PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE ON HEALTHY LIFESTYLE TO PREVENT ACID PEPTIC DISEASES AMONG THE WORKERS OF SELECTED INDUSTRIES IN TUMKUR.WIHT A VIEW TO DEVELOP INFORMATION BOOKLET”
SUBMITTED BY:
SHEEBA CHERIAN
1ST YEAR M.SC
MEDICAL SURGICAL NURSING
SRIDEVI COLLEGE OF NURSING
TUMKUR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTAION.
1 / NAME OF THE CANDIDATE AND ADDRESS / SHEEBA CHERIANSHRIDEVI COLLEGE OF NURSING,
SIRA ROAD, LINGAPURA
TUMKUR.
2 / NAME OF THE INSTITUTE / SRIDEVI COLLEGE OF NURSING
TUMKUR.
3 / COURSE OF STUDY AND SUBJECT / 1ST YEAR MSC NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE ON HEALTHY LIFESTYLE TO PREVENT ACID PEPTIC DISEASES AMONG THE WORKERS OF SELECTED INDUSTRIES IN TUMKUR.WIHT A VIEW TO DEVELOP INFORMATION BOOKLET”.
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Everything in excess is opposed to nature”
The stomach is an enlarged segment of the digestive tract in the left superior part of the abdomen. Its shape and size vary from person to person even within the same individual its size and shape change from time to time depending on its food content and the posture of the body.1
Disease of the stomach and small bowel are common and cause significant morbidity, economic hardships and health consequences. Acid peptic ulcer diseases alone accounted for an estimated $12.4 billion in direct costs in 1998.
The term peptic ulcer disease (P.U.D) generally refers to spectrum of disorders that includes gastric ulcers (G.U), pyloric ulcer, duodenal ulcer (DU) and post operative ulcers at or near the site of surgical anastomosis2.
Pathologically the definition of a peptic ulcer is straightforward it is a defect in the gastric or duodenal wall that extends through the muscularis mucosa (the lower most limit of the mucosa into the deeper layers of the wall sub-mucosa or the mascularis propria). It is with in these layers, layers that the ulcer may erode a major blood vessel to produce the complication of potentially life- threatening haemorrhage3.
Peptic ulcer disease is a condition characterized by erosion of the Gastro Intestinal (GI) mucosa resulting from the digestive action of HCl acid and pepsin. Any portion of the GI tract that comes into contact with gastric secretions is susceptible to ulcer development including the lower esophagus, stomach duodenum, and margin of gastojejunal anastomosis after surgical procedures. There are approximately 500,000 new cases of ulcers diagnosed and over 4 million recurrences of PUD each year4.
Perforation of peptic ulcer usually presented as an acute-abdomen. Nearly one-third of the patients have no history of the disease. Initial symptoms of perforated duodenal or gastric ulcer, includes a severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually accompanied by vomiting and nausea. There is rapid generalization of pain and examination shows peritonitis with lack of bowel sounds. In 10% of cases there is associated episode of melena. Perforated peptic ulcer is more common in elderly patient which may be selected to higher use of NSAID also die to ambiguous signs of the disease there is a delay in diagnosis. Elderly patients are likely to have other medical problems which increase the rate of morbidity and mortality in this group5.
There are some measures to decrease the risk of peptic ulcer disease and perforation since about 30% of patients with perforated peptic ulcer is taking NSAID. Use of these drugs should be lessened or at least use concomitant anti-ulcer medications smoking cessation and abstinence from alcohol should also increase the risk of complicated peptic ulcer. Early diagnosis and treatment of peptic ulcer have important role in prevention of complication6
6.1 NEED FOR THE STUDY:
Gastric ulcers are very common and affects all age group irrespectively. Peptic ulcer affects 1 in every 10 people. The annual incidence of gastric ulcer varies approximately 1 case per 1000 population in Japan to 1.5 cases per 1000 population in Scotland. In the US 2% of general population gets affected with peptic ulcers. The male to female ratio is 1:1 in US and 18:1 in India7.
A survey was conducted on epidemiology of Helicobacter pylori and peptic ulcer among residents aged above 15 years in India. There were 80 symptomatic and 67 asymptomatic individuals. The prevalence of active peptic ulcer was 3.4% and life time prevalence was 8.8%. The duodenal to gastric ulcer ratio was 12:1. The study concluded that peptic ulcer was more prevalent in the elderly and dyspeptic patients8.
