RAJIV GANDHI UNIVERSYITY OF HEALTH SCIENCE, KARNATAKA,
BANGALORE.
A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE REGARDING MENSTRUAL
BLOOD BANK AMONG GRADUATE STUDENTS
IN SELECTED COLLEGE
AT KOLAR.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
NAME : Mrs.JANAKI
A E C S PAVAN COLLEGE OF NURSING,
KOLAR-563101
RAJIV GANDHI UNIVERSYITY OF HEALTH SCIENCE, KARNATAKA,
BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
SL NONAME OF THE CANDIDATE AND ADDRESS / Mrs.JANAKI
PAVAN COLLEGE OF NURSING
NAME OF THE INSTITUTION / PAVAN COLLEGE OF NURSING,
KOLAR-563101
COURSE OF THE STUDY AND SUBJECT / Ist YEAR, M.Sc (N)
OBSTRETRICS AND GYNECOLOGICAL NURSING
DATE OF ADMISSION
TITLE OF THE TOPIC / A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE REGARDING MENSTRUAL BLOOD BANK AMONG GRADUATE STUDENTS IN SELECTED COLLEGE AT KOLAR.
6.1. INTRODUCTION
Adolescence is regarded as aunique phase of human development. Among adolescence girls menarche is an impartment landmark in the process of growth and maturation. Through menstruation is anatural and normal physiological process for all healthy adult women as ever it has been surrounded by secrecy and in many societies.1
The word adolescence is derived from a Latin verb adolesence, which means to grow into maturity. An adolescent belongs to a vital age group not only because they are “enterent population” to parenthood but also because they are on the threshold between child hood and adult hood. As they attempt to cross his threshold they face various physiological, psychological and developmental changes.1
The word "menstruation" is etymologically related to "moon". The terms "menstruation" and "menses" are derived from theLatinmensis(month), which in turn relates to theGreekmene(moon) and to the roots of the English wordsmonthandmoon.2
Girls may start their menstrual period as early as nine years of age and as late as 16 years old. The average age a girl a being menstruating is 12. Since it is too early for the girls they would not have prepared physically and mentally for the menstruation. When the girls attain menarche they feel shy to even disclose to their mothers. There will be few chances to maintain hygiene during menstruation since the matter is not discussed in the nuclear families. Even though girls of today get information through media it cannot be applied practically unless it is explained.3
Themenstrual cycleis the scientific term for thephysiologicalchanges that occur in fertilewomenand other femaleprimatesfor the purposes ofsexual reproduction. This article focuses on the human menstrual cycle, a "monthly" cycle that takes approximately 28 days to complete although this does vary from person to person.4
Menstruation is also calledmenstrual bleeding,menses,catameniaor aperiod. The average age of menarche in humans is 12–13 years, but is normal anywhere between ages 8 and 16. Factors such as heredity, diet and overall health can accelerate or delay menarche. The cessation of menstrual cycles at the end of a woman's reproductive period is termedmenopause.Eumenorrheadenotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).The averageblood lossduring menstruation is 35 milliliters with 10–80 ml considered normal.5
The endometrial lining of the uterus has an outstanding capacity for regeneration .Angiogenesis is a critical factor of the proliferative endometrial phase of the menstrual cycle. It is the process of new blood vessels formation from preexisting vasculature and is fundamental to the human menstrual cycle. The uterine endometrium is an active tissue that undergoes regular cycles of growth and breakdown and is recognized as one of the few adult tissues where significant angiogenesis occurs on a routine,the endometrium lining expands by 5-7 mm in thickness within each menstrual cycle.7
6.2. NEED FOR THE STUDY
Till date women have been discarding menstrual blood as an unwanted and unsanitary waste. However, a new research has found thatmenstrual blood is a rich source of stem cells that have the ability to multiply and differentiate into any kind of cells. Earlier, blood from umbilical cord was regarded as the ultimate reserve for stem cells. Only those who have given birth at anytime of their life were able to preserve the stem cells as they were obtained from umbilical cord. Butresearchers have now discovered and successfully harvested stem cells from menstrual blood making it possible for all the women including those who have never given birth to preserve stem cells for themselves. The discovery of stem cells in the menstrual blood has given a new meaning to menstruation for women who earlier considered menstruation asnothing but a painfuland necessary evil.6
Approximately 19% (1/5th)of the world’s population is in the group of 10-19 years. As they are passing through a transition period, from childhood to adulthood, they are under going a lot of physical as well as psychological stress, due to the changes taking place in their body.1
The Menstrual stem cells (MeSC’s) have a great importance for clinical translation of regenerative therapies. The studies demonstrate that these are a unique population of cells that can be safely isolated and can provide us with an expandable source of stem cells from women until they reach menopause. Considering their relevance and importance in treatment of rare diseases including certain neuro disorders, it becomes crucial for women to preserve their menstrual blood in the Menstrual Blood Bank.Although Menstrual Blood banking is still new and lot of research is still going on menstrual blood, if its benefits are utilized, it can prove to be very beneficial for all women who wanttogive themselves the gift ofgood health.
