Nuclear power plant: state of knowledge of the population living in the area of the Cattenom special intervention plan. A cross-sectional study.

In France information campaigns are periodically conducted within a 10 km radius of nuclear power plants on the protective actions to be adopted in the event of a nuclear accident. The aim of this study was to assess the knowledge of the inhabitants of the Cattenom PPI area on the recommended actions to be adopted in the event of a nuclear accident after the information campaign that took place from 2016 to 2017 and compare its results with a similar study carried out before the information campaign. We performed a cross-sectional study in the Cattenom PPI area after the 2016-2017 information campaign. We administered questionnaires in ten municipalities selected by lot. These questionnaires contained queries on the general protective actions and required approach to taking potassium iodide (KI). The results obtained were compared with the results of a study conducted before the information campaign in the same area. Out of 200 questionnaires administered, 122 people responded. Only 40% of respondents remembered the information campaign. Only 16% knew all of the recommended protective actions. 78% of households had KI and only 60% knew the objective of KI intake. Compared to the results of the study before the information campaign, KI coverage was better (69% versus 78%, p = 0.02) and the dosage was better known (16% versus 28%, p = 0.0003). This study provides an overview of the effectiveness of information campaigns on the procedure in the event of a nuclear accident. This study highlights the insufficient knowledge of people living in the Cattenom PPI area.

Persistent organic pollutants, pesticides, and the risk of thyroid cancer: systematic review and meta-analysis.

Previous epidemiological studies have reported persistent organic pollutants (POPs) and some nonpersistent pesticides and the risk of thyroid cancer. The aim of this study was to assess the association between exposure to POPs, pesticides, and thyroid cancer by carrying out a meta-analysis. Literature searches were performed using PubMed, Embase, and reference lists of relevant articles. Summary risk estimates for thyroid cancer were calculated using fixed-effects and random-effects models. In addition, several subgroup and sensitivity analyses were carried out. Fifteen studies were reviewed, and eight studies were included in the meta-analysis. Pesticide exposure showed positive, statistically significant associations with thyroid cancer [odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15-1.91, I=48%, Pheterogenetiy=0.05]. After subgroup analysis, herbicide exposure (OR=3.00, 95% CI=1.38-6.54) and agricultural exposure to pesticides (OR=1.86, 95% CI=1.04-3.32) was associated with an increased risk of thyroid cancer. A sensitivity analysis showed that the results were robust. Exposure to pesticides was associated with an increased risk of thyroid cancer in this meta-analysis. Future studies should investigate exposure to POPs or pesticides with controls for potential confounders using biological samples.

Effect of Thyroid-Related Symptoms on Long-Term Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Population-Based Study in Sweden.

BACKGROUND: Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence, and life-long follow-up as well as medication with levothyroxine may be necessary. The aim of this study was to clarify how thyroid-related symptoms affect health-related quality of life (HRQoL) 14-17 years after diagnosis in Swedish DTC patients. METHODS: From the all-encompassing population-based Swedish Cancer Registry, 353 patients diagnosed with DTC during 1995-1998 were identified and invited to answer a study-specific questionnaire and the HRQoL questionnaire SF-36 14-17 years after their diagnosis. Subgroups were studied according to thyroid-related symptoms, both symptoms correlated to thyroid disease or levothyroxine treatment and side effects from surgery and radioiodine treatment. RESULTS: Of the patients with DTC, 279 (79%) answered the questionnaires. In all, only 19 (7%) reported a recurrence. Patients with one single symptom (e.g., fatigue, sleeping disorders, irritability, lower stress resistance, muscle weakness, bodily restlessness, sweating, palpitations, or flushes) had significantly lower HRQoL measured with the SF-36 compared to those without that specific symptom (p < 0.001). Furthermore, those 238 patients with at least one symptom, regardless of which one, had significantly lower HRQoL in all eight SF-36 domains compared to patients that no thyroid symptom (n = 34; p < 0.001). In seven patients, the questionnaires were not complete in terms of the thyroid-related questions. The association between thyroid symptoms and lower HRQoL remained after adjusting for age, sex, comorbidities, education, and menopause. CONCLUSIONS: DTC patients reporting thyroid symptoms scored lower in HRQoL compared to those with no symptoms >14 years after diagnosis.

First Successful Pre-Distribution of Stable Iodine Tablets Under Japan's New Policy After the Fukushima Daiichi Nuclear Accident.

