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In this review, we survey some significant advances in the medical care of babies <1000 g and we highlight the development of care pathways that ensure optimal antenatal care, which is a prerequisite for good neonatal outcomes. We also suggest that the long overdue development of family integrated care will in the end prove at least as important as the recent medical advances., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Our study's premise was that normative care beliefs can inform the current care policy debate. We conducted latent class regression analyses on two waves of Netherlands Kinship Panel Study data (n = 4,163) to distinguish care ideals that captured multiple dimensions of normative care beliefs simultaneously. We also assessed how these care ideals have shifted in the early twenty-first century. We distinguished four care ideals: warm-modern (family and state jointly responsible for caring, egalitarian gender roles), cold-modern (large state responsibility, restricted family responsibility, egalitarian gender roles), traditional (restricted state responsibility, large family responsibility, moderately traditional gender roles), and cold-traditional (large state responsibility, restricted family responsibility, traditional gender roles). Between 2002 and 2011, there has been a shift away from warm-modern care ideals and towards cold-modern care ideals. This is remarkable, because Dutch policy makers have increasingly encouraged family members to take on an active role in caring for dependent relatives.

This article analyzes the implementation of inter-sector initiatives linked to the Family Grant, Family Health, and School Health Programs in the Manguinhos neighborhood in the North Zone of Rio de Janeiro, Brazil. The study was conducted in 2010 and 2011 and included document review, local observation, and 25 interviews with program managers, professionals, and staff. This was an exploratory case study using a qualitative approach that identified constraints and opportunities for inter-sector health experiences, contributing to the debate on the effectiveness of health promotion and poverty relief programs.

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). As Peek points out, Don Bloch's vision is alive and well. Teams of health and behavioral health professionals are now working in concert with a shared biopsychosocial frame of reference to improve care and health. You have the opportunity to be involved and move science forward. Seek out like-minded colleagues and expect your system to collect process and outcome metrics. Learn and disseminate your knowledge so that we can provide the outstanding services we all deserve., ((c) 2015 APA, all rights reserved).)

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). C. J. Peek has provided us with a masterful integration of Don Bloch's vision of collaborative family health care and the evolution over the past 20 years of the field. The current author was very fortunate to be part of the initial meeting at Wingspread in 1994. As a family systems-oriented community and public health-trained psychiatrist, my primary focus over 30 years has been on families facing chronic illness and disability and collaborative care efforts in specialty, primary, rehabilitation, and palliative care medicine. In my view, the ability of the health care consumer (patient and his or her family members) and professional worlds to collaborate in a more egalitarian and less hierarchical and wary manner remains a significant constraint to progress., ((c) 2015 APA, all rights reserved).)

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., ((c) 2015 APA, all rights reserved).)

C. J. Peek has done us two lasting services with this beautiful summary. He has reminded us of Don Bloch's contributions to the beginning of collaborative family health care, and he has catalogued the elements of Don's vision for the field. Don's vision was for "collaborative family health care." Although we have made a great deal of progress developing collaborative health care that he would endorse, the full vision including the family as a basic unit of care and of understanding in health care is still ahead of us. The requirement of the inclusion of the family in the formulation of the patient-centered medical home may provide the impetus for a full realization of the "unrounded corners" version of Don's vision., ((c) 2015 APA, all rights reserved).)

Background: Don Bloch is the central figure in the origin story for the field of collaborative family health care; the journal Families, Systems, & Health; and for the Collaborative Family Healthcare Association (CFHA). He exerted extraordinary intellectual and practical leadership for all 3. He convened a national working session in 1994 that took stock of the field and set out next steps, one of which was to create the interprofessional organization dedicated to collaborative family health care that is now CFHA., Purpose: As part of honoring Don Bloch's contributions to the field and this journal, this article sets out tenets of his original vision and traces next steps toward this vision generated by national groups between 1994 and 2014, showing what is the same or different over these 20 years, and especially what this means for the field going forward., Method: Precepts of Don Bloch's original vision are drawn from his writings, including the briefing papers he prepared for the national Wingspread group convened in 1994, which also set out next steps for the field. These steps are then compared with next developmental steps for the field generated by CFHA conference attendees in 2004 and again in 2014, after reviewing the history of the organization and the field., Conclusion: Much of Don Bloch's vision has remained relevant to health care transformation, with a number of areas showing significant accomplishment and acceptance, whereas others remain aspirational, and a few others arguably being more difficult to achieve now than when Don articulated them., ((c) 2015 APA, all rights reserved).)

