Download Talcum powder

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MS. DURGA LAKSHMI.N
1YEAR M.Sc. (NURSING)
OBSTETRICS AND GYNECOLOGY
YEAR 2012-2014
SRI VENKATESHWARA COLLEGE OF NURSING
NO: 98, MARUTHI INDUSTRIAL ESTATE,
PEENIYA 2ndSTAGE,
BANGALORE-560058.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE KARNATAKA
1
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1
NAME OF THE
CANDIDATE AND
ADDRESS
2
NAME OF THE
INSTITUTION
3
COURSE OF THE
STUDY AND SUBJECT
MS. DURGA LAKSHMI .N
1ST YEAR M.Sc. (N)
SRI VENKATESHWARA COLLEGE
OF
NURSING,
NO.98 MARUTHI INDUSTRIAL
ESTATE,
PEENYA 2ND STAGE,
BANGALORE – 560 058
SRI VENKATESHWARA COLLEGE
OF
NURSING
NO. 98, MARUTHI INDUSTRIAL
ESTATE,
PEENYA2ND STAGE,
BANGALORE- 560 058
1ST YEAR M.Sc. NURSING
OBSTETRICS AND GYNECOLOGY
05-06-2012
4
5
DATE OF ADMISSION
TO THE COURSE
A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED
TEACHING
PROGRAMME
ON
KNOWLEDGE
REGARDING
IMPACT OF USING TALCUM
POWDER ON GENITAL AREA
AMONG WOMEN IN SELECTED
COMMUNITY
AREA
AT
BANGALORE.
TITLE OF THE TOPIC
2
6. BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
“A fit healthy body –that is the best fashion statement”
-JESS C SCOTT
The beauty of women is not in the clothes she wears, the figure that she carries or the
way she combs her hair. True beauty in women is reflected in her sole. Most women just
need certain products that adhere to their own personal make up needs. So in that kit talc
powder also plays an important role.1
Talc is derived from the Persian dialect through Arabic, the word ‘talc’,has its origins in
not just these two distinct languages, but in Greek as well namely talq. It is a moisture
well and helps cut down on friction, making it useful for keeping skin dry and helping to
prevent rashes. It is widely used in cosmetic products such as baby powder,adult body
and facial powders, as well as in a number of other consumer products.2
Normally talcum powder gives the skin a smooth and slick sensation. In rural area people
were using this talcum powder rubbed over the body and it gives odor freshness and
absorbs the perspiration under arms and crotch. It is sprinkled over the hair haven’t time
to wash, it use in between huge chubby legs. It is used to keep body parts dry. It is using
in face for beauty purpose. It also uses the area below neck and back. Women sometimes
use talc powder to avoid chafing between the thighs while wearing skirts.2.
3
Even though talc is useful in many ways it has adverse effect on our body. Talc is toxic.
And women are the large group who uses talc in daily life. Talc particles cause tumors in
human ovaries and lungs. Numerous studies have shown a strong link between frequent
use of talc in the female genital area and ovarian cancer. Talc particles are able to move
through the reproductive system and become imbedded in the lining of the ovary.
Researchers have found talc particles in ovarian tumors and have found that women with
ovarian cancer have used talcum powder in their genital area more frequently than
healthy women.3
Women who are already at a risk of ovarian cancer, due to reason such as the start
of menstruation at an early stage, and history of cancer in the family, are at increased risk
of ovarian cancer with the use of talcum powder. According to the large scale research
studies, the use of talcum powder by women, on genitals causes the minute particles
travel into the ovaries and leads to rapid multiplication of ovarian cells. This is one of the
prime characteristics of cancer. This however depends on exactly how much talcum
powder is being used. When used in excess the risk of ovarian cancer may increase.4
The relation between talcum powder and ovarian cancer has become explored in
the whole part of the world, but it is unexplored in rural part of Bangalore. Women health
is an important indicator for describing the mortality condition progress in health and
overall social and economic well-being of a country.
4
6.2 NEED FOR THE STUDY
Ovarian cancer has emerged as one of the most common malignancies affecting women
in India. The incident rate is increasing drastically; total population of women in the
world is 591,400,000 in that 24% women is having ovarian cancer or high risk. Ovarian
cancer is an important cause of morbidity and mortality, especially middle aged women.
