Sachiko Hojo

Application of Quick Environment Exposure Sensitivity Inventory (QEESI©) for Japanese population: study of reliability and validity of the questionnaire

A standardized questionnaire has not been established for screening or diagnostic assessment of patients with multiple chemical sensitivity (MCS) in Japan. In the US, Miller and Prihoda (1999a, b) developed a questionnaire that could be used internationally, the Quick Environment Exposure Sensitivity Inventory (QEESI©), to assist researchers and clinicians in evaluating patients and populations for chemical sensitivity. The Japanese version of QEESI©was subsequently translated by Ishikawa and Miyata (1999). The present study was performed to investigate the reliability and validity of QEESI©(Japanese version) for research purposes and for evaluation of patients with MCS in Japan. A total of 498 subjects were recruited from the general population of Miyagi prefecture, Japan. The factor structure in QEESI©was analyzed with 40 items on four subscales except for the items in ‘Masking’ using principal components analysis with Promax rotation. The results showed that 30 items on three subscales, ‘Chemical Inhalant Intolerances,’ ‘Symptom Severity,’ and ‘Life Impact’ except for ‘Other Intolerances’ were consistent with those reported for the US population by Miller and Prihoda (1999a). Cronbach’s a reliability coefficient ranged between 0.87 and 0.94 indicating high internal consistency in the 30 items on three subscales. Next, we compared the mean scores on three subscales of QEESI©in two groups: 131 self-reported MCS group who were new outpatients at the Environmental Medical Center in Kitasato Institute Hospital, and 131 members of the general population (controls) who were matched for both gender and age with the self-reported MCS group. Mean scores on each subscale for the self-reported MCS group were significantly greater than those for controls (PB < 0.001). Mean scores on all of the 30 items on three subscales for the self-reported MCS group were also significantly greater than for the controls (PB < 0.001). These findings indicated that the 30 items on three subscales in QEESI©can be used for surveys and for diagnostic assessment of patients with MCS as well as for comparative studies between patients in Japan and in other countries.

Evaluation of subjective symptoms of Japanese patients with multiple chemical sensitivity using QEESI

ObjectivesThe Quick Environment Exposure Sensitivity Inventory (QEESI©) has been used as a questionnaire to evaluate subjective symptoms of patients with multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance, in Japan. However, no cutoff value for Japanese subjects has yet been established. We designed this study to establish a cutoff value for Japanese subjects using QEESI© for screening of MCS patients.MethodsA questionnaire using the QEESI© was administered to 103 MCS patients and 309 healthy control subjects matched for age and sex. QEESI© scores of the two groups were compared using logistic regression analysis, receiver operating characteristic analysis, and the Mann–Whitney test.ResultsCutoff values for Japanese subjects were determined for the Chemical Intolerance subscale (40), Symptom Severity subscale (20), and Life Impact subscale (10). The subjects whose scores exceeded the cutoff values in any two subscales accounted for 88.4% of the patients but only 14.5% of the controls.ConclusionsOur results suggest that subjects meeting two out of three subscale criteria can be screened as “patients suffering from a low level of environmental chemicals such as MCS” in Japan.

Use of QEESI© questionnaire for a screening study in Japan

QEESI© (Miller and Prihoda, 1999a: Toxicology and Industrial Health, 15, 370) was applied to 498 subjects, recruited from the general population of Miyagi prefecture, Japan, who had not been diagnosed previously as having multiple chemical sensitivity (MCS) or sick building syndrome. Seventeen (3.8%) of 440 subjects who returned valid completed questionnaires were classified as having symptoms ‘very suggestive’ of MCS using the four-classification system of Miller and Prihoda (1999a). We conducted detailed telephone interviews with these 17 individuals. All were visiting local hospitals on an outpatient basis with diagnoses other than MCS and had either current or previous presumed chemical exposure. Therefore, we recommended they undergo a medical check by MCS medical experts and indoor air quality assessment. Seven subjects participated in both the medical check and indoor air quality monitoring, six subjects participated in indoor air quality monitoring only and four subjects participated in neither. The seven subjects who participated in both the medical check and monitoring were diagnosed as having MCS by the above expert physicians. In nine houses of 13 subjects who participated in indoor environmental quality (IEQ) survey, acetaldehyde (9/9), formaldehyde (8/9), total volatile compounds (TVOCs) (6/9) and paradichlorobenzene (3/9) levels were above the respective guideline values for indoor air concentrations, outlined by the Ministry of Health, Labor and Welfare of Japan and were presumed to act as factors contributing to the subjects’ hypersensitivity and onset or development of symptoms. These results suggested that there might still be a population of patients not properly diagnosed as having MCS by clinicians in Japan. Therefore, we verified the efficacy of QEESI (Japanese version) for screening of MCS patients. The results of indoor air quality analysis suggested the manifestation and deterioration of MCS in Japan might be precipitated by indoor air pollutants, such as formaldehyde, acetaldehyde, volatile compounds (VOCs) and paradichlorobenzene.

