Download 1 st year M.Sc. Nursing

PROFORMA FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. SHEENA MATHEW
1st year M.Sc. Nursing
Paediatric Nursing
2010-2012 Batch.
Sarvodaya College of Nursing.
Bangalore – 560079.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE
CANDIDATE AND
ADDRESS
Ms .SHEENA MATHEW
1st year M.Sc Nursing,
Sarvodaya College of Nursing,
Near Raheja Apartments, 11/2 Magadi Road,
Agrahara Dasarahalli,
Bangalore-560079
2.
NAME OF THE INSTITUTION
Sarvodaya College of Nursing
3.
COURSE OF STUDY AND
SUBJECT
1st year M.Sc Nursing,
(Paediatric Nursing)
4.
DATE OF ADMISSION OF THE
COURSE
TITLE OF THE TOPIC
10.05.2010
5.
“A Study To Evaluate The Effectiveness Of
Structured Teaching Programme Regarding Lactose
Intolerance In Children Among Mothers In Selected
Community Areas, Bangalore”.
6.
7.
Brief resume of the work
6.0 Introduction
6.1 Need for the study
6.2 Review of the literature
6.2.1 Statement of the problem
6.3 Objectives of the study
6.3.1 Operational definition
6.3.2 Assumptions
6.3.3 Hypothesis
6.3.4 Sampling criteria
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
MATERIALS AND METHODS
7.1 Sources of Data: Data will be collected from the mothers in selected community areas,
Bangalore.
7.2 Method of Data Collection: Interview method
7.3 Does the study require any investigations or interventions to be conducted on the
patients or other human beings or animals? YES
7.4 Has ethical clearance been obtained from your institution? YES the report is here with
attached
8. List of references: Enclosed
2
RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE
SHEENA MATHEW,
CANDIDATE AND
1st Year M.Sc (Nursing),
ADDRESS
Sarvodaya College Of Nursing,
Near Raheja Apartments,11/2 Magadi Road,Agrahara
Dasarahalli,Bangalore -560079.
2
NAME OF THE
Sarvodaya College Of Nursing. Bangalore - 560079
INSTITUTION
3.
COURSE OF STUDY
AND SUBJECT
4.
DATA OF ADMISSION
1st Year M.Sc Nursing,
Paediatric Nursing
10.05.2010
OF THE COURSE
5.
TITLE OF THE TOPIC
“A Study To Evaluate The Effectiveness Of
Structured Teaching Programme Regarding Lactose
Intolerance In Children Among Mothers In Selected
Community Areas, Bangalore”.
3
6. BRIEF RESUME OF INTENDED WORK
6.0 INTRODUCTION:
“To keep the body in good health is a duty, for otherwise we shall not be able to trim the
lamp of wisdom, and keep our mind strong and clear………”
-Buddha
Lactose is the naturally occurring sugar found in all milk (human, cow, goat,
etc).It is a disaccharide, which is composed of 2 sugars coupled together- glucose and
galactose.1 It is a major carbohydrate in infant’s food. An enzyme in the intestine called
lactase is necessary to split the glucose and galactose apart to digest lactose. When there
is lactase deficiency it leads to intolerance of lactose.
Lactose intolerance was first noted as a gastro intestinal upset and skin problem in
some who consumed milk. This was noted by the ancient Greek physician Hippocrates
(460-370 B.C). However it was only in the 20th century that the syndrome was more
widely described by modern medical science.2
Lactose intolerance is often incorrectly referred to as a “milk allergy” or “lactose
allergy”. Lactose intolerance however, is not an allergy, because it does not involve a
reaction of immune system, it is an adverse reaction.3
Lactose intolerance is an ability of the body to digest significant amounts of
lactose due to a shortage of enzyme lactase, which is normally produced by the cells that
line the small intestine.4 When there is lactase deficiency, lactose is broken down by
bacteria in the lower intestines. The bacterial wastes combine with sugars to ferment into
gas and toxins.1
4
Lactose intolerance can occur in any age group or population. However people of
African, Asian, Jewish, Hispanic, Middle Eastern are at risk for developing lactose
intolerance. Overall about 75% of the world’s population, including 25% of those in U.S,
loses their lactase after weaning. 90% of Asian Americans have lactose intolerance.
Approximately 1 in 9 or 11.03% or 30 to 50 million people are affected in USA. Lactose
intolerance levels also increases with age. At 2-3 years, 6 years and 9-10 years.
Prevalence has been estimated that 2-7.5% of otherwise normal infants are affected by
milk protein intolerance. It may rarely present for 1st time in older children and recur in
adults.5
Lactose intolerance is one of the most common non allergenic food sensitivities.1
Common foods and beverages that contain lactose and can cause lactose intolerance
include milk, ice cream, soft cheese, sour cream, yogurt and any food that is made with
dairy products. Recent research shows that yogurt with active cultures produce some of
the lactase enzyme required for proper digestion. 6
Lactase deficiency is of 4 types:
Congenital lactase deficiency- it is extremely rare, presents during the newborn
period.

