RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

MRS. ARYA BEN MANIYAN,1ST YEAR MSc NURSING, THE OXFORD COLLEGE OF NURSING,NO 6/9 & 6/11, 1ST CROSS,BEGUR ROAD, HONGASANDRA,BENGALURU- 560068.

2. NAME OF THE INSTITUTION

THE OXFORD COLLEGE OF NURSING,NO 6/9 & 6/11, 1ST CROSS,BEGUR ROAD, HONGASANDRA,BENGALURU - 560068.

3. COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSING,

MEDICAL SURGICAL NURSING.

4. DATE OF ADMISSION TO THE COURSE

27 .10 .2009

5. TITLE OF THE TOPIC A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON RISK FACTORS AND PREVENTION OF CORONARY ARTERY DISEASE AMONG MALES IN SELECTED URBAN COMMUNITY, BENGALURU.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“To keep the body in good health is a duty... otherwise we shall not be able to keep

our mind strong and clear.” 

-Buddha

Health is ever changing and has the potential for ranging from high level

wellness to extremely poor health. Wellness is indicated by the capacity of the person to

perform to the best or her ability, a reported feeling of well being and a feeling that

“everything is together” and harmonious. Health is seen as resulting from health

promotion strategies including multiphase screening, genetic testing, lifestyle

monitoring programme, environmental and mental health program, risk reduction,

nutrition and health education. The term illness refers to deviation from the normal

health1.

Coronary heart disease is a leading factor causing morbidity and mortality, both

in the developing and developed countries around the world. Angina pectoris (Chest

pain caused by insufficient blood supply to the heart) and acute myocardial infarction

(Heart attack) are the two most common features of coronary heart diseases, also known

as coronary artery disease2.

Coronary artery disease has probably affected human beings throughout history.

But it is only in the last century or so that it has emerged as a leading cause of death 3.

Coronary artery disease (CAD) has been often considered an affluent persons disease. It

is caused by easy and sedentary lifestyle, high calorie and high fat diet4.

The Kaiser Study showed that hospitalisation rate for heart disease among

Indian patients was four times higher than the rest of its America. High rates of

coronary artery disease have been observed among Indians living in other countries.

Indians living in the subcontinent have caught up with high rates observed among

Indians living abroad. Recent studies have found that prevalence of heart disease in

North India and Chennai to be 10% and 11% respectively. Slightly higher than the 10%

rate among Indian participants in the American-based coronary artery disease study4.

It is estimated that 60 million Americans have cardiovascular disease,

approximately 1/5 of the population. Over 1 million acute myocardial infarctions occur

yearly, of which 1/3 are recurrent and almost 20-30% are manifest as sudden death.

Cardiovascular disease is the largest cause of out of hospital death. The majority of

cardiovascular disease events occur in subjects over 65, the aging of the population in

the US and throughout the world heralds a continuing rise of coronary artery disease

prevalence5.

According to World Health Organisation (WHO) bulletins, 1.2 million Indians

died from heart disease in 1990 and it predicts that by 2010, 100 million Indians will

have heart disease (25% of all cardiac patients globally) and by 2020, India will

supersede all other nations in terms of CAD prevalence. A vegetarian diet can be

strongly cardio protective, if done right, but the Indian vegetarian diet typically has

large amounts of saturated and trans fats, along with high glycaemic carbohydrates.

Vegetarian and non-vegetarian Indians have similarly high rates of coronary artery

disease. However, coronary artery disease rates among rural Indians is absent half that

among urban Indians despite higher rates of smoking amongst villages4.

Second trait of coronary artery disease amongst Indians is its severity. A British

study found that, among patients with myocardial infarction, Indians suffered a higher

rate of cardiac arrest before reaching the hospital than patients from other ethnic groups.

Serious forms of coronary artery disease, especially left main coronary artery disease

and three-vessel disease are twice as common among Indians as in whites, and more

common among Indian men4.

High homocysteine levels are associated with improper diet and cooking

practices, while high levels of C- reactive protein are associated with abdominal obesity

and physical inactivity. Real impact of obesity and diabetes is through cardiovascular

disease and hypertension4.

A population strategy of prevention is needed to complement the high risk

approach in Indians, as is true in any other population. This experience should be

utilised to the fullest to reduce the averages of coronary artery disease in the Indian

subcontinent. Since atherosclerosis has its origin in childhood, preventive strategies

should also begin as early in life as possible, through it is probably never too late4.

