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PubMed1981

Teaching the family system concept in family medicine.

Teaching the family system concept to physicians is difficult, as it entails a new way of thinking, at odds with the familiar linear medical model that focuses on the individual patient. This conceptual difference and the confusion between working with families in family medicine and family therapy explain the slow or superficial acceptance of family as the unit of care. Five principles have been found to be useful in teaching: (1) specific teaching techniques should take into account previous training and current time constraints; (2) evidence for the relevance of system theory to diagnosis, treatment, and prevention should be evaluated early in the teaching program; (3) clarity of expectations is crucial; (4) emphasis should be on the natural role of the family physician as first-line family advisor and the use of interviewing and observational skills already well developed; and (5) synthesis of the psychosocial and physical aspects of illness will occur naturally if the family physician is the teacher of family system concepts and the role model for their application in practice.

Adult↗
PubMed1990

Do black family headship structures make a difference in teenage pregnancy? A comparison of one-parent and two-parent families.

"The black communities of the United States have a disproportionate number of single-parent families: In point of fact, over one half of all black families with children are single-parent families; the great majority of these single-parent families are headed by females. The fastest growing segment of single parent families is young never-married females who...have incomes below the poverty line. Using a causal model analysis, this particular study undertook to compare subsamples of continuous two-parent and one-parent families to find out what intra-familial dynamics 'cause' early versus late teenage pregnancy. The results suggest that positive child-parent affect is generally associated with delayed teenage pregnancy, and negative child-parent affect is generally associated with early teenage pregnancy. Moreover, the father's influence is significant in both two-parent and one-parent families."

Black or African American↗
PubMed1992

The family profile: a new self-report instrument for family assessment.

The Family Profile is a new self-report family assessment instrument that is grounded in family theory and designed following a construct validation approach to instrument design that integrated theoretical concepts with test construction and empirical analysis. Development consisted of three component phases: rational theoretical design, empirical structural analysis, and psychometric validation. The first theoretical design phase resulted in a 231-item instrument with 13 construct scales. Structural analysis data were collected from a pilot sample of 160 patients selected from 6 family practice clinics in urban, suburban, and rural locations. After revision based on item and scale analysis, a 129-item instrument was administered to a random sample of 876 patients from family practices throughout Minnesota. Responses were analyzed for item- and scale-distribution characteristics, item-scale and scale-scale correlations, correlation with social desirability, factor analysis to confirm or disconfirm the existence of the theoretical dimensions, internal consistency reliability, and test-retest reliability. This analysis reduced the instrument to 90 items from all 13 postulated constructs that cluster into 6 main factors--Family Concordance, Family Discordance, Marital Strength, Active Involvement, Religiosity, and Parental Leadership. The Family Profile is also temporally stable and free from social desirability bias. Validation (construct and criterion) and normative data studies of various populations are in progress.

Family↗
PubMed1996

Suicidal behavior runs in families. A controlled family study of adolescent suicide victims.

BACKGROUND: While previous studies have shown an increased rate of suicidal behavior in the relatives of suicide victims, it is unclear if this is attributable merely to increased familial rates of psychiatric disorders. Therefore, we conducted a family study of adolescent suicide victims (suicide probands) and community control probands (controls) to determine if the rates of suicidal behavior were higher in the relatives of adolescent suicide probands even after adjusting for differences in the familial rates of psychiatric disorders. METHOD: The relatives of 58 adolescent suicide probands and 55 demographically similar controls underwent assessment for Axis I and II psychiatric disorders, lifetime history of aggression, and history of suicidal behavior (attempts and completions) using a combination of family study and family history approaches. RESULTS: The rate of suicide attempts was increased in the first-degree relatives of suicide probands compared with the relatives of controls, even after adjusting for differences in rates of proband and familial Axis I and II disorders (odds ratio, 4.3; 95% confidence intervals, 1.1-16.6). On the other hand, the excess rate of suicidal ideation found in the relatives of suicide probands was explained by increased familial rates of psychiatric disorders. Among suicide probands, higher ratings of aggression were associated with higher familial loading for suicide attempts. CONCLUSIONS: Liability to suicidal behavior might be familially transmitted as a trait independent of Axis I and II disorders. The transmitted spectrum of suicidal behavior includes attempts and completions, but not ideation, and the transmission of suicidal behavior and aggression are related.

Adolescent↗
PubMed1999

Bivariate familial correlation analysis of quantitative traits by use of estimating equations: application to a familial analysis of the insulin resistance syndrome.

