Int. J. med. Appl.health. Vol. 1, No.

1, 2013

ASSESSMENT OF NUTRITIONAL STATUS OF GERIATRIC POPULATION IN SARGODHA CITY

1 2 3
Abdul Ghani , SarfrazHussain , Muhammad Zubair
1
Department of Medical Nutrition and Dietetics Sargodha Medical College, University of Sargodha, Pakistan
2
Institute of Food Science and Nutrition, University of Sargodha, Pakistan
3
Department of Statistics, University of Sargodha, Pakistan
*Address for Correspondence:pdmed@uos.edu.pk

ABSTRACT

This study was conducted to assess the nutritional status of geriatric people aged 60 years and above in four Union
Councils of Sargodha city. A representative sample of 380 subjects (randomly selected) was studied out of which
209 were males and 171 were females. Nutritional status was evaluated by anthropometric measurements to
calculate the body mass index, mid-arm circumference, calf circumference and by data collected through the Mini
Nutritional Assessment (MNA). The MNA results revealed that 5.53% of subjects were malnourished and 42.10%
were at risk of malnutrition. Malnutrition was more prominent in males (3.16%) as compared to the females
(2.37%) of same age group. The prevalence of malnutrition was significantly higher in upper age group of geriatric
(80 years and above) population. Age factor was negatively associated with the nutritional status. Mini-nutritional
Assessment appears to be a practical and reliable method to assess the nutritional status of elderly people but
could not detect yet surplus nutritional problems in elderly. Gender, loss of appetite, development of
neuropsychological problems like dementia and depression, etc., dental problems, mode of feeding and level of
difficulty in feeding, self-view of health and nutrition status, daily consumption of more than three prescriptions of
drugs, daily number of full course meals, body mass index, all correlated significantly (0.05-.001) with MNA
screening score. Early identification of malnutrition in the community followed by necessary medical and social
interventions could ameliorate the nutritional status of old people and consequently their health and quality of
life. Management requires a holistic approach and underlying causes such as chronic illness, depression,
medication and social isolation must be treated.
Keywords: Nutritional Status, geriatrics, malnutrition, Mini-Nutritional Assessment

INTRODUCTION satisfy their medical and physiological needs. The

Average life expectancy throughout the world is
increasing year by year leading to an overall increase
of geriatric population. Goals of improving the
quality of life for all, reducing mortality and
morbidity rates and increasing the life span are
emphasized in all regions of the world. The
worldwide rise in the population of elderly people
has also made its impact on Pakistan. With limited
resources and a poor knowledge of aging and its
problems, Pakistan is facing many challenges in the
care of its elderly population.
Geriatric medicine is not recognized as a separate
specialty in Pakistan. Older patients are seen and
treated by general practitioners or other doctors of
different specialties. There is no comprehensive
care. Elderly patients often receive fragmented
treatment. No inpatient rehabilitation centers and
geriatric wards in the hospital exist for patients with
strokes, fractures, and other geriatric disorders.
Outpatient physical therapy services are however
widely available but use is limited. Our elderly does
not receive the desired medical attention which can
disease burden in our elderly is high and some data
is available regarding common diseases in the elderly
but by and large most numbers are observational.
Majority of elderly in Pakistan have a sedentary
lifestyle which may play a significant role in
immobility disorders, loss of muscle mass and falls,
which are common geriatric syndromes. There is
little data on depression in the elderly because of
the stigma associated to mental illnesses. Dementia
may also be presenting later as most elderly patients
depend on their families for shopping,
transportation and financial interactions leading to a
delayed manifestation of functional decline.
Nutritional status can be assessed by using Mini
Nutritional Assessment (MNA) Questionnaire. To the
best of the knowledge of the researcher, there is no
study available regarding the assessment of
nutritional status of geriatric population using MNA
in Pakistan. It is the dire need of the hour to develop
medical and social programs for our elderly that help
meet their needs at their doorsteps. The objective of
this study was to assess the nutritional status of

