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Okul öncesi çocukların ekran kullanım sürelerinin ebeveyn ekran kullanım alışkanlıkları ve aile işlevleri ile ilişkisi

Yıl 2021, Cilt: 46 Sayı: 1, 343 - 351, 31.03.2021
https://doi.org/10.17826/cumj.780582

Öz

Amaç: Bu çalışmda okul öncesi çocukların ekran kullanım sürelerinin ebeveyn ekran kullanım alışkanlıkları ve aile işlevleri ile ilişkisinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza Adana ili, Sarıçam ilçesinde anaokuluna devam eden çocuğu olan 198 ebeveyni dahil ettik. Veriler bir anket formu ve Aile Değerlendirme Ölçeği kullanılarak toplandı. Ekran süreleri; tablet, TV, cep telefonu ve bilgisayar başında geçirilen süre toplanarak hesaplandı.
Bulgular: Çocukların %57,6’sının hafta içi, %76,3’ünün hafta sonu ekran kullanım sürelerinin iki saatin üzerinde olduğu ve yaş arttıkça ekran süresinin arttığı saptandı. Ebeveynlerden %88,9’u ekran konusunda aile içi kurallarının olduğunu, %62,6’sı çocuklarının yemek yerken ekran karşısında olduğunu, %44,4’ü çocuklarının kendine ait bir ekranının olduğunu, %90,9’u aile veya çocuk hekimlerinden ekran kullanımı konusunda herhangi bir öneri almadıklarını bildirdi. Ebeveynlerin eğitim düzeyinin düşük olmasının, ekran konusunda aile içi kuralların olmamasının, çocukların kendilerine ait ekranlarının olmasının, hekimlerin ekran kullanımı konusunda öneride bulunmamasının çocukların ekran kullanım sürelerini arttırdığı bulundu. Çocukların ekran kullanım süreleri ile ebeveynlerin ekran kullanım süreleri arasında ve çocukların hafta içi ekran kullanım süreleri ile aile işlevlerinin iletişim alt ölçeği arasında ilişki saptandı.
Sonuç: Çalışmanın bulguları göz önüne alındığında, bu yaş grubuyla birçok teması olan aile hekimlerinin ve pediatristlerin bunu fırsata çevirerek ebeveynlere ekran kullanımı konusunda danışmanlık vermede daha aktif rol almaları için bireysel ve kurumsal girişimler önerilir.