Familial correlation analysis involving two traits may give a better insight into the etiology of multifactorial syndromes than familial analysis focused on single traits. Significant cross-trait correlations between biological relatives but not between spouses suggest that the two traits share common transmissible factors whereas correlations between spouses additionally suggest the influence of shared lifestyle factors. We apply the Estimating Equations (EE) technique to the estimation of intra-trait and cross-trait familial correlations on two quantitative traits. Unlike maximum likelihood methods, the EE method does not require one to specify the joint distribution of the traits. Estimation of correlations and of their variance involves an iterative three-stage algorithm which converges rapidly. The generalized Wald test can be used to test any specific hypothesis of familial resemblance. This method has great flexibility for handling covariates and incomplete family data. A simulation study indicated that the EE technique performed well in large samples (100 families), both in terms of type I error and coverage probability . However, in small samples (50 families), an increase of the type I error and a decrease of the coverage probability was observed. As an illustration, we applied this technique to a family study of metabolic factors involved in the Insulin Resistance Syndrome (body mass index, insulin, triglycerides, HDL-cholesterol, and diastolic blood pressure). The study was carried out in a sample of 216 healthy nuclear families with > or =2 offspring. The results suggested the existence of a common transmissible (genetic or cultural) factor influencing both body mass index and insulin, whereas the weak clustering of triglycerides and HDL-cholesterol would be more compatible with the influence of shared lifestyle factors.

Algorithms↗
PubMed1984

Measuring family functioning with the MMPI: a reliability and concurrent validity study of three MMPI family scales.

Examined the utility of three MMPI family scales. Three MMPI family scales and three criterion family scales were administered to 110 undergraduates. Internal consistency coefficients were calculated for each MMPI family scale. Relationships between the MMPI family scales and the criterion scales are examined by a correlational analysis. Findings suggest that the MMPI family scales are reliable and concurrently valid measures of an individual's perception of interpersonal family relationships. Procedures for scoring and interpreting the MMPI family scales are examined. The findings also indicate which MMPI family scale is the overall best scale.

Adolescent↗
PubMedDate not supplied

Proband family uptake of familial-genetic counselling.

Familial-genetic counselling for breast/ovarian cancers is a process initiated by a proband, and designed for all her/his blood relatives. This study focused on family members' uptake of an invitation to participate in counselling as a function of proband and family determinants. Of 163 breast/ovarian syndrome families tested, 67 carrying one of the three known Jewish mutations were included. For both the proband and family members, demographic variables, cancer status, position in the family and type of referral (proband only) were examined. Eligible family members' uptake rate was 34%. Lower family uptake was associated with the proband having cancer, and/or being doctor-referred (vs self-referred). Individuals of either the proband's or older generations had lower uptake rates compared with family members of younger generations. Being a cancer patient or a first degree relative of either a cancer patient or the proband was related to higher uptake. The study results indicate that baseline information routinely gathered by counselling services can be useful in predicting uptake. Providing insight into complex barriers to genetic counselling, these results also suggest potential directions for interventions to improve uptake, thereby enhancing individuals' abilities to make informed decisions regarding issues such as genetic testing.

Adult↗
PubMed2001

Our family, whose perspective? An investigation of children's family life and health.

Most quantitative studies of family life and family members' well-being rely on single informants in relation to both. This raises two issues; first, the validity of an individual's perceptions of family life, second, that part of any obtained association may arise because the same person provided information on both. This study addresses these methodological points, plus the substantive issue of whether family structure is related to child health/adjustment independently of family process. It employs reports of family life from 11-year-olds and their parents, and of child health/adjustment obtained via self-report as well as from parents and teachers. Variance in child health/adjustment explained by family structure alone is extremely small. The strongest relationships between family process and child health/adjustment occur in respect of reports from the same informant, although some cross-informant relationships exist. Caution when interpreting studies of family life and well-being which rely on single informants is suggested, and the need for increased understanding of the reasons behind any obtained associations highlighted.

Child↗
PubMed1996

Malignant familial hypertrophic cardiomyopathy in a family with a 453Arg-->Cys mutation in the beta-myosin heavy chain gene: coexistence of sudden death and end-stage heart failure.

