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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA, PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION MR. SHANTAPPA HEBBALATTI 1ST YEAR M.SC NURSING MEDICAL SURGICAL NURSING YEAR 2011-2013 CAUVERY COLLEGE OF NURSING, TERISIAN COLLEGE CIRCLE, SIDHARTHANAGAR, MYSORE. [1] 1 NAME OF THE MR. SHANTAPPA HEBBALATTI CANDIDATE 1st YEAR M.Sc NURSING, AND ADDRESS CAUVERY COLLEGE OF NURSING, MYSORE. 2 NAME OF THE CAUVERY COLLEGE OF NURSING, MYSORE-570007 INSTITUTION 3 COURSE OF STUDY MASTER OF NURSING - AND SUBJECT 4 DATE OF ADMISSION TO COURSE 5.1 TITLE OF THE STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING EARLY DETECTION AND PREVENTION OF PROSTATE CANCER AMONG BUS DRIVERS IN MYSORE. 5.2 STATEMENT OF A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF THE INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING PROBLEM EARLY DETECTION AND PREVENTION CANCER AMONG BUS DRIVERS IN MYSORE. [2] OF PROSTATE 6. BRIEF RESUME OF THE INTENTED STUDY “Look to your health; and if you have it, praise God and value it next to conscience; for health is the second blessing that we mortals are capable of, a blessing money can't buy. “ - Izaak Walton 6.1 INTRODUCTION:The prostate is a gland of men located in middle of the bladder and rectum. As men have only prostate, so prostate cancer is the disease of the man. The main function of Prostate gland is to produce and store fluid which comes out from a man’s penis during ejaculation. The urethra tube that carries urine from the bladder to penis is fully encircled by Prostate gland. The enlargement of Prostate causes urination problem of men. Prostate cancer means cells in the Prostate grow uncontrollably and invade the nearby tissues and other parts of the body. The abnormally grown tissues are called tumors. The benign tumors are those tumors which are not life threatening. Only malignant tumors can spread to other parts of the body. Though usually Prostate cancer is slow growing, it has the possibility of quick growth and expansion. 1 Prostate cancer is the most common cancer in men and the second most common cause of cancer death in American men older than 55year age. In 1999, African American men prostate cancer is the most prevelent cancer, overall its incidence is twice. Let us speak, general population of men and death rate is about 3times greater about 1:5men in the united states develop prostate cancer, and esteemated 1,80,000 new cases of prostate cancer are diagnosed each year, and 37,000men who already have it, die from it each year. 2 Risk factors include, increase in age and possibly high fat diet. The genetic association of prostate cancer, as the increased incidence within family is still being investigated. The growth of prostate gland depends on the presence of androgenic harmones, such as testosterone, because Dihydrotestesterone is the important pramoter of prostate cancer. 2 [3] According to WHO report, in developing countries, about one-third of cancers can be prevented, one-third can be detected early and and can be cured, and the remaining third needs supportive care. For various reasons, over two third of cancers in India present with advanced incurable stage. Due to the advanced stage of disease at presentation, increasing cancer treatments will have very little impact in the outcome. The most cost effective means to impact cancer outcome in the community is to channel resources in prevention of preventable cancers, and early detection and down staging of cancer and provide standardized protocol based treatment of diagnosed patients. Those patients who are diagnosed with cancer needs to be treated based on a standardized treatment protocol, which needs to be carried out with the support of multy-disciplinery sub-site based tumour board in partener with comprehensive cancer centres . By tying up peripheral cancer care facilities with tumour boards of comprehensive cancer centres will ensure standardized cancer management of a high standard in the community, potential for research to improve outcomes and educational opportunities at both basic and advanced levels, preferential channels for reference and management of patients reffered from the peripheral centres would be commitment of the comprehensive cancer centres. After completion of treatment the patient needs long tem surveillance, which is best carried out in the community in partnership with cancer centres 3 6.2 NEED FOR THE STUDY Working as bus drivers has several health risks. A large proportion of these health risks are attributable to stress related disorders. This will result in loss of productivity and early loss of highly skilled