Peripheral blood of children exposed to radiation as a consequence of the Chernobyl AES accident]

As many as 103 children exposed to minor doses of radiation after the Chernobyl accident were examined for peripheral blood morphology. Statistical and individual analysis did not reveal any pathological alterations on the part of the hemograms of the radiated children. At the same time they manifested certain deviations in the form of leukopenia, lymphopenia and neutropenia, suggesting the action produced by radiation factor. On the whole, these alterations were characterized as adaptation ones of multifactorial genesis. The data obtained support an assumption that the changes in the quantitative composition of blood exposed to radiation in the doses not exceeding the maximal permissible limits were not remarkable, occurring within the physiological boundaries and could be detected only during observations made over time. Emphasis is laid on the necessity of further monitoring of the hemopoietic system of the radiated children according to the current principles of dispensary observation.     

Assessment of the immunohematological status of children exposed to low doses of ionizing radiation in the early and late periods after the Chernobyl AES accident]

The qualitative and quantitative parameters of hemopoiesis and immunocompetent cells were studied in 365 children in the early "iodine" and long-term periods after the accident. In accordance with primary response, a group consisting of 28 subjects with so-called "radiation injury" was distinguished. The early period was marked by unusual qualitative and quantitative hematological changes which, however, did not lead to the development of the hematological syndrome characteristic of acute radiation injury. Certain deviations that corresponded to somatic pathology were detectable at the late periods after the accident.     

A study of the relationship of ninety background, developmental, behavioural and medical factors to childhood accidents

A sample of 991 five-year-old children was divided into three groups on the basis of accidental injuries they had received in their first five years of life. Group one (N = 505) had had no accidents, group two (N = 326) had had one accident and group three (N = 160) had had two or more accidents. The groups were then compared on ninety background, developmental behavioural, and medical measures. No consistent differences between the three groups were identified. It is argued that attempts to identify those more liable to accidents lack utility and have an inhibitory effect on accident prevention In view of this, it is advocated that future accident research should concentrate on identifying unsafe aspects of the environment.     

The prognosis of near-drowned children.

Thirty children were treated for near-drowning in the Children's Hospital, University of Helsinki during 1971--1976. The patients were divided into 3 groups according to the prognosis: group I included 13 children (43%) with a favourable prognosis, group II four children (13%) with a less favourable prognosis who developed severe sequelae, and group III 13 children with poor prognosis and in whom the subsequent outcome proved fatal. The surviving children underwent neurological, neurophysiological and psychological examination 6--58 months after the accident. The children in group I had slight neurological or psychological signs, some children presented a lowered intellectual functioning level. The children in group II were tetraplegic, unable to speak and had convulsions. The following factors were important in affecting prognosis: the longer the immersion time, the worse the prognosis. However, prognosis could still be favourable with an immersion-time of 11-20 min. Prognosis was bad if the first pH value was less than 7.00. The arterial oxygen pressure values measured during the treatment did not correlate with the prognosis but a low rectal temperature on admission was usually associated with a bad prognosis. The degree of EEG-disturbance had a prognostic value. However, the follow-up recording correlated better with the prognosis than the recordings during the first 24 hours, after which worsening of the EEG sometimes showed a progressive brain lesion.     

A controlled study of health education in accident prevention: the Rockland County Child Injury Project. 1966.

The Rockland County Child Injury Prevention Project was designed to test the effects of public health education for parents on the incidence of accidental injuries to children under 7 years of age in a controlled situation. The incidence of accidental injuries, defined as any actual or presumed trauma following an accident for which medical or dental attention was obtained, was determined in a study population before, during, and after exposure to the educational program and in a comparable control group during a corresponding period of time. The study group was exposed to an intensive education program involving neighborhood discussion groups conducted by lay and professional leaders, meetings with organized groups, and a monthly newsletter. The study population was organized into small neighborhood units of about 24 homes within the suburban housing developments. To measure the effect of the education program, accident rates were computed for each three month reporting period, projected on an annual basis. No consistent differences were discernible in the trends in the accident rates between the study and control groups during the three years of the project. On the contrary, the curve for the study group crossed that of the control group on no less than five occasions. There was a sharp decline in accidents during the second half of the education phase. Any conclusions regarding a positive effect of the education program proved untenable in the light of the sharp and disproportionate increase in the accident rate in the study group during the six month phase after education had stopped. After what appeared to be a contrary trend earlier, developments during this period demonstrated vividly the need to continue reporting for a sufficient time in a controlled situation to be sure that fortuitous changes over short periods do not lead to unwarrented conclusion. The flow of reports from hospitals was more consistent than from physicians. This suggested that, in selected control studies, adequate rates for comparative purposes might have been obtained entirely from hospital records.     

