Cancer risk among Holocaust survivors in Israel-A nationwide study

Exposure to Holocaust is associated with chronic morbidity in older adults-Results from national health and nutrition surveys

BACKGROUND

Although studies have suggested that Holocaust survivors are more likely than their non-Holocaust-exposed counterparts to suffer from mental and chronic morbidity, methodology differences and potential confounders often compromise result replicability and external validity. We examined associations between Holocaust exposure and chronic morbidity, as well as overall risk of mortality.

METHODS

Sociodemographic, health-related behavior and nutritional-intake data from two representative National Health and Nutrition Survey Ages 65 and Over-the 2005-2006 MABAT ZAHAV 1 (MZ1) and the 2014-2015 MZ2, including face-to-face interviews and anthropometric measurements-were analyzed. Demographic, health, nutritional and lifestyle characteristics, and exposure to the Holocaust were self-reported. Longitudinal data on overall mortality were obtained by linking the MZ1 population to the population registry dataset. Associations between Holocaust exposure and prevalence of chronic morbidity and risk factors were estimated by multivariable logistic regression analyses, and to risk of overall mortality by Cox regression analysis, both adjusted to significant covariates.

RESULTS

Among 2096 study participants aged 75.7 ± 6.1 years, 47.0% male, 518 were Holocaust survivors. In the fully adjusted model, Holocaust exposure was associated with increased prevalence of heart disease (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.07-1.83), metabolic syndrome (OR 2.28, CI 1.23-4.21), and stroke (OR 1.77, CI 1.17-2.69), but not cancer or osteoporosis. Holocaust exposure did not substantially affect the overall risk of mortality (hazard ratio 1.10, CI 0.92-1.32).

CONCLUSIONS

Further research is needed to understand the mechanisms governing long-term outcomes of exposure to acute physical or mental trauma.

Psychological reactions to the coronavirus pandemic: a comparative study of Holocaust survivors and other older adults in Israel

BACKGROUND

The current study examines psychological reactions to the COVID-19 pandemic among older adults living in Israel. Based on the 'life events, stress, coping and health theory,' we hypothesized that due to their traumatic early life history and dearth of emotional and physical coping resources, Holocaust survivors would be more vulnerable than other older adults to the negative effects of this difficult and prolonged life event on their mental health.

METHODS

Based on structured questionnaires with closed questions, we interviewed 306 Holocaust survivors and non-survivors aged 75 + during the COVID-19 pandemic.

RESULTS

Univariate data analysis showed that Holocaust survivors had fewer coping resources in terms of health status and educational level than non-survivors. As expected, Holocaust survivors also reported a greater extent of COVID-19-related anxiety, and more depression, which worsened during the pandemic. However, both groups did not differ in their will to live, which is an indicator of general well-being and commitment to continue living. In multivariate analyses conducted to explain COVID-19 anxiety in the entire sample and separately on each of the two groups, the best explanatory variables were other psychological variables especially increased depression.

CONCLUSIONS

It seems that Holocaust survivors are more emotionally vulnerable to the pandemic's negative effects than other older adults, in support of the 'life events, stress, coping and health theory,' but despite this, they show resilience in their will to continue living. Policy makers and practitioners are recommended to identify Holocaust survivors and other vulnerable older people and investigate their specific needs. Interventions should include practices for maintaining and boosting resilience and well-being by increasing appropriate emotional and cognitive internal and external coping resources, especially during prolonged periods of hardship.

[Long-term medical complications of Holocaust trauma]

Holocaust survivors are currently confronted with the problems inherent to ageing such as illness, frailty, dependency and isolation. A study was carried out to assess the long-term medical consequences of the Holocaust trauma.

Teaching the Holocaust in Nursing Schools: The Perspective of the Victims and Survivors

In recent years, there has been increased recognition of the significance and relevance of Holocaust studies to nurses. However, these studies are rarely integrated in the nursing curriculum, and even when they are, the focus is usually on healthcare personnel who collaborated with the Nazi regime. This article aims to bridge this gap by analyzing a comprehensive requisite curriculum on the Holocaust for graduate nursing students. We emphasize the work of Jewish healthcare professionals during the Holocaust and the dilemmas they faced, as well as the trauma and resilience of Holocaust survivors, their treatment today, and implications for treating other patients. This article examines how studying these issues affected the graduate students. It analyzes the reflective accounts written by the students, using qualitative content analysis and Grounded Theory. The findings suggest that students received tools to act professionally and empathetically while demonstrating greater sensitivity to the patients’ identity, past experiences, trauma, and how the hospital as a “total institution” affects them. Many of the students developed conscious leadership. The program used a personalized pedagogical approach that contributed to experiential learning but was also emotionally challenging for the participants. We recommend including Holocaust studies as a requisite component in nursing programs worldwide.

Holocaust Experience and Mortality Patterns: 4-Decade Follow-up in a Population-Based Cohort

Research on mortality associated with exposure to the Holocaust is relevant for a better understanding of the effects of genocides on survivors. To our knowledge, previous studies have not investigated the long-term cause-specific mortality of Holocaust survivors. We compared mortality rates among Israelis born in European countries controlled by the Nazis during World War II with those among Israelis of European descent who did not have this exposure. Records of 22,671 people (45% women; 5,042 survivors) from the population-based Jerusalem Perinatal Study (1964-1976) were linked to the Israeli Population Registry, which was updated through 2016. Cox models were used for analysis, with 2-sided tests of statistical significance. Risk of all-cause mortality was higher among exposed women (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.05, 1.27) than in unexposed women. No association was found between Holocaust exposure and male all-cause mortality. In both sexes, survivors had higher cancer-specific mortality (HR = 1.17 (95% CI: 1.01, 1.35) in women and HR = 1.14 (95% CI: 1.01, 1.28) in men). Exposed men also had excess mortality due to coronary heart disease (HR = 1.39, 95% CI: 1.09, 1.77) and lower mortality from other known causes combined (HR = 0.86, 95% CI: 0.75, 0.99). In summary, experiencing the Holocaust was associated with excess all-cause and cancer-specific mortality in women and cancer- and coronary heart disease-specific mortality in men.

Consequences of holocaust on physical health of survivors: bibliography review

OBJECTIVE

Period of elderly age preordains the occurrence of many health issues. People deported during World War II to concentration camps suffered from malnutrition, lack of sleep, physical and mental exhaustion. Recently, the health condition of Holocaust survivors is often complicated as a result of physical punishments and different torture methods as well as mental hardships which they had suffered during deportation. The consequences often have psychosomatic nature thus the survivors are often receivers of health care. The topic of bibliography review is based on the need to objectivize and systematically evaluate subjective health issues of Holocaust survivors in connection with trauma related to the stay in a concentration camp. The aim is to offer a review of effects of the Holocaust on health of different body systems for survivors in concentration camps and Jewish ghettos in the course of World War II.

METHODS

To map the subjective problems of Holocaust survivors, evidence-based medicine (EBM) method has been used with the help of scientific database PubMed, CINAHL Plus with full text, ProQuest and other sources with specific key words and Boole operators. Prognostic type of clinical/review questions has been selected for the bibliography review, which is trying to predict the probability of relation or output of illness/condition and based on diseases or symptoms seriousness to find out expectancy for treatment/improvement of care.

RESULTS

175 studies have been found in basic search with the use of key words both in English and in Czech language. The search has not been time-limited. The advanced search has focused on different body systems and health damage due to Nazi experiments. Fourteen studies have been used to complete the study. The research results have confirmed the significant effect of Holocaust trauma on body condition of the survivors. The reasons of this condition were insufficient nutrition, unsuitable and harmful hygienic, living and working conditions and brutality of the guards. According to the research, these factors have impacted all organ systems, mainly locomotion and cardiovascular ones. The results have shown a more frequent occurrence of osteoporosis, fractures of long bones and corresponding chronical pain of people of Jewish origin who had gone through different forms of torture during World War II. Other present symptoms include gastrointestinal problems, tumors mainly in the area of colorectum and lungs. Moreover, the stay in concentration camps had influence on women's menstrual cycle.

CONCLUSION

The studies of Holocaust effects are an example of the influence of an extreme mental and physical burden on the body condition of the survivors' health. The results of the studies have shown a wide range of the effects also in mental and social areas.

The Linear No-Threshold Model of Low-Dose Radiogenic Cancer: A Failed Fiction

The linear no-threshold (LNT) model for low-dose, radiogenic cancer has been a fixture of radiation protection and regulatory requirements for decades, but its validity has long been contested. This article finds, yet again, more questionable data and analyses purporting to support the model, this within the “gold-standard” data set for estimating radiation effects in humans. Herein is addressed a number of significant uncertainties in the Radiation Effects Research Foundation’s Life Span Study (LSS) cohort of atomic bomb survivors, especially in its latest update of 2017, showing that the study’s support of the LNT model is not evidence based. We find that its latest 2 analyses of solid cancer incidence ignore biology and do not support the LNT model. Additionally, we identify data inconsistencies and missing causalities in the LSS data and analyses that place reliance on uncertain, imputed data and apparently flawed modeling, further invalidating the LNT model. These observations lead to a most credible conclusion, one supporting a threshold model for the dose–response relationship between low-dose radiation exposure and radiogenic cancer in humans. Based upon these findings and those cited from others, it becomes apparent that the LNT model cannot be scientifically valid.

Elevated cancer risk in Holocaust survivors residing in Israel: A retrospective cohort study

BACKGROUND

The purpose of this study was to examine the incidence of malignant diseases among Holocaust survivors in Israel compared with European and American immigrants who did not experience the Holocaust.

METHODS

Study subjects included Holocaust survivors born in European countries under Nazi occupation before 1945, who immigrated to Israel after 1945 and were alive as of the year 2000. Living survivors were identified based on recognition criteria in accordance with the Holocaust Survivor Benefits Law. The comparison group consisted of Clalit enrollees who were born before 1945 in European countries not under Nazi occupation and were alive in 2000 or were born in any European country or America, immigrated to Israel before 1939 and were alive in 2000. The incidence of malignant diseases was compared in univariate and Poisson regression models analyses, controlling for age, smoking, obesity, diabetes and place of residence.

RESULTS

The study included 294,543 Holocaust survivors, and the mean age at the beginning of follow-up was 74 ± 8.7 years; 43% males. In multivariable analyses, the rate ratio (RR) values for males and females were 1.9 and 1.3 for colon cancer, 1.9 and 1.4 for lung cancer, 1.6 and 1.4 for bladder cancer and 1.2 and 1.3 for melanoma, respectively. For prostate cancer in males, the RR was 1.4, while for breast cancer in females, it was 1.2.

CONCLUSIONS

The incidence of malignant diseases among Holocaust survivors residing in Israel was higher than that among non-Holocaust survivors. These associations remained statistically significant in a multivariable analysis and were stronger for males.

Extreme population-level events: Do they have an impact on cancer?

The report by Sadetzki and colleagues in this issue showcases the impact of a horrendous event—the Holocaust—on subsequent health decades after the occurrence. Two additional calamities—country‐wide famines and population‐level discrimination—are provided as examples of this phenomenon to add evidence to the causal pathway identified by Sadetzki et al.

See also pages 3335‐45.