RESUMEN
Natural window ventilation is frequently employed in schools in Europe and often leads to inadequate levels of human bioeffluents. However, intervention studies that verify whether recommended ventilation targets can be achieved in practice with reasonable ventilation regimes and that are also suitable for countries with cold winters are practically non-existent. To explore the initial situation in Switzerland we carried out carbon dioxide (CO2) measurements during the winter in 100 classrooms, most of which (94%) had natural window ventilation. In more than two thirds of those, the hygienic limit value of 2000 ppm specified for CO2 in the Swiss Standard SN 520180 (2014) was exceeded. To improve ventilation behavior, an intervention was implemented in 23 classrooms during the heating season. Ventilation was performed exclusively during breaks (to avoid discomfort from cold and drafts), efficiently, and only for as long as was necessary to achieve the ventilation objective of compliance with the hygienic limit value (strategic ventilation). The intervention included verbal and written instructions, awareness-raising via a school lesson and an interactive tool for students, which was also used to estimate the required duration of ventilation. CO2 exposure was significantly reduced in pilot classes (Wilcoxon signed-rank test, p = 3.815e-06). Median CO2 levels decreased from 1600 ppm (control group) to 1097 ppm (intervention group), and the average proportion of teaching time at 400-1400 ppm CO2 increased from 40% to 70%. The duration of ventilation was similar to spontaneous natural window ventilation (+5.8%). Stricter ventilation targets are possible. The concept of the intervention is suitable for immediate adoption in schools with natural window ventilation for a limited period, pending the installation of a mechanical ventilation system. The easy integration of this intervention into everyday school life promotes compliance, which is particularly important during the COVID-19 pandemic.
Asunto(s)
Contaminación del Aire Interior/prevención & control , COVID-19/prevención & control , Monitoreo del Ambiente/métodos , Exposición por Inhalación/prevención & control , Ventilación/métodos , Adolescente , Contaminación del Aire Interior/análisis , COVID-19/epidemiología , COVID-19/transmisión , Dióxido de Carbono/análisis , Niño , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Masculino , SARS-CoV-2 , Instituciones Académicas , Estaciones del Año , Suiza/epidemiologíaRESUMEN
Indoor settled dust may result in substantial human exposure to chemicals, especially by ingestion following hand-to-mouth or hand-to-object-to-mouth contact. As with other environmental media related to exposure, dust may thus be subject to regulation. An international scientific workshop was convened in Paris in September 2019 firstly to assess the relevance for public health of setting guidelines for indoor settled dust, and secondly to discuss scientific and technical challenges related to such guidelines. The main discussions and conclusions, with consensus achieved, are reported herein. Discussions concerned general considerations, objectives and definitions, relevance for a health-based guideline, units of measure, and finally derivation of the guideline. These points should be addressed when considering an indoor settled dust guideline as part of a policy to reduce exposure indoors to a given chemical or group of chemicals.
Asunto(s)
Contaminación del Aire Interior , Polvo , Salud Pública , Exposición a Riesgos Ambientales , Monitoreo del Ambiente , HumanosRESUMEN
BACKGROUND: Researchers dealing with environmental illnesses face complex diagnostic and methodological difficulties. Poor objective findings contrast with high subjective suffering and a firm belief that environmental exposure is the only source of complaints. The Basel pilot research project established a multi-modal assessment procedure and assessed complaints attributed to the environment. Medical, psychological and environmental findings were evaluated as to their pathogenic validity. Furthermore, patients were pooled into distinguishable subgroups in order to formulate more appropriate therapy strategies. METHODS: Sixty-three patients took part in the threefold diagnostic approach (medical examination, psychiatric exploration, environmental analysis) of a mixed qualitative/quantitative study. Interdisciplinary case conferences allowed a consensus rating of the aetiological relevance of the findings to be reached. The discrepancy between self-rating and experts' judgement was exploited for subgroup formation. RESULTS: About 50% of the patients' symptoms could be attributed to psychiatric causes. Based on self-rating and experts' judgement, four subgroups were distinguished with differing medical, psychiatric and environmental aetiologies, personality traits and interactional competencies. CONCLUSIONS: Patients with environment-related disorders form a heterogeneous group. An interdisciplinary assessment and a comparison between self- and experts' judgements enable a more differentiated psychotherapeutic procedure and may enhance future treatment success.
