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Teaching family-centered perinatal care in family medicine, Part 2.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Anesthesia, Obstetrical↗

Teaching family-centered perinatal care in family medicine, Part I.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Curriculum↗

[Family influence on cancer screening participation in seven communities in Taiwan].

Cancer is the leading cause of death in Taiwan. Since there is no definitive method for cancer prevention, early detection play a major role in fighting cancer. Factors that affect people's willingness to participate cancer screening have been discussed widely except for those relating to the family. The family's role in motivation & influencing its members to participate in an invited cancer-screening program was studied in seven Taiwanese communities. 5% of participants in each area for both genders were chosen by stratified random sampling, and matched with teice-informed nonparticipants who were chosen by sex, age, and neighborhood. By means of a home visit and structured questionnaire, 729 of the 987 eligible cases were interviewed (73.9%). The main findings were that the response was higher among people with higher education, nonsmokers, and those who felt the scheduled time and place of attendance was suitable and convenient. Moreover, in the 6 variables related to family (family structure, family life cycle, cancer history in family and friends, family APGAR, family support about health problems, and family's opinion about cancer screening), the last 4 variables were found to be significantly related by chi-square analysis to the attendance. Finally, a logistic regression analysis adjusted by age, sex, education, smoking habits, time available and traffic factors was used to analyze how family factors affect attendance. The result was cancer history in family and friends (odd ratio = 2.42) and family's encouragement (odd ratio = 1.85) had a positive association.

Adult↗

Family size, household production, and life cycle saving.

"Changing family size and labour-leisure choice are introduced into a life cycle model. Saving corresponds with empirical observation in some ways better, and in others worse, as a result. Changing family size reduces aggregate saving and generates substantial dissaving at peak size, indicating that bequests, uncertainty, and liquidity constraints should also be modelled. However, the age profile of consumption is humped, and labour-leisure choice produces a drop in consumption on retirement, both corresponding well with observation." (SUMMARY IN FRE)

Economics↗

Genograms: a psychosocial assessment tool for hospice.

Genograms are a valuable and non-threatening evaluation tool for hospice patients and families. The genogram provides basic information about the family including the role of each member and the family dynamics. As the diagram is drawn, family life cycle issues and relationships between family members become evident. The genogram may go beyond the household to include supportive neighbors, friends, and community resources. Religious and spiritual support is also noted. The information is used to assess family needs and to provide interventions both before the death and during bereavement.

Caregivers↗

[Relationship between anxiety and family dynamics].

OBJECTIVE: In the present study we tried to find the likely association between anxiety and a disturbed family dynamic in patients who attended Primary Care for consultation. DESIGN: An observational, crossover study with 150 patients (64.7% women) chosen by systematised random sampling was performed. Patients were grouped in various bivariable categories: sex, marital status, where from, cultural level, occupation, size of family, stage of their life-cycle, family sub-system and income, which were compared with the results from the Stai Anxiety and the Apgar Family tests. 95% significance level; two months data-gathering. RESULTS: Among the most relevant findings were negative correlation in the value of the Stai Anxiety test vs the Apgar Family test, with r = -0.27 and level of significance between [-0.42 < r < -0.12]. A multivariant study using Dummy type variables found association between Anxiety and being Female, with a Beta coefficient of -6.2172 [CI -10.2044/-2.0342]. There was also association of size of family and disturbed family dynamic, with Beta coeff. = -0.2437 and CI [-0.4706/-0.0168]. CONCLUSIONS: a) There is a correlation between anxiety and disturbed family dynamic. b) Being female is a risk factor, when before anxious patients, of a disturbed family dynamic. c) Family size is also a risk factor, before an anxious patient, of a disturbed family dynamic.

Anxiety↗

Changing perspectives on the American family in the past.

Past reviews of American family history, while providing useful information about certain aspects of family life in the past, have inadequately addressed the conceptual framework informing the discipline. Juster begins by reviewing 4 approaches developed by social scientists for studying the family: household composition, generations, family cycle, and life-course. The life-course perspective seems the most promising for a dynamic, complex view of families that links changes in the domestic sphere to wider societal trends and concerns. Using the analytical perspective of the life-course, he then examines significant historiographical contributions in 4 areas of family life - childbearing, early child development, adolescence, and old age.

Americas↗

Stage-specific transcription of distinct repertoires of a multigene family during Plasmodium life cycle.

Members of a multigene family in the rodent malaria parasite Plasmodium yoelii yoelii code for 235-kilodalton proteins (Py235) that are located in the merozoite apical complex, are implicated in virulence, and may determine red blood cell specificity. We show that distinct subsets of py235 genes are expressed in sporozoites and hepatic and erythrocytic stages. Antibodies to Py235 inhibited sporozoite invasion of hepatocytes. The switch in expression profile occurred immediately after transition from one stage to another. The results suggest that this differential expression is driven by strong biological requirements and provide evidence that hepatic and erythrocytic merozoites differ.