Destekleyen Kurum

Çukurova Üniversitesi Bilimsel Araştırma Projeleri Birimi

Proje Numarası

TTU-2017-8506

Kaynakça

  • 1. Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. and Council on Communications and Media. Children and Adolescents and Digital Media. Pediatrics 2016;138 (5): e20162593 doi: https://doi.org/10.1542/peds.2016-2593. [accessed 25 April 2020].
  • 2. Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children's Performance on a Developmental Screening Test. JAMA Pediatrics 2019;173(3):244-250. doi:10.1001/jamapediatrics.2018.5056. [accessed 25 April 2020].
  • 3. Venetsanou F, Emmanouilidou K, Kouli O, Bebetsos E, Comoutos N et al. Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018. International Journal of Environmental Research and Public Health 2020;17(5):1645. doi: 10.3390/ijerph17051645. [accessed 25 April 2020].
  • 4. Straker L, Zabatiero J, Danby S, Thorpe K, Edwards S. Conflicting Guidelines on Young Children's Screen Time and Use of Digital Technology Create Policy and Practice Dilemmas. The Journal of Pediatrics 2018; 202: 300-303. doi: https://doi.org/10.1016/j.jpeds.2018.07.019 [accessed 25 April 2020].
  • 5. Saunders TJ, Vallance JK. Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions. Applied Health Economics and Health Policy 2017;15(3):323-331. doi: 10.1007/s40258-016-0289-3 [accessed 25 April 2020].
  • 6. Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open 2019;9:e023191. doi: 10.1136/ bmjopen-2018-023191 [accessed 25 April 2020].
  • 7. Domingues-Montanari S. Clinical and psychological effects of excessive screen time on children. Journal of Paediatrics and Child Health. 2017;53(4):333-338. doi: 10.1111/jpc.13462. [accessed 25 April 2020].
  • 8. American Academy of Pediatrics (2018). Children and media tips from the American Academy of Pediatrics [online]. Website https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx [accessed 26 April 2020].
  • 9. World Health Organization (‎2019)‎. Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age [online]. Website https://apps.who.int/iris/handle/10665/311664. License: CC BY-NC-SA 3.0 IGO [accessed 25 April 2020].
  • 10. Turner K. Well-Child Visits for Infants and Young Children. American Family Physician 2018;98(6):347-353.
  • 11. Ministry of Health, General Directorate of Public Health, Baby-Child-Adolescent Monitoring Protocols (in Turkish), Ankara-2018.
  • 12. De Craemer M, Lateva M, Iotova V, De Decker E, Verloigne M et al. (ToyBox-study group). Differences in Energy Balance-related Behaviours in European Preschool Children: the ToyBox-study. Plos One 2015;10(3):e0118303. doi: 10.1371/journal.pone.0118303 [accessed 25 April 2020].
  • 13. Rakel RE, Rakel DP. Psychosocial Influences on Health. In: Ahmed SM, Hersberger PJ, Lemkau JP (editors). Textbook of Family Medicine. 9th ed. Philadelphia, PA, USA: Elsevier; 2015. pp. 25-33.
  • 14. White JM, Klein DM. The Systems Framework. Family Theories, 3rd edition. Sage Publications: Thousand Oaks, CA, 2008: pp 151-177.
  • 15. Altun D. An Investigation Of Preschool Children's Digital Footprints and Screen Times and of Parents Sharenting and Digital Parenting Roles. International Journal of Eurasia Social Sciences 2019;10(35):76-97.
  • 16. World Health Organization (2019). To grow up healthy, children need to sit less and play more [online]. Website https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more [accessed 25 April 2020].
  • 17. Trinh MH, Sundaram R, Robinson SL, Lin TC, Bell EM et al. Association of Trajectory and Covariates of Children’s Screen Media Time. JAMA Pediatrics 2020;174(1):71-78. doi: 10.1001/jamapediatrics.2019.4488 [accessed 25 April 2020].
  • 18. De Decker E, De Craemer M, De Bourdeaudhuij I, Wijndaele K, Duvinage K et al. Influencing factors of screen time in preschool children: an exploration of parents' perceptions through focus groups in six European countries. Obesity Reviews 2012;13:75-84.
  • 19. The effect of Cloud I mental illness on family functions (in Turkish). TC Prime Ministry Undersecretariat of Women and Social Services, Ankara, 1993.
  • 20. Shah RR, Fahey NM, Soni AV, Phatak AG, Nimbalkar SM. Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study. Journal of Family Medicine and Primary Care 2019;8(6):1999–2002. doi: 10.4103/jfmpc.jfmpc_206_19 [accessed 25 April 2020].
