{"id":30443,"date":"2025-06-28T17:28:34","date_gmt":"2025-06-28T14:28:34","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=30443"},"modified":"2025-06-29T12:44:07","modified_gmt":"2025-06-29T09:44:07","slug":"diyabet-ve-asilama","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/06\/28\/diyabet-ve-asilama\/","title":{"rendered":"Diyabetik Bireylerin A\u015f\u0131lanmas\u0131nda Eri\u015fkin A\u015f\u0131 Polikliniklerinin Rol\u00fc – \u00c7ok Merkezli Bir \u00c7al\u0131\u015fma"},"content":{"rendered":"

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

A\u015f\u0131lama, 18. y\u00fczy\u0131lda ke\u015ffedilmesinden bu yana, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n \u00f6nlenmesi ve koruyucu hekimlik uygulamalar\u0131 aras\u0131nda en \u00f6nemli m\u00fcdahalelerden biri olarak kabul edilmektedir (1). G\u00fcn\u00fcm\u00fczde de en etkili ve en g\u00fcvenli koruyucu sa\u011fl\u0131k hizmetlerinde biri olarak \u00f6nemini korumaktad\u0131r (1).<\/p>\n

Sanayile\u015fme ile ticaretin, ula\u015f\u0131m\u0131n ve ileti\u015fimin artmas\u0131, infeksiyon hastal\u0131klar\u0131n\u0131n yay\u0131l\u0131m\u0131n\u0131 kolayla\u015ft\u0131rm\u0131\u015f; ya\u015flanan n\u00fcfusun bu s\u00fcre\u00e7ten etkilenmesi ise ka\u00e7\u0131n\u0131lmaz olmu\u015ftur. Her y\u0131l binlerce insan, a\u015f\u0131 ile \u00f6nlenebilir hastal\u0131klar nedeniyle hastaneye yatmakta ve bu durum kimi zaman \u00f6l\u00fcmle sonu\u00e7lanabilmektedir (2). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), 2012 y\u0131l\u0131nda 194 \u00fcye devletin kat\u0131l\u0131m\u0131yla, t\u00fcm topluluklar\u0131n a\u015f\u0131ya adil eri\u015fimini sa\u011flamak ve milyonlarca insan\u0131n \u00f6l\u00fcm\u00fcn\u00fc \u00f6nleyebilmek amac\u0131yla K\u00fcresel A\u015f\u0131 Eylem Plan\u0131 (Global Vaccine Action Plan) yay\u0131mlam\u0131\u015ft\u0131r (2). Bu planda, yaln\u0131zca \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131lamas\u0131 de\u011fil; ayn\u0131 zamanda ya\u015fla birlikte ortaya \u00e7\u0131kan komorbid durumlar, organ ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemlerinde meydana gelen de\u011fi\u015fiklikler ile infeksiyon hastal\u0131klar\u0131n\u0131n s\u0131kl\u0131\u011f\u0131nda, \u015fiddetinde ve mortalitesinde g\u00f6r\u00fclen art\u0131\u015flar nedeniyle eri\u015fkin d\u00f6nemdeki a\u015f\u0131lama uygulamalar\u0131n\u0131n \u00f6nemi de vurgulanmaktad\u0131r (3,4).<\/p>\n

G\u00fcn\u00fcm\u00fczde d\u00fcnyada 537 milyon insan\u0131n diyabet hastal\u0131\u011f\u0131 ile ya\u015fad\u0131\u011f\u0131 ve \u00f6zellikle d\u00fc\u015f\u00fck-orta gelirli \u00fclkelerde, her d\u00f6rt ki\u015fiden \u00fc\u00e7\u00fcn\u00fcn diyabetli oldu\u011fu bildirilmi\u015ftir (5). Diabetes mellitus (DM) tan\u0131s\u0131 alm\u0131\u015f bireyler, eri\u015fkin d\u00f6nem a\u015f\u0131lamas\u0131nda \u00f6ncelikli hedef gruplar\u0131ndan birini olu\u015fturmaktad\u0131r. Glikoz metabolizmas\u0131ndaki bozulmalar, diyabetli bireylerde fagositoz, kemotaksis ve l\u00f6kosit fonksiyonlar\u0131nda bozukluklara neden olmaktad\u0131r (6,7). Bu nedenle diyabetik bireyler infeksiyon hastal\u0131klar\u0131na kar\u015f\u0131 daha duyarl\u0131 hale gelmekte, olu\u015fabilecek infeksiyonlar daha \u015fiddetli seyretmekte ve \u00f6l\u00fcm riski artmaktad\u0131r. \u0130nfeksiyon hastal\u0131klar\u0131na kar\u015f\u0131 korunman\u0131n en etkili ve g\u00fcvenli yolu olan a\u015f\u0131lama, bu bireyler i\u00e7in ayr\u0131 bir \u00f6nem ta\u015f\u0131maktad\u0131r (8).<\/p>\n

G\u00fcn\u00fcm\u00fczde, Amerika Birle\u015fik Devletleri Hastal\u0131k Kontrol ve \u00d6nleme Merkezleri (Centers for Disease Control and Prevention, CDC), diyabetik bireylerin pn\u00f6mokok, influenza, hepatit B, tetanoz (tetanoz-difteri, Td) ve herpes zostar (zona) a\u015f\u0131lar\u0131 ile a\u015f\u0131lanmas\u0131n\u0131 \u00f6nermektedir (9). \u00dclkemizde de diyabetik bireyler i\u00e7in bu a\u015f\u0131lar tavsiye edilmektedir (10).<\/p>\n

Eri\u015fkin ba\u011f\u0131\u015f\u0131klama uygulamalar\u0131, birinci basamak aile hekimli\u011fi hizmetlerinin yan\u0131 s\u0131ra, ikinci ve \u00fc\u00e7\u00fcn\u00fc basamak sa\u011fl\u0131k kurulu\u015flar\u0131nda bulunan eri\u015fkin a\u015f\u0131 polikliniklerinde de y\u00fcr\u00fct\u00fclmektedir. Diyabet hastalar\u0131n\u0131n bir b\u00f6l\u00fcm\u00fc, farkl\u0131 nedenlerle hastanelere ba\u015fvurabilmektedir. Bu ba\u015fvurular s\u0131ras\u0131nda a\u015f\u0131lanma olas\u0131l\u0131\u011f\u0131n\u0131n sunulmas\u0131, \u201cka\u00e7\u0131r\u0131lm\u0131\u015f f\u0131rsatlar\u0131n\u201d azalt\u0131lmas\u0131 a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n

