Mental Findings in Trauma Victims.

INTRODUCTION: In medico-legal evaluation of trauma patients, the bio-psychological effects of the trauma and the severity of the injuries require to be evaluated. In this study, assuming the fact that psychiatric assessment is not taken into consideration in physical trauma cases, we planned to show the presence of psychological trauma in our medico-legally evaluated patients who presented with different types of traumas and to review the mental findings and diagnoses in trauma victims. METHOD: We retrospectively analyzed the hospital records of 1975 patients aged 18 years or older who presented to the Department of Forensic Medicine at Dokuz Eylül University School of Medicine for medico-legal evaluation between 1999 and 2009. Psychiatric assessment was performed in 142 patients by the Department of Psychiatry. The data contained in medico-legal reports and patient records were then examined with respect to patients' age, gender, nature of traumatic events, psychiatric diagnoses, descriptive characteristics of the patients, severity of trauma and past history of mental disorder and trauma experience. Results of the medicolegal evaluations were also analyzed. RESULT: Of the 142 patients, 80 (56.3%) were female and their average age was 40.30±17.17 years. The most frequent traumatic events were traffic accidents (29.6%) and violence-related blunt force trauma (28.9%). When the distribution of the most common psychiatric diagnoses was examined, it was found that anxiety disorders were found in 69 cases (48.6%), adjustment disorders were found in 16 cases (11.3%) and mood disorders were found in 12 cases (8.5%). Among anxiety disorders, acute stress disorder (n=39) and post-traumatic stress disorder (PTSD) (n=27) were the most common ones. In 27 cases of the 142, it was determined that, psychiatric symptoms and findings did not meet the diagnostic criteria of any psychiatric disorder. Diagnosis of psychiatric disorder was not significantly related with traumatic experiences, comorbidity, marriage status, education level or lack of health insurance. CONCLUSION: We assume elucidating the presence of a psychological trauma is crucial not only for the health benefit but also for legal rights of the patient. The necessity of considering merely the international diagnostic criteria in determining the existence of psychiatric trauma and its severity level can bring forth some difficulties in medico-legal evaluation.

Domestic violence on pregnant women in Turkey.

OBJECTIVE: Domestic violence is accepted worldwide as an important health problem. Besides diagnosis and treatment process, there are difficulties when considering of medico-legal evaluation of pregnant women subjected to domestic violence. As a signatory of the ''Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)'' Turkey has certain commitments regarding domestic violence and made regulations on national law. The purpose of the present study is to demonstrate the prevalence of domestic violence during pregnancy among the women who applied to obstetrics clinics and evaluating of the participants' knowledge level about the legal legislation concerning domestic violence. FINDINGS: Pregnant women attending for antenatal care to department of Gynecology and Obstetrics were interviewed using an anonymous and confidential questionnaire. The questionnaire used was a version of Abuse Assessment Screen with guidance of references. 28 (13.4%) women stated that they had been subjected to violence before pregnancy. Only 10 (4.67%) women had stated experience of violence during pregnancy. 148 (69.2%) of them had stated that they had no knowledge about any legislation concerning domestic violence in our country. CONCLUSION: We believe that society awareness should be increased and the health workers should be informed about their ethical and legal responsibilities concerning domestic violence during pregnancy. The knowledge and sensitivity of health care personnel in Prenatal Clinics and Family Planning Services should be increased and examination protocols should be provided about domestic violence against pregnant women.

Health profiles of methyl bromide applicators in greenhouses in Turkey

<p><b>INTRODUCTION</b>Methyl bromide is a toxic substance that has hazardous effects on human health with acute and chronic exposure. Our previous study showed that methyl bromide applicators frequently use large amounts of methyl bromide haphazardly in greenhouses in the prefectures of Narlidere and Balcova in the Aegean city of Izmir. This study aims to evaluate the health conditions of these workers.</p><p><b>MATERIALS AND METHODS</b>Our previous study showed that there are 38 methyl bromide applicators in our study area. After the informed consent of methyl bromide applicators was obtained, a questionnaire was used for a survey of demography and symptoms. Each subject was examined before and after application of the compound. Blood and urine samples were collected and stored. Blood samples were analysed for methyl bromide and bromide ion, kidney and liver function tests and lipid profile.</p><p><b>RESULTS</b>The age range of subjects was 19 to 53 years (mean age: 41 +/- 8.57). This study showed that methyl bromide applicators use large amounts of methyl bromide disregarding legal regulations and that some of them had nonspecific complaints. Subjects had been working as methyl bromide applicators for approximately 9.7 +/- 4.15 years. A total of 69.7% of methyl bromide applicators reported that they did not use protective equipment while 33.3% of them had a history of acute methyl bromide intoxication. A statistically significant relationship was found between the usage of protective equipment and the level of blood bromide ion in the blood (P <0.05).</p><p><b>CONCLUSION</b>Usage of methyl bromide, training, screening and follow-up of applicators must be rigorously controlled in accordance with national legal arrangements and international protocols. Greater efforts are required in the implementation of controls to achieve the targets set by the legal regulations and to ensure continual improvement in the limitation of the risks of this environmental hazard.</p>

The approach taken by the physicians working at educational hospitals in Izmir towards patient rights.

OBJECTIVE: Considered as a reflection of human rights in our modern day, patient rights have been gaining increasing importance. This particular subject has been discussed from various perspectives in different countries and legal sanctions imposed. "Patient Rights Directives" in Turkey came into effect in 1988. The present study was carried out in order to determine how well the physicians working in Izmir, the third largest city of Turkey, are aware and informed of these directives. METHODS: Our study is an observational-cross sectional descriptive one. The research was conducted among the physicians working in nine training hospitals in Izmir province using a random sampling method. 1,500 questionnaires with 19 multiple-choice questions were distributed in the study. 567 of the forms were returned. Statistical assessment of the data obtained was carried out using the x(2) test on SPSS 10.0 Windows Program. RESULTS: Of the physicians participating in the study, 43% were female and 57% male. The average age was 32 +/- 7.76 years. 40% of the participating physicians were not aware of the legal arrangements (directive). 63% of the participants stated that they had not read any kind of legislation related to patients' rights. Only 34% of the participants knew that the legal sanctions were put into effect in the form of "directive." CONCLUSION: Legal arrangements related to patient rights in the world are being put into effect within the framework of human rights. Turkey is one of the first countries to have completed the legal procedures in this field. PRACTICE IMPLICATIONS: We believe it is necessary that this particular issue be included both in the training programs of the medical faculties and supported by all parts of the society including physicians if these legal procedures are to work effectively.

Pesticide use among greenhouse workers in Turkey.

Pesticides are chemicals use of which has increased worldwide since the Second World War in order to improve the quality and the quantity of agricultural products. Their harmful effects on the environment and the human health have also been seen as usage increases. Although there have been studies about the harmful effects of pesticides on human health in the developing countries, there is limited data about the use of pesticides in Turkey. The aim of our study was to obtain data about the use of pesticides in greenhouse in Turkey. About 131 greenhouse workers were interviewed with within the province of Izmir: 63.8% graduated from primary school; 49.2% were living in region where the greenhouses were located; 46.2% were working in their own greenhouses; 42.3% had health insurance; 86.9% used pesticides and 59.3% did not take protective cautions during use pesticide. The application technique, location, amount, time or any other required information of the pesticides used have not been recorded by the greenhouse workers.