Predicting the Sick Building Syndrome (SBS) occurrence among Pharmacist assistant in Banjarmasin South Kalimantan

Background: Banjarmasin has the highest number of pharmacies among the other area in South Kalimantan. One of the main types of work in stores is a pharmacist’s assistant. With their typical indoor job activities and the higher risk of chemical exposures, assistant pharmacist tends to experience the sick building syndrome occurrence. This research aims to identify the primary determinant on the SBS event among pharmacy assistant working at pharmacies in Banjarmasin. Methods: This is a cross-sectional research with analytical observation method. The research location takes place in 13 pharmacies in the city of Banjarmasin with 73 pharmacy assistants that meet the inclusion criteria serve as respondents. The study analyzes several variables such as SBS occurrence, respondents characteristics, working conditions including room density, temperature, humidity, air velocity and indoor lighting. Results: 7KHUH DUH UHVSRQGHQWV KDYLQJ DQ 6%6 RFFXUUHQFH ZLWK D VLJQL¿FDQW FRUUHODWLRQ EHWZHHQ WKH SBS occurrences with respondents psycho-social condition (OR 26,479), years of service (OR, 9.882), indoor lighting condition (OR 8,912) and respondents behaviors related to SBS occurrences (OR 13,859). Conclusion: Working environments such as inadequate indoor lighting, working hours arrangement and rest facilities are the determinants of SBS. (Health Science Journal of Indonesia 2017;8(2):118-23)

In the past twenty years, a lot of closed-multi story building have been built with their air circulation GHSHQGLQJ HQWLUHO\ RQ DUWL¿FLDO V\VWHPV VXFK DV Air Conditioner (AC). The condition will lead to pollution caused by AC system ventilation, so it will affect the indoor air quality as well as decreasing of oxygen level. 1 According to the National Population Agency, 2.7 million people were estimated died from air pollution worldwide; 2.2 million among of them are caused by indoor air pollution. In fact, 70-80% time is spent by humans for indoor activity. Consistently, (EPA) FDWHJRUL]HG WKH LQGRRU SROOXWLRQ DV WKH WRS ¿YH RI environmental risks for public health. 2 It has known that many materials are leading to poor indoor air quality. The problem is complex since human use modern and sophisticated equipments. If the equipment is not properly maintained, it will become the indoor air pollution source and may cause health problems such as SBS. 3 Sick Building Syndrome (SBS) or also called as Tight Building Syndrome or Building Related Illness / Building Related Occupant Complaints Syndrome is a situation in which building residents complained about health problems and acute comfort. These DUH UHODWHG WR WLPH VSHQW LQ D EXLOGLQJ XVXDOO\ • hours), but the symptoms are not unique, and there DUH QR FDXVH WR EH LGHQWL¿HG 4 Research on Forensic Laboratories and Ballistic Test Laboratory in Indonesian National Police laboratory showed that there were some shreds of evidence that chemicals can cause a risk for SBS in the laboratory SHUVRQQHO 7KLV ¿QGLQJ ZDV VXSSRUWHG E\ WKH previous observation results stating that the staff was working in lab mostly worked without using a mask that lead to the increase of SBS risk. 5 Based on South Kalimantan Provincial Health 2I¿FH LW KDV EHHQ UHFRUGHG WKDW XQWLO WKH HQG RI 2014, most of South Kalimantan pharmacies can be found in Banjarmasin and tends to have various variations on their services. Compared to other regions, the pharmacies in Banjarmasin working area have higher work intensity, especially on pharmacist assistants with drugs processing. This condition also supported by more physicians in Banjarmasin region than other.
Most of the pharmacy buildings in Banjarmasin uses Air Conditioner (AC) as the air regulation system in their employee room, especially pharmacist assistant. Most of the pharmacy assistant work face to face with the diverse variety of chemicals in the form of drug dosage form for ± 8 hours/day from Monday to Sunday with only a couple of times for day-off in each month.
The pharmacist assistants have a higher risk of SBS due to their exposure on various chemicals acting as Volatil organic compounds (VOCs). 6 Also, the characteristics and behavior of a pharmacist assistant may affect on SBS occurrence, such as gender and age changing on person's endurance, as well by the use of Personal Protective Equipment (PPE) such as masks, gloves and lab coats which can minimize the contaminants exposure on pharmacist assistants.
This study aims to determine the determinant of SBS occurrence including characteristics, behavioral and environmental factors of pharmacist assistant as well as to predict the SBS occurrence by pharmacist assistants working in Banjarmasin working region.

