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PubMed2006

Engaging families as experts: collaborative family program development.

This article presents the collaborative family program development (CFPD) model, a collaborative research-based approach to creating community-based programs for families. In this approach, families are viewed as experts on the nature of their challenges and on what they desire in a program. This approach is particularly useful in developing programs for families who have experienced social oppression and who may have been reluctant to participate in programs created for them by professionals without their consultation. In contrast, when professionals adopt the stance of respectful learners, families respond by actively engaging in the program development research and in the program created from it. This article describes the nature and complexities of a collaborative program development stance, the unique contribution to community-based program development offered by a family systems focus, and the 10 steps in the CFPD approach. These 10 steps guide movement from initiating the project and forming collaborative professional partnerships to engaging cultural consultants; conducting in-depth research to understand the problems, resources, contexts, and recommendations from the perspective of families who will receive the program and from the perspective of front-line professionals working with these families; transforming research findings into program contents and formats; and implementing, evaluating, revising, and replicating the program. The approach is illustrated by a program called Fresh Start for Families, developed and replicated for families in New York City who are homeless and attempting to move from welfare to work.

Community Health Services↗
PubMed2004

The family life-path theory: a tool for nurses working in partnership with families.

The purpose of this article is to describe the family life-path theory. The theory may offer nurses an alternative model for use in working in partnership with the family of a child with a long-term illness. It is important that nurses have a deep understanding of a family's everyday life. The better nurses know the family and the context in which it lives, the more individual advice and coping strategies that they are able to find in partnership with a family, and thus to support the family in achieving a good quality of life. The theory describes the life of a family of a child with asthma as a lifepath. The dimensions of the family's life-path are environment, the child's becoming ill, the family's view of health, their attitude towards illness, everyday routines and social network. The unpredictability of asthma, optimism about the future and normalization of life are factors that guide families towards achievement of a good quality of life for their child.

Asthma↗
PubMed2000

Pod people. Response of family physicians and family practice nurses to Kosovar refugees in Greenwood, NS.

OBJECTIVE: To explore roles of family physicians and family practice nurses who provided care to Kosovar refugees at Greenwood, NS. DESIGN: Qualitative study based on individual interviews with family physicians and family practice nurses. SETTING: Family practices in Halifax, NS. PARTICIPANTS: Six family practice nurses, four physician faculty members, four community-based family physicians, and two family medicine residents were interviewed. Participants were purposefully chosen from the roster of service providers. METHOD: All interviews were conducted by one of the researchers and were semistructured. Interviews lasted approximately 30 minutes and were immediately transcribed. Key words and phrases were identified and compared with subsequent interviews until saturation was achieved. MAIN FINDINGS: Data yielded four analytical categories: the clinical encounter, expectation and experience, role and team functioning, and response. Participants reported how providing care in the context of a refugee camp was both similar to and different from their daily activities in family practice, as were their working relationships with other health care professionals. CONCLUSION: Primary care for refugees during complex health emergencies is often underreported in the literature. Yet family practice physicians and nurses recounted that they had the requisite skills to provide care in such a context.

Adult↗
PubMed2003

Perceived parental acceptance-rejection, family-related factors, and socio-economic status of families of adolescent heroin addicts.

AIM: To compare adolescent heroin addicts and non-addicts with respect to their perceived parental acceptance and rejection, family factors (structure of the family, parents' marital status, and psychopathological disorders in the family), socio-economic status, and subjective appraisal of their family relations. METHODS: Fifty-two heroin addicts aged between 17 and 21, were compared with a group of 52 non-addicts of the same age. The comparison group was selected from an ad-hoc sample of high-school juniors and seniors and first- and second-year university students. Only participants who reported never to have taken any drugs were selected for the group of non-addicts. The perceived parental behavior of mothers and fathers was assessed by the 32-item version of Rohner's Parental Acceptance-rejection Questionnaire. Three other questionnaires were constructed to collect information on family factors, socio-economic status, subjective appraisal of family relations, and drug usage. RESULTS: The addicts perceived their mothers as more rejecting (p=0.018 for total score), more aggressive (p=0.007), and showing more undifferentiated rejection (p=0.001) than non-addicts. The addicts perceived their fathers as more rejecting then their mothers (p=0.002 for total score), less warm and accepting (p<0.001), and more neglecting (p=0.001). In comparison with non-addicts, the addicts evaluated the relationships with their mothers (p=0.001) and general satisfaction with their families (p=0.021) as poorer. Adolescent addicts mostly came from intact families. In the addicts' primary families (mother, father, and siblings), there was significantly higher incidence of addiction (p=0.041), schizophrenia (p=0.022), and suicide or attempted suicide (p=0.012). Addicts' families belonged to higher income groups then non-addicts (p=0.021). Addicts' fathers were on average less educated than non-addicts' fathers (p=0.040); typically to a high school level. The education level of addicts' mothers was similar to that of non-addicts' mothers (p=0.091), typically they were educated to a high school level. CONCLUSION: The results of this research indicate the importance of parental rearing practices, especially mothers', on adolescent drug abuse and addiction. As addicts perceived their mothers as more rejecting than non-addicts, mothers' rejection could be one of the major risk factors for developing drug addiction.

