{"id":28651,"date":"2024-06-29T14:51:27","date_gmt":"2024-06-29T11:51:27","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=28651"},"modified":"2024-06-29T15:32:00","modified_gmt":"2024-06-29T12:32:00","slug":"biyopsikososyal-karsilastirma","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2024\/06\/29\/biyopsikososyal-karsilastirma\/","title":{"rendered":"COVID-19 ve Kronik \u0130nfeksiyonu Olan Hastalar\u0131n Biyopsikososyal A\u00e7\u0131dan Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

D\u00fcnyada son 20 y\u0131lda, t\u00fcberk\u00fcloz (TB), hepatit, insan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi virusu (HIV) gibi kronik infeksiyon hastal\u0131klar\u0131na Ebola virusu hastal\u0131\u011f\u0131, \u015fiddetli akut solunum yolu sendromu (severe acute respiratory syndrome-SARS), H5N1 kaynakl\u0131 ku\u015f gribi (avian influenza), Orta Do\u011fu solunum sendromu (Middle East respiratory syndrome-MERS) ve koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) eklenmi\u015ftir (1). Bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n birey ve toplum \u00fczerinde \u00e7ok y\u00f6nl\u00fc etkileri vard\u0131r. Sa\u011fl\u0131k bak\u0131m\u0131na uyum, ev-aile ve geni\u015f aile ili\u015fkisi, mesleki ve sosyal \u00e7evre, cinsel ili\u015fkiler ve psikososyal bask\u0131 alanlar\u0131n\u0131 i\u00e7eren \u00e7ok boyutlu yap\u0131, hastal\u0131\u011fa psikososyal uyum olarak tan\u0131mlan\u0131r (2). Literat\u00fcrde, bula\u015f\u0131c\u0131 hastal\u0131\u011f\u0131 olan ki\u015filerin psikososyal uyumundan \u00e7ok psikolojik morbiditeyi tan\u0131mlamaya odaklan\u0131ld\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Yap\u0131lan \u00e7al\u0131\u015fmalarda, COVID-19 nedeniyle hastanede tedavi g\u00f6ren hastalarda; %22.4 ila %55.3 aras\u0131ndaki oranlarda kayg\u0131 bozuklu\u011fu, %28.4 ila %60.2 aras\u0131ndaki oranlarda depresyon semptomlar\u0131 bildirilmi\u015ftir (3-5). K\u00fcresel d\u00fczeyde, HIV\/AIDS hastalar\u0131nda depresyon (%30.31) ve madde ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 (%25.13) en s\u0131k olmak \u00fczere psikiyatrik bozukluklar\u0131n genel n\u00fcfusa g\u00f6re daha yayg\u0131n oldu\u011fu g\u00f6sterilmi\u015ftir (6). Kronik hepatit B ve hepatit C hastalar\u0131nda psikiyatrik morbidite oran\u0131n\u0131n %48.6 oldu\u011fu saptanm\u0131\u015ft\u0131r (7). T\u00fcberk\u00fcloz hastalar\u0131n\u0131n %26\u2019s\u0131nda kayg\u0131 bozuklu\u011fu, %60.5\u2019inde depresyon, %49\u2019unda yaln\u0131zl\u0131k belirlenmi\u015f ve hastalar\u0131n %47.6\u2019s\u0131n\u0131n damgalamaya maruz kald\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r (8). Yine TB hastalar\u0131yla yap\u0131lan ba\u015fka bir \u00e7al\u0131\u015fmada, psikolojik s\u0131k\u0131nt\u0131 prevalans\u0131 %63.3 olup damgalanma ile psikolojik s\u0131k\u0131nt\u0131 aras\u0131nda ili\u015fki oldu\u011fu bildirilmi\u015ftir (9). Yap\u0131lan \u00e7al\u0131\u015fmalarda, COVID-19 da dahil olmak \u00fczere bula\u015f\u0131c\u0131 hastal\u0131klarda damgalanman\u0131n yayg\u0131nl\u0131\u011f\u0131 ve ruh sa\u011fl\u0131\u011f\u0131 \u00fczerine olumsuz etkisi ortaya konulmu\u015ftur (10).<\/p>\n

