Amaç: Bu çalışmanın amacı, radyasyona maruz kalan sağlık çalışanları ile radyasyona maruz kalmayan idari görevde yer alan çalışanların kan karaciğer enzim ve protein seviyelerini karşılaştırmak ve radyasyonun karaciğer enzim seviyeleri üzerine olan etkisini ortaya koymaktır Gereç ve Yöntem: Bu çalışmanın verileri bir eğitim ve araştırma hastanesi çalışanlarının periyodik muayene sonuçlarının retrospektif olarak taranması sonucu elde edilmiştir. Radyoloji Kliniği’nde çalışan tüm personel ile idari görevde yer alan tüm personel araştırmanın popülasyonunu oluşturmaktadır. Gruplar arası karşılaştırmalar kategorik değişkenler için Ki-kare, korelasyon analizleri, iki ortalama arası farkın önemlilik testi ve Mann-Whitney U testi ile değerlendirilmesi yapılmıştır. İstatistiksel anlamlılık düzeyi p

Background This study aimed to determine the tendency of older adults to present to the emergency department with pain complaints during the COVID-19 pandemic compared to the prepandemic period. Methods A cross-sectional, retrospective study design was used. Data were collected from the electronic medical records of older people who presented to emergency departments with pain before (March 2019-March 2020) and during the COVID-19 pandemic (April 2020-July 2021). We identified 10 pain diagnosis groups using ICD-10 codes. Patient data were grouped and cleaned using SQL scripts on the Oracle database. Results It was determined that 13.3% of 405,404 older people had presented to the emergency department with pain between March 2019 and July 2021. There was a 14.2% decrease in such admissions during the pandemic period. In the study, an increase was observed in the rates of older adults presenting to the emergency department with myalgia and joint pain. In contrast, the rates of those presenting with low back and neck pain, headache, eye pain, dysuria, and acute pain decreased during the pandemic. In the regression analysis, predictors for older adults’ presentation to the emergency department with pain included age over 85 years (OR: 1.403), female gender (OR: 1.053), and myalgia (OR: 2.471). Conclusions During the COVID-19 pandemic, our study revealed fewer presentations to the emergency department for pain-related complaints. To prevent severe health problems from delayed care, we recommend expanding telemedicine, remote pain management, and home-based care. Further research is needed to examine the long-term effects of increased myalgia and joint pain.

The response phase is a phase of disaster management that begins when a disaster occurs. The experience of the First Responders who responded in the first days to the 2023 earthquake in Turkey, which killed more than fifty thousand people, is expected to inform and add value to the preparations for subsequent disasters. A qualitative approach was used; focus group interviews were conducted with 15 first responders (8 fire fighters and 7 medical personnel) that responded in the first moments of the devastating Kahramanmaraş and Hatay earthquakes. The interviews conducted in June 2023. A qualitative approach with the thematic analysis method was employed. Based on the analyses the research six main themes and 13 subthemes were identified. The identified themes were resources, needs, collaboration, innovation, disaster management and challenges. The participants emphasized the need for better communication tools, protective equipment, and technologies such as drones and advanced sensors to enhance disaster response efforts. The findings also highlight the critical role of collaboration between different organizations and the necessity for integrated disaster management practices and applications. The findings obtained from the views of experienced first responders will inspire national and international disaster crisis managers, policy makers and technology providers to develop more effective disaster response methods. Through technological solutions and better training, the safety and effectiveness of first responders can be significantly improved in future disaster scenarios. This study fills an important gap in the literature by investigating the innovation needs and challenges faced by first responders during the 2023 earthquakes in Türkiye. In this study, the gap analysis was determined through interviews conducted with teams that responded to the 2023 major Turkey earthquake in the initial hours following the disaster. These findings are of significant value in guiding the improvement of the approaches and development of technological products in the field of disaster management.

Background Participatory approaches in child maltreatment (CM) research increasingly focus on involving children, youth, and adults as co-researchers. However, little is known about their use in Europe. Objective To review the European literature on participatory approaches in CM research. Methods The study was undertaken by members of the Euro-CAN (COST Action 19,106) representing 35 countries in the European region. Focusing on the European research literature, we searched eight databases for studies investigating CM and using a participatory approach. The review followed scoping review guidelines and PRISMA-ScR, with thematic analysis for data synthesis. Results We identified 4927 potentially relevant articles, of which 307 were fully assessed for eligibility, and eight were ultimately included. The included studies addressed all types of CM; however, only two studies involved child and youth survivors of CM, while six involved children and youth from the community. Notably, no studies involving adult survivors were found. The findings indicate that children, youth, and adults can be involved in all stages of the research process, but the level of participation remains low. Eighteen different participatory methods were identified, and the ethical procedures and safeguarding of co-investigators varied significantly. Several barriers and challenges were identified, including issues related to adult gatekeeping behaviors, parental consent, confidentiality, and practical difficulties. Conclusions The involvement of children, youth, and adults as co-researchers in CM research across Europe remains limited, with considerable variation in methods and procedures. These findings inform an ongoing e-Delphi study aimed at building consensus recommendations for participatory CM research.

The concurrent challenges of the COVID-19 pandemic and a significant earthquake in Izmir on October 30, 2020, presented a unique scenario for disaster management and response. This study focuses on the impact of the earthquake, which resulted in 117 fatalities, including 1 due to drowning, and injured 1034 individuals, alongside widespread structural damage including to the Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital. The objective is to assess the activation and implementation of the hospital disaster plan amidst the ongoing pandemic. Through a retrospective evaluation of all actions undertaken as per the Hospital Disaster Emergency Plan within the Disaster Management cycle, this study examines the decision-making process for the hospital evacuation on October 30, 2020, the evacuation of COVID-19 patients, and the strategies employed to increase hospital capacity. Of 216 patients hospitalized at the time of the earthquake, 65 were transferred to other facilities under COVID-19 protocols. The prolonged nature of pandemics and the likelihood of secondary disasters underscore the importance of comprehensive risk assessments and dynamic disaster planning, considering simultaneous multiple hazards. This study suggests the inclusion of multi hazard scenarios and diverse evacuation methods by using types of ambulances, such as ground, helicopter, and boat.

