THE EXPERTISE OF THE CAUSAL RELATIONSHIP BETWEEN THE DEVELOPMENT OF ARTERIAL HYPERTENSION WITH PARTICIPATION IN WORKS FOR LIQUIDATION OF THE CONSEQUENCES OF CHORNOBYL NPP ACCIDENT IN REMOTE POSTACCIDENTAL PERIOD. / EKSPERTYZA PRYChYNNOGO ZV'IaZKU ROZVYTKU ARTERIAL'NOÏ GIPERTENZIÏ Z UChASTIu V ROBOTAKh PO LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChORNOBYL'S'KII AES U VIDDALENOMU PISLIaAVARIINOMU PERIODI.

Loss of health and work ability, as well as deaths from diseases of the circulatory system (DCS), first of all arterialhypertension (AH), due to radiation exposure (RE) in the conditions of Chernobyl catastrophe (ChC) in the performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposurenot through their own fault but due to a radiation accident, caused the development of a special form of medicalexpertise as part of the of medical social protection system for these suffered contingents. OBJECTIVE: to optimize decision-making criteria for the expert estimation of the casual relationship between development and progression of AH under the influence of RE in clean-up workers of the Chornobyl NPP accident (CWs)in the remote postaccidental period based on the study of odds ratio (OR) of the course of the disease. MATERIAL AND METHODS: A retrospective analysis of the structure of 16073 cases of victims of the Chornobyl NPP(ChNPP) accident, considered by the Central Interagency Expert Commission of Ministry of Health of Ukraine for diseases, reason of disability and death causal relationship to ChNPP accident (CIEC) during 2014-2016, allowed toform a group of 401 cases of CW with AH to determine the OR of the course of the disease. The main group consisted of 330 CWs for whom the development of AH has a causal relationship with the participation in the work for liquidation consequences of the Chornobyl NPP accident (WLAc), the comparison group - 71 CWs in respect of whoma negative expert decision was made. There were not significant differences between both groups of CWs in doseof external radiation exposure (DERE) in the main group - (0.155 ± 0.085) Sv, in CWs of the comparison group -(0.135 ± 0.086) Sv (р = 0.868). RESULTS: In the remote postaccidental period, HSC take the second place (39.62 %) in the structure of medicalexpertise of the causal relationship of the diseases development and progression with RE for all categories of victims of the Chernobyl accident. The share of cases of AH was 28.4% of the total number of cases considered CWs. Inthe structure of cases of relationship of diseases of CWs that led to death, the share of AH was 17.8 %. In CWs themain group the AH developed in (9.4 ± 6.2) years after participation in WLAc, which is on average 6 years earlierthan in the comparison group (р < 0.001). AH in the main group of CWs developed at the age of 5.8 years youngerthan in the comparison group (р = 0.0005). The need for inpatient treatment come 8.6 years earlier (14.6 ± 7.7years) than in CWs comparison group (р < 0.001). At DERE 0,05 Sv and over, increases the probability of developmentand progression of AH that has causal relationship with participation in the WLAc. For medical expertise of thecausal relationship of the AH development and progression with WLAc at DERE 0.20 Sv and over the significant evidence value have the next criteria: terms Somatoform Vegetative (autonomic) Dysfunction (SVD) development(within 3,5 years) and its transformation into AH (within 7 years), verification of the AH diagnosis (within 9,5 years),inpatient treatment for SVD or AH (within 15 years), vascular events (Acute Cerebrovascular Accident - Stroke(ACVA) - within 24 years after participation in the WLAc or 11 years after the AH diagnosed, myocardial infarction(MI) - within 22 years after participation in the WLAc or 10.5 years after the AH diagnosed), the establishment ofpermanent disability. CONCLUSION: Radiation factor has an evidence influence on the development and progression of AH in CWs. Criteria ofthe development and progression of AH in CWs can be used for evidence-based medical expertise for estimation of thecausal relationship of the disease with the WLAc in the remote post accidental period at DERE more than 0.20 Sv.

