Health effects of the Chernobyl disaster: illness or illness behavior? A comparative general health survey in two former Soviet regions

Training of clinical triage of acute radiation casualties: a performance comparison ofon-siteversusonlinetraining due to the covid-19 pandemic

A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionising radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the medical treatment protocols for radiation accident victims (n= 167) and the system for evaluation and archiving of radiation accidents based on case histories (n= 24) for training purposes of medical personnel. From 2016 to 2019, we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (a) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (b) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, two-fold decrease,p= 0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%,p= 0.001), ARS (92.4% vs 96.7%,p= 0.002) and hospitalisation (93.5% vs 97.0%,p= 0.002) decreased by around 3%-7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25%-75% interquartile range increased 3-7-fold. (c) Comparison of dose estimates performed by training participants with hematologic acute radiation syndrome (HARS) severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2-4 and support for clinical decision making at dose estimates >1.5 Gy, regardless of teaching format. (d) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.

Estimation of Health-Related Quality of Life Losses Owing to a Technological Disaster in Brazil Using EQ-5D-3L: A Cross-Sectional Study

OBJECTIVES

In 2015, a dam collapsed at Samarco iron ore mine in the municipality of Mariana, Brazil, and contaminated more than 600 km of watercourses and destroyed almost 1600 acres of vegetation. Nineteen people died and more than 600 families lost their homes. This study aimed to estimate health-related quality of life (HRQoL) losses owing to this disaster.

METHODS

We collected data from a probabilistic sample of 459 individuals aged 15 years or older. Household face-to-face interviews were conducted in December 2018. Pre-event data were not available for this population, so respondents were asked to evaluate at present and in retrospect their health status using EQ-5D-3L. The Minas Gerais societal value sets for EQ-5D-3L health preferences, estimated in 2011, were used to calculate utility losses. The health loss estimation from EQ-5D will form the basis for the calculation of compensation payments for the victims.

RESULTS

Approximately 74% of the study population suffered some HRQoL loss. On average, EQ-5D index values decreased from 0.95 to 0.76. The greatest effects were observed for the anxiety/depression dimension, followed by pain/discomfort. Before the tragedy, the proportion of individuals with severe anxiety/depression and pain/discomfort was equal to 1% rising to 23% and 11%, respectively.

CONCLUSIONS

Catastrophic losses owing to the Samarco disaster were found. The EQ-5D-3L instrument showed feasibility and sensitiveness to measure HRQoL losses owing to a negative health shock in a low-income Brazilian population.

Chronic disaster impact: the long-term psychological and physical health consequences of housing damage due to induced earthquakes

OBJECTIVES

To evaluate the long-term (psychosomatic) health consequences of man-made earthquakes compared with a non-exposure control group. Exposure was hypothesised to have an increasingly negative impact on health outcomes over time.

SETTING

Large-scale gas extraction in the Netherlands causing earthquakes and considerable damage.

PARTICIPANTS

A representative sample of inhabitants randomly selected from municipal population records; contacted 5 times during 21 months (T1: N=3934; T5: N=2150; mean age: 56.54; 50% men; at T5, N=846 (39.3%) had no, 459 (21.3%) once and 736 (34.2%) repeated damages).

MAIN MEASURES

(Psychosomatic) health outcomes: self-rated health and Mental Health Inventory (both: validated; Short Form Health Survey); stress related health symptoms (shortened version of previously validated symptoms list). Independent variable: exposure to the consequences of earthquakes assessed via physical (peak ground acceleration) and personal exposure (damage to housing: none, once, repeated).

RESULTS

Exposure to induced earthquakes has negative health consequences especially for those whose homes were damaged repeatedly. Compared with a no-damage control group, repeated damage was associated with lower self-rated health (OR:1.64), mental health (OR:1.83) and more stress-related health symptoms (OR:2.52). Effects increased over time: in terms of relative risk, by T5, those whose homes had repeated damage were respectively 1.60 and 2.11 times more likely to report poor health and negative mental health and 2.84 times more at risk of elevated stress related health symptoms. Results for physical exposure were comparable.

CONCLUSION

This is the first study to provide evidence that induced earthquakes can have negative health consequences for inhabitants over time. It identifies the subpopulation particularly at risk: people with repeated damages who have experienced many earthquakes. Findings can have important implications for the prevention of negative health consequences of induced earthquakes.

