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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE MR. JINJI B.S. M.SC. NURSING AECS MAARUTI COLLEGE OF NURSING, BANGALORE. 2. NAME OF INSTITUTION THE AECS MAARUTI COLLEGE OF AND NURSING, No.99, NEAR AECS ADDRESS MAARUTI DENTAL COLLEGE, KAMMANHALLI, OFF B.G.ROAD,BANGALORE.560076 3. COURSE OF THE STUDY M.SC. NURSING 1st YEAR AND SUBJECT COMMUNITY HEALTH NURSING 4. 5. DATE OF ADMISSION TO COURSE 17 JUNE 08 TITLE OF THE TOPIC “KNOWLEDGE REGARDING HEALTH HAZARDS OF GLOBAL WARMING AMONG ADULTS IN URBAN AREAS OF BANGALORE SOUTH WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET .’’ INTRODUCTION Over coming decades, humankind is likely to be subjected to the impacts of rapid environmental change that is attributable at least in part to human activities. While the balance between humans and their resource-base has always been delicate, the accelerated changes resulting from industrialization and significant global population increase over the last century has resulted in visible impacts on the global environment and the resource base that determine the basic conditions for human health, in particular food and water availability and quality. The impacts of climatic change on human health are complex to ascertain, because populations have different vulnerabilities to climate and susceptibility to disease. However, there are likely to be two distinct types of impacts, those related to the physiological effects of heat and cold, and indirect effects such as the spread of vectorborne pathogens into areas where disease currently does not exist or was eradicated in the past, in and out-migration of allergenic pollen, and enhanced air pollution in large cities. 1 Most of the consequences of global warming would result from physical changes: sea level rise, higher local temperatures, and changes in rainfall patterns, but synergistic affects such as warming causing the release of methane hydrates or clathrates; oceans and forests and species dying off create many unforeseen impacts such as a decrease in the amount of oxygen in the earth's atmosphere. Due to global warming heat most frequently occur with sudden increases in heat stress. Heat waves regularly produce an increase in the incidence of heat casualties. And few newcomers to very hot climates can afford to ignore the potential hazards of the first few days of heat exposure. The initial physiological adjustments to heat, involving changes in cutaneous vasodilatation and fluid balance, often produce mild swelling of the ankles or feet . Syncope can be precipitated by a sudden change in posture or by venous stasis in the legs during prolonged standing. Skin disorders, such as prickly heat and skin rashes, may occur when sweat is allowed to accumulate on unventilated skin. Increased fluid requirements in warmer environments make it imperative to ensure adequate supplies of potable water as a primary health objective. Even when drinking-water is freely available, sweat losses in hot environments are not usually completely replaced. 2 It is important to increase awareness of the potential health effects of changes in the climate. For this purpose, region-specific educational material that addresses particular local health problems should be produced. Such materials should be distributed to professionals, schools, and the general population. 6. BRIEF FESUME OF INTENDED WORK 6.1 Need for the study: Global warming could do more to hurt your health than simply threaten summertime heat stroke, says a public health physician. Although heat related illnesses and deaths will increase with the temperatures, climate change is expected to also attack human health with dirtier air and water, more flood-related accidents and injuries, threats to food supplies, hundreds of millions of environmental refugees, and stress on and possible collapse of many ecosystems that now purify our air and water.1 World Health Organization Regional Director for the Western Pacific, warned: “We have now reached a critical stage in which global warming has already seriously impacted lives and health, and this problem will pose an even greater threat to mankind in coming decades if we fail to act now. Among the potential effects of global warming would be the appearance of mosquitoes where they were previously absent, with the accompanying threat of malaria and dengue fever. Some regions might be at risk of reduced rainfall, causing a shortage of fresh water and introducing the danger of waterborne diseases. Millions of people could be at risk of malnutrition and hunger if arable lands become unworkable2. Global warming will cause more deaths in summer because of higher temperatures but these will not be offset by fewer deaths in milder winters finds an analysis published online ahead of print in Occupational and Environment Medicine. The Harvard researchers analyzed city-specific weather data related to the deaths of more than 6.5 million people in 50 US cities between 1989 and 2000. They found that during two-day cold snaps there was a 1.59 percent increase in deaths because of the extreme temperatures. However, during similar periods of extremely hot weather death rates went up by 5.74 percent. Deaths did not rise as steeply when temperature fluctuations were less extreme. Deaths from all causes are known to rise when temperatures go up, and heart attacks and cardiac arrests are more likely when it is very cold. It was anticipated that global warming would increase deaths during hot temperatures but that this would be compensated for by fewer deaths in the winter. But the authors conclude: "Our findings suggest that decreases in cold weather as a result of global warming are unlikely to result in decreases in cold-related mortality in the US. Heat-related mortality, in contrast, may increase, particularly if global warming is associated with increased variance of summer temperature. 