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Covıd-19 Pandemisinin Toplum Ağız Diş Sağlığına Etkileri ve Etik Sorunlar

Yıl 2021, Cilt: 4 Sayı: S-1, 83 - 95, 31.10.2021
https://doi.org/10.26650/JARHS2021-945653

Öz

COVID-19 pandemisi, ağız sağlığı eşitsizliklerinin artmasına, topluma yönelik ağız diş sağlığını geliştirme programlarının ve koruyucu ağız sağlığı hizmetlerinin kısıtlanmasına neden olmaktadır. Ortak risk yaklaşımına göre kronik sistemik hastalıklar ile aynı risk faktörlerini paylaşan ağız hastalıklarının yönetilebilmesi için ağız sağlığı hizmetlerinin birinci basamak sağlık hizmetlerine entegre edilmesi gerekmektedir. ‘Tek Sağlık’ konsepti benimsenerek halk sağlığı uygulamalarında multidisipliner çalışmalara ağırlık verilmelidir. Toplumun ağız sağlığı çıktılarını arttırmak için biyopsikososyal yaklaşım çerçevesinde sektörler arası işbirliği, çalışma esnekliği, kapasitesi, sosyal adalet, eşitlik ve insan hakları etik kuralları dikkate alınarak planlanan ağız sağlığını geliştirme programlarına ihtiyaç vardır. Toplumun “COVID-19 ve Ağız Sağlığı” konusunda okuryazarlığını arttırmak için enformasyon teknolojileri ve sosyal medya ağları kullanılmalıdır. Bu dönemde, sürveyans ve halk sağlığı çalışmaları vasıtasıyla toplumsal düzeyde ağız sağlığı ihtiyaç değerlendirilmesinin yapılması da önemlidir. Hareket kısıtlaması ve sağlığın sosyal belirteçleri nedeniyle ağız sağlığı hizmetlerine ulaşmada zorluk yaşayan dezavantajlı gruplar, çocuk ve yaşlılar için ağız sağlığının korunması ve geliştirilmesine yönelik programlara öncelik verilmelidir.

