Introduction
Human health is an important resource in any population. However humans are always exposed to health hazards that could be from the outside environment, workplaces, homes and from other organisms. One of the greatest accidents that have resulted in health problems is the Chernobyl disaster. This accident was caused by a flawed reactor that was being operated by inexperienced personnel. As a result, there was a serious explosion that released some radioactive material into the environment. Two of the workers died that same day the accident happened and 28 others followed in a span of few weeks after the incident. Their deaths were attributed to acute poisoning by the radiation. It is presumed that mistakes done by the operatives were due to the isolation that resulted from the cold war. Ukraine in 1986, was still suffering from insecurity risk culture. As a result, inadequately trained personnel found their way into dealing with serious health hazard industries like working in radioactive reactors. The result was a disaster. The accident razed the Chernobyl reactor and caused serious health injuries to those who were exposed. The diagnosis of the bodies of the people who died indicated coronary thrombosis. Later on, over 237 individuals were originally suspected to be experiencing symptoms of acute radiation syndrome due to the exposure. The deadly syndrome was afterwards established in 134 more inhabitants.
Background
After the cold war, many nations were determined to be secure, armed and find military supremacy. Investing in nuclear was highly considered as the trend towards achieving that kind of independence. Ukraine was one of the nations that ventured in nuclear reaction plants. The Chernobyl reactor was close to the Belarus boarder only about 20km away. At the time of the accident, there were four reactors (Rahu, 2003, p. 296). The incidence took place in 1986 on 26th April. The operators dealing with reactor 4 decided to run some test but things got out of control due to deficiencies in engineering skills. They were in fact operating the reactor in unstable conditions and improperly. As a consequence, power surge occurred causing the fuel to overheat and so leading to a series of explosions which damaged the reactor badly (Breidablik et al, 2008, p. 74).
Radioactive material released into the atmosphere affected several people and resulted into death of 30 people. The radio active material was released in a period of about 10 days despite the efforts by the government to drop neutron absorbing materials in the reactor (Rahu, 2003, p. 296). Later there was another 5 day period of decreasing release of these dangerous radiations into the atmosphere. The radioactive material spread in the areas towards the Soviet Union and a greater part of Europe.
The impact of the expose on health was quite severe considering that despite the fact that two people died immediately, 28 other died in a span of three months. The following year, 1987 to 2004, 19 cases were reported to die from symptoms related to the exposure (Rahu, 2003, p. 298). There was no one reported off-site to have suffered serious exposure to the radiation though there have been numerous cases of thyroid cancer diagnoses since the incidence. This is most likely due to the inhalation of the radioactive iodine fallout. Moreover, larger parts of Ukraine were contaminated by the radiation. Others areas that experienced varying degrees of radiation include Belarus, Russia and some parts of Europe (Santrock, 2010, p. 69).
Impact of the Accident on Human Health
When radioactive materials are released, they spread information of ionizing agents which could be alpha, beta gamma and other kinds. When these agents encounter human cells, they cause damage and even death to these cells. This is because they are able to penetrate and cause destabilization to the genetic material of the cells. The exposure is often measured in terms of energy taken by the body per unit mass – dosage absorbed (Breidablik et al, 2008, p. 74). Considering that the exposure at Chernobyl was so severe causing a number of organs to absorb the radiation, it has been very common for the analysts to use an additional concept which is described as the effective dose. This is characteristic of the overall health risk from the radiation or combination of exposure results (William, 2002m, p. 543). Effective dose is measured in Siervert (Sv) but one unit Sv is rather great level of dose. Therefore the levels of exposures are often indicted in millsievert (mSv).
Most of the workers from the reactor plant did not have serious exposure and their levels were described as low based on the whole body dose. This is what can be compared to very low background radiation that accumulates over a year like for 20 years. Only the on-site reactor workers and emergency personnel at the exploded reactor suffered serious exposure (Santrock, 2010, p. 69). Particularly, the highest dose exposures were recorded among onsite employees and the Emergency personnel. This was up to 1000 people. The rest of the operation employees recovered in a span of four years and the levels were as low as 100mSv according to state registries from affected nations. There low levels were recorded in the spring of 1986 of up to 33mSv.