Adolescent↗
PubMedDate not supplied

Levels of family involvement in patient visits by family medicine faculty.

BACKGROUND: This study investigates levels of family involvement (LFI) in patient visits by family medicine faculty, extends validity testing of the LFI model, and provides data for comparison with a previous study of LFI in patient visits by family practice residents. METHODS: Twenty visits were taped for each of five physician faculty and were rated according to whether family involvement was indicated and if it occurred. RESULTS: Of the 100 visits, 47 showed minimal or no family involvement. Of the 29 visits when faculty provided medical information and advice to a family, 66% involved children. Family issues were discussed in only 18% of visits if only adult patients were considered. Overall, however, family involvement occurred in 80% of the visits in which it was indicated. The results of this study, which involved faculty, showed slightly higher family involvement levels than found for residents in a previous study, but the difference was not statistically significant. CONCLUSION: The similarity between faculty LFI in this study and LFI exhibited by residents in a previous study may mean that both groups are currently exhibiting appropriate LFI. However, the unexpected findings may be a function of the research tools' inadequate sensitivity. Methodology changes are recommended to increase sensitivity in measuring family orientation, particularly for individual adult patients.

Adult↗
PubMed1993

The relationship of family structure and family conflict to adjustment in young adult college students.

This study examined whether the structural intactness of the family and/or perceived family conflict was related to young adult adjustment as assessed by measures of ego identity status and psychological distress. The physical-wholeness model holds that family structure is the major variable affecting adjustment, while the psychological-wholeness model posits family conflict as the critical variable. In the present study, undergraduate college students (N = 285) were classified as belonging to an intact two-parent family or a nonintact family, and as coming from homes characterized by low, medium, or high levels of conflict. A statistically significant relationship between family conflict and adjustment was observed; there was no significant association between family structure and adjustment. Individuals from families perceived as being low or medium in level of conflict reported fewer psychiatric symptoms and demonstrated higher levels of ego identity than did those from families perceived as high in conflict. These findings support the psychological-wholeness model. It is suggested that future research be directed toward developing more refined measures of interpersonal conflict.

Adaptation, Psychological↗
PubMed1996

Medical students' and private family physicians' perceptions of family practice.

BACKGROUND: Many studies have attempted to determine what factors influence medical students' career selections. This study determined students' perceptions of family practice, examined what variables influenced these perceptions, and measured whether medical students' perceptions were similar to or different from those of practicing family physicians. METHODS: The two populations studied were students sampled at an Ohio medical school over the first 3 years of their training and a random sample of Ohio family physicians. Each subject was asked to complete a questionnaire that asked about perceptions of family practice and demographic information. RESULTS: A total of 719 (69%) students and 295 (59%) family physicians responded to the survey. Sixty-seven percent of the physician responders were actively involved in medical student teaching. More than 94% of the students had exposure to family physicians during their preclinical education. Students' perceptions were different than physicians' perceptions about lifestyle issues, patient care, and practice characteristics; over time, these approached the physicians' perceptions. However, the perceptions of family physicians and students about professional issues were similar. DISCUSSION: Medical students and family physicians have different perceptions about family practice. Students' perceptions become similar to physicians' perceptions as they progress through the educational system, while, at the same time, their interest in family practice declines.

Attitude↗
PubMed2006

Early-onset Alzheimer disease in families with late-onset Alzheimer disease: a potential important subtype of familial Alzheimer disease.

