Linda Lewin - Academia.edu (original) (raw)

Papers by Linda Lewin

Archives of Psychiatric Nursing, 2015

The purpose of this study was to examine the experiences of sexual abuse by 95 children of two ge... more The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.

Journal of Pediatric Health Care, 2008

Journal of Pediatric Health Care, 2012

The purpose of the secondary analysis was to determine agreement of parents and children to the i... more The purpose of the secondary analysis was to determine agreement of parents and children to the interpersonal violence (IPV) items on the Keep Your Children/Yourself Safe and Secure (KySS) survey to assess mental health concerns. A comparative, descriptive design was used to determine the level of agreement between parent/child dyads on the 15 attitude/knowledge and worry items related to IPV (n = 563 dyads). Single mother/son and 10- to 12-year-olds had less agreement than other dyad combinations and child age groups. Six of the 10 knowledge/attitude items had significant differences, including multigenerational occurrence of sexual abuse, the effect of harsh parenting, witnessing domestic violence, and incidence of physical abuse. The least agreement was on sexual abuse, incidence of physical abuse, and outcome of strict parenting (p < .001). Parents had greater worry about the parent-child relationship than did the children (p < .001). Parents and clinicians may not realize how different their understanding of IPV is from that of children. Identifying items of least agreement can inform parents and clinicians in targeting violence education and prevention.

Journal of Pediatric Health Care, 2012

Introduction: The purpose of this methodological article is to describe the development, implemen... more Introduction: The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age. Method: A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90

Journal of Human Lactation, 2012

The United States has not met the majority of the Centers for Disease Control and Prevention goal... more The United States has not met the majority of the Centers for Disease Control and Prevention goals for breastfeeding duration. Studies have shown a lack of knowledge about breastfeeding by health care professionals and students (HCP/S). Web-based education can be a cost-effective manner of education for HCP/S. "BreastfeedingBasics" is an online free educational program available for use. This study compares information in "BreastfeedingBasics" to the breastfeeding knowledge competencies recommended by the US Breastfeeding Committee (USBC). It also evaluates usage of "BreastfeedingBasics" by users and health care professional faculty. Using anonymous information from Web site users, the authors compared mean pre-test and post-test scores of the modules as a measure of the knowledge gained by HCP/S users. They evaluated usage by demographic information and used a Web-based survey to assess benefits of usage of "BreastfeedingBasics" to faculty. Overall, 15 020 HCP/S used the Web site between April 1999 and December 2009. "BreastfeedingBasics" meets 8 of the 11 USBC knowledge competencies. Mean post-test scores increased (P < .001) for all modules. Faculty reported its benefits to be free, broad scope, and the ability to be completed on the students' own time; 84% of the faculty combined the use of "BreastfeedingBasics" with clinical work. Use of "BreastfeedingBasics" can help HCP/S meet the USBC core breastfeeding knowledge competencies and gain knowledge. Faculty are satisfied with its use. Wider use of "BreastfeedingBasics" to help improve the knowledge of HCP/S may help in improving breastfeeding outcomes.

Journal of Forensic Nursing, 2012

The purpose of this study was to describe the knowledge level of nurse practitioners regarding sy... more The purpose of this study was to describe the knowledge level of nurse practitioners regarding symptoms of child sexual abuse in children with cognitive disabilities. A total sample of 43 nurse practitioners from two professional nurse practitioner organizations was surveyed to assess child sexual abuse symptoms identification in intellectually disabled children using a revised edition of the Child Sexual Abuse Knowledge Survey. Data collected showed nurse practitioners have deficits in identifying various parts of prepubescent female genitalia. The majority of nurse practitioners did not check genitalia in regular physical exams, did not feel competent to perform this type of evaluation, and were not aware of their professional organizations' position regarding checking for child sexual abuse. When assessing a child with an intellectual disability, nurse practitioners must accurately assess physical symptoms and behaviors that could have resulted from sexual abuse. Examining children for sexual abuse is a required duty of the nurse practitioner as evidenced by the position statements of the various professional organizations and nurse practitioners must be aware of their required scope of practice.

