Search PubMed⌕ Search

Biomedical subjects

D Sadowsky

Publications and source records attributed to D Sadowsky.

At least 19 recordsLinked to original sources
PubMed1997

Comparing predictors of willingness to treat HIV+ patients for New York City male and female general practice dentists 50 years of age or younger.

OBJECTIVES: This article develops and compares gender-specific predictive models for willingness to treat HIV-infected patients (PHIV+) for male and female private general practice dentists (GPDs). METHODS: Based on mail survey data collected in Manhattan and Queens, New York City (73.3% response rate), hierarchical multiple regression analyses were conducted for male and female dentists 50 years of age or younger (n = 763) and for those in solo practice. RESULTS: The gender-specific predictive models (R2s = 0.72) do not differ, except for the influence of practice viability, a moderately strong, statistically significant predictor for men, while the least powerful, statistically nonsignificant predictor for women. This distinction remains for solo male and female practitioners. Informal/formal collegial norms are more influential predictors within the solo female model than within the solo male model. CONCLUSIONS: Findings are encouraging for further work in developing predictive models for clinician subpopulations, with an eye toward developing intervention strategies that reflect key predictive factors for each group.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Dentists' HIV-related ethicality: an empirical test.

This article attempts to determine to what extent, in the context of treating HIV+ patients, a sample of New York dentists has attitudes, opinions, experiences, and reported behaviors which are consistent with the core ethical principle that "the dentist's primary professional obligation shall be service to the public." The article explores and reports differences in these characteristics in two groups of dentists, one strongly agreeing that dentists are ethically obligated to treat HIV+ patients and one strongly disagreeing with the same proposition. Acceptance of extra exposure to risk among health professionals seems not to be as pervasive as it once was. Conspicuous differences in perceived risk, safety, and potential loss of income associated with HIV, as well as concerns about treating homosexuals, are apparent between the two groups of dentists mentioned above.

Attitude of Health Personnel↗
PubMed1996

Predicting dentists' willingness to treat HIV-infected patients.

Access to oral health care is extremely important for those infected with HIV, because oral findings can lead to early detection and improved staging and management of HIV infection. In addition, oral lesions associated with HIV infection are often debilitating, but can be managed effectively with proper oral health care. There is ample evidence that dentists have, at times, resisted accepting HIV positive patients (PHIV+). The intent of the research project described below was to develop and test a model predicting dentists' willingness to treat PHIV+. Data were collected from a sample of dentists practising in New York City. The dependent variable was a scale constructed of items measuring willingness to treat PHIV+ under varying conditions. Independent variables were entered into a multiple linear regression equation in iterative attempts to arrive at a model predicting dentists' willingness to treat PHIV+, which was both parsimonious and had explanatory power. The final model included five independent variables measuring: (1) perceived safety; (2) willingness to treat homosexuals; (3) perceived ethical obligation to treat PHIV +; (4) past experience; and (5) perceived norms of colleagues. Perceived safety and perceived norms of colleagues had by far the most predictive power of all independent variables. R2 for the model = 0.58.

Attitude of Health Personnel↗
PubMed1996

Differences between Asian-American and white American dentists in attitudes toward treatment of HIV-positive patients.

In a survey of Asian (n = 115) versus white (Caucasian) (n = 920) dentists practicing in two boroughs of New York City, Asian dentists expressed significantly more negative attitudes toward and more unwillingness to treat HIV-positive patients than did white dentists. Despite this consistent pattern across most survey items, the two groups were more similar regarding perceptions of professional obligation and their colleague's willingness to treat those with HIV. In an examination of the influence of acculturation processes on these attitudes, a comparison of attitude differences among the subgroup of Asian dentists receiving their dental education in the United States versus abroad showed some differences, with Asian dentists educated outside the United States expressing somewhat more negative attitudes. As Asian Americans become increasingly represented among practicing dentists in the United States, their relative unwillingness to treat HIV-positive patients may have an impact on access to oral health care among HIV-positive persons living in the United States.

