Documente Academic
Documente Profesional
Documente Cultură
o Introduction:
Eat to live and dont live to eat
Digestive system is the food processing system of human body. The whole
digestive system is in the form of a long, hollow, twisted and turned tube, called the
alimentary canal, which starts from the oral cavity and ends at the anus.1
Digestion is the chemical breakdown of large food molecules into smaller
molecules that can be used by cells. The breakdown occurs when certain specific
enzymes are mixed with the food.2 The stomach secretes digestive juices which help
in digestion of food. Digestive juices contain gastric acid (hydrochloric acid) and the
enzyme pepsin. The stomach and the duodenum digest every food item which passes
through them to absorb nutrients from it, the duration and the digestion quality differs
from person to person.3
A peptic ulcer, also known as ulcus pepticum, PUD or peptic ulcer disease, is an
ulcer defined as mucosal erosions equal to or greater than 0.5 cm of an area of the
gastrointestinal tract that is usually acidic and thus extremely painful.4
An ulcer may form in any part of the digestive tract, which is exposed to acid
gastric juice. It is usually found in the stomach (gastric ulcer) and the duodenum
(duodenal ulcer). Peptic ulcers results from hyperacidity in the stomach dietic
indiscretion like over eating, taking of heavy meals or highly spiced foods, coffee,
alcohol, smoking, ingestion of certain drugs particularly aspirin, food poisoning
(campylobacter food poisoning) infections like influenza, septicemia, gout, antiinflammatory drugs, Helicobacter pylori infections.5
More and more people are suffering from digestive disorders these days. Peptic
ulcer is the leading one resulting from poor diets, unhealthy lifestyles and the use of
caffeine, cigarettes and alcohol. Even milder forms of ulcer may endanger a persons
life if the disorder is not appropriately treated. 4
According to the latest WHO data published in April 2011 Peptic Ulcer
Disease Deaths in India reached 108,392 or 1.20% of total deaths. The age adjusted
Death Rate is 12.37 per 100,000 of population ranks India #5 in the world. According
to this study adolescents of the age group16-20yrs are affected by peptic ulcer.6
In the United States there are approximately 100,000 new cases and 4 million
recurrences of peptic ulcer diseases yearly. The one-year point prevalence of Peptic
ulcer diseases in the U.S is about 1.8% of a life time prevalence of 8-14%. Estimated
annual direct costs for Peptic ulcer diseases are $3.3 billion with additional costs of
6.2 billion .Peptic ulcer disease due to H. pylori is unlikely to have its initial
presentation at age 50 years.7
In Western countries H. pylori infects about 20% at age 20, 30% at age 30, 80%
at age 80. Prevalence is higher in third world countries where it is estimated at about
70% of the population, whereas developed countries show a maximum of 40% ratio.8
Approximately 25 millions Indians are suffering from peptic ulcer disease at
some point in their life time. Duodenal ulcers are 5 to 10 times more common than
gastric ulcers. The incidence for duodenal ulcer is 30 to 60 years of age. The male and
female ratio is 3:1. The incidence of gastric ulcer is usually 50years of age and over. It
affect male and female in the ratio of 2:1.each year there are 500,000 to 850,000 new
cases of peptic ulcer disease and more than 1 million ulcer related hospitalizations.9
In Kashmir, The point prevalence of peptic ulcer was 4.72% and the life time
prevalence was 11.22%. The prevalence of peptic ulcer increased with age, with a
peak prevalence of 28.8% in the fifth decade of life. Peptic ulcer was not related to
socio economic status.10
Nowadays youngsters are attracted towards ready to eat food and fried foods, this
attitude among youngsters render their nutritional status to be imbalanced. Hence due
to these causes the rate of peptic ulcer diseases is on the rising stride. Sometimes these
ulcerative diseases tend to take another route i.e they might tend to become malignant.
So youngsters need to eat some natural foods which have got more nutrients and
which is more healthy and nutritious and yields more energy.
Health is wealth with poor health we will lose all wealth .So it is important to
live a healthy life to save and enjoy our wealth.
