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PubMed2003

A family aggregation study: the influence of family history and other risk factors on language development.

Substantial evidence continues to accrue for familial transmission of specific language impairment (SLI). The incidence in families with a history of SLI is estimated at approximately 20%-40%, whereas in the general population the estimated incidence is about 4%. Typical aggregation studies compare data on the speech and language status of parents and siblings of individuals with SLI (the probands) to similar data from family members of control individuals with no speech or language disorder history. In the present study, family aggregation of SLI was examined for a unique sample of children who were ascertained before 6 months of age and thus did not have SLI, but were born into a family with a positive history of SLI (FH+). No study to date has examined the pattern of affectance in families of children ascertained at such a young age. In addition, the ratio of boys to girls born into such families was investigated, as previous studies have suggested alterations in the expected gender ratios. Consistent with prior research, SLI was found to aggregate in families; the average affectance rate in FH+ families was 32%, with significantly more boys (41%) reported as having SLI than girls (16%). A comparison of FH+ and control families (FH-) on sociodemographic factors and medical history revealed differences in the overall rate of autoimmune diseases; FH+ families reported a significantly higher incidence (35%) compared to FH- families (9%). Finally, the 3-year language abilities of a subset of 32 children from FH+ families were compared with those of 60 children from FH- families. Children from FH+ families scored significantly lower on standardized measures of language and were more likely to fall below the 16th percentile (28%) than children from FH- families (7%). These results provide converging evidence that children from FH+ families are indeed at greater risk of developing language delay compared to children from control families.

Autoimmune Diseases↗
PubMed2003

Minority ethnic families and family-centred care.

Family-centred care has generally treated families as though they were all two-parent families. For most minority ethnic families, this treatment is especially inappropriate because a greater percentage of the children are cared/live in non-traditional households, their families are heterogeneous and are primarily oriented towards extended families. However, the involvement of the extended family in family-centred care remains non-existent. This therefore suggests that there currently exists a lack of appreciation in appropriately implementing the concept of family-centred care among minority ethnic families. For this aspect of family-centred care to be explored, this article will provide an overview of the child-rearing styles of minority ethnic families including the role of extended family in child care, before discussing the need to involve the extended family in family-centred care. This analysis should enhance the general awareness of children's nurses and may facilitate a more comprehensive family-centred care to minority ethnic children and their families.

Attitude to Health↗
PubMed1982

Family theory and family therapy models: comparative review with implications for nursing practice.

Although theories of the family and theories of family therapy have different origins and purposes, both provide the basis for a family focused nursing approach. Family theory is a practice theory with a focus on health while family therapy is a practice theory with a focus on pathology. Thus, the contributions of each are different. For nurses to adapt and apply the principles of the two theories correctly, they first must understand whether application of a basic theory with a focus on health or a practice theory with a focus on pathology is appropriate in the particular nursing situation. For example, if a husband is hospitalized, recovering from a myocardial infarction, a family focused nursing approach is mandatory in providing optimal nursing care. Assessment of the family situation will provide clues for the functional or dysfunctional state of the family and the appropriateness of utilizing family theory or family therapy principles. If the current state of family relationships is optimal, application of family theory principles than can be applied to guide health promotion on a family level is appropriate. Organizational and dynamic aspects of the family promoting the husband's recovery can be accentuated, supported, and emphasized in the nursing care. However, if the current state of family relationships is pathological, application of family therapy principles is appropriate. Here the goal of the nursing care is restoration of functional organizational patterns and interactive processes between family members.

Family↗
PubMed1999

Family climates: family factors specific to disturbed eating and bulimia nervosa.

