"Altersdiagnostische Maßnahmen bei unbegleiteten minderjährigen Flüchtlingen im europäischen Vergleich"
Abstract
~~ english version below ~~
Weltweit hat sich die soziale, wirtschaftliche und umweltbedingte Situation der Menschheit ver-schlechtert und führt zu einem Anstieg der Fluchtbewegungen. In Europa kommen vor allem unbe-gleitete Kinder und Jugendliche ohne Dokumente an, die besonderes schutzbedürftig sind. Die Be-hörden der europäischen Länder veranlassen aufgrund der ressourcenintensiven Unterstützung, die Minderjährigen zusteht, in vielen Fällen eine Altersdiagnostik. Die mangelnde Einheitlichkeit der europäischen Praxis steht in diesem Zusammenhang ebenso in der Kritik, wie auch die konkret an-gewendeten Methoden. Daher stellt sich die Frage, welche der in Europa angewendeten Methoden sich zur einheitlichen Anwendung für altersdiagnostische Maßnahmen an unbegleiteten minderjäh-rigen Flüchtlingen in Europa eignet. Zur Beantwortung der Frage kommt eine Methodentriangulation zum Einsatz, die einerseits interdisziplinäre Interviews mit Expert_innen und andererseits eine breite Literaturrecherche zur kritischen Beleuchtung des Themas durch Studien, Stellungnahmen und Emp-fehlungen von betroffenen Personen, Expert_innen und Organisationen für und von Betroffenen beinhaltet. Dadurch kann eine inter- und transdisziplinäre Analyse in humanökologischer Sicht ge-währleistet werden. Dabei wurde deutlich, dass keine der bisher in Europa angewendeten Metho-den sich zur einheitlichen Anwendung eignet. Die angewendeten Ansätze der Altersdiagnostik, der anthropologisch-medizinische Ansatz und der soziopsychologische Ansatz, weisen beide Mängel hinsichtlich ihrer Wissenschaftlichkeit, unpraktischer Anwendung und ethischer Bedenken auf. Viel-mehr konnte gezeigt werden, dass sich ein holistischer Zugang zu einer Altersdiagnostik bei unbeglei-teten minderjährigen Flüchtlingen zur einheitlichen Anwendung in Europa eignen würde.
English version:
Social, economic, and environmental issues have negatively impacted the life of humanity world-wide, leading to an increase of refugee and migration movements. The number of separated and therefore vulnerable children and adolescents without any documents is rising, especially in Europe. Because of the resource-intensive support which unaccompanied minors need, many European countries induce an age assessment upon them. The lack a unified European strategy concerning age assessment methods, as well as the particular methods applied, have been subject to critique. That leads to the question, which of the applied methods - if any - is suitable for age assessment of unaccompanied children. To answer the question, a method triangulation is used, which includes on the one hand interdisciplinary interviews with experts and on the other hand a broad literature re-search to critically illuminate the topic through studies, statements and recommendations of affect-ed persons, experts, and organizations. Thus, an inter- and transdisciplinary analysis in a human ecological perspective can be guaranteed. The results showed that none of the so far used methods are suitable. Both approaches, the medical-anthropological approach, and the socio-psychological approach, indicate shortcomings regarding to their scientific methods, impractical applications, and ethical concerns. It was deduced, that a holistic approach would be most suitable for an age as-sessment for unaccompanied refugee children in Europe.
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The present study correlated the mineralization of third molars to chronological age using a modified classification based on Demirjian’s stages in a Brazilian subpopulation and compared with the original classification. A total of 1082 patients with age ranging from 6 to 26 years were included in the sample, with at least one third molar on panoramic radiographs. The third molars were classified according to the original Demirjian classification (8 stages) and a new model based on the Demirjian method, where the original stages were grouped into four stages: AB—enamel mineralization; CD—crown dentin mineralization; EFG—root formation; and H—complete development. Statistical analyses were performed by Kruskal-Wallis/Dunn tests (α = 0.05) and the multinomial logistic regression model. Data were analyzed according to percentiles for the probability of an individual being over 18 years old. The mean ages of the stages in both classifications did not present a significant difference between superior and inferior arches (p < 0.05). The differences in mean ages between all the stages of mineralization were statistically significant (p < 0.001) only for the 4-stage classification. Males attained root formation and complete formation earlier than females (p < 0.05) in the 4-stage classification. The modified classification system showed dependence between chronological age and mineralization stages of third molars, simplifying the age estimation process. At stage H, females present a 95.7% chance of being over 18, while for males, this probability is 89.6%. This modified classification system simplifies the dental age estimation process based on third molars and can be used as a reference for future studies.
Zusammenfassung
In der vorliegenden Studie sollte die Aussagekraft sozialpädagogischer Altersschätzungen im Vergleich zu forensischen Altersbegutachtungen, die entsprechend den Empfehlungen der Arbeitsgemeinschaft für Forensische Altersdiagnostik durchgeführt worden waren, analysiert werden. Hierfür wurden 47 Fälle ausgewertet, bei denen sowohl sozialpädagogische Altersschätzungen von in Jugendhilfeeinrichtungen betreuten unbegleiteten minderjährigen Flüchtlingen als auch forensische Altersgutachten zur Verfügung standen. In 44 Fällen, in denen die Einrichtungen von Minderjährigkeit ausgingen, bescheinigten die forensischen Altersgutachten in 12 Fällen zweifelsfreie Volljährigkeit und in 24 weiteren Fällen wahrscheinliche Volljährigkeit. In 2 Fällen, in denen die Einrichtungen die Minderjährigkeit anzweifelten, wurden im Ergebnis der forensischen Altersbegutachtung in dem einen Fall zweifelsfreie Volljährigkeit und in dem anderen Fall wahrscheinliche Volljährigkeit festgestellt. In einem Fall, in dem die Einrichtung von Volljährigkeit ausging, wurde auf der Grundlage der forensischen Altersbegutachtung wahrscheinliche Volljährigkeit mit noch möglicher Minderjährigkeit attestiert. Objektivierbare psychosoziale Kriterien, mit denen Volljährigkeit zweifelsfrei festgestellt werden kann, ließen sich nicht erkennen. Es ist davon auszugehen, dass der Anteil falsch-positiver Minderjährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen deutlich höher als bei forensischen Altersbegutachtungen ist. Ebenso scheint ein relevantes Risiko falsch-positiver Volljährigkeitsfeststellungen bei sozialpädagogischen Altersschätzungen zu bestehen. Es wurde geschlussfolgert, dass sozialpädagogische Altersschätzungen keine überzeugende Alternative zu forensischen Altersbegutachtungen darstellen.