Recently, scientists discovered that the stromal cells are present in endometrial tissues However, obtaining these cells directly is an invasive procedure.6
India has a population of more than a billion with about equal division between men and women. According to the census 2012, it was found that there are about 100 million women who live in urban areas, with a literacy rate of about 80 %( India Census 2012). Assuming that there are 60 million women who undergo menstruation, out of which 20 million women live in Tier 1 and 2 cities (which is the primary target area for a company like LifeCell). Of these 20 million women, let’s assume that only 1% of these women have the financial clout to buy this service, the figure is still around 200,000 women that LifeCell can target. This makes it an attractive proposition for LifeCell to pursue.8
Indian women are considered to be one the most conservative women in the world and many still have superstitious belief on menstruation. When interviewed with the urban women, it was found that about 80% of women associated had superstitious belief like not visiting temples. On the positive side, about 1/3 rd of the women from India’s most 43 cosmopolitan cities (Mumbai and Delhi) did not follow any traditions associated with menstruation. These women also considered menstrual blood to be a biological waste, whereas about 3/5 th of the women from a relatively conservative city like Chennai considered it as impure.8
When the respondents were explained about the menstrual blood stem cells banking, it was found that close to 3/5 th of the women thought this was believable. Over 4/5 th of younger women found the concept believable possibly because they were fascinated by the concept while the older women were skeptical about it. It was also found that about 70% of the women from Mumbai and Delhi believed in the concept whereas just 34% of the women from Chennai and Bangalore believed in the concept. At the overall level, 2/5 Th of the women were willing to collect the blood and those who were no open to collecting the blood, most of them felt uncomfortable and considered it be to a dirty procedure. Among those who did not believe, about ¾ th of them demanded credibility from doctors/ gynecologists. Close to half of the respondents also mentioned that popularizing the concept through media and people with prior experience to testify the concept would make them believe. Hygiene of the menstrual cup was a key concern to more than 4/5 th of the respondents.8
Above studies shows that education is one of main source for increasing the knowledge and changing the behavior of students regarding menstrual blood banking. So it is an awful need to study this problem more deeply by many more nurse researchers.
6.3. REVIEW OF LITERATURE
Review of literature involves systematic identification, location, scrutiny and summary of written materials that contain information on research problem. The literature review is based on an extensive survey of books, journals and international nursing index. Research and non-research literature were reviewed to broaden the understanding and gain insight into the problem under study.
The review has been divided under the following headings.
- Review related to menstruation
- Review related to menstrual blood banking
- Review related to structured teaching programme.
