PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“ ASSESSMENT OF KNOWLEDGE AND ATTITUDE REGARDING THE EMERGENCE OF CARDIOVASCULAR DISORDER IN RELATION TO MODERN LIFESTYLE AMONG ADULTS RESIDING AT SELECTED URBAN AREA IN BANGALORE WITH A VIEW TO DEVELOP AN INFORMATIONAL BOOKLET.”
SUBMITTED BY,
JINU THOMAS,
I YEAR M.Sc. NURSING,
KOSHY’S COLLEGE OF NURSING,
SY.NO. 31/1HENNUR-BAGALUR ROAD,
KADUSONNAPPANAHALLI,
KANNUR POST, BANGALORE.
Rajiv Gandhi University of Health Sciences, Karnataka
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the candidate andaddress / JINU THOMAS, 1 Year M.Sc.(N)
KOSHYS COLLEGE OF NURSING,
HENNUR-BAGALUR ROAD
KADUSONNAPPANAHALLI, KANNUR P.O,
BANGALORE-562149.
2 / Name of the Institution / KOSHYS COLLEGE OF NURSING
3 / Course of study and subject / 1Year M.Sc. Nursing
Medical-Surgical Nursing
4 / Date of admission to course / 18-06-2012
5 / Title of the topic / “ASSESSMENT OF KNOWLEDGE AND ATTITUDE REGARDING THE EMERGENCE OF CARDIOVASCULAR DISORDER IN RELATION TO MODERN LIFESTYLE AMONG ADULTS RESIDING AT SELECTED URBAN AREA IN BANGALORE WITH A VIEW TO DEVELOP AN INFORMATIONAL BOOKLET.”
6 .BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“As the arteries grow hard ,
The heart grows soft”.
William benkinson.
The heart is the engine of human life. Beating almost 100,000 times a day .more than 36 million times each year ,endlessly beating examines the heart as a muscle .pushing approximately five quarts of blood in an endless course to deliver to every cell of the human body.1
Cardiovascular diseases continues to be a major cause of morbidity and mortality in western societies approximately two out of three incidents of myocardial infarction (MI) occur without warning and of note ,one third of first MI’s are fatal ;20% of patients die out of hospitals and 13% die within the first 24-48 hours of hospitalization.2
When people move from a rural to an urban environment ,they become sedentary and or may adopt western life styles .Decreased physical activity and increased consumption of calories and saturated fat results in abdominal obesity ,insulin resistance and atherogenicdyslipidemia .These acquired metabolic abnormalities appear to have a synergistic effect on the development of cardiovascular disease in genetically predisposed individuals.3
Cardiovascular disorders are a generic term for disorders of heart and blood vessels. Over 64 million people some type of cardiovascular diseases .Although heart disease is primarily thought of as a disease affecting older adults ,it is third killer of adult ages between 25-44years and the second leading cause of death in adult ages between 45-64 years.4
Cardiovascular disorders comprises group of diseases of heart and the vascular system. The major conditions are coronary artery disease ,rheumatic heart disease ,and valvular diseases that continues to be an important health problem on many developing countries ,in India 2.27 million people died due to cardiovascular diseases (CVD) during 1990,prevalence of cardiovascular diseases is reported to be 2-3 times higher in urban population ,as compared to the rural population.5
The main risk factor of cardio vascular diseases is hypertension, cigarette smoking, and obesity, lack of physical activity, hyper lipidemia and high alcohol intake. Some researchers says that the risk of CVD is increased in association with a person displaying characteristics of type A behavior pattern including aggressiveness, competitive drive and chronic sense of time urgency.6
Coronary heart disease has its origin in childhood. High cholesterol levels measured in children and adolescents are indicative of concurrent atherosclerotic changes and probably predict adult coronary heart disease. Screening, children and adolescents or young adults for serum lipid levels in order to efficiently prevent premature adult coronary disease.7
Rheumatic fever is also a cause for heart diseases. Rheumatic fever appears to be a hypersensitivity reaction of group A Beta hemolytic streptococcal infection, in which antibodies are manufactured and it will react at specific tissue sites, especially the heart and the joints. Incidence is highest in children between ages 5 and 15, probably as a result of malnutrition and crowded living conditions. Later in life this leads to major valvular problem.8
There is also a higher rate of abdominal obesity among the urban population ,with urban men having a waist to hip ratio of 0.99 compared to 0.95 among rural men,these increases in body mass index and waist to hip ratio result in significant insulin resistance and dyslipidaemia.9
6.1.NEED FOR THE STUDY:
Many health prediction in 21stcentury, cardio vascular diseases topping the list of death and disability. 16.7 million Or 29.2% of total global deaths due to CVD were reported in 2009. About 80% of global cardio vascular diseases related deaths now occurring in developing countries, which covers most countries in Asia. The WHO estimates that 60% of world cardiac patients are from India.
