Frequency of positive aspirations in anesthesia of the inferior alveolar nerve by the direct technique

Objectives: Evaluate the frequency of positive aspirations and complications resulting from anesthesia of the inferior alveolar nerve by the direct technique. Study design: The sample was composed of 138 anesthetic injections applied with Duflex syringes with reflux. The anesthesia was applied in patients of both sexes of various ages for procedures in which such anesthesia would be necessary. Results: The results showed 4.3% of positive aspirations in vivo. When the percentages of positive aspiration on the right and left sides were compared, no significant association was found. A greater number of positive aspirations was observed in the 15-30-year-old age group. It is emphasized that the only type of complication associated with positive aspirations was hematoma. Conclusions: The percentage of positive aspirations from inferior alveolar nerve block by the direct technique is significant, and for the most part they do not appear in the form of a thin thread, requiring great care on the part of the person applying the anesthesia

Improving access to cardiac rehabilitation in rural and remote areas: a protocol for a community-based qualitative case study

Background/Aims Heart disease is the largest single cause of death and contributes to poor quality of life and high healthcare costs in Australia. There are higher rates of heart disease in rural and remote areas, with the highest rates in Aboriginal and Torres Strait Islander people. Cardiac rehabilitation is known to improve health outcomes for people with heart disease but referral rates remain low (30.2% overall and 46% following acute coronary syndrome) in Australia. Further, access to cardiac rehabilitation in rural and remote areas is affected by there being few centre-based services, and poor use of home-based services. The aim of this protocol is to investigate: (i) understanding of cardiac rehabilitation by health staff, community leaders and community participants discharged from hospital following treatment for heart disease; (ii) access and support for cardiac rehabilitation in rural and remote areas via health service availability in each community. Methods A qualitative case study methodology, using an interpretive descriptive framework, will be used together with content analysis that will encompass identification of themes through a deductive/inductive process. Conclusions To improve access to services and health outcomes in rural and remote areas, a strong evidence base is essential. To achieve this, as well as having appropriate methodology, it is necessary to build relationships and trust with local communities and healthcare providers. This research protocol describes a qualitative community-based case study, together with processes to build sound relationships required for effective data collection through semi-structured interviews or focus groups. Each step of the pre-research planning data collection and analysis is described in detail for the guidance of future researchers

Assessing the quality of health research from an Indigenous perspective: The Aboriginal and Torres Strait Islander quality appraisal tool

2020 The Author(s). Background: The lack of attention to Indigenous epistemologies and, more broadly, Indigenous values in primary research, is mirrored in the standardised critical appraisal tools used to guide evidence-based practice and systematic reviews and meta-syntheses. These critical appraisal tools offer no guidance on how validity or contextual relevance should be assessed for Indigenous populations and cultural contexts. Failure to tailor the research questions, design, analysis, dissemination and knowledge translation to capture understandings that are specific to Indigenous peoples results in research of limited acceptability and benefit and potentially harms Indigenous peoples. A specific Aboriginal and Torres Strait Islander Quality Appraisal Tool is needed to address this gap. Method: The Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) was developed using a modified Nominal Group and Delphi Techniques and the tool\u27s validity, reliability, and feasibility were assessed over three stages of independent piloting. National and international research guidelines were used as points of reference. Piloting of the Aboriginal and Torres Strait Islander QAT with Aboriginal and Torres Strait Islander and non-Indigenous experts led to refinement of the tool. Results: The Aboriginal and Torres Strait Islander QAT consists of 14 questions that assess the quality of health research from an Aboriginal and Torres Strait Islander perspective. The questions encompass setting appropriate research questions; community engagement and consultation; research leadership and governance; community protocols; intellectual and cultural property rights; the collection and management of research material; Indigenous research paradigms; a strength-based approach to research; the translation of findings into policy and practice; benefits to participants and communities involved; and capacity strengthening and two-way learning. Outcomes from the assessment of the tool\u27s validity, reliability, and feasibility were overall positive. Conclusion: This is the first tool to appraise research quality from the perspective of Indigenous peoples. Through the uptake of the Aboriginal and Torres Strait Islander QAT we hope to improve the quality and transparency of research with Aboriginal and Torres Strait Islander peoples, with the potential for greater improvements in Aboriginal and Torres Strait Islander health and wellbeing

Study protocol: a pragmatic randomised controlled trial of a 12-week physical activity and nutritional education program for overweight Aboriginal and Torres Strait Islander women

