Araştırma Makalesi
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SOSYOEKONOMİK DÜZEYİ DÜŞÜK BÖLGELERDE KONUT KOŞULLARI VE OKUL ÇAĞI ÇOCUKLARININ SAĞLIĞI İLE İLİŞKİSİ

Yıl 2020, Cilt: 6 Sayı: 2, 192 - 210, 31.08.2020

Öz

Konut koşulları çocukların sağlığı üzerine etkilidir. Kesitsel nitelikteki araştırma 15.10.2017-30.04.2018’de bir ilin sosyoekonomik düzeyi düşük bölgelerinde konut koşulları ve ilkokul çocuklarının sağlığı ile ilişkisini değerlendirmek amacıyla gerçekleştirildi. Tanıtıcı Özellikler Formu, Çocuk Sağlığı Anketi, fizik muayene ve Konut Değerlendirme Formu kullanılarak 95 öğrenci ve yaşadıkları konutların incelenmesinden elde edilen veriler, tanımlayıcı istatistikler, Kruskal-Wallis Testi, Mann-Whitney-U, Korelasyon analizleriyle değerlendirildi. Öğrencilerin yaşı 7,77±1,54 yıl, yarısı kız (%54), aile geliri 1800 ₺’dir. Öğrencilerin %89,4’ünde bir veya daha fazla sağlık sorunu mevcuttur. Gecekondular en düşük konut uygunluk puanına sahiptir. Konutlara ilişkin en sık saptanan sorunlar konut dışında yeterli aktivite alanının olmaması, konut içinde güvenlik ve yapıya ilişkindir. Toplam konut uygunluk puanı ile ağrı (r=-0,204), fiziksel sağlık sorunları nedeniyle rol ve sosyal kısıtlılık (r=-0,315) ve aile uyumu puanı (r=0,302) ilişkilidir (p<0,05). Konut uygunluk puanı mevcut sağlık problemi saptanmayan çocuklarda daha yüksekse de, gruplar arasında fark yoktur. Gelir, konut uygunluğu ve aile uyumuyla; aile uyumu da çocuğun psikososyal sağlığıyla ilişkilidir (p<0,05). Konut uygunluğunda gelir temel belirleyicidir. Okul çağı çocuklarının sağlığında konutlar katalizör etkiye sahiptir. Çocukların sağlığını korumak ve aile uyumunu sürdürmek için toplumsal etmenlerden kaynaklı eşitsizlikleri azaltmaya yönelik sosyal politikalar geliştirilmelidir. Gecekondu tipi konutlar sosyal yardımlarla iyileştirilmelidir. Birinci basamakta hemşireler tarafından ev ziyaretleri yapılarak konutlardaki risk faktörlerini önlemeye yönelik ailelere eğitimlerin verilmesi önerilir.

Destekleyen Kurum

Yoktur

Proje Numarası

Yoktur.