Bu \u00e7al\u0131\u015fmada, diyabetik bireylerin a\u015f\u0131lanmas\u0131nda, eri\u015fkin a\u015f\u0131 polikliniklerinin rol\u00fc ve \u00f6neminin de\u011ferlendirilmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Tan\u0131mlay\u0131c\u0131 nitelikte ger\u00e7ekle\u015ftirilen bu \u00e7al\u0131\u015fmaya, b\u00fcnyesinde Aile Hekimli\u011fi Klini\u011fi bulunan 14 farkl\u0131 \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k kurulu\u015fu dahil edildi. Bu merkezlerin Aile Hekimli\u011fi polikliniklerine, 15 Eyl\u00fcl 2023 \u2013 15 Ekim 2023 tarihleri aras\u0131nda herhangi bir nedenle ba\u015fvuran, 18 ya\u015f ve \u00fczerindeki diyabet hastalar\u0131 \u00e7al\u0131\u015fma kapsam\u0131nda de\u011ferlendirildi. \u00d6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fc, ara\u015ft\u0131rmada test edilmek istenen hipotezin anlaml\u0131l\u0131k d\u00fczeyi ve etki b\u00fcy\u00fckl\u00fc\u011f\u00fc dikkate al\u0131narak G*Power 3.1.9.4 program\u0131 (Heinrich Heine \u00dcniversitesi, D\u00fcsseldorf, Almanya) ile hesapland\u0131. Anlaml\u0131 bir fark saptanabilmesi i\u00e7in, \u03b1=0.05, testin g\u00fcc\u00fc (1-\u03b2) %95 olarak belirlendi; bu parametrelere g\u00f6re minimum \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fc 384 ki\u015fi olarak hesapland\u0131. <\/span><\/p>\n

\u00c7al\u0131\u015fmada, diyabet hastalar\u0131 i\u00e7in \u00f6nerilen t\u00fcm a\u015f\u0131lar\u0131 (13-valanl\u0131 konjuge pn\u00f6mokok [KPA13], influenza, zona, hepatit B ve Td a\u015f\u0131lar\u0131) yapt\u0131rm\u0131\u015f olan bireyler, CDC y\u00f6nergelerine uygun olarak \u201ctam a\u015f\u0131l\u0131\u201d olarak kabul edildi. Hastane ba\u015fvurusu s\u0131ras\u0131nda tam a\u015f\u0131l\u0131 oldu\u011fu tespit edilen bir ki\u015finin yan\u0131 s\u0131ra ba\u015fvurulan kurumda eri\u015fkin a\u015f\u0131 poliklini\u011fi bulunmamas\u0131 durumunda, a\u015f\u0131lara eri\u015fimde ya\u015fanabilecek g\u00fc\u00e7l\u00fckler nedeniyle fiziksel engeli olan veya hareket k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 bulunan bireyler \u00e7al\u0131\u015fmaya al\u0131nmad\u0131.<\/p>\n

Kat\u0131l\u0131mc\u0131lar\u0131n bilgilendirilmi\u015f onamlar\u0131n\u0131n al\u0131nmas\u0131n\u0131n ard\u0131ndan, verilerin toplanmas\u0131nda ara\u015ft\u0131rmac\u0131 taraf\u0131ndan y\u00fcz y\u00fcze uygulanan ve 16 sorudan olu\u015fan yap\u0131land\u0131r\u0131lm\u0131\u015f bir veri formu (Ek 1<\/b><\/span>) kullan\u0131ld\u0131. Formun ilk b\u00f6l\u00fcm\u00fcnde; kat\u0131l\u0131mc\u0131lar\u0131n ya\u015f\u0131n\u0131, e\u011fitim d\u00fczeyini, DM tan\u0131 s\u00fcresini, ba\u015fvurulan kurumda eri\u015fkin a\u015f\u0131 hizmeti olup olmad\u0131\u011f\u0131na dair bilgilerini, eri\u015fkin a\u015f\u0131lamas\u0131na dair bilgi kaynaklar\u0131n\u0131 ve eri\u015fkin a\u015f\u0131 poliklini\u011fi ve eri\u015fkin a\u015f\u0131lamas\u0131 ile ilgili g\u00f6r\u00fc\u015flerini sorgulayan sorular mevcuttu. Ayr\u0131ca, bu b\u00f6l\u00fcmde kat\u0131l\u0131mc\u0131lar\u0131n daha \u00f6nce yapt\u0131rd\u0131klar\u0131n\u0131 beyan ettikleri eri\u015fkin a\u015f\u0131lar\u0131 da soruldu. Formun ikinci b\u00f6l\u00fcm\u00fcnde ise kat\u0131l\u0131mc\u0131lara daha \u00f6nce diyabet tan\u0131s\u0131 nedeniyle herhangi bir a\u015f\u0131 \u00f6nerilip \u00f6nerilmedi\u011fi, bu kapsamda a\u015f\u0131 yapt\u0131r\u0131p yapt\u0131rmad\u0131klar\u0131 ve yapt\u0131rd\u0131larsa hangi a\u015f\u0131lar\u0131 yapt\u0131rd\u0131klar\u0131 soruldu. Kat\u0131l\u0131mc\u0131lara, diyabet hastalar\u0131 i\u00e7in \u00f6nerilen KPA13, influenza, zona, hepatit B ve Td a\u015f\u0131lar\u0131 hakk\u0131nda bilgi verildi ve bu a\u015f\u0131lar\u0131 yapt\u0131rmalar\u0131 \u00f6nerildi. Ayn\u0131 zamanda, ba\u015fvurulan merkezde a\u015f\u0131 poliklini\u011fi mevcutsa bu poliklinik ile ilgili bilgi verildi.<\/p>\n