Background The Emergency Medical Services (EMS) and emergency service sectors are constantly facing new and emerging threats. Looking back to the last couple of years, emergencies faced by Europe and third countries, such as forest fires, flooding, storms, earthquakes, and terrorist attacks, or attacks associated with chemical, biological, radiological, nuclear, and explosive materials, pose a real challenge for EMS and emergency practitioners. The aim of this study is to present the methods and steps of determining emergency medical services' gaps, challenges, and innovation needs, and to guide future projects in the idea of Pre-Commercial Procurement (PCP) as a method and practice. Methods This study was based on a mixed-method approach that combines both qualitative and quantitative research. The method mix included an in-depth literature review, detailed surveys, comprehensive workshops, and a collaborative elaboration of case studies with EMS practitioners and managers. Results The literature review undergone for Structuring the EMS Ecosystem and 11 subjects identified and “other” added for possible unclassified subjects. In total, 245 EMS practitioners completed the 57 survey questions. The survey participants were from 15 different countries. According to the findings from these surveys, EMTs across Europe do not demonstrate equal levels of disaster preparedness or access to innovative technologies, which, once implemented, would make their work more effective and save resources. The workshop and case study insights showed that sharing data between all components of the EMS ecosystem, which is essential during everyday work, especially to tackle Mass Casualty Incidents. Conclusion The iProcureSecurity CSA project laid a robust foundation for future advancements in EMS. By addressing the identified gaps and leveraging innovative solutions, the European EMS can become more resilient, efficient, and capable of meeting the challenges posed by both routine and large-scale emergency situations.

Purpose: In addition to its psychologically and socially negative effects on society, the COVID-19 pandemic has affected the sexual behavior of individuals. This study investigated the relationship between changes in sexual drive and well-being during the COVID-19 pandemic period. Materials and methods: The data of this cross-sectional study were collected using a web-based survey between 12 May and August 12, 2021, with the voluntary participation of 231 individuals. The survey form included questions on sociodemographic and health-related characteristics, employment status, sex life before and in the COVID-19 pandemic period and status of having a partner, and COVID-19 diagnostic status, in addition to the Short Warwick-Edinburgh Mental Well-Being Scale. Results: A reduction in sexual drive in the pandemic period was reported by 71 (30.7%) of the participants. The group whose sexual drive decreased had significant differences in terms of age, marital status, the status of having children, and Warwick-Edinburgh scale scores compared to the groups whose sexual drive increased or remained unchanged (respectively, p=0.009, p=0.039, p=0.041, and p