Quality of Life and Intention to Return among Former Residents of Tomioka Town, Fukushima Prefecture 9 Years after the Fukushima Daiichi Nuclear Accident

We evaluated the association between health-related quality of life (HR-QOL) and intent to return home among former residents of Tomioka Town, Fukushima Prefecture 9 years after the Fukushima Daiichi nuclear accident to support the recovery of the community after the accident. We conducted a questionnaire survey asking residents about their intention to return to their original home, risk perception for radiation exposure, HR-QOL using the HR-QOL Short Form 8 (SF-8), and sense of coherence using the Sense of Coherence Scale (SOC-13). Among the 1029 residents, a total of 138 (13%) had already returned to Tomioka (group 1), 223 (22%) were undecided (group 2), and 668 (65%) had decided not to return (group 3). Group 2 had poorer HR-QOL than groups 1 and 3, especially physical function, body pain, general health, social functioning, and mental health. The ratio of residents with a better sense of coherence was significantly higher in group 1 than in groups 2 and 3. Our present study indicated poorer HR-QOL among residents who were undecided about returning home. It is necessary to provide a model for a multidisciplinary approach for the public during the recovery phase of a nuclear accident.

Fukushima Triple Disaster and the Road to Recovery: a Qualitative Exploration of Resilience in Internally Displaced Residents

Six years after the March 2011 Triple Disaster, over 35,000 Japanese individuals remain in temporary housing. Evacuated residents, many of who are elderly, face mental health challenges. This study evaluates the well being of individuals living in temporary housing within Fukushima. Reactions to relocation were explored using Photovoice, a community-based participatory research method, in which a set of research questions are examined qualitatively through photographs and interviews. Seven participants (average age = 69.7) were provided cameras to answer a set of self-generated questions, a process that was repeated three times. An initial analysis found resilience among participants, which was explored using a theoretical framework of resiliency. Residents discussed how relocation has disrupted their lives and coping strategies they employ to ameliorate stressors. They were often optimistic and future-oriented, stating that they wanted to "live strong" after the disaster. These resilient mindsets were personified in action: all engaged in hobbies, critical for their emotional well being. Participants also emphasized the importance of community and familial support. The evidence of resilience in participants is encouraging, suggesting that these vulnerable elderly internally displaced residents are recovering from the disruption of relocation. These themes should be explored in larger temporary housing communities. Considering the number of relocated individuals today, understanding how to foster resilience could be used to inform the development of future temporary housing shelters.

The Associations between Self-Reported Exposure to the Chernobyl Nuclear Disaster Zone and Mental Health Disorders in Ukraine

BACKGROUND

In 1986, Reactor 4 of the Chernobyl nuclear power plant near Pripyat, Ukraine exploded, releasing highly-radioactive materials into the surrounding environment. Although the physical effects of the disaster have been well-documented, a limited amount of research has been conducted on association of the disaster with long-term, clinically-diagnosable mental health disorders. According to the diathesis-stress model, the stress of potential and unknown exposure to radioactive materials and the ensuing changes to ones life or environment due to the disaster might lead those with previous vulnerabilities to fall into a poor state of mental health. Previous studies of this disaster have found elevated symptoms of stress, substance abuse, anxiety, and depression in exposed populations, though often at a subclinical level.

MATERIALS AND METHODS

With data from The World Mental Health Composite International Diagnostic Interview, a cross-sectional large mental health survey conducted in Ukraine by the World Health Organization, the mental health of Ukrainians was modeled with multivariable logistic regression techniques to determine if any long-term mental health disorders were association with reporting having lived in the zone affected by the Chernobyl nuclear disaster. Common classes of psychiatric disorders were examined as well as self-report ratings of physical and mental health.

RESULTS

Reporting that one lived in the Chernobyl-affected disaster zone was associated with a higher rate of alcohol disorders among men and higher rates of intermittent explosive disorders among women in a prevalence model. Subjects who lived in the disaster zone also had lower ratings of personal physical and mental health when compared to controls.

DISCUSSION

Stress resulting from disaster exposure, whether or not such exposure actually occurred or was merely feared, and ensuing changes in life circumstances is associated with increased rates of mental health disorders. Professionals assisting populations that are coping with the consequences of disaster should be aware of possible increases in psychiatric disorders as well as poorer perceptions regarding personal physical and mental health.