Kat\u0131lan kurumlar\u0131n yaln\u0131zca 2 (%14.2)\u2019sinde eri\u015fkin a\u015f\u0131 poliklini\u011fi yoktu. Di\u011fer 12 (%85.8) kurumda aktif olarak hizmet veren eri\u015fkin a\u015f\u0131 poliklinikleri mevcuttu. Kat\u0131l\u0131mc\u0131lar\u0131n bir ayl\u0131k takip s\u00fcrecinin sonunda, kendilerine \u00f6nerilen a\u015f\u0131lardan herhangi birini yapt\u0131r\u0131p yapt\u0131rmad\u0131klar\u0131 ve yapt\u0131rd\u0131larsa hangi a\u015f\u0131lar\u0131 yapt\u0131klar\u0131 kay\u0131t alt\u0131na al\u0131nd\u0131.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in, \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Etik Kurulu\u2019ndan 12 Eyl\u00fcl 2023 tarihli ve 4089 say\u0131l\u0131 karar ile onay al\u0131nd\u0131.<\/p>\n

\u0130statistiksel Analizler<\/h3>\n

Verilerin analizi i\u00e7in IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, ABD) yaz\u0131l\u0131m\u0131 kullan\u0131ld\u0131. Kategorik de\u011fi\u015fkenler i\u00e7in frekans (s\u0131kl\u0131k) ve y\u00fczde, say\u0131sal de\u011fi\u015fkenler i\u00e7in ise medyan (minimum, maksimum) de\u011ferleriyle tan\u0131mlay\u0131c\u0131 istatistikler \u00f6zetlendi. Verilerin da\u011f\u0131l\u0131m\u0131, Kolmogorov-Smirnov testi ile de\u011ferlendirildi. Gruplar aras\u0131 kar\u015f\u0131la\u015ft\u0131rmalarda Pearson \u03c7\u00b2 testi kullan\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fma, toplam 14 merkezde 388 kat\u0131l\u0131mc\u0131 ile ger\u00e7ekle\u015ftirildi. Kat\u0131l\u0131mc\u0131lar\u0131n ya\u015f i\u00e7in medyan de\u011feri 60 olup ya\u015f aral\u0131\u011f\u0131 19 ile 95 aras\u0131nda de\u011fi\u015fmekteydi. Kat\u0131l\u0131mc\u0131lar\u0131n 215 (%55.4)\u2019i kad\u0131n, 173 (%44.6)\u2019\u00fc erkekti. E\u011fitim d\u00fczeyine g\u00f6re da\u011f\u0131l\u0131m incelendi\u011finde, lise alt\u0131 e\u011fitime sahip olanlar 250 (%64.4) ki\u015fiyle \u00e7o\u011funlu\u011fu olu\u015ftururken; lise ve \u00fcst\u00fc e\u011fitim d\u00fczeyine sahip olanlar 138 (%35.6) ki\u015fi idi.<\/p>\n

Kat\u0131l\u0131mc\u0131lar\u0131n \u00e7o\u011funlu\u011fu be\u015f y\u0131ldan uzun s\u00fcredir diyabet tan\u0131s\u0131 alm\u0131\u015ft\u0131 (n=286, %73.7). Diyabet tan\u0131s\u0131 bir y\u0131ldan k\u0131sa olan birey say\u0131s\u0131 33 (%8.5), 1\u20135 y\u0131l aras\u0131 olanlar\u0131n say\u0131s\u0131 ise 69 (%17.8) idi.<\/p>\n

Kat\u0131l\u0131mc\u0131lara ba\u015fvurduklar\u0131 kurumda eri\u015fkin a\u015f\u0131 poliklini\u011fi olup olmad\u0131\u011f\u0131 soruldu\u011funda, 108 (%27.8) ki\u015fi bu t\u00fcr bir poliklini\u011fin varl\u0131\u011f\u0131ndan haberdar oldu\u011funu belirtti. Bilgi kayna\u011f\u0131 sorguland\u0131\u011f\u0131nda, bu ki\u015filerin 38 (%35.2)\u2019i poliklini\u011fi kendisinin g\u00f6rd\u00fc\u011f\u00fcn\u00fc, 22 (%20.4)\u2019si aile hekimi taraf\u0131ndan bilgilendirildi\u011fini, 19 (%17.6)\u2019u ba\u015fka bir bran\u015f hekimi taraf\u0131ndan bilgilendirildi\u011fini, 15 (%13.8)\u2019i bilgilendirme mesaj\u0131 ald\u0131\u011f\u0131n\u0131, 14 (%13)\u2019\u00fc ise bu bilgiyi sosyal \u00e7evresinden edindi\u011fini ifade etti.<\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> Eri\u015fkin A\u015f\u0131laman\u0131n Gerekli Oldu\u011funu D\u00fc\u015f\u00fcnen Kat\u0131l\u0131mc\u0131lar\u0131n A\u015f\u0131lanmalar\u0131nda Etkili Olan Fakt\u00f6rlerin Da\u011f\u0131l\u0131m\u0131 (Sadece eri\u015fkin a\u015f\u0131lamay\u0131 gerekli g\u00f6ren bireylerin yan\u0131tlar\u0131 de\u011ferlendirilmi\u015ftir).<\/i><\/p><\/div>\n

\"\"<\/a>

\u015eekil 2.<\/strong> Eri\u015fkin A\u015f\u0131lamas\u0131n\u0131n Gerekli Olmad\u0131\u011f\u0131n\u0131 D\u00fc\u015f\u00fcnen Kat\u0131l\u0131mc\u0131lar\u0131n A\u015f\u0131 Yapt\u0131rmama Nedenlerinin Da\u011f\u0131l\u0131m\u0131 (Sadece eri\u015fkin a\u015f\u0131lamas\u0131n\u0131 gereksiz bulan bireylerin yan\u0131tlar\u0131 de\u011ferlendirilmi\u015ftir).<\/i><\/p><\/div>\n

