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Lehto MT, Kauppila T, Kautiainen H, Rahkonen O, Laine MK, Pitkälä K. Who visits primary health care general practitioners and why? A register-based study in a Finnish city. Int J Circumpolar Health 2024; 83:2366034. [PMID: 38870400 DOI: 10.1080/22423982.2024.2366034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
This is a register-based study that examines the distribution of diagnoses made by general practitioners (GPs) in the public primary health care of the city of Vantaa, Finland. Data were gathered from the electronic health record (EHR) system and consisted of every record entered into the EHR system between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of the 10th edition of International Classification of Diseases (ICD-10) diagnosis recordings were reported and calculated. Among GP visits, the 88 most common diagnoses covered 75% of all diagnoses. The most common diagnoses were related to the musculoskeletal (3.8%, ICD code M54) and respiratory systems (6.0%, ICD-10 code J06). Primary health care GP services were mostly used by children (age <5 years) and older adults (>65 years). Health examinations - mostly children's and maternity clinics appointments/visits - covered 20% of the GP office visits. Women between the ages 15-79 years had relatively more GP visits compared to men. The 88 most commonly recorded diagnoses covered the majority of the GP visits. Health examinations for the healthy were an important part of GPs' work. In an urban Finnish city, GP services were predominantly used by children and older adults.
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Affiliation(s)
- Mika T Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, Vantaa, Finland
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, Vantaa, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- MedCare LTD, Äänekoski, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Köteles F, Nordin S. Do somatic symptom distress and attribution predict symptoms associated with environmental factors? J Psychosom Res 2024; 179:111637. [PMID: 38442536 DOI: 10.1016/j.jpsychores.2024.111637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Not much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs). METHODS We used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs. RESULTS Using binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings. CONCLUSION Overall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.
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Affiliation(s)
- Ferenc Köteles
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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Köteles F, Nordin S, Claeson AS. Associations between symptoms, modern health worries, and somatosensory amplification in patients with building-related symptoms. J Psychosom Res 2023; 173:111476. [PMID: 37643562 DOI: 10.1016/j.jpsychores.2023.111476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The objective of the present study was to investigate the associations between somatosensory amplification, modern health worries (MHWs), and symptoms among patients with building-related symptoms (BRS). METHODS Patients with self-reported and medically confirmed BRS (n = 83) were included in this cross-sectional study. The Somatosensory Amplification Scale (SSAS) was used to quantify the tendency to amplify somatic sensations and perceive them as unpleasant and dangerous. Concerns about harmful effects of modern technologies were assessed with the Modern Health Worries Scale (MHWS). Symptoms commonly found in different forms of environmental intolerance were assessed with the Environmental Hypersensitivity Symptom Inventory (EHSI). RESULTS Patients with BRS were characterized by more frequent and more severe environmental hypersensitivity symptoms compared to a reference population. Females and those with co-morbid self-reported chemical intolerance reported even more symptoms. MHWS and SSAS scores showed weak to moderate associations with symptoms, even after adjusting for socio-economic variables. However, neither the mean MHWS score or the SSAS score of our sample differed from normative scores. CONCLUSION Patients with BRS are not characterized by elevated levels of MHWs and somatosensory amplification, thus other, psychosocial and/or environmental, factors may have contributed to the development of the condition. However, the associations between severity of symptoms and MHWs and somatosensory amplification suggest that psychosocial characteristics may substantially influence symptom experience in this group.
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Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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Lu X, Hojo S, Mizukoshi A, Katoh T. Prevalence and correlation of multiple chemical sensitivity and electromagnetic hypersensitivity with age, sex, and depression in the Japanese population: a retrospective study. BMC Public Health 2023; 23:1205. [PMID: 37344806 DOI: 10.1186/s12889-023-16152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In Japan, there are currently no definitive conclusions regarding the characteristics of multiple chemical sensitivity (MCS) and electromagnetic hypersensitivity (EHS). This study aimed to determine the prevalence and correlation of MCS and EHS with age, sex, and depression in the Japanese population. METHODS An anonymous self-report questionnaire was distributed to 2,007 participants. Variables such as MCS, EHS, depression score, and demographic characteristics were individually evaluated using the U-test, chi-squared test, and correlation analyses. Moreover, we performed a covariance structure analysis to build a structural equation model. RESULTS Older individuals and women were more likely to exhibit MCS and EHS symptoms. Moreover, depression was correlated with MCS and EHS. CONCLUSIONS Although MCS and EHS are strongly correlated, they exhibit distinct characteristics and symptoms, indicating that they can be regarded as separate conditions.
