Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning.

To quantify the impact of the COVID-19 pandemic and public health interventions on parent and child mental health and family relationships, we examined change in individual and family functioning in a sample of parents enrolled in a prevention trial; we examined change before the pandemic (2017-2019) when children were an average of 7 years old to the first months after the imposition of widespread public health interventions in the United States (2020) with paired t tests and HLM models. We examined moderation by parent gender, education, family income, and coparenting conflict. We found large deteriorations from before the pandemic to the first months of the pandemic in child internalizing and externalizing problems and parent depression, and a moderate decline in coparenting quality. Smaller changes were found for parent anxiety and parenting quality. Mothers and families with lower levels of income were at particular risk for deterioration in well-being. Results indicate a need for widespread family support and intervention to prevent potential family "scarring," that is, prolonged, intertwined individual mental health and family relationship problems.

Para cuantificar el efecto de la pandemia de la COVID-19 y de las intervenciones de salud pública en la salud mental de los padres y los niños y en las relaciones familiares, analizamos los cambios en el funcionamiento individual y familiar en una muestra de padres inscriptos en un ensayo de prevención; estudiamos el cambio antes de la pandemia (2017-2019) cuando los niños tenían un promedio de 7 años hasta los primeros meses después de la imposición de las intervenciones generalizadas de salud pública en los Estados Unidos (2020) con pruebas t apareadas y modelos lineales jerárquicos. Analizamos la moderación por género, educación, ingresos familiares y conflicto de cocrianza de los padres. Hallamos grandes deterioros desde antes de la pandemia hasta los primeros meses de la pandemia en problemas de interiorización y exteriorización de los niños y depresión de los padres, y una disminución moderada de la calidad de la cocrianza. También encontramos cambios más pequeños en la ansiedad de los padres y la calidad de la crianza. Las madres y las familias con niveles más bajos de ingresos estuvieron en riesgo particular de deterioro del bienestar. Los resultados indican la necesidad de apoyo familiar generalizado y de intervenciones para prevenir posibles «secuelas¼ familiares, p. ej.: salud mental individual interconectada y prolongada y problemas en las relaciones familiares.

Triadic family structures and their day-to-day dynamics from an adolescent perspective: A multilevel latent profile analysis.

Relationship structure (patterns of relative closeness among multiple family members) and dynamics (changes in relationship structures overtime) are two main aspects of family system functioning, yet empirical tests of these concepts lag behind theory. Recent growth in advanced methods for complex data structures makes it possible to empirically capture structures and dynamics within multiple family relationships overtime. To answer how relationship structure may fluctuate from day to day, this study used multilevel latent profile analysis (MLPA) as an innovative and feasible method to capture mother-father-adolescent (MFA) relationship structures and dynamics on a daily basis. Using daily adolescent reports of mother-father (MF), mother-adolescent (MA), and father-adolescent (FA) closeness from 144 two-parent families for up to 21 days, we identified six day-level MFA structures: Cohesive (33% of days; three close dyads), Mother-Centered (9%; closer MF, average MA, less close FA), Adolescent-Centered (4%; less close MF, closer MA and FA), MA-Coalition (3%; closer MA, less close MF and FA), Disengaged (23%; three less close dyads), and Average (28%; three approximately average dyads). We identified five types of MFA dynamics at the family level: Stable Cohesive (35% of families; exhibited Cohesive structure most days), Stable Disengaged (20%; Disengaged structure most days), Stable MA-Coalition (3%; MA-Coalition structure most days), Stable Average (24%; Average structure most days), and Variable (17%; varied among multiple structures). Methodologically, daily diary designs and MLPA can be useful tools to empirically examine concrete hypotheses of complex, non-linear processes in family systems. Substantive and methodological implications are discussed.

La estructura de las relaciones (los patrones de cercanía relativa entre varios miembros de la familia) y su dinámica (los cambios en las estructuras de las relaciones con el tiempo) son dos aspectos principales del funcionamiento familia-sistema, sin embargo, las pruebas empíricas de estos conceptos se retrasan en relación con la teoría. El crecimiento reciente en los métodos avanzados de estructuras de datos complejos hace posible captar empíricamente las estructuras y la dinámica dentro de las relaciones de varias familias con el tiempo. Para responder cómo la estructura de las relaciones puede variar día a día, se utilizó en este estudio un análisis de perfiles latentes multinivel como método innovador y viable para captar las estructuras y la dinámica de las relaciones madre-padre-adolescente (MPA) diariamente. Utilizando informes diarios de los adolescentes sobre la cercanía madre-padre (MP), madre-adolescente (MA) y padre-adolescente (PA) de 144 familias de dos padres durante un máximo de 21 días, identificamos seis estructuras MPA de nivel diario: cohesiva (el 33 % de los días; tres díadas cercanas), centrada en la madre (el 9 %; más cercanía MP, MA promedio, menos cercanía PA), centrada en el adolescente (el 4 %; menos cercanía MP, más cercanía MA y PA), alianza MA (el 3 %; mas cercanía MA, menos cercanía MP y PA), indiferente (el 23 %; tres díadas menos cercanas), y promedio (el 28 %; tres díadas aproximadamente promedio). Identificamos tres tipos de dinámica MPA al nivel de la familia: cohesiva estable (el 35 % de las familias demostró una estructura cohesiva la mayoría de los días), indiferente estable (el 20 %; estructura indiferente la mayoría de los días), alianza MA estable (el 3 %; estructura de alianza MA la mayoría de los días), promedio estable (el 24 %; estructura promedio la mayoría de los días), y variable (el 17 %; varió entre numerosas estructuras). Metodológicamente, los diseños de registro diario y el análisis de perfiles latentes multinivel pueden ser herramientas útiles para analizar empíricamente hipótesis concretas de los procesos complejos y no lineales de los sistemas familiares. Se debaten las consecuencias sustanciales y metodológicas.

Patterns of Interactions Between Youth and Resident Stepmothers: A Latent Class Analysis.

Stepparent-child relationships are a core pillar of stepfamily functioning and well-being. Stepparents can take on a variety of roles in the lives of their stepchildren, ranging from de facto parents to distant acquaintances. There remain important opportunities to explore specific interactional patterns between youth and stepparents, particularly resident stepmothers. Drawing from a family systems perspective, the purpose of the current study is to explore patterns of youth-stepmother interaction across recreational, personal, academic, and disciplinary domains of family life. Latent class analysis is conducted using a representative sample of 295 youth (mean age: 15.82 years, SD = 1.63; 41% female; 65% non-Hispanic White) residing in father-stepmother households who have living nonresident mothers at Wave I of the National Longitudinal Study of Adolescent to Adult Health. The optimal latent class solution yielded four interactional patterns, labeled versatile and involved (21%), inactive (12%), casually connected (17%), and academically oriented (50%). The latent classes are also contrasted with respect to stepfamily relationship quality, youth well-being, and socio-demographic characteristics. Foremost, the results illustrate significant variability in the patterns of interactions between youth and their resident stepmothers, which could be attributed to youths' varying autonomy-seeking efforts and other complex family dynamics. Consistent with a family systems perspective, associations between youth-stepmother interactional patterns and family and youth outcomes highlight the importance of the relationship between youth and their resident stepmothers. Importantly, not all interactional patterns differed significantly across outcomes, suggesting that no one pattern is universally optimal in father-stepmother families with adolescent children.

Las relaciones entre padrastros, madrastras e hijastros son un pilar fundamental del funcionamiento y el bienestar de las familias ensambladas. Los padrastros y las madrastras pueden asumir diversos roles en las vidas de sus hijastros, desde padres de hecho a personas con una relación distante. Quedan importantes oportunidades de analizar patrones interactivos específicos entre los jóvenes y los padrastros y madrastras, particularmente las madrastras residentes. Basándonos en una perspectiva de sistemas familiares, el propósito del presente estudio es analizar patrones de interacción entre los jóvenes y las madrastras en ámbitos recreativos, personales, académicos y disciplinarios de la vida familiar. Se realiza un análisis de clases latentes utilizando una muestra representativa de 295 jóvenes (edad promedio: 15.82 años, desviación típica = 1.63; 41 % de sexo femenino; 65 % raza blanca no hispana) que viven en hogares conformados por el padre y la madrastra, y que tienen madres vivas no residentes en la fase I del "Estudio Longitudinal Nacional de Salud de Adolescentes a Adultos" (National Longitudinal Study of Adolescent to Adult Health). La solución óptima de clase latente arrojó cuatro patrones interactivos llamados adaptables e interesados (21 %), inactivos (12 %), conectados ocasionalmente (17 %), y orientados académicamente (50 %). Las clases latentes también se contrastan con respecto a la calidad de la relación de la familia ensamblada, el bienestar de los jóvenes y las características sociodemográficas. Principalmente, los resultados ilustran la variabilidad significativa en los patrones de interacciones entre los jóvenes y sus madrastras residentes, que podrían atribuirse a los distintos esfuerzos de búsqueda de autonomía por parte de los jóvenes y a otras dinámicas familiares complejas. De acuerdo con una perspectiva de sistemas familiares, las asociaciones entre los patrones interactivos entre los jóvenes y las madrastras y los resultados de las familias y los jóvenes destacan la importancia de la relación entre los jóvenes y sus madrastras residentes. Cabe señalar que no todos los patrones interactivos difirieron considerablemente entre los resultados, lo cual sugiere que ningún patrón es óptimo a nivel universal en las familias de padres y madrastras con hijos adolescentes.

