RAJIV GANDHI UNIVERSITYOF HEALTH SCIENCE
KARNATAKA, BANGALORE
ANNEXURE I
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1. / NAME AND ADDRESS OF THE CANDIDATE / Ms. SONIA VARGHESE1ST YEAR MSc NURSING
K.N.N. COLLEGE OF NURSING
YELAHANKA, BANGALORE, KARNATAKA
2. / NAME OF THE INSTITUTION / KNN COLLEGE OF NURSING,
CA 23/B, A SECTOR, SATELITE TOWN,
YELAHANKA, BANGALORE-64
3. / COURSE OF STUDY AND SUBJECT / MASTER IN OBSTETRIC AND GYNECOLOGICAL NURSING
4. / DATE OF ADMISSION OF THE STUDY / 15-10-2011
5. / TITLE OF THE STUDY / A STUDY TO ASSESS THE EFECTIVENESS OF COMPUTER ASSISTED TEACHING ON KNOWLEGDE OF POLYCYSTIC OVARIAN SYNDROME (PCOS) AND ITS PREVENTION AMONG ADOLESCENT GIRLS IN SELECTED PU COLLEGES, BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
What we found was that girls are healthy, strong, determined and Confident until they hit adolescence, then, things start to change, and lose some Of that confidence -Kelley Parisi
Adolescence is one of the most fascinating and complex transitions in the life span: a time of accelerated growth and change, second only to infancy; a time of expanding horizons, self-discovery, and emerging independence; a time of metamorphosis from childhood to adulthood.1
God blessed Eve and said: Have many children so that your descendants will live all over the earth.(Genesis1:22). Every good and perfect gift is from above, father of the heavenly lights has blessed women with ovaries to become fruitful ,these ovaries produces ovum which undergo fertilization by its union with sperm to form zygote which results in reproduction.sometimes ovum may become fluid filled ,infected and may cause profound biological, physical, behavioral, and social problems.
As a growing adolescent, problem related to Puberty is the main stress for both girls and boys. In adolescent girls,menstruation is a natural phenomena gifted by god, it starts when a girl attain puberty. Now adays Menstrual disorders (58.06%) are found to be the commonest gynaecological problem in adolescents and are not corrected due to lack of knowledge and awareness of the complications that early menstrual disorders causes.2
Polycystic ovarian syndrome(PCOS) is a complex, heterogenous and one of the most common female endocrine disorder. Polycystic ovarian syndrome(PCOS) occurs when the ovaries don’t make enough hormones for the eggs to mature.Instead of releasing a mature egg during ovulation, some of the follicles in the ovaries turn into fluid-filled sacs called cysts. It affects about 5-10% of the chid bearing age(20-40years) and produces symptoms and is thought to be one of the leading causes of infertility.3
It is estimated that between 22 and 33 per cent of women have polycystic ovaries. The cause of Polycystic ovarian syndrome(PCOS) remains unknown, although both environmental and genetical factors are implicated. It occurs amongst all races and nationalities, and is the most common hormonal disorder among women of reproductive age. The syndrome is characterized by chronic hyperandrogenism, acne and hirsutism, insulin resistance which is often associated with obesity of BMI >30 kg/m2,type II diabetes, high cholesterol levels,male pattern hair loss and anovulation resulting in irregular menstruation, amenorrhea.4
Polycystic ovarian syndrome(PCOS) requires a prompt diagnosis, which requires the presence of two of the following three conditions. i) Oligo and /or anovolution for more than 6 months ii) polycystic ovaries in ultrasound iii)clinical/ biochemical evidence of hyperandrogenism.5
Polycystic ovarian syndrome(PCOS) has a wide spectrum of consequences in adolescent girls and thus needed to be treated completely and as soon as possible. Polycystic ovarian syndrome(PCOS) 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 syndrome(PCOS) may have its origin already in fetal life, but becomes clinically manifest during adolescence with maturation of the hypothalamic-pituitary-ovarian axis.