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). C. J. offers us a breathtaking, magnificent gift, itself made from gifts. He has taken something good-Don's seminal contributions- and by showing them off in their properly revealed context, like a stone in a setting, has multiplied their value and created something new in its own right. Make no mistake: this article is a work of serious research, conducted according to the methods of the longest-running research tradition of all-historical research, and specifically, comparative historical research (Turner, 2014)., ((c) 2015 APA, all rights reserved).)

Background: We reviewed the literature on family therapy and dementia to investigate the following: what is known about the use of family therapy in the context of living with dementia; what are the challenges of working in this context; and what guidelines/models are available to guide family therapists working with families living with dementia., Methods: We searched English language literature from 1992 onwards, classified the resulting papers into broad categories of theoretical, expository, or research (descriptive, quantitative, or qualitative), and conducted a narrative review to draw learning points from the identified papers., Results: In total 31 papers were identified: five theoretical, 11 expository; and 15 research papers. Several papers described methodologies; psychotherapeutic interventions applied to family members; or complex intervention packages in which the role of family therapy could not be separately identified, rather than family therapy. A range of outcomes were investigated, often involving the caregiver. Several authors suggest areas in dementia care where family therapy is likely to be beneficial., Conclusions: Although the literature on family therapy and dementia has grown over the past 25 years and suggests potentially useful roles for therapy, a number of challenges exist in terms of context, family, and therapy itself. There is a need for further research, particularly into the following fields: How to evaluate the success of therapy; how to ensure treatment integrity; how to make techniques from family therapy available more widely; and how to train the health and social care workforce in working with families.

Most of the authors in this issue of Future of Children focus on a single strategy for helping both adults and children that could become a component of two-generation programs. Lindsay Chase-Lansdale and Jeanne Brooks-Gunn, on the other hand, look at actual programs with an explicit two-generation focus that have been tried in the past or are currently under way. These explicitly two-generation programs have sought to build human capital across generations by combining education or job training for adults with early childhood education for their children. Chase-Lansdale and Brooks-Gunn explain the theories behind these programs and review the evidence for their efficacy. A first wave of such programs in the 1980s and 1990s produced mostly disappointing results, but the evaluations they left behind pointed to promising new directions. More recently, a second wave of two-generation programs--the authors dub them "Two-Generation 2.0"--has sought to rectify the flaws of earlier efforts, largely by building strong connections between components for children and adults, by ensuring that children and adults receive services of equal duration and intensity, and by incorporating advances in both education and workforce development. These Two-Generation 2.0 programs are still in their infancy, and we have yet to see clear evidence that they can achieve their goals or be implemented cost-effectively at scale. Nonetheless, Chase-Lansdale and Brooks-Gunn write, the theoretical justification for these programs is strong, their early results are promising, and the time is ripe for innovation, experimentation, and further study.

Turning a ship requires small but steady and deliberate efforts over time. During the past 9 years, Wisconsin's Maternal and Child Health (MCH) Program has begun to utilize the life-course perspective as its framework for guiding efforts around women's health, early childhood systems, children and youth with special health care needs, chronic disease integration, and elimination of racial and ethnic disparities in birth outcomes. In collaboration with many state and national partners, Wisconsin's MCH Program has integrated the life-course perspective into efforts that include the following: increasing professional and public awareness of the framework; creating focus groups and social marketing campaigns in communities most affected by health disparities; expanding preconception and women's health initiatives; integrating with traditionally "non-MCH" programs such as chronic disease programs; and shifting Title V resources from provision of individual services to assurance of effective early childhood systems. Wisconsin's implementation of the life-course perspective has not been without challenges, but opportunities have also been identified along the journey. Initial efforts focused on training and supporting partners in their understanding and application of the life-course framework, and a train-the-trainer model was discovered to be key to achieving these goals. We took care to engage special populations and their advocates and to work closely with local communities. We hope that the lessons we have learned in this process will provide guidance for others as they work to incorporate life course into their MCH work. The life-course perspective has helped us to inform partners, policy makers, and funders of the need for a new approach in addressing racial and ethnic disparities in health.

This article focuses on differences in health and welfare outcomes for families with children in three European countries, discussed in relation to national policies for child and family welfare. Data consist of policy documents and cross-national surveys. The document analysis was based on policy documents that described government policies. The statistical analyses utilize data from the European Social Survey. For the analyses in this article, a sub-sample of child families was selected from the countries Slovenia, Sweden, and the United Kingdom. Data showed that England's policy has mainly addressed socially disadvantaged groups and areas. Sweden and Slovenia are mainly developing universal policies. The United Kingdom has high scores for subjective general health, but a steep income gradient in the population. Parents in England experience the highest level of at-risk-of-poverty. Sweden generally scores well on health outcomes and on level of at-risk-of-poverty, and the gradient in self-rated general health is the mildest. Slovenia has the weakest economy, but low levels of inequality and low child at-risk-for-poverty scores. The Slovenian example suggests that not only the level of economic wealth, but also its distribution in the population, has bearings on health and life satisfaction, not least on the health of children.

