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PubMed2000

Reconceptualizing the work-family interface: an ecological perspective on the correlates of positive and negative spillover between work and family.

Ecological theory was used to develop a more expanded conceptualization of the work-family interface and to identify significant correlates of multiple dimensions of work-family spillover. Using data from employed adults participating in the National Survey of Midlife Development in the United States (N = 1,986), negative spillover from work to family, positive spillover from work to family, negative spillover from family to work, and positive spillover from family to work were found to be distinct work-family experiences. Analyses indicated that work and family factors that facilitated development (e.g., decision latitude, family support) were associated with less negative and more positive spillover between work and family. By contrast, work and family barriers (e.g., job pressure, family disagreements) were associated with more negative spillover and less positive spillover between work and family. In some cases, results differ significantly by gender.

Adult↗
PubMed2003

Functioning of child maltreating families: lack of resources for caring within the family.

The purpose of this study was to develop a preliminary theoretical model of functioning of child maltreating families. Child maltreatment was defined as physical, psychological or sexual abuse or neglect caused by the child's primary caregivers. The aim was to generate knowledge needed in developing understanding and the care of these families. Data were collected using interviews with open-ended questions from child maltreating families (n = 20). Transcribed interviews were analysed by using grounded theory and its constant comparative method. The categories of family functioning included structural factors of the family, relationships between family members, relationships outside the family, family strengths, and risk factors and manifestations of maltreatment. The relationships that emerged between these categories included conflicts and negative circles of family life and the effects of child maltreatment on the family. Lack of resources for caring within the family emerged as the core category which described the phenomenon in general and was connected to all other categories of family functioning. The findings can be useful in developing the care of child maltreating families, in nursing education and in preventing child maltreatment.

Adolescent↗
PubMedDate not supplied

Family-provider relationships and well-being in families with preterm infants in the NICU.

OBJECTIVE: The purposes of this study were the following: (1) to describe maternal perceptions of family-provider relationships in the neonatal intensive care unit (NICU) and (2) to examine associations between maternal perceptions of family-provider relationships in the NICU and well-being in families with preterm infants. DESIGN: The study's design was descriptive and correlational. SETTING: The study took place in 5 NICUs in midwestern United States. PARTICIPANTS: The study included 55 mothers of preterm infants hospitalized in the NICU. MEASURES: Self-report measures: the Family-Provider Relationships Instrument-NICU, Ryff's measure of psychologic well-being, and the General Scale of the Family Assessment Measure. RESULTS: Mothers of preterm infants who depicted their family's relationship with their child's primary health care providers in the NICU as positive and family-centered reported more satisfaction with the care received. In addition, these mothers expressed a greater willingness to seek help from health care providers. When mothers reported a discrepancy between what they wanted the family-provider relationships to be like and what they believed the relationship was like, they were less satisfied with care received. Mothers who wanted and believed they had positive family-centered relationships with providers were more satisfied with the care received and they reported higher levels of psychologic well-being. CONCLUSION: The nature of the relationships that families develop with health care providers in the NICU may have a profound influence on how individuals and families respond to the experience of having a preterm infant. Health care providers who incorporate the key elements of family-centered care into their practice can have a positive influence on well-being in families of preterm infants.

Adolescent↗
PubMed1998

Family dynamics of families with cancer in Finland.

The purpose of this study was to describe family dynamics of families with cancer on the basis of Barnhill's framework for healthy family systems. The sample consisted of families in which one member had cancer. Both the patients (n = 96) and their relatives (n = 96) participated in the study (n = 192). The data for the study were collected using the Family Dynamics Questionnaire and the Family Dynamics Measure. The results indicated that the cancer of a single family member did not impair family functioning, but that family dynamics were considered quite good. There were no statistically significant differences between cancer patients and relatives on any of the family dynamics dimensions. However, an examination of sociodemographic characteristics did reveal some differences. Older relatives reported more enmeshment and rigidity than did younger relatives, whereas the latter reported more role conflict than older relatives. Older patients reported more rigidity than younger patients. Relatives who were men reported more enmeshment than women, whereas women reported more role conflict. Relatives of two-member families reported more rigidity than relatives with a larger family. Patients who reported a serious illness in the family described more mutuality, better flexibility, and clearer communication than patients who did not report such an illness. Also, relatives who mentioned a serious illness reported more mutuality and flexibility.

