A descriptive examination of international family/shared meals: Prevalence, meal types, media at meals, and emotional well-being.

INTRODUCTION: Studies in the United States have shown associations between family/shared meal frequency and child health and well-being. Less is known about family/shared meal characteristics (e.g., frequency, meal type, meal activities) in adults and international samples and whether there are protective associations between family/shared meal frequency and emotional well-being. Also unknown, is whether family meals provide protective associations for other family members in the household. METHOD: In a 2022 cross-sectional study, an online survey was administered in the United States, Italy, and Germany. One adult respondent (49.5% female; Mage = 45.6) from each household (n = 1,983) reported on family/shared meals and well-being. A second family member (e.g., partner, child) responded in a subset of households (n = 1,915). Descriptive statistics by country, Spearman correlations between meal frequency and well-being, and Kruskal-Wallis comparisons of mood indicators across countries were run. RESULTS: The majority of adults across countries engaged in six or more family/shared meals per week, with more meals on weekends. Breakfast, lunch, and dinner family/shared meals were more common on weekends, and European countries reported engaging in a higher prevalence of all meal types. Higher frequency of family/shared meals was significantly correlated with fewer depressive symptoms, more connectedness, and higher levels of happiness in adults across countries and in a second household member. DISCUSSION: Family/shared meals were beneficial across an international sample and may provide protective spillover effects for multiple household members. Clinicians and researchers who work with families may want to consider assessing for and intervening on family meal frequency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture.

PURPOSE: Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture. METHODS: We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30 days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥ 28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC). RESULTS: 1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7-5.5-fold higher 30-day mortality (p ≤ 0.001), and 1.9-3.2-fold higher likelihood of prolonged LOS (p ≤ 0.001). Worse mobility was associated with a 2.3-3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p < 0.001) and a 1.3-2.0-fold higher likelihood of complications within 30 days (p ≤ 0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733-0.777] to NHFS + mobility 0.808 [0.789-0.828], and LOS, AUROC NHFS 0.584 [0.557-0.611] to NHFS + mobility 0.616 [0.590-0.643]. CONCLUSION: Incorporating mobility assessment into risk scores may improve casemix adjustment, prognostication following hip fracture, and identify high-risk patient groups requiring enhanced post-operative care at admission.

Relationship-undermining statements by psychotherapists with clients who present with marital or couple problems.

This study examined the prevalence of relationship undermining statements by psychotherapists as reported by clients in individual therapy who presented with relationship problems, and whether these statements were associated with worse outcomes for client relationships. Participants (n = 101) reported on recollections of whether their therapist had suggested that their partner would never change, had a diagnosable personality/mental health disorder, had negative motives, that the relationship was doomed from the start or beyond repair now, or that divorce/breakup was their best option. Findings showed high prevalence of these undermining statements and associations with poorer relationship outcomes and shorter duration of therapy. We discuss potential explanations for this phenomenon and offer implications for the training of therapists who treat individual clients with relationship problems.

African American marital confiding relationships: A national survey and a test of an educational intervention.

We present two related studies on confiding about relationships among African Americans. Study one examined how African Americans serve as confidants in their social networks for people having couple relationship concerns. Using a national survey of African American adults, this study documented the prevalence of confiding relationships, the kinds of problems brought to confidants, and which confidant behaviors are seen as helpful and not helpful. Study two was a randomized controlled trial of Marital First Responders-AA, a culturally adapted version of the Marital First Responders program. Results showed improved skills among African Americans participants who were already natural confidants, as well greater frequency of confiding interactions in their social networks. Enhancing the abilities of natural confidants may be particularly important in the African American community because of stresses on couple relationships and the relatively lower use of therapy services.

Implementing grip strength assessment in hip fracture patients: a feasibility project.

OBJECTIVES: Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. METHODS: A scalable protocol and a corresponding training programme of instructional presentations and practical assessments were designed and delivered by and for physiotherapy staff. Grip strength values were collected pre-surgery on patients with hip fracture at a single centre whilst supine in bed. Implementation of the process was evaluated using narrative, quantitative and cost measures. RESULTS: 53 hip fracture patients with a mean age 80.6 (SD 10.4), of which 36 (67.9%) were female, were included. Testing was offered to 42/52 (81%) patients. Cognitive impairment prevented 14/42 (33%) of patients from completing testing; one patient declined testing. Of the 27 patients who completed testing, 14/27 (52%) had low grip strength as defined by EWGSOP2 criteria. The projected cost of testing for one year was £2.68-£2.82 per patient. Fidelity to the protocol was high using multiple criteria. CONCLUSIONS: Grip strength assessment is acceptable to physiotherapy staff and can be rapidly and cost-effectively implemented into hip fracture admission assessment.

How long do people wait before seeking couples therapy? A research note.

A widely cited but poorly supported idea in the couples therapy field is that the average couple waits six years before starting therapy for serious relationship problems. This figure is often accompanied by the notion that many couples come "too late" and have poor prospects for recovery. This is the first large-sample study on the delay between the onset of serious marital problems and entry into couples therapy (N = 270) and individual therapy (N = 101) for relationship problems. We found an average interval of 2.68 years from onset of problems and entering couples therapy, with the great majority of couples entering therapy within two years. Findings were similar for seeking individual therapy for relationship problems. The main clinical implication is that therapists have little reason to be pessimistic about the majority of couples waiting so long before starting therapy that their problems are not resolvable.

Divorce Ambivalence and Reasons for Divorce in Iran.

This study examined divorce attitudes and reasons for divorce in Iran, a nation experiencing a rapid increase in divorce. Using instruments translated into Farsi with a sample of 230 Iranian spouses filing for divorce, we found a preponderance of common relational reasons for divorce (such as growing apart and not getting enough attention), along with high rates of interpersonal violence reported by wives. Study participants showed considerable rates of divorce ambivalence, along with openness to reconciliation services. The findings were compared with similar studies of the United States spouses in the divorce process. Clinical implications include a careful approach to considering how discernment counseling might be adapted to the cultural situation of Iran, and particularly the special concerns of Iranian women.

Este estudio analizó las actitudes durante el divorcio y los motivos de divorcio en Irán, un país que atraviesa un aumento rápido del divorcio. Utilizando documentos traducidos al farsi con una muestra de 230 cónyuges iraníes que presentaron una demanda de divorcio, descubrimos una preponderancia de motivos relacionales comunes para el divorcio (por ejemplo, irse apartando y no recibir suficiente atención), junto con índices altos de violencia interpersonal informados por las esposas y quejas sobre la gestión económica informadas por los esposos. Los participantes del estudio demostraron índices considerables de ambivalencia acerca del divorcio, así como una actitud abierta a servicios de reconciliación. Los resultados se compararon con estudios similares de cónyuges de los Estados Unidos que estaban en proceso de divorcio. Las implicancias clínicas incluyen un enfoque cuidadoso de la consideración de cómo la terapia de discernimiento podría adaptarse a la situación cultural de Irán, y particularmente a las inquietudes especiales de las mujeres iraníes.

Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score.

OBJECTIVES: Independent validation of risk scores after hip fracture is uncommon, particularly for evaluation of outcomes other than death. We aimed to assess the Nottingham Hip Fracture Score (NHFS) for prediction of mortality, physical function, length of stay, and postoperative complications. DESIGN: Analysis of routinely collected prospective data partly collected by follow-up interviews. SETTING AND PARTICIPANTS: Consecutive hip fracture patients were identified from the Northumbria hip fracture database between 2014 and 2018. Patients were excluded if they were not surgically managed or if scores for predictive variables were missing. METHODS: C statistics were calculated to test the discriminant ability of the NHFS, Abbreviated Mental Test Score (AMTS), and American Society of Anesthesiologists (ASA) grade for in-hospital, 30-day, and 120-day mortality; functional independence at discharge, 30 days, and 120 days; length of stay; and postoperative complications. RESULTS: We analyzed data from 3208 individuals, mean age 82.6 (standard deviation 8.6). 2192 (70.9%) were female. 194 (6.3%) died during the first 30 days, 1686 (54.5%) were discharged to their own home, 211 (6.8%) had no mobility at 120 days, 141 (4.6%) experienced a postoperative complication. The median length of stay was 18 days (interquartile range 8-28). For mortality, C statistics for the NHFS ranged from 0.68 to 0.69, similar to ASA and AMTS. For postoperative mobility, the C statistics for the NHFS ranged from 0.74 to 0.83, similar to AMTS (0.61-0.82) and better than the ASA grade (0.68-0.71). Length of stay was significantly correlated with each score (P < .001 by Jonckheere-Terpstra test); NHFS and AMTS showed inverted U-shaped relationships with length of stay. For postoperative complications, C statistics for NHFS (0.54-0.59) were similar to ASA grade (0.53-0.61) and AMTS (0.50-0.58). CONCLUSIONS AND IMPLICATIONS: The NHFS performed consistently well in predicting functional outcomes, moderately in predicting mortality, but less well in predicting length of stay and complications. There remains room for improvement by adding further predictors such as measures of physical performance in future analyses.