drivers. The impact of sick events occurring in public transport bus drivers will be enormous on the society at large. This would result in risk to life of passengers, other road users and pedestrians as well as damage to property and vehicles. Driving as a profession puts strain on healthy life style practices of an individual. The health of bus drivers is an important issue in public health, occupational health, transport policy and employment conditions. There has not been a concerted effort to target those factors that cause poor health and this is an area of neglect that needs urgent attention especially in a developing country like ours. Measures to protect and improve the health status of bus drivers should be pursued in a way that maximises gains to all sectors of society at large and [4] individual and family in particular.There has been a deterioration in work conditions of bus drivers over the last 20 years. 24 Risk indicators related to the work environment evaluated among male professional drivers in Sweden showed that significantly more drivers than controls had a work situation characterized by high demands, low decision making abilities, low social support at work, and shift work. It also showed that significantly more drivers than controls were sedentary in their leisure time, smokers, overweight, and consumed a significantly higher proportion of milk fat per day.25 Low physical activity in leisure time,26high incidence of smokers,27 and obesity were also found among professional drivers in other studies. The excess proportion of overweight drivers could be a consequence of their eating habits and their low physical activity both at work and during their leisure time. These results indicate the importance of trying to change the lifestyle of the drivers to decrease the risk of prostate cancer. Cancer of the prostate ranks as the fourth most common in men globally, with an estimated 396.100 new cases a year in 1990, which is almost a 100% increase over the 1975 estimate. Incidence rates are low in Asian and North African populations, ranging from 1 to 9 per 100,000. Studies carried out in India indicate a low incidence of the disease (3.9 per 100,000) A majority of the prostate malignancies detected in North Africa are at the T1.C Stage. This is attributed to the presence of comprehensive screening programme with the prostate specific Antigen (PSA) as its screening Tool. There is a lack of clinical data pertaining to levels of prostate specific Antigen (PSA) in the Indian population. No study targeting the Indian population exist which aims to stratify the incidence of prostate carcinoma based on prostate specific Antigen (PSA) measurements. An effort therefore needs to be made to create awareness of early detection and prevention of prostate carcinoma. 4 Dr.k ramachandra reddy maintains population based registry it says, in world, it is estimated that about 9 million new cancer cases are diagnosed every year and over 4.5 million people die from cancer each year in the world. In india, the estimated number of new cancers per year is about 7 lakhs and over 3.5 lakhs people die of cancer each year. And in karnataka would be about 1.5 lakhs cancer cases at any given time in karnataka and about 35,000 new cancer cases are added to this pool each year. Cumulative risks are the absence of other causes of death, the risk of developing cancer by an individual among bangaloreans [5] would be 15.1% in males and 16.8% in females (cumulative risk). In other words, one in six persons in either sex has the risk of developing cancer during their life time.5 Prostate cancer is the most common non-skin cancer among men in most western populations, and it is the second leading cause of cancer death among U.S. men. Despite its high morbidity, the etiology of prostate cancer remains largely unknown. Advancing age, race, and a family history of prostate cancer are the only established risk factors. Many possible risk factors, including androgens, diet, physical activity, sexual factors, inflammation, and obesity, have been implicated, but their roles in prostate cancer etiology remain unclear. It is estimated that as much as 42% of the risk of prostate cancer may be accounted for by genetic influences, including individual and combined effects of rare, highly penetrant genes, more common weakly penetrant genes, and genes acting in concert with each other. Numerous genetic variants in the androgen biosynthesis/metabolism, Results of these studies may lead to better detection, treatment, and, ultimately, prevention of prostate cancer. 