Adaptation, Psychological↗
PubMed2000

Familial clustering of symptoms and disruptive behaviors in multiplex families with attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine familial clustering of attention-deficit/hyperactivity disorder (ADHD), ADHD subtypes, symptoms, and oppositional behaviors in affected sibling pairs (ASPs) and their parents. METHOD: One hundred thirty-two ASPs, ranging in age from 5 to 25 years and ascertained through clinic and volunteer referrals, were examined for DSM-IV ADHD subtypes, oppositional defiant disorder (ODD), and conduct disorder (CD) with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Two hundred fifty-six parents in these families were assessed by means of the SADS-Lifetime version, Modified for the Study of Anxiety Disorders, Updated for DSM-IV (SADS-LA-IV), and the Behavioral Disorders supplement of the K-SADS-PL to determine ADHD, ODD, and CD. RESULTS: Fifty-five percent of families ascertained through an ASP have at least one parent with a lifetime diagnosis of ADHD. The frequency of ADHD in at least one parent was higher in families with at least one affected girl (63%) than in families with only affected boys (45%) (p = .02). There was no evidence that affected siblings or parents within ASP families showed similar patterns of ADHD symptoms, such as ADHD subtype classification. In contrast, CD significantly clustered in ASP families. CONCLUSIONS: The sex difference in prevalence of ADHD among ASPs is consistent with a model of inheritance in which girls require a greater loading of familial influences to develop ADHD. The lack of familial clustering of ADHD symptoms within ASP families suggests that hyperactive and inattentive symptoms reflect common familial underpinnings and not unique familial effects. In contrast, CD seems to reflect unique familial underpinnings distinct from those underlying ADHD.

Adolescent↗
PubMed2003

Increased risk of breast cancer in relatives of malignant melanoma patients from families with strong cancer familial aggregation.

The aim of this study was to evaluate the risk of occurrence of malignancies of different site of origin in patients with malignant melanoma (MM) of the skin and their first-degree relatives from families with cancer familial aggregations with unknown pathogenetic background (CFA). We analysed tumour spectrum and age at diagnosis of malignancies in 51 families with MM/CFA. In addition, we evaluated observed frequency (OF); expected frequency (EF); and relative risk (RR) of occurrence of malignancies in these families. In all cases peripheral blood examination of common Polish founder BRCA1 mutations was performed. In 25 families, we analysed loss of heterozygosity of BRCA1 and BRCA2 genes. We identified two subgroups of cases: 22 MM/CFA families with MM diagnosed before 55 years (< or =55 MM/CFA) and 29 MM/CFA families with MM diagnosed after 55 (>55 MM/CFA). In these families we observed increased proportion of breast cancers: 17.52% in the first subgroup (mean age of diagnosis 48.5) and 12.15% in the second subgroup. The odds ratio for breast tumours occurring before 50 in < or =55 MM/CFA families was 3.71. We also observed increased numbers of liver cancers, CSU and leukaemias. OF and EF analyses revealed increased risk of occurrence of cancers of breast (OF 10.4%, EF 4.5%) and liver (OF 1.9%, EF 0.8%) in women from MM/CFA families, RR for breast tumours was approximately 3.3 in < or =55 MM/CFA families. Molecular examination of MM/CFA families revealed no alterations within the BRCA2 gene and one germline mutation of the BRCA1 gene. In conclusion, it seems to be justified to consider systematic breast surveillance beginning at the age around 35-40 years as an option in women from < or =55 MM/CFA families.

Adult↗
PubMed2005

Bridging the divide between families and health professionals' perspectives on family-centred care.