6.1 NEED FOR THE STUDY

“Use your health, even to the point of wearing it out. That is what it is for. Spend all

you have before you die; do not outlive yourself.”

-Bernard Shaw

Coronary artery disease has a high prevalence in Asian Indian. The acute

myocardial infarction or ischemic heart disease is rapidly increasing in India and in

developing countries.Cardiovascular diseases are predicted to be one of the major

causes of death in the country in future. Coronary artery diseases will take epidemic

proportion by 2015. Half of deaths in India are likely to be caused by coronary artery

disease. It will overtake infectious diseases as most common cause of disease in the

country. The predisposition to the disease is six times more than the West and 20 times

than the Chinese4.

By the year 2015, cardiovascular disease could be the most important cause of

mortality in India. The prevalence of coronary artery disease increased from 1% in 1960

to 9.6% in 1995 in urban populations and in rural areas it has almost doubled in the last

decades6.

According to the World Health Organization (WHO) estimates, in 2004, 17.1

million people around the world died from cardiovascular disease and the number is

expected to grow to 23.4 million in 2030. Chest pain is the most common initial

symptom in patients diagnosed with coronary artery disease. "Non-specific" chest pain

was the fourth most common cause of emergency visits, which accounted for 1.6

million visits in 23 selected states in US, in the year 2005, according to the latest news

and numbers from the Agency for Healthcare Research and Quality4.

About one-fifth of the cases who approached the emergency department with the

complaint of chest pain in the US, just 5-15% found to be heart attacks and other

cardiac diseases. In countries like India, a sizable number of people seek emergency

services with "Chest Pain" as the chief complaint. Therefore, it would be important to

study the risk factors affecting the survival rate for those patients who sought the

emergency services with chest pain as the chief complaint4.

Specific risk factors for Indians are obesity, uncontrolled diabetes, insulin

resistance, high triglyceride, low HDL cholesterol, high blood pressure and smoking. 13

to 17 percent of the Indian population suffers from metabolic syndrome. While the

incidence is coming down in West it is rising in India. This is due to the deficiency in

our system.Indians have been known to have a higher prevalence of coronary artery

disease in presence of low rates of traditional cardiac risk factors like obesity, smoking,

cholesterol and hypertension. Of course, some other traditional risk factors

e.g., diabetes, physical inactivity, low HDL levels and also emerging risk factors like

lipoprotein(a) level, metabolic syndrome, homocysteine, fibrinogen, C-reactive protein

(CRP) have been shown to have a high prevalence amongst Indians7.

Elevated levels of lipoprotein (a) are genetically inherited and have been said to

make Indians susceptible to heart disease at a young age by magnifying the effect of

high LDL and low HDL cholesterol, hastening atherosclerosis. Other emerging risk

factors may be partly genetic and partly life style related7. It has recently been observed

that mild renal insufficiency (creatinine >1.5 in women, >2.0 in men) or a creatinine

clearance of less than 70, are associated with increased coronary artery disease risk5.

Clinical research studies have demonstrated that effective coronary artery

disease risk factor reduction results in decreases in coronary artery disease morbidity

and mortality. A recent report indicates that in young males under the age of 40,

traditional coronary artery disease risk factors remain predictive of premature coronary

events5. But we have to understand that these diseases are preventable, predictable and

curable.

Awareness creation is joint responsibility of health team members, media, and

also the individual. Organizing the joint programmes with health team members for

mass educations, fitness classes in school driven into the individuals that they have to

be aware of it. The society should understand the seriousness of the problem7.

Major role of the nurse is delivering preventive, promotive and curative care for

the patients in the hospital and individuals in the community. As a part of prevention,

the investigator mind to assess the knowledge regarding risk factor and prevention of

coronary artery disease among urban men and also to improve their knowledge by

utilising the information booklet on risk factor and prevention of coronary artery disease

to change their sedentary lifestyles in the urban community which helps to reduce the

risk factor and also prevent the coronary artery disease.

6.2 REVIEW OF LITERATURE

6.2.1 Studies related to coronary artery disease.

6.2.2 Studies related to risk factors of coronary artery disease.

6.2.3 Studies related to prevention of coronary artery disease.

6.2.4 Studies related to significance of coronary artery disease in urban community.

6.2.5 Studies related to effectiveness of information booklet.

6.2.1 Studies related to coronary artery disease

A cross sectional survey study was conducted regarding coronary artery disease

epidemic in Pakistan more electrocardiographic evidence of ischemia in women than in

men. Study revealed that one in 5 middle aged adult in urban Pakistan may have

underlying coronary artery disease. Women are at greater risk than men and

recommended that concerted efforts are needed to reduce the burden of conventional

risk factors for coronary artery disease and must target both women and men in this

population8.

