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PubMed1986

My family made me do it: the influence of family therapists' families of origin on their occupational choice.

This study is an empirical test and exploration of the folklore about family life correlates of family therapists' occupational choice. The folklore is translated into systems concepts, including role complementarity and the mutually determining effect of process and roles. Fifty-nine family therapists, 49 siblings of the therapists, and 51 undifferentiated, non-helping professionals were compared on FACES (29), The Complementary Role Questionnaire, and on demographic data. Inconsistencies in the results led to a critique of the clinical faithfulness of current systems measures. Family therapists did not differ on FACES, but did differ in aspects of roles from their siblings and from the control professionals.

Adaptation, Psychological↗
PubMed1997

[The family physician and his "patient with family". Significance of the family system in treatment of patients in general practice].

From a systemic perspective the general practitioner and the patient form a "medical-therapeutic system", which has the same features as other social systems. As the patient is also a part of his family system there are (more or less detectable) interactions between these two relevant systems as well. Compliance-from a systemic point of view-is not only an indication of the functioning of the "medical-therapeutic system" but also a result of those interactions between two relevant systems. Clinical trials show that with his interventions the general practitioner helps in solving problems of difficult, blocked family relationships with the goal of an adequate coping strategy for all involved family members.

Adult↗
PubMed1990

Culturally sensitive family assessment: an evaluation of the family assessment device used with Hawaiian-American and Japanese-American families.

This article reports the results of a study of the McMaster Family Assessment Device (FAD) used with samples drawn from two non-Anglo ethnic groups: Hawaiian-Americans and Japanese-Americans living in Hawaii. The results showed that the FAD appeared to make appropriate assessments of Hawaiian-American study participants' families and inappropriate assessments of Japanese-American study participants' families. Results also suggested that cultural norms regarding family functioning may vary according to socioeconomic status. FAD modifications are suggested.

Asian↗
PubMed1991

Familial aggregation of lipids and lipoproteins in families ascertained through random and nonrandom probands in the Iowa Lipid Research Clinics family study.

The aggregation of lipids [total cholesterol (CH) and triglyceride (TG)] and lipoproteins [high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL)] in families ascertained through random and nonrandom probands in the Iowa Lipid Research Clinics family study was examined. Nonrandom probands were selected because their lipid levels (at a prior screening visit) exceeded a certain pre-specified threshold. The statistical method conditions the likelihood function on the actual event that the proband's value is beyond the threshold. This method allows for estimation of the path model parameters in randomly and nonrandomly ascertained families jointly and separately, thus enabling tests of heterogeneity between the two types of samples. Marked heterogeneity between the random and the hyperlipidemic samples is detected in the multifactorial transmission for TG and HDL, and moderate heterogeneity is detected for CH and LDL, with a pattern of higher genetic heritability estimates in the random than nonrandom samples. The observed pattern of heterogeneity is compatible with a higher prevalence in the random sample of certain dyslipoproteinemias that are associated with nonelevated lipids. For the random samples, genetic heritabilities are higher for CH and HDL (about 60%) than for TG and LDL (about 50%). For the nonrandom samples those estimates are about 45, 40, 35 and 30% for HDL, CH, LDL and TG, respectively. Little to no cultural (familial environmental) heritability is evident for CH and LDL, although 10-20% of the phenotypic variance is due to cultural factors for TG and HDL. These results suggest that the etiologies for lipids and lipoproteins may be quite different in random versus hyperlipidemic samples.

Adult↗
PubMed2003

Coronary artery disease risk in familial combined hyperlipidemia and familial hypertriglyceridemia: a case-control comparison from the National Heart, Lung, and Blood Institute Family Heart Study.