OBJECTIVES: To describe and discuss key findings from a recent research project that challenge an increasingly prevalent theme, apparent in both family-centred care research and practice, of conceptualizing family-centred care as shifting care, care management, and advocacy responsibilities to families. The purpose of the research, from which these findings emerged, was to develop a conceptualization of family-centred care grounded in the experiences of families and direct health-care providers. DESIGN: Qualitative research methods, following the grounded theory tradition, were used to develop a conceptual framework that described the dimensions of the concept of family-centred care and their interrelationships, in the substantive area of children's developmental services. This article reports on and extends key findings from this grounded theory study, in light of current trends in the literature. SETTING AND PARTICIPANTS: The substantive area that served as the setting for the research was developmental services at a children's hospital in Alberta, Canada. Data was collected through focus groups and individual interviews with 37 parents of children diagnosed with a developmental problem and 16 frontline health-care providers. FINDINGS: Key findings from this research project do not support the current emphasis in family-centred care research and practice on conceptualizing family-centred care as the shifting of care, care management, and advocacy responsibilities to families. Rather, what emerged was that parents want to work truly collaboratively with health-care providers in making treatment decisions and on implementing a dynamic care plan that will work best for child and family. DISCUSSION AND CONCLUSIONS: A definition of collaboration is provided, and the nature of collaborative relationships described. Contributing factors to the difficulty in establishing true collaborative relationships between families and health-care professionals, where the respective roles to be played by health-care professionals and families are jointly determined, are discussed. In light of these findings we strongly advocate for the re-examination of current family-centred care policy and practice.

Adult↗
PubMed2004

Risks for conduct disorder symptoms associated with parental alcoholism in stepfather families versus intact families from a community sample.

BACKGROUND: It is not known if the prevalence of parental psychiatric disorders is higher in stepfather than intact families, or if parental alcoholism is differentially associated with risk for conduct disorder (CD) symptoms in stepfather families versus intact families. METHOD: The sample comprised 839 girls and 741 boys from 792 intact families and 99 girls and 67 boys from 83 stepfather families from a population-based registry of twins aged between 8 and 17 years. Children's current psychiatric symptoms were assessed at personal interview with the child, mother and father. Parental histories of psychiatric disorder were assessed at personal interview with each residential parent. Associations between CD symptoms and parental alcoholism were characterized using both linear and Poisson regression, and results are presented with and without adjustment for maternal drug use during pregnancy, parental conflict, and estimated socioeconomic status (SES) based on census tract data. RESULTS: Mothers from stepfather families had a higher lifetime prevalence of alcoholism, antisocial personality disorder, depression and social phobia than mothers from intact families. Stepfathers had a higher lifetime prevalence of alcoholism and depression than biological fathers from intact families. Children from stepfather families had more externalizing (CD/ODD) symptoms than children from intact families. Girls who lived with an alcoholic stepfather had significantly more CD symptoms than girls who lived with an alcoholic biological father. Boys who lived with an alcoholic stepfather had significantly fewer CD symptoms than boys who lived with an alcoholic biological father. This sex difference was statistically significant. Adjustment for maternal drug use during pregnancy, parental conflict, and estimated SES based on census tract data did not change these findings. CONCLUSIONS: Children living in stepfather families are exposed to more parental psychiatric risk factors than children from intact families. The increased risk for CD symptoms in girls (but not boys) from stepfather families is partly mediated by or associated with the stepfather's history of alcoholism.

Adolescent↗
PubMed1997

Family functioning and mental illness: a comparison of psychiatric and nonclinical families.

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61), bipolar disorder (n = 60), major depression (n = 111), anxiety disorder (n = 15), eating disorder (n = 26), substance abuse disorder (n = 48), and adjustment disorder (n = 46). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.

Adaptation, Psychological↗
PubMed2005

Families' experiences of support provided by resource-oriented family professionals in Finland.

This study describes the support provided by resource-oriented family workers in Finland and the prerequisites for such support. Family workers consisted of professionals such as public health nurses, nurses, social educators, psychologists, kindergarten teachers, and social workers. The overall research project consisted of four separate studies carried out within the Families With Children Project. The findings of the four studies were aggregated and submitted to a secondary analysis. Interview data from 51 parents across 44 families with young children were included in the analysis. The families reported that they received emotional, cognitive, instrumental, and community and network support from the family workers. The work of resource-oriented family professionals was facilitated by the arrangements and orientation of the service model and by the quality of interaction between the family worker and the family. The families' experiences of support underlined the multiple dimensions of the cooperative relationship and the usefulness of the supportive interaction. The findings extend the understanding of resource-oriented family work from the perspective of families and offer important implications for the caring of families with young children.