This article serves as an introduction to the FQS special issue "Participatory Qualitative Research." In recent years there has been a resurgence of interest in participatory research strategies. The articles in this special issue come from different disciplines. Against the background of concrete empirical research projects, they address numerous conceptual considerations and methodological approaches. After reading the contributions, and engaging with the authors' arguments, we were prompted to focus in particular on those areas in which further work needs to be done. They include, on the one hand, fundamental principles of participatory research, such as democratic-theory considerations, the concept of "safe space," participation issues, and ethical questions. And, on the other hand, we focus on practical research considerations regarding the role and tasks of the various participants; specific methodological approaches; and quality criteria-understood here in the sense of arguments justifying a participatory approach. Our aim is to stimulate a broad discussion that does not focus only on participatory research in the narrower sense. Because participatory methodology poses certain knowledge-and research-related questions in a radical way, it has the potential to draw attention to hitherto neglected areas in qualitative methodology and to stimulate their further development.
Background : Growth assessment based on standardized height and weight tables and charts is an essential part of healthcare monitoring and services for children and adolescents. The present systematic and meta-analysis study aimed to determine the height of Iranian children aged 7 to 18 years and compare it with the global standards.
Methods: A meta-analysis was performed on all relevant studies published until November 2018. The databases Iranmedex, Magiran, SID, IranDoc, Medline, Scopus, PubMed, Science Direct, Web of Knowledge, Cochrane and Google Scholar were searched using mesh and non-mesh keywords. Findings of the reviewed studies were compiled using the random effects model. Data heterogeneity was calculated using the Q statistic and the I 2 index.
Results: 37 articles were found eligible for inclusion in the meta-analysis. The total sample size in these studies was 395,210, consisting of 189,985 males and 205,372 females. The mean height of 18-year-old Iranian girls ( ) was, respectively, 5.30, 5.38, 5.37 cm lower than the reference figures given by WHO ( ), CDC ( ), and NCHS ( ). Similarly, the mean height of 18-year-old Iranian boys ( ) was, respectively, 5.05, 5.09, 5.07 cm lower than the WHO ( ), CDC ( ), and NCHS ( ) standards.
Conclusions: Given the slightly different growth pattern and low mean height of Iranian girls and boys compared to the global standards, it is imperative to develop and provide more generalizable growth charts for Iranian children in order to improve the quality of growth assessment undertaken for these age groups.
BACKGROUND: Many researchers have been indicated that premature hair greying (PHG) may be associated with the multifactorial problem include genetic, trace elements deficiencies and some medical problems such as metabolic disorders. However, the risk factors for premature hair greying are not well known for young adult.
AIM: This study aimed to determine the risk factors of hair greying in young adult.
METHODS: We conducted a cross-sectional study recruited 100 respondents of a college student at the Universitas Sumatera Utara (USU) with the inclusion criteria: male, less than 25 years old with hair greying and not have skin pigmentation disorders. The questionnaires about greying of hair status, family history of greying and history of family disease were collected by self-report.
RESULTS: The age of participants in this study was 20.09 ± 2.01 years (mean ± SD). The mean onset of PHG was 15.23 ± 3.52 years (range: 9 – 22 years). The family history of PHG was 39% with paternal in 262%; maternal in 10%% and both parents in 3%. There was a significant difference between several grey hairs with a family history of PHG P = 0.045. The family history with metabolic disorders; hypertension was 29%, obesity was 25%, and diabetes Mellitus (DM) was 15%. Limitations: Owing to the use of questionnaires, the possibility of recall bias exists. The young female was not evaluated in this study.
CONCLUSION: The family history of PHG and onset of greying are important risk factors associated with PHG of a young adult.
Context:
Predicting one's attainment of age of majority is a controversial issue and considered as important aspect in medicolegal cases. In India, individuals older than 18 years of age have full capacity regarding civil conduct and are tried as adults for criminal charges.
Aims and objective:
To compare the accuracy of Olze et al., stages of radiographic visibility of root pulp, and Cameriere's third molar maturity index (I3M < 0.08) to estimate the age of majority.
Materials and methods:
A total of 615 digital orthopantomographs of children aged between 15 and 22 years. The lower left third molars were evaluated using ImageJ computer software. The effectiveness of both methods was evaluated using sensitivity, specificity, positive likelihood ratios (LR+), and LR negative (LR-).
Results:
For I3M < 0.08, the sensitivity, specificity, LR+, LR- were 0.76, 0.72, 2.79, 0.32 and 0.67, 0.76, 2.83, 0.43 in males and females respectively. For Stage 0, the sensitivity, specificity, LR+, LR- were 0.68, 0.86, 5.18, 0.36 and 0.72, 0.91, 8.63, 0.31, respectively.
Conclusion:
Stage 0 of Olze's radiographic root pulp visibility showed to be more accurate than cutoff value of I3M< 0.08 in discriminating adults and minors of Hyderabad sample when a test of high sensitivity and specificity is required.
This study aimed to establish the influence of socioeconomic and nutritional factors on the age of eruption of the mandibular third molar among Ugandans aged 10-20 years.
Materials and methods:
This was a cross-sectional study carried out in a dental clinic of Mulago Hospital between January and December 2017. The background information was obtained from the participants using a questionnaire in the form of an oral interview. The anthropometric measurements were obtained using a tape measure and a weighing scale, while dental radiographs were used to determine the eruption stages of the mandibular third molar.
Statistical analysis:
The data were analyzed using STATA 13 and summarized using descriptive statistics and multivariate analyses. Statistical significance was inferred at P < 0.05.
Results:
Participants in the overweight body mass index category were statistically significantly associated with the age of the mandibular third molar eruption (P < 0.05) compared to their normal counterparts. There was no statistically significant association between socioeconomic status and age of eruption of third molar teeth (P > 0.05). Age of eruption was statistically significantly higher among males than females (P > 0.05).
Conclusion:
The findings of the present study reveal that overweight influences early eruption of the mandibular third molar tooth, although there is no trend between socioeconomic status and the age of eruption of the mandibular third molar.
Aim:
This study aimed at establishing the age for third molar eruption among Ugandans aged 10-20 years.
Materials and methods:
This was a cross-sectional study comprising 471 male and 541 female patients attending Mulago Dental Clinic. Patients' orthopantomographs were assessed for third molar eruption as described by Olze et al. Age was summarized using means/SD. Jaw and sex differences were assessed using Student's t-test.
