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PubMed1999

The needs of the family of critically ill neurosurgical patients: a comparison of nurses' and family members' perceptions.

In this study, researchers identified the important needs of family members of critically ill neurosurgical patients and explored the relationship between needs and unmet needs as perceived by nurses and family members. A total of 52 family members and 36 nurses in three neurosurgical special care units in Hong Kong were asked to complete the Chinese version of the 45-item Critical Care Family Needs Inventory. The rank order of most important needs reported by family members indicates that the majority of needs are related to assurance; needs for support and comfort were much less important. When rating needs, nurses underrated most of the needs considered important by family members. Needs for proximity were also underrated in importance by nurses when compared to family ratings, and needs for support were heavily overrated by nurses. The needs for proximity were least met. An inverse relationship between nurses' ratings of importance and the frequency of unmet needs was demonstrated. The most important need that was also largely unmet was having a specific person call when unable to visit. The findings of this study indicate areas of unmet need that require additional nursing interventions.

Adolescent↗
PubMed1991

Multiple family member visits to family physicians. Terminology, classification, and implications.

A study was designed to investigate "the family as the unit of care" in family medicine consultations from the patient's end of the physician-patient axis, unlike most previous related studies, which have concentrated on it from the physician's perspective. During 2 separate weeks in November 1987 and February 1988, nine Israeli family physicians collected demographic and family-related data concerning the spontaneous visiting patterns generated by 1156 persons (899 patients and 257 nonpatients) who attended 796 separate consultations at their clinics during this time. More than one patient attended 12% of the consultations, and more than one person, patient or nonpatient, was present at 36%. At 31% of the consultations children alone or children and adults were recorded as patients (child consultations), and at 69% only adult patients were present (adult consultations). Adults were recorded as second or third patients at 19% of the child consultations but at only 5% of the adult consultations. The child consultations alone yielded 86% of all the nonpatients documented. Basic terminology and methodology for investigating such multiple family member visits to family physicians is discussed as well as the composition of the different family units encountered and their possible significance.

Adult↗
PubMed1989

[Methods for selecting foster families for psychiatric family care].

Psychiatric foster family care of no more than two patients living in the foster family can be seen as a therapeutic setting, where longterm chronic patients can improve in their social functioning. Recent studies found the family characteristics as decisive for potential therapeutic effects. So the question arises how to select adequate foster family applicants. In an empirical study with 105 applicant-families we have tried to uncover the selection-procedures and mechanism of the foster care team that finally lead to adequate/non-adequate distinction. The results of the study show that the differences between the two applicant groups (selected vs non selected) are not identical with the intended selection criteria of the team members. Some major differences were found in areas that were totally independent from the team-criteria: the selected-as-adequate-families had a more intensive exchange with the outside world, educated more children and were therefore assumed to be socially more competent than the not selected applicant group. So selecting foster families comes up as a complicated decision making process that goes beyond checking up some criteria.

Adult↗
PubMed1989

Family recovery from alcoholism. Mediating family factors.

The problems families face during recovery from alcoholism are complex and pervasive. Sobriety for the alcoholic without concurrent alterations in family member relationships and improved family functioning too often leads to relapse and the demise of the family unit. The degree to which a family is able to modulate demands, use resources, implement effective coping strategies, and make necessary relationship adjustments may determine the extent to which treatment effects will be maintained. For those families who have successfully worked together to overcome the negative effects of alcoholism, the experience becomes a major catalyst to continued growth, maturity, and a healthier lifestyle. The nurse has a significant role in assisting the family with early recovery needs and in developing new behaviors for maintaining therapeutic gains.

Alcoholism↗
PubMed1987

Promotion of family enrollment in an urban family practice residency program.

Although a basic goal of family practice is to provide care for all members of the family, few studies have been done to test the ease of accomplishing this goal. At the Downstate Medical Center Department of Family Practice in Brooklyn, New York, an attempt was made to increase family enrollment by introducing several educational interventions directed at patients and resident physicians. Family enrollment levels were documented during a study period from June 1981 to September 1982, and again in June 1984. Both before and after the intervention efforts, family enrollment levels remained the same. It was concluded that the educational interventions used were unsuccessful in both short-term and long-term follow-up. Only one subgroup that participated in a specific educational intervention (patient orientation groups) showed an increase in family enrollment.

Family↗
PubMed1980

Family Court counselling with separating families.

Family Court counsellors, attached to the Family Court, see married couples who are separating, particularly those already involved, or likely to be, in Court disputes concerning their children. Children seen by the counsellors are from families in crises, and are usually detrimentally affected by family separation, and more so by any accompanying conflict. The impact on them depends on their developmental stage and position in the family system, and may be manifested in aggressive behaviour, general anxiety, psychosomatic symptoms, or manipulation and 'acting out'. The examination of the whole family system is essential to defuse the situation and thereby move the focus from the children; the close cooperation of all professionals working with the family is necessary to achieve this.

