Fractional exhaled nitric oxide (FeNO) among school children in Java and Sumatra, Indonesia: associations with respiratory symptoms, house dust mite sensitization and the home environment.

OBJECTIVE: To study associations between fractional exhaled nitric oxide (FeNO) and asthma, airway symptoms, sensitization to common allergens, outdoor pollution and home environment among 380 students in eight junior high schools in two areas in Indonesia. METHODS: Data on health and home were collected by a face-to face interview before measuring FeNO and performing skin prick test against common allergens. Exploratory linear mixed and logistic regression models were employed. RESULTS: Geometric mean of FeNO was 17.8 ppb (GSD 2.09) and 139 students (36.6%) had elevated FeNO (>20 ppb). In total, 107 students (28.2%) were sensitized to house dust mite (HDM) (Der p1 or Der f1), 4 (1.1%) to cat and 3 (0.8%) to mold (Cladosporium or Alternaria). Moreover, 20 students (5.3%) had diagnosed asthma, 38 (10.0%) had current wheeze, and 107 (28.2%) had current rhinitis. HDM sensitization, diagnosed asthma, current wheeze, and current rhinitis were associated with FeNO. In total, 281 students (73.9%) had mold or dampness, 232 (61.1%) had environmental tobacco smoke (ETS) and 43 (11.3%) had other odor at home. Indoor mold or dampness and other odor at home were associated with FeNO. ETS was negatively associated with FeNO. CONCLUSION: HDM sensitization and elevated FeNO can be common among children in this part of Indonesia. The high prevalence of elevated FeNO indicate that undiagnosed childhood asthma is common. Dampness, mold and odor at home can be associated with increased FeNO while ETS can be associated with decreased FeNO.

Indoor microbiome, microbial and plant metabolites, chemical compounds, and asthma symptoms in junior high school students: a multicentre association study in Malaysia.

BACKGROUND: Indoor microbial exposure is associated with asthma, but the health effects of indoor metabolites and chemicals have not been comprehensively assessed. METHODS: We collected classroom dust from 24 junior high schools in three geographically distanced areas in Malaysia (Johor Bahru, Terengganu and Penang), and conducted culture-independent high-throughput microbiome and untargeted metabolomics/chemical profiling. RESULTS: 1290 students were surveyed for asthma symptoms (wheeze). In each centre, we found significant variation in the prevalence of wheeze among schools, which could be explained by personal characteristics and air pollutants. Large-scale microbial variations were observed between the three centres; the potential protective bacteria were mainly from phyla Actinobacteria in Johor Bahru, Cyanobacteria in Terengganu and Proteobacteria in Penang. In total, 2633 metabolites and chemicals were characterised. Many metabolites were enriched in low-wheeze schools, including plant secondary metabolites flavonoids/isoflavonoids (isoliquiritigenin, formononetin, astragalin), indole and derivatives (indole, serotonin, 1H-indole-3-carboxaldehyde), and others (biotin, chavicol). A neural network analysis showed that the indole derivatives were co-occurring with the potential protective microbial taxa, including Actinomycetospora, Fischerella and Truepera, suggesting these microorganisms may pose health effects by releasing indole metabolites. A few synthetic chemicals were enriched in high-wheeze schools, including pesticides (2(3H)-benzothiazolethione), fragrances (2-aminobenzoic acid, isovaleric acid), detergents and plastics (phthalic acid), and industrial materials (4,4-sulfonyldiphenol). CONCLUSIONS: This is the first association study between high-throughput indoor chemical profiling and asthma symptoms. The consistent results from the three centres indicate that indoor metabolites/chemicals could be a better indicator than the indoor microbiome for environmental and health assessments, providing new insights for asthma prediction, prevention and control.

Fractional exhaled nitric oxide (FeNO) and respiratory symptoms in junior high school students in Penang, Malaysia: the role of household exposure.

