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The association between environmental Mn exposure and parkinsonism is unclear. To characterize the association between environmental Mn exposure and parkinsonism, we performed population-based sampling of residents older than 40 in Meyerton, South Africa (N\u2009=\u2009621) in residential settlements adjacent to a large Mn smelter and in a comparable non-exposed settlement in Ethembalethu, South Africa (N\u2009=\u200995) in 2016\u20132020.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A movement disorders specialist examined all participants using the Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3). Participants also completed an accelerometry-based kinematic test and a grooved pegboard test. We compared performance on the UPDRS3, grooved pegboard, and the accelerometry-based kinematic test between the settlements using linear regression, adjusting for covariates. We also measured airborne PM<jats:sub>2.5<\/jats:sub>-Mn in the study settlements.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Mean PM<jats:sub>2.5<\/jats:sub>-Mn concentration at a long-term fixed site in Meyerton was 203 ng\/m<jats:sup>3<\/jats:sup> in 2016\u20132017 \u2013 approximately double that measured at two other neighborhoods in Meyerton. The mean Mn concentration in Ethembalethu was ~\u200920 times lower than that of the long-term Meyerton site. UPDRS3 scores were 6.6 (CI 5.2, 7.9) points higher in Meyerton than Ethembalethu residents. Mean angular velocity for finger-tapping on the accelerometry-based kinematic test was slower in Meyerton than Ethembalethu residents [dominant hand 74.9 (CI 48.7, 101.2) and non-dominant hand 82.6 (CI 55.2, 110.1) degrees\/second slower]. Similarly, Meyerton residents took longer to complete the grooved pegboard, especially for the non-dominant hand (6.9, CI -2.6, 16.3\u00a0s longer).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Environmental airborne Mn exposures at levels substantially lower than current occupational exposure thresholds in the United States may be associated with clinical parkinsonism.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12940-021-00712-3","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T21:03:00Z","timestamp":1615842180000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Severity of parkinsonism associated with environmental manganese exposure"],"prefix":"10.1186","volume":"20","author":[{"given":"Brad A.","family":"Racette","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gill","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy W.","family":"Dlamini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Prathibha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay R.","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwiza","family":"Ushe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"Checkoway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne","family":"Sheppard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan Searles","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,15]]},"reference":[{"issue":"Suppl 3","key":"712_CR1","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1289\/ehp.00108s3429","volume":"108","author":"M Aschner","year":"2000","unstructured":"Aschner M. 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Toxicology. 2013;314(1):95\u20139.","journal-title":"Toxicology"}],"container-title":["Environmental Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-021-00712-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12940-021-00712-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-021-00712-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T21:03:19Z","timestamp":1615842199000},"score":1,"resource":{"primary":{"URL":"https:\/\/ehjournal.biomedcentral.com\/articles\/10.1186\/s12940-021-00712-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,15]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["712"],"URL":"https:\/\/doi.org\/10.1186\/s12940-021-00712-3","relation":{},"ISSN":["1476-069X"],"issn-type":[{"value":"1476-069X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,15]]},"assertion":[{"value":"17 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Washington University School of Medicine Human Research Protection Office (St. Louis, Missouri, U.S.) and the University of the Witwatersrand Human Research Ethics Committee (Johannesburg, Gauteng province, South Africa) approved this study (IRB ID #201506129).All participants provided written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"B.A. Racette receives research support from the following government and non-governmental organizations: National Institute of Environmental Health Sciences (R01ES026891, R01ES026891-S1, R01ES025991, R01ES025991-02S1, R01ES030937-S1, R01ES029524), National Institute of Occupational Safety and Health (R01OH011661), Cure Alzheimer\u2019s Fund, Department of Defense (PD190057), Hope Center for Neurologic Disorders (Washington University). Dr. Racette has received honoraria (personal compensation) for lectures from the University of Michigan and Harvard University. He has received personal compensation for peer review from the Parkinson Study Group, service on the National Advisory Environmental Health Sciences Council for NIEHS, and legal testimony on behalf of the Johnson and Bell law firm.G. Nelson receives research support from the following government organization: NIEHS (R01ES026891, R01ES026891-S1, R01ES025991, R01ES025991-02S1). She also receives personal compensation from journal \u201cOccupational Health Southern Africa\u201d for which she serves as editor.W. W. Dlamini declares no disclosures relevant to the manuscript.P. Prathibha declares no disclosures relevant to the manuscript.J.R. Turner receives research support from the following government and non-governmental organizations: NIH (R01ES025991, R01ES029846, R01HD098255, P42ES023716), UNICEF (GLA\/2880\/2019\/002-PCA), and FHWA\/DOT (DTFH6117C00036). Dr. Turner has received personal compensation for service on the Science Advisory Board for EPA.M. Ushe receives research support from the following government organizations: NIEHS (R01ES025991) and NINDS (R01NS109487).H. Checkoway receives research support from the NIOSH (R01OH011661) and NIEHS (R01ES025991). In 2020, he also received an honorarium for serving as a member of the Scientific Review Panel for University of Cincinnati Risk Science Center Assessment of the Carcinogenic Effects of Ethylene Oxide.L. Sheppard receives research support from the following governmental and non-governmental organizations: NIEHS and NIA (R01ES026187), NIEHS (R25ES025503, R01ES026891, R01ES027696, R01ES026246, R01ES029509, R01ES029524), NIA (P01AG055367), Health Effects Institute. She has received personal compensation for service to the Environmental Protection Agency and the Health Effects Institute, and for peer review for The Lancet Planetary Health. She received small tokens of appreciation in lieu of travel to the Centre for Air Pollution, Energy, and Health Research in Australia.S. Searles Nielsen receives research support from the following governmental and non-governmental organizations: R01ES026891-03, K01ES028295-03, R01ES025991-05, R01ES025991-02S1, R01ES029524-02, Cure Alzheimer\u2019s Fund, Department of Defense (PD190057).Statistical Analysis conducted by Susan Searles Nielsen and Wendy W. Dlamini at Washington University School of Medicine and Lianne Sheppard at the University of Washington.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}