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PubMed2002

Effect of formaldehyde on the expression of adhesion molecules in nasal microvascular endothelial cells: the role of formaldehyde in the pathogenesis of sick building syndrome.

BACKGROUND: Formaldehyde is associated with sick building syndrome (SBS), a set of diffuse and irritative symptoms predominantly involving the eyes and the respiratory tract. However, its pathophysiological mechanism in SBS has not yet been clarified. OBJECTIVE: In this study we investigated the effect of formaldehyde on the expression of adhesion molecules on human mucosal microvascular endothelial cells (HMMECs). Furthermore, we investigated the effect of formaldehyde on adhesiveness of HMMECs to eosinophils. MATERIALS AND METHODS: HMMECs were incubated with various concentrations of formaldehyde (1 ng/mL-1 microg/mL) for 24 h, and the expressions of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) on HMMECs were evaluated by flow cytometry. The change in the expression of ICAM-1 and VCAM-1 mRNA was then evaluated by reverse transcriptase polymerase chain reaction. To understand the role of formaldehyde in eosinophilic inflammation of the nasal mucosa, we examined the effects of formaldehyde on the adhesiveness between HMMECs and eosinophils by eosinophil adhesion assay. RESULTS: Formaldehyde increased the surface expressions of ICAM-1 and VCAM-1 on HMMECs. Formaldehyde also induced ICAM-1 and VCAM-1 mRNA. In addition, the adhesiveness between HMMECs and eosinophils was also increased by formaldehyde. CONCLUSION: These in vitro studies suggest that formaldehyde may play a role as the irritant of the nasal mucosa by increasing the expressions of adhesion molecules on HMMECs and by enhancing the adhesiveness between HMMECs and eosinophils.

Cell Adhesion↗

PubMedDate not supplied

Sick-building syndrome fatigue as a possible predation defense.

Sick-building syndrome is an illness characterized by fatigue, headache, and upper-respiratory complaints. It is usually associated with modern office buildings, structures with an impervious outer shell and inoperable windows. Poor air quality, specific pollutants, and inadequate ventilation are considered common causes. The ability to smell faint odors requires air that is free of contamination. Human evolutionary ancestors depended on odors for survival. Even the slightest increase in the ability to smell a predator conveyed a distinct, immediate survival advantage. Conversely, an enormous survival advantage would also accrue to the animal that sought protection or avoided activity when this vital olfactory information was unavailable. Such would be the case with fire on the savannah. The foraging, olfactory dependent animal, unable to smell predators because of contaminated air, would be quickly snatched by a keen-sighted carnivore. There exist, however, well-described reflexes from the nose mediated through the trigeminal nerve that discourage activity when these free nerve endings are irritated. This mechanism may serve as a defense against predation. In adulterated atmosphere the animal, subdued by these reflexes, would be less likely to venture forth and, therefore, less vulnerable to predators. Similar reflexes may persist in humans, activated by poor air quality, air ill-suited for the dissemination of odors. I suggest that the human perception of these inhibitory reflexes is the feeling of fatigue associated with the sick building syndrome.

Air Pollution, Indoor↗

PubMed2006

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

OBJECTIVES: Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS. METHODS: Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study--an ongoing health survey of office based civil servants. A self-report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42-62 years working in 44 buildings were included in this study. RESULTS: No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non-significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis. CONCLUSIONS: The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.

Adult↗

PubMed1997

Sick building syndrome--a wolf in sheep's clothing.

OBJECTIVE: Reading this article will acquaint the reader with possible outcomes associated with the diagnosis of "sick building syndrome." The definition, epidemiology, and precipitating events of this symptom complex are distinguished from other defined building-related illnesses. DATA SOURCE: The author's experience with many patients presenting with this diagnostic label and selected studies on indoor pollution and "sick building syndrome" are carefully reviewed. STUDY SELECTION: Pertinent scientific investigations on "sick building syndrome" and previously published reviews on this and related subjects that met the educational objectives were critically reviewed. RESULTS: "Sick building syndrome" is a pseudodiagnosis composed of nonspecific, transient symptoms without proven biologic markers. Its application in the clinical setting invites frequent subsequent linkage to other similar vague diagnoses associated with chronic debility and lack of therapeutic intervention. CONCLUSION: The reader is encouraged to avoid the use of this term in favor of a simpler, descriptive diagnosis (e.g., transient office-related annoyance and/or irritation) or if this seems inadequate, adoption of the diagnostic label of "idiopathic building intolerance."

