Occupational skin and respiratory symptoms, and disease, are common problems. Workers can develop new disease or aggravate existing disease as a result of exposures at work. Many workers are exposed to chemicals that can cause both respiratory and skin responses and there is evidence that some workers experience symptoms in both systems. There is also evidence that skin exposure may lead to sensitization and the development of respiratory disease. There is very little research that has examined both airborne and skin exposures together with lung and skin outcomes. The purpose of this thesis was to further investigate the relationships between occupational exposures, skin symptoms and disease, and respiratory symptoms and disease. Four studies were undertaken to improve our understanding of these complex relationships. Results from a study of clinical patch test data determined that seven of the ten most common occupational contact allergens are also capable of causing occupational asthma and that these common occupational exposures may not be recognized as sensitizers in common reference materials. Exposure-response relationships for skin symptoms were modeled in bakery workers and auto body shop workers using historical data; significant exposure-response relationships were found for auto body workers. In two separate studies of concurrent skin and respiratory symptoms, workers did report concurrent skin and respiratory symptoms. In predictive models, subjects reporting a history of eczema were more likely to report concurrent skin and respiratory symptoms. Overall, the results from this thesis provide more evidence that the skin and respiratory systems are associated. This body of work suggests that: (1) several common occupational exposures can cause disease in both the skin and respiratory system; (2) a portion of workers report both skin and respiratory symptoms; and (3) exposure-response relationships do exist for skin symptoms, both work-related and non-work-related. Future studies need to gather detailed information about exposure and response in both systems in order to better determine the role of exposure(s) in the development of skin and respiratory symptoms. Improved understanding of these relationships will allow for more targeted and effective exposure prevention strategies and will ultimately reduce the burden of occupational disease.

Occupational skin and respiratory symptoms, and disease, are common problems. Workers can develop new disease or aggravate existing disease as a result of exposures at work. Many workers are exposed to chemicals that can cause both respiratory and skin responses and there is evidence that some workers experience symptoms in both systems. There is also evidence that skin exposure may lead to sensitization and the development of respiratory disease. There is very little research that has examined both airborne and skin exposures together with lung and skin outcomes. The purpose of this thesis was to further investigate the relationships between occupational exposures, skin symptoms and disease, and respiratory symptoms and disease. Four studies were undertaken to improve our understanding of these complex relationships. Results from a study of clinical patch test data determined that seven of the ten most common occupational contact allergens are also capable of causing occupational asthma and that these common occupational exposures may not be recognized as sensitizers in common reference materials. Exposure-response relationships for skin symptoms were modeled in bakery workers and auto body shop workers using historical data; significant exposure-response relationships were found for auto body workers. In two separate studies of concurrent skin and respiratory symptoms, workers did report concurrent skin and respiratory symptoms. In predictive models, subjects reporting a history of eczema were more likely to report concurrent skin and respiratory symptoms. Overall, the results from this thesis provide more evidence that the skin and respiratory systems are associated. This body of work suggests that: (1) several common occupational exposures can cause disease in both the skin and respiratory system; (2) a portion of workers report both skin and respiratory symptoms; and (3) exposure-response relationships do exist for skin symptoms, both work-related and non-work-related. Future studies need to gather detailed information about exposure and response in both systems in order to better determine the role of exposure(s) in the development of skin and respiratory symptoms. Improved understanding of these relationships will allow for more targeted and effective exposure prevention strategies and will ultimately reduce the burden of occupational disease.

The overall aim of this thesis is to increase our knowledge of the physical environment of office workers with special focus on electromagnetic fields and to address the question of whether electromagnetic fields can directly or indirectly contribute to symptoms or discomfort among video display terminal ( VDT) workers. Furthermore, we have measured light modulation from various commonly used light sources in laboratory conditions and, as a second step, used modulated light as stimulus for provocation of neurophysiological responses in persons with perceived “electrical hypersensitivity” (EHS).During the last 20 years work-related illness among office workers has received increased attention. Changes in the physical environment, the introduction of VDTs and other electrical equipment and changes in light conditions have been discussed in this context. The basis for this thesis is the interdisciplinary Office Illness Project in Northern Sweden. Using a questionnaire completed by 4,943 office workers, 150 VDT workers with or without facial skin symptoms were selected for a case referent study of the electromagnetic fields in offices.When the measurements in the offices were performed in 1989, the general level of the 50 Hz magnetic fields in the offices was rather low, but in 5% of the offices the flux density exceeded 0.5 pT. At this level VDT monitors were shown to display detectable instability (jitter). Furthermore, the ability of test subjects (healthy volunteers) to detect jitter was shown to depend on both the amplitude and frequency characteristics of this instability. The study indicates that the instability of computer monitors and thereby the instability of the visual image of the VDT screen might be an increasing problem since it is known that the harmonic content of the general magnetic field in offices is on the rise.VDT monitors contributed to the magnetic field level at VDT workplaces in both extremely low and very low frequency ranges. However, the dominant source of electric fields in rooms was ungrounded electrical equipment, not VDT screens.High electric fields in the extremely low frequency range in the offices were associated with skin symptoms among VDT workers. The causal nature of this association cannot be determined since it may depend on undetected factors related to exposure. No associations were found, however, for any of the VDT-related electromagnetic fields and skin symptoms.Commonly used fluorescent tubes in our office environment have a degree of modulation of the light (flicker) that varies widely from less than 1% (fluorescent tubes with high frequency gear) up to nearly 100%. When persons with perceived EHS were exposed to flickering light, a higher amplitude of brain cortex responses were found at all tested frequencies compared with control subjects. These findings are of considerable interest, but further studies are required in order to establish a possible relationship between flickering light and discomfort/symptoms in persons with perceived EHS. / digitalisering@umu

The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers. The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses. In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more work- related facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents. The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS). / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 5 uppsatser.</p> / digitalisering@umu