Research Protocol 1st Submission

8/3/2019 Research Protocol 1st Submission

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DE LA SALLE HEALTH SCIENCES INSTITUTECOLLEGE OF MEDICINE

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

CM2 SY 2011-2012

OUTPUT 7: RESEARCH PROTOCOL

Exposure to Air-conditioning Systems in Classrooms Leads to Mild Severity of Allergic Rhinitis in

Second Year High School Students of Selected Schools in Dasmarias City, Cavite: A Cross-

Sectional Study.

SUBMITTED ON:

October 13, 2011

SUBMITTED TO:

DR. JOVILIA M. ABONG

SUBMITTED BY:

GROUP 1A

ARCAIRA, JOSHUA A.

ABAD, MARY RAINA ANGELI

ANCHETA, JONATHAN

BASUL, CHARINE

CARAVEO, JULIEN NICOLE

CRUZ, SPICA

ESPINOZA, FAITH KRISTINE

GARCIA, RAY WILSON

KALALO, GERARD MICHAEL


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OUTPUT 7: RESEARCH PROTOCOL

GROUP 1A, DR. JOVILIA M. ABONG

I. INTRODUCTION

Research Question and Hypothesis

Research Question:

Among second year high school students with allergic rhinitis of selected schools in Dasmarias, Cavite,

will exposure to air-conditioned school rooms affect the severity of their allergic rhinitis?

Research Hypothesis:

Exposure to air-conditioned rooms alleviates the symptoms and occurrence of allergic rhinitis and poor

ventilation leads to its severity.

Background of the Research Question

The researchers are concerned with the fact that more than 20% of the American population is affected by

allergic rhinitis (AR) [1] and moreover, the Philippines has ranked with the highest prevalence of rhinitis

and asthma among other Asian countries. [2] With this the researchers deemed to determine the factors that

may lead to the exacerbation of allergic rhinitis and in turn discover methods of how to prevent the

progression of its severity. AR has been shown to decrease performance of students in school leading to

absenteeism of students. [3] Poor ventilation in the classrooms lead to increased exposure to allergens such

as pollen, cockroaches, and molds that may ultimately lead to the exacerbation of the students AR

interfering with the students capacity to do his/her daily activities. [4], [5] Hence the researchers wish to

determine if there is an association between exposure to air-conditioning systems in the classrooms and

the occurrence of mild allergic rhinitis.

Significance of the Study

In attempt to determine the classroom environment that would lead to less occurrence of symptoms of AR

leading to mild severity AR, the researchers would like to contribute somehow in helping the students

cope with their condition and be able to maximize their potential in school.

II. RESEARCH OBJECTIVES

General Objective: To determine if the exposure to the air-conditioning system affects the severity

of allergic rhinitis in second year high school students of selected schools in Dasmarias, Cavite.

Specific Objectives:

1. To identify the prevalence of allergic rhinitis among second year high school students of

selected schools in of Dasmarias, Cavite based on their exposure to air-conditioned rooms.

2. To identify the prevalence of allergic rhinitis among second year high school students of

selected schools in Dasmarias, Cavite based on their exposure to non-air-conditioned

classrooms.


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3. To determine the severity of allergic rhinitis according to ARIA classifications.

4. To identify the risk factors of allergic rhinitis present in the classroom or school, such as the

presence of molds, chalk dust, house dust, and cockroaches.

5. Compare the severity of allergic rhinitis in students who are exposed to air-conditioned

classrooms and those who are not exposed to air-conditioned classrooms.

III. LITERATURE REVIEW

Epidemiology of Disease of interest

According to a demographic and epidemiologic study by Settipane, allergic rhinitis affects more than

20% of the American population. [1] This percentage is alarming on its own, making allergic rhinitis fairly

common among the population. Furthermore, it was observed by the ISAAC (International Study of

Allergy and Asthma in Children) that the Philippines was ranked with the highest prevalence rate of

common allergies (rhinitis and asthma) - encompassing countries like Thailand, Indonesia, and South

Korea. These studies have triggered interest into the disease and have inspired us to study the diseasefurther as well. [2]

From the same study by the ISAAC, they discovered that among Filipino teenagers, 13-14 year-

olds presented with the highest prevalence rate among age groups with 32.5% of them having allergic

rhinitis. [2] Hence, our study will be focusing on the high school year level where the specific age group

mentioned is found.

Ventilation and air-conditioning systems can be sources of microbial aerosols either from

contaminated air entering the system or directly from microbial growth within the system. Poor

ventilation may allow an accumulation of particulates, pollutants, and allergens inside school buildings

and decreased air circulation may increase transmission of respiratory infections. Building structural

problems, such as heating or air conditioning systems venting near an air intake may contribute to these

exposures. Due to this, the associations between school absenteeism and poor ventilation, vermin, and

cumulative exposure to building condition problems are greater for younger students. Young children,

aged 5 to 18 years old,are also known to bemore susceptible to airborne pollutants than adults because of

their greater activity, smaller airways, and faster ventilation rates.[3] Therefore, it is important to look into

which of the learning environments is more likely to help students achieve their full potential and keep

them healthy.

According to Meltzer, approximately one in five children will develop symptoms of allergic

rhinitis by two to three years of age. In children who are six years of age, about 40% of them will have

symptoms and up to 30% will be affected during their adolescence. [4] Furthermore, a study by Blaiss

pointed out that allergic rhinitis can interfere with a childs daily activities such as learning in school. It

also affects a childs behavior and psychosocial health thus affecting the childs quality of life overall.Due to this, a consensus panel was formed in 2004 to assess the impact allergic rhinitis has on school

children and determine how to improve prevention and treatment, so an affected childs quality of life and

school performance could improve. One of the things they considered in this consensus is that poor

environmental conditions, such as places that have inadequate ventilation or poor indoor quality, can

exacerbate allergic rhinitis. It is advised that the best way to prevent allergic rhinitis from occurring is by

providing clean indoor environments that will reduce the amount of allergens present indoors. This

includes having an air-conditioning system and proper ventilation.[4], [5]


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Risk factors and possible Confounding variables of the study

Allergens/Irritants

Allergens and irritants present in the environment are part of the confounding variables of the study. One

of the allergens that commonly trigger allergic rhinitis is pollen. In a cohort study conducted in Sweden in

2003, it has been identified that pollen accounted for seventy-three percent (73%) of the trigger factorsthat cause allergic rhinitis.

[6]Moreover, the incidence of allergic disease has been thought to be

constantly increasing [7] and this has been attributed to the increased exposure of children to air pollution,

probably because of the presence of particulates in the air. [8]. The condition of the classroom, as will be

surveyed upon implementation of the study, is a confounding variable to this research because as already

mentioned, allergens comprise a big part of the triggers of allergic rhinitis and these allergens or irritants

may be present in the classroom in the form of dust from unwashed curtains, carpets, or table cloths that

may trigger a more severe allergic reaction. Furthermore, exposure to chalk dust, especially in a poorly

ventilated classroom, may also trigger allergic rhinitis of the affected students.