Hastalar\u0131n ruh sa\u011fl\u0131\u011f\u0131n\u0131 etkileyen fakt\u00f6rlerden biri de hastal\u0131\u011f\u0131 nas\u0131l alg\u0131lad\u0131klar\u0131 yani bireyin mevcut hastal\u0131\u011f\u0131na bak\u0131\u015f a\u00e7\u0131s\u0131d\u0131r.\u00a0Hastal\u0131k alg\u0131lama modeli; bireylerin bir sa\u011fl\u0131k tehdidi veya tan\u0131 s\u0131ras\u0131nda semptom ve deneyimlerini nas\u0131l anlamland\u0131rd\u0131klar\u0131n\u0131 ve sonras\u0131nda belirli ba\u015fa \u00e7\u0131kma davran\u0131\u015flar\u0131n\u0131 nas\u0131l takip ettiklerini a\u00e7\u0131klayan bir \u00e7er\u00e7eveyi temsil etmektedir. Bireyler hastal\u0131klar\u0131n\u0131 kendilerine a\u00e7\u0131klamaya ve hastal\u0131k durumlar\u0131n\u0131 y\u00f6netmeye yard\u0131mc\u0131 olmak i\u00e7in hastal\u0131klar\u0131n\u0131n soyut temsillerini olu\u015ftururlar. Bu temsiller, hastal\u0131\u011fa ili\u015fkin bili\u015fsel ve duygusal deneyimlere, ya\u015fanan semptomlara, hastal\u0131\u011f\u0131n nedenlerine ve sonu\u00e7lar\u0131na ili\u015fkin bilgilere dayanmaktad\u0131r (11). Di\u011fer kronik hastal\u0131klarda oldu\u011fu gibi bula\u015f\u0131c\u0131 hastal\u0131klara ili\u015fkin alg\u0131lar da \u00e7e\u015fitlidir ve tedavi aramaya, yay\u0131lman\u0131n azalt\u0131lmas\u0131na yard\u0131mc\u0131 olan tutum ve davran\u0131\u015flar\u0131n anla\u015f\u0131lmas\u0131, kayg\u0131 bozuklu\u011fu ve depresyon dahil psikososyal sonu\u00e7lar\u0131n azalt\u0131lmas\u0131 (12) ve ya\u015fam kalitesinin y\u00fckseltilmesi (13,14) a\u00e7\u0131s\u0131ndan kritik \u00f6neme sahiptir. Ruh sa\u011fl\u0131\u011f\u0131 sonu\u00e7lar\u0131n\u0131 iyile\u015ftirmek amac\u0131yla ki\u015filerin sosyal destek sistemlerinin de ara\u015ft\u0131r\u0131lmas\u0131 ve g\u00fc\u00e7lendirilmesi \u00f6nerilmektedir. Sosyal deste\u011fin, tedavi uyumu da dahil olmak \u00fczere hastal\u0131\u011f\u0131n etkileriyle ba\u015fa \u00e7\u0131kma ve depresyonla ili\u015fkisi COVID-19, TB, HIV ve hepatit tan\u0131l\u0131 hastalarda ortaya konmu\u015ftur (4,15-17). T\u00fcm bu sonu\u00e7lar, bula\u015f\u0131c\u0131 hastal\u0131\u011f\u0131 olan bireylerin psikososyal boyutunun de\u011ferlendirilmesinin \u00f6nemli oldu\u011funu g\u00f6stermektedir. Yap\u0131lan \u00e7al\u0131\u015fmalarda psikolojik morbiditenin y\u00fcksek oldu\u011fu tutarl\u0131 olarak g\u00f6sterilmesine ra\u011fmen, \u00e7al\u0131\u015fmalar\u0131n \u00f6rneklemini tek bir infeksiyon hastal\u0131\u011f\u0131 olan bireyler olu\u015fturmaktad\u0131r. Ayr\u0131ca pandemi d\u00f6neminde, COVID-19 hastalar\u0131n\u0131n deneyimi kadar kronik hastal\u0131\u011f\u0131 ve \u00f6zellikle HIV gibi kronik infeksiyonu olan bireylerin de psikososyal sa\u011fl\u0131k verilerinin toplanmas\u0131 \u00f6nem kazanm\u0131\u015ft\u0131r (18,19). Ara\u015ft\u0131rmac\u0131lar\u0131n, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n akut ve kronik s\u00fcre\u00e7lerinin hastalar\u0131n psikososyal durumuna etkisinin farkl\u0131 oldu\u011funa dair klinik g\u00f6zlemlerinin yan\u0131 s\u0131ra COVID-19 ile di\u011fer viral infeksiyonlar\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmalar\u0131n yetersizli\u011fi bu konuyu irdelemenin bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n etkilerini anlamada faydal\u0131 olaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrm\u00fc\u015ft\u00fcr. \u00c7al\u0131\u015fmam\u0131zda, yatarak takip edilen COVID-19 ve kronik infeksiyonu (TB, hepatit, HIV) olan hastalar\u0131n demografik ve klinik \u00f6zelliklerinin, hastal\u0131k ve damgalanma alg\u0131lar\u0131n\u0131n, sosyal destek d\u00fczeylerinin ve psikososyal uyumlar\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 ama\u00e7land\u0131.<\/span><\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Kesitsel ve tan\u0131mlay\u0131c\u0131 olarak ger\u00e7ekle\u015ftirilen bu \u00e7al\u0131\u015fma Ocak 2021-Ocak 2022 tarihleri aras\u0131nda \u0130stanbul ilinde bulunan Sultangazi Haseki E\u011fitim ve Ara\u015ft\u0131rma Hastanesi \u0130nfeksiyon Servisi\u2019nde yatarak tedavi g\u00f6ren 260 hasta aras\u0131ndan se\u00e7ilen 100 hasta ile ger\u00e7ekle\u015ftirildi. Hastalar\u0131n se\u00e7ilme kriterleri; T\u00fcrk\u00e7e anlay\u0131p konu\u015fabilme, en az okuryazar olma, TB, hepatit, HIV veya ciddi seyirli COVID-19 hastal\u0131\u011f\u0131ndan birine sahip olma ve yeti\u015fkin (18 ya\u015f\u0131ndan b\u00fcy\u00fck) olma idi. Hastalar g\u00f6n\u00fcll\u00fc olarak \u00e7al\u0131\u015fmaya kat\u0131ld\u0131. Veriler, bilgilendirilmi\u015f onam formunu imzalamay\u0131 takiben; ki\u015fisel bilgi formu, \u201cHastal\u0131\u011fa Psikososyal Uyum \u00d6z-Bildirim \u00d6l\u00e7e\u011fi\u201d, \u201cHastal\u0131k Alg\u0131s\u0131 \u00d6l\u00e7e\u011fi\u201d ve \u201c\u00c7ok Boyutlu Alg\u0131lanan Sosyal Destek \u00d6l\u00e7e\u011fi\u201d kullan\u0131larak topland\u0131.<\/span><\/p>\n

Ki\u015fisel Bilgi Formu;<\/i><\/b><\/span> <\/i><\/b>ara\u015ft\u0131rmaya kat\u0131lan hastalar\u0131n demografik (ya\u015f, cinsiyet, medeni durum, e\u011fitim seviyesi, \u00e7al\u0131\u015fma ve ekonomik durumu) ve klinik (t\u0131bbi tan\u0131, hastal\u0131k s\u00fcresi, hastanede yat\u0131\u015f s\u00fcresi, komorbid hastal\u0131k varl\u0131\u011f\u0131) \u00f6zelliklerini i\u00e7ermekte idi. Formda ayr\u0131ca, \u201c\u00c7evreniz taraf\u0131ndan hastal\u0131\u011f\u0131n\u0131zdan dolay\u0131 damgaland\u0131\u011f\u0131n\u0131z\u0131, d\u0131\u015fland\u0131\u011f\u0131n\u0131z\u0131 hissediyor musunuz?\u201d sorusuna yer verildi.<\/p>\n

Hastal\u0131\u011fa Psikososyal Uyum \u00d6z-Bildirim \u00d6l\u00e7e\u011fi;<\/i><\/b><\/span> hastal\u0131\u011fa psikososyal uyumu \u00f6l\u00e7mek amac\u0131yla geli\u015ftirilmi\u015f olup T\u00fcrk\u00e7e \u00e7evirisinin ge\u00e7erlilik \u00e7al\u0131\u015fmas\u0131 yap\u0131lm\u0131\u015ft\u0131r (20). \u00d6l\u00e7e\u011fin soru say\u0131s\u0131 46\u2019d\u0131r ve \u201csa\u011fl\u0131k bak\u0131m\u0131na oryantasyon<\/i>\u201d (8 soru), \u201cmesleki \u00e7evre<\/i>\u201d (6 soru), \u201caile \u00e7evresi<\/i>\u201d (8 soru), \u201ccinsel ya\u015fam<\/i>\u201d (6 soru), \u201cgeni\u015f aile ili\u015fkileri<\/i>\u201d (5 soru), \u201csosyal \u00e7evre<\/i>\u201d (6 soru), \u201cpsikolojik bask\u0131<\/i>\u201d (7 soru) olmak \u00fczere yedi alt \u00f6l\u00e7e\u011fi vard\u0131r. Her soruda uyum derecesini 0 (en olumlu yan\u0131t) ile 3 (en olumsuz yan\u0131t) puan aras\u0131nda belirleyen d\u00f6rt ifade bulunmaktad\u0131r. Bu \u00f6l\u00e7ekle yap\u0131lan ara\u015ft\u0131rmalarda 35 alt\u0131 puanlar \u201ciyi psikososyal uyum\u201d, 35-51 aral\u0131\u011f\u0131ndaki puanlar \u201corta derecede psikososyal uyum\u201d, 51 \u00fcst\u00fc puanlar ise \u201ck\u00f6t\u00fc uyum\u201d olarak belirtilmektedir. \u00c7al\u0131\u015fmam\u0131zda, \u00f6l\u00e7e\u011fin Cronbach alfa de\u011feri 0.94 olarak bulundu.<\/p>\n

Hastal\u0131k Alg\u0131s\u0131 \u00d6l\u00e7e\u011fi;<\/i><\/b><\/span> hastan\u0131n rahats\u0131zl\u0131\u011f\u0131 hakk\u0131nda alg\u0131s\u0131n\u0131 \u00e7ok y\u00f6nl\u00fc olarak de\u011ferlendirmektedir.\u00a0 <\/span>\u00d6l\u00e7ekte; \u2018hastal\u0131k belirtileri<\/i>\u2019 (14 hastal\u0131k belirtisi), \u2018hastal\u0131k hakk\u0131ndaki g\u00f6r\u00fc\u015fler\u2019<\/i> (38 madde ve 7 alt \u00f6l\u00e7ek) ve \u2018hastal\u0131k nedenleri<\/i>\u2019 (18 madde ve 4 alt \u00f6l\u00e7ek) olmak \u00fczere \u00fc\u00e7 b\u00f6l\u00fcm bulunmaktad\u0131r. \u2018Hastal\u0131k hakk\u0131ndaki g\u00f6r\u00fc\u015fler<\/i>\u2019 b\u00f6l\u00fcm\u00fcn\u00fcn alt \u00f6l\u00e7ekleri; s\u00fcre (akut\/kronik), sonu\u00e7lar, ki\u015fisel kontrol, tedavi kontrol\u00fc, hastal\u0131\u011f\u0131 anlayabilme, s\u00fcre (d\u00f6ng\u00fcsel) ve duygusal temsillerdir. \u2018Hastal\u0131k nedenleri\u2019<\/i> b\u00f6l\u00fcm\u00fcn\u00fcn alt \u00f6l\u00e7ekleri; ba\u011f\u0131\u015f\u0131kl\u0131k, risk etmenleri, psikolojik at\u0131flar, kaza ya da \u015fans\u0131 i\u00e7ermektedir.\u00a0 <\/span>\u00d6l\u00e7e\u011fin T\u00fcrk\u00e7e uyarlamas\u0131n\u0131n ge\u00e7erlilik ve g\u00fcvenilirlik \u00e7al\u0131\u015fmas\u0131 ger\u00e7ekle\u015ftirilmi\u015f olup Cronbach alfa de\u011feri; \u201chastal\u0131k belirtileri<\/i>\u201d b\u00f6l\u00fcm\u00fcnde 0.76, \u201chastal\u0131k hakk\u0131ndaki g\u00f6r\u00fc\u015fler<\/i>\u201d b\u00f6l\u00fcm\u00fcnde 0.73 ve \u201chastal\u0131k nedenleri<\/i>\u201d b\u00f6l\u00fcm\u00fcnde 0.79 olarak bulunmu\u015ftur (21).\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131zda \u00f6l\u00e7e\u011fin Cronbach alfa de\u011feri s\u0131ras\u0131yla 0.77, 0.70 ve 0.88 olarak belirlendi.<\/p>\n

\u00c7ok Boyutlu Alg\u0131lanan Sosyal Destek \u00d6l\u00e7e\u011fi; <\/i><\/b><\/span>farkl\u0131 \u00fc\u00e7 kaynaktan elde edilen sosyal deste\u011fin yeterlili\u011fini \u00f6znel olarak incelemektedir. Toplamda 12 maddeden ve \u00fc\u00e7 alt \u00f6l\u00e7ekten (aile, \u00f6zel bir insan, arkada\u015f) olu\u015fur. Yan\u0131tlar 1 (kesinlikle hay\u0131r) ile 7 (kesinlikle evet) aras\u0131nda puanlan\u0131r. Puanlar\u0131n toplam\u0131n\u0131n fazla olmas\u0131 alg\u0131lanan deste\u011fin y\u00fcksek oldu\u011funu g\u00f6stermektedir. \u00dclkemiz i\u00e7in ge\u00e7erlilik ve g\u00fcvenilirlik \u00e7al\u0131\u015fmas\u0131 yap\u0131lan \u00f6l\u00e7e\u011fin toplam Cronbach alfa de\u011feri 0.89 iken alt boyut Cronbach alfa de\u011ferleri de aile i\u00e7in 0.85, arkada\u015f i\u00e7in 0.88 ve \u00f6zel bir insan i\u00e7in 0.92 olarak saptanm\u0131\u015ft\u0131r (22).\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131zda Cronbach alfa katsay\u0131lar\u0131 s\u0131ras\u0131yla; 0.85, 0.48, 0.81 ve 0.85 olarak tespit edildi. Aile boyutu de\u011ferlendirmeye al\u0131nmad\u0131.<\/p>\n

Ara\u015ft\u0131rman\u0131n kriterlerini kar\u015f\u0131layan hastalar, \u00e7al\u0131\u015fman\u0131n hangi ama\u00e7la yap\u0131ld\u0131\u011f\u0131, toplanan verilerin gizlili\u011fi konusunda bilgilendirildi ve onamlar\u0131 al\u0131nd\u0131.\u00a0 <\/span>\u00d6z-bildirim \u00f6l\u00e7eklerinin yer ald\u0131\u011f\u0131 anket formu uygun olduklar\u0131 zaman diliminde, samimi ve i\u00e7ten bir \u015fekilde yan\u0131tlamalar\u0131 i\u00e7in kat\u0131l\u0131mc\u0131lara b\u0131rak\u0131ld\u0131; anla\u015f\u0131lmayan soruyu bo\u015f b\u0131rakabilecekleri ve her zaman ara\u015ft\u0131rmac\u0131ya sorular\u0131 i\u00e7in d\u00f6nebilecekleri hakk\u0131nda bilgi verildi. Veri toplama formunun doldurulmas\u0131 yakla\u015f\u0131k 15-20 dakika s\u00fcr\u00fcyordu. Yan\u0131tlanmas\u0131 tamamlanan anket formlar\u0131 kontrol edilerek ara\u015ft\u0131rmac\u0131 (ZAA) taraf\u0131ndan geri topland\u0131.<\/p>\n

