Factors associated with prospective development of environmental annoyance

AI-based soundscape analysis: Jointly identifying sound sources and predicting annoyancea)

Soundscape studies typically attempt to capture the perception and understanding of sonic environments by surveying users. However, for long-term monitoring or assessing interventions, sound-signal-based approaches are required. To this end, most previous research focused on psycho-acoustic quantities or automatic sound recognition. Few attempts were made to include appraisal (e.g., in circumplex frameworks). This paper proposes an artificial intelligence (AI)-based dual-branch convolutional neural network with cross-attention-based fusion (DCNN-CaF) to analyze automatic soundscape characterization, including sound recognition and appraisal. Using the DeLTA dataset containing human-annotated sound source labels and perceived annoyance, the DCNN-CaF is proposed to perform sound source classification (SSC) and human-perceived annoyance rating prediction (ARP). Experimental findings indicate that (1) the proposed DCNN-CaF using loudness and Mel features outperforms the DCNN-CaF using only one of them. (2) The proposed DCNN-CaF with cross-attention fusion outperforms other typical AI-based models and soundscape-related traditional machine learning methods on the SSC and ARP tasks. (3) Correlation analysis reveals that the relationship between sound sources and annoyance is similar for humans and the proposed AI-based DCNN-CaF model. (4) Generalization tests show that the proposed model's ARP in the presence of model-unknown sound sources is consistent with expert expectations and can explain previous findings from the literature on soundscape augmentation.

Prevalence and correlation of multiple chemical sensitivity and electromagnetic hypersensitivity with age, sex, and depression in the Japanese population: a retrospective study

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.

Urban Stress and its Association with Symptoms of Depression, Fatigue, and Sleep Disruption in Women in Mexico City

Women in urban neighborhoods often face disproportionately higher levels of environmental and social stressors; however, the health effects from urban stressors remains poorly understood. We aimed to evaluate the association between urban stress and symptoms of depression, fatigue, and sleep disruption in a cohort of 460 women in Mexico City. To assess urban stress, women were administered the Urban Annoyances (Nuisances Environnementales) scale. Six constructs were summarized to create an overall index. Depressive symptoms were assessed using the Edinburgh Depression Scale; the Patient-Reported Outcomes Information System scales were used to assess sleep disruption and fatigue. Linear regression models were used to estimate the association with continuous symptoms comparing women with high urban stress to those with lower levels. Models were adjusted for socioeconomic status, education, age, social support, and previous depressive symptoms. High urban stress was associated with greater depressive symptoms (β: 1.77; 95%CI: 0.83, 2.71), fatigue (β: 2.47; 95%CI: 0.87, 4.07), and sleep disruption (β: 2.14; 95%CI: 0.54, 3.73). Urban stress plays an important role in women's psychological and physical health, highlighting the importance of including these measures in environmental health studies. Urban interventions, such as promoting alternative transport options, should additionally be addressed to improve health of urban populations.

Laboratory Test Results in Patients with Workplace Moisture Damage Associated Symptoms—The SAMDAW Study

The mechanisms of health effects of moisture damage (MD) are unclear, but inflammatory responses have been suspected. The usefulness of laboratory and allergy tests among patients in secondary healthcare with symptoms associated with workplace MD were examined. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total serum immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and skin prick testing were assessed and analyzed in relation to multiple chemical sensitivity (MCS) and perceived stress in 99 patients and 48 controls. In analysis, t-tests, Mann-Whitney tests, and chi-squared tests were used. Minor clinically insignificant differences in blood counts were seen in patients and controls, but among patients with asthma an elevated neutrophil count was found in 19% with and only in 2% of patients without asthma (p = 0.003). CRP levels and ESR were low, and the study patients’ FeNO, total IgE, or allergic sensitization were not increased compared to controls. The level of stress was high among 26% of patients and 6% of controls (p = 0.005), and MCS was more common among patients (39% vs. 10%, p < 0.001). Stress or MCS were not significantly associated with laboratory test results. In conclusion, no basic laboratory or allergy test results were characteristic of this patient group, and neither inflammatory processes nor allergic sensitization were found to explain the symptoms among these patients. While the value of basic laboratory tests should not be ignored, the use of allergy tests does not seem necessary when symptoms are indicated to be workplace-related.