<p>Abstract</p> <p>Background</p> <p>Aboriginal and Torres Strait Islander women have a higher prevalence and incidence of obesity and type 2 diabetes than non-Indigenous Australian women. Physical inactivity is a key modifiable risk factor for obesity and evidence shows that even modest reductions in waist circumference (WC) have significant health benefits. Trialing physical activity programs in difficult-to-reach high risk groups, especially urban Indigenous Australians poses distinct implementation challenges.</p> <p>Methods/Design</p> <p>The trial objective is to evaluate the effectiveness of a structured 12-week physical activity group program with nutritional advice. The design is a pragmatic randomised controlled trial. This study protocol describes the implementation and evaluation of the program. Participants are randomised into either an intervention or waitlisted group. The waitlisted group have a 12 month waiting period before commencing the 12-week program. Participant data is collected at baseline, 12, 24 and 52 weeks. Participants are Aboriginal and Torres Strait Islander women, aged 18-64 years with a waist circumference greater than 80 centimetres residing in Adelaide. The primary outcome measure is WC change immediately post program from baseline. Secondary outcomes include short term and long term changes in WC, weight, blood pressure, fasting blood glucose, insulin, insulin resistance (calculated HOMA), haemoglobin A1C (HbA1C), triglycerides and C-reactive protein (CRP). Behavioural and psychosocial surveys are administered to assess physical activity, dietary intake and the participant's motivation, self-efficacy and perceived social support for physical activity. Qualitative interviews focusing on participants' motivation, enablers and barriers to healthy eating and physical activity will be undertaken. Implementation fidelity and participation are also assessed.</p> <p>Discussion</p> <p>The Aboriginal and Torres Strait Islander Women's Fitness Program (WFP) is designed to provide a rigorous physiological and client-based evaluation of a structured 12-week program aimed to increase metabolic fitness and reduce WC in this high risk population. Evaluation results aim to provide the support necessary to design programs that are accessible, affordable and effective at reducing WC, while also improving the metabolic profile of overweight Aboriginal and Torres Strait Islander women.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry <a href="http://www.anzctr.org.au/ACTRN12610000224022.aspx">ACTRN12610000224022</a></p

IRRITABILIDADE E FALTA DE ÂNIMO: SINTOMAS DA MENOR ANDROPAUSA

Andropause, also known as "male menopause", is a biological phenomenon that affects men as they age, characterized by the gradual decrease in testosterone levels. This hormonal process can trigger several symptoms, including irritability and lack of energy. This study aims to investigate and synthesize relevant information about the relationship between andropause and these symptoms through an integrative literature review. The objective of this integrative literature review is to analyze scientific studies and case reports related to andropause, specifically examining the association between decreased testosterone levels and symptoms of irritability and low mood. To conduct this integrative literature review, we performed a comprehensive search of scientific databases, including PubMed, Scopus, and Google Scholar, using search terms related to andropause, testosterone, irritability, and low mood. Studies were selected that addressed the relationship between decreased testosterone levels and associated emotional symptoms. The inclusion criteria included research published in the last ten years, in English or Portuguese, with varied methodologies, including clinical trials, observational studies and systematic reviews. Andropause is a natural male aging process that can result in significant symptoms, such as irritability and lack of energy. Understanding this relationship is essential to providing adequate care to men facing these challenges. Testosterone replacement therapy and lifestyle changes represent valuable strategies for alleviating these symptoms, although the risks and benefits must be carefully weighed. More research is needed to deepen our understanding of andropause and its impacts on men's health.A andropausa, também conhecida como "menopausa masculina", é um fenômeno biológico que afeta homens à medida que envelhecem, caracterizado pela diminuição gradual dos níveis de testosterona. Esse processo hormonal pode desencadear diversos sintomas, entre eles a irritabilidade e a falta de ânimo. Este estudo tem como objetivo investigar e sintetizar informações relevantes sobre a relação entre a andropausa e esses sintomas por meio de uma revisão integrativa da literatura. O objetivo desta revisão integrativa da literatura é analisar estudos científicos e relatos de casos relacionados à andropausa, especificamente examinando a associação entre a diminuição dos níveis de testosterona e os sintomas de irritabilidade e falta de ânimo. Para conduzir esta revisão integrativa da literatura, realizamos uma busca abrangente em bases de dados científicas, incluindo PubMed, Scopus e Google Scholar, utilizando termos de pesquisa relacionados à andropausa, testosterona, irritabilidade e falta de ânimo. Foram selecionados estudos que abordaram a relação entre a diminuição dos níveis de testosterona e os sintomas emocionais associados. Os critérios de inclusão contemplaram pesquisas publicadas nos últimos dez anos, em inglês ou português, com metodologias variadas, incluindo ensaios clínicos, estudos observacionais e revisões sistemáticas. A andropausa é um processo natural de envelhecimento masculino que pode resultar em sintomas significativos, como irritabilidade e falta de ânimo. A compreensão dessa relação é fundamental para fornecer um atendimento adequado aos homens que enfrentam esses desafios. A terapia de reposição de testosterona e as mudanças no estilo de vida representam estratégias valiosas para aliviar esses sintomas, embora os riscos e benefícios devam ser cuidadosamente avaliados. Mais pesquisas são necessárias para aprofundar nossa compreensão da andropausa e seus impactos na saúde masculina

