INTRODUCTION:

A goiter from the Latin gutteria, struma) is a swelling of the neck or larynx resulting from enlargement of the thyroid gland (thyromegaly), associated with a thyroid gland that is not functioning properly. (en.wikipedia.org).

The burden of thyroid disease in the general population is enormous. Thyroid disorders are the most common among all the endocrine diseases in India.

In studies from western literature as many as 50% of people in the community have microscopic nodules, 3.5% have occult papillary carcinoma, 15% have palpable goiters, 10% demonstrate an abnormal thyroid-stimulating hormone level, and 5% of women have overt hypothyroidism or hyperthyroidism. (Mathew John, 2008).

A cross-sectional study was conducted to assess the knowledge, practice, perception and adverse reactions among hair dye users among patients, their attendees and staff of SDUMC. A questionnaire (28) pertaining to use of hair dyes and reactions to them was administered randomly. The demographic data are expressed as mean ± standard deviation, quantitative data expressed as percentages. A total of 263 volunteers responded of which 52.5% and 47.5% were females and males respectively with mean age of 32.40 ± 6.01 years. The participants started using hair dye at an age of 27 (±3.63) years. Synthetic dyes were used by 91%. Frequency of use in a year was 2-5 times in 51%. Instruction of the package insert was followed by 63.5%. Skin test was never performed in 34% prior to their use. Nearly 96% expressed hair dyeing was unsafe during pregnancy, lactation and in children. Adverse reactions were reported by 42%, with headache (63%) and itching (38%) being the most common. Hair dyeing was started at very early age. Majority used semi-permanent dyes even though they perceived natural dyes were safe. They continued dyeing despite adverse reactions, which indicates cosmetic importance.

Dharmistha Patel, Sarala Narayana, Bhuvana Krishnaswamy, 2013:

Chemically, resorcinol is a dihydroxy benzene. Benzene is a natural constituent of crude oil, and one of the most basic petrochemicals. Benzene is also known to increase risk of cancer and other illnesses. Scientists use benzene along with other chemicals to make resorcinol, or they may fuse resins with potassium hydroxide to make it. In hair color products, resorcinol works with other chemicals in the formula to provide a permanent color effect. Particularly colors with more yellow tones use resorcinol, though it can exist in any coloring product. (http://www.annmariegianni.com).

NEED FOR THE STUDY:

According to the World Health Organization (WHO), animal studies show that resorcinol caused thyroid dysfunction, effects on the central nervous system, and alterations in the adrenal glands. The organization adds that the ingredient was highly toxic after oral or subcutaneous (under the skin) administration. The laboratory studies showed that high doses of resorcinol inhibited thyroid peroxidase enzymes, disrupting thyroid hormone synthesis and causing changes in the thyroid gland that were consistent with goiter—thyroid enlargement. This condition causes difficulties in regulating metabolism, which can result in weight gain, malnutrition, and immune system dysfunction (http://www.annmariegianni.com).

Many people in India now started to use hair dye. It is shocking news that more than one third of women in India over age of 20 years started to use hair dye but having less awareness about side effects of these hair dyes. The researcher would hear the association between the hair dye usage and goiter and had interest to prove scientifically. So the researcher had intention to measure the association between the use of hair dye and presence of Goiter.

STATEMENT OF THE PROBLEM:

A case control study on Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District, Tamilnadu.

OBJECTIVES:

1. To find out the association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District

2. To identify the risk of Goitre those who were exposure to hair dye among women attending Thyro Care Clinic, Karur District.

HYPOTHESIS:

H₁: There is a significant association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

H_{2 :}There is a significant risk of Goitre those who were exposure to hair dye among women attending Thyro Care Clinic, Karur District.

RESEARCH METHODOLOGY:

· The research design: The case control design was used

· Setting of the study: Conducted at Thyro Care Clinic, Karur District

· Research variable: Exposure to hair dye and the goiter

· Sample: women attending Thyro Care Clinic, Karur District.

· Sample Size: The total sample size is 300

· Sampling technique: Purposive sampling technique was used.

