Biomedical subjects

Laura S Sadowski

Publications and source records attributed to Laura S Sadowski.

9 recordsLinked to original sources

PubMed2006

Coping with asthma in immigrant Hispanic families: a focus group study.

BACKGROUND: Little is known about how childhood asthma affects immigrant Hispanic families in the United States. Qualitative research is effective for understanding the social, cultural, functional, and structural aspects of asthma in the family context. Furthermore, such knowledge is necessary to develop culturally appropriate interventions for these families. OBJECTIVES: To describe participants' perceptions of their roles in caring for an asthmatic child, to compare family patterns of caring for an asthmatic child by parents' country of origin, to identify barriers to caring for an asthmatic child, and to evaluate specific coping needs of low-income immigrant Hispanic families caring for an asthmatic child. METHODS: Five focus groups were conducted with low-income, immigrant, Spanish-speaking Hispanic adults caring for an asthmatic child, including community health workers, mothers, fathers, and grandparents, along with women with asthma. Audiotaped focus groups were transcribed verbatim in Spanish, forward translated into English, and back translated into Spanish. Data analysis was performed using qualitative analytic methods. RESULTS: Forty-one participants represented a range of countries of origin. Different themes emerged for community health workers vs parents and grandparents and for women vs men caring for a child with asthma. All the participants reported strong beliefs in using folk medicines. Barriers identified included language, culture, poverty, lack of health insurance, and poor living conditions. CONCLUSIONS: Results highlight the lack of asthma self-management skills, diagnostic uncertainty, and the use of folk medicine as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in this vulnerable population.

Adaptation, Psychological↗

PubMed2006

Teaching cardiac examination skills. A controlled trial of two methods.

OBJECTIVE: To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings. DESIGN: Firm-based single-blinded controlled trial. SETTING: Inpatient service at a university-affiliated public teaching hospital. PARTICIPANTS: Eighty Internal Medicine residents. METHODS: The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, "demonstration and practice" (DP) (n=26) or (2) an innovative method, "collaborative discovery" (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE). RESULTS: All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings. CONCLUSIONS: Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.

Cardiology↗

PubMed2004

The world studies of abuse in the family environment (WorldSAFE): a model of a multi-national study of family violence.

The World Studies of Abuse in the Family Environment (WorldSAFE) designed and implemented a study of family violence--intimate partner violence and child abuse and neglect--using standardized methods to cover over 12,000 women in eighteen communities within five lesser-developed countries. The rationale, process and methods for developing the population-based survey are described. Standardized methods included common training of investigators and field staff, sampling strategies, eligibility criteria, instruments, data collection methods, operational definitions, analysis strategies and data management. Special features of the WorldSAFE model are described--namely an ecological conceptual framework, an extensive and broad-based dissemination strategy, and community advisory boards. The World Studies of Abuse in the Family Environment (WorldSAFE) Steering Committee and principal investigators are as follows: Bhopal (India): Gandhi Medical College, S.S. Bhambal (MD) and A.K. Upadhyaya (MD). Chapel Hill (USA): University of North Carolina at Chapel Hill, Shrikant Bangdiwala (PhD); Wanda Hunter (MPH); Desmond K. Runyan (MD, DrPH); and Laura S. Sadowski (MD, MPH). Chennai (India): Chennai Medical College, Saradha Suresh (MD) and Shuba Kumar (PhD). Delhi (India): All India Institute of Medical Sciences, R.M. Pandey (PhD). Ismailia (Egypt): Suez Canal University Faculty of Medicine, Fatma Hassan (MD, PhD). Lucknow (India): King George's Medical College, M.K. Mitra (MD) and R.C. Ahuja (MD). Manila (the Philippines): University of the Philippines School of Medicine, Laurie Ramiro (PhD); M. Lourdes Amarillo (MS); Bernadette Madrid (MD). Nagpur (India): Government Medical College, Dipty Jain (MD). São Paulo (Brazil): Escola Paulista de Medicina, Isabel Bordin (MD) and Christine Silvestre De Paula. Temuco (Chile): Universidad de La Frontera, Sergio R. Muñoz (PhD) and Beatriz Vizcarra. Thiruvananthapuram (India) formerly Trivandrum: Government Medical College, M.K.C. Nair (MD) and Rajamohanan Pillai (MD). Vellore (India): Christian Medical College, L. Jeyaseelan (PhD) and Abraham Peedicayil (MD).