During the year 2002 it is ranked third frequency(4.1%) among all, with an estimated 2,
04,499 new cases occurring in the world at 2005. The standardized incidence rate is
varied from as low as 0.06 per 100,000 women in China, Hong Kong to a high of 16.3
Switzerland.
During the period 2001-2006 the standardized incident rate in India for ovarian cancer
varied from 0.9 to 8.4 per 100,000 people. The total women’s population rate in India is
31, 05742crore in that 14% women increase in ovarian cancer risk of using talcum
powder.
The Surveillance, Epidemiology and End Result (SEER) program of national cancer
institute is available most data through 2008. The American cancer society estimates that
in 2012, about 22,280 new cases of ovarian cancer will be diagnosed and 15,500 women
will die of ovarian cancer in the United State.5
In India the age specific incidence rate for ovarian cancer revealed that the disease
increase from 35years of age reaches peak between the ages 55-64.The trend analysis by
period showed an increasing trend in the incidence rate of ovarian cancer with a mean
annual percentage ranged from 0.7% to 2.4%. During the period 2004-2006 proportion of
ovarian cancer varied from 1.7% to 8.7% of all female all female cancers in various rural
5
population based registries operating under the network of National Cancer Registry
Programme(NCRP) of Indian Council Medical Research.6
The incidence rate is varies for different studies and researches. The mean annual range
in rural area of Bangalore from year 2006-2010 is 0.7 to 3.4% in middle aged women by
using talcum powder on genital area.7
The overall increase in risk, if it exists, is likely to be small. For example, one analysis
combining data from 16 studies published before 2008 found about a 30% increase in
ovarian risk among talc users. The average woman's lifetime risk of ovarian cancer is
about 1.4%, so even with a 30% increase; her lifetime risk would be about 1.8%. Still,
talc is widely used in many products, so it is important to determine if the increased risk
is real. Research in this area continues.8
A New England Case Control Study and National Health Study in 2008 reveal
the use of talcum powder on the genitals and the risk of contracting ovarian cancer. They
are also tried to see how certain genetic factors might affect this risk .In these case over
3000 women were studied, with 1385 of them having ovarian cancer and another 1802
women not having contracted disease. Each year more than 600 women in UK are
diagnosed with ovarian cancer, In USA more than 20, 000 women.9
The most recent research into the link between talcum powder and ovarian cancer has
suggested that using talcum powder in the pelvic area may increase the risk of getting
ovarian cancer. Apparently the tiny particles can travel though the genital area to the
ovaries and cause an inflammation which may cause cancer cell to flourish. The findings
published in the journal cancer epidemiology, apply only talcum powder used around the
6
private parts not on rest of the body 6% of ovarian cancer risk is increasing for those
applying powder every day in private area.10
Numerous studies have shown a strong link between frequent use of talc in the
female genital area and ovarian cancer. Talc particles able to move through the
reproductive system and become embedded in the lining of the ovary. Women with
ovarian cancer have used talcum powder in their genital area more frequently than
healthy women. Day by dayincreasing the risk of ovarian cancer among women, due to
the usage of talcum powder on genital area.11
The researcher had own experience on this specific topic,her neighbor who is at her 40’s
and who didn’t had any family history of any kind of cancers was diagnosed with ovarian
cancer and after the detailed history taking and checkup doctor concluded that the cause
for the ovarian cancer can be due to excessive use of talc powder as she was using talc
powder in large amount. This incident and so many recent studies which showed that talc
powder is cause for ovarian cancer has given the researcher more interest to conduct a
study on impact of using talcum powder on genital area among women.
7
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on knowledge
regarding impact of using talcum powder on genital area among women in selected
community area at Bangalore”.
6.4 OBJECTIVES OF THE STUDY
1. To assess the pretest knowledge regarding impact of using talcum powder on genital
area among women.
2. To assess the posttest knowledge regarding impact of using talcum powder on genital
area among women.
3. To evaluate the effectiveness of structured teaching programme regarding impact of
using talcum powder.
