Araştırma Makalesi
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Stigmatization of People Living with HIV in Healthcare Workers

Yıl 2025, Cilt: 22 Sayı: 1, 159 - 164, 26.03.2025
https://doi.org/10.35440/hutfd.1600902

Öz

Background: Human Immunodeficiency Virus (HIV) infection is a chronic disease and increasing today. Stigma and discrimination are among the biggest challenges facing by people living with HIV (PLWH). A stigmatized person is subject to prejudice and dis-credit by others due to their illness. In discrimination, this prejudice turns into a negative action against the person. Stigmatization and discrimination against PLWH among healthcare professionals cause disruptions in healthcare services. This study aimed to show the level of knowledge of the healthcare workers in a training and research hospital about HIV and the extent of the stigma-tization of PLWH.
Materials and Methods: A total of 304 volunteers from assistant and specialist doctors, nurses/laboratory workers, cleaning staff/caregivers in our hospital were included in the study between 18-25 March 2022. They were asked to fill out a 12-question questionnaire online. The approaches to healthcare workers in their social and professional lives, their knowledge levels about HIV/Acquired Immunodeficiency Syndrome (AIDS) and an undetectable level of HIV viral load in the blood does not transmit HIV infection to his/her sexual partner “Undetectable=Untransmittable” (U=U) were questioned.
Results: Of the participants, 63.9% were female and 36.5% were men. In total, 43.4% people were doctors, 29.9% people were nurses/laboratory workers and 26.6% people were cleaning staff/caregivers and 33.6% of those who answered the questions are between the ages of 20-29, 13.2% are between the ages of 40-49, and 7.9% are between the ages of 50-65. HIV infected healthcare worker providing health care to their relative, sharing food with a PLWH and using the same toilet did not create a significant difference in attitudes among healthcare workers. While performing surgery on PLWH caused hesitation among doctors and nurses/laboratory workers, non-invasive procedures caused hesitation among auxiliary health personnel. Staff and caregivers had the least basic knowledge of HIV. The concept of U=U was best known to doctors (p<0.001). There was no signifi-cant difference in the post-informing attitudes among healthcare workers who had not heard of the concept U=U before (p=0.226).
Conclusions: The low level of education and insufficient knowledge of healthcare workers about HIV cause the fear of being infected, which leads to stigma and disruption in health services. The lack of change in the dripping attitude despite education suggested that other factors caused stigma. However, starting information training during the student years and repeating it at regular intervals within the hospital will reduce stigma among healthcare professionals.

