Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study

Indoor air quality and sick building syndrome symptoms in administrative office at public university

Sick Building Syndrome (SBS) is an illness among workers linked to time spent in a building. This study aimed to investigate the Indoor Air Quality (IAQ) and symptoms of Sick Building Syndrome (SBS) among administrative office workers. The IAQ parameters consist of ventilation performance indicators, and physical and chemical parameters were measured using specified instruments for three days during weekdays. The SBS symptoms were assessed by a questionnaire adopted from the Industry Code of Practice of Indoor Air Quality (ICOP-IAQ) 2010 among 19 employees from the office in East Coast Malaysia. Relationship between past symptoms and present symptoms which are draught (past symptoms) with feeling heavy headed (present symptoms) (r = 0.559, p < 0.05), room temperature too high (past symptoms) was highly correlated with feeling heavy headed (present symptoms) (r = 0.598, p < 0.01) and cough (present symptoms) (r = 0.596, p < 0.01). Room temperature (past symptoms) has a positive medium relationship with cough (present symptoms) (r = 0.477, p < 0.05) and scaling itching scalp or ears (present symptoms) has a relationship between stuffy bad air (r = 0.475, p < 0.05) and dry air (r = 0.536, p < 0.05). There was a significant association between RH with drowsiness (χ2 = 7.090, p = 0.049) and dizziness (χ2 = 7.090, p = 0.049). The association was found between temperature and SBS symptoms between temperature with headache (χ2 = 7.574, p = 0.051), feeling heavy-headed (χ2 = 8.090, p = 0.046), and skin rash itchiness (χ2 = 7.451, p = 0.044). Air movement also showed a positive association with symptoms of feeling heavy-headed (x2 = 8.726, p = 0.021). PM10 has positive significance with SBSS which are feeling heavy-headed (χ2 = 7.980, p = 0.023), and eyer's irritation (χ2 = 7.419, p = 0.038). The conclusion of this study showed that there were positive significant between temperature and relative humidity toward SBSS.

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.

TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.

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.

Oxidative stress in Hashimoto's thyroiditis: possible adjuvant therapies to attenuate deleterious effects

A number of studies have shown that oxidative stress is related to the pathogenesis of several immunological diseases, such as Hashimoto's thyroiditis (HT), although there is no plausible mechanism to explain it. Thus, we aimed at hypothesizing and providing some possible mechanisms linking oxidative stress to autoimmunity aspects and its implications for HT, as well as adjuvant therapeutic proposals to mitigate the deleterious effects. Our hypothesis is that deficient eating habits, autoimmune regulator gene predisposing gene, dysbiosis and molecular mimicry, unfolded proteins and stress in the endoplasmic reticulum, and thymus involution appear to be the main potential factors leading to HT oxidative stress. Likewise, we show that the use of minerals selenium and zinc, vitamins D and C, as well as probiotics, can be interesting adjuvant therapies for the control of oxidative damage and poor prognosis of HT. Further clinical trials are needed to understand the real beneficial and side effects of these supplements.

Indoor Air Quality in Elderly Centers: Pollutants Emission and Health Effects

The world population is ageing, in particular in the developed world, with a significant increase in the percentage of people above 60 years old. They represent a segment of the population that is more vulnerable to adverse environmental conditions. Among them, indoor air quality is one of the most relevant, as elders spend comparatively more time indoors than younger generations. Furthermore, the recent COVID-19 pandemic contributed immensely to raising awareness of the importance of breathing air quality for human health and of the fact that indoor air is a vector for airborne infections and poisoning. Hence, this work reviews the state of the art regarding indoor air quality in elderly centers, considering the type of pollutants involved, their emission sources, and their health effects. Moreover, the influence of ventilation on air quality is also addressed. Notwithstanding the potential health problems with the corresponding costs and morbidity effects, only a few studies have considered explicitly indoor air quality and its impacts on elderly health. More studies are, therefore, necessary to objectively identify what are the impacts on the health of elderly people due to the quality of indoor air and how it can be improved, either by reducing the pollutants emission sources or by more adequate ventilation and thermal comfort strategies.

Prevalence of sick building syndrome in hospital staff and its relationship with indoor environmental quality

The aim of this study was to determine the prevalence of sick building syndrome (SBS), and its relationship with indoor environmental quality in hospital settings. This cross-sectional study was carried out on 300 hospital staff in Sivas. MM 040 NA Hospital questionnaire was applied. In the hospital indoor environments, air quality (carbon monoxide (CO), carbon dioxide (CO₂), oxygen (O₂), methane (CH₄), hydrogen sulfide (H₂S), nitrogen oxides (NO_x)), lighting, noise, respirable dust and thermal comfort measurements were made. The prevalence of SBS was determined as 64.7-74.1% in the hospitals. It was found that the risk of SBS was 4.31 times higher for those who complained about variable room temperature and 3.11 times higher for those who complained about noise, and decreased 1.01 times with the increase in lighting level. In order to minimize the risk of SBS, it is thought that all healthcare administrators should be informed about SBS.

A Creative Concept to empower office workers addressing work-related health risks

Among office workers, the sedentary work-related health challenges are mainly associated with the fact that they often sit for up to 10 hr a working day. Members of the Research Group conducted a research program to assist the office workers of an international telecommunication company's affiliate in Budapest to enhance comfort levels in the office work environment. The data collection included a Comfort Survey to reveal employees' sense of comfort related to Indoor Environmental Quality (IEQ) components and the characteristics of employees' feelings and behavior during working hours. Moreover, a measurement of IEQ components was carried out and focused on air quality, lighting, sound exposure and thermal comfort parameters. Based on the survey's results, a Creative Concept was developed to empower office workers to address work-related health risks, notably sedentary work risks. The Creative Concept consists of five elements: a Comfort Map as an IEQ-related application to select a suitable workplace, redesigning concepts to increase the use of lounges, a newly developed work pad to improve personal hygiene in an office environment, recommendations for creating a health-enabling work environment and a workplace training program to raise health awareness. After validation, our Creative Concept can function as a multi-component workplace health promotion method to offer assistance for a wide variety of offices to create a health-enabling working environment.

