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Dentists’ work environment from an ergonomic perspective
Contact: Leni Skoglund
The purpose of the study was to try to reduce problematic work positions by testing the use of stools to increase the flexibility of working positions. Working positions were judged using an inclinometer. The results showed that the back is held more vertical when the stool is used and resulted in a natural way of stretching the ribcage.
Effects of naprapathic treatment in comparison with evidence-based medical treatment
Contact: Eva Skillgate (Karolinska Institutet +46 8 52487995), Eva Vingård
A randomised controlled study is being performed in collaboration with Karolinska Institutet in whichnaprapathic treatment is being compared with evidence-based treatment by medical doctors in the case of pain and problems in the lower back, and neck. The study involves four hundred patients and examinations and treatment has already been carried out. A follow-up study is in progress and we expect to publish the results in the beginning of 2007. This work is part of the doctoral studies of Eva Skillgate, with Eva Vingård as co-supervisor.
Effects of part-time sick-leave on the individual, working group, and the organisation
Contact: Leif Sieurin
Purpose
We aim to describe the consequences of part-time sick-leave on the individual and colleagues, and also the management and organisation. The study is a standalone continuation of the “HaKuL study” that was carried out 2000-2004.
Questions to be answered
What does part-time sick leave mean to:
- the individual, with respect to health state, quality of life and continued contact to working life?
- the group, with respect to the working conditions of the non-sick-listed individuals, and the organisation of the daily work.
- the organisation and manager in general with regard to planning of work, fulfilling goals, together with the possibility of employing temporary employees both short and long term?
How can part-time sick-leave be effective for both the individual and the organisation?
Which organisational and individual factors influence the result of “part-time sick-leave”?
Background
Long-term sick-leave has recently become a major problem in Sweden. The government has set a goal of halving the number of people taking sick-leave by 2008. In order to reduce the impact of sick-leave on the community it has been suggested that part-time sick-leave should be the norm whilst applications for full-time sick-leave should be the subject of special examinations. This would be linked to a change in the social security system regarding responsibilities for costs during long-term sick-leave.In addition to the overall economic gains for the community, persons on sick-leave would be expected to gain by retaining their contact with the place of employment by working, where possible, according to their capacity. Complete alienation from the working community would be expected to be less. However, there is, as yet, no scientific evidence that supports these assumptions.
The majority of workplaces in the public sector must have a high productivity. An employee should be efficient in order to meet this demand. This has meant that it has been difficult for those not able to work full-time to maintain their position. Full-time sick-leave has therefore often been a solution even if the individual might be able to work part-time. In the former case, a temporary employee working full-time can effectively fill the position.
If part-time sick-leave as a norm should become reality then it will place great demands on the organisation which must select those tasks that can be performed by the employee and those that cannot. Heavy and complex tasks can be distributed between a smaller number of employees with possible deleterious effects on their health. An adaptation of work to an increase in part-time sick-leave will place major demands on the organisation and stress already pressed line managers even more.
This study is performed as a standalone continuation of the project ”Sustainable working health in local government” (HAKuL project), which was a longitudinal study comprising 9 000 local government employees during 1999-2004.
Method
In November 2005, all employees that had been on sick-leave for 28 days or more were invited to the study.
Focus-groups interviews have been carried out together with colleagues to the sick-listed individual and the closest line manager.
The current status
Eva Vingård, Leif Sieurin, Malin Josephson, Frida Bengtsson, Marianne Ekdahl and Stefan Stark worked in the project.
The project included a total of 12 000 employees in the municipalities of Malung, Olofström, the social administration in the municipality of Ockelbo, parts of the municipality of Uppsala, together with Dalekarlia local government , and Uppsalas psychiatric department.
The projects ethical application has been approved.
The project has been established with all involved workplaces and key people have been contacted.
Statistical analysis of earlier data has been performed in order to estimate the extent of the study. These calculations indicate that approximately 15 % of the employees are absent on any one day, approximately 10 % have been absent from work for more than 28 days, and of these more than one third are on part-time sick-leave.
The data register has been evaluated.
The questionnaire for those who have been on sick-leave longer than 28 days has been prepared, tested, and sent out.
The first focus-group interviews have been held with sick-listed and managers. Administrative managers and several politicians have also been interviewed.
Literature reviews and studies are in progress.
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On the way towards results
Initial results indicate that part-time sick-leave works best if those on sick-leave are capable of working a full period (including all elements of the work) but need to do so less often. It can otherwise be difficult to regard oneself as a member of the working team. Those manager and politicians who were interviewed were all positive to the idea of part-time sick-leave. It appears, however, that part-time sick-leave has mostly been applicable after a long-term absence from work. Only a few are sick-listed part-time during the first three months.
Further interviews are planned with politicians, administrative managers, social-security workers and personnel at company health centres. The analysis of the questionnaire results has started. These answers will show the way for further interviews.
A first, partial report is expected to be completed during the autumn of 2006.
Effects on forestry workers handling insecticide treated conifer plants
Contact: Lena Elfman
In this study we will investigate the effects of pesticides on forestry workers handling treated conifer plants. We will specifically study health related effects after exposure of cypermethrin and imidachloprid. This is a double-blind placebo controlled study where the forestry workers will handle both treated and un-treated conifer plants during at least 3 days/week with the weekend as washout period between the different treatments. Each person enrolled in the study will have to answer a questionnaire combined with biological monitoring of exposure by measurement of inflammation markers in nasal lavage fluid and a metabolite (3-phenoxy-benzoic acid, 3-PBA) in urine. Most part of the field study will be performed during August- September and results will be compiled during November 2007. Occupational and Environmental Medicine perform this study at the request of The Forestry Research Institute of Sweden, Uppsala.
Contact: Helena Anundi
The environment for car-drivers is being investigated. Renewable fuels are used more often as a way to reduce the discharge of greenhouse gases. The number of ethanol-driven cars is therefore on the increase. There are studies that show that cars driven on E85 discharge approximately the same amount of formaldehyde as cars driven by petrol (SOU 1996:184). The Swedish Environmental Protection Agency has shown, however, that a petrol-driven car can discharge more formaldehyde than an ethanol-driven car (report 5143).
In our study we have compared the exposure when driving ethanol-driven and petrol-driven Ford Focus cars. We measure the exposure to formaldehyde, VOC (volatile organic compounds), total dust, ultra-fine particles, relative humidity, temperature, carbon dioxide, and also lung function by PEF-measurement. The project is in progress.
Follow-up study of the work environment of dental care personnel. Part 2 Ergonomics
Contact: Leni Skoglund
The purpose of the study was to investigate, describe and analyse the ergonomic problems that dental care personnel are exposed to in their daily work, and also give suggestions for measures to reduce the incidence of workload-related problems.
Tasks which were visually and precision-demanding were carried out in a standing position and engaged muscles of the shoulders and arms. Work in a sitting position, such as inspection of X-ray films, involved the neck and upper spine whilst leaning forward. Performing injections involved static muscular tension in the shoulder and arm.
Suggestions for improvements included a good sitting position to reduce loads on the disks of the back and neck, and the use of mirrors together with information on ergonomics during training.
Health of small scale enterprisers
Contact: Kristina Gunnarsson
The aims are to describe the small scale enterprisers’ own health and working situation, to compare the health and working conditions of small scale enterprisers with other workers in small scale enterprises, and to identify those health and work environment factors that are important for the company’s survival. Data is obtained through the questionnaire “The small scale enterprisers’ health and welfare” which was sent out to 788 small scale enterprisers in Uppsala county during 2001/2002 and 523 answered, and the population study ”Life and Health 2000” in Uppsala county, in which nine thousand people participated. The questions in this questionnaire have been used in earlier scientific investigations at our department.
Hearing status among commercial pilots and cabin crew
Contact: Torsten Lindgren
In this study the hearing status of commercial pilots was evaluated and was compared with a reference group. The comparison was made for the high frequency pure tone average over 3, 4 and 6 kHz. The studied group was 658 commercial pilots. The pure-tone average was collected from the regularly health examinations of the pilots. The reference group was a standardized national database of hearing thresholds from a general adult pollution, aged 20 to 79 hears, not exposed to hazardous occupational noise. The results points out that there was no difference in high frequency pure tone average between the group of commercial pilots and the control group.
The study is now expanded to include tinnitus and hearing status also of the cabin crew.
Life events, and coping strategies in relation to problems in the lower back and neck
Contact: Eva Skillgate (Karolinska Institutet +46 8 52487995), and Eva Vingård.
The study ‘Music-Norrtälje’ included investigations of the individual’s experience of traumatic events during the past 5 years, and the strategies for coping to meet various difficulties. The relationship between coping strategies and problems in the lower back and neck/shoulders was investigated using ‘case-control methodology’. We expect to publish the results during 2006. This work is included in Eva Skillgate’s doctoral project, with Eva Vingård as co-supervisor.
Contact person: Margareta Torgén
MERA stands for ”Metoder för Effektivare Rehabilitering i Arbetslivet” or ”Methods for effective rehabilitation in working life”. This is an evaluation of rehabilitation work at two of Stora Enso’s companies in Sweden, conducted in collaboration with the National Institute for Working Life in Stockholm and Occupational and Environmental Medicine in Uppsala.
Aims
· To evaluate how rehabilitation works in practice in two of Sweden’s paper mills, and including an economic evaluation.
· To study the supervisors’work environment, health and conditions for good leadership at the two companies.
Background
The project was performed in collaboration with the two companies’ respective personnel and occupational health service departments. The two facilities share a common goal: to improve rehabilitation, particularly with respect to prevention and early action. The supervisors have an important role in the rehabilitation process and their responsibilities have increased in recent years to include matters concerning employee’s sick-leave, needs for adjustment and rehabilitation. This resulted in an expansion of the study to include all personnel in leadership positions.
Implementation
The study was performed as a prospective evaluation of all new rehabilitation cases that the company decided to pursue, with a follow-up of 12-24 months. The rehabilitation work was expected to continue as usual under the duration of the project with minimal interference by the project itself. This was achieved by delegating the local project work to those involved in the company’s rehabilitation work. In addition, a local project assistant was appointed at every facility to be responsible for the implementation of the local project.
Method
- Personnel data for the whole company
This included information registered centrally concerning the number of employees, early retirements, sick-leave, and realised rehabilitation measures for both companies earlier and during the project’s duration.
- Structured interviews of participants in rehabilitation work
Participants in the company’s rehabilitation work were interviewed to determine how problems were identified, the measures taken, the resources available and the results obtained. This included, for example, supervisors, union representatives, officers at the social security centre, and personnel in the company’s health centre.
- Questionnaires
These were used to collect information on the current and previous occupations of those rehabilitated, their physical and psychosocial situation at work, self-rated health, ability to work, sleep and recovery, education, family status, leisure activities, motivation, attitude to work, and life style. The questionnaires were answered after the decision to carry out rehabilitation measures and when these had been completed. Information on the work leaders’ working conditions and health was also gathered.
- Economy of rehabilitation
For each individual who got rehabilitating measures, economic analyses were performed with focus on the company and the community. Profitability was calculated by including the effect of the individual’s reduced work capacity (factual or potential) and also the measures that have been taken.
The final result: spreading the results and knowledge
The project has been presented at each company and in national and international conferences during 2005 and 2006. Two reports are planned for 2007; a descriptive report on how rehabilitation was conducted at the two companies, and a separate report focusing on the supervisors’ situation.
Musculoskeletal disorders among an Iranian industrial population - Prevalence, incidence and associations with work related physical, psychosocial exposures as well as life style factors
Contact: Mostafa Ghaffari, Akbar Alipour, Eva Vingård
Musculoskeletal pain and disorders such as low back pain (LBP) and neck-shoulder pain (NSP) are major health problems in the world. Most epidemiological data on LBP and NSP is related to developed and industrialized countries and there is little information about low back and neck-shoulder pain in the general population in developing and low-income countries. There are even fewer studies in working populations.
Iran has a young population, half of the inhabitants being less than 25 years of age. During the last 20 years the workforce in Iran has undergone major changes: from being uneducated - even illiterate - or with a low level of education, and male-dominated, to being more and more educated or highly educated, and with an increasing female participation. This transition from a developing country to a more developed state in respect of industrialization creates new situations, exposures and challenges that may affect workers’ health.
In order to generate knowledge about the epidemiology of low back and neck-shoulder pain in Iran, this research program among an Iranian industrial population was conducted in 2002. The project was started by a cross-sectional epidemiological study for measuring the prevalence of musculoskeletal disorders among industrial population in Iran, and was continued by a prospective cohort study for measuring the incidence of LBP and NSP with three years follow-up. Measurement tools for this study are different questionnaires and registration systems for outcomes. In other parts of this project we are trying to determine the effects of work-related physical and psychosocial exposures as well as life style factors on incidence and recurrence of LBP or NSP.
For this study, one of the biggest industrial groups in Iran and also in the Middle East, was chosen. Iran Khodro Industrial Group (IKCO) is the largest vehicle manufacturer in Iran with more than 18,000 full-time employees. The study population comprises all employees of the company.
There are a limited number of longitudinal studies from western countries about the incidence of low back and neck-shoulder pain. This is one of the first studies to include this number of participants with different job titles from a developing country. Comparing results from this study with other studies from developed and industrialized countries will be interesting and generate valuable knowledge about the nature of musculoskeletal disorders and will be useful for further intervention programs.
Contact: Malin Josephson
Musculoskeletal problems are the major cause of long-term sick-leave in men and women and also the most common reason for newly-granted sickness benefits. How do ergonomics, psychological and social factors within and outside work, affect the risk of problems with back and neck, the risk that the problem will remain, and the possibility of return to health?
Our institution takes part in the Musculoskeletal Intervention Centre (MUSIC) in the project The Stockholm Study, MUSIC-Norrtälje study and the follow-up of MUSIC-Norrtälje. The purpose of the Stockholm Study was to develop methods to measure the physical and psychosocial stresses at work; the MUSIC-Norrtälje study was an epidemiological case-control study with the purpose of identifying the causes of musculoskeletal problems in the working environment. These studies are conducted in collaboration with the National Institute for Working Life, Karolinska Institutet and the Dpt of Occupational and Environmental Health within the Stockholm County Council.
Personality, stress and the Sick Building Syndrome (SBS)
Contact: Roma Runeson
The term “Sick Building” has sometimes been used to describe buildings where poor air quality can lead to medical symptoms such as irritation of the eye, nose or throat, facial skin problems, and also tiredness and headache. Since the symptoms are unspecific and the etiology is unclear, there is clearly a need to study to what extent these symptoms are caused by factors other than deficiencies in the indoor environment, in relation to individual sensitivities, vulnerability and stress at work or in social relationships.
The judgement of personality based on personality scales and personality tests is undergoing intensive development. An analysis of the literature on SBS indicated that few studies have considered the importance of vulnerability and stress in the individual, neither when concerning the reporting of symptoms in connection with problems with indoor environment nor the symptoms coupled to the indoor environment (symptoms concerning the eye, nose and throat, skin symptoms, headache and tiredness).
People who regard themselves as sick with diffuse symptoms turn to psychiatric care or medical care, with similar symptoms. It is therefore important to cover both physical and mental explanations to symptoms to ensure effective preventative and curative measures.
We have carried out a project in which we studied the relationship between on the one hand symptoms of the eye, nose, throat, and skin, together with headaches and tiredness, and, on the other, personality and work-related stress, as measured using a selection of well-established methods.
The verbal personality scales included Sense of Coherence (SOC), which was developed by Antonovsky, and Karolinska Scale of Personality (KSP). Stress in working life was measured with the demand-control-support model developed by Karasek and Thorell. Stress was also studied using a non-verbal test based on projective drawing, The Drawing Personality Profile (DPP).
The research was performed with epidemiological methodology, including cross-sectional studies and longitudinal incident studies. Two follow-up studies have been performed. The study population consisted of both employees in buildings with problematic indoor environments (a 9-year follow-up study) and random selections from the general public (a 10-year follow-up study).
Publications
Runeson R, Norbäck D, af Klinteberg B , Edling C. The influence of personality, measured by the Karolinska Scales of Personality (KSP), on symptoms among subjects in suspected sick-buildings. Indoor Air, 2004;14: 394-404.
Runeson R, Norbäck D, Stattin H. Symptoms and sense of coherence (SOC)- A follow-up study of personnel from workplace buildings with indoor air problems. Int Arch Occup Environ Health, 2003;76:29-30
Runeson R, Norbäck D. Associations between “Sick building syndrome”, psychological factors and personality traits. Perceptual and Motor skills, 2005;100:747-759).
Roma Runeson, Kurt Wahlstedt, Gunilla Wieslander, Dan Norbäck (2006) Personal and psychosocial factors and symptoms compatible with sick building syndrome (SBS) in the Swedish workforce. Indoor Air 2006; 16: 445-53.
The purpose of the present study was to test the hypothesis that classroom noise is related to stress-reactions among primary school children stress was monitored via symptoms of fatigue and headache, systolic blood pressure, reduced diurnal cortisol variation and indicators of emotional distress. Occupational limits for noise are set for the prevention of hearing impairment. There are however several other unwanted effects of chronic noise exposure below the occupational limits. Increased risk of cardiovascular disease has been shown for environmental noise exposure from 65-70 dB. In classrooms of pupils of the fourth grade (10 years old) daily measurements of equivalent sound levels (Leq) were made during four weeks, evenly distributed from September to December. One day each week of study the pupils answered a questionnaire about disturbance and symptoms and blood pressure and salivary cortisol were measured. The first and fourth week the children also performed a standardized drawing test of emotional indicators. Daily measurements of equivalent sound levels (Leq during school day) ranged from 59 to 87 dB(A). Positive correlations with equivalent sound-levels (Leq) were found for symptoms of fatigue and headache, reduced diurnal cortisol variability and emotional indicators of anxiety.
Present sound levels in Swedish classrooms can exceed current occupational action limits and are directly or indirectly related to stress-reactions among the children. These results together with a recent national report on an increase in stress-related symptoms among school children implicates a focus on health risks in the school environment.
Wålinder R, Gunnarsson K, Runeson R, Smedje G. Physiological and psychological stress reactions in relation to classroom noise. Scand j Work Environ Health. 2007. 13;4:260-266
Psychosocial work environment for air stewardesses
Contact: Torsten Lindgren
A study in progress including both the physical and psychosocial work environment of cabin attendants. This study cover many aspects of the work, including asthma, allergies and irritative symptoms as well as psychosocial and organisational aspects such as demand, control, social support (Karasek/Teorell model), burn out (Maslach), and conflicts between the demands of the work and social demands at home (e.g. child care).
Reasons for leaving the care sector or changing the place of work
Contact: Malin Josephson
There is or will be a shortage of personnel in the care sector in almost all EU countries. More knowledge is needed regarding the reasons for quitting or taking sick-leave in order to create working conditions such that the care sector becomes a more attractive employer and more remain in employment.
The clearest result in the study is that turnover among nurses and assistant nursesis not particularly high and that most of those that quit continued to work within the care sector. The probability that one quits increases if one feels excluded by management or colleagues, if the work is physically taxing, or if one cannot cope with work due to poor health or vitality.
Those who quit have been asked why they did so, their current employment and what would be needed for them to return to their previous job. The most common reasons for leaving their work were the desire for personal development, discontent with working conditions, and the need for a pay-rise. Those leaving work in the care sector more often stated private reasons for quitting.
The study was part of a EU-financed international collaboration, Nurse’s Early Exit Study – NEXT. Ten European companies participated in the project, which was coordinated from the University in Wüppertal, Germany. Some of the results have been reported in a Swedish report and an international version will hopefully be published during 2006. More information on NEXT can be found here.