Background: There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care., Objective: To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (EHR)., Design: Pilot trial., Participants, Intervention: Patients were enrolled from four primary care practices and were asked to collect family health history before a physical exam using either telephone-based interactive voice response (IVR) technology, a secure Internet portal, or a waiting room laptop computer, with portal assigned by practice. Intervention practices were compared to a "usual care" practice, where there was no standard workflow to document family history (663 participants in the three intervention arms were compared to 296 participants from the control practice)., Main Measures: New documentation of any family history in a coded EHR field within 30 days of the visit. Secondary outcomes included participation rates and validity., Key Results: Demographics varied by clinic. Documentation of new family history data was significantly higher, but modest, in each of the three intervention clinics (7.5 % for IVR clinic, 20.3 % for laptop clinic, and 23.1 % for patient portal clinic) versus the control clinic (1.7 %). Patient-entered data on common conditions in first degree relatives was confirmed as valid by a genetic counselor for the majority of cases (ranging from 64 to 82 % in the different arms)., Conclusions: Within primary care practices, valid patient entered family health history data can be obtained electronically at higher rates than a standard of care that depends on provider-entered data. Further research is needed to determine how best to match different portals to individual patient preference, how the tools can best be integrated with provider workflow, and to assess how they impact the use of screening and prevention.

Background: Stressful early life experience may have adverse consequences in adulthood and may contribute to behavioral characteristics that increase vulnerability to alcoholism. We examined early life adverse experience in relation to cognitive deficits and impulsive behaviors with a reference to risk factors for alcoholism., Methods: We tested 386 healthy young adults (18 to 30 years of age; 224 women; 171 family history positive for alcoholism) using a composite measure of adverse life experience (low socioeconomic status plus personally experienced adverse events including physical and sexual abuse and separation from parents) as a predictor of performance on the Shipley Institute of Living scale, the Stroop color-word task, and a delay discounting task assessing preference for smaller immediate rewards in favor of larger delayed rewards. Body mass index (BMI) was examined as an early indicator of altered health behavior., Results: Greater levels of adversity predicted higher Stroop interference scores (F = 3.07, p = 0.048), faster discounting of delayed rewards (F = 3.79, p = 0.024), lower Shipley mental age scores (F = 4.01, p = 0.019), and higher BMIs in those with a family history of alcoholism (F = 3.40, p = 0.035). These effects were not explained by age, sex, race, education, or depression., Conclusions: The results indicate a long-term impact of stressful life experience on cognitive function, impulsive behaviors, and early health indicators that may contribute to risk in persons with a family history of alcoholism., (Copyright © 2012 by the Research Society on Alcoholism.)

An international body of scientific research indicates that growth of job insecurity and precarious forms of employment over the past 35 years have had significant negative consequences for health and safety. Commonly overlooked in debates over the changing world of work is that widespread use of insecure and short-term work is not new, but represents a return to something resembling labor market arrangements found in rich countries in the 19th and early 20th centuries. Moreover, the adverse health effects of precarious employment were extensively documented in government inquiries and in health and medical journals. This article examines the case of a large group of casual dockworkers in Britain. It identifies the mechanisms by which precarious employment was seen to undermine workers and families' health and safety. The article also shows the British dockworker experience was not unique and there are important lessons to be drawn from history. First, historical evidence reinforces just how health-damaging precarious employment is and how these effects extend to the community, strengthening the case for social and economic policies that minimize precarious employment. Second, there are striking parallels between historical evidence and contemporary research that can inform future research on the health effects of precarious employment.