Culture significantly influences individuals' lives and shapes their behaviour in an ecological framework. In this chapter, we examine the issue of children's participation in research about child abuse and neglect (CAN) in the context of Turkey – a country that bridges the Asian and European continents. This study was based on a review examining studies on CAN in Turkey. Thus, the main goal was to find cultural explanations for the scarcity of participatory research with children in the field of child maltreatment. A review examining studies on CAN in Turkey found that no study included children victims of CAN or explored why children victims of CAN have not been participating in research. Therefore, we analysed ecological factors influencing the participation of children in CAN studies and interpreted the findings based on our observations as experts in this field. The analysis indicated that causes are not only due the characteristics of the caregivers and children but also result from the interaction of various environmental and systemic factors. Recommendations for politicians and researchers to increase children's participation in research are discussed. Keywords Turkey Ecological system approach Cultural factors Child abuse and neglect Values Family Citation Koçtürk, N., Cankardaş, S., Sofuoğlu, Z. and Ulukol, B. (2023), "Cultural Factors Affecting the Participation in Research of Children Victims of Child Abuse and Neglect: The Case of Turkey", Roth, M., Alfandari, R. and Crous, G. (Ed.) Participatory Research on Child Maltreatment with Children and Adult Survivors (Emerald Studies in Child Centred Practice), Emerald Publishing Limited, Bingley, pp. 83-98. https://doi.org/10.1108/978-1-80455-526-220231006 Publisher: Emerald Publishing Limited Copyright © 2023 Nilüfer Koçtürk, Sinem Cankardaş, Zeynep Sofuoğlu and Betül Ulukol. Published under exclusive licence by Emerald Publishing Limited. These works are published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of these works (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode. License These works are published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of these works (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode. Introduction Child abuse and neglect (CAN) is a critical social problem affecting an individual's childhood and adult life (Dobson et al., 2021; Levin & Liu, 2021). To address the problem of CAN in terms of both treatment and prevention, we need to know the prevalence and extent of the problem (Sumner et al., 2015). The creation of policies for families and children, employment of experts working in the field of child protection and services for children and families depend on understanding the mechanisms and estimating the prevalence of CAN. The literature shows that millions of children around the world are exposed to maltreatment (Mathews et al., 2020; Stoltenborgh et al., 2013a, 2013b). However, in many countries, the extent of CAN is not clearly known, and many nations lack reliable comparative national prevalence data (Mathews et al., 2020; Sumner et al., 2015). This is relevant, particularly for undeveloped countries. According to meta-analyses by Stoltenborgh et al. (2013a, 2013b) and Jud et al. (2016), prevalence rates of CAN are primarily based on data from developed countries, and few studies have focused on underdeveloped or developing countries. Although the rates in developed countries are worrisome, they are much higher in underdeveloped or developing countries (Klevens & Ports, 2017; Stoltenborgh et al., 2013b). In this chapter, we examine the issue of children's participation in research about CAN in the context of Turkey – a country that bridges the Asian and European continents. Turkey's unique cultural characteristics are unlike European countries or other Muslim countries (Sunar & Fişek, 2005). Legally, it adopts the concept of a secular state and has citizens of different nationalities and religions, although many residents are Muslims (Sunar & Fişek, 2005). Due to this mosaic structure of the country, the child's position in the family and right to participate in research may vary among ethnic cultures (Coşgun, 2019; Güçlü, 2016). In addition, the position of the child in the family in Turkey is affected by many factors, such as the structure of the family (extended or nuclear), sociocultural status, place of residence and political and religious views of parents (Güçlü, 2016; Taşkın, 2009). In the traditional family type, hierarchical and asymmetrical family relations among father, mother and child are nourished by strict religious and social teachings (Günaydın & Aşan, 2017). In rural areas, a traditionalist perspective often persists in family structures if the parents' education level is low or the parents do not adopt a secular perspective (Güçlü, 2016). Women and children are expected to submit to authority in these family structures, and fathers and other men are seen as authority figures (Koçtürk, 2021; Sunar & Fişek, 2005). The traditional view of children as dependent on parental authority might also be reflected in how research on family relationships, CAN and gendered violence is conducted. Due to urbanisation and the transition from traditional to nuclear family structures, the balance of authority in the family has begun to differentiate; these changes in family structures have led to more democratic parental attitudes of family members towards children (Güçlü, 2016). In family structures where the mother is involved in working life (Ayyıldız, 2005) and a secular perspective is adopted, the position of the child is valued and a more democratic parenting approach is adopted (Günaydın & Aşan, 2017; Sunar & Fişek, 2005). In other words, the child's position in the family is evaluated in parallel with the mother's position (Koçtürk, 2021). As urbanisation, parents' education level and egalitarian perspectives towards gender equality advance, both family relations and shared authority change, alongside changes in the family position of the child (Coşgun, 2019; Güçlü, 2016). In this book chapter on factors affecting children's participation in research, we focus on the problem in the context of the dominant culture, which is characterised as collectivist and patriarchal. Children in Turkey are less involved in CAN research (Uslu & Kapçı, 2014). For example, a report that systematically evaluated relevant studies in Turkey emphasised the limited number of studies on the prevalence of child sexual abuse and that child participation is at a low level (Uslu & Kapçı, 2014). Indeed, there is no national database for CAN victims in Turkey; few studies have been conducted with internationally accepted measures and, therefore, data are not comparable internationally (Eratay, 2000). In the Child Abuse and Domestic Violence Research in Turkey study by UNICEF (2010), the prevalence of emotional abuse was 51%, physical abuse was 43% and sexual abuse was 3% in a sample of 1,886 children aged 7–18. In a survey in eight Eastern European countries, among 1,763 children, the physical abuse rate was 14.6%, domestic violence witnessing was 17.9%, emotional neglect was 8.7%, emotional abuse was 3.7% and sexual abuse was 6.9% (Bellis et al., 2014). Methodological problems like differences in the definition of CAN have led to different results among different samples and regions and the inability to compare these results (Koçtürk, 2019). In most studies, data have been obtained from parents or retrospectively from adults (Uslu & Kapçı, 2014), indicating that cultural issues influence how research in CAN is implemented. This chapter focuses on the impact of cultural factors on children's participation in research. Using ecological theory as the conceptual framework, we examine the effect of cultural barriers to conducting research with children, particularly myths about CAN. The concept of cultural factors affecting children's participation in research, as the term suggests, refers to a psychosocial context. Moreover, this issue, which involves individuals younger than 18 years old, is not independent of their social environment, especially their parents. From a theoretical point of view, this opinion is compatible with the ecological system approach. Although this approach provides a holistic, context-specific and multilevel perspective on CAN (Martinello, 2020), it can also guide researchers and experts in identifying and finding solutions to the problem of why fewer children who are victims of CAN are involved in research. For these reasons, this book chapter primarily provides information on the ecological system approach and the micro and macro barriers and factors that affect children's participation in research. In this framework, this book chapter deals with the difficulties experienced in the legal processes for conducting research with children in Turkey, myths about CAN in society, fear of stigmatisation of children and their families and other systemic problems from an ecological perspective. Finally, recommendations for politicians and researchers to increase children's participation in research are made. Conceptual Perspective: Ecological System Approach According to the ecological point of view (Belsky, 1980; Bronfenbrenner, 1979; Rosa & Tudge, 2013), the formation of a behaviour is affected by various systems in which the individual exists and their interactions with others; in other words, it is based on a multifactorial etiology. According to Bronfenbrenner (1979), human development occurs through progressively more complex reciprocal interaction between an actively evolving biopsychological person and the people, objects and symbols in their immediate environment (Eriksson et al., 2018; Rosa & Tudge, 2013). In other words, according to this theory, when the environmental conditions with which a child interacts directly (e.g. family) or indirectly (e.g. parent–school collaboration) are appropriate, the probability of realising their inherited traits and potential increases (Bronfenbrenner, 1979). Bronfenbrenner (1979) emphasised four systems with this concept of context: microsystem, mesosystem, exosystem and macrosystem. The microsystem is the most proximal setting where a developing person can interact face-to-face with physical environments such as home, childcare, playground and workplace (Rosa & Tudge, 2013). Regarding the CAN phenomenon, four microsystems typically surround children: experiences in the family, with teachers, with peers and in the school environment (Lee, 2011). The mesosystem is the relationship between two or more microsystems in which the developing person actively participates (Rosa & Tudge, 2013). In the context of CAN, the mesosystem refers to interactions between the child's systems, such as those between the child's family and the perpetrator and between the child's teachers and family (Rosa & Tudge, 2013). The exosystem is an environment in which the developing child does not participate actively but still experiences its influence in their life – for example, school curricula and popular media (Martinello, 2020; Rosa & Tudge, 2013). In the context of CAN, the difficulty of working conditions for parents is an example of this system (Maguire-Jack et al., 2022). The macrosystem involves the core beliefs, values, cultural attitudes and ideologies such as those of the economic, social, educational, legal and political systems that affect the child's culture and society at a broader level (Martinello, 2020; Rosa & Tudge, 2013). We see the impact of the macrosystem on other ecological environments through its reflection on the functioning of subsystems (e.g. family, school). Methods This study involved a review of studies on CAN in Turkey. Articles and theses were searched in the National Thesis Center Database (Council of Higher Education – Thesis), Ulakbim, and Web of Science databases between November and December 2022 using the following keywords: ‘child abuse’ and/or ‘child neglect’ and ‘child participation.’ Although more than 20,000 studies were identified in the first stage, when the search was limited to the scope of the research question, the research team did not find any article directly looking for reasons why victims of CAN have not participated in research. Therefore, the research question was adjusted to look for cultural factors acting as barriers and hindering children's participation in CAN studies in Turkey, along with factors that enable their participation, in the various ecological systems described in Bronfenbrenner's theoretical framework. Ecological Factors Influencing Participation of Children in Research Adopting Bronfebrenner's (1979) conceptual framework, we argue that to understand and increase the participation of child victims of CAN in research, we need to understand values, principles, traditions, norms and regulations intertwined in the process–person–context–time model. Thus, we analysed the Turkish literature on CAN, looking for possible cultural barriers and enabling factors at all levels of the ecological system: microsystem, mesosystem, exosystem and macrosystem. Microsystem To gain direct access to children who are victims of CAN, it is necessary to be in environments such as family and school, which are included in the microsystem of children. However, even professionals providing services to children in Turkey, before conducting any research with children or asking for the child's participation request, must obtain permission from the parents. In other words, it is not possible for children to participate in research without the permission of the child's parents. According to the Patient Rights Regulation (1998), the law obligates researchers to get parents' informed consent for their child's participation before consent can be obtained from the children. Factors that may affect children's participation in research in the scope of microsystem include the following: Family structure: In families where a traditional patriarchal family structure is dominant, the father may make all final decisions about the child, including participation in research. This situation not only prevents the provision of the most fundamental rights of the child, such as the right to participation, but also prevents reaching the child in the face of problems such as neglect and domestic abuse. To overcome this problem, it is necessary to either reach the child without being dependent on the parents in the framework of the principle of the best interests of the child or encourage parents to allow their child to participate in research. Parental beliefs: Factors specific to parents come into play and may negatively affect children's participation in research. Namely, in cases of neglect and domestic abuse, parents likely will not want their children to participate in CAN research to protect them or other family members because of collectivism. The findings of studies on reasons for the late disclosure of child victimisation (Koçtürk & Bilginer, 2020) and withdrawal of complaints (Koçtürk & Bilginer, 2019) also support this view. Sharing problems experienced in the family with others is not desired, as reflected in proverbs such as ‘The arm is broken, but it remains in the sleeve.’ In other words, macrosystem factors such as culture and ideologies also play a role in the microsystem by influencing parents' attitudes, beliefs and values. Parental knowledge and myths: Various myths exist among parents about sexual abuse and disclosure (Kızıldağ & Koçtürk, 2021). These sexual abuse myths specific to the victim, abuser and abuse may also prevent their children from participating in CAN research (e.g. ‘Preschoolers all make up that they've been sexually abused’; Kızıldağ & Koçtürk, 2021). Parents who are not abusive do not consider it positive to conduct research on these issues because they see talking about sexuality as a taboo and fear the influence on their children. For example, in one study, 70% of parents reported that talking to their children about sexual abuse is against their beliefs and culture (Üstündağ, 2022). Some nonabusive parents in Turkey do not find it positive to conduct research on sexual abuse, because they consider it taboo to talk about sexuality and think that any questions about sexuality do not match and might adversely affect their child's sexual development. To prevent possible reactions from parents and not affect their children, CAN research may not be allowed by authorised institutions, including ethical committees (Uslu & Kapçı, 2014). This situation hinders research on CAN survivors. Fearing of conflict with parents: Studies on CAN are not institutionally favoured due to misconceptions and attitudes such as not confronting parents institutionally (e.g. family getting angry with school administrators for reporting suspected abuse to the authorities; Kabul & Bıkmazer, 2022), not dealing with processes such as forensic notification because it requires additional time and effort (Haylı & Durmuş, 2015), the fact that sexuality is taboo, and because some parents use corporal punishment with their children for disciplinary purposes. Experts working with children fear conflict with parents because they feel alone and have security concerns in any conflict situation (Siviş-Çetinkaya, 2015). In this context, mesosystem and macrosystem factors indirectly prevent access to children. Difficulty reaching children: Families with low socioeconomic levels in Turkey do not send their children to preschool (Toran & Özgen, 2018). Considering that the first people to be told about neglect and abuse in the family experienced by children are the people close to the children, in the absence of the educator, disclosure of abuse is difficult, unless children interact with a different social environment and develop trust in a person. At this point, the microsystem through which access to children can be provided in Turkey is health institutions. Considering that some children in Turkey are not taken to health institutions even for compulsory vaccinations (Bozkurt, 2018; Kurçer et al., 2005), it becomes difficult to reach some preschool children in rural areas or in families with low socioeconomic status. On the other hand, although children's councils have been established by official institutions such as the Ministry of Family and Social Services and municipalities to ensure the participation of children in decisions on issues such as municipal activities, these children's councils are not available in every province and district (Erbay, 2013). Similarly, few nongovernmental organisations allow children to take an active role, and they do not have microsystem resources to present their views via the internet or phone. In summary, apart from child follow-up centres where children who are victims of sexual abuse are interviewed and a few associations and child protection units, no other formal or informal services can advocate for children. Mesosystem As previously highlighted, the mesosystem involves the relationship between two or more microsystems in which the developing person actively participates. In this context, parental interactions with health institutions or school are the most common mesosystem concepts we encounter. However, factors related to child neglect, such as parents' indifference, unwillingness, lack of time and low level of education, are barriers to parental involvement with health and education institutions (Toran & Özgen, 2018). Considering that the involvement of neglectful parents may already be low, low parental involvement can also reduce children's participation in CAN research. On the other hand, the insufficient number of health personnel, teachers and school psychological counsellors prevents meeting with parents by making home visits. In summary, it is difficult to get legal permission (i.e. informed consent) from parents in cases where parental involvement is low due to the lack of a follow-up system where interviews between experts and family members are mandatory. This situation not only prevents the identification of children who are victims of CAN but also prevents children from participating in CAN research. Exosystem Regarding school curricula and media as exosystem variables, child participation is not at the desired level in both areas (Beyazova et al., 2016; Şirin, 2014), and there is no national programme or policy on raising awareness or participation in research on CAN in the school curriculum or media. Similarly, no programmes are conducted across the country for parents. However, the media is a key source of CAN information for families, according to a study by Rheingold et al. (2012), demonstrating that the exosystem can affect how families comprehend CAN. In Turkey, the media does not fulfil the duty of educating society about CAN, and it broadcasts in a way that does not comply with the ethical principles of journalism in terms of language, style and how the news is presented and may lead to the revictimisation of the child (e.g. revealing the identity of the victim, publishing the victim's photo, not believing the victim's statement; Çakmak, 2018). As Bandura (1973) suggested in social learning theory, the child can learn through observation of various channels such as the social environment, media and school curriculum and predict what they may encounter in the society in which they live if they report a CAN event. In other words, the fact that a CAN incident is seen and being presented as something shameful in society may lead to the fear of being revealed as a survivor (Kabul & Bıkmazer, 2022). This situation can be considered an indirect factor affecting children's participation in research. Macrosystem Regarding the formation, emergence and intervention processes of CAN, the effects of culture at the individual, familial and country levels are evident. At the individual level, not wanting to be stigmatised or labelled, such as wanting to forget the event by avoiding triggers or reminders, and the fear of revealing one's identity are essential variables that can affect participation in research and the reliability of research results. These variables are not independent of culture. In this context, possible cultural factors that may affect the participation of child victims in research in Turkey can be expressed as follows: Beliefs and myths about CAN: Myths about traumatic experiences and victims can be an essential factor influencing the process of reporting and participating in research. For example, the belief that abuse must be concealed to protect the family's honour (Koçtürk & Bilginer, 2020) or that talking about traumatic events can increase pain (Özbağrıaçık-Çağlayan, 2014) are examples of these myths. Other beliefs in the existing culture include trying to forget rather than expressing embarrassing events to preserve honour or dignity. These beliefs can influence the behaviour of victims. In the ecological system approach, cultural beliefs indirectly direct individuals' behaviour (Bronfenbrenner, 1979). Sexist culture: Myths that blame the victim are also an extension of sexism and fed by the culture in which the individual lives (e.g. ‘If sexual abuse has occurred more than once, the victim has consented’; Koçtürk & Kızıldağ, 2018). Unfortunately, these incorrect cultural teachings in Turkey are sometimes conveyed to the child through a comment by their parents or other individuals in their social circle (microsystem) and sometimes through a news report or words of judgment on television or social media (exosystem). This situation may affect victims' participation in research in Turkey, which is a collectivist culture. Stigmatisation of the child: According to the findings of studies on trauma and myths, CAN victims are ashamed of the event they have experienced and hide it to avoid being labelled and excluded (Koçtürk & Bilginer, 2019, 2020; Sayın et al., 2013). In this context, it would be helpful to consider social desirability as an essential factor that may affect the participation of survivors in research (Bergen & Labonté, 2020; DiLillo et al., 2006). Fear of exclusion and stigmatisation of the family by society: In the familial context, parents' fears of discrimination or exclusion from society often prevent the disclosure of abuse experiences. This culture is modelled as extremely strong to young children via the verbal and nonverbal behaviours of their parents and social environment such that even if they think that their parents will support them, children often do not report their abusive experiences due to various fears (Koçtürk & Bilginer, 2020). For example, in a study with victims of sexual abuse in Turkey, children's most common causes of delayed reporting were fear of creating domestic problems, upsetting their parents and being identified with the event in their social environment (Koçtürk & Bilginer, 2020). In Turkey, where family values and collectivism are praised, it may be inevitable that the individual needs of victims are ignored, and that they want to avoid reporting for the sake of familial and cultural elements. In other words, there is a fear that experiences of abuse may lead to negative consequences in the family such as exclusion and stigmatisation in society, and dishonouring the family. That would explain why children often do not participate in CAN research. Insufficient tracking capacity of the child protection systems: The child protection system in Turkey does not yet have sufficient resources to reach out to and manage all cases considered at risk of CAN in their families, which can be also a critical macrosystemic variable that affects identifying the monitoring of child abuse at societal level. In summary, from an ecological point of view, many factors that prevent access to children arise from macrosystem variables such as social values, the desire to avoid possible criticism in society and inadequate child protection systems. Implications for Increasing Children's Participation in Research As evidenced in this review, many systemic barriers affect children's participation in CAN research in Turkey, that can be identified especially at microsystem and macrosystem levels. When families with children (microsystem) embrace traditional societal values and judgments related to parental authority and power imbalance (macrosystem), it results in a vicious circle that bars children's access to participation in research. For this reason, it is necessary to carry out intervention and prevention studies at various levels according to the ecological system approach to increase the participation of children experiencing CAN in research and enable them to raise their voices. In light of this information, the following implications for politicians and researchers in increasing children's participation in research can be proposed according to the different ecological levels (Fig. 5.1). Opens in a new window.Fig. 5.1. Suggested Implications for Politicians and Researchers to Increase Children's Participation in Research. As shown in Fig. 5.1, to create adequate conditions for research with children, the following changes are recommended at the individual, microsystem, mesosystem, exosystem and macrosystemic levels. Individual Level Studies can be carried out to understand and influence the values and attitudes of children regarding the reporting of CAN and facilitate and encourage their participation in research. In light of the principle of the child's best interests, caregivers' gatekeeping power should be limited and children's consent should be the primary consideration for CAN research. However, to prevent children from being harmed by research, the content of the research should be evaluated by a scientific ethics board and psychosocial support should be provided to children regarding possible risks after the research. In addition, culturally sensitive measurement tools, which can be used throughout the country, can assess possible CAN exposure among children and identify children who do not want to report, thereby increasing children's participation in research. To increase survivors' self-confidence and eliminate repeat-abuse patterns, studies that psychosocially strengthen survivors should be carried out, and all survivors should be informed about these activities. Microsystem It is essential to strengthen family members and experts (such as teachers and health workers) in the microsystem of children, changing their myths and negative attitudes (sexism, blaming the victim) and ensuring that they receive social support in areas such as security following disclosure, to encourage children's participation in research. In addition, parents can be trained on issues such as the importance of talking about CAN and the fact that the taboo regarding this subject can cause much more harm to children. Experts in the field of child protection should routinely evaluate each child and raise awareness of children's rights. Online platforms can be created by the Ministry of Family and Social Services for research and notifications. Mesosystem For the mesosystem to be effective, it is essential to increase parental participation in schools and health institutions. In settings such as schools,

