Childhood cancer has obvious impacts on the children themselves, but also has impacts on their families and siblings. While studies have been conducted on the impacts of cancer on children and their parents, there has been limited consideration of the impacts of cancer on healthy siblings. Some studies have suggested that siblings of children with cancer are the most emotionally disregarded and distressed of all family members as a result of their sibling having cancer. Exposure to stress has a negative impact on the immune system and places siblings at risk for health problems. Thus, finding mechanisms to ameliorate stress are critical. Early intervention and treatment may serve as protective factors against risky behavior and lead to more normative child development and well-being. One method of improving the psychosocial adjustment of siblings of children with cancer has been through interventions such as camp experiences that include opportunities for campers to experience social support. There is a need to better understand the efficacy of intervention programs designed to reduce stress across a variety of settings. The focus of this study was if campers experience social support (emotional, informational, and instrumental) at a three and one-half day residential camp, and the elements of camp campers’ identified as leading to social support. Participant observations of camp and semi-structured interviews with selected campers were used to help gain insights concerning the impact of the camp experience on siblings of children with cancer. Coding of responses was undertaken, which led to the identification of themes and subthemes. Findings provided a narrative description of how campers perceived social support. In addition, social comparison was identified as a critical mechanism for meeting camper’s biological, physiological and behavioral needs. Overarching perceptions of campers were that people at camp were nice and staff was instrumental in facilitating universality and a cycle of reciprocity. Implications of this study suggest intentionally designed camps have the ability to impact a broad range of attitudes and behaviors. The study also supports theory of how structures and processes of social relationships work in relation to good health; and can be applied to a camp setting.

Childhood cancer has obvious impacts on the children themselves, but also has impacts on their families and siblings. While studies have been conducted on the impacts of cancer on children and their parents, there has been limited consideration of the impacts of cancer on healthy siblings. Some studies have suggested that siblings of children with cancer are the most emotionally disregarded and distressed of all family members as a result of their sibling having cancer. Exposure to stress has a negative impact on the immune system and places siblings at risk for health problems. Thus, finding mechanisms to ameliorate stress are critical. Early intervention and treatment may serve as protective factors against risky behavior and lead to more normative child development and well-being. One method of improving the psychosocial adjustment of siblings of children with cancer has been through interventions such as camp experiences that include opportunities for campers to experience social support. There is a need to better understand the efficacy of intervention programs designed to reduce stress across a variety of settings. The focus of this study was if campers experience social support (emotional, informational, and instrumental) at a three and one-half day residential camp, and the elements of camp campers' identified as leading to social support. Participant observations of camp and semi-structured interviews with selected campers were used to help gain insights concerning the impact of the camp experience on siblings of children with cancer. Coding of responses was undertaken, which led to the identification of themes and subthemes. Findings provided a narrative description of how campers perceived social support. In addition, social comparison was identified as a critical mechanism for meeting camper's biological, physiological and behavioral needs. Overarching perceptions of campers were that people at camp were nice and staff was instrumental in facilitating universality and a cycle of reciprocity. Implications of this study suggest intentionally designed camps have the ability to impact a broad range of attitudes and behaviors. The study also supports theory of how structures and processes of social relationships work in relation to good health; and can be applied to a camp setting.

Background: Almost one child a day is diagnosed with cancer in Sweden. When a child is affected with cancer a whole family, not least siblings will face a new way of life. A sibling’s relationship is unique and can only be fully understood by the ones that have experienced it themselves. There are many advantages in involving family in the caring of a child and also to see the family as a unit. Aim: The aim of the study was to illuminate siblings’ experiences of living in a family with a child with cancer. Methods: This is a literature review based on the result of ten scientific articles with qualitative approach. All articles have been examined to ensure the qualitative value of them and have been textual analyzed. Included articles have qualitative approaches to seek for depth and find siblings’ experiences. Chosen theoretical framework has been used to further lift the result. Results: Four main themes emerged from the result; altered living, need of information, anxiety and grief and support interventions. What these four have in common is that the way of life was altered. Conclusion: Siblings to a child with cancer is an exposed group both physically, mentally and emotionally. There are still gaps to fill regarding what nurses can do to identify and meet siblings needs during a cancer period and altered living. Clinical significance: This literature review can contribute to enhanced knowledge about what it is like being a sibling to a child with cancer. Key words: siblings, cancer, altered living / Bakgrund: I Sverige drabbas nästan ett barn varje dag av cancer. När ett barn drabbas avcancer ställs en hel familj, inte minst syskonen inför en ny livsvärld. En syskonrelation är unikoch kan endast förstås av de som levt i en. Det finns många fördelar med att involverafamiljen i omvårdnaden av ett barn och att se familjen som en enhet. Syfte: Syftet medstudien är att belysa syskons upplevelse av att leva i en familj med ett cancersjukt barn.Metod: Detta är en litteraturstudie baserad på resultatet av tio vetenskapliga artiklar. Samtligaartiklar har kvalitetsgranskats och analyserats. Inkluderade artiklar har varit kvalitativa, dettaför att söka efter djup och finna syskonens upplevelser. Vald teoretisk referensram haranvänts för att ytterligare lyfta resultatet. Resultat: Fyra huvudteman framkom ur resultatet;förändrad vardag, behov av information, oro och sorg samt stödinsatser. Det gemensammaför dessa teman är att livsvärlden blev förändrad. Slutsats: Syskonen till barn med cancer ären utsatt grupp så väl fysiskt, psykiskt som emotionellt. Fortfarande finns kunskapsluckor omhur sjuksköterskor ska identifiera och bemöta syskonens behov under cancerperioden och ideras förändrade livsvärld. Klinisk betydelse: Denna litteraturstudie kan bidra till ökadkunskap om hur det är att vara syskon till ett barn med cancer.

This study explores the relationships that emerge between socioeconomic status (SES) and the prevalence of several health outcomes in children of different ages utilizing administrative data housed at The Manitoba Centre for Health Policy (MCHP). This research also determines the effect that family has on a child developing (or not developing) a specific health outcome. Finally, the relationship between prevalence and familial aggregation are examined. The Johns Hopkins ACG(r) Case-Mix System grouped various physician and hospital diagnosis codes into 32 Aggregated Diagnostic Groups (ADGs). Eight of these ADGs were assessed at four age groups (0-3, 4-8, 9-13 & 14-18) for each member of the final study population. Each member was assigned to one of six SES groups, five income quintile groups and one social assistance group. Familial aggregation was determined for eight selected ADGs using an intraclass correlation coefficient (ICC). Statistical contrasts were made for SA vs. Q1-Q5 and an overall linear trend (SA – lowest; Q5 – highest) to establish the SES differences for the prevalence and familial aggregation of a particular condition. Many of the conditions across SES had statistically significant (p<0.05) linear and SA vs. Q1-Q5 contrasts for 3 both ICCs and prevalence at all age groups. Of the eight ADGs that familial aggregation was calculated, chronic conditions related to the eye had the highest ICCs at all age groups. Injury ADGs had consistently lower ICCs for all age groups. Factors that affected the results of ICC estimation for binary outcomes include the number of bootstrap selections, the width of the age group and the event rate for the outcome of interest. Suggested future research includes a validity review of ICC estimates for binary outcomes, exploring the variables that may reduce or eliminate the SES gradient for ICCs and exploring the aggregation for different study samples within Manitoba.