D\u00fcnya Tabipler Birli\u011fi Helsinki Bildirgesi\u2019ne uygun olarak y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fma i\u00e7in Bolu Abant \u0130zzet Baysal\u00a0\u00dcniversitesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 16 Mart 2021 tarih ve 2021\/75 karar numaras\u0131yla onay al\u0131nd\u0131.\u00a0 <\/span>Kurum izni, 3 \u015eubat 2021 tarihinde \u0130l Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc taraf\u0131ndan verildi.<\/p>\n

\u0130statistiksel Analizler<\/h3>\n

Verilerin analizi, SPSS (Statistical Package for the Social Sciences) versiyon 22.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile yap\u0131ld\u0131. Verilerin normal da\u011f\u0131lmad\u0131\u011f\u0131 tespit edildi\u011fi i\u00e7in parametrik olmayan testler kullan\u0131ld\u0131. Kategorik verilerin de\u011ferlendirilmesinde say\u0131 (n), y\u00fczde (%), s\u00fcrekli verilerin ve \u00f6l\u00e7eklerin de\u011ferlendirilmesinde medyan, minimum ve maksimum kullan\u0131ld\u0131. COVID-19 ve kronik infeksiyon grubunun demografik \u00f6zelliklerinin, damgalanma alg\u0131s\u0131n\u0131n ve psikososyal uyumunun kar\u015f\u0131la\u015ft\u0131rmas\u0131 \u03c7\u00b2\u00a0testi; ya\u015f, hastaneye yat\u0131\u015f s\u00fcresi, hastal\u0131k alg\u0131s\u0131, sosyal destek ve psikososyal uyum a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131rma Mann-Whitney U testi ile yap\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i> <0.05 olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n
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Tablo 1.<\/strong> Hastalar\u0131n Sosyodemografik ve Klinik \u00d6zellikleri (N=100)<\/p><\/div>\n

\u00c7al\u0131\u015fmam\u0131za kat\u0131lan 100 hastan\u0131n medyan ya\u015f\u0131 40 (19-91) y\u0131l olup 56\u2019s\u0131 erkek ve 53\u2019\u00fc evli idi. \u0130lkokul mezunu olan hasta say\u0131s\u0131 41, \u00e7al\u0131\u015fan hasta say\u0131s\u0131 59 idi; orta d\u00fczeyde geliri oldu\u011funu bildiren hasta say\u0131s\u0131 72 olarak tespit edildi. Altm\u0131\u015f hasta COVID-19, 40 hasta ise kronik infeksiyon [TB (%11), hepatit (%14), HIV (%15)] tan\u0131s\u0131 alm\u0131\u015ft\u0131; hastal\u0131k s\u00fcresini bir aydan az olarak bildiren hasta say\u0131s\u0131 56 idi (Tablo 1).<\/p>\n

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Tablo 2.<\/strong> COVID-19 ve Kronik \u0130nfeksiyon Grubunun Demografik \u00d6zellikleri, Komorbid Hastal\u0131k Varl\u0131\u011f\u0131, Damgalanma ve Psikososyal Uyum A\u00e7\u0131s\u0131ndan Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

COVID-19 ve kronik infeksiyon grubundaki hastalar\u0131n cinsiyeti ve ekonomik durumu a\u00e7\u0131s\u0131ndan istatistiksel olarak fark olmad\u0131\u011f\u0131 (p<\/i>>0.05), medeni durumlar\u0131 a\u00e7\u0131s\u0131ndan fark oldu\u011fu (p<\/i>=0.03) tespit edildi. COVID-19 olanlar\u0131n 30 (%50)\u2019u \u00e7al\u0131\u015fm\u0131yorken, kronik infeksiyonu olanlar\u0131n 11 (%27.5)\u2019inin \u00e7al\u0131\u015fmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (p<\/i>=0.04). \u0130ki grup aras\u0131nda istatistiksel olarak fark saptanmasa da COVID-19 hastalar\u0131nda komorbid hastal\u0131k varl\u0131\u011f\u0131n\u0131n daha fazla oldu\u011fu g\u00f6zlendi (p<\/i>=0.05). Damgalanma a\u00e7\u0131s\u0131ndan hastal\u0131k gruplar\u0131 aras\u0131nda istatistiksel olarak anlaml\u0131 fark bulundu (p<\/i><0.001); COVID-19 olanlar\u0131n 42 (%70)\u2019sinin, kronik infeksiyonu olanlar\u0131n 10 (%25)\u2019unun damgalanmad\u0131\u011f\u0131n\u0131 alg\u0131lad\u0131\u011f\u0131 saptand\u0131. Psikososyal uyum a\u00e7\u0131s\u0131ndan da iki grup aras\u0131nda istatistiksel olarak fark g\u00f6r\u00fcld\u00fc (p<\/i>=0.002); COVID-19 olanlar\u0131n 31 (%51.7)\u2019nin, kronik infeksiyonu olanlar\u0131n 8 (%20)\u2019inin iyi psikososyal uyum sa\u011flad\u0131\u011f\u0131 belirlendi (Tablo 2).<\/p>\n

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Tablo 3.<\/strong> COVID-19 ve Kronik \u0130nfeksiyon Grubunun Ya\u015f, Hospitalizasyon S\u00fcresi, Hastal\u0131k Alg\u0131s\u0131, Sosyal Destek ve Psikososyal Uyum A\u00e7\u0131s\u0131ndan Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

