RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES by mikesanye

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									     RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
               BANGALORE, KARNATAKA

      PROFORMA FOR REGISTRATION OF SUBJECTS FOR
                    DISSERTATION

                             MS.J.SUDHA
1. NAME OF THE CANDIDATE     GAYATHRI COLLEGE OF NURSING,
   AND ADDRESS               KOTTIGEPALYA
                             BANGALORE


2. NAME OF THE INSTITUTION   GAYATHRI COLLEGE OF NURSING,
                             KOTTIGEPALYA
                             BANGALORE


3. COURSE OF STUDENT AND     FIRST YEAR M.SC NURSING
   SUBJECT                   OBSTETRIC AND GYNAECOLOGICAL
                             NURSING


4. DATE OF ADMISSION TO      05-06-2008
   COURSE

                             A COMPARATIVE STUDY TO ASSESS
                             THE RELATIONSHIP BETWEEN
5. TITLE OF THE TOPIC        MENSTRUAL PAIN AND BODY MASS
                             INDEX (BMI) AMONG ADOLESCENTS
                             IN SELECTED COLLEGE, BANGALORE




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6. BRIEF RESUME OF THE INTENDED WORK: -


 “Women are strong pillars in our society who have proved time and again that they
                   can do anything they put their mind into”

INTRODUCTION: -


       “Women’s natural health is very fragile even if women are strong about it and there are times

when if you extend your body a bit of help it will reward you with health and peace of mind”

       By this quotation we come to know the importance of women’s health. But they have so

many health problems such as breast problems, cystitis, endometritiasis, fat around the middle,

fibroids, heavy periods, hysterectomy, infertility, irregular periods, menopause, miscarriage, no

periods, osteoporosis, ovarian cysts, painful menstruation, premenstrual syndrome, polycystic ovary

syndrome, uterine prolapse, thrush, vaginal infection, weight control.

       Now a days menstrual pain is the one of the common problem among women. Particularly

girls in their teens or early twenties. Usually the pain starts a day or two days before the menstrual

flow and tends to cease after one or two days of menstruation.            It also known as primary

dysmenorrhoea. Women get menstrual pain because the lining of the uterus releases a substance

called prostaglandins. It causes contractions often causes the uterus to go into spasms, which causes

pain, and may even lead to tiredness dizziness and nausea

       Dysmenorrheal is thought to result form excessive production of prostaglandins which causes

painful contraction of the uterus and arteriolar vasospasm. Psychological factors such as anxiety and

tension may also contribute to dysmenorrhoea. As women grow older dysmenorrhoea often decreases

and frequently completely resolves after child birth.

       Dysmenorrhoea or painful menstruation occurs at or a day before the onset of menstruation and

disappears by the end of mensus. Painful menstruation, particularly in the lower abdomen and back


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and usually of a cramping nature, is known as dysmenorrhoea. Dysmenorrhoea is most prevalent in

the first three years after menarche. Although it can arise later in any woman’s reproductive life.

Dysmenorrhoea is classified as primary and secondary.

       Thousands of women within North Americans are over weight. Over weight related illness are

the causes for the number of death with in the continent. In order to look into the ways that weight

may cause severe menstrual pain and cramps. Body Mass Index (BMI) higher than 30kg that is

considered as obese.

       The relationship between prevalence of dysmenorrhoea with sociodemographic factors such as

mean age and parity, lifestyle factors including smoking, alcohol consumption, and stress, physical

factor such as Body Mass Index( BMI ) and health factor such as infertility, obesity, smoking and

alcohol consumption did not show any significant relationship with dysmenorrhoea.

       The irregularity of the menstrual cycle and menstrual pain was reported by 40% of respondents

at an early postmenarcheal age. The risks for irregular menstrual cycles and menstrual pain were BMI

<17.5kg/m2 95% confidence interval. Menstrual irregularity and menstrual pain at an early post

menarcheal age can be considered as an indicator of difficulties in psychosocial adaptability of

managed females.

       Calculation of BMI is achieved by dividing the clients weight in kilograms by height in meter

squared. Weight in kg divided by height2(m2).

       BMI = Weight in kg
             --------------------
            (Height in meter2)

       A body mass index of greater than 25 defines the upper boundaries of healthy weight and

places a client at higher medical risk of respiratory disease, tuberculosis, digestive system and some

cancer. Body mass index maintaining a healthy or ideal body weight requires a balance between the




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expenditure of energy and the intake of nutrients. Generally when energy requirements of a individual

equate with the daily caloric intake, the body weight remains stable.

       Adolescents is a transitional stage of physical and mental human development that occurs

between childhood and adulthood.         This transition involves biological(ie pubertal), social and

psychological changes though the biological or physiological ones are the easiest to measure

objectives.   Historically, puberty has been heavily associated with teenagers and the onset of

adolescent development.     In recent years, however, the start of puberty has seen in increase in

preadolescent and extension beyond the teenage years making adolescent less simple to discern.

