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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1.
Name of the candidate and address
Mrs R.BHARATHI PRIYA
(in block letters)
SRI LAKSHMI COLLEGE OF NURSING,
127/1, SRI GANDADAKAVAL, MAGADI
MAIN ROAD, VISHWANEEDAM POST,
SUNKADAKATTE, BANGALORE-91.
2.
SRI LAKSHMI COLLEGE OF NURSING,
Name of the Institution
127/1, SRI GANDADAKAVAL, MAGADI
MAIN ROAD, VISHWANEEDAM POST,
SUNKADAKATTE, BANGALORE-91.
3.
Course of study and subject
M. Sc. NURSING
OBSTETRIC AND
GYNAECOLOGICAL NURSING
4.
Date of admission to the course
5.
Title of the study
01-06-2012
“A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET
ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN SYNDROME (PCOS)
AMONG THE FEMALE STUDENTS IN SELECTED DEGREE COLLEGES AT
BANGALORE KARNATAKA” .
1
6.
BRIEF RESUME OF THE INTENDED WORK
6.1
Introduction
Polycystic ovary syndrome - A metabolic malady, the mother of all lifestyle disorders in
women - Can Indian health budget tackle it in future?
The diverse and complex female endocrine disorder polycystic ovary syndrome
(PCOS), which affects 1 in 15 women worldwide, is a major economic health burden that is
likely to expand together with obesity, says Dr Theresa Hickey and Prof Robert Norman,
says in edition of University of Adelaide, Australia. 1
The name polycystic ovary syndrome sounds worrying, but it doesn’t need to be. It is a
very common condition affecting as many as 25% of “normal” women in some series. So at
one end of the scale there are people with no obvious abnormality, and at the other extreme,
people with excessive facial or body hair, infrequent periods and in fertility. 2
Polycystic ovarian syndrome (PCOS) is the 4th gynaecological problem of hospital
admission. About 15 – 20 % of women in reproductive age group are affected by PCOS. A
study conducted to understand the magnitude of Polycystic ovarian syndrome(PCOS) with
sample size of 257 volunteers who were examined with ultrasonography showed that 22%
were found to have polycystic ovaries. 3
The World Health Organization criteria for classification of an ovulation include the
determination of oligomenorrhea (menstrual cycle >35 days) or amenorrhea (menstrual cycle
> 6 months) in combination with concentration of prolactin, follicle stimulating hormone
(FSH) and estradiol. Almost 80% of an ovulation patients have normal serum FSH and
estradiol levels and demonstrate very heterogeneous symptoms ranging from an ovulation,
obesity, biochemical or clinical hyperandrogenism and insulin resistance. PCOS is the most
common cause of an ovulation in women with normal serum FSH and estradiol levels. Despite
the heterogeneity in symptoms associated with PCOS, the essential feature is arrested
follicular development at the stage when selection of the dominant follicle should normally
occur. In a normal menstrual cycle, one egg is released from a dominant follicle – essentially a
2
cyst that bursts to release the egg. After ovulation the follicle remnant is transformed into a
progesterone-producing corpus luteum, which shrinks and disappears after approximately 12–
14 days. In PCOS, there is a so-called “follicular arrest”, i.e., several follicles develop to a size
of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more).
The small ovarian follicles are believed to be the result of disturbed ovarian function with
failed ovulation, reflected by the infrequent or absent menstruation that is typical of the
condition. 4
Polycystic Ovarian Syndrome (PCOS) is the most commonly reported endocrine
disease and the most common cause of infertility among women of childbearing age.