Kat\u0131l\u0131mc\u0131lar\u0131n 296 (%76.3)\u2019s\u0131 a\u015f\u0131 polikliniklerinin eri\u015fkin a\u015f\u0131lamas\u0131n\u0131 art\u0131raca\u011f\u0131n\u0131, 22 (%5.7)\u2019si art\u0131rmayaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcn\u00fc, 70 (%18)\u2019i ise bu konuda karars\u0131z oldu\u011funu belirtti. Eri\u015fkinlerin a\u015f\u0131lanmas\u0131n\u0131n gereklili\u011fi konusunda, 296 (%76.3) ki\u015fi eri\u015fkinlerin de \u00e7ocuklar gibi a\u015f\u0131lanmas\u0131 gerekti\u011fini, 38 (%9.8) ki\u015fi eri\u015fkinlerin a\u015f\u0131lanmas\u0131n\u0131n gerekli olmad\u0131\u011f\u0131n\u0131, 54 (%13.9) ki\u015fi ise bu konuda karars\u0131z oldu\u011funu bildirdi. Eri\u015fkin a\u015f\u0131lamas\u0131n\u0131n gerekli oldu\u011funu d\u00fc\u015f\u00fcnen bireylerin a\u015f\u0131lanmas\u0131na etki eden fakt\u00f6rlerin da\u011f\u0131l\u0131m\u0131 \u015eekil 1\u2019de, gereksiz oldu\u011funu d\u00fc\u015f\u00fcnen ki\u015filerin a\u015f\u0131lanmama nedenlerinin da\u011f\u0131l\u0131m\u0131 ise \u015eekil 2\u2019de sunuldu.<\/p>\n

Kat\u0131l\u0131mc\u0131lar\u0131n yapt\u0131rm\u0131\u015f olduklar\u0131n\u0131 beyan ettikleri en s\u0131k \u00fc\u00e7 a\u015f\u0131 s\u0131ras\u0131yla; koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) a\u015f\u0131s\u0131 (%91.2, n=354), Td a\u015f\u0131s\u0131 (%43.3, n=168) ve influenza a\u015f\u0131s\u0131 (%42.3, n=164) idi. En az yapt\u0131r\u0131lan a\u015f\u0131lar ise; insan papilloma virusu (Human Papillomavirus Vaccine, HPV) a\u015f\u0131s\u0131 (%0.3, n=1), zona a\u015f\u0131s\u0131 (%0.3, n=1) ve menenjit a\u015f\u0131s\u0131 (%2.3, n=9) olarak saptand\u0131. Bunlar\u0131n d\u0131\u015f\u0131nda, 83 (%21.4) ki\u015fi KPA13, 51 (%13.1) ki\u015fi hepatit B ve 15 (%3.9) ki\u015fi hepatit A a\u015f\u0131s\u0131 yapt\u0131rm\u0131\u015ft\u0131.<\/p>\n

Kat\u0131l\u0131mc\u0131lar aras\u0131nda, diyabet tan\u0131s\u0131 nedeniyle kendisine a\u015f\u0131 \u00f6nerildi\u011fini belirten 67 (%17.3) ki\u015fi bulunmaktayd\u0131. Geriye kalan 304 (%78.4) kat\u0131l\u0131mc\u0131 daha \u00f6nce diyabet tan\u0131s\u0131 nedeniyle kendisine a\u015f\u0131 \u00f6nerilmedi\u011fini, 17 (%4.3) kat\u0131l\u0131mc\u0131 ise buna ili\u015fkin bir \u015fey hat\u0131rlamad\u0131\u011f\u0131n\u0131 ifade etti. Daha \u00f6nce kendisine a\u015f\u0131 \u00f6nerilen kat\u0131l\u0131mc\u0131lar aras\u0131nda, influenza a\u015f\u0131s\u0131 49 (%73.1) ki\u015fiye, KPA13 a\u015f\u0131s\u0131 43 (%64.2) ki\u015fiye, hepatit B a\u015f\u0131s\u0131 6 (%9) ki\u015fiye ve Td a\u015f\u0131s\u0131 2 (%3) ki\u015fiye \u00f6nerilmi\u015fti. Diyabet tan\u0131s\u0131 nedeniyle zona a\u015f\u0131s\u0131 \u00f6nerildi\u011fini belirten kat\u0131l\u0131mc\u0131 yoktu. Kat\u0131l\u0131mc\u0131lar\u0131n \u00f6nerilen a\u015f\u0131lar\u0131 yapt\u0131rma durumuna bak\u0131ld\u0131\u011f\u0131nda; Td a\u015f\u0131s\u0131 \u00f6nerilen ki\u015filerin tamam\u0131n\u0131n, influenza a\u015f\u0131s\u0131 \u00f6nerilenlerin 44 (%89.8)\u2019\u00fcn\u00fcn, KPA13 \u00f6nerilenlerin 39 (%90.7)\u2019unun ve hepatit B a\u015f\u0131s\u0131 \u00f6nerilenlerin 5 (%83.3)\u2019inin\u00a0 <\/span>a\u015f\u0131 yapt\u0131rd\u0131\u011f\u0131 tespit edildi.<\/p>\n

\u00c7al\u0131\u015fmaya kat\u0131lan 14 kurumun 12 (%85.8)\u2019sinde a\u015f\u0131 poliklini\u011fi vard\u0131. Kat\u0131l\u0131mc\u0131lar\u0131n 328 (%84.5)\u2019i eri\u015fkin a\u015f\u0131 poliklini\u011fi olan bir kuruma ba\u015fvurmu\u015fken 60 (%15.5)\u2019\u0131 eri\u015fkin a\u015f\u0131 poliklini\u011fi olmayan bir kuruma ba\u015fvurmu\u015ftu.<\/p>\n

