The interaction between voice disorders and stress for work ability of teachers

OBJECTIVE

Less attention has been paid to the interaction between voice disorders, stress, and indoor environmental quality for work ability in teachers. Therefore, our aim was to study whether lower work ability associated more strongly when the variables of voice disorders and stress at work were combined as opposed to evaluating these two factors separately.

METHODS

We conducted a questionnaire study including validated self-assessment of work ability and a technical assessment of school buildings utilizing a sample of 1198 and a subsample (n = 538) of Finnish teachers.

RESULTS

When combined, voice disorders and stress at work had a stronger association to decreased work ability than when they were evaluated separately. The occurrence of stress was more prevalent in poor and moderate work ability than the occurrence of voice disorders. Nine out of 10 of the teachers who had neither voice disorders nor stress reported good work ability, while four out of 10 of the teachers who suffered from both voice disorders and stress had poor work ability. As regards the background variables, nearly half of the subjects working in the non-problem buildings have neither stress nor voice disorders.

DISCUSSION

We recommend offering support for reducing stress at work to improve teachers' work performance. The findings also support the maintenance of school buildings and keeping them in good condition. Follow-up studies are needed to investigate the possible effects of voice disorders and the associated variables on work ability.

The Association Between Work-related Stress, Indoor Air Quality and Voice Problems Among Teachers - Is There a Trend?

INTRODUCTION

Hoarseness and other voice problems are common in occupations where the person has to speak, sing or shout in a work environment containing dust, noise, gaseous or particulate irritants. In recent years, stress has often been associated with voice problems.

OBJECTIVE

The aim of this study was to examine trends over a period of time of the prevalence of voice problems and reported stress in Finnish school buildings.

STUDY DESIGN

School buildings from different parts of the country were studied for ten years using a similar questionnaire (N = 1721). Five schools participated before and after the remediation of an indoor air problem in the school buildings (n = 315).

RESULTS

In the pilot study (2007-2008), the reported work-related stress was on a very low level (3%) and the prevalence of hoarseness was 10%. After the economic crisis in 2008, the stress was observed to have increased. During the follow-up (2008-2017), the reported stress had continued to increase and in the latest surveys it was 21% and the prevalence of hoarseness 34%. Indoor air factors correlated significantly with hoarseness even when controlling for age, gender, owning pets and job satisfaction in a logistic regression model. In the school buildings where the remediation of the building was completed, the prevalence of hoarseness decreased but the level of stress increased. In general, the proportion of respondents reporting stress was lower than the proportion of respondents with hoarseness. Additionally, the reported stress also correlated with factors other than health in the education branch, especially economic resources and major changes in the core curriculum.

CONCLUSION

Hoarseness and work-related stress have, to a large extent, different risk factors. Over time, the proportion of individuals with stress has been at a lower level than the proportion of respondents with voice problems; hence, we conclude that it is quite unlikely that stress would be a causative risk factor for hoarseness. We recommend that irritant dust and gases should be reduced from the work environment of teachers to enable recovery from hoarseness and other voice problems. Coping with work-related stress should be alleviated with other measures.

Indoor microbial exposure increases complement component C3a and C-reactive protein concentrations in serum

Indoor exposure to microbial growth, caused by moisture damage, has been an established health risk for several decades. It is likely that a damp indoor environment contains biological pollutants that trigger both the innate and adaptive branches of the immune system. In this study, we investigated the association between moisture damage related microbial exposure and serum C3a, C5a and CRP concentrations in Finnish adults. Serum C3a and CRP concentrations were elevated in individuals exposed to moisture damage and microbial growth in an indoor air environment. The elevated concentrations may be due to environmental factors present in moisture-damaged buildings. Complement activation and the resulting proinflammatory cleavage products may be a driving factor in inflammatory responses following exposure to indoor moisture damage and related microbial growth.

