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PubMed1993

Does teaching by family physicians in the second year of medical school increase student selection of family practice residencies?

BACKGROUND AND OBJECTIVES: Most educators feel that early instruction by family physician teachers increases the probability of students selecting family practice residencies. METHODS: To examine this hypothesis, a retrospective cohort study was performed to evaluate residency selection of students who received their second-year Introduction to Clinical Medicine (ICM) teaching either from family physicians or other specialists (most commonly, internists). RESULTS: For the 971 students who could be followed to residency, 13.6% of those having family physicians as instructors and 15.7% of those having other specialists as instructors chose family practice residencies. The difference is not significant. CONCLUSION: It is probable that the effect of having a family physician as a second-year ICM instructor is not significant enough to be detected by a study of this size and is simply "washed out" by other factors. It is also possible that no positive effect of second-year teaching by family physicians on residency selection exists.

Adult↗
PubMed1996

[Familial prevalence in chronic intestinal inflammatory disease. Differences among groups of patients with and without a familial history].

OBJECTIVE: To assess the prevalence of familial occurrence in patients with inflammatory bowel disease and to evaluate the differences among groups of patients with and without familial history. PATIENTS AND METHODS: Complete information about sex, age of onset of inflammatory bowel disease, initial location, extracolonic manifestations and perianal disease (in Crohn's disease) was obtained from 187 patients, 99 with Crohn's disease, and 88 with ulcerative colitis. RESULTS: In 9 patients (9%) with Crohn's disease and 11 (12.5%) with ulcerative colitis, at least one first-degree relative also had inflammatory bowel disease. Three relatives of patients with Crohn's disease had ulcerative colitis and no relative of patients with ulcerative colitis had Crohn's disease. As compared with the group of patients with ulcerative colitis and no familial history, patients with familial history had more frequently distal location and extra-colonic manifestations. No differences were observed among patients with Crohn's disease and familial or non familial history. CONCLUSIONS: Prevalence of inflammatory bowel disease in relatives of patients with Crohn's disease or ulcerative colitis is increased. In ulcerative colitis, it is possible to segregate two different groups according to familial history.

Adolescent↗
PubMed1997

[On intra-familial clinical diversities of a familial amyotrophic lateral sclerosis with a point mutation of Cu/Zn superoxide dismutase (Asn 86-Ser].

In a familial amyotrophic lateral sclerosis (FALS) with SOD-1 mutation (Asn 86-Ser), there were intra-familial clinical diversities. The proband, a daughter patient, shows a mild clinical course of 16 years. Her father died of respiratory failure in 3 years. His initial symptom was weakness of upper extremity. The daughter's first symptom was that of lower extremities. Her respiratory-assist started after 9 years from the onset. She is alive under whole-day respiratory assist while she had been taking nutrients per os for 15 years. Her abilities of swallowing remain, even more dependent of tube-feeding (15 years after the onset). The fact of the presence of intra-familial clinical varieties with SOD-1 mutation in FALS suggests that the mutation is not an exclusive factor to determine the clinical phenotype, age of the onset and rapidity of illness of FALS associated with SOD-1 mutation. We collect reports of FALS with SOD-1 mutation which have similar diversities of intra-familial clinical manifestations as our family. Varieties of intra-familial clinical manifestations of motor neuron disease are shown in 9 families with SOD-1 mutation. The genetic error appears to have a limit, and is not a exclusive cause of FALS. However, we should not underestimate the significance of the discovery of a gene, since it might offer a clue to still unanswered riddle of ALS pathogenesis.

Amyotrophic Lateral Sclerosis↗
PubMed1987

Structural considerations in the contemporary Taiwanese farm family: survival of the large family ideal.

The structure of farm families in an industrializing rural area in west-central Taiwan is explored using data for 96 households in Hsiu-Shui district. The results suggest that despite modernization and social change, "the large family ideal still persists and expresses itself as a compartmental family which offers both the individual freedom of a nuclear family and the support and security of a large extended family."

Agriculture↗
PubMed1998

Family nursing in intensive care. Part One: Is family nursing appropriate in intensive care?

