato estruturado, como as Bases de Dados Computacionais. Nesse sentido, no Laboratório de Bioinformática da Universidade Estadual do Paraná em parceria com o Serviço de Coloproctologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas foi desenvolvido o Processo de Mapeamento de Laudos Médicos (PMLM) por ontologias com o propósito de prover apoio para a transformação de laudos médicos textuais não estruturados em uma representação estruturada. Entretanto, as técnicas empregadas no PMLM devem ser executadas separadamente e manualmente por meio de instruções computacionais, dificultando o seu uso por profissionais que não sejam da área computacional. Assim, o objetivo deste trabalho consiste em automatizar e otimizar o PMLM por ontologias mediante a integração de suas técnicas de processamento de textos em uma ferramenta computacional. Para isso, foi construído um Sistema Computacional Colaborativo (SCC) utilizando o modelo de desenvolvimento por prototipagem, que é aplicado de cinco etapas: comunicação; plano rápido; modelagem; construção do protótipo; e avaliação e feedback. Esse sistema computacional foi avaliado em conjunto com especialistas do domínio, os quais constataram que o SCC atende às especificações determinadas e apresenta-se de grande valia para a extração e o estudo de padrões que podem ser encontrados em textos médicos. O SCC foi também submetido a uma avaliação experimental, por meio da aplicação do PMLM automatizado em um conjunto de 100 laudos médicos textuais artificiais que simulam descrições de exames de Endoscopia Digestiva Alta (EDA), apresentando bons resultados. Desse modo, com o PMLM por ontologias automatizado, implementado no SCC, é possível a realização de estudos mais completos e detalhados, contribuindo com a geração de novos conhecimentos.

À la suite du dévoilement d’une agression sexuelle, l’examen médical est l’une des étapes importantes qui sont recommandées pour les enfants victimes, mais seulement certains d’entre eux le complètent. L’objectif de la présente étude est de vérifier si les enfants qui font l’examen anogénital à la suite du dévoilement d’agression sexuelle sont différents de ceux qui n’en font pas ainsi que de documenter les variables, notamment les caractéristiques de l’enfant, de la famille, de l’agresseur et de l’agression, qui pourraient prédire le fait de compléter cet examen. L’échantillon est composé de 211 enfants âgés de 6 à 13 ans recevant des services au Centre d’expertise Marie-Vincent. Une régression logistique binaire révèle que l’absence d’emploi de la mère (RC = 6,15), être victime d’une agression sexuelle très sévère (RC = 6,02), être victime d’un agresseur adulte (RC = 3,43) et provenir d’une famille monoparentale (RC = 2,89) contribuent à prédire si l’examen anogénital est réalisé ou pas à la suite du dévoilement. Les résultats confirment que les enfants complètent l’examen surtout afin de trouver des éléments de preuves et que parmi ceux qui pourraient en bénéficier pour leur bien-être, plusieurs ne sont pas rencontrés. / Following the disclosure of sexual assault, the medical examination is one of the most important steps recommended for child victims, but only some of them undergo the examination. The objective of this study was to determine whether children who undergo an anogenital examination following a disclosure of sexual assault are different than those who do not, as well as to document the variables, particularly, the characteristics of the child, the family, the aggressor and the assault, that could predict whether or not an anogenital examination is conducted. The study group was composed of 211 children within between the ages of 6 to 13 years old receiving services at the Centre d’expertise Marie-Vincent. A binary logistic regression reveals that when the mother is unemployed (RC = 6.15), being a victim of a very violent sexual assault (RC = 6.02), being a victim of an adult aggressor (RC = 3.43) and coming from a single-parent family (RC = 2.89) contribute to predicting if the anogenital exam is given or not following the disclosure. Results confirm that the primary goal of the anogenital examination is to find elements of proof and that many children who could benefit from this test for their wellbeing are not being examined.