Victor S. Koscheyev

The Psychosocial Aftermath of the Chernobyl Disaster in an Area of Relatively Low Contamination

INTRODUCTIONnThere has been relatively little attention paid to the mid- and long-term effects of large-scale disasters, particularly their effects on children and young people. At the present time, the impact of the Chernobyl catastrophe on the daily lives of the affected population may include one of strong psychological stress due to uncertainty about ultimate health outcomes. Persons in the Chernobyl region in specific areas of low contamination may be affected similarly. This investigation assesses radiation concerns and attitudes about health and government information, nine years after the disaster, in a group of adults and adolescents residing in a relatively uncontaminated village in the Chernobyl area.nnnMETHODSnQuestionnaires were administered to 94 adults and 50 adolescents. Items assessed beliefs about extent of radiation exposure, health concerns regarding oneself and family members, past and current preoccupation about the disaster, and trust in the accuracy of government information about health effects.nnnRESULTSnConsiderable uncertainty was demonstrated in both adults and adolescents about the extent of their and their families exposure to radiation. Marked distrust of past and current government information about health effects was evident. A large proportion of subjects reported that they still thought frequently about the Chernobyl accident. They worried about health problems related to radiation exposure whenever they or their family members exhibited physical symptoms or complaints, and they urged family members to go to a medical clinic for evaluation to assess these symptoms.nnnCONCLUSIONSnThe extent of long-term concerns about the personal and family health effects of the Chernobyl disaster in this population residing in a relatively uncontaminated village is striking: the psychological impact on adolescents is considerable. The stress generated is maintained by the realistic uncertainty about the ultimate health consequences to the overall population as a result of radiation exposure and distrust in government information about contamination levels in this particular village. The level of stress and its effects on physical and mental health may increase over time if there is a rise in morbidity in the area. The continuing health needs of the extremely large population affected by the Chernobyl disaster need to be addressed.

Visual analog scales for assessment of thermal perception in different environments.

INTRODUCTIONnSubjective thermal perception in stable and dynamic environments has been measured primarily by categorical rating scales. At present, there is an increasing use of visual analog scales (VAS) to assess whole body and body region thermal perceptions in laboratory and other thermal environments.nnnDISCUSSIONnThe rationale behind the use of VAS is that individuals are more accurate in conveying their subjective experience if they are not forced to make ratings according to numbers or categories. Unipolar scales have the advantage of focusing on a single subjective perception, such as the amount of cold the subject experiences. With bipolar scales (e.g., cold to hot), the sensitivity in measuring the extent of a specific thermal experience may be diminished because the subject needs to make a discontinuous change from one thermal perception to another.nnnCONCLUSIONSnThe robust psychometric properties of VAS indicate their usefulness in measuring thermal experience. Unipolar VAS with a large equal interval scoring range will enable the investigator to measure small gradients of change in perceptual experience. However, the subjective perception of thermal status is not highly accurate at thermal extremes, and caution is needed in sole reliance on subjective report in these conditions.

Augmentation of blood circulation to the fingers by warming distant body areas.

Abstract Future activities in space will require greater periods of time in extreme environments in which the body periphery will be vulnerable to chilling. Maintaining the hands and fingers in comfortable conditions enhances finger flexibility and dexterity, and thus effects better work performance. We have evaluated the efficacy of promoting heat transfer and release by the extremities by increasing the blood flow to the periphery from more distant parts of the body. The experimental garment paradigm developed by the investigators was used to manipulate the temperature of different body areas. Six subjects, two females and four males, were evaluated in a stage-1 baseline condition, with the inlet temperature of the circulating water in the liquid cooling/warming garment (LCWG) at 33u2009°C. At stage 2 the total LCWG water inlet temperature was cooled to 8u2009°C, and at stage 3 the inlet water temperature in specific segments of the LCWG was warmed (according to protocol) to 45u2009°C, while the inlet temperature in the rest of the LCWG was maintained at 8u2009°C. The following four body- area-warming conditions were studied in separate sessions: (1) head, (2) upper torso/arm, (3) upper torso/arm/head, and (4) legs/feet. Skin temperature, heat flux and blood perfusion of the fingers, and subjective perception of thermal sensations and overall physical comfort were assessed. Finger temperature (Tfing) analyses showed a statistically significant conditionu2009×u2009stage interaction. Post-hoc comparisons (Tfing) indicated that at stage 3, the upper torso/arm/head warming condition was significantly different from the head, upper torso/arm and legs/feet conditions, showing an increase in Tfing. There was a significant increase in blood perfusion in the fingers at stage 3 in all conditions. Subjective perception of hand warmth, and overall physical comfort level significantly increased in the stage 3 upper torso/arm/head condition. The findings indicate that physiological methods to enhance heat transfer by the blood to the periphery within protective clothing provide an additional tool for increasing total and local human comfort in extreme environments.

Psychological status of chernobyl nuclear power plant operators after the nuclear disaster

Chief operators at the Chernobyl power plant were assessed at four time points after the nuclear disaster and compared to a comparable group of chief operators at another nuclear power station. MMPI findings demonstrated a significant increase over time in health concerns, depression, and other indicators of stress in those operators working at the station at the time of the assessment. There was also an increase in the proportion with at least one MMPI clinical scale in the abnormal range. The authors hypothesize that the continuing uncertainty of the safety of working at Chernobyl may have contributed to these findings by either increasing the stress levels of those who remained at this power station, or through attracting workers who were less well adjusted before volunteering to work there.

Comparison of different cooling regimes within a shortened liquid cooling/warming garment on physiological and psychological comfort during exercise.

The aim of this study was to compare the effectiveness of different cooling regime intensities to maintain physiological and subjective comfort during physical exertion levels comparable to that engaged in during extravehicular activities (EVA) in space. We studied eight subjects (six males, two females) donned in our newly developed physiologically based shortened liquid cooling/warming garment (SLCWG). Rigorous (condition 1) and mild (condition 2) water temperature cooling regimes were compared at physical exertion levels comparable to that performed during EVA to ascertain the effectiveness of a lesser intensity of cooling in maintaining thermal comfort, thus reducing energy consumption in the portable life support system. Exercise intensity was varied across stages of the session. Finger temperature, rectal temperature, and subjective perception of overall body and hand comfort were assessed. Finger temperature was significantly higher in the rigorous cooling condition and showed a consistent increase across exercise stages, likely due to the restriction of heat extraction because of the intensive cold. In the mild cooling condition, finger temperature exhibited an overall decline with cooling, indicating greater heat extraction from the body. Rectal temperature was not significantly different between conditions, and showed a steady increase over exercise stages in both rigorous and mild cooling conditions. Ratings of overall comfort were 30% higher (more positive) and more stable in mild cooling (p<0.001). The mild cooling regime was more effective than rigorous cooling in allowing the process of heat exchange to occur, thus maintaining thermal homeostasis and subjective comfort during physical exertion.

Lessons learned and unsolved public health problems after large-scale disasters.

BACKGROUNDnThis paper examines the considerable medical and psychological problems that ensue after disasters in which massive populations are affected for extended and sometimes unknown time periods. The organization of disaster response teams after large-scale disasters is based on experiences as a medical specialist at Chernobyl immediately after this catastrophe. Optimal ways of dealing with the immediate medical and logistical demands as well as long-term public health problems are explored with a particular focus on radiation disasters. Other lessons learned from Chernobyl are explained.nnnISSUESnCurrent concerns involve the constant threat of a disaster posed by aging nuclear facilities and nuclear and chemical disarmament activities. The strategies that have been used by various groups in responding to a disaster and dealing with medical and psychological health effects at different disaster stages are evaluated. The emergence of specialized centers in the former Soviet Union to study long-term health effects after radiation accidents are described. Worldwide, there has been relatively little attention paid to mid- and long-term health effects, particularly the psychological stress effects. Problems in conducting longitudinal health research are explored.nnnRECOMMENDATIONSnThe use of a mobile diagnostic and continuously operating pre-hospital triage system for rapid health screening of large populations at different stages after a large-scale disaster is advisable. The functional systems of the body to be observed at different stages after a radiation disaster are specified. There is a particularly strong need for continued medical and psychosocial evaluation of radiation-exposed populations over an extended time and a need for international collaboration among investigators.