6.1. NEED FOR THE STUDY

       Obese individuals often experience distruption of the menstrual cycle, including interruption of

the menstrual cycle, abnormal menstrual flow and increased pain associated with menstrual cycle.

       The prevalence of menstrual irregularity at an early post menarcheal age and various bio

psychosocial factors associated with menstrual irregularity. The irregularity of the menstrual cycle

was reported by 40% respondents at an early postmenarcheal age. The risks for irregular menstrual

cycles were BMI <17.5kg/m2.

The prevalence of menstrual pain in western is relatively high and has been shown to be related to

many factors eg age, menarche age, parity, menstrual cycle regularity, cigarette smoking, dietary

habits. However, less data are available for traditional societies within which here are presumably not

as many potentially disturbing factors that could influence menstrual symptoms. The main factor

related to menstrual pain was the age at which woman first give birth. It is hypothesized that an earlier

start to reproductive life in some way decreased the sensitivity of the uterus to prostaglandins.

       Low fat, vegetarian diet reduces dysmenorrhoea and premenstrual symptoms.               In a cross

design, 33 women followed a low fat vegetarian diet for two menstrual cycles. For two additional

cycles, they followed their customary diet while taking a supplement placebo pill. Dietary intake,



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body weight, pain duration and intensity and premenstrual symptoms were assessed during each study

phase. Near body weight was lower during the diet (66.1-+11.3kg) compared with the supplement

phase (67.9+or – 12kg) to diet phase (2.7+ or – 1.9) days compared with change from base line to

supplement phase 3.6 + or – 1.7 days. Pain intensity fell significantly during the diet phase, compared

with baseline , for the worst, second worst and third worst days and the mean durations of

premenstrual concentration, behavioural change, and water retention symptoms were reduced

significantly compared with the supplement phase. A low fat-vegetarian diet was associated with

reductions in body weight, dysmenorrhoea duration and intensity and premenstrual symptom duration.

Anecdotal reports indicate that a low-fat vegetarian diet might reduce menstrual pain in some

individuals.   The present study tested the hypothesis that a low fat vegetarian diet reduces

dysmenorrhoea and premenstrual symptoms in women with moderate to severe menstrual pain.

        A study investigated the epidemiology of dysmenorrhoea in Japanese women of menstrual age.

Among 823 enrolled participates are range 18-51 years dysmenorrhoea was reported 15.8% during the

one month period. Common associated symptoms included headache, back pain, fatigue,

dysmenorrhoea is significantly associated with younger age and employment status.

        Hirata M, Kumabe K, Inone Y, conducted a study, many female adolescents are suffering from

menstrual pain and their daily activities are often adversely affected. It is therefore, necessary to

clarify what factors are associated with menstrual pain in order to assist in improving their quality of

life.   The prevalence of menstrual pain among the college women was very high, 82.8% , the

frequency being greatest in the underweight group (BMI<19.8). Current trend among young women

is to wish to be thin and the fact that nearly half of Japanese females age 15 to 24 are already lean.

This study suggests that it is very important to take measures to counteract young women’s enthusiasm

for excessive dieting or other approaches to weight loss since this will help reduce their menstrual

pain and improve their quality of life.



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        The American physician found the prevalence of dysmenorrhoea is highest in adolescent

women, with estimates ranging from 20 to 90%. The prevalence of dysmenorrhoea of 90% in women

19 years of age and 67% in women 24 years of age 10% of 24years old reported pain that interfered

with daily function. Most adolescents self medicate with over the counter medicines and few consult a

physician about dysmenorrhoea.

       Sharma P, Malhotra C, Taneja D K, Saha R, conducted a study on the problems related to

menstruation among adolescent girls.       The types and frequency of problems on daily routine.

Dysmenorrhoea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of

premenstrual syndrome. Other related problems were present in 55.1% of study subjects. Daily

routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments,

disturbed sleep and decreased appetite 17.24% had to miss a class and 25% had to abstain from work.

Conclusion stated that screen adolescent girls for menstruation related problems and provide them

with counseling services and relevant information on possible treatment options. Besides, there is a

need to emphasis on designing menstrual health programmes for adolescents.

       Women tend to believe they are best at values BMI between 20 to 22 and men are usually

satisfied with a BMI of 23 to 25. If the BMI is between 17 to 22, life expectancy is longer than

average. It does not need to lose weight. If the BMI is between 23 and 25 are not considered

overweight by most people. But if BMI is 26 or more that is not good.

       Menstrual pain is the most common gynecological complain of women and the main cause of

women missing work, school and other activities. Statistics indicate that over 140 million working

hours are lost annually as a result of dysmenorrhoea.

