Offspring Of Survivors Research Articles

The intergenerational legacy of the 1959–1961 Great Chinese Famine on children’s cognitive development

We investigate the effect of early exposure to malnutrition on the cognitive abilities of the offspring of survivors in the context of a natural experiment; i.e., the Great Chinese Famine (GCF) of 1959–61. We employ a novel dataset – the China Family Panel Studies (CFPS) – to do so. The paper finds that the cognitive abilities of children whose fathers were born in rural areas during the famine years (1959–1961) were impaired by exposure to the GCF and the negative effect was greater for girls than boys, whereas children whose mothers were born in rural areas during the famine years were not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.

Survey and comparison of psychological factors between descendants and non-descendants of survivors of the atomic bomb: Generational differences in mental health indicators

BackgroundThe effects of the atomic bomb experience on survivors and their children have been a topic of human and research interest since early in the postwar era. The topic has centered around knowledge of physical health and studies on germline genetic effects in the second-generation offspring of survivors. However, comparatively little has been done to understand the psychological impact. PurposeThe present study focuses on generational factors related to the psychological makeup of second and third generation descendants of atomic bomb survivors. Specifically, this study takes depressive symptoms and factors related to health anxiety into consideration as mental health indicators to offer preliminary evidence that addresses this gap. ObjectiveData was collected from participants with and without familial affiliation to atomic bomb survivors stratified by age. This resulted in 50 participants that reported having at least one parent who was an atomic bomb survivor categorized as second-generation descendants, 50 participants with at least one grandparent that was an atomic bomb survivor, 50 unrelated participants within an age range of 50–69, and 50 unrelated participants within an age range of 30–49. MethodDepressive symptom severity among participants was examined with the Center for Epidemiologic Studies Depression Scale (CES-D), and health anxiety was examined using the Sense of Health Anxiety Scale (SHAS). ResultA significant difference was observed for participants without relatives who experienced the atomic bomb such that depressive symptom scores for second generation participants were higher than third generation participants (F (1, 197) = 8.38, p < .01, η2 = 0.04). A between-group difference for third generation participants with and without relatives who experienced the atomic bomb was observed such that third-generation participants with relatives had higher CES-D scores (F (1, 197) = 6.36, p < .01, η2 = 0.03). The levels of health anxiety did not differ between generations with or without relatives of atomic bomb survivors. ConclusionOur findings indicated a difference in depressive symptom tendencies between second and third generation individuals related to atomic bomb survivors. These results suggest that future studies examine the difference in psychological effects between generations as they relate to possible processes that lead to an increase in depressive symptoms.

Risk of somatic diseases in offspring of survivors with childhood or adolescent central nervous system tumor in Sweden

With the improvement of treatments, a growing number of survivors with childhood or adolescent central nervous system (CNS) tumor are parenting their own children. We aimed to explore the risk of somatic diseases among children of these survivors compared to population controls. Children of survivors with CNS tumor below age of 20 were identified between 1973 and 2014 by combining the several Swedish registers. Five children without parental CNS tumor were matched randomly to generate the population comparisons. Relative risk (RR) and absolute excess risk (AER) were calculated for overall somatic diseases, and hazard ratio (HR) was calculated for specific type of somatic diseases. A total of 2231 somatic disease diagnoses were identified in children of survivors with a cumulative incidence rate of 94.77 per 1000 person‐years, whereas the rate was 92.79 in matched comparisons thus resulting in an overall RR of 1.02 (95% CI = 0.98‐1.07) and AER of 1.98 (95% CI = −2.06, 6.13). Specifically, five of 1364 children of survivors had CNS tumor with an incidence rate of 0.21 per 1000 person‐year, whereas the rate was 0.04 in children of matched children, generating a HR of 4.91 (95% CI = 1.42‐16.96). Children of male survivors were at a statistically increased risk of malignancy, as well as infectious and parasitic diseases. In conclusion, no significantly higher risk of overall somatic diseases was found in children of survivors with CNS tumor before the age of 20, but children with a paternal diagnosis of CNS tumor had significantly increased risk of malignancies and infectious and parasitic diseases.

Poor academic performance in offspring of survivors with childhood or adolescent central nervous system tumor in Sweden.

The number of children who were born after their parents were diagnosed with central nervous system (CNS) tumor is increasing, but it remains largely unknown regarding the academic performance of these children. We aimed to investigate whether children of survivors with childhood or adolescent CNS tumor were associated with poor academic performance. Children of survivors of CNS tumor were identified by combining the nationwide Swedish Cancer Register and the Multi-Generation Register, and those who have completed compulsory education in Sweden between 1989 and 2015 were included in our study. "Poor academic performance" was defined as a z-score of the academic performance below the 10th percentile. Conditional logistic regression and quantile regression were used to examine the association. A total of 655 children were born after their parental diagnosis of CNS tumor and they had 1.39 times higher risk of achieving poor academic performance as compared to the matched comparisons (95% CI = 1.10-1.76). The poor academic performance was even more pronounced in boys, among those with a paternal diagnosis of CNS tumor and those with a parental ependymoma. The observed association differed depending on preterm birth. In addition, the strength of the association declined with the increased quantiles of academic performance z-score. Our data suggest that parental CNS tumor affects the subsequent academic achievements among children born after the parental tumor.

Risk of being born preterm in offspring of survivors with childhood or adolescent central nervous system tumor in Sweden.

An increasing number of patients with central nervous system (CNS) tumor could survive to reproductive age. However, it is largely unknown whether the history of CNS tumor might affect pregnancy outcome. We aimed to explore the risk of being born preterm among children of CNS tumor survivors. By linking several nationwide registers in Sweden, we identified 1,369 children whose parents were childhood or adolescent CNS tumor survivors. Children whose parents did not have CNS tumor were matched randomly with a 5:1 ratio to generate the reference group. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI). The prevalence of preterm birth (PTB) was 6.9% among children of survivors with CNS tumor and 5.2% among the matched controls. Children of survivors had an increased risk of PTB (adjusted OR = 1.29, 95%CI 1.01-1.65) compared to the matched controls. This risk was increased specifically among offspring of those diagnosed in childhood (adjusted OR = 1.53, 95%CI 1.14-2.06) but not adolescence (adjusted OR = 0.89, 95%CI 0.56-1.41). For families with more than one child, the risk was slightly lower among the second child as compared to the first child. The risk was negatively associated with time interval between parental diagnosis and childbirth. Parental medulloblastoma and ependymoma were most strongly associated with a higher risk of PTB. Children of survivors with CNS tumor experienced an elevated risk of PTB. However, the risk diminishes gradually after parental diagnosis of CNS tumor. Offspring of childhood CNS tumor survivors and medulloblastoma or ependymoma survivors may have the highest risk of PTB.

Sub-lethal concentrations of the entomopathogenic fungus, Beauveria bassiana increase fitness costs of Helicoverpa armigera (Lepidoptera: Noctuidae) offspring.

We assessed the effects of exposure of the cotton bollworm, Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) larvae to the entomopathogenic fungus Beauveria bassiana (isolate DC2) on life history parameters of the subsequent generation. Mortality assays against second instar larvae showed B. bassiana isolates to be significantly virulent, causing high mortality. Life history parameters such as developmental time, fecundity and survivorship were affected in the offspring of survivors of exposure to LC25 and LC50 concentrations of B. bassiana DC2. Pre-adult duration of H. armigera was significantly extended and total longevity and female progeny fecundity were decreased. Oviposition duration was shortened compared to offspring of untreated controls. All population parameters including intrinsic (r) and finite (λ) rates of increase and net (R0) and gross (GRR) reproductive rates were significantly decreased in offspring derived from H. armigera larvae treated with B. bassiana DC2. The intrinsic rate of increase (r) was 0.198 d-1, 0.120 d-1 and 0.111 d-1, respectively, for the F1 generation of controls (untreated), LC25- and LC50-treated cotton bollworm. The morphogenetic effects of B. bassiana observed due to the indirect effect of sub-lethal concentrations included abnormal pupae and adults and mortality resulted from the malformations. Pupal weight was reduced in offspring of treated individuals but sex ratios did not differ. Our results revealed that B. bassiana increased fitness costs of H. armigera in both direct (mortality) and indirect (disruption of normal development) ways. Adverse effects of sub-lethal fungal treatments on the parent generation carried over to the next generation.

Risk for congenital anomalies in offspring of childhood, adolescent and young adult cancer survivors.

Offspring of cancer survivors (CS) may be at risk for congenital anomalies due to the mutagenic therapies received by their parents. Our population-based cohort study aimed to investigate the risk for congenital anomalies in offspring of CS compared to offspring of their siblings. Using the Finnish Cancer Registry, Central Population Register, and Hospital Discharge Register, we identified hospital contacts due to congenital anomalies in 6,862 offspring of CS (early-onset cancer between 1953 and 2004) and 35,690 offspring of siblings. Associations between congenital anomalies and cancer were evaluated using generalized linear regression modelling. The ratio of congenital anomalies in offspring of CS (3.2%) was slightly, but non-significantly, elevated compared to that in offspring of siblings (2.7%) [prevalence ratio (PR) 1.07, 95% confidence interval (CI) 0.91-1.25]. When offspring of childhood and adolescent survivors (0-19 years at cancer diagnosis) were compared to siblings' offspring, the risk for congenital anomalies was non-significantly increased (PR 1.17, 95% CI 0.92-1.49). No such increase existed for offspring of young adult survivors (20-34 years at cancer diagnosis) (PR 1.01, 95% CI 0.83-1.23). The risks for congenital anomalies were elevated among offspring of CS diagnosed with cancer in the earlier decades (1955-1964: PR 2.77, 95% C I 1.26-6.11; and 1965-1974: PR 1.55, 95% C I 0.94-2.56). In our study, we did not detect an overall elevated risk for congenital anomalies in offspring of survivors diagnosed in young adulthood. An association between cancer exposure of the parent and congenital anomalies in the offspring appeared only for those CS who were diagnosed in the earlier decades.

Avoiding longing: the case of ‘hidden children’ in the Holocaust

Longing is a neglected subject in psychological research and theory despite the fact that it is an important component of human life. Drawing on clinical examples, this article offers thoughts on the place of longing in the lives of Holocaust child survivors and those of second-generation offspring of survivors. The first part describes the concept of longing and its distinction from nostalgia and desire, while the second part uses some clinical examples to describe patterns of avoidance of longing: prohibition, denial, superficial contacts, avoidance and inability to separate. The article ends with an examination of healthy, adaptive aspects of longing that can be used for a richer, healthier life.

Young adult female cancer survivors’ concerns about genetic cancer risk in offspring.

121 Background: More than 362,000 female cancer survivors under 40 years old live in the US. Research consistently shows no increased cancer risk among offspring of cancer survivors in the absence of a hereditary cancer. Still survivors voice concerns over the health of future children. This analysis explores young adult female cancer survivors’ (YAFCS) perceptions of genetic cancer risk and related reproductive concerns. Methods: Eligible females were aged 18-35, at least one year post-treatment. Participants were recruited using social media posts from 17 young adult cancer advocacy groups and directed to an anonymous web-based survey that included the Reproductive Concerns after Cancer Scale (RCACS), with a 3-item “Concerns about Future Child Health” subscale. Results: 346 YAFCS completed the full survey, and based on logic-based branching, 192 respondents could have completed the RCACS: 177 (92%) completed the entire scale and 187 (97%) completed the child’s health subscale. Mean RCACS score was 58.5 (sd = 11.6; range 22-86); mean child’s health score was 11.3 (sd = 3.3; range 3-15), with a negative skew. At the item-level, 65% of the sample worried about passing along cancer risk to offspring; 71% worried about family health history affecting future children; and 60% were afraid their children would have a high chance of getting cancer. RCACS and child’s health subscale scores did not vary by age, race, education, income, or diagnosis. Further, mean scores did not vary between survivors of family cancer syndromes (breast, ovarian, colorectal) and those with other diagnoses (RCACS: t = 1.4, df = 175, p = .14; child’s health: t = 0.02, df = 185, p = .99). Conclusions: Despite studies showing minimal genetic cancer risk in offspring of survivors, many YAFCS have concerns about the health of future children. This may be related to mistaken beliefs that genetic mutations within tumor cells are transmissible or unawareness of availability of pre-implantation genetic diagnosis for embryo selection in those with transmissible genetic mutations. There is a need to educate patients about these issues to enable them to make family building choices based on accurate information about genetic risk.

Postulating Traumatic Stress Disorders

This special issue of Biological Psychiatry, “Understanding PTSD: From Mind to Molecules,” is focused on neurobiological studies that inform our scientific approach to posttraumatic stress disorder (PTSD). By virtue of the requirement that a lifethreatening stressor precede its onset, PTSD is distinguished from other mental disorders. Although mental health clinicians and researchers acknowledge the contributions (and presumably very complex interactions) of psychological, social, and biological factors in the generation of virtually all mental disorders, only PTSD (and the other trauma and stressorrelated disorders with it shares a chapter in DSM-5) has exposure to a traumatic stressor or stressors as a mandatory antecedent. In other words, PTSD is the quintessential biopsychosocially determined disorder; as such, it demands the efforts of a diverse and eclectic set of researchers and experimental methods to understand its etiology and consider novel approaches to its treatment. Such is the spirit of this special issue, where we have brought together a multitalented group of basic and translational researchers to share their insights into the nature of PTSD and its potential prevention and management. The time frame of inquiry begins very early in development, with Rodgers and Bale (1) describing an intriguing body of preclinical work positing the transgenerational transmission of stress through male germ cells; this work has been echoed in clinical studies demonstrating not only an increase in PTSD among adult offspring of survivors of extreme trauma (i.e., the Holocaust) but also a possible epigenetic reflection of that increased risk in glucocorticoid-relevant genes or their promoters (2). Bock et al. (3) review and insightfully integrate a body of animal and human literature that emphasizes possible molecular bases for prenatal stress exposures adversely affecting emotional and cognitive development of the brain. Zannas et al. (4) provide a comprehensive review of epigenetic studies relevant to PTSD and in so doing forge a path for future research in this area, highlighting opportunities and challenges that lie ahead. Together, these articles paint a picture of the brains of certain individuals being primed in utero to experience stressful life experiences differently than others. How can we begin to tie together these observations with findings of specific genetic vulnerabilities for PTSD that may operate through altering stress responsiveness (e.g., FKBP5 and allele-specific demethylation in association with childhood trauma exposure (5))? What is the physiologic and molecular nature of this altered brain response to stress? There is evidence that exposure of the hippocampus to glucocorticoids after stress results in a PTSD-like set of memory impairments that includes the inability to restrict fear to the appropriate context (i.e., there is an overgeneralization of the fear response (6)). Could it be that the hippocampus of individuals at risk for PTSD is exposed to functionally elevated levels of

Rapid assessment of rat eradication after aerial baiting

Summary Eradication of introduced rodents on islands is increasingly implemented as a conservation tool. Aerial baiting, currently the main eradication technique, provides no information on whether eradication has been achieved. Success is usually evaluated after a standard period of 2 years with no sign of rodents. We describe a novel approach to assess the success of eradication efforts based on a project to eradicate ship rats Rattus rattus from Isabel Island (82 ha), Mexico. We used detection and home‐range parameters obtained from a capture–recapture study completed prior to aerial baiting to build a spatial‐survey model that predicts probability of eradication after the treatment. The spatial‐survey model estimated a &gt;99% probability of success after two surveys with no rats detected. This approach can be used to make eradication projects more cost‐effective. Survivors, if any, could be located and dispatched by localized control methods. This avoids repeat aerial baiting of the whole island if failure becomes apparent. This model is a useful tool for (a) assessing the probability of eradication within weeks, rather than years of an operation, and (b) predicting the required survey effort to achieve a probability of success consistent with the costs and risks of falsely declaring eradication success. Synthesis and applications: Rapid assessment of success after rodent eradication efforts on islands results in financial savings by potentially reducing the duration of the projects. Improvements in biosecurity guidelines might also accrue as delays in detecting rats after an operation may confound their identification as offspring of survivors or re‐invaders. Advanced techniques and predictive modelling will increase confidence among partners and donors and allow more efficient achievement of regional programmes.

Intergenerational Effects of the Holocaust: Subjective Well-Being in the Offspring of Survivors

Offspring of Holocaust survivors have been the subject of much research into how traumatic events affect future generations. This study considers the effects of the Holocaust on the well-being rather than trauma of offspring of Holocaust survivors in Australia. 285 Jewish participants completed a questionnaire to measure components of subjective well-being. Analyses revealed that offspring of Holocaust survivors reported lower general positive mood than non-OHS. This result was limited to offspring of Holocaust survivors with two survivor parents. These findings imply that effects of the Holocaust are transmitted to nonclinical offspring of Holocaust survivors and that the number of survivor parents is a crucial determinant in understanding these transgenerational outcomes.

Radiation risk of individual multifactorial diseases in offspring of the atomic-bomb survivors: a clinical health study

There is no convincing evidence regarding radiation-induced heritable risks of adult-onset multifactorial diseases in humans, although it is important from the standpoint of protection and management of populations exposed to radiation. The objective of the present study was to examine whether parental exposure to atomic-bomb (A-bomb) radiation led to an increased risk of common polygenic, multifactorial diseases—hypertension, hypercholesterolaemia, diabetes mellitus, angina pectoris, myocardial infarction or stroke—in the first-generation (F1) offspring of A-bomb survivors. A total of 11 951 F1 offspring of survivors in Hiroshima or Nagasaki, conceived after the bombing, underwent health examinations to assess disease prevalence. We found no evidence that paternal or maternal A-bomb radiation dose, or the sum of their doses, was associated with an increased risk of any multifactorial diseases in either male or female offspring. None of the 18 radiation dose–response slopes, adjusted for other risk factors for the diseases, was statistically significantly elevated. However, the study population is still in mid-life (mean age 48.6 years), and will express much of its multifactorial disease incidence in the future, so ongoing longitudinal follow-up will provide increasingly informative risk estimates regarding hereditary genetic effects for incidence of adult-onset multifactorial disease.

Secondary salutogenic effects in veterans whose parents were Holocaust survivors?

Addressing the ongoing controversy over inter-generational transmission of trauma, we examined the impact of the Nazi Holocaust on PTSD course and co-morbid symptoms (e.g., depression, anxiety) among offspring of survivors following their own adversity in two longitudinal studies. Two samples of Israeli war veterans included Second Generation Holocaust (i.e., SGH) survivors and comparable veterans with no such family history (i.e., not-SGH). Study I: 1982 Lebanon War veterans (N = 669) were assessed 1, 3, and 20 years after the war. Study II: 1973 Yom Kippur War veterans (N = 343) were followed up 18, 30, and 35 years after the war. Results indicated that SGH endorsed higher PTSD and co-morbid symptoms criteria rates than not-SGH veterans in the initial post-war years but this pattern was reversed in the long-term, that is, lower rates were evident among SGH in later follow-ups. These findings suggest the development of a complex trauma reaction among offspring of trauma survivors. Possibly there is a transmission of positive trauma outcomes from one generation to the next rather than merely negative ones. Future studies are therefore warranted to re-evaluate the notion of inter-generational transmission of trauma and examine its components.

Parental styles in second generation effects of genocide stemming from the Khmer Rouge regime in Cambodia

This study examined the impact of parental styles on second generation effects of trauma among adolescent offspring of survivors of the Khmer Rouge (KR) genocide in Cambodia. Two hundred high school students completed measures addressing their parents' trauma stemming from the KR regime, parental styles (role reversing, overprotective), depression and anxiety. Parents' role reversing parental style and mothers' overprotective parenting were shown to mediate the impact of their trauma symptoms on the child's depression and anxiety. The implications of the findings are discussed.

Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study

The reproductive implications of mutagenic treatments given to children with cancer are not clear. By studying the risk of untoward pregnancy outcomes, we indirectly assessed the risk of transmission of germline damage to the offspring of survivors of childhood cancer who were given radiotherapy and chemotherapy. We did a retrospective cohort analysis, within the Childhood Cancer Survivor Study (CCSS), of the risk of stillbirth and neonatal death among the offspring of men and women who had survived childhood cancer. Patients in CCSS were younger than 21 years at initial diagnosis of an eligible cancer, were treated at 25 US institutions and one Canadian institution, and had survived for at least 5 years after diagnosis. We quantified the chemotherapy given to patients, and the preconception radiation doses to the testes, ovaries, uterus, and pituitary gland, and related these to the risk of stillbirth or neonatal death using Poisson regression analysis. Among 1148 men and 1657 women who had survived childhood cancer, there were 4946 pregnancies. Irradiation of the testes (16 [1%] of 1270; adjusted relative risk 0.8 [95% CI 0.4-1.6]; mean dose 0.53 Gy [SD 1.40]) and pituitary gland (17 [3%] of 510, 1.1 [0.5-2.4] for more than 20.00 Gy; mean dose 10.20 Gy [13.0] for women), and chemotherapy with alkylating drugs (26 [2%] of 1195 women, 0.9 [0.5-1.5]; ten [1%] of 732 men, 1.2 [0.5-2.5]) were not associated with an increased risk of stillbirth or neonatal death. Uterine and ovarian irradiation significantly increased risk of stillbirth and neonatal death at doses greater than 10.00 Gy (five [18%] of 28, 9.1 [3.4-24.6]). For girls treated before menarche, irradiation of the uterus and ovaries at doses as low as 1.00-2.49 Gy significantly increased the risk of stillbirth or neonatal death (three [4%] of 69, 4.7 [1.2-19.0]). Our findings do not support concern about heritable genetic changes affecting the risk of stillbirth and neonatal death in the offspring of men exposed to gonadal irradiation. However, uterine and ovarian irradiation had serious adverse effects on the offspring that were probably related to uterine damage. Careful management is warranted of pregnancies in women given high doses of pelvic irradiation before puberty. Westlakes Research Institute, National Cancer Institute, and Children's Cancer Research Fund.

Hospitalizations among children of survivors of childhood and adolescent cancer: A population‐based cohort study

Curative but potentially mutagenic cancer therapy might lead to untoward disorders and increased hospitalization among the offspring of childhood cancer survivors. Hospitalizations in childhood were evaluated in a population-based cohort of 1,920 offspring of 3,963 childhood cancer survivors, 6,394 offspring of 5,657 siblings and 9,594 population-based comparisons. The Danish Cancer Registry, Central Population Register and National Hospital Register were used to identify study subjects and hospitalizations. The probability for children in the offspring cohorts of being hospitalized before a given age was estimated using the Kaplan-Meier method. Hospitalization rate ratios (HRRs) were calculated using a Cox proportional hazards model with population comparisons as referent. Little differences in hospitalization histories were seen among offspring in the 3 cohorts. HRRs of overall hospitalization was 1.05 (95% CI, 0.98-1.12) for offspring of survivors and 1.01 (95% CI, 0.97-1.05) for offspring of siblings, neither of which was significantly different from that of population comparisons. No significant associations were seen for most of the main diagnostic groups of diseases including infections and perinatal disorders. A 6-fold excess risk of hospitalization for malignant tumors in survivors' offspring, however, could largely be explained by hereditary cancer syndromes, and part of the 2-fold excess hospitalization for benign tumors might similarly be explained by an underlying genetic susceptibility or by increased surveillance of children born to survivors. Assuming that hospitalization is an indicator of multifactorial genetic disease, the findings provide further reassurance that cancer therapies do not confer a high risk of such conditions in offspring born after treatments.

Pregnancy outcome in female childhood cancer survivors

The number of childhood cancer survivors has dramatically increased and consequently, an increasing number of survivors may now wish to conceive. Recently, several studies have described that previous treatment with abdominal radiotherapy may increase the risk of adverse pregnancy outcome. We conducted a retrospective single centre cohort study of childhood cancer survivors with a singleton live birth between January 2000 and December 2005. Pregnancy outcome was compared with data from the Netherlands Perinatal Registry, a nationwide database of pregnancy outcome parameters of all births in the Netherlands registered by midwives, obstetricians and paediatricians. Data were available on 40 survivors and 9031 controls. Median age at diagnosis was 6.9 years (range 0.1-16.8 years). The median interval between diagnosis and date of delivery was 21.6 years (range 7.4-36.1 years). In the whole cohort, pregnancy outcome was not different between survivors and controls. However, survivors treated with abdominal radiotherapy delivered preterm and had post-partum haemorrhage (mean gestational age in survivors = 34.9 versus 39.2 weeks in controls, P = 0.001; 33% in survivors versus 5% in controls, P = 0.007, respectively). The offspring of survivors had normal birthweight after adjustment for gestational age (mean birthweight in offspring of survivors 2503 versus 1985 g; P = 0.22). Childhood cancer survivors irradiated to the abdomen have an earlier delivery and higher incidence of post-partum haemorrhage. This stresses the need for close monitoring of the delivery, including inpatient perinatal care, in this group of childhood cancer survivors.

Hopelessness, Temperament, Anger and Interpersonal Relationships in Holocaust (Shoah) Survivors’ Grandchildren

The psychiatric literature is divided with regard to the long-term psychological effects associated with Holocaust (Shoah) experiences because the findings of clinical and empirical studies often contradict each other. Despite case reports of emotional sequelae related to intergenerational transmission of trauma, recent empirical research has suggested that offspring of survivors of the Shoah did not differ from other children and found no evidence that traumatic experiences of survivors of the Shoah affected their children's and grandchildren's adjustment. To shed light on some of the differences between the empirical and clinical observations, the present study set out to compare the grandchildren of survivors of the Shoah and persons of the same age whose families had not been through the Shoah experience. This study compared the two groups on some psychological dimensions relevant to traumatic sequelae: hopelessness, temperament, personality, attitudes, and interpersonal expectations. Subjects were 124 equally divided among the Shoah survivors' grandchildren and comparison groups; we administered to all subjects TEMPS-A Rome, Beck Hopelessness Scale, State-Trait Anger Expression Inventory, and 9AP (9 Attachment Profile). We found no differences between two groups in Hopelessness, Dysthimic/Cyclotimic/Anxious, Hyperthimic temperament, and self-perception; instead the Shoah survivors' grandchildren have a view of the other as rejecting, hostile, submissive, insecure, unreliable, and competitive in the interpersonal relationships. The Shoah survivors' grandchildren are similar to controls in affective temperament, hopelessness and self-perception, but they are more irritable and angry than controls, and their perception about others is deeply negative. Attribution theory was used to elucidate these findings.

Radiotherapy for childhood cancer and risk for congenital malformations in offspring: a population‐based cohort study

Offspring of childhood cancer survivors may be at risk of genetic disease due to the mutagenic cancer treatments received by their parents. Congenital malformations were evaluated in a population-based cohort study of 1715 offspring of 3963 childhood cancer survivors and 6009 offspring of 5657 survivors' siblings. The Danish Central Population Register, Cancer Registry and Hospital Register were used to identify study subjects and congenital malformations. Gonadal and uterine radiation doses were characterized based on standard radiation-treatment regimens. The prevalence of congenital malformations at birth in offspring of survivors (44 cases, 2.6%) was slightly higher but not statistically different from that of offspring of siblings (140 cases, 2.3%) [prevalence proportion ratio (PPR), 1.1; 95% confidence interval, 0.8-1.5] or of the general population (observed-to-expected ratio, 1.2; 0.9-1.6). Including malformations diagnosed later in life did not change the ratios appreciably. The risk for malformations was slightly higher in the offspring of irradiated parents than in that of non-irradiated parents (PPR 1.2 vs 1.0) but was unrelated to gonadal dose. This study provides evidence that cancer therapy of children does not increase the risk for malformations in their offspring. Continued monitoring of genetic risks among their offspring, however, is warranted.