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NEDENSEL ÇIKARIM SÜRECİ VE BAZI ÖNEMLİ KAVRAMLAR: ETKİ DEĞİŞTİRİCİ, KARIŞTIRICI, ÇARPIŞTIRICI VE MEDİYATÖR

Yıl 2023, Cilt: 8 Sayı: 3, 361 - 374, 29.10.2023

İsmail Çevik Pınar Okyay

https://doi.org/10.35232/estudamhsd.1307812

Öz

Günümüzde, hastalıkların hemen hepsinin multifaktöriyel etiyolojilere sahip olduğu düşünülmektedir. Bir hastalığın ortaya çıkmasının birden fazla etkenin, farklı oranlarda ve farklı mekanizmalarla yaptığı etkiler neticesinde olması, aynı zamanda bir etken ile onun sonucu arasında diğer tüm etkilerden soyutlanmış bir ilişki olamayacağı anlamına da gelmektedir. Etken ile hastalık arasındaki ilişkiyi etkileyen ve nedenselliği çarpıtan üçüncül faktörler mutlaka olacaktır. Bu yüzden, epidemiyologlar ve bilimsel çalışmalar yürütecek olan diğer tüm araştırmacılar tarafından etki değiştirici, karıştırıcı, çarpıştırıcı ve mediyatör gibi kavramların bilinmesi ve çalışmaların tüm aşamalarında bu üçüncül faktörlerin mutlaka gözetilmesi gerekmektedir.

Anahtar Kelimeler

Nedensellik etki değiştirici karıştırıcı değişken karıştırıcı çarpıştırıcı mediyatör

