No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Public health and economic impact of dampness and mold
Abstract
Abstract
Abstract The public health risk and economic impact of dampness and mold exposures was assessed using current asthma as a health endpoint. Individual risk of current asthma from exposure to dampness and mold in homes from W.J. Fisk, Q. Lei-Gomez & M.J. Mendell [(2007) Indoor Air17, 226–235], and asthma risks calculated from additional studies that reported the prevalence of dampness and mold in homes were used to estimate the proportion of US current asthma cases that are attributable to dampness and mold exposure at 21% (95% confidence internal 12–29%). An examination of the literature covering dampness and mold in schools, offices, and institutional buildings, which is summarized in the Appendix, suggests that risks from exposure in these buildings are similar to risks from exposures in homes. Of the 21.8 million people reported to have asthma in the USA, approximately 4.6 (2.7–6.3) million cases are estimated to be attributable to dampness and mold exposure in the home. Estimates of the national cost of asthma from two prior studies were updated to 2004 and used to estimate the economic impact of dampness and mold exposures. By applying the attributable fraction to the updated national annual cost of asthma, the national annual cost of asthma that is attributable to dampness and mold exposure in the home is estimated to be $3.5 billion ($2.1–4.8 billion). Analysis indicates that exposure to dampness and mold in buildings poses significant public health and economic risks in the USA. These findings are compatible with public policies and programs that help control moisture and mold in buildings.
... Many Canadian First Nation families live in a house that is not suitable including inadequate house size for the occupant composition, house in need of major repairs, and dampness and mold issues [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Respiratory illness disproportionately affects First Nation populations in Canada in which some of the associated factors include economic, environmental, social and historic factors; with housing being an important environmental factor associated with respiratory illness [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. There is almost no data or research on housing conditions specific to rural First Nations communities in Canada, and none in Saskatchewan. ...
... Addressing housing suitability in rural First Nations communities is important to improving health outcomes with residents in the houses. In addition to crowding, the majority of the houses surveyed would be considered to have housing inadequacy due to a house in need of major repairs, mold and smell of mold in the house, water or dampness in the house, and these house conditions have been associated with health outcomes of occupants [24][25][26][27][28][29][30][31][32][33]. Almost half of the houses surveyed in this study indicated the house was in need of major repairs. ...
... Dampness and mold were common in the houses surveyed with over half of the houses having mold and dampness, which is higher than mold levels reported in non-Aborignal rural homes in Saskatchewan [28,31]. Mold and dampness have been associated with health outcomes and linked to upper and lower respiratory conditions in adults and children in both Indigenous and non-Indigenous populations [23][24][25][26][27][28][29][30][31]. Respiratory illness disproportionately effects First Nation peoples in Canada with house conditions known to be an important environmental determinant of health [1][2][3][4][5][6][7][8][9][10][11][12]. ...
Housing and house conditions on First Nation communities in Canada are important determinants of health for community members. Little is known about rural First Nation housing in the Canadian Prairies. The aim was to survey houses in two rural First Nation communities in Saskatchewan, Canada to understand housing conditions, prevalence of mold/mildew and dampness, and sources, locations and frequency of mold and dampness. Surveys were conducted with an adult member of each household in 144 houses. Surveys assessed: size, age, and number of rooms in the house; number of individuals residing in the house; presence of mold/mildew and dampness, and sources, locations and frequency of mold and dampness. Houses were mostly two-bedrooms (25.7%) or more (67.4%). Thirty-one percent of houses had six or more people living in the house with crowding present in 68.8% of houses. Almost half of the houses (44.5%) were in need of major repairs. More than half of the houses had water or dampness in the past 12 months in which dripping/puddles and standing water were most commonly identified and were from surface water and plumbing. More than half of the houses indicated that this dampness caused damage. A smell of mold or mildew was present in over half of the houses (52.1%) and 73.3% of these houses indicated that this smell was always present. Housing adequacy including crowding, dampness, and mold are significant issues for houses in these two rural Saskatchewan First Nation communities. Housing inadequacy is more common in these rural communities as compared to Canadian statistics. Housing inadequacy is modifiable and is important to address for multiple reasons, but notably, as a social determinant of health. Federal government strategy to address and redress housing in First Nation communities in Canada is a fiduciary responsibility and critical to reconciliation.
... Sadly, there is a 30% to 50% increase in poor respiratory health outcomes for occupants of damp and moldy buildings (Mudarri & Fisk, 2007). While there are consensus documents to help guide water damage mitigation and mold remediation practices, there is a lack of research to determine whether following these practices align to successful mitigation or restoration projects. ...
... The Bailey (2005) text provided a comprehensive guide to mold growth within a building, but the author was careful to state that mold itself was not the problem, but rather a symptom of the real problem (i.e., moisture). Mudarri and Fisk (2007) estimated that 20 to 50% of homes have one or more signs of dampness. Water activity in the substrate is the primary environmental condition that allows mold to colonize, and water activity is the amount of "free" water available to microorganisms. ...
... Asthma is a noncommunicable respiratory disease that in many cases may be preventable and it is estimated that approximately 40 million people in the United States suffer from asthma with an average cost of treating one patient annually at $3,100.00 (Nunes, Pereira, & Morais-Almeida, 2017). Mudarri and Fisk (2007) conducted a study that assessed the number of cases of asthma in U.S. homes that could be attributed to exposure to dampness and mold. Of the 21.8 million people reported to have asthma in the United States, approximately 4.6 million (21%) could be attributed to indoor dampness and mold. ...
Abstract
Background: Exposure to indoor dampness and mold is associated with an increased risk of poor respiratory health. In the United States, $3.5 billion is spent annually on asthma attributed to dampness and mold in homes, and one home, out of every 50 insured homes, files a water damage claim each year. Each of these claims involves incidents that introduce damp and moldy conditions into homes, and mold spores are aerosolized when damp and moldy building materials are disturbed during mitigation and remediation work. The consensus guideline documents, ANSI/IICRC S500 Standard and reference guide for professional water damage restoration – fourth edition: 2015 [S500] and the ANSI/IICRC S520 Standard for professional mold remediation – third edition: 2015 [S520], recommend training, work practices, and cleaning protocols to guide water damage mitigation and mold remediation work. The consensus guidelines also recommend evaluating the completion of projects by the use of a third-party assessment by an Indoor Environmental Professional, which includes air testing for airborne mold spores, physical evaluation, and visual assessment.
Objective: The purpose of this study was to determine the correlations between how closely water damage mitigation and mold remediation work follows consensus guidelines and the results of Indoor Environmental Professional assessments, especially mold spores.
Design: A nonexperimental, correlational design using secondary data was chosen as the ideal method to determine whether consensus guidelines were followed for water damage mitigation and mold remediation work.
Results: There was a significant correlation between how closely work followed consensus guidelines and the Indoor Environmental Professional (pass-fail) assessment (p < .001), with the greatest observed values between (fail + does not follow), (fail + partially follows), and (pass + does follow). There was also a significant correlation between the airborne mold spore count in the work area and how closely the work followed consensus guidelines (p < .001), with the mean rank for spore significantly higher when the work (does not follow) consensus guidelines. Moreover, there was a significant association between the airborne mold spore count in the work area and the Indoor Environmental Professional (pass-fail) assessment (p < .001), with the mean rank of spore for (pass) significantly lower than the mean rank for (fail).
Conclusion: Significant correlations were found between how thoroughly water damage mitigation and mold remediation work followed consensus document guidelines and the Indoor Environmental Professional assessment, especially airborne mold spore testing in the work area. As demonstrated in this study, the more closely mold remediation work follows consensus document guidelines, the more likely the project will pass post-remediation verification and airborne mold spore testing. Furthermore, fewer airborne mold spores in the work area were associated with mold remediation work that followed the consensus document guidelines, although there were significant associations between the manner in which the mold remediation work was performed, specifically, the use of explicit engineering controls. Water damage mitigation and mold remediation professionals that follow the consensus guideline document recommendations may reduce health risks to building occupants, while lowering disease burden and healthcare costs through effectively reducing the exposure to indoor moldy conditions following water damage mitigation and mold remediation work.
Keywords: mold, spore, water, damage, restoration, remediation, ANSI/IICRC S500, ANSI/IICRC S520, indoor environmental professional
... Multiple adverse health effects, such as upper and lower respiratory tract symptoms, asthma exacerbation and development, are evidently associated with damp indoor environment and mold (Bornehag et al. 2001;Mendell et al. 2011;WHO 2009). High prevalence of moisturedamage in building stocks across many countries (Eurostat, 2020;Mudarri & Fisk, 2007) and people spending most of their time indoors (Klepeis et al. 2001;Perez-Padilla et al. 2010) make this a relevant public health issue. Despite of decades of dedicated research, the substantial burden for public health and the enormous economic impact (Mudarri & Fisk, 2007), neither the mechanisms underlying the associations between indoor dampness and adverse health effects nor causally involved exposing agents have conclusively been revealed. ...
... High prevalence of moisturedamage in building stocks across many countries (Eurostat, 2020;Mudarri & Fisk, 2007) and people spending most of their time indoors (Klepeis et al. 2001;Perez-Padilla et al. 2010) make this a relevant public health issue. Despite of decades of dedicated research, the substantial burden for public health and the enormous economic impact (Mudarri & Fisk, 2007), neither the mechanisms underlying the associations between indoor dampness and adverse health effects nor causally involved exposing agents have conclusively been revealed. Toxicological studies have supported the assumption of microbial exposure contributing to the observed health effects (Mendell et al. 2011;WHO 2009), but there are overall little and contradictory indications from the epidemiological literature that would strongly suggest a causal involvement of microbial exposure in moisture damage -related health effects. ...
Background
Multiple health effects are associated with moisture damage in buildings. Studies explaining these associations and cell-level mechanisms behind the observed health effects are urgently called for.
Objectives
We focused on characterizing gene expression in human airway epithelium after exposure to indoor air particulate matter (PM) sampled from houses with and without moisture damage, alongside determination of general toxicological markers.
Methods
We performed detailed technical building inspections in 25 residential houses and categorized them based on the detection of moisture damages and the probability of occupant exposure. PM sampling was complemented by microbiological and volatile organic compound assessment. We exposed human airway constructs to three dilutions (1:16, 1:8, 1:4) of collected PM from moisture-damaged (index) and non-moisture-damaged (reference) houses and imaged selected constructs with electron microscopy. We analyzed general toxicological markers and the RNA of exposed constructs was sequenced targeting genes associated with toxicological pathways. We did groupwise comparisons between index and reference houses and pairwise comparisons in matched index/reference houses.
Results
In groupwise comparison, gene Cytochrome P450 Family 1 Subfamily A Member 1 (CYP1A1) was statistically significantly over-expressed in index houses at all dilutions of collected PM and Nuclear Factor Kappa B Subunit 1 (NFKB1) at dilution 1:4 of collected PM. In pairwise index/reference house comparison, several genes related to multiple toxicological pathways were activated, largest expression differences seen for CYP1A1. However, none of the genes was consistently expressed in all the matched pairs, and general toxicological markers did not differentiate index and reference houses.
Discussion
The exposure to PM from index houses activated toxicology -related genes in airway constructs. Differential expression was not consistent among all the index/reference pairs, possibly due to compositional differences of bioactive particles. Our study highlights CYP1A1 and NFKB1 as potential targets in moisture damage -associated cellular responses.
... According to previous studies, many fungi grow indoors as mold where moisture is present. Some of these fungi can cause toxic reactions and may lead to infections in susceptible individuals and excessive mold growth can contribute to respiratory illness and infections [15,16]. ...
Objectives: Shopping malls are fast becoming one of the most visited public spaces globally. However, information on the possible environmental conditions in relation to health hazards in shopping malls is poorly documented in developing countries. This study assessed the sanitary conditions, waste management, safety measures and sources of air pollution associated with selected shopping malls in Nigeria.
Study Design: a descriptive cross-sectional study design was adopted using a comparative approach.
Methods: Three shopping malls (Mall Q, Mall R, and Mall S) in urban areas in Ibadan, Oyo State, Nigeria, were selected using convenience sampling technique. Three major shopping malls were selected using convenience sampling technique. Fifty seven, thirty five, and twenty nine stores were sampled in Mall Q, Mall R, and Mall S respectively. Direct on-site built environment and sanitary conditions of shopping malls were assessed using an observational checklist.
Results: It was observed that all the selected shopping malls had air vents that were free from dust, unbroken walls, and emergency exits, although mold growths were observed on the walls and ceilings of Mall Q and Mall R. Toilet facilities were present and functional across all the shopping malls. Waste management facilities were available across the shopping malls with the absence of overfilled waste bins as regular emptying of the waste bins was a routine. Also, various safety measures and equipment were utilized across all the shopping malls, but safety signals and smoke detectors were absent in Mall R. Furthermore, Mall R and S were 5 m within the proximity of major roads, parking lots and public drainage channels.
Conclusions: These findings reveal a need for improvement in the hygiene and sanitary conditions within shopping malls. Hence, there should be periodic environmental monitoring, and proper housekeeping practices should be encouraged in shopping malls in Nigeria.
... Bien que le bilan annuel Net ZEB soit un indicateur de la performance énergétique du bâtiment, il n'est pas suffisant pour caractériser pleinement les Net ZEBs (Sartori et al., 2012). En effet, les échanges d'énergie sur des échelles de temps plus courtes (mensuelles, journalières, horaires, etc.) sont importants étant donné que le facteur limitant est souvent la puissance maximale pouvant être importée ou exportée (Gunnbjörnsdóttir et al., 2006;Institut National de Santé Publique du Quebec, 2002;Mendell et al., 2011;Mudarri & Fisk, 2007;WHO, 2009 (Nejat et al., 2015). Ce polluant est devenu prioritaire depuis quelques années du fait de son lien étroit avec la respiration humaine et le renouvellement de l'air (ANSES, 2013). ...
La performance d'une maison ne doit pas être mesurée uniquement en fonction de sa consommation et de sa production d'énergie. Le niveau de confinement, la QAI et le confort doivent également être pris en compte pour assurer le bien-être des occupants. En effet, il existe dans la littérature un grand nombre d'indicateurs de performance de bâtiments basés sur différents paramètres en fonction des informations à obtenir. Le calcul de la plupart de ces indicateurs est ambigu car il ne précise pas clairement les lieux et périodes de mesure, le pas de temps, la prise en compte d’un scenario d’occupation ou même les valeurs limites à ne pas dépasser. L'absence de consensus sur les indicateurs de performance à utiliser et sur la manière de les calculer rend difficile la comparaison des maisons. Cette thèse a pour objectif principal de proposer un référentiel robuste d’indicateurs de performance qui peut être utilisé à la fois dans la phase de conception et pendant la phase d'occupation du logement. Ces indicateurs seront principalement calculés par rapport à de paramètres facilement mesurables à l’aide de sondes installées dans les bâtiments connectés, à savoir, la consommation électrique, la température, l’humidité et les concentrations de CO2, de COVT, de HCHO et de PM2,5.Pour cela, la méthodologie de travail cherchera à :•Inventorier l’ensemble des indicateurs basés sur un paramètre unique existants dans la littérature et les valeurs de référence correspondantes.•Identifier le pas de temps adéquat pour la mesure de chaque paramètre.•Expertiser la sensibilité des indicateurs en lien avec le scénario d’occupation afin de définir les informations nécessaires à leur utilisation.•Identifier les indicateurs les plus adaptés pour décrire les conditions à l’intérieur d’un logement à partir des mesures à disposition.•Evaluer la variabilité saisonnière et pluriannuelle des résultats des indicateurs pour ainsi définir le temps d’observation minimum qui permet d’obtenir une information suffisante pour évaluer la performance d’un bâtiment.•Et enfin, proposer un référentiel opérationnel, composé d’une sélection des différents indicateurs précédemment discutés, accompagné d’un ensemble de recommandation pour son utilisation optimale.
... Indoor exposures such as these are concerning since children spend most of their time indoors [6]. Prior research indicates that damp conditions, water damage, mold, and pests such as cockroaches, are common environmental exposures in U.S. homes [7]. Indoor mold is more common in low-income homes that are older and that lack air conditioning and carpeting [8,9]. ...
(1) Objectives: To examine the associations of child tobacco smoke exposure (TSE) with home quality and housing instability. (2) Methods. A secondary analysis of 32,066 U.S. 0–11-year-old children from the 2018–2019 National Survey of Children’s Health was conducted. Child home TSE status was defined as: no TSE: child lived with no smokers; thirdhand smoke (THS) exposure only: child lived with a smoker(s) who did not smoke indoors; and secondhand smoke (SHS) and THS exposure: child lived with a smoker(s) who smoked indoors. Home quality was assessed by the presence of mold or pesticide use and housing instability was assessed by home ownership, frequency of moves, and number of household members. We conducted weighted multivariable logistic regression and linear regression models while adjusting for important child covariates. (3) Results: In total, 12.3% had home THS exposure only and 1.6% had home SHS and THS exposure. Compared to children with no home TSE, children with home SHS and THS exposure were 2.60 times more likely (95%CI = 1.73, 3.92) to have mold inside their homes; 1.57 times more likely (95%CI = 1.09, 2.26) to live in homes where pesticides were used ≥1 time during the past 12-months; and more likely to have more frequent moves (β = 1.06, 95%CI = 0.62, 1.50). (4) Conclusions: Children with home TSE have higher rates of mold, pesticide use, frequent moves, and household members compared to children with no home TSE. Children with TSE should also be screened for home quality and housing instability and provided with appropriate interventions and resources.
... Two selected illustrations are the corrosion of rebars in concrete due to chloride ingress via the pore water, and the formation of mould on interior finishes owing to excessive interior humidity levels. Numbers from the United States indicate that the proportion of current US asthma cases attributable to dampness and mould exposure is just over 20 % (Mudarri and Fisk, 2007), and that roughly one out of four US bridges is structurally deficient, often as the result of reinforcement corrosion (AASHO, 2008). The reliable assessment of moisture transfer in building materials is thus crucial, requiring efficient numerical tools for unsaturated moisture transfer in porous building materials. ...
... There is also a lack existing asthma, asthma development, current asthma, ever-diagnosed asthma, bronchitis, respiratory infection, allergic rhinitis, dyspnea, wheezing, cough, upper respiratory symptoms, and eczema; and limited or suggestive evidence of an association with the common cold and allergy/atopy [1,2,4,26]. In addition, Mudarri and Fisk's report indicated that 20% (95% confidence interval: 12-29%) of current U.S. asthma cases were attributable to indoor dampness/mold exposure and that the related annual cost was USD 3.5 billion [27]. In Europe, about 15% of new childhood asthma and 5-15% of new adult asthma was estimated to be attributable to home dampness/mold [11,12]. ...
Indoor dampness and mold are prevalent, and the exposure has been associated with various illnesses such as the exacerbation of existing asthma, asthma development, current asthma, ever-diagnosed asthma, bronchitis, respiratory infection, allergic rhinitis, dyspnea, wheezing, cough, upper respiratory symptoms, and eczema. However, assessing exposures or environments in damp and moldy buildings/rooms, especially by collecting and analyzing environmental samples for microbial agents, is complicated. Nonetheless, observational assessment (visual and olfactory inspection) has been demonstrated as an effective method for evaluating indoor dampness and mold. The National Institute for Occupational Safety and Health developed an observational assessment method called the Dampness and Mold Assessment Tool (DMAT). The DMAT uses a semi-quantitative approach to score the level of dampness and mold-related damage (mold odor, water damage/stains, visible mold, and wetness/dampness) by intensity or size for each of the room components (ceiling, walls, windows, floor, furnishings, ventilation system, pipes, and supplies and materials). Total or average room scores and factor-or component-specific scores can be calculated for data analysis. Because the DMAT uses a semi-quantitative scoring method, it better differentiates the level of damage compared to the binary (presence or absence of damage) approach. Thus, our DMAT provides useful information on identifying dampness and mold, tracking and comparing past and present damage by the scores, and prioritizing remediation to avoid potential adverse health effects in occupants. This protocol-type article describes the DMAT and demonstrates how to apply it to effectively manage indoor dampness and mold-related damage.
... This suggests water leakages into the buildings from the outdoor environment or from indoor faulty plumbing. According to a similar study by [14], dampness was defined on the basis of self-reported indicators, such as water leakage or water damage and visible mould growth on walls, floors or ceilings. The number of persons observed during sampling was found to be more in the offices samples within the CA premises. ...
Indoor air quality (IAQ) has been identified by the Environmental Protection Agency (EPA) as one of the most urgent top five environmental risks to public health. Numerous studies have documented that sick building syndrome (SBS) is surprisingly common even in buildings without widespread complaints and its relationship with hypersensitivity disease are often associated with exposure to high concentration of airborne microbial organisms. To contribute to knowledge on IAQ, this study evaluates the levels and composition of bacterial and fungal contamination of different offices in a tertiary institution in Southwestern Nigeria. A cross sectional design was used to compare the indoor airborne microbial load of three categories of offices within the institution premises: the central administrative (CA), academic (AC) and work and maintenance (W&M) offices. Indoor temperature (ºC) and relative humidity (%) of the respective offices were measured using a 5-in-1 multi-tester N21FR made in China and categorized into comfort and high levels. Air samples were collected using a TE-10-890 Andersen single stage microbial air sampler and the total counts per cubic metre were compared with the American Industrial Hygiene Association guideline (AIHA). Data were analyzed using descriptive statistics, t-test, Spearman's rank correlation and regression analysis. Offices in CA recorded the highest mean indoor Total Bacteria Count (TBC) of 22.6 ± 12.2cfu/m 3 as compared to W&M (18.3 ± 10.4cfu/m 3) and AC (15.6 ± 8.4cfu/m 3) p<0.05. However, AC offices recorded the highest mean Total Fungi Count (TFC) of 3.6 ± 2.3cfu/m 3 as compared to CA (3.5 ± 1.7cfu/m 3) and W&M (3.3 ± 2.1cfu/m 3) p>0.05. The indoor TBC and TFC of the categories of offices were found to be lower than the AIHA guideline limit. The number of persons at the point of sampling was found to significantly predict the level of indoor TBC, p<0.01. The most isolated bacteria were Staphylococcus spp., Streptococcus spp. and Micrococcus spp., whereas Cladosporium spp., Aspergillus spp. were the most abundant fungi isolates. The present study implicated population as a major source of microbial contamination in the office environment. Adequate knowledge about indoor air quality in terms of microbial contamination and its implication on health should be provided to staff of the institution in the hierarchy of control measures to mitigate the levels of indoor airborne microorganisms.
... [16]. Sick Structure Syndrome has widespread financial and communal impact [17][18][19]. Frequent acquaintance to these pollutants can cause numerous health dilemmas, including irritations and lethal effects, infections, aversions and other breathing or skin infections [20]. According to preceding studies exposed that in presence of water photocatalytic process is active against varied organisms, like algae, viruses and bacteria. ...
polymeric materials along with nanoparticles are widely used to protect from microbial propagation. In humid environments, enclosed edifice is amongst the foremost propagation substrates aimed at microorganisms. Antimicrobial coatings could help to stop microbial proliferation or, reduce the number of microorganisms growing on inside buildings. This paper deals with inhibition of Escherichia coli bacteria by TiO2 and silver nano-particles doping along with poly acrylate-based copolymers. Coated glass was characterized for FTIR, antimicrobial activity, UV Visible Spectroscopy and water contact angle for hydrophobicity and SEM analysis for surface morphology. The disk diffusion method was used for bacterial inhibition. Results revealed that developed material has good adhesion with glass and shows transparency, hydrophobicity and antibacterial activity. Which shows that coating material can be used for significant antibacterial coatings to protect window glass table ware glass doors etc. further these coatings are transparent, UV radiation protected and hydrophobic in nature which also enhance the self-cleaning effects. In addition, the coating has photocatalytic activity due to the presence of TiO2 and showed momentous antibacterial events after 2,4 and 6 hrs and this efficiency would be increased by improving formulation composition.
... When humidity and moisture are not effectively controlled, persistent dampness can lead to material damage, corrosion, structural decay, and microbial growth, including mold. Cognizant health authorities have established an association between damp buildings and the increased potential for adverse health effects (IOM 2004, WHO 2009, New York State 2010, Mudarri and Fisk 2007. ASHRAE believes that the potential for these problems can and should be reduced by limiting the buildup of indoor moisture through the decisions and actions taken by designers, contractors, owners, and occupants of buildings. ...
Persistent dampness in buildings contributes to negative health outcomes for occupants. The causes of health-relevant dampness are complex and involve decisions that often overlap responsibilities of different design professions and are affected by decisions of building contractors, owners, operators and occupants.
https://www.ashrae.org/file%20library/about/position%20documents/pd_limiting-indoor-mold-and-dampness-in-buildings-2021.pdf
... The overall negative impact on the health of users is recognized worldwide as 'sick building syndrome (SBS)', manifesting itself in the population operating, partially or totally, inside buildings affected by micro-organisms deposits, as a result of degradation of indoor air quality by contamination with spores and toxins [1][2][3][4][5][6][7]. The most common mycotoxins whose presence has been identified in indoor air but also in the body of the population that stayed in the contaminated environment are Ochratoxin (OCT), aflatoxin B1, Trichothecene [8][9][10][11][12][13][14]. These microtoxins are also produced by molds of the Aspergillus and Penicillium genera and are genotoxic, immunotoxic, hepatotoxic, mutagenic and potentially carcinogenic [8,15]. ...
