Posttraumatic Stress and Burnout Symptoms in Forensic Doctors and Staff in a Mortuary.

We aimed to investigate burnout and posttraumatic stress symptoms in mortuary staff members who work for the Council of Forensic Medicine where more than 4500 autopsies are annually performed.The data were collected from 142 mortuary staff members from the Council of Forensic Medicine, Turkey. The participants were divided into the following 4 groups: forensic medicine specialists (n = 40, 28.2%), forensic medicine residents (n = 54, 38.0%), autopsy technicians (n = 24, 16.9%), and other staff members (n = 24, 16.9%). All of the participants completed a brief sociodemographic form and standardized questionnaires to assess health symptoms, such as the Maslach Burnout Inventory and Posttraumatic Symptom Screening Scale.Forensic medicine staff members are at risk for developing psychological health symptoms, such as burnout or posttraumatic stress, due to work-related stressors. We observed that autopsy technicians seemed to have more emotional exhaustion and posttraumatic stress disorder symptoms, whereas resident doctors had a lower sense of personal accomplishment.

Head Trauma-Related Deaths Among Preschool Children in Istanbul, Turkey.

OBJECTIVE: Head trauma takes place among the leading causes of mortality in children. This study aimed to determine the risk factors of head trauma-related deaths among children younger than 5 years in Istanbul, Turkey. MATERIAL AND METHODS: This study was conducted using the records of the Morgue Department of the Council of Forensic Medicine in Istanbul. The records of cases autopsied between 2008 and 2012 were retrospectively investigated. Of all preschool children deaths, 203 head trauma-related deaths were included in the study. RESULTS: Of all, 117 (57.6%) were males and 86 (42.4%) were females. Most cases (107, 52.70%) were between the ages of 12 and 36 months. The most common mechanism of injury was "fall from a height" with 97 cases (47.78%), followed by "traffic accidents" (67, 33%) and "hit by falling objects" (19, 9.35%). Skull fracture was detected in 176 cases (86.69%), of which 81 (46.02%) were characterized with linear fracture. Furthermore, skull fracture was accompanied by 1 or more skeletal bone fracture in 64 cases. Retinal hemorrhage was investigated in 5 cases of suspected physical abuse and only 2 of them showed retinal hemorrhage findings. CONCLUSIONS: Obtained findings revealed that fall from a height was the leading cause of death among unnatural deaths in children younger than 5 years. Domestic accident was found to be a significant risk factor in childhood deaths. Traffic fatalities were among leading causes of death in childhood in our country, likewise in all around the world. Children were found to be more vulnerable to traumas when they start to move around with incomplete motor skills. Therefore, education of parents in terms of child supervision and installing safety precautions toward preschool children will be helpful in preventing such injuries. On the contrary to some findings in the literature, more severe lesions were also prominent even in case of short-range falls from a height.

Facial emotion recognition in male antisocial personality disorders with or without adult attention deficit hyperactivity disorder.

OBJECTIVE: We aimed to investigate facial emotion recognition abilities in violent individuals with antisocial personality disorder who have comorbid attention deficient hyperactivity disorder (ADHD) or not. METHOD: The photos of happy, surprised, fearful, sad, angry, disgust, and neutral facial expressions and Wender Utah Rating Scale have been performed in all groups. RESULTS: The mean ages were as follows: in antisocial personality disorder with ADHD 22.0 ± 1.59, in pure antisocial individuals 21.90 ± 1.80 and in controls 22.97 ± 2.85 (p>0.05). The mean score in Wender Utah Rating Scale was significantly different between groups (p<0.001). The mean accurate responses to each facial emotion between groups were insignificant (p>0.05) excluding disgust faces which was significantly impaired in ASPD+ADHD and pure ASPD groups. Antisocial individuals with attention deficient and hyperactivity had spent significantly more time to each facial emotion than healthy controls (p<0.05) while pure antisocial individual had more time to recognize disgust and neutral faces than healthy controls (p<0.05). CONCLUSION: Study of complex social cognitive abilities in adults with ADHD and violent behaviors is lacking. This study is the first, investigating the differences according to social cognition cues in violent individual that revealed no significance within pure antisocial individuals and antisocial individuals with ADHD.

Carbon monoxide-related deaths in Ankara between 2001 and 2011.