BACKGROUND: Genetic influences on the development of late-onset Alzheimer disease (LOAD) are heterogeneous and ill defined. OBJECTIVE: To determine the genetic risk factors for LOAD. DESIGN: We asked the following questions: (1) Does early-onset Alzheimer disease (EOAD) occur in families with predominantly LOAD? and (2) Does the apolipoprotein E (APOE) genotype explain the wide differences in onset age in LOAD families? SETTING: University of Washington Alzheimer Disease Research Center, Seattle. PARTICIPANTS: A total of 136 kindreds and a separate group of 29 affected parent-child pairs. MAIN OUTCOME MEASURES: We evaluated the kindreds with familial LOAD for the occurrence of EOAD and the affected parent-child pairs with a 20-year or more difference in the age at onset. RESULTS: In the 136 kindreds with LOAD, 104 had only late-onset cases (men, 36%), whereas 32 families (24%) had a combination of LOAD and EOAD cases. The 44 EOAD cases in these families accounted for 20% of cases of AD in the 32 families and 6% in all 136 families. The early-onset cases had a mean +/- SD onset age of 56.1 +/- 3.2 years (range, 45-59 years; men, 50%). Seven (28%) of 25 individuals with EOAD sampled did not have an APOE epsilon4 allele, and 2 of the earliest-onset cases were epsilon3/epsilon3. In 29 parent-child pairs with a 20-year or more difference in age at onset, 7 (35%) of the 20 children sampled did not have an APOE epsilon4 allele. CONCLUSIONS: Many LOAD families (approximately 25%) have at least 1 individual with EOAD, and in these individuals, the ratio of men to women is nearly 50%, suggesting a possible subtype of familial AD. The APOE genotype plays an important role in these early-onset cases, but at least one fourth of the risk must represent the influence of other genetic and/or environmental factors. These LOAD families with early-onset cases represent an important resource for investigation of these factors.

Age of Onset↗
PubMed2004

Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history.

CONTEXT: A family history of certain cancers is associated with an increased risk of developing cancer. Both cancer screening and genetic services referral decisions are often based on self-reported pedigree information. OBJECTIVE: To determine the accuracy of self-reported family cancer history information. DATA SOURCES: English-language articles were retrieved by searching MEDLINE (1966-June 2004) using Medical Subject Headings family, genetic predisposition to disease, medical history taking, neoplasm, and reproducibility of results. Additional articles were identified through bibliography searches. STUDY SELECTION: Original studies in which investigators validated self-reported family history by reviewing the identified relatives' medical records, death certificate, or cancer registry information were included, as well as studies that evaluated breast, colon, ovarian, endometrial, and prostate cancers. DATA EXTRACTION: Two of the 3 investigators independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of self-reported family cancer history information. Only data from studies that evaluated both positive and negative family cancer histories were included within the analyses. A total of 14 studies met the search criteria and were included in the review. DATA SYNTHESIS: For patients without a personal history of cancer, the positive and negative LRs of a family history of the following cancers in a first-degree relative were 23.0 (95% confidence interval [CI], 6.4-81.0) and 0.25 (95% CI, 0.10-0.63) for colon cancer; 8.9 (95% CI, 5.4-15.0) and 0.20 (95% CI, 0.08-0.49) for breast cancer; 14.0 (95% CI, 2.2-83.4) and 0.68 (95% CI, 0.31-1.52) for endometrial cancer; 34.0 (95% CI, 5.7-202.0) and 0.51 (95% CI, 0.13-2.10) for ovarian cancer; and 12.3 (95% CI, 6.5-24.0) and 0.32 (95% CI, 0.18-0.55) for prostate cancer, respectively. Positive predictive values tended to be better in articles concerning first-degree relatives compared with second-degree relatives. CONCLUSIONS: Patient-reported family cancer histories for first-degree relatives are accurate and valuable for breast and colon cancer risk assessments. Negative family history reports for ovarian and endometrial cancers are less useful, although the prevalence of these malignancies within families is low.

Family↗
PubMed1998

Familial breast cancer in the family-cancer database.

We use the population-based Family-Cancer Database from Sweden to study familial breast cancer. The size of the population and the nation-wide registration of cancer offer unique possibilities for epidemiological studies of familial cancer, including complete and unbiased identification of cases in the probands and in their relatives, and complete and unbiased identification of the family relationships. Using the Database, we wanted to answer the following questions: (i) proportion of familial breast cancer among all breast cancers; (ii) familial relative risks in breast cancer alone or in combination with another cancer, defined either through the mother or the daughter; (iii) modification of familial risk by age; and (iv) effects of paternal breast cancer alone or in combination with maternal breast cancer. The proportion of familial female breast cancer among all breast cancers before 54 years of age in Sweden was 8.7%. The familial relative risk was about 1.8, but is likely to decrease to about 1.5 in the ageing population. The higher familial relative risks were evident in young women, being 4.0 when both the mothers and their daughters were diagnosed at ages <40 years. Paternal breast cancer, in combination with maternal breast cancer, caused a large (but not statistically significant) risk in the daughters. In mothers and daughters, ovarian but not colon cancer was increased in combination with breast cancer.