The development of mold films on the cement surfaces of buildings is a health and safety problem for the population, aesthetic but also in terms of their durability. The use of specific performance of cementitious composites containing TiO2 nanoparticles, photoactivated by UV radiation, can be a viable solution to mitigate to eliminate these problems. The experimental studies presented aim to analyze the capacity to inhibit the development of mold type Aspergillus and Penicillium on the surface of composite materials with nano-TiO2 content and the identification of the optimal range of nanomaterial addition. The identification and analysis of the inhibition halo (zone with a biological load of maximum 1–10 colonies of microorganisms) confirmed the biocidal capacity of the cementitious composites, but also indicated the possibility that an excess of TiO2 nanoparticles in the mixture could induce a development of cell resistance, which would be unfavorable both in terms of behavior and in terms of cost.
... In the Islamic medical tourism context, medical tourists' beliefs regarding Islamic medical care practices of the doctors may influence their satisfaction towards the medical care services delivered. As medical care practices are considered as high-credence services, Muslim patients place great faith in the doctor's ability to provide medical care (Mudarri and Fisk, 2007;Rahman and Zailani, 2016). The patients' evaluations of the medical care services offered by doctors can be referred to as the relationship between physicians and patients in which they will look for friendly, helpful, attentive and caring doctors (Gaur et al., 2011;Suki et al., 2011). ...
Islamic medical tourism is defined as a short-term journey of individuals to destinations, outside their usual environment, primarily seeking health benefits at hospitals that practice Islamic principles in the delivery of their health services. With the growing market demand worldwide, hospitals around the world are increasingly equipping themselves to serve Muslim tourists who have specific needs and requirements. Providers of Islamic medical tourism are required to have a sound understanding of Islamic medical service components to ensure the satisfaction of patients who come from different nations. The main purpose of this chapter is to search the predominant medical tourism-related aspects of the Islamic perspective that will contribute to the niche market of Islamic medical tourism industry in the local and global process. This study employs a search method and synthesizes the relevant literature in the discipline of medical tourism services and highlight that Islamic medical tourism is a promising tourism concept with huge business prospects. This chapter explores the concepts, development, and challenges of Islamic medical tourism services, and finds that its development depends on good infrastructure, environment, 2 technology, investment and marketing strategy. The study proposes some strategies, policy and managerial recommendations for the provision of Islamic medical tourism.
... [16]. Sick Structure Syndrome has widespread financial and communal impact [17][18][19]. Frequent acquaintance to these pollutants can cause numerous health dilemmas, including irritations and lethal effects, infections, aversions and other breathing or skin infections [20]. According to preceding studies exposed that in presence of water photocatalytic process is active against varied organisms, like algae, viruses and bacteria. ...
... Flooding can exacerbate mold and dampness inside buildings, leading to potentially adverse health outcomes. A national analysis estimated the health cost associated with asthma attributable to indoor mold and dampness to be $3.5 billion (Mudarri and Fisk 2007). ...
Climate change is a major environmental challenge that is likely to affect many aspects of life in Illinois, ranging from human and environmental health to the economy. Illinois is already experiencing impacts from the changing climate and, as climate change progresses and temperatures continue to rise, these impacts are expected to increase over time. This assessment takes an in-depth look at how the climate is changing now in Illinois, and how it is projected to change in the future, to provide greater clarity on how climate change could affect urban and rural communities in the state. Beyond providing an overview of anticipated climate changes, the report explores predicted effects on hydrology, agriculture, human health, and native ecosystems.
... mould exposures) in buildings, with the estimates ranging from 18% to 50%, and these affect human health. 30,[41][42][43][44][45] The relative humidity is one of the environmental factors contributing to airborne microorganisms' vitality with higher bacteria and fungi. 18 However, humidity with a lower percentage is the limiting factor for indoor microorganisms. ...
Occupants of buildings spent most of their time indoors and posed themselves to the indoor biological contaminants (i.e. bacteria and fungi) in the built environment. However, the factors that influenced the prevalence of suspended bacteria and fungi in the air of the built environment are not well recognised. Authorities must take the growth of biological contaminants seriously to prevent serious health effects among occupants of buildings. This review summarises the factors (i.e. outdoor air, dust, ventilation problems, humidity/moisture surface problems and human occupancy) of indoor biological contaminants and their species in buildings that could worsen the indoor air quality. Bacteria species could exist in various indoor buildings (i.e. schools, cafeterias, mosques, faculties, child day-care centres, hospitals, dwellings, educational buildings, homes, elderly care centres, libraries, restaurants, and factories). The dominant bacteria were Bacillus spp. (24.1 %), Staphylococcus spp. (20.7 %), and Micrococcus spp. (20.7 %) whereas for fungi species were Penicillium spp. (25 %), Cladosporium spp. (21.9 %), and Aspergillus spp. (21.9 %).
... While associations point toward exposure to fungi and bacteria grown on damp building materials as the mediator of these health effects, causal relationships are not established to the point that specific airborne taxa or levels are attributable to health effects 2 . Dampness and mold have been reported in approximately 50% of U.S. homes 3,4 and self-reported in 4% to over 29% of homes in the European Union 5 . ...
This commentary is intended to provide a research roadmap for utilizing recent chemical and molecular-biological technological advances for addressing dampness and mold in buildings. The perspective is unique in that both the mold industry practitioners and academic researchers drive the questions. Research needs were derived from a 2018 international workshop attended by practitioners, researchers and governmental representatives, where challenges and opportunities in the mold remediation and restoration field were discussed focusing on the need to develop new tools that improve building diagnosis and clearance certification for mold inspectors and remediators. Suggestions are made on how new technologies surrounding DNA-based sequence analysis for fungal and bacterial identification and real-time chemical sensor technology can be leveraged by practitioners to improve inspection and remediation. The workshop put into effect a logical progression to distill and extract practice-based implications and encourage the process of transfer of the science to practice. Goals for the workshop, and this subsequent paper, are also centered on encouraging US government-funding agencies to better position and define research on the built environment geared for end-user scientists and practitioners to better explore practical solutions to dampness and mold in indoor environments. By facilitating the workshop forum and targeting industry, field practitioners, and government agencies, a sharing of needed commonalities may be infused into future research agendas and outreach efforts.
... For example, a meta-analysis study showed that mold and dampness in residential buildings were associated with a 30%-50% increase in reported respiratory problems and asthma cases. If this turns out to be a causal relationship, the total health related costs could be around $3.5 billion [102]. Alsmo and Holmberg [103] found that poor air quality is a major problem that Swedish schools face, and it can degrade the health of teachers and students, while increasing the societal burden through health costs, absenteeism, poor academic performance and productivity losses. ...
Even before the COVID-19 pandemic, people spent on average around 90% of their time indoors. Now more than ever, with work-from-home orders in place, it is crucial that we radically rethink the design and operation of buildings. Indoor Environmental Quality (IEQ) directly affects the comfort and well-being of occupants. When IEQ is compromised, occupants are at increased risk for many diseases that are exacerbated by both social and economic forces. In the U.S. alone, the annual cost attributed to sick building syndrome in commercial workplaces is estimated to be between $10 billion to $70 billion. It is imperative to understand how parameters that drive IEQ can be designed properly and how buildings can be operated to provide ideal IEQ to safeguard health. While IEQ is a fertile area of scholarship, there is a pressing need for a systematic understanding of how IEQ factors impact occupant health. During extreme events, such as a global pandemic, designers, facility managers, and occupants need pragmatic guidance on reducing health risks in buildings. This paper answers ten questions that explore the effects of buildings on the health of occupants. The study establishes a foundation for future work and provides insights for new research directions and discoveries.
... Toxic molds growing in homes and work buildings can produce poisonous mycotoxins that exacerbate preexisting health conditions [6,7]. In recent years within the United States, mold-related asthma has affected 4.6 million people for a total annual cost of $3.5 billion [8]. The costs of deleterious fungal growth are substantial in agriculture, as well. ...
We use a 785 nm shifted excitation Raman difference (SERDS) technique to measure the Raman spectra of the conidia of 10 mold species of especial toxicological, medical, and industrial importance, including Stachybotrys chartarum, Penicillium chrysogenum, Aspergillus fumigatus, Aspergillus flavus, Aspergillus oryzae, Aspergillus niger, and others. We find that both the pure Raman and fluorescence signals support the hypothesis that for an excitation wavelength of 785 nm the Raman signal originates from the melanin pigments bound within the cell wall of the conidium. In addition, the major features of the pure Raman spectra group into profiles that we hypothesize may be due to differences in the complex melanin biosynthesis pathways. We then combine the Raman spectral data with neural network models to predict species classification with an accuracy above 99%. Finally, the Raman spectral data of all species investigated is made freely available for download and use.
... On the other hand, existing studies have shown that respiratory tract infections, asthma, dermatitis and other allergies, and even infectious diseases can be caused by exposure to or the inhalation of mold and its metabolites for a long time, as confirmed by the Institute of Medicine (IOM) and the World Health Organization (WHO) [3][4][5]. In Northern Europe and North America, according to the estimation, 20% to 40% of buildings are contaminated by indoor mold [6], which has a significant impact socially and economically [7,8]. For example, costs related to indoor mold pollution have been estimated by the United States and Scandinavia, where the results show that annual 2 of 16 social and economic costs caused by high humidity and mold growth are 2.3-4.7 billion US dollars for allergic rhinitis and 1.1-2.3 billion US dollars for acute rhinitis [5]. ...
The climate characteristics of the islands in the Nansha Islands of China are a typical marine climate including high temperature, high relative humidity, high salt content, strong solar radiation, and long sunshine. These can provide suitable conditions for mold reproduction on the surface of the wall in a building. Therefore, mildew pollution on the wall for a long time can easily damage the building’s structure. It does not only directly affect the appearance of the building, but also indirectly affects the indoor environment and human health. In this paper, dominant fungi in the residential buildings on thee Nansha Islands of China are Aspergillus, Penicillium, and Cladosporium. Critical lines of temperature and relative humidity for mould growth on the interior surfaces of island residential building envelopes have been given and discussed. The results show that the risk of mould growth on the wall with different materials, from low to high, is reinforced concrete, aerated concrete block, coral aggregate, brick, and wood. Furthermore, in order to prevent the room regulated by air conditioner from being contaminated by mould, indoor air temperature should be set variable and controlled between 26 °C and 28 °C, the relative humidity should be changed between 50% and 80%.
... The transmission of microbial pathogens in the BE is also manifested by the fact that every year there are 1.7 million hospital acquired infections (HAIs) in the US, resulting in 99000 related deaths every year (Curtis, 2008). Moreover, about 21% of asthma cases in the US can be attributed to dampness and mold in the BE, particularly residential homes, costing $3.5 billion annually (Mudarri and Fisk, 2007). It was found that reduced microbial diversity in the BE is associated with the development of asthma (Ege et al., 2011). ...
Built environments, occupants, and microbiomes constitute a system of ecosystems with extensive interactions that impact one another. Understanding the interactions between these systems is essential to develop strategies for effective management of the built environment and its inhabitants to enhance public health and well-being. Numerous studies have been conducted to characterize the microbiomes of the built environment. This review summarizes current progress in understanding the interactions between attributes of built environments and occupant behaviors that shape the structure and dynamics of indoor microbial communities. In addition, this review also discusses the challenges and future research needs in the field of microbiomes of the built environment that necessitate research beyond the basic characterization of microbiomes in order to gain an understanding of the causal mechanisms between the built environment, occupants, and microbiomes, which will provide a knowledge base for the development of transformative intervention strategies toward healthy built environments. The pressing need to control the transmission of SARS-CoV-2 in indoor environments highlights the urgency and significance of understanding the complex interactions between the built environment, occupants, and microbiomes, which is the focus of this review.
... The presence of fungi in buildings causes the biodegradation of the materials used in construction by changing their functional properties [1][2][3][4][5]. They also contribute to the deterioration of the air quality in the room due to the presence of toxic metabolites [6][7][8][9][10][11][12]. ...