OBJECTIVE: The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey. METHODS: Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10,720 medico-legal autopsy reports were obtained and reviewed by the authors. RESULTS: Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100,000), followed by Karabuk (8.3/100,000), Cankiri (7.8/100,000) and Kirsehir (5.0/100,000). DISCUSSION AND CONCLUSION: These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Attitudes among medical and nonmedical university students toward the survivors of childhood abuse.

OBJECTIVE: Childhood sexual abuse (CSA) is increasing, and current studies should address issues such as stigmas and casual attitudes that may be amenable to intervention. Thus, we aimed to investigate the effects of education on the attitudes of medical students toward CSA survivors. METHOD: We divided medical students into 2 groups: preclinical and clinical medical students. We compare the attitudes of nonmedical students with the attitudes of medical students with respect to survivors of CSA. All participants were asked to complete a questionnaire about stigmatization. RESULTS: There were 572 students in our study, 347 of whom were enrolled in medical school. Of the 347 medical students, 151 were from the preclinical group, and 196 were from the clinical practice group. The remainder of the participants (n = 225) were in other fields of university. Of the medical students, 68.3% responded negatively about "asking a survivor of abuse to supervise their child for a few hours," whereas 62.7% of the nonmedical students responded negatively. When asked, "What would you think if your child wanted to marry a survivor of sexual abuse?", 72.9% of the medical students and 59.1% of the nonmedical students displayed negative attitudes toward that idea. Our research also found that significantly more preclinical students than clinical students would not want to be in a companionship/friendship with a CSA survivor at work (P = .015) or in their neighborhoods (P = .034). CONCLUSION: Both medical and nonmedical students seem to have negative thoughts about sexual abuse survivors, particularly when the issue involves their own children and/or social situations. Thus, the medical professionals must be careful and should avoid over interpretations of findings on childhood abuse studies that may lead to stigmatization.

Burn and vital risk criteria in industrial accidents (as forensic medicine approach).

BACKGROUND: Burn traumas resulting from industrial accidents may generate a death risk. In such cases a forensic report should be filled up. In forensic findings, the death risk which is associated with the degree of trauma, of the victim is as important as the treatment of the subject. The aim of our research was to investigate what degree of burns causes fatality and which type of industrial accidents cause them. METHODS: This research was done between the dates October 2004 and December 2006 with the descriptive epidemiology method by the evaluation of all data entered emergency surgical room- burn unit. The results of the study were analyzed with respect to its socio-demographic characteristics clinical findings of the type of burn and the type of the event which caused the burn. Categorical variables were assessed using Chi-square test, continuous variables were tested by Pearson's correlation. RESULTS: For the total 128 incidents, 69.5% (n=89) were males and 30.5% (n=39) females. 28.9% (n=37) of the incidents were industrial accidents. 48.6% (n=18) of the burns were caused by boiling water, 32.4% (n=12) due to contact by flame, 10.8% (n=4) electrocution and %8.2 (n=3) due to burns by contact with chemicals. The 19.50% (n=25) of the incidents had ended up by loss of life, 80.5% (n=103) were cured and discharged. The incidents which had resulted under 20%, the mortality rate was 1.3% (n=1), the incidents which had above 20%, the mortality rate was 49.0% (n=24) (p=0.0001). CONCLUSION: The degree of burn was found to be valuable in determining the death risk but the extent of the burned area was found to be more deterministic in assessing this particular risk.

Differences in Handwritings of Schizophrenia Patients and Examination of the Change after Treatment.

The aim of this study was to analyze the differences between the handwritings of schizophrenia patients and healthy subjects in addition to the changes that occurred in schizophrenia patients' handwriting in response to the treatment. The test subjects were 29 schizophrenia patients and 29 healthy individuals with the same age, gender, and dominant hand. The changes in the handwritings were examined according to 14 different parameters. On the day of admittance, the percentage of extra letters was 16.7%, and after 7-10 days of hospitalization, it rose to 33.3%. The percentage of skipped words decreased from 29.2% to 16.7% after 7-10 days of hospitalization, and to 10% after 3 weeks. The letters written by schizophrenia patients are significantly larger in height and width compared to the control group. The schizophrenia patients showed a higher incidence of crossed-out letters, adding extra words, missing punctuation as well as missing words.

Forensic and clinical carbon monoxide (CO) poisonings in Turkey: A detailed analysis.