22

geriatric population 60 years of age and above. The
results are expected to help in designing policies and
making plans regarding health care provision for the
elderly in Pakistan.
MATERIALS AND METHODS
Research Design: This study was cross sectional and
nutritional status assessment was done by using 18
items (30 points) Mini Nutritional assessment
(MNA). MNA scale includes questions regarding
appetite, mobility, acute and chronic illness,
medication history, dietary history, anthropometric
measurements (Body Mass Index, Mid Upper Arm
Circumference and Mid-Calf Circumference etc).
Research Instruments and Types: Standard mini
nutritional assessment questionnaire was the
research instrument used in this study.
Population: In the present study, Nutritional Status
of geriatric population of age 60 and above was
assessed. This study was conducted in four selected
Union Councils (Satellite Town, Factory Area, Tariq
Abad and Block No. 25) of Sargodha city (Punjab,
Pakistan). The total population of Sargodha city is
1,023,000 and the population of our selected UC’s is
200,000 (Anonymous, 2010). The total geriatric
population in the four Union Councils is 12,000 (6%
of general population) (Saniya et al2010).
Sample and Sampling Techniques: In the study, two
stage sampling scheme was used. At first stage, four
Union Councils were selected at random out of 22
Union Councils in Sargodha city. In the second stage,
stratified random sampling with equal allocation was
used and selected 400 individuals randomly aged 60
years and above, 100 from each Union Council. Data
was collected by home visits along with the team of
researcher after taking the consent of the
individuals. 380 subjects participated in this study.
Research Instruments and Types: Standard mini
nutritional assessment questionnaire was the
research instrument used in this study (attached as
Appendix-A). All anthropometric measurements
were taken in duplicate by trained interviewers and
an average of two measurements was calculated.
Weight of subjects was recorded on a calibrated
scale to the nearest 100 gram. Height was recorded
using a stadiometer. Calf circumference was
measured to the nearest 0.5 cm at the largest
circumference of the calf with the knee and ankle
23
Abdul Ghani ,Sarfraz Hussain , M Zubair
o
bent at 90 angles (Anonymous, 1997). Mid upper
arm circumference was measured as the
circumference of the right upper arm in the middle.
The body mass index (BMI) was calculated from an
individual's weight in kilogram divided by the square
of the height in meters. Nutritional status of geriatric
population was accessed by using mini nutritional
assessment which is an instrument designed for
elderly people (Guigozet al1996). MNA is a rapid and
simple tool with high sensitivity (96%) and specificity
(98%) to determine nutritional status of elderly
persons (Gazzottet al 1997; Compan, 1999;
Rubenstein, 1999).
Data Collection and Statistical Test: Data was
collected from the subjects aged 60 years and above
at their homes. The data thus, collected was
analyzed using a statistical packages for social
sciences and the results were tabulated. For testing
of homogeneity in the response of males and
females, Pearson Chi-Square test was applied. SPSS
version 20 was used to find that bivariate relation in
responses. P-Value from 0.05-0.001 was taken in the
testing.
RESULTS
The Table 1 reveals that in the total sample of 380
people, 160 subjects (42.10%) were at risk of
malnutrition (MNA score between 17 and 23.5
points). 21 subjects (5.53%) were malnourished.
Their MNA score was less than 17 points. 199
subjects (52.37%) were well-nourished. Their MNA
score was above 24 points.Table 2 reveals that 88
males (23.16%) and 72 females (18.95%) were at risk
of malnutrition. 3.16% males and 2.37% females
were suffering from malnutrition. Males were
predominant and had poor nutritional status as
compared to females of same age group
The results are significant at P-value 0.05-0.001
(Table 3). Table 4 reveals that among the 60-70 years
subgroup, there were 93 males (54.71%) and 77
females (45.29%). In age subgroup of 70-80 years,
there were 80 males (55.17%) and 65 females
(44.83%) and in the age subgroup of 80 years and
above, males were 36 (55.38%) and females were 29
(44.62%). Thus, total males in all age subgroups were
209 (55%) and females were 171 (45%).The results
are significant at P-value 0.05-0.001 (Table 5).
 Int. J. med. Appl.health. Vol. 1, No.1, 2013

Table I: Distribution of subjects (total) and their nutritional status as per MNA score

Well-Nourished At Risk of malnutrition Malnutrition

Total %
Subjects % Subjects % Subjects %

199 52.37 160 42.10 21 5.53 380 100

Table:2 Distribution of subjects (male and female) and their nutritional status
Well Nourished At Risk of malnutrition Malnutrition

