Background: Multiple epidemiological studies have shown that exposure to pesticides is associated with adverse health outcomes. However, the literature on pesticide-related health effects in the Latin American and the Caribbean (LAC) region, an area of intensive agricultural and residential pesticide use, is sparse. We conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations with the goal of identifying knowledge gaps and research capacity building needs.
Methods: We searched PubMed and SciELO for epidemiological studies on pesticide exposure and human health in LAC populations published between January 2007 and December 2021. We identified 233 publications from 16 countries that met our inclusion criteria and grouped them by health outcome (genotoxicity, neurobehavioral outcomes, placental outcomes and teratogenicity, cancer, thyroid function, reproductive outcomes, birth outcomes and child growth, and others).
Results: Most published studies were conducted in Brazil (37%, n = 88) and Mexico (20%, n = 46), were cross-sectional in design (72%, n = 167), and focused on farmworkers (45%, n = 105) or children (21%, n = 48). The most frequently studied health effects included genotoxicity (24%, n = 62) and neurobehavioral outcomes (21%, n = 54), and organophosphate (OP) pesticides were the most frequently examined (26%, n = 81). Forty-seven percent in = 112) of the studies relied only on indirect pesticide exposure assessment methods. Exposure to OP pesticides, carbamates, or to multiple pesticide classes was consistently associated with markers of genotoxicity and adverse neurobehavioral outcomes, particularly among children and farmworkers.
Discussion: Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations, but methodological limitations and inconsistencies undermine the strength of the conclusions. It is critical to increase capacity building, integrate research initiatives, and conduct more rigorous epidemiological studies in the region to address these limitations, better inform public health surveillance systems, and maximize the impact of research on public policies. https://doi.org/10.1289/EHP9934
Introduction
The Latin America and the Caribbean (LAC) region accounts for 14% of global agricultural production and 23% of the world's exports of agricultural and fisheries commodities.1 The rapid increase of farming in the region in the last decades has been coupled with an extensive use of pesticides (defined as chemical compounds that may either kill, obstruct, or manage the growthof any organism that damages a crop)2'3 and a lack of pesticide use regulations or implementation thereof.4-6 It is estimated that pesticide use in LAC countries accounts for 20% of worldwide consumption3 and that more pesticides are used in Central and South America on a per capita basis (1.84 and 1.78 kg of pesticide per person per year, respectively3'7) than in other regions in the world.
Intensive use of pesticides in the LAC region for agricultural and public health vector control purposes8 has resulted in widespread chronic human exposure, particularly among those living in agricultural communities. Pathways of chronic exposure include pesticide drift from treated fields to nearby homes or schools,9-12 take-home exposure,13 and consumption of contaminated food and water.14-17 Elevated occupational exposures in this region are also a concern as workers who apply pesticides or work in treated agricultural fields are exposed to mixtures of pesticides, such as insecticides [e.g., organophosphate (OP) and organochlorine (OC) pesticides],18'19 herbicides (e.g., glyphosate, the most widely used pesticide in the world),20 and fungicides (e.g., chlorothalonil, bis-dithiocarbamates, and benzimidazoles) .21
Although multiple studies around the world, including those conducted in LAC countries, have shown that pesticides have a negative impact on human health,22'23 public health surveillance and monitoring systems on pesticide use and associated illness are nonexistent or extremely limited in the LAC region.5'24-28 In addition, several pesticides banned in the United States, Europe, and Canada because they were deemed as a potential threat to human health have been or continue to be used in some LAC countries.28-30 Climate change could also exacerbate the health risks of pesticide exposures among LAC populations owing to enhanced chemical toxicity, increased rates of chemical degradation, enhanced volatilization of pesticides to the atmosphere or surface deposition of airborne pesticides, or changes in the frequency and amount of pesticides used.31'32
Promotion of high-quality epidemiological studies with standardized direct exposure assessment methods, the establishment of biomonitoring and environmental surveillance programs, and the development of evidence-based prevention policies and interventions have been suggested as means to protect the health of populations exposed to pesticides.33-35 Still, there is little information on the current state of research on the health effects of pesticides in the LAC region. Previous systematic literature reviews and meta-analyses of studies conducted in LAC populations have focused on one specific class of pesticides or specific active ingredient (e.g., OP pesticides,36'37 pyrethroids,38 glyphosate39), one specific age group (e.g., children37'40-42), or one health outcome (e.g., genotoxicity,43 neurobehavior,36'37'40 or respiratory health41). To address existing gaps of knowledge and identify research capacity building needs in the region, we conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations.
Methods
Search Strategy
We undertook a scoping review of the literature to identify all primary published data encompassing health effects of occupational or environmental exposure to pesticides in LAC populations. Our methods were guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) statement.44 We searched PubMed and the Scientific Electronic Library Online (SciELO) for all studies published between January 2007 and December 2021. For PubMed, we used the following search string: (pesticides [All Fields] AND "Latin America" [All Fields]) OR (pesticides [All Fields] AND Aruba [All Fields]) OR (pesticides [All Fields] AND Bahamas [All Fields]) OR (pesticides [All Fields] AND Barbados [All Fields]) OR (pesticides [All Fields] AND "Cayman Islands" [All Fields]) OR (pesticides [All Fields] AND Cuba [All Fields]) OR (pesticides [All Fields] AND Curacao [All Fields]) OR (pesticides [All Fields] AND Dominica [All Fields]) OR (pesticides [All Fields] AND "Dominican Republic" [AllFields]) OR (pesticides [All Fields] AND Grenada [All Fields]) OR (pesticides [All Fields] AND Guadeloupe [All Fields]) OR (pesticides [All Fields] AND Haiti [All Fields]) OR (pesticides [All Fields] AND Jamaica [All Fields]) OR (pesticides [All Fields] AND Martinique [All Fields]) OR (pesticides [All Fields] AND "Puerto Rico" [All Fields]) OR (pesticides [All Fields] AND "Saint Barthelemy" [All Fields]) OR (pesticides [All Fields] AND "Saint Kitts and Nevis" [All Fields]) OR (pesticides [All Fields] AND "Saint Lucia" [All Fields]) OR (pesticides [All Fields] AND "Saint Maarten" [All Fields]) OR (pesticides [All Fields] AND "Saint Vincent and the Grenadines" [All Fields]) OR (pesticides [All Fields] AND "Trinidad and Tobago" [All Fields]) OR (pesticides [All Fields] AND "Turks and Caicos Islands" [All Fields]) OR (pesticides [All Fields] AND "Virgin Islands" [All Fields]) OR (pesticides [All Fields] AND Belize [All Fields]) OR (pesticides [All Fields] AND "Costa Rica" [All Fields]) OR (pesticides [All Fields] AND "El Salvador" [All Fields]) OR (pesticides [All Fields] AND Guatemala [All Fields]) OR (pesticides [All Fields] AND Honduras [All Fields]) OR (pesticides [All Fields] AND Mexico [All Fields]) OR (pesticides [All Fields] AND Nicaragua [All Fields]) OR (pesticides [All Fields] AND Panama [All Fields]) OR (pesticides [All Fields] AND Argentina [All Fields]) OR (pesticides [All Fields] AND Bolivia [All Fields]) OR (pesticides [All Fields] AND Brazil [All Fields]) OR (pesticides [All Fields] AND Chile [All Fields]) OR (pesticides [All Fields] AND Colombia [All Fields]) OR (pesticides [All Fields] AND Ecuador [All Fields]) OR (pesticides [All Fields] AND "French Guiana" [All Fields]) OR (pesticides [All Fields] AND Guyana [All Fields]) OR (pesticides [All Fields] AND Paraguay [All Fields]) OR (pesticides [All Fields] AND Peru [All Fields]) OR (pesticides [All Fields] AND Suriname [All Fields]) OR (pesticides [All Fields] AND Uruguay [All Fields]) OR (pesticides [All Fields] AND Venezuela [All Fields]) AND (""2007/01/0""[Date- Publication]: ""2021/12/ 3""[Date- Publication])) (i.e., names of the 43 LAC countries and territories, as defined by the International Society of Environmental Epidemiology (ISEE) LAC Chapter).45 For SciELO, we used the following search string: ((pesticides AND Latin America)) OR ((pesticides AND Aruba)) OR ((pesticides AND Bahamas)) OR ((pesticides AND Barbados)) OR ((pesticides AND Cayman islands)) OR ((pesticides AND Cuba)) OR ((pesticides AND Curacao)) OR ((pesticides AND Dominica)) OR ((pesticides AND Dominican Republic)) OR ((pesticides AND Grenada)) OR ((pesticides AND Guadeloupe)) OR ((pesticides AND Haiti)) OR ((pesticides AND Jamaica)) OR ((pesticides AND Martinique)) OR ((pesticides AND Puerto Rico)) OR ((pesticides AND Saint Barthelemy)) OR ((pesticides AND saint Kitts and Nevis)) OR ((pesticides AND Saint Lucia)) OR ((pesticides AND Saint Maarten)) OR ((pesticides AND Saint Vincent and the Grenadines)) OR ((pesticides AND Trinidad and Tobago)) OR ((pesticides AND Turks and Caicos islands)) OR ((pesticides AND Virgin Islands)) OR ((pesticides AND Belize)) OR ((pesticides AND Costa Rica)) OR ((pesticides AND El Salvador)) OR ((pesticides AND Guatemala)) OR ((pesticides AND Honduras)) OR ((pesticides AND Mexico)) OR ((pesticides AND Nicaragua)) OR ((pesticides AND Panama)) OR ((pesticides AND Argentina)) OR ((pesticides AND Bolivia)) OR ((pesticides AND Brazil)) OR ((pesticides AND Chile)) OR ((pesticides AND Colombia)) OR ((pesticides AND Ecuador)) OR ((pesticides AND French Guiana)) OR ((pesticides AND Guyana)) OR ((pesticides AND Paraguay)) OR ((pesticides AND Peru)) OR ((pesticides AND Suriname)) OR ((pesticides AND Uruguay)) OR ((pesticides AND Venezuela)) and filtered the results by date of publication. The initial search was conducted on 30 May 2017, with subsequent updates on 1 May2019, 4 February 2021, and 27 April 2022 (for papers published until 31 December 2021). We also identified potentially relevant citations not retrieved by the initial literature searches by scanning the references of relevant studies throughout the course of title and abstract screening and data abstraction (Figure 1; see Supplemental Material for the list of studies retrieved from PubMed and SciELO).
Study Selection
After removing duplicate records, titles and abstracts of literature search results were scanned for eligibility by two reviewers, with discrepancies resolved by a third reviewer. Studies were selected for full-text review when they met all of our inclusion criteria: a) original full paper that presented unique data from an analytical observational epidemiological study (i.e., cohort, cross-sectional, or case-control study); b) environmental or occupational exposure to pesticides; c) conducted in one of the 43 LAC countries and territories, as defined by the ISEE LAC Chapter45; and d) published in English, Spanish, or Portuguese. We excluded studies if they met one of the following criteria: a) did not report original results (i.e., reviews, meta-analysis, comments, letters, editorials, and case reports); b) were experimental, toxicological, or ecological studies; c) were based on animal or human tissues; or d) reported preliminary results (e.g., conference abstracts or papers that were later updated or revised in a peer-reviewed journal article). Full texts were assessed by two reviewers for final inclusion, with a third reviewer again resolving any discrepancies.
Data Abstraction
We abstracted the following characteristics from the selected publications: bibliographic citation information (i.e., authors, year of publication, and country), characteristics of the study population(i.e., sample size, study area), study design, type of pesticides assessed (e.g., pesticide class or pesticide active ingredient), exposure and health outcome assessment methods, and main study findings. We grouped the studies into eight categories based on the main health outcome assessed: a) genotoxicity, b) neurobehavioral outcomes, c) placental outcomes and teratogenicity, d) cancer, e) thyroid function, f) reproductive outcomes, g) birth outcomes and child growth, and h) other health outcomes.
Because of the expected methodological heterogeneity among the selected studies (e.g., variability in study design; exposure and outcome assessment methods), results were not intended to be combined through meta-analysis. Instead, we conducted a narrative synthesis to highlight the strengths and limitations of the current evidence base and to ultimately draw conclusions about the state of research on the health effects of pesticide exposure in LAC populations, including key challenges moving forward.
Results
The PubMed and SciELO search retrieved 9,934 and 481 citations, respectively, and the review of references from relevant publications yielded 10 additional citations (Figure 1). After removing 78 duplicates, 10,023 publications that did not meet inclusion criteria based on titles/abstracts, and 91 that did not meet inclusion criteria based on full-text reviews, 233 publications were included in this review. Although publications reported on studies from 16 (37%) of the 43 LAC countries and territories, most studies were conducted in Brazil (37%, " = 88) and Mexico (20%, ra = 46) (Table 1). Studies were primarily cross-sectional in design (72%, n= 167), and the most frequently studied populations were farmworkers (45%, n= 105) or children (21%, " = 48). Between 2007 and 2021, the average number ± standard deviation (SD) of publications was ~15.6±7.0/y, range: 5 in 2008 to 27 in 2020) (Figure SI). Nearly half(47%, n= 112) of the published studies relied solely on indirect pesticide exposure assessment methods (e.g., questionnaire, job status ascertainment via death certificate or surveillance system) (Table 1 and Table SI). Blood was the biological matrix most frequently used to assess pesticide exposure (74%, n = 99 of the 124 studies that used direct exposure assessment methods). Most published studies focused on OP pesticides (26%, n = 81) or multiple classes of pesticides (32%, ra=100). The most studied health effects included genotoxicity (24%, n = 62) and neurobehavioral outcomes (21%, n = 54) (Table 1 and Table SI).
Genotoxicity
Sixty-two publications examined associations of pesticide exposure with cytogenetic or DNA damage (Table 2). Most publications were derived from cross-sectional studies that evaluated DNA damage from accessible tissues, such as blood or buccal cells, via comet assays, telomere attrition, or DNA methylation of candidate genes. Eleven of the 62 publications focused on children. Three of these 11 publications assessed exposure to OC pesticides by measurement of blood or hair OC pesticide concentrations,46-48 whereas the remaining 8 examined exposure to a mixture of pesticides including OP pesticides, pyrethroids, herbicides, or "multiple pesticide classes" via questionnaire.30'49-55 Of the 3 publications that measured blood or hair OC pesticide concentrations,46-48 2 were from cross-sectional studies of school-age Mexican children and reported associations with genotoxic damage-as indicated by DNA damage assessed via comet assay47 or higher frequency of micronuclei and other nuclear abnormalities in buccal cells.48 A third publication from a cross-sectional investigation of mother-child pairs in Mexico reported null associations with DNA and cytogenetic damage measured in maternal blood at delivery and cord blood.46 Five publications examining exposures to more than one pesticide class in children from Mexico,49'51 Argentina,50'54 and Paraguay53 reported associations of higher residential or parental occupational pesticide exposure with cytogenetic damage-assessed via buccal micro-nuclei and other nuclear abnormalities. Similarly, in a prospective study of school-age children living near a tobacco-producing region in Brazil, researchers found that malondialdehyde, protein carbonyl, and vitamin C levels were higher at the beginning of the pesticide application period than at the leaf harvest period.52
In contrast, 2 publications from small cross-sectional studies of children from Colombia30 and Bolivia55 reported null associations of maternal occupational pesticide exposure-assessed via questionnaire-and urinary atrazine concentrations with cytogenetic damage.
Thirteen publications from cross-sectional studies examined associations of exposure to OP or carbamate pesticides with cytogenetic or DNA damage in adults, primarily among those occupa-tionally exposed (Table 2). One cross-sectional study assessed OP pesticide exposure via questionnaire only and reported higher DNA damage-quantified via comet assay-among workers compared with controls.56 The other 12 studies assessed exposure to OP or carbamate pesticides using urinary dialkyl phosphate (DAP) metabolite concentrations or blood cholinesterase (ChE) measurements, but 11 of them evaluated exposure-outcome associations using predetermined categorical exposure variables based on occupation (e.g., high, moderate, and no exposure)57-65 or residence (e.g., rural or urban).66 Nine of these 11 publications reported associations with genotoxic outcomes, such as changes in DNA methylation patterns of candidate tumor suppressor genes, among moderate- or high-exposure groups.57'59'61-67 Two publications reported no differences in markers of cytogenetic or DNA damage between exposed workers and controls.58'60 The only cross-sectional study that used urinary DAP concentrations in its exposure-outcome analyses reported null associations with DNA methylation but observed group differences when OP pesticide exposure was assessed as a categorical variable.68
Thirty-eight publications examined associations of exposure to pesticides other than OCs, OPs, or carbamates or exposure to multiple pesticide classes with genotoxicity among adults (Table 2). Twenty-five publications estimated occupational pesticide exposure using questionnaire data only and all reported associations of exposure to pesticides with increased cytogenetic damage, including higher frequencies of chromosomal aberrations and micronu-clei, DNA damage, oxidative stress, or telomere shortening.69-93 In addition, 10 publications from cross-sectional studies of farmworkers/pesticide applicators and controls assessed pesticide exposure using blood ChE measurements but only evaluated exposure-outcome associations using categorical exposure variables.94-103 All 10 publications reported that occupational pesticide exposure was associated with higher levels of DNA or cytogenetic damage, such as higher frequencies of chromosomal aberrations, nuclear buds, or cell death. Similarly, a publication from a cross-sectional study in Argentina reported increased cytogenetic damage among those living near agricultural fields (<500 m),104 whereas a publication from a cross-sectional study in Ecuador reported null associations of residential use of the herbicide glyph -osate with chromosomal aberrations frequency and karyogram alterations.105 Last, a publication from a cross-sectional study of rice field workers in Colombia reported associations of two pesticide mixtures (one mixture of OC pesticides and one of carbamates)-assessed via measurement of pesticide metabolites in blood and urine-with DNA damage.106
Overall, studies published to date provide consistent evidence of an association between exposure to different pesticide classes such as OP pesticides and carbamates and genotoxic damage in children and adults living in LAC countries. Notably, most of the studies that have been published were cross-sectional in design, assessed pesticide exposure via questionnaire, and had small sample sizes.
Neurobehavioral Outcomes
Fifty-four publications, primarily derived from cross-sectional studies, examined the potential neurobehavioral effects of pesticide exposure in children, adolescents, and adults (Table 3). Twelveof these 53 publications reported on the association between exposure to OC pesticides and child neurodevelopment107-115; 6 publications focused on the same Mexican cohort,107-109112-114 5 focused on the same Guadeloupean cohort,110111115-117 and 1 was a cross-sectional study from Brazil. Three publications from the prospective cohort study in Mexico reported that higher prenatal dichlorodiphenyltrichloroethane (DDT) exposure-as indicated by measurement of its primary breakdown product dichlorodiphe-nyldichloroethylene (DDE) in serum-was associated with lower psychomotor development during the first year of life,107 poorer verbal and memory skills and a poorer general cognitive index at 3.5-5 years of age,112 and poorer spatial orientation at 5 years of age.113 A fourth publication from the same cohort study reported that maternal intake of omega-3 and -6 fatty acids during pregnancy modified the association of prenatal DDT exposure with poorer motor and memory skills at 3.5-5 years of age,114 whereas 2 other publications from this cohort reported null associations of prenatal DDT exposure with child neurodevelopment at 1 month109 and at 12-30 months of age.108 Four publications from the prospective Guadeloupean cohort study reported that higher cord blood concentrations of chlordecone-an OC pesticide that was extensively used in banana plantations in the French West Indies-were associated with impaired cognitive and motor function at 7 months of age,110 lower fine motor scores at 18 months of age (among boys only),111'117 and poorer visual contrast sensitivity at 7-8 years of age.115 A fifth publication from the Guadeloupean cohort study reported null associations of prenatal and childhood chlordecone exposure with sex-typed play behavior at 7 years of age.n6 The one Brazilian cross-sectional study reported that higher concentrations of several OC pesticide metabolites were associated with poorer performance intelligence quotient, resistance to distraction, or processing speed at 6-16 years of age.118 The only publication that examined the association of OC pesticide exposure- as indicated by measurement of (3-hexachlorocyclohexane ((3-HCH), DDT, DDE, and dieldrin in serum-with neurodegenerative disorders among adults was from a cross-sectional study conducted in Costa Rica and reported null associations.119
Eleven publications examined the association of OP or carbamate pesticides with neurobehavioral outcomes in children or adolescents (Table 3). Six publications from cross-sectional studies in Ecuador reported that children and adolescents who lived in floricultural communities-in which OP pesticides and carbamates are intensively used-or whose mothers worked as floriculturists during pregnancy had adverse neurobehavioral outcomes, including poorer motor or socioindividual skills at 3-61 months of age120'121; attention, executive function, and memory deficits at 4-9 years of age (in boys only)122; impaired motor coordination, visual performance, and visual memory at 6-8 years of age123; and more depression symptoms at 11-17 years of age (particularly among girls).124'125 In line with these findings, a seventh publication reported that Ecuadorian children 4-9 years of age who were examined sooner after the end of an increased pesticide use period had lower attention/inhibitory control, visuospatial processing, and sensorimotor scores than children examined later.126 A publication from a cross-sectional study of Chilean school-age children who lived in agricultural communities reported associations of OP pesticide exposure-as indicated by measurement of urinary DAP metabolites-with poorer processing speed.127 A publication from a prospective cohort study in Mexico reported that prenatal exposure to the OP pesticide chlorpyrifos-assessed by measurement of 3,5,6-trichloro-2-pyridinol (TCPy) in maternal urine samples collected during the third trimester of pregnancy-was associated with increased attention problems in school-age boys and girls.128 Conversely, two cross-sectional studies found null or protectiveassociations of OP pesticide exposure with neurodevelopmental outcomes among children.121129 In a publication from Ecuador, investigators reported that maternal employment in the flower industry or pesticide use on domestic crops at the time of child assessment was associated with improved communication, gross motor, and problem-solving skills at 24-61 months of age.130 A publication from Argentina reported null associations of OP exposure-assessed via blood ChE levels-with motor function and visuospatial processing at 7-10 years of age, but it also reported worse neurodevelopmental outcomes among children living in an agricultural community compared with those living in a nonagricultural community.129
Eight publications examined the association of OP or carbamate pesticides with neurobehavioral outcomes and neurodegenerative disorders among adults (Table 3). Seven of the studies described in these publications were cross-sectional and found that workers exposed to pesticides (i.e., farmworkers and endemic disease control agents) and adults who lived in agricultural communities had impaired cognitive, executive function, memory and attention, and verbal fluency skills131-134; poorer discrimination sensitivity and deep reflexes132; increased odds of polyneuropathy135; or increased odds of psychological distress and suicidal ideation.136'137 Conversely, a publication from a cross-sectional study in Brazil reported that farmworkers who did not handle/apply pesticides-but who used less personal protective equipment (PPE) and had less training on safe pesticide use practices-had more adverse health outcomes (e.g., feeling easily tired, feeling worthless) than pesticide applicators.138
Seven publications from two prospective cohort studies, four cross-sectional studies, and one case-control study examined the associations of exposure to multiple pesticide classes with child neurodevelopment (Table 3). Of these seven publications, four assessed exposure using direct assessment methods139-142; two examined exposure using predetermined categorical exposure variables based on residence143 or proximity to treated agricultural fields144; and one examined maternal pesticide exposure history via questionnaire.145 A publication from a prospective cohort study in Costa Rica found an association of prenatal exposure to manganese (Mn)-containing fungicides-assessed by measurement of urinary ethylenethiourea (ETU) as well as blood and hair Mn in maternal samples collected during pregnancy- with lower social-emotional and cognitive scores in children at 1 year of age.141 A publication from a prospective cohort study in Mexico reported that prenatal exposure to pyrethroids-as indicated by measurement of 3-phenoxybenzoic acid (3-PBA) in maternal urine samples collected during the third trimester of pregnancy-was associated with lower mental development scores at 24 months of age, but not at 36 months of age.142 Notably, a publication from a cross-sectional study of school-age children in Costa Rica reported that higher urinary 3-PBA concentrations were associated with poorer processing speed scores (particularly in girls), but also that urinary TCPy concentrations were associated with poorer working memory (among boys only), visual-motor coordination, and decreased ability to discriminate colors.140 In contrast, a publication from a small cross-sectional study also conducted in Costa Rica139 reported null associations of exposure to OP pesticides, pyrethroids, and herbicides-assessed via pesticide-specific metabolites (e.g., urinary 3-PBA and TCPy concentrations)-and neurodevelopmental outcomes among children 4-10 years of age. A publication from a study conducted in Jamaica reported that maternal exposure to pesticides from 3 months before pregnancy to the end of breastfeeding was associated with an increased risk of autism spectrum disorder.145 Last, two publications from cross-sectional studies in Ecuador144 and Brazil143 reported that children and adolescentswho lived near agricultural fields in which OP pesticides and other pesticide classes were extensively used had poorer neurodevelopmental outcomes compared with those who lived farther from the fields (or in nonagricultural communities), including poorer cognitive skills, motor function, memory/learning, visuospatial processing, or attention/inhibitory control.
Fifteen publications evaluated the neurobehavioral effects of exposure to multiple pesticide classes, predominantly assessed via occupational exposure history, among adults (Table 3). Nine of these publications reported that workers exposed to pesticides (i.e., farmworkers and endemic disease control agents), farmworkers who had experienced an acute pesticide poisoning (APP), and adults who lived in agricultural or rural communities had cognitive impairment146'147; increased odds of minor psychiatric disorders such as depression, anxiety, and somatic disorders148-152; suicidal ideation153'154; or an array of neurological symptoms.151'155 Three publications from cross-sectional and case-control studies conducted in Costa Rica119 and Brazil156'157 reported associations between exposure to multiple classes of pesticides-assessed via questionnaire-and increased odds of Parkinson's disease. Notably, publications from two studies of Brazilian workers reported null associations of pesticide exposure with essential tremor158 and acute intoxication symptoms.159 A publication from a small cross-sectional study of farmworkers in Costa Rica reported a null association between exposure to Mn-containing fungicides-assessed by measurement of toenail and hair Mn concentrations-and cortical brain activity during a working memory task.160
Overall, studies published to date provide consistent evidence of associations between prenatal and childhood exposure to pesticides such as OP pesticides and carbamates and impaired neurodevelopment in LAC children and adolescents. Some of the adverse neurodevelopmental outcomes that have been reported include poorer cognition, memory, and attention, as well as anxiety and depression. Publications from studies of farmworkers in LAC countries also provide consistent evidence of associations between exposure to multiple classes of pesticides-assessed mainly via questionnaire-and impaired neurobehavioral performance, psychological distress, suicidal ideation, and neurodegenerative disorders.
Placental Outcomes and Teratogenicity
Thirteen publications from seven cross-sectional studies, five case-control studies, and one prospective cohort study reported on the potential placental and teratogenic effects of pesticide exposure (Table 4). Seven of these 13 publications reported on the association of exposure to OC pesticides or multiple pesticide classes with congenital malformations. A case-control study conducted in Mexico reported that children whose mothers had higher serum hexachlorobenzene (HCB), (3-HCH, DDT, or DDE concentrations at delivery had increased odds of cryptorchidism.161 Similarly, publications from studies conducted in Brazil162-164 and Mexico165 reported associations of parental occupational pesticide use or environmental pesticide exposure (e.g., being born in a floricultural community) before or during pregnancy-ascertained via questionnaire-with increased odds of congenital malformations, including male external genital malformations. In contrast, publications from case-control studies in Brazil166 and Guadeloupe167 found null associations between pesticide exposure and malformations in general.
Six publications, all from cross-sectional studies conducted either in Mexico or Argentina, reported on the associations between exposure to OP or carbamate pesticides and placental outcomes (Table 4). Each of these studies measured blood ChE or placental carboxylesterase activity levels but used predetermined exposurecategories (e.g., rural vs. urban) in exposure-outcome analyses. Among the most prevalent outcomes associated with pesticide exposure were alterations in lipid composition and oxidative status of placental mitochondria,168'169 as well as changes in the expression of placental cytokines and levels of placental enzymes (e.g., argi-nase, ornithine decarboxylase).170 Publications from two cross-sectional studies conducted in Mexico and in Argentina reported that pesticide exposure was associated with a higher placental maturity index171 and higher placental weight.54 Conversely, three publications from Argentina reported largely null associations with placental morphological parameters (e.g., weight, placental weight to neonate weightratio).169'170'172
To date, a small number of publications have reported on the association of pesticide exposure with placental or teratogenic outcomes in LAC populations and their findings are inconsistent. Some published studies found associations of exposure to OCs, OPs/carbamates, and multiple pesticide classes (retrospectively assessed via questionnaire in case-control studies) with outcomes such as alterations in lipid composition and oxidative stress of placental mitochondria and increased odds of congenital malformations. Other studies observed null associations with outcomes such as placental morphological parameters and risk of malformations.
Cancer
Fourteen publications examined the association of pesticide exposure with cancer or cancer-related mortality in children or adults (Table 5). Thirteen publications reported findings from case-control studies; 12 of these studies used indirect exposure assessment methods (i.e., questionnaires or death certificates indicating occupation at the time of death) and 11 examined multiple pesticide classes. Two studies, 1 case-control and 1 prospective cohort, examined associations of serum OC pesticide concentrations with the risk of prostate cancer or prostate cancer recurrence.173'174
Five publications reported that children whose mothers were occupationally or environmentally exposed to pesticides before, during, or after pregnancy had increased odds of leukemia.175-179 For instance, in a Brazilian case-control study, children whose mothers were exposed to pyrethroid insecticides during pregnancy had increased odds of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) at 0-23 months of age.178 Similarly, in a Costa Rican case-control study, boys, but not girls, whose mothers reported using insecticides inside their homes in the year before pregnancy, during pregnancy, and while breastfeeding had increased odds of childhood ALL.175 Maternal report of pesticides sprayed on farms or companies near the home during pregnancy and while breastfeeding was also associated with childhood ALL in the Costa Rican study.175 Another publication from this Costa Rican case-control study reported that children whose fathers were occupationally exposed to any pesticide during pregnancy, but particularly the second trimester, had increased odds of leukemia.176
Five publications examined the association of pesticide exposure with breast cancer,180'181 cutaneous melanoma,182 prostate cancer,174 and prostate cancer recurrence173 in adults. Two publications reported that women who reported using insecticides in their homes during adulthood (>18 years of age)180 or who lived near agricultural fields181 had increased odds of breast cancer. Another publication found that study participants who were ever exposed to pesticides had increased odds of cutaneous melanoma, with stronger associations among those with indoor residential pesticide exposure, particularly for those with a high frequency of use (>4 times per year) or long duration of exposure (>10 y).182 In addition, two studies from Guadeloupe reported associations of serum concentrations of two OC pesticides,
DDE and chlordecone, with increased risk of prostate cancer174 or its biochemical recurrence.173
Four publications assessed the association of occupational pesticide exposure with mortality by non-Hodgkin lymphoma183 or esophageal,184 brain,185 or stomach186 cancer in adults using death certificate data to ascertain occupation at the time of death. More specifically, a publication from a study conducted in Brazil reported mostly null associations between agricultural work and the risk of death by non-Hodgkin lymphoma.183 Conversely, three publications reported that farmworkers had increased odds of dying from esophageal, brain, and stomach cancers than non-farmworkers; two of these publications also reported increased odds of dying from brain185 and stomach186 cancer among farmworkers who lived in the areas of greatest pesticide use.
The small number of studies published to date and included in this scoping review provide somewhat consistent evidence of associations between maternal pesticide exposure before or during pregnancy and increased risk of leukemia among LAC children. In addition, eight of nine publications of studies conducted in adults reported evidence of residential or occupational pesticide exposure with an increased risk of various types of cancer or death by cancer. Nevertheless, these findings must be interpreted with caution given that all studies assessed exposure to multiple pesticide classes via questionnaire and examined different types of cancer.
Thyroid Function
Sixteen publications from 10 cross-sectional studies and 6 prospective cohort studies reported on the associations of pesticide exposure with thyroid function (Table 6). Four of these 16 publications examined the potential thyroid effects of OC pesticide exposure-assessed via measurement of OC pesticide metabolites in blood or breast milk-among children.117'187-189 Briefly, a publication from a cross-sectional study of mother-newborn pairs in Bolivia reported null associations of cord blood DDT and DDE concentrations with neonatal thyroid-stimulating hormone (TSH) levels.188 However, a publication from a cross-sectional study of Brazilian children (0-14 years of age) found that higher concentrations of 17 (of 19) OC pesticides, including DDE and DDT but not chlordecone, were associated with increased levels of total triiodothyronine (T3) or free thyroxine (T4), but not with TSH.187 Two publications from a prospective cohort study in Guadeloupe reported associations of early-life chlordecone exposure-as indicated by measurement of chlordecone in cord blood and breast milk samples-with elevated TSH or decreased T3 and T4 at 3 months and at 7 years of age, with some evidence of effect modification by sex.117'189
Five publications reported on the association between exposure to OC pesticides and thyroid function in adults (Table 6). A publication from a cross-sectional study of individuals living near an abandoned pesticide factory in Brazil reported various associations of OC pesticide concentrations with thyroid hormone levels, which differed between men and women.190 For example, among men, higher endosulfan 2 concentrations were associated with decreased T3 levels, whereas higher (3-HCH and DDT concentrations were associated with decreased free T4 levels. Among women, higher a-chlordane, DDT, endosulfan 2, and methoxychlor concentrations were associated with increased T3 levels, whereas higher HCB, heptachlor, and DDT concentrations were associated with increased T4 levels.190 A publication from a cross-sectional study of farmworker families in Brazil also reported associations of several OC pesticide concentrations with increased TSH (i.e., y-chlordane), total T3 (i.e., y-chlordane, (3-HCH, heptachlor epoxide B, fraras-nonachlor, DDE, and endosulfan 2), or free T4 (i.e., dieldrin).191 Two publications fromdifferent prospective cohort studies in Mexico reported associations of serum DDE concentrations with increased total T3 or T4 levels among male floriculture workers192 and pregnant women living in a floriculture area.193 In addition, a cross-sectional study of Colombian farmworkers and their partners found associations of serum DDE, heptachlor, endosulfan 1, and three or more OC pesticides with increased odds of subclinical hypothyroidism.194
Six publications examined associations of OP or carbamate pesticide exposure-assessed by measurement of urinary DAP metabolite concentrations or blood ChE activity-with thyroid function (Table 6), but only one focused on children.195 The latter publication from a cross-sectional study of Ecuadorian adolescents living in agricultural areas reported that lower acetylcholinesterase (AChE) activity was associated with increased free T4 and decreased TSH levels among girls, but not boys.195 Two publications from a prospective cohort study of adult floriculture workers in Mexico reported that higher DAP metabolite concentrations were associated with increased TSH and total T4 levels196 and that these associations were modified by paraoxo-nase 1 (PONl192RR)-191 Similarly, a publication from a cross-sectional study in Brazil reported increased TSH, but also decreased T3 and T4 levels, among farmworkers compared with unexposed controls.198 In contrast, two publications from cross-sectional studies in Mexico199 and Venezuela200 reported null associations of occupational or para-occupational exposure to OP pesticides with thyroid hormone levels. Last, a publication from a cross-sectional study in Brazil examined associations between exposure to multiple pesticide classes-ascertained via questionnaire-and thyroid function among adults and reported associations of recent use of dithiocarbamate fungicides with decreased TSH levels, recent use of X-cyhalothrin (pyrethroid insecticide) with decreased free and total T4 levels, and recent use of paraquat (herbicide) with decreased free T3 levels.201 Overall, published studies on the associations of pesticide exposure and thyroid function among LAC populations have reported mixed findings with notorious differences between pesticide active ingredients, age groups, and sexes.
Reproductive Outcomes
Sixteen publications reported on the association of pesticide exposure with reproductive outcomes such as reproductive hormone profiles among adults (Table 7). Four of these 16 publications focused on OC pesticide exposure and used direct pesticide exposure assessment methods.189'202-204 A publication from a prospective cohort study in Guadeloupe reported that higher cord blood chlordecone concentrations were associated with elevated androsterone and testosterone in 7-y-old boys and girls.189 Notably, a publication from a prospective cohort study of male floriculture workers in Mexico reported that higher serum DDE concentrations were associated with decreased prolactin and testosterone, but also with increased inhibin B.202 A publication from a cross-sectional study of individuals living near an abandoned pesticide factory in Brazil (mentioned above) reported that higher serum heptachlor and DDT concentrations were associated with decreased testosterone levels among men and that higher serum aldrin, HCB, DDT, endosulfan 2, and mirex concentrations were associated with increased estradiol levels, decreased luteinizing hormone (LH) levels, or decreased follicle-stimulating hormone (FSH) levels among periVpostmenopausal women.203 Furthermore, a publication from a case-control study in Brazil reported that infertile women had higher detectable serum DDE concentrations than fertile women.204
Seven publications examined associations of OP or carbamate pesticide exposure with reproductive outcomes, six ascertained exposure via urinary DAP metabolites or blood ChE levels,200'205-209and one assigned exposure based on the season of sample collection (spray vs. nonspray)210 (Table 7). A publication from a prospective cohort study in Mexico reported lower sperm volume and count among farmworkers who sprayed OP pesticides compared with non-farmworkers, but mostly null associations between urinary DAP metabolite concentrations and seminal parameters.209 Three publications from cross-sectional studies conducted in Peru,208 Mexico,207 and Venezuela200 reported increased seminal pH, lower percentage of live sperm, and lower seminal fructose levels among farmworkers compared with non-farmworkers. The study conducted in Venezuela also reported that lower butyrylcholinesterase (BChE) activity was associated with an increased damage to sperm chromatin among farmworkers.200 A publication from a cross-sectional study of male floriculture workers in Mexico reported that higher urinary DAP metabolite concentrations were associated with decreased inhibin B, FSH, or LH levels, but also with increased testosterone levels.207 Another publication based on the same study population reported that higher urinary DAP metabolite concentrations were associated with increased FSH and prolactin levels, but decreased testosterone and inhibin B levels.205 Last, although one publication from a prospective cohort study of pregnant women in Argentina reported a weak association between higher AChE activity and increased progesterone levels,206 a cross-sectional study of women in Argentina reported no difference in progesterone and estradiol levels measured in the spray and non-spray seasons.210
Five publications from four cross-sectional studies and one retrospective cohort study reported on the associations of exposure to pesticides other than OCs, OPs, or carbamates or exposure to multiple pesticide classes with reproductive outcomes (Table 7). All studies relied on questionnaires to assess environmental or occupational pesticide exposure,201'211-213 but one of them also measured blood ChE activity.214 Two publications from studies conducted in Brazil214 and Venezuela213 reported associations of pesticide exposure with reduced sperm quality-as indicated by parameters such as decreased sperm concentration and higher sperm DNA fragmentation index-among farmworkers/rural men compared with controls/urban men. The publication from the cross-sectional study conducted in Brazil also reported that men living in rural areas and who mixed or applied pesticides had increased testis volume, decreased LH levels, or increased testosterone:LH ratios compared with men living in rural areas and who did not mix or apply pesticides, but the publication reported null associations of blood ChE activity with reproductive hormones and semen quality.214 A publication from another cross-sectional study in Brazil reported that recent use of fungicides in general, X-cyhalothrin (pyrethroid insecticide), and phthalimide (fungicide) was associated with increased LH levels in men living in agricultural communities.201 A cross-sectional study of reproductive-age women in Venezuela found that women who were occupationally exposed to pesticides had longer menstrual cycles than those who were not exposed.212 Last, a publication from a retrospective cohort of fertile women aerially exposed to glyphosate in Colombia reported null associations with fecundability.211
Overall, publications from studies conducted to date provide some evidence of associations between exposure to pesticides, particularly OC pesticides, OP pesticides, and carbamates, with reproductive outcomes such as infertility, changes in sex hormone levels (e.g., testosterone and estradiol), and alterations in semen quality among adults in LAC countries. Although 10 of 16 studies employed direct exposure assessment methods, most were cross-sectional in design and had small sample sizes, limiting causal inference.
Birth Outcomes and Child Growth
Thirteen publications reported on the association of pesticide exposure with birth outcomes and infant/child growth (Table 8). Of the 13 publications, 7 focused on OC pesticides,188'215-217 4 on OP pesticides or carbamates,54'169'172'210 1 on Mn-containing fungicides,218 and 1 on multiple pesticide classes.219 A publication from a small cross-sectional study in Brazil reported null associations of maternal and newborn contamination indices- estimated using metal and OC pesticide concentrations measured in maternal blood at delivery and cord blood-with birth outcomes.217 In contrast, a publication from a cross-sectional study of mother-newborn pairs from Bolivia reported that higher cord blood DDT concentrations were associated with lower birth weight, whereas higher cord blood DDE concentrations were associated with higher birth weight and shorter gestation length.188 Publications from two prospective cohort studies in Mexico reported null associations of prenatal DDT or DDE exposure with birth outcomes and child growth during the first year of life216 and up to 43 months of age.215 Three publications from a prospective cohort study in Guadeloupe reported that higher cord blood chlordecone concentrations were associated with shorter length of gestation and increased risk of preterm birth,220 lower birth weight in children whose mothers gained a large amount of weight during pregnancy,221 and higher body mass index (BMI) at 3-18 months of age.222
Four publications from cross-sectional studies in Argentina examined the association between prenatal OP pesticide exposure and fetal growth. Two of them reported a lower mean birth weight among mother-newborn pairs from a rural area compared with controls,54'169 whereas the other two found no differences in growth parameters between exposure groups.172'223 A publication from a prospective cohort study conducted in Argentina reported lower birth length and smaller head circumference in children living in proximity to pesticide applications compared with those living in an urban area.219 Finally, a publication from a prospective cohort study of mother-newborn pairs living near banana plantations aerially sprayed with Mn-containing fungicides in Costa Rica found that maternal Mn concentrations in hair, but not blood, were positively associated with infant chest circumference.218
Overall, the small number of published studies that have examined the association of pesticide exposure with birth size and child growth in LAC populations have reported mixed findings. More specifically, about half of the studies found some evidence of adverse outcomes and the other half reported null associations.
Other Health Problems
Kidney function. Nine publications reported on the association between pesticide exposure-ascertained only via questionnaire- and kidney function (Table 9). Notably, six of these nine publications reported null associations with estimated glomerular filtration rate (eGFR) levels or prevalence of chronic kidney disease (CKD).224-229 In contrast, a publication from a cross-sectional study conducted in Nicaragua reported that accidental pesticide inhalation (ever), but not lifetime days of mixing/applying pesticide or lifetime days of working in fields with pesticide use, was associated with reduced eGFR.230 A publication from a cross-sectional study in Mexico reported a reduction in eGFR levels among migrant and seasonal farmworkers (who did not apply or mix pesticides) from preharvest to late harvest, as well as lower GFR levels among farmworkers who worked in conventional fields compared with those who worked in organic fields.231 Last, a publication from a prospective cohort study of school-age children from a tobacco-producing region in Brazil reported increased levels ofmicroalbuminuria at the beginning of the pesticide application period compared with the leaf harvest period, suggesting that children environmentally exposed to xenobiotics in rural areas may suffer from early kidney dysfunction.52
Respiratory and allergic outcomes. Seven publications from three cross-sectional studies, two prospective cohort studies, and one case-control study reported on the associations of pesticide exposure with respiratory and allergic outcomes (Table 9). Publications from all three cross-sectional studies focused on occupational exposure to pesticides,232-234 but only one examined exposure-outcome associations using direct methods of pesticide exposure assessment.234 One of the publications reported increased odds of wheeze and shortness of breath among Costa Rican female farmworkers exposed to chlorpyrifos and terbufos compared with the control group (organic farmworkers/unexposed women) but found no differences in lung function between groups.232 In contrast, a cross-sectional study of farmworkers and their relatives living in rural areas in Brazil observed associations between years of working with pesticides and pesticide handling frequency with decreased pulmonary function.233 A publication from a study of Colombian farmworkers reported that those exposed to mixtures of pesticides containing paraquat-assessed via urinary biomarkers-and profenofos or glyphosate-assessed via questionnaire-had an increased prevalence of allergic rhinitis.234 This publication also reported that farmworkers chronically exposed to paraquat had an increased prevalence of self-reported asthma.
Four studies examined the potential effects of pesticide exposure on respiratory and allergic outcomes among mothers and their children. For instance, a publication from a prospective cohort study in Costa Rica reported that self-reported current pesticide use near the home (yes/no) and higher urinary concentrations of 5-hydroxytiabendazole (5-OH-TBZ)-a metabolite of the fungicide thiabendazole-were associated with increased odds of asthma among mothers, whereas previous work in agriculture was associated with decreased odds of rhinitis but increased odds of eczema.235 A publication from this same cohort study in Costa Rica reported an association between high urinary ETU concentrations during the first half of pregnancy and increased odds of lower respiratory tract infections (LRTIs) in the first year of life.236 This publication also reported that high ETU concentrations during the second half of pregnancy were associated with decreased odds of wheezing in the first year of life. Notably, a publication from a prospective cohort study in Mexico reported null associations of prenatal DDT or DDE exposure with LRTIs months among boys assessed up to 30 months of age.237 At last, a publication from a case-control study of school-age children in Brazil reported that factors such as living close to agricultural activity, and aerial pesticide spraying near the home were associated with increased odds of uncontrolled asthma at 6-7 and 13-14 years of age.235
Liver injury. Eight publications reported on the association of pesticide exposure with markers of liver injury (Table 9). Six of the eight publications were from studies that ascertained pesticide exposure only via questionnaire,81'88'206'238-240 whereas two studies measured blood ChE241 or blood P-glucuronidase activity.242 A publication from a cross-sectional study in Mexico reported that a higher activity of P-glucuronidase-a sensitive biomarker of OP pesticide exposure243'244-was associated with increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (GGT) levels.242 Notably, a publication from a cross-sectional study conducted in Brazil reported null associations of AChE and BChE activities with markers of liver injury, but it also reported that farmworkers had lower AST and ALT levels than controls.241 In contrast, apublication from a second study in Brazil reported higher AST levels in farmworkers than in controls during the high pesticide exposure period, but it also reported lower ALT levels in farmworkers during both the high and low pesticide exposure periods.239 A publication from a prospective cohort study of rural pregnant women environmentally exposed to OP pesticides in Argentina reported higher AST, but not ALT, levels during the spraying period compared with the prespraying period.206 Likewise, a publication from a cross-sectional study conducted in Brazil reported higher AST and ALT levels in Brazilian female, but not male, farmworkers occupationally exposed to multiple classes of pesticides than in controls.238 A published cross-sectional study conducted in Ecuador also found that women living in one agricultural community, but not women living in another agricultural area, had a greater percentage of ALT and AST levels exceeding normal levels compared with controls.81 A publication from a separate cross-sectional study in Brazil reported lower alkaline phosphatase levels in farmworkers who had worked with pesticides than in those who had not.88 Last, a publication from a cross-sectional study of individuals living close to an uncontrolled contaminated site containing the residues and leftovers of a deactivated OC pesticide factory in Brazil reported null associations of pesticide exposure with markers of liver injury.240
Hematological parameters and lipid profiles. Fourteen publications reported on the associations of pesticide exposure with hematological parameters (Table 9). Twelve of the 14 publications relied on questionnaires to assess environmental or occupational pesticide exposure52'54'73'81'94'96'98'238'245-248; only 2 ascertained exposure via direct exposure assessment and used these measurements in their exposure-outcome analyses.242'249 Four publications reported null associations with hematological parameters.54'94'98'238 Conversely, 2 publications from cross-sectional studies conducted in Mexico96 and Ecuador81 reported higher hemoglobin and hematocrit levels in those occupationally or environmentally exposed to pesticides than in those unexposed. In addition, a publication from a different cross-sectional study in Mexico (mentioned above) found that higher P-glucuronidase activity was associated with higher hemoglobin and hematocrit levels.242 A case-control study conducted in Brazil, Argentina, and Mexico found increased odds of aplastic anemia among adults exposed to pesticides.245
A publication from a cross-sectional study in Brazil reported decreased neutrophils and monocytes among tobacco farmworkers exposed to multiple pesticide classes, but not among controls.73 Notably, a publication from a prospective cohort study of school-age children from a tobacco-producing region in Brazil (mentioned above) also reported lower numbers of neutrophils, monocytes, and basophils, but higher hemoglobin levels and lymphocytes, at the beginning of the pesticide application period compared with the leaf harvest period.52 Similarly, a publication from a cross-sectional study of Brazilian farmworkers and their families reported that detectable serum concentrations of various OC pesticides [i.e., hexachlorocyclohexane (HCH), aldrin, hepta-chlor, fraras-nonachlor, endosulfan, endrin, DDT, DDE, and methoxychlor] were associated with lower numbers of white blood cells, particularly monocytes and eosinophils.249 This publication also reported that detectable serum concentrations of y-chlordane were associated with lower hemoglobin levels. Last, cross-sectional studies conducted in Brazil246'247 and Colombia248 reported associations between farm work, length of pesticide exposure (i.e., >10 y), and exposure during the harvest period with alterations in various hematological parameters, including hemoglobin levels and number of leukocytes, platelets, and monocytes.
Eight publications reported on associations between pesticide exposure and lipid profiles in LAC populations (Table 9); three of them reported null associations.94'96'98 Two publications from cross-sectional studies conducted in Ecuador81 and Mexico250 reported lower cholesterol or low-density lipoprotein levels among individuals with high pesticide exposure compared with those with moderate or no exposure. The study in Mexico also found associations of higher blood BChE activity with higher cholesterol, triglyceride, very low-density lipoprotein, or total lipid levels, but these associations varied by BMI.250 A publication from another cross-sectional study in Mexico (mentioned above) found that higher P-glucuronidase activity was associated with higher cholesterol, triglyceride, and total lipid levels, but also with lower high-density lipoprotein levels.242 A publication from a cross-sectional study of coffee harvesters in Colombia exposed to OP pesticides reported that higher blood BChE activity was associated with hypercholesterolemia (defined as total cholesterol >200 mg/dL).251 Conversely, a cross-sectional study in Brazil reported higher total cholesterol levels among farmworkers who had not worked with pesticides.88
Acoustic damage. Eight publications from cross-sectional studies conducted in Brazil evaluated the association of exposure to either the OP pesticide malathion or several pesticide classes- assessed via questionnaire-with hearing problems (Table 9). Seven of the eight publications reported that elevated pesticide exposure was associated with acoustic damage, as indicated by poorer performance in tests such as the Distortion Product Otoacoustic Emissions (DPOAE) test, the Transient Stimulus Otoacoustic Emissions (TSOAE) test, the Duration Pattern test (DPT), and the Gaps-in-Noise test (GIN).252-258 In contrast, a publication from a small cross-sectional study of rural workers in Brazil reported null associations between AChE activity and hearing loss.259
Other outcomes. Single publications reported on the associations of pesticide exposure with various health outcomes (Table 9). Overall, these publications-which were primarily from cross-sectional studies that ascertained exposure solely through questionnaires-reported associations of exposure to several classes of pesticides with a variety of outcomes, including changes in blood pressure,251'260-262 diarrhea,263 rheumatoid arthritis,264 high blood glucose levels242 and glutathione ^-transferase activity,265 sleep disorders,266 skin problems,62'84'103'267'268 thoracic spine and neck pain,269'270 changes in interleukin expression,102 overweight/obesity,271 green tobacco sickness,272 and death273-275; however, results should be interpreted with caution given the limited weight of evidence. In addition, some publications reported that pesticide exposure was associated with poorer general health status or symptoms of APP (e.g., fatigue/tiredness, nervousness, headache, anxiety, and depression).57'62'84'103'138'159'223'267'268'276'277
Overall, publications from studies conducted to date provide somewhat consistent evidence of the associations between pesticide exposure with acoustic damage and changes in markers of liver injury (e.g., when comparing exposed with unexposed or when comparing exposed during the spraying and prespraying season). Conversely, published studies that have examined the associations of pesticide exposure with kidney function, respiratory/allergic outcomes, and hematological parameters and lipid profiles in LAC populations have reported mixed findings. All these reported associations need to be interpreted with caution given that most published studies were relatively small, cross-sectional in design, and assessed exposure to multiple classes of pesticides via questionnaire.
Discussion
The results of our scoping review provide some evidence that exposure to pesticides may adversely impact the health of LAC populations. For instance, we observed that occupational andresidential exposure to OP pesticides or several pesticide classes was consistently associated with higher levels of increased chromosomal aberration frequency, nuclear buds, oxidative stress, or cell death. We also observed relatively consistent evidence of the adverse neurobehavioral effects of elevated OP pesticide and carbamate exposure levels, particularly among children and farmworkers. The latter finding is in line with those of previous systematic reviews on the neurobehavioral effects of OP pesticide exposure.23'36'37'40'278'279 Published studies on teratogenicity and placental outcomes, cancer, thyroid function, reproductive outcomes, and birth outcomes and child growth were largely heterogeneous in terms of pesticide exposure and outcome assessment methods and their results were mixed. Findings on other health outcomes, including respiratory and allergic effects, were too sparse to discern the directionality of an effect, if any.
To our knowledge, only one literature review besides ours has focused on the health effects of pesticide exposure in different populations from a specific region of the world.280 This systematic literature review of all research on environmental and human health issues associated with pesticide exposure in sub-Saharan Africa published between 2006 and 2021 reported some findings consistent with ours.280 For example, the review of sub-Saharan Africa literature found that OC and OP pesticides were the pesticides classes most frequently studied in the region. In our scoping review, we found that OC and OP pesticides such as DDT, endo-sulfan, and chlordane-pesticides that have been banned by countries in the European Union and the United States281-283- were among the pesticides classes most frequently examined in the LAC region. Both reviews identified that published studies were primarily cross-sectional in design and relied largely on indirect pesticide exposure assessment methods (e.g., questionnaire, job status ascertainment). Notably, the most frequently examined health effects in sub-Saharan Africa studies were signs and symptoms of APP (self-reported and doctor-diagnosed), whereas genotoxicity and neurobehavioral outcomes were the most frequently assessed among LAC populations.
As more research on the health effects of pesticide exposure is conducted in LAC countries, we believe that it is critical to address three fundamental limitations to the current body of literature. First, there must be a more widespread investment in research capacities across the LAC region. In our scoping review, we identified studies from 16 of the 43 LAC countries and territories, and 2 countries- Brazil and Mexico-accounted for nearly 60% of the included studies. Central American countries (except for Costa Rica) and Caribbean territories were among those with the lowest research outputs, and evidence suggests that efforts to increase research capacities often focus on the countries with some existing capacity,284 perpetuating health inequities in countries with the lowest levels of research and support. Second, future research must address limitations in study design and data collection to increase the rigor and robustness of epidemiological findings. Given the limited funding to develop infrastructure and conduct research in most LAC countries,285 most studies included in this review were small cross-sectional studies-which are important in terms of hypothesis generation but have limited causal inference. In addition, nearly half of the studies included in this review relied on indirect exposure assessment methods (e.g., questionnaires or exposure classification based on self-report, job title, or area of residence), which may result in exposure misclassification that could bias epidemiological findings toward the nuu286-288 an(j potentially account for conflicting study findings.289 Self-reported pesticide exposure may be particularly prone to recall bias288'289 and may be worsened under certain conditions, including studies of participants with low educational attainment or high residential mobility.290 Furthermore, pesticide use in LAC countries varies by crop and season-which causessignificant exposure variation, both in terms of intensity and chemical composition291-and farmworkers or pesticide applicators are often not informed of the specific pesticide active ingredients used in their farms.233'277'292 In our scoping review, most of the studies that assessed pesticide exposure via biomonitoring relied on analysis of a single sample and may have not accurately captured chronic exposure to pesticides with short biological half-lives and high inter- and intra-individual variability,293'294 which are frequently used in LAC countries. This potential exposure misclas-sification due to single time point sampling may have biased study findings toward or away from the null, depending on the time in which the exposure was captured. Last, studies included in our review employed a wide range of health outcome assessment methods, which were often not validated nor considered gold standards, hindering comparisons of study findings across populations within and outside of the LAC region. Third, studies should employ more robust statistical analyses and more systematic reporting of methods and results to facilitate comparisons across study populations. We found that many studies lacked clear presentation of key information, such as the covariates used in multivariable analyses or the specific pesticide(s) being examined (e.g., some publications solely indicated they collected samples to be analyzed for AChE activity, and we inferred they were examining OPs and carbamates). In addition, multiple studies did not report effect estimates and simply reported the prevalence of the outcome among exposed and unexposed groups. Strengthening research capacity in the LAC region is needed to increase the rigor of epidemiological studies and generate robust evidence regarding associations between pesticide exposure and its health effects.
In addition to addressing the limitations raised above, several knowledge gaps remain regarding the health effects of pesticides in LAC populations. As an example, a limited number of studies included in our review have assessed exposure to current-use pesticides that are applied widely in the LAC region and the rest of the world, such as pyrethroids, glyphosate, neonicotinoids, and fungicides.20'295-297 Similarly, few studies have examined the health effects of early-life exposure to pesticides-a critical period of brain298'299 and lung300'301 development-or the effects of pesticides on common chronic diseases, such as cardiometabolic disorders and neurodegenerative diseases.302'303 Although farmworkers and those living in agricultural areas are simultaneously exposed to numerous pesticides,304 only three studies have examined the health effects of exposure to pesticide mixtures using statistical methods that accounted for copollutant confounding.82'106'234 More studies are needed to understand the true independent and aggregate effect of exposure to mixtures of pesticides,305'306 which may require more widespread training of researchers in environmental mixtures methods. Finally, it is increasingly understood that the health effects of environmental chemicals may be due in part to interactions with nonchemical exposures, such as poverty, neighborhood violence, and malnutrition.307-310 Socioeconomically disadvantaged populations in LAC countries, such as immigrants or indigenous people, have less access to legal protections and are frequent victims of unregulated work arrangements, leading to disproportionately high levels of pesticide exposure292 and potentially more adverse health outcomes. Nevertheless, few of the studies included in our scoping review examined the joint effects of pesticides and unique psychosocial stressors experienced by populations in the region.
Recommendations for Future Research
In LAC countries and territories, generating robust evidence on the health effects of pesticide exposure is essential to inform agricultural policies and public health surveillance programs aimed at post-registration control of pesticides and the development and implementation of pesticide safety guidelines. Given the resourcelimitations and sociocultural context of agricultural populations across the LAC region, potential areas of prioritization for future work include the following:
o Increasing funding for research and capacity building. The Pan American Health Organization (PAHO), a regional office of the World Health Organization (WHO) for the Americas, has called for strengthening research in each member country to promote health equity and socioeconomic development.311 Given the widespread use of pesticides across the LAC region, it is imperative to strengthen institutional capacities to produce research and generate robust evidence that could be used to inform national and regional health policies. For example, difficulties associated with pesticide biomonitoring may be amplified in studies conducted in LAC countries owing to limited laboratory capacity and availability of analytical techniques to measure biomarkers of exposure. In addition, insufficient funding and infrastructure limit the ability to carry out large-scale epidemiological studies, which may contribute to the widespread reliance on small cross-sectional studies.
To improve the quality and quantity of health research in the LAC region, capacity building must become a key component of global research funding, with a focus on countries where the infrastructure and capacity do not currently exist.285 Although some models have proposed increased "North-South" collaborations, these projects often align with the priorities of the funders, rather than the countries' needs, and few projects have resulted in sustainable long-term partnerships that are equitable to the investigators in the home countries where the research was conducted.312 We recommend that any collaborations with institutions outside of the LAC region explicitly include local researchers in the design and implementation of the study,313 focus on capacity development in the country, and critically examine power dynamics to ensure more equitable partnerships where the research is tailored to the needs of the local populations.314
o Increasing collaboration within the LAC region. Beyond collaborations outside of the LAC region, we recommend increasing research synergies and the development of more interdisciplinary research teams across LAC countries. For example, the creation of networks of researchers within the region could contribute to the homogenization of exposure and health outcomes assessments (e.g., specific test or scale employed, age of assessment) and the systematization of reporting methods and results in publications, improving the ability to compare and synthesize results across studies. Previous literature discussing the need for increased research synergies in the LAC region have specifically focused on supporting early career researchers through initiatives such as in the development of national and regional graduate programs that strengthen regional collaborations, enable sustainable research careers, and decrease the high mobility of doctoral students and early career researchers outside of the region.315
Although farming systems and ecological conditions vary across the LAC region,316 increased homogenization of research within the region could potentially contribute to the homogenization of regulatory decisions, such as banning particular hazardous pesticides that are subject of international conventions and agreements, improving management and control of pesticides, restricting dispersive pesticide applications methods (e.g., light aircrafts, spray-booms), implementing pesticide-free buffer zones, and promoting sustainable agriculture and alternatives to pesticide use, which could result in more protective policies at both the national and regional levels.
o Increasing rigor of epidemiological studies. Studies that can incorporate biomonitoring should consider the use of bio-markers that reflect exposure to specific pesticides, including current-use pesticides (e.g., glyphosate, neonicotinoids, pyr-ethroids), and should assess exposure at multiple time points, if possible. In studies where biomonitoring is cost prohibitive or logistically infeasible, indirect exposure assessment may be improved by incorporating additional methods that are less prone to bias, including purchasing/inventory records, personal exposure monitoring (e.g., breathing zone air sampling, dermal wipes), environmental sampling data (e.g., ambient air monitoring, drinking water),9'11'12 and development of surrogate exposure estimates based on nearby pesticide use assessed via Geographic Information Systems.33 In addition, rather than dichotomously classifying participants as farmworkers vs. non-farmworkers, studies could employ more detailed occupational assessments and job-exposure matrices examining factors such as job titles and tasks, specific crops and active ingredients, and more complete occupational history that may decrease error due to exposure misclassification.288 Studies should also use standardized and validated outcome assessment methods across population subgroups from different LAC countries and territories to improve researchers' ability to compare findings across studies inside and outside the region.
In addition to increasing the rigor when designing epidemiological studies, we recommend the inclusion of more robust statistical analyses and a shift away from the presentation of bivariate results alone. We also recommend the sys-tematization of the presentation of key information in the methods and results of publications, including the specific pesticides being assessed, statistical methods used, and study results to facilitate comparisons across studies and better support causal inference.
Strengths and Limitations of This Scoping Review
Given the methodological differences in study design, populations studied, and exposure and health outcome assessments employed across the studies included in this review, we were not able to summarize the evidence on health effects of pesticide exposure in LAC populations using a quantitative synthesis or meta-analysis. In addition, our search strategy was focused on the use of the word "pesticides" plus Latin America or "pesticides" plus each of the names of the 43 LAC countries and territories. This strategy may have led to missed information because some studies could have used more specific keywords such as the pesticide's nature (e.g., herbicides, fungicides, insecticides) or the names of pesticide active ingredients (e.g., mancozeb, chlorde-cone). Our literature search also focused solely on PubMed and SciELO, and it is possible that other common databases in the LAC region, such as Latindex and Latin American and Caribbean Health Sciences Literature (LILACS), could have yielded additional publications. Despite its limitations, we believe that this scoping review provides a useful overview of the status of the research regarding the health effects of pesticide exposure and gives insight into existing data gaps and research capacity building needs in the region.
Conclusions
Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations. Nevertheless, methodological limitations such as reliance on cross-sectional study designs and indirect exposure assessment methods, as well as heterogeneity in the assessment of healthoutcomes and presentation of study findings, undermine the strength of the conclusions. We recommend increasing capacity building, integrating research initiatives, and conducting more rigorous epidemiological studies that can address these limitations, better inform public health surveillance systems, and increase the impact of research on public policies. Acknowledgments We acknowledge the leadership of the Latin American and the Caribbean (LAC) Chapter of the International Society of Environmental Epidemiology (ISEE) for their support of this article. Agnes Soares da Silva is a staff member of the Pan American Health Organization. The contents are the sole responsibility of the authors and do not necessarily reflect the official views, decisions, or policies of the Pan American Health Organization or ISEE LAC. For more information on ISEE LAC Chapter, please visit https://isee-lac.org/. L.A.Z.V., M.T.M.Q., M.B., G.C., S.C., and A.M.M. conceived the scoping review. Literature search and screening were carried out by L.A.Z.V., C.H., and M.T.M.Q. Full-text review and information extraction were conducted by L.A.Z.V., C.H., M.T.M.Q., L.Q.A., M.B., R.B., A.C., R.A.F., C.F., N.G., J.P.G.J., B.A.L., M.P.M., M.R.S., A.R.S., N.T., B.vW.dJ., G.M.C., A.J.H., A.S.daS., S.C., and A.M.M. The first draft of the manuscript was written by L.A.Z.V. and M.T.M.Q. and critically reviewed by C.H., L.Q.A., A.J.H., A.S.daS., S.C., and A.M.M. Figures and tables were elaborated by L.A.Z.V., C.H., and A.M.M. All authors read and approved the final manuscript.
References 1. OECD/FAO (Organization for Economic Cooperation and Development, Food and Agriculture Organization). 2019. AOCED-FAO Agricultural Outlook 2019-2028. Special Focus: Latin America. Rome, Italy: Paris/Food and Agriculture Organization of the United Nations, https://reliefweb.int/attachments/22af2430-3306-308b-9f79-174616ac4148/CA4076EN.pdf [accessed 30 June 2022]. 2. Jepson PC, Murray K, Bach 0, Bonilla MA, Neumeister L 2020. Selection of pesticides to reduce human and environmental health risks: a global guideline and minimum pesticides list. Lancet Planet Health 4(2):e56-e63, PMID: 32112748, https://doi.Org/10.1016/S2542-5196(19)30266-9.
3. FA0 (Food and Agriculture Organization). 2019. FA0STAT food and agricultural data, pesticide use data 2019. http://www.fao.Org/faosta1/en/#data/RP [accessed 16 January 2022]. 4. Winkler MS, Atuhaire A, Fuhrimann S, Mora A, Niqagaba C, Oltramare C, et al. 2019. Environmental exposures, health effects and institutional determinants of pesticide use in two tropical settings. DORA Eawag. https://www.dora. Iib4ri.ch/eawag/islandora/objec1/eawag:19081 [accessed 16 February 2022].
5. Wesseling C, Corriols M, Bravo V. 2005. Acute pesticide poisoning and pesticide registration in Central America. Toxicol Appl Pharmacol 207(suppl 2):697-705, PMID: 16153991, https://doi.Org/10.1016/j.taap.2005.03.033. 6. Caldas ED. 2016. Pesticide poisoning in Brazil. In: Reference Module in Earth Systems and Environmental Sciences, pp. 419-427. New York, NY: Elsevier.
7. World Bank. 2020. Population, total. https://data.worldbank.org/indicator/SP. POP.TOTL?end=2020&start=1960&view=chart [accessed 17 January 2022]. 8. Bardach AE, Garcia-Perdomo HA, Alcaraz A, Tapia Lopez E, Gandara RAR, Ruvnsky S, et al. 2019. Interventions for the control of Aedes aegypti'm Latin America and the Caribbean: systematic review and meta-analysis. Trap Med Int Health 24(5):530-552, PMID: 30771267, https://doi.org/10.1111/tmi.13217.
9. Cordoba Gamboa L, Solano Diaz K, Ruepert C, van Wendel de Joode B. 2020. Passive monitoring techniques to evaluate environmental pesticide exposure: results from the Infanfs Environmental Health study (ISA). Environ Res 184:109243, PMID: 32078818, https://doi.Org/10.1016/j.envres.2020.109243. 10. Dereumeaux C, Fillol C, Quenel P, Denys S. 2020. Pesticide exposures for residents living close to agricultural lands: a review. Environ Int 134:105210, PMID: 31739132, https://doi.Org/10.1016/j.envint.2019.105210.
11. Pozo K, Llanos Y, Estellano VH, Cortes S, Jorquera H, Gerli L, et al. 2016. Occurrence of chlorpyrifos in the atmosphere of the Araucania Region in Chile using polyurethane foam-based passive air samplers. Atmos Pollut Res 7(4):706-710, https://doi.Org/10.1016/j.apr.2016.03.003. 12. Cortes S, Pozo K, Llanos Y, Martinez N, Foerster C, Leiva C, et al. 2020. First measurement of human exposure to current use pesticides (CUPs) in the
atmosphere of central Chile: the case study of Mauco cohort. Atmos Pollut Res 11(4):776-784, https://doi.Org/10.1016/j.apr.2019.12.023. 13. Lopez-Galvez N, Wagoner R, Quiros-Alcala L, Ornelas Van Home Y, Furlong M, Avila E, et al. 2019. Systematic literature review of the take-home route of pesticide exposure via biomonitoring and environmental monitoring. Int J Environ Res Public Health 16(121:2177, PMID:31248217,https://doi.org/10.3390/ijerph16122177.
14. Caldas ED, Boon PE, Tressou J. 2006. Probabilistic assessment of the cumulative acute exposure to organophosphorus and carbamate insecticides in the Brazilian diet. Toxicology 222(1 2):132 142, PMID: 16563591, https://doi.org/10. 1016/j.tox.2006.02.006. 15. Caldas ED, Souza LCKR. 2004. Chronic dietary risk for pesticide residues in food in Brazil: an update. Food Addit Contam 21(11):1057 1064, PMID: 15764334, https://doi.org/10.1080/02652030400009225. 16. Benitez-Diaz P, Miranda-Contreras L 2013. Surface water pollution by residues in Venezuela and other Latin American countries. Rev Int de Contam Ambient 29(1 ):7-23.
17. de Carvalho Dores EFG, De-Lamonica-Freire EM. 2001. Aquatic environment contamination by pesticides. Case study: water used for human consumption in Primavera do Leste, Mato Grosso-preliminary analyses [in Portuguese]. Quim Nova 24:27-36, https://doi.org/10.1590/S0100-40422001000100007. 18. Gonzalez-Andrade F, Lopez-Pulles R, Estevez E. 2010. Acute pesticide poisoning in Ecuador: a short epidemiological report. J Public Health 18(5):437-442, https://doi.org/10.1007/s10389-010-0333-y.
19. Corriols M, Marin J, Berroteran J, Lozano LM, Lundberg 1. 2009. Incidence of acute pesticide poisonings in Nicaragua: a public health concern. Occup Environ Med 66(31:205-210, PMID: 19028804, https://doi.org/10.1136/oem.2008.040840. 20. Benbrook CM. 2016. Trends in glyphosate herbicide use in the United States and globally. Environ Sci Eur 28(1):3, PMID: 27752438, https://doi.org/10.1186/ S12302-016-0070-0.
21. Gullino ML, Tinivella F, Garibaldi A, Kemmitt GM, Bacci L, Sheppard B. 2010. Mancozeb: past, present, and future. Plant Dis 94(9): 1076-1087, PMID: 30743728, https://doi.org/10.1094/PDIS-94-9-1076. 22. Kim KH, Kabir E, Jahan SA. 2017. Exposure to pesticides and the associated human health effects. Sci Total Environ 575:525-535, PMID: 27614863, https://doi.Org/10.1016/j.scitotenv.2016.09.009.
23. Sapbamrer R, Hongsibsong S. 2019. Effects of prenatal and postnatal exposure to organophosphate pesticides on child neurodevelopment in different age groups: a systematic review. Environ Sci Pollut Res Int 26(18):18267-18290, PMID: 31041704, https://doi.org/10.1007/s11356-019-05126-w. 24. Staudacher P, Fuhrimann S, Farnham A, Mora AM, Atuhaire A, Niwagaba C, et al. 2020. Comparative analysis of pesticide use determinants among smallholder farmers From Costa Rica and Uganda. Environ Health Insights 14:1178630220972417, PMID: 33402828, https://doi.org/10.1177/1178630220972417.
25. Thundiyil JG, Stober J, Besbelli N, Pronczuk J. 2008. Acute pesticide poisoning: a proposed classification tool. Bull World Health Organ 86(3):205-209, PMID: 18368207, https://doi.org/10.2471/blt.08.041814. 26. Corriols M, Marin J, Berroteran J, Lozano LM, Lundberg I, Thorn A 2008. The Nicaraguan Pesticide Poisoning Register: constant underreporting. Int J Health Serv 38(41:773-787, PMID: 19069292, https://doi.Org/10.2190/HS.38.4.k. 27. Cervantes Morant R. 2010. Plaguicidas en Bolivia: sus implicaciones en la salud, agricultura y medio ambiente. Rev virtual REDESMA4(1).
28. Kesavachandran CN, Fareed M, Pathak MK, Bihari V, Mathur N, Srivastava AK. 2009. Adverse health effects of pesticides in agrarian populations of developing countries. Rev Environ Contam Toxicol 200:33-52, PMID: 19680610, https://doi.org/10.1007/978-1-4419-0028-9_2. 29. Bravo V, Rodriguez T, van Wendel de Joode B, Canto N, Calderon GR, et al. 2011. Monitoring pesticide use and associated health hazards in Central America. Int J Occup Environ Health 17(3):258-269, PMID: 21905395, https://doi.org/10.1179/107735211799041896.
30. Ruiz-Guzman JA, Gomez-Corrales P, Cruz-Esquivel A, Marrugo-Negrete JL 2017. Cytogenetic damage in peripheral blood lymphocytes of children exposed to pesticides in agricultural areas of the department of Cordoba, Colombia. Mutat Res Genet Toxicol Environ Mutagen 824:25-31, PMID: 29150047, https://doi.Org/10.1016/j.mrgentox.2017.10.002. 31. Noyes PD, McElwee MK, Miller HD, Clark BW, Van Tiem LA, Walcott KC, et al. 2009. The toxicology of climate change: environmental contaminants in a warming world. Environ Int 35(6):971-986, PMID: 19375165, https://doi.org/10. 1016/j.envint.2009.02.006.
32. Weiss FT, Leuzinger M, Zurbriigg C, Eggen HIL 2016. Chemical Pollution in Low- and Middle-Income Countries. Diibendorf, Switzerland: Swiss Federal Institute of Aquatic Science and Technology (Eawag). 33. Goodman JE, Prueitt RL, Boffetta P, Halsall C, Sweetman A. 2020. "Good epidemiology practice" guidelines for pesticide exposure assessment. Int J Environ Res Public Health 17(14):5114, PMID: 32679916, https://doi.org/10.3390/ ijerph17145114.
34. Ntzani EE, Ntritsos G CM, Evangelou E, Tzoulaki I. 2013. Literature review on epidemiological studies linking exposure to pesticides and health effects. EFSA Support Publ 10(10):497E, https://doi.org/10.2903/sp.efsa.2013.EN-497.
35. EFSA PPR (EFSA Panel on Plant Protection Products and their Residues), Ockleford C, Adriaanse P, Berny P, Brock T, Duquesne S, et al. 2017. Scientific Opinion of the PPR Panel on the follow-up of the findings of the External Scientific Report'Literature review of epidemiological studies linking exposure to pesticides and health effects'. EFSA J 15(10):e05007, PMID: 32625302, https://doi.Org/10.2903/j.efsa.2017.5007.
36. Muhoz-Quezada MT, Lucero BA, Iglesias VP, Muhoz MP, Cornejo CA, Achu E, et al. 2016. Chronic exposure to organophosphate (OP) pesticides and neuropsychological functioning in farm workers: a review. Int J Occup Environ Health 22(1):68-79, PMID: 27128815, https://doi.org/10.1080/10773525.2015.1123848. 37. Muhoz-Quezada MT, Lucero BA, Barr DB, Steenland K, Levy K, Ryan PB, et al. 2013. Neurodevelopmental effects in children associated with exposure to organophosphate pesticides: a systematic review. Neurotoxicology 39:158-168, PMID: 24121005, https://doi.Org/10.1016/j.neuro.2013.09.003.
38. Lucero B, Munoz-Quezada MT. 2021. Neurobehavioral, neuromotor, and neu-rocognitive effects in agricultural workers and their children exposed to pyr-ethroid pesticides: a review. Front Hum Neurosci 15:648171, PMID: 34335205, https://doi.org/10.3389/fnhum.2021.648171. 39. Chang ET, Odo NU, Acquavella JF. 2022. Systematic literature review of the epidemiology of glyphosate and neurological outcomes. Int Arch Occup Environ Health Preprint posted online 23 May 2022, PMID: 35604441, https://doi.Org/10.1007/S00420-022-01878-0.
40. Dorea JG. 2021. Exposure to environmental neurotoxic substances and neurodevelopment in children from Latin America and the Caribbean. Environ Res 192:110199, PMID: 32941839, https://doi.Org/10.1016/j.envres.2020.110199. 41. Buralli RJ, Dultra AF, Ribeiro H. 2020. Respiratory and allergic effects in children exposed to pesticides-a systematic review. Int J Environ Res Public Health 17(8):2740, PMID: 32316194, https://doi.org/10.3390/ijerph17082740.
42. Rozas ME. 2021. Revision de Estudios Epidemiologicos sobre Efects de los Plaguicidas en Ninas, Nihos e Inantes de America Latina. Buenos Aires, Argentina: Red de Accion en Plaguicidas y sus Alternativas de America Latina (RAP-AL). https://reduas.com.ar/wp-content/uploads/2021/12/Revision-de-Estudios-epidemiologicos_ni%C3%B1os_plaguicidas_Maria-Elena-Rozas-071221.doc-1.pdf [accessed 30 June 2022].
43. Sanchez-Alarcon J, Milic M, Kasuba V, Tenorio-Arvide MG, Montiel-Gonzalez JMR, Bonassi S, et al. 2021. A systematic review of studies on genotoxicity and related biomarkers in populations exposed to pesticides in Mexico. Toxics 9(11):272, PMID: 34822663, https://doi.org/10.3390/toxics9110272. 44. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. 2018. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467^73, PMID:30178033, https://doi.org/10.7326/M18-0850. 45. Latin American and the Caribbean Chapter of the International Society of Environmental Epidemiology. 2018. Bylaws: International Society for Environmental Epidemiology Latin American and the Caribbean (LAC) Chapter, https://iseepi.org/ docs/ISEE_LAC_Chapter_Bylaws_FINAL.pdf [accessed 8 August 2022].
46. Alvarado-Hernandez DL, Montero-Montoya R, Serrano-Garcia L, Arellano-Aguilar 0, Jasso-Pineda Y, Yahez-Estrada L 2013. Assessment of exposure to organochlorine pesticides and levels of DNA damage in mother-infant pairs of an agrarian community. Environ Mol Mutagen 54(2):99-111, PMID: 23355095, https://doi.org/10.1002/em.21753. 47. Jasso-Pineda Y, Diaz-Barriga F, Yahez-Estrada L, Perez-Vazquez FJ, Perez-Maldonado IN. 2015. DNA damage in Mexican children living in high-risk contaminated scenarios. Sci Total Environ 518-519:38-48, PMID: 25747362, https://doi.Org/10.1016/j.scitotenv.2015.02.073.
48. Anguiano-Vega GA, Cazares-Ramirez LH, Rendon-Von Osten J, Santillan-Sidon AP, Vazquez-Boucard CG. 2020. Risk of genotoxic damage in schoolchildren exposed to organochloride pesticides. Sci Rep 10(1):17584, PMID: 33067503, https://doi.org/10.1038/s41598-020-74620-w. 49. Gomez-Arroyo S, Martinez-Valenzuela C, Calvo-Gonzalez S, Villalobos-Pietrini R, Waliszewski SM, Calderon-Segura ME, et al. 2013. Evaluacion del riesgo genotoxico de nihos mexicanos que viven cerca de zonas agricolas con aspersion aerea de plaguicidas. Rev Int Contam Ambie 29:217-225.
50. Bernardi N, Gentile N, Manas F, Mendez A, Gorla N, Aiassa D. 2015. Assessment of the level of damage to the genetic material of children exposed to pesticides in the province of Cordoba. Arch Argent Pediatr 113(2):126-131, PMID: 25727816, https://doi.org/10.5546/aap.2015.eng.126. 51. Castaheda-Yslas IJ, Arellano-Garcia ME, Garcia-Zarate MA, Ruiz-Ruiz B, Zavala-Cerna MG, Torres-Bugarin 0. 2016. Biomonitoring with micronuclei test in buccal cells of female farmers and children exposed to pesticides of Maneadero Agricultural Valley, Baja California, Mexico. J Toxicol 2016:7934257, PMID: 26981119, https://doi.Org/10.1155/2016/7934257.
52. Nascimento SN, Goethel G, Baierle M, Barth A, Brucker N, Charao MF, et al. 2017. Environmental exposure and effects on health of children from a
tobacco-producing region. Environ Sci Pollut Res Int 24(3)2851-2865, PMID: 27838906, https://doi.org/10.1007/s11356-016-8071-5. 53. Leite SB, Franco de Diana DM, Segovia Abreu JA, Avalos DS, Denis MA, Ovelar CC, et al. 2019. DNA damage induced by exposure to pesticides in children of rural areas in Paraguay. Indian J Med Res 150(3):290-296, PMID: 31719300, https://doi.org/10.4103/ijmr.IJMR_1497_17.
54. Quintana MM, Vera B, Magnarelli G, Guihazu N, Rovedatti MG. 2017. Neonatal, placental, and umbilical cord blood parameters in pregnant women residing in areas with intensive pesticide application. Environ Sci Pollut Res Int 24(25):20736-20746, PMID: 28718019, https://doi.org/10.1007/s11356-017-9642-9. 55. Barron Cuenca J, Aguilar Mercado X, Navia Bueno P. 2015. Exposicion a pla-guicidas, desnutricion cronica y daho genotoxico en menores de tres ahos. Luribay. Cuad Hosp Clin 56(2):9-17. 56. Franco FC, Alves AA, Godoy FR, Avelar JB, Rodrigues DD, Pedroso TMA, et al. 2016. Evaluating genotoxic risks in Brazilian public health agents occupational^ exposed to pesticides: a multi-biomarker approach. Environ Sci Pollut Res Int 23(19):19723-19734, PMID: 27406225, https://doi.org/10.1007/s11356-016-7179-y.
57. SilverioACP, MachadoSC, Azevedo L, Nogueira DA, de Castro Graciano MM, Simoes JS, et al. 2017. Assessment of exposure to pesticides in rural workers in southern of Minas Gerais, Brazil. Environ Toxicol Pharmacol 55:99-106, PMID: 28843102, https://doi.Org/10.1016/j.etap.2017.08.013. 58. Zepeda-Arce R, Rojas-Garcia AE, Benitez-Trinidad A, Herrera-Moreno JF, Medina-Diaz IM, Barron-Viva nco BS, et al. 2017. Oxidative stress and genetic damage among workers exposed primarily to organophosphate and pyrethroid pesticides. Environ Toxicol 32(6):1754-1764, PMID: 28233943, https://doi.org/10. 1002/tox.22398.
59. Benitez-Trinidad AB, Medina-Diaz IM, Bernal-Hernandez YY, Barron-Vivanco BS, Gonzalez-Aria CA, Herrera-Moreno JF, et al. 2018. Relationship between LINE-1 methylation pattern and pesticide exposure in urban sprayers. Food Chem Toxicol 113:125-133, PMID: 29374593, https://doi.Org/10.1016/j.fct.2018.01.035. 60. Xotlanihua-Gervacio MDC, Guerrero-Flores MC, Herrera-Moreno JF, Medina-Diaz IM, Bernal-Hernandez YY, Barron-Vivanco BS, et al. 2018. Micronucleus frequency is correlated with antioxidant enzyme levels in workers occupational^ exposed to pesticides. Environ Sci Pollut Res Int 25(31 ):31558-31568, PMID: 30206828, https://doi.org/10.1007/s11356-018-3130-8.
61. Herrera-Moreno JF, Medina-Diaz IM, Bernal-Hernandez YY, Ramos KS, Alvarado-Cruz I, Quintanilla-Vega B, et al. 2019. Modified CDKN2B (p/5) and CDKN2A ipIS) DNA methylation profiles in urban pesticide applicators. Environ Sci Pollut Res Int 26(15):15124-15135, PMID: 30924039, https://doi.org/ 10.1007/sl 1356-019-04658-5. 62. Butinof M, Fernandez RA, Lerda D, Lantieri MJ, Filippi I, Diaz MDP. 2019. Biomonitoreo en exposicion a plaguicidas y su aporte en vigilancia epidemiologica en agroaplicadores en Cordoba, Argentina. Gac Sanit 33(3):216-221, PMID: 29510874, https://doi.Org/10.1016/j.gaceta.2017.12.002.
63. Bernieri T, Moraes MF, Ardenghi PG, Basso da Silva L 2020. Assessment of DNA damage and cholinesterase activity in soybean farmers in southern Brazil: high versus low pesticide exposure. J Environ Sci Health B 55(4):355-360, PMID: 31868080, https://doi.org/10.1080/03601234.2019.1704608. 64. Valencia-Quintana R, Lopez-Duran RM, Milic M, Bonassi S, Ochoa-Ocaha MA, Uriostegui-Acosta MO, et al. 2021. Assessment of cytogenetic damage and cholinesterases' activity in workers occupational^ exposed to pesticides in Zamora-Jacona, Michoacan, Mexico. Int J Environ Res Public Health 18(12):6269, PMID: 34200547, https://doi.org/10.3390/ijerph18126269.
65. Aiassa DE, Mafias FJ, Gentile NE, Bosch B, Salinero MC, Gorla NBM. 2019. Evaluation of genetic damage in pesticides applicators from the province of Cordoba, Argentina. Environ Sci Pollut Res Int 26(20):20981-20988, PMID: 31115805, https://doi.org/10.1007/s11356-019-05344-2. 66. Simoniello MF, Contini L, Benavente E, Mastandrea C, Roverano S, Paira S. 2017. Different end-points to assess effects in systemic lupus erythematosus patients exposed to pesticide mixtures. Toxicology 376:23-29, PMID: 27497885, https://doi.Org/10.1016/j.tox.2016.08.003.
67. Martinez LN, Mastandrea C, Benavente E, Roverano S, Paira S, Poletta GL, et al. 2016. Evaluacion de estres oxidativo en pacientes con Lupus Eritematoso Sistemico y su posible relacion con la exposicion ambiental a agroquimicos. Acta Toxicol Argent 24(1 ):10 20. 68. Paredes-Cespedes DM, Herrera-Moreno JF, Bernal-Hernandez YY, Medina-Diaz IM, Salazar AM, Ostrosky-Wegman P, et al. 2019. Pesticide exposure modifies DNA methylation of coding region of WRAP53a, an antisense sequence of p53, in a Mexican population. Chem Res Toxicol 32(7): 1441 -1448, PMID: 31243981, https://doi.org/10.1021/acs.chemrestox.9b00153.
69. Jors E, Gonzales AR, Ascarrunz ME, Tirado N, Takahashi C, Lafuente E, et al. 2007. Genetic alterations in pesticide exposed Bolivian farmers: an evaluation by analysis of chromosomal aberrations and the comet assay. Biomark Insights 2:439-445, PMID: 19662224, https://doi.Org/10.1177/117727190700200017. 70. Kehdy FSG, Cerqueira EMM, Bonjardim MB, Camelo RM, Castro MCL 2007. Study of the cytogenetic effects of occupational exposure to pesticides onsanitation workers in Belo Horizonte, Brazil. Genet Mol Res 6(3):581 593, PMID: 17985311.
71. Khayat CB, Costa EOA, Gongalves MW, da Cruz e Cunha DM, da Cruz AS, de Araujo Melo CO, et al. 2013. Assessment of DNA damage in Brazilian workers occupationally exposed to pesticides: a study from Central Brazil. Environ Sci Pollut Res Int 20(10):7334-7340, PMID: 23640389, https://doi.org/10.1007/ S11356-013-1747-1. 72. Wilhelm CM, Calsing AK, da Silva LB. 2015. Assessment of DNA damage in floriculturists in southern Brazil. Environ Sci Pollut Res Int 22(11):8182-8189, PMID: 25516252, https://doi.org/10.1007/s11356-014-3959-4.
73. Alves JS, da Silva FR, da Silva GF, Salvador M, Kvitko K, Rohr P, et al. 2016. Investigation of potential biomarkers for the early diagnosis of cellular stability after the exposure of agricultural workers to pesticides. An Acad Bras Cienc 88(1):349-360, PMID: 26839999, https://doi.org/10.1590/0001-3765201520150181. 74. Kahl VFS, Simon D, Salvador M, Branco CdosS, Dias JF, da Silva FR, et al. 2016. Telomere measurement in individuals occupationally exposed to pesticide mixtures in tobacco fields. Environ Mol Mutagen 57(1):74-84, PMID: 26426910, https://doi.Org/10.1002/em.21984.
75. Chaves TVS, Islam MT, de Moraes MO, de Alencar MVOB, Gomes DCV, de Carvalho RM, et al. 2017. Occupational and life-style factors-acquired mutagenicity in agric-workers of northeastern Brazil. Environ Sci Pollut Res Int 24(18):15454-15461, PMID: 28510803, https://doi.org/10.1007/s11356-017-9150-y.
76. Tomiazzi JS, Judai MA, Nai GA, Pereira DR, Antunes PA, Favareto APA. 2018. Evaluation of genotoxic effects in Brazilian agricultural workers exposed to pesticides and cigarette smoke using machine-learning algorithms. Environ Sci Pollut Res Int 25(2):1259-1269, PMID: 29086360, https://doi.org/10.1007/ s11356-017-0496-y. 77. Vazquez Boucard C, Lee-Cruz L, Mercier L, Ramirez Orozco M, Serrano Pinto V, Anguiano G, et al. 2017. A study of DNA damage in buccal cells of consumers of well- and/or tap-water using the comet assay: assessment of occupational exposure to genotoxicants. Environ Mol Mutagen 58(8):619-627, PMID: 9S71J179 httnc7/Hni nrn/10 mn9/pm 99111
Lot 14 1 /L, II LLpb.//UUI.UI y/ 1 U. 1 \i\iLj<d\\\.LL III. 78. Hutter HP, Khan AW, Lemmerer K, Wallner P, Kundi M, Moshammer H. 2018 Cytotoxic and genotoxic effects of pesticide exposure in male coffee farmworkers of the Jarabacoa Region, Dominican Republic. Int J Environ Res Public Health 15(8):1641, PMID: 30081446, https://doi.org/10.3390/ijerph15081641. 79. Claudio SR, Simas JMM, Souza ACF, do Carmo Baracho de Alencar M, Yamauchi LY, Ribeiro DA. 2019. Genomic instability and cytotoxicity in buccal mucosal cells of workers in banana farming evaluated by micronucleus test. Anticancer Res 39(3):1283-1286, PMID: 30842159, https://doi.org/10.21873/ anticanres.13239.
80. Kahl VFS, Dhillon VS, Simon D, da Silva FR, Salvador M, Branco CDS, et al. 2018. Chronic occupational exposure endured by tobacco farmers from Brazil and association with DNA damage. Mutagenesis 33(2): 119-128, PMID: 29669110, https://doi.org/10.1093/mutage/gex045. 81. Arevalo-Jaramillo P, Idrobo A, Salcedo L, Cabrera A, Vintimilla A, Carrion M, et al. 2019. Biochemical and genotoxic effects in women exposed to pesticides in southern Ecuador. Environ Sci Pollut Res Int 26(24):24911-24921, PMID: 31243655, https://doi.org/10.1007/s11356-019-05725-7. 82. Barron Cuenca J, Tirado N, Barral J, AN I, Levi M, Stenius U, et al. 2019. Increased levels of genotoxic damage in a Bolivian agricultural population exposed to mixtures of pesticides. Sci Total Environ 695:133942, PMID: 31756860, https://doi.Org/10.1016/j.scitotenv.2019.133942.
83. Cepeda S, Forero-Castro M, Cardenas-Nieto D, Martinez-Agiiero M, Rondon-Lagos M. 2020. Chromosomal instability in farmers exposed to pesticides: high prevalence of clonal and non-clonal chromosomal alterations. Risk Manag Healthc Policy 13:97-110, PMID: 32104116, https://doi.org/10.2147/ RMHP.S230953. 84. Hutter HP, Poteser M, Lemmerer K, Wallner P, Sanavi SS, Kundi M, et al. 2020. Indicators of genotoxicity in farmers and laborers of ecological and conventional banana plantations in Ecuador. Int J Environ Res Public Health 17(4):1435, PMID: 32102275, https://doi.org/10.3390/ijerph17041435.
85. Salazar-Flores J, Pacheco-Moises FP, Ortiz GG, Torres-Jasso JH, Romero-Renteria 0, Briones-Torres AL, et al. 2020. Occupational exposure to organo-phosphorus and carbamates in farmers in La Cienega, Jalisco, Mexico: oxidative stress and membrane fluidity markers. J Occup Med Toxicol 15(1 ):32, PMID: 33133223, https://doi.org/10.1186/s12995-020-00283-y. 86. da Silva J, Moraes CR, Heuser VD, Andrade VM, Silva FR, Kvitko K, et al. 2008 Evaluation of genetic damage in a Brazilian population occupationally exposed to pesticides and its correlation with polymorphisms in metabolizing genes. Mutagenesis 23(5):415-422, PMID: 18550589, https://doi.org/10.1093/mutage/ gen031.
87. de Souza Espindola Santos A, Parks CG, Senna MM, de Carvalho LVB, Meyer A. 2021. Exposure to pesticides and oxidative stress in Brazilian agricultural communities. Biomarkers 26(6):539-547, PMID: 34082618, https://doi.org/10. 1080/1354750X.2021.1933593.
88. Cattelan MDP, Maurer F, Garcia F, Berro LF, Machado MM, Manfredini V, et al. 2018. Occupational exposure to pesticides in family agriculture and the oxidative, biochemical and hematological profile in this agricultural model. Life Sci 203:177-183, PMID: 29689275, https://doi.Org/10.1016/j.lfs.2018.04.038. 89. Kahl VFS, Dhillon V, Fenech M, de Souza MR, da Silva FN, Marroni NAP, et al. 2018. Occupational exposure to pesticides in tobacco fields: the integrated evaluation of nutritional intake and susceptibility on genomic and epigenetic instability. Oxid Med Cell Longev 2018:7017423, PMID: 29967663, https://doi.org/ 10.1155/2018/7017423.
90. Marcelino AF, Wachtel CC, Ghisi NdeC. 2019. Are our farm workers in danger? Genetic damage in farmers exposed to pesticides. Int J Environ Res Public Health 16(3):358, PMID: 30691246, https://doi.org/10.3390/ijerph16030358. 91. Simoniello MF, Kleinsorge EC, Scagnetti JA, Grigolato RA, Poletta GL, Carballo MA. 2008. DNA damage in workers occupationally exposed to pesticide mixtures. J Appl Toxicol 28(8):957-965, PMID: 18636400, https://doi.org/ 10.1002/jat.1361. 92. de Bortoli GM, de Azevedo MB, da Silva LB. 2009. Cytogenetic biomonitoring of Brazilian workers exposed to pesticides: micronucleus analysis in buccal epithelial cells of soybean growers. Mutat Res 675(1 2):1 4, PMID: 19386239, https://doi.Org/10.1016/j.mrgentox.2009.01.001.
93. Martinez-Valenzuela C, Gomez-Arroyo S, Villalobos-Pietrini R, Waliszewski S, Calderon-Segura ME, Felix-Gastelum R, et al. 2009. Genotoxic biomonitoring of agricultural workers exposed to pesticides in the north of Sinaloa State, Mexico. Environ Int 35(8):1155-1159, PMID: 19665797, https://doi.Org/10.1016/j. envint.2009.07.010. 94. Remor AP, Totti CC, Moreira DA, Dutra GP, Heuser VD, Boeira JM. 2009. Occupational exposure of farm workers to pesticides: biochemical parameters and evaluation of genotoxicity. Environ lnt35(2):273-278, PMID: 18678410, https://doi.Org/10.1016/j.envint.2008.06.011.
95. Simoniello MF, Kleinsorge EC, Carballo MA. 2010. Evaluacion bioquimica de trabajadores rurales expuestos a pesticidas. Medicina (B Aires) 70:489-498, PMID: 21163734. 96. Payan-Renteria R, Garibay-Chavez G, Rangel-Ascencio R, Preciado-Martinez V, Muhoz-lslas L, Beltran-Miranda C, et al. 2012. Effect of chronic pesticide exposure in farm workers of a Mexico community. Arch Environ Occup Health 67(1):22-30, PMID: 22315932, https://doi.org/10.1080/19338244.2011.564230.
97. Benedetti D, Nunes E, Sarmento M, Porto C, Dos Santos CEI, Dias JF, et al. 2013. Genetic damage in soybean workers exposed to pesticides: evaluation with the comet and buccal micronucleus cytome assays. Mutat Res 752(1-2):28-33, PMID: 23347873, https://doi.Org/10.1016/j.mrgentox.2013.01.001. 98. Adad LMDM, de Andrade HH, Kvitko K, Lehmann M, Calcante AADCM, Dihl RR. 2015. Occupational exposure of workers to pesticides: toxicogenetics and susceptibility gene polymorphisms. Genet Mol Biol 38(3):308-315, PMID: 9RRnnd*3d httnc7/Hni nrn/10 1RQn/91d1 R-d7R7^S^9nidn^^R
£0DUU404, II LLpb.//UUI.UI y/ 1 U. 1 DSU/O 141 J 4/ D1OOOAU I4U000. 99. Bianco GE, Suarez E, Cazon L, de la Puente TB, Ahrendts MRB, De Luca JC. 2017. Prevalence of chromosomal aberrations in Argentinean agricultural workers. Environ Sci Pollut Res Int 24(26):21146-21152, PMID: 28730367, https://doi.org/10.1007/s11356-017-9664-3. 100. Hilgert Jacobsen-Pereira C, Dos Santos CR, Troina Maraslis F, Pimental L, Feigo AJL, Silva CI, et al. 2018. Markers of genotoxicity and oxidative stress in farmers exposed to pesticides. Ecotoxicol Environ Saf 148:177-183, PMID: 29055201, https://doi.Org/10.1016/j.ecoenv.2017.10.004.
101. de Oliveira AFB, de Souza MR, Benedetti D, Scotti AS, Piazza LS, Garcia ALH, et al. 2019. Investigation of pesticide exposure by genotoxicological, biochemical, genetic polymorphic and in silico analysis. Ecotoxicol Environ Saf 179:135-142, PMID: 31035247, https://doi.Org/10.1016/j.ecoenv.2019.04.023. 102. Lovison Sasso E, Cattaneo R, Rosso Storck T, Spanamberg Mayer M, SanfAnna V, Clasen B. 2021. Occupational exposure of rural workers to pesticides in a vegetable-producing region in Brazil. Environ Sci Pollut Res Int 28(20):25758-25769, PMID: 33469792, https://doi.org/10.1007/s11356-021-12444-5.
103. Filippi 1, Lucero P, Bonansea Rl, Lerda D, Butinof M, Fernandez RA, et al. 2021. Validation of exposure indexes to pesticides through the analysis of exposure and effect biomarkers in ground pesticide applicators from Argentina. Heliyon 7(9):e07921, PMID: 34522813, https://doi.Org/10.1016/j.heliyon.2021.e07921. 104. Mafias F, Agost L, Salinero MC, Mendez A, Aiassa D. 2021. Cytogenetic markers and their spatial distribution in a population living in proximity to areas sprayed with pesticides. Environ Toxicol Pharmacol 88:103736, PMID: 34478866, https://doi.Org/10.1016/j.etap.2021.103736.
105. Paz-y-Miho C, Muhoz MJ, Maldonado A, Valladares C, Cumbal N, Herrera C, et al. 2011. Baseline determination in social, health, and genetic areas in communities affected by glyphosate aerial spraying on the northeastern Ecuadorian border. Rev Environ Health 26(1):45-51, PMID: 21714381, https://doi.org/10.1515/ reveh.2011.007. 106. Varona-Uribe ME, Torres-Rey CH, Diaz-Criollo S, Palma-Parra RM, Narvaez DM, Carmona SP, et al. 2016. Exposure to pesticide mixtures and DNAdamage among rice field workers. Arch Environ Occup Health 71 (1):3-9, PMID: 24972111, https://doi.org/10.1080/19338244.2014.910489. 107. Torres-Sanchez L, Rothenberg SJ, Schnaas L, Cebrian ME, Osoria E, Del Carmen Hernandez M, et al. 2007. In utero p,p'-DDE exposure and infant neu-rodevelopment: a perinatal cohort in Mexico. Environ Health Perspect 115(3):435-439, PMID: 17431495, https://doi.org/10.1289/ehp.9566.
108. Torres-Sanchez L, Schnaas L, Cebrian ME, Hernandez MdeIC, Valencia EO, Garcia Hernandez RM, et al. 2009. Prenatal dichlorodiphenyldichloroethylene (DDE) exposure and neurodevelopment: a follow-up from 12 to 30 months of age. Neurotoxicology 30(6):1162-1165, PMID: 19733589, https://doi.org/10.1016/ j.neuro.2009.08.010.
109. Bahena-Medina LA, Torres-Sanchez L, Schnaas L, Cebrian ME, Chavez CH, Osorio-Valencia E, et al. 2011. Neonatal neurodevelopment and prenatal exposure to dichlorodiphenyldichloroethylene (DDE): a cohort study in Mexico. J Expo Sci Environ Epidemiol 21(6):609-614, PMID: 21750576, https://doi.org/ 10.1038/jes.2011.25. 110. Dallaire R, Muckle G, Rouget F, Kadhel P, Bataille H, Guldner L, et al. 2012. Cognitive, visual, and motor development of 7-month-old Guadeloupean infants exposed to chlordecone. Environ Res 118:79-85, PMID: 22910562, https://doi.org/ 10.1016/j.envres.2012.07.006.
111. Boucher 0, Simard MN, Muckle G, Rouget F, Kadhel P, Bataille H, et al. 2013. Exposure to an organochlorine pesticide (chlordecone) and development of 18-month-old infants. Neurotoxicology 35:162-168, PMID: 23376090, https://doi.org/ 10.1016/j.neuro.2013.01.007. 112. Torres-Sanchez L, Schnaas L, Rothenberg SJ, Cebrian ME, Osorio-Valencia E, Hernandez MdeIC, etal. 2013. Prenatal p,p'-DDE exposure and neurodevelopment among children 3.5-5 years of age. Environ Health Perspect 121 (2):263 268, PMID: 23151722, https://doi.org/10.1289/ehp.1205034.
113. Osorio-Valencia E,Torres-Sanchez L, Lopez-Carrillo L, Cebrian ME, Rothenberg SJ, Hernandez Chavez MdeIC, et al. 2015. Prenatal p,p'-DDE exposure and establishment of lateralization and spatial orientation in Mexican preschooler. Neurotoxicology 47:1-7, PMID: 25572880, https://doi.Org/10.1016/j.neuro.2014. 12.011. 114. Ogaz-Gonzalez R, Merida-Ortega A, Torres-Sanchez L, Schnaas L, Hernandez-Alcaraz C, Cebrian ME, et al. 2018. Maternal dietary intake of polyunsaturated fatty acids modifies association between prenatal DDT exposure and child neurodevelopment: a cohort study. Environ Pollut 238:698-705, PMID: 29621729, https://doi.Org/10.1016/j.envpol.2018.03.100.
115. Saint-Amour D, Muckle G, Gagnon-Chauvin A, Rouget F, Monfort C, Michineau L, et al. 2020. Visual contrast sensitivity in school-age Guadeloupean children exposed to chlordecone. Neurotoxicology 78:195-201, PMID: 32217184, https://doi.Org/10.1016/j.neuro.2020.02.012. 116. Cordier S, Forget-Dubois N, Desrochers-Couture M, Rouget F, Michineau L, Monfort C, et al. 2020. Prenatal and childhood exposure to chlordecone and sex-typed toy preference of 7-year-old Guadeloupean children. Environ Sci Pollut Res Int 27(33):4097H0979, PMID: 31264154, https://doi.org/10.1007/ s11356-019-05686-x.
117. Cordier S, Bouquet E, Warembourg C, Massart C, Rouget F, Kadhel P, et al. 2015. Perinatal exposure to chlordecone, thyroid hormone status and neurodevelopment in infants: the Timoun cohort study in Guadeloupe (French West Indies). Environ Res 138:271-278, PMID: 25747818, https://doi.Org/10.1016/j. envres.2015.02.021. 118. Campos E, Freire C, Novaes CdeO, Koifman RJ, Koifman S. 2015. Exposure to organochloride pesticides and the cognitive development of children and adolescents living in a contaminated area in Brazil. Rev Bras Saude Matern Infant 15(1 ):105-120, https://doi.Org/10.1590/S1519-38292015000100009.
119. Steenland K, Mora AM, Barr DB, Juncos J, Roman N, Wesseling C. 2014. Organochlorine chemicals and neurodegeneration among elderly subjects in Costa Rica. Environ Res 134:205-209, PMID: 25173053, https://doi.Org/10.1016/j. envres.2014.07.024. 120. Handal AJ, Harlow SD, Breilh J, Lozoff B. 2008. Occupational exposure to pesticides during pregnancy and neurobehavioral development of infants and toddlers. Epidemiology 19(6):851-859, PMID: 18813021, https://doi.org/10.1097/ EDE.0b013e318187cc5d.
121. Handal AJ, Lozoff B, Breilh J, Harlow SD. 2007. Neurobehavioral development in children with potential exposure to pesticides. Epidemiology 18(3):312-320, PMID: 17435439, https://doi.org/10.1097/01.ede.0000259983.55716.bb. 122. Suarez-Lopez JR, Himes JH, Jacobs DR Jr, Alexander BH, Gunnar MR. 2013. Acetylcholinesterase activity and neurodevelopment in boys and girls. Pediatrics 132(6):e1649-e1658, PMID: 24249815, https://doi.org/10.1542/peds. 2013-0108.
123. Harari R, Julvez J, Murata K, Barr D, Bellinger DC, Debes F, et al. 2010. Neurobehavioral deficits and increased blood pressure in school-age children prenatally exposed to pesticides. Environ Health Perspect 118(6):890-896, PMID: 20185383, https://doi.org/10.1289/ehp.0901582.
124. Suarez-Lopez JR, Hood N, Suarez-Torres J, Gahagan S, Gunnar MR, Lopez-Paredes D. 2019. Associations of acetylcholinesterase activity with depression and anxiety symptoms among adolescents growing up near pesticide spray sites. Int J Hyg Environ Health 222(7):981-990, PMID: 31202795, https://doi.Org/10.1016/j.ijheh.2019.06.001. 125. Suarez-Lopez JR, Nguyen A, Klas J, Gahagan S, Checkoway H, Lopez-Paredes D, et al. 2021. Associations of acetylcholinesterase inhibition between pesticide spray seasons with depression and anxiety symptoms in adolescents, and the role of sex and adrenal hormones on gender moderation. Expo Health 13(1 ):51-64, PMID: 33748533, https://doi.org/10.1007/s12403-020-00361-w.
126. Suarez-Lopez JR, Checkoway H, Jacobs DR Jr, Al-Delaimy WK, Gahagan S. 2017. Potential short-term neurobehavioral alterations in children associated with a peak pesticide spray season: the Mother's Day flower harvest in Ecuador. Neurotoxicology 60:125-133, PMID: 28188819, https://doi.org/10.1016/ j.neuro.2017.02.002. 127. Muhoz-Quezada MT, IglesiasV, Lucero-Mondaca B.2011. Exposicion a orga-nofosforados y desempeho cognitivo en escolares rurales chilenos: un estu-dio exploratorio. Rev Fac Nac Salud Publica 29(3):256-263. 128. Fortenberry GZ, Meeker JD, Sanchez BN, Barr DB, Panuwet P, Bellinger D, et al. 2014. Urinary 3,5,6-trichloro-2-pyridinol (TCPY) in pregnant women from Mexico City: distribution, temporal variability, and relationship with child attention and hyperactivity. Int J Hyg Environ Health 217(2-3):405-412, PMID: 24001412, https://doi.Org/10.1016/j.ijheh.2013.07.018.
129. Martos-Mula AJ, Saavedra ON, Wierna NR, Ruggeri MA, Tschambler JA, Carreras A, et al. 2013. Afectacion de las funciones cognitivas y motoras en nihos residentes de zonas rurales de Jujuy y su relacion con plaguicidas inhib-idores de la colinesterasa: un estudio piloto. Acta Toxicol Argent 21(1 ):15-25. 130. Handal AJ, Lozoff B, Breilh J, Harlow SD. 2007. Effect of community of residence on neurobehavioral development in infants and young children in a flower-growing region of Ecuador. Environ Health Perspect 115(1): 128-133, PMID: 17366832, https://doi.org/10.1289/ehp.9261.
131. Corral SA, de Angel V, Salas N, Zuhiga-Venegas L, Gaspar PA, Pancetti F. 2017. Cognitive impairment in agricultural workers and nearby residents exposed to pesticides in the Coquimbo Region of Chile. Neurotoxicol Teratol 62:13-19, PMID: 28579518, https://doi.Org/10.1016/j.ntt.2017.05.003. 132. Muhoz-Quezada MT, Lucero B, Iglesias V, Muhoz MP, Achu E, Cornejo C, et al. 2016. Organophosphate pesticides and neuropsychological and motor effects in the Maule Region, Chile [in Spanish]. Gac Sanit 30(3):227-231, PMID: 26907086, https://doi.Org/10.1016/j.gaceta.2016.01.006.
133. Ramirez-Santana M, Zuhiga-Venegas L, Corral S, Roeleveld N, Groenewoud H, Van der Velden K, et al. 2020. Reduced neurobehavioral functioning in agricultural workers and rural inhabitants exposed to pesticides in northern Chile and its association with blood biomarkers inhibition. Environ Health 19(1 ):84, PMID: 32698901, https://doi.org/10.1186/s12940-020-00634-6. 134. Ramirez-Santana M, Zuhiga-Venegas L, Corral S, Roeleveld N, Groenewoud H, van der Velden K, et al. 2020. Association between cholinesterase's inhibition and cognitive impairment: a basis for prevention policies of environmental pollution by organophosphate and carbamate pesticides in Chile. Environ Res 186:109539, PMID: 32361078, https://doi.Org/10.1016/j.envres.2020.109539.
135. Grillo Pizarro A, Achu Peralta E, Muhoz-Quezada MT, Lucero Mondaca B. 2018. Exposure to organophosphate pesticides and peripheral polyneuropathy in workers from Maule Region, Chile [in Spanish]. Rev Esp Salud Publica 92: e201803006, PMID: 29553128. 136. Wesseling C, van Wendel de Joode B, Keifer M, London L, Mergler D, Stallones L 2010. Symptoms of psychological distress and suicidal ideation among banana workers with a history of poisoning by organophosphate or n-methyl carbamate pesticides. Occup Environ Med 67(11):778 784, PMID: 20798019, https://doi.org/10.1136/oem.2009.047266.
137. Serrano-Medina A, Ugalde-Lizarraga A, Bojorquez-Cuevas MS, Garnica-Ruiz J, Gonzalez-Corral MA, Garcia-Ledezma A, et al. 2019. Neuropsychiatric disorders in farmers associated with organophosphorus pesticide exposure in a rural village of northwest Mexico. Int J Environ Res Public Health 16(5):689, PMID: 30813607, https://doi.org/10.3390/ijerph16050689. 138. Buralli RJ, Ribeiro H, Iglesias V, Muhoz-Quezada MT, Leao RS, Marques RC, et al. 2020. Occupational exposure to pesticides and health symptoms among familyfarmers in Brazil. Rev Saude Publica 54:133, PMID: 33331527, https://doi.org/ 10.11606/s 1518-8787.2020054002263.
139. Lu C, Essig C, Root C, Rohlman DS, McDonald T, Sulzbacher S. 2009. Assessing the association between pesticide exposure and cognitive development in rural Costa Rican children living in organic and conventional coffee farms. Int J Adolesc Med Health 21(4):609-621, PMID: 20306773, https://doi.org/10.1515/ ijamh.2009.21.4.609. 140. van Wendel de Joode B, Mora AM, Lindh CH, Hernandez-Bonilla D, Cordoba L, Wesseling C, et al. 2016. Pesticide exposure and neurodevelopment in children aged 6-9 years from Talamanca, Costa Rica. Cortex 85:137-150, PMID: 27773359, https://doi.Org/10.1016/j.cortex.2016.09.003.
141. Mora AM, Cordoba L, Cano JC, Hernandez-Bonilla D, Pardo L, Schnaas L, et al. 2018. Prenatal mancozeb exposure, excess manganese, and neurodevelopment at 1 year of age in the Infants' Environmental Health (ISA) study. Environ Health Perspect 126(5):057007, PMID: 29847083, https://doi.org/10. 1289/EHP1955.
142. Watkins DJ, Fortenberry GZ, Sanchez BN, Barr DB, Panuwet P, Schnaas L, et al. 2016. Urinary 3-phenoxybenzoic acid (3-PBA) levels among pregnant women in Mexico City: distribution and relationships with child neurodevelopment. Environ Res 147:307-313, PMID: 26922411, https://doi.Org/10.1016/j. envres.2016.02.025.
143. Eckerman DA, Gimenes LS, de Souza RC, Galvao PR, Sarcinelli PN, Chrisman JR. 2007. Age related effects of pesticide exposure on neurobehavioral performance of adolescent farm workers in Brazil. Neurotoxicol Teratol 29(1):164-175, PMID: 17123781, https://doi.Org/10.1016/j.ntt.2006.09.028. 144. Friedman E, Hazlehurst MF, Loftus C, Karr C, McDonald KN, Suarez-Lopez JR. 2020. Residential proximity to greenhouse agriculture and neurobehavioral performance in Ecuadorian children. Int J Hyg Environ Health 223(1 ):220-227, PMID: 31607631, https://doi.Org/10.1016/j.ijheh.2019.08.009.
145. Christian MA, Samms-Vaughan M, Lee M, Bressler J, Hessabi M, Grove ML, et al. 2018. Maternal exposures associated with autism spectrum disorder in Jamaican children. J Autism Dev Disord 48(8):2766-2778, PMID: 29549549, https://doi.Org/10.1007/s10803-018-3537-6. 146. Steenland K, Wesseling C, Roman N, Quiros 1, Juncos JL 2013. Occupational pesticide exposure and screening tests for neurodegenerative disease among an elderly population in Costa Rica. Environ Res 120:96-101, PMID: 23092715, https://doi.Org/10.1016/j. envres.2012.08.014.
147. Hansen MRH, Jors E, Lander F, Condarco G, Debes F, Bustillos NT, et al. 2017. Neurological deficits after long-term pyrethroid exposure. Environ Health Insights 11:1178630217700628, PMID: 28469448, https://doi.org/10. 1177/1178630217700628. 148. Conti CL, Barbosa WM, Simao JBP, Alvares-da-Silva AM. 2018. Pesticide exposure, tobacco use, poor self-perceived health and presence of chronic disease are determinants of depressive symptoms among coffee growers from Southeast Brazil. Psychiatry Res 260:187-192, PMID: 29202382, https://doi.org/ 10.1016/j.psychres.2017.11.063.
149. Campos Y, dos Santos Pinto da Silva V, Sarpa Campos de Mello M, Barros Otero U. 2016. Exposure to pesticides and mental disorders in a rural population of southern Brazil. Neurotoxicology 56:7-16, PMID: 27350176, https://doi.org/ 10.1016/j.neuro.2016.06.002. 150. Conti CL, Borgoi AR, Almanga CCJ, Barbosa WM, Archanjo AB, de Assis Pinheiro J, et al. 2020. Factors associated with depressive symptoms among rural residents from remote areas. Community Ment Health J 56(7): 1292 1297, PMID: 32451795, https://doi.org/10.1007/s10597-020-00637-0.
151. Farnham A, Fuhrimann S, Staudacher P, Quiros-Lepiz M, Hyland C, Winkler MS, et al. 2021. Long-term neurological and psychological distress symptoms among smallholder farmers in Costa Rica with a history of acute pesticide poisoning. Int J Environ Res Public Health 18(17):9021, PMID: 34501611, https://doi.Org/10.3390/ijerph 18179021.
152. Faria NM, Fassa AG, Meucci RD, Fiori NS, Miranda VI. 2014. Occupational exposure to pesticides, nicotine and minor psychiatric disorders among tobacco farmers in southern Brazil. Neurotoxicology 45:347-354, PMID: 24875484, https://doi.Org/10.1016/j.neuro.2014.05.002. 153. Cruzeiro Szortyka ALS, Faria NMX, Carvalho MP, Feijo FR, Meucci RD, Flesch BD, et al. 2021. Suicidality among South Brazilian tobacco growers. Neurotoxicology 86:52-58, PMID: 34214458, https://doi.Org/10.1016/j.neuro.2021.06.005.
154. Gonzaga CWP, Baldo MP, Caldeira AP. 2021. Exposure to pesticides or agroe-cological practices: suicidal ideation among peasant farmers in Brazil's semi-arid region. Cien Saude Colet 26(9):4243-4252, PMID: 34586275, https://doi.org/ 10.1590/1413-81232021269.09052020. 155. Portilla-Portilla A, Pinilla-Monsalve GD, Caballero-Carvajal AJ, Gomez-Rodrigues E, Marin-Hernandez LR, et al. 2014. Prevalencia de signos y sintomas asociados a la exposicion directa a plaguicidas neurotoxicos en una poblacion rural colombiana en 2013. Rev Medicas UIS 27(21:41- 49.
156. Vasconcellos PRO, Rizzotto MLF, Obregon PL, Alonzo HGA. 2020. Exposigao a agrotoxicos na agricultura e doenga de Parkinson em usuarios de urn servigo publico de saude do Parana, Brasil. Cad Saude Colet 28:567-578, https://doi.org/ 10.1590/1414-462x202028040109. 157. Silvestre GCSB, Ferreira MJM, Figueiredo SEFMR, Silva CALD, Siqueira HH, Silva AMCD. 2020. Parkinson disease and occupational and environmental exposure to pesticides in a region of intense agribusiness activity in Brazil: a case-control study. J Occup Environ Med 62(12):e732-e737, PMID: 33031131, https://doi.org/10.1097/JOM.0000000000002043.
158. de Azevedo MFA, Meyer A. 2017. Essential tremor in endemic disease control agents exposed to pesticides: a case-control study [in Portuguese]. Cad Saude Publica 33(8):e00194915, PMID: 28832787, https://doi.org/10.1590/0102-311X00194915.
159. de Araujo AJ, de Lima JS, Moreira JC, Jacob SdoC, Soares MdeO, Monteiro MCM, et al. 2007. Exposigao multipla a agrotoxicos e efeitos a saude: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 12(1):115-130, PMID: 17680063, https://doi.org/10.1590/S1413-81232007000100015. 160. Palzes VA, Sagiv SK, Baker JM, Rojas-Valverde D, Gutierrez-Vargas R, Winkler MS, et al. 2019. Manganese exposure and working memory-related brain activity in smallholder farmworkers in Costa Rica: results from a pilot study. Environ Res 173:539-548, PMID: 30991177, https://doi.Org/10.1016/j. envres.2019.04.006.
161. Bustamante Montes LP, Waliszewski S, Hernandez-Valero M, Sanin-Aguirre L, Infanzon-Ruiz RM, Jahas AG. 2010. Prenatal exposure to organochlorine pesticides and cryptorchidism [in Spanish]. Cien Saude Colet 15(suppl 1 ):1169-1174, PMID: 20640275, https://doi.org/10.1590/S1413-81232010000700025. 162. Oliveira NP, Moi GP, Atanaka-Santos M, Silva AM, Pignati WA. 2014. Congenital defects in the cities with high use of pesticides in the state of Mato Grosso, Brazil [in Portuguese]. Cien Saude Colet 19(10):4123-4130, PMID: 25272121, https://doi.org/10.1590/1413-812320141910.08512014.
163. Ueker ME, Silva VM, Moi GP, Pignati WA, Mattos IE, Silva AMC. 2016. Parenteral exposure to pesticides and occurence of congenital malformations: hospital-based case-control study. BMC Pediatr 16(1):125, PMID: 27520287, https://doi.org/10.1186/s12887-016-0667-x. 164. Gaspari L, Sampaio DR, Paris F, Audran F, Orsini M, Neto JB, et al. 2012. High prevalence of micropenis in 2710 male newborns from an intensive-use pesticide area of Northeastern Brazil. Int J Androl 35(3):253-264, PMID: 22372605, https://doi.Org/10.1111/J.1365-2605.2011.01241 .x.
165. Castillo-Cadena J, Mejia-Sanchez F, Lopez-Arriaga JA. 2017. Congenital malformations according to etiology in newborns from the floricultural zone of Mexico state. Environ Sci Pollut Res Int 24(8):7662-7667, PMID: 28124266, https://doi.org/10.1007/s11356-017-8429-3. 166. Silva SR, Martins JL, Seixas S, Silva DC, Lemos SP, Lemos PV. 2011. Congenital defects and exposure to pesticides in Sao Francisco Valley [in Portuguese]. Rev Bras Ginecol Obstet 33(1):20-26, PMID: 21625789.
167. Rouget F, Kadhel P, Monfort C, Viel JF, Thome JP, Cordier S, et al. 2020. Chlordecone exposure and risk of congenital anomalies: the Timoun Mother-Child Cohort Study in Guadeloupe (French West Indies). Environ Sci Pollut Res Int 27(33):40992^0998, PMID: 31376129, https://doi.org/10.1007/s11356-019-06031-y. 168. Vera B, Santa Cruz S, Magnarelli G. 2012. Plasma cholinesterase and carboxy-lesterase activities and nuclear and mitochondrial lipid composition of human placenta associated with maternal exposure to pesticides. Reprod Toxicol 34(3):402-407, PMID: 22580221, https://doi.Org/10.1016/j.reprotox.2012.04.007.
169. Rivera Osimani VL, Valdez SR, Guihazu N, Magnarelli G. 2016. Alteration of syncytiotrophoblast mitochondria function and endothelial nitric oxide synthase expression in the placenta of rural residents. Reprod Toxicol 61:47-57, PMID: 26939719, https://doi.Org/10.1016/j.reprotox.2016.02.018. 170. Bulgaroni V, Lombardo P, Rivero-Osimani V, Vera B, Dulgerian L, Cerban F, et al. 2013. Environmental pesticide exposure modulates cytokines, arginase and ornithine decarboxylase expression in human placenta. Reprod Toxicol 39:23-32, PMID: 23557688, https://doi.Org/10.1016/j.reprotox.2013.03.010.
171. Acosta-Maldonado B, Sanchez-Ramirez B, Reza-Lopez S, Levario-Carrillo M. 2009. Effects of exposure to pesticides during pregnancy on placental maturity and weight of newborns: a cross-sectional pilot study in women from the Chihuahua State, Mexico. Hum Exp Toxicol 28(8):451-459, PMID: 19744971, https://doi.org/10.1177/0960327109107045. 172. Chiapella G, Genti-Raimondi S, Magnarelli G. 2014. Placental oxidative status in rural residents environmentally exposed to organophosphates. Environ Toxicol Pharmacol 38(1):220-229, PMID: 24959959, https://doi.Org/10.1016/j.etap.2014. 06.001.
173. Brureau L, Emeville E, Helissey C, Thome JP, Multigner L, Blanchet P. 2020. Endocrine disrupting-chemicals and biochemical recurrence of prostate cancer after prostatectomy: a cohort study in Guadeloupe (French West Indies). Int J Cancer 146(3):657-663, PMID: 30892691, https://doi.org/10.1002/ijc.32287. 174. Emeville E, Giusti A, Coumoul X, Thome JP, Blanchet P, Multigner L 2015. Associations of plasma concentrations of dichlorodiphenyldichloroethylene and polychlorinated biphenyls with prostate cancer: a case-control study in Guadeloupe (French West Indies). Environ Health Perspect 123(4):317 323, PMID: 25493337, https://doi.org/10.1289/ehp.1408407.
175. Hyland C, Gunier RB, Metayer C, Bates MN, Wesseling C, Mora AM. 2018. Maternal residential pesticide use and risk of childhood leukemia in Costa Rica. Int J Cancer 143(6):1295-1304, PMID: 29658108, https://doi.org/10.1002/ijc.31522. 176. Monge P, Wesseling C, Guardado J, Lundberg 1, Ahlbom A, Cantor KP, et al. 2007. Parental occupational exposure to pesticides and the risk of childhood leukemia in Costa Rica. Scand J Work Environ Health 33(4):293-303, PMID: 17717622, https://doi.org/10.5271/sjweh.1146.
177. Hernandez-Morales AL, Zonana-Nacach A, Zaragoza-Sandoval VM. 2009. Associated risk factors in acute leukemia in children. A cases and controls
study [in Spanish]. Rev Med Inst Mex Seguro Soc 47(5):497-503, PMID: 20550859.
178. Ferreira JD, Couto AC, Pombo-de-Oliveira MS, Koifman S, Brazilian Collaborative Study Group of Infant Acute Leukemia. 2013. In utero pesticide exposure and leukemia in Brazilian children < 2 years of age. Environ Health Perspect 121(2):269-275, PMID: 23092909, https://doi.org/10.1289/ehp.1103942. 179. Ferreira JD, Couto AC, Alves LC, Pombo de Oliveira MdoS, Koifman S. 2012. Exposigoes ambientais e leucemias na infancia no Brasil: uma analise exploratoria de Sua associagao. Rev Bras Estud Popul 29:477-492, https://doi.org/ 10.1590/S0102-30982012000200014.
180. Ortega Jacome GP, Koifman RJ, Rego Monteiro GT, Koifman S. 2010. Environmental exposure and breast cancer among young women in Rio de Janeiro, Brazil. J Toxicol Environ Health A 73(13-14):858-865, PMID: 20563919, https://doi.org/10.1080/15287391003744773. 181. Silva AMC, Campos PHN, Mattos IE, Hajat S, Lacerda EM, Ferreira MJM. 2019. Environmental exposure to pesticides and breast cancer in a region of intensive agribusiness activity in Brazil: a case-control study. Int J Environ Res Public Health 16(20):3951, PMID: 31627286, https://doi.org/10. 3390/ijerph 16203951.
182. Segatto MM, Bonamigo RR, Hohmann CB, Miiller KR, Bakos L, Mastroeni S, et al. 2015. Residential and occupational exposure to pesticides may increase risk for cutaneous melanoma: a case-control study conducted in the south of Brazil. Int J Dermatol 54(12):e527-e538, PMID: 26266338, https://doi.org/10. 1111/ijd.12826. 183. Boccolini PM, Boccolini CS, Chrisman JR, Koifman RJ, Meyer A. 2017. Non-Hodgkin lymphoma among Brazilian agricultural workers: a death certificate case-control study. Arch Environ Occup Health 72(3):139-144, PMID: 27097109, https://doi.Org/10.1080/19338244.2016.1179167.
184. Meyer A, Alexandre PC, Chrisman JdeR, Markowitz SB, Koifman RJ, Koifman S. 2011. Esophageal cancer among Brazilian agricultural workers: case-control study based on death certificates. Int J Hyg Environ Health 214(2):151-155, PMID: 21159552, https://doi.Org/10.1016/j.ijheh.2010.11.002. 185. Miranda-Filho AL, Monteiro GT, Meyer A. 2012. Brain cancer mortality among farm workers of the State of Rio de Janeiro, Brazil: a population-based case-control study, 1996-2005. Int J Hyg Environ Health 215(5):496-501, PMID: 22118878, https://doi.Org/10.1016/j.ijheh.2011.10.007.
186. Boccolini PdeMM, Asmus CIRF, Chrisman JdeR, Camara VdeM, Markowitz SB, Meyer A. 2014. Stomach cancer mortality among agricultural workers: results from a death certificate-based case-control study. Cad Saude Colet 22:86-92, https://doi.org/10.1590/1414-462X201400010013. 187. Freire C, Koifman RJ, Sarcinelli P, Rosa AC, Clapauch R, Koifman S. 2012. Long term exposure to organochlorine pesticides and thyroid function in children from Cidade dos Meninos, Rio de Janeiro, Brazil. Environ Res 117:68-74, PMID: 22776325, https://doi.Org/10.1016/j.envres.2012.06.009.
188. Arrebola JP, Cuellar M, Bonde JP, Gonzalez-Alzaga B, Mercado LA. 2016. Associations of maternal o,p'-DDT and p,p'-DDE levels with birth outcomes in a Bolivian cohort. Environ Res 151:469-477, PMID: 27567351, https://doi.org/10. 1016/j.envres.2016.08.008. 189. Ayhan G, Rouget F, Giton F, Costet N, Michineau L, Monfort C, et al. 2021. In utero chlordecone exposure and thyroid, metabolic, and sex-steroid hormones at the age of seven years: a study from the TIMOUN Mother-Child Cohort in Guadeloupe. Front Endocrinol 12:771641, PMID: 34880833, https://doi.org/10. 3389/fendo.2021.771641.
190. Freire C, Koifman RJ, Sarcinelli PN, Simoes Rosa AC, Clapauch R, Koifman S. 2013. Long-term exposure to organochlorine pesticides and thyroid status in adults in a heavily contaminated area in Brazil. Environ Res 127:7-15, PMID: 24183346, https://doi.Org/10.1016/j.envres.2013.09.001.
191. Piccoli C, Cremonese C, Koifman RJ, Koifman S, Freire C. 2016. Pesticide exposure and thyroid function in an agricultural population in Brazil. Environ Res 151:389-398, PMID: 27540871, https://doi.Org/10.1016/j.envres.2016.08.011. 192. Blanco-Muhoz J, Lacasaha M, Lopez-Flores 1, Rodriguez-Barranco M, Gonzalez-Alzaga B, Bassol S, et al. 2016. Association between organochlorine pesticide exposure and thyroid hormones in floriculture workers. Environ Res 150:357-363, PMID: 27344267, https://doi.Org/10.1016/j.envres.2016.05.054.
193. Hernandez-Mariano JA, Torres-Sanchez L, Bassol-Mayagoitia S, Escamilla-Nuhez MC, Cebrian ME, Villeda-Gutierrez EA, et al. 2017. Effect of exposure to p,p'-DDE during the first half of pregnancy in the maternal thyroid profile of female residents in a Mexican floriculture area. Environ Res 156:597-604, PMID: 28448812, https://doi.Org/10.1016/j.envres.2017.04.013. 194. Londoho AL, Restrepo B, Sanchez JF, Garcia-Rios A, Bayona A, Landazuri P. 2018. Pesticides and hypothyroidism in farmers of plantain and coffee growing areas in Quindio, Colombia [in Spanish]. Rev Salud Publ (Bogota) 20(2):215-220, PMID: 30570004, https://doi.org/10.15446/rsap.v20n2.57694.
195. Phillips S, Suarez-Torres J, Checkoway H, Lopez-Paredes D, Gahagan S, Suarez-Lopez JR. 2021. Acetylcholinesterase activity and thyroid hormone levels in Ecuadorian adolescents living in agricultural settings where
organophosphate pesticides are used. Int J Hyg Environ Health 233:113691, PMID: 33581413, https://doi.Org/10.1016/j.ijheh.2021.113691. 196. Lacasaha M, Lopez-Flores 1, Rodriguez-Barranco M, Aguilar-Garduho C, Blanco-Muhoz J, Perez-Mendez 0, et al. 2010. Association between organophosphate pesticides exposure and thyroid hormones in floriculture workers. Toxicol Appl Pharmacol 243(1):19-26, PMID: 19914268, https://doi.org/10.1016/ j.taap.2009.11.008.
197. Lacasaha M, Lopez-Flores 1, Rodriguez-Barranco M, Aguilar-Garduho C, Blanco-Muhoz J, Perez-Mendez 0, et al. 2010. Interaction between organophosphate pesticide exposure and P0N1 activity on thyroid function. Toxicol Appl Pharmacol 249(1):16-24, PMID: 20691716, https://doi.Org/10.1016/j.taap. 2010.07.024. 198. Bernieri T, Rodrigues D, Barbosa IR, Ardenghi PG, Basso da Silva L 2019. Occupational exposure to pesticides and thyroid function in Brazilian soybean farmers. Chemosphere 218:425-429, PMID: 30476775, https://doi.Org/10.1016/j. chemosphere.2018.11.124.
199. Torres-Sanchez L, Gamboa R, Bassol-Mayagoitia S, Huesca-Gomez C, Nava MP, Vazquez-Potisek Jl, et al. 2019. Para-occupational exposure to pesticides, P0N1 polymorphisms and hypothyroxinemia during the first half of pregnancy in women living in a Mexican floricultural area. Environ Health 18(1):33, PMID: 30975138, https://doi.org/10.1186/s12940-019-0470-x. 200. Miranda-Contreras L, Gomez-Perez R, Rojas G, Cruz I, Berrueta L, Salmen S, et al. 2013. Occupational exposure to organophosphate and carbamate pesticides affects sperm chromatin integrity and reproductive hormone levels among Venezuelan farm workers. J Occup Health 55(3):195-203, PMID: 23445617, https://doi.org/10.1539/joh.12-0144-fs.
201. Santos R, Piccoli C, Cremonese C, Freire C. 2019. Thyroid and reproductive hormones in relation to pesticide use in an agricultural population in Southern Brazil. Environ Res 173:221-231, PMID: 30928852, https://doi.org/10. 1016/j.envres.2019.03.050. 202. Blanco-Muhoz J, Lacasaha M, Aguilar-Garduho C, Rodriguez-Barranco M, Bassol S, Cebrian ME, et al. 2012. Effect of exposure to p,p'-DDE on male hormone profile in Mexican flower growers. Occup Environ Med 69(1 ):5-11, PMID: 21558473, https://doi.org/10.1136/oem.2010.059667.
203. Freire C, Koifman RJ, Sarcinelli PN, Rosa AC, Clapauch R, Koifman S. 2014. Association between serum levels of organochlorine pesticides and sex hormones in adults living in a heavily contaminated area in Brazil. Int J Hyg Environ Health 217(2-3):370-378, PMID: 23972672, https://doi.Org/10.1016/j.ijheh.2013.07.012. 204. Bastos AM, Souza MdoC, Almeida Filho GL, Krauss TM, Pavesi T, Silva LE. 2013. Organochlorine compound levels in fertile and infertile women from Rio de Janeiro, Brazil. Arq Bras Endocrinol Metabol 57(5):346-353, PMID: 23896800, https://doi.org/10.1590/s0004-27302013000500003.
205. Aguilar-Garduho C, Lacasaha M, Blanco-Muhoz J, Rodriguez-Barranco M, Hernandez AF, Bassol S, et al. 2013. Changes in male hormone profile after occupational organophosphate exposure. A longitudinal study. Toxicology 307:55-65, PMID: 23153546, https://doi.Org/10.1016/j.tox.2012.11.001. 206. Cecchi A, Rovedatti MG, Sabino G, Magnarelli GG. 2012. Environmental exposure to organophosphate pesticides: assessment of endocrine disruption and hepatotoxicity in pregnant women. Ecotoxicol Environ Saf 80:280-287, PMID: 22494479, https://doi.Org/10.1016/j.ecoenv.2012.03.008.
207. Blanco-Muhoz J, Morales MM, Lacasaha M, Aguilar-Garduho C, Bassol S, Cebrian ME. 2010. Exposure to organophosphate pesticides and male hormone profile in floriculturist of the state of Morelos, Mexico. Hum Reprod 25(7):1787-1795, PMID: 20435691, https://doi.org/10.1093/humrep/deq082. 208. Yucra S, Gasco M, Rubio J, Gonzales GF. 2008. Semen quality in Peruvian pesticide applicators: association between urinary organophosphate metabolites and semen parameters. Environ Health 7:59, PMID: 19014632, https://doi.org/ 10.1186/1476-069X-7-59.
209. Recio-Vega R, Ocampo-Gomez G, Borja-Aburto VH, Moran-Martinez J, Cebrian-Garcia ME. 2008. Organophosphorus pesticide exposure decreases sperm quality: association between sperm parameters and urinary pesticide levels. J Appl Toxicol 28(5):674-680, PMID: 18046699, https://doi.org/10.1002/jat.1321. 210. Silvia SC, Magnarelli G, Rovedatti MG. 2020. Evaluation of endocrine disruption and gestational disorders in women residing in areas with intensive pesticide application: an exploratory study. Environ Toxicol Pharmacol 73:103280, PMID: 31683255, https://doi.Org/10.1016/j.etap.2019.103280.
211. Sanin LH, Carrasquilla G, Solomon KR, Cole DC, Marshall EJ. 2009. Regional differences in time to pregnancy among fertile women from five Colombian regions with different use of glyphosate. J Toxicol Environ Health A 72(15-16):949-960, PMID: 19672763, https://doi.org/10.1080/15287390902929691. 212. Rojas M, Guevara H. 2014. Estudio preliminar sobre ocupacion y estilos de vida como factores condicionantes del ciclo menstrual en mujeres de una region de Venezuela. Rev Cienc Salud 12(3):385-400, https://doi.org/10.12804/ revsalud12.03.2014.07.
213. Miranda-Contreras L, Cruz I, Osuna J, Gomez-Perez R, Berrueta L, Salmen S, et al. 2015. Efectos de la exposicion ocupacional a plaguicidas sobre la
calidad del semen en trabajadores de una comunidad agricola del estado Merida, Venezuela. Invest Clin 56(2):123-136, PMID: 26299054.
214. Cremonese C, Piccoli C, Pasqualotto F, Clapauch R, Koifman RJ, Koifman S, et al. 2017. Occupational exposure to pesticides, reproductive hormone levels and sperm quality in young Brazilian men. Reprod Toxicol 67:174-185, PMID: 28077271, https://doi.Org/10.1016/j.reprotox.2017.01.001. 215. Cupul-Uicab LA, Hernandez-Avila M, Terrazas-Medina EA, Pennell ML, Longnecker MP. 2010. Prenatal exposure to the major DDT metabolite 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and growth in boys from Mexico. Environ Res 110(6):595-603, PMID: 20566194, https://doi.Org/10.1016/j. envres.2010.06.001.
216. Garced S, Torres-Sanchez L, Cebrian ME, Claudio L, Lopez-Carrillo L 2012. Prenatal dichlorodiphenyldichloroethylene (DDE) exposure and child growth during the first year of life. Environ Res 113:58-62, PMID: 22244494, https://doi.Org/10.1016/j.envres.2011.12.002. 217. Motta IS, Volpato GT, Damasceno DC, Sinzato YK, Vesentini G, Rudge CV, et al. 2016. Contamination index. A novel parameter for metal and pesticide analyses in maternal blood and umbilical cord. Acta Cir Bras 31(7):490-497, PMID: 27487285, https://doi.org/10.1590/S0102-865020160070000010.
218. Mora AM, van Wendel de Joode B, Mergler D, Cordoba L, Cano C, Quesada R, et al. 2015. Maternal blood and hair manganese concentrations, fetal growth, and length of gestation in the ISA cohort in Costa Rica. Environ Res 136:47-56, PMID: 25460620, https://doi.Org/10.1016/j.envres.2014.10.011. 219. Cecchi A, Alvarez G, Quidel N, Bertone MC, Anderle S, Sabino G, et al. 2021. Residential proximity to pesticide applications in Argentine Patagonia: impact on pregnancy and newborn parameters. Environ Sci Pollut Res Int 28(40):56565-56579, PMID: 34060016, https://doi.org/10.1007/s11356-021-14574-2.
220. Kadhel P, Monfort C, Costet N, Rouget F, Thome JP, Multigner L, et al. 2014. Chlordecone exposure, length of gestation, and risk of preterm birth. Am J Epidemiol 179(5):536-544, PMID: 24401561, https://doi.org/10.1093/aje/kwt313. 221. Herve D, Costet N, Kadhel P, Rouget F, Monfort C, Thome JP, et al. 2016. Prenatal exposure to chlordecone, gestational weight gain, and birth weight in a Guadeloupean birth cohort. Environ Res 151:436-444, PMID: 27560981, https://doi.Org/10.1016/j. envres.2016.08.004.
222. Costet N, Pele F, Comets E, Rouget F, Monfort C, Bodeau-Livinec F, et al. 2015. Perinatal exposure to chlordecone and infant growth. Environ Res 142:123-134, PMID: 26133809, https://doi.Org/10.1016/j.envres.2015.06.023. 223. Barron Cuenca J, Tirado N, Vikstrom M, Lindh CH, Stenius U, Leander K, et al. 2020. Pesticide exposure among Bolivian farmers: associations between worker protection and exposure biomarkers. J Expo Sci Environ Epidemiol 30(4):730-742, PMID: 30787424, https://doi.org/10.1038/s41370-019-0128-3.
224. Ruiz-Alejos A, Caplin B, Miranda JJ, Pearce N, Bernabe-Ortiz A. 2021. CKD and CKDu in northern Peru: a cross-sectional analysis under the DEGREE protocol. BMC Nephrol 22(1):37, PMID: 33478431, https://doi.org/10.1186/s12882-021-02239-8. 225. Vela XF, Henriquez DO, Zelaya SM, Granados DV, Hernandez MX, Orantes CM. 2014. Chronic kidney disease and associated risk factors in two Salvadoran farming communities, 2012. MEDICC Rev 16(2):55-60, PMID: 24878650, https://doi.Org/10.37757/MR2014.V16.N2.9.
226. Wesseling C, Aragon A, Gonzalez M, Weiss I, Glaser J, Rivard CJ, et al. 2016. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open 6(12): e011034, PMID: 27932336, https://doi.org/10.1136/bmjopen-2016-011034. 227. Smpokou ET, Gonzalez-Quiroz M, Martins C, Alvito P, Le Blond J, Glaser J, et al. 2019. Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy. Occup Environ Med 76(12):920-926, PMID: 31562235, https://doi.org/10.1136/oemed-2019-105772.
228. Sanoff SL, Callejas L, Alonso CD, Hu Y, Colindres RE, Chin H, et al. 2010. Positive association of renal insufficiency with agriculture employment and unregulated alcohol consumption in Nicaragua. Ren Fail 32(7):766-777, PMID: 20662688, https://doi.Org/10.3109/0886022X.2010.494333. 229. Prudente IRG, Souza BRS, Nascimento LC, Gongalves VSDS, Silva DSD, Rabelo TK, et al. 2021. Nephrotoxic effects caused by occupational exposure to agro-chemicals in a region of northeastern Brazil: a cross-sectional study. Environ Toxicol Chem 40(4):1132 1138, PMID: 33315273, https://doi.org/10.1002/etc.4962.
230. Raines N, Gonzalez M, Wyatt C, Kurzrok M, Pool C, Lemma T, et al. 2014. Risk factors for reduced glomerular filtration rate in a Nicaraguan community affected by Mesoamerican nephropathy. MEDICC Rev 16(2):16-22, PMID: 24878645, https://doi.Org/10.37757/MR2014.V16.N2.4. 231. Lopez-Galvez N, Wagoner R, Canales RA, Ernst K, Burgess JL, de Zapien J, et al. 2021. Longitudinal assessment of kidney function in migrant farm workers. Environ Res 202:111686, PMID: 34273367, https://doi.Org/10.1016/j.envres. 2021.111686.
232. Fieten KB, Kromhout H, Heederik D, van Wendel de Joode B. 2009. Pesticide exposure and respiratory health of indigenous women in Costa Rica. Am J Epidemiol 169(12):1500-1506, PMID: 19372212, https://doi.org/10.1093/aje/kwp060.
233. Buralli RJ, Ribeiro H, Mauad T, Amato-Lourengo LF, Salge JM, Diaz-Quijano FA, et al. 2018. Respiratory condition of family farmers exposed to pesticides in the state of Rio de Janeiro, Brazil. Int J Environ Res Public Health 15(6):1203, PMID: 29890615, https://doi.org/10.3390/ijerph15061203.
234. Diaz-Criollo S, Palma M, Monroy-Garcia AA, Idrovo AJ, Combariza D, Varona-Uribe ME. 2020. Chronic pesticide mixture exposure including paraquat and respiratory outcomes among Colombian farmers. Ind Health 58(1 ):15 21, PMID: 30996154, https://doi.org/10.2486/indhealth.2018-0111. 235. Alhanti B, van Wendel de Joode B, Soto Martinez M, Mora AM, Cordoba Gamboa L, Reich B, et al. 2022. Environmental exposures contribute to respiratory and allergic symptoms among women living in the banana growing regions of Costa Rica. Occup Environ Med 79(7):469-476, PMID: 34969778, https://doi.Org/10.1136/oemed-2021 -107611.
236. Mora AM, Hoppin JA, Cordoba L, Cano JC, Soto-Martinez M, Eskenazi B, et al. 2020. Prenatal pesticide exposure and respiratory health outcomes in the first year of life: results from the Infants' Environmental Health (ISA) study. Int J Hyg Environ Health 225:113474, PMID: 32066110, https://doi.Org/10.1016/j.ijheh. 2020.113474. 237. Cupul-Uicab LA, Terrazas-Medina EA, Hernandez-Avila M, Longnecker MP. 2014. Prenatal exposure to p,p'-DDE and p,p'-DDJ in relation to lower respiratory tract infections in boys from a highly exposed area of Mexico. Environ Res 132:19-23, PMID: 24742723, https://doi.Org/10.1016/j.envres.2014.03.017.
238. Lermen J, Bernieri T, Rodrigues IS, Suyenaga ES, Ardenghi PG. 2018. Pesticide exposure and health conditions among orange growers in Southern Brazil. J Environ Sci Health B 53(4):215-221, PMID: 29336665, https://doi.org/ 10.1080/03601234.2017.1421823. 239. Bernieri T, Rodrigues D, Randon Barbosa I, Perassolo MS, Grolli Ardenghi P, Basso da Silva L 2021. Effect of pesticide exposure on total antioxidant capacity and biochemical parameters in Brazilian soybean farmers. Drug Chem Toxicol 44(2):170-176, PMID: 30950301, https://doi.org/10.1080/01480545.2019.1566353.
240. Bahia CA, Guimaraes RM, Asmus CIRF. 2014. Alteragoes nos marcadores hepaticos decorrentes da exposigao ambiental a organoclorados no Brasil. Cad Saude Colet22(2):133-141, https://doi.org/10.1590/1414-462X201400020005. 241. Cestonaro LV, Garcia SC, Nascimento S, Gauer B, Sauer E, Goethel G, et al. 2020. Biochemical, hematological and immunological parameters and relationship with occupational exposure to pesticides and metals. Environ Sci Pollut Res Int 27(23):29291-29302, PMID: 32436094, https://doi.org/10.1007/ s11356-020-09203-3.
242. Ruiz-Arias MA, Herrera-Moreno JF, Medina-Diaz IM, Bernal-Hernandez YY, Gonzalez-Arias CA, Rojas-Garcia AE. 2018. p-Glucuronidase and its relationship with clinical parameters and biomarkers of pesticide exposure. J Occup Environ Med 60(11):e602-e609, PMID: 30256302, https://doi.org/10.1097/JOM. 0000000000001460. 243. Hernandez A, Gomez MA, Pena G, Gil F, Rodrigo L, Villanueva E, et al. 2004. Effect of long-term exposure to pesticides on plasma esterases from plastic greenhouse workers. J Toxicol Environ Health A 67(14):1095-1108, PMID:
15205026, https://doi.Org/10.1080/15287390490452371. 244. Ueyama J, Satoh T, Kondo T, Takagi K, Shibata E, Goto M, et al. 2010. p-Glucuronidase activity is a sensitive biomarker to assess low-level organo-phosphorus insecticide exposure. Toxicol Lett 193(1): 115-119, PMID: 20026393, https://doi.Org/10.1016/j.toxlet.2009.12.009. 245. Maluf E, Hamerschlak N, Cavalcanti AB, Junior AA, Eluf-Neto J, Falcao RP, et al. 2009. Incidence and risk factors of aplastic anemia in Latin American countries: the LATIN case-control study. Haematologica 94(9):1220-1226, PMID: 19734415, https://doi.org/10.3324/haematol.2008.002642.
246. Jacobsen-Pereira CH, Cardoso CC, Gehlen TC, Regina Dos Santos C, Santos-Silva MC. 2020. Immune response of Brazilian farmers exposed to multiple pesticides. Ecotoxicol Environ Saf 202:110912, PMID: 32800247, https://doi.org/ 10.1016/j.ecoenv.2020.110912. 247. Dalbo J, Filgueiras LA, Mendes AN. 2019. Effects of pesticides on rural workers: haematological parameters and symptomalogical reports. Cien Saude Colet 24(7):2569-2582, PMID: 31340274, https://doi.org/10.1590/1413-81232018247. 19282017.
248. Cortes-lza SC, Rodriguez Al, Prieto-Suarez E. 2017. Assessment of hematological parameters in workers exposed to organophosphorus pesticides, carbamates and pyrethroids in Cundinamarca 2016-2017. Rev Salud Publica (Bogota) 19(4):468-474, PMID: 30183850, https://doi.org/10.15446/rsap.v19n4.68092. 249. Piccoli C, Cremonese C, Koifman R, Koifman S, Freire C. 2019. Occupational exposure to pesticides and hematological alterations: a survey of farm residents in the South of Brazil. Cien Saude Colet 24:2325-2340, PMID: 31269189, https://doi.org/10.1590/1413-81232018246.13142017. 250. Molina-Pintor IB, Rojas-Garcia AE, Bernal-Hernandez YY, Medina-Diaz IM, Gonzalez-Arias CA, Barron-Vivanco BS. 2020. Relationship between butyryl-cholinesterase activity and lipid parameters in workers occupational^ exposed to pesticides. Environ Sci Pollut Res Int 27(31 ):39365-39374, PMID: 32648216, https://doi.org/10.1007/s11356-020-08197-2.
251. Siller-Lopez F, Garzon-Castaho S, Ramos-Marquez ME, Hernandez-Canaveral I. 2017. Association of paraoxonase-1 Q192R (rs662) single nucleotide variation with cardiovascular risk in coffee harvesters of central Colombia. J Toxicol 2017:6913106, PMID: 29430251, https://doi.org/10.1155/ 2017/6913106.
252. Guida HL, Morini RG, Cardoso ACV. 2010. Avaliagao audiologica em trabalha-dores expostos a ruido e praguicida. Braz J Otorhinolaryngol 76(4):423-427, PMID: 20835526, https://doi.org/10.1590/S1808-86942010000400003. 253. Bazilio MM, Frota S, Chrisman JR, Meyer A, Asmus CI, Camara VdeM. 2012. Temporal auditory processing in rural workers exposed to pesticide. J Soc Bras Fonoaudiol 24(2):174-180, PMID: 22832687, https://doi.org/10.1590/s2179-64912012000200015.
254. Alcaras PAdeS, Larcerda ABM, Marques JM. 2013. Study of evoked otoa-coustic emissions and suppression effect on workers exposed to pesticides and noise. Codas 25(6):527-533, PMID: 24626978, https://pdfs.semanticscholar. Org/a0b6/451a8a094fc9bc9b654131 be07073d347c66.pdf [accessed 30 June 2022], 255. de Sena TR, Vargas MM, Oliveira CC. 2013. Hearing care and quality of life among workers exposed to pesticides [in Portuguese]. Cien Saude Colet 1816)1753-1761 PMID-93759541
256. Garcia TR, de Andrade MIKP, Frota SM, Miranda MF, Guimaraes RM, Meyer A. 2017. Fungao coclear em escolares expostos aos agrotoxicos. Codas 29(3): e20160078, PMID: 28538825, https://doi.org/10.1590/2317-1782/20172016078. 257. Tomiazzi JS, Pereira DR, Judai MA, Antunes PA, Favareto APA. 2019. Performance of machine-learning algorithms to pattern recognition and classification of hearing impairment in Brazilian farmers exposed to pesticide and/or cigarette smoke. Environ Sci Pollut Res Int 26(7):6481-6491, PMID: 30623325, https://doi.org/10.1007/s11356-018-04106-w.
258. de Souza Alcaras PA, Zeigelboim BS, Corazza MCA, Liiders D, Marques JM, de Lacerda ABM. 2021. Findings on the central auditory functions of endemic disease control agents. Int J Environ Res Public Health 18(13):7051, PMID: 34280998, https://doi.org/10.3390/ijerph18137051. 259. Mattiazzi AL, Caye JL, Frank JG, Endruweit Battisti ID. 2020. Hearing screening and cholinesterase activity among rural workers exposed to pesticides. Rev Bras Med Trab 17(2):239-246, PMID: 32270126, https://doi.org/10.5327/ Z1679443520190374.
260. Suarez-Lopez JR, Jacobs DR Jr, Himes JH, Alexander BH. 2013. Acetylcholinesterase activity, cohabitation with floricultural workers, and blood pressure in Ecuadorian children. Environ Health Perspect 121(5):619-624, PMID: 23359481, https://doi.org/10.1289/ehp.1205431. 261. Suarez-Lopez JR, Hong V, McDonald KN, Suarez-Torres J, Lopez D, De La Cruz F. 2018. Home proximity to flower plantations and higher systolic blood pressure among children. Int J Hyg Environ Health 221(8):1077-1084, PMID: 30131222, https://doi.Org/10.1016/j.ijheh.2018.08.006.
262. Suarez-Lopez JR, Amchich F, Murillo J, Denenberg J. 2019. Blood pressure after a heightened pesticide spray period among children living in agricultural communities in Ecuador. Environ Res 175:335-342, PMID: 31150932, https://doi.Org/10.1016/j.envres.2019.05.030. 263. Cupul-Uicab LA, Terrazas-Medina EA, Hernandez-Avila M, Longnecker MP. 2017. In utero exposure to DDT and incidence of diarrhea among boys from tropical Mexico. Environ Res 159:331-337, PMID: 28841520, https://doi.org/10. 1016/j.envres.2017.08.027.
264. Meyer A, Sandler DP, Beane Freeman LE, Hofmann JN, Parks CG. 2017. Pesticide exposure and risk of rheumatoid arthritis among licensed male pesticide applicators in the Agricultural Health Study. Environ Health Perspect 125(7):077010, PMID: 28718769, https://doi.org/10.1289/EHP1013. 265. Mejia-Sanchez F, Montenegro-Morales LP, Castillo-Cadena J. 2018. Enzymatic activity induction of GST-family isoenzymes from pesticide mixture used in floriculture. Environ Sci Pollut Res Int 25(1):601-606, PMID: 29052146, https://doi.Org/10.1007/s11356-017-0410-7.
266. Machado AKF, Wendt A, Wehrmeister FC. 2018. Sleep problems and associated factors in a rural population of a southern Brazilian city. Rev Saude Publica 52(1):5s, https://doi.org/10.11606/S1518-8787.2018052000260. 267. Butinof M, Fernandez RA, Stimolo Ml, Lantieri MJ, Blanco M, Machado AL, et al. 2015. Pesticide exposure and health conditions of terrestrial pesticide applicators in Cordoba Province, Argentina. Cad Saude Publica 31(3):633-646, PMID: 25859729, https://doi.org/10.1590/0102-311x00218313.
268. Cezar-Vaz MR, Bonow CA, de Mello MCVA, da Silva MRS. 2016. Socio-envi-ronmental approach in nursing: focusing on rural labor and the use of pesticides. Rev Bras Enferm 69(6):1179-1187, PMID: 27925096, https://doi.org/10. 1590/0034-7167-2016-0364. 269. de Carvalho MP, Fiori NS, Meucci RD, Faria NMX, Fassa AG. 2020. Thoracic spine pain and associated factors among tobacco farmers. Rev Bras Saude Ocup 45:e33, https://doi.org/10.1590/2317-6369000002019.
270. Fassa AG, Spada Fiori N,Dalke Meucci R, MiillerXavier Faria N, Peres de Carvalho M. 2020. Neck pain among tobacco farm workers in southern Brazil [in Spanish]. Salud Colect 16:e2307, PMID: 33147389, https://doi.org/10.18294/sc.2020.2307.
271. Araujo RAL, Cremonese C, Santos R, Piccoli C, Carvalho G, Freire C, et al. 2021. Association of occupational exposure to pesticides with overweight and abdominal obesity in family farmers in southern Brazil. Int J Environ Health Res 2021:1 12, PMID: 34844470, https://doi.org/10.1080/09603123.2021.1991284.
272. Campos E, Costa VIDB, Alves SR, Rosa ACS, Geraldino BR, Meira BDC, et al. 2020. Occurrence of green tobacco sickness and associated factors in farmers residing in Dom Feliciano Municipality, Rio Grande do Sul State, Southern Region of Brazil. Cad Saude Publica 36(8):e00122719, PMID: 32813792, https://doi.org/10.1590/0102-311x00122719. 273. Schneider Medeiros M, Reddy SP, Socal MP, Schumacher-Schuh AF, Mello Rieder CR. 2020. Occupational pesticide exposure and the risk of death in patients with Parkinson's disease: an observational study in southern Brazil. Environ Health 19(1):68, PMID: 32552814, https://doi.org/10.1186/s12940-020-00624-8.
274. Okuyama JHH, Galvao TF, Silva MT, Grupo Datatox. 2020. Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017. Rev Bras Epidemiol 23:e200024, PMID: 32401920, https://doi.org/10.1590/1980-549720200024. 275. Luce D, Dugas J, Vaidie A, Michineau L, El-Yamani M, Multigner L 2020. A cohort study of banana plantation workers in the French West Indies: first mortality analysis (2000-2015). Environ Sci Pollut Res Int 27(33):41014-41022, PMID: 31621027, https://doi.org/10.1007/s11356-019-06481-4.
276. de Souza A, Medeiros Ados R, de Souza AC, Wink M, Siqueira IR, Ferreira MB, et al. 2011. Evaluation of the impact of exposure to pesticides on the health of the rural population: Vale do Taquari, State of Rio Grande do Sul (Brazil) [in Portugeuse]. Cien Saude Colet 16(8):3519-3528, PMID: 21860952, https://doi.Org/10.1590/s1413-81232011000900020. 277. Muhoz-Quezada MT, Lucero B, Iglesias V, Levy K, Muhoz MP, Achu E, et al. 2017. Exposure to organophosphate (OP) pesticides and health conditions in agricultural and non-agricultural workers from Maule, Chile. Int J Environ Health Res 27(1):82-93, PMID: 28002976, https://doi.org/10.1080/09603123.2016. 1268679.
278. Gonzalez-Alzaga B, Lacasaha M, Aguilar-Garduho C, Rodriguez-Barranco M, Ballester F, Rebagliato M, et al. 2014. A systematic review of neurodevelop-mental effects of prenatal and postnatal organophosphate pesticide exposure. Toxicol Lett 230(2):104-121, PMID: 24291036, https://doi.Org/10.1016/j. toxlet.2013.11.019.
279. Takahashi N, Hashizume M. 2014. A systematic review of the influence of occupational organophosphate pesticides exposure on neurological impairment. BMJ Open 4(6):e004798, PMID: 24961715, https://doi.org/10.1136/ bmjopen-2014-004798. 280. Fuhrimann S, Wan C, Blouzard E, Veludo A, Holtman Z, Chetty-Mhlanga S, et al. 2022. Pesticide research on environmental and human exposure and risks in sub-Saharan Africa: a systematic literature review. Int J Environ Res Public Health 19(1):259, PMID: 35010520, https://doi.org/10.3390/ijerph19010259.
281. Muhoz-Piha C, Avila Forcada S. 2004. Effects of an environmental tax on pesticides in Mexico. Ind Environ 27(2):33-36. 282. Sharma A, Kumar V, Shahzad B, Tanveer M, Sidhu GPS, Handa N, etal. 2019. Worldwide pesticide usage and its impacts on ecosystem. SN Appl Sci 1(11):1446, https://doi.org/10.1007/s42452-019-1485-1.
283. Directorate Generalfor External Policies of the Union. 2021. The Use of Pesticides in Developing Countries and Their Impact on Health and the Right to Food. PE 653.622. Brussels, Belgium: European Commission, European Parliament Policy Department https://www.europarl.europa.eu/RegData/etudes/STUD/2021/653622/EXPO_ STU(20211653622_EN.pdf [accessed 30 June 2022]. 284. McKee M, Stuckler D, Basu S. 2012. Where there is no health research: what can be done to fill the global gaps in health research? PLoS Med 9(4): e1001209, PMID: 22545025, https://doi.org/10.1371/journal.pmed.1001209.
285. Tulloch-Reid MK, Saravia NG, Dennis RJ, Jaramillo A, Cuervo LG, Walker SP, et al. 2018. Strengthening institutional capacity for equitable health research: lessons from Latin America and the Caribbean. BMJ 362:k2456, PMID: 30012634, https://doi.org/10.1136/bmj.k2456. 286. Blair A, Thomas K, Coble J, Sandler DP, Hines CJ, Lynch CF, et al. 2011. Impact of pesticide exposure misclassification on estimates of relative risks in the Agricultural Health Study. Occup Environ Med 68(7):537-541, PMID: 21257983, https://doi.Org/10.1136/oem.2010.059469.
287. Bradman A, Kogut K, Eisen EA, Jewell NP, Quiros-Alcala L, Castorina R, et al. 2013. Variability of organophosphorous pesticide metabolite levels in spot and 24-hr urine samples collected from young children during 1 week. Environ Health Perspect 121(1 ):118-124, PMID: 23052012, https://doi.org/10.1289/ehp.1104808. 288. Carles C, Bouvier G, Lebailly P, Baldi I. 2017. Use of job-exposure matrices to estimate occupational exposure to pesticides: a review. J Expo Sci Environ Epidemiol 27(2):125 140, PMID: 27189257, https://doi.org/10.1038/jes.2016.25.
289. Ohlander J, Fuhrimann S, Basinas I, Cherrie JW, Galea KS, Povey AC, et al. 2020. Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993-2017. Occup Environ Med 77(6):357-367, PMID: 32098789, https://doi.org/10.1136/oemed-2019-105880.
290. Mueller W, Atuhaire A, Mubeezi R, van den Brenk I, Kromhout H, Basinas I, et al. 2022. Evaluation of two-year recall of self-reported pesticide exposure among Ugandan smallholder farmers. Int J Hyg Environ Health 240:113911, PMID: 35030437, https://doi.Org/10.1016/j.ijheh.2021.113911.
291. Tielemans E, Bretveld R, Schinkel J, van Wendel de Joode B, Kromhout H, Gerritsen-Ebben R, et al. 2007. Exposure profiles of pesticides among greenhouse workers: implications for epidemiological studies. J Expo Sci Environ Epidemiol 17(6):501-509, PMID: 17299530, https://doi.org/10.1038/sj.jes.7500544. 292. Lopez-Galvez N, Wagoner R, Beamer P, de Zapien J, Rosales C. 2018. Migrant farmworkers' exposure to pesticides in Sonora, Mexico. Int J Environ Res Public Health 15(12)2651, PMID: 30486281, https://doi.org/10.3390/ijerph15122651.
293. Barr DB, Bravo R, Weerasekera G, Caltabiano LM, Whitehead RD Jr, Olsson AO, et al. 2004. Concentrations of dialkyl phosphate metabolites of organo-phosphorus pesticides in the U.S. population. Environ Health Perspect 112(2): 186-200, PMID: 14754573, https://doi.org/10.1289/ehp.6503. 294. Bradman A, Castorina R, Barr DB, Chevrier J, Harnly ME, Eisen EA, et al. 2011. Determinants of organophosphorus pesticide urinary metabolite levels in young children living in an agricultural community. Int J Environ Res Public Health 8(4):1061 1083, PMID: 21695029, https://doi.org/10.3390/ijerph8041061. 295. Buszewski B, Bukowska M, Ligor M, Staneczko-Baranowska I. 2019. A holistic study of neonicotinoids neuroactive insecticides-properties, applications, occurrence, and analysis. Environ Sci Pollut Res Int 26(34):34723-34740, PMID: 31520389, https://doi.org/10.1007/s11356-019-06114-w.
296. Jeschke P, Nauen R, Schindler M, Elbert A. 2011. Overview of the status and global strategy for neonicotinoids. J Agric Food Chem 59(7)2897-2908, PMID: 20565065, https://doi.org/10.1021/jf101303g. 297. Li HZ, Cheng F, Wei Y, Lydy MJ, You J. 2017. Global occurrence of pyrethroid insecticides in sediment and the associated toxicological effects on benthic invertebrates: an overview. J Hazard Mater 324(pt B)258-271, PMID: 27825741, https://doi.Org/10.1016/j.jhazmat.2016.10.056.
298. Rauh VA, Margolis AE. 2016. Research review: environmental exposures, neu-rodevelopment, and child mental health-new paradigms for the study of brain and behavioral effects. J Child Psychol Psychiatry 57(7):775-793, PMID: 26987761, https://doi.org/10.1111/jcpp.12537. 299. Hensch TK. 2004. Critical period regulation. Ann Rev Neurosci 27(1):549-579, PMID: 15217343, https://doi.org/10.1146/annurev.neuro.27.070203.144327.
300. De Luca G, Olivieri F, Melotti G, Aiello G, Lubrano L, Boner AL. 2010. Fetal and early postnatal life roots of asthma. J Matern Fetal Neonatal Med 23(suppl 3):80-83, PMID: 20925457, https://doi.org/10.3109/14767058.2010.509931. 301. Raanan R, Harley KG, Balmes JR, Bradman A, Lipsett M, Eskenazi B. 2015. Early-life exposure to organophosphate pesticides and pediatric respiratory symptoms in the CHAMACOS cohort. Environ Health Perspect 123(2):179-185, PMID: 25369257, https://doi.org/10.1289/ehp.1408235.
302. Baygi F, Herttua K, Jensen OC, Djalalinia S, Mahdavi Ghorabi A, Asayesh H, et al. 2020. Global prevalence of cardiometabolic risk factors in the military population: a systematic review and meta-analysis. BMC Endocr Disord 20(1):8, PMID: 31931788, https://doi.org/10.1186/s12902-020-0489-6. 303. Gitler AD, Dhillon P, Shorter J. 2017. Neurodegenerative disease: models, mechanisms, and a new hope. Dis Models Mech 10(5):499-502, PMID: 28468935, https://doi.org/10.1242/dmm.030205.
304. Damalas CA, Koutroubas SD. 2016. Farmers' exposure to pesticides: toxicity types and ways of prevention. Toxics 4(1):1, PMID: 29051407, https://doi.org/ 10.3390/toxics4010001. 305. Hamra GB, Buckley JP. 2018. Environmental exposure mixtures: questions and methods to address them. Curr Epidemiol Rep 5(2):160-165, PMID: 30643709, https://doi.org/10.1007/s40471-018-0145-0.
306. Gibson EA, Nunez Y, Abuawad A, Zota AR, Renzetti S, Devick KL, et al. 2019. An overview of methods to address distinct research questions on environmental mixtures: an application to persistent organic pollutants and leukocyte telomere length. Environ Health 18(1):76, PMID: 31462251, https://doi.org/10. 1186/sl 2940-019-0515-1. 307. Appleton AA, Holdsworth EA, Kubzansky LD. 2016. A systematic review of the interplay between social determinants and environmental exposures for early-life outcomes. Curr Environ Health Rep 3(3)287-301, PMID: 27344145, https://doi.Org/10.1007/S40572-016-0099-7.
308. Cory-Slechta DA. 2005. Studying toxicants as single chemicals: does this strategy adequately identify neurotoxic risk? Neurotoxicology 26(4):491-510, PMID: 16112317, https://doi.Org/10.1016/j.neuro.2004.12.007. 309. Clougherty JE, Shmool JLC, Kubzansky LD. 2014. The role of non-chemical stressors in mediating socioeconomic susceptibility to environmental chemicals. Curr Environ Health Rep 1(4):302 313, https://doi.org/10.1007/ s40572-014-0031-y.
310. Kordas K, Lonnerdal B, Stoltzfus RJ. 2007. Interactions between nutrition and environmental exposures: effects on health outcomes in women and children. J Nutr 137(12)2794-2797, PMID: 18029501, https://doi.org/10.1093/ jn/137.12.2794.
311. Pan American Health Organization/World Health Organization. 2009. Policy on Research for Health. Document CD49/10 of the 49th Directing Council, 61st Session of the Regional Committee. Washington, DC: Pan American Health Organization/World Health Organization, https://www.paho.org/hq/dmdocuments/ 2009/CD49-10-e.pdf [accessed 15 June 2022].
312. Franzen SRP, Chandler C, Lang T. 2017. Health research capacity development in low and middle income countries: reality or rhetoric? A systematic meta-narrative review of the qualitative literature. BMJ Open 7(1):e012332, PMID: 28131997, https://doi.Org/10.1136/bmjopen-2016-012332. 313. AN R, Finlayson A, Indox Cancer Research Network. 2012. Building capacity for clinical research in developing countries: the INDOX Cancer Research Network experience. Glob Health Action 5(1):17288, PMID: 22566788, https://doi.org/10. 3402/gha.v5i0.17288.
314. Barreto ML. 2009. Health research in developing countries. BMJ 339:b4846, PMID: 19933304, https://doi.org/10.1136/bmj.b4846. 315. Lopez-Verges S, Valiente-Echeverria F, Godoy-Faundez A, Fernandez Rivas D, Urbani B, Berger JJ, et al. 2021. Call to action: supporting Latin American early career researchers on the quest for sustainable development in the
region. Front Res Metr Anal 6:657120, PMID: 34056515, https://doi.org/10.3389/ frma.2021.657120. 316. Vryzas Z, Ramwell C, Sans C. 2020. Pesticide prioritization approaches and limitations in environmental monitoring studies: from Europe to Latin America and the Caribbean. Environ Int 143:105917, PMID: 32619916, https://doi.org/10. 1016/j.envint.2020.105917.
317. Rocha CBD, Nascimento APC, da Silva AMC, Botelho C. 2021. Uncontrolled asthma in children and adolescents exposed to pesticides in an area of intense agribusiness activity [in Portuguese]. Cad Saude Publica 37(5): e00072220, PMID: 34133636, https://doi.org/10.1590/0102-311x00072220. 318. Saunders L, Kadhel P, Costet N, Rouget F, Monfort C, Thome JP, et al. 2014. Hypertensive disorders of pregnancy and gestational diabetes mellitus among French Caribbean women chronically exposed to chlordecone. Environ Int 68:171-176, PMID: 24727072, https://doi.Org/10.1016/j.envint.2014.03.024.
319. Hutter HP, Poteser M, Lemmerer K, Wallner P, Kundi M, Moshammer H, et al. 2021. Health symptoms related to pesticide use in farmers and laborers of ecological and conventional banana plantations in Ecuador. Int J Environ Res Public Health 18(3):1126, PMID: 33514015, https://doi.org/10.3390/ijerph18031126.
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Abstract
Background: Multiple epidemiological studies have shown that exposure to pesticides is associated with adverse health outcomes. However, the literature on pesticide-related health effects in the Latin American and the Caribbean (LAC) region, an area of intensive agricultural and residential pesticide use, is sparse. We conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations with the goal of identifying knowledge gaps and research capacity building needs. Methods: We searched PubMed and SciELO for epidemiological studies on pesticide exposure and human health in LAC populations published between January 2007 and December 2021. We identified 233 publications from 16 countries that met our inclusion criteria and grouped them by health outcome (genotoxicity, neurobehavioral outcomes, placental outcomes and teratogenicity, cancer, thyroid function, reproductive outcomes, birth outcomes and child growth, and others). Results: Most published studies were conducted in Brazil (37%, n = 88) and Mexico (20%, n = 46), were cross-sectional in design (72%, n = 167), and focused on farmworkers (45%, n = 105) or children (21%, n = 48). The most frequently studied health effects included genotoxicity (24%, n = 62) and neurobehavioral outcomes (21%, n = 54), and organophosphate (OP) pesticides were the most frequently examined (26%, n = 81). Forty-seven percent in = 112) of the studies relied only on indirect pesticide exposure assessment methods. Exposure to OP pesticides, carbamates, or to multiple pesticide classes was consistently associated with markers of genotoxicity and adverse neurobehavioral outcomes, particularly among children and farmworkers. Discussion: Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations, but methodological limitations and inconsistencies undermine the strength of the conclusions. It is critical to increase capacity building, integrate research initiatives, and conduct more rigorous epidemiological studies in the region to address these limitations, better inform public health surveillance systems, and maximize the impact of research on public policies.
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1 Centro de Investigaciones de Estudios Avanzados del Maule, Universidad Catolica del Maule, Talca, Chile
2 Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, Berkeley, California, USA
3 School of Public Health and Population Science, Boise State University, Boise, Idaho, USA
4 Centro de Investigacion en Neuropsicologia y Neurociencias Cognitivas, Facultad de Ciencias de la Salud, Universidad Catolica del Maule, Talca, Chile
5 Facultad de Ciencias Medicas, Universidad Nacional de Cordoba, Cordoba, Argentina