Primary lactase deficiency- develops the during childhood at different age groups.
It is the most common cause of lactose intolerance.7 70% of the world’s
population has primary lactase deficiency5.

Secondary lactase deficiency- results secondary to damage of the intestinal lumen,
from small bowel injury (gastro enteritis, persistent diarrhea, chemotherapy)
5
which decreases or destroys the enzyme lactase. Can present at any age, but it is
more common in infancy.

Developmental lactase deficiency –is the relative lactase deficiency observed in
premature infants of < 34 weeks gestation.7
The individual who has lactose deficiency is unable to digest lactose. As a result
of this deficiency, certain specific manifestations are shown which includes- abdominal
distention, diarrhea, recurrent abdominal pain, flatulence, bloating, nausea, abdominal
cramps, and symptoms of colic in infants. Infrequently severe cases of lactose intolerance
in children have been shown to cause damage to the lining of the intestine and severe
persistent diarrhea, weight loss, malnutrition and because the nutrients are not absorbed,
the infant or child fails to thrive.8
Lactose intolerance can be diagnosed by lactose tolerance test, hydrogen breath
test, stool acidity test, blood glucose test and home self test. Treatment includes general
measures; dietary changes; lactase supplementation through oral lactase capsules, tablets,
etc; calcium and vitamin D supplements; low lactose diet, etc. Latest treatment includes
lactaid, lactrase. 9
6.1. NEED FOR THE STUDY:
Lactose intolerance is the most common food intolerance that affects at least 1 out
of 10 people.5 Of 24 milk-allergic individual studied half were found to be lactose
intolerant. Lactase is an enzyme that is present in the lining of the gut, which degrades
6
lactose, present in the milk. If a person does not have enough lactase, the body cannot
digest the lactose. Instead the lactose is used by bacteria, gas is formed and person
experiences bloating, abdominal pain and diarrhea. Since lactose is found in mother’s
milk, almost all infants of nursing age are able to digest it. But past weaning and with
increasing age, progressively fewer children retain this ability. Lactose is an important
source of energy; it promotes the absorption of calcium, phosphorus and iron and has a
probiotic effect on the gut flora.
A study conducted on black children found lactose intolerance in 11% of 4-5 year
olds, 50% of 6-7 year olds and 72% of 8-9 year olds. 1
An observational study was conducted to systematically review the evidence to
determine lactose intolerance prevalence, bone health after dairy exclusion diets,
tolerable dose of lactose in subjects with diagnosed lactose intolerance. The prevalence of
lactose intolerance was assessed according to the diagnostic test used, such as lactose
challenge, intestinal biopsies of lactase enzyme levels, genetic tests, and symptoms.
Reported symptoms, lactose dose and formulation, and co-ingested food were analyzed in
association with tolerability of lactose. It was concluded that there are race and age
differences in lactose intolerance prevalence. Children with low lactose intake have
worse bone outcomes compared assigned to receive supplemental dairy interventions.
Lactose reduced milk may be an effective strategy to reduce some lactose intolerance
symptoms.10
Overall about 75% of the world’s population, including 25% of those in the U.S
loses their lactase enzyme post weaning. Expression of the lactase starts to decline in
7
most persons at age 2 years; almost 4 billion people worldwide have lactose
malabsorption.11 Almost 90% of Asians and Africans are affected. The condition is least
among persons of northern European descent. While in India north Indians have a much
lower prevalence than south Indians, at approximately 25% and 65% respectively.
A multicenter study was carried out in India to determine the incidence of lactose
intolerance from the different parts of the country. The incidence was found to be 66.6%
in the subjects from 2 south Indian centers at Trivandrum and Pondicherry. In contrast,
the incidence in subjects from a north Indian centre in NewDelhi was much lower i.e.,
27.4%. 12
A study was conducted to determine the frequency of lactose malabsorption