Indoor air quality and sick building syndrome in a university setting: a case study in Greece

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Building-related illness (BRI) in all family members caused by mold infestation after dampness damage of the building

Introduction: In 2010, dampness damage in a single-family house caused a massive mold infestation. In the further course, the 5 family members developed severe health problems. This report investigates the extent and cause of the water damage. In addition, the various visible fungal infestations were analyzed in a specialized laboratory. Results: Due to building construction errors, starting from the basement, an increased moisture penetration of the residential building was detected. Within 2 years, massive mold infestation occurred. In 2016, the following species were detected: Cladosporium sphaerospermum, Chaetomium globosum, Penicillium chrysogenum, Scopularis brevicaulis, Acremonium furculum, A. charticola and A. sclerotigenum, Trichomonascus apis Aspergillus versicolor and Debaryomyces hansenii. Additionally, different black molds were macroscopically detected. The severity of the disease process varied, probably due to the different daily exposure of the family members, and possibly influenced by age. The children presented acute episodes with nocturnal cough, associated with sleep disturbances and respiratory infections with severe rhinitis. In addition, general fatigue was noticeable. The course of the disease was complicated by recurrent nightly nosebleeds. The mother developed a much more severe course as chronic fatigue syndrome. Additionally, the following continuous complaints occurred: sore throat and headache, nocturnal irritable cough, chronic rhinitis, difficulty concentrating, increasing forgetfulness and word-finding disorders, cognitive impairment with reduced short-term memory, extremely dry eyes with red sclerae, morning stiffness, dyspnea, disturbed temperature regulation (chills), increased feeling of thirst, and menstrual disorders. The father's building-related illness (BRI) was comparatively mild due to much lower exposure, with nocturnal irritable cough, rhinitis, and marked fatigue. In 2018, after moving out of the house, the father was symptom-free after 2 weeks, the three children after 6 months, but the mother only after 18 months. Discussion: The symptoms are consistent with reports from the literature, according to which fatigue, sleep disturbances, lack of concentration and headache as well as recurrent infections of the upper respiratory tract are caused by microbial volatile organic compounds (MVOCs) released by molds. The association with recurrent nosebleeds in childhood has not been described in this form before. Conclusion: Since in all family members complete remission of symptoms occurred after cessation of the 6-year exposure, there is no doubt that the BRI was caused by the massive mold infestation.

Parent's self-reported indoor environment-related symptoms and health worry increase symptom reports among their children at school-Study in two independent populations

Little is known whether parent's indoor environment quality (IEQ)-related symptoms or health perceptions influence the risk of self- or parent-reported symptoms in their children. We assessed (i) the association of parents' IEQ-related symptoms with IEQ-related symptoms in their children at school and (ii) whether parental IEQ-related health worry increases the risk for children's symptoms. We used two Finnish studies: a national, population-based survey of indoor air and related health problems (n = 611 parents) and a subset of survey for all primary school pupils (grade 3-6) and their parents in Helsinki, which also included school IEQ-related symptoms reported by children (n = 1617 parent-child dyads). In the school survey, parent's own symptoms increased strongly their reporting of their children's symptoms at school (aOR 4.0, 95% CI 2.7-6.0 for parents experiencing a lot of symptoms) and also symptoms reported by the child itself (aOR 2.2, 95% CI 1.5-3.1). Similar, but slightly weaker associations were seen with parental IEQ-related health worries. Results remained unchanged when adjusted for the IEQ of school buildings or parental and children's allergic diseases. Similar associations were seen in the national survey between parent's symptoms at work and child's symptoms at school. The results suggest that parents' health perceptions may increase the reporting of children's IEQ-related symptoms even more than is typically seen for many indoor air contaminants.

Low-grade systemic inflammation and the workplace

BACKGROUND

Psychosocial and physical stressors can elicit the stress response, co-ordinated by interactions between neuroendocrine and inflammatory processes. The central role of the immune system, specifically low-grade systemic inflammation, is sometimes overlooked in work-related stress research.

OBJECTIVE

To review evidence that work-related psychosocial and physical stressors can stimulate a low-grade systemic inflammation which, through interactions with the neurohormonal systems, may impact on the well-being and productivity of workers.

METHODS

Literature searches were performed by databases and by hand. Databases used included Interface - EBSCOhost Research Databases; PsycINFO; Academic Search Complete; Africa-Wide Information; CINAHL; E-Journals; MEDLINE and PsycARTICLES.

RESULTS

Psychosocial stressors, infections, poor indoor air quality, musculoskeletal injuries and chemicals can stimulate a low-grade systemic inflammation that may adversely affect workers' mental and physical health, as well as productivity. The psychological and physical effects caused by infection-induced inflammation are generally referred to as sickness behaviour and those caused by poor indoor air quality as sick building syndrome.

CONCLUSIONS

Stressor-induced low-grade systemic inflammation can be a causal factor in the physical and behavioural symptoms of work-related stress. It is therefore important that those involved with the health of workers be cognisant of inappropriate or chronic low-grade inflammation as a potential health hazard.

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.

Health, work performance, and risk of infection in office-like environments: The role of indoor temperature, air humidity, and ventilation

Epidemiological and experimental studies have revealed the effects of the room temperature, indoor air humidity, and ventilation on human health, work and cognitive performance, and risk of infection. In this overview, we integrate the influence of these important microclimatic parameters and assess their influence in offices based on literature searches. The dose-effect curves of the temperature describe a concave shape. Low temperature increases the risk of cardiovascular and respiratory diseases and elevated temperature increases the risk of acute non-specific symptoms, e.g., dry eyes, and respiratory symptoms. Cognitive and work performance is optimal between 22 °C and 24 °C for regions with temperate or cold climate, but both higher and lower temperatures may deteriorate the performances and learning efficiency. Low temperature may favor virus viability, however, depending on the status of the physiological tissue in the airways. Low indoor air humidity causes vulnerable eyes and airways from desiccation and less efficient mucociliary clearance. This causes elevation of the most common mucous membrane-related symptoms, like dry and tired eyes, which deteriorates the work performance. Epidemiological, experimental, and clinical studies support that intervention of dry indoor air conditions by humidification alleviates symptoms of dry eyes and airways, fatigue symptoms, less complaints about perceived dry air, and less compromised work performance. Intervention of dry air conditions by elevation of the indoor air humidity may be a non-pharmaceutical treatment of the risk of infection by reduced viability and transport of influenza virus. Relative humidity between 40 and 60% appears optimal for health, work performance, and lower risk of infection. Ventilation can reduce both acute and chronic health outcomes and improve work performance, because the exposure is reduced by the dilution of the indoor air pollutants (including pathogens, e.g., as virus droplets), and in addition to general emission source control strategies. Personal control of ventilation appears an important factor that influences the satisfaction of the thermal comfort due to its physical and positive psychological impact. However, natural ventilation or mechanical ventilation can become sources of air pollutants, allergens, and pathogens of outdoor or indoor origin and cause an increase in exposure. The "health-based ventilation rate" in a building should meet WHO's air quality guidelines and dilute human bio-effluent emissions to reach an acceptable perceived indoor air quality. Ventilation is a modifying factor that should be integrated with both the indoor air humidity and the room temperature in a strategic joint control to satisfy the perceived indoor air quality, health, working performance, and minimize the risk of infection.

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.

Psychosocial factors and indoor environmental quality in respiratory symptom reports of pupils: a cross-sectional study in Finnish schools

OBJECTIVES

Poor indoor environmental quality (IEQ) in schools is related to higher respiratory symptoms of pupils, but little is known about the importance of other factors. This study examined the associations between different psychosocial factors and other pupils' individual and allergic characteristics, beyond school IEQ, and reporting of respiratory symptoms in pupil-administered and parent-administered questionnaires.

SETTING

All primary and secondary schools in two areas of Helsinki, Finland.

PARTICIPANTS

Primary school pupils (grade 3-6, n=8775, 99 school buildings) and secondary school pupils (grade 7-9, n=3410, 30 school buildings) reported their respiratory symptoms, as well as psychosocial factors and individual characteristics. Parents of primary school pupils (grade 1-6, n=3540, 88 school buildings) also filled in questionnaires, but the response rate was low (20% in 2017 and 13% in 2018).

MAIN OUTCOME MEASURE

Respiratory symptoms were reported in relation to the school environment and in general (without such relation) by pupils or parents.

RESULTS

Worry about IEQ and low school satisfaction, and asthma and hay fever were related to higher reporting of respiratory symptoms in three samples. The variance between schools in respiratory symptoms was low (intraclass correlation=0.6%-2.4%). Psychosocial factors, especially worry about school's IEQ, explained more of the variance between schools in symptoms than IEQ among secondary school pupils and parents, but not among primary school pupils for symptoms in general. Worry about IEQ also modified the associations between IEQ and respiratory symptoms, but only in parental reports.

CONCLUSION

In addition to IEQ, psychosocial factors and pupils' individual and allergic characteristics were related to higher reporting of respiratory symptoms in all three samples. Psychosocial factors explained more variance between schools than IEQ, although it was 2.4% at most. Other factors beyond IEQ should be considered when interpreting symptom reporting in indoor air questionnaires.

Differences in chemical composition of indoor air in rooms associated/not associated with building related symptoms

Building related health effects or symptoms (BRS), known also as sick-building syndrome (SBS), are a phenomenon that is not well understood. In this study, air samples from 51 rooms associated with BRS and 34 control rooms were collected on multi-sorbent tubes and analyzed by a non-target approach using comprehensive two-dimensional gas chromatography and high-resolution mass spectrometry techniques. The large amount of data gathered was analyzed using multivariate statistics (principle component analysis (PCA) and partial least squares (PLS)). This new analysis approach revealed that in rooms where people experienced BRS, petrochemicals and chemicals emitted from plastics were abundant, whereas in rooms where people did not experience BRS, flavor and fragrance compounds were abundant. Among the petrochemicals benzene and 2-butoxyethanol were found in higher levels in rooms where people experienced BRS. The levels of limonene were sometimes in the range of reported odor thresholds, and similarly 3-carene and beta-myrcene were found in higher concentrations in indoor air of rooms where people did not experience BRS. It cannot be ruled out that these compounds may have influenced the perceived air quality. However, the overall variability in air concentrations was large and it was not possible to accurately predict if the air in a particular room could cause BRS or not.

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.

Indoor Air Pollution, Related Human Diseases, and Recent Trends in the Control and Improvement of Indoor Air Quality

Indoor air pollution (IAP) is a serious threat to human health, causing millions of deaths each year. A plethora of pollutants can result in IAP; therefore, it is very important to identify their main sources and concentrations and to devise strategies for the control and enhancement of indoor air quality (IAQ). Herein, we provide a critical review and evaluation of the major sources of major pollutant emissions, their health effects, and issues related to IAP-based illnesses, including sick building syndrome (SBS) and building-related illness (BRI). In addition, the strategies and approaches for control and reduction of pollutant concentrations are pointed out, and the recent trends in efforts to resolve and improve IAQ, with their respective advantages and potentials, are summarized. It is predicted that the development of novel materials for sensors, IAQ-monitoring systems, and smart homes is a promising strategy for control and enhancement of IAQ in the future.

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).

Health-related quality among life of employees with persistent nonspecific indoor-air-associated health complaints

OBJECTIVE

Nonspecific health complaints associated with indoor air are common in work environments. In some individuals, symptoms become persistent without an adequate explanation. The aim was to study factors that associate with the health-related quality of life (HRQoL) of employees with persistent, nonspecific indoor-air-related symptomatology.

METHODS

We present baseline results of a randomized controlled trial of interventions targeted on the HRQoL of the employees with indoor-air-associated nonspecific symptoms. The main participant-inclusion criterion was the presence of persistent indoor-air-related multiorgan symptoms with no known pathophysiological or environment-related explanation. As a comparison for participants´ HRQoL (n = 52) we used data from the general-population Health 2011 study (BRIF8901) including information on subjects matched to the participants´ working status and age and subjects with asthma, anxiety or depressive disorder, or other chronic conditions with work disability.

RESULTS

The participants showed greater and a clinically significant impairment of HRQoL [M = 0.83, SE = 0.013] than individuals from the general population [M = 0.95, SE = 0.001, p < .001, Hedges´ g = 2.33] and those with asthma [M = 0.93, SE = 0.005, p < .001, Hedges´ g = 1.46], anxiety and depressive disorder [M = 0.89, SE = 0.006, p < .001, Hedges´ g = 0.73], or a chronic condition with work disability [M = 0.91, SE = 0.003, p < .001, Hedges´ g = 1.11]. Prevalent symptoms of depression, anxiety, and insomnia and poor recovery from work were associated with a poor HRQoL.

CONCLUSIONS

Individuals with nonspecific indoor-air-associated symptoms have a poorer HRQoL than individuals in the general population with a globally burdensome disease. Psychological distress associated with a poor HRQoL should be considered in the making of decisions about the treatment of these patients.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02069002.

Sick Building Syndrome and Other Building-Related Illnesses

Sick building syndrome (SBS) and building-related illnesses are omnipresent in modern high-rise buildings. The SBS is a complex spectrum of ill health symptoms, such as mucous membrane irritation, asthma, neurotoxic effects, gastrointestinal disturbance, skin dryness, sensitivity to odours that may appear among occupants in office and public buildings, schools and hospitals. Studies on large office buildings from USA, UK, Sweden, Finland, Japan, Germany, Canada, China, India, Netherlands, Malaysia, Taiwan, and Thailand, substantiate the occurrence of SBS phenomena. The accumulated effects of a multitude of factors, such as the indoor environmental quality, building characteristics, building dampness, and activities of occupants attribute to SBS. A building occupant manifests at least one symptom of SBS, the onset of two or more symptoms at least twice, and rapid resolution of symptoms following moving away from the workstation or building may be defined as having SBS. Based on the peer-reviewed documentation, this chapter elaborates the magnitude of building-related health consequences due to measurable environmental causations, and the size of the population affected. The mechanisms and causative factors of SBS and illnesses include, for example, the oxidative stress resulting from indoor pollutants, VOCs, office work-related stressors, humidification, odours associated with moisture and bioaerosol exposure. Related regulatory standards and strategies for management of SBS and other illnesses are elaborated.