Percent
Total
Percent

Percent

Percent

Percent

Percent

Percent
Female

Female

Female
Male

Male

Male
109 28.68 90 23.68 88 23.16 72 18.95 12 3.16 9 2.37 380 100
Table: 3 Analyses of variance for distribution of subjects according to gender in different age subgroups
Chi-Square Tests
Pearson Chi-Square Value df P-value
122.380 2 0.000***
Results are significant at (0.05-0.001), where *=0.05,**=0.01 and ***=0.001.
Table: 4 Distribution of subjects according to gender in different age subgroups
Age Subgroup Male Percent Female Percent Total Percent
60-70 93 54.71 77 45.29 170 44.74
70-80 80 55.17 65 44.83 145 38.15
80 and above 36 55.38 29 44.62 65 17.11
Total 209 55 171 45 380 100
Table: 5 Analyses of variance for distribution of subjects according to their nutritional status of all age subgroups
Chi-Square Tests
Pearson Chi-Square Value df P-value
Well nourished 63.815 2 0.000***
At Risk of malnutrition 53.094 4 0.000***
Malnutrition 11.700 4 0.020*
Results are significant at (0.05-0.001), where *=0.05,**=0.01 and ***=0.001.

Table :6 Distribution of subjects according to their nutritional status of all age subgroups
Well Nourished At Risk of malnutrition Malnutrition
Subgroup

Percent
Age

Percent

Percent

Percent

Percent

Percent

Percent
Female

Female

Female
Male

Male

Male

Total

60-70 58 34.12 50 29.41 33 19.41 25 14.71 2 1.18 2 1.1 170 100

8
70-80 39 26.90 32 22.07 37 25.52 31 21.38 4 2.76 2 1.3 145 100
8
80 & 12 18.46 8 12.31 18 27.69 16 24.62 6 9.23 5 7.6 65 100
above 9
Total 109 28.68 90 23.68 88 23.16 72 18.95 12 3.16 9 2.37 380 100
Grand Total 199 52.37 160 42.10 21 5.5 380 100
3

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Table. 6 revealed the status of nutrition in all age
subgroups under study. In the subgroups of age 60-
70 years 58 males (34.12%) and 50 females (29.41%)
were well nourished. 33 males (19.41%) and 25
female (14.71%) were at the risk of malnutrition. 2
male (1.18%) and 2 female (1.18%) were found to be
suffering from malnutrition. In the age subgroup of
70-80 years, 39 males (26.90%) and 32 females
(26.90%) and 32 females (22.07%) were well
nourished. 37 males (25.52%) and 31 females
(21.38%) were found at risk of malnutrition. 4 males
(2.76%) and 2 females (1.38%) were found to be
above, 12 males (18.46%) and 8 females (12.31%)
were well nourished. 18 males (22.69%) and 16
females (24.62%) were at risk of malnutrition. In
same age subgroup, 6 males (9.23%) and 5 females
(7.69%) were found to be suffering from
malnutrition.
DISCUSSION
Nutritional status of geriatric population aged 60
years and above was assessed using Mini Nutritional
Assessment (MNA) Questionnaire. All the subjects
above 60 years were divided into three age
subgroups as per convenience of the researcher. The
study was conducted in four Union Councils of
Sargodha city spreading on an area of 4 sq. km.
There were 380 persons aged 60 years and above
who were interviewed at their homes. Age subgroup
of 60-70 years (44.74%) was in majority and the
results obtained have been discussed in the light of
available literature as under.
In the present study, 5.53% subjects were suffering
from malnutrition and 42.10% subjects were at risk
of malnutrition as assessed with MNA. Similar results
(5.8%) in older people living in community were
reported in Germany (Kaiser et al 2010), (7.1%) in
community dwelling elderly in India (Bawejaet
al2008), (6.5%) in elderly living at their homes in
Turkey (Ozgeet al2005). These results of present
study (prevalence of malnutrition) differ from study
of Beck and Ovesen (1998), which was conducted in
a mixed population and the prevalence of
malnutrition was 5-40%. The results of present study
also differ from the results of the study of Rita et al.
(2011) who conducted a cross sectional study in the
elderly living in the community in Brazil and the
prevalence of malnutrition was 1.3%.
It was observed in this study that malnutrition was
most common in upper geriatric age group (80 years
& above males (9.23%) and females (7.69%)) as
compared to lower geriatric age group (60-70 years
age subgroup 1.18 % each males and females). This
23
Abdul Ghani ,Sarfraz Hussain , M Zubair
age group is moredependent, less mobile and was
suffering from different type of diseases like
Hypertension, Diabetes Mellitus, Ischemic Heart
Disease, Acid Peptic Disease, Dementia, Dental
Problems and difficulties in intake of diet.
Furthermore, this group was most isolated as
compared to 60-70 years of age group. Physical
immobility and social isolation further aggravates
the problem.
Sarah et al. (2005) conducted a cross-sectional study
with the aim to measure the effect, if any of age, on
nutritional status in elderly people. After adjusting
for disability and co-mobility, age alone had a
significant and independent effect on important
anthropometric and biochemical nutritional
assessment variables. They concluded that
increasing age was independently associated with
poor nutritional status. Baweja (2008) reported that
as the age increases, malnutrition and risk of
malnutrition increases. Similar trends of declining
nutritional status with increasing age were present
in study by Soiniet al (2004).
In the present study, malnutrition was prominent in
the males (23.16%) as compared to females (18.95%)
of the same age group as per score of MNA. This
factor was more prominent in at risk group of
nutritional status. This observation was in
accordance with Iftikharet al (2011), who reported in
their cross sectional study that malnutrition was
common in apparently healthy Pakistani men.
Geriatric medicine is not recognized as a separate
specialty in Pakistan. Older patients are seen and
treated by general practitioners or other doctors of
different specialties. There is no comprehensive
care. Elderly patients often receive fragmented
treatment. No inpatient rehabilitation centers and
geriatric wards in the hospital exist for patients with
strokes, fractures, and other geriatric disorders.
Outpatient physical therapy services are however
widely available but use is limited. Our elderly does
not receive the desired medical attention which can
satisfy their medical and physiological needs. The
disease burden in our elderly is high and some data
is available regarding common diseases in the elderly
but by and large most numbers are observational.
Majority of elderly in Pakistan have a sedentary
lifestyle which may play a significant role in
immobility disorders, loss of muscle mass and falls,
which are common geriatric syndromes. There is
little data on depression in the elderly because of
the stigma associated to mental illnesses. Dementia
may also be presenting later as most elderly patients
depend on their families for shopping,

