Ozden Gökdemir Izmir¹, Yasmin Ghaseminejad¹, Birkan Bayrak², Halime Seda Küçükerdem³

1. Izmir University of Economics, İzmir, Turkey

2. Dokuz Eylül University, İzmir, Turkey

3. Bozyaka Research and Training Hospital, İzmir, Turkey

^*Corresponding author:Dr Ozden Gokdemir, Associate Professor , Izmir University of Economics, İzmir, Turkey, Email: gokdemirozden@gmail.com

Abstract

Introduction: Abnormal uterine or vaginal bleeding is a common concern among women in primary care, particularly during the perimenopausal period. This case report discusses a 49-year-old woman who presented to her family physician with complaints of vaginal bleeding after six months of amenorrhea. This type of bleeding raises concerns about potential underlying conditions, requiring a structured diagnostic and management approach in primary care. Case Presentation: A 49-year-old female patient visited her family physician after experiencing vaginal bleeding following six months without a menstrual cycle. Initial evaluation included a detailed history, physical examination, and laboratory investigations. Hormonal testing revealed elevated LH and FSH levels, consistent with the postmenopausal transition. A pelvic ultrasound was ordered to assess the endometrial thickness and rule out structural causes such as polyps or fibroids. Management and Risk Assessment: Given her age and the nature of her symptoms, the patient was considered to be at low risk for coronary heart disease and stroke, with a 10-year cardiovascular risk of less than 1%. Based on the SCORE Turkey model, she was advised to follow healthy lifestyle recommendations. The primary care management plan involved monitoring her bleeding pattern and considering a referral for further gynecological evaluation if the bleeding persisted or additional symptoms developed. Conclusion: Primary care physicians play a crucial role in the early detection and management of abnormal uterine bleeding in women approaching menopause. In this case, a comprehensive evaluation helped identify the possible hormonal cause of the bleeding and guided appropriate lifestyle and follow-up recommendations.

Introduction

Human-made fires are crucial disasters while post-fire actions, which generally ignore the critical role of biodiversity in ecosystem recovery, are also one of the consequences.. The increasing frequency of wildfires, exacerbated by climate change, demands a strategic response that integrates ecological, educational, and health perspectives.[1]

One of the examples are from Turkey. Under Turkish law, forest crimes are considered serious offenses with no possibility of amnesty, as stated in the 1982 Constitution and Forest Law No. 6831. These crimes, including arson and illegal logging, are treated as urgent cases, even during judicial recesses, and must be immediately prosecuted by public prosecutors.[2]

Turkey's forests, particularly coniferous species like Pinus brutia and Pinus nigra, are highly susceptible to fires, especially in the Mediterranean region during hot, windy conditions. The 2008 forest fire in Antalya’s Serik district was one of the largest recorded, affecting nearly 15,800 hectares of Calabrian pine forests. [3]

Globally, forest fires are a major threat, often caused by human activities such as land clearing, agriculture, and negligence. The Food and Agriculture Organization (FAO) highlights the role of human factors in forest fires and has published guidelines for effective legislation and management across different countries, emphasizing the importance of addressing these human-caused risks.[2]

Current reforestation efforts in Turkey tend to prioritize rapid, economically driven regrowth, often through monoculture plantations, rather than allowing for the natural restoration of native ecosystems. This approach can severely disrupt biodiversity, reduce habitat availability, and diminish ecosystem resilience. It is essential that post-fire recovery plans incorporate a broader understanding of ecological principles, focusing on the preservation of native species and habitats that are crucial for long-term sustainability.

Role of Family Medicine and Medical Education in Promoting Planetary Health

Family physicians, as frontline healthcare providers, have a unique role in promoting public awareness about the links between environmental health and human health. Integrating concepts of Planetary Health into family medicine education can help bridge this gap. Educational initiatives, such as the WHO's Air Pollution Course for Health Workers (OpenWHO), aim to equip healthcare professionals with the knowledge needed to address environmental risk factors affecting their patients' health. Additionally, programs like Stanford’s Medical Education for Human and Planetary Health emphasize the importance of including environmental determinants in medical curricula, preparing future physicians to recognize and mitigate health impacts from climate-related events like wildfires.[4]

Incorporating online resources and training platforms, such as those available through the University of Rio Grande do Sul’s Telessaúde Moodle Platform, can provide family medicine practitioners with accessible tools to educate their patients on the health risks associated with poor environmental practices. For instance, educating communities about the importance of biodiversity and sustainable land management can help foster more resilient, ecologically balanced landscapes that support both human health and wildlife.

Example of Needs in Primary Care- After Fire

Chronic Respiratory and Cardiovascular Monitoring:[5]

Long-term Respiratory Health Surveillance: Ongoing assessments and pulmonary function tests for patients with chronic respiratory issues to monitor for long-term effects.

Cardiovascular Monitoring: Smoke exposure can increase cardiovascular risks; primary care should monitor blood pressure and heart health, especially in older adults.

Mental Health Care and Counseling:[6]

Post-Traumatic Stress Disorder (PTSD) Screening: Primary care can screen for PTSD, anxiety, and depression that may develop after wildfires, offering referrals for counseling or therapy.

Immunizations and Infection Control

Vaccination Programs: Wildfire recovery may lead to crowded shelters and increased risk of communicable diseases; vaccinations for flu and pneumonia may be necessary.

Infection Monitoring: Respiratory and skin infections should be monitored in the weeks following the fire.

Community Health Education and Resources:[7]

Education on Respiratory Protection: Guidance on using masks, air purifiers, and creating “clean air” spaces.

Nutrition and Physical Activity: Programs to support recovery, especially for those displaced or with disrupted routines.

Long-term Environmental and Occupational Health Risks:[8-10]

Monitoring for Respiratory Diseases: For people repeatedly exposed to smoke, long-term monitoring for respiratory diseases is recommended.

Occupational Health for First Responders: Follow-up assessments for firefighters and emergency workers exposed to high levels of smoke and physical strain.

A Call for Ecologically Informed Policy and Education

To address the challenges highlighted in the article, it is imperative that post-fire activities are guided by ecologically informed policies that prioritize biodiversity. This requires collaboration between environmental scientists, healthcare providers, and policymakers. By integrating Planetary Health principles into medical education and public health strategies, we can equip family physicians and other healthcare workers with the knowledge to advocate for sustainable, biodiversity-friendly practices that benefit both human and environmental health.[11][12]

Conclusion

Primary care providers have an essteial role as a key point of contact for both immediate and long-term healthcare needs following a wildfire. By addressing acute issues, providing ongoing follow-up care, and facilitating access to community resources, they play a vital role in the comprehensive recovery and resilience of affected populations. “To know how” could be achieved by the well-structured, evidence-based educational resources.

Conflicts of Interest

None

References

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Received: January 11, 2025;
Accepted: February 06, 2025;
Published:February 11, 2025 .

To cite this article : Izmir OG, Ghaseminejad Y, Bayrak B, Küçükerdem HS. The Impact of Adverse Childhood Experiences (ACEs) on Maternal Health and Developmental Outcomes: Current Trends and Ethical Considerations. Health Education and Public Health. 2025; 8(1): 576-579. doi: 10.31488/HEPH.191.

© The Author(s) 2025.