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Course Description

CourseCodeSemesterT+P (Hour)CreditECTS
MEDICAL ANTHROPOLOGY and SOCIAL DIMENSIONS of MEDICINE-Yearly32+0-2
Course Program
Prerequisites Courses
Recommended Elective Courses
Language of CourseEnglish
Course LevelFirst Cycle (Bachelor's Degree)
Course TypeElective
Course CoordinatorProf.Dr. Hülya AKAN
Name of Lecturer(s)Prof.Dr. Hülya AKAN
Assistant(s)
AimMedical Anthropology is a subfield of anthropology that draws upon social, cultural, biological, and linguistic anthropology to better understand those factors which influence health and well being (broadly defined), the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilization of pluralistic medical systems. The discipline of medical anthropology draws upon many different theoretical approaches. It is as attentive to popular health culture as bioscientific epidemiology, and the social construction of knowledge and politics of science as scientific discovery and hypothesis testing. Medical anthropologists examine how the health of individuals, larger social formations, and the environment are affected by interrelationships between humans and other species; cultural norms and social institutions; micro and macro politics; and forces of globalization as each of these affects local worlds. AIM Explain health and well-being (broadly defined), disease experience and distribution, disease prevention and treatment, factors influencing recovery and treatment, social processes of care planning, pluralistic medicine, and cultural influences on health
Course ContentThis course contains; What is anthropology?
What is applied medical anthropology?
Systems approaches to health

,MAJOR MEDICAL ANTHROPOLOGY THEORIES
,Different Perspectives Of Health,Causality Of Diseases,Health and culture
,Socail dimensions of health and bio psychosociocultural approach to health,Medical Systems And Medical Pluralism,Environment and Health,Globalization and Health
People in motion,Emerging -Reemerging Infections

,Aging Population,Stigmatısatıon And Medicalization,Anthropology of Genes And Genomics,Legal Addictions and Illict Drugs,Health Equity And Equality: Is It Possible?.
Dersin Öğrenme KazanımlarıTeaching MethodsAssessment Methods
AIM: Understanding health and well-being (broadly defined), disease experience and distribution, disease prevention and treatment, factors influencing recovery and treatment, social processes of care planning, pluralistic medicine, and cultural influences on health
Comprehend the definition of anthropology and applied medical anthropology9E, H
Comprehend the main approaches of medical anthropology10, 5, 9E
Explain the health, illness, disease and sicknessconcepts10, 4, 5, 9E
Explain the impact of illness experience on diagnosis, treatment and follow-up processes in an individual and social context4, 5, 9E, H
Explain the causality approaches in medicine5, 9H
Explain the culture and health relation10, 14, 5H
Analyse the social dimensions of health 14, 9E, H
Explain the medical pluralism, medical diversity, medical hybridisation/syncretism, integrative medicineconcepts10, 12, 14, 5, 9E, H
Explain the environment health relation10, 13, 14, 37, 5, 9E, H
Explain the impact of galobalisation on health List the globalisation related health problems 10, 37, 5, 9E, H
Analyse the impact of aging on public health Understand how social dimensions of life affect the elderly health 14, 20, 37, 5, 9E, H
Explain the stigmatisation impact in an individual context10, 37, 5E, H
Explain the impact of madicalisation on public and individual health 10, 20, 37E, H
Analyse how quaternary prevention could be incorporated to daily clinical practice10, 14, 9E, H
Understand the link between human history and genetic variations14, 9E, H
Explain theoritical approaches to the interrelations among epigenetics, behaviour and health 14, 9E, H
Explain impact of legal and illegal addictions on individual life and health10, 37, 5, 9E, H
Explain equality and equity concepts in health14, 37E, H
Understand professional responsibility of indiscrimination and being culturally sensitive during patient care10, 14, 19
Teaching Methods:10: Discussion Method, 12: Problem Solving Method, 13: Case Study Method, 14: Self Study Method, 19: Brainstorming Technique, 20: Reverse Brainstorming Technique, 37: Computer-Internet Supported Instruction, 4: Inquiry-Based Learning, 5: Cooperative Learning, 9: Lecture Method
Assessment Methods:E: Homework, H: Performance Task

