Ahmet Turla

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Health professionals' attitude toward euthanasia: a cross-sectional study from Turkey.

There is an ongoing debate on the definition of euthanasia and attempts to change laws about euthanasia and its practice in many countries. It is the medical doctors and the other health professionals who will elucidate the issue. Therefore, we performed this study to reveal attitude of Turkish health professionals toward euthanasia. This is an observational and cross-sectional study and data were collected with a questionnaire. The questionnaire was distributed to 545 health professionals in Samsun, a city in the Black Sea Region in Turkey. Data were analyzed with SPSS package programs. Of all health professionals included in the study, 43.5% were medical doctors and 45.5% auxiliary health professionals. Of all participants, 33.6% did not object to euthanasia and 7.9% were asked to perform euthanasia. Eighty point seven percent of the participants noted that euthanasia could be abused even if a euthanasia law were passed. It can be concluded that the health professionals should have a chance to discuss euthanasia and that their attitude toward and their expectations and worries about euthanasia should be taken into account when a euthanasia law is drafted.

Prevalence of Childhood Physical Abuse in a Representative Sample of College Students in Samsun, Turkey

The main objective of this article is to obtain the prevalence of childhood physical abuse experiences in college students.This cross-sectional study was performed on a gender-stratified random sample of 988 participants studying at Ondokuz Mayis University, with self-reported anonymous questionnaires. It included questions on physical abuse in childhood, on whom and why the violence was inflicted, and on the reactions exhibited. Of the 988 participants, 527 (53.3%) had a history of childhood physical abuse (64.0% in men and 41.6% in women). The prevalence of being subject to physical violence was 1.5 times higher in men. Mothers more frequently inflicted violence on daughters and fathers on sons. According to participants, most frequent reasons for physical violence were “loss of perpetrator’s self-control” and “establishment of discipline at home.” The most frequent statement observed among the participants was humiliation after subjection to physical violence. It is concluded that the first (and the most) important preventive measure is to protect and strengthen the social, economic, and judicial status of the Turkish family. Second, it should by all means be prevented that violence remains legal in some social conditions like child abuse.

Depression and post-traumatic stress disorder in child victims of sexual abuse: perceived social support as a protection factor

Abstract Background Social support has been shown to play a protective role against the development of post-traumatic stress disorder (PTSD) and depression in individuals exposed to trauma. Aims The purpose of this study was to investigate the effect of perceived social support on depression and PTSD in child victims of sexual abuse and to determine the relationship between them. Method In total 182 victims of sexual abuse aged 6–18 at time of interview were assessed. Clinical interviews, the Children’s Depression Inventory (CDI) and the Child Posttraumatic Stress Reaction Index (CPTS-RI) were used to assess children’s psychological status, while the Perceived Social Support Scale-Revised (PSSS-R) was used to measure social support. Results Girls had significantly higher median CDI and CPTS-RI scores than boys, while no significant difference was determined between boys and girls in terms of PSSS-R scores. A statistically significant negative correlation was determined between CDI and PSSS-R scores, CPTS-RI scores and PSSS-R scores in girls, while no significant correlation was identified in male victims. Conclusions In conclusion, we think that social support networks for victims of sexual abuse need to be broadened and increased, and that importance should be attached to protective approaches in that context.

The Psychiatric Consequences of Child and Adolescent Sexual Abuse

INTRODUCTION The purpose of this study was to investigate the psychiatric consequences of sexual abuse and its associated factors in children and adolescents referred to our child and adolescent psychiatry clinic from official medico-legal units. METHODS All victims of sexual abuse (n=590) aged 1-18 (mean: 13.56±3.38) referred from forensic units to Ondokuz Mayis University Child and Adolescent Psychiatry Clinic over a period of 2 years [boys: 83 (14.1%); girls: 507 (85.9%)] were included. Child and adolescent psychiatry and forensic medicine specialists evaluated all the cases. The Wechsler Intelligence Scale for Children-Revised Form (WISC-R) and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T) were applied. RESULTS Abuse-related psychiatric diagnoses (of which 45.9% were major depressive disorder and 31.7% were post-traumatic stress disorder cases) were made in 75.2% of the cases. In 80.3% of the cases, the perpetrators were known to their victims [incest, n=91 (15.1%)], and intercourse took place in 48.8%. Although gender and age were not significantly associated with the appearance of any psychiatric disorders, severity of abuse (e.g., intercourse; p=.006), additional physical assault (p<.001), and incest (p<.001) had a significant correlation with psychiatric disorders. To explore the predictive value of multiple factors in the appearance of any sexual assault-related psychiatric disorder, a logistic regression model was used to determine the best linear combination of age, gender, abuse severity, incest, involvement of any other victim, additional physical assault, and length of time from first abuse to first psychiatric evaluation. This combination of variables (occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation) significantly predicted the appearance of a psychiatric disorder of any kind (χ2=55.42; df=7; n=522; p<.001). CONCLUSION Our findings reveal that the occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation predict higher rates of sexual abuse-related psychiatric disorders.