In India ,according to World Health Report 2002, cardiovascular diseases will be the largest cause of death and disability by 2020 . In 2020 AD, 2.6 million Indians are predicted to die due to coronary heart disease which constitutes 54.1 % of all cardiovascular diseases deaths. Nearly half of these deaths are likely to occur in young and middle aged individuals (30-69 years). Currently Indians experience cardiovascular diseases deaths at least a decade earlier than their counterparts in countries with established market economies. The Global Burden of Disease study estimates that 52% of cardiovascular diseases deaths occur below the age of 70 years in India as compared to 23% in established market economies, resulting in a profound adverse impact on its economy. The contributing factors for the growing burden of cardiovascular diseases are increasing prevalence of cardiovascular risk factors especially hypertension, dyslipidemia, diabetes, overweight or obesity, physical inactivity and tobacco use. It is an area where major health gains can be made through the implementation of primary care interventions and basic public health measures targeting diet, lifestyles and the environment.19
The incidence of heart disease in India reported by different studies showed that, the prevalence of CAD has almost doubled in the rural area and increased nine fold in urban population. The incidence is higher in south India compared to North India. The result shows that the incidence of CVD in Trivandrum was 13.9%, Chennai 11% and Karnataka 12.63%. About two third of unexpected cardiac deaths occur without prior recognition of cardiac disease. 16
Cardiovascular diseases account for a large proportion of all deaths and disability worldwide. Global Burden of Disease Study reported that in 1990 there were 5.2 million deaths from cardiovascular diseases in economically developed countries and 9.1 million deaths from the same causes in developing countries. However, whereas about one-quarter of all cardiovascular disease deaths occurred in persons who were less than 70 years of age in the developed world, more than about half of these deaths occurred in those less than 70 years in the developing world.2 It has been predicted that by the year 2020 there will be an increase by almost 75% in the global cardiovascular disease burden. Almost all of this increase will occur in developing countries.22
The situation in India is more alarming. Reddy reported that mortality from cardiovascular diseases was projected to decline in developed countries from 1970 to 2015 while it was projected to almost double in the developing countries. In the Global Burden of Disease Study it was reported that of a total of 9.4 million deaths in India in 1990, cardiovascular diseases caused 2.3 million deaths (25%). 1.2 million deaths were due to coronary heart disease and 0.5 million due to stroke. It has been predicted that by 2020 there would be a11% increase.23
A study was conducted on Prevalence of Cardiovascular Disease in an Urban Population in India. A prevalence survey of cardiovascular disease was carriedout in a Indian town involving a house-to-house clinicaland electrocardiographic examination of all the 2,030 personsabove the age of 30 years residing in the area. The sample isconsidered adequate and representative of urban population ofIndia. The diagnosis of cardiovascular disease was based on history ofmyocardial infarction or angina pectoris and electrocardiographicabnormalities according to criteria used by Epstein and associates. Theprevalence rates of cardiovascular disease for men and women were similar to thosefound in Tecumseh. The prevalence of cardiovascular disease increased with age,with socio-economic status, with the sedentary nature of occupation,and in hypertensive’s. Those with cardiovascular disease were more obese than others,and the prevalence showed a positive correlation with subscapsularskin fold thickness in men. 62% of the men and88% of the women had clinically silent cardiovascular disease. No comparable publisheddata on prevalence of cardiovascular disease in the general population in Indiais available.18
A community based study was conducted to assess prevalence of rheumatic fever and rheumatic heart disease in urban Bangladesh. Echocardiography was done among 5923 urban Bangladeshi peoples aged 35-50 years. The results revealed that the prevalence of rheumatic heart disease was found 1.2 per 1000(95% confidence interval 0.3- 2.1). The study concluded that screening is necessary to detect rheumatic heart disease among adults. They suggest that timely treatment for the risk factors will prevent occurrence of rheumatic heart disease in future16.