Studies suggest that stress may predispose someone to ulcer or sustain existing ulcers. Some expert’s in fact estimate that social and psychological factors may contribute role in 30% to 60% of peptic ulcers 3. A study conducted in an industrial population in India found that employees had perceived job stress and incidence of peptic ulcer among these employees was 13.68% 9.
A study about epidemiology of pylori and peptic ulcer in India has been conducted in Chandigarh. The study randomly covered all sectors of Chandigarh and they screened 2649 persons. The study results shown that there were 80 symptomatic and 67 asymptomatic individuals. The point prevalence of active peptic ulcer was 3.4% and the life time prevalence was 8.8%. The duodenal to gastric ulcer ratio was 12:1 and peptic ulcer was more common in elderly. Helicobacter pylori was associated with age only and did not depend on sex, socioeconomic status or dyspepsia of the 38 asymptomatic person having h. pylori infection.10
The study, designed to overcome methodological problems inherent in earlier prevalence studies of peptic ulcer, was carried out in a municipality in northern Norway. It included the total population of 2027, aged 20-60 years, and comprised a questionnaire and search for previously diagnosed peptic ulcers in the local medical records for all subjects, and additional endoscopy of all subjects with dyspepsia and their matched healthy controls (n = 619). The overall prevalence was 10.5% in men and 9.5% in women, a sex ratio close to one and a higher duodenal-gastric ratio than previously reported from this region. A substantial 1% prevalence of asymptomatic ulcers was also observed.11
The above studies suggest use to provide necessary knowledge regarding healthy lifestyle to prevent complication and help the worker to change the undesirable faulty lifestyle. So the researcher felt to assess the knowledge and practice of healthy lifestyle to prevent acid peptic diseases among the workers of industries with a view to impart information booklet to educate them
6.2 REVIEW OF LITERATURE:
Review of literature is an important source for development of research project. It helps to gain an insight into the research problem and provides information of what has been done previously. It helps the researcher to be familiar with the existing studies and also provides base for methodology tool for data collection and research design.
The relevant studies are organized into the following categories based on objectives.
1. Based on knowledge and practice regarding acidic peptic disease.
2. Studies related to preventive measures of peptic ulcer
BASED ON KNOWLEDGE AND PRACTICE REGARDING ACIDIC PEPTIC DISEASE
A study was conducted on knowledge on causes related to peptic ulcer disease was carried out in United States. 72% of general public were unaware of association between helicobacter pylori infection and peptic ulcer disease. To increase there awareness among general public, the health care providers has developed an awareness and education campaign in 2007. During late 2007 a population based survey was conducted, the findings were indicating that only 27% of general public were unaware of the association between helicobacter pylori infection and peptic ulcer disease.12
A study was conducted on peptic ulcer disease and Jamaican patients’ awareness. 51 patients with peptic ulcer disease were studied regarding there awareness of their disorder. 63% of the patient had known their ulcer location but 37% were unaware of their diagnosis. 76% patients thought that poor eating habits were contributing cause of their illness. 39% thought the stress was a cause and 16% implicated heredity. This study shows that Jamaican patient awareness of their ulcer disease were inadequate.13
A study was conducted on the patient with peptic ulcer and their knowledge of the factors influencing the development of disease. 210 patients were selected as sample. 48.2% indicated peptic ulcer was a significant health and social problem for person having it. It was found that all patients had definite view on the factors causing and influencing it. The most negative influence on the health condition of patients was stress situation. The generally accepted negative influence of abnormal nourishment on peptic ulcer was mentioned by half of the respondents.14
The researcher stated that , the origins of gastric hyperacidity. gastric acid and duodenal ulcer appearance includes genetic predisposition, incorrect diet and unbalanced diet , eg, increased stress level, cigarette smoking, herbal drugs have been proved to be very effective in the treatment of hyperacidity, gastric and duodenal ulcers. The most often used herbs include muculinisemen, psyllisemen, aithaeaeradix, alogel etc15
STUDIES RELATED TO PREVENTIVE MEASURES OF PEPTIC ULCER
