RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTARTION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

BINIL GEORGE

1ST YR MSc NURSING

KNN COLLEGE OF NURSING

YELAHANKA, BANGALORE-64

2 NAME OF THE

INSTITUTION

KNN COLLEGE OF NURSING

CA23/B, ‘A’SECTOR, K.H.B

SATELLITE TOWN

YELAHANKA, BANGALORE-64

3 COURSE OF STUDY

AND SUBJECT

MASTER OF SCIENCE IN NURSING

CHILD HEALTH NURSING

4 DATE OF

ADMISSION TO THE

COURSE

15.10.2011

5 TITLE OF THE

TOPIC

EFFECTIVENESS OF COMPUTER ASSISTED

TEACHING ON HUMAN GENETICS &

PREVENTION OF GENETIC DISORDERS IN

CHILDREN AMONG ADOLSCENTS OF

SELECTED PRE-UNIVERSITY COLLEGE AT

BANGLORE

6. BRIEF RESUME OF THE INTENDED WORK.

6.1. INTRODUCTION

BACK GROUND OF THE STUDY:-

“Characteristics like bright blue eyes and dimples aren’t the only things

children inherit from their parents. The bad comes with the good, and on rare occasion

a child can be the recipient of an inherited genetic mutation from mom or dad.”

Genetics is the science of inheritance. It aims to understand the mechanism by

which the blueprints for life are passed through generations and variations in these

blueprints are essential for evolution. The word Genetics is derived from Ancient Greek

word “genitive” that means “origin”. The fact that living things inherit traits from their

parents has been used since pre-historic times to improve crop plants and animals through

selective breeding. The modern science of genetics, seeks to understand the process of

inheritance, only began with the work of Gregory Mendel in the mid-nineteenth century.

Who observed that organisms inherit traits via discrete units of inheritance, which are

now called genes.1

The word ''chromosome'' comes from the Greek word ''chroma'' means colour and

''soma'' means body. Human cells have 23 pairs of large linear nuclear chromosomes:-22

pairs of autosomes and one pair of sex chromosomes (XX — female or XY —

male).Certain genetic traits are linked to a person's sex and are passed on through the sex

chromosomes. The autosomes contain the rest of the genetic hereditary information. A

chromosome is an organized structure of DNA and protein that is found in cells.2

Deoxyribonucleic acid (DNA) is a nucleic acid containing the genetic instructions

used in the development and functioning of all known living organisms (with the

exception of RNA viruses like HIV viruses). The DNA segments carrying this genetic

information are called genes3

A gene is a unit of heredity in a living organism. It normally resides on a stretch

of DNA. Genes hold the information to build and maintain an organism's cells and pass

genetic traits to offspring.4

Three main classes of genetic disorders are Single-gene disorders that means

mutations in single genes often causing loss of function, Multifactorial conditions that

means variants in genes interacting with the environment and causing alteration of

function, and Chromosomal disorders that means causing chromosomal imbalance and

alteration in gene dosage.5

The following factors are the causes or the risk factors for the genetic disorders

are A family history of a genetic disease, Parents who are closely related or part of a

distinct ethnic or geographic community like Consanguineous marriages, High birth rate,

Lack of expertise in genetic counselling, Improper antenatal care, prenatal diagnosis and

genetic testing, Recurrent abortions or still birth deliveries, Certain Cancers,

Environmental factors such as climate, Smoking, lifestyle, food habits, Poor diet , lack of

exercise, obesity etc.6

The common genetic disorders in Indian communities are G6PD (Glucose-6-

Phosphate Dehydrogenase) Deficiency Anaemia, Down Syndrome (impairment of

cognitive ability, physical growth & facial appearance), Thalassemia (abnormality in

the protein part of red blood cells), Sickle Cell Anaemia (abnormal, rigid, sickle shape

of red blood cells), Homocystinuria (disorder of the metabolism of the amino acid

methionine), Glaucoma (diseases of the optic nerve), Muscular Dystrophy (progressive

muscle weakness)

The management of genetic disease can be divided into counselling, diagnosis,

and treatment. In brief, the fundamental purpose of genetic counselling is to help the

individual or family understand their risks and options and to empower them to make

informed decisions. The cooperation of family members may be required to achieve

diagnosis for a given individual, and, once accurate diagnosis of that individual has

been determined, there may be implications for the diagnoses of other family members.

