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BACKGROUND: Increases in demands on patients' family members that are not reduced by family strengths may contribute to decreases in family adaptation and complicate patients' recovery after trauma. The purpose of this study was to examine family demands (prior stressors and severity of patients' injuries) and family strengths and capabilities (hardiness, resources, coping, and problem-solving communication) associated with outcomes of family well-being and adaptation. METHODS: A multivariate, descriptive design based on the Resiliency Model of Family Stress was used. A convenience sample of family members (N = 51) of adult patients participated within the first 2 days of critical injury. Family demands were measured with the Family Inventory of Life Events and Changes and the Acute Physiology, Age, and Chronic Health Evaluation III. Family strengths were measured with the Family Hardiness Index, Family Inventory of Resources for Management, Family Crisis Oriented Personal Evaluation Scale, and Family Problem Solving Communication Index. Family adaptation outcomes were measured with the Family Well Being Index and Family Adaptation Scale. RESULTS: Increases in family demands were significantly related to decreases in family strengths and family adaptation. Family demands scores accounted for 40% of the variance in family well-being scores. The only significant family strength variable influencing family adaptation was problem-solving communication. CONCLUSIONS: Increases in family demands seem to be an important indicator of the amount of assistance a family may need. Interventions that help mobilize family strengths, such as problem-solving communication, may be effective in promoting the adaptation of families of critically injured patients.
Detailed medical family history data have been proposed to be effective in identifying high-risk families for targeted intervention. With use of a validated and standardized quantitative family risk score (FRS), the degree of familial aggregation of coronary heart disease (CHD), stroke, hypertension, and diabetes was obtained from 122,155 Utah families and 6,578 Texas families in the large, population-based Health Family Tree Study, and 1,442 families in the NHLBI Family Heart Study in Massachusetts, Minnesota, North Carolina, and Utah. Utah families with a positive family history of CHD (FRS > or =0.5) represented only 14% of the general population but accounted for 72% of persons with early CHD (men before age 55 years, women before age 65 years) and 48% of CHD at all ages. For strokes, 11% of families with FRS > or =0.5 accounted for 86% of early strokes (<75 years) and 68% of all strokes. Analyses of >5,000 families sampled each year in Utah for 14 years demonstrated a gradual decrease in the frequency of a strong positive family history of CHD (-26%/decade) and stroke (-15%/decade) that paralleled a decrease in incidence rates (r = 0.86, p <0.001 for CHD; r = 0.66, p <0.01 for stroke). Because of the collaboration of schools, health departments, and medical schools, the Health Family Tree Study proved to be a highly cost-efficient method for identifying 17,064 CHD-prone families and 13,106 stroke-prone families (at a cost of about $27 per high-risk family) in whom well-established preventive measures can be encouraged. We conclude that most early cardiovascular events in a population occur in families with a positive family history of cardiovascular disease. Family history collection is a validated and relatively inexpensive tool for family-based preventive medicine and medical research.
The Family APGAR questionnaire was used to determine the prevalence of self-reported family dysfunction present in patients who attended a family practice center, to determine whether knowledge of the Family APGAR score increased the frequency with which family physicians evaluated family functioning and diagnosed family dysfunction, and to determine whether certain psychosomatic complaints associated with family dysfunction were more common in a group of patients with a Family APGAR score of less than 6. To achieve these purposes, all patients entering the center were asked to fill out a Family APGAR questionnaire during the month of March 1984. Physicians learned of the results in a randomly selected one half of all cases. A chart review was conducted one month later. Twenty-four percent of patients reported family dysfunction (APGAR less than 6). Knowledge of the APGAR score did not increase the frequency with which physicians evaluated family function (20 percent known vs 17 percent unknown) or diagnosed family dysfunction (6.3 percent known vs 6.4 percent unknown). Patients with self-reported family dysfunction as defined by the Family APGAR did not have more psychosomatic complaints noted in their charts than patients without self-reported family dysfunction. Family dysfunction is a common problem in family practice patients, it is recorded infrequently in patients' charts, and knowledge of the results of a screening device does not increase the frequency with which family dysfunction is noticed.