RESULTS:

Table.1. Frequency and percentage distribution of presence of goiter among women attending Thyro Care Clinic, Karur District

Presence of goiter	Frequency	Percentage
Yes	68	23%
No	232	77%
Total	300	100%

Figure 1. The cone diagram showing the percentage distribution of goiter among women

Table.2. Frequency and percentage distribution of exposure to hair dye among women attending Thyro Care Clinic, Karur District

Exposure to hair dye	Frequency	Percentage
Yes	110	37%
No	190	63%
Total	300	100%

Figure2. The cylinder diagram showing the percentage distribution of women exposure to hair dye

Table .3. Showed that the association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

Purposively selected samples		Exposure to hair dye		Total	CV	TV
Presence of Goiter		Yes	No
	Yes (cases)	57	11	68	82.5	3.84
	No (control)	53	179	232
Total		110	190	300

P < 0.05 Not significant

The table shows the calculated chi-square value (82.5) is more than the table value (3.84) for 1 degree of freedom at 0.05 level of significant. It reveals that there was strong association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

Table.4. Contingency table applied to Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

Purposively selected samples		Exposure to hair dye		Total
Presence of Goiter		Yes	No
	Yes (cases)	57	11	68
	No (control)	53	179	232
Total		110	190	300

Exposure rates:

Incidence among exposed: a/a+c = 57/110 = 0.518 x 100= 52%

Incidence among non exposed: 11/190 = 0.0578x100 = 5.8%

Relative risk:

Incidence among exposed / Incidence among non exposed

52/5.8 = 8.96

Odds ratio

= ad/bc

= 57x179/ 11x 53

= 10203/583

= 17.5

The table. 4. Shows that the frequency of exposure to hair dye and frequency of goiter among women attending Thyro Care Clinic, Karur. The incident rate among exposed to hair dye was 52% and 5.8% among non exposed to hair dyes. The relative risk goiter among women exposed goiter was 8.96.

The odds ratio shows that a risk of having the goiter among women exposed to hair dyes was 17.5 times higher than those who did not exposed to hair dyes.

DISCUSSION:

Objective 1: To find out the association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

Table. 3. The table shows the calculated chi-square value (82.5) is more than the table value (3.84) for 1 degree of freedom at 0.05 level of significant. It reveals that there was strong association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District.

So the first hypothesis (H₁) “There is a significant association between the Exposure to hair dye and the goiter among women attending Thyro Care Clinic, Karur District” was accepted.

Objective 2:

To identify the risk of Goitre those who were exposure to hair dye among women attending Thyro Care Clinic, Karur District

The incident rate among exposed to hair dye was 52% and 5.8% among non exposed to hair dyes. The relative risk goiter among women exposed goiter was 8.96. The odds ratio shows that a risk of having the goiter among women exposed to hair dyes was 17.5 times higher than those who did not exposed to hair dyes.

So the second hypothesis (H₂₎“There is a significant risk of Goitre those who were exposure to hair dye among women attending Thyro Care Clinic, Karur District” was accepted.

IMPLICATIONS FOR NURSING:

· The nursing personnel working in hospital and community settings can reinforce the side effects of hair dye and its impact on thyroid.

· Nursing educator can educate the nursing professionals about the importance of screening for learning disabilities for protecting the child from social stress in order to make the healthy society.

· Nursing educator can influence the society and can create awareness about chemical hair dyes.

· The study may be issued for further reference.

· Dissemination of results can create awareness among common public which helps to avoid complications due to chemicals in hair dye.

RECOMMENDATIONS:

· The similar study can be conducted with large samples

· The similar study can be conducted by comparing the different products of cosmetic dyes

· This similar study can be replicated on large scale there by findings can be generalized for the target population.

· A similar study can be done among hair dressers and other professionals those who are continuously exposed to hair dye.

REFERENCES:

1. http://www.apiindia.org/pdf/medicine_update_2008

2. www.en.wikipedia.org

3. International Journal of Trichology. 2013 Jul-Sep; 5(3): 140–143, http://www.ncbi.nlm.nih.gov

4. http://www.annmariegianni.com

Received on 23.11.2015 Modified on 29.11.2015

Int. J. Nur. Edu. and Research.2016; 4(2):103-106.

DOI: 10.5958/2454-2660.2016.00023.5