The publication concerns the problem of adopting proper environmental conditions in the assessment of mold development in the so-called thermal bridges in the form of corners. The paper discusses the factors determining the development of mold and the models that predict its growth. The conditions of the internal microclimate, which is used in hygrothermal diagnostics of walls, were also recalled. Thermal bridges are areas where mold development takes place, therefore the climatic conditions in the room taken for their assessment—as it is currently applied—are considered inappropriate. This thesis is confirmed by the results of in situ studies of changes in temperature and relative humidity in the area of corners. Some of these findings are presented in the work. On their basis, the author introduces the concept of the so-called geometric climate that would take into account the change of these parameters within thermal bridges of the corner type.
... Indeed, spores, hyphal fragments and microbial volatile organic compounds (mVOCs) can be emitted from mouldy surfaces [17] and the size of these particles is small enough to be inhaled [16,18,19]. A chronic exposure to moulds can induce a hypersensitivity in healthy adults [20], as well as respiratory problems such as asthma in young children [21][22][23], adults [24] and older adults [25]. The most common indoor fungi that can cause such pathologies are Penicillium spp. ...
The presence of growing fungi in the indoor environment has been associated with the development of respiratory problems such as asthma or allergic rhinitis, as well as the worsening of respiratory pathologies. Their proliferation indoors could be a result of water leakage or inadequate ventilation. Although the factors promoting mould growth have been widely investigated in traditional dwellings, little work has been done in energy efficient dwellings. Here, the effectiveness of ventilation type, i.e., natural or mechanical, in influencing mould development was estimated in 44 recent and 105 retrofitted energy efficient dwellings. Fungi growing on surfaces were investigated in the dwellings situated in rural, peri-urban, and urban regions of Switzerland. The presence of these fungi was also investigated in bedroom settled dust. Information on building characteristics and owners' lifestyle were collected. Significant associations were found with the level of urbanisation, the location of mouldy area in dwellings, and the diversity of fungal taxa. Dwellings in peri-urban zones showed the most frequent fungal contamination in the owners' bedroom and the highest diversity of fungal genera among dwellings. While the urbanisation level or the ventilation type favoured no specific genus, we found marked disparities in the diversity of fungi growing on surfaces in naturally ventilated versus mechanically ventilated dwellings. Aspergillus, in particular, was a frequent surface contaminant in bedrooms with natural ventilation, but not in those mechanically ventilated. We observed a strong association between fungal growth on surfaces and the number of fungal particles counted in the settled dust of owners' bedrooms. These results demonstrate the importance of ventilation systems in energy efficient dwellings in controlling fungal proliferation in living areas.
... The environmental and health benefits of efficiently using primary and final energy have repeatedly been studied (Maidment et al., 2014;Howden-Chapman, 2015;Mudarri and Fisk, 2007;Ringel et al., 2016;Willand et al., 2015). Also, the economic impacts have been well studied over the last years. ...
In this paper, we develop a quantitative indicator approach including 20 indicators to measure the multiple benefits of energy efficiency (MB-EE). The MB-EEs are classified into three groups: environmental (e.g. energy savings, emissions), economic (e.g. GDP, employment), and social (health, energy poverty) aspects. We explain the methodological approach, the underlying data sources and limitations. The indicator set has been applied to 29 countries (EU28 plus Norway) for the period 2000 to 2015, proving that it allows to conduct in-depth comparisons of developments and differences across Europe. The indicator set also supports the design of well-suited energy policies by allowing to take into account, on an informed basis, more of the multiple impacts of energy efficiency.
For example, our analysis of the effect of energy savings for the period 2000 to 2015 in Germany shows GHG savings of about 158 MtCO2eq., about 30,000 avoided deaths due to less air pollution, a reduction of Germany's import dependency by 5.8 percentage points and a growth of GDP by around 0.3% per year for the period 2010 to 2015) as a consequence of improved energy efficiency. To conclude, the presented approach allows to comprehensively and regularly assess policies in terms of their MB-EEs.
... In contrast, uncontrolled fungal growth can be costly to human health, agriculture, forestry, and livestock. For example, around 4.6 million people in the U.S. suffer a loss of ~$3.5 billion annually from mold-related asthma 5 . In total, mold exposure, infection, and damage lead to agricultural losses of millions of dollars to American agri-producers every year 6 . ...
Successful approaches to identification and/or biological characterization of fungal specimens through Raman spectroscopy may require the determination of the molecular origin of the Raman response as well as its separation from the background fluorescence. The presence of fluorescence can interfere with Raman detection and is virtually impossible to avoid. Fluorescence leads to a multiplicity of problems: one is noise, while another is “fake” spectral structure that can easily be confused for spontaneous Raman peaks. One solution for these problems is Shifted Excitation Raman Difference Spectroscopy (SERDS), in which a tunable light source generates two spectra with different excitation frequencies in order to eliminate fluorescence from the measured signal. We combine a SERDS technique with genetic breeding of mutant populations and demonstrate that the Raman signal from Aspergillus nidulans conidia originates in pigment molecules within the cell wall. In addition, we observe unambiguous vibrational fine-structure in the fluorescence response at room temperature. We hypothesize that the vibrational fine-structure in the fluorescence results from the formation of flexible, long-lived molecular cages in the bio-polymer matrix of the cell wall that partially shield target molecules from the immediate environment and also constrain their degrees of freedom.
... Molds, also known as filamentous fungi, are ubiquitous in the indoor environment in tropical and subtropical areas where moisture is present. A number of studies have reported the prevalence of mold growth on household materials in dwellings and schools (Yang et al. 1997;Wong et al. 2004;Gunnbjornsdottir 2006;Mudarri and Fisk 2007). ...
Indoor mold grows ubiquitously in humid areas and can affect occupants’ health. To prevent indoor mold contamination, one of the key measures suggested by the World Health Organisation and United States Environmental Protection Agency is to maintain an indoor relative humidity (RH) level below 75% or at 30–60%, respectively. However, in tropical and subtropical areas, maintaining these suggested RH levels is equivalent to operating a 24-h air-conditioner (AC) or dehumidifier, which is energy-consuming. As a large part of building expense, the operation time of ACs has been regularly proposed to be cut down because of the requirement of building sustainability. This leads to a trade-off between sustainable building performance and indoor mold hygiene. To balance this trade-off, more sustainable alternatives, such as those that target physical environments (e.g. nutrient and temperature level) or apply new surface coating technologies to inhibit mold growth, have been launched. Despite these initiatives, indoor mold contamination remains an unresolved issue, mainly because these alternative measures only exhibit limited effectiveness or require extra effort. This review aims to summarize the currently adopted mold control measures and discuss their limitations as well as the direction for the future development of sustainable mold control strategies.
Significance and Impact of the Study
People spend most of their time indoors and hence the presence of indoor mold contamination can compromise the occupants’ health. With the wake of climate change which is expected to see an increase in RH and temperature, tropical and subtropical areas are even more prone to mold contamination than they used to be. This study may help facilitate the development of sustainable and effective mold control strategies in the indoor environment.
... Specifically, indoor mold will increase the risk of chronic rhinosinusitis hypersensitivity, pneumonitis/allergic alveolitis and allergic fungal sinusitis [6][7][8][9]. Chronical exposures to microbial contaminants can trigger sick building syndrome (SBS) [10][11][12], including asthma, rhinitis or bronchitis symptoms. ...
Mold growth poses a high risk to a large number of existing buildings and their users. Air leakage through the air cavities of the building walls, herein gaps between walls and air conditioner pipes penetrating the walls, may increase the risks of interstitial condensation, mold growth and other moisture-related problems. In order to quantify the mold growth risks due to air leakage through air cavity, an office room in a historical masonry building in Nanjing, China, was selected, and its indoor environment has been studied. Fungi colonization can be seen on the surface of air conditioner pipes in the interior side near air cavity of the wall. Hygrothermometers and thermocouples logged interior and exterior temperature and relative humidity from June 2018 to January 2020. The measured data show that in summer the outdoor humidity remained much higher than that of the room, while the temperature near the air cavity stays lower than those of the other parts in the room. Hot and humid outdoor air may condense on the cold wall surface near an air cavity. A two-dimensional hygrothermal simulation was made. Air leakage through the air cavities of walls proved to be a crucial factor for mold growth.
... For example, a 2011 study found that 23.4 million of 110 million housing units were considered unhealthy residences based on the presence of rodents, leaks, peeling paint, or faulty smoke alarms (Raymond et al., 2011), while, 5.8 million residences were considered inadequate based on moderate or severe (Bonnefoy, 2007), and poor mental health (Pevalin et al., 2017). The chronic exposures to hazards such as lead, mold, allergens, or poor sanitation can impact health and functioning (National Research Council US Committee on Measuring Lead in Critical Populations., 1993;Mudarri and Fisk, 2007), while inadequate structural characteristics can impact personal safety through an increased risk for injury. However, debate exists on the pathways that drive the associations between housing and health, as contemporaneous adversities such as food insecurity, poverty, and unsafe neighborhoods are also independently tied to poor health (Bennett et al., 2007; Comission on Social Determinants of Health (CSDH), 2008). ...
Nearly a quarter of the homes in the United States were considered unhealthy or inadequate, but whether these housing characteristics have direct effects on health or whether they are driven by other contextual housing and neighborhood characteristics remains unclear. The purpose of this study was to quantify the independent associations between poor housing quality and adult health outcomes, adjusting for socioeconomic factors (e.g. income to poverty ratio, food insecurity) and other contextual housing characteristics (e.g. rental status, number of people per household, unsafe neighborhood). Using in-person household interview data from wave 1 of the 2014 Survey of Income and Program Participation (SIPP), a secondary analysis was performed using a series of logistic regression models. The 2014 SIPP sample is a multistage stratified sample of 53,070 housing units designed to represent the civilian, noninstitutionalized population of the United States (N = 55,281 adults ages 18 and older). Our results indicated that poor housing quality was associated with poorer health status (OR: 1.17, CI [1.11, 1.23]), higher medical utilization (OR: 1.11 CI: [1.06, 1.16]), and a higher likelihood of hospitalization (OR: 1.07, CI [1.02, 1.12]). Non-housing-related government assistance, food security, and safe neighborhoods only partially explained associations between housing quality and health outcomes. Evaluating current local, state, and federal policy on housing quality standards may help determine if these standards decrease the number of Americans residing in inadequate homes or result in improvements in health and reductions in healthcare costs. Simply put, the home is where [we suggest] the health is.
... Water as liquid and vapor are known to be transported through building envelopes via liquid penetration, diffusion, capillary suction and air infiltration. Moisture accumulation and high moisture content within envelope assemblies has been associated with poor indoor air quality (Mudarri and Fisk 2007), structural damage and costly repairs (Zabel and Morrell 2012). ...
Building envelope design and analysis through simulation tools are areas of research and professional practice within the architecture, engineering, and construction (AEC) industries that can have substantial economic outcomes. Approximately 20% of whole building capital costs are associated with building envelopes. High moisture content within building envelopes is known to promote mold and corrosion while also reducing thermal resistance. Thus, simulating envelope moisture behavior is useful in evaluating designs. To allow for future stochastic and degradation modeling this project has augmented the open source platform, HAM-Tools and verified its results by using WUFI Pro 6.1 software. HAM-Tools is a robust one-dimensional H.A.M. analysis software using MATLAB and Simulink computational environments which allows for further development and research. In this work, wind-driven rain, rain penetration, as well as heat & moisture sources in air layers have been added to HAM-Tools. The paper compares the results from HAM-Tools and WUFI for a set of common ventilated cladding scenarios. Insulation degradation (which cannot be analyzed in WUFI) is also integrated into HAM-Tools and moisture content is simulated over a 10-year period to demonstrate how the platform can be used to examine long term moisture impact. The results of the study show that HAM-Tools and WUFI can produce relatively close results for moisture content within the envelope given the same ventilated scenarios. The 10-year studies with and without insulation degradation show that there are times where there are significant differences in the moisture content predicted with and without insulation degradation.
... Exposure to moisture damage and mold at home is associated with considerably increased risk for upper and lower respiratory tract morbidity including exacerbation and development of asthma (Mendell et al., 2011;World Health Organization, 2009). With roughly half of the houses in United States affected with damp-ness or mold, as many as one in five asthma cases may be attributable to these exposures (Mudarri and Fisk, 2007). ...
... Exposure to moisture damage and mold at home is associated with considerably increased risk for upper and lower respiratory tract morbidity including exacerbation and development of asthma (Mendell et al., 2011;World Health Organization, 2009). With roughly half of the houses in United States affected with damp-ness or mold, as many as one in five asthma cases may be attributable to these exposures (Mudarri and Fisk, 2007). ...