Course Outline

OrderSubjectsPreliminary Work
2What is anthropology?
What is applied medical anthropology?
Systems approaches to health

None
3MAJOR MEDICAL ANTHROPOLOGY THEORIES
Prereading: Scientific papers and news about covid 19 pandemics
4Different Perspectives Of HealthExplore and discuss with your group: the experiences of fallowing patients regarding their diagnosis: - 35 yrs old woman with fibromyalgia - 60 yrs old man asymptomatic and diagnosed colon cancer during routine screening - 40 yrs old woman having hypertension and diabetes - 40 yrs old woman with diagnosis of ovarian cancer - 20 yrs old male with the diagnosis of AIDS
5Causality Of DiseasesManuscripts to be read : Group A -Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751-1757. doi:10.2105/AJPH.2011.300433 GRUP B -HIV and Tuberculosis: a Deadly Human Syndemic. 2011. Candice K. Kwan, Joel D. Ernst GRUP C -Wilson PA, Nanin J, Amesty S, Wallace S, Cherenack EM, Fullilove R. Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City. J Urban Health. 2014;91(5):983-998. doi:10.1007/s11524-014-9895-2 GRUP D Xavier Hall, C.D., Evans, D.P. Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women. BMC Public Health 20, 1260 (2020). https://doi.org/10.1186/s12889-020-09352-7
6Health and culture
Small group work Health-culture relation Hypertension / cardiovascular diseases: Group A1, A2 Chronic obstructive airway disease: Grup B1, B2 Depression in teenage group : Grup C1, C2 In home violence: Grup D1, D2 Newborn feeding /childhood feeding: Grup E1, E2 Individual work: Conduct an open-ended question survey with a relative with a chronic illness and discover what their illness means to them and submit a report (300-500 words)
7Socail dimensions of health and bio psychosociocultural approach to healthReading: The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care https://journals.sagepub.com/doi/pdf/10.15256/joc.2015.5.35
8Medical Systems And Medical PluralismIndividual search about the subject -------Reading suggestions: Cant S. Medical Pluralism, Mainstream Marginality or Subaltern Therapeutics? Globalisation and the Integration of ‘Asian’ Medicines and Biomedicine in the UK. Society and Culture in South Asia. 2020;6(1):31-51. doi:10.1177/2393861719883064 Akan H, İzbırak G, Kaspar ÇE, Apaydın Ç, Aydın S, Demircan N, Erten G, Özer C, Şahin AH, Hayran O. Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey. BMC Complementary and Alternative Medicine 2012, 12:115 doi:10.1186/1472-6882-12-115 Akan H. Medikal plüralizm. Jour Turk Fam Phy 2019; 10 (2): 98-108. Doi: 10.15511/jtfp.19.00298. -------- Group work: Literature search How medical pluralism/ medical diversity affects our daily practice as a physician?
9Environment and Health1-Video presentation: Blue eye of desert (Çölün mavi gözü) or any video about Aral sea ---think about what would be the health problems related to environmental change due to shrinkage of the Aral sea 2-Find similar examples from your country /region and guess what health problems you will face if you will work in that area after garduation Homework: Write down a reflection paper about 1.-2. İtems
10Globalization and Health
People in motion
3- Read the example about the “toxic milk of arctic people” (will be provided by the tutor) 4-https://www.euro.who.int/en/health-topics/health-determinants/migration-and-health 5- Global Health observatory https://www.who.int/data/gho https://www.who.int/data/gho/publications statistics 2020 ----------- Group work : Choose one chemical and explore its realtion with indivudial and public health
11Emerging -Reemerging Infections