       Women experience markedly compromised quality of life and inability to function in several

setting. So, the researcher attempts to assess the relationship of BMI with menstrual pain. It will help

to identify the factors and concentrate to improve the quality of life in women.



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       The researcher observed in many colleges that adolescents students are more attracted towards

junk foods as compared to other age groups. In this age, they want to be independent and also want to

experiment something. Some are more physique conscious. As they are the future of country, thus

interest was aroused to assess the prevalence of BMI among adolescents.

       “”Above all, Don’t worry, Be happy. It’s unhealthy to have anxiety over a les-than-perfect

body image. And, if this calculator’s description of your body seems wrong for you, just trust your

own judgment.      A healthy mental attitude is just as important as physical fit and stress and

dysmenorrhoea”.

6.2.REVIEW OF LITERATURE

       The review of literature for the present study is organized under the following.

       Strinic T, Bukovic D, Pavelic L , etal conducted a study to examined the prevalence of

dysmenorrhoea in female adolescents and the influence of anthropological characteristics and life style

factors on menstrual pain. Two hundred and ninety seven girls from several elementary and secondary

schools were interviewed about the presence         of the menstrual pain, their age, height, weight,

menarcheal age, menstrual cycles quality, smoking and sexual activity. The group of dysmenorrheic

adolescents there was infrequent missing activities and bed rest, but missing school was observed in

22% and taking pills for pain was observed in 96% of the subjects, young girls who experienced

menstrual pain are good candidates for a prophylactic therapy, such as hormonal contraception. A

replication of this study is needed for public health services in the future to improve the quality of life

of the dysmenorrheic young women.

       Vanhoff MH, Voorhorst FJ, Kaptein MB etal conducted a cross sectional population based

study; the association between the menstrual pattern in ninth grade school girls and calendar age,

gynaecological age, body mass index and historical parameters was investigated. The study result

stated that gynaecological age was strongly associated with the prevalence of program could have been



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the source of the reduction in premenstrual syndrome of the experimental group of young adolescents

girls.

                Swallen K C, Reither EN, Haas SA etal conducted a study the childhood and adolescent

overweight and obesity have increased substantially in the past 2 decades, raising concerns about the

physical and psychosocial consequences of childhood obesity.         The investigated the association

between obesity and health related problems among adolescents. The study result stated that using a

nationally representative sample found that obesity in adolescence is linked with poor physical quality

of life. However, in the general population adolescents with above normal body mass index did not

report poorer emotional, school or social functioning

         Viner RM, Haines MM, Tahlor SJ etal conducted a study that investigated weight perception,

dieting and emotional well being across the range of body mass index (BMI) in a population based

multi-ethnic sample of early adolescents. The study revealed that the high levels of current dieting for

weight control and inaccurate perception of body mass are common across all ethnic groups.

Interventions to prevent or treat obesity in black or minority ethnicity groups must consider culture

differences in the relationship between body mass self –esteem and psychological distress.

         Montero P, Bernis C, Fernandez V etal, conducted study revealed that using a cross-sectional

sample of 1147 urban adolescents, aged between 14 to 20 years. The variability of some menstrual

cycle indicators was related to weight and the results showed that attempting to lose weight is

significant associated with increased prevalence of menstrual irregularity and menstrual pain. This

finding is independent of body mass index.

         The above studies and literature review have been useful for the researcher in understanding

the depth and need for the proposed study and in getting insight on the study aspects. The review

allows the resources to establish the need of study adopt the research design, develop the tools and

strategies and decide on the pain for data analysis.



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6.3 STATEMENT OF THE PROBLEM

      A COMPARATIVE STUDY TO ASSESS THE RELATIONSHIP BETWEEN

MENSTRUAL PAIN AND BODY MASS INDEX (BMI) AMONG ADOLESCENTS IN

SELECTED COLLEGE, BANGALORE.

6.4.OBJECTIVES OF THE STUDY

  o To assess the menstrual pain and body mass index among adolescents.
  o To compare the relationship between menstrual pain and body mass index among adolescents.

  o To find out the association between menstrual pain and body mass index with selected
      demographic variables of adolescents.

6.5. DELIMINATION

          1. The study is limited to selected college, Bangalore.

          2. The study is limited to adolescents.

          3. The study is limited to 4 weeks.

6.6. HYPOTHESIS

      H1 There will be significant correlation between menstrual pain and body mass index.

6.7 OPERATIONAL DEFINITIONS

     Menstrual Pain: - A painful or difficult menstruation that incapacitate day today activities.

     Body Mass Index: - Body Mass Index maintaining a healthy or ideal body weight requires a

      balance between the expenditure of energy and the intake of nutrients. Generally when energy

      requirements of an individual equate with the daily caloric intake the body weight remains

      stable.

