Effectiveness of Empowerment Strategies using Community Participatory Approach in Prevention of Cancer Cervix Interms of Health Seeking and Risk Reduction Behaviours among Women

ABSTRACT: A study to assess the effectiveness of empowerment strategies using community participatory approach in prevention of cancer cervix interms of health seeking and risk reduction behaviour among women in selected rural areas of Sivaganga District for the award for the degree of Doctor of Philosophy in Nursing to The Tamil Nadu Dr. M.G.R. Medical University, Chennai during the year 2015. INTRODUCTION: Cervical cancer remains the second leading type of cancer death in women worldwide. India ranking 4th place in cervical cancer incidence. It is estimated that 1, 34, 420 new cases and 72,825 death occurred as a result of cancer cervix. Cumulative life time risk & death risk are about 2.5% and 1.4% respectively for Indian women. High risk HPV strains are recognized as the primary cause of cervical cancer. Furthermore, certain risky behaviour have been shown to increase cervical cancer risk. A broader definition of risky sexual behaviour has included having unprotected sexual activity, inconsistent use of condoms having high risk partners and survival sex etc. The disease is preventable if it is identified at an early stage. Cervical cancer screening played vital role in changing the trend of incidence and death rate due to cancer cervix. The alarming national data on the mortality and morbidity rates of cervical cancer emphases that there is an urgent need to gear the policies and programmes aimed at preventing cancer cervix. Knowledge and behaviour changes are the significant factors, which need to be targeted in prevention measures. Multifaceted interventions such as educational intervention, counseling and skill building etc, will helps in changing behavior through cognitive and affective behavioural changes. AIM AND OBJECTIVES: The present study is aimed to assess the effectiveness of empowerment strategy using community participatory approach in prevention of cancer cervix interms of health seeking and risk reduction behaviour among women. The objectives of the study are to, 1. To identify the woman who are at risk of developing cancer cervix. 2. To evaluate the effectiveness of empowerment strategies in prevention of cancer cervix in terms of desirable changes in knowledge, health seeking and risk reduction behaviour. 3. To correlate between post test, knowledge, and post test risk reduction and health seeking behaviour among woman in experimental group. 4. To find out the association between post intervention health seeking and risk reduction behaviours and selected demographic variables such as age, parity, education, income, History RTI/STIs, dietary pattern, frequency of consuming Non-vegetarian, history of menstruation. METHODS: True experimental pre test and post test control group design was used for the present study. 5 rural areas of Mana Madurai Block, Sivaganga district was selected by using simple random (Lottery method) technique. Women in the age group of 30-55 years, consented to take part in the study were assessed for their level of risk for cancer cervix by using structured interview schedule on cancer cervix risk tool. Total of 152 women who were at high risk, willing to participate in the study selected as sample. Pre intervention assessment was done in the first week and followed by administration of empowerment strategies includes video assisted teaching, risk reduction counseling and skill building intervention. Post intervention I and II assessment was done on 6th and 11th week. The following tools are used for data collection such as structured interview schedule on cancer cervix and structured interview schedule on health seeking behaviour and risk reduction behaviour rating scale. Descriptive and inferential statistics are used to analyze the findings. RESULTS: Major findings of the present study is, • One fourth of the women (25%) had high risk, while the risk was moderate in as many as 63% and low in only 12% of women. • There is a significant improvement in post intervention II mean scores of knowledge in experimental group than the control group [‘t’ = 11.07, P<0.05]. • There is a significant improvements in post intervention II mean scores of health seeking behaviour than control group [‘t’ = 17.10, P<0.001]. • There is a significant improvements in post intervention II mean scores of risk reduction behaviour than control group [‘t’ = 11.42, P<0.001]. • There is a positive correlation between knowledge with health seeking behaviour is r = 0.462 and with risk reduction behaviour r = 0.401 (at P<0.01 level). • There is a positive correlation between health seeking and risk reduction behaavour (r = 0.455, P<0.01). The present study findings concluded that, video assisted teaching, risk reduction counseling and skill building interventions are effective in improving knowledge regarding cancer cervix, health seeking and risk reduction behavior among women in selected rural areas of Sivaganga District. RECOMMENDATIONS: Empowerment strategy is more effective and can be utilized in clinical as well as in public health settings to curb the serious public health menace of cancer cervix

