BackgroundGenetic factors play an important role in Alzheimer's Disease development. Specifically, the apolipoprotein E (APOE4) gene has the strongest associated risk factor for disease development and drastically increases risk in patients who are homozygous for the gene. APOE4 is involved in lipid metabolism and contributes to Alzheimer's by forming amyloid‐beta protein and neurofibrillary tangles in the brain. In terms of risk reduction, there are studies outlining various lifestyle modifications like specific diets and regular exercise.MethodCase StudyResultThis case focuses on a 69‐year‐old female with new onset memory loss and genetic testing revealing her to be homozygous for the APOE4 gene. She has two older siblings who were both diagnosed with early onset Alzheimer's disease and who were also homozygous for the APOE4 gene. The siblings presented with clinically significant cognitive impairments at ages 62 and 64. When the current patient learned of her genetic status and watched her siblings' cognition deteriorate, she made major lifestyle changes to try and prevent the disease. The patient quit her job to focus on daily exercise, healthy sleep habits, and stress reduction. She additionally began following a vegan diet prioritizing fruits, vegetables, and healthy fats. Currently, the patient's clinical symptoms are progressing significantly slower in comparison to her siblings, and she has not yet been given an official diagnosis of Alzheimer's disease.ConclusionAround 2% of the world's population is homozygous for APOE4, making it increasingly rare for three siblings within one family to present with this genetic makeup, two of whom go on to develop early onset Alzheimer's disease. Further medical testing is warranted regarding the current patient's cognitive status and biomarkers for Alzheimer's Disease. This case study could contribute to a greater understanding of protective lifestyle changes that delay Alzheimer's disease, specifically in patients who are homozygous for the APOE4 gene.

Extensive research has focused on parent advocacy, but the advocacy efforts of siblings of autistic individuals remain less studied. This study aims to identify the correlates of individual and systemic advocacy among siblings of autistic individuals. Using a national survey, 256 adult siblings of autistic individuals indicated their advocacy activities. Descriptive statistics and hierarchical regressions were used for analyses. Results indicated that, although siblings often engaged in both individual and systemic advocacy, they present as distinct constructs with varying correlates. Older siblings who engaged in future planning and/or were knowledgeable about disability policy were more likely to conduct individual advocacy. Systemic advocacy was greater among siblings more connected to the disability community and had reciprocal exchanges of tangible support.

Actinidia arguta, also known as mini kiwi (due to its small size) or hardy kiwi (due to its frost resistance), is becoming an increasingly popular fruit alongside its commercially older siblings, i.e., A. deliciosa (green kiwi fruit) and A. chinensis (golden kiwifruit), from the Actinidiaceae family. This review paper discusses the biological and pharmacological properties of A. arguta fruits, with a special focus on methods of the bioactive component analysis. Mini kiwi is a valuable source of bioactive compounds, which contribute to its health-promoting properties, among others: antioxidant, neuroprotective, anticholinergic, antitumor, anti-inflammatory, antidiabetic, antiobesity as well as antiatherosclerotic ones. They are briefly discussed, illustrating the action of bioactive ingredients and the methods of analysis, which are presented in the tables. This review includes a concise characterization of A. arguta and updates the current field of knowledge about its diverse biological activities, which are undoubtedly related to the content of bioactive components and the methods used for their isolation and analysis. The information included in this review paper will be helpful in perceiving mini kiwi not only as a tasty fruit but also as a source of bioactive ingredients with beneficial, health-promoting effects on the body. Effective isolation of these components can contribute to the future development of antiaging and anticancer drugs, which undoubtedly will lead to further research and promote this species.

Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations, and preterm infants and those with older siblings are at increased risk. Despite recommendations for nirsevimab prophylaxis, data on outcomes in high-risk infants are lacking. To assess the association of nirsevimab prophylaxis with RSV-related lower respiratory tract infection (LRTI) hospitalization risk and in-hospital severity among infants, overall and by high-risk groups. This retrospective multicenter cohort study comparing RSV seasons before (April 1, 2023, to March 31, 2024) and after (April 1, 2024, to March 31, 2025) universal nirsevimab prophylaxis implementation included all live births from 5 neonatal hospitals serving the Italian provinces of Ravenna, Faenza, Forlì, Cesena, and Rimini with no exclusions based on gestational age or comorbidities. Participants were followed up from hospital discharge until first RSV hospitalization, first birthday, or season end, with time-to-event analysis. Data from centralized electronic medical records included demographics, nirsevimab administration, and polymerase chain reaction-confirmed RSV. Nirsevimab prophylaxis vs no prophylaxis. The primary outcome was RSV-associated hospitalization in the first year of life. The secondary outcome was LRTI severity measures-hospital length of stay, high-flow nasal cannula (HFNC) use, and intensive care unit (ICU) admission. Hierarchical Cox proportional hazards regression models (with health care center as a random effect) were used to adjust for seasonality and relevant covariates, with sensitivity analyses using multiple models and non-RSV LRTI comparisons. Among 13 624 newborns (mean [SD] gestational age of 39.4 [1.8] weeks; 51.4% male, 4.8% preterm, and 49.5% with older siblings), nirsevimab prophylaxis achieved 79.2% coverage of the study population. Among 292 infants hospitalized with RSV LRTI (2.1%), fewer were in the postnirsevimab than prenirsevimab season group (72 [24.7%] vs 220 [75.3%]; P < .001), with a population-level reduction in hospitalization hazard (hazard ratio [HR], 0.32; 95% CI, 0.25-0.44; P < .001). In a separate within-month analysis comparing infants born in the same calendar month and therefore at similar baseline RSV risk, nirsevimab prophylaxis was associated with a lower hazard of RSV hospitalization (HR, 0.11; 95% CI, 0.06-0.21; P < .001). Prematurity (HR, 2.93; 95% CI, 2.11-4.07; P < .001) and living with older siblings (HR, 4.57; 95% CI, 4.15-5.03; P < .001) remained associated with higher hospitalization risk among infants who received prophylaxis. Among hospitalized infants, nirsevimab was associated with reduced HFNC use (OR, 0.33; 95% CI, 0.11-0.97; P = .04) but not with shorter stays (incidence rate ratio, 0.81; 95% CI, 0.63-1.03; P = .09). In this multicenter cohort study, nirsevimab prophylaxis was associated with substantially lower RSV hospitalization risk and reduced in-hospital RSV severity, supporting its implementation as a public health strategy. However, the persistent risk associated with prematurity and household RSV exposure suggests a need for supplemental approaches to optimize RSV prevention in high-risk infants.

This study examines how parental leadership, entrepreneurial self-efficacy, and entrepreneurial resilience—viewed through social capital theory—shape intentions around family business succession in Saudi Arabia. It also investigates the moderating role of the presence of older siblings, exploring how family dynamics affect the transfer of social capital and the likelihood of succession. This research employs structural equation modeling to analyze data from 522 respondents in Saudi Arabia. Entrepreneurial self-efficacy emerges as a key factor in shaping intentions around family business succession, highlighting the importance of psychological resources in this process. The moderating analysis shows that the presence of older siblings weakens the impact of parental guidance and entrepreneurial traits on intentions around family business succession, possibly due to competition among siblings for leadership roles in the family firm. These findings underscore the need for family businesses to strategically manage the distribution of social capital, especially in households with multiple siblings. Initiatives that enhance entrepreneurial self-efficacy and resilience can improve preparedness for succession. Moreover, addressing sibling rivalry through structured succession planning and conflict resolution mechanisms is essential for maintaining business continuity in the Saudi context. Based on social capital theory, this research offers a new perspective on how a family’s resources, networks, and relationships influence intentions around family business succession. Emphasizing the moderating role of sibling dynamics provides useful insights into managing family business transitions in Saudi Arabia, where family ties and social capital are vital.

Day care attendance is known to be an important source of infection transmission in children. Having older siblings has also been shown to increase the risk of recurrent infections. We use comprehensive register data to study if the cumulative antibiotic use in children differs according to the duration of how long the child has been in home care before entering day care. The study focuses on children born in Finland between 2000 and 2005, with follow-up until age 12. Children are linked to their biological parents, and the analysis includes control variables such as mother’s age and education level. In addition to descriptive evidence, we employ statistical models to study the association between the duration of home care and antibiotic exposure. The results show that almost all children were exposed to prescribed antibiotics within the first 12 years of their life. One fifth of the children had more than 15 antibiotic purchases by the age of 12. Four most commonly prescribed antibiotics were amoxicillin, azithromycin, cefalexin, and amoxicillin with beta-lactamase inhibitor. The results from Poisson regression model affirmed that cumulative use was lower in children with longer home care duration. Regardless of the number siblings, the number of cumulative antibiotic purchases remained lowest in the group of children with the longest home care period, and the results remained robust after controlling for the mother’s age and education, and immigrant background. These findings contribute to a broader understanding of how early childhood care arrangements may be associated with long-term patterns of antibiotic use, with potential relevance for public health planning and antimicrobial stewardship.

Experiences of siblings of children with chronic health conditions: A qualitative study in the Australian context.

The dynamic relationships between children’s, parents’, and siblings’ mental health have yet to be systematically explored. The present study employed network analysis to investigate concurrent and longitudinal associations of mental health symptoms in children during early childhood and their parents and siblings. A total of 3750 cohort members (47.9% female; Mage = 3.1 at T1), along with their mothers, fathers, and older siblings from the Millennium Cohort Study (MCS), were assessed for mental health problems at two waves spaced two years apart. Contemporaneous networks revealed extensive associations between intra-individual and inter-individual symptoms within the family. The older siblings’ symptoms were the strongest bridging symptoms connecting to their younger siblings. Temporal networks demonstrated directional effects from parent to child, father to mother, and older sibling to younger sibling. Maternal depressive feelings exhibited the strongest predictive effect in the family network. Overall, our findings suggest the spillover effect of mental health problems within families, underscoring the need to consider the psychological symptoms of other family members when treating individual symptoms.

Major gut microbiota perturbations in firstborn infants compared to those with older siblings soon after delivery.

Abstract Background Globally, it has been estimated that 10 to 25 percent of children under 18 years of age old have a special health care need. Having a sibling with special health care needs can have diverse effects. This study describes existing literature on the health and well-being of siblings of children and youth with special health care needs (CYSHCN). Methods This scoping review of reviews includes a comprehensive search of reviews focusing on the health and well-being of siblings of CYSHCN. We searched the Scopus and Epistemonikos databases from 2014 to 2024 and found 8648 unique results. Results 25 articles met our inclusion criteria. Three major themes were identified: siblings as carers and invisible family members, positive effects of growing up with CYSHCN, and psychosocial challenges. Some findings indicated siblings felt marginalized and neglected in their families. The siblings take on increased responsibilities, which can influence their wellbeing. While developing greater empathy, patience, and maturity, many experienced psychological issues such as anxiety. Social difficulties, such as lower overall social wellbeing, behavioral problems and challenges at school are also more common than for siblings of typically developing children. Girls, older siblings and minorities showed higher risk of negative effects. Evidence on physical health challenges was limited. Results on quality of life varied by child's condition and the severity of it. Conclusions Siblings CYSHCN face significant challenges and require support. However, the positive aspects of growing up with CYSHCN are equally meaningful. Professionals working with these families should focus on supporting siblings as individuals. Further research is needed on the siblings’ physical health, as well as how their intersecting roles within the family and society affect their wellbeing. Supporting these families better requires research on the pathways behind the outcomes. Key messages • Siblings of children and youth with special health care needs (CYSHCN) face significant challenges, but also experience meaningful personal growth. Siblings should be supported as individuals. • More research is needed on the physical health of siblings of CYSHCN. There is also a need for intersectional research to inform better public policies.

Introduction. Bronchiolitis is the leading cause of Emergency Room (ER) visits and hospitalizations in infants, primarily due to Respiratory Syncytial Virus (RSV) infection [1,2]. The COVID-19 pandemic, along with the associated non-pharmaceutical interventions, led to a marked decline in bronchiolitis cases during the 2020–2021 season [3]. However, in 2021, a resurgence of RSV resulted in a double increase in bronchiolitis-related hospital admissions in several countries [4]. In Italy, data on bronchiolitis trends after COVID-19 remain limited. A multicentre study from 27 hospitals in Lombardy [5] and a single-centre study from Genoa [6] both suggest increased hospitalizations and ER visits in recent seasons but relaying on data limits a comprehensive national understanding. Objectives. This study aims to analyse the impact of the COVID-19 pandemic on bronchiolitis-related Emergency Room (ER) visits in infants aged 0–6 months in Lombardy, Italy. It also explores potential factors underlying any observed changes, including shifts in population demographics, variations in disease severity, alterations in age distribution, and the effects of COVID-19 on infant susceptibility. Methods. We used linked administrative data on healthcare utilization covering the entire population of residents in Lombardy. Two distinct cohorts were analysed: a paediatric cohort of one million births for descriptive trend analyses to assess the indirect effects of COVID-19, and a maternal-paediatric cohort for hypothesis-driven analyses on the potential direct effects. We calculated incidence rates (IRs) of bronchiolitis-related ER visits between 2012 and 2023, using hospital admissions as a proxy for more severe disease. Due to the lack of swab testing in newborns, we used maternal COVID-19 vaccination as a proxy to investigate direct effects. Multivariable-adjusted logistic regression was employed to assess the association between COVID-19 vaccination before or during pregnancy and bronchiolitis-related ER visits in the first six months of life. To evaluate whether any observed associations could be explained by underlying family-level factors, we applied a negative control design, comparing ER visit rates in older siblings born to mothers who were later vaccinated with those born to mothers who remained unvaccinated. Results. Bronchiolitis incidence rates (IRs) showed a marked shift after 2020, with rates dropping to near zero in 2020–2021, then doubling in 2021–2023 compared to pre-pandemic levels, increasing from 2 to ≥4 per 100 person-time, as shown in Figure 1. In exploring potential explanations for this change, we ruled out shifts in population demographics, disease severity (hospital admissions remained consistently at half the IR of ER visits, as illustrated in Figure 1), and age distribution at the time of visits. Maternal COVID-19 vaccination before or during pregnancy was associated with a reduced risk of bronchiolitis-related ER visits in infants (adjusted OR = 0.59 [95% CI: 0.50–0.69]). The negative control analysis suggested that this association is unlikely to be fully explained by family-level confounding, as no similar association was observed in older siblings (adjusted OR = 1.50 [0.93–2.47]). Conclusions. Consistent with previous studies, our findings confirm the absence of bronchiolitis ER visits during the first COVID-19 lockdown and highlight the subsequent rise in cases during 2021–2023. The protective role of maternal COVID-19 vaccination on infant bronchiolitis strongly suggests that (pre- or post-natal) SARS-CoV-2 infection contributes to explaining the large increase in incidence post-pandemic.

Siblings are an important part of an individual’s early-life environment and may therefore play an important role in shaping an individual’s survival. The quantification of sibling effects on survival is challenging, however, especially in long-lived species with extended parental care and overlapping generations, such as humans. Here, we use historical parish data from Switzerland to quantify how the number of older siblings and their survival status, age and sex are associated with childhood survival. Across 2941 focal individuals born between 1750 and 1870, the total number of older siblings did not predict an individual’s childhood survival probability. However, distinguishing between siblings by their survival status, age and sex revealed several associations, which in some cases also interacted with the sex of the focal individual: while older brothers close in age reduced the survival of girls (but not boys), having more older sisters close in age improved their younger sibling’s survival. Our results therefore suggest that older siblings play an important role in shaping early-life survival and highlight that the strength and direction of sibling-related associations are context-dependent and can arise through both biological and cultural factors.

Sandwich generation or sandwich generation is a condition where someone is in a pinch like a sandwich, this sandwich generation is in a pinch in the family from their parents and also from other family members such as their younger siblings or older siblings, a condition where someone who becomes a sandwich generation must support two family members while he also has to support himself in terms of food, education, health and so on, this phenomenon has occurred a lot because of the inability of parents to be truly ready to take on their great responsibilities as parents, so that it has an impact on their children or even grandchildren and subsequent generations.

BackgroundThis study examines gender differences in early childhood cognitive development in rural China, focusing on the role of sibling structure. While gender disparities have narrowed in recent decades, concerns remain regarding unequal household resource allocation in low- and middle-income countries, particularly in contexts shaped by traditional son preference.MethodsData from 1,320 children aged 3 to 7 years across 11 nationally designated poverty counties in the Qinling Mountain region of western China were analyzed. Cognitive ability was assessed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV). Descriptive statistics and multivariate regression models were employed to investigate the associations between sibling structure and cognitive outcomes by gender.ResultsA negative association was observed between the number of siblings and cognitive scores, with a substantially larger effect for girls. Gender disparities were also evident across sibling composition and age spacing: girls with older siblings, especially those within a three-year age gap, exhibited lower cognitive scores than boys. With respect to birth order, both boys and girls demonstrated first-born and last-born advantages, though the cognitive benefits were less pronounced for girls. These disparities are likely shaped by resource dilution, reduced parental investment, and lower educational expectations for girls.ConclusionsGender differences in early cognitive development persist in rural western China and appear to be significantly influenced by family structure. Traditional norms may continue to affect intra-household resource allocation, often to the detriment of girls. These findings underscore the need for gender-sensitive policy interventions aimed at promoting equitable early childhood development and supporting long-term human capital accumulation.Trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23599-y.

Understanding households in which very young children are contributing to the family.

ABSTRACT Aiming to examine social norms regarding secondborn's sharing behaviour after the reversal of the one-child policy, three studies were conducted to explore preschoolers’ sharing behaviours (Study 1, n = 88); their evaluations (Study 2, n = 93); and adults’ evaluations (Study 3, n = 535) of younger siblings’ sharing behaviour toward their older siblings, good friends, and strangers. The results showed that secondborn preschoolers tended to share more with older siblings and good friends than with strangers, while being indifferent to or making no distinction between older siblings and good friends. However, both preschoolers and adults tended to be more tolerant if secondborn preschoolers shared less with older siblings than with strangers or good friends. Overall, these findings suggest that the traditional norm of ‘older gives way to younger’ persists as a social norm in contemporary China, despite the growing emphasis on sibling interactions and fairness in sibling sharing.

Selection of a suitable donor for allogeneic hematopoietic stem cell transplantation (allo-HCT) has mainly relied on HLA matching and, to date, a matched sibling donor (MSD) remains the first choice. However, patients with acute myeloid leukemia (AML) are older and therefore tend to have older siblings. Haploidentical donors (HIDs) are easily available, and offspring are younger than siblings. As donor age has been associated with worse outcomes, a younger HID might be a better choice than an older MSD for older patients with AML who receive transplantation in first complete remission (CR1). From the European Society for Blood and Marrow Transplantation registry database, we selected patients with AML aged ≥60 years who received transplantation in CR1, either from MSD aged ≥50 years or HID ≤40 years. HIDs received posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis, and MSDs received in vivo T-cell depletion. A total of 1247 patients were identified, including 721 MSDs and 526 HIDs. In univariate analysis, HID was associated with lower relapse incidence (P = .01), higher nonrelapse mortality (NRM; P = .01). The 2-year probability of overall survival (OS), leukemia-free survival (LFS), and GVHD-free and relapse-free survival (GRFS) were 62.5%, 56%, and 47%, respectively for the all population. In multivariate analysis, we confirmed that HID was associated with less relapse but more NRM, which translated into similar OS, LFS, and GRFS. Based on this retrospective study, young HIDs led to less relapse but higher NRM than older MSDs after allo-HCT in an older population with AML in CR1.

Japan introduced a routine rotavirus vaccination programme in October 2020, and infants born in or after August 2020 were eligible to be vaccinated under full government subsidy. However, the effects of this programme on vaccination coverage and vaccination factors remain unclear. This study aimed to determine the changes in rotavirus vaccination coverage and factors among infants residing in a Japanese municipality before and after the introduction of routine rotavirus vaccinations. This retrospective cohort study was conducted using vaccination records, resident register data and medical claims data acquired from a municipality. We identified infants born between April 2019 and February 2022; infants born before August 2020 were analysed as 'pre-introduction', and infants born in or after August 2020 were analysed as 'post-introduction'. The pre-post changes in vaccination coverage were examined using an interrupted time-series analysis. To identify vaccination factors, we analysed the associations of sociodemographic and socioeconomic factors with rotavirus vaccination status using Poisson regression and modified least-squares regression analyses. The risk ratios and risk differences were estimated. We analysed 26 174 infants (pre-introduction: 12 532, post-introduction: 13 642). The introduction of routine rotavirus vaccinations was immediately followed by an increase of 11.24% in vaccination coverage. These increases were notable among infants with ≥3 siblings (40.47%) and infants covered by public assistance (60.65%). Next, infants with older siblings, younger mothers, single-mother households and use of public assistance were less likely to be vaccinated in the pre-introduction period. The post-introduction period showed generally similar trends in vaccination factors. However, the introduction of routine rotavirus vaccinations substantially reduced the impact of these factors on vaccination status. The introduction of the routine rotavirus vaccination programme improved vaccination coverage and reduced the impact of sociodemographic and socioeconomic factors on vaccine uptake.

The 2007-2009 economic recession was among the largest in U.S. history, which had reverberating impacts on families within the United States and globally. Latine families were among those most adversely affected economically, yet did not show increased negative outcomes in their psychosocial and physical health. Informed by the Family Stress Model and using a mixed methods approach, this study examined the qualitative experiences of 111 Mexican-origin families during this recession and its impact on their family relationships and adjustment. Ninety mothers (Mage = 44.07 years), 67 fathers (Mage = 47.03 years), 47 younger siblings (57% women; Mage = 17.74 years), and 50 older siblings (58% women; Mage = 21.06 years) specifically noted that the recession impacted their family via three broad themes: changes to family dynamics, strategies for managing financial hardship, and impacts on well-being. Additionally, we quantitatively assessed how early-recession sociodemographic, familial, and cultural characteristics related to participants' experiences. Parents who reported more positive adjustment strategies and well-being in their narratives reported having warmer parent-child relationships and more egalitarian gender role attitudes when the recession began. In addition, youths' higher religiosity was linked to more recession-related family conflict. Our findings highlight how family members work together to buffer the effects of economic hardship via reorganizing resources, fostering interdependence, placing family needs above one's own, and having flexibility in one's roles. As such, these findings have the potential to inform expansions of the Family Stress Model to capture resilience and strength in Mexican-origin families and inform culturally responsive programming in the future. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In Iran, few studies have been conducted on children's oral and dental indices and the effect of mothers' oral health literacy on these indices. This study was conducted with the aim of determining the level of mothers' oral health literacy (OHL) in relation to the oral health status of children attending dental clinics, compared to comprehensive health services. In this cross-sectional study conducted in Iran, we examined the oral health of 436 children aged 3-12 and their mothers. The study utilized the WHO's pathway model and the Fisher-Owens framework to assess structural, intermediate, and direct factors influencing oral health. Data were collected through clinical examinations and interviews, focusing on demographics, oral health literacy (Adult Oral Health Literacy Questionnaire), and behaviors (Children's Oral Health Behavior Questionnaire). The dental health assessment indicated moderate levels of decayed, missing, and filled teeth, affecting 42.6% of individuals in comprehensive health services and 45.7% in dental clinics. In both groups, children's oral health behavior improved with older siblings, age, and a smaller household size (p < 0.05). In dental clinics, higher maternal oral health literacy was linked to a lower incidence of dental issues (IRR = 0.73, p = 0.007). Children of mothers with higher education exhibited a lower incidence rate of dental problems compared to those with housewife mothers (IRR = 0.75, p = .001). Additionally, moderate oral health behavior in children correlated with a reduced incidence of dental issues compared to poor oral health behavior (IRR = 0.50, p = .001). The study's findings indicate that higher maternal oral health literacy is positively associated with improved oral health in children. This underscores the significance of educational initiatives designed to enhance mothers' understanding of oral health, ultimately contributing to better dental health outcomes for their children.