6 Mortality is only one in six American men diagnosed with prostate cancer will eventually die from it. Nevertheless, 30,350 prostate cancer deaths are expected in the U.S. in 2005, making prostate cancer the second leading cause of cancer death among U.S. men, after lung cancer (1). Age adjusted prostate cancer mortality rates from 38 countries in 1998. Overall the pattern of mortality worldwide reflects that of incidence, although the mortality rates show less variation between countries. 6 Prostate cancer is now the most commonly diagnosed male cancer in many western countries. Currently there are 37,000 new cases a year in the UK; 218,000 in the USA; 25,000 in Canada and 17,000 new cases a year in Australia. The number of recorded cases has increased a lot in recent years. This is partly due to the increased use of the PSA test, which has resulted in more cases being detected, and partly due to the fact that men are living longer. Like most cancers, prostate cancer is more common in those over 60years. 7 In an unpublished study, Dr.Chaitrathara surgical oncologist funded by the Kerala State Council for Science, Technology and Environment, has found that the risk of prostate cancer is very high in men above 60 years of age.The raising incidence of prostate cancer could become a major health problem, warns ,experts working in the area It is time to plan [6] some large-scale population screening studies to look into the matter. Regular screening might increase the detection rate of early cancers, said Dr Chithrathara, who along with Dr Riju R Menon and Dr Vaidhyanathan had found this trend of increasing prostate cancer in men. In the study centered around Ernakulam, healthy men older than 50 years of age were screened. “Many of them had come to hospitals for executive or comprehensive checkups. From the screening of nearly 1,500 men in the ages 50-80 years, the researchers concluded that the rate of incidence is as high as 275 per one lakh persons. The test for Prostate Specific Antigen (PSA) showed a value of 1.19 in men aged between 50-59 which went up to 1.99 in men aged between 60-69 and further up to 2.38 in the age group of 70-75. While the study team attempted to get a co-relation between the dietary habits, smoking and obesity with the incidence of prostate cancer, they could not get clear-cut pictures on smoking and obesity. However, they found that vegetarians were at a lower risk than nonvegetarians. Obesity can however delay the diagnosis of prostate cancer in two ways. One is that it makes digital rectal examination, a major screening tool more difficult and the second is that the hormone changes makes the chances of detection remote using the Prostate Specific Antigen test. Those persons who showed abnormalities in digital rectal examination in the study were subjected to transrectal ultrasound and CT/MRI scans. Biopsies were also done to confirm the cases. Early detection is feasible in our state. Conducting urology camps with the help of social organisations can really help, Screening impact on population depends on the successful diagnosis and treatment of detected cases. Probably the state also needs to think of financial assistance for diagnosis and treatment. 8 It is evident that most cancers are largely preventable. Despite this facilities for screening and proper management of patients are grossly limited in india. More than two third cancer patients are already in an advanced stage at the time of diagnosis. Appropriate strategies have been developed, including creating public awareness about cancer control and application of self or assisted cancer screening techniques. In India, under district cancer control programme project, in selected districts medical and paramedical staff of the district hospital and anganwadi workers have been trained on the examination and reffering the suspected cases to the district hospital for the further evaluation. However, modified district cancer control programme need to be extended to more states and peripheral areas of the country. 9 [7] C.S. Ratkal professor and head of the Department of Nephro-urology of Victoria hospital, Addressing a press conference stated that prostate cancer was the most common disease among men in the 40 and above age group. And the incidence of prostate cancer in India was more than 20 million. Of every 20 men, nine die due to cancer owing to lack of awareness, he said. About one in six men will be diagnosed with prostate cancer during his life time. Persons who were over 40 and are overweight will have a higher risk of developing this disease. Surgery was the main mode of treatment for prostate cancer. The common technique was “Radical Prostatectomy” which involves removing the prostate gland, seminal vesicles and lymph nodes. The possible side effects of the procedure include some urinary incontinence, infertility and erectile dysfunction. 