Women in Dermatology: Considerations over Their Recognition and Prominence.

According to the Federal Council of Medicine's demographic data from 2020, the medical specialty with the highest number of women is dermatology; with 77.9% within the total of 9,078 specialists. The male/female ratio is 0.28, that is, for each man, there are more than 3 women Dermatologists. Analyze the participation of women in Brazilian dermatology and their representation in leadership positions through data review. A literature review of the National Library of Medicine PubMed database was performed in May 2022 and data review of the SBD database. According to the Brazilian Society of Dermatology (SBD), about 80% of its associated Doctors are women. Despite this correlation, since its foundation in 1912, the SBD has already had 62 directorates, of which 53 were known to be presided over by men and 4 of them are unknown. Among the directorates that are known, only five (8.62%) were chaired by women.

Facing further challenges in cancer data quality and harmonisation.

This article highlights the recent and ongoing activities of European population-based cancer registries (PBCRs) in data quality and harmonisation in the framework of the collaboration between the European Network of Cancer Registries (ENCR) and the Directorate-General Joint Research Centre (JRC), the science and knowledge centre of the European Commission. The article concludes the Frontiers in Oncology's Research Topic "Joining Efforts to Improve Data Quality and Harmonization Among European Population-Based Cancer Registries", which has been an opportunity for several European researchers to share their experience on cancer data quality and harmonisation. Such experience will be helpful for PBCRs in view of future challenges and opportunities in cancer epidemiology, with a few examples discussed in the present article.

Nasal filling guided by high frequency ultrasound: Reducing risks.

BACKGROUND: Given the significant increase in the quantity of cosmetic procedures utilizing hyaluronic acid fillers, including in the nasal region, the initial evaluation of patients using high frequency ultrasound becomes a crucial instrument in evaluating and handling nonsurgical rhinoplasty. AIMS: The aim of this article is to introduce an assessment methodology for nasal filling guided by high frequency ultrasound. PATIENTS/METHODS: A prospective and single-center study was conducted with 12 Latin American patients. The patients underwent nasal filling with hyaluronic acid following high power ultrasound mapping. RESULTS AND CONCLUSIONS: In the evaluation of the GAIS scale, all patients reported improvement with the treatment. No infections, nodules, ischemia, or other relevant adverse effects were noted. Real-time ultrasound-guided filler techniques have been developed to reduce the risk of vascular compromise, confirming the distribution pattern of blood vessels. It's also crucial to visualize the cannula at the same moment as the vessels, even if the previous vascular mapping was performed. Therefore, the utilization of high frequency ultrasound can act as a pivotal tool in augmenting procedure safety.

Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation.

BACKGROUND: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. OBJECTIVE: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. METHODS: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. RESULTS: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. CONCLUSIONS: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges.

Geographical and temporal differences in gastric and oesophageal cancer registration by subsite and morphology in Europe.

Background: Gastric and oesophageal cancers pose a serious public health concern. In 2020 a total of 189,031 incident cases (136,038 stomach, 52,993 oesophagus) and 142,508 deaths (96,997 stomach, 45,511 oesophagus) were estimated in Europe. Oesophago-gastric cancers are a heterogeneous disease, with different aetiology and epidemiology for the various topographic subsites and main histopathological types. Topography subsite and morphology is key information to allow differentiating oesophago-gastric cancers. Correct registration and coding of such variables are fundamental in allowing proper description of the epidemiology of different subsites and histopathological types of oesophago-gastric cancers. The aim of this article is to highlight geographical and temporal variability in topography and morphology of oesophago-gastric cancers observed in Europe in the considered period. Methods: Data collected in the framework of the ENCR-JRC (European Commission's Joint Research Centre) data call and feeding the European Cancer Information System (ECIS) were used to assess the variability of topography and morphology registration of gastric and oesophageal cancer in Europe in the period 1995-2014. Malignant cancers of the stomach and the oesophagus were selected following, respectively, topography codes C16 and C15 of the International Classification of Diseases for Oncology, third edition (ICD-O-3). Analyses were performed by subsite, morphology group, year, sex, and European region. Results: A total of 840,464 incident cases occurring in the period 1995-2014 - 579,264 gastric (67.2%) and 276,260 (32.8%) oesophageal carcinomas - was selected for the analysis. Data was recorded by 53 PBCRs (9 based in Northern Europe, 14 in Western Europe, 3 in Eastern Europe and 27 in Southern Europe) from 19 countries. Conclusion: A wide variability in oesophago-gastric cancers topographic subsites and histopathological types patterns was observed, with a corresponding improvement in accuracy of registration in the analysis period. PBCRs are ideally placed to guide the epidemiological evaluations of such a complex group of diseases, in collaboration with clinicians, patients and other public health stakeholders.

Interprofessional education in undergraduate dental curricula: A systematic review.

INTRODUCTION: Health professionals who effectively communicate and coordinate their work increase patient safety and quality of care. Therefore, an interprofessional education (IPE) program may be a valuable addition to the curriculum of health science courses. This study aims to verify how IPE has been implemented in undergraduate dental program curricula. METHODS: This is a qualitative systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with qualitative and qualitative-quantitative studies selected in the period between 2011 and 2021. The guiding question was as follows: how has IPE been implemented in undergraduate dentistry curricula around the world? The quality of the included articles was assessed using the CASP Qualitative Checklist (2018). RESULTS: After the review, 22 studies were selected and data were extracted following the acronym PICo (Population, phenomenon of Interest, and COntext). The majority of studies in which IPE is included in Dentistry come from North American universities. Regarding the IPE teaching methodology, the use of active methodologies was observed and the interprofessional skills most common were role clarity, teamwork, and communication. CONCLUSION: This systematic review indicated that Dentistry is included in interprofessional activities in many studies around the world, and primarily with colleagues in medicine, nursing, and pharmacy programs. IPE teaching takes place through the use of active methodologies and develops important skills for interprofessional work.

Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting.

INTRODUCTION: Coronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays. OBJECTIVE: To evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG. METHODS: Prospective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery. RESULTS: The study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease. CONCLUSION: Patients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.

Relationship between trunk control and gross motor development of infants in the first year of life: A systematic review.

OBJECTIVE: to verify the relationship between the level of trunk control and the acquisition of gross motor skills in the first year of life. METHODS: a searching strategy was developed using the PICO tool and performed in the databases PubMed, Cochrane Library, Virtual Library in Health, Embase, and Scopus, from September 2020 to July 2022. The methodological quality of the articles was evaluated by the Ottawa Quality Assessment Scale Cohort Studies (NOS). RESULTS: six studies that evaluated the level of trunk control and gross motor development in infants aged 4 to 12 months were found. Four studies evaluated full-term infants, and only two studies evaluated preterm infants comparing them to full-term ones. Five studies showed high methodological quality and one study, low methodological quality. Most studies found significant correlation between the levels of segmental trunk control (static, active, and reactive), by the Segmental Assessment Trunk Control (SATCo), and gross motor development (prone, supine, sitting, standing, and walking) by the Alberta Infant Motor Scale (AIMS). CONCLUSION: trunk control is directly related to gross motor development in different postures in infants between 7 and 12 months.

Effects of wrist orthoses in reducing pain in individuals with carpal tunnel syndrome: a systematic review.

PURPOSE: To examine the effectiveness of wrist orthoses in reducing pain in individuals with carpal tunnel syndrome. MATERIALS AND METHODS: The searches were carried out in the CINAHL, Cochrane Library, EMBASE, Regional Portal of the Virtual Health Library, PubMed, Scopus, and Web of Science databases on 18 February 2021, and updated on 16 February 2023. Four independent evaluators performed the steps for inclusion of studies following the recommendations of the PRISMA and methods of the Cochrane Handbook for systematic review. RESULTS: Three randomized clinical trials, two quasi-randomized clinical trials and one cohort study met the inclusion criteria. The visual analogue scale and numeric analog scale were used as a tool to assess pain outcome. The treatment period ranged from 2 weeks to 3 months. The period of use varied between nighttime only, and nighttime plus daytime. Most orthoses promoted a statistically significant reduction in intensity pain at night, at rest or during activities. Only one study carried out follow-up after the end of treatment and showed that pain reduction was maintained up to 6 months after treatment. CONCLUSIONS: The findings suggest that the isolated use of orthoses were effective in reducing pain in individuals with carpal tunnel syndrome.