4. To find out the association between the posttest knowledge regarding impact of using
talcum powder on genital area among women with their selected demographic variables.
8
6.5 OPERATIONAL DEFINITIONS
Assess: In this study it refers to measure the knowledge of impact of using talcum
powder on genital area among women.
Effectiveness: In this study it refers to the extent to which the structured teaching
programme on impact of using talcum powder on genital area has achieved the desired
effect in improving the knowledge among women.
Structured teaching programme: In this study it refers to systematically planned
instruction by lectures cum discussion method designed to provide information regarding
impact of using talcum powder on genital area.
Impact: In this study it refers to ill effects or consequences of using talcum powder.
Talcum powder: In this study it refers to softest mineral exist in the earth in a powder
form to use for beauty purpose.
Rural women: It refers the female people who all are living in the rural area attained
reproductive age between15-45.
6.6 ASSUMPTIONS
 It is assumed that the women may possess inadequate knowledge on impact of
using talcum powder on genital area.
 It is assumed that the structured teaching programme may increase the level of
knowledge on impact of using talcum powder on genital area.
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6.7 HYPOTHESES
H1- The mean posttest knowledge scores is significantly higher than the mean pretest
knowledge scores.
H2- There is a significant increase in knowledge regarding impact of using talcum
powder on genital area among women after structured teaching.
H3- There is a significant association between the post knowledge on impact of using
talcum powder on genital area among women and their selected demographic variables.
6.8REVIEW OF LITERATURE
“Good research does not exist in vacuum”. This chapter deals with the literature which is
reviewed and relevant to the present study.
Literature review is a key research in the research process, the task of reviewing involves
the identification selection of critical analysis and reporting of existing information on
topic of interest. The main goal literature review is to develop a strong base to carry out
research scholarly activities in education and to improve knowledge about impact of
using talcum powder among women’s in rural area. Literature review can serve the
number of important function in the research process and they play a critical role for
nurse seeking to develop evidence based practical.
A case control study was conducted on ovarian cancer and talc reveals the opportunities
for genital exposure to talc were assessed in 215 white female with epithelial ovarian
10
cancers and in 215 control women from the matched age, race and residence. Ninety two
(42.8%) cases regularly used talc either as a dusting powder on perineum or on sanitary
napkins compared with 61(28.4%) controls. They are having a high risk for ovarian
cancer. This provides more support for an association between talc and ovarian cancer.12
A study was conducted by Australian National Endometrial Cancer Study (ANECS)
among 1399 women with newly diagnosed histologically confirmed primary endometrial
cancer and 740 control women provided risk factor information via telephone interview.
Results found there is some significant association between use of talc in perineal area
that is 95%is having risk of endometrial cancer .Composite variables combining
frequency and duration of talc use were also associated with risk.13
A case control study was conducted on perineal talc exposure and epithelial
ovarian cancer risk in 22 countries of central California that comprise the reporting area
for 2 regional cancer registries. Telephone interviews were conducted with 256 cases
diagnosed and 1,122 controls frequency matched on age and ethnicity. Questions on
perineal talc included frequency of use, duration of use and specific years when talc was
used. The odds ratio for ever use of talc was 1.37 compared to never users. Talc use and
epithelial ovarian cancer risk was highest in the women with serious invasive tumors.
