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BİRİNCİ BASAMAK SAĞLIK HİZMETLERİNDE UYKU BOZUKLUKLARI TARAMASI VE DEĞERLENDİRİLMESİ

Yıl 2019, Cilt: 4 Sayı: 2, 232 - 243, 14.05.2019
https://doi.org/10.35232/estudamhsd.526007

Öz

Uyku; sağlığın korunması, iyi bir yaşam kalitesi ve
gün boyunca iyi bir performans için önemli olan temel bir ihtiyaçtır. Uyku
bozuklukları, başta uykusuzluk bozuklukları ve obstrüktif uyku apnesi olmak
üzere, toplumda yaygın olarak görülürler. Kronik uyku bozukluklarının uzun
dönem kümülatif etkileri; mental problemler, kardiyovasküler hastalıklar,
diyabet, obezite ve depresyon gibi pek çok olumsuz sağlık sonucu ile
ilişkilidir. Uyku problemleri; yol açtığı bu sonuçlar nedeniyle, koruyucu
hekimlik açısından ciddiye alınmalıdır. Bununla birlikte; prevalansının
yüksekliğine ve ciddi sağlık sonuçları olmasına rağmen, toplumda uyku bozukluğu
olan bireylerin yalnızca %20’si doğru tanı ve tedavi alabilmektedir. Bu
sebeple, uyku problemlerinin sonuçları; mortalite ve morbidite hızları,
kazalar, yaralanmalar ve sağlık hizmetlerinin kullanımı gibi birçok halk
sağlığı göstergesini etkiler. Epidemiyolojik çalışmalar, uyku sorunlarının
tanınması ve danışmanlık hizmeti verilmesinin önündeki engeller arasında; zaman
yetersizliği, uyku sorunlarının hastalar tarafından hekimlerine daha az
bildirilmesi, uyku bozukluklarının ciddi olmadığına dair yanlış kanılar ve
hekimlerdeki farkındalık ve bilgi eksiklikleri olduğunu göstermiştir. Bu
derlemede; toplumda yaygın görülen uyku bozukluklarının değerlendirilmesi için,
birinci basamak sağlık hizmetlerinde kullanılabilecek tarama araçları
sunulmuştur. 

