Effect of ventilation systems on prevalence of symptoms

associated with "sick buildings" in Brazilian commercial

establishments
Maria De Fatima Barrozo Costa; Lelia de Souza da Rocha Brickus. Archives of Environmental
Health 55.4 (Jul/Aug 2000): 279-83.
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In this questionnaire study, the authors compared the prevalence of certain symptoms and signs
associated with Sick Building Syndrome and perceptions relative to environmental discomfort of
employees in a central-air-conditioned dropping center and in natural-ventilation commercial
shops located on the streets of Niteroi, Rio de Janeiro, Brazil. There was a statistically significant
higher prevalence of symptoms (e.g., water and itching of eyes, sore throat, nose irritation,
difficulty breathing, skin irritation, sneezing) that were characteristic of Sick Building Syndrome
in the air-conditioned building than in the naturally ventilated stores. The results indicated that
there exists a continuing need for further research in Brazilian work environments.

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Headnote
ABSTRACT. In this questionnaire study, the authors compared the prevalence of certain
symptoms and signs associated with Sick Building Syndrome and perceptions relative to
environmental discomfort of employees in a central-air-conditioned shopping center and in
natural-ventilation commercial shops located on the streets of Niteroi, Rio de Janeiro, Brazil.
There was a statistically significant higher prevalence of symptoms (e.g., water and itching of
eyes, sore throat, nose irritation, difficulty breathing, skin irritation, sneezing) that were
characteristic of Sick Building Syndrome in the air-conditioned building than in the naturally
ventilated stores. The results indicated that there exists a continuing need for further research in
Brazilian work environments.
IN TODAY'S BRAZILIAN SOCIETY, more and more people are working in nonindustrial
workplaces. In these work environments, several possibly hazardous chemical or biological
agents can act individually or collectively, and unfavorable environments for occupants may

result. Indoor air quality (IAQ) investigations are only in the early stages in Brazil.',2 In 1996,
smoking was banned in Brazilian public buildings, but people nonetheless continue to smoke in
these locations. At present, government agencies are beginning discussions with the public about
indoor air guidelines for mechanically ventilated environments. In 1998, the Brazilian Ministry
of Health3 regulated the operation and maintenance of central-air-conditioned systems in
buildings.
In several investigations, researchers have focused on IAQ in nonindustrial environments in
developed nations. These studies generated much data about symptoms or specific diseases that
occur in mechanically ventilated buildings.4-6 A range of symptoms-such as headache and
irritated nose, throat, and eyes-is more prevalent among workers in air-conditioned environments
than among those in naturally ventilated environments. When researchers compare the ultimate
effects of mechanically ventilated buildings in developed countries and in warmer countries (e.g.,
Brazil), they must account for differences in climate, socioeconomic status, method of working,
type of air-conditioning systems, furniture, and building features.
During the 1980s, the building of huge central-airconditioned shopping centers in several major
Brazilian cities occurred. These shopping centers are modern in design and light in structure.
Synthetic materials are used widely, and the buildings are ventilated mechanically and are well
insulated. These shopping centers employ thousands of people, and they are frequented by many
thousands of customers every day. Very specific indoor environments result from the
concentration of people (i.e., customers and workers) and from the commercial activities. One
shopping center can contain many kinds of stores (e.g., clothing, book, shoe, food, printshop,
bowling, theater). Inasmuch as the products for sale have been manufactured recently, they retain
high chemical compound emission rates. Given the aforementioned factors, as well as the low
ventilation rates and the presence of an indoor parking lot, poor air quality can exist in these
environments.
In the current study, we present results from a survey of 3,254 workers employed at a central-airconditioned shopping center and in naturally ventilated street stores in Niteroi, Brazil. We
attempted to delineate relevant physical and psychosocial risks factors in the workplaces
investigated. In addition, we sought to relate these risks to individuals' physical and
psychological health.
Method
This comparative study was undertaken in downtown Niteroi, a bayside city surrounded by
Guanabara Bay and located 20 km from downtown Rio de Janeiro in southeast Brazil. The
climate in Niteroi is tropical; the monthly mean temperatures vary between 21 C (une and July)
and 29 C (anuary and February). Situated at a latitude of 22E54'S and a longitude of 43E10'W,
the city has uniformly high yearly temperatures, high humidity, and abundant rainfall (average =
1,207 mm/y). The questionnaire was conducted in September 1996. We identified shoe- and
clothing-store employees who worked either in stores located in a central-airconditioned
shopping center (i.e., study group) or in naturally ventilated shoe and clothing stores located on
streets near the shopping center (i.e., reference group).