Orthoses are effective in reducing pain in individuals with carpal tunnel syndrome.Orthoses can be used nighttime or nighttime plus daytime according to the necessity.Prefabricated orthosis may represent lower cost and greater accessibility.Pain reduction can be maintained up to 6 months after the end of treatment.

The Joint Research Centre-European Network of Cancer Registries Quality Check Software (JRC-ENCR QCS).

The core activity of population-based cancer registries (PBCRs) is to gather information from all new cancer cases in a defined geographic area, in order to measure the magnitude of cancer burden and to provide a basis for cancer research. The Joint Research Centre-European Network of Cancer Registries Quality Check Software (JRC-ENCR QCS) is a Java standalone desktop application, under development since 2015, created to support PBCRs in the validation of the collected data. The JRC-ENCR QCS performs internal consistency checks on the cancer registry dataset, to detect impossible or unlikely codes or combination of codes, and is thereby an important tool to support the validation efforts by registries and improve data quality and European-wide harmonisation. The software package also includes the JRC CSV Data layout converter, a complementary tool for transforming PBCR incidence files into a format compatible with the JRC-ENCR QCS. This paper gives an overview of the JRC-ENCR QCS, describing the role of the software in processing data files submitted by PBCRs contributing to the European Cancer Information System (ECIS) as well as its functionalities. The development of the JRC-ENCR QCS is an evolving process, with regular updates implementing new and revised European and International recommendations and classifications.

Plasticity of face-hand sensorimotor circuits after a traumatic brachial plexus injury.

Background: Interactions between the somatosensory and motor cortices are of fundamental importance for motor control. Although physically distant, face and hand representations are side by side in the sensorimotor cortex and interact functionally. Traumatic brachial plexus injury (TBPI) interferes with upper limb sensorimotor function, causes bilateral cortical reorganization, and is associated with chronic pain. Thus, TBPI may affect sensorimotor interactions between face and hand representations. Objective: The aim of this study was to investigate changes in hand-hand and face-hand sensorimotor integration in TBPI patients using an afferent inhibition (AI) paradigm. Method: The experimental design consisted of electrical stimulation (ES) applied to the hand or face followed by transcranial magnetic stimulation (TMS) to the primary motor cortex to activate a hand muscle representation. In the AI paradigm, the motor evoked potential (MEP) in a target muscle is significantly reduced when preceded by an ES at short-latency (SAI) or long-latency (LAI) interstimulus intervals. We tested 18 healthy adults (control group, CG), evaluated on the dominant upper limb, and nine TBPI patients, evaluated on the injured or the uninjured limb. A detailed clinical evaluation complemented the physiological investigation. Results: Although hand-hand SAI was present in both the CG and the TBPI groups, hand-hand LAI was present in the CG only. Moreover, less AI was observed in TBPI patients than the CG both for face-hand SAI and LAI. Conclusion: Our results indicate that sensorimotor integration involving both hand and face sensorimotor representations is affected by TBPI.

Quality indicators: completeness, validity and timeliness of cancer registry data contributing to the European Cancer Information System.

Population-based Cancer Registries (PBCRs) are tasked with collecting high-quality data, important for monitoring cancer burden and its trends, planning and evaluating cancer control activities, clinical and epidemiological research and development of health policies. The main indicators to measure data quality are validity, completeness, comparability and timeliness. The aim of this article is to evaluate the quality of PBCRs data collected in the first ENCR-JRC data call, dated 2015. Methods: All malignant tumours, except skin non-melanoma, and in situ and uncertain behaviour of bladder were obtained from 130 European general PBCRs for patients older than 19 years. Proportion of cases with death certificate only (DCO%), proportion of cases with unknown primary site (PSU%), proportion of microscopically verified cases (MV%), mortality to incidence (M:I) ratio, proportion of cases with unspecified morphology (UM%) and the median of the difference between the registration date and the incidence date were computed by sex, age group, cancer site, period and PBCR. Results: A total of 28,776,562 cases from 130 PBCRs, operating in 30 European countries were included in the analysis. The quality of incidence data reported by PBCRs has been improving across the study period. Data quality is worse for the oldest age groups and for cancer sites with poor survival. No differences were found between males and females. High variability in data quality was detected across European PBCRs. Conclusion: the results reported in this paper are to be interpreted as the baseline for monitoring PBCRs data quality indicators in Europe along time.