Menstruation is anormal physiological cycle common to all females of the reproductive age group. Menstruation may be defined as “a periodic vaginal bleeding which the women herself must diagnose as menstruation based on her previous experience and on accompanying signs and symptoms.”9
A cross-sectional descriptive study carried out on 1100 school adolescent girls in district Wardha, Central India. Data were collected using a self-administered structured questionnaire onmenstruation. Mean ages of menarche were 13.51 + 1.04 years and 13.67 + 0.8 years for urban and rural areas respectively. Abnormalcyclelength was common and affected 30.48%. The majority 56.15 experienced dysmenorrheal and 56.16 percent had premenstrual syndrome. Self medication was practiced by 7.13% of the adolescent girls. The most common premenstrual symptom was headache 26.74%. Absenteeism from the school 13.9% was the effect ofmenstruationrelated problems on their daily routine. Majority of the girls 75.58% had discussed menstrual problems with someone, most commonly with their mothers 38.15%. There was a general lack of information about menstrual issues especially with regards tocyclelength, duration of menses and age at menarche. The mean age of menarche was significantly higher in girls involved in vigorous sporting activity in urban area compared to their non-sporting counterparts.10
A Cross-sectional descriptive study using self-administered questionnaire. Four hundred and fifty six girls whose ages ranged from 14-19 years with mean and median ages of 16 ± 0.93 years and 16 years respectively were surveyed. Their ages at menarche ranged from 9 years to 16 years and the mean age at menarche was 12.5 ±1.28 years. Their menstrualcyclelengths ranged from 21-35 days with mean menstrualcycle length of 27.9± 0.9 days; the mode and median were both 28 days. The mean duration of menstrual flow was 4.9 days with mode and median of 5 days. Seventy one percent had menses lasting 3-5 days while 27.2% had menses lasting over 5 days. Some 24% had irregular menses six months after their menarche and 59.6% were experiencing menses with clots. The prevalence of dysmenorrhoea was 74.4%.Some 80.2% of the girls got counseling and education on care for their menses from their parents.11
A study conducted on menstrual bleeding patterns are considered relevant indicators of reproductive health The authors evaluated self-reported bleeding patterns, incidence of spotting, and associations with reproductive hormones among 201 women in the BioCycle Study with 2 consecutive cycles. Women bled for a median of 5 days (standard deviation: 1.5) duringmenstruation, with heavier bleeding during the first 3 days. Only 4.8% of women experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20, 95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval: 0.03, 0.09) throughout thecyclewere associated with heavier menstrual bleeding, and higher follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and volume were reduced after anovulatory compared with ovulatory cycles (geometric mean blood loss: 29.6 vs. 47.2 mL; P = 0.07). 12
A cross-sectional study in 2 Asian countries. A standard questionnaire was designed inclusive of socio- demographiccharacteristicsof subjects as well asmenstrualhistory. Quantitative variables were analyzed using Falconars' formula as well as maximum likelihood analysis. Structural modeling was then applied to twin correlations to provide estimates of the relative genetic and/or environmental factors contribution in determining the measured trait. Menstrualcharacteristicswere found to be under environmental influence where the best fitting model for menstrualinterval and duration was common environment. Proband-wise concordance analysis for amount of menstruation, amenorrhea, and irregular menstruation revealed no genetic influence. The best fitting model formenstrualirregularity was CE (C73%, E27%). The same model was defined for amenorrhea (C48%, E52%).Environmental factors are most likely responsible to determine themenstrualflow, its integrity, and regularity. 13
A study conducted on menstrualstatus data were collected from 596 secondary-school students from the Amman area via a self-administered questionnaire. The students' mean age was 15.7 ± 1.5 years. Mean age at menarche was 13.1 ± 1.1 years for those who recalled it and 12.8 ± 1.4 years per the probit analysis. Menstruation duration was 4 to 7 days for 73.6% of the students, and it was more than 7 days for 2.2%. Mid-cyclepain was reported by 30.9% and dysmenorrhea by 37.6% of the students, 8% of who needed to miss school 1 day percycle. Body mass index was correlated with age at menarche.14
A study conducted on technology to reprogram human somaticcellsback to pluripotency allows the production of patient-specific induced pluripotentstem cells(iPSCs) and holds a great promise for regenerative medicine. Thus, in an effort to develop a suitable source for iPSC studies to avoid the limitations mentioned above, we have here identified stromalcellsderived frommenstrualblood(MenSCs) as suitable candidates. In the present study, we found that MenSCs can be reprogrammed to pluripotent status by doxycycline-inducible lentiviral transduction of OCT4, SOX2, and KLF4. The resulting MenSC-iPSCs showed the same characteristics as human embryonicstem cellswith regard to morphology, pluripotent markers, gene expression, and the epigenetic status of pluripotent-cell-specific genes. Thesecellswere able to differentiate into variouscelltypes of all 3 germ layers both in vitro and in vivo.15