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Affiliation(s)
- Xi Lu
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.
| | - Sachiko Hojo
- Shokei Gakuin University, Natori, Miyagi, 981-1295, Japan
- Graduate School of Dentistry, Tohoku University, Sendai, Miyagi, Japan
| | - Atsushi Mizukoshi
- Department of Environmental Medicine and Behavioral Science, Kindai University Faculty of Medicine, Osakasayama, Osaka, 589-8511, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
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Nordin S, Köteles F, Witthöft M, Van den Bergh O, Nyback MH, Sainio M. Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population. ENVIRONMENTAL RESEARCH 2023; 229:115945. [PMID: 37080270 DOI: 10.1016/j.envres.2023.115945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
| | - Ferenc Köteles
- Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, And Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany.
| | | | | | - Markku Sainio
- Outpatient Clinic for Functional Disorders, Helsinki University Hospital, Helsinki, Finland.
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Traini E, Martens AL, Slottje P, Vermeulen RCH, Huss A. Time course of health complaints attributed to RF-EMF exposure and predictors of electromagnetic hypersensitivity over 10 years in a prospective cohort of Dutch adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159240. [PMID: 36209879 DOI: 10.1016/j.scitotenv.2022.159240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Some individuals attribute health complaints to radiofrequency electromagnetic field (RF-EMF) exposure. This condition, known as idiopathic environmental intolerance attributed to RF-EMFs (IEI-RF) or electromagnetic hypersensitivity (EHS), can be disabling for those who are affected. In this study we assessed factors related to developing, maintaining, or discarding IEI-RF over the course of 10 years, and predictors of developing EHS at follow-up using a targeted question without the condition of reporting health complaints attributed to RF-EMF exposure. METHODS Participants (n = 892, mean age 50 at baseline, 52 % women) from the Dutch Occupational and Environmental Health Cohort Study AMIGO filled in questionnaires in 2011/2012 (T0), 2013 (T1), and 2021 (T4) where information pertaining to perceived RF-EMF exposure and risk, non-specific symptoms, sleep problems, IEI-RF, and EHS was collected. We fitted multi-state Markov models to represent how individuals transitioned between states ("yes", "no") of IEI-RF. RESULTS At each time point, about 1 % of study participants reported health complaints that they attributed to RF-EMF exposure. While this percentage remained stable, the individuals who reported such complaints changed over time: of nine persons reporting health complaints at T0, only one reported IEI-RF at both T1 and T4, and two newly reported health complaints at T4. Overall, participants had a 95 % chance of transitioning from "yes" to "no" over a time course of 10 years, and a chance of 1 % of transitioning from "no" to "yes". Participants with high perceived RF-EMF exposure and risk had a general tendency to move more frequently between states. CONCLUSIONS We observed a low prevalence of IEI-RF in our population. Prevalence did not vary strongly over time but there was a strong aspect of change: over 10 years, there was a high probability of not attributing symptoms to RF-EMF exposure anymore. IEI-RF appears to be a more transient condition than previously assumed.
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Affiliation(s)
- Eugenio Traini
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands.
| | - Astrid L Martens
- PBL Netherlands Environmental Assessment Agency, Bezuidenhoutseweg 30, 2594 AV The Hague, the Netherlands
| | - Pauline Slottje
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Roel C H Vermeulen
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
| | - Anke Huss
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
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Huang PC, Chiang JC, Cheng YY, Cheng TJ, Huang CY, Chuang YT, Hsu T, Guo HR. Physiological changes and symptoms associated with short-term exposure to electromagnetic fields: a randomized crossover provocation study. Environ Health 2022; 21:31. [PMID: 35255916 PMCID: PMC8902720 DOI: 10.1186/s12940-022-00843-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The biological association between electromagnetic fields (EMF) and idiopathic environmental intolerance attributed to EMF (IEI-EMF) has not been established. To assess the physiological changes and symptoms associated with exposure to EMF, we conducted a randomized crossover provocation study. METHODS We recruited 58 individuals with IEI-EMF (IEI-EMF group) and 92 individuals without IEI-EMF (control group). In a controlled environment, all participants received EMF signals mimicking those from mobile phone base stations in a randomized sequence under the blinded condition. During the course, participants reported their symptoms and whether they perceived EMF, and we monitored their physiological parameters, including blood pressure (BP), heart rate (HR), and HR variability. RESULTS The IEI-EMF and control groups reported similar frequencies of symptoms during both the provocation and sham sessions. No participant could accurately identify the provocation. In both groups, physiological parameters were similar between the two sessions. The control group, but not the IEI-EMF group, had elevated HR when they perceived EMF exposure. CONCLUSIONS No symptoms or changes in physiological parameters were found to be associated with short-term exposure to EMF, and no participant could accurately detect the presence of EMF. Moreover, the participants in the control group, but not those in the IEI-EMF group, had elevated HR when they perceived EMF.
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Affiliation(s)
- Po-Chang Huang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Jui-Chin Chiang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Yun Cheng
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Tain-Junn Cheng
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Yuan Huang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
- Tainan Science-Based Industrial Park Clinic, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ya-Ting Chuang
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ti Hsu
- Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
- Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan.
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Watrin L, Nordin S, Szemerszky R, Wilhelm O, Witthöft M, Köteles F. Psychological models of development of idiopathic environmental intolerances: Evidence from longitudinal population-based data. ENVIRONMENTAL RESEARCH 2022; 204:111774. [PMID: 34506786 DOI: 10.1016/j.envres.2021.111774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
The origin of idiopathic environmental intolerances (IEIs) is an open question. According to the psychological approaches, various top-down factors play a dominant role in the development of IEIs. The general psychopathology model assumes a propensity towards mental ill-health (negative affectivity) increases the probability of developing IEIs. The attribution model emphasizes the importance of mistaken attribution of experienced somatic symptoms; thus, more symptoms should lead to more IEIs. Finally, the nocebo model highlights the role of expectations in the development of IEIs. In this case, worries about the harmful effects of environmental factors are assumed to evoke IEIs. We estimated cross-lagged panel models with latent variables based on longitudinal data obtained at two time points (six years apart) from a large near-representative community sample to test the hypothesized associations. Indicators of chemical intolerance, electromagnetic hypersensitivity, and sound sensitivity fit well under a common latent factor of IEIs. This factor, in turn, showed considerable temporal stability. However, whereas a positive association was found between IEIs and increased somatic symptoms and modern health worries six years later, the changes therein could not be predicted as hypothesized by the three psychological models. We discuss the implications of these results, as well as methodological aspects in the measurement and prediction of change in IEIs.
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Affiliation(s)
- Luc Watrin
- Institute for Psychology and Education, Ulm University, Germany.
| | | | - Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary
| | - Oliver Wilhelm
- Institute for Psychology and Education, Ulm University, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary
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Azuma K, Uchiyama I, Kunugita N. Potential factors affecting chronic chemical intolerance associated with constitutional predisposition or lifestyle and environment during childhood: From a six-year follow-up study. J Psychosom Res 2021; 151:110665. [PMID: 34763204 DOI: 10.1016/j.jpsychores.2021.110665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Japanese chemical intolerance (JCI) study was conducted in January 2012 with a cohort of 7245 adults from population-based sampling. This study aimed to investigate the childhood constitutional and environmental factors involved in the development of chronic CI from the prospective cohort study. METHODS In the cohort, 4683 persons were identified after six years. Self-reported questionnaires were administered to the subjects to obtain information on CI status; medical history; constitution, lifestyle, and housing environment during childhood; and recent psychosomatic states. We assessed the differences between individuals with persisting CI status during the follow-up (defined as chronic CI) and controls not having CI status during the follow-up. RESULTS A total of 2500 individuals responded. Multiple logistic regression analyses revealed significant associations between chronic CI and motion sickness to car or bus and allergic conjunctivitis during childhood. Significant associations between a possible increased risk of CI and the existence of high-voltage power lines close to housing, the use of vinyl covering in wall material, the use of strong perfume by a family member, and the experience of stinky odor of paint or wax at elementary school were observed. However, the use of carpet in floor material and plaster coating in wall material was associated with a possible decreased risk of CI. CONCLUSIONS Some potential constitutional predisposition from childhood, including inherent susceptibility in the autonomic nervous system may be involved in the development of CI.
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Affiliation(s)
- Kenichi Azuma
- Department of Environmental Medicine and Behavioral Science, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan; Department of Environmental Health, National Institute of Public Health, Wako 351-0197, Japan.
| | - Iwao Uchiyama
- Sick-house Medical Science Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto 606-8225, Japan.
| | - Naoki Kunugita
- Occupational and Community Health Nursing Division, Department of Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan; Department of Environmental Health, National Institute of Public Health, Wako 351-0197, Japan.
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Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312296. [PMID: 34886041 PMCID: PMC8657242 DOI: 10.3390/ijerph182312296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.
