atatürk university medical faculty 2010-2011 semester i class 1 family medicine lectures yrd. doç....

Atatürk University Medical Faculty 2010-2011 Semester I

Class 1 Family Medicine Lectures

Yrd. Doç. Dr. Memet IŞIKmemetisik@yahoo.com

Objektives

At the end of this lecture, the participants will be able

to;

Describe “family” and discuss new forms of

families.

Discuss functions of the family

Discuss the importance of social support

Discuss the role of family on individual’s health.

Discuss the role of family in the prevention of

diseases.

WHAT IS A “FAMILY”?The smallest social unit in the community,

based on marriage and blood ties, consisting of wife, husband, children and siblings.

Pequengnant and Bray, 1997: Group of people who are biologically, emotionally and legally bound.

Major social institution found in all human societies

a group of individuals living under one roof and usually under one head

a group of persons of common ancestrythe basic unit in society traditionally

consisting of two parents rearing their children

Family ImageUsual image: working father + housewife mother

+ dependent children

Reality: This is becoming less and less common

as more & more mothers work outside the home.

Also because of rising divorce rates.

Turkish Family Structure1997 USA: The proportion of children out of wedlock 32%Bird ST. Beyond Marital Status: Relationship Type and Duration And the Risk of Low Birth Weight. Family Planning Perspectives 2000

2003 TR: The proportion of children out of wedlock 0 %

Turkish Population and Health Surveys 2003

Importance of Social SupportThe relation between social relationships and

health is as important as morbidity and mortality effects of many diseases.

House ve ark. 1988

We can categorize social support as "structured" and "functional“.

Importance of Links Between RelativesSocial support is an important factor for

mortality estimates.Regardless of socioeconomic status, previous

health status and health practices, dying of individuals who are alone is as twice as than individuals living within a family.

Importance of SpouseProbability of dying of the surviving spouse within

6 month after dying of one of the couple is high. -Accidents, violence, alcohol, heart attack, lung cancer

Martikainen P, Valkonen T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 1996;86(8):1087-1093.

Risk is higher in younger then older ones.Compared to persons with living spouses,

probability of dying of the remaining couple is 17% more in males, 6% in females.

Martikainen P, Valkonen T. Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health 1996;50(3):264-268.

Preventive Medicine and FamilyFamily is the first application area of

preventive medicineWorld Health Organization. Statistical Indices of Family Health No. 589:17,

1976.

A healthy lifestyle is learned, applied and will be replaced in family.

Health Problems In Our Age

Chronic Illness and FamilyCigaretteObesityImmobilityHypertension

Family Members Interact Family members have similar risk factorsAre fed from the same kitchenHarmful habits in the family will be copied

In the case of smoking parents or siblings, smoke are more likelySalt, calories, cholesterol, fat consumption ... Gegenetic also have effect

Chronic Illness and FamilyFamilies affect the course of chronic

illnesses.Individuals with chronic illness affects the

familyFamily meetings can be helpful

Psychiatric disordersThe presence of chronic patientsBedridden patientsIncompatibility

Family may be supportive or fetterSometimes families can be supportive

can remind to take drugwhole family out for a walk ...

Sometimes the opposite might bemake fun of exercising family membersmake fun of of the individuals who

sports .

New Forms of the “Family”Cohabiting couples (with or without children)Single parent family (because of teen

pregnancy, divorce or abandonment)“Blended” family: a social unit consisting of

two previously married parents and the children of their former marriages

Homosexual couples e.g. Netherlands has legalised homosexual marriages

Functions of the FamilyFunctions:

Companionship (“marry for love”)Sex and reproductionSocial ObligationsSocialisation of childrenSocial support (especially during crises)Economic cooperation

Family StructureNuclear family: Father, mother and kids

Extended family: The above plus grandparents

“Family life cycle” – structure of an individual family changes over time

The Family is ChangingChanging roles (role = “expected behavior”

that goes with a social position)

People marry later, have fewer kids, and also have them later

More divorces

Single parent families (these are more likely to be poor)

The Family is ChangingMore working mothers and “latchkey kids”Children may be unsupervised and feel

neglected and unlovedWorking mothers are stressed (“Supermom

Syndrome” and “Double Burden of Women”)

Stressed Working MothersExamples:Female nurses with childrenFemale doctors with children

Role conflict: Being a good doctor to one’s patients versus being a good mother to one’s kids

Effects of Family on Health1) Effects on Illness Behaviour: Stoic? self-medicate? seek alternative

medicine? Effects on medical adherence: the extent to which a person's behavior coincides with medical or health advice

e.g. religion & health (faith healing)

Effects of Family on Health2) Effects on patients with long term illness:

Quality of care provided by family members (female relatives as care providers for kids, husbands, in-laws and elderly parents)

Effects of Family on Health3) Family and social networks promote health:

Socially isolated have poorer mental health; recover slower from sickness

The Dysfunctional Family“Troubled family that has a negative effect on

the physical or psychological well-being of its individual family members”

Effects of Family on Health4) Dysfunctional families and poor parenting:

Child abuse – neglect, physical abuse, verbal abuse, sexual abuse

OverindulgenceDomestic violenceAlcoholism and substance-abuse in the

familyGambling problems

NOTE !!Families with divorced parents are NOT

NECESSARILY dysfunctional families !

Effects of Family on Health5) Learning of health-related behaviour

e.g. quality of diet and health (including obesity), smoking and passive smoking, alcohol (religion & alcohol consumption), risk-taking behaviour, values and behaviour (including sexual behaviour)

Effects of Family on Health6) Family changes can affect health

“Stressful life events” such as marital breakdown and divorce, death of spouse etc. increase risk of sickness for other family members

Large families: can affect health of kids in a negative manner

Effect of Sickness on the Family1) Effect of chronic disease or death

Role changes: if the wife gets sick or dies, the husband has to adjust (or vice-versa)

Economic pressures: family member stops work to care for the sick, patient is unable to work, medical bills become high

Effect of Sickness on the Family2) Stress from taking care of sick family

member e.g. Alzheimer’s disease, serious mental

illness, relative who is bed-ridden or incontinent

3) Stigmatizing diseases such as HIV/AIDS e.g. hostility from neighbours,

abandonment by own family

THANK YOU