Working Conditions and Sick Building Syndrome among Health Care Workers in Vietnam

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Reviewer 1

In the introduction part, I would expect to get some information about exact symptoms that will be evaluated with the short description on which of SBS factors are connected with each symptom. SBS is a collection of certain factors that may have a definite impact on people's feelings. SBS itself is not a particular cause.

Thanks for your recommendation. I have added some information below:

For example, high CO2 levels related to symptoms like nausea, headaches, nasal irritation, dyspnea, and throat dryness, high light intensity were likely to report skin dryness, eye pain, and malaise. Similarly, high temperatures correlated with symptoms such as sneezing, skin redness, itchy eyes, and headache, while high relative humidity was likely to report sneezing, skin redness, and pain of the eyes. Lower respiratory symptoms were relationship with high workload, longer work hours, chemical exposure, migraine, and exposure to new interior painting.

The research was done from March to June. Have people's responses regarding the sense of thermal comfort been assessed, taking into account different external conditions, or maybe in Vietnam during this period, the parameters of the outside air are constant?

Vietnam belongs to the tropical climate area; therefore, there was quite a difference between external conditions and internal conditions. However, participants always stay at the workplace as overload work and only shift from one department to another. In this study, we found that varying room temperature had significantly higher SBS score.

Was the ventilation assessed in the rooms in which the surveyed people reside? Have feelings of comfort been associated with the type of ventilation? This seems important.

Thank you very much for your comments. The study setting established in 2013 and met the international criteria, they had maintenance plans each year. In this study, we had only measured the airspeed indicator. A previous study also showed that ventilation associated with work productivity, there's a significant increase in production as ventilation rates increase, by 1.7% for every two-fold increase of ventilation rate. Therefore, we took the ventilation into a limitation in the discussion part.

I would expect more information on the Indoor air quality in the building (temperature, relative humidity, CO2 concentration). Did you check it?

Thanks for your suggestion. We had added these indicators to this manuscript. I hope that it is better than before.

SBS is strongly connected with the building (building envelope, ventilation type, furnishing). Can SBS be reduced by giving the knowledge of SBS to HCW? It was stated in the Conclusions. I think that this knowledge should be provided to architects, builders, owners, and maintenance of the building. 

Thank you so much. We have already added it into conclusion. Taken together with our findings, the working condition criteria approach trained for architects, builders, owners, and maintenance of the building is highly recommended for indoor air quality improvement. Furthermore, larger-sample studies about physical stressors are urgent need to better manage SBS. 

The number of people who took part in the survey is small, but it's probably hard to get a larger sample.

Yes. To be honest, HCWs were always busy so it is quite difficult to invite them to join the study. In this study, we recruited the number of participants as much as we can.

7) Conclusions are not very clear:

providing knowledge to HCW will reduce SBS - How? Please elaborate,

how would the findings contribute to SBS-prevention policy-making? Have HCWs have any influence in SBS? SBS is connected to the building and its equipment, IAQ, ventilation. I don't know how your findings could inspire HCWs to make SBS-prevention policy, could you give specific indicators on how to promote IAQ to prevent SBS?

Thank you so much. We have revised and rewritten the conclusion below:

HCWs in the hospitals are exposed to the physical stressors in working conditions which have a potential increased SBS score and the severity of SBS. The risk factors could be varying room temperature, dust, and dirt, light, and stuffy “bad” air were the predominant influences for SBS. Our study reveals that working conditions are important and significantly associated with SBS. Taken together with our findings, the working condition criteria approach trained for architects, builders, owners, and maintenance of the building is highly recommended for indoor air quality improvement. Furthermore, larger-sample studies about working conditions are urgent need to better manage SBS. 

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Reviewer 2

English of the manuscript should be thoroughly reviewed because there are many grammatical and spelling errors in the text.

Thank you very much for considering our manuscript. We apologized for my mistakes. We have already checked and hope that it will be better than previous version.

In the abstract, the authors should mention the influencing factors they studied. It is essential that both the title and the abstract give an honest indication of what the paper contains. The abstract should be concise and precise, indicating to the potential
reader two things: (a) what was done, and (b) important results obtained.

We revised the title and abstract in detail below:

Work environment and sick building syndrome among health care workers in Vietnam.