Adolescent↗
PubMed1996

How family influences practice of obstetrics. Do married women family physicians make different choices?

PURPOSE: To examine the influence of family, past and current, on married women family physicians' and to understand why and how some women continue to practise obstetrics. PARTICIPANTS: Purposive sample of nine married women family physicians who currently practise obstetrics. METHOD: Qualitative in-depth interviews. FINDINGS: Analysis identified four main influences of family on participants' practice of obstetrics: family of origin, transitions in the life cycle, children, and the marital relationship. CONCLUSIONS: These women described how they combined the roles of wife, mother, daughter, sister, and doctor. Family was a powerful influence throughout their practice lives. Finding a balance between the demands of practice, particularly obstetrics, and family relationships was an ongoing process. The process was also influenced by transitions in the life cycle.

Adaptation, Psychological↗
PubMed1996

[Validity and reliability of the family Apgar family function test].

OBJECTIVE: The aim of this study is to analyse the validity and reliability of the Apgar family questionnaire on family function. DESIGN: A crossover and descriptive study. SETTING: Urban health centre. PATIENTS: 656 patients of the Zaidín-Sur health centre in Granada were interviewed at home. The questionnaire was repeated an average of 6 days later to 60 of the patients (30 with an interviewer and 30 filling in their own). MEASUREMENTS AND MAIN RESULTS: The within-class correlation coefficients for the 5 items in the Apgar-family we over 0.55, both for self-filled and interviewer questionnaires; the scale coefficients were 0.86 and 0.81, respectively. Item-scale correlation varied between 0.61 and 0.71. Crombach's alpha was 0.84 and none of the items, when taken out of the scale, increased the alpha. The factorial analysis isolated only one factor. 16% of the sample had dysfunctional Apgar-family: the average score was 8.4. After adjustment (multiple logistic regression), the following were significantly linked to family dysfunction: lack of social support; being widowed or separated/divorced; greater perception of susceptibility to, or seriousness of, illness; being an over-user of the health service; and being a woman. CONCLUSIONS: The Apgar-family questionnaire on family function is valid and reliable.

Cross-Over Studies↗
PubMed1984

Size of family of orientation and family size preference: a replication.

"Past studies have found a modest, positive association between size of family of orientation and preferred family size and fertility behavior in the family of procreation. While there is some consistency in the findings, contradictions are also noted. The present study replicates earlier studies dealing with preferred family size, and seeks to resolve some of the contradictions by utilizing multiple classification analysis to determine the simultaneous impact of parental family size, religion, happiness, life style stability, and birth order on family size preference." The data, collected in 1981-1982, concern 379 U.S. college students.

Americas↗
PubMed1994

[Nuclear families by family life cycle category, January 1, 1992].

"In this article, family life-cycle categories [in the Netherlands] are defined by the ages of the youngest and the eldest child. The figures are from an enumeration from automated municipal population registers. For each inhabitant sex, year of birth, marital status, country of birth, family relationship and a number of other characteristics were obtained. The family relationship shows whether or not a person lives in a nuclear family and if so, what position they have therein (e.g. spouse, parent, child). On the basis of these data three types of nuclear families were defined...." (SUMMARY IN ENG)

Age Factors↗
PubMed2001

Cognitive deficits associated with a recently reported familial neurodegenerative disease: familial encephalopathy with neuroserpin inclusion bodies.

BACKGROUND: We recently discovered an autosomal dominant disease causing a progressive dementia. The disease is caused by a point mutation in the gene coding for the serine protease inhibitor (ie, serpin) neuroserpin. The mutation results in an unstable neuroserpin protein that readily aggregates into intraneuronal inclusions that we identify as Collins bodies. The bodies are distributed throughout the cerebral hemispheres but are significantly more numerous in the cortex and the substantia nigra. We have named the disease familial encephalopathy with neuroserpin inclusion bodies (FENIB). OBJECTIVES: To describe the cognitive and neurophysiological changes exhibited by individuals with FENIB and to correlate the phenotypic expression of the disease with the neuropathological findings. DESIGN: Multiple case studies using neuropsychological assessment, electroencephalography (EEG), magnetic resonance imaging (MRI), and single-photon emission computed tomographic (SPECT) studies of family members were performed. Using these measures, we also compared family members in whom the mutation is present with family members in whom the mutation was absent to control for nonspecific familial factors. SUBJECTS: Nine individuals (5 women, aged 31-64 years; 4 men, aged 43-67 years) from 2 generations of family members related to the first reliably identified individual with symptoms of this disease. Symptoms, by self-report and reports of other family members, ranged from asymptomatic to severe dementia. Six of the 9 individuals carried the disease mutation. RESULTS: All subjects with the mutation demonstrated some cognitive changes, with the greatest demonstrated by subjects older than 40 years. The changes included restricted attention, concentration, and response regulation functions, reduced controlled oral fluency (word-list generation), and restricted visuospatial organization. In general, recall memory was not as affected as other cognitive domains. The most severely affected subject demonstrated global dementia with prominent frontal lobe features. Findings on SPECT showed anomalies limited to frontal areas in the less affected subjects and more global, patchy areas of hypoperfusion in the more severely affected subjects. The 3 oldest and most affected subjects demonstrated slowing on EEG findings. The MRI findings were noncontributory except in the 2 most severe cases, which showed global cortical atrophy. CONCLUSIONS: Cognitive changes in mildly to moderately affected subjects were characterized by deficits in frontal and frontal-subcortical area-dependent processes. Continued progressive deterioration of cerebral functions with relative sparing of recall memory suggests a unique dementia associated with this disease.