Parameters influencing population annoyance pertaining to air pollution

Annoyance caused by particulate matter qualifies as a public health problem, as it can be seen as an ambient stressor causing stress, diseases and affecting the quality of life. Previous studies have shown a complex relationship between annoyance and perception of air pollution, health problems occurrences, air pollutants concentration levels and location within the urban area, which should be better investigated. The objective of this work is to identify the parameters that influences perceived annoyance caused by air pollution. Additionally, we propose the analyses of exposure-response relationship between perceived annoyance and concentration levels of particulate matter (TSP and PM₁₀). Questionnaire-based surveys were conducted in sub regions around of the air quality monitoring stations in metropolitan area of Vitoria, Brazil. Logistic regression was used to identify the associations between qualitative questionnaire variables and air pollution expressed by PM concentrations. Results have shown that 90% of the population reports nuisance by air pollution and about 80% of respondents frequently perceived air pollution by dust. The determinants parameters and subjective factors related to particles annoyance perception can be used in order to predict air pollution impact on the studied region population. By exposure-response relationship when the concentration level of PM increases, the probability of being annoyed also grows. The results and the methodology discussed here can be very useful for planning purposes where the stakeholders usually do not have access to detailed information, especially for micro-management in a regional or city-planning level.

Psychological models of development of idiopathic environmental intolerances: Evidence from longitudinal population-based data

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.

Potential factors affecting chronic chemical intolerance associated with constitutional predisposition or lifestyle and environment during childhood: From a six-year follow-up study

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.

Study of the Correlation Between Multiple Chemical Sensitivity and Personality Using the Quick Environmental Exposure Sensitivity Inventory Questionnaire and the Temperament and Character Inventory

OBJECTIVE

We conducted an analysis using the Quick Environmental Exposure Sensitivity Inventory to examine the correlation between multiple chemical sensitivity (MCS) and personality traits by using temperament and character inventory, and environmental exposures.

METHODS

An anonymous questionnaire was distributed to 667 employees working at an IT manufacturing plant in Japan. Variables including chemically sensitive population (CSP), personality, and environmental chemical exposure were individually evaluated using U-test, chi-squared test, and correlation analyses. We also did covariance structure analysis to build a structural equation model.

RESULTS

There was little direct impact of temperament on the CSP, while there was a significant impact of character on the CSP. Women were more likely to exhibit symptoms of CSP.

CONCLUSION

MCS is correlated with personality, impacted more by character acquired later in life than innate temperament. There were sex differences in the incidence of MCS.

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

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).

Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous

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.

Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives

OBJECTIVE

Systematic bibliography analysis of about the last 17 years on multiple chemical sensitivity (MCS) was carried out in order to detect new diagnostic and epidemiological evidence. The MCS is a complex syndrome that manifests as a result of exposure to a low level of various common contaminants. The etiology, diagnosis, and treatment are still debated among researchers.

METHOD

Querying PubMed, Web of Science, Scopus, Cochrane library, both using some specific MESH terms combined with MESH subheadings and through free search, even by Google.

RESULTS

The studies were analyzed by verifying 1) the typology of study design; 2) criteria for case definition; 3) presence of attendances in the emergency departments and hospital admissions, and 4) analysis of the risk factors.

OUTLOOK

With this review, we give some general considerations and hypothesis for possible future research.

Factors affecting self-reported chemical intolerance: A five-year follow-up study in Japan

OBJECTIVE

Chemical intolerance (CI) has become a strong public health concern in industrialized countries. The Japanese Chemical Intolerance (JCI) study was conducted in January 2012 with a cohort of 7245 adults from population-based sampling as the baseline. The aim of the present study was to investigate the factors involved in the improvement and development of CI from the five-year follow-up study.