Studies of personnel in the public sector
Contacts: Malin Josephson and Eva Vingård
Background
Nearly 50 % of women working in Sweden are employees in local authorities and public service sectors. Women in this local service sector have the largest rate of sick-leave, and increases in sick-leave are highest in this group which also has a significantly higher than average level of long-term sick-leave. The single largest group is women working in nursing and care. Absence from work is higher for women than men and has increased more. The average age of the sick-listed women is less than that of sick-listed men.
The ability to work can be seen as a balance between what an individual can manage and what the work demands. Work in the care sector places great physical and mental demands on the employees. Well-being and good health depend on a balance between the demands of the job and the resources available to the individual. Leaving work in the care sector for sick-leave or another job can depend to some extent on the demands placed by the work and the terms of employment that are offered.
A number of studies are being performed within the framework, and as a development of the project ”Work and sustainable health in the public sector in Sweden”.
Bullying at work
Bullying at work increases the risk of long-term disease and quitting work. Which terms of employment and which type of leadership promote bullying and what prevents bullying? Are there working groups that are free from bullying and what can we learn from them? An international scientific article and a Swedish summary are being prepared during 2007.
Zest for work
Promotion of health and prevention of disease in the employees includes the creation of conditions for zest for work and functioning work groups. Zest for work is not a well-defined concept but includes many different factors depending on the individual. In this study, zest for work comprises attitude, experience and influence over the working situation.
The study includes the measurement of the conditions that the individual regards as important for zest for work. The focus is placed on how the work is experienced and gives an overview of zest for work independent of the particular aspects taken up by the individual.
The study showed that poor health and stressful psychosocial working conditions were more common amongst those with low zest for work. The results have been published in a Swedish report and publication of an international version is in progress.
What promotes and what hinders increased influence for personnel in elderly care?
One way to relate to stresses in ones working life is to shift the responsibility to the surroundings and assume that oneself has no influence. Alternatively the individual and the group can develop through increased knowledge and experience and thereby improve the ability to influence one’s own working conditions. Sustainable health is based on this ability to influence one’s own working situation.
The commitment of the previous project on work and sustainable health within elderly-care in six municipalities was aimed at increasing the ability of employees to influence their own health and zest for work. The purpose of the study was to describe what was happening under the surface and behind the official documentation when projects are run in local government. In a summary that is being prepared in collaboration with the Swedish Municipal Workers’ Union, the process of this intervention work is described from the different angels of the participants.The goal is that we and our readers should be able to reflect over and learn from the difficulties and possibilities that we have experienced.
Supervision of workplaces with complex and deep-rooted psychosocial problems
Contact: Roma Runeson
Frequent changes in working life place a series of new demands on all employees. There is risk of ill health when the surroundings do not take the individual’s vulnerability into consideration. We often place the blame on individuals instead of the organisation. Psychosocial problems arise in defective organisations. The organisation should therefore be taken into consideration when looking for solutions. Defects can be more easily identified if the nature of a well-functioning organisation is considered. Organisations that work well are transparent, that is to say the decision-making and the support and steering can be understood by the employees and are in line with the goals for the business. It is easier to agree on solutions if there is agreement regarding nature of the problem.
Health is influenced by the various personalities at the workplace. We influence each other continuously and the interactions between individuals are acknowledged and modified daily. Healthy, mature people can be in conflict but are friendly and open to new constructive contact the following day. This is typical of a healthy organisation. Other aspects of a healthy organisation include clear and enthusiastic leadership, aims and goals that are clear to all, an organisation with support and steering which support the business, feed-back and rewards for all, and the organisation adapts according to the demands of its surroundings.
This project focused on inspection of the psychosocial work environment performed by the Work Environment Authority’s inspectors. The basis of the inspection is the applicable work environment legislation. The inspector must determine how the leadership and organisation work according to the employer’s description. Furthermore, the inspector must find out how the employees regard their working situation and also the nature of the working conditions. Finally, the inspector should judge which level of legislation is applicable.
Clarity in the organisation and respect for the individual are the basic prerequisites for creating confidence between management and the employees. The management should demonstrate that these are fulfilled when handling ill-health and sick-leave.
Systematic work environment management (SWEM) in companies
Contact: Kristina Gunnarsson
Companies that were included in the study ” Work environment and work environment management in small manufacturing companies in Dalecarlia” were invited to participate in the project. It was a collaboration with small companies in Dalecarlia, The National Institute for Working Life, universities and The Swedish Work Environment Authority. Eleven companies participated in the two-year project.
The projects goals were to
- improve work environment management in line with the existing provisions
- enable develop of competence in the workplace
- improve the work environment
- study how regulations are adapted to small companies
The companies could choose between two methods for implementation of SWEM. One method was supervisory model development by the Department of Occupational and Environmental Medicine in Örebro, and the other method was a network model. Both models included regular meetings. The supervisory model always involved meetings at the company in question and all personnel participated. The network model included only meetings between managers and safety delegates. The results showed that all companies improved their SWEM-status. Fifty percent of the companies using the network model reached up to SWEM-status 3 whilst 70 percent of those using the supervisory model reached the same level. A SWEM-status of 3 indicates that SWEM is working according to The Swedish Work Environment Authority. SWE-status has a maximum level of 4. Factors that had a major effect, independent of working method, include the attitude of the upper management, and the level of involvement of the personnel in environmental work.
The ’Health capital’ in small companies
Contact person: Kristina Gunnarsson
The project was carried out as a collaboration project with small companies in Uppsala county, The Institute for Personnel and Company Development (IPF), The Social Insurance Administration, the insurance company Länsförsäkringar in Uppsala, occupational health services, The Federation of Private Enterprises, and the Department of Occupation of Environmental Medicine.The goals with the project concerning small companies were:
- to increase the knowledge of the work environment in owners of small companies
- to increase the knowledge of the company’s work environment
- to increase the knowledge of how health issues were handled in the company
- to test methods for supporting the small company’s work on the work environment
- to develop a method to bring the health capital into the balance of accounts
The project included seminars about the work environment, health and health economics during a year. The small companies that participated were also included in the reference group for a questionnaire “The small scale enterprisers’ health and well-being” that was sent out to all small scale enterprisers in Uppsala county.
The painting profession
Contact: Gunilla Wieslander
The health risks in the painting profession have been known for centuries. During the 1970’s and 1980’s neurological effects, primarily after exposure to solvents, were brought to light. The painting profession has been classified internationally as an occupation with a high risk of cancer, including lung cancer (IARC, 1999). It includes exposure to many substances, including paints with high levels of isocyanates, which give rise to asthma. However, house painters in Sweden do not use such paints. Despite this, studies at our department in the beginning of the 1990’s showed that house painters have an increased risk of asthmatic symptoms and bronchial hyperreactivity, together with adverse effects on eyes and skin (see references). In a longitudinal study we showed selection effects for asthma that were related to commercial painting and even an increased risk of asthma symptoms in painters with the greatest exposure to volatile organic compounds.
House painters are also exposed to particles in connection with sanding, puttying, and similar work, as well as emissions from the putty, filler and paints. Water-based paints have dominated the market for the last twenty years (see reference). The composition of the water-based paints has changed radically and certain compounds, such as glycol, glycol-ethers, and texanol have been reduced in level or eliminated (see reference). Biocides, such as izothiazolinones, must still be added to hinder microbial growth. We showed in an earlier project that painters had an increased level of certain biomarkers in nasal-lavage, as compared to samples from unexposed personnel (janitors).
References
Wieslander G. Water Based Paints-Occupational Exposure and Some Health Effects. Comprehensive Summaries of Uppsala Dissertations from the faculty of Medicine 519, 1995:60pp. Uppsala University (Thesis).
Wieslander G, Norbäck D, Edling C. Airway symptoms among house painters in relation to exposure to volatile organic compounds (VOCs)-a longitudinal study. Ann Occup Hyg, 1997;41:155-166
Lundgren B, Wieslander G, Rosell L, Sundahl M, Norbäck D, Jonsson B, Sandvall A, Pyykkö R. ”Målarexpo”-System för utvärdering av vattenburna färger. SP Sveriges provnings-och Forskningsinstitut, Kemi och Materialteknik SP RAPPORT 1999-06.
Wieslander G, Norbäck D. Asthma, respiratory symptoms, and nasal inflammation in house painters mainly exposed to water based paints. In: Advances in the Prevention of occupational respiratory Diseases. Eds Keizo Chiotani.
The psychosocial pulse of the workplace (APP)
Contact: Roma Runeson
APP is a checklist to identify risks and weaknesses in the psychosocial work environment. APP has been developed by Roma Runeson at the Dpt for Occupational and Environmental Medicine at the University Hospital, Uppsala, and Brit-Marie Kjölstrud at the Work Environment Authority, Falun, Sweden.
The checklist is objective and easy to use. The questions concern the most relevant psychosocial risks and they are linked to instructions and paragraphs in the work environment legislation. Examples of questions include the following: Is my organisation sufficiently manned? How does the personnel policy work? Do too many take sick-leave? Is the turnover of personnel too high? Are there any risks? Do we work under time pressure? Has the workload increased in the last few years? Can we counter stress, for example with support or supervision from the management? The checklist can be used by everyone: work environment inspectors who want a quick overview of a workplace, as support in union activities, by the management, and by everyone who wants to measure their employment situation. The checklist can be used by the individual or group, for example in personnel meetings. The forty-five questions help to quickly build a picture of what creates stress and also possible improvements.
The checklists first page bears the citation from an unknown colonel: “An army’s morale is governed by how one takes care of its dead and wounded”. All employers have a responsibility to ensure that work on the occupational environment is effective, and to take care of those who need help. Support from the Work Environment Authority’s provision on Systematic Work Environment Management together with our checklist provides valuable tools to enable the manager to effectively take care of the social working environment.
