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      Farming, well water consumption, rural living, and pesticide exposure in early life as the risk factors for Parkinson disease in Iğdır province

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      , MD
      Neurosciences
      Riyadh : Armed Forces Hospital

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          Abstract

          Objectives:

          To investigate potential risk factors for Parkinson’s disease (PD) in elderly individuals rural living in Turkey.

          Methods:

          In total, 72 consecutive elderly Parkinson disease patients referred to the Neurology Clinic, Iğdir State Hospital, Iğdır, Turkey were included in the study. A structured questionnaire comprising questions on history of pastoral living, pit water consumption, and exposure to ionizing radiation and pesticides was administered to the patients. The patients were divided into 2 groups on the basis of water consumption: well water consumption group and city network consumption group.

          Results:

          Of 72 patients with PD, 49 (68.1%) exposed to well water while 23 (31.9%) did not exposed to well water. The average duration of well water consumption was 20 (standard deviation 6) years ( p<0.01) in group 1. Nitrate, sulfate and heavy metal levels were significantly higher in well water than in city network water ( p<0.05).

          Conclusion:

          Consumption of well water containing heavy metals and nitrates in early life may contribute to the etiology of Parkinson disease in elderly individuals in Iğdır province of Turkey

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          Most cited references16

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          Parkinson's Disease and the Environment

          Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder that affects an estimated 10 million sufferers worldwide. The two forms of PD include familial and sporadic, and while the etiology of PD is still largely unknown, the condition is likely to be multifactorial with genetic and environmental factors contributing to disease genesis. Diagnosis of the condition is attained through the observation of cardinal clinical manifestations including resting tremor, muscle rigidity, slowness or loss of movement, and postural instability. Unfortunately, by the time these features become apparent extensive neurological damage has already occurred. A cure for PD has not been identified and the current therapy options are pharmaceutical- and/or surgical-based interventions to treat condition symptoms. There is no specific test for PD and most diagnoses are confirmed by a combination of clinical symptoms and positive responses to dopaminergic drug therapies. The prevalence and incidence of PD vary worldwide influenced by several factors such as age, gender, ethnicity, genetic susceptibilities, and environmental exposures. Here, we will present environmental factors implicated in sporadic PD onset. By understanding the mechanisms in which environmental factors interact with, and affect the brain we can stride toward finding the underlying cause(s) of PD.
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            Association between Parkinson’s Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis

            Objective Bradford Hill’s viewpoints were used to conduct a weight-of-the-evidence assessment of the association between Parkinson’s disease (PD) and rural living, farming and pesticide use. The results were compared with an assessment based upon meta-analysis. For comparison, we also evaluated the association between PD and cigarette smoking as a “positive control” because a strong inverse association has been described consistently in the literature. Methods PubMed was searched systematically to identify all published epidemiological studies that evaluated associations between Parkinson’s disease (PD) and cigarette smoking, rural living, well-water consumption, farming and the use of pesticides, herbicides, insecticides, fungicides or paraquat. Studies were categorized into two study quality groups (Tier 1 or Tier 2); data were abstracted and a forest plot of relative risks (RRs) was developed for each risk factor. In addition, when available, RRs were tabulated for more highly exposed individuals compared with the unexposed. Summary RRs for each risk factor were calculated by meta-analysis of Tier 1, Tier 2 and all studies combined, with sensitivity analyses stratified by other study characteristics. Indices of between-study heterogeneity and evidence of reporting bias were assessed. Bradford Hill’s viewpoints were used to determine if a causal relationship between PD and each risk factor was supported by the weight of the evidence. Findings There was a consistent inverse (negative) association between current cigarette smoking and PD risk. In contrast, associations between PD and rural living, well-water consumption, farming and the use of pesticides, herbicides, insecticides, fungicides or paraquat were less consistent when assessed quantitatively or qualitatively. Conclusion The weight of the evidence and meta-analysis support the conclusion that there is a causal relationship between PD risk and cigarette smoking, or some unknown factor correlated with cigarette smoking. There may be risk factors associated with rural living, farming, pesticide use or well-water consumption that are causally related to PD, but the studies to date have not identified such factors. To overcome the limitations of research in this area, future studies will have to better characterize the onset of PD and its relationship to rural living, farming and exposure to pesticides.
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              Environment, lifestyle, and Parkinson's disease: Implications for prevention in the next decade

              There is evidence from observational studies for a role of a number of environmental exposures and lifestyle habits in modulating the risk for Parkinson's disease. Environmental and lifestyle associations, if causal, represent opportunities for Parkinson's disease prevention or disease modification at individual and population levels. In the past decade, additional evidence has been published that improves causal inference and/or enhances our understanding of the complexity of these associations. A number of gene-environment interactions have been elucidated, and our understanding of the roles of physical activity, pesticide and other chemical exposures, dietary habits, emotional stress, head injury, and smoking has been refined. In the next decade, better techniques will help us to close the gaps in our knowledge, including taking into account Parkinson's disease heterogeneity and gene and risk factor interactions in observational studies. To do this, larger datasets, global consortia, genomewide environment interaction studies, prospective studies throughout the lifespan, and improvements in the methodology of clinical trials of physical activity will be key. Despite the caveats of observational studies, a number of low-risk and potentially high-yield recommendations for lifestyle modification could be made to minimize the individual and societal burdens of Parkinson's disease, including dietary modifications, increasing physical activity, and head injury avoidance. Furthermore, a reduction in pesticide use could have a major impact on global health related to and beyond Parkinson's disease. Given the increasing prevalence of this disorder, formulating and promoting these recommendations should be a high priority. © 2019 International Parkinson and Movement Disorder Society.
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                Author and article information

                Journal
                Neurosciences (Riyadh)
                Neurosciences
                nsj
                nsj
                Neurosciences
                Neurosciences
                Riyadh : Armed Forces Hospital
                1319-6138
                1319-6138
                April 2020
                : 25
                : 2
                : 129-135
                Affiliations
                [1] From the Medical Biochemistry, Department of Neurology, Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey.
                Author notes
                Address correspondence and reprint request to: Dr. Aydın Çağaç, Department of Neurology, Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey. E-mail: aydincagac@ 123456hotmail.com ORCID ID: https://orcid.org/0000-0002-4476-0947
                Article
                Neurosciences-25-129
                10.17712/nsj.2020.2.20190104
                8015530
                32351250
                3d62f6f7-8706-4e1e-b4a4-8200be274805
                Copyright: © Neurosciences

                Neurosciences is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work.

                History
                : 24 October 2019
                : 22 December 2019
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