Epidemiology of Exposure/Factor of interest

According to Busse, an allergic reaction is usually caused by an allergen. In the cases of people with

allergic rhinitis, when they breathe in these allergens such as pollens or dust, these cause their bodies to

release certain chemicals like histamine, bradykinin, and the like. These chemicals cause the persons with

AR to experience symptoms of allergic reactions such as itching, swelling, and mucous production.

Pollens that cause AR may differ depending on the person who inhales such pollens. Usually the smaller,

hard-to-see pollens cause AR more often than the bigger ones. Examples of plants that produce the said

pollens are deciduous and evergreen trees, grasses, and ragweed. Development of symptoms may depend

on the amount of pollen present in the air. During dry, hot, windy days there may be more pollens present

in the air thus, the increasing the probability of developing symptoms of AR. However, during cool,

damp, rainy days pollens may not be abundant in the air since they would most likely be washed in the

ground. Reactions to allergens may also include eczema and asthma which are also part of the allergic

reaction. The most common cause of developing AR is still genetic in nature. The chance of having AR is

high if both parents have the disease.[9]

Togias stated that inflammatory mediators produced by mast cells that are activated by antigen-

IgE cause the symptoms of AR. The mediators directly or indirectly target the end organs. For example,

the histamine released by mast cells stimulates the sensory nerves which lead to sneezing, pruritus,

rhinorrhea, and nasal congestion. Symptoms may also arise due to the phenomenon of hyper-

responsiveness to non-allergenic stimuli like cold air and other irritants. The phenomenon is believed to

have arisen from the allergic inflammation on the sensory nerves that supply the mucosa of the upper

respiratory tract mucosa. Different kinds of non-allergenic triggers were shown to act on the nasal mucosaby the means of sensorineural stimulation. The responsiveness to these stimuli is also heightened in AR

compared to healthy individuals. Also, stimulation of sensory nerves can produce inflammatory changes

in AR. Such inflammation is called neurogenic inflammation but the mechanism behind this is not yet

known. However, Alkis also stated that evidence exists that neurotrophin nerve growth factor, the one

responsible for the changes in the sensory nerves, is found in elevated levels in the nasal secretions of

persons with perennial AR compared to healthy individuals. The nerve growth factor is also acutely


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released into nasal fluids after being triggered by allergens in patients with allergic disease. AR is also

very common among patients with asthma of atopic origin.[10]

Accurate records on the prevalence of allergic rhinitis are lacking before the 20th

century.

According to a demographic and epidemiologic study by Settipane, allergic rhinitis affects more than

20% of the American population.[9]

The study showed that 64% of 1836 students originally tested 23

years ago were followed up. Seventeen new cases of asthma (10.5%) have developed in the 162 subjectswho previously suffered from seasonal AR. Nineteen new cases of asthma (3.6%) had developed in the

528 subjects without previous symptoms. Subjects without symptoms but had previous positive skin prick

tests were somewhat more likely to have developed asthma compared to people with negative tests

(10.6% versus 3.2%).[11], [12]

Summary of Related Studies

According to Kutintara, allergic rhinitis (AR) is the most common of all allergic diseases. The prevalence,

which ranges from 4% to 40%, of this disease is spreading worldwide, including the Asia Pacific region.

It has a great impact on a persons daily life. 82% of AR sufferers in the United States reported that theyalways or usually have symptoms at work or school. It is responsible for about 2 million lost school-days

each year in the United States and a significant large number of Thai children indicated that their allergysymptoms were severe enough to limit their activities. [13]

Another study in Spain conducted by Jauregui et. al. states that AR is the most common chronic

disorder that affects the pediatric population.[16]

Data shows that AR and rhinoconjunctivitis represent the

main cause of 55.5% of all patients seen in Spanish allergology clinics. Again, it is important to note thata third of the population of 13-14 year-old teenagers suffer from the symptoms of AR. [17] It has been also

stated in the study that AR somehow impairs daily activities such as visual coordination, retention

capacity, and reaction time of students. [18]

Avoidance is the primary method in treating AR. Those with allergies can reduce their allergic

symptoms by reducing their exposure to allergens. This includes promoting a healthy indoor environment.

The main allergens that are found indoors are allergens from dust mites, cockroaches, and molds. Theseallergens can be avoided by knowing how to eliminate them. These allergens commonly survive in

environments that are warm, moist and humid. Dust mites cannot live in an environment that has a

relative humidity of less than 50% while cockroaches and molds only thrive in areas of warmth and

humidity. Therefore, other than keeping an AR patients surrounding environment clean, it is alsorecommended to have an air-conditioning system or proper ventilation system so that it can reduce the

amount of allergens present in the patients environment by reducing the humidity and heat levels. [13]

In congruence with the aforementioned study, according to Zacharisen, a member and a fellow of

the American Academy of Asthma, Allergy, and Immunology, the key to reducing the severity of

symptoms a child experiences at school is avoidance of these allergens. If it is possible, parents should

talk to school personnel to make them aware of the allergy triggers of their children so as to avoid

aggravating their allergies. [14]

A study in Boston conducted by Blaisse stated that the symptoms of allergic rhinitis and the

adverse effects of medications taken can diminish or lessen the cognitive function and learning of

students. This can also affect the quality of student-life if aggravated. What is unfortunate is that most

conditions are left under-diagnosed or under-treated because symptoms are often discounted by parents as

just allergies. [15] The study further noted that aside from the loss of cognitive function in children with


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moderate to severe AR, this can also cause irritability and fatigue leading to the inattentiveness and

difficulty in concentrating in school. One of the most important components of management, according

to the study, is to educate the patient and the family about avoiding the allergens that the children are

allergic to.

Sleep disturbances were caused by nasal congestion/blockade and also frequent awakenings

during at night due to allergic inflammation. AR causes sleep disturbances, daytime sleepiness,

absenteeism, presenteeism, irritability, restlessness, mood disorders, and an altered social life.

Presenteeism is the inattention, distraction, and lack of attention of the students while inside the

classroom due to the symptoms of AR. Obviously, one of the main causes of learning difficulty and

school failure is the students inability to concentrate due to untreated ARgiven that it is in fact one of

the most common chronic illnesses that hits children and teenagers.[16], [19]

Focusing on the building conditions wherein classrooms are situated, a study that concerns

transmission of airborne diseases was conducted in Peru. Rooms that only had natural measures for

encouraging airflow were compared with mechanically ventilated rooms that were built much more

recently. A comparison was also done between naturally ventilated rooms in old hospitals and naturallyventilated rooms in newer hospitals. Results showed that natural ventilation had high rates of air

exchange, with an average of 28 air changes per hour. 50 year old hospitals had the highest ventilation

with an average of 40 air changes per hour due to its structure. This rate is far higher compared to the 17

air changes per hour in naturally ventilated rooms in modern hospitals, which have lower ceilings and

smaller windows. [20]

In line with this, a study about the impact of school building conditions on student absenteeism in

Upstate New York, researchers investigated this by obtaining data from the 2005 Building Condition

