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.     

Development of New Volatile Organic Compound (VOC) Exposure Metrics and their Relationship to “Sick Building Syndrome” Symptoms

Abstract Occupants of office buildings are exposed to low concentrations of complex mixtures of volatile organic compounds (VOCs) that encompass a number of chemical classes and a broad range of irritancies. “Sick building syndrome” (SBS) is suspected to be related to these exposures. Using data from 22 office areas in 12 California buildings, seven VOC exposure metrics were developed and their ability to predict self-reported SBS irritant symptoms of office workers was tested. The VOC metrics were each evaluated in a multivariate logistic regression analysis model adjusted for other risk factors or confounders. Total VOCs and most of the other metrics were not statistically significant predictors of symptoms in crude or adjusted analyses. Two metrics were developed using principal components (PC) analysis on subsets of the 39 VOCs. The Irritancy/PC metric was the most statistically significant predictor of adjusted irritant symptoms. The irritant potencies of individual compounds, highly correlated nature of indoor VOC mixtures, and probable presence of potent, but unmeasured, VOCs were variously factored into this metric. These results, which for the first time show a link between low level VOC exposures from specific types of indoor sources to SBS symptoms, require confirmation using data sets from other buildings.     

Individual and Occupational Correlates of the Sick Building Syndrome

Results of a questionnaire survey of 939 workers from 5 air-conditioned offices where smoking was prohibited are reported. Levels of carbon monoxide, carbon dioxide, formaldehde, respirable particulates, and temperature, relative humidity, and illuminance were measured in these buildings, but these did not correlate with symptom reports. The number of sick building syndrome symptoms per worker was related linearly to perceived indoor air quality, job stress, job satisfaction, allergies, eyewear, and seasonal affective disorder. Two hundred and fifty five of these workers also completed a battery of psychological measures. Measures of depression, personality variables, situational stress, vulnerability to stress, and individual differences in circadian rhythms did not correlate with the numbers of sick building syndrome symptoms per worker, although depression did correlate with the number of symptoms when these were weighted for their frequency of occurrence in the previous month. Job stress and perceptions of indoor air quality correlated with both the unweighted and weighted indices of sick building syndrome.     

The Office Environment Model: A Conceptual Analysis of the Sick Building Syndrome*

Abstract This paper examines the phenomenon sick building syndrome and related concepts, and proposes a theoretical model, the Office Environment Model, to explain the relationship between office environment and health. The sick building syndrome should be thought of as a figurative concept of everyday language, rather than as a single disease entity. This is because the phenomenon consists of several types of relations between different environmental determinants and health. Based on Popper's framework of three worlds, the model divides the office environment ontologically into physical and social, and the health outcomes into physiological and psychological. The outcome is further categorized into two dimensions: anatomic site (eyes, respiratory tract, skin, and central nervous system), and hypothesized underlying mechanism (mechanical irritation and inflammation, immunological reaction, toxicity, infection, and environmental psychological stress). The model stipulates the following types of causal relations. The physical environment causes physical and psychological effects via physiological and/or psychological processes. The social environment causes physical and psychological effects via psychological processes. The physical and social environment may have synergistic effects, and constitutional factors such as gender and atopy are additional determinants of the outcomes, as well as possible modifiers of the relations between environment and health. To understand the health effects of the office environment, it is necessary to focus separately on different determinant-outcome relations, bearing in mind that the different determinants affect human health concurrently and sometimes the effects may be synergistic.     

Mechanical Ventilation in Office Buildings and the Sick Building Syndrome. An Experimental and Epidemiological Study

The effects of mechanical ventilation on the sick building syndrome (SBS) were studied in an office building with 2150 employees, where the mechanical ventilation and indoor air quality were commonly blamed for causing symptoms typical of the SBS (nasal, eye, and mucous membrane symptoms, lethargy, skin symptoms and headache). The mechanical ventilation rates in the building were high (mean 26 l/s/person). To test the hypothesis that mechanical ventilation causes the SBS, a controlled experimental study was carried out by shutting off the ventilation in one part of the building and reducing the ventilation rate by 75% and 60% in two areas while leaving one part unaltered as a control. The experimental reduction of the ventilation rate did not alleviate the symptoms. On the contrary, the reduction of the ventilation rate caused a slight but statistically significant relative increase in symptoms (p < 0.05). In the cross-sectional analysis of the baseline data the SBS symptoms did not associate significantly with the ventilation rate (range 7–70 l/s/person). In the linear regression model, a positive correlation was found between temperatures above 22°C and the occurrence of symptoms (p < 0.05). Subjects exposed to environmental tobacco smoke had more symptoms than those not exposed (p < 0.01). Women reported more symptoms than men (p < 0.001). In addition, any prior history of allergic diseases (p < 0.001) and a negative attitude towards the social atmosphere at work (p < 0.001) were significant determinants of the SBS.     