We studied associations between fractional exhaled nitric oxide (FeNO), health and household exposure among school children (N = 348) in Penang, Malaysia. Multiple logistic regression and linear mixed models were applied. Overall, 46.0% had elevated FeNO (>20 ppb) and 10.6% diagnosed asthma. Male gender (p = 0.002), parental asthma or allergy (p = 0.047), cat allergy (p = 0.009) and seafood allergy (p < 0.001), diagnosed asthma (p = 0.001), wheeze (p = 0.001), ocular symptoms (p = 0.001), rhinitis (p = 0.002) and respiratory infections (p = 0.004) were all associated with FeNO. Students exposed to ETS had lower FeNO (p = 0.05). Dampness and mould was associated with wheeze (p = 0.038), especially in wooden homes (interaction p = 0.042) and among students with elevated FeNO (interaction p = 0.024). Cat keeping increased rhinitis (p = 0.041) and respiratory infections (p = 0.008) and modified the dampness associations. In conclusion, FeNO can be associated with ocular and respiratory symptoms. Elevated FeNO, cat keeping and a wooden house can enhance the risk of wheeze when exposed to dampness and mould.

Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study.

BACKGROUND: There is limited and conflicting evidence on the effect of menopause on asthma. OBJECTIVES: We sought to study whether the incidence of asthma and respiratory symptoms differ by menopausal status in a longitudinal population-based study with an average follow-up of 12 years. METHODS: The Respiratory Health in Northern Europe study provided questionnaire data pertaining to respiratory and reproductive health at baseline (1999-2001) and follow-up (2010-2012). The study cohort included women aged 45 to 65 years at follow-up, without asthma at baseline, and not using exogenous hormones (n = 2322). Menopausal status was defined as nonmenopausal, transitional, early postmenopausal, and late postmenopausal. Associations with asthma (defined by the use of asthma medication, having asthma attacks, or both) and respiratory symptoms scores were analyzed by using logistic (asthma) and negative binomial (respiratory symptoms) regressions, adjusting for age, body mass index, physical activity, smoking, education, and study center. RESULTS: The odds of new-onset asthma were increased in women who were transitional (odds ratio, 2.40; 95% CI, 1.09-5.30), early postmenopausal (odds ratio, 2.11; 95% CI, 1.06-4.20), and late postmenopausal (odds ratio, 3.44; 95% CI, 1.31-9.05) at follow-up compared with nonmenopausal women. The risk of respiratory symptoms increased in early postmenopausal (coefficient, 0.40; 95% CI, 0.06-0.75) and late postmenopausal (coefficient, 0.69; 95% CI, 0.15-1.23) women. These findings were consistent irrespective of smoking status and across study centers. CONCLUSIONS: New-onset asthma and respiratory symptoms increased in women becoming postmenopausal in a longitudinal population-based study. Clinicians should be aware that respiratory health might deteriorate in women during reproductive aging.

Fungal DNA in dust in Swedish day care centres: associations with respiratory symptoms, fractional exhaled nitrogen oxide (FeNO) and C-reactive protein (CRP) in serum among day care centre staff.

PURPOSE: To study associations between fungal DNA in day care centres, fractional exhaled nitric oxide (FeNO) and inflammatory markers in day care centre staff. METHODS: Totally, 62 staff (90 %) from five day care centres in Sweden participated. All were females. Settled dust was collected and analysed for five sequences of fungal DNA by quantitative PCR. Levels of FeNO (NIOX MINO 50 ml/min) and serum levels of eosinophilic cationic protein, myeloperoxidase (MPO) and high-sensitivity C-reactive protein in blood (HsCRP) were measured. Dynamic spirometry was performed, and dyspnoea was measured. Biomarkers and dyspnoea ratings were log-transformed, and associations were analysed by linear mixed models, adjusting for age, atopy, smoking, body mass index (BMI), ETS and dampness/mould at home. RESULTS: Geometric mean (GM) for FeNO was 15.3 ppb, 6% were smokers, 14% were obese, 31% were overweight and 18% had atopy. GM concentration was 2.16 × 10(5) cell equivalents (CE)/g for total fungal DNA, 2310 CE/g for Aspergillus/penicillium (Asp/Pen) DNA, 17 CE/g for Aspergillus versicolor DNA and 14 CE/g dust for Streptomyces DNA. FeNO was associated with total fungal DNA (p = 0.004), Asp/Pen DNA (p = 0.005) and Streptomyces DNA (p = 0.03). HsCRP was associated with total fungal DNA (p = 0.03) and BMI (p = 0.001). Dyspnoea was associated with Asp/Pen DNA (p = 0.04). Subjects with ETS at home had lower lung function (FEV1) (p = 0.03), and those with dampness/mould at home had lower MPO (p = 0.03). CONCLUSION: Fungal contamination in day care centres, measured as fungal DNA, can be a risk factor for airway inflammation, and CRP is associated with BMI.

Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe.

Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged ≥80 years were at higher risk. Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.

Associations between environmental characteristics, high-resolution indoor microbiome, metabolome and allergic and non-allergic rhinitis symptoms for junior high school students.

Rhinitis is one of the most prevalent chronic diseases globally. Microbiome exposure affects the occurrence of rhinitis. However, previous studies did not differentiate allergic rhinitis (AR) and non-allergic rhinitis (NAR) in the microbial association analysis. In this study, we investigate 347 students in 8 junior high schools, Terengganu, Malaysia, who were categorized as healthy (70.9%), AR (13.8%) and NAR (15.3%) based on a self-administered questionnaire and skin prick tests of pollen, pet, mould and house dust mite allergens. Classroom microbial and metabolite exposure in vacuumed dust was characterized by PacBio long-read amplicon sequencing, quantitative PCR and LC-MS-based untargeted metabolomics. Our findings indicate a similar microbial association pattern between AR and NAR. The richness in Gammaproteobacteria was negatively associated with AR and NAR symptoms, whereas total fungal richness was positively associated with AR and NAR symptoms (p < 0.05). Brasilonema bromeliae and Aeromonas enteropelogenes were negatively associated with AR and NAR, and Deinococcus was positively associated with AR and NAR (p < 0.01). Pipecolic acid was protectively associated with AR and NAR symptoms (OR = 0.06 and 0.13, p = 0.009 and 0.045). A neural network analysis showed that B. bromeliae was co-occurring with pipecolic acid, suggesting that the protective role of this species may be mediated by releasing pipecolic acid. Indoor relative humidity and the weight of vacuum dust were associated with AR and NAR, respectively (p < 0.05), but the health effects were mediated by two protective bacterial species, Aliinostoc morphoplasticum and Ilumatobacter fluminis. Overall, our study reported a similar microbial association pattern between AR and NAR and also revealed the complex interactions between microbial species, environmental characteristics, and rhinitis symptoms.

Digestive functional symptoms among commercial pilots in relation to diet, insomnia, and lifestyle factors.

BACKGROUND: The aim of our study was to identify associations between digestive symptoms among pilots and diet, insomnia, and lifestyle factors. METHODS: A standardized questionnaire was mailed to all Stockholm pilots on duty in a Swedish airline company: 354 pilots and 564 office workers from the same company participated. Associations were analyzed by multiple logistic regressions with mutual adjustment. RESULTS: Of the pilots, 9.9% reported poor appetite, 15.2% heartburn, 12.4% diarrhea, 62.1% bloating, 9.3% constipation, and 14.4% epigastralgia. Pilots reported more bloating and poor appetite compared with office workers. The prevalence of insomnia was 70.6% among pilots and 63.1% among office workers. Among pilots, insomnia was related to poor appetite, heartburn, diarrhea, bloating, constipation, and epigastralgia. There were no associations between insomnia and digestive symptoms among office workers. Among pilots, higher body mass index (BMI) was related to heartburn and smokers more often suffered from constipation. Frequent milk consumption was associated with heartburn and less constipation; female pilots suffered from more constipation. The number of years as an active pilot was negatively associated with epigastralgia and bloating. CONCLUSION: Insomnia and some digestive symptoms were more common among pilots than office workers. In addition to insomnia, BMI, smoking, female gender, and milk consumption were associated with some digestive symptoms. The strong association between insomnia and digestive symptoms among pilots, but not among office workers, suggests a stress component related to this occupation.

