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The effects of smartphone addiction on sleep quality and obesity level in obese men

Yıl 2023, Cilt: 4 Sayı: 6, 656 - 662, 31.12.2023
https://doi.org/10.47582/jompac.1388131

Öz

Aims: To investigate the effects of smartphone addiction on sleep quality and body mass index (BMI) values in obese men.
Methods: During the study period, 90 men aged 18 to 45 years who were monitored for obesity, presented to the hospital, and agreed to participate in the study were recruited. The study statistically evaluated sleep quality and factors affecting it using patient demographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), the Smart Phone Addiction Scale (SPAS), and the Hospital Anxiety-Depression Scale (HADS).
Results: Patients were divided into two groups according to PSQI score: PSQI ≥5 n:51 (56.7%) and PSQI <5 n:39 (43.3%). The association between PSQI scores and age, body mass index (BMI), educational status, HADS-A, and HADS-D, SPAS, was examined. HADS-A, and HADS-D, SPAS scores were higher in the group with poor sleep quality (p<0.001). In addition, a high smartphone addiction score was found to increase the presence of PSQI ≥5 12-fold. It was shown that BMI values were higher in patients with high SPAS (p< 0.030).
Conclusion: Poor sleep quality and smartphone addiction appear to influence BMI in obese individuals. Studies to improve sleep quality are very important to identify modifiable risk factors, improve the design of prevention programs, and reduce the prevalence of obesity in the young population.