Destekleyen Kurum

Yok

Kaynakça

  • 1. Hayran O. Bilimsel Araştırmalar Ne Kadar Bilimsel: Karıştırıcılar, Çarpıştırıcılar ve Etki-Ölçüm Değiştiriciler. J Biotechnol Strateg Heal Res [Internet]. 2021 Nov 17; Available from: https://dergipark.org.tr/tr/doi/10.34084/bshr.1020533
  • 2. Hulswit M. A Short History of ‘Causation’ [Internet]. [cited 2022 Mar 21]. Available from: http://see.library.utoronto.ca/SEED/Vol4-3/Hulswit.htm
  • 3. Evans AS. Evans As. Causatıon And Dısease: A Chronologıcal Journey: The Thomas Parran Lecture1. Am J Epidemiol [Internet]. 1978 Oct 1;108(4): 249–58. Available from: https://doi.org/10.1093/oxfordjournals.aje.a112617
  • 4. Last JM, editor. A Dictionary of Epidemiology. 4th ed. Oxford University Press; 2001.
  • 5. Susser M. Glossary: causality in public health science. J Epidemiol Community Heal [Internet]. 2001 Jun 1;55(6):376–8. Available from: https://jech.bmj.com/lookup/doi/10.1136/jech.55.6.376
  • 6. Cohen J. The Evolution of Koch’s Postulates. Infect Dis (Auckl) [Internet]. 2017 [cited 2022 Apr 6];1-3.e1. Available from: https://www.sciencedirect.com/science/article/pii/B9780702062858000010?via%3Dihub
  • 7. Susser M. Causal thinking in the health sciences : concepts and strategies of epidemiology. Oxford University Press;1973.
  • 8. Ventriglio A, Bellomo A, Bhugra D. Web of causation and its implications for epidemiological research. Int J Soc Psychiatry [Internet]. 2016 Feb 12;62(1):3–4. Available from: http://journals.sagepub.com/doi/10.1177/0020764015587629
  • 9. Krieger N. Epidemiology and the web of causation: Has anyone seen the spider? Soc Sci Med [Internet]. 1994 Oct;39(7):887–903. Available from: https://linkinghub.elsevier.com/retrieve/pii/027795369490202X
  • 10. Şenaras AE, Üniversitesi BU. COVID- 19 Salgınında Sağlık Çalışanlarının Enfekte Olmasına İlişkin Nedensel Döngü Diyagramı Causal Loop Diagram For Infection Of Healthcare Workers In The COVID-19 Outbreak. 2021 (May 2020):1039–52.
  • 11. Hill AB. The Environment and Disease: Association or Causation? J R Soc Med [Internet]. 1965;58(5):295–300. Available from: https://journals.sagepub.com/doi/10.1177/003591576505800503
  • 12. Howick J, Kelly P, Kelly M. Establishing a causal link between social relationships and health using the Bradford Hill Guidelines. SSM - Popul Heal [Internet]. 2019 Aug;8:100402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31193417
  • 13. Rothman KJ, Greenland S. Causation and Causal Inference in Epidemiology. Am J Public Health [Internet]. 2005 Jul 1;95(S1):S144–50. doi:10.2105/AJPH.2004.059204.
  • 14. Rothman KJ. Epidemiology: An Introduction. 2nd Editio. Oxford: Oxford University Press; 2012.
  • 15. Rothman KJ. Causes. Am J Epidemiol [Internet]. 1976 Dec 1;104(6):587–92. Available from: doi:10.1093/oxfordjournals.aje.a112335.
  • 16. Greenland S. Invited Commentary on “Causes.” Am J Epidemiol [Internet]. 1995;141(2). Available from: https://www.sjsu.edu/faculty/gerstman/eks/Rothman1976.pdf
  • 17. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd edition. Philadelphia: Lippincott, Williams and Wilkins; 2012.
  • 18. Aschengrau A, Seage GR. Essentials of Epidemiology in Public Health. 4th Edition. 2020. 541 p.
  • 19. LaMorte WW. The Sufficient-Component Cause Model [Internet]. [cited 2022 Apr 7]. Available from: https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_causality/ep713_causality4.html
  • 20. International Epidemiological Association. A Dictionary of Epidemiology. 6th Editio. Porta M, editor. Oxford University Press; 2016.
  • 21. Principles of Epidemiology | Lesson 3 -Section 6 [Internet]. [cited 2023 Mar 27]. Available from: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html
  • 22. LaMorte WW, Sullivan L. Confounding and Effect Measure Modification [Internet]. Boston University School of Publich Health. [cited 2022 Mar 30]. Available from: https://sphweb.bumc.bu.edu/otlt/mph-modules/bs/bs704-ep713_confounding-em/bs704-ep713_confounding-em_print.html
  • 23. Roditi RE, Veling M, Shin JJ. Age: An effect modifier of the association between allergic rhinitis and Otitis media with effusion. Laryngoscope [Internet]. 2016 Jul;126(7):1687–92. Available from: https://onlinelibrary.wiley.com/doi/10.1002/lary.25682
  • 24. Confounding - Catalog of Bias [Internet].[cited 2022 Mar 30]. Available from: https://catalogofbias.org/biases/confounding/