COVID-19 grubunun kronik infeksiyon grubundaki hastalara g\u00f6re ya\u015flar\u0131n\u0131n daha y\u00fcksek (p<\/i>=0.003), hastanede yat\u0131\u015f s\u00fcresinin ise daha k\u0131sa (p<\/i><0.001) oldu\u011fu tespit edildi. Gruplar\u0131n hastal\u0131k belirtileri ve s\u00fcreleri a\u00e7\u0131s\u0131ndan alg\u0131lar\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde fark saptanmad\u0131 (p<\/i>>0.05). Hastal\u0131k alg\u0131s\u0131 a\u00e7\u0131s\u0131ndan; COVID-19 hastalar\u0131na g\u00f6re kronik infeksiyonu olanlar\u0131n hastal\u0131klar\u0131n\u0131 daha iyi anlayabildiklerini d\u00fc\u015f\u00fcnd\u00fckleri (p<\/i>=0.001), hastal\u0131\u011f\u0131n sonu\u00e7lar\u0131ndan daha fazla etkilendikleri (p<\/i><0.001), duygusal temsillerinin daha y\u00fcksek oldu\u011fu (p<\/i>=0.04), ki\u015fisel ve tedavi kontrol\u00fcn\u00fcn ise daha d\u00fc\u015f\u00fck oldu\u011fu (p<\/i><0.05) belirlendi. Kronik infeksiyonu olan hastalar\u0131n COVID-19 hastalar\u0131na g\u00f6re sosyal destek alg\u0131s\u0131n\u0131n daha d\u00fc\u015f\u00fck oldu\u011fu bulundu (p<\/i><0.05). COVID-19 ve kronik infeksiyon hastal\u0131\u011f\u0131 olanlar\u0131n psikososyal uyum alt \u00f6l\u00e7eklerinden cinsel ya\u015fam ve sosyal \u00e7evre d\u0131\u015f\u0131nda di\u011fer boyutlar\u0131n s\u0131ra ortalamalar\u0131 aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde fark oldu\u011fu (p<\/i><0.05), kronik infeksiyonu olanlar\u0131n toplam ve alt \u00f6l\u00e7eklerde psikososyal uyum puan\u0131n\u0131n daha y\u00fcksek yani uyumun daha k\u00f6t\u00fc oldu\u011fu g\u00f6r\u00fcld\u00fc (Tablo 3).<\/p>\n

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Tablo 4.<\/strong> COVID-19 ve Kronik \u0130nfeksiyon Grubunun Hastal\u0131\u011f\u0131n Olas\u0131 Nedenlerine Y\u00f6nelik At\u0131flar\u0131n\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

Kronik infeksiyonu olan hastalar\u0131n COVID-19 hastalar\u0131na g\u00f6re hastal\u0131klar\u0131n\u0131 daha \u00e7ok v\u00fccut direncinin azalmas\u0131na (p<\/i>=0.001), kendi davran\u0131\u015flar\u0131na (p<\/i><0.001) ve tutumlar\u0131na (p<\/i><0.001), stres ya da endi\u015feye (p<\/i><0.001), diyet al\u0131\u015fkanl\u0131klar\u0131na (p<\/i>=0.001), ge\u00e7mi\u015flerindeki k\u00f6t\u00fc t\u0131bbi bak\u0131ma (p<\/i><0.001), aile problemlerine (p<\/i><0.001), a\u015f\u0131r\u0131 \u00e7al\u0131\u015fmaya (p<\/i>=0.001), duygusal durumlar\u0131na (p<\/i><0.001), alkol (p<\/i>=0.004) ve sigara kullan\u0131m\u0131na (p<\/i><0.001), ki\u015filik \u00f6zelliklerine (p<\/i><0.001), \u015fans veya k\u00f6t\u00fc talihe (p<\/i><0.001) atfettikleri saptand\u0131. \u00c7evre kirlili\u011fine ve ya\u015flanmaya at\u0131f COVID-19 hastalar\u0131nda daha fazla olmakla birlikte aradaki fark istatistiksel olarak anlaml\u0131 d\u00fczeyde de\u011fildi (p<\/i>>0.05). COVID-19 ve kronik infeksiyonu olan hastalar\u0131n kal\u0131tsall\u0131k, bir mikrop ya da virus, kaza veya yaralanma nedeninin s\u0131ra ortalamalar\u0131 a\u00e7\u0131s\u0131ndan istatiksel olarak anlaml\u0131 d\u00fczeyde fark tespit edilmedi (p<\/i>>0.05) (Tablo 4).<\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, infeksiyon servisinde yatarak tedavi g\u00f6rmekte olan COVID-19 ve kronik infeksiyon (TB, hepatit, HIV) hastal\u0131\u011f\u0131 olan bireylerin demografik (ya\u015f, e\u011fitim, medeni ve \u00e7al\u0131\u015fma durumu) \u00f6zellikleri ve hastanede yat\u0131\u015f s\u00fcreleri a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 d\u00fczeyde fark oldu\u011fu tespit edildi. Ara\u015ft\u0131r\u0131lan di\u011fer de\u011fi\u015fkenlerden; hastal\u0131k alg\u0131s\u0131n\u0131n sonu\u00e7lar\u0131, ki\u015fisel ve tedavi kontrol\u00fc, hastal\u0131\u011f\u0131 anlayabilme, duygusal temsil boyutlar\u0131 ve hastal\u0131\u011f\u0131n olas\u0131 nedenlerine y\u00f6nelik at\u0131flar\u0131 ile damgalanma hissi, sosyal destek alg\u0131lar\u0131 ve psikososyal uyumlar\u0131 a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde fark oldu\u011fu belirlendi.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda kronik infeksiyon hastalar\u0131na g\u00f6re COVID-19 hastalar\u0131n\u0131n ya\u015flar\u0131n\u0131n daha y\u00fcksek oldu\u011fu g\u00f6r\u00fcld\u00fc. Di\u011fer \u00e7al\u0131\u015fmalarda COVID-19 nedeniyle hastanede yatarak tedavi g\u00f6ren hastalar\u0131n medyan ya\u015f\u0131n\u0131n 45-56 y\u0131l aras\u0131nda de\u011fi\u015fti\u011fi (23,24) bildirilmi\u015f olup bu sonu\u00e7lar \u00e7al\u0131\u015fmam\u0131zla uyumludur. Kronik infeksiyonlardan biri olan HIV i\u00e7in \u00fclkemizdeki olgular\u0131n en \u00e7ok g\u00f6r\u00fcld\u00fc\u011f\u00fc ya\u015f grubunun 35-39 y\u0131l oldu\u011fu bildirilmi\u015ftir (25). T\u00fcrkiye Verem Sava\u015f\u0131 2020 Raporu\u2019nda 2018 y\u0131l\u0131nda t\u00fcberk\u00fcloz insidans\u0131n\u0131n 45 ya\u015f\u0131ndan itibaren artt\u0131\u011f\u0131 bildirilmi\u015ftir (26). Viral hepatitlerin ise en fazla 25-44 ya\u015f grubunda g\u00f6r\u00fcld\u00fc\u011f\u00fc belirtilmektedir (27). Bu verilerin \u00e7al\u0131\u015fmam\u0131z\u0131n sonucunu destekledi\u011fi g\u00f6r\u00fclmektedir.\u00a0 <\/span>Kronik infeksiyonlara g\u00f6re COVID-19 hastalar\u0131n\u0131n ya\u015flar\u0131n\u0131n daha y\u00fcksek olmas\u0131; ileri ya\u015fta olup komorbid hastal\u0131klar\u0131 olan, oksijen deste\u011fi gereken, ciddi seyirli COVID-19 hastalar\u0131n\u0131n hastaneye yatarak tedavi g\u00f6rmesiyle a\u00e7\u0131klanabilir (28). \u0130ki grup aras\u0131nda hastaneye yat\u0131\u015f s\u00fcresindeki ortaya \u00e7\u0131kan fark ise hastal\u0131klar\u0131n do\u011fas\u0131 ve tedavilerindeki farkl\u0131l\u0131klardan kaynaklanabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda elde edilen psikososyal de\u011fi\u015fkenlerle ilgili sonu\u00e7lara odakland\u0131\u011f\u0131m\u0131zda, COVID-19 ve kronik infeksiyonu olan hastalar\u0131n bula\u015f\u0131c\u0131 hastal\u0131klar\u0131 hakk\u0131nda alg\u0131lar\u0131nda farkl\u0131 ve benzer y\u00f6nler oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Her iki hasta grubu da hastal\u0131\u011f\u0131n nedensellik risk fakt\u00f6r\u00fcn\u00fcn bir mikrop veya virus oldu\u011funun fark\u0131ndad\u0131r. Koronovirusun yak\u0131n temasla bula\u015ft\u0131\u011f\u0131 ve hastalar\u0131n da b\u00f6yle d\u00fc\u015f\u00fcnd\u00fckleri di\u011fer \u00e7al\u0131\u015fmalarda da ortaya konmu\u015ftur (29). Hepatit B (30) ve hepatit C (31) hastalar\u0131 ile yap\u0131lan \u00e7al\u0131\u015fmalarda farkl\u0131 yollarla bula\u015fman\u0131n \u00fczerinde durulurken, yak\u0131n zamanda yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada hepatit C virusu infeksiyonu olan hastalara nedensellik risk fakt\u00f6rleri soruldu\u011funda %79.3\u2019\u00fcn\u00fcn bilmiyorum yan\u0131t\u0131 verdi\u011fi bildirilmi\u015ftir (32). HIV hastalar\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada, hastalar\u0131n \u00e7o\u011fu bula\u015fma nedenini cinsel ili\u015fki ya da kan yolu \u015feklinde bildirilirken, %34\u2019\u00fc bula\u015fma yolunu bilmiyorum olarak ifade etmi\u015ftir (33). T\u00fcberk\u00fcloz i\u00e7in ise hem \u00fclkemizde hem de di\u011fer \u00fclkelerde yap\u0131lan \u00e7al\u0131\u015fmalar, daha \u00e7ok k\u00f6t\u00fc ya\u015fam ko\u015fullar\u0131n\u0131n \u00f6n plana \u00e7\u0131kt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir (34,35). \u00c7al\u0131\u015fmam\u0131zda da kronik infeksiyonu olan hastalar hastal\u0131klar\u0131n\u0131; v\u00fccut direncinin azalmas\u0131na, ge\u00e7mi\u015fte k\u00f6t\u00fc bak\u0131m almaya, strese ya da endi\u015feye, duygusal durumlar\u0131na, ki\u015filik \u00f6zelliklerine, aile problemlerine, sa\u011fl\u0131ks\u0131z ya\u015fam bi\u00e7imine daha fazla ba\u011flam\u0131\u015flard\u0131r. Hastal\u0131klar\u0131n toplumda g\u00f6r\u00fclme prevalans\u0131 ile ili\u015fkili olarak hastalar\u0131n hastal\u0131\u011fa bak\u0131\u015f a\u00e7\u0131s\u0131 ve psikososyal durumlar\u0131 etkilenebilir. Pandemi d\u00f6neminde g\u00f6r\u00fclen y\u00fcksek COVID-19 olgu say\u0131lar\u0131 d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, hastalar\u0131n hastal\u0131\u011f\u0131 kabullenme oranlar\u0131n\u0131n daha y\u00fcksek, hastal\u0131k i\u00e7in olas\u0131 nedenlerde ise risk fakt\u00f6rlerine ve psikolojik etkenlere at\u0131flar\u0131n\u0131n daha d\u00fc\u015f\u00fck olmas\u0131 beklenebilecek bir sonu\u00e7tur. COVID-19 grubu, hastal\u0131\u011f\u0131 kendileri ile ilgili nedenlere ba\u011flamay\u0131p daha \u00e7ok pandeminin ola\u011fan bir sonucu olarak d\u00fc\u015f\u00fcn\u00fcyor olabilir.<\/p>\n

