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Chapter I INTRODUCTION

A. Background of the Study

Open your window on a sunny afternoon, and what do you hear? The chirping of the birds? The yelling of the playing children? Odds are these days we hear chirping of the birds but not the children. Gone were the days when we see the children enjoying an after school “habulan”. Instead, children spend time watching television, using the computer and playing video games. Consequently, as these kids spend more time in front of the television, computer and video screens, their physical activity levels decrease and thus, their body weight increases.

To make matters worse, with the emerging technologies of the modern world, children are bombarded with well-crafted TV ads from fast food chains and other purveyors of high fat, high-sugar meals and snacks. A recently study reported that two to six years old who watch television are more likely to choose food products advertised on TV than children who do not watch commercials. These highly effective advertising campaigns combined with a physically inactive lifestyle, have undeniably produced a generation of kids who are at risk for obesity-diabetes associated medical condition.

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Obesity is a serious medical condition that negatively affects a child’s health or well being. It occurs when a child is well above the normal weight for his/her age and height off course, all children gain weight as they grow older, but extra pounds-more than what is needed to support their growth and development can lead to childhood obesity. It is particularly troubling because the extra pounds often start kids on the path to health problems that were once confined to adults such as diabetes. What is more alarming is that obesity increased from 5 percent in 1964 and about 15 percent in 1994 today. It is about 20 percent – and rising.

Diabetes is the name given to disorders in which the body has trouble regulating its blood glucose or blood sugar levels. It is actually a disorder of the immune system. When the body’s immune system attacks and destroys certain cells in the pancreas, an about the size of the hand that is located behind the lower part of the stomach. These cells, called Beta cells are contained, along with other types of cell within small islands of endocrine cells called the pancreatic islets. Beta cells normally produce insulin, a hormone that helps the body move the glucose contained food into cells throughout the body which is used for energy. But when the Beta cells are destroyed, little or no insulin can be produced and the glucose stays in the blood instead, where it can cause serious damage to all organ systems in the body.

Researchers said that the incidence of Diabetes among obese children is growing faster than earlier and will double from 2005 levels in a little over a decade if present trends

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continue. It has been said that obese children are more likely to develop Diabetes than that of the normal weight. Obesity has been presented as a risk factor for Diabetes, as it reached epidemic proportions globally along with an adoption to sedentary lifestyles. The excessive high fat, high-sugar food and inadequate physical activity which is synonymous to the cause of Diabetes have been accounted for such epidemic which the children are not immune to.

This study is projected to investigate the risk factors affecting children whose parents are diagnosed with diabetes, not only to understand its complex etiology but also because of its increasing public health demand in the hope to combat to the onset of epidemics. Furthermore, imperative efforts shall be directed at a surveillance of these risk factors and diabetes especially among the young people.

B. Statement of the Problem

The study aims to identify the risk factors that affect children with diabetic parents. Specifically, it seeks to answer the following queries:

1. What is the level of awareness on the risk factors among children whose parents are diagnosed with diabetes? 2. What lifestyle modification strategies can be employed to reduce the risk factors affecting children whose parents are diagnosed with diabetes?

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3. What are the evidences of lifestyle modifications that help reduce risk factors among children whose parents are diagnosed with diabetes?

C. Significance of the Study

The study will serve as an impetus to battle against obesity and diabetes among children that put them at a greater risk for severe complications in the future.

This study would serve as source of information for readers on disease-factor orientation, prevention and provide groundwork for similar studies in the same future with the same concerns.

This study will be an eye opener and will make the officials of the school and higher offices realize the evidence of health conditions amidst the educational system. The findings of this study will encourage school officials to come up with programs that will cater to the health needs of pupils.

The study could be use as a reference for future researchers whose main aim is to improve the lives of Filipino children.

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D. Scope and Delimitation

The study will focus on obese children whose parents are diagnosed with diabetes mellitus. The focus of inquiry will be premised on the risk factors that would likely lead to Diabetes Mellitus if not prevented and controlled.

Furthermore, the study will focus on the lifestyle modification strategies that will be used to improve the lives of the children whose parents were diagnosed with diabetes mellitus. This will cover a period of one year.

