Tradução e adaptação transcultural brasileira do Cuestionario para detección del Síndrome del Edifício Enfermo / Traducción y adaptación transcultural brasileña del Cuestionario para la detección del Síndrome del Edificio Enfermo / Brazilian Translation and Cross-Cultural Adaption of the Questionnaire for Detecting Sick-Building Syndrome

Introdução: A mensuração de fenômenos em Saúde possui implicação na detecção precoce de agravos. A Saúde do Trabalhador no Brasil e seu potencial para internacionalização facilitam o uso de materiais estrangeiros de mensuração de fenômenos. Objetivo: Adaptar transculturalmente o Cuestionario para Detección del Síndrome del Edifício Enfermo para o contexto de trabalhadores de saúde brasileiros. Métodos: Estudo metodológico, transversal, quantitativo, a partir das etapas: 2 traduções iniciais, 1 síntese das traduções, 2 retrotraduções, comitê de especialistas e pré-teste realizado com 37 trabalhadores de saúde de um hospital. As variáveis numéricas foram abordadas por análise estatística descritiva univariada, utilizando-se tabelas de frequência para sumarizar os dados. Resultados: O instrumento foi traduzido e submetido às etapas de adaptação transcultural, e sofreu alterações de itens, além de adequações: semântica, idiomática, cultural e conceitual. Os trabalhadores participantes do pré-teste também contribuíram com modificações no questionário e eram em sua maioria técnicos de enfermagem, enfermeiros e médicos; referiram preocupação com sua saúde, e muitos apresentaram queixas de adoecimento físico relacionado ao trabalho. Após as modificações de itens e substituições de termos, foi obtida uma versão adaptada. O pré-teste possibilitou a observação de problemas frequentes como trabalho em turnos prolongados e a pouca oportunidade de tomada de decisão do trabalhador. Conclusão: O questionário adaptado para o português do Brasil está adequado ao contexto dos trabalhadores de saúde brasileiros e constitui recurso a detecção precoce da Síndrome do Edifício Doente na visão contextual do trabalho(AU)

Introducción: La medición de los fenómenos de salud tiene implicaciones para la detección temprana de enfermedades. La salud laboral en Brasil y su potencial de internacionalización facilitan el uso de materiales extraños para medir fenómenos. Objetivo: Adaptar transculturalmente el cuestionario para detección del síndrome de edificio enfermo en el contexto de los trabajadores de salud brasileños. Métodos: Estudio metodológico, transversal y cuantitativo, a partir de los pasos: 2 traducciones iniciales, 1 síntesis de traducciones, 2 traducciones posteriores, comité de expertos y prueba previa realizada con 37 trabajadores de salud de un hospital. Las variables numéricas se abordaron por análisis estadístico descriptivo univariado, utilizando tablas de frecuencia para resumir los datos. Resultados: El instrumento fue traducido y sometido a las etapas de adaptación intercultural, y sufrió cambios en los ítems, así como ajustes: semántico, idiomático, cultural y conceptual. Los trabajadores que participaron en la prueba previa también contribuyeron a las modificaciones en el cuestionario y fueron en su mayoría técnicos de enfermería, enfermeras y médicos; informaron preocupación por su salud y muchos se quejaron de enfermedades físicas relacionadas con el trabajo. Después de las modificaciones de los ítems y las sustituciones de términos, se obtuvo una versión adaptada. La prueba previa permitió observar problemas frecuentes, como trabajar turnos largos y la poca oportunidad para que el trabajador tomara decisiones. Conclusiones: El cuestionario adaptado al portugués brasileño es apropiado para el contexto de los trabajadores de salud brasileños y es una característica de detección temprana del síndrome del edificio enfermo en la vista del trabajo(AU)

Introduction: The measurement of health phenomena has implications concerning early detection of diseases. Occupational health in Brazil and its potential for internationalization facilitate the use of foreign materials to measure phenomena. Objective: To adapt, cross-culturally, the questionnaire for the detection of sick-building syndrome in the setting of Brazilian health workers. Methods: Methodological, cross-sectional and quantitative study based on the following steps: two initial translations, one synthesis of translations, two subsequent translations, a committee of experts, and a preliminary test carried out with 37 health workers from a hospital. The numerical variables were addressed by univariate descriptive statistical analysis, using frequency tables to summarize the data. Results: The instrument was translated and subjected to the intercultural adaptation stages, and underwent changes in the items, as well as adjustments of the following types: semantic, idiomatic, cultural and conceptual. The workers who participated in the pre-test also contributed to the modifications in the questionnaire and were mostly nursing technicians, nurses and doctors; they reported concern for their health, and many complained over work-related physical illnesses. After the modifications of the items and the substitutions of terms, an adapted version was obtained. The pre-test revealed frequent problems, such as working long shifts and little opportunity for the worker to make decisions. Conclusions: The questionnaire adapted to Brazilian Portuguese is appropriate for the setting of Brazilian health workers, and is a feature of early detection of sick-building syndrome in the workplace(AU)