Early detection and dietary management will prevent the occurrence of the mental

deficiency and other problems.7

Counselling can be a helpful intervention for many life issues like adjustment

or acceptance of given disability, management in terms of training, adaptive or

vocational guidance and can help in finding employment and living independently. The

most important aspect of training of these counsellors is to identify genetic disorders in

a given population. This can be done by simply taking a detailed family history and

recognising some of the genetic disorders. They can then advise the families about

further tests to be done to screen them or organise services with reference labs/hospital

to do these tests.8

If the couple have a child with a genetic disorder the counsellor can be of great

help by providing a complete and accurate view of the situation, the nature of the birth

defect and what its recurrence would mean in practical terms for all involved. The

counsellor can also provide emotional support and understanding during what can be a

very difficult time. If there are decisions to be made about the pregnancy, care of a

child, having more children, or about the ability of the family to cope with ongoing

problems, the parents can make informed choices with the facts in hand. The concept

of genetic defects can be frightening and confusing. A genetic counsellor is trained to

help translate the information clearly and to be an emotional resource to help affected

individuals deal with the situations they face.9

All the couples who are suspected with genetic disorders must undergo genetic

testing to determine their chances of passing genetic disorder to their child. According

to Medline Plus, there are approximately 900 different types of genetic tests available.

These genetic tests can help hopeful parents make a decision concerning whether or not

having a child is the right choice, as well as provide information concerning your

baby's health while it's still in the womb. If a genetic disorder is detected, metabolic or

otherwise, treatment can begin immediately to prevent complications and to ensure that

your child has the best possible chances for living a normal, healthy life.10

Luckily, the prevention of genetic diseases has gotten a big boost as genetic

testing has become more advanced. The risk of some genetic conditions, such as

obesity or heart disease, can be reduced drastically with a healthy diet and regular

physical activity.11

6.2NEED FOR THE STUDY

Human genetics describes the study of inheritance as it occurs in human beings.

Genes can be the common factor of the qualities of most human-inherited traits. Study

of human genetics can be useful as it can answer questions about human nature,

understand the diseases, and prevent the disease and development of effective disease

treatment. A genetic disorder is an illness caused by abnormalities

in gene or chromosome, especially a condition that is present from before birth. Most

genetic disorders are quite rare and affect one person in every several thousand or

millions. A genetic disorder is a disease that is caused by an abnormality in an

individual's DNA. Abnormalities can range from a small mutation in a single gene to

the addition or subtraction of an entire chromosome or set of chromosomes.12

Worldwide, 15 million people have clinically apparent thalassemic disorders.

Reportedly, there are about 240 million carriers of b-thalassemia worldwide, and in India

alone, the number is approximately 30 million with a mean prevalence of3.3%. They are

encountered among all ethnic groups and in almost every country around the world.

Every year approximately 100,000 children with Thalassemia Major are born world over,

of which10,000 are born in India. It is estimated that there area about 65,000-67,000 b-

thalassemia patients in our country with around 9,000-10,000 cases being added every

year. The carrier rate for b-thalassemia gene varies from 1 to 3% in Southern India to 3%

to15% in Northern India. Certain communities in India, such as Sindhis and Punjabis

from Northern India,Bhanushali’s, Kutchis, Lohana’s from Gujarat,Mahar’s,

Neobuddhist’s, Koli’s and Agri’s from Maharashtra, &Gowda’s and Lingayat’s from

Karnataka etc. have a higher carrier rate.13

With a very large population and high birth rate, and consanguineous marriage

favoured in many communities, there is a high prevalence of genetic disorders in India.

