RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NIKY MATHEW
I ST YEAR M.SC NURSING
OBSTETRICS AND GYNAECOLOGY
YEAR 2013-2015
CAUVERY COLLEGE OF NURSING,
TERISIAN COLLEGE CIRCLE,
SIDHARTHA LAYOUT,
MYSORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCE BANGLORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE / NIKY MATHEW2 / NAME AND ADDRESS OF THE INSTITUTION / I ST YEAR M.SC NURSING
CAUVERY COLLEGE OF NURSING,
TERISIAN COLLEGE CIRCLE,
SIDHARTHA LAYOUT,
MYSORE.
3 / SUBJECT AND COURSE OF STUDY / MASTER OF SCIENCE IN NURSING- OBSTETRICS AND GYNAECOLOGY
4 / DATE OF ADMISSION TO THE COURSE / 05/07/2013
5 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME REGARDING THE KNOWLEDGE OF POLYCYSTIC OVARIAN DISEASE (PCOD) AND ITS PREVENTION AMONG ARTS COLLEGE STUDENTS IN SELECTED ARTS COLLEGE AT MYSORE
5.1 / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING ON THE KNOWLEDGE OF POLYCYSTIC OVARIAN DISEASE (PCOD) AND ITS PREVENTION AMONG ARTS COLLEGE STUDENTS IN SELECTED ARTS COLLEGE AT MYSORE
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“The past you cannot change, but today is yours. Live it to the fullest of your awakened awareness.”
By: Danielledane
Adolescents and young women make up around 40percent of the population of the India.The behavioral patterns established during these developmental periods help determine young people's current health status and their risk for developing chronic diseases in adulthood. Early adult is a critical transitional period that includes the biological changes of puberty and the need to negotiate key developmental tasks, such as increasing independence and normative experimentation. The leading causes of illness and death among adolescents and young women are largely preventable.Health outcomes for adolescents and early adults are grounded in their social environments and are frequently mediated by their behaviors. 1
Polycystic ovarian disease (PCOD) affects thousands of women in the world and is a common cause of infertility. Androgen excess and insulin resistance are hallmarks of the disorder. Understanding the pathogenesis of PCOD helps understand the breakthroughs in treatments available to practitioners. This review will examine naturopathic treatment options for women with PCOD.
The cause of polycystic ovary disease is still unknown, but there is some evidence that it is an inherited condition. The incidence rates in mothers and sisters of women with PCOD are 24 percent and 32 percent, respectively.
Polycystic ovarian disease (PCOD) has a wide spectrum of consequences in adult girls and thus needed to be treated completely and as soon as possible. Polycystic ovarian disease (PCOD) is more common in adolescent age group where the patients will be suffering from abnormal bleeding as a result of anovulation within one year of menarche. Polycystic ovarian disease (PCOD) may have its origin already in fetal life, but becomes clinically manifest during adolescence with maturation of the hypothalamic-pituitary-ovarian axis.2
The main concern in caring adulthood with PCOD involves irregular menstruation cycles with early adults have difficulty raising issues of menstruation due to fear of disease and often show ignorance related to health services. In adolescent girls possible complications are sterility, obesity, high blood pressure, diabetes, increased risk of endometrial cancer and risk of breast cancer.3
Polycystic ovarian disease (PCOD) is the most common endocrinopathy of reproductive-age women in the world, affecting roughly 30% of this population. It accounts for 75% of women with amenorrhea and 85% of women with androgen excess/hirsute. In 1935, Stein and Leventhal published their report of seven women with unexplained an-ovulation, amenorrhea, hirsutism, obesity, and enlarged polycystic-appearing ovaries. Ovarian wedge resection resulted in two pregnancies and regular cycles in remaining five. Ovarian wedge resection involves removing a section of the tissue that then allows ovulation to occur, although the exact mechanism is unclear. Since then, much has been learned about this disorder in terms of clinical manifestations, etiology, diagnosis, and treatment.4
The most common signs and symptoms that women with PCOD present with include menstrual irregularity, hirsutism, acne, acanthosis nigricans, infertility, obesity, and increased risk of cardiovascular disease. Menstrual irregularity presents as either amenorrhea or oligomenorrhea due to anovulatory cycles. A small percent of women with PCOD, even though they are anovulatory, continue to menstruate regularly. It is estimated that 40% of hirsute women who have normal menses are anovulatory. Hirsutism and acne in women with PCOD are signs of androgen excess and are present in 70% of women with PCOD and 10% of women without PCOD.PCOD is common cause of female infertility due to anovulatory -cycles, and infertility is frequently the initial reason the patient seeks medical advice. Infertility affects 75% of obese women with PCOD.The obesity seen with PCOD is typically characterized by an increase in the waist circumference more than 35 inches as opposed to overall obesity. This type of obesity is associated with insulin resistance, glucose intolerance, and dyslipidemia. Dyslipidemia is common in women with PCOD; up to 70% of PCOD patients in the US have dyslipidemia. Women with PCOD have higher LDL and non-HDL cholesterol regardless of body size, placing them at risk for cardiovascular disease.5