Bula\u015f\u0131c\u0131 hastal\u0131\u011f\u0131 olan hastalarla yap\u0131lan \u00e7al\u0131\u015fmalar hem bili\u015fsel hem de duygusal a\u00e7\u0131dan hastal\u0131k alg\u0131s\u0131n\u0131n olumsuz ve tedavi kontrol\u00fc a\u00e7\u0131s\u0131ndan farkl\u0131 oldu\u011funu g\u00f6stermektedir (32,35,36). Hepatit C virusu infeksiyonu \u00f6l\u00fcmc\u00fcl bir hastal\u0131k ve tedavi kontrol\u00fc d\u00fc\u015f\u00fck bir hastal\u0131k olarak alg\u0131lan\u0131rken (32); TB tan\u0131l\u0131 hastalar\u0131n hastal\u0131klar\u0131yla ilgili olduk\u00e7a endi\u015feli olmakla birlikte tedavi olacaklar\u0131na inand\u0131klar\u0131 belirlenmi\u015ftir (35). COVID-19 hastalar\u0131n\u0131n ki\u015fisel ve tedavi kontrol\u00fcn\u00fcn orta\/y\u00fcksek d\u00fczeyde oldu\u011fu saptanm\u0131\u015ft\u0131r (12,37). \u00c7al\u0131\u015fmam\u0131zda kronik infeksiyonu ve COVID-19 hastal\u0131\u011f\u0131 olan iki grup aras\u0131nda, semptomlar\u0131 hastal\u0131klar\u0131na ba\u011flamada fark olmamakla birlikte, kronik infeksiyonu olanlar\u0131n hastal\u0131\u011f\u0131 daha \u00e7ok anlayabildikleri, ya\u015fad\u0131klar\u0131 sonu\u00e7lar\u0131 daha olumsuz alg\u0131lad\u0131klar\u0131 ve hastal\u0131kla provoke olan duygusal etkinin daha fazla oldu\u011fu g\u00f6r\u00fcld\u00fc; COVID-19 grubundaki hastalarda ise hastal\u0131kla ba\u011flant\u0131l\u0131 ki\u015fisel ve tedavi kontrol\u00fc daha y\u00fcksekti. Sonu\u00e7 olarak, iki grubun hastal\u0131k alg\u0131lar\u0131nda \u00f6nemli farkl\u0131l\u0131klar oldu\u011fu ortaya \u00e7\u0131kt\u0131. \u00c7o\u011fu sa\u011fl\u0131k profesyoneli, hastalar\u0131n rahats\u0131zl\u0131klar\u0131yla ilgili g\u00f6r\u00fc\u015f ve d\u00fc\u015f\u00fcncelerini s\u0131kl\u0131kla g\u00f6z ard\u0131 etmektedir. Oysa hastal\u0131k alg\u0131s\u0131n\u0131n de\u011ferlendirilmesi, tedavi ba\u015far\u0131s\u0131n\u0131 engelleyebilecek davran\u0131\u015f sorunlar\u0131n\u0131n ele al\u0131nmas\u0131na yard\u0131mc\u0131 olacakt\u0131r.<\/p>\n