A study was conducted to determine the prevalence of coronary artery disease

and related risk factors in individuals with a history of premature coronary artery

disease in their first degree relatives. The study included 700 healthy individuals with a

history of premature coronary artery disease in their parents or siblings in Tehran heart

center in 2003-2004 with the age group of 15-65 years. The result shows that diabetes

was found in 5.3%, hypertension in 20.6%, cholesterol above 200 mg/dl is 39.9%. In

addition 6.4% had ECG changes and 3% echocardiography abnormalities and

concluded that risk factor determination in these individuals may prove to be more9.

A descriptive cross sectional survey study was conducted to assess the

prevalence of different coronary artery risk factors on 3000 healthy adults at the age

group of 18 years and above. Demographic data and risk factors were determined by

taking history, physical examination and laboratory tests. The prevalence rate shows

that out of 1381 (46%) females and 1619 (54%) male, 6,3% were diabetic, 21.6% were

smoker and 15% had positive familial heart disease history. 61% had total cholesterol

level > 200 mg/dl, 32% triglycerides > 200 mg/dl, 47.5% LDC>130 mg/dl, 5.4%

HDC < 35 mg/dl, 13.7% systolic blood pressure>140 mmHg, 9.1% diastolic blood

pressure>90 mmHg and 87% of them were physically inactive10.

6.2.2 Studies related to risk factors of coronary artery disease.

A descriptive study on the pre hospital care records of the emergency

management and research institute among 2020 emergency victims with chest pain as

the chief complaints reported there. Of all the risk factors studied, gender (male), age

(65 and above) and incidence location proved to be the risk factors for the non survival

of the victims with chest pain as medical emergency. The result shows that survival

rate increase to 33% with response time less than 15 minutes, from less than 5% with

the response time more than 15 minutes and concluded that risk factors affecting the

survival of emergency victims with chest pain as a chief complaints2.

A study conducted on 2656 consecutive patients in India to evaluate

conventional risk factors including lipid profile in proven coronary artery disease. Of

these 2399 subjects had angiographically proven coronary artery disease (group 1)

while 257 had normal coronary artery disease (group 2). The result shows that the

Indians coronary artery disease occurs at lower levels of total cholesterol, low density

lipoprotein cholesterol, high triglycerides and low high density lipoprotein levels than

other populations. It also says that younger patients have a more atherogenic lipid

profile than the older subgroup with coronary artery disease, and smoking and family

history of premature coronary artery disease are the most common associated risk

factors11.

A study was conducted to demonstrate whether increased physical activity can

safely reduce the increased cardiovascular mortality due to physical inactivity. In this

study the effect of physical activity on direct and indirect cardiovascular parameters and

clinical end points were analysed. The result shows that physical inactivity is important

risk factors for cardiovascular and overall mortality. The study recommended that

regular physical activity can contribute to an enormous health benefit in general

population12.

6.2.3 Studies related to prevention of coronary artery disease

A study was conducted to determine safety and efficacy of exercise training in

coronary artery disease with low ejection fraction and to evaluate whether outcomes

differ in patients with normal or reduced ejection fraction on 227 patients with coronary

artery disease. Based on the ejection fraction the patients were grouped in to 3 groups:

normal ejection fraction (55-75% -120 patients), moderately reduced ejection fraction

(35-54% - 77 patients) and low ejection fraction (<35% -30 patients). The result shows

that there was significant increase in the study. The percentage chance of low ejection

fraction is 20.7%, moderately reduced ejection fraction is 22% and normal ejection

fraction is 21%. The study recommended that low ejection fraction patients with

coronary heart disease can safely participate in a medically supervised exercise

programme and experience significant gains in exercise capacity equivalent to those

with normal ejection fraction13.