Kaynakça

  • 1. WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19 -11 March 2020. (Cited 12.04.2021) Available from URL: https://www.who.int/directorgeneral/ speeches/detail/who-director-generalsopening- remarks-at-the-media-briefingoncovid- 19---11-march-2020.
  • 2. Ghani F. Covid-19 Outbreak - Immediate and long-term impacts on the dental profession. Pak J Med Sci 2020;36(COVID19-S4):126-9.
  • 3. Mascitti M, Campisi G. Dental Public Health Landscape: Challenges, Technological Innovation and Opportunities in the 21st Century and COVID-19 Pandemic. Int J Environ Res Public Health 2020;17:3636.
  • 4. Mantas J. The Importance of Health Informatics in Public Health During the COVID-19 Pandemic. Stud Health Technol Inform 2020;272:487-8.
  • 5. Sycinska-Dziarnowska M, Paradowska- Stankiewicz I. Dental Challenges and the Needs of the Population during the Covid-19 Pandemic Period. Real-Time Surveillance Using Google Trends. Int J Environ Res Public Health 2020;17(23):8999.
  • 6. Kathree BA, Khan SB, Ahmed R, Maart R, Layloo N, Asia-Michaels W. COVID-19 and its impact in the dental setting: A scoping review. PLoS ONE 2020;15(12): e0244352
  • 7. Elster N, Parsi, K. Oral Health Matters: The Ethics of Providing Oral Health During COVID-19. HEC Forum 2021; 33(1-2):157-64.
  • 8. Watt RG. COVID-19 is an opportunity for reform in dentistry. Lancet 2020; 15;396(10249):462.
  • 9. Singh S. Public Oral Health Care During COVID-19: Time for Reflection and Action. Front Med (Lausanne) 2021;8:610450.
  • 10. Daly J, Black EAM. The impact of COVID-19 on population oral health. Community Dent Health 2020;37(4):236-8.
  • 11. Shamsoddin E, DeTora LM, Tovani-Palone MR, Bierer BE. Dental Care in Times of the COVID-19 Pandemic: A Review. Med Sci 2021;9(1):13.
  • 12. WHO. Considerations for the provision of essential oral health services in the context of COVID-19. (Cited 21.04.2021) Available from URL: https://www.who.int/publications/i/item/ who-2019-nCoV-oral-health-2020.1.
  • 13. Benzian H, Beltrán-Aguilar E, Mathur MR, Niederman R. Pandemic Considerations on Essential Oral Health Care. J Dent Res 2021;100(3):221-5.
  • 14. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med 2020; 8(7): 659–61.
  • 15. Schwendicke F, Krois J, Gomez J. Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis. J Dent 2020;99:103387.
  • 16. Brian Z, Weintraub JA. Oral Health and and Access. Prev Chronic Dis 2020;17:E82. Erratum in: Prev Chronic Dis 2020;17:E93.
  • 17. Kalash DA. How COVID-19 deepens child oral health inequities. J Am Dent Assoc 2020;151(9):643-5.
  • 18. Westgarth, D. COVID-19 and Community Dental Services: The challenges ahead. BDJ In Pract 2020;33: 14–9.
  • 19. Şahin B, İlgün G. Assessment of the efficiency of dental services in Turkey. Health Policy Technol 2018: 7(2): 173–81.
  • 20. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. 2019 Yılı Birim Faaliyet Raporu. (Cited 15.03.2021) Available from URL: https:// hsgm.saglik.gov.tr/depo/birimler/izlemedegerlendirme- db/faaliyet-raporu/2019_DDB_ BRM_FAALYET_RAPORU.pdf.
  • 21. Üstün N, Akgöl BB, Bayram M. Influence of COVID-19 pandemic on paediatric dental attendance. Clin Oral Investig 2021;30:1–7.
  • 22. Luo W, Lee GHM, Nalabothu P, Kumar H. Paediatric dental care during and post- COVID-19 era: Changes and challenges ahead. Pediatr Dent J 2021;31(1):33-42.
  • 23. León S, Giacaman RA. COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms. JDR Clin Trans Res 2020;5(4):290-2.
  • 24. Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J 2020; 32(4): 181–6.
  • 25. Scrapping PHE, a threat to oral health?. Br Dent J 2020;229(5):272.
  • 26. Bains R, Bains VK. Oral health care, COVID-19 and challenges. J Global Oral Health 2020;3(2):130-6.
  • 27. Silva Dayane Helen Ferreira, Camargos Júlia Hinkelmann de, Rodrigues Jefferson Guimarães, Nogueira Leilismara Sousa, Azevedo Dênia Alves de, Carvalho Maria das Graças et al . Impact of oral hygiene in patients undergoing mechanical ventilation in the COVID-19 pandemic. Rev. Assoc. Med. Bras. [Internet]. 2020 [cited 2021 May 06] ;66( Suppl 2 ): 96-101.