Teşekkür

-

Kaynakça

  • World Health Organisation. WHO housing and health guidelines. 2018:2-12. https://apps.who.int/iris/bitstream/handle/10665/276001/9789241550376-eng.pdf?ua=1
  • Eurostat. Archive:Housing conditions - Statistics Explained. 2014. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Archive:Housing_conditions&oldid=329485
  • Boch SJ, Taylor DM, Danielson ML, Chisolm DJ, Kelleher KJ. ‘Home is where the health is’: Housing quality and adult health outcomes in the survey of income and program participation. Prev Med (Baltim). 2020;132:105990.
  • Shah SN, Fossa A, Steiner AS, Kane J, Levy JI, Adamkiewicz G, et al. Housing Quality and Mental Health: the Association between Pest Infestation and Depressive Symptoms among Public Housing Residents. J Urban Heal. 2018 Oct;95(5):691–702.
  • DCLG. English Housing Survey. Communities. 2015;1–73. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/860076/2018-19_EHS_Headline_Report.pdf
  • Aitken D, Hodgson P, Cook G, Lawson A. Facework and trust in facilitating healthfocused housing interventions. PLoS One. 2017;12(4):1–15.
  • E. Nalçacı, O. Hamzaoğlu EÖ. Eleştirel Sağlık Sosyolojisi Sözlüğü. Nazım Kitaplığı, 1.Baskı, İstanbul 2006.
  • Hood E. Dwelling disparities: How poor housing leads to poor health. Environ Health Perspect. 2005 May;113(5):A310.
  • T.C. Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2018. https://dosyasb.saglik.gov.tr/Eklenti/36134,siy2018trpdf.pdf?0
  • American Public Health Association, National Healthy Housing Standard,2014. https://www.apha.org/-/media/files/pdf/factsheets/national_healthy_housing_standard.ashx?la=en&hash=2327FDCB656995F0AA232E5DBDF39131F2E33C4A
  • Şahiner P, Özkan Ö, Hamzaoğlu O. Kocaeli ilindeki sosyoekonomik düzeyi düşük hanelerde ev kazası insidansı ve risk faktörleri. TAF Preventive Medicine Bullletin. 2011;10(3):257-268
  • World Health Organization. International Workshop on Housing , Health and Climate Change : Developing guidance for health protection in the built environment ­ mitigation and adaptation responses Meeting report. 2010. https://www.who.int/hia/house_report.pdf
  • Berberoğlu U. Konut sağlığı. Akbaba M, ed. Halk sağlığı bakış açısı ile çevre sağlığı. 1. Baskı. Ankara: Türkiye Klinikleri. 2019;97-101.
  • Bureau NC. Housing and the health of young children: policy and evidence briefing for the VCSE sector. 2016. https://www.ncb.org.uk/sites/default/files/field/attachment/Housing%20and%20the%20Health%20of%20Young%20Children.pdf
  • Oudin A, Richter JC, Taj T, Al-Nahar L, Jakobsson K. Poor housing conditions in association with child health in a disadvantaged immigrant population: A cross-sectional study in Rosengård, Malmö, Sweden. BMJ Open. 2016;6(1):1-9.
  • Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric asthma health disparities: race, hardship, housing, and asthma in a national survey. Acad Pediatr. 2017;17(2):127–34.
  • Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, et al. Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions. Indoor Air. 2017;27(2):478–86.
  • Cai J, Li B, Yu W, Wang H, Du C, Zhang Y, et al. Household dampness-related exposures in relation to childhood asthma and rhinitis in China : A multicentre observational study. Environ Int. 2019;126:735–46.
  • Curl A, Kearns A, Mason P, Egan M, Tannahill C, Ellaway A. Physical and mental health outcomes following housing improvements : Evidence from the GoWell study. 2015;12–9.
  • Türkiye İstatistik Kurumu. İstatistiklerle Çocuk. 2014. http://www.tuik.gov.tr/PreHaberBultenleri.do;jsessionid=x2TpX8phG2W8yLkRcX4VfTQbCd6Qmm0jdRfm79W3htb55r1mkk1r!85161143?id=18622
  • S. Topuz, Ö. Ülger, B. Elbasan, H. Yakut YA. Türkiye’de farklı engellere sahip çocukların annelerinin yaşam kalitesinin ve psikososyal destek ihtiyaçlarının araştırılması: Pilot çalışma. Turk J Physiother Rehabil. 2014; 25(2):63-71.
  • Hepner KA, Sechrest L, Bissell K. Confirmatory factor analysis of the Child Health Questionnaire-Parent Form 50 in a predominantly minority sample. Qual Life Res. 2002;11(8):763–73.
  • Westendorp T, Verbunt JA, Remerie SC, Smeets RJEM. Responsiveness of the Child Health Questionnaire-Parent Form in adolescents with non-specific chronic pain or fatigue. Eur J Pain (United Kingdom). 2014;18(4):540–7.