Relationship between sick building syndrome and indoor air quality among hospital staff

BACKGROUND

Sick building syndrome (SBS) is defined as a condition occurring in those who live or work in a modern building and who suffer from symptoms such as headache, fatigue, lack of concentration and irritation of the skin and mucous membranes.

OBJECTIVES

The aim of this study was to evaluate the relationship between personal characteristics, environmental factors and the prevalence of SBS among the secretaries working in a hospital.

METHOD

In this cross-sectional study, questionnaires were administered to all secretaries who were working in Kutahya hospital in January and March 2018. The questionnaire used in the study included the sociodemographic characteristics of the participants and the question form "MM 040 NA Hospital" to evaluate SBS symptoms. These symptoms were the clinical symptoms reported by the secretaries as a result of exposure to factors within the hospital. Temperature, humidity, carbon dioxide concentration, light intensity and noise level were measured in the indoor environment of the hospital. Chi square test, Spearman's correlation coefficient and logistic regression models were used in the analysis of data.

RESULTS

The study was completed with 177 people, 61.6% women, and the mean age was 30.14±5.7. The prevalence of SBS was found to be 20.9%. The risk of SBS was found to be 2.9 times higher for females, 2.8 times higher for individuals who described the working environment as dusty, 2.6 times higher for subjects complaining of stuffy "bad" air, dry air and an unpleasant odour. All measurements were found to be within acceptable limits. The risk of SBS was found to be 1.2 times higher with increases in the measured noise level, and 2.1 times higher with increased carbon dioxide (CO2) concentrations.

CONCLUSION

The factors impacting the risk of experiencing SBS were determined. Bearing these factors in mind, we think that hospital administrations should be informed about arrangements and measures that will improve the quality of the internal environment of the hospital.

Effects of low-level inhalation exposure to carbon dioxide in indoor environments: A short review on human health and psychomotor performance

Scientific literature and documents pertaining to the effects of inhalation exposure to carbon dioxide (CO₂) on human health and psychomotor performance were reviewed. Linear physiological changes in circulatory, cardiovascular, and autonomic systems on exposure to CO₂ at concentrations ranging from 500 to 5000 ppm were evident. Human experimental studies have suggested that short-term CO₂ exposure beginning at 1000 ppm affects cognitive performances including decision making and problem resolution. Changes in autonomic systems due to low-level exposure to CO₂ may involve these effects. Further research on the long-term effects of low-level CO₂ exposure on the autonomic system is required. Numerous epidemiological studies indicate an association between low-level exposure to CO₂ beginning at 700 ppm and building-related symptoms. Respiratory symptoms have been indicated in children exposed to indoor CO₂ concentrations higher than 1000 ppm. However, other indoor comorbid pollutants are possibly involved in such effects. In the context of significant linear increase of globally ambient CO₂ concentration caused by anthropogenic activities and sources, reducing indoor CO₂ levels by ventilation with ambient air represents an increase in energy consumption in an air-conditioned building. For the efficient energy control of CO₂ intruding a building from ambient air, the rise of atmospheric CO₂ concentration needs to be urgently suppressed.

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.

Sick building syndrome and associated risk factors among the population of Gondar town, northwest Ethiopia

BACKGROUND

Sick building syndrome (SBS) consists of a group of mucosal, skin, and general symptoms temporally related to residential and office buildings of unclear causes. These symptoms are common in the general population. However, SBS symptoms and their contributing factors are poorly understood, and the community associates it with bad sprits. This community-based cross-sectional study was, therefore, conducted to assess the prevalence and associated factors of SBS in Gondar town.

METHODS

A community-based cross-sectional study was conducted from March to April 2017. A total of 3405 study subjects were included using multistage and systematic random sampling techniques. A structured questionnaire and observational checklists were used to collect data. SBS was assessed by 24 building-related symptoms and confirmed by five SBS confirmation criteria. Multivariable binary logistic regression analysis was used to identify factors associated with SBS on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. The Hosmer and Lemeshow goodness of fit test was used to check model fitness, and variance inflation factor (VIF) was also used to test interactions between variables.

RESULTS

The prevalence of SBS in Gondar town was 21.7% (95% CI = 20.3-23.0%). Of this, the mucosal symptoms account for 64%, the general symptoms account for 54%, and the skin symptoms account for 10%. From study participants who reported SBS symptoms, 44% had more than one symptom. Headache (15.7%), asthma (8.3%), rhinitis (8.0%), and dizziness (7.5%) were the commonest reported symptoms. SBS was significantly associated with fungal growth in the building [AOR = 1.25, 95% CI = (1.05, 1.49)], unclean building [AOR = 1.26, 95% CI = (1.03, 1.55)], houses with no functional windows [AOR = 1.35, 95% CI = (1.12, 1.63)], houses with no fan [AOR = 1.90, 95% CI = (1.22, 2.96)], utilization of charcoal as a cooking energy source [AOR = 1.40, 95% CI = (1.02, 1.91)], cooking inside the living quarters [AOR = 1.31, 95% CI = (1.09, 1.58)], and incensing and joss stick use [AOR = 1.48, 95% CI = (1.23, 1.77)].

CONCLUSION

The prevalence of SBS in Gondar town was high, and significant proportion of the population had more than one SBS symptom. Headache, asthma, rhinitis, and dizziness were the commonest reported SBS symptoms. Fungal growth, cleanliness of the building, availability of functional windows, availability of fan in the living quarters, using charcoal as a cooking energy source, cooking inside the quarters, and incensing habit or joss stick use were identified as factors associated with SBS. Improving the sanitation of the living environment and housekeeping practices of the occupants is useful to minimize the prevalence of SBS.

Physicochemical risk factors for building-related symptoms in air-conditioned office buildings: Ambient particles and combined exposure to indoor air pollutants

We conducted a cross-sectional epidemiological study to examine the correlation between indoor air quality (IAQ) and building-related symptoms (BRSs) of office workers in air-conditioned office buildings. We investigated 11 offices during winter and 13 offices during summer in 17 buildings with air-conditioning systems in Tokyo, Osaka, and Fukuoka, and we included 107 office workers during winter and 207 office workers during summer. We conducted environmental sampling for evaluating IAQ and concurrently administered self-reported questionnaires to collect information regarding work-related symptoms. Multivariate analyses revealed that upper respiratory symptoms showed a significant correlation with increased indoor temperature [odds ratio (OR), 1.55; 95% confidence interval (CI), 1.11-2.18] and increased indoor concentration of suspended particles released from the ambient air pollution via air-conditioning systems (OR, 1.31; 95% CI, 1.08-1.59) during winter. In particular, smaller particles (particle size>0.3μm), which possibly penetrated through the filter media in air-conditioning systems from ambient air, were correlated with upper respiratory symptoms. The use of high-efficiency particulate air filters in air-conditioning systems and their adequate maintenance may be an urgent solution for reducing the indoor air concentration of submicron particles. Several irritating volatile organic compounds (VOCs) (e.g., formaldehyde, acetaldehyde, ethylbenzene, toluene, and xylenes) that were positively correlated with the indoor air concentration among their VOCs, were associated with upper respiratory symptoms, although their indoor air concentrations were lower than those specified by the indoor air quality guideline. A new approach and strategy for decreasing the potential combined health risks (i.e., additive effect of risks) associated with multiple low-level indoor pollutants that have similar hazardous properties are required.

