Tooth wear: prevalence and associated factors in general practice patients.

OBJECTIVES: To estimate the prevalence of tooth wear and to investigate factors associated with tooth wear in patients from general practices in the Northwest United States. METHODS: Data on the diagnosis and treatment of oral diseases during the previous year were collected in a survey with a systematic random sample of patients (n= 1530) visiting general dentists from the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) (n=80). Prevalence ratios (PRs) of moderate to severe occlusal and incisal tooth wear by patient characteristics were estimated using cluster-adjusted multiple binomial regression for adults (18+ years) and children/adolescents (3-17 years). RESULTS: For adults, the mean number of teeth with wear facets was 5.4 [95% confidence interval (CI) =4.6-6.2] and 51% of the adults had four or more teeth with wear. Participants 45-64 and 65+ years old were 1.3 (95% CI=1.1-1.6) and 1.4 (95% CI=1.1-1.8) times as likely to have 4+ teeth with moderate to severe wear facets as participants 18-44 years old. Adult males had a 20% (PR=1.2; 95% CI=1.1-1.4) higher prevalence of wear than adult females. Adults who were using, or had ever used occlusal splints had higher prevalence of tooth wear compared to those who never used such appliances (PR=1.3; 95% CI=1.0-1.5). Adults with any periodontal bone loss also had a 20% higher prevalence of wear than adults without periodontal disease (PR=1.2; 95% CI=1.0-1.4). For children/adolescents, the mean number of teeth with moderate to severe wear facets was 1.6 (95% CI=0.9-2.6) and 31% of the children had one or more teeth with wear facets. The adjusted prevalence ratio of tooth wear (1+ teeth with wear facets) for boys was 1.6 times as high (95% CI=1.1-2.4) as compared with girls. The prevalence of wear for children 12+ years old was 50% (PR=0.5; 95% CI=0.3-0.8) lower than that of children <12 years old. Angle's class II was associated with higher tooth wear prevalence (PR= 1.8; 95% CI=1.3-2.6) than class I. Children with posterior or anterior open bite had lower prevalence of wear than their counterparts (PR=0.6; 95% CI=0.3-1.0). No associations were observed between tooth wear and orthodontic treatment, missing teeth, and race/ethnicity. CONCLUSION: Tooth wear is a prevalent condition in this population. Among adults, higher prevalences of tooth wear were observed among those who were older, males, had used occlusal splints and had periodontal disease. Among children, higher prevalences were associated with younger age, male gender, class II malocclusion and the absence of open bite. Submitted on behalf of the Northwest PRECEDENT network, with support from NIDCR grants DE016750 and DE016752.

Lexical access in Chinese speech comprehension and production.

This paper offers a description of Chinese speech comprehension and production processes that demonstrates why the word is the unit of lexical access-the Lexical Unit-in Chinese natural speech. It is argued that an access model which posits the morpheme as the Lexical Unit would be unlikely, as it must assume for Chinese either a real-time morpheme combination algorithm (i.e., an on-line grammar that takes morphemes as basic combinatory units) or an improbable lexical processing mechanism in which morphemes are identified as the first step in accessing precompiled words.

Above reproach: developing a comprehensive ethics and compliance program.

