{"id":3511,"date":"2022-08-15T10:00:18","date_gmt":"2022-08-15T07:00:18","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3511"},"modified":"2022-07-17T23:47:43","modified_gmt":"2022-07-17T20:47:43","slug":"alkolkullanimbozukluguvemortalite","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2022\/08\/15\/alkolkullanimbozukluguvemortalite\/","title":{"rendered":"Alkol Kullan\u0131m Bozuklu\u011fu Nedeniyle Acil Servise Ba\u015fvuruyu Takiben Akut Yaralanma Mortalitesi ve T\u00fcm Nedenlere Ba\u011fl\u0131 Mortaliteler"},"content":{"rendered":"

Alkol t\u00fcketimi ve bununla birlikte alkole ba\u011fl\u0131 morbidite ve mortalite g\u00fcnden g\u00fcne artmaktad\u0131r. Bu mortalite alkol\u00fcn kronik etkilerine (karaci\u011fer sirozu, kardiyovask\u00fcler komplikasyonlar gibi) ba\u011fl\u0131 olabildi\u011fi gibi ki\u015finin akut yaralanmalar\u0131na (motorlu ara\u00e7 kazalar\u0131, d\u00fc\u015fme, bilin\u00e7siz toksikasyon, intihar, cinayet) da ba\u011fl\u0131d\u0131r. Potansiyel olarak akut \u00f6l\u00fcm riski artan bu bireylerde bu hastalara \u00f6zg\u00fc farkl\u0131l\u0131k anlamak; bu hastalar \u00fczerindeki yakla\u015f\u0131mlar\u0131 belirlemek ve \u00f6nlenebilir \u00f6l\u00fcmlerin \u00f6n\u00fcne ge\u00e7mek ad\u0131na \u00f6nemlidir. Bu yaz\u0131m\u0131zda Drug and<\/em> Alcohol Dependence<\/em> adl\u0131 dergide 2022 Temmuz\u2019unda yay\u0131nlanan \u201cAcute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder<\/a>\u201d<\/em> adl\u0131 yaz\u0131dan bahsedece\u011fim [1].<\/p>\n

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

Amerika Birle\u015fik Devletleri verilerine g\u00f6re alkole ba\u011fl\u0131 yaralanmalar 21. y\u00fczy\u0131l\u0131n ilk dekad\u0131nda y\u0131ll\u0131k %5 ve ikinci dekad\u0131nda ise y\u0131ll\u0131k %1 artm\u0131\u015ft\u0131r [2, 3]. Bu art\u0131\u015flar detayl\u0131 olarak incelendi\u011finde \u00f6zellikle kad\u0131nlarda, orta ya\u015fl\u0131 ve ya\u015fl\u0131 ki\u015filerde belirgin oldu\u011fu g\u00f6r\u00fclmektedir. Bu ilgili e\u011filimlerin n\u00fcfus sa\u011fl\u0131\u011f\u0131 \u00fczerindeki etkilerini anlamak, halk sa\u011fl\u0131\u011f\u0131 m\u00fcdahalelerini belirleyebilmek i\u00e7in kritik bir \u00f6neme sahiptir. Bu ama\u00e7la, potansiyel olarak \u00f6nlenebilir akut \u00f6l\u00fcm nedenleri a\u00e7\u0131s\u0131ndan y\u00fcksek risk alt\u0131ndaki alkol kullan\u0131c\u0131 alt gruplar\u0131n\u0131n belirlenmesi, klinik m\u00fcdahalelerin hedeflenmesine yard\u0131mc\u0131 olabilir.<\/p>\n

Alkol kullanan bireylerde kullanmayan bireylere g\u00f6re artm\u0131\u015f mortalite mevcuttur. Bu oran 2 kat (kanser ve kardiyovask\u00fcler hastal\u0131klara ba\u011fl\u0131) ile 15 kata (karaci\u011fer sirozuna ba\u011fl\u0131) kadar de\u011fi\u015fmektedir [4]. Benzer \u015fekilde bu hastalar acil servise ba\u015fvurular\u0131nda da artm\u0131\u015f mortalite riskiyle kar\u015f\u0131 kar\u015f\u0131yad\u0131r. \u00d6zellikle ilave medikal ve psikiyatrik komorbiditeleri olan bireylerde bu risk daha da artm\u0131\u015ft\u0131r. Bu hastalar\u0131n kronik s\u00fcre\u00e7lerde alkole ba\u011fl\u0131 medikal durumlar\u0131n\u0131 inceleyen bir\u00e7ok \u00e7al\u0131\u015fma olmas\u0131na ra\u011fmen akut s\u00fcre\u00e7te yaralanma riskini inceleyen \u00e7al\u0131\u015fmalar azd\u0131r. Yap\u0131lan bu \u00e7al\u0131\u015fmada da alkol\u00fcn kronik etkileri d\u0131\u015f\u0131ndaki yaralanmalar\u0131 tan\u0131mlayabilmek ve y\u00fcksek risk alt\u0131ndaki pop\u00fclasyonlar ile birlikte bu ki\u015filerin risk alt\u0131nda oldu\u011fu zaman periyodunu tan\u0131mlamak ama\u00e7lanm\u0131\u015ft\u0131r. B\u00f6ylelikle acildeki indeks vizit sonras\u0131nda artm\u0131\u015f risk saptanan bir periyot veya riskli bir pop\u00fclasyon bulunabilirse bu s\u00fcreyi kapsayan ya da bu pop\u00fclasyona y\u00f6nelik \u00f6nlemler ile morbidite ve mortalitelerin azalt\u0131labilece\u011fi d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015f.<\/p>\n

