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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1.
NAME OF THE CANDIDATE
Mrs. SHASHIKALAVATHI
AND ADDRESS
GOUTHAM COLLEGE OF NURSING
MANJUNATHA NAGAR,
WEST OF CHORD ROAD RAJAJINAGAR,
BANGALORE-10.
2.
NAME OF THE INSTITUTION
GOUTHAM COLLEGE OF NURSING
MANJUNATHA NAGAR,
WEST OF CHORD ROAD
RAJAJINAGAR, BANGALORE-10.
3.
COURSE OF STUDY AND
I YEAR M.Sc. NURSING
SUBJECT
OBSTETRICS AND GYNAECOLOGICAL
NURSING.
4.
DATE OF ADMISSION TO
16.10.2007.
COURSE
5.
TITLE OF THE TOPIC
A STUDY TO ASSESS THE
EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON
POLYCYSTIC OVARY SYNDROME
AMONG THE ADOLESCENT GIRLS IN A
SELECTED COLLEGE OF BANGALORE.
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6.
BRIEF RESUME OF THE INTENEDED WORK
6.1
NEED FOR THE STUDY:
Pcos (Polycystic Ovary syndrome) an endocrine disorder, which means
normal hormone cycles are interrupted. The syndrome was originally reported by
Stein and Leventhal in 1935 when they described a group of women with
Amenorrhea, Infertility, Hirsuitism and enlarged poly cystic ovaries. Polycystic
are two to five times larger than normal ovaries. Women are usually diagnosed
when in their 20’s or 30’s. This can contribute to infertility. Possible
complications are, Sterility, Obesity, Related conditions like high blood pressure
and diabetes, Increased risk of Endometrial Cancer, Possible increased risk of
Breast Cancer.1
Pcos is reported to be growing problem with Adolescent girls .It can be
very difficult to diagnose pcos in teenage girls as they often experience irregular
or absent menses and acne. The underlying cause of pcos may or may not be
detectable in Adolescents during the onset of pcos symptoms. As a result
researchers report that pcos is often missed in this age group. This causes great
concern among clinicians due to the potentially serious complications associated
with these conditions.2
Pcos occurs in 5% to 10% of women, making it one of the most common
endocrine disorder.3 Pcos is a heterogeneous endocrine disorder that affects about
1 in15 women worldwide.4 The prevalence of pco in Indian sub continent Asian
women was 52%.5Polycystic morphology seen in ultrasound is approximately
22% of women.6 Hirsutism is a common problem in India as elsewhere in the
world. Idiopathic hirsutism 38.7%, pcos 37.3%.. In India nearly 40% of women
are affected by pcos. But among them only 60% come to hospitals for treatment,
when they recognize that they have got infertility21.
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Pcos also known by the name Stein Leventhal syndrome is a variety of
symptoms. The symptoms of pcos includes, irregular or no menstrual periods,
Acne, obesity, excess hair growth, oily skin, dandruff., Infertility, skin
discolorations, High cholesterol levels, Elevated blood pressure and Abnormal
hair growth and distribution. Any of the above symptoms and signs may be
absent in pcos, with the exception of irregular or no menstrual periods. All
women with pcos will have irregular or no menstrual periods.8
A report released in the British journal of obstetrics and gynecology in
2000 indicated that up to 40% of women with pcos have either impaired glucose
tolerance or type 2 diabetes by age 40. In addition, with pcos, high levels of
insulin stimulate the ovaries to produce large amounts of testosterone (A male
hormone), which can possibly prevent ovaries from releasing an egg each month
thus causing infertility. High testosterone levels can also cause excessive hair
growth male pattern boldness and acne. In patients with pcos insulin resistance
encourages the storage of fat and the production of excessive amounts of
testosterone.9
Pcos are readily identified by pelvic ultrasound because, they are
larger than normal size (overage volume three times that in normal women).10
The diagnosis of pcos is based on ultrasound scan of the ovaries using a vaginal
probe and a hormone profile including measurement of FSH /LH, testosterone
and androstenedione .11
Lifestyle modification with increased physical activity and weight
reduction remains first line of therapy.12 Treatment of Pcos includes weight loss
of more than 5% of previous weight is important and will help in restoring the
hormonal
milieu
to
some
extent.
Cigarette
smoking
raises
DHEA
(Dehydroepiandrostenedione, Which produces androgens) it should be avoided.
Estrogen suppresses androgen and adrenal production. It is in oral contraceptives.
Dexomethosone 0.5Mg or Prednisolone 5Mg at bed time also reduces androgen
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production. Hirsutism is treated with cyproteron acetate (Prevents recurrence of
hirsutism) Infertility is treated With clomiphene 80% ovulate and 40% conceive.
Surgery is reserved for those in who medical therapy fails hyper stimulation
occurs. Surgery comprises laparoscopic multiple punctures of the cysts with
electrocautery or laser.13
The symptoms of pcos are major source psychological morbidity and can
negatively affect quality of life of adolescents. One of the symptoms acne is the
area least reported upon in terms of its impact upon health related quality of
life.14 A few small studies have also suggested an increased risk of depression in
women with pcos.15
As pcos is among the most common during adolescence, there is always a
need to investigate all new relevant data. Early recognition and prompt treatment
of Pcos in adolescents is important to prevent long term sequel. More research is
necessary in order to find answers to many clinical and the theoretical aspects of
the syndrome.16
The onset of pcos occurs during adolescence since it is known that
incidence of pcos is more among adolescents. They are suffering from physical
and psychological morbidity. There is an increasing number of adolescents are
presenting with signs of pcos and also there is an increased risk of cardiovascular,
metabolic and depressive disorders. Mainly they will face problems like
disturbance in their body image because of certain pcos related problems. It
causes a psychological disturbances and also if untreated it may lead to
complication of pcos. The pcos is a source of psychological morbidity and also
can negatively affect the quality life of adolescents. So, early recognition,
prevention and treatment is important to prevent long term sequel and to develop
a positive attitude and follow healthy life style. From the above studies the
investigator found adolescent girls have lack of knowledge regarding pcos and
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they are neglecting taking care of the disease. Hence, the researcher is interested
to educate the adolescent girls regarding pcos by giving them self instructional
module and assess the effectiveness of Self instructional module.
6.2
REVIEW OF LITERATURE:
Review of literature for this study has been organized under the
following headings.
6.2.1. Studies related to polycystic ovary syndrome.
6.2.2 Studies related to prevalence of polycystic ovary syndrome.
6.2.3 Studies related to etiology of polycystic ovary syndrome.
6.2.4 Studies related to diagnosis and treatment of polycystic ovary
Syndrome.
6.2.5
Studies related to complications of polycystic ovary syndrome.
6.2.6
Studies related to quality of life of adolescents with polycystic ovary
syndrome.
6.2.1. Studies related to polycystic ovary syndrome.
A study conducted on Pcos is a heterogeneous endocrine disorder that
affects about 1 in 15 women worldwide. The major endocrine disruption is
excessive androgen secretion or activity, and a large proportion of women also
have abnormal insulin activity. Many body systems are affected in Pcos, resulting
in several health complications including menstrual malfunction, infertility,
hirsutism, acne, obesity, and metabolic syndrome. Women with this disorder have
an established increased risk of developing type 2 Diabetes and still debated
increased
risk
of
cardiovascular
disease.
The
diagnostic
traits
Pcos
hyperandrogenism, chronic and anovulation, and polycystic ovaries, after
exclusion of other conditions that cause these same features.4
A study conducted on “pcos and adolescents” by US scientists that is
pcos is the most common form of chronic anovulation associated with androgen
excess perhaps occurring in 5% to 10% of reproductive age women. Infertility is
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caused by failure of ovulation although hyper secretion of LH (leutinizing
hormone) is also and important in this regard, obesity often associated with an
increase in the ratio of waist to hip circumference is the 3rd classical feature. The
classical profile is the hyper secretion of LH androgens with normal circulating
FSH, prolactin and thyroxin concentration. In-fact spectrum of endocrine findings
occurs, reflecting the phenotype heterogeneity of the Pcos. In a study of more
than 1500 cases 44% had and elevated serum LH and 22% an elevated serum
total testosterone concentration. Levels of LH were raised most commonly in the
women complaining of infertility and of testosterone in those complaining of
hirsutism.10
6.2.2 Studies related to prevalence of polycystic ovary syndrome.
A study conducted on “Prevalence of pcos in Women of Reproductive
Age”. 189 healthy women aged between 20-45 years were included in the study.
The women were divided into 2 groups, those 35 years of age and younger and
those 36 years age and older, on cycle days 1-6 trans vaginal ultrasound was
performed and blood samples were collected. There was 14.2% prevalence of
pcos in entire group (27/189). The prevalence was 21.6% in women 35years and
younger and 7.8% in the women 36years and older. Significantly more irregular
cycles were seen in women with pcos than in those with normal (44%v/s 19%).
In healthy women, the prevalence of pcos varies with age. The binding are more
common in women younger than 35 years.17
A study conducted on Prevalence of ultrasonography proved polycystic
ovaries in North Indian women with type 2 diabetes mellitus. Polycystic ovary
syndrome as well as type 2 diabetes mellitus is common medical conditions
linked through insulin resistance. 105 reproductive age group women with diet
and /or oral hypoglycemic treated T2DM were the subjects of the study. 60 nondiabetic women served as controls. Trans abdominal ultrasonographic assessment
of the ovaries was used to diagnose pcos. Clinical, biochemical and hormonal
parameters were also noted. Ultrasonographic prevalence of pco was higher in
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women with diabetes than in non-diabetic subjects, whereas that of pcos was
37.1% in diabetic subjects and 25% in non-diabetic controls. Diabetic women
with pco had diabetes of significantly longer duration than those without pco.
Among both diabetic and non-diabetic women, those with pco had significantly
higher plasma LH, LH/FSH ratio, and total testosterone and androstenedione
levels. This study demonstrates a higher prevalence of pco in women with T2DM
as compared to non-diabetic subjects 18.
6.2.3 Studies related to etiology of polycystic ovary syndrome.
The cause of pcos is unknown, but studies suggest a strong genetic
component that is affected by gestational environment, life style factors, or both.4
A study conducted on Epidemiologic and etiologic aspects of hirsutism in
Kashmiri women in the Indian subcontinent. To assess the prevalence of
hirsutism and study its etiology in the Kashmir Valley of the Indian subcontinent.
5000 women attending various hospitals for reasons unrelated to hirsutism and
150 consecutive women referred for hirsutism were in study. The etiology of
hirsutism revealed idiopathic hirsutism in 38.7%, pcos in 37.3%, postmenopausal
state in 9.2%, adrenal tumors in 2.1%, congenital adrenal hyperplasia in 1.4%,
and drug-induced hirsutism in 0.7%. The cause remained undetermined in 10.6%
of patients. Hirsutism is as common a problem in the Kashmir Valley (India) as
elsewhere in the world. Idiopathic hirsutism (38.7%), pcos (37.3%), and
postmenopausal state (9.2%) are common causes of hirsutism. Late-onset
congenital adrenal hyperplasia is a relatively uncommon cause of hirsutism in the
Kashmir Valley.7
6.2.4 Studies related to diagnosis and treatment of polycystic ovary
Syndrome.
A study conducted on “Diagnosis Management of Pcos-A Practical
Guide”, Pcos is a syndrome, which can be defined as a group of recognizable
patterns of symptoms or abnormalities that indicate a particular medical situation.
The current definition of Pcos requires the presence of two of the following three
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conditions: (i) Oligo and /or anovalation, (ii) Clinical and/or biochemical signs of
hyper androgenism, and (iii) Polycystic ovaries-and the exclusion of other
etiologies.
An approach to a patient with possible Pcos should be directed
towards making a diagnosis and screening for associated endocrine abnormalities.
Therapeutic interventions are directed towards addressing the need of the patient
at present and towards preventing long term complications of the syndrome.