METHODS
This is a quantitative research with cross-sectional design and using analytic observational. The population in this study consisted of 325 assistant pharmacist who worked in 123 pharmacies in the city of Banjarmasin. Based on inclusion and exclusion criterias, 73 pharmacist's assistants were obtained as respondent. Checklist, questionnaire and observation sheet were used to identify the SBS cases, respondent's characteristics and respondent physical environment, while the lux meter was used to measure lighting conditions. The respondent characteristics, room density, temperature, humidity, air velocity, and indoor lighting condition were independent variables, while the occurrence of SBS was the dependent variable. The Chi Square test was conducted to determine the VLJQL¿FDQW UHODWLRQVKLS EHWZHHQ 6%6 RFFXUUHQFH DQG contributing factors to the arisen symptoms, while the logistic regression was used to determine the relationship between variables. Multivariate analysis was carried out in four stages, i.e., multivariate models candidate selection, multivariate modeling, WKH LQWHUDFWLRQ WHVW DQG ¿QDO PRGHOLQJ

RESULTS
One of factors causing the emergence of SBS was the indoor air pollution 3 in which it was closely related to the room space density. 7 The pharmacist working space varied between 9m 2 to 20 m 2 with P SHUVRQ DYHUDJH GHQVLW\ %DVHG RQ WKH • 6 m2 / person standard workspace density, 8 among DUHD REVHUYHG ¿YH RI WKHP ZHUH FODVVL¿HG DV an abnormal densities rooms and did not meet the minimum standards of space density requirement.
Based on working environment and industrial light intensity standards, working space required at least: 100 lux of light intensity, 9 150 lux for drugstore 10 and 200 lux on the drug storage chamber. 11 The pharmacist assistants workspace lighting intensity range between 82.5 -145. 8   Five of the nine variables that were analyzed showed D VLJQL¿FDQW DVVRFLDWLRQ ZLWK WKH 6%6 RFFXUUHQFH on pharmacist's assistant in Banjarmasin (S ) ie psychosocial condition (p-value = 0.000), respondents year of services (p-value = 0.011), respondent knowledge related SBS (p-value = ), respondents attitude of respondents against the risk of SBS (p-value = 0.002) and SBS risky behaviors performed by respondents (p-value = 0.000).  Table  3, among nine variables analyzed, there were only four variables remain included. Psychosocial 0.000 0.000 0.000 0.000 0.000 0.000 Year   Table 6. As for the year of service variable, it can be concluded that if an assistant pharmacist has more than one year of duty, then the chances of SBS against them increased by 6655 times compared with the pharmacist's assistant with the year of service less than one year.
With the 9.473 of OR value for behaviors, it can be interpreted that the more a pharmacist's assistant demonstrated risky behaviors against SBS, that slightly increase the chances of SBS cases by 9.473 times compared with the pharmacist's assistant who performed less risky activities. Some of the behaviors that were suspected to play a role in the SBS incident were the excessive usage of synthetic room fragrances, 14 passive smoking, 8 non-compliance with the Personal Protective Equipment (PPE) regulation and the habit of using chemical sanitizers and disinfectant. 15 And for lighting variable, with OR of 5.847, it can be interpreted that if the lighting condition in pharmacist's assistant working area were getting worsen, then it would be likely to increase the SBS occurrence up to 5,847 times higher than pharmacist's assistant who is working in good lighting condition environment.

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(R-square) value by 0.683, which means that the regression model obtained could explain 68.3% of the dependent variable variation of SBS occurrence at pharmacies in Banjarmasin working area. Thus the psychosocial condition, year of service, behaviors and lighting variables were able to explain the SBS occurrence by 68.3%, while 31.7% was explained by other variables.