  • 21. Bucksch J, Sigmundova D, Hamrik Z, Jorma T, Michal K et al. International trends in adolescent screen time behaviors from 2002 to 2010. Journal of Adolescent Health 2016;58:417-425.
  • 22. Hinkley T, Salmon J, Okely AD, Trost SG. Correlates of sed- entary behaviours in preschool children: a review. International Journal of Behavioral Nutrition and Physical Activity 2010;7: 66-76.
  • 23. Barkin S, Ip E, Finch S, Slora E, Wasserman R. Parental Media Mediation Styles. American Academy of Pediatrics 2020 [online]. Website https://www.aap.org/en-us/professional-resources/Research/Pages/Parental-Media-Mediation-Styles.aspx [accessed 26 April 2020].
  • 24. Carson V, Spence JC, Cutumisu N, Cargill L. BMC Public Health 2010, 367. doi: https://doi.org/10.1186/1471-2458-10-367 [accessed 26 April 2020].
  • 25. Kubik MY, Gurvich OV, Fulkerson JA. Association Between Parent Television-Viewing Practices and Setting Rules to Limit the Television-Viewing Time of Their 8- to 12-Year-Old Children, Minnesota, 2011-2015. Preventing Chronic Disease 2017;14:160235. doi: http://dx.doi.org/10.5888/pcd14.160235 [accessed 26 April 2020].
  • 26. Smith BJ, Grunseit A, Hardy LL, King L, Wolfenden L, Milat A. Parental influences on child physical activity and screen viewing time: a population based study. BMC Public Health 2010;8(10):593. doi: 10.1186/1471-2458-10-593 [accessed 26 April 2020].
  • 27. Birken CS, Maguire J, Mekky M, Manlhiot C, Beck CE et al. Parental Factors Associated with Screen Time in Pre-school Children in Primary-care Practice: a TARGet Kids! Study. Public Health Nutrition 2011;14(12):2134-8. doi: 10.1017/S1368980011000516 [accessed 26 April 2020].
  • 28. Jusienė R, Urbonas V, Laurinaitytė I, Rakickienė L, Breidokienė R et al. Screen Use During Meals Among Young Children: Exploration of Associated Variables. Medicina (Kaunas) 2019;14;55(10):688. doi: 10.3390/medicina55100688 [accessed 26 April 2020].
  • 29. LeBlanc AG, Katzmarzyk PT, Barreira TV, Broyles ST, Chaput JP et al. Correlates of Total Sedentary Time and Screen Time in 9-11 Year-Old Children around the World: The International Study of Childhood Obesity, Lifestyle and the Environment. PLoS One 2015;10(6):e0129622. doi: 10.1371/journal.pone.0129622 [accessed 26 April 2020].
  • 30. Nikken P, Schols M. How and Why parents guide the media use of young children. Journal of Child and Family Studies 2015;24:3423-3435. doi:10.1007/s10826-015-0144-4 [accessed 26 April 2020].
  • 31. Määttä S, Kaukonen R, Vepsäläinen H, Lehto E, Ylönen A et al. The mediating role of the home environment in relation to parental educational level and preschool children's screen time: a cross-sectional study. BMC Public Health 2017; 17(1):688. doi: 10.1186/s12889-017-4694-9 [accessed 26 April 2020].
  • 32. Jago R, Stamatakis E, Gama A, Carvalhal IM, Nogueira H et al. Parent and child screen-viewing time and home media environment. American Journal of Preventive Medicine 2012;43(2):150-8. doi: 10.1016/j.amepre.2012.04.012 [accessed 26 April 2020].
  • 33. Schoeppe S, Vandelanotte C, Bere E, Lien N, Verloigne M et al. The Influence of Parental Modelling on Children’s Physical Activity and Screen Time: Does It Differ by Gender? European Journal of Public Health 2017;27(1):152-157. doi: https://doi.org/10.1093/eurpub/ckw182 [accessed 26 April 2020].
  • 34. Loprinzi PD. Association of Family Functioning on Youth Physical Activity and Sedentary Behavior. Journal of Physical Activity Health 2015;12(5):642-8. doi: 10.1123/jpah.2014-0031 [accessed 26 April 2020].
  • 35. Schmidt ME, Haines J, O'Brien A, McDonald J, Price S et al. Systematic Review of Effective Strategies for Reducing Screen Time Among Young Children. Obesity (Silver Spring) 2012;20(7):1338-54. doi: 10.1038/oby.2011.348 [accessed 26 April 2020].
  • 36. Belay B, Frintner MP, Liebhart JL, Lindros J, Harrison M et al. US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017. The Journal of Pediatrics 2019;211:78-84.e2. doi: 10.1016/j.jpeds.2019.04.030 [accessed 26 April 2020].
  • 37. Lavigne M, Birken CS, Maguire JL, Straus S, Laupacis A. Priority Setting in Paediatric Preventive Care Research. Europe PMC (Archives of Disease in Childhood) 2017;102(8):748-753. doi: 10.1136/archdischild-2016-312284 [accessed 26 April 2020].