Results:
Complete eruption (Stage D) ranged between 13 and 20 years. The mean age at complete eruption for girls and boys was 17.5-18 years and 18.2-18.6 years, respectively. Mean age was statistically significantly (P < 0.05) lower among girls compared to boys for all third molar teeth (#18, #28, #38, and #48). The difference in mean eruption times between girls and boys was -0.62 (95% confidence interval: 0.2-1.0, P = 0.006). At 18 years, 40% or 41% maxillary and 52% or 53% mandibular molars were completely erupted. There were statistically significant differences in eruption between the sexes and jaws for all teeth (P < 0.05).
Conclusions:
Given the fact that the percentage of erupted third molars by age 18 was found to be <50% on an average in this Ugandan population, we should reconsider the use of third molar eruption as a definitive tool for age estimation in this population.
Objective:
Dental development is a useful method for age estimation. Although third molar eruption is commonly used to estimate age in Uganda, it is reported to be unreliable because of external influences. The more reliable radiographic techniques have inter-ethnic differences but data from sub-Saharan Africa are limited regarding estimating age in young adults. This study, therefore, aimed at determining the accuracy of Demirjian's classification of the lower third molar, a common dental age estimation method, in estimating key ages in a Ugandan population using Ugandan references. Dental records of 1021 Ugandans aged 10-22 years were assigned to two groups; reference and test. The reference data was retrieved from a database of a previous bigger research project.
Results:
The overall sample population comprised of 514/1021 (50.3%) males. The mean age was 15.8 (3.6) years. No significant sex differences in dental age were established in the reference sample (520 records). Accuracy values (area under the curve) at the 12-, 14-, 16- and 18-year cut-offs were between 0.83 and 0.90 using the test sample (501 records). The results suggest that Demirjian's classification of the lower third molars is a useful method for age estimation in the young urban Ugandan population in the 10-22-year age-group.
Highly relevant for both clinical and legal medicine applications, the established radiological methods for estimating unknown age in children and adolescents are based on visual examination of bone ossification in X-ray images of the hand. Our group has initiated the development of fully automatic age estimation methods from 3D MRI scans of the hand, in order to simultaneously overcome the problems of the radiological methods including (1) exposure to ionizing radiation, (2) necessity to define new, MRI specific staging systems, and (3) subjective influence of the examiner. The present work provides a theoretical background for understanding the nonlinear regression problem of biological age estimation and chronological age approximation. Based on this theoretical background, we comprehensively evaluate machine learning methods (random forests, deep convolutional neural networks) with different simplifications of the image information used as an input for learning. Trained on a large dataset of 328 MR images, we compare the performance of the different input strategies and demonstrate unprecedented results. For estimating biological age, we obtain a mean absolute error of 0.37 ± 0.51 years for the age range of the subjects ≤ 18 years, i.e. where bone ossification has not yet saturated. Finally, we validate our findings by adapting our best performing method to 2D images and applying it to a publicly available dataset of X-ray images, showing that we are in line with the state-of-the-art automatic methods for this task.
Importance
A secular trend for earlier menarcheal age has been established in girls but there are few studies of pubertal timing for boys.
Objective
To determine if there is a secular trend for earlier pubertal timing among boys.
Design, Setting, and Participants
For this population-based retrospective cohort study conducted in Gothenburg, Sweden, we collected heights and weights from school health records for boys born consecutively from January 1 and onwards in 1947 and every 5 years from 1951 to 1996 (n = 375 for each birth cohort from 1947-1991, n = 340 for the birth cohort in 1996, and n = 4090 for the total cohort). We estimated age at the peak height velocity (PHV), the maximum growth velocity during puberty, and childhood body mass index (BMI) at age 8 years for all study participants. The data were analyzed during 2018 and 2019. Boys were eligible if they had a complete personal identity number and data to calculate their age at PHV and childhood BMI. Approximately 2.4% of the original study population was excluded because they lacked a personal identity number, and in the remaining study population, 4090 (69%) had sufficient data to calculate childhood BMI and age at PHV.
Exposures
The exposure was birth year and a potential confounding factor was childhood BMI.
Main Outcomes and Measures
The outcome was age at PHV.
Results
Of the 4090 participants, most were white and the mean (SD) age at PHV was 13.9 (1.1) years. A linear regression model revealed a significant association between year of birth and age at PHV. Age at PHV was 1.5 months earlier for every decade increase in birth year (95% CI, −1.72 to −1.19; P < .001). After adjusting for childhood BMI, age at PHV was 1.2 months earlier per decade increase in birth year (95% CI, −1.41 to −0.89). All analyses were repeated in the subgroup of boys born in Sweden and with parents born in Sweden with similar results, indicating that the secular trend was not explained by demographic changes in the population between 1947 and 1996.
Conclusions and Relevance
We provide evidence of a secular trend for earlier pubertal timing in boys that is partially explained by an increased childhood BMI, but other factors that are unknown contribute.
To assess the estimation of chronological age based on the stages of third molar development following the eight stages (A-H) method of Demirjian et al. in Chennai population of South India.
A sample consisting of 848 individuals (471 males and 377 females) aged between 14 and 30 years was randomly selected for the clinical evaluation and 323 orthopantomograms with clinically missing third molars were taken for radiological evaluation using Demirjian's method from a Chennai population of known chronological age and sex. Statistical analysis was performed using Pearson's Chi-square test and mean values were compared between the study groups using t-test or analysis of variance (ANOVA) followed by Tukey's highly significant difference (HSD). In the present study, P < 0.05 was considered as the level of significance.
The results showed that the mean age of having clinically completely erupted maxillary third molars was 22.41 years in male subjects and 23.81 years in female subjects and that of mandibular third molars was 21.49 years in male subjects and 23.34 years in female subjects. Mandibular third molars were clinically missing more often in females than in males. Eruption of mandibular third molars was generally ahead of the emergence of maxillary third molars into the oral cavity. Third molar development between male and female subjects showed statistically significant differences at calcification stage F and stage G in maxillary third molars and stage F in mandibular third molars (P < 0.05).
There are differences indicating that maxillary and mandibular third molar eruption reached Demirjian's formation stages earlier in males than in females. It is suggested that in future studies, to increase the accuracy of age determination, indications of sexual maturity and ossification should also be evaluated in addition to third molar mineralization.
Estimation of age represents a central focus of forensic anthropological analysis of human skeletal remains and of the living. Advances registered in recent research include the topics of taphonomic impact, new anatomical areas of interest, histology, population variation, the dental pulp chamber, technology, mathematical approaches, biochemical analysis and techniques specifically targeting the living. This article reviews the historical development of age estimation methods and considers likely future directions.
