Gender and the Physical and Psychosocial Work Environments are Related to Indoor Air Symptoms

Occupational exposure and health surveys at metal additive manufacturing facilities

Introduction

Additive manufacturing is a novel state-of-the art technology with significant economic and practical advantages, including the ability to produce complex structures on demand while reducing the need of stocking materials and products. Additive manufacturing is a technology that is here to stay; however, new technologies bring new challenges, not only technical but also from an occupational health and safety perspective. Herein, leading Swedish companies using metal additive manufacturing were studied with the aim of investigating occupational exposure and the utility of chosen exposure- and clinical markers as predictors of potential exposure-related health risks.

Methods

Exposure levels were investigated by analysis of airborne dust and metals, alongside particle counting instruments measuring airborne particles in the range of 10 nm-10 μm to identify dusty work tasks. Health examinations were performed on a total of 48 additive manufacturing workers and 39 controls. All participants completed a questionnaire, underwent spirometry, and blood and urine sampling. A subset underwent further lung function tests.

Results

Exposure to inhalable dust and metals were low, but particle counting instruments identified specific work tasks with high particle emissions. Examined health parameters were well within reference values on a group level. However, statistical analysis implied an impact on workers kidney function and possible airway inflammation.

Conclusion

The methodology was successful for investigating exposure-related health risks in additive manufacturing. However, most participants have been working <5 years. Therefore, long-term studies are needed before we can conclusively accept or reject the observed effects on health.

The Continuum of Severity of Functional Impairment Due to Indoor Air Symptoms: Prevalence and Determinants

OBJECTIVE

The aim of the study is to study functional impairment due to indoor air-related symptoms and associated characteristics.

METHODS

A questionnaire survey of a random sample of Finnish people aged 25 to 64 years. Analyses were done using multivariate multinomial logistic regression.

RESULTS

A total of 23.1% reported indoor air-related symptoms, 1.8% severe functional impairment due to symptoms, 5.3% moderate, 11.1% mild, and 4.9% reported no impairment. Those with severe functional impairment showed the strongest associations with comorbid diseases, for example, asthma and irritable bowel syndrome, perceived sensitivities to several environmental factors, like chemicals, and likelihood of having symptoms in multiple organs, while those with no or little functional impairment showed weak or even inverse associations. Similar results emerged with severity of indoor air-related symptoms.

CONCLUSIONS

Individuals with indoor air-related symptoms are a very heterogeneous group. This should be better considered in future research and clinical practice.

Stress and Sleep in Relation to Severity of Building Related Symptoms

OBJECTIVE

This study investigates different aspects of stress and sleep in medically examined individuals with varying severity of building-related symptoms (BRS).

METHODS

Three questionnaires were used to assess acute and long-term stress and sleep (Perceived Stress Scale; Shirom Melamed Burnout Questionnaire, and Karolinska Sleep Questionnaire).

RESULTS

Individuals with BRS, regardless of severity, did not differ in level of perceived stress (indicator of short-term stress). The indicators of long-term stress differed between the groups where an increased severity was associated with higher levels of burnout and sleep problems.

CONCLUSIONS

The study suggests an association between symptom severity and measures of long-term stress and sleep quality. This has implications for the treatment of persons affected by BRS, because not only the environment needs to be treated, but also the concurrent signs of distress, such as burnout or sleep problems.

A longitudinal study on the effects of hygro-thermal conditions and indoor air pollutants on building-related symptoms in office buildings

We conducted a longitudinal epidemiological study for over 1 year in Tokyo and Osaka, Japan, beginning June 2015, to examine the association between indoor environmental factors and building-related symptoms (BRSs) in office workers. Data were obtained from 483 subjects (225 females and 258 males) in 24 office rooms in 11 office buildings. Environmental monitoring was conducted for hygro-thermal conditions and carbon dioxide and sampling was performed for indoor air pollutants. Questionnaires were concurrently administered to collect information on participants' perceptions of their comfort and health and the conditions of the work environments. Multivariable analyses revealed that upper respiratory symptoms were significantly correlated with a decrease in both relative [odds ratio (OR): 0.77; 95% confidence intervals (CI): 0.62-0.95; p = 0.014] and absolute humidity (OR: 0.89; 95% CI: 0.81-0.97; p = 0.008). Statistically, significant evidence was found that average relative humidity of <38% (OR: 2.68; 95% CI: 1.36-5.27; p = 0.004) showed the most significant association with increased risk of upper respiratory symptoms. Air concentrations of carbon dioxide showed no significant correlation with BRSs at mean concentrations <1000 ppm in most buildings surveyed. Most indoor air pollutant concentrations were relatively low or lower than the values set by indoor air quality guidelines and the values of thresholds for sensory irritation. Air concentrations of indoor air pollutants showed no significant correlation with BRSs. Our data emphasize the importance of appropriate humidity control during low humidity in winter.