Adult↗
PubMed1995

Assessing HIV-related attitudes and orientations of male and female general dentists.

This article examines differences between male and female general practitioners in private practice in New York City with regard to their attitudes and orientations toward treating HIV-infected patients. The survey asked about willingness to treat such patients and perceptions that might influence that willingness, particularly those related to safety and self-efficacy and risk of occupationally acquiring HIV. Possible explanations for gender-related differences are considered. Implications of these findings for the development of HIV-related continuing education programs are discussed.

Adult↗
PubMed1994

Effect of Salmonella endotoxin administered to the pregnant sheep at 133-142 days gestation on fetal oxygenation, maternal and fetal adrenocorticotropic hormone and cortisol, and maternal plasma tumor necrosis factor alpha concentrations.

We studied the effects of maternal exposure to endotoxin on pregnancy outcome, stimulation of the hypothalamo-hypophyseal-adrenal axes (HHAA) of ewes and their fetuses, and maternal production of tumor necrosis factor alpha (TNF alpha), a central mediator in the pathogenesis of bacterial endotoxemia. Either endotoxin (lipopolysaccharide, LPS) from Salmonella typhimurium or saline was administered to pregnant sheep (n = 10) at 137.6 +/- 3.5 days gestational age by slow i.v. infusion at 1 microgram.kg-1 total dose over a 3-h period. Fetuses of ewes treated with LPS became hypoxemic by 2.5 h after initiation of LPS infusion. Maternal ACTH increased and peaked during LPS administration to levels approximately 10-fold greater in treated than in control ewes. In contrast, fetal ACTH levels were maximum at 6-12 h. Maternal and fetal cortisol levels were significantly different from control levels by 1 and 12 h, respectively. Maternal plasma TNF alpha peaked (6-7-fold over baseline) at 1-2 h after initiation of LPS administration and steadily declined over the following 48 h. Four of 5 treated ewes either delivered or their fetuses died within 28 h. In summary, infusion of LPS caused fetal hypoxemia and stimulated both fetal and maternal HHAA followed by preterm labor by 28 h after infusion in 4 of 5 ewes. Three of the fetuses died in utero. Maternal plasma TNF alpha rose rapidly, but the specific role it may play in initiation of preterm labor remains to be elucidated.

Adrenocorticotropic Hormone↗
PubMed1994

Measuring dentists' willingness to treat HIV-positive patients.

This survey of urban dentists found that willingness to treat HIV-positive patients was not a dichotomous decision. Variables that influence a dentist's willingness to treat these patients are identified. Other studies and the impact of willingness to care are considered.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Effects of repeated administration of cocaine to the fetal sheep in the last days of pregnancy.

OBJECTIVE: There are no reports on the direct effects of repeated cocaine administration to the fetus in late pregnancy. The aim of our study was therefore to examine the effects of repeated fetal exposure to cocaine on fetal development. STUDY DESIGN: Ten fetal sheep were instrumented at 123 +/- 1 days' gestation. Five fetuses received a single daily intravenous injection of cocaine (2 mg/kg) commencing at 130 to 131 days of gestation until delivery at 132 to 144 days of gestation; those fetuses were compared with fetuses that did not receive cocaine (n = 5). RESULTS: Basal fetal arterial blood gas values, blood pressure, heart rate, and nuchal and diaphragmatic activities did not change in the days preceding labor. Fetal arterial PO2 fell after cocaine administration, but this was significant only on the first day. Cocaine induced consistent significant alterations in fetal pH and PCO2, blood pressure, and heart rate. During labor cocaine stimulated diaphragmatic and nuchal muscle activity when compared with the other days. There was no increase in diaphragmatic and nuchal muscle activity in the controls. CONCLUSION: Our studies indicate that in fetal sheep the cardiovascular and blood gas response to cocaine in late pregnancy is not altered by repeated exposure to cocaine and that cocaine stimulates fetal breathing during labor.

Animals↗
PubMed1993

Predicting dentists' perceived occupational risk for HIV infection.

