DISSERTATION ON
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN
SYNDROME AMONG THE ADOLESCENT GIRLS IN SELECTED COLLEGE, CHENNAI.”
M.SC. (NURSING) DEGREE EXAMINATION
BRANCH- III OBSTETRICS AND GYNECOLOGICAL NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI - 03.
A dissertation submitted to
THE TAMIL NADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI- 600 032
In partial fulfillment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN
SYNDROME AMONG THE ADOLESCENT GIRLS IN SELECTED COLLEGE, CHENNAI.”
Examination : M.Sc. (Nursing) Degree Examination Examination Month and Year : October 2019
Branch and Course : III- OBSTETRICS AND
GYNECOLOGICAL NURSING
Register No : 301721254
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI-03.
Sd: ____________________ Sd: ___________________
Internal Examiner External Examiner
Date: ___________________ Date: __________________
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY,
CHENNAI- 600 032.
CERTIFICATE
This is to certify that this dissertation titled “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN SYNDROME AMONG THE ADOLESCENT GIRLS IN SELECTED COLLEGE, CHENNAI” is a bonafide work done by Mrs.N.JOTHI, M.Sc.(N), II year student, College of Nursing, Madras Medical College, Chennai-03, submitted to The Tamil Nadu Dr. M.G.R Medical University, Chennai. In partial fulfillment of the university rules and regulations towards the award of degree of MASTER OF SCIENCE IN NURSING, BRANCH III, OBSTETRICS AND GYNECOLOGICAL NURSING, under our guidance and supervision during the academic period from 2017-2019.
Ms.A.Thahira Begum, M.Sc(N)., MBA., M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai -03.
Dr.R.Jayanthi, MD, FRCP(Glasg)., Dean,
Madras Medical College, Chennai -03.
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN
SYNDROME AMONG THE ADOLESCENT GIRLS IN SELECTED COLLEGE, CHENNAI.”
Approved by the Dissertation Committee on 24.07.2018
CLINICAL SPECIALITY GUIDE
Mrs.S.THENMOZHI, M.Sc(N)., _____________
Lecturer in Obstetrics & Gynaecological Nursing, College of Nursing,
Madras Medical College, Chennai -03.
HEAD OF THE DEPARTMENT
Mrs.A.THAHIRA BEGUM, M.Sc(N)., M.B.A., M.Phil., _____________
Principal,
College of Nursing,
Madras Medical College, Chennai-03.
DEAN
DR.R.JAYANTHI, MD., FRCP (Glasg)., ___________
Dean,
Madras Medical College, Chennai-03.
A Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI
In partial fulfillment of the requirement for award of the degree
MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
ACKNOWLEDGEMENT
A major research project like this is never the work of anyone alone. The contribution of many different people, in their different ways, has made this possible. First of all, with all my humility and sincerity, I thank Almighty God for the wisdom and perseverance that he had bestowed upon me during this research work, and indeed, throughout my life.
Next to God,
I express my genuine gratitude to the Institutional Ethics Committee of Madras Medical College for giving me an opportunity to conduct this study.
I also extend my gratitude to our respected Dr.R.Jayanthi, M.D., F.R.C.P(Glasg)., Dean, Madras Medical College, Chennai and the Institutional Ethics Committee for granting me the permission to conduct the study in this esteemed institution.
With deep sense of colossal contemplating, I express my whole hearted gratitude to my esteemed guide, a feat personality Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai for her treasured guidance, moral support and patience, thought provoking suggestions, prudent guidance, valuable support and suggestion, expert opinion and motivational support molded me to make this research study a grand success.
I owe my deepest sense of gratitude to Dr.R.Shankar Shanmugam, M.Sc(N), MBA., Ph.D., Reader, College of Nursing, Madras Medical College, Chennai from his suggestions, timing guidance and support to proceed my study in successful way as well as make my
proceeding steps in an easy way and ample of thanks for the different approaches with artful outcome of my study and hearty thanks for resolving the practical issues while proceeding my data collections.
I wish to express my special and sincere heartful thanks to Former Director Dr.Santhi Gunasingh, MD., DGO., Director of Institute of Obstetrics and Gynecology and Government Hospital for Women and Children granting permission to conduct the study.
My heart felt thanks to Dr.Shobha, MD., DGO., Director, Institute of Obstetrics and Gynecology and Government hospital for Women and Children, Egmore, Chennai-08, for her valuable guidance and validated the content encouragement in making this study a grand success.
I would like to express my deep thanks to Mrs.S.Lilli Puspam, M.Sc(N)., HOD, Department of Obstetrics and Gynecological Nursing, College of Nursing, Madras Medical College, for her highly instructive research mentorship, her hard work, efforts, interest and sincerity to mould this study in successful way, her easy approachability and understanding nature inspired me and she laid strong foundation on research. It is very essential to mention his wisdom; helping nature had made my research a lively and everlasting one.
I am extremely grateful to Mrs.S.Thenmozhi, M.Sc(N)., Lecturer in Obstetrics and Gynecological Nursing, for her encouragement, valuable suggestion, support and advice given in this study.
I am extremely grateful to Mrs.V.Vijayalakshmi, M.Sc(N)., Former Lecturer, in Obstetrics and Gynecological Nursing, College of Nursing, Madras Medical College, for her encouragement, valuable suggestion, support and advice given in the study.
At this time I wish to express my deepest gratitude to Dr.G.Mala, M.Sc(N)., Ph.D., Nursing Tutor, CON, Madras Medical College, Chennai for her support, encouragement and outstanding guidance for me.
I immensely extend my gratitude and thanks to Mr.K.Kannan, M.Sc(N)., M.B.A, Nursing Tutor in Child Health Nursing, College of Nursing, Madras Medical College, for his timely assistance in guidance, motivation, encouragement, valuable suggestion, support and advice given towards the successful completion of this study.
Extent my special thanks to all the faculty members of College of Nursing, Madras Medical College, Chennai -03 for the support and assistance given by them in all possible manners to complete this study.
It’s my duty to convey my thanks to all experts, Dr.G.Manilakshmi, DNB., and Dr.A.Nasrin, MD., DGO., Assistant Professor, Institute of Obstetrics and Gynecology and Government Hospital for Women and Children, Egmore, Chennai, and Dr.Susila., RN, RM, M.Sc(N)., Ph.D., Billroth College of Nursing, Madhuravoyal, Chennai. Mrs.A.I.Chitra, Vice Principal, G.R.T College of Nursing, Thiruthani, who validated the research tool and guided me with valuable suggestions and corrections, constructive judgments while validating the tool.
