Fungal Volatile Organic Compounds: More Than Just a Funky Smell?

Many volatile organic compounds (VOCs) associated with industry cause adverse health effects, but less is known about the physiological effects of biologically produced volatiles. This review focuses on the VOCs emitted by fungi, which often have characteristic moldy or "mushroomy" odors. One of the most common fungal VOCs, 1-octen-3-ol, is a semiochemical for many arthropod species and also serves as a developmental hormone for several fungal groups. Other fungal VOCs are flavor components of foods and spirits or are assayed in indirect methods for detecting the presence of mold in stored agricultural produce and water-damaged buildings. Fungal VOCs function as antibiotics as well as defense and plant-growth-promoting agents and have been implicated in a controversial medical condition known as sick building syndrome. In this review, we draw attention to the ubiquity, diversity, and toxicological significance of fungal VOCs as well as some of their ecological roles.

Numerical Simulations of Synthetic Ester Hydrolysis in the Indoor Environment.

The hydrolysis of synthetic esters (SEs), including phthalates and adipates, in damp indoor environments can lead to the release of volatile organic compounds implicated in poor air quality and acute health impacts, known as "sick building syndrome" (SBS). We have adapted the multiphase atmospheric chemistry box model, GAMMA, to simulate SE hydrolysis occurring in surface films in the indoor environment, along with multilayer boundary layer mass transfer and ventilation, in order to investigate this phenomenon on a process level. We then applied the model to analyze three scenarios in which hydrolysis has been hypothesized to have a significant impact on indoor air quality. Simulation results suggest that (1) alkaline hydrolysis of bis(2-ethylhexyl) adipate (DEHA) and bis(2-ethylhexyl) phthalate (DEHP) from PVC flooring on damp surfaces alone is not sufficient to explain the levels of 2-ethylhexanol reported in indoor air during episodes of SBS; (2) acute exposure to 2,2,4-trimethyl-1,3-pentanediol (TMPD) may be of concern during and shortly after the application of latex paint on an alkaline surface; and (3) alkaline hydrolysis of SEs following their airborne uptake in aqueous films is not expected to generate considerable amounts of alcohols associated with SBS.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population.

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

Moisture damage and fungal contamination in buildings are a massive health threat - a surgeon's perspective.

OBJECTIVES: Indoor air toxicity is of major public health concern due to the increase in humidity-induced indoor mould exposure and associated health changes. The objective is to present evidence for the causality of health threats and indoor mould exposure. METHODS: PubMed search on the following keywords: dampness, mould, indoor air quality, public health, dampness, and mould hypersensitivity syndrome, sick building syndrome, and building-related illness as well as information from the health authorities of Bavaria and North Rhine-Westphalia, the Center of Disease Control (CDC), World Health Organisation (WHO), and guidelines of professional societies. RESULTS: The guidelines of professional societies published in 2017 are decisive for the assessment of the impact of mould pollution caused by moisture damage on human health and for official regulations in Germany. Until 2017, a causal connection between moisture damage and mould exposure could usually only be established for pulmonary diseases. The health risk of fungal components is apparent as documented in the fungal priority pathogens list (FPPL) of the WHO. Since 2017, studies, especially in Scandinavia, have proved causality between moisture and mould exposure not only for pulmonary diseases but also for extrapulmonary diseases and symptoms. This was made possible by new test methods for determining the toxicity of fungal components in indoor air. Environmental medical syndromes, e.g., dampness and mould hypersensitivity syndrome (DMHS), sick building syndrome (SBS), building-related symptoms (BRS), and building-related illness (BRI), and fungal pathogens, e.g., Aspergillus fumigatus, pose a major threat to public health. CONCLUSION: There is evidence for the causality of moisture-induced indoor moulds and severe health threats in these buildings. According to these findings, it is no longer justifiable to ignore or trivialize the mould contamination induced by moisture damage and its effects on pulmonary and extrapulmonary diseases. The health and economic implications of these attitudes are clear.