APP is free of charge and can be copied at will. It can be obtained at this site or by ringing +46 18 611 36 54.
Violence and threats as a problem in the work environment
Contact: Malin Josephson
Violence and threats of violence is an increasing problem in the workplace in Sweden and abroad. The overall purpose of this study is to learn more about violence and threat of violence among employees in local authorities. This includes studying the possible consequences of violent incidents, as well as ill-health, reduced quality of work, and absenteeism. An additional purpose is the identification of factors related to the individual and work that increase the risk of exposure to violence or threat of violence.
The project is conducted in collaboration with the Section of Personal Injury Prevention at Karolinska Institutet in Stockholm.
Work environment and work environment management in small manufacturing companies in Dalecarlia
Contact: Kristina Gunnarsson
This was a study of the prerequisites for systematic work environment management of small workplaces, SWEM. The study was conducted in collaboration with The National Institute for Working Life in Stockholm, The Swedish Work Environment Authority, small companies and the local union organisations in Dalecarlia and was performed in 27 small manufacturing companies in different branches. The companies were spread throughout Dalecarlia. The studies concerned the current work environment, how occupational safety and SWEM were organised, the training level of the personnel and management, and how the company’s healthcare system was utilized. The results showed that 18 of the 27 companies had not implemented SWEM. Five companies had progressed relatively far but none of the companies had a fully functional SWEM. The employees’ safety delegates had participated in many more courses concerning the occupational environment than the management. Only 17 of the companies had direct contact with occupational healthcare organizations. The largest occupational risks were accidents, noise, and physical workloads.
Working hours for nurses in the Nordic countries
Contact: Malin Josephson
About 60 percent of the nurses in Sweden and Norway, and approximately 85 percent in Finland work full-time. What causes these differences and what are the consequences in terms of the nurse’s work, the balance between career and life outside work, and nurse’s health?
The project is conducted in collaboration with the University of Oslo and the Finnish Occupational Health Institute.
A comparative study of volatile organic compounds (VOC) in homes in Sweden and Japan
A statistical model for the classification of multi-family resedential buildings with a higher prevalence of Sick Build Syndrome (SBS) than expected
Day care centres, building dampness and antioxidants
Health evaluation of different ventilation systems in schools
HESE - Health Effects of the School Environment
Home environment, comfort and health – occupant reactions in a multi-family residential building with demand controlled ventilation
Incidence of asthma in relation to damp and mould in homes (ECRHS II)
Personality, stress and the Sick Building Syndrome
Signs of stress in children in relation to noise in school
Sustainable healthy houses
The home environment in Shanghai
The school environment in Asia
The school environment in Knivsta, Uppsala County, Sweden
Validation of Stockholm’s Indoor Environment Questionnaire (SIEQ)
A comparative study of volatile organic compounds (VOC) in homes in Sweden and Japan
Contact: Dan Norbäck
The home is the indoor environment where we spend two thirds of our life. Airborne chemical pollutants in homes can originate from various sources e.g. building materials, interior decorations and fittings, cleaning materials, and other household chemical products. Traffic exhausts and other airborne air pollutants such as nitrogen dioxide from the outdoor environment are additional sources of pollutants in the home. Exposure can vary between homes since building materials and chemical products are produced in different ways in different countries. There are few comparative studies between different countries concerning the chemical substances that are present in domestic air. This project entailed measuring different VOC, formaldehyde and nitrogen dioxide in 37 homes in Nagoya, Japan, and 27 homes in Uppsala, during the building heating season. The level of formaldehyde, nitrogen dioxide and chlorinated VOC were higher in both indoor and outdoor air in Nagoya. The level of formaldehyde in indoor air was on average 17.6 mg/m3 in Nagoya and 8.3 mg/m3 in Uppsala. The indoor level of nitrogen dioxide was 98.5 mg/m3 in Nagoya and 6.7 mg/m3 in Uppsala. The level of nitrogen dioxide outside the homes was on average 57.6 mg/m3 in Nagoya and 6.8 mg/m3 in Uppsala. WHO´s guidelines are 100 mg/m3 for formaldehyde (30-minute maximum level) and 40 mg/m3 for nitrogen dioxide (yearly average). The level of chlorinated VOC (1,1,1,-trichlorethane, carbon tetrachloride, trichlorethylene, tetrachlorethylene, and para-dichlorobenzene) were 3-40 times higher in Japan. In Nagoya, modern concrete buildings had in general higher levels of both formaldehyde and nitrogen dioxide in comparison with older wooden houses built in the traditional manner. Japanese homes with gas-fire heating without separate ventilation had higher levels of nitrogen dioxide (113.2 mg/m3) in comparison with homes with “clean” heating (70.5 mg/ m3). In addition, the level of paradichlorobenzene in the air was much higher in Japanese homes where mothballs containing this chemical were used. In Uppsala, there was no clear correlation between building factors and the level of pollutants in the homes. One article has been published and another concerning non-chlorinated VOC is planned.
Publications
Sakai K, Norbäck D, Mi Y-H, Shibata E, Kamijima M, Yamada T, Takeuchi Y. A comparison of indoor air pollutants in Japan and Sweden: Formaldehyde, nitrogen dioxide and chlorinated volatile organic compounds. Environmental Research 2004;94:75-85.
A statistical model for the identification of multi-family residential buildings with a higher prevalence of Sick Building Syndrome (SBS) than expected
Contact: Karin Engvall
The purpose of the project was to use stepwise multiple regression analysis to develop a model for the identification of multi-family residential buildings where occupants altogether had a higher prevalence of the Sick Building Syndrome (SBS) than expected. The analyses were carried out using a large dataset collected in 1991-93 with answers from occupants in 9808 apartments in 609 multi-family residential buildings from different building periods in Stockholm. Ten models were run on the dataset, one model for each of five symptoms (irritated eyes, nose, throat, and also cough and facial eczema), firstly for the problem itself and then if the occupant related the problem to the home environment. The factors that had largest explanatory value for general problems were the presence of allergy (OR 4.6 – 6.8), sex (OR 1.1 – 2.3), age (OR 0.4 – 1.6) and also living in rented public owned housing (OR 1.2-1.7).
The model was then applied to the dataset and probabilities could be calculated for respondents that fulfilled the different explanatory factors. A predicted prevalence of health problems could be calculated for the single building and be compared to the actual prevalence.If the difference between the expected and actual prevalence was significant then the house was classified as either a problem-house with too many symptomatic occupants, or a non-problematic house with a normal or lower level of problems. When applied on all buildings in the study it was found that younger houses, built 1985-1990, had a higher prevalence of occupants with symptoms, 15 %, compared to 10 % in the older houses, built 1961-1975. The conclusion was that classification of multi-home buildings with respect to health aspects requires that one controls for personal factors such as gender, age and allergy, and also the ownership/rent status of the property. The analyses and the model will be examined and validated within the “Sustainable healthy houses” project.
The project was carried out as part of Karin Engvall’s doctorate thesis and also as a collaboration project between the Institution for Medical Science/Occupational and Environmental Medicine at Uppsala University, The City of Stockholm’s Office of Research and Statistics, and the company White Architects. Dan Norbäck was the primary supervisor.
Publications
K Engvall et al. ” Development of Multiple Regression Model to Identify Multi-Family Residential buildings with a High Prevalence of Sick Building Syndrome (SBS)”
Indoor Air 2000; 10:101-110
Day care centres, building dampness and antioxidants
Contact: Gunilla Wieslander
Employees at two day care centres, one with and one without dampness problems, received dietary supplements in the form of buckwheat biscuits with and without the antioxidant rutin (a blinded dietary study).
We have carried out a study with the aim of increasing knowledge on how our health is affected by diet and damp-damaged indoor environments. Buckwheat is a crop, the kernel of which is used to produce gluten-free flour, which is used in Russian blini, buckwheat porridge, noodles and biscuits. It is consumed by approximately 200 million people in the world, including those who are oversensitive to gluten i.e. suffering from celiac disease. A number of healthy effects have been demonstrated for buckwheat, such as reduction in blood fats and reduced swelling of the legs. Pharmaceutical preparations have been made from buckwheat. There have, however, been no investigations into possible protective effects on eyes and respiratory mucous membranes of buckwheat strains with high levels of antioxidants. This study was carried out for five weeks on personnel in day care centres in the spring of 2005. Three clinical investigations on eyes and respiratory tracts were carried out before consumption of the dietary supplements (placebo biscuits and antioxidant rich biscuits), after two-weeks consumption, and finally after four weeks of consumption. A preliminary analysis of the results suggests that symptoms of tiredness, nasal blockage and headache were less frequent after eating biscuits. Those who received most antioxidants were less tired and showed somewhat of an improvement in inflammatory markers in nasal lavage fluid. More analysis will be performed. Some reduction of inflammatory markers (ECP, and MPO) in serum blood at the end of high consumption of antioxidants was also found.
Publications
Wieslander G, Fabjan N, Kreft I, Janson C, Spetz-Nyström U, Vomberger B, Tagesson C, Leandersson P., Norbäck D. An experimental study on health effects of consumption of an new type of tartary buckwheat biscuits with high levels of the antioxidant rutin. Proceedings from the Int Symposium on buckwheat and dietary culture. 8-12 August, 2005, Xichan, China.
Health evaluation of different ventilation systems in schools
Contact: Dan Norbäck
It is important to have adequate ventilation in schools and other teaching locales due to the high person density. There is also a need to reduce heating costs. These demands can be conflicting. We therefore need to evaluate different technical solutions for ventilation in schools and teaching locales with respect to health in order to determine systems that can offer both low heating costs and good health.
Are dirty ventilation filters a health problem?