More than a decade of research has characterized the families of individuals with bulimia and bulimia anorexia (Anorexia Nervosa, Binge/Purging Type) as less expressive, less cohesive, and experiencing more conflicts than normal control families. This two-part study investigated variables believed more directly related to disturbed eating and bulimia as contributing to a "family climate for eating disorders." In Study 1. a nonclinical sample of 324 women who had just left home for college and a sample of 121 mothers evaluated their families. Principal-components analyses revealed the same factor structure for both students and mothers, with Family Body Satisfaction, Family Social Appearance Orientation, and Family Achievement Emphasis loading together, representing the hypothesized family climate for eating disorders: the remaining variables loaded with the more traditional family process variables (conflict, cohesion, expressiveness), representing a more general family dysfunction. As predicted, the family climate for eating disorders factor score was a more powerful predictor of disturbed eating. Study 2 extended these findings into a clin ical population, examining whether the family climate for eating disorders variables would distinguish individuals with bulimia from both depressed and healthy controls. Groups of eating-disordered patients (n = 40) and depressed (n = 17) and healthy (n = 27) controls completed family measures. The eating-disordered group scored significantly higher on family climate variables than control groups. Family process variables distinguished clinical groups (depressed and eating disordered) from healthy controls, but not from one another. Controlling for depression removed group differences on family process variables, but family climate variables continued to distinguish the eating-disordered group from both control groups. Indications for further research are discussed.

Adolescent↗
PubMed1999

Family-level coping in juvenile rheumatoid arthritis: assessing the utility of a quantitative family interview.

OBJECTIVE: To explore the viability of a quantitative family interview to describe family-level coping strategies used to deal with juvenile rheumatoid arthritis (JRA)-related stressors for early and late adolescents. METHOD: A structured interview protocol with 30 adolescents with JRA and family members assessed ways JRA disrupts or changes family functioning. Emotional reactions, sequential phases of family response, and treatment adherence were discussed. Interviews were coded for family-level coping. To assess adjustment, family members completed the Youth Self Report and the Family Environment Scale. The pediatric rheumatologist provided medical information. RESULTS: The family interview produced both quantitative and qualitative data. Families reported multiple JRA-related stressors (mean 6.6). For many adolescents, treatment adherence was problematic. Families used all 3 types of coping strategies (appraisal-, problem-, and emotion-focused) to varying degrees. Problem-focused approaches were most commonly used and included seeking support (used by 73% of families), self-reliance (70%), and family coordination (70%) for dealing with specific problems, and seeking information about JRA (67%). Emotion-focused approaches, such as impulsive outbursts and diminished awareness of others' feelings, were associated with problematic adjustment. Few differences were found between the families of early and late adolescents. CONCLUSION: The quantitative family interview has the potential to be a useful tool in documenting JRA-related stressors, family-level coping processes, and how family-level coping is associated with treatment adherence and psychosocial adjustment.

Adaptation, Psychological↗
PubMed1991

Families of children with developmental disabilities: an examination of family hardiness.

Using the Typology Model of Adjustment and Adaptation, a family stress model, relationships among family hardiness, family stressors, family appraisal, coping, social support, and satisfaction with family functioning were examined in a sample of 57 families of children with developmental disabilities. Family hardiness was associated with family appraisal, social support, parental coping related to maintaining family integration, and satisfaction with family functioning. Higher satisfaction with family functioning was correlated with coping-integration, network support, functional support, and hardiness. Lower satisfaction with family functioning was associated with higher family stressor scores, social support loss, and increased parental age. Over 42% of the variance in family functioning was accounted for by family hardiness, functional support, family stressors, and parental age. The results highlight the value of continued investigations of hardiness in families.

Adaptation, Psychological↗
PubMed2003

Family participation in care to the critically ill: opinions of families and staff.

BACKGROUND: Allowing family members to participate in the care of patients in intensive care units (ICUs) may improve the quality of their experience. No previous study has investigated opinions about family participation in ICUs. METHODS: Prospective multicenter survey in 78 ICUs (1,184 beds) in France involving 2,754 ICU caregivers and 544 family members of 357 consecutive patients. We determined opinions and experience about family participation in care; comprehension (of diagnosis, prognosis, and treatment) and satisfaction (Critical Care Family Needs Inventory) scores to assess the effectiveness of information to families and the Hospital Anxiety and Depression score for family members. RESULTS: Among caregivers 88.2% felt that participation in care should be offered to families. Only 33.4% of family members wanted to participate in care. Independent predictors of this desire fell into three groups: patient-related (SAPS II at ICU admission, OR 0.984); ICU stay length, OR 1.021), family-related (family member age, OR 0.97/year); family not of European descent, OR 0.294); previous ICU experience in the family, OR 1.59), and those related to emotional burden and effectiveness of information provided to family members (symptoms of depression in family members, OR 1.58); more time wanted for information, OR 1.06). CONCLUSIONS: Most ICU caregivers are willing to invite family members to participate in patient care, but most family members would decline.

