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Why do women suffer from sick building syndrome more often than men?--subjective higher sensitivity versus objective causes.

Office workers often report so-called sick building syndrome (SBS) symptoms affecting the skin, mucous membranes and nervous system. The recurring higher prevalence of SBS in women was investigated using questionnaire and ergonomic data from the German ProKlimA-Project. The hypothesis that working conditions and job characteristics for women are inferior to those of men was tested for groups of risk factors. Finally, gender-specific multiple logistic regression models were compared. It was found that 44.3% of women (n = 888) and 26.2% of men (n = 576) suffer SBS with significant differences between men and women for many variables. Considering sub-groups--supposing the same circumstances in psycho-social and work-related conditions--gender-specific SBS prevalence rates differ as for the whole sample, e.g. 35.9% of women with the most favourable job characteristic suffer SBS (men: 19.4%), 53.0% of women with the most unfavourable job characteristic suffer SBS (men: 33.3%). These results show that women suffer more SBS than men independent of personal, most work-related and building factors. Multiple logistic models define self-reported acute illness, job satisfaction, software quality and job characteristics as significant gender-independent risk factors. Number of persons/room, self-reported allergy and smoking are characteristic female risk factors. Age is a significant risk factor only in men.

Adult↗

[Sick building syndrome].

If within a group of people in a building or inner rooms non-specific health symptoms that diminish or vanish when the person is leaving the room are diagnosed, we call it Sick-Building-Syndrome (SBS). Physical, chemical, biological and psychological factors are held responsible for causing SBS. Generally, the non-specific health syndromes are not regarded as disease-causers although employees definitely suffer from these syndromes. It is characteristic for SBS that neither chemical-toxicological measurings of harmful substances in the air of inner rooms nor measurings of said substances concerning the biological material show any results that prove a health damage. Especially people employed at video display unit have to face a considerable strain on their health which is individually and interindividually rated and borne. If SBS occurs in the field of work the problems that come with it have to be taken seriously. Physicians and technicians have to analyse the problem and eliminate the deficiencies connected herewith. Generally the well-being concerning the physical, intellectual and psychological area desired by employees can be restored--and the Sick-Building-Syndrome can be cured. This is a very long and difficult procedure. Chronic courses of the SBS do not occur very often. SBS cannot be accepted as an occupational disease.

Diagnosis, Differential↗

A toxicologic approach for evaluating cases of sick building syndrome or multiple chemical sensitivity.

The nonspecificity of symptoms and exposures commonly reported as "sick building syndrome" is very similar to that reported for the condition termed "multiple chemical sensitivity (MCS)." In many instances health care practitioners are divided on the reality of the latter. As in all scientific cases of possible cause-and-effect relationships, an organized, dispassionate approach should be used to evaluate each claim of MCS. Most obviously, known medical conditions must be ruled out before chemical "sensitivity" is proposed. Also, several questions on the toxicology of the chemical exposure must be addressed. Although temporality may be apparent (toxicity followed exposure), the time frame for the appearance of symptoms must be appropriate to the exposure conditions and chemical(s) involved. The chemical(s) must have known or reasonably inferred properties to cause the claimed effect. The dose(s) received must be adequate to effect a response (dose-response characteristics). Alternate causation must be evaluated thoroughly, that is, are there other more logical explanations for the symptoms? In contrast to single-chemical exposures, exposure to mixtures of chemicals, as commonly found in sick buildings, is very difficult to evaluate. However, a rational, scientific approach to cause-and-effect questions will help avoid erroneous and subjective decision making.

Air Pollution, Indoor↗

[Sick building syndrome in bank employees].

This study seeks, for the first time, to identify the sick building syndrome in Brazil. The study population consisted of 312 bank-clerks distributed in two closed buildings situated in S. Paulo city, Brazil. Data were collected by questionnaire, the design was cross-sectional and analysis made by logistic regression. Female, job satisfaction and inappropriate temperature were related to general symptoms. Female and inappropriate temperature were related to mucus membrane symptoms. Job satisfaction was related to absenteeism.