Three types of preventions are advocated by WHO, Primordial, primary and secondary. In the case of Cardiovascular and hypertension scientists are now recommending primordial prevention as the best method of prevention.
The above studies shows clearly that, life style changes are a major cause of cardiovascular disease morbidity in urban areas. So the researcher found it relevant to assessing the knowledge of urban adults and to provide them with information booklet regarding emergence of cardiovascular disorder in relation to modern urban life style .
6.2 REVIEW OF LITERATURE:
Literature review is a key step in research process .Review of relevant literature is an analysis of research sources to generate a picture of what is known about a particular situation .The primary purpose of reviewing relevant literature is to gain broad back ground or understanding of the information that is available related to a problem in conducting research, the literature review facilitates selecting a problem and purpose , developing a frame work and formulating a research plan.17
In order to attempt this goal in the present study, an attempt has been made to review and discuss the related literature. In this study review of literature is classified in the following headings.
In this study review of literature is classified in the following headings
Section1-Studies and literature related to prevalence of emerging cardiovascular disorders among urban adult
Section 2 -studies and literature related to risk factors of emerging cardiovascular disorders
Section 3- Studies and literature related to knowledge regarding prevention and management of cardiovascular disorders.
Section 4 -Studies and literature related to attitude of emerging cardiovascular disease among urban adult
Section1-Studies and literature related to prevalence of emerging cardiovascular disorders among urban adult
An epidemiological survey was conducted to assess the prevalence of heart disease among selected urban population in South India. About 1399 samples, less than 20 years participated in the study. The result revealed that the overall prevalence of heart disease was 11%. The study concluded that the prevalence of heart disease is rising rapidly in urban India. Life style changes and aggressive control of risk factors are urgently needed to reverse this trend.1
A cross sectional survey was conducted to assess the prevalence of Ischemic Heart Disease (IHD) among urban population. A structured questionnaire was given to 350 samples aged below 40 years. The results revealed that the prevalence of IHD was 11.6% and one of the risk factor hypertension was 47.2%. The prevalence of IHD was higher among smokers, hypertensive people and persons with high BMI (Body Mass Index). The study concluded that the prevalence of heart disease and coronary risk factors is higher in the urban population.2
A study was conducted to assess the prevalence and riskfactors for General practitioners coronary artery disease in a native urbanSouth Indian population.Of the total of 1,399 eligible subjects (age 20 years), 1,262(90.2%) participated in the study. All the study subjects underwenta glucose tolerance test and were categorized as having normalglucose tolerance, impaired glucose tolerance ordiabetes. Twelve-lead electrocardiogram was performedin 1,175 individuals (84%). The overall prevalence rate of coronary artery disease is more in urban population in India.3
A comparative study was conducted on Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India. A cross-sectional survey of two randomly selected villages from the Moradabad district and 20 randomly selected streets in the city of Moradabad. The 3575 subjects were between 25 and 64 years old; 1769 (894 men and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived in the city. The survey methods were questionnaires, physical examination and electrocardiography. Results of the study was overall prevalence of coronary artery disease, based on a clinical diagnosis and an electrocardiogram, was 9·0% in the urban and 3·3% in the rural population. The prevalences were significantly higher in the men compared with the women in both urban (11·0 vs 6·9%) and rural (3·9 vs 2·6%) populations, respectively. Smoking was a significant risk factor of coronary disease in men.4
A study was conducted regarding the rising coronary artery disease in India based on Electrocardiogram defined coronary heart disease. Thirty one studies were reviewed. The sample sizes of the studies varied from approximately 500 to 14 000, with response rates generally over 90%. Results show that Prevalence range was higher in urban than rural areas in men (35–90/1000 v 17–45/1000) and women (28–93/1000 v 13–43/100.5
2Section -studies and literature related to risk factors of emerging cardiovascular disorders