Additionally, Norman, Dewally, Legro and Hickey report that PCOS is the “most frequent
cause of hyperandrogenism and oligo-an ovulation, both of which have substantial
psychological, social, and economic consequences (2007, 685). Originally reported by Stein
and Leventhal in 1935, it is estimated that between five and ten percent of women suffer
from PCOS. While the name of the syndrome is indicative of the presence of ovarian cysts,
not all women with PCOS exhibit this particular symptom. In fact, women with PCOS may
have two or more of a constellation of symptoms which may include amenorrhea (the
absence of a regular menstrual cycle), infertility, hirsutism (the abnormal growth of hair in
places such as the face, neck, abdomen and chest), acne, weight gain, insulin resistance/type
2 diabetes, high cholesterol, high blood pressure, thinning hair or male pattern baldness,
acanthosis nigricans (areas of darkened skin discoloration generally found on the neck,
breasts, arms or thighs), skin tags, pelvic pain, anxiety and/or depression generally related
towards one’s appearance or the inability to conceive, and sleep apnea. 5
6.2
Need for study
PCOS is the most common female endocrine disorder. Monika Woosley, RD, a leading
nutrition expert onPCOS and eating disorders has termed PCOS “the perfect endocrine
storm”
Polycystic ovary syndrome (PCOS) has recently been shown to affect a striking 12%–
21% of Australian reproductive-age women, being more common among those who are
overweight or of Indigenous background. PCOS can be a frustrating experience for women, a
complex syndrome for clinicians and a scientific challenge for researchers, and is a major
public health concern. Although reproductive features are prominent, PCOS has potential for
major metabolic consequences, including obesity and related type 2 diabetes mellitus (DM2)
as well as cardiovascular disease (CVD), all of which are currently national health priority
3
areas. It also has significant mental health and psychological impact, impairing quality of
life. Because increased obesity exacerbates incidence, prevalence and severity of PCOS, and
weight loss improves reproductive, metabolic and psychological features, lifestyle change
should be first-line therapy for PCOS. It is estimated that 70% of Australian women with
PCOS remain undiagnosed; clinical practice is inconsistent; psychological issues are underrecognised; and there is little focus on lifestyle and prevention, with most services targeting
infertility and costly assisted reproductive technology. Given the prevalence, disease burden,
health costs and clear gaps in care, PCOS is highlighted in national policy and has been
prioritised by government. 6
PCOS affects 7-10% of women of childbearing age (15 to 45 years).In women of
Indian subcontinent, prevalence rates as high as 50% have also been detected. PCOS was
responsible for 18% of infertility and 40% of hirsutism cases in a study conducted at
Srinagar. PCOS seems to run in families, and it is likely that it is a genetic disorder. Sisters
of PCOS patients have about a 50% chance of also having PCOS. Metabolic syndrome was
diagnosed in 46% ladies with PCOS in a study at Kolkotta recently. 7
Prevalence Rate for Polycystic ovary syndrome is approximately 1 in 40 or 2.50% or
6.8 million people in USA.8
Division of yoga and life sciences prospectively studied 460 girls aged 15 to 18 years
from a residential college in Andhra Pradesh, South India, who underwent clinical
examination. Out of which 72 girls with oligomenorrhea and/or hirsutism were invited for
biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS by
Rotterdam criteria. PCOS was defined as the presence of any two of the three features: (1)
Oligo/amenorrhea: absence of menstruation for 45 days or more and/or ≤8 menses per year.
(2) Clinical hyperandrogenism: Modified Ferriman and Gallway (mFG) score of 6 or higher.
(3) Polycystic ovaries: presence of >10 cysts, 2-8 mm in diameter, usually combined with
increased ovarian volume of >10 cm(3), and an echo-dense stroma in pelvic ultrasound
scan.Out of 460 girls, one (0.22%) had oligo/amenorrhea with clinical hyperandrogenism, 29
(6.30%) had oligomenorrhewith polycystic ovaries, one (0.22%) had polycystic ovaries with
clinical hyperandrogenism and 11 (2.39%) had oligomenorrhea with polycystic ovaries in the
presence of clinical hyperandrogenism. Thus 42 (9.13%) girls satisfied Rotterdam's criteria
for PCOS, which increased to 50.46 (10.97%) when inputed data were included. The study
concluded that the prevalence of PCOS in Indian adolescents is 9.13%.This draws attention
4
to the issue of early diagnosis in adolescent girls. 9
Another population study reported that ultrasound scan showed that appearance of
polycystic ovaries were present in 20% of women with normal menstrual cycles, in 26–32%
with amenorrhoea, in 87–90% with oligomenorrhoea and in 90–95 % with hirsutism. One
more study reported 50% women with recurrent miscarriage had the ultrasound picture of
polycystic ovary. 10
According to women’s health organization Epigee, oligomenorrhea, or irregular periods,
affect about 30% of women in their reproductive years. While amenorrhea, or the absence of
menstruation (not caused by pregnancy), will happen to almost every woman at one point in
her life.
According to a 2012 study conducted by the Child Development Center at Medical
College in Kerala, India ,PCOS is a leading cause of menstrual irregularity. Using a sample
population of girls between 15 and 17 years of age who had reported menstrual irregularity
and had not previously been examined for PCOS, researchers found that nearly 60% of all
subjects did indeed have PCOS. 11
The potential health consequences of polycystic ovary syndrome are a lifelong issue.
There is little doubt that the prevalence of impaired glucose tolerance and diabetesmellitus is
increased substantially in women with polycystic ovary syndrome, although the magnitude of
the increase depends on the prevalence of obesity in the population, and racial influences are
evident. The evidence for increased risk of cardiovascular disease in women with polycystic
ovary syndrome is less clear, although cardiovascular risk factors are substantially increased,
including hyperlipidaemia, hyperandrogenaemia, hypertension, markers of prothrombotic
state and markers of inflammation.
