Araştırma Makalesi
BibTex RIS Kaynak Göster

THE RELATIONSHIP BETWEEN CORONAVIRUS FEAR AND ANXIETY IN PREGNANT WOMEN DURING COVID-19 OUTBREAK

Yıl 2022, Cilt: 10 Sayı: 1, 58 - 72, 10.03.2022

Mustafa Durmuş Nurdilan Şener Filiz Ersöğütçü

https://doi.org/10.33715/inonusaglik.1018018
Cited By: 1

Öz

The aim of this research is to determine the relationship between coronavirus (COVID-19) fears and anxiety levels of pregnant women. The research was conducted in descriptive and cross-sectional design with 461 pregnant women between 15.10.2020-15.11.2020. Data were collected using personal information form, COVID-19 Fear Scale, and Beck Anxiety Scale. There was no statistically significant difference between the women's occupation, number of pregnancies, family structure, and income status, and the total mean scores of COVID-19 fear (p>0.05). While the coronavirus fear average score of pregnant women (21.29±6.08) was above the medium level, it was found to be at a moderate level for anxiety (15.85±9.80). It was determined that there was a significant positive difference between the COVID-19 fear and anxiety in pregnant women (r=.399, p<0.01). It can be recommended to provide telephone consultation service to pregnant women during the pandemic to reduce their fear and anxiety levels and inform them using mass communication methods.

Anahtar Kelimeler

Anxiety COVID-19 Pregnant women.