DISCUSSIONS
7KH VLJQL¿FDQW FRUUHODWLRQ EHWZHHQ 6%6 RFFXUUHQFH with psychosocial conditions was shown in a variety of SBS's typical health problems caused by stress rather than by the building condition. The existence of workplace automation and computer WHFKQRORJ\ FDQ LPSURYH ZRUN HI¿FLHQF\ EXW ZLWK these circumstances, workers were demanded to maximize their performance. Workers must enhance their ability and can cope with the heavier workload. $OVR YDULRXV FRPSODLQWV RI 6%6 DOVR LQÀXHQFHG by factors outside environment, such as personal problems, work and psychologically considered to affect one's sensitivity to SBS. 4,16 Excessive stress or dissatisfaction, poor interpersonal relationships and poor communication are also often seen to be associated with SBS. 14 $JHV LQÀXHQFH RQ WKH LPPXQH V\VWHP VR DV WKH ROGHU the age of the individual then the correspondingly reduced personal stamina. Younger age also played a role in causing the SBS symptoms and complaints. The possible causes that could happen because when the age reached the working and productive period, usually employees were expected to show their optimal performance, so their stamina can be decreased. 4 )HZ IDFWRUV ZHUH VXVSHFWHG IRU WKH LQVLJQL¿FDQW relationship between the age of the respondent to the SBS occurrences. Among them were unnormal data distribution and respondents who did not include in the working age criteria were mostly at the age of 64 years above years, so the rise symptoms are degenerative disease symptoms and excluded from SBS criteria.
Out of the 29 respondents who experienced SBS, 48.28% of them were included in the risk category RI \HDUV RI VHUYLFH DQG GHPRQVWUDWHG D VLJQL¿FDQW relationship. Such condition mainly due to the duration of individual working activities in the room were assumed could lead to chronic health problems. The longer the person working length, the more numerous and varied health concerns experienced. The extended period of indoor working activities is believed to affect the different exposure level against indoor pollutants. 17 Previous research has explained that workers with ten years of service or more had a greater risk of the SBS occurrence, 18 as a result of workclimate acclimatization the workers experienced by themselves. 19 But at the case with the pharmacist assistant pharmacist in Banjarmasin, with the year of service relatively short (> 1 year) they had the same risk of developing the magnitude of SBS. This might happen due to the pharmacist assistant's type of work that is closely related to drugs and other chemicals that can be a source of indoor air pollution. 5 Related to attitudes, the correlation between the respondents' attitudes towards SBS risk with the occurrence of SBS by the Rais et al. research ZKLFK VWDWHG WKDW DWWLWXGH KDV D VLJQL¿FDQW relationship with the employee's behaviors on SBS risk activities. 20 The attitude itself was a reaction or closed response from the individual to the object or stimulus. Manifestations of such attitudes simply can not be seen directly, but can only be interpreted in advance of the covert behavior. Such behavior will be known through the actions committed by a person.
Among 29 respondents who experienced the SBS events, 22 of them demonstrate risky actions against SBS occurrence. The analysis also showed D VLJQL¿FDQW FRUUHODWLRQ S EHWZHHQ WKH respondents acts with the SBS event experienced by them. Some of the behaviors that may play a role in the SBS occurence include smoking, unwell maintained air-conditioning facilities as well as the habits of using sanitizer and disinfectant. 21 In Table 2 shows that 51.72% of the total 29 respondents exposed to SBS were working in a room with normal lighting levels (intensity <100 or> 200 lux), while 48.28% others operating in the normal light work environment. Based on the results of chi-square tests .
S YDOXH RI S! ZDV REWDLQHG WKLV PHDQV WKDW WKHUH LV QR VLJQL¿FDQW FRUUHODWLRQ EHWZHHQ the respondent's environment lighting condition with Sick Building Syndrome (SBS) occurrence in pharmacy assistants in the city of Banjarmasin.
One of the factors that could potentially lead to the LQVLJQL¿FDQW FRUUHODWLRQ EHWZHHQ WKH OLJKWLQJ FRQGLWLRQV with SBS occurrence is because the lighting mostly LQÀXHQFHG E\ WKH DUWL¿FLDO OLJKW ZLWK FRQVWDQW LQWHQVLW\ over time to time due to a closed room. The condition also can make individual's sense of vision becomes accustomed adapted to such lighting condition in such an extended period. However, this study has limitations GXH WR WKH H[FOXVLRQ RI VSHFL¿F YDULDEOHV RI SKDUPDFLVW ¶V assistant job characteristics, such as chemicals exposure on the drugs compounding activity.
In conclusion, this study concluded that the respondents who had experienced Sick Building 6\QGURPH V\PSWRPV KDG D VLJQL¿FDQW DVVRFLDWLRQ between psychosocial variables, the length of service, knowledge, attitudes and actions. Respondent's psychosocial condition, years of service, respondents behaviors and working area lighting condition were YDULDEOHV WKDW LQÀXHQFHG WKH RFFXUUHQFH RI 6%6