DE LA SALLE HEALTH SCIENCES INSTITUTE COLLEGE 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 CrossSectional 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

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. 1

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 disease further as well. [2] From the same study by the ISAAC, they discovered that among Filipino teenagers, 13-14 yearolds 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 be more 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] 2

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 factors that 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 antigenIgE 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 hyperresponsiveness 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 mucosa by 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

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 20 th 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 subjects who 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 they always 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 allergy symptoms 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 that a 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. These allergens 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 also recommended 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 4

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 naturally ventilated 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 with visible 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]

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 confounding variablesways 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 students in 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 Variable Allergic 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

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 restricted by 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 Variable Air-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 which can 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 7

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 because the 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 airconditioning 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.

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 9

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 airconditioning 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. p1 The 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. p2 The 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 hypothesis when 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 Test The 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 p2 30.7 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 the following 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 YOUR NAME: YOUR AGE: years Month Year

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. 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? 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? Have you ever had hay fever? 2 Yes No

Yes No 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 Sneezing (especially violent and in bouts) Nasal obstruction (feeling of being unable to breathe through your nose) Itchy nose Watery, red, itchy eyes 2. How long do your symptoms last?
(Answer Yes or No for each time frame below.)

Yes No Yes No Yes No Yes No Yes No

More than four days a week More than four weeks in a row 3. How do your symptoms affect you?

Yes No Yes No

(Answer Yes for any of the symptoms listed below that apply. Answer No for all that do not.)

My symptoms disturb my sleep. My symptoms restrict my daily activities (sports, leisure, etc.) My symptoms restrict my participation in school or work. My symptoms are troublesome to me. 4. How much do your symptoms bother you?

Yes No Yes No Yes No Yes No

(On a scale of 0 to 10, with 0 being Not at all and 10 as Very much, indicate how much your symptoms bother you Tick only one.)

0 1 2 3

4 5 6 7

8 9 10

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3. CHECKLIST FOR CLASSROOM CONDITIONS Checklist for the presence of MOLDS (http://www.moldunit.com/mold-detection.html) Yes No Yes No Yes No 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. 2. Wet cellulose materials such as paper, cardboard, ceiling tiles and wood products. 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. 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_tellroaches.html) (http://www.roebourne.wa.gov.au/Assets/environment/hs0025%20cockroach%20management.pdf) Yes No Yes No 1. Presence of dripping faucets and bathrooms. 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. 3. Evidence of holes from chewing such as paper and cardboards.

Yes No

Checklist for the presence of HOUSE DUST Yes No Yes No Yes No 1. Presence of curtains, pillows, carpets 2. Presence of dust when you touch or rub with your hand the materials mentioned above. 2. Presence of dust above the tables, chairs, window sills, and the floor.

Checklist for the presence of CHALK DUST Yes No Yes No Yes No Yes No 1. Presence of chalk (for writing on the board) and specify if it is dustless or not. 2. Presence of chalk dust in corners of the board and on the board eraser. 3. Presence of a wet rag for cleaning the chalk board. 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 clinical immunology. 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 at school. (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 18

[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; 368:733743. 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 July 16, 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, Allergic Rhinitis [cited 2011 July 31] Available from: http://www.webmd.com/allergies/tc/allergicrhinitis-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, 2011 from 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, from http://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 8 August 2011] Available from http://www.medicinenet.com/indoor_allergens/article.htm [28] Oliver, S., Mold Detection How to Detect Toxic Mold in your Home? [cited 8 August 2011] Available from http://ezinearticles.com/?Mold-Detection---How-to-Detect-Toxic-Mold-in-YourHome?&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/ewhsemt/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_OnlineQuestionnaireGuidewm38sp.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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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 B Letter 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 airconditioned 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 Allergic Rhinitis 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. Arcaira
Group Leader (09159084464)

NOTED BY: Dr. Jovilia M. Abong

Group Preceptor

Dr. Isaac A. Ilano

2 Year Coordinator, Community Medicine
nd

Dr. Christine S. Tinio

Chair, Family and Community Medicine Department

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APPENDIX C Informed 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 Sciences Institute 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 Second Year High School Students of Selected Schools in the City of Dasmarias, 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 severity of Allergic Rhinitis in second year high school students of selected schools in the City of Dasmarias, Cavite. Specific Obejectives: 1. To identify the prevalence of Allergic Rhinitis among second year high school students of selected 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 of selected schools in the City of Dasmarias, Cavite based on their exposure to non air-conditioned rooms. 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, 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. Since our study requires the participation of second year high school students with Allergic Rhinitis, 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 would take no longer than 10 minutes to answer to assess the severity of your childs Allergic Rhinitis. Your childs participation in this study is completely voluntary and will not affect his/her grades in any way. There are no known risks involved in this study and, as a benefit, you and your child will be able to learn more about the severity of your childs Allergic Rhinitis. To protect your childs confidentiality, the questionnaire will not be shared with anyone, including school authorities, other parents, or any other students, unless required by law. Your child may quit this study at any time by writing Stop or I do not wish to participate on the questionnaire. The questionnaire given will be kept by our preceptor, Dr. Jovilia Abong, and by my groupmates and me. This letter will serve as a consent form for your childs participation and will be kept in the Family and 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 our advisor. 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 been explained 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 my childs participation at any time without penalty.

Students Name (Please Print)

Date

Parents Name and Signature

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

Student Researcher

Date

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APPENDIX D Informed 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 kursong Medisina sa De La Salle Health Sciences Institute at lider ng aming grupo sa Family and Community Medicine. Kami po ay nagsasagawa ng isang pag-aaral na pinamagatang 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. Ang aming pag-aaral ay mayroong mga sumusunod na layunin: Pangkalahatang Layunin: Upang matukoy kung ang pagkakalantad sa silid-aralan na may aircondition ay nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang 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 nasa ikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon sa kanilang pagkakalantad sa air-conditioned na silid-aralan. 2. Upang malaman ang lawak ng pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon 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 sa ikalawang antas ng sekundarya na mayroong Allergic Rhinitis, ang inyong anak ay napili namin upang maging 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 pang mga 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.

25

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 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 sa pananaliksik na ito. Nasagot ko lahat ng mga katanungan ng magulang na ito. Binigyan ko ang legal na tagabantay ng kalahok ng kopya ng pirmadong kaalamang pagpayag na sulat.

Mag-aaral na Tagapagsaliksik

Petsa

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APPENDIX E Informed 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 Sciences Institute 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 Second Year 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 severity of Allergic Rhinitis in second year high school students of selected schools in the City of Dasmarias, Cavite. Specific Obejectives: 1. To identify the prevalence of Allergic Rhinitis among second year high school students of selected 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 of selected schools in the City of Dasmarias, Cavite based on their exposure to non air-conditioned rooms. 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, 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. 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 10 minutes to answer to assess the severity of your allergic rhinitis. Your parent(s) or legal guardian(s) have already given permission for you to be a part of this study, but if you do not wish to participate, you may choose not to. Your participation in this study will not affect your grades in any way. There are no known risks 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 school authorities, your parents, or any other students, unless required by law. You may quit this study at any time by writing Stop or I do not wish to participate on the questionnaire. The questionnaire given will be kept 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

27

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 risks associated with participation in this research. I have answered all questions that have been raised and I have provided the participant with a copy of this form.

Student Researcher

Date

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APPENDIX F Informed 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 De La Salle Health Sciences Institute at lider ng aming grupo sa Family and Community Medicine na nagsasaliksik sa isang pag-aaral na pinamagatang 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. Ang aming pag-aaral ay mayroong mga sumusunod na layunin: Pangkalahatang Layunin: Upang matukoy kung ang pagkakalantad sa silid-aralan na may aircondition ay nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang 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 ikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon sa kanilang pagkakalantad sa air-conditioned na silid-aralan. 7. Upang malaman ang pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang antas ng sekundarya sa mga napiling paaralan sa Lungsod ng Dasmarias, Cavite ayon sa kanilang 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 sa ikalawang antas ng sekundarya na mayroong Allergic Rhinitis, ikaw ay napili namin upang maging kalahok 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, maliban kung 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.

29

Kung mayroon kang mga katanungan ukol sa pag-aaral na ito, huwag kang mag-alinlangang makipagusap 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 isang kopya ng form na ito. ito ng pananaliksik at ako ay nakatanggap ng

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 na inilahad at binigyan ko ang kalahok ng isang kopyang form na ito.

Mag-aaral na Tagapagsaliksik

Petsa

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