Kaynakça

  • Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., Pakpour, A. H. (2020). The Fear of COVID-19 Scale: Development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Akarsu, R., Şahiner, L. (2020). Çok İleri Maternal Yaş Gebelik Sonuçlarının Değerlendirilmesi. ACU Sağlık Bil Derg, 11(3), 522-525.
  • Altın, Z. (2020). Elderly people in covıd-19 outbreak. Tepecik Eğit. ve Araşt. Hast. Dergisi, (30), 49-57.
  • Arslan, B., Arslan, A., Kara, S., Öngel, K., Mungan, M.T. (2011). Rısk factors for pregnancy anxıety and depressıon: assessment ın 452 cases. Tepecik Eğitim Hastanesi Dergisi, 21(2), 79-84.
  • Bakioğlu, F., Korkmaz, O., Ercan, H. (2020). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 1-14.
  • Beck A. T., Epstein, N., Brown G., Steer, R.A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893.
  • Can, H., Çakır, L. (2012). Gebelikte sosyodemografik değişkenlerin anksiyete ve depresyon düzeyleriyle ilişkisi. The Journal of Turkish Family Physician,3(2), 35-42.
  • Chen, Y., Li, Z., Zhang, Y.Y., Zhao, W.H., Yu, Z.Y. (2020). Maternal health care management during the outbreak of coronavirus disease. J Med Virol, 92(7), 731-739.
  • Colizzi, M., Bortoletto, R., Silvestri, M., Mondini, F., Puttini, E., Cainelli, C., …Zoccante L. (2020). Medically unexplained symptoms in the times of Covid‐19 pandemic: A case‐report. Brain, Behavior, & Immunity ‐ Health, 5. 100073.
  • Çelik, A. N., Bay, F. (2020). Gebelikte ruh sağlığı problemlerine yeni bir etken: Covid-19. Anadolu Ebeler Derneği Kongre Bildiri Kitapçığı, 11-22.
  • Çiçek, B., Almalı, V. (2020). The relationship between anxiety self-efficacy and psychological well-being during Covıd-19 pandemic process: comparison of private and public sector employees. Electronic Turkish Studies, 15(4), 241-260.
  • Duman, M., Taşhan, S.T., Serin EK. (2019). Examining the reproductive health behaviors of women with chronic disease. HUHEMFAD-JOHUFON, 6(2), 83-89.
  • Dündar, T., Özsoy, S. (2020). Nursıng care of coronavırus ınfectıon durıng Pregnancy. Kadın Sağlığı Hemşireliği Dergisi, 6(2), 101-114.
  • Effati-Daryani, F., Zarei, S., Mohammadi, A., Hemmati, E., Yngyknd, S. G., Mirghafourvand, M. (2020). Depression, Stress, Anxiety and Their Predictors İn Iranian Pregnant Women During the Outbreak of Covıd-19. Bmc Psychology, 8(1), 1-10.
  • Hossain, M. A., Jahid, I.K., Hossai, K, M. A., Walton, L. M., Uddin, Z., Haque, O., …Hossain Z. (2020). Knowledge, attitudes, and fear of COVID-19 during the Rapid Rise Period in Bangladesh. PloS one, 15(9), 1-13.
  • Gülseren, Ş. (2012). Depresyon ve Anksiyete. Klinik Psikiyatri Dergisi, 7(1), 5-13.
  • Güler, O., Hatırnaz, Ş. (2020). Comparison of the levels of antenatal anxiety in pregnant women admitted for delivery before and after COVID-19 outbreak in Turkey. The Official Publication of Perinatal Medicine Foundation, Turkish Perinatology Society and Turkish Society of Ultrasound in Obstetrics and Gynecology, 28(2), 108-112.
  • Güleç, D., Eminov, A., Kavlak, O. (2020). Investigation of anxiety and depression level and nursing care satisfaction in high risk pregnant women. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 7(1), 70-75.
  • Juan, J., Gil, M. M., Rong, Z., Zhang, Y., Yang, H., Poon, L. C. (2020). Effect of coronavirus disease 2019 (COVID‐19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound in Obstetrics & Gynecology, 56(1), 15-27.
  • Julia, H. (2020). Covıd-19: What implications for sexual and reproductive health and rights globally?, sexual and reproductive health matters. Sexual and Reproductive Health Matters, 28, 1.
  • Kahyaoglu, S. H., Kucukkaya, B. (2020). Anxiety, depression, and related factors in pregnant women during the COVID‐19 pandemic in Turkey: A web‐based cross‐sectional study. Perspectives in Psychiatric Care, 1-9.
  • Karkin, P. Ö., Sezer, G., Şen, S., Duran, M. (2021). Gebe olan ve olmayan kadinlarda Koronavirüs-19 fobisinin karşilaştirilmasi. Kocaeli Tip Dergisi, 10 (Destek: 2), 176-180.
