Bora Büken

Comparison of the three age estimation methods: Which is more reliable for Turkish children?

BACKGROUND Three atlases-the GOK, the Greulich-Pyle (GP), and the Tanner-Whitehouse (TW3)-are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents. MATERIALS AND METHODS The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (+/- standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test. RESULTS For girls, the most accurate method was the TW3 (mean differences (d): -0.21 (p<0.05)), following by the GP (d: 0.66 (p<0.001), and the GOK (d: 2.99 (p<0.001)). For boys, the most accurate method was the GP (d: -0.02 (p>0.05)), followed by the TW3 (d: -0.18 (p<0.05)) and GOK (d: 1.05 (p<0.001)). DISCUSSION AND CONCLUSIONS Results show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GOK atlas for estimating the BA. GOK could be used for boys aged 11-14 years but it should not be used for girls.

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.

Analysis of tractor-related deaths

ABSTRACT The aim of the study was to evaluate the properties of tractor-related death cases and discuss the precautions in order to prevent such events. For this aim, reports made between 2006 and 2009 by the First Specialty Board of Council of Forensic Medicine (FSBCFM), Turkey, were evaluated retrospectively. Forty-one tractor-related death cases were included in this study. Thirty-five (85.4%) of the cases were male. The mean age was 42.52 ± 25.1 (with a range between 1 and 84 years old). The average time interval between the incident and death was 13.76 ± 33.53 days (range: 0–176 days) and 20 (48.8%) cases died on the incident spot or during transportation to the hospital. Among the cases, 34.1% (n = 14) were drivers, whereas 39.0% (n = 16) were passengers and the remaining were pedestrians (26.9%, n = 11). The accident was caused by the tractor rolling over in 34.1%, the victim being run over in 22.0%, and the victim falling from the tractor or trailer in 22.0% of the cases. Most of the events (56.1%) occurred on the road. In conclusion, tractors must not be used as a transportation vehicle for passengers. Periodic training of drivers can be useful for reducing tractor-related accidents.

Çığlık (Çocuk İstismarı Araştırmalarından Elde Edilen Verilerin Bildirimi Zorunlu mu, Neden?)

ÖZET Türk Ceza Kanunu’na göre; sağlık mesleği mensupları görevlerini yaptıkları sırada suç belirtisi ile karşılaştıklarında durumu adli makamlara bildirmek zorundadırlar. Çocuk istismarı araştırmaları, suç niteliğinde bir eylemi konu alır. Klinik ortamda yapılan araştırmalarda, istismar bulgusuna rastlanmışsa bildirimin zorunlu olduğuna şüphe yoktur. Ancak, anketlerde de bildirim gerekli midir? Çocukların kendi kendine cevapladığı anketlerin çocuk istismarı araştırmalarında, en geçerli/güvenilir yöntemlerden biri olduğu bildirilmektedir. Anketlerde, kimliğin gizleneceği garantisi verilmesi katılımı ve yanıtlanma oranını arttırmaktadır. Bu çalışmada amaç, yoğun cinsel istismara maruz kaldığını bildirerek yardım talep eden olgu özelinde; “çocuk istismarı anketlerinde suç ile ilişkilendirilebilecek veriler elde edilmişse bunların bildirimi gerekli midir?” sorusuna yanıt aramaktır. “Bildirim denek hakları açısından sorun teşkil eder mi? ‘Sır saklama prensibi’nin ihlali midir, bildirimin sınırları ne olmalıdır? Bilgilendirme nasıl yapılmalıdır? Rıza alırken çocuklara kimliklerini açıklamamaları söylenmeli, kimliklerinin açıklanmayacağı garantisi verilmeli midir? Bu garantinin sınırları ne olmalıdır? Bildirim, araştırmanın geçerliliğini, güvenirliliğini etkiler mi?” sorularına yanıt aranmaktadır.

Konya’da Çocukluk Çağında Meydana Gelen Ateşli Silah Yaralanmasına Bağlı Ölümler

Sonuc olarak, kullan›m› giderek artan ateflli silahlar›n evler- de bulundurulmas› nedeniyle, bu silahlar›n cocukluk ca¤› olumlerine yol acabildii gorulmektedir. Halk›m›z›n; bulundu- ¤u ortamda cocuklar›n ateflli silahlara kolayca ulaflabilmeleri halinde, intihar veya kaza orijinli yaralanma ve olum olaylar›- n›n meydana gelebilecei, bu nedenle ev gibi yaflam alanlar›nda mumkun olduunca ateflli silah bulundurulmamas›, mutlaka bulunmas› gerekiyorsa cocuklar›n ulaflamayaca¤›, yuksek ko- numlarda veya salam kilit alt›na al›nm›fl alanlarda emniyetinin salanmas› gerektii konusunda eitilmesinin gerekli ve faydal› olduunu duflunuyoruz. Anahtar kelimeler: Cocuk, ateflli silah, olum, adli t›p SUMMARY In this study, it was aimed to examine the deaths related to the firearm injuries during childhood in Konya and the infor- mation such as demographic aspects of the cases, the types of the firearms, origin, and the region of injury, place of case, pla- ce of death, shooting distance, and the owner of the firearm. With this purpose, the cases which were autopsied by Kon- ya Branch of Forensic Medicine Council and by forensic medi- cine expert in the districts of Konya between 1999 and 2007 were retrospectively examined. Among 985 death cases at the age of 18 and under; 50 (5.1%) were determined to occur as