Stable iodine tablets are effective in reducing internal exposure to radioactive iodine, which poses a risk for thyroid cancer and other conditions. After the Fukushima Daiichi nuclear power plant accident, the Japanese government shifted its policy on stable iodine tablet distribution from "after-the-fact" to "before-the-fact" and instructed local governments to pre-distribute stable iodine tablets to residents living within a 5-km radius of nuclear facilities. The nation's first pre-distribution of stable iodine tablets was carried out in June and July of 2014 in Kagoshima Prefecture. Health surveys were conducted so that the medication would not be handed out to people with the possibility of side effects. Of the 4715 inhabitants in the area, 132 were found to require a physician's judgment, mostly to exclude risks of side effects. This was considered important to prevent the misuse of the tablets in the event of a disaster. The importance of collective and individualized risk communication between physicians and inhabitants at the community health level was apparent through this study. Involvement of physicians through the regional Sendai City Medical Association was an important component of the pre-distribution. Physicians of the Sendai City Medical Association were successfully educated by using the Guidebook on Distributing and Administering Stable Iodine Tablets prepared by the Japan Medical Association and Japan Medical Association Research Institute with the collaboration of the National Institute of Radiological Sciences and the Japanese government. Thus, the physicians managed to make decisions on the dispensing of stable iodine tablets according to the health conditions of the inhabitants. All physicians nationwide should be provided continuing medical education on stable iodine tablets. (Disaster Med Public Health Preparedness. 2017;11:365-369).

The First Meeting of the WHO Guideline Development Group for the Revision of the WHO 1999 Guidelines for Iodine Thyroid Blocking.

The meeting held in May 2014 in Würzburg, Germany, discussed the scope of the revision of the 1999 WHO guidelines for iodine thyroid blocking (ITB) by following the WHO handbook for guideline development. This article describes the process and methods of developing the revised, evidence-based WHO guidelines for ITB following nuclear and radiological accidents, the results of the kick-off meeting as well as further steps taken to complete the revision.

Familial adenomatous polyposis in pediatrics: natural history, emerging surveillance and management protocols, chemopreventive strategies, and areas of ongoing debate.

Familial adenomatous polyposis (FAP) is a hereditary condition with a near 100 % lifetime risk of colorectal cancer without prophylactic colectomy. Most patients with FAP have a mutation in the adenomatous polyposis coli gene on chromosome 5q22. This condition frequently presents in children with polyps developing most frequently in the second decade of life and surveillance colonoscopy is required starting at age ten. Polyps are found not only in the colon, but in the stomach and duodenum. Knowledge of the natural history of FAP is important as there are several extra-colonic sequelae which also require surveillance. In infants and toddlers, there is an increased risk of hepatoblastoma, while in teenagers and adults duodenal carcinomas, desmoid tumors, thyroid cancer and medulloblastoma are more common in FAP than in the general population. Current chemopreventive strategies include several medications and natural products, although to this point there is no consensus on the most efficacious and safe agent. Genetic counseling is an important part of the diagnostic process for FAP. Appropriate use and interpretation of genetic testing is best accomplished with genetic counselor involvement as many families also have concerns regarding future insurability or discrimination when faced with genetic testing.

Nuclear power plant emergency preparedness: results from an evaluation of Michigan's potassium iodide distribution program.

BACKGROUND: In 2009, the Michigan Department of Community Health (MDCH) made potassium iodide (KI), a nonprescription radio-protective drug, available by mailing vouchers redeemable at local pharmacies for KI tablets, at no cost to residents living within 10 miles of Michigan's 3 nuclear power plants (NPPs). MDCH conducted an evaluation of this program to determine Michigan's KI coverage and to assess general emergency preparedness among residents living near the NPPs. METHODS: KI coverage was estimated based on redeemed voucher counts and the 2010 Census. Telephone surveys were administered to a random sample (N = 153) of residents living near Michigan's NPPs to evaluate general emergency preparedness, reasons for voucher use or nonuse, and KI knowledge. RESULTS: Only 5.3% of eligible residences redeemed KI vouchers. Most surveyed residents (76.5%) were aware of living near an NPP, yet 42.5% reported doing "nothing" to plan for an emergency. Almost half of surveyed voucher users did not know when to take KI or which body part KI protects. Among voucher nonusers, 48.0% were either unaware of the program or did not remember receiving a voucher. CONCLUSIONS: Additional efforts are needed to ensure that all residents are aware of the availability of KI and that recipients of the drug understand when and why it should be taken. Minimal emergency planning among residents living near Michigan's NPPs emphasizes the need for increased emergency preparedness and awareness. Findings are particularly salient given the March 2011 Fukushima Daiichi Nuclear Power Plant emergency in Japan.

Advances in cervical cancer control and future perspectives.

The knowledge that the persistent infection with high-risk (HR) human papillomavirus (HPV) is the etiological factor in the development of cervical cancer has led to the development of the HPV DNA detection methods as well as the prophylactic vaccine against the most common HR-HPV types, HPV 16 and 18. Despite HPV vaccination, cervical cancer screening will remain the main preventive measure for both vaccinated and non-vaccinated women, but the nature of screening and management of women with cervical disease is being adapted to the new technologies. Although, HPV DNA detection is more sensitive that cytology, its specificity is lower, since most HPV infections are transient. Therefore, other methods are considered to improve the management of women with cervical disease. Typing of HPV DNA and viral load measurements are still used for research purposes only. Detection of viral oncogene E6/E7 transcripts, which is the marker of the productive infection, is a promising tool for follow-up of HPV DNA-positive women. The detection of p16INK4a over-expression, as an indirect test of E6/E7 expression, is used for confirmation of cervical neoplasia. Despite the lack of standardization, the detection of p16INK4a is useful in clinical settings, however its reproducibility in the management of low-grade and borderline cases is low. Future perspectives include the determination of the methylation status of several cellular genes that could predict the progression of the disease.

Assessment of potassium iodide (KI) distribution program among communities within the emergency planning zones (EPZ) of two nuclear power plants.

The primary objective of this study was to evaluate a joint state and local government-sponsored potassium iodide (KI) distribution program in New Jersey. This program is part of a radiological emergency response system for residents living within the Emergency Planning Zones (EPZs) of nuclear power facilities. KI pills and an informational fact sheet were distributed locally at six different public clinics in the summer of 2002. In this study, a mailed survey was developed, pilot tested, and sent to the general public to assess knowledge about KI use. The survey consisted of two groups of people, those who attended a KI distribution clinic and those that did not attend a clinic. There was a statistically significant difference in knowledge among the two groups of survey respondents regarding KI prophylaxis, with a mean of 46% of survey questions answered correctly by those who attended a clinic vs. 15% by those who did not attend. Certain questions were problematic for the public to answer correctly and included potential low compliance with government instructions for taking KI, confusion regarding where the public can obtain KI pills during an emergency, and the lack of awareness on the proper use of KI for children, pregnant women, and persons over the age of 40 y. Additional outreach in these specific areas is warranted. This study also found that there was a highly variable geographic pattern of homes that have a supply of KI pills, with some areas having 60% of the households supplied with pills from the clinic while other areas had as low as 1% of the homes supplied with KI pills.

Current national health insurance policies for thyroid cancer prophylactic surgery in the United States.

The efficacy of prophylactic thyroidectomy in patients with positive RET mutational analysis, familial thyroid cancer, or both has been reported. As cost has become critical to medical decision-making, this study was designed to evaluate currently existing coverage policies for prophylactic thyroidectomy. A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members, and 35% (n = 53) had fewer than 100,000 enrolled members. Only 9% of private plans have specific policies for coverage of prophylactic thyroidectomy for patients with a strong family history of thyroid cancer, 19% provided no coverage, and 72% had no policy. Only 9% of private plans have specific policies for patients with a known thyroid cancer genetic mutation, 12% provided no coverage, and 79% had no policy. Governmental carriers were less likely to provide coverage for prophylactic surgery: 4% for a strong family history and 6% for a genetic mutation. Altogether, 52% of government carriers provided no coverage for patients with a strong family history, and 50% provided no coverage in patients with a known genetic mutation; 44% of governmental carriers had no policy for either clinical scenario. Limited health insurance coverage for prophylactic thyroidectomy is offered in both private and governmental plans, with variations in coverage. As genetic testing becomes more widespread and with the potential identification of a gene predisposing to familial nonmedullary thyroid cancer, more uniform policies should be established to enable appropriate high risk candidates broader, equal coverage and access to these procedures.

[Economic analysis of diagnostic and therapeutic methods in cases of cold thyroid nodules]. / Analyse économique des approaches diagnostiques et thérapeutiques du nodule froid de la thyroïde.

This article studies how two diagnostic tests (cytological puncture and 201thallium scanning) can be combined to obtain a more efficient approach of cold thyroid nodules. Diagnostic and therapeutic approaches are compared on the basis of four criteria: financial cost (immediate and delayed), number of labelled cancers, pre- and postoperative death rates and number of complications.

Managing thyroid abnormalities in adults exposed to upper body irradiation in childhood: a decision analysis. Should patients without palpable nodules be scanned and those with scan defects be subjected to subtotal thyroidectomy?

This decision analysis compares two currently recommended management strategies for adults at increased risk for thyroid carcinoma due to childhood upper body irradiation who present without palpable thyroid nodularity: 1) scan-surgery: initially thyroid scan every patient, then perform subtotal thyroidectomy for each patient with single or multiple scan defects; and 2) no scan reexamine: do not scan initially, but reexamine at least every 2 yr, reserving surgery for those in whom palpable nodularity later develops. When surgical morbidity and mortality are taken into account, the expected utility of the no scan reexamine strategy slightly outweighs that of scan-surgery; this preference is maintained in several sensitivity analyses, unless more than 80% of occult cancers progress to palpable size. Moreover, the financial costs of universal scanning coupled with surgery are considerably greater. The no scan-reexamine approach, therefore, deserves serious consideration as the preferred strategy. Since the expected utilities of the two strategies are nearly equal, however, patient attitudes toward risk should be given particular weight in choosing management.