Diante das dificuldades em estimar a idade de adultos e procurando se basear em pesquisas com evidência de qualidade, o presente trabalho objetivou verificar a eficácia do método de estimativa de idade de Lamendin por meio de uma revisão sistemática com metanálise e também aplicando a técnica a uma amostra brasileira. Para a metanálise, foram pesquisados estudos que tinham como objetivo mostrar a eficácia do método, comparando as idades cronológica e estimada da amostra. Foram excluídos os artigos com amostra histórica, os que modificaram a técnica, os que analisaram outros aspectos do método sem retratar sua eficácia e os que apresentaram a amostra em grupo único com indivíduos de menos de 25 anos de idade. Em seguida, a escala de qualidade de evidência QUADAS foi utilizada com modificações. A amostra final foi constituída de oito estudos. O trabalho de campo foi realizado numa amostra composta de 49 dentes provenientes de 26 crânios da coleção do Centro de Estudo e Pesquisa em Ciências Forenses do IML de Guarulhos-SP. Os resultados mostraram que os estudos identificados descuidam de alguns aspectos metodológicos e que o método é ineficaz em idosos, mas que produz boas estimativas nos outros adultos. Nos brasileiros, adultos jovens mostraram as menores médias das diferenças Entretanto, existem discordâncias na literatura quanto à faixa etária em que o método funciona melhor. Diante do exposto, sugerimos que os estudos tenham mais rigor metodológico e que a técnica seja testada antes de ser usada numa determinada população, para que se possa constatar em qual faixa etária os resultados são mais precisos. Uma pesquisa com uma amostra brasileira maior também deve ser realizada, para que se possa verificar se sexo e tipo de dente influenciam os resultados. / Given the difficulties in estimating the age of adults and trying to rely on surveys of quality evidence, this study aimed to determine the effectiveness of Lamendins method of age estimation through a systematic review and meta-analysis and also by applying the technique to a Brazilian sample. For the meta-analysis, we researched studies that aimed to show the effectiveness of the method by comparing the chronological and estimated ages of the sample. We excluded studies with historical samples, those that changed the technique, the ones that analyzed other aspects of the method without presenting results on effectiveness and the ones that presented the sample in a single group with individuals less than 25years of age. Then, the quality evidence scale QUADAS was used with some modifications. The final sample consisted of eight studies. Fieldwork was conducted in a sample of 49 teeth from 26 skulls from the collection of the Center for Study and Research in Forensic Sciences from the IML Guarulhos-SP. The results showed that the studies identified could be methodologically careless and that the method is ineffective in the elderly, but produces good estimates for other adults. In Brazil, young adults showed the smallest mean errors. However, there are discrepancies in the literature as to the age at which the method works best. We suggest that the studies have more methodological rigor and that the technique be tested before used in a given population, so it can be verified at what age the results are more accurate. A research with a larger Brazilian sample should be made, so it can be confirmed if sex and type of tooth influence the results.