Hoarseness among nurses

While many occupations are at risk for vocal health issues much of the current research has focused on teachers. The prevalence of hoarseness among nurses has not received much attention. The aim of this study was to determine the current prevalence of hoarseness among nurses and also to identify potential environmental risk factors from their working environment. The health data was collected from Finnish healthcare workers. Our findings are based on 13,560 health questionnaires which were statistically analyzed. Our results suggest that the one-year period prevalence of hoarseness was 30% and all the environmental problems which we evaluated (draft, room temperature too high, variable room temperature, room temperature too low, dry air, stuffy indoor air, moist air/ high humidity, inadequate ventilation, smell of mold or cellar, sewer odor, other unpleasant odors, tobacco smoke, noise and detectable dust or dirt) had an increasing effect on hoarseness. In conclusion, clear associations were found between environmental problems and hoarseness in nurses. Furthermore, efforts should be made to repair defective ventilation systems, remediate indoor air problems due to moisture damage and improve overall maintenance to protect the vocal health of nurses.

Self-reported voice disorders of teachers and indoor air quality in schools: a cross-sectional study in Finland

OBJECTIVE

We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings.

METHODS

We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts.

RESULTS

Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11-1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99-1.64).

DISCUSSION

In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.

The prevalence and risk factors of hoarseness among pupils in elementary schools in the South of Finland

Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children.Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools.Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption.Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes.

Occupational Risk Factors for Hoarseness Among Police Officers in Finland

PURPOSE

Police officers have many work-related risks. In Finland, hoarseness and other respiratory symptoms and related risk factors have not been investigated on a national level. In many of the work tasks carried out by the police, an excellent physical and mental condition is essential.

METHOD

Our aim was to determine the prevalence of hoarseness and related respiratory symptoms and to investigate eventual occupational risk factors associated with hoarseness. We also compared different work tasks and remediation procedures in three police stations with indoor air problems.

MATERIAL

In all, 767 persons completed a nation-wide e-mail survey. The study population is approximately 11% of the total police force in Finland. Half of the study population were men. In three cities, we evaluated the outcome of different type of remediation methods after the moisture damaged buildings were renovated. The prevalence of hoarseness was compared in different work tasks and the risk associated with indoor air, work-related stress, and background factors were estimated. Information on the remediation was obtained from the employer.

RESULTS

Altogether, 30.5% of the respondents had hoarseness and 15.5% had work-related stress. Almost 9% were smokers and 43% had pets at home. Of all the respondents, 13% had asthma. Hoarseness was not related to work-related stress. The strongest risk factors for hoarseness were asthma and exposure to mold odor, dusts and cold temperatures after adjusting for age, gender, smoking and pet-owning. When three renovation techniques were compared, the best results were found in the building with a thorough remediation and the removal of mold from the building.

CONCLUSIONS

We conclude that the exposure to irritant gases, fumes, and bioaerosols should be minimized whenever possible in order to avoid incident asthma and voice problems.

The prevalence of hoarseness among health care professionals: time trends and effect of remediation in working conditions in 2007-2018

PURPOSE

The purpose of this study was to investigate time trends in the prevalence of hoarseness among health care professionals in primary health care units (PHC) and in hospitals from 2007 to 2018. Moreover, purpose was to discover potential indoor environmental quality (IEQ) risk factors as well as to determine the effect of the remediation of the indoor air problems on the prevalence of hoarseness.

METHODS

The health status was collected from all employees in these units/hospitals (N = 1564/1199) with questionnaires and the follow-ups were carried out as an open cohort. Based on building condition inspections, buildings were classified to be an "exposed" or "reference" buildings by third-party experts. The before and after remediation results were compared to reference buildings.

RESULTS

During follow-up, hoarseness has not increased in those PHC units with good IEQ. In the pilot study, the prevalence of hoarseness in non-exposed reference building was 5.9%, and it stayed approximately at the same level throughout the follow-up. Whereas in buildings with an IEQ problem the prevalence of hoarseness varied between 16.2 and 36.1% and it decreased to 11.4% after the remediations. In a large hospital with severe IEQ problems, the prevalence of hoarseness was 39.1%, and in hospital buildings with a milder exposure 23.3%. The most important risk factors for hoarseness were asthma, allergic rhinitis and IEQ problems.

