Objectives Neuropsychiatric disorders and increased suicide rates have been associated with exposure to cholinesterase inhibiting organophosphates. This study examined symptoms of psychological distress, including suicidal ideation, among banana workers in Costa Rica previously exposed to a cholinesterase inhibiting pesticide. Methods 78 workers who had received medical attention 1e3 years previously for occupational pesticide poisoning were recruited: 54 had been exposed to organophosphate, 24 to carbamate, and 43 and 35, respectively, had single and multiple poisoning episodes with a cholinesterase inhibitor. Referents were 130 nonpoisoned workers randomly selected from company payrolls. Psychological distress symptoms during the month prior to interview were obtained using the Brief Symptom Inventory (BSI), which has a general severity index and nine subscale scores. Differences in abnormal BSI scores (T score$63) were assessed through multivariate logistic regression for all poisoned and for subcategories of poisoned as compared to non-poisoned workers. Results Organophosphate poisoned workers reported significantly more symptoms than non-poisoned on all but one symptom dimension. Significant trends of increasing symptoms with increasing number of previous poisonings were seen for somatisation, obsessivecompulsiveness, interpersonal sensitivity, depression and anxiety. Carbamate poisoned workers only had increased scores for somatisation. The ORs for suicidal thoughts were: all poisoned 3.58 (95% CI 1.45 to 8.84); organophosphate poisoned 3.72 (1.41 to 9.81); carbamate poisoned 2.57 (0.73 to 9.81); and 2.65 and 4.98, respectively for 1 and $2 poisonings (trend p¼0.01). Conclusions This cross-sectional study showed a relationship between acute occupational poisoning with organophosphates and psychological distress including suicidal ideation. Stronger designs are needed to address causality.

Objectives To characterise geographical distribution and time trends of chronic kidney disease (CKD) mortality in the context of the epidemic of Mesoamerican nephropathy (MeN), likely related to occupational heat stress and other, unknown, factors. Method Vital statistics (1970-2012) provided deaths from CKD and unspecified renal failure. Data of four censuses were extrapolated to derive person-years by sex and 10-year age groups for the seven provinces and 81 counties. SMRs were compared for three time periods between provinces and between counties, with national rates as reference. To assess time trends, age-specific and age-standardised mortality rates were computed for 5-year periods. Results During 1970-2012, 3843 men and 2452 women died from CKD. In the Guanacaste province, the SMR for 1997-2012 was four-fold in men and twofold in women. In Guana-caste, CKD mortality increased from the mid-1970s in men, and mid-1980s in women. Age-standardised rates per 100.000 in men aged ≥30 increased from 5.8 in the early seventies to 75.0 in 2007-2012, compared to 5.9 to 16.2 in the rest of Costa Rica. For women, rates increased from 4.5 to 20.7 in Guana-caste versus 4.2 to 9.7 in the rest of the country. Within Guana-caste, there was marked spatial variation in mortality between counties, with patterns being consistent between time periods but different for men and women. Conclusions Guanacaste is a heterogeneous CKD "hot spot," affecting mostly men, but to lesser extent also women. CKD seemed high already four decades ago in the province. These findings are pertinent for etiologic research.

