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HUZUREVİ MENÜLERİNİN BESİN ÖGESİ ÖRÜNTÜ PROFİLİ VE MIND DİYETİNE UYUMUNUN DEĞERLENDİRİLMESİ

Yıl 2021, , 362 - 384, 31.08.2021
https://doi.org/10.21020/husbfd.944414

Öz

Amaç: Bu çalışmanın amacı, Ankara’da faaliyet gösteren huzurevinde uygulanan menülerinin Besin Öğesi Örüntü Profiline göre değerlendirilmesi ve menülerin MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diyetine uyumunun belirlenmesidir. Gereç ve Yöntem: Bu çalışmada, Ankara’da bulunan kamuya bağlı ve özel olarak hizmet veren iki huzurevinde yaz ve kış mevsimlerinde sunulan menüler besin öğesi örüntü profiline göre incelenmiş ve MIND diyetine uyumu değerlendirilmiştir. Menülerin enerji ve besin öğesi içerikleri ulusal ve uluslararası referans değerleri ile karşılaştırılmıştır. Bulgular: Menülerin MIND skorları kamuya bağlı huzurevinde her iki mevsimde 5, özel huzurevinde yaz ve kış mevsiminde sırasıyla 7 ve 6 olarak bulunmuştur. Menülerin NRF9.3 (Nutrient Rich Food 9.3) ve E-NRF (Elderly-NRF) puanları en yüksek (sırasıyla 57,4±35,8 ve 119,1±65,1) özel huzurevinin kış menüsünde, en düşük (sırasıyla 45,8±23,1 ve 97,2±37,7) kamu huzurevi yaz menüsünde tespit edilmiştir. Sonuç: Menülerin MIND diyeti uyumlarının artırılması için menülerde zeytinyağı kullanımının, tam tahılların, balık ve dutsu meyvelerin verilme sıklığının artırılması, hamur işi, tatlı ve kırmızı et verilme sıklığının azaltılması gerektiği tespit edilmiştir. Huzurevi sakinlerinin bilişsel performans ve sağlıklarının korunması ve iyileştirilmesi için menü planlamada enerji ve besin öğesi gereksinimleri ile beslenme durumlarını etkileyen etkenler göz önünde bulundurularak menü planlama ilkelerine uyulmalıdır.