Distributive Justice in Family Relations.

The aim of this paper is to highlight the important contribution of the lens of distributive justice to an understanding of family relations. Existent justice research in the family tends to focus on specific family relations: spouses, parents and young children, elderly parents and adult children, with most research addressing the division of labor between spouses. We seek to go beyond the specific family relations in order to highlight justice-related themes that are common across family relations. We elaborate upon three claims. First, we show that while the ideal of equality underpins justice in contemporary Western societies, actual distribution practices across family relations are characterized by persistent inequality. Second, although the gap between the ideal of equality and unequal distribution practices may create a sense of injustice among family members, we show why this is not necessarily the case. Third, we elaborate upon the positive and negative consequences that result from feelings of justice or injustice across family relations. We conclude by discussing the interweaving of love and justice in the family.

El objetivo de este artículo es destacar la importante contribución de la perspectiva de la justicia distributiva para comprender las relaciones familiares. Las investigaciones existentes sobre la justicia en la familia tienden a centrarse en relaciones familiares específicas: cónyuges, padres e hijos pequeños, padres ancianos e hijos adultos; y la mayor parte de estas investigaciones abordan la división del trabajo entre los cónyuges. Intentamos ir más allá de las relaciones familiares específicas a fin de destacar temas relacionados con la justicia que son comunes entre las relaciones familiares. Nosotros ampliamos tres afirmaciones. Primero, demostramos que si bien el ideal de igualdad apoya la justicia en las sociedades occidentales contemporáneas, las prácticas actuales de distribución entre las relaciones familiares se caracterizan por la desigualdad constante. Segundo, aunque la brecha entre el ideal de igualdad y las prácticas de distribución desigual puede generar una sensación de injusticia entre los miembros de la familia, demostramos por qué esto no necesariamente es así. Tercero, señalamos las consecuencias positivas y negativas que resultan de los sentimientos de justicia o injusticia entre las relaciones familiares. Finalizamos con una discusión alrededor de la interrelación entre amor y justicia en la familia.

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature.

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.

Un enfoque sistémico de la investigación sobre las familias y la salud debería captar la red compleja dentro de la cual están insertados los familiares, incluidas las relaciones entre varias familias y los sistemas más amplios de asistencia sanitaria. Sin embargo, gran parte de la investigación sobre las familias y la salud centrada en los familiares adultos se ha concentrado únicamente en las relaciones íntimas, generalmente en las relaciones conyugales. Esto desatiende el resto de las relaciones familiares fuertemente influyentes que lo adultos conservan, y en las que posiblemente se centren cada vez más a medida que envejecen. Realizamos un análisis sistemático de la bibliografía sobre las familias y la salud de los adultos, y conservamos 72 artículos que posteriormente se codificaron temáticamente para destacar los ejes principales de esta área de investigación. Los resultados recalcan seis temas, entre los cuales se encuentran: la calidad de las relaciones familiares, la composición familiar, los factores conductuales en la salud y la asistencia sanitaria, los mediadores psicofisiológicos, el cuidado, y la salud en la vejez. Los resultados respaldan una subrepresentación de los familiares aparte de la pareja íntima en las investigaciones sobre la salud de los adultos.

[Association of family typology and dysfunction in families with adolescents from a Mexican population]. / Asociación de tipología familiar y disfuncionalidad en familias con adolescentes de una población mexicana.