METHODS

From the 7245 cohort, 735 persons with CI (case) were identified, and 1750 controls without CI were randomly selected to match gender and age for case and control groups. Self-reported questionnaires were administered to the subjects of the two groups to obtain information on status of CI; medical history; medical, lifestyle, or physical interventions; changes in living situation or occupation; and psychosomatic states.

RESULTS

A total of 909 individuals responded during the follow-up period. After five years, improvement in CI was observed in 67.7% of the case group. Status of CI was reported in 6.7% of the control group. Multiple logistic regression analyses revealed that baseline atopic dermatitis and negative psychosomatic states including irritability, fatigue, anxiety, depressed mood, and somatic symptoms were significantly associated with development of CI in controls. Appropriate physical activity and maintaining a regular lifestyle including diet or sleep during the last three years of the follow-up period were significant factors for improvement of CI in the case group.

CONCLUSIONS

Ensuring appropriate physical activity and regular lifestyle rather than improving physical environment lead to improvement of CI. Stable psychosomatic state is essential for preventing CI.

"These Power Lines Make Me Ill": A Typology of Residents' Health Responses to a New High-Voltage Power Line

Little attention has been devoted to the potential diversity in residents' health responses when exposed to an uncertain environmental health risk. The present study explores whether subgroups of residents respond differently to a new high-voltage power line (HVPL) being put into operation. We used a quasi-experimental prospective field study design with two pretests during the construction of a new HVPL, and two posttests after it was put into operation. Residents living nearby (0-300 m, n = 229) filled out questionnaires about their health and their perception of the environment. We applied latent class growth models to investigate heterogeneity in the belief that health complaints were caused by a power line. Classes were compared on a wide range of variables relating to negative-oriented personality traits, perceived physical and mental health, and perceptions of the environment. We identified five distinct classes of residents, of which the largest (49%) could be described as emotionally stable and healthy with weak responses to the introduction of a new power line. A considerable minority (9%) responded more strongly to the new line being activated. Residents in this class had heard more about the health effects of power lines beforehand, were more aware of the activation of the new line, and reported a decrease in perceived health afterwards. Based on our findings we can conclude that there is a considerable heterogeneity in health responses to a new HVPL. Health risk perceptions appear to play an important role in this typology, which has implications for risk management.

The association between multiple chemical sensitivity and mental illness: Evidence from a nationally representative sample of Canadians

OBJECTIVE

The goal of the present study was to investigate the association between multiple chemical sensitivity (MCS) and major depressive disorder (MDD), generalized anxiety disorder (GAD), MDD and GAD comorbidity (MDD+GAD), severe distress, and positive mental wellbeing.

METHODS

This cross-sectional investigation was carried out using the 2012 Canadian Community Health Survey - Mental Health Component. The study population consisted of 21,977 individuals aged 20 and older, from Canada's ten provinces. Odds ratios were computed using multinomial logistic regression to calculate estimates of the association between MCS and mental illness. All analyses were weighted to take into account the complex survey design.

RESULTS

Individuals with MCS had 2.37 (1.55, 3.64) times greater odds of MDD, 3.09 (1.80, 5.30) times greater odds of MDD+GAD, and 2.60 (1.67, 4.07) times greater odds of severe distress. No association between MCS and GAD was observed. A sex difference was observed with males with MCS having lower odds of positive mental wellbeing, whereas no association was observed in females.

CONCLUSIONS

The present study findings supported an association between MCS and mental illness. The causal mechanism supporting this association remains unclear.

Psychological symptoms and health-related quality of life in idiopathic environmental intolerance attributed to electromagnetic fields

OBJECTIVE

Need for better understanding of the etiology of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) motivated the present study of psychological symptoms and health-related quality of life (HRQoL) in person who attribute health problems to electromagnetic fields.

METHODS

Participants with IEI-EMF (n=114) and a population-based sample of referents (n=104) were investigated with six subscales of the Symptom Checklist 90 (SCL-90) to assess psychological symptoms, and with eight subscales of the Short Form (36) Health Survey (SF-36) to assess HRQoL.

RESULTS

Significantly higher scores were found on obsessive/compulsive behavior, interpersonal hypersensitivity, hostility, phobic anxiety, paranoid thoughts in the IEI-EMF group compared to referents, whereas only a tendency of such a difference was found for psychotism. Furthermore, poorer HRQoL in the IEI-EMF group, compared to referents, were found regarding physical and social functioning, physical and emotional role limitations, general health, vitality, bodily pain, and mental health. Significant correlation with moderate to strong effect sizes were found between several of the SCL-90 and SF-36 subscales.

CONCLUSION

The results suggest that IEI-EMF is associated with various types of psychological symptoms and with poor HRQoL. Clinical implications include theoretical support for cognitive behavioral therapy, and, although further research is needed, that attention should be directed towards feelings of inferiority and uneasiness in relationships as well as anger, hostility and resentment towards other people.

Nocebo responses to high-voltage power lines: Evidence from a prospective field study

BACKGROUND

Experimental studies suggest that nocebo responses might occur after exposure to equipment emitting electromagnetic fields such as high voltage power lines (HVPLs) or mobile phone base stations.

OBJECTIVES

The present study investigates to what extent health responses to a new HVPL can be explained by beliefs of residents regarding the health effects of HVPLs.

METHODS

We used a quasi-experimental prospective field study design with two pretests during the construction of a new HVPL, and two posttests after it has been put into operation. Residents living near (0-300 m, n=229; 300-500 m, n=489) and farther away (500-2000 m, n=536) filled out questionnaires about their health and their beliefs about the negative health effects of power lines. Longitudinal mediation models were applied to investigate to what extent these beliefs could explain a change in reported symptoms after the new line was put into operation.

RESULTS

Significant (p<.01) indirect effects were found for proximity on the increase in reported cognitive (R(2)=0.41) and somatic (R(2)=0.79) symptoms after the power line was put into operation through an increase in the belief that power lines causes health effects. The direct effects of proximity on an increase in reported symptoms were not significant.

CONCLUSIONS

Our findings suggest that increases in reported health complaints after a new HVPL has been put into operation can be explained by nocebo mechanisms. Future field studies are needed to know whether our findings extend to other environmental health issues in a community.

Mindfulness-based cognitive therapy (MBCT) for multiple chemical sensitivity (MCS): Results from a randomized controlled trial with 1 year follow-up

OBJECTIVE

Multiple chemical sensitivity (MCS) is a medically unexplained condition characterized by symptoms from multiple organ systems following the perception of common odorants. The condition can cause severe functional impairment for afflicted individuals. The aim of this study was to assess the effects of mindfulness-based cognitive therapy (MBCT) for individuals with MCS.

METHODS

The intention-to-treat sample (ITT) included 69 individuals who had been randomized to either MBCT or treatment as usual (TAU). The primary outcome measure was the Quick Environmental Exposure and Sensitivity Inventory (QEESI), which measures the following aspects of

MCS

impact of MCS on daily life, symptoms, and reactions following chemical exposures. Secondary outcome measures included the Brief Illness Perception Questionnaire (BIPQ) and the anxiety and depression subscales of the symptom checklist 92 (SCL-92). Participants were assessed at baseline and post treatment, and at follow-up periods of 6- and 12-months.

RESULTS

We found no effect of MBCT on the primary outcome, nor did we find an effect on levels of depression or anxiety. We did, however, find positive changes in illness perceptions, which were sustained at 12-month follow-up. Dropout rates were low, suggesting MBCT was well received and regarded as an acceptable intervention by individuals with MCS.

CONCLUSIONS

Overall, these results suggest that MBCT does not change overall illness status in individuals with MCS, but that MBCT positively changes emotional and cognitive representations. Possible explanations for these results are discussed.

The relationship of modern health worries to non-specific physical symptoms and perceived environmental sensitivity: A study combining self-reported and general practice data

OBJECTIVE

The present study investigates the association of modern health worries (MHW) with self-reported as well as general practitioner (GP)-registered non-specific physical symptoms (NSPS), medication use, alternative therapy consultations, sleep quality and quality of life. The interrelation between MHW, general environmental sensitivity and the aforementioned outcomes is also explored.

METHODS

Self-reported questionnaires and data from electronic medical records from 21 general practices in The Netherlands were combined in a sample of 5933 adult participants.

RESULTS

The majority of the participants reported increased worries about potential health effects from environmental exposures. The highest worry scores were reported by people who perceived themselves as more vulnerable to environmental stressors. After adjustment for socio-demographic characteristics and diagnosed psychiatric morbidity, higher MHW were significantly associated with increased self-reported prevalence and duration of NSPS, symptom-related healthcare utilization, GP-registered NSPS, alternative therapy consultations and lower sleep quality and quality of life. These associations were statistically mediated by perceived environmental sensitivity. No association was observed between worries and GP-registered medication prescriptions.

CONCLUSION

Modern health worries are very common in the general population. They are associated with self-reported as well as clinically defined NSPS and as such might play a key role in the process of developing and maintaining environmental sensitivities and related symptoms. A large cross-cultural longitudinal study would help to determine important aspects such as temporal precedence and stability of MHW and the relevant psychosocial context within which symptomatic conditions occur.

Negative affect is associated with development and persistence of chemical intolerance: a prospective population-based study

OBJECTIVE

Chemical intolerance (CI) is characterised by negative health effects attributed to a heightened responsiveness to common airborne chemicals. This longitudinal study explored the hypothesised role of negative affect in the development and persistence of CI in a general population.

METHODS

A general population sample aged 19 to 72 years was examined in 2006-2008 and again in 2011-2012. Longitudinal data on CI were analysed with the purpose of examining baseline negative affect as a risk factor for having developed CI at 5-year follow-up and for reporting persistent CI. Participants were classified as reporting no signs of CI, having symptoms of CI and as being a likely CI case based on self-reported reactions to 11 common chemical exposures, symptoms related to chemical exposures and daily life adjustments attributed to reactions when exposed to chemicals.

RESULTS

A total of 69.4% of the participants who had reported CI at baseline also reported CI at follow-up. In participants with no baseline CI, 15.5% reported CI at follow-up and 18.1% reported symptoms related to chemicals but no daily life adjustments. Baseline negative affect was positively and statistically significantly associated with both development and persistence of CI.

CONCLUSIONS

Initial reports of CI were found to be persistent over time, and a considerable proportion of the participants with no CI at baseline reported having developed CI after 5 years. The positive association between negative affect and CI at the 5-year follow-up supports negative affect as a possible risk factor for CI.

City dweller responses to multiple stressors intruding into their homes: noise, light, odour, and vibration

Urban densification increases exposure to noise, light, odour, and vibration in urban dwellings. Exposure from combined environmental stressors intruding into the home could increase the risk of adverse effects on wellbeing, even when the exposure is at a relatively low level. This study assesses the prevalence of annoyance with a combination of potential environmental stressors common in urban areas and the association with wellbeing. A questionnaire was sent by mail to residents in five areas in Halmstad (Sweden) with similar socioeconomic and housing characteristics but different exposure (response rate 56%; n=385). Of the respondents, 50% were annoyed to some degree by at least one of the suggested stressors, most commonly by noise and vibration from local traffic. Structural equation modelling showed that annoyance led to lowered quality of life via the mediating construct residential satisfaction, which in turn was influenced by place attachment and perceived restoration possibilities in the dwelling. Stress had a negative impact on quality of life, but was not directly correlated to annoyance. Stress was however correlated with sensitivity. The findings suggest that dose-response relationships for environmental stressors should be studied in a broader context of environmental and individual factors. Also relatively low levels of exposure should be mitigated, especially if several stressors are present.

Prevalence and Characteristics of Chemical Intolerance: A Japanese Population-Based Study

Population-based cross-sectional study was performed to estimate the prevalence of chemical intolerance and to examine the characteristics of the sample. A Web-based survey was conducted that included 7,245 adults in Japan. The criteria for chemical intolerance proposed by Skovbjerg yielded a prevalence of 7.5% that was approximately consistent with that reported from a Danish population-based survey. Female gender, older age, and renovation in the house during the past 7 years were positively associated with chemical intolerance. Improvements in the condition were observed with daily ventilation habits. Medical history of atopic dermatitis, allergic rhinitis, food allergy, multiple chemical sensitivity, and depression were associated with chemical intolerance. Fatigue, depressed mood, and somatic symptoms were also positively correlated with chemical intolerance. Better elucidation of the causes, comorbidities, concomitants, and consequences of chemical intolerance has the potential to provide effective solutions for its prevention and treatment.

Anaesthesia Management in Patients with Multiple Chemical Sensitivity Syndrome

Multiple Chemical Sensitivity (MCS) is characterised by the appearance of numerous and sometimes severe symptoms, when subjects are in contact with various chemicals and medicinal substances. Currently there are no useful guidelines for managing clinical issues and, specifically, anaesthesia for patients with MCS. This case report describes anaesthesia management in a patient affected by clinically documented MCS and a latex allergy, a candidate for a laparoscopic cholecystectomy operation.

Transcranial pulsed electromagnetic fields for multiple chemical sensitivity: study protocol for a randomized, double-blind, placebo-controlled trial

Background

Multiple chemical sensitivity (MCS) is a chronic condition of unknown etiology. MCS is characterized by recurrent nonspecific symptoms from multiple organ systems in response to chemical exposures in concentrations that are normally tolerated by the majority of the population. The symptoms may have severe impact on patients’ lives, but an evidence-based treatment for the condition is nonexisting. The pathophysiology is unclarified, but several indicators point towards abnormal processing of sensory signals in the central nervous system. Pulsed electromagnetic fields (PEMF) offer a promising new treatment for refractory depression and can be targeted at the brain, thereby activating biochemical cell processes.

Methods/Design

In a parallel, randomized, double-blind, placebo-controlled trial conducted at the Danish Research Centre for Chemical Sensitivities, the effects of PEMF in MCS patients will be assessed using the Re5 Independent System. Based on sample size estimation, 40 participants will be randomized to either PEMF therapy or placebo. The allocation sequence will be generated by computer. All involved parties (that is, participants, investigators, the research nurse, and the statistician) will be blinded to group allocation. The participants will receive PEMF therapy or placebo applied transcranially 30 minutes twice a day for 7 days a week over 6 consecutive weeks. Outcomes will be measured at baseline, once weekly during treatment, post treatment, and at 2.5-month and 4.5-month follow-up according to a predefined timetable. The primary outcome will be a measurement of the impact of MCS on everyday life. The secondary outcomes will be measurements of MCS symptoms, psychological distress (stress, anxiety or depressive symptoms), capsaicin-induced secondary punctate hyperalgesia, immunological markers in serum, and quality of life.

Discussion

This trial will assess the effects of PEMF therapy for MCS. Currently, there is no treatment with a documented effect on MCS, and in terms of healthcare there is very little to offer these patients. There is thus a great need for well-conducted randomized trials aimed at assessing possible treatment effects. A positive outcome will pave the way for improved healthcare and understanding of this very disabling and overlooked condition.

Trial registration

ClinicalTrials.gov, NCT01834781

Metric properties and normative data for brief noise and electromagnetic field sensitivity scales

Aims: Lack of brief questionnaire instruments for quantifying affective reactions to and behavioral disruptions attributed to sounds and electromagnetic fields (EMFs) motivated the present development and metric evaluation of such instruments, called the 11-item Noise Sensitivity Scale (NSS-11) and the 11-item Electromagnetic Field Sensitivity Scale (EMFSS-11). Another objective was to establish normative data for these instruments. Method: Data from 3406 individuals who took part in the Västerbotten Environmental Health Study was used. The participants constitute a random sample of inhabitants in the county of Västerbotten in Sweden, aged 18 to 79 years, stratified for age and gender. The participants responded to the NSS-11 and EMFSS-11 and to additional questions for evaluation of concurrent validity. Results: The results show satisfying reliability (Cronbach α = 0.71–0.85, varying with age group and gender), concurrent validity, and unidimensionality of the NSS-11 and EMFSS-11, and that the scales generate scores with approximately normal distributions, irrespective of age group and gender. Mean scores, standard deviations, and confidence intervals constitute normative data. Conclusions: The favorable metric properties of the NSS-11 and EMFSS-11 in combination with their fast usage suggest that they are particularly useful for assessment in epidemiological studies, and have the advantage of available normative data.

Living with a Chemically Sensitive Wife: A “We” Situation

Objectives. Multiple chemical sensitivity (MCS) is a medically unexplained and socially disabling disorder characterized by negative health effects attributed to exposure to common airborne chemicals. How spouses of chemically sensitive women experience and cope with their partners illness has not been described previously. Methods. This study presents data from three semistructured focus group interviews with a selective sample of 13 men whose spouses had MCS. Data was analyzed using systematic text condensation with a special focus on coping. Results. The informants expressed a great concern for their wives and described their role in the relationship as that of a “watchdog”, always alert and ready to protect. A considerable amount of time and effort was thus given to avoid symptom-eliciting chemicals to prevent illness. Informing guests of restrictions and observing neighbours’ daily routines were common occurrences. Masks, installation of additional air filters in cars and houses, and other protective measures had necessitated several participants taking on extra work to alleviate the economic burden. The wives' illness had thus become a “we” situation. Discussion. In conclusion, MCS was perceived as a “we” situation and may thus impose considerable strain on the relationship and the family as a whole.

Mindfulness-based cognitive therapy for multiple chemical sensitivity: a study protocol for a randomized controlled trial

Background

Multiple chemical sensitivity (MCS) is a condition characterized by recurrent, self-reported symptoms from multiple organ systems, attributable to exposure to a wide range of chemically unrelated substances at low levels. The pathophysiology is unknown, and affected individuals generally favor avoidance of the symptom triggering substances as a coping strategy. The impact of MCS on daily life may thus be severe. An intervention that may effectively reduce the impact of MCS, alleviate the symptoms and the psychological distress associated with the condition is therefore highly needed. In this study we will assess the effects of a mindfulness-based cognitive (MBCT) program on MCS.

Methods/Design

Using a randomized controlled design (RCT), we will compare MBCT with treatment as usual (TAU). The MBCT intervention will include 8 weekly 2.5 hour sessions, and 45 minutes of mindfulness home practice 6 days each week. Participants will be asked to complete questionnaires at baseline, post-treatment, and at 6 and 12 months’ follow-up. Based on sample size estimation, 82 participants will be randomized to either the MBCT intervention or to TAU. The primary outcome will be a measure of the impact of MCS on the participants’ lives. The secondary outcome measures are physical symptoms of psychological distress, perceived stress, illness perceptions, QOL, and work ability. Lastly, we will assess whether any effect of MBCT on the primary effect measure is mediated by level of mindfulness, self-compassion, perceived stress, and rumination.

Discussion

This trial will provide important information on the effects of MBCT on MCS.

Trials registration

Clinical trials identifier NCT01240395