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Chapter II REVIEW OF LITERATURE AND CONCEPTUAL FRAMEWORK

A. Review of Literature According to health service reports, there has been a 54 per cent increase in the number of adolescents in the 15-19 year age group in the country, between 1988 and 1996. Prevalence of Type II diabetes in children was first reported in developed countries but with more adopting Western life styles and food culture, the emerging picture here is no different, it is pointed out. This is a relatively new and rare phenomenon among children and as doctors we know so little about it. But one can foresee a clear upswing in devastating complications arising out of diabetics in our next generation, as soon as they step into adulthood. Children who develop Type I or juvenile diabetes early in life have to be administered insulin right from the beginning to control their blood sugar levels.. However, children here are now developing Type II diabetes mostly because of some predisposing factors. (Poulose, 2004). 1) Risk Factors Affecting Children of Parents Diagnosed with DM. a. Lack of Awareness. Undiagnosed diabetes becomes more common especially in children. Often people are unaware of the onset of their diabetes since symptoms of the disease can remain undetected for many years until they reach adulthood. Even worse, complications such as eye disease can begin to develop seven years before

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diagnosis. During the time that diabetes remains undiagnosed and untreated, complications are developing without the person's knowledge.. Clearly, early intervention is the key. Children at risk for obesity and its attendant health risks must be identified at a young age, and measures must be taken to head off potential complications. Early detection, patient education, caring intervention -- they're all tasks tailor-made for the family physician (Zimmerman, 2000). b. Faulty diet. Ninety percent of people who have been diagnosed with diabetes is caused by faulty diet. Unhealthy eating contributes largely to health problems. Too much fat, not enough fiber and too many simple carbohydrates all contribute to the diagnosis of diabetes in the future. Eating right can turn the diagnosis around and reverse. c. Obesity. Childhood obesity can carry with it some heavy health risks that often last well into adulthood .Obese children also are twice more likely to have diabetes than children who are of normal weight, according to a new study from the University of Michigan Health System. The study, published in the February issue of Diabetes Care, is the most recent national study to estimate the prevalence of children with diabetes. As children’s waistlines have continued to grow so has concern that obesity will lead to even more children developing diabetes before they’ve graduated from high school. And caring for the combination of these children’s diabetes and obesity may place more strain on the health care system. (Lee, 2006).

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d. Lack of Exercise. With the emerging technology of the modern age kids of today’s generation tend to spend most of their time in front of video screens than playing outside. These inactivity leads to the development of health problems such as diabetes. The more inactive they are, the greater is the risk of having diabetes. Physical activity helps control weight, uses up glucose as energy, and helps your cells to become more sensitive to insulin. Exercise enables your muscles to absorb glucose and burn energy and is therefore a very sound way to stay away from the diabetes.. Having the right amount of exercise can and will really affect your weight. Without exercise we would not burn or eliminate the calories you digest from foods you eat. Exercise is merely eliminating calories by perspiration. Exercise also helps lower your blood pressure (Ryan, 2007). 2) Lifestyle Modification Strategies

Health Education. Teaching and counseling on healthy living. Health education covers topics such as hygiene, nutrition, and sex education. It also addresses alcohol and drug misuse, smoking, and other threats to health. In most secondary schools, health education is included within a course of personal and social education; it may also be integrated into subjects such as biology, home economics, or physical education. a. School-Based Intervention Measures of Obesity. An interdisciplinary program designed to increase awareness of obesity and change the behaviors

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of Dutch school children appears to have reduced the amount of sugary beverages consumed by boys and girls and also improved body composition in girls alone, but did not seem to affect other behaviors. Amika S. Singh, Ph.D., and colleagues at VU University Medical Center, EMGO Institute, Amsterdam, the Netherlands, assessed the effectiveness of the intervention among 1,108 adolescents (average age 12.7). The program included 11 lessons in biology, physical education and lifestyle changes over eight months. b. Weight management. Self-recognition of obese status is often the initial step toward successful weight management. Among children, parental recognition of overweight status in their child may also be necessary for weight management success given the role of parents in engaging their child in weight-related behaviors. Among overweight and obese children, the desire to lose weight was strongly associated with parental ability to correctly recognize their child's weight status. Thus, those interventions promoting healthy weight perceptions for pediatric weight management should target not only children but also their parents. c. Exercise Program. Starting a fitness training program for your child can be very easy if you just use some initiative. You don't have to get them to the gym which is boring for them and expensive for you, but you can use other methods. Make sure that they don't watch TV for more than 1 hour at a time. If they are watching a movie, make sure that they don't get to watch anything

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else or play computer games that day. Rather encourage them to play outside. You can go to the park, let them run around the garden, or give them other activities to keep them occupied. If the weather is horrible, it can be tempting to forego the fitness training program and let them just sit in front of the TV or play games, but you can control these things too. Get them games that are active like the dance mats, and sports games where they have to do all the movements. You can also make up dancing games for them, or if they are young enough let them only watch a program that gets them up and moving with fun songs and dancing.

3) Evidences of Lifestyle Modification

a.