OBJECTIVE: To determine the association between family typology and dysfunction in families with adolescents in a Mexican population. DESIGN: Cross-sectional observational study. SETTING AND POPULATION: A total of 437 families in a Mexican population with adolescents attending a public high school. MAIN MEASUREMENTS: Determination of family typology (Mexican Family Medicine Council and Consensus) and family function (family APGAR) in adolescents and their parents/guardians. Identification of families with concordant perceptions among members (Cohen kappa), in which the association between typology and perception of family dysfunction was determined (odds ratio [OR]). RESULTS: The types of families are associated with family function by kinship, physical presence in the home and the level of family poverty. From the perception of the adolescent, the types are associated with: simple nuclear (OR 0.5, 95% CI 0.3-0.8), extended single parent (OR 1.9, 95% CI 1.03-3.5), integrated nucleus (OR 0.6, 95% CI 0.4-0.9), low family poverty (OR 0.5, 95% CI 0.3-0.8), and high family poverty (OR 5.3, 95% CI 1.5-18.6). From the perception of the tutor: the single parent (OR 1.9, 95% CI 1.09-3.4), and high family poverty (OR 2.9, 95% CI 1.1-7.7). There were 259 families with concordant perception of family function/dysfunction with a κ=0.189, determining that the types associated are: simple nuclear (OR 0.4, 95% CI 0.2-0.7), single-parent (OR 1.7, 95% CI 0.80-3.8), integrated nucleus (OR 0.5, 95% CI 0.3-0.8), non-integrated nucleus (OR 1.9, 95% CI 1.09-3.5), and high family poverty (OR 13.8, 95% CI 1.7-108.5). CONCLUSION: The family types with adolescents associated with family dysfunction are single-parent families with a non-integrated nucleus and high family poverty, and as protective factors, the simple nuclear and integrated nucleus.

[Family functioning, parental rearing and its relationship to nutritional status in preschoolers]. / Funcionalidad familiar, crianza parental y su relación con el estado nutricional en preescolares.

AIM: To analyze association among family functioning, parental rearing and nutritional status in preschoolers. DESIGN: Quantitative, descriptive and correlational cross-sectional study. LOCATION: Preschool public institutions in Nuevo León, Mexico. Primary Care. PARTICIPANTS: Sample of 228 dyads (mother or father and preschooler); sole inclusion criterion was to be main responsible for the upbringing of the preschooler. MAIN MEASUREMENTS: Sociodemographic data questionnaire was used, nutritional status was determined based on the recommendations of the World Health Organization, Family Adaptability and Cohesion Evaluation Scale and Parental Rearing Style Questionnaire were used. Descriptive and Spearman's correlation coefficient were obtained. RESULTS: Mean age of parents was 32.09 years, 60.5% of mothers were housewives and 100% of fathers had a job; mean years of schooling were 12.16, 68.9% of participants were married; 29.4% of preschoolers were overweight or obese. Regarding family functioning it was identified that 44.3% is semi-related in cohesion dimension. The parental rearing style that prevailed was the permissive with 62.3%. CONCLUSIONS: Most parents presented an imbalance in family functioning. No statistical significance was found among family functioning and parental rearing with nutritional status in preschoolers (P<.05).

The Role of Parents in Emerging Adults' Psychological Well-Being: A Person-Oriented Approach.

The purpose of this study was to gain an overview of Spanish emerging adults' family relationships and their link with psychological well-being and psychological distress. The sample comprised 1502 undergraduate students (903 women and 599 men) aged between 18 and 29 (M = 20.32 and SD = 2.13), recruited from two universities in Spain. A cluster analysis identified three groups of families based on the centrality of five family variables: parental involvement, parental support for autonomy, parental warmth, behavioral control, and psychological control. The three groups or clusters were labeled high-quality family relationships (HQ), intermediate-quality family relationships (IQ), and low-quality family relationships (LQ). Women were overrepresented in the HQ cluster, whereas men were overrepresented in the IQ cluster. Moreover, emerging adults who perceived better family relationships (high levels of parental involvement, parental support for autonomy and parental warmth, and low levels of behavioral and psychological control) were found to have a higher level of psychological adjustment. Thus, our results indicate that family plays a key role in the psychological well-being of emerging adults. The discussion focuses on the implications of this finding for the parent-child relationship, and explores how it extends our knowledge about family relationships during emerging adulthood.