OBJECTIVE: Sepsis remains a common cause of death. The cereblon (CRBN) protein, which is involved in important cellular processes, plays a role in sepsis. This cross-sectional study aimed to show the CRBN protein expression and its effects on patients in the intensive care unit. PATIENTS AND METHODS: Samples were taken by deep tracheal aspiration from patients. The presence of CRBN was pathologically investigated using immunohistochemical tests and polyclonal antibodies against CRBN. The relationship between gender, sepsis, steroid, survival and the presence of CRBN was examined. RESULTS: Respiratory and neurologic diseases were the most common reasons for admission. Acinetobacter was the most frequent microorganism. In patients with more than normal inflammatory cells, a negative correlation was observed between CRBN expression and leukocyte rate (p=0.031). In patients with CRBN, there was no correlation between steroid and mortality, APACHE/Glasgow score, hospital stay length, and ICU. CONCLUSIONS: Although the prognosis for sepsis is better in CRBN-deficiency animals, the presence of CRBN in humans does not affect it. In our study, CRBN decreased as inflammatory cells increased in the patient’s aspiration material. The response to steroids, an immunomodulator, did not change with the presence of the immunomodulator target molecule, CRBN. Therefore, using immunomodulators in the treatment of sepsis should be reconsidered.

Abstract Background- Sepsis remains a common cause of death. Involving in important cellular processes, the cereblon (CRBN) protein plays a role in sepsis. This study aimed to show the CRBN protein expression and its effects on the patients in the intensive care unit. Methods- Samples were taken by deep tracheal aspiration from patients. The presence of CRBN was pathologically investigated by using immunohistochemical tests and polyclonal antibodies against CRBN. The relationship between gender, sepsis, steroid, survival, and the presence of CRBN was examined. Results- Respiratory and neurologic diseases were the most common reasons for admission. Acinetobacter was the most frequent microorganism. In patients with more than normal inflammatory cells, we observed a negative correlation between CRBN expression and PNL rate (p = 0.031). In patients with CRBN, there was no correlation between steroid and mortality, APACHE/Glasgow score, length of stay in hospital and ICU. Conclusion- Although the prognosis in sepsis is better in CRBN-deficiency animals, the presence of CRBN in humans does not affect it. The more we saw inflammatory cells in aspiration material, the less there was a CRBN. The response to steroids, an immunomodulator, did not change with the presence of the immunomodulator target molecule, CRBN. This requires us to reconsider using immunomodulators in the treatment of sepsis.

Firefighters are at high risk of experiencing mental disorders like other first responders. Although the studies on the prevalence of mental health problems in firefighters are common in the literature, it is seen that there are limited studies on the causes of these problems. This study aimed to investigate the risk of depression and traumatic stress symptoms among firefighters working in Turkey. In addition, it was aimed to investigate the variables before and during the event that predicted the traumatic stress symptoms. For this purpose, data were collected from the 468 firefighters working in the fire department of 35 provinces that agreed to participate in the study by using the Behavior, Safety, and Culture-First Responders, Patient Health Questionnaire-2, and Impact of Events Scale. It was seen that approximately half of the firefighters met the diagnosis of possible post-traumatic stress disorder, and approximately one fifth had a risk of depression. It was observed that the level of distress experienced during the event was the variable that explained the higher variance in the level of traumatic stress symptoms. Findings indicate that firefighters should have access to the psychological support system. Thus, it may be possible to prevent the continuation of mental problems and decrease in the quality of life.

Within the ASSISTANCE Project (Adapted Situation Awareness Tools and Tailored Training Scenarios for Increasing the Capabilities and Enhancing the Protection of First Responders) the development of a novel and advanced training programme is currently underway to adapt to the needs and characteristics of first responders. Once the methodology was ready, a complete training curriculum was prepared in order to probe the concept of the European training network based on online Virtual Reality platforms. The curriculum is composed of subjects, which have been developed with a stepwise approach, taking into consideration the pre-requisites needed foreach subject and a gradual increase in difficulty and complexity. These subjects can be divided into two different types: theoretical subjects, which will be taught through the Moodle server and practical subjects, which will be taught through the performance of different virtual scenarios with the available Virtual Reality platforms. Each subject definition includes a short summary of the subject, their main, general and specific objectives as well as their preferred evaluation method and the pre-requisites needed. This paper presents the ASSISTANCE training methodology and the curriculum developed including the preliminary scheduling needed to complete all the proposed subjects.