Comorbidity and Multimorbidity of Asthma and Allergy and Intolerance to Chemicals and Certain Buildings.

OBJECTIVES: We tested the hypothesis of high comorbidity between asthma/allergy and chemical intolerance (CI) and between asthma/allergy and building intolerance (BI), and high multimorbidity between asthma/allergy, CI, and BI. METHODS: Population-based questionnaire data were used from 530 participants with asthma/allergy (allergic asthma, nonallergic asthma, allergic rhinitis, and/or atopic dermatitis), 414 with self-reported and 112 with physician-diagnosed CI, and 165 with self-reported and 47 with physician-diagnosed BI. Separate reference groups were formed for each of the five case groups. RESULTS: Adjusted odds ratios varied from 4.6 to 13.1 for comorbidity, and from 6.6 to 46.4 for multimorbidity. CONCLUSION: The large comorbidity and multimorbidity between asthma/allergy, CI, and BI evokes the question as to whether there are similarities in underlying mechanisms between these conditions.

Sick building syndrome (SBS) among office workers in a Malaysian university--Associations with atopy, fractional exhaled nitric oxide (FeNO) and the office environment.

There are few studies on sick building syndrome (SBS) including clinical measurements for atopy and fractional exhaled nitric oxide (FeNO). Our aim was to study associations between SBS symptoms, selected personal factors, office characteristics and indoor office exposures among office workers from a university in Malaysia. Health data were collected by a questionnaire (n=695), skin prick test (SPT) (n=463) and FeNO test (n=460). Office settled dust was vacuumed and analyzed for endotoxin, (1,3)-ß-glucan and house dust mites (HDM) allergens group 1 namely Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1). Office indoor temperature, relative air humidity (RH), carbon monoxide (CO) and carbon dioxide (CO2) were measured by a direct reading instrument. Associations were studied by two-levels multiple logistic regression with mutual adjustment and stratified analysis. The prevalence of weekly dermal, mucosal and general symptoms was 11.9%, 16.0% and 23.0% respectively. A combination of SPT positivity (allergy to HDM or cat) and high FeNO level (≥25 ppb) was associated with dermal (p=0.002), mucosal (p<0.001) and general symptoms (p=0.05). Der f1 level in dust was associated with dermal (p<0.001), mucosal (p<0.001) and general (p=0.02) symptoms. Among those with allergy to D. farinae, associations were found between Der f 1 levels in dust and dermal (p=0.003), mucosal (p=0.001) and general symptoms (p=0.007). Office-related symptoms were associated with Der f 1 levels in dust (p=0.02), low relative air humidity (p=0.04) and high office temperature (p=0.05). In conclusion, a combination of allergy to cat or HDM and high FeNO is a risk factor for SBS symptoms. Der f 1 allergen in dust can be a risk factor for SBS in the office environment, particularly among those sensitized to Der f 1 allergen.

The Diagnosis of Sick House Syndrome: the Contribution of Diagnostic Criteria and Determination of Chemicals in an Indoor Environment.

OBJECTIVE: The study group for sick house syndrome (SHS) in Japan has proposed the classifications, definition and diagnostic criteria for chemical-associated SHS. We compared the physicians' diagnoses to the diagnoses based on the patients' interview sheets including diagnostic criteria only. METHODS: We examined 287 patients with complaints of SHS-like symptoms. We also checked determinations of chemical substances in the patients' homes. RESULTS: A total of 76.0% of the patients were diagnosed as having SHS. Physicians diagnosed 87.6% of those patients as having chemical-associated SHS based on SHS classifications, definition and diagnostic criteria. Based on the patients' interview sheets, 50.3% of the patients who were diagnosed as chemical-associated SHS corresponded to the diagnostic criteria. The 51 of those chemical-associated SHS patients had answered that the chemical substance levels in their homes had been checked, and 20 of those patients answered that at least one of the chemical substance levels was above that set in the guideline by the Japanese Ministry of Health, Labour and Welfare. CONCLUSIONS: Physicians should use all of the classifications, definition and diagnostic criteria. Even if the chemical levels in the home are under the guideline levels, the diagnosis of chemical-associated SHS should not be excluded.