Kaynakça

  • TÜİK (2020). Türkiye İstatistik Kurumu, İstatistiklerle Yaşlılar. https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2020-37227 adresinden elde edildi.
  • Adjibade, M., Assmann, K. E., Julia, C., Galan, P., Hercberg, S., & Kesse-Guyot, E. (2019). Prospective association between adherence to the MIND diet and subjective memory complaints in the French NutriNet-Santé cohort. Journal of neurology, 266(4), 942-952.
  • Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer's & Dementia, 11(6), 718-726. doi:https://doi.org/10.1016/j.jalz.2015.05.016
  • Berendsen, A. A. M., Kramer, C. S., & Groot, L. C. P. G. M. d. (2019). The Newly Developed Elderly Nutrient-Rich Food Score Is a Useful Tool to Assess Nutrient Density in European Older Adults. Frontiers in Nutrition, 6(119), 1-14. doi:10.3389/fnut.2019.00119
  • Berendsen, A. M., Kang, J. H., Feskens, E. J., de Groot, C., Grodstein, F., & van de Rest, O. (2018). Association of long-term adherence to the mind diet with cognitive function and cognitive decline in American women. The journal of nutrition, health & aging, 22(2), 222-229.
  • Berendsen AM, v. L. L., van den Heuvel EG, Matthys C, Peter S, de Groot LC. (2016). Conventional foods, followed by dietary supplements and fortified foods, are the key sources of vitamin D, vitamin B6, and selenium intake in Dutch participants of the NUAGE study. Nutr Res., 36, 1171–1181.
  • Blekkenhorst, L. C., Prince, R. L., Hodgson, J. M., Lim, W. H., Zhu, K., Devine, A. ve diğerleri (2015). Dietary saturated fat intake and atherosclerotic vascular disease mortality in elderly women: a prospective cohort study. The American journal of clinical nutrition, 101(6), 1263-1268.
  • Buckinx, F., Allepaerts, S., Paquot, N., Reginster, J.-Y., De Cock, C., Petermans, J., & Bruyère, O. (2017). Energy and nutrient content of food served and consumed by nursing home residents. The journal of nutrition, health & aging, 21(6), 727-732.
  • Demirel, Y., Bilici, S., & Köksal, E. (2018). Özel ve devlet huzurevleri menülerinin kalite ve yeterlilik açısından değerlendirmesi. Beslenme ve Diyet Dergisi, 46(1), 24-29.
  • Dikmen, D., & Pekcan, G. (2013). Besin Ögesi Örüntü Profili: Toplu Beslenme Hizmeti Veren Kuruluşlarda Uygulanan Menülerin Değerlendirilmesi. Beslenme ve Diyet Dergisi, 41(3), 234-241.
  • Dominguez, L. J., Farruggia, M., Veronese, N., & Barbagallo, M. (2021). Vitamin D Sources, Metabolism, and Deficiency: Available Compounds and Guidelines for Its Treatment. Metabolites, 11(4), 255.
  • Drewnowski, A. (2009). Defining Nutrient Density: Development and Validation of the Nutrient Rich Foods Index. Journal of the American College of Nutrition, 28(4), 421S-426S. doi:10.1080/07315724.2009.10718106
  • EFSA (2009). European Food Safety Authority. Review of labelling reference intake values-Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the review of labelling reference intake values for selected nutritional elements. . EFSA J. 7:1008. doi: 10.2903/j.efsa.20 09.1008.
  • FDA (2020). Food and Drugs Chapter I --Food And Drug Admınıstratıon Department Of Health And Human Servıces Subchapter B - Food For Human Consumption, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9 adresinden elde edildi.
  • Fresán, U., Bes-Rastrollo, M., Segovia-Siapco, G., Sanchez-Villegas, A., Lahortiga, F., de la Rosa, P.-A., & Martínez-Gonzalez, M.-A. (2019). Does the MIND diet decrease depression risk? A comparison with Mediterranean diet in the SUN cohort. European journal of nutrition, 58(3), 1271-1282.
  • Gardener, S. L., & Rainey-Smith, S. R. (2018). The role of nutrition in cognitive function and brain ageing in the elderly. Current nutrition reports, 7(3), 139-149.
  • Grieger, J., & Nowson, C. (2007). Nutrient intake and plate waste from an Australian residential care facility. European journal of clinical nutrition, 61(5), 655-663.
  • Hosking, D. E., Eramudugolla, R., Cherbuin, N., & Anstey, K. J. (2019). MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimer's & Dementia, 15(4), 581-589.
  • Kheirouri, S., & Alizadeh, M. (2021). MIND diet and cognitive performance in older adults: a systematic review. Critical Reviews in Food Science and Nutrition, 1-19.
  • Kupisz-Urbańska, M., Płudowski, P., & Marcinowska-Suchowierska, E. (2021). Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency. Nutrients, 13(4), 1247.
  • Lam, I. T., Keller, H. H., Duizer, L., & Stark, K. (2015). Micronutrients on the menu: Enhancing the quality of food in long-term care for regular, nontherapeutic menus. Canadian Journal of Dietetic Practice and Research, 76(2), 86-92.
  • Leij-Halfwerk, S., Verwijs, M. H., van Houdt, S., Borkent, J. W., Guaitoli, P., Pelgrim, T. ve diğerleri. (2019). Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults≥ 65 years: a systematic review and meta-analysis. Maturitas, 126, 80-89.
  • Lengyel, C. O., Zello, G. A., Smith, J. T., & Whiting, S. J. (2003). Evaluation of menu and food service practices of long-term care facilities of a health district in Canada. Journal of Nutrition for the Elderly, 22(3), 29-42.
  • Mao, X.-Y., Yin, X.-X., Guan, Q.-W., Xia, Q.-X., Yang, N., Zhou, H.-H. ve diğerleri. (2021). Dietary nutrition for neurological disease therapy: Current status and future directions. Pharmacology & Therapeutics, 107861.
  • McEvoy, C. T., Guyer, H., Langa, K. M., & Yaffe, K. (2017). Neuroprotective diets are associated with better cognitive function: the health and retirement study. Journal of the American Geriatrics Society, 65(8), 1857-1862.
  • Milà, R., Abellana, R., & Farran, A. (2009). Nutritional assessment of the menus in five geriatric homes and their adaptation to the recomended intakes for the elderly population. Actividad Dietética, 13(02), 51-58.
  • Mooradian, A. D., Smith, M., & Tokuda, M. (2017). The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clinical nutrition ESPEN, 18, 1-8.
  • Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Barnes, L. L., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet slows cognitive decline with aging. Alzheimer's & Dementia, 11(9), 1015-1022.
  • Nations, U. (2019). World Population Ageing. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf adresinden elde edildi.
  • Nelson, L., & Tabet, N. (2015). Slowing the progression of Alzheimer’s disease; what works? Ageing research reviews, 23, 193-209.
  • Newberry, C., & Dakin, G. (2021). Nutrition and Weight Management in the Elderly. Clinics in Geriatric Medicine, 37(1), 131-140.
  • NNR. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012 : Integrating Nutrition and Physical Activity. . Copenhagen K: Nordic Council of Ministers (2014).
  • Oh, S. W., Koo, H. S., Han, K. H., Han, S. Y., & Chin, H. J. (2017). Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PloS one, 12(12), e0188770.
  • Samieri, C., Morris, M.-C., Bennett, D. A., Berr, C., Amouyel, P., Dartigues, J.-F. ve diğerleri. (2018). Fish intake, genetic predisposition to Alzheimer disease, and decline in global cognition and memory in 5 cohorts of older persons. American journal of epidemiology, 187(5), 933-940.
  • Sánchez-Campillo, M., Torralba, C., López, M. Á., Zamora, S., & Pérez-Llamas, F. (2010). Strategies for improving nutritional value of the meals offered by public nursing homes for the elderly. Nutricion hospitalaria, 25(6), 1014-1019.
  • Scarmeas, N., Anastasiou, C. A., & Yannakoulia, M. (2018). Nutrition and prevention of cognitive impairment. The Lancet Neurology, 17(11), 1006-1015.
  • Türkiye Beslenme Rehberi TÜBER 2015. T.C. Sağlık Bakanlığı Yayın No: 1031, Ankara, 2016
  • Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., Corella, D., De la Torre, R., Martínez-González, M. Á., Salas-Salvadó, J. ve diğerleri. (2015). Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA internal medicine, 175(7), 1094-1103.
  • Van Wymelbeke, V., Sulmont-Rossé, C., Feyen, V., Issanchou, S., Manckoundia, P., & Maître, I. (2020). Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents. Appetite, 153, 104749.
  • Watson, R. R. (2017). Nutrition and functional foods for healthy aging: Academic Press.