Aim: The COVID-19 outbreak continues to pose a threat to people's physical and mental health all over the world. The health professionals who are directly involved in the fight against the pandemic may experience stress during this crisis that can cause Burnout and Secondary traumatic stress. The objective of our study was to assess the burnout among physicians during COVID-19 pandemic and to determine related factors. Materials and Methods: A cross-sectional online survey was conducted. The demographical and occupational data were collected using a questionnaire and burnout level was assessed by Maslach Burnout Inventory (MBI). Results: 748 physicians took the survey. The burnout levels stated by the physicians were found to be significantly higher than before the pandemic [median before pandemic 3 (CDA: 2-4); median 4 (2-5) during pandemic; p <0.001]. Personal Accomplishment (PA), Emotional Exhaustion (EE) and Depersonalization (D) scores of participants directly providing medical services to COVID-19 cases were significantly higher (p <0.05). While EE and D scores were highest in first step workers, PA scores were highest in third step workers. PA scores were lower in man and EE scores were higher in women (p<0.05). Negative correlation was found between the age and the EE [r: (-) 0.087; p< 0.017] and D [r: (-) 0.233; p<0.001] subscale scores. Conclusion: We concluded that women, younger, first step and frontline workers had higher risks for burnout, so individual, structural, and organizational arrangements should be made by giving priority to these risky groups.

Background: The number of mobile phone users in the world is expected to pass the five billion by 2019. Globally; internet coverage rate is 56, 8%. Despite of these facts people in emergency response need reaches Command and Control Centers (CCC) through voice call which causes time delays. These time delays could be dangerous in case of life threatening emergencies. So the Next Generation Emergency Services (NEXES) which was a Research and Innovation Action was granted by European Commission. NEXES aims to research, test and validate the promising integration of IP-based communication technologies and interoperability into the next generation emergency services, so that they attain increased effectiveness and performance. Empowered by smartphones with cameras, messaging and internet-based applications connecting to social media, citizens expect emergency services to use the same technologies. NEXES innovates the approach to the dynamics between emergency services and citizens, allowing (i) the use of total conversation capabilities in emergencies, including social media, to the benefit of citizens, including those with disability or special needs (ii) the exploitation of improved location information to rapidly and effectively identify and locate the caller and the incident site and (iii) the leverage of Internet-enabled connectivity to enhance interoperability and shared awareness among emergency services, to the benefit of a more secure society. Testing in a real life setting and giving feedbacks was a part of the project. Accessibility of every citizen to emergency services was one of the main goal of the project. We consider not only injured or disabled people are vulnerable for accessibility but also sometimes people can be transiently impaired for example after a dentistry operation. After the completion of NEXES Application we test it in a real life setting. Two cars placed like they are crashed and a virtual command prepared. Participants got roles like; virtual CCC staff, first responders, driver (the crashed victim who was also cannot speak due to dental surgery) and citizens etc. After the crash the driver was unconscious but his car sent automated call to virtual CCC. Few minutes later driver’s situation was changed he was conscious but he was unable to speak. He activated his NEXES application in his smart phone. At the same time his medical info and location info transferred to the virtual CCC. Dispatcher started and starts total conversation which enables real time audio and video call, text message features. Dispatchers understood the traffic collision and the symptoms/findings of the trapped victim and dispatched the suitable vehicles and equipment and gave first aid instructions to stop bleeding to the trapped victim. After the testing verbal feedbacks collected from the victim and first responders (and dispatchers) to improve the features of the NEXES Application. 1) First Responder Feedbacks: 1.1) Advantages; • NEXES Application improves situational awareness of first responders and dispatchers. • Dispatcher can see the situation easily and decide what to do which vehicle and team to dispatch to the scene. • Enables communication • Dispatchers can get more info from the scene in mass causality incidents • Reduces response time • Easy to give post-dispatch instructions • Easy to correct interventions if bystanders doing inadequate or wrong • First aid interventions start early in the scene • Quick and easy usage • It improves also first responders and callers’ /citizens’ communication and enables situational awareness for PSOs/first responders • Increases survival rate 1.2) Disadvantages; • When more video calls received more dispatchers may be necessary • When you want to show something so you must turn your telephone, there is no option to change the way of camera. • Dependant to internet • Dependant to technology (you need a smart phone) • The application must be downloaded before and citizens must be trained • Out of battery or low/poor internet or internet disconnection • If PSAP operator gets another video call both conversations can be heard • People who do not use smart telephone will be excluded • Network may cause problem 1.3) Suggestions; • The front or back cameras of the phone must be selected optionally • Video recording feature could be necessary • Photo recording feature could be necessary • Language options must be prepared • Calling from computers, laptops and/ or tablets must be achieved • Patient medical history must be seen in the PSAP’s screen • It must be tested in mass causality incident environment • May be another system can be improved apart from the internet • Public training has great importance • Needs media adds for dissemination 2) Citizen Feedbacks: 2.1) Advantages; • Real time video call, text message and voice call features are very helpful for people in need of help • Rapid response of first responders could be provided • Improved accessibility for deaf or blind people • Better communication between EROs and citizens • Provides interactive response to the people in need • Buying time until arriving of first responder teams (giving necessary medical instructions to the bystanders) • Providing text message feature • NEXES Mini App easy to use for people in panic 2.2) Disadvantages; • Training is necessary for citizens • Dependant to internet speed • Location information cannot be suitable for multi-layer buildings • When people pushes NEXES App closure key, the app closes immediately so it can happen accidentally, it is better to add an option like “are you sure to close NEXES App?” So people can choose “yes” or “no” options. • Only one camera can be used, using both cameras will be more helpful • More training is needed for elder people 2.3) Suggestions; • Automatic location information must be provided if the location status is closed on the phone • “Enter” button must be added for sending text massages because people cannot understand if the text message is sent or not • The text fond must be bigger • Interfaces could be developed in order to make the app easy to use • Information notes can be added • Instructive videos can be added • Educational videos must be prepared for esp citizens in order to enhance public training • Many people have smart televisions so if NEXES App can be adapted to smart tvs it will be easier to for elder people and children • More cooperation is necessary with telephone service providers. Conclusion: NEXES Application enhances post-crash response time and quality.