Body Mass Index (BMI), which is a primary mediator in the relationship between
Pcos and HRQL in obese Pcos adolescents. Any intervention directed at reducing
central obesity will not only improve quality of life but also correct
hyperinsulinism and improve fertility and lipid and androgen profile19.
A study conducted on “Current Approaches to the Diagnosis and
Treatment of Polycystic Ovarian Syndrome in Youth”. Pcos often presents during
late adolescence but in some cases certain features are evident even before
menarche. The diagnosis is based on a typical physical exam and laboratory
evidence
of
hyper
androgenism,
such
as
elevated
free
testosterone,
androstenedione and dehydroepiandrosterone sulfate (DHEAS), decreased sex
hormone-binding globulin (SHBG) and increased luteinizing hormone (LH). An
ovarian ultrasound may detect the multiple cysts. Oral contraceptive therapy is
used to reduce androgen and LH levels with resultant improvement in acne and
hirsutism, and the induction of regular menses. Anti androgens are usually
required for a substantial improvement in hirsutism score. Insulin sensitizers such
as metformin are a new class of drugs utilized in treatment of pcos. Despite all
the available medications, life-style changes are the mainstay of therapy as
weight loss and exercise improve all parameters of Pcos without the potential side
effects of medication.20
A study conducted on Benefits of Kayakalpa Yoga over pcos patients,
The aim of the study is to evaluate the benefits Kayakalpa yoga in pcos patients.
“Natural forces within us are the best healers of diseases.” Pituitary glands
control the endocrine metabolism of our body. By giving treatment to pituitary
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gland the pcos could be cured. Kayakalpa yoga is an intrinsic factor, done to
regulate the endocrine metabolism of our body. Pcos is one of the endocrinal
disorders; this yogasana is applicable to patients suffering from pcos. Obesity is
one of the causative factors for pcos patients .Due to this yogasana our body will
be reduced. So in the study, a new approach is analyzed to control the obesity
factor in pcos patients. Kayakalpa yoga is a rejuvenating technique , which
maintains the potency of our body and extends life span.21
6.2.7
Studies related to complications of polycystic ovary syndrome.
A study conducted on increase risk of the depressive disorders in women
with pcos, is associated with several metabolic complications. A few small
studies have also suggested an increased risk of depression in women with Pcos.
The goals of this study were to estimate the prevalence of depressive disorders in
women with Pcos compared with controls and to evaluate the correlation between
depression, hyperandrogenism, and other metabolic markers. Women with pcos.
Women without pcos seen during the same time. Period for an annual exam were
used as control subjects. Depressive disorders, Women with pcos were at an
increased risk for depressive disorders compared with controls. The report was a
significantly increased risk of depressive disorders in women with Pcos and
recommend routine screening in this population.15
6.2.8 Studies related to quality of life of adolescents with polycystic ovary
syndrome.
A study conducted on “Quality of life in adolescent girls with Pcos”, A
Cross-sectional study of female adolescents conducted at an urban hospital with
97 adolescents girls with Pcos and 186 healthy women. HRQL (health related
quality life) scores as determine by the child health questionnaire-child self report
form. It says Adolescents with Pcos experience lower HRQL compared with
healthy adolescents.3
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6.3
STATEMENT OF THE PROBLEM:
A study to assess the Effectiveness of self instructional module on
polycystic ovary syndrome among the adolescent girls in a selected college of
Bangalore.
6.4
OBJECTIVES OF THE STUDY:
1. Assess the knowledge regarding poly cystic ovary syndrome among
adolescent girls.
2. Assess the effectiveness of self instructional module on polycystic ovary
syndrome among adolescent girls.
3. Determine the association between the selected demographic variables
with the knowledge of adolescent girls regarding polycystic syndrome.
6.5
OPERATIONAL DEFINITIONS:
1. KNOWLEDGE
Refers to the responses of subjects on self administered questionnaire on Pcos.
2. EFFECTIVENESS.
.
Refers to the gain in knowledge as determined by significant difference in
pre test and post test scores.