  • Kırman A. İşitme Engelli Çocuk ve Adölesanların Sağlık Durumlarını Etkileyen Etmenlerin Belirlenmesi. Dokuz Eylül Üniversitesi Sağlık Bilimleri Enstitüsü Çocuk Sağlığı ve Hastalıkları Hemşireliği Yüksek Lisans Tezi, İzmir 2009.
  • Mood EW. APHA-CDC : Recommended Minimum Housing Standards. 1986;1–81. http://nchharchive.org/LinkClick.aspx?fileticket=uGqGpbBc2h4%3D&tabid=550
  • Umumi Hıfzısıhha Kanunu. 1930. 6/5/1930 tarih 1489 Sayılı Resmi Gazete. https://www.mevzuat.gov.tr/MevzuatMetin/1.3.1593.pdf
  • Ç. Güler ZÇ. Çevre Sağlığı Temel Kaynak Dizisi No:10 Konut Sağlığı. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü. 1994.
  • World Health Organization. WHO| BMI-for-age (5-19 years). WHO 2007 https://www.who.int/growthref/who2007_bmi_for_age/en/
  • Neira M, Prüss-Ustün A. Preventing disease through healthy environments: A global assessment of the environmental burden of disease. Toxicol Lett. 2016;259:S1.
  • Yalpır Ş, Bünyan Ünel F. Investigation and reduction of criteria affecting the value of land plot in turkey and ınternational standards by factor analysis. Afyon Kocatepe Univ J Sci Eng. 2016;16(2):303–22.
  • Ari I, Yıkmaz RF, Ustunisik B, Rahmanlar M, Altınsoy S, Yılmaz SA, et al. Sürdürülebilir Kalkınma Amaçları Değerlendirme Raporu. Türkiye Cumhuriyeti Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı. 2019. http://www.sbb.gov.tr/wp-content/uploads/2020/03/Surdurulebilir-Kalkinma-Amaclari-Degerlendirme-Raporu_13_12_2019-WEB.pdf
  • Yılmaz V. Introduction: Social policies and social inequalities in contemporary Turkey. Res Policy Turkey. 2018;3(2):103–14.
  • Turley R, Saith R, Bhan N, Rehfuess E CB. Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socioeconomic outcomes. Individ Place Support. 2013;72–7.
  • Marí-Dell’Olmo M, Novoa AM, Camprubí L, Peralta A, Vásquez-Vera H, Bosch J, et al. Housing policies and health ınequalities. Int J Heal Serv. 2017;47(2):207–32.
  • Ramírez-Hernández H, Perera-Rios J, May-Euán F, Uicab-Pool G, Peniche-Lara G, Pérez-Herrera N. Environmental risks and children’s health in a Mayan community from southeast of Mexico. Ann Glob Heal. 2018;84(2):292–9.
  • Türkiye İstatistik Kurumu. İstatistiklerle Aile, 2018.
  • World Health Organization. WHO Guidelines for indoor air quality: Household fuel combustion. WHO 2018. https://www.who.int/airpollution/guidelines/household-fuel-combustion/en/
  • Banwarth P, Barnhill V, Blatt M, Brown A, Deas J, Dyer G, et al. Regional Health Assessment Linn , Benton , & Lincoln Counties, Oregon. Regional Health Assessment. 2015. https://www.co.benton.or.us/sites/default/files/fileattachments/health_department/page/201/regional_health_assessment_final_pdf.pdf
  • Braubach M, Jacobs DE, Ormandy D. Environmental burden of disease associated with inadequate housing: Methods for quantifying health impacts of selected housing risks in the WHO European Region. WHO Reg Off Eur. 2011;238. http://www.euro.who.int/__data/assets/pdf_file/0003/142077/e95004.pdf
  • Ruan H, Xun P, Cai W, He K, Tang Q. Habitual sleep duration and risk of childhood obesity: Systematic review and dose-response meta-analysis of prospective cohort studies. Sci Rep. 2015;5:1–14.
  • CDC. Toilets & Latrines | Global Water, Sanitation and Hygiene | Healthy Water | CDC. 2015. https://www.cdc.gov/healthywater/global/sanitation/toilets.html
  • Thomson H, Thomas S, Sellstrom E PM. Housing improvements for health and associated socio- economic outcomes (Review). ResearchOnline. 2013;61(1):27–37.
  • Chambers EC, Pichardo MS, Rosenbaum E. Sleep and the housing and neighborhood environment of urban latino adults living in low-ıncome housing: The AHOME Study. Behav Sleep Med. 2016;14(2):169–84.
  • Pevalin DJ, Reeves A, Baker E, Bentley R. The impact of persistent poor housing conditions on mental health: A longitudinal population-based study. Prev Med (Baltim). 2017;105:304–10.
  • Christian H, Zubrick SR, Foster S, Giles-Corti B, Bull F, Wood L, et al. The influence of the neighborhood physical environment on early child health and development: A review and call for research. Health Place. 2015;33:25–36.
  • Villanueva K, Badland H, Kvalsvig A, O’Connor M, Christian H, Woolcock G, et al. Can the neighborhood built environment make a difference in children’s development? Building the research agenda to create evidence for place-based children’s policy. Academic Pediatrics. Elsevier Inc. 2016:16;10–9.
Yıl 2020, Cilt: 6 Sayı: 2, 192 - 210, 31.08.2020