among healthy southern and northern Indian populations by genetic analysis and lactose
hydrogen breath and tolerance tests. This study was conducted to compare the frequency
of lactose malabsorption in healthy southern and northern Indian populations. A total of
153 subjects, 76 from southern and 77 from northern India were evaluated using a lactose
tolerance test (LTT), lactose hydrogen breath test (lactose HBT), and polymerase chain
reaction to identify the lactase gene. The LTT result was abnormal in 88.2% of southern
Indians and in 66.2% of northern Indians. Lactose HBT result was abnormal in78.9% of
southern Indians and in 57.1% of northern Indians. It was concluded that the frequency
and degree of lactose malabsorption is higher in southern than in northern Indian
populations because of genetic differences in these populations.13
8
A prospective study was conducted to determine the humoral immune responses
to cow milk antigens in the first year of life. This study aimed at delineating the
development of humoral immune response to cow milk antigens in healthy infants.
Twenty-five healthy newborns were enrolled, and seen at scheduled visits at the ages of
three, six and eleven months, and they formed two groups: those breastfed and those fed
adapted cow milk formulae. At the age of three months, in the formula fed group, cells
secreting specific IgA to cow milk antigens were detected despite low levels of IgA
serum antibodies. The total number of IgA secreting cells increased with age (p = 0.001).
The milk in the infant diet directly influenced this development so that the age related
increase was significantly greater in the formula fed group (p = 0.04). The results indicate
that diet has a significant effect on the developing immune system, and that healthy
infants are able to respond in an antigen specific fashion to dietary antigens, which may
be central in attaining clinical tolerance of such antigens.14
The researcher observed children suffering from lactose intolerance especially
post weaning and most often it was misdiagnosed with other gastro intestinal conditions
in majority of the cases, as it resembles other conditions and diseases such as irritable
bowel syndrome, celiac disease, food poisoning, gastro enteritis, etc. Thus by reviewing
the above facts, the investigator felt that giving knowledge to the mothers in the
community is the best way to weed out misinformation and piece together countless facts
in order to see the “big picture”. This reduces the delay in the legitimate treatment of a
serious underlying problem. Hence the investigator selected research on giving a
9
Structured Teaching Programme Regarding Lactose Intolerance to Mothers in Selected
Community area.
6.2. REVIEW OF THE LITERATURE:
The review of literature is a summary of current knowledge about a particular
practice problem and includes what is known and not known about the problem. The
literature is reviewed to summarize knowledge for use in practices or to provide a basis
for conducting a study.
A study conducted to determine lactose and milk intolerance in recurrent
abdominal pain of childhood, lactose tolerance test was performed in 70 children with
idiopathic recurrent abdominal pain (IRAP) and 50 matched controls. The prevalence of
lactose malabsorption in IRAP patients (47.1%) was significantly higher than in controls
(18%). When milk was withheld for a 4 week period, 33% (11/33) of lactose
malabsorbers and 16.2% (6/37) of lactose absorbers were relieved of their symptoms.15
A case control study was conducted in Northern India among 124 patients with
Irritable bowel syndrome (IBS) and 53 age- and- gender matched Healthy Subjects (HS)
were studied for lactose intolerance using the Lactose Hydrogen Breath Test and Lactose
Tolerance Test. The study was aimed to evaluate the frequency of lactose intolerance in
patients with Irritable Bowel Syndrome as compared with Healthy subjects. Symptoms
following lactose ingestion (diarrhea, bloating or distension) during the test and history of
milk intolerance were recorded. The results showed that 89/124 (72%) and 32/53 (60%)
10
IBS patients and Healthy subjects were positive by breath hydrogen test and 82/124
(66%) and 38/53 (71%) by lactose tolerance test. Thus it was concluded that the
frequency of lactose intolerance is high and comparable among IBS patients and Healthy