Keywords: Healthcare workers, HIV/AIDS, Stigma

Kaynakça

  • 1. Başaran NÇ. HIV İnfeksiyonunun Doğal Seyri. Ünal S, Tümer A, ed. Güncel Bilgiler Işığında HIV/AIDS, Bilimsel Tıp Yayınevi, An-kara, 2016; 95-109.
  • 2. Clinicalinfo.hıv [homepage on the Internet]. Guidelines: Adult-adolescent HIV treatment. [updated 28 April 2024]. Available from: www.clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/treatment-goals-adult-adolescent-arv.pdf
  • 3. UNAIDS.org [homepage on the Internet]. Treatment archive. [updated 10 September 2024]. Available from: www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2024/july/20240722_global-aids-update
  • 4. Saglık.gov [homepage on the Internet]. HIV-AIDS-İSTATİSTİK. [updated 18 April 2024]. Available from: www.hsgm.saglik.gov.tr › hiv-aids-l iste › hiv-aids-istatislik
  • 5. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Cham-bers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;13;6(7):e011453.
  • 6. Whiteside-Mansell L, Sockwell L, Martel I. HIV stigma: a clinical provider sample in the Southern US. Journal of the National MedicalAssociation. 2020;112(6):668.
  • 7. Demirtaş FA, Şahin N. HIV ve Damgalanma: Bir Sistematik Der-leme. Sağlık ve Toplum 2022;32 (2) 13-25.
  • 8. Chambers L, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015;3:15:848.
  • 9. National Institute of Allergy and Infecyious Diseases [homepage on the Internet]. [updated 5 February 2024]. HIV Undetectab-le=Untransmittable (U=U), or Treatment as Prevention. Avai-lable from: www.niaid.nih.gov/diseases-conditions/treatment-prevention
  • 10. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimina-tion against people living with HIV by healthcare providers, So-uthwest Ethiopia. BMC Public Health. 2012; 12:522.
  • 11. Saglık.gov. [homepage on the Internet]. Bulaşıcı hastalıklar. [updated 26 April 2024]. Available from: www.saglik.gov.tr/depo/birimler/Bulasici-hastaliklar-db/hastaliklar/HIV-AIDS/Tani Teda-vi_Rehberi/HIV_AIDS_Kontrol_Programi.pdf
  • 12. Stutterheim SE, Sicking L, Brands R, Baas I, Roberts H, Brakel WHv, et al. Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings. AIDS PATIENT CA-RE and STDs. 2014; 28(12).
  • 13. Bayrak B, Keten S, Fincancı M. Sağlık Çalışanlarının HIV/AIDS Olgularına Yaklaşımları. Klimik Dergisi 2014; 27(3):103-108.
  • 14. Kalkan İA, Mut ANU, Darakci SM, Demir Y, Aktar F, Çelen MK. Bir Üniversite Hastanesindeki Hekim ve Hemşirelerin HIV/AIDS ile İzlenen Hastalara Yönelik Bilgi ve Ön Yargi Düzeyleri. Van Tıp Dergisi. 2021;28(1): 91-99,
  • 15. Hassan ZM, Wahsheh MA. Knowledge and attitudes of Jordanian nurses towards patients with HIV/AIDS: Findings from a na-tionwide survey. Issues Ment Health Nurs 2011; 32:774–84.
  • 16. Magdi HM, Abd El-Fatah SR, Nawal AA, Afefe AH. Knowledge, attitudes and practice of nurses working with HIV/AIDS pati-ents. Egypt J Health Care 2013; 4:1–14.
  • 17. Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: Results of field testing in China, Do-minica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16:18718.
  • 18. Marranzano M, Ragusa R, Platania M, Faro G, Coniglio MA. Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily. Epi-demiol Biostat Public Health 2013; 10:e8731-1–6.
  • 19. Platten M, Pham HN, Nguyen HV, Nguyen NT, Le GM. Knowled-ge of HIV and factors associated with attitudes towards HIV among final-year medicals tudents at Hanoi medical university in Vietnam. BMC Public Health. 2014;14:265
  • 20. Örnek-Köseoğlu Ö, İşcan-Kocamış E. Hastane Ve Üniversite’de Stigma: HIV/AIDS Pozitif Hastalarına Yönelik Tutum, Davranış ve İnanışların İncelenmesi, İstanbul. Sürekli Tıp Eğitimi Dergisi. 2022; 31(1): 1-13.
  • 21. Örnek-Köseoğlu Ö, Tabak F, Mete B. Stigma in Hospital: an examination of beliefs and attitudes towards HIV/AIDS patients, Istanbul, AIDS Care,2020;32(8):1045-1051.
  • 22. İnci A, Altan Y, Biçer İG, Derbent A, Salihoğlu S. Knowledge level about HIV/AIDS among healthcare workers at intensive ca-re unit. Klimik Dergisi. 2018; 31(2): 110-4.
  • 23. Ali A, Ali N, Nasir U, Aadil M, Wapas N, Zil-E-Ali A, et al. Compa-rison of Knowledge and Attitudes of Medica land Dental Stu-dents towards HIV/AIDS in Pakistan. Cureus 2018;4; 10(4):e2426.
  • 24. Srithanaviboonchai K, Chariyalertsak S, Nontarak J, Assanang-kornchai S, Kessomboon P, Putwatana P, et al. Stigmatizing atti-tudes toward people living with HIV among general adult Thai population: Results from the 5th Thai National Health Examina-tion Survey (NHES). PLoS ONE 2017; 12:e0187231.
  • 25. Shah S, Elgalib A, Al-Wahaibi A, Al-Fori M, Raju P, Al-Skaiti M, et al. Knowledge, Attitudes and Practices Related to HIV Stigma and Discrimination Among Healthcare Workers in Oman. Sultan Qaboos Univ Med. 2020 Feb;20(1):e29-e36.
  • 26. Houston P, Powell E, Khan J, Sultana S, Kwagyan J, Kharfen M, et al. Thirty-five years later: HIV stigma in Washington, DC he-alth care workers. J Assoc Nurses AIDS Care. 2019;30(3):344–351.
  • 27. D.C. Law Library - § 3–1205.10. Term and renewal of licenses, registrations, or certifications. Accessed October 13, 2020. https://code. dccouncil.us/dc/council/code/sections/3-1205.10.html.
  • 28. Spence AB, Wang C, Michel K, Ocampo JM, Kharfen M, Merens-tein D, et al. HIV releated stigma among healthcare providers: Opportunities for education and training. J Int Assoc Provid AIDS Care. 2022 Jan-Dec:21:23259582221114797.
  • 29. Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: Results of field testing in China, Do-minica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16:18718.
  • 30. Gerbert B, Maguire BT, Bleecker T, Coates TJ, McPhee SJ. Pri-mary care physicians and AIDS. Attitudinal and structural barri-ers to care. JAMA. 1991; 266(20): 2837-42.
  • 31. Andrewin A, Chien L-Y. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care STDS. 2008; 22(11):897–906.
  • 32. Ekstrand ML, Ramakrishna J, Bharat S, Heylen E. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. Journal of the International AIDS Society. 2013; 16(3Suppl 2).
  • 33. Geter A, Herron AR, Sutton MY. HIV-Related Stigma by Health-care Providers in the United States: A Systematic Review. AIDS PatientCare STDS. 2018;32(10):418-424.