This study posed two questions: what is the level of perceived occupational risk among American general practice dentists (GPDs)? What factors influence perception of occupational risk for HIV infection among GPDs? In data obtained from a national mail survey of 1351 GPDs (response rate, 88%) 31% of American GPDs expressed disagreement with the statement that HIV+ individuals can be safely treated in their office settings. Of the 16 variables entered into a multiple regression equation, 9 variables had a statistically significant influence on dentists' assessment of occupational risk. In order of their influence they were (1) concern re the economic viability of the practice, (2) ethical obligation to treat patients at risk, (3) certainty of having treated patients with HIV infection, (4) risk attributed to four accidental occupational exposures, (5) concern re treatment of homosexuals, (6) relevant continuing education exposure, (7) personal worry re transmission of HIV infection from patients, (8) implementation of infection control behaviors, (9) number of patients seen per week. Statistically nonsignificant predictors of interest included age, knowledge level re HIV transmission routes, practice location in a high prevalence area, and perceived effectiveness of infection control behaviors. Results argue for intervention programs with less focus on delivery of factual information regarding the transmission of the disease and the effectiveness of infection control techniques, and more emphasis on the themes of practice economic viability, professional ethics, and structured educational encounters involving dentists' knowing exposure to HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A model predicting dentists' willingness to treat HIV-positive patients.

Data for this study of dentists' willingness to treat HIV-positive (HIV+) individuals were derived from a survey of a probability sample of American general practitioner dentists (GPD). Data were received from 1,351 active GPD, which represented an 88% response rate. Because the outcome measure--willingness to treat HIV+ patients--is dichotomous, i.e., yes/no, logistic regression was selected as the statistical technique to be used for the creation of a predictive model. Seventeen independent variables were initially considered. The final and most parsimonious model contains six independent variables, of which perceived safety in treating HIV+ patients has the most predictive power. Fear of consequences for the practice, if HIV+ patients were seen, was also a powerful predictor, with a sense of ethical responsibility and a past history of treating HIV+ patients also being important predictive variables. Knowledge level about transmission of HIV and concern about risks associated with treating homosexuals were also significant.

Attitude of Health Personnel↗
PubMed1991

Cocaine in pregnancy: the effect of maternal administration of cocaine on the maternal and fetal pituitary-adrenal axes.

The effects of cocaine on the maternal and fetal pituitary-adrenal axis in vivo during pregnancy have not been reported. Six pregnant ewes and their fetuses underwent instrumentation at 113 to 119 days' gestation. Ewes were assigned to receive an intravenous bolus injection of vehicle or cocaine (0.5, 1.0, or 2.0 mg.kg-1) at 124 to 136 days' gestation. Maternal arterial blood gases, fetal pH and fetal PCO2 were unchanged after injection of cocaine or vehicle. After administration of 2.0 mg.kg-1 cocaine, arterial fetal PO2 fell 3.2 +/- 1.72 mm Hg (p less than 0.05) at +5 minutes, returning to baseline by +15 minutes. Maternal and fetal adrenocorticotropin levels rose within 5 minutes after the highest cocaine dose (p less than 0.05). There was a significant (p less than 0.05) increase in maternal cortisol at all doses of cocaine and in fetal cortisol at +15 minutes after the 2.0 mg.kg-1.

Adrenocorticotropic Hormone↗
PubMed1991

Lack of effect of fetal administration of cocaine on maternal and fetal plasma adrenocorticotropin, cortisol and lactate concentrations at 127-138 days gestational age.

Few in vivo studies have been done to characterize the effects of cocaine on the maternal and fetal pituitary-adrenal axis during pregnancy. We, therefore, administered cocaine (2 mg.kg-1) intravenously to 6 fetal sheep at 127-138 days of gestation. There was a transient reduction in fetal arterial pO2 with a concomitant increase in pCO2 and a prolonged fall in pH (p less than 0.05) following cocaine injection. No changes were seen in maternal pO2, pCO2 or pH. Maternal adrenocorticotropin (ACTH), cortisol and lactate were not affected by fetal administration of cocaine. Although there was a tendency for fetal plasma ACTH, cortisol and lactate to rise after administering cocaine, the increases were not statistically significant. Previous studies have shown that cocaine administration to the ewe at a similar stage of pregnancy results in increased fetal plasma ACTH concentrations. The results of the present study indicate that cocaine administration to the fetus compromises fetal gas exchange and acid-base balance but the effects on the fetal pituitary-adrenal axis are less pronounced than after maternal administration of cocaine.