transportation and financial interactions leading to a
delayed manifestation of functional decline.
Good nutrition and a balanced diet can be beneficial
for the elderly in many ways. Provision of good
nutrition prevents many nutritional health problems;
improve the management of some existence
diseases; fastens recovery from many illnesses;
increases mental, physical and social well-being. It
may be difficult for some older persons to get
enough food, especially if they are, dependant, poor,
unable to drive and go outside. For an older person,
a request for help may be equated to a loss of
independence. Many eligible older people are
missing meals and are poorly nourished simply
because they don’t know of available resources to
help them. Irregular meal patterns and weight loss,
often caused by difficulties in preparing food (when
they are living alone) are warning signs that
malnutrition may be developing.
Nasir (2008) reported that despite severe socio-
economic pressures, Pakistani society has stood for
high value, respect and dignity of human life. Being
the Pakistani, we regard old age as a mark of
wisdom, esteem and faithfulness. This is due to the
strong ties that exist in the joint family system
strengthened by religious values dignifying the
status of geriatric group of society. The constitution
of Pakistan declares promotion of social and
economic well-being of the elderly people as one of
its main objectives. It is the duty of the state to
provide basic necessities of life for those citizens
who are unable to earn livelihood on account of
sickness, infirmity or unemployment. Pakistan is
heavily indebted as a result of world-wide economic
recession and the process of globalization. The issue
such as income security, housing and medical care
for elderly have assumed increased importance.
WHO declared 2010 “Health for All” and one of their
goal is to pay attention on elderly health (Krinke,
2005). Government of Pakistan views second world
assembly on aging as an opportunity to identify gaps
for re-designing strategies and to assess the progress
made so far in achieving the desired goals and
actions to fully support made by this Assembly at
Madrid. But due to severe economic constraints,
Pakistan is facing many difficulties to launch any
developmental program. These problems has
aggravated due to decrease in Pakistan exports after
th
11 September 2009 developments. Therefore, it is
very difficult to allocate resources for social
development, thus, increasing dependence on
international financial assistance. Aging will pose a
22
Int. J. med. Appl.health. Vol. 1, No.1, 2013
challenge to the economy and social planning of the
nation in coming years of which the Government is
fully aware. Financial and Technical Assistance by
international donors (like IMF and World Bank etc)
can assist us in achieving the goals set for welfare of
elderly (Nasir, 2008).
To the best of the knowledge of the researcher,
there is no study available regarding the assessment
of nutritional status of geriatric population using
MNA in Pakistan. It is the dire need of the hour to
develop medical and social programs for our elderly
that help meet their needs at their doorsteps. Such
programs should also provide caregiver education,
training and facilities to family members caring for
their older relatives. This need was also highlighted
by one study that surveyed local communities. Some
interest in geriatric health has recently been
generated in the medical community. Articles citing
the health problems of the elderly have been
published. These have highlighted some medical and
social problems faced by our elderly. In addition
some media (both print and other) has also focused
their attention towards the elders in our society.
At the end, however, we expect that efforts will be
made for the improvement of medical care of our
elderly population with the help of related
knowledge and skill building of our medical
professionals. This can be achieved by increasing
health awareness of our public and allowing better
access to appropriate preventive and medical care
for our elderly. The present study was conducted
only in four Union Councils of Sargodha city and may
not be representative of elderly population of
Pakistan. In order to accomplish the
abovementioned tasks, further studies are needed in
larger population from different geographical areas
of Pakistan to reflect a representative sample with
individuals from different socio-cultural background.
Medical and social programs should be devised for
our elderly to help meet their needs in the comfort
of their homes. Health education should be given to
the caregivers about nutrition and its principles i.e.,
dietetics. Emphasis should be given on print and
electronic media to focus their attention towards the
elders in our society. Geriatric should be taught at
Undergraduate and Postgraduate level especially in
public sector educational institutions. All the medical
students should recognize for the teaching and
learning geriatrics so that all Doctors are trained to
understand the need of our elderly patients. All the
paramedical health care providers like Dispensers,
Nurses, Hospital Pharmacists, Physiotherapy
Assistants, etc. should receive the Medical Training