Whilst there are clearly advantages to using mechanical ventilation in the school environment there are also disadvantages. Such systems need regular service: ventilation ducts must be cleaned and air-filters changed. There are sometimes health problems and complaints despite satisfactory air-flow. One hypothesis is that this could be caused by contamination of air due to the accumulation of mould, bacteria and other airborne contaminants in intake filters. We therefore carried out a double-blind experiment to study this problem. The experiment was performed in a school building in Uppsala with two ventilation units, which each supplied air to one half of the building. A new air-filter was installed in one unit whilst the other retained the 10-month-old air-filter. After two months the old filter was moved to the other unit, and a new filter was installed. Pupils filled in questionnaires during the two periods. The eyes and nasal mucous membranes of the pupils were investigated using objective clinical methods. The results showed that pupils had problems with eyes and throat twice as often when exposed to the old air-filters; the prevalence of nasal blockage also was higher according to the objective tests. The amount of mould and bacteria increased in the filter with time, especially during the autumn. The conclusion is that ventilation filters should be changed not only after the pollen season but also after the mould-rich damp autumn.
How is the school environment affected by filter-free ventilation systems?
Certain ventilation companies have developed filter-free ventilation systems in order to avoid problems with contaminants in intake filters. The disadvantage with these systems is of course that the occupants are not protected against particulate contaminants in the outdoor air. We performed an experiment in a school with a classroom with a filter-free ventilation system with displacement supply air. Another classroom was equipped with mixing supply air and exhaust ventilation including intake filters. The pupils in both classrooms were given medical examinations and then exchanged classrooms. Pupils in the classroom with filter-free ventilation said the air was fresher and they suffered less from tiredness and headaches, than the pupils in the other classroom. This could be at least partly explained by a temperature effect since the inlet air was cooler in the filter-free system. There was no significant difference between the two systems with respect to irritation of eyes or nasal mucous membranes, as measured with objective medical tests. The filter-free intake air contained somewhat higher levels of mould and bacteria, and even higher levels of ozone, as compared with intake air that had passed through a filter. On the other hand, the filter-free intake air contained lower levels of other chemical substances such as butanols. There was no difference in levels of mould and bacteria between the two classrooms. This is due to the fact that the children themselves, together with their activity, are the dominant source of particle contamination and the contribution from the intake air is not so significant.
Another investigation was performed in computer rooms at the University of Lund. This involved measuring the effect of energy-saving ventilation, which was controlled by carbon dioxide levels, on indoor environment and health. This investigation has not yet been reported.
Reports and proceedings:
Janson A, Pekonen T, Waher J. Airborne particle concentration in two classrooms with mixing and displacement ventilation. Proceeding from Indoor Air 2005, Beijing, China, Vol. 1, pp. 847-851.
Smedje G, Norbäck D, Wieslander G, Wålinder R. Effects of contaminated supply air filters on symptoms from the eyes and nose- a double-blind experimental study. Proceedings from 9th International Conference on Indoor Air quality and Climate, Indoor Air 2002,Santa Cruz, California, Vol 2, pp.1032-1037.
HESE - Health Effects of the School Environment
Contact: Dan Norbäck
This first study of European school environments was carried out during 2004-2005. The EU-financed project was performed in Sweden, Norway, Denmark, Italy and France, and included measurements of exposures in the school environment related to asthma, allergies and effects on eyes and the respiratory tract in primary school children. Forty-six classrooms were studied in 21 schools. The schools in Sweden and Norway generally fulfilled the ventilation norms since the majority had effective mechanical ventilation. The schools in the remaining countries did not meet the ventilation norm (<1000 ppm carbon dioxide) at all since they did not have mechanical ventilation systems. Allergens from furry animals were detected in all school rooms, both in south and north Europe. Classrooms in Sweden and Norway had the lowest airborne levels of cat and dog allergens, and lower levels of particulates, mould and bacteria. The levels of airborne allergens in France and Italy was 2-5 times higher than that in Sweden. Horse allergen in dust was, however, a phenomenon specific to Sweden: we have an unusually high number of riders in Sweden. The results show that an effective mechanical ventilation system is a prerequisite for a good indoor environment in schools. Extensive investment in ventilation in Scandinavia during the 90’s has improved the indoor environment in schools, but a corresponding investment in other parts of Europe still appears unlikely. The frequency of wheezing in pupils was high in those classrooms with higher levels of particles (PM10>50 mg/m3). Pupils in classrooms with higher levels of carbon dioxide ( >1000 ppm) had a higher frequency of dry cough at night, and ‘wheeze’.
The project was been reported to DG Sanco in the EU during 2006. The project leader was Dr Piersante Sestinin, Siena, Italy. Dan Norbäck was responsible for environmental monitoring and was also the local project leader in Uppsala.
Publications
Norbäck D, Sestini P, Elfman L, Wieslander L, Sigsgaard T, Canciani M, Ciarliegio G, Annesi-Maesano I, Nystad W, Viegi G, on behalf of the HESE group Health effects of the school environment (HESE): Indoor environment in primary schools in Italy, France, Denmark Norway and Sweden. Proceedings from the Healthy Buildings 2006, June 4-8, 2006, Lisbon.
Simoni M, Annesi-Maesano I, Sigsgaard T, Norbäck D, Wieslander G, Nystad W, Canciani M, Vieg G, Sestini P. Relationships between school indoor environment and respiratory/allergical health in children of five European Countries (HESE Study). Proceeding from the 16th Annual Congress of the European Respiratory Society , 2-6 September, 2006, Munich.
Home environment, comfort and health – occupant reactions in a multi-family residential buildings with demand-controlled ventilation
Contact: Karin Engvall and Dan Norbäck
The purpose of the project was to determine if a new principle of ventilation is sustainable with respect to health, good comfort for the inhabitants, and also if it is user-friendly and robust. New energy-saving measures are being tested as a response to increased energy consumption for heating multi-home dwellings and also the EU directive (2002/91/EC), which concerns declaration of energy consumption in buildings. Demand-controlled exhaust air ventilation, which involves reducing airflow when no-one is at home, is being tested in a new multi-family residential building in Stockholm. Technical function controllers will evaluate the system after it has been in operation for at least one year. Additional technical measurements relevant for the occupant and his/her health will be made in order to relate comfort and health to the indoor environment. Furthermore, a questionnaire is being given to the occupants, and also those of a reference building in the same quarter. The reference building is fitted with a traditional exhaust air system. Through the integrated programme for measuring the performance of the ventilation system in relation to the building design and from the occupant’s point of view, interdisciplinary discussions are enabled within one and the same evaluated object.
This is a collaboration project between the Institution for Medical Science/Occupational and Environmental Medicine at Uppsala University, the building company JM, the consultant WSP, and The Swedish Energy Agency.
Incidence of asthma in relation to damp and mould in homes (ECRHS II)
Contact: Dan Norbäck
There are few longitudinal studies concerning the relationship between the incidence of asthma and the presence of damp-related damage or mould in homes. In the European Community Respiratory Health Survey 8740 young adults in 25 centres in Europe and 2 in USA and Australia have participated. The cohort has been followed from 1991-93 until 1998-2002, with an average follow-up time of 8.9 years. The follow-up involved visits by building inspectors, including dust-sampling, to 4576 homes (approximately 200/centre), generally involving homes occupied by the same person during the whole study period. A group of 1605 people already had asthma or asthma symptoms from the beginning and they were therefore excluded from the analysis. Tests were also carried out for allergy to common allergens, a metacholine test to measure bronchial hyperreactivity (BHR), and dynamic spirometry to measure lung function.
Water damage, damp patches and visible mould were common indoors. Forty-three percent reported that they lived in a home with water damage, and 44.3 % reported that they lived in a home with visible mould growth indoors, at some time during the study period. Damp and mould in homes was the least common in the Nordic countries and nearly ten times more common in Great Britain, USA (Portland), and Australia (Melbourne). The relative risk (RR) was calculated using multiple binomial regression. Incidence of asthma was more common in homes with water leaks (RR=1.29; 95% CI 1.00-1.66), damp patches (RR=1.36; 95% CI 1.00-1.70) and visible mould (RR=1.36;95% CI 1.08-1,70). Incidence of asthma with verified BHR was more common in homes with mould in living rooms (RR=2.28; 95% CI 1.17-4.45). When the data was stratified it could be seen that the correlation was strongest among those who had verified mould allergy against Cladosporium or Alternaria. There was also a correlation between damp damage and mould growth in homes, and incidence of asthma. Occupants in homes with damp and mould in any room (bedroom, living room, bathroom) had more frequently newly-diagnosed asthma (RR=1.50; 95% CI 1.01-2.23). In addition, there was a correlation between damp and mould in bedrooms and ‘wheeze’, as well as asthma in combination with BHR (RR=2.84; 95% CI 1.00-8.06). The conclusion from the study is that damp and mould in homes may be an important environmental factor for the incidence of asthma.
The project leader for the whole of ECRHS I and II was Peter Burney at the National Heart and Lung Institute, London. Dan Norbäck has been involved in the indoor environment group within ECRHII.
Publications:
Norbäck D, Zock J-P, Heinrich J, Svanes C, Sunyer J, Kunzli N, Villani S, Oliveri M, Soon A, Plana E, Jarvis D on behalf of the ECRHSII group. Onset of asthma in relation to indoor moulds and building dampness: The longitudinal European Community Respiratory Health Survey ECRHS-II. Proceedings from Healthy Buildings 2006, 4-8 June 2006, Lisbon.
Norbäck D, Zock J-P, Heinrich J, Svanes C, Sunyer J, Kunzli N, Villani S, Oliveri M, Soon A, Plana E, Jarvis D. Onset of asthma in relation to indoor moulds and building dampness: A nine year follow up study within ECRHS-II. Proceedings from the at 16th Annual Congress of the European Respiratory Society, 2-6 September, 2006, Munich.
Personality, stress and the Sick Building Syndrome (SBS)
Contact: Roma Runeson
The term “Sick Building” has sometimes been used to describe buildings where poor air quality can lead to medical symptoms such as irritation of the eye, nose or throat, facial skin problems, and also tiredness and headache. Since the symptoms are unspecific and the etiology is unclear, there is clearly a need to study to what extent these symptoms are caused by factors other than deficiencies in the indoor environment, in relation to individual sensitivities, vulnerability and stress at work or in social relationships.