BACKGROUND: Conventional wisdom suggests that a diagnosis of familial combined hyperlipidemia (FCHL) carries a substantially greater risk of premature coronary artery disease (CAD) than a diagnosis of familial hypertriglyceridemia (FHTG). However, no population-based studies have critically addressed this issue. METHODS AND RESULTS: FCHL and FHTG were diagnosed in 10.2% and 12.3% of 334 random control families and in 16.7% and 20.5% of 293 families with at least one case of premature CAD. The diagnosis of either FCHL or FHTG in an individual was associated with an odds ratio for CAD of 2.0 (P=0.003 and 0.002, respectively). However, odds ratios for premature CAD associated with both lipid disorders decreased substantially and identically with further adjustment for hypertension, diabetes, and especially HDL cholesterol, triglycerides, or apolipoprotein B. Similar results were found for differences in carotid intima-medial thickness and ankle-brachial index. Metabolic syndrome was identified in 65% of FCHL and 71% of FHTG patients compared with 19% in controls without FCHL or FHTG and was associated with an odds ratio of 3.3 (P<0.0001). The increased prevalence of the metabolic syndrome alone could account for the elevated CAD risk associated with both FCHL and FHTG. CONCLUSIONS: FCHL and FHTG appear more alike than dissimilar. Further, the risk of CAD in FCHL and FHTG was strongly related to features of the metabolic syndrome. These findings suggest that the hypertriglyceridemia in FHTG is not benign and may warrant a change in epidemiological, genetic, and clinical approaches to these lipid disorders.

Adult↗
PubMed1995

Families helping families: an innovative approach to the provision of respite care for families of children with complex medical needs.

Over the past thirty years, rapid advances in medical technologies have resulted in a marked increase in the numbers of children surviving with significant medical and developmental difficulties. The general trend in society away from institutional care, in conjunction with these technological advances, has resulted in the expectation that parents will provide care at home for children with significant disabilities, often in the absence of adequate social service supports. This article describes a family support project, Families Helping Families, which implemented a cost-effective, family-centered approach to the provision of respite care for children with complex medical needs. The paper presents the role of the social worker in developing and implementing the program. Barriers to more widespread implementation of the model, both in the state system and within the medical community, are also described.

Child↗
PubMed1999

[Relationship between identified patient (IP) with alcoholic problems and familial factors: in reference to family function, co-dependence, family group and self-help group participation].

In 1994, a survey was conducted to 105 wives of alcoholics (identified patient: IP) about levels of their family adaptability, cohesion, co-dependence, family group and self-help group participation. In 1995, a follow-up survey was conducted to the same wives. 87 wives responded to the follow-up questionnaire. 17 responses were excluded due to too many missing responses. Statistical analyses were therefore conducted to the remaining 70 subjects. The following results were found. 1) Balanced as opposed to extreme levels of cohesion were associated with abstinence. 2) Family system changes on cohesion and/or adaptability dimensions were associated with abstinence. 3) Wife's over-involvement with drinking husband somewhat appeared to be related to continuation of drinking. As for participation in family group or self-help groups, there was no significant difference between abstinence and drinking groups.

Alcoholics Anonymous↗
PubMed1997

Parent and family support groups with African American families: the process of family and community empowerment.

This article describes a process of family and community empowerment in which psychologists, along with community, school and religious leaders, intervened on a multisystemic level and formed a parent and family support group to empower families in helping their at-risk adolescents to succeed. The adolescents, who were predominantly African American, had been arrested for fighting at school and were experiencing academic and behavioral difficulties. Critical incidents in the group development and the family and community empowerment process are described.

Adolescent↗
PubMed1991

Familial aggregation of lipids and lipoproteins in families ascertained through random and nonrandom probands in the Stanford Lipid Research Clinics Family Study.

We examined the familial aggregation of lipids [total cholesterol (CH) and triglyceride (TG)] and lipoproteins [high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL)] in families ascertained through random and nonrandom probands in the Stanford Lipid Research Clinics Family Study. Nonrandom probands were selected because their lipid levels at a prior screening visit exceeded a certain prespecified threshold. The statistical method is based on selection through indirect truncation on a correlated trait (in which the likelihood function is conditioned on the actual event that the proband's value is beyond the threshold). This method allows for estimation of the path model parameters in randomly and nonrandomly ascertained families jointly and separately, thus enabling tests of heterogeneity between the two types of samples. The results suggest that the multifactorial transmission is homogeneous in the random and hyperlipidemic samples for CH. However, the evidence for heterogeneity is moderate for LDL, marked HDL, and mixed for TG. The general pattern of observed results is for somewhat higher genetic heritabilities in the random than nonrandom samples, which is compatible with a higher prevalence in the random sample of certain dyslipoproteinemias associated with nonelevated lipids. Substantial genetic heritability is found for CH, HDL, and LDL, with somewhat lower estimates for TG. Cultural heritability is low but significant for all four traits. Little or no spouse resemblance or nontransmitted shared sibship effects are seen. In contrast to the findings from previous studies, little or no parental cultural transmission is seen.