The purposes of this study were to identify the family coping strategies among families with chronically ill children and to explore the relationship between the family system (variables), the family burden and the family coping. One hundred fifty-two families with chronically ill children were studied. The Japanese version of Family Adaptability and Cohesion Evaluation Scales II and the Family Coping Behavior Inventory II were used. The result were 1) the family cohesion and adaptability in families with a chronically ill child tended to be lower than normal families; 2) the integration coping pattern was positively related with family cohesion and the family burden; 3) the problem solving coping pattern was positively related with the family burden; 4) the normalization coping pattern was negatively related with the family burden and positively related with the family cohesion; 5) the crisis response coping pattern was positively related with the family burden and negatively related with the family cohesion.
Using the Typology Model of Adjustment and Adaptation, a family stress model, the differences in family stressors, resources, family types, parental coping patterns, and child health indices were examined in 27 single-parent families and 27 two-parent families who had a child with cerebral palsy. The two groups of families were matched on the severity of the child's handicap and the age and gender of the parent. There was no significant difference between the two groups of families on the accumulation of stressors and demands, resource strains, family types, family cohesion, family resources of esteem/communication, mastery/health, extended family social support, and the child health indices of overall physical health status and health improvement. Single-parent families were significantly lower on financial well-being and the mother's coping related to maintaining family integration, cooperation, and optimism about the situation. Single-parent families also were higher on family adaptability than two-parent families, reflecting an ability to be more flexible in family rules, power structure, and role relationships.
The article analyses the concept of family nursing, which is defined and described by reference to its key characteristics (e.g. Rodgers 1989, Meleis 1991). Other, closely related and to some extent even substitutable concepts identified in the article are family systems nursing and family-centered nursing. The broad area of family therapy is excluded from the discussion since the purpose is to concentrate on the nursing of healthy families. Family nursing is defined in three different ways depending on the place and the role of the family on practical nursing: family as a context, as a sum of its parts and as a client. Concept of family-centered nursing is included in these three levels, but also levels minimal emphasis on family and family therapy, which are not included in the concept of family nursing. However, it is concluded that the two concepts can be regarded as closely related. Family systems nursing can be regarded either as one sub-concept to family nursing and family-centered nursing or as a kindred concept. It is suggested that a serious debate should be started in Finland on these concepts and that research should be undertaken in different nursing situations to find out how these concepts occur in reality.
PURPOSE: To conduct a longitudinal study of the effect of implementing a required third-year family practice clerkship or a department of family medicine on the proportion of graduating medical students choosing family practice as a specialty. METHOD: Using national data sets, the authors studied the proportion of students who chose family practice as a specialty at each medical school that implemented a required third-year family practice clerkship or a department of family medicine between 1984 and 1993. They compared the mean proportions of students choosing family practice for the three years before and three years after implementation of the required clerkship or the department. They controlled for national trends by comparing study schools with schools that did not have required family practice clerkships. RESULTS: The mean proportions of students who chose family practice increased 2.36% above control schools (95% CI = 1.06, 3.65) in public schools and 2.07% (95% CI = -2.58, 6.73) in private schools after a required third-year clerkship was implemented. The proportion of students choosing family practice declined by 0.84% (95% CI = -4.05, 2.47) after a department of family medicine was established. CONCLUSION: Implementing a required third-year family practice clerkship led to an immediate, significant increase in the proportion of students choosing family practice. Implementing a department of family medicine had no noticeable effect on the proportion of students choosing family practice in the first three years after implementation.
In 1984 a national registry of families with familial adenomatous polyposis was set up in The Netherlands to promote screening in those families. Eight-two families had been registered by the end of 1988. Analysis of the pedigrees showed that 204 family members at risk had not yet been screened. The diagnosis of familial adenomatous polyposis was histologically confirmed in 230 patients. These patients were subdivided into two groups. Group A comprised patients with familial adenomatous polyposis referred because they were symptomatic, and Group B relatives of these patients who were found by screening to have familial adenomatous polyposis. The authors compared these groups with respect to the occurrence of colorectal carcinoma. Fifty-four patients were found to have a colorectal carcinoma at the time of diagnosis of familial adenomatous polyposis, i.e., 49 of the 104 patients in Group A (47 percent) and five of the 126 patients in Group B (4 percent). The average age at diagnosis of the 104 patients in Group A was 35 years (range, 13 to 66 years) and that of the 126 patients in Group B was 24 years (range, 8 to 59 years). By the age of 40 years, 90 percent of the patients in group B had been diagnosed. Late onset of familial adenomatous polyposis was found in four families. Endoscopy and/or radiography of the upper digestive tract were (was) performed in 44 of the 230 patients. Nineteen patients (43 percent) were found to have polyps in the stomach or duodenum, or both. In our series, only one patient died from cancer of the upper digestive tract (ampullary carcinoma). These results show conclusively that screening leads to the early detection of familial adenomatous polyposis. The value of a national registry is proved by the finding of many at-risk family members who had not previously been screened. Screening should start between the ages of 10 and 12 and should continue up to the age of 50. In the rare cases of families with an apparently late onset of familial adenomatous polyposis, screening should be continued up to age 60. More studies are needed to determine the natural history of polyps in the upper digestive tract.