Characterization of stores. The central-air-conditioned shopping center, constructed in the mid1980s, comprised 5 floors of predominantly open-plan stores. The building has an area of 70,000
mz. This area is distributed among 270 stores, restaurants, movie theaters, and a 3-story indoor
garage for more than 1,000 automobiles. Approximately 3,500 people are employed by the
shopping center, which is frequented by 50,000 individuals each day. The naturally ventilated
street stores were constructed in the late 1930s, and they are located on streets near the large
shopping center. The naturally ventilated buildings are adjacent to several busy streets in a
commercial zone.
All structures in our study were concrete and had either wall paint or wall furnishings (i.e., wood,
ceramic, paper and formic wood). The floor materials were wood or ceramic or plastic tiles.
Carpeting was found in only the shoe stores. Furnished materials were made of varnished wood
and synthetic materials. The shoppingcenter environment was brighter than that in the street
stores, and computerized fluorescent lamps were used throughout the center. The street stores,
however, had good daylight exposure supplemented by ceiling suspended fluorescent lights.
Study population. The source population comprised 384 workers in 43 stores located at the
shopping center and 39 workers in street stores. We selected shopping-center stores randomly,
whereas we selected street stores if they were similar to the shopping-center stores with respect
to size, commercial activity, and furnishing materials.
Eighty-five percent of workers (n = 325) answered a self-administered questionnaire; 13 workers
were excluded because they had been at the job less than 6 mo. The final study population
comprised 309 workers (i.e., 80% of the source population); 196 workers were in the study group
(SG), and 188 workers were in the reference group (RG).
Questionnaire survey. We distributed a self-administered questionnaire to the source population
in September of 1996.' The participants were questioned about each symptom studied. We also
included questions about indoor air quality and complaints related to the work environment, as
well as questions about personal and environmental factors potentially related to symptoms. We
did not inform the participants of the specific purposes of our study.
We analyzed the results with chi-square and p values (p < .05), and all statistical analyses were
performed with Statistical Package EPI INFO software (version 6.04 from the World Health
Organization).
Results
In mechanically ventilated buildings, architectural features (e.g., airtight construction) lit
predominantly by fluorescent lights have been implicated in the etiology of health problems. In
the SG, 68% reported at least one Sick Building Syndrome symptom, compared with 41 % in the
RG. The majority of workers at the central-- air-conditioned building said that the symptoms
were most acute during the times they spent at their workplaces (Fig. 1 ).

Select demographic data for the subpopulations we studied are presented in Table 1. The age of
workers and their smoking habits were similar in both groups, but there was a slightly higher
number of females in the SG (57%) than in the RG (52%).
A slightly higher duration of employment (i.e., individuals who had worked 2+ y) was evident in
the SG (i.e., 75% had worked 2+ y in the facilities studied) than in the RG (48.3%). Poor morale
about low salaries was expressed by 47.8% of the SG and by 46.3% of the RG; 8-hr shifts were
the norm for both groups. In addition to sales activities, employees were responsible for
organizational and maintenance duties.
Less than 7.5% of the study and reference populations considered themselves irritated, sad,
and/or stressed (Table 2). The two groups differed, however, with respect to environmental
conditions to which they were subjected (Fig. 2). In the RG population, 59.7% complained about
noise, compared with 1.9% of the SG (p < .001 ). Complaints about type of illumination (12.2%
RG, 41.9% SG; p < .001 ); humidity (5.4% RG, 14.4% SG; p < .01 ); and odor (10.8% RG,
40.6% SG; p < .001 ) were prevalent environmental concerns in this study (Table 3).
General symptoms and p values are presented in Table 4. Of the 12 general symptoms studied,
significant p values were determined for 5 (i.e., headache, lethargy, fever associated with
inadequate room temperature, neck and back pain). A strong difference was noted for lethargy (p
< .001 ), and a significant difference existed for headache (p < .05), fever (p < .05), back pain (p
< .01 ), and neck pain (p < .01 ). No significant difference existed between the two groups with
respect to allergy symptoms (15% SG, 12.8% RG), asthma conditions (0.6% SG, RG = 0%), and
bronchitis (< 1.3% for both groups).
The majority of the symptoms that differed significantly between the groups were respiratory and
allergic in nature (Table 5). The most significant differences (p < .001 ) between the groups
existed for eye focusing, sore-- throat irritation, cold- and flu-like symptoms, and difficulty in
breathing. With the exception of coughing and wheezing, all remaining symptoms (Table 4) were
significantly different in the two groups (p = .01-.05).
Discussion
The primary reason that we included environmental discomfort data (Table 3) was to indicate
which aspects of the environments were of most concern to workers. The noise-related
complaints, which were raised by 59% of workers from the reference group, were based on the
amount of street traffic that occurred near each store. In addition, the high-illumination
complaints resulted from the use of fluorescent lights, which radiate more ultraviolet (UV) rays
than do natural light. It is well known that UV irradiation may cause eye irritation, especially to
photosensitive individuals. Robertson et al .$ studied buildings with central-air-conditioned
systems or natural ventilation and found that workers shared a great dislike of fluorescent
lighting.
The main reason for odor-related complaints from the study group population was an exchange
rate of less than 10% air/hr in the air-conditioned system. Such exchange favors a build-up of
odorous substances that result from the release of chemical substances from fastfood restaurants,

