Correction of skeletal Class II malocclusion with camouflage orthodontic treatment generally requires the extraction of the maxillary first premolars to provide space for retraction of the maxillary incisors. Retraction of incisors changes the position of the incisors and the dimensions of the dental arch, which can cause changes in tongue posture and affect the upper airway. The purpose of this study was to determine the relationship between premolar extraction on the dimensions of upper airway and tongue posture in skeletal Class II malocclusion. This study was designed as a retrospective cohort using lateral cephalometric radiographs before and after orthodontic treatment. The samples in this study consisted of 44 samples of adult patients (n = 44) aged 18-40 years, who were divided into 2 groups: 22 subjects treated without premolar extraction and 22 subjects treated with premolar extraction. Lateral cephalometric radiographic analysis were used to measure the dimensions of the upper airway by analyzing superior posterior airway space (SPAS), middle airway space (MAS), inferior airway space (IAS), vertical airway length (VAL), and tongue posture (tongue length and height tongue) using imageJ software. No Statistically significant different changes were observed as seen from the following results: SPAS (p = 0.709), MAS (p = 0.365), IAS (p = 0.562), (p = 0.401), tongue length (p = 0.578), tongue height (p = 0.086) in the sample group without extraction premolar. No significant alterations in the upper airway and tongue posture measurement were observed in the sample group with extraction premolar. Premolar extraction with retraction on upper incisors did not affect upper airway dimensions and toung posture in skeletal Class II malocclusion.
The stress nurses face in hospitals at work will greatly affect the quality of nursing services provided to patients. This study aims to analyze what factors affect the work stress on nurses. This research is a quantitative study with a research design using the analytical survey method with a Cross Sectional approach. The research was conducted at Rantauprapat Hospital, Labuhanbatu Regency. The sample was 82 nurses obtained by purposive sampling. Data analysis was performed using a univariate analysis test, Bivariate using a chi-square test, and Multivariate using multiple Logistic regression. The results showed that in the univariate analysis of 82 respondents, most of the respondents were 36-45 years old, namely 36 (43.9%), and had a D3 Nursing education level, namely 45 (54.9%). In the Bivariate analysis, it was found that there was the effect of workload on nurses' work stress (p= 0.000), there was an effect of the work environment on nurses' work stress (p= 0.000), there an effect of career development on nurse stress (p= 0.000), there was the effect of role conflict double the work stress of nurses (p= 0,000). In the multivariate analysis, the most dominant variable affecting the work stress of nurses was career development with a p value of 0.007, t count = 2.273 (r table = 0.2146). Based on the results of this study, it is recommended that the hospital provide the duties and responsibilities given should not be less or excessive so that work stress on nurses.
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