Adult↗
PubMed2004

The effects of family resources, coping, and strains on family adjustment 18 to 24 months after the NICU experience.

PURPOSE: To examine the relationship of family coping, resources, and strains on family adjustment over time following the NICU experience. DESIGN: Longitudinal, correlational study based on the Resiliency Model of Family Stress, Adjustment and Adaptation. SAMPLE: Data were collected, through mailed questionnaires, from 71 couples, 18 to 24 months following the birth of their infant. The data are a follow-up from a previous study conducted at the time of the infant's birth. MAIN OUTCOME VARIABLES: The dependent variable in the study was family adjustment, measured by the McMaster Family Assessment Device. The independent variables were family resources, as measured by the Family Inventory of Resource Management; family coping, as measured by the Family Crisis Oriented Evaluation Scales; family strain, as measured by the Family Inventory of Life Events and Changes; and parent gender, family system (first-time parent or not), and the child's health, as measured by the Demographic Information Questionnaire. RESULTS: Family adjustment improved over time for mothers but decreased for fathers. Fathers of infants with ongoing health problems reported significantly poorer family adjustment. Family resources were related to family adjustment and decreased over time for both parents. Families used more coping mechanisms and different coping patterns over time.

Adaptation, Psychological↗
PubMed1997

Donor insemination: child development and family functioning in lesbian mother families.

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.

Adult↗
PubMed2002

The diabetes social support questionnaire-family version: evaluating adolescents' diabetes-specific support from family members.

OBJECTIVE: To develop and evaluate the Diabetes Social Support Questionnaire-Family Version (DSSQ-Family) for adolescents with type 1 diabetes. METHODS: Normative and individualized approaches to scoring were examined. Also examined were associations between diabetes-specific family support and adolescents' age, disease duration, gender, emotional support from family and friends, and treatment adherence. The most supportive family behaviors were identified as well. Adolescents (n = 74) rated 58 DSSQ-Family behaviors on their supportiveness and frequency and completed measures of emotional support from family and friends and treatment adherence. After eliminating nonsupportive items, the Total DSSQ-Family and five areas of diabetes care (insulin, blood testing, meals, exercise, emotions) were scored for frequency (normative approach) and frequency x support (individualized approach). The upper quartile of the DSSQ-Family items was identified as most supportive. RESULTS: Scores from the DSSQ-Family had high internal consistency. Higher frequency and individualized ratings were related to younger adolescent age and to more family emotional support and cohesion, but not to friend support or family conflict (in general). The individualized ratings were significant predictors of adolescents' adherence, even when controlling for age and general levels of family support. The most supportive family behaviors reflected emotional support for diabetes. CONCLUSIONS: The DSSQ-Family is a useful clinical and research tool for measuring adolescents' perceptions of diabetes-specific family support. Future interventions should stress family support for management tasks, taking into account the adolescent's perceptions of supportive behaviors. Additional research is needed with culturally diverse adolescents and with other chronic pediatric conditions.

Adolescent↗
PubMed1997

Family dynamics of families with mental health problems in Finland.

This study forms part of the International Family Dynamics Project. Its purpose was describe the family functioning of families with mental health problems on the basis of Barnhill's framework for healthy family systems. The sample consisted of 160 families in which one family member had mental health problems. Both the patients and their relatives took part. The data were collected by questionnaires, i.e. The Family Dynamics Measure and The Family Dynamics Questionnaire. According to the results, mental health patients described family functioning as fairly poor, while relatives described it as fairly good. However, patients' and relatives' perceptions of family functioning did not differ significantly. There were some statistically significant differences between patients' and relatives' perceptions of different family dynamics dimensions. Relatives reported more mutuality (P = 0.006) and clearer communication (P = 0.009) than patients. Older mental health patients reported more isolation than patients under 30. Relatives who mentioned some serious illness in the family reported more role conflict than those who didn't. No differences were found by gender, family structure or education. The results indicated that the mental health problems of a single family member did not impair family dynamics. The study showed that the resources and functioning of families are fairly good in spite of the illness in the family.