Sağlık Çalışanlarında HIV ile Yaşayan Bireylere Yönelik Damgalama

Yıl 2025, Cilt: 22 Sayı: 1, 159 - 164, 26.03.2025
https://doi.org/10.35440/hutfd.1600902

Öz

Amaç: Günümüzde insan immün yetmezlik virüsü (Human Immunodeficiency Virus - HIV) enfeksiyonu tedavi edilebilir kronik bir hastalık olup görülme sıklığı artmaktadır. Bu enfeksiyona sahip olan hastaların karşılaştığı en büyük zorluklardan biri damgalan-ma ve ayrımcılıktır. Damgalanan kişi, hastalığı nedeniyle başkaları tarafından ön yargıya ve itibarsızlaştırmaya maruz kalmakta-dır. Ayrımcılıkta ise bu ön yargı, kişiye karşı olumsuz bir eyleme dönüşmektedir. Sağlık çalışanları arasında HIV ile yaşayan bireylere (HİYB) yönelik damgalama ve ayrımcılık, sağlık hizmetlerinde aksamalara neden olmaktadır. Bu çalışmada, bir eğitim ve araştırma hastanesindeki sağlık çalışanlarının HIV enfeksiyonu hakkındaki bilgi düzeyi ve HİYB'lere yönelik damgalanmanın boyutu incelenmiştir.
Materyal ve metod: Hastanemizde çalışan asistan ve uzman doktorlar, hemşire ve laborantlar ile temizlik personeli ve hasta bakıcılardan oluşan toplam 304 kişi, gönüllülük esasına dayalı olarak 18-25 Mart 2022 tarihleri arasında çalışmaya dahil edilmiş-tir. Katılımcılardan internet üzerinden 12 soruluk bir anket doldurmaları istenmiştir. Katılımcıların HİYB’lere karşı sosyal ve mesleki hayatlarındaki yaklaşımları, HIV/edinsel immün yetmezlik sendromu (Acquired Immunodeficiency Syndrome - AIDS) ve kanda belirlenemeyen HIV viral yükü olanların cinsel yolla hastalığı bulaştırmadığını belirten “Belirlenemeyen=Bulaştırmayan” (B=B) hakkındaki bilgi düzeyleri değerlendirilmiştir.
Bulgular: Ankete katılanların %63,9’u kadın, %36,5’i erkektir. Katılımcıların %43,4’ü doktor, %29,9’u hemşire/laborant ve %26,6’sı hasta bakıcı/temizlik personeli olup toplamda %45,4’ü 20-29, %33,6’sı 30-49, %13,2’si 40-49, %7,9’u 50-65 yaş aralığın-dadır. HIV ile enfekte bir sağlık çalışanının yakınına sağlık hizmeti vermesi, HİYB ile yemeğini paylaşmak veya aynı tuvaleti kullanmak sağlık çalışanları arasında belirgin bir tutum farklılığı oluşturmamıştır. HIV ile enfekte kişilerin ameliyatında bulunmak doktorlar ile hemşireler ve laborantlar için daha büyük bir endişe kaynağı olmuştur. Temizlik personelleri ve hasta bakıcılar ise non-invaziv işlemler konusunda daha çekingen yaklaşmaktadır. HIV ile ilgili temel bilgilere en az temizlik personelleri ve hasta bakıcılar sahiptir. Belirlenemeyen=Bulaştırmayan kavramı en çok doktorlar tarafından bilinmektedir (p<0,001). Daha önce B=B kavramını duymayan katılımcıların bilgilendirme metni sonrasındaki tutumlarında sağlık çalışanları arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p=0,226).
Sonuç: Sağlık çalışanlarının eğitim düzeyinin düşük olması ve HIV hakkındaki bilgilerinin yetersizliği, enfekte olma korkusuna yol açarak damgalamaya ve sağlık hizmetlerinde aksamaya neden olmaktadır. Bu nedenle, sağlık çalışanlarına yönelik HIV ile ilgili bilgilendirme eğitimlerinin meslek hayatına başlanmadan önce öğrencilik yıllarında verilmesi ve hastane içinde belirli periyotlarla tekrar edilmesi, damgalamayı azaltabilecektir.

