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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
1 NAME OF THE CANDIDATE AND ADDRESS
Ms. BINCY BABU
1st YEAR M.Sc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN, KARNATAKA.
2 NAME OF THE INSTITUTION
N.D.R.K. COLLEGE OF NURSING, B.M. ROAD,
HASSAN, KARNATAKA.
3 COURSE OF STUDY AND SUBJECT
MASTER OF SCIENCE IN NURSING
(OBSTETRICS AND GYNAECOLOGICAL NURSING)
4 DATE OF ADMISSION TO THE COURSE
15/06/2010
5 TITLE OF THE TOPIC “EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE REGARDING
NATURAL REMEDIES FOR DYSMENORRHEA
AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH
SCHOOL HASSAN, KARNATAKA”
5.1 STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE
EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE REGARDING
NATURAL REMEDIES FOR DYSMENORRHEA
AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH
SCHOOL HASSAN, KARNATAKA”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
6 BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
“The god of heaven, who created us, has given us the simple things of nature for our healing, so we
should help our self with those natural remedies and try to bring back the sunshine into our life”1
The term adolescent comes from a Latin word “Adalescere” which means “to grow up”.
Within this development phase, physical, social and psychological issues are interwoven that
create unique characteristic, behaviors and needs. Adolescence seems to be a chaotic and at the
same time a vibrant period of human life. 2
According to Wolman, “adolescence is a transitional stage of development between
childhood and adulthood”. Inception of puberty declares the attainment of adolescence. Boys and
Girls face it entirely differently. Girls their reproductive system changes , they become hairy, voice
shrinks, lots of pimple on face and above all there is a onset of menstruation and it brings with it
menstrual cramps; which are known medically as dysmenorrhea. 2
Menarche is the transitional phase of life in girls. Young girls secrete small, rather constant
amounts of estrogen, a marked increase occurs between the 8-11yrs of age. More over increase
amount and variations in gonadotrophin and estrogen secretions develop into a cyclic pattern at
least a year before menarche or the first menstrual period.2
Menstruation is a periodic uterine bleeding that begins with the shedding of secretary
endometrium approximately 14 days after ovulation. Dysmennorhea or menstrual pain is the pain
in the lower abdomen before or during menstruation. The pain sometimes radiates to the lower
back or thigh area. Other symptoms may include nausea, loose stools, sweating, and dizziness.
During a woman's menstrual cycle, the endometrium thickens in preparation for potential
pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up
uterine tissue is not needed and thus shed. 2
Molecular compounds called prostaglandins are released during menstruation, due to the
destruction of the endometrial cells, and the resultant release of their contents. Release of
prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These
substances are thought to be a major factor in primary dysmenorrhea. When the uterine muscles
contract, they constrict the blood vessels to the tissue of the endometrium, which, in turn, breaks
down and dies. These uterine contractions continue as they squeeze the old, dead endometrial
tissue through the cervix and out of the body through the vagina. These contractions, and the
resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps"
experienced during menstruation. 3
There are two types of menstrual cramps: Primary and secondary dysmenorrhea. Primary
dysmenorrhea which usually starts within several years after your first menstrual periods,
involves no physical abnormality. Hormone like substances called prostaglandins, which are
produced naturally in the body are thought to cause this cramps and be responsible for the pain and
inflammation. Secondary Dysmenorrhea, on the other hand, has an underlying physical cause such
as endometriosis, pelvic inflammatory disease, uterine fibroids, and uterine polyps. 3
Drugs are any supplement that contains chemicals or unnatural substances which alters our
brain chemistry, hormones or mentality. The point is that it triggers our brain into not sending
communications to our nerves; this allows us to think that everything is fine when it may not be.