Screen time of preschool children in relation to their parents screen usage habits and family functions

Yıl 2021, Cilt: 46 Sayı: 1, 343 - 351, 31.03.2021
https://doi.org/10.17826/cumj.780582

Öz

Purpose: The aim of this study was to investigate the screen time of preschool children in relation to their parents’ screen-use habits and family functions.
Materials and Methods: We included 198 parents whose children were attending a kindergarten in Sarıçam district of Adana. Data were collected using a questionnaire and the Family Assessment Scale. Screen times were calculated by adding up the time spent in front of tablets, TV, mobile phones, and computers.
Results: The screen times were >2 h in 57.6% children on weekdays and in 76.3% on weekends, and screen times increased as age increased. Further, 88.9% parents indicated that they had family rules about screen use, 62.6% stated that their children were in front of the screen while eating, and 44.4% said their children had a screen of their own, whereas 90.9% told that they had not received any recommendations regarding screen use from family physicians or pediatricians. Low education level of parents, lack of family rules on screen use, children having their own screens, and having received no recommendations from doctors regarding screen use were noted to increase the screen times of children. There was a relationship between the screen times of children and that of parents as well as between screen times of children on weekdays and the communication subscale of family functions.
Conclusion: From the results of the study, individual and institutional initiatives are recommended for family physicians and pediatricians who have many contacts with this age group to turn it into an opportunity and have a more active role in advising parents regarding screen use

Proje Numarası

TTU-2017-8506

Kaynakça

  • 1. Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. and Council on Communications and Media. Children and Adolescents and Digital Media. Pediatrics 2016;138 (5): e20162593 doi: https://doi.org/10.1542/peds.2016-2593. [accessed 25 April 2020].
  • 2. Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children's Performance on a Developmental Screening Test. JAMA Pediatrics 2019;173(3):244-250. doi:10.1001/jamapediatrics.2018.5056. [accessed 25 April 2020].
  • 3. Venetsanou F, Emmanouilidou K, Kouli O, Bebetsos E, Comoutos N et al. Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018. International Journal of Environmental Research and Public Health 2020;17(5):1645. doi: 10.3390/ijerph17051645. [accessed 25 April 2020].
  • 4. Straker L, Zabatiero J, Danby S, Thorpe K, Edwards S. Conflicting Guidelines on Young Children's Screen Time and Use of Digital Technology Create Policy and Practice Dilemmas. The Journal of Pediatrics 2018; 202: 300-303. doi: https://doi.org/10.1016/j.jpeds.2018.07.019 [accessed 25 April 2020].
  • 5. Saunders TJ, Vallance JK. Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions. Applied Health Economics and Health Policy 2017;15(3):323-331. doi: 10.1007/s40258-016-0289-3 [accessed 25 April 2020].
  • 6. Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open 2019;9:e023191. doi: 10.1136/ bmjopen-2018-023191 [accessed 25 April 2020].
  • 7. Domingues-Montanari S. Clinical and psychological effects of excessive screen time on children. Journal of Paediatrics and Child Health. 2017;53(4):333-338. doi: 10.1111/jpc.13462. [accessed 25 April 2020].
  • 8. American Academy of Pediatrics (2018). Children and media tips from the American Academy of Pediatrics [online]. Website https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx [accessed 26 April 2020].
  • 9. World Health Organization (‎2019)‎. Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age [online]. Website https://apps.who.int/iris/handle/10665/311664. License: CC BY-NC-SA 3.0 IGO [accessed 25 April 2020].
  • 10. Turner K. Well-Child Visits for Infants and Young Children. American Family Physician 2018;98(6):347-353.
  • 11. Ministry of Health, General Directorate of Public Health, Baby-Child-Adolescent Monitoring Protocols (in Turkish), Ankara-2018.
  • 12. De Craemer M, Lateva M, Iotova V, De Decker E, Verloigne M et al. (ToyBox-study group). Differences in Energy Balance-related Behaviours in European Preschool Children: the ToyBox-study. Plos One 2015;10(3):e0118303. doi: 10.1371/journal.pone.0118303 [accessed 25 April 2020].
  • 13. Rakel RE, Rakel DP. Psychosocial Influences on Health. In: Ahmed SM, Hersberger PJ, Lemkau JP (editors). Textbook of Family Medicine. 9th ed. Philadelphia, PA, USA: Elsevier; 2015. pp. 25-33.
  • 14. White JM, Klein DM. The Systems Framework. Family Theories, 3rd edition. Sage Publications: Thousand Oaks, CA, 2008: pp 151-177.
  • 15. Altun D. An Investigation Of Preschool Children's Digital Footprints and Screen Times and of Parents Sharenting and Digital Parenting Roles. International Journal of Eurasia Social Sciences 2019;10(35):76-97.
  • 16. World Health Organization (2019). To grow up healthy, children need to sit less and play more [online]. Website https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more [accessed 25 April 2020].
  • 17. Trinh MH, Sundaram R, Robinson SL, Lin TC, Bell EM et al. Association of Trajectory and Covariates of Children’s Screen Media Time. JAMA Pediatrics 2020;174(1):71-78. doi: 10.1001/jamapediatrics.2019.4488 [accessed 25 April 2020].
  • 18. De Decker E, De Craemer M, De Bourdeaudhuij I, Wijndaele K, Duvinage K et al. Influencing factors of screen time in preschool children: an exploration of parents' perceptions through focus groups in six European countries. Obesity Reviews 2012;13:75-84.
  • 19. The effect of Cloud I mental illness on family functions (in Turkish). TC Prime Ministry Undersecretariat of Women and Social Services, Ankara, 1993.
  • 20. Shah RR, Fahey NM, Soni AV, Phatak AG, Nimbalkar SM. Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study. Journal of Family Medicine and Primary Care 2019;8(6):1999–2002. doi: 10.4103/jfmpc.jfmpc_206_19 [accessed 25 April 2020].
  • 21. Bucksch J, Sigmundova D, Hamrik Z, Jorma T, Michal K et al. International trends in adolescent screen time behaviors from 2002 to 2010. Journal of Adolescent Health 2016;58:417-425.
