family-health

# Family Health — Hereditary Risk Assessment & Family History Management Manage family health history and assess genetic predisposition risk based on documented family disease patterns. Provide personalized screening recommendations and preventive care guidance. ## When to Use - User mentions family medical history ("my father had...") - User asks about hereditary disease risks - User wants to understand genetic predisposition - User asks about screening recommendations based on family history - User wants to build a family health tree - Trigger phrases: "family history", "hereditary", "genetic risk", "parents' health", "inherited", "family disease" ## Step 1: Gather Family Health Data Ask the user about their family health history. Use Socratic approach: **First-degree relatives** (ask about each): - Father: age, health conditions, age at diagnosis of any diseases - Mother: age, health conditions, age at diagnosis - Siblings: health conditions, age at diagnosis **Second-degree relatives** (if provided): - Grandparents: health conditions, cause of death, age at death - Aunts/Uncles: health conditions **For each condition, record:** - Who has it (relationship) - What condition - Age at diagnosis - Severity (if provided) ## Step 2: Calculate Genetic Risk Score Based on OpenClaw family-health-analyzer algorithm: ### Weighted Risk Formula ``` Genetic Risk Score = (F1 × 0.4) + (F2 × 0.3) + (F3 × 0.3) Where: - F1 = First-degree relatives with condition (weight 0.4) - F2 = Early-onset cases (<50 years) × 0.3 - F3 = Family clustering score × 0.3 ``` ### Family Clustering Score | Pattern | Score | |---------|-------| | No family history | 0 | | 1 second-degree relative | 0.2 | | 1 first-degree relative | 0.4 | | 2 first-degree relatives (same condition) | 0.6 | | 3+ first-degree relatives | 0.8 | | Cross-generational (parent + grandparent) | 0.7 | ### Early-Onset Multiplier | Age at Diagnosis | Multiplier | |-----------------|-----------| | ≥60 years | 0 | | 50-59 years | 0.2 | | 40-49 years | 0.5 | | <40 years | 1.0 | ## Step 3: Risk Classification ### By Score Range | Risk Level | Score | Interpretation | |------------|-------|---------------| | Low | <40 | Normal population risk, follow standard screening | | Moderate | 40-69 | Elevated risk, consider earlier/more frequent screening | | High | ≥70 | Significant genetic predisposition, personalized screening plan required | ### By Condition Category **Cardiovascular** - High risk: 1 parent with MI/stroke <55 (male) or <65 (female) - Moderate risk: 2+ relatives with hypertension before 50 - Elevated screening: lipid panel, BP monitoring from age 30 **Diabetes** - High risk: 1 first-degree relative with T2DM - Very high risk: 2+ first-degree relatives, or 1 with early onset (<50) - Elevated screening: HbA1c from age 35, or 10 years before earliest family diagnosis **Cancer** - High risk: 2+ first-degree relatives with same cancer - Very high risk: Any first-degree relative diagnosed <50 - BRCA/Lynch syndrome referral if indicated **Mental Health** - Family history of depression, anxiety, or substance use - Triggers earlier PHQ-9/GAD-7 monitoring - Increased suicide risk awareness **Thyroid/Nodules** - Family history of thyroid cancer or autoimmune thyroid disease - Triggers more frequent thyroid monitoring - Lower threshold for FNA biopsy consideration ## Step 4: Personalized Screening Recommendations Based on risk score, recommend: ### Low Risk - Standard age-based screening per USPSTF guidelines - Maintain healthy lifestyle ### Moderate Risk - Start screening 5-10 years earlier than standard recommendation - Increase frequency (e.g., annual instead of every 3 years) - Consider additional biomarkers ### High Risk - Start screening at earliest recommended age or 10 years before earliest family diagnosis - Discuss with doctor about genetic referral if applicable - Consider comprehensive screening panel - Lifestyle intervention with highest priority ## Step 5: Cross-Dimensional Correlation Family history should inform other skills: | Family History | Auto-Correlations to Trigger | |---------------|------------------------------| | Cardiovascular | vital-monitor (BP priority), chronic-care (hypertension), preventive-care (cardiac screening) | | Diabetes | chronic-care (glucose monitoring), nutrition-advisor (carbs control) | | Cancer | preventive-care (cancer screening), mental-health (cancer anxiety) | | Thyroid | chronic-care (thyroid nodule monitoring), vital-monitor (TSH tracking) | | Mental Health | mental-health (more frequent PHQ-9), sleep-analyzer (sleep-health link) | ## Step 6: Create Family Health Record Store in `health/` directory: ``` health/ ├── Family History.md └── Family History.json ``` ### JSON Schema ```json { "family_history": { "first_degree": [ { "relative": "father", "conditions": [ { "name": "Type 2 Diabetes", "age_at_diagnosis": 55, "severity": "controlled", "notes": "On metformin" } ] } ], "second_degree": [ { "relative": "maternal_grandmother", "conditions": [ { "name": "Breast Cancer", "age_at_diagnosis": 62, "severity": "treated", "notes": "Early stage, no recurrence" } ] } ] }, "risk_assessment": { "cardiovascular": { "score": 52, "level": "moderate", "factors": ["father MI at 58"] }, "diabetes": { "score": 40, "level": "moderate", "factors": ["father T2DM at 55"] } }, "screening_recommendations": [ { "test": "HbA1c", "start_age": 35, "frequency": "annual", "reason": "Family history of T2DM" } ], "last_updated": "2026-03-21" } ``` ## Output Format ```markdown # Family Health Assessment — [Date] ## Family History Summary | Relative | Condition | Age at Dx | Notes | |----------|-----------|-----------|-------| | Father | Type 2 Diabetes | 55 | On metformin | | Mother | Hypertension | 58 | Controlled | | Mat. Grandmother | Breast Cancer | 62 | Treated | ## Genetic Risk Scores | Condition | Score | Risk Level | Key Factors | |-----------|-------|------------|-------------| | Type 2 Diabetes | 52 | Moderate | Father T2DM at 55 | | Cardiovascular | 45 | Moderate | Father MI at 58 | | Breast Cancer | 32 | Low | 1 second-degree, age >50 | ## Screening Recommendations **Diabetes Screening** - Start: Age 35 (10 years before father's diagnosis) - Frequency: Annual - Test: HbA1c or fasting glucose **Cardiovascular Screening** - Start: Age 30 (earlier due to family history) - Frequency: Annual lipid panel + BP check - Consider: CAC scoring after 40 ## Cross-Dimensional Correlations 🔗 Family history of T2DM + cardiovascular disease → increased monitoring priority → Recommend: nutrition-advisor (carb awareness), vital-monitor (BP + glucose tracking) ## Action Plan - [ ] Complete detailed family health interview - [ ] Schedule HbA1c test at next checkup - [ ] Discuss lipid panel with doctor - [ ] Add BP monitoring to weekly routine ``` ## Safety Boundaries **Can Do:** - Collect and document family health history - Calculate statistical risk scores based on family patterns - Recommend screening schedules based on risk level - Provide lifestyle modification guidance - Cross-correlate family history with current health data - Educate about genetic risk factors **Cannot Do:** - Diagnose genetic or hereditary diseases - Predict individual disease probability with certainty - Recommend specific treatment plans - Replace genetic counseling - Interpret genetic test results (refer to genetic counselor) **Every output must include:** > ⚠️ This risk assessment is based on family health history patterns and is for informational purposes only. It does not constitute a medical diagnosis. Consult your healthcare provider for personalized screening plans and medical advice. Genetic counseling is recommended for high-risk families. ## Reference Standards - ACC/AHA: Cardiovascular risk screening with family history - ADA: Diabetes risk screening based on family history - USPSTF: Age-based screening modifications for high-risk individuals - NCCN: Cancer family history assessment guidelines