Collaborative Research and Action: Empowering an Exposed Community

 说明（由申请方提供）：密歇根州多溴联苯登记处的设立是为了研究因美国历史上最大的农业灾难而接触溴化阻燃剂的数千人的健康状况。该团队先前的研究表明，与多溴联苯（PBB）接触相关的显著健康影响包括月经初潮提前，流产风险增加，女性雌激素水平降低，男性泌尿生殖系统问题增多。在过去的几年里，埃默里大学的研究人员在密歇根州各地举行了十几次社区会议，与社区合作伙伴合作，与社区分享研究成果，回应社区需求，并为未来的研究计划寻求社区投入。这项拟议的研究由科学家、社区伙伴和公共卫生官员合作开发，解决了多溴联苯社区表达的几个主要关切。具体而言，受影响的个人表示有兴趣寻求一种可能的治疗方法，将多溴联苯从他们的身体中去除，对多溴联苯对其子女和孙辈的遗传影响表示关切，对生殖以外的健康问题表示持续关切，并对当地保健提供者似乎不知道全州范围内的多溴联苯接触和/或其可能的健康影响感到沮丧。为了解决这些问题，拟议的研究有四个具体目标。第一项是通过进行随机双盲试验，评估营养补充剂（一种不可吸收的人造脂肪）作为加速消除多溴联苯的潜在手段的效用。第二个目标将通过研究三代25个家庭，探索与多溴联苯接触有关的表观基因组变化的遗传性。将检查父母、子女和孙辈的表观基因组，以确定与父母直接接触多溴联苯有关的表观遗传模式是否在子女和孙辈中明显存在。目标三将解决社区对生殖结果以外的其他健康影响的关切。包括575名新参加者在内的参加者将填写健康调查表，并提供血清样本进行分析，以确定多溴联苯接触是否与神经变性疾病、关节疼痛/紊乱、癌症、免疫功能和肝脏/胰腺问题有关。如果任何自我确定的不良后果与多溴联苯接触有关，将寻求额外的资金，以进一步探讨这些关联。最后，公共卫生行动计划将寻求提高密歇根州的环境卫生意识。将为医疗保健提供者、政策制定者和公民制定教育计划，以提高当地解决暴露问题的能力。

 DESCRIPTION (provided by applicant): The Michigan PBB Registry was established in order to study the health of thousands of people exposed to brominated flame retardants as a result of the largest agricultural disaster in US history. Previous research by this team has shown significant health effects associated with exposure to polybrominated biphenyls (PBB) including earlier menarche, increased risk of miscarriages and lower estrogen levels among women, and more urogenital problems among men. Over the past few years, Emory researchers have conducted over a dozen community meetings throughout Michigan, collaborated with community partners, shared research findings with the community, responded to community needs, and sought community input for future research plans. This proposed study, collaboratively developed by scientists, community partners, and public health officials, addresses several major concerns expressed by the PBB community. Specifically, affected individuals have expressed interest in a possible treatment to remove PBBs from their bodies, concern about heritable effects from PBB on their children and grandchildren, continuing health concerns beyond those related to reproduction, and frustration that local health-care providers seem unaware of the statewide PBB exposure and/or its possible health effects. To address these concerns, the proposed study has four specific aims. The first is to evaluate the utility of nutritional supplement, a non-absorbable artificial fat, as a potential means of accelerating the elimination of PBB by conducting a randomized double-blind trial. The second aim will explore the heritability of changes in the epigenome associated with PBB exposure by studying 25 families across three generations. The epigenome of parents, their children, and their grandchildren will be examined to determine if epigenetic patterns associated with direct exposure to PBB of parents are apparent in the children and grandchildren. Aim three will address community concerns regarding additional health effects beyond reproductive outcomes. Participants, including 575 new enrollees, will complete health questionnaires and provide serum samples for analysis to determine if PBB exposure is associated with neurodegenerative diseases, joint pain/disorder, cancer, immune function and liver/pancreatic problems. If any of the self-identified adverse outcomes are associated with PBB exposure, additional funding will be sought to further explore these associations. Finally, the public health action plan will seek t raise environmental health awareness in Michigan. Educational programs will be developed for healthcare providers, policy-makers, and citizens to increase local capacity to address exposure concerns.