Environmental radiation level, radiation anxiety, and psychological distress of non-evacuee residents in Fukushima five years after the Great East Japan Earthquake: Multilevel analyses

The present study aimed to clarify the associations among radiation exposure or psychological exposure to the Fukushima nuclear power plant accident (i.e., fear/anxiety immediately after the accident), current radiation anxiety, and psychological distress among non-evacuee community residents in Fukushima five years after the Great East Japan Earthquake, which occurred in March 2011. A questionnaire survey was administered to a random sample of non-evacuee community residents from 49 municipalities of Fukushima prefecture from February to April 2016, and data from 1684 respondents (34.4%) were analyzed. Environmental radiation levels at the time of the accident were ascertained from survey meter data, while environmental radiation levels at the time of the survey were ascertained from monitoring post data. In the questionnaire, immediate fear/anxiety after the accident, current radiation anxiety, and psychological distress were measured using a single-item question, a 7-item scale, and K6, respectively. Multilevel linear or logistic regression models were applied to analyze the determinants of radiation anxiety and psychological distress. The findings showed that environmental radiation levels at the time of the survey were more strongly associated with radiation anxiety than radiation levels immediately after the accident. Disaster-related experiences, such as direct damage, disaster-related family stress, and fear/anxiety after the accident, and demographic characteristics (e.g., younger age, being married, low socioeconomic status) were significantly associated with radiation anxiety. Environmental radiation levels at the time of the accident or survey were not significantly associated with psychological distress. Radiation anxiety largely mediated the association between fear/anxiety after the accident and psychological distress. In addition to environmental radiation levels, respondents’ radiation anxiety was affected by multiple factors, such as disaster-related experiences and demographic characteristics. Radiation levels were not associated with psychological distress in non-evacuee community residents. Rather, fear/anxiety after the nuclear power plant accident may be a determinant of psychological distress, mediated by radiation anxiety.

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Environmental radiation levels affected radiation anxiety.

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Environmental radiation levels did not affect psychological distress.

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Fear/anxiety at time of nuclear power plant accident affected radiation anxiety.

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Fear/anxiety at time of accident affected psychological distress.

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Radiation anxiety mediated the effect of fear/anxiety on psychological distress.

The effect of a behavioral activation program on improving mental and physical health complaints associated with radiation stress among mothers in Fukushima: a randomized controlled trial

BACKGROUND

Mothers living with small children in Fukushima prefecture may experience radiation anxiety and related symptoms after the Fukushima Dai'ich Nuclear Power Plant Accident. A behavioral activation (BA) program was developed to improve their psychosomatic symptoms. The purpose of this randomized controlled trial was to examine the effectiveness of a BA program for improving psychological distress and physical symptoms among mothers with preschool children in Fukushima-prefecture 3 years after the Fukushima Daiichi Nuclear Power Plant accident.

METHODS

Participants were recruited from mothers living with a preschool child(ren) in Fukushima city and surrounding areas though a newspaper advertisement, posters, and flyers. Participants allocated to the intervention group received a newly developed group-based BA program, which consisted of two 90- min lessons with a 1-week interval. Psychological distress and physical symptoms as a primary outcome, and radiation anxiety and positive well-being (liveliness and life satisfaction) as a secondary outcome, were measured at baseline, 1- and 3-month follow-ups.

RESULTS

Participants were randomly allocated to either an intervention or a control group (18 and 19, respectively). The BA program showed a marginally significant intervention effect on psychological distress (p = 0.051) and physical symptoms (p = 0.07) at 1-month follow-up, while the effect became smaller at 3-month follow-up. The effect sizes at 1-month were medium to large (-0.72 and -0.56, respectively). There was a significant intervention effect on increasing liveliness at 3-month follow-up (p = 0.02); and there were marginally significant effects on life satisfaction at 1- and 3-month follow-ups (both p = 0.09).

CONCLUSIONS

This BA program may be effective for improving psychological distress, physical symptoms, and well-being, at least for a short duration, among mothers with preschool children after the nuclear power plant accident in Fukushima, while a further large-scale study is needed.

TRIAL REGISTRATION

The UMIN Clinical Trials Registry (UMIN-CTR; ID =  UMIN000014081 ). Registered 27 May 2014.

Psychological distress and the perception of radiation risks: the Fukushima health management survey

Objective

To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster.

Methods

We analysed cross-sectional data from a survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders.

Findings

Out of the 180 604 people who received the questionnaire, we included 59 807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, CI: 1.42–1.89) for immediate effects; OR: 1.48 (99.9% CI: 1.32–1.67) for delayed effects and OR: 2.17 (99.9% CI: 1.94–2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors.

Conclusion

Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress.

Mental disorders that exacerbated due to the Fukushima disaster, a complex radioactive contamination disaster

AIM

The Fukushima disaster was caused by an earthquake that occurred on 11 March 2011. Following the serious damage caused by the earthquake and the subsequent tsunami, radioactive contamination occurred because of the meltdown accident at the Fukushima nuclear power plant. We investigated what mental disorders were likely to become exacerbated under these conditions.

METHODS

We surveyed psychiatric outpatients at Fukushima Medical University Hospital for 1 month (31 days) from the day of the earthquake (March–April 2011).

RESULTS

The survey revealed that bipolar I disorder was most likely to become exacerbated under the conditions and that the exacerbation exhibited was more likely to involve manic switches than depression.