Pervasive gaps in Amazonian ecological research.

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%-18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost.

Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis.

Hyaluronic acid filler injections are regarded as the gold standard procedure for facial rejuvenation. Standing as the second most injected cosmetic filler, calcium hydroxyapatite-based fillers are also widely used worldwide. However, to our knowledge, prospective studies assessing patient satisfaction and sonographic changes in dermal thickness after a single session of a hybrid filler combining hyaluronic acid and calcium hydroxyapatite have not been previously published. Methods: This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure. Results: According to our findings, 20% of the subjects had an exceptional improvement; 20%, "very improved"; and 60%, "improved." Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001). Conclusion: In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.

Morphometry and skeletopy of kidneys and renal vessels in Alouatta guariba clamitans (Primates: Atelidae): case reports.

Various animal models are used for research; however, non-human primates are well suited for biomedical research owing to their genetic homology with humans. The objective of this research was the anatomical characterization of red howler's kidneys in view of the scarcity of information in the literature. Protocols were approved by the Committee for Ethics in the Use of Animals at the Federal Rural University of Rio de Janeiro (number 018/2017). The study was conducted at the Laboratory of Teaching and Research in Domestic and Wild Animal Morphology, Federal Rural University of Rio de Janeiro. Specimens of Alouatta guariba clamitans were collected from the Serra dos Órgãos National Park road in Rio de Janeiro and subsequently frozen. Four adult cadavers (two males and two females) were used, identified, and injected with a 10% formaldehyde solution. Later, the specimens were dissected, and measurements and topography of the kidneys and renal vessels were recorded. The kidneys of A. g. clamitans resemble a "bean seed," with a smooth surface. The longitudinal section shows two distinct regions, cortical and medullary; in addition, the kidneys are unipyramidal. The renal arteries emerged from the abdominal aorta as a single vessel posterior to the renal veins. The renal veins drained directly into the caudal vena cava as a single vessel in all specimens.

Vários modelos animais são usados para pesquisa, no entanto, primatas não humanos são adequados para pesquisas biomédicas devido à sua homologia genética com humanos. O objetivo desta pesquisa foi a caracterização anatômica dos rins do Bugio, tendo em vista a escassez de informações na literatura. Os protocolos foram aprovados pelo Comitê de Ética no Uso de Animais da Universidade Federal Rural do Rio de Janeiro (número 018/ 2017). O estudo foi realizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Silvestres da Universidade Federal Rural do Rio de Janeiro. Espécimes de Alouatta guariba clamitans foram coletados da estrada para o Parque Nacional da Serra dos Órgãos no Rio de Janeiro, e posteriormente congelados. Foram utilizados quatro cadáveres adultos (dois machos e duas fêmeas), identificados e injetados com solução de formaldeído a 10%. Os rins de A. g. clamitans assemelham-se a uma "semente de feijão", com superfície lisa. Ao corte longitudinal apresenta duas regiões distintas, cortical e medular, além disso, apresenta-se unipiramidal. As artérias renais emergiram da aorta abdominal como um único vaso, posteriormente às veias renais. As veias renais drenaram diretamente para a veia cava caudal como um único vaso em todos os espécimes.

Translation and cross-cultural adaptation of the pediatric cerebral performance category (PCPC) and pediatric overall performance category (POPC) to Brazilian Portuguese.