A report from nurses’ health study a 16 year follow up of more than 84,000

women, five coronary artery disease risk factors were identified to predict

cardiovascular disease in women who were healthy at baseline. Most of the risk factors

are related to lifestyle habits: type of diet, body mass index, smoking and physical

activity. The other major risk factor identified in this long term prospective

observational study was alcohol consumption. At the lowest quintile of all 5 risk factors

there was an 83% decrease of cardiovascular events. The result says that 90% of

attributable risk of subsequent coronary artery disease was related to environmental or

lifestyle factors, such as diet and body weight. Thus in diabetes prevention program,

individuals randomised to intensive lifestyle intervention over a three year period had a

80% decrease likelihood of developing diabetes compared to usual lifestyle5.

6.2.4 Studies related to significance of coronary artery disease in urban

community

A cross sectional study was conducted in various bank employers in Belgaum

city, to estimate the prevalence of risk factors of coronary heart disease and to assess the

knowledge regarding risk factors of coronary heart disease. The result shows the

prevalence of risk factors of coronary heart disease as hypertension 31%, diabetes 21%,

high serum total cholesterol 29%, high triglycerides 39%, high LDL cholesterol 19.3%,

low HDL cholesterol 17.7%, smoking 26%, sedentary habits 44%, and positive family

history 12%, overweight (BMI> 25 kg/m2) 33%. Among these 55% of the study

subjects had at least two of these risk factors. The study shows a disturbing burden of

coronary risk factors in the study population14.

An epidemiological study was conducted to assess the prevalence and risk

factors for coronary artery disease in a native urban South Indian population. Among

1399, 1262 (90.2%) populations are participated in the study. All the study subjects

underwent a glucose tolerance test and were categorised as having normal glucose

tolerance, impaired glucose tolerance or diabetes. Twelve lead electrocardiograms were

performed in 1175 (84%) individual. The result shows that the overall prevalence rate

of coronary artery disease is 11.0%. The prevalence rate of coronary artery disease for

NGT is 9.1%, IGT is 14.9% and diabetes is 21.4%. The study recommended that life

style changes and aggressive control of risk factors are urgently needed to reverse the

rapidly rising of coronary artery disease15.

A study was conducted to determine temporal changes in the prevalence and

level of awareness of cardiovascular risk factors in a symptomatic North Indian urban

population. All asymptomatic office executives who underwent routine health check up

at a tertiary care center during the year 2000 and 2005 are included in the study. Clinical

evaluation includes history of cardiovascular risk factors, anthropometry, blood pressure

measurement and biochemical investigations were performed. The result shows that

83.2% in the year 2000 were males compared to 76.8% in the year 2005. Age and sex

adjusted prevalence of hypertension, diabetes, impaired fasting glucose and metabolic

syndrome was higher in the year 2005 compared to 2000. The study shows that in the

office executives belonging to urban region, prevalence of cardiovascular risk factors is

high and is increasing with time16.

A descriptive cross sectional study was conducted to assess the prevalence of

different risk factors in patients above 30 years old attending the OPD on 246 patients.

The result shows that most of the males 17% were between the age of 40 and 49 years

while the maximum numbers of females were aged 60 years old and above. The

prevalent risk factors such as a history of hypertension were found to be 28%, diabetes

13%, significant family history 17%. The study recommended that urgent measures

based on primordial and primary prevention need to be taken from the school level to

modify the lifestyle & behaviour of the people of the slum community17.

A study was conducted to investigate whether coronary heart disease is rising in

India and assess the quality of evidence. 31 studies were reviewed and the sample size

varied from 500- 1400 with response rate generally over 90%. The 3 incidence studies

used different criteria. The result shows that incidence of myocardial infarction in urban

India in the 14 years to 1991 remained similar at about 6/1000 in males and 2/1000 in

females. Prevalence range was higher in urban than rural area in men (35-90/1000 vs.

17-45/1000) and for women (28-93/1000 vs. 13-43/1000). It says that using a relatively

objective measures of coronary heart disease it was found that coronary heart disease is

more common in urban than rural areas of India, but there was little evidence of a rise in

coronary heart disease over time, especially in men18.

A study was conducted to identify and compared coronary artery disease risk

factors quantified as “coronary heart disease risk point standards” among 3 ethnic

groups (white non Hispanic, Hispanic and black non Hispanic) of college students in

Florida city, completed the cardiovascular risk assessment instruments and had blood

pressure reading recorded. Blood sample was collected and blood lipids were measured.

The result shows that black non Hispanic scored significantly P>0.033 higher than

white non Hispanic. A significant ethnic difference was found with 38.4% of the black

non Hispanic being in the fair to very poor categories as compared 23.3% of Hispanics

and 20.0% of white non Hispanics. This study indicates strong gender and ethnic

difference in coronary heart disease risk factors among college age population19.

