Effects of increased recirculation air rate and aircraft cabin occupancy on passengers' health and well-being - Results from a randomized controlled trial.

BACKGROUND: Aircraft cabins are special environments. Passengers sit in close proximity in a space with low pressure that they cannot leave. The cabin is ventilated with a mixture of outside and recirculated air. The volume of outside air impacts the carbon footprint of flying. Higher recirculation air rates could be considered to save energy and divert less kerosene from producing thrust. OBJECTIVES: To investigate whether higher recirculation air rates in aircraft cabins negatively affect passengers' health and well-being and if occupancy plays a role in this. METHODS: In a 2 (occupancy: full and half-occupied) X 4 (ventilation regime) factorial design with stratified randomization, participants were exposed in an aircraft segment in a low-pressure tube during a 4-h simulated flight. Ventilation regimes consisted of increasing proportions of recirculated air up to a maximum CO2 concentration of 4200 ppm. Participants rated comfort, health symptoms, and sleepiness multiple times. Heart rate (variability), as stress marker, was measured continuously. RESULTS: 559 persons representative of flight passengers regarding age (M = 42.7, SD = 15.9) and sex (283 men) participated. ANCOVA results showed hardly any effect of both factors on self-reported health symptoms, strong main effects of occupancy on comfort measures, and interaction effects for sleepiness and physiological stress parameters: Participants in the half-occupied cabin hardly reacted to increased recirculation air rates and show overall more favorable responses. Participants in the fully occupied cabin reported higher sleepiness and had stress reactions when the recirculation air rate was high. DISCUSSION: This large-scale RCT shows the importance of occupancy, a previously neglected factor in indoor air research. The proximity of other people seems to increase stress and exacerbate reactions to air quality. Further studies on causal pathways are needed to determine if recirculation air rates can be increased to reduce the carbon footprint of flying without detrimental effects on passengers.

Autonomy in the context of cognitive demands-is the resource becoming a stressor?

OBJECTIVE: Autonomy is often associated with positive linear effects on health whereas non-linear correlations have received only sporadic attention. Assuming that the use of autonomy also represents a cognitive demand, this study examines whether health effects of autonomy change depending on further cognitive demands and whether curvilinear relationships can be identified. METHODS: A survey was carried out in three SMEs with established work analysis questionnaires. 197 Employees were classified into groups with high and with low cognitive demands by means of a two-step cluster analysis. This was modeled as moderator together with curvilinear effects of autonomy in regression analyses. RESULTS: Curvilinear associations were found for emotional exhaustion, cynicism, and anxiety. They were strongest for anxiety. No moderating effects of cognitive demands and no consistently significant modeled relations were found. CONCLUSION: The results confirm that autonomy has a positive influence on the health of employees. However, autonomy should not be seen as an isolated resource but embedded in the organizational and societal context.

Traffic safety knowledge gain of ambulance drivers after simulator-based training.

BACKGROUND: Compared to other road users, ambulance drivers are at a higher accident risk while driving with warning lights and sirens. No standard exists for training or education for emergency medical service employees driving ambulances. Training programs should positively influence knowledge. However, knowledge gain can be influenced by several different factors. This study developed a knowledge test for ambulance drivers to determine influencing factors on knowledge and its gain by simulator-based training. METHODS: Two parallel knowledge test forms with 20 questions each were designed in several steps and tested on up to 174 participants. Questionnaires were used to study associated and influencing factors, such as objective experience, subjective attitudes, personality, motivation and demographic data. RESULTS: Test construction showed good overall parallelism of the two tests as well as reliability and sensitivity. There was no correlation between subjective and objective knowledge gain, but participants with higher subjective knowledge gain showed a higher variation in objective knowledge. Younger age, higher qualification, higher number of license classes, fewer traffic violations, and more traffic safety trainings were positively associated with knowledge, whereas less yearly driving mileage, more traffic safety trainings, and higher risk sensitivity positively influenced knowledge gain through the training. CONCLUSION: Knowledge and its gain through training are very low. Reasons for the lack of predictive power of some variables, such as motivation, personality and attitudes, are discussed. This study presents a new tool for testing knowledge on driving with warning lights and sirens. It shows the need for objective testing and for further research in this special area.