A study revealed that Induced pluripotentstem cells(iPSCs) were originally generated by forced ectopic expression of four transcription factors genes-OCT4, KLF4, SOX2, and c-MYC-in fibroblasts. Menstrualblood-derived mesenchymalcells (MBMCs) are multipotentcellsthat show detectable levels of some of the core EScellsregulators. The aim of this study was to determine whether reprogramming efficiency could be increased by using MBMCs as acellsource to generate iPSCs.Cellswith high nucleus/cytoplasm ratio can be detected about 5 days of posttransduction, and colonies of typical ES-likecellsbegun to appear after 7 days. At day 15, colonies were picked up and expanded for characterization. Our results show that the reprogramming was faster and with efficiency around 2-5%, even in the absence of ectopic expression of c-MYC.16
A study revealed that menstrualbloodis easily accessible, renewable, and inexpensive source ofstem cells. In this study, we investigated the chondrogenic differentiation potential ofmenstrualblood-derivedstem cells(MenSCs) compared with that of bone marrow-derivedstem cells(BMSCs) in two-dimensional culture. MenSCs were strongly positive for mesenchymalstem cellmarkers in a manner similar to that of BMSCs. Differentiated MenSCs showed strong immunoreactivity to a monoclonal antibody against Collagen type 2, in a pattern similar to BMSCs. Accumulation of proteoglycans in differentiated MenSCs was also comparable with that in differentiated BMSCs. However, the mRNA expression patterns as judged by RT-PCR of chondrogenic markers such as Collagen 2A1, Collagen 9A1 and SOX9 in MenSCs were different from those in BMSCs. Given these findings, MenSCs appear to be a uniquestem cellpopulation with higher proliferation than and comparable chondrogenic differentiation ability to BMSCs in two-dimensional culture.17
A study conducted on menstrualbloodstromalstem cells(MBSCs) have been demonstrated to exhibitstem cellproperties such as the capability for self-renewal and multipotency, allowing for multilineage differentiation. In this study, we examined the potential effect of MBSCs on proliferation of peripheralblood mononuclearcells(PBMCs) in allogeneic mixed lymphocyte reaction (MLR).Menstrualbloodwas collected from healthy donors aftermenstrualbloodflow initiated and its mononuclearcellfraction was separated.Cellswere subsequently cultured and adherentcellswere allowed to propagate and used asstem cells. For functional analysis, PBMCs were co-cultured with MBSCs, collected after 4 days and added to allogeneic PBMCs. MBSCs showed surface and intracellular markers of mesenchymalstem cellswith the exception of the high expression of Oct-4A. MBSCs affected the proliferative response of PBMC in a dose-dependent manner.18
A study revealed that we are in the beginning of the era of regenerative medicine and many researchers are testing adultstem cellsto be used for tissue repair and regeneration in the human body. Many adultstem cellshave been discovered since the late 1990's with more recently a novel adultstem celldescribed inmenstrualblood. Themenstrualbloodis derived from shedding of the endometrial lining, specifically the functionalis layer, which contains highly proliferativecellsused to prepare the female body for implementation of a fertilized egg.Cellcharacterization experiments of stromalstem cellsdiscovered in menstrualbloodhave demonstratedcellsto be multipotent which can successfully differentiate in vitro intocelllineages derived from the mesoderm and the ectoderm. The study demonstratesmenstrualstem cellsare a novelcell population that may be routinely and safely isolated to provide a renewable source ofstem cellsfrom child-bearing women.19
A study revealed cerebrovascular diseases are the third leading cause of death and the primary cause of long-term disability in the United States. The only approved therapy for stroke is tPA, strongly limited by the short therapeutic window and hemorrhagic complications, therefore excluding most patients from its benefits. Parkinson's and Huntington's disease are the other two most studied basal ganglia diseases and, as stroke, have very limited treatment options.Stem cellscan be opportunely used to modulate inflammation, abrogatecelldeath and, therefore, preserve neural function. We here discuss the role ofstem cellsas restorative treatments for basal ganglia disorders, including Parkinson's disease, Huntington's disease and stroke, with special emphasis to the recently investigated menstrualbloodstem cells. We highlight the availability, proliferative capacity, pluripotentiality and angiogenic features of thesecellsand explore their present and future experimental and clinical applications.20