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PubMed2002

Simultaneous introduction of HIV type 1 subtype A and B viruses into injecting drug users in southern Ukraine at the beginning of the epidemic in the former Soviet Union.

The vast majority of HIV-1 strains from the epidemic in the former Soviet Union (FSU) belong to subtype A (IDU-A) and CRF03_AB (IDU-A/B), for which IDU-A is one of parental strains; no epidemic by another parental virus, belonging to subtype B (IDU-B), has yet been identified. To characterize viruses present during the early stage of the epidemic in southern Ukraine, where the first outbreaks in the FSU were registered, we obtained partial env and pol sequences from IDUs from Odessa and Nikolaev and compared them with viruses from other outbreaks. All viruses from Odessa belonged to the IDU-A type, which is in accord with previous studies. At the same time, we found that the outbreak in Nikolaev was caused by IDU-B viruses, indicating that this outbreak is the result of an independent virus introduction. Phylogenetic analysis of viruses from the FSU supported the epidemiological data suggesting that the HIV-1 epidemic in the FSU started in southern Ukraine.

Disease Outbreaks↗
PubMed1998

Molecular epidemiology of an HIV-1 subtype A subcluster among injection drug users in the Southern Ukraine.

Phylogenetic characterization of primary isolates from 17 HIV-1-infected individuals within a recent epidemic in the city of Odessa, Ukraine was conducted. The isolates were drawn from two time periods, 1993 and 1996. The 1996 isolates coincided with the first apparent expansion of HIV-1 among injection drug users (IDU). Multi-locus phylogenetic analysis indicated that HIV-1 gag, env, tat, and long terminal repeat (LTR) sequences all conformed to the HIV-1 classification of a subcluster within subtype A. There was no evidence for intersubtype recombinants among these isolates. A number of potential signature sequences, particularly within env, were identified in these two time periods, possibly suggesting a selective pressure on viral evolution among IDU. Results of this study are consistent with a recent introduction and subsequent independent evolution of an HIV-1 subtype A subcluster among IDU in the Southern Ukraine. This study demonstrates a congruence of multi-locus phylogenetic analysis, and suggests that non-B genetic subtypes, such as HIV-1 subtype A, may become relevant to the study of IDU transmission in the future.

Amino Acid Sequence↗
PubMed2006

A cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident: thyroid cancer in Ukraine detected during first screening.

BACKGROUND: The Chornobyl accident in 1986 exposed thousands of people to radioactive iodine isotopes, particularly (131)I; this exposure was followed by a large increase in thyroid cancer among those exposed as children and adolescents, particularly in Belarus, the Russian Federation, and Ukraine. Here we report the results of the first cohort study of thyroid cancer among those exposed as children and adolescents following the Chornobyl accident. METHODS: A cohort of 32 385 individuals younger than 18 years of age and resident in the most heavily contaminated areas in Ukraine at the time of the accident was invited to be screened for any thyroid pathology by ultrasound and palpation between 1998 and 2000; 13 127 individuals (44%) were actually screened. Individual estimates of radiation dose to the thyroid were available for all screenees based on radioactivity measurements made shortly after the accident and on interview data. The excess relative risk per gray (Gy) was estimated using individual doses and a linear excess relative risk model. RESULTS: Forty-five pathologically confirmed cases of thyroid cancer were found during the 1998-2000 screening. Thyroid cancer showed a strong, monotonic, and approximately linear relationship with individual thyroid dose estimate (P<.001), yielding an estimated excess relative risk of 5.25 per Gy (95% confidence interval [CI] = 1.70 to 27.5). Greater age at exposure was associated with decreased risk of radiation-related thyroid cancer, although this interaction effect was not statistically significant. CONCLUSION: Exposure to radioactive iodine was strongly associated with increased risk of thyroid cancer among those exposed as children and adolescents. In the absence of Chornobyl radiation, 11.2 thyroid cancer cases would have been expected compared with the 45 observed, i.e., a reduction of 75% (95% CI = 50% to 93%). The study also provides quantitative risk estimates minimally confounded by any screening effects. Caution should be exercised in generalizing these results to any future similar accidents because of the potential differences in the nature of the radioactive iodines involved, the duration and temporal patterns of exposures, and the susceptibility of the exposed population.