6.2.5 Studies related to effectiveness of information booklet

A study conducted teaching regarding warning signs in pregnancy using a

specially designed information booklet on 30 primigravida women. The findings

revealed that the mean post test score of 88.79% was significantly higher than the mean

pre test score 25.58% indicating the position effect of information booklet on the

knowledge level of primigravida women20.

A quasi experimental research was done among 353 women on effectiveness of

a peri menopausal health education intervention for mid wife in Northern Taiwan. 179

women were in the control group. Effectiveness of health education booklet was

assessed by pre test, followed by distribution of booklet and post test scores on health

knowledge and perceived per menopausal disturbances. The findings revealed that the

intervention group had significantly reduced scores P<0.005 and reported that increased

practice of healthy behaviour P<0.001 compared to the control group21.

A study was conducted on the effect of information booklet provided to care

givers of patients undergoing haemodialysis on knowledge of home care management.

The major finding of the study shows that the overall knowledge scores obtained by the

care givers in the pre test were 50.35% and 86.25% in the post test. The mean score was

35-89% with‘t’ test value 13.4 which is highly significant improvement in care givers

knowledge in post test after they underwent the information booklet22.

A study conducted to evaluate the effectiveness of an information booklet on

cancer risk factors for 30 undergraduate students. The major findings of the study

showed that the information booklet was effective in increasing the knowledge of the

college students and the study conducted, 93.67% students gained the information

through information booklet23.

A study conducted to report a scientific approach incorporating patient’s

information booklet about ureteric stents on 30 patients. 80% of patients reported

dissatisfaction about the information they received. Patients wanted more information

about the use, adverse effects of stents on daily life. 85% preferred all relevant

information about the use of stents to be in written format with illustration and drawing.

As evidenced by conclusion, booklet is expected to be an effective tool for patient’s

communication that would help patients cope better with indwelling stents and be useful

in counselling patients24.

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON

RISK FACTORS AND PREVENTION OF CORONARY ARTERY DISEASE

AMONG MALES IN SELECTED URBAN COMMUNITY, BENGALURU.

6.3. OBJECTIVES OF THE STUDY

6.3.1 To assess the knowledge of males regarding the risk factors and prevention

of coronary artery disease.

6.3.2 To administer information booklet on risk factors and prevention of coronary

artery disease among males in selected urban community.

6.3.3 To assess the effectiveness of information booklet by comparing the pre and

post test knowledge scores.

6.3.4 To find out the association between the knowledge scores with selected

demographic variables.

6.4 HYPOTHESES OF THE STUDY

This study attempted to examine the following hypothesis:

RESEARCH HYPOTHESIS

H1- There will be significant difference between the pre and post test knowledge scores

of males regarding risk factors and prevention of coronary artery disease.

H2 – There will be significant association between the knowledge scores with selected

demographic variables.

6.5 VARIABLES UNDER THE STUDY

Independent variable:

Information booklet on risk factors and prevention of coronary artery disease.

Dependent variables:

Knowledge of males regarding risk factors and prevention of coronary artery

disease.

6.6 OPERATIONAL DEFINITIONS

1. Effectiveness:

It refers to the extent to which the information booklet, on risk factors and

prevention of coronary artery disease produce effect in males of selected urban

community, evident from gain in knowledge scores.

2. Knowledge:

It refers to the correct response of males in relation to the risk factors and

prevention of coronary artery disease elicited through structured knowledge

questionnaire.

3. Males:

It refers to the individuals who are living in the selected urban community, Begur

Bengaluru with the age group of 30—50 years.

4. Risk factors:

It refers to any factors, which cause a person or a group of people to be vulnerable

to coronary artery disease which are as follows:

Non Modifiable:

Age

Sex

Family history

Race

Hereditary

Modifiable:

Smoking

Hypertension

Lipid disorders

Diabetes Mellitus

Sedentary lifestyle

Obesity

Alcohol

Dietary Factors

5. Prevention:

It refers to the measures to be taken to reduce coronary artery disease.

6. Coronary artery disease:

It refers to an imbalance between the supply and demand of the heart for

oxygenated blood. It includes atherosclerosis, angina pectoris and myocardial

infarction.

7. Urban community:

It refers to the selected urban community, Begur, Bengaluru located 2 kilometres

away from the college in Bengaluru with the population of 51171 and having a

primary health centre.

