Understanding Risk Gradients from Environment on Native American Child Health Trajectories: Toxicants, Immunomodulation, Metabolic syndromes, & Metals Exposure

摘要 紧急美洲原住民回声队列将建立在积极的纳瓦霍出生队列研究(NBCS)的基础上， 将后续期限延长到目前的12个月协议之外，并增加了另外两个部落，即 夏延河和奥格拉拉苏族部落，以评估环境暴露对废弃环境的影响 地雷废物对出生结果和儿童发育的影响。这项研究是第一次大规模的 与部落合作，在部落人口中进行环境暴露和儿童健康 并将帮助建立部落内部的研究能力以及部落工作人员的能力 进行详细的发展评估。这项研究将跟踪被录取的儿童的发展，直到 5岁跟踪神经和身体发育相对于环境的轨迹或模式 暴露于部落土地上或附近废弃的硬岩和铀矿产生的金属混合物。确实有 在美国西部有161,000个这样的废弃矿井，其中4,000个废弃的铀矿通常是 没有围栏，没有标记，儿童可以进入。仅在纳瓦霍民族，就有500多个被遗弃的铀 自上一座煤矿关闭以来，矿山30多年来一直没有得到修复。拟议的研究将 解决ECHO计划确定的两个关键健康结果重点领域 产前和儿童早期接触对1)神经发育和2)肥胖的影响。基于该团队的 初步发现，这项研究将集中在暴露在空气中导致的免疫功能失调 妊娠期间的金属混合物，以及这种失调导致神经发育的机制 延误和肥胖。这项工作将作为美国国立卫生研究院环境研究联盟的一部分进行 对儿童健康结果的影响(ECHO)，将试图将多达50,000名儿童聚集在一起 从现有的出生队列研究中了解毒物、社会、营养和 文化环境对发展轨迹的影响。纳入美洲原住民队列将为 该联盟首次深入研究了#年土著人口正常儿童发展的进展情况 此外，环境逆境如何影响这一进程。美洲土著人的死亡率要高得多。 贫穷和失业，缺乏包括清洁饮用水和下水道在内的许多基本基础设施，以及 教育完成率较低。然而，他们也有很强的文化认同，在儿童方面的力量- 来自大家庭的养育，以及对重大发展里程碑的欣赏差异 与发展韧性有关，这有助于克服逆境。因此，他们的 将了解暴露对这些重要健康后果的影响纳入这一努力将带来 这不仅有助于我们通过纳入以下内容来了解美国的发展 以主权部落国家为代表的多样性，但也将有利于部落向 制定政策和临床护理，提高儿童发挥其最大潜能的能力。

Summary The URGENT Native American ECHO Cohort will build on the active Navajo Birth Cohort Study (NBCS), extending the follow up period beyond the current 12 month protocol, and adding two additional tribes, the Cheyenne River and Oglala Sioux Tribes, to assess the impact of environmental exposures to abandoned mine waste on birth outcomes and child development. The study, the first large-scale assessment of environmental exposures and children’s health in tribal populations is conducted in partnership with tribal communities and will help to build both research capacity within the tribes as well as capacity of tribal staff to conduct detailed developmental assessments. The study will follow development of the enrolled children until age 5 to track trajectories or patterns of neuro- and physical development with respect to environmental exposures to metal mixtures from abandoned hard rock and uranium mines on or near tribal lands. There are 161,000 such abandoned mines in the Western US, 4,000 of them abandoned uranium mines which are often unfenced, unmarked and accessible to children. On Navajo Nation alone, more than 500 abandoned uranium mines remain un-remediated more than 30 years since the closing of the last mine. The proposed research will address two of the key health outcome focus areas identified by the ECHO program through study of the effects of prenatal and early childhood exposure on 1) neurodevelopment, and 2) obesity. Based on the team’s preliminary findings, the research will focus on dysregulation of immune function as a result of exposure to metal mixtures during gestation, and mechanisms by which this dysregulation can lead to neurodevelopmental delays and obesity. The work will be conducted as part of the NIH Consortium to study Environmental Influences on Child Health Outcomes (ECHO) which will attempt to bring together as many as 50,000 children from existing birth cohort studies to understand the complex interactions of toxicant, social, nutritional, and cultural environments on developmental trajectories. Inclusion of the Native American Cohort will bring to the Consortium the first in-depth look at how normal child development progresses in Native populations in addition to how environmental adversity affects that course. Native Americans have far greater rates of poverty and unemployment, lack much essential infrastructure including clean drinking water and sewers, and have lower educational completion rates. However, they also have strong cultural identities, strength in child- rearing from extended families, and differences in appreciation of significant developmental milestones that have been associated with the development of resilience that helps in overcoming adversity. Therefore, their inclusion in this effort to understand the effects of exposure on these important health outcomes will bring a perspective that will serve not only to inform our understanding of development in the US through inclusion of the diversity represented by the sovereign tribal nations, but will also be of benefit to the tribes in informing the development of policies and clinical care that enhances the ability of children to reach their maximum potential.