Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv.
Subjective health legacy of the Chornobyl accident: a comparative study of 19-year olds in Kyiv.
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DOI：
10.1186/1471-2458-9-417
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发表时间：
2009-11-17
影响因子：
4.5
通讯作者：
Carlson GA
中科院分区：
文献类型：
--
作者：
Bromet EJ;Taormina DP;Guey LT;Bijlsma JA;Gluzman SF;Havenaar JM;Carlson H;Carlson GA
自1986年Chornobyl事故以来，对乌克兰受影响儿童的身体健康进行了监测，但没有对他们的健康状况进行研究。这项研究调查了在子宫或婴儿时期暴露于放射性尘埃的乌克兰青少年的健康认知，以及流行病学和氯诺贝利对自我报告健康的影响。我们在基辅评估了三组19岁的青少年：262名来自核电站附近受污染地区的疏散人员；261名同学控制组；325名基于人口的控制组。疏散人员和同学在11岁时进行了评估。对青少年及其母亲(N=766)进行了结构化访谈，随后进行了一般体检(N=722)和血液测试(N=707)。比例优势Logistic回归和多组通径分析是主要的统计学检验。检查和血液测试结果在不同组之间相似，只是疏散人员触诊发现甲状腺肿大率(17.8%)明显高于以前的同学(8.7%)和以人群为基础的对照组(8.0%)。此外，四名疏散人员和一名人口控制组接受了甲状腺手术。与对照组相比，疏散者对自己的健康评价最低，在访谈前5年内报告的医学诊断疾病更多，特别是甲状腺疾病、偏头痛和血管功能障碍。这些主观健康报告的一致风险因素(P<；0.001)是疏散状态、女性、多次住院以及对Chornobyl的健康风险认知。在调整后的模型中，三组母亲对孩子健康的评价都比青少年本身更负面，母亲的评分与青少年的健康报告唯一相关。在纵向疏散人群和同学样本中，路径分析表明，母亲在孩子11岁时的健康评分预测了他们后来的评估，而这反过来又与青少年的自我报告有关。疏散人员的自我评价越负面，就与许多风险因素有关，这些风险因素包括多次住院、健康风险认知和流行病学风险因素。甲状腺癌和其他诊断的增加无疑是疏散人员主观健康状况不佳的原因之一。母亲观念的强烈影响有利于为家庭制定风险沟通方案，而不是将母亲或青少年作为单独的目标群体。
Since the Chornobyl accident in 1986, the physical health of exposed children in Ukraine has been monitored, but their perceived health has not been studied. This study examines health perceptions of Ukrainian adolescents exposed to radioactive fallout in utero or as infants, and the epidemiologic and Chornobyl-related influences on self-reported health. We assessed three groups of 19-year olds in Kyiv: 262 evacuees from contaminated areas near the plant; 261 classmate controls; and 325 population-based controls. The evacuees and classmates were previously assessed at age 11. Structured interviews were conducted with the adolescents and their mothers (N = 766), followed by general physical examinations (N = 722) and blood tests (N = 707). Proportional odds logistic regression and multi-group path analysis were the major statistical tests. The examination and blood test results were similar across groups except for a significantly elevated rate of thyroid enlargement found by palpation in evacuees (17.8%) compared former classmates (8.7%) and population-based controls (8.0%). In addition, four evacuees and one population control had had a thyroidectomy. Compared to controls, the evacuees rated their health the least positively and reported more medically diagnosed illnesses during the 5 years preceding the interview, particularly thyroid disease, migraine headache, and vascular dystony. The consistent risk factors (p < 0.001) for these subjective health reports were evacuee status, female gender, multiple hospitalizations, and health risk perception regarding Chornobyl. All three groups of mothers rated their children's health more negatively than the adolescents themselves, and maternal ratings were uniquely associated with the adolescents' health reports in the adjusted models. In the longitudinal evacuee and classmate subsamples, path analysis showed that mothers' health ratings when the children were age 11 predicted their later evaluations which in turn were associated with the adolescent self-reports. The more negative self-evaluations of the evacuees were linked to a number of risk factors, including multiple hospitalizations, health risk perceptions, and epidemiologic risk factors. The increased rate of thyroid cancer and other diagnoses no doubt contributed to the evacuees' less positive subjective health. The strong effect of the mothers' perceptions argues in favor of developing risk communication programs for families rather than for mothers or adolescents as separate target groups.
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