PROBLEMS OF MEDICAL EXPERTISE FOR DISEASES THAT BRING TO DISABILITY AND DEATH AS A RESULT OF RADIATION EXPOSURE INFLUENCE IN CONDITIONS OF THE CHERNOBYL CATASTROPHE IN REMOTE POSTACCIDENTAL PERIOD. / PROBLEMY MEDYChNOÏ EKSPERTYZY ZAKhVORIuVAN', ShchO PRYZVELY DO VTRATY PRATsEZDATNOSTI TA SMERTI VNASLIDOK VPLYVU IONIZUIuChOGO OPROMINENNIa V UMOVAKh ChORNOBYL'S'KOÏ KATASTROFY U VIDDALENOMU PISLIaAVARIINOMU PERIODI.

BACKGROUND: The Chornobyl catastrophe (ChCt) resulted in radiation exposure of great quantity of people. Amongthem there were personnel of Chernobyl NPP (ChNPP) and workers of supporting enterprises, radiation protectionprofessionals, clean-up workers of different specialties including military personnel that were send for liquidationof its consequences, inhabitants of the Prypyat city and Chernobyl 30km exclusive zone (including children) thatwere evacuated during first days after accident and population of radioactive contaminated territories. Loss ofhealth, disability and death as a result of radiation exposure influence in conditions of the ChCt under discharge ofprofessional, military or official duties and/or living on radiation contaminated territories not by his own fault callfor developing of special form of medical expertise as part of medical social protective system for this contingents.The objective of the study was to analyze the state of medical and social expertise for the interdependence of thediseases that bring to the disability and death with the impact of the Chornobyl accident consequences for the adultpopulation and to determine the main directions for improvement of this system. MATERIALS AND METHODS: The analysis of the medical expertise state for the interdependence of the diseases thatbring to the disability and death by the effect of the Chornobyl accident consequences for the adult population ina remote post-accidental period during 2013-2017 years (26142 personal medical expert investigations) was per-formed. RESULTS AND CONCLUSIONS: It was determined that the total number of population suffered from ChCt during 2007-2018 years reduced for 26.05 % or by 657,988 persons. At the same time, there has been rapid increase in the num-ber of victims with disability who received positive medical expertize certificate about interdependence of diseasewith effect of ChCt (the 1st category according Ukrainian legislation) - from 40,106 in 1995 to 107,115 in 2018. Theincrease in the frequency of medical expertise cases of oncological diseases - 51,49 %, as well as cases concerningthe interdependence of diseases that caused the deaths of the victims - 34,99 % were shown. The outstandingissues of the medical expertise of diseases interdependence with ChCt effects for certain categories of victims (thy-roid cancer in persons who have lost their status after reaching adulthood, the definition of the legitimacy of thestatus of victims for inhabitants of territories that undergone radiation ecological control (the 4th-V category) thatrequire changes and additions to the legislative framework are discussed.

Radiation protection and health of personnel of contracting enterprises participating in works for transformation of the object "shelter" of SSE Chornobyl NPP into an ecologically safe system.

UNLABELLED: Transformation of the object "Shelter" (OS) of SSE Chornobyl NPP into an ecologically safe system is one of the most important state programs in Ukraine. Both medical and dosimetric measures on healthcare of personnel participating in these works ranks the main place among most actual problems of contemporary clinical radiobiology, radiation hygiene, and radiation protection. The study objective was to work out and implement the medical and biophysical checking of the health status and workability both with radiation protection of personnel executing works on transformation of OS into an ecologically safe system. MATERIALS AND METHODS. The interdependent complex program of medical and biophysical (for internal and external irradiation) control of personnel executing the production tasks under conditions of ionizing radiation impact and open sources of ionizing radiation. Realization of medical examination envisages the estimation of the status of haemopoietic, immune, endocrine, respiratory systems, organ of vision, nervous system, psychics status and psychophysiological adaptation, ear, both with circulatory, digestive, urogenital, and bone-muscular system. There were 19434 cases of medical control of personnel in total. RESULTS: Results of the input medical control testify to the following: 4698 (48.90%) were admitted to work, 4909 (51.10%) were rejected. Individual annual effective doses of irradiation in the major part of cases did not exceed 12 mSv. There were 1845 cases of 239+240Pu content in excrements exceeding the level of 1.5 mBq/sample at a current biophysical control. Individual doses of internal irradiation at that did not exceed 1 mSv. CONCLUSIONS: The program of medical and biophysical service for reconstruction works on the OS proved its necessity and efficiency as its results showed that under the unique radiation-hygienical conditions not engineering challenges and technical problems but issues of how to save the health and workability of people and prevent the overdose of personnel including due to an internal irradiation are most critical.