METODOLOJ\u0130<\/h2>\n

Kaliforniya eyaletinin tamam\u0131n\u0131 kapsamakta olan bu \u00e7al\u0131\u015fma retrospektif kohort bir \u00e7al\u0131\u015fma olarak planlanm\u0131\u015f. 2009 ve 2011 y\u0131llar\u0131 aras\u0131nda en az\u0131ndan bir kere olmak \u00fczere Kaliforniya eyaletine ba\u011fl\u0131 acil serviste alkol kullan\u0131m bozuklu\u011fu tan\u0131s\u0131 alan, 10 ya\u015f \u00fczerindeki b\u00fct\u00fcn hastalar d\u00e2hil edilmi\u015f. Hastalar\u0131 d\u00e2hil ederken kay\u0131tlar \u00fczerinden gidilmi\u015f ve International Classification of Diseases<\/em> (ICD) kodlar\u0131 kullan\u0131lm\u0131\u015f. Bu kodlar ile alkol ba\u011f\u0131ml\u0131l\u0131\u011f\u0131, alkol suistimali, alkol \u00e7ekilmesi<\/strong> veya alkol zehirlenmesi<\/strong> tan\u0131s\u0131 alan hastalar d\u00e2hil edilmi\u015f.<\/p>\n

\u00c7al\u0131\u015fmaya d\u00e2hil edilen hastalar\u0131n alkol kullan\u0131m bozuklu\u011fu tan\u0131s\u0131 ald\u0131klar\u0131 acil ziyaretleri sonras\u0131ndaki bir y\u0131llar\u0131 kay\u0131tlardan incelenmi\u015f. Bu s\u00fcre boyunca hastalar\u0131n akut yaralanmalara ba\u011fl\u0131 (kas\u0131ts\u0131z toksikasyon, intihar, cinayet, motorlu ara\u00e7 kazas\u0131, d\u00fc\u015fme, yang\u0131n gibi) ve b\u00fct\u00fcn sebeplere ba\u011fl\u0131 mortaliteleri de\u011ferlendirilmi\u015f. Ayr\u0131ca Kaliforniya Eyaletindeki 2009 ve 2012 y\u0131llar\u0131 aras\u0131ndaki b\u00fct\u00fcn \u00f6l\u00fcmler incelenerek ya\u015f gruplar\u0131na g\u00f6re grupland\u0131r\u0131lm\u0131\u015f ve standardize \u00f6l\u00fcm y\u00fczdeleri hesaplanm\u0131\u015f. Alkol kullan\u0131m bozuklu\u011fu olan bireylerin bu normal pop\u00fclasyona g\u00f6re \u00f6l\u00fcm risklerindeki art\u0131\u015f da standardized mortality ratios<\/em> (SMR) olarak belirtilmi\u015f. Hastalar\u0131n ya\u015fay\u0131p ya\u015famad\u0131klar\u0131 ve \u00f6l\u00fcm nedenleri ise California Department of Public Health Vital Records<\/em> arac\u0131l\u0131\u011f\u0131yla kontrol edilmi\u015f (Eyalet d\u0131\u015f\u0131nda \u00f6len hastalar d\u0131\u015flanm\u0131\u015f, yakla\u015f\u0131k olarak %1).<\/p>\n

Hastalar\u0131n karakteristik verileri ise; cinsiyet (kad\u0131n\/erkek), ya\u015f gruplar\u0131 (10-24, 25-44, 45-64 ve \u2265<\/strong>65), \u0131rk\/etnik k\u00f6ken (Hispanik olmayan beyaz, Hispanik olmayan siyahi, Hispanik, Asyal\u0131 ve di\u011ferleri) ve sa\u011fl\u0131k g\u00fcvence durumu olarak incelenmi\u015f.<\/p>\n

SONU\u00c7LAR<\/h2>\n

\u00c7al\u0131\u015fma s\u00fcresi boyunca Kaliforniya eyaleti acil servislerine 10 ya\u015f \u00fczerinde 25,3 milyon<\/strong> hasta ba\u015fvurusu olmu\u015f. Bunlar\u0131n yakla\u015f\u0131k %3,2\u2019sinde<\/strong> alkol kullan\u0131m bozuklu\u011fu tan\u0131s\u0131 mevcutmu\u015f. Ba\u015fvuru s\u0131ras\u0131nda \u00f6l\u00fcmc\u00fcl olmayan 437.855<\/strong> benzersiz \u015fekilde tan\u0131mlanabilen vaka kayd\u0131na ula\u015f\u0131lm\u0131\u015f. Buna ilaveten ba\u015fvuru s\u0131ras\u0131nda \u00f6l\u00fcmle sonu\u00e7lanan 5786<\/strong> vakaya ula\u015f\u0131lm\u0131\u015f. \u00d6l\u00fcmle sonu\u00e7lanan hastalar 1 y\u0131ll\u0131k takip analizlerinden d\u0131\u015flanm\u0131\u015f. Ba\u015fvuru s\u0131ras\u0131nda \u00f6l\u00fcmle sonu\u00e7lanmayan hastalar\u0131n karakteristik \u00f6zellikleri Tablo 1\u2019de verilmi\u015ftir.<\/p>\n