Adolescent↗
PubMedDate not supplied

[Characteristics of families of women with restricting anorexia nervosa compared with families of normal probands].

This study compares families of women with restricting anorexia nervosa with families of women without any psychiatric history on the following variables: parents' eating problems (Eating Attitudes Test: EAT-26) and psychopathology (Symptom Checklist-90-R: SCL-90-R); family members' perceptions of the parent-daughter relationship (Parental Bonding Instrument: PBI) and the family's overall functioning (Self-Report Family Inventory: SFI). Twenty-eight young women suffering from restricting anorexia nervosa, 27 non-clinical women and their respective parents, completed these questionnaires and also participated in a semi-structured individual interview. Our results demonstrated that parents in the two groups had similar eating attitudes and behaviors. However, parents of women with anorexia nervosa reported more problems with alcohol consumption than non-clinical parents. There were no differences between the two groups on the measure of family functioning (SFI), all scores in the families of anorectics being within normal limits. All the daughters, however, reported less family cohesion and more family conflict than did their parents. On the PBI, all the daughters reported receiving more care from their mothers than their fathers; the anorectic women reported experiencing more maternal control, intrusiveness and overprotection. The relationship between each family member's perception of family functioning and the parent-daughter relationship was examined. Anorectic daughters associate the emotional health of their family with the care received from both parents, whereas control women associate this variable with their father's attitudes and behaviors. However, fathers from both groups do not consider their own care or protection as having contributed to the health of the family.

Adolescent↗
PubMed1993

Genetic linkage analysis in familial breast and ovarian cancer: results from 214 families. The Breast Cancer Linkage Consortium.

Breast cancer is known to have an inherited component, consistent in some families with autosomal dominant inheritance; in such families the disease often occurs in association with ovarian cancer. Previous genetic linkage studies have established that in some such families disease occurrence is linked to markers on chromosome 17q. This paper reports the results of a collaborative linkage study involving 214 breast cancer families, including 57 breast-ovarian cancer families; this represents almost all the known families with 17q linkage data. Six markers on 17q, spanning approximately 30 cM, were typed in the families. The aims of the study were to define more precisely the localization of the disease gene, the extent of genetic heterogeneity and the characteristics of linked families and to estimate the penetrance of the 17q gene. Under the assumption of no genetic heterogeneity, the strongest linkage evidence was obtained with D17S588 (maximum LOD score [Zmax] = 21.68 at female recombination fraction [theta f] = .13) and D17S579 (Zmax = 13.02 at theta f = .16). Multipoint linkage analysis allowing for genetic heterogeneity provided evidence that the predisposing gene lies between the markers D17S588 and D17S250, an interval whose genetic length is estimated to be 8.3 cM in males and 18.0 cM in females. This position was supported over other intervals by odds of 66:1. The location of the gene with respect to D17S579 could not be determined unequivocally. Under the genetic model used in the analysis, the best estimate of the proportion of linked breast-ovarian cancer families was 1.0 (lower LOD-1 limit 0.79). In contrast, there was significant evidence of genetic heterogeneity among the families without ovarian cancer, with an estimated 45% being linked. These results suggest that a gene(s) on chromosome 17q accounts for the majority of families in which both early-onset breast cancer and ovarian cancer occur but that other genes predisposing to breast cancer exist. By examining the fit of the linkage data to different penetrance functions, the cumulative risk associated with the 17q gene was estimated to be 59% by age 50 years and 82% by age 70 years. The corresponding estimates for the breast-ovary families were 67% and 76%, and those for the families without ovarian cancer were 49% and 90%; these penetrance functions did not differ significantly from one another.