  • 28. Sampson V. Oral hygiene risk factor. Br Dent J 2020;228(8):569.
  • 29. Moosavi MS, Aminishakib P, Ansari M. Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach. J Oral Microbiol 2020;12(1):1794363.
  • 30. Cavalcante-Leão BL, de Araujo CM, Basso IB, Schroder AG, Guariza-Filho O, Ravazzi GC, Gonçalves FM, Zeigelboim BS, Santos RS, Stechman-Neto J. Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? A systematic review. J Clin Exp Dent 2021;13(2):179-89.
  • 31. Lloyd-Jones G, Molayem S, Pontes CC, Chapple I. The COVID-19 Pathway: A Proposed Oral- Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures. J Oral Med and Dent Res 2021; 2(1):1- 25.
  • 32. Dental Health Foundation Ireland. Tooth Brushing Coronavirus and COVID 19. Available from: www.dentalhealth.ie/assets/files/pdf/ toothbrushes_-_covid_19_april_2020.pdf. (Alıntılama tarihi 10.02.2021).
  • 33. Canadian Dental Hygienists Association. Caring for Your Oral Health During the COVID-19 Pandemic. The Canadian Dental Hygenist Assosiation. (Cited 10.02.2021) Available from URL:https://www.dentalhygienecanada.ca/ dhcanada/DHCanada/Preventive_Oral_Care/ Oral_Health_During_COVID19.aspx.
  • 34. FDI. Fact sheet: Protect your oral health during the COVID-19 pandemic. (Cited 10.03.2021) Available from URL:https:// www.worldoralhealthday.org/sites/default/ files/2021-01/WOHD21-factsheet-covid19-EN. pdf.
  • 35. FDI. As COVID-19 shifts learning online, FDI supports parents and teachers with digital resources on oral health education. (Cited 10.03.2021) Available from URL:https:// https:// www.fdiworlddental.org/covid-19-shiftslearning- online-fdi-supports-parents-andteachers- digital-resources-oral-health.
  • 36. Wang Y, Zhou CC, Shu R, Zou J. Oral Health Management of Children during the Epidemic Period of Coronavirus Disease 2019. Sichuan Da Xue Xue Bao Yi Xue Ban 2020;51(2):151-4.
  • 37. da Costa CB, Peralta FDS, Ferreira de Mello ALS. How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review. Telemed J E Health 2020;26(7):945-54.
  • 38. Maret D, Peters OA, Vaysse F, Vigarios E. Integration of telemedicine into the public health response to COVID-19 must include dentists. Int Endod J 2020;53(6):880-1.
  • 39. Telles-Araujo GT, Caminha RDG, Kallás MS, Santos PSDS. Teledentistry support in COVID-19 oral care. Clinics (Sao Paulo) 2020;75:e2030.
  • 40. Tao Z, Chu G, McGrath C, Hua F, Leung YY, Yang W, Su Y. Nature and Diffusion of COVID-19– related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo. J Med Internet Res 2020;22(6):e19981.
  • 41. Boon-Itt S, Skunkan Y. Public Perception of the COVID-19 Pandemic on Twitter: Sentiment Analysis and Topic Modeling Study. JMIR Public Health Surveill 2020;6(4):e21978.
  • 42. TDB. Türk Dişhekimleri Birliği Diş Hekimliği Meslek Etiği Kuralları. Türk Diş hekimleri Birliği Yayınları- Mevzuat Dizisi, Ekim 2013, Ankara.
  • 43. ADA. Guidance on Continuing to Practice Ethically during COVID-19. (Cited 10.02.2021) Available from URL:https://success.ada.org/~/ media/CPS/Files/COVID/ADA_COVID_ How_Do_I_Ethically_See_Patients_During_ Pandemic.pdf.
  • 44. Ethics Subcommittee of the Council on Ethics, Bylaws and Judicial Affairs. Ethical practice during the COVID-19 pandemic. J Am Dent Assoc 2020;151(5):377-8.
  • 45. Saxena A, Bouvier PA, Shamsi-Gooshki E, Köhler J, Schwartz LJ. WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal. J Med Ethics 2021:106959.
  • 46. Pan American Health Organization.Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic. (Cited 20.02.2021) Available from URL: https:// iris.paho.org/handle/10665.2/52091.
  • 47. Seneviratne CJ, Lau MWJ, Goh BT. The Role of Dentists in COVID-19 Is Beyond Dentistry: Voluntary Medical Engagements and Future Preparedness. Front Med (Lausanne) 2020;7:566.
  • 48. Jorwal P, Bharadwaj S, Jorwal P. One health approach and COVID-19: A perspective. J Family Med Prim Care 2020;9(12):5888-91.
  • 49. Liu C, Onudiwe F. The ‘new normal’ in oral health promotion. Br Dent J 2020;229(10):641- 2.