Adolescent↗
PubMed2006

Dosimetric monitoring in Ukraine--present status and path to the future.

Despite wide use of nuclear energy and radiation sources in industry and medicine, there is no centralised dose accounting system in Ukraine; existing dosimetry services operate obsolete manual thermoluminescence dosemeter (TLD) readers and do not meet modern proficiency standards. Currently, dosimetric monitoring is required for approximately 42,000 occupationally exposed workers, including 9100 in medicine, 17,000 employees of nuclear power plants and approximately 16,000 workers dealing with other sources of occupational exposure. This article presents the plan of elaboration of the United System for monitoring and registration of individual doses which has the aim of harmonisation of individual monitoring in Ukraine through securing methodical unity; scientific and methodological guidance of individual dosimetric control; procurement of common technical policy regarding nomenclature and operation of instrumentation; implementation of quality assurance programmes; development and support of information infrastructure, in particular operation of the national registry of individual doses; training and certification of personnel engaged in the system of individual dosimetric monitoring.

Algorithms↗
PubMed1994

Thyroid doses resulting from the Ukraine Chernobyl accident--Part I: Dose estimates for the population of Kiev.

In the context of the radiation exposure of the Ukrainian population resulting from the Chernobyl accident, the quantification of the thyroid doses due to iodine incorporation is of special interest. This first part of a series of planned publications deals with the dose and risk estimation for Kiev citizens. Although these doses are expected to be considerably lower than those for some other regions of Ukraine, the investigations started with this population because the quantification of the thyroid doses due to iodine incorporation is of special interest. This first part of a series of planned publications deals with the dose and risk estimation for Kiev citizens. Although these doses are expected to be considerably lower than those for some other regions of Ukraine, the investigations started with this population because of the availability of rather reliable measurements and because of the size of this population. The methods developed allowed the estimation of individual thyroid doses. The average values of individual thyroid doses for five age groups (birth years 1983-1986, 1979-1982, 1975-1978, 1971-1974, and < 1971) are 104, 62, 19, 18, and 41 mGy, respectively. The collective thyroid doses were estimated as 83 x 10(3) person-Gy for those born before 1971 and as 38 x 10(3) person-Gy for younger inhabitants. The numbers of expected thyroid cancers in the whole Kiev population are 66 and 130, respectively.

Accidents↗
PubMed1994

Fallout radioactivity in soil and food samples in the Ukraine: measurements of iodine, plutonium, cesium, and strontium isotopes.

To estimate the level and distribution of fallout attributable to the 26 April 1986 Chernobyl nuclear power station accident in the Ukraine, we sampled several kinds of substances at Korosten, Zhitomir and at Katyuzhanka, Vishgorod, Kiev in the Ukraine, and measured the radioactivity of 137Cs, 134Cs, 90Sr, 129I, 238Pu, 239,240Pu, and the density of 127I (stable). The substances investigated were soil, dry milk, wheat, rye, drinking water, and mushrooms. Except for the mushrooms collected, which were sampled at Katyuzhanka, Vishgorod, and at Kiev, all substances were at Korosten, Zhitomir. The activity of 137Cs, 134Cs, 90Sr, 238Pu, and 239,240Pu were all higher in soil and mushrooms than in the other four substances. The activity of 137Cs was 960 and 1,210 Bq kg-1 in the two soil samples and 6,110 Bq kg-1 in the mushrooms. The activity of 134Cs was approximately 15% of 137Cs in the two soil samples while < 3% of 137Cs in the mushrooms. The activity concentration level of 90Sr as compared to 137Cs concentration was 15-31% in food samples other than mushrooms but only 1.9% in mushrooms and 1.4 and 1.2% in the two soil samples. The radioactivity ratios, 238Pu: 239,240Pu and 239,240Pu: 137Cs, suggested that the proportion of cesium radioisotopes and 239,240Pu in the soil attributable to the Chernobyl accident was approximately 100% and 10-20%, respectively, while approximately 100% of 239,240Pu in the mushrooms was attributable to the accident. The activity of 129I was small but the ratio of 129I: 127I in the two soil samples was 4.3 x 10(-8) and 1.0 x 10(-7), which is approximately 10 times larger than that in the global fallout. These results suggest that the areas where the soil was sampled are iodine-deficient and were contaminated slightly by the Chernobyl accident.

