Ngā Rahunga i roto i ngā Tiakitanga Tangata me te Hiahia mō ngā Mahi ā-Motu
I roto i tētahi whakamātautau haumanu i utua e te kāwanatanga o Amerika, i whakanohoia he whakakī niho kei roto he mercury ki roto i ngā tamariki ngoikore—he tokomaha o rātou he pani kua noho ki roto i te whare tiaki tamariki—i te wā e puta ana ngā whakapae nui mō te tukino ā-ira i roto i te pūnaha tonu i noho ai rātou. Ahakoa te piki haere o ngā taunakitanga mō te tukino me te mōhiotanga ā-roto i waenga i ngā kairangahau, i haere tonu te rangahau, me te whakaara ake i ngā pātai hohonu mō te mea i tino tiakina ēnei tamariki hei kaupapa tangata.
Ko ngā tuhinga i whiwhihia mā roto i ngā tono mō te Ture Whakawātea Mōhiohio (e ai ki ngā kōrero a Noel Fritsch i roto i te Kōnae Motu) me ngā pūrongo tirotiro i muri mai a Anita Vazquez Tibau, kua whakaoho anō i te arotakenga o te whakawakanga Casa Pia, e kī ana ehara i te mea he koretake te tirotiro, engari he pakaru pūnaha hoki o ngā ārai matatika mō ētahi o ngā kaiuru tino whakaraerae i roto i ngā rangahau e utua ana e te kāwanatanga ā-motu.
Ko tēnei rangahau i utua e te NIH he tauira kua tuhia mō te ngoikore nui o ngā tikanga matatika me ngā ture, ā, e tono ana kia arotakehia tonutia e te kāwanatanga motuhake, kia mārama katoa, kia mahi whakatikatika hoki hei tiaki i te hauora o te iwi whānui me te whakahoki mai i te whakawhirinaki ki ngā rangahau tangata.
Ngā Tamariki Whakaraerae, Te Tukino Pūnaha, me te Whakaraerae Tonu
Tata ki te 507 ngā tamariki i whakaurua ki te whakamātautau, he tokomaha o rātou nō ngā wāhanga o te kāwanatanga e noho ana i ngā whare hauora Casa Pia i Lisbon, Potukara. I whiwhi ēnei tamariki—mai i te 8 ki te 12 tau te pakeke i te tīmatanga—i ngā whakakī niho kei roto te mercury i ngā wā tino nui o te whanaketanga o te pūnaha io me te tinana. I taua wā anō, i pāngia rātou e tētahi taiao i tuhia i muri mai mō te tukino ā-ira me te tinana whānui.
Kei raro i ngā ture ā-motu i te 45 CFR Wāhanga 46, Wāhanga iti D, ka whakapiki ake i ngā tiakitanga mō ngā tamariki, inā koa ko ngā tiakitanga a te kāwanatanga. Kei roto i ēnei ko ngā whakaritenga mō ngā kaitautoko motuhake, te whakaiti i te akiaki, te awe kino rānei, me ngā herenga pakari mō te rangahau e whai wāhi ana ki te mōrearea nui atu i te iti rawa me te kore he painga tika (§46.406–409). E whakaatu ana ngā taunakitanga kāore i te tika te whakamahi, te whakatinana rānei i ēnei tiakitanga, ā, ka ara ake ngā pātai nui mō te whakaae whai whakaaro, te tirotiro, me te whakamārama matatika mō te haere tonu o te rangahau i waenganui i ngā mōrearea e mōhiotia ana o te mercury me te kino kua pūrongohia.
I haere tonu te rangahau, kāore he aukati, ā, i whakararuraru i ngā kaiuru ngoikore ki te konukōrei i a rātou e pāngia ana e te whara nui atu. Ko te huihuinga o te whakararuraru rangahau me te tukino ā-whare he tino pakaru o ngā mātāpono o te Pūrongo Belmont—te whakaute i te tangata, te atawhai, me te tika.