     Adolescent: - Adolescents is the period considered to be a 14-21 years developmental span

      beginning with the onset of pubescence (beginning of sexual maturation).



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7.MATERIAL AND METHODS: -

7.1     Source of Data: - Data will be collected from the adolescents in selected college, Bangalore.

7.2     Method of Data Collection: -

7.2.1   Research Approach: - Comparative survey approach.

7.2.2   Research Design: - Comparative research design

7.2.3   Setting of the study: - The study will be conducted in selected College of Nursing, Bangalore.

7.2.4   Sample size : - 60 adolescent girls

7.2.5   Sampling Techniques: -purpose sampling technique.

7.2.6 SAMPLING CRITERIA

INCLUSION CRITERIA

        1. Adolescence who is having menstrual pain.

        2. Both obese and lean adolescent.

EXCLUSION CRITERIA

        Adolescents who are not having dysmenorrhoea.

7.2.7 Data Collection Tool: -

        The researcher will use structured interview schedule. It consists of structured questionnaire

with demographic variables.

7.2.8 Method of Data Analysis and Presentation: -

        The researchers will use appropriate comparative and inferential statistical analysis to present

analysis in the forms of tables, figures.

Comparative Statistics

        Mean, median, mode and standard deviation.




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Inferential Statistics

      1. Parametric: -

            I. Paired test will be used to evaluate the significant difference between menstrual pain and

               body mass index.

           II. Paired test will be used to evaluate the significant difference between level of menstrual

               pain.

7.3      DOES          THE     STUDY        REQUIRES           ANY       INVESTIGATION              OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN

OR ANIMALS?

YES, The study requires the investigation to measure the BMI among adolescents.

7.4     HAS ETHICAL               CLEARANCE              BEEN     OBTAINED          FROM        YOUR

INSTITUTION?

      1. Permission will be obtained from the research committee of the selected College, Bangalore.

      2. Permission will be obtained from authorities of selected College, Bangalore.

      3. Informed consent will be obtained from subjects who are willing to participate in the study.




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8 LIST OF REFERENCES

  1. Varney’s “Text book of Midwifery” all India publishers and distributor regd, 4th edition, Page

     no. 382-383.

  2. Ladewig, London<olds “Essentials of maternal newborn nursing”, 3rd edition Page no. 44-45.

  3. Donna L Wong, “Maternal child nursing care” Mosby Page no.1105-1106.

  4. DC Dutta, “ Gyaenacological Nursing” New central book Agency(p) Ltd, 6th Edition Page no.

     165-168.

  5. Brunner and suddarths’s “Text book of medical and surgical Nursing” Lippincot, 9th edition

     Page no. 1105-1106.

  6. Joyce M Black, “Medical and surgical nursing” 7th edition volume I Page no. 752-753.

  7. Strinic. T, “Anthropological and clinical characteristics in adolescent women with

     dysmenorrhoea”, pubmed-indexed for medline.

  8. Hirata, M, “Relationship between the frequency of menstrual pain and body weight in female

     adolescents”, Pubmed indexed for medline.

  9. Vanhoff MH, Adolescents with gynaecological age, body mass index and historical

     relationship of menstrual cycle pattern in 14-17 years old parameters.

  10. Pudes JJ, Blun CA, Mueller B, Menstrual cycle symptoms are associated with obesity. Eur J

     Clin Invest 2006 Jan 36(1): page no. 58-64.

  11. Swatten KC, Reither EN, Hass AS, overweight, obesity and health related quality of life among

     adolescents.

  12. Pawlswski B, prevalence of menstrual pain in relation to the reproductive life history of

     women.

  13. Nightingale nursing times volume_3 issue-11th February 2008 page No. 33, 58.




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 14. Montero P, Bernis C, Fernandez V, influence of body mass index and slimming habits on

    menstrual pain and cycle irregularity J Biosoc Sci 1996, July, page No. 315-23.

 15. Montanino G, Montanio Oliva M, menstrual patterns, pain symptoms, body mass index and

    smoking habits in women.1998, 22(2): page No. 132.6

ELECTRONIC MEDIA

 1. www.pubmed.com.

 2. www.medline.co.

 3. www.google.com

 4. www.cinhal.com

 5. www.oxfordjournale.com




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9.    NAME OF THE CANDIDATE : MS. SUDHA J



10.   REMARKS OF GUIDE : GOOD



11.   11.1 NAME AND DESIGNATION OF THE GUIDE

      Mrs. Shenbagalakshmi V, Principal & Prof

      11.2SIGNATURE



      11.3 HEAD OF THE DEPARTMENT :Mrs. Shenbagalakshmi V

      11.4 SIGNATURE

12.

      12.1 NAME OF THE PRINCIPAL : Mrs. Shenbagalakshmi V

      12.2 REMARKS OF THE PRINCIPAL :GOOD



      12.3 SIGN




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