10 Only certain types of skin cancer affect more men. Prostate Cancer Is the Second Leading Cause of Cancer Death in Men Among American men, prostate cancer is the second leading cause of cancer deaths. Only lung cancer claims more lives each year. Almost 30,000 men per year succumb to prostate cancer. Prostate Cancer Rates Have Remained Steady Over the Last Decade Prostate cancer rates have remained roughly the same over the past decade. During the first few years after the PSA test was put into widespread use, the rate seemed to increase dramatically. This was likely not due to more men actually having the disease, however. With a better screening method in place . more men with prostate cancer were actually being diagnosed for the first time. Now, the PSA test has been in place for a number of years and the number of men being diagnosed each year has levelled off. 11 As National cancer institute says that, In 1975, the annual prostate cancer incidence rate among U.S. males was 94 new cases diagnosed per 100,000 men; the mortality rate was 31 deaths per 100,000 men. The incidence rates among white men and African American men were 92 and 141 new cases, respectively, per 100,000 men; the mortality rates for white men and African American men were 29 and 56 deaths, respectively, per 100,000 men. But today i,e in 2007, the latest year for which we have updated statistics, the U.S. incidence rate for prostate cancer was approximately 166 new cases diagnosed per 100,000 men; the mortality rate was approximately 24 deaths per 100,000 men. 12 The work conditions are known to be worse in a developing country like India. This deterioration is largely the result of traffic congestion and its associated air and noise pollution but also with the pressures of maintaining a demanding schedule in circumstances [8] that make that task almost impossible. These circumstances damage the health of bus drivers in a way that is unacceptable. I the researcher seen in clinical duties and as well my neighbour uncle suffering from prostate cancer but he didn’t knew the diagnosis, when he was approached me to solve his problem. I discussed with my consultant doctor. He said its, prostate cancer. I was unable to see that, he is finding problems in his even Daily living activities. I my relatives alone there are three members are Drivers only. So this motivated to work on this study to evaluate the effectiveness of self instructional module on knowledge regarding early detection and prevention of prostate cancer among bus drivers. Karnataka State Road Transport Corporation (KSRTC) being a large, economically successful state government enterprise is expected to lead other transport organizations in providing preventive and promotive health care services to their employees according to job specific health hazards and risks. Hence this study has been planned to review the evidence on the health problems of bus drivers and to make recommendations for a significant improvement in the health status of this group of professionals. 6.8 REVIEW OF LITERATURE Review of literature is defined as broad, comprehensive in depth systematic and critical review of scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communication. Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systemic examination of publication relevant to research project. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge, insight and general scholarship of the researchers.13 Solenova LG, Smulevich VB, Dymova EG, Beresneva AD. Conducted study on general and cancer morbidity among municipal transport drivers in Moscow, they took,the mortality and cancer morbidity in 1969 to 1988 were followed up among 2528 men. In the first decade, prostatic cancer mortality was statistically significantly higher in bus drivers with length of service of over 20 years. 14 [9] Lüngen M, Rath T, Schwartze D, Büscher G, Bokern E. conducted study in ‘convergence tendencies in inpatient oncological care after implementation of diagnosisrelated groups in germany.’ Claims data of about 23,600,000 insured within the inclusive period 2004-2007. All cases with the main diagnosis of prostate cancer, in the study. Broken down by entities and years, graphical and statistical concentration measures as well as the percentages of different hospital size classes were calculated. Increasing case numbers could be observed for all entities within the period prostate cancer: +12.5%; The concentration measures showed hardly any changes in the course of time. The absolute increase of case numbers seems to affect those hospitals with case numbers higher than 50 per year above average [prostate cancer cases in a hospital group including hospitals with more than 50 cases 2004 and 2007: 81.6%; prostate cancer: 67.4% whereas case numbers of hospital groups including hospitals with case numbers less than 50 per year remain unchanged or grow more slowly. 