Adult↗
PubMed2000

[Clinical characteristics of familial rheumatoid arthritis in Spain. A study of 73 families. Spanish Consortium for Rheumatoid Arthritis (CEAR) and European Consortium for Familial Rheumatoid Arthritis (ECRAF)].

OBJECTIVE: To describe clinical characteristics and the homogeneity of disease expression between involved members in multicase Spanish rheumatoid arthritis (RA) families. PATIENTS AND METHODS: 73 families with two or more siblings with RA were found, with a total of 149 patients distributed in 79 pairs (70 sib pairs, and 3 sib trios). Demographic, clinical and radiological characteristics were recorded in a standard questionnaire. RESULTS: Clinical characteristics were similar to those of sporadic RA with a high frequency of women (78%), positive rheumatoid factor (RF) (86%), erosions (89%) and a 25% of the patients having extraarticular disease. The most important variable in disease severity was disease duration. The concordance between family members of the same age and calendar year of disease onset, and the pattern of disease expression, was not higher than expected, showing that the disease is heterogenic. CONCLUSION: Environmental factors seem to be more important in RA susceptibility. Clinical characteristics of familiar RA in Spain do not seem to be different from sporadic RA, although differences were found in disease expression within families that may be due to variation of genetic or environmental factors, responsible for the susceptibility and disease duration.

Adult↗
PubMed2005

["Family members inform family members" - family members as group moderators for psychoeducational groups in schizophrenia].

OBJECTIVES: To train interested and capable family members as group moderators of psychoeducational groups for family members in schizophrenia. METHOD: Development and evaluation of a curriculum consisting of 5 separate steps: participating in a psychoeducational group, participating in training-workshops, conducting psychoeducational group sessions with professional co-moderation, independently conducting psychoeducational group sessions, recruiting of future group moderators. RESULTS: Step 1, 2 and 3: statistically significant knowledge increase about schizophrenia, changed concept of illness. DISCUSSION: The 5-step curriculum appears to be a useful instrument for training family members as group moderators of psychoeducational groups for family members in schizophrenia.

Aged↗
PubMed2005

Analysis of somatic molecular changes, clinicopathological features, family history, and germline mutations in colorectal cancer families: evidence for efficient diagnosis of HNPCC and for the existence of distinct groups of non-HNPCC families.

OBJECTIVE: To analyse somatic molecular changes, clinicopathological features, family history, and germline mutations in families with colorectal cancer (CRC). METHODS: Molecular changes (K-ras and beta-catenin mutations, chromosome 18q allele loss (LOH), APC LOH, microsatellite instability (MSI), and expression of beta-catenin and p53) were examined in four series of CRC patients with proven or probable hereditary disease: hereditary non-polyposis colon cancer (HNPCC); MYH associated polyposis (MAP); multiple (>5) colorectal adenomas without familial adenomatous polyposis (FAP); and other families/cases referred to family cancer clinics (FCC series). HNPCC was diagnosed using a combination of germline mutation screening and tumour studies. A series of unselected CRC patients was also studied. RESULTS: There was overlap between genetic pathways followed by each type of CRC, but significant differences included: increased frequency of K-ras mutation and reduced frequency of APC LOH in cancers from MAP, but not from multiple adenoma patients; reduced frequency of LOH in HNPCC CRCs; and increased MSI in CRCs from HNPCC, but not from FCC or multiple adenoma patients. HNPCC was apparently detected efficiently by combined germline and somatic analysis. Cancers from the FCC, unselected, and multiple adenoma series shared similar molecular characteristics. In the FCC and multiple adenoma series, hierarchical cluster analysis using the molecular features of the cancers consistently identified two distinct groups, distinguished by presence or absence of K-ras mutation. CONCLUSIONS: While K-ras mutation status is known to differentiate hereditary bowel cancer syndromes such as MAP and FAP, it may also distinguish groups of non-HNPCC, FCC patients whose disease has different, as yet unknown, genetic origins.

Adult↗
PubMedDate not supplied

[Familial juvenile nephronophthisis (report on 16 families with shared family tree)].