Journal of Clinical Epidemiology, 1990

We conducted a historical prospective study of 124 cystic fibrosis (CF) patients colonized with P... more We conducted a historical prospective study of 124 cystic fibrosis (CF) patients colonized with Pseudomonas cepacia (cases) and 124 sex and age matched non-colonized CF patients (controls). Thirty-two of the colonized patients died in the first year following P. cepacia colonization compared to 8 of the control patients, a highly significant difference (p less than 0.001). In the second year, there was no significant difference in mortality between the two groups. Cases as a group had poorer pulmonary function and chest X-ray scores than controls up to 2 years before P. cepacia first appeared in their sputum or throat cultures. Regression analysis of pulmonary function tests (percent predicted FEV1 and RV/TLC) for each subject from 3 years before to 2 years after colonization revealed significant differences between cases and controls in slope for FEV1 and in slope and intercept for RV/TLC. When compared separately according to gender, the differences between cases and controls are significant in females but not in males. These results suggest that patients with poor pulmonary function are more prone to colonization with P. cepacia, that a subgroup of these patients will be dramatically affected and die within a year, and that the organism continues to exert a less dramatic negative effect on the pulmonary function of those patients who survive the initial acute effects of colonization, particularly in female patients.

Journal of Addictions Nursing, 2014

Mothers who abuse substances are likely to have insecure emotional attachment with their children... more Mothers who abuse substances are likely to have insecure emotional attachment with their children, placing their children at risk for social-emotional and psychiatric conditions. Sobriety does not inevitably improve parenting. We tested recruitment methods, audiovisual (AV) recording procedures, the protocol for identifying child abuse risk, the coding of mother-child interactions, and retention of the sample for repeated measures as the first phase in examining mother-child relational quality of women in substance abuse treatment. This innovative study involved AV recordings to capture the in-vivo mother-child interactional behaviors that were later coded and analyzed for mean scores on the 64-item Parent-Child Relational Quality Assessment. Repeated measurement was planned during treatment and two months after discharge from treatment. The pilot involved a small sample (n = 11) of mother-child (<6 years) dyads. Highest and lowest ratings of interaction behaviors were identified. Mothers showed less enthusiasm and creativity but matched their child's emotional state. The children showed appropriate motor skill items and attachment behaviors. The dyad coding showed less mutual enjoyment between the mother and child. Eight of the participants could not be located for the second measurement despite multiple contact methods. AV recordings capture rich, descriptive information that can be coded for interactional quality analysis. Repeated measurement with this cohort was not feasible, thus needing to assess for additional/more frequent contacts to maintain the sample.

Issues in Mental Health Nursing, 2010

The purpose of this study is to describe mothers with serious mental illness who have experienced... more The purpose of this study is to describe mothers with serious mental illness who have experienced domestic violence and are involved with child protective services. One hundred twenty-two files from the Department of Child and Family Services were reviewed. According to this retrospective review, the majority of the mothers and children had been exposed to domestic violence (62.6%). Mothers with the diagnoses of major depression-single episode and major depression-recurrent were most likely to have disclosed domestic violence exposure, compared to mothers with other serious mental illnesses. Our findings, and that of other cited studies, support the practice of routine assessment of domestic violence in women with serious mental illnesses, identification of safe havens for mothers and children, and access to continuing parenting support for these vulnerable family groups.

Archives of Psychiatric Nursing, 2009

Purpose: To describe mothers with serious mental illness (SMI) and their children, who are involv... more Purpose: To describe mothers with serious mental illness (SMI) and their children, who are involved with child protective services. Methods: A retrospective review was conducted of 122 files from a large metropolitan Department of Child and Family Services. Findings: The most frequently occurring diagnoses in these mothers were polysubstance dependence (39.3%) and dual diagnoses (mental illness with substance abuse; 19.7%). There was an overrepresentation of African American mothers (60%) compared with the county population and a greater prevalence of child neglect (59.0%) compared with national prevalence. Most mothers and children had been exposed to domestic violence (62.6%). Mental health services were seldom utilized, and foster care was the most common placement (36.5%). Also, there was close spacing of the age of the children, with an average of 1.25 years between siblings. Conclusions: Identifying common descriptive factors of mothers with mental illness can assist in responding to mothers with SMI and their children. There is a need to coordinate services of the Department of Child and Family Service and mental health providers that address parenting and the support of children.