Group work : One emerging infection will be chosen by the group and its affect on health will be explored
12Aging PopulationFilm watch: Choose one of them and watch Nergis Hanım (For Turkish speaking students) The savages (2007) Away from her (2007) --------------------Prereading: Turkey Elderly Health Report https://www.tuseb.gov.tr/tuhke/uploads/yayinlar/makaleler/pdf/27-12-2021__61c9abcc1b4f8__yasli_sagligi_raporu.pdf
13Stigmatısatıon And MedicalizationVideo Watch Medicalization: https://youtu.be/qc2R4UGmGx8 Shyness to illness: https://youtu.be/O1DdfRN3LLw Medicalization good or bad?: https://youtu.be/BJy_9kICDP4 Beauty patch: https://youtu.be/0IGhrqA3zys ------------------------------------------------------Film watch: Philedelphia Jonathen Demme, 1993 -----------------------Reading: -Quaternary prevention: an evidence-based concept aiming to protect patients from medical harm. Carlos martins et all. British Journal of General Practice 2019; 69 (689): 614-615. DOI: https://doi.org/10.3399/bjgp19X706913 - Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24(1):106-111. doi:10.1080/13814788.2017.1422177
14Anthropology of Genes And GenomicsIndividual search about the subject
15Legal Addictions and Illict DrugsHow social media affects teenages:https://youtu.be/7QWoP6jJG3k Small Group Works Group A: Cigarette smoking Group B. Alcohol consuming Group C: Internet and gambling Group D: Ilicit drugs Group E: Pipe
16Health Equity And Equality: Is It Possible?Video watch: Universal health coverage https://www.youtube.com/watch?v=VQ3sHfYzcv8&feature=youtu.be-------------------Individual search about the subject------------------ Reflection about the whole course
Resources

Course Contribution to Program Qualifications

Course Contribution to Program Qualifications
NoProgram QualificationContribution Level
12345
1
Knows structural (morphological) and operational (functional) properties of the normal human (medical) and disorder (disease) states
X
2
Knows diagnostic methods and treatment modalities of disorders (diseases).
3
Knows the causes of disease conditions, ways of protection and methods of promoting and improving community health.
X
4
Knows the methods of developing and applying health related knowledge at advanced level.
5
Able to reach multidisciplinary advanced knowledge regarding health-related disciplines, interpret and apply the knowledge.
X
6
Performs a complete clinical examination of human body structurally and functionally and identifies problems.
7
Interprets laboratory results for diagnosis, compares with clinical data and develop solution proposals.
8
Selects and implements appropriate tools for the promotion and development of individual and community health.
X
9
Plans and conducts an advanced study on health independently.
10
Develops new strategic approaches to solve the problems encountered in the promotion and development of individual and community health.
11
Takes the responsibility of any type of practice when diagnosing and treating human body
12
Takes the role as a leader or a team worker when solving health related problems.
13
Evaluates knowledge and skills regarding health with a critical approach and develops a positive attitude towards lifelong learning.
X
14
Informs the patient, related people, institutions and the society about the health problems and transfers solution proposals in writing, verbally and visually using effective communication means.
15
Critically reviews, develops and acts on changes in social relations and norms that guide such relationships.
X
16
Uses English at least at the European Language Portfolio B2 Level, monitors knowledge and communicates in his field.
17
Able to use advanced computer skills and informatics and communication technologies at a level required by the field.
18
Acquires, interprets, implements and announces data related to the health and acts in accordance with social, scientific, cultural and ethical values and teaches these values.
X
19
Develops strategies, policy and implementation plans in the field of health and evaluates the results obtained within the framework of quality processes.
X
20
Shares studies on the promotion and development of health with interdisciplinary specialists systematically, supporting with quantitative and qualitative data.
X
21
Has adequate awareness on occupational health and safety issues.

Assessment Methods

Contribution LevelAbsolute Evaluation
Rate of Midterm Exam to Success 40
Rate of Final Exam to Success 60
Total 100
ECTS / Workload Table
ActivitiesNumber ofDuration(Hour)Total Workload(Hour)
Course Hours13232
Guided Problem Solving000
Resolution of Homework Problems and Submission as a Report21224
Term Project122
Presentation of Project / Seminar2816
Quiz000
Midterm Exam000
General Exam000
Performance Task, Maintenance Plan000
Total Workload(Hour)74
Dersin AKTS Kredisi = Toplam İş Yükü (Saat)/30*=(74/30)2
ECTS of the course: 30 hours of work is counted as 1 ECTS credit.

