RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE KARNATAKA BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address (in block letters) / VINOD R.CITY COLLEGE OF NURSING
SHAKTHINAGAR
MANGALORE - 575016
2. / Name of the Institution / CITY COLLEGE OF NURSING
SHAKTHINAGAR
MANGALORE- 575016
3. / Course of Study and Subject / M. Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the Course / 4.6.2008
5. / Title of the study
ASSESSMENT OF KNOWLEDGE AND FACTORS INFLUENCING GASTRITIS AMONG STUDENTS OF SELECTED COLLEGES AT MANGALORE WITH A VIEW TO PROVIDE A PAMPHLET.
6. / Brief resume of the intended work
6.1 Introduction
Gastrointestinal system is one of the systems of our body which has a relation with diet. Upper gastrointestinal inflammatory process is exceedingly common and has a wide spectrum of cause and manifestation. Gastric disorders are common; unless treated promptly and completely, they can continue to cause problems throughout the person’s life. Clients need assistance to learn a new way of eating in order to achieve and maintain health and to make necessary lifestyle changes.1
Gastritis, an inflammation or irritation of the lining of the stomach, can be a brief and sudden illness (acute gastritis) , a long lasting condition (chronic gastritis) , or a special condition and occasionally rare form of gastritis can be serious or even life-threatening, due to ongoing symptoms or internal bleeding.2 Gastritis, which is caused by Helicobacter pylori (H. pylori) and the risk factors like smoking, alcohol consumption, tobacco use, spicy food, drugs, stress, swallowed foreign bodies, and infections, causes excessive inflammation, irritation of mucous membrane and excessive gastric secretion that rupture and inflame the stomach mucosa and lead to the manifestations of gastrointestinal tract dysfunction.3 The frequent usage of alcohol, smoking, drug, tobacco, excess stress and spicy diet will affect the normal lining of mucosa in stomach. It will break the lining of stomach mucosa and the affected person will get abdominal pain, indigestion, nausea, vomiting and burning pain in epigastric region.4
Adolescence is the time of transition from childhood to adulthood. During this period lots of physical and psychological changes take place. As a result the blooming buds of future face a dilemma in their life. Moreover, this brings stress and tension. While majority of youngsters overcome their problems, others attempt lifestyle modification. The factors like peer group pressure and excess freedom attributes lifestyle changes through alcoholism, smoking, tobacco and spicy food influence the occurrence of gastritis. 5
6.2 The need for the study
Gastritis is a common medical problem. Up to 10% of people who come to a hospital emergency department with an abdominal pain, have gastritis. The incidence of gastritis in India is approximately 3 in 869 that is about 12,25,614 people suffering from gastritis out of the total 1,06,50,70,607 population. The seroprevalence studies from Delhi, Hyderabad and Mumbai have shown that by ten years of age more than 50% and by 20 years more than 80% of population is infected with gastritis.6
Gastritis caused by H. pylori. Up to 9 out of 10 gastritis is caused by bacterial invasion with H. pylori. The studies among adults conducted in Bangalore have shown high prevalence of H. pylori (78%) and similar study conducted in Allahabad has shown a 77.2% of prevalence of H. pylori among adults aged 19-26 years. All
the studies have shown that H. pylori infection is very common in India and most of the adult population is infected.7 A study was conducted to find out the nature and extent of gastritis in symptomatic Chilean adolescents with H. pylori-associated gastritis. The study sample consisted of 73 patients aged between 14-20 years referred for upper gastrointestinal endoscopy. The study findings revealed that 60 patients (83%) had histological chronic gastritis of the antrum and in 45 (63%) the lesion also involved the gastric corpus, 90% of patients with chronic gastritis were colonised by H. pylori. The study concluded that there was a high prevalence of extensive lesions of H. pylori associated chronic gastritis in adolescent patients.8
The study was conducted to investigate the association of H. pylori and Aden carcinoma in Taiwan. Data was collected from 823 subjects – 92 healthy volunteers, 117 patients with gastritis, and 148 with gastric Aden carcinomas. The study finding showed that 54.4% was seropositivity cases, 83.8% of gastritis patients had a higher seropositivity than healthy volunteers (63.01%) and gastric Aden carcinoma patients (63.2%) (p< 0.01%). The study recommended that the seropositivity of H. pylori patients was higher than in healthy volunteers only in younger age, and there was a need to conduct health education programmes for younger age groups regarding gastritis. 9
Gastric problems can also impair psychological development and negatively influence environment and leisure time.4 It is reported that an individual’s personal problems (e.g. reduced performance at school and college) , relationship problems (quarrel or arguments) , and delinquency problems (scuffle and fight) may lead to gastritis.10 A comparative study was conducted to find out the association of smoking and upper gastrointestinal lesions at Government Medical College, Patiala, Punjab. The sample size comprised of 80 college students (40 smokers and 40 non-smokers) , selected by simple random sampling. The data was collected by structured questionnaire and upper gastrointestinal endoscopy (UGI). The findings of the study revealed that significantly more oesophagitis (23%) , gastritis (45.8%) and duodenal lesions (17%) were seen in dyspeptic smokers than in dyspeptic non-smokers (7.5%, 18.5% and 10% respectively). The study concluded that dyspeptic smokers have significantly higher incidence of UGI lesions than dyspeptic non-smokers and that there is a cumulative effect of increase in smoking on the severity of these lesions. 11
From the above literature, it is clearly evident that most of changes in lifestyle patterns are adopted during the period of adolescence. Gastritis can be cured with appropriate antibiotic treatment. However, many healthcare providers do not treat gastritis patient with antibiotics rather than by lifestyle modification. As global health programme in the 21st century, it is necessary to explore alternative approaches to provide better health services to people. Hence the investigator was motivated to carryout a study on the assessment of knowledge and factors influencing gastritis among college students. The focus of nursing intervention is education and modification of client’s behaviours to promote health and lifestyle pattern with a view to provide a pamphlet.