An estimated 495,000 infants with congenital malformations, 390,000 with G6PD

deficiency, 21,400 with Down syndrome, 9,000 with thalassaemia, 5,200 with sickle cell

disease, and 9,760 with amino acid disorders are born each year. Due to inadequate

diagnostic, management and rehabilitation facilities, the burden of these disorders is

greater than in Western countries. Although genetic diseases receive little attention from

the health services, research funding by the government has been liberal. Community

control of common disorders like thalassaemia, Down syndrome, neural tube defects, and

muscular dystrophies deserves high priority, and genetic services should be integrated

into the existing primary health care and medical services.14

In a study conducted in Indian Council for Medical Research Centre for

Biomedical Research, and the Department of Biochemistry, Indian Institute of Science,

Bangalore 560012, India; and the Department of Anatomy and Human Biology, King's

College, London on 407 infants and children, a total of 35 genetic diseases was diagnosed

in 63 persons: 44 with single gene defects, 12 with polygenic disorders, and seven with

Down's syndrome.15

A study was conducted on Perspectives of Adolescents and Young Adults from

Fragile X Families. The data indicate that the adolescents and young adults in this study

advocate disclosing these aspects of genetic risk at significantly different ages. In

addition, the reasoning they provide for timing their disclosure differs as well. Overall

that data suggest that the adolescents and young adults in this study would prefer to be

informed that a disorder runs in their family in early childhood to allow time to adjust to

this information.16

A study by Royal College of Physicians has estimated that 2 – 3% of births result

in babies with either congenital or genetically determined abnormalities. This means that

approximately 13000 births a year in the UK are affected by a genetic disorder. Some

conditions may manifest themselves only later in life and 5.5% of the population will

have developed a genetic condition by the age of 25 years. Later in life, this figure rises to

approximately 60% if conditions in which genetics plays some role are included.17

So, from all the above points we can conclude that the awareness and knowledge

regarding the human genetics and the prevention of genetic disorders is very important

among the adolescents.

6.3 REVIEW OF LITERATURE

Review of Literature is key step in research process. It provides you with the

current theoretical and scientific knowledge about a particular problem and resulting in

synthesis of what is known or not known.

Section (a) Review Related To Prevalence of Genetic Disorders In Children

Section (b) Studies Related To Human Genetics

Section (c) Studies Related To Genetic Disorders

Section (d) Studies Related To Prevention of Genetic Disorders

Section (e) Studies Related To Knowledge of Adolescent on Genetic Disorder

Section (f) Studies Related To Effectiveness of CAT among Adolescents

Section (a) Review Related To Prevalence of Genetic Disorders In Children

A study conducted by Dimes Birth Defect Foundation, in 2006 reported the birth

defect prevalence in India as 64.4 (per 1000 live births).18

A study conducted in 2005 by Rao and Ghosh reported that 1 out of 20 children

admitted to hospital has a genetic disorder that ultimately account for about 1 out of 10

childhood deaths. In India’s urban areas, congenital malformations and genetic disorders

are the third most common cause of mortality in newborns.19

A population study conducted by P A Baird, T W Anderson, H B Newcombe, and

R B Lowry, The data base of an ongoing population-based registry with multiple sources

of ascertainment was used to estimate the present population load from genetic disease in

more than 1 million consecutive live births. It was found that, before approximately age

25 years, greater than or equal to 53/1,000 live-born individuals can be expected to have

diseases with an important genetic component.20

Section (b) Studies Related To Human Genetics

A study conducted by Harvard University in 2007 regarding human genetics

found that A new structure is needed to provide resources to enhance, promote and

coordinate human genetics education across the world to design, expand, and improve

technical platforms, to facilitate translation of genetic discoveries that advance human

health.21

A study conducted by American medical education and research association in

2000, regarding genetic variation in human beings found that the genetic mutation and

genetic disorders are occurring due to genetic and non-genetic factors thus the study

recommends there is a need to establish additional departments of medical genetics in

medical schools.22

Section (c) Studies Related To Genetic Disorders

A group of studies entered in IGDD (Indian genetic disorder database) holds

entries for 52 genetic diseases and 63 related genes collated from 123 reports, published

during 1993–2010. Currently, 2394 patients and 3366 carriers (resident or non-resident

Indian individuals) are enlisted in the database harbouring 6647 mutations of which 780

are unique in nature. Majority of these mutations are miss sense changes (41.3%)

followed by other types of mutations.23

El-Hazmi M A F suggested in his article, spectrum of genetic disorders and the

impact on health care delivery that, until recently, infectious diseases and malnutrition-

related disorders constituted the major cause of ill health and mortality in the world

population. However, advances in treatment of such disorders and increased

understanding of the molecular basis of heredity have led to genetically transmitted

conditions becoming a major cause of morbidity and mortality. Several disorders,

including chromosomal (Down syndrome, Turner syndrome), single-gene (sickle-cell

disease, thalassaemia, glucose-6-phosphate Dehydrogenase deficiency, haemophilia,

inborn errors of metabolism) and Multifactorial disorders (coronary artery disease,

arteriosclerosis, diabetes mellitus, hypertension, obesity) are common and becoming

increasingly important.24

Section (d) Studies Related To Prevention of Genetic Disorders

Hanan H in an article “Genetic disorders and congenital abnormalities: strategies

for reducing the burden in the Region” report that the magnitude of the problem of

genetic disorders can be attributed to several factors including the high rate of traditional

consanguineous marriages. Public health measures directed at the prevention of

congenital and genetically determined disorders, the dearth of genetic services and

inadequate health care prior to and during pregnancy.25

“Medical genetics in Primary health care” an article by Christianson L A,

proposes that to achieve a decrease in the birth prevalence of serious genetic disorders

and birth defects requires the implementation of population screening programmes.

Different options for population screening programe exist, and each country would need

to decide which programmes to initiate according to their needs and circumstances.26

Section (e) Studies Related To Knowledge of Adolescent On Genetic Disorder

An article was published in Journal for Specialists in Paediatric Nursing Volume

17, Issue 2, pages 159–167, April 2012 regarding Older adolescents, DIYGA (Do It

Yourself Genetic Assessment).The purpose of this research was to investigate older

adolescents, perceptions and factors that influence their intentions to utilize DIYGA

services. A convenience sample of 111 undergraduate students completed an online

survey based on the Theory of Planned Behaviour. Most respondents (80.4%) had not

heard of DIYGA services. Predictors of intentions to use DIYGA services included

attitudes, subjective norms, and perceived risk of developing a genetic disorder.27

A survey was conducted among 707 school students (55.6% males, 44.4%

females) in Delhi to find out their knowledge about human genetics Data were collected

as written responses to a close-ended questionnaire. The knowledge of students about

human genetic was found to be poor. The majority of students were not aware of the

prevalence of genetic disorders in the community. Many students (75%) felt that genetic

laboratory facilities and counselling services are necessary in this country. The study

indicates that there is a need to introduce the basics of human genetics in the school

curriculum and to implement strategies for awareness programs about genetic disorders

and their early detection for possible intervention.28

Section (f) Studies Related To Effectiveness of Cat among Adolescents

A meta-analysis was performed to synthesize existing research comparing the

effects of computer-assisted instruction versus traditional instruction on students in

Taiwan. Fifty-two studies were located from four sources, and their quantitative data was

transformed into effect size. The overall grand mean of the study-weighted effect size for

all 52 studies was 0.55. The results suggest that computer assisted instruction is more

effective than traditional instruction in Taiwan.29

A study was conducted on school teachers’ attitudes towards computer assisted

instruction at University of Gaziantep, Turkey in a multifaceted way. After a pilot study,

the questionnaire was applied to a sample population of 145 school teachers that were

chosen randomly. The results revealed that school teachers attitudes towards

computer assisted instruction are positive. Age, sex, teaching experience, level of

proficiency in English and computer usage skills have no or little effects over these

attitudes . The study concludes that school teachers who have prior knowledge on

computers expose rather positive attitudes towards computers in education. Another

important outcome of the study is the existence of a gender gap in terms of computer

assisted instruction. Although there seems to be no difference between male and

female school teachers concerning their background education regarding computers,

male teacher feel confident about the matter, whereas female teacher feel

uncomfortable about using computers in their lessons.30

6.4 STATEMENT OF THE PROBLEM

“A study to assess effectiveness of computer assisted teaching on human genetics

and prevention of genetic disorders in children among adolescents of selected pre-

university colleges at Bangalore”