of the common medical problems in old age people.
Public awareness towards the needs of elderly
should be enhanced through Radio, Television,
Internet, Free Seminars, etc. at hospital and
Universities via patient and family education.
Community education programs should be initiated
to help families understand common geriatric
illnesses like dental problems, Diabetes Mellitus,
Obesity, Fractures, Eye diseases and Hypertension
etc. All the elders should be encouraged to take part
in part-time teaching and in charity work so that the
healthy elders may contribute towards society.
Elders helping elders could be another low cost
feasible programme. To develop a program on the
line of World Health Organization (WHO); vision for
the health of the elderly that encourages community
participation and focuses on the combined role of
Government, Institutional and Community
Participation. Old age benefit schemes should be
strengthened. Supply of medicines on rebates could
be a useful step for the reduction of hardships.
Modern science has shown the way to grow old with
grace and good health and as a useful member of
the society. The elderly must remain active, promote
and improve friendships, see their prayers regularly,
recite the Holy Quran, have positive thinking, take
balanced diet, have adequate rest and realize their
limitations.
CONCLUSIONS
The prevalence of malnutrition (by MNA) is
significantly higher in upper age group of geriatric
(80 years and above) population. Age factor is
negatively associated with the nutritional status.
Mini Nutritional Assessment (MNA) appears to be a
practical and reliable method to assess the
nutritional status of elderly people. Management of
malnutrition in the elderly population requires the
involvement of multiple disciplines for its diagnosis
and treatment.
Recommendations
Necessary Steps should be taken for the
1. Enrichment of the food with specific
micronutrients including iron, iodine , vitamin
B6, E and long term provision of β carotene
2. Assessment of nutritional status of the elderly
population in the community using simple
tools. Modification of MNA including its
validity and reliability testing and comparing
to other nutritional status indicators that are
23
Abdul Ghani ,Sarfraz Hussain , M Zubair
more sensitive so that MNA can be applied in
a better way in the community.
3. Merger of nutritional management with
clinical practice and establishment of geriatric
wards in the hospitals.
4. In the light of the growing number of elderly
in Pakistan there many peoples who will be
malnourished, so additional studies must be
carried out to assess these and other
alternative solutions.
REFERENCES
Anonymous.1988. Survey of Elderly, A Case Study of
Lahore District, Lahore (M/S Ideal Consultancy
Agency, Arbi, Ghulam Shabbir). Pakistan,
Special Education and Social Welfare Division.
Anonymous 1990. Survey of Elderly, A Case Study of
Islamabad (Draft), Islamabad. Pakistan, Special
Education and Social Welfare Division.
Anonymous 1997. Obesity: preventing and
managing the global epidemic. Report on
consulting meeting. World Health Organization.
Anonymous 2001. Federal Bureau of Statistics.
Pakistan Demographic Survey.
Anonymous 2003. Sex and Age Distribution of World
Population. Volume II.Department of Economic
and Social Affairs, Population Division,
ST/ESA/SER.A/180, New York, USA. World
Population Prospects, The 2002 Revision.
Anonymous 2003. World Population Prospects.
Calculated on the basis of UN.
Baweja, S., H. Agarwal, A. Mathur, J.R.Haldiyaa, and
A. Mathur, 2008. Assessment of Nutritional
Status and Related Risk Factors in Community
Dwelling Edlerly in Western Rajasthan. Journal
of the Indian Academy of Geriatrics, 5-13.
Beck, A.M., L. Ovesen, and M. Osler, 1999. The mini
nutritional assessment (MNA) and the
determine your health checklist (NSI checklist)
Compan, B., A. Dicastri, J.M.Plaze, and F. Arnaud-
Battandier, 1999.Epidemiological study of
malnutrition in elderly patients in acute, sub-
acute and long-term care using the
MNA.Journal of Nutrition Health Aging, 3:146-
51.
Iftikhar, A., L. Anis, P. Graham, and P. Parvez, P. 2011.
Relationship between anthropometric variables
and nutrient intake in apparently healthy male
elderly individuals: A study from Pakistan.
Nutrition Journal.10:111.
Kaiser, M.J., J.M. Bauer, C.Ramsch, W.Uter, Y. Guigoz,
Y., T. Cederholm, D.R. Thomas, P.S. Anthony,
 Int. J. med. Appl.health. Vol. 1, No.1, 2013

