02/04/2012. Aims of study. Methods Transcultural adaptation. Reliability tests

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1 ODOR AWARENESS SCALE MODIFIED TURKISH VERSION (OASmTR) and EXPOSURE and ODOR PERCEPTION in HOSPITAL WORKERS Sibel Kiran*, Saadet Colak Özdemir** MD, PhD, Assoc.Prof. Zonguldak Karaelmas University, School of Medicine, Health Science Institute, Public Health Department, ** Nurse, Occupational health services of Uzun Mehmet Occupational DiseaseS Hospital, MpH in Public Health, Zonguldak Turkey Aims of study The purposes of this study were, - To adapt the Odor Awareness Scale (OAS Smeets et. al.) transculturally into Turkish, To test its usage in field studies as a practical tool, - To apply OAS to hospital workers (OAS modified Turkish or TOAS), and to evaluate its relation to occupational exposure status Methods Transcultural adaptation Cross-sectional design The Scale was applied to hospital workers in March-April 0 The study was carried out in a small local occupational disease hospital with a total of 87 workers. of 87 workers were reached; were excluded because of missing data and finally workers were included (6.9 %). Self-reported positive and negative OAS ( Questions) : Monique A.M. Smeets, Hendrik N.J. Schifferstein, Sarai R. Boelema and Gerty Lensvelt-Mulders, The Odor Awareness Scale: A New Scale for Measuring Positive and Negative Odor Awareness, Chem. Senses : 7 7, Advance Access Publication July, 008 Standart transcultural adaptation procedure was performed (translation-retranslation by bilingual translators; expert panel evaluation by public health, ENT and neurology specialists, occupational physician and occupational nurse and pilot application) Reliability tests Test-retest repeatability was studied in a sample of 0 workers from a different hospital with correlation between two evaluations (in one week) Intraclass corelations coefficent: 0.96( ) Conditions include: the same measurement procedure the same measuring instrument the same location the same observer (training nurse gave the instructions) After re-evaluation and redaction the test was ready to be applied to the study group Variables; OASmTR (0 questions adapted version) Sociodemographics-age, sex, health conditions, habits and working conditions Working features- for analysis especially exposure to dust or chemicals in the working environment

2 Cronbach alfa of all questions in this group was 0.76 for items Kaiser-Meyer-Olkin Measure,879 of Sampling Adequacy. Bartlett's Approx. Chi- 96,66 Test of Square Sphericity df 96 Sig.,000 Total Variance Explained Initial Eigenvalues Rotation Sums of Squared Loadings Component Total % of Variance Cumulativ e % Total % of Variance Cumulativ e %,08 7,79 7,79,667,8,8,6 7,67,,68,6 9,,70, 0,76,06 0,6 9,7,86,6,00,6 9,878 9,6,0,8 9,78,9 7,7 7,0 6,76,67 6,8,86,8 6,99 7,080,76 66,8,,96 66,8 8,98,96 69,797 9,897,80 7,60 0,808,6 7,8,7,98 77,6,66,078 79,0,69,06 8,6,6,9 8,76,,660 8,7 6,,67 86,77 7,9, 88, 8,8, 89,78 9,9,9 90,977 0,,07 9,08,0,00 9,08,,976 9,060,8,89 9,9,,79 9,7,,78 96,0 6,6,78 97,0 7,9,608 97,88 8,7,9 98,87 9,7,89 98,876 0,7,8 99,0,,9 99,69,097,0 00,000 Extraction Method: Principal Component Analysis. Cronbach alfa of all questions in this group was 0.96 for 0 items Cronbach's Alpha N of Items.96 0 Kaiser-Meyer-Olkin Measure of Sampling Adequacy..9 Bartlett's Test of Sphericity Approx. Chi-Square 0.80 df 90 Sig..000 Total variance explained Initial Eigenvalues Rotation Sums of Squared Loadings Component Total % of Variance Cumulative % Total % of Variance Cumulative % 9,08 6,0 6,0,8 6,9 6,9,9 6,797,89,8 6,9,,8 6,89 9,08,98,990 9,0,08,9 6,0,0,6 6,0,99,69 68,9 6,77,876 7,79 7,78,9 76,8 8,6,08 79,90 9,6,80 8,00 0,9,6 8,86,, 87,087,7,6 89,,9,977 9,00,6,78 9,98,9,6 9, 6,6, 9,76 7,,0 96,967 8,0,00 98,066 9,0,09 99,08 0,8,9 00,000 These subdomains and relevant questions were determined as: odor attention (,0,,,), odor recognition-differentiation (7,8,9,8), positive odor (,,,, 6,) and negative odor (,6, 7,9,0). Component Positive Negative odour Odour odour Odour attention recognition Q,77 Q,8 Q,609 Q, Q, Q6,,6 Q7,669 Q8,780 Q9,607 Q0,69 Q,8 Q,7 Q,680 Q, positive odor odor attention odor recognitiondifferentiation Q,808 Q6,6 Q7,66 Q8,,9 6 7 negative odor Q9,8 Q0,789 Rotated Component Matrix(a) Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization

3 . When you walk through the woods, do you pay attention to the odors surrounding you?. When someone is busy in the kitchen, do you notice the odor of the food being prepared?. Do you notice food odors emanating from houses when you are outdoors?. When you are studying, or concentrated in general, do you get distracted by odors in the environment?. When you visit someone else s house, do you notice how it smells? 6. Do you sniff at a new book? 7. When an acquaintance smells differently from normal, for example, because of a new perfume, do you immediately notice? 8. Do you notice the smell of people s breath or sweat? 9. Do you pay attention to the perfume, the aftershave or deodorant other people use? 0. Are you the first one to smell gas?. Are you the first one to smell when the milk is sour?. Are you the first one to smell a fire, even when the smell only comes from a barbecue or fireplace?. Are you the first one to smell spoilt food in the fridge?. Do you feel cheerful or happy when you pick up a pleasant odor in the air?. Do you get angry or annoyed by an indistinct or unfamiliar smell in the environment? 6. Does an unpleasant smell in the environment that won t go away make you anxious? 7. Do odors revive strong or vivid memories in you? 8. Do you sniff at clothes before you put them on? 9. The smell of smoke or food is still lingering in your clothes from the night before. Do you put on new clothes because of the smell? 0. Does the smell of food sometimes put you off it? Results Group mean age was 6.±9., mean working year.±8.7 % 0. Nurse, %.0 MD, %. technicians and laboratory workers, %. support workers and % cleaners and other health workers 7.7% of study group were female and.% were male. Mean total score was (between ) Positive odour Recognition and differ. Odour attention Negative odour N = Mean Std. Deviation Minimum Maximum Minimum Maximum Mean Std. Deviation Age Packyear smoking BMI Sex N Mean Std. Deviation P* Positive OA Female Odor recognition/differentiation Male Female 8.6. Male Odour attention Female Male Negative odour Female Male Age Female Pack-year of smoking Male Female Male BMI Female Male exposure year Female exposure level (0-) exposure level (0-) Male Female Male 8.9. Female Male 8.6. Positive Odour Odour Negative Packyear OA rec/differ attention OA Age BMI Exp. Year Positive OA Pearson Correlation A significant inverse correlation between Sig. (-tailed) cigarette package-year and positive odor Odor Pearson Correlation,6(**) recognition/diff awarenes and a significant negative erentiation Sig. (-tailed),000 correlation between exposure to chemicals Odour attention Pearson Correlation,8(**),90(**) and odor recognition was found. All Sig. (-tailed),000,000 domains of odor scores were affected in Negative odour Pearson Correlation,69(**),69(**),600(**) the people who were exposed to dust Sig. (-tailed),000,000,000 Age Pearson Correlation,070,0 -,00,00 Sig. (-tailed),68,70,96,9 Pack-year of Pearson Correlation -,(*),9,78,97,6(*) smoking N= Sig. (-tailed),0,69,,6,06 BMI Pearson Correlation -, -,08 -, -,0,9(**), Sig. (-tailed),7,60,66,,00,6 Pearson Correlation -,0 -, -,06,09 -,(**),0,78 exposure year Sig. (-tailed),7,6,00,86,007,766,06 Pearson Correlation -,09 -,9(**) -,08 -,00 -,0,06 -,0,8(**) exposure (0-) Sig. (-tailed),688,00,8,7,66,,7,000 exposure Pearson Correlation -,8(**) -,8(**) -,8(*) -,9(*) -,, -,0,9,00,00,0,0,7,8,887, Sig. (-tailed) Discriminant validity Since smoking and pack year is significantly higher in male workers partial correlation analysis was performed, and even though the sex effect was adjusted, there was negative significant correlation between level of chemical exposure and odor recognition-differentiation ( rho: -0.7; p:0.007) negative significant corelation between level of dust exposure and positive odor ( rho: -0.7; p:0.00) Negative significant corelation between level of dust exposure and odor recognition(rho: -0.7; p: 0.0), attention(rho:-0.; 0.0), negative odor (rho:-0.9; 0.0) By categorizing the scores of four different domain in factor analysis as being below or over the mean, multivariate logistic regression analysis was performed for evaluating the effects of age, sex, working with chemical agents accorging to work group (0-), working years, working in dusty environment (0-), smoking (ever-never) and BMI