AGE AND GENDER-SPECIFIC FEATURES OF CYTOGENETIC CHANGES IN BUCCAL EPITHELIUM IN INDIVIDUALS RESIDING IN THE «SICK BUILDING¼.

OBJECTIVE: The aim: The study of cytomorphological and cytogenetic features of the buccal epithelium of residents of apartments who complained of unpleasant odors in their homes. PATIENTS AND METHODS: Materials and methods: The state of buccal epithelium in residents of multi-story buildings was studied. A total of 237 individuals were examined, 117 males and 120 females, aged from 6 to 81 years. Buccal cells were collected using a sterile spatula and stained with a 2.5% solutionofaceto-orcein and 1% light green. The preparations were examined using a light microscope OPTON Axioskop (Germany) with oil immersion at a magnification of x1000. Statistical processing of the data was performed using IBMSPSS Statistics 29.0.0.0 (t-Student criterion; Mann-Whitney; ANOVA: Tukey; T3-Dunnett), with p≤0.05. RESULTS: Results: Cytomorphological and cytogenetic abnormalities, compared to physiological limits, were mainly manifested as karyorrhexis, nuclear doubling, the appearance of epitheliocytes with perinuclear vacuoles, or nuclear vacuolization. The frequency of micronuclei was observed in the range of (0.3-2.8 ‰). The highest micronucleus index (per 1000 cells, ‰) was observed among males aged 15-39 years and females over 65 years old. In both sexes, the lowest micronucleus indices were found in the age group of 6-14 years. CONCLUSION: Conclusions: in the «sick building¼ an increase in the frequency of micronucleus occurrence among males and females was observed simultaneously with increasing age.

Effects of occupant behaviors on perceived dormitory air quality and sick building syndrome symptoms among female college students.

We performed a cross-sectional survey of 2143 female students in a university in Tianjin, China regarding perceived air quality (PAQ) and sick building syndrome (SBS) symptoms in the student dormitory. The prevalence of general, mucosal, and skin symptoms was 22.1%, 21.9%, and 26.3%, respectively. The three most prevalent PAQ complaints were "dry air" (48.9% often), "stuffy odor" (18.2%), and "other unpleasant odors" (5.1%), and they were significant risk factors for 11-12 out of 12 SBS symptoms (adjusted odds ratios [AOR]: 1.6-5.8). Survey data of 1471 undergraduates, whose dorms were of uniform layout and furnishing, were used to further investigate the influences of occupancy level and occupant behaviors on PAQ and SBS symptoms. Frequent use of air freshener/perfume was a significant risk factor for "dry air," less frequent room cleaning and higher occupancy density were significant risk factors for "stuffy odor," and less natural ventilation was a significant risk factor for both "stuffy odor" and "pungent odor." These factors were also significantly associated with some SBS symptoms. In particular, the use of air freshener/perfume exhibited a significant dose-response pattern with "fatigue" (sometimes: AOR 1.3; often: AOR 2.0) and with "irritated, stuffy, or runny nose" (sometimes: AOR 1.6; often: AOR 2.2).

The effect of inhaled air temperature on thermal comfort, perceived air quality, acute health symptoms and physiological responses at two ambient temperatures.

We explored the importance of inhaled air temperature on thermal comfort, perceived air quality, acute non-clinical health symptoms, and physiological responses. Sixteen subjects stayed in a stainless-steel chamber for 90 min. They experienced four conditions with two inhaled air temperatures of 22 and 30°C and two ambient temperatures of 22 and 30°C in a 2 × 2 design. They wore breathing masks covering their mouth and nose to control the inhaled air temperature; the air was provided from an adjacent twin stainless-steel chamber. The subjects evaluated thermal conditions and health symptoms on visual-analogue scales. Skin temperature and electrocardiography were recorded. Whole-body thermal sensation and skin temperature did not change when the temperature of inhaled air was changed. Perceived air quality was significantly improved when subjects sat in the chamber at 30°C and inhaled air with a temperature of 22°C; under these conditions lip and throat dryness were significantly reduced. The lower inhaled air temperature increased time-domain heart rate variability indicators and decreased heart rate and the LF/HF ratio, suggesting that the parasympathetic nervous system was activated and the sympathetic nervous system was suppressed.

Associations between indoor environment and lifestyles and sick building syndrome symptoms among adults in Taiyuan and Urumqi of China.

The complex and uncertain causes of sick building syndrome (SBS) have become one of the most challenging and hot issues worldwide. Studies on the correlation between indoor environment and SBS based on local characteristics are relatively limited in China. We studied typical SBS risk factors related to the indoor environment and lifestyle in two northern Chinese cities. The study population was drawn from parents of pre-school children in randomized daycare centers in Taiyuan, Shanxi, and Urumqi, Xinjiang, China (N = 6838). Data on SBS and indoor environment were obtained from cross-sectional questionnaires. Odds ratios (OR) were estimated by multilevel logistic regression and adjusted using gender, atopy, own smoking, home size, and dampness index. Results showed that location, homeownership, year of construction completion, changes in the indoor environment (new furniture and decorations), and changes in indoor air (smoking, burning mosquito repellent and incense, cooking fuels including electricity, natural gas, coal, and wood) might contribute to different levels of SBS in Chinese adults, including eye, nasal, throat, dermal symptoms, and headache and tiredness. The results of the subgroup analysis suggest city and gender differences in susceptibility. Daily cleaning, window opening, and improved ventilation effectively improved SBS. People should improve their indoor environment and lifestyles based on sensitivity factors, gender, and geographic characteristics to reduce SBS risks.

A high environmental composite quality factor score was associated with the risk of sick building syndrome among adults in northeast China.

OBJECTIVES: Epidemiological evidence regarding the association between the combination of indoor and outdoor neighborhood pollution and sick building syndrome (SBS) among adults is limited and inconsistent. A cross-sectional study was conducted to investigate the association between the environmental composite quality factor score and SBS among adults. METHODS: This study included 2594 females and 666 males aged 18-77 years enrolled from the Northeast China. The environmental composite quality factor score was computed based on factors potentially associated with SBS risk, including the outdoor neighborhood pollution sources (the housing on the street, the presence of pollutants within 100 m of the house (gutters, garbage stations, noise, chemical pollution, and dust pollution), and the presence of arterial roads, factories, and chimneys) and indoor pollution sources (redecoration, clean fuel used for heating/cooking, cooking oil fume (COF) outside kitchen, using of mosquito coil or repellent, and using of incense). We performed multivariate logistic regression analysis to calculate the odds ratios (ORs) and 95% confidence intervals (95%CIs) between environmental composite quality factor score, indoor pollution composite factor score, outdoor neighborhood pollution composite factor score, and SBS adjustment for covariates. Further, we also did the stratified analysis and constructed a weighted score to verify the results. RESULTS: Compared with the lowest environmental composite quality factor score, the ORs of the highest scores were: 1.58 (95% CI, 1.20-2.27, Ptrend = 0.001) for general symptoms; 1.73 (95% CI, 1.35-2.23, Ptrend < 0.001) for mucosal symptoms and 1.75 (95% CI, 1.34-2.29, Ptrend < 0.001) for dermal symptoms and 1.81 (95% CI, 1.36-2.42, Ptrend < 0.001) for all of the three symptoms. We also observed similar patterns with the using of weighted scores and stratified analysis. CONCLUSION: Higher exposure to indoor pollution sources and outdoor pollution sources near the residence may be associated with a higher risk of SBS in adults in northeast China.

Prevalence of sick building syndrome in hospital staff and its relationship with indoor environmental quality.