CONCLUSION

A good indoor environment and the remediation of damaged buildings seem to promote a better condition of the voice in health care workers.

Groundwater radon exposure and risk of lung cancer: A population-based study in Finland

Naturally occurring radioactive elements can be found in groundwater and exposure to such elements is associated with an increased risk of lung cancer. In this study, we aimed to observe the association between exposure to these radioactive elements in groundwater and the risk of lung cancer in selected regions in Finland. This is a population-based study from 1955 to 2019 in Finland. The exposed municipalities with their corresponding hospital districts were selected based on radon measurements at groundwater treatment plants. Lung cancer cases were obtained from the Finnish cancer registry. The 5-year incidence rates for lung cancer were calculated and a comparison was made between each of the hospital districts with radon exposure. More than 93,000 cases of lung cancer were reported in the radon-exposed regions over the examined period of 64 years. The highest number of cases was recorded in the Helsinki University hospital district and the least in the Southern Savo hospital district. Similarly, the lung cancer incidence rate was highest in Lapland and lowest in the Southern Savo hospital district. The number of daily smokers in the working-age population appears to have decreased in all the hospital districts from 2013 to 2018. A statistically significant increased risk of lung cancer was observed in the high radon-exposed hospital districts compared to those with lower exposure. Groundwater radon exposure is observed to be associated with an increased risk of lung cancer.

Transferring from moisture damaged school building to clean facilities - The avoidance of mold exposure induces a decline in symptoms and improvement in lung function among personnel

Working in a moisture-damaged building can cause different symptoms and effects on lung functions. Moving to a clean environment, it is believed to reduce symptoms and alleviate potential adverse health effects. This case study monitors the health effects of personnel in one school building before and after all school activities were transferred from a moisture-damaged school building to clean premises. The whole school staff was invited to attend this follow-up study. All participants (N = 45) were interviewed, and pulmonary functions were measured by spirometry and exhaled nitric oxide testing (FE_NO) before transferring the school activities to a new building and the control measurements were performed twice; three months and six months after the transfer. After transferring to temporary facilities, 82% of participants felt that their symptoms were improved or resolved and the pulmonary functions were improved; 50% of those who had decreased pulmonary functions at the beginning, their pulmonary function values returned to normal after three months. Over the next six months, the perceived symptoms continued to reduce so that 93% of the respondents felt fully asymptomatic with respect to indoor air, and the spirometry results improved further. Transferring workers from the damaged building to healthy environment provided beneficial health effects on pulmonary functions and to perceived symptoms even in a relatively short time period. Based on this study, and from the perspective of promoting and protecting the health and well-being of personnel, transferring school activities from a moisture damaged building to clean facilities brought considerable advantages, despite the possible cost and difficulties of finding replacement facilities.

Prevalence of Hoarseness in Primary Health Care and Hospitals-Associations With Different Work Tasks and Environmental Factors Among Nurses

OBJECTIVES

The voice is one of the most essential tools necessary for nurses achieve high care satisfaction and safety. Research on hoarseness has mainly focused on professional speakers, like teachers. The aim of this study was to determine the current prevalence of hoarseness among six subgroups of nurses (registered nurses, primary care nurses, pediatric nurses, laboratory nurses, dental nurses, and midwives) and also to identify potential environmental risk factors in their working environment.

METHODS

The health data was collected in collaboration with two health care professional trade unions. The findings are based on 15,553 returned health questionnaires which were statistically analyzed.

RESULTS

The 1-year prevalence of hoarseness among all participating nurses was 30.2 % in this data, but the variation between different occupational subgroups was significant; ranging from 25 % for laboratory nurses to 38 % for midwives. These findings were in line with perceived environmental problems and the differences between the sub-groups were not explained by the participants suffering from asthma, sinusitis, rhinitis, or common respiratory infections; there were no explanatory differences in the prevalence's of the above-mentioned diseases.

CONCLUSIONS

The variation in prevalence of hoarseness between the different occupational subgroups was significant and the prevalence was found to be in line with perceived environmental problems. The most common problems were stuffiness, dry air, and inadequate ventilation. In addition, both a perceived "sewer odor" and "smell of mold or cellar" in one's own working environment were also found to be significant risk factors for hoarseness. Based on this study, the current indoor air problems in Finnish health care facilities can be verified and are a source of risk to nurses' voices.

Asthma, allergies and respiratory symptoms in different activity groups of swimmers exercising in swimming halls

BACKGROUND

Respiratory symptoms are common in competitive swimmers. However, among these and in swimmers at other activity levels the swimming distance, the total spent time in swimming halls and their medical background varies. Our objectives were, first, to assess their medical histories and the associations with respiratory symptoms among swimmers in different activity groups and then second, to study the pulmonary function findings and related medications in competitive swimmers who exercise in swimming hall environments the most.

METHODS

First, 1118 participants consisting of 133 competitive-, 734 fitness- and 251 occasional swimmers answered questionnaires concerning their medical background, their respiratory symptoms in connection to swimming distance and their amount of time spent in swimming halls. Secondly, in 130 competitive swimmers, pulmonary function was tested by spirometry and a specific questionnaire was used to assess respiratory symptoms, medical histories and prescribed medication.

RESULTS

Respiratory symptoms were reported by 18% of the studied swimmers. Competitive swimmers had significantly more symptoms than fitness- and occasional swimmers. Naturally competitive swimmers swum more than 2000 m and stayed by the pool more than 90 min, longer than the other activity groups of swimmers. Spirometry testing showed airway obstruction in 15 swimmers, which was 12% of the 130 competitive swimmers. 21 of them, had physician-diagnosed asthma and 16 of these individuals had prescribed medication for it.

CONCLUSIONS

Competitive swimmers had the highest swimming hall exposure and reported significantly more respiratory symptoms. A high prevalence of airway obstruction findings in competitive swimmers with asthma and allergies suggests a need for future recommendations for regular testing and special medical care for competitive swimmers.

Indoor-related microbe damage induces complement system activation in building users

In this comparative study, serum complement system antimicrobial activity was measured from 159 serum samples, taken from individuals from microbe-damaged (70 samples) and from reference buildings (89 samples). Antimicrobial activity was assessed using a probe-based bacterial Escherichia coli-lux bioluminescence system and comparison was made at a group level between the experimental and reference group. The complement activity was higher in users of microbe-damaged buildings compared with the reference group and the significant (P < 0.001) increase in activity was found in the classical reaction pathway. This study strengthens our notion that exposure to indoor-related microbe damage increases the risk for systemic subclinical inflammation and creates a health risk for building users.

Investigating the short- and long-term effects of antibacterial agents using a real-time assay based on bioluminescent E. coli-lux

We have previously established that the E. coli-lux assessment is a convenient tool for rapid measurements of the kinetical features of short-term toxicity caused by various factors. In this study, kinetic measurements of seven specifically acting model antibacterials (i.e., polymyxin B, chloramphenicol, nalidixic acid, kanamycin, deoxynivalenol, erythromycin and tetracycline) and two metals (AgNO₃ and CdCl₂) against E. coli-lux through a bioluminescence- and optical density-based real-time assay that combined short- and long-term toxicity assessments were performed. Bacteria were exposed to antibacterials and the effects were reported as the half-maximum effective concentration (EC₅₀) after 30 min and 10 h. Regarding the 10-hour endpoints, all reference compounds, except deoxynivalenol, showed dose-response inhibition in the studied concentration range. The analysis of chloramphenicol, kanamycin, erythromycin, tetracycline and nalidixic acid clearly revealed the limitations of short-term inhibition tests. No significant differences were observed between the results obtained from luminescence inhibition and growth inhibition assays. The kinetical data from measurements provide differentiation between bacteriostatic and bactericidal mechanisms of various types of antibacterial agents. The combined assessment of short- and long-term effects reduces the risk of the underestimation of toxicity due to an inaccurate endpoint selection. The cost-efficient and fully automated E. coli-lux assessment technique may offer possibilities for high-throughput screening procedures.