4 Logistic regression analysis results for positive odour 9,0% C.I.for positive odour Lower Upper Lower Upper Lower Upper Lower Upper Ste sex(f) -,,69,8,06,98,08,06 p Age,0,0,09,96,06,970,06 (a) exposure () -,70,678,08,98,9,,867 (),8,689,6,07,,09 6, smoking() -,9,67,9,6,0,,7 Constant,,0,77,78,6 Logistic regression analysis for positive odour which revealed that exposure to dust increases the risk of having positive odor score below median. times (.-6) Logistic regression analysis results for odour attention 9,0% C.I.for odour attention Lower Upper Lower Upper Lower Upper Lower Upper Step sex() -,9,,88,,676,9,8 (a) Age -,00,0,08,86,996,9,0 expo.(),00,7,000,99,00,0,9 expo.(),,60,989,0,080, 7,8 Smoking(),979,9,969,06,66,6 6,99 Constant,76,9,98,8,778 Exposure to dust increases the risk of having odour attention score below median.0 times, smoking.6 times Logistic regression analysis results for odour recognition/differentiation odour 9,0% C.I.for recogn./differ Lower Upper Lower Upper Lower Upper Lower Upper Step sex(),6,0,,,98,8,07 (a) Age,0,0,7,6,0,96,060 expo.(),79,9,89,08,07,8,789 expo.(),79,67,877,090,08,88, smoking(),78,7,9,086,9,896,70 Constant -,98,0,79,7,99 Logistic regression analysis results for negative odour 9,0% C.I.for negative OA Lower Upper Lower Upper Lower Upper Lower Upper Step sex() -,8,9,79,7,68,9,8 (a) Age -,07,0,66,,98,90,08 expo.() -,07,6,0,878,9,76,0 expo.(),8,,067,796,,6,7 smoking(),68,0,87,,07,6,07 Constant,9,987,99,8,00 0 of Last questions -never - seldom - someti mes - often - always Does odour affect your mood? Is someone with unpleasant odour unattractive? Is someone with pleasant odour attractive? Are you bothered with not smelling when you get cold? How important is it to you that your sheets smell fresh? How important is it to you that your partner has a pleasant smell? Do you find it important that flowers are fragrant? How important are odours to you in everyday life? Do you look for another seat in public place if someone close to you has an unpleasant smell? Is bad smell a reason for you to not returning a workplace? How do workers assess their own odour perception Much less sensitiv e than Less sensitiv e than Equally sensitive to More sensitive than Much more sensitive than Percentage(N=).8% 9.0%.%.%.% Means of ; Positive odour Odour attention Odour recognition/differe ntiation Negative odour

5 Discussion Which do you much prefer not happen/miss most See with glasses 9.8 Loss of your little toe. Loss of hearing in one ear. Loss of smell 9. No answer.0 When this preference question is analysed; there was no difference among odour scores of responders with preferences of not seeing with glasses, not loosing little toe or not loosing one ear. On the other hand individuals with lower odour attention were found to have higher neglect for loss of smell. % There was positive correlation between the levels they are affected and the odour scores. (neverseldom groups; for last item) The responders in never or seldom groups in all questions were found to have odour attention scores lower than mean; the responders in never or seldom groups in questions of avoidance of people or workplace with unpleasant odours were found to have recognition/differantiation scores lower than mean These findings might be interpreted that the odour scale does its job When questions of odour related behaviours are evaluated, odour attention scores was found to be most influential on daily life and can be used for repeated evaluations Odour attention fields questions of this scales can be studied with comparative practical odour tests We keep on using this scale in various populations and conditions Strenghts This is the first approach to evaluate the as a screening test in a field related occupational exposure Weakness and limitations Cross-sectional Sample size, mising data, No external criterion validity (confirmation with a biologically or wellknown valid smelltest) Sibel Kiran, June 9-, EPICOH- NEUREOH 008, Costa Rica Conclusion Odor Awareness Scale domains are affected by cultural perception It is practical to be used in the field. In this respect, it might be improved to be a rapid screening and follow-up instrument to detect changes (the possible adverse effects of especially chronic exposure on smell sense) Zonguldak Thanks for your attention Sibel Kiran, June 9-, EPICOH- NEUREOH 008, Costa Rica