How can a healthcare organization improve the public's confidence in the conduct of its business operations? What can it do to ensure that it can thrive despite being the subject of public and governmental scrutiny and doubt? Healthcare providers must establish standards of conduct that are above reproach and ensure that those standards are clearly articulated and strictly adhered to. This article describes the merits of a comprehensive ethics and compliance program, suggests five basic elements of such a program--organizational support/structure, setting standards, creating awareness, establishing a mechanism for reporting exceptions, and monitoring and auditing--and then demonstrates how those elements should be applied in several high-risk areas. Fundamentally, an ethics and compliance program has two purposes: to ensure that all individuals in an organization observe pertinent laws and regulations in their work; and to articulate a broader set of aspirational ethical standards that are well-understood within the organization and become a practical guideline for organization members making decisions that raise ethical concerns. Every ethics and compliance program should contain certain fundamental aspects. First, the effort must have the active support of the most senior management in the organization. To instill a commitment to ethics and compliance absent a clear and outspoken commitment to such purposes by organization leaders is simply impossible. Second, an ethics and compliance program is fundamentally about organizational culture--about instilling a commitment to observe the law and, more generally, to do the right thing. Third, ethics and compliance are responsibilities of operating management (sometimes called line management). Although staff such as compliance officers are obligated to provide the necessary resources for a successful program and to design the program, such staff officers cannot achieve implementation and execution. Only operating managers can do that. Fourth, an ethics and compliance effort should be about the conduct of individuals, not about "checking the boxes" in a model plan or generating attractive written or educational materials. Such an effort is about individuals on a day-to-day basis knowing what is expected of them and doing it and about never compromising integrity, regardless of pressures faced. A great deal of progress has been made in healthcare organizations in the development of increasingly sophisticated ethics and compliance programs. A particularly energetic focus has been placed on these programs since formal government guidance regarding compliance programs was first issued in the laboratory area about two years ago and as more sophisticated automated monitoring tools have been developed. As ethics and compliance programs have become more sophisticated, certain best practices have been established. This discussion will set forth approaches to ethics and compliance in the context of what are believed to be illustrative best practices. Much of what is described here is descriptive of the efforts of Columbia/HCA Healthcare Corporation from October 1997 to the present; however, this article has been presented not as a mere descriptive piece but rather as a set of normative guidelines. We hope that other healthcare providers will find this to be of practical use. Provider settings pose certain unique challenges that are specifically addressed in this discussion; however, many of the issues raised can be adapted to other healthcare organizations. For simplicity's sake, because the authors of this article all work on a daily basis primarily with hospitals, the article is written from a hospital perspective.

The Job Context Index: a guide for improving the 'fit' between nurses and their work environment.

Stress and burnout have reached crisis levels among hospital nurses. The authors of this paper address this problem with the development of a scale to improve the 'fit' between a nurse and his/her work environment, thereby potentially increasing satisfaction, and reducing stress and burnout. Approximately 1000 hospital nurses, randomly selected from a large eastern state, described their work in each of 10 clinical areas; their reports enabled the construction of the Job Context Index, which rank orders the 10 settings on three dimensions, including general work pressure/uncertainty, routinization of tasks, and co-worker interdependence. Nurses, as well as educators and administrators, may find their index a useful tool for matching nurses' temperaments and workstyles with the characteristics of the clinical areas in which they might be working.

Occupational stress among nurses in hospital settings.

1. This study provides empirical evidence for the repeated statements by hospital nurses that their work situation is overwhelmingly stressful. 2. Stress seems to arise from the overall complexity of nurses' work rather than specific tasks required of nurses. 3. Stressors are uniform across clinical areas, especially with regard to perceived work pressure. 4. Among the most frequently cited stressors for nurses in nearly every hospital setting were "keeping track of many things"; "It is hard to predict what will happen each day"; and "Simple mistakes could have dire consequences."

In search of the moral foundation of nursing.

This article is offered as an extension of the work of Yarling and McElmurry, who ostensibly discussed the moral foundations of nursing. They did not actually broach their intended topic, but they did offer important clues for further analysis. This presentation attempts to show how the moral foundation of nursing might be discerned by indicating both its linkage to the great moral ideas and certain confusions in current nursing ideology. It is claimed that the moral foundation of nursing--indeed, the moral inspiration at the heart of nursing practice--must come from a clearly developed understanding of the idea of nursing.

Subjective stress, job satisfaction, and job performance of hospital nurses.

This research concerns the relationship of subjective stress, job satisfaction, and job performance in hospital nurses. Obtained were self reports from 366 nurses, and performance ratings from 165 supervisors and 139 co-workers nominated by the original respondents. Reported are the results of exploratory path analyses, based on a general model, whereby standardized beta coefficients were used to estimate paths. The findings are that stress and job satisfaction are not directly related, and that stress, primarily acting through depression, is associated with lower levels of job performance. Job satisfaction is unrelated to job performance, and is based on depression and hostility which are affected by stress and personal characteristics.

Tone production deficits in nonfluent aphasic Chinese speech.

Previous studies demonstrating a right hemisphere lateralization of musical, tonal, and intonational stimuli had suggested that in aphasic tone language speakers, the tonal phonemes might be subject to a lesser degree of deficit than consonantal phonemes. Using a word repetition task, this research demonstrates that left-damaged nonfluent aphasic speakers of Chinese experience a tonal production deficit which is both quantitatively and qualitatively equivalent to the deficit experienced by these speakers in the production of consonants. It is suggested that in tone languages, lexical specification of tone contour information results in left hemisphere lateralization of that information, thus making the tonal phonemes vulnerable to left hemisphere damage.