  • Kasapoğlu, F. 2020). Examining the relationship between fear of covıd-19 and spiritual well-being. Spiritual Psychology and Counseling, 5(3), 341-354.
  • Kaya, Z. F., Özkan, N., Toprak, D. (2018). Depression and anxiety in pregnancy. Konuralp Tıp Dergisi, 10(1), 20-25.
  • Keskin, H. L., Özyer, Ş. Ş., Sahin, D., Ünlü, S., Özcan, N., Tayman, C., …Moraloğlu Tekin Ö. (2020). Obstetric management in covıd-19 pandemic. The Journal of Gynecology Obstetrics and Neonatology, 17(2), 394-399.
  • Lebel, C., MacKinnon, A., Bagshawe, M., Tomfohr-Madsen, L., Giesbrecht, G. (2020). Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. Journal of affective disorders, 277, 5-13.
  • Mappa, I., Distefano, F.A., Rizzo, G. (2020). Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: A prospectic observational study. Journal of Perinatal Medicine, 48(6), 545-550.
  • Moyer, C.A., Compton, S.D., Kaselitz, E., Muzik, M. (2020). Pregnancy-related anxiety during covıd-19: a nationwide survey of 2740 pregnant women. Archives of Women's Mental Health, 23, 757–765.
  • Özcan, H., Elkoca, A., Yalçın, Ö. (2020). COVID-19 ınfectıon and ıts effects on pregnancy. Anatol Clin, 25, 43-50.
  • Preis, H., Mahaffey, B., Heiselman, C., Lobel, M. (2020). Pandemic-related pregnancy stress and anxiety among women pregnant during the coronavirus disease 2019 pandemic. American Journal of Obstetrics & Gynecology MFM, 2(3),1-3.
  • Saccone, G., Florio, A., Aiello, F., Venturella, R., De Angelis, M. C., Locci, M., … Di Spiezio Sardo, A. (2020). Psychological impact of coronavirus disease 2019 in pregnant women. American Journal of Obstetrics & Gynecology, 223(2), 293-295.
  • Sakaoğlu, H. H., Orbatu, D., Emiroglu, M., Çakır, Ö. (2020). Spielberger state and trait anxiety level in healthcare professionals during the covıd-19 outbreak: A case of tepecik Hospital. Tepecik Eğit. ve Araşt. Hast. Dergisi, 30,1-9.
  • Salehi, L., Rahimzadeh, M., Molaei, E., Zaheri, H., Esmaelzadeh‐Saeieh, S. (2020). The relationship among fear and anxiety of Covıd‐19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain and Behavior, 10(11),1-8.
  • Sanaeinasab, H., Saffari, M., Sheykh-Oliya, Z., Khalaji, K., Laluie, A., Al Zaben, F., Koenig, H. G. (2020). A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized Controlled Trial. Health Care for Women International, 1-18.
  • Samancı, M. (2020). A global outbreak: COVID-19. Samsun Sağlık Bilimleri Dergisi, 5(1), 6-11.
  • Sahin, B. M., Kabakci, E. N. (2021). The experiences of pregnant women during the COVID-19 pandemic in Turkey: A qualitative study. Women and Birth, 34(2), 162-169
  • Tanriverdi, G., Gürsoy, M.Y., Kaymak, G.Ö. (2020). COVID-19 Pandemic from a public health nursing perspective. Journal of Publıc Health Nursıng, 2(2), 126-142.
  • Türen, D. E., Kılıç, F. (2020). Determination of the anxiety level in pregnant women who administer to the obstetrics clinic within the covıd-19 pandemia period. Selcuk Medıcal Journal, 36(4), 352-356.
  • Ulusoy, M., Sahin, N. H., Erkmen, H. (1998). The Beck anxiety inventory: psychometric properties. Journal of cognitive psychotherapy, 12(2), 163-172.
  • Yue, C., Liu, C., Wang, J., Zhang, M., Wu, H., Li, C., Yang, X. (2020). Association Between Social Support and Anxiety Among Pregnant Women İn The Third Trimester During the Coronavirus Disease 2019 (Covıd-19) Epidemic İn Qingdao, China: The Mediating Effect of Risk Perception. The International Journal of Social Psychiatry.
  • Zhou, Y,, Shi, H., Liu, Z., Peng, S., Wang, R., Qi, L., …Zhang X. (2020). The prevalence of psychiatric symptoms of pregnant and non-pregnant women during the COVID-19 epidemic. Translational psychiatry, 10(1), 1-7.
  • World Health Organization. Coronavirus Disease (Covıd-19). Available from.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports Accessed 2021 February, 23.