Etik Beyan

Etik kuru onayını ekledim

Destekleyen Kurum

yok

Teşekkür

Katkılarından dolayı Dr Galip Demir e teşekkür ederiz

Kaynakça

  • Ortega FB, Sui X, Lavie CJ, Blair SN. Body mass index, the most widely used but also widely criticized index: would a criterion standard measure of total body fat be a better predictor of cardiovascular disease mortality? Mayo Clin Proc. 2016;91(4):443-455.
  • Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028-2037.
  • Stranges S, Tigbe W, Gómez-Olivé FX, Thorogood M, Kandala N-B. Sleep problems: an emerging global epidemic? findings from the INDEPTH WHOSAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep. 2012;35(8):1173-1181.
  • Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013;5:27-35.
  • Peltzer K, Pengpid S, Samuels T, et al. Prevalence of overweight/obesity and its associated factors among university students from 22 countries. Int J Environ Res Public Health. 2014;11(7):7425-7441.
  • Spaeth AM, Dinges DF, Goel N. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep. 2013;36(7):981-990.
  • Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14(4):402.
  • Dempsey J, Veasey S, Morgan B, O'Donnell C. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112.
  • Vargas PA, Flores M, Robles E. Sleep quality and body mass index in college students: the role of sleep disturbances. J Am Coll Heal. 2014;62(8):534-541
  • Punamäki RL, Wallenius M, Nygård CH, Saarni L, Rimpelä A. Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness. J Adolesc. 2007;30(4):569-585.
  • World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: The World Health Organization; 2000.
  • Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds underweight among women in most developing countries. Am J Clin Nutr. 2005;81(3):714-721.
  • Kwon M, Lee JY, Won WY, et al. Development and validation of a smartphone addiction scale (SAS). Plos One. 2013;8(2):e56936.
  • Demirci K, Orhan H, Demirdas A, Akpinar A, Sert H. Validity and reliability of the Turkish Version of the Smartphone Addiction Scale in a younger population. Bull Clin Psychopharmacol. 2014;24(3):226-234.
  • Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
  • Agargün MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Türk Psikiyatri Derg. 1996;7:107-115.
  • Zigmond AS, Snaith PR. The hospital anxiety and depression scale. Acta Psyciatry Scandinavia. 1983;67(6):361-370.
  • Aydemir Ö, Güvenir T, Kuey L, et al. Hastane anksiyete ve depresyon ölçeği Türkçe formunun geçerlilik ve güvenilirliği. Türk Psikiyatri Derg. 1997;8:280-287.
  • Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-626.
  • Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med. 2014;15(12): 1456-1462.
  • Olds T, Blunden S, Dollman J, Maher C. Day type and the relationship between weight status and sleep duration in children and adolescents. Aust N Z J Public Health. 2010;34(2):165-171.
  • Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557-567.
  • Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab. 2010;24(5):687-702.
  • Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62
  • Jennings J, Muldoon M, Hall M. Self-reported sleep quality is associated with the metabolic syndrome. Sleep. 2007;30(2):219-223.
  • Rahe C, Czıra M, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep Med. 2015;16(10):1225-1228.
  • Grandner MA, Jackson NJ, Pak VM, Gehrman PR. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012;21(4):427-433.
  • James BO, Omoaregba OJ, Igberase OO. Prevalance and correlates of poor sleep quality among medical students at a Nigerian University. Ann Nigerian Med. 2011;5(1):1-5.
  • Saygılı S, Akıncı AÇ, Arıkan H, Dereli E. Üniversite öğrencilerinde uyku kalitesi ve yorgunluk. Electronic J Vocational Colleges. 2011;1(1):88-94.
  • Mayda AS, Kasap H, Yıldırım C. 4-5-6. sınıf tıp fakültesi öğrencilerinde uyku bozukluğu sıklığı. Düzce Üni Sağ Bil Enst Derg. 2012;2(2):8-11.
  • Ankara HG, Tekin B, Öz E. Elmayı en çok kim ısırıyor? akıllı telefon bağımlılığını etkileyen sosyoekonomik faktörlerin tespiti. Bilişim Tekn Derg. 2020;13(3):235-242.
  • Obuz, M.T. Akıllı telefon kullanıcılarının akıllı telefon bağımlılık düzeyi, fiziksel aktivite düzeyi, yaşam kalitesi ve uyku kalitesinin incelenmesi. Yüksek Lisans Tezi. Üsküdar Üniversitesi Sağlık Bilimleri Enstitüsü, Fizyoterapi ve Rehabilitasyon Anabilim Dalı, 2022.
  • Alosaimi FD, Alyahya H, Alshahwan H, Al Mahyijari N, Shaik SA. Smartphone addiction among university students in Riyadh, Saudi Arabia. Saudi Med J. 2016:37(6):675.
  • Araghi MH, Agielski A, Neira I, et al. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. Sleep. 2013;36(12):1859-1865.
  • Harada T, Morikuni M, Yoshii S, Yamashita Y, Takeuchi H. Usage of mobile phone in the evening or at night makes Japanese students evening-typed and night sleep uncomfortable. Sleep Hypn. 2002;4(4):149-153.
  • Zhang MX, Wu AMS. Effects of smartphone addiction on sleep quality among Chinese university students: the mediating role of self-regulation and bedtime procrastination. Addict Behav. 2020;111:106552.
  • Thomée S, Härenstam A, Hagberg M. Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults--a prospective cohort study. BMC Public Health. 2011;11(1):1-11.
  • Arora T, Broglia E, Thomas GN, Taheri S. Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias. Sleep Med. 2014;15(2):240-247.
  • Loughran SP, Wood AW, Barton JM, Croft R, Thompson B, Stough C. The effect of electromagnetic fields emitted by mobile phones on human sleep. Neuroreport. 2005;16(17):1973-1976.
  • Huber R, Treyer V, Borbely AA, et al. Electromagnetic fields, such as those from mobile phones, alter regional cerebral blood flow and sleep and waking EEG. J Sleep Res. 2002;11(4):289-295.
  • Thomée S, Eklöf M, Gustafsson E, Nilsson R, Hagberg M. Prevalence of perceived stress, symptoms of depression and sleep disturbances in relation to information and communication technology (ICT) use among young adults – an explorative prospective study. Computers Human Behav. 2007;23(3):1300-1321.
  • Amra B, Shahsavari A, Shayan-Moghadam R, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr. 2017;93(6):560-567.
  • Wu AM, Cheung VI, Ku L, Hung EP. Psychological risk factors of addiction to social networking sites among Chinese smartphone users. J Behav Addict. 2013;2(3):160-166.
  • Lee JE, Jang SI, Ju YJ, Kim W, Lee HJ, Park EC. Relationship between mobile phone addiction and the incidence of poor and short sleep among Korean adolescents: a longitudinal study of the Korean Children & Youth Panel Survey. J Korean Med Sci. 2017;32(7):1166-1172.
  • Kim HJ, Min JY, Kim HJ, Min KB. Accident risk associated with smartphone addiction: a study on university students in Korea. J Behav Addict. 2017;6(4):699-707.
  • Harwood J, Dooley JJ, Scott AJ, Joiner R. Constantly connected – the effects of smart-devices on mental health. Computers Human Behav. 2014;34:267-272.
  • Ithnain N, Ghazali SE, Jaafar N. Relationship between smartphone addiction with anxiety and depression among undergraduate students in Malaysia. Int J Health Sci Res. 2018;8(1):163-171.
  • Cellini N, DiGiorgio E, Mioni G, DiRiso D. Sleep and psychological difficulties in Italian school age children during COVID-19 lockdown. J Pediatr Psychol. 2021;46(2):153-167.
  • Bruni O, Malorgio E, Doria M, et al. Changes in sleep patterns and disturbances in children and adolescents in Italy during the COVID-19 outbreak. Sleep Med. 2022;91:166-174.