15 Jack A. Clark, Thomas S. Inui, Rebecca A. Silliman, Barbara G. Bokhour, Steven H. Krasnow, Richard A. Robinson, et.al, conducted study on Patients’ Perceptions of Quality of Life After Treatment for Early Prostate Cancer.’ Using survey method Patients with previously treated prostate cancer and a reference group of men with a normal prostatespecific antigen (PSA) level and no history of prostate cancer completed questionnaires. Innovative scales assessed behavioral consequences of urinary dysfunction, sexuality, health worry, PSA concern, perceived cancer control, treatment decision making, decision regret, and cancer-related outlook. Urinary, bowel, and sexual dysfunction were assessed with symptom indexes; health status was assessed by the Physical and Mental Summaries of the Short Form. The study results were, reported greater urinary, bowel, and sexual dysfunction, but similar health status. They reported worse problems of urinary control, sexual intimacy and confidence, and masculinity, and greater PSA concern. Perceptions of cancer control and treatment decisions were positive, but varied by treatment: prostatectomy patients indicated the highest and observation patients indicated the lowest cancer control. Bowel and sexual dysfunction were associated with poorer sexual intimacy, masculinity, and perceived cancer control; masculinity and PSA concern were associated with greater confidence in treatment choice; and diminished sexual intimacy and less interest in PSA were associated with greater regret. And the study Conclusion was, the lack of change in global measures of health status after treatment for early prostate cancer obscures important influences in men’s [10] lives; cancer diagnosis and treatment complications may result in complex outcomes. Aggressive treatment may confer confidence in cancer control, yet be countered by diminished intimate relationships and masculinity, which accompany sexual dysfunction. 16 Sunny L, Yeole BB, Kurkure AP, Hakama M, Shiri R, Mathews S, Shastri NG, Advani SH. Conucted the study in ‘cumulative risk and trends in incidence of prostate cancer in Mumbai, India,’ using data collected by the Bombay Population-based Cancer Registry from the year 1986 to 2000.During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were registered by the Bombay Population-based Cancer Registry. For evaluation of the trend, they applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the evaluation. Cumulative incidence rates percentages were calculated by adding up the age specific incidence rates at single ages and then expressed as a percentage. Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 showed the probability estimates indicated that one out of every 59 men will contract a prostate cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. 17 Carol L. Hanchette M.A. Gary G. Schwartz Ph.D., M.P.H conducted study on ‘Geographic patterns of prostate cancer mortality. Evidence for a protective effect of ultraviolet radiation.’ In 1992. Recently it was hypothesized that low levels of vitamin D, a hormone with potent antitumor properties, may increase the risk for clinical prostate cancer. Because the major source of vitamin D is casual exposure to ultraviolet (UV) radiation, the authors examined the geographic distributions of UV radiation and prostate cancer mortality in 3073 counties of the contiguous United States using linear regression and trend surface analyses.These data lend support to the hypothesis that UV radiation may protect against clinical prostate cancer. Viewed in conjunction with other recent data, including those demonstrating a differentiating effect of vitamin D on human prostate cancer cells, these findings suggest that vitamin D may have an important role in the natural history of prostate cancer. 