  • 25. McNamee R. Confounding and confounders. Occup Environ Med [Internet]. 2003 Mar 1;60(3):227 LP – 234. Available from: http://oem.bmj.com/content/60/3/227.abstract
  • 26. Kilic S. Effect size. J Mood Disord [Internet]. 2014;4(1):44. Available from: http://www.scopemed.org/fulltextpdf.php?mno=152916
  • 27. Weinberg CR. Toward a Clearer Definition of Confounding. Am J Epidemiol [Internet]. 1993 Jan1;137(1):1–8. Available from: https://academic.oup.com/aje/article/303163/Toward
  • 28. Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine Dependence and Psychiatric Disorders in the United States. Arch Gen Psychiatry [Internet]. 2004 Nov 1;61(11):1107. Available from: http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archpsyc.61.11.1107
  • 29. Flesch M, Morbach S, Erdmann E, Bulut D. Weingenuss und Prävention der koronaren Herzkrankheit. Herz [Internet]. 2016 Sep 19;41(6):469–77. Available from: http://link.springer.com/10.1007/s00059-016-4467-8
  • 30. Holmberg MJ, Andersen LW. Collider Bias. JAMA [Internet]. 2022 Apr 5;327(13):1282. Available from: https://jamanetwork.com/journals/jama/fullarticle/2790247
  • 31. Tönnies T, Kahl S, Kuss O. Collider bias in observational studies. Dtsch Arztebl Int [Internet]. 2022 Feb 18; Available from: https://www.aerzteblatt.de/10.3238/arztebl.m2022.0076
  • 32. Griffith GJ, Morris TT, Tudball MJ, Herbert A, Mancano G, Pike L, et al. Collider bias undermines our understanding of COVID-19 disease risk and severity. Nat Commun [Internet]. 2020 Nov 12;11(1):5749. Available from: https://www.nature.com/articles/s41467-020-19478-2
  • 33. Holmberg MJ, Andersen LW. Collider Bias. JAMA [Internet]. 2022 Mar 14 [cited 2022 Apr 5]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2790247
  • 34. Lipsky AM, Greenland S. Causal Directed Acyclic Graphs. JAMA [Internet]. 2022 Mar 15;327(11):1083. Available from: https://jamanetwork.com/journals/jama/fullarticle/2789646
  • 35. Keogh E, Eccleston C. Sex differences in adolescent chronic pain and pain-related coping. Pain [Internet]. 2006 Aug;123(3):275–84. Available from: https://journals.lww.com/00006396-200608000-00009
  • 36. Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology [Internet]. 1999 Jan;10(1):37–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9888278
  • 37.Greenland S. Invited Commentary: Variable Selection versus Shrinkage in the Control of Multiple Confounders. Am J Epidemiol [Internet]. 2007 Dec 12;167(5):523–9. Available from: https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwm355
  • 38. Kamangar F. Confounding variables in epidemiologic studies: basics and beyond. Arch Iran Med [Internet]. 2012 Aug;15(8):508–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22827790
  • 39. Kirkwood K, Sterne JAC. Essential Medical Statistics. Malden, Mass: Blackwell Science.; 2003.
  • 40. Wunsch G. Confounding and control. Demogr Res [Internet]. 2007 Feb 6;16:97–120. Available from: http://www.demographic-research.org/volumes/vol16/4/
  • 41. Keiding N, Clayton D. Standardization and Control for Confounding in Observational Studies: A Historical Perspective. Stat Sci [Internet]. 2014 Nov 1;29(4). Available from: https://projecteuclid.org/journals/statistical-science/volume-29/issue-4/Standardization-and-Control-for-Confounding-in-Observational-Studies--A/10.1214/13-STS453.full
  • 42. Kahlert J, Gribsholt SB, Gammelager H, Dekkers OM, Luta G. Control of confounding in the analysis phase - an overview for clinicians. Clin Epidemiol [Internet]. 2017 Mar;Volume 9:195–204. Available from: https://www.dovepress.com/control-of-confounding-in-the-analysis-phase-ndash-an-overview-for-cli-peer-reviewed-article-CLEP
  • 43. The Mantel Haenszel Method [Internet]. [cited 2022 Apr 19]. Available from: https://wiki.ecdc.europa.eu/fem/Pages/T he Mantel Haenszel Method.aspx
  • 44. Yıldız F, Okyay P. Karıştırıcı Etkenlerin Kontrolünde Mantel Haenszel Testi. Sağlık ve Toplum [Internet]. 2017; 27(1):53–60. Available from: https://ssyv.org.tr/wp-admin/uploader/std2017/Karistirici_Etkenlerin_Testi.pdf
  • 45. Wakkee M, Hollestein LM, Nijsten T. Multivariable Analysis. J Invest Dermatol [Internet]. 2014 May;134(5):1–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15367774
  • 46. ENCePP Home Page [Internet]. [cited 2022 Apr 21]. Available from: https://www.encepp.eu/standards_and_guidances/methodologicalGuide6.shtml#sixtwothree

