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PubMed1986

Stress levels in families with intellectually handicapped preschool children and families with nonhandicapped preschool children.

Family stress levels were examined using the Questionnaire on Resources and Stress (QRS) in 42 New Zealand families with preschool intellectually handicapped (moderately and severely retarded) children and 42 families with nonhandicapped preschool children. Maternal age was employed as a blocking factor (less than 30 years versus 30 years and above). The families with intellectually handicapped children showed significantly higher stress levels on 13 of the 15 QRS scales, but maternal age did not appear to be implicated in family stress levels. The results suggest that stress levels are somewhat elevated in families with preschool children, the tendency being particularly marked in families with intellectually handicapped children. The implications of these findings for family intervention and support programmes are considered, together with the need for research into the various ecological contexts of the individual, family, peer group and social institutions, as well as of the interactions within and between these contexts as mediators of coping resources in families with intellectually handicapped children.

Adult↗

PubMed2006

Predictors of between-family and within-family variation in parent-child relationships.

BACKGROUND: Previous studies have found that multiple factors are associated with parent-child relationship quality, but have not distinguished potential sources of between-family and within-family variation in parent-child relationship quality. METHODS: Approximately equal numbers of biological (non-stepfamilies), single-mother, stepfather, and complex/stepmother stepfamilies were selected from a large community study in England. The sample comprised 404 children in 171 families. Parent-child warmth/support and conflict/negativity were assessed using questionnaire and interview methods; family socio-demographic data were collected from parent report. RESULTS: Multilevel model analyses indicated substantial within-family variation in parent-child relationship quality, and greater within-family variation in complex/stepmother families compared to other family types. Within-family variation was largely accounted for by differences in the siblings' biological relatedness to the mother and father and to child-specific factors, notably aggressive behavior. CONCLUSIONS: The findings illustrate how research using multilevel model designs and analytic strategies may enhance our understanding of family process.

Child↗

PubMed1992

Families in the sealed room: interaction patterns of Israeli families during SCUD missile attacks.

This study attempted to delineate styles of family interaction and behavior during war. Sixty-six families were randomly selected during the first week of the Gulf War and were telephone-interviewed using a semi-structured questionnaire. Qualitative methodology was used to analyze the interview transcripts. Three themes emerged: the emotional atmosphere (degree of expressed stress), mode of family organization, and extent and form of interpersonal relationship. When these categories were considered, four types of families were found: (1) the Anxious Family, characterized by high level of stress, low role distribution, negative interaction style; (2) the Cautious Family, with high stress, clear role allocation, positive interaction among members; (3) the Confident Family, typified by low stress level, clear role allocation, and positive non-interaction; and (4) the Indifferent family, characterized by low stress level, no role allocation, and negative non-interaction. These findings are discussed in terms of recent attempts to clarify the concept and describe the process of family coping, as well as in terms of understanding family behavior in other stressful situations.

Adaptation, Psychological↗

PubMed2005

Letting the family know: balancing ethics and effectiveness when notifying relatives about genetic testing for a familial disorder.

OBJECTIVE: To increase the awareness among at risk relatives of the availability of genetic testing for a familial disorder while respecting their autonomy and privacy. METHODS: This was a comparison of preintervention and postintervention cohorts of families carried out in a state wide clinical service providing genetic counselling and testing for people at risk of familial adult onset cancer. Unaffected relatives who were not clients of the service in 74 kindreds with familial mutations causing familial breast and ovarian cancer, hereditary non-polyposis colorectal cancer, or Cowden syndrome were included in the study. In the baseline cohort (41 kindreds), family members who were clients of the clinical service and had been shown to be carriers of mutations were asked to advise relatives that genetic testing was available. In the intervention cohort (33 kindreds), the clinical service obtained consent to advise at risk relatives by letter that genetic testing was available. The main outcome measures were: (a) proportion of unaffected first and second degree relatives of the proband in each family whose genetic status was clarified within 2 years of the mutation being identified in the family, and (b) concerns regarding privacy and autonomy voiced by relatives receiving these letters. RESULTS: In the baseline cohort, the average proportion of relatives in each family whose genetic status was clarified was 23%. In the intervention cohort, the average proportion of relatives in each family whose genetic status was clarified was 40% (p = 0.001). None of the relatives in the intervention cohort complained of a breach of privacy or autonomy. CONCLUSION: Clinical services can take an effective and proactive approach to notifying relatives who are not their clients of the availability of genetic testing without compromising principles of privacy and autonomy.

Adolescent↗

PubMed2006

Family nursing education and family nursing practice in Nigeria.

A survey of six Nigerian nursing program curricula was conducted to determine the extent to which family nursing theory was used as a reference for conceptualizing nursing care in Nigeria. In addition, 25 nurse clinicians were purposely selected from three levels of primary, secondary, and tertiary health care units in Ile-Ife, Nigeria, and were interviewed to determine the extent to which nurses in practice reported using family assessment tools in their practice. The survey of the postgraduate curricula showed that master's and doctorally prepared nurses specializing in community health nursing have a theoretical base in family nursing theory. The limited focus on family nursing theory in basic, postbasic, and first-degree nursing curricula was deemed inadequate to develop the knowledge and skills necessary for all practicing nurses to embrace family-focused care in Nigeria. In nursing practice, families were seen to be involved in nursing care only to the extent of meeting financial and physical care needs of their family members. Findings from this study point to the need for a reorientation of the nursing curricula in Nigeria to include more family nursing theory. Specialized education of family nurse practitioners who would function at all levels of care also is a desirable goal to provide holistic health care to Nigerian families.

Attitude of Health Personnel↗

PubMed1999

Marital conflict, family processes, and boys' externalizing behavior in Hispanic American and European American families.

Used self-report and observational measures to explore associations among marital conflict, triadic family processes, and child adjustment in Hispanic American, European American, and biethnic families. One hundred and thirteen families with a 7- to 11-year-old son participated. More similarities than differences were found between European American and Hispanic American families. A hierarchical parenting style was associated with externalizing behaviors for European American and biethnic families but not for Hispanic American families. Marital conflict and disengaged family alliances were associated with child externalizing behavior for all ethnic groups. Ethnicity was not found to moderate the relation between marital conflict and family functioning, and greater levels of marital conflict were associated with disengaged family interactions and also with lax or inconsistent parenting. Implications for understanding cross-ethnic issues in family systems and child adjustment are discussed.

Analysis of Variance↗

PubMed1999

Does a family history of cancer increase the risk for postmenopausal endometrial carcinoma? A prospective cohort study and a nested case-control family study of older women.

BACKGROUND: As part of the hereditary nonpolyposis colon carcinoma (HNPCC) constellation of neoplasia caused by defects in mismatch repair genes, some endometrial carcinomas are known to have a genetic contribution to etiology. However, most endometrial carcinomas occur in postmenopausal women, presumably without the HNPCC defect. Consequently, the genetic contribution to these cases is unclear. The objective of this study was to determine whether family history of cancer is a risk factor for endometrial carcinoma in older women. METHODS: The authors analyzed incident endometrial carcinoma data, as well as data on family history of various cancers in first-degree relatives, from a cohort of 24,848 postmenopausal Iowa women ages 55-69 years who were cancer free at baseline in 1986. Because a positive family history is dependent on many factors, including the age of the patient, the number of relatives, and the distribution of other risk factors in relatives, the authors also conducted a nested case-control study on family members of 95 patients with endometrial carcinoma diagnosed during 1988-1989 and 91 cancer free controls who were chosen randomly from subjects matched for age (+/-1 year). RESULTS: During 10 years of follow-up of the cohort, 322 incident endometrial carcinoma cases occurred. Women who reported a positive family history of cancer overall or at any specific site (e.g., the endometrium, colon, or breast) were not at increased risk for endometrial carcinoma. Adjustment for potential confounders, such as age, obesity, parity, oral contraceptive use, and estrogen replacement therapy, did not alter these results. Analysis of the family members of the cases and controls produced little evidence to suggest that this lack of association between family history and endometrial carcinoma could be explained by unequal distribution of known risk factors among relatives. Case family members were slightly older than control family members, but no significant differences were found in body mass index (kg/m2), age at menarche, age at menopause, or number of pregnancies. Relation to a case or control was not associated with increased risk of endometrial, ovarian, breast, or colon carcinoma for family members. Controlling for a variety of potential confounders did not alter the results. CONCLUSIONS: No evidence was found that genetics contribute to the risk of postmenopausal endometrial carcinoma for women with no personal cancer history.

Aged↗

PubMed1998

[The phenomenon of families who are involved in decision making about life support withdrawal in family members].