6.5 OBJECTIVES OF THE STUDY

• To assess the pre-test level of knowledge regarding human genetics and prevention of

genetic disorders in children among adolescents of selected pre-university college,

Bangalore

• To evaluate the effectiveness of Computer Assisted Teaching on human genetics and

prevention of genetic disorders in children among adolescents of selected pre-

university college, Bangalore.

• To find the association between pre test level of knowledge on human genetics and

prevention of genetic disorders and selected demographic variables of adolescents

6.6 HYPOTHESES

H1: There will be a significant difference between the mean pre-test and mean post-test

knowledge score on human genetics and prevention of genetic disorders in children

among adolescents.

H2: There will be a significant association between pre test level of knowledge and

selected demographic variables of adolescents on human genetics and prevention

of genetic disorders.

6.7 OPERATIONAL DEFINITIONS

Assess: Is an activity to decide the level of knowledge on human genetics and prevention

of genetic disorders in children among adolescents of selected pre university college

Bangalore.

Effectiveness: It refers to the significant gain in knowledge on human genetic disorders

and prevention of genetic disorders by computer assisted teaching as determined by

significant difference in pre test and post test knowledge score.

Computer Assisted Teaching: It is a method of teaching the students with the use of

computer using power point presentation includes video and animation for a period of 30

– 40 minutes.

Knowledge: It is a method of adolescents understanding and ability to answer structured

questionnaires on human genetics and prevention of genetic disorders.

Human Genetics: Human genetics describes the study of inheritance as it occurs in

human beings.

Genetic disorders: A genetic disorder is an illness caused by abnormalities

in gene or chromosome, especially a condition that is present from before birth

Prevention of genetic disorder in children: Early detection and through health

education about the causes and risk factors

Adolescents: Adolescents refer to the male and female persons between the age group of

13 and 19.

6.8 ASSUMPTIONS

The study assumed that;

• The Adolescent studying in Pre-University colleges may have some knowledge on

human genetics and prevention of genetic disorders in children

• Computer Assisted Teaching will be an effective teaching strategy to enhance the

knowledge of the adolescents regarding human genetics and prevention of genetic

disorders in children

• Imparting knowledge on human genetic and practice of genetic disorder may help

adults to modify their lifestyle and hence reduce the rate of occurance of genetic

disorders in future

6.9. DELIMITATIONS

The study is delimited to;

• Adolescents of age group 13-19 years studying in selected Pre- University

colleges at Bangalore.

• Sample Size delimited to 60 adolescents only.

• 4 weeks Period of data collection only.

7. MATERIALS AND METHODS.7.1. SOURCES OF DATA

Data will be collected from adolescents of selected Pre-University colleges at Bangalore

7.2. METHODS OF DATA COLLECTION

7.2.1 TYPE OF STUDY OR RESEARCH APPROACH

Quantitative experimental study

7.2.2 RESEARCH DESIGN

One group pre-test post-test Pre-experimental design

7.2.3VARIABLES

Independent variable:

Computer Assisted Teaching Programme on human genetics and prevention of genetic

disorders in children.

Dependent variable:

Knowledge level of adolescents on human genetics and prevention of genetic disorders in

children.

7.2.4 SAMPLING TECHNIQUE

Convenient sampling technique

7.2.5 SAMPLES & SAMPLE SIZE

Sample size consists of 60 adolescent students in selected pre-university college

7.2.6 SELECTION CRITERIA

Inclusion criteria:-

Adolescents who are;

• Willing to participate in the study.