Etik Beyan

Çalışma için 01.03.2023 tarihinde İstanbul Haseki Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan (karar no: 41-2023) onay alındı.

Kaynakça

  • 1. Başaran NÇ. HIV İnfeksiyonunun Doğal Seyri. Ünal S, Tümer A, ed. Güncel Bilgiler Işığında HIV/AIDS, Bilimsel Tıp Yayınevi, An-kara, 2016; 95-109.
  • 2. Clinicalinfo.hıv [homepage on the Internet]. Guidelines: Adult-adolescent HIV treatment. [updated 28 April 2024]. Available from: www.clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/treatment-goals-adult-adolescent-arv.pdf
  • 3. UNAIDS.org [homepage on the Internet]. Treatment archive. [updated 10 September 2024]. Available from: www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2024/july/20240722_global-aids-update
  • 4. Saglık.gov [homepage on the Internet]. HIV-AIDS-İSTATİSTİK. [updated 18 April 2024]. Available from: www.hsgm.saglik.gov.tr › hiv-aids-l iste › hiv-aids-istatislik
  • 5. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Cham-bers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;13;6(7):e011453.
  • 6. Whiteside-Mansell L, Sockwell L, Martel I. HIV stigma: a clinical provider sample in the Southern US. Journal of the National MedicalAssociation. 2020;112(6):668.
  • 7. Demirtaş FA, Şahin N. HIV ve Damgalanma: Bir Sistematik Der-leme. Sağlık ve Toplum 2022;32 (2) 13-25.
  • 8. Chambers L, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015;3:15:848.
  • 9. National Institute of Allergy and Infecyious Diseases [homepage on the Internet]. [updated 5 February 2024]. HIV Undetectab-le=Untransmittable (U=U), or Treatment as Prevention. Avai-lable from: www.niaid.nih.gov/diseases-conditions/treatment-prevention
  • 10. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimina-tion against people living with HIV by healthcare providers, So-uthwest Ethiopia. BMC Public Health. 2012; 12:522.
  • 11. Saglık.gov. [homepage on the Internet]. Bulaşıcı hastalıklar. [updated 26 April 2024]. Available from: www.saglik.gov.tr/depo/birimler/Bulasici-hastaliklar-db/hastaliklar/HIV-AIDS/Tani Teda-vi_Rehberi/HIV_AIDS_Kontrol_Programi.pdf
  • 12. Stutterheim SE, Sicking L, Brands R, Baas I, Roberts H, Brakel WHv, et al. Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings. AIDS PATIENT CA-RE and STDs. 2014; 28(12).
  • 13. Bayrak B, Keten S, Fincancı M. Sağlık Çalışanlarının HIV/AIDS Olgularına Yaklaşımları. Klimik Dergisi 2014; 27(3):103-108.
  • 14. Kalkan İA, Mut ANU, Darakci SM, Demir Y, Aktar F, Çelen MK. Bir Üniversite Hastanesindeki Hekim ve Hemşirelerin HIV/AIDS ile İzlenen Hastalara Yönelik Bilgi ve Ön Yargi Düzeyleri. Van Tıp Dergisi. 2021;28(1): 91-99,
  • 15. Hassan ZM, Wahsheh MA. Knowledge and attitudes of Jordanian nurses towards patients with HIV/AIDS: Findings from a na-tionwide survey. Issues Ment Health Nurs 2011; 32:774–84.
  • 16. Magdi HM, Abd El-Fatah SR, Nawal AA, Afefe AH. Knowledge, attitudes and practice of nurses working with HIV/AIDS pati-ents. Egypt J Health Care 2013; 4:1–14.
  • 17. Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: Results of field testing in China, Do-minica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16:18718.
  • 18. Marranzano M, Ragusa R, Platania M, Faro G, Coniglio MA. Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily. Epi-demiol Biostat Public Health 2013; 10:e8731-1–6.
  • 19. Platten M, Pham HN, Nguyen HV, Nguyen NT, Le GM. Knowled-ge of HIV and factors associated with attitudes towards HIV among final-year medicals tudents at Hanoi medical university in Vietnam. BMC Public Health. 2014;14:265
  • 20. Örnek-Köseoğlu Ö, İşcan-Kocamış E. Hastane Ve Üniversite’de Stigma: HIV/AIDS Pozitif Hastalarına Yönelik Tutum, Davranış ve İnanışların İncelenmesi, İstanbul. Sürekli Tıp Eğitimi Dergisi. 2022; 31(1): 1-13.
  • 21. Örnek-Köseoğlu Ö, Tabak F, Mete B. Stigma in Hospital: an examination of beliefs and attitudes towards HIV/AIDS patients, Istanbul, AIDS Care,2020;32(8):1045-1051.
  • 22. İnci A, Altan Y, Biçer İG, Derbent A, Salihoğlu S. Knowledge level about HIV/AIDS among healthcare workers at intensive ca-re unit. Klimik Dergisi. 2018; 31(2): 110-4.
  • 23. Ali A, Ali N, Nasir U, Aadil M, Wapas N, Zil-E-Ali A, et al. Compa-rison of Knowledge and Attitudes of Medica land Dental Stu-dents towards HIV/AIDS in Pakistan. Cureus 2018;4; 10(4):e2426.
  • 24. Srithanaviboonchai K, Chariyalertsak S, Nontarak J, Assanang-kornchai S, Kessomboon P, Putwatana P, et al. Stigmatizing atti-tudes toward people living with HIV among general adult Thai population: Results from the 5th Thai National Health Examina-tion Survey (NHES). PLoS ONE 2017; 12:e0187231.
  • 25. Shah S, Elgalib A, Al-Wahaibi A, Al-Fori M, Raju P, Al-Skaiti M, et al. Knowledge, Attitudes and Practices Related to HIV Stigma and Discrimination Among Healthcare Workers in Oman. Sultan Qaboos Univ Med. 2020 Feb;20(1):e29-e36.
  • 26. Houston P, Powell E, Khan J, Sultana S, Kwagyan J, Kharfen M, et al. Thirty-five years later: HIV stigma in Washington, DC he-alth care workers. J Assoc Nurses AIDS Care. 2019;30(3):344–351.
  • 27. D.C. Law Library - § 3–1205.10. Term and renewal of licenses, registrations, or certifications. Accessed October 13, 2020. https://code. dccouncil.us/dc/council/code/sections/3-1205.10.html.
  • 28. Spence AB, Wang C, Michel K, Ocampo JM, Kharfen M, Merens-tein D, et al. HIV releated stigma among healthcare providers: Opportunities for education and training. J Int Assoc Provid AIDS Care. 2022 Jan-Dec:21:23259582221114797.
  • 29. Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: Results of field testing in China, Do-minica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc 2013; 16:18718.
  • 30. Gerbert B, Maguire BT, Bleecker T, Coates TJ, McPhee SJ. Pri-mary care physicians and AIDS. Attitudinal and structural barri-ers to care. JAMA. 1991; 266(20): 2837-42.
  • 31. Andrewin A, Chien L-Y. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care STDS. 2008; 22(11):897–906.
  • 32. Ekstrand ML, Ramakrishna J, Bharat S, Heylen E. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. Journal of the International AIDS Society. 2013; 16(3Suppl 2).
  • 33. Geter A, Herron AR, Sutton MY. HIV-Related Stigma by Health-care Providers in the United States: A Systematic Review. AIDS PatientCare STDS. 2018;32(10):418-424.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Bulaşıcı Hastalıklar
Bölüm Araştırma Makalesi
Yazarlar

Melike Nur Özçelik 0000-0001-8590-230X

Esra Zerdali 0000-0002-7023-6639

Filiz Pehlivanoglu 0000-0001-9943-6004

Gonul Sengoz 0000-0002-1950-7288

Erken Görünüm Tarihi 18 Mart 2025
Yayımlanma Tarihi 26 Mart 2025
Gönderilme Tarihi 13 Aralık 2024
Kabul Tarihi 10 Mart 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 22 Sayı: 1

Kaynak Göster

Vancouver Özçelik MN, Zerdali E, Pehlivanoglu F, Sengoz G. Sağlık Çalışanlarında HIV ile Yaşayan Bireylere Yönelik Damgalama. Harran Üniversitesi Tıp Fakültesi Dergisi. 2025;22(1):159-64.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty