Should Pass/Fail Grading Be Used Instead of Traditional Letter Grades in Dental Education? Two Viewpoints: Viewpoint 1: Pass/Fail Grading Improves Learning Experiences for Students and Viewpoint 2: Traditional Letter Grading Provides Objective Evaluation for Dental Education.

Discussions about which grading system (letter grade or pass/fail) is more effective in dental education have been occurring for several decades. As more institutions continue to consider the change from the traditional five-tier letter grading system (A/B/C/D/F) to a two-tier grading system (pass/fail), this debate will likely continue. This point/counterpoint article examines arguments for and against each type of grading system, taking into consideration academic performance, learning outcomes, psychological well-being, learning environment, acceptance/performance in postgraduate educational programs, and student motivation. Viewpoint 1 supports the position that a pass/fail system improves learning experiences for dental students, whereas Viewpoint 2 argues that the traditional letter grading system provides for more objectivity and reliability in student evaluation.

Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy.

Behaviors during pregnancy including eating, exercise, cigarette smoking, and other substance use affect the health of a pregnant woman and her fetus. However, little is known about what influences pregnant women to engage in these health behaviors. Based upon relevant theory, we hypothesized that because health-promoting behaviors require continuous efforts that may depend upon a reliable, stable set of resources, intrapersonal traits, namely self-esteem and optimism, would be associated with the practice of health-promoting behaviors during pregnancy. In addition, we hypothesized that variables reactive to the more immediate context, pregnancy-specific stress and perceived control over pregnancy, would be associated with the practice of health-impairing behaviors. We distinguished health-promoting and health-impairing behaviors in a diverse sample of 165 pregnant women and investigated whether such behaviors are associated with distinct psychosocial factors. Results supported study hypotheses and provide evidence that even after controlling for maternal age, income, body mass index, and gestation, a stable, self-relevant disposition, self-esteem, is associated with the practice of health-promoting behaviors in pregnancy whereas pregnancy-specific stress, a situationally-evoked factor, is associated with the practice of health-impairing prenatal behaviors. Perceived control over pregnancy, which may reflect stable disposition and situational perceptions, was associated with health-promoting and health-impairing behaviors.

Predicting birth outcomes: together, mother and health care provider know best.

OBJECTIVE: To examine contributors to perceived risk in pregnancy and its utility in predicting lower birth weight and earlier delivery in conjunction with health care providers' assessment of obstetric risk. METHODS: 165 pregnant women at high (n=34) or low (n=131) obstetric risk completed assessments of perceived risk, stress, optimism, and health behaviors using well-validated instruments and measures designed for this study. Medical charts were abstracted for gestational age at delivery and birth weight. RESULTS: 40% of the sample perceived their risk status differently than their health care provider. Stress, poor reproductive history, provider assigned risk, and unhealthful behaviors were significant, independent predictors of perceived risk (R(2)=.37). The greatest difference in birth weight (p=.003) and gestational age (p=.05) was between women considered at low risk by both self and provider and women considered at high risk by both. Perceived risk improved prediction of adverse birth outcomes, especially lower birth weight, in women considered by providers to be at low risk. CONCLUSION: Women's perceptions of risk are an important contributor to prediction of birth outcomes, but the combination of information from both a woman and her health care provider is superior. Incorporating women's perceptions into obstetric risk determination may help to reduce the number of women identified as high risk who subsequently have a normal birth outcome (false positives), and more importantly, the number of women considered to be at low risk who ultimately experience an adverse outcome (false negatives).

The proportion of elderly in Pennsylvania is slipping but....

Media reports describing the anticipated increase of tens of millions of elderly residents and their attendant billions of dollar costs for health services during the next decades are difficult for any person to place in proper perspective. As a result, these estimates become "just numbers" not actual people. Census Bureau reports are used at the national, state and county levels to provide an increased meaningful picture when the 65 and older population of Pennsylvania will increase to 22.6 percent of the state population. In 2000, 12.4 percent of the U.S. population was 65 years and older (15.6 percent in Pennsylvania, 1.9 million elderly). Only in the state of Florida was the proportion greater. In 2010, the proportion of elderly in the population of Pennsylvania ranked 4th (behind Florida, West Virginia and Maine). It was tied for 3rd (behind Florida and North Dakota) with 2.5 percent of the population 85 years and over. By 2030, the projected number of elderly in Pennsylvania (22.6 percent of the state population) will rank 11th. But ... "Starting on Jan 1, (2011) our 79-million-strong baby boomer generation will be turning 65 at the rate of one elderly every eight seconds.

Fewer children in New York State.

Census Bureau reports for the 2010 Census detail the slowing overall growth of the number of children, with specific emphasis on the increasing proportion of Hispanic children in the population. A review of these data at the national and state levels, in particular, New York State and its counties, is carried out with regard to potential developments in dental services for children.

Many people unable to obtain dental care due to cost.

While overall spending for dental services appears to be favorable during the period after the last recession, a review of a series of government and private agency reports indicates an increasing proportion of the population is unable to secure needed services due to cost factors. In addition, projections for annual increases in future spending for dental services are lower than for other professional health services.

Hispanics with disabilities in Texas congressional districts.

It is difficult to comprehend the difficulties faced by individuals with special needs and their families when they are couched in "mega numbers". These complications are magnified further in considering the burgeoning Hispanic population with disabilities in Texas. The need is to somehow "personalize" these numbers if we are to bring increased attention to these individuals with special needs. To this end, Census Bureau data at the Congressional District level were used to illustrate an approach to personalize the information for community residents and health practitioners.

A wake-up call: people with HIV and AIDS live longer.

A national survey found that Americans' sense of urgency about HIV/AIDS as a national health problem has fallen dramatically. A review of government and foundation reports is used to emphasize the continuing extent of the epidemic in New York State and the United States. The emphasis is on the need for dentists to consider modifications for dental services, given the reality that many individuals with HIV/AIDS are living longer.

A more intellectually, medically and physically disabled society: the case of the United States.

To bring attention to the fact that repeated emphasis on the worldwide increasing number of elderly, with only a passing reference to the magnitude and consequences of the hundreds of millions of elderly with disabilities, neglects to consider the associated burgeoning human and financial costs.

Knowing is believing: information and attitudes towards physical activity during pregnancy.

Physical activity is safe for most pregnant women and improves maternal fitness and birth outcomes. Yet, despite evidence of benefit, prevalence rates are low. Research in other populations suggests that attitudes and information are associated with physical activity. We examined the sources and types of information that women receive about physical activity during pregnancy and their association with attitudes towards prenatal physical activity. We also investigated whether particular groups of women are more likely to receive physical activity information. Questionnaires were completed by 179 ethnically and socio-economically diverse pregnant women. Women who were younger, unpartnered, less educated and had less income were less likely to report receiving information about prenatal physical activity. Receipt of information concerning benefits and risks of activity, risks of inactivity and specific techniques was associated with more favourable attitudes towards physical activity. Women who perceived low risk of birth complications also held more favourable attitudes. Some viewed all forms of physical activity as dangerous. Results suggest that providing information about benefits and risks of prenatal physical activity may motivate pregnant women to practice better health behaviours.

Mapping dental establishments in New York State just before the recession.

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

Do you consider complementary and alternative medicine in your medical history review?

Complementary and alternative medicine (CAM) represents a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional medicine. Nevertheless, 83 million adults and 8.5 million children used these products and services in 2007 alone, spending almost $34 billion out-of-pocket for many products that have not been proven and, in fact, may be contraindicated. A review is used to raise awareness and concern among dental practitioners as they consider new and current patient medical histories.

Who was using dental services just prior to the recession and how do we plan for the recovery?

Since the start of the current economic recession in December 2007, the number of unemployed persons has increased by 7.6 million to 15.1 million (as of October 2009), and the unemployment rate has doubled to 9.8 percent. The economics of dentistry during the 2007-2009 recession are considered from the perspective of earlier recessions. The eventual turnaround in the economy is considered in terms of the need for dental practices to be extended to serve the multitude of underserved individuals in our communities.

Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis.

This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2,424 patients) and STAI (34 trials, 2,029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care.

Keeping current with evolving makeup of New York State population.

The changing residential population of New York State requires continued monitoring if health practitioners are to maintain an awareness of the individuals in their community. A review of federal agency reports provides a general overview of state and national demographic and health factor characteristics.

Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.

OBJECTIVE: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. DESIGN: Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. MAIN OUTCOME MEASURES: Gestational age at delivery, birth weight, preterm delivery (<37 weeks), and low birth weight (<2,500 g). RESULTS: A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. CONCLUSION: Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancy-specific stress may be a more powerful contributor to birth outcomes than general stress.

Factors associated with depressed mood in chronic pain patients: the role of intrapersonal coping resources.

UNLABELLED: The purpose of this study was to examine processes through which chronic pain can result in depressed mood and to determine whether intrapersonal coping resources, namely high self-esteem and optimism, affect these processes. We hypothesized that pain severity contributes to depressed mood largely because pain interferes with involvement in important pursuits. We then examined whether intrapersonal resources are directly associated with pain severity, interference, and depressed mood and whether resources moderate associations between pain and interference or between interference and depressed mood. Structured interviews containing psychometrically robust measures were conducted with 141 outpatients of a university hospital-affiliated chronic pain center. As predicted, interference mediated much of the association between pain severity and depressed mood, and high resources were associated with less severe pain, less interference, and lower depressed mood. The association between pain severity and interference was stronger for people with high than people with low intrapersonal resources. The pattern of results that emerged from this study illustrates that intrapersonal coping resources may affect chronic pain patients through a variety of differentiated mechanisms. Pain severity appears to have greater adverse impact on the activity of people who possess highly positive self-views and outlook, but these resources are also associated with better emotional status. PERSPECTIVE: Pain had greater adverse impact on the activity of people with highly positive self-views and outlook, but these coping resources were also associated with better emotional status. Chronic pain sufferers with few resources may require different interventions than those with more positive views of themselves and the world around them.