OBJECTIVE: To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns. SETTING: Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessional home visiting to improve family functioning, promote child health and development, and prevent child maltreatment. DESIGN: Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. SUBJECTS: Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373). MEASURES PROCESS: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. RESULTS: Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have >/=12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but >/=80% of those active at 1 year, received core home visiting services. Performance varied by program site. CONCLUSIONS: It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.
We studied family members' care experiences during the palliative care phase as predictors of family members' health and family functioning during the palliative care phase and three months following the death of the patient. Eighty family members of advanced cancer patients participated in the study at time one (T1) (palliative care phase) and 64 family members completed the data collection protocol at time two (T2) (three months bereavement). Data were also obtained from 36 of the patients within one month of their deaths. Fulfillment theory accounted for 31% of the variance in family care satisfaction and Discrepancy theory accounted for 72% of the variance in family care satisfaction. Discrepancy theory predicted family functioning in the bereavement period (r = -0.33, p < 0.05). Patients' quality of life scores were moderately correlated with family members' health during the palliative care phase (r = -0.38, p < 0.05). Family members' scores on the health index (symptom of stress scale) were significantly lower (p < 0.05) than normative scores reported in a study using a healthy population. The strongest predictor of family members' health scores in the bereavement period was their health score at T1 (r = 0.71, p < 0.01). As well, family functioning at T1 was strongly correlated with family functioning at T2.
The primary goal of this study was to clarify if and how differences in the functioning of single-mother and two-parent families relate to the occurrence of behavioral problems among inner-city boys (ages 10-15). Data were collected on family relationships, parenting practices, the positive influence of male family members, and the severity of externalizing behavior problems. Results indicated that (1) multiple family risk factors contribute to the occurrence of behavior problems; (2) most family risk factors were generalizable to both single-mother and two-parent families; (3) although boys in single-mother families were at greater risk for developing behavior problems than boys in two-parent families, the risks associated with single motherhood were offset by a structured family environment, an effective disciplinary strategy that allowed for some degree of adolescent autonomy, and the positive involvement of a male family member; and (4) not all differences in the functioning of single-mother and two-parent families were associated with problem behavior, underscoring the importance of distinguishing between adaptive and maladaptive aspects of single-mother family functioning.
Dehydroepiandrosterone sulfate (DHEAS) was examined in random (control) and nonrandom (case) families participating in the Cincinnati Myocardial Infarction and Hormone (CIMIH) family study. The case families were ascertained through white men who survived a myocardial infarction (MI) before the age of 56, whereas control families were recruited through advertisements and through an adolescent boy maturation study. Both familial correlations and genetic effects of DHEAS were investigated. First, maximum likelihood estimates of the sex-specific familial correlations (corrected for nonrandom ascertainment) suggested that there was significant heterogeneity between the two sampling types. This heterogeneity was isolated to the male sibling correlation, which was higher in the case than control families. Post hoc analyses suggested that the sibling group heterogeneity may be in part a function of age, since the control sample offspring were on average much younger than those in case families. No sex differences other than those for the siblings were noted in the familial correlations. Second, heritability was investigated in control families using a simple path model (TAU) that allowed for sex differences. The only significant model parameter was the sex-specific familiarity (combined polygenic and familial environmental effects), which was larger in females (74%) than in males (29%). In general, these analyses suggested that (1) DHEAS may play only a limited role in the increased risk for premature MI, and (2) the degree of heritable (familial) variation may be dependent on sex.
Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemann's (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.