Mild closed head injury in children compared to traumatic fractured bone; neurobehavioural sequelae in daily life 2 years after the accident

Two years after an accident resulting in either a mild head injury or a fractured bone, two groups of 22 children each, aged 4–14 years, were examined for the existence of any neurobehavioural symptoms by means of a standardized questionnaire filled out by their caretakers. Selection of the children was based on reports of the Accident and Emergency Department in 1 year. Significantly more symptoms were reported after mild head injury. The main symptoms reported were headache, dizziness, fatigue and memory problems. The total number of symptoms in the children with mild head injury exceeded four times this in the group of children with a fractured bone. Conclusion Even 2 years after a mild head injury there are still residual symptoms in daily life. Received: 23 April 1998 / Accepted in revised form: 28 October 1998     

Childhood accidents--an endemic of epidemic proportion.

Information about accidental injury to children was obtained by studying children who presented at hospitals in South Glamorgan during a 6-month period. Just under 10 000 children who lived in the area presented at hospital, which, if extrapolated means that 20% of children each year might be expected to attend hospital after an accident. The majority (71%) of children needed only simple investigation, treatment, or reassurance. The distance between the site of the accident and the hospital was directly related to the number of children presenting. The most common cause of injury was a fall, but dog bites also caused concern. Bicycle injuries were more common than police statistics indicate. We conclude that accident and emergency departments should give special attention to children.     

儿童意外损伤对心脏的危害研究

目的　研究儿童意外损伤对心脏的危害。方法　将１６６ 例意外损伤患儿分为中毒组（４８例） ,烧烫伤组（５８ 例） ,气管异物组（６０ 例） ,设同龄对照组（５０ 例） 。用紫外法对各组患儿进行心肌酶谱测定并对各类损伤患儿做常规心电图检查和心电监护。结果　心肌酶谱异常７９ 例,阳性率４７－５９ ％ 。心电图异常６３ 例,阳性率３７－９５ ％ 。中毒组ＣＫ、ＣＫＭＢ、ＨＢＤ、ＬＤＨ 均明显升高,与对照组比较有明显差异Ｐ＜ ０－０１ 。烧烫伤组ＨＢＤ、ＬＤＨ 明显高于对照组,Ｐ＜ ０－０１ 。气管异物组各项心肌酶与对照组比较均无显著差异,Ｐ＜ ０－０５ 。结论　各类意外损伤对心脏的危害依次为中毒、烧烫伤、气管异物。ＣＫ、ＣＫＭＢ 升高为心肌损害主要指标。ＨＢＤ、ＬＤＨ 升高对心肌损害判断亦具特异性     

THE PROGNOSIS OF NEAR-DROWNED CHILDREN

Abstract. Thirty children were treated for near-drowning in the Children's Hospital, University of Helsinki during 1971–1976. The patients were divided into 3 groups according to the prognosis: group I included 13 children (43%) with a favourable prognosis, group II four children (13%) with a less favourable prognosis who developed severe sequelae, and group III 13 children with poor prognosis and in whom the subsequent outcome proved fatal. The surviving children underwent neurological, neurophysiological and psychological examination 6–58 months after the accident. The children in group I had slight neurological or psychological signs, some children presented a lowered intellectual functioning level. The children in group II were tetraplegic, unable to speak and had convulsions. The following factors were important in affecting prognosis: the longer the immersion time, the worse the prognosis. However, prognosis could still be favourable with an immersion-time of 11–20 min. Prognosis was bad if the first pH value was <7.00. The arterial oxygen pressure values measured during the treatment did not correlate with the prognosis but a low rectal temperature on admission was usually associated with a bad prognosis. The degree of EEG-disturbance had a prognostic value. However, the follow-up recordings correlated better with the prognosis than the recordings during the first 24 hours, after which worsening of the EEG sometimes showed a progressive brain lesion.     

Posttraumatische Hypophyseninsuffizienz beim Neugeborenen

We present the case of a newborn with severe head trauma after a car accident and posttraumatic hypopituitarism. Five days after the accident, initial alterations in circulating hormone levels manifested as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) with severe hyponatremia. This was followed by polyuria with hypernatremic dehydration. Further alterations were secondary hypothyroidism and hypocortisolism as well as hyperprolactinemia. Treatment consisted of desmopressin, L-thyroxine, and hydrocortisone. Within 10 months, we observed the gradual recovery of pituitary gland function.     

Medically attended injuries among young children: observations in a suburban area. 1964.

A control study of the effect of public health education on the rate of accidental injuries among children under 7 years of age in a newly developing suburban area provided an opportunity to gain an insight into the nature and extent of the accident problem itself during a one year baseline period preceding the educational phase of the study. An accident was arbitrarily defined as any actual or presumed trauma following an incident for which direct medical or dental attention was obtained. Data were gathered through regular visits of data collectors to physicians, dentists, and hospitals in the area. An annual accident rate of 124 per 1000 children under 7 years of age was found. Two or more accident occurred to 10% of the children. The highest injury rate by age (179 per 1000 children) was found among 2 year old children, with the rate amount 2 year old boys 75% higher than any other age-sex group. The possible relationships of suburban living to the type and location of accidents by age and sex and to the variation in accidents by day of week are also presented.     

Epidemiologic study of sports injuries in children

From 1981 to 1982, within a one year period, all medically treated childrens' accidents were recorded in the public and private medical facilities of a French health care district near Paris. Sports injuries represented 11% of all injuries, and in children aged 12 years and over, sports areas were the leading site of accidents (24%). Seven hundred thirty-eight sports injuries to children aged 6 years and over were analysed and compared to other types of accidental injuries (home, school and traffic accidents). The overall incidence of sports injuries was estimated to be 1.1% in children aged 6 to 14 years. Out-of-school sports accidents were more frequent among boys, but boys and girls had similar injury rates in school physical education. Most lesions were benign but the fracture rate was 22%. A majority of lesions were located on the upper limb. Most commonly, the mechanism of accident was a forward fall and children were injured without any participation of sports equipment. The hospitalization rate was 11%. Repeated hospital admissions and a long time elapsing between the accident and full recovery were significantly more often observed than in other types of accidents. This might be explained by a higher rate of epiphyseal fractures and internal fixations. Eighteen months after the accident, musculo-skeletal sequelae were observed in 12% of the inpatient children.     

Childhood head injuries: accidental or inflicted?

OBJECTIVES: To determine the relative incidence of accidental and abusive causes of head injuries in children younger than 6.5 years, to identify the types of craniocerebral damage resulting from reported mechanisms of injury, and to assess the likelihood of injuries being accidental or inflicted. METHODS: Retrospective review of medical records of 287 children with head injuries aged 1 week to 6.5 years admitted to a metropolitan children's hospital from January 1986 through December 1991. Those patients with diagnoses of skull fracture; concussion; subarachnoid hemorrhage (SAH); subgaleal, epidural, or subdural hematoma (SDH); parenchymal contusion or laceration; and closed head injury were included. Criteria were used for inclusion in categories of definite abuse or accident. RESULTS: Accidents accounted for 81% of cases and definite abuse for 19%. The mean age of the accident group was 2.5 years and for the definite abuse group, 0.7 years. Major differences were seen in the incidence of the following: SDH, 10% in the the accident group and 46% in the the definite abuse group; SAH, 8% in accident group and 31% in the definite abuse abuse; and retinal hemorrhages, 2% in the accident group and 33% in the definite abuse group. Associated cutaneous injuries consistent with inflicted injury were seen in 16% of the accident group and 50% of the definite abuse group. Twenty-three percent of those in the accident group were injured in motor vehicle crashes (MVCs), 58% by falls, 2% in play activities, and the rest had insufficient medical record information. In 56% of those in the definite abuse group, there was no history to account for the injuries and no history of MVC. In 17%, a fall was said to have been the mechanism of injury. In 24%, inflicted injury was admitted. Mortality rates were 13% in the definite abuse group and 2% in the accident group. Median hospital stay was 9.5 days for the definite abuse group and 3 days for the accident group. In falls less than 4 feet in the accident group, 8% had SDH, 2% had SAH, and none had retinal hemorrhages; among those in the definite abuse group reportedly falling less than 4 feet, 38% had SDH, 38% had SAH, and 25% had retinal hemorrhages. CONCLUSIONS: A substantial percentage of head injuries requiring hospitalization in children younger than 6.5 years are attributable to inflicted injury. Subdural hematoma, subarachnoid hemorrhage, retinal hemorrhages, and associated cutaneous, skeletal, and visceral injuries are significantly more common in inflicted head injury than in accidental injury.     

Psychological Testing on Schoolchildren Before and After Pollution of Drinking Water in North Cornwall

Abstract— The tap water supply in Camel ford, North Cornwall and environs was contaminated by aluminum and other metals in 1988. Richmond tests were routinely given before and after the pollution and here scores are compared between 39 children from schools in the contaminated area and 64 children from Cornish schools outside the polluted area.
The study was retrospective and it was not possible to determine whether or how much polluted water individuals had consumed No differences were found between groups either before or after the pollution accident nor was there any evidence for any sub-group of the polluted group which had been affected
The limits of conclusions which can be drawn from data available are discussed.     

Diabetes unmasked by electric shock

Following an accidental electric shock, a boy with no previous symptoms developed hyperglycaemia, rapidly evolving into diabetes. He was aglycosuric for 24 hours after the shock. Islet cell antibodies were shown shortly after the accident. Although destined to develop diabetes, it seems likely that the electric shock unmasked impaired glucose tolerance. Glucose homoeostasis should be monitored in children following significant electric shocks.     

Child restraint law effects on motor vehicle accident fatalities and injuries: the New Mexico experience

The New Mexico State Legislature passed a child restraint law applicable to children less than 5 years of age that became effective in June 1983. To evaluate the effectiveness of this law, we analyzed traffic accident data for New Mexico from January 1981 through September 1984. During this period, there were 20,972 children younger than 5 years of age in motor vehicle accidents. Restraint usage increased for this age group from a low of about 10% in 1981 to more than 40% in 1984 (P less than 10(-6)). Unrestrained children younger than 5 years of age were five times more likely to be killed and two times more likely to be injured than restrained children. Analysis of motor vehicle accident fatality and injury rates pre- and post-law revealed a 33% reduction in motor vehicle accident fatality rates and a 12.6% reduction in nonfatal injury rates for children younger than 5 years. We conclude that child restraint devices are effective in reducing motor vehicle accident fatalities and injuries in young children and the child restraint law has been effective in increasing child restraint usage and in reducing childhood death and injury in New Mexico.     

Infant temperament, childhood accidents, and hospitalization

The role of infant temperament in predicting the incidence of hospitalization and accidents of children under the age of 5 was studied in a prospective follow-up study. Temperament type and profile was originally measured for 1,855 infants (6 to 8 months of age). We obtained data for 270 who had later been hospitalized because of accidents or illnesses. Of these, the temperament of 35 who had suffered a contusion, poisoning, burns, or other accidents were more closely analyzed. The results show that a disproportionate number of all hospitalized children had earlier been characterized as "difficult" in their temperament. This was typical, however, for both the accident group and other hospitalized children. The hospitalized children had a significantly more negative mood and higher intensity of responses to normal everyday life situations. The accident group differed from other hospitalized children in being mainly more persistent but also showed a tendency to higher activity level and negative reactions to new situations. The results do not support a straightforward hypothesis of an early accident prone temperament but point out the significance of temperament in the processes of hospitalization and accidents.     