Adult↗
PubMed1999

Maternal perceptions of family-provider relationships and well-being in families of children with Down syndrome.

The purpose of this study was twofold: (a) to describe parental perceptions of family-provider relationships, and (b) to explore links between parental perceptions of family-provider relationships and well-being in families with children who have Down syndrome. Mailed questionnaires were used to collect data from 94 families that include a child with Down syndrome. Data from 89 mothers are the focus of this report. The results indicate that when mothers of children with Down syndrome believe that their family's relationship with health care providers is positive and family-centered, they feel more satisfied with the care that their child is receiving and they are more likely to seek help from health care providers. In addition, when a discrepancy exists between what mothers want the family-provider relationship to be and what they believe the relationship is, mothers feel less satisfied with the care that their child is receiving. Finally, higher levels of individual and family well-being are reported by mothers who (a) want, and believe they have, positive family-centered relationships with providers, and (b) feel more satisfied with care received. Results of this study contribute to a better understanding of the role that health care providers play in individual and family adaptation to chronic conditions.

Adolescent↗
PubMed1994

Genes and family environment in familial clustering of cancer.

Familial clustering of a disease is defined as the occurrence of the disease within some families in excess of what would be expected from the occurrence in the population. It has been demonstrated for several cancer types, ranging from rare cancers as the adenomatosis-coli-associated colon cancer or the Li-Fraumeni syndrome to more common cancers as breast cancer and colon cancer. Familial clustering, however, is merely an epidemiological pattern, and it does not tell whether genetic or environmental causes or both in combination are responsible for the familial clustering. Familial clustering may be due to genetic predisposition to the disease, but exposure to environmental factors--shared by members of some families, but not by members of other families--may also cause familial clustering and hence mimic genetic inheritance in the study of nuclear families. Based on assumptions regarding the individual steps in the biological process starting with exposure to carcinogens and ending with death from disseminated cancer we suggest that genetic and environmental factors may both be involved in most of these steps. The present paper focuses on research methodologies necessary to discriminate between the effect of genes and family environment in the development of cancer.

Causality↗
PubMed2006

The Strengthening Washington D.C. Families project: a randomized effectiveness trial of family-based prevention.

The Strengthening Washington DC Families Project (SWFP) examined implementation fidelity and effectiveness when a selective, evidence-based prevention program was implemented with a sample of 715 predominantly African American families across multiple settings in an urban area. Using a true experimental design, this study reports on the differential effectiveness of four conditions (child skills training only, parent skills training only, parent and child skills training plus family skills training, and minimal treatment controls) in reducing child antisocial behavior and its precursors. Major challenges with recruitment and retention of participants and uneven program coverage were documented. No statistically significant positive effects for any of the program conditions were observed, and a statistically significant negative effect on child reports of Negative Peer Associations was observed for children of families assigned to the family skills training condition. Two marginally significant findings were observed: Child's positive adjustment favored families assigned to family skills training condition relative to minimal treatment and child training only, and family supervision and bonding was lower for children in family skills training than in the other three conditions. Hypotheses about potential explanations for the weaker than expected effects of this program are offered, as are thoughts about the infrastructure necessary to successfully implement family strengthening programs and the future of prevention science.

Adult↗
PubMed1991

Intrafamilial sexual abuse: family-of-origin and family-of-procreation characteristics of female adult victims.

We examined connections between incest victims' family-of-origin and family-of-procreation characteristics in a sample of 40 American women who were in treatment for childhood or adolescent experiences of victimization. Retrospective data on their families-of-origin were collected along with their perceptions of current relationships with family members in the three-generational system. Results showed a close association between family-of-origin and family-of-procreation characteristics, especially in the areas of intergenerational intimacy, intergenerational fusion/individuation, and personal authority. A number of significant correlations were also found between subjects' past and present relationships with family-of-origin members and the dimensions of moral and religious orientation, achievement, and intellectual and cultural orientation, conflict, and control in their family-of-procreation. Some aspects of individual adjustment, including alienation, emotional discomfort, and defensiveness, were strongly related to various family-of-origin and family-of-procreation characteristics.