 <\/p>\n

Tablo 1 <\/strong>Acil Servise \u0130lk Ba\u015fvuru S\u0131ras\u0131ndaki Hasta Karakteristikleri<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Karakteristik \u00d6zellik<\/strong><\/td>\nn (%)<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Kad\u0131n cinsiyet, n (%)<\/strong><\/td>\n141.312 (%32,2)<\/td>\n<\/tr>\n
Ortalama ya\u015f (SD)<\/strong><\/td>\n44,5 (17,3)<\/td>\n<\/tr>\n
\u00a0\u00a010\u201318 ya\u015f<\/td>\n20.463 (%4,7)<\/td>\n<\/tr>\n
\u00a0\u00a019\u201324 ya\u015f<\/td>\n51.622 (%11,8)<\/td>\n<\/tr>\n
\u00a0\u00a025\u201344 ya\u015f<\/td>\n141.724 (%32,4)<\/td>\n<\/tr>\n
\u00a0\u00a045\u201364 ya\u015f<\/td>\n169.895 (%38,8)<\/td>\n<\/tr>\n
\u00a0\u00a0\u2265\u00a065 ya\u015f<\/td>\n54.151 (%12,4)<\/td>\n<\/tr>\n
Irk\/Etnik K\u00f6ken, n (%)<\/strong><\/td>\n<\/td>\n<\/tr>\n
Hispanik Olmayan, Beyaz<\/td>\n237.933 (%54,3)<\/td>\n<\/tr>\n
\u00a0\u00a0Hispanik Olmayan, Siyahi<\/td>\n50.721 (%11,6)<\/td>\n<\/tr>\n
\u00a0\u00a0Hispanik<\/td>\n115.207 (%26,3)<\/td>\n<\/tr>\n
\u00a0\u00a0Asyal\u0131<\/td>\n12.797 (%2,9%)<\/td>\n<\/tr>\n
Hispanik Olmayan Di\u011ferleri<\/td>\n21.197 (%4,8%)<\/td>\n<\/tr>\n
Sa\u011fl\u0131k G\u00fcvence T\u00fcr\u00fc, n (%)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00a0\u00a0\u00d6zel<\/td>\n120.165 (%27,5)<\/td>\n<\/tr>\n
\u00a0\u00a0Medicare<\/td>\n65.969 (%15,1)<\/td>\n<\/tr>\n
\u00a0\u00a0Medicaid<\/td>\n104.619 (%23,9)<\/td>\n<\/tr>\n
\u00a0Kendi \u00d6demeli<\/td>\n132.661 (%30,3)<\/td>\n<\/tr>\n
\u00a0\u00a0Di\u011fer<\/td>\n14.081 (%3,2)<\/td>\n<\/tr>\n
Alkol Kullan\u0131m Bozukluklar\u0131:* <\/strong><\/td>\n<\/td>\n<\/tr>\n
Alkol Ba\u011f\u0131ml\u0131l\u0131\u011f\u0131<\/td>\n134.939 (%30,4)<\/td>\n<\/tr>\n
Alkol \u0130stismar\u0131<\/td>\n310.580 (%70,0)<\/td>\n<\/tr>\n
\u00a0\u00a0Alkol \u00c7ekilmesi<\/td>\n8420 (%1,9)<\/td>\n<\/tr>\n
Acil Servis Ba\u015fvuru Sonlan\u0131m\u0131<\/strong><\/td>\n<\/td>\n<\/tr>\n
Taburcu<\/td>\n261.550 (%59,7)<\/td>\n<\/tr>\n
Hastaneye Yat\u0131\u015f<\/td>\n170.983 (%39,1)<\/td>\n<\/tr>\n
\u00a0\u00a0Di\u011fer<\/td>\n5322 (%1,2)<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

*: Bir hasta ayn\u0131 anda birden fazla grupta bulunabilir.<\/p>\n

Bu hastalar\u0131n bir y\u0131ll\u0131k s\u00fcre\u00e7leri izlendi\u011finde 2671<\/strong> hastan\u0131n bahsedilen akut yaralanmalara ba\u011fl\u0131 \u00f6ld\u00fc\u011f\u00fc g\u00f6r\u00fclm\u00fc\u015f. Mortalite oran\u0131 her 100.000 ki\u015fi i\u00e7in 608,6<\/strong> olarak hesaplanm\u0131\u015f. Yine Kaliforniya eyaleti verilerine g\u00f6re b\u00fct\u00fcn pop\u00fclasyon ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda 8 kat daha fazla (Standardized Mortality Ratio<\/em> (SMR): 8.0<\/strong> [%95 GA: 7,7-8,3]) oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f (Tablo 2).<\/p>\n

 <\/p>\n

Tablo 2. <\/strong>Alkol kullan\u0131m bozuklu\u011fu olan bireylerde bir y\u0131ll\u0131k inceleme s\u00fcresince se\u00e7ili \u00f6l\u00fcm sebeplerine ba\u011fl\u0131 mortalitelerin incelenmesi\u00a0<\/strong><\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\n\u00d6l\u00fcmler, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\nSMR (%95 GA)<\/strong><\/td>\nAkut \u00d6l\u00fcm Sebepleri Aras\u0131ndaki Y\u00fczde<\/strong><\/td>\n<\/tr>\n
\u0130ntihar<\/strong><\/td>\n527<\/td>\n124,7<\/td>\n6,8 (6,2-7,4)<\/td>\n%19,7<\/td>\n<\/tr>\n
Cinayet <\/strong><\/td>\n167<\/td>\n39,5<\/td>\n4,8 (4,1-5,6)<\/td>\n%6,3<\/td>\n<\/tr>\n
Kas\u0131ts\u0131z \u00d6l\u00fcmler<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0\u00a0 Toksikasyon<\/strong><\/td>\n1241<\/td>\n293,7<\/td>\n15,1 (14,3-16,0)<\/td>\n%46,5<\/td>\n<\/tr>\n
\u00a0\u00a0 Motorlu ara\u00e7 kazalar\u0131<\/strong><\/td>\n303<\/td>\n71,7<\/td>\n5,6 (4,9-6,2)<\/td>\n%11,3<\/td>\n<\/tr>\n
\u00a0\u00a0 D\u00fc\u015fme veya yanmaya ba\u011fl\u0131<\/strong><\/td>\n341<\/td>\n80,7<\/td>\n9,3 (8,3-10,3)<\/td>\n%12,8<\/td>\n<\/tr>\n
Di\u011fer akut nedenler<\/strong><\/td>\n92<\/td>\n21,8<\/td>\n1,92 (1,6-2,4)<\/td>\n%3,4<\/td>\n<\/tr>\n
Se\u00e7limi\u015f akut nedenler<\/strong><\/td>\n2671<\/td>\n608,6<\/td>\n8,0 (7,7-8,3)<\/td>\n%100<\/td>\n<\/tr>\n
Do\u011fal yollu \u00f6l\u00fcmler<\/strong><\/td>\n21.297<\/td>\n5040,0<\/td>\n6,3 (6,2-6,4)<\/td>\n–<\/td>\n<\/tr>\n
B\u00fct\u00fcn sebeplere ba\u011fl\u0131 \u00f6l\u00fcmler<\/strong><\/td>\n24.089<\/td>\n5700,7<\/td>\n6,5 (6,4-6,6)<\/td>\n–<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

SMR: Standardized Mortality Ratio: Kaliforniya pop\u00fclasyonunda benzer \u00f6zellik g\u00f6steren ki\u015filere g\u00f6re \u00f6l\u00fcm oran\u0131. <\/em><\/p>\n

Bu \u00f6l\u00fcmler s\u00fcre a\u00e7\u0131s\u0131ndan detayl\u0131 olarak incelendi\u011finde; \u00d6l\u00fcmlerin,<\/p>\n