Adult↗
PubMed1995

Familial clustering of multiple measures of adiposity and fat distribution in the Québec Family Study: a trivariate analysis of percent body fat, body mass index, and trunk-to-extremity skinfold ratio.

OBJECTIVE: To assess whether independent or common (pleiotropic) familial factors (i.e., genetic and/or common environment) underlie the observed associations among measures of body mass, body fat, and its distribution. DESIGN: A familial correlation model involves both parents and offspring, and gives rise to three types of familial correlations (spouse, parent-offspring, and sibling). A pattern of significant familial correlations suggests that the trait is determined by familial factors (i.e., genetic and/or environmental heritability). Cross-trait familial correlations are also estimated, both within individuals (intraindividual) and between family members (interindividual). Interindividual cross-trait familial correlations (e.g., trait 1 in parents with trait 2 in offspring) lead to the same type of familial inferences regarding bivariate heritabilities. SUBJECTS AND MEASURES: Measures of total body fat (% body fat-%BF), fat distribution (trunk/extremity skinfold ratio-TER), and body mass index (BMI) were assessed in 1239 individuals from 309 nuclear families participating the Québec Family Study. RESULTS: All three adiposity measures are cross-correlated within individuals. However, interindividual cross-trait correlations, which alone are capable of suggesting common familial determinants, are significant only for BMI with each of %BF and TER (bivariate heritabilities of 10% and 18%, respectively), and not for %BF and TER. CONCLUSION: Although all three adiposity measures are correlated within individuals, there appear to be entirely different underlying genes and/or environmental factors influencing the adiposity phenotypes of total body fat and fat distribution. The BMI, however, apparently shares some familial determinants with both total body fat and fat distribution.

Adolescent↗
PubMed2005

Patient evaluation on family doctors' family orientation.

Family orientation is one of basic features of family practice. The purpose of the study was to explore the patients' opinions about family physician involvement in family related issues, and to identify the factors that may influence the patients' opinions. Altogether 514 patients completed a questionnaire. Logistic regression analysis was used to predict the factors which determine patient orientation to talk about family related issues. The results indicate that the patients' health and the family background influence their willingness to talk to family physicians about their family related problems. The findings of the study confirm that special attention should be paid to patients who definitely have family problems because of chronic illness, or an alcohol or drug using family member, or those who are widowed or divorced. Also, the ethnic origin was found to have an impact on patient opinions of family physicians' family involvement.

Adolescent↗
PubMed1985

One-person family therapy: a modality of brief strategic family therapy.

The One-Person Family Therapy approach to the treatment of drug abuse described here is based on the Brief Strategic Family Therapy conceptual framework. It represents an innovative integration of family therapy techniques that have proven effective in working with entire families and techniques specifically designed for use with one family member. OPFT appears to be as effective as conjoint family therapy with adolescent drug abusers and their families. It thus provides skilled family therapists (generally master's-level social workers and psychologists with training and experience in structural family therapy) with a novel and useful tool for carrying out family therapy, while minimizing the problem of retaining entire families in therapy. Further work should concentrate on improving our ability to engage families of drug-abusing adolescents in the therapy process, generalizing results to other types of samples, learning more about using an OP who is not also the identified patient, exploring the possibility of switching OPs, exploring the use of spaced followup therapy, and integrating OPFT and CFT sessions more fully. However, it is clear that OPFT is a practical, cost-effective, field-oriented intervention for use with drug-abusing adolescents.

Adolescent↗
PubMed2004

Familial juvenile hyperuricemic nephropathy: detection of mutations in the uromodulin gene in five Japanese families.