Consumption of contaminated food did not result in any significant increase in the level of dosage. On the other hand, the level of thyroid doses were so much varied over a great range. These factors included age of victims, milk ingestion, and the degree of area contamination. The thyroid doses fell in the range of 50Gy to very few Gys (Absorbed dose is measured in Gray (G) – joule/kg) depending o the area the people lived and their age (Rahu, 2003, p. 298). Inhabitants of Pripyat had substantially little thyroid dose levels though the area is in the vicinity of Chernobyl. This was achieved by taking of stable iodine medication. Consumption of milk from cattle that consumed pasture immediately following the accident was implicated in the high levels of thyroid doses among children and also the reason why a lot of children developed thyroid cancer (Breidablik et al, 2008, p. 74). Basically, the general population has been exposed to little background exposures over the past decades or by consumption of foods, water or inhalation.
There are few cases of health problems closely linked to the accident in Chernobyl. They are thyroid cancer, cataracts and leukemia.
Thyroid Cancer: this is one problem that has increased in Chernobyl especially among children. This is due to the fact that the main radionuclides that were released from the explosion were active constituent of the iodine element- iodine -131. This element was important for some months. Thyroid glands carry out their normal physiological functions and they accumulate iodine that is circulating blood for metabolism (Breidablik et al, 2008, p. 76). Thus iodine was so much increased due to exposure among the residents via inhalation or consumption (ingestion) particularly milk. Thyroid being very vulnerable to cancer induction from radiation, the outcome was development of thyroid cancers. Of the population, children were discovered to be most vulnerable as the number of cancer diagnoses substantially increased (Manor et al, 2001, p.601).
It is estimated that over 4000 incidences had been diagnosed with thyroid cancer aged between few months to 18 years. These groups were less that 14 year s at the time of the accident. Recent statistics from the Ukrainian and Belarusian registries show that the number is about 5000. This figure could differ slightly because of the method of reporting but the overall figure observed in these nations is certainly over 4000.
Most of the cases were given medical attention based on best prognosis according to their lifestyles. Bearing in mind the rarity of thyroid cancer in children, the rest of the population highly exposed radiation, and the magnitude of the health risk related to the radiation, it is likely that the greater number of cancer cases that are being reported today among children previously exposed are from the Chernobyl exposure.
More cases of thyroid cancer are likely to occur in the future though scientific research does not show the long-term level of risk (William, 2002m, p. 544).
It is pertinent to realize that the mitigation measures that were employed greatly minimized the consequences substantially. Stable iodine medication were given to the victims immediately and those who took them between 6 and 30 hours later had decreased thyroid dose estimated 6 times less.
Leukemia and Other Cardiovascular Problems: there are several studies that have indicated that ionizing radiations are risk factors for solid cancers. Epidemiological studies among survivors of atomic bombs, people working in firms dealing in radioactive material or patient who underwent radiotherapy ended up developing some forms of cancers (William, 2002m, p. 544). Recently, there have been many results indicating that cardiovascular problems were associated with exposure. In this view, the risk of developing leukemia was expected from Chernobyl for the exposed population (Manor et al, 2001, p.601). Considering the amount of dose taken into the body, it is likely that this population did not have the correct the statistical tool to detect the increase in poisoning, though detection of maximum exposure to personnel was possible. Recently, studies have been conducted and they revealed a double rise in cases of CLL-Leukemia since 1987 to 1997 in Russia for those patients who were exposed to over 150 Gy. Ongoing studies of employees offer additional information on potential augmented leukemia risk (William, 2002m, p. 545). Nonetheless, as the risk of leukemia induced by radiation reduces over years since exposure, its impact on morbidity and mortality, is probable to loose significance with time.