The aim of this study was to determine the prevalence of sick building syndrome (SBS), and its relationship with indoor environmental quality in hospital settings. This cross-sectional study was carried out on 300 hospital staff in Sivas. MM 040 NA Hospital questionnaire was applied. In the hospital indoor environments, air quality (carbon monoxide (CO), carbon dioxide (CO2), oxygen (O2), methane (CH4), hydrogen sulfide (H2S), nitrogen oxides (NOx)), lighting, noise, respirable dust and thermal comfort measurements were made. The prevalence of SBS was determined as 64.7-74.1% in the hospitals. It was found that the risk of SBS was 4.31 times higher for those who complained about variable room temperature and 3.11 times higher for those who complained about noise, and decreased 1.01 times with the increase in lighting level. In order to minimize the risk of SBS, it is thought that all healthcare administrators should be informed about SBS.

Indoor air quality and sick building syndrome in a university setting: a case study in Greece.

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Symptoms and oxylipins in plasma before and after exposure to rooms in which individuals have both experienced and not experienced building-related symptoms - an exploratory study.

The aim of this study was to investigate if there are differences in symptom ratings and plasma concentrations of oxylipins as a measure of acute inflammation between individuals with building-related symptoms (BRS) and referents during exposure to rooms where people experienced BRS and rooms where they did not experience BRS. Medically examined individuals with BRS and healthy, age and sex matched referents working in the same building were exposed for 60 min. Ratings of symptoms and collection of blood to measure oxylipins in plasma were performed before and after each exposure. Individuals with BRS reported more symptoms (mostly mucosal) than the referents in the problem rooms and there was a tendency towards a difference between the groups in concentration of metabolites from the cyclooxygenase pathway (COX). The mean reported intensity of symptoms among all participants was also found to be positively correlated with both COX and lipoxygenase (LOX-15) oxylipins in problem rooms.

Rapid and selective detection of macrocyclic trichothecene producing Stachybotrys chartarum strains by loop-mediated isothermal amplification (LAMP).

Cytotoxic macrocyclic trichothecenes such as satratoxins are produced by chemotype S strains of Stachybotrys chartarum. Diseases such as stachybotryotoxicosis in animals and the sick building syndrome as a multifactorial disease complex in humans have been associated with this mold and its toxins. Less toxic non-chemotype S strains of S. chartarum are morphologically indistinguishable from chemotype S strains, which results in uncertainties in hazard characterization of isolates. To selectively identify macrocyclic trichothecene producing S. chartarum isolates, a set of sat14 gene-specific primers was designed and applied in a loop-mediated isothermal amplification (LAMP) assay using neutral red for visual signal detection. The assay was highly specific for S. chartarum strains of the macrocyclic trichothecene producing chemotype and showed no cross-reaction with non-macrocyclic trichothecene producing S. chartarum strains or 152 strains of 131 other fungal species. The assay's detection limit was 0.635 pg/rxn (picogram per reaction) with a reaction time of 60 min. Its high specificity and sensitivity as well as the cost-saving properties make the new assay an interesting and powerful diagnostic tool for easy and rapid testing.

Associations between indoor environment in residential buildings in wet and dry seasons and health of students in upper northern Thailand.

We performed a repeated questionnaire study on home environment and health (six medical symptoms) in 1159 junior high school students (age 12.8 ± 0.7 years) in upper northern Thailand in wet and dry seasons. Data on outdoor temperature, relative humidity (RH), and air pollution were collected from nearest monitoring station. Odds ratios (OR) were calculated by multi-level logistic regression. Most common symptoms were rhinitis (62.5%), headache (49.8%), throat (42.8%), and ocular symptoms (42.5%). Ocular symptoms were more common at lower RH and rhinitis more common in dry season. Water leakage (28.2%), indoor mold (7.1%), mold odor (4.1%), and windowpane condensation (13.6%) were associated with all six symptoms (ORs: 1.3-3.5). Other risk factors included cat keeping, environmental tobacco smoke (ETS), other odor than mold odor, gas cooking, and cooking with biomass fire. Biomass burning inside and outside the home for other reasons than cooking was associated with all six symptoms (ORs: 1.5-2.6). Associations between home environment exposure and rhinitis were stronger in wet season. In conclusion, dampness-related exposure, windowpane condensation, cat keeping, ETS, gas cooking, and biomass burning can impair adolescent health in upper northern Thailand. In subtropical areas, environmental health effects should be investigated in wet and dry seasons.