Total viable molds and fungal DNA in classrooms and association with respiratory health and pulmonary function of European schoolchildren.

Indoor molds are associated with adverse respiratory effects in children. Although schools are important exposure sources of molds, objective measurements were more often taken in homes. Our aim was to assess indoor molds in schools and related effects on schoolchildren health. The Health Effects of the School Environment study (HESE) included 21 schools (46 classrooms) in Italy, Denmark, Sweden, Norway, and France and 654 schoolchildren (mean age 10 yr). Information on schoolchildren was collected by standardized questionnaires. Measurements of total viable molds (VM, colony-forming units, cfu/m(3)) and total/specific fungal DNA (cell equivalents, CE/g dust) were taken inside all classrooms in the cold season during normal activities, using the same standardized methodology. Pulmonary function tests were performed on 244 pupils. VM (mean, 320,cfu/m(3)) and total fungal DNA (geometric mean, 2.2 × 10(5) ± 2.1 CE/g dust) were detectable in all classrooms. The levels were significantly higher in buildings with mold/dampness problems. VM, but not fungal DNA, were inversely related to ventilation rate. VM exceeded the maximum standard of 300 cfu/m(3) in 33% of the classrooms. In the past 12 months, dry cough at night (34%) and rhinitis (32%) were the mostly reported. Children exposed to VM levels ≥ 300 cfu/m(3), compared with those exposed to lower levels, showed higher risk for past year dry cough at night (odds ratio, OR: 3.10, 95% confidence interval, CI: 1.61-5.98) and rhinitis (OR: 2.86, 95% CI: 1.65-4.95), as well as for persistent cough (OR: 3.79, 95% CI: 2.40-5.60). Aspergillus/Penicillium DNA was significantly positively associated with wheeze, and Aspergillus versicolor DNA with wheeze, rhinitis, and cough. There were significant inverse associations of Aspergillus versicolor DNA with forced vitality capacity (FVC) and Streptomyces DNA with both FEV(1) and FVC. In conclusion, indoor VM and fungal DNA were commonly found in monitored European schools and adversely related to respiratory health. Schools should be routinely tested through both culturable and non-culturable methods for global indoor molds' evaluation.

Fractional exhaled nitric oxide in relation to asthma, allergic rhinitis, and atopic dermatitis in Chinese children.

OBJECTIVE: Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation. Our aim was to analyze the interrelationship and differentiate the predicting effects of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) on the FeNO levels in children from mainland China. METHODS: A case-control study with age- and gender matched 1:1 was designed based on a larger cross-sectional survey on asthma, AR, and AD in Shanghai. A self-administered questionnaire was used to collect information on children's health information. Children with positive reports on physician-diagnosed asthma and/or AR and/or AD were recruited as cases, and children with no report of any of the diseases were designated as controls. The FeNO measurement was performed online, using the NIOX MINO® instrument (Aerocrine AB, Solna, Sweden) at 50 ml/min. RESULTS: A total of 130 subjects (65 cases and 65 controls, average age = 10 years) were recruited in this study. The average FeNO level was significantly higher in the cases (29.8 ± 1.9 ppb) than that in the controls (13.3 ± 1.7 ppb) (p < .001). Using multiple linear regression analysis controlling for confounding factors, including parental asthma/allergic diseases and home exposure, asthma (ß = 0.330, p < .001) and AR (ß = 0.157, p = .006) showed significant predicting effects for high FeNO levels, whereas AD was not related to the FeNO levels. CONCLUSIONS: Both asthma and AR could independently increase the FeNO levels in Chinese schoolchildren. Other diseases besides asthma should be considered when applying FeNO as a screening tool for asthma in Chinese children.

Eating buckwheat cookies is associated with the reduction in serum levels of myeloperoxidase and cholesterol: a double blind crossover study in day-care centre staffs.