Kaynakça

  • 1. Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. International journal of environmental research and public health. 2018;15(3):519.
  • 2. Özbay SY, Bilici M. Uykunun Nörobiyolojisi ve Fizyolojisi. Psikiyatride Güncel. 2016;6(2):89-95.
  • 3. Mental Health Foundation, Sleep Matters: The Impact Of Sleep On Health And Wellbeing. 2011. https://www.mentalhealth.org.uk/publications/sleep-report/ (Erişim Tarihi: 09.02.2019)
  • 4. Sateia MJ. International Classification of Sleep Disorders-Third Edition. CHEST. 2014;146(5):1387-94.
  • 5. Crowley K. Sleep and sleep disorders in older adults. Neuropsychology review. 2011;21(1):41-53.
  • 6. Ohayon MM. Prevalence and comorbidity of sleep disorders in general population. La Revue du praticien. 2007;57(14):1521-8.
  • 7. Im E, Kim G-S. Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans. Medicine. 2017;96(37):e7744-e.
  • 8. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes care. 2003;26(2):380-4.
  • 9. Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. Archives of internal medicine. 2005;165(8):863-7.
  • 10. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet (London, England). 1999;354(9188):1435-9.
  • 11. Bjorvatn B, Sagen IM, Oyane N, Waage S, Fetveit A, Pallesen S, et al. The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res. 2007;16(1):66-76.
  • 12. Cappuccio FP, Taggart FM, Kandala N-B, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-26.
  • 13. Kapur VK, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, et al. The medical cost of undiagnosed sleep apnea. Sleep. 1999;22(6):749-55.
  • 14. Kapur VK, Redline S, Nieto FJ, Young TB, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289-96.
  • 15. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. The American journal of psychiatry. 1997;154(10):1417-23.
  • 16. Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, et al. Driver sleepiness and risk of serious injury to car occupants: population based case control study. BMJ (Clinical research ed). 2002;324(7346):1125.
  • 17. Akerstedt T, Fredlund P, Gillberg M, Jansson B. A prospective study of fatal occupational accidents -- relationship to sleeping difficulties and occupational factors. J Sleep Res. 2002;11(1):69-71.
  • 18. Baldwin DC, Jr., Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217-23.
  • 19. Luyster FS, Choi J, Yeh C-H, Imes CC, Johansson AEE, Chasens ER. Screening and evaluation tools for sleep disorders in older adults. Applied nursing research : ANR. 2015;28(4):334-40.
  • 20. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-6.
  • 21. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatric services (Washington, DC). 2005;56(3):332-43.
  • 22. Rosen RC, Zozula R, Jahn EG, Carson JL. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting. Sleep medicine. 2001;2(1):47-55.
  • 23. Al-Kandari S, Alsalem A, Al-Mutairi S, Al-Lumai D, Dawoud A, Moussa M. Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students. Sleep health. 2017;3(5):342-7.
  • 24. Brown FC, Buboltz WC, Jr., Soper B. Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine (Washington, DC). 2002;28(1):33-8.
  • 25. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews. 2015;22:23-36.
  • 26. Yetkin S. Uykusuzluk. Psikiyatride Güncel. 2016;6(2):106-15.
  • 27. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
  • 28. Suen LK, Tam WW, Hon KL. Association of sleep hygiene-related factors and sleep quality among university students in Hong Kong. Hong Kong medical journal = Xianggang yi xue za zhi. 2010;16(3):180-5.
  • 29. Li J, Zhou K, Li X, Liu M, Dang S, Wang D, et al. Mediator Effect of Sleep Hygiene Practices on Relationships Between Sleep Quality and Other Sleep-Related Factors in Chinese Mainland University Students. Behavioral sleep medicine. 2016;14(1):85-99.
  • 30. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi'nin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7(2):107-15.
  • 31. Anders MP, Breckenkamp J, Blettner M, Schlehofer B, Berg-Beckhoff G. Association between socioeconomic factors and sleep quality in an urban population-based sample in Germany. European journal of public health. 2014;24(6):968-73.
  • 32. Koh HW, Lim RB, Chia KS, Lim WY. The Pittsburgh Sleep Quality Index in a multi-ethnic Asian population contains a three-factor structure. Sleep & breathing = Schlaf & Atmung. 2015;19(4):1147-54.
  • 33. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2009;35(9):877-83.
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  • 35. Lee JA, Sunwoo S, Kim YS, Yu BY, Park HK, Jeon TH, et al. The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients. Journal of Korean medical science. 2016;31(2):240-6.
  • 36. Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, et al. Inquiring about insomnia may facilitate diagnosis of depression in the primary care setting. Psychiatry and clinical neurosciences. 2017;71(6):383-94.
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SCREENING and ASSESSMENT for SLEEP DISORDERS in PRIMARY HEALTH CARE

Yıl 2019, Cilt: 4 Sayı: 2, 232 - 243, 14.05.2019
https://doi.org/10.35232/estudamhsd.526007

Öz

Sleep is a basic human need
and is important for health, good quality of life and performing well during
the day. Sleep disorders, especially insomnia and obstructive sleep apnea, are common in the community. The cumulative long-term effects of these
disorders are associated with a wide range of adverse health consequences
including mental problems, cardiovascular diseases, diabetes, obesity and
depression. Sleep problems should be taken seriously in terms of preventive
medicine due to these consequences. However, despite their high frequency and
significant outcomes, less than 20% of individuals with sleep disorders are
correctly diagnosed and treated. Therefore, consequences of sleep conditions
affect many important indicators of public health such as mortality and morbidity
rates, accidents, injuries, and health care utilization. Epidemiologic studies
suggest that barriers to screening and counselling for sleep disorders include;
limited time, low reporting of sleep problems by patients, misconceptions about
the seriousness of sleep disorders, lack of awareness among physicians, and
insufficient physician knowledge. In this review; assessment tools that can be
used in primary health care for screening for common sleep problems are
presented.