Over the past 10 years there has been a growing body of literature on family nursing. Although the term 'family nursing' is not one which is in common use in the UK, a significant amount of literature has appeared which discusses issues relating to the nursing support of families with a member who is ill. This paper will review the concepts involved and will then discuss the appropriateness of such an approach within the specialty of intensive care. As the paper concludes that family nursing could be an appropriate approach to nursing the patient in this type of area, it would seem logical to consider what needs the family may have. The research concerning the identification of the needs of families when they have a member in intensive care is discussed in part two.

Clinical Competence↗
PubMed2005

The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

Adolescent↗
PubMed1998

The medical officer of health, the social worker, and the problem family, 1943 to 1968: the case of family service units.

It has sometimes been assumed that the Report of the Seebohm Committee on the Local Authority and Allied Personal Social Services of 1968 and subsequent Local Authority (Social Services) Reorganization signalled a reduction in the influence of Medical Officers of Health in the care of poor and disorganized families and an increase in that of social workers. This article considers the role of Medical Officers of Health in the care of such families in the period after the Second World War, and their relationship with one of the key voluntary social work agencies in the field, Pacifist Service Units/Family Service Units. By examining the shift in responsibility from public health doctors to social workers and using the Bristol Family Service Unit as a case study, it argues that in many areas the Children and Young Persons Act of 1963 was used formally to transfer responsibility for such families to the Children's Departments and that the process was complete before the Seebohm Committee reported in 1968. It also suggests that those families in difficulty who remained the responsibility of the Public Health Department, and who were thought to have increased in number during the course of the 1960s, presented health visitors and public health doctors with a different range of problems, although they continued to be labelled problem families.

Community Health Workers↗
PubMed1999

Family accommodation of obsessive-compulsive symptoms: instrument development and assessment of family behavior.

Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study's purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives' own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient's clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.

Adaptation, Psychological↗
PubMed2003

Rehab rounds: Involving families in rehabilitation through behavioral family management.

Introduction by the column editors: A wide variety of family psychoeducational approaches for persons with serious and persistent mental illness have been developed and used by mental health professionals since the introduction of such approaches in the 1960s (1). From 1970 to 1975, multifamily psychoeducation was implemented for large numbers of clients and relatives at the Oxnard Mental Health Center (2) and was followed by systematic studies of multifamily therapy at the Maudsley Hospital in London in 1976 (3) and Camarillo State Hospital in California in 1978 to 1980 (4). The type of intervention that arose from this work comprised a series of educational sessions followed by training in communication and problem-solving skills. Behavioral learning principles were used to promote acquisition of knowledge, coping skills, and problem solving for families. Other procedures and variants on this theme have proliferated throughout the United States and in many other countries (5). Most of these approaches have in common an adherence to practical goals that are individualized for each family and an educational rather than a "therapeutic" slant. In an attempt to overcome the obstacles to widespread clinical use of family interventions, a variety of dissemination strategies have been tried, including academic detailing, consensus building among all stakeholders (6), and the development of modules consisting of trainers' manuals, consumers' workbooks, slide shows, and video-assisted learning (7,8). This month's column describes one of the variants of family psychoeducation-behavioral family management-and its components, illuminated by case vignettes and results of efficacy studies.

Behavior Therapy↗
PubMed1989

Focal family therapy outcome study. I: Patient and family functioning.

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.

Adolescent↗
PubMed2006

Listening to the family's voice: Nordic nurses' movement toward family centered care.

Clinical nurses, teachers, and researchers in the Nordic countries are faced with increasing expectations in identifying their contribution to knowledge development in family nursing at national and international levels. In this paper, I provide an insight into the contribution of Nordic nurses to family centred care (family system nursing), present findings from an integrative review on family nursing in the Nordic countries, share with you examples of family level interventions, and offer some ideas regarding where we might want to direct our focus in family system nursing in the future.

Activities of Daily Living↗
PubMedDate not supplied

[The prevalance of the nuclear family in the Spanish family system].