Detail Informations of the Course

Course Description

CourseCodeSemesterT+P (Hour)CreditECTS
MEDICAL ANTHROPOLOGY and SOCIAL DIMENSIONS of MEDICINE-Yearly32+0-2
Course Program
Prerequisites Courses
Recommended Elective Courses
Language of CourseEnglish
Course LevelFirst Cycle (Bachelor's Degree)
Course TypeElective
Course CoordinatorProf.Dr. Hülya AKAN
Name of Lecturer(s)Prof.Dr. Hülya AKAN
Assistant(s)
AimMedical Anthropology is a subfield of anthropology that draws upon social, cultural, biological, and linguistic anthropology to better understand those factors which influence health and well being (broadly defined), the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilization of pluralistic medical systems. The discipline of medical anthropology draws upon many different theoretical approaches. It is as attentive to popular health culture as bioscientific epidemiology, and the social construction of knowledge and politics of science as scientific discovery and hypothesis testing. Medical anthropologists examine how the health of individuals, larger social formations, and the environment are affected by interrelationships between humans and other species; cultural norms and social institutions; micro and macro politics; and forces of globalization as each of these affects local worlds. AIM Explain health and well-being (broadly defined), disease experience and distribution, disease prevention and treatment, factors influencing recovery and treatment, social processes of care planning, pluralistic medicine, and cultural influences on health
Course ContentThis course contains; What is anthropology?
What is applied medical anthropology?
Systems approaches to health

,MAJOR MEDICAL ANTHROPOLOGY THEORIES
,Different Perspectives Of Health,Causality Of Diseases,Health and culture
,Socail dimensions of health and bio psychosociocultural approach to health,Medical Systems And Medical Pluralism,Environment and Health,Globalization and Health
People in motion,Emerging -Reemerging Infections

,Aging Population,Stigmatısatıon And Medicalization,Anthropology of Genes And Genomics,Legal Addictions and Illict Drugs,Health Equity And Equality: Is It Possible?.
Dersin Öğrenme KazanımlarıTeaching MethodsAssessment Methods
AIM: Understanding health and well-being (broadly defined), disease experience and distribution, disease prevention and treatment, factors influencing recovery and treatment, social processes of care planning, pluralistic medicine, and cultural influences on health
Comprehend the definition of anthropology and applied medical anthropology9E, H
Comprehend the main approaches of medical anthropology10, 5, 9E
Explain the health, illness, disease and sicknessconcepts10, 4, 5, 9E
Explain the impact of illness experience on diagnosis, treatment and follow-up processes in an individual and social context4, 5, 9E, H
Explain the causality approaches in medicine5, 9H
Explain the culture and health relation10, 14, 5H
Analyse the social dimensions of health 14, 9E, H
Explain the medical pluralism, medical diversity, medical hybridisation/syncretism, integrative medicineconcepts10, 12, 14, 5, 9E, H
Explain the environment health relation10, 13, 14, 37, 5, 9E, H
Explain the impact of galobalisation on health List the globalisation related health problems 10, 37, 5, 9E, H
Analyse the impact of aging on public health Understand how social dimensions of life affect the elderly health 14, 20, 37, 5, 9E, H
Explain the stigmatisation impact in an individual context10, 37, 5E, H
Explain the impact of madicalisation on public and individual health 10, 20, 37E, H
Analyse how quaternary prevention could be incorporated to daily clinical practice10, 14, 9E, H
Understand the link between human history and genetic variations14, 9E, H
Explain theoritical approaches to the interrelations among epigenetics, behaviour and health 14, 9E, H
Explain impact of legal and illegal addictions on individual life and health10, 37, 5, 9E, H
Explain equality and equity concepts in health14, 37E, H
Understand professional responsibility of indiscrimination and being culturally sensitive during patient care10, 14, 19
Teaching Methods:10: Discussion Method, 12: Problem Solving Method, 13: Case Study Method, 14: Self Study Method, 19: Brainstorming Technique, 20: Reverse Brainstorming Technique, 37: Computer-Internet Supported Instruction, 4: Inquiry-Based Learning, 5: Cooperative Learning, 9: Lecture Method
Assessment Methods:E: Homework, H: Performance Task