Bir ayl\u0131k s\u00fcre\u00e7 sonunda, eksik olan ve yapt\u0131r\u0131lmas\u0131 \u00f6nerilen a\u015f\u0131lar\u0131n yapt\u0131r\u0131l\u0131p yapt\u0131r\u0131lmad\u0131\u011f\u0131na bak\u0131ld\u0131\u011f\u0131nda; 80 (%20.6) kat\u0131l\u0131mc\u0131n\u0131n kendisine \u00f6nerilen a\u015f\u0131lardan herhangi birini yapt\u0131rd\u0131\u011f\u0131 tespit edildi. Herhangi bir a\u015f\u0131y\u0131 yapt\u0131rm\u0131\u015f olan ki\u015filer aras\u0131ndaki 75 (%93.8) kat\u0131l\u0131mc\u0131n\u0131n ba\u015fvurdu\u011fu kurumda a\u015f\u0131 poliklini\u011finin mevcut oldu\u011fu g\u00f6r\u00fcld\u00fc. Hepatit B a\u015f\u0131s\u0131 yapt\u0131ran 15 (%18.8), KPA13 a\u015f\u0131s\u0131 yapt\u0131ran 64 (%80), Td a\u015f\u0131s\u0131 yapt\u0131ran 10 (%12.5) ve influenza a\u015f\u0131s\u0131 yapt\u0131ran 3 (%3.8) kat\u0131l\u0131mc\u0131 mevcuttu. Zona a\u015f\u0131s\u0131 yapt\u0131ran kat\u0131l\u0131mc\u0131 bulunmamaktayd\u0131.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> Diyabet Tan\u0131s\u0131 Nedeniyle \u00d6nerilen A\u015f\u0131lar A\u00e7\u0131s\u0131ndan Kat\u0131l\u0131mc\u0131lar\u0131n A\u015f\u0131 Ge\u00e7mi\u015fleri ve Bir Ayl\u0131k Takip S\u00fcrecindeki A\u015f\u0131lanma Durumlar\u0131n\u0131n Eri\u015fkin A\u015f\u0131 Poliklini\u011fi Varl\u0131\u011f\u0131na G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Kat\u0131l\u0131mc\u0131lar\u0131n DM i\u00e7in \u00f6nerilen a\u015f\u0131lara ili\u015fkin a\u015f\u0131lanma ge\u00e7mi\u015fleri ile bir ayl\u0131k takip s\u00fcrecindeki a\u015f\u0131lanma durumlar\u0131n\u0131n, ba\u015fvurduklar\u0131 kurumda a\u015f\u0131 poliklini\u011fi olup olmamas\u0131na g\u00f6re da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de sunuldu. Bir ayl\u0131k s\u00fcrecin sonunda, tam a\u015f\u0131l\u0131 birey say\u0131s\u0131nda de\u011fi\u015fiklik olmamakla birlikte KPA13 ile a\u015f\u0131lanan birey say\u0131s\u0131n\u0131n oran\u0131 %21.4\u2019ten %37.9\u2019a y\u00fckselmi\u015fti. Takip s\u00fcrecinin sonunda, \u00f6nerilen a\u015f\u0131lardan herhangi birini yapt\u0131r\u0131p yapt\u0131rmama durumu ile cinsiyet ve diyabet tan\u0131l\u0131 olma s\u00fcresi aras\u0131nda anlaml\u0131 d\u00fczeyde farkl\u0131l\u0131k saptanmad\u0131 (s\u0131ras\u0131yla p<\/i>=0.500 ve p<\/i>=0.399). E\u011fitim d\u00fczeyi lise ve alt\u0131 olan kat\u0131l\u0131mc\u0131lar\u0131n herhangi bir a\u015f\u0131 yapt\u0131rma oran\u0131, lise \u00fcst\u00fc e\u011fitim d\u00fczeyine sahip kat\u0131l\u0131mc\u0131lara g\u00f6re anlaml\u0131 olarak daha y\u00fcksekti (p<\/i>=0.027).<\/p>\n

Diyabet nedeniyle \u00f6nerilen a\u015f\u0131lardan herhangi birini, bir ayl\u0131k takip s\u00fcreci i\u00e7inde yapt\u0131ran kat\u0131l\u0131mc\u0131lar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011fu, eri\u015fkin a\u015f\u0131 poliklini\u011fi bulunan kurumlara ba\u015fvurmu\u015ftu (p<\/i>=0.011).\u00a0 <\/span>\u0130nfluenza, Td, ve hepatit B a\u015f\u0131lar\u0131n\u0131 yapt\u0131rma ile ba\u015fvurulan kurumda a\u015f\u0131 poliklini\u011fi olma durumlar\u0131 aras\u0131nda ili\u015fki saptanmad\u0131 (p<\/i>>0.05); ancak KPA13 a\u015f\u0131s\u0131n\u0131 yapt\u0131rm\u0131\u015f olan ki\u015filerin \u00e7o\u011funlu\u011funun ba\u015fvurdu\u011fu kurumda eri\u015fkin a\u015f\u0131 poliklini\u011fi mevcuttu ve aralar\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde bir farkl\u0131l\u0131k vard\u0131 (p<\/i>=0.002).<\/p>\n

\u0130RDELEME<\/h2>\n

Eri\u015fkin a\u015f\u0131 polikliniklerinin diyabetik bireylerin a\u015f\u0131lanmas\u0131na etkisinin de\u011ferlendirildi\u011fi bu \u00e7al\u0131\u015fmada, diyabet tan\u0131l\u0131 bireylerde influenza, hepatit B, Td, pn\u00f6mokok ve zona a\u015f\u0131lar\u0131 ile ba\u011f\u0131\u015f\u0131klama oranlar\u0131n\u0131n genel olarak d\u00fc\u015f\u00fck oldu\u011fu saptand\u0131. Ancak, eri\u015fkin a\u015f\u0131 poliklini\u011fi olan kurumlarda diyabetik bireylerin s\u00f6z konusu a\u015f\u0131lar ile a\u015f\u0131lanma oranlar\u0131n\u0131n belirgin \u015fekilde artt\u0131\u011f\u0131 g\u00f6sterildi.<\/p>\n