CAUSAL INFERENCE AND SOME IMPORTANT CONCEPTS: EFFECT MODIFIER, CONFOUNDER, COLLIDER, AND MEDIATOR

Yıl 2023, Cilt: 8 Sayı: 3, 361 - 374, 29.10.2023

İsmail Çevik Pınar Okyay

https://doi.org/10.35232/estudamhsd.1307812

Öz

In modern times, it is believed that most diseases have multifactorial etiologies. The emergence of a disease results from the combined effects of multiple factors operating at different rates and through different mechanisms. This also implies that there cannot be a relationship between a cause and its outcome that is isolated from all other influences. There will always be third factors that influence and distort the relationship between a cause and a disease. Therefore, it is crucial for epidemiologists and all other researchers conducting scientific studies to be aware of concepts such as effect modifier, confounder, collider, and mediator and to consider these third factors throughout all stages of their research.

Anahtar Kelimeler

Causality effect modifier confounding variable confounder collider mediator

Kaynakça

  • 1. Hayran O. Bilimsel Araştırmalar Ne Kadar Bilimsel: Karıştırıcılar, Çarpıştırıcılar ve Etki-Ölçüm Değiştiriciler. J Biotechnol Strateg Heal Res [Internet]. 2021 Nov 17; Available from: https://dergipark.org.tr/tr/doi/10.34084/bshr.1020533
  • 2. Hulswit M. A Short History of ‘Causation’ [Internet]. [cited 2022 Mar 21]. Available from: http://see.library.utoronto.ca/SEED/Vol4-3/Hulswit.htm
  • 3. Evans AS. Evans As. Causatıon And Dısease: A Chronologıcal Journey: The Thomas Parran Lecture1. Am J Epidemiol [Internet]. 1978 Oct 1;108(4): 249–58. Available from: https://doi.org/10.1093/oxfordjournals.aje.a112617
  • 4. Last JM, editor. A Dictionary of Epidemiology. 4th ed. Oxford University Press; 2001.
  • 5. Susser M. Glossary: causality in public health science. J Epidemiol Community Heal [Internet]. 2001 Jun 1;55(6):376–8. Available from: https://jech.bmj.com/lookup/doi/10.1136/jech.55.6.376
  • 6. Cohen J. The Evolution of Koch’s Postulates. Infect Dis (Auckl) [Internet]. 2017 [cited 2022 Apr 6];1-3.e1. Available from: https://www.sciencedirect.com/science/article/pii/B9780702062858000010?via%3Dihub
  • 7. Susser M. Causal thinking in the health sciences : concepts and strategies of epidemiology. Oxford University Press;1973.
  • 8. Ventriglio A, Bellomo A, Bhugra D. Web of causation and its implications for epidemiological research. Int J Soc Psychiatry [Internet]. 2016 Feb 12;62(1):3–4. Available from: http://journals.sagepub.com/doi/10.1177/0020764015587629
  • 9. Krieger N. Epidemiology and the web of causation: Has anyone seen the spider? Soc Sci Med [Internet]. 1994 Oct;39(7):887–903. Available from: https://linkinghub.elsevier.com/retrieve/pii/027795369490202X
  • 10. Şenaras AE, Üniversitesi BU. COVID- 19 Salgınında Sağlık Çalışanlarının Enfekte Olmasına İlişkin Nedensel Döngü Diyagramı Causal Loop Diagram For Infection Of Healthcare Workers In The COVID-19 Outbreak. 2021 (May 2020):1039–52.
  • 11. Hill AB. The Environment and Disease: Association or Causation? J R Soc Med [Internet]. 1965;58(5):295–300. Available from: https://journals.sagepub.com/doi/10.1177/003591576505800503
  • 12. Howick J, Kelly P, Kelly M. Establishing a causal link between social relationships and health using the Bradford Hill Guidelines. SSM - Popul Heal [Internet]. 2019 Aug;8:100402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31193417