Amino Acid Sequence↗

A team's three-dimensional approach to assisting the end-stage renal disease family.

This review will identify ways in which the interdisciplinary team assists a family confronting end-stage renal disease (ESRD) for the first time. The developmental models of the family life cycle and the ESRD life cycle are used to understand the family's needs. The treatment team uses a three-dimensional approach of education, support, and communication to enhance family coping.

Adult↗

Bipolar illness and the family.

The purpose of this article is to introduce family systems therapy and "family focused treatment" to clinicians working with patients who are diagnosed with bipolar illness. The characteristic traits of healthy family functioning are identified as a template for the clinician to work with the family toward management of bipolar illness. Nathan Ackerman's model of how families handle crises and Carter's and McGoldrick's work with family life cycles provide a guide to understanding family systems work. The focus is on the family system and not just the patient. The issues of bipolar illness are addressed in the family context. Based on the research of Goldstein and Miklowitz and others, treatment of bipolar illness is differentiated from other chronic mental illnesses. Family focused treatment is offered as a model to manage dynamics off bipolar illness. An essential component of therapy with the patient and the family is addressing grief. Interventions and treatment suggestions are offered.

Bipolar Disorder↗

Who is the family doctor? Relating primary care to family care.

Many families receive care as intact family units. To determine which specialists provide this family care, a subset of families (N = 447) enrolled in the Rand Health Insurance Experiment were examined. Among families designating a single primary care physician, family physicians and general practitioners provided 65.9% to 89.7% of their family care. Internists provided 20.0% and 27.3% of family care for younger and older couples, respectively. The remaining specialties, including pediatrics and obstetrics-gynecology, each provided less than 5% of family care; these small proportions of family care may reflect the specialists' self-imposed limits in primary care roles. As family members matured, families used fewer pediatricians and obstetrician-gynecologists for primary care and concurrently increased their use of family physicians or general practitioners. Care for intact families is provided predominantly by family physicians or general practitioners, although in families without children, internists also play an important role. Self-defined limits in primary care roles by physicians in various specialties and the changing use of specialties during the family life cycle largely determined which specialties provided family care.

Adolescent↗

Chronic illness and the life cycle: a conceptual framework.

This article provides a conceptual framework for thinking about the system created at the interface of chronic illness with the family life cycle. First, a psychosocial typology and time phases of illness schema is described as a necessary, preliminary step to create a common language that bridges the worlds of illness, individual, and family development. This schema organizes similarities and differences between diseases in a manner useful to psychosocial-developmental rather than biomedical inquiry. Then, drawing on several major life-cycle theories in the literature, key concepts (periods of transition, life-structure building and maintaining, centripetality, and centrifugality) are used in a complementary fashion to link these three lines of development. Equipped with these psychosocial languages, consideration is given to transgenerational aspects of illness, loss, and crisis, and the interwoven threads of illness, family, and individual development. Clinical vignettes are provided to highlight this conceptual framework.

Adaptation, Psychological↗

Towards a balanced whole: the well-functioning family.

Counters a preoccupation with the dysfunctional family with a description of healthy family functioning through a balancing process between polar opposites. Constructs a Core Dimensions of Family Functioning assessment diagram, integrating the various perspectives of essential family therapies and culminating in the dimension of a spiritual presence in the family. Emphasizes the competence of families and couples to balance competing demands through a case presentation of a critical family life cycle transition.

Family Health↗

Family as client: using Gordon's health pattern typology.

The community health nursing faculty at Kent State University organized a family assessment instrument in accordance with the health pattern typology described by Gordon (1982). Students use the instrument with traditional and nontraditional families at every stage of the family life cycle. Reasons for initial visits to the families range from newborn health promotion to skilled nursing for acute and chronic conditions. The instrument helps students conceptualize the family as client and explore the concept of family nursing diagnoses.

Community Health Nursing↗

[Analysis of factors affecting family function].

The purpose of this study was to identify the degree of family function and to determine factors influencing family function. The subjects for this study were 451 adults and high school students among the general population from J city. Data were collected by questionnaire from Sept. 1 to Nov. 30, 1989. The measurement tool was the Family Function Questionnaire (APGAR) developed by Smilkstein. Data were analysed by statistical methods including Mean, S.D, t-test and ANOVA. The following results were obtained: 1. The mean Family APGAR score was 5.70 +/- 0.11, in a range from 0-10. 2. Scores from 0 to 6, which fall into the dysfunctional family range, were recorded for 266 families (59.6%). 3. Significant variables among general characteristics influencing family function were age, sex, marital status, educational levels, monthly income and occupation (p less than .001). 4. Significant variables among family characteristics influencing family function were family life cycle (p less than .01), utilization of family resources (p less than .01) and family atmosphere (p less than .001).

Family↗