The judgement of personality based on personality scales and personality tests is undergoing intensive development. An analysis of the literature on SBS indicated that few studies have considered the importance of vulnerability and stress in the individual, neither when concerning the reporting of symptoms in connection with problems with indoor environment nor the symptoms coupled to the indoor environment (symptoms concerning the eye, nose and throat, skin symptoms, headache and tiredness).
People who regard themselves as sick with diffuse symptoms turn to psychiatric care or medical care, with similar symptoms. It is therefore important to cover both physical and mental explanations to symptoms to ensure effective preventative and curative measures.
We have carried out a project in which we studied the relationship between on the one hand symptoms of the eye, nose, throat, and skin, together with headaches and tiredness, and, on the other, personality and work-related stress, as measured using a selection of well-established methods.
The verbal personality scales included Sense of Coherence (SOC), which was developed by Antonovsky, and Karolinska Scale of Personality (KSP). Stress in working life was measured with the demand-control-support model developed by Karasek and Thorell. Stress was also studied using a non-verbal test based on projective drawing, The Drawing Personality Profile (DPP).
The research was performed with epidemiological methodology, including cross-sectional studies and longitudinal incident studies. Two follow-up studies have been performed. The study population consisted of both employees in buildings with problematic indoor environments (a 9-year follow-up study) and random selections from the general public (a 10-year follow-up study).
Publications
Runeson R, Norbäck D, af Klinteberg B , Edling C. The influence of personality, measured by the Karolinska Scales of Personality (KSP), on symptoms among subjects in suspected sick-buildings. Indoor Air, 2004;14: 394-404.
Runeson R, Norbäck D, Stattin H. Symptoms and sense of coherence (SOC)- A follow-up study of personnel from workplace buildings with indoor air problems. Int Arch Occup Environ Health, 2003;76:29-30
Runeson R, Norbäck D. Associations between “Sick building syndrome”, psychological factors and personality traits. Perceptual and Motor skills, 2005;100:747-759).
Roma Runeson, Kurt Wahlstedt, Gunilla Wieslander, Dan Norbäck (2006) Personal and psychosocial factors and symptoms compatible with sick building syndrome (SBS) in the Swedish workforce. Indoor Air 2006; 16: 445-53.
Signs of stress in children in relation to noise at school
Contact: Robert Wålinder
Questionnaires have shown that there is an increase in reports of stress-related symptoms by Swedish children. The background is of course multi-factorial. The educational environment has been highlighted in the ongoing work concerning public health policy objectives. Physical, psychological and social defects in the school environment may cause stress-symptoms in children.
Previous research has demonstrated that noise in schools has a negative effect on learning. Exposure of children, as in adults, to loud noise has been linked to stress reactions such as increased blood pressure, increased excretion of catecholamines, irritation and reduced psychological well-being.
Research has to some extent supported the view that the acute stress-reaction leading to energy mobilisation during stressful situations (fight/flight), if repeated often and without sufficient possibility of recovery, can lead to a number of undesirable effects. These include defects in cellular repair, reduced immune defence, effects on the central nervous system, disturbances in hormonal control, and even changes in the expression of certain genes. Repeated mobilisation of energy reserves can even result in an inability to answer to external demands, which can in extreme cases lead to burn-out/exhaustion.
Various stress mechanisms in children can be investigated using a series of tests. The physiological effects that can be studied are blood pressure and pulse, together with the overall effect, “Rate Pressure Product”, which is the product of systolic blood pressure and pulse. The biochemical markers that can be related to stress are cortisol, adrenalin, noradrenalin, testosterone, prolactin, lyzozyme, and HbA1c. Methods for saliva analysis of cortisol and lyzozyme are developed and validated.
The effect of stress on children has previously been studied whereby emotional indicators in children’s drawings has been employed as a measure of stress. Other methods for studying stress consist of age-related questionnaires.
The primary goal of the study is to map out stress reactions to noise in children in the school environment through a battery of well-known biological stress-markers together with a selection of psychological tests of children’s psychosocial experiences. A secondary goal is to determine if the known stress-markers for adults are applicable to children, and also if there is a useable psychological stress test for children.
Results are presented in a first manuscript that has been submitted for publication.
Sustainable healthy houses
Contact: Karin Engvall
The projects primary goal is to reduce health-risks in indoor environments. In Sweden, the building sector now has an undertaking and directive to begin to declare the buildings indoor environment and energy consumption. It is important that the building’s environment is perceived as comfortable and healthy. Several large surveys in the 90’s, based on questionnaires, indicated that the risk of Sick Building Syndrome (SBS) was higher in younger buildings. One of these surveys was ‘House and Health’ in Stockholm’s multi-family residential buildings during 1991-93, which included 12 667 occupants in 609 buildings. The City of Stockholm implemented their environmental programme 2002-2006 in 2003, which describes the city’s goals and a large number of indicators which could be measured and followed-up. Several of these indicators concerned healthy buildings.
One objective of the project was to carry out a questionnaire-based survey of the same size as that performed in 1991-93. The results will be used to develop methods to describe the status and also change. This should provide references that can be used by those responsible for building, the owners of buildings, local government, and to steer towards goals for indoor environment and health.
This is a collaboration project between the Institution for Medical Science/Occupational and Environmental Medicine (research), the Environmental Department of Stockholm city (implementation), together with the Department of Occupational and Environmental Medicine at Karolinska Institutet, and the company White architects.
The home environment in Shanghai
Contact: Dan Norbäck
We have carried out several studies of the indoor environment in China and Korea during the 00’s, as part of a research collaboration with researchers in Asia. In one study, we investigated the presence of allergens, microbial components in dust, together with chemical pollutants in homes in Shanghai, a large city (population of 16 million) in the most well-developed region of China. Thirty homes in different parts of Shanghai were chosen through personal contacts. The majority (68 %) were new homes (<10 years), often (90 %) in multi-occupant dwellings. None of the occupants owned furry pets. The majority of the beds (90 %) had mattresses of the traditional Chinese type, which consist of bundles of cotton fibres.
Dust samples were taken from bed dust (N=27), and floor-dust (N=28) using special sampling devices from ALK, during visits to 29 homes during January and February, 2002. The bed samples were taken using the same method as used in the ECRHS-study. Dust samples were analysed for allergens from house dust mites (Der p 1 and Der f 1), cat, dog and horse, as well as the mould Alternaria alternaria, using the ELISA method. In addition, levels of formaldehyde, nitrogen dioxide, sulphur dioxide and ozone were measured both indoors and outside the homes for 1 week, and radon was measured in the homes for 3 months.
House dust mites were found in all samples, both in bed- and floor-dust. The median level was 8430 ng/g (<200-36400 ng/g) for Der p1 and 5410 ng/g (<200-105850 ng/g) för Der f 1. Seven bed samples contained cat allergen (26 %), and 7 (26 %) contained dog allergen. The maximum levels were >8400 ng/g Fel d 1 and 700 ng/g Can f 1 i bed dust. Floor-dust samples contained at most 8400 ng/g Fel d 1 and 900 ng/g Can f 1. One bed sample contained horse allergen at a very low level (90 ng/g Equ cx). Formaldehyde levels were high in certain homes, due to the presence of new building materials and new interior decorations.
It was concluded that allergen from house dust mites is common in homes in Shanghai, and in 78% of bedrooms the levels were so high (>2000 ng/g) as to give a risk of sensitisation. This can be explained by Shanghai’s damp, warm climate. Fifty-four percent of the bedrooms had detectable levels of allergens from furry animals, despite the fact that no-one had cats or dogs in the homes. This suggests that there is an indirect spread of animal allergen in Shanghai.
Formaldehyde and nitrogen dioxide were other pollutants that were present at relatively high levels. The level of formaldehyde exceeded WHOs guideline (100 mg/m3 ) in 10 % of homes, with a maximum of 321 mg/m3. The level of nitrogen dioxide was high both in the homes (33-89 mg/m3) and outside the homes (39-86 mg/m3) due to traffic outside and gas-cookers indoors, and almost always exceeded WHOs guideline (40 mg/m3). The level of radon was low (6-33 Bq/m3) in all homes.
The school environment in Asia
Contact: Dan Norbäck
We have carried out studies in schools in China and Korea during the 00’s as part of collaborative work on the indoor environment with researchers in Asia. PhD student Zhuohui Zhao has studied the school environment in Taiyuan in northwest China. This town lies in an area with some of the highest levels of airborne pollutants in the world. PhD student Jeong Lim Kim has studied the school environment in Korea. Research Assistant Yahong Mi has previously carried out school projects in Shanghai. Mechanical ventilation in schools in these regions is unknown, and the only ventilation is through windows. This can lead to problems since the pollutant levels in the outdoor air in Asian cities can be high. One can choose between opening the windows and letting in car exhaust fumes, or keeping the windows closed and having a poor indoor environment anyway. In addition, classes can have 40-60 pupils, with double the density of people as seen in Sweden. The Chinese classroom is much colder during the winter, with temperatures of 12-16 degrees, whilst the Korean classrooms had temperatures comparable to those in Sweden. The classrooms had the advantage of containing almost no bookshelves, textiles etc that could accumulate dust. In addition, the pupils cleaned the classroom themselves every day in both China and Korea. Cat and dog allergens were present in the air in Chinese and Korean classrooms but the level of cat allergen was low in Korea since only three percent of the children had a cat at home.
The medical aspects of the PhD studies are still be analysed. The first studies from Shanghai indicated that problems with asthma were more common in schools with higher levels of nitrogen dioxide in the classrooms. Asthma symptoms and respiratory infections were less common in schools with high levels of endotoxins and muramic acid in dust. Only a few percent of the classrooms had visible signs of dampness or mould.