Increased Awareness. Reaching and maintaining a healthier weight is

important for your overall health and well being. If you are significantly overweight, you have a greater risk of developing many diseases including high blood pressure, Type 2 diabetes, stroke, and some forms of cancer. For obese adults, even losing a few pounds or preventing further weight gain has health benefits. b. Weight Loss. Weight loss is a decrease in body weight resulting from either

voluntary (diet, exercise) or involuntary (illness) circumstances. Most instances of weight loss arise due to the loss of body fat, but in cases of extreme or severe weight loss, protein and other substances in the body can also be depleted.

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c.

Physically Active. Encouraging increased physical activity can be a big

challenge if the kids would rather watch TV or play computer games. Another hurdle: promoting healthy activities. Muscle cells have more insulin receptors than fat cells, so a person can decrease insulin resistance by exercising. Being more active also lowers blood sugar levels by helping insulin to be more effective.

B. Related Studies

The study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control.

A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parents reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c).

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There were significant differences in the mean HbA1c values between the older and the younger patients. Parental involvement in BGM was significantly related to adherence to BGM in both groups’ adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients.

Parental involvement in BGM supports more frequent BGM is associated with better metabolic control. These findings suggest that encouraging parental involvement in BGM with 10-15 year old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.

B. Theoretical Framework

Margaret A. Newman Health as Expanding Consciousness Theory As nurses moved into research to test nursing theory and improve nursing practice, they drew heavily on research methodologies used by medical and social

science, which entailed isolation, quantification, and manipulation of variables aimed at predicting cause and effect. The medical model focused on the body and causal explanations of illness (i.e., A causes B, or atherosclerotic plaque causes heart attacks). The social science model took a systems approach, which looked at the

interrelationships between variables and their effect on a specified outcome (i.e., A +

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B + C + D are interrelated in their effect on E; or diet, exercise, smoking, family history, and lifestyle are interconnected in their effect on heart attacks). Margaret Newman’s theory (1979, 1990, 1994a, 1997a, 1997b) proposes that we cannot isolate, manipulate, and control variables in order to understand the whole of a phenomenon. The nurse and client form a mutual partnership to attend to the pattern of meaningful relationships and experiences in the client’s life, as well as the meaning of the heart attack and through the insight gained, the client undergoes an expansion of consciousness. We must use a methodology that does not divide people’s lives into fragmented variables, but rather attends to the nature and meaning of the whole (Newman, 1994a, 1997a, 1997b). The HEC perspective sees disease as an explication of the underlying implicit pattern of the person, family, or community. Disease can be part of the process of expanding consciousness (Newman 1994a, 1997a, 1997b). To provide a metaphorical illustration of how disease can be an explication of the underlying implicit pattern, Newman (1994a) uses Bohm’s image of a fish tank with two video cameras focused on it —one from the narrow side of the tank and the other from the broad side. If two television screens were projecting the two images, they would project very different views of the movements of the fish, but the observer would get a sense of the underlying pattern. So, too, it is with disease and states of health—they are both explicit projections of the underlying pattern of the person or of the community Nurses and their clients know that there has been an expansion of consciousness when there is a richer, more

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meaningful quality to their relationships. Relationships that are more open, loving, caring, connected, and peaceful are a manifestation of expanding consciousness.

C. Conceptual Framework

The figure illustrates the concept of the study using Margaret Newman health as expanding consciousness theory. It presents the Risk Factors Affecting Children (Lack of Awareness, Faulty Diet Obesity, and Lack of Exercise) which are identified in the Assessment phase. In Planning and Implementation phase it presents the Lifestyle Modification Strategies and the Evidences of Lifestyle Modifications is presented in the Evaluation phase.

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Figure 1. The Process Flowchart

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E. Definitions of Variables

Risk Factors Affecting Children who’s Parents are diagnosed with Diabetes Mellitus Lack of awareness- Refers to the level of inadequate knowledge regarding their health status and being at risk of having diabetes mellitus.

Faulty diet- Refers to the unhealthy eating habits

Obesity-Refers to the condition of the children wherein there is an excess of weight or weight is over than the required weight for their age and height.

Lack of exercise- Refers to the sedentary lifestyle or the lack of physical activity of the children and the family.

Lifestyle Modification Strategies

School-based intervention measures of obesity-Refer to the involvement of the school in monitoring and controlling the health status of the students. Weight management exercise-refers to the process of weight control and weight maintenance to achieve desired BMI.

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Exercise program- refers to the modifications of inactive lifestyle to an active lifestyle.

Health Education- Refers to the measures that will be use for health teaching regarding disease prevention and control.

Evidences of Lifestyle Modification

Increase awareness- refers to the level of knowledge regarding risk factors of DM Weight loss- refers to the decrease in weight of the respondents. Physically active- refers to active lifestyle. .