Indoor exposure to Streptomyces albus and Aspergillus versicolor elevates the levels of spore-specific IgG, IgG1 and IgG3 serum antibodies in building users - A new ELISA-based assay for exposure assessment

Moisture-indicative microbes in buildings are associated with a variety of symptoms, ranging from mild irritation to severe clinical illnesses. These symptoms are caused principally by dried, dormant and dead microbe material like spores, mycelium and microbe metabolites, leading to the activation of the immune system and formation of the antigen-specific immunoglobulins. This activation presumably takes place through the respiratory track and is a normal immune reaction against pathogenic invaders. During continuous exposure, a prolonged state of inflammation will follow, and this forms a considerable health risk for a building's occupant. A new ELISA system utilizing spores from two species Streptomyces albus and Aspergillus versicolor as an antigen was developed to reveal the related immunological processes. In 159 persons, microbial exposure was observed to increase the levels of spore-specific IgG, IgG1 and IgG3 serum antibody levels of individuals residing in microbe-dense buildings compared with the control reference buildings. No differences were detected in the levels of S. albus- and A. versicolor-specific serum IgA or IgM levels.

The associations of indoor environment and psychosocial factors on the subjective evaluation of Indoor Air Quality among lower secondary school students: a multilevel analysis

Subjective evaluation of Indoor Air Quality (subjective IAQ) reflects both building-related and psychosocial factors, but their associations have rarely been studied other than on the individual level in occupational settings and their interactions have not been assessed. Therefore, we studied whether schools' observed indoor air problems and psychosocial factors are associated with subjective IAQ and their potential interactions. The analysis was performed with a nationwide sample (N = 195 schools/26946 students) using multilevel modeling. Two datasets were merged: (i) survey data from students, including information on schools' psychosocial environment and subjective IAQ, and (ii) data from school principals, including information on observed indoor air problems. On the student level, school-related stress, poor teacher-student relationship, and whether the student did not easily receive help from school personnel, were significantly associated with poor subjective IAQ. On the school level, observed indoor air problem (standardized β = -0.43) and poor teacher-student relationship (standardized β = -0.22) were significant predictors of poor subjective IAQ. In addition, school-related stress was associated with poor subjective IAQ, but only in schools without observed indoor air problem (standardized β = -0.44).

Indoor environmental quality in school buildings, and the health and wellbeing of students

Poor indoor environmental quality (IEQ) in classrooms may be a risk for health symptoms and cause absence from school. We conducted a comprehensive study in order to assess the connection between IEQ in Finnish elementary school buildings and the health and academic performance of sixth grade students. The specific aim of the present paper was to study the school- or grade-level prevalence of symptoms in relation to IEQ. The school- or grade-level (i.e. group level) prevalence of self-reported symptoms and perceived IEQ was studied using data collected by a health questionnaire comprising 37 questions. The health questionnaire was sent to all 6th grade students in a stratified random sample of 355 elementary schools in Finland. Indoor environmental conditions were assessed with measurements of ventilation rate and thermal conditions of classrooms in a subsample of 56 schools. Altogether 297 elementary schools participated in the health questionnaire study and a total of 4248 questionnaires were returned (estimated response rate 62.6%). The most common weekly symptoms in the spring semester were fatigue (7.7%), stuffy nose (7.3%), and headache (5.5%). However, both mean prevalence values for different symptoms among all 6th grade students and group-level prevalence values for specific symptoms varied considerably. On the group level, the prevalence values most frequently found above 95% CI (calculated for N=15) were wheezing, cough with wheezing, and fever over 37°C. The most frequently reported IEQ factors causing daily inconvenience in classrooms were noise (11.0%) and stuffy air/poor indoor air quality (IAQ) (7.0%), which were also found most frequently above 95% CI on the group level (calculated for N=15), together with self-reported high indoor temperature and dust or dirtiness. Self-reported daily stuffiness/poor IAQ was significantly correlated with measured mean temperatures and ventilation rates in classrooms. High prevalence of students' self-reported stuffiness/poor IAQ may indicate high indoor temperature or low ventilation rate in classrooms. Also high group level prevalence of other IEQ factors and certain symptoms may be indicative of IEQ problems that should be further studied. The results of this study can be used as a reference for assessing the questionnaire-based prevalence of self-reported symptoms among 6th graders, and their association with IEQ in classrooms. For such assessment, the number of students responding to the questionnaire must be carefully considered, also bearing in mind that prevalence values are symptom specific.