Building-Related Symptoms among Office Employees Associated with Indoor Carbon Dioxide and Total Volatile Organic Compounds.

This study investigated whether sick building syndrome (SBS) complaints among office workers were associated with the indoor air quality. With informed consent, 417 employees in 87 office rooms of eight high-rise buildings completed a self-reported questionnaire for symptoms experienced at work during the past month. Carbon dioxide (CO2), temperature, humidity and total volatile organic compounds (TVOCs) in each office were simultaneously measured for eight office hours using portable monitors. Time-averaged workday difference between the indoor and the outdoor CO2 concentrations (dCO2) was calculated as a surrogate measure of ventilation efficiency for each office unit. The prevalence rates of SBS were 22.5% for eye syndrome, 15.3% for upper respiratory and 25.4% for non-specific syndromes. Tiredness (20.9%), difficulty in concentrating (14.6%), eye dryness (18.7%) were also common complaints. The generalized estimating equations multivariate logistic regression analyses showed that adjusted odds ratios (aORs) and 95% confidence interval (CI) per 100 ppm increase in dCO2 were significantly associated with dry throat (1.10, 95% CI=(1.00-1.22)), tiredness (1.16, 95% CI=(1.04-1.29)) and dizziness (1.22, 95% CI=(1.08-1.37)). The ORs for per 100 ppb increases in TVOCs were also associated with upper respiratory symptoms (1.06, 95% CI=(1.04-1.07)), dry throat (1.06, 95% CI=(1.03-1.09)) and irritability (1.02, 95% CI=(1.01-1.04)). In conclusion, the association between some SBS symptoms and the exposure to CO2 and total VOCs are moderate but may be independently significant.

[Psychosocial factors in indoor work-related symptoms. Application of the MM040/IAQ questionnaire. ]. / Fattori psicosociali nei sintomi correlate al lavoro in interni. Applicazione del questionario MM040/IAQ.

AIMS: To study the relationship between psychosocial factors and the perception of the work environment by means of a questionnaire and to evaluate the efficacy of using a questionnaire for contributing to the solution of environmental problems and for monitoring work-related stress. METHODS: Before the routine medical examination, the occupational physician administered questionnaires to all the employees who had been working at least one year in an indoor environment in 28 companies. 4,029 out of 4,129 subjects participated (97.6%). RESULTS: There was a significant association between psychosocial factors and perception of the work environment. The association between psychosocial factors and symptoms was also significant. CONCLUSIONS: RESULTS confirmed the role of psychosocial factors in the perception of the work environment and in the attribution of symptoms to occupational exposure, without excluding the possibility that symptoms were actually caused by occupational exposure. The questionnaire proved to be a valid tool for monitoring perceived occupational stress.

[Clinical findings of the patients with sick building syndrome and the results of environmental measurement].

OBJECTIVES: Although many survey reports on sick house syndrome have been published, few clinical studies have reported sick building syndrome (SBS) in Japan. We examined patients with SBS-like complaints by clinical observation and made environment measurements. METHODS: The subjects of our study were 11 office workers (2 men and 9 women) who visited our hospital because of poor physical condition after the construction and painting of a fireproof vault in their office. We performed a medical interview, biochemical examinations of blood, immunological tests, pulmonary function tests, and psychological tests. The environment in the office was evaluated 3 times at 27, 55, and 132 days after the cessation of vault construction. A questionnaire survey was distributed to the workers who did not visit our hospital. RESULTS: The workers resumed work 9 days after the end of construction: Shortly after the resumption of work, most of the workers smelled a bad odor, and complained of headache, malaise, disturbed concentration, and eye irritation. Acrylic resin paint was used for painting the vault, and the concentrations of toluene, xylene, and total volatile organic compounds (T-VOC) on day 27 after painting were 2,972, 2,610, and 7,100 µg/m³, respectively. One hundred and thirty-two days after painting, the concentrations of toluene, xylene, and T-VOC decreased to unscented levels of 78, 113, and 261 µg/m³, respectively. CONCLUSION: Seven females among the eleven patients were diagnosed as having SBS on the basis of the time of the onset of the symptoms, negative results of allergy and other organic diseases, and the results of the environment measurements. From the responses of the other workers (22 men and 1 woman) to the survey questionnaire, the development and the disappearance of complaints, such as bad odor and unpleasantness, agreed with change of the level of toluene in the vault, which confirmed the validity of the SBS diagnosis.

