Developing more effective family planning, family health and family welfare programmes: opportunities for government-NGO collaboration. Executive summary and policy implications.
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Asia↗
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The family covenant: addressing disclosure, families, and family physicians.
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Confidentiality↗
Demography and family practice; some demographic considerations of significance in the Lamontville family practice of the Institute of Family and Community Health, Durban.
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Academies and Institutes↗
[FAMILY NEUROSES AND FAMILY THERAPY. DISCUSSION OF NEW PSYCHOANALYTIC RESULTS OBTAINED BY M. GROTJAHN. II. ASPECTS OF TREATMENT TECHNIC IN PSYCHOANALYTIC FAMILY THERAPY].
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Communication↗
A formula for the 1970s: estimating need for subsidized family planning services. Commentary: Family planning need and the future of the family planning program.
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Community Health Services↗
Family cohesion, expressiveness and conflict in alcoholic families.
This study estimated family cohesiveness, expressiveness, and conflict in a primary care sample of alcoholics and non-alcoholics with and without a family history of alcoholism. Subjects completed the NIMH Diagnostic Interview Schedule alcohol subscale, based on DSM-III criteria, and a family environment scale. Alcoholics with a family history of alcoholism (Alc+FH+) reported significantly less cohesion and expressiveness, and more conflict in their present families than did either non-alcoholics with a family history of alcoholism (Alc-FH+) or non-alcoholics with no family history of alcoholism (Alc-FH-). Non-alcoholics who grew up in alcoholic families (Alc-FH+) reported present family relationships similar to non-alcoholics with no family history of alcoholism (Alc-FH-). Results suggest a family history of alcoholism alone was not associated with differences in perceptions of present family relationships. The findings of this study raise questions about the general perception that individuals who grew up in alcoholic families experience more family dysfunction in adulthood. The presence of two factors together--family history and alcohol problems in the subject--produced the perception of family dysfunction.
Adolescent↗
Family history as a risk factor for coronary heart disease in South African families.
This article presents data on, and applies a procedure for the statistical quantification of, family history as a risk factor for coronary heart disease (CHD) in three sub-samples (groups) of families: I--a healthy control group; II--families with familial hypercholesterolaemia (FH); and III--families identified by an index case with CHD. With regard to the average family history of CHD (calculated as an index for each family, and as a mean index for each group), group II differs significantly from group I and marginally significantly from group III; family groups I and III do not differ from each other statistically. By means of significance tests developed for this purpose, the groups of families are shown to be significantly heterogeneous, by being composed of families highly resistant against and susceptible to CHD. This is illustrated for example in group II, where some FH families can be shown to be highly resistant to CHD, compared with other FH families with a very strong history of CHD. The exact number and proportion of such families at different levels of significance is calculated and the actual families with the highest and lowest calculated family indices, respectively, are then identified (illustrated by examples). The practical significance of the statistical procedure of quantifying and applying family history as a risk factor for CHD, is discussed in terms of epidemiological and preventive health considerations.
Adolescent↗
Family practice maternity care in America: ruminations on reproducing an endangered species--family physicians who deliver babies.
BACKGROUND: The majority of family physicians do not deliver babies. One reason might be the family physician's intrinsic comfort with person- or patient-centered care compared with the common obstetric approach of disease or physician-centered maternity care. Another reason might be the uncritical intrusion of technology into maternity care. In addition, family physicians often are made to feel unwelcome in many maternity care systems. METHODS: The medical literature from 1984 to 1994 was searched for the topics of obstetrics, maternity care, family-centered birthing, and family practice education. Reasons to argue whether family physicians should provide maternity care were selected, and articles were chosen that described the self-reported reasons students, residents, or physicians give whether to provide maternity care. RESULTS AND CONCLUSIONS: There is no scientifically supportable reason for excluding family physicians from maternity care in any setting, and the current maternity care system, in many locations, creates an attitude of taught helplessness among family physicians. In addition, family practice educators must for a variety of reasons be the primary role models and teachers of family-centered birthing for family practice learners. Generally, the groups that should be involved in providing maternity care in the future should include (1) better informed and more independent pregnant patients, (2) maternity care nurses, (3) doulas, (4) midwives, (5) family physicians, and (6) specialized physicians. Specifically, family physicians and midwives have a historic and philosophic similarity that would argue for a much closer working and practicing relationship between these two professionals. Family-centered birthing provides excellent outcomes. Birthing is both foundational and intrinsic to family practice. Conversely, without family physicians maternity care in America might not be able to reach its full potential.