Altered vascular endothelial function in young women with polycystic ovary syndrome is
well documented, and increased death rates from cardiovascular disease have been shown in
Polycystic Ovarian Syndrome women with menstrual irregularity (possibly with polycystic
ovary syndrome) in the Nurses’ Health Study. Such evidence makes it clear that PCOS is a
complex condition, requiring careful and attentive treatment over the course of a woman’s
life. The increased risk across multiple body systems has the potential to put women in a
rather precarious position .The vast amount of information and research on PCOS has been
published by those in the medical field, especially those in the area of endocrinology. This
5
particular fact suggests the need to consider the production of knowledge. 5
Department of Obstetrics, Gynaecology and Reproductive Sciences, College of
Medicine, University of Saskatchewan says polycystic ovary syndrome (PCOS) is a complex
endocrine disorder that affects 6% to 10% of reproductive aged women. It is a poorly
understood and often undiagnosed condition that has implications for the health of affected
women. They assessed changes in knowledge, feelings, and daily health practices related to
PCOS in clinical research study participants. Sixty-eight women who had received
counselling and education about PCOS while participating in a clinical research study were
invited to complete an online survey that assessed levels of concern, knowledge, healthy
dieting, active living, and health care satisfaction before and after the study. Women with
PCOS felt that they had more knowledge and motivation to implement preventive health
strategies after participating in a clinical research study. Education about how PCOS affects
their immediate and long-term health enabled women with PCOS to feel physical and
psychological benefits and to engage more with their health care providers. 12
A prospective, non interventional case control study was conducted with 60 primary
infertility patients, attending the gynecological department, S.S. Institute of Medical Sciences
and Research Centre, Davangere, Karnataka. Aim is to establish the relation between PCOS
and metabolic syndrome. An incidence of 38% of metabolic syndrome was noted in the PCOS
cases studied. Women with PCOS were strongly associated with metabolic syndrome when
compared with the controls. Obesity, high triglycerides and low high density lipoprotein levels
are closely linked to insulin resistance and they are independent predictors of myocardial
infarction and cardiovascular disease. Results strongly indicate the need for comprehensive
screening and education program for women of all ages with PCOS. Modification of lifestyle
factors such as diet and exercise along with insulin sensitizers and lipid lowering agents can
prevent long term health risks. 13
Research consistently demonstrates that the first line of treatment for this condition is
weight loss. Weight loss and dietary changes appear to affect all parameters of hormonal
fluctuation. Because of potential side effects of many medications, weight reduction of obese
patients should be the primary goal of treatment. The addition of antiandrogenic and insulin
regulating agents should be added only to enhance the effects of weight loss. Experimental
evidence has indicated that the typical western diet, which is high in fat and refined
carbohydrate and low in fiber, induces insulin resistance and precedes obesity.
Epidemiological evidence indicates that a diet rich in fruits, vegetables, and high fiber
6
complex carbohydrates is associated with a lower risk of chronic disease. Studies of obese
women with menstrual abnormalities have demonstrated that cycles can potentially normalize
and fertility be re-established following weight loss. Traditionally, sex steroids and thyroid
hormones have been considered to be the major regulators of SHBG concentration, but dietary
factors may be a more important consideration.
Studies have been designed to explore caloric content and the role of dietary fat in the
regulation of energy intake and weight loss. A study was performed to evaluate caloric
consumption in women who each consumed a sequence of three two-week diets of low,
medium, and high fat content. Results showed that by altering the type of food consumed,
specifically fat, even without restrictions on amounts, spontaneous weight loss could be
achieved
in
both
obese
and
non-obese
individuals
on
a
low
fat
diet.
14
India has witnessed about 30 per cent rise in polycystic ovary syndrome (PCOS) cases
in the last couple of years. It is a cause for major concern since it is increasingly being
diagnosed in women who are in their reproductive age. Lack of awareness and lifestyle
changes are considered to be the major factor leading to this phenomenon. There is a need to
increase awareness among women so as to avoid major cases of fertility problem in future,
according to Dr Rajeev Punjabi, gynecologist and obstetrician, Tulip Women’s HealthCare
Centre, Mumbai. Dr Punjabi informs that women with PCOS have to maintain their lifestyle
and control their diet for keeping PCOS under control. Women with PCOS should try to opt
for low glycemic index foods, as they will cause a slower rise in blood sugar. Avoid those
carbohydrates that trigger more hunger or cravings. The study stresses, “Women should be
educated on the ill effects of this disorder since it can lead to a lot of problems. It’s a problem
that needs urgent attention, since the incidence rate is increasing at a higher rate. Education,
awareness, and self-control is the only way to control it from rising further and affecting more
women15.”
The above study suggest that the majority of the women are lacking knowledge on polycystic
ovary syndrome. PCOS is most commonly reported endocrine disorder which has life long
potential health consequences. Life style modification and diet can prevent polycystic ovary
syndrome and risk factors. Hence the researcher is interested in assessing the effectiveness of
the information booklet on knowledge regarding polycystic ovary syndrome among the
female students in selected degree colleges Bangalore at Karnataka which will help the
7
female students to increase knowledge regarding polycystic ovary syndrome.
6.3
Review of literature
Literature review is a standard requisition of scientific research. It means reading and
writing the pertinent information of the attempt in research topic to understand better about
the proposed topic. It also supports and explaines why the proposed topic is taken for
research, and avoid unnecessary duplication explore the feasibility and illuminate the way of
new researcher.
The Review of Literature is organized as follows: Section A:- Literature related to incidence and prevalence of Polycystic ovarian
syndrom (PCOS).
 Section B:- Literature related to etiology,
clinical features, diagnosis,
Management and Complication of Polycystic ovarian syndrome(PCOS).
 Section
C:-
Literature
related
to
Prevention
of
Polycystic
ovarian
syndrome(PCOS)
 Section D:- Literature related to Knowledge of college girls on Polycystic
ovarian syndrome(PCOS)
 Section E:-Literature related to effectiveness of information booklet
Section A:- Literature related to incidence and Prevalence
of polycystic ovarian
syndrome(PCOS
5-10% women of childbearing age (20-40); 30% of women have some PCOS symptoms
(NWHIC).
16
The incidence of PCOS varies according to the diagnostic criteria. Polycystic ovaries on
ultrasound are noted in up to 25%-30% of reproductive aged women. Thus the vast majority
of women with polycystic ovaries do not have the syndrome. Women with unexplained
hyperandrogenic chronic an ovulation (i.e. NIH criteria) make up approximately 7% of
reproductive age women10
8
The prevalence is estimated to be 4-8% in studies performed in Greece, and Spain.The
prevalence of PCOS is increasing the world over and is showing a galloping increase in
parallel with the rising prevalence of type 2 diabetes mellitus (T2DM). Use of different
diagnostic criteria may partly account for it, as has recently been shown (18%) in the first
community-based prevalence study based on current Rotterdam diagnostic criteria. PCOS
has also been noted to affect 28% of unselected obese and 5% of lean women. In 2006,based
on US data and traditionally lower prevalence estimates, the anticipated economic burden of
PCOS in Australia was AU$400 million (menstrual dysfunction 31%, infertility 12% and
PCOS-associated diabetes 40% of total costs), representing a major health and economic
burden. 17
Section B:- Literature related to etiology, clinical features, diagnosis, Management and
Complication of of polycystic ovarian syndrome(PCOS
Odunsi and Kidd have put together the main theories that have been proposed in
previous studies regarding etiology of PCOS.
1. The luteinizing hormone-theca interstitial cell (LHTIC) theory suggests that the
pathophysiologic mechanisms leading to abnormally elevated levels of LH underlie
the phenomenon of PCOS. The theory suggests that high levels of circulating LH
cause an increase in the growth of TIC in developing follicles, which leads to androgen
overproduction and follicular atresia.
2. The follicle stimulating hormone-granulosa cell (FSH-GC) theory suggests that the
reduced FSH leads to subnormal induction of cytochrome P450 aromatase in the
granulosa cells, leading to elevated androgen levels. This may be due to insufficient
bioactive FSH in the follicular microenvironment to induce P450 aromatase gene
expression, dysfunctional FSH receptor signal transduction mechanism, or the
presence of inhibitors (such as epidermal growth factor and insulin-like growth factor
(IGF)-binding protein that prevent the normal expression of P450 aromatase activity.
3. The third theory relates to the growth factor- autocrine-paracrine system. In PCOS,
there is evidence of an altered IGF/insulin system, and these act as mediators of
biologic responses of the selectogenic and atretogenic follicular hormones. 18
In a study published in 1998 in the journal Fertility and Sterility, Ricardo Azziz, a
professor of obstetrics and gynaecology at the University of Alabama at Birmingham, looked
at 13women with too much body hair who thought they were having regular periods. By
9
measuring their progesterone levels, he found that 40 percent of them actually ovulating
irregularly. That suggests PCOS.
A Harvard study found that 80 percent of women with fewer than six periods a year had
abnormally high levels of male hormones. They, too, may be PCOS women. There is often no
simple proof that a woman has polycystic ovarian syndrome (PCOS); diagnosis is based
primarily on a woman's medical history and tests for insulin resistance. But the presence of
several of the symptoms – infertility, hirsutism, menstrual irregularities and insulin resistance
– is strong evidence.
PCOS can be a challenge to diagnose because the disorder presents with a wide range of
signs and symptoms that can easily be missed (Azziz,2004). Given the heterogeneity of the
disorder, this condition is often under-diagnosed. Widely accepted criteria for diagnosis of
PCOS in adolescent patients are based on standards that were established at the 1990
Consensus Conference of the National Institute on Child Health and Human Development
(Kent & Legro, 2002). These criteria include chronic an ovulation and hyperandrogenism in
the absence of other endocrine disorders. The presence of polycystic ovaries is not a criterion
for diagnosis in adolescents as it is with young adults and middle age women as determined
by the Rotterdam Criteria (2004). 2
Despite the high prevalence of PCOS, the diagnosis and differential diagnosis remains
confusing. This is in part due to the lack of a specific diagnostic test for the disorder. The
diagnosis of PCOS is based on hyperandrogenism or chronic anovulation in the absence of
specific pituitary and/or adrenal disease .Oftentimes the clinical history and a few laboratory
tests are enough to make the diagnosis and exclude other entities that may present in much the
same way. A careful history and physical examination, looking for other signs of those
disorders that may not be a part of PCOS, must be performed. Pelvic ultrasonography may be
very helpful in the evaluation as well, but polycystic ovaries are not specific for PCOS with
over 20% of “normal” women having this finding. The number of follicles and ovary volume
are both important in the ultrasound evaluation19
It is estimated that 60% to 80% of women with PCOS demonstrate elevated circulating
androgen levels. Serum levels of free testosterone, and not total testosterone, are more
frequently elevated in women with PCOS. Serum free testosterone is therefore considered to
be the most sensitive biochemical marker supporting a diagnosis of PCOS. Hirsutism is the
most common clinical manifestation of hyperandrogenism in women. Approximately 60% to
70% of women with PCOS have hirsutism. Hirsutism is defined as excessive terminal hair
10
growth that takes on a male pattern distribution. One third of women with PCOS, particularly
younger women, demonstrate acne. Androgens participate in the development of acne by
stimulating sebum production, thereby providing optimal conditions for bacterial colonization
with organisms. While the actual prevalence of alopecia in women with PCOS is relatively
low compared with other androgenic symptoms (approximately 5%), an association with
polycystic ovaries has been reported, and this observation merits an investigation of whether
alopecia is actually increased in prevalence or severity in women with PCOS. Menstrual
disturbances in PCOS generally present in the form of oligo-amenorrhea (fewer than eight
episodes of menstrual bleeding per year or menses that occur at intervals greater than 35
days). The researchers believe a conservative diagnosis is more likely to motivate appropriate
education, judicious treatment, and long-term follow-up of patients as the actual health risks
of these distinct phenotypes are slowly revealed. 20
A descriptive study was conducted in Holy Family Hospital, Rawalpindi, Pakistan from
Nov 2001 to Oct 2002 to review different clinical endocrine manifestation of polycystic
ovarian syndrome in adolescent girls. Adolescent girls diagnosed with polycystic ovaries on
ultrasound seen in the out patients department for menstrual problems were included in the
study. Their body mass index, waist hip ratio, hirsutism scoring was done. Serum FSH and LH
were estimated to see the ratio. A total of 52 unmarried girls between 15 to 25 years of age
were included. Most of the girls were having oligomenorrhea (88%). While overweight girls
were 34 (65%) and mild to moderate hirsutism was seen in 46 (88%). Serum FSH:LH ratio
was normal in 25 (48%) and raised in 27 (52%). Earliest manifestation was hirsutism, and as
body weight increased, there was linear increase in hirsutism and menstrual disturbances. The
study concluded Polycystic Ovarian syndrome, a common problem of women of reproductive
age group is affecting their life physically, mentally and socially. The clinical
manifestations
are
variable
with
obesity
playing
the
key
role.
21
A study was designed to assess, with a randomized, double-blind, placebo-controlled
protocol, the effects on menstrual abnormalities of a 6-month course of metformin in a group
of 23 subjects with PCOS with normal glucose tolerance. Subsequently, 18 of these subjects
and 14 additional women with PCOS were included in an open trial to evaluate the long-term
effects of metformin on clinical features of the syndrome and to determine any baseline
predictors of the treatment’s efficacy. In conclusion, in women with PCOS metformin
treatment reduced hyperinsulinemia and hyperandrogenemia, independently of changes in
body weight. In a large number of subjects these changes were associated with striking,
11
sustained improvements in menstrual abnormalities and resumption of ovulation. Higher
plasma insulin, lower serum androstenedione, and less severe menstrual abnormalities are
baseline predictors of clinical response to metformin. 22
Stress, pollution, and diet all affect the course of PCOS although it is not yet known
exactly how they influence the disease. Under stress, the body responds by increasing
hormone production, including production of cortisol and adrenaline, the “fight or flight”
hormones. Cortisol can encourage weight gain, irregular periods, acne, excess body hair, high
blood pressure, and diabetes – exacerbating PCOS symptoms. 23
In an observational study of adolescent women with PCOS, van Hooff et al found a
significant decrease in the frequency of self-reported acne, dysmenorrhea, and menstrual
irregularities in those engaging in more than eight hours of sporting activity per week.
Although few studies have reported on the link between exercise and PCOS, clear associations
have been made with regard to exercise and its effects on obesity and insulin resistance.
A recent study in The Journal of the American Medical Association (JAMA) confirmed that
fiber consumption could predict insulin levels, weight gain, and other cardiovascular risk
factors more strongly than saturated fat consumption. Chromium is one of the most widely
studied nutritional interventions in the treatment of glucose- and insulin-related irregularities.