Asunto(s)
Enfermedades Ambientales/psicología , Trastornos Somatomorfos/diagnóstico , Adulto , Anciano , Contaminación del Aire Interior/efectos adversos , Animales , Exposición a Riesgos Ambientales , Enfermedades Ambientales/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Autoevaluación (Psicología) , Trastornos Somatomorfos/psicología , Estrés PsicológicoRESUMEN
BACKGROUND: Adequate assessment of symptoms of patients suffering from environmental illnesses requires appropriate procedures such as psychological and psychiatric diagnostics, medical screening and a thorough analysis of noxious environmental factors. The Basel pilot research project established a multi-methodological assessment procedure that meets these criteria. However, an exhaustive three-fold analysis is very costly in terms of both equipment and personnel, and hence the need for a heuristic approach and pre-screening persists. METHOD: The three-fold diagnostic approach was preceded by a structured psychodynamic interview; the findings were used to construct a new profile of the patient's interactional behaviour (IB) in conjunction with the interviewer's countertransference. The extent to which this new profile could predict the results of the multi-method assessment was then assessed. RESULTS: A low level of IB on the part of the patient significantly predicted the degree of stress and the extent of the psychiatric diagnosis, including personality disorders. A negative IB was associated with negative personality traits. Furthermore, a high level of IB implied more medical, but not more environmental, findings which could plausibly be related to the patient's complaints. CONCLUSIONS: Assessment of patients' IB in conjunction with one's own countertransference is very helpful as a preliminary heuristic approach and may lead to consequences for treatment and therapy. Therefore, the training provided for experts who deal with patients suffering from environment-related complaints should place more specific emphasis on assessing patients' behaviour and on incorporating information gathered from countertransference. Nevertheless, an interdisciplinary assessment including medical, psychological/psychiatric, and environmental expertise remains mandatory for adequate and satisfactory diagnosis of patients with environment-related complaints.
Asunto(s)
Contratransferencia , Enfermedades Ambientales/diagnóstico , Enfermedades Ambientales/psicología , Relaciones Profesional-Paciente , Conducta , Enfermedades Ambientales/terapia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Personalidad , Encuestas y CuestionariosRESUMEN
BACKGROUND: A multidisciplinary approach and a multi-modal methodology are needed to assess idiopathic environmental illnesses. SAMPLE: 61 patients took part in all diagnostic steps. METHOD: In the Basel pilot research project on environmental illness, a threefold diagnostic approach was established: patients had a medical and allergological examination, a psychiatric and psychological exploration and an environmental analysis of their homes. RESULTS: There is a clear psychological impact on environmental illness: 46 % of the symptoms could be traced back to psychological factors, and 18 % seemed to be influenced by them. Nevertheless, in 28 % more than one of the three dimensions was seen as important. Values within the self reporting questionnaires show high correspondence. Whereas patients and experts agree in many instances that there are psychological factors, they disagree in attributing clinical relevance to them. This discrepancy is helpful for explaining the difficulties therapists may encounter as to the patients' compliance. CONSEQUENCES: Environmental illness should be diagnosed and treated on an interdisciplinary basis including psychosomatic medicine.
Asunto(s)
Enfermedades Ambientales/psicología , Enfermedades Ambientales/terapia , Adulto , Enfermedades Ambientales/diagnóstico , Femenino , Humanos , Hipersensibilidad/diagnóstico , Masculino , Persona de Mediana Edad , Proyectos Piloto , Medicina Psicosomática , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIM: In Switzerland, the prevalence of health problems attributed to environmental exposures is unknown, and views differ regarding its magnitude. In the present study we investigated the frequency of environmentally related health problems amongst the patients of Swiss sentinel physicians and assessed symptoms and suspected environmental exposures. METHODS: During 2002, nearly 250 "Swiss Sentinel Surveillance Network" physicians were asked to record the number of patients presenting with environmental health problems and to complete a questionnaire inquiring about suspected environmental exposures and health problems. Physicians offering "alternative" medical therapies also participated in the study. The results were compared with the experience of a Basel University pilot project which evaluated patients with environment-related health problems simultaneously from the medical, psychiatric and environmental viewpoint. RESULTS: 354 environment-related consultations were reported by 72 physicians, corresponding to 0.03% of all sentinel-physician consultations. There were considerable differences both within the group of Sentinella physicians, and between physicians offering "alternative" medical therapies and the Sentinella physicians, in the frequency of environmentally-related consultations, the character of the reported symptoms and the suspected environmental exposures. CONCLUSION: Overall, environmental medicine consultations in general practice were rare. However, experience of the environmental medicine pilot project showed that concerned persons seek help from various health care providers and from environmental agencies. Effective treatment should include counselling by medical, psychiatric and environmental professionals.
Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Métodos Epidemiológicos , Vigilancia de Guardia , Encuestas y Cuestionarios , SuizaRESUMEN
BACKGROUND: Diagnostics and therapy of environmentally related disorders are hampered by one-sided assumptions and by discrepancies between therapists' and patients' assessments of the disease cause. OBJECTIVES: Discrepancies between patient and expert opinions are examined as to (1) whether the sample can be classified in subgroups according to the convergence or divergence between self and expert rating, (2) which features and (3) which disorder-related behaviour and concepts characterize these groups. METHODS: Medical, psychopathological and environmental symptoms were assessed and their relative influence evaluated. Four subgroups were defined by differentiating between high and low psychological stress according to self and expert judgment, and then compared using statistical and qualitative methods. RESULTS: 61 patients were assessed and assigned to four different subgroups according to the number of psychiatric diagnoses, psychological conflicts, personality structure, environmental exposure and psychosocial integration. CONCLUSIONS: Diagnostics of environmentally related disorders must be based on interdisciplinary tools. Treatment should incorporate the individual patient's conception of his or her disorder.
Asunto(s)
Enfermedades Ambientales/diagnóstico , Determinación de la Personalidad , Psicoterapia , Adulto , Anciano , Comorbilidad , Exposición a Riesgos Ambientales/efectos adversos , Enfermedades Ambientales/psicología , Enfermedades Ambientales/terapia , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Persona de Mediana Edad , Grupo de Atención al Paciente , Inventario de Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Autoevaluación (Psicología) , Sensibilidad y Especificidad , Ajuste Social , Estrés Psicológico/complicacionesRESUMEN
PROBLEM: To assess symptoms attributed to the environment from an interdisciplinary perspective and to evaluate the plausibility of the participants' individual theory of a causal relationship between exposure and health impairment. METHOD: We assessed the medical, psychiatric and environmental background in every participant in an environmental medicine project and discussed the explanatory value of our findings for each reported symptom. RESULTS: Every second participant had at least one symptom that could be plausibly explained by simultaneously occurring medical, psychological or environmental findings. In 40% of the participants the research team rated the association between an environmental exposure and the health complaints to be 'plausible'. Psychiatric disorders were frequent, but did not exclude environmentally caused symptoms. CONCLUSION: Only an interdisciplinary structure including medical, psychiatric and environmental expertise is likely to adequately diagnose and advise persons with environmentally related symptoms.
Asunto(s)
Exposición a Riesgos Ambientales , Enfermedades Ambientales/diagnóstico , Enfermedades Ambientales/etiología , Estado de Salud , Consejo , Enfermedades Ambientales/complicaciones , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Trastornos Mentales/etiología , Persona de Mediana Edad , Grupo de Atención al PacienteRESUMEN
Indoor air levels of coplanar polychlorinated biphenyls (mono- and non-ortho substituted PCB) of various buildings were determined. As a consequence of the presence of joint sealings containing PCB, total PCB concentrations in indoor air up to 4,200 ng/m3 were detected (data based on a survey including 29 sampling sites). In a PCB contaminated industrial building, total indoor air PCB levels up to 13,000 ng/m3 were measured. Typical PCB congeners in indoor air include PCB 28, PCB 52, and PCB 101. Concentrations of coplanar (dioxin-like) PCB have been determined for six different sites. The most abundant coplanar PCB congener in indoor air is PCB 118, followed by PCB 105, PCB 123, and PCB 77 in various order. Levels of coplanar PCB, expressed as toxicity equivalents (TEG), do correlate well with the total indoor air PCB concentration: a total PCB level of 1,000 ng/m3 corresponds to a concentration of coplanar PCB of 1.2 pg TEQ/m3. Based on this correlation and on an indoor air PCB level of 6,000 ng/m3 (tentative guideline value for PCB in indoor air in Switzerland based on a daily exposure of 8 h), the maximum daily intake of coplanar PCB via indoor air was estimated to be 0.6 pg TEQ/kg body weight.