18 Seidler A, Heiskel H, Bickeböller R, Elsner G were studied on ‘Association between diesel exposure at work and prostate cancer..’The possible etiologic relevance of occupational factors such as cadmium, cutting oils, diesel fuel and fumes, herbicides, [11] polycyclic aromatic hydrocarbons (PAH), polychlorinated biphenyls, soot, tar, mineral oil, and solvents to prostate cancer was studied. A case-referent study design was used to recruit 192 subjects with histologically confirmed prostate cancer and 210 referents who had prostate cancer Data were gathered with a self-administered questionnaire and analyzed using logistic regression to control for age, region, and cigarette smoking. The analysis of dose-years yielded a statistically significant association between occupational exposure to diesel fuel or fumes and prostate cancer only exposure to PAH was significantly associated with prostate cancer.19 Nilsson S, Norlén BJ, Widmark A. conducted study on ‘Self learning materials and modules for health workers for the development utilisation and education’ using meta analysis and retrospective method A systematic review of radiation therapy trials in prostate cancer has been performed by according to principles adopted by the Swedish Council of Technology Assessment in Health Care (SBU). This synthesis of the literature is based on data from one meta-analysis, 30 randomized trials, many dealing with hormonal therapy, 55 prospective trials, and 210 retrospective studies. Totally the studies included 152,614 patients. There is fairly strong evidence that patients with localized, intermediate risk, and high risk . There is some evidence that 3D conformal radiotherapy results in reduced late rectal toxicity and acute anal toxicity compared with radiotherapy administered with nonconformal treatment volumes. There is some evidence that postoperative external beam radiotherapy after radical prostatectomy in patients There is fairly strong evidence that shortterm endocrine therapy prior to and during radiotherapy results in increased disease-free survival, increased local control, reduced incidence of distant metastases, and reduced causespecific mortality in patients with locally advanced disease. There is some evidence that short-term endocrine therapy prior to and during radiotherapy results in increased There is strong evidence that adjuvant endocrine treatment after curative radiotherapy results in improved local control, increased freedom from distant metastases, and increased diseasefree survival in patients with loco-regionally advanced and/or high-risk disease. There is moderately strong evidence that adjuvant endocrine treatment after radiotherapy results in longer overall survival compared with radiotherapy alone in patients with loco-regionally advanced disease. 20 Held JL, Osborne DM, Volpe H, Waldman AR.conducted study on ‘Cancer of the prostate: treatment and nursing implications. Using observational study, to review the [12] clinical manifestations, current treatment, and nursing management of prostate cancer. Because no definitive method for identifying clinically important lesions exists, much controversy surrounds prostate cancer treatment. Issues significant to the diagnosis and treatment of all stages of prostate cancer are identified, and nursing care concerns focusing on treatment and disease related problems are presented. Nursing care focuses on providing patients with accurate information to make informed decisions regarding treatment for early stage disease, on promoting comfort, and on preventing and managing treatment and disease-related complications. Nursing diagnoses include knowledge deficit; altered sexual patterns, body image disturbance, altered urinary elimination, diarrhea, impaired skin integrity, and pain, fatigue, bleeding, and infection, all of which are related to surgery, pathologic fractures, spinal cord compression, and edema of the scrotum/lower extremities.21 LITERATURE ON SELF INSTRUCTION MODULE. To develop a self instructional module, the related literature is reviewed. The technical report of world health organisation (WHO) in 1985, suggests the following phases be involved in developing self instructional material. i) Preparatory phase; This includes collection of data, that serves as baseline information for planning aself learning material, its implementation and evaluation. ii) Implementation phase; Includes preparation, production, dessimenation, assessment, and monitoring activities concerned with the module. iii) Evaluation phase; This phase includes evaluation of input process, product and impact on health status of population. 22 Torney and Thompson (1982) profess that, the learning module is a strategy for individualising instruction in a self contained Instructional unit that focuses on a single concept or topic and has a few well defined objectives. Individual study is a process. The elements of learning module according to Torney and Thompson are, [13] - Table of content. - Introduction; including purpose, terminal objectives and general objectives. - List of pre-requisites and suggested resources. - Pre-test - Activities - Self check for progress. - Post test and - Feedback on module The review of literature has helped the Investigator to become aware of the various methodologies, used in various studies. It has helped in every step of the study from the statement of problem to the conclusion of the study. 