Biomedical subjects

Frank Putnam

Publications and source records attributed to Frank Putnam.

7 recordsLinked to original sources

PubMed2006

Hypothalamic-pituitary-adrenal axis function in dissociative disorders, post-traumatic stress disorder, and healthy volunteers.

BACKGROUND: This study investigated basal and stress-induced hypothalamic-pituitary-adrenal (HPA)-axis alterations in dissociative disorders (DDs). METHODS: Forty-six subjects with DD without lifetime post-traumatic stress disorder (PTSD), 35 subjects with PTSD, and 58 healthy comparison (HC) subjects, free of current major depression, were studied as inpatients. After a 24-hour urine collection and hourly blood sampling for ambient cortisol determination, a low-dose dexamethasone suppression test was administered, followed by the Trier Social Stress Test. RESULTS: The DD group had significantly elevated urinary cortisol compared with the HC group, which was more pronounced in the absence of lifetime major depression, whereas the PTSD and HC groups did not differ. The DD group demonstrated significantly greater resistance to, and faster escape from, dexamethasone suppression compared with the HC group, whereas the PTSD and HC groups did not differ. The three groups did not differ in cortisol stress reactivity, but both psychiatric groups demonstrated a significant inverse correlation between dissociation severity and cortisol reactivity, after controlling for all other symptomatology. The PTSD subgroup with comorbid DD tended to have blunted stress reactivity compared with the HC group. CONCLUSIONS: The study demonstrates a distinct pattern of HPA-axis dysregulation in DDs, emphasizing the importance of further study of stress-response systems in dissociative psychopathology.

Adult↗

PubMed2005

Physician knowledge and management of children exposed to domestic violence in Ohio: a comparison of pediatricians and family physicians.

Active members of the Ohio chapters of American Academy of Family Physicians (FP=1,498) and American Academy of Pediatrics (Ped=1,725) were surveyed about their knowledge and management regarding children exposed to domestic violence (DV). Characteristics of respondents were analyzed by use of Chi-square analysis. Logistic regression was performed to identify predictors of DV knowledge and management. The response rate was 33.3%. Family physicians were more likely to know their local DV agency and recognize the adult symptoms of DV, such as unexplained injury. Pediatricians were more likely to report the child who saw a fight between parents to child protective services. Continuing work to increase physicians' comfort and ability to assess for DV and manage exposed children is needed.

Adult↗

PubMed2005

Intimate partner violence research in the health care setting: what are appropriate and feasible methodological standards?

The past 20 years of research has exposed the profound cost of intimate partner violence (IPV) in health care problems and health care dollars for victims and bystanders. As a result, professional organizations encourage clinicians to identify IPV victims and to refer them to community resources. To date there is little evidence to show the value of these efforts, and many completed studies are criticized for methodological weaknesses. IPV studies are challenging to design, and the double-blind randomized controlled trial may be an impossible standard. To move forward, funders and study committees are encouraged to reassess the standards for IPV research methodologies.

Battered Women↗

PubMed2004

Heart period and variability findings in preschool children with posttraumatic stress symptoms.

BACKGROUND: Traumatic experiences for young children might result in profound neurodevelopmental changes, compared with adults. Our aim was to examine autonomic control of heart rate in traumatized young children. METHODS: Sixty-two children who had suffered traumas and 62 nontraumatized control children, aged 20 months to 6 years, were assessed for posttraumatic stress disorder (PTSD) symptoms, interbeat interval, respiratory sinus arrhythmia (RSA), family rehearsal of the trauma, and parent-child relationship quality. RESULTS: Traumatized children with PTSD and traumatized children without PTSD both had decreased heart period in response to a trauma stimulus relative to the nontraumatized group (both p < .0167). there was no main effect for RSA change scores, however, there was a significant interaction effect between parental positive discipline with PTSD symptoms and RSA. The most sympathetic children had decreased RSA during the trauma stimulus when they had caregivers with less positive discipline during a clean-up nd family rehearsal with PTSD symptoms. CONCLUSIONS: These findings underscore that psychopathology in young children ought to be assessed in the context of psychophysiology and parent-child relationship to optimally understand the mechanisms of maladaptation during this complex developmental period.

Adaptation, Psychological↗

PubMed2004

What are providers' reporting requirements for children who witness domestic violence?

Each year, 3.3 to 10 million children are exposed to domestic violence/abuse (DV). Providers' reporting obligations for these children are unclear. The child maltreatment statutes available on state's web sites (through August 2003) were reviewed. Only Alaska defines DV in the presence of a child as child abuse within its juvenile code. Within their child abuse definition and reporting statutes, many states include language such as "substantial risk" or "imminent danger" of "physical harm" or "mental injury." Although knowledge of the state law is an important first step, abiding by it may be challenging because most statutes are open to wide interpretation. As a result, providers are encouraged to seek advice from local child maltreatment specialists who understand the local legal interpretations and resources.

Child↗

PubMed2003

Every user succeeds.

By applying proven models in user-interface design and training, we deployed a Web-based data collection and reporting system that has been enthusiastically embraced by users with limited computer equipment and skills. Social workers and nurses now submit forms paperlessly as they visit thousands of new mothers across seven counties. The value of the underlying database has been enhanced by immediate validity checks, up-to-the-minute summary reports, and instantaneous access to all previous entries.

Ambulatory Care Information Systems↗

PubMedDate not supplied

Mothers' comfort with screening questions about sensitive issues, including domestic violence.

PURPOSE: To assess patient ratings of comfort alone and in front of children with 5 domestic violence (DV) screening questions designed with less graphic language compared with questions about other sensitive issues. METHODS: A sample of mothers (n = 200), including a small sample of Spanish-speaking women, were recruited from community locations. Mothers rated their perceptions of comfort for answering 13 sensitive issue screening questions (including sexual risk, substance abuse, depression, and DV questions). Logistic regression was performed to analyze participants' characteristics with respect to summary comfort scores. In addition, 40 mothers were asked to talk about their comfort in answering the DV questions. These interviews were audiotaped and analyzed. RESULTS: Mothers preferred to answer all questions alone. Comfort with answering the DV screening questions in front of their children was higher than comfort with sexual risk or depression questions and was similar to comfort with substance abuse questions. Latina mothers had more discomfort with the DV questions than other ethnicities. CONCLUSIONS: Although mothers were more comfortable with answering sensitive questions alone than in the presence of children, this may not be feasible in busy offices. General DV questions may be appropriate to ask in front of children as an initial screen.

Adult↗