[The adventures of "Sick Building Syndrome"]. / Les aventures du «syndrome du bâtiment malsain¼.

The Sick Building syndrome concept is used to describe a variety of minor symptoms that afflict groups of people in the workplace or in public buildings. In theory, the sick building syndrome is characterized by an unspecified etiology: it underlines a multiplicity of possible causes, environmental or psychosocial, which produce various effects. In practice, the concept is often misused as a synonym of the psychogenic syndrome. The paper explores this "etiological reduction" and highlights some of the problematic consequences. The authors advocate for the recognition of uncertainty, which is in their opinion, a source and driver of renewed reflection in the public health area.

Cambio climático y piel: retos diagnósticos y terapéuticos / Climatic Change and Skin: Diagnostic and Therapeutic Challenges

Numerosos científicos informan de una tendencia actual al calentamiento global y a la disminución de las precipitaciones. Su cuantía, sus causas y la influencia de la actividad humana son motivo de controversia. Un aumento de la temperatura podría incrementar la prevalencia de algunas patologías cutáneas; más personas padecerían piel sensible y una mayor xerosis cutánea por disminución de la humedad relativa. Las alteraciones de la función de la barrera cutánea aumentarían la gravedad y prevalencia de la dermatitis atópica. La mayor proporción de radiación UVB que alcanza la superficie terrestre, unida a hábitos poblacionales de aumento de fotoexposición, junto con una fotoprotección incorrecta, hacen esperables mayores tasas de cáncer cutáneo y de fotoenvejecimiento. Además, los hábitats de diversos vectores de patologías infecciosas están cambiando. Afrontar estos problemas, en caso de que se produjesen, será un reto para el dermatólogo, que tendrá una importante labor de prevención, diagnóstico y tratamiento precoz de estas patologías (AU)

Scientifics are warning us about a global warming tendency and diminished rainfalls. Quantity, causes and human activity influence remain controversial. Warming could increase prevalence of some cutaneous pathology. Sensible skin and skin xerosis would be more prevalent if relative humidity decreases. Alterations of skin barrier`s function would increase seriousness and prevalence of atopic dermatitis. Furthermore, the higher UVB proportion reaching Earth′s surface, in conjunction with increased sunbathing population habits, will increase cutaneous cancer and photoaging rates without a correct photoprotection. Also, habitats of some infectious diseases` vectors are changing. The facing of these problems will be a real challenge for the dermatologist, who will have a very important role on prevention, diagnoses and early treatment of them (AU)

Relationship between indoor chemical concentrations and subjective symptoms associated with sick building syndrome in newly built houses in Japan.

OBJECTIVES: This study explored possible associations between chemical substances and sick building syndrome (SBS)-type symptoms of residents living in new houses in Japan. METHODS: We randomly sampled 5,709 newly built conventional homes. In the end, 1,479 residents in 425 households completed a questionnaire survey and agreed to environmental monitoring for indoor aldehydes and volatile organic compounds (VOCs) to be conducted in their homes. If the residents had complained about at least one SBS-related symptom, they were classified as suffering from SBS. Multiple logistic regression analysis was used to select predictive chemical factors of SBS symptoms. RESULTS: About 14% of the subjects suffered from SBS. Many aldehydes and VOCs were associated factors of optical, nasal, and gular symptoms in univariate analysis. After adjustment for other possible risk factors, formaldehyde dose-dependently showed to be a significant risk factor for SBS. Several chemicals had tendency to be associated with SBS symptoms. CONCLUSIONS: Chemicals detected in Japanese newly built houses tend to increase the risk of subjective symptoms in residents suffering from SBS.

[Functional somatic syndromes in the treatment of allergic diseases and their related disorders].

Functional somatic syndromes (FSS) are characterized by patterns of persistent bodily complaints for which adequate examination does not reveal sufficiently explanatory structural or other specified pathology. Here we reviewed the following diseases or pathologies: nervous cough, vocal cord dysfunction, multiple chemical sensitivity and sick building syndrome. All of these often accompany co-morbid psychiatric disorders, such as anxiety disorder and depression. Therefore, bio-psycho-social understanding and approach are required for diagnosis and treatment of patients with these diseases. Specific psychotherapy may be applicable when symptoms are aggravated by psychological factors.