This is a study of a group of 23 patients from 16 families with a shared family tree, developing chronic renal insufficiency (CRI). Out of the 23 patients, 18 were female and five male with an average renal death age of 18.4 years old, showing fevo clinical manifestations. The main reason for consultation was the significant level of anemia. 17 patients had normal arterial tension, 1 patient manifested severe artery hypertension (AHT), 3 manifested mild AHT, and 2 manifested slight AHT. All the patients entered the final stage of CRI with a low level of hemoglobin overaging 6.5 g%. The urinalysis revealed an average SG of 1,010, without proteinuria or with slight proteinuria, lower than 500 mg in 24 hours. Three patients had microhematuria and the remainder had normal urinary sediment. A renal ultrasound in 18 cases revealed a bilateral reduction in the kidney size, loss of the cortcomedullar relation, an increase in the echogenety of the renal parenchyma, scattered in all cases, and the presence of corticomedullar cysts in 5 cases. The histopathological study performed in 8 cases revealed some findings which were compatible with chronic interstitial nephritis with corticomedullar cysts. The findings resemble those described in the literature in cases of familial juvenile nephronophthisis (FJN). An important aspect to be pointed out is the presence of an interstitial infiltrate with mononuclear cells, an even more significant feature than any previously reported. We can conclude that the members of these familial groups are carriers of FJN of recessive autosomic transmission, which, in view of some differences in the clinical presentation, age of onset of, CRI some biochemical and morphological findings, and the absence of genetic alterations as described in type 1 FJN, is a variant of this disease.

Adolescent↗
PubMed1978

Familial aspects of mixed connective tissue disease (MCTD). I. Occurrence of systemic lupus erythematosus in another member in two families and aggregation of MCTD in another family.

Three families are reported in which one member had MCTD and another member had either MCTD or systemic lupus erythematosus (SLE). In one family both mother and daughter probably had MCTD. The daughter, however, had prominent SLE features and kidney involvement. In another family, the mother had MCTD and the daughter had SLE; while in a third family one sister had MCTD and the other had SLE with prominent arthritis but negative anti-ribonucleoprotein (RNP) antibodies.

Adult↗
PubMed1989

Closing the gap between grand theory and mental health practice with families. Part 1: The framework of systemic organization for nursing of families and family members.

This paper proposes a nursing framework for individuals and families that was inductively derived from existing knowledge and the author's personal experience. The framework is based on the premise that all things are organized as systems. Individuals, family systems, and the environment are interrelated and the congruence of patterns and rhythms between systems and subsystems signifies health. Nursing involves assisting individuals and families to reduce anxiety by weighing against each other the two major dimensions of system control and congruence or spirituality with the aim of maintaining a dynamic equilibrium.

Family↗
PubMed1979

Familial aggregation of blood pressure and weight in adoptive families. II. Estimation of the relative contributions of genetic and common environmental factors to blood pressure correlations between family members.

An analysis of the familial aggregation of blood pressure (BP) was conducted to provide estimates of the role of genes and household environment in determining the phenotypic resemblance between biologically related family members. The biological model used for this analysis parameterizes the correlations between family members into the contributions of genetic and environmental variability shared within and across generations. Hypothesis testing about different parameters in the model suggests that shared environment explains larger fractions of the parent-natural child and the full sib correlations for diastolic BP than for systolic BP. For diastolic BP, children in a household share the effects of common environment in addition to the effects which they share with their parents. Dependence of the degree of resemblance between household members on the effects of environmental factors shared within and a-ross generations is not explained by the variability of length of cohabitation among individuals.

Adolescent↗
PubMed1991

National curricular guidelines for third-year family medicine clerkships. The Society of Teachers of Family Medicine (STFM) Working Committee to Develop Curricular Guidelines for a Third-Year Family Medicine Clerkship.

In most U.S. medical schools, required clerkships in internal medicine, pediatrics, surgery, obstetrics and gynecology, and psychiatry are considered the core components of a student's clinical education. Because the specialty of family practice is not as well established in the medical school curriculum, the federal government is interested in promoting the specialty as part of its continuing efforts to increase the number of primary care physicians. Therefore, in August 1989 the Division of Medicine, Bureau of Health Professions, United States Department of Health and Human Services, awarded a purchase order to the Society of Teachers of Family Medicine to develop curricular guidelines for third-year family medicine clerkships. The authors represent the working committee that developed these guidelines. This paper describes the process used to develop the core curricular guidelines, presents the product of the curriculum development activities, and discusses dissemination, implementation, and further development activities.

Clinical Clerkship↗