Purpose: To assess exposure-response relations between exposure to magnetic fields and neurobehavioral effects. Materials and Methods:Twenty company volunteers completed a neurobehavioral test battery after they moved their heads with the magnetic field absent, and while they moved their heads in the inhomogenous stray fields of 1.5 and 3.0 T MRI magnets. Results:The value of the stray fields at the position of the head of the volunteer was estimated to be 0.6 T and 1.0 T on the 1.5 T and 3.0 T systems, respectively. Exposureresponse relations were found for visual (-2.1%/100 mT) and auditory (-1.0%/100 mT) working memory, eye-hand coordination speed (-1.0%/100 mT), and visual tracking tasks (-3.1%/100 mT). Eye-hand precision, scanning speed, and visual contrast sensitivity were apparently not influenced by the magnetic field strength. Conclusion:Additional research should focus on the potential side effects of interventional MR procedures because of the exposure to strong magnetic fields of these systems. RECENT TRENDS IN DIAGNOSTIC MRI procedures include a more extensive use of interventional procedures (1-3) and the use of stronger magnets (4). Although these procedures have certain advantages, they also expose the operating teams to high static, inhomogeneous magnetic fields generated by these systems because the operating teams operate in the stray field of the magnet. Although it has been shown that reports of field-induced sensory effects in the vicinity of MRI magnets can be elicited even when the magnet is ramped down (5), the incidence of sensations of nausea, vertigo, metallic taste, and magnetophosphenes (brief flashing lights) increases with the magnetic field strength (5,6). This supports the concept of field-dependent sensory effects (7). In addition, a recent study suggested that exposure to the magnetic fields generated by a 1.5 T MRI magnet temporarily affects the subject's performance in the psychomotor and visuosensory domains, but not in the short-term memory and attention domains (8). The latter finding was supported by a study with an 8 T magnetic field (9). The affected performance in the psychomotor and visuosensory domains could potentially influence the work of operating personnel performing interventional procedures (10).In this study we evaluated exposure-response relations between exposure to magnetic fields and neurobehavioral effects. The results provide additional evidence for a causal relation between exposure and effects. MATERIALS AND METHODS Study PopulationTwenty healthy male volunteers (age ϭ 25-59 years, mean ϭ 42 years) were selected from the business unit of a company that developed and manufactured MRI magnets. The volunteers were familiar with strong magnetic fields and MRI scanners, but did not necessarily work with the scanners on a daily basis. Their education varied from secondary vocational education (N ϭ 5) to B.Sc. (N ϭ 12) and Ph.D. (N ϭ 3) levels. Exposure AssessmentAll subjects were exposed for 30 minutes in three different sessions to the stray field of the ...

The interactive use of magnetic resonance imaging (MRI) techniques is increasing in operating theaters. A study was performed on 17 male company volunteers to assess the neurobehavioral effects of exposure to magnetic fields from a 1.5 Tesla MRI system. The subjects' neurobehavioral performances on a neurobehavioral test battery were compared in four 1-hr sessions with and without exposure to magnetic fields, and with and without additional movements. Adverse effects were found for hand coordination (-4%, P < 0.05; Pursuit Aiming II) and near visual contrast sensitivity (-16% and -15%, P < 0.10; Vistech 6000™). The results from the remaining tests were inconclusive due to a strong learning effect. No additional effect from gradient fields was detected. The results indicate that working near a 1.5 Tesla MRI system may lead to neurobehavioral effects. Further research is recommended, especially in members of operating teams using interactive MRI systems. Magn Reson Med 50:670 -674, 2003.

The Talamanca County in Costa Rica has large-scale banana and small-scale plantain production, probably causing pesticide exposure in indigenous children. We explored to what extent different community actors are aware of children's pesticide hazards and how their awareness related to socio-economical and cultural conditions. Methods comprised eight focus groups with fathers and mothers separately, 27 semi-structured interviews to key actors, and field observations. As a whole, the indigenous plantain farmers and banana plantation workers had some general knowledge of pesticides concerning crop protection, but little on acute health effects, and hardly any on exposure routes and pathways, and chronic effects. People expressed vague ideas about pesticide risks. Inter-community differences were related to pesticide technologies used in banana and plantain production, employment status on a multinational plantation versus smallholder status, and gender. Compared to formalized practices on transnational company plantations, where workers reported to feel protected, pesticide handling by plantain smallholders was not perceived as hazardous and therefore no safety precautions were applied. Large-scale monoculture was perceived as one of the most important problems leading to pesticide risks in Talamanca on banana plantations, and also on neighboring small plantain farms extending into large areas. Plantain farmers have adopted use of highly toxic pesticides following banana production, but in conditions of extreme poverty. Aerial spraying in banana plantations was considered by most social actors a major determinant of exposure for the population living nearby these plantations, including vulnerable children. We observed violations of legally established aerial spraying distances. Economic considerations were most mentioned as the underlying reason for the pesticide use: economic needs to obtain the production quantity and quality, and pressure to use pesticides by other economic agents such as middlemen. Risk perceptions were modulated by factors such as people's tasks and positions in the production process, gender, and people's possibilities to define their own social conditions (more fatalistic perceptions among banana workers). The challenge for the future is to combine these insights into improved health risk assessment and management that is culturally adequate for each particular community and agricultural context.

A cross-sectional study was conducted in 2007 to evaluate the relation between pesticide exposure and respiratory health in a population of indigenous women in Costa Rica. Exposed women (n = 69) all worked at plantain plantations. Unexposed women (n = 58) worked at organic banana plantations or other locations without pesticide exposure. Study participants were interviewed using questionnaires to estimate exposure and presence of respiratory symptoms. Spirometry tests were conducted to obtain forced vital capacity and forced expiratory volume in 1 second. Among the exposed, prevalence of wheeze was 20% and of shortness of breath was 36% versus 9% and 26%, respectively, for the unexposed. Prevalence of chronic cough, asthma, and atopic symptoms was similar for exposed and unexposed women. Among nonsmokers (n = 105), reported exposures to the organophosphate insecticides chlorpyrifos (n = 25) and terbufos (n = 38) were strongly associated with wheeze (odd ratio = 6.7, 95% confidence interval: 1.6, 28.0; odds ratio = 5.9, 95% confidence interval: 1.4, 25.6, respectively). For both insecticides, a statistically significant exposure-effect association was found. Multiple organophosphate exposure was common; 81% of exposed women were exposed to both chlorpyrifos and terbufos. Consequently, their effects could not be separated. All findings were based on questionnaire data. No relation between pesticide exposure and ventilatory lung function was found.

Background: Mancozeb and its main metabolite ethylene thiourea (ETU) may alter thyroid function; thyroid hormones are essential for fetal brain development. In Costa Rica, mancozeb is aerially sprayed at large-scale banana plantations on a weekly basis.Objectives: Our goals were to evaluate urinary ETU concentrations in pregnant women living near large-scale banana plantations, compare their estimated daily intake (EDI) with established reference doses (RfDs), and identify factors that predict their urinary ETU concentrations.Methods: We enrolled 451 pregnant women from Matina County, Costa Rica, which has large-scale banana production. We visited 445 women up to three times during pregnancy to obtain urine samples (n = 872) and information on factors that possibly influence exposure. We determined urinary ETU concentrations using liquid chromatography mass spectrometry.Results: Pregnant women’s median urinary ETU concentrations were more than five times higher than those reported for other general populations. Seventy-two percent of the women had EDIs above the RfD. Women who lived closest (1st quartile, < 48 m) to banana plantations on average had a 45% (95% CI: 23, 72%) higher urinary ETU compared with women who lived farthest away (4th quartile, ≥ 565 m). Compared with the other women, ETU was also higher in women who washed agricultural work clothes on the day before sampling (11%; 95% CI: 4.9, 17%), women who worked in agriculture during pregnancy (19%; 95% CI: 9.3, 29%), and immigrant women (6.2%; 95% CI: 1.0, 13%).Conclusions: The pregnant women’s urinary ETU concentrations are of concern, and the principal source of exposure is likely to be aerial spraying of mancozeb. The factors predicting ETU provide insight into possibilities for exposure reduction.Citation: van Wendel de Joode B, Mora AM, Córdoba L, Cano JC, Quesada R, Faniband M, Wesseling C, Ruepert C, Öberg M, Eskenazi B, Mergler D, Lindh CH. 2014. Aerial application of mancozeb and urinary ethylene thiourea (ETU) concentrations among pregnant women in Costa Rica: The Infants’ Environmental Health Study (ISA). Environ Health Perspect 122:1321–1328; http://dx.doi.org/10.1289/ehp.1307679

Manganese (Mn), an essential nutrient, is a neurotoxicant at high concentrations. We measured Mn concentrations in repeated blood and hair samples collected from 449 pregnant women living near banana plantations with extensive aerial spraying of Mn-containing fungicide mancozeb in Costa Rica, and examined environmental and lifestyle factors associated with these biomarkers. Mean blood Mn and geometric mean hair Mn concentrations were 24.4 μg/L (8.9–56.3) and 1.8 μg/g (0.05–53.3), respectively. Blood Mn concentrations were positively associated with gestational age at sampling (β = 0.2; 95% CI: 0.1 to 0.2), number of household members (β = 0.4; 95% CI: 0.1 to 0.6), and living in a house made of permeable and difficult-to-clean materials (β = 2.6; 95% CI: 1.3 to 4.0); and inversely related to smoking (β = −3.1; 95% CI: −5.8 to −0.3). Hair Mn concentrations were inversely associated with gestational age at sampling (% change = 0.8; 95% CI: −1.6 to 0.0); and positively associated with living within 50 m of a plantation (% change = 42.1; 95% CI: 14.2 to 76.9) and Mn concentrations in drinking water (% change = 17.5; 95% CI: 12.2 to 22.8). Our findings suggest that pregnant women living near banana plantations aerially sprayed with mancozeb may be environmentally exposed to Mn.