Assessment of knowledge of adolescents regarding the disease will help the
nursing personnel to plan and carry out health education training programs related to
2
specific disease to enhance their awareness and takes proper precautions to prevent
the occurrence of disease, to reduce the morbidity and mortality rate caused by peptic
ulcer. The literature review has revealed that awareness of peptic ulcer is essential for
preventing it in future life time. Hence the researcher is interested in increasing
awareness of adolescents to prevent the occurrence of peptic ulcer disease.
these literatures and work experience, as a researcher, I have decided to take up this
study in view to those belonging to adolescent group derive necessary knowledge
about risk factors and prevention of peptic ulcer and decided to provide the self
instructional module.
o Research problem:
A study to assess the effectiveness of Self Instructional Module (SIM) on knowledge
regarding risk factors and prevention of peptic ulcer among adolescents (10-19yrs) in
selected senior secondary schools of Patiala, Punjab.
o Aim of study:
To assess the effectiveness of Self Instructional Module (SIM) on knowledge
regarding risk factors and prevention of peptic ulcer among adolescents (10-19yrs).
o Objectives:
1. To assess the level of knowledge regarding risk factors and prevention of peptic
ulcer among adolescents (10-19yrs) before and after administration of Self
Instructional Module.
2. To assess the effectiveness of Self Instructional Module on risk factors and
prevention of peptic ulcer among adolescents (10-19yrs).
3. To associate pretest knowledge regarding risk factors and prevention of peptic
ulcer among adolescents (10-19yrs) with their selected sociodemographic
variables.
o Operational definitions:
Assess: It refers to measure the knowledge of adolescents (10-19yrs) regarding
risk factors and prevention of peptic ulcer.
Effectiveness: The extent to which the self instructional module on risk factors
and prevention of peptic ulcer achieve its desired effect in improving the
knowledge of adolescents.
5
o Hypothesis:
H1:
The mean post-test knowledge scores of adolescents regarding risk factors and
prevention of peptic ulcer will be significantly higher than their mean pretest
knowledge scores.
H0:
adolescents regarding risk factors and prevention of peptic ulcer with their selected
sociodemographic variables.
o Assumptions:
1. Adolescents (10-19yrs) will possess some knowledge regarding risk factors and
prevention of peptic ulcer.
2. Adolescents (10-19yrs) knowledge will increase after the administration of selfinstructional module regarding risk factors and prevention of peptic ulcer.
o Delimitations:
The study is delimitated to adolescents (10-19yrs) in selected senior secondary
schools of Patiala, Punjab.
patients. Patients who took spicy food had a significantly higher rate of H.pylori
infection positivity (p=0.04). It was concluded that the prevalence of H.pylori
infection is similar in duodenal and gastric ulcer and intake of spicy food is a risk
factor for peptic ulcer. 18
Lee KM et al conducted a cohort study in South Korea to evaluate the relationship
between peptic ulcer disease (PUD) and acute pancreatitis. A total of 78 patients with
acute pancreatitis were included in this study. Results revealed that among 78 patients,
41 patients (52.6%) with acute pancreatitis suffered from PUD, but only 13 (31.7%)
patients with PUD were infected by H. pylori. The study concluded that patients with
acute pancreatitis are liable to suffer from PUD. 19
7
disorders
were
associated
with
Peptic
ulcer
that
disease.
Specifically, generalized anxiety disorder (GAD) (Odds ratio (OR) = 3.43) was
most associated with peptic ulcer disease, followed by panic disorder (OR = 3.11),
Dysthymia (OR = 3.59), and bipolar disorder (OR = 2.91). It was concluded that
mood /anxiety disorders are associated with increased rates of Peptic ulcer disease;
nicotine and alcohol dependence seems to play a substantial role in explaining the link
with Peptic ulcer disease. 20
Aro P et al conducted a study in Kalix Hospital, Sweden to explore the prevalence,
symptomatology and risk factor for peptic ulcer in a general adult population. A
random sampling was done. The prevalence of peptic ulcer was 4.1% (20 gastric
ulcers and 21 duodenal ulcers). The results have shown that eight subjects with
duodenal ulcer (38%) lacked evidence of current Helicobacter pylori infection.
Smoking, aspirin use, and obesity were risk factors for gastric ulcer; smoking, lowdose (160 mg) aspirin use, and Helicobacter pylori infection were risk factors for
duodenal ulcer. 21
Kanbay M et al undertook a study to determine the relationship between H. pylori
and ABO/Rhesus blood groups, age, gender, and smoking. Blood samples were tested
for H.pylori antibodies, and ABO/Rhesus blood group antigen typing was performed.