Evaluation of the radiographic visibility of root pulp in mandibular third molars has been suggested as an alternative method for estimation of legal age threshold in living individuals when the root apices are mature. Here, we assessed the accuracy of this method for age thresholds of 18 and 21 years. A sample of 463 panoramic radiographs of individuals aged between 16 and 34 years was examined. The root pulp visibility of the mandibular third molars was scored; the stages ranged from 0 to 3. A receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to select optimal cut-offs for 18- and 21-year-old thresholds. As prognostic predictors, the selected cut-offs were stages 1 and 2 for the 18- and 21-year-old thresholds of both sexes, respectively. For the 18-year-old threshold, the AUC, sensitivity and specificity were 0.829, 83.1% and 66.7% in females; and 0.930, 89.4% and 90.9% in males, respectively. For the 21-year-old threshold, the AUC, sensitivity and specificity were 0.874, 72.8% and 92.0% in females; and 0.906, 85.5% and 88.2% in males, respectively. The accuracy of the method for estimating the 18- and 21-year-old thresholds ranged from moderate to high. Therefore, the method must be used in conjunction with other age estimation methods, especially to predict whether a female has reached 18 years of age.
Background
There is growing scientific evidence supports a link between increased childhood adiposity and early onset of puberty in girls worldwide in recent decades. However, the data from Chinese girls remain ambiguous. The aims of this study were to estimate the puberty milestones and examine attainment of puberty associated with obesity and central obesity in Chinese Han schoolgirls.
Methods
The cross-sectional school-based study examined 2996 Han schoolgirls aged 9 to 19 years from 6 provinces in China. Trained clinicians assessed the girls for height, weight, waist circumference, Tanner stages of breast and pubic hair development, and menarcheal status. We classified girls as normal weight, overweight, or obese based on BMI, and as normal weight or central obese based on the waist-height ratio, then estimated and compared median age at a given Tanner stage or greater by weight class using Probit models.
Results
The median age at menarche was 12.36 years. The median ages at breast stages(B) 2 through 5 were 10.03, 11.38, 13.39, and 15.79 years, respectively, and at pubic hair stages(PH) 2 through 5 were 11.62, 12.70, 14.38, and 16.92 years, respectively. Girls from urban areas experienced menarche, B3 and B4 stages, and PH3 through PH5 stages earlier. Girls with central obesity and overweight/obesity reached puberty earlier at almost every Tanner stage of breast and pubic hair than normal girls. Girls with obesity developed PH2 and PH3 earlier than their overweight peers. However, we did not find any significant differences between girls with overweight and obesity at all stages of breast development.
Conclusions
Childhood obesity, including both overweight/obesity and central obesity, is associated with earlier attainment of puberty in Chinese Han schoolgirls.
Objectives
Radiographic evaluation of the wisdom teeth (third molar) formation is a widely used age assessment method for adolescents and young adults. This systematic review examines evidence on the agreement between Demirjian’s development stages of the third molar and chronological age.
Methods
We searched four databases up until May 2016 for studies reporting Demirjian’s stages of third molar and confirmed chronological age of healthy individuals aged 10–25 years. Heterogeneity test of the included studies was performed.
Results
We included 21 studies from all continents except Australia, all published after 2005. The mean chronological age for Demirjian’s stages varied considerably between studies. The results from most studies were affected by age mimicry bias. Only a few of the studies based their results on an unbiased age structure, which we argue as important to provide an adequate description of the method’s ability to estimate age.
Conclusion
Observed study variation in the timing of Demirjian’s development stages for third molars has often been interpreted as differences between populations and ethnicities. However, we consider age mimicry to be a dominant bias in these studies. Hence, the scientific evidence is insufficient to conclude whether such differences exist.
Key Points
• There is significant heterogeneity between studies evaluating age assessment by Demirjian’s third molar development.
• Most of the studies were subject to the selection bias age mimicry which can be a source of heterogeneity.
• Presence of age mimicry bias makes it impossible to compare and combine results. These biased studies should not be applied as reference studies for age assessment.
Background/Aim. Persons identification and their age assessment is necessary in vast number of cases and there are different methods used for such purposes. Numerous studies indicate that the third molar development could play a crucial role in identifying an individual`s age. The aim of this study was to determine the possibility for estimating the chronological age based on the third molar development stages in children and young adults in the Serbian population. Methods. A total of 570 Serbian patients aged 6?27 years were included in this study. Out of the total number of subjects, there were 248 males with an average age of 12.21 ? 3.91 years, and 332 females with an average age of 12.88 ? 4.06 years. Stages of dental formation were determined on orthopantomograms by comparing with standard Demirjian radiographic appearances. Results. Third molars mineralization occured more rapidly in males than in females. Most of the persons with third molar (the stage H development according to the Demirjian method) were older than 18 years. Conclusion. ?hird molar mineralization stages determination on orthopantomograms is useful additional method for determination of chronological age in living individuals. This finding might be important for forensic studies, focusing on the determination of the legally important ages. Variability among different ethnic groups has to be taken into consideration when applying this method. It is necessary to carry out extensive surveys on a larger sample in order to determine the norms for assessing the dental and chronological age of Serbian population.
Objective: To assess the genetic and environmental influences on the variability of human third molar (M3) root mineralization stages via a twin study. Design: The study sample consisted of 162 same-sex twins (66 dizygotic and 96 monozygotic, mean age: 17.9 years) with normal growth and development. Panoramic radiographs were evaluated to assess root mineralization stages of the upper and lower third molars, using the method of Demirijian et al. (1973). Zygosity was established using 15 specific DNA markers. Results: Females developed their third molar roots earlier in life than males. Monozygotic twins (MZ) demonstrated higher intra-pair correlations for M3 root development stages than did DZ twins. An ACE model with additive genes, as well as common and specific environmental factors, provided the best explanation of variation in M3 root development. The mineralization of M3 roots showed highly additive genetic determination, varying from 60 to 63%, whereas a common environment contributed from 25 to 27%, and a specific environment only accounted 14% of the total variation, at most. Conclusions: A considerable proportion of the total variability of the third molar root mineralization rate can be attributed to additive genetic effects, while common and specific environmental effects have a smaller, yet significant, impact.
Purpose
To develop a deep learning bone age assessment model based on pelvic radiographs for forensic age estimation and compare its performance to that of the existing cubic regression model.
Materials and method
A retrospective collection data of 1875 clinical pelvic radiographs between 10 and 25 years of age was obtained to develop the model. Model performance was assessed by comparing the testing results to estimated ages calculated directly using the existing cubic regression model based on ossification staging methods. The mean absolute error (MAE) and root-mean-squared error (RMSE) between the estimated ages and chronological age were calculated for both models.