Introduction: Home smoking bans significantly reduce secondhand smoke exposure among children, but parents may offer discordant reports on whether there is a home smoking ban. The purpose of this study was to examine national trends in (a) parental discordance/concordance in the reporting of home smoking bans and (b) correlates of discordant/concordant reports among two-parent households with underage children from 1995 to 2007., Methods: Data from the 1995/1996, 1998/1999, 2001/2002, 2003, and 2006/2007 Tobacco Use Supplement of the U.S. Current Population Survey were used to estimate prevalence rates and multinomial logistic regression models of discordant/concordant parental smoking ban reports by survey period., Results: Overall, the percentage of households in which the 2 parents gave discordant reports on a complete home smoking ban decreased significantly from 12.7% to 2.8% from 1995 to 2007 (p < .001). Compared with households where both parents reported a complete smoking ban, discordant reports were more likely to be obtained from households with current smokers (p < .01) across survey periods. Compared with households where both parents reported the lack of a complete home smoking ban, discordant reports were more likely among households with college graduates, no current smokers, and parents with Hispanic ethnicity (p < .05)., Conclusions: Parental concordance on the existence of a home smoking ban increased from 1995 to 2007. This suggests estimates of home smoking bans based on just one parent may be more reliable now than they were in the past. Interventions to improve the adoption and enforcement of home smoking bans should target households with current smoker parents.

Background: High-deductible health plans (HDHPs) are an increasingly common strategy to contain health care costs. Individuals with chronic conditions are at particular risk for increased out-of-pocket costs in HDHPs and resulting cost-related underuse of essential health care., Objective: To evaluate whether families with chronic conditions in HDHPs have higher rates of delayed or forgone care due to cost, compared with those in traditional health insurance plans., Design: This mail and phone survey used multiple logistic regression to compare family-level rates of reporting delayed/forgone care in HDHPs vs. traditional plans., Participants: We selected families with children that had at least one member with a chronic condition. Families had employer-sponsored insurance in a Massachusetts health plan and >12 months of enrollment in an HDHP or a traditional plan., Main Measures: The primary outcome was report of any delayed or forgone care due to cost (acute care, emergency department visits, chronic care, checkups, or tests) for adults or children during the prior 12 months., Results: Respondents included 208 families in HDHPs and 370 in traditional plans. Membership in an HDHP and lower income were each independently associated with higher probability of delayed/forgone care due to cost. For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes ≥400% FPL]. Similar associations were observed for children., Conclusions: Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care.

Background: Home smoking bans significantly reduce the likelihood of secondhand smoke exposure among children and non-smoking adults. The purpose of this study was to examine national trends in (1) the adoption of home smoking bans, (2) discrepancies in parental smoking ban reports and (3) household and parental correlates of home smoking bans among households with underage children from 1995 to 2007., Methods: The authors used data from the 1995-1996, 1998-1999, 2001-2002, 2003 and 2006-2007 Tobacco Use Supplement of the US Current Population Survey to estimate prevalence rates and logistic regression models of parental smoking ban reports by survey period., Results: Overall, the prevalence of a complete home smoking bans increased from 58.1% to 83.8% (p<0.01), while discrepancies in parental reports decreased from 12.5% to 4.6% (p<0.01) from 1995 to 2007. Households with single parent, low income, one or two current smokers, parents with less than a college education or without infants were consistently less likely to report a home smoking ban over this period (p<0.05)., Conclusions: Despite general improvements in the adoption of home smoking bans and a reduction on parental discrepancies, disparities in the level of protection from secondhand smoke have persisted over time. Children living in households with single parents, low income, current smoker parents, less educated parents or without infants are less likely to be protected by a home smoking ban. These groups are in need of interventions promoting the adoption of home smoking bans to reduce disparities in tobacco-related diseases.

The authors investigated whether cognitive function may be used as an endophenotype for longevity by assessing the cognitive performance of a family-based cohort consisting of 1380 individuals from 283 families recruited for exceptional survival in field centers in Boston, New York, Pittsburgh, and Denmark. Cognitive performance was assessed in the combined offspring of the Long Life Family Study (LLFS) probands and their LLFS siblings as compared with their spouses' cognitive performance. Our results indicate that the combined offspring of the LLFS probands and their siblings achieve significantly higher scores on both digit forward and backward tasks (p = 5 10(-5) and p = 8 10(-4) respectively) as well as on a verbal fluency task (p = 0.008) when compared with their spouse controls. No differences between groups were found for the other cognitive tests assessed. We conclude that LLFS family members in the offspring generation demonstrate significantly better performance on multiple tasks requiring attention, working memory, and semantic processing when compared with individuals without a family history of exceptional survival, suggesting that cognitive performance may serve as an important endophenotype for longevity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Aim: This article reports on trends in health outcomes for family caregivers of hip-fractured patients and the effects of social support on these outcomes., Background: Little is known about the impact of caregiving on the health outcomes of family caregivers of patients with hip fracture., Method:   For this prospective, correlational study, data were collected from 135 family caregivers of hip-fractured elders (2001-2005). Data on health-related quality of life and social support were collected from family caregivers at 1, 3, 6 and 12 months after discharge of the older hip-fractured patient., Findings: During the 12 months after the patients' discharge, family caregivers' scores improved significantly in role performance-related scales, including bodily pain, social function, role limitations due to emotional problems and role limitations due to physical problems. However, caregivers' scores for general health and mental health were significantly lower at 12 months [59·91 (sd = 24·54) and 65·91 (sd = 14·36) respectively] than at 1 month after discharge [64·35 (sd = 23·29) and 67·94 (sd = 18·47) respectively]. The trends for most subscale scores for health-related quality of life were positively related to perceived availability of social support., Conclusions: Caring for a hip-fractured older family member over a sustained period may enhance family caregivers' role performance, but have a negative impact on their perceived general health and mental health. These results suggest that home care nurses should develop interventions early after discharge to assess and improve family caregivers' health perception, mental health and social support., (© 2011 Blackwell Publishing Ltd.)

