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Lubel SY, Dichtiar R, Sinai T, Keinan-Boker L. Exposure to Holocaust is associated with chronic morbidity in older adults-Results from national health and nutrition surveys. J Am Geriatr Soc 2024; 72:1491-1500. [PMID: 38529878 DOI: 10.1111/jgs.18875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Shay Y Lubel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
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Sarfati S, Astruc A, Taïeb J, Cohen M, Lambrozo J, Halioua B. [Long-term medical complications of Holocaust trauma]. SOINS. GERONTOLOGIE 2022; 27:39-42. [PMID: 35393034 DOI: 10.1016/j.sger.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Samuel Sarfati
- Département de médecine générale, faculté de médecine Versailles-Saint-Quentin- en-Yvelines, 2 avenue de la Source- de-la-Bièvre, 78100 Montigny-le-Bretonneux, France
| | - Alexis Astruc
- Département universitaire de médecine générale, UFR santé, médecine et biologie humaine, université Sorbonne Paris Nord, 74 rue Marcel-Cachin, 93017 Bobigny cedex, France
| | - Jonathan Taïeb
- Centre du sommeil et de la vigilance, Assistance publique-Hôpitaux de Paris, Hôtel-Dieu, 75004 Paris, France
| | - Marc Cohen
- Œuvre de secours aux enfants, centre de santé Elio-Habib, 25 boulevard de Picpus, 75012 Paris, France
| | | | - Bruno Halioua
- Cabinet médical, 56 boulevard Saint-Marcel, 75005 Paris, France.
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Youssim I, Gorfine M, Calderon-Margalit R, Manor O, Paltiel O, Siscovick DS, Friedlander Y, Hochner H. Holocaust Experience and Mortality Patterns: 4-Decade Follow-up in a Population-Based Cohort. Am J Epidemiol 2021; 190:1541-1549. [PMID: 33564866 DOI: 10.1093/aje/kwab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 02/01/2023] Open
Abstract
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.
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Weinstein G, Lutski M, Keinan-Boker L, Goldbourt U, Tanne D. Holocaust exposure and late-life cognitive performance in men with coronary heart disease. J Psychiatr Res 2021; 134:1-7. [PMID: 33360219 DOI: 10.1016/j.jpsychires.2020.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Holocaust victims experienced extreme physical and mental stress that could lead to prolonged deficits in psychological and physiological well-being. We aimed to examine whether exposure to Holocaust conditions is associated with cognitive function and decline in a sample of old male adults with coronary heart disease (CHD). METHODS The sample included 346 individuals with CHD who participated in a clinical trial in 1990-1997 (mean age 56.7 ± 6.5 y). During 2004-2008 (mean age 71.8 ± 6.5 y) and 2011-2013 (mean age 77.1 ± 6.4 y) participants underwent computerized cognitive assessments. Exposure to Holocaust conditions was based on self-report at the second assessment. Linear regression and mixed-effect models were conducted to evaluate the associations between Holocaust survivorship and subsequent cognitive performance and rate of cognitive decline. RESULTS Forty-Three participants (12%) survived concentration camps/ghettos, 69 (20%) were Holocaust survivors who escaped concentration camps/ghettos, and 234 (68%) were not Holocaust survivors. After adjustment for potential confounders, concentration camp/ghetto survivors had poorer global cognitive performance and poorer attention (β = -3.90; 95%CI: 7.11;-0.68 and β = -4.11; 95%CI: 7.83;-0.38, respectively) compared to individuals who were not exposed to Holocaust conditions. Additionally, participants who reported being at concentration camps/ghettoes had increased cognitive decline in global performance and executive function (β = -0.19; 95%CI: 0.37;-0.008 and β = -0.29; 95%CI: 0.53;-0.06, respectively) compared to participants who were not Holocaust survivors. Lastly, those who were Holocaust survivors but not in concentration camps/ghettos had greater decline in attention (β = -0.11; 95%CI: 0.21;-0.01). DISCUSSION Exposure to Holocaust conditions in early-life may be linked with poorer cognitive function and greater cognitive decline decades later in old-adults with CHD.
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Affiliation(s)
- Galit Weinstein
- School of Public Health, University of Haifa, Haifa, Israel.
| | - Miri Lutski
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel; The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Tanne
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel
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Horáčková K, Ševčovičová A, Hrstka Z, Moravcová M, Lásková M, Derňarová Ľ. Consequences of holocaust on physical health of survivors: bibliography review. Cent Eur J Public Health 2020; 28:237-244. [PMID: 32997481 DOI: 10.21101/cejph.a5650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/01/2020] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Kateřina Horáčková
- Faculty of Health Studies, Pardubice University, Pardubice, Czech Republic
| | - Andrea Ševčovičová
- St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Zdeněk Hrstka
- Faculty of Health Studies, Pardubice University, Pardubice, Czech Republic
| | - Markéta Moravcová
- Faculty of Health Studies, Pardubice University, Pardubice, Czech Republic
| | - Martina Lásková
- St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Ľubica Derňarová
- Faculty of Health Care, University of Presov, Presov, Slovak Republic
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Hidayat K, Du X, Shi BM, Qin LQ. Foetal and childhood exposure to famine and the risks of cardiometabolic conditions in adulthood: A systematic review and meta-analysis of observational studies. Obes Rev 2020; 21:e12981. [PMID: 32048436 DOI: 10.1111/obr.12981] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022]
Abstract
A systematic review and meta-analysis of observational studies was performed to provide a deeper understanding of the associations between foetal and childhood exposure to famine and the risks of type 2 diabetes mellitus (T2DM), metabolic syndrome, hypertension, hyperglycaemia, dyslipidaemia, obesity, overweight, coronary heart disease, stroke, and nonalcoholic fatty liver disease (NAFLD) in adulthood. Both foetal and childhood exposure to famine were positively associated with the risks of T2DM (foetal exposure: RR 1.37, 95% CI, 1.23-1.52; childhood exposure: RR 1.33, 95% CI, 1.08-1.64), metabolic syndrome (RR 1.26, 95% CI, 1.07-1.50; RR 1.24, 95% CI, 1.13-1.35), hypertension (RR 1.30, 95% CI, 1.07-1.57; RR 1.33, 95% CI, 1.02-1.74), hyperglycaemia (RR 1.27, 95% CI, 1.11-1.45; RR 1.25, 95% CI, 1.10-1.42), dyslipidaemia (RR 1.48, 95% CI, 1.33-1.66; RR 1.27, 95% CI, 1.12-1.45), obesity (RR 1.19, 95% CI, 1.02-1.39; RR 1.13, 95% CI, 1.00-1.28), overweight (RR 1.17, 95% CI, 1.07-1.29; RR 1.07, 95% CI, 1.00-1.14), coronary heart disease (RR 1.22, 95% CI, 1.00-1.51; RR 1.21, 95% CI, 1.09-1.35), and moderate-to-severe NAFLD (RR 1.66, 95% CI, 1.07-2.57; RR 1.68, 95% CI, 1.41-1.99) in adulthood. No association was observed for the risks of stroke or mild NAFLD. Adjustments for age, alcohol, smoking, body mass index, and physical activity nullified some associations. The associations were generally stronger in women than in men. In summary, foetal and childhood exposure to famine may confer greater risks of developing certain cardiometabolic conditions in adulthood, particularly in women. The extent to which risks for cardiometabolic conditions are associated with early-life famine appears to be determined by certain factors in adulthood.
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Affiliation(s)
- Khemayanto Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Xuan Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
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Hoffman Y, Shrira A. Variables Connecting Parental PTSD to Offspring Successful Aging: Parent-Child Role Reversal, Secondary Traumatization, and Depressive Symptoms. Front Psychiatry 2019; 10:718. [PMID: 31681033 PMCID: PMC6803468 DOI: 10.3389/fpsyt.2019.00718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
The effects of parental trauma on offspring of Holocaust survivors (OHS) are debated in the literature. Recently, scholars suggested that it may be more productive to ask when and via which mechanisms such effects are observed. Following, the current study examines if parental Holocaust-related posttraumatic stress disorder (PTSD) symptoms are linked with the aging processes of their middle-aged offspring. Beyond this association, we also suggested a putative mediation path, indicating three underlying mechanisms by which parental trauma lingers on: perceived parent-child role reversal, secondary traumatization, and depressive symptoms. Using a convenience sample of 682 community-dwelling participants, comprising 341 older adult parent-middle-aged offspring dyads (M age = 81.71 and 54.58 for parents and offspring, respectively) to address this issue. Parents reported PTSD with the valid measure of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. OHS reported perceived parent-child role reversal, secondary traumatization, depressive symptoms, and completed indices of successful aging. Based on parents' reports, we divided the parent-offspring dyads into three groups: OHS whose parents had probable PTSD (n dyads = 43), OHS whose parents did not have PTSD (n dyads = 161), and comparison with parents who did not undergo the Holocaust (n dyads = 137). Findings reveal that OHS with parents suffering from probable PTSD aged less successfully than comparisons. Serial mediation analyses validated the aforementioned putative pathway (perceived parent-child role reversal, secondary traumatization, and depression) linking parental PTSD with offspring successful aging. Our findings are discussed through a vignette depicting a fictional OHS character. These underlying mechanisms suggest that different types of interventions, each geared towards a specific mechanism, may mitigate the lingering effect of parental PTSD on diminished OHS successful aging.
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Affiliation(s)
- Yaakov Hoffman
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Blazer DG, Pieper CF. Cardiac Disease in Elderly Holocaust Survivors Who Live in Israel: A Case for Risk and Resilience. J Am Geriatr Soc 2018; 66:1661-1662. [DOI: 10.1111/jgs.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging, School of Medicine; Duke University; Durham NC
| | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Center for the Study of Aging, School of Medicine; Duke University; Durham NC
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