Course Outline

OrderSubjectsPreliminary Work
2What is anthropology?
What is applied medical anthropology?
Systems approaches to health

None
3MAJOR MEDICAL ANTHROPOLOGY THEORIES
Prereading: Scientific papers and news about covid 19 pandemics
4Different Perspectives Of HealthExplore and discuss with your group: the experiences of fallowing patients regarding their diagnosis: - 35 yrs old woman with fibromyalgia - 60 yrs old man asymptomatic and diagnosed colon cancer during routine screening - 40 yrs old woman having hypertension and diabetes - 40 yrs old woman with diagnosis of ovarian cancer - 20 yrs old male with the diagnosis of AIDS
5Causality Of DiseasesManuscripts to be read : Group A -Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751-1757. doi:10.2105/AJPH.2011.300433 GRUP B -HIV and Tuberculosis: a Deadly Human Syndemic. 2011. Candice K. Kwan, Joel D. Ernst GRUP C -Wilson PA, Nanin J, Amesty S, Wallace S, Cherenack EM, Fullilove R. Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City. J Urban Health. 2014;91(5):983-998. doi:10.1007/s11524-014-9895-2 GRUP D Xavier Hall, C.D., Evans, D.P. Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women. BMC Public Health 20, 1260 (2020). https://doi.org/10.1186/s12889-020-09352-7
6Health and culture
Small group work Health-culture relation Hypertension / cardiovascular diseases: Group A1, A2 Chronic obstructive airway disease: Grup B1, B2 Depression in teenage group : Grup C1, C2 In home violence: Grup D1, D2 Newborn feeding /childhood feeding: Grup E1, E2 Individual work: Conduct an open-ended question survey with a relative with a chronic illness and discover what their illness means to them and submit a report (300-500 words)
7Socail dimensions of health and bio psychosociocultural approach to healthReading: The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care https://journals.sagepub.com/doi/pdf/10.15256/joc.2015.5.35
8Medical Systems And Medical PluralismIndividual search about the subject -------Reading suggestions: Cant S. Medical Pluralism, Mainstream Marginality or Subaltern Therapeutics? Globalisation and the Integration of ‘Asian’ Medicines and Biomedicine in the UK. Society and Culture in South Asia. 2020;6(1):31-51. doi:10.1177/2393861719883064 Akan H, İzbırak G, Kaspar ÇE, Apaydın Ç, Aydın S, Demircan N, Erten G, Özer C, Şahin AH, Hayran O. Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey. BMC Complementary and Alternative Medicine 2012, 12:115 doi:10.1186/1472-6882-12-115 Akan H. Medikal plüralizm. Jour Turk Fam Phy 2019; 10 (2): 98-108. Doi: 10.15511/jtfp.19.00298. -------- Group work: Literature search How medical pluralism/ medical diversity affects our daily practice as a physician?
9Environment and Health1-Video presentation: Blue eye of desert (Çölün mavi gözü) or any video about Aral sea ---think about what would be the health problems related to environmental change due to shrinkage of the Aral sea 2-Find similar examples from your country /region and guess what health problems you will face if you will work in that area after garduation Homework: Write down a reflection paper about 1.-2. İtems
10Globalization and Health
People in motion
3- Read the example about the “toxic milk of arctic people” (will be provided by the tutor) 4-https://www.euro.who.int/en/health-topics/health-determinants/migration-and-health 5- Global Health observatory https://www.who.int/data/gho https://www.who.int/data/gho/publications statistics 2020 ----------- Group work : Choose one chemical and explore its realtion with indivudial and public health
11Emerging -Reemerging Infections