El propósito de este estudio fue obtener una visión de conjunto de las relaciones familiares de los adultos emergentes españoles y su vínculo con el bienestar psicológico y el distrés psicológico. La muestra estuvo compuesta por 1502 alumnos universitarios (903 mujeres y 599 hombres) de entre 18 y 29 años (M = 20.32 y SD = 2.13), convocados de dos universidades de España. Un análisis de grupos identificó a tres grupos de familias basándose en la centralidad de cinco variables familiares: participación de los padres, fomento de la autonomía por parte de los padres, calidez de los padres, control del comportamiento y control psicológico. Los tres grupos o agrupaciones se clasificaron como relaciones familiares de alta calidad (AC), relaciones familiares de calidad intermedia (CI) y relaciones familiares de baja calidad (BC). Las mujeres estuvieron sobrerrepresentadas en el grupo de AC, mientras que los hombres estuvieron sobrerrepresentados en el grupo de CI. Además, se descubrió que los adultos emergentes que percibieron mejores relaciones familiares (niveles altos de participación de los padres, fomento de la autonomía por parte de los padres y calidez de los padres, y niveles bajos de control conductual y psicológico) tuvieron un nivel más alto de adaptación psicológica. Por lo tanto, nuestros resultados indican que la familia desempeña un papel clave en el bienestar psicológico de los adultos emergentes. El debate se centra en las consecuencias que tiene este resultado para la relación entre padres e hijos, y analiza cómo amplía nuestro conocimiento acerca de las relaciones familiares durante la adultez emergente.

Home Environment and Self-Efficacy Beliefs among Native American, African American, and Latino Adolescents.

Context helps determine what individuals experience in the settings they inhabit. Context also helps determine the likelihood that those experiences will promote adaptive development. Theory suggests likely interplay between various aspects of home context and development of ideas about self that influence patterns of development for children. This study addressed relations between two aspects of home life (companionship and investment, modeling and encouragement) and three types of self-efficacy beliefs (enlisting social resources, independent learning, self-regulatory behavior) considered important for long-term adaptive functioning. The study focused on three groups of minority adolescents (Native American, African American, Latino). Relations were examined using regression models that also included four aspects of household risk that often hinder the development of self-efficacy. Although findings varied somewhat across the three groups, significant relations emerged between the two domains of home life examined and self-efficacy beliefs in all three groups, even controlling for overall household risk. Companionship and investment appeared particularly relevant for African American adolescents, while modeling and encouragement appeared particularly relevant for Native American adolescents. Both were relevant for Latino adolescents.

El contexto ayuda a determinar lo que las personas viven en los entornos que habitan. El contexto también ayuda a determinar la probabilidad de que esas experiencias promuevan el desarrollo adaptativo. La teoría sugiere una probable interacción entre varios aspectos del contexto hogareño y el desarrollo de ideas acerca del yo que influyen en los patrones de desarrollo de los niños. Este estudio abordó las relaciones entre dos aspectos de la vida hogareña (compañerismo e inversión, modelado y fomento) y tres tipos de creencias de autoeficacia (designación de recursos sociales, aprendizaje independiente, comportamiento autorregulado) consideradas importantes para el funcionamiento adaptativo a largo plazo. El estudio se centró en tres grupos de adolescentes de grupos minoritarios (nativo americanos, afroamericanos, latinos). Se analizaron las relaciones usando modelos de regresión que también incluyeron cuatro aspectos de riesgo doméstico que generalmente obstaculizan el desarrollo de la autoeficacia. Aunque los resultados variaron un poco en los tres grupos, surgieron relaciones significativas entre los dos ámbitos de la vida hogareña analizados y las creencias de autoeficacia en los tres grupos, aún teniendo en cuenta el riesgo doméstico general. El compañerismo y la inversión parecieron particularmente relevantes en los adolescentes afroamericanos, mientras que el modelado y el fomento parecieron particularmenete relevantes en los adolescentes nativo americanos. Ambos fueron relevantes en los adolescentes latinos.

Stepfamily Relationship Quality and Children's Internalizing and Externalizing Problems.