Drugs have chemicals that fluctuate the actual chemical balance in the brain. This will often
subside your symptoms but will rarely fix it. Natural remedies do not alter hormone balance,
change chemical level in the brain or tricks your body. They are not synthetic or manmade; they
are simply from earth and are here to help with problems that we face. 4
Many girls describe dysmenorrhea as a “monthly dread” because their experience with it is
worse. Medicines which we take usually include NSAIDs. They provide symptomatic relief but
have increasing adverse effects with long term use. NSAIDs can have side effects of nausea,
dyspepsia, peptic ulcer, and diarrhea. Natural remedies do not alter our body mechanism and has
no adverse effects. People have been using herbs and plants as medicine since dawn. Prescription
drugs are fairly a new concept in terms of last century. For thousands of years many problems have
been fixed and cured by natural remedies. Scientist .has tried to duplicate natural remedies by way
of chemical and hormonal elements. Natural remedies are not only much safer than using drugs but
also a lot cheaper and above all nothing can get any simpler than these remedies. 4
3
6.2 NEED FOR STUDY
“Adolescence is a period of storm and stress”
G. Stanley Hall4
“Human development process”, is the most mysterious part, nature has ever created.
Everyone agrees with it. While passing through the various stages under this “development
process”, adolescence perhaps is the most complicated phase, we ever experience. Bodily changes,
adjustment with the peer groups and many other things causes havoc in the adolescence period.
Both sexes have to cope up entirely differently. In girls there is onset of menstruation with it
comes the deadly menstrual cramps or dysmenorrhea.4
Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull,
nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or
may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist
with excessively heavy blood loss, known as menorrhagia. The main symptom of dysmenorrhea is
pain concentrated in the lower abdomen in the umbilical region or the suprapubic region of the
abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thigh and
lower back. Other symptoms may include nausea and vomiting, diarrhea or constipation, headache,
dizziness, disorientations, hypersensitivity to sound, light, smell and touch, fainting, and fatigue.
Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end
of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels
in the body that occur with ovulation. 5
Typical menstruation in adolescence includes moderate to severe pain in association with
a high number of menstrual symptoms, school absence and interference with life activities. It
should be effectively managed to minimize menstrual morbidity. In a cross sectional study done in
senior high school on girls aged between 15 and 19yrs a typical menstruation includes pain (93%),
cramping (71%), pre menstrual symptoms (96%) and mood disturbances (23%). This interferes
4
with life activities and school absence. 36% of the girls missed schools during menstruation. The
report indicated moderate to high interference with four out of nine life activities. 6
For a quick relief from these menstrual cramps girls usually take NSAIDs or birth control
pills it will definitely cause side effects which might affect her future. A 2001 systematic review
found that no conclusions can be made about the efficacy of commonly used modern lower dose
combined oral contraceptive pills for primary dysmenorrhea. Norplant and Depo-Provera are also
not effective, since these methods often induce amenorrhea. A 2008 systematic review found
promising evidence for Chinese herbal medicine for primary dysmenorrhea. A double-blind,
controlled study indicated that treatment with an extract of guava leaf resulted in significant
reduction of symptoms. So, if from the starting itself we switch on to natural remedies it is
definitely going to alleviate the menstrual cramps or as we call it “The Deadly Dysmenorrhea”. 7
These natural remedies include:
EXERCISE - It relives cramps because it helps release beta- endorphins which are internal opiods
one’s own “human morphine”. It produces analgesia (pain relief) and helps to burn prostaglandins,
chemicals released during menstruation that cause muscle contraction much faster. 8
DIETARY PATTERN- If we talk about diet whole grain breads, pasta and cereals, fibers and
proteins and other carbohydrates helps reduce pain. Calcium has to be included in diet as it tends
to stabilize muscle tone. Fish oil also helps as two compounds eicosapentaenoic acid
docosahexenoid acid decrease prostaglandin levels. 9
AROMATHERAPY-A practice of using volatile plant oils for psychological and physical well-
being. They stimulate brain function and also absorbed through skin, where they travel through the
blood stream and promote whole body healing. As applied topically they do not alter metabolism.