Diante das dificuldades em estimar a idade de adultos e procurando se basear em pesquisas com evidência de qualidade, o presente trabalho objetivou verificar a eficácia do método de estimativa de idade de Lamendin por meio de uma revisão sistemática com metanálise e também aplicando a técnica a uma amostra brasileira. Para a metanálise, foram pesquisados estudos que tinham como objetivo mostrar a eficácia do método, comparando as idades cronológica e estimada da amostra. Foram excluídos os artigos com amostra histórica, os que modificaram a técnica, os que analisaram outros aspectos do método sem retratar sua eficácia e os que apresentaram a amostra em grupo único com indivíduos de menos de 25 anos de idade. Em seguida, a escala de qualidade de evidência QUADAS foi utilizada com modificações. A amostra final foi constituída de oito estudos. O trabalho de campo foi realizado numa amostra composta de 49 dentes provenientes de 26 crânios da coleção do Centro de Estudo e Pesquisa em Ciências Forenses do IML de Guarulhos-SP. Os resultados mostraram que os estudos identificados descuidam de alguns aspectos metodológicos e que o método é ineficaz em idosos, mas que produz boas estimativas nos outros adultos. Nos brasileiros, adultos jovens mostraram as menores médias das diferenças Entretanto, existem discordâncias na literatura quanto à faixa etária em que o método funciona melhor. Diante do exposto, sugerimos que os estudos tenham mais rigor metodológico e que a técnica seja testada antes de ser usada numa determinada população, para que se possa constatar em qual faixa etária os resultados são mais precisos. Uma pesquisa com uma amostra brasileira maior também deve ser realizada, para que se possa verificar se sexo e tipo de dente influenciam os resultados. / Given the difficulties in estimating the age of adults and trying to rely on surveys of quality evidence, this study aimed to determine the effectiveness of Lamendins method of age estimation through a systematic review and meta-analysis and also by applying the technique to a Brazilian sample. For the meta-analysis, we researched studies that aimed to show the effectiveness of the method by comparing the chronological and estimated ages of the sample. We excluded studies with historical samples, those that changed the technique, the ones that analyzed other aspects of the method without presenting results on effectiveness and the ones that presented the sample in a single group with individuals less than 25years of age. Then, the quality evidence scale QUADAS was used with some modifications. The final sample consisted of eight studies. Fieldwork was conducted in a sample of 49 teeth from 26 skulls from the collection of the Center for Study and Research in Forensic Sciences from the IML Guarulhos-SP. The results showed that the studies identified could be methodologically careless and that the method is ineffective in the elderly, but produces good estimates for other adults. In Brazil, young adults showed the smallest mean errors. However, there are discrepancies in the literature as to the age at which the method works best. We suggest that the studies have more methodological rigor and that the technique be tested before used in a given population, so it can be verified at what age the results are more accurate. A research with a larger Brazilian sample should be made, so it can be confirmed if sex and type of tooth influence the results.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death. Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths annually are caused by CVD (51% from strokes and 45% from coronary artery disease) worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a 42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually from CVD, mainly in the form of strokes and heart disease. The WHO compared the death rates of high-income countries to those of low- and middle-income countries, like South Africa, and the results show that CVD deaths are declining in high-income countries but rapidly increasing in low- and middle-income countries. Although there are several risk prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use of a physical examination, ECG changes and positive serum cardiac maker levels. Internationally the same practice is used to diagnose acute coronary syndrome but risk assessment tools are used additionally to this practise because of limitations of the ECG and serum cardiac markers when it comes to NSTE-ACS. Objective: The aim of this study was to systematically appraise evidence on the accuracy of acute coronary syndrome risk prediction tools in adults. Methods: An extensive literature search of studies published in English was undertaken. Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL. Other sources were also searched, and cross-sectional studies, cohort studies and randomised controlled trials were reviewed. All articles were screened for methodological quality by two reviewers independently with the QUADAS-2 tool which is a standardised instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was calculated for each risk score and an SROC curve was created. This curve was used to evaluate and compare the prediction accuracy of each test. Results: A total of five studies met the inclusion criteria of this review. Two HEART studies and three GRACE studies were included. In all, 9 092 patients participated in the selected studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants) were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was 1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On the SROC curve analysis, there was a trend for the GRACE risk score to perform better than the HEART risk score in predicting acute coronary syndrome in adults. Conclusion: Both risk scores showed that they had value in accurately predicting the presence of acute coronary syndrome in adults. The GRACE showed a positive trend towards better prediction ability than the HEART risk score. / AFRIKAANSE OPSOMMING: Agtergrond: Koronêre bloedvatsiekte is ‘n vorm van kardiovaskulêre siekte. Koronêre hartsiekte manifesteer in drie maniere: angina pectoris, akute koronêre sindroom en hartdood. Drie-en-dertig mense sterf daagliks aan ‘n miokardiale infarksie (hartdood). Daar is 7,5 miljoen sterftes jaarliks as gevolg van kardiovaskulêre siektes (51% deur beroertes en 45% as gevolg van koronêre hartsiektes) wêreldwyd. Globaal is die sterfte syfer as gevolg van koronêre vaskulêre siekte net 4% in vergelyking met Suid Afrika, wat ‘n 42% sterfte syfer het. Dit word voorspel dat teen die jaar 2030 daar 25 miljoen sterfgevalle jaarliks sal wees, meestal toegeskryf aan kardiovaskulêre siektes. Die hoof oorsaak van sterfgevalle sal toegeskryf word aan beroertes en hart siektes. Die WHO het die sterf gevalle van hoeinkoms lande vergelyk met die van lae- en middel-inkoms lande, soos Suid Afrika, en die resultate het bewys dat sterf gevalle as gevolg van kardiovaskulêre siekte is besig om te daal in hoe-inkoms lande maar dit is besig om skerp te styg in lae- en middel-inkoms lande. Daar is verskeie risiko-voorspelling instrumente wat wêreldwyd gebruik word om isgemiese risiko te voorspel, maar Suid Afrika gebruik geen van die risiko-voorspelling instrumente nie. Huidiglik word akute koronêre sindroom gediagnoseer met die gebruik van n fisiese ondersoek, EKG verandering en positiewe serum kardiale merkers. Internationaal word die selfde gebruik maar risiko-voorspelling instrumente word aditioneel by gebruik omdat daar limitasies is met EKG en serum kardiale merkers as dit by NSTE-ACS kom. Doelwit: Die doel van hierdie sisematiese literatuuroorsig was om stelselmatig die bewyse te evalueer oor die akkuraatheid van akute koronêre sindroom risiko-voorspelling instrumente vir volwassenes. Metodes: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. Cochrane biblioteek, MEDLINE, Embase en CINAHL databases was deursoek. Ander bronne is ook deursoek. Die tiepe studies ingesluit was deurnsee-studies, kohortstudies en verewekansigde gekontroleerde studies. Alle artikels is onafhanklik vir die metodologiese kwaliteit gekeur deur twee beoordeelaars met die gebruik van die QUADAS-2 instrument, ‘n gestandaardiseerde instrument. ‘n Aangepaste Cochrane data instrument is gebruik om data te onttrek. Data is opgeneem in Review Manager 5.2 sagteware vir ontleding. Sensitiwiteit en spesifisiteit is bereken vir elke risiko instrument en ‘n SROC kurwe is geskep. Die SROC kurwe is gebruik om die akkuraatheid van voorspelling van elke instrument te evalueer en te toets. Resultate: Twee HEART studies en drie GRACE studies is ingesluit. In total was daar 9 092 patiente wat deelgeneeem het in die gekose studies. Skattings van sensitiwiteit vir die HEART risiko instrument (twee studies, 3268 deelnemers) was 0,51 (95% CI 0,47 to 0,56) en 0,68 (95% CI 0,60 to 0,75) spesifisiteit vir die HEART risiko instrument was 0,89 (95% CI 0,88 to 0,91) en 0,92 (95% CI 0,90 to 0,94). Skattings van sensitiwiteit vir die GRACE risiko instrument (drie studies, 5824 deelnemers) was 0,28 (95% CI 0,13 to 0,53); 0,20 (95% CI 0,14 to 0,29) en 0,79 (95% CI 0,58 to 0,93). Die spesifisiteit vir die GRACE risiko instrument was 0,97 (95% CI 0,95 to 0,99); 0,97 (95% CI 0,95 to 0,98) en 0,78 (95% CI 0,73 to 0,82). Met die SROC kurwe ontleding was daar ‘n tendens vir die GRACE risiko instrument om beter te vaar as die HEART risiko instrument in die voorspelling van akute koronêre sindroom in volwassenes. Gevolgtrekking: Altwee risiko instrumente toon aan dat albei instrumente van waarde is. Albei het die vermoë om die teenwoordigheid van akute koronêre sindroom in volwassenes te voorspel. Die GRACE toon ‘n positiewe tendens teenoor beter voorspelling vermoë as die HEART risiko instrument.