THE IMPACTS OF THE COVID-19 PANDEMIC ON DENTAL PUBLIC HEALTH AND ETHICAL ISSUES

Yıl 2021, Cilt: 4 Sayı: S-1, 83 - 95, 31.10.2021
https://doi.org/10.26650/JARHS2021-945653

Öz

The COVID-19 pandemic causes an increase in oral health inequalities, restriction of oral health promotion programs and preventive oral health services for the community. According to the common risk approach, oral health services should be integrated into primary health care services in order to manage oral diseases that share the same risk factors with chronic systemic diseases. Multidisciplinary studies should be focused on public health practices by adopting the “One Health” concept. In order to increase the popuation based oral health outcomes, there is a need for oral health promotion programs that take into account the cooperation between sectors, working flexibility, capacity,the ethical rules of social justice, equality and human rights within the framework of the biopsychosocial approach. Information technologies and social media networks should be used to increase the literacy of the population on “COVID-19 and Oral Health”. In this period, it is also important to carry out oral health needs assessment at population level through surveillance and public health studies. Priority should be given to programs for the protection and improvement of oral health among disadvantaged groups, children and the elderly who have difficulty in accessing oral health services due to limitation of movement and social determinants of health.

Kaynakça

  • 1. WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19 -11 March 2020. (Cited 12.04.2021) Available from URL: https://www.who.int/directorgeneral/ speeches/detail/who-director-generalsopening- remarks-at-the-media-briefingoncovid- 19---11-march-2020.
  • 2. Ghani F. Covid-19 Outbreak - Immediate and long-term impacts on the dental profession. Pak J Med Sci 2020;36(COVID19-S4):126-9.
  • 3. Mascitti M, Campisi G. Dental Public Health Landscape: Challenges, Technological Innovation and Opportunities in the 21st Century and COVID-19 Pandemic. Int J Environ Res Public Health 2020;17:3636.
  • 4. Mantas J. The Importance of Health Informatics in Public Health During the COVID-19 Pandemic. Stud Health Technol Inform 2020;272:487-8.
  • 5. Sycinska-Dziarnowska M, Paradowska- Stankiewicz I. Dental Challenges and the Needs of the Population during the Covid-19 Pandemic Period. Real-Time Surveillance Using Google Trends. Int J Environ Res Public Health 2020;17(23):8999.
  • 6. Kathree BA, Khan SB, Ahmed R, Maart R, Layloo N, Asia-Michaels W. COVID-19 and its impact in the dental setting: A scoping review. PLoS ONE 2020;15(12): e0244352
  • 7. Elster N, Parsi, K. Oral Health Matters: The Ethics of Providing Oral Health During COVID-19. HEC Forum 2021; 33(1-2):157-64.
  • 8. Watt RG. COVID-19 is an opportunity for reform in dentistry. Lancet 2020; 15;396(10249):462.
  • 9. Singh S. Public Oral Health Care During COVID-19: Time for Reflection and Action. Front Med (Lausanne) 2021;8:610450.
  • 10. Daly J, Black EAM. The impact of COVID-19 on population oral health. Community Dent Health 2020;37(4):236-8.
  • 11. Shamsoddin E, DeTora LM, Tovani-Palone MR, Bierer BE. Dental Care in Times of the COVID-19 Pandemic: A Review. Med Sci 2021;9(1):13.
  • 12. WHO. Considerations for the provision of essential oral health services in the context of COVID-19. (Cited 21.04.2021) Available from URL: https://www.who.int/publications/i/item/ who-2019-nCoV-oral-health-2020.1.