Accidents↗
PubMed1996

Internal exposure from the ingestion of foods contaminated by 137Cs after the Chernobyl accident. Report 1. General model: ingestion doses and countermeasure effectiveness for the adults of Rovno Oblast of Ukraine.

The Chernobyl accident, which occurred in April 1986, resulted in the atmospheric release of about 70--100 PBq of 137Cs. This paper examines the doses to the adult population of the northern part of Rovno Oblast, Ukraine, from ingestion of 137Cs. Fallout of 137Cs in these regions was lower than in other regions of Ukraine. However, the transfer of 137Cs from soil to milk in the region considered is high (up to 20 Bq L-1 per kBq m-2) and results in the predominance of internal doses compared to those from external exposure. Numerous measurements of 137Cs soil deposition, 137Cs milk contamination, and 137Cs body burden have been made in the area and form the basis of a general model of internal exposure from the ingestion of foods contaminated by 137Cs. This paper has two main purposes. The first is to develop the general phenomenological description of the process leading to internal exposure from the ingestion of 137Cs contaminated foods in the situation where different countermeasures are realized. The second is to apply the model for the adult population of the northern part of the Rovno Oblast (first report) for the limited time period of up to six years after the accident. The doses actually received by the adults are estimated to be four to eight times smaller than the doses calculated for the situation without countermeasures.

Adult↗
PubMed2000

Internal exposure from the ingestion of foods contaminated by 137Cs after the Chernobyl accident--report 2. Ingestion doses of the rural population of Ukraine up to 12 y after the accident (1986-1997).

Doses from the ingestion of 134Cs and 137Cs during 12 y following the Chernobyl accident have been estimated for approximately 3 million persons living in rural areas of the Zhitomir, Rivne, and Kyiv Oblasts of northern Ukraine. This assessment is based upon an extensive monitoring campaign that provided measurements of 137Cs in more than 120,000 samples of milk and in more than 100,000 persons; such measurements were made in approximately 4,500 locations. Two approaches were used for the dose assessment. In the first approach a so-called reference dose is estimated for each settlement on the basis of measured 137Cs concentration in milk, determination of the milk equivalent of diet, and consumption rates; a further assumption is that a high fraction of the food consumed is produced locally. The reference dose is used as the official dose estimate, which is the basis for any decision on possible financial compensation and economic privileges. In a second step, the so-called real age-dependent dose is estimated from the results of whole body counter measurements and the kinetics of radiocesium in the human body. Real doses above 0.5, 5, and 50 mSv were received by about 40%, 10%, and 0.2%, respectively, of the considered population. With the exception of 1986, for which the monitoring results were limited, the real individual doses derived from whole-body counting are consistently lower than the reference doses. However, this difference declined from a factor of 3-4 in 1987-1989 to a factor of approximately 1.5 in the mid 1990's. The difference between reference and real doses is attributed to the effectiveness of countermeasures implemented after the accident. The effectiveness of these countermeasures decreased with time due to increasing economic problems in Ukraine. The collective reference and real doses of the rural population due to the intake of 134Cs and 137Cs are estimated to be 13,300 and 5,300 person-Sv, respectively. Thus, about 8,000 person-Sv is estimated to have been averted by countermeasures.

Age Factors↗
PubMed2002

Chernobyl accident: retrospective and prospective estimates of external dose of the population of Ukraine.