Humans↗

PubMed1993

[A stink bomb in an office environment. Sick building syndrome with toxic rhinitis after exposure to fusel].

In 1983 WHO, defined "The Sick Building Syndrome". Various conditions influence the indoor climate, among others the degassing of chemicals. An epidemic of sick building syndrome is described in a two year old office building. The symptoms appeared after exposure to toxic chemicals released by a stink bomb--a form of exposure not previously described in the literature. Gas chromatographic analysis of the content of the stink bomb revealed 22 different chemicals likely to be remains from an alcoholic fermentation process. Twenty-four employees were exposed. A questionnaire investigation of the employees revealed that seven had symptoms related to the exposure. A clinical investigation of those who claimed to have symptoms took place. Six of the seven patients were investigated. They all had toxic rhinitis with bleeding. Owing to an unsystematic procedure it took more than two months before the indoor climate was normalized. The toxic rhinitis and other symptoms gradually decreased over more than four months. In order to minimize potential health damage due to the sick building syndrome, we recommend that experts should be consulted within this particular field.

Adult↗

PubMedDate not supplied

Methodologic aspects of the study of modern-age diseases: the example of sick-building syndrome.

In recent decades, variously identified nebulous disorders such as sick-building syndrome, electrical hypersensitivity, and chronic fatigue syndrome, characterized by combinations of nonspecific symptoms and absence of demonstrable signs have appeared. Their similar nonspecific etiologic attributions have given rise to generic names such as "modern-age disease" and "symptom-based conditions." The lack of demonstrable biological correlates as well as the vagueness of the etiologic attributions makes modern-age diseases unusually problematic to study with epidemiologic methods, potentially leading to serious biases. Case studies of sick-building syndrome demonstrate that qualitative methods can help to elucidate the dynamic processes involved in syndrome development.

Epidemiologic Methods↗

PubMed1998

Epidemiology of sick building syndrome and its associated risk factors in Singapore.

OBJECTIVES: To investigate the occurrence of sick building syndrome in a tropical city, and its relation to indoor air quality and other factors. METHODS: 2856 office workers in 56 randomly selected public and private sector buildings were surveyed. The study consisted of a self administered questionnaire assessing symptoms and perception of the physical and psychosocial environment, inspection of the building plans and premises, and measurement of temperature, relative humidity, respirable particles, chemicals, bioaerosols, and other variables. RESULTS: Symptoms typical of the sick building syndrome were reported in 19.6% of the respondents. Multivariate modelling substantiated contributions associated with low thermal comfort, high work related stress, too much noise, a history of allergy or other medical conditions, poor lighting, young employees, and female sex. Measurements of indoor air quality or ventilation were not found to be reliable predictors of the symptoms. CONCLUSION: The survey confirmed the presence of sick building syndrome and its risk factors in the tropics. A biopsychosocial approach to the problem involving symptomatic treatment, environmental control, good ergonomic design, and stress management is recommended.

Adolescent↗

PubMed1992

Sick building syndrome. Medical evaluation of two work forces.

Sick building syndrome, characterized by upper respiratory irritative and central nervous system symptoms, is poorly understood. Building ventilation problems are frequent, although causative agent(s) are unknown. Few studies have addressed clinical characterization of symptomatic building occupants. Employees from two sites underwent standardized evaluation including medical history, physical examination and screening neurologic and neuropsychologic testing while acutely symptomatic. Both symptomatic and asymptomatic individuals were evaluated when one of the sites was evacuated. Baseline evaluation results for this group were available for comparison. Symptoms of both work forces mirrored those reported in the literature. General medical examination abnormalities were few and minor, while neurologic and neuropsychologic examinations documented mental status, cerebellar, and neurobehavioral deficits. There were statistically significant changes from baseline. Abnormalities were self-limited. Controlled evaluations of symptomatic sick building occupants should be performed to verify these findings.