Combustion is one of the fundamental processes in learning and teaching in laboratories that leads to the release of gaseous pollutants that are both hazardous and a threat to the environment and health of individuals. This paper sought to measure the amount of combustion pollutants generated and their effects on the indoor air quality of a typical university laboratory using some selected laboratories in Ahmadu Bello University Zaria as a case study. The Combustion pollutants were measured using an IMR 1400C gas analyser. At the same time, its effects were assessed using a well-structured questionnaire designed and administered to hundred and twenty-seven laboratory users who were randomly selected. Data collected from the questionnaires were analysed using computer-based SPSS software. The results revealed that CO during combustion exceeded the ASHRAE 62 and NAAQS limit of 9ppm, reaching up to 45ppm at some points; also, oxygen was observed to be at a critical level of 20.9% and at some point falling below the limit to 20.4%. It was also observed that fatigue (RII: 0.81) is the most prominent symptom of poor indoor air quality during combustion, among other symptoms like coughing and sneezing, dryness and irritation of eyes and throat, sinus congestion, shortness of breath and headache, arranged in the order of intensity. The absence of functional fume hoods, laboratory congestion, and inadequate ventilation systems intensify the discomforting effect of combustion-generated pollutants in laboratories. Thus, it is recommended that fume hoods should be well maintained for functionality and installed in Laboratories where they do not exist (chemistry lab I). Finally, providing adequate ventilation systems in the laboratories would help increase safety in labs for learning and teaching purposes. Keywords: Combustion Generated Pollutants, Indoor Air Quality, Measurement of Pollutants.
As the decision‐making basis for “safety” in risk management and risk assessment activities, acceptable risk has always been an important topic of risk‐related research. Based on the records in the Science Citation Index Expanded database and Social Sciences Citation Index database via the Web of Science Core Collection, 1124 articles or reviews related to acceptable risk in engineering and operations research and management science were retrieved. These documents, published between 1961 and 2021, covered 3056 authors, 75 countries/territories, 1296 institutions, and 323 journals. In this study, bibliometric data such as annual growth trends were analyzed by using descriptive statistics. Through the co‐occurrence maps created by CiteSpace and Gephi, the most productive and influential countries/territories, institutions, and authors as well as their cooperation networks were identified. Further analysis was conducted to determine the core publications and publication sources in this field through co‐citation analysis. Insights into focus areas and research topics over time were obtained through keyword co‐occurrence analysis. This study provides a macroscopic overview of acceptable risk research and may help researchers better understand this research field and predict its dynamic directions.
Mold toxin exposure by inhalation and ingestion has significant health consequences for humans. In this article, we discuss the sources of these everyday toxins and their relevance to patient health. The effects of mycotoxins can present across all body systems, and the resulting symptoms can be acute, cumulative, and chronic. These effects can occur discretely, but they can also present alongside other clinical entities. It is important for the clinician to recognize the phenomenon of mycotoxin illness, because as a primary cause, it does not resolve with current standards of care for conditions secondary to it.
This chapter examines how the spread of new classes of synthetic chemicals, and antimicrobial compounds in particular, over the last century have transformed indoor and global ecologies. The circulation of these chemicals within late industrial environments and bodies is challenging the notion that toxicity is always bound to specific, tracible substances. Modern sanitation and antibiotics were supposed to break the link between disease and the environment, thus freeing landscapes and buildings to be engineered for other purposes. This chapter examines how failures to adequately appreciate and interrogate indoor ecological interactions in the development of disease, and an overreliance on antimicrobial forms of disease control, have contributed to Antimicrobial Resistance, inflammatory disease and the accumulation of pollutants in bodies and ecologies around the world.
Dampness has been a major concern in building structurally sound concrete buildings for the past century. Several remedies and technologies proposed thus far involve various principles and strategies adopted from different disciplines of study. Despite the problem being around for so long, reliable data corresponding to effectiveness of methods devised to prevent dampness and eventual corrosion of the reinforcement have not been accurately explicated. This paper provides an overview of technologies available so far to solve the issue of dampness and sheds light on the most effective methods proven so far.
Distinct from homelessness, housing instability can include moving frequently between residences (also known as “couch surfing”), being behind on rent payments, or being threatened with evictions. While estimating the number of people with unstable housing is difficult given inconsistent definitions, 2.3 million people annually face evictions alone. In addition to housing instability, six million households live in substandard housing conditions nationally, an estimate virtually unchanged in 20 years. Unstable housing and poor housing quality are associated with adverse health outcomes, particularly for those with chronic diseases, and are therefore an important consideration in the management of emergency department patients. Research across settings has found that both housing instability and poor housing quality are common among emergency department patients. This chapter provides guidance for emergency providers on assessing and responding to patients’ housing stability and quality status in the emergency department and beyond.
The paper presents a study aimed at investigating the indoor air quality (IAQ) and people’s perception regarding the indoor environment of schools and public buildings in Timisoara. The indoor air quality monitoring was performed during the cold season, in the period January 2020 – February 2021. Six public buildings – schools and administrative edifices belonging to the municipality were subject of monitoring. An Andersen microbial air sampler was used to enumerate the numbers and different kinds of respirable bacteria and fungi inside of the selected classrooms and offices. The results of the specialized laboratory analyses indicate that the microbiological contaminant counts, expressed in colonyforming unit (CFU/m ³ ), fall within the permissible limits for all monitored rooms. No beta-hemolytic streptococci or Staphylococcus aureus were identified, conditionally pathogenic bacteria for the upper respiratory tract. Most moulds were of the genus Penicillium, without having a pathogenic significance for humans. Occupants’ perception on indoor air quality, thermal comfort, health complaints and symptoms such allergies or respiratory illnesses with possible connection to the Sick building syndrome were surveyed by questionnaire. The findings were analysed and a plan to improve IAQ in the public buildings was proposed, with specific measures to increase the comfort and health of the learning and working environment.
There is mounting evidence that exposure to household dampness/mold (D/M) is the cause of respiratory, allergic diseases for children. While few research focuses on the effects caused by building environment changes, from a longitudinal investigation perspective, especially for China experiencing a rapid development in recent years. This study aimed to explore the changes of D/M in Chinese homes over the past 10 years and identify the impacts of climate, building energy efficiency and residents' behaviors. The cross-sectional surveys were repeatedly conducted in children’ residences in 2010 (Period I) and 2019 (Period II), among Taiyuan, Urumqi in northern China, and Nanjing, Shanghai, Wuhan, Changsha, Chongqing in southern China. Finally, 23465 children in Period I and 34720 children in Period II were involved, with no changes of residences since birth. The results showed that the proportions for reported D/M indicators were significantly reduced in Period II: e.g., 93.8% and 84.1% residents respectively answered no visible mold spots and damp stains in current residences, compared to only 78.3% and 62.2% in Period I. Southern homes accounted for high proportions for D/M indicator occurrences; warm-humid climate, annual higher precipitation and lower sunshine hours, etc., exacerbated the indoor D/M exposure risks. While residents' behaviors like ventilation, airing quilt/beddings, regular cleaning ameliorated the reported D/M significantly. The findings, from a temporal and spacious dimension perspective, advance our understanding of indoor D/M changes, precisely improvement in children’ homes over the past 10 years, benefiting to promote indoor air quality standards in China.
The health implications of mould contamination in housing are widely accepted, however preventing and treating mould growth is a complicated issue of interrelated factors. Building design, location, ambient conditions and occupant behaviour all affect mould, creating difficulty in both identifying and addressing the root cause. In this study, a cohort of 233 residential properties with recently remediated mould issues were investigated to understand remediation methods employed and identify factors contributing to mould growth. The root cause and success of remediation was explored for a subset of 30 of the properties. The study showed that remediation without sufficiently addressing the root cause of mould issues is not effective in preventing mould growth from reoccurring in the short term, with 40% of the subset of properties experiencing regrowth within 12 months. Subsequently, indoor environment conditions were monitored for five (5) of these properties over the course of a year including temperature and humidity, to identify contributing or correlated factors to mould growth. Properties with extensive mould growth were found to have particularly high wall surface temperatures compared to the room air dewpoint temperature. Humidity levels in all properties were elevated, with mould affected properties experiencing bedroom humidity levels above 80% for between 7 and 45% of the time. These conditions were evaluated against mould risk indicators such as those from BS5250, ISO13788, CIBSE Guide A and ASHRAE 160, however none of these indicators were able to reliably predict the risk of mould occurrence in the specific cohort of five monitored properties in our study..
This study assessed associations between house characteristics and mold and musty odor, using data from three consecutive (2005, 2010, and 2015) New Zealand House Condition Surveys, involving a total of 1616 timber‐framed houses. Mold, musty odor, and house characteristics were assessed by independent building inspectors. We used multivariate logistic regression analyses mutually adjusted for other house characteristics for each survey separately. Positive and independent associations were found with tenure, ventilation, insulation, and envelope condition for both mold in living and bedrooms and musty odor. In particular, we found significant dose‐response associations with envelope condition, ventilation, and insulation. Odds of mold increased 2.4–15.9 times (across surveys) in houses with the worst building envelope condition (BEC; p < 0.05–0.001 for trend); optimal ventilation reduced the risk of mold by 60% and the risk of musty odor by 70%–90% (p < 0.01 for trend). Other factors associated with mold and musty odor included: tenure, with an approximate doubling of odds of mold across surveys; and insulation with consistent dose‐response patterns in all outcomes and surveys tested (p < 0.05 for trend in two surveys with mold and one survey for odor). In conclusion, this study showed the importance of BEC, ventilation, and insulation to avoiding harmful damp‐related exposures.
This chapter reviews current knowledge about the health effects of several environmental conditions on home fuel poverty, including physiological and epidemiological aspects of cold and heat related illness, and epidemiological studies on excess morbidity and mortality. the inadequate home concept has been addressed with further contributions that have on mental health, asthma (dampness and mould), noise, CO poisoning and lung cancer for radon exposure. Measures for reducing cold and heat related mortality and morbidity related to poor energy housing include appropriate urban planning and housing design. this contributes confirm that poor housing quality is a significant public health issue. However, to realize a large health potential associated with adequate, safe and healthy homes, joint action on health and nonhealth sectors is required. the development of specific guidelines for general and healthcare practitioners to better manage information on patients living in bad situations of fuel poverty is desirable.
Fuel poverty affects around 34% of European homes, representing a considerable burden to society and healthcare systems. This pilot study assesses the impact of an intervention to install a new first time central heating system in order to reduce fuel poverty on household satisfaction with indoor temperatures/environment, ability to pay bills and mental well-being. In Cornwall, 183 households received the intervention and a further 374 went onto a waiting list control. A post-intervention postal questionnaires and follow-up phone calls were undertaken ( n = 557) to collect data on household demographics, resident satisfaction with indoor environment, finances and mental well-being (using the Short Warwick-Edinburgh Mental Wellbeing scale). We compared responses between the waiting list control and intervention group to assess the effectiveness of the intervention. A total of 31% of participants responded, 83 from the waiting list control and 71 from the intervention group. The intervention group reported improvements in the indoor environment, finances and mental well-being. However, these benefits were not expressed by all participants, which may result from diverse resident behaviours, lifestyles and housing characteristics. Future policies need to consider whole house approaches alongside resident training and other behaviour change techniques that can account for complex interactions between behaviours and the built environment.
Biodeterioration challenges range from poor indoor air quality and exterior marble defacing to more dangerous building degradation. People often change the look of degraded walls by painting over them, removing carpets as well as replacing damaged wood and papers to improve their aesthetic value. Due to a lack of public awareness and health care infrastructure, the degradation rate is increasing in many countries. There is a need for a review of the international literature supporting practical recommendations. In this critical review paper, the role of microbes in deteriorating buildings, their health impacts in terms of mycotoxins and diverse strategies to handle them are discussed. Moreover, the forthcoming challenges associated with biodegradation and their health impacts have been addressed. Key recommendations have been made: (a) increase of awareness due to community involvement in enhancing moisture control, (b) improvement of cleaning processes and the use of air conditioning systems, (c) regular inspection and maintenance regimes for buildings and (d) cleaning of heating and air conditioning units and associated replacements of filters. The review provides a broad overview of the subject area and should be of interests to generalists working in a wide range of disciplines relevant to indoor air quality.
Housing is considered a core social determinant of health (SDH) through mechanisms such as the quality, affordability, and location of the home. However, few nationally representative studies examine these mechanisms simultaneously with child health and healthcare use. To determine the associations between home quality and child health, a series of logistic regression analyses was employed using the Survey of Income and Program Participation (SIPP). The 2014 SIPP sample is a multistage, stratified sample of 53,070 housing units from 820 sample areas designed to represent the civilian, noninstitutionalized population of the United States. The analytic sample included 12,964 children aged 2–14 years. Poor housing quality was defined as whether the home had holes in the floor, cracks in the ceiling, plumbing issues, and/or pest problems. Outcome measures included child health status, number of medical visits, and hospitalizations. The results indicated that poor housing quality was associated with poorer health (OR = 1.16, 95% CI = 1.05–1.27) and a greater number of medical visits (OR = 1.11, 95% CI = 1.03, 1.20) after controlling for number of persons per household, neighborhood safety, nonmetropolitan status, parent’s ability to afford housing-related expenses, and other SDH. Future work investigating and intervening on the SDH in children could specifically include the quality and contexts in which homes are situated.