Results
For all test samples (between 10 and 25 years old), the mean MAE and RMSE between the automatic estimates using the proposed deep learning model and the reference standard were 0.94 and 1.30 years, respectively. For the test samples comparable to those of the existing cubic regression model (between 14 and 22 years old), the mean MAE and RMSE for the deep learning model were 0.89 and 1.21 years, respectively. For the existing cubic regression model, the mean MAE and RMSE were 1.05 and 1.61 years, respectively.
Conclusion
The deep learning convolutional neural network model achieves performance on par with the existing cubic regression model, demonstrating predictive ability capable of automated skeletal bone assessment based on pelvic radiographic images.
Key Points
• The pelvis has considerable value in determining the bone age.
• Deep learning can be used to create an automated bone age assessment model based on pelvic radiographs.
• The deep learning convolutional neural network model achieves performance on par with the existing cubic regression model.
Objectives
The purpose of this study was to examine the association of prepubertal body mass index (BMI) and weight status with pubertal development in boys and girls in Chongqing, China.
Methods
In a longitudinal study, 1237 students (695 boys and 542 girls) were recruited from Chongqing, China, and examined at baseline, then followed every 6 months for three and a half years. Height, weight, testicular volume, and breast development were measured at every examination. Age of first spermatorrhea and menarche were obtained from self‐report. Subjects were divided into normal weight, overweight, and obese groups according to baseline BMI. Multivariable Cox regression analysis was used to examine the association of BMI and weight status with pubertal development.
Results
In girls, higher prepubertal BMI increased the chance of earlier menarche (hazards ratio (HR): 1.205, 95% confidence interval (95% CI): 1.151‐2.261) and breast development (HR: 1.092, 95% CI: 1.045‐1.142). Girls in the overweight (HR: 2.605, 95% CI: 1.716‐3.956) and obese (HR: 2.565, 95% CI: 1.603‐4.103) groups had an increased risk of early menarche compared with those in the normal weight group, while only overweight was associated with an increased risk for earlier breast development (HR: 1.469, 95% CI: 1.024‐2.108). In boys, higher prepubertal BMI was significantly associated with the timing of first spermatorrhea (HR: 1.054, 95% CI: 1.004‐1.106) and testicular development (HR: 1.098, 95% CI: 1.063‐1.135). Overweight (HR: 1.672, 95% CI: 1.204‐2.322) and obesity (HR: 1.598, 95% CI: 1.135‐2.249) increased the hazard of earlier testicular development compared with the normal weight group, while no significant differences were detected among the three weight groups in terms of time to first spermatorrhea.
Conclusions
Higher prepubertal BMI was associated with earlier puberty in both Chinese boys and girls.
During 2014–2015, Sweden received asylum applications from more than 240,000 people, of which more than 40,000 were termed unaccompanied minors. In a large number of cases, claims by asylum seekers of being below 18 years were not trusted by Swedish authorities. To handle the situation, the Swedish national board of forensic medicine (Rättsmedicinalverket, RMV) was assigned by the government to create a centralized system for medical age assessments. RMV introduced a procedure including two biological age indicators; x-ray of the third molars and magnetic resonance imaging of the distal femoral epiphysis. In 2017, a total of 9617 males and 337 females were subjected to this procedure. No validation study for the procedure was however published, and the observed number of cases with different maturity combinations in teeth and femur were unexpected given the claims originally made by RMV. We present a general stochastic model enabling us to study which combinations of age indicator model parameters and age population profiles are consistent with the observed 2017 data for males. We find that, contrary to some RMV claims, maturity of the femur, as observed by RMV, appears on average well before maturity of teeth. According to our estimates, approximately 15% of the tested males were children. These children had an approximate 33% risk of being classified as adults. The corresponding risk for an adult to be misclassified as a child was approximately 7%. We determine uncertainties and ranges of estimates under reasonable perturbations of the prior.
Age estimation of adolescents and young adults is important both legally and medicolegally. During this age period, only the third molars are still in development. We aimed to determine the correlation between chronological age and third molar development in an Indonesian population using the Demirjian method. The sample consisted of 407 panoramic radiographics obtained from Indonesians aged between 8 and 25 years. Statistical analysis used a Pearson correlation test, and regression analysis was performed to obtain the regression formula to calculate the age estimation. The result of Pearson correlation test showed a strong correlation (p>0.75) between each third molar and age (p < 0.05). Regression correlations obtained included the sum model of four third molars, three third molars, two third molars, and one third molar. There was a very strong correlation between chronological age and third molar development in the Indonesian population.
The purpose of this investigation was to determine the impact of heritability on third molar agenesis in twins. The study sample consisted of 284 same sex twins (172 monozygotic and 112 dizygotic), whose mean ages were 19.7 ± 4.3 and 18.9 ± 4.8 years, respectively. The monozygotic group consisted of 36.3% males and 63.7% females, while the dizygotic group consisted of 50.1% males and 49.9% females. The zygosity of the twins was established using 15 specific DNA markers. The prevalence of third molar agenesis in monozygotic twins was 19.6%, which was higher than in the dizygotic twins group (15.50%) (p = 0.004). In both groups, third molar agenesis was more frequent in the maxilla than in the mandible (p = 0.000). Agenesis of the maxillary third molars was mostly affected by additive genetic factors (62-63%), with the common environment and the specific environment accounting for up to 25% and 13%, respectively. In contrast, agenesis of the lower third molars was associated with a higher additive genetic determination (81-83%), with the specific environment accounting for 17% to 19%. The study's conclusion is that the formation of the third molars follicle is strongly controlled by additive genetic factors.
Background
In Germany, a public discussion has recently been initiated on age determination of young migrants without valid identity documents. With reference to the so-called Horvath clock it has been frequently asked whether methods for age estimation based on DNA methylation analysis can already be used in forensic practice.
Objective
Against this background it was examined whether the epigenetic methods proposed so far for age estimation already meet the requirements that have to be met in the German legal system before being used in forensic practice.
Results and conclusion
The epigenetic approach for age estimation is undoubtedly promising; however, it has to be concluded that this approach is not yet sufficiently mature for use in forensic practice, because essential research questions still remain unclear and the error ranges that can be anticipated from the published data still appear to be too high for an application in cases of young migrants with unknown age. After clarification of all relevant research questions and adequate optimization of appropriate methods with respect to their accuracy, it would be necessary to formulate scientific standards (from sampling to the details of expert opinions) and to establish further quality assurance strategies (e. g. interlaboratory proficiency testing). Only in this way will it be possible to ensure a level of expertise that is indispensable in the forensic context in Germany. Of course, when using these methods, relevant legal and ethical principles will have to be taken into account.
