Methodological aspects of unspecific building related symptoms research

Abstract: This thesis deals with methological issues in the study of chemical exposure and sick building syndrome (SBS). SBS is a combination of general, mucosal and skin symptoms that some people experience when staying in specific buildings. The aim was to find chemical patterns associated with SBS, but also to address methological problems in such study.The plan was to conduct a case-control study comparing the two groups’ chemical exposure, where cases were defined as those having at least one general, one mucosal and one skin symptom each week the last three months. For the planning it was necessary to know if cases and controls could be selected from the same building. If everyone in a building have the same chemical exposure it is no use to compare exposure between two persons at the same workplace. In the first paper exposure to more than 100 compounds is compared between 79 participants working in eight buildings. It was found that for the majority of compounds the variation in exposure was larger within buildings than between buildings, which means that cases and controls could be allowed to work in the same building.The second paper is a comparison of three adsorbents usability in finding differences in chemical exposure between SBS cases and controls. This was done by using chemometrical methods but comparisons of sampled amounts, blank values and reproducibility were also done. Tenax TA was found to be the best adsorbent, hence used in the case-control study.In recent years ozone and ozone reaction products with unsaturated volatile organic compounds (VOCs) has been in focus. Nitrogen dioxide is another gas affecting oxidation of reactive VOCs. Formaldehyde is an irritant formed when unsaturated VOCs are oxidised, and in some studies a relation with SBS has been found. In paper three the relation between personal exposure to formaldehyde, nitrogen dioxide, ozone, terpenes and SBS has been investigated among more than 200 office workers in a case control study in Umeå and Vasa. Cases (based on symptoms during the week of measurements) had lower ozone exposure than controls. No further associations were found at present exposure levels. A planed analysis of relations to VOCs could not be done due to analytical problems, and problems due to difficulties with consistent identification of compounds in a very large data set. These problems are further discussed in the thesis.In the case-control, study participants answered questionnaires about symptoms during "the past three months", "right now" (when answering the questionnaire), and during the week of exposure measurements. In the fourth paper the stability of symptoms were compared by answers at different occasions. It was found that the case/control concept was as stable as individual symptoms. More participants with atopic disease and those 41 years old or younger changed class compared with those without atopic disease and older participants. Measurement activities appeared to make participants report more symptoms. Fatigue, dry eyes and dry skin are suggested to be symptoms with strongest, and illness/dizziness to be weakest association with IAQ.