Kaynakça

  • 1. Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. International journal of environmental research and public health. 2018;15(3):519.
  • 2. Özbay SY, Bilici M. Uykunun Nörobiyolojisi ve Fizyolojisi. Psikiyatride Güncel. 2016;6(2):89-95.
  • 3. Mental Health Foundation, Sleep Matters: The Impact Of Sleep On Health And Wellbeing. 2011. https://www.mentalhealth.org.uk/publications/sleep-report/ (Erişim Tarihi: 09.02.2019)
  • 4. Sateia MJ. International Classification of Sleep Disorders-Third Edition. CHEST. 2014;146(5):1387-94.
  • 5. Crowley K. Sleep and sleep disorders in older adults. Neuropsychology review. 2011;21(1):41-53.
  • 6. Ohayon MM. Prevalence and comorbidity of sleep disorders in general population. La Revue du praticien. 2007;57(14):1521-8.
  • 7. Im E, Kim G-S. Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans. Medicine. 2017;96(37):e7744-e.
  • 8. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes care. 2003;26(2):380-4.
  • 9. Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. Archives of internal medicine. 2005;165(8):863-7.
  • 10. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet (London, England). 1999;354(9188):1435-9.
  • 11. Bjorvatn B, Sagen IM, Oyane N, Waage S, Fetveit A, Pallesen S, et al. The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res. 2007;16(1):66-76.
  • 12. Cappuccio FP, Taggart FM, Kandala N-B, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-26.
  • 13. Kapur VK, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, et al. The medical cost of undiagnosed sleep apnea. Sleep. 1999;22(6):749-55.
  • 14. Kapur VK, Redline S, Nieto FJ, Young TB, Newman AB, Henderson JA. The relationship between chronically disrupted sleep and healthcare use. Sleep. 2002;25(3):289-96.
  • 15. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. The American journal of psychiatry. 1997;154(10):1417-23.
  • 16. Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, et al. Driver sleepiness and risk of serious injury to car occupants: population based case control study. BMJ (Clinical research ed). 2002;324(7346):1125.
  • 17. Akerstedt T, Fredlund P, Gillberg M, Jansson B. A prospective study of fatal occupational accidents -- relationship to sleeping difficulties and occupational factors. J Sleep Res. 2002;11(1):69-71.
  • 18. Baldwin DC, Jr., Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217-23.
  • 19. Luyster FS, Choi J, Yeh C-H, Imes CC, Johansson AEE, Chasens ER. Screening and evaluation tools for sleep disorders in older adults. Applied nursing research : ANR. 2015;28(4):334-40.
  • 20. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-6.
  • 21. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatric services (Washington, DC). 2005;56(3):332-43.
  • 22. Rosen RC, Zozula R, Jahn EG, Carson JL. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting. Sleep medicine. 2001;2(1):47-55.
  • 23. Al-Kandari S, Alsalem A, Al-Mutairi S, Al-Lumai D, Dawoud A, Moussa M. Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students. Sleep health. 2017;3(5):342-7.
  • 24. Brown FC, Buboltz WC, Jr., Soper B. Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine (Washington, DC). 2002;28(1):33-8.
  • 25. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews. 2015;22:23-36.
  • 26. Yetkin S. Uykusuzluk. Psikiyatride Güncel. 2016;6(2):106-15.
  • 27. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
  • 28. Suen LK, Tam WW, Hon KL. Association of sleep hygiene-related factors and sleep quality among university students in Hong Kong. Hong Kong medical journal = Xianggang yi xue za zhi. 2010;16(3):180-5.
  • 29. Li J, Zhou K, Li X, Liu M, Dang S, Wang D, et al. Mediator Effect of Sleep Hygiene Practices on Relationships Between Sleep Quality and Other Sleep-Related Factors in Chinese Mainland University Students. Behavioral sleep medicine. 2016;14(1):85-99.
  • 30. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi'nin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7(2):107-15.
  • 31. Anders MP, Breckenkamp J, Blettner M, Schlehofer B, Berg-Beckhoff G. Association between socioeconomic factors and sleep quality in an urban population-based sample in Germany. European journal of public health. 2014;24(6):968-73.
  • 32. Koh HW, Lim RB, Chia KS, Lim WY. The Pittsburgh Sleep Quality Index in a multi-ethnic Asian population contains a three-factor structure. Sleep & breathing = Schlaf & Atmung. 2015;19(4):1147-54.
  • 33. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2009;35(9):877-83.
  • 34. Okubo N, Matsuzaka M, Takahashi I, Sawada K, Sato S, Akimoto N, et al. Relationship between self-reported sleep quality and metabolic syndrome in general population. BMC public health. 2014;14:562.
  • 35. Lee JA, Sunwoo S, Kim YS, Yu BY, Park HK, Jeon TH, et al. The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients. Journal of Korean medical science. 2016;31(2):240-6.