Prevalence of all blood groups were O (29.2%), A(38.2%), B(17.8%), and
AB(14.8%). Patients in blood groups A and O were more prone to H. pylori infection
than were patients in other blood groups (P<0.05), and patients in the AB blood group
were less prone to H. pylori infection compared with patients in other blood groups
(P<0.05). The results demonstrates that H. pylori infection can be related to ABO
blood group, age, gender and smoking. 22
Mitani K et al carried out a prospective study among 52 patients with H. pylori
infection and 34 patients without H. pylori infection. The results shows that Gastric
ulcers developed in 8 (15%) of 52 patients with H. pylori infection, but not in patients
8
without H. pylori
increases the risk for development of gastric ulcers and gastric ulcers developed
through the progression of H. pylori-associated gastric mucosal atrophy. 23
Stevanovic D and Ivanisevic V carried out a comparative study to evaluate the risk
factors among 2 group of patients. First group consisted of Patients with acute gastric
or duodenal
peptic ulcer bleeding. In both groups the anterior wall of the duodenum is the most
Common localization. In this group of patients there was a high percentage of
penetrating ulcers (62.5%) with active arterial bleeding. The presence of Helicobacter
pylori infection is statistically significant higher in the group of patients with bleeding
peptic ulcers. It was concluded that age of patient, localization of ulcer, diameter and
Helicobacter pylori infection are very important and well known risk factors for the
development of bleeding peptic ulcer. 24
Jain A et al conducted a study to evaluate the association of various risk factors such
as smoking, alcohol, NSAIDs, inadequate dietary intake of fibers and consumption of
spicy foods with chronic duodenal ulcer in Maulana Azad Medical College, New
Delhi. A total of 16 consecutive patients with endoscopically proven duodenal ulcer
(DU) constituted the test group while 160 subjects with non-ulcer dyspepsia (NUD)
were recruited as controls. Results shows that there were significantly greater number
of smokers (80%) and alcoholics (58%) in the male population of duodenal ulcer
group as compared to the controls (49% smokers & 15% alcoholics). Similar trend
was seen in relation to history of chronic exposure to NSAIDs (29% in duodenal
ulcer & 11% in non-ulcer dyspepsia) and inadequate intake of fiber in diet (66% and
39% respectively). It was concluded that in North Indian subjects, alcohol
consumption, smoking, inadequate intake of fiber in diet and use of NSAIDs are the
risk factors associated with duodenal ulcer disease. 25
Svanes C et al undertook a study to assess the role of smoking in ulcer perforation.
Sample consists of total of 168 consecutive patients with gastroduodenal ulcer
perforation and 4469 control subjects from a population based health survey. The
results shows that Current smoking increases the risk for ulcer perforation 10-fold in
the age group 1574 years (OR 9.7, 95% CI 5.9 to 15.8) and there was a highly
9
Chapter-III: Methodology
o Research Approach:
Quasi-experimental study approach will be adopted in present study.
o Research design:
One group pretest-post test design
Group
Intervention(X)
Adolescents (10-
Assessment of
Administration of
Assessment of
self instructional
knowledge
selected senior
module regarding
regarding risk
factors and
of Patiala,
prevention of
prevention of
prevention of
Punjab.
adolescents (10-
adolescents (10-
adolescents (10-
19yrs).
regarding risk
o Research setting:
The study will be conducted in selected senior secondary schools of Patiala,
Punjab.
o Target population:
Adolescents (10-19yrs) studying in selected senior secondary schools of Patiala,
Punjab.
11
o Sample size:
Total sample of the study will consists of 60 adolescents studying in selected
senior secondary schools of Patiala, Punjab.
o Sample technique:
Simple random sampling
o Sampling criteria:
Inclusion criteria
1. Adolescents who are available at the time of data collection.
2. Adolescents who are willing to participate in the study.
o Selection and development of tool:
A structured Knowledge questionnaire will be used as a tool for the present study.
Tool will be selected after reviewing the related literature and after the consultation
with the expert.
o Description of tool:
Tools for data collection are divided into following categories:
Part I: Items on demographic variables will be listed under sociodemographic data.
Part II: Items on knowledge regarding risk factors and prevention of peptic ulcer will
be listed under structured knowledge questionnaires.
o Validity of the tool:
The content validity of the tool will be established in consultation with the
expert.
o Ethical consideration:
Ethical clearance will be obtained from Institutional Ethical Committee (IEC)
and the permission will be obtained from the selected senior secondary schools for
data collection.
Anonymity and confidentiality of the study participants will be maintained.
o Plan for data analysis:
The data obtained will be analyzed in terms of terms of the objective of the
study using descriptive and inferential statistics.
Descriptive statistics:
To describe demographic variable by percentage, mean, mode, median and
standard deviation.
Inferential statistics:
1. Paired t test to find significance of difference between the pre test and post test
mean knowledge score of adolescents (10-19yrs) on risk factors and prevention of
peptic ulcer.
13
2. Chi square test to determine the association between the knowledge regarding risk
factors and prevention of peptic ulcer among adolescents ( 10-19yrs) with selected
demographic variables.
14
FIGURE:
SCHEMATIC
PRESENTATION
METHODOLOGY
15
OF
RESEARCH