  • 13. Rothman KJ, Greenland S. Causation and Causal Inference in Epidemiology. Am J Public Health [Internet]. 2005 Jul 1;95(S1):S144–50. doi:10.2105/AJPH.2004.059204.
  • 14. Rothman KJ. Epidemiology: An Introduction. 2nd Editio. Oxford: Oxford University Press; 2012.
  • 15. Rothman KJ. Causes. Am J Epidemiol [Internet]. 1976 Dec 1;104(6):587–92. Available from: doi:10.1093/oxfordjournals.aje.a112335.
  • 16. Greenland S. Invited Commentary on “Causes.” Am J Epidemiol [Internet]. 1995;141(2). Available from: https://www.sjsu.edu/faculty/gerstman/eks/Rothman1976.pdf
  • 17. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd edition. Philadelphia: Lippincott, Williams and Wilkins; 2012.
  • 18. Aschengrau A, Seage GR. Essentials of Epidemiology in Public Health. 4th Edition. 2020. 541 p.
  • 19. LaMorte WW. The Sufficient-Component Cause Model [Internet]. [cited 2022 Apr 7]. Available from: https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_causality/ep713_causality4.html
  • 20. International Epidemiological Association. A Dictionary of Epidemiology. 6th Editio. Porta M, editor. Oxford University Press; 2016.
  • 21. Principles of Epidemiology | Lesson 3 -Section 6 [Internet]. [cited 2023 Mar 27]. Available from: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html
  • 22. LaMorte WW, Sullivan L. Confounding and Effect Measure Modification [Internet]. Boston University School of Publich Health. [cited 2022 Mar 30]. Available from: https://sphweb.bumc.bu.edu/otlt/mph-modules/bs/bs704-ep713_confounding-em/bs704-ep713_confounding-em_print.html
  • 23. Roditi RE, Veling M, Shin JJ. Age: An effect modifier of the association between allergic rhinitis and Otitis media with effusion. Laryngoscope [Internet]. 2016 Jul;126(7):1687–92. Available from: https://onlinelibrary.wiley.com/doi/10.1002/lary.25682
  • 24. Confounding - Catalog of Bias [Internet].[cited 2022 Mar 30]. Available from: https://catalogofbias.org/biases/confounding/
  • 25. McNamee R. Confounding and confounders. Occup Environ Med [Internet]. 2003 Mar 1;60(3):227 LP – 234. Available from: http://oem.bmj.com/content/60/3/227.abstract
  • 26. Kilic S. Effect size. J Mood Disord [Internet]. 2014;4(1):44. Available from: http://www.scopemed.org/fulltextpdf.php?mno=152916
  • 27. Weinberg CR. Toward a Clearer Definition of Confounding. Am J Epidemiol [Internet]. 1993 Jan1;137(1):1–8. Available from: https://academic.oup.com/aje/article/303163/Toward
  • 28. Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine Dependence and Psychiatric Disorders in the United States. Arch Gen Psychiatry [Internet]. 2004 Nov 1;61(11):1107. Available from: http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archpsyc.61.11.1107
  • 29. Flesch M, Morbach S, Erdmann E, Bulut D. Weingenuss und Prävention der koronaren Herzkrankheit. Herz [Internet]. 2016 Sep 19;41(6):469–77. Available from: http://link.springer.com/10.1007/s00059-016-4467-8
  • 30. Holmberg MJ, Andersen LW. Collider Bias. JAMA [Internet]. 2022 Apr 5;327(13):1282. Available from: https://jamanetwork.com/journals/jama/fullarticle/2790247
  • 31. Tönnies T, Kahl S, Kuss O. Collider bias in observational studies. Dtsch Arztebl Int [Internet]. 2022 Feb 18; Available from: https://www.aerzteblatt.de/10.3238/arztebl.m2022.0076
  • 32. Griffith GJ, Morris TT, Tudball MJ, Herbert A, Mancano G, Pike L, et al. Collider bias undermines our understanding of COVID-19 disease risk and severity. Nat Commun [Internet]. 2020 Nov 12;11(1):5749. Available from: https://www.nature.com/articles/s41467-020-19478-2