Preliminary results are presented from a research project on trends in family characteristics in modern Spain. "The goal of this research has been to know the grade of stability in the family institution and the influence of other alternative ways of living together apart from the traditional family. To sum up, we can regard the prevalence of the nuclear family in Spanish society as evident. In the same way, the responsibility of parenthood still is a marriage responsibility and has its place within the family. In spite of that, a transformation has taken place, as well as in other aspects, in relation to the concept and the reality of the family institution, which preserves its special character in the European context." (SUMMARY IN ENG)

Developed Countries↗
PubMed1980

The cycle of family function: a conceptual model for family medicine.

Information gained from family studies requires integration in the educational matrix of family medicine. To facilitate this activity a model that synthesizes major theories and definitions is presented. This paper describes a conceptual model that includes components that have been identified as basic to the recognition and understanding of the family in trouble. It is proposed that knowledge of family function as represented in the model, the Cycle of Family Function, will, in turn, help the physician assess and manage problems presented by patients who are victims of stress related to family problems.

Adaptation, Psychological↗
PubMed1999

Familial paroxysmal dystonic choreoathetosis: clinical findings in a large Japanese family and genetic linkage to 2q.

BACKGROUND: Paroxysmal dystonic choreoathetosis (PDC) is a rare familial movement disorder that has been mapped to chromosome 2q31-36. OBJECTIVE: To study the first Japanese family with PDC clinically and genetically. PATIENTS AND METHODS: We studied a large Japanese family in which at least 17 members in 6 generations have been affected by PDC. We interviewed and examined 26 family members, 8 of whom revealed choreoathetosis-like and dystonialike involuntary movement and 1 of whom revealed no involuntary movement but only muscle stiffness such as the aura of paroxysmal dystonic choreoathetosis (PDC). Genetic linkage studies of this family were carried out with polymorphic DNA markers. RESULTS: The attacks of involuntary movement or muscle stiffness were precipitated by ovulation, menstruation, emotional stress, or caffeine or alcohol ingestion. Magnetic resonance imaging of the brain revealed no abnormalities. Clonazepam therapy was effective for reducing the attacks, and ingestion of garlic was believed by patients to be effective for softening the attacks. An affected woman with only muscle stiffness showed remission after hysterectomy for hysteromyoma. This woman also had the disease haplotype and transferred it to her typical PDC-affected daughter. Maximal pairwise logarithm of odds scores exceeding 2.00 were obtained at D2S2250, D2S1242, D2S377, D2S2148, and D2S126. The PDC gene was demonstrated by linkage analyses to be located in a 15.3-centimorgan interval lying between D2S371 and D2S339 based on pairwise and multipoint logarithm of odds scores and obligate recombination events in affected individuals. CONCLUSIONS: Linkage of PDC to chromosome 2q32-36 was confirmed in a Japanese family. The clinical characterizations of this family with PDC include that ovulation seems also to be a precipitating factor of the attacks and that hysterectomy seems to be effective for softening the attacks. Although low-dose clonazepam treatment was most effective, garlic use was believed by affected members to be effective for softening the attacks. Furthermore, based on the results of clinical and genetic analyses, we suggest that muscle stiffness without involuntary movement may represent a forme fruste of PDC.

Athetosis↗
PubMed1996

Familial uveal melanoma, III. Is the occurrence of familial uveal melanoma coincidental?.

OBJECTIVE: To ascertain whether the familial occurrence of uveal melanoma was coincidental in kindreds in which 1 first-degree relative of the proband had also been affected with primary uveal melanoma. PATIENTS: In a series of 4500 patients with primary uveal melanoma, 17 kindreds were identified in which a first-degree relative of the proband had also been affected with primary uveal melanoma. DESIGN: In the 17 families in which a first-degree relative of the proband had been affected, primary uveal melanoma was classified as familial. In the remaining 4483 families, primary uveal melanoma was classified as sporadic. The expected number of affected first-degree relatives of probands for a family was estimated, assuming an incidence rate of 6 cases per million population per year in each type of family. RESULTS: The expected number of affected first-degree relatives was calculated to be 0.81, with an SE of 0.08, compared with 17 observed affected first-degree relatives (P < .001). CONCLUSION: Our study provides strong statistical evidence that occurrence of familial uveal melanoma is not coincidental.