Thyroid consequences of the Chernobyl nuclear accident

It is well recognized that the use of external irradiation of the head and neck to treat patients with various non-thyroid disorders increases their risk of developing papillary thyroid carcinoma years after radiation exposure. An increased risk of thyroid cancer has also been reported in survivors of the atomic bombs in Japan, as well as in Marshall Island residents exposed to radiation during the testing of hydrogen bombs. More recently, exposure to radioactive fallout as a result of the Chernobyl nuclear reactor accident has clearly caused an enormous increase in the incidence of childhood thyroid carcinoma in Belarus, Ukraine, and, to a lesser extent, in the Russian Federation, starting in 1990. When clinical and epidemiological features of thyroid carcinomas diagnosed in Belarus after the Chernobyl accident are compared with those of naturally occurring thyroid carcinomas in patients of the same age group in Italy and France, it becomes apparent that the post-Chernobyl thyroid carcinomas were much less influenced by gender, virtually always papillary (solid and follicular variants), more aggressive at presentation and more frequently associated with thyroid autoimmunity. Gene mutations involving the RET proto-oncogene, and less frequently TRK, have been shown to be causative events specific for papillary cancer. RET activation was found in nearly 70% of the patients who developed papillary thyroid carcinomas following the Chernobyl accident. In addition to thyroid cancer, radiation-induced thyroid diseases include benign thyroid nodules, hypothyroidism and autoimmune thyroiditis, with or without thyroid insufficiency, as observed in populations after environmental exposure to radioisotopes of iodine and in the survivors of atomic bomb explosions. On this basis, the authors evaluated thyroid autoimmune phenomena in normal children exposed to radiation after the Chernobyl accident. The results demonstrated an increased prevalence of circulating thyroid antibodies not associated with significant thyroid dysfunction. This finding is consistent with the short period of follow-up, but it is highly likely that these children will develop clinical thyroid autoimmune diseases in the future. Therefore, screening programmes for this at-risk population should focus, not only on the detection of thyroid nodules and cancer, but also on the development of thyroid autoimmune diseases.     

Health effects of the Chernobyl disaster. Fifteen years afterwards

The Chernobyl nuclear accident of 1986 released large quantities of radioactive material causing heavy contamination in widespread areas of the former Soviet Union. Each summer, several hundred children visit Spain from Chernobyl. In this article we describe the accident, the environmental contamination, the mechanisms of radiation injury and the dose-response relationships. We review the health effects of exposure to ionizing radiation and the health impact of the Chernobyl catastrophe. We propose guidelines for the medical management and evaluation of children on temporary visits. The health status of adults and especially that of children in Belarus, Ukraine and the Russian Federation has been adversely affected. According to present knowledge, Chernobyl has given rise to a marked increase in the incidence of papillary thyroid cancer, psychological consequences and socioeconomic disruption. Many studies report that the incidence of other diseases has increased, but not all health problems seen after the nuclear accident can be attributed to radiation. Given the long latency period for diseases induced by radiation exposure, long-term follow-up of all potentially affected individuals is important. Fifteen years after the Chernobyl accident the international community is still learning scientific, medical and humanitarian lessons.     

Post-traumatic stress disorder in pre-school aged children after a gas explosion

To evaluate the sensitivity of diagnostic criteria for post-traumatic stress disorder (PTSD) in pre-school aged children involved in a gas explosion, post-traumatic symptoms of the children were investigated four times after the accident, immediately, 10 days, 6 months, and 1 year later. Using symptoms at 6 months after the accident, sensitivity of diagnostic criteria was assessed by comparing the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and the alternative criteria for infants and young children [10]. In addition, the published Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) and its modified version proposed by us were also evaluated their sensitivity to rate the symptoms. Girls had a tendency to show more post-traumatic symptoms than boys. Although no children met DMS-IV criteria for PTSD, 8 children out of 32 were diagnosed as having PTSD with alternative criteria. With our modified CPTSD-RI, all eight children were decidedly more statistically distinguishable from those without PTSD than with original index. CONCLUSION: our data indicate that the sensitivity of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th edition) and the Child Post-Traumatic Stress Disorder Reaction Index in rating symptoms of pre-school aged children is not sufficient. The alternative criteria of the former and modified version of the latter would be the better choice in this age group.