Adult↗
PubMed2004

Family transmission and heritability of externalizing disorders: a twin-family study.

BACKGROUND: Antisocial behavior and substance dependence disorders exact a heavy financial and human cost on society. A better understanding of the mechanisms of familial transmission for these "externalizing" disorders is necessary to better understand their etiology and to help develop intervention strategies. OBJECTIVES: To determine the extent to which the family transmission of externalizing disorders is due to a general vs a disorder-specific vulnerability and, owing to the genetically informative nature of our data, to estimate the heritable vs environmental nature of these transmission effects. DESIGN: We used structural equation modeling to simultaneously estimate the general and specific transmission effects of 4 externalizing disorders: conduct disorder, adult antisocial behavior, alcohol dependence, and drug dependence. SETTING: Participants were recruited from the community and were interviewed in a university laboratory. PARTICIPANTS: The sample consisted of 542 families participating in the Minnesota Twin Family Study. All families included 17-year-old twins and their biological mother and father. MAIN OUTCOME MEASURES: Symptom counts of conduct disorder, the adult criteria for antisocial personality disorder, alcohol dependence, and drug dependence. RESULTS: Transmission of a general vulnerability to all the externalizing disorders accounted for most familial resemblance. This general vulnerability was highly heritable (h2 = 0.80). Disorder-specific vulnerabilities were also detected for conduct disorder, alcohol dependence, and drug dependence. CONCLUSIONS: The mechanism underlying the familial transmission of externalizing disorders is primarily a highly heritable general vulnerability. This general vulnerability or common risk factor should be the focus of research regarding the etiology and treatment of externalizing disorders.

Adolescent↗
PubMed1997

Comparison of the family history with the family study method: report from the Camberwell Collaborative Psychosis Study.

We assessed the accuracy of the family history (FH-RDC) and family study (SADS-L) methods for obtaining information about the presence of psychopathology in 274 first-degree relatives of patients with psychotic disorders. The family history method had only modest sensitivity, 40.8% for affective disorders and 58.6% for psychotic disorders, but high specificity, 94.1% for affective disorders and 98.7% for psychotic disorders. For both disorders, sensitivity was higher for relatives who had had previous psychiatric admissions. However, with the family study method, we found that relatives with affective disorder were more likely to be interviewed than those relatives with other disorders. Hence, the family study method may be prone to selection bias that distorts morbid risk estimates. We conclude that the best way of collecting information regarding family psychopathology is to interview directly as many relatives as possible and to collect supplementary family history information on unavailable relatives.

Adolescent↗
PubMed1997

Analysis of 31 families with an apparently autosomal-dominant transmission of migraine with aura in the nuclear family.

We analyzed 31 families selected for an apparently autosomal-dominant mode of inheritance of migraine with aura (MA) in the nuclear family. The nuclear families were expanded with first- and second-degree relatives. All interviews were made by physicians experienced in headache diagnoses. The criteria of the International Headache Society were used. The population relative risk among children in nuclear families was similar to the estimated population relative risk of MA assuming an autosomal-dominant mode of inheritance. The population relative risk tended to decrease among first-degree relatives outside nuclear families and further among second-degree relatives. Both first- and second-degree relatives outside the nuclear families had a statistically significant lower risk of MA than expected. Thus, autosomal-dominant inheritance with or without reduced penetrance was unlikely. Autosomal-recessive inheritance was unlikely because of the unequal sex distribution. Other modes of inheritance were considered as well. Mitochondrial and X-linked inheritance were excluded because of paternal transmission. The female preponderance was too low to explain sex-influenced inheritance. We conclude that MA most likely has a multifactorial inheritance even in high-risk families with MA.

Adolescent↗
PubMed1996

Reconceptualizing family caregiving: family-based illness care during chemotherapy.