Cabin air quality on non-smoking commercial flights: A review of published data on airborne pollutants.

We reviewed 47 documents published 1967-2019 that reported measurements of volatile organic compounds (VOCs) on commercial aircraft. We compared the measurements with the air quality standards and guidelines for aircraft cabins and in some cases buildings. Average levels of VOCs for which limits exist were lower than the permissible levels except for benzene with average concentration at 5.9 ± 5.5 µg/m3 . Toluene, benzene, ethylbenzene, formaldehyde, acetaldehyde, limonene, nonanal, hexanal, decanal, octanal, acetic acid, acetone, ethanol, butanal, acrolein, isoprene and menthol were the most frequently measured compounds. The concentrations of semi-volatile organic compounds (SVOCs) and other contaminants did not exceed standards and guidelines in buildings except for the average NO2 concentration at 12 ppb. Although the focus was on VOCs, we also retrieved the data on other parameters characterizing cabin environment. Ozone concentration averaged 38 ppb below the upper limit recommended for aircraft. The outdoor air supply rate ranged from 1.7 to 39.5 L/s per person and averaged 6.0 ± 0.8 L/s/p (median 5.8 L/s/p), higher than the minimum level recommended for commercial aircraft. Carbon dioxide concentration averaged 1315 ± 232 ppm, lower than what is permitted in aircraft and close to what is permitted in buildings. Measured temperatures averaged 23.5 ± 0.8°C and were generally within the ranges recommended for avoiding thermal discomfort. Relative humidity averaged 16% ± 5%, lower than what is recommended in buildings.

[SARS-CoV-2 Infections during Travel by Train and Bus: A Systematic Review of Epidemiological Studies]. / SARS-CoV-2 Infektionen während Reisen mit Bahn und Bus. Ein systematisches Review epidemiologischer Studien.

AIM: The aim of this review is to identify epidemiological studies on the risk of infection with SARS-CoV-2 during travel by train and bus and to critically evaluate them also with regard to extrapolating the findings to the German situation. METHODS: Systematic review based on searching two electronic databases (PubMed, Web of Science) according to the principle of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) for epidemiological studies on SARS-CoV-2 or COVID-19 and travel by train or bus. RESULTS: Searches of the two electronic databases yielded 746 publications. Of these, 55 met the selection criteria and were included in the full-text search. Finally, 5 original publications were used to answer the question about SARS-CoV-2 infections related to long-distance travel by train and 4 related to bus travel. The studies were very heterogeneous and referred almost exclusively to long-distance travel in China. They consistently showed a risk of infection when infected persons travelled in the same train, car or bus without mouth-to-nose (MNB) coverage. The risk was not limited to those sitting in close proximity to an infected fellow traveler. Despite all the differences between travel by train and bus in China and Germany, there is no fundamental doubt that the reported results from China can also be extrapolated to Germany in qualitative terms. However, it must be taken into account that the results of the three key publications predominantly included the period before the lockdown in China without the strict use of MNB. Thus, the question remains whether the results would be similar under current conditions with MNB and more virulent viral mutations. No single study was found related to infection when using public transportation. CONCLUSIONS: There are several lines of evidence that travel by train is associated with a significantly lower risk of infection compared with the risk of infection in the home environment. Due to a lack of observational data, one will need to model the risk of infection for long-distance travel by bus and use of local public transport based on air exchange in the passenger compartment, travel duration, distance from other passengers, and ultimately passenger density.

Age, aging and physiological dysregulation in safety-critical work: a retrospective longitudinal study of helicopter emergency medical services pilots.