While research shows a clear link between chromium and glucose metabolism, evidence for
its interaction in insulin resistant states is a bit more ambiguous. 24
A study was conducted with the aim to assess differences in anxiety and depression
between women with and without (controls) polycystic ovary syndrome (PCOS).
A
systematic review and meta-analysis of published literature comparing women with PCOS to
control groups on anxiety and depression. Electronic databases were searched up to 17
December 2010. The inverse variance method based, as appropriate, on a random- or fixedeffects model in Review Manager, Version 5 was used to analyse the data. Twelve
comparative studies were included; all studies assessed depression and six also assessed
anxiety . Analysis revealed higher depression and anxiety scores in the participants with, than
without, PCOS. Studies controlling for BMI showed a smaller difference between women
with PCOS and controls on anxiety and depression scores than studies not controlling for
BMI.
Women with PCOS on average tend to experience mildly elevated anxiety and
depression, significantly more than women without PCOS. Women with PCOS with lower
BMI tended to have slightly lower anxiety and depression scores, suggesting that having a
12
lower BMI reduces anxiety and depression. 25
PCOS patients are at higher risk for the metabolic syndrome, which is a group of
cardiovascular risk factors that include dyslipidemia, type 2 diabetes mellitus, hypertension,
and obesity. In a study of 254 women with PCOS, the prevalence of impaired glucose
tolerance was 31% compared with 10.3% in controls, and the prevalence of type 2 diabetes
was 7.5 % compared with 1.5% in controls26
Section C:- Literature related to Prevention of Polycystic ovarian syndrome(PCOS)
The evidence is overwhelming that diets rich in fruits, vegetables, complex
carbohydrates,and fiber lower chronic disease risk. High fiber diets, particularly diets high in
soluble fiber, prevent dyslipidemia and lower blood pressure .Overall, findings are ambiguous
regarding the supplemental use of flaxseed, glucomannan, guar gum, vitamin E, chromium,
magnesium, and the botanical saw palmetto for PCOS . Exercise is proven to reduce insulin
resistance and facilitate weight loss. Women with PCOS should participate in regular aerobic
exercise and strength training to improve their physical and mental well-being27
A study was conducted to evaluate the influence of Dietary management and Physical
exercise on ovarian function and metabolic parameters in overweight adolescent girl with
Polycystic ovarian syndrome (PCOS). A sample of 57adolescent girls were supervised by
dietician on randomized 4 month trial with three interventions and a long term follow up. The
result shows that on average, body mass index was reduced 6% by the dietary management,
3% by the exercise and 5% by the combined interventions. The menstrual pattern significantly
improved in 69% and ovulation confirmed in 34%. The study highlights that dietary
management and exercise or combination of both are equally effective in improving
reproductive function in obese adolescent girls with PCOS. 28
Section D:-Literature related to Knowlegde of adolescent girls on Polycystic ovarian
syndrome(PCOS)
As many as 1 out of every 15 assessed was found to be suffering with PCOD in
Wellington college and their knowledge was very poor regarding the subject. College girls
were afraid to talk about their disease to the parents 29
A study was conducted in Australia to describe young women perception and awareness
of Polycystic ovarian syndrome (PCOS), among age group of 18-22years using a
questionnaire. The study showed that participants lacked knowledge about the disease and
13
complicated quality of life(p=0.033). The young women only perceived the risk of obesity
(p=0.0001), infertility (p=0.023), loss of femininity (p=0.035) and loss of sexuality (p=0.003).
The study highlights that young women did not know the disease but only few risks associated
with it knowing the disease and therefore health education regarding PCOS is helpful in
knowing the disease and perceived risk outcomes through educational methods. 30
Section E:- Literature related to effectiveness of information booklet
A study was conducted to assess the effectiveness of information booklet on knowledge
of people residing in selected areas of Pune city regarding Disaster Preparedness. Evaluative
approach and quasi experimental one group pre-test post-test research design was used.
Sample for the current study was selected according to non-probability purposive sampling
technique consists of men and women between 21 to 50 years residing in diverse areas of
Pune city. Semi-structure questionnaire was used to assess the effectiveness of information
booklet on knowledge about disaster preparedness of study samples. Descriptive and
inferential statistics had been used for data analysis. Analysis of the data showed that majority
88.3% of people in pre -test were having moderately adequate knowledge (scores 11-20),
8.3% of people in pre-test were having inadequate knowledge (scores 0-10) and only 3.3% of
people in pre-test were having adequate knowledge (scores 21-30), whereas in post-test
majority 81.7% of the people had adequate knowledge (scores 21-30) and 18.3 % of people in
post-test were having moderately adequate knowledge(scores 11-20), which indicates that the
information booklet improved knowledge of people regarding disaster preparedness
31
The
study supports that the information booklet is effective in improving knowledge.