I render my deep sense of sincere thanks to Dr.T.Mohanashree, M.A., Ph.D., P.G.D.P.R., Principal, Sri Kanyaka Parameswari Arts &
Science College For Women, Parry’s, Chennai, and Joseph Durai, M.A., M.Phil., Ph.D., Principal, Patrician College of Arts and Science, Adyar, Chennai, for have given me the permission to conduct this study in their esteemed institutions and also, for his valuable suggestions and guidance for this study.
I owe my deepest sense of gratitude to Mr.A.Venkatesan, M.Sc.(Statistics)., P.G.D.C.A., Statistician for his suggestion and guidance in statistical analysis.
I thank our librarian Mr.S.Ravi., M.L.I.S, College of Nursing, Madras Medical College for his co-operation and assistance which built the sound knowledge for this study.
I thank Mrs.P.Petchiammal, M.A., B.ED., M.Phil., for editing and providing certificate of English editing.
I thank Mrs.V.Mahadevi, M.A., B.Ed., M.Phil., for editing and providing certificate of Tamil editing.
I have much pleasure of expressing my cordial appreciation and thanks to all the College Students, Sri Kanyaka Parameswari Arts and Science College, Parry’s, Chennai and Patrician College of Arts and Science, Adyar, who participated in the study with interest and cooperation.
My special and deep thanks to My lovable Husband Mr.M.Ramachandran, My daughter M.R.Kasika, my beloved Brother N.Suruliraj, my father Late.N.Nataraj and my mother S.Eswari for their loving support and timely help to complete the study successfully and my whole heart thanks to my family, relatives, colleague and well-wishers for their timely help, support, cooperativeness for my successful completion of my study.
I express my special thanks to my lovable friends K.Dhanalaxshmi, S.Subashree and A.Anantha Jothi for her support and encouragement in my research.
At final note, I extend my thanks to all those who have been directly and indirectly associated with my study at various stages not mentioned in this acknowledgement.
I am deeply obliged to college professors as participants for sacrificing their valuable time and extending their kind cooperation to provide data and in structured teaching programme on knowledge regarding polycystic ovarian syndrome, without them it was not possible for me to complete this study.
I am greatly indebted to all my batch mates and friends who helped me during the course of my study. My hearty thanks as well as gratitude to all dear and near ones for all their love, prayers, care, support and encouragement which gave confidence to achieve the goal.
I extend my heartfelt gratitude to those who have contributed directly or indirectly for the successful completion of this dissertation.
I thank the OMNIPRESENT GOD, for answering my prayers for giving me the strength to plod on during each and every phase of my life.
ABSTRACT
Title: Structured Teaching Programme On Knowledge Regarding Polycystic Ovarian Syndrome Among The Adolescent girls
Polycystic ovarian syndrome is a common health problem caused by an imbalance of reproductive hormones among females. The hormonal imbalance enhance problems in the ovaries. Title: “A study to assess the effectiveness of structured teaching programme on knowledge regarding polycystic ovarian syndrome among the adolescent girls in selected college, Chennai”.
Objectives: To assess the pre test and post test level of knowledge on polycystic ovarian syndrome among study group and control group and to compare the pre test and post test level of knowledge and to associate the demographic variable with post test level of knowledge regarding polycystic ovarian syndrome. Methods and materials: A true experimental design was chosen. Simple random sampling technique used to select the sample as 100 adolescent girls. 30 semi structured questionnaires was used to assess the knowledge level. Results: Effectiveness of the study is point estimate of adequate knowledge level in study group was 76% and adequate knowledge level in control group was 0.00% (P=0.001). Discussion: Sonia Rawat et al (2017) explained structured teaching programme was effective in improving the knowledge of adolescent girls on PCOS (p<0.05). This was supported to my study. So structured teaching programme improved the knowledge level among the adolescent girls.
Conclusion: Statistical significance was calculated by using chi square test and student independent t-test. So enhanced knowledge regarding polycystic ovarian syndrome should be used in developing highly effective educational progrmme in college. Structured teaching programme is safer and more effective intervention in all settings.
Key words: effectiveness, knowledge, adolescent00 girls
LIST OF CONTENTS
CHAPTER CONTENTS PAGE
NO
I INTRODUCTION 1
1.1 Need for the study 8
1.2 Statement of the problem 14
1.3 Objectives of the study 14
1.4 Operational definition 15
1.5 Assumption 16
1.6 Hypotheses 16
1.7 Delimitation 16
1.8 Conceptual framework 16
II REVIEW OF LITERATURE 22
III RESEARCH METHODOLOGY 47
3.1.Research approach 47
3.2.Research design 47
3.3.Research variables 48
3.4.Study setting 48
3.5.Duration of the study 49
3.6.Study population 49
3.7. Sample 50
3.8 .Sample size 50
3.9.Sampling technique 50
3.10. Sampling Criteria 50
3.11. Description of tool 50
CHAPTER CONTENTS PAGE NO
3.12. Content Validity 52
3.13. Reliability of tool 52
3.14 Ethical Consideration 53
3.15. Pilot Study 53
3.16. Data collection procedure 53
3.17. Intervention Protocol 55
3.18. Data analysis 55
IV DATA ANALYSIS AND INTERPRETATION 58
V DISCUSSION 96
VI SUMMARY,CONCLUSION,IMPLICATION,
RECOMMENDATION, LIMITATION 108
6.1 Summary of the study 108
6.2 Implication 111
6.3 Recommendation 113
6.4 Limitation 113
6.5 Conclusion 113
REFERENCE APPENDICES
LIST OF TABLES
TABLE
NO. TITLE
3.2.1 Study design
3.10.1 Description of questionnaires scoring table 3.11.1 Level of knowledge scoring table
3.17 Structured Teaching Programme time duration table 4.1 Demographic profile
4.2 Pre-test level of knowledge score in percentage (study group)
4.2.1 Test score interpretation
4.3 Pre-test level of knowledge score (control group) 4.4 Domainwise pretest percentage of knowledge 4.5 Pre-test level of knowledge (chi square test) 4.6 Domainwise post test percentage of knowledge 4.7 Post-test level of knowledge (chi square test)
4.8 Domainwise comparison of pre test mean knowledge 4.9 Domainwise comparison of post test mean knowledge 4.10 Domainwise comparison of pre-test and post test mean
knowledge (study group)
4.11 Domainwise comparison of pre-test and post test mean knowledge (control group)
4.12 Comparison of pre-test and post test level of knowledge study group and control group (McNemer’s test)
4.13 Domainwise percentage of knowledge gain score
4. 14 Effectiveness of structured teaching programme and generalization of knowledge gain score
4. 15 Association between post test level of knowledge score and demographic variables (study group)
4. 16 Association between post test level of knowledge score and demographic variables (control group)
LIST OF FIGURES
FIGURE
NO TITLE
1.1 Causes of Infertility in India 1.2 Nurses role model
1.3 Conceptual frame work based on Pender’s Health promotion Model
3.1 Description of study design
3.2 Schematic representation of the study 4.1 Age distribution of adolescent girls 4.2 Religion of adolescent girls
4.3 Type of family 4.4 Place of residence
4.5 Education status of family head 4.6 Family monthly income
4.7 Occupation status of family
4.8 Previous information about reproductive health related disease
4.9 Number of adolescent girls in the family
4.10 Family history of reproductive health related disease 4.11 Pre test level of knowledge score
4.12 Post test level of knowledge score
4.13 Standard error compares the adolescent girls pre-test and post test knowledge score
4.14 Pre-test and post test percentage of knowledge score
4.15 Association between adolescent girls post test level of knowledge score and their age
4.16 Association between adolescent girls post test level of knowledge score and place of residence
4.17 Association between adolescent girls post test level of knowledge score and their father’s occupation status
LIST OF APPENDICES
S.NO. TITLE
1. Certificate approval by Institutional Ethics Committee 2. Certificate of content validity by experts
3. Letter seeking permission for conducting the study 4. Certificate for English Editing
5. Certificate for Tamil Editing 6. Informed consent
7. Study tools
8. Lesson plan (English) 9. Lesson plan (Tamil) 10. Photographs
11. Pamphlet for polycystic ovarian syndrome
12. Power point presentation content of polycystic ovarian syndrome
LIST OF ABBREVIATIONS
ABBREVIATION EXPANSION
AGREE Appraizal of Guideling for Research and Evaluation
AUB Abnormal Uterine Bleeding
AGEs Advanced Glycatin end Products ART Assisted Reproduction Techniques
BMI Body Mass Index
CA Cryproterone Acetate
CREI Centre for Research, Education and Innovation
DM Diabetes Mellitus
DSG Desogestrel
DHEA Dehydroepiandrosterone
DUB Disfunctional Uterine Bleeding
FG Femtogram
FSH Follicle Stimulating Hormone GDM Gestational Diabetes Mellitus GnRH Gonadotropine Relising Hormone
GRADE Grading of Recommendations, Assessment, Development and Evaluation
HDL-C High Density lipoprotein
HPO Hypothalamic pituitary ovarian HOMA-IR Homeostatic Model Assessment IVF Invitro Fertilization
LH Luteinising Hormone
LDL-C Low Density Lipoprotein
MS Metabolic Syndrome
ABBREVIATION EXPANSION mTOR Mammalian Target of Rapamycin NASH Nonalcoholic Steato Hepatitis NAFLD Non Alcoholic Fatty Liver Disease
OCC Oral Contraceptives
OHSS Ovarian Hyper Stimulation Syndrome
OH Oral Hydroxyprogesterone
OGTT Oral Gulucose Tolerance Test OCD Obscessive Compulsive Disorder PI3K Phosphatidylinositol 3 kinese
POF Pemature Ovarian Failure
PKB Protein Kinese-B
QUICKI Quantitative Insulin Sensitivity Check Index
RCT Randomized Control Trials
TSH Thyroid Stimulating Hormone
TGs Triglycerides
CHAPTER – I INTRODUCTION
“ Hope is the only thing stronger than fear”
-Proverb The word adolescence comes from latin word adolescere, meaning
‗to grow up‘ is the transtitional stage of physical, psychological, emotional and social development that generally occurs during the period from puberty to legal adulthood. Adolescence is usually associated with the teenage years, but its physical, psychological or cultural expressions may begin earlier and end later. For example, puberty now typically starts during preadolescence, particularly in girls.
The information from various perspectives, including psychology, biology, history, sociology, education and anthropology fields are used for a thorough understanding of adolescence in society. Within all these perspectives, adolescence is viewed as a transitional period between childhood and adulthood, whose cultural purpose is the preparation of children for adult roles. It is one of the period of multiple transitions from living circumstance to another.
There can be different ages at which an individual is considered mature enough for society to entrust them with certain privileges and responsibilities. Such privileges and responsibilities include having finishing certain levels of education, marriage, legal sexual relations, driving a vehicle, serving in the armed forces or on a jury, voting and accountability for upholding the law. Adolescence is usually accompanied by an increased independence allowed by the parents and legal guardians, including less supervision as compared to preadolescence.
In adolescent development, adolescence can be defined biologically, as the physical transition marked by the onset of puberty and the termination of physical growth, cognitively as changes in the ability to think abstractly and multidimensionally, or socially as a period of preparation for adult roles. Major pubertal and biological changes include changes in the sex organs, height, weight and muscle mass as well as major changes in the brain structure and organization.
Primary sex growth of scrotum and testes is followed by the growth of penis. At that time the penis develops, the seminal vesicles, bulbourethral gland and prostate also enlarge and develop. One year after the beginning of accelerated penis growth, the first ejaculation of seminal fluid generally occurs, although this is often determined culturally rather than biologically, since for many boys first ejaculation occurs as a result of masturbation. Boys are generally fertile before they have an adult appearance. In females, changes in the primary sex characteristics involve growth of the vagina, uterus, and other aspects of the reproductive system. Menarche is the beginning of menstruation which is a relatively late development which follows a series of hormonal changes. Generally after menarche a girl is not fully fertile until several years, as regular ovulation follows menarche by about two years. Unlike males, females appear physically mature before they are capable of becoming pregnant.
In males changes in the secondary sex characteristics include every change that is not directly related to sexual reproduction. These changes involve appearance of facial, pubic and body hair, increased development of the sweat glands, deepening of the voice, roughening of the skin around the upper arms and thighs. In females, secondary sex changes involves widening of the hips, enlargement of breasts, development of pubic and underarm hair, widening of the areolae and elevation of the nipples.