Following the Chernobyl accident many activities were conducted in Ukraine in order to define the radiological impact. Considered here are gamma spectrometric analyses of soil-depth-profile samples taken in the years 1988-1999, gamma spectrometric measurements of radionuclide concentration in soil samples taken in 1986, and measurements of external gamma-exposure rate in air. These data are analyzed in this paper to derive a "reference" radionuclide composition and an attenuation function for the time-dependent rate of external gamma exposure that changes due to the migration of radiocesium into the soil column. An attenuation function for cesium is derived that consists of two exponential functions with half lives of 1.5 and 50 y. The dependencies of attenuation on direction and distance from the Chernobyl Nuclear Power Plant are also demonstrated. On the basis of these analyses the average individual and collective external gamma doses for the population of Ukraine are derived for 1986, 1986-2000, and 1986-2055. For the 1.4 million persons living in rural areas with 137Cs contamination of >37 kBq m(-2), the collective effective dose from external exposure is estimated to be 7,500 person-Sv by the end of 2000. A critical group of 22,500 persons who received individual doses of >20 mSv is identified for consideration of increased social and medical attention.

Adolescent↗
PubMed2006

Predictors of HIV sero-status among drug injectors at three Ukraine sites.

OBJECTIVE: To assess the HIV serostatus of injection drug users (IDU) in Ukraine, as well as associations between serostatus and selected demographic and risk factors. DESIGN AND METHODS: IDU were recruited from the streets in Kiev, Odessa and Makeevka/Donesk. Participants were interviewed using an HIV risk behavior assessment and tested for HIV with a finger-stick rapid test. Multiple logistic regression was used to identify determinants of HIV infection. RESULTS: Of the 891 IDUs surveyed, one-third came from each site and 22% were female. Their mean age was 29 years and on average they had been injecting for slightly more than 10 years. Seven hundred and seventy-eight of the total sample did not know their HIV status when first interviewed; they are the participants in this investigation. Overall, 33% tested positive for HIV, including 34% in Kiev, 51% in Odessa and 17% in Makeevka/Donesk. Independent predictors of HIV included injecting a sedative/opiate mixture, female sex, having sex with a person who was HIV positive or whose HIV status was unknown and injecting daily. HIV-negative IDU were significantly younger than those infected, they were more likely to be from Makeevka/Donesk and they were more likely to have been sexually active. CONCLUSIONS: Rates of HIV infection among IDU vary considerably across Ukraine, although even in the site with the lowest rate nearly one in five was infected. The extent of drug and sex-related risk behaviors calls for interventions to reduce the spread of HIV and other infectious diseases.

Adult↗
PubMed2006

Implantation of single-piece foldable acrylic IOLs in small children in the Ukraine.

PURPOSE: To evaluate the efficacy and outcome of implantation of a single-piece foldable acrylic intraocular lens (IOL) in children younger than 2 years in the Ukraine. METHODS: A total of 31 children from all over the Ukraine with a median age of 11 months (range 2-28 months) underwent cataract surgery with anterior and posterior capsulorhexis, implantation of a single-piece AcrySof SA30AL IOL and anterior dry vitrectomy. Of these, 22 patients attended the last follow-up. Ten patients had follow-up periods of 12 months; 12 had follow-up periods of 18 months. At the postoperative visits, we investigated visual acuity (VA), whether or not the subject had strabismus, lens epithelial cell migration and signs of secondary glaucoma. RESULTS: The single-piece IOL remained clinically centred in all eyes. No secondary glaucoma was detected. Eleven patients needed surgery for after-cataract. All but two patients achieved better VA after surgery. Many patients suffered from deprivation amblyopia as quite a few cataracts were probably congenital; however, the improvement in VA shows that cataract surgery was worth performing despite the late intervention. CONCLUSION: The foldable single-piece acrylic IOL seems to be well tolerated by children aged 0-2 years. No serious complications were seen and no patient developed secondary glaucoma within the follow-up time. However, lens epithelial cells are very lively in this age group.

Acrylic Resins↗
PubMed2004

Caries prevalence, oral health behavior, and attitudes in children residing in radiation-contaminated and -noncontaminated towns in Ukraine.