Survey of Upstate New York schools with 2005 New York State Education department students

absenteeism data at the individual school level and evaluated associations between building conditions

and absenteeism at or above the 90th

percentile. As a result, researchers associated absenteeism withvisible molds, humidity, poor ventilation, vermin, building condition problems, and building system or

structural problems related to these conditions. They also saw that schools in lower socioeconomic

districts and schools attended by younger students showed the strongest association between poor

building conditions and absenteeism. With this study, there were some limitations. Some confounding

variables were the external exposures such as traffic pollution and exposures from a students home could

have affected this study. In addition, absenteeism due to illness or other reasons could not be

distinguished. The study's ecological design did not allow collection of information on individual health

outcomes or reasons for absenteeism. In conclusion, they found associations between student absenteeism

and adverse school building conditions. As a recommendation, further studies should confirm these

findings and prioritize strategies for school condition improvements.[3]


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Conceptual Framework

Figure 1. Conceptual framework of the research study. Exposure to air-conditioning systems in the

classrooms lead to less presence of allergens or irritants such as molds, cockroaches, house and chalk dust

ultimately leading to mild (decreased) severity of AR.

IV. METHODOLOGY

Research Design

The type of study that the researchers are going to be implementing is a cross-sectional research design.

The researchers deem this the most necessary research design just to see whether or not there is a

relationship between the number of hours exposed to air-conditioning systems and the exacerbation of

Allergic Rhinitis. Moreover, this research design is appropriate because the Disease Variable of the

research, which is Allergic Rhinitis, is not a rare disease (thus eliminating the use of a case-control study).

However, in doing a cross-sectional study, the researchers must take note of and control the confoundingvariablesways of which will be discussed in the latter part of the description of the research design.

Definition of Study Population / Study Groups

The study population will be 2nd year highschool studentsin the Philippine setting. From this population,

a sample of students who have AR will be considered for the study.

Source of Subjects

The sample populations will be gathered from select schools in Dasmarias, Cavite, ideally one private

and public school in order to acquire subjects that have exposure to an air conditioned school environment

and one that is not.

Operational Definition of Variables

Dependent VariableAllergic Rhinitis

Allergic rhinitis (often called allergies or hay fever) occurs when the immune system

overreacts to particles in the air that you breathe. When the immune system attacks the particles in

the body, it causes symptoms such as sneezing and a runny nose. Over the time, allergens may

begin to affect you less, and the severity of the symptoms also decreases.[21]

It is characterized as


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the inflammation of nasal passages, usually associated with watery nasal discharge and itching of

the nose and eyes after exposure to the allergen.

Around two-thirds of people with allergic rhinitis manifest the symptoms before the age of 30

but the age at which the symptoms occur may vary. Genetics greatly affects the chance of having

allergic rhinitis of an individual. Usually if one or both parents have the disease, their offspring

will have a high chance of inheriting the disease. People with allergic rhinitis can also be restrictedby the disease in their day to day activities and this may result to increase in time away from

school or work. Also, in the US, millions of dollars are spent every year for doctor services and

medicine for treating the chronic illness. Symptoms of this illness are triggered by many different

allergens and these usually include plant pollens, molds, dust, and allergens produced by cats or

dogs. The amount of these allergens is affected by the season as the spread of pollens and spores

are determined by the amount of wind in a particular season. [22]

Independent VariableAir-conditioning System

According to the Department of Health of Hong Kong, sudden change in temperature both

indoor and outdoor may activate the release of inflammatory agents. They stated that the room

should be maintained at around 25 degrees Celsius.[23]

The air conditioner is a common appliance usually found in many buildings both private and

public. It is used to cool the air found indoors to make the people inside the building more

comfortable. Air conditioners nowadays are not only used for cooling the air, some types of air

conditioners can warm the indoor air especially those that are found in places where people

experience the winter season. In addition to their air temperature changing capability, the air

conditioners nowadays are also capable of filtering, disinfecting and dehumidifying the air to make

the people using the appliance more comfortable that is why the air conditioner is also regarded as

comfort-making-machine by some people. [24]

Confounding Variables:

Allergens are substances or particles that are foreign to the body and can cause allergic

reaction in certain people. Pollens, molds, cockroaches, and dusts are examples of allergens whichcan be found in the environment. In managing allergies, it is suggested to reduce the level of

exposure to these allergens.[27]

According to an article by deShazo and Kemp, the spores coming from molds can be a trigger

in releasing the symptoms of allergic rhinitis. Also, according to them, molds thrives in damp

environments such as air-conditioning vents, water traps, refrigerator drip trays, shower stalls,

leaky sink and damp basements if not cleaned regularly and under certain conditions, the growth

of these organisms can be considerable and exacerbate allergy symptoms.[25]

Since allergic rhinitis

is difficult to cure, the focus is on preventing the attack of the symptoms. Molds are seen as

cotton-like element that is usually in the color of gray, green, black or white. These molds produce

strong earthy and musty odors, although some are odor-free. The smell could be an indication of

infection.[28]

Many different triggers that may cause a student to experience symptoms of asthma and

allergy are found inside a typical classroom. These triggers include the pollens from the plants

found near or inside a classroom, dust mites and mold spores. The cleanliness of the room may

also play a factor in triggering the allergic reactions. The students themselves may also carry

allergens produced by their pet cats or dogs that may be attached to their clothes and these

allergens can be in contact with the students with asthma or allergy. Chalk dusts are also usually


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the causes of allergic reactions inside the classroom since the teachers usually use chalks for

writing on the green boards.[26]

Chalk dusts are particles produced when a chalk crayon is used to write on chalkboards.

These usually remain suspended in the air because these particles are not so heavy so as a result,

teachers and students usually inhale small amount of these and become trapped in the mucous

layers of the throat and upper lungs. This does not usually pose a threat to normal persons becausethe accumulated chalk dust is naturally expelled out through coughing and the remaining chalk

dust is safely absorbed by the body. However, in persons with chronic breathing issues or allergic

rhinitis these chalk dust can irritate their upper respiratory tract and trigger their symptoms and can

be dangerous for the person who inhaled the chalk dust.[29]

Cockroaches are recognized as powerful indoor allergens. They are among the oldest living

species residing the earth. These creatures are hardy and adaptable that thrives in areas where food

and water supplies are plentiful. They can be found around dripping faucets and kitchen areas. The

allergen produced by cockroaches is from the saliva, body parts and even their digestive enzymes.

These particles become airborne when disturbed by motion in the room.[27]

Steps to be Undertaken

These are the steps to be done in our procedure to collect data for this project:

1. Randomly select four (4) High Schools in Dasmarias, Cavite. Classify into with air-

conditioning system and without air-conditioning system by contacting the principal of the selected

schools.

2. Evaluate the classroom conditions of each school.

The group will visit each high school and evaluate the environmental conditions of each classroom

that will be part of the research. An integrated checklist from Health Canada and IAQ Tools for

Schools [30], [31] will be given to teacher or adviser of each classroom document and evaluate the

conditions.

