OFFICE ILLNESS The Worker, the Work and the Workplace

This thesis addresses health problems related to indoor environmental factors in office workers. The overall aim is to increase knowledge about the relationship between the occurrence of perceived symptoms and potential risk indicators, and about methodological issues of relevance for future research and preventive work. The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers. The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses. In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more workrelated facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents. The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS).