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The syndromes described by Kanner and Rett-Hagberg: overlap in an extended family.

An extended family is reported in which Rett-Hagberg syndrome, autism with mild ataxia and autism with profound mental retardation occurred separately in three female second-cousins. The authors suggest alternative explanations for the possible association between autism and Rett-Hagberg syndrome: that they may be closely related genetic disorders, or that they may constitute relatively homogeneous phenotypes with several possible aetiologies.

Adolescent↗

The extended family encounter.

The extended family encounter is a planned, prolonged physician-family interaction that allows an in-depth approach to a challenging clinical problem. A protracted and intense interaction may be indicated when organic, emotional or family problems are unresponsive to usual methods of continuing and comprehensive care. It will often provide vital data, afford diagnostic insight, help crystallize the plan of management and enhance the relationship between the patient and his family.

Adolescent↗

A better outlook for schizophrenics living in extended families.

Cases of schizophrenia and schizophreniform attacks living in extended families have been compared to cases with similar diagnoses in nuclear families. Both diagnostic groups living in extended families presented earlier: they had lower rates of withdrawal symptoms and higher rates of behavioural disturbances and subjective suffering. Inter-generational conflict was a significantly more common precipitating factor in patients living in extended families; this was therapeutically utilized to induce family support. Patients from extended families had a lower tendency to deteriorate into with drawn, affectively blunted residual states.

Adult↗

HLA prediction model for extended family matches.

This article derives a probabilistic model for predicting HLA matches from a population of extended family members. (Extended family members are defined as either first cousins or blood-related aunts or uncles). The model uses family pedigree information and haplotype frequency data to estimate the likelihood of a match. Results are given for many ethnic groupings. A case study is also described. This technique is most applicable when all family members are of the same ethnic origin, which increases the likelihood of a match among a small number of family members, and the patient possesses a haplotype having a frequency exceeding 10%, within the patient's ethnic population. Under such conditions, an extended family search can frequently approximate the success rate of a single sibling search.

Adult↗

Rehabilitation of schizophrenics by the extended family.

Patterns of care by extended and nuclear families for their patients were studied in relation to 540 Arab schizophrenic outpatients in Qatar. The extended family differs from the nuclear family not only in its larger size but also in the greater emotional commitment of its members to each other's well being. The extended family is more tolerant of patients' minor behavioural abnormalities and temporary protective withdrawals. It is more helpful in the supervision of patients' medication and their social adjustment and leisure-time occupation. Being more traditionally oriented, the extended family helps patients to understand their illness experiences in terms of cultural belief systems once they lose the components that cannot be contained in these systems. Extended family members are less likely than nuclear family members to tax the patients' emotional resources and limited repertoire of social skills.

Adult↗

The effect of extended family living on the mental health of three generations within two Asian communities.

BACKGROUND: A study by Shah & Sonuga-Barke (1995) identified a relationship between family structure and the mental health of Pakistani Muslim mothers and their children. Children in extended families fared better, but their mothers fared worse than their nuclear family counterparts. The present study replicates and extends this study by exploring the impact of nuclear and extended family living on the mental health of three generations (children, mothers and grandmothers) in British Hindu as well as Muslim communities. METHOD: 44 Muslim and 42 Hindu families participated in the study. The mental health of mothers and grandmothers and the behavioural problems of children (aged 5-11) were examined. Both mothers and grandmothers completed the Hospital Anxiety and Depression Scale. The children's behavioural adjustment was rated by their teachers using the Rutter Scale. Other relevant variables such as acculturation levels were also measured. RESULTS: Children and grandmothers were better adjusted in extended families than nuclear families. In contrast, mothers were better adjusted in nuclear families. This interaction between family type and generation was evident in both Muslim and Hindu families and did not appear to be mediated by other variables such as acculturation. Furthermore, mothers' and childrens' adjustment was significantly correlated with grandmothers', but not mothers', mental health in extended families (although not in nuclear families). DISCUSSION: These results provide further evidence for the link between family structure and mental health in Asian communities. They also challenge some of the assumptions about maternal mental health, its effects on child adjustment and its links to systems of social support. In extended families where social support was likely to be most available mothers were at greatest risk, while their children profited and this advantage seemed to be linked to the grandmaternal presence.

Adaptation, Psychological↗

The effects of group therapy on bereaved extended family of children with cancer.

The impact of the death of a child from cancer and subsequent grief on the extended family members has not been documented. Additionally, the effect of a support group for these individuals has not been explored. Therefore, this one group pretest/post-test study sought to determine the effects of participation in a support group for bereaved extended family members whose child died from cancer. Extended family members completed the Emotions Profile Index before and after the group sessions. Descriptive data were collected from the cotherapists' process log and the participants' evaluation. No significant differences were found between pretest and post-test scores for any emotional state. However, the group process log showed significant clinical data related to the intensity of the grief experienced and ways of coping with the loss. The Bereaved Extended Family Group Evaluation demonstrated the usefulness of the group experience. Tentative conclusions support the value of such a group in providing a forum for the bereaved extended family to ventilate feelings of anger and sadness and find ways to cope with the future.

Adaptation, Psychological↗

Emotional and behavioural problems in primary school children from nuclear and extended families in Korea.

The changes occurring within Korean society provide an opportunity for studying the influence of family structure on children's emotional and behavioural problems. Children aged 7-13 years from two Korean cities were assessed for emotional and behavioural problems in school by their teachers, using the Children's Behaviour Questionnaire. In Study 1, 326 children from extended families were compared with demographically matched nuclear family children in the same school classes. In Study 2, a further sample of 204 extended family children was compared with pair-matched nuclear family children, in order to replicate the findings. Children from Study 1 were followed up 2.5 years later. Children from extended families had lower behaviour problems scores and the prevalence of serious problems was lower in extended family children. These differences were most marked in relation to externalising behaviour problems and were stable over the studies and time. Grandparents in extended families may increase children's resiliency by providing sources of attachment, affection, and knowledge, as well as having indirect effects through their support of parents. Consistent with recent ideas about the cognitive bases for behaviour problems, it may be that rules for behaviour derived from traditional cultural beliefs and values are internalised by children from extended families and generalise to prevent behaviour problems in school.

Adolescent↗

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe.

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Acquired Immunodeficiency Syndrome↗

Endemic amebiasis in an extended family.

Two cousins from a large Spanish-American family were simultaneously diagnosed as having amebic liver abscesses. Survey of 183 extended-family members revealed that 45.7% of 162 had a positive amebiasis indirect hemagglutination test and 12.6% of 111 had cysts or trophozoites of Entamoeba histolytica demonstrated in a single stool examination. A total of five family members had had liver abscesses; two deaths had occurred. In a random sample survey of the remainder of the community, only one person (0.3%) had a positive serologic test. Within the extended family, person-to-person appeared to be the predominant mode of transmission. Water supplies were not contaminated. Both community and extended family homes had the same source of water. Type and source of food supply were not correlated with infection and there was no evidence to implicate an infected food handler. Clustering of seropositivity occurred in homes without indoor toilets. Homes of the extended family were more crowded and significantly fewer of them had indoor toilets. Endemic foci of amebiasis continue to exist in the United States. Follow-up family and other close contacts of persons with amebiasis will frequently identify other cases.

Feces↗

Mental health of elderly Asians in Britain: a comparison of Hindus from nuclear and extended families of differing cultural identities.

OBJECTIVE: To compare the psychological adjustment of grandmothers from nuclear and extended families within British Hindu communities, and to investigate the influence of cultural identity. DESIGN: Interviews were carried out with Hindu grandmothers, mothers and granddaughters living in both nuclear and extended families. SETTING: The sample was drawn from the total population of Asian Hindu girls aged between 13 and 17 years at four comprehensive schools in the London Borough of Redbridge. PARTICIPANTS++: The final sample consisted of 36 and 34 sets of individuals in extended and nuclear families, respectively. MEASURES: Questionnaire measures were obtained of the following variables: cultural integrity, traditionalism, religious participation, ethnic identity, anxiety, depression, self-esteem. RESULTS: Grandmothers were better adjusted in extended families than in nuclear families. This adjustment was in part mediated by the level of traditional belief within the family. Elders whose granddaughters had an exclusively 'Indian' or 'Hindu' ethnic identity were better adjusted than those whose granddaughters included a 'British' ethnic identity. CONCLUSIONS: This study confirmed findings from earlier studies that grandmothers in extended families were significantly better adjusted in comparison to those from nuclear families. Ethnic identity of the adolescent, independent of its salience and commitment to the adolescent, had a significant relationship to the grandmother's mental health.

Acculturation↗

The extended family and support for people with AIDS in a rural population in south west Uganda: a safety net with holes?

It is commonly assumed that the extended family in Africa provides a safety net for individuals in times of need. This paper examines this assumption using data on the care of people with AIDS in a rural population in South West Uganda. Over a six month period data were collected by counsellors on the care given to 30 (17 women, 13 men) AIDS patients by their families. In 27 of the 30 cases there was evidence of limited care. Various reasons were given for this by the carers, including lack of food and money for medications and the carer's other family responsibilities. For 17 clients who died during the study period, records of seven cases show that other relatives were asked to help with care but refused on the grounds of poverty or other commitments. However, in all but one of these cases extended families did provide assistance for the funeral. The findings suggest that there is a need to question the assumption that the extended family, in the culture under study, is able to provide adequate support for AIDS patients.

Acquired Immunodeficiency Syndrome↗

[The use of extended family APGAR index in OPD].

The present study was designed to evaluate the clinical availability of extended family APGAR in OPD. Five hundred and twenty two patients were collected from three different out-patient departments were studied during a 6 month period. All 522 patients were over 12 years of age and asked to completed an extended family function questionnaire. The patient's age, sex, marital status, occupation, education, family role, socioeconomic status and religion were also recorded. The results showed that there were significant difference among the extended scores of patient's marital status and the socioeconomic status. We also found that patients suffering from family problems, psychosomatic problems and multiple problems have significantly lower extended scores. Because only 3 patients were diagnosed as having family problems by a chart reviewed in all 522 patients, we suggest further research on the extended family APGAR before widely using it in OPD.