Puberty is a period of several years in which rapid physical growth and psychological changes occur, highest development in sexual maturity. The average age of onset of puberty is at 12 for boys and 11 for girls. Every person‘s individual timetable for puberty is influenced primarily by heredity, although environmental factors such as diet and exercise, lack of physical activity also exert some influences. These factors can also contribute to precious and delayed puberty. Some of the most significant parts of pubertal development involve distinctive physiological changes in individual‘s weight, height, body composition, respiratory and circulatory systems. These changes are mostly influenced by hormonal activity. Hormones play vital role, priming the body to behave in a certain way once puberty begins and an active role, referring to changes in hormones during adolescence that trigger behavioral and physical changes.
Puberty is a long process and starts with an abundance in hormone production, and more physical changes will occurs. It is characterized by the appearance and development of secondary sexual characteristics in females development of breasts and large curved and prominent hips and in males a deeper voice and larger adam‘s apple and a strong shift in hormonal balance towards the stage of adult . This is changed by the master gland of pituitary, which secretes a large amount of hormonal agents into the blood, and initiates a chain reaction to occur. The female and male gonads are activated, which puts them into rapid growth and development. The triggered gonads now commence to produce more of the needed chemicals. The ovaries predominantly drop estrogen and the testes primarily release testosterone. These hormone production enhance gradually until sexual maturation is met. So me boys may develop gynecomastia due to sex hormones imbalance, obesity and tissue responsiveness.
During puberty facial hair in males normally appear in a specific order. At the corners of the upper lip the first facial hair appear to grow, typically between fourteen and seventeen years of age . It spreads into of form a moustache over the entire upper lip. This is followed by the appearance of hair on the upper part of the cheeks and the area under the lower lip. Hair eventually spreads into the side s and lower border of the chin and the rest of the lower face to form a full beard. In human biological processes, this specific order may vary among some individuals. Facial hair is often present in late adolescence, around ages seventeen and eighteen, but may not appear until significantly later. 10 years after puberty some men do not develop full facial hair. For another 2- 4 years after puberty facial hair continues to get coarser, darker and thicker.
Ejaculation is the major landmark of puberty for males, which occurs, on average, at age thirteen. For females, menarche is the onset of menstruation, which occurs on average between ages twelve and thirteen. The age of menarche is influenced by heredity, but a girl‘s diet and lifestyle and exercise contributes as well. Regardless of genes, a girl must have a certain proportion of body fat to attain menarche.
Consequently, girls those who have a high fat diet and are not physically active in the beginning. On an average, the girls‘ diet contains not so much fat and activities involve fat reducing exercise.
Girls who experience maturation are in societies in which children are expected to perform physical labor which should begin at later age in adolescent period.
At the time of puberty they can have important psychological and social consequences . The boys who are early maturing are usually taller and stronger than their friends. They have the advantage in capturing the attention of potential partners and in becoming hand - picked for sports. Pubescent boys often tend to have a good body image,
they are more confident, secure and more independent. Late maturing boys can be not so much confident because of poor body image when comparing themselves to already developed friends and peers. However, early puberty is not always positive for boys, in boys early sexual maturation can be accompanied by increased aggressiveness due to the surge of hormones that affect them. Because they look older than their peers, pubescent boys may face increased social pressure to conform to adult norms, Society may view them as more emotionally advanced, despite the fact that their cognitive and social development may lag behind their appearance. Many studies have shown that early maturing boys are more likely to be sexually active and they are more likely to participate in risky behaviors.
In girls, early menarche can sometimes lead to increased self consciousness, through a typical aspect in maturing females. Pubescent girls can become more insecure and dependent because of their bodies developing in advance. Consequently, girls that reach sexual maturation early are more compared with their peers to develop anorexia nervosa (such as eating disorders). Girls might deal with some sexual problems from older boys before they are mentally and emotionally mature. They have earlier sexual experiences and more unwanted pregnancies than late maturing girls. Early maturing girls are more exposed to drug abuse.
BACKGROUD OF THE STUDY
Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones among females. The hormonal imbalance enhance problems in the ovaries. The ovaries make the egg that is released each month as the part of healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation time.
The world level prevalence of PCOS ranges from 5-10% women between 15 to 44 years. During the years the women can have children, have polycystic ovarian syndrome. Most women find out they have PCOS in their 20s and 30 years age of life, when they have problems getting pregnant and see their doctor. But PCOS will happen at any age after puberty. There are no systematic countrywide studies evaluating prevalence of PCOS in India and furthermore, data on prevalence among Indian adolescents is variable (3.0-23%). Around 10.97% of Indian female population is suffering from PCOS. As compared to 6.3% in Srilanka and 2.4% in China. This large variation in the number of patients as compared to other Asian countries may be due to fact that India is the world capital of diabetes and PCOS.
According to a study conducted by Metropolis in India, 25.88% and 18.62%
women are suffering from this disease in eastern and northern parts of the country respectively. Prevalence rate of PCOS in the Asian regions have a range of 2.4-9% in China, Srilanka and India. The South Asian studies revealed that the prevalence has been reported to the range from 13% to 22% and between 4% and 11% in western literature.
Nidhi, R et al (2011) conducted a study in which prevalence of PCOS in Indian adolescence is 9 to 13%. According to a study conducted in U.S, 11 percent women of reproductive age group are affected by polycystic ovarian syndrome , but in adolescents it may be
as high as 50%. In recent years India has witnessed 30 percent rise in incidence of PCOS in young adults due to changes in lifestyle.
Muhd Asraf Gaine et al (2016) conducted a study about the Observation of phenotype variation among Indian women with polycystic ovarian syndrome from Delhi and Srinagar. In this study they assess the phenotypic viability among Indian polycystic ovarian syndrome (PCOS) women. They were evaluated clinically. Hormonal and biochemical parameters of these women were followed in 2 tertiary care institutions located in Delhi and Srinagar. A total of 299 women underwent estimation of T4, TSH, LH, FSH, total testosterone, cortisol, prolactin, 17OH and lipid profile, in addition to post OGTT, C-peptide, glucose and insulin measurements. Among the women with PCOS, mean age, age of menarche, height, serum LH and systolic and diastolic blood pressure were comparable. PCOS women from Delhi had significantly higher basal metabolic rate (BMI) (26.99 ± 5.38 versus 24.77 ± 4.32 kg/m(2), p = 0.01), glucose intolerance (36 versus 10%), insulin resistance as measured by HOMA-IR (4.20 ± 3.39 versus 3.01 ± 2.6; p = 0.006) and QUICKI (0.140±
0.013 versus 0.147 ± 0.015; p = 0.03) while PCOS from Srinagar had higher FG score (12.12 ± 3.91 versus 10.32 ± 2.22; p = 0.01) and serum total testosterone levels (0.65 ± 0.69 versus 0.86 ± 0.41 ng/ml; p = 0.01.
two clear phenotypes, obese hyperinsulinaemic, dysglycemic women from Delhi and lean hyperandrogenic women from Srinagar are more. This is the first repot in north Indian women with polycystic ovarian syndrome (PCOS) showing phenotypic differences in clinical, hormonal and biochemical parameters despite being in the same region.