  • 36. Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, et al. Inquiring about insomnia may facilitate diagnosis of depression in the primary care setting. Psychiatry and clinical neurosciences. 2017;71(6):383-94.
  • 37. Aysan E, Karaköse S, Zaybak A, İsmailoğlu EG. Üniversite öğrencilerinde uyku kalitesi ve etkileyen faktörler. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2014;7(3):193-8.
  • 38. Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine. 2006;29(3):223-7.
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  • 40. Chehri A, Kiamanesh A, Ahadi H, Khazaie H. Psychometric Properties of the Persian Version of Sleep Hygiene Index in the General Population. Iranian journal of psychiatry and behavioral sciences. 2016;10(3):e5268.
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  • 42. Seun-Fadipe CT, Aloba OO, Oginni OA, Mosaku KS. Sleep Hygiene Index: Psychometric Characteristics and Usefulness as a Screening Tool in a Sample of Nigerian Undergraduate Students. Journal of Clinical Sleep Medicine. 2018;14(8):1285-92.
  • 43. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. 2000;23(2):243-308.
  • 44. Lack L, Miller W, Turner D. A survey of sleeping difficulties in an Australian population. Community health studies. 1988;12(2):200-7.
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  • 46. Aslan S, Gulcat Z, Selda Albayrak F, Maral I, Yetkin S, Sutcigil L, et al. Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey. International journal of psychiatry in clinical practice. 2006;10(1):52-8.
  • 47. Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry and clinical neurosciences. 2015;69(9):543-52.
  • 48. Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, et al. Risk factors for incident chronic insomnia: a general population prospective study. Sleep medicine. 2012;13(4):346-53.
  • 49. Chesson A, Jr., Hartse K, Anderson WM, Davila D, Johnson S, Littner M, et al. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2000;23(2):237-41.
  • 50. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2008;4(5):487-504.
  • 51. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep medicine. 2001;2(4):297-307.
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  • 53. Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-8.
  • 54. Gagnon C, Belanger L, Ivers H, Morin CM. Validation of the Insomnia Severity Index in primary care. Journal of the American Board of Family Medicine : JABFM. 2013;26(6):701-10.
  • 55. Chung K-F, Kan KK-K, Yeung W-F. Assessing insomnia in adolescents: Comparison of Insomnia Severity Index, Athens Insomnia Scale and Sleep Quality Index. Sleep medicine. 2011;12(5):463-70.
  • 56. Jaisoorya TS, Dahale AB, Sunil KG, Manoj L, Gokul GR, Thennarassu K. Insomnia in primary care—a study from India. Sleep health. 2018;4(1):63-7.
  • 57. Gamsızkan Z, Aslan S. Birinci Basamakta İnsomnia Sıklığı ve İlişkili İnanç ve Tutumların Değerlendirilmesi. Journal of Cognitive Behavioral Psychotherapy and Research. 2014;3(3):156-61.
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  • 62. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Therapeutic advances in chronic disease. 2015;6(5):273-85.
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  • 65. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.
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  • 67. Johns MW. Daytime Sleepiness, Snoring, and Obstructive Sleep Apnea: The Epworth Sleepiness Scale. Chest. 1993;103(1):30-6.
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  • 70. Burgess KR, Havryk A, Newton S, Tsai WH, Whitelaw WA. Targeted case finding for OSA within the primary care setting. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2013;9(7):681-6.
  • 71. Manni R, Politini L, Ratti MT, Tartara A. Sleepiness in obstructive sleep apnea syndrome and simple snoring evaluated by the Epworth Sleepiness Scale. Journal of Sleep Research. 1999;8(4):319-20.
  • 72. Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW. Does snoring predict sleepiness independently of apnea and hypopnea frequency? American journal of respiratory and critical care medicine. 2000;162(4 Pt 1):1512-7.
  • 73. Karakoç Ö, Akçam T, Gerek M, Birkent H. Horlama ve Obstüriktif Uyku Apneli Hastalarda Epworth Uykululuk Skalasının Güvenilirliği. Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2007;6(3):86-9.
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Toplam 78 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Derlemeler
Yazarlar

Alican Sarısaltık 0000-0002-7317-404X

Ahmet Topuzoğlu 0000-0002-7497-548X

Yayımlanma Tarihi 14 Mayıs 2019
Gönderilme Tarihi 13 Şubat 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 4 Sayı: 2

Kaynak Göster

Vancouver Sarısaltık A, Topuzoğlu A. BİRİNCİ BASAMAK SAĞLIK HİZMETLERİNDE UYKU BOZUKLUKLARI TARAMASI VE DEĞERLENDİRİLMESİ. ESTÜDAM Halk Sağlığı Dergisi. 2019;4(2):232-43.

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