Acid-Base Equilibrium↗
PubMed1991

Lack of effect of fetal administration of cocaine on maternal and fetal plasma adrenocorticotropin, cortisol and lactate concentrations at 127-138 days gestational age.

Few in vivo studies have attempted to characterize the effects of cocaine on the maternal and fetal pituitary-adrenal axis during pregnancy. We, therefore, administered cocaine (2 mg.kg-1) intravenously to 6 fetal sheep at 127-138 days of gestation. There was a transient reduction in fetal arterial pO2 with a concomitant increase in pCO2 and a prolonged fall in pH (p less than 0.05) following cocaine injection. No changes were seen in maternal pO2, pCO2 or pH. Maternal plasma adrenocorticotropin, cortisol and lactate were not affected by fetal administration of cocaine. Although there was a tendency for fetal plasma adrenocorticotropin, cortisol and lactate to rise after administering cocaine, the increases were not statistically significant. Previous studies have shown that cocaine administration to the ewe at a similar stage of pregnancy results in increased fetal plasma adrenocorticotropin concentrations. The results of the present study indicate that cocaine administration to the fetus compromises fetal gas exchange and acid base balance, but the effects on the fetal pituitary-adrenal axis are less pronounced than after maternal administration of cocaine.

Adrenocorticotropic Hormone↗
PubMed1991

Comparing dentists' attitudes and knowledge concerning AIDS: differences and similarities by locale.

A stratified random sample of 1,351 general practitioners in the continental United States was surveyed to determine dentists' attitudes relevant to treating AIDS/HIV+ patients and knowledge regarding the transmission of HIV infection. Survey results were analyzed nationally and by practice locale: high HIV+ prevalence urban areas, other urban areas, rural areas. While there are differences in fear-related HIV attitudes among GPs in the three locales, they are not present in attitude toward willingness to treat and knowledge of AIDS transmission. For dentistry, such findings in large part refute the National Commission on AIDS charges regarding the treatment of AIDS in rural America.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The use of direct mail to increase clinician knowledge: an intervention study.

A probability sample of American general practitioner dentists, 40 years of age or older, in solo private practice, was the target of two direct mail interventions offered at two different times, to test whether knowledge regarding prophylaxis of patients at risk for infective endocarditis could be improved. Tests of knowledge were responses in a mail questionnaire to clinical vignettes, designed to elicit the content of antibiotic regimens used for patients at risk. The research design enabled detection of (1) the effect of the interventions; (2) the differences in their effect; (3) the attenuation of their effect; and (4) the effect of time. Where baseline knowledge was low, it was improved and did not rapidly disappear. Both mail interventions were equally effective, in most instances, and there was no attenuation of the interventions' effect and no effect of time on the control groups' knowledge over a 4 1/2 month period. The results suggest that it is possible to improve clinicians' knowledge of expert recommendations through direct mail intervention.

Adult↗
PubMed1991

Dentists' sources of information about patient medications and other issues of medical management.

The frequency of use of sources of information about medications used for patients and other issues of medical management are analyzed in a national sample of general practice dentists (GPs). Subgroups of urban/rural, solo/nonsolo, and younger/middle-aged/older dentists are examined for differences between groups. Assessing mean frequency of use for the entire group, the most frequently used sources of medical information are: 1) the consultant network; 2) the patient's physician; and 3) the Physicians' Desk Reference (PDR). Professional meetings, professional journals, and pharmaceutical detail people are the least frequently used sources. Frequency of use of information sources is related to solo/nonsolo status and to age, but not locale.

Adult↗