Academic Medicine, 1999

In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT... more In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT) with an integrated curriculum as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This study compared the performance of the first cohort of students to participate in the PCT third year with that of their classmates and determined student attitudes toward their experiences. The performances of 24 PCT and 81 traditional students on the Medical School Admissions Test (MCAT) and the United States Medical Licensure Examination (USMLE) Step 1 and 2 were compared using analysis of variance. Grades on the six core clerkships were compared using chi-square analysis. Performances of the PCT students and a subset of traditional students on the generalist school's objective structured clinical exam (OSCE) were compared using multivariate analysis. The students reported their perceptions on a questionnaire. The traditional students had significantly higher scores on the physical science section of the MCAT and on the USMLE Step 1, but at the end of year three, their USMLE Step 2 scores did not differ. Grade distributions in the core clerkships did not differ, except in psychiatry, where the PCT students received honors significantly more often. The PCT students had a lower mean score on the internal medicine National Board of Medicine Examiners shelf exam but performed better on the generalist OSCE exam. A majority of PCT students reported that they would choose the integrated third year again and recommend it to others.

Background: Standardizing the experiences of medical students in a community preceptorship where ... more Background: Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles.

Journal of Aggression, Maltreatment & Trauma, 2015

ABSTRACT Most child sexual abuse research is based on the recollections of adults whose perspecti... more ABSTRACT Most child sexual abuse research is based on the recollections of adults whose perspectives and biases might hinder identification of abuse risk factors. This study examined children’s immediate postassault reports. A convenience sample of health records of 95 children ages 6 to 14 treated in emergency departments from 2006 to 2010 was examined. Child victims’ mean age was 11.3; most were African American (87%) girls (86%) who were abused on weekends (73%). Most parents and caregivers (63%) reported alleged sexual abuse within 24 hours; 57% obtained medical help within 12 hours of abuse. Perpetrators had a mean age of 23.3, were overwhelmingly male (97%), and known to the child victims (80%), usually through their mothers, explaining why most children (57%) offered no resistance. Education, research, and health policy are needed to increase awareness of the potential for sexual abuse and physical harm to children by men known to the family.

Archives of Psychiatric Nursing, 2015

The purpose of this study was to examine the experiences of sexual abuse by 95 children of two ge... more The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.

Journal of Pediatric Health Care, 2008

Journal of Pediatric Health Care, 2012

The purpose of the secondary analysis was to determine agreement of parents and children to the i... more The purpose of the secondary analysis was to determine agreement of parents and children to the interpersonal violence (IPV) items on the Keep Your Children/Yourself Safe and Secure (KySS) survey to assess mental health concerns. A comparative, descriptive design was used to determine the level of agreement between parent/child dyads on the 15 attitude/knowledge and worry items related to IPV (n = 563 dyads). Single mother/son and 10- to 12-year-olds had less agreement than other dyad combinations and child age groups. Six of the 10 knowledge/attitude items had significant differences, including multigenerational occurrence of sexual abuse, the effect of harsh parenting, witnessing domestic violence, and incidence of physical abuse. The least agreement was on sexual abuse, incidence of physical abuse, and outcome of strict parenting (p < .001). Parents had greater worry about the parent-child relationship than did the children (p < .001). Parents and clinicians may not realize how different their understanding of IPV is from that of children. Identifying items of least agreement can inform parents and clinicians in targeting violence education and prevention.

Journal of Pediatric Health Care, 2012

Introduction: The purpose of this methodological article is to describe the development, implemen... more Introduction: The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age. Method: A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90