Estimating the forensic age of living individuals is ever more important in forensic practice, due to the ongoing increase of migratory flows, amongst other causes. Using the Greulich and Pyle method on a sample of 1150 individuals of the Spanish population (n = 560, 0–18 years for girls, and n = 590, 0–19 years for boys), the mean difference between the bone and chronological ages was obtained: 0.01 years (− 0.81, + 0.92) for girls and 0.33 years (− 1.15, + 0.34) for boys. For a same class of age and sex, the inherent variability was also evaluated: (0.41–1.25) for girls and years (0.36–1.76) for boys. To minimise systematic errors with regard to the reference population, adjustment factors are proposed for each age and sex. A sequential classification criterion based on decision trees is postulated to improve reliability in the prediction of maturity. Implementation of the decision criterion in three categories enables the doubtful individuals to be separated into the category of “undetermined” and to satisfactorily classify in the categories of “mature” and “under age”: 0.96 (0.86–0.99) specificity; 1.00 (0.92–1.00) specificity; and 1.00 (0.92–1.00) predictive value.
In historical accounts of the circumstances of ordinary people's lives, nutrition has been the great unknown. Nearly impossible to measure or assess directly, it has nonetheless been held responsible for the declining mortality rates of the nineteenth century as well as being a major factor in the gap in living standards, morbidity and mortality between rich and poor. The measurement of height is a means of the direct assessment of nutritional status. This important and innovative study uses a wealth of military and philanthropic data to establish the changing heights of Britons during the period of industrialization, and thus establishes an important dimension to the long-standing controversy about living standards during the Industrial Revolution. Sophisticated quantitative analysis enables the authors to present some striking conclusions about the actual physical status of the British people during a period of profound social and economic upheaval, and Height, Health and History will provide an invigorating statistical edge to many debates about the history of the human body itself.
According to international regulations, unaccompanied minor status determination implies a different set of rights, needs and entitlements than migrant adults. In forensic scenarios, the age assessment of refugee and asylum seekers who do not have reliable documentation is based on the application of different medical and non-medical methods. A multidisciplinary and holistic approach based on a gradual implementation of these methods is recommended worldwide. Many healthcare professionals consider medical age assessment, especially when performed through radiology, highly intrusive and ethically questionable because it is conducted without medical or therapeutic benefits. About dental examination, the evaluation of the third molar development can provide very useful information on the crucial age limit of 18 years. Demirjian’s scoring system and the third molar maturity index (I3 M) developed by Cameriere et al. (2008) are the two most common quantitative methods for dental age estimation. An ethical evaluation of the dental age estimation performed by these radiological methods through the four principles of biomedical ethics (autonomy, beneficence, non-maleficence and justice) is discussed here.
Objectives:
Worldwide data on age at menarche suggest a gradually earlier maturation, which is stabilizing in some societies. The interplay between socioeconomic, behavioral, and environmental factors generates uncertainty about the current status and future trend of age at menarche in most societies. Therefore, we aimed to describe trends in age at menarche during the 20th century in Portugal.
Methods:
A sample of 11 274 women born between 1920 and 1992 in northern Portugal, recruited to participate in three population-based cohorts (EPIPorto, EPITeen, and Generation XXI) was evaluated. Age at menarche across birth year categories was compared using ANOVA and the rate of change over time using linear regression.
Results:
Age at menarche decreased with birth year (-31.1 days per 5 years; β = -.017, P < .001), women born before 1930 having a significantly higher age at menarche than those who were born after 1990 (mean (SD) = 13.1 (1.83) vs 12.0 (1.25), P < .001).
Conclusions:
The decrease in age at menarche in northern Portugal suggests that a plateau is yet to be reached. Attention to time trends in age at menarche is relevant for health promotion since there is a possible relationship between pubertal timing and the later development of the metabolic syndrome.
Objective: To correlate the stages of 3M mineralization with the chronological age of South Brazilians and assess the prevalence of complete mineralization in the threshold of 18 years old (age of legal majority). Study Design: The sample consisted of 1,013 panoramic radiographs from South Brazilian subjects aged between 15 and 23 years old. Demirjian's Tooth Development Stages (1973) was applied to classify the 3M mineralization into 8 stages (from A to H). Results: Stages D, E, F and G were more associated with subjects aged under 18 years old, while stage H was associated with subjects older than 18 years old. A smaller part of the sample ageing 18 years old or above it, was found to be on stages D to G (9.1% and 16.9% for upper and lower 3M, respectively). Considering exclusively stage H, the probability of someone being above 18 years old is 96.4% for upper 3M for male and 88,2% for female, and for lower 3M, 95,1% and 78,4%, respectively. Males presented an earlier development of this dental element, but at stage H, this age difference was significant only for the lower arch (p=0.018). Conclusion: Demirjian's Tooth Development Stages can be a useful tool to assess 3M mineralization for age estimation. When analyzing the stage H, the probability of the individuals were above 18 years old is high, both male and female, in upper 3M or lower 3M. This sample has shown future studies should consider the influence of ethnic and genetic factors over 3M development.
Background:
Canities, or hair graying, is believed to be driven by the cytotoxic effect of reactive oxygen species on follicular melanocytes, thus raising the concern that premature hair graying (PHG) may represent an outward sign of systemic oxidative stress.
Objective:
This study aimed to identify the physiological, psychological, and lifestyle factors associated with PHG (defined as graying at age ≤30 years) in men and women.
Materials and methods:
Data from 467 participants (female = 354 and male = 113; age: 18-77 years) were collected and analyzed, including demographic information, medical history, family history, supplement intake, and lifestyle factors.
Results:
PHG was found to be significantly associated with a history of PHG in the mother, P<0.001, odds ratio (OR) = 3.165; father, P<0.001, OR = 5.166; maternal grandparent, P= 0.002, OR = 2.442; paternal grandparent, P= 0.007, OR = 2.369; and siblings, P<0.001, OR = 3.125. PHG was significantly associated with iron deficiency (P = 0.026, OR = 1.751) and family history of depression (P = 0.012, OR = 1.603), while herpes simplex virus infection (P = 0.004, OR = 0.367) and smoking history (P = 0.003) demonstrated significant negative associations. In Caucasians only (n = 306), in addition to these trends, irritable bowel syndrome was also significantly associated with PHG (P = 0.010, OR = 2.753). In Asians only (n = 75), history of heart disease in a first-degree relative (P = 0.038) was significantly associated with PHG.
Limitations:
As a survey study, the findings may be subject to recall bias.