COVID-19 Salgını Sürecinde Gebe Kadınlarda Coronavirüs Korkusu ile Anksiyete Arasındaki İlişki

Yıl 2022, Cilt: 10 Sayı: 1, 58 - 72, 10.03.2022

Mustafa Durmuş Nurdilan Şener Filiz Ersöğütçü

https://doi.org/10.33715/inonusaglik.1018018
Cited By: 1

Öz

Bu araştırmanın amacı gebelerin koronavirüs (COVID-19) korkuları ile anksiyete düzeyleri arasındaki ilişkiyi belirlemektir. Araştırma, 15.10.2020-15.11.2020 tarihleri arasında 461 gebe ile tanımlayıcı ve kesitsel desende yapılmıştır. Veriler kişisel bilgi formu, COVID-19 Korku Ölçeği ve Beck Anksiyete Ölçeği kullanılarak toplanmıştır. Kadınların mesleği, gebelik sayısı, aile yapısı ve gelir durumu ile COVID-19 korku toplam puan ortalamaları arasında istatistiksel olarak anlamlı bir fark görülmemiştir (p>0.05). Gebelerin korona virüs korku ortalama puanı (21.29±6.08) orta düzeyin üzerindeyken, kaygı için orta düzeyde (15.85±9.80) bulunmuştur. Gebelerde COVID-19 korkusu ile anksiyete arasında pozitif yönde anlamlı fark olduğu belirlenmiştir (r=.399, p<0.01). Pandemi döneminde gebelerin korku ve kaygı düzeylerini azaltmak için telefonla danışma hizmeti verilmesi ve kitle iletişim yöntemleri kullanılarak bilgilendirilmeleri önerilebilir.