Adult↗
PubMed1991

Family interactions within incest and nonincest families.

OBJECTIVE: The study addressed the questions, What are the interactional patterns in families in which incest occurs? and Do these patterns differ from those of families with other clinical problems? METHOD: The families for the study were chosen from two outpatient clinics; the C. Henry Kempe, National Center for the Prevention and Treatment of Child Abuse and Neglect provided access to families with incest, and the nonincest families each had a child seen in a university child psychiatry clinic. In each of these settings, 30 families were selected in the order of referral for evaluation. All families agreed to participate. Each family was given two tasks to perform during a structured interview. The interviews were videotaped, and 15-20-minute segments were rated independently by two of the authors, who used the Beavers-Timberlawn Family Evaluation Scale to assess interactional behaviors within each family. RESULTS: The incest families were significantly more dysfunctional in all but one area of family interaction. The distribution of power within a family did not differentiate the two types of families. CONCLUSIONS: The incest families dysfunctional patterns that seemed to support and maintain the incestuous behavior were a rigid family belief system, a dysfunctional parental coalition, parental neglect and emotional unavailability, and the inability to nurture autonomy in family members.

Adult↗
PubMed1996

The Melbourne Family Grief Study, I: Perceptions of family functioning in bereavement.

OBJECTIVE: The aim of this study was to identify patterns of family functioning in adult families after the death of a parent. METHOD: One hundred fifteen families completed measures of family functioning, grief, psychological state, and social adjustment 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (a total of 670 individual responses). Cluster analytic methods were applied to develop a typology of perceptions of family functioning during bereavement. RESULTS: Five types of families emerged from dimensions of cohesiveness, conflict, and expressiveness on the Family Environment Scale. Thirty-six percent of the families were considered supportive because of their high cohesiveness, and another 23% resolved conflict effectively. Two types were dysfunctional: hostile families, distinguished by high conflict, low cohesiveness, and poor expressiveness, and sullen families, who had more moderate limitations in these three areas; they declined in frequency from 30% at time 1 to 15% at time 3. The remaining type (26%), termed intermediate, exhibited midrange cohesiveness, low control, and low achievement orientation. The typology at time 1 predicted typologies at time 2 and time 3. There were no age or gender differences among the family types, but offspring, as compared with spouses, were overrepresented in the hostile families. CONCLUSIONS: Family types can be identified, allowing at-risk families to be helped to prevent complications of grief. Screening with the family relationship index of the Family Environment Scale would facilitate such a family-centered approach.

Adaptation, Psychological↗
PubMed2006

Development and dissemination of potentially better practices for the provision of family-centered care in neonatology: the family-centered care map.

OBJECTIVE: Family-centered care has become integral to the provision of quality neonatal intensive care. However, practices that reflect the core principles of family-centered care have not been described fully in the literature or implemented and evaluated consistently within newborn intensive care. The objective of this study was to create a family-centered care map that enhances the ability of the health care team to work with families to coordinate and deliver care in a holistic manner to meet the developmental, physical, and psychosocial needs of NICU patients and their families. METHODS: Potentially better practices were developed for sequential clinical phases by using standardized methods. These included focus groups with families, brainstorming sessions with staff, literature review, and input from established family advisory groups and family-centered care experts. Potentially better practices then were integrated into the family-centered care map that was configured in a Web-based format. Overall utility will be evaluated by determining the effect of the family-centered care map on length of stay, parental satisfaction, and family-centered care beliefs and practices among NICU staff. RESULTS: Sixty-three potentially better practices were identified for 7 clinical phases and 3 variations that were believed to characterize the clinical course of a typical NICU patient. A prototype of the Web-based family-centered care map that illustrates the clinical phases with links to the related potentially better practices, operational processes, and case studies was created. Baseline data from a care provider survey, from a family satisfaction survey, and on length of stay have been collected. CONCLUSIONS: Quality improvement methods and collaboration among 3 centers led to the development of an innovative Web-based resource to assist individual care providers and family advisors to provide comprehensive family-centered care to infants and families. Implementation of the family-centered care map has potential to affect positively the quality of newborn intensive care and lead to improved long-term outcomes.