Trade Study of an Exploration Cooling Garment

A trade study was conducted with a goal to develop relatively high TRL design concepts for an Exploration Cooling Garment (ExCG) that can accommodate larger metabolic loads and maintain physiological limits of the crewmembers health and work efficiency during all phases of exploration missions without hindering mobility. Effective personal cooling through use of an ExCG is critical in achieving safe and efficient missions. Crew thermoregulation not only impacts comfort during suited operations but also directly affects human performance. Since the ExCG is intimately worn and interfaces with comfort items, it is also critical to overall crewmember physical comfort. Both thermal and physical comfort are essential for the long term, continuous wear expected of the ExCG. The subsystems and design considerations that were studied include the amount and placement of cooling, the ventilation system, the carrier structure in terms of the number and configuration of garment components, garment materials, the cooling line configuration, ancillary equipment, water connectors, and a bio-medical harness. The guiding principle of the ExCG system is the physiological design of cooling. Based on this study, it is recommended that the ExCG be configured as a one piece garment with physiologically placed cooling lines on the head, back, top of the shoulders, ribs, lower arms, inner thighs, and calves. Placement of tubing in these physiological zones was based on the results of a cooling analysis and crew survey. An optimal cooling line configuration was selected through analytical and experimental investigation of different materials, tube geometries, and tube routing. An assessment of the ventilation system, beginning with a historical perspective and considering a wide range of options including a vent system on the pressure garment, concluded that a vent system should be integral with the ExCG. Materials were selected based on the mapping of material functionality of different physiological zones. This paper will discuss the recommended ExCG system concept and its expected ability to meet goals and requirements described in the Crew, Robotics, and Vehicle Equipment (CRAVE) delivery order (DO 25) for the ExCG. This concept will maintain crew thermal balance and physical comfort while simplifying ExCG operations and logistics.

Comparison of Shortened and Standard Liquid Cooling Garments to Provide Physiological and Subjective Comfort During EVA

The shortened liquid cooling/warming garment (SLCWG) developed by the University of Minnesota group was compared with the standard NASA liquid cooling/ventilating garment (LCVG) garment during physical exertion in comfort (24°C) and hot (35°C) chamber environments. In both environmental conditions, the SLCWG was just as effective as the LCVG in maintaining rectal temperature (Tre) in a thermal comfort range; sweat production on the face was less; and subjective perception of overall and local body comfort was higher. The findings indicate that the SLCWG produces the same or greater comfort level as that achieved with the LCVGs total coverage of the body surface.

Cooling and Thermal Control Strategies in the Space Suit for Routine and Emergency Situations

A series of demonstration studies were conducted with the aim of better understanding how to regulate body heat and thus enhance thermal comfort of astronauts during EVA requiring intensive physical exertion. The first study evaluated body zone heat transfer under different cooling temperatures in a liquid cooling garment (LCG), confirming the effectiveness of areas with high density tissue. The second study evaluated different configurations of hoods and neck scarves to maximize heat extraction from these key areas for heat release. The third study explored the possibility of regulating body heat by control of the water temperature circulating through selected body zones in the LCG, or blocking heat dissipation from particular body areas. The potential of heat insertion/removal from the head, hands, and feet to stabilize body comfort was evaluated in terms of the ability to advance this heat current “highway” from the core. These strategies for achieving heat regulation show potential for further more comprehensive study.

Informative Value of Temperatures in Different Areas of the Human Body for Correcting Body Thermal Imbalance during Extravehicular Activities

Identification of noninvasive and informative sites on the body reflecting the development of body thermal imbalance during extravehicular activities (EVAs) is highly important for enhancing astronaut safety. Temperature changes were evaluated on several areas of the head (the mastoid fossa (Tmf), the forehead (Tfo), and the cheek (Tch)) and on the fingers (Tfing). Subjects were dressed in a multicompartment liquid cooling/warming garment. Studies I and II consisted of different combinations of hood versus garment cooling or warming imposed across stages; studies III and IV involved sagittally divided cooling or warming regimes with the hood worn (study III) or with the head uncovered (study IV). In studies I and II, Tmf significantly (P < 0.05) differed between stages 2, when the head was cooled and the rest of the body heated, and 3, when the head was heated and the rest of the body cooled. The Tmf changes were consistent with the thermal conditions imposed on the head but not reflective of the developing body heat deficit. In study III, the Tmf at stages 2 and 3 on the right or the left followed the thermal conditions on the ipsilateral side of the body (P < 0.01). In study IV, Tfing showed no significant differences across stages. In studies I–IV, Tfing showed consistent changes across stages (P < 0.05), reflecting the developing body heat deficit. In all studies, there were no significant differences in rectal temperature (Tre) across stages. Tmf and temperatures at other head skin sites did not respond in accordance with the actual intensity of a heat or cold flux from the garment and were not reflective of the overall development of body thermal imbalance. Tfing was a more adequate indicator of initial thermal destabilization and provided information that would be useful for monitoring the thermal balance and comfort during EVAs.