PURPOSE: Concurrent progressive physiological dysregulation in different organ systems may be a driver of phenotypical frailty and is associated with morbidity and performance declines. In aging societies, health and performance of older workers are given increased scrutiny. However, there are few studies researching the effect of age on physiological dysregulation specifically in the working population and none for high-risk occupations with close medical supervision. Here, we aim to investigate this association cross-sectionally and longitudinally in a healthy sample of European helicopter emergency medical services pilots. METHODS: Using a retrospective cohort design, we constructed indices of (a) physiological dysregulation state (N = 52 participants) and (b) pace of change (N = 41 participants, average follow-up 7.9 years) based on measurements of 18 health risk-associated biomarkers, as documented in the participating pilots' aeromedical examination records. The relationship of these two indices with average age (range 27.9-60.6 years) and average baseline age (29.3-57.2 years), respectively, was modeled by weighted least squares regression, adjusting for region of origin, smoking, and medication. RESULTS: Longitudinally, dysregulation significantly increased over the follow-up period, but the pace of change did not increase with baseline age. Cross-sectionally, we observed a significant negative quadratic effect of age on physiological dysregulation state, with maximum estimated physiological dysregulation at ages 45-50. CONCLUSIONS: As hypothesized, progression of dysregulation over approximately 8 years is observable in a healthy occupational sample but it does not accelerate (i.e., does not increase with baseline age). Increases in dysregulation are counteracted by what appears to be a strong healthy worker survivor effect. The study shows that the development of physiological dysregulation in high-risk occupations differs from that in the general population and that physiological dysregulation indices may be helpful in reconciling safety concerns and fair treatment of aging workers in safety-critical jobs.

A training intervention for home care nurses in cross-cultural communication: An evaluation study of changes in attitudes, knowledge and behaviour.

AIMS: To assess whether a training intervention in cross-cultural communication can positively impact attitudes, knowledge and behaviour and to investigate possible dependencies between these components. DESIGN: (Controlled) longitudinal multimethod evaluation. METHODS: A training based on theoretical considerations and informed by semi-standardized interviews with home care nurses was developed and evaluated. Participants rated their cross-cultural attitudes, knowledge and behaviour and answered case vignettes assessing their knowledge before and after this training. Shift observations assessed behaviourial aspects at t1 and t2. Data were collected between June 2016-March 2017 and between April 2017-November 2017. Analyses of variance and multiple linear regression models were employed. RESULTS: The training showed promising tendencies with cross-cultural attitudes, knowledge and behaviour with diverging results for initially quite high self-reports showing positive but mostly not significant developments and objective assessments mostly showing significant positive changes. There were significant associations between self-reported cross-cultural behaviour at t1 and objective cross-cultural knowledge at t2, whereas self-rated and objectively assessed knowledge showed no significant associations. Shift observations showed significant positive developments in participants' communication behaviour. CONCLUSION: Our study shows the importance of using different methods and targeting different outcomes areas to rate impacts of (cross-cultural) training interventions. Future studies should consider challenging conditions in home care nursing affecting the success of interventions and investigate mechanisms of skill acquisition in nursing. IMPACT: This is one of very few studies using multi-method approach to evaluate a cross-cultural competency intervention and simultaneously assess cross-cultural attitudes, knowledge and behaviour including possible dependencies between these aspects.

Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study.

The diagnosis of depression, a frequent comorbidity of chronic obstructive pulmonary disease (COPD), is often supported by questionnaires, such as the Patient Health Questionnaire 9 (PHQ-9). It is unknown to which extent its single questions are affected by the clinical characteristics of COPD patients.We addressed this question in 2255 GOLD grade 1-4 patients from the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) COPD cohort. The dependence on COPD severity was assessed using symptoms, exacerbation risk (GOLD A-D; modified Medical Research Council dyspnoea scale (mMRC)), and frequent comorbidities as predictors of PHQ-9 results, while including age, gender, body mass index (BMI) and smoking habits as covariates.Symptoms and exacerbation risk were associated with depression in an additive manner, with mean elevations in the PHQ-9 sum score by 2.75 and 1.44 points, respectively. Asthma, sleep apnoea, gastrointestinal disorders, osteoporosis and arthritis were linked to increases by 0.8 to 1.3 points. Overall, the COPD characteristics contributed to the mean PHQ-9 score by increases from 4.5 or 5.2 to 6.3 points, respectively, when either taking GOLD A as reference or the absence of comorbidities. This finding was independent of the diagnosis of mental disorder or the intake of antidepressants. The presence of COPD led to an increase in the proportion of scores indicating depression from 12 to 22%. Single item analysis revealed homogenous effects regarding GOLD groups, but heterogeneous effects regarding GOLD grades.These findings indicate specific effects of COPD severity on the PHQ-9 depression score, especially symptoms and exacerbation risk, explaining the high prevalence of depression in COPD. Alternative explanations like an overlap of COPD severity and PHQ-9 items are discussed. Of note, we also found COPD treatment effects on depression scores.