Long-Termed Field Survey of Indoor Air Quality and Health Hazards in Sick House

Abstract In order to determine the factors of origin of Sick House Syndrome (SHS), data of indoor air quality in the sick houses and field survey were collected and carried out respectively, over three summer seasons from 2000 to 2002, from 35 houses where occupants are suspected of suffering from the so-called Multiple Chemical Sensitivity (MCS) and SHS, in the Miyagi prefecture of Japan. This survey consisted of the measurements of indoor air pollutants (the concentration of formaldehyde and volatile organic compounds (VOC)), air tightness and ventilation rate, together with questionnaire regarding environmental conditions, subjective symptoms and lifestyle. Medical examination was also conducted to residents having heavy symptoms. In addition, 15 houses out of 35 houses were investigated continuously for another two or three years. As the results, the average values of formaldehyde concentration and TVOC of the investigated rooms from this study are 0.12 ppm and 1557 μg/m3, respectively. The formaldehyde concentration in over 71% of rooms exceeds the guideline from the Ministry of Health, Labour and Welfare of Japan. While the VOC concentrations have been reducing, the formaldehyde concentration has hardly changed. The most frequently described symptoms are mucosal and respiratory symptoms (such as eye irritation, sore throat, cough). In addition, it is revealed that many patients are found having allergic diseases. The relationships between the measurement results of indoor chemical substance concentrations and the symptoms obtained from questionnaire, suggest that the symptoms become serious not only in the houses with higher concentration of TVOC, but also in the houses with lower concentration.

Development and evaluation of an electromagnetic hypersensitivity questionnaire for Japanese people

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self‐selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin‐related, head‐related, auditory and vestibular, musculoskeletal, allergy‐related, sensory, and heart/chest‐related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test–retest analysis, and high Cronbachs α coefficients (0.853–0.953) from each subscale. A comparison of scores of each subscale between self‐selected EHS subjects and age‐ and sex‐matched controls using bivariate logistic regression analysis, Mann–Whitney U‐ and χ 2 tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353–372, 2016.

Study of the different Cutoff Point of the QEESI Questionnaire as a Screening Tool for Sick Building Syndrome Diagnosis in Taiwan

Abstract The Indoor Air Quality Management Act in Taiwan formally came into effect in November 2012 to protect public health. Studies have reported that public and private buildings in Taiwan currently have been facing pollution problems regarding indoor air quality (IAQ), which threatens the health of occupants.1), 2) To clarify the correlation between the indoor air environment and influences on human health by using an economical and efficient method, the United States, Japan, and other countries use screening tools first to understand the health effects on building occupants, and, subsequently, adopt appropriate examination methods once primary influential factors are identified. To enable the integration of research results from Taiwan with those from abroad, this study introduced the quick environmental exposure and sensitivity inventory (QEESI) questionnaire, which the United States, Japan, and other countries have implemented for many years. In this study, the applicability of the QEESI questionnaire in screening sick building syndrome (SBS) in Taiwan was examined by observing the association between the QEESI score and IAQ survey results. The results from Taiwan were compared with those from the United States and Japan. A questionnaire concerning personal and residential environmental factors was also incorporated to identify factors with significant predictive power for the QEESI score. The following conclusions were derived from this study. 1. The correlation between the IAQ survey values and the QEESI score indicates the capability of the QEESI questionnaire to identify problems related to sick buildings and to serve as a screening tool for SBS in Taiwan. 2. Currently, using the cutoff points proposed by Japanese researchers3-5) to judge the QEESI score can optimally enhance the correlation between the IAQ survey results and the QEESI scores for people in Taiwan. 3. Eight factors with significant predictively power for the QEESI score include gender, age, an understanding of the mechanism of SBS occurrence, allergy history, building type, air ventilation, the use of deodorants and fragrances, and smoking. These factors can serve as key points when performing on-site examinations.

