Chornobyl and reproductive health of a female rural population (an epidemiological study).

OBJECTIVE: To study the combined effect of radioactive and chemical factors on the reproductive health of a female rural population residing and working on territories contaminated after the Chornobyl accident. MATERIALS AND METHODS: The sociological questioning and gynecological examination of 1850 women have been made including the evaluation of 29520 medical reports of deliveries, 19502 medical reports of newborns, 1694 medical reports of women with spontaneous abortions as well as the state of menstrual function in 480 girls-adolescents residing on the contaminated territories. The radioactive contamination of the studied territories as well as the total effective dose of radiation for the population was evaluated by the results of the general dosimetric dose established for settlements of Ukraine. Factors of the work environment (noise, microclimate, dust, bacterial air pollution, work intensity and strain) were studied by the common hygienic methods and assessed by the criteria of the "Hygienic Classification of Work..." # 4137-86. The residues of pesticides, their isomers and products of transformation in biological fluids (blood, breast milk, cord blood) were assayed by gas-liquid chromatography method and electron capture detector with the device "Kristallux 4000" and the model M-3700. Correlative, regression, and discriminative analyses were used for mathematical processing of the data. RESULTS: It is proved that the reproductive health of rural women has become significantly worse after the Chornobyl accident, the most expressed disorders are seen in young women aged under 30. Worsening of reproductive health is found being the result of a combined effect of factors of radioactive and nonradioactive nature, specific for territories of residence, occupational activity and style of life. In particular, the effect of pesticides at the background of the radioactive contamination is likely to be an additional risk factor of disorders of the reproductive health of women. According to the biomonitoring data the content of organochlorine pesticides in biological fluids of women with reproductive health disorders was significantly higher (p<0.05) vs. with healthy ones. It is established that women of the childbearing age residing on territories with the density of contamination of more than 5 Ci/km and with rates of pesticide load over 5 kg/ha should be referred to a high risk group of the reproductive health disorders. CONCLUSION: The perspectives of epidemiological studies on the reproductive health are related on the use of the combination of many-aspect healthcare and biological approaches. It is equally important to assess adequately the factors of environment and work-related conditions, and their combined effect with dwelling load.

Results from a Ukrainian-US collaborative study: prevalence and predictors of respiratory symptoms among Ukrainian coal miners.

BACKGROUND: Underground coal mining is an expanding industry in Ukraine, yet little is known about the burden of respiratory disease among Ukrainian miners. METHODS: A Fogarty International Center-supported collaboration between researchers at the University of Illinois and the Institute of Occupational Health in Kyiv, Ukraine formed to improve capacity for conducting and monitoring medical surveillance among Ukrainian coal miners. A cross-sectional survey among a random sample of working and former miners was conducted; demographic, work, and health information were collected using a standardized questionnaire. Weighted prevalence rates were calculated and predictors of respiratory symptoms explored. RESULTS: Improvements in infrastructure, including spirometry and chest radiography testing, transformed medical surveillance among these miners. Results from the health study included that the prevalence of respiratory symptoms was higher among former compared to current miners (shortness of breath 35.6% vs. 5.1%; chronic bronchitis 18.1% vs. 13.9%, respectively). A statistically significant exposure-response relationship was observed between years mining and respiratory symptoms in former miners and between years mining at the coal face and respiratory symptoms among current miners. Evidence of downward bias from the healthy worker survivor effect was observed. CONCLUSIONS: This successful international collaboration built a sustainable infrastructure for conducting workplace medical surveillance and research. The resulting study was the first in the western literature to report on respiratory symptoms in this population; likely underestimation of disease rates due to selection and measurement biases was demonstrated. Efforts should continue to build this collaboration and to characterize and reduce respiratory illness among Ukrainian coal miners.

Predictors of elevated blood lead levels among 3-year-old Ukrainian children: a nested case-control study.

OBJECTIVES: Lead is common in the general population. However, data are lacking for the Ukraine and many other countries from the former Soviet Union (FSU). In this study we evaluate the level of blood lead among 212 Ukrainian children and determine predictors of elevated lead levels. We also describe the health effects associated with elevated blood lead. METHODS: A nested case-control study from a prospective cohort of Ukrainian 3-year-old children was conducted in March 1998. Blood assays were analyzed for lead by labs at the Centers for Disease Control and using portable examination kits. We evaluated predictors of elevated blood lead (blood levels in the upper quartile >4.65 microg/dL) using a multivariable logistic regression model. The model included socioeconomic status, parent occupation, environmental tobacco smoke, hygiene, diet, and health status. RESULTS: The geometric mean lead level was 3.15 microg/dL (range, 0.7--22.7). In our adjusted model, we observed a strong association between lead levels in the upper quartile and children whose fathers worked manual labor jobs in industries associated with lead exposures [adjusted odds ratio (OR)=2.25; P=0.025] and mothers who smoke indoors (adjusted OR=2.87; P=0.047). Daily hygiene and dietary habits were not associated with elevated lead levels. No increased risks of overall morbidity or lead-associated illness were observed (anemia, dental caries, renal disease, cardiovascular diseases, and musculoskeletal complaints). CONCLUSION: This is the first study to describe lead levels and associated variables among Ukrainian children in the peer-reviewed literature. Elevated lead levels in these children were associated with paternal occupation and mothers smoking indoors. At age 3 no adverse health effects were observed. More data are needed to determine the level of heavy metal contamination in children from the Ukraine and many other former Soviet nation-states.

Occupational health and safety from communist to capitalist structures.

This article focuses on individual effects of the transformation from communist to capitalist structures in the system of occupational health and safety (OHS). Despite basic similarities among the communist nations the systems of OHS differed immensely. The political changes during transformation additionally contributed to varying opportunities for the development of OHS systems. Changes affecting the living and working conditions are significant and are demonstrated by the development of new work structures and work biographies. This is reflected in changed attitudes to demands and contents of work. No differences, however, were found between the employed and unemployed when asked about these issues. Conclusions for OHS in postcommunist states are drawn.

Use of subjective and nonsubjective methodologies to evaluate lens radiation damage in exposed populations--an overview.

The general epidemiological acceptability of prevalence, or incidence, for assessing risk of radiation cataract development has dictated an almost exclusive dependence on cataract onset as a measure of cataractogenicity for given doses of radiation. The advent of instrumentation capable of acquiring images amenable to quantitative analyses offers the possibility of exploiting "relative opacification" as an added, if not exclusive, parameter. This development is particularly important in efforts to assess populations such as that in the Altai, which are temporally far removed from their exposure and among whom there exists a large subset with extant cataracts. The new technologies, Scheimpflug and retroillumination imaging, combined with the application of the appropriate analytical algorithms can not only provide quantitative and nonsubjective assessment of lens transparency, but also serve as a means to immortalize the state of the pathology at the time of acquisition. Highly relevant to the assessment of an aging exposed population is the use of lens epithelial fragments as potential dosimeters. The material is routinely available as a result of cataract extraction procedures and is amenable to the application of a modified micronucleus (MN) assay. The MN assay in the lens has tremendous advantages over its use in other tissues for a number of reasons, not least of which is that lens MNs are extremely long-lived. Given the relative ease of application and its potential as a radiation bioindicator, the lens MN assay should be considered in any follow-up of populations exposed to ionizing radiation.

Actual medical and ergonomic problems in agriculture in the Ukraine.

A new agrarian policy in a number of countries caused the necessity to introduce additional measures aimed at preventing of agricultural workers' health. The epidemiological studies in the Ukraine revealed the prevalence of cardiovascular diseases (ischemic heart disease, arterial hypertension) particularly among operators of agricultural machines and workers being in contact with pesticides. The state of health of women working in greenhouses and those in sugar beet growing is assessed. The rate of spontaneous abortions and other pregnancy disorders as well as the retardation in physical development of newborns and infants are evaluated. The necessity to improve the ergonomy of agricultural machines, to increase their quality and reliability is emphasized. The search of physiological optimum of efforts to steering wheel and pedals is given as an example. This approach is of general significance and can be applied to road-building machines as well. The role of pesticide management in the Ukraine is also considered in this paper. The damage to human health and the environment is most often connected with violations of regulations, or persistent usage of highly toxic substances. The most urgent tasks are the revision of the registered and applied pesticides, development of new ecological and hygienic standards, improvement of biomonitoring methods and efficiency of the state sanitary supervision.

Health effects of pesticides on female beet growers.

The working conditions of female beet growers and their health effects were studied. Dust, chemical substances, physical strain and the forced working posture were among the occupational factors producing adverse health effects. Contact with pesticides is believed to be the major factor in the development of chronic pathology and temporary disability among female beet-growers. There is a need to promote a system of preventive measures, including comprehensive biological monitoring and control of pesticide concentrations in the environment.