[Drawing up a Guideline for Handling Information and Communication Technology, Flexibility and Availability in Small and Medium Enterprises]. / Erstellung eines Handlungsleitfadens für einen gesundheitsförderlichen Umgang mit Informations- und Kommunikationstechnologien, Flexibilisierung und Erreichbarkeit in kleinen und mittleren Unternehmen.

BACKGROUND: Within the last decades the world of work has changed enormously. Due to new Information and Communication Technologies (ICT), working at any time from any place has become possible. Flexibility, availability and the dissolution of boundaries between work and private life are the possible results of this development. The spread of this development and possible consequences on the affected employee's health and wellbeing have been examined so far especially in big companies. Small and medium-sized enterprises (SME) are rarely subjects of scientific studies in this context. OBJECTIVE OF THIS PAPER: The aim of this work was to develop a guideline based on experiences and results of a study regarding flexibility in the business world (FlexA), as well as a systematic literature research. The target populations of this guideline are SMEs, focusing on integrating a health promoting way in dealing with ICT, flexibility and availability within the corporate culture. METHODS: In order to delineate the current state in of research in ICT-related work interventions, a systematic review in data bases e. g. PsycINFO, EconLit and Medline was carried out. The search strategy used the key words "work", "intervention", "ICT", "mental strain", "flexibility" and "availability". In addition, grey literature and findings from the FlexA study were used to formulate the current guideline. RESULTS: Based on the exclusion criteria, all studies from the systematic literature search were excluded after title and abstract screening. Within grey literature research, 4 relevant publications could be identified. The measures, developed during the corporate workshops of the FlexA study, e. g. the implementation of collective regulations in the company, were included in the guideline. CONCLUSION: Due to the ongoing development of ICT and flexibility in daily business life, it is getting more and more important to follow this progress. Executives and corporate management are responsible to actively shape this trend in a health-promoting way in their enterprises. The current guideline was made to support the corporate management in this task and it is an important instrument for a health-promoting use of ICT in daily business life taking in to consideration flexibility and availability.

Occupational Stress in Helicopter Emergency Service Pilots From 4 European Countries.

OBJECTIVE: Working conditions are known to affect motivation, well-being, and ultimately work performance. Helicopter emergency medical services (HEMS) pilots' work is highly demanding and safety critical, but virtually no published data on occupational stress and strain symptoms in HEMS pilots are available. We investigated work stressors and resources and their association with work engagement, subjective well-being, and energy levels in European HEMS pilots. METHODS: Cross-sectional questionnaire data were collected consecutively from 72 European HEMS pilots (24 Western European and 48 Eastern European, mean age = 51.9 years). We examined the stressor, resource, and strain symptom levels by age group and region of origin and the association of stressors and resources with work engagement, well-being, and energy. RESULTS: Although the responses differed notably between the Eastern and Western European pilots, their overall profile was quite favorable. At the same time, those stressor/resource variables, which on average had the most favorable ratings, were the most strongly associated with (reduced) well-being and energy. CONCLUSION: On the whole, the HEMS pilots' perception of their work situation appears to be positive, and they are highly engaged in their work. The pilots' strong identification with their work should be taken into account in pilot mental health support systems.

Aging and Cardiometabolic Risk in European HEMS Pilots: An Assessment of Occupational Old-Age Limits as a Regulatory Risk Management Strategy.