Subjects from Northern India and patients with IBS more often reported symptoms
following lactose ingestion despite levels of breath hydrogen level similar to Healthy
Subjects.16
A descriptive cross sectional study involving 196 severely malnourished children
with diarrhea aged 3-60 was done in Mwanamugimu Nutrition Unit (MNU), Mulago
Hospital. This study was therefore designed to establish the prevalence of lactose
intolerance and associated factors in this population. During this study period, 196
severely malnourished children with diarrhea were recruited, 50 of whom had evidence
of lactose intolerance and it occurred more commonly in kwashiorkor (36.0%) than
marasmic-kwashiorkar (24.0%) and marasmus (17.7%). It was concluded that the
prevalence of lactose intolerance in this study setting of 25.5% is relatively high. Routine
screening by stool pH and reducing substances should be performed especially in the
severely malnourished children with diarrhea presenting with oedematous malnutrition,
perianal skin erosion, higher mean stool frequency and having had >2 diarrhea episodes
in the previous 3 months.17
A study was performed to determine the prevalence and age of onset of primary
lactose maldigestion in healthy Black and Indian children, and to determine whether this
was of clinical significance. More black (22 of 44-50%) than Indian children (10 of 4522.2%) had lactose maldigestion, the development which was age-related. 1 of 16 (6.3%)
11
Indian children aged under 8 years were maldigesters, compared with 5 of 13 (38.5%)
aged over 10 years. Most children had a very low intake of milk.18
A prospective study was conducted to determine the role of lactose malabsorption
in 80 school children with recurrent abdominal pain. Malabsorption was documented in
40% on the basis of elevated levels of hydrogen in their breath. In children with
malabsorption who completed a six- week diet trial, 70% reported increased frequency of
pain when placed on their usual lactose-containing diet. It was concluded that the Lactose
malabsorption has a substantial role in the symptoms of children with recurrent
abdominal pain.19
A study was conducted to determine lactose intolerance frequency in children
with food allergy. The number of 87 children with food allergy who were below and
above 5 years of age was included in the study. 51 patients above 5 years of age and 36
patients below 5 years of age were studied. Lactose intolerance symptoms, hydrogen
breath test, activity of lactase and villous atrophy were investigated. Thus positive result
of biological trial in hydrogen breath test was observed in 10% of patients who were
below 5 years of age and in 26% patients above 5 years with food allergy. Frequent
partial villous atrophy was observed in younger patients (41.38%) than in children above
5 years of age (17.86%).20
A study was conducted to determine milk and dairy products consumption and
their connection with lactose intolerance in children above 5 years of age in selected
disorders of the alimentary tract. The numbers of 301 patients above 5 years of age were
included into the study. Milk and dairy products consumption habits, lactose intolerance
12
symptoms, hydrogen breath test, activity of lactase and villous atrophy were investigated.
It was concluded that frequent (33-55%) decreased sweet milk consumption in children in
spite of clinical symptoms after ingestion of milk was observed. The biggest lactose
intolerance symptoms frequency was observed in children who didn’t drink milk and in
children with decreased consumption of sweet milk due to complaints after ingestion of
milk.21
A double-blind crossover study was conducted to assess symptoms associated
with milk ingestion in children with lactose maldigestion. In this study 30 children (11
males) age 3 to 17 years with lactose maldigestion were studied. The subjects ingested
240m L daily of either lactose-hydrolyzed or lactose-containing milk for 14 days. Diaries
were kept daily that recorded diet, medication use, and symptoms. There was a
significant increase in abdominal pain experienced by study participants during the
lactose ingestion period when compared to the lactose-free period. It was concluded that
ingestion of 12g of lactose daily is associated with increased abdominal pain in