  • 13. Benzian H, Beltrán-Aguilar E, Mathur MR, Niederman R. Pandemic Considerations on Essential Oral Health Care. J Dent Res 2021;100(3):221-5.
  • 14. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med 2020; 8(7): 659–61.
  • 15. Schwendicke F, Krois J, Gomez J. Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis. J Dent 2020;99:103387.
  • 16. Brian Z, Weintraub JA. Oral Health and and Access. Prev Chronic Dis 2020;17:E82. Erratum in: Prev Chronic Dis 2020;17:E93.
  • 17. Kalash DA. How COVID-19 deepens child oral health inequities. J Am Dent Assoc 2020;151(9):643-5.
  • 18. Westgarth, D. COVID-19 and Community Dental Services: The challenges ahead. BDJ In Pract 2020;33: 14–9.
  • 19. Şahin B, İlgün G. Assessment of the efficiency of dental services in Turkey. Health Policy Technol 2018: 7(2): 173–81.
  • 20. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. 2019 Yılı Birim Faaliyet Raporu. (Cited 15.03.2021) Available from URL: https:// hsgm.saglik.gov.tr/depo/birimler/izlemedegerlendirme- db/faaliyet-raporu/2019_DDB_ BRM_FAALYET_RAPORU.pdf.
  • 21. Üstün N, Akgöl BB, Bayram M. Influence of COVID-19 pandemic on paediatric dental attendance. Clin Oral Investig 2021;30:1–7.
  • 22. Luo W, Lee GHM, Nalabothu P, Kumar H. Paediatric dental care during and post- COVID-19 era: Changes and challenges ahead. Pediatr Dent J 2021;31(1):33-42.
  • 23. León S, Giacaman RA. COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms. JDR Clin Trans Res 2020;5(4):290-2.
  • 24. Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J 2020; 32(4): 181–6.
  • 25. Scrapping PHE, a threat to oral health?. Br Dent J 2020;229(5):272.
  • 26. Bains R, Bains VK. Oral health care, COVID-19 and challenges. J Global Oral Health 2020;3(2):130-6.
  • 27. Silva Dayane Helen Ferreira, Camargos Júlia Hinkelmann de, Rodrigues Jefferson Guimarães, Nogueira Leilismara Sousa, Azevedo Dênia Alves de, Carvalho Maria das Graças et al . Impact of oral hygiene in patients undergoing mechanical ventilation in the COVID-19 pandemic. Rev. Assoc. Med. Bras. [Internet]. 2020 [cited 2021 May 06] ;66( Suppl 2 ): 96-101.
  • 28. Sampson V. Oral hygiene risk factor. Br Dent J 2020;228(8):569.
  • 29. Moosavi MS, Aminishakib P, Ansari M. Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach. J Oral Microbiol 2020;12(1):1794363.
  • 30. Cavalcante-Leão BL, de Araujo CM, Basso IB, Schroder AG, Guariza-Filho O, Ravazzi GC, Gonçalves FM, Zeigelboim BS, Santos RS, Stechman-Neto J. Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? A systematic review. J Clin Exp Dent 2021;13(2):179-89.
  • 31. Lloyd-Jones G, Molayem S, Pontes CC, Chapple I. The COVID-19 Pathway: A Proposed Oral- Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures. J Oral Med and Dent Res 2021; 2(1):1- 25.
  • 32. Dental Health Foundation Ireland. Tooth Brushing Coronavirus and COVID 19. Available from: www.dentalhealth.ie/assets/files/pdf/ toothbrushes_-_covid_19_april_2020.pdf. (Alıntılama tarihi 10.02.2021).
  • 33. Canadian Dental Hygienists Association. Caring for Your Oral Health During the COVID-19 Pandemic. The Canadian Dental Hygenist Assosiation. (Cited 10.02.2021) Available from URL:https://www.dentalhygienecanada.ca/ dhcanada/DHCanada/Preventive_Oral_Care/ Oral_Health_During_COVID19.aspx.