K.E. Charlton, M. Maggio, A.C. Tsai, B.Vellas,

and C.C. Sieber, (2010). Frequenc of
malnutrition in older adults: A multinational
perspective using the mini nutritional
assessment. Journal of Geriatric Society,
9:1734-8.
Krinke, U.N. 2005.Nutrition and the elderly. In: Brown
J.E. Nutrition through the life cycle 2nd Edition.
Belmot CA; Thomson Wadsworth.420-41.
Nasir, S. 2008. The situation of elderly population in
Pakistan: Problems and Prospects. PJSE.
Available on
http://www.specialsedu.com/2011/01/situatio
n-of-elderly-population-in. html
th
Assessed on 2012 August 10 .
Nasir, Z.M. and S.M. Ali, 2000.Labor Market
Participation of the Elderly. The Pakistan
Development Review, 4: 1075-1086.
Ozge, K., K. Eda, R.Neslisah, and P. Gulden,
2005.Assessment and evaluation of the
nutritional status of the elderly using two
different instruments. Saudi Med J, 10:1611-16.
Rita, S.V.R., I.D.R. Maria, and C.B. Mary,
2011.Malnutrition and associated variables in
an elderly population of Criciuma SC. Rev.
Assoc. Med. Bras.1.
Saniya, R. and A. Gohar, 2010. Ageing in Pakistan A
new challenge. Ageing International, 1-5.
Sarah, F. and G. Salah, 2005. Age as a determinant of
nutritional status: A cross sectional study.
Nutritional Journal, 4:28.
Soini, H., P. Routasalo, and H.
Lagstrom,2004.Characteristic of the mini-
nutritional assessment in elderly home care
patients.European Journal of Clinical Nutrition,
58:64-70.
Rubenstein, L.Z. 1999. Comprehensive geriatric
assessment (CGA) and the MNA: the overview
of CGA, nutritional assessment and
development of a shortened version of the
mini-nutritional assessment. In: Vellas B., Garry
P.J. and Guigoz Y. (1999). Mini nutritional
assessment: research and practice in elderly.
Nestle clinical and performance nutrition
workshop series. Basel: Karger, 1:101-106.

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