These school projects also included an investigation into whether diet played a role in the occurrence of asthma symptoms in pupils in China and Korea. High consumption of fish, shellfish and fruit appeared to give a protective effect. This data is being published. An ongoing collaborative project is addressing the school environment in Malaysia.
Publications
Mi Y-H, Elfman L, Eriksson S, Johansson M, Smedje G, Tao J, Mi Y-L. Norbäck D. Indoor allergens in schools: a comparison between Sweden and China. Proceedings from 9th International Conference on Indoor Air quality and Climate, Indoor Air 2002,Santa Cruz, California, Vol 2, pp.449-454.
Mi Y-H, Norbäck D, Tao J, Mi Y-L, Ferm M. Current asthma and respiratory symptoms among pupils in Shanghai, China: Influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in the classrooms. Indoor Air 2006; 16:454-464.
Norbäck D, Wang Z-H, Wieslander G, Zhao Z-H, Mi Y-H, Li Y-Y, Zhang Z. Asthma, eczema, and reports on pollen and cat allergy among children in urban and rural parts of Shanxi province, China. Int Arch Occup Environ Health 2006 (in press)
Norbäck D, Mi Y-H, Larsson L, Wady L, Tao J, Mi Y-L. Current asthma, respiratory infections and hypersensitivity to moulds in pupils in Shanghai, China, in relation to microbial components in the classrooms. Proceedings from 9th International Conference on Indoor Air quality and Climate, Indoor Air 2002,Santa Cruz, California, Vol 3, pp.410-415. Zhao ZH, Elfman L, Wang ZH, Zhang Z, Norbäck D. A comparative study of asthma, pollen cat and dog allergy among pupils and allergen levels in schools in Taiyuan city, China and Uppsala, Sweden. Indoor Air 2006;16:404-13
The school environment in Knivsta, Uppsala County
Contact: Dan Norbäck
This study included all primary and secondary schools in Knivsta municipality, south of Uppsala. One school was recently built (1999) and another had been subject to major renovations 1999. The study was carried out in the eight schools during 2000 and included 1014 (68 %) of the pupils and 157 (76 %) of the personnel. A PhD student, Jeong-Lim Kim, studied the pupils’ asthma and allergy symptoms in relation to the schools’ indoor environment as well as dietary factors. She also studied the interaction between dietary factors and exposure to allergens in the classroom with respect to respiratory symptoms. Temperature, relative humidity and carbon dioxide levels were measured in the classrooms using continuous-monitoring instruments. Measurements also included levels of formaldehyde, volatile organic compounds (VOC) and microbial volatile organic compounds (MVOC), both in the classroom and outside the school. The air exchange rate was measured using tracer gas. Settled dust from the classrooms was collected by standardised vacuum cleaning through ALK-filters. Samples were subsequently analysed for allergens from cat (Fel d 1), dog (Can f 1), horse (Equ c x), and house-dust mites (Der p 1 and Der f 1), and cockroaches (Bla g 1).
Of the pupils, 7.7 % had diagnosed asthma, 6.8% allergy to cats, 4.8%, allergy to dogs, and 8.8% allergy to pollens. Those pupils who ate fruit more often, or lived in homes where food was prepared using olive oil had a lower frequency of diagnosed asthma. Those who drank milk or ate fish more often had lower frequency of asthmatic symptoms the last year. Those who ate fast-food such as hamburgers more often, or lived in homes where more unsaturated fat was used in cooking, had a higher prevalence of asthmatic symptoms.
Allergens from furry animals, including from cats, dogs, and horses, were found in all schools and often at high levels. Children had asthmatic symptoms, such as ‘wheeze’ more often in those schools with higher levels of dog and horse allergen. The correlation between allergens in schools and asthmatic symptoms was stronger among children who seldom drank milk and where butter was not used at home. The conclusion is that animal allergens in school can be a risk factor for asthmatic symptoms in pupils, and that there can be an interaction between dietary factors and exposure to allergen.
Another part of the project involved investigating the relationship between asthmatic symptoms and mould, bacteria, MVOC, formaldehyde, and certain plasticizers (texanol, TXIB, 2-ethyl-1-hexanol) in classrooms. The prevalence of asthma diagnosis was higher in pupils in classes with higher levels of MVOC. There was also a relationship between the levels of Texanol and TXIB in the classroom, and asthmatic symptoms. The highest levels of MVOC, Texanol and TXIB were detected in two new schools. There was no relationship between levels of MVOC and levels of moulds or bacteria in the air. There was, however, a correlation between levels of MVOC and plasticizers. The conclusion is that MVOC and plasticizers in class rooms can be risk factors for asthmatic symptoms in pupils, but it is unclear if MVOC is an indicator for exposure to microbes.
Of the personnel, 16.1 % reported being diagnosed with asthma, 18.1 % currently used asthma medicine, 13.1 % were allergic to cats, 9,7% to dogs, and 26 % were allergic to pollen. These levels are over the average level for school personnel in Uppsala County. The correlation between the symptoms in the school personnel and diet, and the schools indoor environment has yet to be analysed.
Publications:
Kim JL, Elfman L, Mi Y, Johansson M, Smedje G, Norbäck D. Current asthma and respiratory symptoms among pupils in relation to dietary factors and allergens in the school environment. Indoor Air 2005; 15: 170-182.
Kim JL, Elfman L; Wieslander G, Smedje G, Norbäck D. Indoor moulds, bacteria, microbial volatile organic compounds (MVOC) and plasticizers in school: Associations with asthma and respiratory symptoms in pupils. (in press 2006).
Validation of Stockholm’s Indoor Environment Questionnaire (SIEQ)
Contac: Karin Engvall
The purpose of the project was to document and validate the questionnaire that Stockholm city has used since the beginning of the 1990’s to evaluate how indoor climate and health is experienced in newly built multi-family residential buildings. The questionnaire is currently recommended in the city’s program for environmentally sound building. There will be a follow-up study concerning how indoor climate and health is experienced in these buildings, as included in the contract with those responsible for building on city-owned land.
The questionnaire is standardised and based on sociological principles for validation. It contains questions regarding how indoor environment is experienced in terms of air quality, temperature, sound and light. There are also questions on the prevalence of asthma, and seven building-related symptoms that are usually included in the so called ‘Sick Building Symptoms’ or SBS. To be reported, problems must occur often or every week for the latest 3 months. There are also questions on the apartment and how it is used, together with questions concerning the occupants and the household. The questionnaire proved to have a high level of concordance on repeated use at various levels – area, building and individual. The response rate has so far been high at over 75%, and the internal refusals have often been low, generally under 6 %. The results are shown in graphical ‘problem profiles’ for indoor environment and health problems respectively. There is a good reference material from a study performed in 1991/93 with answers from 609 multi-home buildings and 9 808 apartments from different building periods in Stockholm. The questionnaire has been used in 2005 within the project on sustainable healthy houses with the purpose of renewing reference values.
The project was performed as part of Karin Engvalls PhD studies, and as a collaboration between the Institution for Medical Science/Occupational and Environmental Medicine and the Institution for Urban and Housing Research, both at Uppsala University, and Stockholm City.
Publications
K Engvall, E Sandstedt, C Norrby.”The Stockholm Indoor Environment Questionnaire: a sociological based tool for assessment of Indoor environment and health in dwellings”. Indoor Air 2003: 13:1-10
Outdoor Environment
Ethanol-driven cars
Exposure to benzene in Uppsala County
Homes close to traffic in Uppsala
The ambient environment project in the European Community Respiratory Health Survey II (ECRHS II)
The horse in township planning
Does bisphenol A induce obesity, metabolic dysfunction and cardiovascular disorders? A translation research program in rats humans.
Contact: Monica Lind
Background:
Own and others research has shown that exposure to endocrine disrupting chemicals (EDCs) can impair cardiovascular (CV) function and induce CV disease (CVD).
Today, special concern is mounting regarding the health effects of the xenoestrogen bisphenol A (BPA), a high-production-volume chemical widely used in production of plastics and in epoxy resins lining food and beverage containers. BPA compound has recently been
associated with obesity, diabetes and CVD in a cross-sectional study in humans.
Our hypothesis is that BPA affects metabolism at low-dose exposure and promotes fat cell differentiation in visceral fat and thereby drives the development of future CVD.
Material and Methods:
In a dose-response study in male and female rats, the effects of BPA on fat distribution will be studied by magnetic resonance imaging (MRI) and blood pressure will be measured by telemetry. Measures of systemic and genomic biomarkers in the rats will be harmonized to those measured in the cohort study (glucose, insulin, HDL-cholesterol, serum trigycerides will be investigated together with markers of inflammation, oxidative stress and adipokines).
In a cohort of 1016 subjects aged 70 (50 % female), circulating BPA will be related to fat distribution by MRI, to multiple CV characteristics and future CVD in a prospective fashion.
Relevance: Using a bench to bedside design the effects of BPA will be thoroughly investigated for a better understanding of the detrimental effects of exposure to BPA
Contact: Helena Anundi
The environment for car-drivers is being investigated. Renewable fuels are used more often as a way to reduce the discharge of greenhouse gases. The number of ethanol-driven cars is therefore on the increase. There are studies that show that cars driven on E85 discharge approximately the same amount of formaldehyde as cars driven by petrol (SOU 1996:184). The Swedish Environmental Protection Agency has shown, however, that a petrol-driven car can discharge more formaldehyde than an ethanol-driven car (report 5143).
In our study we have compared the exposure when driving ethanol-driven and petrol-driven Ford Focus cars. We measure the exposure to formaldehyde, VOC (volatile organic compounds), total dust, ultra-fine particles, relative humidity, temperature, carbon dioxide, and also lung function by PEF-measurement. The project is in progress.
Exposure to benzene in Uppsala county
Contact: Helena Anundi
The Swedish Environmental Health Commission estimated that 3-15 cancer cases per yearare caused by benzene in the environment. We are therefore studying the exposure of the population in Uppsala county to benzene. In the study we measure the exposure to benzene in the population, its correlation to different activities and compare with the proposed low risk level of 1.3 µg/m 3.