The oils are not used in undiluted form. 10
HEATING PADS – It can be used as it dilates the blood vessels and relives from pain. If there is a
build up of blood in the pelvic region that is causing the pain, the application of ice is more
appropriate. 11
ACCUPRESSURE- It is a traditional healing practice that is based on the same principles as
acupuncture. Instead of applying needles to acupuncture points, pressure is applied. A point that
is often recommended by acupuncturists for menstrual cramps is called spleen -6. It is a simple
home remedy. 12
5
These type of natural remedies can be applied in any setting by any persons, and require no
special training. So I want to educate the adolescence girls regarding natural remedies for
dysmenorrhea for dysmenorrhea through STP.
6.3 STATEMENT OF PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STP ON KNOWLEDGE REGARDING NATURAL REMEDIES FOR DYSMENORRHEA AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH SCHOOL, HASSAN, KARNATAKA”.
6.4 OBJECTIVES OF THE ST UDY:-
1. To assess the knowledge of adolescence girls in experimental and control group regarding
natural remedies for dysmenorrhea before giving Structured Teaching Programme.
2. To develop and administer Structured Teaching Programme regarding natural remedies for
dysmenorrhea to adolescent girls in the experimental group.
3. To assess the knowledge of adolescence girls in experimental and control group regarding
natural remedies for dysmenorrhea after the administration of structured teaching
programme.
4. To compare the pretest and posttest knowledge in experimental and control group.
5. To associate the pretest and posttest knowledge of adolescent girls regarding natural
remedies for dysmenorrhea with selected demographic variable(age, education, media,
income, religion, magazine)
6.5 HYPOTHESIS
NULL HYPOTHESIS
Ho: There will not be any significant difference between the pretest score and posttest
knowledge score regarding natural remedies for dysmenorrhea among the experimental group.
6
RESEARCH HYPOTHESIS
H1: There will be a significant difference between the pretest score and posttest knowledge
score regarding natural remedies for dysmenorrhea among the experimental group.
H2: There will be significant association between knowledge scores (pretest, posttest) with
selected demographic variables.
6.6 ASSUMPTIONS
1. STP will improve the knowledge of adolescence girls regarding Natural remedies for
dysmenorrhea.
2. Adolescent girls will use this knowledge in the future to manage dysmenorrhea.
3. Natural remedies does not cause any side effects as compared to medications
6.7 OPERATIONAL DEFINITIONS
EVALUATE-It refers to the process of judging or determining the worth or quality. In this study it
refers to the effectiveness of Structured Teaching Program by judging or determining the worth
regarding natural remedies for dysmenorrhea in adolescent girls
EFFECTIVENESS- It refers to improvement in the knowledge scores of adolescent girls
regarding natural remedies for dysmenorrhea after giving STP.
STRUCTURED TEACHING PROGRAM- It refers to set of systematically organized
instructions and discussions related to natural remedies for dysmenorrhea.
KNOWLEDGE- It refers to state of knowing and understanding of adolescent girls regarding
natural remedies for dysmenorrhea.
ADOLESCENT GIRLS- It refers to girls in the age group of 12-16years studying at CKS girl’s
high school, Hassan, Karnataka.
NATURAL REMEDIES-A therapeutic or preventive health care practice that are not practiced
in traditional medicinal communities and offer treatment that differ from standard medical
practice. In this study it refers to the exercise, dietary pattern, aromatherapy, heating pads and
acupressure.
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DYSMENORRHEA- It refers to the pain or discomfort associated with menstruation.
6.8 CRITERIA FOR SAMPLE SELECTION
Inclusion criteria
The study will include adolescent girls who are
Aged above 12yrs and below 16yrs studying in CKS girls’ high school.
Have attained menarche.
Present during the study
Exclusion criteria
The study will not include adolescent girls who are
Aged below 12yrs and above 16yrs studying in CKS girls high school
Have not attained menarche
Not present during the study
.