Brazil↗

PubMed2004

Training and field methods in the WorldSAFE collaboration to study family violence.

INTRODUCTION: This paper describes the collaborative efforts of research teams from medical schools in India, Chile, Egypt, the Philippines, Brazil, and the United States to develop and implement a core protocol for household surveys on family violence and to conduct standardized training for field workers. Our objectives are to share successes and difficulties encountered in training and field work and to offer recommendations for similar undertakings. METHODS: Study methods, developed by a multidisciplinary group of international investigators, were documented in a procedures manual. On-site standardized training was conducted and field workers were monitored for adherence to protocol. Special attention was given to safety and ethical issues. RESULTS: Overall, the training protocol and field methods were successful with relatively few problems encountered. Study participants were receptive to the interview and cooperated in safety procedures. The most common problem in the field was interruptions of the interview, mostly by children. Community advisory boards were actively involved in some of the sites, providing guidance on the safety and logistical aspects of the study, facilitating access to study communities, and providing community service information that could be shared with all study participants. CONCLUSIONS: WorldSAFE successes were attributed to rigorous standardized training and monitoring of field work; meticulous protocol implementation; unflagging attention to the ethical issues and to safeguarding study participants, field workers, and data; and openness and trust developed among the collaborators during the extended developmental phase.

Brazil↗

PubMed2004

Intimate partner violence and the role of socioeconomic indicators in WorldSAFE communities in Chile, Egypt, India and the Philippines.

BACKGROUND: The literature documenting the influence of socioeconomic status (SES) on health and injury does not provide a clear consensus on how to account for socioeconomic indicators in population and health outcome studies across countries. The World Studies of Abuse in the Family Environment (WorldSAFE) consortium conducted a series of population-based, multi-stage probability sampling cross-sectional surveys in selected communities in five countries from 1997 to 2003 that allows for the examination of the relationship of SES with current physical and psychological intimate partner violence (IPV). METHODS: Women aged 15-49 years (n = 3975) from six urban low- and middle-income communities participating the the WorldSAFE consortium were interviewed. Using a standardized instrument, the following SES indicators were collected: dwelling ownership, land ownership, number of rooms in the house along with number of residents, toilet facilities, ownership of 13 specific individual/household items, current work status of the woman and her husband/partner, and years of formal schooling completed by the woman and her husband/partner. A family asset index was constructed using principal coordinate analysis. The outcome variables utilized in this manuscript were current (past 12 months) physical IPV, and current psychological IPV. Basic bivariate associations between the categorical predictors and outcome variables were followed by a multiple logistic regression analysis to investigate the effect of covariates on the study outcomes. RESULTS: The were considerable variability among the six sampled communities with respect to the relationship between socioeconomic indicators and current physical and psychological IPV. In general, the employment status of the woman was related to her experience of intimate partner violence, and her educational level and family's assets index were protective factors. When considered in multiple logistic regression models, the asset index was the only indicator that was consistently significant across communities. CONCLUSION: The derived asset index as an SES indicator was found to be associated with current psychological and physical IPV against women across the sampled six communities in four countries.

Adolescent↗

PubMed2004

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

BACKGROUND: Violence against women is recognized by globally as a serious health and social problem that impedes development. OBJECTIVES: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. DESIGN: Population-based household surveys. SETTINGS: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. PARTICIPANTS: Women aged 15-49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). MAIN OUTCOME MEASURES: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors of actions--namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). RESULTS: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum) 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). CONCLUSIONS: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Adolescent↗

PubMed2004

World studies of abuse in the family environment--risk factors for physical intimate partner violence.

OBJECTIVES: To identify risk factors for physical intimate partner violence against women in Chile, India, Egypt and the Philippines. DESIGN: Population-based household survey. SETTINGS: Selected urban communities in Temuco, Chile; ISmailia, Egypt; Lucknow, Trivandrum and Vellore in India and Metro Manila, Philippines. PARTICIPANTS: Women aged 15-49 years of age who care for at least one child younger than 18 years of age. The number of participants was 442 in Chile, 631 in Egypt, 506 in Lucknow, 700 in Trivandrum, 716 in Vellore and 1000 in the Philippines. MAIN OUTCOME MEASURE: Risk of and protective factors against lifetime physical IPV. RESULTS: Significant associations were found between several risk factors like regular alcohol consumption of the husband/partner, past witnessing of father beating mother, the woman's poor mental health and poor family work status, with any lifetime physical IPV. Woman's poor mental health and witnessing father beat mother were statistically significant only in a few sites. Poor family work status, differences in employment between husband and wife and experiencing harsh physical punishment during childhood, were not found to be statistically significant across all sites. Protective factors, like higher levels of husband's and wife's education, were only found to be significantly associated with any lifetime physical IPV in Trivandrum, India. Social support was not significantly associated with any lifetime physical IPV across all sites. CONCLUSIONS: These large population-based household surveys have provided empirical evidence of the widespread nature of domestic violence and the relative commonality of risk factors across sites.