Obez Erkeklerde Akıllı Telefon Bağımlılığının Uyku Kalitesi ve Obezite Düzeyi Üzerine Etkisi

Yıl 2023, Cilt: 4 Sayı: 6, 656 - 662, 31.12.2023
https://doi.org/10.47582/jompac.1388131

Öz

Amaç: Obez erkeklerde akıllı telefon bağımlılığının uyku kalitesi ve beden kitle indeksi üzerine etkisini araştırmak
Yöntem : Çalışma süresi içerisinde hastaneye başvuran ve çalışmaya katılmayı kabul eden obezite nedeniyle takipli 18-45 yaş arasında 90 erkek alınmıştır. Çalışmada hastaların demogrofik özellikleri, Akıllı Telefon Bağımlılığı Ölçeği (ATBÖ), Pitssburgh Uyku Kalitesi Indeksi (PUKİ) ve Hastane Anksiyete-Depresyon Ölçeği (HADÖ) kullanılarak uyku kalitesi ve etki eden faktörler istatistiksel olarak değerlendirilmiştir.
Bulgular: Hastalar PUKİ sonucuna göre PUKİ ≥5 n:51 (%56,7) ve PUKİ <5 n:39 (%43,3) olarak 2 gruba ayrıldı. PUKİ sonuçları ile yaş, BMI, eğitim durumu, ATBÖ, HADÖ-A ve HADÖ-D arasındaki ilişki incelendi. Uyku kalitesi bozuk olan grupta ATBÖ, HADÖ-A ve HADÖ-D puanları daha yüksek bulunmuştur (p<0,001). Ayrıca akıllı telefon bağımlılık ölçeği puanı yüksek olmasının PUKİ ≥5 varlığını 12 kat artırdığı görülmüştür. ATBÖ yüksek olanlarda BMI değerlerinin daha yüksek olduğu bulunmuştur (p< 0,030).

Sonuç: Kötü uyku kalitesi ve akıllı telefon bağımlılığı obezlerde BMI etkilediği görülmektedir. Uyku kalitesini iyileştirmeye yönelik çalışmalar, değiştirilebilir risk faktörlerinin belirlenmesi, önleme programı tasarımının iyileştirilmesi, genç populasyonda obezite prevalansının azaltılması için çok önemlidir.