Havagiray R Chitme (2017) conducted a study, The findings of the study revealed isulin sensitivity and resistance in infertile women with polycystic ovarian syndrome; In this study they says that there is a common misconception that all women with polycystic ovarian syndrome (PCOS) are overweight. However, the mean BMI in women
with PCOS in her study was 24.3 kg/ m2, with the normal weight range, which is in agreement with the literature that describes PCOS among lean women as well. An Indian study proved the presence of abnormal waist circumference and increased waist-to-hip ratio with normal BMI has a very high prevalence of diabetes in the Indian population.
Health care professional role is to educate the adolescent girls about preventive measures of polycystic ovarian syndrome such as maintaining normal body weight, avoid junk food, routine physical exercise, adequate rest and sleep, healthy diet, sufficient intake of water, control of stress and take high quality supplements.
General interventions that helps to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be underlying cause. As PCOS appear to cause significant emotional distress, appropriate support may be useful. Where PCOS is related with overweight or obesity, successful weight loss is one of the most effective method of restoring normal ovulation or menstruation, eventhough most of the women find it very difficult to achieve and sustain weight loss. Normal body weight, body compositions improve the pregnant rate, menstrual regularity, ovulation, hyperandrogenism, insulin resistance, lipids and quality of life to occur with weight loss independent of diet composition.
1.1 NEED FOR THE STUDY
You’ll never change your life until you change something you do daily The secret of your success is found in your daily routine
-Proverb 1 IN 5 WOMEN AFFECTED BY PCOS IN INDIA! BUT FRET NOT, WE HAVE THE SOLUTION:
Nowadays polycystic ovaries are more common, affecting around 20 percentage of women. Polycystic ovaries syndrome (PCOS) is very
common, affecting 5-10 percent of women. The term polycystic ovaries describes ovaries that contain many small cysts (about twice as many as in normal ovaries), usually no bigger than 8 millimeters each situated just below the surface of the ovaries. These cysts are containing follicles that have not developed properly due to hormonal abnormalities.
The study on polycystic ovarian syndrome to observe the trends in PCOS cases in young women in India reveales, that one in 5 women suffer from PCOS problem and East India leads the chart with 1 in 4 women suffering from PCOS. Polycystic ovarian syndrome commonly known as PCOS is a very prevalent reproductive disorder in women and one of the leading cause of infertility among wo men. Polycystic ovary syndrome is the name given to a condition in which women with polycystic ovaries also have one or more additional symptoms. It was first discovered in 1935 by Doctors Stein and Leventhal, so for many years it was known as the Stein- Leventhal syndrome.
Metropolis Health care ltd (2016) conducted a comprehensive pan India study on 27,411 samples of testosterone over a period of 18 months. Out of 27,411 samples, around 4,824, (17.60%) of the females are facing hormonal associated risk with polycystic ovarian syndrome (PCOS).
The increasing trend of polycystic ovarian syndrome is mainly seen in the age group 15 – 30 years. Among the samples tested in East India is found alarming levels of 25.88% women affected by polycystic ovarian syndrome, followed by 18.62%. In North India, which can be largely attributed to lack of awareness among young women and ignorance.
Cheung P.Anthony (2010), According to their study, Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder that affects approximately 5% to 10% of women in the reproductive age (15
- 45) group. Depending on the population being examined; however, prevalence rates as high as 26% have been reported. Obesity has been recognized as an important factor in the pathogenesis of polycystic ovarian syndrome. Estimates of the prevalence of obesity in women with PCOS vary from 35% to 60%
Ehrmann (2005), According to his study Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting about 5 to 10% women of reproductive age group worldwide. It is also estimated to be the major cause of an- ovulatory infertility accounting for about 73%
of cases. Variance in prevalence among population is thought to be dependent on ethnic origin, race and other environmental factors on the phenotype
Rao Venkat (2011), According to a report conducted by the International Institute of Population Sciences, infertility is growing at an alarming pace, especially in the cities. Around 250 million individuals are estimated to be attempting parenthood at any given time, 13 to 19 million couples are likely to be infertile. This study showed that infertility has risen by 50 percent in the country.
British journal of obstetrics and gynecology (2000) A report indicated that up to 40% of women with polycystic ovarian syndrome have either impaired glucose tolerance or type 2 diabetes by age 40. In addition, with Polycystic ovarian syndrome, high levels of insulin stimulate the ovaries to produce large amounts of testosterone (A male hormone), which can possibly prevent ovaries from releasing an egg each month thus causing infertility. High testosterone levels can also cause excessive hair growth male pattern, boldness and acne. In patients with polycystic ovarian syndrome insulin resistance encourages the storage of fat and the production of excessive amounts of testosterone.
The Hindu (2011) The World Health Organization estimates that more than 180 million people worldwide have diabetes. The number is likely to increase double by 2030. China and India have the highest number of diabetes in the world and many are undiagnosed Diabetic tendency affects a woman in her life. In the adolescent period along with obesity it leads to menstrual irregularities and infrequent egg production and ovulation which is called polycystic ovarian syndrome (PCOS). Most of the young girls show insulin resistance with high blood sugar when challenged with glucose over load. These young girls w hen they go for infertility treatment produce less quality eggs. Even high dose of hormones and medicines have poor pregnancy rates.
Polycystic ovaries syndrome is a set of symptoms due to enhanced androgens (male hormones) in females. Polycystic ovarian s yndrome signs and symptoms such as irregular or no menstrual periods, heavy periods, acne, pelvic pain, excess body and facial hair, patches of thick, darker, velvety skin and difficulty in getting pregnant. Associated diseases like type 2 diabetes, obesity, heart disease, mood disorders, obstructive sleep apnea, and endometrial cancers are possible.
PCOS is due to a combined genetic and environmental factors.
Risk factors are lack of physical exercise, obesity, and a history of someone with that condition. Diagnosis is based on 2 of the 3 following findings; high androgen levels, no ovulation, and ovarian cysts. Cyst may be find out by ultrasound. Other diseases that produces similar symptoms include hypothyroidism, adrenal hyperplasia, and high blood levels of prolactin.