Management of Carpal Tunnel Syndrome.

The American Academy of Orthopaedic Surgeons (AAOS) has developed Appropriate Use Criteria (AUC) for Management of Carpal Tunnel Syndrome. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. To provide the evidence foundation for this AUC, the AAOS Evidence-Based Medicine Unit provided the writing panel and voting panel with the 2016 AAOS Clinical Practice Guideline titled Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. The Management of Carpal Tunnel Syndrome AUC clinical patient scenarios were derived from indications typical of patients with suspected carpal tunnel syndrome in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of treatments. The 135 patient scenarios and 6 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Confiding About Problems in Marriage and Long-Term Committed Relationships: A National Study.

This study examined confiding patterns in a national sample of 1000 U.S. adults aged 25-70 to inform the development of an educational program for confidants, called Marital First Responders. Results showed that 73% of U.S. adults have been a confidant to someone with a problem in a marriage or long-term committed relationship. The most common confiding relationship was between friends, followed by siblings. Confidants reported a wide range of problems brought to them, ranging from everyday complaints to serious issues such as infidelity and divorce. Confiders identified the most and least helpful responses. Findings suggest that naturally occurring confiding relationships have considerable potential to be the first level of help for troubled couple relationships.

Play it forward! A community-based participatory research approach to childhood obesity prevention.

BACKGROUND: To date there has been limited success with childhood obesity prevention interventions. This may be due in part, to the challenge of reaching and engaging parents in interventions. The current study used a community-based participatory research (CBPR) approach to engage parents in cocreating and pilot testing a childhood obesity prevention intervention. Because CBPR approaches to childhood obesity prevention are new, this study aims to detail the creation, including the formation of the citizen action group (CAG), and implementation of a childhood obesity prevention intervention using CBPR methods. METHOD: A CBPR approach was used to recruit community members to partner with university researchers in the CAG (n = 12) to create and implement the Play It Forward! childhood obesity intervention. The intervention creation and implementation took 2 years. During Year 1 (2011-2012), the CAG carried out a community needs and resources assessment and designed a community-based and family focused childhood obesity prevention intervention. During Year 2 (2012-2013), the CAG implemented the intervention and conducted an evaluation. Families (n = 50; 25 experimental/25 control group) with children ages 6-12 years participated in Play It Forward! RESULTS: Feasibility and process evaluation data suggested that the intervention was highly feasible and participants in both the CAG and intervention were highly satisfied. Specifically, over half of the families attended 75% of the Play It Forward! events and 33% of families attended all the events. CONCLUSION: Equal collaboration between parents and academic researchers to address childhood obesity may be a promising approach that merits further testing.

Discernment Counseling for "Mixed-Agenda" Couples.

This article describes discernment counseling, an approach to working with couples where one partner is leaning toward divorce and the other wants to preserve the relationship and work on it in couples therapy. These "mixed-agenda" couples are common in clinical practice but have been neglected in the literature. The goal of discernment counseling is clarity and confidence regarding the next steps for the relationship, based on a deeper understanding of each partner's contributions. Sessions emphasize individual conversations with each partner. An analysis of 100 consecutive cases found that about half of the couples chose to start couples therapy in order to reconcile, with most of the rest choosing the divorce path. Longer term follow-up information is also presented.

Don Bloch's vision: A commentary.

Comments on the article "Don Bloch's vision for Collaborative Family Health Care: Progress and next steps" by C. J. Peek (see record 2015-25290-002). Every visionary deserves a skilled integrator and synthesizer such as C. J. Peek. Don would have been impressed with this concise account of the evolution of his own ideas and those of his colleagues in the Collaborative Family Health Care Association, which is Don's greatest legacy-a participatory, visionary, nonguild membership organization. Don Bloch's ecosystemic perspective was all about flattening hierarchies conceptually, clinically, and organizationally. His emphasis on families was also connected to this flattening of hierarchies. Inclusion of families creates more potential for true partnership because the patient needs a team as much as the clinician needs one. The current author wants to hold up the issues of hierarchies, power, and guilds.

Contributions of medical family therapy to the changing health care system.

Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

A response to "joint principles: integrating behavioral health care into the patient-centered medical home".

Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Association for Marriage and Family Therapy (AAMFT) represents a mental health profession with a long track record in integrated primary care, particularly with family medicine. The authors begin by affirming several core themes in the joint principles-behavioral health (JP-BH) statement. They then offer a systemic/relational perspective on the patient-centered medical home that goes beyond the focus of the JP-HP.

Outcomes of an intensive couple relationship education program with fragile families.

Couple relationship education (CRE) has been proposed as one means to help fragile families stabilize their relationships. The current research is one of the first studies to look at the outcomes of a CRE program with fragile families in the areas of couple stability and marriage formation. Data were from the Family Formation Project, a federal and state funded program working with fragile family couples (n = 96) in a metropolitan area. A historical cohort control group quasi-experimental research design was used with a matched control group from the Fragile Family and Child Well-being Study. The intervention consisted of in-home education and support, group educational events, and social service referrals. Findings showed that couples had the same rate of couple stability as the control group but an increased rate of marriage. These findings suggest that CRE can help fragile families achieve marriage when that is their goal, but that some fragile families may need more than CRE to help them stabilize their relationship, or they may be better off separating.

The individual and combined influence of the "quality" and "quantity" of family meals on adult body mass index.

Although there is a well-established literature showing a positive association between the frequency of family meals and child and adolescent healthful dietary intake and lower body mass index (BMI), little is known about the association between family meal frequency (quantity) and adult health outcomes and whether quality (distractions) of family meals influences adult BMI. This study investigates the association between the quantity and quality of family meals and adult BMI. Data were from a nationally representative sample of 4,885 adults ages 25 to 64 years (56% female), from which an analytic sample of 1,779 parents was drawn for the current study. Multiple linear regression was used to test the relationship between family meal frequency and quality of family meals and adult BMI, controlling for sociodemographics. Interactions between family meal quantity and quality were also examined. The quantity of family meals and the quality of family meals were both independently related to adult BMI. Specifically, the frequency of family meals was associated with lower adult BMI and lower quality of family meals was associated with higher adult BMI. The interaction between quantity and quality was not statistically significant. Results suggest that both the quantity and quality of family meals matter for adult BMI, but one is not dependent on the other. Health care providers who work with families may want to consider promoting the importance of the quality and quantity of family meals to benefit the entire family.

Healthful eating and physical activity in the home environment: results from multifamily focus groups.

OBJECTIVE: To explore multiple family members' perceptions of risk and protective factors for healthful eating and physical activity in the home. DESIGN: Ten multifamily focus groups were conducted with 26 families. SETTING AND PARTICIPANTS: Community setting with primarily black and white families. Family members (n = 103) were aged 8 to 61 years. MAIN OUTCOME MEASURES: Risk and protective factors for healthful eating and physical activity in the home environment. ANALYSIS: A grounded hermeneutic approach. RESULTS: Ten major themes were identified by family members related to health behaviors in the home environment, including accessibility to healthful foods and activity, time constraints, stage of youth development, individual investment in health behaviors, family investment in health behaviors, family meals and shared activities, parent modeling, making health behaviors fun, making health behaviors part of the family lifestyle, and community investment in family health behaviors. CONCLUSIONS AND IMPLICATIONS: This study identified the importance of the family system and the reciprocal influences within the home environment on health behaviors. In addition, individual and community-level suggestions were identified. Insights from the families provide leads for future research and ideas for the prevention of youth obesity.

Single mothers raising children with "male-positive" attitudes.

Among the challenges facing single mothers, a particularly difficult one is how to help children develop "male-positive" attitudes in situations when the parents have broken up and children have no active relationship with the father. Despite a large academic literature on single mothering, there is strikingly little discussion on this topic. Using symbolic interactionism and family systems theory, we offer psychoeducational messages for single mothers who want to raise their children with male-positive attitudes. We also call for a new cultural conversation on an issue ignored for too long.

The Families and Democracy and Citizen Health Care Project.

This article describes and updates the work of the Families and Democracy and Citizen Health Care Project, which engages with community concerns in order to effect change on many system levels. The project draws on family therapy's tradition of interest in larger social issues and adds democratic public theory and community organizing strategies. Since 1999 we have developed 14 citizen initiatives with a wide range of groups on a diverse set of problem areas. We describe the overall project and several of its initiatives, we address research and evaluation issues, and we outline opportunities for marriage and family therapists to learn how to do this work in their own communities.