There are several studies after Chernobyl incidence on cancers and leukemia prevalence in populations staying in areas previously contaminated. Most of the research, nonetheless, there are methodological limitations and do not have statistical tool. This is again not a convincing proof presently that the occurrence of leukemia or the solid cancers apart from thyroid, especially that the rate has increased children (Hatch et al, 2009, p. 899). It is thought, however, that many solid cancers, the latent time is likely to increase than for leukemia or thyroid. Concerning cancers, 10 to 15 years or even more could not be enough for evaluation. Therefore it could be too premature to fully assess the full radiological impact of Chernobyl incidence. Consequently, medical care and annual evaluations of exceedingly exposed workers from Chernobyl has to proceed even today (Manor et al, 2001, p.603). When there is lack of expressed risk of cancer, except thyroid – is not evidence that there is no increase taking place. That kind of an increase is anticipated to be very hard to recognize in the absence of careful and all-encompassing epidemiological researches with personal dose estimates. It is pertinent to note that, with numerous people exposed, there are little variations in the models that are employed in assessing the risks when the dose is very low and the effects of these estimates of extra cancer cases (Hatch et al, 2009, p. 902).
There is some recent rise in morbidity and mortality of the victims caused by circulatory or cardiovascular problems. Cases of cardiovascular system diseases have to be interpreted with caution since it is possible that there could be indirect influence of confusing reasons like stress and standard of living (Manor et al, 2001, p.604). Cataracts: on eye examinations among children and the crisis and recovery operation employees evidently revealed that cataracts could develop in relation with exposure from the Chernobyl incidence. Information found from researches on crisis and recovery employees indicate that exposures to doses rather less than previously encountered down to about mGy could be cataractogenic. A follow up research of Chernobyl residents and workers will go along way to confirm and predict capacity of risk of developing cataracts from radiation and more significantly, offer the data vital to be able to review the possibility of whichever resultant illustration dysfunction.
Reproduction: due to the relatively low dose that the people got exposed to, there has not been proof or possibility of reduced fertility in men or women in the population as a direct consequence of that exposure. These doses could not likely cause any impact of the number of adverse pregnancy results, stillbirths, birth complications or the general health of the babies to be born (Hatch et al, 2009, p. 899). The birthrates could be low in the affected areas due to fears of having children in such situations are obscured by the highest rate of abortions. Moreover many young people shifted from that area. There is no distinguishable rise in hereditary impact caused by the exposure is predictable based on the low risk coefficient approximated.
Methodology
There are several people who got exposed to the radioactive material in Chernobyl and have since then been showing some symptoms of radiation poisoning. From that time, their health has been under constant monitoring by state as well as international agencies (Gilmore et al, 2002, p. 2178). There is also some inconvertible proof of increased case of thyroid cancers from the cohorts studied and inadequately authenticated or inconsistently sustained declarations regarding the elevated number of birth defects, leukemia and even mental retards. The assumptions are habitually and significantly reported even in the media. In light of this, it’s pertinent to study the “Chernobyl generation” and their health status even today as they are now young adults. Basically the adults sampled from this area indicated significantly high differences in health from physical examinations.
The hypothesis derived here was that there were similar differences between the objective health of individuals from the contaminated areas and their subjective health.
Sample: the study was carried out in Kyiv region in Ukraine. This is the place where several –people were resettled following the explosion in 1986. The study was conducted on individuals aged about 22 years to 26 years. This means that the study covered three groups of people; those who were infants at the time of the accident or those who were not yet born. The sample size was 262 participants as evacuees from Chernobyl, 261 classmates as comparatives and the control sample from the general population was 325. The other group includes those who were actually exposed and evacuated from the contaminated area.
Evacuees were identified from previous studies by other researchers and from the list of evacuees prepared by Kyiv registries. Basically the families that had a child in utero or aged about 16 months by then were selected. 300 evacuees and mothers took part in the study. This was a 91% response. The participants were 24 years of age on average. 80% of them were from Pripyat. There was another 300 Kyiv classmates of the exposed population used as the comparison group and also their mothers took part.