Adult↗

Time-extended family interviewing.

This paper presents a family-therapy technique--time-extended family interviewing--in which the therapist extends the traditional one-hour interview to three to seven hours, by plan, at a particular point in the life of a case and for a particular purpose. Extended sessions promote movement in a case for a variety of reasons. Furthermore, the use of such sessions highlights the dimension of time as an important element of good casework practice.

Adult↗

Perception of the social support role of the extended family network by some Nigerians with schizophrenia and affective disorders.

Enquiries into patients' perception of psychosocial support from families should help objectively to identify the strengths and needs of families with sick members, in order to enhance management. The aim of this study was to identify the categories of relatives in the extended family whom a sample of Nigerian psychiatric patients perceived as having provided material, social and emotional support, and the factors associated with these perceptions. 123 schizophrenics and 31 patients with major affective disorders attending out-patient clinics were interviewed. Using operational definitions of family member (i.e. tendency to confide in and expect support from a relative), it appears that the size of extended family network that was mostly relied upon for support was five, including parents, full siblings, uncles/aunts, first cousins and in-laws. There were no significant differences in summary scores of family size and social support between the two illness groups. Age and duration of illness were significantly negatively correlated with perception of supports. The size of family network with whom patients interacted was predicted by tendency to confide in members, and emotional support. The findings indicate that the presumed support of the extended family should not negate the need to strengthen the resources of the nuclear family, in order to provide a focus for attraction and deployment of materials needed for the effective care of patients.

Adolescent↗

The mental health of Muslim mothers in extended families living in Britain: the impact of intergenerational disagreement on anxiety and depression.

OBJECTIVES: The study assessed the impact of intergenerational differences of opinion over child rearing on the mental health of Muslim mothers living in extended families. DESIGN: The study adopted a correlational design in an attempt to identify factors that accounted for mental health problems. METHODS: The child-rearing attitudes of mothers and grandmothers, mothers' mental health, levels of family acculturation and a range of other background and demographic information was collected from 54 extended families living in two Muslim communities in London using Urdu versions of standard questionnaires. RESULTS: Rates of depression and anxiety among the mothers in the study were high. Grandmothers had more traditional attitudes to child rearing than did mothers. Intergenerational discrepancy over child rearing was more marked in more acculturated families. Discrepancy was associated with higher levels of mothers' anxiety and depression. CONCLUSIONS: The unusually high levels of depression and anxiety displayed by Muslim mothers living in extended families can in part be accounted for by patterns of intergenerational discrepancy. These possibly reflect discordant world views within those families that have been assimilated into the dominant British culture.

Acculturation↗

Extended family living among older people in six Latin American countries.

This study examined and compared demographic and urban/rural residence underpinnings to people 60 and over living in an extended family household in six Latin American countries. Household samples of the World Fertility Survey gathered in the middle 1970s were sued, as was a combination of crosstabular and logit techniques. We found that, in contrast to Western countries, a majority of the elderly population lived in extended family households. This was more likely in the Dominican Republic than in Colombia, Costa Rica, Panama, or Peru, which was, in turn, more likely than in Mexico. However, such differences were most apparent among the married, not the unmarried. In all countries, unmarried people were more likely to live in extended family households than were married people. Among unmarried elderly, the likelihood was greater for women than for men. Contrary to initial expectations, neither urban/rural residence nor age among the elderly themselves tended to be important.

Aged↗

Genetic counseling in hereditary nonpolyposis colorectal cancer: an extended family with MSH2 mutation.

OBJECTIVES: Molecular genetic advances have increased the demand for DNA testing. We describe DNA based genetic counseling in a hereditary nonpolyposis colorectal cancer (HNPCC) family. METHODS: This extended HNPCC family was found to harbor the MSH2 germline mutation. Family history, medical, and pathology documents enabled us to secure a high degree of verification that the kindred qualified as HNPCC. DNA testing revealed the MSH2 germline mutation that was verified independently in two laboratories. Genetic counseling was provided before DNA testing and disclosure of MSH2 findings. RESULTS: Genetic counseling revealed a variety of findings characterized by emotional stress in MSH2 germline mutation carriers. Concerns centered around reproductive issues, potential transmission of the deleterious gene to their progeny, and discrimination by insurance carriers and employers. More than one-half of the patients found to harbor the MSH2 mutation considered the option of prophylactic subtotal colectomy. CONCLUSION: DNA testing should be restricted to well-verified candidate families in which genetic counseling should be mandatory. HNPCC family members sought genetic risk assessment for their own health and that of their children. Contrasting emotional responses took place when told of their gene testing status and this required a sensitive empathetic listening ear. Patients have many concerns about their lifetime cancer destiny when told that they harbor the culprit MSH2 germline mutation.

Adult↗