{"id":387,"date":"2012-07-08T11:32:01","date_gmt":"2012-07-08T08:32:01","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=387"},"modified":"2012-07-08T11:32:01","modified_gmt":"2012-07-08T08:32:01","slug":"jet-lag-ve-shift-lag-sendromlari","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=387","title":{"rendered":"Jet lag ve shift lag sendromlar\u0131"},"content":{"rendered":"<p style=\"text-align: justify;\"><a href=\"http:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/jet-lag.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignleft size-full wp-image-389\" title=\"jet-lag\" src=\"http:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/jet-lag.jpg\" alt=\"\" width=\"250\" height=\"201\" srcset=\"https:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/jet-lag.jpg 250w, https:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/jet-lag-68x55.jpg 68w\" sizes=\"(max-width: 250px) 100vw, 250px\" \/><\/a>\u0130nsan organizmas\u0131 g\u00fcnl\u00fck (sirkadian) ritimlerle uyumlu bir i\u015fleyi\u015f g\u00f6sterir. G\u00fcn\u00fcn belirli saatlerinde daha aktif ve verimli olunurken, belirli periyodlarda da fiziksel ve zihinsel i\u015flevlerde yava\u015flama olur. Bu ritmin d\u0131\u015far\u0131dan baz\u0131 zorlamalarla de\u011fi\u015ftirilmesi halinde ortaya \u00e7\u0131kan uyumsuzluk tablolar\u0131, jet lag ve shift lag sendromlar\u0131 olarak bilinir. Bunlar insan\u0131n fiziksel ve zihinsel yetersizlikler ya\u015famas\u0131na ve sonu\u00e7ta kaza yapmas\u0131na yol a\u00e7t\u0131\u011f\u0131 i\u00e7in \u00f6zel \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>A. Jet Lag <\/strong><\/p>\n<p style=\"text-align: justify;\">Boylamlar ge\u00e7ilerek (transmeridien) yap\u0131lan uzun menzilli ve s\u00fcratli k\u0131talararas\u0131 yolculuklarda, i\u00e7sel-biyolojik saatle var\u0131lan b\u00f6lgenin co\u011frafi saati aras\u0131ndaki uyumsuzluk (desenkronizasyon), bir dizi zihinsel ve fiziksel performans bozukluklar\u0131na yol a\u00e7ar. Jet lag (<em>jet sarho\u015flu\u011fu, jet yorgunlu\u011fu, jet mahmurlu\u011fu, u\u00e7ak alt\u0131<\/em>) denen bu sendromun havac\u0131lar i\u00e7in potansiyel bir problem oldu\u011funa ilk kez 1931\u2032de Post ve Getty taraf\u0131ndan dikkat \u00e7ekilmi\u015f, daha bilimsel yakla\u015f\u0131m ise 20 y\u0131l sonras\u0131nda Strughold\u2019dan gelmi\u015ftir (4,8,9).<\/p>\n<p style=\"text-align: justify;\">Beyinde suprakiazmatik \u00e7ekirdekteki pacemaker, bilemedi\u011fimiz bi\u00e7imde zaman ayar\u0131 yapmakta olup, belirli periyodlarda sinir h\u00fccrelerini ate\u015flemektedir. Zaman ayar\u0131n\u0131n d\u0131\u015f uyar\u0131c\u0131lar\u0131 (<strong><em>zeitgebers<\/em><\/strong>) olarak bilinenlerin en \u00f6nemlisi \u0131\u015f\u0131kt\u0131r; di\u011ferleri d\u0131\u015f \u0131s\u0131 de\u011fi\u015fimleri, yemek ve uyku ihtiyac\u0131, sosyal zorunluluklar, fizik aktivite, vs\u2019dir. En \u00f6nemli uyar\u0131c\u0131 olan \u0131\u015f\u0131k, g\u00f6zden retinaya ula\u015ft\u0131\u011f\u0131nda buradaki sinirleri uyararak beyine sinyaller g\u00f6nderilmesini ba\u015flat\u0131r. Melatonin salg\u0131s\u0131 bask\u0131lan\u0131r, Serotonin artar ve sistem aktivitesi h\u0131zlan\u0131r. D\u0131\u015f \u0131\u015f\u0131\u011f\u0131n ve \u0131s\u0131n\u0131n azald\u0131\u011f\u0131 k\u0131\u015f aylar\u0131nda mevsimsel depresyonlar\u0131n ve intiharlar\u0131n, \u0131\u015f\u0131\u011f\u0131n ve \u0131s\u0131n\u0131n artt\u0131\u011f\u0131 bahar-yaz aylar\u0131nda manilerin daha \u00e7ok g\u00f6r\u00fclmesi bu fakt\u00f6r ile izah edilmektedir. G\u00fcne\u015f \u0131\u015f\u0131\u011f\u0131ndan daha az nasiplenen kuzey \u00fclkelerinde depresyon ve intihar oranlar\u0131n\u0131n y\u00fcksekli\u011finin de, mevsimsel depresyon hastalar\u0131na sabah saatlerinde kuvvetli \u0131\u015f\u0131\u011fa maruz b\u0131rakmak \u015feklinde uygulanan fototerapinin de rasyoneli budur (kuvvetli \u0131\u015f\u0131k uyaran\u0131 ile serotonin\u2019i artt\u0131rmak). Milyonlarca y\u0131l g\u00fcn \u0131\u015f\u0131\u011f\u0131yla uyan\u0131p ko\u015fu\u015fturan, hava karar\u0131nca uykuya ge\u00e7en hayvanlar aras\u0131nda do\u011fal d\u00fczene sadece insano\u011flu ba\u015fkald\u0131rm\u0131\u015ft\u0131r. Biyolojik saatinin komutlar\u0131na kar\u015f\u0131 gelerek geceleyin de aktivitelerini s\u00fcrd\u00fcren, g\u00fcn do\u011fumuna inat uyanmayan (yani kronobiyolojik z\u0131tla\u015fmaya giren) insano\u011flu, belki baz\u0131 rahats\u0131zl\u0131klar hissederek bunun faturas\u0131n\u0131 \u00f6demekte; bir yandan da otantik ya\u015fama d\u00f6n\u00fc\u015f g\u00fcd\u00fcs\u00fcyle k\u0131rsal nostaljiler ve \u015fehirden ka\u00e7\u0131\u015f fantezileri ya\u015famaktad\u0131r.<\/p>\n<p style=\"text-align: justify;\">Jet lag belirtileri, uyku-uyan\u0131kl\u0131k (ayd\u0131nl\u0131k\/karanl\u0131k) paternlerine ko\u015fut i\u015fleyen hormon sal\u0131n\u0131m\u0131, v\u00fccut \u0131s\u0131s\u0131, h\u00fccre rejenerasyonu ve beyin dalga aktivitelerindeki alt\u00fcst olu\u015fla ilgilidir. Jet lag, k\u0131talararas\u0131 uzun u\u00e7u\u015flar yapan u\u00e7u\u015f m\u00fcrettebat\u0131n\u0131, uzay adamlar\u0131n\u0131, bilimsel ve politik toplant\u0131lara kat\u0131lmak \u00fczere seyahat eden ki\u015fileri ve yar\u0131\u015fmalara kat\u0131lacak sporcular\u0131 \u00f6zellikle ilgilendirir. Zihinsel ve fiziksel performans kayb\u0131, bu ki\u015filerin ba\u015far\u0131lar\u0131n\u0131 \u00f6nemli d\u00fczeyde azaltabilir (4,6,8,10).<\/p>\n<p style=\"text-align: justify;\"><strong>Semptomatoloji:<\/strong> Uykusuzluk, yorgunluk, haz\u0131ms\u0131zl\u0131k, kab\u0131zl\u0131k, i\u015ftahs\u0131zl\u0131k, ba\u015f ve v\u00fccut a\u011fr\u0131lar\u0131, terleme, bulan\u0131k g\u00f6rme, dizoryantasyon, zihin kar\u0131\u015f\u0131kl\u0131\u011f\u0131, konsantrasyon zorlu\u011fu, zaman ve mesafe alg\u0131s\u0131 bozulmalar\u0131, reaksiyon zaman\u0131 uzamas\u0131, sinirlilik, yarg\u0131, karar ve bellek kusurlar\u0131\u2026<\/p>\n<p style=\"text-align: justify;\">Jet lag sendromuyla ilgili temel bilgiler \u015funlardan ibarettir:<\/p>\n<p style=\"text-align: justify;\"><strong>1.<\/strong> D\u00fcnyan\u0131n \u00e7evresi 360 boylamla b\u00f6l\u00fcmlenmi\u015ftir. Her iki boylam aras\u0131 4 dakikada, her 15 boylam 1 saatte ge\u00e7ilir; buna 1 zaman dilimi denir. D\u00fcnya \u00e7evresinde 24 zaman dilimi vard\u0131r. D\u00f6rtten az zaman dilimi kaymas\u0131 tolere edilebilmekte, 5 ve daha fazla say\u0131da zaman dilimi kaymalar\u0131 jet lag belirtilerini artt\u0131rmaktad\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>2.<\/strong> Jet lag belirtilerinin devam s\u00fcresi kabaca \u2018ge\u00e7ilen zaman dilimi kadar g\u00fcn\u2019d\u00fcr; ba\u015fka bir ifadeyle, var\u0131lan yere v\u00fccudun uyumu ve belirtilerinin kaybolmas\u0131 (resenkronizasyon), aradaki saat fark\u0131 kadar g\u00fcn al\u0131r. (\u0130nce hesaplamalarda resenkronizasyon g\u00fcnde 1,5 saate \u00e7\u0131kabilir; yani ge\u00e7ilen zaman diliminin 2\/3\u2032\u00fc kadar g\u00fcne k\u0131salabilir.) Ancak tam d\u00fczelmenin daha uzun (bat\u0131 y\u00f6nl\u00fc 6 zaman dilimi kaymas\u0131nda d\u00fczelmenin 10 g\u00fcn, do\u011fu y\u00f6nl\u00fc kaymada 13 g\u00fcn) s\u00fcrd\u00fc\u011f\u00fcn\u00fc iddia edenler de vard\u0131r (12). \u0130nsanlar\u0131n %30\u2032u jet lag\u2019\u0131 daha uzun s\u00fcrelerde atlatabilirler; \u00f6zellikle ya\u015fl\u0131lar\u0131n jet lag belirtileri daha uzun s\u00fcrer.<\/p>\n<p style=\"text-align: justify;\"><strong>3.<\/strong> Kuzey-g\u00fcney veya g\u00fcney-kuzey u\u00e7u\u015flar\u0131nda zaman dilimi ge\u00e7ilmedi\u011fi, saat ve gece g\u00fcnd\u00fcz fark\u0131 olmad\u0131\u011f\u0131 i\u00e7in genellikle uyumsuzluk belirtisi g\u00f6r\u00fclmez (9).<\/p>\n<p style=\"text-align: justify;\"><strong>4.<\/strong> Gece-g\u00fcnd\u00fcz farkl\u0131l\u0131\u011f\u0131n\u0131n \u00e7ok belirgin olmad\u0131\u011f\u0131 kutup b\u00f6lgelerinde ya\u015fayan insanlar\u0131n jet lag\u2019den a\u015f\u0131r\u0131 derecede etkilenmeyecekleri i\u00e7in, belki de jet lag problemi itibariyle en problemsiz pilotlar\u0131n eskimolardan \u00e7\u0131kaca\u011f\u0131, fantastik bir varsay\u0131m olarak ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr (5).<\/p>\n<p style=\"text-align: justify;\"><strong>5.<\/strong> Bat\u0131dan do\u011fuya do\u011fru olan u\u00e7u\u015flar, do\u011fu-bat\u0131 y\u00f6nl\u00fclere g\u00f6re daha problemlidir; uykusuzluk ba\u015fta olmak \u00fczere belirtilerin \u015fiddeti daha fazla, d\u00fczelme s\u00fcresi daha uzundur (2,5,6,9,11,12).<\/p>\n<p style=\"text-align: justify;\"><strong>6.<\/strong> Vatan veya ev y\u00f6n\u00fc u\u00e7u\u015flarda (do\u011fuya do\u011fru bile olsa) jet lag etkileri daha iyi tolere edilebilmektedir (9).<\/p>\n<p style=\"text-align: justify;\"><strong>7.<\/strong> Jet lag belirtilerinin g\u00fcn ge\u00e7tik\u00e7e azalmas\u0131 beklenirken, \u00fc\u00e7\u00fcnc\u00fc g\u00fcn bozukluklar\u0131n\u0131n ilk g\u00fcnlere g\u00f6re daha \u015fiddetli olmas\u0131 ilgin\u00e7tir (5).<\/p>\n<p style=\"text-align: justify;\"><strong>8.<\/strong> Var\u0131lan b\u00f6lgenin yeme-i\u00e7me-uyuma saatlerine riayet etmek ve sosyal aktivitelerine kat\u0131lmak uyum s\u00fcresini k\u0131salt\u0131r. Daha yolculu\u011fun ba\u015flang\u0131c\u0131nda kol saatini var\u0131lacak b\u00f6lgenin saatine ayarlamak, adaptasyona yard\u0131mc\u0131 olabilir. Kritik g\u00f6revleri olan ki\u015filerin gidecekleri yerlere 3-7 g\u00fcn \u00f6nce gidip uyum i\u00e7in zaman kazanmalar\u0131 en iyi yoldur (8).<\/p>\n<p style=\"text-align: justify;\"><strong>9.<\/strong> Proteinden zengin kahvalt\u0131 ve (d\u00fc\u015f\u00fck proteinli + y\u00fcksek karbonhidratl\u0131) ak\u015fam yeme\u011fi yemek, uyum s\u00fcresini k\u0131saltmakta yararl\u0131 g\u00f6r\u00fclmektedir (2,9).<\/p>\n<p style=\"text-align: justify;\"><strong>10.<\/strong> Ki\u015finin resenkronizasyon i\u00e7in aktif \u00e7aba g\u00f6stermesi ve y\u00fcksek motivasyona sahip olmas\u0131 durumlar\u0131nda jet lag\u2019in olumsuz etkilerini yenmesi daha kolayla\u015fmaktad\u0131r. N\u00f6rotik ve ekstrovert ki\u015filerin semptomatolojisi daha zengin, introvertlerin sirkadien de\u011fi\u015fimlerden etkilenmesi g\u00f6rece azd\u0131r (3,4,11).<\/p>\n<p style=\"text-align: justify;\"><strong>11.<\/strong> Pilotlar\u0131n uzun menzilli u\u00e7u\u015f \u00f6ncesinde yar\u0131m saatlik bir \u015fekerleme uykusu (<em>nap<\/em>), yapmalar\u0131 performans\u0131 artt\u0131r\u0131r; 30 dakikadan daha uzun uykular sersemlik ve uykululuk yaratabilir. U\u00e7u\u015f s\u0131ras\u0131ndaki mikrouykular \u00e7ok tehlikelidir. \u0130kiden fazla pilotla uzun u\u00e7u\u015flar yap\u0131lan askeri ve sivil u\u00e7aklarda uyku kabinleri vard\u0131r, ancak buralarda her pilotun rahat\u00e7a uyuyabilece\u011fi konusu \u015f\u00fcphelidir.<\/p>\n<p style=\"text-align: justify;\"><strong>12.<\/strong> K\u0131talararas\u0131 uzun u\u00e7u\u015f g\u00f6revi \u00f6ncesinde ve sonras\u0131nda en az 2 gece tam uyku uyunmu\u015f olmal\u0131; b\u00f6yle uzun u\u00e7u\u015flardan sonra pilotlara k\u0131sa menzilli (intrameridian) u\u00e7u\u015flar yaz\u0131lmal\u0131d\u0131r<\/p>\n<p style=\"text-align: justify;\"><strong>13.<\/strong> Uzun u\u00e7u\u015flarda kol ve bacaklar\u0131 germe hareketleri yapmak, gezinmek, bir \u015feyler yiyip i\u00e7mek ve \u00e7evredekilerle konu\u015fmak, uyan\u0131kl\u0131l\u0131\u011f\u0131 artt\u0131rmada i\u015fe yarayan y\u00f6ntemlerdir.<\/p>\n<p style=\"text-align: justify;\"><strong>14.<\/strong> Biyolojik saati d\u00fczenleyen <strong>kronobiyotik ila\u00e7lar<\/strong> gerekti\u011finde doktor kontrol\u00fcnde kullan\u0131labilir. Do\u011fu y\u00f6nl\u00fc u\u00e7u\u015flarda g\u00fcn k\u0131sald\u0131\u011f\u0131 i\u00e7in periyod k\u0131salt\u0131c\u0131 ila\u00e7lar <em>(Nomifensine, Chlordiazepoxide, Estradiol, Desmethylimipramine, Melatonin)<\/em> yararl\u0131d\u0131r. (Melatonin\u2019in yarars\u0131z oldu\u011fu da s\u00f6ylenmektedir.) Bat\u0131 y\u00f6nl\u00fc u\u00e7u\u015flarda ise g\u00fcn uzd\u0131\u011f\u0131 i\u00e7in periyod geni\u015fletici ila\u00e7lar al\u0131nmas\u0131 uygundur: <em>Theophylline, Deuterium, Lithium, Amphetamine, Clorgyline, Ethyl Alcohol, <\/em>vs. (9). Kronobiyotik ila\u00e7lardan re\u00e7etesiz sat\u0131lan ve \u00f6zellikle yolcular\u0131n s\u0131kl\u0131kla kulland\u0131klar\u0131 Melatonin ile No Jet-Lag\u2019dir.<\/p>\n<p style=\"text-align: justify;\"><strong>15.<\/strong> Kahve, \u00e7ay ve t\u00fct\u00fcn uyar\u0131c\u0131 olarak; melatonin, alkol ve k\u0131sa etkili uyku ila\u00e7lar\u0131 da uykusuzlu\u011fu gidermek amac\u0131yla ampirik y\u00f6ntemler olarak kullan\u0131lmaktad\u0131r. T\u0131bbi olarak etkinli\u011fi kan\u0131tlanm\u0131\u015f olan uyar\u0131c\u0131lar <em>kafein, modafinil, pemoline, metilfenidat ve amfetamin<\/em>\u2018dir. Stimulanlar\u0131n sonraki uyku periyodlar\u0131n\u0131 bozmas\u0131 olas\u0131l\u0131\u011f\u0131 da unutulmamal\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>16.<\/strong> I\u015f\u0131\u011fa (\u00f6zellikle g\u00fcne\u015f \u0131\u015f\u0131\u011f\u0131na) maruz kalmak, melatonini azaltmak ve serotonini artt\u0131rmak yoluyla sirkadian ritmi d\u00fczenlemede yararl\u0131d\u0131r. (2,8,9,10,11).<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>Jet Lag prati\u011fi<\/strong><strong> <\/strong><\/p>\n<p style=\"text-align: justify;\">Havac\u0131l\u0131k art\u0131k 7 g\u00fcn\/24 saat\u2019l\u0131k bir end\u00fcstri oldu\u011fundan, erken kalk\u0131\u015flar, gece u\u00e7u\u015flar\u0131, pe\u015fpe\u015fe zaman dilimi ge\u00e7i\u015fleri rutindir. Gece veya g\u00fcnd\u00fcz u\u00e7u\u015flar\u0131nda uyuklayan, yorgunluk, dikkat da\u011f\u0131n\u0131kl\u0131\u011f\u0131 ve alg\u0131 bozuklu\u011fu ya\u015fayan pilotlar u\u00e7u\u015f emniyeti i\u00e7in risktir. K\u0131talararas\u0131 uzun menzilli u\u00e7u\u015flara ait kaza oranlar\u0131, k\u0131sa-orta menzilli u\u00e7u\u015flara g\u00f6re 3 kat fazlad\u0131r (13). Havac\u0131l\u0131k t\u0131bb\u0131ndan beklenen, uzun u\u00e7u\u015flar yapan insanlara ve \u00f6zellikle de emniyetli u\u00e7u\u015f yapmas\u0131 istenen u\u00e7u\u015f ekiplerine jet lag\u2019den kurtulma \u00e7arelerini sunmas\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\">Jet lag\u2019in prati\u011fiyle ilgili bir \u00f6rnek: \u0130ngiltere\u2019den \u00f6\u011fle \u00fczeri kalkan bir u\u00e7a\u011f\u0131n yolcusu Los Angeles\u2019e vard\u0131\u011f\u0131nda, i\u00e7 saati 20\u2032yi, lokal saat ise \u00f6\u011flen 12\u2032yi g\u00f6sterdi\u011fi i\u00e7in bir karma\u015fa ya\u015fayacak; yolcu kendi i\u00e7 saatine g\u00f6re gece yar\u0131s\u0131 gibi hissetti\u011fi saatte uykuya yatacak ve ortalama 8 saat sonra (kendi sabah\u0131na) uyand\u0131\u011f\u0131nda Los Angeles\u2019te gece saat 01 oldu\u011funu fark ederek kendini ikinci bir karma\u015fan\u0131n i\u00e7inde bulacakt\u0131r. Bu s\u00fcre\u00e7te sindirim sisteminin ac\u0131kma, yeme ve bo\u015falt\u0131m d\u00fczenleri de bozulacakt\u0131r. Bu problemler, emniyetli bir u\u00e7u\u015f yapmas\u0131 beklenen pilotlar i\u00e7in yolculara g\u00f6re daha b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r.<\/p>\n<p style=\"text-align: justify;\">Iberia Airlines\u2019in, Madrid\u2019den Mexico City ve Tokyo\u2019ya u\u00e7u\u015flar yapan \u0130spanyol pilotlar\u0131nda 2 y\u0131ll\u0131k periyodu kapsayan ara\u015ft\u0131rmas\u0131 jet lag sorununu irdelemi\u015ftir. \u0130lki bat\u0131 y\u00f6n\u00fcne ve 7 zaman dilimi, ikincisi do\u011fu y\u00f6n\u00fcne ve 8 zaman dilimi ge\u00e7ilerek yap\u0131lan bu u\u00e7u\u015flar\u0131n d\u00f6n\u00fc\u015fleri de tersine oldu\u011fu i\u00e7in, iki y\u00f6nl\u00fc jet lag etkilerinin analizine f\u0131rsat vermi\u015ftir. 50 ya\u015f alt\u0131 ve 50 ya\u015f \u00fcst\u00fc olarak iki gruba ay\u0131r\u0131lan pilotlarda u\u00e7u\u015f \u00f6ncesi 2 g\u00fcn, var\u0131lan \u015fehirde kalma s\u00fcresince 2 g\u00fcn ve Madrid\u2019e d\u00f6n\u00fc\u015f\u00fc takibeden 2 g\u00fcn olmak \u00fczere toplam 6 g\u00fcnl\u00fck kay\u0131tlar\u0131 (nab\u0131z, v\u00fccut \u0131s\u0131s\u0131, anksiyete, yorgunluk ve zaman tahmin becerisi) tutularak analiz edilmi\u015ftir. Genelde jet lag semptomlar\u0131 (\u00f6zellikle yorgunluk) do\u011fu y\u00f6nl\u00fc u\u00e7u\u015flarda ve 50 ya\u015f alt\u0131 grupta biraz daha fazla g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Anksiyete mola periyodunda ve 50 ya\u015f alt\u0131 grupta artm\u0131\u015ft\u0131r. Zaman tahmin becerisi u\u00e7u\u015f bitimlerinde bozulmu\u015f ve oldu\u011fundan ileri saatler s\u00f6ylenmi\u015ftir (11).<\/p>\n<p style=\"text-align: justify;\">Finlandiya\u2019da yap\u0131lan ba\u015fka bir ara\u015ft\u0131rmada ise ABD\u2019nin Seattle (bat\u0131 y\u00f6nl\u00fc) ve Japonya\u2019n\u0131n Tokyo kentlerine (do\u011fu y\u00f6nl\u00fc) u\u00e7an kabin ekiplerinin (285 bayan, 57 erkek) jet lag sorunu incelenmi\u015ftir. Gittikleri kentlerde birer hafta dinlenme periyodu ge\u00e7iren ekiplere, uyku kalitesi, yatakta kalma s\u00fcresi, jet lag\u2019den ka\u00e7 g\u00fcnde kurtulduklar\u0131 gibi sorular sorulmu\u015ftur. Beklenen bir sonu\u00e7 olarak, do\u011fu y\u00f6nl\u00fc u\u00e7u\u015flar uyku kalitesini bozmu\u015ftur. Bat\u0131 y\u00f6nl\u00fc g\u00fcnd\u00fcz u\u00e7u\u015flar\u0131ndan sonra yatakta kalma s\u00fcresi azalm\u0131\u015f; Helsinki\u2019ye d\u00f6n\u00fc\u015flerdeki ev uykular\u0131n\u0131n s\u00fcre ve kalitesi artm\u0131\u015ft\u0131r. Ev d\u0131\u015f\u0131 konaklamalarda daha \u00e7ok alkol t\u00fcketilmesinin uyku kalitesini bozan etmenlerden birisi oldu\u011fu da vurgulanm\u0131\u015ft\u0131r. Ev y\u00f6nl\u00fc u\u00e7u\u015flardaki semptomlar\u0131n azl\u0131\u011f\u0131, ev rahatl\u0131klar\u0131 yan\u0131nda, ailevi ve sosyal mutluluklarla da ilgili g\u00f6r\u00fclmektedir (12).<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>Jet Lag\u2019den Kurtulma<\/strong><strong>:<\/strong> Ge\u00e7ilen her zaman dilimi 1 saatlik bir kaymaya e\u015fde\u011ferdir; var\u0131lan b\u00f6lgenin saatlerine bedenin adaptasyonu ise, ge\u00e7en her g\u00fcn i\u00e7in 1,5 saat kadard\u0131r. Yani e\u011fer 9 saatlik bir zaman fark\u0131 s\u00f6z konusu ise, var\u0131lan yere uyum 6 g\u00fcnde tamamlanacakt\u0131r. Londra\u2019dan Los Angeles\u2019e u\u00e7an pilot (al\u0131\u015fk\u0131n oldu\u011fu uyku d\u00fczenine g\u00f6re yat\u0131p kalkmak ko\u015fuluyla) 2-3 g\u00fcn sonra tekrar Londra\u2019ya d\u00f6nerse orada jet lag ya\u015famayabilir. Jet lag\u2019in yaratt\u0131\u011f\u0131 rahats\u0131zl\u0131klar ve d\u00fczelme s\u00fcresi seyahatin y\u00f6n\u00fcne g\u00f6re de\u011fi\u015febilmektedir:<\/p>\n<p style=\"text-align: justify;\"><strong>a. <\/strong>Bat\u0131ya U\u00e7u\u015f (Londra-NY): Londra\u2019dan 5 saat geride olan NY\u2019da \u00f6\u011fle 5 saat ge\u00e7 olur. B\u00f6ylece NY\u2019a varan bir pilot i\u00e7in g\u00fcn 29 saate uzar. V\u00fccudun biyolojik saati 24 de\u011fil, 25 saat oldu\u011fundan jet lag \u00f6l\u00e7\u00fcs\u00fc 29-25 = <strong>4 saat<\/strong> olacakt\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>b. <\/strong>Do\u011fuya u\u00e7u\u015f (NY-Londra): Bu u\u00e7u\u015fta g\u00fcn 24-5=19 saate k\u0131salacak, 25-19 = <strong>6 saatlik<\/strong> jet lag olacakt\u0131r. Bu hesaplamalar, ayn\u0131 \u00f6l\u00e7\u00fcde zaman dilimi kaymas\u0131 olmas\u0131na kar\u015f\u0131n, do\u011fu y\u00f6nl\u00fc u\u00e7u\u015flardaki jet lag\u2019in daha \u015fiddetli ge\u00e7ti\u011fini g\u00f6stermektedir.<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>Jet Lag\u2019den Korunma Teknikleri<\/strong><strong>:<\/strong> E\u011fer uzun bir u\u00e7u\u015f sonras\u0131 k\u0131sa bir mola verilip hemen d\u00f6n\u00fclecekse, var\u0131lan yerin yeme ve uyuma saatlerine g\u00f6re de\u011fil, kalk\u0131\u015f yerindeki al\u0131\u015f\u0131lm\u0131\u015f programa uygun davran\u0131lmas\u0131 gerekir. En zor molalar, var\u0131lan yerde 24 saat civar\u0131 kal\u0131\u015flard\u0131r. \u00c7\u00fcnk\u00fc bu s\u00fcre hem tek bir uyku seans\u0131yla halledilecek kadar k\u0131sa, hem de 2 iyi uyku s\u0131\u011fd\u0131r\u0131lacak kadar geni\u015f de\u011fildir. Bu nedenle var\u0131\u015f sonras\u0131 s\u0131n\u0131rl\u0131 bir istirahat, bir s\u00fcre sonra da kalk\u0131\u015fa kadar iyi bir uyku \u015feklinde bir d\u00fczenleme yap\u0131lmal\u0131d\u0131r. Daha uzun s\u00fcreli molalarda, var\u0131lan yerin yeme ve uyuma saatlerine olabildi\u011fince uyumlu davran\u0131lmas\u0131 \u00f6nerilmektedir.<\/p>\n<p style=\"text-align: justify;\">Uyku pl\u00e2nlamas\u0131: U\u00e7u\u015f \u00f6ncesi uyku d\u00fczeninde 3 basit kural dikkate al\u0131nmal\u0131d\u0131r:<\/p>\n<ul style=\"text-align: justify;\">\n<li>1. Kural: 1 saat uyku uyumakla, 2 saat uyan\u0131kl\u0131k kredisi kazan\u0131l\u0131r,<\/li>\n<li>2. Kural: Gerekti\u011fi kadar uyku, g\u00f6reve ba\u015flama saatine yak\u0131n bitecek \u015fekilde ayarlanmal\u0131d\u0131r,<\/li>\n<li>3. Kural: 1\/3 kural\u0131 uygulanmal\u0131d\u0131r.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>\u00d6rnek:<\/strong> Bir pilot Londra\u2019dan NY\u2019a 5 saatlik bir u\u00e7u\u015f ile gelmi\u015ftir ve 24 saat mola s\u00fcresi vard\u0131r. Otel odas\u0131na vard\u0131\u011f\u0131nda lokal saat 21\u2032i g\u00f6stermektedir. Uyku kredisi s\u0131f\u0131rd\u0131r; pilot uyku pl\u00e2nlamas\u0131n\u0131 2 \u015fekilde yapabilir:<\/p>\n<p style=\"text-align: justify;\"><strong>1. Se\u00e7enek<\/strong><strong>:<\/strong> Pilot u\u00e7u\u015fa kadar olan 24 saatlik s\u00fcrenin son 8 saatini uykuda ge\u00e7irmek zorundad\u0131r (2. Kural). Kalan 16 saatin uyku pl\u00e2nlamas\u0131 3. Kural\u2019a g\u00f6re yap\u0131labilir: 16\u2032n\u0131n \u00fc\u00e7te biri olan 5 saat 20 dakika s\u00fcre hemen otele var\u0131ld\u0131\u011f\u0131nda uyunarak, sonraki 10 saat 40 dakika (2. Kural) uyan\u0131k ge\u00e7irilerek tamamlan\u0131r ve son 8 saat tekrar uyunarak lokal saate g\u00f6re ertesi g\u00fcn 21\u2032de uyan\u0131l\u0131p u\u00e7u\u015fa ge\u00e7ilmi\u015f olur. Bu s\u0131rada pilotun v\u00fccut saati 02\u2032dir ama 16 saatlik bir uyan\u0131kl\u0131k kredisi kazan\u0131lm\u0131\u015f durumdad\u0131r. Bu se\u00e7enek u\u00e7u\u015f \u00f6ncesinde 8 saat uyku uyunmu\u015f olmas\u0131yla avantajl\u0131; ancak 5 saat 20 dakikal\u0131k ilk uyku periyodunun \u00e7ok kaliteli olmay\u0131\u015f\u0131, ayr\u0131ca gece ve sabah erken saatlere gelen (02,20-13) uyan\u0131kl\u0131k periyodunun asosyal ve s\u0131k\u0131c\u0131 olmas\u0131 y\u00f6nleriyle de dezavantajl\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>2.<\/strong> <strong>Se\u00e7enek<\/strong><strong>:<\/strong> Pilot otel odas\u0131na geldikten sonra 1 saat 20 dakikal\u0131k k\u0131sa bir uyku uyur; 22,20\u2032den 01\u2032e kadar 2 saat 40 dakika gece e\u011flencesini takiben 4 saat daha uyur; 05-13 aras\u0131n\u0131 uyan\u0131k ge\u00e7irir ve sonra saat 13-21 aras\u0131ndaki \u00fc\u00e7\u00fcnc\u00fc uykusunu 8 saat olarak ger\u00e7ekle\u015ftirerek u\u00e7u\u015fa ba\u015flar. Bu pl\u00e2nlaman\u0131n avantajlar\u0131: Uyan\u0131kl\u0131k devrelerinde sosyal aktiviteler daha canl\u0131d\u0131r; ayr\u0131ca 1. ve 3. uyku periyodar\u0131n\u0131n uyku kalitesi olduk\u00e7a iyi, v\u00fccut \u0131s\u0131s\u0131 da d\u00fc\u015f\u00fc\u015ftedir. Dezavantajlar\u0131: Uyku devreleri k\u0131sa ve rahats\u0131z edicidir, ayr\u0131ca 2. periyod uykusunda v\u00fccut \u0131s\u0131s\u0131 y\u00fckseli\u015ftedir ve bu da kaliteyi bozan bir unsurdur.<\/p>\n<p style=\"text-align: justify;\">\u0130deal pl\u00e2nlama i\u00e7in 2 u\u00e7 \u00f6neri getirilebilir: U\u00e7u\u015f ekipleri transmeridyen u\u00e7u\u015flar\u0131ndan sonra vard\u0131klar\u0131 b\u00f6lgede ya jet lag etkilerinden tamamen kurtulana kadar yeterli bir s\u00fcre (Finli pilotlar gibi 7-8 g\u00fcn) kalacaklar, ya da al\u0131\u015fk\u0131n olduklar\u0131 d\u00fczene g\u00f6re izole ya\u015fay\u0131p-uyuyarak k\u0131sa zamanda d\u00f6n\u00fc\u015f yolculu\u011fu yapacaklard\u0131r. Bu ikinci se\u00e7enek biyolojik saati korumaya y\u00f6nelik olup daha tercih edilesidir; ancak yeterli uyku ve istirahat periyodu b\u0131rak\u0131lmadan d\u00f6n\u00fc\u015f u\u00e7u\u015funa ge\u00e7ildi\u011finde riski fazlad\u0131r (11).<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>B. Shift Lag<\/strong><\/p>\n<p style=\"text-align: justify;\">Co\u011frafi b\u00f6lge de\u011fi\u015ftirmeden, i\u015f zorunluklar\u0131yla (<em>n\u00f6bet, acil durumlar, gece g\u00f6revleri vs.<\/em>) ya\u015fama <em>(\u00e7al\u0131\u015fma)<\/em> periyodu ile uyuma <em>(dinlenme)<\/em> periyodunun k\u0131smen veya tamamen yer de\u011fi\u015ftirmesi hallerinde v\u00fccudun i\u00e7 ritmi bu yeni d\u00fczene uymakta zorlan\u0131r. Bu durum k\u0131talararas\u0131-transmeridien u\u00e7u\u015flardaki jet lag\u2019a benzer belirtiler \u00e7\u0131kmas\u0131na neden olur (7). \u0130nsanlar\u0131n \u00e7o\u011fu g\u00fcnd\u00fcz \u00e7al\u0131\u015f\u0131p gece istirahat etmeye al\u0131\u015f\u0131k ve yatk\u0131nd\u0131rlar; bunun tersine \u00e7evrilmesinde, jet lag\u2019dekine benzer yorgunluk, uykusuzluk, genel keyifsizlik hali, gastroentestinal ve di\u011fer psikosomatik yak\u0131nmalar belirir (9).<\/p>\n<p style=\"text-align: justify;\">G\u00fcnd\u00fcz \u00e7al\u0131\u015f\u0131p gece dinlenen ortalama insan\u0131n bu d\u00fczenini art\u0131 ve eksi y\u00f6nlerde \u00e7eki\u015ftiren iki kronotip tan\u0131mlanm\u0131\u015ft\u0131r:<\/p>\n<p style=\"text-align: justify;\"><strong>1.\u00a0 Tarlaku\u015flar\u0131:<\/strong> V\u00fccut \u0131s\u0131lar\u0131 g\u00fcn\u00fcn erken saatlerinde y\u00fckselen, g\u00fcnd\u00fcz aktiviteleri fazla olan \u2018<em>sabah ku\u015flar\u0131\u2019<\/em> grubudur; performans e\u011frileri i\u00e7ed\u00f6n\u00fcklere benzeyen, erken yat\u0131p erken kalkan bu grup insanlar horozlara da benzetilmi\u015ftir.<\/p>\n<p style=\"text-align: justify;\"><strong>2.\u00a0 Bayku\u015flar:<\/strong> Ge\u00e7 yat\u0131p ge\u00e7 kalkan, v\u00fccut \u0131s\u0131lar\u0131 g\u00fcn\u00fcn ileri saatlerinde pik yapan, performanslar\u0131 da bu zamanlarda y\u00fckselen \u2018<em>gece ku\u015flar\u0131<\/em> veya <em>ak\u015fam insanlar\u0131<\/em>\u2018 grubudur. Geceleyin daha verimli ve \u00fcretken olan bu (nokt\u00fcrnal) insanlar\u0131n hayvanlar d\u00fcnyas\u0131ndaki di\u011fer e\u015fde\u011ferleri hamamb\u00f6cekleri, solucanlar ve kurba\u011falard\u0131r. (2,5,9)<\/p>\n<p style=\"text-align: justify;\">Al\u0131\u015fk\u0131n olunan \u00e7al\u0131\u015fma\/dinlenme periyodunun de\u011fi\u015ftirilmesiyle v\u00fccut \u0131s\u0131s\u0131, kan \u015feker d\u00fczeyi ve zihinsel \u00e7al\u0131\u015fma kapasitesi etkilenir; psikosomatik bozukluklar \u00e7\u0131kar. Hava trafik kontrol\u00f6rlerinde vardiya de\u011fi\u015fimlerinin tetikledi\u011fi hipertansiyon ve mide \u00fclseri olgular\u0131 bildirilmi\u015ftir. Vardiya de\u011fi\u015fimine zaman i\u00e7inde al\u0131\u015fma ve buna ba\u011fl\u0131 rahats\u0131zl\u0131klarda azalma olsa bile toplum d\u0131\u015f\u0131 kalmak ve herkesten ayr\u0131 bir zaman diliminde ya\u015famak olgusu ayr\u0131ca \u00f6nemli bir psikososyal sorundur (1). Vardiya de\u011fi\u015fiminin yol a\u00e7t\u0131\u011f\u0131 psikomotor bozukluklar, kaza oranlar\u0131n\u0131n gece yar\u0131s\u0131ndan sabaha kadar olan s\u00fcrelerde en y\u00fcksek oranlara \u00e7\u0131kmas\u0131 ile kendisini g\u00f6sterir (3). <strong>3 Mile<\/strong><strong> Island<\/strong> n\u00fckleer reakt\u00f6r kazas\u0131 (N.York-1979) gece vardiya de\u011fi\u015fiminin hemen akabinde; <strong>Chernobyl<\/strong> n\u00fckleer reakt\u00f6r kazas\u0131 (Ukrayna-1983) ve <strong>Bhopal<\/strong> kimyasal fabrika kazas\u0131 (Hindistan-1984) da sabah\u0131n erken saatlerinde meydana gelmi\u015ftir. Her \u00fc\u00e7 kazada da vardiya d\u00fczensizli\u011fi, kaza etmenleri aras\u0131nda g\u00f6sterilmi\u015ftir (2).<\/p>\n<p style=\"text-align: justify;\">Vardiyal\u0131 \u00e7al\u0131\u015fman\u0131n zorunlu oldu\u011fu fabrikalar, hastaneler, emniyet ve askerlik te\u015fkilatlar\u0131, ula\u015f\u0131m ve ta\u015f\u0131mac\u0131l\u0131k sekt\u00f6r\u00fc gibi alanlardaki vardiya d\u00fczenlemelerinde dikkat edilmesi gereken prensipler \u015funlard\u0131r:<\/p>\n<p style=\"text-align: justify;\"><strong>1.<\/strong> Birka\u00e7 saatlik \u00e7al\u0131\u015fma periyodu kaymalar\u0131 ciddi problem yaratmaz.<\/p>\n<p style=\"text-align: justify;\"><strong>2.<\/strong> \u0130leri saatlere do\u011fru olan vardiya kayd\u0131rmalar\u0131na (bat\u0131 y\u00f6nl\u00fc u\u00e7u\u015flar gibi) daha iyi tahamm\u00fcl edilir.<\/p>\n<p style=\"text-align: justify;\"><strong>3.<\/strong> Vardiya s\u00fcreleri 3 haftadan az, 4 haftadan \u00e7ok olmamal\u0131d\u0131r. Devaml\u0131 olarak belirli bir vardiyada \u00e7al\u0131\u015fmaya istekli olanlar b\u00fcnyesel yatk\u0131nl\u0131k veya al\u0131\u015fkanl\u0131k nedeniyle bu kural\u0131n d\u0131\u015f\u0131nda tutulabilirler.<\/p>\n<p style=\"text-align: justify;\"><strong>4.<\/strong> Vardiya de\u011fi\u015fimlerindeki ilk 4 g\u00fcn kritiktir. \u00d6nemli g\u00f6rev yerlerindeki ki\u015filerin ilk 4 g\u00fcnde o vardiyaya al\u0131\u015f\u0131k ki\u015filerle desteklenmesi gerekir.<\/p>\n<p style=\"text-align: justify;\"><strong>5.<\/strong> Gece vardiyalar\u0131n\u0131n daha k\u0131sa tutulmas\u0131 ve ancak iyi bir istirahatten sonra gece \u00e7al\u0131\u015fmas\u0131na ba\u015flan\u0131lmas\u0131 do\u011frudur.<\/p>\n<p style=\"text-align: justify;\"><strong>6.<\/strong> Ki\u015filerin dikkat ve uyan\u0131kl\u0131klar\u0131n\u0131 canl\u0131 tutmak i\u00e7in gece vardiyas\u0131nda yiyecek, i\u00e7ecek, m\u00fczik yay\u0131n\u0131 gibi uyar\u0131c\u0131 y\u00f6ntemler yararl\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>7.<\/strong> \u0130\u015fg\u00f6renlerin vardiya de\u011fi\u015fimlerini daha iyi tolere edebilmeleri i\u00e7in g\u00f6rev motivasyonlar\u0131n\u0131 y\u00fcksek tutman\u0131n yollar\u0131 aranmal\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\"><strong>8.<\/strong> Vardiya d\u00fczenlemelerinde ki\u015filerin <em>sabah veya ak\u015fam insan\u0131<\/em> olu\u015flar\u0131 dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong> <\/strong><strong>KAYNAKLAR<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong> 1.<\/strong> Cooper CLThe stress of work: An overview. Aviat Space Environ. Med. 1985; 56: 627-31<\/p>\n<p style=\"text-align: justify;\"><strong>2.<\/strong> Hawkins FH. Human factors in flight. Gower Tech. Press. 1987 Aldershot, England. P.48-57<\/p>\n<p style=\"text-align: justify;\"><strong>3.<\/strong> Klein KE, Wegman HM. Circadian rhythms of human performance and resistance: Operational aspects.<\/p>\n<p style=\"text-align: justify;\">AGARD Lecture Series No.105. 1979<\/p>\n<p style=\"text-align: justify;\"><strong>4.<\/strong> Klein KE, Wegman HM. Circadian rhythms in air operations. AGARD Lecture Series No.105. 1979<\/p>\n<p style=\"text-align: justify;\"><strong>5.<\/strong> McGann B. Psychological aspects of transmeridian flights. Institute of\u00a0 Psychology Dublin, Ireland. The Irish<\/p>\n<p style=\"text-align: justify;\">Airline Pilots Ass. Paper No.2, 1971<\/p>\n<p style=\"text-align: justify;\"><strong>6.<\/strong> Rayman RB. Circadian Rhythms. In: Fundamentals of Aerospace Medicine. Edited by Roy L Dehart.<\/p>\n<p style=\"text-align: justify;\">Pergammon Press N.York 1985, Chapter 13: 414<\/p>\n<p style=\"text-align: justify;\"><strong>7.<\/strong> Schroder DJ, Goulden DRA. Bibliography of shift work research: 1950-1982 FAA.-AM-83-17 Oklahoma. 1983<\/p>\n<p style=\"text-align: justify;\"><strong>8.<\/strong> Strughold H. Circadian rhythms: Aerospace medical aspects. In: Aerospace Medicine, Edited by Randel HW.<\/p>\n<p style=\"text-align: justify;\">2nd. Edit. 1971 p.47-55<\/p>\n<p style=\"text-align: justify;\"><strong>9.<\/strong> Winget CM, DeRoshia CW, et al. A review of human physiological and performance changes associated with<\/p>\n<p style=\"text-align: justify;\">desynchronosis of biological rhythms. Aviat Space Environ. Med. 1984;54: 1085-93<\/p>\n<p style=\"text-align: justify;\"><strong>10.<\/strong> Wooten VD. Fatigue and desynchronosis in aircrew. The Federal Air Surgeon\u2019s Medical Bulletin. Summer 2002: 8-9<\/p>\n<p style=\"text-align: justify;\"><strong>11.<\/strong> Ariznavarreta C, Cardinali DR, Villanua MA, et al. Circadian rhythms in airline pilots submitted to long-haul<\/p>\n<p style=\"text-align: justify;\">transmeridian flights. Aviat Space Environ. Med. 2002; 73:445-55<\/p>\n<p style=\"text-align: justify;\"><strong>12.<\/strong> Suvanto S, Partinen M, Harma M, Ilmarinen J. Flight attendants\u2019 desynchronosis after rapid time zone changes.<\/p>\n<p style=\"text-align: justify;\">Aviat Space Environ. Med. 1990; 61:543-7<\/p>\n<p style=\"text-align: justify;\"><strong>13.<\/strong> Roach GD, Rodgers M, Dawson D. Circadian adaptation of aircrew to transmeridien flight. Aviat Space<\/p>\n<p style=\"text-align: justify;\">Environ. Med. 2002; 73:1153-60<\/p>\n<h2 style=\"text-align: justify;\"><\/h2>\n<p style=\"text-align: justify;\"><strong>Haz\u0131rlayan: <\/strong>Dr. M. \u00c7eting\u00fc\u00e7<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0130nsan organizmas\u0131 g\u00fcnl\u00fck (sirkadian) ritimlerle uyumlu bir i\u015fleyi\u015f g\u00f6sterir. G\u00fcn\u00fcn belirli saatlerinde daha aktif ve verimli olunurken, belirli periyodlarda da fiziksel ve zihinsel i\u015flevlerde yava\u015flama olur. Bu ritmin d\u0131\u015far\u0131dan baz\u0131 zorlamalarla de\u011fi\u015ftirilmesi halinde ortaya \u00e7\u0131kan uyumsuzluk tablolar\u0131, jet lag ve shift lag sendromlar\u0131 olarak bilinir. Bunlar insan\u0131n fiziksel ve zihinsel yetersizlikler ya\u015famas\u0131na ve sonu\u00e7ta kaza yapmas\u0131na yol a\u00e7t\u0131\u011f\u0131 i\u00e7in \u00f6zel [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-387","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=387"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/387\/revisions"}],"predecessor-version":[{"id":390,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/387\/revisions\/390"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=387"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=387"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}