EVALUATION OF NURSING HOME MENUS’ NUTRIENT PROFILING AND ADHERENCE TO MIND DIET

Yıl 2021, , 362 - 384, 31.08.2021
https://doi.org/10.21020/husbfd.944414

Öz

Objectıves: The objective of this study is to evaluate the menus of nursing homes operating in Ankara according to the Nutrient Profiling and to determine the adherence to the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet. Materıals and Methods: The menus served in summer and winter in two public and private nursing homes in Ankara were examined according to the nutrient profiling and their adherence to the MIND diet was evaluated. Energy and nutrient contents of the menus were compared with national and international reference values. Results: The MIND scores of the menus were 5 in both seasons in the public nursing home, 7 and 6 in the private nursing home in summer and winter, respectively. The highest NRF9.3 (Nutrient Rich Food 9.3) and E-NRF (Elderly-NRF) scores (57.4 ± 35.8 and 119.1 ± 65.1, respectively) were found in the winter menu of the private nursing home, and the lowest scores (45.8±23.1 and 97.2±37.7, respectively) were found in the summer menu of the public nursing home. Conclusion: The use of olive oil and the frequency of serving whole grains, fish and berries should be increased, and the frequency of serving pastries, sweet and red meat should be reduced in order to increase the adherence to the MIND diet. Menus should be planned according to the menu planning principles, and the energy and nutrient requirements and the factors affecting their nutritional status should be considered for protecting and improving the cognitive performance and health of nursing home residents.