Our study reveals that working conditions are important and significantly associated with SBS. Taken together with our findings, the physical stressors criteria approach trained for architects, builders, owners, and maintenance of the building is highly recommended for indoor air quality improvement. Furthermore, larger-sample studies about physical stressors are urgent need to better manage SBS

In line 13, replace “interviews was conducted for collecting” by “interviews were conducted to collect”

In line 27, replace “was” by “is”

In line 28, write “for” between difficulty and concentrating

In line 29, replace “affected” by “affects”

In line 34, replace “was more pollutant” by “is sometimes more polluted”

In line 40, replace “was” by “is”

In line 41, it seems that “being female workers” does not correspond to this sentence because the authors are mentioning factors associated with SBS

In line 43, replace “was” by “is”´

In line 45 erase the word “present”

In line 58 replace “HCWs was needed” by “HCWs were needed”

In line 82 write “to” between “related” and “working”

In line 96 erase “is” after SBS

In line 97 write “for” between “difficulty” and “concentrating”

In line 128 write “they” between “and” and “had”,

Thank you again for helping us revising line by line grammatical and spelling errors. We have revised and checked it again.

About lines 138-139, how frequent were these symptoms felt?  

Thank you so much. We have added the frequent of feeling symptoms to manuscript. Participants weekly reported these symptoms.

It seems that the sentence of line 128 is incomplete, I believe they must write something after the words three years, please check.

It was replaced by “they had three years working experience.

The contribution of the manuscript is not well presented. Probably they could write it as: This study aims to evaluate the correlation of SBS and the symptoms among HCW’s.

We already changed as the sentence which you recommended: “This study aims to evaluate the correlation of SBS and the symptoms among HCWs”.

Join tables of page 5 and 6 if they are the same table

Yes, there are the same table. We tried my best to make it shorter than previous version. However, it also depends on format from the editors.

The conclusion is not meaningful, there is no connection to the Introduction by way of the question(s) or hypotheses you posed.

We have revised and rewritten in below:

HCWs in the hospitals are exposed to the physical stressors in working conditions which have a potential increased SBS score and the severity of SBS. The risk factors could be varying room temperature, dust, and dirt, light, and stuffy “bad” air were the predominant influences for SBS. Our study reveals that working conditions are important and significantly associated with SBS. Taken together with our findings, the physical stressors criteria approach trained for architects, builders, owners, and maintenance of the building is highly recommended for indoor air quality improvement. Furthermore, larger-sample studies about physical stressors are urgent need to better manage SBS. 

The references do not have the same format

We have checked and revised it based on the journal’s guideline  

Nothing is mentioned about the air conditioning systems, did the buildings they analyzed have air conditioners?

Thanks for your comments. We have added several indicators including temperature, relative humidity, CO₂, PM₁₀, Airspeed, electromagnetic radiation, light, and level of noise. We hope that it is better than a previous version.

Review 3

Please, consider to perform a linguistic and editorial revision of the text, which presents some errors and typos

Thank you so much for consideration our manuscript. We have checked and revised it line by line.

A part of the text is organized in very short chapters, which in some cases are little more than a list of parameters collected for the purpose of the study (2.2 - 2.5). Perhaps to facilitate reading it would be good to reorganize this part of the text and refer to the tables to list these parameters. in the same way paragraphs 3.1 to 3.5 are a few lines each. It may be more useful to organize them more efficiently. it's just general advice, though. I leave the decision to the authors.

Thanks for your suggestions. Actually, we mean that we want to follow the questionnaire’s structure (demographics, working environment, working conditions, SBS score, environmental monitoring). we will try my best to organize it more efficiently.

Just a consideration. If I have interpreted the study well, the questionnaire is based on the perception of the work environment by the subjects. Could this aspect have introduced a bias? (subjects who complain of SBS symptoms perceive the environment in a more negative way than others). Although difficult to undertake, the execution of inspections to confirm the information relating to the work environments obtained with the questionnaire, even only with the use of qualitative (checklist) or quantitative (physical, indoor air quality measurements) and the quality of the indoor environment) in the environments frequented by the subjects, it would have supported the evidence obtained. Can this be considered a limitation of the study?

Thanks for your comments. We added several chemical monitoring indicators in this version. In addition, we also added some limitations to the study. We hope that this version is better than the previous version.