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Chapter III RESEARCH METHODOLOGY

A. Research Design

The study employed the Descriptive- qualitative type of research. Descriptive in a way that the end product is a rich description of the phenomenon under study. It will attempt to identify the existing condition of “what” of a situation and the “why” of it will be identified.

B. Sampling Design

The study will be conducted a selected public school within the city proper. The sampling technique will be non-probability sampling specifically purposive-network sampling. There will be 10 respondents from the school and with the following criteria: a. Officially enrolled in the school b. Obese c. Must be school age (6-12 years old) d. Willing to be part of the study.

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C. Research Instrument

The study will utilize the following instruments in gathering data:

Research instrument no.1- survey questionnaire- the instrument will be use to gather the demographic profile of the respondents (age, grade, school, and ethnicity) and anthropometric measurement data (weight, height, BMI, and DBW).

Research instrument no.2- focus group discussion- the instrument will be use to gather data regarding the family’s lifestyle such as the food they eat, physical activities.

Research instrument no. 3 BMI Table for 6- 9 years old and 10- 12 years old. This instruments will be use to identify if the respondents are obese or not. The table present the low BMI, normal BMI, and high BMI for boys/male and girls/female.

Research instrument no. 4 Food Pyramid Guide- this will be use to ensure the dietary adequacy that offer five (5) categories of food to choose from. This is a simple and easy to follow daily eating guide.

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D. Reliability and Validity

The instrument and tools that were used for the study will undergo further testing to determine its usefulness in gathering and identifying the risk factors that affects children whose parents diagnosed with diabetes mellitus.

Table of Specifications Research Problem 1. What is the level of awareness on the risk factors among children whose parents are diagnosed with diabetes? Data Needed Risk Factors  Lack of Awareness 1. What factors do you know that causes diabetes mellitus? 2. Do you know the complications of diabetes mellitus? 3. What interventions you have done after you were diagnosed with Blueprint of Record Tool

diabetes mellitus? 4. Do you have beliefs about diabetes mellitus? 5. Do you follow these beliefs? 6. Do you think all fat children are

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healthy?

 Faulty Diet

1. How many times you eat in a day? 2. What are the foods served during regular meals?  Breakfast __bread __rice __fruits __milk __root crops

__cereal __coffee __meat __vegetables __fish __dried fish

__________others  Lunch __fruits

__rice __meat

__vegetables __root crops __fish __coffee __soft drinks ___________others  Dinner

__rice __meat __fruits __vegetables __fish

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__root crops __soft drinks

__coffee

_____________others

3. What are the foods served between meals?  Snacks a.m.

___________________________ ___________________________ ____specify  Snacks afternoon

___________________________ ___________________________ ____specify  Snacks p.m.

___________________________ _____________________specify

4.

What are the usual foods your child wants to eat?

5. Do you allow him/her to eat these

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kinds of foods? 6. How often?

1. In your opinion, is your child healthy?  Obesity 2. Do you think he/she is heavy for his/her age? 3. What causes obesity? 4. What do you think are the possible ways to prevent obesity?

1. What are your child’s physical activities?  Lack of Exercise 2. How do they spend their leisure time? 3. What kind of games are they indulged to? 4. How often do they watch

television? 5. How often do they play video and

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computer games? 2. What lifestyle  Health Education 1. What modification lifestyle do you know to prevent the onset of diabetes 2. What are the the risks children factors with

modifications strategies can

be employed to reduce the risk factors affecting children whose parents are  Exercise Program

affecting

diabetic parent? 1. What do you do during

weekends? 2. Does your child undergo exercise programs? What kind of exercise program?

diagnosed with diabetes?

 Weight Management

1. Are you conscious on your child’s weight? What do you do to maintain your child’s desirable weight?

3. What are the evidences lifestyle modifications that help reduce of

 Weight Loss

1. Is there any change in the weight of your child after the practice of lifestyle modification? 2. Did the weight increase or

decrease?

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risk

factors  Increase Awareness 1. How do these risk factors affect the children with diabetic parents? 2. How do the knowledge on these risk factors decrease the

among children whose are parents

diagnosed

with diabetes?

possibility of having diabetes mellitus? E. Plan for Data Presentation, Analysis and Interpretation This section presents analysis and interpretations of the data that will be gathered from the respondents through survey questionnaire and focus group discussion. The data will be tallied, analyzed and interpreted. The sequence of presentation will be based on the order of specific problems in the statements of the problems and survey questionnaires.

Table I. Presentation of Profiles of Respondents

School A

Frequenc y 10

Gender Grade Ethnicity Male Female 1 2 3 4 5 6 Bisaya Zamboangueňo Tausug

Table II. Anthropometric Measurement Data Student 1 Age Weight Height BMI

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2 3 4 5 6 7 8 9 10