    \n
  • \u0130lk 30 g\u00fcn i\u00e7erisinde %15,5 (n=413),<\/li>\n
  • \u0130lk 90 g\u00fcn i\u00e7erisinde %33,9 (n=904),<\/li>\n
  • \u0130lk 6 ay i\u00e7erisinde %58,1 (n=1554) ger\u00e7ekle\u015fti\u011fi g\u00f6r\u00fclm\u00fc\u015f (\u015eekil 1).<\/li>\n<\/ul>\n

    \"\"<\/p>\n

    \u015eekil 1:<\/strong> Acil servise ba\u015fvurudan sonraki 12 saatlik ay s\u00fcresince akut yaralanmaya ba\u011fl\u0131 \u00f6l\u00fcmlerin ya\u015flara g\u00f6re k\u00fcm\u00fclatif insidans\u0131.<\/p>\n

    Akut yaralanmalara ba\u011fl\u0131 \u00f6l\u00fcm nedenlerine bak\u0131ld\u0131\u011f\u0131nda, \u00f6l\u00fcmlerin yakla\u015f\u0131k olarak yar\u0131s\u0131 kas\u0131ts\u0131z toksikasyonlar sebebiyle ger\u00e7ekle\u015fmi\u015ftir. Normal pop\u00fclasyona oranla bu 15,1 kat daha y\u00fcksektir. Bu toksikasyonlara neden olan maddeler incelendi\u011finde;<\/p>\n

      \n
    • %38,9\u2019u tan\u0131mlanmam\u0131\u015f ila\u00e7lar ile,<\/li>\n
    • %30,1\u2019i narkotik ve hal\u00fcsinojenler ile,<\/li>\n
    • %17,3\u2019\u00fc alkole ba\u011fl\u0131 ve<\/li>\n
    • %9,8\u2019i sedatif ve hipnotik ila\u00e7lara ba\u011fl\u0131 oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f.<\/li>\n<\/ul>\n

      Akut \u00f6l\u00fcm nedenlerinde ikinci s\u0131rada ise intihar oldu\u011fu tespit edilmi\u015f, \u00f6l\u00fcmlerin yakla\u015f\u0131k %20\u2019sinden sorumlu oldu\u011fu ve normal pop\u00fclasyona g\u00f6re 6,8 kat fazla oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f.<\/p>\n

      Ayr\u0131ca \u00f6l\u00fcmler ya\u015f gruplar\u0131na g\u00f6re de analiz edilmi\u015f (Tablo 3, \u015eekil 2). Her ne kadar bu ya\u015f gruplar\u0131na g\u00f6re SMR\u2019leri kar\u015f\u0131la\u015ft\u0131rmak do\u011fru olmasa da (\u00c7\u00fcnk\u00fc SMR hesaplan\u0131rken her ya\u015ftaki risklere g\u00f6re yap\u0131lmakta) akut yaralanmaya ba\u011fl\u0131 \u00f6l\u00fcm, normal sebeplere ba\u011fl\u0131 \u00f6l\u00fcm ve b\u00fct\u00fcn nedenlere ba\u011fl\u0131 \u00f6l\u00fcm 25-44 ya\u015f grubu (s\u0131ras\u0131yla SMR de\u011ferleri;\u00a0 8,1; 15,1; 12,6) ve 45-64 ya\u015f grubu (s\u0131ras\u0131yla SMR de\u011ferleri; 9,6; 11,2; 11,1) aras\u0131nda belirgin olarak y\u00fcksek \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n

      Tablo 3:<\/strong> Alkol kullan\u0131m bozuklu\u011fu olan bireylerin bir y\u0131ll\u0131k incelemelerinde se\u00e7ili \u00f6l\u00fcm sebeplerine ba\u011fl\u0131 ya\u015fa spesifik mortalite oranlar\u0131<\/p>\n

      \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      \u00d6l\u00fcm Sebebi<\/strong><\/td>\n10-24 ya\u015f<\/strong><\/td>\n25-44 Ya\u015f<\/strong><\/td>\n45-64 Ya\u015f<\/strong><\/td>\n\u2265\u200965 ya\u015f<\/strong><\/td>\n<\/tr>\n
      \u00d6l\u00fcm, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\n\u00d6l\u00fcm, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\n\u00d6l\u00fcm, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\n\u00d6l\u00fcm, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\n<\/tr>\n<\/thead>\n
      \u0130ntihar<\/strong><\/td>\n39<\/td>\n54,2<\/td>\n168<\/td>\n119,8<\/td>\n269<\/td>\n165,7<\/td>\n51<\/td>\n106,1<\/td>\n<\/tr>\n
      Cinayet<\/strong><\/td>\n37<\/td>\n51,5<\/td>\n72<\/td>\n51,3<\/td>\n53<\/td>\n32,7<\/td>\n5<\/td>\n10,4<\/td>\n<\/tr>\n
      Kas\u0131ts\u0131z \u00d6l\u00fcmler<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
      \u00a0\u00a0Zehirlenme<\/strong><\/td>\n68<\/td>\n94,6<\/td>\n437<\/td>\n311,7<\/td>\n689<\/td>\n424,4<\/td>\n47<\/td>\n97,7<\/td>\n<\/tr>\n
      Motorlu Ara\u00e7 Kazalar\u0131<\/strong><\/td>\n27<\/td>\n37,6<\/td>\n90<\/td>\n64,2<\/td>\n149<\/td>\n91,8<\/td>\n37<\/td>\n76,9<\/td>\n<\/tr>\n
      D\u00fc\u015fme veya yanmaya ba\u011fl\u0131<\/strong><\/td>\n3<\/td>\n4,2<\/td>\n38<\/td>\n27,1<\/td>\n170<\/td>\n104,7<\/td>\n130<\/td>\n270,3<\/td>\n<\/tr>\n
      Di\u011fer akut nedenler <\/strong><\/td>\n3<\/td>\n4,2<\/td>\n23<\/td>\n16,4<\/td>\n55<\/td>\n33,9<\/td>\n11<\/td>\n22,9<\/td>\n<\/tr>\n
      Se\u00e7ilmi\u015f akut nedenler<\/strong><\/td>\n177<\/td>\n246,2<\/td>\n828<\/td>\n590,5<\/td>\n1385<\/td>\n853,1<\/td>\n281<\/td>\n584,4<\/td>\n<\/tr>\n
      Do\u011fal yollu \u00f6l\u00fcmler<\/strong><\/td>\n65<\/td>\n90,4<\/td>\n1600<\/td>\n1141,1<\/td>\n10.654<\/td>\n6562,5<\/td>\n8978<\/td>\n18.670,0<\/td>\n<\/tr>\n
      B\u00fct\u00fcn sebeplere ba\u011fl\u0131 \u00f6l\u00fcmler<\/strong><\/td>\n247<\/td>\n343,5<\/td>\n2464<\/td>\n1757,3<\/td>\n12.105<\/td>\n7456,3<\/td>\n9273<\/td>\n18.895,0<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