Attitude of Health Personnel↗
Do families get family care?
To determine the prevalence of family care, we measured the extent to which a subset of 732 families, from those enrolled in the Rand Health Insurance Experiment, perceive and use a single primary care physician. Although only 16.7% of these families had all members with a majority of their visits to the same physician, 45.4% identified a single primary care physician for all family members. (For older couples, this percentage reached 73.5%). An intermediate proportion of families had visits by all family members to a single physician. Children received less family care, but as families matured, family care increased for both children and parents. Our results suggest an inverse relationship between family care and education level. The availability of general-family practitioners, family income, insurance coverage, and population size were not significant determinants of family care. We conclude that family members share the perception of having a single "family physician," which is reflected in their patterns of utilization.
Adult↗
Familial abdominal aortic aneurysms: collection of 233 multiplex families.
OBJECTIVE: This study investigated a large number of families in which at least two individuals were diagnosed with abdominal aortic aneurysms to identify the relationship of the affected relatives to the proband. SUBJECTS AND METHODS: Families for the study were recruited through various vascular surgery centers in the United States, Finland, Belgium, Canada, the Netherlands, Sweden, and the United Kingdom and through our patient recruitment website (www.genetics.wayne.edu/ags). RESULTS: We identified 233 families with at least two individuals diagnosed with abdominal aortic aneurysms. The families originated from nine different nationalities, but all were white. There were 653 aneurysm patients in these families, with an average of 2.8 cases per family. Most of the families were small, with only two affected individuals. There were, however, six families with six, three with seven, and one with eight affected individuals. Most of the probands (82%) and the affected relatives (77%) were male, and the most common relationship to the proband was brother. Most of the families (72%) appeared to show autosomal recessive inheritance pattern, whereas in 58 families (25%), abdominal aortic aneurysms were inherited in autosomal dominant manner, and in eight families, the familial aggregation could be explained by autosomal dominant inheritance with incomplete penetrance. In the 66 families where abdominal aortic aneurysms were inherited in a dominant manner, 141 transmissions of the disease from one generation to another were identified, and the male-to-male, male-to-female, female-to-male, and female-to-female transmissions occurred in 46%, 11%, 32%, and 11%, respectively. CONCLUSION: Our study supports previous studies about familial aggregation of abdominal aortic aneurysms and suggests that first-degree family members, male relatives, in particular, are at increased risk. No single inheritance mode could explain the occurrence of abdominal aortic aneurysms in the 233 families studied here, suggesting that abdominal aortic aneursyms are a multifactorial disorder with multiple genetic and environmental risk factors.
Aortic Aneurysm, Abdominal↗
Health family trees: a tool for finding and helping young family members of coronary and cancer prone pedigrees in Texas and Utah.
We report on the feasibility and utility of a new approach for identifying the small percentage of families in the general population with strong familial predisposition to early coronary heart disease, strokes, and common familial cancers (breast, colon, lung), using the "Health Family Tree," a medical family history. A total of 24,332 "trees" were completed by parents and students in 37 high schools in 14 urban and rural communities in Texas and Utah during the years 1980-86. Completed "trees" were obtained from 68 per cent of all enrolled students. High-risk families, included 1,796 families with early coronary disease (7.5 per cent of all student families or 3.7 per cent of their parents' families), 870 stroke families (3.6 per cent), and 415 cancer prone families (1.7 per cent). Among these 3,081 high-risk families there were 8,245 family members already reported to have been diagnosed by a physician to have the familial disease of interest and 43,269 high risk unaffected siblings and offspring of these persons. The average cost per identified high-risk unaffected person was under $10. We conclude that the "Health Family Tree" is a feasible and cost-effective way to find high-risk families.
Adolescent↗
Identification of nurse-family intervention sites to decrease health-related family boundary ambiguity in PICU.
The most common explanation of parental stress associated with hospitalized children is based on individual stress theory. Using a family stress and family systems approach with an emphasis on examining family integrity, this qualitative study selected families in the Pediatric Intensive Care Unit (PICU) with high boundary ambiguity in the caregiving environment and identified potential sites for nursing actions that impede or assist families in maintaining family integrity. Within three days of admission of their child to a major tertiary children's hospital PICU, 29 families were recruited and screened with a Health-Related Family Boundary Ambiguity Scale. High scoring families (n = 11) were interviewed using an open-ended method. Data were analyzed using a content analysis method, and results were interpreted within a family systems framework. The following three potential areas of intervention to encourage family integrity during acute illness of a child were identified: fostering family normalcy, respecting family rights, and strengthening the family boundary. Implications for initiating or improving family centered care in the PICU are discussed.