Prevention is better than cure. Polycystic ovarian disease (PCOD) can be prevented in women by early diagnosis and treatment helps in preventing complication. Lifestyle modification, including weight reduction, nutritional plans, exercise, and smoking cessation, is beneficial in managing PCOD patients and is often considered the first line of therapy for the treatment and management of PCOD. Oral contraceptive pills (OCPs) are often employed to control PCOD symptoms such as acne, hirsutism, and irregular menses. Insulin sensitizing agent, metformin has the most effectiveness in PCOD to improve insulin resistance. Clomid or Letroze are the first line of medication used in treatment of infertility in PCOD patients which help in ovulation. Surgery comprises laparoscopic multiple punctures of the cysts with electrocautery or laser. When Medical and Surgical line of treatments has failed assisted reproductive techniques like IUI or In Vitro Fertilization (IVF) is the next options to be considered.6
6.2 NEED FOR THE STUDY
Now a day’s adult girls are unaware about polycystic ovarian disease (PCOD) which is more prevalent. A substantial proportion of the worldwide burden of Polycystic ovarian disease (PCOD) could be prevented through the application of existing knowledge and by implementing programs for control and early detection and treatment is important to prevent long term sequel and to develop a positive attitude and follow healthy life style, as well as public health campaigns promoting physical activity and a healthier dietary intake.7
Polycystic ovary disease (PCOD) is now recognized as a heterogeneous disorder that results in overproduction of androgens, primarily from the ovary, leading to an ovulation and hirsutism and is associated with insulin resistance. Long term sequellae of PCOD include higher risk for diabetes, obesity, metabolic syndrome, endometrial hyperplasia, and anovulatory infertility. Symptoms in the adolescent include oligomenorrhea, hirsutism, acne, and weight gain. Insulin resistance, impaired glucose tolerance, and diabetes have also been demonstrated in adolescents who have PCOD. Treatment should be instituted early to decrease symptoms and long term sequellae of PCOD. Weight loss, oral contraceptives, and antiandrogens are effective in treating the symptoms of this disorder. Insulin-sensitizing medications have been shown to be effective but should be used with caution until larger randomized trials have shown short- and long term benefits and efficacy over traditional therapies in the early adult population.8
Some studies have suggested that the syndrome is inherited as an autosomal dominant genetic trait. Human traits, including the classic genetic diseases, are the product of the interaction of two genes, one received from the father and one from the mother. In dominant disorders, a single copy of the disease gene (received from either the mother or father) will be expressed "dominating" the other normal gene and resulting in the appearance of the disease. The risk of transmitting the disorder from affected parent to offspring is 50 percent for each pregnancy.
Other studies have suggested that some women may have a genetic predisposition to PCOD. A genetic predisposition means that a person may carry a gene for a disease but it may not be expressed unless something in the environment triggers the disease.9
The prevalence reported in earlier studies varies between 2.2% to 26%. These variations are due to difficulties in hormonal evaluation and lack of consensus on diagnostic criteria. For diagnosis of PCOD, ovarian ultrasonography and blood tests have to be done in the follicular phase. This limits large epidemiological studies in the community. Using different criteria, prevalence has been estimated as 4.0%-11.9% in the community from 3 different countries.
The increasing prevalence of obesity among adolescent and young women with PCOD may partly depend on the increasing worldwide epidemic of obesity, although this hypothesis should be supported by long-term prospective epidemiological trials. This may have great relevance in preventive medicine and offer the opportunity to expand our still limited knowledge of the genetic background of the PCOD itself.