Buckwheat food is a good source of antioxidants, e.g. rutin, and other beneficial substances. Here we investigated the effects of the intake of common buckwheat (low rutin content) and tartary buckwheat cookies (high rutin content) on selected clinical markers. A double blind crossover study was performed among female day-care centre staffs (N = 62) from five day-care centres. Participants were randomly divided into two groups. The first group initially consumed four common buckwheat cookies per day (16.5 mg rutin equivalents/day) for two weeks, while the second group consumed four tartary buckwheat cookies per day (359.7 mg rutin equivalents/day). Then the groups switched their type of cookies and consumed them for another two weeks. We monitored selected clinical markers related to cardiovascular disease and lower airway inflammation, lung function, and subjective breathing difficulties in the staffs. Intake of tartary buckwheat cookies reduced the serum level of myeloperoxidase (MPO) by a factor 0.84 (p = 0.02). When grouping the two types of buckwheat cookies together, there was a reduction of total serum cholesterol (p < 0.001) and HDL-cholesterol (p < 0.001) during the study period, with improved lung vital capacity (p < 0.001). The degree of reduction in total and HDL cholesterol levels was similar in staffs with low and high body mass index (cut off 25). In conclusion, intake of tartary buckwheat cookies with high level of the antioxidant rutin may reduce levels of MPO, an indicator of inflammation. Moreover, intake of both types of buckwheat cookies may lower cholesterol levels.

Respiratory health among Korean pupils in relation to home, school and outdoor environment.

There are few studies about school-environment in relation to pupils' respiratory health, and Korean school-environment has not been characterized. All pupils in 4th grade in 12 selected schools in three urban cities in Korea received a questionnaire (n = 2,453), 96% participated. Gaseous pollutants and ultrafine particles (UFPs) were measured indoors (n = 34) and outdoors (n = 12) during winter, 2004. Indoor dampness at home was investigated by the questionnaire. To evaluate associations between respiratory health and environment, multiple logistic- and multi-level regression models were applied adjusting for potential confounders. The mean age of pupils was 10 yr and 49% were boys. No school had mechanical ventilation and CO(2)-levels exceeded 1,000 ppm in all except one of the classrooms. The indoor mean concentrations of SO(2), NO(2), O(3) and formaldehyde were 0.6 µg/m(3), 19 µg/m(3), 8 µg/m(3) and 28 µg/m(3), respectively. The average level of UFPs was 18,230 pt/cm(3) in the classrooms and 16,480 pt/cm(3) outdoors. There were positive associations between wheeze and outdoor NO(2), and between current asthma and outdoor UFPs. With dampness at home, pupils had more wheeze. In conclusion, outdoor UFPs and even low levels of NO(2) may adversely contribute to respiratory health in children. High CO(2)-levels in classrooms and indoor dampness/mold at home should be reduced.

A Review on Epidemiological and Clinical Studies on Buckwheat Allergy.

BACKGROUND: Cultivated buckwheat include two species originating from China: common buckwheat (Fagopyrum esculentum) and tartary buckwheat (Fagopyrum tartaricum). Buckwheat can cause IgE-mediated allergy, including severe allergic reactions and anaphylaxis. Exposure can occure when eating buckwheat food (food allergen), when producing or handling buckwheat food (occupational exposure) or when sleeping on buckwheat husk pillows (houeshold environmental exposure). METHODS: A search on buckwheat allergy in the medical datbase PubMed from 1970-2020. RESULT: A number of allergenic proteins have been identified in common buckwheat (e.g., Fag e 1, Fag e 2 and Fag e 3) and in tartary buckwheat (e.g., Fag t 1, Fag t 2, Fag t 3). Clinically relevant cross-reactivity has been described between buckwheat and peanut, latex, coconut, quinoa, and poppy seed. The prevalence of buckwheat allergy in the population can be estimated as 0.1-0.4% in Japan, Korea and buckwheat consuming areas of China. Among patients in allergy clinics in different countries, 2-7% has confirmed buckwheat allergy. School studies from Japan and Korea found 4-60 cases of buckwheat-related anaphylaxis per 100,000 school children. The incidence of severe allergic reactions to buckwheat, including anaphylaxis, can be estimated as 0.1-0.01 cases per 100,000 person-years. CONCLUSIONS: Buckwheat allergy is a neglected allegy deserving further attention but severe allergic reactions are rare.

