Reliability analysis of visual examinations carried out by school-teachers and a dental assistant in the detection of dental caries.

AIM: This study aims to investigate the reliability of examinations performed by teachers and by a dental assistant in detection of cavitated surfaces. METHODS: A sample of 168 students, aged 5-14 years, attending a public school in Duque de Caxias, Rio de Janeiro, was examined by persons with three different training backgrounds: a dentist, a dental assistant, and schoolteachers. Examinations were performed in the school with the aid of a tongue blade under natural light. Kappa statistics were estimated to assess agreement between the observers. Sensitivity, specificity, and positive and negative predictive value tests helped validate observations performed by the group of laypersons. RESULTS: The findings suggest satisfactory agreement with the dentist, with kappa values of 0.730 and 0.781 for the teachers and the dental assistant, respectively. The absence of cavities was easily detected (specificity = 96%). More caution is required in positive results indicated by the teachers or the dental assistant because these were not always confirmed subsequently (sensitivity = 76%) by the dentist. CONCLUSION: The aid of untrained personnel in dental epidemiology was shown to be a valid alternative for a signposting role.

Treatment of subclinical hypothyroidism reduces atherogenic lipid levels in a placebo-controlled double-blind clinical trial.

Many studies have found clinical and metabolic alterations in subclinical hypothyroidism, however, there are disagreements about the benefits of levothyroxine therapy. The objective of the present study was to analyze the effects of 6 months of treatment on the lipid profile of patients with subclinical hypothyroidism. A randomized double blind, placebo-controlled clinical assay was conducted. Sixty patients were enrolled in stratified random allocation by TSH levels that generated similar groups in average: free thyroxine levels, lipid levels, age, clinical score, and sedentary. At 6 months, 18 patients in the levothyroxine and 20 in the placebo group were reevaluated and a fall in all atherogenic lipid variables was observed with treatment. The TC and LDL-c variations (-22.6+/-37.2 and -18.5+/-34.6 mg/dl, respectively) in the group that received LT4 were statistically different (p=0.023 and p=0.012) from those occurring in the placebo group (+7.3+/-37.1 and +14.7+/-40.6 mg/dl). Baseline characteristics associated with better improvement in the levels of TC and LDL-c were the presence of TPO-Ab, TSH levels >8.0 microUI/ml, Body Mass Index >or=25 kg/m2, and the presence of menopause. We concluded that treatment with dose-adjusted levothyroxine reduced atherogenic lipid levels in some patients. Further studies to determine the effects of LT4 replacement in specific subgroups of SH patients are still necessary, especially in patients with TSH <8.0 microUI/ml.