The importance of length and area estimate for forensic medicine without using a measurement tool.

Background/aim: Accurately measuring and recording the length or area of lesions affects the judgement of the forensic report, surgical wound management and, in some countries, the billing of health care services. The aim of this study was to determine whether the length and area of lesions described by physicians by estimation are accurate. Materials and methods: This study was designed as a cross-sectional descriptive study and was conducted with 494 participants consisting of internists and physicians at Ondokuz Mayis University, Faculty of Medicine. The participants were asked to estimate the lengths or areas of 6 different shapes in the questionnaire form without using a measuring instrument. Results: Of the participants, 216 (43.7%) were interned physicians and 278 (56.3%) were physicians. Most 122 people (24.7%) answered the curved line shape with a length of 4 cm as "exact value". The average of the values given by the internists to each shape was higher than the average of the values given by the physicians to each shape and was found to be further away from the true value. It was determined that more than half of the participants gave values above the actual length and area values of the shapes. It was observed that the rate of correct estimation of line shapes was higher than the rate of correct estimation of area shapes both as exact values and with ±10% margin of error. For line shapes, it was observed that the number of those who gave exact values decreased as the line length increased. Conclusion: When preparing forensic reports, determining surgical wound management and billing, estimated data should not be used in lesion description. It would also be useful to develop tools that will enable physicians to make measurements in terms of easy use.

Sexual Abuse of Children in Turkey: Psychiatric Evaluation of 1785 Cases.

Introduction: This study aims to investigate the characteristic features of sexual abuse of children with a focus on psychiatric consequences and other associated elements. Methods: We evaluated 1785 child sexual abuse cases who were referred to the Ondokuz Mayis University Faculty of Medicine Forensic Medicine Department for examination and forensic reports during the 14-year period between 2006 - 2019. The study involved the examination of the patient files/records of victims of child sexual abuse. Results: The girls represented 81.8% of victims of sexual abuse, while all perpetrators were male. The mean ages at the time of abuse were 12.7±3.1 (2-17) years in girls and 10.7±3.2 (2-17) years in boys. In vast majority of the cases, perpetrators were found to be acquaintances of the victims (87.2%). 43% of child sexual abuse cases involved penetration. Psychological examination revealed that psychiatric pathology developed in 64.6% of the children who were exposed to sexual abuse. Being female, the presence of penetration and the presence of incest significantly increased the development of any psychiatric pathologies. Conclusion: Sexual abuse of children is a multidimensional public health problem. Additional education services to raise awareness of the children and their relatives, and the establishment of social and legal support schemes for victims and the families for sexual abuse and its consequences are deemed necessary.

Experiences of LGBTI+ individuals in accessing right to health; a survey study from Turkey.

Background: In Turkey, LGBTI+s is experiencing discrimination in all areas of their lives. Objectives: We aimed to determine the problems experienced by LGBTI+s living in Turkey in accessing their right to health. Methods: An online questionnaire containing 37 open-ended and multiple-choice questions about respondent's demographic characteristics, experiences in accessing and receiving health services was prepared. Between October 2018 and December 2019, the survey was disseminated via social media platforms and sent to LGBTI+ friendly institutions. 81 people responded to the survey. Results: 43.2% had at least one chronic disease. Participants stated that 44.5% of them go to a health institution <3 times in a year. 91.4% of the participants declared that they never or rarely said their sexual identity/orientation at the health institutions, and 39.2% of them encountered negative behaviour when they did. 98.8% of the participants said that they think physicians do not have enough information about LGBTI+s. Conclusions: The knowledge and attitude of healthcare professionals are one of the essential determinants of LGBTI+s' use of their right to health. Alienating and homophobic behaviors against LGBTI+s is the biggest problem for LGBTI+s to receive quality health care in Turkey.

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

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.

Child sexual abuse in Turkey: an analysis of 1002 cases.

This study investigated the characteristics of abuse suffered by children, the dimensions of the psychiatric effects associated with abuse, and the factors affecting these. One thousand two cases aged under 18, exposed to sexual abuse, and referred over a 7-year period were assessed. Girls represented 80.8% of cases, and the numbers rose with age. The aggressors were all male, and 88.2% were known to their victim. Approximately half the children were exposed to sexual abuse involving penetration. Psychological pathology was identified in 62.1%. Female gender, the presence of penetration, physical violence, and incest significantly increased the development of psychological pathology. Levels of awareness in people close to and trusted by the child must be raised to minimize the adverse effects of trauma in the long term, preventive measures must be taken, and medical and social support units from which victims can receive assistance need to be established.

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.

[Mistakes and omissions in judicial reports prepared in emergency services]. / Acil serviste düzenlenen adli raporlardaki hata ve eksiklikler.

BACKGROUND: We aimed in this study to determine any mistakes or omissions made while preparing judicial reports, which contribute to the judicial process. METHODS: In this study, we evaluated as samples 351 judicial reports of victims who applied to the Emergency Service of Ondokuz Mayis University between January 1, 2005 and December 31, 2005 with respect to the judicial facts, and we recorded any mistakes or omissions of data in these reports. RESULTS: We determined that there was no record of age in 6% of the judicial reports, of examination time in 71.8%, of traumatic lesion or not in 30.5%, of the state of consciousness in 58.7%, and of the presence or not of life-threatening risks in 2.6%. The name of the physician who prepared the report was not provided in 8.0% of the reports. The most important omission is that none of the reports had the name, surname or signature of the person who had taken the prepared report. CONCLUSION: We concluded that, after graduation, it is necessary for physicians, who are responsible for both treating the patients and writing judicial reports, to attend in-service training programs. They must also be properly advised regarding their responsibilities in judicial cases.

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.

Fatalities due to methyl alcohol intoxication in Turkey: an 8-year study.

The aim of this study is to examine methyl alcohol poisoning cases from the medico-legal point of view. The records of the Morgue Department of Council of the Forensic Medicine were reviewed retrospectively for all methyl alcohol poisonings for the period of 27.10.1992 and 30.05.2001. The victim's age, sex, death year, death place, methyl alcohol blood levels, the source of methyl alcohol, accompanying laboratory results and histopathologic tissue changes were recorded. The number of deaths due to the methyl alcohol poisoning was 271 during that period of time. Two hundred and forty-two of the (89.3%) total 271 methyl alcohol fatalities were men and 29 (10.7%) of were women. The largest age group was 36-40 years old, followed by 41-45. The methyl alcohol blood concentrations ranged widely from 50 to 755 mg for per 100 ml. There were 222 cases (81.9%) with the methyl alcohol blood concentrations over 100 mg/dl. Twenty-nine (10.7%) victims were poisoned through the consumption of cologne and three of them with alcoholic beverage named "Raki". Consumed products were not known in all other cases because of insufficient patient history and data. As a conclusion, regarding the distribution according to years, mortality due to methyl alcohol intoxication in our country have been proceeding on a certain level. In order to decrease the mortality due to methyl alcohol intoxication, some precautions should be developed that could prevent the production and consumption of alcoholic beverages illegally produced.