In 2015, the Ministry of the Environment in Finland renewed the legislation and the National Building Code of Finland. It released completely new legislation concerning repair design. This was due to widely known issues relating to the indoor air quality of private and public buildings. In the autumn of 2019, the Ministry of the Environment in Finland published a guide concerning the repairs of moisture and microbial damage. It is available in Finnish and Swedish. This guide is a follow-up of the Environmental Guide “Building Moisture and Indoor Air Quality Assessment”, published 2016. It completes the series of guides for the execution of a project repairing indoor air quality issues, from a condition assessment to the completion of repairs and the implementation of the building. These guides lead through common practices and how these issues shall be dealt with in Finland.
Families often struggle to manage their child's asthma. Clinicians caring for children with asthma struggle too as they are tasked with balancing the limited time available in clinic and the need to provide comprehensive care. As a direct consequence, critical gaps in asthma care remain with respect to asthma education and the identification and reduction of environmental asthma triggers in the home. A home visit model that augments clinic-based care is a viable way to fill gaps in understanding, address incomplete adherence patterns, improve disease control by shifting the focus of asthma management to reduction of environmental asthma triggers, and bring cost savings to the health care system.
Asthma and related factors were assessed by mailed questionnaires among 2041 young adult participants in a smoking prevention project in California in 1993. Hispanics had lower prevalence of physician-reported asthma when compared to blacks and whites. Blacks were significantly more likely to be hospitalized or visit emergency rooms because of asthma or wheezing. After adjusting for sex, race, and educational level, family history of asthma was strongly associated with subjects' asthma (odds ratio = 3.1, 95% CI: 2.4-4.3 for physician-reported asthma; OR = 3.3, 95% CI: 2.4-4.5 for current asthma). Exposure to parental smoking (both parents smoked more than half a pack of cigarettes a day) during childhood (reported when participants were in grade 7) was significantly associated with physician-reported asthma (OR = 2.9, 95% CI: 1.6-5.6) and current asthma (OR = 3.3, 95% CI: 1.7-6.4). The study also found that self-reported mold growth at home was significantly associated with asthma (OR = 2.0, 95% CI: 1.2-3.2). After adjusting for cigarette smoking and demographic variables, use of crack cocaine was marginally significantly associated with current asthma (OR = 2.3, 95% CI: 1.0-5.2), but not with physician-reported asthma (OR = 1.5, 95% CI: 0.7-3.3).
This study investigated two schools, one of which had previous mold problems. Pupils aged 6 to 13 yr were investigated using a questionnaire on symptoms and a skin prick test. The amount of airborne (1--> 3)-beta-D-glucan was measured in the classrooms. The levels were significantly higher in the problem school than in the control school (15.3 versus 2.9 ng/m3). The extent of respiratory as well as general symptoms was higher among the pupils in the problem school. Among the atopics, the extent of symptoms of dry cough, cough with phlegm, and hoarseness was similar to the nonatopics in the control school, but significantly higher in the problem school. The results suggest that (1--> 3)-beta-D-glucan, either by itself or as an indicator of molds, is a risk indicator of airways inflammation.
To evaluate dose-response relationships between airway inflammation/systemic symptoms and dampness exposure, we conducted a self-reported questionnaire study on risk factors among 1237 employees in 19 air-conditioned office buildings in the Taipei area. The odds ratio for eye irritation was 1.34 when either stuffy odor or mold was present in the buildings. The odds ratio increased to 1.72 when both stuffy odor and mold were present, to 3.14 when water damage was also present, and to 5.03 when four dampness exposure factors were present. Dampness in the building had a dose-response effect on eye irritation, cough, and lethargy/fatigue.
Several epidemiological studies have described an association between adverse health effects and exposure to mould and microbes present in the indoor air of moisture-damaged buildings. However, the biochemical linkage between microbial exposure and the large variety of reported respiratory symptoms is poorly understood. In the present study, the authors compared the respiratory symptoms, the production of inflammatory mediators interleukin (IL)-1, IL-4, IL-6, tumour necrosis factor-alpha (TNF-alpha) and cell count in nasal lavage fluid and induced sputum samples of subjects working in moisture-damaged and control school buildings. The sampling was performed and the questionnaires were completed at the end of the spring term, at the end of the summer vacation (2.5 months), during the winter term and after a 1-week winter holiday. The authors found a significant elevation of IL-1, TNF-alpha and IL-6 in nasal lavage fluid and IL-6 in induced sputum during the spring term in the subjects from the moisture-damaged school building compared to the subjects from the control building. The exposed workers reported sore throat, phlegm, eye irritation, rhinitis, nasal obstruction and cough in parallel with these findings. The present data suggests an association between microbial exposure, and symptoms as well as changes in pro-inflammatory mediators detected from both the upper and lower airways.
The association between home dampness and lower respiratory symptoms in children has been well documented. Whether fungal exposures contribute to this association is uncertain. In a prospective birth cohort of 499 children of parents with asthma/allergies, we examined in-home fungal concentrations as predictors of lower respiratory illnesses (LRI) (croup, pneumonia, bronchitis, and bronchiolitis) in the first year. In multivariate analyses, we found a significant increased relative risk (RR) between LRI and high levels (more than the 90th percentile) of airborne Penicillium (RR = 1.73, 95% confidence interval [CI], 1.23, 2.43), dust-borne Cladosporium (RR = 1.52; CI, 1.02, 2.25), Zygomycetes (RR = 1.96; CI, 1.35, 2.83), and Alternaria (RR = 1.51; CI, 1.00, 2.28), after controlling for sex, presence of water damage or visible mold/mildew, born in winter, breastfeeding, and being exposed to other children through siblings. In a multivariate analysis, the RR of LRI was elevated in households with any fungal level at more than the 90th percentile (RR = 1.86; CI, 1.21, 2.88). Exposure to high fungal levels increased the risk of LRI in infancy, even for infants with nonwheezing LRI. Actual mechanisms remain unknown, but fungi and their components (glucans, mycotoxins, and proteins) may increase the risk of LRI by acting as irritants or through increasing susceptibility to infection.
We conducted a 1-year epidemiologic study in Boston, Massachusetts, beginning May 1997, to examine the associations between environmental factors and office workers' health. We recruited 98 subjects (81 females and 17 males) in 21 offices in four office buildings. We conducted environmental sampling every 6 weeks and concurrently administered detailed questionnaires to collect information on work-related symptoms, psychosocial factors, and perceptions of the office environments. In multivariate analyses, eye irritation was positively correlated with floor dust [odds ratio (OR) = 1.46; 95% confidence intervals (CI), 1.14-1.86] and reported lack of office cleanliness (OR = 1.52; 95% CI, 1.11-2.08). Nonspecific symptoms were positively associated with unidentified chair fungi (OR = 1.87; 95% CI, 1.11-3.15) and several self-reported conditions, including a history of asthma (OR = 3.15; 95% CI, 1.26-7.87), more people in offices (OR = 1.71; 95% CI, 1.16-2.51), lack of office cleanliness (OR = 2.85; 95% CI, 1.72-4.73), and low job satisfaction (OR = 1.72; 95% CI, 1.06-2.81). Upper respiratory symptoms were positively associated with total fungal concentrations recovered from chair dust (OR = 1.35; 95% CI, 1.07-1.70) and the following self-reported conditions: more people in offices (OR = 1.45; 95% CI, 1.01-2.08), lack of office cleanliness (OR = 1.62; 95% CI, 1.15-2.30), and jobs frequently requiring hard work (OR = 1.43; 95% CI, 1.05-1.95). This study emphasizes the importance of maintaining a clean, uncrowded workspace and the importance of chair fungi as a correlate for health effects.
Unlabelled:
Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building-relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists classified rooms for water stains, visible mold, mold odor, and moisture using semi-quantitative scales and then estimated individual exposure indices weighted by the time spent in specific rooms. The semi-quantitative exposure indices significantly predicted building-related respiratory symptoms, including wheeze [odds ratio (OR) = 2.3; 95% confidence interval (CI) = 1.1-4.5], chest tightness (OR = 2.2; 95% CI = 1.1-4.6), shortness of breath (OR = 2.7; 95% CI = 1.2-6.1), nasal (OR = 2.5; 95% CI = 1.3-4.7) and sinus (OR = 2.2; 95% CI = 1.2-4.1) symptoms, with exposure-response relationships. We found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms. Our findings suggest that observational semi-quantitative indices of exposure to dampness and mold can support action to prevent building-related respiratory diseases.
Practical implications:
Current air sampling methods have major limitations in assessing exposure to mold and other biological agents that may prevent the demonstration of associations of bioaerosol exposure with health. Our study demonstrates that semi-quantitative dampness/mold exposure indices, based solely on visual and olfactory observation and weighted by time spent in specific rooms, can predict existence of excessive building-related respiratory symptoms and diseases. Relative extent of water stains, visible mold, mold odor, or moisture can be used to prioritize remediation to reduce potential risk of building-related respiratory diseases. From a public health perspective, these observational findings justify action to correct water leaks and repair water damage in order to prevent building-related respiratory diseases. This approach can also be a basis for developing practical building-diagnostic tools for water-incursion.
We conducted a study on building-related respiratory disease and associated social impact in an office building with water incursions in the northeastern United States. An initial questionnaire had 67% participation (888/1,327). Compared with the U.S. adult population, prevalence ratios were 2.2-2.5 for wheezing, lifetime asthma, and current asthma, 3.3 for adult-onset asthma, and 3.4 for symptoms improving away from work (p < 0.05). Two-thirds (66/103) of the adult-onset asthma arose after occupancy, with an incidence rate of 1.9/1,000 person-years before building occupancy and 14.5/1,000 person-years after building occupancy. We conducted a second survey on 140 respiratory cases, 63 subjects with fewer symptoms, and 44 comparison subjects. Health-related quality of life decreased with increasing severity of respiratory symptoms and in those with work-related symptoms. Symptom status was not associated with job satisfaction or how often jobs required hard work. Respiratory health problems accounted for one-third of sick leave, and respiratory cases with work-related symptoms had more respiratory sick days than those without work-related symptoms (9.4 vs. 2.4 days/year; p < 0.01). Abnormal lung function and/or breathing medication use was found in 67% of respiratory cases, in 38% of participants with fewer symptoms, and in 11% of the comparison group (p < 0.01), with similar results in never-smokers. Postoccupancy-onset asthma was associated with less atopy than preoccupancy-onset asthma. Occupancy of the water-damaged building was associated with onset and exacerbation of respiratory conditions, confirmed by objective medical tests. The morbidity and lost work time burdened both employees and employers.
The Passaic Asthma Reduction Effort (PARE) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARE questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.
The objectives of this study were to develop an initial semi-quantitative estimate of costs of indoor air quality problem prevention, mitigation, and remediation activities in US buildings and to provide useful information for a more comprehensive and accurate survey. This is intended to be more of a map of the territory rather than a precise cost estimate.
Building dampness in the floor construction is known to cause chemical degradation of polyvinyl chloride floor coatings, but few epidemiological studies on this topic have been published. Another topic of interest is the different symptoms in different buildings constructed with different building materials and with different architectural designs. The term Sick Building Syndrome (SBS) is sometimes used to describe irritation to the eyes, skin, and upper airways, headache and fatigue in relation to the indoor environment. The aim of our investigation was to study symptoms in relation to building dampness and type of building in geriatric hospitals. Four hospitals for geriatrics were selected to represent buildings with different ages and design, irrespectively of symptom prevalence. All staff (n = 95) were requested to answer a medical questionnaire, 88 (93%) participated. Measurements of room temperature, relative air humidity, air flow rate, illumination, moulds, bacteria, formaldehyde and other volatile compounds, respirable dust, carbon monoxide, carbon dioxide, nitrogen dioxide and ozone were carried out in all buildings. Statistical analyses were performed by bivariate analysis, and multiple logistic regression, adjusting for possible influence of building age, age of the subjects, gender, tobacco smoke, atopy and the perceived psychosocial work environment. Dampness in the upper concrete floor surface (75–84%), ammonia under the floor [3 parts per million (3 ppm)], and 2-ethyl-1-hexanol in the air were detected in two buildings built in 1985 and 1993. Increased occurrence of ocular, nasal and throat symptoms, and dry facial skin were found in the damp buildings. Those in the specially designed building had fewer of these symptoms. In conclusion, the study provides new evidence on possible health effects of dampness-related alkaline degradation of di(2-ethyl-hexyl) phthalate (DEPH) in PVC-building material. Emissions related to degradation of DEPH due to dampness in the floor construction, detected by an increase of 2-ethyl-1-hexanol in the air, seems to increase the occurrence of ocular, nasal, throat and facial skin symptoms. The indoor environment of one specially designed building with a high ceiling and avoidance of fluorescent lighting and interior plastic materials, seemed to have a positive influence on well-being. Our results support the view that building dampness should be avoided, and shows that it is possible to construct a new building where the inhabitants have few symptoms. Copyright © 1999 John Wiley & Sons, Ltd.