Anahtar Kelimeler

Anksiyete COVID-19 Gebe kadınlar

Kaynakça

  • Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., Pakpour, A. H. (2020). The Fear of COVID-19 Scale: Development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Akarsu, R., Şahiner, L. (2020). Çok İleri Maternal Yaş Gebelik Sonuçlarının Değerlendirilmesi. ACU Sağlık Bil Derg, 11(3), 522-525.
  • Altın, Z. (2020). Elderly people in covıd-19 outbreak. Tepecik Eğit. ve Araşt. Hast. Dergisi, (30), 49-57.
  • Arslan, B., Arslan, A., Kara, S., Öngel, K., Mungan, M.T. (2011). Rısk factors for pregnancy anxıety and depressıon: assessment ın 452 cases. Tepecik Eğitim Hastanesi Dergisi, 21(2), 79-84.
  • Bakioğlu, F., Korkmaz, O., Ercan, H. (2020). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 1-14.
  • Beck A. T., Epstein, N., Brown G., Steer, R.A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893.
  • Can, H., Çakır, L. (2012). Gebelikte sosyodemografik değişkenlerin anksiyete ve depresyon düzeyleriyle ilişkisi. The Journal of Turkish Family Physician,3(2), 35-42.
  • Chen, Y., Li, Z., Zhang, Y.Y., Zhao, W.H., Yu, Z.Y. (2020). Maternal health care management during the outbreak of coronavirus disease. J Med Virol, 92(7), 731-739.
  • Colizzi, M., Bortoletto, R., Silvestri, M., Mondini, F., Puttini, E., Cainelli, C., …Zoccante L. (2020). Medically unexplained symptoms in the times of Covid‐19 pandemic: A case‐report. Brain, Behavior, & Immunity ‐ Health, 5. 100073.
  • Çelik, A. N., Bay, F. (2020). Gebelikte ruh sağlığı problemlerine yeni bir etken: Covid-19. Anadolu Ebeler Derneği Kongre Bildiri Kitapçığı, 11-22.
  • Çiçek, B., Almalı, V. (2020). The relationship between anxiety self-efficacy and psychological well-being during Covıd-19 pandemic process: comparison of private and public sector employees. Electronic Turkish Studies, 15(4), 241-260.
  • Duman, M., Taşhan, S.T., Serin EK. (2019). Examining the reproductive health behaviors of women with chronic disease. HUHEMFAD-JOHUFON, 6(2), 83-89.
  • Dündar, T., Özsoy, S. (2020). Nursıng care of coronavırus ınfectıon durıng Pregnancy. Kadın Sağlığı Hemşireliği Dergisi, 6(2), 101-114.
  • Effati-Daryani, F., Zarei, S., Mohammadi, A., Hemmati, E., Yngyknd, S. G., Mirghafourvand, M. (2020). Depression, Stress, Anxiety and Their Predictors İn Iranian Pregnant Women During the Outbreak of Covıd-19. Bmc Psychology, 8(1), 1-10.
  • Hossain, M. A., Jahid, I.K., Hossai, K, M. A., Walton, L. M., Uddin, Z., Haque, O., …Hossain Z. (2020). Knowledge, attitudes, and fear of COVID-19 during the Rapid Rise Period in Bangladesh. PloS one, 15(9), 1-13.
  • Gülseren, Ş. (2012). Depresyon ve Anksiyete. Klinik Psikiyatri Dergisi, 7(1), 5-13.
  • Güler, O., Hatırnaz, Ş. (2020). Comparison of the levels of antenatal anxiety in pregnant women admitted for delivery before and after COVID-19 outbreak in Turkey. The Official Publication of Perinatal Medicine Foundation, Turkish Perinatology Society and Turkish Society of Ultrasound in Obstetrics and Gynecology, 28(2), 108-112.
  • Güleç, D., Eminov, A., Kavlak, O. (2020). Investigation of anxiety and depression level and nursing care satisfaction in high risk pregnant women. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 7(1), 70-75.
  • Juan, J., Gil, M. M., Rong, Z., Zhang, Y., Yang, H., Poon, L. C. (2020). Effect of coronavirus disease 2019 (COVID‐19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound in Obstetrics & Gynecology, 56(1), 15-27.
  • Julia, H. (2020). Covıd-19: What implications for sexual and reproductive health and rights globally?, sexual and reproductive health matters. Sexual and Reproductive Health Matters, 28, 1.
  • Kahyaoglu, S. H., Kucukkaya, B. (2020). Anxiety, depression, and related factors in pregnant women during the COVID‐19 pandemic in Turkey: A web‐based cross‐sectional study. Perspectives in Psychiatric Care, 1-9.
  • Karkin, P. Ö., Sezer, G., Şen, S., Duran, M. (2021). Gebe olan ve olmayan kadinlarda Koronavirüs-19 fobisinin karşilaştirilmasi. Kocaeli Tip Dergisi, 10 (Destek: 2), 176-180.
  • Kasapoğlu, F. 2020). Examining the relationship between fear of covıd-19 and spiritual well-being. Spiritual Psychology and Counseling, 5(3), 341-354.
  • Kaya, Z. F., Özkan, N., Toprak, D. (2018). Depression and anxiety in pregnancy. Konuralp Tıp Dergisi, 10(1), 20-25.
  • Keskin, H. L., Özyer, Ş. Ş., Sahin, D., Ünlü, S., Özcan, N., Tayman, C., …Moraloğlu Tekin Ö. (2020). Obstetric management in covıd-19 pandemic. The Journal of Gynecology Obstetrics and Neonatology, 17(2), 394-399.