The overall objective of this study was to explore and describe the phenomenon of families who are involved in deciding about withdrawal of life-support treatment of a family member. A phenomenon analysis was undertaken in two phases. During the first phase, secondary analysis of primary data was done on the family used in Burger's study (1996: 1-175) and was followed up by phenomenological interviews with families used as member checking from the same circumstances and according to the same criteria that Burger (1996: 1-185) used in her study. Data were analysed in collaboration with an independent coder. The family used as member checking in this study is also used as data control. A literature control was conducted as part of data control. The themes that were identified included were: physical and bodily experiences of families; defence mechanisms used by families to cope with grief; emotional experiences of families; need of knowledge/perceptions/outlook on life/internal conflict/feelings of guilt/ability to make decisions/respect of patient wishes/the effect of time and prior experiences; support needed by an given to families; spiritual and supernatural experiences/hope/acceptance/ability to 'let go' of the patient. In phase two, guidelines were described for psychiatric nurse specialists to mobilise resources for families to promote, maintain and restore their mental health as an integral part of health.

Adaptation, Psychological↗

PubMed2000

Discussions of "code status" on a family practice teaching ward: what barriers do family physicians face?

BACKGROUND: Patients want physicians to ascertain their wishes related to resuscitation, yet such discussions of "code status" are often delayed in the hospital setting, which compromises patient autonomy. Few studies have examined family physicians' views on this topic. Our objectives were to explore the experiences of family physicians and family practice residents in establishing code status with their patients who had been admitted to hospital and to identify barriers to these discussions. METHODS: Semistructured, in-depth interviews were conducted with 5 family physicians and 5 family practice residents admitting patients to a family practice teaching ward in a university-affiliated urban tertiary care hospital. Interview transcripts were analysed inductively, and grounded theory was used to identify conceptual categories and recurring themes. Key findings were validated by means of member checking with participants, consensus meetings of the research team and consultation with qualitative researchers. RESULTS: Barriers to code-status discussions included personal discomfort with confronting mortality, fear of damaging the doctor-patient relationship or harming the patient by raising the topic of death, limited time to establish trust, and difficulty in managing complex family dynamics. In spite of these challenges, family physicians and residents viewed discussions of resuscitation as a significant part of their role. INTERPRETATION: Family physicians and residents need to develop personal awareness about difficulties in confronting mortality, enhance their communication strategies for broaching the topic of code status in the context of a trusting doctor-patient relationship and sharpen their skills in understanding and managing family dynamics related to end-of-life decisions. Awareness of the barriers to code-status discussions can inform research, education and hospital policy. Consultation with patients is needed to develop effective communication strategies.

Attitude to Death↗

PubMed2000

Cultural orientation, family cohesion, and family support in suicide ideation and depression among African American college students.

This study extends previous research by examining the role of communalism, family cohesion, and family support in suicide ideation and depression in African American college students. Participants were 188 African American introductory psychology students (126 female, 61 male) from a historically black college. (1) Results showed that communalism, family cohesion, and family support were positively associated with each other. Higher levels of family cohesion and family support were associated with lower levels of suicide ideation and depression. Linear regression analyses showed a main effect for communalism and family support. Having strong communal values was positively related to suicide ideation and depression. Having strong family support was associated with fewer experiences of suicide ideation and depression. Stepwise regression analyses indicated that family support explained more variance in suicide ideation and depression than family cohesion. Implications of these results for future research and practice are discussed.

Adolescent↗

PubMedDate not supplied

Social support and family assets: the perceptions of low-income lone-mother families about support from home visitation.

BACKGROUND: Research on lone-mother families has commonly focussed on psychosocial risk factors and deficits rather than family assets (strengths and resiliency characteristics). The negative impacts of poverty and social isolation have been well documented. Home visitation programs provide formal support to overburdened families, yet little research has focussed on the meaning of support (e.g., formal and informal) from the perspective of families. METHODS: This qualitative exploratory descriptive study was completed in southwestern Alberta, with a purposeful sample of 13 families (mean annual income of dollar 15,423 and 2.1 children) using mixed measurement (clinical tools and 2 semi-structured interviews). RESULTS: Similarities and differences in support and three lone-mother family structures were identified. A few lone-mother families described transformative experiences related to affirmative support from the home visitor. Not all families reported having 'enough support' to meet their needs. Sources of change in family assets included: a) support from the home visitor, b) 'other supports', or c) personal growth. On balance, support from home visitation was most commonly described as supporting these changes. SUMMARY: Support and assets were explored from a broad family and environmental context. Practice implications for home visitation and areas for future research were identified.

Adult↗

PubMed2005

Familial seropositive rheumatoid arthritis in North American Native families: effects of shared epitope and cytokine genotypes.