Personal sampling was performed by 93 persons without occupational exposure to solvents, principally office employees, in the six municipals of Uppsala county. The mean exposure to benzene during one week was 2 µg/m3. Smokers and those exposed to environmental tobacco smoke had a mean exposure of 3.5 µg/m3.
Homes close to traffic in Uppsala
Contact: Dan Norbäck
The Swedish environmental goal for fresh air states that air should be so clean that people’s health is not negatively affected. There is currently a Swedish environmental quality norm and suggested EU-limit for annual average level of nitrogen dioxide (NO2) of 40 μg/m3. The effect of living close to traffic on the health of 133 adults in 94 homes in central Uppsala was investigated using questionnaires and physiological tests. Only homes with natural ventilation (reliant on passive ventilation without fans) and situated on the bottom or first floor were included in the study.
We performed measurements both indoors and outdoors of nitrogen dioxide (NO2), nitrogen oxide (NO), ozone (O3), together with specific volatile organic carbons (VOC), including benzene. Noise was measured in five highly-exposed buildings. The medical investigation was performed in the home. We measured the tear-films stability, swelling in the nasal mucous membrane as measured by acoustic rhinometry, inflammatory markers in the nasal mucous membrane, lung function, blood pressure, and also EKG during 24 hours to determine variation in heartbeat. The study comprised 74 individuals who lived close (< 5 m) to a highly-trafficked street, together with a control group pf 59 individuals who lived in the same area but further (> 100m) from highly-trafficked streets.
The average levels of pollutants outside the homes were 19.3 μg/m3 NO2, 23.2 NO μg/m3 and 35.9 μg/m3 O3. A total of 59 individuals had high levels of NO2 (21-40 μg/m3) and 74 individuals had low levels of NO2 (3-20 μg/m3) outside the home. Fifteen of those living close to highly-trafficked streets had low NO2 levels and were therefore included in the low-exposure group. The average levels in the bedroom were 11.5 μg/m3 NO2, 22.1 NO μg/m3 and 5.8 μg/m3 O3. Individuals in homes with high NO2 levels outside aired their home less often, in contrast with those who had low NO2 outside. Those having high NO2 levels outside the home had 8 % lower lung function (FEV1) (p=0.008) and 6.2% lower forced vital capacity (p=0.03), as compared with those with a low level, after adjusting for confounders. There was no correlation between lung function and levels of traffic pollutants in the home. There was also no correlation between traffic pollutants, either indoors or outdoors, and blood pressure, swelling of the nasal mucous membranes, concentrations of biomarkers in nasal lavage (ECP, MPO, lysozyme, albumin), tear-film stability (BUT), or the occurrence of asthmatic symptoms, pollen allergy, allergy to furry animals, or rhinitis symptoms. Those with high NO2 levels outside, however, had respiratory infections more frequently (p=0.03), and there was a negative correlation between NO2 outside the home and one of the parameters of heart frequence variability (HRV TI) (p<0.05).
The quality of sleep was lower for those who had high NO2 levels outside the home. They experienced more often difficulties in falling asleep (p=0.003), were more often woken in the night by traffic noise (p<0.001), were more often exhausted when waking (p=0.01), and fell asleep more often at work (p=0.004). They also experienced that the air quality in the home was poor (p<0.001), 31 % were disturbed by traffic noise, 26 % had problems hearing radio or TV due to street noise, and many experienced daily problems with not being able to open windows in the living room (43 %) or bedroom (40 %) due to traffic. Noise measurements in five highly-exposed homes gave a daily average indoors of 38-41 dB(A) (average 40), and the noise level was over 45 db(A) for 3-20 % of the time. Volatile organic compounds (VOC) were measured at street level at six highly exposed street sections for ten weeks. The average level of benzene at four of the six sites exceeded the Swedish Environmental Protection Agency’s proposed guideline of 2.5 μg/m3.
The conclusion of the investigation is that traffic close to homes that gives a weekly average level of NO2 of at least 20-40 μg/m3 outside the home can give rise to sleep problems, problems related to noise, increased incidence of respiratory infections, reduced lung function, and reduced heart rate variability. These are levels of NO2 that are significantly less that the accepted daily average of 60 μg/m3, and the accepted yearly average of 40 μg/m3.
Publications
Norbäck D, Wålinder R, Wieslander G, Janson C. Lung function and respiratory symptoms in relation to NO2 from traffic exhaust outside dwellings in heavy trafficked streets in central Uppsala, Sweden. Proceedings from the 16th Annual Congress of the European Respiratory Society (ERS) in Munich, Germany 2-6 September, 2006.
The ambient environment project in the European Community Respiratory Health Survey (ECRHSII)
Project leader: Peter Burney (for the whole of ECRHS I and II)
Participant from Uppsala in the ambient environment group within ECRHSII: Dan Norbäck
The European Community Respiratory Health Survey (www.ecrhs.org) is an EU-financed multi-centre study that was initiated by lung clinics at 54 centres within and outside the EU. It includes a working group that studies airborne pollutants in the ambinet environment. Initially, historical data from the 1990’s was compiled for various air pollutants in the 36 European cities that were originally included when the European study started in the period 1989-1992. Data was collected for sulphur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxide (NO), total particulates (TSP), soot (Black smoke), PM10 and ozone (O3). The average level of SO2 during the last 3 years of the study (1997-99) varied between 1 mg/m3 (Umeå) to 33 mg/m3 in Oviedo in Spain. The three-year average for PM10 varied between 13 mg/m3 in Göteborg and 47 mg/m3 in Dublin. The level of SO2 in Europe had decreased considerably during the 90’s whereas the levels of NO2, TSP, and PM10 were more of less constant during the 90’s, and O3 tended to increase somewhat (Kûnsli et al., 2004).
Fine particles (PM2.5) and NO2 were measured in 21 cities in ten European countries during June 2000 to November 2001, within the framework of ECRHSII. Air pollutants were measured at every centre for 7 days every month for a year. The yearly average and winter average of PM2.5 varied more than 10 times between centres. Reykjavik hade the lowest yearly average (3.7 mg/m3), whilst Turin, Verona and Pavia in northern Italy had the highest yearly averages (35.3-44.9 mg/m3). Levels were higher during the winter but the pattern of seasonal variation differed between centres. Northern Italy had the highest winter averages (55.3-59.2 mg/m3). Uppsala had a yearly average of 10.4 mg/m3, 11.7 mg/m3 as winter average, and 7.2 mg/m3 as summer average. The yearly average for NO2 varied from 4.9 to 72.1 mg/m3 with the lowest value in Reykjavik and the highest yearly averages (>50 mg/m3) in Antwerp, Paris, Barcelona, Turin, Verona and Pavia. There was a fairly high correlation between the yearly average for PM2.5 and NO2 (Spearman´s r=0.75), but a poorer correlation between the monthly averages for both pollutants (Hazenkamp-von Arx, 2003; Hazenkamp-von Arx, 2004).
In a later project 15 elements were measured (Al, As, Br, Ca, Cl, Cu, Fe, K, Mn, Pb, S, Si, Ti, V, Zn), together with reflectance (blackening), in the same dust samples used to measure PM2.5. There was a large variation in the levels of elements between centres, with the lowest levels in Reykjavik, and up to eighty times higher levels in northern Italy. The levels of sulphur were the highest (Götchi et al, 2005). Finally, the oxidative properties of the PM2.5 fractions were measured in two test systems. The first measured the dust’s ability to generate free hydroxyl radicals. The second method measured the dust’s ability to destroy defence afforded by anti-oxidants in a synthetic alveolar fluid. There was a low correlation between the oxidative properties of the dust and other properties. This indicates that the oxidative properties of particulate pollutants cannot be predicted by chemical analysis (Kûnsli et al., 2006). We are currently compiling additional publications.
Reports and international publications:
Kûnsli N, Naef R, Xhillari D (2004) European Community Respiratory Health Survey II. Final report of work package 5: Historical data of ambient air pollution in 36 European cities of ECRHSI and II, doi: http://www.ecrhs.org.
Götschi T, Hazenkamp-von Arx ME, Heinrich J, et al. Elemental composition and reflectance of ambient fine particles at 21 European locations. Atmospheric Environment 2005; 39: 5947-5958.
Hazenkamp-von Arx ME, Götschi Fellman T, Oglesby L, et al. PM 2.5 assessment in 21 European study centers of ECRHSII –Method and first winter results. J Air Waste Mang Assoc 2003;53:617-628.
Hazenkamp-von Arx ME, Götchi T, Ackermann-Liebrich U, et al. PM2.5 and NO2 assessment in 21 European centres of ECRHSII: annual means and seasonal differences. Atmospheric Environment 2004; 38:1943-1953.
Kûnsli N; Mudway IS, Götchi T, et al. Comparison of oxidative properties, light absorbance, total and elemental mass concentration of ambient PM2.5 collected at 20 European sites. Environmental Health Perspectives 2006; 114(5):684-90.
Sunver J, Jarvis D, Gotschi T, et al. Chronic bronchitis and urban air pollution in an international study. Occup Environ Med 2006 (in press)
Contact: Lena Elfman
In this study we will investigate the effects of pesticides on forestry workers handling treated conifer plants. We will specifically study health related effects after exposure of cypermethrin and imidachloprid. This is a double-blind placebo controlled study where the forestry workers will handle both treated and un-treated conifer plants during at least 3 days/week with the weekend as washout period between the different treatments. Each person enrolled in the study will have to answer a questionnaire combined with biological monitoring of exposure by measurement of inflammation markers in nasal lavage fluid and a metabolite (3-phenoxy-benzoic acid, 3-PBA) in urine. Most part of the field study will be performed during August- September and results will be compiled during November 2007. Occupational and Environmental Medicine perform this study at the request of The Forestry Research Institute of Sweden, Uppsala.
Effects on forestry workers handling insecticide treated conifer plants
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