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.     

Associations between indoor CO2 concentrations and sick building syndrome symptoms in U.S. office buildings: an analysis of the 1994-1996 BASE study data

Higher indoor concentrations of air pollutants due, in part, to lower ventilation rates are a potential cause of sick building syndrome (SBS) symptoms in office workers. The indoor carbon dioxide (CO2) concentration is an approximate surrogate for indoor concentrations of other occupant-generated pollutants and for ventilation rate per occupant. Using multivariate logistic regression (MLR) analyses, we evaluated the relationship between indoor CO2 concentrations and SBS symptoms in occupants from a probability sample of 41 U.S. office buildings. Two CO2 metrics were constructed: average workday indoor minus average outdoor CO2 (dCO2, range 6-418 ppm), and maximum indoor 1-h moving average CO2 minus outdoor CO2 concentrations (dCO2MAX). MLR analyses quantified dCO2/SBS symptom associations, adjusting for personal and environmental factors. A dose-response relationship (p < 0.05) with odds ratios per 100 ppm dCO2 ranging from 1.2 to 1.5 for sore throat, nose/sinus, tight chest, and wheezing was observed. The dCO2MAX/SBS regression results were similar.     

A subsurface “drift and pile” protection scheme for the construction of a shallow metro tunnel

In the construction of a shallow running-tunnel for Beijing metro line No. 13, due to restrictions by the surface environment of the area, a subsurface protection scheme was applied: two small cross-section drifts with shotcrete linings were constructed at above each side of the subway running tunnel, and reinforced concrete piles were installed into the ground from within the drifts. The piles were rigidly connected with the floor slabs of the drift linings, so that the drifts could effectively help extend the height of the protected zone of ground. With no disturbance to the normal living of the residents in the area, the major objective of the scheme was to separate the negative effects of tunneling on two nearby high-rise residential buildings, one at each side of the tunnel, respectively. Relating to the scheme, this paper presents the relevant site conditions, design concepts and analyses, constructions and monitoring highlights.     

Onset of mucosal, dermal, and general symptoms in relation to biomarkers and exposures in the dwelling: a cohort study from 1992 to 2002

We examined the associations between biomarkers of allergy and inflammation, indoor environment in dwellings, and incidence and remission of symptoms included in the sick building syndrome (SBS) and changes in the home environment of 452 adults who were followed from 1992 to 2002 within the Uppsala part of the European Community Respiratory Health Survey (ECRHS). The 10-year incidence (onset) of general, mucosal, and dermal symptoms was 8.5%, 12.7%, and 6.8%, respectively. Dampness or indoor molds at baseline was a predictor of incidence of general (relative risk [RR] = 1.98), mucosal (RR = 2.28), and dermal symptoms (RR = 1.91). Women had higher incidence of general (RR = 1.74) and mucosal symptoms (RR = 1.71). Indoor painting increased the incidence of general symptoms (RR = 1.62). Bronchial responsiveness (BR), eosinophil counts in blood, total IgE and eosinophilic cationic protein (ECP) in serum at baseline were predictors of incidence of SBS. At follow-up, BR, total IgE, and C-reactive protein (CRP ) were associated with increased incidence of SBS. Moreover, subjects with doctor-diagnosed asthma at baseline had a higher incidence of general (RR = 1.65) and mucosal symptoms (RR = 1.97). In conclusion, female gender, dampness or indoor molds, indoor painting, and biomarkers of allergy and inflammation were associated with a higher incidence of SBS symptoms, in particular mucosal symptoms. PRACTICAL IMPLICATIONS: The focus in Sweden on indoor environment issues over the last few decades has resulted in improvements in dwellings, and reduced tobacco smoking, which could be beneficial for public health. Reducing dampness and molds in the dwelling place is another important way of reducing occurrence of SBS symptoms in the general adult population. The association between the incidence of SBS symptoms and clinical biomarkers of allergy and inflammation suggests a common etiology between inflammatory diseases, including asthma, rhinitis, and SBS. Lastly, good agreement between self-reported and clinically diagnosed atopy indicates that questionnaire data on atopy can be used in epidemiological studies.     

Municipalities and the “new” internationalism: Cautionary notes from Canada

This study attempts to assess the impact of municipal internationalism for cities and towns involved in more comprehensive types of global interchange. Focusing on two Canadian-sponsored linkages — involving the cities of Lethbridge (Alberta) and Ica (Peru), and Toronto (Ontario) and São Paulo (Brazil), respectively — the study supports the findings of earlier research which reveals that intensive municipal exchange can pay real dividends to the participants involved. At the same time, however, closer examination of exchange dynamics in each case shows that the process can also produce certain unintended — and negative — consequences not previously identified in the literature. These, in turn, appear to affect not only the quality of specific projects, but the continued vitality of the exchange process itself — thus limiting the overall benefits of the phenomenon.     

Sick building syndrome and perceived indoor environment in relation to energy saving by reduced ventilation flow during heating season: a 1 year intervention study in dwellings

Ventilation in Scandinavian buildings is commonly performed by means of a constant flow ventilation fan. By using a regulated fan, it is possible to make a seasonal adjustment of outdoor ventilation flow. Energy saving can be achieved by reducing the mechanical ventilation flow during the heating season, when natural ventilation driven by temperature differences between outdoor and indoor is relatively high. This ventilation principle has been called 'seasonally adapted ventilation (SAV)'. The aim was to study if a 25-30% reduction of outdoor ventilation flow during heating season influenced sick building syndrome (SBS) and the perception of the indoor environment. This was done in a 1-year cross-over intervention study in 44 subjects in a multi-family building. During the first heating season (November to April), one part of the building (A) got a reduced flow during the heating season [0.4-0.5 air exchanges per hour (ACH)] while the other part (B) had constant flow (0.5-0.8 ACH). The next heating season, part A got constant flow, while part B got reduced ventilation flow. Reduced ventilation increased the relative air humidity by 1-3% in the living room (mean 30-37% RH), 1-5% in the bathroom (mean 48-58% RH) during heating season. The room temperature increased 0.1-0.3 degrees C (mean 20.7-21.6 degrees C), mean carbon dioxide (CO2) concentration in the bedroom increased from 920 to 980 p.p.m. at reduced flow. The indoor air quality was perceived as poorer at reduced outdoor airflow, both in the bedroom and in the apartment as a whole. There was a significant increase of stuffy odor (P = 0.05) at reduced outdoor airflow and the indoor air quality was perceived as poorer, both in the bedroom (P = 0.03) and in the apartment as a whole (P = 0.04). No significant influence on SBS symptoms or specific perceptions such as odors, draught, temperature, air dryness or stuffy air could be detected. In conclusion, reducing the ventilation flow in dwellings to a level below the current Swedish ventilation standard (0.5 ACH) may cause a perception of impaired air quality. Technical measurements could only demonstrate a minor increase of indoor temperature, relative air humidity, and bedroom CO2 concentration. This illustrates that it is important to combine technical measurements with a longitudinal evaluation of occupant reactions, when evaluating energy-saving measures. PRACTICAL IMPLICATIONS: It is important to combine technical measurements with a longitudinal evaluation of occupant reactions, when evaluating energy-saving measures. Reduction of outdoor airflow in dwellings below the current ventilation standard of 0.5 ACH may lead to a perception of impaired air quality, despite only a minor increase of bedroom CO2-concentration.     

Usages of the “cultural landscape” concept in Norwegian and Nordic landscape administration

This paper summarizes the results of an analysis of differing usages of the concept of “cultural landscape” and related concepts in Norwegian and Nordic government policy and applied research documents. The analysis indicates how inconsistent or unclear use of concepts can hinder interdisciplinary and intersectorial communication. The role of rhetoric, the changing usage of concepts over time and different value loadings for similar concepts are exemplified. Confusion arises partly because previously separate academic discourses, based on separate but overlapping sets of values, have come together in a common discourse promoted by the application of research to government policy. The principal participants in this discourse are agricultural interests, nature conservation interests, cultural heritage interests and local planning interests.     

The prevalence and incidence of sick building syndrome in Chinese pupils in relation to the school environment: a two-year follow-up study

There are few incidence studies on sick building syndrome (SBS). We studied two-year change of SBS in Chinese pupils in relation to parental asthma/allergy (heredity), own atopy, classroom temperature, relative humidity (RH), absolute humidity (AH), crowdedness, CO?, NO?, and SO?. A total of 1993 participated at baseline, and 1143 stayed in the same classrooms after two years. The prevalence of mucosal and general symptoms was 33% and 28% at baseline and increased during follow-up (P < 0.001). Twenty-seven percent reported at least one symptom improved when away from school. Heredity and own atopy were predictors of SBS at baseline and incidence of SBS. At baseline, SO? was associated with general symptoms (OR=1.10 per 100 μg/m3), mucosal symptoms (OR=1.12 per 100 μg/m3), and skin symptoms (OR=1.16 per 100 μg/m3). NO? was associated with mucosal symptoms (OR=1.13 per 10 μg/m3), and symptoms improved when away from school (OR=1.13 per 10 μg/m3). Temperature, RH, AH, and CO? were negatively associated with prevalence of SBS. Incidence or remission of SBS was not related to any exposure, except a negative association between SO? and new skin symptoms. In conclusion, heredity and atopy are related to incidence and prevalence of SBS, but the role of the measured exposures for SBS is more unclear. PRACTICAL IMPLICATIONS: We found high levels of CO? indicating inadequate ventilation and high levels of SO? and NO?, both indoors and outdoors. All schools had natural ventilation, only. Relying on window opening as a tool for ventilation in China is difficult because increased ventilation will decrease the level of CO? but increase the level of NO? and SO? indoors. Prevalence studies of sick building syndrome (SBS) might not be conclusive for causal relationships, and more longitudinal studies on SBS are needed both in China and other parts of the world. The concept of mechanical ventilation and air filtration should be introduced in the schools, and when planning new schools, locations close to heavily trafficked roads should be avoided.     

The conservation of historic areas in the UK: A case study of “Grainger Town”, Newcastle upon Tyne

Conservation in the UK is generally regarded as having undergone a sea-change in the late 1960s and early 1970s, as policy- and decision-makers retreated from comprehensive development and embraced conservation. Using part of the city centre of Newcastle upon Tyne as a case study, this article examines this thesis. Beneath simple measures, such as the amount of the city centre which is classified as historic, a more complex picture emerges. A framework for interventions in the historic environment is theorised and there is found to be a continuing tension between conservation approaches which seek to visually manage the city and those which place stress on historic fabric and morphology.     

Biosphere reserves and the “Yucatán” syndrome: another look at the role of NGOs

After centuries of cultural and economic conquest of the Americas by European and Euro-American conquistadors, contemporary rhetoric in ex-colonial powers heralds the decline of material and ideological imperialism. Instead, it is purported that today's world is peopled by a great brotherhood, with the more affluent striving to relieve their less fortunate, underdeveloped kith. This conviction is inherent in organizations which dispense money, information, training, and other resources in the name of community development and endangered species and environmental conservation. What is rarely perceived – and practically never said – is that these “benevolent” foreign aid activities typically result in the concentration of resources and power in the hands of a few, the building of empires, and the compounding of already difficult situations, counter-productive to stated objectives. The Yucatán Peninsula is a classic case of persistent imperialism: the geographic name is a corruption of the Mayan “matan cub a than” (“I do not understand you”), while contemporary development and conservation programs habitually exhibit cultural ignorance and dominance. This paper explores a diverse literature on non-governmental organizations, reflects on likely consequences of cultural dominance, and implores professional anthropologists to be adventurous in propagating anthropological knowledge relevant to environmental protection.     

Characterization of Linoleum. Part 1: Measurement of Volatile Organic Compounds by use of the Field and Laboratory Emission Cell, “FLEC”⋆

The volatile organic compounds (VOCs) emitted from 12 linoleum samples were measured by use of the “Field and Laboratory Emission Cell” (FLEC) with sampling on Tenax TA followed by thermal desorbtion and GC/FID or GC/MS analysis. Major VOCs were alkanals, alkenals and fatty acids. The emissions were measured after 24 h in FLEC and again after one month's storage in a well ventilated room. The emission profiles of hexanal, nonanal and propanoic acid were modeled for four linoleum samples using a new exponential diffusion model. The time required to reach 50% of the odor threshold concentrations in a standard room was from 113 to 2296 hours. The applicability of the diffusion model for modeling long-term emission needs to be further evaluated considering possible continuous oxidative emission.     

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.