Survey on changes in subjective symptoms, onset/trigger factors, allergic diseases, and chemical exposures in the past decade of Japanese patients with multiple chemical sensitivity

BACKGROUND Recently, with rapid changes in the Japanese lifestyle, the clinical condition of patients with multiple chemical sensitivity (MCS) may also have undergone change. Thus, we conducted a new survey for subjective symptoms, ongoing chemical exposures, the prevalence of allergic diseases, and presumed onset/trigger factors in patients with MCS and compared results with those of an old survey from ten years ago. METHODS The new survey was conducted from 2012 to 2015 and the old survey was independently conducted from 1999 to 2003, meaning it was not a follow-up study. Patients were initially diagnosed by physicians at five medical institutions with MCS specialty outpatient services, with 111 and 103 patients participating in the new and old surveys, respectively. The controls were a general population living in Japan, with 1313 and 2382 participants in the new and old surveys, respectively. Subjective symptoms and ongoing chemical exposure were evaluated using a quick environmental exposure sensitivity inventory. Additionally, from clinical findings recorded by an attending physician, the prevalence of allergic diseases and presumed onset/trigger factors were evaluated. Differences between new and old surveys were analyzed using logistic regression analyses and significance tests. RESULTS Compared with ten years ago: (1) Regarding factors affecting patients with ongoing chemical exposures, the proportion of patients affected decreased significantly for two items only (insecticides and second-hand smoke). The proportion of controls showing ongoing exposure to 8 out of 10 items changed significantly. (2) In patients, scores for chemical intolerances, other intolerances, and life impacts increased significantly. (3) In terms of the prevalence of allergic diseases among patients with MCS, bronchial asthma (adjusted odds ratio [AOR]: 5.19), atopic dermatitis (AOR: 3.77), allergic rhinitis (AOR: 5.34), and food allergies (AOR: 2.63) increased significantly, while hay fever (AOR: 0.38) and drug allergies (AOR: 0.40) decreased significantly. (4) With regard to construction and renovation, which was the presumed predominant onset/trigger factor for MCS 10 years ago, this decreased from 68.9% to 35.1%; in contrast, electromagnetic fields (0.0%-26.1%), perfume (0.0%-20.7%), and medical treatment (1.9%-7.2%) increased significantly, confirming the diversification of onset/trigger factors. CONCLUSION Compared to ten years ago, for patients with MCS, an increase in avoidance behavior toward chemical substance exposures, which were presumed to be aggravating factors for symptoms, was confirmed. It has been suggested that the ongoing chemical exposure of the general population in Japan has largely changed. In addition, for patients with MCS, chemical intolerances and life impacts have become severe, the prevalence of the main allergic diseases has increased, and onset/trigger factors have become diversified.

Field Survey on the Relation between IAQ and Occupants' Health in 40 Houses in Southern Taiwan

Abstract Taiwan and Japan are similar in life style and customs. Taiwan is geographically situated in a subtropical climate zone which is deemed as a future model of Japanese climate if global warming continues. It is therefore advantageous for Japanese to know the present IAQ (Indoor Air Quality) situations in Taiwan. The research was carried out in two phases. The first phase used questionnaire surveys to collect the relevant information of the occupants and their living environments, and QEESI questionnaires (Chinese version) for information regarding their health conditions. In the second phase, IAQ measurements were conducted in the 40 houses which were selected among volunteers of the first survey. Measurement items were temperature, humidity and concentrations of carbonyl compounds and VOCs (Volatile Organic Compounds). Verification measurements were conducted to investigate the hypothesis in the two houses, A and B, selected from 40 measured houses. The amount of furnishing materials in the two houses was quite different. Finally, the questionnaire results, QEESI (Quick Exposure Sensitivity Inventory) scores, and IAQ data were compared accordingly to determine the factors that cause SHS (Sick House Syndrome). The results are as follows. 1. For areas deficient in SHS and/or MCS (Multiple Chemical Sensitivity) diagnoses, combining QEESI investigations and IAQ measurements in the surveys is successful in screening SH and discovering SHS. 2. To reduce indoor air pollution effectively, it is insufficient just to regulate the materials and the quantity of interior furnishings. Construction process, ventilation rate, airflow path, and an overall plan with strict assessment should all be included in the regulations.