Samsun’da Yaşlılık Dönemi Düşmeler: 2010-2015

Objective: The purpose of this study is to evaluate cases over the age of 65 who are admitted for falling and to lead the way for the measures to be taken to minimize the harm.Materials and Methods: 489 patients at and over the age of 65 who were admitted to Ondokuz Mayis University Health Application and Research Center due to falling between the dates of 01.08.2010 and 31.07.2015 were included in the study.Forensic files and hospital automation system data of the cases were analyzed and their genders, ages, time of admission, type of fall, wound areas, fractured bones, presence of comorbid disease, the department in which they were treated and their treatment status were examined retrospectively. The data obtained from this cross- sectional study were assessed with SPSS 15.0 program.Results: 230 (47,0%) of the cases were men, while 259 (53,0%) were women. The cases were mostly admitted in July (12.3%), on Sundays (15.7%) and between 16.00 and 23.59 (46.6%). The most frequent place of fall was inside the house (43,3%). Internal organ injury was seen in 16,4% of the patients while bone fracture was seen in 53,2%. Most frequently fractured bone was the femur (41,5%).Conclusion: Injuries associated with falling due to the increase in old population creates an important social problem. Falling is not an inevitable result of old age. Preventing falls in old age will decrease the dependency about daily life activities, increase life quality and decrease health care costs.

Injuries and Deaths That Resulting From Bicycle and Motorcycle Accidents

SUMMARY Bu cal›flmada; bisiklet ve motosiklet kazas› sonucu yaralanan ve olen olgular›n, demografik ve klinik ozellikleri araflt›r›larak, kazalara bal› yaralanmalar›n nas›l olufltuunun ayd›nlat›lmas›, yaralanmalar›n ciddiyetinin azalt›lmas›na yonelik cozum one- rileri sunulmas› amaclanm›flt›r. Bisiklet ve motosiklet kazas› sonucu yaralanarak Ondokuz May›s Universitesi (OMU) T›p Fakultesi Hastanesinde ilk mu- dahalesi ve tedavisi yap›lan 256 olguya ait demografik ve klinik veriler incelenmifl, elde edilen veriler SPSS 10.0 paket program› ile deerlendirilmifltir. Hem bisiklet hem de motosiklet kazas› sonucu yaralananla- r›n counlukla (%89.1) erkek olduu, bisiklet kazalar›n›n en fazla 10-19 yafl grubunda, motosiklet kazalar›n›n ise 20-29 yafl grubunda goruldu¤u tespit edilmifltir. Bisiklet kazalar›n›n daha cok duflme, motosiklet kazalar›n›n ise carp›flma sonucu meyda- na geldii, her iki grupta da en s›k yuz bolgesinin yaraland›¤›, bunu bisiklet kazalar›nda ust ekstremitenin, motosiklet kazala- r›nda da bafl bolgesinin izledii saptanm›flt›r. Tum veriler dunyada ve ulkemizde motosiklet ve bisiklet kullan›m›n›n ve buna paralel olarak da bu araclarla meydana gelen kazalar›n h›zla artt›¤›n› gostermektedir. Bu sorunun daha buyuk boyutlara ulaflmamas› icin flimdiden daha ciddi onlemler

Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi’ne Başvuran Adli Nitelikteki Olguların Dağılımı 1994-2006

Although dentofacial injuries are rare in routine forensic practice, they are important in terms of medical and forensic consequences. In this descriptive study, we aim to determine the features of the forensic cases admitted to Ondokuz Mayis University (OMU) faculty of dentistry between January 1994 and February 2006 (sociodemographic features, type of the incident, location of the fracture, radiologic examination, clinical diagnosis, treatment, extra injuries, sequels, loss of teeth and surgical intervention) and compare the results with those of similar studies. The mean age of 53 patients included in the study is 32,8 + 16,08 (7-76). Forty-six patients are male (86,8%), 7 are female (13,2%). Of 53 patients who experienced dentofacial trauma, 11 are self employed (%20,8), 10 are students (18,9%), 8 are farmers (15,1%), 12 deal with various jobs (22,6%) and the occupation of 12 patients have not been reported (22,6%). Thirty-four them are hospitalized due to an attack (64,2%) and 11 of them are admitted due to traffic accident (20,8%). Panorex radiography is the most widely used procedure and was used in 48 cases (90,6%). In 51 of the cases (96,2%) fracture was detected in the facial bones and mandibles. Fracture was observed in 33 (97,1%) out of 34 Among patients hospitalized due to assault and in 10 (90,9%) out of 11 hospitalized due to traffic accident. When the cases were examined with respect to alveolar fracture and loss of teeth, alveolar fracture was observed in 13 of the cases (24,5%) and at least one tooth loss was observed in 23 of the cases (43,4%). Dentofacial trauma cases that have been handled by some departments of the medical faculties up to now are likely to be handled by the dentistry thanks to the increase in the number of the qualified surgeons and the staff. Hence it would be useful to arrange postgraduate courses about forensic odontology for the dentists in order to prevent mistakes in forensic evaluations and legal sanctions.Key words: Dentofacial injuries, forensic case, fracture