The stepfamily literature is replete with between-group analyses by which youth residing in stepfamilies are compared to youth in other family structures across indicators of adjustment and well-being. Few longitudinal studies examine variation in stepfamily functioning to identify factors that promote the positive adjustment of stepchildren over time. Using a longitudinal sample of 191 stepchildren (56% female, mean age = 11.3 years), the current study examines the association between the relationship quality of three central stepfamily dyads (stepparent-child, parent-child, and stepcouple) and children's internalizing and externalizing problems concurrently and over time. Results from path analyses indicate that higher levels of parent-child affective quality are associated with lower levels of children's concurrent internalizing and externalizing problems at Wave 1. Higher levels of stepparent-child affective quality are associated with decreases in children's internalizing and externalizing problems at Wave 2 (6 months beyond baseline), even after controlling for children's internalizing and externalizing problems at Wave 1 and other covariates. The stepcouple relationship was not directly linked to youth outcomes. Our findings provide implications for future research and practice.

The Meaning of the Sperm Donor for Heterosexual Couples: Confirming the Position of the Father.

In the literature, relatively little attention has been paid to the meaning of donor involvement in the intimate couple dyad. The current study aimed to enrich our understanding of couples' meaning-making regarding the anonymous sperm donor and how they dealt with the donor involvement. Semi-structured interviews were conducted with nine couples, who had at least one child conceived through sperm donation. Our thematic analysis showed that the donor conception was seen as a different path to create a normal family. Once the family was formed, most couples avoided talking about the donor because it was perceived as disrupting men's growing confidence in their position as father. Participants tried to confirm the position of the father to protect the family relationships. Uncertainties about how they were perceived as parents showed the continuing dominance of genetic ties within our social discourse. Participants also dealt with reminders of the donor in their daily life. Overall, they tried to manage the space taken up by the donor and to protect the position of the father. We relate our findings to literature on topic avoidance and shared obliviousness in families. For counseling practice, it could be useful to explore couples' meaning-making about the donor as this seemed to serve family functioning.

EXAMINING LONG-TERM EFFECTS OF AN INFANT MENTAL HEALTH HOME-BASED EARLY HEAD START PROGRAM ON FAMILY STRENGTHS AND RESILIENCE.

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home-based Early Head Start (IMH-HB EHS) program on family functioning. The sample includes 152 low-income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH-HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH-HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH-HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH-HB EHS services are maintained after services cease.

[Need for the role of the patient's family members at the intensive care unit]. / Necesidad de rol en los familiares del paciente en la unidad de cuidados intensivos.

AIM: To know the current status for the role of family members in the intensive care unit and its evolution, analyzing areas for improvement and learning about the nursing role. METHODS: This work is a literature review. The selected articles included two of the key words in their title. Articles before year 2000 were excluded, except some work of great interest. RESULTS: Family members lose their role and suffer a crisis when one of them is at the intensive care unit. Their normal role into the family changes or disappears. Obtaining a participation role increases satisfaction and decreases anxiety in relatives. Nursing professionals are essential in addressing this need. CONCLUSIONS: Solving the need for this role decreases anxiety and stress on relatives and patients. Their implication on the patient process enhances and helps professionals to know the patient's background.

Looking for solutions: gender differences in relationship and parenting challenges among low-income, young parents.

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes.

Relationships, environment, and the brain: how emerging research is changing what we know about the impact of families on human development.

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at-risk child to prevent or minimize the onset of mental illness including providing partnerships with at-risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.

[Cohesion and family adaptability in women with epilepsy: cross-sectional study]. / Cohesión y adaptabilidad familiar en mujeres con epilepsia: estudio transversal analítico.

OBJECTIVE: To test the hypothesis that women with epilepsy come from families with poor cohesion and adaptability to the disease, compared with healthy women. DESIGN: Cross-sectional study. SETTING: A retrospective study was done on 263 women from a neurology outpatient department and a family medicine unit from the Mexican Social Security Institute in Sonora (Mexico) between 2010 and 2011. PARTICIPANTS: Were 82 women with epilepsy (cases), and 181 healthy women (control group). Age and area of residence was utilized to pair the sample (1:2,2). MEASUREMENTS: Univariate analysis was performed for socio-demographic variables, family type, socio-economic status, level of cohesion and family adaptability based on FACES III. A logistic regression analysis was performed for those variables that were associated with functionality of family in women with and without epilepsy. RESULTS: A family dysfunction were found in 22% of epileptic women (OR = 2.91 [2.17, 3.89], p=.0001). Univariate analysis suggested the presence of epilepsy and of family dysfunction associated with age, disease more than 15 years of evolution, and family type (rural, urban and traditional). The logistic regression model confirmed an association only for presence of epilepsy (OR = 7.30 [4.00, 13.33], p=.0001). CONCLUSION: The study answers the hypothesis that women with epilepsy live in families with greater psychosocial impairment, manifested by deficiencies in cohesion and adaptability to the disease, compared with healthy women.

The family in the intensive care unit in the face of a situational crisis.

OBJECTIVE: to explore the experience of family members of a relative hospitalised in the Intensive Care Unit and recognise their emotions and needs and describe the phases or milestones they go through and the strategies they use to cope with the situations that arise. METHOD: Qualitative study developed under the grounded theory method proposed by Anselm Strauss and Juliet Corbin. During the period from July 2017 to July 2019, semi-structured interviews were conducted with 26 relatives of hospitalised patients in fifteen third-level private clinics in the city of Manizales and Medellín, Colombia. In the latter, 200 h of participant observation were performed in ICUs of two private third-level clinics. The analysis procedure consisted of a microanalysis of the data and the process of open, axial, and selective coding of the information was continued. RESULTS: We identified that the experience of relatives when they accompany their sick relative in the Intensive Care Unit is represented in two categories: family disorganisation which is characterised by generating a change and mismatch in family dynamics and, family reorganisation in which a restoration of order is sought to cope with the situation. CONCLUSIONS: The family in the Intensive Care Unit develops a situational crisis characterised by intense, varied, and negative emotions and needs that wear down the relatives. Faced with this, family members undertake a reorganisation process to restore the order of family dynamics to cope with the situation and overcome difficulties.

Psychological and social impact on parents of children with feeding difficulties.

OBJECTIVES: The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents' perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families. METHODS: Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or other illness). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form [PSI-SF] and Goldberg's General Health Questionnaire [GHQ-28]) and a parental opinion survey. RESULTS: We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician's recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the GHQ-28, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio [aOR] compared to controls, 4.18; 95% confidence interval [CI], 1.96-8.87; OR compared to sick controls, 6.25; 95% CI, 2.79-13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (PSI-SF) compared to the healthy control group (adjusted mean difference [AMD], 21; 95% CI, 12.19-29.81) and the sick control group (AMD, 20; 95% CI, 9.81-30.19). CONCLUSIONS: Parents of children with FDs have a high level of stress and risk of anxiety and depression, with repercussions at the social, family, couple and work levels. The relationship with the paediatrician may also be affected.

Needs and participation strategies proposed by the family in the daily care of the critically ill patient.

INTRODUCTION: The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. OBJECTIVE: I) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and II) to study the participation strategies proposed by the relatives. METHODS: Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. RESULTS: 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. CONCLUSIONS: It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.

Confirmatory factor analysis of the family APGAR questionnaire.

INTRODUCTION: In Colombia, the family APGAR questionnaire is often used to evaluate family function. However, there is no confirmatory factor analysis (CFA) to corroborate the proposed one-dimensional structure in Colombian adolescent students. OBJECTIVE: To perform CFA on the APGAR family questionnaire in high-school students of Santa Marta, Colombia. METHOD: A total of 1462 students of tenth and eleventh grade of official and private schools completed the family APGAR questionnaire. Students between 13 and 17 years old (M = 16.0, SD = 0.8) were included, of which 60.3% were female, and 55.3% were tenth grade students. The χ2, RMSEA, CFI, TLI and SMSR were estimated in the CFA. The internal consistency of the dimension was calculated with Cronbach alpha and McDonald omega coefficients. RESULTS: In the CFA the indexes were χ2 = 9.11, df = 5, P = 0.105; RMSEA = 0.024 (CI90%, 0.000-0.048), CFI = 0.998, TLI = 0.996, and SMSR = 0.009. Cronbach alpha coefficient was 0.819 and McDonald omega, 0.820. CONCLUSIONS: The one-dimensional structure of the APGAR family scale is confirmed in high-school students of Santa Marta, Colombia. This questionnaire is reliable and valid for the measurement of family function in school-aged adolescents.