3 Global Warming is a serious threat to the world population and the health hazards are enormous. Prevention of these health hazards is very essential by creating awareness among the population. Therefore the researcher has felt the need to explore the knowledge regarding health hazards of global warming with a view to develop information booklet. 6.2 Review of Literature: A study conducted on impact of Global warming on viral disease is believed to induce a gradual climate change. Hence, it was predicted that tropical insects might expand their habitats thereby transmitting pathogens to humans. Although this concept is a conclusive presumption, clear evidence is still lacking-at least for viral diseases. Epidemiological data indicate that seasonality of many diseases is further influenced by strong single weather events, inter-annual climate phenomena, and anthropogenic factors. So far, emergence of new diseases was unlinked to global warming. Re-emergence and dispersion of diseases was correlated with translocation of pathogen-infected vectors or hosts. Variation in the incidence of vector-borne diseases is associated with extreme weather events and annual changes in weather conditions. Moreover, it is assumed that global warming might lead to an increase of infectious disease outbreaks. While a number of reports link disease outbreaks to single weather events, the El Niño/Southern Oscillation and other large-scale climate fluctuations, no report unequivocally associates vector-borne diseases with increased temperature and the environmental changes expected to accompany it. 4 A study conducted on Climate change and health: global to local influences on disease risk. The World Health Organization has concluded that the climatic changes that have occurred since the mid 1970s could already be causing annually over 150,000 deaths and five million disability-adjusted life-years mainly in developing countries The less developed countries are, ironically, those least responsible for causing global warming. Many health outcomes and diseases are sensitive to climate, including: heat-related mortality or morbidity; air pollution-related illnesses; infectious diseases, particularly those transmitted, indirectly, via water or by insect or rodent vectors; and refugee health issues linked to forced population migration. Yet, changing landscapes can significantly affect local weather more acutely than long-term climate change. Land-cover change can influence micro-climatic conditions, including temperature, evapo-transpiration and surface run-off, that are key determinants in the emergence of many infectious diseases.5 A study conducted on the global warming harmful to health will expand the incidence and distribution of many serious medical disorders. Global warming, aside from indirectly causing death by drowning or starvation, promotes by various means the emergence, resurgence, and spread of infectious diseases. This article addresses the health effects of global warming and disrupted climate patterns in detail. Among the greatest health concerns are diseases transmitted by mosquitoes, such as malaria, dengue fever, yellow fever, and several kinds of encephalitis. Such disorders are projected to become increasingly prevalent because their insect carriers are very sensitive to meteorological conditions. In addition, floods and droughts resulting from global warming can each help trigger outbreaks by creating breeding grounds for insects whose desiccated eggs remain viable and hatch in still water. Other effect of global warming is the increase of the incidence of waterborne diseases because of lack of clean water. 6 A study conducted on climatic change and global infectious disease threat reveals the world's climate is warming up and, while debate continues about how much change we can expect, it is becoming clear that even small changes in climate can have major effects on the spread of disease. Erwin K Jackson, a member of Greenpeace International's Climate Impacts Unit and a delegate to the 11th session of the United Nations Intergovernmental Panel on Climate Change (Rome, 11-15 December), reviews the scientific evidence of this new global threat to health. 7 A study conducted on climatic change and water borne and vector borne disease considers the potential impact on human health from waterborne and vector-borne infections. It concentrates on the impact of two possible changes to climate; increased frequency of heavy rainfall events, with associated flooding and increased temperature. . There have been numerous reported of outbreaks that followed flooding that led to contamination of underground sources of drinking water. Heavy rainfall also leads to deterioration in the quality of surface waters that could adversely affect the health of those engaged in recreational water contact. It is also concluded that there may be an increase in the number of cyanobacterial blooms because of a combination of increased nutrient concentrations and water temperature. It is considered unlikely that climate change will lead to an