cleaning products, and from the sale of tobacco and smoke-related products. One must remember
that the shopping center in our study is frequented by approximately 50,000 individuals each day.
Fanger et al.9 studied the relationship between odor and poor air quality, and they concluded that
the human olfactory and other senses are often more sensitive to poor air quality than to any
other chemical analysis.
We confirmed that more than 50% of workers in each group complained about uncomfortable
workplace temperatures. As noted earlier, questionnaires were answered during the spring
season, which is very hot and humid. The complaints raised by the RG were expected inasmuch
as the stores had natural ventilation. The SG's complaints indicated that the air-conditioning
systems alone were not sufficient to guarantee thermal comfort. Air-conditioning systems must
be adjusted properly if comfortable temperatures are to be maintained. Unfortunately, cold
temperatures in buildings in Brazil are very common. Santos et al.10 identified the same effect
when they investigated thermal comfort in bank employees in Sao Paulo, Brazil. The airconditioning system, if not thermally adjusted, can cause harm to the occupants' health because
when the individuals exit the building, they often are greeted by very high outdoor temperatures.
This sudden change in temperature can make the occupants feel very sick.
We added mean age, smoking habits, work stress, ergonomics, stomach pain, and work
satisfaction to our research to provide insight about confounding parameters in the target
population. With the exception of ergonomics, no significant differences were found. Both
groups studied participated in on-the-job activities that require standing for a long time and
lifting of packages; therefore, complaints about ergonomics in both groups were common. The
significant differences found for back and neck pain (Table 4) were associated with use of
computers at 80% of the shopping-center stores. The majority of street stores, however, were not
equipped with computers. Sauter et al.11 reported that video display terminal (VDT) operators
sometimes experience higher levels of musculoskeletal complaints than clerical workers who do
not use such equipment. Therefore, the results are consistent with the job characteristics of the
population we studied. Moreover, in some studies investigators12 have reported that use of VDTs
is associated with irritating ocular symptoms in air-conditioned environments. In our study, we
found a significant difference in ocular symptoms between the groups (Table 5) that was
attributable to use of VDTs by the employees of the shopping center.
Our results are similar to those found in developed nations,'31'4 where there has been a high
incidence of symptoms among employees who work at mechanically ventilated buildings verus
those who work at naturally ventilated facilities. The results of these investigations underscore
the fact that prevalence of symptoms is not caused by one single factor but, rather, by a
combination of factors.
Conclusion
In this study, we found a higher incidence of workrelated complaints and general and irritative
symptoms in employees who worked in air-conditioned environments located in a tropical area.
In the past, research studies'5,16 of the Sick Building Syndrome have focused mainly on office
workers. In our current study, we found that such symptoms were also common among other
populations, as was the case with commercial-establishment workers. We must conduct