       <\/p>\n

      \"\"<\/p>\n

      \u015eekil 2:<\/strong> Ya\u015f gruplar\u0131na g\u00f6re do\u011fal ve akut yarlanmalara ba\u011fl\u0131 \u00f6l\u00fcmlerin b\u00fct\u00fcn \u00f6l\u00fcmlere oran\u0131<\/p>\n

      Erkeklerde, kad\u0131nlara g\u00f6re y\u0131ll\u0131k \u00f6l\u00fcm oranlar\u0131 yakla\u015f\u0131k olarak %50 fazla (her 100.000\u2019de 708,3\u2019e kar\u015f\u0131 473,9) oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f. B\u00fct\u00fcn sebeplere ba\u011fl\u0131 \u00f6l\u00fcmler i\u00e7erisinde akut \u00f6l\u00fcmlerin erkeklerde %11,3 kad\u0131nlarda ise %10,4\u2019l\u00fck bir orana sahip oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f (Tablo 4). Alkol kullan\u0131m bozuklu\u011fu olan erkekler ve kad\u0131nlarda do\u011fal \u00f6l\u00fcmlere ve b\u00fct\u00fcn nedenlere ba\u011fl\u0131 \u00f6l\u00fcmlerin normal pop\u00fclasyona g\u00f6re s\u0131kl\u0131\u011f\u0131nda benzer art\u0131\u015fta oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f (do\u011fal \u00f6l\u00fcmler; erkek SMR= 6,4; kad\u0131n SMR=6,0 ve b\u00fct\u00fcn \u00f6l\u00fcmlerde erkek SMR=6,5; kad\u0131n SMR=6,3). Fakat kad\u0131nlarda akut yaralanmalara ba\u011fl\u0131 \u00f6l\u00fcm art\u0131\u015f\u0131n\u0131n (SMR=12,2)<\/strong> erkeklere g\u00f6re (SMR= 7,2) <\/strong>daha fazla oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f.<\/p>\n

      Tablo 4:<\/strong> Alkol kullan\u0131m bozuklu\u011fu olan bireylerin cinsiyet spesifik bir y\u0131ll\u0131k mortalite oranlar\u0131<\/p>\n

      \n\n\n\n\n\n\n\n\n\n\n\n\n\n
      \u00d6l\u00fcm Nedeni<\/strong><\/td>\nErkekler<\/strong><\/td>\nKad\u0131nlar<\/strong><\/td>\nRiziko Oranlar\u0131<\/strong><\/td>\n<\/tr>\n
      \u00d6l\u00fcmler, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\n\u00d6l\u00fcmler, n<\/strong><\/td>\nHer 100.000 ki\u015fi i\u00e7in \u00f6l\u00fcm-y\u0131l<\/strong><\/td>\nHR (%95 GA)<\/strong><\/td>\n<\/tr>\n
      \u0130ntihar<\/strong><\/td>\n395<\/td>\n138,5<\/td>\n132<\/td>\n96,1<\/td>\n0,70 (0,57-0,85)<\/td>\n<\/tr>\n
      Cinayet <\/strong><\/td>\n146<\/td>\n51,2<\/td>\n21<\/td>\n15,3<\/td>\n0,30 (0,19-0,47)<\/td>\n<\/tr>\n
      Kas\u0131ts\u0131z \u00d6l\u00fcmler<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
      \u00a0\u00a0 Toksikasyon<\/strong><\/td>\n903<\/td>\n316,6<\/td>\n338<\/td>\n246,1<\/td>\n0,78 (0,69-0,88)<\/td>\n<\/tr>\n
      \u00a0\u00a0 Motorlu ara\u00e7 kazalar\u0131<\/strong><\/td>\n240<\/td>\n84,2<\/td>\n63<\/td>\n45,9<\/td>\n0,55 (0,41-0,72)<\/td>\n<\/tr>\n
      \u00a0\u00a0 D\u00fc\u015fme veya yanmaya ba\u011fl\u0131<\/strong><\/td>\n264<\/td>\n92,6<\/td>\n77<\/td>\n56,1<\/td>\n0,61 (0,47-0,78)<\/td>\n<\/tr>\n
      Di\u011fer akut nedenler<\/strong><\/td>\n72<\/td>\n25,3<\/td>\n20<\/td>\n14,6<\/td>\n0,58 (0,35-0,95)<\/td>\n<\/tr>\n
      Se\u00e7ilmi\u015f akut nedenler<\/strong><\/td>\n2.020<\/td>\n708,3<\/td>\n651<\/td>\n473,9<\/td>\n0,67 (0,61-0,73)<\/td>\n<\/tr>\n
      Do\u011fal yollu \u00f6l\u00fcmler<\/strong><\/td>\n15.682<\/td>\n5.498,8<\/td>\n5.615<\/td>\n4.087,5<\/td>\n0,75 (0,72-0,77)<\/td>\n<\/tr>\n
      B\u00fct\u00fcn sebeplere ba\u011fl\u0131 \u00f6l\u00fcmler<\/strong><\/td>\n17.803<\/td>\n6.242,5<\/td>\n6.286<\/td>\n4.576,0<\/td>\n0,73 (0,71-0,76)<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

      *:Riziko oranlar\u0131 Cox regresyon model testleri ile hesaplanm\u0131\u015f. Erkekler referans olarak al\u0131narak kad\u0131n olman\u0131n spesifik \u00f6l\u00fcmlere ba\u011fl\u0131 riski analiz edilmi\u015f. HR: Hazard Ratio. GA: G\u00fcven aral\u0131\u011f\u0131. <\/em><\/p>\n

      TARTI\u015eMA<\/h2>\n

      Alkol kullan\u0131m bozuklu\u011fu olan bireylerin demografik olarak e\u015fleni\u011fi olan pop\u00fclasyona g\u00f6re akut yaralanmalara ba\u011fl\u0131 \u00f6l\u00fcm riskleri 2 ila 15 kata kadar artma oldu\u011fu saptanm\u0131\u015ft\u0131r. Kas\u0131ts\u0131z zehirlenme ve intiharlar bu akut \u00f6l\u00fcmlerin 2\/3\u2019\u00fcn\u00fc olu\u015fturmaktad\u0131r. Alkol kullan\u0131m bozuklu\u011fu olan hastalarda b\u00fct\u00fcn sebeplere ba\u011fl\u0131 \u00f6l\u00fcmler normal pop\u00fclasyona g\u00f6re 6,5 kat artm\u0131\u015ft\u0131r. 2009-2011 d\u00f6nemindeki vakalar\u0131 inceleyen bu \u00e7al\u0131\u015fma g\u00fcn\u00fcm\u00fczde g\u00fcncel kohortlarla da desteklenebilirse, bu riske sahip hastalarda yeni klinik yakla\u015f\u0131mlar ve halk sa\u011fl\u0131\u011f\u0131 planlamalar\u0131 ka\u00e7\u0131n\u0131lmaz bir gereksinimdir.<\/p>\n

      Bu \u00e7al\u0131\u015fma, daha \u00f6nceki \u00e7al\u0131\u015fmalardan esinlenerek alkol kullan\u0131m bozuklu\u011fu olan ki\u015filerde spesifik \u00f6l\u00fcm nedenlerini ya\u015fa ve cinsiyete g\u00f6re analiz etmi\u015ftir. 10-24 ya\u015f aral\u0131\u011f\u0131ndaki gen\u00e7 pop\u00fclasyonda akut yaralanmaya ba\u011fl\u0131 \u00f6l\u00fcmler b\u00fct\u00fcn \u00f6l\u00fcmlerin 3\/4\u2019\u00fcn\u00fc olu\u015fturdu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. 25-44 ya\u015f aras\u0131nda ise bu oran 1\/3\u2019e d\u00fc\u015ft\u00fc\u011f\u00fc saptanm\u0131\u015ft\u0131r. Gen\u00e7 hasta pop\u00fclasyonunda \u00f6l\u00fcm oranlar\u0131 ya\u015fl\u0131 hastalara g\u00f6re az olsa bile kas\u0131ts\u0131z zehirlenme, intihar ve cinayete ba\u011fl\u0131 \u00f6l\u00fcmler a\u00e7\u0131s\u0131ndan y\u00fcksek risk alt\u0131nda olmalar\u0131 acil serviste erken d\u00f6nemde uygulanabilir tedavi ve koruma \u00f6nlemlerinin gereksinimini vurgulamaktad\u0131r. Bunlar potansiyel olarak riskli gen\u00e7 pop\u00fclasyona y\u00f6nelik a\u015f\u0131r\u0131 doza, intihara ya da bu ki\u015filere kar\u015f\u0131 \u015fiddete y\u00f6nelik koruma uygulamalar\u0131n\u0131 (bir dan\u0131\u015fman e\u015fli\u011finde ev veya okul temelli g\u00f6zetim gibi) kapsamaktad\u0131r. Buna kar\u015f\u0131l\u0131k ise 45-64 ya\u015f aral\u0131\u011f\u0131ndaki hasta pop\u00fclasyonunda akut yaralanmaya ba\u011fl\u0131 \u00f6l\u00fcmler b\u00fct\u00fcn \u00f6l\u00fcmlerin %11\u2019ini, 65 ya\u015f \u00fcst\u00fcndeki pop\u00fclasyonda ise %3\u2019\u00fcn\u00fc olu\u015fturdu\u011fu saptanm\u0131\u015ft\u0131r. Bu hastalarda \u00f6l\u00fcmlerin daha \u00e7ok do\u011fal sebeplere \u00f6zellikle de alkol\u00fcn kronik sonu\u00e7lar\u0131na (alkolik karaci\u011fer hastal\u0131\u011f\u0131, karaci\u011fer ya da pankreas kanseri, iskemik kalp hastal\u0131\u011f\u0131) ba\u011fl\u0131 oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu \u00e7al\u0131\u015fmada hastalar\u0131n alkol tedavisi al\u0131p almad\u0131klar\u0131 incelenmemi\u015f olsa da g\u00fcncel veriler alkol kullan\u0131m bozuklu\u011fu olan 50 ya\u015f ve \u00fcst\u00fc bireylerin yaln\u0131zca %10\u2019unun tedavi ald\u0131\u011f\u0131n\u0131 g\u00f6stermektedir [5]. Dolay\u0131s\u0131yla alkole ba\u011fl\u0131 akut \u00f6l\u00fcmler ya\u015fl\u0131larda daha az g\u00f6r\u00fclse bile kronik \u00f6l\u00fcmler ve kar\u015f\u0131lanmam\u0131\u015f tedavi nedenlerinden \u00f6t\u00fcr\u00fc bu hastalarda da acil servisten taburculuk sonras\u0131 alkol kullan\u0131m bozuklu\u011fu tedavisi gerekti\u011fi vurgulanmaktad\u0131r. Bu hastalar i\u00e7in tedavi protokolleri, karma\u015f\u0131k t\u0131bbi durumlar\u0131n entegre y\u00f6netimininin yan\u0131 s\u0131ra e\u015flik eden psikiyatrik hastal\u0131klar, mesleki, ki\u015filer aras\u0131 ili\u015fkiler ve bar\u0131nma ihtiya\u00e7lar\u0131 da dahil olmak \u00fczere multidisipliner olarak planlanmal\u0131d\u0131r [6, 7]. Ayr\u0131ca ya\u015fl\u0131 hastalarda d\u00fc\u015fme veya yanmaya ba\u011fl\u0131 \u00f6l\u00fcmler akut yaralanmalar\u0131n yar\u0131s\u0131n\u0131 olu\u015fturmaktad\u0131r. Bu y\u00fczden bu sebeplere kar\u015f\u0131 klinik fark\u0131ndal\u0131k ve bunlara kar\u015f\u0131 koruyucu \u00f6nlemlerin al\u0131nmas\u0131 gerekmektedir.<\/p>\n

      Alkol kullan\u0131m bozuklu\u011fu olan erkeklerin akut yaralanmaya ba\u011fl\u0131, do\u011fal nedenlere ba\u011fl\u0131 ve b\u00fct\u00fcn nedenlere ba\u011fl\u0131 \u00f6l\u00fcmler a\u00e7\u0131s\u0131ndan kad\u0131nlara g\u00f6re daha y\u00fcksek riskte oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Fakat normal pop\u00fclasyondaki \u00f6l\u00fcm risklerine g\u00f6re oranland\u0131\u011f\u0131nda kad\u0131nlarda akut yaralanmaya ba\u011fl\u0131 \u00f6l\u00fcm a\u00e7\u0131s\u0131ndan cinsiyet spesifik SMR art\u0131\u015f\u0131n\u0131n daha belirgin oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Do\u011fal nedenlere ba\u011fl\u0131 ve b\u00fct\u00fcn nedenlere ba\u011fl\u0131 \u00f6l\u00fcmlerde fark saptanmam\u0131\u015ft\u0131r. Roerecke ve Rehm\u2019in 2013 y\u0131l\u0131nda yapt\u0131\u011f\u0131 meta-analiz sonucunda baz\u0131 farkl\u0131 sonu\u00e7lar \u00e7\u0131km\u0131\u015ft\u0131r. Bu meta-analiz alkol kullan\u0131m bozuklu\u011fu olan hastalar\u0131 i\u00e7eren 81 g\u00f6zlemsel \u00e7al\u0131\u015fmay\u0131 ele alm\u0131\u015f ve 221.683 \u00f6l\u00fcmle sonu\u00e7lanan 853.722 hastay\u0131 i\u00e7eren kapsaml\u0131 bir \u00e7al\u0131\u015fmad\u0131r. Sonu\u00e7 olarak ise b\u00fct\u00fcn nedenlere ba\u011fl\u0131 uzun d\u00f6nem mortalite kad\u0131nlarda daha y\u00fcksek \u00e7\u0131km\u0131\u015ft\u0131r [8]. Bu farkl\u0131l\u0131\u011f\u0131n nedeni net olarak ortaya konulamasa da \u00e7al\u0131\u015fman\u0131n dizayn\u0131ndan (acil servise ba\u015fvuran hastalar\u0131 i\u00e7ermesi ve 1 y\u0131ll\u0131k mortalite gibi k\u0131sa sonlan\u0131m\u0131 i\u00e7ermesi) kaynaklanabilece\u011fi d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015f.<\/p>\n

      \u00d6l\u00fcm riskinde art\u0131\u015flar kad\u0131n ve erkek aras\u0131nda farkl\u0131 olmas\u0131na ra\u011fmen \u00f6l\u00fcm nedenlerinin y\u00fczdesine bak\u0131ld\u0131\u011f\u0131nda cinsiyetler aras\u0131 fark olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f. \u00d6rne\u011fin her iki grup i\u00e7inde zehirlenmeye ba\u011fl\u0131 \u00f6l\u00fcmler b\u00fct\u00fcn \u00f6l\u00fcmlerin %50\u2019sinden sorumlu iken, intihar %20\u2019sinden ve d\u00fc\u015fme\/yanma yaralanmalar\u0131 ise %12\u2019sinden sorumlu oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f.<\/p>\n

      Mortalite art\u0131\u015f\u0131 zaman a\u00e7\u0131s\u0131ndan incelendi\u011finde ise ilk 6 ayda daha belirgin y\u00fcksek g\u00f6r\u00fclmesine ra\u011fmen 12 ayl\u0131k takip boyunca s\u00fcrekli olarak y\u00fcksek seyretmi\u015ftir. Dolay\u0131s\u0131yla alkol kullan\u0131m bozuklu\u011fu alan bireyler mortalite a\u00e7\u0131s\u0131ndan y\u00fcksek riskli grubu olu\u015fturmaktad\u0131r ve s\u00fcrekli bir klinik bak\u0131ma ihtiya\u00e7 duyduklar\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

      L\u0130M\u0130TASYONLAR<\/h2>\n

      \u00c7al\u0131\u015fma Kaliforniya eyaleti gibi b\u00fcy\u00fck bir pop\u00fclasyonu kapsamaktad\u0131r. Kaliforniya eyaletinin kay\u0131tlar\u0131n\u0131n kapsaml\u0131 ve detayl\u0131 olmas\u0131na ra\u011fmen her eyalette benzer yakla\u015f\u0131m yoktur. Ayr\u0131ca bu \u00e7al\u0131\u015fma Kaliforniya eyaletinin 2009-2012 y\u0131l\u0131ndaki verileri i\u00e7ermektedir. Dolay\u0131s\u0131yla bu \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131 di\u011fer zaman periyotlar\u0131na ve Amerika\u2019n\u0131n di\u011fer eyaletlerine ya da Amerika d\u0131\u015f\u0131na genellenememektedir. Son 10 y\u0131lda alkol kullan\u0131m bozuklu\u011funda art\u0131\u015f g\u00f6z \u00f6n\u00fcnde ald\u0131\u011f\u0131nda bu t\u00fcr \u00e7al\u0131\u015fmalar\u0131n ileride de yap\u0131lmas\u0131 ve \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131n\u0131 geli\u015ftirmesi gerekmektedir. Ayr\u0131ca bu \u00e7al\u0131\u015fma alkol kullan\u0131m bozuklu\u011fu hastalar\u0131nda uyu\u015fturucu kullan\u0131m\u0131, psikiyatrik bozukluklar, alkol kullan\u0131m bozuklu\u011funa ba\u011fl\u0131 tekrarlayan acil ba\u015fvurular\u0131, mevcut kronik hastal\u0131klar gibi bu hastalar\u0131 ilgilendiren potansiyel hasta karakteristikleri incelenmemi\u015ftir. Son olarak ise \u00f6l\u00fcm analizleri CDC\u2019nin alkole ba\u011fl\u0131 akut \u00f6l\u00fcm sebeplerine odaklanm\u0131\u015f olsa da bu \u00f6l\u00fcmlerin do\u011frudan alkol kullan\u0131m\u0131na ba\u011fl\u0131 oldu\u011funu s\u00f6ylemek m\u00fcmk\u00fcn de\u011fildir.<\/p>\n

      SONU\u00c7<\/h2>\n

      Alkol kullan\u0131m bozuklu\u011fu tan\u0131s\u0131 olan acil servis hastalar\u0131, hayatlar\u0131 boyunca artm\u0131\u015f mortalite riskine sahip bir pop\u00fclasyonu olu\u015fturmaktad\u0131r. Ya\u015fa ba\u011fl\u0131 olarak \u00f6l\u00fcm nedenlerinin (\u00f6rne\u011fin; a\u015f\u0131r\u0131 doz veya intihar) de\u011fi\u015fiklik g\u00f6stermesi bu hastalara y\u00f6nelik \u00f6nlemleri ve klinik i\u015flemleri belirleyebilir. Bu bulgular, bu klinik pop\u00fclasyonda \u00f6l\u00fcm risklerini azaltmay\u0131 ama\u00e7layan acil servise dayal\u0131 klinik ve halk sa\u011fl\u0131\u011f\u0131 \u00f6nleme \u00e7abalar\u0131n\u0131n potansiyel \u00f6nemi ve de\u011ferinin alt\u0131n\u0131 \u00e7izmektedir.<\/p>\n

      \u00d6NEML\u0130 VURGULAR<\/h2>\n
        \n
      • Normal pop\u00fclasyona g\u00f6re, alkol kullan\u0131m bozuklu\u011fu olan hastalarda 6,5 kat daha fazla mortalite g\u00f6r\u00fclmektedir.<\/li>\n
      • Bu hastalar\u0131n akut yaralanmalara ba\u011fl\u0131 (trafik kazas\u0131, intihar, cinayet vb.) ani \u00f6l\u00fcm riskleri de daha y\u00fcksektir.<\/li>\n
      • Ani \u00f6l\u00fcmlerin %50’sinden bilin\u00e7sizce olan zehirlenmeler ve %20\u2019sinden de intiharlar sorumludur.<\/li>\n
      • Gen\u00e7 hastalar\u0131n b\u00fct\u00fcn nedenlere ba\u011fl\u0131 \u00f6l\u00fcmleri incelendi\u011finde %72\u2019sinden ani \u00f6l\u00fcmler sorumludur.<\/li>\n<\/ul>\n

        SON S\u00d6Z<\/h2>\n

        Acil servisler g\u00fcnden g\u00fcne yo\u011funlu\u011fu artan ve bir\u00e7ok sebeple m\u00fccadelede ilk basama\u011f\u0131 olu\u015fturan merkezler haline gelmi\u015ftir. Acil servislerin dizayn\u0131 ve \u00e7al\u0131\u015fma prensipleri kronik sorunlar\u0131n \u00e7\u00f6z\u00fcm\u00fcne odakl\u0131 de\u011fildir. Fakat alkol kullan\u0131m bozuklu\u011fu gibi kronik bir sorunu olan hastalar\u0131n fark\u0131ndal\u0131\u011f\u0131n\u0131n olu\u015fmas\u0131 ya da koruyucu \u00f6nlemlerin ba\u015flamas\u0131 ad\u0131na ilk basamak olarak \u00f6nemli bir yere sahiptir. Bu y\u00fczden eldeki imkanlar dahilinde bu hastalar\u0131n ya da yak\u0131nlar\u0131n\u0131n mutlaka bilgilendirilmesi ve gerekli y\u00f6nlendirmelerin yap\u0131lmas\u0131 \u00f6nemlidir.<\/p>\n

         <\/p>\n

        KAYNAKLAR<\/h2>\n
          \n
        1. Goldman-Mellor, S., M. Olfson, and M. Schoenbaum, Acute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder.<\/em> Drug and alcohol dependence, 2022. 236<\/strong>: p. 109472.<\/li>\n
        2. White, A.M., et al., Trends in alcohol\u2010related emergency department visits in the United States: results from the Nationwide Emergency Department Sample, 2006 to 2014.<\/em> Alcoholism: clinical and experimental research, 2018. 42<\/strong>(2): p. 352-359.<\/li>\n
        3. Grucza, R.A., et al., Trends in adult alcohol use and binge drinking in the early 21st\u2010Century United States: A meta\u2010analysis of 6 national survey series.<\/em> Alcoholism: clinical and experimental research, 2018. 42<\/strong>(10): p. 1939-1950.<\/li>\n
        4. Roerecke, M. and J. Rehm, Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis.<\/em> International journal of epidemiology, 2014. 43<\/strong>(3): p. 906-919.<\/li>\n
        5. Choi, N.G. and D.M. DiNitto, Alcohol use disorder and treatment receipt among individuals aged 50 years and older: Other substance use and psychiatric correlates.<\/em> Journal of Substance Abuse Treatment, 2021. 131<\/strong>: p. 108445.<\/li>\n
        6. Savic, M., et al., Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review.<\/em> Substance abuse treatment, prevention, and policy, 2017. 12<\/strong>(1): p. 1-12.<\/li>\n
        7. Wakeman, S.E., et al., Effect of integrating substance use disorder treatment into primary care on inpatient and emergency department utilization.<\/em> Journal of general internal medicine, 2019. 34<\/strong>(6): p. 871-877.<\/li>\n
        8. Roerecke, M. and J. Rehm, Alcohol use disorders and mortality: a systematic review and meta\u2010analysis.<\/em> Addiction, 2013. 108<\/strong>(9): p. 1562-1578.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

          Alkol t\u00fcketimi ve bununla birlikte alkole ba\u011fl\u0131 morbidite ve mortalite g\u00fcnden g\u00fcne artmaktad\u0131r. Bu mortalite alkol\u00fcn kronik etkilerine (karaci\u011fer sirozu, kardiyovask\u00fcler komplikasyonlar…<\/p>\n","protected":false},"author":1237,"featured_media":3515,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014,10019],"tags":[47,10030,10022,406],"class_list":["post-3511","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","category-tft","tag-alkol","tag-mortalite","tag-tft","tag-toksikoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3511","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1237"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3511"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3511\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3515"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3511"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3511"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}