Consumer Behavior↗
PubMedDate not supplied

The behavior of Italian family physicians regarding the health problems of women and, in particular, family planning (both contraception and NFP).

The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.

Contraception↗
PubMed1996

Familial hemiplegic migraine in the west of Scotland: a clinical and genetic study of seven families.

OBJECTIVES: Clinical and genetic characterisation of families in the west of Scotland with familial hemiplegic migraine. METHODS: Families with familial hemiplegic migraine were identified via probands attending the regional paediatric neurology and child development centre. All available family members were assessed clinically and genetic linkage studies for the known familial hemiplegic migraine gene locus on chromosome 19 were carried out on three families. RESULTS: Seven unrelated kindreds with familial hemiplegic migraine were identified. Clinical information was obtained on 138 family members, 27 of whom fulfilled the International Headache Society criteria for familial hemiplegic migraine. Whereas the severity, duration, frequency, and temporal progression of acute hemiplegic migrainous attacks showed pronounced variability within and between families, and even in the same individual over time, no true clinical heterogeneity of the condition was apparent. Genetic linkage analysis gave results consistent with linkage to the familial hemiplegic migraine gene locus on chromosome 19p in one family. In the other two families, evidence against linkage was obtained. There was no significant clinical difference between these three families. CONCLUSIONS: This study provides characterisation of the clinical features of familial hemiplegic migraine in a British population. Significant variability was found in the frequency and character of migraine attacks within and between families, and no true clinical heterogeneity was identified. On the other hand, further evidence for genetic heterogeneity of the condition was found.

Adolescent↗
PubMed2000

Family and staff perceptions of the role of families in nursing homes.

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.

Adult↗
PubMed2003

Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial.

Family Focused Grief Therapy (FFGT) is a new model of brief intervention, which is commenced during palliative care for those families shown to be at high risk of poor adaptation, and continued preventively into bereavement with the aim of improving family functioning and reducing the morbid consequences of grief. In this paper, baseline data on 81 families (363 individuals) selected by screening from a palliative care population are explored to confirm our previously reported observation that high levels of psychosocial morbidity are positively associated with worsening family dysfunction. The Family Relationships Index (FRI) was used for screening and the Family Assessment Device (FAD) as an independent family outcome measure. The Beck Depression Inventory (BDI), Brief Symptom Inventory (BSI) and Social Adjustment Scale (SAS) were the psychosocial measures. Families were classified according to their functioning based on the FRI. To allow for correlated family data, statistical analyses employed the generalized estimating equation (GEE) method, controlling for gender and depression (BDI). Screening of 257 families (701 individuals) revealed 74 (29%) well-functioning families and 183 (71%) at some risk of morbid outcome. Of the latter, 81 (44%) gave informed consent to enter a randomized controlled trial of FFGT. Patients had a mean age of 57 years, 51% were male and they suffered from cancer, with a median length of illness from diagnosis to death of 25 months. In accordance with the FFGT model, their family types were identified as Intermediate 51%, Sullen 26% and Hostile 23%. These were significantly associated with steadily increasing levels of distress (BSI) and poor social adjustment (SAS). The FAD confirmed the concurrent accuracy of the FRI. As significantly greater levels of psychosocial morbidity were present in families whose functioning as a group was poorer, support was generated for a clinical approach that screens for families rather than individuals at high risk. The predictive validity of the FRI as a screening measure was confirmed. Overall, these baseline data point to the importance of a family-centred model of care.

Adaptation, Psychological↗