Bakgrund: Människor som inkluderas i varandras liv har stor påverkan på varandra. Varje gång ett barn insjuknar i cancer drabbas således hela barnets familj. Familjerelationer och vardagen blir turbulent jämfört med den trygghet familjen vanligtvis erbjuder och de friska syskonen hamnar ofta i skymundan. Syskonen drabbas, till följd av situationen, utav såväl somatiska som psykologiska problem och kan behöva hjälp av stödinsatser för att kunna ta sig igenom vardagen. Syfte: Att beskriva resultatet av stödinsatser som finns för syskon till cancersjuka barn. Metod: En litteraturstudie baserad på 10 vetenskapliga artiklar med kvalitativ (2), kvantitativ (6) och mixad (2) ansats. Resultat: Effekter från tre typer av stödinsatser presenteras. Stödgrupper, syskonläger och individuella stödinsatser visar alla en signifikant minskning av ångestsymtom, PTSD, psykisk stress, depressiva symtom, rädsla och isolering. Stödinsatserna resulterade i ökad livskvalitet, självkänsla, självuppfattning och kunskap om sjukdomen. Syskonenen upplevde samhörighet med övriga grupp- och lägerdeltagare samt sin egen familj. Grupptillhörighet visade sig vara betydelsefull. Slutsats: Studien visar att stödinsatser har en positiv effekt på syskon till cancersjuka barn där ökad kunskap, sammanhållning och grupptillhörighet var bidragande faktorer. Resultatet speglar vikten av familjefokuserad omvårdnad. Klinisk betydelse: Sjuksköterskor har en viktig roll i den familjecentrerade vården. Sjuksköterskor bör kunna identifiera syskon som mår dåligt och rekommendera dem till lämpliga stödsatser. / Background: People who are included in each other's life, have a great influence on one another. Every time a child is diagnosed with cancer the child's whole family is affected. Family relationships and everyday life becomes turbulent compared to the security the family usually offers and the healthy siblings often end up neglected. Because of this, these siblings face both somatic and psychological problems and may need support to get through everyday life. Aim: To describe the outcome of supporting interventions available for siblings of children with cancer. Methods: A literature review based on 10 scientific articles with a qualitative (2), quantitative (6) and mixed (2) approach. Results: The outcome of three types of support interventions is presented. Support groups, sibling camps and individual support actions all show a significant decrease in anxiety symptoms, PTSD, mental stress, depressive symptoms, fear and isolation. These supportive interventions resulted in increased quality of life, self-esteem, self-perception and knowledge about the disease. Siblings experienced connectedness with the other group and camp participants and also with their own family. Group membership showed to be meaningful. Conclusion: The study shows that support interventions have a positive effect on siblings of children with cancer where knowledge, cohesion and group belonging were contributing factors. The result reflects the importance of family-focused nursing. Clinical Implications: Nurses have an important role in family-centered care. The nurse should identify siblings who feel bad and consequently recommend suitable support interventions.

Exposure to domestic violence in childhood has serious consequences for children’s health and well-being and is an important predictor of domestic abuse. However, as compared to other forms of domestic abuse, the effects of exposure to domestic violence on the quality of sibling interactions have been relatively underexplored. The major objective of the current study was to examine the impact of exposure to domestic violence on the quality of the sibling relationship, and to better understand the influence of age and gender on sibling aggression. Social learning theory and family systems theory were the guiding frameworks for this study. Participants consisted of 47 school-aged sibling dyads with a history of exposure to domestic violence recruited from the community. Aggressive behaviour was measured by standardized questionnaires completed by mothers and children and by observations of naturalistic sibling interactions. As predicted, analyses of observed aggression which controlled for exposure to domestic violence revealed brothers were significantly more aggressive than sisters or mixed gender dyads. Unexpectedly, analyses of observed aggression found that boys were significantly more aggressive with their siblings than their female counterparts when exposure to maternal violence was taken into account. Findings indicate that children exposed to domestic violence, especially boys, may be at greater risk for aggressive behaviour. Results are expected to be useful for practice and future research.

The needs and concerns of the siblings of children who are deaf-blind were studied. Subjects included 12 siblings (eight males, four females) whose families are involved in the Utah Intervener Services Program. Information was collected by conducting one-on-one interviews with the siblings. The Siblings' Perceptions of the Intervener Interview (SPII) and Taylor's Siblings' Problems Questionnaire were administered. The results indicated that individual sibling's perspectives were unique, varying from positive to negative. As a group, the siblings made positive comments about the intervener and their life with their deaf-blind brother or sister.