  • 22. Hinkley T, Salmon J, Okely AD, Trost SG. Correlates of sed- entary behaviours in preschool children: a review. International Journal of Behavioral Nutrition and Physical Activity 2010;7: 66-76.
  • 23. Barkin S, Ip E, Finch S, Slora E, Wasserman R. Parental Media Mediation Styles. American Academy of Pediatrics 2020 [online]. Website https://www.aap.org/en-us/professional-resources/Research/Pages/Parental-Media-Mediation-Styles.aspx [accessed 26 April 2020].
  • 24. Carson V, Spence JC, Cutumisu N, Cargill L. BMC Public Health 2010, 367. doi: https://doi.org/10.1186/1471-2458-10-367 [accessed 26 April 2020].
  • 25. Kubik MY, Gurvich OV, Fulkerson JA. Association Between Parent Television-Viewing Practices and Setting Rules to Limit the Television-Viewing Time of Their 8- to 12-Year-Old Children, Minnesota, 2011-2015. Preventing Chronic Disease 2017;14:160235. doi: http://dx.doi.org/10.5888/pcd14.160235 [accessed 26 April 2020].
  • 26. Smith BJ, Grunseit A, Hardy LL, King L, Wolfenden L, Milat A. Parental influences on child physical activity and screen viewing time: a population based study. BMC Public Health 2010;8(10):593. doi: 10.1186/1471-2458-10-593 [accessed 26 April 2020].
  • 27. Birken CS, Maguire J, Mekky M, Manlhiot C, Beck CE et al. Parental Factors Associated with Screen Time in Pre-school Children in Primary-care Practice: a TARGet Kids! Study. Public Health Nutrition 2011;14(12):2134-8. doi: 10.1017/S1368980011000516 [accessed 26 April 2020].
  • 28. Jusienė R, Urbonas V, Laurinaitytė I, Rakickienė L, Breidokienė R et al. Screen Use During Meals Among Young Children: Exploration of Associated Variables. Medicina (Kaunas) 2019;14;55(10):688. doi: 10.3390/medicina55100688 [accessed 26 April 2020].
  • 29. LeBlanc AG, Katzmarzyk PT, Barreira TV, Broyles ST, Chaput JP et al. Correlates of Total Sedentary Time and Screen Time in 9-11 Year-Old Children around the World: The International Study of Childhood Obesity, Lifestyle and the Environment. PLoS One 2015;10(6):e0129622. doi: 10.1371/journal.pone.0129622 [accessed 26 April 2020].
  • 30. Nikken P, Schols M. How and Why parents guide the media use of young children. Journal of Child and Family Studies 2015;24:3423-3435. doi:10.1007/s10826-015-0144-4 [accessed 26 April 2020].
  • 31. Määttä S, Kaukonen R, Vepsäläinen H, Lehto E, Ylönen A et al. The mediating role of the home environment in relation to parental educational level and preschool children's screen time: a cross-sectional study. BMC Public Health 2017; 17(1):688. doi: 10.1186/s12889-017-4694-9 [accessed 26 April 2020].
  • 32. Jago R, Stamatakis E, Gama A, Carvalhal IM, Nogueira H et al. Parent and child screen-viewing time and home media environment. American Journal of Preventive Medicine 2012;43(2):150-8. doi: 10.1016/j.amepre.2012.04.012 [accessed 26 April 2020].
  • 33. Schoeppe S, Vandelanotte C, Bere E, Lien N, Verloigne M et al. The Influence of Parental Modelling on Children’s Physical Activity and Screen Time: Does It Differ by Gender? European Journal of Public Health 2017;27(1):152-157. doi: https://doi.org/10.1093/eurpub/ckw182 [accessed 26 April 2020].
  • 34. Loprinzi PD. Association of Family Functioning on Youth Physical Activity and Sedentary Behavior. Journal of Physical Activity Health 2015;12(5):642-8. doi: 10.1123/jpah.2014-0031 [accessed 26 April 2020].
  • 35. Schmidt ME, Haines J, O'Brien A, McDonald J, Price S et al. Systematic Review of Effective Strategies for Reducing Screen Time Among Young Children. Obesity (Silver Spring) 2012;20(7):1338-54. doi: 10.1038/oby.2011.348 [accessed 26 April 2020].
  • 36. Belay B, Frintner MP, Liebhart JL, Lindros J, Harrison M et al. US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017. The Journal of Pediatrics 2019;211:78-84.e2. doi: 10.1016/j.jpeds.2019.04.030 [accessed 26 April 2020].
  • 37. Lavigne M, Birken CS, Maguire JL, Straus S, Laupacis A. Priority Setting in Paediatric Preventive Care Research. Europe PMC (Archives of Disease in Childhood) 2017;102(8):748-753. doi: 10.1136/archdischild-2016-312284 [accessed 26 April 2020].
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma
Yazarlar

Emine Çelik 0000-0002-1326-0413

Yelda Özer 0000-0003-4753-1311

Sevgi Özcan 0000-0003-4601-5032

Proje Numarası TTU-2017-8506
Yayımlanma Tarihi 31 Mart 2021
Kabul Tarihi 3 Ekim 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 46 Sayı: 1

Kaynak Göster

MLA Çelik, Emine vd. “Screen Time of Preschool Children in Relation to Their Parents Screen Usage Habits and Family Functions”. Cukurova Medical Journal, c. 46, sy. 1, 2021, ss. 343-51, doi:10.17826/cumj.780582.