Öz

Proje Numarası

Yoktur.

Kaynakça

  • World Health Organisation. WHO housing and health guidelines. 2018:2-12. https://apps.who.int/iris/bitstream/handle/10665/276001/9789241550376-eng.pdf?ua=1
  • Eurostat. Archive:Housing conditions - Statistics Explained. 2014. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Archive:Housing_conditions&oldid=329485
  • Boch SJ, Taylor DM, Danielson ML, Chisolm DJ, Kelleher KJ. ‘Home is where the health is’: Housing quality and adult health outcomes in the survey of income and program participation. Prev Med (Baltim). 2020;132:105990.
  • Shah SN, Fossa A, Steiner AS, Kane J, Levy JI, Adamkiewicz G, et al. Housing Quality and Mental Health: the Association between Pest Infestation and Depressive Symptoms among Public Housing Residents. J Urban Heal. 2018 Oct;95(5):691–702.
  • DCLG. English Housing Survey. Communities. 2015;1–73. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/860076/2018-19_EHS_Headline_Report.pdf
  • Aitken D, Hodgson P, Cook G, Lawson A. Facework and trust in facilitating healthfocused housing interventions. PLoS One. 2017;12(4):1–15.
  • E. Nalçacı, O. Hamzaoğlu EÖ. Eleştirel Sağlık Sosyolojisi Sözlüğü. Nazım Kitaplığı, 1.Baskı, İstanbul 2006.
  • Hood E. Dwelling disparities: How poor housing leads to poor health. Environ Health Perspect. 2005 May;113(5):A310.
  • T.C. Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2018. https://dosyasb.saglik.gov.tr/Eklenti/36134,siy2018trpdf.pdf?0
  • American Public Health Association, National Healthy Housing Standard,2014. https://www.apha.org/-/media/files/pdf/factsheets/national_healthy_housing_standard.ashx?la=en&hash=2327FDCB656995F0AA232E5DBDF39131F2E33C4A
  • Şahiner P, Özkan Ö, Hamzaoğlu O. Kocaeli ilindeki sosyoekonomik düzeyi düşük hanelerde ev kazası insidansı ve risk faktörleri. TAF Preventive Medicine Bullletin. 2011;10(3):257-268
  • World Health Organization. International Workshop on Housing , Health and Climate Change : Developing guidance for health protection in the built environment ­ mitigation and adaptation responses Meeting report. 2010. https://www.who.int/hia/house_report.pdf
  • Berberoğlu U. Konut sağlığı. Akbaba M, ed. Halk sağlığı bakış açısı ile çevre sağlığı. 1. Baskı. Ankara: Türkiye Klinikleri. 2019;97-101.
  • Bureau NC. Housing and the health of young children: policy and evidence briefing for the VCSE sector. 2016. https://www.ncb.org.uk/sites/default/files/field/attachment/Housing%20and%20the%20Health%20of%20Young%20Children.pdf
  • Oudin A, Richter JC, Taj T, Al-Nahar L, Jakobsson K. Poor housing conditions in association with child health in a disadvantaged immigrant population: A cross-sectional study in Rosengård, Malmö, Sweden. BMJ Open. 2016;6(1):1-9.
  • Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric asthma health disparities: race, hardship, housing, and asthma in a national survey. Acad Pediatr. 2017;17(2):127–34.
  • Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, et al. Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions. Indoor Air. 2017;27(2):478–86.