Objective: To examine the impact of the ban on smoking in enclosed public places implemented in England in July 2007 on children's exposure to secondhand tobacco smoke., Design: Repeated cross-sectional surveys of the general population in England., Setting: The Health Survey for England., Participants: Confirmed non-smoking children aged 4-15 with measured saliva cotinine participating in surveys from 1998 to 2008, a total of 10,825 children across years., Main Outcome Measures: The proportion of children living in homes reported to be smoke-free; the proportion of children with undetectable concentrations of cotinine; geometric mean cotinine as an objective indicator of overall exposure., Results: Significantly more children with smoking parents lived in smoke-free homes in 2008 (48.1%, 95% CI 43.0% to 53.1%) than in either 2006 (35.5%, 95% CI 29.7% to 41.7%) or the first 6 months of 2007, immediately before the ban came into effect (30.5%, 95% CI 19.7% to 43.9%). A total of 41.1% (95% CI 38.9% to 43.4%) of children had undetectable cotinine in 2008, up from 34.0% (95% CI 30.8% to 37.3%) in 2006. Geometric mean cotinine in all children combined was 0.21 ng/ml (95% CI 0.20 to 0.23) in 2008, slightly lower than in 2006, 0.24 ng/ml (95% CI 0.21 to 0.26)., Conclusions: Predictions that the 2007 legislative ban on smoking in enclosed public places would adversely affect children's exposure to tobacco smoke were not confirmed. While overall exposure in children has not been greatly affected by the ban, the trend towards the adoption of smoke-free homes by parents who themselves smoke has received fresh impetus.

In this article, we study temporal, regional, and social variation in infant and childhood death clustering in The Netherlands, using data from three provinces. The data relate to children born in 90,000 marriages contracted between the beginning and the last quarter of the nineteenth century. Descriptive indicators show that death clustering was more frequent in the province of Zeeland and more common in the lower classes, and that it increased in two provinces over time. Shared frailty hazard models make it clear that the number of children who died before the birth of an index child had a negative effect on the mortality of index children, whereas earlier stillbirths and the number of children who died when the index child was at a young age had an increasing effect on the mortality of index children.

Purpose: This study utilises an ecological design to analyse the relation between concurrent temporal trends in sudden infant death syndrome (SIDS) rates and prevalence of smoke-free households with infants in the USA, controlling for an important risk factor, infant supine sleep position., Methods: Annual state-specific SIDS cases were computed using period linked birth/infant death files; the prevalence of 100% smoke-free homes with infants using Tobacco Use Supplement to the Current Population Survey data, and percentage of infants in supine sleep position from National Infant Sleep Position data, for years 1995-2006. Incidence rate ratios relating trends in SIDS cases and risk factors were determined using time-series negative binomial regression. Population-level health effects were assessed with secondhand smoke (SHS) exposure population attributable fractions and excess attributable SIDS deaths., Results: For every 1% absolute increase in the prevalence of smoke-free homes with infants, SIDS rates decreased 0.4% from 1995 to 2006, controlling for supine sleep position. Nationally, it is possible that 20% of the 1326 total SIDS cases were attributable to childhood SHS exposure at home in 2006 with potentially 534 fewer infant deaths attributable to SHS exposure in 2006 than in 1995, owing to an increasing prevalence of 100% smoke-free homes with infants. Cumulatively, 4402 (lower 95% CI) to 6406 (upper 95% CI) excess SIDS cases may have been attributable to SHS exposure in the home over the 12-year study period., Conclusions: The uptake of voluntary restrictions on smoking inside the home may present a public health benefit for infants in their first year of life. In light of inherent ecological study design limitations, these results warrant further individual level research linking postnatal SHS exposure and SIDS.