A health and housing questionnaire was administered to children, ages 9-11, living in 24 communities in the United States and Canada. Logistic regression analysis examined the relationship between respiratory health symptoms (bronchitic, asthmatic and lower respiratory) and housing factors. The health risks (expressed as relative odds) were controlled for gender, parental asthma, parental chronic obstructive pulmonary disease and parental education, as well as between-city differences. Lower respiratory symptoms had significantly higher odds ratios reported in older homes (1.12), homes with smokers (1.24), air conditioners (1.14), air cleaners (1.37), and humidifiers (1.47). Home dampness (1.48) and the individual mold and water variables were all significantly associated with increased symptoms. Similar results were reported for bronchitic and asthmatic symptoms. While air conditioners and air cleaners were confounded with symptoms, humidifiers remained significant after controlling for childhood atopy.
Unlabelled:
Five hundred and twenty-two teachers from 15 public schools, eight 'water-damaged' schools, and seven 'non-damaged' schools with no visible water damage were included in a cross-sectional design. Mold growth was assessed by recording the amount of dust on the floor and in the air in classrooms and the content of a number of mold species in the dust (CFU/g dust). The evaluation of health symptoms included symptoms recorded by questionnaire and spirometry, bronchial challenge, and CO-diffusion capacity. Nasal lavage fluid was analyzed for IL-8 and ECP. Personal and psychosocial factors were included as confounders. In this study population mucus membrane irritation symptoms (MMI) and general symptoms were reported more frequently by women than by men with odds ratios ranging from 1.4 to 2.1. Women's reports of symptoms from mucous membranes and skin and general symptoms were positively associated with mold exposure. Odds ratio for 'difficult to concentrate' after adjustment for confounders was 11.2 (1.4-90.1, 95% CI) at high levels of mold exposure. None of the lung function tests performed in this study were associated with mold exposure, to the 'water damaged' vs. 'non-damaged' classification, or to the symptoms reported. IL-8 and ECP were not associated either.
Practical implications:
Psychosocial and personal reasons dominate in MMI and general symptoms. Headache and difficulties to concentrate associated with indoor mold exposure, mainly for women. No lung function impairment associated with indoor mold exposure.
This study examined the relationship between measures of home dampness and respiratory illness and symptoms in a cohort of 4,625 eight- to 12-yr-old children living in six U.S. cities. Home dampness was characterized from questionnaire reports of mold or mildew inside the home, water damage to the home, and the occurrence of water on the basement floor. Symptoms of respiratory and other illness were collected by questionnaire. Pulmonary function was measured by spirometry. Signs of home dampness were reported in a large proportion of the homes. In five of the six cities, one or more of the dampness indicators were reported in more than 50% of the homes. The association between measures of home dampness and both respiratory symptoms and other non-chest illness was both strong and consistent. Odds ratios for molds varied from 1.27 to 2.12, and for dampness from 1.23 to 2.16 after adjustment for maternal smoking, age, gender, city of residence, and parental education. The relationship between home dampness and pulmonary function was weak, with an estimated mean reduction of 1.0% in FEF25-75 associated with dampness and 1.6% with molds. We conclude that dampness in the home is common in many areas of the United States and that home dampness is a strong predictor of symptoms of respiratory and other illness symptoms among 8- to 12-yr-old children.
To assess the occurrence of respiratory and other symptoms among workers in relation to dampness in day-care centers, a random sample of 30 day-care centers in the city of Espoo, Finland, was selected for the study. The study population consisted of 268 female day-care workers, who filled in a questionnaire. Dampness was found to be common: water damage had taken place in 70% of the centers, and workers perceived mold odor in 17% of them. Adjusted risk of work-related eye and respiratory symptoms was in general higher among the day-care workers exposed to both water damage and mold odor than among the unexposed. The prevalence of eye symptoms was statistically significantly higher. The results provide new evidence of the importance of dampness and mold problems in the work environment as determinants of respiratory and irritative symptoms.
Indoor risk factors for physician-diagnosed asthma and wheezing in the past 12 months without previous asthma diagnosis were assessed in a survey of parents of 5-9-year-old Seattle primary school students. Among the 925 respondents, 106 (11%) reported a physician diagnosis of asthma, 66 (7%) had wheezing without diagnosis, and 753 (82%) were asymptomatic. After adjusting for age, sex, gender, ethnicity, medical history, socioeconomic status (SES) and parental asthma status, an increased risk of physician diagnosis of asthma was associated with household water damage, the presence of one or more household tobacco smokers, and at least occasional environmental tobacco smoke (ETS) exposure. Similarly, an increased risk of wheezing in the past 12 months among children without diagnosed asthma was associated with household water damage, presence of one or more household tobacco smokers, and occasional or more frequent ETS exposure. No increased risk of either condition was associated with gas, wood, or kerosene stove use, household mold, basement water, or wall/window dampness. Similarities in the indoor risk factors patterns between diagnosed asthma and wheezing without diagnosis suggested a similar etiology of these two conditions. The slightly higher association between ETS and asthma may indicate that parents of diagnosed asthmatics were more conscious of ETS, and were more likely to prohibit household smoking by resident smokers. Future research is needed to quantify which aspects of household water damage are related to respiratory illness.
This cost of illness analysis examines national cost and resource utilization by persons with asthma using a single, comprehensive data source, the 1987 National Medical Expenditure Survey. Direct medical expenditures included payments for ambulatory care visits, hospital outpatient services, hospital inpatient stays, emergency department visits, physician and facility payments, and prescribed medicines. Indirect medical costs included costs resulting from missed work or school and days with restricted activity at work. Point estimates and 95% confidence intervals (CI) were calculated and inflated to 1994 dollars. The total estimated cost was $5.8 billion (95% CI, $3.6 to $8 billion). The estimated direct expenditures were $5.1 billion (95% CI, $3.3 to $7.0 billion), and indirect expenditures were valued at $673 million (95% CI, $271 to $1,076 million). Hospitalization accounted for more than half of all expenditures. More than 80% of resources were used by 20% of the population (defined as 'high-cost patients'). The estimated annual per patient cost for those high-cost patients was $2,584, in contrast with $140 for the rest of the sample. Findings from this study indicate that future asthma research and intervention efforts directed at hospitalizations and high-cost patients could help to decrease health care resource use and provide cost savings.
We performed a clinical study in 99 children attending schools with moisture problems and compared the findings with those of 34 children from a reference school. The aim of the study was to evaluate the possible association between respiratory or allergic diseases in the pupils and moisture or mould problems in the school buildings.
Asthma was diagnosed in nine (6.7%) children: eight of them came from the moisture-problem schools and all were over 10 y old. In addition, 17 non-asthmatic children had suffered from wheezing and 21 from long-term cough, both symptoms being suggestive of occult asthma. If moisture problems were observed both at home and in the school, the frequency of asthma was 21% and the combined frequency of asthma and wheezing was 43%. The presence of allergic rhinoconjuntivitis or atopic dermatitis had no association with moisture or mould problems. We performed skin-prick tests to 13 moulds in all the 133 children. A positive reaction (> 3 mm) was observed in only six (5%) of them. All six positive children reacted to at least one moisture-indicative mould, Fusarium roseum, Aspergillus fumigatus, Phoma herbarum or Rhodotorula rubra. None of these cases came from the reference school. There was a significant association between positive reactions to moisture-indicative moulds and asthma; four (44%) of the nine children with asthma had such reactions. In addition, all the 6 reactive children had either asthma or wheezing.
We report preliminary evidence for an association between moisture or mould problems in the school building and the presence of manifest and occult asthma in the pupils. Our results show that skin-test positivity to moulds is rare in children. However, reactivity to moisture-indicative moulds seems to be associated with the occurrence of asthma or wheezing.
Poor indoor air quality has been suggested to be related to the increase in the prevalence of asthma that has occurred in the western world, especially among children and young persons. Apart from the home, school is the most important indoor environment for children.
The aims were to study the prevalence of current asthma among secondary pupils and its relationship to the school environment, but also to personal factors and domestic exposures.
Data on asthmatic symptoms, other health aspects, and domestic exposures were gathered using a questionnaire which was sent to 762 pupils in the seventh form (13-14 years old) in 11 randomly chosen schools in the county of Uppsala in Sweden. Pupils answering 'yes' to having had asthma diagnosed by a physician, and having had recent asthma attacks, or who used asthma medication were defined as having current asthma. Data on exposures at school were gathered by measurements in 28 classrooms. The relationship between asthma and exposures was analysed by multiple logistic regression.
The questionnaire was completed by 627 (82%). Current asthma was found among 40 pupils (6.4%). Current asthma was more common in those who had an atopic disposition, or food allergy, or who had attended a day care centre for several years. Controlling for these factors, current asthma was related to several factors in the school environment. There were more pupils with current asthma in schools that were larger, had more open shelves, lower room temperature, higher relative air humidity, higher concentrations of formaldehyde or other volatile organic compounds, viable moulds or bacteria or more cat allergen in the settled dust.
Although the pupils attended school for a minor part of their time, our study indicates that the quality of the school environment is of importance and may affect asthmatic symptoms.
We sought to determine the association between office workers' respiratory tract symptoms and immediate skin test reactions with exposure to fungal and house dust mite aeroallergens at their work sites.
An initial prevalence survey was conducted among 1102 full-time workers in six mechanically ventilated, air-conditioned, nonindustrial buildings in downtown Montreal. Detailed environmental measures of 214 subjects' work sites were determined. Half of the workers reported frequent work-related respiratory tract symptoms on the initial survey. Participants simultaneously underwent allergy skin prick testing and completed a second self-administered questionnaire.
Contaminant levels were low and not associated with symptoms in the great majority of workers. For approximately 17% of workers, symptoms were associated with exposure to total concentrations of house dust mite allergen greater than 1 microg/gm floor dust (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.3, 19.5]) or to detectable airborne Alternaria allergens in their offices (OR, 3.3; 95% CI, 1.2, 9.4 and in the ventilation system supplying their offices (OR, 3.9; 95% CI, 1.6, 9.6). Workers with positive skin test reactions to Alternaria extract were exposed at their work site to airborne Alternaria allergen (OR, 4.4; 95% CI, 1.4, 14.5) and cited significantly more respiratory symptoms on both questionnaires. Detection of airborne Alternaria allergen at work sites was significantly associated with detection in the ventilation system (OR, 4.0; 95% CI, 1.4,10.9); this was in turn associated with lower efficiency filters.
Potentially avoidable exposure to aeroallergens accounted for symptoms in a small subgroup of office workers with frequent work-related respiratory tract symptoms.
Prevalence of and risk factors for asthma were examined in 1085 Head Start families at 18 Head Start sites in four high-risk community areas in 1994. A total of 13.9% of the families reported diagnosed asthma in their Head Start child and 18.8% reported that their child wheezed in the last 12 months. A total of 26.9% of respondents reported asthma in the immediate family of the child. Low birth weight (1500-2499 g), very low birth weight (<1500 g), and self-reported exposure to dampness or mold in the last 12 months were significantly associated with self-reported diagnosed asthma (OR = 1.93; 95% CI 1.17-8.73), (OR = 4.5; 95% CI 1.25-16.3), and (OR = 1.94; 95% CI 1.23-3.04), respectively. The young age of the children in Head Start, as well as the high prevalence of asthma in their families, suggest that the Head Start programs offer an unusual opportunity for asthma prevention programs.
Indoor bioaerosols (i.e., bacteria, fungi, endotoxin, and beta-1,3-glucan) were determined in daycare centers, office buildings, and domestic environments in the Taipei area. In addition, we used a questionnaire survey to determine associations between indoor dampness, bioaerosols, and airway inflammation and systemic symptoms. We demonstrated that the median levels of indoor bacteria and fungi were the highest in daycare centers, followed by those in homes and office buildings. Similar patterns were observed for endotoxin and beta-1,3-glucan. The prevalences of airway inflammation and systemic symptoms were higher for females in office buildings than for employees in daycare centers; all symptoms were more prevalent in females than males. With respect to the relationship between bioaerosol exposure and airway inflammation and systemic symptoms, we found a strong association between beta-1,3-glucan and lethargy/fatigue.