Bone marrow transplantation (BMT) is the treatment of choice for many malignancies and other childhood disorders. Acknowledging that the entire family is affected when a child undergoes a BMT, increasing research attention has been given to understanding this experience from the perspectives of recipients, parents and the family as a whole. Yet, minimal attention has been directed at understanding the experience of healthy siblings as they transition through the BMT experience. Before intervention studies can be undertaken that will help healthy siblings transition through the BMT experience, knowledge about the impact of the experience on siblings is needed. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit detailed descriptions of the lived experience of siblings. Participants were children, adolescents and young adults with a sibling who had undergone a BMT during childhood. Participants were recruited from a pediatric BMT clinic in Western Canada. Semi-structured, open-ended interviews that explored siblings’ memories about what it is like to be a sibling of a child who has had a BMT were conducted with each participant. Demographic data and field notes were recorded. All interviews and field notes were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of siblings’ lived experience of transitioning through the BMT trajectory as an interruption in family life. Four themes communicated the essence of siblings’ lived experience: (1) life goes on, (2) feeling more or less a part of a family, (3) faith in God that things will be okay, and (4) feelings around families. Differences between donor and non-donor siblings are highlighted. Siblings’ recommendations for health care professionals are also provided. Results from this study will help health professionals better anticipate the diverse and shifting needs and demands of siblings of pediatric BMT patients. Recommendations for future research and innovations in nursing interventions are provided.

Exposure to domestic violence in childhood has serious consequences for children’s health and well-being and is an important predictor of domestic abuse. However, as compared to other forms of domestic abuse, the effects of exposure to domestic violence on the quality of sibling interactions have been relatively underexplored. The major objective of the current study was to examine the impact of exposure to domestic violence on the quality of the sibling relationship, and to better understand the influence of age and gender on sibling aggression. Social learning theory and family systems theory were the guiding frameworks for this study. Participants consisted of 47 school-aged sibling dyads with a history of exposure to domestic violence recruited from the community. Aggressive behaviour was measured by standardized questionnaires completed by mothers and children and by observations of naturalistic sibling interactions. As predicted, analyses of observed aggression which controlled for exposure to domestic violence revealed brothers were significantly more aggressive than sisters or mixed gender dyads. Unexpectedly, analyses of observed aggression found that boys were significantly more aggressive with their siblings than their female counterparts when exposure to maternal violence was taken into account. Findings indicate that children exposed to domestic violence, especially boys, may be at greater risk for aggressive behaviour. Results are expected to be useful for practice and future research.

This study explores the relationships that emerge between socioeconomic status (SES) and the prevalence of several health outcomes in children of different ages utilizing administrative data housed at The Manitoba Centre for Health Policy (MCHP). This research also determines the effect that family has on a child developing (or not developing) a specific health outcome. Finally, the relationship between prevalence and familial aggregation are examined. The Johns Hopkins ACG(r) Case-Mix System grouped various physician and hospital diagnosis codes into 32 Aggregated Diagnostic Groups (ADGs). Eight of these ADGs were assessed at four age groups (0-3, 4-8, 9-13 & 14-18) for each member of the final study population. Each member was assigned to one of six SES groups, five income quintile groups and one social assistance group. Familial aggregation was determined for eight selected ADGs using an intraclass correlation coefficient (ICC). Statistical contrasts were made for SA vs. Q1-Q5 and an overall linear trend (SA – lowest; Q5 – highest) to establish the SES differences for the prevalence and familial aggregation of a particular condition. Many of the conditions across SES had statistically significant (p<0.05) linear and SA vs. Q1-Q5 contrasts for 3 both ICCs and prevalence at all age groups. Of the eight ADGs that familial aggregation was calculated, chronic conditions related to the eye had the highest ICCs at all age groups. Injury ADGs had consistently lower ICCs for all age groups. Factors that affected the results of ICC estimation for binary outcomes include the number of bootstrap selections, the width of the age group and the event rate for the outcome of interest. Suggested future research includes a validity review of ICC estimates for binary outcomes, exploring the variables that may reduce or eliminate the SES gradient for ICCs and exploring the aggregation for different study samples within Manitoba.