A population oriented participants were selected for use as the control group to offer information on a representative test of the non-evacuee young adults in Kyiv. They were chosen by use of a sampling tool from Kiev International sociology institute. This software generated a random list of the families in Kiev first by picking a street, followed by selection of the house and finally screening of the telephones.
The Design and Process
The study involved two stages with home interviews that relied on self reported health problem and potentials rather perceived risk and then followed by a medical examination at a clinic in Kyiv. The researchers were trained by the institute of sociology to carry out the interviews professionally (Gilmore et al, 2002, p. 2178). The interviews were also monitored directly. A computer-assisted process was applied in conducting interviews. The second stage was carried out by trained medical nurses and doctors were used for monitoring. These participants were required to complete an informed consent to ensure eligibility. For clarity, all the instructions and steps were deciphered from English to Ukrainian and Russian. The study entailed structured interviews on the young adults and their mothers giving a sample of 766 and the next step which was physical examination was conducted on 722 while blood tests were done on 707 people. Major statistical tests for that reason were odds regression and path analysis for that unique sample.
Measures: subjective health elements were recorded from interview whereby risk factors were also noted in specific homes. The objective medical elements were collected after 2 to 4 weeks alter.
Subjective health: scaled questionnaire was administered to the participants who had the choice of indicating their health status as being poor, very poor, satisfactory, excellent or good. Self-rating of the medical condition has been used before to evaluate morbidity as an overall pointer of healthiness (William, 2002m, p. 545). Since the responses in excellent and very poor were very few, the other categories were combined to end up with three groups – excellent good, poor/poorer and satisfactory (Gilmore et al, 2002, p. 2178). The investigators used standardized checklist of abnormalities to assert the self-reported poor health. The medically diagnosed and then treated. The assessment concentrated on 7 conditions mostly associated with Chernobyl incidence by ‘layman’. They include arthritis, thyroid disease, migraine, anemia, GIT problems, immune system problems, somatic symptoms and cardiovascular conditions. A ten year frame was applied where scores wee dichotomised into 1 – excellent/good, 2- satisfactory and 3 poor/poorer (1, 2, ≥ 3).
The Risk Factors: for subjective health, the following were used as the main epidemiologic risk factors; gender, self-esteem, communication, material situation, basic role (attended vs. not attended university). Higher risk were from low esteemed people, those with poor communication as well as those hospitalized for long over the past ten years coded in 1, 2 and ≥ 3. Reasons for being hospitalized were numerous and ranged from general check ups to minor health conditions like sinusitis and even major process like surgeries (Gilmore et al, 2002, p. 2179). Important risk perceptions included in the analysis were that; the participant believed that his/her healthy problem was as a result of Chernobyl incidence and also believed that the incidence would have adverse impact on the health of future generations (Burlakova, 2010, p. 87). Responses were totally agree, agree, somewhat, disagree, totally disagree. Considering that most of the young adults responded somewhat and that the perception of t risk was meant to judge the severity of the risk, the response were recorded as agreed, somewhat and disagreed (William, 2002m, p. 545). In relation to the above variables, mothers were told to evaluate their children’s healthiness.
The mothers to evacuees and those to classmates gave the assessment ratings since the exposure.
Medical tests: these were done for about 2 to 4 hours at the clinic after the interview. The design was a blind technique since the nurses were not aware that the participants were evacuees from Chernobyl or the controls. Element measured included height, blood pressure, heart rate, respiration, body weight and temperature. The participants were thereafter examined by internists, cardiologists and ophthalmologist randomly. Ophthalmologists assessed the eye’s cornea, lens, retina and pupils (Jacob et al, 2000, p. 26). Cardiologists assessed heart condition and state of blood vessels and the internists studied throat, nose, ears, chest, skin abdomen and overall wellbeing. After conducting bloods tests, the doctors and nurses did an overall rating of healthiness of the participants in terms of minor or major health conditions.