INTRODUCTION: Several studies investigating the oral health status of children living in Ukraine after the Chernobyl catastrophe revealed an increase of caries in children residing in radionucleotide-contaminated areas. PURPOSE: (1) To compare prevalence of dental caries in contaminated and noncontaminated towns; and (2) to determine if there is a difference between dental behaviors and attitudes of children residing in contaminated and noncontaminated areas that may have contributed to differences in caries prevalence. METHODS: Children aged 13-14 were randomly selected in two towns of approximately the same population size (33 000): Ovruch (n = 119) from a contaminated area and Mirgorod (n = 100) from a noncontaminated area. Data on behaviors and attitudes were collected via a self-administered questionnaire having six domains: (i) family background; (ii) dental anxiety; (iii) dental utilization; (iv) oral hygiene; (v) use of fluoride toothpaste; and (vi) sugar consumption. Oral examinations included information on carious lesions, restorations, missing teeth, and soft tissue abnormalities. Caries prevalence was compared using a t-test. Regression analysis was conducted to determine the independent contribution of oral hygiene behaviors and dental utilization. RESULTS: There was a significant difference in caries prevalence in the contaminated town (mean DMFT = 9.1 +/- 3.5) versus the noncontaminated town (mean DMFT = 5.7 +/- 1.4; P < 0.000). Oral hygiene practices, age, and utilization of dental services were not found to be associated with differences in DMFT score between the two communities. CONCLUSION: There was a significantly higher caries prevalence in a radiation-contaminated town compared to a noncontaminated town of Ukraine. The difference was not explained by differences in oral health knowledge, attitudes or behaviors.

Adolescent↗
PubMed2002

Illicit drug use and its health consequences in Belarus, Russian Federation and Ukraine: impact of transition.

The objective of this paper was to analyze the impact of the transition period on illicit drug use and its health consequences in Belarus, the Russian Federation and Ukraine. Available data were compiled to illustrate the trends and policy responses since 1991, when the countries had become politically independent and implemented radical changes in their social systems, which is particularly prominent in the Russian Federation and Ukraine. The transition period was associated with a rapid and dramatic increase in the supply of drugs combined with an increased demand, which was influenced by a range of social, economic and psychological factors. There was a sharp increase in negative public health consequences too. Inadequate policy responses might have had serious implications for economic and human development in the countries with a total population of more than 200 million people. The role of research to support policy responses is also discussed.

Health Status↗
PubMed2000

Report on bariatric surgery in the Ukraine.

BACKGROUND: Morbid obesity (MO) is a problem internationally, including in the Ukraine. We present the surgical treatment of MO in the Ukraine over the last 15 years, during which intestinal bypasses and various gastric reduction procedures were performed. METHODS: 198 patients with MO underwent: jejunoileal (JI) bypass 64, non-adjustable gastric banding (NGB) 34, Roux-en-Y gastric bypass (RYGBP) 1, horizontal gastroplasty 1, vertical banded gastroplasty (VBG) 2, and abdominal lipectomy 96. The 96 men and 102 women weighed 160-290 kg (mean 210+/-SD18 kg). Mean body mass index was >60 kg/m2. These patients had a high incidence of hypertension, diabetes, sleep apnea, menstrual disorders, impotency in men and infertility in women. RESULTS: At 1 year, after JI bypass 61 patients lost a mean of 62+/-17 kg and after NGB 11 kg. After JI bypass, 1 patient died in the early postoperative period from acute respiratory insufficiency and 2 died in the first year from acute liver insufficiency. The JI bypass was reversed in 2 patients due to uncontrollable malabsorption syndrome; 1 year after reversal, the weight of these patients exceeded their preoperative weight. In the early postoperative period, 1 patient died after NGB and 1 after RYGBP, from acute respiratory insufficiency. Postoperative weight loss was associated with decrease in the co-morbidities of MO, but after JIB, there was a high incidence of bypass enteritis, excessive malabsorption, formation of renal stones and gallstones. After NGB, no complications have been identified. Isolated lipectomy was performed in 44 patients, lipectomy combined with a bariatric operation in 31, and lipectomy after loss of the excess body weight in 21. CONCLUSIONS: Bariatric surgery was very effective in weight loss, accompanied by reduction or disappearance of the co-morbidities of MO, with considerable improvement in quality of life.

Adolescent↗
PubMed2006

Questionnaire- and measurement-based individual thyroid doses in Ukraine resulting from the Chornobyl nuclear reactor accident.