The main concern in caring adolescent with PCOS involves irregular menstruation cycles with young adolescents have difficuly 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.6
Prevention is better than cure. Polycystic ovarian syndrome(PCOS) can be prevented in adolescents by early diagnosois and treatment helps in preventing complication. Lifestyle modification, including weight reduction, nutritional plans, exercise, and smoking cessation, is beneficial in managing PCOS patients and is often considered the first line of therapy for the treatment and management of PCOS.oral contraceptive pills (OCPs) are often employed to control PCOS symptoms such as acne, hirsutism, and irregular menses. Insulin sensitizing agent, metformin has the most effectiveness in PCOS to improve insulin resistance.Clomid or Letroze are the first line of medication used in treatment of infertility in PCOS patients which help in ovulation.Surgey comprises laproscopic 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) are the next options to be considered.7
Now adays adolescents girls are unaware about Polycystic ovarian syndrome(PCOS) which is more prevalent. A substantial proportion of the worldwide burden of Polycystic ovarian syndrome(PCOS)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.
6.2 NEED FOR THE STUDY
Polycystic ovarian syndrome(PCOS) is 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 ovaries are two to five times larger than normal ovaries.8
Polycystic ovarian syndrome (PCOS) is the 4th gynecological problem of hospital admission. About 15 – 20 % of women in reproductive age group are affected by PCOS. A study conducted to understand the magnitude of Polycystic ovarian syndrome(PCOS) with sample size of 257 volunteers who were examined with ultrasonography showed that 22% were found to have polycystic ovaries. Another population study reported that ultrasound scan showed that appearance of polycystic ovaries were present in 20% of women with normal menstrual cycles, in 26–32% with amenorrhoea, in 87–90% with oligomenorrhoea and in 90–95 % with hirsutism. One more study reported 50% women with recurrent miscarriage had the ultrasound picture of polycystic ovary
Polycystic ovarian syndrome(PCOS) is one of the most common female endocrine disorder.It is one of the leading cause of infertility.Polycystic ovarian syndrome(PCOS) is a major concern in women in their reproductive age.It affects 105 million women world wide. In 2002 it was estimated that 2 million women were affected with Polycystic ovarian syndrome(PCOS) in U.S. The highest prevalence and hirsutism rates are seen in United kingdom, China, New Zealand, south Asian emigrants setteeled in England and in women of Asian Indian origin.9
In 2008, 40% of U.S women were diagnosed with Polycystic ovarian syndrome(PCOS). In Australia PCOS appears to be the common cause of oligo-ovulatory infertility affecting 20-35% infertile women .
A cross sectional study was conducted in 2006 on prevalence of Polycystic ovarian syndrome(PCOS) in Iranian adolescents girls to assess the predominant features of this disorder. The results shows that out of the 1430 girls , 90 girls were diagnosed with Polycystic ovarian syndrome(PCOS) are found to have acne(31.3%), frontal hair loss(3.1%), dyslipidemia(70%), and obesity(45%) and there is a greater chances in adolescent girls for developing gestational diabetes, pre-eclampsia, preterm labor and prenatal mortality. The study highlights that adolescents have early manifestations of PCOS, therefore it is important to provide education about a change in lifestyle and physical activity at schools and universities which might result in a decrease in future adverse outcomes of the syndrome, both at the family and social level.10
In India, the prevalence of PCOS in adolescence is 9.13 %. India has witnessed about 30% rise in pcos cases in the last couple of years. This draws attention to the issue of early diagnosis in adolescent girls. In Karnataka, incidence of PCOS among adolescent is estimated to be 11-26%.11
A study was conducted on prevalence of Polycystic ovarian syndrome(PCOS) in India among 136 adolescent girls between 15 and 17 years of age. The study highlights that 36% of adolescent girls are found to have PCOS 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 ofPCOSin an effort to improve the reproductive health of adolescent girls.12