3. SELF INSTRUCTIONAL MODULE.
Refers to a booklet of contents prepared by the investigator and validated by
experts. It contains the meaning, signs and symptoms, management and
prevention of pcos, which will be provided to the subjects for self reading and
gaining information.
4. POLY CYSTIC OVARY SYNDROME.
Polycystic ovary syndrome is a complex condition affecting many organ
sites in reproductive age women including the hypothalamus, pituitary, ovary,
pancreas, peripheral glucose sensitive tissues, and skin in different individuals.
5. ADOLESCENT GIRLS
Refers to the first and second year PUC students.
6.6
HYPOTHESES
H1 - There will be significant difference between pre test and post test level of
knowledge among of adolescent girls regarding Pcos.
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6.7
ASSUMPTIONS
Its is a assumed that
1. Adolescent girls will be willing to express their knowledge regarding
polycystic ovary syndrome.
2. Self instructional module increases the knowledge of adolescent girls
regarding polycystic ovary syndrome.
6.8
DELIMITATIONS:
1. The study is delimited to adolescent girls only
2. Adolescent girls who are available at the period of study.
3. Measurement of knowledge scores of Adolescent girls once before and
after effectiveness of self instructional module.
6.9
PROJECTED OUTCOME
1. The study will enhance the knowledge of Adolescent girls on Pcos and
help in increasing autonomy and operate in a desirable manner to
achieve positive health.
2. The study will generate new knowledge on attitudes of Pcos among
Adolescent girls.
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MATERIALS AND METHODS
7.1
SOURCE OF DATA
Adolescent girls in a selected college of
Bangalore.
7.2
METHODS OF COLLECTION OF DATA.
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7.2.1
SAMPLE CRITERIA
Inclusion criteria of the
1. Adolescent girls in a selected college
study
2. Adolescent girls available during data
collection.
3. Who are willing to participate.
4. Who understand the language
Kannada, English and Hindi.
1. Not willing to participate in the study.
Exclusion criteria of the
2. Adolescent girls not attending college.
study
7.2.2
RESEARCH DESIGN
Pre Experimental design. One group pre test
and post test design.
7.2.3
VARIABLES UNDER
STUDY
7.2.4
INDEPENDENT
VARIABLE
Self instructional module.
DEPENDENT
VARIABLES.
Knowledge of adolescent girls regarding
polycystic ovary syndrome..
ATTRIBUTE
VARIABLE
Age, socioeconomic status, Education.
SETTING OF THE STUDY
Study will be conducted in a selected
college of Bangalore.
7.7.5
SAMPLE TECHNIQUE
The researcher will use convenience sampling
technique.
7.2.6
SAMPLE SIZE
The sample size consists of 30 Adolescent girls
7.2.7
TOOLS OF RESEARCH
Level of knowledge of Adolescent girls about
Pcos can be assessed by questionnaire on
knowledge of Adolescent girls about Pcos.
7.2.8
COLLECTION OF DATA
An informed consent will be obtained from the
12
subjects The process of the study will be
explained to the subjects. Structured
questionnaire will be administered to the
subject to assess the knowledge level.
Subsequently to the pre test, a self instructional
module on poly cystic ovary syndrome will be
given to the adolescent girls. Following this on
4th day the investigator will assess the
knowledge score by post test using structured
questionnaire. Study duration is of 30 days.
7.2.9
METHOD OF DATA
By using descriptive and inferential statistics.
ANALYSIS AND
The plan of data analysis will be as follows
1. Organize the data in a master sheet /
PRESENTATION
computer
2. Frequencies and percentages for the
analysis of background data
3. Mean , median, SD and ‘F’ values to
determine the significance
4. Chi-square test to determine the
association
7.3
Does the study require any investigation or intervention to be conducted on
patients or other human or animals? If so, please describe briefly?
The study requires administration of questionnaire
7.4
Has the ethical clearance been obtained from the institutional authorities of
the particular institution and students
Yes. Ethical clearance and informed consent will be obtained from the
institutional authorities and students. Privacy, confidentiality and anonymity will
be guarded. Scientific objectivity of the study will be maintained with honesty
and impartiality.
13
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