Parkinson’s disease (PD) is an idiopathic disease of the nervous system characterized by progressive tremor, bradykinesia, rigidity, and postural instability. It has been postulated that exogenous toxicants, including pesticides, might be involved in the etiology of PD. In this article we present a comprehensive review of the published epidemiologic and toxicologic literature and critically evaluate whether a relationship exists between pesticide exposure and PD. From the epidemiologic literature, there does appear to be a relatively consistent relationship between pesticide exposure and PD. This relationship appears strongest for exposure to herbicides and insecticides, and after long durations of exposure. Toxicologic data suggest that paraquat and rotenone may have neurotoxic actions that potentially play a role in the development of PD, with limited data for other pesticides. However, both the epidemiology and toxicology studies were limited by methodologic weaknesses. Particular issues of current and future interest include multiple exposures (both pesticides and other exogenous toxicants), developmental exposures, and gene–environment interactions. At present, the weight of evidence is sufficient to conclude that a generic association between pesticide exposure and PD exists but is insufficient for concluding that this is a causal relationship or that such a relationship exists for any particular pesticide compound or combined pesticide and other exogenous toxicant exposure.

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Health surveillance is an essential tool in monitoring health in an armed force and in helping to protect the health of service personnel. This study used a literature search and direct contacts with individual countries to identify and evaluate health surveillance mechanisms used by armed forces worldwide. The study identified several health surveillance mechanisms ranging from periodic health assessments of personnel to complex databases of medical data linked to demographic and other supporting data. Essential elements of an effective health surveillance system are outlined, including the requirement that systems are adequately supported and allow the routine monitoring of health at the population level consistently throughout an armed force and consistently during times of peace and during operations. Areas for further research and development include linking of data on hazardous exposures, jobs and the locations of personnel with medical data, and the follow-up of personnel beyond their military service.