Air Pollution, Indoor↗

Influences on sick building syndrome symptoms in three buildings.

Relationships between symptoms typical of sick building syndrome, musculoskeletal symptoms, and reported indoor environmental exposures, psychological state, work stress and interpersonal relationships at work, were investigated among 624 office workers in three buildings. Symptom prevalences were similar in the three buildings, and were slightly lower in the two buildings characterized by its inhabitants as 'sick' than in the one building not considered to be 'sick'. Women were more likely than were men to complain of most symptoms in all three buildings. Multiple regression showed psychological symptoms and sex to be significant independent predictors of symptoms. Reported odours, and uncomfortable humidity and temperature were also independently associated with symptoms. The study indicates that sex and psychological symptoms are important predictors of perceived building related illness.

Adult↗

The sick building syndrome: prevalence studies.

Random samples or the entire workforce in nine offices in which similar clerical work was being performed were studied using a doctor administered questionnaire that inquired into symptoms that have been linked with the "sick building syndrome." Five of the offices were fully air conditioned, one had recirculation of air and mechanical ventilation, and three were naturally ventilated. Workers in three air conditioned and three naturally ventilated buildings were interviewed blind. Seven of the buildings were studied at our request in the absence of any known problem. Comparison of prevalences of symptoms between the naturally ventilated and the other buildings showed a repeated pattern of nasal, eye, and mucous membrane symptoms with lethargy, dry skin, and headaches. There were highly significant excesses of these six symptoms in the air conditioned buildings when compared by chi 2 tests with the naturally ventilated buildings. It is suggested that these six symptoms represent the sick building syndrome and that the size of the problem is probably greater than is currently recognised. Possible causes are discussed.

Air Conditioning↗

Influence of personal characteristics, job-related factors and psychosocial factors on the sick building syndrome. Danish Indoor Climate Study Group.

The influence of personal characteristics, life-style, job-related factors, and psychosocial work factors on symptoms of the sick building syndrome was investigated in Greater Copenhagen, Denmark. The buildings were not characterized beforehand as "sick" or "healthy." Of the 4369 employees sent a questionnaire, 3507 returned them. Multivariate logistic regression analyses of the multifactorial effects on the prevalence of work-related mucosal irritation and work-related general symptoms among the office workers showed that sex, job category, work functions (handling of carbonless paper, photocopying, work at video display terminals), psychosocial factors of work (dissatisfaction with superiors or colleagues and quantity of work inhibiting job satisfaction) were associated with work-related mucosal irritation and work-related general symptoms, but these factors could not account for the differences between the buildings as to the prevalence of the symptoms. The building factor (i.e., the indoor climate) was strongly associated with the prevalence of the symptoms.

Adult↗

Development of a multiple regression model to identify multi-family residential buildings with a high prevalence of sick building syndrome (SBS).

The aim was to develop a multiple logistic regression model to identify multi-family houses with an increase of sick building syndrome (SBS). In Stockholm, 609 multi-family buildings with 14,235 dwellings were selected by stratified random sampling. The response rate was 77%. Multiple logistic regression analysis was applied, adjusting for ownership of the building, building age and size, age, gender, and atopy. Females, subjects with allergy, those above 65 yr, and those in new buildings reported significantly more SBS. Subjects owning their own building reported less SBS, but the relationship between ownership and building age was strong. A regression model, including factors with a high explanatory value was developed. According to the model, 5% of all buildings built before 1961, 13% of those built 1976-1984, and 15% of those built 1985-1990 would have significantly more SBS than expected. In conclusion, SBS is related to personal factors, building age, and ownership of the building. To identify multi-family buildings with more SBS than expected, it is necessary to adjust for ownership and population characteristics.

Adolescent↗

An investigation into sick building syndrome among local authority employees.