  • Lebel, C., MacKinnon, A., Bagshawe, M., Tomfohr-Madsen, L., Giesbrecht, G. (2020). Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. Journal of affective disorders, 277, 5-13.
  • Mappa, I., Distefano, F.A., Rizzo, G. (2020). Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: A prospectic observational study. Journal of Perinatal Medicine, 48(6), 545-550.
  • Moyer, C.A., Compton, S.D., Kaselitz, E., Muzik, M. (2020). Pregnancy-related anxiety during covıd-19: a nationwide survey of 2740 pregnant women. Archives of Women's Mental Health, 23, 757–765.
  • Özcan, H., Elkoca, A., Yalçın, Ö. (2020). COVID-19 ınfectıon and ıts effects on pregnancy. Anatol Clin, 25, 43-50.
  • Preis, H., Mahaffey, B., Heiselman, C., Lobel, M. (2020). Pandemic-related pregnancy stress and anxiety among women pregnant during the coronavirus disease 2019 pandemic. American Journal of Obstetrics & Gynecology MFM, 2(3),1-3.
  • Saccone, G., Florio, A., Aiello, F., Venturella, R., De Angelis, M. C., Locci, M., … Di Spiezio Sardo, A. (2020). Psychological impact of coronavirus disease 2019 in pregnant women. American Journal of Obstetrics & Gynecology, 223(2), 293-295.
  • Sakaoğlu, H. H., Orbatu, D., Emiroglu, M., Çakır, Ö. (2020). Spielberger state and trait anxiety level in healthcare professionals during the covıd-19 outbreak: A case of tepecik Hospital. Tepecik Eğit. ve Araşt. Hast. Dergisi, 30,1-9.
  • Salehi, L., Rahimzadeh, M., Molaei, E., Zaheri, H., Esmaelzadeh‐Saeieh, S. (2020). The relationship among fear and anxiety of Covıd‐19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain and Behavior, 10(11),1-8.
  • Sanaeinasab, H., Saffari, M., Sheykh-Oliya, Z., Khalaji, K., Laluie, A., Al Zaben, F., Koenig, H. G. (2020). A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized Controlled Trial. Health Care for Women International, 1-18.
  • Samancı, M. (2020). A global outbreak: COVID-19. Samsun Sağlık Bilimleri Dergisi, 5(1), 6-11.
  • Sahin, B. M., Kabakci, E. N. (2021). The experiences of pregnant women during the COVID-19 pandemic in Turkey: A qualitative study. Women and Birth, 34(2), 162-169
  • Tanriverdi, G., Gürsoy, M.Y., Kaymak, G.Ö. (2020). COVID-19 Pandemic from a public health nursing perspective. Journal of Publıc Health Nursıng, 2(2), 126-142.
  • Türen, D. E., Kılıç, F. (2020). Determination of the anxiety level in pregnant women who administer to the obstetrics clinic within the covıd-19 pandemia period. Selcuk Medıcal Journal, 36(4), 352-356.
  • Ulusoy, M., Sahin, N. H., Erkmen, H. (1998). The Beck anxiety inventory: psychometric properties. Journal of cognitive psychotherapy, 12(2), 163-172.
  • Yue, C., Liu, C., Wang, J., Zhang, M., Wu, H., Li, C., Yang, X. (2020). Association Between Social Support and Anxiety Among Pregnant Women İn The Third Trimester During the Coronavirus Disease 2019 (Covıd-19) Epidemic İn Qingdao, China: The Mediating Effect of Risk Perception. The International Journal of Social Psychiatry.
  • Zhou, Y,, Shi, H., Liu, Z., Peng, S., Wang, R., Qi, L., …Zhang X. (2020). The prevalence of psychiatric symptoms of pregnant and non-pregnant women during the COVID-19 epidemic. Translational psychiatry, 10(1), 1-7.
  • World Health Organization. Coronavirus Disease (Covıd-19). Available from.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports Accessed 2021 February, 23.
Toplam 42 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Mustafa Durmuş 0000-0002-7559-4187

Nurdilan Şener 0000-0002-7096-4660

Filiz Ersöğütçü 0000-0002-5334-4830

Erken Görünüm Tarihi 4 Mart 2022
Yayımlanma Tarihi 10 Mart 2022
Gönderilme Tarihi 2 Kasım 2021
Kabul Tarihi 14 Ocak 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 10 Sayı: 1

Kaynak Göster

APA Durmuş, M., Şener, N., & Ersöğütçü, F. (2022). THE RELATIONSHIP BETWEEN CORONAVIRUS FEAR AND ANXIETY IN PREGNANT WOMEN DURING COVID-19 OUTBREAK. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 10(1), 58-72. https://doi.org/10.33715/inonusaglik.1018018

Cited By

Investigation of Mothers' Fear of Covid-19 and the Status of Receiving Antenatal Care During the Pandemic Process
Cumhuriyet Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi
https://doi.org/10.51754/cusbed.1333102
 Kapak Resmi İndir

      iThenticate Logo             logo-dark.png          Açık Dergi Erişimi (BOAI)    24980  Bu eser Creative Commons Atıf 4.0 Uluslararası Lisansı ile lisanslanmıştır.