Holocaust survivors: Health and longevity 70 years later

Background

Holocaust survivors (HS) alive today form a unique and disappearing population, whose exposure to systematic genocide occurred over 70 years ago. Negative health outcomes were widely documented prior to age 70. We examine the hypothesis that the experience of remote trauma continues to negatively affect health, functional status, and survival between the ages of 85–95.

Methods

The Jerusalem Longitudinal Study (1990–2022) followed a representative sample of Jerusalem residents born 1920–1921, at ages 85, 90 and 95. Home assessment included medical, social, functional, and cognitive status, and mortality data. Subjects were classified: (1) HS-Camp (HS-C): survived slave-labor, concentration, or death camps; (2) HS-Exposed (HS-E): survived Nazi occupation of Europe; (3) Controls: European descent, outside Europe during WWII. We determined Hazards Ratios (HR), adjusting for gender, loneliness, financial difficulty, physical activity, ADL dependence, chronic ischemic heart disease, cancer, cognitive deficits, chronic joint pain, self-rated health.

Results

At ages 85 (n = 496), 90 (n = 524), and 95 (n = 383) the frequency of HS-C versus HS-E versus Controls was 28%/22%/50%, 19%/19%/62%, and 20%/22%/58%, respectively. No consistent significant morbidity differences were observed. Mortality between ages 85–90 and 90–95 years was 34.9% versus 38% versus 32.0%, and 43.4% versus 47.3% versus 43.7%, respectively, with no significant differences in survival rates (log rank p = 0.63, p = 0.81). Five-year mortality adjusted HRs were insignificant for HS-C and HS-E between ages 85–90 (HR 0.87, 95% CI 0.54–1.39; HR 1.14, 95% CI 0.73–1.78) and ages 90–95 (HR 0.72, 95% CI 0.39–1.32; HR 1.38, 95% CI 0.85–2.23).

Conclusions

Seventy years following their trauma and suffering during the Holocaust, the significant impairments of health, function, morbidity, and mortality which have accompanied survivors throughout their entire adult life, were no longer observed. Indeed, it is likely that survivors living >85 years old represent a uniquely resilient population of people, whose adaptation to adversity has accompanied them throughout their lives.     

Diabetic cardiomyopathy: Where are we 40 years later?

Diabetic cardiomyopathy is a cardiac disease that arises as a result of the diabetic state, independent of vascular or valvular pathology. It manifests initially as asymptomatic diastolic dysfunction, which progresses to symptomatic heart failure. The compliance of the heart wall is decreased and contractile function is impaired. The pathophysiology is incompletely understood, but appears to be initiated both by hyperglycemia and changes in cardiac metabolism. These changes induce oxidative stress and activate a number of secondary messenger pathways, leading to cardiac hypertrophy, fibrosis and cell death. Alterations in contractile proteins and intracellular ions impair excitation-contraction coupling, while decreased autonomic responsiveness and autonomic neuropathy impair its regulation. Extensive structural abnormalities also occur, which have deleterious mechanical and functional consequences.     

Diversion colitis 25 years later: the phenomenon of the disease

Background

Diversion colitis (DC) seems to be common in stoma patients, and the restoration of the continuity of the digestive tract is crucial for relief from the inflammatory process. No prospective studies of the late effects of DC on the lower gastrointestinal (GI) tract mucosa and the clinical condition of patients have been reported.

Methods

Data from 23 patients who underwent stoma creation were analysed during the reversal period (A) and at an average of 3 months (B1) and 5.6 years (B2) after restoration of GI tract continuity. Every monitoring visit included endoscopy, histology and assessment of the clinical condition of patients.

Results

Shortly after GI tract restoration (B1), a significant decrease in inflammation was observed. The Ki67 positivity percentage increased, but this was not significant. At an average of 5.6 years after restoration (group B2), the clinical symptoms were mild. More patients presented with endoscopically detected inflammation of the mucosa, but its severity was not significantly higher than that at 3 months after reversal. Histological inflammation was more common, and its severity was significantly higher than that shortly after reversal but similar to that before reversal. The Ki67 positivity percentage decreased at the last examination (B2).

Conclusions

The results of this study show a complex recurrence of histological inflammation several years after GI tract restoration but without clinical and endoscopic inflammation and with good clinical condition. DC can potentially have a late influence on the rectal mucosa, even after stoma closure.

     

The black/white disability gap: persistent inequality in later life?

OBJECTIVES: Previous research on differences between Black and White older adults has produced inconsistent results on whether a gap in disability exists and whether it persists over time. The present research identifies several reasons for the inconsistent results to date and examines Black/White differences in disability trajectories over 6 years. METHODS: Data from the North Carolina Established Populations for the Epidemiologic Studies of the Elderly (1986-1992) are used to estimate the disability gap and trajectory over time for both Black and White older adults. RESULTS: Results indicate that a disability gap between Black and White adults exists, but after socioeconomic resources, social integration, and other health indicators are adjusted for, the trajectories of disability by race are not significantly different. Controlling for incident morbidity over time accounts for the significant difference in level of disability between the two groups. DISCUSSION: This research supports the "persistent inequality" interpretation, indicating that Black adults have higher morbidity and disability earlier in life compared with White adults, and that the gap neither converges nor diverges over time.     

The future of gastroenterology—The next 25 years

Summary Gastroenterology frequently has been considered a backward, undeveloped specialty of clinical medicine, albeit one that deals with many and frequently occurring diseases and has many interested practitioners. In the past few years increasing numbers of young basic medical scientists have turned with keen interest to this almost virgin clinical field and have brought with them the techniques of their respective disciplines. Research in gastroenterology, which has lagged until now, is also receiving increasing pecuniary support. One can predict that in the next 25 years the development of scientific knowledge of the gastrointestinal tract and of diagnosis and therapeutic measures will move on apace.The development of means to quantitate many of the functions of the gastrointestinal tract in health and disease and the use of newer techniques, such as those offered by anatomic, biochemical, and physiologic scientists, should help greatly to expand our knowledge of diseases of the alimentary system. The electron microscope, the determination of the amounts and kinds of enzymes in the blood and cells, studies of motor function and standardization of results, newer techniques of biopsy of liver and intestinal mucosa, and clear definitions and understanding of absorption are all among the factors that will influence and develop this specialty.Ways to control acid and enzyme secretion, how to govern the motor activity of the gastrointestinal tract, development of a better understanding of parenteral nutrition and of the relation of nutritional disturbances to disease of the liver—these are some of the boons to therapy that can be looked for in the quarter-century ahead.The clinical gastroenterologist in the future will stand on an increasingly firm foundation of scientific medicine. The need for a carefully taken history and of a sympathetic and understanding physician who can properly interpret what the scientific studies of his patient have shown will in fact be as great as if not greater than before.     

N-acetylcysteine in acute cardiology: 10 years later: what do we know and what would we like to know?!

N-acetylcysteine (NAC) is known in a variety of branches of medicine. This paper addresses in detail the action of NAC as it is emerging from research and clinical trials over the past decade in cardiology, giving rise to new concepts. The result is a process resembling creation of a mosaic from individual pieces. Also, the role of NAC in acute cardiology, during acute reperfusion in particular, is defined.