6.2 Review of literature
A study was to find out the association of H. pylori infection with lifestyle, chronic disease, body indices and age at menarche in Danish adults. Random sampling technique was used to select 3,608 Danish adults. The data was collected by questionnaire about lifestyle factors. The finding of the study revealed that the seroprevalence of H. pylori infection was associated with weekly alcohol intake 6 drinks (odds ratio 0.7, 95% confidence interval 0.6-0.9) due to a low rate of H. pylori infection among wine drinkers (odds ratio 0.6, 95% confidence interval 0.5-0.7). No association was found with smoking habits or serum lipids. People with upper quartile BMI (body mass index) 26.8 kg/m2 were more likely to be seropositive for antibodies to H. pylori (odds ratio 1.6, 95% confidence interval 1.1-2.4). The likelihood of being seropositive for IgG antibodies to H. pylori increased with age at menarche (odds ratio per year 1.10, 95% confidence interval 1.02-1.19). The study concluded that the seroprevalence of H. pylori infection is increased in people with alcoholic, smoking people and with high BMI, it may evaluate to history of late menarche in Danish women.12
A study was conducted to find out the relationship of smoking with H. pylori incidence in gastritis patients at Indira Gandhi Medical College in North India. The sample size comprised of 300 patients (143 cases (47.7%) were males and 157 cases (52.7%) were females) of gastritis, selected by simple random techniques. The data was collected by structured questionnaire. The finding of the study revealed that smokers were 99, out of which 64 (64.64%) were H. pylori positive and among non-smokers 113 (56.21%) were H. pylori positive. The difference in incidence of H. pylori infection among smokers and non-smokers was not much (P > 0.1). The study concluded that the incidence of H. pylori positivity was high among smokers than non-smokers.13
A cross-sectional study was conducted to examine the association between lifestyle factors and development of gastritis among H. pylori-seropositive Japanese in Brazil. The sample size comprised of 291 seropositive individuals (129 males and 162 females) between the ages 18 to 25 years. The sample for the study was selected by simple random sampling. The data was collected using self-administered questionnaire. The study findings revealed that the prevalence of gastritis was 31.9% (95% confidence intervals, 26.6%–37.6%). The proportion of subjects with gastritis increased with age, the association with smoking and alcohol drinking were significant. The length of education was inversely associated with gastritis, while infrequent rice intake was preventive, odds ratio relative to everyday rice intake was 0.13 (95% confidence intervals, 0.39-0.46). The study concluded that frequent rice intake was a risk factor for developing gastritis among the H. pylori infected Japanese.14
A prospective study was conducted to find out the effect of smoking, alcohol and diet on the development of gastritis among American men of Japanese ancestry in Hawaii. The sample comprised of 7,624 American men who were selected randomly. After 1,49,291 person-year of observations, there were 2,801 incidents of gastritis and gastric ulcer. The risk of gastritis progressively increased with excess use of cigarette smoking and due to diet problems. In contrast alcohol was associated with this type of gastritis. The study concluded that the risk of gastritis was positively associated with use of alcohol, table salt/soy sauce and smoking.156.3 Statement of the problem
Assessment of knowledge and factors influencing gastritis among students of selected colleges at Mangalore with a view to provide a pamphlet.
6.4 Objectives of the study
1. To determine the level of knowledge among college students regarding gastritis by structured knowledge questionnaire.
2. To identify the factors influencing gastritis among college students by a rating scale.
3. To find out the relationship with knowledge and factors influencing gastritis among college students.
4. To find out the association with knowledge score and selected demographic variables of college students.
5. To find out the association with factors influencing gastritis and selected demographic variables of college students.