OBJECTIVE: A number of North American native (NAN) populations have high prevalence rates of both rheumatoid arthritis (RA) and the shared epitope (SE). We examined the phenotype and familial incidence of RA in a NAN population, and investigated how the SE and cytokine genes may affect disease risk within affected families. METHODS: NAN patients with seropositive RA or polyarthritis rheumatoid factor (RF) positive juvenile idiopathic arthritis (JIA) were identified from clinical databases. Patients were recruited consecutively as they presented for clinic visits. Family pedigrees were constructed and consenting relatives were interviewed and examined. The risk of RA within families was calculated by multiple logistic regression. Input variables were the SE and cytokine genotypes. Probands and affected relatives were entered as the affected group, and unaffected relatives within families as the unaffected group. Results were confirmed among unrelated subjects, i.e., unrelated patients and unaffected relatives of other probands. RESULTS: The familial prevalence of RA was 0.50 (95% confidence intervals 0.30, 0.70) among 28 families studied. The interleukin 10 (IL-10) promoter -1082 G/A genotype decreased the odds of RA relative to the A/A genotype in affected families (OR 0.247, 95% CI 0.081, 0.751; p = 0.014) and among unrelated subjects (OR 0.203, 95% CI 0.064, 0.640; p = 0.006). The G/G genotype yielded an OR of 0.093 (95% 0.013, 0.676; p = 0.019) among unrelated subjects. The SE had no effect in these calculations. CONCLUSION: There was a high familial prevalence of RA in this NAN cohort. In susceptible NAN families, the risk of RA was reduced by IL-10 genotypes, whereas the SE did not affect risk. Study of healthy NAN controls is required to determine if these conclusions apply to this NAN population as a whole.

Adolescent↗

PubMed1990

Publications by family physicians in non-family medicine journals.

Why do some family physician (FP) authors submit manuscripts to non-family medicine journals instead of to family medicine journals? This study identified all 32 FP-authored articles that were published in several widely read non-family medicine journals over a 4-year period. Twenty-nine (90.6%) of the FP authors thus identified responded to a questionnaire soliciting the article's publication history. Of the 29, only one author had initially submitted his article to a family medicine journal. The most common reason cited by the other authors for not submitting to a family medicine journal was a perception that the non-family medicine journals had wider readership and prestige than family medicine journals. Other authors indicated that institutional promotion and tenure committees give less weight to publications in family medicine journals and, therefore, these authors felt it was preferable to publish in non-family medicine journals.

Faculty, Medical↗

PubMed1995

[Possible relationship between overweightness and prevalence of hyperlipemia in the children of patients with heterozygote familial hypercholesterolemia and combined familial hyperlipemia].

BACKGROUND: Heterozygote familial hypercholesterolemia and combined familial hyperlipemia are associated to a greater risk of coronary disease. Combined familial hyperlipemia has classically been indicated to manifest after the second decade in life. The aim of this study was to establish whether a systematic search would demonstrate the existence of combined familial hyperlipemia earlier and analyze whether the antropometric parameters related with the overweightedness accompany the appearance of the lipid disorders of this disease found at an early age. PATIENTS AND METHODS: Different lipid parameters were studied in 89 subjects under the age of 18 who were children of patients with heterozygote familial hypercholesterolemia and combined familial hyperlipemia. Likewise the weight, height and waist/hip quotient were evaluated. Hyperlipemia was considered as the presence of cholesterol/LDL and/or triglicerides greater than the 95 percentile for age and sex. RESULTS: Hyperlipemia was observed in 51% and 40% of the children of patients with heterozygote familial hypercholesterolemia and combined familial hyperlipemia, respectively. The body mass index and the waist/hip quotient of the latter children significantly correlated with the cholesterol-HDL values and the LDL/HDL quotient. CONCLUSIONS: The patients with known combined familial hyperlipemia have a high percentage of children with hyperlipemia during infancy. These data suggest a possible association between obesity in the appearance of hyperlipemia in the children of patients with combined familial hyperlipemia at this age.

Adolescent↗

PubMed1995

Breast cancer and family history: a multivariate analysis of levels of tumor HER2 protein and family history of cancer in women who have breast cancer.

BACKGROUND: The HER2 gene, located on the long arm of chromosome 17, codes for a protein with the characteristics of a growth factor receptor. In a preliminary study, we reported that high levels of tumor HER2 (erbB-2/neu) protein are associated with a family history of breast cancer (that is, one or more female blood relatives with breast cancer). METHODS: We have now collected a larger number of subjects (94) and performed a multivariate analysis of the independent variables family history of breast cancer, tumor estrogen receptor, age, and tumor DNA index. Family history of breast cancer was assessed by questioning the patient, in many cases by telephone. RESULTS: HER2 levels were significantly higher in women with a family history of breast cancer (p = 0.015, two-tailed t-test). The 27 women with family history were predominantly postmenopausal, mean age 61 +/- 2.3 (mean +/- SEM), versus a mean age of 56 +/- 1.7 for the 67 women with no family history. Of the 27 women with a family history of breast cancer, 13 had a first-degree relative (mother or sister) with the disease. The remaining 14 women had other relatives (grandmothers, aunts, cousins, or a niece) with breast cancer. The results of multiple linear regression analysis, with HER2 as the dependent variable, showed that family history of breast cancer was significantly associated with elevated HER2 levels in the tumors (p = 0.0038), after controlling for the effects of age, tumor estrogen receptor, and DNA index. CONCLUSIONS: The association of family history of breast cancer and elevated tumor HER2 protein suggests that postmenopausal familial breast cancer may be associated with altered HER2 expression.

Biomarkers, Tumor↗

PubMedDate not supplied

What do family members expect from the family physician of a deceased loved one?

BACKGROUND AND OBJECTIVES: This study examined what actions are expected from a family physician by the family members of a deceased patient immediately following the death of the patient. METHODS: Those listed as next of kin on the charts of deceased patients of a suburban family practice residency were asked to complete a questionnaire about their expectations of their family member's family physician after the death. RESULTS: Expectation of the surveyed actions was surprisingly low, with attendance at the funeral the least expected, followed closely by acknowledgment of the anniversary of the family member's death. Nearly half of the respondents expected a telephone call shortly after the death, while close to one third expected the physician to ask about their emotional well-being at their next visit. CONCLUSIONS: The results suggest that family members do not expect or rarely expect any action from their family member's family physician after the death. However, comments received with the survey indicate that any gesture of sympathy or show of concern from the family physician was greatly appreciated by the survivors.

Death↗

PubMed1997

BRCA2 in American families with four or more cases of breast or ovarian cancer: recurrent and novel mutations, variable expression, penetrance, and the possibility of families whose cancer is not attributable to BRCA1 or BRCA2.

In order to evaluate the role of inherited BRCA2 mutations in American families--particularly the appearance in America of European founder mutations--the BRCA2 coding sequence, 5' UTR, and 3' UTR were screened in 22 Caucasian American kindreds with four or more cases of breast or ovarian cancer. Six mutations were found that cause a premature-termination codon; four of them have been reported elsewhere, and two are novel. In the four families with previously seen mutations, the distinct lineages at high risk of cancer were of Dutch, German, Irish, and Ashkenazi Jewish ancestry; mutations in Europe reflect these ancestries. The families with novel mutations were Puerto Rican Hispanic (exon 9 deletion 995delCAAAT) and Ashkenazi Jewish (exon 11 deletion 6425delTT). Among female BRCA2-mutation carriers, risks of breast cancer were 32% by age 50 years, 67% by age 70 years, and 80% by age 90 years, yielding a lifetime risk similar to that for BRCA1 but an older distribution of ages at onset. BRCA2 families also included multiple cases of cancers of the male breast (six cases), ovary (three cases), fallopian tube (two cases), pancreas (three cases), bladder (two cases), and prostate (two cases). Among 17 Ashkenazi Jewish families with four or more breast or ovarian cancers, 9 families (including 3 with ovarian cancer and 1 with male breast cancer) carried none of the three ancient mutations in BRCA1 or BRCA2. To date, both BRCA2 and BRCA1 have been screened by SSCA, supplemented by the protein-truncation test, in 48 families with four or more breast or ovarian cancers. Mutations have been detected in BRCA1 in 33 families, in BRCA2 in 6 families, and in neither gene in 9 families, suggesting both the probable cryptic nature of some mutations and the likelihood of at least one other BRCA gene.

Adult↗

PubMed1995

Grief in family and cultural context: learning from Latino families.

The following article offers an integrative theory of family development in sociocultural context, which critically examines the goodness of fit between the grief experiences of culturally diverse families and prevailing North American grief practices. This model suggests that many Latino families, even when they are themselves from a variety of national backgrounds with somewhat different sociopolitical histories and cultural practices, offer an approach to death and grief that can enhance developmental outcomes in family bereavement. These qualities include a focus on family and extended family relationships as developmental resources; an appreciation of the spiritual and psychological continuity between the living and the dead; and an appreciation of the need to keep working on relationships, even after a death, so as to create new, more optimal shared understandings of family past, present, and future. The bereavement story of the Ruiz family, who migrated from rural Puerto Rico to the United States, serves to illustrate the ways that integration of Latino family experience into mental health models of grief can help expand understanding and improve bereavement outcomes for all families.

Cross-Cultural Comparison↗