A study conducted in Bangalore, identified an increasing number of adolescent girls in the city are falling prey to Polycystic ovarian syndrome(PCOS). The study result shows that Incidences of Polycystic ovarian synrome(PCOS) have increased from 5% to20% among adolescent girls over the last five to eight years. Incidence of Polycystic ovarian syndrome(PCOS) is increasing may be because of food habits, lifestyle changes, or rising environmental pollution. It’s the frequent cause of infertility. The study highlights that some Polycystic ovarian syndrome(PCOS) symptoms may be of concern, especially in adolescent girls. Education and support are important in helping young women with the physical and psychological aspects of PCOS.13
A study was conducted on effects of lifestyle management on prevention of Polycystic ovarian syndrome (PCOS) in obese adolescent girls. A sample of 59 obese girls between age group 12-18 yr were included in the study and intervention was a 1 year lifestyle management based on diet, exercise training and behaviour 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 PCOS.14
Polycystic ovarian syndrome is the most common cause of anovulation/oligoovulation among women of reproductive age. A study was conducted to assess adolescent perception and awareness about Polycystic ovarian syndrome(PCOS) by a computer based research. In this study 657 adolescent girls were included .Physicians were the most common provider of PCOS information by questionares which was configured electronically for all study participants, irrespective of age.The results shows that patient had emotional disturbances associated with PCOS such as"frustration" (67%), "anxiety" (16%), "sadness" (10%), and "indifference"(2%). The study highlights that most of the girls had negative emotions with PCOS and these girls approched obstetrician-gynecologist for want of PCOS education. The study concludes that there is a greater need for education among Polycystic ovarian syndrome among adolescent girls.15
A computer assisted program was conducted in california. This program helped adolescents to get adequate knowledge regarding Polycystic ovarian syndrome(PCOS) and it provide insight into how PCOS affected adolescents in their reproductive age. The participants were allowed free discussion about this distressing syndrome with the hope of letting othersknow and it also helps in clear up some misconceptions and pave the way for those who are struggling with this diorder to begin formulate a treatment path that will aid in bringing resolution to their problem.16
The above studies on Computer assisted teaching on Polycystic ovarian syndrome(PCOS) 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 peventive measure before any complication happens. It also helps us to evaluate the knowledge of adolscence before and after computer assisted teaching which suggest that computer assisted teaching is an effective tool in continiuing education programme.
Polycystic ovarian syndrome(PCOS) has drawn a lot of attention in the recent years being the leading cause of infertility among women. The incidence of pcos is more among adolescentssuffering from physical and psychological morbidity.Assessing adolescents regarding Polycystic ovarian syndrome (PCOS) is desirable to understand this upcoming health issue and formulate effective programme to enhance the quality of life of the people. Improving knowledge among adolescents regarding prevention and early detection of Polycystic ovarian syndrome(PCOS) can go a long way in taming the disease. From the above studies the investigator found adolescent girls have lack of knowledge regarding PCOS and its prevention at the primary level as they are neglecting taking care of the disease. Hence, the researcher is interested to educate the adolescent girls regarding Polycystic ovarian syndrome(PCOS) and its prevention through computer assisted teaching.
6.3 REVIEW OF LITERATURE
The Review of Literature is organized as follows:-
Section a.Literature related to Prevalence and Etiology of Polycystic ovarian syndrome(PCOS).
Section b. Literature related to Treatment and Complication of Polycystic ovarian syndrome(PCOS).
Section c. Literature related to Prevention of Polycystic ovarian syndrome(PCOS)
Section d. Literature related to Knowlegde of adolescent girls on Polycystic ovarian syndrome(PCOS)
Section e. Literature related to Computer assisted teaching on Polycystic ovarian syndrome(PCOS) among adolescent girls.