Adult↗

PubMed2000

The effects of outdoor air supply rate in an office on perceived air quality, sick building syndrome (SBS) symptoms and productivity.

Perceived air quality, Sick Building Syndrome (SBS) symptoms and productivity were studied in a normally furnished office space (108 m3) ventilated with an outdoor airflow of 3, 10 or 30 L/s per person, corresponding to an air change rate of 0.6, 2 or 6 h-1. The temperature of 22 degrees C, the relative humidity of 40% and all other environmental parameters remained unchanged. Five groups of six female subjects were each exposed to the three ventilation rates, one group and one ventilation rate at a time. Each exposure lasted 4.6 h and took place in the afternoon. Subjects were unaware of the intervention and remained thermally neutral by adjusting their clothing. They assessed perceived air quality and SBS symptoms at intervals, and performed simulated normal office work. Increasing ventilation decreased the percentage of subjects dissatisfied with the air quality (P < 0.002) and the intensity of odour (P < 0.02), and increased the perceived freshness of air (P < 0.05). It also decreased the sensation of dryness of mouth and throat (P < 0.0006), eased difficulty in thinking clearly (P < 0.001) and made subjects feel generally better (P < 0.0001). The performance of four simulated office tasks improved monotonically with increasing ventilation rates, and the effect reached formal significance in the case of text-typing (P < 0.03). For each two-fold increase in ventilation rate, performance improved on average by 1.7%. This study shows the benefits for health, comfort and productivity of ventilation at rates well above the minimum levels prescribed in existing standards and guidelines. It confirms the results of a previous study in the same office when the indoor air quality was improved by decreasing the pollution load while the ventilation remained unchanged.

Adolescent↗

PubMed1995

Influence of indoor air quality and personal factors on the sick building syndrome (SBS) in Swedish geriatric hospitals.

OBJECTIVES: Sick building syndrome (SBS) involves symptoms such as irritation to the eyes, skin, and upper airways, headache, and fatigue. The relations between such symptoms and both personal and environmental factors were studied in 225 female hospital workers, working in eight hospital units in the south of Sweden. METHODS: Symptoms of SBS and personal factors were measured by means of a standardised self administered questionnaire. The technical investigation comprised a building survey and measurements of room temperature, supply air temperature, air humidity, and exhaust air flow. RESULTS: The prevalence of symptoms differed from one unit to another. The mean value of weekly complaints of fatigue was 30%, of eye irritation 23%, and of dry facial skin 34%. Eye irritation was related to work stress, self reported exposure to static electricity, and was also more common in buildings with a high ventilation flow and a high noise level (55 dB(A)) from the ventilation system. Nasal symptoms were related to asthma and hay fever only. Throat symptoms were more common in smokers, subjects with asthma or hay fever, new buildings, and in buildings with a high ventilation flow. Facial skin irritation was related to a lack of control of the work conditions, and was more common in new buildings, and buildings with a high ventilation flow and ventilation noise. General symptoms, such as headache and fatigue, were related to current smoking, asthma or hay fever, work dissatisfaction, and static electricity. CONCLUSION: As the prevalence of symptoms was high, there is a need to improve the indoor environment as well as the psychosocial environment in hospitals. These improvements could include a reduction of ventilation noise, minimised smoking, and improvements in the psychosocial climate. Further research is needed to identify indoor climatic factors that cause the increased prevalence of symptoms of SBS in new buildings.

Air Pollution, Indoor↗

PubMed1997

Indoor air pollutants and sick building syndrome: a case study and implications for the community health nurse.