increase in disease linked to mains drinking water, although private supplies would be at risk from increased heavy rainfall events. Although increased temperature could lead to climatic conditions favourable to increases in certain vector-borne diseases such as malaria, the infrastructure in the UK would prevent the indigenous spread of malaria8 STATEMENT OF THE PROBLEM: A STUDY TO ASSESS THE KNOWLEDGE REGARDING HEALTH HAZARDS OF GLOBAL WARMING AMONG ADULTS IN URBAN AREAS OF BANGALORE SOUTH WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET. 6.3 Objectives 1. To assess the knowledge regarding health hazards of global warming among adults in urban areas of Bangalore south 2. To find out the association between knowledge and selected demographic variables 3. To develop an information booklet on the health hazards of global warming. Operational definition Assess - In this study it refers to adults’ knowledge about health hazards of global warming Knowledge - In this study it refers to correct responses of adult health hazards on Global warming Adults - In this study it refers to male and female aged between 18 to 45 years. Health Hazards of Global warming: In this study it refers to selected health problems such as vector borne diseases, infectious diseases and heat strokes due to climactic change. Information Booklet: In this study, it refers to a booklet containing information on health hazards of global warming and its prevention that is self paced and self explanatory. Hypothesis: H1: There is a significant association between the knowledge and selected demographic variables Variables of Study: 1. Research variables: knowledge of adults regarding health hazards of global warming 2 Demographic Variables: In this study demographic variable such as age, sex, Education occupation, and income. Delimitation: This study is limited to male and female adults aged between 18 to 45 years Bangalore South. 7. Material and Methods: 7.1. Sources of Data:-The data will be collected from adults of at selected areas of Gottegere PHC Bangalore South. 7.2. Methods of Data Collection: - The Researcher personally will collect the data from adults of Gottegere PHC Banglore south Research Approach: Non experimental survey approach. Research Design: Descriptive survey study. Research Setting: The study will be conducted at selected areas of Gottegere PHC Bangalore South. Population: The population of study comprises of adults males and females. Sample Size: study comprises of adults 50 males and 50 females. Sampling technique: Convenient sampling technique will be used to select the samples among selected areas of Bangalore south Sampling criteria: Inclusion criteria: 1 Adults who are willing to participate in the study 2 Adults who are available during the period of data collection Data Collection Tools: The tool will consists of structured interview schedule Section 1: This section consists of items on demographic variables regarding adults Section 2: This section consists of knowledge questions regarding health hazards of global warming Method of data analysis The data will be analyzed using descriptive and inferential statistical techniques. Descriptive statistical technique like mean, median, mode, percentage and standard deviation will be used. Inferential statistical technique like chi-square correlation, coefficient of correlation and relevant statistical techniques will be used. 7.3. Does the study required any investigation or intervention to be conducted on patient and other human or animals? NO, it is only a descriptive study. 7.4 Has ethical clearance been obtained from your institution? Ethical clearance is obtained from AECS Maaruti college of nursing. Written permission will be obtained from concerned authorities. Written permission will be obtained from the adults who are involved in the study before collecting the data. 8.0 List of References 1. Health Effects of Temperature Cold Weather,(online) available from URL http://www.co2science.org. 2. Global warming will threaten health through dirtier air, hotter days, and more natural disasters. Mongabay (.online) october 23;2006: available from URL //www.mmedicalnewstoday.com 3. Global Warming And Your Health Science,(oline) Oct, .29 2 available from URL, http ://www .science daily .com 4. Zell R, krumbholz A, Wutzler P, Impact of g lobal warming on viral disease. Curr Opin Biotechnol(.online) 2008 Oct 31 (online)PMID: 15146981. 5. Diaz JH, “influence of global warming on natural disasters and their public health outcomes”(online). 2007 Jan-Feb;2(1):33-42. 6. Epstein PR, global warming harmful to health Center for Health and the Global Environment, Harvard Medical School, USA Comment in Sci Am (online). 2000 Aug;283(2):8.Available URL ;http//www.ncbi.nlm.gov. PMID: 10914399. 7. Jackson EK, climatic change and global infectious disease threats. Med J( online) Aust. 1995 Dec 4-18; 163(11-12):570-4. Links PMID: 8538543. 8. Hunter PR Climate change and waterborne and vector-borne disease School of Medicine, Health Policy and Practice(,online) University of East Anglia, Norwich, UK.availablefrom URL:s [email protected] PMID: 12675935 9 SIGNATURE OF THE CANDIDATE 10 REMARKS OF THE GUIDE: 11 11.1 NAME AND DISIGNATION OF GUIDE DR. B.S. SHAKUNTALA DEAN AND PRINCIPAL HOD COMMUNITY HEALTH NURSING AECS MAARUTI COLLEGE OF NURSING, BANGALORE 11.2 SIGNATURE: 11.3 CO-GUIDE: 11.4 SIGNATURE: 11.5 HEAD OF THE DEPARTMENT: SIGNATURE: 12 12.1 REMARKS OF THE PRINCIPAL: 12.2 SIGNATURE: DR. B.S. SHAKUNTALA