PCOS is not curable. Treatment may involve lifestyle changes such as exercise and weight loss. Birth control pills are improving the regulation of menstruation, acne and excess hair growth. Metformin and anti-androgens tablets may also help. Other hair removal techniques and
acne treatments may be used for treatment of PCOS. These efforts to improve the fertility include weight loss. These measures are not effective invitro fertilization (IVF) as used by some one.
Not all the women with PCOS have difficulty in becoming pregnant. For those that do, anovulation or infrequent ovulation is a common cause. Other factors include changed levels of gonadotropins, hyperandrogenemia and hyperinsulinemia. Like women without PCOS, women with PCOS that are ovulating may be infertile due to other causes, such as tubal blockages due to a history of sexually transmitted diseases.
NURSES ROLE
Nurses play a vital role in educating the adolescent girls regarding polycystic ovarian syndrome, its causes, signs and symptoms, diagnosis, management and lifestyle modifications by structured teaching programme on polycystic ovarian syndrome.
CARE PROVIDER
As a care provider, the nurse helps the adolescent girls regain health through the healing process. The nurse addresses the holistic care needs of adolescent girls, including measures to restore emotional, spiritual and social wellbeing. The care giver helps the adolescent girls and families, sets the goals and meets those goals with a minimal cost of time and energy.
ADVOCATE
In the role of advocate, the nurse protects the client‘s human and legal rights and provides assistance in asserting those rights, if the need arises. The nurse advocates for the adolescent girls, keeping in mind their religion and culture.
EDUCATOR
As an educator, the nurse explains the adolescent girls concepts and facts about health, demonstrates the procedures such as self care activities, determines that the adolescent girls fully understands , reinforces learning or behavior and evaluates the girls progress in learning. Teaching activities can be planned in a more formal way such as when the nurse teaches about polycystic ovarian syndrome. The nurse uses teaching methods that match the adolescent girls capabilities and needs and incorporates other resources, such as the family, in teaching plans.
LEADER
A nurse leader manages adolescent girls care and delivery of special care such as create awareness about polycystic ovarian syndrome.
COLLABORATOR
As a collaborator the nurse collaborates the services of all groups contributing to the care of adolescent girls and their family and society.
RESEARCHER
A nurse researcher investigates problems of polycystic ovarian syndrome to improve nursing care and to further define and expand the scope of nursing practice.
Nurse researcher has selected this study because even today the adolescent girls are less aware about polycystic ovarian syndrome and consequently leads to infertility. Hence the nurse researcher felt the need to identify the learning needs of adolescent girls, a future mothers and educating them regarding polycystic ovarian syndrome through structured teaching programme among adolescent girls at Arts and Science college, Chennai.
1.2 STATEMENT OF THE PROBLEM
―A study to assess the effectiveness of structured teaching programme on knowledge regarding polycystic ovarian syndrome among the adolescent girls in selected college, Chennai.‖
1.3 OBJECTIVES OF THE STUDY
To assess the pre-test level of knowledge regarding polycystic ovarian syndrome among study group and control group.
To assess the post-test level of knowledge regarding polycystic ovarian syndrome among study group and control group.
To compare the pretest and post-test level of knowledge regarding polycystic ovarian syndrome among study group and control group.
To associate demographic variable with post-test level of knowledge regarding polycystic ovarian syndrome .
1.4 OPERATIONAL DEFINITIONS
EffectivenessIn this study effectiveness refers to the extent to which the structured teaching Programme on polycystic ovarian syndrome as achieved the desired effect in improving the knowledge of adolescent girls as evident from gain in knowledge score.
Structured teaching programme
Systemically organized teaching strategies for adolescent girls includes,
Anatomy and physiology of uterus
Causes/ at risk factors of polycystic ovarian syndrome
Signs and symptoms of polycystic ovarian syndrome
Diagnosis of polycystic ovarian syndrome
Management of polycystic ovarian syndrome
Complications of polycystic ovarian syndrome
Lifestyle modifications of polycystic ovarian syndrome Knowledge
It is the correct response by the adolescent girls regarding polycystic ovarian syndrome which is measured by the questionnaire.
Polycystic ovarian syndrome
Polycystic ovarian syndrome is a condition in women characterized by irregular or no menstrual periods, acne, obesity and excess hair growth.
Adolescent girls
Girls aged between 13-19 years of age.
1.5 ASSUMPTIONS
The adolescent girls may have inadequate knowledge regarding polycystic ovarian syndrome
Structured teaching programme provides an opportunity for learning and better understanding regarding polycystic ovarian syndrome
1.6 RESEARCH HYPOTHESES
H1 There will be significant difference between pre test and post test level of knowledge scores of the adolescent girls regarding polycystic ovarian syndrome
H2 There will be significant association between post test level of knowledge with selected socio demographic variables.
1.7 DELIMITATION
Limited to 4 weeks
This study will be conducted on adolescent girls aged between 13-19 years.
1.8 CONCEPTUAL FRAMEWORK
A frame work is a brief explanation of a theory or those portions of a theory to be tested in a quantitative study. A conceptual framework
is an analogous to the frame of a house. Just as the foundation supports a house, a theoretical frame work that provides a rationale for predictions about the relationships among variables of a research study.
Conceptualization refers as the process of forming ideas, designs and plan. Conceptual framework refers to the process of referring general or abstract ideas which are formulated by generalizing from particular manifestation of certain behavior or character. These abstracts are referred to as concepts. The purpose of conceptual framework is to organize concepts that represent essential knowledge that might be used by many disciplines.
Conceptual framework of the present study is founded on the Revised health Promotional Model (Pender 19196) by Nola J. Pender.
Health Promotional Model encompasses behaviors for enhancing health and potentially applies across the life span (Pender, 1996; Pender et al, 2002). The Health promotional Model has been used extensively as a framework for research aimed at predicting health promoting lifestyle as well as specific behaviors. Major concepts of health Promotional Model are-
Individual characteristics and experiences
Behavior specific cognitions and affect
Behavioral outcomes
The main Individual characteristics and experiences that affect subsequent health actions of the adolescent girls to gain knowledge regarding polycystic ovarian syndrome.