A study, attempted to assess the level of knowledge about palliative care among nurses
working in the oncology department using a self administered structured questionnaire and
also to assess the effectiveness of information booklet designed on various aspects of
palliative care on their knowledge in Indo American Cancer Hospital, Hyderabad, AP, India.
A structured self administered questionnaire was prepared and administered as a pre-test. An
information booklet was developed pertaining to the general concepts of palliative care, care
components (physical, social, emotional and spiritual) and role of the nurse in palliative care
and it was given to the participants. As a post test, the same questionnaire was re-administered
after four days to the same study subjects. Pre-test and post-test knowledge scores were
compared and the findings were analyzed statistically.
The information booklet was effective in enriching the knowledge of nurses on palliative
14
care. Enhancing the nurse’s knowledge about palliative care will promote their understanding
of the needs of the advanced stage patients and will enable them to provide quality care. 32
This study supports that the information booklet is effective in improving the knowledge
of the people.
6.4
Statement of the problem
“A study to assess the effectiveness of the information booklet on knowledge regarding
polycystic ovarian syndrome (PCOS) among female students of selected degree colleges at
Bangalore , Karnataka
6.5
Objectives of the study
Objectives of the study are to:
1.
To assess the existing level of knowledge regarding polycystic ovarian syndrome
among the female students of degree colleges by knowledge score in experimental
group and comparison group.
2.
To administer Information Booklet to only experimental group.
3.
To evaluate the effectiveness of the information booklet regarding polycystic ovarian
syndrome among the female students of degree colleges in experimental group by post
test knowledge score.
4.
To asses the post test knowledge level regarding polycystic ovarian syndrome among
the comparison group.
5.
To find out the difference between level of knowledge on PCOS among the female
students of degree colleges by post test knowledge score in experimental group and
comparison group.
6.
To find out the association between demographic variables such as age, year of
education, religion, family income, occupation of the father, occupation of the mother,
type of family, life style, nutrition, place of residence and source of information with
the pre test knowledge score among the female students of degree colleges.
6.6
Operational definitions
ASSESS: It is the organised systematic continuous process of collecting data from pre test and
15
Post test knowledge regarding polycystic ovary syndrome score among the female students of
degree colleges.
Effectiveness: In this study, it refers effectiveness refers to the extent to which information
booklet has achieved the desired effect to increase in the knowledge on PCOS among the
female students of degree colleges as assessed by the post test.
Information booklet: In this study it refers self-learning information prepared in English to
improve the knowledge on poly cystic ovary syndrome which includes anatomy and
physiology of uterus, definition, incidence and prevalence, etiology, pathophysiology, clinical
manifestation, management ,complications and prevention of PCOS.
Knowledge: In this study, it refers to the correct responses by the female students of degree
colleges regarding polycystic ovarian syndrome as elicited through a self administered
questionnaire.
Polycystic ovarian syndrome: Polycystic ovary syndrome (PCOS) is one of the most
common female endocrine disorders.The principal features are anovulation, resulting in
irregular menstruation, amenorrhea, ovulation-related infertility, and polycystic ovaries;
excessive amounts or effects of androgenic hormones, resulting in acne and hirsutism;
and insulin resistance, often associated with obesity, Classic symptoms include excess facial
and body hair, acne, obesity, irregular menstrual cycles, and infertility.
Female students of seleted degree colleges female Students studying in the selected degree
colleges other than professional colleges at Bangalore in Karnataka.
HYPOTHESIS:6.7
H1. There will be statistically significant difference between pre-test and post-test knowledge
scores among female students of degree colleges in experimental and comparison group
regarding polycystic ovary syndrome (PCOS) at 0.01 and 0.05 level of significance.
H2- There will be significant association between selected demographic variables with the
level of knowledge of female students regarding polycystic ovary syndrome (PCOS) in
experimental and comparison group at 0.01 and 0.05 levels of significance.
6.8
ASSUMPTIONS:-
6.8.1
The female students of degree colleges may not have adequate knowledge about polycystic
ovary syndrome (PCOS).
6.8.2
The female students of degree colleges would willingly participate in the study and express
16
their knowledge on polycystic ovary syndrome (PCOS).
6.8.3
6.8.4
The female students of degree colleges will be curious to learn about polycystic ovary
syndrome (PCOS).
The information booklet will be effective to improve the knowledge of female students of
degree colleges.
6.9
6.9.1
6.9.2
DELIMITATIONS:The study is delimited to the female students of degree colleges at Bangalore, Karnataka.
Assessment of knowledge is based on the responses to the objective type test item used in self
administered questionnaire.
7.0
MATERIALS AND METHODS:SOURCE OF DATA
7.1
The data will be collected from female students of selected degree colleges at Bangalore,
Karnataka
7.2
METHOD OF COLLECTION OF DATA :-
7.2.1
RESERCH DESIGN
Quasi experimental non equivalent control group design will be used
(O1XO2) –Experimental group
(O1XO2)-Comparison group
7.2.2
RESEARCH APPROACH
Quantitative Evaluative survey approach will be used.
