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Biomedical subjects

C Kunzel

Publications and source records attributed to C Kunzel.

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

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

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

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↗
PubMed1989

Professional life cycle changes and their effect on knowledge level of dental practitioners.

Utilizing a national data set (U.S.A.), the effect of age and age-related professional characteristics on dentists' knowledge with regard to prevention of infective endocarditis was examined. The following research questions were addressed: (1) Do age-related characteristics produce different effects on knowledge level at various stages of professional careers?; (2) What are the key changes in these age-related characteristics and what processes are suggested by these changes? Multiple regression analysis assessed the influence of potential predictors of variation in knowledge level with regard to prevention of infective endocarditis for the entire sample. Using these findings as a guide, variation in the effect of significant predictor variables was then analyzed for three time segments of approximately equal duration: early professional life less than 40, mid-professional life 40-54, and older professional life 55 or greater than. Age had a profoundly negative effect on knowledge level, i.e. the level progressively declines as clinicians grow older. The impact of the age-related characteristics on knowledge level of infective endocarditis prevention also varied according to the stage of the professional life cycle. Indices measuring the size or extent of theoretical understanding, in-office networks, institutional affiliations, and consulting networks were significant predictors of endocarditis prevention knowledge for younger clinicians. For those 40-54, only practice organization (office business and staff size and diversity) was a significant predictor, while for older clinicians theoretical understanding was the only significant predictor. Differences in the mean levels of these predictor (independent) variables across age groups were also examined via ANOVA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

'Usual and customary' practice versus the recommendations of experts: clinician noncompliance in the prevention of bacterial endocarditis.

Data were collected from a representative sample of American general practitioners to ascertain adherence to the recommendations by the American Heart Association (AHA) concerning management of patients at risk for bacterial endocarditis. Inconsistencies were found in the prescribing of appropriate risk-related therapies such as proper timing, selection of antibiotics, and associated dosages. It is suggested that clinicians' compliance level with these recommendations may be raised by a careful reading of the AHA's latest findings.

Adult↗
PubMed1989

Knowledge acquisition processes: dissemination of expert recommendations to general practice dentists.

We examined structural determinants of general practice dentists' knowledge of the most recent American Heart Association recommendations for the prevention of bacterial endocarditis. Using data from a 1986 national telephone survey of 578 respondents (response rate = 81%), we developed and analyzed a structural model, in which we investigated the contributions to knowledge by age, professional practice settings, colleague networks, and formal educational experiences. Age, practice organization, and institutional affiliations are direct contributors to knowledge. Formal professional channels of reeducation do not contribute directly to knowledge level; rather, their effect is expressed through institutional affiliations.

Age Factors↗
PubMed1988

Dentists' knowledge, case-finding behavior, and confirmed diagnosis of oral cancer.

A questionnaire was developed for dental general practitioners that was used to measure three types of clinician knowledge believed to be central to the early detection and management of oral cancer. Oral cancer management issues (case-finding behavior and clinician knowledge of patient outcomes) were also studied. The hypothesis that clinician knowledge is associated with oral cancer case-finding behavior could not be validated, but the hypothesis that clinician case-finding behavior is associated with knowledge of confirmed oral cancer or precancerous diagnoses was substantiated.

Analysis of Variance↗
PubMed1988

Recommendations for prevention of bacterial endocarditis: compliance by dental general practitioners.

Telephone interviews were conducted with a national sample of general practice dentists (n = 460). Clinical vignettes were used to test clinicians' knowledge of, and compliance with, the 1984 American Heart Association (AHA) recommendations for prevention of bacterial endocarditis. Analyses of the data document a relatively low level of knowledge of correct indications and regimens for antibiotic prophylaxis to prevent endocarditis. Respondents were unsure, and often incorrect, about the relationship between a variety of cardiac conditions and potential risk for endocarditis. Compliance with the guidelines for proper dosage and timing of antibiotics was also problematic. Those clinicians who had a better understanding of patient risk factors and the principles underlying the AHA recommendations were more likely to follow them, as were practitioners who kept a copy of the recommendations in the office. The findings are significant in view of previous suggestions that use of inappropriate antibiotic regimens may predispose to adverse outcomes.

American Dental Association↗