The U.S. National Cancer Institute (NCI), in cooperation with the Ministries of Health of Belarus and of Ukraine, is involved in epidemiological studies of thyroid diseases presumably related to the Chornobyl accident, which occurred in Ukraine on 26 April 1986. Within the framework of these studies, individual thyroid absorbed doses, as well as uncertainties, have been estimated for all members of the cohorts (13,215 Ukrainians and 11,918 Belarusians), who were selected from the large group of children aged 0 to 18 whose thyroids were monitored for gamma radiation within a few weeks after the accident. Information on the residence history and dietary habits of each cohort member was obtained during personal interviews. The methodology used to estimate the thyroid absorbed doses resulting from intakes of (131)I by the Ukrainian cohort subjects is described. The model of thyroid dose estimation is run in two modes: deterministic and stochastic. In the stochastic mode, the model is run 1,000 times for each subject using a Monte Carlo procedure. The geometric means of the individual thyroid absorbed doses obtained in the stochastic mode range from 0.0006 to 42 Gy. The arithmetic and geometric means of these individual thyroid absorbed doses over the entire cohort are 0.68 and 0.23 Gy, respectively. On average, the individual thyroid dose estimates obtained in the deterministic mode are about the same as the geometric mean doses obtained in the stochastic mode, while the arithmetic mean thyroid absorbed doses obtained in the stochastic mode are about 20% higher than those obtained in the deterministic mode. The distributions of the 1000 values of the individual thyroid absorbed dose estimates are found to be approximately lognormal, with geometric standard deviations ranging from 1.6 to 5.0 for most cohort subjects. For the time being, only the thyroid doses resulting from intakes of (131)I have been estimated for all subjects. Future work will include the estimation of the contributions to the thyroid doses resulting from external irradiation and from intakes of short-lived ((133)I and (132)Te) and long-lived ((134)Cs and (137)Cs) radionuclides, as well as efforts to reduce the uncertainties.

Body Burden↗
PubMed1999

Outcomes of 17,137 pregnancies in 2 urban areas of Ukraine.

OBJECTIVES: Frequent terminations of pregnancy and high rates of fetal loss have been reported, but not confirmed, in the former eastern bloc. A census of pregnancies in Ukraine, a former eastern bloc country, was conducted to determine the rates of these events. METHODS: All pregnancies registered in 2 urban areas were enumerated. During a 19-month period between 1992 and 1994, 17,137 pregnancies and their outcomes were recorded. RESULTS: Sixty percent of the pregnancies were voluntarily terminated, generally before the 13th week. In pregnancies delivered at 20+ weeks, fetal mortality was 29 per 1000, nearly 5 times the rate among Whites in the United States. There was a greater proportion of very early deliveries (20-27 weeks) in Ukraine, as well as higher death rates at all gestational ages. Perinatal mortality was estimated to be 35 per 1000, about 3 times the US rate. CONCLUSIONS: This is believed to be the first study in the former eastern bloc to ascertain all of the clinically recognized pregnancies in a specified period and to determine their outcomes. The data document elevated reproductive risks in a former Soviet state.

Abortion, Induced↗
PubMed1993

Health care and public health in the former Soviet Union, 1992. Ukraine--a case study.

The dissolution of the Soviet Union created many problems for the health care systems of the New Independent States (NIS). To address these problems, the U.S. Secretary of State convened a coordinating conference in Washington, D.C., on 22-23 January 1992 at which more than 50 nations and organizations were represented. After this conference, an expert medical working group visited 10 republics of the NIS during February and March 1992. Hospitals, public health facilities, and pharmaceutical plants and distribution sites were visited to assess the health care needs of a large population in a vast geographic area. It was concluded that the massive health care system of the Soviet Union remains largely intact but has major economic and supply deficiencies. The assessment process and findings in one republic, Ukraine, are presented. Ukraine was chosen because of its size, location, and representativeness.

Accidents↗
PubMedDate not supplied

[The determinants of the spread of HIV among injection drug addicts in Ukraine].

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.

Acquired Immunodeficiency Syndrome↗