Advances in Residential Design Related to the Influence of Geomagnetism

Since the origin of the Modern Movement, there has been a basic commitment to improving housing conditions and the well-being of occupants, especially given the prediction that 2/3 of humanity will reside in cities by 2050. Moreover, a compact model of the city with tall buildings and urban densification at this scale will be generated. Continuous constructive and technological advances have developed solid foundations on safety, energy efficiency, habitability, and sustainability in housing design. However, studies on improving the quality of life in these areas continue to be a challenge for architects and engineers. This paper seeks to contribute health-related information to the study of residential design, specifically the influence of the geomagnetic field on its occupants. After compiling information on the effects of geomagnetic fields from different medical studies over 23 years, a case study of a 16-story high-rise building is presented, with the goal of proposing architectural design recommendations for long-term occupation in the same place. The purpose of the present work is three-fold: first, to characterize the geomagnetic field variability of buildings; second, to identify the causes and possible related mechanisms; and third, to define architectural criteria on the arrangement of uses and constructive elements for housing.

Personal, Psychosocial and Environmental Factors Related to Sick Building Syndrome in Official Employees of Taiwan

Sick building syndrome (SBS) is a combination of symptoms that can be attributed to exposure to specific building conditions. The present study recruited 389 participants aged 20–65 years from 87 offices of 16 institutions to examine if personal factors, work-related psychosocial stress, and work environments, were associated with five groups of SBS symptoms, including symptoms for eyes, upper respiratory tract, lower respiratory tract, skin, and non-specific systems. Indoor environmental conditions were monitored. Data were analyzed using multivariate logistic regression (MLR) analyses and were reported as adjusted Odds Ratios (aOR). SBS symptoms for eyes were associated with older age, sensitivity to tobacco, and low indoor air flow. Upper respiratory symptoms were related to smoking, low social support, longer work days, and dry air. High indoor air flow was associated with reduced upper respiratory symptoms (aOR = 0.29; 95% confidence interval (CI) = 0.13–0.67). Lower respiratory symptoms were associated with high work pressure, longer work hours, chemical exposure, migraine, and exposure to new interior painting. Recent interior painting exposure was associated with a high estimated relative risk of low respiratory symptoms (aOR = 20.6; 95% CI = 2.96–143). Smoking, longer work days, low indoor air flow, indoor dryness, and volatile organics exposure, were associated with other non-specified symptoms including headache, tiredness, difficulty concentrating, anger, and dizziness. In conclusion, there are various SBS symptoms associated with different personal characteristics, psychosocial, and environmental factors. Psychosocial factors had stronger relationships with lower respiratory symptoms than with other types of SBS symptoms. Good ventilation could reduce risk factors and may relieve SBS symptoms.

Vitamin C and Immune Function

Vitamin C is an essential micronutrient for humans, with pleiotropic functions related to its ability to donate electrons. It is a potent antioxidant and a cofactor for a family of biosynthetic and gene regulatory enzymes. Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C supports epithelial barrier function against pathogens and promotes the oxidant scavenging activity of the skin, thereby potentially protecting against environmental oxidative stress. Vitamin C accumulates in phagocytic cells, such as neutrophils, and can enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing. It is also needed for apoptosis and clearance of the spent neutrophils from sites of infection by macrophages, thereby decreasing necrosis/NETosis and potential tissue damage. The role of vitamin C in lymphocytes is less clear, but it has been shown to enhance differentiation and proliferation of B- and T-cells, likely due to its gene regulating effects. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. In turn, infections significantly impact on vitamin C levels due to enhanced inflammation and metabolic requirements. Furthermore, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. Prophylactic prevention of infection requires dietary vitamin C intakes that provide at least adequate, if not saturating plasma levels (i.e., 100–200 mg/day), which optimize cell and tissue levels. In contrast, treatment of established infections requires significantly higher (gram) doses of the vitamin to compensate for the increased inflammatory response and metabolic demand.

Impact of Dry Eye Symptoms and Daily Activities in a Modern Office

PURPOSE

Modern offices and the use of electronic devices are increasing factors in work-related eye symptoms. However, symptoms of eye fatigue or dry eye sensation can be mixed and confusing. This study surveys the eye symptoms reported during a working day at modern offices to investigate the possible inhibition on daily work activities.

METHODS

Two online digital surveys were sent to three different work locations, by direct e-mail. Survey A consisted of 14 questions that investigated eye symptoms experienced during daily activities at work and the impact on daily activities. Survey B consisted of four general questions, the Dutch Ocular Surface Disease Index, the Work Productivity and Activity Index, and the Illness Perception Questionnaire.

RESULTS

A total of 505 participants completed survey A, and 213 completed survey B. The participants reported that a high proportion of their day was spent working on a computer (60%). The majority experienced an air draft (79.1%) and had no adjustable light (81.5%) at their workspace. Dry eye-related symptoms were reported at a significantly higher frequency at work than at home (P < .001). Up to 70% experienced some inhibition of daily activity at work due to eye symptoms, with more than 5% experiencing symptoms most or all of the time. Indoor environment, work environment, and general health were perceived as the main reasons for developing dry eye. Compared with males, females showed a statistically significant higher Ocular Surface Disease Index score (P < .001) and experienced more inhibition and adverse effects on daily life and work productivity.

CONCLUSIONS

This investigation shows that dry eye symptoms have a negative impact on daily activities at work. These findings suggest that multidisciplinary understanding of the negative impact of dry eye by a range of specialists will be of help in managing work-related dry eye.

Effect of Job Strain on Job Burnout, Mental Fatigue and Chronic Diseases among Civil Servants in the Xinjiang Uygur Autonomous Region of China

Job strain is a major concern in view of its effects among civil servants associated with job burnout, mental fatigue and chronic diseases. The objective of this study was to assess the job strain level among civil servants and examine the effect of job strain on job burnout, mental fatigue and the resulting chronic diseases. A cross-sectional study with a representative sample consisting of 5000 civil servants was conducted from March to August 2014. Using a structured questionnaire, the job strain level, job burnout and mental fatigue were measured by using the Personal Strain Questionnaire (PSQ), Maslach Burnout Inventory (MBI) and Multidimensional Fatigue Inventory (MFI-20), respectively. Overall, 33.8% of the civil servants were found to be afflicted with high and moderate job strain. The characteristics of most of the civil servants with a higher-job strain level were as follows: female, Uygur, lower educational level and job title rank, shorter working experience, married marital status, and lower income level. Civil servants suffering from chronic disease mainly had hypertension and coronary heart disease, which accounted for 18.5% of the diseases. Civil servants with a high-job strain level exhibited higher rates of burnout, mental fatigue scores and incidence of chronic diseases. There was a multiple linear regression model composed of three predictor variables in job burnout, which accounted for 45.0% of its occurrence: female gender, lower-income level, higher-job strain in civil servants, the greater the rate of job burnout was. Four factors—male gender, lower-job title rank, higher-job strain, shorter-job tenure of civil servants—explained 25.0% of the mental fatigue model. Binary logistic regression showed that intermediate-rank employees (OR = 0.442, 95% CI: 0.028–0.634; p < 0.05), job tenure of 10–20 years (OR = 0.632, 95% CI: 0.359–0.989; p < 0.05), and low-job strain (OR = 0.657, 95% CI: 0.052–0.698; p < 0.05) were all associated with significantly lower odds of chronic disease. The risk of chronic disease was higher in civil servants with high-job burnout scores and mental fatigue scores compared with civil servants with lower scores (OR = 1.139, 95% CI: 1.012–3.198; OR = 1.697, 95% CI: 1.097–2.962). These data provide evidence for the effects of job strain on job burnout, mental fatigue and chronic diseases among civil servants.

Evaluating prevalence and risk factors of building-related symptoms among office workers: Seasonal characteristics of symptoms and psychosocial and physical environmental factors

Background

Psychosocial and environmental factors at the workplace play a significant role in building-related symptoms (BRSs). Environmental factors change during summer cooling and winter heating using air-conditioning systems. Thus, significant risk factors in each season need to be clarified.

Methods

A nationwide cross-sectional study was conducted during summer in Japan and seasonal differences between summer and winter were evaluated. Self-administered questionnaires were distributed to 489 offices. Possible risk factors for BRSs associated with the work environment, indoor air quality, and job stressors were examined by multiple regression analyses.

Results

Among people having at least one BRS, the prevalence of BRSs in summer (27.8%) was slightly higher than that in winter (24.9%). High prevalence was observed for eye and nasal symptoms related to dryness and general symptoms related to psychological distress in both seasons. Analyses revealed that dryness of air was an important and significant risk factor associated with BRSs, and job stressors were significantly associated with general symptoms in both seasons. Conversely, humidity was a significant risk factor of general symptoms in summer (odds ratio, 1.20; 95% confidence interval, 1.02–1.43). Carpeting, recently painted walls, and unpleasant chemical odors in summer and noise, dust and dirt, and unpleasant odors such as body or food odors in both seasons were significant risk factors for BRSs.

Conclusions

Improvements in the physical environmental qualities in an office throughout the year are important along with the reduction in psychological distress related to work.

Electronic supplementary material

The online version of this article (doi:10.1186/s12199-017-0645-4) contains supplementary material, which is available to authorized users.

Social support and its interrelationships with demand-control model factors on presenteeism and absenteeism in Japanese civil servants

OBJECTIVES

To elucidate the impact of social support and its interrelations with other demand-control-support (DCS) model factors on presenteeism and absenteeism, and to determine which DCS factors were most influential.

METHODS

Questionnaires from 2535 local government employees were analyzed. The Brief Job Stress Questionnaire (BJSQ) was used to assess DCS factors including job demand, job control, and social support from supervisors and coworkers. The Stanford Presenteeism Scale 13-item version (SPS-13) was used to evaluate both absenteeism (absent days) and presenteeism. For the latter, the Work Impairment Score (WIS) and the Work Output Score (WOS) were also used. Possible confounder-adjusted logistic and negative binomial regression analyses were performed to obtain odds ratios (ORs) for WIS and WOS and relative risks (RRs) for absenteeism according to DCS factors.

RESULTS

Higher job control had a significantly protective effect on higher WIS in both males and females and a lower WOS in males. Based on a point estimate of an OR per 1 standard deviation change of each DCS factor, job control had the strongest effect on higher WIS in both males and females and a lower WOS in males. Higher job demand resulted in significantly higher ORs for both male and female WIS, and a lower WOS in females. Support from supervisors had a significantly protective effect on higher WIS in females and a lower WOS in males. Support from coworkers had a significantly protective effect on higher WIS in males. Higher support from coworkers had a significantly protective effect on absenteeism among both males and females, and higher job control had a significantly protective effect in females. The combination of high job strain and low support from supervisors had a significantly worsening effect, except for absenteeism in females. High job strain and low support from coworkers had a significantly worsening effect except for WOS in males.

CONCLUSIONS

The results suggest job control was the DCS factor most related to presenteeism. Higher support from supervisors and coworkers had a protective effect on presenteeism, and higher job demand had a worsening effect. Higher support from coworkers had a protective effect on absenteeism among both males and females. Interventions should focus on improving job control as a possible countermeasure to presenteeism, and encouraging support from coworkers as a possible countermeasure to absenteeism.

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).

Comparing cognitive-behavioural psychotherapy and psychoeducation for non-specific symptoms associated with indoor air: a randomised control trial protocol

INTRODUCTION

Indoor air-related conditions share similarities with other conditions that are characterised by medically unexplained symptoms (MUS)-a combination of non-specific symptoms that cannot be fully explained by structural bodily pathology. In cases of indoor air-related conditions, these symptoms are not fully explained by either medical conditions or the immunological-toxicological effects of environmental factors. The condition may be disabling, including a non-adaptive health behaviour. In this multifaceted phenomenon, psychosocial factors influence the experienced symptoms. Currently, there is no evidence of clinical management of symptoms, which are associated with the indoor environment and cannot be resolved by removing the triggering environmental factors. The aim of this study is to compare the effect of treatment-as-usual (TAU) and two psychosocial interventions on the quality of life, and the work ability of employees with non-specific indoor air-related symptomatology.

METHODS AND ANALYSES

The aim of this ongoing randomised controlled trial is to recruit 60 participants, in collaboration with 5 occupational health service units. The main inclusion criterion is the presence of indoor air-related recurrent symptoms in ≥2 organ systems, which have no pathophysiological explanation. After baseline clinical investigations, participants are randomised into interventions, which all include TAU: cognitive-behavioural psychotherapy, psychoeducation and TAU (control condition). Health-related quality of life, measured using the 15D-scale, is the primary outcome. Secondary outcomes include somatic and psychiatric symptoms, occupational factors, and related underlying mechanisms (ie, cognitive functioning). Questionnaires are completed at baseline, at 3, 6 and 12-month follow-ups. Data collection will continue until 2017. The study will provide new information on the individual factors related to indoor air-associated symptoms, and on ways in which to support work ability.

ETHICS AND DISSEMINATION

The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, has granted approval for the study. The results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT02069002; Pre-results.

Self-reported health and comfort in 'modern' office buildings: first results from the European OFFICAIR study

In the European research project OFFICAIR, a procedure was developed to determine associations between characteristics of European offices and health and comfort of office workers, through a checklist and a self-administered questionnaire including environmental, physiological, psychological, and social aspects. This procedure was applied in 167 office buildings in eight European countries (Portugal, Spain, Italy, Greece, France, Hungary, the Netherlands, and Finland) during the winter of 2011-2012. About 26 735 survey invitation e-mails were sent, and 7441 office workers were included in the survey. Among respondents who rated an overall comfort less than 4 (23%), 'noise (other than from building systems)', air 'too dry', and temperature 'too variable' were the main complaints selected. An increase of perceived control over indoor climate was positively associated with the perceived indoor environment quality. Almost one-third of office workers suffered from dry eyes and headache in the last 4 weeks. Physical building characteristics were associated with occupants' overall satisfaction (acoustical solutions, mold growth, complaints procedure, cleaning activities) and health (number of occupants, lack of operable windows, presence of carpet and cleaning activities). OFFICAIR project provides a useful database to identify stressors related to indoor environmental quality and office worker's health.

Prevalence and risk factors associated with nonspecific building-related symptoms in office employees in Japan: relationships between work environment, Indoor Air Quality, and occupational stress

A nationwide cross-sectional study of 3335 employees was conducted in 320 offices in Japan to estimate the prevalence of building-related symptoms (BRSs) and determine the risk factors related to work environment, Indoor Air Quality, and occupational stress. Data were collected through self-administered questionnaires. The prevalences of general symptoms, eye irritation, and upper respiratory symptoms were 14.4%, 12.1%, and 8.9%, respectively. Multiple logistic regression analyses revealed that eye irritation was significantly associated with carpeting [odds ratio (OR), 1.73; 95% confidence interval (CI), 1.24-2.41], coldness perception (OR, 1.28; 95% CI, 1.13-1.45), and air dryness perception (OR, 1.61; 95% CI, 1.42-1.82). General symptoms were significantly associated with unpleasant odors (OR, 1.37; 95% CI, 1.13-1.65), amount of work (OR, 1.24; 95% CI, 1.06-1.45), and interpersonal conflicts (OR, 1.44; 95% CI, 1.23-1.69). Upper respiratory symptoms were significantly associated with crowded workspaces (OR, 1.36; 95% CI, 1.13-1.63), air dryness perception (OR, 2.07; 95% CI, 1.79-2.38), and reported dustiness on the floor (OR, 1.39; 95% CI, 1.16-1.67). Although psychosocial support is important to reduce and control BRSs, maintaining appropriate air-conditioning and a clean and uncrowded workspace is of equal importance.

Decreased work ability associated to indoor air problems--An intervention (RCT) to promote health behavior

INTRODUCTION

Indoor air problems may induce respiratory irritation and inflammation. In occupational settings, long-lasting non-specific building-related symptomatology, not fully medically explained, is encountered. The symptomatology may lead to illness, avoidance behavior and decreased work ability. In Finland, investigations of workers suspected of occupational asthma have revealed excess disability. There are no well-established clinical practices for the condition.

OBJECTIVE

The aim was to develop a clinical intervention for patients with non-specific indoor air-related symptoms and decreased work ability.

METHODS

A randomized controlled trial including psychoeducation and promotion of health behavior was carried out in 55 patients investigated for causal relationship between work-related respiratory symptoms and moisture damaged workplaces. Inclusion criteria for disability was the work ability score (WAS)≤7 (scale 0-10) and indoor air-related sick leave ≥14 days the preceding year. After medical evaluation and the 3-session counseling intervention, follow-up at 6-months was assessed using self-evaluated work-ability, sick leave days, quality of life, and illness worries as outcome measures.

RESULTS

The mean symptom history was 55.5 months. 82% (45 out of 55) had asthma with normal lung function tests in most cases, although reporting abundant asthma symptoms. 81% of patients (39/48) had symptomatology from multiple organ systems without biomedical explanation, despite environmental improvements at work place. At the psychological counseling sessions, 15 (60%) patients of the intervention (INT, n=25) group showed concerns of a serious disease and in 5 (20%), concerns and fears had led to avoidance and restricted personal life. In the 6-month follow-up, the outcomes in the INT group did not differ from the treatment as usual group.

CONCLUSION

No intervention effects were found. Patients shared features with medically unexplained symptoms and sick building syndrome or idiopathic environmental intolerance. Long environment-attributed non-specific symptom history and disability may require more intensive interventions. There is a need for improved recognition and early measures to prevent indoor-associated disability.

TRIAL REGISTRATION NUMBER

Single-center randomized controlled trial (ISRCTN33165676).

Social determinants of the sick building syndrome: exploring the interrelated effects of social position and psychosocial situation

This paper examines the importance of various social factors for the prevalence of "sick building syndrome" (SBS) in residential buildings. A survey has been conducted in Malmö, Sweden, resulting in 1131 randomly selected residents participating in the study (response rate 57 %). Two clusters of social factors were examined: the socio-structural position of the individual and psychosocial aspects of the housing situation. The results show that country of birth, in particular, and also education and employment status are important predictors of "domestic SBS". "Housing satisfaction" turns out to be an important psychosocial predictor of SBS, explaining, for example, why immigrants report more symptoms than natives.

Noise effect on comfort in open-space offices: development of an assessment questionnaire

It is currently accepted that noise is one of the most important annoyance factors in open-space offices. However, noise levels measured in open spaces of the tertiary sector rarely exceed 65 dB(A). It, therefore, appears necessary to develop a tool that can be used to assess the noise environment of these offices and identify the parameters to be taken into consideration when assessing the noise annoyance. This article presents a questionnaire to be filled by people working in such environment, and a case study in different open plan offices. The majority of the 237 respondents consider that the ambient noise level in their environment is high and that intelligible conversations between their colleagues represent the main source of noise annoyance. This annoyance was significantly correlated with their evaluation of sound intensity, which could not be represented by A-weighted level measurements.

A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All

Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine's 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one's life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person's life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future.

Overlap in prevalence between various types of environmental intolerance

Environmental intolerance (EI) is characterized by attribution of several, multisystem symptoms to specific environmental exposures, such as exposure to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs) and everyday sounds. The symptoms are medically unexplained, non-specific and the symptoms overlap between different types of EI. To approach the issue of underlying mechanisms the matter of overlap in prevalence between intolerances can provide valuable information. The aim of the study was to examine if the overlap between intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds is larger than the expected overlap if no association would exist between them. The study was using cross-sectional data from the Västerbotten Environmental Health Study in Sweden; a large questionnaire-based survey. 8520 adults (18-79 years) were randomly selected after stratification for age and sex, of whom 3406 (40%) participated. Individuals with the four types of intolerance were identified either through self-report, or by having been physician-diagnosed with a specific EI. The overlaps between the four EIs were greater than predictions based on coincidence for both self-reported and diagnosed cases (except for the overlap between diagnosed intolerance to sounds and EMFs). The results raise the question whether different types of EI share similar underlying mechanisms, or at least that the sufferers of EI share some predisposition to acquire the conditions.

The effect of job strain on psychological morbidity and quality of life in military hospital nurses in Taiwan: a follow-up study

This study investigated changes in job strain in female nurses serving in a military hospital system being restructured and the effect of these changes on psychological morbidity and quality of life (QOL). Questionnaire surveys were sent twice to 618 nurses working in three military hospitals in southern Taiwan at the beginning and at follow up a half year later. A Job Content Questionnaire was used to divide subjects into high and low strain groups. The General Health Questionnaire and the WHO QOL Questionnaire were used to assess psychological morbidity and QOL. Four hundred eighteen nurses completed the study. Initially, the high strain group had a greater prevalence of psychological morbidity and lower QOL than the low strain group. At follow up, high strain group did not have a greater prevalence of psychological morbidity, though significant differences in QOL remained. Job control and social support directly affected the QOL (B=0.42, p<0.001; B=0.41, p=0.038, respectively) and the psychological demand affected directly on psychological morbidity (B=0.12, p<0.001). Job control and psychological demand are different aspects in job strain to impact the psychological morbidity and QOL in nurses working in military hospitals in Taiwan.

Toluene Exposure Leads to a Change in Expression Patterns of β Defensins in the Mouse Tracheal Epithelium

Defensins are generally implicated in the quick resistance of epithelial surfaces to microbials; however, recent reports have indicated that defensins also have unknown purposes in relation to noninfectious diseases. In this study, the localization patterns of anti-microbial peptides, β defensins (BDs), in the tracheal epithelium of male C3H mice under exposure to toluene were analyzed by immunohistochemistry. Mice were exposed one to ten times to toluene for 30 min by nose-only inhalation. Expression of BDs was revealed by immunohistochemistry in serial sections of trachea after the final exposure. Expression of BD-1 was usually observed at almost the same levels in all exposure groups, and expression of BD-2 was observed in the control group; however, the signals for BD-2 decreased gradually with frequency of exposure. In the group exposed ten times, expression of BD-2 decreased to far lower than that of the control group. No expression of BD-3 was detected in any groups. Interestingly, expression of BD-4 increased to the maximum in the group exposed four times and decreased to a level lower than that of the control in the group exposed ten times. The results of the present study indicated that toluene gas might change the expression pattern of BDs in the tracheal epithelial cells. The oscillation of expression of BD-4 was quite characteristic and might contribute to morphological damage in on the epithelial cells.

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.

Human reference values for acute airway effects of five common ozone-initiated terpene reaction products in indoor air

Ozone-initiated monoterpene reaction products have been hypothesized to cause eye and airway complaints in office environments and some have been proposed to cause skin irritation and sensitization. The respiratory effects of 60 min exposures to five common oxidation products from abundant terpenoids (e.g. limonene), used as solvent and fragrance in common household products or present in skin lipids (e.g. squalene), were studied in a head out mouse bioassay. This allowed determination of acute upper airway (sensory) irritation, airflow limitation in the conducting airways, and pulmonary irritation in the alveolar region. Derived human reference values (RFs) for sensory irritation were 1.3, 0.16 and 0.3 ppm, respectively, for 4-acetyl-1-methylcyclohexene ( 0.2 ppm) [corrected], 3-isopropenyl-6-oxo-heptanal (IPOH), and 6-methyl-5-heptene-2-one (6-MHO). Derived RFs for airflow limitation were 0.8, 0.45, 0.03, and 0.5 ppm, respectively, for dihydrocarvone (DHC), 0.2 ppm [corrected], 4-oxo-pentanal (0.3 ppm) [corrected], and 6-MHO. Pulmonary irritation was unobserved as a critical effect. The RFs indicate that the oxidation products would not contribute substantially to sensory irritation in eyes and upper airways in office environments. Reported concentrations in offices of 6-MHO and 0.3 ppm [corrected]would not result in airflow limitation. However, based upon the RFs for IPOH and 0.3 ppm [corrected], precautionary actions should be considered that disfavor their formation in excess.

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.

Headache symptoms and indoor environmental parameters: Results from the EPA BASE study

Objective:

The objective of this investigation was to determine the prevalence of migraine and headache symptoms in a national sample of US office employees. Also, we explored the association of headache symptoms with indoor environmental parameters of the work place.

Background:

Sick building syndrome (SBS), which includes headache, is a common global phenomenon, but the underlying environmental cause is uncertain.

Materials and Methods:

We used data from the 1994–1998 US Environmental Protection Agency's (EPA) Building Assessment and Survey Evaluation, a cross-sectional study of workers employed in 100 public and private office buildings across 25 states. The study used a self-administered questionnaire to assess headache frequency and prevalence of self-reported physician-diagnosed (SRPD) migraine. Indoor environmental parameters (IEP) were collected per EPA protocol from each building over a 1-week period and included carbon dioxide, carbon monoxide, temperature, relative humidity, particulate matter, volatile organic compound, illuminance, and sound level. The standards of American Society of Heating, Refrigerating and Air Conditioning Engineers were used to categorize IEP as either within- or out-of-comfort range for human dwelling. These limits delineate whether a parameter value is safe for human dwelling. Out-of-comfort range IEPs are associated with SBS and other human diseases. SRPD migraine and headache frequency were the primary outcome measures of the study. Multivariate logistic regression analyses were employed for the purpose of assessing the association between the outcome variable and IEPs.

Results:

Of the 4326 participants, 66% were females and 60% were between 30 and 49 years. Headache frequency during the last 4 weeks was as follows: None in 31%, 1–3 days in 38%, 1–3 days per week in 18%, and every or almost every workday in 8%. Females had higher SRPD migraine prevalence compared to males (27% vs. 11%, P<0.001) and were more likely to report any headache in the last month compared to males (75% vs. 53%, P<0.001). Odds of SRPD migraine were higher (P<0.05) for those exposed to IEP out-of-comfort range, and odds of exposure to out-of-comfort range IEPs were higher in groups who reported higher headache frequencies.

Conclusions:

Migraine diagnosis and elevated headache frequency are associated with an uncomfortable indoor environment. Periodic assessments and adjustments of IEP may have a beneficial impact on employees who are vulnerable to SBS.