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PubMed2001

Towards an understanding of the high death rate among young people with diabetes in Ukraine.

AIMS: Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. METHODS: Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. RESULTS: Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. CONCLUSIONS: Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers.

Adolescent↗
PubMed2005

[Permanent hypoparathyroidism due to thyroid cancer surgical procedures in patients exposed to radiation in the Chernobyl, Ukraine, nuclear reactor accident].

BACKGROUND AND OBJECTIVE: Postoperative hypoparathyroidism is a rare, but complex endocrine disorder. The purpose of this case series study was to evaluate the symptoms, signs and sequelae of the disease in a major homogeneous patient group after the Chernobyl accident in the Ukraine. PATIENTS AND METHODS: This study is based on a random sample of 25 patients with symptomatic permanent hypoparathyroidism after surgical procedures on the thyroid for carcinoma following the Chernobyl accident in May 1986. They underwent physical examination and their parathyroid hormone and calcium levels in serum were determined. The signs, symptoms and sequelae of their disease were systematically assessed by a validated specific questionnaire. The extent of individual distress by the symptoms and signs were analysed by using a Likert scale (points between 1 = no and 5 = maximal distress). RESULTS: In 14 patients (56%) (age at time of operation: 18.24 +/- 4.26 years) paresthesias occurred at least every third day. Very frequent general symptoms were joint pains and hair loss (in 17 patients / 68%). 19 patients (76%) had enamel defects, 17 (68%) increasingly dry skin since the operation. Psychical symptoms like excitability (20 patients / 80%) and depressed mood since the operation (16 patients / 64%) were strikingly frequent. The patients were affected more by dry skin (2,76 on the Likert scale) than by paraesthesias (2,56) or joint pains (2,68) and most of all by depressive mood (2.96) and excitability (3.38). 4 patients (16%) had kidney stones, while osteoporosis and osteosclerosis occurred in 7 (28%) respectively 3 persons (12%). 6 patients (24%) had cataracts and 3 (12%) had basal ganglia calcification. Interestingly, 1/3 of all patients had only non-characteristic symptoms of the disease consistent with a latent form of hypoparathyroidism. CONCLUSIONS: Our data partly show a severe form of hypoparathyroidism of very young persons in the Chernobyl region, a finding which strongly supports the need of exact diagnosis and interdisciplinary treatment options of this postoperative disorder.

Adolescent↗
PubMed2000

Evaluation of a single dose of diphtheria-tetanus toxoids among adults in Odessa, Ukraine, 1995: immunogenicity and adverse reactions.

Epidemic diphtheria spread to Ukraine in 1991, where it peaked in 1995 with >5,000 reported cases. To refine epidemic control strategies, immunogenicity of a tetanus-diphtheria toxoids vaccine (Td) containing 2 limits of flocculation (Lf) diphtheria toxoid was evaluated. During a mass vaccination campaign, adults at a clinic in Odessa received one dose of Td. At enrollment, 57.2% of 341 study participants had levels of diphtheria antitoxin (DAT) >/=0.1 IU/mL. Thirty and 180 days after receiving one dose of Td, 91.5% and 84.5% of the participants, respectively, had DAT levels >/=0.1 IU/mL. However, among 40- to 49-year-old participants, only 78.8% and 73.8% had DAT levels >/=0.1 IU/mL at 30 and 180 days, respectively. This study suggests that one dose of 2 Lf diphtheria toxoid is highly effective in raising DAT to protective levels in most adults; however, the study also shows that certain age groups, particularly persons 40-49 and, to a lesser degree, 30-39 years old may require additional doses or a complete three-dose primary vaccination series for optimal protection against diphtheria.

Adolescent↗
PubMed2000

Ukraine, 1992: first assessment of diphtheria vaccine effectiveness during the recent resurgence of diphtheria in the Former Soviet Union.

A case-control study in Ukraine provided the first data on the field effectiveness of Russian-produced vaccine during the 1990 diphtheria resurgence in the former Soviet Union. For each of 262 diphtheria cases <15 years of age who were reported from January through October 1992, 2 controls, matched by age and clinic, were selected. The effectiveness of three doses of diphtheria vaccine was 98.2% (95% confidence interval: 90.3-99.9). Among controls, 84% had received three or more vaccinations by 2 years of age. These results suggest that the following five hypothesized causes of the outbreak appeared unlikely: appearance of a new "mutant" diphtheria strain, low potency of the Russian-produced diphtheria vaccine, inadequate cold chain, poor host immunogenicity due to radiation exposure from Chernobyl, and low routine childhood vaccination coverage. It is concluded that initial priority for scarce resources for controlling this outbreak should be placed on vaccination of persons susceptible to diphtheria (e.g., adults) rather than revaccination of children.