susceptible children with lactose maldigestion. A trial of dietary lactose restriction may
be beneficial in reducing abdominal pain in children with lactose maldigestion.22
A Study was investigated to determine whether colonic fermentation of lactose is
correlated with lactose intolerance. 28 Chinese subjects had undergone 1 glucose and 2
lactose challenges, consistent lactose tolerant and intolerant subjects with no complaints
after glucose administration were classified on the basis of the 6-h symptom scores.
Before the challenges, fecal samples were collected for in vitro incubation with lactose.
The incubation was carried out in a static system under anaerobic conditions for 5h
13
during which samples were taken for measurement of short chain fatty acids, lactate,
lactose, glucose and galactose. Fecal bacterial composition was determined by
fluorescent in situ hybridization. Fecal bacterial composition did not differ between the 2
groups. The results indicate that the degree and rate of lactose hydrolysis in the colon do
not play a role in lactose intolerance. By comparing the in vitro lactose- fermenting
indices of fecal bacteria from lactose-tolerant and intolerant subjects it was suggested that
the colonic fermentation of lactose by the microbiota plays a role in lactose intolerance.
The fermentative processes after lactose is hydrolyzed are related to the development of
symptoms.23
A retrospective Study was conducted to evaluate the prevalence of celiac disease
in patients with lactose intolerance. This study included 54 patients from southern Italy,
referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of
milk or dietary lactose. They had a positive H2-lactose breath test and a negative H2glucose breath test. All patients were screened for possible celiac disease by measuring
the serum level of IgA antibodies to endomysium, anti-transglutaminase. Patients
positive for atleast one of these markers were submitted to upper gastrointestinal
endoscopy. It was evaluated that high prevalence of celiac disease was observed in
patients with a positive H2- lactose breath test compared to healthy controls. In these
subjects lactase deficiency seems to be the only manifestation of celiac disease.24
14
6.2.1. STATEMENT OF THE PROBLEM:
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM REGARDING LACTOSE INTOLERANCE IN CHILDREN
AMONG MOTHERS IN SELECTED COMMUNITY AREA, BANGALORE”.
6.3. OBJECTIVES OF THE STUDY:
1. To assess the pre- test knowledge on lactose intolerance among mothers.
2. To assess the post- test knowledge on lactose intolerance among mothers.
3. To evaluate the effectiveness of structured teaching programme among mothers
regarding Lactose intolerance.
4. To find out the association between knowledge of mothers on Lactose
intolerance and selected demographic variables.
6.3.1. OPERATIONAL DEFINITION:
1. EFFECTIVENESS: It refers to the extent to which the structured teaching
programme regarding lactose intolerance has achieved the desired effect in
improving the knowledge of mothers as assessed by post test.
2. STRUCTURED TEACHING PROGRAM: It refers to systematically planned
group instructions designed to provide information on meaning, causes, types,
signs and symptoms, diagnostic tests, treatment regarding lactose intolerance by
using charts, flash cards.
3. MOTHERS: Refers to women with children in the age group below 5 years.
15
6.3.2. ASSUMPTIONS.
The study assumes that:
1. The mothers may possess inadequate knowledge on lactose intolerance.
2. The mothers may misdiagnose lactose intolerance.
6.3.3. HYPOTHESES:
H1- The knowledge level of mothers will be increased regarding lactose intolerance after
the structured teaching programme than before the structured teaching programme.
H2- There will be significant association between the knowledge and the selected
demographic variables.
6.3.4. SAMPLING CRITERIA:
INCLUSION CRITERIA.
Mothers:
1.
who are willing to participate in the study.
2. who are available at the time of data collection.
3.
who are able to understand Kannada/ English.
EXCLUSION CRITERIA.
Mothers:
1.
who are health professionals.
2.
who have attended health programme on lactose intolerance previously.
16
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
Data will be collected from mothers in selected community areas in Bangalore.
7.2 METHODS OF DATA COLLECTION.