  • 34. FDI. Fact sheet: Protect your oral health during the COVID-19 pandemic. (Cited 10.03.2021) Available from URL:https:// www.worldoralhealthday.org/sites/default/ files/2021-01/WOHD21-factsheet-covid19-EN. pdf.
  • 35. FDI. As COVID-19 shifts learning online, FDI supports parents and teachers with digital resources on oral health education. (Cited 10.03.2021) Available from URL:https:// https:// www.fdiworlddental.org/covid-19-shiftslearning- online-fdi-supports-parents-andteachers- digital-resources-oral-health.
  • 36. Wang Y, Zhou CC, Shu R, Zou J. Oral Health Management of Children during the Epidemic Period of Coronavirus Disease 2019. Sichuan Da Xue Xue Bao Yi Xue Ban 2020;51(2):151-4.
  • 37. da Costa CB, Peralta FDS, Ferreira de Mello ALS. How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review. Telemed J E Health 2020;26(7):945-54.
  • 38. Maret D, Peters OA, Vaysse F, Vigarios E. Integration of telemedicine into the public health response to COVID-19 must include dentists. Int Endod J 2020;53(6):880-1.
  • 39. Telles-Araujo GT, Caminha RDG, Kallás MS, Santos PSDS. Teledentistry support in COVID-19 oral care. Clinics (Sao Paulo) 2020;75:e2030.
  • 40. Tao Z, Chu G, McGrath C, Hua F, Leung YY, Yang W, Su Y. Nature and Diffusion of COVID-19– related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo. J Med Internet Res 2020;22(6):e19981.
  • 41. Boon-Itt S, Skunkan Y. Public Perception of the COVID-19 Pandemic on Twitter: Sentiment Analysis and Topic Modeling Study. JMIR Public Health Surveill 2020;6(4):e21978.
  • 42. TDB. Türk Dişhekimleri Birliği Diş Hekimliği Meslek Etiği Kuralları. Türk Diş hekimleri Birliği Yayınları- Mevzuat Dizisi, Ekim 2013, Ankara.
  • 43. ADA. Guidance on Continuing to Practice Ethically during COVID-19. (Cited 10.02.2021) Available from URL:https://success.ada.org/~/ media/CPS/Files/COVID/ADA_COVID_ How_Do_I_Ethically_See_Patients_During_ Pandemic.pdf.
  • 44. Ethics Subcommittee of the Council on Ethics, Bylaws and Judicial Affairs. Ethical practice during the COVID-19 pandemic. J Am Dent Assoc 2020;151(5):377-8.
  • 45. Saxena A, Bouvier PA, Shamsi-Gooshki E, Köhler J, Schwartz LJ. WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal. J Med Ethics 2021:106959.
  • 46. Pan American Health Organization.Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic. (Cited 20.02.2021) Available from URL: https:// iris.paho.org/handle/10665.2/52091.
  • 47. Seneviratne CJ, Lau MWJ, Goh BT. The Role of Dentists in COVID-19 Is Beyond Dentistry: Voluntary Medical Engagements and Future Preparedness. Front Med (Lausanne) 2020;7:566.
  • 48. Jorwal P, Bharadwaj S, Jorwal P. One health approach and COVID-19: A perspective. J Family Med Prim Care 2020;9(12):5888-91.
  • 49. Liu C, Onudiwe F. The ‘new normal’ in oral health promotion. Br Dent J 2020;229(10):641- 2.
Toplam 49 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Diş Hekimliği
Bölüm Derleme
Yazarlar

Kadriye Peker 0000-0003-1436-6508

Gülsüm Ak 0000-0002-3339-1568

Özen Onur 0000-0003-3659-4464

Sabire Deger İşler 0000-0002-1455-2127

Mustafa Mert Açıkgöz 0000-0002-2346-1622

Yayımlanma Tarihi 31 Ekim 2021
Gönderilme Tarihi 31 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 4 Sayı: S-1

Kaynak Göster

MLA Peker, Kadriye vd. “Covıd-19 Pandemisinin Toplum Ağız Diş Sağlığına Etkileri Ve Etik Sorunlar”. Sağlık Bilimlerinde İleri Araştırmalar Dergisi, c. 4, sy. S-1, 2021, ss. 83-95, doi:10.26650/JARHS2021-945653.