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Visual analogue scales for detecting changes in symptoms of the sick building syndrome in an intervention study.

OBJECTIVES: This study tested questionnaires using visual analogue scales (VAS) in a cleaning intervention study and attempted to find a simple way of analyzing the replies to the questionnaires. METHODS: A VAS questionnaire made up of 26 questions was developed and marked once a week for 28 weeks by the room occupants in 3 buildings. A total of 1248 questionnaires was used in the analysis of the results. A simple model based on the differences between a person's average responses during 2 different periods was used in the analysis. RESULTS: No clear effect of the cleaning was found. Several significant correlations between different questions were established. Estimates for the design of future studies are given. CONCLUSIONS: The VAS questionnaire proved to be feasible for this type of study. It is suggested that each intervention period should last 4 weeks if the questionnaire is used once a week. However, the length of the period also depends on the expected latency of the symptoms, on how long it takes for environmental conditions to be affected by the intervention, and on how quickly conditions return to "normal" during control periods.

Adult↗

Associations among sick building syndrome, psychosocial factors, and personality traits.

A mailed questionnaire assessed personality traits of a cohort of 194 subjects followed from 1988 to 1998 measured by the Karolinska Scales of Personality and Sense of Coherence Scale, medical symptoms, and 3 VAS scales on Perceived Psychosocial Work Satisfaction. Subjects initially worked in 19 Swedish buildings with indoor environmental problems. There was a relatively high correlation between SOC scores and KSP scale scores (R2=.54 in men and .55 in women), and there was a sex-KSP interaction on the association between the two sets of scores. An increase of symptom score (SC difference) during the follow-up period was associated with higher psychic anxiety (p<.01 for both men and women), higher socialization (p<.01 for men) and lower inhibition of aggression (p<.05 for men), in stepwise multiple linear regression models. Moreover, the perceived satisfaction scores were associated with personality scale scores, and subjects with a higher sense of coherence reported higher work satisfaction (p<.01). In conclusion, personality aspects seem to play an important role for reporting medical symptoms, work satisfaction, work stress, and climate of cooperation at work, but different personality aspects could be important in men and women.

Aggression↗

A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings.

The human health risk for chronic illnesses involving multiple body systems following inhalation exposure to the indoor environments of water-damaged buildings (WDBs) has remained poorly characterized and the subject of intense controversy. The current study assessed the hypothesis that exposure to the indoor environments of WDBs with visible microbial colonization was associated with illness. The study used a cross-sectional design with assessments at five time points, and the interventions of cholestyramine (CSM) therapy, exposure avoidance following therapy, and reexposure to the buildings after illness resolution. The methodological approach included oral administration of questionnaires, medical examinations, laboratory analyses, pulmonary function testing, and measurements of visual function. Of the 21 study volunteers, 19 completed assessment at each of the five time points. Data at Time Point 1 indicated multiple symptoms involving at least four organ systems in all study participants, a restrictive respiratory condition in four participants, and abnormally low visual contrast sensitivity (VCS) in 18 participants. Serum leptin levels were abnormally high and alpha melanocyte stimulating hormone (MSH) levels were abnormally low. Assessments at Time Point 2, following 2 weeks of CSM therapy, indicated a highly significant improvement in health status. Improvement was maintained at Time Point 3, which followed exposure avoidance without therapy. Reexposure to the WDBs resulted in illness reacquisition in all participants within 1 to 7 days. Following another round of CSM therapy, assessments at Time Point 5 indicated a highly significant improvement in health status. The group-mean number of symptoms decreased from 14.9+/-0.8 S.E.M. at Time Point 1 to 1.2+/-0.3 S.E.M., and the VCS deficit of approximately 50% at Time Point 1 was fully resolved. Leptin and MSH levels showed statistically significant improvement. The results indicated that CSM was an effective therapeutic agent, that VCS was a sensitive and specific indicator of neurologic function, and that illness involved systemic and hypothalamic processes. Although the results supported the general hypothesis that illness was associated with exposure to the WDBs, this conclusion was tempered by several study limitations. Exposure to specific agents was not demonstrated, study participants were not randomly selected, and double-blinding procedures were not used. Additional human and animal studies are needed to confirm this conclusion, investigate the role of complex mixtures of bacteria, fungi, mycotoxins, endotoxins, and antigens in illness causation, and characterize modes of action. Such data will improve the assessment of human health risk from chronic exposure to WDBs.

Adult↗

The sick building syndrome and mass hysteria.

Significant overlaps of symptoms in SBS and MH exist including central nervous system manifestations, mucous membrane irritation, skin abnormalities, and eye symptomatology. Both occur with greater frequency in women with lower job rank and in patients with psychological and physical stresses. No specific cause has been identified in over 75% of the cases of SBS. Remotely, less than 25% have been alleged to be secondary to an environmental toxin but even removal of the inciting irritant does not improve the symptoms. Not surprisingly, litigation is lurking in the background with the chronic complainer. There has been no evidence of exposure to toxins or VOCs that exceed the NIOSH safety standards in any SBS cases. The importance of a thorough work up is to distinguish those cases that are secondary to bacteria or toxic contaminants and infection where significant morbidity and death have occurred in the building related illness. Although this is a separate entity it indicates that the building environment can be a significant cause of morbidity and mortality. Other variables such as temperature and humidity do influence the frequency of SBS symptomatology. It may be that we are not yet sophisticated enough to find the causes that are present within our current paradigms. Current levels of toxic data testing may not be sensitive enough to realize that they might be a cause of toxicity. It might be that at low levels with multiple toxins and VOCs present, the additive effects may cause toxic symptomatology whereas individually they do not. In summary, SBS is an emerging phenomena within our litigious society.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollution, Indoor↗

Self-leveling mortar as a possible cause of symptoms associated with "sick building syndrome".

In newly constructed houses and buildings in which self-leveling mortar containing casein has been used, residents and office employees have noted a bad odor and have complained of headache, eye and throat irritation, and tiredness. These problems were suspected to result from the degradation products emitted from the mortar. Samples obtained from dry mortar powder and from mortar in buildings where casein was used and from control buildings were found to contain microorganisms (mean of 10(2) culture forming units/g). Environmental species were predominantly found, e.g., Bacillus, Clostridium, Micrococcus, and Propionibacterium. Fungi were found occasionally; no evidence of bacterial degradation was found. Headspace and gas chromatographic-mass spectrometric analysis of air from the newly constructed houses and from hydroxide-degraded casein revealed the presence of amines in the 0.003-0.013 ppm range and the presence of ammonia and sulfhydryl compounds, all of which in low concentrations can cause the symptoms observed. These substances, however, were not detected in control buildings.

Air Microbiology↗

Sick building syndrome in a Canadian office complex.

A comprehensive questionnaire survey with limited environmental measurements was undertaken in a large sealed office complex where health complaints had been made by employees since the complex was first occupied. Most respondents suffered from upper respiratory tract irritation, eye and skin irritation, and many less specific complaints. Symptoms started shortly after first employment, were troublesome only at work, and persisted at other work locations within the complex. Employees who worked in cubicles tended to complain more than those who worked in open areas or closed offices; however, evidence of less than optimal ventilation, temperature, and humidity correlated poorly with symptom prevalence. The building was designed and ventilated for open-plan use; later partition into offices and cubicles appeared to aggravate the situation. Although concern about pregnancy outcome was expressed by women who conceived while employed at the complex, rates of spontaneous abortion and fetal defect were close to expectation.

Adolescent↗