This study provide a good support for the hypothesis that perineal talc use is associated
with an increased risk of epithelial ovarian cancer.14
A study was conducted about endometrial cancer risk it included 66,028 women with 599
incident cases of invasive endometrial adeno carcinoma diagnosed. A positive association
was observed among women ever use of talcum powder was linked with a 21%increase
in risk of endometrial cancer where as regular use was associated with a 24% increase in
risk. In addiction they observed a borderline increase in risk with increasing frequency of
use. Results shows perineal talcum powder use increases the risk of endometrial cancer
particularly among post- menopausal women.15
11
An experimental study of ovarian cancer was conducted and it shows the ovarian cancer
represents the sixth most commonly diagnosed cancer among women in the world and
cause more death per year than any other cancer of female reproductive system despite
the high incidence and mortality rates. Established risk factors include age, family
history, oral contraceptives, use of talcum powder, hormonal replacement therapy and
other life style factors. This study concluded that there was direct link with talcum
powder and ovarian cancer.16
A case control study was conducted about genital talc exposure and risk of ovarian
cancer, has suggested an increased risk of ovarian cancer in Massachusetts and
Hampshire. It involves 563 women with newly diagnosed epithelial ovarian cancer and
523 control women. This was selected either by random digit dialing or through list of
residence. Use of body powders was assessed through personal interview and exposure
odds ratio for the use of talc in genital hygiene was calculated. The cases were more
likely than controls (45%Vs 36%) to have used talc as a body powder in some manners
and the excess was confined to patients who talc on perineum directly or as a dusting
powder to underwear or sanitary napkins. They concluded there is a significant
association between the use of talc in genital area and risk of epithelial ovarian cancer.17
A Meta analytical study was conducted on examining potential relationship
between talc exposure and ovarian cancer, the concern that use of talc or talc containing
substances in the perineal region of women may subject them an increased risk of ovarian
cancer has become an important issue in the study of ovarian cancer. The epidemiological
studies examining the possibility of this relationship are reviewed and Meta –analysis of
their results are performed. The conclusion reached here in that evidence regarding
cancer associated with talc exposure is equivocal.18
12
A study was conducted on perineal talc exposure and risk of ovarian cancer, the
epidemiological studies and their perspective on the interpretation of the findings
including potential limitation, biases and issues surrounding the plausibility of casual
association. This study was concluded that the range of relative risk estimates from
epidemiology 1.0 to 1.8 is plausible. In addition, clinico-pathological studies are needed
to confirm or deny the reports of talc embedded in human ovarian tissue and reports of
talc migration through the human female reproductive tract.19
A study was conducted on perineal use of talcum powder and risk of ovarian cancer,It is
one of the most common gynecological neoplasms especially in industrialized countries.
The etiology of the disease is not well understood, except that inherited mutations in the
breast cancer genes BRCA-1 and BRCA-2 account for up to 10% of all cases, and breast
feeding reduce the risk. This study concluded that some environmental exposure notably
a increased exposure of talc on genital area have been suspected as ovarian cancer.20
A study was conducted on biological effects of cosmetic talc. This study reveals
two primary issues 1) a weak but not casual association of hygiene use of cosmetic talc
and ovarian cancer and 2) lung cancer. The evidentiary weight of the most significant of
the epidemiological and laboratory studies and their biological significance for human
risk assessment are briefly discussed. Publications describing granulomatous lesions
attributed to talc on surgical gloves and consequences of accidental inhalations infants are
also reviewed. The literature reviewed does provide any convincing that pure cosmetic
talc, when used as intended presents a health risk to the human consumer.21
A case control study was conducted on perineal powder exposure and risk of
ovarian cancer. This study evaluated the risk of epithelial ovarian cancer with genital
exposure to various forms of powder application case included all women aged 20-79
years in three countries of western Washington who are diagnosed 64.3% of eligible
13
cases were interviewed. It is a random digit dialing; overall response among control
women was 68.0%. In that ovarian cancer cases were more likely than controls. After
adjustment for age and other methods of genital powder application, an evaluated relative
risk of ovarian cancer was noted only women with a history of perineal dusting that is
95%. These results offer support for development of ovarian cancer and suggest of
perineal powder exposure.22
A study was conducted on perineal talc use and ovarian cancer risk. A number of
observational studies conducted over the last two decades suggest an association between
use of talc powders on the female perineum and increased risk of ovarian cancer. A
subset of these reports shows a roughly 30-60% increased risk of ovarian cancer
associated with perineal exposure of talc. These scientific approaches include
consideration of the strength of the association, the consistency of the finding across
studies and existence of biological explanation of the observed phenomenon, among
others. When applied to context of a proposed talc and ovarian cancer association, they
concluded that the weak statistical association observed in a number of epidemiological
studies support and a casual association.23
A study was conducted on vaginal exposure to talc and other particulates ply an
important role in ovarian cancer. Of the 539 controls, 280 are hospitalized without overt
cancer, and 259 were chosen from the general population by random digit telephone
dialing. Ninety seven (52%) of the cancer patients habitually used talcum powder on
perineum, compared with 247 (46%) controls.