Ngā Taunakitanga Pūtaiao mō te Kino: Kei tua atu i ngā Whakatau Taketake
Kāore i te whakaatuhia e te whakamātautau taketake he rerekētanga whanonga roro toharite nui i waenga i ngā rōpū amalgam me ngā rōpū hiato. Heoi, i whakaatuhia e ngā tātaritanga motuhake i muri mai o taua huinga raraunga ngā tohu mārama o te kino, inā koa i roto i ngā rōpū iti e tika ana kia kitea i roto i te koiora me ngā pūnaha koiora motuhake:
- Te paitini o ngā whatukuhu: Woods et al. (2008) i tautuhia ngā tohu koiora o te ahotea ngongo me te glomerular whatukuhu e hono ana ki te pānga o te mercury mai i te amalgam.
- Te whakararuraru i te ara heme: I tuhia e Woods et al. (2009) ngā whakarerekētanga o ngā kōtaha porphyrin mimi, e rite ana ki te taumahatanga o te tinana mercury, inā koa i roto i ngā tamariki nohinohi.
- Ngā pānga o te whatukuhu e whakawhirinaki ana ki te horopeta: I kitea i roto i ngā tātaritanga anō a Geier et al. (2012–2013) he hononga hiranga i waenga i te whakaaturanga o te amalgam me ngā tohu o te kino o ngā ngongo proximal, tae atu ki te microalbuminuria me ngā whakarerekētanga o te glutathione S-transferase.
- Te ngoikore o te roro me te ira: I kōrero a Woods et al. (2014) mō ngā ngoikoretanga hinengaro me ngā ngoikoretanga whanonga e pā ana ki te mercury i roto i ngā tamariki he momo ira motuhake (hei tauira, ngā momo CPOX4 me BDNF), e tohu ana ko ngā hua kore toharite i huna i te kino i roto i ngā rōpū iti ngoikore.
E whakaatu ana ēnei tātaritanga anō i ngā herenga o ngā whakatau o te rangahau taketake, tae atu ki te kore pea e aro nui ki ngā pānga o te rōpū iti, ngā whanaungatanga horopeta-tauhohenga, me ngā pānga mō te wā roa. Te āhua nei kua kitea he kino whai tikanga haumanu engari kāore i te tino kitea i roto i ngā pūrongo tuatahi.
Te Whakawhirinakitanga Ture ki ngā Raraunga Kua Whakararuhia
Ahakoa ēnei kitenga me ngā haki whero matatika, kei te haere tonu ngā tari o Amerika—tae atu ki te NIH me te FDA—ki te whakahua i te whakamātautau Casa Pia i roto i ngā tauākī kaupapa here me ngā aromatawai haumaru e tautoko ana i te whakamahinga o te amalgam niho i roto i ngā tamariki. Ko ngā ngana ki te whakapuaki i ēnei āwangawanga mā te tuku pānuitanga pāpāho i whakakahoretia e ngā ratonga tohatoha me te mea he "whakaaro noa iho," ahakoa i ahu mai i ngā tuhinga FOIA me ngā tātaritanga anō i arotakehia e ngā hoa.
Ka ara ake tēnei i tētahi pātai matua: He aha ngā taunakitanga kua tuhia mō te mōrearea ki ngā tamariki whakaraerae e tautoko tonu ana i ngā kaupapa here a te iwi whānui, ahakoa kei te tūtaki ngā karanga mō te arotake anō ki te ātete a ngā umanga?
Ngā Petihana Whaimana mō te Haepapatanga
Hei whakautu, kua tukuna he pitihana whaimana ki te Tari Tiaki Rangahau Tangata (OHRP) e tono ana:
- He aromatawai tonu mō te tutuki i ngā whakaritenga o te whakamātautau me ngā IRB e pā ana.
- He whakataunga whaimana mō te kore tutuki i te 45 CFR 46, Wāhanga Iti D.
- Te whakamutua o te whakawhirinaki ā-motu ki ngā raraunga a Casa Pia i roto i ngā whakataunga ture, kaupapa here rānei.
- Te whakawhanake me te whakatinana i ngā Mahere Mahi Whakatikatika me te Ārai (CAPA).
- Te whakarite i te whakatikatika me te tautoko mō ngā kaiuru i ora tonu.
Kua tukuna he tono tirotirohanga ki te Tari Kaitirotiro Matua o te HHS (OIG), e aro ana ki:
- Ngā ngoikoretanga o te tirotiro a te NIH me te IRB.
- Te whakamahinga tonu a te FDA i ngā raraunga.
- Te rawaka o te pūrongo mō ngā aituā kino me te pono o ngā raraunga.
- Te urupare a te kāwanatanga (te kore rānei) ki ngā pūrongo mō te tukino i te wā o te rangahau.
He Kaupapa Hauora Whānui Ake
Ehara te whakamātautau Casa Pia i te huihuinga hītori takitahi. Neke atu i te 180 miriona o ngā Amerikana kei te mau tonu i ngā whakakī amalgam mercury, ā, ka iti tonu te pānga ki a rātou. He nui ngā arai kei te pā ki te tango haumaru, nui hoki, tae atu ki te iti o ngā tākuta kua whakangungua ki ngā tikanga haumaru-mercury, pērā i te Tikanga Tango Amalgam Mercury Haumaru (SMART) a te IAOMT.
Kāore anō kia whiwhi ngā kaiuru tuatahi—kua pakeke inaianei—i te whakamōhiotanga pūnaha mō ngā mōrearea mō te wā roa, te aroturuki hauora whānui, te tautoko rānei mō te whakatikatika. E takahi ana tēnei korenga i te whakauru i ngā mea ki ngā herenga matatika taketake ki ngā kaupapa rangahau.
Kei te tono tonu ngā kaitautoko pērā i a David Kennedy rāua ko Anita Vazquez Tibau, me ngā whakahaere pērā i te IAOMT, kia mārama, kia arotakehia anō ngā raraunga motuhake, me te tika.
Ngā Mahi i Manakohia mō ngā Tohunga me ngā Kaitautoko
Tēnā koa tohaina tēnei tuhinga kia whānuitia ai te mōhiotanga ki ēnei take matatika me te hauora tūmatanui. Tēnā koa whakaarohia te īmēra atu ki te Tari o te Hēkeretari i te Tari Hauora me ngā Ratonga Tangata (HHS) hei akiaki i te tautoko ā-motu, te whakamōhiotanga, te aroturukitanga, me te whakatikatika mō ngā tāngata i pāngia e te whakawakanga Casa Pia. Whakapā atu ki te Hēkeretari o te HHS, a Robert F. Kennedy, Jr., ki secretary@hhs.gov, waea atu rānei ki te nama waea kore utu 1-877-696-6775.
E akiakihia ana ngā mema o te IAOMT, ngā tohunga niho, ngā kairangahau, me ngā tāngata e māharahara ana kia mahi i ēnei mahi:
- Me tono Arotake ā-Motu — Tukuna ngā uiuinga ōkawa ki ngā komiti tirotiro a te HHS, OHRP, NIH, FDA, me te pāremata mō te whakawhirinaki tonu ki ngā raraunga a Casa Pia.
- Tautoko i te Aromatawai Anō Motuhake — Tautokohia te tātaritanga anō mārama, a te hunga tuatoru, o te huinga raraunga katoa, me te aro nui ki ngā pānga o ngā rōpū iti, te ngoikore o te ira, me ngā putanga mō te wā roa.
- Ngā Paerewa Tango Haumaru mō te Mercury Whakatairanga — Whakatairanga me te whakawhānui ake i te whakangungu i roto i ngā tikanga e ahu mai ana i ngā taunakitanga, kua whakamanahia e SMART mō te tango i te amalgam hei whakaiti i te pānga atu.
- Tautoko i te Whakaora i te Pāngia — Tautoko i ngā mahi kua whakaritea hei whakarato:
- Te whakamōhiotanga me te whakapuakitanga mōrearea kua whai māramatanga ki ngā kaiuru.
- Ko te aroturukitanga hauora mō te wā roa e arotahi ana ki ngā pūnaha whatukuhu, pūnaha io, me te pūnaha ārai mate.
- Te urunga atu ki te tango haumaru i te amalgam mēnā e tika ana mā te rata.
- Te whai whakaaro ki te tautoko i te tango paitini e ahu mai ana i ngā taunakitanga me te tiaki e whai whakaaro ana ki ngā whara.
- Whakawhanake i te Mōhiotanga o te Iwi — Tohaina ngā tuhinga kua manatokohia, tae atu ki ngā tuhinga FOIA, ngā tātaritanga anō kua arotakehia e ngā hoa mahi, me ngā tukunga ture, me te whakatenatena anō i te kōrero pūtaiao tuwhera.
Whakamutunga: Te Wā mō te Kawenga
Kei roto i te whakawakanga Casa Pia tētahi huihuinga morearea: ngā hapa matatika i roto i te tiaki i te hunga tino ngoikore, te whakaatu hē pea i te pūtaiao, me te whakawhirinaki tonu ki ngā raraunga hapa i raro i ngā ture. Mā te kore aro ki ēnei take ka mau tonu te kino ki ngā patunga taketake, ā, ka whakararu i te whakawhirinaki ki te tirotiro ā-motu mō te rangahau tangata me te haumaru o ngā rauemi niho.
Mo IAOMT
Ko te International Academy of Oral Medicine and Toxicology (IAOMT) he whatunga ā-ao o ngā tākuta niho, ngā rata, me ngā kairangahau e whakapau kaha ana ki te whakatairanga i te tiaki niho haumaru, e ahu mai ana i te pūtaiao, e whakatairanga ana i te hauora o te tinana katoa.
Te Whakamātautau Taketake me ngā Whakaputanga Tuatahi
DeRouen TA, Martin MD, Leroux BG, et al. (2006). Ngā pānga neurobehavioral o te amalgam niho i roto i ngā tamariki: he whakamātautau haumanu matapōkere. JAMA, 295(15):1784–1792. (Pūrongo putanga neurobehavioral matua; kāore i kitea he rerekētanga toharite nui.)
Bernardo M, Luis H, Martin MD, et al. (2007). Te oranga me ngā take mō te korenga o te amalgam me ngā whakahoutanga o muri hiato i whakanohoia ki roto i tētahi whakamātautau haumanu matapōkere. Journal of the American Dental Association, 138(6):775–783. (Te roa o te whakaora me ngā reiti korenga.)
Ngā Tohu Koiora me ngā Tātari Tuarua mai i te Tīma Taketake
Woods JS, Martin MD, Leroux BG, et al. (2008). Ngā tohu koiora o te pono o te whatukuhu i roto i ngā tamariki me ngā taiohi e pāngia ana e te konukōre niho: ngā kitenga mai i te whakamātautau konukōre tamariki a Casa Pia. Environmental Research, 108(3):393–399. (GST-alpha mimi, GST-pi, me te albumin hei tohu kino o te whatukuhu.)
Woods JS, Martin MD, Leroux BG, et al. (2009). Te whakaputanga porphyrin mimi i roto i ngā tamariki e rongoatia ana ki te mercury amalgam: ngā kitenga mai i te Casa Pia Children's Dental Amalgam Trial. Journal of Toxicology and Environmental Health, Part A, 72(14):891–896. (Ngā kōtaha porphyrin hei tohu mō ngā pānga mercury ki te hanganga heme.)
Lauterbach M, Martins IP, Castro-Caldas A, et al. (2008). Ngā putanga pūnaha io i roto i ngā tamariki me te pānga ki te konukōre e pā ana ki te amalgam me te kore: e whitu tau o ngā tirotiro roa i roto i tētahi whakamātautau matapōkere. Journal of the American Dental Association, 139(2):138–145. (Ngā tohu mārō me ngā tohu ngohengohe o te pūnaha io.)
Ngā pepa tautoko, ngā pepa hoahoa rānei tāpiri:
DeRouen TA, et al. (2002). Ngā take i roto i te hoahoa me te tātari i tētahi whakamātautau haumanu matapōkere hei aromatawai i te haumaru o ngā whakahoutanga o te amalgam niho i roto i ngā tamariki. Ngā Whakamātautau Hauora Whakahaeretia.
Evens CC, Martin MD, Woods JS, et al. (2001). Te tirotiro i te pānga o te methylmercury ki te kai i roto i te rangahau Casa Pia. Journal of Toxicology and Environmental Health, Wāhanga A.
Te Ngāwari o te Ira me ngā Tātaritanga Anō o te Neurobehavioral (Woods et al.)
Woods JS, Heyer NJ, Echeverria D, et al. (2012). Te whakarerekētanga o ngā pānga whanonga-roro o te mercury mā te polymorphism ira o te coproporphyrinogen oxidase i roto i ngā tamariki. Neurotoxicology and Teratology, 34(5):513–521.
Woods JS, Heyer NJ, Russo JE, et al. (2013). Te whakarerekētanga o ngā pānga whanonga-roro o te mercury mā ngā momo ira o te metallothionein i roto i ngā tamariki. Neurotoxicology and Teratology, 39:36–44.
Woods JS, Heyer NJ, Russo JE, Martin MD, Farin FM (2014). Ngā momo ira e pā ana ki te ngoikore o te roro ki te mercury: ngā kitenga whakarāpopototanga mai i te Casa Pia Children's Amalgam Clinical Trial. Neurotoxicology, 44:288–302. (He whakarāpopototanga whānui o ngā whakarerekētanga ira, tae atu ki ngā momo CPOX4 me BDNF.)
Ngā Tātaritanga Anō Motuhake nā Geier me ētahi atu (Arotahi ki te Horomanga-Whakautu)
Geier DA, Carmody T, Kern JK, King PG, Geier MR (2011). He whanaungatanga nui i waenga i te whakaraeraetanga o te mercury mai i ngā amalgams niho me ngā porphyrins mimi: he aromatawai anō i te whakamātautau amalgam niho a ngā tamariki Casa Pia. Biometals, 24(2):215–224.
Geier DA, Carmody T, Kern JK, King PG, Geier MR (2012). He whanaungatanga e whakawhirinaki ana ki te horopeta i waenga i te whakaraeraetanga o te mercury mai i ngā ranunga niho me ngā taumata mercury i roto i te mimi: he aromatawai anō o te Whakamātautau Amalgam Niho a ngā Tamariki Casa Pia. Human & Experimental Toxicology, 31(1):11–17.
Geier DA, Carmody T, Kern JK, King PG, Geier MR (2013). He whanaungatanga nui e pā ana ki te horopeta i waenga i te pānga o te mercury mai i ngā ranunga niho me ngā tohu koiora o te pono o te whatukuhu: he aromatawai anō i te whakamātautau ranunga niho a ngā tamariki Casa Pia. Human & Experimental Toxicology, 32(4):434–440.
Notes:
I te whakamātautau tuatahi, i matapōkeretia ngā tamariki ~507 (8–12 tau te pakeke i te tīmatanga) ki ngā whakaora whakakotahi, ki ngā whakaora hiato rānei, ā, i whai i aua whakaora mō te 7 tau. Kāore i whakanuia e ngā whakatau tuatahi ngā rerekētanga toharite nui o ngā putanga whanonga-roro, engari i whakaatuhia e ngā tātaritanga tuarua me ngā tātaritanga anō ngā tohu i roto i ngā rōpū iti, ngā whanaungatanga horopeta-tauhohenga, ngā tohu koiora whatukuhu, me te ngoikore o te ira.