Adolescent↗
PubMed2000

Case-control evaluation of an adult diphtheria immunization program in Ukraine.

In response to concerns about diphtheria vaccine efficacy, a case-control study was undertaken in Ukraine in 1996 to determine whether those recently immunized were indeed protected from disease, whether multiple doses were more protective, whether contact with children was related to disease, and whether there were detectable differences in protective efficacy between Western and Russian vaccines. In each of the three sites (one rural and two urban), 60 adults with laboratory-confirmed cases of diphtheria were identified from health center records along with 2 adult controls, who were matched to the case by neighborhood. Demographic and vaccination data were gathered from health center records. Using conditional logistic regression to estimate odds ratios, it was determined that cases were more likely to have had no vaccine in the year prior to the index data (odds ratio, 5.0; 95% confidence interval, 2.8-9.0), for a vaccine efficacy of 80%. Two doses gave greater protection, living with children increased disease risk, and no difference was detectable between the Russian and Western vaccines.

Adolescent↗
PubMed2000

Assessment of vaccination coverage among adults 30-49 years of age following a mass diphtheria vaccination campaign: Ukraine, April 1995.

Ukraine has been experiencing epidemic diphtheria since 1991. In efforts to control this epidemic, a mass vaccination campaign was held in April 1995. Persons not vaccinated in the previous 3 years were considered eligible for vaccination with tetanus-diphtheria toxoids (Td). Two cluster sample surveys were conducted to determine vaccination coverage achieved. In the urban and rural survey areas, respectively, 628 and 618 persons 30-49 years of age were interviewed. Fifty-nine percent of urban and 58% of rural participants were eligible for vaccination. During the vaccination campaign, 58% (95% confidence interval [95% CI], 47.1-69.2) of eligible persons received Td in the urban area, compared with 92% (95% CI, 89.2-95.3) in the rural area. Apparent barriers to vaccination included misconceptions about the safety, efficacy, and need for booster doses of Td. Future vaccination campaigns should include targeted information and education messages. Mass vaccination campaigns can be successful in vaccinating large numbers of adults; however, in urban areas, additional efforts may be required to achieve levels of coverage adequate to confer herd immunity and interrupt the diphtheria epidemic.

Adult↗
PubMed2002

Elevated minisatellite mutation rate in the post-chernobyl families from ukraine.

Germline mutation at eight human minisatellite loci has been studied among families from rural areas of the Kiev and Zhitomir regions of Ukraine, which were heavily contaminated by radionuclides after the Chernobyl accident. The control and exposed groups were composed of families containing children conceived before and after the Chernobyl accident, respectively. The groups were matched by ethnicity, maternal age, parental occupation, and smoking habits, and they differed only slightly by paternal age. A statistically significant 1.6-fold increase in mutation rate was found in the germline of exposed fathers, whereas the maternal germline mutation rate in the exposed families was not elevated. These data, together with the results of our previous analysis of the exposed families from Belarus, suggest that the elevated minisatellite mutation rate can be attributed to post-Chernobyl radioactive exposure. The mechanisms of mutation induction at human minisatellite loci are discussed.

Abnormalities, Radiation-Induced↗
PubMed2002

The need for changes in ICRP policy: some examples based on the Chernobyl experience in Ukraine.

Current ICRP policy in radiological protection (ICRP Publication 60) is based on the independent restriction of exposure and sources for practice and intervention. Such subdivision of exposure and sources leads to a number of problems and contradictions in different applications. In a recent memorandum of the ICRP, published in the Journal of Radiological Protection in 2001, and ICRP Publications 81 and 82, the directions for settling some of these problems are indicated. This paper shows that in Ukraine, after the Chernobyl accident, a number of problems and contradictions occurred as the result of strictly separated limitation of the sources and exposure. These are demonstrated through four 'radiological paradoxes': (1) resettlement of inhabitants from territories radioactively contaminated after the Chernobyl accident to 'clean' ones, but with anomalous high levels of radon exposure in houses; (2) necessity of summation of the Chernobyl accidental doses and doses caused by normally operating nuclear power plant (NPP) to meet the requirements of Ukrainian law, which is based on the principle of 'social equity' of different sources of exposure; (3) the necessity to answer the question of primary importance: when will the Chernobyl accident finally end and when can exposure from contaminated territories be considered as exposure from old contamination? (4) the start of decommissioning of the Chernobyl NPP and transformation of the 'Object Shelter' (located inside the exclusion zone) are now slowed down because of the absence of a definite ideology for dose limitation of workers involved, who are exposed to several types of source simultaneously. The authors believe that the concept of controllable dose as presented by Professor Roger H Clarke on behalf of the ICRP can resolve such paradoxes. The changes to ICRP policy need to be made carefully in order to provide an orderly transition.

