Nuclear disasters and health: lessons learned, challenges, and proposals
Nuclear disasters and health: lessons learned, challenges, and proposals
复制标题
DOI：
10.1016/s0140-6736(15)60994-1
复制
发表时间：
2015-08-01
期刊：
影响因子：
168.9
通讯作者：
Clarke, Mike
中科院分区：
文献类型：
--
作者：
Ohtsuru, Akira;Tanigawa, Koichi;Clarke, Mike
过去的核灾难，如1945年的原子弹爆炸和核电站的重大事故，突出表明了在这两种情况下辐射对公众健康的潜在影响的相似性，包括与辐射照射无关的健康问题。虽然核灾难的罕见性限制了对循证干预措施和战略进行严格研究的机会，但重要的是要确定经验教训并制定有效的计划，以保护公众，最大限度地减少负面影响，并保护应急工作人员免受高剂量辐射的影响。此外，还需要开展研究，以帮助决策者避免已在医院的病人和其他弱势群体在撤离期间过早死亡。由于核灾难可能影响数十万人，每次灾难都有相当多的人面临身心伤害的风险。在核灾难后的恢复期间，医生可能需要筛查心理负担，并为许多可能经历长期流离失所的受影响居民提供一般的身心健康护理。对医疗保健专业人员来说，除了解释辐射防护的需要外，可靠地传达个性化风险已经成为一项挑战。为了克服风险沟通的困难，并提供决策援助，以保护工人，弱势群体和居民在核灾难后，医生应该接受核灾难应对培训。这种培训应包括基于证据的干预措施，支持平衡潜在危害和益处的决策，并考虑到提供社区卫生保健的科学不确定性。一个开放和联合的学习过程对于为未来的核灾难做好准备并将其影响降到最低至关重要。
Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.