Kronik hastal\u0131klar\u0131 olan ki\u015filerin, sa\u011fl\u0131k riskleri ve bu risklere kar\u015f\u0131 alabilecekleri \u00f6nlemler hakk\u0131nda bilgi sahibi olmalar\u0131, koruyucu sa\u011fl\u0131k uygulamalar\u0131ndan faydalanabilmeleri a\u00e7\u0131s\u0131ndan \u00f6nemlidir. Bu y\u00fczden, risk grubundaki bireyler sahip olduklar\u0131 risklere uygun olarak a\u015f\u0131lar konusunda bilgilendirilmeli ve bu a\u015f\u0131lara eri\u015fimleri kolayla\u015ft\u0131r\u0131lmal\u0131d\u0131r. Yap\u0131lan farkl\u0131 \u00e7al\u0131\u015fmalarda; \u00f6nceden bu konuda e\u011fitim alm\u0131\u015f ya da bilgi sahibi bireylerin a\u015f\u0131lanma oranlar\u0131n\u0131n daha y\u00fcksek oldu\u011fu (11), a\u015f\u0131 \u00f6nerilmemesinin a\u015f\u0131 yapt\u0131rmama nedenleri aras\u0131nda ilk s\u0131ralarda yer ald\u0131\u011f\u0131 (12) ve hekim \u00f6nerisinin a\u015f\u0131lanma davran\u0131\u015f\u0131n\u0131 belirlemede en \u00f6nemli etken oldu\u011fu g\u00f6sterilmi\u015ftir (13). \u00c7al\u0131\u015fmam\u0131zda, kat\u0131l\u0131mc\u0131lar\u0131n \u00e7o\u011fu a\u015f\u0131 yapt\u0131rmalar\u0131nda en \u00f6nemli etkenin hekim \u00f6nerisi oldu\u011funu belirtmekle birlikte, yaln\u0131zca her be\u015f kat\u0131l\u0131mc\u0131dan biri, diyabet tan\u0131s\u0131 nedeniyle daha \u00f6nce a\u015f\u0131 \u00f6nerisi ald\u0131\u011f\u0131n\u0131 ifade etti. Ayn\u0131 zamanda, \u00adkat\u0131l\u0131mc\u0131lar\u0131n %20\u2019sinin ba\u015fvurdu\u011fu kurumda eri\u015fkin a\u015f\u0131 poliklini\u011fi varl\u0131\u011f\u0131 hakk\u0131nda bilgi sahibi oldu\u011fu ve bu ki\u015filerin \u00e7o\u011funlu\u011funun bu bilgiyi doktorlar\u0131ndan edindi\u011fi g\u00f6r\u00fcld\u00fc. Bu durum, \u00f6ncelikli olarak bireylerin mevcut durumlar\u0131na y\u00f6nelik a\u015f\u0131lanma ihtiya\u00e7lar\u0131 ve a\u015f\u0131ya ula\u015fabilecekleri kaynaklar konusunda bilgilendirilmesinin \u00f6nemini g\u00f6stermektedir.<\/p>\n

Eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131 etkileyen fakt\u00f6rler aras\u0131nda yaln\u0131zca bilgi eksikli\u011fi de\u011fil, ayn\u0131 zamanda a\u015f\u0131 g\u00fcvenli\u011fi ve etkinli\u011fine y\u00f6nelik endi\u015feler, a\u015f\u0131lama maliyetleri ve bireylerin kendi sa\u011fl\u0131k risklerini yeterince alg\u0131lamamalar\u0131 da yer almaktad\u0131r (14). \u00c7al\u0131\u015fmam\u0131zda, kat\u0131l\u0131mc\u0131lar\u0131n a\u015f\u0131lanmas\u0131nda hekim \u00f6nerisinin ard\u0131ndan ikinci s\u0131rada a\u015f\u0131lar\u0131n \u00fccretsiz olmas\u0131 belirtilmi\u015f olup bu durum maliyet fakt\u00f6r\u00fcn\u00fcn a\u015f\u0131lanma \u00ad\u00fczerindeki \u00adetkisini destekler niteliktedir. \u00d6te yandan, a\u015f\u0131 yapt\u0131rmama nedenleri aras\u0131nda en s\u0131k bildirilenler; a\u015f\u0131lara g\u00fcven duymama ve diyabet nedeniyle a\u015f\u0131 olunmas\u0131 gerekti\u011fine inanmama \u015feklinde s\u0131ralanm\u0131\u015ft\u0131r. Dolay\u0131s\u0131yla bu s\u00fcre\u00e7 yaln\u0131zca bireysel fark\u0131ndal\u0131kla de\u011fil, hekimin aktif bilgilendirmesi ve sa\u011fl\u0131k sisteminin eri\u015fimi kolayla\u015ft\u0131rmas\u0131 ile desteklenmesi gereken \u00e7ok boyutlu bir yakla\u015f\u0131m gerektirmektedir. A\u015f\u0131 ile ilgili bilgi eksikli\u011finin yan\u0131nda, a\u015f\u0131ya eri\u015fim zorlu\u011funun eri\u015fkin a\u015f\u0131lamas\u0131ndaki en \u00f6nemli engellerden biri oldu\u011fu unutulmamal\u0131d\u0131r (15).<\/p>\n

Diyabet hastalar\u0131n\u0131n a\u015f\u0131lanma oranlar\u0131 ile ilgili olarak farkl\u0131 \u00e7al\u0131\u015fmalarda elde edilen sonu\u00e7lar de\u011fi\u015fkendir. Bir derleme \u00e7al\u0131\u015fmas\u0131nda, a\u015f\u0131lanma oranlar\u0131n\u0131n pn\u00f6mokok a\u015f\u0131s\u0131 i\u00e7in %37 ila %53, hepatit B a\u015f\u0131s\u0131 i\u00e7in %13.5 ila %39 ve influenza a\u015f\u0131s\u0131 i\u00e7in ise %41 ila %79.5 aras\u0131nda de\u011fi\u015fti\u011fi; ancak, genel pop\u00fclasyonla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda a\u015f\u0131lanma oranlar\u0131n\u0131n hala d\u00fc\u015f\u00fck oldu\u011fu bildirilmi\u015ftir (14). \u00dclkemizde, yine diyabetik bireylerin a\u015f\u0131lanma durumlar\u0131n\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, influenza, pn\u00f6mokok, hepatit B ve zona ile a\u015f\u0131lanma oranlar\u0131 s\u0131ras\u0131yla %28.5, %4.8, %5.5 ve %1.2 olarak bildirilmi\u015ftir (11). Bir di\u011fer \u00e7al\u0131\u015fmada ise influenza, Td, pn\u00f6mokok ve hepatiti B a\u015f\u0131lar\u0131 i\u00e7in oranlar s\u0131ras\u0131yla %34.1, %20.8, %9.9 ve %7.8 olarak saptanm\u0131\u015ft\u0131r (16). Bu \u00e7al\u0131\u015fmalar, farkl\u0131 y\u00fczdeler bildiriyor olsa da genel e\u011filim olarak diyabetik bireylerde a\u015f\u0131lanma oranlar\u0131n\u0131n yetersiz kald\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. \u00c7al\u0131\u015fmam\u0131zda da benzer \u015fekilde, tam a\u015f\u0131l\u0131 birey say\u0131s\u0131n\u0131n yaln\u0131zca bir ki\u015fi oldu\u011fu saptand\u0131.<\/p>\n

Kat\u0131l\u0131mc\u0131lar\u0131n ba\u015fvuru an\u0131ndaki a\u015f\u0131lanma oranlar\u0131n\u0131n da d\u00fc\u015f\u00fck olmas\u0131, bu bulguyu desteklemektedir.<\/p>\n

Eri\u015fkinlerde grip a\u015f\u0131s\u0131 ile ba\u011f\u0131\u015f\u0131klama oranlar\u0131n\u0131 de\u011ferlendiren bir \u00e7al\u0131\u015fmada, a\u015f\u0131lanman\u0131n \u00f6n\u00fcndeki en \u00f6nemli \u00fc\u00e7 engel; bilgi d\u00fczeyi, sa\u011fl\u0131k hizmetlerine y\u00f6nelik tutumlar ve sa\u011fl\u0131k sistemine duyulan g\u00fcven eksikli\u011fi olarak bildirilmi\u015ftir (17). Diyabetik bireylerin de\u011ferlendirildi\u011fi ba\u015fka bir \u00e7al\u0131\u015fmada ise a\u015f\u0131lanmaman\u0131n gerek\u00e7esi olarak sunulan en \u00f6nemli nedenler; faydal\u0131 olup olmayaca\u011f\u0131n\u0131 bilmeme, etkili oldu\u011funa inanmama ve yapt\u0131rmay\u0131 unutma olarak tespit edilmi\u015ftir (18). \u00dclkemizde, diyabetli bireylerin a\u015f\u0131lanma oranlar\u0131na y\u00f6nelik yap\u0131lan bir \u00e7al\u0131\u015fmada, a\u015f\u0131lanmaman\u0131n ilk nedeni a\u015f\u0131 ile ilgili bilgilendirme yap\u0131lmamas\u0131 olup ikinci s\u0131rada a\u015f\u0131lar\u0131n zararl\u0131 etkileri oldu\u011funa inanma yer almaktad\u0131r (11). Bu \u00e7al\u0131\u015fmalarda, a\u015f\u0131lanmamaya neden olan en \u00f6nemli etkenin bilgi eksikli\u011fi\/yetersizli\u011fi oldu\u011fu g\u00f6r\u00fclmektedir. \u00c7al\u0131\u015fmam\u0131zda da hekim \u00f6nerisinin en \u00f6nemli etken olarak \u00f6ne \u00e7\u0131kmas\u0131, do\u011fru ve yeterli bilgilendirmenin a\u015f\u0131lama \u00fczerindeki etkisini a\u00e7\u0131k\u00e7a g\u00f6stermektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, a\u015f\u0131lanma oranlar\u0131 e\u011fitim d\u00fczeyi d\u00fc\u015f\u00fck ki\u015filerde e\u011fitim d\u00fczeyi y\u00fcksek ki\u015filere k\u0131yasla daha y\u00fcksek saptanm\u0131\u015ft\u0131r. Hem diyabet geli\u015fiminde hem de komplikasyonlar\u0131n ortaya \u00e7\u0131kmas\u0131nda d\u00fc\u015f\u00fck sosyoekonomik d\u00fczeyin risk fakt\u00f6r\u00fc olu\u015fturdu\u011fu bilinmektedir (19,20). Dolay\u0131s\u0131yla bu ki\u015filerin hastal\u0131k takip ve komplikasyonlar\u0131n\u0131n y\u00f6netimi s\u00fcre\u00e7lerinde sa\u011fl\u0131k hizmetleriyle temas s\u0131kl\u0131\u011f\u0131 daha fazla olabilir ve bu da a\u015f\u0131lanma fark\u0131ndal\u0131\u011f\u0131n\u0131n artmas\u0131na katk\u0131 sa\u011flam\u0131\u015f olabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n yap\u0131ld\u0131\u011f\u0131 zaman diliminin, influenza a\u015f\u0131lar\u0131n\u0131n yayg\u0131n olarak uyguland\u0131\u011f\u0131 d\u00f6nemi kapsamamas\u0131, influenza ile a\u015f\u0131lanma oranlar\u0131n\u0131n d\u00fc\u015f\u00fck \u00e7\u0131kmas\u0131na neden olmu\u015f olabilir. Ayn\u0131 \u015fekilde, hepatit B a\u015f\u0131s\u0131 uygulanmadan \u00f6nce serolojik test yap\u0131lmas\u0131n\u0131n gereklili\u011fi, bu a\u015f\u0131n\u0131n yap\u0131lma oran\u0131n\u0131 da etkilemi\u015f olabilir. Takip s\u00fcresinin uzat\u0131lmas\u0131 durumunda, her iki a\u015f\u0131 i\u00e7in de ba\u011f\u0131\u015f\u0131klama oranlar\u0131n\u0131n artmas\u0131 beklenebilir.<\/p>\n

Birinci basamak, koruyucu sa\u011fl\u0131k hizmetlerinin ana temelidir. Ancak, hastalar\u0131n bir k\u0131sm\u0131 izlem ve tedavilerini birinci basamak d\u0131\u015f\u0131nda ger\u00e7ekle\u015ftirmektedir. Eri\u015fkin a\u015f\u0131 poliklinikleri, bu bireyler i\u00e7in \u00f6nemli bir a\u015f\u0131lanma noktas\u0131d\u0131r; ayn\u0131 zamanda, bran\u015f hekimlerinin takibindeki \u00f6zellikli hasta gruplar\u0131n\u0131n a\u015f\u0131lanmas\u0131nda da etkili bir rol \u00fcstlenmektedirler. Bu poliklinikler, a\u015f\u0131ya eri\u015fimi kolayla\u015ft\u0131rman\u0131n yan\u0131 s\u0131ra hastalar\u0131n bilgilendirilmesinde ve fark\u0131ndal\u0131\u011f\u0131n art\u0131r\u0131lmas\u0131nda \u00f6nemli rol oynamaktad\u0131rlar. Hastaneye ba\u015fvuru s\u0131ras\u0131nda g\u00f6nderilen bilgilendirme mesajlar\u0131 ya da hastane i\u00e7inde yer alan eri\u015fkin a\u015f\u0131 poliklini\u011fi tabelalar\u0131 dahi, bireylerin bu hizmetten haberdar olmas\u0131n\u0131 sa\u011flayabilmektedir. Nitekim \u00e7al\u0131\u015fmam\u0131zda da bilgi mesaj\u0131 ile bilgilendirildi\u011fini ifade eden kat\u0131l\u0131mc\u0131lar mevcuttur. <\/span><\/p>\n