Dose-Response Relationship, Radiation↗
PubMed2002

Cigarette smoking and stages of change among men and women in Kiev, Ukraine.

BACKGROUND: Assisting current smokers to progress towards stopping smoking entails identifying their readiness to stop and understanding the factors that may influence their readiness. Relations were established between certain predictor variables (intensity of smoking, age at initiation, duration of smoking, and gender) and stages of readiness to change smoking behaviour in Kiev, Ukraine. METHODS: Analysis was based on a convenient sample of 536 current smokers who completed a stages-of-change questionnaire in a public square in the centre of Kiev's business district, between 22 and 25 July 2000. Frequency distributions, odds ratios, the Kolmogorov-Smirnov test and the Wilcoxon rank-sum test were used to summarize and describe the data. Tests of significance were based on the 0.05 level. RESULTS: The majority of participants (56.1%) were categorized as precontemplative. Less than 20% of the subjects were prepared for action to change smoking behaviour. Later age at smoking initiation was associated with fewer cigarettes smoked per day. Females were more likely then males to seriously consider cutting down the number of cigarettes they smoked. However, males were more likely to have intentionally quit smoking for at least one day within the past year. CONCLUSION: Information on stages of readiness to stop smoking provided by this study may be useful for improving the effectiveness of smoking cessation programmes in Kiev.

Adolescent↗
PubMed2005

On the European Union's new eastern border: health promotion, HIV and Ukraine.

HIV control in Ukraine is a pressing public health challenge and national efforts to control the epidemic have been hindered by a lack of capacity and resources. One component of control is the need to raise awareness. Implementing a health promotion strategy through the education system and through multi-sector network with early stakeholder ownership resulted in a limited budget being spent principally on production costs rather than purchasing media time and space with considerable savings. Early involvement of powerful corporate stakeholders in multi-disciplinary teams has the potential to enhance the effectiveness and efficiency of health promotion measures in a post-Soviet transitional economy.

European Union↗
PubMed1999

Cancer mortality in Russia and Ukraine: validity, competing risks and cohort effects.

BACKGROUND: The dramatic increase in mortality in Russia and Ukraine in the late 1980s and 1990s has been due to increases in certain causes of death, particularly cardiovascular disease and accidents and violence. In contrast, there has been a slight fall in mortality from cancer. METHODS: This paper presents an analysis of trends and patterns in cancer mortality and examines four possible explanations for its recent fall: changes in data collection; cohort effects; competing mortality from other causes of death; and improvements in health care. RESULTS: All contribute to some extent to the observed changes, with each affecting predominantly different age groups. There is evidence of a significant underrecording of cancer deaths among the elderly especially in rural areas and of significant changes in coding practices in the early 1990s. Competing mortality from cardiovascular diseases and accidents can explain some reduction in male deaths from cancer in middle age. Birth cohort effects can explain some reduction among males after early middle age and among females at all ages. The impact of changes in health care are more difficult to identify with certainty but there is evidence of reduced deaths from childhood leukaemia. IMPLICATIONS: Recent changes in mortality in Russia are complex and their understanding will require a multidisciplinary approach embracing demography, epidemiology and health services research.

Adolescent↗
PubMed1994

The mobility of 137Cs and 90Sr in agricultural soils in the Ukraine, Belarus, and Russia, 1991.