A longitudinal study of environmental risk factors for subjective symptoms associated with sick building syndrome in new dwellings.

This study was performed to explore possible environmental risk factors, including indoor chemicals, mold, and dust mite allergens, which could cause sick building syndrome (SBS)-type symptoms in new houses. The study was conducted in 2004 and 2005 and the final study population consisted of 86 men and 84 women residing in Okayama, Japan. The indoor concentrations of indoor aldehydes, volatile organic compounds, airborne fungi, and dust mite allergens in their living rooms were measured and the longitudinal changes in two consecutive years were calculated. A standardized questionnaire was used concomitantly to gather information on frequency of SBS-type symptoms and lifestyle habits. About 10% of the subjects suffered from SBS in the both years. Crude analyses indicated tendencies for aldehyde levels to increase frequently and markedly in the newly diseased and ongoing SBS groups. Among the chemical factors and molds examined, increases in benzene and in Aspergillus contributed to the occurrence of SBS in the logistic regression model. Indoor chemicals were the main contributors to subjective symptoms associated with SBS. A preventive strategy designed to lower exposure to indoor chemicals may be able to counter the occurrence of SBS.

[Diagnosis of multiple chemical sensitivity by chemical compounds exposure tests].

OBJECTIVE: There are no specific signs or symptoms in Multiple Chemical Sensitivity (MCS), so diagnosis of MCS depends on a history, QEESI symptom scores and exclusion of other diseases. A gold standard of diagnosis of MCS is a chemical compound exposure test in which changes of symptoms are used to decide the results positive or negative. We have done chemical compound exposure tests to diagnose MCS in 51 patients. METHODS: Chemical compound exposure tests were done in a special facility (the exposure chamber) in our hospital. Used VOC were formaldehyde or toluene. Maximum exposure concentrations were 0.08 ppm and 0.07 ppm for formaldehyde and toluene, respectively. Forty patients had the tests by a open test manner and 11 patients by a single blinded manner. RESULTS: In the open tests, 18 patients had positive results and 22 patients negative. In 22 patients who had negative results, eleven showed no symptoms by chemical exposures, and other 11 claimed symptoms before VOC went into the chamber. In the single blinded tests, 4 patients had positive results and 7 patients negative. CONCLUSION: The chemical exposure test is the most reliable test to diagnose MCS, so standardization of the methods of the test is necessary.

Symptom definitions for SBS (sick building syndrome) in residential dwellings.

The potential risk factors for sick building syndrome (SBS) in newly built dwellings were investigated. Two different definitions for SBS were used, a narrow definition (symptoms related to home environment and continuously occurring in the last 3 months were regarded as positive) and another relatively broad definition (symptoms related to home environment and either continuously or sporadically occurring in the last 3 months were regarded as positive). With both definitions indoor air chemicals, especially TVOC, and high stress during work were found to be significantly associated with SBS symptoms. Allergic history was more associated with narrow-sense symptoms and odor perception with broad-sense symptoms. The results indicate that the broad definition be preferred to find more potential risk factors.

Projective drawings for assessing stress among subjects with medical symptoms compatible with sick building syndrome, and validation of a modified version of the Stress Load Index from the Drawing Personality Profile: a pilot study.

It was hypothesized that subjects with medical symptoms would show more signs of stress in projective drawings. A Stress Load Index, including five signs of stress in drawings, was evaluated. A questionnaire with an instruction to draw "a person in the rain" was sent to a cohort of 195 subjects, and the drawings were analysed blindly for eight stress items. Men had a higher index than women (p < .05) and drew clouds more often (p < .05). Drawing of clouds was associated with headache (adjOR = 4.28; 95% CI 1.75; 11.68). Drawing of puddles was associated with ocular symptoms (adjOR = 3.22; 95% CI 1.38, 7.50), facial dermal symptoms (adjOR= 2.94; 95% CI 1.28, 6.81), and tiredness (adjOR = 2.44; 95% CI 1.05, 5.67). Drawing of long rain strokes was associated with nasal symptoms (adjOR = 2.28; 95% CI 1.05, 2.06) and headache (adjOR = 3.20; 95% CI 1.28, 8.05). Age and stress load were predictors of sick building syndrome symptoms (p < .05). In conclusion, a nonverbal projective drawing test detected sex differences which represent directions opposite to those with verbal methods. These need empirical assessment.

Classification of patients complaining of sick house syndrome and/or multiple chemical sensitivity.