Conclusions:
Important associations exist between PHG and family history of PHG, psychiatric history, supplement use, and vitamin deficiencies, providing insight into the pathophysiology and potential comorbidities of PHG.
Age estimation is a crucial matter in several forensic and legal instances. The literature recommends carrying out hand and wrist radiograph to assess skeletal age. Much research has been conducted to examine the application of various methods in different categories. Our study aims to evaluate the reliability of Greulich and Pyle, Tanner-Whitehouse 2, and FELS methods in Beninese and Italian samples, with a total of 204 subjects, 102 (51 were male and 51 were female) from Benin and 102 (51 were male and 51 were female) from Italy, aged between 4 and 19 years. Hand-wrist radiographs were carried out at Saint Luc Hospital in Cotonou for the African sample and in 2 hospitals in Southern Italy for Italian sample. Skeletal maturity was obtained, applying the 3 methodologies. The arithmetic mean of the 3 ages obtained was calculated, as well as the possible difference between the known chronological age and the estimated mean skeletal age. Data were analyzed statistically using the χ test, Student t test, and Bland-Altman plots. There are no significant statistical differences between real age and skeletal age calculated using the Greulich and Pyle and FELS methods. Comparison between Tanner-Whitehouse 2 and the average of the methods used results in statistically significant, but clinically insignificant, differences.
Premature graying of hair (PGH) is defined as graying of hair before the age of 20 years in Caucasians and before 30 years in African American population. It can severely affect the self-esteem of an individual. The exact etiopathogenesis remains unknown, although it has been associated with premature aging disorders, atopy, and autoimmune diseases. Patients, who present with PGH, should be assessed for syndromes and metabolism diseases. Hair dyes remain the main modality of the treatment for cosmetic concerns after nutritional supplementation.
Aim
Premature hair graying (PHG) is commonly observed in society, but there are a few studies evaluating risk factors associated with PHG. We aimed to evaluate the socio‐clinical risk factors associated with PHG in this study.
Methods
A total of 1192 volunteers between 18 and 20 years old were included in this cross‐sectional study. Volunteers were asked to fill in a questionnaire on socio‐clinical risk factors associated with PHG such as smoking, alcohol consumption, diet preference, atopy history, and family history of PHG and Perceived Stress Scale (PSS).
Results
Three hundred and seventy‐seven (31.6%) of the 1192 volunteers had PHG. Vegetarian diet preference, atopy history, and family history of PHG were significantly higher in subjects with PHG. Mean body mass index (BMI) and PSS scores were higher in subjects with PHG, but was not statistically significant. In the ordinal logistic regression analysis according to severity of PHG, male gender, BMI, alcohol consumption, and history of paternal PHG were significantly higher and onset age of PHG was significantly lower in PHG group.
Conclusion
Our study is the first study reporting a relationship between PHG and diet. It may be possible to prevent PHG or reduce its severity with some lifestyle changes such as diet preference, having normal weight, and decreasing alcohol consumption.
Objective:
To evaluate the extent to which pubertal timing alters the classification of extremes of attained stature across race-ethnicity groups of youths in the US.
Study design:
We performed analyses of height and Tanner staging data of 3206 cross-sectional national sample of youths ages 8-18 years (53% male, n = 1606), 72% of whom were non-Hispanic white, 9% Mexican American, and 19% non-Hispanic black . Specialized growth models were used to derive Tanner-stage-age-adjusted z scores (TSAHAZ). The prevalence of shortness (<-1SD) and tallness (≥+1SD) status was quantified using TSAHAZ.
Results:
Highly variable patterns of prevalence of shortness and tallness via chronologic age height z score (CAHAZ) were observed in results stratified by race-ethnicity and sex. Tallness CAHAZ prevalence was high among non-Hispanic white and non-Hispanic black male youths relative to Mexican American (40.0%-43.3% vs 20.5%) with a similar pattern in female youths. In both sexes, this pattern was eliminated with TSAHAZ, with Mexican American youth becoming statistically not different from their non-Hispanic white and non-Hispanic black peers.
Conclusions:
Differences in timing of puberty between race-ethnicity groups affects estimated prevalence of shortness and tallness of attained height that remains uncaptured with CAHAZ. Adjustment for pubertal development might help isolate crucial determinants of attained stature and other aspects of body composition that may be most responsive to intervention programs in populations. The curves developed by adjusting for pubertal status may help the clinician avoid misclassification of children with early and late pubertal development.
Aim
To assess trends over 40 years regarding prevalence and severity of periodontitis in a Swedish adult population.
Materials and methods
Cross‐sectional examinations using the same clinical protocol have been repeated every ten years (1973‐2013) in a Swedish city with focus on periodontal disease in adults. Periodontal recordings included all teeth, excluding 3rd molars. Periodontal disease experience was classified (no/minor, moderate and severe).
Results
The no/minor group increased from 43% in 1983 to 60% in 2013. There was a non‐significant trend for a decrease of the severe group. Over the 40‐year period the number of teeth increased significantly and at the examination 2013 the severe group accounted for this increase. More than 60% of the study population in 2013 had no periodontal pockets (PD) > 6mm. The number of PD > 4 mm and > 6 mm were unaltered between 2003 and 2013 in all age groups, except for the 20‐year‐olds. This group showed a statistically significant increase of > 4 mm PD.
Conclusions
The proportion of individuals without periodontitis increased over the 40‐year period. The number of teeth increased significantly in the population and in 2013 this increase occurred entirely in the severe group. Finally, there was a trend toward diminished prevalence of severe periodontitis.
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The diversity of approaches and the high number of publications on sub-adult age estimation is a testament to the relevance of this particular area of forensic anthropological research. However, a downside of this diversity is the many methodological, sampling and statistical discrepancies between publications, which can lead to difficulties in method definition, application and comparison. Several authors have published recommendations highlighting standardized methodological parameters that should be respected and clearly appear in the original publications for anthropological methods to be valid. This study aims to objectively evaluate a corpus of 269 publications on dental and skeletal postnatal sub-adult age estimation using these recommendations translated into descriptors. These descriptors cover five sampling and five statistical parameters that can be considered valid or invalid according to published methodological recommendations. Parameter and descriptor distributions are shown in frequency tables and graphs, illustrating the general invalidity of the sampling and/or statistical protocols. Provided our corpus of methods is an accurate representation of available publications, the extrapolation of these results leads to conclude that most sub-adult age estimates are at worst invalid, at best questionable, and almost certainly method-dependent. In view of this study, rigorous and standardized sampling and statistical approaches should be preferred when applying and building sub-adult age estimation methods.