Adolescent↗
PubMed1998

Novel germline p16(INK4) allele (Asp145Cys) in a family with multiple pancreatic carcinomas. Mutations in brief no. 148. Online.

As part of a search for causative genes of familial pancreatic carcinoma, the p16 genes were sequenced in members of 21 families with a phenotype of familial pancreatic carcinoma (2 or more first degree relatives affected). One family was found in which members carried a novel p16 allele with a G to T transversion at position 451, creating a missense amino acid change at codon 145 (Asp to Cys) and possibly disrupting the donor splice site of the exon 2/3 boundary. This coding change is not a known polymorphism, and occurs at a codon position in which another missese/splicing change has been shown to be linked to familial melanoma/pancreas cancer.

Alleles↗
PubMed1999

Accuracy of proband reported family history: the NHLBI Family Heart Study (FHS).

Proband-reported family histories are widely used in research and counseling, yet little is known about the validity of family history reporting. The Family Heart Study (FHS), a population-based study of familial cardiovascular disease, gathered family history information from 3,020 middle-aged probands in four U.S. communities. Probands reported on the history of coronary heart disease (CHD), diabetes, hypertension, and asthma among a total of 10,316 living relatives (9,186 siblings, 1,130 parents) and 2,685 spouses. Questionnaires were returned by 6,672 siblings, 901 parents, and 2,347 spouses, yielding response rates of 73, 79, and 87%, respectively. Utilizing the relatives' self-report as the standard, sensitivity of the proband report on their spouse, parent, and sibling was 87, 85, and 81% for CHD, 83, 87, and 72% for diabetes, 77, 76, and 56% for hypertension, and 66, 53, and 39% for asthma, respectively. Most specificity values were above 90%. Analyses using generalized estimating equations (GEE) were performed to evaluate differences in proband accuracy based on the proband's age, gender, disease state, center, and ethnicity. In multivariate models, age, gender, and disease status were significantly associated with the accuracy of proband's report of sibling disease history, but had little effect on the accuracy of their report on spouses or parents. In general, older probands were significantly less accurate reporters of disease than younger probands. These results demonstrate that CHD family history can be captured effectively based on proband reports, but suggest that additional family contacts may be helpful when working with older probands or with chronic diseases that have few recognized medical events or procedures.

Asthma↗
PubMed1998

Familial aggregation of delusional depression: re-examination in a recent family study.

BACKGROUND: Delusional (D-MDD) and nondelusional depression (ND-MDD) differ in clinical presentation, biological abnormalities, course of illness, and treatment response. Family data, however, have been less consistent regarding differential risk both for any major depression (MDD) and specifically D-MDD in relatives of D-MDD probands. In an earlier family study, we observed a 1.5-fold increase in rates of any MDD, specificity of transmission of D-MDD, and increased rates of bipolar disorders in relatives of D-MDD compared to relatives of ND-MDD probands. In a new family study, we attempted to replicate these findings. METHOD: A family study of 361 directly interviewed adult first-degree relatives (FDRs) of 163 probands (118 with MDD and 45 screened normal controls) was used to examine familial aggregation of any MDD, D-MDD, and bipolarity by proband delusional status. RESULTS: Compared to FDRs of ND-MDD probands, FDRs of D-MDD probands were at modestly increased risk for any MDD. These results were unaffected by adjustment for proband ascertainment source, comorbidity, or whether probands had chronologically primary MDD. There was a trend toward increased rates of broadly defined bipolarity (bipolar I, bipolar II, or cyclothymia) in FDRs of D-MDD compared to FDRs of ND-MDD probands. CONCLUSION: Results from the present study were broadly consistent with those from our previous work. While other lines of evidence for D-MDD as a distinct subtype are more compelling than family data, it would be of methodologic interest to identify sources of inconsistency across studies in findings concerning the familial aggregation of delusional depression.

Adolescent↗