8. Information booklet:

It refers to a self learning printed material which contains information regarding

risk factors and prevention of coronary artery disease.

6.7 ASSUMPTIONS

6.7.1 Males may have some knowledge regarding the risk factors and prevention of

coronary artery disease.

6.7.2 Males in selected urban community may improve and update their knowledge

regarding risk factors and prevention of coronary artery disease by utilising the

information booklet.

MATERIAL AND METHODS

7.1 SOURCES OF DATA

The data will be collected from males living in selected urban community, Begur

Bengaluru.

7.2 METHOD OF DATA COLLECTION

Self administered structured knowledge questionnaire will be used to assess the

knowledge on risk factors and prevention of coronary artery disease.

7.2.1 RESEARCH APPROACH

Pre-Experimental research approach will be used to conduct the study.

7.2.2 RESEARCH DESIGN

One group pre and post test design will be used.

7.2.3 RESEARCH SETTING

Study will be conducted in selected urban community Begur, Bengaluru.

7.2.4 POPULATION

The population of the present study comprise of males who are residing in

selected community with age group of 30-50 years.

7.2.5 SAMPLE SIZE

The sample size of present study consists of 40 males residing in selected urban

community, Begur, Bengaluru.

7.2.6 SAMPLING TECHNIQUE

Purposive sampling technique will be used to select the samples.

7.2.7 SAMPLING CRITERIA

Inclusion criteria

1. Males who are willing to participate in the study.

2. Males who are available at the period of data collection.

Exclusion criteria

1. Males who are less than the age group of 30 years.

2. Males who are more than the age group of 50 years.

3. Males, who are able to read, write and speak Kannada.

7.2.8 TOOLS FOR DATA COLLECTION

Self administered structured knowledge questionnaire will be used to collect the

data which consists of part I and part II

Part- I: Consists of items on demographic variables such as age, sex,

educational qualification, occupation and source of information etc.

Part- II: Consists of knowledge items related to risk factors and prevention of

coronary artery disease.

7.2.9 DATA ANALYSIS METHOD

The data analysis will be done through descriptive and inferential statistics.

Descriptive statistics

Frequency, mean percentage, and standard deviation will be used to

describe the demographic variables and to compute knowledge scores.

Inferential statistics

Parametric test-paired’ test to compare pre and post test knowledge

scores.

Non parametric test- chi- square test will be used to find out the

association between pre and post test knowledge scores with selected

demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR

ANIMALS?

Yes, the information booklet will have an impact on males regarding risk factors

and prevention of coronary artery disease.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?

Ethical clearance is obtained from the research committee of THE OXFORD

COLLEGE OF NURSING, Bengaluru. The copy of ethical clearance certificate

is enclosed.

Permission will be obtained from the authorities of concerned urban community

Bengaluru where the study is scheduled to be conducted.

Informed consent will be obtained from the participants who are willing to

participate in the study.

8. LIST OF REFERENCES

1. Smeltzer C, Bare G B. Brunner and suddarth’s text book of Medical surgical

Nursing. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2004.

2. Jena N B, Kadithi A. Study of risk factors affecting the survival rate of emergency

victims with chest pain as chief complaints. 2009 Dec 17; 34(4): 293-297.

3. Lawrence Deckelbaum. M. D. Heart attacks and coronary artery disease. Yale

University. School of medicine Heart book.2005.

4. Kumar S. Coronary artery disease in India. 2006 Aug [cited 22/04/2010]: Available

on http:// display magazine online. com/

5. Abrama J. Primary prevention of coronary artery disease. 2003 Feb [cited

02/05/2010]: Available on www.winessumit.com

6. Sing R B, Sharma J P. et. al. Prevalence of coronary artery disease and coronary risk

factor in rural and urban populations of India. European Heart Journal. 1997; 18:

1728-1735.

7. Xavier D. Coronary artery disease. 2004 July [cited 03/05/2010]: Available on

www.pharmabiz.com.

8. Jafar T H, Qudri Z, Chaturved N et. al. Population based cross sectional survey

regarding coronary artery epidemic in Pakistan-more electrocardiographic evidence of

ischemia in women than men. Heart journal. 2007 july 23; 27(3): 200-206.

9. Salarifar M, Kazemeni S M, Hajizenali A M. Prevalence of coronary artery disease

and related to risk factors in first degree relatives of patients with premature coronary

artery disease. Tehran University Medical Journal. 2007; 65(1): 45-54.