• Studying in selected Pre University Colleges at Bangalore.

• Present at the period of data collection

Exclusion Criteria:-

Adolescents who are;

• Adolescent who does not belong to age group between 13-19 years

• Who are not available at the time of data collection.

• Belong to science group who have under gone educational programme on human

genetic and genetic disorder

7.2.7 DURATION OF STUDY

4 weeks of data collection

7.2.8 TOOL OR INSTRUMENT

Section A: Socio demographic profile

Section B: Self structured knowledge questionnaire on human genetics and prevention of

genetic disorders in children

7.2.9 DATA COLLECTION PROCEDURE

A formal consent from respective PU college authorities is taken and samples are

selected through a convenient sample technique. Written consent will be taken from the

participants after explaining the purpose of the study. Pre-test will be conducted using

self structured knowledge questionnaire to assess the knowledge of the students on

human genetics and prevention of genetic disorders in children and computer assisted

teaching regarding human genetics and prevention of genetic disorders in children will be

conducted in the same day on the 8th day post test will be conducted using the same

knowledge questionnaire.

7.2.10 PLAN FOR STATISTICAL ANALYSIS

It includes descriptive and inferential statistics.

Descriptive statistics

(a) Frequency and percentage distribution will be use to analyze socio-demographic

variable

(b) Mean, mean percentage an d standard deviation will be used to assess the pre-test

and post-test knowledge score of pre-university college students

Inferential statistics

(a) The paired‘t’ test will be used to assess the effectiveness of computer assisted

teaching.

(b) Chi-square test will be used to find out the association of pre-test level knowledge

with selected socio demographic variables of pre-university college students.

7.3 does the study requires any investigation or intervention to be conducted on

patients/ humans/animals? If so describe briefly

Yes, computer assisted teaching will be provided to pre- University college

student with the aim to improve knowledge on human genetic and its prevention

7.4 Has ethical clearance being obtained from your institution?

Yes, Ethical clearance will been obtained from the ethical committee of the

institution and Permission has been obtained from the authority of Pre-University

College. And written consent will be obtained from subjects, confidentiality and

anonymity of subject will be obtained.

8. LIST OF REFERENCES

1. American Society of Human Genetics Board of Directors, AmericanCollege of Medical Genetics Board of Directors. 1995.

2. Balfour-Lynn I, Madge S, Dinwiddie R. 1995.Testing carrier status insiblings of patients with cystic fibrosis. Archives of Disease in Childhood72:167–168.

3. Borry P, Fryns J-P, Schotsmans P, Dierickx K. 2006. Carrier testing inminors: A systematic review of guidelines and position papers. EuropeanJournal of Human Genetics 14:133–138.

4. Borry P, Goffin T, Nys H, Dierickx K. 2007. Attitudes regarding carriertesting in incompetent children:Asurvey of European clinical geneticists.European Journal of Human Genetics 15:1211–1217.

5. Human Genome Project Information.(n.d.).Gene testing. Retrieved December 8, 2008, Website:http://www.ornl.gov/sci/techresources/Human_Genome/medicine/genetest.shtml#procon.

6. LabCorp.(2007). Common prenatal genetic testing. Retrieved December 8, 2008, from https://www.labcorp.com/genetics/prenatal_genetic_testing/index.html.

7. National Institute of Health.(n.d.).Specific genetic disorders.Retrieved December 8, 2008, from the National Human Genome Research Institute Web site: http://www.genome.gov/10001204

8. Brown-Smith N. 1998. Family secrets. Journal of Family Issues 19:20–23.

9. Clarke A. 1994. The genetic testing of children.Working Party of theClinical Genetics Society (UK). Journal of Medical Genetics 31:785–797.

10. Fleiss JL, Chilton NW, Wallenstein S. 1979. Ridit analysis in dental clinicalstudies. Journal of Dental Res 58:2080–2084.