Adolescent↗
PubMed2005

Adapting the structural family systems rating to assess the patterns of interaction in families of dementia caregivers.

PURPOSE: This study adapted the Structural Family Systems Ratings (SFSR), an observational measure of family interactions, for dementia caregivers. This article presents the development of the SFSR-Dementia Caregiver adaptation (SFSR-DC) and examines relationships between specific family-interaction patterns and caregiver distress. DESIGN AND METHODS: The families of 177 Cuban American and White non-Hispanic American caregivers of dementia patients were assessed at baseline, 6, 12, and 18 months. Structural family theory and clinical experience were used to identify family interaction patterns believed to be related to caregiver emotional functioning. Factor analysis was used to refine subscales and develop a multiscale measure. RESULTS: Six reliable subscales were related to caregiver distress and included in the SFSR-DC. There were two second-order factors. The SFSR-DC was provisionally cross-validated and showed invariance across the two ethnic groups. IMPLICATIONS: The SFSR-DC provides a method for examining specific and multiple interaction patterns in caregiver families and thus can advance knowledge regarding the role of the family in the stress processes of caregiving. These findings support the relevance of family interactions in caregiver distress and suggest that a treatment approach aimed at supporting family closeness and conflict resolution and reducing negativity might enhance caregiver well-being.

Aged↗
PubMed1992

Family resources and stress: a comparison of families of children with cystic fibrosis, diabetes, and mental retardation.

Assessed patterns of stress in families of children with pediatric conditions that varied on 2 dimensions: (a) fatal vs. nonfatal outcome and (b) presence vs. absence of cognitive impairment. Families of children with cystic fibrosis (n = 23), diabetes (n = 24), and moderate mental retardation (n = 24) were compared to families of well children (n = 24) in 3 age groups. Maternal responses to a multidimensional measure of family stress, the Questionnaire on Resources and Stress--Short Form (QRS-S), indicated that families of children with chronic conditions did not differ from families of well children on scales assessing generic aspects of family stress, such as family conflict. However, diagnostic groups differed on QRS-S scales assessing stressors specific to the child's disability (e.g., families of children with mental retardation were characterized by concerns about caring for the child as an adult). There was no evidence of higher levels of stress for families of older children. Data on the internal consistency of QRS-S scales and their relation to measures of maternal and child adjustment are presented.

Adolescent↗
PubMed1995

Family environment and the interrelation of family structure, child behavior, and metabolic control for children with diabetes.

Examined perceptions of the family environment in a cross-regional sample of 90 families who had children with diabetes and 89 controls. Families were classified as either traditional (intact) or nontraditional (single-parent or blended families). Parents of children with diabetes reported less family expressiveness, which was a predictor of clinically higher levels of child behavior problems than controls. Parents in nontraditional families reported lower levels of organization, less emphasis on active-recreational pursuits, and more child behavior problems than traditional families. An additive effect of diabetes and nontraditional family structure was found for children with diabetes from nontraditional families, who reported substantially less cohesion than all other groups. Nontraditional family structure was more disruptive for children with diabetes than for controls; it was the best predictor of behavior problems and was related to poorer metabolic control.

Adolescent↗
PubMed2001

Familial resemblance in ventilatory threshold: the HERITAGE Family Study.

PURPOSE: This study investigates the familial resemblance of VO2 at the ventilatory threshold (VO2vt) from 199 nuclear families (100 White and 99 Black) participating in the HERITAGE Family Study. METHODS: VO2vt (mL x min(-1)) was determined in the sedentary state and again after 20 wk of aerobic cycle ergometer exercise training in 339 individuals (131 parents and 228 of their offspring), aged between 17 and 65 yr. VO2vt was adjusted for weight, age, fat mass, and fat-free mass by using regression methods. RESULTS: There was evidence for significant familial resemblance in the sedentary state for VO2vt (maximal heritability = 58% in White and 54% in Black families) and VO2vt/VO2max (maximal heritability = 38% in White and 39% in Black families). Spouse, sibling, and parent-offspring relationships for VO2vt were significant at baseline, suggesting that both genetic and shared environmental factors may contribute to the familial resemblance in the sedentary state. There was a moderate familial component in the response of VO2vt to aerobic exercise training in Whites (22%) and a larger component in Blacks (51%). In Blacks, the familial effect for VO2vt/VO2max appeared to be accounted for by fat and fat-free mass. CONCLUSION: These results show a strong familial contribution to VO2vt in the sedentary state and to the response of VO2vt to aerobic exercise training.

Adolescent↗