Prior related behavior – refers to frequency of the same or similar behavior in the past. Direct and indirect effects on the likelihood of engaging in the health-promoting behavior. In the
present study prior related behavior is the previous knowledge of the adolescent girls regarding polycystic ovarian syndrome (Anatomy and Physiology of uterus, meaning, causes, signs and symptoms, diagnosis, treatment, complications, lifestyle modifications PCOS.
Personal factors – are characterized as biological psychological and socio-cultural. Personal biological factors – These factors are variables such as age,
Personal psychological factors – These factors are variables such as self-esteem, self motivation, personal competence, perceived health status and definition of health. Present study does not considered any personal psychological factors.
Socio-cultural factors- include variables such as race, ethnicity, acculturation, education and socioeconomic status. In this study the main socio-cultural factors under consideration are type of family, resident of the student, educational status of the family head, family monthly income, father‘s occupation, information on polycystic ovarian syndrome, number of adolescent girls in the family, family history of reproductive health related disease.
The main Behavioral – Specific Cognitions and affect are as follows:
Perceived Benefits of action – refer to the anticipated positive outcomes that will occur from health behavior. Perceived benefit of action in this present study was that adolescent girls can reduce the consequences occurrence of polycystic ovarian syndrome.
Perceived barriers to action- are anticipated, imagined or real block and personal costs of undertaking a given behavior. In this study the perceived barriers are those that prevents from taking health actions.
Perceived self-efficacy- perceived self efficacy is the judgement of personal capability to organize and execute a health promoting behavior. In the present study perceived self-efficacy is to understand what is polycystic ovarian syndrome, prevalence, causes, signs and symptoms, treatment, complications and lifestyle modifications.
Activity related affect- the subjective feelings that occur before, during and following an activity can influence whether a person will repeat the behavior again or maintain the behavior. In this study, lack of knowledge regarding polycystic ovarian syndrome. During structured teaching programme asking doubts and clarifying regarding PCOS. After intervention is to increase knowledge and self confidence.
Interpersonal behavior- are cognitions concerning behaviors, beliefs or attitudes of others. Primary sources of interpersonal influ ences are peer groups, families and health care providers.
Situational influences- situational influences are personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. They include perceptions of option available, demand characteristics and asthetic features of the environment in which given health promoting behavior is proposed to take place. In this study the lack of knowledge regarding PCOS is considered.
The immediate antecedents of Behavioral outcomes are as follows:
1) Commitment to a plan of action- Describes the concept of intention and identification of a planned strategy that leads to implementation of health behavior. In this study the commitment to a plan of action is the active participation of adolescent girls in the structured teaching programme and gain of knowledge regarding PCOS, and the planned strategy that leads to positive health behavior.
2) Health promotion behavior- a health promoting behavior is an end point or action outcome directed toward attaining positive health outcomes such as optimal well being, personal fulfillment and
3) Productive living- in this study health promoting behavior understands the prevention and reducing health related issues about polycystic ovarian syndrome such as maintain normal body weight, increase water intake, high rich fiber and green leafy vegetables and fruits, low carbohydrate diet and exercise etc.
4) Immediate competing demands and preferences- competing demands are those behaviors over which an individual has a low level of control. Here it is competing preferences behaviors over which an individual has a high level of control; however , this control depends on the individual‘s ability to be self regulating. In here the knowledge level of adolescent girls to prevent and reduce the health related issues about PCOS
CONCEPTUAL FRAMEWORK BASED ON MODIFIED PENDERS HEALTH PROMOTION MODEL Behavioral Characteristics Behavioral Specific Cognition And Affect Behavioral Outcome
PRIOR RELATED BEHAVIOR:
Previous knowledge such as ,Anatomy &
physiology of uterus, Meaning, Causes, Signs & symptoms, Diagnosis, Treatment,
complications, Lifestyle modifications
of PCOS
DEMOGRAPHIC VARIABLES:
Age, Religion, Type of family, Resident of student, Educational
status of the family head, Family monthly
income, Father‘s occupation, Information on reproductive health disorder, Number of adolescent girls in the family, Family history
of disease.
S T U D Y A N D C O N T R O L G R O U P
ASSESSMENT{{[ OF PRETEST LEVEL OF KNOWLEDGE
PERCEIVED BENEFITS OF ACTION Adolescent Girls participated in STP they
gain knowledge on PCOS.
PERCEIVED BARRIERS TO ACTION Inadequate knowledge, not interested, unwilling, not knowing the consequences
of PCOS.
ACTIVITY RELATED AFFECT After STP adolescent girls will gain
adequate knowledge on PCOS.
PERCEIVED SELF EFFICACY Adolescent girls may have previous
experiences about PCOS INTERPERSONAL INFLUENCES
Education, life style modification, socioeconomic state of adolescent girls
may influence in reduce the consequences of PCOS.
SITUATIONAL INFLUENCES lack of physical activity, nonnutritive diet,
hormonal imbalance, stressful life and environment, heredity influence the
occurrence of PCOS.
Immediate Competing Demands And Preferances:
Demands: Lack of knowledge Preferance: Reduce the
consequences of PCOS
Commitment To Plan Of Action: STP regarding PCOS
Routine Activities
Feedback
Inadequate Response
Health Promotion Behavior Adolescent girls participated in the study will gain
adequate knowledge on
PCOS.
S t u d y
Co nt ro l
CHAPTER – II
REVIEW OF LITERATURE
Review of literature is defined as broad, comprehensive in depth systematic and critical review of scholarly publications unpublished scholarly print materials, audiovisual materials and personal communications. Review of literature is a key step in research process.
Review of literature refers to an extensive, exhaustive and systemic examination of publications relevant to research project.
Hence the review of literature done behind the study is organized under the following heading.
Prevalence of polycystic ovarian syndrome
Causes/ At risk factors of polycystic ovarian syndrome
Signs and symptoms of polycystic ovarian syndrome
Diagnosis of polycystic ovarian syndrome
Treatment of polycystic ovarian syndrome
Management of polycystic ovarian syndrome
Complications of polycystic ovarian syndrome
Lifestyle modifications of polycystic ovarian syndrome
Knowledge of polycystic ovarian syndrome
STUDIES REATED TO PREVALENCE OF POLYCYSTIC OVARIAN SYNDROME:
Abruzzese GA, Motta AB (2015) conducted a study on
―Nonalcoholic fatty liver disease in children and adolescents - Relationship with polycystic ovary syndrome.‖ Nonalcoholic fatty liver
disease (NAFLD) is the accumulation of triglycerides (TGs) within hepatocytes exceeding 5% of liver weight. NAFLD is a pathological processes from nonalcoholic fatty liver or simple steatosis to nonalcoholic steatohepatitis (NASH), cirrhosis, hepatocellular carcinoma and fibrosis. As NAFLD induces metabolic syndrome (MS), then NAFD is associated with type 2 diabetes mellitus, insulin resistance, polycystic ovarian syndrome and hypertension. The present review aims to discuss recent findings of NAFLD in children and adolescents and considering the features in common with PCOS.