3. Screen students for allergic rhinitis.Each student will be screened through a questionnaire, based sections of the ISAAC questionnaire, to

eliminate those who do not have allergic rhinitis from the study group. [32] This will help in making

the research study more specific to those who have allergic rhinitis and how the classroom conditions

can alleviate or exacerbate their symptoms.4. Sections of the ARIA questionnaire will be given to each student who has AR in which it will ask

them if their symptoms are better or worse when they are in the classroom and what specific

conditions help or harm them. [33]

5. Evaluate each students questionnaire.

Each students questionnaire will be evaluated to see what particular conditions affect the severity of

their AR. There will also be a particular focus on whether having an air-conditioning system present

or not alleviates or worsens each students AR symptoms.


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Schematic Diagram of the Design

Fig 2. Schematic diagram showing the exposures and the possible outcomes of the study

Possible Biases and Plans to Control / Minimize these Biases

Enumeration of all biases/limitations

The study will only focus on the role of ventilation inside the classrooms in the relief and

exacerbation of allergic rhinitis among 2nd year highschool students studying in Dasmarias,

Cavite. It will not include other respiratory diseases and illness that may be affected by the

difference in ventilation.

The possible biases in the study are:

Selection bias

Expectation bias

Plan to minimize these biases in the study

Selection bias may happen when subjects being compared are not similar, and may result to

data that is not representative of the population of interest.[34]

With the use of proper screening

methods for the study population, we will select subjects that are similar in almost all aspects in

order to gather a more representative and comparable data.

Expectation bias happens when there is no masking or blinding implemented in the study

and this may influence and tarnish the data to be gathered towards the expected or desired

outcome.[34]

To minimize this bias, a high level of objectivity must be maintained with each of the

members of the group of researchers in the gathering of data and its analysis.

Sampling Method

Firstly, in selecting for the respondents of the study, a list of all the schools in Dasmarinas City, both

public and private, was obtained. Two schools with air conditioning systems will be randomly chosen

from the list and two schools without air conditioning systems will also be randomly chosen. Fish bowl

method will be used in selecting for both schools. However, before selecting for the schools, those with


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air conditioning systems and those without must be identified first. To do this, the principals of the

schools will be contacted through telephone calls and be politely asked to elicit the presence of air-

conditioning systems in their classrooms and the number of second year students they have.

Selection of Cases

For the selection of cases, among the students of the selected schools with air conditioning

systems, random sections per school will be selected via the fish bowl method . The students of

the selected sections will be given ISAAC questionnaires for screening and selection of students

with allergic rhinitis.

Selection of Controls

For the selection of controls, the same process in the selection of the cases will be utilized but

instead of choosing from the list schools with air conditioning system, list of schools without air

conditioning systems will be used.

Fig 3. Schematic diagram of the method to be employed in selection of cases and controls in the study.

Sample Size

Definition of variables used in the calculations

1. p1The p1 variable is the estimate of the sample population for the high school students who study in

air-conditioned classrooms that have mild allergic rhinitis.

2. p2The p2 variable is the estimate of the sample population for the high school students who study in

non-air-conditioned classrooms that have mild allergic rhinitis.


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3. Alpha ()Alpha is the probability of committing a type I error, which means rejecting the null hypothesis

when in fact the null hypothesis is true. In the study, this is when results show that there is no

association between exposure to air-conditioning system and alleviation of severity of AR when

in fact there is.

4. Beta ()

Beta is the probability of committing a type II error, which means retaining the null hypothesiswhen the null is false. In the study, this is when we fail to reject the null hypothesis even if there

is sufficient evidence to state otherwise.

5. Direction of TestThe study is a one tailed test because we are leaning towards the result of which air-conditioning

helps in alleviating the severity of AR.

Values

p1 30.7

p2 13.4

0.95

0.80

The p1 and p2 values were based on the following study:

Mendell, M.J. & Smith, A.H. (1990). Consistent Pattern of Elevated Symptoms in

Airconditioned Office Buildings: A Reanalysis of Epidemiologic Studies.

American Journal of Public Health. (80) 10.

Computation Using a Computer Program (Open Epi)

Figure 3. Inputted values in Open Epi in the computation of a computer-generated sample size.


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Figure 4. Total sample size computed was 202, meaning 101 students will comprise the exposed group

and the other 101 students will be the unexposed group.

Data Collection

Method of Data Collection

The researchers method of data collection will primarily include the use of questionnaires and checklists.

The questionnaires (ISAAC-based) shall first be given to students to screen each whether or not they have

Allergic Rhinitis. After being able to screen the students, we shall be administering questionnaires to the

students who are positive for Allergic Rhinitis. The questions are primarily based on the ARIA

classification of severity for Allergic Rhinitis. This will enable the researchers to determine whether or

not there is exacerbation of the students Allergic Rhinitis due to exposure to air-conditioned rooms and

non air-conditioned rooms and to classify them as to mild or severe to moderate Allergic Rhinitis.

Moreover, the researchers will also use a checklist to survey the classroom conditions the

students are exposed to. These will include conditions inside and outside of the room that could possibly

affect the students conditions.


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Source of Data

Sources for the researchers data will primarily come from second year high school students of the

selected schools that will be included in the study. Moreover, observation will also be used to survey the

environmental conditions inside and outside of the students classrooms to identify possible attributing

factors to the trigger and exacerbation of ones Allergic Rhinitis.

Data Collection Tool

The researchers tools will include:

1. ISAAC-based questionnaires to screen for Allergic Rhinitis

2. ARIA Classification questionnaire for determining the severity of the students

Allergic Rhinitis

3. Checklist for Classroom Conditions

Please see attached questionnaires and checklist.


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1. ISAAC QUESTIONNAIRE FOR SCREENING STUDENTS

Study Instruments for 13/14 year olds

Instructions for Completing Questionnaire and Demographic Questions (Section 7.1)

On this sheet are questions about your name, school, and birth dates. Please write your answers to thefollowing questions in the space provided.

All other questions require you to tick (check) your answer in a box. If you make a mistake, put a cross in

the box and tick the correct answer. Tick only one option unless otherwise instructed.

___________________________________________________________________________________

SCHOOL:

TODAYS DATE:

Day Month Year

YOUR NAME:

YOUR AGE: years

YOUR DATE OF BIRTH:

Day Month Year

(Tick all your answers for the rest of the questionnaire)

Are you: MALE FEMALE


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Core Questionnaire for Allergic Rhinitis (Section 7.3)

All questions are about problems which occur when you DO NOT have a cold or the flu.

1 Have you ever had a problem with sneezing, or a runny, or

blocked nose when you DID NOT have a cold or the flu?

Yes

No

IF YOU HAVE ANSWERED NO PLEASE SKIP TO QUESTION 4.

2 In the past 12 months, have you had a problem with sneezing,

or a runny, or blocked nose when you DID NOT have a cold

or the flu?

Yes

No

IF YOU HAVE ANSWERED NO PLEASE SKIP TO QUESTION 4.

3 In the past 12 months, has this nose problem been

accompanied by itchy-watery eyes?

