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Biomedical subjects

P A Hulme

Publications and source records attributed to P A Hulme.

8 recordsLinked to original sources
PubMed2000

Symptomatology and health care utilization of women primary care patients who experienced childhood sexual abuse.

OBJECTIVE: The purpose of this study was to (1) determine the symptomatology of women primary care patients who experienced childhood sexual abuse (CSA), using both a self-report survey and a chart review, and (2) determine their health care utilization patterns, using chart and information system reviews. METHOD: An ex post facto research design was used. Women primary care patients who experienced CSA were compared with those who reported no CSA. Participants were recruited from a random sample of women patients from a large primary care clinic. They were mailed the survey; chart and information system reviews were conducted on those who returned surveys. RESULTS: Of the 395 participants, 23% reported past CSA on the survey. Women who experienced CSA reported 44 out of 51 physical and psychosocial symptoms more frequently than their counterparts who reported no past CSA. Further, they experienced these symptoms more intensely and in greater number. In their charts, however, far fewer differences in symptoms between groups were found. Nonetheless, women who experienced CSA visited the primary care clinic an average of 1.33 more times than women with no CSA, and they incurred an average of $150 more in primary care charges over a 2-year period. CONCLUSIONS: The findings indicate that many women primary care patients who experienced CSA suffer multiple symptoms that are not reflected in their charts. In addition, the findings demonstrate that not only is CSA associated with increased primary care visits, but also increased primary care costs, as measured by charges.

Adult↗
PubMed1999

Residential status and birth outcomes: is the rural/urban distinction adequate?

In studies comparing the birth outcomes of rural and urban women, residency status is frequently defined dichotomously as either rural or urban. Since residency status appears to be a continuum, however, the usefulness of other categorization systems needs to be explored. The purpose of this study was to compare birth outcomes using a three-level variable for residency status (rural, rural adjacent to urban, and urban). The study population was comprised of women who delivered by cesarean section over an 18-month period (N = 263) at a tertiary care hospital. Data were collected from patient charts, interviews, and the hospital information system. Residency status was determined by county of residence. Birth outcomes examined included gestational age, birthweight, Apgar scores, maternal complications, length of hospital stay, and costs of hospital care. Rural women had worse birth outcomes overall and traveled the greatest distance for delivery. Rural-adjacent women had the best birth outcomes of the three groups, yet were the youngest, least educated, least likely to be married, and the least likely to be privately insured. By using a nondichotomous three-level variable for residency status, two distinct groups of rural women were identified whose maternal health care needs may differ from each other.

Adult↗
PubMed1998

Healthcare reform in Puerto Rico. Managed care in a unique environment.

To reduce healthcare costs, Puerto Rico has adopted an innovative managed-care program to replace its old public healthcare system. Under the new program, healthcare funding for the medically indigent is being transferred from government-run hospitals and clinics to contracted private insurers who provide a wide range of services on a capitated payment plan. This well-planned initiative addresses the need to cut healthcare costs in Puerto Rico, but whether it will successfully meet the healthcare needs of beneficiaries in the long run is up for debate.

Health Care Reform↗
PubMed1996

Somatization in Hispanics.

1. Major psychological disorders are found universally, but their form and content are modified by culture. In addition, the expression of psychosocial distress is largely shaped by cultural values and beliefs. 2. Preliminary research indicates Hispanics are more likely to somatize than Anglos when experiencing psychosocial disorders or psychosocial distress. 3. Additional research is required into the sources of stress for hispanic women, especially those born in the United States, and its effect on their health.

Adult↗
PubMed1996

Geriatric hemodialysis patients: a comparative study of vascular access.

OBJECTIVES: To compare vascular access in hemodialysis patients > or = 65 years of age with those < 65 years on the following: 1) comorbid disease status, 2) types of vascular access used, and 3) outcome. SAMPLE/SETTING: Hemodialysis patients in a four-state region (Iowa, Kansas, Nebraska, and Missouri) from both free-standing and hospital-affiliated providers were sampled (n = 267). A stratified sampling strategy was used in order to obtain approximately equal-sized age groups (< 65 years and > or = 65 years). DESIGN: A descriptive, longitudinal study with a 1-year follow-up period. METHODS: Following the placement of a permanent vascular access, information was collected by the dialysis nursing staff about the configuration of the access, needle gauge used for cannulation, dialysis prescriptions, diabetic status, and other comorbid disease conditions. Odds ratios (OR) for vascular access thrombosis (VAT) risk were calculated between the two age groups. RESULTS: Comparisons between the two age groups suggest a higher frequency of polytetrafluorethylene (PTFE) grafts in the > or = 65-year-old age group. Peripheral vascular disease (PVD) prevalence was also higher in elders. Oral anticoagulants reduced the risk of VAT in those < 65-year-old group. Patients age > or = 65 years with a PTFE graft experienced a higher risk of VAT (OR 3.38, 95% confidence interval 1.43, 8.11) than those in the same age group with an arteriovenous fistula (AVF). CONCLUSIONS: PTFE grafts are used more frequently among geriatric hemodialysis patients, possibly due to the increased prevalence of peripheral vascular disease (PVD). While use of oral anticoagulants is effective in reducing the risk of VAT among those < 65 years, it did not significantly reduce VAT risk in geriatric hemodialysis patients. This observation may be due to the higher frequencies of PTFE grafts in elderly patients.

Aged↗
PubMedDate not supplied

Symptoms of female survivors of child sexual abuse.

Women who suffered sexual abuse as children often experience a variety of physical and psychosocial symptoms as adults. Identifying this pattern of symptoms might assist health professionals in recognizing and treating nonreporting survivors of child sexual abuse. In this study, the Adult Survivors of Incest (ASI) Questionnaire (Brown & Garrison, 1990) was used to determine the symptoms and contributing factors for 22 adult survivors of child sexual abuse. Six physical symptoms were experienced by 50% of the subjects, and over 75% of the subjects experienced 11 psychosocial symptoms. The number of physical symptoms correlated significantly with other victimizations (r = .59) and number of psychosocial symptoms (r = .56). The findings suggest that the ASI Questionnaire was effective in identifying patterns of symptoms and contributing factors of adult survivors of child abuse. Additional study is needed to determine the usefulness of this questionnaire in identifying nonreporting survivors in clinical situations.

Adolescent↗