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.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Para melhor avaliar a transmissÃo interfamiliar da infecÃÃo por H. pylori durante a infÃncia, foi investigada a prevalÃncia de infecÃÃo por H. pylori em famÃlias de uma comunidade urbana pobre de Fortaleza no Cearà com alta prevalÃncia de H. pylori . A infecÃÃo por H. pylori foi investigada em 570 membros de 128 famÃlias dessa comunidade, atravÃs do teste respiratÃrio marcado com 13C-urÃia em crianÃas e atravÃs do teste ELISA em mÃes e outros parentes adultos. A prevalÃncia geral da infecÃÃo por H. pylori em todos os indivÃduos analisados foi 65.9% (376/570) a qual aumentou com a idade (p <0,001) variando de 28,9%, em crianÃas de 6 meses a 5 anos, para 82% em adultos com mais de 40 anos. A existÃncia de infecÃÃo materna e o nÃmero de irmÃos infectados foram fatores de risco independentes para a infecÃÃo por H. pylori na infÃncia (OR = 2,2, IC95% = 1,0-4,6 e OR = 4.3, IC95% = 2,3-8,1, respectivamente). O nÃmero de irmÃos, nÃmero de irmÃos mais novos, e o nÃmero de irmÃos mais novos infectados tambÃm foram associados à infecÃÃo na infÃncia atravÃs da anÃlise univariada. O nÃmero de irmÃos mais novos infectados permaneceu independentemente associado com a infecÃÃo (p = 0,000), mesmo apÃs o controle de todas as variÃveis acima citadas, alÃm do status H. pylori de irmÃos e mÃes, idade, nÃmero de pessoas por quarto, e nÃmero de crianÃas no mesmo domicÃlio / To further evaluate interfamilial transmission of H. pylori infection during childhood, we investigated the prevalence of H. pylori infection in family members from a poor H. pylori high prevalence urban community in the Northeast of Brazil. H pylori infection was investigated in 570 members of 128 households, by 13C-urea breath test in children and by ELISA in mothers and other adult relatives. The overall prevalence of H. pylori infection 65.9% (376/570) increased with age (p < 0.001) and ranged from 28.9%, in children aged 6 months to 5 years to 82% in adults over 40 years. An H. pylori positive mother and the number of infected siblings are independent risk factors for childhood H. pylori infection (OR = 2.2, 95% CI = 1.0-4.6 and OR = 4.3, 95% CI = 2.3-8.1, respectively). The number of siblings, number of younger siblings, and number of infected younger siblings were also associated with the infection in the univariate analysis. The number of infected younger siblings remained independently associated with the infection (p=0.000), even after controlling for all the above cited variables, in addition to the H. pylori status of siblings and mothers, age, number of people per room, and number of children in the household. The transmission of H. pylori occurs from infected mothers to their offspring and among siblings, notably from younger siblings to the older ones.

Death of a child is a very painful experience for parents and remaining siblings who experience physiological and emotional symptoms as described by the parents. There are few reports from the remaining siblings on their physical and emotional health and even less data on their treatments and associated health care costs after sibling loss. The purpose of this study in children who have lost a sibling in the NICU/PICU, ER or those who have been sent home on technology dependent equipment to die, is to compare parents’ and children’s perceptions of the surviving sibling’s health, identify factors related to these perceptions, and describe treatments for the sibling’s physical and mental health at 2 and 4 months after a sibling’s death. Sixty four surviving siblings and their parents reported on the siblings’ mental and overall health. Available treatment charges (visits to the emergency room, physician office, hospitalization, and any health services (mental & physical) since the sibling death were collected from bills and insurance receipts. Cause of child death (acute or chronic) was collected from the deceased child’s hospital record. The relationship between parent and sibling’s perception of the surviving sibling’s health, and anxiety and depression at 2 and 4 months post the death were measured using the Children’s Depression Inventory and the Spence Anxiety Scales. Data were analyzed using: T-Tests, ANOVA, Pearson correlations, frequencies and descriptive statistics. Findings indicated that at 2 and 4 months parent’s perceived their surviving siblings’ health to be better than the child perceived his/her health to be. At 4 months fathers rated the siblings’ health compared to their peers lower than the siblings. Greater child anxiety was related to lower father’s ratings of the child’s health now and compared to peers. Treatments and charges increased from 2 months to 4 months with males having more treatments than females. The majority of the treatments consisted of routine physician visits, non-routine physician visits, emergency room/urgent care visits and counseling. Study findings can help guide healthcare providers and educators in identifying those children that are at high risk for negative health effects after the death of a sibling.