A field study on clinical signs and symptoms in cleaners at floor polish removal and application in a Swedish hospital.

AIM: To study health effects in hospital cleaners (N = 21) at floor polish removal and application. METHODS: The cleaners were investigated before exposure (Monday = day 1), after polish removal work (day 2), and after application of floor polish (day 3). Ratings of symptoms, tear-film break-up-time (BUT), nasal patency and biomarkers in nasal lavage were studied. RESULTS: There was a significant increase both day 2 and day 3, as compared to pre-exposure, in ocular, nasal, throat symptoms, solvent smell, dyspnoea, and general symptoms such as headache and fatigue. Posterior nasal patency was decreased day 2 (p < 0.01) and day 3 (p < 0.01). No change of nasal biomarkers (ECP, MPO, lysozyme, albumin) was seen. BUT was decreased after polish removal (p < 0.01), but not after polish application. Separate test of the weekday effect in non-exposed showed slight improvements, or no change of symptoms or clinical signs from Monday to Wednesday. Air concentrations of ethylene glycol monoethyl ether, ethylene glycol monobutyl ether, diethylene glycol monoethyl ether, dipropylene glycol monomethyl ether, diethylene glycol monoethyl ether and ethylene glycol phenyl ether 103, 666, 13,650, 7,000, 67, and 27 microg/m(3), respectively, at polish application. Glycol ether levels were reduced to 3% after 2 days and 0.3% after 17 days. CONCLUSIONS: Emissions from a common water-based polish remover and floor polish system may cause ocular and airway irritation and general symptoms, and reduce tear-film stability and nasal patency. The levels of glycol ethers had a rapid decay.

Ocular symptoms, tear film stability, nasal patency, and biomarkers in nasal lavage in indoor painters in relation to emissions from water-based paint.

PURPOSE: Despite the decreased use of solvent-based paint (SBP) and increased use of water-based paints (WBP) with possible risk for microbial growth, few health studies are available. The aim was to study the symptoms and ocular and nasal biomarkers in house painters in relation to paint use and personal exposure to volatile organic compounds (VOC) and microbial VOC (MVOC) during indoor painting with WBP. METHODS: All house painters from three major companies and unexposed controls (janitors from one company) were invited, 94% (N = 31) and 95% (N = 20) of non-asthmatics participated, respectively. Tear film break-up time (BUT), nasal patency by acoustic rhinometry, and biomarkers in nasal lavage (NAL) were measured at work, and a doctor's administered questionnaire was answered. Personal sampling (8 h) of formaldehyde, VOC, and MVOC was performed in 17 house painters using WBP. RESULTS: House painters had increase in ocular symptoms, decreased BUT, and increased NAL-lysozyme, when compared to controls. Painters reporting mucosal irritation from WBP had less nasal patency and higher NAL-myeloperoxidase (NAL-MPO). A large proportion of the VOC consisted of propylenglycol, diglycol ethers, and Texanol. There was an association between 8-h exposure to propylene glycol and NAL-eosinophilic cationic protein (NAL-ECP), 2-phenoxyethanol levels and reduced BUT, sum of aliphatic glycol ethers and increased NAL-MPO. Increased levels of 1-octen-3-ol, one MVOC, were related to reduced nasal patency and increase in NAL-MPO. CONCLUSIONS: House painters may have a risk for adverse physiological reactions in the ocular and nasal mucosa. A minority of painters susceptible to WBP can react with neutrophilic nasal inflammation. Different chemicals in the paint could cause either neutrophilic or eosinophilic inflammation, or reduced tear film stability. In addition, house painters are exposed to MVOC which may affect the nasal mucosa.

Psychosocial work environment and medical symptoms among Swedish commercial airline cabin crew.