Carbon monoxide (CO) is produced by incomplete combustion of organic compounds. Its intoxication usually results from inhalation of fumes from improper heating stoves, motor vehicles, or smoke from fires. It can reversibly bind various heme-containing proteins such as hemoglobin, myoglobin, cytochrome p450 and cytochrome oxidases. Among them, it has a high affinity for hemoglobin (230-270 times more avidly than oxygen) with which it forms carboxy-hemoglobin (HbCO) leading to decrease in oxygen-carrying capacity followed by end-organ hypoxia. A tissue hypoxia may then result in transient or permanent damage of important organs like central nervous system and even death. CO poisonings from different reasons are an important cause of morbidity and mortality in Turkey. The purpose of this study on CO poisonings in Turkey is to sum up and analyze the best available researches in both forensic and clinical toxicology fields. This was achieved by synthesizing the results of Turkish and English papers on forensic and clinical CO poisoning cases conducted in universities, institutes, hospitals and other official or private organizations in Turkey. Total of 47,523 medico-legal autopsy data collected from 9 different forensic medicine branches and emergency rooms in different year intervals were reviewed and 980 CO poisoning cases were determined. To calculate the frequency of CO poisoning within all the autopsies carried out and fatal poisoning cases, the number of cases was divided by the total number of medico-legal autopsies and total fatal poisoning cases. The mean age of cases, the source of CO gas, the most common seasons and months, gender, and blood HbCO levels were also taken into consideration if the data is available. Under the light of the findings, we may suggest that determination of affecting factors in CO poisoning is going to be one of the key subjects for planning preventive interventions.

Fatal ethyl and methyl alcohol-related poisoning in Ankara: A retrospective analysis of 10,720 cases between 2001 and 2011.

Methyl and ethyl alcohol poisoning are still responsible for high morbidity and mortality rates. The purpose of this retrospective study was to examine ethyl and methyl alcohol poisoning related deaths in Ankara and surrounding cities between 2001 and 2011 and compare them with previous studied conducted in Turkey and other countries. For this purpose, 10,720 medico-legal autopsy cases performed in Ankara Branch of the Council of Forensic Medicine were reviewed in terms of alcohol poisonings. The deaths due to methanol and ethanol poisoning were 74 (0.69% of all medico-legal autopsies performed) and the distribution among them was 35 (47.3%) for methanol poisoning and 39 (52.7%) for ethanol poisoning. Overwhelming majority of the cases were male (n = 67, 90.5%). The mean age of the victims was 44.9 ± 10.9 years and ranging from 21 to 92 years. The age group of 35-49 years was the mostly affected. Most of the cases were seen in 2004 (n = 12, 16.2%). The levels of postmortem blood alcohol levels were available for all cases and the mean alcohol levels were 322.8 ± 155.5 mg/dL ranging from 74 to 602 mg/dL for methanol and 396.8 ± 87.1 mg/dL and ranging from 136 to 608 mg/dL for ethanol. Early diagnosis is essential for successful treatment in methanol and ethanol poisoning. Besides increased awareness, more sensitive/specific diagnostic tools, and the prompt approach to the poisoned individual should be implemented in the hospitals.

Attitudes among judiciary and junior clerks toward the survivors of childhood sexual abuse.

Childhood sexual abuse is a growing concern throughout the world, although the legal sequelae of this phenomenon are frequently neglected. We aimed to reveal and compare the attitudes of judiciary and junior clerks toward sexually abused children that might contribute to these sequelae. We divided 302 study participants into two groups of judiciary members and junior clerks. All the participants were asked to anonymously complete a questionnaire about stigmatization, including questions assessing social distance, dangerousness and skillfulness. In their responses, 51.2% of the judiciary and 64.0% of the junior clerks displayed a negative attitude toward "asking a childhood sexual abuse (CSA) survivor to supervise their child for few hours" (p=0.029). When asked "What would you think if your child wanted to marry a CSA survivor?" 76.5% of the judiciary and 84.1% of the junior clerks were opposed to the idea (p=0.095). Interestingly, significantly more judiciary than junior clerks believed that a "CSA survivor can control his/her rage" (p=0.001), and significantly more of the junior clerks did not believe that "CSA survivors do not behave impulsively" (p=0.034). Both groups of legal professionals in this study appear to distance themselves from or have negative thoughts about CSA survivors, particularly when the issue involves their own children and/or social situations. Along with other factors, these negative assumptions might also contribute to lower prosecution rates and retestifying procedures.