A study was conducted on role of psychosomatic factors in peptic ulcer disease. A service of 70 consecutive male and female adult patients were categorized by peptic symptoms and divided into four groups. a) Control, b) Gastric ulcer, c) Duodenal ulcer and d) Chronic non- ulcer dyspepsia. All patients were interviewed and asked to answer questionnaire that included demographics, medical history and the incidence of negative life events when compared to other study groups. Negative life event that produce considerable stress may predispose to peptic symptoms in certain population.16
References and further reading may be available for this article. To view references and further reading you must purchase this article. A study was conducted to understand the relation between Helicobacter pylori infection and diet as a most important environmental factor contributing to duodenal ulcer. This study aimed at causation, treatment and prevention of duodenal ulcer occurrence. Results revealed that soluble fiber from fruit and vegetables seem to be protective against duodenal ulcer and refined sugars a risk factor. The role of fiber in the treatment and prevention of occurrence of duodenal ulcer is uncertain, as is that of essential fatty acids. However, none of the epidemiological studies on the relationship between diet and duodenal ulcer disease controlled for Helicobacter pylori.17
A study was conducted on diet therapy of peptic ulcer. Information from 326 dietitians representing 50 states on the diet therapy of peptic ulcer disease in their hospitals was analyzed. A bland diet was the most commonly used diet for peptic ulcer diet in 250 (77%) of the hospitals. 72% used a bland first (or) second. Milk was given routinely or usually in 55% of the 326 hospitals. On discharge, dietitian in one half of the hospitals instructed their patients on a bland diet where as the remaining dietitian instructed their patients on a regular (or) modified regular diet.18
References and further reading may be available for this article. To view references and further reading you must purchase this article.
A study was conducted to investigate whether Neem bark extract have any antisecretory and antiulcer effects in human subjects. For this purpose, a group of patients suffering from acid-related problems and gastroduodenal ulcers were orally treated with the aqueous extract of Neem bark. The lyophilised powder of the extract when administered for 10 days at the dose of 30 mg twice daily caused a significant (p < 0.002) decrease (77%) in gastric acid secretion. The volume of gastric secretion and its pepsin activity were also inhibited by 63% and 50%, respectively. Some important blood parameters for organ toxicity such as sugar, urea, creatinine, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, albumin, globulin, hemoglobin levels and erythrocyte sedimentation rate remained close to the control values. The bark extract when taken at the dose of 30–60 mg twice daily for 10 weeks almost completely healed the duodenal ulcers monitored by barium meal X-ray or by endoscopy. One case of esophageal ulcer (gastroesophageal reflux disease) and one case of gastric ulcer also healed completely when treated at the dose of 30 mg twice daily for 6 weeks. The levels of various blood parameters for organ toxicity after Neem treatment at the doses mentioned above remained more or less close to the normal values suggesting no significant adverse effects. Neem bark extract thus has therapeutic potential for controlling and prevention of gastric hypersecretion and gastroesophageal and gastroduodenal ulcers.18
A study was conducted on effect of smoking and alcohol as contributing factors of peptic ulcer. 200 young adults were randomized selected into an intervention group and control group for a 1 week run-in and 2 week study. The results shown that the young adults who do not smoke or consume alcohol have less gastric acid secretion, and also less prone to get peptic ulcer. But the young adults consuming alcohol or smoking suffers with peptic ulcer in their lifetime. 19
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE ON HEALTHY LIFESTYLE TO PREVENT ACID PEPTIC DISEASES AMONG THE WORKERS OF SELECTED INDUSTRIES IN TUMKUR
6.4 OBJECTIVES OF THE STUDY
· To assess the knowledge of industrial worker regarding healthy lifestyle to prevent acid peptic diseases.
· To assess the practice of industrial worker regarding healthy lifestyle to prevent acid peptic diseases
· To find out the correlation between knowledge and practice of industrial worker regarding healthy lifestyle to prevent acid peptic diseases.
· To find out the association between knowledge and practice of industrial worker regarding healthy lifestyle to prevent acid peptic diseases. with the selected demographical variables
· To prepare and distribute an informational booklet on healthy lifestyle to prevent acid peptic diseases.
6.5 OPERATIONAL DEFINITIONS:
· Assess: The scoring of obtained response to a structured questionnaire.