title: Exposure-response relationship between gastrointestinal problems among waste collectors and bioaerosol exposure.
abstract: OBJECTIVE
  A high frequency of gastrointestinal problems has previously been reported for waste collectors. The present study relates the gastrointestinal problems to measurements of the bioaerosols that waste collectors are exposed to during work.
  
  
  METHODS
  A job-exposure matrix was constructed from a combination of questionnaire data and field measurements. The questionnaire data were collected from 1747 male waste collectors and a comparison group of 1111 male municipal workers. Moreover a total of 189 full-shift personal samples was collected. The samples were used for characterizing the bioaerosol exposure described by viable fungi, total count of fungal spores, microorganisms, and endotoxins.
  
  
  RESULTS
  In a multivariate analysis, high exposure to endotoxins was associated with nausea [prevalence proportion ratio (PPR) 1.60], and the risk of reporting nausea decreased with decreasing exposure so that workers with low exposure had the fewest reports (PPR 1.39) in the comparison with the unexposed group. High exposure to endotoxins was also associated with reports of diarrhea (PPR 5.60), and the risk of reporting diarrhea decreased with decreasing exposure so that the workers with low exposure had the fewest reports (PPR 3.02). The same pattern existed for exposure to fungi, for which high exposure resulted in the most reports (PPR = 4.59), and for diarrhea, for which low exposure resulted in the fewest reports (PPR = 3.15).
  
  
  CONCLUSIONS
  An exposure-response relationship was found between nausea and endotoxin exposure and between diarrhea and exposure to both endotoxins and viable fungi.
authors.affiliation: Department of Occupational Medicine, National Institute of Occupational Health, Copenhagen, Denmark.
authors.forename: U I
authors.initials: UI
authors.lastname: Ivens
authors.forename: N O
authors.initials: NO
authors.lastname: Breum
authors.forename: N
authors.initials: N
authors.lastname: Ebbehøj
authors.forename: B H
authors.initials: BH
authors.lastname: Nielsen
authors.forename: O M
authors.initials: OM
authors.lastname: Poulsen
authors.forename: H
authors.initials: H
authors.lastname: Würtz
mesh_terms: D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure; D012037:Refuse Disposal; D018505:Waste Management