To study the relationships between dampness in concrete floors and building design on the one hand, and symptoms and medical signs of the eyes and nose in hospital workers, on the other.
Four hospitals for geriatrics were selected to represent buildings with different ages and design, irrespective of symptom prevalence. The first building was built in 1925. The second, built in 1985, was known to have dampness in the floor. Conventional building techniques were used in the third building, built in 1993, and the last building was built in 1994, and was specially designed to include high ceilings, and minimal use of fluorescent lighting and interior plastic materials. The interior surfaces were painted with water-based beeswax glazing. All staff (n=95) working day shifts were invited to take part in a medical examination of the eyes and nose including acoustic rhinometry and nasal lavage, and a medical questionnaire, and 93% participated. Measurements of temperature, relative air humidity, air flow, illumination, volatile organic compounds (VOCs), molds, and bacteria were carried out in all buildings, together with measurements of formaldehyde, respirable dust, carbon monoxide (CO), carbon dioxide (CO(2)), nitrogen dioxide (NO(2)) and ozone. Statistical analyses were performed by bivariate analysis, and linear, ordinal, and logistic multiple regressions, adjusting for age, gender, tobacco smoking, atopy, and the perceived psychosocial work environment.
Dampness in the upper concrete floor surface (75-84%), ammonia under the floor [3 parts per million (ppm)], and 2-ethyl-1-hexanol in the air were detected in the two buildings built in 1985 and 1993. Increased occurrences of ocular and nasal symptoms, an increased concentration of lysozyme in nasal lavage, and decreased tear film stability were found in the subjects working in the damp buildings. Those in the specially designed building had fewer ocular and nasal symptoms, and increased tear film stability. All buildings had low levels of formaldehyde, molds, bacteria, ozone, and NO(2). The lowest total concentration of VOCs, and the highest concentration of specific VOCs of microbial origin, were found in the building with special design.
The study provides new evidence of the role of dampness-related alkaline degradation of di-(2-ethylhexyl) phthalate (DEHP) in polyvinyl chloride (PVC) building material. Emissions related to degradation of DEHP due to dampness in the floor, indicated by increased 2-ethyl-1-hexanol in the air, seem to increase both the secretion of lysozyme from the nasal mucosa and the occurrence of ocular and nasal symptoms. The indoor environment of the specially designed building with high ceilings and no fluorescent lighting or interior plastics seemed to have a positive influence on the nasal and ocular mucous membranes.
Initially, we performed a questionnaire study on 622 school children aged 7 to 13 y. The study was supplemented with a clinical study including skin prick tests to 13 molds in 212 (34%) children with doctor-diagnosed asthma or parental-reported wheezing or prolonged cough. These children were attending one of two elementary schools, one with moisture problems (index) school, the other being the control school. The objective of the study was to evaluate whether exposure to moisture and sensitization to molds are associated with respiratory manifestations in school children.
The prevalence of asthma was 4.8%, which was similar in the children from both schools. The children from the index school more often had wheezing (16% vs 6%; p <0.001) and cough (21% vs 9%: p < 0.001) symptoms than control children. Positive skin reactions to molds were rare (2.4%), being present in 7% of asthmatic and in 1-2% of non-asthmatic children (NS). Lower respiratory tract infections were more common in the spring than in the fall in children from the index school, but not in control children, and the difference between the schools was significant in emergency visits (OR =2.0, p <0.01) and antibiotic courses (OR = 2.1, p < 0.01).
We found evidence of an association between moisture or mold problems in the school building and the occurrence of respiratory infections, repeated wheezing and prolonged cough in school children.
Asthma symptoms in adults in relation to the indoor environment.
To study the relationships between current asthma symptoms (wheeze or attacks of breathlessness) and the indoor environment and dampness in hospitals.
A study among personnel (n = 87) in four geriatric hospitals in winter. Indoor air pollutants, dampness in the concrete floor, and allergens in settled dust were measured. Multiple logistic regression analysis was applied, adjusting for age, sex, atopy, and dampness in the participants' own dwellings.
Current asthma symptoms were reported by 17%, and 8% had doctor's diagnosed asthma. Asthma symptoms were more common (adjusted odds ratio = 8.6; 95% confidence interval 1.3-56.7) in two buildings with signs of dampness-related degradation of di(ethylhexyl)-phthalate (DEHP) in polyvinyl chloride (PVC) floor material, detected as presence of 2-ethyl-1-hexanol (2-32 microg/m3) in indoor air (CAS nr 104-76-7). Asthma symptoms were related to higher relative humidity in the upper concrete floor construction, and ammonia in the floor. The newest hospital, built by an anthroposophic society, had low levels of dampness and few asthma symptoms (4%). Cat (Fel d1) and dog allergens (Can f1) were found in dust from all buildings (geometric mean 340 ng/g and 2490 ng/g, respectively). House dust mite allergens (Derp1, Derf1, or Derm1) were found in 75% of all samples (geometric mean 130 ng/g). There was no relationship between allergen levels and asthma symptoms.
Asthma symptoms may be related to increased humidity in concrete floor constructions and emission of 2-ethyl-1-hexanol, an indicator of dampness-related alkaline degradation of plasticiser DEHP. Moreover, geriatric hospitals can be contaminated by significant amounts of cat, dog and mite allergens.
The authors sought to determine whether exposure to molds, resulting from moisture damage in a school, was associated with increased respiratory symptoms and morbidity among schoolchildren and whether the renovation of this building resulted in a decrease in prevalence of respiratory symptoms and morbidity. The study was a follow-up (1-y interval) of children between the ages of 7 and 12 y from two elementary schools in a Finnish suburb. In addition to a questionnaire completed by the parents, the authors assessed the respiratory health of children by examining the health records of a local health center. In the cross-sectional study, the prevalence of symptoms and infections were higher in the exposed group, as were visits to a physician and use of antibiotics. The school was renovated, after which all prevalence decreased and no significant differences remained, except for visits to a physician (according to questionnaire responses). Therefore, moisture damage and exposure to molds increased the indoor air problems of schools and affected the respiratory health of children.
As new health care strategies compete with existing ones for limited resources, the health care system and its providers are beginning to turn to health economic analyses to help inform choices in the delivery of care. This 2-part review examines the current health economic literature for asthma and rhinitis. This first installment of the review focuses on studies that characterize the economic burden of asthma and rhinitis and examines how resources are allocated to the care of persons with asthma and rhinitis. In 1998, asthma in the United States accounted for an estimated 12.7 billion dollars annually. Similarly, in 1994, allergic rhinitis was estimated to cost 1.2 billion dollars. Most of the costs for these conditions are attributed to direct medical expenditures, with medications emerging as the single largest cost component. Indirect costs also represent an important social effect. While cost-of-illness studies help to characterize the economic burden, comparative health economic studies evaluate the value of new and existing strategies for clinical care. The second part of this review will explore how comparative studies have contributed to understanding how to best diagnose and treat asthma and allergic rhinitis.
The purpose of this study was to assess the occurrence of immunoglobulin E sensitization to common environmental allergens (atopy) and new allergic diseases among schoolchildren after starting school in a water-damaged school building. The staff and pupils of a Finnish elementary school with visible water damage and mold complained of respiratory and skin symptoms. The school building was examined and widespread moisture damage was found. A control school with no visible water damage was also examined. No indication of exceptional microbial growth was found in the samples taken from this school.
History of allergic diseases and the year of diagnosis were established by a questionnaire. IgE antibodies to the common environmental allergens were determined from randomly selcted groups from both schools.
Elevated IgE values were significantly more common among the exposed children, as was the occurrence of new allergic diseases after the children started at the school.
The odds ratios for the IgE values of the study groups indicated a possible relationship between exposure to microorganisms and IgE sensitization. Exposure to spores, toxins, and other metabolites of molds may have complex results with unknown immunogenic effects that may act as a nonspecific trigger for allergic sensitization leading to the development of atopy.
Upper airway symptoms have frequently been reported in people working or residing in damp buildings. However, little information has been available on objective pathophysiologic findings in relation to these environments. Twenty-eight teachers, who had worked for at least five years in a recently renovated school that had had severe moisture problems for years, were randomly selected for this study. Eighteen teachers, who had worked in another school that had no moisture problems, were randomly selected to serve as the control group. Although remedial measures had been taken, an increase in the prevalence of mucous membrane irritations was still reported by the teachers in the target school. We used a nasal challenge test with three concentrations of histamine (1, 2 and 4 mg/mL). Recordings of swelling of the nasal mucosa were made with rhinostereometry, a very accurate optical non-invasive method. The growth curves of mucosal swelling induced by the three concentrations of histamine differed significantly between the two groups (p < 0.01). The frequencies of atopy, evaluated with the skin-prick test, were almost identical in both groups. The study indicates that long-term exposure to indoor environments with moisture problems may contribute to mucosal hyperreactivity, of the upper airways. Such hyperreactivity also seems to persist for at least one year after remedial measures have been taken.
To study the relationship between basophil histamine release (HRT) to indoor moulds, indicating specific IgE, and building-related symptoms (BRS), asthma, and hay fever in individuals working in damp and mouldy buildings.
A cross-sectional study was performed among 86 school staff members, who on average had worked 143 months (range: 3-396) in moist buildings with mould growth in the constructions. A questionnaire concerning mucous membrane symptoms, facial skin symptoms, central nervous system symptoms, hay fever, and asthma was fulfilled by the participants, and blood samples were taken. Eight mould species growing on building constructions were identified and cultivated to obtain allergenic materials for testing. The presence in serum of IgE specific to moulds was verified by histamine release test (HRT) based on passive sensitization of basophil leukocytes. The validity of the method was confirmed by parallel testing of patients allergic to grass- and birch pollen and by the shift from positive to negative response after removal of serum IgE and by using sham sensitization.
The prevalence of most BRS was between 32% and 62%. Positive HRT, showing serum IgE specific to one or more of the moulds, was observed in 37% of the individuals. The highest frequency of positive HRT was found to Penicillium chrysogenum and then to Aspergillus species, Cladosporium sphaerospermum and Stachybotrys chartarum. A significant association was found between most BRS and positive HRT, whereas no association was observed between positive HRT to moulds and self reported hay fever or asthma.
Positive HRT to indoor moulds, showing the presence in serum of IgE specific to the fungi, was found to be related to BRS in individuals working in damp and mouldy buildings. Whether the association is of causal character is a question for further studies. The test may be useful in the evaluation and study of possible mould induced BRS.
Several epidemiological investigations concerning indoor environments have indicated that "dampness" in buildings is associated to health effects such as respiratory symptoms, asthma and allergy. The aim of the present interdisciplinary review is to evaluate this association as shown in the epidemiological literature. A literature search identified 590 peer-reviewed articles of which 61 have been the foundation for this review. The review shows that "dampness" in buildings appears to increase the risk for health effects in the airways, such as cough, wheeze and asthma. Relative risks are in the range of OR 1.4-2.2. There also seems to be an association between "dampness" and other symptoms such as tiredness, headache and airways infections. It is concluded that the evidence for a causal association between "dampness" and health effects is strong. However, the mechanisms are unknown. Several definitions of dampness have been used in the studies, but all seems to be associated with health problems. Sensitisation to mites may be one but obviously not the only mechanism. Even if the mechanisms are unknown, there is sufficient evidence to take preventive measures against dampness in buildings.
This paper provides a synthesis of current knowledge about the associations of ventilation system types in office buildings with sick building syndrome (SBS) symptoms and discusses potential explanations for the associations. Most studies completed to date indicate that relative to natural ventilation, air conditioning, with or without humidification, was consistently associated with a statistically significant increase in the prevalence of one or more SBS symptoms, by approximately 30 to 200%. In two of three analyses from a single study (assessments), symptom prevalences were also significantly higher in air-conditioned buildings than in buildings with simple mechanical ventilation and no humidification. The available data also suggest, with less consistency, an increase in risk of symptoms with simple mechanical ventilation relative to natural ventilation. Insufficient information was available for conclusions about the potential increased risk of SBS symptoms with humidification or recirculation of return air. The statistically significant associations of mechanical ventilation and air conditioning with SBS symptoms are much more frequent than expected from chance and also not likely to be a consequence of confounding by several potential personal, job, or building-related confounders. Multiple deficiencies in HVAC system design, construction, operation, or maintenance, including some which cause pollutant emissions from HVAC systems, may contribute to the increases in symptom prevalences but other possible reasons remain unclear.