In spite of extensive research on cancer and the family, little is known about the process of taking on the caregiving role when a family member is diagnosed with cancer. Family caregiver role acquisition was investigated in a grounded theory study of 19 family caregivers and 20 persons with cancer, interviewed across the course of chemotherapy. The initial analysis revealed that caregiving could not be understood in isolation from self-care in this sample and a reconceptualization of the target phenomenon was needed. Accordingly, the concept of family-based illness care was developed to encompass both self-care and caregiving. Twelve dimensions of family-based illness care and three prototypical patterns of illness care involvement were identified. Patterns of involvement fluctuated over time, a phenomenon labeled shifting patterns of self-care and caregiving. Shifting patterns of self-care and caregiving was so characteristic of illness care during chemotherapy that it became the core concept of the grounded theory. This conceptualization emphasizes the dyadic nature of family-based illness care during chemotherapy.

Antineoplastic Agents↗
PubMed1993

Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. A report of the Gilda Radner Familial Ovarian Cancer Registry.

BACKGROUND: According to previous reports, primary peritoneal carcinoma indistinguishable from primary ovarian adenocarcinoma had developed in five women with a history of familial ovarian cancer who had undergone prophylactic oophorectomy. METHODS: The records from the Gilda Radner Familial Ovarian Cancer Registry were reviewed for instances of prophylactic oophorectomy and cases of primary peritoneal carcinoma occurring after prophylactic oophorectomy. RESULTS: From 1981 through July 1992, the Gilda Radner Familial Ovarian Cancer Registry accessioned 931 families (a total of 2221 cases of familial ovarian cancer). Currently, 324 women in these families have undergone prophylactic oophorectomy as a preventive measure against the subsequent development of ovarian cancer. Primary peritoneal carcinoma indistinguishable histologically from primary ovarian adenocarcinoma has developed in six of these women 1-27 years after prophylactic oophorectomy. CONCLUSIONS: Based on this finding and other reports of such primary peritoneal carcinoma, a prospective international study is planned. This study will compare the incidence of peritoneal carcinoma in first- or second-degree relatives who underwent prophylactic oophorectomy because of a family history of ovarian cancer with that of those who did not undergo prophylactic oophorectomy.

Adenocarcinoma↗
PubMed2000

Familial history of metabolic disorders and the multiple metabolic syndrome: the NHLBI family heart study.

UNLABELLED: A case-control study was conducted to investigate the association between family history of obesity, hypertension, and diabetes and the co-occurrence of metabolic disorders associated with the multiple metabolic syndrome (MMS). Included were 1,448 African and European American men and women aged 48-71 who participated in both the third cohort examination of the Atherosclerosis Risk in Communities study, 1992-1994, and phase I of the Family Heart Study 1993-1995. The joint occurrence of hypertension, dyslipidemia, and diabetes or impaired fasting glucose in an individual determined his/her status of "affected" (MMS: n = 97), while the absence of these three metabolic disorders determined his/her status of "unaffected" ( CONTROL: n = 527). First-degree relatives provided the information to calculate family risk scores (FRSs) for the phenotypes under study: obesity, diabetes and hypertension. Although the majority of cases were obese (76.3%), family history of obesity was associated only weakly with the MMS, while family history of diabetes, or hypertension was associated significantly with the MMS (controlling for age, race, gender, and sampling group). Obesity of cases and controls modified the strength of these associations-odds ratios were 2.5(95% CI:1.1-6.1) and 2.9(95% CI:1.2-7.0) for the diabetes and hypertension FRSs in the non-obese, while in obese individuals the respective odds ratios were 1.6(95% CI:0.9-2.8) and 1.7(95% CI:0.9-3.1). These results may imply that obesity, whether familial or environmental in nature, is associated with the development of the MMS, while in non-obese individuals a family history of diabetes, hypertension, or obesity is a marker of genetic predisposition to components of the MMS.

Aged↗
PubMed1996

A family retreat as a comprehensive intervention for children with arthritis and their families.

OBJECTIVE: Family resources and coping skills are important to adaptation to pediatric chronic illness. Psychological and educational interventions have been found to enhance the coping skills of children with juvenile rheumatic disease (JRD) and their families. We examined the efficacy of a 3-day family retreat as a multidisciplinary, comprehensive treatment. METHODS: Children with JRD and their caregivers completed questionnaires assessing the children's behavioral and emotional functioning, pain, strain on caregivers' work and leisure activities, and caregivers' psychological distress before and 6 months after the family retreat. Principal caregivers were both parents for 16 children, mothers only for 10 children, and an aunt for 1 child. RESULTS: Improvements were found in children's emotional functioning, strain on caregivers' work, and strain on caregivers' leisure activities. Reductions in reported pain were not consistently revealed. CONCLUSIONS: Family retreats are an efficacious, multidisciplinary approach to helping families of children with JRD cope with the disease and its manifestations. Importantly, retreats offer a comprehensive intervention package that might not be available to families on an individual basis.

Adaptation, Psychological↗