The health status of some 6,000 workers from Latvia who went to clean-up the Chernobyl Nuclear Power Plant (CNPP) site following the explosion on 26 April 1986 has been analyzed. The data on these workers have been recorded in the Latvian State Register of Occupational disease patients and people exposed to ionizing radiation due to Chernobyl NPP accident (Latvian State Register) that was established in 1994. From these data, estimates have been made of external ionizing radiation to which these workers were exposed together with observations on the impact of exposure to heavy metals (especially lead and zinc) and radioactive isotopes released during the reactor 'meltdown'. These factors along with psycho-emotional and social-economic stresses account for a marked excess of mortality and morbidity in the group of CNPP accident clean-up workers compared with that of the non-exposed normal Latvian population adjusted for age and sex. The number of diseases or conditions in the CNPP accident clean-up workers has progressively risen from an average of 1.3 in 1986 to 10.9 in 2007. This exceeds for the Latvian population when adjusted for age and sex. The most serious conditions affect the nervous, digestive, respiratory, cardiovascular, endocrine (especially thyroid) and immunological systems. While the morbidity associated with diseases of the respiratory and digestive systems has decreased in recent years that in the other systems is increasing. In recent years, there has been an increased occurrence of cancers affecting the thyroid, prostate and stomach. Clinical and laboratory investigations suggest that surviving CNPP accident clean-up workers exhibit signs of immuno-inflammatory reactions causing premature aging with evidence of autoimmune diseases and immunological deficiencies or abnormalities. It is suggested that the CNPP accident clean-up workers may have a specific syndrome, the 'Chernobyl post-radiation neurosomatic polypathy', due to sustained oxidant stress injury, as a result of exposure to radiation and lead.

(RR= 1.82,) is also associated with this outcome, although nonsignificantly. Distinguishing stress-related from radiation-induced effects in this data set was difficult and these findings should provide a basis for later hypothesis testing in other cohorts. Environ Health Perspect 105(Suppl 6): 1539-1544 (1997)

Epidemiologic studies on the health effects of the Chernobyl disaster have focused largely on physical health, whereas the psychological consequences have received little attention. The authors have assessed the associations of various exposure variables with mental and psychosomatic distress in a sample of 1412 Latvian liquidators drawn from the State Latvian Chernobyl Clean-up Workers Registry. The outcome was a mixed mental-psychosomatic disorder occurring during 1986 to 1995. Comparisons among subgroups of the cohort classified according to exposure type or level were based on the proportional hazards model. Length of work (> or = 28 days) in a 10-km radius from the reactor (relative risk [RR] = 1.39, 95% confidence interval [CI] 1.14-1.70), work (> 1 time) on the damaged reactor roof (RR = 1.46, 95% CI 1.02-2.09), forest work (RR = 1.41, 95% CI 1.19-1.68), fresh fruit consumption (> or = 1 time/day) (RR = 1.72, 95% CI 1.12-2.65) are risk factors for mixed mental-psychosomatic disorder. Construction of the sarcophagus (RR = 1.82, 95% CI 0.89-3.72) is also associated with this outcome, although nonsignificantly. Distinguishing stress-related from radiation-induced effects in this data set was difficult and these findings should provide a basis for later hypothesis testing in other cohorts.

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The paper summarises the main findings on Chernobyl Nuclear Power Plant (CNPP) accident recovery workers from Latvia and their health disturbances, which have been studied by the authors during the last two decades. Approximately 6000 persons from Latvia participated in CNPP clean-up works in 1986–1991. During their work period in Chernobyl they were exposed to external as well as to internal irradiation, but since their return to Latvia they were living in a relatively uncontaminated area. Regular careful medical examinations and clinical studies of CNPP clean-up workers have been conducted during the 25 years after disaster, gathering knowledge on radiation late effects. The aim of the present review is to summarise the most important information about Latvian CNPP clean-up worker health revealed by thorough follow-up and research conducted in the period of 25 years after the accident. This paper reviews data of the Latvian State Register of Persons Exposed to Radiation due to CNPP Accident and gives insight in main health effects found by the researchers from the Centre of Occupational and Radiological Medicine (Pauls Stradiņš Clinical University Hospital) and Rīga Stradiņš University in a number of epidemiological, clinical, biochemical, immunological, and physiological studies. Latvian research data on health condition of CNPP clean-up workers in the late period after disaster indicate that ionising radiation might cause premature ageing and severe polymorbidity in humans.

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Investigation of occupational morbidity in wood processing industry in comparison with other manufacturing industries and with occupational morbidity in Latvia at large The aim of the study was to investigate occupational morbidity in the wood processing industry to gain understanding of the real situation of occupational health and to improve the diagnostics of occupational diseases. The occupational morbidity in Latvia has gradually increased from 1993 to 2004, with a slight decrease in 2005 and 2006 followed by an increase in 2007. In the year 2004, the number of first-time occupational diseases patients exceeded the number of occupational diseases patients registered in the year 1993 by 9.5, but the number of registered first-time incidences of occupational diseases in comparison with 1993 had increased by 14.5 times. In the manufacturing industry, wood and cork production, a trend of increasing rate of occupational diseases can also be observed in Latvia. A particularly rapid increase was observed in specific illnesses related to the musculoskeletal and connective tissue system, carpal tunnel syndrome as well as to occupational hearing loss, which might be explained by changes in the occupational risk factors. Despite an increase in the total number of occupational diseases in the industry of wood and cork products over the whole study period, these industries have lower levels of occupational diseases in comparison with occupational morbidity in such fields as health and social care, the extraction industry and quarry management, transportation and transport services, communications and telecommunications. In developed European Union countries, over the last few years, the number of occupational diseases has decreased, while there has been an increasing trend in Latvia. This can be explained by the fact that the working conditions in the European Union have been improving over the last few decades, and correspondingly the number of occupational diseases is decreasing. However, in Latvia, the diagnostics of the occupational diseases is rapidly improving, while improvement of working conditions has started relatively recently. Furthermore, the process has not been rapid, and therefore, results could be expected only in the future.

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