Professional Documents
Culture Documents
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
2.
3.
M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL
NURSING
4.
27.06.2011
5.
ON
OVARIAN
SYNDROME
ADOLESCENT
KNOWLEDGE
GIRLS
(PCOS)
IN
AMONG
SELECTED
MANGALORE.
6.
REGARDING
POLYCYSTIC
MOTHERS
OF
RURAL AREA
OF
6.1
Introduction
Adolescence is a period having the sense of identity and the sense of intimacy. It is
the transition from childhood to adulthood and so it is not a smooth one. In addition to this
intellectual and emotional upheaval, rapid body growth causes them anxiety and cultural
pressures of todays world add further stress to their uncertainty1. 10 to 20% of the world
population comprises adolescents and their problems have not been fully appreciated and
addressed until recent times2.
Gynaecological problems of adolescents occupy a special space in the spectrum of
gynaecological disorders of all ages. Menstrual abnormalities are the common problems of
adolescents. Menstrual disorders (58.06%) were found to be the commonest gynaecological
problem3.
Polycystic ovarian syndrome (PCOS) is a group of recognizable patterns of
symptoms or abnormalities which requires the presence of two of the following three
conditions. i) Oligo and /or anovolution ii) polycystic ovaries iii) hyperandrogenism 4.
6.2
in 15 women worldwide .It is the most frequent cause of hyperandrogenism and oligoanovulation which have substantial psychological, social and economic consequences.
Immigrant populations from the Indian subcontinent to the UK and Australian women of
aboriginal heritage also have a higher prevalence of PCOS5.
It was first described by Stein and Leventhal in 1935 with significant clinical
implications like menstrual irregularities, hirsutism, infertility, suboptimal obstetrical
outcome and long term complications like impaired glucose tolerance, diabetes mellitus type
2, dyslipidaemia, coronary artery disease and endometrial hyperplasia6.
Studies in first-degree relatives of patients with PCOS shows that 24% of mothers
and 32% of sisters are affected, suggesting a major genetic association. Screening of an
unselected population in the south-western United states showed 4% incidence of PCOS7.
In women of Indian subcontinent, prevalence rates of PCOS are as high as 50% have
been detected. It is responsible for 18% of infertility and 40% of hirsutism cases in a study
conducted at Srinagar. Metabolic syndrome was diagnosed in 46% womens with PCOS in a
study done in Kolkota8. Women diagnosed as having PCOS before pregnancy have an
increased risk of developing gestational diabetes. PCOS is a genetic disorder that each child
has a 50% of inheriting the disorder from a parent who carries the gene9.
Obesity is an important pathogenic factor in the development of hyper-androgenism
in women with PCOS thereby affects ovulation, pregnancy rates and outcomes. Obesity and
PCOS increases the risk for infertility10.
A comprehensive community-based study among 3443 adolescent girls (15-18 years)
done to find out the prevalence of PCOS from 10 schools, Trivandrum. Among them, 339
girls are with the symptoms of PCOS and they were under-nourished (37.6%), normal
weight (51.2%), overweight (8.6%) and obese (2.6%)11. Lack of awareness and lifestyle
changes are considered to be the major factor leading to this phenomena.
A retrospective study done in 58 preadolescent and adolescent girls to study the age
at diagnosis of PCOS and to compare risk factors involved in causing PCOS highlighted that
PCOS may occur at a younger age in girls who develop early pubarche and thelarche.
Therefore, the diagnosis and workup should be considered in young girls with risk factors
suggestive of PCOS12.
PCOS is the most common endocrinologic disorders during adolescence, so there is
always a need to investigate all new relevant data. Early recognition and prompt treatment of
PCOS in adolescents is important to prevent long term complications 13. From all the above
studies the researcher found that mothers of adolescent girls have to obtain adequate
knowledge regarding PCOS because mothers are there with the children around the clock
and are well positioned to be valid reporters about their childs health needs.
As a nurse, the researcher has a pivotal role in creating awareness among mothers of
adolescent girls about how to identify the symptoms and modification to be brought in order
to prevent further complications of PCOS. Hence the researcher felt that learning package
will be an effective teaching strategy to impart knowledge to mothers of adolescent girls
Review of literature
a.
b.
c.
d.
e.
f.
a.
of teaching on home care management of diabetes mellitus among 50 samples selected using
purposive sampling technique. The structured questionnaire used and found that 60% of
participants had inadequate knowledge, 40% of them had moderate knowledge and none of
them had adequate knowledge in the pre-test. In the post-test it is found that 70% of the
participants gained adequate knowledge, 30% had gained moderate knowledge and none of
them had inadequate knowledge. The overall mean and standard deviation increased in posttest (M=30.06, SD=3.45) when compared with pre-test (M=19.30, SD=4.67)14.
b.
prevalence of PCOS in Indian adolescents. 72 girls with oligomenorrhea and hirsutism were
invited for diagnosis of PCOS by Rotterdam criteria. Out of 460 girls, one had
oligo/amenorrhea with clinical hyperandrogenism, 29 had oligomenorrhea with polycystic
ovaries, one had polycystic ovaries with clinical hyperandrogenism and 11 had
oligomenorrhea with polycystic ovaries in the presence of clinical hyperandrogenism. Thus
42 girls satisfied Rotterdam's criteria for PCOS, which increased to 50.46(10.97%) when
imputed data were included. The study draws attention to the issue of early diagnosis of
PCOS in adolescent girls because the prevalence of PCOS in Indian adolescents is 9.13%16
c.
of the PCOS among 657 women of age group of 26-34 years. A questionnaire was used and
the study revealed that patients emotions associated with the diagnosis of PCOS include
frustration (67%), anxiety (16%), sadness (10%), and indifference (2%). Therefore, the
awareness regarding PCOS can be achieved through wide public service announcements or
other structured media exposure, as they would be helpful15
d.
obese and lean PCOS women and their health hazards. The women were diagnosed to have
PCOS by the Rotterdam 2003 criteria. Group A included overweight and obese, Group B
included normal weight and lean and were further divided into two groups according to their
body mass index. The result is found that the prevalence of menstrual irregularities, clinical
hyperandrogenism, endometrial hyperplasia (EH), and type 2 diabetes mellitus was
significantly higher in the obese group, whereas android central obesity was similar in both
groups. The study highlighted that diabetes and EH appears to be more prevalent in the
obese, putting a greater risk of morbid problems at a much younger age than the lean ones 17
e.
to evaluate menstrual irregularities with Pelvic ultrasound and hormonal studies. Patients
were divided in three groups according to ultrasound ovarian volumes: group I (n = 16) both
ovaries <10 cm3; group II (n = 8) one of the ovaries
ovaries
10 cm3. The result showed that Serum levels of LH, LH: FSH ratio, testosterone,
and androstenedione were significantly higher in group III. Positive predictive value of both
ovarian volumes
negative predictive value was 81%, sensitivity was 63%, and specificity was 100%. This
study concluded that in adolescent patients with menstrual disorders, bilateral ovarian
volumes of higher than 10 cm3 are correlated with the diagnosis of PCOS18
f.
an urban hospital with 97 adolescent girls with PCOS and 186 healthy controls. Health
related quality life (HRQL) scores as determine by the child health questionnaire-child self
report form. The study says that adolescents with PCOS experience lower HRQL compared
with healthy adolescents19.
6.4
polycystic ovarian syndrome (PCOS) among mothers of adolescent girls in selected rural
area of Mangalore.
6.5
1.
assess the pre-test knowledge score regarding polycystic ovarian syndrome among
the mothers of adolescent girls using structured questionnaire.
2.
3.
find out the association between the pre-test knowledge scores and selected baseline
variables of mothers.
6.6
Operational definitions
Effectiveness: In this study, effectiveness refers to the extent to which learning package has
achieved the desired effect on increase in the knowledge among the mothers of adolescent
girls as assessed by the structured knowledge questionnaire.
Learning package: The learning package consists of a planned instructional programme on
Assumptions
The study assumes that
mothers of adolescent girls may have the interest to participate in the study
learning package may help the mothers of adolescent girls to improve the knowledge
on polycystic ovarian syndrome.
6.8
Delimitations
The study will be delimited to:
6.9
Hypotheses
The mean post- test knowledge scores of the mothers of adolescent girls regarding
polycystic ovarian syndrome will be significantly higher than the mean pre-test
knowledge scores.
H2:
7.
Source of data
Data will be collected from mothers of adolescent girls in selected rural area of
Mangalore.
7.1.1
Research design
Experimental group
O1:
X:
Learning package
O2:
Post-test knowledge regarding polycystic ovarian syndrome 7 days after the learning
package.
7.1.2
Setting
The study will be conducted at Surathkal, rural area of Mangalore.
7.1.3
Population
In this study, mothers of adolescent girls aged within 11-17 years, residing at selected
7.2
7.2.1
Sampling procedure
For this study, non-probability purposive sampling technique will be used.
7.2.2
Sample size
Sample size for the present study will be 50 mothers of adolescent girls.
7.2.3
7.2.4
7.2.5
Tool 1:
PART I: Baseline pro-forma
PART II: Structured knowledge questionnaire
7.2.6
concerned authority of the particular rural area. The purpose of the study will be explained to
the participants. Informed consent will be obtained from the participants. The pre-test will be
conducted using structured knowledge questionnaire this will be followed by administering
the learning package. The post-test will be conducted using the same structured knowledge
9
7.3
Has ethical consideration been obtained from the institution in case of the
above?
Yes, ethical clearance will be obtained from the ethical committee of the institution.
8.
References
1.
Marlow RD, Redding AB. Textbook of paediatric nursing. 6th ed. New Delhi:
Elsevier; 2002.
2.
Padubidri GV, Daftary NS. Hawkins & Bourne Shaws textbook of gynaecology. 13 th
ed. New Delhi: Elsevier; 2004.
3.
4.
5.
Norman JR, Deiwally D, Legro SR, Hickey ET. Polycystic ovary syndrome. The
Lancet 2007 Aug;370(9588):685-97.
6.
Puri M, Sharma G. Insulin Sensitisers in PCOS. Obs & Gynaec 2004 Mar;9(3):1813.
10
7.
Pteifer MS, Kives S. Polycystic ovary syndrome in the adolescent. Obstet Gynaecol
Clin North Am 2009 Mar;36(1):129-52.
8.
Gagan. Pcos The Hidden epidemic Aug 2009. [online]. Available from:
URL:http://www.whereincity.com/ medical/ topic/ women-health/ articles/ 704.htm.
9.
10.
Sharma N. Obesity: A risk factor for infertility. Obs & Gynae 2001 Sep;6(9):539-43.
11.
12.
13.
14.
15.
16.
Sills SE, Perloe M, Tucker JM, Kaplan RC, Genton GM, Schattman LG. Diagnostic
and
treatment
characteristics
of
polycystic
ovary
syndrome:
descriptive
11
18.
Herter DL, Magathaes AJ, Spritzer MP. Relevance of the determination of ovarian
volume in adolescent girls with menstrual disorders. Journal of Clinical Ultrasound
1996 Jun;24(5):243-8.
19.
Trent ME, Rich M, Austin SB, Gordon CM. Quality of life in adolescent girls with
polycystic ovary syndrome. Arch Pediatr Adolesc Med 2002 Jun;156(6):556-60.
12
9.
10.
11.
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12
12.2 Signature
13.
13.1
13.2
Signature
13