Background:In order to diagnose child abuse, physicians need to consider the possibility of abuse in every child they encounter, have sufficient information about the topic and manage the cases according to current law.Aims:To determine the knowledge level of physicians on child abuse and to learn their opinions about the procedures when they suspect child abuse.Study Design:A questionnaire (cross-sectional) study.Methods:A detailed questionnaire was applied to 390 physicians of whom 233 were general practitioners. The first part of the questionnaire included demographic variables (age, gender, occupational experience) and the frequency of child physical abuse cases encountered, since that is the most easily diagnosed and proven form of abuse. The second part consisted of 32 questions about diagnosis of physical child abuse and procedures during the follow-up of the cases. Statistical analyses were performed using SPSS version 18.0.Results:Of the participating physicians, 47.4% (n=185) were female and only 13.1% of the physicians had some kind of postgraduate training on child abuse. The correct response rate of specialists compared to general practitioners was significantly higher. A total of 263 (72.3%) physicians thought that there was a specific law on physical child abuse in the Turkish Republic. More than two-thirds of physicians thought that reporting should only be addressed to Social Services and physicians should not be obliged to report to law enforcement.Conclusion:The results of the present study adds to the already known necessity for better training of physicians about physical child abuse and the need to refresh their knowledge through postgraduate courses. According to current regulations, it is obligatory to report abuse cases to the public prosecutor and/or police, therefore physicians also need training in respect of the legal status and medico-legal approach to these cases.
Diathermy plays an integral part in most operations, either for dissection or coagulation, and it is used on a regular basis by surgeons of all specialties. Even though modern diathermy equipment is considered to be safe, accidents still do happen. These accidents particularly occur if the operation is performed in emergency situations in which the patient's clinical condition is urgently fatal and the members of the team could only focus to the surgical area. The false steps in monopolar diathermy application cause a situation called the diathermy burns. In this report we present the case of a man who had acute chest pain due to rupture of aortic aneurism. While he was being taken into operation, cardiopulmonary arrest developed. He was resuscitated intra operatively and the operation was completed. After this operation burns on the anterior surface of the right hand, elbow and the distal forearm were noticed. We wanted to emphasize that accidental diathermy burns can cause unsightly scarring that limits motion in affected joints or function of other tissues and review the literature to explain possible causes and dealing with this kind of situation in the medicolegal aspects.
Amaç: COVID-19 Pandemi döneminde ülkemizde alınan önlemler ve kısıtlamaların bir sonucu olarak Antalya Çocuk İzlem Merkezine müracaat ettirilen olgu sayılarındaki nicel azalmanın analizi ve etkilerine karşı öneriler geliştirilmesi amaçlanmıştır. Gereç ve Yöntem: Kesitsel çalışmaya 2019 Mart-Nisan ve 2020 Mart-Nisan aylarında cinsel istismar nedeni ile Antalya Çocuk İzlem Merkezine müracaat ettirilen toplam 309 olgu alınmıştır. Her iki grup sosyo-demografik parametreler ve merkezde yapılan değerlendirmeler açısından incelenmiş, istatistiksel analizler yapılmıştır. Bulgular: Antalya Çocuk İzlem Merkezinde 2019 yılı Mart-Nisan aylarında 211 (%68.3); 2020 yılı Mart-Nisan aylarında 98 (%31.7) olgu değerlendirlmiştir. Tüm olguların yaş aralığı 1-18 arasında değişmekte olup yaş ortalaması 12.95 ± 3.24’tür. Olguların 257’si (%83.2) kadındır. 225 (%72.8) olguda kesin cinsel istismar bulguları saptanmıştır. Bildiren kişilere ve oranlarına bakıldığında kontrol grubunda en sık öğretmenler (%39.3) ardından ebeveynler (%37.4) iken; çalışma grubunda en sık ebeveynler (%35.1) ardından öğretmenler (%30.9) olduğu saptanmıştır. Kontrol grubunda failin sevgili-arkadaş olma oranı %40.8 iken, çalışma grubunda (pandemi döneminde) bu oran %24.5’e düşmüştür. Sonuç: Pandemi döneminde çocuk cinsel istismarı risk faktörleri artarken aynı dönemde ihbar edilme oranlarının düştüğü saptanmıştır. Çalışmamızda öğretmenlerin istismarın ihbar edilmesindeki rolü ortaya konmuştur. Hukuk ve tıp profesyonellerinde multidisipliner yaklaşım açısından bu dönemde anlamlı bir fark saptanmamıştır.
In this study; a case about three brothers exposed to long-lasting severe neglect and abuse up to cachexia and severe depression will be presented and discussed in the light of the literature data. It was learned from the statements of the suspect, mother and child victims that father worked at night shift, that a distant relative who began to live at their home to help with the expenses of the house for the last three years, had sexual and emotional relationship with the mother during the day, that although this person act well in the beginning but in time he left the three children hungry for several days in order to punish, hang them to the ceiling from their hands and feet, used physical violence like punch, beatings, extinguished illuminated cigarettes in their bodies, made skin burns by using a lighter and that father and mother turned a blind eye even knowing all that for a long time. It was reported that one day a second suspect who was brought by this suspect and stayed at home with them for two months, took the children into the bathroom with the purpose to wash them and that he applied anal sexual abuse to the younger child at the age of three years. In the examination it was determined that the four years old youngest brother was highly cachectic, unable to stand, unable to sit, lied constantly, had difficulties in talking, had decreased skin turgor and tone, was cachectic, had bruises, burns, scars in different parts of the body at different ages and an old fracture in the mandible was seen in the radiography. The 9-year-old middle brother testified likewise and strained and swollen appearance of abdomen, growth retardation, extensive bruising also on both cheeks and at the rear of the right thigh were determined in the examination. Ecchymosis and hematoma in both cheeks and left auricula was detected on the 11-year-old oldest brother. After a detailed evaluation it was found that the child was admitted to the hospital due to a fall, four years ago, due to activity and attention disorders six and four months ago. It is remarkable that child abuse and neglect incident was not detected in the examinations done at the hospital before.
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