Journal of Human Lactation, 2012

The United States has not met the majority of the Centers for Disease Control and Prevention goal... more The United States has not met the majority of the Centers for Disease Control and Prevention goals for breastfeeding duration. Studies have shown a lack of knowledge about breastfeeding by health care professionals and students (HCP/S). Web-based education can be a cost-effective manner of education for HCP/S. "BreastfeedingBasics" is an online free educational program available for use. This study compares information in "BreastfeedingBasics" to the breastfeeding knowledge competencies recommended by the US Breastfeeding Committee (USBC). It also evaluates usage of "BreastfeedingBasics" by users and health care professional faculty. Using anonymous information from Web site users, the authors compared mean pre-test and post-test scores of the modules as a measure of the knowledge gained by HCP/S users. They evaluated usage by demographic information and used a Web-based survey to assess benefits of usage of "BreastfeedingBasics" to faculty. Overall, 15 020 HCP/S used the Web site between April 1999 and December 2009. "BreastfeedingBasics" meets 8 of the 11 USBC knowledge competencies. Mean post-test scores increased (P < .001) for all modules. Faculty reported its benefits to be free, broad scope, and the ability to be completed on the students' own time; 84% of the faculty combined the use of "BreastfeedingBasics" with clinical work. Use of "BreastfeedingBasics" can help HCP/S meet the USBC core breastfeeding knowledge competencies and gain knowledge. Faculty are satisfied with its use. Wider use of "BreastfeedingBasics" to help improve the knowledge of HCP/S may help in improving breastfeeding outcomes.

Journal of Forensic Nursing, 2012

The purpose of this study was to describe the knowledge level of nurse practitioners regarding sy... more The purpose of this study was to describe the knowledge level of nurse practitioners regarding symptoms of child sexual abuse in children with cognitive disabilities. A total sample of 43 nurse practitioners from two professional nurse practitioner organizations was surveyed to assess child sexual abuse symptoms identification in intellectually disabled children using a revised edition of the Child Sexual Abuse Knowledge Survey. Data collected showed nurse practitioners have deficits in identifying various parts of prepubescent female genitalia. The majority of nurse practitioners did not check genitalia in regular physical exams, did not feel competent to perform this type of evaluation, and were not aware of their professional organizations' position regarding checking for child sexual abuse. When assessing a child with an intellectual disability, nurse practitioners must accurately assess physical symptoms and behaviors that could have resulted from sexual abuse. Examining children for sexual abuse is a required duty of the nurse practitioner as evidenced by the position statements of the various professional organizations and nurse practitioners must be aware of their required scope of practice.

Journal of Clinical Epidemiology, 1990

We conducted a historical prospective study of 124 cystic fibrosis (CF) patients colonized with P... more We conducted a historical prospective study of 124 cystic fibrosis (CF) patients colonized with Pseudomonas cepacia (cases) and 124 sex and age matched non-colonized CF patients (controls). Thirty-two of the colonized patients died in the first year following P. cepacia colonization compared to 8 of the control patients, a highly significant difference (p less than 0.001). In the second year, there was no significant difference in mortality between the two groups. Cases as a group had poorer pulmonary function and chest X-ray scores than controls up to 2 years before P. cepacia first appeared in their sputum or throat cultures. Regression analysis of pulmonary function tests (percent predicted FEV1 and RV/TLC) for each subject from 3 years before to 2 years after colonization revealed significant differences between cases and controls in slope for FEV1 and in slope and intercept for RV/TLC. When compared separately according to gender, the differences between cases and controls are significant in females but not in males. These results suggest that patients with poor pulmonary function are more prone to colonization with P. cepacia, that a subgroup of these patients will be dramatically affected and die within a year, and that the organism continues to exert a less dramatic negative effect on the pulmonary function of those patients who survive the initial acute effects of colonization, particularly in female patients.

Journal of Addictions Nursing, 2014

Mothers who abuse substances are likely to have insecure emotional attachment with their children... more Mothers who abuse substances are likely to have insecure emotional attachment with their children, placing their children at risk for social-emotional and psychiatric conditions. Sobriety does not inevitably improve parenting. We tested recruitment methods, audiovisual (AV) recording procedures, the protocol for identifying child abuse risk, the coding of mother-child interactions, and retention of the sample for repeated measures as the first phase in examining mother-child relational quality of women in substance abuse treatment. This innovative study involved AV recordings to capture the in-vivo mother-child interactional behaviors that were later coded and analyzed for mean scores on the 64-item Parent-Child Relational Quality Assessment. Repeated measurement was planned during treatment and two months after discharge from treatment. The pilot involved a small sample (n = 11) of mother-child (<6 years) dyads. Highest and lowest ratings of interaction behaviors were identified. Mothers showed less enthusiasm and creativity but matched their child's emotional state. The children showed appropriate motor skill items and attachment behaviors. The dyad coding showed less mutual enjoyment between the mother and child. Eight of the participants could not be located for the second measurement despite multiple contact methods. AV recordings capture rich, descriptive information that can be coded for interactional quality analysis. Repeated measurement with this cohort was not feasible, thus needing to assess for additional/more frequent contacts to maintain the sample.