  • Cai J, Li B, Yu W, Wang H, Du C, Zhang Y, et al. Household dampness-related exposures in relation to childhood asthma and rhinitis in China : A multicentre observational study. Environ Int. 2019;126:735–46.
  • Curl A, Kearns A, Mason P, Egan M, Tannahill C, Ellaway A. Physical and mental health outcomes following housing improvements : Evidence from the GoWell study. 2015;12–9.
  • Türkiye İstatistik Kurumu. İstatistiklerle Çocuk. 2014. http://www.tuik.gov.tr/PreHaberBultenleri.do;jsessionid=x2TpX8phG2W8yLkRcX4VfTQbCd6Qmm0jdRfm79W3htb55r1mkk1r!85161143?id=18622
  • S. Topuz, Ö. Ülger, B. Elbasan, H. Yakut YA. Türkiye’de farklı engellere sahip çocukların annelerinin yaşam kalitesinin ve psikososyal destek ihtiyaçlarının araştırılması: Pilot çalışma. Turk J Physiother Rehabil. 2014; 25(2):63-71.
  • Hepner KA, Sechrest L, Bissell K. Confirmatory factor analysis of the Child Health Questionnaire-Parent Form 50 in a predominantly minority sample. Qual Life Res. 2002;11(8):763–73.
  • Westendorp T, Verbunt JA, Remerie SC, Smeets RJEM. Responsiveness of the Child Health Questionnaire-Parent Form in adolescents with non-specific chronic pain or fatigue. Eur J Pain (United Kingdom). 2014;18(4):540–7.
  • Kırman A. İşitme Engelli Çocuk ve Adölesanların Sağlık Durumlarını Etkileyen Etmenlerin Belirlenmesi. Dokuz Eylül Üniversitesi Sağlık Bilimleri Enstitüsü Çocuk Sağlığı ve Hastalıkları Hemşireliği Yüksek Lisans Tezi, İzmir 2009.
  • Mood EW. APHA-CDC : Recommended Minimum Housing Standards. 1986;1–81. http://nchharchive.org/LinkClick.aspx?fileticket=uGqGpbBc2h4%3D&tabid=550
  • Umumi Hıfzısıhha Kanunu. 1930. 6/5/1930 tarih 1489 Sayılı Resmi Gazete. https://www.mevzuat.gov.tr/MevzuatMetin/1.3.1593.pdf
  • Ç. Güler ZÇ. Çevre Sağlığı Temel Kaynak Dizisi No:10 Konut Sağlığı. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü. 1994.
  • World Health Organization. WHO| BMI-for-age (5-19 years). WHO 2007 https://www.who.int/growthref/who2007_bmi_for_age/en/
  • Neira M, Prüss-Ustün A. Preventing disease through healthy environments: A global assessment of the environmental burden of disease. Toxicol Lett. 2016;259:S1.
  • Yalpır Ş, Bünyan Ünel F. Investigation and reduction of criteria affecting the value of land plot in turkey and ınternational standards by factor analysis. Afyon Kocatepe Univ J Sci Eng. 2016;16(2):303–22.
  • Ari I, Yıkmaz RF, Ustunisik B, Rahmanlar M, Altınsoy S, Yılmaz SA, et al. Sürdürülebilir Kalkınma Amaçları Değerlendirme Raporu. Türkiye Cumhuriyeti Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı. 2019. http://www.sbb.gov.tr/wp-content/uploads/2020/03/Surdurulebilir-Kalkinma-Amaclari-Degerlendirme-Raporu_13_12_2019-WEB.pdf
  • Yılmaz V. Introduction: Social policies and social inequalities in contemporary Turkey. Res Policy Turkey. 2018;3(2):103–14.
  • Turley R, Saith R, Bhan N, Rehfuess E CB. Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socioeconomic outcomes. Individ Place Support. 2013;72–7.
  • Marí-Dell’Olmo M, Novoa AM, Camprubí L, Peralta A, Vásquez-Vera H, Bosch J, et al. Housing policies and health ınequalities. Int J Heal Serv. 2017;47(2):207–32.