Adolescent↗

PubMed2004

Spousal physical violence against women during pregnancy.

OBJECTIVE: To determine the prevalence of physical violence during pregnancy and the factors associated with it. DESIGN: A population-based, multicentre, cross sectional household survey. SETTING: Rural, slum and urban non-slum areas of Bhopal, Chennai, Delhi, Lucknow, Nagpur, Trivandrum and Vellore, in India. PARTICIPANTS: A total of 9938 women who were 15 to 49 years of age and living with a child younger than 18 years old. METHODS: Probability proportionate to size sampling of households was performed in three strata. Trained field workers administered a structured questionnaire. Women who reported domestic violence were asked about violence during pregnancy. Outcome variables included six violent behaviours: slap, hit, kick, beat, use of weapon and harm in any other way. Moderate to severe violence was defined as experience of any one or more of the following behaviours: hit, beat or kick. Odds ratios were calculated for risk and protective factors of violence during pregnancy using logistic regression. MAIN OUTCOME MEASURES: Physical spousal violence. RESULTS: The lifetime experience, during pregnancy, of being slapped was 16%, hit 10%, beat 10%, kicked 9%, use of weapon 5% and harmed in any other way 6%. Eighteen percent of women experienced at least one of these behaviours and 3% experienced all six. The overall prevalence of moderate to severe violence during pregnancy was 13%. Logistic regression showed that the factors determining whether a woman experienced moderate to severe violence during pregnancy were: husband accusing wife of an affair (OR 7.1; 95% CI 5.1 to 9.8), dowry harassment (OR 4.1; 95% CI 2.8 to 6.1), husband having an affair (OR 3.7; 95% CI 2.8 to 4.8), husband being regularly drunk (OR 3.2; 95% CI 2.6 to 4.1), low education of husband (OR 2.8; 95% CI 1.4 to 5.6), substance abuse by husband (OR 2.6; 95% CI 1.3 to 5.5), no social support (OR 1.8; 95% CI 1.1 to 3.0), three or more children (OR 1.6; 95% CI 1.2 to 2.1) and household crowding (OR 1.1; 95% CI 1.0 to 1.2). CONCLUSION: In this study, 12.9% of women experienced moderate to severe physical violence during pregnancy. Suspicion of infidelity, dowry harassment, husband being regularly drunk and low education of husband were the main risk factors for violence during pregnancy.

Adolescent↗

PubMed2002

Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial.

BACKGROUND: The value of azithromycin for treatment of acute bronchitis is unknown, even though this drug is commonly prescribed. We have investigated this question in a randomised, double-blind, controlled trial. METHODS: Adults diagnosed with acute bronchitis, without evidence of underlying lung disease, were randomly assigned azithromycin (n=112) or vitamin C (n=108) for 5 days (total dose for each 1.5 g). All individuals were also given liquid dextromethorphan and albuterol inhaler with a spacer. The primary outcome was improvement in health-related quality of life at 7 days; an important difference was defined as 0.5 or greater. Analysis was by intention to treat. FINDINGS: The study was stopped by the data-monitoring and safety committee when 220 patients had been recruited. On day 7, the adjusted difference in health-related quality of life was small and not significant (difference 0.03 [95% CI -0.20 to 0.26], p=0.8). 86 (89%) of 97 patients in the azithromycin group and 82 (89%) of 92 in the vitamin C group had returned to their usual activities by day 7 (difference 0.5% [-10% to 9%], p>0.9). There were no differences in the frequency of adverse effects; three patients in the vitamin C group discontinued the study medicine because of perceived adverse effects, compared with none in the azithromycin group. Most patients (81%) reported benefit from the albuterol inhaler. INTERPRETATION: Azithromycin is no better than low-dose vitamin C for acute bronchitis. Further studies are needed to identify the best treatment for this disorder.

Acute Disease↗