The Associations of Meteorological and Environmental Factors with Memory Function of the Older Age in Urban Areas

Individual, meteorological, and environmental factors are associated with cognitive function in older age. However, little is known about how meteorological and environmental factors interact with individual factors in affecting cognitive function in older adults. In the current study, we used mixed effects models to assess the association of individual, meteorological, and environmental factors with cognitive function among older adults in urban areas. Data from 2623 adults aged 60 to 91 years from 25 provinces (or autonomous regions/municipalities) from the China Family Panel Studies (CFPS) were used. We used the memory test in CFPS to measure memory function, while meteorological data from the daily climate data set of China’s surface international exchange stations, and the traffic and greening data compiled by the National Bureau of Statistics (NBS) of China, were used to assess meteorological and environmental factors. The ICC of the empty model indicated that 7.7% of the variation in memory test scores for the older adults was caused by provincial characteristics. Results showed that the temperature and relative humidity of provinces moderated the effect of gender on the memory function for the older urban adults. Specifically, in the high temperature areas, memory scores for females were higher than those of males, and in the middle humidity areas, memory scores were also higher for the females than those of males. This study explained how meteorological and environmental factors played roles in influencing demographic factors on memory function among older adults. Further research is needed to better define the role and potential mechanism of this moderation.

Subjective indoor air quality and thermal comfort among adults in relation to inspected and measured indoor environment factors in single-family houses in Sweden-the BETSI study

Totally 1160 adults living in single-family houses in Sweden participated in a questionnaire survey on subjective indoor air quality (SIAQ). Inspectors investigated the dwellings and performed home measurements (mean indoor temperature 21.4 °C, mean indoor air humidity 34.2%, mean indoor air exchange rate 0.36 ac/h and mean moisture load indoor 1.7 g/m³). Totally 15.5% perceived draught, 28.0% perceived too high room temperature, 42.4% unstable room temperature, 36.8% too low room temperature, 19.6% stuffy air, 19.8% dry air and 29.9% dust or dirt. Measured room temperature was related to perception of room temperature. Higher relative air humidity was related to perceived unstable room temperature (OR = 1.70) and too low room temperature (OR = 1.96). Higher absolute air humidity was related to too high room temperature (OR = 1.21), unstable room temperature (OR = 1.34) and too low room temperature (OR = 1.35). Higher measured relative humidity, absolute air humidity and moisture load were all associated with stuffy air and unpleasant odor (OR = 1.45-1.97). Higher air exchange rate was related to less perceived unstable room temperature (OR = 0.93). Higher U value was related to draught (OR = 1.17), too low room temperature (OR = 1.09), unpleasant odor (OR = 1.12) and dust and dirt (OR = 1.07). New concrete slab foundation was related to less stuffy air (OR = 0.39) (vs. basement). Damp foundation was associated with more stuffy air (OR = 1.44) and unpleasant odor (OR = 1.61). Window pane condensation was related to stuffy air (OR = 1.88). Moldy odor reported by inspector was related to stuffy air (OR = 1.73). Observed mold in the attic was associated with more stuffy air and unpleasant odor. In conclusion, complaints of room temperature can indicate poor thermal environment. Higher air exchange rate can create a more stable thermal sensation. Excess indoor humidity, lower degree of thermal insulation, presence of window pane condensation and indoor dampness/mold can impair SIAQ. Higher ventilation and concrete slab foundation with underlying thermal insulation can improve SIAQ.

Factors Affecting Occupants’ Satisfaction in Governmental Buildings: The Case of the Kingdom of Bahrain

Satisfaction is a very important factor in improving productivity and performance in the work environment. This study aims to investigate the levels of occupants’ satisfaction with the indoor environmental quality (IEQ) in the governmental buildings in the Kingdom of Bahrain and to investigate the impact of occupants’ demographics and building attributes (non-IEQ factors) on these levels. For these purposes, the study used a questionnaire that has 17 indoor environmental quality (IEQ) factors in addition to a group of non-IEQ factors. The questionnaire was distributed by hand or using email to 279 employees in the Bahraini governmental sector. The findings of the study revealed that occupants in the Bahraini governmental buildings are not strongly satisfied with IEQ factors, especially with sound privacy, followed by visual privacy and amount of space, and then noise levels. The findings also showed that for most IEQ factors, men are more satisfied than women are, those who work in enclosed private offices are more satisfied than those who work in open-plan offices, and those who have central air-conditioning at their workplace are more than those who have a wall-mounted air conditioner. The impact of age, nature of work, duration of working in the current building and at the current workstation, weekly working hours, and proximity to the window were also investigated. Accordingly, a group of recommendations was suggested aiming to improve the levels of occupants’ satisfaction.

Association of subjective health symptoms with indoor air quality in European office buildings: The OFFICAIR project

The aim of this study was to explore the association between the building-related occupants' reported health symptoms and the indoor pollutant concentrations in a sample of 148 office rooms, within the framework of the European OFFICAIR research project. A large field campaign was performed in 37 office buildings among eight countries, which included (a) 5-day air sampling of volatile organic compounds (VOCs), aldehydes, ozone, and NO₂ (b) collection of information from 1299 participants regarding their personal characteristics and health perception at workplace using online questionnaires. Stepwise and multilevel logistic regressions were applied to investigate associations between health symptoms and pollutant concentrations considering personal characteristics as confounders. Occupants of offices with higher pollutant concentrations were more likely to report health symptoms. Among the studied VOCs, xylenes were associated with general (such as headache and tiredness) and skin symptoms, ethylbenzene with eye irritation and respiratory symptoms, a-pinene with respiratory and heart symptoms, d-limonene with general symptoms, and styrene with skin symptoms. Among aldehydes, formaldehyde was associated with respiratory and general symptoms, acrolein with respiratory symptoms, propionaldehyde with respiratory, general, and heart symptoms, and hexanal with general SBS. Ozone was associated with almost all symptom groups.

Skin sensitivity to capsaicin, perceived stress and burn out among patients with building-related symptoms

Objective

The mechanisms behind building-related symptoms have remained unknown despite many years of research. It is known that environmental and psychosocial factors are of importance. Some receptors in the Transient Receptor Potential family elicit the same symptoms when stimulated, as reported by those suffering from building-related symptoms. The aim of this study was to compare capsaicin sensitivity between people with and without skin symptoms. A second aim was to investigate perceived stress among individuals with different levels of capsaicin sensitivity.

Methods

People referred to an occupational health care unit and judged to have building-related symptoms by a physician answered a questionnaire regarding their symptoms. Solutions with different capsaicin concentrations were applied to participants’ nasolabial folds. Self-reported stress and burnout were assessed using two questionnaires: the Perceived Stress Scale (PSS) and the Shirom-Melamed Burnout Questionnaire (SMBQ).

Results

We found that people who reported facial erythema or itching, stinging, tight or burning facial skin were more sensitive than those without symptoms and similarities with Sensitive Skin are discussed. We also found that participants who reacted to the lowest capsaicin concentrations scored significantly higher on scales for stress and burnout.

Conclusions

We found associations between sensitivity to capsaicin and skin symptoms among people with building-related symptoms, as well as associations between capsaicin sensitivity and perceived stress/burnout.

Working Conditions and Sick Building Syndrome among Health Care Workers in Vietnam

Background: Little is known about risk factors for sick building symptoms (SBS) among health care workers (HCWs) who often face the workload, exposure to chemicals, and biological contaminants in the workplace. This study aims to evaluate the correlation between SBS and the symptoms among HCWs. Methods: A total of 207 HCWs were recruited in a large hospital-based cross-sectional survey between March and June 2017, southern Vietnam. Face-to-face interviews were conducted for collecting data on demographics, SBS-related symptoms, working environments, and conditions. Indoor environmental conditions were measured. SBS scores, ranging from 0 to 24, were determined by a sum of the scores of general symptoms, mucosal irritation, and skin symptoms; multivariate regression analyses and the Lindeman, Merenda, and Gold (LMG) test were used to investigate the predictors and its impact on the SBS. Results: A mean SBS score was 9.7 (range: 1–21). Compared with males, females were more likely to report higher SBS scores (10.2 vs. 7.9, p < 0.001). Being female, atopy, varying temperature room, stuffy “bad” air dust, and dirt had higher SBS scores of 2.0; 1.8; 1.7; 1.9; 3.8, respectively. LMG test showed that dust and dirt, and stuffy “bad” air were the predominant risk factors for SBS. Conclusions: Our study reveals that working conditions are important and significantly associated with SBS. Taken together with our findings, the working condition criteria approach trained for architects, builders, owners, and maintenance of the building is highly recommended for indoor air quality improvement. Furthermore, larger-sample studies about working condition are urgently needed to better manage SBS.

Perception of indoor air quality (IAQ) by workers in underground shopping centers in relation to sick-building syndrome (SBS) and store type: a cross-sectional study in Korea

Background

We examined the indoor air quality (IAQ) perceptions of workers and their relationships with the symptoms of sick-building syndrome (SBS) and store types in underground shopping centers.

Methods

In 2017, 314 store workers in nine underground shopping centers in Seoul, Korea, were assessed. The all participants’ stores were partially opened onto a passage. Using questionnaires, they were asked about their demographics, job characteristics, 16 SBS symptoms, and seven IAQ perceptions. The SBS symptoms were categorized as skin, eye irritation, respiratory, or general. An IAQ perception score was calculated by adding the number of positive responses to each type of IAQ and categorized into three levels.

Results

The prevalence of SBS symptom groups in the previous month was 43.6% for skin symptoms, 62.4% for eye irritation symptoms, 65.6% for respiratory symptoms, and 64.7% for general symptoms. Participants who perceived IAQ were more likely to have SBS symptoms (odds ratio: 1.81–7.84). The type of store employing the workers was associated with several IAQ perceptions. Subjects who worked in clothing and fashion-accessory stores were more likely to have high IAQ perception scores than those who worked in food services.

Conclusions

About half of the store workers in underground shopping centers had experienced SBS symptom groups in the previous month. The SBS symptom groups were associated with almost all IAQ perceptions. Because IAQ perception was associated with store type, studies of IAQ in working areas might need to improve store workers’ health in underground shopping centers.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6988-6) contains supplementary material, which is available to authorized users.

Probability of Abnormal Indoor Air Exposure Categories Compared with Occupants’ Symptoms, Health Information, and Psychosocial Work Environment

Indoor air problems are complicated and need to be approached from many perspectives. In this research, we studied the association of four-level categorisation of the probability of abnormal indoor air (IA) exposure with the work environment-related symptoms, group-level health information and psychosocial work environment of employees. We also evaluated the multiprofessional IA group assessment of the current indoor air quality (IAQ) of the hospital premises. We found no statistical association between the four-level categorisation of the probability of abnormal IA exposure and the employees’ perceived symptoms, health information, and perceived psychosocial work environment. However, the results showed a statistical association between perceived symptoms and man-made vitreous fibre sources in ventilation. Furthermore, extensive impurity sources in the premises increased the employees’ contact with health services and their perceived symptoms. The employees perceived stress and symptoms in all categories of abnormal IA exposure, which may be related to IAQ or other factors affecting human experience. Prolonged process management may influence users’ experiences of IAQ. The results suggest that an extensive impurity source in premises does not always associate with the prevalence of perceived symptoms. We conclude that indoor air questionnaires alone cannot determine the urgency of the measures required.

The mystery of dry indoor air - An overview

"Dry air" is a major and abundant indoor air quality complaint in office-like environments. The causality of perceived "dry air" and associated respiratory effects continues to be debated, despite no clear definition of the complaint, yet, has been provided. The perception of "dry air" is semantically confusing without an associated receptor but mimics a proto-state of sensory irritation like a cooling sensation. "Dry air" may also be confused with another common indoor air quality complaint "stuffy air", which mimics the sense of no fresh air and of nasal congestion. Low indoor air humidity (IAH) was dismissed more than four decades ago as cause of "dry air" complaints, rather indoor pollutants was proposed as possible exacerbating causative agents during the cold season. Many studies, however, have shown adverse effects of low IAH and beneficial effects of elevated IAH. In this literature overview, we try to answer, "What is perceived "dry air" in indoor environments and its associated causalities. Many studies have shown that the perception is caused not only by extended exposure to low IAH, but also simultaneously with and possibly exacerbated by indoor air pollutants that aggravate the protective mucous layer in the airways and the eye tear film. Immanent diseases in the nose and airways in the general population may also contribute to the overall complaint rate and including other risk factors like age of the population, use of medication, and external factors like the local ambient humidity. Low IAH may be the single cause of perceived "dry air" in the elderly population, while certain indoor air pollutants may come into play among susceptible people, in addition to baseline contribution of nasal diseases. Thus, perceived "dry air" intercorrelates with dry eyes and throat, certain indoor air pollutants, ambient humidity, low IAH, and nasal diseases.

Psychosocial Problems, Indoor Air-Related Symptoms, and Perceived Indoor Air Quality among Students in Schools without Indoor Air Problems: A Longitudinal Study

The effect of students' psychosocial problems on their reporting of indoor air quality (subjective IAQ) and indoor air-related (IA-related) symptoms has not been studied in schools in a longitudinal setting. Therefore, we analyzed whether changes in students' psychosocial problems (socioemotional difficulties and perceived teacher⁻student relations) between the beginning of seventh grade (age 12⁻13 years) and the end of ninth grade (15⁻16 years) predicted subjective IAQ and IA-related symptoms at the end of ninth grade. In order to explore the independent effect of psychosocial factors, we focused only on students in schools without observed indoor air problems. The analysis was of longitudinal data (N = 986 students) using latent change modelling. Increased socioemotional difficulties were related to more IA-related symptoms (standardized beta = 0.20) and deteriorated subjective IAQ (standardized beta = 0.20). Increased problems in teacher⁻student relations were related to deteriorated subjective IAQ (standardized beta = 0.21). Although students' psychosocial problems explained only 9⁻13% of the total variances, our findings support the notion that psychosocial factors also need to be taken into account in the evaluation of IAQ and the prevalence of IA-related symptoms in schools.

[Integration of sex/gender into environmental health research. Results of the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET)]

The comprehensive consideration of sex/gender in health research is essential to increase relevance and validity of research results. Contrary to other areas of health research, there is no systematic summary of the current state of research on the significance of sex/gender in environmental health. Within the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET) the current state of integration of sex/gender aspects or, respectively, gender theoretical concepts into research was systematically assessed within selected topics of the research areas environmental toxicology, environmental medicine, environmental epidemiology and public health research on environment and health. Knowledge gaps and research needs were identified in all research areas. Furthermore, the potential for methodological advancements by using gender theoretical concepts was depicted. A dialogue between biomedical research, public health research, and gender studies was started with the research network GeUmGe-NET. This dialogue has to be continued particularly regarding a common testing of methodological innovations in data collection and data analysis. Insights of this interdisciplinary research are relevant for practice areas such as environmental health protection, health promotion, environmental justice, and environmental health monitoring.

Association between Four-Level Categorisation of Indoor Exposure and Perceived Indoor Air Quality

The aim of this study was to develop and test a tool for assessing urgency of indoor air quality (IAQ) measures. The condition of the 27 buildings were investigated and results were categorized. Statistical test studied the differences between the categories and the employees&rsquo; complaints about their work environment. To study the employees&rsquo; experiences of the work premises, a validated indoor air (IA) questionnaire was used. This study reveals a multifaceted problem: many factors affecting IAQ may also affect perceived IAQ, making it difficult to separate the impurity sources and ventilation system deficiencies affecting to employee experiences. An examination of the relationship between the categories and perceived IAQ revealed an association between the mould odour perceived by employees and mould detected by the researcher. A weak link was also found between the assessed categories and environmental complaints. However, we cannot make far-reaching conclusions regarding the assessed probability of abnormal IA exposure in the building on the basis of employee experiences. According to the results, categorising tool can partly support the assessment of the urgency for repairs when several factors that affect IAQ are taken into account.

The Importance of Specific Workplace Environment Characteristics for Maximum Health and Performance: Healthcare Workers' Perspective

OBJECTIVE

To examine the importance of specific workplace environment characteristics for maximum health and performance, assigned by healthcare employees, and how they relate to the nature of their work.

METHODS

A cross-sectional mixed-method study was conducted with content analysis and robust regression models to examine the relationship between workplace environment characteristics and perceived importance in promoting health and performance.

RESULTS

Our findings suggest that perceptions of key environment characteristics that safeguard health and performance in healthcare workplaces may vary by employee sex, setting, and nature of healthcare work involved. Theme and model descriptions of the influence of these factors on participant perceptions are provided.

CONCLUSIONS

Employee feedback on workplace characteristics that impact health and performance could be instrumental in determining the priorities of workplace design.

The associations of indoor environment and psychosocial factors on the subjective evaluation of Indoor Air Quality among lower secondary school students: a multilevel analysis

Subjective evaluation of Indoor Air Quality (subjective IAQ) reflects both building-related and psychosocial factors, but their associations have rarely been studied other than on the individual level in occupational settings and their interactions have not been assessed. Therefore, we studied whether schools' observed indoor air problems and psychosocial factors are associated with subjective IAQ and their potential interactions. The analysis was performed with a nationwide sample (N = 195 schools/26946 students) using multilevel modeling. Two datasets were merged: (i) survey data from students, including information on schools' psychosocial environment and subjective IAQ, and (ii) data from school principals, including information on observed indoor air problems. On the student level, school-related stress, poor teacher-student relationship, and whether the student did not easily receive help from school personnel, were significantly associated with poor subjective IAQ. On the school level, observed indoor air problem (standardized β = -0.43) and poor teacher-student relationship (standardized β = -0.22) were significant predictors of poor subjective IAQ. In addition, school-related stress was associated with poor subjective IAQ, but only in schools without observed indoor air problem (standardized β = -0.44).

The workplace as a factor of job satisfaction and productivity

Purpose

– The purpose of this study is to examine degree of job satisfaction of the University of Athen’s (UOA) administrative staff, specifically regarding the workplace and its impact on their productivity.

Design/methodology/approach

– Questionnaires were distributed to 160 administrative personnel of the UOA. The study entails descriptive analysis, independent samples t-tests, ANOVA, Pearson correlations (two-tailed) and regression analysis of the data collected.

Findings

– The results indicate that the UOA’s administrative staff is dissatisfied with most aspects of their workplace, which is characterized by an inability to encourage and support new forms of office work. This scenario was also found to have a negative effect on productivity. In addition, regression analysis showed that satisfaction with the workplace is a significant predictor of employee productivity.

Research limitations/implications

– A limitation of this study is that the sample was not from the UOA administrative staff that works in more recently constructed office buildings away from the Athens city center. Further investigation would also be needed to identify possible differences in satisfaction with the workspace and its impact on productivity, based on demographic characteristics, such as the level of education and years of employment.

Practical implications

– The research results may be useful to public institution administrations like that of the UOA, as it highlights changes in the workplace which can have significant impact on employee job satisfaction and productivity, and consequently, the efficiency and effectiveness of the services provided.

Originality/value

– This study examines aspects of the workspace of a public organization regarding their individual attributes. Given that the existing Greek literature in this field does not contain a discussion on the impact of the workplace on job satisfaction and productivity as far as the public sector is concerned, this paper may contribute to a smoother and more efficient provision of services from its organizations/institutions.

Sick Building Syndrome Among Junior High School Students in Japan in Relation to the Home and School Environment

Purpose:

There is an increasing concern about sick building syndrome (SBS), especially in Asia. The aim of this study is to investigate associations between SBS and the home, school environment and personal factors among Japanese junior high school students.

Methods:

We investigated students in four junior high schools in Hyogo in Kansai area, Japan. A questionnaire study was performed among students (n=1056), 12-15 years old. Temperature and relative air humidity was measured in the classrooms and dust was collected from the classroom floors and air and was analysed for cat and dog allergens. Associations were analysed by multi-level logistic regression.

Results:

Mucosal symptoms (45.4%), general symptoms (38.9%) and skin symptoms (22.6%) were common. Totally 8.8% reported cat allergy, 6.1% dog allergy, 6.0% mold allergy and 25.7% pollen allergy. Atopy, window pane condensation, floor dampness and odor at home and high relative air humidity in the classrooms were associated with SBS.

Conclusion:

The prevalence of SBS symptoms was high and associated with both home and school environment. Window pane condensation and floor dampness at home can increase the risk for SBS symptoms in students. Moreover high relative air humidity at school may increase the risk for SBS.

Work-related symptoms in indoor environments: a puzzling problem for the occupational physician

PURPOSES

People who work indoors often manifest symptoms related to the work environment. Sick building syndrome (SBS) is a condition closely associated with sealed, air-conditioned workplaces and is especially frequent in countries with a cold climate. However, it is also present in Mediterranean countries where artificial ventilation accompanies the natural one. The significance of personal factors, air quality perception, and psychosocial work conditions in relation to SBS and other work-related symptoms needs to be clarified.

METHODS

Workers from 28 companies in the Latium region of Italy were invited to answer a questionnaire during their routine medical examination at the workplace. A total of 4,029 out of 4,129 took part in the survey, giving a response rate of 97.6 %.

RESULTS

A high percentage of workers (31.9 %) reported symptoms related to work, and two-thirds of the employees (65.4 %) complained of environmental problems. In logistic regression models, personal factors (gender, smoking habit, age, and atopy), anxiety and depression, environmental discomfort and job strain were associated both with symptoms of SBS and other work-related symptoms. There was a significant association between the perception of stuffy air, dry air, and electricity and cases of SBS. Some associations between symptoms and the work environment lacked biological plausibility.

CONCLUSIONS

The occupational physician's task is to systematically monitor workers' symptoms and their perception of the work environment in order to analyze this relationship and indicates the best mode of preventing illness/discomfort. This paper provides a method and reference values.

Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building

BACKGROUND

Water damage in buildings has been associated with reports of upper airway inflammation among occupants.

METHODS

This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages.

RESULTS

Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females.

CONCLUSIONS

In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.

Gender, airborne chemical monitoring, and physical work environment are related to indoor air symptoms among nonindustrial workers in the Klang Valley, Malaysia

Objectives:

The purpose of this study was to analyze the relationship of airborne chemicals and the physical work environment risk element on the indoor air symptoms of nonindustrial workers.

Design:

A cross-sectional study consisting of 200 office workers. A random selection of 200 buildings was analyzed for exposure and indoor air symptoms based on a pilot study in the Klang Valley, Malaysia.

Methods:

A set of modified published questionnaires by the Department of Occupational Safety and Health (DOSH), Malaysia and a previous study (MM040NA questionnaire) pertaining to indoor air symptoms was used in the evaluation process of the indoor air symptoms. Statistical analyses involving logistic regression and linear regression were used to determine the relationship between exposure and indoor air symptoms for use in the development of an indoor risk matrix.

Results:

The results indicate that some indoor air pollutants (carbon monoxide, formaldehyde, total volatile organic compound, and dust) are related to indoor air symptoms of men and women. Temperature and relative humidity showed a positive association with complaints related to the perceived indoor environmental condition (drafts and inconsistency of temperature). Men predominantly reported general symptoms when stratification of gender involved exposure to formaldehyde. Women reported high levels of complaints related to mucosal and general symptoms from exposure to the dust level indoors.

Conclusion:

Exposure to pollutants (total volatile organic compounds, carbon monoxide, and formaldehyde) and physical stressors (air temperature and relative humidity) influence reported symptoms of office workers. These parameters should be focused upon and graded as one of the important elements in the grading procedure when qualitatively evaluating the indoor environment.

Asthma related to workplace dampness and impaired work ability

PURPOSE

To examine the long-term effects on work ability among patients previously diagnosed with occupational asthma (OA) or work-exacerbated asthma (WEA) or symptoms in relation to workplace dampness.

METHODS

A questionnaire follow-up was used to study 1,098 patients (of whom 87 % were female) examined because of a suspected occupational respiratory disease caused by building dampness and mold. Self-rated work ability and early withdrawal from work were the two outcomes of the study. As determinants, we investigated the influence of the asthma diagnosis given in the initial examinations (OA or WEA), the number of persistent indoor air symptoms, and the psychosocial factors at work.

RESULTS

With a mean follow-up of 7.8 years, 40 % of the OA patients, under 65 years of age, were outside worklife versus 23 % of the WEA patients and 15 % of the patients with only upper respiratory symptoms at baseline. The diagnosis of OA was associated with a nearly sixfold risk for early withdrawal from work in a comparison with a reference group with upper respiratory symptoms. A perceived poor social climate at work and poor experiences with supervisory co-operation were associated with impaired work ability outcomes. Those with multiple, long-term indoor air symptoms considerably more often perceived their work ability to be poor when compared with those with less significant symptoms.

CONCLUSIONS

Adverse work ability outcomes are associated with asthma in relation to workplace dampness. The study raises the need for effective preventive measures in order to help workers with indoor air symptoms sustain their work ability.

Sick building syndrome (SBS) and sick house syndrome (SHS) in relation to psychosocial stress at work in the Swedish workforce

PURPOSE

Medical symptoms called sick building syndrome (SBS) and sick house syndrome (SHS) are usually investigated separately: in this study, SBS and SHS were explored simultaneously. The significance of personal factors, perceptions of air quality, and psychosocial work situation in explaining SBS and SHS were investigated.

METHODS

A random sample of 1,000 subjects (20-65 year) received a postal questionnaire including questions on personal factors, medical symptoms, and the psychosocial demand-control-support model. The response rate was 70 % (n = 695), of which 532 were occupationally active.

RESULTS

In logistic regression models, atopy, poor air quality at work, and low social support, especially low supervisor support, were associated with both SBS and SHS when age, gender, smoking, and BMI were introduced. The general work-related symptoms (headache, tiredness, nausea, and sensation of a cold) were also related to low control over work.

CONCLUSIONS

The perception of poor physical environmental conditions is associated with common medical symptoms that are both work and home related. The associations between medical symptoms and poor air quality are still present, even when controlling for the psychosocial environment.

School environment as predictor of teacher sick leave: data-linked prospective cohort study

Background

Poor indoor air quality (IAQ) and psychosocial problems are common in schools worldwide, yet longitudinal research on the issue is scarce. We examined whether the level of or a change in pupil-reported school environment (IAQ, school satisfaction, and bullying) predicts recorded sick leaves among teachers.

Methods

Changes in the school environment were assessed using pupil surveys at two time points (2001/02 and 2004/05) in 92 secondary schools in Finland. Variables indicating change were based on median values at baseline. We linked these data to individual-level records of teachers’ (n = 1678) sick leaves in 2001–02 and in 2004–05.

Results

Multilevel multinomial logistic regression models adjusted for baseline sick leave and covariates showed a decreased risk for short-term (one to three days) sick leaves among teachers working in schools with good perceived IAQ at both times (OR = 0.6, 95% CI: 0.5-0.9), and for those with a positive change in IAQ (OR = 0.6, 95% CI: 0.4-0.9), compared to teachers in schools where IAQ was constantly poor. Negative changes in pupil school satisfaction (OR = 1.8, 95% CI: 1.1-2.8) and bullying (OR = 1.5, 95% CI: 1.0-2.3) increased the risk for short-term leaves among teachers when compared to teachers in schools where the level of satisfaction and bullying had remained stable. School environment factors were not associated with long-term sick leaves.

Conclusions

Good and improved IAQ are associated with decreased teacher absenteeism. While pupil-related psychosocial factors also contribute to sick leaves, no effect modification or mediation of psychosocial factors on the association between IAQ and sick leave was observed.

[Variations of indoor environment and the prevalence of sick house syndrome over three-year period in detached houses in Sapporo]

OBJECTIVES

The purpose of this study was to investigate annual variations in indoor environmental chemical, fungal and dust mite allergen levels, with regards to variations in sick house syndrome (SHS) symptoms over a three-year period.

METHODS

Detached houses were randomly selected from a building plan approval application, and a questionnaire survey was conducted in 2003 in Sapporo, Japan. Indoor environmental measurements and a self-administered questionnaires survey were conducted on the selected houses in 2004, 2005 and 2006. The same protocol was used for the three-year period to measure the levels of chemicals, fungi and dust mite allergens. A personal questionnaire to assess SHS was distributed to all inhabitants of the dwellings along with one questionnaire to assess housing characteristics.

RESULTS

In 2004, 2005 and 2006, the owners of 104, 64 and 41 houses, respectively, agreed to participate in this study. Forty-one houses and the 127 inhabitants who participated in this three-year survey period were included in the analysis to evaluate the associations between differences in environmental measurements and SHS. The levels of formaldehyde, acetone, toluene, Alternaria and Cladosporium tended to decrease, whereas those of limonene and Aspergillus tended to increase over the three-year period. Increasing levels of Cryptococcus and the dampness index in individual houses correlated with increasing SHS symptom scores in the inhabitants after mutual adjustment.

CONCLUSIONS

Although the average levels of chemicals and fungi were relatively low, the results show the relationship between annual variations in indoor environmental measurements and variations in SHS symptom scores.

"Healthy" eye in office-like environments

Eye irritation symptoms, e.g. dry eyes, are common and abundant symptoms reported in office-like environments, e.g. aircraft cabins. To improve the understanding of indoor related eye symptomatology, relevant knowledge from the ophthalmological and indoor environmental science literature has been merged. A number of environmental (relative humidity, temperature, draft), occupational (e.g. visual display unit work), and individual (e.g. gender, use of cosmetics, and medication) risk factors have been identified, which are associated with alteration of the precorneal tear film (PTF); these factors may subsequently exacerbate development of eye irritation symptoms by desiccation. Low relative humidity including reduced atmospheric pressure further increases the water evaporation from an altered PTF; in addition, work with visual display units may destabilize the PTF by lower eye blink frequency and larger ocular surface. Results from epidemiological and clinical studies support that relative humidity >40% is beneficial for the PTF. Only few pollutants reach high enough indoor concentrations to cause sensory irritation of the eyes, while an altered PTF may exacerbate their sensory effect. Sustained low relative humidity causes impairment of the PTF, while its stability, including work performance, is retained by low gaze and intermittent breaks.

Symptoms, complaints, ocular and nasal physiological signs in university staff in relation to indoor environment - temperature and gender interactions

Symptoms, signs, perceptions, and objective measures were studied in university buildings. Two problem buildings with a history of dampness and complaints were compared with two control buildings. Health investigations among university staff were performed at the workplace (n = 173) including tear film stability [non-invasive break-up time (NIBUT) and self-reported break-up time (SBUT)], nasal patency (acoustic rhinometry), nasal lavage fluid analysis [NAL: eosinophil cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin] and atopy by total serum IgE and IgE antibodies (Phadiatop). Exposure assessment included inspections, thermal and atmospheric climate at 56 points modelled for all work sites. Multiple regressions were applied, controlling for age and gender. Exposure differences between problem buildings and controls were small, and variations between rooms were greater. Workers in the problem buildings had more general and dermal symptoms, but not more objective signs than the others. Adjusted day NIBUT and SBUT increased at higher night air temperatures, with B (95% CI) 0.6 (0.04-1.2) and 1.3 (-0.02 to 2.5), respectively. Higher relative humidity at mean day air temperature <22.1 degrees C was associated with adjusted NIBUT and SBUT, with B (95% CI) 0.16 (0.03-0.29) and 0.37 (-0.01 to 0.75), respectively. Air velocity below recommended winter values and reduced relative humidity in the range of 15-30% were associated with dry air and too low temperature.

PRACTICAL IMPLICATIONS

Thermal climate in university buildings may be associated with both perceptions and physiological signs. Reduced night time air temperature, increased difference in air temperature between day and night, and fast changes in air temperature might impair indoor environment. This may have implication for energy-saving policies. It might be difficult to identify the exposure behind, and find the reason why, some buildings are defined as 'problem buildings'.

Sick building syndrome in relation to air exchange rate, CO(2), room temperature and relative air humidity in university computer classrooms: an experimental study

OBJECTIVE

To study the effects of ventilation and temperature changes in computer classrooms on symptoms in students.

METHODS

Technical university students participated in a blinded study. Two classrooms had higher air exchange (4.1-5.2 ac/h); two others had lower (2.3-2.6 ac/h) air exchange. After 1 week, ventilation conditions were interchanged between the rooms. The students reported symptoms during the last hour, on a seven-step rating scale. Room temperature, relative air humidity (RH) carbon dioxide (CO(2)), PM10 and ultra-fine particles (UFP) were measured simultaneously (1 h). Illumination, air velocity, operative temperature, supply air temperature, formaldehyde, NO(2) and O(3) were measured. Multiple logistic regression was applied in cross-sectional analysis of the first answer (N = 355). Those participating twice (N = 121) were analysed longitudinally.

RESULTS

Totally 31% were females, 2.9% smokers and 3.8% had asthma. Mean CO(2) was 993 ppm (674-1,450 ppm), temperature 22.7 degrees C (20-25 degrees C) and RH 24% (19-35%). Lower and higher air exchange rates corresponded to a personal outdoor airflow of 7 l/s*p and 10-13 L/s*P, respectively. Mean PM10 was 20 microg/m(3) at lower and 15 microg/m(3) at higher ventilation flow. Ocular, nasal and throat symptoms, breathlessness, headache and tiredness were significantly more common at higher CO(2) and temperature. After mutual adjustment, ocular (OR = 1.52 per 1 degrees C), nasal (OR = 1.62 per 1 degrees C) and throat symptoms (OR = 1.53 per 1 degrees C), headache (OR = 1.51 per 1 degrees C) and tiredness (OR = 1.54 per 1 degrees C) were significantly associated with temperature; headache was associated only with CO(2) (OR = 1.19 per 100 ppm CO(2)). Longitudinal analysis demonstrated that increased room temperature was related to tiredness (P < 0.05).

CONCLUSION

Computer classrooms may have CO(2) above 1,000 ppm and temperatures above 22 degrees C. Increased temperature and CO(2) may affect mucosal membrane symptoms, headaches and tiredness. Room temperature was most important. CO(2) associations may partly be temperature effects.

Atopy, symptoms and indoor environmental perceptions, tear film stability, nasal patency and lavage biomarkers in university staff

OBJECTIVE

Study associations between airway symptoms, complaints on environmental perceptions, atopy definitions and biomarkers including tear film stability (BUT), nasal patency and nasal lavage (NAL). Personal predictors (gender, age, smoking, infections) for the biomarkers as well as associations between the biomarkers were also assessed.

METHODS

A cross-sectional study of 173 employees in four university buildings, response rate 86%. Tear film break up time (BUT) was measured by a non-invasive method (NIBUT) and self-reported (SBUT). NAL-analysis included eosinophilic cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin. Total serum IgE, and specific IgE using Phadiatop was measured. Data on subjective symptoms, environmental perceptions and background data were collected by use of a questionnaire. Multiple regression analyses were applied.

RESULTS

Mean age was 43 years, 21% had weekly ocular, 21% nasal, and 17% laryngeal symptoms. Women had more complaints on environmental perceptions, shorter BUT and less nasal patency. Neither atopy (Phadiatop) nor Total IgE or allergy in the family, but asthma and hay fever was associated with mucosal symptoms or perceptions. Subjects with positive Phadiatop had higher levels of all NAL-biomarkers. Those with ocular symptoms had shorter BUT. Nasal symptoms were related to respiratory infections and laryngeal symptoms to NAL-lysozyme. Perceiving dry air was associated with lower BUT and reduced nasal volume difference before and after decongestion. Older subjects had greater nasal patency, and less atopy. All NAL-biomarkers were positively correlated. Higher lysozyme level was associated with less nasal patency and greater nasal decongestion.

CONCLUSIONS

BUT and NAL-lysozyme was associated with ocular, nasal, laryngeal symptoms and indoor environmental perceptions. Ever having had asthma and ever having had hay fever were predictors for symptoms and perceived air quality, respectively. Phadiatop, Total IgE, familiar allergy and ever eczema were not associated to symptoms or perceived environments. Age, gender and Phadiatop were main predictors for ocular and nasal biomarkers.