BACKGROUND: Associations between stress measured by the demands-control model, iso-strain model, and stress-related symptoms among cabin crew were studied. METHODS: A questionnaire about psychosocial work environment and symptoms was answered by 918 (82%) flight attendants, stewards, and pursers at one airline company in 2005. Adjustment was made for age, gender, smoking, job category, and flight length using multiple logistic regression. RESULTS: Weekly headaches, concentration difficulties, fatigue, and gastrointestinal symptoms were reported at rates of 18%, 10%, 56%, and 13%, respectively. Pursers scored higher on control than the others and they had lower associations between the strain measured by the demands-control model and symptoms than stewards and flight attendants. All symptoms were more common in the high strain situation than in the low strain (reference). An active situation was related to an excess of symptoms. Low social support in the iso-strain model increased risk of symptoms. CONCLUSIONS: Demands-control and iso-strain models are useful in studying stress-related symptoms in cabin crews. The dimension of social support adds explanatory value.

Psychosocial and ergonomic factors, and their relation to musculoskeletal complaints in the Swedish workforce.

A random sample of 1 000 subjects (20-65 years old) from the national population of Sweden received a questionnaire; 70% (n=695) replied, of whom 532 were occupationally active. Female gender, working with neck and/or body bent forward, arms above shoulders, and precision work tasks were predictors of musculoskeletal symptoms. Neck, shoulder, and upper back symptoms were more common in a strained situation at work (high demands, low control) (adjusted odds ratios [adjOR] 2.76, 2.80, and 2.26, respectively). Among females, neck and shoulder symptoms were more common in an iso-strain situation (high demands, low control and low social support) (adjOR 4.43 and 3.69, respectively), and low back symptoms were more common at low social support combined with a passive work situation (adjOR 3.35). No associations were found between iso-strain model and symptoms among males. In conclusion, iso-strain work situation was associated with neck symptoms among females, even when controlling for ergonomic factors.

Hearing status among cabin crew in a Swedish commercial airline company.

PURPOSE: To study hearing loss in commercial airline cabin crew (CC). METHODS: Totally 155 male and 781 female CC (n = 936) in a Swedish airline company underwent repeated audiometric tests during 1974-2005. The last test was used to study hearing loss. The mean test values at 3, 4, 6 kHz were used for the ear with worse hearing loss. Data were compared with a Swedish population (n = 603) who were not occupationally exposed to noise. Equivalent noise levels (Leq) were measured in different aircraft. RESULTS: Leq was 78-84 dB (A), maximum A-weighted exposure was 114 dB. Median values for all ages were close to the reference group. No association was found between years of employment and hearing loss, when adjusting for age and gender by multiple logistic regression analysis. CONCLUSION: Cabin crew are exposed to equivalent noise levels below the current Swedish occupational standard, and have normal age-matched hearing threshold levels.

Tinnitus among airline pilots: prevalence and effects of age, flight experience, and other noise.

INTRODUCTION: Frequent or constant tinnitus can be a problem for pilots because it can be distracting and/or interfere with communications in the cockpit. We studied tinnitus in a population of airline pilots to determine its prevalence and identify predictors. METHODS: A total of 418 male and 42 female pilots on duty in a Swedish airline returned a completed tinnitus questionnaire (response rate 79%). Multiple logistic regression analysis was performed; variables retained in the model included age, smoking, exposure to loud impulse noise during leisure time, previous work as a military pilot, years of employment as a commercial pilot, and type of aircraft. When available, the pilots' most recent routine audiometric test (N = 388) was used to study the association between hearing impairment and tinnitus. RESULTS: A total of 40% of respondents had experienced tinnitus for more than 5 min during the past year, 18% reported constant or severe tinnitus, and 12% had at some time visited a doctor for problems related to tinnitus. There were associations between tinnitus and age, impulse noise, and hearing impairment at 3, 4, and 6 kHz. There was no association with aircraft type or work as a military pilot. Pilots with tinnitus were more likely to report themselves disturbed by noise in the cockpit. CONCLUSION: These results show that tinnitus is relatively common among pilots and can create problems with sensitivity to noise. The frequency of tinnitus is most closely related to age, gender, exposure to high impulse noise during leisure time, and hearing impairment.

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

BACKGROUND: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. METHODS: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. FINDINGS: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. INTERPRETATION: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.