Bireylerin a\u015f\u0131ya eri\u015fimini kolayla\u015ft\u0131rmak, a\u015f\u0131lanma oranlar\u0131n\u0131n artmas\u0131nda b\u00fcy\u00fck rol oynayacakt\u0131r. \u00c7al\u0131\u015fmam\u0131zda, diyabetik bireylerin kendileri i\u00e7in \u00f6nerilen a\u015f\u0131larla a\u015f\u0131lanma durumlar\u0131na bak\u0131ld\u0131\u011f\u0131nda a\u015f\u0131 poliklini\u011fi olan kurumlarda bu oran\u0131n 15 kat fazla oldu\u011fu g\u00f6r\u00fclmektedir. A\u015f\u0131 poliklini\u011fi varl\u0131\u011f\u0131nda, b\u00fct\u00fcn a\u015f\u0131lar\u0131n yap\u0131lma oran\u0131 artm\u0131\u015ft\u0131r; KPA13 \u00f6zelinde ise a\u015f\u0131lanm\u0131\u015f birey say\u0131s\u0131 yakla\u015f\u0131k iki kat\u0131na \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n

Eri\u015fkin a\u015f\u0131 poliklinikleri sayesinde binlerce ki\u015fi a\u015f\u0131lanmakta ve \u00f6zellikle farkl\u0131 bran\u015f hekimlerinin y\u00f6nlendirdi\u011fi risk grubu bireylerin de a\u015f\u0131lanmas\u0131 sa\u011flanmaktad\u0131r (21,22). Bu nedenle, aile hekimli\u011finin temel hizmetlerinden olan a\u015f\u0131lama hizmetlerinin yaln\u0131zca birinci basamak merkezlerde de\u011fil, ikinci ve \u00fc\u00e7\u00fcnc\u00fc basamak merkezlerde de sunulmas\u0131 sa\u011flanmal\u0131, eri\u015fkin a\u015f\u0131 polikliniklerinin say\u0131s\u0131 art\u0131r\u0131lmal\u0131 ve bireylerin a\u015f\u0131ya eri\u015fimini kolayla\u015ft\u0131rarak a\u015f\u0131lanma oranlar\u0131n\u0131n art\u0131\u015f\u0131na katk\u0131 sa\u011flanmal\u0131d\u0131r.<\/p>\n

Bu \u00e7al\u0131\u015fmada yaln\u0131zca \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k kurulu\u015flar\u0131na ba\u015fvuran diyabetik bireylerin a\u015f\u0131lanma oranlar\u0131 de\u011ferlendirilmi\u015ftir. Dolay\u0131s\u0131yla, birinci ve ikinci basamak sa\u011fl\u0131k kurulu\u015flar\u0131nda eri\u015fkin a\u015f\u0131lamaya kat\u0131lan bireylerin verileri \u00e7al\u0131\u015fmaya dahil edilmemi\u015ftir. Ayr\u0131ca, bireylerin a\u015f\u0131 ge\u00e7mi\u015fleri ve a\u015f\u0131lanma durumlar\u0131 tamamen beyana dayal\u0131 olarak toplanm\u0131\u015ft\u0131r. Bu durum, \u00e7al\u0131\u015fman\u0131n k\u0131s\u0131tl\u0131l\u0131klar\u0131 aras\u0131nda yer almaktad\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, diyabetik bireylerin a\u015f\u0131lanma y\u00fczdelerinin d\u00fc\u015f\u00fck kald\u0131\u011f\u0131, bireylerin \u00e7o\u011funlu\u011funun a\u015f\u0131lanma gereklilikleri ve eri\u015fkin a\u015f\u0131 poliklinikleri konusunda yeterli bilgiye sahip olmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Ancak, eri\u015fkin a\u015f\u0131 polikliniklerinin varl\u0131\u011f\u0131n\u0131n ve bireylere y\u00f6nelik bilgilendirme yap\u0131lmas\u0131n\u0131n, diyabetik bireylerin a\u015f\u0131lanmas\u0131na olumlu katk\u0131 sa\u011flad\u0131\u011f\u0131 g\u00f6sterildi. Sonu\u00e7 olarak; toplumun eri\u015fkin a\u015f\u0131lar\u0131 konusunda bilgilendirilmesi, a\u015f\u0131ya eri\u015fimin kolayla\u015ft\u0131r\u0131lmas\u0131 ve eri\u015fkin a\u015f\u0131 polikliniklerinin yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131, diyabetli bireylerin ba\u011f\u0131\u015f\u0131klama oranlar\u0131n\u0131 anlaml\u0131 \u00f6l\u00e7\u00fcde art\u0131racakt\u0131r.<\/span><\/p>\n

Ek Dok\u00fcman\u0131 g\u00f6r\u00fcnt\u00fclemek i\u00e7in t\u0131klay\u0131n\u0131z.<\/span><\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e A\u015f\u0131lama, 18. y\u00fczy\u0131lda ke\u015ffedilmesinden bu yana, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n \u00f6nlenmesi ve koruyucu hekimlik uygulamalar\u0131 aras\u0131nda en \u00f6nemli m\u00fcdahalelerden biri olarak kabul edilmektedir (1). G\u00fcn\u00fcm\u00fczde de en etkili ve en g\u00fcvenli koruyucu sa\u011fl\u0131k hizmetlerinde biri olarak \u00f6nemini korumaktad\u0131r (1). Sanayile\u015fme ile ticaretin, ula\u015f\u0131m\u0131n ve ileti\u015fimin artmas\u0131, infeksiyon hastal\u0131klar\u0131n\u0131n yay\u0131l\u0131m\u0131n\u0131 kolayla\u015ft\u0131rm\u0131\u015f; ya\u015flanan n\u00fcfusun bu s\u00fcre\u00e7ten etkilenmesi ise […]<\/p>\n","protected":false},"author":4,"featured_media":30660,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5758,5254,5552,6129],"class_list":["post-30443","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-asilama","tag-diabetes-mellitus-2","tag-eriskin-asilama","tag-koruyucu-hekimlik"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30443","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=30443"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30443\/revisions"}],"predecessor-version":[{"id":30693,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30443\/revisions\/30693"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/30660"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=30443"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=30443"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=30443"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}