11. Fleiss JL, Levin B, Paik MC. 2003. Statistical Methods for Rates andProportions, 3rd ed. New York: Wiley.

12. Fryer A. 2000.Inappropriate genetic testing of children. Archives of Diseasein Childhood 83:283–285.

13. McConkie-Rosell A, Spiridigliozzi GA. 2004. ‘‘Family matters’’: A conceptualframework for genetic testing in children. J Genet Couns 13:9–29.

14. McConkie-Rosell A, Spiridigliozzi GA, Rounds K,Dawson DV, Sullivan JA,Burgess D, Lachiewicz AM. 1999. Am J Med Genet82:206–211.

15. McConkie-Rosell A, Spiridigliozzi G, Dawson D, Sullivan J, LachiewiczAM.2002.AmJ Med Genet 110:36–44.

16. McConkie-Rosell A, Spiridigliozzi GA, Melvin E, Dawson DV, LachiewiczAM. 2008. Living with genetic risk: Effect on adolescent self-concept.AmJ Med Genet Part C Semin Med Genet 148C:56–69.

17. Mehta CR, Patel NR. 1983. A network algorithm for performing Fisher’sexact test in r x c contingency tables. J Am Statistical Assoc 78:427–434.

18. Potter W, Levine-Donnerstein D. 1999. Rethinking validity and reliabilityin content analysis. J ApplCommun Res 27:258–284.

19. Rosen A, Wallenstein S, McGovern MM. 2002. Attitudes of pediatricresidents toward ethical issues associated with genetic testing in children.Pediatrics 110:360–363.

20. Ross LF, Moon MR. 2000. Ethical issues in genetic testing of children. ArchPediatrAdolesc Med 154:873–879.

21. Rousseau F, Rouillard P, Morel ML, Khandjian EW, Morgan K. 1995.Prevalence of carriers of premutation-size alleles of the FMRI gene—Andimplications for the population genetics of the fragile X syndrome. Am JHum Genet 57:1006–1018.

22. Sparbel KJH, Driessnack M, Williams JK, Schutte DL, Tripp-Reimer T,McGonigal-Kenney M, Jarmon L, Paulsen JS. 2008. Experiences of teensliving in the shadow of Huntington disease. J Genet Couns 17:327–335.

23. Turner G, Webb T, Wake S, Robinson H. 1996. Prevalence of fragile Xsyndrome.Am J Med Genet 64:196–197.Wertz DC, Fanos JH, Reilly PR. 1994. Genetic testing for children andadolescents. Who decides? JAMA 272:875–881.24. Database for the mutations of the Finnish disease heritage. Hum. Mutat. 2002;19:16-

22.The cypriot and Iranian national mutation frequency databases. Hum. Mutat.

2006;27:598-599.

25. Hellenic National Mutation database: a prototype database for mutations leading to

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inherited disorders worldwide. Nucleic Acids Res. 2007; 35:D690-D695.

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Scientific Publications;2001.

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9. SIGNATURE OF THE CANIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF:

11.1. GUIDE: Mrs. ANJANA MATHEW

HOD CHILD HEALTH NURSING

KNN COLLEGE OF NURSING

CA23/B, K.H.B SATELLITE TOWN

YELAHANKA, BANGALORE.

11.2. SIGNATURE OF THE GUIDE:

11.3. HEAD OF THE DEPARTMENT: Mrs. ANJANA MATHEW

HOD CHILD HEALTH NURSING

KNN COLLEGE OF NURSING

CA23/B, K.H.B SATELLITE TOWN

YELAHANKA, BANGALORE.

11.4. SIGNATURE OF THE H.O.D:

12. REMARK OF THE PRINCIPAL:

12.1. NAME OF THE PRINCIPAL: Prof. JOBI JACOB, MSc (N)

PRINCIPAL & HOD OF O.B.G (N)

KNN COLLEGE OF NURSING

CA23/B, K.H.B SATELLITE TOWN

YELAHANKA, BANGALORE.

12.2. SIGNATURE OF THE PRINCIPAL: