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Title: PROBLEMS OF MEDICAL EXPERTISE FOR DISEASES THAT BRING TO DISABILITY AND DEATH AS A RESULT OF RADIATION EXPOSURE INFLUENCE IN CONDITIONS OF THE CHERNOBYL CATASTROPHE IN REMOTE POSTACCIDENTAL PERIOD.
Author: Sushko VO, Kolosynska OO, Tatarenko OM, Nezgovorova GA, Berestjana ZM, Ustinov SI, Hapeyenko DD.
Journal: Probl Radiac Med Radiobiol; 2018 Dec; 23():471-480. PubMed ID: 30582864.
Abstract:
BACKGROUND: The Chornobyl catastrophe (ChCt) resulted in radiation exposure of great quantity of people. Amongthem there were personnel of Chernobyl NPP (ChNPP) and workers of supporting enterprises, radiation protectionprofessionals, clean-up workers of different specialties including military personnel that were send for liquidationof its consequences, inhabitants of the Prypyat city and Chernobyl 30km exclusive zone (including children) thatwere evacuated during first days after accident and population of radioactive contaminated territories. Loss ofhealth, disability and death as a result of radiation exposure influence in conditions of the ChCt under discharge ofprofessional, military or official duties and/or living on radiation contaminated territories not by his own fault callfor developing of special form of medical expertise as part of medical social protective system for this contingents.The objective of the study was to analyze the state of medical and social expertise for the interdependence of thediseases that bring to the disability and death with the impact of the Chornobyl accident consequences for the adultpopulation and to determine the main directions for improvement of this system. MATERIALS AND METHODS: The analysis of the medical expertise state for the interdependence of the diseases thatbring to the disability and death by the effect of the Chornobyl accident consequences for the adult population ina remote post-accidental period during 2013-2017 years (26142 personal medical expert investigations) was per-formed. RESULTS AND CONCLUSIONS: It was determined that the total number of population suffered from ChCt during 2007-2018 years reduced for 26.05 % or by 657,988 persons. At the same time, there has been rapid increase in the num-ber of victims with disability who received positive medical expertize certificate about interdependence of diseasewith effect of ChCt (the 1st category according Ukrainian legislation) - from 40,106 in 1995 to 107,115 in 2018. Theincrease in the frequency of medical expertise cases of oncological diseases - 51,49 %, as well as cases concerningthe interdependence of diseases that caused the deaths of the victims - 34,99 % were shown. The outstandingissues of the medical expertise of diseases interdependence with ChCt effects for certain categories of victims (thy-roid cancer in persons who have lost their status after reaching adulthood, the definition of the legitimacy of thestatus of victims for inhabitants of territories that undergone radiation ecological control (the 4th-V category) thatrequire changes and additions to the legislative framework are discussed. Peredumovy. Chornobyl's'ka katastrofa (ChKT) pryzvela do radiatsiĭnogo oprominennia velykoï kil'kosti liu-deĭ. Sered nykh – personal Chornobyl's'koï AES ta pratsivnyky suprovidnykh organizatsiĭ, spetsialisty z pytan'iadernoï bezpeky, uchasnyky robit z likvidatsiï naslidkiv avariï riznykh spetsial'nosteĭ, u tomu chysli viĭs'kovo-sluzhbovtsi, meshkantsi mista Pryp’iat' ta 30 km zona vidchuzhennia ChAES (vkliuchaiuchy diteĭ), iaki buly evakuĭovani vpershi dni pislia avariï ta naselennia radioaktyvnykh zabrudnenykh terytoriĭ. Vtrata zdorov’ia ta pratsezdatnosti, atakozh vypadky smerti vnaslidok vplyvu radiatsiĭnogo oprominennia v umovakh ChKT pry vykonanni profesiĭnykh,viĭs'kovykh abo sluzhbovykh obov’iazkiv ta / abo prozhyvanni na radioaktyvno zabrudnenykh terytoriiakh, otrymuiuchydodatkovu dozu oprominennia ne z vlasnoï provyny, vymagaiut' rozrobky spetsial'noï formy medychnoï eksperty-zy iak chastyny systemy medychnogo sotsial'nogo zakhystu dlia tsykh kontyngentiv.Metoiu doslidzhennia bulo proanalizuvaty stan medychnoï ta sotsial'noï ekspertyzy dlia vstanovlennia zv’iazku zakh-voriuvan', shcho pryzvodiat' do invalidnosti ta smerti z vplyvom naslidkiv avariï na Chornobyl's'kiĭ AES dlia do-roslogo naselennia, ta vyznachyty osnovni napriamky udoskonalennia tsiieï systemy.Material i metody. Provedenyĭ analiz stanu medychnoï ekspertyzy zv’iazku zakhvoriuvan', invalidnosti ta prychynsmerti postrazhdalykh vnaslidok avariï na Chornobyl's'kiĭ AES u viddalenomu pisliaavariĭnomu periodi vprodovzh2013–2017 rokiv (26142 medychni ekspertni spravy).Rezul'taty ta vysnovky. Vyznacheno, shcho zagal'na kil'kist' postrazhdalogo naselennia za period 2007–2018 rr.skorotylasia na 26,05 % abo na 657 988 osib. Maie mistse strimke zrostannia kil'kisti postrazhdalykh kategoriï1 – z 40106 u 1995 rotsi do 107115 u 2018 rotsi. Vprodovzh 2013–2017 rr. vstanovlena vysoka chastota rozgliadumedychnykh ekspertnykh sprav shchodo vypadkiv raku (51,49 %) ta smerteĭ (34,99 %). Pervynna medychna ekspertyzau 35,12% vypadkiv bula provedena dlia uchasnykiv likvidatsiï naslidkiv avariï na ChAES (kategoriï 2A, 3A) ta u 41,99 %vypadkiv dlia poterpilykh, iaki prozhyvaiut' u zoni pidvyshchenogo radiologichnogo kontroliu (kategoriia 4 V). Pry per-vynniĭ medychniĭ ekspertyzi chastota rozgliadu vypadkiv smerti dlia uchasnykiv likvidatsiï naslidkiv avariï na ChAESkategoriï 2A stanovyla 30,65 %, kategoriia 3A – 15,97 %, kategoriia 4-V – 23,75 % vypadkiv. Chastka medychnoï eks-pertyzy vypadkiv smerti bula naĭvyshchoiu dlia 1 kategoriï – 79,14 % vypadkiv. Vyznacheni nevyrisheni pytannia pro-vedennia ekspertyzy zv’iazku zakhvoriuvan' deiakykh kategoriĭ postrazhdalykh (rak shchytovydnoï zalozy u osib, iakivtratyly status poterpilykh pislia dosiagnennia povnolittia, vyznachennia chynnosti statusu postrazhdalogo kategoriï4-V), shcho vymagaie zmin ta dopovnen' do zakonodavchoï bazy.

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