  • Ramírez-Hernández H, Perera-Rios J, May-Euán F, Uicab-Pool G, Peniche-Lara G, Pérez-Herrera N. Environmental risks and children’s health in a Mayan community from southeast of Mexico. Ann Glob Heal. 2018;84(2):292–9.
  • Türkiye İstatistik Kurumu. İstatistiklerle Aile, 2018.
  • World Health Organization. WHO Guidelines for indoor air quality: Household fuel combustion. WHO 2018. https://www.who.int/airpollution/guidelines/household-fuel-combustion/en/
  • Banwarth P, Barnhill V, Blatt M, Brown A, Deas J, Dyer G, et al. Regional Health Assessment Linn , Benton , & Lincoln Counties, Oregon. Regional Health Assessment. 2015. https://www.co.benton.or.us/sites/default/files/fileattachments/health_department/page/201/regional_health_assessment_final_pdf.pdf
  • Braubach M, Jacobs DE, Ormandy D. Environmental burden of disease associated with inadequate housing: Methods for quantifying health impacts of selected housing risks in the WHO European Region. WHO Reg Off Eur. 2011;238. http://www.euro.who.int/__data/assets/pdf_file/0003/142077/e95004.pdf
  • Ruan H, Xun P, Cai W, He K, Tang Q. Habitual sleep duration and risk of childhood obesity: Systematic review and dose-response meta-analysis of prospective cohort studies. Sci Rep. 2015;5:1–14.
  • CDC. Toilets & Latrines | Global Water, Sanitation and Hygiene | Healthy Water | CDC. 2015. https://www.cdc.gov/healthywater/global/sanitation/toilets.html
  • Thomson H, Thomas S, Sellstrom E PM. Housing improvements for health and associated socio- economic outcomes (Review). ResearchOnline. 2013;61(1):27–37.
  • Chambers EC, Pichardo MS, Rosenbaum E. Sleep and the housing and neighborhood environment of urban latino adults living in low-ıncome housing: The AHOME Study. Behav Sleep Med. 2016;14(2):169–84.
  • Pevalin DJ, Reeves A, Baker E, Bentley R. The impact of persistent poor housing conditions on mental health: A longitudinal population-based study. Prev Med (Baltim). 2017;105:304–10.
  • Christian H, Zubrick SR, Foster S, Giles-Corti B, Bull F, Wood L, et al. The influence of the neighborhood physical environment on early child health and development: A review and call for research. Health Place. 2015;33:25–36.
  • Villanueva K, Badland H, Kvalsvig A, O’Connor M, Christian H, Woolcock G, et al. Can the neighborhood built environment make a difference in children’s development? Building the research agenda to create evidence for place-based children’s policy. Academic Pediatrics. Elsevier Inc. 2016:16;10–9.
Toplam 46 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Emine Öncü

Ezgi Önen Bu kişi benim 0000-0003-2083-8225

Sümbüle Köksoy Vayısoğlu 0000-0002-3302-037X

Proje Numarası Yoktur.
Yayımlanma Tarihi 31 Ağustos 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 6 Sayı: 2

Kaynak Göster

APA Öncü, E., Önen, E., & Köksoy Vayısoğlu, S. (2020). SOSYOEKONOMİK DÜZEYİ DÜŞÜK BÖLGELERDE KONUT KOŞULLARI VE OKUL ÇAĞI ÇOCUKLARININ SAĞLIĞI İLE İLİŞKİSİ. International Anatolia Academic Online Journal Health Sciences, 6(2), 192-210.

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