CONCLUSION

On the basis of the results of our study, particular care must be taken to follow up bipolar I disorder patients after a natural disaster. Our results also suggested the possible origin of bipolar I disorder.

Aftershocks associated with impaired health caused by the great East Japan disaster among youth across Japan: a national cross-sectional survey

Background

The Great East Japan earthquake, subsequent tsunamis and the Fukushima nuclear incident had a tremendous impact on Japanese society. Although small-scale surveys have been conducted in highly affected areas, few have elucidated the disaster’s effect on health from national perspective, which is necessary to prepare national policy and response.

Objective

The aim of the present study was to describe prefecture-level health status and investigate associations with number of aftershocks, seismic intensity, a closer geographical location to the Fukushima Nuclear Power Plant, or higher reported radiation dose in each prefecture even after adjusting for individual socioeconomic factors, by utilizing individual-level data acquired from a national cross-sectional Internet survey as well as officially reported prefecture-level data.

Methods

A Japanese government research institute obtained 12,000 participants by quota sampling and 7335 participants were eligible for the analysis in an age range between 17 and 27 years old. We calculated the percentage of people with decreased subjective health in each prefecture after the earthquake. Variability introduced by a small sample size for some prefectures was smoothed using empirical Bayes estimation with a random-intercept logistic model, with and without demographic factors. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs) for change of subjective health associated with prefecture-level and individual-level factors.

Results

Adjusted empirical Bayes estimates were higher for respondents commuting in the northeast region (Iwate 14%, Miyagi 19%, and Fukushima 28%), which faces the Pacific Ocean, while the values for Akita (10%) and Yamagata (8%) prefectures, which do not face the Pacific Ocean, were lower than those of Tokyo (12%). The values from the central to the western region were clearly lower. The number of aftershocks was coherently associated with decreased health (OR 1.05 per 100 times, 95% CI 1.04-1.06; P<.001) even after adjusting for covariates (OR 1.02 per 100 times, 95% CI 1.00-1.05; 1.32 per 1000 times, 95% CI 1.03-1.71; P=.049). In contrast, seismic intensity of the initial earthquake (OR 0.87, 95% CI 0.65-1.17; P=.36), radiation dose (OR 1.16, 95% CI 0.82-1.64; P=.41), and distance from the Fukushima Nuclear Power Plant (OR 1.00, 95% CI 0.99-1.00; P=.66) were not. Change in job condition (OR 2.05, 95% CI 1.72-2.45; P<.001), female (OR 1.43, 95% CI 1.19-1.69; P<.001), higher age (OR 1.06 per year, 95% CI 1.02-1.11; P=.005), and duration of evacuation longer than 4 weeks (OR 1.44, 95% CI 1.06-1.97; P=.02) seemed to decrease perceived health status.

Conclusions

We found nationwide differences that show decreased health status because of the Great East Japan disaster according to prefecture. The number of aftershocks, change in work conditions, being female, a higher age, and duration of the evacuation were risk factors for the population after the major earthquake, tsunamis, and nuclear incident.

The Immediate Pulmonary Disease Pattern following Exposure to High Concentrations of Chlorine Gas

Background. Classification of pulmonary disease into obstructive, restrictive, and mixed patterns is based on 2005 ATS/ERS guidelines and modified GOLD criteria by Mannino et al. (2003), but these guidelines are of limited use for simple spirometry in situations involving mass casualties. Aim. The purpose of this study was to apply these guidelines to patients who underwent simple spirometry following high concentration of chlorine gas inhalation after a train derailment in Graniteville, South Carolina. Methods. We retrospectively investigated lung functions in ten patients. In order to classify pulmonary disease pattern, we used 2005 ATS/ERS guidelines and modified GOLD criteria along with our own criteria developed using available simple spirometry data. Results. We found predominant restrictive pattern in our patients with both modified GOLD and our criteria, which is in contrast to other chlorine exposure studies where obstructive pattern was more common. When compared to modified GOLD and our criteria, 2005 ATS/ERS guidelines underestimated the frequency of restrictive disease. Conclusion. Diagnosis of pulmonary disease patterns is of importance after irritant gas inhalation. Acceptable criteria need to be developed to evaluate pulmonary disease through simple spirometry in events leading to mass casualty and patient surge in hospitals.

[Quality of life in individuals exposed to cesium-137 in Goiânia, Goiás State, Brazil]

This cross-sectional observational study in Goiânia, Goiás State, Brazil in a sample of 56% of 111 individuals exposed to cesium-137 aimed to evaluate their quality of life and associations with socio-demographic factors. The study used the WHOQOL-BREF and the Monitoring System for Radiation Victims. Participants were divided according to international criteria: Group I - radiation dermatitis and / or cytogenetic dosimetry above 20 rads (n = 33) and Group II - cytogenetic dosimetry ≤ 20 rads (n = 29), totaling 62 subjects. Among the WHOQOL-BREF domains, environment showed the highest mean scores (59.88, SD = 20.39) and psychological the lowest (53.02, SD = 17.98). Associations between the physical, psychological, and social domains were significant for the age variable. There was no difference between groups. The association between socio-demographic factors and quality of life was not significant. Radiation victims suffer considerable impact on quality of life, with persistent psychosocial problems, especially among those older than 41 years.

Long-term mental health outcomes following the 2004 Asian tsunami disaster: A comparative study on direct and indirect exposure

There is inadequate information on the long-term mental health outcomes among disaster victims in low and middle income countries. It is especially so for the vast majority of victims who are indirectly exposed to disasters. To address this gap in knowledge we examined the prevalence of psychiatric morbidity, particularly anxiety, depression and post-traumatic stress disorder (PTSD) in the 2004 Asian tsunami victims in India, 4.5 y after the disaster. It was also intended to compare the mental health outcomes of the victims with direct exposure to tsunami waters and those who were indirectly exposed to tsunami disaster (people living near the sea who escaped tsunami waters but witnessed the disaster and suffered various losses). In a cross-sectional epidemiological study, 666 randomly selected victims in South India were assessed for psychiatric morbidity through the Self-Reporting questionnaire (SRQ), Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale, Self-Rating Scale for PTSD (SRS-PTSD) and suicidality screening. The disaster experience, quality of life and socio-demographic profile were also assessed. Psychiatric morbidity based on SRQ was 77.6% and estimated prevalence of anxiety symptoms (23.1%), depression (33.6%), PTSD (70.9%) and comorbidity (44.7%) suggested nature and extent of the psychiatric morbidity in the tsunami victims. The direct exposure group had a significantly greater proportion of psychiatric morbidity based on SRQ, anxiety symptoms and suicide attempts. Factors which predicted psychiatric morbidity were: lack of formal education, perception of disaster as highly stressful, damage to home and loss of livelihood and livestock. In conclusion, a large proportion of Asian tsunami victims were observed to have continuing mental health problems 4.5 y after the disaster, which highlighted the need for psychiatric services for the affected communities.

Literature review and global consensus on management of acute radiation syndrome affecting nonhematopoietic organ systems

OBJECTIVES

The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.

METHODS

English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.

RESULTS

No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.

CONCLUSIONS

High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.

Rapid Health and Needs assessments after disasters: a systematic review

Background

Publichealth care providers, stakeholders and policy makers request a rapid insight into health status and needs of the affected population after disasters. To our knowledge, there is no standardized rapid assessment tool for European countries. The aim of this article is to describe existing tools used internationally and analyze them for the development of a workable rapid assessment.

Methods

A review was conducted, including original studies concerning a rapid health and/or needs assessment. The studies used were published between 1980 and 2009. The electronic databasesof Medline, Embase, SciSearch and Psychinfo were used.

Results

Thirty-three studies were included for this review. The majority of the studies was of US origin and in most cases related to natural disasters, especially concerning the weather. In eighteen studies an assessment was conducted using a structured questionnaire, eleven studies used registries and four used both methods. Questionnaires were primarily used to asses the health needs, while data records were used to assess the health status of disaster victims.

Conclusions

Methods most commonly used were face to face interviews and data extracted from existing registries. Ideally, a rapid assessment tool is needed which does not add to the burden of disaster victims. In this perspective, the use of existing medical registries in combination with a brief questionnaire in the aftermath of disasters is the most promising. Since there is an increasing need for such a tool this approach needs further examination.

Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv

Background

Since the Chornobyl accident in 1986, the physical health of exposed children in Ukraine has been monitored, but their perceived health has not been studied. This study examines health perceptions of Ukrainian adolescents exposed to radioactive fallout in utero or as infants, and the epidemiologic and Chornobyl-related influences on self-reported health.

Method

We assessed three groups of 19-year olds in Kyiv: 262 evacuees from contaminated areas near the plant; 261 classmate controls; and 325 population-based controls. The evacuees and classmates were previously assessed at age 11. Structured interviews were conducted with the adolescents and their mothers (N = 766), followed by general physical examinations (N = 722) and blood tests (N = 707). Proportional odds logistic regression and multi-group path analysis were the major statistical tests.

Results

The examination and blood test results were similar across groups except for a significantly elevated rate of thyroid enlargement found by palpation in evacuees (17.8%) compared former classmates (8.7%) and population-based controls (8.0%). In addition, four evacuees and one population control had had a thyroidectomy. Compared to controls, the evacuees rated their health the least positively and reported more medically diagnosed illnesses during the 5 years preceding the interview, particularly thyroid disease, migraine headache, and vascular dystony. The consistent risk factors (p < 0.001) for these subjective health reports were evacuee status, female gender, multiple hospitalizations, and health risk perception regarding Chornobyl. All three groups of mothers rated their children's health more negatively than the adolescents themselves, and maternal ratings were uniquely associated with the adolescents' health reports in the adjusted models. In the longitudinal evacuee and classmate subsamples, path analysis showed that mothers' health ratings when the children were age 11 predicted their later evaluations which in turn were associated with the adolescent self-reports.

Conclusion

The more negative self-evaluations of the evacuees were linked to a number of risk factors, including multiple hospitalizations, health risk perceptions, and epidemiologic risk factors. The increased rate of thyroid cancer and other diagnoses no doubt contributed to the evacuees' less positive subjective health. The strong effect of the mothers' perceptions argues in favor of developing risk communication programs for families rather than for mothers or adolescents as separate target groups.

Determinants of participation in a longitudinal two-stage study of the health consequences of the Chornobyl nuclear power plant accident

Background

The determinants of participation in long-term follow-up studies of disasters have rarely been delineated. Even less is known from studies of events that occurred in eastern Europe. We examined the factors associated with participation in a longitudinal two-stage study conducted in Kyiv following the 1986 Chornobyl nuclear power plant accident.

Methods

Six hundred child-mother dyads (300 evacuees and 300 classmate controls) were initially assessed in 1997 when the children were 11 years old, and followed up in 2005–6 when they were 19 years old. A population control group (304 mothers and 327 children) was added in 2005–6. Each assessment point involved home interviews with the children and mothers (stage 1), followed by medical examinations of the children at a clinic (stage 2). Background characteristics, health status, and Chornobyl risk perceptions were examined.

Results

The participation rates in the follow-up home interviews were 87.8% for the children (88.6% for evacuees; 87.0% for classmates) and 83.7% for their mothers (86.4% for evacuees and 81.0% for classmates). Children's and mothers' participation was predicted by one another's study participation and attendance at the medical examination at time 1. Mother's participation was also predicted by initial concerns about her child's health, greater psychological distress, and Chornobyl risk perceptions. In 1997, 91.2% of the children had a medical examination (91.7% of evacuees and 90.7% of classmates); in 2005–6, 85.2% were examined (83.0% of evacuees, 87.7% of classmates, 85.0% of population controls). At both times, poor health perceptions were associated with receiving a medical examination. In 2005–6, clinic attendance was also associated with the young adults' risk perceptions, depression or generalized anxiety disorder, lower standard of living, and female gender.

Conclusion

Despite our low attrition rates, we identified several determinants of selective participation consistent with previous research. Although evacuee status was not associated with participation, Chornobyl risk perceptions were strong predictors of mothers' follow-up participation and attendance at the medical examinations. Understanding selective participation offers valuable insight for future longitudinal disaster studies that integrate psychiatric and medical epidemiologic research.

Psychological and perceived health effects of the Chernobyl disaster: a 20-year review

The mental health impact of Chernobyl is regarded by many experts as the largest public health problem unleashed by the accident to date. This paper reviews findings reported during the 20-y period after the accident regarding stress-related symptoms, effects on the developing brain, and cognitive and psychological impairments among highly exposed cleanup workers. With respect to stress-related symptoms, the rates of depressive, anxiety (especially post-traumatic stress symptoms), and medically unexplained physical symptoms are two to four times higher in Chernobyl-exposed populations compared to controls, although rates of diagnosable psychiatric disorders do not appear to be elevated. The symptom elevations were found as late as 11 y after the accident. Severity of symptomatology is significantly related to risk perceptions and being diagnosed with a Chernobyl-related health problem. In general, the morbidity patterns are consistent with the psychological impairments documented after other toxic events, such as the atomic bombings of Hiroshima and Nagasaki, the Three Mile Island accident, and Bhopal. With respect to the developing brain of exposed children who were in utero or very young when the accident occurred, the World Health Organization as well as American and Israeli researchers have found no significant associations of radiation exposure with cognitive impairments. Cognitive impairments in highly exposed cleanup workers have been reported by Ukrainian researchers, but these findings have not been independently confirmed. A seminal study found a significant excess death rate from suicide in cleanup workers, suggesting a sizable emotional toll. Given the magnitude and persistence of the adverse mental health effects on the general population, long-term educational and psychosocial interventions should be initiated that target primary care physicians, local researchers, and high risk populations, including participants in ongoing cohort studies.

Factor structure of the General Health Questionnaire (GHQ-12) in subjects who had suffered from the 2004 Niigata-Chuetsu Earthquake in Japan: a community-based study

Background

Factor structure of the 12-item General Health Questionnaire (GHQ-12) was studied by a survey of subjects who had experienced the 2004 Niigata-Chuetsu earthquake (6.8 on the Richter scale) in Japan.

Methods

Psychological distress was measured at two years after the earthquake by using GHQ-12 in 2,107 subjects (99.0% response rate) who suffered the earthquake. GHQ-12 was scored by binary, chronic and Likert scoring method. Confirmatory factor analysis was used to reveal the factor structure of GHQ-12. Categorical regression analysis was performed to evaluate the relationships between various background factors and GHQ-12 scores.

Results

Confirmatory factor analysis revealed that the model consisting of the two factors and using chronic method gave the best goodness-of-fit among the various models for factor structure. Recovery in the scale for the factor 'social dysfunction' was remarkably impaired compared with that of the factor 'dysphoria'. Categorical regression analysis revealed that various factors, including advanced age, were associated with psychological distress. Advanced age affected the impaired recovery of factor 'social dysfunction' score as well as total GHQ score.

Conclusion

The two-factor structure of GHQ-12 was conserved between the survey at five month and that at two years after the earthquake. Impaired recovery in the ability to cope with daily problems in the subjects who had experienced the earthquake was remarkable even at two years after the earthquake.

The Chernobyl accident 20 years on: an assessment of the health consequences and the international response

Twenty years after the Chernobyl accident the WHO and the International Atomic Energy Authority issued a reassuring statement about the consequences. Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents. So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment in future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure. Because of the uncertainties from and the consequences of the accident, it is essential that investigations of its effects should be broadened and supported for the long term. The United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.

Health-related quality of life of firefighters and police officers 8.5 years after the air disaster in Amsterdam

BACKGROUND

In 1992 a cargo aircraft crashed into apartment buildings in Amsterdam. In the troublesome aftermath rumours emerged on potential toxic exposures and health consequences. The aim of this study is to assess the long-term impact of this disaster on the health-related quality of life (HRQoL) of professional assistance workers.

METHODS

Historic cohort study, using questionnaires to assess occupational disaster exposure, HRQoL (SF36), and background variables, at on average 8.5 years post-disaster. Participating were the exposed professional firefighters (n = 334) and police officers (n = 834) who reported disaster-related task(s), and their non-exposed colleagues who did not report such tasks (n = 194, and n = 634, respectively).

RESULTS

Multivariate logistic regression analysis showed that exposed workers reported a significantly lower physical HRQoL and vitality than non-exposed workers. Exposed police officers also reported a lower mental HRQoL. Among exposed workers, a lower HRQoL was reported significantly more often by workers who had a close one affected by the disaster; by firefighters who rescued people, cleaned-up, or witnessed the immediate disaster scene; and by police officers who supported the injured. Exposed police officers who perceived the disaster as 'not bad' reported a lower HRQoL less often than those to whom it was 'the worst ever'.

CONCLUSIONS

This study demonstrates that professional disaster assistance workers are at risk for a lower HRQoL, even after years.

The chernobyl accident 20 years on: an assessment of the health consequences and the international response

BACKGROUND

The Chernobyl accident in 1986 caused widespread radioactive contamination and enormous concern. Twenty years later, the World Health Organization and the International Atomic Energy Authority issued a generally reassuring statement about the consequences. Accurate assessment of the consequences is important to the current debate on nuclear power.

OBJECTIVES

Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents.

DISCUSSION

So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths ; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects, such as mini-satellite instability, which is potentially important. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment of Chernobyl's future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure.

CONCLUSIONS

Because of the uncertainties over the dose from and the consequences of the Chernobyl accident, it is essential that investigations of its effects should be broadened and supported for the long term. Because of the problems with the international response to Chernobyl, the United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.

Attribution of physical complaints to the air disaster in Amsterdam by exposed rescue workers: an epidemiological study using historic cohorts

BACKGROUND

In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables.

METHODS

Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks.

RESULTS

Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution.

CONCLUSION

This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization.

Medical and psychiatric casualties caused by conventional and radiological (dirty) bombs

Bombing is the preferred method of terrorist attack. Unfortunately, the frequency and prevalence of this form of terrorism/criminal act/means of extortion are increasing in the United States. These attacks result in specific physical and psychiatric trauma, and produce both acute and long-term psychiatric sequelae. It will become increasingly important for trauma surgeons, emergency physicians and psychiatrists to be familiar with the special needs and treatment of these patients. This paper reviews the physical and psychiatric consequences of high explosive and radiological (dirty) bombs, and makes recommendations for the psychiatric management of bombing victims.

Epidemiological study air disaster in Amsterdam (ESADA): study design

Background

In 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, killing 43 victims and destroying 266 apartments. In the aftermath there were speculations about the cause of the crash, potential exposures to hazardous materials due to the disaster and the health consequences. Starting in 2000, the Epidemiological Study Air Disaster in Amsterdam (ESADA) aimed to assess the long-term health effects of occupational exposure to this disaster on professional assistance workers.

Methods/Design

Epidemiological study among all the exposed professional fire-fighters and police officers who performed disaster-related task(s), and hangar workers who sorted the wreckage of the aircraft, as well as reference groups of their non-exposed colleagues who did not perform any disaster-related tasks. The study took place, on average, 8.5 years after the disaster. Questionnaires were used to assess details on occupational exposure to the disaster. Health measures comprised laboratory assessments in urine, blood and saliva, as well as self-reported current health measures, including health-related quality of life, and various physical and psychological symptoms.

Discussion

In this paper we describe and discuss the design of the ESADA. The ESADA will provide additional scientific knowledge on the long-term health effects of technological disasters on professional workers.

Somatic symptoms in women 11 years after the Chornobyl accident: prevalence and risk factors

Exposure to the Chornobyl nuclear power plant explosion resulted in widespread, persistent somatic complaints, but little is known about the nature and risk factors for these conditions. This study compares the health reports of 300 women evacuated to Kyiv from the contamination zone around the plant and 300 controls with a child in the same homeroom as the evacuees in 1997. The interview addressed somatic concerns, risk factors for poor health, and Chornobyl-related stress. Compared with controls, evacuees reported significantly more health problems and rated their health more poorly overall. These differences remained significant after controlling for demographic and clinical risk factors, including the tendency to amplify physical symptoms. Significantly more evacuees received a diagnosis of a Chornobyl-related illness by a local physician, believed that their health and their children's health had been adversely affected, and were positive for Chornobyl-induced post-traumatic stress disorder. After controlling for these Chornobyl stress variables, the differences in number of health problems commonly attributed to Chornobyl remained significant but differences in general health ratings did not. The perceptions of controls were similar to those of women in a national sample. The relationship between Chornobyl stress and illness was twice as strong in evacuees (odds ratio = 6.95) as in Kyiv controls (odds ratio = 3.34) and weakest in the national sample (odds ratio = 1.64). The results confirm the persistence and nonspecificity of the subjective medical consequences of Chornobyl and are consistent with the hypothesis that traumatic events exert their greatest negative impacts on health in vulnerable or disadvantaged groups.

Chernobyl fallout and outcome of pregnancy in Finland

Possible effects of Chernobyl fallout on outcome of pregnancy in Finland were evaluated in a nationwide follow-up study. The outcomes were the rate of live births and stillbirths, pregnancy loss, and induced abortions by municipality. Exposure was assessed based on nationwide surveys of radiation dose rate from the Chernobyl fallout, from both external and internal exposures. Using these measurements, we estimated the monthly dose rate for each of the 455 Finnish municipalities. On average, the dose rate from Chernobyl fallout reached 50 microSv per month in May 1986--a doubling of the natural background radiation. In the most heavily affected area, 4 times the normal background dose rates were recorded. Given the underlying regional differences in live birth, stillbirth, and abortion rates, we used longitudinal analysis comparing changes over time within municipalities. A temporary decline in the live birth rate had already begun before 1986, with no clear relationship to the level of fallout. A statistically significant increase in spontaneous abortions with dose of radiation was observed. No marked changes in induced abortions or stillbirths were observed. The decrease in the live birth rate is probably not a biological effect of radiation, but more likely related to public concerns of the fallout. The effect on spontaneous abortions should be interpreted with caution, because of potential bias or confounding. Further, there is little support in the epidemiologic literature on effects of very low doses of radiation on pregnancy outcome.

The accelerated occurrence of age-related changes of organism in Chernobyl workers: a radiation-induced progeroid syndrome?

The rate of aging was studied in 306 persons working at Chernobyl Atomic Power Station after the accident by means of integral and partial biological age assessment. An accelerated rate of aging was found in 81% of men and in 77% of women in comparison with a control random population sample of Kiev. Persons younger than 45 years appeared to be more vulnerable to radiation. The biological age of persons who worked in the contaminated zone immediately after the disaster exceeded the biological age in those who arrived in Chernobyl 4 months later. The biological age in the investigated persons exceeded its average populational value for 5 years (the integral biological and partial cardiopulmonary age) and for 11 years for the partial psychological age. These data may underlie the concept of radiation progeroid syndrome as the form of accelerated aging.