Results are presented from studies concerning the behavior of the Chernobyl-derived radionuclides 137Cs and 90Sr in soil-plant agricultural systems in the Ukraine, Belarus, and Russia during 1991. The sites, representing ploughed and natural pastures, were located at varying distances between 50 and 650 km and varying directions from the Chernobyl reactor site. The 137Cs activity concentrations in the upper 0-5 cm soil layer ranged from 25-1,000 kBq m-2 and were higher in natural pastures as compared to ploughed pastures. For 90Sr, activity levels ranged from 1.4-40 kBq m-2, and the highest 90Sr deposition was observed in the Gomel Region, Belarus. The highest 90Sr: 137Cs ratio was also observed in the Gomel soils, i.e., 15% as compared to between 0.72 and 7.4% in the other soils. The mobility of radionuclides was studied by means of sequential extraction. For all soils, between 60 and 95% of the 137Cs was found to be strongly bound to soil components. In the Russian and Ukrainian soils, between 40 and 98% of the 90Sr was found in the easily extractable fractions, and the distribution of 137Cs and 90Sr followed that of the naturally occurring stable isotopes of cesium and strontium. However, in the Gomel soils, between 20 and 50% of the 90Sr was easily extractable and the distribution of 90Sr within the extraction fractions did not follow that observed for stable strontium. These results are thought to reflect the association of 90Sr with fuel particles deposited in the Gomel Region. The mobility of 90Sr is expected to increase with time (as the particles weather) in these soils.

Cesium Radioisotopes↗
PubMed1995

Evaluation of the 131I thyroid-monitoring measurements performed in Ukraine during May and June of 1986.

After the Chernobyl accident in 1986, about 150,000 monitoring measurements were performed in Ukraine. From this data base, 40,000 measurements were selected for which the results of the reference-source measurements could be analyzed by statistical means. The majority of these measurements are of high quality. In this paper, the uncertainties introduced due to the variabilities of anatomic parameters and the measurement geometry are quantified by measurements using a thyroid-neck phantom. Parameters considered are the thyroid mass, the thickness of the tissue overlying the thyroid as well as the detector-neck distance, the orientation, and the horizontal and vertical position of the detector. The uncertainty introduced due to the variability of these factors corresponds to a coefficient of variation in the range of 25-40% for the measured activity.

Adolescent↗
PubMed1995

Radiocesium body burdens in immigrants to Israel from areas of the Ukraine, Belarus and Russia near Chernobyl.

Of the 500,000 immigrants from the former Soviet Union who came to Israel during 1990-1993, about 100,000 are estimated to have come from radiocontaminated areas near Chernobyl. These people were subject to chronic uptake of environmental radiocesium over protracted periods. During October-November 1991, a joint Israeli-Canadian investigation measured radiocesium body burdens in immigrants to Israel from the Ukraine, Belarus, and the southern Russian republic in order to provide factual information on radiocesium levels to concerned immigrants and to relate the body burdens to the geographic area of residence before coming to Israel. Assessments were made of 137Cs body burdens in 1,228 volunteer men, women, and children. These measurements were accompanied by medical assessments based on clinical histories and examinations. Radiocesium levels were strongly dependent on the duration of residence in Israel, with the highest levels being found in the most recent immigrants. The maximum level, extrapolated back to the time of leaving the former Soviet Union, was estimated to be about 0.83 kBq (10.3 Bq kg-1). Of the most recent immigrants from the Kiev region (< 101 days in Israel), only 15% had back extrapolated body burdens > 50 Bq, whereas 53% of those coming from Gomel and other towns in the contaminated zones (> 3.7 x 10(10) Bq km-2 of radiocesium) had detectable levels > 50 Bq. People coming from the latter region had significantly higher body burdens as compared to those from the former, in accordance with the higher degree of ground radiocesium contamination reported for the latter region. Women and children showed considerably lower total radiocesium content in comparison to men. All radiocesium body burdens at the time of measurement were too low to be of health concern.

Adolescent↗
PubMed1996

The results of selective cytogenetic monitoring of Chernobyl accident victims in the Ukraine.

Selective cytogenetic monitoring of the highest priority groups of Chernobyl disaster victims has been carried out since 1987. In 1992-1993, 125 liquidators (irradiated mainly in 1986) and 42 persons recovering from acute radiation sickness of the second and third degrees of severity were examined. Cytogenetic effects (an elevated level of unstable as well as stable markers of radiation exposure) were found in all groups, which showed a positive correlation with the initial degree of irradiation severity even 6-7 y after the accident. Comparative scoring of conventional staining vs. G-banding in 10 liquidators showed the identical rate of unstable aberrations. At the same time, the yield of stable aberrations for G-banded slides exceeded the frequency for conventional staining. In order to study possible mutagenic activity of chronic low levels of irradiation, the cytogenetic monitoring of some critical groups of the population (especially children and occupational groups--tractor drivers and foresters) living in areas of the Ukraine contaminated by radionuclides was carried out. In all the examined groups, a significant increase in the frequency of aberrant metaphases, chromosome aberrations (both unstable and stable), and chromatid aberrations was observed. Data gathered from groups of children reflect the intensity of mutagenic impact on the studied populations and demonstrate a positive correlation with the duration of exposure. Results of cytogenetic examination of adults confirmed the importance of considering the contribution of occupational radiation exposure to genetic effects of Chernobyl accident factors on the population of contaminated areas. Results of our investigations demonstrated the possibility of evaluating the mutagenic impact of acute and long-term irradiation of different intensities on somatic cells of persons undergoing radiation exposure due to the Chernobyl accident and confirmed the need to introduce new informative genetic methods [especially fluorescence in situ hybridization (FISH)] for reliable retrospective cytogenetic dosimetry of radiation exposure in Chernobyl accident victims.