Purpose:
To explore the possibility of determining majority via a morphology-based examination of the epiphyseal-diaphyseal fusion by 3.0 T magnetic resonance imaging (MRI), a prospective cross-sectional study developing and applying a new stage classification was conducted.
Materials and methods:
344 male and 350 female volunteers of German nationality between the ages of 12-24 years were scanned between May 2013 and June 2015. A 3.0 T MRI scanner was used, acquiring a T1-weighted (T1-w) turbo spin-echo sequence (TSE) and a T2-weighted (T2-w) TSE sequence with fat suppression by spectral pre-saturation with inversion recovery (SPIR). The gathered information was sifted and a five-stage classification was formulated as a hypothesis. The images were then assessed using this classification. The relevant statistics were defined, the intra- and interobserver agreements were determined, and the differences between the sexes were analysed.
Results:
The application of the new classification made it possible to correctly assess majority in both sexes by the examination of the epiphyses of the knee joint. The intra- and interobserver agreement levels were very good (κ > 0.80). The Mann-Whitney-U Test implied significant sex-related differences for most stages.
Conclusion:
Applying the presented MRI classification, it is possible to determine the completion of the 18th year of life in either sex by 3.0 T MRI of the knee joint.
Key points:
• Based on prospective referential data a new MRI classification was formulated. • The setting allows assessment of the age of an individual's skeletal development. • The classification scheme allows the reliable determination of majority in both sexes. • The staging shows a high reproducibility for instructed and trained professional personnel. • The proposed classification is likely to be adaptable to other long bone epiphyses.
Die Präzision einiger gängiger Methoden zur forensischen Altersbestimmung ist begrenzt; bei anderen kann das Ergebnis durch Faktoren wie Diabetes oder Hitzeeinwirkung verfälscht werden, und manchmal fehlt es schlicht an geeignetem Untersuchungsmaterial. Die Erstellung eines DNA-Methylierungsprofils stellt in vielen Fällen eine zuverlässige Alternative dar.
Objectives:
Dental age (DA) estimation is frequently used in the fields of orthodontics, paediatric dentistry and forensic science. DA estimation methods use radiology, and are reliable and non-destructive according to the literature. The Demirjian method is currently the most frequently used method, but recently, the Willems method was reported to have given results that were more accurate for some regions. The aim of this study was to detect and compare the accuracy of DA estimation methods for children and adolescents from the Thrace region, Turkey. The mean difference between the chronological age (CA) and the DA was selected as the primary outcome measure, and the difference range according to sex and age group was selected as the secondary outcome.
Materials and methods:
Panoramic radiographs (n=766) from a Thrace region population (380 males and 386 females) ranging in age from 6 to 14.99 years old were evaluated. DA was calculated using both the Demirjian and the Willems methods.
Results:
The mean CA of the subjects was 11.39±2.34 years (males=11.08±2.42 years and females=11.70±2.23 years). The mean difference values between the CA and the DA (CA-DA) using the Demirjian method and the Willems method were -0.87 and -0.17 for females, respectively, and -1.04 and -0.40 for males, respectively. For the different age groups, the differences between the CA and the DA calculated using the Demirjian method (CA-DA) ranged from -0.53 to -1.46 years for males and from -0.19 to -1.20 years for females, while the mean differences between the CA and the DA calculated by the Willems method (CA-DA) ranged from -0.19 to -0.50 years for males and from 0.20 to -0.49 years for females.
Conclusion:
The results suggest that the Willems method produced more accurate results for almost all age groups of both sexes, and it is better suited for children from the Thrace region of Turkey, than the Demirjian method.
There has been a secular decline in age at menarche since the 19 th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973–1977, to 12.9 years and 12.3 years, respectively, among those born in 1993–1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968–1972 birth cohort to 53.4% for the 1988–1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women’s education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.
To evaluate which method is the most applicable for estimating estimate dental age in Brazilian children, Nolla or Demirjian. For this purpose, both methods were reviewed and the differences between them brought to light. A total of 403 healthy children between the ages of 7 and 13 years with satisfactory panoramic radiographs, similar socio-economic background and ethnic origin were included. Panoramic radiographs were examined by the Nolla and Demirjian methods. Dental age was calculated for both methods, and the differences between the dental age and the chronological age were compared with analysis of variance with post hoc Dunnett. The Nolla method showed no significant difference in relation to chronological age in the majority of age groups for boys and girls, except for 12-year-old boys (over-estimation of 1.00) and between 11- and 12-year-old girls (over-estimation of 0.51 and 0.59, respectively). An over-estimation of the dental age was observed by using the Demirjian method (for boys 0.89-1.84 and for girls 0.69-1.97) for all age groups. The Nolla method is suitable for Brazilian children when it comes to age estimate with care to growth spurt beginning (around 11 and 12 years). However, the Dermijian method should not be used, because it over-estimated the age in both sexes.
Warming stresses developing countries
Weather-induced conflicts in developing countries spill over to developed countries through asylum applications. One approach to estimating the future impacts of climate change is to look at the effects of weather fluctuations. These transient shocks can be interpreted analytically as randomly distributed treatments applied to countries around the world. Missirian and Schlenker analyzed the relation between these localized shocks to agriculture and applications by that country's migrants for asylum in the European Union. When temperatures in the source country deviated from a moderate optimum around 20°C that is best for agriculture, asylum applications increased. Thus, the net forecast is for asylum applications to increase as global temperatures rise.
Science , this issue p. 1610
Nowadays, given the massive migration movements toward and across EU countries, age assessment can be highly useful for estimating the real age of asylum seekers or in medico-legal assessments of age-disputed children charged with criminal acts. Demirjian et al.'s dental maturity score is currently a dental scoring system universally adopted for age assessment of unidentified children. Here we explore the biological compatibility of Demirjian's scores with respect to the estimation of certain chronological ages of forensic interest through an algorithm based on the theory of constrained graphs integrated with combinatory analysis. Rather than simply respect Demirjian's indications (direct method) on a sample of children, we followed a reverse procedure (indirect method) as follows: i. chronological age selection and identification of the corresponding maturity score (MS); ii. determination of all the possible combinations of dental maturity stages whose sum of the scores is equal to the MS under consideration; iii. checking for all such possible combinations the biological congruity of the state of maturity of each tooth compared to the chronological age initially chosen. By evidencing dental development inconsistencies, our mathematical approach explains why Demirjian's method typically overestimates age. Therefore, even if the method in question remains the recommended way to assess individual dental maturity, it should definitely be considered unsuitable for application in certain forensic scenarios, particularly as regards the most disputed age range 14-16 years.