7.2.3
SETTING
Study will be conducted in selected degree colleges at Bangalore, Karnataka.
7.2.4
VARIABLES UNDER STUDY
INDEPENDENT VARIABLES
Information Booklet on polycystic ovary syndrome (PCOS) .
DEPENDENT VARIABLE
17
Knowledge of the female students of degree college on polycystic ovary syndrome (PCOS) .
EXTRANEOUS VARIABLE
Demographic variables such as age, year of education, religion, family income, occupation of
the father, occupation of the mother, type of family, life style, nutrition, place of residence and
source of information of female students of selected degree colleges.
7.2.5
POPULATION
Target population: The target population of the study comprises of female students of degree
colleges
Accessible population: Female students of selected degree colleges at Bangalore, Karnataka.
7.2.6
SAMPLE
The sample of the study consists of female students of selected degree colleges at Bangalore,
Karnataka.
7.2.7
SAMPLE SIZE
In this study sample consists of 120 female students of selected degree colleges at Bangalore,
Karnataka.60 female students of one college for experimental group, 60 female students of
other college for comparison group
7.2.8
SAMPLING TECHNIQUE:
Non probability, purposive sampling technique will be used.
7.2.9
SAMPLING CRITERIA:
INCLUSION CRITERIA
1. Female students studying in selected degree colleges.
2.
Female students of age group 17-21years.
3.
Female students who can communicate in English.
4.
Female students available during period of study.
EXCLUSION CRITERIA
18
1. Female students of age groups more than 21 years.
2. Female students who are not willing to participate in the study.
3. Female students who are not available at the time of study.
4. Female students studying in professional colleges.
5. Female students who are married.
7.2.8
TOOLS FOR DATA COLLECTION:
The self administered questionnaire will be used to collect data.
The tool for data collection consists of two sections.
Section A: Self administered questionnaire seeks information on demographic variables such
as age, year of education, religion, family income, occupation of the father, occupation of the
mother, type of family, life style, nutrition, place of residence and source of information
Section B: Structured questionnaire to assess the knowledge of PCOS among female
students of selected degree colleges
7.2.9
DATA COLLECTION PROCEDURE:
The data will be collected by using self administered questionnaire on Demographic variables
such as Demographic variables such
age, year of education, religion, family income,
occupation of the father, occupation of the mother, type of family, life style, nutrition, place of
residence and source of information and the knowledge of female students of selected degree
colleges
The pre-test knowledge level of the female students will be assessed by using self
administered questionnaire following that the Information Booklet on poly cystic ovary
syndrome will be given to the students. After a week post test is conducted by using the Self
administered questionnaire to know the effectiveness of Information Booklet on poly cystic
ovary syndrome .
METHODS OF DATA ANALYSIS AND INTERPRETATION:
7.2.10
The obtained data will be analyzed through Descriptive AND inferential statistics.
Descriptive statistics
-
Demographic variables are to be analyzed in terms of frequency and percentage.
19
-
Assessing the knowledge regarding poly cystic ovary syndrome in female students of
the selected degree colleges will be interpreted by descriptive statistics such as mean,
median and standard deviation.
Inferential statistic
-
Effectiveness of Information Booklet on PCOS among female students of the selected
degree colleges will be analyzed by t-test.
-
Chi-square test will be used to determine the association between selected
demographic variables and pre test knowledge level of PCOS in female students of the
selected degree colleges
7.2.11 DURATION OF DATA COLLECTION:
Four weeks
7.2.12
PROJECTED OUTCOME:
There will be significant increase in the knowledge among female students of the
selected degree colleges regarding poly cystic ovary syndrome.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes, Information Booklet on poly cystic ovary syndrome will be given to the study
participants as a part of the research study.
7.4
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION
 Yes, ethical clearance will be obtained from the research committee of Srilakshmi College
of Nursing, Bangalore.
 Ethical clearance will be obtained from the authorities of selected degree colleges,
Bangalore, Karnataka.
 Informed consent will be obtained from the female students who are willing to participate
in the study.
20
8
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9.
Signature of the candidate
10.
Remarks of the guide
11.
Name and designation of (in block letters)
ASSISTANT PROFESSOR
11.1 Guide
HOD O.B.G
SRI
LAKSHMI
COLLEGE
OF
COLLEGE
OF
NURSING
BANGALORE
11.2 Signature
LECTURER
11.3 Co-guide
SRI
LAKSHMI
NURSING
BANGALORE
11.4 Signature
ASSISTANT PROFESSOR
11.5 Head of the department
HOD O.B.G
SRI
LAKSHMI
NURSING
BANGALORE
11.6 Signature
12.
12.1 Remarks of Chairman and principal
12.2 Signature
24
COLLEGE
OF