Self-administered questionnaires were used to find out the prevalence among employees working in the three local authority premises in a Health District of self-reported illness which could be associated with sick building syndrome. Eye symptoms were found to be more common among employees working in a typing centre using VDUs. The symptoms tiredness, lethargy and influenza-like ('flu-like) illness, including aches in the limbs, were reported in significantly higher numbers by employees working in areas where there was evidence of increased pressure of work and worries over job losses. Dry throat and blocked or stuffy nose were symptoms reported in significantly higher proportions by employees working in certain buildings, where anecdotal evidence suggested that there could be problems with temperature regulation. This study also confirmed findings by other studies that for some symptoms women complain in significantly higher numbers than men. It was concluded that the type of work people do, in addition to the type of building they work in, play an important role in self-reported illnesses. Causation of sick building syndrome is complex and probably of multifactorial origin.

Administrative Personnel↗

Visual display terminal work and sick building syndrome--the role of psychosocial distress in the relationship.

The present study investigated the association between visual display terminal (VDT) work and sick building syndrome (SBS) and the role of psychosocial factors in the relationship. Subjects were 2,161 Japanese office workers who responded to a cross-sectional anonymous self-administered questionnaire survey. Questions included were derived from the Miljömedicin 040, a validated questionnaire on SBS symptoms. After exclusion of data with missing information, data for 1,881 subjects were used for analysis. Multivariate logistic regression was used to estimate the odds ratio for SBS with adjustment for potential confounding factors, including psychosocial work stress. In multivariate analysis, the odds ratio for SBS was significantly elevated for men engaged in VDT work for 4 or more hours a day (OR=2.5, 95%CI: 1.0, 5.9) compared with less than 1 hour a day, showing a significant trend association (P for trend=0.04). In women, although the odds ratio for SBS with VDT use of 4 or more hours a day was somewhat elevated with adjustment for non-psychosocial factors (OR=1.5, 95%CI: 0.5, 4.3), the increase was greatly attenuated after adjustment for psychosocial work distress (OR=1.1). In conclusion, our study suggests that extended hours of VDT use might be related to increased SBS symptoms. Moreover, psychosocial distress related to VDT work might mediate the relationship between VDT use and SBS symptoms in women.

Adult↗

The presence of fungi associated with sick building syndrome in North American zoological institutions.

A total of 110 sites from five zoological institutions were examined to determine whether fungi associated with sick building syndrome (SBS) were prevalent in the exhibits or night-time holding facilities and to investigate whether the presence of these organisms was associated with declining breeding rates or increases in morbidity and mortality (or both). Each site was sampled with an Andersen two-stage air sampler using Sabourauds dextrose agar media and a Burkard personal volumetric air sampler. Suspect surfaces were also sampled. High levels of airborne Penicillium chrysogenum, a fungal species associated with poor indoor air quality, were recovered from 16 sites out of all five institutions. Five culturable growth sites of Stachybotrys chartarum, a species strongly associated with SBS and commonly known as "black mold," were recovered from surfaces at two institutions. A wide range of other fungal species was recovered in low numbers from all institutions. A Fisher exact test analysis showed a significant nonrandom association between high levels of P. chrysogenum and sites with records of poor animal health. This study indicated that significant numbers of airborne fungi associated with SBS and poor indoor air quality are present in zoological institutions and that they could affect animal health and reproduction rates and zoo staff.

Air Microbiology↗

Indoor pollution and sick building syndrome symptoms among workers in day-care centers.

In this study, we investigated indoor air quality and symptoms of respiratory illness in 264 nursing workers at 28 day-care centers in Taipei. Geometric mean concentrations of indoor and outdoor bacteria were 735 colony-forming units in air (CFU/m3) and 384 CFU/m3, respectively. In addition, geometric mean concentrations of indoor and outdoor fungi were 1,212 CFU/m3 and 1,032 CFU/m3, respectively. Aspergillus, Cladosporium, and Penicillium-microfungi that occurred most commonly-were found indoors and outdoors. Geometric mean concentrations of house dust mite allergens, Der p I and Der p V, were 58 ng/g dust and 14 ng/g dust, respectively. In addition, the observed high prevalence of dampness or mold problems in the day-care centers indicated that dampness was very common in this subtropical region. We found a significant relationship between dampness and work-related sick building syndrome in the day-care-center workers. Furthermore, concentrations of fungi were lower in the day-care centers equipped with air conditioners/air cleaners than in centers that lacked such equipment. Also, Aspergillus was associated strongly with work-related sick building syndrome in the day-care-center workers.

