ObjectiveTo systematically review and perform a meta-analysis of radiation associated risks of cardiovascular disease in all groups exposed to radiation with individual radiation dose estimates.DesignSystematic review and meta-analysis.Main outcome measuresExcess relative risk per unit dose (Gy), estimated by restricted maximum likelihood methods.Data sourcesPubMed and Medline, Embase, Scopus, Web of Science Core collection databases.Eligibility criteria for selecting studiesDatabases were searched on 6 October 2022, with no limits on date of publication or language. Animal studies and studies without an abstract were excluded.ResultsThe meta-analysis yielded 93 relevant studies. Relative risk per Gy increased for all cardiovascular disease (excess relative risk per Gy of 0.11 (95% confidence interval 0.08 to 0.14)) and for the four major subtypes of cardiovascular disease (ischaemic heart disease, other heart disease, cerebrovascular disease, all other cardiovascular disease). However, interstudy heterogeneity was noted (P<0.05 for all endpoints except for other heart disease), possibly resulting from interstudy variation in unmeasured confounders or effect modifiers, which is markedly reduced if attention is restricted to higher quality studies or those at moderate doses (<0.5 Gy) or low dose rates (<5 mGy/h). For ischaemic heart disease and all cardiovascular disease, risks were larger per unit dose for lower dose (inverse dose effect) and for fractionated exposures (inverse dose fractionation effect). Population based excess absolute risks are estimated for a number of national populations (Canada, England and Wales, France, Germany, Japan, USA) and range from 2.33% per Gy (95% confidence interval 1.69% to 2.98%) for England and Wales to 3.66% per Gy (2.65% to 4.68%) for Germany, largely reflecting the underlying rates of cardiovascular disease mortality in these populations. Estimated risk of mortality from cardiovascular disease are generally dominated by cerebrovascular disease (around 0.94-1.26% per Gy), with the next largest contribution from ischaemic heart disease (around 0.30-1.20% per Gy).ConclusionsResults provide evidence supporting a causal association between radiation exposure and cardiovascular disease at high dose, and to a lesser extent at low dose, with some indications of differences in risk between acute and chronic exposures, which require further investigation. The observed heterogeneity complicates a causal interpretation of these findings, although this heterogeneity is much reduced if only higher quality studies or those at moderate doses or low dose rates are considered. Studies are needed to assess in more detail modifications of radiation effect by lifestyle and medical risk factors.Systematic review registrationPROSPERO CRD42020202036
BackgroundWe examined the human toll and subsequent humanitarian crisis resulting from the Russian invasion of Ukraine, which began on 24 February 2022.MethodWe extracted and analysed data resulting from Russian military attacks on Ukrainians between 24 February and 4 August 2022. The data tracked direct deaths and injuries, damage to healthcare infrastructure and the impact on health, the destruction of residences, infrastructure, communication systems, and utility services – all of which disrupted the lives of Ukrainians.ResultsAs of 4 August 2022, 5552 civilians were killed outright and 8513 injured in Ukraine as a result of Russian attacks. Local officials estimate as many as 24 328 people were also killed in mass atrocities, with Mariupol being the largest (n=22 000) such example. Aside from wide swaths of homes, schools, roads, and bridges destroyed, hospitals and health facilities from 21 cities across Ukraine came under attack. The disruption to water, gas, electricity, and internet services also extended to affect supplies of medications and other supplies owing to destroyed facilities or production that ceased due to the war. The data also show that Ukraine saw an increase in cases of HIV/AIDS, tuberculosis, and Coronavirus (COVID-19).ConclusionsThe 2022 Russia-Ukraine War not only resulted in deaths and injuries but also impacted the lives and safety of Ukrainians through destruction of healthcare facilities and disrupted delivery of healthcare and supplies. The war is an ongoing humanitarian crisis given the continuing destruction of infrastructure and services that directly impact the well-being of human lives. The devastation, trauma and human cost of war will impact generations of Ukrainians to come.
Effects of radiation exposure from the Chernobyl nuclear accident remain a topic of interest. We investigated whether children born to parents employed as cleanup workers or exposed to occupational and environmental ionizing radiation post-accident were born with more germline de novo mutations (DNMs). Whole-genome sequencing of 130 children (born 1987-2002) and their parents did not reveal an increase in the rates, distributions, or types of DNMs versus previous studies. We find no elevation in total DNMs regardless of cumulative preconception gonadal paternal (mean = 365 mGy, range = 0-4,080 mGy) or maternal (mean = 19 mGy, range = 0-550 mGy) exposure to ionizing radiation and conclude over this exposure range, evidence is lacking for a substantial effect on germline DNMs in humans, suggesting minimal impact on health of subsequent generations.
The neural diathesis-stressor hypothesis of schizophrenia, where neurobiological genetic predisposition to schizophrenia can be provoked by environmental stressors is considered as a model of the effects of exposure to ionizing radiation. Analysis of information from electronic databases (MEDLINE, PsycINFO, EMBASE, Current Contents, Elsevier BIOBASE) and hand-made search was carried out. There are comparable reports on increases in schizophrenia spectrum disorders following exposure to ionizing radiation as a result of atomic bombing, nuclear weapons testing, the Chernobyl accident, environmental contamination by radioactive waste, radiotherapy, and also in areas with high natural radioactive background. The results of experimental radioneurobiological studies support the hypothesis of schizophrenia as a neurodegenerative disease. Exposure to ionizing radiation causes brain damage with limbic (cortical-limbic) system dysfunction and impairment of informative processes at the molecular level that can trigger schizophrenia in predisposed individuals or cause schizophrenia-like disorders. It is supposed that ionizing radiation can be proposed as a risk factor for schizophrenia spectrum disorders. The hypothesis that ionizing radiation is a risk factor for schizophrenia spectrum disorders can be tested using data from the Chernobyl accident aftermath. Implementation of a study on schizophrenia spectrum disorders in Chernobyl accident victims is of significance for both clinical medicine and neuroscience.
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