1. Introdução à Medicina Validity of remote dental diagnosis of children by medical students

2. Introdução à Medicina Introduction Portuguese children oral health care is deficient 49% have dental caries (by Direcção-Geral de Saúde)* 56% never went to the dentist (by Sociedade Portuguesa de Estomatologia e Medicina Dentária)* References in last slide * References in last slide

3. Introdução à Medicina Introduction Telemedicine using low-cost and widespread technology Our study is based on Dr Rui Amávels study What is the reproducibility and validity of remote diagnosis by first year medical students using photographs as a method of screening children's dental problems?

4. Introdução à Medicina Participants and Methods

5. Introdução à Medicina Study design Target-population - first year medical students of Universidade do Porto ObservationalTransversalAnalytical Unit of study – photographs Diagnosis method evaluation study

6. Introdução à Medicina Data collection Photographs Sixty six children Three photos for each child Dr Rui Amávels criteria

7. Introdução à Medicina Data collection Questionnaire filling Recognition of necessity of specialists attendance

8. Introdução à Medicina Statistical Analysis Divide the photos for three disjoint sets (22 children for each): I, II and III Divide the photos for three disjoint sets (22 children for each): I, II and III Two groups of 4 students (A and B) and one of 5 (C). (13 class members) Two groups of 4 students (A and B) and one of 5 (C). (13 class members) Comparison of the two stages Comparison of the two stages Intra observer agreement Intra observer agreement Inter observer agreement Inter observer agreement Correction rate Correction rate Sensibility Sensibility Specificity Specificity Comparison with specialists Comparison with specialists Stage 1 Group A: Set I Group B: Set II Group C: Set III Stage 2 Group A: Set II Group B: Set III Group C: Set I

9. Introdução à Medicina Flowchart Beginning Read 1 st analysis of the first stage Read 2 nd analysis of the first stage Intra-observer agreement rate Inter-observer agreement rate Read Gold Standard

10. Introdução à Medicina Flowchart End Compare 1st and 2nd analysis with Gold Standard Specificity and Sensibility Record results and conclusions Explore errors Read 1st and 2nd analysis of the second stage

11. Introdução à Medicina Gantt chart 1. Formation with Dr Rui Amável 2. First analysis of the first stage 3. Second analysis of the first stage 4. Comparison of the results 5. First analysis of the second stage 6. Second analysis of the second stage 7. Comparison of the results

12. Introdução à Medicina Expected Results First year medical students are able to recognize the necessity of specialists attendance only by looking at children mouths photos…

13. Introdução à Medicina References Leao JC, Porter SR. Telediagnosis of oral disease. Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, England. PMID: 10863389 Pubmed Almeida CM, Petersen PE, André SJ, Toscano A. Changing oral health status of 6- and 12- year-old schoolchildren in Portugal. Department for Community Dental Health, Faculty of Dental Medicine, University of Lisbon, Portugal. PMID: 14696739 PubMed Rui Amável, José Bulhosa, Ricardo Cruz-Correia. Potencial of teledentistry in the early diagnosis of caries. Proceedings of the 1st Medical Informatics Symposium. 2008 Programa "Mês da Saúde Oral" da Colgate Portugal e SPEMD - Relatório Estatístico de Set.2006. (2006). Retrieved Fev 2008, from http://www.spemd.pt/indexRastreios.html http://www.spemd.pt/indexRastreios.html Wheeler, T. (1999). Smile for the camera: telemedicine comes to your local dentist's office. Telemed Today, 14(5), 42. Ministério da Saúde. (2008). Estudo Nacional de Prevalência das Doenças Orais. Lisboa. Shortliffe, E., & Cimino, J. (2006). Biomedical Informatics – Computer Applications in Health Care and Biomedicine (3rd ed.): Springer Sociedade Portuguesa de Estomatologia e Medicina Dentária. (2007). Newsletter nº6: Colgate Palmolive AMG, C. (1994). Contribuição para o estudo da prevalência e da gravidade da cárie dentária nos dentes temporários das crianças portuguesas. Universidade do Porto, Porto Bashshur, R., Sanders, J., & Shannon, G. (1997). Telemedicine: Theory and practice. Springfield, IL.