The purpose of this study is to explore the influences of family coping behaviors, psychological distress, social support, and patient behavioral problems on family functioning in families providing care for a member with schizophrenia. Family stress theory provided the theoretical framework for this study. A convenience sample of 58 families providing care for a family member with schizophrenia was recruited from a metropolitan area in a southeastern state. The majority of the caregivers were mothers who were married and college educated. The mean age of the caregiver was 59 years, with an average of 17 years in providing care for the family member. Findings indicate that family psychological distress and patient behavioral problems are important factors in family functioning. This knowledge may be useful for mental health nurses in assessing families and developing nursing interventions.
This paper explores two hypotheses: first, that household structure, the people who live in one's household, and perceived family, the people one considers members of one's family, are different entities among urban black pregnant women; and second, that the perceived family is a stronger predictor of social, psychological, and health outcomes than is household structure. The study data are from the first interview of a prospective study of a consecutive sample of 140 black pregnant women patients of a Cleveland, Ohio, university hospital family practice center. The study hypotheses are supported: household structure and perceived family differ in their size and the inclusion or exclusion of members of the family of origin and the father of the baby. Household structure is strongly correlated with demographic variables such as age, socioeconomic status, and household income, whereas perceived family is less strongly associated with these measures. Perceived family, but not household structure, is associated with family functioning, measures of psychological status, worries about household change, and better family and parental relationships during the woman's childhood.
There is no control over the information provided with sequences when they are deposited in the sequence databases. Consequently mistakes can seed the incorrect annotation of other sequences. Grouping genes into families and applying controlled annotation overcomes the problems of incorrect annotation associated with individual sequences. Two databases (http://www.mendel.ac.uk) were created to apply controlled annotation to plant genes and plant ESTs: Mendel-GFDb is a database of plant protein (gene) families based on gapped-BLAST analysis of all sequences in the SWISS-PROT family of databases. Sequences are aligned (ClustalW) and identical and similar residues shaded. The families are visually curated to ensure that one or more criteria, for example overall relatedness and/or domain similarity relate all sequences within a family. Sequence families are assigned a 'Gene Family Number' and a unified description is developed which best describes the family and its members. If authority exists the gene family is assigned a 'Gene Family Name'. This information is placed in Mendel-GFDb. Mendel-ESTS is primarily a database of plant ESTs, which have been compared to Mendel-GFDb, completely sequenced genomes and domain databases. This approach associated ESTs with individual sequences and the controlled annotation of gene families and protein domains; the information being placed in Mendel-ESTS. The controlled annotation applied to genes and ESTs provides a basis from which a plant transcription database can be developed.
Multipoint linkage analysis was undertaken with eight Xq cloned DNA sequences which identify one or more restriction fragment length polymorphisms in 26 families. These families comprise seven phase known normal families with three or more males in the third generation, seven families segregating for haemophilia B, one large family with dyskeratosis congenita, and 11 families with the fragile X syndrome. Phase known meioses informative for three or more loci supported the order centromere--DXYS1--DXS107--DXS102, DXS51--F9--FRAXA--DXS15, DXS52, F8--Xqter in each group of families studied. One of the normal families was segregating for protan colour blindness and showed a phase known recombination which would support the order centromere--F9--DXS52--CBP--Xqter. With the exception of DXYS1, all of these sequences have been localised to Xq27----qter by in situ hybridisation or hybridisation to Xq fragment panels, and on this basis should lie within 20 cM of one another. No recombination was observed between the sequences localised to Xq28, namely DXS52, F8, and DXS15 (between DXS15 and DXS52 Z = 12.25 at theta = 0 with confidence limits of 0 to 5 cM). However, an excess of recombination was apparent in the region of FRAXA with maximal lod scores as follows: F9 versus FRAXA (Z = 2.05, theta = 0.19), DXS52 versus FRAXA (Z = 1.85, theta = 0.26), and DXS15 versus FRAXA (Z = 1.33, theta = 0.27). No consistent differences were observed in the frequency of recombination when families with the fragile X syndrome were compared with normal families or families segregating for other X linked conditions. These results are compared with other published work and support the conclusion that although measurable linkage exists between these flanking markers and FRAXA, the intervals as measured by the frequency of meiotic recombination will seriously limit their clinical usefulness.