Adult↗
PubMed2001

Age- and sex-specific relative thyroid radiation exposure to 131I in Ukraine after the Chernobyl accident.

The age- and sex-dependence of the 131I induced count rates is determined for the measurements performed in Ukraine after the Chernobyl accident on the thyroids of over 60,000 persons. For this, the individual measurements are scaled in such a way that the mean values over age and sex on one side and the mean values over measurement series on the other side are normalized to one. The resulting distribution of all scaled measurements is roughly log-normal. Half of them lie within a factor 1.6 of the median. 131I induced count rates have a minimum at birth year 1986, about half the value of adults. The maximum count rates with about 30% above adults are reached for males around age 16 y. The count rates are up to about 40% (at age 14-17 y) higher for males than for females. The results are within statistical uncertainties independent of the geographical area and the urban or rural nature of the settlements. Starting from the relative count rates, the age- and sex-dependence is calculated for the thyroid activities 1 mo after the accident for the integrated activities and for the doses. The dose of young children is a factor of about 6.5 higher than that of adults. Uncertainties are estimated throughout.

Adolescent↗
PubMed2003

Evaluation of radioactive exposure from 137Cs in contaminated areas of Northern Ukraine.

The paper gives averages of 137Cs deposition densities in soils from three areas in Northern Ukraine measured 12 to 15 y following the Chernobyl accident: in an area near Narodici (75 km west of the Chernobyl nuclear power plant in the so-called zone II) heavily contaminated by the Chernobyl fall-out and in areas around Korosten and Zhitomir showing contamination levels to be much lower. The three areas exhibited very different 137Cs deposition densities of 2.2 MBq m(-2), 400 kBq m(-2), and 5 kBq m(-2), respectively. During a 1-y observation, measurements of the 137Cs transfer in the food chain to humans and 137Cs whole body contents dependent on the 137Cs daily intake were carried out under realistic conditions of the rural inhabitants who lived in settlements within zone II. Detailed investigations of components of the daily diet showed that the high 137Cs contamination levels found in soils of zone II do not affect in any way low 137Cs concentrations of all important agricultural products harvested and consumed by villagers. With regard to consumption habits of the population of zone II, mushrooms and wild berries were found to contribute more than 95% of the 137Cs daily intake to the 137Cs whole body content of about 12 kBq (with maximum values up to 760 kBq) measured in a group of inhabitants of zone II during a period from July 1998 to July 1999. The median of the annual dose of these inhabitants from external and internal exposures was 1.2 mSv y(-1) with a geometric standard deviation of 2.6. Excluding extreme habits, the geometric mean of the total exposure was 1.0 mSv y(-1) with a geometric standard deviation of 1.3.

Adolescent↗
PubMed2006

Dietary iodine intake in residents of northwestern regions of ukraine contaminated by the chernobyl accident.

Daily iodine intake in Ukrainian subjects of northwestern regions was estimated in relation to the health effects on inhabitants after the Chernobyl accident. Total diets were collected from 106 locations for children and adult males by a duplicate portion study. Iodine was rapidly determined by inductively coupled plasma mass spectrometry after chemical separation. Iodine concentration on a dry basis for Ukrainians was 0.11 microg g(-1) and the daily iodine intake was in the range of 2.80-372 microg per person. The median, geometric mean, and standard deviation were 28.1, 32.7, and 2.51 microg, respectively. The yearly trend of the intake had almost no change. Regional differences would be expected to exist among the 10 areas of the Ukraine, but no clear differences appeared in the present findings. Daily iodine intake in Ukrainians was lower than the recommended dietary intake (RDI) allowance (150 microg), and its lack would be related to the high prevalence of goiter in the country.

Adult↗