Old-age limits are imposed in some occupations in an effort to ensure public safety. In aviation, the "Age 60 Rule" limits permissible flight operations conducted by pilots aged 60 and over. Using a retrospective cohort design, we assessed this rule's validity by comparing age-related change rates of cardiometabolic incapacitation risk markers in European helicopter emergency medical service (HEMS) pilots near age 60 with those in younger pilots. Specifically, individual clinical, laboratory, and electrocardiogram (ECG)-based risk markers and an overall cardiovascular event risk score were determined from aeromedical examination records of 66 German, Austrian, Polish, and Czech HEMS pilots (average follow-up 8.52 years). Risk marker change rates were assessed using linear mixed models and generalized additive models. Body mass index increases over time were slower in pilots near age 60 compared to younger pilots, and fasting glucose levels increased only in the latter. Whereas the lipid profile remained unchanged in the latter, it improved in the former. An ECG-based arrhythmia risk marker increased in younger pilots, which persisted in the older pilots. Six-month risk of a fatal cardiovascular event (in or out of cockpit) was estimated between 0% and 0.3%. Between 41% and 95% of risk marker variability was due to unexplained time-stable between-person differences. To conclude, the cardiometabolic risk marker profile of HEMS pilots appears to improve over time in pilots near age 60, compared to younger pilots. Given large stable interindividual differences, we recommend individualized risk assessment of HEMS pilots near age 60 instead of general grounding.

Job strain, bullying and violence at work and asthma in Peruvian cleaners-a cross-sectional analysis.

OBJECTIVES: An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions. METHODS: The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed. RESULTS: The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (pChi(2) = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all pChi(2) < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both pChi(2) < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5-21.4) and violence (2.4; 1.1-5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9-13.8). CONCLUSIONS: Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.

Medical risks in older pilots: a systematic review on incapacitation and age.

PURPOSE: Our ageing society faces an ageing work force. The target of this systematic review was to analyse whether pilots have a measurable age-dependent increased risk of incapacitation due to medical reasons. METHODS: Publications listed in PubMed, NCBI and EMBASE were identified using defined terms. Two independent raters analysed 2,342 retrieved publications by predefined criteria. Ten publications met the inclusion criteria. RESULTS: Four publications use a similar numerator (in-flight incapacitation) and identical denominator (flight hours) and show in-flight incapacitation of pilots happening 0.19-0.45 times/10(6) flight hours. Two of these studies did not analyse the possible correlation of incapacitation and age, and two did not use the denominator flight hours here. Age dependency of incapacitation is analysed in seven publications: Three analyse in-flight incapacitation and four analyse general incapacitation to fly. All but one--the only one including professional pilots older than 60 years--show an age-depending increase in incapacitation. The increase in in-flight incapacitation is far less than the increase in general flight incapacitation. CONCLUSIONS: Medical in-flight incapacitation is a very rare event. Whether the increase in in-flight incapacitation results in an increase in accidents or can be compensated for by error reduction through experience cannot be answered. A register of all pilots with a clear identification system to follow their career and health, their accidents and impairments, might help to reconsider the grounding of pilots over 60 and to define better criteria than mere age.

Pilots' age and incidents in helicopter emergency medical services: a 5-year observational study.

BACKGROUND: Helicopter emergency medical services (HEMS) are considered to have a higher risk of incidents compared to other airborne operations. As HEMS poses high cognitive demands, age-related cognitive changes of helicopter pilots might become a safety risk. The aim of this study was to estimate the association between the age of pilots and incidents in HEMS. METHODS: We conducted a retrospective observational study of incidents during HEMS operations of one Austrian and two German air rescue organizations between 2007 and 2011. The sample included 257 regularly operating HEMS pilots. Age of the pilots varied between 44.52 yr (SD = 7.80) in 2007 and 46.57 yr (SD = 8.14) in 2011. Incidents were categorized as the number of HEMS operations with at least one liability damage (LD). Statistical analyses used multilevel growth curve modeling with generalized linear mixed models. RESULTS: 1770 LD were observed during 402.372 HEMS operations (approximately four LD per 1000 operations). From 2007 to 2011 the average number of LD per year varied between M = 0.95-1.77 for pilots < 35 yr to M = 0.25-1.53 for pilots > or = 60 yr. There was no statistically significant main effect of pilot's age on the number of LD. There was a trend of an interaction effect between age and time, which suggests that pilots with higher age tended to be involved in slightly fewer LD with time than younger pilots. DISCUSSION: In sum, findings provide no evidence that older pilots have a higher risk than younger pilots of being involved in an incident during HEMS operations.

Selection, optimization, and compensation in nursing: exploration of job-specific strategies, scale development, and age-specific associations to work ability.