Association of subjective health symptoms with indoor air quality in European office buildings: The OFFICAIR project.

The aim of this study was to explore the association between the building-related occupants' reported health symptoms and the indoor pollutant concentrations in a sample of 148 office rooms, within the framework of the European OFFICAIR research project. A large field campaign was performed in 37 office buildings among eight countries, which included (a) 5-day air sampling of volatile organic compounds (VOCs), aldehydes, ozone, and NO2 (b) collection of information from 1299 participants regarding their personal characteristics and health perception at workplace using online questionnaires. Stepwise and multilevel logistic regressions were applied to investigate associations between health symptoms and pollutant concentrations considering personal characteristics as confounders. Occupants of offices with higher pollutant concentrations were more likely to report health symptoms. Among the studied VOCs, xylenes were associated with general (such as headache and tiredness) and skin symptoms, ethylbenzene with eye irritation and respiratory symptoms, a-pinene with respiratory and heart symptoms, d-limonene with general symptoms, and styrene with skin symptoms. Among aldehydes, formaldehyde was associated with respiratory and general symptoms, acrolein with respiratory symptoms, propionaldehyde with respiratory, general, and heart symptoms, and hexanal with general SBS. Ozone was associated with almost all symptom groups.

Associations of indoor carbon dioxide concentrations, air temperature, and humidity with perceived air quality and sick building syndrome symptoms in Chinese homes.

The indoor environment influences occupants' health. From March 1, 2018, to February 28, 2019, we continuously monitored indoor temperature (T), relative humidity (RH), and CO2 concentration in bedrooms via an online system in 165 residences that covered all five climate zones of China. Meanwhile, we asked one specific occupant in each home to complete questionnaires about perceived air quality and sick building syndrome (SBS) symptoms at the end of each month. Higher CO2 concentration was significantly associated with a higher percentage of perceived stuffy odor and skin SBS symptoms. Higher relative humidity was associated with higher percentage of perceived moldy odor and humid air, while lower RH was associated with a higher percentage of perceived dry air. Occupants who lived in residences with high RH were less likely to have mucosal and skin SBS symptoms (adjusted odds ratio (AOR): 0.73-0.78). However, the benefit of high humidity for perceived dry air and skin dryness symptoms is weaker if there is a high CO2 concentration level.

Teachers' work-related non-literature-known building-related symptoms are also connected to indoor toxicity: A cross-sectional study.

A previous study showed that classical building-related symptoms (BRS) were related to indoor dust and microbial toxicity via boar sperm motility assay, a sensitive method for measuring mitochondrial toxicity. In this cross-sectional study, we analyzed whether teachers' most common work-related non-literature-known BRS (nBRS) were also associated with dust or microbial toxicity. Teachers from 15 schools in Finland completed a questionnaire evaluating 20 nBRS including general, eye, respiratory, hearing, sleep, and mental symptoms. Boar sperm motility assay was used to measure the toxicity of extracts from wiped dust and microbial fallout samples collected from teachers' classrooms. 231 teachers answered a questionnaire and their classroom toxicity data were recorded. A negative binomial mixed model showed that teachers' work-related nBRS were 2.9-fold (95% CI: 1.2-7.3) higher in classrooms with highly toxic dust samples compared to classrooms with non-toxic dust samples (p = 0.024). The RR of work-related nBRS was 1.8 (95% CI: 1.1-2.9) for toxic microbial samples (p = 0.022). Teachers' BRS appeared to be broader than reported in the literature, and the work-related nBRS were associated with toxic dusts and microbes in classrooms.

