1
|
Bjørklund G, Semenova Y. Serum levels of glycosylated hemoglobin, insulin, total protein and their association with somatoform disorder in environmentally exposed populations in Kazakhstan. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2025; 114:104637. [PMID: 39778758 DOI: 10.1016/j.etap.2025.104637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/18/2024] [Accepted: 01/03/2025] [Indexed: 01/11/2025]
Abstract
Biochemical blood parameters may serve as biomarkers of environmental pollution, with somatoform disorder (SD) being of interest. This study examined serum glycosylated hemoglobin (HbA1C), insulin, total protein, and SD prevalence in populations from polluted areas in Kazakhstan. It assessed the predictive value of these parameters for SD, along with other risk factors. A cross-sectional study of 1881 individuals (ages 18-52) in Kazakhstan used the PHQ-15 questionnaire to assess SD. HbA1C was measured via immunoturbidimetry, insulin via immunoassay, and total protein via colorimetry. HbA1C levels > 6.5 % identified undiagnosed diabetes in 2.4 % of control residents, with higher rates in Ust-Kamenogorsk (10.6 %), Berezovka/Aksay (4.8 %), and Borodulikha/Abay (3.7 %). Pollutant-exposed populations had higher rates of hyperinsulinemia. Moderate to severe SD was more common in Ust-Kamenogorsk (26.6 %) and Berezovka/Aksay (27.2 %) than in controls, with lower rates in Borodulikha/Abay (16.7 %). Age, HbA1c levels, and residence near the condensate gas extraction plant significantly increased the odds of having moderate to severe SD, while being male and of Kazakh ethnicity significantly decreased the odds. The study links environmental exposure to increased rates of SD, diabetes, and insulin resistance.
Collapse
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway; Semey Medical University, Semey, Kazakhstan.
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| |
Collapse
|
2
|
Bjørklund G, Semenova Y. Serum levels of thyroxine, thyroid-stimulating hormone, and anti-thyroid peroxidase antibodies and their association with anxiety in environmentally exposed populations in Kazakhstan. Arch Toxicol 2025; 99:825-833. [PMID: 39799523 DOI: 10.1007/s00204-024-03908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 11/20/2024] [Indexed: 01/15/2025]
Abstract
Little is known about the impact of environmental pollution on thyroid function in the non-occupationally exposed population of Kazakhstan. This study aimed to investigate serum levels of thyroxine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (TPO) antibodies in the environmentally exposed population of Kazakhstan in relation to symptoms of anxiety. A total of 1,388 nominally healthy individuals residing in areas exposed to three major types of environmental pollution prevalent in Kazakhstan-non-ferrous metallurgy, condensate gas extraction, and activities of the Semipalatinsk Nuclear Test Site (SNTS)-were enrolled. All comparisons were made with 493 individuals residing in settlements without industrial or military pollution. Serum-free T4, TSH, and anti-TPO levels were tested using a solid-phase chemiluminescent immunoassay. The Generalized Anxiety Disorder 7-item (GAD-7) inventory was utilized to screen for anxiety symptoms. The prevalence of subclinical hypothyroidism was significantly higher in residents of settlements near the condensate gas field than in control sites (20.3 vs. 15.0%). In comparison, the prevalence of overt hypothyroidism was insignificantly higher (0.7 vs. 0.6%). The prevalence of subclinical hyperthyroidism was insignificantly higher in residents of settlements around the SNTS. The prevalence of overt hyperthyroidism was insignificantly higher in residents of areas proximal to the condensate gas field compared to the controls. The prevalence of both normal and elevated serum levels of anti-TPO antibodies did not differ significantly between different sites. Moderate and severe anxiety symptoms were the least common in residents of the two control sites (5.9%). This study carries potential implications for tailored public health interventions and policies.
Collapse
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610, Mo i Rana, Norway.
- Semey Medical University, Semey, Kazakhstan.
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| |
Collapse
|
3
|
Kairatova GK, Khismetova ZA, Smailova DS, Serikova-Esengeldina DS, Berikuly D, Akhmetova KM, Shalgumbayeva GM. Assessment of Skills of Caregivers Providing Care for Stroke Patients in East Kazakhstan Region. Healthcare (Basel) 2024; 13:27. [PMID: 39791634 PMCID: PMC11719777 DOI: 10.3390/healthcare13010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/22/2024] [Accepted: 12/24/2024] [Indexed: 01/12/2025] Open
Abstract
OBJECTIVES This study investigated stroke survivors and the characteristics of care management after discharge from hospital to home. The study aimed to identify caregiving difficulties and to assess mastery of skills in implementing recovery activities at home. This was a cross-sectional study. METHODS As part of the study, we interviewed 205 informal caregivers caring for stroke survivors. For descriptive statistics, frequencies, mean, medians, and standard deviations were calculated. RESULTS Caregivers determined that the main aim was to restore motor activity in 58% (p ≤ 0.021), and the difficulties they most often encounter during caregiving are difficulties related to obtaining information from medical personnel, or not understanding the information received in people under 50 years of age, which were indicated in 47.9% of cases, while in people over 50 years of age, this indicator was 49.5%. The emotional state of the informal caregivers is closely interrelated with the state of stroke survivors. The informal caregivers with a higher education are more resistant to these changes related to the patient's health. CONCLUSIONS The informal caregivers in East Kazakhstan face challenges such as inadequate preparation, limited resources, and emotional strain, hindering effective care. High rates of stroke-related impairments highlight the need for better rehabilitation programs and informal caregiver support. Future research should assess intervention programs and support systems.
Collapse
Affiliation(s)
- Gulnaz K. Kairatova
- Department of Public Health, Semey Medical University, Semey City 071400, Kazakhstan; (G.K.K.); (Z.A.K.); (D.S.S.-E.); (D.B.)
| | - Zaituna A. Khismetova
- Department of Public Health, Semey Medical University, Semey City 071400, Kazakhstan; (G.K.K.); (Z.A.K.); (D.S.S.-E.); (D.B.)
| | - Dariga S. Smailova
- Scientific Department, Kazakh National Medical University named after S.D. Asfendiyarov, Almaty 050012, Kazakhstan;
| | - Dinara S. Serikova-Esengeldina
- Department of Public Health, Semey Medical University, Semey City 071400, Kazakhstan; (G.K.K.); (Z.A.K.); (D.S.S.-E.); (D.B.)
| | - Duman Berikuly
- Department of Public Health, Semey Medical University, Semey City 071400, Kazakhstan; (G.K.K.); (Z.A.K.); (D.S.S.-E.); (D.B.)
| | - Kamila M. Akhmetova
- Department of Public Health, Astana Medical University, Astana 010000, Kazakhstan;
| | - Gulnar M. Shalgumbayeva
- Department of Public Health, Semey Medical University, Semey City 071400, Kazakhstan; (G.K.K.); (Z.A.K.); (D.S.S.-E.); (D.B.)
| |
Collapse
|
4
|
Jahng JWS, Little MP, No HJ, Loo BW, Wu JC. Consequences of ionizing radiation exposure to the cardiovascular system. Nat Rev Cardiol 2024; 21:880-898. [PMID: 38987578 PMCID: PMC12037960 DOI: 10.1038/s41569-024-01056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
Ionizing radiation is widely used in various industrial and medical applications, resulting in increased exposure for certain populations. Lessons from radiation accidents and occupational exposure have highlighted the cardiovascular and cerebrovascular risks associated with radiation exposure. In addition, radiation therapy for cancer has been linked to numerous cardiovascular complications, depending on the distribution of the dose by volume in the heart and other relevant target tissues in the circulatory system. The manifestation of symptoms is influenced by numerous factors, and distinct cardiac complications have previously been observed in different groups of patients with cancer undergoing radiation therapy. However, in contemporary radiation therapy, advances in treatment planning with conformal radiation delivery have markedly reduced the mean heart dose and volume of exposure, and these variables are therefore no longer sole surrogates for predicting the risk of specific types of heart disease. Nevertheless, certain cardiac substructures remain vulnerable to radiation exposure, necessitating close monitoring. In this Review, we provide a comprehensive overview of the consequences of radiation exposure on the cardiovascular system, drawing insights from various cohorts exposed to uniform, whole-body radiation or to partial-body irradiation, and identify potential risk modifiers in the development of radiation-associated cardiovascular disease.
Collapse
Affiliation(s)
- James W S Jahng
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, UK
| | - Hyunsoo J No
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA, USA
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
- Greenstone Biosciences, Palo Alto, CA, USA.
| |
Collapse
|
5
|
Bjørklund G, Pivina L, Semenova Y. Genetic Polymorphisms in Cardiovascular Disease: Effects Across Three Generations Exposed to Radiation from the Semipalatinsk Nuclear Test Site. Cardiovasc Toxicol 2024; 24:870-878. [PMID: 39030318 DOI: 10.1007/s12012-024-09885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 06/19/2024] [Indexed: 07/21/2024]
Abstract
The population in the areas neighboring the Semipalatinsk Nuclear Test Site (SNTS) in the eastern region of Kazakhstan faces increased cardiovascular disease (CVD) risk. Previous research has not explored gene polymorphisms related to CVD in this population. Therefore, the present study examines the prevalence of six CVD-associated genotypes in three generations exposed to SNTS radiation. The genotyping of ApoE Leu28 → Pro, AGT Met174 → Thr, AGT Met235 → Thr, eNOS T786 → C, PON1 Gln192 → Arg, and EDN 1 Lys198 → Asn was performed using real-time polymerase chain reaction. The present study encompassed a cohort of 218 participants with a familial history of arterial hypertension and/or carotid artery disease spanning at least three generations. The analysis unveiled significant disparities in the prevalence of ApoE Leu28 → Pro, eNOS T786 → C, and PON1 Gln192 → Arg genotypes across different generations. Furthermore, a substantial variation in the distribution of the eNOS T786 → C genotype was observed between individuals of Kazakh and Russian ethnicities. Nevertheless, no significant discrepancies were detected in the frequencies of the investigated genotypes between genders. Further research in this area is warranted to enhance the understanding of the genetic factors contributing to CVD in the population exposed to radiation from the SNTS. Specifically, future studies should broaden the scope of genetic polymorphisms investigated and include representatives of healthy individuals who have not been exposed to radiation as controls.
Collapse
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610, Mo I Rana, Norway.
- Semey Medical University, Semey, Kazakhstan.
| | - Lyudmila Pivina
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| |
Collapse
|
6
|
Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
Collapse
Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
| |
Collapse
|
7
|
Bjørklund G, Semenova Y. Serum calcium and magnesium levels and quality of life in environmentally exposed populations in Kazakhstan. Biometals 2024; 37:895-904. [PMID: 38329650 DOI: 10.1007/s10534-023-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/23/2023] [Indexed: 02/09/2024]
Abstract
The relationship between the levels of essential elements and various aspects of well-being in environmentally exposed populations still needs to be better understood. The present study aims to investigate the potential connections between serum concentrations of calcium (Ca), magnesium (Mg), and quality of life (QoL) in environmentally exposed populations in Kazakhstan. The present study involved 1881 nominally healthy individuals aged 18-52 years who were permanent residents of Abay, Borodulikha, Ust-Kamenogorsk, Kurchum, Uralsk, Aksay, and Berezovka settlements. These settlements were selected to represent different types of environmental exposure: radioactive fallout from the Semipalatinsk Nuclear Test Site (SNTS), non-ferrous metallurgy, and the condensate gas field, compared to environmentally unexposed territories. The Russian version of the SF-36 questionnaire was used to assess the participants' quality of life. Serum Ca levels were measured using colorimetry with O-cresolphthalein, and serum Mg concentrations were measured using colorimetry with xylidyl blue. Both elevated and decreased serum Ca levels were more frequently observed in the environmentally exposed populations. The prevalence of hypermagnesemia was highest among residents near the condensate gas field. Environmentally exposed populations residing near the SNTS and in Ust-Kamenogorsk exhibited lower scores in some QoL domains. In contrast, people near the condensate gas field showed comparable or even higher QoL scores than the control population. Only serum Mg demonstrated a significant association with the average QoL scores, while Ca did not show such an association. These findings have important implications for public health interventions.
Collapse
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
- Semey Medical University, Semey, Kazakhstan.
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| |
Collapse
|
8
|
Little MP, Boerma M, Bernier MO, Azizova TV, Zablotska LB, Einstein AJ, Hamada N. Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease. BMC Public Health 2024; 24:1601. [PMID: 38879521 PMCID: PMC11179258 DOI: 10.1186/s12889-024-18701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/23/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period. METHODS We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review. RESULTS There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. CONCLUSIONS There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.
Collapse
Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Room 7E546, 9609 Medical Center Drive MSC 9778, Bethesda, MD, 20892-9778, USA.
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK.
| | - Marjan Boerma
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sureté Nucléaire, Fontenay Aux Roses, France
| | - Tamara V Azizova
- Clinical Department, Southern Urals Biophysics Institute, Chelyabinsk Region, Ozyorskoe Shosse 19, Ozyorsk, 456780, Russia
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94143, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| |
Collapse
|
9
|
Little MP, Azizova TV, Richardson DB, Tapio S, Bernier MO, Kreuzer M, Cucinotta FA, Bazyka D, Chumak V, Ivanov VK, Veiga LHS, Livinski A, Abalo K, Zablotska LB, Einstein AJ, Hamada N. Ionising radiation and cardiovascular disease: systematic review and meta-analysis. BMJ 2023; 380:e072924. [PMID: 36889791 PMCID: PMC10535030 DOI: 10.1136/bmj-2022-072924] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To systematically review and perform a meta-analysis of radiation associated risks of cardiovascular disease in all groups exposed to radiation with individual radiation dose estimates. DESIGN Systematic review and meta-analysis. MAIN OUTCOME MEASURES Excess relative risk per unit dose (Gy), estimated by restricted maximum likelihood methods. DATA SOURCES PubMed and Medline, Embase, Scopus, Web of Science Core collection databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Databases were searched on 6 October 2022, with no limits on date of publication or language. Animal studies and studies without an abstract were excluded. RESULTS The meta-analysis yielded 93 relevant studies. Relative risk per Gy increased for all cardiovascular disease (excess relative risk per Gy of 0.11 (95% confidence interval 0.08 to 0.14)) and for the four major subtypes of cardiovascular disease (ischaemic heart disease, other heart disease, cerebrovascular disease, all other cardiovascular disease). However, interstudy heterogeneity was noted (P<0.05 for all endpoints except for other heart disease), possibly resulting from interstudy variation in unmeasured confounders or effect modifiers, which is markedly reduced if attention is restricted to higher quality studies or those at moderate doses (<0.5 Gy) or low dose rates (<5 mGy/h). For ischaemic heart disease and all cardiovascular disease, risks were larger per unit dose for lower dose (inverse dose effect) and for fractionated exposures (inverse dose fractionation effect). Population based excess absolute risks are estimated for a number of national populations (Canada, England and Wales, France, Germany, Japan, USA) and range from 2.33% per Gy (95% confidence interval 1.69% to 2.98%) for England and Wales to 3.66% per Gy (2.65% to 4.68%) for Germany, largely reflecting the underlying rates of cardiovascular disease mortality in these populations. Estimated risk of mortality from cardiovascular disease are generally dominated by cerebrovascular disease (around 0.94-1.26% per Gy), with the next largest contribution from ischaemic heart disease (around 0.30-1.20% per Gy). CONCLUSIONS Results provide evidence supporting a causal association between radiation exposure and cardiovascular disease at high dose, and to a lesser extent at low dose, with some indications of differences in risk between acute and chronic exposures, which require further investigation. The observed heterogeneity complicates a causal interpretation of these findings, although this heterogeneity is much reduced if only higher quality studies or those at moderate doses or low dose rates are considered. Studies are needed to assess in more detail modifications of radiation effect by lifestyle and medical risk factors. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020202036.
Collapse
Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Tamara V Azizova
- Clinical Department, Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk Region, Russia
| | - David B Richardson
- Department of Environmental and Occupational Health, Irvine Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Soile Tapio
- Technische Universität München, Munich, Germany
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sureté Nucléaire, Fontenay aux Roses, France
| | | | - Francis A Cucinotta
- Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Vadim Chumak
- National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Victor K Ivanov
- Medical Radiological Research Center of Russian Academy of Medical Sciences, Obninsk, Russia
| | - Lene H S Veiga
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Alicia Livinski
- National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA
| | - Kossi Abalo
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Komae, Tokyo, Japan
| |
Collapse
|
10
|
Ygiyeva D, Pivina L, Messova A, Urazalina Z, Semenova Y, Dyussupov A, Dyussupov A, Belikhina T, Syzdykbayev M, Batenova G, Akhmetova A, Adams A. Paramedic To Provider Consultation Challenges in the Emergency Department in Kazakhstan: An Online Survey. Open Access Emerg Med 2023; 15:69-77. [PMID: 36923062 PMCID: PMC10010182 DOI: 10.2147/oaem.s401331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Consultation is an important and necessary aspect of patient care in the emergency department. We prospectively examined difficulties during the consultation process between paramedics and providers in emergency departments in Kazakhstan. Methods The paramedics were interviewed using various platforms and face-to-face meetings. Questionnaires were administered to paramedics to gather feedback on the current consultation process. In our survey, 202 paramedics of ambulance from the cities of Semey, Pavlodar, and Ust-Kamenogorsk, located in the North and East of Kazakhstan took part. Results Serious barriers to effective consultation were identified during consultations with cardiologists, pediatricians, and traumatologists. Weekends, as well as nighttime, are associated with more consultation difficulties. The most common problems for paramedics are non-attendance of the consultant, refusal of hospitalization by the consultant, and referral to other specialists and departments. More than 40% of the respondents noted the desire to share responsibility for the patient with medical consultants, which indicates uncertainty in their own knowledge due to the limited work experience of the majority of respondents. Conclusion Barriers that arise during the consultation process of patients with emergency conditions can lead to unfavorable outcomes. Strategies to address these barriers are needed to improve the quality of patient care. This review aims to understand and evaluate the issues that arise during the consultation process.
Collapse
Affiliation(s)
- Diana Ygiyeva
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Lyudmila Pivina
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Assylzhan Messova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Zhanar Urazalina
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Yuliya Semenova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Almas Dyussupov
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Altay Dyussupov
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Tatyana Belikhina
- Nuclear Medicine Department, Center of Nuclear Medicine and Oncology, Semey, Abay Region, Kazakhstan
| | - Marat Syzdykbayev
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Gulnara Batenova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Ayaulym Akhmetova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Amber Adams
- JoAnne Gay Dishman School of Nursing, Lamar University, Beaumont, TX, USA
| |
Collapse
|