Adolescent↗
Spirituality and family nursing: spiritual assessment and interventions for families.
AIM: The aim of this paper is to propose a guideline for spiritual assessment and interventions explicitly for families, while considering each family member's unique spirituality. BACKGROUND: Spirituality's positive effect is pervasive in health care and in the lives of many families; therefore, there is a need to integrate spiritual assessment and interventions in total family care. DISCUSSION: The majority of published guidelines on spiritual assessment and interventions are designed predominantly for individuals. They fail to differentiate between individual and family spirituality or offer only brief discussions on family spirituality. Such guidelines are potentially problematic. They may lead nurses to focus only on individual spirituality and neglect to discern family unit spirituality or recognize the presence of conflicts in spiritual perspectives within the family. While other disciplines such as social work and family therapy have several guidelines/strategies to assess family spirituality, there is a dearth of such guidelines in the family health nursing and spirituality literature, in spite of the rhetoric about incorporating spirituality as part of total family assessment. As a beginning solution, guidelines are proposed for spiritual assessment and interventions for the family as a unit, and the category of spiritual interpretation to represent diagnosis is introduced. Case studies exemplify how to integrate the guideline, and illustrate elements that may favour specific interpretations which would guide the interventions. CONCLUSION: As nurses continually strive to assist families with their health needs, they must also attend to their spiritual needs, as one cannot truly assess a family without assessing its spirituality.
Adaptation, Psychological↗
Structural family therapy: its application to Chinese families.
In summary, it can be stated that structural family therapy, for a variety of reasons, offers an appropriate treatment model for dysfunctional Chinese families. Since the family, not the individual, is the more important unit in Chinese culture, the model offers the opportunity for the total family to participate in changing dysfunctional individual and family patterns. The model focuses upon structure, which is the essence of the Chinese family. In addition, it is problem- and growth-oriented, creates a nondefensive atmosphere in which family members can change, and works toward helping family members improve communication and modify behavior. It is important to stress that it does not focus upon helping family members make significant changes in their value system. Furthermore, the model can be applied to most problem areas, because it is assumed that the presenting problem is reinforced by family structure and repetitive patterns. Consequently, family interactional patterns that reinforce the presenting problems are the major focus of the treatment. Finally, the model allows for the utilization of theories and practice principles of other clinical approaches. Structural family therapists assume the role of authority figures who are experts in family therapy. They view the family within the context of its environment, are sensitive to the cultural norms of the group with which they are working, and utilize supportive services as an integral part of treatment. More important, therapists believe in the power of families to make changes and work toward helping them become involved in a new process of interaction that will lead to satisfactory changes.
Acculturation↗
All in the family: headaches and abdominal pain as indicators for consultation patterns in families.
PURPOSE: Headaches and abdominal pain are examples of minor ailments that are generally self-limiting. We examined the extent to which patterns of visits to family physicians for minor ailments, such as headaches or abdominal pain, cluster within families. METHODS: Using information from the Second Dutch National Survey of General Practice for 96 family practices, we analyzed the visits of families with at least 1 child aged 12 years or younger during a period of 12 months. RESULTS: Family patterns were clearest in the visits of mothers and children. A large part of the similarity in the frequencies of contact by mothers and daughters could be attributed to shared family factors. This finding was especially true for families with a child who had a headache or abdominal pain as the presenting symptom, rather than physical trauma or chronic disease. Within families, we did not find any specific patterns of diagnoses. Diagnoses were recorded by family physicians. In the case of young children, family similarity may have been overestimated because parents initiated the visits and put their child's health problem into words. CONCLUSIONS: Visits to family physicians for headaches or abdominal pain can be seen as indicators of consultation patterns in families. Family patterns related to minor ailments are likely to be a result of socialization. Family consultation patterns might point toward specific needs of families and consequently at a different approach to treatment.
Abdominal Pain↗
A novel glycoside hydrolase family 105: the structure of family 105 unsaturated rhamnogalacturonyl hydrolase complexed with a disaccharide in comparison with family 88 enzyme complexed with the disaccharide.