A study was conducted to assess the life style related risk factors of cardio vascular diseases among Indian adolescents. Centers for disease control and prevention recommended questionnaire was administered to 866 adolescents aged 11-18 years. The study revealed that 8-12% of boys are smokers; 6-8% had taken alcohol at least once in the last month. About 13.6% of students said that there is no benefit of eating fruits and vegetables, 81.3% of the students were eating fast food, and 36.8% were taking carbonated drinks once in a day. The study concluded that life style related risk factors of Cardio vascular disorders are present in Indian adolescents. Preventive measures should be taken to prevent future burden.7
A study was conducted for finding out the risk factors of coronary artery disease among Navajo Indians. Interviews and examinations of 303 men and 485 women between the ages of 20 to 60 years were done. The study identified certain risk factors like over weight (men 35%, women 62%), diabetes mellitus (men 17%, women 25%), hypertension (men 23%, women 14%).A large proportion of men reported that they currently smoked cigarette (23%) and chew tobacco (men 37%, women 31%). The study identified fasting serum triglyceride and Low density lipoproteins are high and concentrations of High density lipoproteins were low. The study suggests that interventional activities may be useful in managing the risk factors to reduce the future burden of Coronary artery disease.8
Cross sectional study was conducted by purposive sampling method among six hundred jat women 300 urban and 300 rural of Haryana India to assess age related trends of blood pressure and prevalence of hypertension as well as correlation of blood pressure with obesity indicators .The results revealed an age associated increase in mean values of systolic and diastolic blood pressure in rural and urban women.9
A cross sectional study was conducted to assess the prevalence and risk factors for coronary artery disease in an urban community in Tenali ,Andhra Pradesh .A survey was carried out in two localities of Tenalitown,namelyGandhinagar and Nazarpet between july 2009 and October 2009 .A total of 534 people aged 20yrs and above in randomly selected houses in each street of the two localities were examined .All of them underwent glucose tolerance test and lipid profile estimation and a 12 –lead electrocardiogram observations from their community based study indicated that prevalence of CAD in urban Andhrapradesh is alarmingly high as observed in other parts of India and urgent steps are to be taken to adopt life style changes and to control risk factors .10
The epidemiological study was conducted at urban middle class locations according to municipal records in years 2009-10 to find out risk factors of cardiovascular diseases .Stratified random sampling using house to house survey was performed .The results showed that among the 739 subjects (men 45 women 288,response 67%) age adjusted prevalence of risk factors in men and women respectively was smoking 95 (21.1)and 12 (4.2).,low physical activity 316(69.6)and 147 (52.3)high fat intake >or =20gm /day 278 (73.4) and 165 (76.4),over weight /obesity 205 (46.2) and 142 (50.7),high waist size 58(129) and 76 (26.6),hypertension 177(39.5)and 71 (24.6),high total cholesterol >or=200mg/dl 148 (33)and 93 (32.7),low HDL cholestrol<40/50mg/dl 113 (25.1)and 157 (55.3)diabetes 62 (15.5)and 25 (10.8) and metabolic syndrome 109 (25.1) respectively .It concluded that there is a high prevalence of multiple cardiovascular risk factors in Indian middle class individuals.8
Section -3. Studies and literature related to knowledge regarding prevention and management of cardiovascular disorders.
A study was conducted to assess the importance of a healthy diet to prevent cardio vascular diseases. The sample were grouped under various levels of intake of saturated and Trans fatty acids, fruits, vegetables and fish. The result indicate that fish and fruits contributed decreased number of cardio vascular diseases .The study concluded that daily intake of fruit, vegetables ,fish take away as much as20-30% of the burden of cardio vascular diseases and result in approximately one extra life year for a 40 years old individual.11
A study was conducted on Management of hypercholesterolemia is a popular method for reducing the risk for coronary artery disease .Elevated cholesterol levels are just one of several risk factors for coronary artery disease; others include cigarette smoking, high blood pressure, lack of physical activity, high levels of dietary fat intake and obesity. More than 35 percent of all adults between the ages of 20 and 74 years of age are suitable candidates for advice on improving cholesterol levels.The Researcher conclude that Physicians should continue to advise patients to limit total dietary fat intake, if diet alone is unsuccessful, drug therapy may be required.12