RESEARCH APPROACH
: Evaluative approach.

RESEARCH DESIGN
: Quasi experimental one group pre test and post
test design.

SETTING
: Selected area, Bangalore.

POPULATION
: Population of present study comprises of
mothers in selected community areas, Bangalore.

SAMPLE
: Women who have met the inclusive criteria

SAMPLE SIZE
: 60

SAMPLING TECHNIQUE
: simple random sampling technique

METHOD DATA COLLECTION

TOOL FOR DATA COLLECTION : Structured Questionnaire

METHOD OF DATA ANALYSIS:
: Interview method
 The researcher will use appropriate statistical technique for data analysis
and present in the forms of Tables and diagrams.
 Demographic variables will be analyzed by using frequency and
percentage distribution. Level of knowledge will be analyzed by mean
percentage and standard deviation. Association between demographic
17
variables and knowledge on lactose intolerance will be analyzed by chi
square test. The effectiveness of structured teaching programme will be
analyzed by paired “t”-test.

DURATION OF STUDY: 4 week

VARIABLES
 DEPENDENT VARIABLE: Knowledge on lactose intolerance
 INDEPENDENT VARIABLE: Structured teaching programme on
knowledge about lactose intolerance
 DEMOGRAPHIC VARIABLE: Age, education, dietary pattern,
socioeconomic status, race, health status, H/O diarrheal diseases,
immunization status, consumption of milk /day, H/O medications.