YteR, a hypothetical protein with unknown functions, is derived from Bacillus subtilis strain 168 and has an overall structure similar to that of bacterial unsaturated glucuronyl hydrolase (UGL), although it exhibits little amino acid sequence identity with UGL. UGL releases unsaturated glucuronic acid from glycosaminoglycan treated with glycosaminoglycan lyases. The amino acid sequence of YteR shows a significant homology (26% identity) with the hypothetical protein YesR also from B. subtilis strain 168. To clarify the intrinsic functions of YteR and YesR, both proteins were overexpressed in Escherichia coli, purified, and characterized. Based on their gene arrangements in genome and enzyme properties, YteR and YesR were found to constitute a novel enzyme activity, "unsaturated rhamnogalacturonyl hydrolase," classified as new glycoside hydrolase family 105. This enzyme acts specifically on unsaturated rhamnogalacturonan (RG) obtained from RG type-I treated with RG lyases and releases an unsaturated galacturonic acid. The crystal structure of YteR complexed with unsaturated chondroitin disaccharide (UGL substrate) was obtained and compared to the structure of UGL complexed with the same disaccharide. The UGL substrate is sterically hindered with the active pocket of YteR. The protruding loop of YteR prevents the UGL substrate from being bound effectively. The most likely candidate catalytic residues for general acid/base are Asp143 in YteR and Asp135 in YesR. This is supported by three-dimensional structural and site-directed mutagenesis studies. These findings provide molecular insights into novel enzyme catalysis and sequential reaction mechanisms involved in RG-I depolymerization by bacteria.
Acetylglucosamine↗
Distribution of familial nephritis antigen in normal tissue and renal basement membranes of patients with homozygous and heterozygous Alport familial nephritis. Relationship of familial nephritis and Goodpasture antigens to novel collagen chains and type IV collagen.
The glomerular basement membranes (GBM) of Alport familial nephritis (FN) are laminated and split and fail to bind Goodpasture autoantibodies by indirect immunofluorescence. The Goodpasture antigen has been localized to multiple peptides of the noncollagenous C terminal (NC1) domain of type IV collagen. The principal target antigen is a 28-kDa peptide (M28) that coisolates with type IV collagen NC1 and which is derived from a larger collagenous molecule. We have shown that two novel 28-kDa peptides found in normal GBM (M28M28+) are absent from collagenase digests of X-linked dominant Alport FN GBM and that monoclonal antibodies specific for these collagen chains fail to bind to Alport GBM. In normal tissue these chains have a distribution restricted to specific basement membranes of kidney, eye, inner ear, lung, and brain, the former three of which are affected in Alport FN. Epitopes on a 26-kDa NC1 peptide identified by an antibody from a transplanted Alport patient (FN antibody) colocalized with the 28-kDa components in these tissues. The FN antibody did not bind to the GBM of homozygous Alport males. Antibodies to the 28-kDa peptides and the FN antibody colocalized in a segmental pattern in heterozygous Alport GBM by indirect immunofluorescence and were unrelated to the normal distribution of type IV collagen. Three of eight homozygous Alport FN tissues showed the presence of the 28-kDa components in Bowman's capsule in a focal distribution, and in four of eight tissues reactive antigen was present in the cytoplasm of some parietal and visceral epithelial cells. These observations support the hypothesis that the genetic abnormality in Alport FN is a defective parent chain of the 26-kDa peptide, which results in failure of normal 28-kDa collagen chain integration.
Antibodies, Monoclonal↗
Family doctors' involvement with families in Estonia.
BACKGROUND: Family doctors should care for individuals in the context of their family. Family has a powerful influence on health and illness and family interventions have been shown to improve health outcomes for a variety of health problems. The aim of the study was to investigate the Estonian family doctors' (FD) attitudes to the patients' family-related issues in their work: to explore the degree of FDs involvement in family matters, their preparedness for management of family-related issues and their self-assessment of the ability to manage different family-related problems. METHODS: A random sample (n = 236) of all FDs in Estonia was investigated using a postal questionnaire. Altogether 151 FDs responded to the questionnaire (response rate 64%), while five of them were excluded as they did not actually work as FDs. RESULTS: Of the respondents, 90% thought that in managing the health problems of patients FDs should communicate and cooperate with family members. Although most of the family doctors agreed that modifying of the health damaging risk factors (smoking, alcohol and drug abuse) of their patients and families is their task, one third of them felt that dealing with these problems is ineffective, or perceived themselves as poorly prepared or having too little time for such activities. Of the respondents, 58% (n = 83) were of the opinion that they could modify also relationship problems. CONCLUSIONS: Estonian family doctors are favourably disposed to involvement in family-related problems, however, they need some additional training, especially in the field of relationship management.
Adult↗