6.5 Operational definitions
1. Knowledge: In this study, knowledge refers to the scores gained by the college students after giving correct responses to knowledge questionnaire.
2. Factors influencing: In this study, influencing factors are circumstances (alcoholism, smoking, spicy food, drug use, stress) whose presence is associated with increased probability of the occurrence of gastritis.
3. Pamphlet: It is used as a learning device for college students to understand gastritis, factors influencing, signs, symptoms and tips on prevention of gastritis.
4. College students: In this study the college students who are studying in the University level of education and refer to both boys and girls in age group of 17-25 years.
6.6 Assumptions
The study assumes that:
· College students will have some knowledge regarding gastritis.
· College students will have one or the other factors influencing gastritis
· Influencing factors have a role in the development of gastritis.
6.7 Delimitations
· The sample size of 100 students studying in selected colleges in the age group of 17-25 years at Mangalore.
6.8 Hypotheses
The hypotheses will be tested at 0.05 level of significance.
H1: There will be significant relationship with the knowledge score and scores of factors influencing gastritis.
H2: There will be significant association with knowledge score and selected demographical variables.
H3: There will be significant association with scores of factors influencing gastritis and selected demographical variables.
7. / Material and methods
7.1 Source of data
In this study the data will be collected from college students studying in selected colleges at Mangalore.
7.1.1 Research design
Descriptive correlative research design.
7.1.2 Setting
The study will be conducted at selected colleges in Mangalore.
7.1.3 Population
Population includes students studying in colleges in the age group of 17-25 years at Mangalore.
7.2 Method of data collection
7.2.1 Sampling procedure
Sampling technique for the present study will be proportionate stratified random sampling technique.
7.2.2 Sample size
The sample size will be 100 students.
7.2.3 Inclusion criteria for sampling
· Students studying in selected colleges at Mangalore.
· Students in the age group of 17-25 years.
· Students who are willing to participate in study.
· Students who are studying University level of education.
7.2.4 Exclusion criteria for sampling
· Students from medical, nursing and paramedical courses.
7.2.5 Instruments intended to be used
· Structured knowledge questionnaire.
· Rating scale to assess factors influencing gastritis.
7.2.6 Data collection method
· Permission will be obtained from concerned authorities of the selected colleges.
· Individual consent will be taken from college students.
· Participant’s present level of knowledge will be determined by administering a structured knowledge questionnaire and factors influencing gastritis will be assessed by administering rating scale.
7.2.7 Plan for data analysis
1. Data will be analysed using mean, median and standard deviation.
2. The relationship with knowledge and factors influencing will be analyzed using Karl-Pearson correlation coefficient.
3. The association with knowledge, factors influencing and demographical variables will be analysed using chi-square test.
7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.
Yes, the investigator needs to assess the knowledge and risk factors influencing gastritis among college students.
As an intervention, a pamphlet on gastritis, factors influencing gastritis and preventive measures of gastritis will be provided.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from authority.
8. / References
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2. Brunner, Suddarth. Textbook of medical surgical nursing. 11th ed. Philadelphia: Lippincott Publishers; 2008.
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4. Black JM. Medical surgical nursing. 7th ed. Philadelphia: Elsevier Publications; 2004.
5. Balachandran M. psychology for nursing students. Maanas Publication.
6. Olga. Gastritis staging. International Journal of Surgical Pathology 2008;16(2):150-4.
7. Poddar U, Thapa BR. H. pylori infection. An Indian perspective. Available from: URL:http://
8. Kato I. Helicobacter pylori and infection. Journal of Gastroenterology and Nutrition 2004 Jun;39(supplement 2):s626-31.
9. Madaan HK, Guptha MM, Sachdeva S. Upper gastrointestinal lesion in smokers – an endoscopy study. Available from: URL:http://www3.interscience.wiley.com./journal/118801147/-cl.
10. Effects of stress. Herald of Health 2007 Aug;4-9.
11. Beirness. Alcohol tolerance in social drinkers: operant and classical conditioning effects. Psychopharmacology;84:393-7.
12. Rossenstock SJ. Association of H. pylori infection. Scandinavian Journal of Public Health 2000;28(1):32-40.
13. Rajashekhar V. Helicobacter pylori infection in chronic smokers. Trop Gastroenterology 2000;71-2.
14. Springer. Lifestyle factors associated with gastritis. International Journal of Clinical Oncology 2003 Dec; 8(6):362-8.
15. Guiralder E, Pena A. Nature and extent of gastritis lesion-H pylori-associated
Gastritis. Available from: URL:http://