Recent genotype-phenotype correlation studies in familial hypertrophic cardiomyopathy (FHC) have revealed that some mutations in the beta- myosin heavy chain (BMHC) gene may be associated with a high incidence of sudden death and a poor prognosis. Coexistence of sudden death and end-stage heart failure in several families with FHC has recently being reported; however, the genetic basis of such families has not been clearly demonstrated. A three-generation Chinese familial hypertrophic cardiomyopathy (FHC) family (family HLI) with two cases of end-stage heart failure and three cases of sudden death was analyzed. The average age of death in the affected members in this family was 34 years old. Genetic linkage analysis using polymorphisms in the (alpha- and beta-myosin heavy chain genes revealed that FHC in this family is significantly linked to the BMHC gene without recombinations. Single-strand conformation polymorphism analysis of exons 8, 9 and 13 to 23 in the BMHC gene showed a polymorphic band on exon 14 that is in complete linkage with the disease status in this family. DNA sequencing analysis in the affected members revealed an 453Arg-->Cys mutation in the BMHC gene. To our knowledge this is the first reported mutation of FHC in Chinese. Our data suggest that the 453Arg-->Cys mutation is associated with a malignant clinical course in FHC due not only to sudden death but also to end-stage heart failure.

Adolescent↗
PubMed2002

Preliminary results of the molecular diagnosis of familial adenomatous polyposis in Cuban families.

BACKGROUND AND AIMS: Familial adenomatous polyposis (FAP) is an autosomal dominant condition characterized by multiple adenomatous polyps in the colon and rectum that inevitably develop into adenocarcinomas if the patient's colon is not removed in time. To date more than 500 mutations related to the disease have been identified in the APC (adenomatous polyposis coli) gene. The molecular study of FAP families was initially introduced in Cuba with the aim of identifying the asymptomatic carriers of APC gene mutations in each family. PATIENTS AND METHODS: We studied 23 individuals from 17 Cuban families who had been diagnosed clinically with FAP. Peripheral DNA was extracted from the index case of each family. Exon 15 of the APC gene was screened for germinal mutations using PCR and DNA heteroduplex. RESULTS: Three different germinal mutations were identified in the mutational clustering region of APC gene by sequencing analysis in five FAP unrelated families. Three families carry the most frequent mutation in APC in codon 1309, while the other two families carry mutations in codons 1061 and 1192, respectively. Two asymptomatic carriers of one family were detected, and later the disease was confirmed by colonoscopy in a very early stage while six members at risk were found to be negative. CONCLUSION: For the first time in Cuba molecular diagnosis of FAP was performed and the development of colorectal cancer prevented in asymptomatic carriers.

Adenomatous Polyposis Coli↗
PubMed1990

Organization of the murine immunoglobulin VH complex: placement of two new VH families (VH10 and VH11) and analysis of VH family clustering and interdigitation.

During B cell development, there is an ordered expression of heavy chain variable region (VH) genes during ontogeny such that JH proximal VH genes are rearranged and expressed before the more JH distal VH genes. Thus, the relative chromosomal position of VH genes is biologically significant. We have previously employed deletion mapping to order the nine described murine VH gene families as follows: 3609-J558-(J606/VGAM3-8/S107)-3660-(X24/Q52/7183 ). (Families within parentheses were not mapped relative to each other.) In this report we continue this analysis by mapping two recently described heavy chain variable region gene families (VH10 and VH11). VH10 is located at the JH proximal end of the major cluster of J558 VH gene segments. VH11 (a very small family) is intermingled with the 3660 family. Although in general VH genes are thought to be clustered, we and others have reported some interspersion between families. To further address this issue, we have analyzed 80 recombinant phage clones containing J558 VH gene segments for the presence of other VH family genes. Our data indicate that the J558 and 3609 VH families are extensively intermingled as has recently been described for the most JH proximal Q52 and 7183 families.

Animals↗
PubMed2006

Familial aggregation of depression, but no familial aggregation of individual depressive symptoms.

BACKGROUND: Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression. METHODS: The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses. RESULTS: Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed. CONCLUSIONS: Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.

Age Factors↗
PubMed2004

Remaking family life: strategies for re-establishing continuity among Congolese refugees during the family reunification process.

The restrictive immigration and refugee policies of many Western countries force most refugee families to remain separated for long periods. Although there is much discussion among professionals in the community and the clinical milieu about the problems families encounter after reunification, the strategies employed by refugees to restore family life have not been paid much attention. This longitudinal study documents the pre- and post-reunification experiences of 12 refugee families from the Democratic Republic of Congo in Montreal. Our results suggest that family separation can be understood as an ambiguous loss, in that the temporary absence of other family members cannot be fully acknowledged because of the perpetual uncertainty and permanent risk to them. Memory work, in the form of shared family memories, attenuates the pain of the absence. Once reunited, family members must re-establish continuity in spite of the many denied rifts between them. The capacity to recall a personal, familial or collective history of previous separation and loss appears to be protective, as if the memory of life's discontinuities provides an opportunity to recreate a partial sense of continuity out of repeating experiences of chaos.

Adult↗
PubMed1999

Familial aggregation of resting blood pressure and heart rate in a sedentary population: the HERITAGE Family Study. Health, Risk Factors, Exercise Training, and Genetics.

