title: Exposure-affecting factors of dairy farmers' exposure to inhalable dust and endotoxin.
abstract: BACKGROUND
  Studies on determinants of dairy farmers' exposure to dust and endotoxin have been sparse and so far none has addressed the combined effect of tasks and farm characteristics.
  
  
  OBJECTIVE
  To study whether and how work tasks and specific stable characteristics influence the level of dairy farmers' personal exposure to inhalable dust and endotoxin.
  
  
  METHODS
  We applied an observational design involving full-shift repeated personal measurements of inhalable dust and endotoxin exposure among 77 subjects (owners and farm workers) from 26 dairy farms. Performed tasks were self-registered in activity diaries, and information on stable characteristics was collected through personal interviews and walk-through surveys. Associations between exposure, tasks, and stable characteristics were examined in linear mixed-effect models with individual and farm treated as random effects. Separate as well as combined models for tasks and stable characteristics were elaborated.
  
  
  RESULTS
  The 124 personal samples collected had a geometric mean level (geometric standard deviation) of 360 EU m(-3) (3.8) for endotoxin exposure and of 1.0mg m(-3) (2.7) for dust exposure. Identified factors that increased endotoxin exposure included a lower outdoor temperature and use of slope-based or back-flushed slurry systems along with milking, distribution of bedding, and handling of feed and seeds in barns. For dust, exposure was higher when fully automatic (robotic) milking was used and during re-penning of animals, handling of feed and seeds, handling of silos and when distributing bedding. Dust exposure increased also as a result of use of rail feed dispensers in a model without fully automatic milking.
  
  
  CONCLUSIONS
  The current exposure to dust and in particular endotoxin among Danish dairy farmers demand effective strategies to reduce their exposure. The present findings suggest that future interventions should focus on feeding and manure handling systems. Use of respirators during handling of feed and distribution of bedding should be advised until adequate risk management measures have been established. The expected increased use of fully automatic milking in the future might increase dust exposure of dairy farmers.
authors.affiliation: 1.Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, bg 1260, 8000 Aarhus C, Denmark ibas@mil.au.dk.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Basinas
authors.affiliation: 1.Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, bg 1260, 8000 Aarhus C, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: 2.Department of Public Health, Institute of Biostatistics, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Erlandsen
authors.affiliation: 1.Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, bg 1260, 8000 Aarhus C, Denmark.
authors.forename: Nils T
authors.initials: NT
authors.lastname: Andersen
authors.affiliation: 3.Department of Engineering, Aarhus University, Finlandsgade 22, 8200 Aarhus N, Denmark.
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Takai
authors.affiliation: 4.Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.affiliation: 1.Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, bg 1260, 8000 Aarhus C, Denmark 5.Department of Occupational Medicine, Danish Ramazzini Center, Aalborg University Hospital, Havrevangen 1, 9000 Aalborg, Denmark.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Omland
authors.affiliation: 4.Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
authors.affiliation: 1.Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Bartholins Allé 2, bg 1260, 8000 Aarhus C, Denmark 6.Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Vivi
authors.initials: V
authors.lastname: Schlünssen
mesh_terms: D000395:Air Pollutants, Occupational / Q000032:analysis*; D000818:Animals; D003612:Dairying; D003718:Denmark; D004391:Dust / Q000032:analysis*; D004731:Endotoxins / Q000032:analysis*; D004784:Environmental Monitoring / Q000379:methods; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis; D007407:Interviews as Topic; D016273:Occupational Exposure / Q000032:analysis*; D012307:Risk Factors
chemical_list: D000395:Air Pollutants, Occupational; D004391:Dust; D004731:Endotoxins
keywords: dairy farmers; determinants; dust; endotoxin; variability