23 6.3 STATEMENT OF THE PROBLEM A study to evaluate the effectiveness of self instructional module on knowledge regarding early detection and prevention of prostate cancer among bus drivers in Mysore. 6.4 OBJECTIVES 1. To assess the pre test level of knowledge on regarding early detection and prevention of prostate cancer among bus driver 2. To assess the post test level knowledge on regarding early detection and prevention of prostate cancer among bus driver 3. To assess the effectiveness of self instructional module on of knowledge on regarding early detection and prevention of prostate cancer among bus driver 4. To associate the level of knowledge on regarding early detection and prevention of prostate cancer among bus driver with their selected demographic variables [14] 6.5 OPERATIONAL DEFINITIONS 1. Effectiveness It refers to the efficiency of self instructional module in improving the level of knowledge of bus drivers in early detection and prevention of prostate cancer. 2. Self instructional module Simplified and understandable information material for self education. Or refers to the systematically developed health educational design 3. Knowledge It refers to the level in knowledge on regarding early detection and prevention of prostate cancer among bus driver 4. Early detection . It refers to prevent overt disease or disablement or complications from prostate cancer 5. Prevention Prevention refers to promote health, to preserve health to restore health from the prostate cancer 6. Prostate cancer Its a cancerous disease, in which the prostate grows uncontrollably and invade the near by tissues and other parts of the body. The abnormally grown tissues are called tumors. Prostate cancer is the most common cancer in men over 50 years of age. 7. Bus drivers Drivers are the one who operates the big vehicle to help the passengers to reach their destiny it’s one of the profession where they work uncomfortable situations. [15] 6.6 RESEARCH HYPOTHESIS H1: There will be significant difference between mean pre test and post test knowledge regarding early detection and prevention of prostate cancer. H2: There will be significant association between the pre test knowledge and attitude regarding early detection and prevention of prostate cancer with their selected demographic variables. 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA Data will be collected from bus drivers in bus depot Bannimantap Mysore. 7.2 METHODS OF DATA COLLECTION i. Research design Pre-experimental design ii. VARIABLES a) Dependent variables Bus drivers knowledge regarding early detection and prevention of prostate cancer. b) Independent variables self-instruction module on knowledge regarding early detection and prevention of prostate cancer. c) Demographic variable Demographic variables of bus drivers such as age, religion, education, occupation, income, history of early detection and prevention of prostate cancer in family and previous source of information. iii. Settings The study will be conducted in Bus depot Bannimantap Mysore. iv. Population v. All drivers engaged in active service in bus depot Bannimantap Mysore. [16] vi. Samples vii. The Drivers who fulfil inclusion criteria will considered as a samples and the sample size is 60. viii. Criteria for sample selection. Inclusion criteria. The study includes; 1. Drivers between age group of 45 to 60 years. 2. Drivers engaged in active service 3. Drivers who can able to read Kannada or English. Exclusion criteria The study excludes; 1. Drivers, those who are already having prostate cancer 2. Drivers who are not willing to participate. 3. Drivers , who are not available during data collection. 4. Drivers , who has already sensitized with similar session before. ix. Sampling technique. Non probability convenience sampling technique will be used select samples for the study x. Data collection: A questionnaire will be developed by the investigator or a standardized method will be used, to evaluate the knowledge on early detection and prevention of prostate cancer Method of data collection: a) Administrative approval will be obtained to conduct the study from the KSRTC Management Mysore will be obtained [17] b) A pre-experimental design will be conducted to evaluate the early detection and prevention of prostate cancer Data collection steps: 1. selection of sample as per sample criteria mentioned above 2. Informed written consent will be obtained from the study subjects 