10. Hatmi Z N, Tahvildari S et. al. Prevalence of coronary artery disease risk factors in

Iran- A population based survey. BMC cardiovascular disorders 2007 Oct 30;

7(32):7-32.

11. Goel P K, Bharti B B et. al. A teritiary care hospital based study of conventional risk

factors including lipid profile in proven coronary artery disease. Indian Heart Journal

2003 May; 55(3): 234-240.

12. Lengfelder W. Physical inactivity- A modifiable risk factors in primary prevention.

2001 Nov 15; 96(11): 661-669.

13. Khailani S, Poptani H et. al. Improvement in exercise capacity after after cardiac

rehabilitation is independent of ejection fraction in patients with coronary artery

disease. 2009 Nov; [cited 03/05/2010]: Available on http://indianheartjournal.com.

14. Shivaramakrishna H R, Wantamutte A S et. al. Risk factors of coronary heart

disease among bank employers of Belgaum city- cross sectional study. Al Ameen J Med

Science. 2010; 3(2): 152-159.

15. Mandal S, Saha J B. et. al. Prevalence of ischemic heart disease among urban

population of Silguri, West Bengal. American College of Cardiology Foundation. 2009;

34(1):19-23.

16. Basal M, Shrivastav S et. al. Time trends in prevalence awareness of cardiovascular

risk factors in an asymptomatic North Indian urban population Journal of association of

physicians of India. 2008; 15(4): 20-28.

17. Deb S, Dasgupta A. A study on risk factors of cardiovascular disease in an urban

health centre of Kolkata. Reed Elsevier publication. New Delhi. 2008; 365.

18. Ahmad N, Bhopal R. Is coronary heart disease rising in India? A systematic review

based on ECG defined coronary heart disease. 2005; 91(6): 719-725.

19. Koutoubi S, Huffman F G. Coronary heart disease risk factors among tri ethnic

college students. The internet journal of cardiovascular research. 2002; 1(1): 30-42.

20. Linseth G, Vasi P. Nausea and vomiting in late pregnancy. Health care women Int.

2002 May. 26(5): 372-386.

21. Taso L I, Huang K E. A study on effectiveness of a peer menopausal health

education intervention for midwife. 2004 Sep; 54(3): 321-328.

22. Fathima L. The effect of information booklet provided to caregivers of patients

undergoing haemodialysis on knowledge of home care management. Nursing Journal

of India. 2003; XCV(4).

23. Bairwa K S. A study to develop and evaluate the effectiveness of an information

booklet on cancer factors, Delhi University. Delhi. 2002, October; vol. LXXXXIII.

24. Joshi H B, Newns N, Stainethiope A et al. The development of a patient information

booklet on uteric stents. BJU Int 2001 sep; 88(4): 329-334.

9. SIGNATURE OF THE STUDENT :

10. REMARKS OF THE GUIDE : It is relevant to conduct this study

as it will help the Urban males to

enhance their knowledge regarding

risk factor and prevention of

coronary artery disease.

11.NAME AND DESIGNATION

OF THE GUIDE : MR. R. BABU

PROFESSOR

11.1 GUIDE’S NAME AND

ADDRESS : MR. R. BABU

:HEAD OF THE DEPARTMENT

MEDICAL SURGICAL NURSING

THE OXFORD COLLEGE OF NURSING

BENGALURU-560068

11.2 SIGNATURE OF THE GUIDE :

11.3. HEAD OF THE DEPARTMENT:

NAME AND ADDRESS : MR. R. BABU

HEAD OF THE DEPARTMENT

MEDICAL SURGICAL NURSING

THE OXFORD COLLEGE OF NURSING

NO 6/9 & 6/11 1ST CROSS

BEGUR ROAD, HONGASANDRA,

BENGALURU-560068.

11.4 SIGNATURE OF H.O.D. :

12. REMARKS OF PRINCIPAL : The research topic is relevant as it

explores the knowledge regarding the risk

factors and prevention of coronary artery

disease among urban males.

13.SIGNATURE OF PRINCIPAL :

Dr. G. KASTHURI, PRINCIPAL/ PROFESSOR

THE OXFORD COLLEGE OF NURSING

NO 6/9 & 6/11 1ST CROSS

BEGUR ROAD, HONGASANDRA

BENGALURU - 560068.