Kaynakça

  • TÜİK (2020). Türkiye İstatistik Kurumu, İstatistiklerle Yaşlılar. https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2020-37227 adresinden elde edildi.
  • Adjibade, M., Assmann, K. E., Julia, C., Galan, P., Hercberg, S., & Kesse-Guyot, E. (2019). Prospective association between adherence to the MIND diet and subjective memory complaints in the French NutriNet-Santé cohort. Journal of neurology, 266(4), 942-952.
  • Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer's & Dementia, 11(6), 718-726. doi:https://doi.org/10.1016/j.jalz.2015.05.016
  • Berendsen, A. A. M., Kramer, C. S., & Groot, L. C. P. G. M. d. (2019). The Newly Developed Elderly Nutrient-Rich Food Score Is a Useful Tool to Assess Nutrient Density in European Older Adults. Frontiers in Nutrition, 6(119), 1-14. doi:10.3389/fnut.2019.00119
  • Berendsen, A. M., Kang, J. H., Feskens, E. J., de Groot, C., Grodstein, F., & van de Rest, O. (2018). Association of long-term adherence to the mind diet with cognitive function and cognitive decline in American women. The journal of nutrition, health & aging, 22(2), 222-229.
  • Berendsen AM, v. L. L., van den Heuvel EG, Matthys C, Peter S, de Groot LC. (2016). Conventional foods, followed by dietary supplements and fortified foods, are the key sources of vitamin D, vitamin B6, and selenium intake in Dutch participants of the NUAGE study. Nutr Res., 36, 1171–1181.
  • Blekkenhorst, L. C., Prince, R. L., Hodgson, J. M., Lim, W. H., Zhu, K., Devine, A. ve diğerleri (2015). Dietary saturated fat intake and atherosclerotic vascular disease mortality in elderly women: a prospective cohort study. The American journal of clinical nutrition, 101(6), 1263-1268.
  • Buckinx, F., Allepaerts, S., Paquot, N., Reginster, J.-Y., De Cock, C., Petermans, J., & Bruyère, O. (2017). Energy and nutrient content of food served and consumed by nursing home residents. The journal of nutrition, health & aging, 21(6), 727-732.
  • Demirel, Y., Bilici, S., & Köksal, E. (2018). Özel ve devlet huzurevleri menülerinin kalite ve yeterlilik açısından değerlendirmesi. Beslenme ve Diyet Dergisi, 46(1), 24-29.
  • Dikmen, D., & Pekcan, G. (2013). Besin Ögesi Örüntü Profili: Toplu Beslenme Hizmeti Veren Kuruluşlarda Uygulanan Menülerin Değerlendirilmesi. Beslenme ve Diyet Dergisi, 41(3), 234-241.
  • Dominguez, L. J., Farruggia, M., Veronese, N., & Barbagallo, M. (2021). Vitamin D Sources, Metabolism, and Deficiency: Available Compounds and Guidelines for Its Treatment. Metabolites, 11(4), 255.
  • Drewnowski, A. (2009). Defining Nutrient Density: Development and Validation of the Nutrient Rich Foods Index. Journal of the American College of Nutrition, 28(4), 421S-426S. doi:10.1080/07315724.2009.10718106
  • EFSA (2009). European Food Safety Authority. Review of labelling reference intake values-Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the review of labelling reference intake values for selected nutritional elements. . EFSA J. 7:1008. doi: 10.2903/j.efsa.20 09.1008.
  • FDA (2020). Food and Drugs Chapter I --Food And Drug Admınıstratıon Department Of Health And Human Servıces Subchapter B - Food For Human Consumption, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9 adresinden elde edildi.
  • Fresán, U., Bes-Rastrollo, M., Segovia-Siapco, G., Sanchez-Villegas, A., Lahortiga, F., de la Rosa, P.-A., & Martínez-Gonzalez, M.-A. (2019). Does the MIND diet decrease depression risk? A comparison with Mediterranean diet in the SUN cohort. European journal of nutrition, 58(3), 1271-1282.
  • Gardener, S. L., & Rainey-Smith, S. R. (2018). The role of nutrition in cognitive function and brain ageing in the elderly. Current nutrition reports, 7(3), 139-149.
  • Grieger, J., & Nowson, C. (2007). Nutrient intake and plate waste from an Australian residential care facility. European journal of clinical nutrition, 61(5), 655-663.
  • Hosking, D. E., Eramudugolla, R., Cherbuin, N., & Anstey, K. J. (2019). MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimer's & Dementia, 15(4), 581-589.
  • Kheirouri, S., & Alizadeh, M. (2021). MIND diet and cognitive performance in older adults: a systematic review. Critical Reviews in Food Science and Nutrition, 1-19.
  • Kupisz-Urbańska, M., Płudowski, P., & Marcinowska-Suchowierska, E. (2021). Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency. Nutrients, 13(4), 1247.
