Dietary supplementation with radionuclide free food improves children's health following community exposure to (137)Cesium: a prospective study

Considerations of Medical Preparedness to Assess and Treat Various Populations During a Radiation Public Health Emergency

During a radiological or nuclear public health emergency, given the heterogeneity of civilian populations, it is incumbent on medical response planners to understand and prepare for a potentially high degree of interindividual variability in the biological effects of radiation exposure. A part of advanced planning should include a comprehensive approach, in which the range of possible human responses in relation to the type of radiation expected from an incident has been thoughtfully considered. Although there are several reports addressing the radiation response for special populations (as compared to the standard 18-45-year-old male), the current review surveys published literature to assess the level of consideration given to differences in acute radiation responses in certain sub-groups. The authors attempt to bring clarity to the complex nature of human biology in the context of radiation to facilitate a path forward for radiation medical countermeasure (MCM) development that may be appropriate and effective in special populations. Consequently, the focus is on the medical (as opposed to logistical) aspects of preparedness and response. Populations identified for consideration include obstetric, pediatric, geriatric, males, females, individuals of different race/ethnicity, and people with comorbidities. Relevant animal models, biomarkers of radiation injury, and MCMs are highlighted, in addition to underscoring gaps in knowledge and the need for consistent and early inclusion of these populations in research. The inclusion of special populations in preclinical and clinical studies is essential to address shortcomings and is an important consideration for radiation public health emergency response planning. Pursuing this goal will benefit the population at large by considering those at greatest risk of health consequences after a radiological or nuclear mass casualty incident.

PSYCHOLOGICAL STATE AND TYPOLOGICAL PERSONALITY FEATURES OF CHILDREN RESIDENTS OF RADIOACTIVELY CONTAMINATED TERRITORIES IN THE REMOTE PERIOD OF CHORNOBYL СATASTROPHE

OBJECTIVE

To evaluate the psycho-emotional state of children-residents of radioactively contaminated territoriesand to characterize the typological features of their personality in the remote period of the Chornobyl catastrophe.

MATERIALS AND METHODS

Psycho-emotional status and typological personality traits were determined in 96 childrenaged 12 to 17 years, who resided in radioactively contaminated territories with a soil contamination density of 137Csabove 185 kBq/m-2, and were admitted for examination and treatment in the pediatric departments of the NRCRMclinic. Psycho-emotional state of children was determined using the test «non-existent animal», which was assessedin points on symptom complexes: anxiety, aggression and neuro-mental exhaustion. The questionnaire of A. Bassand A. Darkey was used to discriminate various aspects of the aggression symptom complex. In all children, the content of incorporated 137Cs was determined using a whole body counter.

RESULTS

The results of the evaluation of the psycho-emotional state of children - residents of radioactively contaminated territories in the remote period of the Chornobyl catastrophe according to the test «non-existent animal»showed, that the state of anxiety was registered in all 96 children (100 %); state of aggression - in 60 children(62.5 %); exhaustion - in 57 children (59.37 %). Depending on the prevalence of the one or another symptom complexes, or their combination, 5 groups of observations were formed and the personality traits of children characteristic for each group were determined. In the largest group I with the predominance of anxiety symptom complex(45,83 % of the total sample) were noted: stable tendency to perceive many life-threatening situations and environment, pessimistic assessment of one's own life perspective, constant high level of anxiety. Girls were in majorityin this group. For group II, which showed a combination of high rates of two symptom complexes - anxiety andaggression (18.75 % of the total sample), the characteristic personality traits were a constant high level of emotional tension, a tendency to perceive the environment with distrust and a sense of guilt that arouses. In group IIIof children (14.58 % of the total sample), the symptom complex of aggression with feelings of alienation, isolationand hostile attitude towards the environment prevailed. Group IV of children (16.67 % of the total sample), with thecombination of signs of exhaustion and anxiety, had poor ability to concentrate, memory and attention deficit disorders, decreased learning ability, constant fatigue and irritability, apathy, inactivity, and inertia. Group V (only 4.17 %of the total sample) was characterized by low (less than 2 points) indices of all three symptom complexes. Girls weremuch more prone to anxiety, boys were more aggressive, sometimes accompanied by anxiety. Symptom complex ofexhaustion was determined with the same frequency in both boys and girls.

CONCLUSION

Assessment of psycho-emotional sphere of children - residents of radioactively contaminated territories in the remote period of the Chornobyl catastrophe according to the «non-existent animal» test revealed in of100 % of children the presence of anxiety signs, in the vast majority - the state of aggression and exhaustion. Therewere no probable associations between the content of incorporated 137Cs (in the range from 111 to 7024 Bq) and thepeculiarities of the psycho-emotional state of children.

Health outcomes related to the provision of free, tangible goods: A systematic review

BACKGROUND

Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes.

METHODS

A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463).

FINDINGS

The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes.

INTERPRETATION

The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.

Lifestyle-related diseases following the evacuation after the Fukushima Daiichi nuclear power plant accident: a retrospective study of Kawauchi Village with long-term follow-up

OBJECTIVES

Kawauchi Village lies 20 km west of the Fukushima Daiichi nuclear power plant. On 16 March 2011, evacuation was ordered due to the threat of radiological exposure, and was lifted in April 2012. In this study, we aimed to evaluate the predisaster and postdisaster health status of the Kawauchi Villagers, measured by routine yearly physical examinations.

METHODS

We analysed the annual health examination data of residents of Kawauchi Village from 2008 to 2013, as available from the Japanese National Health Insurance system. Data from 2011 were not available due to the disaster. Since the health data included the same participants repeatedly from year to year, the sample was non-independent and generalised estimated equation modelling was used. A predisaster time period (2008-2010) was categorised for comparison with postdisaster 2012 and 2013. The outcome examined was the prevalence of metabolic disease, and was adjusted for confounding factors.

RESULTS

Data for 20.6%-25.9% of the total residents were available in this period. In 2013, the prevalence of metabolic syndrome (from 17.0% to 25.2%, p<0.001), diabetes (from 11.3% to 17.0%, p<0.001), dyslipidaemia (from 43.2% to 56.7%, p<0.0001), hyperuricaemia (from 5.2% to 8.4%, p=0.006) and chronic kidney disease (from 16.1% to 26.7%, p<0.001) was found to be elevated significantly compared to predisaster years, while that of obesity or hypertension did not change.

CONCLUSIONS

The present follow-up study for Kawauchi Village revealed an increase in lifestyle-related disease following the March 2011 disaster and subsequent evacuation, and this trend still continues 2 years later.