Abu Hasim H (2016) conducted a study on, ―Twenty years of ovulation induction with metformin for PCOS; what is the best available evidence?‖ The reproductive benefits of metformin, a drug provide ameliorate insulin resistance in polycystic ovarian syndrome. In this review, randomized controlled trials (RCT) and meta- analysis of RCT comparing metformin are critically appraised and summarized. Evidence is insufficient to favour the use of metformin plus clomifene citrate, metformin or instead of clomifene citrate for ovulation induction in women with newely diagnosed polycystic ovarian syndrome. Evidence is also inadequate to recommend metformin as a primary treatment for non- obese women with polycystic ovarian syndrome. A beneficial effect of metformin co- treatment in increasing clinical pregnancy rates and reducing the risk of ovulation hyper stimulation syndrome in PCOS women undergoing assisted reproduction techniques (ART). There is no evidence was found of less risk of spontaneous abortion or enhanced risk of major anomalies in women with polycystic ovarian syndrome taking metformin during the first trimester.
Al Khalifah RA, Florenz et al (2016) a study conducted on
―Metformin or oral contraceptives for adolescents with polycystic ovarian syndrome.‖ Polycystic ovarian syndrome (PCOS) is a common endocrine disease in females. The limited evidence to support various
treatment choices. This leads to various types of treatment practices. In this study they were used randomized control trial design to evaluate the use of metformin versus oral contraceptive pills for the treatment of polycystic ovarian syndrome in adolescents aged 11 to 19 years. Overall treatment resulted in modest improvement in menstrual cycle frequency weighted mean difference (WMD) = 0.27, P < .01, 95% confidence interval (CI) – 0.33 to – 0.21) and mild reduction of acne scores (WMD
= 0.3, p = .02, 95% CI 0.05 to 0.55). Current evidence is derived from very low to quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing more side effects. So they suggest that future high quality RCTs are needed for the treatment of adolescents with PCOS.
Wolf WM, Wattick RA, et al (2018) conducted a study on ― Geographical prevalence of polycystic ovary syndrome as determined by region and race / ethnicity‖. In polycystic ovarian syndrome common symptoms are irregular menstrual cycle, hirsutism and polycystic ovaries as well as an increased risk for a multitude of conditions, like dyslipidemia, insulin resistance, and infertility. The prevalence of PCOS is generally thought to be between 3% and 10% but it is widely unknown for specific subpopulations based on geographical location.
Based on high degree of variability and inconsistencies between the diagnostic criteria, the challenge that exists when determining the prevalence of PCOS. There are a large percent of individuals that remain undiagnosed even after visiting multiple health care workers. They are suggest that most of the studies conducted across the world are small sample size, selection bias and lack of comparability across studies.
Few number of studies that have examined the prevalence of polycystic ovary syndrome across the united states. Based on the National Institutes of Health (NIH)‘s diagnostic criteria, there is a similar prevalence of PCOS documented across the united states, the united
Kingdom, Greece, , Australia Spain and Mexico. Some other studies have shown some differences between geographical location and race.
The existing data is not conclusive enough to determine whether or not there is no significant differences in the prevalence of PCOS across geographical location, racial or ethnic groups. This review will seek to determine the prevalence of polycystic ovarian syndrome based on geographical location and race/ethnicity.
Brutocao C, Zaiem F, et al (2018) conducted a study on ― Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis‖. Previous studies suggest that polycystic ovary syndrome can be related with mood and psychiatric disorders. The aim of this study is to check the prevalence of any psychiatric illness in women with polycystic ovary syndrome. In this study random effects model was used to generate pooled estimates and 95% confidence intervals. In this study they included 57 studies reporting on 1,72,040 women. The most of the studies reported depression and anxiety. Women with PCOS were more likely to have a clinical diagnosis of depression (odds ratio (OR), 2.79; 95% CI, 1.43- 2.23-3.50), anxiety (OR, 2.75; 95% CI 1.22-1.55), but not social phobia or panic disorder. They are using various scales, the severity of symptoms of depression, obsessive compulsive disorder anxiety, and somatization disorders were higher compared to women without polycystic ovary syndrome. PCOS is associated with an enhanced risk of diagnosis of depression, anxiety, obsessive compulsive disorder and bipolar disorder. It is associated with worse symptoms of depression, anxiety, somatization and OCD. Screening for these disorders to allow early intervention may be warranted.
STUDIES RELATED TO CAUSES / AT RISK FACTORS OF POLYCYSTIC OVARIAN SYNDROME:
Broughton DE, Moley KH (2017) conducted a study on ― Obesity and female infertility; potential mediators of impact.‖ The worldwide upward trend in obesity has been dramatic, now affecting > 20% of American women of reproductive age. Obesity is related with many harmful maternal and fetal effects prenatally, but it also provide a negative impact on female fertility. Women with obesity are mostly affected by ovulatory dysfunction due to dysregulation of the hypothalamic-pituitory-ovarian axis. Women with PCOS those who are also obese demonstrate a severe metabolic and reproductive disorders.
Obese women have reduced fecundity even when eumenorrheic and demonstrate poorer outcomes in vitro fertilization treatment. Obesity appears to affect the oocyte and the embryo of preimplantation with disrupted meiotic spindle formation and mitochondrial dynamics.
Surplus free fatty acids may have a harmful effect in reproductive tissues, leading to cellular damage and a low grade inflammatory response. Changes in levels of adepokines, like leptin, in the obese can affect steroidogenesis and mostly affect the developing embryo. The endometrium is susceptible, with evidence of inadequate stromal decidualization in obese women. This may explain subfecundity due to impaired receptivity and may lead to placental abnormalitie s as manifested by increased rates of abortion, stillbirth and preeclampsia in the obese women. Majority of interventions have been explored to mitigate the effect of obesity on infertility, including physical activity, weight loss, dietary factors and bariatric surgery. These data are largely mixed with few high quality studies to guide us. Through this study they suggest that improve our understanding of the pathophysiology of obesity in human reproduction hope to identify novel treatment strategies.