Air Microbiology↗

Symptoms related to the sick building syndrome in a general population sample: associations with atopy, bronchial hyper-responsiveness and anxiety.

OBJECTIVE: The sick building syndrome (SBS) is a term mainly applied to irritative symptoms in the eyes, skin and upper airways that are experienced in certain environments. The aim of this study was to investigate the characteristics of subjects from the general population that report SBS-related symptoms. METHODS: The study comprised a randomly selected population of 418 individuals aged 20-45 years. The subjects underwent a structured interview, skin prick tests, a methacholine provocation test and answered two questionnaires respectively assessing psychiatric status and the presence of SBS symptoms. RESULTS: Eighty-seven subjects (21%) reported one or more SBS symptom weekly. Most common were general symptoms reported by 10% of the population. Female sex (odds ratio [OR] = 2.1), atopy (OR = 2.2) and anxiety (OR = 2.6) were significant independent risk factors for reporting at least one SBS-related symptom. Anxiety (OR = 3.2) and depression (OR = 4.4) were significant predictors for general symptoms, while bronchial hyper-responsiveness was a significant predictor for pharyngeal symptoms (dryness in the throat, sore throat and irritating cough) (OR = 5.4). CONCLUSIONS: Sick building symptoms are common in the general population and among women, while atopy and anxiety increase the risk of reporting such symptoms. Psychological factors are mainly related to general symptoms, while bronchial hyperresponsiveness is connected with pharyngeal symptoms.

Adult↗

Relationships between occupant personality and the sick building syndrome explored.

Increasing evidence shows that certain personality traits, such as negative affectivity (trait NA), are strongly associated with the reporting of symptoms. The role of personality in sick building syndrome (SBS) symptom reporting is therefore explored with the aid of a questionnaire completed by occupants living in apartments with indoor climate problems. A good fit to empirical data was obtained for a path model in which somatization intervenes between a general psychological factor (predominated by trait NA) and SBS. Occupants with "normal" and "aberrant" NA profiles were classified by cluster analysis and further divided according to frequency of symptoms. For occupants with 5 or more SBS symptoms, those with "aberrant" NA profiles have very similar SBS symptom profiles to those with "normal" NA profiles. This indicates that an occupant's trait NA score cannot be used for predicting his or her SBS symptom profile or frequency of SBS symptoms. An unexpected finding was that the occupants with "aberrant" NA profiles also perceived factors in the indoor (air) environment as less adverse than the 5 or more symptom reporting occupants with "normal" NA profile. Pennebaker and Brittingham's competition of external and internal cues model may explain the results for the occupants with "aberrant" NA profiles, however, our empirical data indicate that, unexpectedly, these occupants may not over-report SBS symptoms but rather under-report adverse environmental perceptions.

Adolescent↗

No consistent risk factor pattern for symptoms related to the sick building syndrome: a prospective population based study.

OBJECTIVES: To examine associations between perceived indoor environment at work and the non-specific symptoms that are often referred to as the sick building syndrome (SBS), using cross-sectional and prospective analyses for a large cohort from the general population. METHODS: The sample comprised 2,164 adults in employment, who completed a postal questionnaire in April 2001. Of these 1,402, who were still working and living in the same place, completed a second questionnaire a year later. The outcome measures were the prevalence of mucous membrane symptoms and general symptoms at baseline and the incidence and persistence of these symptoms at follow-up. Self-reports of the indoor environment from the baseline questionnaire were used as predictors in the analyses. RESULTS: Inconsistent results were found between the cross-sectional and the longitudinal analyses for the associations between perceived indoor environment factors at work and symptoms. Whereas mucous membrane symptoms in the cross-sectional analysis were significantly associated with self-reported high temperature and dry air, the prospective analyses showed that onset of mucous membrane symptoms was associated with the sensation of draught, dry air, and noise. Persistent mucous membrane symptoms were associated only with stuffy air. General symptoms were associated with self-reported stuffy air and dry air in the cross-sectional analysis, while draught was the only predictor of onset of general symptoms. We found no predictors in the indoor environment for the persistence of general symptoms. CONCLUSIONS: The symptoms that are often connected with SBS are very common symptoms in the general population among manual workers as well as non-manual workers. Our study gives only limited support to the hypothesis of causal relationships between the indoor environment and these symptoms. We found no evidence of persistent mucous membrane symptoms and general symptoms related to specific factors in the indoor environment.

Adolescent↗

[The sick building syndrome (SBS)].

AN INCREASINGLY COMMON ENVIRONMENTAL HEALTH PROBLEM: Complaints related to indoor environment represent one of the most frequent problems that environmental health practitioners are confronted with. Hence the incidence of the Sick Building Syndrome (SBS) has been increasing since the Seventies. DIFFERING DEFINITIONS AND CLINICAL PRESENTATIONS: The WHO defines SBS as an excess of complaints and symptoms occurring in certain occupants of non-industrial buildings. The syndrome can only be evoked after elimination in the person concerned of a disease related to the building, the aetiological agent of which is identifiable. The symptoms described during SBS (headaches, concentration problems, asthenia, irritation of the skin or nasal mucosa, of the eyes and upper respiratory tract.) are non specific and frequently observed in the general population. AN UNKNOWN CASE, BUT NUMEROUS AETIOLOGICAL FACTORS SUSPECTED: There is no unanimously accepted definition nor physio-pathological theory to explain the occurrence of SBS in a particular building. Many favouring factors, including the type and rate of ventilation, volatile organic compounds, particles and humidity have been suspected. TECHNICAL, SOCIAL, AND MEDICAL MANAGEMENT IS REQUIRED: Although the symptoms are benign, they can be uncomfortable or even handicapping and prevent the functioning of workplaces. The SBS, the social and economical costs of which are high, requires multidisciplinary management.

Humans↗

The sick building syndrome: a chicken and egg situation?

OBJECTIVES: To examine the temporal relationship and specificity between self-reports on the indoor environment at work and symptoms that are traditionally connected with the sick building syndrome (SBS). METHODS: This questionnaire study used a prospective full panel design as regards self-reports on exposure and outcome. At the baseline, the sample comprised 2,164 adults selected randomly from the general population. Of these 1,402, who were still working and living in the same place, completed a second questionnaire a year later. Health measures were symptoms that are traditionally connected with the SBS, as well as some "dummy" symptoms that hardly can be causally related to the indoor environment. The associations between self-reports on the indoor environment and these symptom groups were assessed both in cross-sectional and longitudinal analyses, the latter examining the normal direction that exposure leads to symptoms as well as the reverse order: that symptoms lead to perceived exposure. RESULTS: In cross-sectional analyses, the indoor environment factors were associated equally with SBS symptoms and with "dummy" symptoms. In longitudinal analyses, only few of the indoor environment factors predicted the development of any of the symptom groups. However, both the SBS symptoms and the "dummy" symptoms were risk factors for beginning to report exposures in the indoor environment. CONCLUSIONS: Symptoms predict future reports on exposures in the indoor environment indicating that it is difficult to determine what existed first: the outcome or the exposure. In addition, the perceived indoor environment is associated not only with the traditional SBS symptoms, but also with symptoms that cannot be physiologically linked to the indoor environment. These results suggest that there is a risk of reporting bias when assessing non-specific symptoms. Thus, many of the associations found in previous cross-sectional studies on SBS symptoms and indoor environment factors may possibly be explained by reporting bias.

Adolescent↗