BACKGROUND: Familial juvenile hyperuricemic nephropathy (FJHN) is an autosomal-dominant disease characterized by hyperuricemia of underexcretion type, gout, and chronic renal failure. We previously reported linkage on chromosome 16p12 in a large Japanese family designated as family 1 in the present study. Recent reports on the discovery of mutations of the uromodulin (UMOD) gene in families with FJHN encouraged us to screen UMOD mutations in Japanese families with FJHN, including family 1. METHODS: Six unrelated Japanese families with FJHN were examined for mutations of the UMOD gene by direct sequencing. To confirm the results of the mutation screening, parametric linkage analyses were performed using markers in 16p12 region and around other candidate genes of FJHN. RESULTS: Five separate heterozygous mutations (Cys52Trp, Cys135Ser, Cys195Phe, Trp202Ser, and Pro236Leu) were found in five families, including family 1. All mutations were co-segregated with the disease phenotype in all families, except for family 1, in which an individual in the youngest generation was found as a phenocopy by the genetic testing. Revised multipoint linkage analysis showed that the UMOD gene was located in the interval showing logarithm of odds (LOD) score above 6.0. One family carrying no mutation in the UMOD gene showed no linkage to the medullary cystic kidney disease type 1 (MCKD1) locus, the genes of hepatocyte nuclear factor-1beta (HNF-1beta), or urate transporters URAT1 and hUAT. CONCLUSION: Our results gave an evidence for the mutation of the UMOD gene in the majority of Japanese families with FJHN. Genetic heterogeneity of FJHN was also confirmed. Genetic testing is necessary for definite diagnosis in some cases especially in the young generation.

Amino Acid Sequence↗
PubMed2003

Progression of familial and non-familial dilated cardiomyopathy: long term follow up.

BACKGROUND: It is unknown whether progression of familial idiopathic dilated cardiomyopathy differs from progression in the non-familial form. It has been suggested that familial disease indicates a worse prognosis, and that this should be considered when planning the timing of heart transplantation. OBJECTIVE: To compare five year survival or time to heart transplantation in an unselected series of patients with dilated cardiomyopathy who had been evaluated for familial v non-familial disease through the echocardiographic investigation of first degree relatives. DESIGN: Medical records were reviewed and questionnaires were mailed to all patients who had previously participated in a family based study of dilated cardiomyopathy. Information was gathered about survival, heart transplantation, and left ventricular ejection fraction (LVEF) measurements. Survival data were censored at the time of cardiac transplantation. RESULTS: Follow up data were obtained for 99 of 101 patients (69 with non-familial and 30 with familial disease). Five year survival was 55% for non-familial and 51% for familial patients (NS). The main predictor of mortality was an LVEF of < 30%. Familial status did not predict mortality. There was no significant difference in follow up LVEF values between the groups. CONCLUSIONS: Five year survival is not significantly different in the familial and non-familial forms of dilated cardiomyopathy.

Adolescent↗
PubMed2000

Tracking of familial resemblance for resting blood pressure over time in the Québec Family Study.

The etiology of familial resemblance for systolic (SBP) and diastolic (DBP) blood pressure, both within a single time point as well as across time points, was assessed to determine how familial etiologies underlying a trait may change across time. SBP and DBP measurements were taken roughly 12 years apart in family members participating in the longitudinal Québec Family Study. A longitudinal (bivariate) familial correlation model yields 3 types of correlations: intraindividual cross-time (e.g., father's BP at time 1 with his own BP at time 2); interindividual within-time (e.g., father time 1 with child time 1); and interindividual cross-time (e.g., father time 1 with child time 2). In addition, the change in BP across time (i.e., time 1-time 2) is examined using a univariate family correlation model. This combined method is useful in assessing the degree to which the same familial factors are operating across time (interindividual cross-time correlations), as well as the degree to which different heritable components are involved across time (change score). Maximal heritabilities for SBP were about 70% at each time point, while for DBP the heritability was larger at time 1 (87%) than time 2 (39%). Both the change scores (48% for SBP and 54% for DBP) and the cross-time comparisons (58% to 72% for SBP and 63% to 65% for DBP) evidenced significant familial resemblance. These results illustrate how simple methodologies can be used to specify how familial etiologies underlying a trait may change across time. For BP, the model includes unique familial factors that are specific to each time measurement, and an additional familial factor which is common to both time points. The factors leading to differences in longitudinal familial resemblance for BP (i.e., the unique factors) may be primarily genetic in origin, while those leading to stability across time may include both genetic and familial environmental effects. Sex and/or age interactions with the genotypes are also suggested.

Adult↗