Yes

No

4 Have you ever had hay fever? Yes

No


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2. ARIA QUESTIONNAIRE

1. What symptoms do you have?(Answer Yes for any of the symptoms listed below that apply. Answer No for all that do not.)

Watery runny nose Yes No

Sneezing (especially violent and in bouts) Yes NoNasal obstruction (feeling of being unable to breathe through your nose) Yes No

Itchy nose Yes No

Watery, red, itchy eyes Yes No

2. How long do your symptoms last?(Answer Yes or No for each time frame below.)

More than four days a week Yes No

More than four weeks in a row Yes No

3. How do your symptoms affect you?(Answer Yes for any of the symptoms listed below that apply. Answer No for all that do not.)

My symptoms disturb my sleep. Yes No

My symptoms restrict my daily activities (sports, leisure, etc.) Yes No

My symptoms restrict my participation in school or work. Yes No

My symptoms are troublesome to me. Yes No

4. How much do your symptoms bother you?(On a scale of 0 to 10, with 0 being Not at all and 10 as Very much, indicate how much yoursymptoms bother you Tick only

one.)

0 4 8

1 5 9

2 6 10

3 7


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3. CHECKLIST FOR CLASSROOM CONDITIONS

Checklist for the presence of MOLDS (http://www.moldunit.com/mold-detection.html)

Yes No 1. Presence of water leaks coming from either rain or air-conditioning units apparent on

the ceiling, walls and pipes or stagnant water.Yes No 2. Wet cellulose materials such as paper, cardboard, ceiling tiles and wood products.

Yes No 3. Appearance of a cottony, velvety, granular or leathery like dirt (in any shade of color)near or within the area where there are water leaks.

Yes No 4. Inspect walls, under carpeting, under cabinets and air ducts for hidden molds.

Checklist for the presence of COCKROACHES(http://www.ehow.com/how_7744440_tell-

roaches.html) (http://www.roebourne.wa.gov.au/Assets/environment/hs-

0025%20cockroach%20management.pdf)

Yes No 1. Presence of dripping faucets and bathrooms.

Yes No 2. Presence of eggs of roaches, dead roaches, insect parts or feces (black gritty substance,

pepper-like) under the cabinets or behind walls and appliances, and sight of cockroaches

themselves.

Yes No 3. Evidence of holes from chewing such as paper and cardboards.

Checklist for the presence of HOUSE DUST

Yes No 1. Presence of curtains, pillows, carpets

Yes No 2. Presence of dust when you touch or rub with your hand the materials mentioned

above.

Yes No 2. Presence of dust above the tables, chairs, window sills, and the floor.

Checklist for the presence of CHALK DUST

Yes No 1. Presence of chalk (for writing on the board) and specify if it is dustless or not.

Yes No 2. Presence of chalk dust in corners of the board and on the board eraser.

Yes No 3. Presence of a wet rag for cleaning the chalk board.

Yes No 4. Presence of a box for cleaning the board eraser.


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V. BIBLIOGRAPHY

[1] Settipane, R.A. (2001). Demographics and Epidemiology of Allergic and Nonallergic Rhinitis

[Abstract]. Allergy Asthma Proc. 22(4): 185-9. Retrieved July 8, 2011 from:

http://www.medscape.com/medline/abstract/11552666.

[2] Philippine Star (2008). Allergic Rhinitis Prevalent among Pinoys. Retrieved July 8, 2011 from:

http://library.pchrd.dost.gov.ph/index.php/news-archive/1080.

[3] Simons, E., Hwang, S., Fitsgerald, E., Keilb, C. & Lin, S. (2009). The Impact of School Building

Conditions on Student Absenteeism in Upstate New York. 100 (9). Research and Practice.

[4] Blaiss, MS. Allergic rhinitis and impairment issues in schoolchildren: a consensus report. Current

Medical Research and Opinion. 2004 Dec; 20(12):1937-52. From:

http://www.redorbit.com/news/health/131029/allergic_rhinitis_and_impairment_issues_in_school

children_a_consensus_report/index.html

[5]Meltzer, E.O. (1998). Treatment Options for the Child with Allergic Rhinitis. Clinical Pediatrics. Jan

1998; 37, 1; ProQuest Research Library. Accessed July 7, 2011.

[6] Alm B, Gokso r E, Thengilsdottir H, Pettersson R, Mo llborg P, Norvenius G, Erdes L, A berg N,

Wennergren G. Early protective and risk factors for allergic rhinitis at age 4 years. Pediatric Allergy and Immunology 2011; 22: 398404. Retrieved July 22, 2011 from

http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2011.01153.x/pdf

[7] Nakagomi T, Itaya H, Tominaga T, et al. (1994). Is atopy increasing? Lancet 1994;343:1212.

Retrieved July 22, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/7903758

[8] Hajat S, et al. Association between air pollution and daily consultations with general practitioners for

allergic rhinitis in London, United Kingdom. American Journal of Epidemiology (2001) 153 (7):

704-714. Retrieved July 22, 2011 from http://aje.oxfordjournals.org/content/153/7/704.full

[9] Busse, P. (2010). Allergic rhinitis. Medlineplus. Retrieved July 16, 2011, from

http://www.nlm.nih.gov/medlineplus/ency/article/000813.htm.

[10] Togias, A. (2004). Unique mechanistic features of allergic rhinitis. Journal of allergy and clinicalimmunology. Retrieved July 16, 2011, from

http://www.sciencedirect.com/science/article/pii/S0091674900093143.

[11] Cauwenberge, et. al. (2004). Epidemiology of Allergic Rhinitis. The UCB Institute of Allergy,

Brussels.

[12] Settipane, R.J., Hagy, G.W., Settipane, G.A.(1994). Long-term risk factors for developing asthma

and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. 15: 21-25.

[13] Kutintara, Benjamas. "Home Environments and Allergen Avoidance Practices in a Hot, Humid

Climate." Virginia Polytechnic Institute and State University, 2002. United States -- Virginia:

ProQuest Dissertations & Theses (PQDT). Web. 17 July 2011.

[14] Health risks in the classroom: children with asthma and allergies need to take special precautions atschool. (2007). American Academy of Asthma, Allergies, and Immunology. Retrieved July 15,

2011 from http://www.kidneeds.com/diagnostic_categories/articles/classrisks02.htm

[15] Mahoney, D. (2005). Allergic rhinitis hits hard in the classroom. Retrieved July 16, 2011 from The

CBS Interactive Business Network website:http://findarticles.com/p/articles/mi_hb4384/is_3_39/ai_n29168995/pg_2/?tag=mantle_skin;conte

nt


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19

[16] Jauregui, I. et al. (2009). Allergic rhinitis and school performance. J Investig Allergol Clin Immunol.