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Suojalehto H, Ndika J, Lindström I, Airaksinen L, Karvala K, Kauppi P, Lauerma A, Toppila-Salmi S, Karisola P, Alenius H. Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance. Int J Mol Sci 2021; 22:ijms221910679. [PMID: 34639020 PMCID: PMC8508786 DOI: 10.3390/ijms221910679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Joseph Ndika
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
| | - Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Liisa Airaksinen
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Kirsi Karvala
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
- Varma, 00098 Helsinki, Finland
| | - Paula Kauppi
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Antti Lauerma
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Piia Karisola
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
| | - Harri Alenius
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
- Institute of Environmental Medicine (IMM), Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +358-50-4489526
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Turunen AW, Tiittanen P, Yli-Tuomi T, Taimisto P, Lanki T. Self-reported health in the vicinity of five wind power production areas in Finland. ENVIRONMENT INTERNATIONAL 2021; 151:106419. [PMID: 33706126 DOI: 10.1016/j.envint.2021.106419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
In many countries, some people living in the vicinity of wind power production areas report having symptoms that they intuitively associate with wind turbines. Recently public discussions have focused especially on wind turbine infrasound. However, scientific evidence supporting an association is lacking. The aim of this study was to assess the association between exposure to wind turbines and the prevalence of self-reported symptoms, diseases and medications. A cross-sectional questionnaire study (n = 2,828) was conducted in the vicinity of five wind power production areas in Finland in 2015-2016. Each area had 3-16 turbines with a nominal power of 2.4-3.3 MW. The response rate was 50% (n = 1,411). Continuous and categorised (≤ 2.5, > 2.5-5, > 5-10 km) distance between the respondents' home and the closest wind turbine was used to represent exposure to wind turbines. Wind turbine sound pressure level outdoors could be reliably modelled only for the closest distance zone where the yearly average was 34 dB and maximum 43 dB. The data on symptoms (headache, nausea, dizziness, tinnitus, ear fullness, arrhythmia, fatigue, difficulties in falling asleep, waking up too early, anxiety, stress), diseases (hypertension, heart insufficiency, diabetes), and medications (analgesics for headache, joint/muscle pain and other pain, and medication for sleep disturbance, anxiety and depression, and hypertension) was obtained from the questionnaire. Logistic regression analyses were adjusted for age, sex, marital status, education, work situation, smoking, alcohol consumption, physical activity, body mass index, and hearing problems. Annoyance and sleep disturbance due to wind turbine noise were inversely associated with the distance to the closest wind turbine. The prevalence of symptoms, diseases and medications was essentially the same in all distance categories. In multivariate regression modelling, the odds ratio estimates were generally close to unity and statistically non-significant. Beyond annoyance and sleep disturbance, there were no consistent associations between exposure to wind turbines and self-reported health problems. The results do not support the hypothesis that broadband sound or infrasound from wind turbines could cause the proposed health problems.
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Affiliation(s)
- Anu W Turunen
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70100 Kuopio, Finland.
| | - Pekka Tiittanen
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70100 Kuopio, Finland
| | - Tarja Yli-Tuomi
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70100 Kuopio, Finland
| | - Pekka Taimisto
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70100 Kuopio, Finland
| | - Timo Lanki
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70100 Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
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Dantoft TM, Nordin S, Andersson L, Petersen MW, Skovbjerg S, Jørgensen T. Multiple chemical sensitivity described in the Danish general population: Cohort characteristics and the importance of screening for functional somatic syndrome comorbidity-The DanFunD study. PLoS One 2021; 16:e0246461. [PMID: 33626058 PMCID: PMC7904225 DOI: 10.1371/journal.pone.0246461] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity. Methods Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex. Results MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS. Conclusions MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.
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Affiliation(s)
- Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- * E-mail:
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Andersson L, Sandberg P, Åström E, Lillqvist M, Claeson AS. Chemical Intolerance Is Associated With Altered Response Bias, not Greater Sensory Sensitivity. Iperception 2020; 11:2041669520978424. [PMID: 33425314 PMCID: PMC7754803 DOI: 10.1177/2041669520978424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022] Open
Abstract
Chemical intolerance is a surprisingly prevalent condition or affliction characterized by adverse reactions to low levels of chemical, often odorous stimulation. Sufferers often assume that their plight is due to an uncommon sensory acuteness, yet studies repeatedly fail to reveal altered detection thresholds. Here, we investigated whether self-reported chemical intolerance is associated with altered sensory sensitivity or response bias. The sensory acuity (sensitivity; A) and sensory decision rule (criterion; B) to n-butanol was assessed using the method of constant stimuli in 82 participants with different degrees of chemical intolerance (low to high). Higher self-reported chemical intolerance was associated with a lower criterion, but not with sensitivity.
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Affiliation(s)
| | - Petra Sandberg
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | | | - Moa Lillqvist
- Department of Psychology, Umeå University, Umeå, Sweden
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15
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Veenaas C, Ripszam M, Glas B, Liljelind I, Claeson AS, Haglund P. Differences in chemical composition of indoor air in rooms associated/not associated with building related symptoms. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 720:137444. [PMID: 32325564 DOI: 10.1016/j.scitotenv.2020.137444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 06/11/2023]
Abstract
Building related health effects or symptoms (BRS), known also as sick-building syndrome (SBS), are a phenomenon that is not well understood. In this study, air samples from 51 rooms associated with BRS and 34 control rooms were collected on multi-sorbent tubes and analyzed by a non-target approach using comprehensive two-dimensional gas chromatography and high-resolution mass spectrometry techniques. The large amount of data gathered was analyzed using multivariate statistics (principle component analysis (PCA) and partial least squares (PLS)). This new analysis approach revealed that in rooms where people experienced BRS, petrochemicals and chemicals emitted from plastics were abundant, whereas in rooms where people did not experience BRS, flavor and fragrance compounds were abundant. Among the petrochemicals benzene and 2-butoxyethanol were found in higher levels in rooms where people experienced BRS. The levels of limonene were sometimes in the range of reported odor thresholds, and similarly 3-carene and beta-myrcene were found in higher concentrations in indoor air of rooms where people did not experience BRS. It cannot be ruled out that these compounds may have influenced the perceived air quality. However, the overall variability in air concentrations was large and it was not possible to accurately predict if the air in a particular room could cause BRS or not.