OBJECTIVE: To translate and culturally adapt the scales Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) to the Brazilian population. METHODS: Two English language proficient professionals independently translated the original version of the scales into Brazilian Portuguese. After consensus, it was generated a translated version of each scale. These were back translated into English by two native English translators. A new consensus process resulted in an English version of each scale, which were compared with the originals and approved by the author. A committee of experts with clinical and academic experience in intensive care checked the validity of the content and produced the pre-final versions of the scales, which were tested by 25 professionals from a Pediatric Intensive Care Unit. An audit was conducted to verify the consistency of the methodological process. RESULTS: The pre-final versions were approved by 96% of the Brazilian professionals. No significant changes were made to the content of the instrument; however, it was identified the need of a guide with instructions on how to use the scales. CONCLUSIONS: The process of translation and cross-cultural adaptation of the scales was completed and resulted in PCPC-BR and POPC-BR scales.

Role of the one-minute sit-to-stand test in the diagnosis of post COVID-19 condition: a prospective cohort study.

OBJECTIVE: To analyze the relationship between one-minute sit-to-stand test (1MSTST) parameters and a diagnosis of post COVID-19 condition in a cohort of patients who previously had COVID-19. METHODS: This was a prospective cohort study of patients with post COVID-19 condition referred for body plethysmography at a tertiary university hospital. Post COVID-19 condition was defined in accordance with the current WHO criteria. RESULTS: Fifty-three patients were analyzed. Of those, 25 (47.2%) met the clinical criteria for post COVID-19 condition. HR was lower in the patients with post COVID-19 condition than in those without it at 30 s after initiation of the 1MSTST (86.2 ± 14.3 bpm vs. 101.2 ± 14.7 bpm; p < 0.001) and at the end of the test (94.4 ± 18.2 bpm vs. 117.3 ± 15.3 bpm; p < 0.001). The ratio between HR at the end of the 1MSTST and age-predicted maximal HR (HRend/HRmax) was lower in the group of patients with post COVID-19 condition (p < 0.001). An HRend/HRmax of < 62.65% showed a sensitivity of 78.6% and a specificity of 82.0% for post COVID-19 condition. Mean SpO2 at the end of the 1MSTST was lower in the patients with post COVID-19 condition than in those without it (94.9 ± 3.6% vs. 96.8 ± 2.4%; p = 0.030). The former group of patients did fewer repetitions on the 1MSTST than did the latter (p = 0.020). CONCLUSIONS: Lower SpO2 and HR at the end of the 1MSTST, as well as lower HR at 30 s after initiation of the test, were associated with post COVID-19 condition. In the appropriate clinical setting, an HRend/HRmax of < 62.65% should raise awareness for the possibility of post COVID-19 condition.

Dental age assessment: scoring systems and models from the past until the present-how is it presented in the court?

OBJECTIVE: The aim of this study is to evaluate the accuracy of the methods from the past and present, such as Demirjian, Cameriere, and AlQahtani, as well as to determine the most reliable method for human age estimation under the request from the courts according to the effect size from each method in age estimation. DESIGN: Four hundred eighty-three orthopantomographic images were selected from 318 patients from Centro Hospitalar Universitário Lisboa Norte aged between 6 and 15 years old. Several measurements of widths and lengths and classification of tooth development stages were performed, according to each age estimation method. The listing of patients and orthopantomographic images were consulted through SECTRA®. All data was entered and analysed using SPSS version 28. Observations' validity was verified through inter- and intraobserver validation. RESULTS: The correlation coefficients between age and age estimates by the three methods on both sides were close to 90%. Regarding the estimation error correlation coefficient, Demirjian and AlQahtani values were low, whereas Cameriere's was significantly negative; i.e., underestimation increases as age increases. Between left and right, any significant difference in age estimation in AlQahtani and Cameriere methods was not observed, but there were great variability and large effect for the Demirjian method. Comparing females and males, the statistical analysis showed no significant differences and quite small effects in the precision of the estimates for any of the methods. Finally, although significant differences were detected when comparing estimated values and age, small effects were revealed except for the Demirjian method which attained a medium effect and, therefore, less consistency of estimation. CONCLUSIONS: Since it was not possible to determine the most reliable method for age estimation, a combined application of different age estimation methodologies is recommended to be use in the courts with relevant statistical data such as effect size.