Background and Aims: An Emergency Medical Service (EMS) can be defined as “a comprehensive system which provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to victims of sudden illness or injury.” EMS focuses on providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent mortality or long-term morbidity. The aims of the study are to define EMS Ecosystem and to analyse in order to define gaps and challenges of EMS. Materials and Methods: This is a review study conducted under IProcureSecurity Project (GA: 833291). EMS Ecosystem is predefined by the project consortium members that consist of mainly experienced EMS providers from 7 countries (Austria, Belgium, Greece, Ireland, Italy, Spain and Turkey) in a face to face workshop. Nineteen key words for literature review is selected in the same meeting. Partners made a broad literature review and add the resources to project system. These consists of; scholarly articles, thesis, online books and reports. More than 150 literature reviewed. Results: EMS gaps and challenges analyses is started after an EMS Ecosystem figure provided by the partners. This figure helped to design a contextual framework and perform the literature review correlated. The analyses phases started after concluded “EMS History” part. The analysed parts under EMS Ecosystem are; EMS Models; The Scene; Ambulance Services; Safety and Situational Awareness of EMS Providers; Medical Treatment; Emergency Call Centres; In Hospital EMS; EMS Workforce; Medical Equipment; Triage Systems; Legislation and Finance; Training; and Logistics. The EMS gaps and challenges found mostly increasing demand, reducing response time, diagnosing the urgency of the call, change in the population’s demography and living conditions, crowd management, high rise building due to urbanism, sending first aid instructions, standardization in EMS equipment and legislations, and technology. Conclusions and Recommendations: Organization and management structure, staff members, finance and logistic system, ambulance types and technical specifications of medical equipment vary widely among EU countries. The gaps and challenges identified from this study will be a basis of needs study. Five workshops planned to make interviews from these findings with all stakeholders. Keywords: EMS Ecosystem, Gaps and challenges, ambulance, innovation needs, References: Laurie J. Morrison, Mark P. Angelini, Marian J. Vermeulen, Brian Schwartz Measuring the EMS patient access time interval and the impact of responding to high-rise buildings, Prehospital Emergency Care, 2008;9:1,14-18 Bohm K, Kurland L. The accuracy of medical dispatch a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):94.

Objective: In this study, we aimed to investigate the relationship between post-traumatic stress disorder and previous knowledge of emergency management, sense of control over the stressor, perceived threat, and somatic symptoms in earthquake and fire survivors.. Method: The data were obtained from the 2009-database of the Izmir Province Fire Department to include the people who had experienced domestic fire (n=92), from the people who had applied to the Health Group Directory after the 2005 earthquake in Seferihisar (n=38) and from the staff of a third step hospital who experienced a fire in public building in 2010 (n=34). The Impact of Events Scale-revised version (IES-R) was used to determine the traumatic stress levels of the participants; and the Behavior, Security, and Culture - Survivor (BeSeCu- 5) questionnaire was used to acquire information on factors before and after the traumatic events. Results: Compared to the fire survivors, the earthquake survivors perceived higher levels of threat and lower levels of control during the event gender, perceived threat, somatic symptoms experienced during the event and perceived control over the event were found to predict the post-traumatic stress disorder. Conclusion: Results of the research suggested that control-focused treatment methods could be effective in treatment of people who had experienced earthquake and fire. It is observed that informing the public about emergency management would be protective for mental health by increasing the sense of control of the individuals at the time of the incident. On the other hand, the positive relationship between PTSD and previous knowledge on emergency suggests that the ringing alarms and practice errors during the fire and earthquake drills could traumatize people. Future research is recommended on the relationship between information processing, somatic symptoms and emotional processes in individuals during earthquake, fire and their drills.

Background: The dictionary definition of safety is “The condition of being protected from or unlikely to cause danger, risk, or injury.”1 Safety is a fundamental human right. In addition, the dictionary definition of road safety is “teaching people how to behave safely when driving or crossing the road.”2 The UN High Commissioner for Human Rights said: “Road safety is a human rights issue. Today, international law brings positive obligations to every State to take all reasonable steps to protect the right to life, the right to personal security, the right to health and the right to develop all persons. Every year, many vehicles are involved in accidents on highways. Road traffic accidents are leading cause of death and disability globally. The aim of this study is to investigate the road traffic accidents occurred in Turkey between the years 2012-2017 and to compare the rates of deaths and injuries by vehicle type involved in these accidents. Methods: Road traffic accidents occurred in Turkey between the years 2012-2017 constitute the universe of the study. The study data was taken from the Turkish Statistical Institute. Percentages were calculated with Microsoft office 365 ProPlus Exel. Percentage distributions were used to compare the values. Results: The total number of vehicles involved in accidents between 2012 and 2017 was 240 thousand, 251 thousand, 264 thousand, 290 thousand, 295 thousand and 294 thousand respectively. Tractor accidents were the most fatal accidents with 8-10% death rate. Tractor accidents were followed by tractor trailer accidents with a 5-8% death rate. Truck accidents were the third deadly vehicle type with a 4-7% death rate. Contrary to expectations, motorcycle accidents had the lowest mortality rate (0.8-2%), but there is no finding about the permanent disabilities and DALY. Cars were the second in the ranking of safe vehicles according to mortal accident rates. Conclusion: The data shows there was no difference in fatality or injury rates by years.