Aboriginal and Torres Strait Islander Men's health_Scoping review

There is currently no commonly agreed definition or consistent description of what defines best practice Aboriginal and Torres Strait Islander men’s health program. This lack of clarity, has in various ways, hindered the development of an evidence base to guide services who wish to improve the delivery of care to Aboriginal and Torres Strait Islander men. The aim of this scoping review is to provide a better understanding of the essential and/or common elements of an Aboriginal and Torres Strait Islander men’s health program, by reviewing related program factors including: origins of program design, program governance, program leads/facilitators, program funding, length and frequency of programs, program outcome assessment and program evaluation

Participant views on participating in a pragmatic randomised controlled trial: the Aboriginal and Torres Strait Islander Women's Fitness Program

Introduction: The inequity of randomising participants to control groups in randomised controlled trials (RCTs) is often considered inappropriate, especially for research trials that include vulnerable populations such as Indigenous peoples. The Aboriginal and Torres Strait Islander Women's Fitness Program conducted a trial that randomly assigned participants to 'active' and 'waitlisted' groups. This paper reports on participant views of the randomisation protocol.\ud \ud Methods: A pragmatic RCT was conducted in an urban setting to assess the effectiveness of the 12-week Aboriginal and Torres Strait Islander Women's Fitness Program on metabolic health outcomes and waist circumference. Qualitative interviews were conducted at follow-up, one of the objectives was to explore participant perspectives on the research protocol, including participant randomisation to 'Active' and 'Waitlisted' groups.\ud \ud Results: A total of 49 interviews were conducted (26 Active and 23 Waitlisted participants). Two key factors influenced participant views on the protocol: 1) group assignment; and 2) how well they understood the research design, including the justification for randomisation. 'Active' participants were concerned about the inequity of the randomisation process but overall supported the study protocol. Although most Waitlisted participants were disappointed about having to wait 12-months for the program, some participants derived motivation from being waitlisted, whilst others lost motivation. Well-informed participants were more likely to express both support for the randomisation process and an understanding of the research benefits than participants not attending an information session prior to registration.\ud \ud Conclusions Participants were more accepting of the research protocol if it was clearly explained to them, if they understood the randomisation process and felt the randomisation was justified in terms of the potential for the results to benefit other Aboriginal and Torres Strait Islander women. Our study suggests that the time and resources required to adequately explain the research protocol in research trials should not be undervalued

Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities

Objective: To describe the main characteristics of systematic reviews addressing questions of chronic disease and related risk factors for Indigenous Australians. Methods: We searched databases for systematic reviews meeting inclusion criteria. Two reviewers assessed quality and extracted characteristics using pre‐defined tools. Results: We identified 14 systematic reviews. Seven synthesised evidence about health intervention effectiveness; four addressed chronic disease or risk factor prevalence; and six conducted critical appraisal as per current best practice. Only three reported steps to align the review with standards for ethical research with Indigenous Australians and/or capture Indigenous‐specific knowledge. Most called for more high‐quality research. Conclusion: Systematic review is an under‐utilised method for gathering evidence to inform chronic disease prevention and management for Indigenous Australians. Relevance of future systematic reviews could be improved by: 1) aligning questions with community priorities as well as decision maker needs; 2) involvement of, and leadership by, Indigenous researchers with relevant cultural and contextual knowledge; iii) use of critical appraisal tools that include traditional risk of bias assessment criteria and criteria that reflect Indigenous standards of appropriate research. Implications: Systematic review method guidance, tools and reporting standards are required to ensure alignment with ethical obligations and promote rigor and relevance