Blood tests involved studying sedimentation rate of the erythrocytes and whole blood smears to study hemoglobin, platelets and leukocytes. The presence of thyroid stimulating hormone was studied by assays of blood samples (Jacob et al, 2000, p. 26). Computerized gamma counter was used to measure radioactivity and fitting it to the standardized curve and analyzing the samples based. The reliability was assured by use of commercially prepared control sera. The assays were carried out in duplicate. The TSH assays showed inter-assay coefficient varied at less than 10%.
Results
The results revealed that 31.7% (83 participants) of the evacuees were exposed to the radiation in utero and 68.3% (179 people) were exposed to the radiation in their infant months. The gender of the evacuees, control and classmates were the same with an overall rate of 51.4% women. The material ability was shown to be 36.5% not capable of affording luxury. 64.6% attended university. Hospitalization was 32.8% for evacuees, 20.3%b for classmates and 18.2% for the control for at-least three hospitalizations and more in the ten years before the study. Concerning the perceived risk, relatively more evacuees thought that they had health problems because of the Chernobyl accident – the rate was 19.8% against 8.8% for classmates and 13.8% of the general population control. On the while, the three groups believed that the exposure from accident would actually cause healthy problems in future or on future generations (Rahu, 2003, p. 299).
Medical tests: on the whole, the blood tests and other examination did not indicate any variations except that significantly many evacuees had enlarged thyroids. Palpation on these glands indicated that the glands were felt and the rates were 17.8% for evacuees against 8.7% for the classmates and controls hand 8.0%. Six participants who had enlarged thyroid also indicated nodular thyroids. These were two from every group (Baverstock & Williams, 2006, p. 1312). Thyroid stimulating hormone assessment was similar in all cases even without enlarged thyroids. Four evacuees had eye cataracts. None was diagnosed with cataracts from the other two groups. On the whole, the ratings indicate that most evacuees (about 12.0%) had suffered major health conditions. This was quite higher than normal population (10.9%) distribution and even much greater that their classmates 7.4%.
Subjective Health: generally the evacuees had a lower rating of their general health compared to their peers. This was rated 36.3% who stated that their health was good compared to 52.1% classmates and 47.4% controls. Evacuees also stated that they has been diagnosed at least 5 out of the 7 listed health conditions particularly migraines, thyroid diseases and cardiovascular problems. Overall many evacuees, 34.0% reported having experienced more than two sicknesses in the past decade – 18.4% classmates and 21.8% control group.
The self-assessment of the health conditions and medical diagnosis of a problem among evacuees did not reveal any significant variations in subjective health since the time of accidental exposure (Baverstock & Williams, 2006, p. 1312). However the connection involving self- testimony of thyroid diagnosis and the actual enlargement on palpation examination by experts was greatly significant at OR = 5.9 as a 95% confidence level. Thus twenty-five people out of the thirty eight that has enlarged thyroids had reported being diagnosed with the problems before compared to the 44 people out of 179 evacuees with normal thyroid. This report was expected because the study entailed medical history of the participants.
The Risk Factors: most of the risk factors mentioned above showed significant association with self- reported health problem except university attendance and supposed health problem on future generations due to exposure (Baverstock & Williams, 2006, p. 1312). The interaction terms were not significant with risks. In evaluated model of analysis, women, poor material condition, low self esteem, and incidences of hospitalization were still significant. Participants who believed that Chernobyl had adversely affected their health rated their health as poor at 3.5 times (Johnson & Wang, 2008, p. 308). Those who had been hospitalized initially rated their health twice less satisfactory. Considering the number of sicknesses, all the risk factors were very significant except communication in family; after adjusting the results, women, university attendance, hospitalization and the state of the evacuees was significantly implied in many illnesses. Hospitalization of at-least twice was likely to report fourfold increase in health risk (Johnson & Wang, 2008, p. 308). Being a woman and trusting that the impact of Chernobyl accident had an adverse impact on health increased the risk of developing a disease by threefold (Burlakova, 2010, p. 89).
Limitations
The research suffered a problem of being done in one area thus limiting the samples and normal variants of a normal population. Generalizing the results would be a great challenge is the evacuees were resulted somewhere else (Johnson & Wang, 2008, p. 309). Furthermore, there was not clear list to show where all the evacuees were resettled since the incidence was disastrous and this could have lead to migration without notification. Though the results were consistent with those from previous results and those from the people who resettled in Israel, the most critical limitation could have been that the initial and most terrific events that were as a result of the accident were not experienced directly by these young adults (Jacob et al, 2000, p. 28). Nonetheless they got the rumors concerning their lives. Furthermore Kyiv could have had some initial radiations contamination since many people were also sent away to Kyiv.
Discussion
The results in this study as particularly striking since the sample were largely healthy as revealed by the medical assessment and activity. The only difference that was significantly distinguishing was the diagnosis nod increased morbidity of enlarged thyroid among the evacuees (N=-38) and previous thyriodectomy (N=4). Also important to note was that at least four evacuees had cataracts. This is in comparison to none of the cases from the rest of the groups. Striking risk factors that were associated with poorer health included hospitalizations, perception of health problems and being female. The risk factors were however not synergistic in nature. Many outcomes show that the exposure was significantly associated with occurrence of the diseased. Many evacuees had prior hospitalizations at-least more that thrice in ten years fro 1/3 of them.
Conclusion
The outcomes indicate that evacuees generally rated their health as being poor due to the exposure in Chernobyl compared to peers. Maternal risk factors were critical in determining the risk and this was independent of other disaster associated concerns. Generally the outcomes show that exposure and price risk was significantly associated with the poor health conditions of the evacuees.
Reference List
- Baverstock, K, & Williams, D. (2006), ‘The Chernobyl Accident 20 Years On: An Assessment of The Health Consequences And The International Response,’ Environ Health Perspect, 114:1312-1317.
- Breidablik, H.J, Meland, E. & Lydersen, S. (2008). Self-Rated Health during Adolescence: Stability and Predictors of Change (Young-HUNT Study, Norway). Eur J Pub Health 2008, 19:73-78.
- Burlakova, E.B. (2010). 20 years after the Chernobyl accident: past, present and future, Commack, N.Y. Nova Science Publishers
- Gilmore, A., Mckee, M., & Rose, R., (2002), Determinants Of and Inequalities in Self-Perceived Health in Ukraine, Soc Sci Med, 55: p. 2177-2188.
- Hatch, M., et al. (2009), ‘Screening Study Of Thyroid Cancer And Other Thyroid Diseases Among Individuals Exposed,’ In Utero To Iodine-131 From Chernobyl Fallout. J Clin Endocrinol Metab 2009, 94:899-906.
- Jacob, P., et al., (2000), ‘Thyroid Cancer Risk In Belarus After The Chernobyl Accident: Comparison With External Exposure,’ Radiation And Environmental Biophysics, Vol. 39, Issue 1, Pp. 25-32
- Johnson, S.B., & Wang, C. (2008), ‘Why Do Adolescents Say They Are Less Healthy Than Their Parents Think They Are? The Importance of Mental Health Varies By Social Class in a Nationally Representative Sample,’ Pediatrics, 121:E307-E313.
- Rahu, M. (2003), ‘Health Effects of the Chernobyl Accident: Fears, Rumours and The Truth,’ Eur J Cancer, 39:295-299.
- Santrock, J. (2010). Life-Span Development, (12th Ed), New York, McGraw-Hill Companies Inc.
- Manor, O., Matthews, S., & Power, C. (2001), ‘Self-Rated Health And Limiting Longstanding Illness: Inter-Relationships With Morbidity In Early Adulthood,’ Int J Epidemiol, 30:600-607.
- William, D. (2002), ‘Science and Society: Cancer after Nuclear Fallout: Lessons From The Chernobyl Accident,’ Nature Reviews Cancer 2, 543-549