Erhan 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.

Emerging Health Sector Problems Affecting Patient Rights in Turkey

It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries’ development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to gain in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries.

Statutory Disclosure in Article 280 of the Turkish Penal Code

A new Turkish Penal Code came into effect on 1 June 2005. Article 280 concerns health care workers’ failure to report a crime. This article removes the responsibility from health care workers to maintain confidentiality, but also removes patients’ right to confidentiality. It provides for up to one year of imprisonment for a health care worker who, while on duty, finds an indication that a crime might have been committed by a patient and who does not inform the responsible authorities about it. This forces the health care worker to divulge the patient’s confidential information. A patient who thinks he or she may be accused of a crime may therefore not seek medical help, which is the universal right of every person. The article is therefore contrary to medical ethics, oaths taken by physicians and nurses, and the understanding of patient confidentiality.

Boşanma Davalarında Çocuğun Velayet Hakkı için Uygun Ebeveynin Belirlenmesi

Bosanma davalari ulkemizde her gecen yil artan siklikta gorulmektedir. Bu davalarda basvuran ciftlerin eger cocuklari varsa davalarda bir de cocugun velayetinin kime verileceginin belirlenmesi gerekmektedir. Bir cocugun gelisimini saglikli bir bicimde tamamlayabilmesi icin ebeveyn, ebeveynligin gereklerini yerine getirebilmelidir. Ebeveynin ebeveynlik becerilerini uzun donemde “yeterince iyi” sekilde yerine getirebilme duzeyi ebeveynlik kapasitesi olarak adlandirilir. Cocugun velayetinin hangi ebeveyne verileceginin belirlenmesinde goz onunde bulundurulmasi gereken onemli unsurlardan biri de ebeveynlerin ebeveynlik kapasitesinin degerlendirilmesidir. Degerlendirme icin hâkim bilirkisiye basvurabilir, burada bilirkisinin duzenleyecegi raporun amaci velayet kararini verirken hâkime yardimci olmaktir. Yapilan degerlendirme, velayetin kime verilmesi gerektigini belirtmekten cok ebeveynlerin var olan durumunu ortaya koyar. Cocugun korunmasi baglaminda yapilan ebeveynlik degerlendirmesi ebeveynlerin klinik degerlendirmelerinden veya ebeveynlik egitiminden farkli bir kavramdir cunku bu degerlendirme adli sureclerde kullanilacaktir. Literaturde ebeveynlik kapasitesi degerlendirmesinde profesyoneller tarafindan aktif olarak kullanilan cesitli degerlendirme araclari vardir. Bu araclar birbirlerinden kucuk farkliliklar gosterebilmektedir. Genellikle degerlendirmede hangi aracin kullanilacagi bilirkisinin insiyatifine birakilmistir ancak aracin uygulandigi toplumun yapisina uygunlugu gozetilmelidir. Makalemizde ebeveynlik kapasitesi degerlendirmesi icin kullanilabilecek objektif olcutlerin neler olabilecegi tartisilmaktadir. Degerlendirmede kullanilabilecegi savunulan iki (Parenting Skils Assessment-10; Parenting Competence 3) aracin ozellikleri irdelenmistir.

Examination of Forensic Cases That are Consulted to the Başkent University Ankara Hospital Because of Traffic Accident

Objective: In this study the judicial notification reports of patients, who were consulted to the Emergency Department of of Baskent University Ankara Hospital as a result of traffic accident happened in the year 2013 was examined in retrospective way and besides the age, gender the place of the accident, type of accident, accident time, injury type and location, the aim was also the evaluation of the deficiencies of the prepared reports.Materials and Methods: The sample of the study, which has definitive feature is comprised of 2397 judicial notification reports, which were prepared in 2013 at Baskent University Ankara Hospital Emergency Service. The study includes the evaluation of 553 (23.07%) of traffic accidents of these reports.Results: The 553 judicial notification reports that were in the study include 38.52% women, 47.92% men, 6.51 % girl and 7.05% boy. 536 case, age information of which were reached, comprises of individuals which are between the ages of <18 (13.97%), 18-40 (51.95%), 41-63 (24,58%), ≥ 64 (9,49%). The 67.81% of the accidents are inside the vehicle, 29.48% of them are out of vehicle traffic accidents. Out of 407 cases with lesion findings, 329 have single system injuries. Head-neck (n:123, 30.23%) and lower extremity injuries (n: 101, 24.82%) rank first and second place respectively.The data of high consultation demand in orthopedic and neurosurgery clinics because of this localizations was obtained. It is determined that only 1.88% (n:10) of the injuries of the applied patients because of traffic accidents have vital risk.Conclusion: The deficiencies in the judicial reports may lead to a loss of a right. The judicial reports should be prepared carefully after traffic accidents in order to prevent any injustice and to protect the citizen’s rights. Emergency service doctors should be trained for the approach to the forensic cases, they should work in coordination with forensic medicine departments by demanding consultation.Keywords: Traffic accident, Forensic case, Emergency service.

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.