Bula\u015f\u0131c\u0131 hastal\u0131klarda en \u00f6nemli sorunlardan biri de damgalanmad\u0131r. \u00c7al\u0131\u015fmam\u0131z, kronik infeksiyonu olan hastalar\u0131n COVID-19 hastalar\u0131na g\u00f6re daha fazla damgaland\u0131\u011f\u0131n\u0131 hissetti\u011fini g\u00f6sterdi. Bu konuda literat\u00fcrde yer alan \u00e7al\u0131\u015fmalarda da benzer sonu\u00e7lar bildirilmi\u015ftir. Hart ve arkada\u015flar\u0131 (38) taraf\u0131ndan 147 HIV ile ya\u015fayan bireyle yap\u0131lan \u00e7al\u0131\u015fmada, AIDS salg\u0131n\u0131 s\u0131ras\u0131nda COVID-19\u2019a k\u0131yasla daha s\u0131k damgalanma, yaln\u0131zl\u0131k ve \u00fcz\u00fcnt\u00fc\/keder ya\u015fad\u0131klar\u0131 bildirilmi\u015ftir. Ba\u015fka bir \u00e7al\u0131\u015fmada kronik hepatit B, kronik hepatit C ve HIV olgular\u0131n\u0131n damgalanma alg\u0131lar\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f ve HIV infeksiyonu grubunda damgalanma alg\u0131s\u0131n\u0131n daha fazla oldu\u011fu belirlenmi\u015ftir (39). HIV\/AIDS, SARS ve TB hastalar\u0131n\u0131n halk taraf\u0131ndan damgalanma d\u00fczeylerini kar\u015f\u0131la\u015ft\u0131ran bir ara\u015ft\u0131rmada, damgalanma d\u00fczeyinin HIV\/AIDS\u2019e kar\u015f\u0131 en fazla oldu\u011fu ve bunu TB ve SARS hastal\u0131\u011f\u0131n\u0131n takip etti\u011fi saptanm\u0131\u015ft\u0131r (40). Alg\u0131lanan damgalanman\u0131n, zay\u0131f sosyal destek ile neredeyse iki kat ili\u015fkili oldu\u011fu g\u00f6sterilmi\u015ftir (41). COVID-19\u2019a g\u00f6re AIDS salg\u0131n\u0131 s\u0131ras\u0131nda insan deste\u011finin kalitesinin daha k\u00f6t\u00fc oldu\u011fu bildirilmi\u015ftir (38). \u00dclkemizde de HIV hastalar\u0131n\u0131n alg\u0131lad\u0131\u011f\u0131 deste\u011fin olduk\u00e7a d\u00fc\u015f\u00fck oldu\u011fu, TB ve COVID-19 hastalar\u0131n\u0131n ise sosyal destek puanlar\u0131n\u0131n y\u00fcksek oldu\u011fu saptanm\u0131\u015ft\u0131r (42-44). \u00c7al\u0131\u015fmam\u0131zda da kronik infeksiyonu olan hastalar\u0131n COVID-19 hastalar\u0131na g\u00f6re alg\u0131lad\u0131klar\u0131 sosyal deste\u011fin daha d\u00fc\u015f\u00fck oldu\u011fu tespit edildi. Kronik hastal\u0131klar\u0131n ilk d\u00f6neminde hastalar\u0131n daha \u00e7ok desteklendi\u011fi ama s\u00fcre uzad\u0131k\u00e7a deste\u011fin azalabildi\u011fi g\u00f6zlenmektedir. COVID-19 s\u00fcrecinde ise temas s\u0131n\u0131rl\u0131 da olsa ortak payla\u015f\u0131lan bir s\u00fcre\u00e7 olarak ya\u015fanmas\u0131, alg\u0131lanan sosyal deste\u011fi olumlu etkilemi\u015f olabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda iki grup aras\u0131nda psikososyal uyum kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, kronik infeksiyonu olan hastalar\u0131n COVID-19 hastalar\u0131na g\u00f6re psikososyal uyumunun daha k\u00f6t\u00fc oldu\u011fu ortaya \u00e7\u0131kt\u0131; bu fark\u0131n; sa\u011fl\u0131k bak\u0131m\u0131na oryantasyon, mesleki \u00e7evre, aile \u00e7evresi, geni\u015f aile ili\u015fkileri ve psikolojik bask\u0131 i\u00e7in de ge\u00e7erli oldu\u011fu g\u00f6r\u00fcld\u00fc. Haggag ve arkada\u015flar\u0131 (45) taraf\u0131ndan yap\u0131lan, hepatit C pozitif ve negatif olan hastalar ile sa\u011fl\u0131kl\u0131 insanlar\u0131n kar\u015f\u0131la\u015ft\u0131rd\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, hepatit C\u2019li hastalar\u0131n hepatit C negatif olanlara g\u00f6re aile, sosyal ve genel uyumunun, sa\u011fl\u0131kl\u0131 insanlara g\u00f6re de aile, sosyal ve genel uyumun yan\u0131 s\u0131ra mesleki uyumun daha k\u00f6t\u00fc oldu\u011fu saptanm\u0131\u015ft\u0131r. Yap\u0131lan bir \u00e7al\u0131\u015fmada, TB hastalar\u0131n\u0131n %15.1\u2019inin hastal\u0131\u011fa k\u00f6t\u00fc uyum sa\u011flad\u0131\u011f\u0131 ve en \u00e7ok olumsuz etkilenen boyutlar\u0131n \u00e7al\u0131\u015fmam\u0131zda elde etti\u011fimiz gibi sa\u011fl\u0131k bak\u0131m\u0131na oryantasyon, mesleki \u00e7evre, aile \u00e7evresi ve psikolojik bask\u0131 olarak s\u0131raland\u0131\u011f\u0131 bildirilmi\u015ftir (46). HIV pozitif kad\u0131nlar \u00fczerinde yap\u0131lm\u0131\u015f bir \u00e7al\u0131\u015fma, ya\u015f\u0131n psikososyal uyumla en anlaml\u0131 d\u00fczeyde korelasyon g\u00f6sterdi\u011fini, hastal\u0131k alg\u0131s\u0131n\u0131n hem do\u011frudan hem dolayl\u0131 olarak etkili oldu\u011funu, e\u011fitim ve alg\u0131lanan deste\u011fin ise dolayl\u0131 yollardan olumlu ve anlaml\u0131 ili\u015fkisini ortaya koymu\u015ftur; psikolojik teorilere g\u00f6re ya\u015flanma daha fazla esneklik, ba\u015fa \u00e7\u0131kma stratejileri ve duygular\u0131 y\u00f6netme becerisiyle ili\u015fkilidir\u00a0(47). \u00c7al\u0131\u015fmam\u0131z\u0131n bulgular\u0131 bir b\u00fct\u00fcn olarak d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, COVID-19 hastalar\u0131n\u0131n ya\u015f\u0131n\u0131n daha y\u00fcksek olmas\u0131, ki\u015fisel ve tedavi \u00fczerinde kontrol hissetmeleri, sosyal desteklerinin daha y\u00fcksek olmas\u0131 psikososyal uyumlar\u0131n\u0131n kronik infeksiyonu olan hastalara g\u00f6re daha y\u00fcksek olmas\u0131n\u0131 a\u00e7\u0131klayabilir. Ayr\u0131ca iki hasta grubunu kar\u015f\u0131la\u015ft\u0131rd\u0131\u011f\u0131m\u0131zda kronik infeksiyon hastal\u0131klar\u0131n\u0131n s\u00fcre\u011fen olmas\u0131, COVID-19 hastal\u0131\u011f\u0131n\u0131n s\u0131n\u0131rl\u0131 s\u00fcrede tedavisinin ger\u00e7ekle\u015fmesi, psikososyal uyum a\u00e7\u0131s\u0131ndan \u00f6nemli fark olu\u015fturmu\u015f olabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z kronik infeksiyonu olan hastalar\u0131n psikososyal bak\u0131m\u0131n\u0131n ihmal edilmemesi gerekti\u011fini g\u00f6stermekle birlikte, ara\u015ft\u0131rman\u0131n tek merkezde yap\u0131lm\u0131\u015f olmas\u0131, verilerin hastalar\u0131n \u00f6z-bildirimine dayal\u0131 olmas\u0131 sonu\u00e7lar\u0131n genellenebilirli\u011fini k\u0131s\u0131tlamaktad\u0131r. Yine de COVID-19 ve TB, HIV, hepatit infeksiyonu olan hastalar\u0131n biyopsikososyal olarak kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 a\u00e7\u0131s\u0131ndan \u00e7al\u0131\u015fmam\u0131z\u0131n \u00f6nemli oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyoruz.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 ve kronik infeksiyon ile yatarak tedavi edilen\u00a0 <\/span>hastalarda psikososyal uyum, hastal\u0131k ve sosyal destek alg\u0131s\u0131 ile damgalanma a\u00e7\u0131s\u0131ndan \u00f6nemli farkl\u0131l\u0131klar oldu\u011fu ortaya kondu. Kronik infeksiyonu olan hastalar\u0131n %47.5\u2019inin, COVID-19 hastalar\u0131n\u0131n %20\u2019sinin psikososyal uyumu k\u00f6t\u00fc idi. Kronik infeksiyonu olanlar\u0131n %25\u2019i kesinlikle damgaland\u0131\u011f\u0131n\u0131, duygusal olarak etkilendi\u011fini ve hastal\u0131\u011f\u0131n olumsuz sonu\u00e7lar\u0131n\u0131 y\u00fcksek olarak alg\u0131lad\u0131\u011f\u0131n\u0131 bildirdi ve kat\u0131l\u0131mc\u0131lar, hastal\u0131klar\u0131n\u0131 v\u00fccut direncinin azalmas\u0131 kadar psikolojik etkenlere de ba\u011flad\u0131lar. Ayr\u0131ca, COVID-19 hastalar\u0131na g\u00f6re TB, HIV, hepatit infeksiyonu olan hastalar sosyal desteklerini daha d\u00fc\u015f\u00fck olarak alg\u0131lamaktayd\u0131.<\/p>\n