EFFECT OF NICORANDIL ON PENTYLENETETRAZOLE (PTZ) INDUCED CONVULSIONS IN MICE

Aims &amp; Objectives: To evaluate or screen the anticonvulsant effect of Nicorandil a potassium channel opener in Pentylenetetrazole(PTZ) induced convusions in albino mice. Materials &amp; Methods: Mice of either sex weighing 20-25gms were selected for the present study. The animals were divided into 6 groups with each group consisting of 6 albino mice. Group 1 mice received placebo (0.2ml of distilled water) intraperitoneally (i.p), group 2 received sodium valproate 200 mg/kg/i.p. as positive control, while groups 3,4, 5 and 6 were administered Nicorandil 5, 10, 20 and 40 mg/kg i.p respectively. Pentylenetetrazole (PTZ) was administered in the dose of 100mg/kg i.p, 30mins after Nicorandil/ control drug pre-treatment. Onset and duration of clonic convulsion were recorded. Results: Nicorandil pretreatment in the dose of 5mg/kg increased onset time and significantly decreased the duration of convulsions,while the doses of 10, 20, 40mg/kg prevented the convulsions. Conclusion: Nicorandil possesses significant anticonvulsant activity comparable to sodium valproate on PTZ induced seizure in albino mice. KEYWORDS: Pentylenetetrazole; Sodium valproate; Nicorandil; Anticonvulsant activity

EFFECT OF NICORANDIL ON PENTYLENETETRAZOLE (PTZ) INDUCED CONVULSIONS IN MICE

Aims &amp; Objectives: To evaluate or screen the anticonvulsant effect of Nicorandil a potassium channel opener in Pentylenetetrazole(PTZ) induced convusions in albino mice. Materials &amp; Methods: Mice of either sex weighing 20-25gms were selected for the present study. The animals were divided into 6 groups with each group consisting of 6 albino mice. Group 1 mice received placebo (0.2ml of distilled water) intraperitoneally (i.p), group 2 received sodium valproate 200 mg/kg/i.p. as positive control, while groups 3,4, 5 and 6 were administered Nicorandil 5, 10, 20 and 40 mg/kg i.p respectively. Pentylenetetrazole (PTZ) was administered in the dose of 100mg/kg i.p, 30mins after Nicorandil/ control drug pre-treatment. Onset and duration of clonic convulsion were recorded. Results: Nicorandil pretreatment in the dose of 5mg/kg increased onset time and significantly decreased the duration of convulsions,while the doses of 10, 20, 40mg/kg prevented the convulsions. Conclusion: Nicorandil possesses significant anticonvulsant activity comparable to sodium valproate on PTZ induced seizure in albino mice. KEYWORDS: Pentylenetetrazole; Sodium valproate; Nicorandil; Anticonvulsant activity

Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Background: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. Methods: In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm2/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0–2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered. Findings: We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0·47 [95% CI 0·30–0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69–0·86] per 10 mL, pinteraction=0·29; diffusion MRI OR 0·87 [0·81–0·94] per 10 mL, pinteraction=0·94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low. Interpretation: Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Funding: Medtronic

PATHOPHYSIOLOGICAL CHANGES IN LIVER TISSUES OF HYPERCALORIE DIET-INDUCED OBESE RATS

Objectives: Hypercalorie diet intake has been associated with many long-term complications including metabolic syndrome, cardiovascular diseases, and nonalcoholic fatty liver disease.Methods: A total of 12 Wistar rats either sex were used in this study. These animals were randomly divided into two groups as control and obese rats. Group 1 consists of six rats weighing 150-200 g and fed with normal pellet chow. Another six rats were fed hypercalorie/cafeteria diet to induce obesity and included in the study after 19 weeks of age. All animals were sacrificed; liver tissues were collected, weighed and sent for the histopathological examination.Results: Weight of liver tissues of was significantly more in obese rats than the control rats. Histopathological examination shows an excessive fat deposition and sinusoidal congestion in the liver tissues of obese rats.Conclusion: Increase in body weight is associated with the increase in fat deposition in the liver tissues which further develops into inflammation and necrosis of liver cells.Keywords: Wistar rats, Hypercalorie/cafeteria diet, Obese rats, Histopathological examination