3. Administration of data collection tools to the sample will be done personally by the investigator Data analysis plan and presentation: Data will be analyzed using descriptive study and inferential statistics 1. Personal variation of the bus drivers knowledge will be analyzed 2. using frequency distribution and percentage 3. paired ‘t’ test will be used to compare the pre-test and post-test knowledge 4. ‘chi’ square test will be used to analyze the association between the pre-test knowledge and socio-economic variables 7.3 Does the study require any investigation or intervention to be conducted on the Patients or other human or animals? -No 7.2 Has ethical clearance been obtained from your institution? Yes, permission will be obtained from concerned authorities and informed consent will be obtained from samples. The privacy and confidentiality of the data will be maintained. [18] 7.3 LIST OF REFERENCES. 1. http://men.webmd.com/picture of the prostate. 2. Brunner and Siddnarth. text book of medical surgical, 9th edition 2010.(1)1306 3. Moni Abraham Kuriakose FRC’s Prof and director. Dept of surg-oncology, Narayan Hrudayalaya, B’lore. RGUHS Cancer Book CME series-4 may-2010-31p, 4. Dr.Ravindrakumar S Pattar.KIMS Hubli on his Dessertattion topic-2008 5. Dr.K Ramchandra Reddy prof.and Head of the Dept of Epidemiology and Biostatistics.KIDWAI Memorial oncology hospital. Banglore 6. http://dceg.cancer.gov/files/hsing113882006.pdf 7. http://www.aicr.org.uk/prostate FAQsstm? 8. Dr.Chaitrathara. surg-oncologist. Keral state councilfor science Technology and Environment. http://ibnlive.in.com/news/prostate cancer on the risein state/191417.60-115.html. 9. NS Murthy, BS Nandakumar, CN Shalini, NS Shivaraj, MS Gouthamand, S Prithvish RGUHS cancer Book CME series-4 may 2010. 10. C S Ratkal, Prof and Head of the Dept of Nephro-urology, Victoria Hospital. 11. http://online library.wiley.com/doi/10.1002/cncr.23373/full 12. National Cancer Institute. Cancer advances in Focus 13. B.T. Basavanthappa, text-book of Education and Research 2010(319) 14. Solenova LG, Smulevich VB, Dymova EG, Beresneva AD..article in Russian General and oncologic morbidityin Moscow municipal transport drivers. 15. Lüngen M, Rath T, Schwartze D, Büscher G, Bokern E. In convergence tendencies in inpatient oncological care after implementation of diagnosis- related groups in germany. 16. Jack A. Clark, Thomas S. Inui, Rebecca A. Silliman, Barbara G. Bokhour, Steven H. Krasnow, Richard A. Robinson, Monica Spaulding and James A. Talcott 2003 by American Society of Clinical Oncology Patients’ Perceptions of Quality of Life After Treatment for Early Prostate Cancer 17. Sunny L, Yeole BB, Kurkure AP, Hakama M, Shiri R, Mathews S, Shastri NG, Advani SH. Cumulative risk and trends in incidence of prostate cancer in Mumbai, India, [19] 18. Article, Geographic patterns of prostate cancer mortality. Evidence for a protective effect of ultraviolet radiation. Carol L. Hanchette M.A. Gary G. Schwartz Ph.D., M.P.H2,*Volume 70, Issue 12, pages 2861–2869, 15 December 1992. 19. Seidler A, Heiskel H, Bickeböller R, Elsner G. Association between diesel exposure at work and prostate cancer.Available from:www.ncbi.nlm.nih.gov/pubmed/9988091 20. http://onlinelibrary.wiley.com/doi/10.1002/ajim4700060305/abstarct 21. Cancer of the prostate: treatment http://www.ncbi.nlm.nih.gov/pubmed/7816678 and Oncol nursing Nurs implications. Forum. 1994 Oct;21(9):1517-29. 22. World Health Technical report series. Self learning materials and modules for health workers for the development utilisation and education. Technical publications: No6:3_16 23. John Whitelegg. Health of Professional Drivers: Report for Transport & General Workers Union. Eco-Logica Ltd; 1995. 24. Hedberg G, Jacobsson K A, Janlert U, et al. Risk indicators of ischemic heart disease among male professional drivers in Sweden. Scand J Work Environ Health 1993;19:326–33. 25. Rosengren A, Anderson K, Wilhelmsen L. Risk of coronary heart disease in middleaged male bus and tram drivers compared to men in other occupations: a prospective study. Inj J Epidemiol 1991;20: 82–7. 26. Hedberg G, Jacobsson K A, Janlert U, et al. Risk indicators of ischemic heart disease among male professional drivers in Sweden. Scand J Work Environ Health 1993;19:326–33. 27. Backman A-L. Health survey of professional drivers. Scand J Work Environ Health 1983;9:30–5. [20] 9 SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE 11. NAME AND DESIGNATION OF THE GUIDE (IN BLOCK LETTERS) 11.1. 11.2. 11.3. 11.4. GUIDE SIGNATURE CO-GUIDE (IF ANY) SIGNATURE 11.5. HEAD OF THE DEPARTMENT 11.6. SIGNATURE 12. REMARKS OF THE CHAIRMAN AND PRINCIPAL 12.1. SIGNATURE [21]