  • Lam, I. T., Keller, H. H., Duizer, L., & Stark, K. (2015). Micronutrients on the menu: Enhancing the quality of food in long-term care for regular, nontherapeutic menus. Canadian Journal of Dietetic Practice and Research, 76(2), 86-92.
  • Leij-Halfwerk, S., Verwijs, M. H., van Houdt, S., Borkent, J. W., Guaitoli, P., Pelgrim, T. ve diğerleri. (2019). Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults≥ 65 years: a systematic review and meta-analysis. Maturitas, 126, 80-89.
  • Lengyel, C. O., Zello, G. A., Smith, J. T., & Whiting, S. J. (2003). Evaluation of menu and food service practices of long-term care facilities of a health district in Canada. Journal of Nutrition for the Elderly, 22(3), 29-42.
  • Mao, X.-Y., Yin, X.-X., Guan, Q.-W., Xia, Q.-X., Yang, N., Zhou, H.-H. ve diğerleri. (2021). Dietary nutrition for neurological disease therapy: Current status and future directions. Pharmacology & Therapeutics, 107861.
  • McEvoy, C. T., Guyer, H., Langa, K. M., & Yaffe, K. (2017). Neuroprotective diets are associated with better cognitive function: the health and retirement study. Journal of the American Geriatrics Society, 65(8), 1857-1862.
  • Milà, R., Abellana, R., & Farran, A. (2009). Nutritional assessment of the menus in five geriatric homes and their adaptation to the recomended intakes for the elderly population. Actividad Dietética, 13(02), 51-58.
  • Mooradian, A. D., Smith, M., & Tokuda, M. (2017). The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clinical nutrition ESPEN, 18, 1-8.
  • Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Barnes, L. L., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet slows cognitive decline with aging. Alzheimer's & Dementia, 11(9), 1015-1022.
  • Nations, U. (2019). World Population Ageing. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf adresinden elde edildi.
  • Nelson, L., & Tabet, N. (2015). Slowing the progression of Alzheimer’s disease; what works? Ageing research reviews, 23, 193-209.
  • Newberry, C., & Dakin, G. (2021). Nutrition and Weight Management in the Elderly. Clinics in Geriatric Medicine, 37(1), 131-140.
  • NNR. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012 : Integrating Nutrition and Physical Activity. . Copenhagen K: Nordic Council of Ministers (2014).
  • Oh, S. W., Koo, H. S., Han, K. H., Han, S. Y., & Chin, H. J. (2017). Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PloS one, 12(12), e0188770.
  • Samieri, C., Morris, M.-C., Bennett, D. A., Berr, C., Amouyel, P., Dartigues, J.-F. ve diğerleri. (2018). Fish intake, genetic predisposition to Alzheimer disease, and decline in global cognition and memory in 5 cohorts of older persons. American journal of epidemiology, 187(5), 933-940.
  • Sánchez-Campillo, M., Torralba, C., López, M. Á., Zamora, S., & Pérez-Llamas, F. (2010). Strategies for improving nutritional value of the meals offered by public nursing homes for the elderly. Nutricion hospitalaria, 25(6), 1014-1019.
  • Scarmeas, N., Anastasiou, C. A., & Yannakoulia, M. (2018). Nutrition and prevention of cognitive impairment. The Lancet Neurology, 17(11), 1006-1015.
  • Türkiye Beslenme Rehberi TÜBER 2015. T.C. Sağlık Bakanlığı Yayın No: 1031, Ankara, 2016
  • Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., Corella, D., De la Torre, R., Martínez-González, M. Á., Salas-Salvadó, J. ve diğerleri. (2015). Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA internal medicine, 175(7), 1094-1103.
  • Van Wymelbeke, V., Sulmont-Rossé, C., Feyen, V., Issanchou, S., Manckoundia, P., & Maître, I. (2020). Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents. Appetite, 153, 104749.
  • Watson, R. R. (2017). Nutrition and functional foods for healthy aging: Academic Press.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Gülsüm Gizem Topal 0000-0002-3959-0808

Sümeyra Sevim 0000-0001-9724-2628

Damla Gümüş 0000-0002-3099-3432

Mevlüde Kızıl 0000-0003-1380-3243

Yayımlanma Tarihi 31 Ağustos 2021
Gönderilme Tarihi 29 Mayıs 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

APA Topal, G. G., Sevim, S., Gümüş, D., Kızıl, M. (2021). HUZUREVİ MENÜLERİNİN BESİN ÖGESİ ÖRÜNTÜ PROFİLİ VE MIND DİYETİNE UYUMUNUN DEĞERLENDİRİLMESİ. Hacettepe University Faculty of Health Sciences Journal, 8(2), 362-384. https://doi.org/10.21020/husbfd.944414