Group work : One emerging infection will be chosen by the group and its affect on health will be explored
12Aging PopulationFilm watch: Choose one of them and watch Nergis Hanım (For Turkish speaking students) The savages (2007) Away from her (2007) --------------------Prereading: Turkey Elderly Health Report https://www.tuseb.gov.tr/tuhke/uploads/yayinlar/makaleler/pdf/27-12-2021__61c9abcc1b4f8__yasli_sagligi_raporu.pdf
13Stigmatısatıon And MedicalizationVideo Watch Medicalization: https://youtu.be/qc2R4UGmGx8 Shyness to illness: https://youtu.be/O1DdfRN3LLw Medicalization good or bad?: https://youtu.be/BJy_9kICDP4 Beauty patch: https://youtu.be/0IGhrqA3zys ------------------------------------------------------Film watch: Philedelphia Jonathen Demme, 1993 -----------------------Reading: -Quaternary prevention: an evidence-based concept aiming to protect patients from medical harm. Carlos martins et all. British Journal of General Practice 2019; 69 (689): 614-615. DOI: https://doi.org/10.3399/bjgp19X706913 - Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24(1):106-111. doi:10.1080/13814788.2017.1422177
14Anthropology of Genes And GenomicsIndividual search about the subject
15Legal Addictions and Illict DrugsHow social media affects teenages:https://youtu.be/7QWoP6jJG3k Small Group Works Group A: Cigarette smoking Group B. Alcohol consuming Group C: Internet and gambling Group D: Ilicit drugs Group E: Pipe
16Health Equity And Equality: Is It Possible?Video watch: Universal health coverage https://www.youtube.com/watch?v=VQ3sHfYzcv8&feature=youtu.be-------------------Individual search about the subject------------------ Reflection about the whole course
Resources

Course Contribution to Program Qualifications

Course Contribution to Program Qualifications
NoProgram QualificationContribution Level
12345
1
Knows structural (morphological) and operational (functional) properties of the normal human (medical) and disorder (disease) states
X
2
Knows diagnostic methods and treatment modalities of disorders (diseases).
3
Knows the causes of disease conditions, ways of protection and methods of promoting and improving community health.
X
4
Knows the methods of developing and applying health related knowledge at advanced level.
5
Able to reach multidisciplinary advanced knowledge regarding health-related disciplines, interpret and apply the knowledge.
X
6
Performs a complete clinical examination of human body structurally and functionally and identifies problems.
7
Interprets laboratory results for diagnosis, compares with clinical data and develop solution proposals.
8
Selects and implements appropriate tools for the promotion and development of individual and community health.
X
9
Plans and conducts an advanced study on health independently.
10
Develops new strategic approaches to solve the problems encountered in the promotion and development of individual and community health.
11
Takes the responsibility of any type of practice when diagnosing and treating human body
12
Takes the role as a leader or a team worker when solving health related problems.
13
Evaluates knowledge and skills regarding health with a critical approach and develops a positive attitude towards lifelong learning.
X
14
Informs the patient, related people, institutions and the society about the health problems and transfers solution proposals in writing, verbally and visually using effective communication means.
15
Critically reviews, develops and acts on changes in social relations and norms that guide such relationships.
X
16
Uses English at least at the European Language Portfolio B2 Level, monitors knowledge and communicates in his field.
17
Able to use advanced computer skills and informatics and communication technologies at a level required by the field.
18
Acquires, interprets, implements and announces data related to the health and acts in accordance with social, scientific, cultural and ethical values and teaches these values.
X
19
Develops strategies, policy and implementation plans in the field of health and evaluates the results obtained within the framework of quality processes.
X
20
Shares studies on the promotion and development of health with interdisciplinary specialists systematically, supporting with quantitative and qualitative data.
X
21
Has adequate awareness on occupational health and safety issues.

Assessment Methods

Contribution LevelAbsolute Evaluation
Rate of Midterm Exam to Success 40
Rate of Final Exam to Success 60
Total 100

Numerical Data

Student Success

Ekleme Tarihi: 05/11/2023 - 12:55Son Güncelleme Tarihi: 05/11/2023 - 12:56