PROJECTED OUTCOMES.
This Study will enable mothers to acquire knowledge regarding lactose
intolerance and weed out the misperceptions about the disease condition.
7.3 Does the study require any investigation or intervention to be conducted on the
patient or other human being or animals?
Yes
7.4 Has ethical clearance been obtained from your institution?
Yes
18
8. LIST OF REFERENCES.
1. “Lactose intolerance: overview”.
URL:http://www.diagnose-me.com/cond/C344821.html. 04 oct 2010.
2. “Lactose intolerance”. URL: http://en.wikipedia.org/wiki/Lactose_intolerance.
18 November 2010.
3. “Lactose intolerance”.
URL:http://www.wrongdiagnosis.com/l/lactose_intolerance/intro.htm 24
Nov 2010
4. “Lactose intolerance”: NIDDK (Excerpt).
URL:http://www.wrongdiagnosis.com/medical/lactose_intolerance.htm 18
Nov 2010
5. “Prevalence and Incidence of lactose intolerance”.
URL:http://www.wrongdiagnosis.com/l/lactose_intolerance/prevalence.htm
.
6 oct 2010
6. “Lactose intolerance”. National Digestive Diseases Information Clearing
house(NDDIC).
URL:http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/. Jun
2009.
7. Marilyn.J.Hockenberry. “Wong’s Essentials of Pediatric Nursing”, 7th
edition.St.Louis, Missouri. 2008. P- 376-377
8. Dorothy.R.Marlow, Barbara. A. Redding .“Textbook of pediatric Nursing”. 6th
19
edition.Philadelphia.2002. P-714-715.
9. “Lactose intolerance”.
URL:http://www.medicinet.com/lactose_intolerance/article.htm.24 Nov 2010.
10. Lactose intolerance and health. Agency for healthcare research and
quality, Rockville.Feb 2010.
URL:http://www.ahrq.gov/clinic/tp/lactinttp.htm.
11. Stefano Gundalini, Richard E Frye. “Lactose intolerance”. eMedicine specialitiesPediatrics . 30 Mar 2010.
URL:http://emedicine.medscape.com/article/930971-followup
12. Tandon RK, Joshi YK, Singh DS, et al. “Lactose intolerance in North and South
Indians”. American Journal of Clinical Nutrition.1981:34: 943-946.
URL:http://www.ajcn.org/content/34/5/943.abstract
13. Janaki Babu, Sunil Kumar, Babu P,et al. “Frequency of lactose malabsorption
among healthy southern and northern Indian populations by genetic analysis
and lactose hydrogen breath and tolerance tests”. American Journal of
Clinical Nutrition. January 2010:91(1):140-146.
URL:http://www.ajcn.org/content/91/1/140.abstract
14. Kaila, M., Arvilommi, H., Soppi, E, et al. “A prospective study of humoral
immune responses to cow milk antigens in the first year of life”. Pediatric
Allergy and Immunology. August 1994: 5 (3): 164–169.
15. Bhan M K,Arora N K,Ghai O.P,et al. “Lactose and milk intolerance in recurrent
20
abdominal pain of childhood” . Indian Journal of Paediatrics. 1982:49(2):199202. URL:http://www.springerlink.com/content/aoj8kg4411074125/
16. Dinesh Gupta,Uday.C.Ghosal,Amita Misra,et al. “Lactose intolerance in patients
with irritable bowel syndrome from northern India:A case-control study”.
Journal of Gastroenterology and Hepatology.Dec 2007:22(12):2261-2265.
URL: http://cat.inist.fr/?amodele=afficheN&cpsidt=19912630.
17.Richard Nyeko,Israel Kalyesubula,Edison Mworozi, et al. “Lactose intolerance
among severely malnourished children with diarrhea admitted to the nutrtion
unit, Mulago hospital, Uganda”. Biomed central pediatric journal.6 may 2010.
URL:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881080/
18. Wittenberg D.F, Moosa.A. “Lactose maldigestion-age-specific prevalence in
Black and Indian children”.S Afr Med J.1990 Oct 20:78(8):470-2
URL:http://http://www.ncbi.nlm.nih.gov/pubmed/2218784.
19.Ronald.G.Barr, Melvin.D.Levine, John.B.Watkins. “Recurrent abdominal pain of
childhood due to lactose intolerance- A Prospective study”. N Engl J Med.28
Jun 1979:300:1449-1452.
URL:http://www.nejm.org/doi/pdf/10.1056/NEJM197906283002602.
20.Hutyra.T, Iwanczak.B. “ Determination of lactose intolerance frequency in
children with food allergy”.Oct 2008:25(148):340-4. URL:
http://www.ncbi.nlm.nih.gov/pubmed/19145933
21
21.Hutyra.T, Iwanczak.B. “Determination of milk and diary products consumption
and their connection with lactose malabsorption or lactose intolerance in
selected disorders of the alimentary tract in children”.Feb 2009:26(152):110-6.
URL: http://www.ncbi.nlm.nih.gov/pubmed/19388514
22. David.A.Gremse, Scott Greer.A, Jonathan Vacik, Paediatric Gastroenterology and
Nutrition. “Abdominal pain associated with lactose ingestion in children with
lactose intolerance”.1 may 2003:42(4):341-345.
URL:http://www.ncbi.nlm.nih.gov/pubmed/12800728.
23.Tao He, Marion.G.Priebe, Hermie J M Harmsen, et al. “Colonic fermentation may
play a role in lactose intolerance in humans”. Journal of Nutrition. Jan
2006:136:58-63. URL:http://jn.nutrition.org/content/136/1/58.abstract.
24. Veronica Ojettia, Gabriella Nuceraa, Alessio Mignecoa. “High Prevalence of
Celiac Disease in Patients with Lactose Intolerance”. Digestion, International
Journal of Gastroenterology.2005;71(2):106-110 .
URL:http://www.ncbi.nlm.nih.gov/pubmed/15775678.
9. Signature of the candidate
:
22
10. Remarks of the guide
:
11. Name and designation (in block letters)
11.1 Guide
:
11.2 Signature
:
11.3 Head of the department
:
11.4 Signature
:
12.1 Remarks of chairman & principal
:
12.2 Signature
:
12.
23