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Siblings are the longest lasting relationships most individuals may experience in their life. What makes sibling relationships unique is the overlap of both shared and unshared experiences. While there is limited research on the mechanisms behind sibling relationships in general, research on Latino/a/x sibling relationships is even more limited. The limited research on Latino/a/x siblings from immigrant families has found they have an impact on each other's cultural adaptations. The current study explored the influence of the acculturation cultural adaptation processes to the U.S. and how this adaptation may impact Latino/a/x sibling relationships. Semi-structured dyadic interviews were conducted with eight sibling dyads (N = 8) and dyadic analysis methods from Tkachuk et al. (2019) were used to analyze the qualitative data. The findings suggest that the sibling relationship is influenced by parental and cultural expectations, unique experiences pertaining to growing up (e.g., sibling positionality), and their shared experiences of growing up in the United States (i.e., shared cultural navigation). Findings regarding the importance of family are congruent with current literature on Latino/a/x immigrant families and a new finding that emerged related to the validation of younger siblings on the experiences of the older siblings. Clinical implications suggest clinicians familiarizing themselves with cross-cultural sibling relationships and the benefits of having siblings in therapy. Limitations and recommendations for future study are discussed. / Master of Science / The Latino/a/x population is among the fastest growing immigrant populations in the United States. There is vast research on immigrant families that emphasize the acculturation processes as crucial to understanding how these families blend multiple cultures. Most of the research of acculturation and its influence on familial relationships focus on parent-child relationships and limited research has been done on the influence of this phenomenon on other family relationships, including sibling relationships. Siblings relationships can be the longest lasting relationship an individual can have in their lifetime and what makes this relationship unique is the overlap of both shared and unshared experiences. The limited research on Latino/a/x siblings from immigrant families has found that siblings have an impact on each other's cultural adaptations. The current study explored the influence of the acculturation cultural adaptation processes to the U.S. and how this adaptation may impact Latino/a/x sibling relationships. Semi-structured dyadic interviews were conducted with eight sibling dyads (N = 8) and dyadic analysis methods from Tkachuk et al. (2019) were used to analyze the qualitative data. The study's findings highlight that the sibling relationship is influenced by parental and cultural expectations, unique experiences pertaining to growing up (e.g., sibling positionality), and their shared experiences of growing up in the United States (i.e., shared cultural navigation). Given these findings, clinical implications suggest clinicians familiarizing themselves with cross-cultural sibling relationships and the benefits of having siblings in therapy. Limitations and recommendations for future study are discussed.

Globally, in both developed and developing countries, the twinning rates have increased since the early 70’s. A large proportion of twins are born preterm and/or small-for-gestational-age (SGA) and/or with a low birth weight. Several studies have been performed on the long-term effect of these non-optimal birth characteristics on future reproductive performance and morbidity. Yet, most studies exclude twins or higher order pregnancies and thus the findings are based on singleton pregnancies only. The aim of the present thesis was therefore to investigate the impact of non-optimal birth characteristics in terms of preterm birth, small-for-gestational age, and low birth weight, on the reproductive pattern and morbidity among twins and singletons Furthermore, the present thesis attempted to establish whether twins and singletons were affected in the same manner. The studies included in this thesis are prospective population-based register studies, including all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1983 (1,000,037 singletons and 16,561 twins) for the first three studies with follow-up till the end of 2006 and 2009. The last study included all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1993 (2,051,479 singletons and 39,726 twins) with follow-up till the end of 2012. In general, twins were found less likely to reproduce between 13 and 33 years of age compared with singletons. Stratifying data by different birth characteristics, it was found that twins had a lower likelihood of reproducing on several different birth characteristics (appropriate-for-gestational-age, normal birth weight, low birth weight, term birth, preterm birth). However, twins born very preterm had an increased likelihood of reproducing compared with singletons born very preterm. Not taking birth characteristics into account, twinning was associated with a higher degree of hospitalization. However, accounting for the diverging birth characteristics this difference diminished and for some diagnoses the relationship was reversed such that twins were actually less likely to be hospitalized compared with singletons. In terms of the heritability of non-optimal birth characteristics singleton mothers born preterm were more predisposed to give birth to a child that was preterm while singleton mothers born SGA more often gave birth to a child either born preterm or SGA. Among twins this heritability was not as evident. The only difference observed was among twin mothers born SGA who were more likely to give birth to a child born SGA. In the extended cohort comprising those born between 1973 and 1993, male and female twins were found to be less likely to become parents compared with singletons. No difference was found among women in terms of having a second child, while male twins were more likely to have a second child compared with male singletons. It was also found that the likelihood of becoming a first-time parent and second-time parent was positively associated with the number of siblings.

T lymphocytes and macrophages appear to play an important role in mediating ß-cell damage and causing Type 1 diabetes. Both activated T cells and macrophages operate and interact through the release of soluble factors called cytokines, which influence the type and magnitude of immune responses. It has been suggested that cytokines such as TNF-α and IL-1α can damage the N-cell directly. In Type 1 diabetes, cytokines are likely to have a critical role in individuals whose immune system is unbalanced allowing the emergence of self-destructive processes. To investigate this possibility, sensitive assays to detect a range of cytokines of potential relevance to the immune pathogenesis of diabetes were establised. Using these, serum levels of IL-1α, IL-1N, TNF-α and IL-6 (macrophage-derived cytokines), IFN-γ and IL-2 (T helper 1 cytokine profile) and IL-4 and IL-10 (T helper 2 profile) have been measured in patients with Type 1 diabetes of different disease duration. Increased levels of TNF-α, IL-1α, IL-2 and IFN-γ were found in recently diagnosed patients with Type 1 diabetes when compared with both disease and metabolic control subjects and with normal controls. The presence of this profile of cytokines implies activation of the TH1 subset of helper cells near to diagnosis of Type 1 diabetes

This thesis addresses to what extent childhood family composition – the number of siblings and whether the parents live together, or whether there are non-parental adults and/or half-siblings in the household or not – contributes to variations in adult earnings. The theoretical perspective suggests that resources mediate the effect. While research has shown that siblings, as well as divorce and remarriage, are negatively linked to child outcomes, there are inconsistencies in previous literature. There has been debate over the unconfoundedness of previous studies, something that is handled here by analyzing large sets of representative data using a robust parameter. The longitudinal dataset used is based on Swedish administrative data and the cohorts analyzed are born in the beginning of the 1970s. The data structure is well suited for the assumptions underlying the semi-parametric method propensity score matching. The findings show that family size impacts on adult earnings. However, this is not always of concern. For example, no effect of siblings is found in affluent families, and if siblings are closely spaced this results in better outcomes for children. Divorce and remarriage do not seem to lower the future earnings of children. Thus, this thesis shows that some of the most well-established patterns in the sociology of the family, namely the link between number of siblings and adult earnings, and between divorce/family re-formation and adult earnings, can be broken by resources.