Skin sensitivity to capsaicin, perceived stress and burn out among patients with building-related symptoms.

OBJECTIVE: The mechanisms behind building-related symptoms have remained unknown despite many years of research. It is known that environmental and psychosocial factors are of importance. Some receptors in the Transient Receptor Potential family elicit the same symptoms when stimulated, as reported by those suffering from building-related symptoms. The aim of this study was to compare capsaicin sensitivity between people with and without skin symptoms. A second aim was to investigate perceived stress among individuals with different levels of capsaicin sensitivity. METHODS: People referred to an occupational health care unit and judged to have building-related symptoms by a physician answered a questionnaire regarding their symptoms. Solutions with different capsaicin concentrations were applied to participants' nasolabial folds. Self-reported stress and burnout were assessed using two questionnaires: the Perceived Stress Scale (PSS) and the Shirom-Melamed Burnout Questionnaire (SMBQ). RESULTS: We found that people who reported facial erythema or itching, stinging, tight or burning facial skin were more sensitive than those without symptoms and similarities with Sensitive Skin are discussed. We also found that participants who reacted to the lowest capsaicin concentrations scored significantly higher on scales for stress and burnout. CONCLUSIONS: We found associations between sensitivity to capsaicin and skin symptoms among people with building-related symptoms, as well as associations between capsaicin sensitivity and perceived stress/burnout.

Removal of chemical hazardous compounds using CATACOAT, a nano-platinum thermal catalyst system.

The performance of CATACOAT, a nano-platinum thermal catalyst system, was evaluated for the removal of chemical hazardous compounds from air. Xylene, benzene, styrene, and toluene were selected as standard volatile organic compounds (VOCs) in this study. In addition, formaldehyde was tested as a chemical hazardous compound. Each VOC, or formaldehyde, was evaporated in a 4,000 L chamber under controlled environments. At the maximum concentration point, CATACOAT was turned on and the concentrations of the chemical hazardous compounds were recorded for 5 h. The air purifier based on H-13-grade high-efficiency particulate air (HEPA) filter was tested in the same way to compare the effects of CATACOAT. Compared with the HEPA filter system, every VOC concentration was significantly decreased with the CATACOAT system only 0.025 h after turning on the air purifier (P values for xylene, benzene, styrene, and toluene are 0.00488, 0.01508, 0.00014, and 0.04690, respectively). After running the air cleaners for 5 h, every VOC and formaldehyde demonstrated significantly decreased concentrations with the CATACOAT system, compared with HEPA filter system (P values for xylene, benzene, styrene, toluene, and formaldehyde are 0.00034, 0.00009, 0.00008, 0.00001, and 0.00571, respectively). In conclusion, the CATACOAT may be a viable solution to control indoor air pollution.

Sick building syndrome among healthcare workers and healthcare associates at observed general hospital in Slovenia.

OBJECTIVE: The aim of this study was to assess the possible associations between self-perceived sick building syndrome (SBS) symptoms among healthcare workers and healthcare associates and self-perceived parameters of indoor work environment quality. METHODS: The cross-sectional study was conducted from February to April 2019. Validated standardized evaluation tools (MM 040 NA Hospital 2007 and MM 040 NA Office 2007) were used for estimating the prevalence of SBS among observed populations. Chi-square and Mann-Whitney U tests for assessing possible associations in SBS symptoms between healthcare workers and associates were used. RESULTS: The response rate was 69.8%. The results showed a lower prevalence of six or more SBS symptoms in healthcare associates (6.4%) compared to healthcare workers (12.0%). Healthcare workers perceived the most frequent risk factors for SBS to be poor air quality, an inappropriate level of relative humidity, and inappropriate room temperature, while the least frequently self-perceived risk factors were inappropriate lighting and noise levels. CONCLUSIONS: This study represents a platform for further analyses - the identification of health risk factors with environmental monitoring.