AIMS: (1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship. BACKGROUND: Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses. DESIGN: The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability. METHODS: Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1). RESULTS: Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability. The positive relationship was stronger for older nurses. CONCLUSION: Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers.

Potentially Critical Driving Situations During "Blue-light" Driving: A Video Analysis.

INTRODUCTION: Driving with warning lights and sirens is highly demanding for ambulance drivers, and the crash risk is much higher than that during normal driving. In this study our goals were to establish a coding protocol to observe how often and how long potentially critical driving situations (PCDS) occur during "blue-light" driving (driving with emergency response lights) and to describe traffic and environmental conditions preceding and accompanying the PCDS. METHODS: We collected randomly drawn video data of real ambulance driving between 2014-2017 in two German federal states. A coding protocol was developed to categorize PCDS into four types ("right of way," "crosswalks," "overtaking" [passing], and "other") and to describe them within the context of road characteristics, incident type, traffic, weather conditions, and driving style. RESULTS: A total of 172 videos of 71 different drivers were chosen randomly covering 1125 minutes of driving with warning lights and sirens. The drivers had a mean age of 33.7 years, and 25.4% were female. A total of 2048 PCDS occurred with a mean duration of five seconds (range of 1-66), amounting to one PCDS every 33 seconds. Twenty percent of the driving time involved PCDS. The rapid driving style (10.5%) showed more PCDS (one every 28.5 seconds), and the defensive driving style showed fewer PCDS (one every 49.6 seconds). Of all detected PCDS, "right of way" situations (57.5%) were most frequent, followed by "overtaking" [passing] maneuvers (30.2%). CONCLUSION: This study used a detailed coding protocol to describe driving with warning lights and sirens. The PCDS occurred less frequently than anticipated, although they were still common events when driving an ambulance, representing significant potential for crashes or near-crashes. These results can be used for insight training programs to raise ambulance drivers' awareness of typical PCDS and associated potential crash risk.

Increased self-reported sensitivity to environmental stimuli and its effects on perception of air quality and well-being.

BACKGROUND: In previous studies, negative associations were found between increased environmental sensitivity and general well-being as well as positive perception of air quality. However, only a few studies with partly inconsistent results examined this relation under exposure. They tried to determine whether people with increased environmental sensitivity react to real environmental conditions with changes in current well-being and perception of air quality. METHODS: Pooled data from two single-blinded randomized controlled trials with different exposure levels were analyzed. Participants were exposed to different levels of volatile organic compounds (VOC) and carbon dioxide (CO2) in the front part of a former in-service wide-body airplane inserted in a low-pressure chamber. Three exposure groups were created depending on the VOC/CO2 levels: low, medium and high. Subjects repeatedly answered questions about their current mental well-being and about perception of air quality and odor intensity. Based on self-reported data the participants were classified into groups with low and higher environmental sensitivity. Data were evaluated using a 2 (environmental sensitivity) x 3 (exposure) ANCOVA with repeated measures. RESULTS: 503 individuals (221 females) participated (mean age: 42.8 ± 14.5 years). Thereof, 166 individuals were assigned to the group with higher environmental sensitivity; they reported poorer psychological well-being regarding vitality (F (1,466) = 16.42, p < .001***, partial η2 = 0.034) and vigilance (F (1,467) = 7.82, p = .005**, partial η2 = 0.016) and rated the pleasantness of air quality (F (1,476) = 7.55, p = .006**, partial η2 = 0.016) and air movement (F (1,474) = 5.11, p = .024*, partial η2 = 0.011) worse than people in the low sensitivity group. Exposure levels showed no effects. No systematic differences between men and women were found. Increased environmental sensitivity shared common variance with negative affectivity, another person-related variable. Its explanatory power was higher for evaluations of the environment whereas no differences between the concepts in explaining current psychological well-being were found. CONCLUSIONS: Even a slightly elevated level of environmental sensitivity led to worse ratings of the environment with no clear relation to the real environment. Consequently, environmental sensitivity should be considered as a confounding factor in environmental exposure studies. The independency from real exposure levels is in line with the results from previous studies showing that the differences in environmental ratings are probably also driven by psychological factors.