Kaynakça

  • Ortega FB, Sui X, Lavie CJ, Blair SN. Body mass index, the most widely used but also widely criticized index: would a criterion standard measure of total body fat be a better predictor of cardiovascular disease mortality? Mayo Clin Proc. 2016;91(4):443-455.
  • Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028-2037.
  • Stranges S, Tigbe W, Gómez-Olivé FX, Thorogood M, Kandala N-B. Sleep problems: an emerging global epidemic? findings from the INDEPTH WHOSAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep. 2012;35(8):1173-1181.
  • Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013;5:27-35.
  • Peltzer K, Pengpid S, Samuels T, et al. Prevalence of overweight/obesity and its associated factors among university students from 22 countries. Int J Environ Res Public Health. 2014;11(7):7425-7441.
  • Spaeth AM, Dinges DF, Goel N. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep. 2013;36(7):981-990.
  • Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14(4):402.
  • Dempsey J, Veasey S, Morgan B, O'Donnell C. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112.
  • Vargas PA, Flores M, Robles E. Sleep quality and body mass index in college students: the role of sleep disturbances. J Am Coll Heal. 2014;62(8):534-541
  • Punamäki RL, Wallenius M, Nygård CH, Saarni L, Rimpelä A. Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness. J Adolesc. 2007;30(4):569-585.
  • World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: The World Health Organization; 2000.
  • Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds underweight among women in most developing countries. Am J Clin Nutr. 2005;81(3):714-721.
  • Kwon M, Lee JY, Won WY, et al. Development and validation of a smartphone addiction scale (SAS). Plos One. 2013;8(2):e56936.
  • Demirci K, Orhan H, Demirdas A, Akpinar A, Sert H. Validity and reliability of the Turkish Version of the Smartphone Addiction Scale in a younger population. Bull Clin Psychopharmacol. 2014;24(3):226-234.
  • Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
  • Agargün MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Türk Psikiyatri Derg. 1996;7:107-115.
  • Zigmond AS, Snaith PR. The hospital anxiety and depression scale. Acta Psyciatry Scandinavia. 1983;67(6):361-370.
  • Aydemir Ö, Güvenir T, Kuey L, et al. Hastane anksiyete ve depresyon ölçeği Türkçe formunun geçerlilik ve güvenilirliği. Türk Psikiyatri Derg. 1997;8:280-287.
  • Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619-626.
  • Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med. 2014;15(12): 1456-1462.
  • Olds T, Blunden S, Dollman J, Maher C. Day type and the relationship between weight status and sleep duration in children and adolescents. Aust N Z J Public Health. 2010;34(2):165-171.
  • Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557-567.
  • Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab. 2010;24(5):687-702.
  • Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62
  • Jennings J, Muldoon M, Hall M. Self-reported sleep quality is associated with the metabolic syndrome. Sleep. 2007;30(2):219-223.
  • Rahe C, Czıra M, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep Med. 2015;16(10):1225-1228.
  • Grandner MA, Jackson NJ, Pak VM, Gehrman PR. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012;21(4):427-433.
  • James BO, Omoaregba OJ, Igberase OO. Prevalance and correlates of poor sleep quality among medical students at a Nigerian University. Ann Nigerian Med. 2011;5(1):1-5.
  • Saygılı S, Akıncı AÇ, Arıkan H, Dereli E. Üniversite öğrencilerinde uyku kalitesi ve yorgunluk. Electronic J Vocational Colleges. 2011;1(1):88-94.
  • Mayda AS, Kasap H, Yıldırım C. 4-5-6. sınıf tıp fakültesi öğrencilerinde uyku bozukluğu sıklığı. Düzce Üni Sağ Bil Enst Derg. 2012;2(2):8-11.
  • Ankara HG, Tekin B, Öz E. Elmayı en çok kim ısırıyor? akıllı telefon bağımlılığını etkileyen sosyoekonomik faktörlerin tespiti. Bilişim Tekn Derg. 2020;13(3):235-242.
  • Obuz, M.T. Akıllı telefon kullanıcılarının akıllı telefon bağımlılık düzeyi, fiziksel aktivite düzeyi, yaşam kalitesi ve uyku kalitesinin incelenmesi. Yüksek Lisans Tezi. Üsküdar Üniversitesi Sağlık Bilimleri Enstitüsü, Fizyoterapi ve Rehabilitasyon Anabilim Dalı, 2022.
  • Alosaimi FD, Alyahya H, Alshahwan H, Al Mahyijari N, Shaik SA. Smartphone addiction among university students in Riyadh, Saudi Arabia. Saudi Med J. 2016:37(6):675.
  • Araghi MH, Agielski A, Neira I, et al. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. Sleep. 2013;36(12):1859-1865.
  • Harada T, Morikuni M, Yoshii S, Yamashita Y, Takeuchi H. Usage of mobile phone in the evening or at night makes Japanese students evening-typed and night sleep uncomfortable. Sleep Hypn. 2002;4(4):149-153.
  • Zhang MX, Wu AMS. Effects of smartphone addiction on sleep quality among Chinese university students: the mediating role of self-regulation and bedtime procrastination. Addict Behav. 2020;111:106552.
  • Thomée S, Härenstam A, Hagberg M. Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults--a prospective cohort study. BMC Public Health. 2011;11(1):1-11.
  • Arora T, Broglia E, Thomas GN, Taheri S. Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias. Sleep Med. 2014;15(2):240-247.
  • Loughran SP, Wood AW, Barton JM, Croft R, Thompson B, Stough C. The effect of electromagnetic fields emitted by mobile phones on human sleep. Neuroreport. 2005;16(17):1973-1976.
  • Huber R, Treyer V, Borbely AA, et al. Electromagnetic fields, such as those from mobile phones, alter regional cerebral blood flow and sleep and waking EEG. J Sleep Res. 2002;11(4):289-295.
  • Thomée S, Eklöf M, Gustafsson E, Nilsson R, Hagberg M. Prevalence of perceived stress, symptoms of depression and sleep disturbances in relation to information and communication technology (ICT) use among young adults – an explorative prospective study. Computers Human Behav. 2007;23(3):1300-1321.
  • Amra B, Shahsavari A, Shayan-Moghadam R, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr. 2017;93(6):560-567.
  • Wu AM, Cheung VI, Ku L, Hung EP. Psychological risk factors of addiction to social networking sites among Chinese smartphone users. J Behav Addict. 2013;2(3):160-166.
  • Lee JE, Jang SI, Ju YJ, Kim W, Lee HJ, Park EC. Relationship between mobile phone addiction and the incidence of poor and short sleep among Korean adolescents: a longitudinal study of the Korean Children & Youth Panel Survey. J Korean Med Sci. 2017;32(7):1166-1172.
  • Kim HJ, Min JY, Kim HJ, Min KB. Accident risk associated with smartphone addiction: a study on university students in Korea. J Behav Addict. 2017;6(4):699-707.
  • Harwood J, Dooley JJ, Scott AJ, Joiner R. Constantly connected – the effects of smart-devices on mental health. Computers Human Behav. 2014;34:267-272.
  • Ithnain N, Ghazali SE, Jaafar N. Relationship between smartphone addiction with anxiety and depression among undergraduate students in Malaysia. Int J Health Sci Res. 2018;8(1):163-171.
  • Cellini N, DiGiorgio E, Mioni G, DiRiso D. Sleep and psychological difficulties in Italian school age children during COVID-19 lockdown. J Pediatr Psychol. 2021;46(2):153-167.
  • Bruni O, Malorgio E, Doria M, et al. Changes in sleep patterns and disturbances in children and adolescents in Italy during the COVID-19 outbreak. Sleep Med. 2022;91:166-174.
Toplam 49 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Nöroloji ve Nöromüsküler Hastalıklar
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Tuba Akıncı 0000-0001-8521-7003

Nazik Okumus 0009-0008-0616-7967

Murat Altay 0000-0001-9431-2803

Yayımlanma Tarihi 31 Aralık 2023
Gönderilme Tarihi 8 Kasım 2023
Kabul Tarihi 15 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 4 Sayı: 6

Kaynak Göster

AMA Akıncı T, Okumus N, Altay M. The effects of smartphone addiction on sleep quality and obesity level in obese men. J Med Palliat Care / JOMPAC / Jompac. Aralık 2023;4(6):656-662. doi:10.47582/jompac.1388131

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Üniversitelerarası Kurul (ÜAK) Eşdeğerliği: Ulakbim TR Dizin'de olan dergilerde yayımlanan makale [10 PUAN] ve 1a, b, c hariç uluslararası indekslerde (1d) olan dergilerde yayımlanan makale [5 PUAN].

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