19, 1: 32-39. Retrieved July 16, 2011 from http://www.jiaci.org/issues/vol19s1/6.pdf

[17] Asher MI, Montefort S, Bjorksten B, Lai CK, Stachan DP, Weiland SK et al. Worldwide time trends

in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood:

ISAAC Phases One and Three repeat multi-country crosssectional surveys. Lancet 2006; 368:733-

743. Retrieved July 16, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/16935684

[18] Wilken JA, Berkowitz R, Kane R. Decrements in vigilance and cognitive functioning associated with

ragweed-induced allergic rhinitis. Ann Allergy Asthma Immunol 2002;89:372380. Retrieved July16, 2011 from http://www.sciencedirect.com/science/article/pii/S1081120610620388

[19] Karande S, Kulkarni M. Poor school performance. Indian J Pediatr 2005; 72(11):961-967. Retrieved

July 16, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/16391452

[20] Siriaksorn, S. (2011). Allergic rhinitis and immunoglobulin deficiency in preschool children with

frequent upper respiratory illness. PubMed. 29(1):73-7. Retrieved July 8, 2011 from

http://www.ncbi.nlm.nih.gov/pubmed/21560491.

[21] Healthwise Staff, Allergic Rhinitis, In: Thompson, E.G. MD, Nelson, H.S. MD, editor, AllergicRhinitis [cited 2011 July 31] Available from: http://www.webmd.com/allergies/tc/allergic-rhinitis-overview

[22] Allergic rhinitis. (2010).Health encyclopedia diseases and conditions.Retrieved July 10, 2011,from http://www.healthscout.com/ency/68/208/main.html.

[23] Retrieved on July 30, 2011 from

http://www.studenthealth.gov.hk/english/health/health_ophp/health_ophp_nos.html

[24] Air conditioner. (2009).Air conditioning and refrigeration information.Retrieved July 30, 2011,

from http://www.air-conditioning-and-refrigeration.com/air-conditioner.html.

[25] deShazo R., Patient Information: Trigger avoidance in allergic rhinitis. Retrieved on July 30, 2011from http://www.uptodate.com/contents/patient-information-trigger-avoidance-in-allergic-rhinitis

[26] Health risks in the classroom: children with asthma and allergies need to take special precautions at

school. Retrieved July 30, 2011, fromhttp://www.kidneeds.com/diagnostic_categories/articles/classrisks01.htm.

[27] Stppler, M.C., MD. Indoor Allergens In: Shiel, W.C. Jr., MD. FACP.FACR., editor, [cited 8August 2011] Available from http://www.medicinenet.com/indoor_allergens/article.htm

[28] Oliver, S., Mold DetectionHow to Detect Toxic Mold in your Home? [cited 8 August 2011]Available from http://ezinearticles.com/?Mold-Detection---How-to-Detect-Toxic-Mold-in-Your-

Home?&id=2589917

[29] Pollick, M. (2011). Is chalk dust harmful? Wise geek: clear answers for common questions.Retrieved August 8, 2011, from http://www.wisegeek.com/is-chalk-dust-harmful.htm.

[30] Classroom Checklist(2007). Health Canada [Website]. Available from: http://www.hc-sc.gc.ca/ewh-

semt/pubs/air/tools_school-outils_ecoles/classroom-salle_classe-eng.php

[31]IAQ tools for Schools. North Hunderton-Voorhees Regional District High School [Website].

Available from: http://www.nhvweb.net/VHS/Math/ABlaustein/toolsforschools/teacher.pdf


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[32]ISAAC Questionnaire . International Study of Asthma and Allergies in Childhood,[Website]. 2011

[cited 2011 August 8]. Available from

http://isaac.auckland.ac.nz/phases/phasethree/corequestionnaire.pdf.

[33]ARIA Questionnaire . Allergic Rhinitis and its Impact on Asthma [Website]. 2011 [cited 2011 July

30]. Available from http://www.whiar.org/docs/ARIA_OnlineQuestionnaireGuidewm3-

8sp.pdf

[34] Hartman, J.M., Forsen, J.W., Wallace, M.S., Neely, J.G. (2002). Tutorials in clinical research: Part

IV: Recognizing and controlling bias.Laryngoscope, 112, 23-31.


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21

VI. APPENDICES

APPENDIX A

Excerpt from the study Consistent Pattern of Elevated Symptoms in Airconditioned Office Buildings: A

Reanalysis of Epidemiologic Studies by Mendell & Smith (1990) in which the values were obtained.


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APPENDIX BLetter to the School Principals

De La Salle Health Science Institute College of Medicine

Dasmarias, Cavite 4114

Date:

Name of Principal:

Position:

Name of School:

Address:

Dear Sir/Maam,

Greetings!

We, Second Year Medical students of De La Salle-Health Sciences Institute College of Medicine, are happy to

inform you that your school has been selected to take part in our research study. In line with this, we would

like to ask your permission to include your school in our study.

The research study is about the effects of exposure to air-conditioned rooms and non air-

conditioned rooms on the severity of Allergic Rhinitis among second year high school students in Dasmarias

City, Cavite. In line with this, we are asking for your kind consideration to let us include your school in our

research endeavor.

Our study will include the surveying and screening of second year high school students for AllergicRhinitis and surveying the environmental conditions in which students are exposed to both inside and outside

of the classroom.

We can assure you that all information will be kept confidential and that these bodies of information

will be used solely for the purpose of the study. If you have further questions or queries with regard to our

request, please feel free to contact us through the number provided below.

We are hoping for your kind consideration. Thank you very much.

Yours in St. La Salle,

Joshua A. ArcairaGroup Leader (09159084464)

NOTED BY:

Dr. Jovilia M. Abong

Group Preceptor

Dr. Isaac A. Ilano

2nd

Year Coordinator, Community

Medicine

Dr. Christine S. Tinio

Chair, Family and Community

Medicine Department


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23

APPENDIX CInformed Consent Letter for the Parents of the Students (English Version)

October 12, 2011

Dear Parents,

My name is Joshua Arcaira. I am a second year medical student at De La Salle Health SciencesInstitute and leader of our group in Family and Community Medicine conducting a study entitled,Exposure to Air-conditioning Systems in Classrooms Leads to Mild Severity of Allergic Rhinitis in SecondYear High School Students of Selected Schools in the City of Dasmarias, Cavite: A Cross-SectionalStudy. Our study will have the following objectives:

General Objective: To determine if the exposure to the air-conditioning system affects the severityof Allergic Rhinitis in second year high school students of selected schools in the City ofDasmarias, Cavite.

Specific Obejectives:1. To identify the prevalence of Allergic Rhinitis among second year high school students ofselected schools in the City of Dasmarias, Cavite based on their exposure to air-conditioned

rooms.2. To identify the prevalence of Allergic Rhinitis among second year high school students ofselected schools in the City of Dasmarias, Cavite based on their exposure to non air-conditionedrooms.3. To determine the severity of Allergic Rhinitis according to ARIA classifications.4. To identify the risk factors of Allergic Rhinitis present in the classroom or school, such as thepresence of molds, chalk, dust, and cockroaches.5. Compare the severity of Allergic Rhinitis in students who are exposed to air-conditionedclassrooms and those who are not exposed to air-conditioned classrooms.

Since our study requires the participation of second year high school students with AllergicRhinitis, your child has been chosen to be included as a participant in our research project.

With your permission, I will ask your child to complete a short four-item questionnaire that wouldtake no longer than 10 minutes to answer to assess the severity of your childs Allergic Rhinitis. Yourchilds participation in this study is completely voluntary and will not affect his/her grades in anyway. There are no known risks involved in this study and, as a benefit, you and your child will be able tolearn more about the severity of your childs Allergic Rhinitis. To protect your childs confidentiality, thequestionnaire will not be shared with anyone, including school authorities, other parents, or any otherstudents, unless required by law.Your child may quit this study at any time by writing Stop or I do notwish to participate on the questionnaire. The questionnaire given will be kept by our preceptor, Dr. JoviliaAbong, and by my groupmates and me.

This letter will serve as a consent form for your childs participation and will be kept in the Familyand Community Medicine Department at the College of Medicine at De La Salle Health Sciences Institute.

If you have any questions or concerns about this study, please feel free to approach me or ouradvisor. You may contact me at 09159084464. Thank you for your kind consideration.

Please have your child return this form to his/her class advisor by (date).

Sincerely yours,

Joshua Arcaira


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Agreement

Statement of Consent

I read the above consent form. The nature, demands, risk, and benefits of the project have beenexplained to me. I am aware that I have the opportunity to ask questions about this research. I

understand that I may withdraw my consent and discontinue m y childs participation at any time withoutpenalty.

Students Name (Please Print) Date Parents Name andSignature

I certify that I have explained to the above named individual the nature and purpose, the potential benefitsand possible risks associated with participation in this research study. I have answered all questions thathave been raised by this parent. I have provided the participants legal guardian with a copy of thissigned consent form.

Student Researcher Date


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APPENDIX DInformed Consent Letter for the Parents of the Students (Filipino Version)

KAALAMANG PAGPAYAG NA SULAT

Oktubre 12, 2011

Mahal kong mga Magulang:

Ang pangalan ko po ay Joshua Arcaira. Ako po ay nasa pangalawang taon ng kursongMedisina sa De La Salle Health Sciences Institute at lider ng aming grupo sa Family and CommunityMedicine. Kami po ay nagsasagawa ng isang pag-aaral na pinamagatang Exposure to Air-conditioningSystems in Classrooms Leads to Mild Severity of Allergic Rhinitis in Second Year High School Studentsof Selected Schools in Dasmarias City, Cavite: A Cross-Sectional Study. Ang aming pag-aaral aymayroong mga sumusunod na layunin:

Pangkalahatang Layunin: Upang matukoy kung ang pagkakalantad sa silid-aralan na may air-condition ay nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasaikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite.

Tiyak na mga Layunin:

1. Upang malaman ang lawak ng pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasaikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Caviteayon sa kanilang pagkakalantad sa air-conditioned na silid-aralan.

2. Upang malaman ang lawak ng pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasaikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Caviteayon sa kanilang pagkakalantad sa mga silid-aralan na walang air-condition.

3. Upang malaman ang kalubhaan ng Allergic Rhinitis ayon sa klasipikasyon ng ARIA.4. Upang malaman ang mga kondisyon sa loob ng silid-aralan na maaaring magdulot ng

Allergic Rhinitis tulad ng lumot, tisa/yeso(chalk), alikabok at ipis.5. Ihambing ang kalubhaan ng Allergic Rhinitis sa ma mag-aaral na lantad sa air-conditioned na

ma silid-aralan at sa mga mag-aaral na hindi lantad sa air-conditioned na silid-aralan.

Sapagkat ang aming pagsasaliksik ay nangangailangan ng partisipasyon ng mga mag-aaral saikalawang antas ng sekundarya na mayroong Allergic Rhinitis, ang inyong anak ay napili namin upangmaging kalahok sa aming pananaliksik.

Sa inyong pahintulot, humihiling po ako sa inyong anak na kumpletuhin ang isang maikling

palatanungan na binubuo ng apat na tanong lamang at ang pagsagot nito ay hindi hihigit sa sampung

minute upang matukoy ang kalubhaan ng Allergic Rhinitis ng inyong anak. Ang paglahok ng inyong anak

ay kusang-loob at hindi makakaapekto sa kanyang marka sa anumang paraan. Sinisiguro po na naming

walang kaakibat na panganib ang pakikilahok sa pag-aaral na ito at bilang benepisyo, malalaman niyo rin

po at ng inyong anak ang kalagayan ng kanyang Allergic Rhinitis. Para mapanatili ang pagiging

kompidensiyal ng mga kaalamang ibabahagi sa amin ng inyong anak, ang palatanungan ay hindi

kailanman ibibigay sa sinumang nanunungkulan sa paaralan, sa ibang mga magulang at ang iba pangmga mag-aaral, maliban kung kinakailangan ng batas. Maaari pong itigil ng inyong anak ang pakikilahok

sa pag-aaral sa anumang oras sa pamamagitan ng pagsulat lamang sa palatanungan ng Hinto o Hindi

ko nais na lumahok. Ang mga palatanungan na ito ay itatago ng aming preceptor na si Dr. Jovilia

Abong, maging ako at aking mga kasama ko sa grupo.

Ang sulat na ito ay nagsisilbing kaalamang pagpayag na sulat para sa pakikilahok ng inyong

anak at itatago sa Family and Community Medicine Department ng College of Medicine sa De La Salle

Health Sciences Institute.


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Kung mayroon kang mga katanungan ukol sa pag-aaral na ito, huwag kang mag-alinlangangmakipag-usap sa akin o sa iyong tagapayo sa klase. Maaari mo akong tawagan o i-text sa numerong09159084464. Maraming salamat po sa inyong pag-unawa at pagpapahintulot.

Mangyari lamang po na ibalik ng inyong anak ang sulat na ito sa tagapayo sa klase sa (petsa).

Lubos na gumagalang,

Joshua Arcaira

Kasunduan

Nabasa ko ang kaalamang pagpayag na sulat. Ang mga detalye, pangangailangan, panganib at

benepisyo ng proyektong ito ay naipaliwanag sa akin. Alam ko na ako ay maaaring magtanong ukol sa

pananaliksik na ito. Naiintindihan ko na maaari kong alisin ang aking pagpayag at ihinto ang pakikilahok

ng aking anak sa anumang oras nang walang parusa.

Pangalan ng Mag-aaral (paki-print) Petsa Pangalan at Pirma ng Magulang

Ipinaliwanag ko ang detalye, dahilan, benepisyo at mga posibleng panganib sa pakikilahok sapananaliksik na ito. Nasagot ko lahat ng mga katanungan ng magulang na ito. Binigyan ko ang legal natagabantay ng kalahok ng kopya ng pirmadong kaalamang pagpayag na sulat.