6.9 LIMITATIONS OF THE STUDY
Study is limited to:
1. Adolescent girls aged between 12- 16yrs.
2. Sample size of 60
3. Period of 4-6 weeks
6.10 SIGNIFICANCE OF THE STUDY
Drugs are any supplement that contains chemicals or unnatural substances which alters our
brain chemistry, hormones. Drugs have chemicals that fluctuate the actual chemical balance in the
brain, they often subside the symptoms. Natural remedies do not alter hormone balance or change
chemical level in the brain. They are simply from earth and are here to help with problems that we
8
face. So this study signifies the importance of imparting knowledge to adolescent girls regarding
natural remedies for dysmenorrhea.
6.11 CONCEPTUAL FRAMEWORK
Conceptual framework based on DOROTHEA .E. OREMS THEORY is planned for this
study.
6.12 REVIEW OF LITERATURE:-
Literature review is based on extensive survey of books, journals and internet search on the
related topics of research study. Review of literature is a systematic identification, location,
scrutiny and summary of written materials that contain information on research problem 13
A single blind randomized experimental study was conducted to examine the effects of
acupressure on menstrual distress in adolescence girls. Two instruments were used to collect data:
The visual analogue scale, the menstrual distress questionnaire scale. Girls received acupressure
intervention protocol for 20 mins and the control group didn’t receive any acupressure
intervention.During the six month follow up, acupressure reduced the pain, distress and anxiety
typical of dysmenorrhea.This controlled trial provides that acupressure therapy provides female
adolescents with dysmenorrhea benefits. 14
A quasi experimental study was done in university of Auckland, New Zealand on exercise
for dysmenorrhea. A search was conducted by using the methodology of the menstrual disorders
and sub fertility group. The selection criteria included randomized controlled trials comparing
exercise with a control or no intervention in women with dysmenorrhea. Trials were independently
selected and data extracted by two review authors They assessed the evidence for the effectiveness
of exercise in the treatment of dysmenorrhea.There appeared evidence from trial that exercise
reduced the menstrual distress and sustained decrease in symptoms over 3 observed cycles. 15
A Randomized placebo controlled trial study was conducted in Public Health College,
iksan; Korea the purpose was to explore the effect of aromatherapy on menstrual cramps in college
students. The subjects were 67 female college students who rated their menstrual cramps to be
greater on a point visual analogue scale. Subjects were randomized into three groups. 9
Aromatherapy was applied topically to the experimental group in the form of an abdominal
massage using one drop of lavender and rose in 5cc of almond oil. The Placebo group received the
same treatment with almond oil and the control group received no treatment. The menstrual
cramps were significantly lowered in the aromatherapy group than in the other two groups. These
findings suggest that aromatherapy is effective in decreasing the severity of menstrual cramps. . 16
A cross-sectional study was conducted by department of epidemiology and preventive
medicine, regarding intake of soy, fat, and dietary fiber and their biological effects on estrogen and
progesterone production and also the severity of menstrual pain. A total of 276 women’s from
three colleges and two nursing schools were selected. Intake of nutrients and foods including soy
products, fats and dietary fiber were estimated by a validated semi quantitative food frequency
questionnaire. The results proved that there is a marked improvement in menstrual pain. 17
A study was done to determine the frequency of dysmenorrhea in adolescence age and
investigate the correlation between menstrual factors and dietary habits and its pathology. The
sample was constituted from 356 students that were subjected to questionnaire, abdominal
ultrasound, and hormonal dosing. The frequency of dysmenorrhea was 85%.As far as dietary
habits, it was noted that a higher consumption of fish, eggs, fruits, and wine is correlated with a
lower frequency of dysmenorrhea. 18
A study was done in the Department of nursing, faculty of health sciences Ataluck
University. The purpose of the study was to investigate the effectiveness of aromatherapy on
dysmenorrhea. It was a quasi - experimental study the participants applied both aromatherapy with
lavender oil and placebo massaged with liquid petroleum and it was tested with the help of visual
analogue scale. Results show that aromatherapy was effective for reducing dysmenorrhea.19
A cross sectional study with 1092 girls from 15 public secondary schools and 3 ethnic
groups were taken. Study was done in university of Malaya, Kuala Lumpur to determine the
prevalence of dysmenorrhea, its impact and treatment behavior of adolescent girls. Overall 74.5%
of the girls who had reached menarche had dysmenorrhea;51.7% of these girls reported that it
caused them to miss school; and 12% said that it caused poor school performance.. The result
showed that their is a need for specific education regarding menstruation and its management in
the school. 20
A study was done in Japan to test the efficacy of heat and steam for the relief of symptoms
of dysmenorrhea in young women. Thirty four female university students were enrolled in the
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study. Subjects documented symptoms of dysmenorrhea on a self recording form using 4 score
scale. They were told to apply heat on the abdomen or lumber region for 1-2hrs on the first,
second, and third days of menstruation. By applying heat subjects felt relief of abdominal pain.
The results showed that heat and steam pads are useful non-pharmacological methods to relieve
symptoms of dysmenorrhea. 21
A randomized control study was done to compare exercise with a control or no intervention
in women with dysmenorrhea. The search was conducted using the methodology of the menstrual
disorder and sub fertility group. Trials were independently selected and data extracted by two
review authors. It was found that the women’s, who underwent exercise regimen got relief from
cramping, lower abdominal pain. Physical exercise has been suggested as a non- medical approach
to the management of dysmenorrhea.22
A prospective daily reporting study examined the relationship between exercise
participation and menstrual pain, physical symptoms and negative mood. The women’s who
participated in exercise reported less pain and a conclusion was made that those who undergo
moderate exercise regimen reported to have less menstrual cramps. 23
7. MATERIAL AND METHODS OF STUDY
7.1 SOURCES OF DATA
This data will be collected from the adolescent girls who are aged between 12-16yrs
studying in CKS girl’s high school, Hassan, Karnataka.
7.2 RESEARCH DESIGN
A Quasi- experimental design is planned for the research study.
Schematic plan of the study
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Key words
O1 = Pretest knowledge regarding natural remedies for dysmenorrhea.
X = Structured teaching programme on natural remedies for dysmenorrhea
O2 = Post test knowledge regarding natural remedies for dysmenorrhea.
_ = No intervention.
No Randomization.
7.3 METHOD OF DATA COLLECTION
Structured questionnaire regarding natural remedies for dysmenorrhea.
7.4 SAMPLING PROCEDURE
1. Population – Adolescent girls 12-16yrs studying in CKS girls’ high school, Hassan,
Karnataka.
2. Sample - Adolescent girls between the age group of 12-16yrs, who fulfilled the
inclusion criteria.
3. Sample size -.60.
4. Sampling technique – Non probability convenient sampling method
5. Research setting- The present study will be conducted in CKS girls’ high school,
Hassan, Karnataka.
EXPERIMENTAL GROUP
O1 X
O
2
CONTROL GROUPO1 _
O2
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8. VARIABLES
Independent variable - Structured teaching programme regarding natural remedies for
dysmenorrhea
Dependent variable - Knowledge of girls regarding natural remedies for dysmenorrhea.
Extraneous variable - Age, education, income, religion, source of information
(Media,magazine).
9. PLAN FOR DATA ANALYSIS
Descriptive and inferential statistics is planned as follows.
Descriptive statistics:
To describe knowledge and sociodemographic variables in number[n], frequency[f],
percentage[%], mean and standard deviation[SD]
Inferential statistics:
To associate the sociodemographic variables with knowledge using chi-square test.
To find out the significant difference between both pretest and post test knowledge score
using paired’t test.
10. PILOT STUDY
10% of sample size is planned for the pilot study.
11. ETH ICAL CONSIDERATION
1. Does the study require any intervention to be conducted on adolescent girls studying in CKS
girls’ high school?
13
Yes
2. Does ethical clearance will be obtained from your institution?
Yes
3 Does the consent will be taken from the CKS girls’ high school?
Yes
12. LIST OF REFERENCES (VANCOUVER STYLE)
1. www.google.com
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2. Irene M Bobak and Margaret Duncan Jensen, “Maternity and gynecological care”; 5 th edn,
Published by Mosby, Page No 1018-1019.
3. Adele Pillitteri, “Maternal and child health nursing, Care of the child bearing and child rearing
family”, 4th edn, Published by Lippincott Williams and Wilkins, Page No 905-910
4. Rashmi Barua, “Adolescence- A period that really matters”; Sept 24 2008, ezinearticles.com.
5. Melissa Conrad Stoppler, “Menstrual cramps (Dysmenorrhea)”; 1996-2010 Medicine. Net.Inc
6. Parker MA, Sneddon AE, Arbon P, “The MDOT study: determining typical menstrual patterns
and menstrual disturbance in a large population based study of Australian teenagers”; Department
of Australian Capital Territory, Jan.2010
7. Zhu X, Proctor M, Wu E, “Chinese herbal medicine for primary dysmenorrhea”; Cochrane
database of systemic reviews 2008, Oct 17 2007.
8. Liu Yung Ye Beatrice, “Exercise for dysmenorrhea”; Aug 6, 2001.
9. Womenshealth.about.com.
10. Einav Keet, “Aromatherapy massage for menstrual pain”; Natural solution magazine, Nov 7
2008
11 Roger P Smith, Andrew M Kaunitz, “Patient information: Painful menstrual periods
(Dysmenorrhea)” www.acog.org.
12. Ehow Contributor, “How to treat menstrual cramps with acupressure”; www.ehow.com.
13. Wiki.answers.com
14. Chen HM, Chen CH, “Effects of acupressure on menstrual distress in adolescent girls”; Chung
Hwa University of Medical Technology, Tainan, Taiwan
15. Brown J, Brown S, “Exercise for Dysmenorrhea”; Obstetrics and Gynecology, University of
Auckland, FMHS, Auckland, New Zealand, 2010 July
16. J Altren, “Effect of aromatherapy on symptoms of dysmenorrhea in college students”; Wong
Wang Public Health College, Iksan Korea, 2006 July-August Page 535-541.
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17. C Nagata, “Association of menstrual pain with intakes of soy, fat and dietary fiber in Japanese
women”; Department of Epidemiology and Preventive Medicine,Gifu University Graduate School
of Medicine, 29 June 2004.
18. Carlo Balbi , Rosalia Musone , Agostino Menditto , Luigi Di Prisco , Eufemia Cassese ,
Maurizio DAjello , M.D et al, “Influence of menstrual factors and dietary habits on menstrual pain
in adolescence age”; Volume 97 Pages 143-148, August 2000
19. Serap Ejdar Apay , Sevban Arslan,”Effect of aromatherapy massage on dysmenorrhea in
Turkish student”Department of nursing, Faculty of health sciences, Ataturk University, Erzurun,
Turkey,22 April 2010.
20. Wong LP,Khoo EM , “Dysmenorrhea in a multiethnic population of adolescent Asian girls”;
Medical Education and research development Unit, University of Malaya, Kuala Lumpur, 2010
Jan.
21. Dr Takayoshi Hosono, “Effects of a heat and steam generating sheet on relieving symptoms of
primary dysmennorhea in young women”; Department of Biomedical Engineering, Journal of
Obstetrics and Gynecological Research Vol:36, No: 4, August, 2010 Page 818 -824.
22. Maryam Rostami, Zahra Abbaspour, Shahnaz Najjar, “Effect of exercise on Dysmenorrhea”
Azad University of Iran, Behbahan Iran
23. Mindy High Tower BA, “Effects of exercise participation on menstrual pain and symptoms”;
Women and Health, Vol 26(4) 1997.
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