The fatal poisoning pattern of Ankara (Turkey) and nearby cities from 2007 to June 2011: a retrospective study in forensic autopsies.

We aimed to obtain an outline of the nature and number of fatal poisonings which still appear to affect widely the population in Turkey. A total of 5921 forensic autopsies were performed between 2007 and 2011 in Ankara and nearby cities and 366 of them were fatal poisonings (219 male, 147 female). Most of the cases were between 41 and 60 years old (n = 84). Most of the fatalities were reported during winter months (48.1%). Carbon monoxide exposure was the most common reason (66.7%) within all the causes followed by medicine and narcotics (13.9%). Postmortem blood alcohol concentrations in ethyl and methyl alcohol poisonings were 385.1 ± 61.9 and 206.8 ± 138.9 mg/dL, respectively. The most common location of deaths was home (71.3%). Fatal poisonings have been a growing global problem because of some shortcomings about the socioeconomic conditions and increasing illicit drug abuse. The level of education, socioeconomic conditions, and legal approaches are very important for the prevention fatal poisonings.

Facial emotion recognition in patients with violent schizophrenia.

BACKGROUND: People with schizophrenia are more likely considered to be violent than the general population. Besides some well described symptoms, patients with schizophrenia have problems in recognizing basic facial emotions which could underlie the misinterpretation of others' intentions that could lead to violent behaviors. We aimed to investigate the facial emotion recognition ability in violent or non-violent patients with schizophrenia. METHODS: The severity in both groups was evaluated according to the Positive and Negative Syndrome Scale. A computer-based test included the photos of four male and four female models with happy, surprised, fearful, sad, angry, disgusted, and neutral facial expressions from Ekman & Friesen's series has been performed to groups. Totally, 41 outpatients with violent schizophrenia and 35 outpatients with non-violent schizophrenia participated in the study. RESULTS: The mean age of violent schizophrenia group was 41.50±7.56, and control group's mean age was 39.94±6.79years. There were no significant differences between groups among reaction time for each emotion while recognizing them (p>0.05). In addition, the accuracy rate of answers towards facial emotion recognition test for each emotion and the distribution misidentifications were not significantly different between groups (p>0.05). CONCLUSIONS: The facial emotion recognition in violent schizophrenia is lacking and we found that the facial emotion recognition ability in violent schizophrenia seems to be a trait feature of the illness.

The effect of caffeic acid phenethyl ester on short-term acute myocardial ischemia.

BACKGROUND: We previously showed that caffeic acid phenethyl ester (CAPE) attenuated NO production, reduced apoptosis, diminished serum CK and AST activities, and is cardio-protective in rat heart subjected to ischemia/reperfusion (I/R). We now studied the short-term cardio-protective effect of CAPE in an I/R rat heart model. MATERIAL/METHODS: Wistar rats were divided into four groups: (i) sham-operated, (ii) I/R, (iii) I/R+CAPE, and (iv) I/R+glutathione. CAPE (10 micromol/kg) was infused i.v. 10 min before occlusion of the left anterior descending coronary artery (8 min) followed by reperfusion (8 min). RESULTS: SOD (p < 0.010) and CAT (p < 0.014) activities were increased and GSH-Px (p < 0.019) activity decreased in the I/R group in cardiac tissues compared with the sham-operated group. There were no effects of CAPE on antioxidant enzyme activities after I/R. Glutathione administration led to decreased SOD activity (p < 0.024) and increased GSH-Px (p < 0.014) activity after I/R. The most prominent effects of CAPE were seen in XO and ADA activities, which were increased after I/R compared with the sham-operated group (p < 0.029 and p < 0.001, respectively). When CAPE was administered, XO and ADA activities were decreased compared with the I/R group (p < 0.045 and p < 0.001). ADA activity was also decreased in the I/R+glutathione group compared with the I/R group. No differences in basal heart rate or systolic or diastolic pressure were noted among the experimental groups. CONCLUSIONS: This study demonstrates that CAPE exerts cardio-protective effects in short-term I/R of rat heart. This protective effect may be mediated by a combination of decreased XO activity and direct antioxidant effects.