Section:- (a) Literature related to Prevalence and Etiology of polycystic ovarian syndrome(PCOS
A study was conducted on Prevalence of Polycystic ovarian syndrome(PCOS) in Indian adolescents aged 15 to 18 years. Out of which 72 girls with oligomenorrhea and/or hirsutism were invited for biochemical, hormonal, and ultrasonographic evaluation for diagnosis ofPCOSby Rotterdam criteria.The study revealed thatone (0.22%) had oligo/amenorrhea with clinical hyperandrogenism, 29 (6.30%) had oligomenorrhea with polycystic ovaries, one (0.22%) had Polycystic ovaries with clinical hyperandrogenism and 11 (2.39%) had oligomenorrhea with polycystic ovaries in the presence of clinical hyperandrogenism. Thus 42 (9.13%) girls satisfied Rotterdam's criteria forPCOS, which increased to 50.46 (10.97%).The study concludes that there is a need to draws attention to the issue of early diagnosis of Polycystic ovarian syndrome(PCOS) in adolescent girls.17
A study was conducted on prevalence of Polycystic ovarian syndrome and its etiological factor in first degree relativesof patients with Polycystic ovarian syndrome(PCOS). The presence of hirsutism and hyperandrogenemia wasdetermined in the mothers and sisters of the patients with PCOS. The rates of Polycystic ovarian syndrome (PCOS) in mothers and sisters of patients with PCOS were 24% and 32%, respectively, although the risk was higher in untreated premenopausal women. The study highlights that their is involvement of a major genetic component in the disorder.18
Section:- (b) Literature related to Complications and Treatment of Polycystic ovarian syndrome(PCOS)
A Retrospective study was carried out to determine whether maternal Polycystic ovary syndrome (PCOS) is associated with adverse pregnancy outcomes . It includes 516 consecutive Italian women who delivered between January and April 2006 and women with hyperandrogenic features not configuring PCOS (Intermediate group) and non-hyperandrogenic controls were 229 women. The study shows that Gestational diabetes mellitus was significantly more frequent in the PCOS group than in the other group (20% vs. 3.6% and 4%; P<0.01) and Preterm birth was more frequent in the PCOS group than in control group (20% vs. 6.9%; P<0.05). The study concludes that women affected by PCOS carry an increased risk of adverse pregnancy outcomes.19
A study was conducted to determine the early metformin treatment to prevent adolescent Polycystic ovarian syndrome( PCOS) in Italy. A sample of 18 girls between age 15 to 18 yearswere enrolled in the study received 1700mg/day tab for 6 months were evaluated for the effects of metformin treatment on ovulatory function, hirsutism, acne,hormonal patterns and body weight.The study result shows that 6 months after the end of metformin trestment, menstrual cycles continued to be regular and ovulatory with normal BMI. Side effects were slight. The study concludes that metformin can be administered to adolescent girls to improve ovulation and hyperandrogenic symptoms.20
Section:- (c) literature related to Prevention of Polycystic ovarian syndrome(PCOS)
A study was conducted to determine the effects of weight loss on menstrual function in adolescents with Polycystic ovarian syndrome(PCOS) with a hypocaloric low-fat diet with those of a very low carbohydrate diet on body mass index(BMI), waist circumference(WC) and menstrual function in overweight adolescents with PCOS. The result shows that overall weight loss averaged 6.5% and those who lost weight were 3.4 times more likely to have improved menstrual function. The study concludes that weight managementas the first-line treatment in adolescents and shows significant improvement in BMI, WC and menstrual function.21
A study was conducted to evaluate the influence of Dietary management and Physical exercise on ovarian function and metabolic parameters in overwight adolescent girl with Polycystic ovarian syndrome(PCOS). A sample of 57 adolescent girls were supervised by dietician on randomized 4 month trial with three interventions and a long term follow up. The result shows that on average, body mass index was reduced 6% by the dietary management, 3% by the exercise and 5% by the combined interventions.the menstrual pattern significantly improved in 69% and ovulation confirmed in 34%. The study highlights that dietary management and exercise or combination of both are equally effective in improving reproductive function in obese adolescent girls with PCOS.22