Sick house syndrome (SHS) is a Japanese concept derived from sick building syndrome (SBS), however SHS includes a broader scope of sickness than does SBS. Symptoms of SHS/SBS disappear after leaving the sick house/building, while symptoms of multiple chemical sensitivity (MCS) are elicited by the chance of chemical exposure after leaving the sick house/building. To establish the concept of SHS, we propose to introduce a new classification for SHS. A total of 214 patients complaining of SHS and/or MCS were independently classified using a new classification by clinical ecologists who are experienced physicians with expert knowledge of clinical ecology and general physicians according to disease pathogenesis from clinical records. The classification is as follows: type 1 (symptoms of chemical intoxication), type 2 (symptoms developed possibly due to chemical exposure), type 3 (symptoms developed not because of chemical exposure but rather because of psychological or mental factors), and type 4 (symptoms developed due to allergies or other diseases). The agreements on the classification made by clinical ecologists and general physicians reached 77.1% (Cohen's kappa=0.631), suggesting that this new classification was both apt and accurate. Relations between SHS and allergy/MCS were also studied. The cases classified as SHS type 4 more frequently had allergic past histories than did other types. The proportion of possible MCS cases was higher in the chemical induced SHS group (types 1 and 2) than in other types among male patients. For the universal use in clinical practice, it is necessary to prepare helpful diagnostic criteria of this SHS classification based on pathogenesis and carry our study forward all over the country.

[Influence of work climate on the sick building syndrome]. / Influenza del clima lavorativo sulla sick building syndrome.

The potential risk factors for sick building syndrome (SBS) are not yet well elucidated. A questionnaire was administered concerning environmental conditions at the work place and complaints before and after the take-over of one company from another corporation. Workers had to move into new company, but were still working in old office building. Before the change, environmental objective and subjective conditions and workers' wellbeing were within normal range. The change did not involved air quality, however results of the questionnaire demonstrated an increased irritation of the mucous membranes and a reduction of well-being. The level and severity of symptoms appeared to be related to perceived indoor environment quality, and depression score. High stress related to work changes was found to be significantly associated with SBS symptoms. The psychosocial work environment can be an important predictor of SBS symptoms.

[Trial of isolation of sick house syndrome and unclassified multiple chemical sensitivities--Definition of sick house syndrome, and symptoms].

PURPOSE: This study was designed to clarify the definition of sick house syndrome (SHS). METHODS: SHS was defined based on the disease related to habitation as follows. 1. The cause of the onset of a disease relates to house. 2. Symptoms appear within house. 3. Symptoms will be less serious or disappear if patient away from house. 4. If patient goes into house, symptoms will appear repeatedly. When it corresponded to all above, it was defined to SHS, and it classified as MCS (multiple chemical sensitivities) without above conditions. Even if SHS is isolated from similar disease completely, characteristic symptoms of MCS are hard to be detected because MCS are combination of two or more diseases. Based on this working hypothesis, the logistic regression by setting MCS as reference was performed so that characteristic symptoms of SHS show odds ratios with exceeding one. RESULTS: The odds ratios with more than two of characteristic symptoms in SHS were "nausea or vomiting" "Troublesome in everything" and the causative substances to which symptoms get worse was "The smell of a perfume and cosmetics". Characteristic symptoms of an allergy disease were detected by comparison with the allergic conjunctivitis, allergic rhinitis, and bronchial asthma, respectively. CONCLUSION: These results showed that the classification method was appropriate. This definition is not fundamentally differed from the definition of the sick-building syndrome of WHO.

[Multiple chemical sensitivity in sick-building syndrome]. / Hipersensibilidad química mútiple en el síndrome del edificio enfermo.

The sick building syndrome includes irritation of the eyes and the respiratory tract neurotoxicity affectation and skin problems, which can occur in individuals under improperly ventilated buildings. Poor air quality, as shown in CO2 atmospheric levels of more than 1,000 ppm, results in a pathological exposure to biological and chemical products. We present a work-related case of multiple chemical hypersensitivity from a dialysis unit that had no air renewal. This person, who was summitted to continuous exposure despite having taken corrective measures in the ventilation, developed chronic fatigue syndrome. An acoustic voice observation alerted of the case which led to the analysis of the environmental conditions which confirmed the relationship between multiple chemical hypersensitivity and chronic fatigue syndrome. This case stresses the neglected fact that all health service centres pose a high risk of chemical exposure and that there exists a lack of rigoroursness in putting in practice scientific medical knowledge.