The familial aggregation of resting systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) was assessed in 98 white families, who participated in the HERITAGE Family Study, and were selected to be sedentary, and primarily nonobese and normotensive. In the present study, 522 family members were sedentary at baseline examination, and resting SBP, DBP, and HR measured during this examination were investigated. If physical activity level is a potent environmental factor, then we expected that the relative contribution of environmental factors to the familial aggregation of blood pressure (BP) would be somewhat reduced, because activity was controlled for in this study. Using a familial correlation model, maximal heritabilities were estimated to be 54%, 41%, and 32% for resting SBP, DBP, and HR, respectively, in these families; and they were 51%, 42%, and 34% for resting SBP, DBP, and HR, respectively, when the data were adjusted for body mass index. The estimates are somewhat higher for BP but similar for HR to those reported in previous family studies, suggesting that the distribution of the underlying etiologic factors in these sedentary families may be similar to those in the general population. There was substantial spouse resemblance in this study, which may be explained by a higher concordance for correlated lifestyle factors including diet, similar activity levels, or by assortative mating for relative weight or dietary preferences.

Adolescent↗
PubMed2001

Coparenting, family process, and family structure: implications for preschoolers' externalizing behavior problems.

This study examined how aspects of triadic-level family interaction relate to preschoolers' externalizing behavior problems. The quality of coparenting, family affective processes, and family structure was assessed at 3 years, and mothers, fathers, and teachers reported on children's externalizing behavior problems at 4 years. High levels of supportive coparenting and more adaptive family structures were associated with fewer externalizing behavior problems, whereas high levels of undermining coparenting and negative affect and less adaptive family structures were associated with more externalizing behavior problems. Moreover, the quality of family affectivity and family structure interacted with coparenting and appeared to influence its effects on the family. This study highlights the importance of focusing on triadic, family-level variables for understanding children's behavior problems.

Adult↗
PubMed1999

Relationships between family dynamics of Finnish child-rearing families, factors causing strain and received support.

The aim of this study was to determine the relationships between family dynamics, the factors causing strain on child-rearing parents and the support available to families from public health nurses. Family dynamics was defined as the family's unique way of functioning and was conceptualized by means of six different dimensions. Questionnaires were sent to 118 families, and of these 85 mothers and 79 fathers participated in the study. According to the findings the majority of parents involved in bringing up children aged 3-4 years assessed their families to be well-functioning. There was a correlation between a low level of factors causing strain on the family and a positive evaluation of family dynamics based on the various dimensions. According to the mothers the support, i.e. emotional, appraisal and instrumental support, received from public health nurses, along with a small number of strain-causing factors on the partner relationship, correlated well with their positive assessments of the mutuality and flexibility of their families.

Adult↗
PubMed2002

Dyslipidemia in young Japanese children: its relation to familial hypercholesterolemia and familial combined hyperlipidemia.

BACKGROUND: Most cases of dyslipidemia found in adults are non-familial. However, in children, especially young children, dyslipidemias other than familial hypercholesterolemia (FH) have not yet been characterized. METHODS: From April 1990 to March 1999, 56 181 children were screened, and 1380 showed abnormal levels of apolipoprotein B (more than 2.5 standard deviations above the mean). Among these, 1198 were re-examined and further characterized by measuring lipids and apolipoproteins, and by their familial histories. RESULTS: Seventy-seven percent of the children (928 of 1198) recalled were diagnosed as being dyslipidemic. Ninety-one children were FH, 423 were type IIa, 128 were type IIb, 98 were type IV, and 188 were hypoalphalipoproteinemia. The presumed incidence of FH was 0.19%, IIa 0.87%, IIb 0.26%, IV 0.20%, and hypoalphalipoproteinemia 0.39%, taking into account the percentage of subjects who refused recall. At regular follow-ups, in many children with type IIb, the phenotypic expression changes from type IIb to IIa or IV. Thus, lipid and apolipoprotein levels were determined in 77 family members in 34 families of children with type IIb. Forty-five family members were dyslipidemic (type IIa 18, type IIb 11, type IV 16). As a result, 27 children (79%) with type IIb met the criteria for familial combined hyperlipidemia. CONCLUSIONS: Children with dyslipidemia had more family or genetic background than adults. Unexpectedly, children with type IIb were mostly familial combined hyperlipidemia. Thus, setting appropriate eating patterns during childhood might be important for normalizing risk factors for atherosclerotic coronary heart disease, especially in children with FH or type IIb.

Analysis of Variance↗
PubMed2003

Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme.

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent-child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.

Adult↗