They concluded that there were
statistically significant trends with increasing frequency or duration of talc use.24
14
6.9 DELIMITATION
 The study is delimitated to women.
 The study is delimitated to 6 weeks.
7.0. MATERIALS AND METHOD
7.1. SOURCE OF DATA
Data will be collected from rural women in selected community area, Bangalore.
7.2. METHOD OF DATA COLLECTION
After obtaining permission from concerned authority a survey will conducted by
investigator to find out the number of women attained reproductive age in between 1545.Informed consentfrom concerned authority and the sample will be obtained by
investigator on the basis of inclusion criteria.
I.
RESEARCH DESIGN
Quasi experimental, one group pre and posttest design.
II.
VARIABLES UNDER STUDY
1. Independent Variable: Structured teaching programme on impact of usingtalcum
powder on genital area.
2. Dependent Variable: Knowledge level of women on impact of using talcum
powder on genital area.
15
3. Demographic variables: age, religion, education, occupation, family income,
marital status,usage of talcum powder, hygiene status, previous source of information
RESEARCH APPROACH
III.
Quantitative evaluative approach.
RESEARCH SETTING
IV.
The study will be conducted in selected community area, Bangalore.
POPULATION
V.
Women attained reproductive age in between 15-45 in selected community area,
Bangalore.
SAMPLE SIZE
VI.
Total sample of the study will consist of 60 rural women in selected community
area,Bangalore.
SAMPLING CRITERIA
VII.
INCLUSION CRITERIA

Thosewho are willing to participate in the
study.
16

Those who are available at the time of data
collection.

Those who are able to read and understand
Kannada or English.
EXCLUSION CRITERIA

Thosewho are not attained reproductive age.

Those who are having chronic illness and
ovarian cancer.
SAMPLE TECHNIQUE
VIII.
Simple random sampling technique.
TOOL FOR DATA
IX.
COLLECTION
Tools for data collection are divided into following categories.
Part 1: It consists of demographic data which gives baseline information regarding
women attained reproductive age such as age, religion, marital status, family
income etc.
Part 2: Self-administered questionnaire to assess knowledge regarding impact of
using talcum powder on genital among women.
17
DATA ANALYSIS METHOD
X.
Descriptive statistics:
To describe demographic variable by percentage, mean, median, mode and
standard deviation.
Inferential statistics:
Paired’t’ test to determine the difference
1.
between pre test and post test knowledge of rural women regarding impact of
using talcum powder on genital area.
2.
Chi square test to determine the association
between the knowledge of women on impact of using talcum powder on genital
area with selected demographic variables.
XI.
PLAN FOR DATA ANALYSIS
The data will be analyzed by means of descriptive statistics and inferential
statistics.
XII.
PROJECTED OUTCOME
Data will be analyzed by means of descriptive and inferential statistics after pretest the
investigator administer information booklet regarding impact of using talcum powder on
genital area among women. Will help to initiate a positive step to preventing the impact
of using talcum powder on genital area.
18
7.3. Does the study require any investigation or intervention to be
conducted on patients or other human or animal?
Yes, only educational intervention helps in to improve the knowledge of rural
women regarding impact of talcum powder.
7.4. Has the ethical clearance been obtained from your institution?
Yes, Ethical clearance obtained from the research committee of Sri Venkateshwara
College Of Nursing, Bangalore.
The informed consent will be obtained from the samples for their willingness to
participate in the study.
19
8. LIST OF REFERENCES
1.
Women and makeup http://www.wisegeek.org/why-do-women-wear
makeup.htm#slideshow.
2.
Talcum powder http://www.wisegeek.org/what-is-talcum-powder.htm.
3. Beauty and womenhttp://www.goodreads.com/quotes/192060-the-beauty-of-a-womanis-not-in-the-clothesices
4. D C.Dutta, Text book off obstetrics included perinatology and infertility, sixth edition
page number 310.
5. National toxicology program, from Wikipedia encyclopedia."Cosmetics and Your
Health - FAQs". Womenshealth.gov. November 2004. http://en.wikipedia.org/wiki/Talc
6.