Issues in Mental Health Nursing, 2010

The purpose of this study is to describe mothers with serious mental illness who have experienced... more The purpose of this study is to describe mothers with serious mental illness who have experienced domestic violence and are involved with child protective services. One hundred twenty-two files from the Department of Child and Family Services were reviewed. According to this retrospective review, the majority of the mothers and children had been exposed to domestic violence (62.6%). Mothers with the diagnoses of major depression-single episode and major depression-recurrent were most likely to have disclosed domestic violence exposure, compared to mothers with other serious mental illnesses. Our findings, and that of other cited studies, support the practice of routine assessment of domestic violence in women with serious mental illnesses, identification of safe havens for mothers and children, and access to continuing parenting support for these vulnerable family groups.

Archives of Psychiatric Nursing, 2009

Purpose: To describe mothers with serious mental illness (SMI) and their children, who are involv... more Purpose: To describe mothers with serious mental illness (SMI) and their children, who are involved with child protective services. Methods: A retrospective review was conducted of 122 files from a large metropolitan Department of Child and Family Services. Findings: The most frequently occurring diagnoses in these mothers were polysubstance dependence (39.3%) and dual diagnoses (mental illness with substance abuse; 19.7%). There was an overrepresentation of African American mothers (60%) compared with the county population and a greater prevalence of child neglect (59.0%) compared with national prevalence. Most mothers and children had been exposed to domestic violence (62.6%). Mental health services were seldom utilized, and foster care was the most common placement (36.5%). Also, there was close spacing of the age of the children, with an average of 1.25 years between siblings. Conclusions: Identifying common descriptive factors of mothers with mental illness can assist in responding to mothers with SMI and their children. There is a need to coordinate services of the Department of Child and Family Service and mental health providers that address parenting and the support of children.

Academic Medicine, 1999

In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT... more In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT) with an integrated curriculum as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This study compared the performance of the first cohort of students to participate in the PCT third year with that of their classmates and determined student attitudes toward their experiences. The performances of 24 PCT and 81 traditional students on the Medical School Admissions Test (MCAT) and the United States Medical Licensure Examination (USMLE) Step 1 and 2 were compared using analysis of variance. Grades on the six core clerkships were compared using chi-square analysis. Performances of the PCT students and a subset of traditional students on the generalist school's objective structured clinical exam (OSCE) were compared using multivariate analysis. The students reported their perceptions on a questionnaire. The traditional students had significantly higher scores on the physical science section of the MCAT and on the USMLE Step 1, but at the end of year three, their USMLE Step 2 scores did not differ. Grade distributions in the core clerkships did not differ, except in psychiatry, where the PCT students received honors significantly more often. The PCT students had a lower mean score on the internal medicine National Board of Medicine Examiners shelf exam but performed better on the generalist OSCE exam. A majority of PCT students reported that they would choose the integrated third year again and recommend it to others.

Background: Standardizing the experiences of medical students in a community preceptorship where ... more Background: Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles.

Journal of Aggression, Maltreatment & Trauma, 2015

ABSTRACT Most child sexual abuse research is based on the recollections of adults whose perspecti... more ABSTRACT Most child sexual abuse research is based on the recollections of adults whose perspectives and biases might hinder identification of abuse risk factors. This study examined children’s immediate postassault reports. A convenience sample of health records of 95 children ages 6 to 14 treated in emergency departments from 2006 to 2010 was examined. Child victims’ mean age was 11.3; most were African American (87%) girls (86%) who were abused on weekends (73%). Most parents and caregivers (63%) reported alleged sexual abuse within 24 hours; 57% obtained medical help within 12 hours of abuse. Perpetrators had a mean age of 23.3, were overwhelmingly male (97%), and known to the child victims (80%), usually through their mothers, explaining why most children (57%) offered no resistance. Education, research, and health policy are needed to increase awareness of the potential for sexual abuse and physical harm to children by men known to the family.