Reliability analysis using the in-lux examination method for dental indices in adolescents for use in epidemiological studies.

OBJECTIVE: To evaluate the in-lux examination method to assess the reliability of examiners for oral health surveys. METHODS: A calibration study involving 10 examiners and 27 patients was conducted, and high-quality photographs of dental epidemiological indices were projected. The latter refers to the in-lux examination method. Two groups, comprised of five examiners each, were trained to assess dental caries (DMFT index) and malocclusion (DAI). The first group carried out in vivo (clinical) and in-lux examinations in the same patients. The second group performed in-lux examinations only. The measurements were repeated to obtain intraexaminer weighted kappa coefficients. RESULTS: Interexaminer weighted kappa coefficients of the in vivo examination method for DMFT and DAI ranged from 0.597 to 0.851 and from 0.574 to 0.844, respectively. The values for in-lux examination were between 0.440 and 0.856 (DMFT) and between 0.524 and 0.783 (DAI). The intraexaminer kappa coefficients of the in vivo examination method ranged between 0.569 and 0.851 (DMFT) and between 0.644 and 0.834 (DAI). In the in-lux method, these values were between 0.426 and 0.831 (DMFT) and between 0.341 and 0.838 (DAI). Three examiners did not reach the minimum acceptable kappa value (k = 0.610) for DMFT, and one for DAI. Of these, one examiner managed to reach the minimum kappa coefficient for DMFT after additional training. The three others maintained the kappa coefficients at lower than acceptable limits. CONCLUSIONS: Calibration, using both in vivo and in-lux examination methods, was able to discriminate the examiners regarding their reliability to reproduce dental indices. The in-lux examination method was considered reliable and can replace the in vivo examination method. The in-lux method might be more feasible to evaluate the reliability of examiners when clinical calibration is unrealistic due to logistic issues and when a large number of examiners are involved in the survey.

Estimativa de idade dental em corpos não identificados: aplicação e desafios da rotina odontolegal / Estimation of dental age in unidentified bodies: application and challenges ofthe forensic odontology routine

O objetivo foi analisar a efetividade dos critérios empregados pela Odontologia Legal, comparando idade estimada (IE) com idade cronológica (IC) dos indivíduos desconhecidos que deram entrada no Instituto Médico Legal Dr. André Roquette em 2017. A amostra final de dados secundários foi de 167 desconhecidos, originados no Sistema de Informatização e Gerenciamento dos Atos de Polícia Judiciária-PCNet. Categorizou-se o uso do critério odontológico (Sim/Não), compreendido por: Dentes Presentes, Desgaste Dentário, Presença de Rebordos Remanescentes, Mineralização das Raízes Dentárias e Estrutura Óssea dos Maxilares, como "Sim" e Elementos Morfológicos do Corpo e Face, Tecidos Anexos como "Não". Os componentes da amostra foram divididos em Grupos 1, 2 e 3, de acordo com o estrato etário. Como resultado, viu-se que a maioria dos desconhecidos era do sexo masculino (91,7%). A prevalência de uso do critério odontológico foi de 100%. Concluiu-se que o uso dos critérios odontológicos é relevante estratégia pericial na estimativa de idade. Contudo, se faz premente a calibração da equipe e padronização de critérios, visando garantir a efetividade e o rigor científico, tanto no IMLAR/BH, como em outros Institutos Médico-legais do país.

[The judicialization of health care: a case study of three state courts in Brazil]. / Judicialização da Saúde: um estudo de caso de três tribunais brasileiros.

The scope of this study was to describe and compare records of the results of lawsuits filed in three Brazilian courts in cases involving the Unified Health System. A survey was made of the judgments listed on electronic sites of Courts of Justice in the states of Pernambuco, Rio Grande do Sul and Minas Gerais using a specific script. A total of 558 judgments was analyzed. There was a greater frequency of ordinary lawsuits (73.1%). In the majority of cases, it was not possible to identify the economic situation of the plaintiff or the legal representative of the defendant (54.5%). In cases where such identification was possible, a public defender was the most common (71.5%). The cases were predominantly individual in all three states. There was a large number of requests for injunctions (83.8%), which were almost always granted (91.2%), with the allegation of urgency/emergency in almost all cases (98.8%). The majority of decisions were favorable to the users of the public healthcare system (97.8%). The decisions studied showed that the users sought to ensure their right to health individually, using the public authorities to file their lawsuit, but there is a perceived difference in posture between legal courts evaluated. There is a strong tendency of the judiciary to accept these requests.