additional questionnaire studies to establish the prevalence of the symptoms described herein in
other Brazilian environments.
The authors thank the many colleagues who contributed to this work. In addition, Dr. Leila S.R.
Brickus thanks Fiocruz/Faperj Cooperation for a research fellowship.
Submitted for publication March 10, 1999; revised; accepted for publication January 10, 2000.
Requests for reprints should be sent to Dr. Leila de Souza da Rocha Brickus, Funda4;ao Oswaldo
Cruz, ENSP/CESTEH, Laboratorio deToxRJ, 21041-210, Brazil.
References
References
References
1.Miguel AH, Aquino Neto FR, Cardoso, JN, et al. Characterization of indoor air quality in cities
of Sao Paulo and Rio de Janeiro, Brazil. Environ Sci Technol 1995(b); 29:338-45.
2. Brickus LSR, Cardoso lN, de Aquino Neto FR. Distributions of indoor and outdoor air
pollutants in Rio de Janeiro, Brazil: implications to indoor air quality in bayside offices. Environ
Sci Technol 198:3:q4RS-9fl
References
3. Ministerio da Saude.. Diario Official da Uniao, 31/08/1998. Brasilia, Brazil: Ministerio da
Sade-Gabinete do Ministro; Secao 1:40-42. [Ministry of Health. Union Official Report,
08/31/98. Brasilia, Brazil: Ministry of Health-Minister Office; section 1:40-42.)
4. Jaakkola ), Tuomaala P, Seppanen O. Textile wall materials and Sick Building Syndrome. Arch
Environ Health 1994; 49:175-81.
5. McDonald JC, Armstrong B, Cherry NM, et al. Sick Building Syndrome in a Canadian office
complex. Arch Environ Health 1993; 48:298-304.
References
6. Rotton J, White SM. Air pollution, the Sick Building Syndrome, and social behavior. Environ
Intern 1996; 22:53-60.
7. Costa MFB. Estudo comparativo da sindrome de edificio doente entre trabalhadores de
ambiente aclimatado artificialmente a com ventilacao natural. [Comparative study of Sick
Building Syndrome among workers in mechanical and natural ventilation environments.] Rio de
Janeiro, Brazil: Universidade Estacio de Sa, Master of Science dissertation; 1998. (English
summary provided.)

8. Robertson AS, Mcinnes M, Glass D, et al. Building sickness: are symptoms related to the
office lighting? Ann Occup Hyg 1989; 33:47-59.
References
9. Fanger PO, Lauridsen J, Bluissen P, et al. Air pollution sources in offices and assembly halls,
quantified by the olf unit. Energy Build 1988; 12:7-19.
10. Santos U, Rumel D, Martarello N, et al. Sindrome dos edificios doentes em bancarios. [Sick
Building Syndrome in bank workers.] Revista de Saude Publica 1992; 26:400-04.
11. Sauter SL, Gottlieb MS, Jones KC, et al. Job and health implications of VDT use: initial
results of the Wisconsin-NIOSH study. Commun ACM 1983; 26:284-93.
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12. Skov P, Valbjorn O. Danish indoor climate study group. The Sick Building Syndrome in the
office environment: the Danish Town Hall study. Environ Int 1987; 13:339-49.
13. Abbritti G, Muzi G, Accattoli MI? et al. High prevalence of Sick Building Syndrome in a
new air-conditioned building in Italy. Arch Environ Health 1992; 47:16-21.
References
14. Mendell M, Smith A. Consistent pattern of elevated symptoms in air-conditioned office
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A case-referent study of personal psychosocial and building-related risk indicators. Int J
Epidemiol 1994; 23:1190-97.
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AuthorAffiliation
MARIA DE FATIMA BARROZO COSTA LEILA DE SOUZA DA ROCHA BRICKUS
Funda;ao Oswaldo Cruz
ENSP/CESTEH
Laboratorio de Toxicologia Rio de Janeiro, Brazil
Copyright HELDREF PUBLICATIONS Jul/Aug 2000

Indexing (details)
Cite
MeSH
Adult, Air Conditioning -- adverse effects, Brazil -- epidemiology, Female, Humans, Male,
Middle Aged, Occupational Exposure -- analysis, Prevalence, Questionnaires, Sick Building
Syndrome -- etiology, Sick Building Syndrome -- physiopathology, Occupational Exposure -adverse effects (major), Sick Building Syndrome -- epidemiology (major), Ventilation -- methods
(major)
Title
Effect of ventilation systems on prevalence of symptoms associated with "sick buildings" in
Brazilian commercial establishments
Author
Maria De Fatima Barrozo Costa; Lelia de Souza da Rocha Brickus
Publication title
Archives of Environmental Health
Volume
55
Issue
4
Pages
279-83
Number of pages
5
Publication year
2000
Publication date
Jul/Aug 2000
Year
2000
Publisher
Kirkpatrick Jordon Foundation
Place of publication
Washington
Country of publication
United States
Publication subject
Public Health And Safety, Abstracting And Indexing Services, Environmental Studies, Medical
Sciences, Physical Fitness And Hygiene
ISSN
00039896
Source type
Scholarly Journals
Language of publication
English
Document type

Journal Article, Comparative Study

Accession number
11005434
ProQuest document ID
201255985
Document URL
http://search.proquest.com/docview/201255985?accountid=44396
Copyright
Copyright HELDREF PUBLICATIONS Jul/Aug 2000
Last updated
2011-09-07
Database
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