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Affiliation(s)
- Cathrin Veenaas
- Department of Chemistry, Umeå University, 90187 Umeå, Sweden.
| | - Matyas Ripszam
- Department of Chemistry, Umeå University, 90187 Umeå, Sweden
| | - Bo Glas
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Ingrid Liljelind
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | | | - Peter Haglund
- Department of Chemistry, Umeå University, 90187 Umeå, Sweden
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16
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Dieudonné M. Electromagnetic hypersensitivity: a critical review of explanatory hypotheses. Environ Health 2020; 19:48. [PMID: 32375774 PMCID: PMC7201940 DOI: 10.1186/s12940-020-00602-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/20/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Electromagnetic hypersensitivity (EHS) is a condition defined by the attribution of non-specific symptoms to electromagnetic fields (EMF) of anthropogenic origin. Despite its repercussions on the lives of its sufferers, and its potential to become a significant public health issue, it remains of a contested nature. Different hypotheses have been proposed to explain the origin of symptoms experienced by self-declared EHS persons, which this article aims to review. METHODS As EHS is a multi-dimensional problem, and its explanatory hypotheses have far-reaching implications, a broad view was adopted, not restricted to EHS literature but encompassing all relevant bodies of research on related topics. This could only be achieved through a narrative approach. Two strategies were used to identify pertinent references. Concerning EHS, a complete bibliography was extracted from a 2018 report from the French Agency for Food, Environmental and Occupational Health & Safety and updated with more recent studies. Concerning related topics, the appropriate databases were searched. Systematic reviews and expert reports were favored when available. FINDINGS Three main explanatory hypotheses appear in the literature: (1) the electromagnetic hypothesis, attributing EHS to EMF exposure; (2) the cognitive hypothesis, assuming that EHS results from false beliefs in EMF harmfulness, promoting nocebo responses to perceived EMF exposure; (3) the attributive hypothesis, conceiving EHS as a coping strategy for pre-existing conditions. These hypotheses are successively assessed, considering both their strengths and limitations, by comparing their theoretical, experimental, and ecological value. CONCLUSION No hypothesis proves totally satisfying. Avenues of research are suggested to help decide between them and reach a better understanding of EHS.
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Affiliation(s)
- Maël Dieudonné
- Max Weber Center, Institut des Sciences de l'Homme, 14 avenue Berthelot, F-69007, Lyon, France.
- Health Services and Performance Research, University Hospital of Lyon, 162 avenue Lacassagne, F-69003, Lyon, France.
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17
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Nordin S. Mechanisms underlying nontoxic indoor air health problems: A review. Int J Hyg Environ Health 2020; 226:113489. [DOI: 10.1016/j.ijheh.2020.113489] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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18
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Selinheimo S, Vuokko A, Hublin C, Järnefelt H, Karvala K, Sainio M, Suojalehto H, Paunio T. Psychosocial treatments for employees with non-specific and persistent physical symptoms associated with indoor air: A randomised controlled trial with a one-year follow-up. J Psychosom Res 2020; 131:109962. [PMID: 32078837 DOI: 10.1016/j.jpsychores.2020.109962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Persistent physical symptoms (PPS) associated with indoor air without an adequate pathophysiological- or environmental-related explanation may lead to work disability and decreased health-related quality of life (HRQoL). We attempted to assess the effect of cognitive behavioural therapy (CBT) for PPS and also psychoeducation (PE) on these symptoms involving disability. METHOD The intention-to-treat (ITT) sample included 52 employees recruited from an occupational healthcare service randomised as either controls undergoing treatment as usual (TAU) or TAU enhanced with CBT or PE. The primary outcome was HRQoL measuring the severity of symptoms and restrictions in everyday life caused by them. Secondary outcomes included depressive, anxiety and insomnia symptoms, and intolerance to environmental factors, assessed at baseline and at 3-, 6- and 12-month follow-ups. RESULTS At the 12-month follow-up assessment point, no statistically significant differences between treatments emerged following adjustment for gender, age, and HRQoL before the waiting period in the ITT analysis [F(2,46)=2.89, p=.07]. The secondary analysis revealed a significant improvement in HRQoL in the combined intervention group as compared with controls [F(1,47)=5.06, p=.03, g=0.41]. In total, 15% of participants dropped out during follow-up. CONCLUSIONS The results suggest that CBT for PPS or PE might not have a robust effect on HRQoL in PPS associated with indoor air, but the study did not achieve the planned power. Despite difficulties during the recruitment process, the final dropout rates remained low, and participants positively evaluated CBT, suggesting that it represents an acceptable treatment to them. Trial status This study was registered at the ClinicalTrials.gov registry (NCT02069002).
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Affiliation(s)
- Sanna Selinheimo
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Christer Hublin
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland; Insurance Medicine and Rehabilitation Unit, Keva, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | | | - Tiina Paunio
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry and the SleepWell Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Haanes JV, Nordin S, Hillert L, Witthöft M, van Kamp I, van Thriel C, Van den Bergh O. "Symptoms associated with environmental factors" (SAEF) - Towards a paradigm shift regarding "idiopathic environmental intolerance" and related phenomena. J Psychosom Res 2020; 131:109955. [PMID: 32058864 DOI: 10.1016/j.jpsychores.2020.109955] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
Abstract
Health conditions characterized by symptoms associated with chemical, physical and biological environmental factors unrelated to objectifiable pathophysiological mechanisms are often labelled by the general term "idiopathic environmental intolerances". More specific, exposure-related terms are also used, e.g. "multiple chemical sensitivities", "electromagnetic hypersensitivity" and "candidiasis hypersensitivity". The prevalence of the conditions varies from a few up to more than 50%, depending on definitions and populations. Based on evolving knowledge within this field, we provide arguments for a paradigm shift from terms focusing on exposure and intolerance/(hyper-)sensitivity towards a term more in line with the perceptual elements that seem to underlie these phenomena. Symptoms caused by established pathophysiologic mechanisms should not be included, e.g. allergic or toxicological conditions, lactose intolerance or infections. We discuss different alternatives for a new term/concept and end up proposing an open and descriptive term, "symptoms associated with environmental factors" (SAEF), including a definition. "Symptoms associated with environmental factors" both is in line with the current knowledge and acknowledge the experiences of the afflicted persons. Thus, the proposed concept is likely to facilitate therapy and communication between health professionals and afflicted persons, and to provide a base for better understanding of such phenomena in healthcare, society and science.
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Affiliation(s)
- Jan Vilis Haanes
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, NO-9038 Tromsø, Norway; Department of Community Medicine, University of Tromsø, NO-9037 Tromsø, Norway.
| | - Steven Nordin
- Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
| | - Lena Hillert
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65 Stockholm, Sweden.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University, DE-55122 Mainz, Germany.
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
| | - Christoph van Thriel
- Leibniz Research Centre for Working Environment and Human Factors, TU Dort-mund University, DE-44139 Dortmund, Germany.
| | - Omer Van den Bergh
- Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, BE-3000, Belgium.
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Nakayama Y, Nakaoka H, Suzuki N, Tsumura K, Hanazato M, Todaka E, Mori C. Prevalence and risk factors of pre-sick building syndrome: characteristics of indoor environmental and individual factors. Environ Health Prev Med 2019; 24:77. [PMID: 31847815 PMCID: PMC6918696 DOI: 10.1186/s12199-019-0830-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With the aim to prevent sick building syndrome and worsening of allergic symptoms, primarily resulting from the indoor environment, the relationships among people's residential environment in recent years, their lifestyle habits, their awareness, and their symptoms were investigated using an online survey. METHODS In the survey, respondents experiencing symptoms specific to sick building syndrome, although they were not diagnosed with sick building syndrome, were categorized in the pre-sick building syndrome group. The relationships among individual characteristics, residential environment, and individual awareness were analyzed. RESULTS Results showed that the prevalence of pre-sick building syndrome was high among young (aged 20-29 years) population of both sexes. In addition, "condensation," "moisture," "musty odors" in the house, and the "use of deodorant and fragrance" were all significantly associated with pre-sick building syndrome. Conversely, there was no significant association with recently built "wooden" houses that are highly airtight and have thermal insulation. CONCLUSIONS Efficient "ventilation" plans and "ventilation" improvement and air conditioning systems to prevent mold and condensation in rooms are necessary to maintain a good, indoor environment that is beneficial for health. Efforts should also be made to encourage individuals to regularly clean and effectively ventilate their homes.
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Affiliation(s)
- Yoshitake Nakayama
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Hiroko Nakaoka
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Norimichi Suzuki
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Kayo Tsumura
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Masamichi Hanazato
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Emiko Todaka
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
| | - Chisato Mori
- Center for Preventive Medical Sciences, Chiba University, 6-2-1 Kashiwanoha, Kashiwa, Chiba, 277-0882 Japan
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Azuma K, Uchiyama I, Tanigawa M, Bamba I, Azuma M, Takano H, Yoshikawa T, Sakabe K. Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous. Environ Health Prev Med 2019; 24:61. [PMID: 31640568 PMCID: PMC6806489 DOI: 10.1186/s12199-019-0816-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background Chemical intolerance (CI) is a chronic condition characterized by recurring and severe symptoms triggered by exposure to low levels of odorous or pungent substances. The etiology of CI has been a controversial subject for a long time. The aim of this review is to summarize findings on the neurological processing of sensory information during and after exposure to low levels of odorous or pungent substances in individuals with CI, focusing on the brain function and networks. Methods Scientific studies on CI published between 2000 and 2019 in academic peer-reviewed journals were systematically searched using medical and scientific literature databases. Only peer-reviewed articles reporting original research from experimental human studies directly associated with CI, and involving related neurological responses or brain imaging after exposure to odorous or pungent substances (i.e., in chemical provocation tests), were considered. Results Forty-seven studies were found to be eligible for a full-text review. Twenty-three studies met the selection criteria and were included in this review. Evidence indicated that differences between subjects with CI and healthy controls were observed by brain imaging during and after exposure to odorous or pungent substances. Differences in brain imaging were also observed between initial exposure and after exposure to these substances. Neurological processing of sensory information after exposure to extrinsic stimuli in the limbic system and related cortices were altered in subjects with CI. A previous documentable exposure event was likely to be involved in this alteration. Conclusions This review documents consistent evidence for the altered neurological processing of sensory information in individuals with CI. Further neurophysiological research exploring the processing of extrinsic stimuli and cognition of sensation through the limbic system and related cortices in CI, and the appearance of symptoms in individuals with CI, are required.
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Affiliation(s)
- Kenichi Azuma
- Department of Environmental Medicine and Behavioral Science, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan. .,Sick-house Medical Science Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto, 606-8225, Japan.
| | - Iwao Uchiyama
- Sick-house Medical Science Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto, 606-8225, Japan.,Outpatient Department of Sick-house Syndrome, Hyakumanben Clinic, Kyoto, 606-8225, Japan
| | - Mari Tanigawa
- Outpatient Department of Sick-house Syndrome, Hyakumanben Clinic, Kyoto, 606-8225, Japan.,Clinical Immune Function Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto, 606-8225, Japan
| | - Ikuko Bamba
- Faculty of Education, Home Economics, Tokyo Gakugei University, Koganei, 184-8501, Japan
| | - Michiyo Azuma
- Department of Human Environmental Design, Faculty of Health Science, Kio University, Kitakatsuragi-gun, 635-0832, Japan
| | - Hirohisa Takano
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Toshikazu Yoshikawa
- Sick-house Medical Science Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto, 606-8225, Japan
| | - Kou Sakabe
- Department of Anatomy and Cellular Biology, Tokai University School of Medicine, Isehara, 259-1193, Japan
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Söderholm A, Liljelind I, Edvardsson B, Nordin S. Development and evaluation of a questionnaire instrument for chemical intolerance, based on the International Classification of Functioning, Disability and Health. Disabil Rehabil 2019; 43:1756-1763. [PMID: 31591906 DOI: 10.1080/09638288.2019.1672812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose was to develop a questionnaire instrument to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance, based on the International Classification of Functioning, Disability and Health, and to assess its validity and reliability. METHOD Development in three steps: (1) choosing items of relevance for chemical intolerance with an expert group, (2) conducting interviews with persons with chemical intolerance, using sampling to redundancy, (3) conducting a survey with 112 respondents at a first assessment and 91 at a second assessment for test-retest. RESULTS The final version of the instrument consists of 57 items divided in three parts, which showed good internal consistency in each part, Cronbach alpha: 0.73-0.87. It had good content validity, readability and face validity. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, and moderate (0.41-0.60) for 17 items. Three items had poor or fair (<0.41) Kappa agreement. CONCLUSION The instrument was found to be valid and reliable. It can be used as a clinical tool to help persons with chemical intolerance to receive the best suited help and support for each individual, identify key points in rehabilitation, measure rehabilitation outcome and establish priority for treatment.IMPLICATIONS FOR REHABILITATIONThe questionnaire instrument based on the International Classification of Functioning, Disability and Health which was developed and evaluated in this study, can be used to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance.Persons with chemical intolerance report lack of support from healthcare and society. Using this questionnaire instrument can help forming the best suited help and support for each individual based on his/her preconditions.This questionnaire instrument can be used to identify key points in rehabilitation and measure rehabilitation outcome.
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Affiliation(s)
- Anna Söderholm
- Department of Public Health, Umeå University, Umeå, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | | | | | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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Vuokko A, Karvala K, Suojalehto H, Lindholm H, Selinheimo S, Heinonen-Guzejev M, Leppämäki S, Cederström S, Hublin C, Tuisku K, Sainio M. Clinical Characteristics of Disability in Patients with Indoor Air-Related Environmental Intolerance. Saf Health Work 2019; 10:362-369. [PMID: 31497334 PMCID: PMC6717934 DOI: 10.1016/j.shaw.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022] Open
Abstract
Background Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance. Methods We investigated 12 patients with indoor air–related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires. Results The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments. Conclusion No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.
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Affiliation(s)
- Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | | | - Marja Heinonen-Guzejev
- University of Helsinki, Department of Public Health, Faculty of Medicine, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Sebastian Cederström
- Outpatient Clinic for Assessment of Ability to Work, Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Katinka Tuisku
- Outpatient Clinic for Assessment of Ability to Work, Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland
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Dieudonné M. Becoming electro‐hypersensitive: A replication study. Bioelectromagnetics 2019; 40:188-200. [DOI: 10.1002/bem.22180] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/22/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Maël Dieudonné
- Centre National de la Recherche Scientifique/Centre Max WeberLyonFrance
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25
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Palmquist E. Chemical intolerance - A puzzling condition. J Psychosom Res 2019; 118:69-70. [PMID: 30782357 DOI: 10.1016/j.jpsychores.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Palmquist
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Sweden.
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26
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Lowden A, Nagai R, Åkerstedt T, Hansson Mild K, Hillert L. Effects of evening exposure to electromagnetic fields emitted by 3G mobile phones on health and night sleep EEG architecture. J Sleep Res 2019; 28:e12813. [DOI: 10.1111/jsr.12813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Arne Lowden
- Stress Research Institute; Stockholm University; Stockholm Sweden
| | - Roberta Nagai
- Stress Research Institute; Stockholm University; Stockholm Sweden
| | - Torbjörn Åkerstedt
- Stress Research Institute; Stockholm University; Stockholm Sweden
- Department of Clinical Neuroscience; Division of Psychology; Karolinska Institutet; Stockholm Sweden
| | - Kjell Hansson Mild
- Department of Radiation Sciences; Radiation Physics; Umeå University; Umeå Sweden
| | - Lena Hillert
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
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27
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Karvala K, Sainio M, Palmquist E, Claeson AS, Nyback MH, Nordin S. Building-Related Environmental Intolerance and Associated Health in the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092047. [PMID: 30235805 PMCID: PMC6163389 DOI: 10.3390/ijerph15092047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 01/13/2023]
Abstract
People frequently attribute adverse symptoms to particular buildings when exposure to pollutants is low, within nonhazardous levels. Our aim was to characterize building-related intolerance (BRI) in the general population. Data were derived from two population-based questionnaire surveys, the Västerbotten and Österbotten Environmental Health Study. We identified cases of BRI if respondents reported symptoms emerging from residing in certain buildings, when most other people had none. The questionnaires covered lifestyle factors, perceived general health, BRI duration and symptom frequency, the emotional and behavioral impact of BRI, coping strategies, and physician-diagnosed diseases. From the total of 4941 participants, we formed two case groups, 275 (5.6%) fulfilled criteria for self-reported BRI, and 123 (2.5%) for BRI with wide-ranging symptoms. Individuals in both case groups were significantly more often female, single, and perceived their general health as poorer than the referents, i.e., those reporting no BRI symptoms. The mean duration of BRI was 12 years. In both case groups, avoidance behavior was found in over 60%, and nearly half of the sample had sought medical care. BRI with wide-ranging symptoms was associated with elevated odds for all studied comorbidities (somatic and psychiatric diseases and functional somatic syndromes). The perceived health of individuals with BRI is poorer and comorbidities are more frequent than among referents. BRI seems to be similar to other environmental intolerances and shares features with functional somatic syndromes.
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Affiliation(s)
- Kirsi Karvala
- Finnish Institute of Occupational Health, 00032 Helsinki, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, 00032 Helsinki, Finland.
| | - Eva Palmquist
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
| | | | | | - Steven Nordin
- Department of Psychology, Umeå University, 901 87 Umeå, Sweden.
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28
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Vuokko A, Karvala K, Lampi J, Keski-Nisula L, Pasanen M, Voutilainen R, Pekkanen J, Sainio M. Environmental Intolerance, Symptoms and Disability Among Fertile-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020293. [PMID: 29419757 PMCID: PMC5858362 DOI: 10.3390/ijerph15020293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 12/12/2022]
Abstract
The purpose was to study the prevalence of environmental intolerance (EI) and its different manifestations, including behavioral changes and disability. Fertile-aged women (n = 680) of the Kuopio Birth Cohort Study were asked about annoyance to 12 environmental factors, symptoms and behavioral changes. We asked how much the intolerance had disrupted their work, household responsibilities or social life. We chose intolerance attributed to chemicals, indoor molds, and electromagnetic fields to represent typical intolerance entities. Of the respondents, 46% reported annoyance to chemicals, molds, or electromagnetic fields. Thirty-three percent reported symptoms relating to at least one of these three EIs, 18% reported symptoms that included central nervous system symptoms, and 15% reported behavioral changes. Indicating disability, 8.4% reported their experience relating to any of the three EIs as at least “somewhat difficult”, 2.2% “very difficult” or “extremely difficult”, and 0.9% “extremely difficult”. Of the latter 2.2%, all attributed their intolerance to indoor molds, and two thirds also to chemicals. As the number of difficulties increased, the number of organ systems, behavioral changes and overlaps of the three EIs also grew. EI is a heterogeneous phenomenon and its prevalence depends on its definition. The manifestations of EI form a continuum, ranging from annoyance to severe disability.
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Affiliation(s)
- Aki Vuokko
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
| | - Jussi Lampi
- Environmental Health, National Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland.
- Social and Health Services, 70701 Kuopio, Finland.
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland.
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O Box 1627, 70211 Kuopio, Finland.
| | - Markku Pasanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Raimo Voutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O Box 1627, 70211 Kuopio, Finland.
- Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland.
| | - Juha Pekkanen
- Environmental Health, National Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland.
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
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