Sonu\u00e7 olarak; sa\u011fl\u0131k profesyonelleri taraf\u0131ndan hastan\u0131n rahats\u0131zl\u0131\u011f\u0131na ili\u015fkin alg\u0131s\u0131n\u0131n erken bir a\u015famada ele al\u0131nmas\u0131, geni\u015f bir yelpazedeki hasta odakl\u0131 tedavi sonu\u00e7lar\u0131na olumlu katk\u0131da bulunarak hastan\u0131n tedavi olmaya inanc\u0131n\u0131 iyile\u015ftirme f\u0131rsat\u0131 sa\u011flayabilir. Ayr\u0131ca, bula\u015f\u0131c\u0131 infeksiyon hastal\u0131\u011f\u0131 olan bireylerin biyopsikososyal y\u00f6netim konusunda desteklenmesi psikolojik morbiditeyi azaltmada yararl\u0131 olacakt\u0131r.<\/p>\n

Ek Doku\u0308manlar\u0131 g\u00f6ru\u0308ntu\u0308lemek i\u00e7in t\u0131klay\u0131n\u0131z.<\/strong><\/em><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e D\u00fcnyada son 20 y\u0131lda, t\u00fcberk\u00fcloz (TB), hepatit, insan ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi virusu (HIV) gibi kronik infeksiyon hastal\u0131klar\u0131na Ebola virusu hastal\u0131\u011f\u0131, \u015fiddetli akut solunum yolu sendromu (severe acute respiratory syndrome-SARS), H5N1 kaynakl\u0131 ku\u015f gribi (avian influenza), Orta Do\u011fu solunum sendromu (Middle East respiratory syndrome-MERS) ve koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) eklenmi\u015ftir (1). Bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n birey ve toplum […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[4391,4588,5905,5907,5906],"class_list":["post-28651","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-bulasici-hastaliklar","tag-damgalama","tag-hastalik-algisi","tag-psikolojik-uyum","tag-sosyal-destek"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=28651"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28651\/revisions"}],"predecessor-version":[{"id":29008,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28651\/revisions\/29008"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=28651"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=28651"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=28651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}