Molds in floor dust and building-related symptoms in adolescent school children

This stratified cross-sectional epidemiological study included 1053 school children aged 13-17 years. All pupils filled in a questionnaire on building-related symptoms and other relevant health aspects. The following exposure measurements were carried out: room temperature, CO2 level, and relative humidity; building characteristics including mold infestation were assessed, and dust was collected from floors, air, and ventilation ducts during a working day. Dust was examined for endotoxin level, and cultivated for viable molds. We did not find a positive association between building-related symptoms and extent of moisture and mold growth in the school buildings. Five of eight building-related symptoms were significantly and positively associated with the concentration of colony forming units of molds in floor dust: eye irritation, throat irritation, headache, concentration problems, and dizziness. After adjusting for different potentially confounding factors in separate analyses of each symptom, the above-mentioned associations between molds in dust and symptoms were still present, except for concentration problems. However, in none of the analyses was mold exposure the strongest covariate, being secondary to either asthma, hay fever, recent airway infection, or psychosocial factors.     

Building-related symptoms and inflammatory potency of dust from office buildings

The aim was to investigate the association between building-related symptoms (BRS) in office buildings and the inflammatory potency of dust (PD). Furthermore, the association between dust potency and various building characteristics was investigated. Occupants of 22 office buildings received a retrospective questionnaire about BRS (2301 respondents). Dust was collected from groups of offices and building characteristics were recorded. The potency of a dust sample to induce interleukin-8 (IL-8) secretion from the lung epithelial cell line A549 was measured as the slope of the initial linear part of the concentration-response curve. Symptoms of the central nervous system (CNS) were associated with the potency of surface dust (OR = 1.4). This association may be due to an association between an index of CNS symptoms and dust potency in offices of 1-6 occupants (OR = 1.5). No single symptoms correlated with the potency of surface dust. The PD was not related to single building factors. The inflammatory PD may be used as an integrated proxy measure of biologically active compounds in dust, reflecting health relevant properties of the dust. PRACTICAL IMPLICATIONS: The potency of surface dust may be used as a crude measurement of the chemical and biological exposures present in the building, and being associated with the development of central nervous system symptoms. However, additional research is needed to establish the predictive value of the potency of surface dust.     

Air filter materials, outdoor ozone and building-related symptoms in the BASE study

Used ventilation air filters have been shown to reduce indoor environmental quality and worker performance and increase symptoms, with effects stronger after reaction of filters with ozone. We analyzed data from the US EPA Building Assessment Survey and Evaluation (BASE) study to determine if ozone and specific filter media have interactive effects on building-related symptoms (BRS). We analyzed a subset of 34 buildings from the BASE study of 100 US office buildings to determine the separate and joint associations of filter medium [polyester/synthetic (PS) or fiberglass (FG)] and outdoor ozone concentration (above/below the median, 67.6 microg/m(3)) with BRS. Using logistic regression models and general estimating equations, we estimated odds ratios (ORs) and 95% confidence intervals for the association of filter medium, ozone, and filter medium x ozone with BRS. Relative to FG + low ozone, PS alone or high ozone alone, were each significantly (P < 0.05) associated only with fatigue/difficulty concentrating (ORs = 1.93 and 1.54, respectively). However, joint exposure to both PS + high ozone, relative to FG + low ozone, had significant associations with lower and upper respiratory, cough, eye, fatigue, and headache BRS (ORs ranged from 2.26 to 5.90). Joint ORs for PS + high ozone for lower and upper respiratory and headache BRS were much greater than multiplicative, with interaction P-values <0.10. Attributable risk proportion (ARP) estimates indicate that removing both risk factors might, given certain assumptions, reduce BRS by 26-62%. These findings suggest possible adverse health consequences from chemical interactions between outdoor ozone and PS filters in buildings. Results need confirmation before recommending changes in building operation. However, if additional research confirms causal relationships, ARP estimates indicate that appropriate filter selection may substantially reduce BRS in buildings, especially in high-ozone areas. PRACTICAL IMPLICATIONS: The results indicate that a better understanding of how filters interact with their environment is needed. While the mechanism is unknown and these findings need to be replicated, they indicate that the joint risk of BRS from polyester/synthetic filters and outdoor ozone above 67.6 microg/m(3) is much greater than the risk from each alone. These findings suggest potential reductions in BRS from appropriate selection of ventilation filter media or implementing strategies to reduce ozone entrained in building ventilation systems. If the relationships were found to be causal, filter replacement and ozone abatement should be undertaken.     

Psychosocial Factors and the “Sick Building-Syndrome”. A case-referent study

Abstract The significance of the psychosocial work environment for the prevalence of symptoms compatible with the “sick building syndrome” (SBS) was studied in a case-referent study including 464 office workers, half of whom had symptoms of SBS. A questionnaire was distributed to all subjects, and representatives of the organisations concerned were interviewed. The aim of the study was to investigate the importance of psychosocial and organisational factors in explaining the prevalence of SBS symptoms among office workers. The results showed that psychosocial work characteristics, such as workload and job satisfaction, as well as worry and reorganisation are factors that have a significant impact on the risk of developing the symptoms of SBS.     

Personal and psychosocial factors and symptoms compatible with sick building syndrome in the Swedish workforce

A random sample of 1000 subjects (20-65 years of age) received a postal questionnaire regarding sick building syndrome (SBS), including the three-dimensional model of demand-control-support (DCS). The response rate was 70% (n = 695), and 532 were occupationally active. Female gender and atopy were the main predictors of symptoms. Eye symptoms were more common at low social support combined with strained work situation [odds ratio (OR) 2.37], and at high social support combined with active work situation (OR 3.00). Throat symptoms were more common at low social support combined with either passive (OR 1.86) or strained situation (OR 2.42). Tiredness was more common at low social support combined with either passive (OR 2.41), strained (OR 2.25), or active situation (OR 1.87), and at high social support combined with active work situation (OR 1.83). Low social support combined with either passive (P = 0.01) or strained job situation (P = 0.01) was associated with a higher symptom score (SC). The lowest SC was found at a relaxed work situation, irrespective of social support. In conclusion, female gender, low age, asthma, atopy and psychosocial work environment are associated with symptoms. The three-dimensional model can predict symptoms compatible with SBS, but in a more complex way than earlier research indicated. Practical Implications A multi-disciplinary approach, including psychosocial stress factors as well as personal factors such as gender, age, atopy and asthma, and indoor exposures, should be applied in studies on symptoms compatible with sick building syndrome (SBS). Males and females perceive psychosocial work conditions differently, and may react differently to job stressors. The psychosocial work environment can be as important as gender and atopy as a predictor of SBS symptoms.     

Teachers' work-related non-literature-known building-related symptoms are also connected to indoor toxicity: A cross-sectional study

A previous study showed that classical building-related symptoms (BRS) were related to indoor dust and microbial toxicity via boar sperm motility assay, a sensitive method for measuring mitochondrial toxicity. In this cross-sectional study, we analyzed whether teachers’ most common work-related non-literature-known BRS (nBRS) were also associated with dust or microbial toxicity. Teachers from 15 schools in Finland completed a questionnaire evaluating 20 nBRS including general, eye, respiratory, hearing, sleep, and mental symptoms. Boar sperm motility assay was used to measure the toxicity of extracts from wiped dust and microbial fallout samples collected from teachers’ classrooms. 231 teachers answered a questionnaire and their classroom toxicity data were recorded. A negative binomial mixed model showed that teachers’ work-related nBRS were 2.9-fold (95% CI: 1.2-7.3) higher in classrooms with highly toxic dust samples compared to classrooms with non-toxic dust samples (p = 0.024). The RR of work-related nBRS was 1.8 (95% CI: 1.1-2.9) for toxic microbial samples (p = 0.022). Teachers’ BRS appeared to be broader than reported in the literature, and the work-related nBRS were associated with toxic dusts and microbes in classrooms.     

急诊科护理人员工作压力调查分析

目的调查分析急诊科护理人员工作压力现状和相关因素。方法采取方便抽样法对22名急诊科护士进行护士工作压力源量表问卷调查,并对不同编制、学历、职称、班次[A班（08：00-15：00）、P班（15：00-22：00）、N班（22：00-08：00）]的急诊科护士的护士工作压力源量表评分进行比较。结果急诊科护士群体排在前两位的压力因素是病人护理方面的问题、工作量及时间分配的问题。不同编制、学历、职称、班次的急诊科护士的护士工作压力源量表评分比较差异有统计学意义（均P〈0.05）,提示急诊科聘用护士、大学本科及以上学历护士、低职称护士以及值P、N班护士的工作压力程度较重。结论护理管理者应根据护士的不同编制、学历、职称、班次有针对性地给予减压措施,减轻影响护士身心健康因素,以提高临床护理工作质量。     

Outdoor ozone and building-related symptoms in the BASE study

Reactions between ozone and indoor contaminants may influence human health and indoor air quality. The U.S. EPA Building Assessment Survey and Evaluation (BASE) study data were analyzed for associations between ambient ozone concentrations and building-related symptom (BRS) prevalence. Multiple logistic regression (MLR) models, adjusted for personal, workplace, and environmental variables, revealed positive relationships (P < 0.05) between ambient ozone concentrations and upper respiratory (UR), dry eyes, neurological and headache BRS (odds ratios ranged from 1.03 to 1.04 per 10 mug/m(3) increase in ambient ozone concentrations). Other BRS had marginally significant relationships with ambient ozone (P < 0.10). A linear dose-response in UR symptoms was observed with increasing ambient ozone (P = 0.03); most other symptoms showed similar but not statistically significant trends. Ambient ozone correlated with indoor concentrations of some aldehydes, a pattern suggesting the occurrence of indoor ozone chemistry. Coupled with the MLR ambient ozone-BRS analysis, this correlation is consistent with the hypothesis that ozone-initiated indoor reactions play an important role in indoor air quality and building occupant health. Replication with increased statistical power and with longitudinal data is needed. If the observed associations are confirmed as causal, ventilation system ozone removal technologies could reduce UR BRS prevalence when higher ambient ozone levels are present. PRACTICAL IMPLICATIONS: This paper provides strong statistical evidence that supports (but does not prove) the hypothesis that ozone entrained into buildings from the outdoor air is involved in increasing the frequency that occupants experience and a range of upper and lower respiratory, mucosal and neurological symptoms by as much as a factor of 2 when ambient ozone levels increase from those found in low-ozone regions to those typical of high-ozone regions. Although replication is needed, the implication is that reducing the amount of ozone entrained into building ventilation systems, either by ambient pollution reduction or engineered gas-phase filtration, may substantially reduce the prevalence of these symptoms experienced by occupants.     

Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building-relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists classified rooms for water stains, visible mold, mold odor, and moisture using semi-quantitative scales and then estimated individual exposure indices weighted by the time spent in specific rooms. The semi-quantitative exposure indices significantly predicted building-related respiratory symptoms, including wheeze [odds ratio (OR) = 2.3; 95% confidence interval (CI) = 1.1-4.5], chest tightness (OR = 2.2; 95% CI = 1.1-4.6), shortness of breath (OR = 2.7; 95% CI = 1.2-6.1), nasal (OR = 2.5; 95% CI = 1.3-4.7) and sinus (OR = 2.2; 95% CI = 1.2-4.1) symptoms, with exposure-response relationships. We found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms. Our findings suggest that observational semi-quantitative indices of exposure to dampness and mold can support action to prevent building-related respiratory diseases. PRACTICAL IMPLICATIONS: Current air sampling methods have major limitations in assessing exposure to mold and other biological agents that may prevent the demonstration of associations of bioaerosol exposure with health. Our study demonstrates that semi-quantitative dampness/mold exposure indices, based solely on visual and olfactory observation and weighted by time spent in specific rooms, can predict existence of excessive building-related respiratory symptoms and diseases. Relative extent of water stains, visible mold, mold odor, or moisture can be used to prioritize remediation to reduce potential risk of building-related respiratory diseases. From a public health perspective, these observational findings justify action to correct water leaks and repair water damage in order to prevent building-related respiratory diseases. This approach can also be a basis for developing practical building-diagnostic tools for water-incursion.     

Indoor climate, psychosocial work environment and symptoms in open-plan offices

To study the indoor climate, the psychosocial work environment and occupants' symptoms in offices a cross-sectional questionnaire survey was made in 11 naturally and 11 mechanically ventilated office buildings. Nine of the buildings had mainly cellular offices; five of the buildings had mainly open-plan offices, whereas eight buildings had a mixture of cellular, multi-person and open-plan offices. A total of 2301 occupants, corresponding to a response rate of 72%, completed a retrospective questionnaire. The questionnaire comprised questions concerning environmental perceptions, mucous membrane irritation, skin irritation, central nervous system (CNS) symptoms and psychosocial factors. Occupants in open-plan offices are more likely to perceive thermal discomfort, poor air quality and noise and they more frequently complain about CNS and mucous membrane symptoms than occupants in multi-person and cellular offices. The association between psychosocial factors and office size was weak. Open-plan offices may not be suited for all job types. PRACTICAL IMPLICATION: Open-plan offices may be a risk factor for adverse environmental perceptions and symptoms.     

A Prevalence Study Of The Sick Building Syndrome (SBS) And Facial Skin Symptoms In Office Workers

The prevalence of symptoms compatible with the Sick Building Syndrome (SBS) was measured in a questionnaire study among 4 943 office workers. An assessment of the relation between SBS symptoms and personal, physical and psychosocial exposure factors was made. In contrast to males, the majority of females were lower-grade staff Females reported annoyance from physical climate factors more often, both at work and at home. Males reported a better psychosocial situation than females. Female gender, asthmalrhinitis, paper and VDT work were related to an increased prevalence of SBS symptoms. The prevalence of facial skin symptoms increased markedly with the amount of VDT work. Psychosocial workload intensifid this relation. Inequalities in physical climate and psychosocial conditions associated with different positions held in the offices can be of importance for the increased occurrence of symptoms among females.     

Critical stressors influencing construction estimators in Hong Kong

The main task of contractors' estimators is to predict the likely costs involved in executing a future project. This is an onerous job as any errors made can undermine project success and ultimately reduce the contractors' profit margins. The inherent uncertainty of most construction work, however, together with the often very short time periods involved, make errors unavoidable. Unsurprisingly, therefore, estimation is considered to be a very stressful business. To identify the nature of the stress involved, a survey of construction estimators in Hong Kong was conducted. Using correlation analysis, regression analysis and structural equation modelling, the relationships amongst the causes (stressors or stress factors) and effects (stress) were examined and a causal structural model developed. The results indicate work overload, role conflict, job ambiguity, and working environment to be the most critical stressors, with work underload and distrust being the main indirectly influencing factors. These results are similar to those of a previous study with site managers, suggesting that job ambiguity and work overload are the common problem in the construction industry. The study of the manageability of stress is expected to inspire other similar research involving other professionals in the construction industry. This is expected to be of particular significance in the long‐term development of stress management in the industry in general.     

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.     

Occupational stress and job demand,control and support factors among construction project consultants

Occupational stress affects the health and wellbeing of people who work, and the construction industry is recognized as a high-stress working environment. The relationship between job demands, job control, workplace support, and experiences of stress in the South African construction context is investigated, using hierarchical regression, factor analysis and structural equation modeling to explore the strength of thirteen factor relationships with perceived stress. Data were gathered from an on-line questionnaire survey response sample of 676 architects, civil engineers, quantity surveyors, and project and construction managers. Predictors displaying a significant relationship with occupational stress are the presence of work–life imbalance, the need to ‘prove’ oneself, hours worked per week, working to tight deadlines, and support from line managers in difficult situations at work. Existing theories of occupational stress are confirmed but not completely supported. The construction industry should give attention to how the need to work long hours is justified. Organizations should look to improving managerial and collegial support for construction professionals, but be careful in engaging in socializing and project team-building activities. Further research will need to focus more deeply on construction-specific job demand factors; explore why women professionals appear to experience more stress than men; and aim to develop reliable early-warning detection techniques for construction professionals.     

Overheating and passive habitability: indoor health and heat indices

As extreme heat and weather events are predicted to increase due to global warming, the risk of human heat stress within buildings will increase. To be resilient, buildings will need the capacity to provide habitable indoor conditions without power for limited amounts of time. Additional indoor thermal standards are required for public health to address ‘passive habitability’ during power outages. Current research on building-related heat stress and numerous heat indices is examined in relation to the development of a new heat-safety metric for use in passively conditioned buildings. Most indoor overheating research relies on outdoor temperature data and has no common indoor heat index for evaluating indoor heat stress. A recommendation is made for using the wet-bulb globe temperature (WBGT) and predicted heat strain (PHS) indices for modelling and monitoring of indoor heat stress in healthy adult populations because both indices utilize the primary thermoregulation variables, have associated heat-stress thresholds, and can be assessed or tracked with existing environmental monitoring methods and predictive energy modelling techniques. Further research is recommended on health effects and exposure limits of vulnerable populations, and the variation in thermal factors within buildings and the building stock.     

Stress among South African construction professionals: a job demand-control-support survey

Research into workplace stress in the construction industry has been dominated by studies undertaken in Hong Kong, England and Australia, with relatively little attention having been paid to African countries. A purposively selected sample of thirty-six construction professionals (comprising architects, project managers, construction managers, engineers and quantity surveyors) based in Cape Town, South Africa, were surveyed regarding their perceptions about, and experiences of, workplace stress. The purpose was to identify and rank job demand, job control and job support factors and to analyse these by gender and professional grouping, both in terms of how respondents perceived them, as well as in terms of how frequently they had experienced them. The main finding was that respondents’ perceptions about the importance of job demand, job control and job support factors were largely consistent with their own experience of these factors. Distinguishing between perceptions and experience of stressors and moderators of stress was, however, considered valuable because the fact that differences were found indicates the need for precision in the design of scales. The highest ranked factors were, respectively, ‘critical time constraints’, ‘volume of work’ and ‘adequate compensation (salary)’. Women and men ranked items differently, as did the various professional groups. The main conclusions were that the construction project environment is a time-pressured, complex, environment in which work-life balance is negatively affected, particularly for women. Control over the type, flow and volume of work were perceived to be the main moderators of stress, whilst salary and career path opportunities were perceived to be the main job support moderators of stress. The applicability of using the job demand–control–support framework was confirmed given that the main stressors, control and support moderators were found to be to be largely consistent with the findings of previous studies. Future research taking a gendered approach should anticipate issues important to female respondents and should consider the benefits of qualitative methods. The design of research focusing on construction professionals should consider using the project team as the unit of analysis to ensure that the influence of the interconnectedness of participants’ roles is taken into account.     

Association of air-conditioning with respiratory symptoms in office workers in tropical climate

To evaluate the association of heating, ventilation and air-conditioning systems (HVAC) and respiratory symptoms in a tropical city, self-administered questionnaires were given to 2000 individuals working in air-conditioned office buildings and to 500 control workers in naturally ventilated buildings. Reported symptoms from the two populations were analyzed using chi-square tests, univariate and multiple logistic regressions models. Symptoms were the outcome variable and the odds ratios were adjusted by gender, age, accumulated work time, smoking habits and atopic background. There was a 79.8% response rate and there was a positive association of nasal symptoms (odds ratio, OR = 1.59, 95% confidence interval, CI = 1.11-2.28), naso-ocular symptoms (OR = 1.58, 95% CI = 1.05-2.38), persistent cough (OR = 3.04, 95% CI = 2.00-4.63) sinusitis symptoms (OR = 1.85, 95% CI = 1.27-2.71) and building-related worsening of the symptoms (OR = 4.92, 95% CI = 2.93-8.27) with working in air-conditioned buildings. In conclusion, our study suggests that artificial air-conditioning is a matter of concern for respiratory symptoms in cities with hot and humid climate. PRACTICAL IMPLICATIONS: This study suggests that indoor air-related respiratory symptoms are a matter of concern in places with hot and humid climate. The regression models were adjusted by confounders that could be used in further reanalysis of indoor air quality related symptoms and ventilation systems with expanded variety of climatic conditions.     

Sick Building Syndrome and Psychosocial Factors - a Literature Review

Abstract Sick building syndrome (SBS) with an unknown etiology has led researchers to focus on the role of psychosocial factors in the work environment as well as on individual characteristics in SBS. Recent research has suggested that psychosocial factors are quite strongly associated with SBS. The associations have been confirmed in buildings that were beforehand considered to be problem cases, and also in buildings whose condition was not known in advance. However, SBS symptoms could not be attributed to psychosocial factors alone. Most of the previous studies have supported the conclusion that SBS most likely is of multifactorial origin related to chemical, physical, biological and psychosocial factors that interact or coincide with one another. Unfortunately, for the time being, it is not possible to characterize adequately the relationship between the various risk factors and the possible mechanisms of SBS. There is an urgent need for more empirical research, especially follow-up studies and interventions, for development of the methodology and for new theory-building in order to better understand the relations between environmental factors, personal factors and the symptoms of SBS. In this literature review, SBS is viewed from an occupational stress perspective.     

Subjective Indoor Air Quality in Schools – The Influence of High Room Temperature,Carpeting, Fleecy Wall Materials and Volatile Organic Compounds (VOC)

There is a growing concern about indoor air quality (IAQ) in schools. We have studied relations between subjective indoor air quality (SIAQ) and measured IAQ among school personnel (N = 97) in six mid-Swedish primary schools. Information on SIAQ and the psychosocial work environment was measured by a self-administered questionnaire, using analogue rating scales. Indoor exposures were quantified by hygienic measurements. Perception of high room temperature was related to a poor climate of cooperation, fleecy wall materials, and the concentration of volatile organic compounds (VOC), including xylene, limonene, and butanols. Perception of air dry-ness was related to atopy, work stress, poor climate of cooperation, high room temperature, low air humidity, and high VOC concentration, including, limonene, and n-alkanes. Perception of dusty air was related to work stress, the role of schoolteacher, and exposure to 2-ethyl-1-hexanol. No relations were found between SIAQ and CO2, building age, or respirable dust. To achieve a good SIAQ, room temperature should be kept at a maximum of 22°C, and exposure to VOCs and fleecy materials should be minimized. Finally, a sound psychosocial work climate is essential for the perception of a good physical indoor climate.     

Prevalence of sick building syndrome symptoms and its associated factors among bank employees in Pokhara Metropolitan,Nepal

A cross-sectional study was conducted to assess the prevalence of sick building syndrome symptoms and its associated factors among bank employees. Data were collected through a self-administered MM040NA questionnaire among 234 employees of commercial banks in Pokhara Metropolitan, Nepal. The prevalence of general, ocular, respiratory, and dermal sick building syndrome symptoms was 47.6%, 11.9%, 11.9%, and 8.1%, respectively. The perceived indoor physical environment was a significant predictor of sick building syndrome symptoms. Besides this, age, disturbance from temperature and work pressure were significantly associated with general symptoms. Ocular symptoms were significantly associated with disturbance from noise at their workplaces and support from fellow workers. Respiratory symptoms were significantly associated with the time spent working with a photocopy machine. Proper maintenance of room temperature, noise control, good ventilation system, and promotion of supportive psychosocial working environment at banks is important to prevent and control the suffering of employees from SBS symptoms.