Since studies performed in experimental suggest that androgen exposure during intrauterine life may affect a women’s susceptibility to develop PCOD later in life, both retrospective and prospective studies in large cohorts or well-selected groups of women should be undertaken. This topic appears to be a promising way of expanding our knowledge on the natural history of PCOD and may open new strategies to prevent it.10
PCOD is one of the most common causes of anovulation and endocrine infertility in women. Several studies have clearly demonstrated that menstrual abnormalities are more frequent in obese than normal weight women with PCOD.Moreover, there is evidence that a reduced incidence of pregnancy and blunted responsiveness to pharmacological treatments to induce ovulation may be more common in obese women with PCOD.In a prospective study carried out in 158 anovulatory women, the dose of clomiphene required to achieve ovulation was positively correlated with body weight.Both insulin resistance and hyperinsulinaemia, which parallel the increase in body fat, may be responsible for the alteration of both spontaneous and induced ovulation observed in obese women with PCOD.11
Polycystic ovarian disease (PCOD) is one of the most common female endocrine disorders which are one of the leading cause of infertility. Polycystic ovarian disease (PCOD) is a major concern in women in their reproductive age. It affects 105 million women worldwide. In 2002 it was estimated that 2 million women were affected with polycystic ovarian disease (PCOD) in U.S. The highest prevalence and hirsutism rates are seen in United Kingdom, China, New Zealand, South Asian emigrant’s setteeled in England and in women of Asian Indian origin.
In 2008, 40% of U.S women were diagnosed with polycystic ovarian disease (PCOD). In Australia PCOD appears to be the common cause of oligo-ovulatory infertility affecting 20-35% infertile women.
In India, the prevalence of PCOD in adolescence is 9.13 %. India has witnessed about 30% rise in PCOD cases in the last couple of years. This draws attention to the issue of early diagnosis in adolescent girls. In Karnataka, incidence of PCOD among adolescent is estimated to be 11-26%.12
A study was conducted on prevalence of polycystic ovarian disease (PCOD) in India among 136 adolescent girls between 15 and 17 years of age. The study highlights that 36% of adult girls are found to have PCOD due to irregular menses (59.9%), hirsuitism (56.3%), acne (17.8%), obesity (17.3%), polycystic ovaries on ultrasound (47.8%) and clinical hyperandrogenism (56.1%). The study concludes thatscreening for menstrual irregularity, obesity and signs of clinical hyperandrogenism are essential for early diagnosis ofPCODin an effort to improve the reproductive health of adolescent girls.13
A study was conducted on effects of lifestyle management on prevention of Polycystic ovarian disease (PCOD) in obese adolescent girls. A sample of 59 obese girls between age group 12-18 year were included in the study and intervention was a 1 year lifestyle management based on diet, exercise training and behavior therapy. The study result shows that 26 girls had reduced body mass index improved most CRF(cardio respiratory fitness) and decreased their IMT(intimal medial thickness) also testosterone concentrations decreased and SHBG(sex hormone binding globulin) concentration increased significantly in girls with weight loss. The prevalence of amenorrhea and oligomenorrhea decreased in the girls with weight loss. The study concludes that weight loss due to lifestyle management is effective to treat menses irregularities, normalize androgens and improve CRF and IMT in obese adolescent girls with PCOD.14
A video assisted program was conducted in California. This program helped adolescents to get adequate knowledge regarding Polycystic ovarian disease (PCOD) and it provide insight into how PCOD affected adolescents in their reproductive age . The participants were allowed free discussion about this distressing syndrome with the hope of letting others know and it also helps in clear up some misconceptions and pave the way for those who are struggling with this disorder to begin formulate a treatment path that will aid in bringing resolution to their problem.15
The above studies on video assisted teaching on polycystic ovarian disease (PCOD) and its prevention played a main role in supporting knowledge in adolescents where they become more aware related to recent issues of reproductive health and helps in assessing the disorder by early screening in hospital or health centers were they adopt preventive measure before any complication happens. It also helps us to evaluate the knowledge of adult girls before and after computer assisted teaching which suggest that computer assisted teaching is an effective tool in continuing education programme.16
Polycystic ovarian disease (PCOD) has drawn a lot of attention in the recent years being the leading cause of infertility among women. The incidence of PCOD is more among adults suffering from physical and psychological morbidity. Assessing adolescents regarding Polycystic ovarian disease (PCOD) is desirable to understand this upcoming health issue and formulate effective programme to enhance the quality of life of the people. Improving knowledge among adult girls regarding prevention and early detection of Polycystic ovarian disease (PCOD) can go a long way in taming the disease. From the above studies the investigator found adult girls have lack of knowledge regarding PCOD and its prevention at the primary level as they are neglecting taking care of the disease. Hence, the researcher is interested to educate the adult girls regarding polycystic ovarian disease (PCOD) and its prevention through computer assisted teaching.17