Ovarian
cancer
national
alliance.http://www.ovariancancer.org/about-ovarian-
cancer/statistics/
7.Myles, “Text Book for Midwives”, Published By Churchill
Livingstone; 14th edition:
762-763.
8. Kolumbia 10 oct2005, Tal and cancer. www. Essential dayspa. Com /forum view
thread php?tid=14153
9.http://www.preventcancer.com/consumers/cosmetics/talc.htm
10.American cancer society
articleshttp://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/talcumpowder- and-cancer
11. National Toxicology Program. "Toxicology and carcinogenesis studies of talc (GAS
No 14807-96-6) in F344/N rats and B6C3F, mice (Inhalation studies) September 1993."
Technical Report Serials
No.421.http://www.preventcancer.com/consumers/cosmetics/talc.htm
20
12.Cramer D W, Welch W R.Ovarian cancer and talc: a case-control study.
1982 Jul 15;50(2):372-6.http://www.ncbi.nlm.nih.gov/pubmed/7083145
13.
ROL-CHICKAGO:
2008.http://bcaction.org/index.php?page=newsletter-42f
http://www.cancer.gov/cancertopics/types/ovarianhttp://www.cancer.org/Cancer/CancerC
ause
14.Mills P K .Perineal talc exposure and epithelial ovarian cancer risk in the Central
Valley of California.2004;112(3):458-64.http://www.ncbi.nlm.nih.gov/pubmed/15382072
15.Karageorgi S, Gates MA.Perineal use of talcum powder and endometrial cancer risk.
Cancer Biomarkers Prev. 2010 May;19(5):1269Epidemiol -75. doi: 10.1158/10559965.EPI-09-1221.http://www.ncbi.nlm.nih.gov/pubmed/20406962
16. Permuth-Wey J, Sellers TA.Epidemiology of ovarian cancer. Methods Mol Biol.
2009; 472:413-37. doi: 10.1007/978-1-60327-4920_20.http://www.ncbi.nlm.nih.gov/pubmed/19107446
17. PubMed Articles.http://www.ncbi.nlm.pmc.articles/PMC.3384556.
18. Gross A J. A meta-analytical approach examining the potential relationship between
talc exposure and ovarian cancer. J Expo Anal Environ Epidemiol. 1995 AprJun;5(2):181-95.http://www.ncbi.nlm.nih.gov/pubmed/7492905
19. Harlow BL. Perineal exposure to talc and ovarian cancer risk. Obstet gynecol 1992;
jul ; 80(1):19-26http://www.ncbi.nlm.nih.gov/pubmed/1603491
20. Langseth H, Hankinson S E. Perineal use of talc and risk of ovarian cancer. J
Epidemiol
Community
Health.
2008
Apr;62(4):358-60.
doi:
10.1136/jech.2006.047894.http://www.ncbi.nlm.nih.gov/pubmed/18339830/
21. Wehner A P.
Biological effects of cosmetic talc. Food Chem Toxicol. 1994
Dec;32(12):1173-84.http://www.ncbi.nlm.nih.gov/pubmed/7813991/
21
22.
Cook
L
S.Perineal powder exposure
and
the
risk
of
ovarian
cancer.1998;148(4);410.http://www.ncbi.nlm.nih.gov/pubmed/9048520
23. Huncharek M, Muscat A .Perineal talc use and ovarian cancer risk: a case study of
scientific standards in environmental epidemiology. Eur j cancer prev. 2011 Nov;20(6):
501-7. doi:
10.1097/CEJ.0b013e3283476242.http://www.ncbi.nlm.nih.gov/pubmed/21712717
24. Whittmore AS, Wu ML,Paffenbarger. Personal and environmental characteristics
related to epithelial ovarian cancer. II. Exposures to talcum powder.2012; 10552;9894http://www.ncbi.nlm.nih.gov/pubmed/3195564
22
9. Signature of the candidate:
10. Remarks of the guide:
1.1 Name and designation of the guide:
1.2 Signature:
1.3 Co-guide:
1.4 Signature:
1.5 Head of the department:
1.6 Signature
12.1 Remarks of the principal:
12.2 signature:
23