Mag-aaral na Tagapagsaliksik Petsa


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APPENDIX EInformed Assent Letter for the Students (English Version)

INFORMED ASSENT LETTER

October 12, 2011

Dear Student:

My name is Joshua Arcaira. I am a second year medical student at De La Salle Health SciencesInstitute and leader of our group in Family and Community Medicine conducting a study entitled,Exposure to Air-conditioning Systems in Classrooms Leads to Mild Severity of Allergic Rhinitis in SecondYear High School Students of Selected Schools in Dasmarias City, Cavite: A Cross-Sectional Study.Our study will have the following objectives:

General Objective: To determine if the exposure to the air-conditioning system affects the severityof Allergic Rhinitis in second year high school students of selected schools in the City ofDasmarias, Cavite.

Specific Obejectives:

1. To identify the prevalence of Allergic Rhinitis among second year high school students ofselected schools in the City of Dasmarias, Cavite based on their exposure to air-conditionedrooms.2. To identify the prevalence of Allergic Rhinitis among second year high school students ofselected schools in the City of Dasmarias, Cavite based on their exposure to non air-conditionedrooms.3. To determine the severity of Allergic Rhinitis according to ARIA classifications.4. To identify the risk factors of Allergic Rhinitis present in the classroom or school, such as thepresence of molds, chalk, dust, and cockroaches.5. Compare the severity of Allergic Rhinitis in students who are exposed to air-conditionedclassrooms and those who are not exposed to air-conditioned classrooms.

Since our study requires the participation of second year high school students with Allergic

Rhinitis, you have been chosen to be included as a participant in our research project.

I kindly ask that you complete a short four-item questionnaire that would take not longer than 10minutes to answer to assess the severity of your allergic rhinitis. Your parent(s) or legal guardian(s) havealready given permission for you to be a part of this study, but if you do not wish to participate, you maychoose not to. Your participation in this study will not affect your grades in any way. There are no knownrisks involved in this study and you will be able to learn more about the severity of your Allergic Rhinitis.To protect your confidentiality, the questionnaire will not be shared with anyone, including schoolauthorities, your parents, or any other students, unless required by law. You may quit this study at anytime by writing Stop or I do not wish to participate on the questionnaire. The questionnaire given will bekept by our preceptor, Dr. Jovilia Abong and by my groupmates and me.

If you have any questions or concerns about this study, please feel free to approach me or your

class advisor. You may also contact me at 09159084464. Thank you for your kind consideration.

Sincerely yours,

Joshua Arcaira


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Agreement

I agree to participate in this research project and I have received a copy of this form.

Students Name (Please Print) Date Students Signature

I have explained to the above named individual the nature and purpose, benefits and possible risksassociated with participation in this research. I have answered all questions that have been raised and Ihave provided the participant with a copy of this form.

Student Researcher Date


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APPENDIX FInformed Assent Letter for the Students (Filipino Version)

KAALAMANG PAGPAYAG NA SULAT

Oktubre 12, 2011

Mahal kong Mag-aaral:

Ang pangalan ko ay Joshua Arcaira. Ako ay nasa pangalawang taon ng kursong Medisina sa DeLa Salle Health Sciences Institute at lider ng aming grupo sa Family and Community Medicine nanagsasaliksik sa isang pag-aaral na pinamagatang Exposure to Air-conditioning Systems in ClassroomsLeads to Mild Severity of Allergic Rhinitis in Second Year High School Students of Selected Schools inDasmarias City, Cavite: A Cross-Sectional Study. Ang aming pag-aaral ay mayroong mga sumusunodna layunin:

Pangkalahatang Layunin: Upang matukoy kung ang pagkakalantad sa silid-aralan na may air-condition ay nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasaikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite.

Tiyak na mga Layunin:

6. Upang malaman ang pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawangantas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon sakanilang pagkakalantad sa air-conditioned na silid-aralan.

7. Upang malaman ang pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawangantas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon sakanilang pagkakalantad sa mga silid-aralan na walang air-condition.

8. Upang malaman ang kalubhaan ng Allergic Rhinitis ayon sa klasipikasyon ng ARIA.9. Upang malaman ang mga kondisyon sa loob ng silid-aralan na maaaring magdulot ng

Allergic Rhinitis tulad ng lumot, tisa/yeso(chalk), alikabok at ipis.10. Ihambing ang kalubhaan ng Allergic Rhinitis sa ma mag-aaral na lantad sa air-conditioned na

ma silid-aralan at sa mga mag-aaral na hindi lantad sa air-conditioned na silid-aralan.

Sapagkat ang aming pagsasaliksik ay nangangailangan ng partisipasyon ng mga mag-aaral saikalawang antas ng sekundarya na mayroong Allergic Rhinitis, ikaw ay napili namin upang magingkalahok sa aming pananaliksik.

Ako ay humihiling sa iyo na sagutan ang isang maikling palatanungan na binubuo ng apat na

katanungan lamang at ang pagsagot nito ay hindi tatagal ng higit sa sampung minute upang malaman

natin ang kalagayan ng iyong Allergic Rhinitis. Ang iyong mga magulang o legal na tagapag-alaga ay

nagbigay na ng pahintulot para sa iyo upang lumahok sa pag-aaral ngunit maaari kang hindi sumali kung

iyong nanaisin. Ang iyong pagsali sa pag-aaral na ito ay hindi makakaapekto sa iyong marka sa anumang

paraan. Walang anumang panganib ang nakaakibat sa pag-aaral na ito at malalaman mo rin mula rito

ang kalubhaan ng iyong Allergic Rhinitis. Upang mapanitili ang pagiging kumpidensyal ng impormasyong

ibabahagi mo sa amin, ang palatanugnan ay hindi kailan man ibabahagi sa sinuman sa mga

namamahala ng inyong paaralan, ang iyong mga magulang at ang iba pang mga mag-aaral, malibankung kakailanganin ng batas. Maaari mong itigil ang pagsali sa pag-aaral sa anumang oras sa

pamamagitan ng pagsulat lang sa palatanungan ng Hinto o Hindi ko nais na lumahok. Ang mga

palatanungan na ito ay itatago ko at aking mga kagrupo maging ang aming preceptor na si Dr. Jovilia

Abong.


31/31

Kung mayroon kang mga katanungan ukol sa pag-aaral na ito, huwag kang mag-alinlangang makipag-

usap sa akin o sa iyong tagapayo sa klase. Maaari mo akong tawagan o i-text sa numerong

09159084464. Maraming salamat sa iyong pag-unawa.

Lubos na gumagalang,

Joshua Arcaira

Kasunduan

Sumasang-ayon ako na lumahok sa proyektong ito ng pananaliksik at ako ay nakatanggap ng

isang kopya ng form na ito.

Pangalan ng Mag-aaral (paki-print) Petsa Pirma ng Mag-aaral

Ipinaliwanag ko sa pinangalanang indibidwal ang pinagmulan at layunin, mga benepisyo at posibleng

panganib nakaugnay sa pakikilahok sa pananaliksik na ito. Sinagot ko ang lahat ng mga katanungan nainilahad at binigyan ko ang kalahok ng isang kopyang form na ito.

Mag-aaral na Tagapagsaliksik Petsa

Research Protocol 1st Submission

Documents

Transcript of Research Protocol 1st Submission