Indoor air pollutants and sick building syndrome are only recently gaining recognition as a public health concern. Unfortunately, however, most nurses feel ill equipped to address such environmental health issues. This article begins with a review of literature on indoor air pollutants and sick building syndrome, followed by a case study of occupant illness in a school since the onset of a school construction and renovation project. Included in the case study is an in-depth analysis of Material Safety Data Sheets (MSDSs) and Product Data Sheets, conducted to examine the potential health effects resulting from product use in the indoor environment. The results of the analysis indicate that a significant number of products used in the project may have induced the reported occupant symptoms. The conclusion of the case study is that building occupants were exposed to multiple products that have numerous acute overexposure health effects and unknown long-term effects, and thereby placed occupants at an ill-defined health risk. The review of literature and case study findings demonstrate the imminent need for community health nurses to assume a proactive role in promoting environmental health. nursing implications are provided to guide the community health nurse's role in cases of sick building syndrome.

Adolescent↗

PubMed2006

[Sick building syndrome due to exposure to pentachlorophenol in the office: a case report].

"Sick building syndrome" (SBS) is a group of symptoms experienced by people working in various buildings. This or another term "building-related illness" (BRI) is used to define illnesses related to modern buildings, mainly offices, in which people spend many working hours. SBS applies to a group of diseases with a fairly homogenous clinical picture and etiology (specific - infectious, allergic and non-specific--for example irritant symptoms). A case of a 51-year-old non-smoking female office worker is reported. After having her working premise renovated, she started to suffer from irritation of mucous membrane of the throat, sore throat and dysphonia. She claimed that these symptoms were associated with exposure to pentachlorophenol (PCP) emitted by the elements of ceiling impregnated with PCP-containing varnish. The concentration of PCP was below the hygiene standards adopted for the work environment. There were no grounds for recognizing occupational intoxication, but the case met the criteria for the sick building syndrome.

Air Pollutants, Occupational↗

PubMed1998

Correlation between the prevalence of certain fungi and sick building syndrome.

OBJECTIVE: To examine the role of fungi in the production of sick building syndrome. METHODS: A 22 month study in the United States of 48 schools (in which there had been concerns about health and indoor air quality (IAQ). Building indoor air and surface samples, as well as outdoor air samples were taken at all sites to look for the presence of fungi or their viable propagules. RESULTS: Five fungal genera were consistently found in the outdoor air and comprised over 95% of the outdoor fungi. These genera were Cladosporium (81.5%), Penicillium (5.2%), Chrysosporium (4.9%), Alternaria (2.8%), and Aspergillus (1.1%). At 20 schools, there were significantly more colony forming units per cubic metre (CFU/m3) (p < 0.0001) of propagules of Penicillium species in the air samples from complaint areas when compared with the outdoor air samples and the indoor air samples from noncomplaint areas. At five schools, there were more, although not significant (p = 0.10), Penicillium propagules in the air samples from complaint areas when compared with the outdoor air samples and the indoor air samples from noncomplaint areas. In 11 schools, the indoor air (complaint areas) fungal ratios were similar to that in the outdoor air. In these 11 schools Stachybotrys atra was isolated from swab samples of visible growth under wetted carpets, on wetted walls, or behind vinyl wall coverings. In the remaining 11 schools, the fungal ratios and CFU/m3 of air were not significantly different in different areas. Many of the schools took remedial action that resulted in an indoor air fungal profile that was similar to that outdoors. CONCLUSIONS: Propagules of Penicillium and Stachybotrys species may be associated with sick building syndrome.

Air Microbiology↗

PubMed2005

A case of sick building syndrome in a Japanese office worker.

The adverse health effects caused by indoor air pollution are termed "sick building syndrome". We report such a patient whose symptoms appeared in the workplace. A 36-year-old female office worker developed nausea and headache during working hours in a refurbished office. After eight months of seeking help at other clinics or hospitals without improvement, she was referred to our hospital. At that time she reacted to the smells of various chemicals outside of the office building. Biochemical findings were all within normal ranges. Specific IgE antibody to cedar pollen was positive and the ratio of TH1/TH2 was 4.5. In the Eye Tracking Test (ETT), vertical eye movement was saccadic. Her anxiety level was very high according to the State-Trait Anxiety Inventory (STAI) questionnaire. Subjective symptoms, ETT findings and anxiety levels on STAI gradually improved during two years of follow-up. One year after the onset of her illness, the formaldehyde concentrations in the building air ranged from 0.017-0.053 ppm. Even though relatively low, chemical exposure from building materials such as formaldehyde induced a range of symptoms. Also, lack of recognition by superiors and doctors that sick building syndrome might have been the source of her illness coupled with her high state of anxiety may have exacerbated her symptoms and led to the onset of multiple chemical sensitivity. Thus psychosocial factors may contribute to sick building syndrome in the workplace.

Adult↗

PubMed1999

A comparison of two studies reporting the prevalence of the sick building syndrome in New Zealand and England.

AIMS: To determine if New Zealand office personnel experienced a prevalence of sick building syndrome type symptoms similar to levels reported in the international literature. METHODS: A cross-sectional study of 360 office workers in Palmerston North was conducted using a questionnaire based on that used in a previous UK study to estimate the frequency of symptoms of the sick building syndrome. RESULTS: More than 80% of both populations experienced some building-related symptoms, with lethargy, stuffy noses, dry throat and headache regularly affect over 40% of both the Palmerston North and UK samples. New Zealand subjects experienced comparable or slightly higher levels of symptoms, except for itchy eyes, which were significantly more prevalent. A gender and employment bias was found in both studies. CONCLUSIONS: Sick building syndrome was found to be sufficiently prevalent in both surveys to warrant concern. There were sufficient similarities between the two populations to suggest that the conclusions from the UK survey are applicable to the New Zealand context.

Cross-Sectional Studies↗

PubMed1998

[The non-specific environmental syndromes MCS (Multiple Chemical Sensitivity), IEI (Idiopathic Environmental Intolerance) and SBS (Sick Building Syndrome)].

This review starts with a clinical description of the most common unspecific environmental diseases, such as Multiple Chemical Sensitivities (MCS), Idiopathic Environmental Intolerances (IEI) and Sick Building Syndrome (SBS). These syndromes are very controversial discussed between scientific medicine and "clinical ecology". In addition, they have fundamental similarities to Chronic Fatigue Syndrome (CFS) and Fibromyalgia. Finally the spectrum of therapeutic approaches is discussed.

Desensitization, Immunologic↗

PubMed1999

The sick-building-syndrome--do women suffer more?

According to recent literature reviews, women seem to be especially prone to report symptoms of the so-called Sick-Building-Syndrome. In a large German study into the Sick-Building-Syndrome (the ProKlimA-project) 4596 persons from 14 buildings around Germany filled out a questionnaire regarding Sick-Building-symptoms and potential psychosocial determinants. The present article presents questionnaire results from 2517 female employees (as compared to 2079 male employees) which showed that women report higher scores in sensory irritation, a higher bodily complaint rate and more negative evaluation of the indoor climate. In addition most psychosocial variables showed less favourable scores for women as compared to men. Gender stratified logistic regression analysis suggests an effect of less favourable working conditions under which women are employed. Thus although women are more prone to express impairments in wellbeing, such expression has to be critically evaluated against the background of their living and working conditions.

Female↗

PubMed1992

Sick building syndrome and related workplace disorders.

It has been estimated that as many as 1.2 million commercial buildings have characteristics of sick building syndrome. That is, persons who work in these buildings describe a cluster of symptoms--irritation of eyes, nose, throat, and skin, respiratory ailments, headaches, dizziness, confusion, and unusual odor or taste sensations--that occur during occupation of the building but diminish when these persons leave these buildings. There have been a number of factors that have been implicated in the development of sick building syndrome. These include type of building ventilation, light intensity, tobacco smoke, wall-to-wall carpeting, crowding, work satisfaction, gender, and presence of volatile organic compounds. Sick building syndrome has many signs and symptoms of other workplace disorders (e.g., neurotoxic disorders, mass psychogenic illness), each of which manifest in rather imprecise psychological and somatic symptoms. There are, however, specific characteristics that distinguish these disorders. It is likely that the development and persistence of the sick building syndrome is not caused solely by building characteristics or simply a result of psychological variables. Rather, a synergistic relationship exists between building, environmental, and individual factors.

Air Pollution, Indoor↗