  • 33. Holmberg MJ, Andersen LW. Collider Bias. JAMA [Internet]. 2022 Mar 14 [cited 2022 Apr 5]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2790247
  • 34. Lipsky AM, Greenland S. Causal Directed Acyclic Graphs. JAMA [Internet]. 2022 Mar 15;327(11):1083. Available from: https://jamanetwork.com/journals/jama/fullarticle/2789646
  • 35. Keogh E, Eccleston C. Sex differences in adolescent chronic pain and pain-related coping. Pain [Internet]. 2006 Aug;123(3):275–84. Available from: https://journals.lww.com/00006396-200608000-00009
  • 36. Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology [Internet]. 1999 Jan;10(1):37–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9888278
  • 37.Greenland S. Invited Commentary: Variable Selection versus Shrinkage in the Control of Multiple Confounders. Am J Epidemiol [Internet]. 2007 Dec 12;167(5):523–9. Available from: https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwm355
  • 38. Kamangar F. Confounding variables in epidemiologic studies: basics and beyond. Arch Iran Med [Internet]. 2012 Aug;15(8):508–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22827790
  • 39. Kirkwood K, Sterne JAC. Essential Medical Statistics. Malden, Mass: Blackwell Science.; 2003.
  • 40. Wunsch G. Confounding and control. Demogr Res [Internet]. 2007 Feb 6;16:97–120. Available from: http://www.demographic-research.org/volumes/vol16/4/
  • 41. Keiding N, Clayton D. Standardization and Control for Confounding in Observational Studies: A Historical Perspective. Stat Sci [Internet]. 2014 Nov 1;29(4). Available from: https://projecteuclid.org/journals/statistical-science/volume-29/issue-4/Standardization-and-Control-for-Confounding-in-Observational-Studies--A/10.1214/13-STS453.full
  • 42. Kahlert J, Gribsholt SB, Gammelager H, Dekkers OM, Luta G. Control of confounding in the analysis phase - an overview for clinicians. Clin Epidemiol [Internet]. 2017 Mar;Volume 9:195–204. Available from: https://www.dovepress.com/control-of-confounding-in-the-analysis-phase-ndash-an-overview-for-cli-peer-reviewed-article-CLEP
  • 43. The Mantel Haenszel Method [Internet]. [cited 2022 Apr 19]. Available from: https://wiki.ecdc.europa.eu/fem/Pages/T he Mantel Haenszel Method.aspx
  • 44. Yıldız F, Okyay P. Karıştırıcı Etkenlerin Kontrolünde Mantel Haenszel Testi. Sağlık ve Toplum [Internet]. 2017; 27(1):53–60. Available from: https://ssyv.org.tr/wp-admin/uploader/std2017/Karistirici_Etkenlerin_Testi.pdf
  • 45. Wakkee M, Hollestein LM, Nijsten T. Multivariable Analysis. J Invest Dermatol [Internet]. 2014 May;134(5):1–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15367774
  • 46. ENCePP Home Page [Internet]. [cited 2022 Apr 21]. Available from: https://www.encepp.eu/standards_and_guidances/methodologicalGuide6.shtml#sixtwothree
Toplam 46 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Halk Sağlığı, Çevre Sağlığı
Bölüm Derlemeler
Yazarlar

İsmail Çevik 0000-0002-3797-4461

Pınar Okyay 0000-0002-3565-1490

Erken Görünüm Tarihi 29 Ekim 2023
Yayımlanma Tarihi 29 Ekim 2023
Gönderilme Tarihi 31 Mayıs 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 8 Sayı: 3

Kaynak Göster

Vancouver Çevik İ, Okyay P. NEDENSEL ÇIKARIM SÜRECİ VE BAZI ÖNEMLİ KAVRAMLAR: ETKİ DEĞİŞTİRİCİ, KARIŞTIRICI, ÇARPIŞTIRICI VE MEDİYATÖR. ESTÜDAM Halk Sağlığı Dergisi. 2023;8(3):361-74.
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