Umbilical artery pH values at birth and risk of asthma at 5 to 6 years of age

BACKGROUND

Intrapartum factors may have a role in the development of asthma and allergic diseases among offspring.

OBJECTIVE

To investigate the association between umbilical arterial pH values at birth and asthma, allergic rhinitis, and atopic eczema in children.

METHODS

We performed a case-control study of 222 asthmatic children and 183 control children aged 5 to 6 years with umbilical artery pH values recorded at birth. Associations were evaluated using logistic regression analysis.

RESULTS

Asthmatic children had significantly lower umbilical artery pH values at birth than nonasthmatics, even after adjusting. Children who were born with pH values of 7.20-7.25 had a 2.62-fold (95% confidence interval [CI], 1.31-5.23) higher risk of asthma and children who were born with umbilical arterial pH values < or = 7.19 had a 3.22-fold (95% CI, 1.51-6.87) higher risk of asthma than children who were born with umbilical arterial pH values of 7.26-7.30. In contrast, children who were born with umbilical arterial pH values > or = 7.30 had a 0.41-fold lower risk of atopic eczema than children who were born with umbilical arterial pH values of 7.26-7.30. No such association was detected between umbilical artery pH values and allergic rhinitis.

CONCLUSIONS

Stressful events at birth may play an important role in the development of asthma during early childhood. In contrast, higher umbilical arterial pH values were associated with a decreased risk of parent-reported atopic eczema at 5-6 years.

Two Legionnaires' disease cases associated with industrial waste water treatment plants: a case report

BACKGROUND

Finnish and Swedish waste water systems used by the forest industry were found to be exceptionally heavily contaminated with legionellae in 2005.

CASE PRESENTATION

We report two cases of severe pneumonia in employees working at two separate mills in Finland in 2006. Legionella serological and urinary antigen tests were used to diagnose Legionnaires' disease in the symptomatic employees, who had worked at, or close to, waste water treatment plants. Since the findings indicated a Legionella infection, the waste water and home water systems were studied in more detail. The antibody response and Legionella urinary antigen finding of Case A indicated that the infection had been caused by Legionella pneumophila serogroup 1. Case A had been exposed to legionellae while installing a pump into a post-clarification basin at the waste water treatment plant of mill A. Both the water and sludge in the basin contained high concentrations of Legionella pneumophila serogroup 1, in addition to serogroups 3 and 13. Case B was working 200 meters downwind from a waste water treatment plant, which had an active sludge basin and cooling towers. The antibody response indicated that his disease was due to Legionella pneumophila serogroup 2. The cooling tower was the only site at the waste water treatment plant yielding that serogroup, though water in the active sludge basin yielded abundant growth of Legionella pneumophila serogroup 5 and Legionella rubrilucens. Both workers recovered from the disease.

CONCLUSION

These are the first reported cases of Legionnaires' disease in Finland associated with industrial waste water systems.

Monitoring success of remediation: seven case studies of moisture and mold damaged buildings

Based on seven case studies of buildings that underwent different degrees of moisture and mold damage remediation, we aimed to develop methodology for assessment of the success of the remediation process. Methods used in gauging the success included technical monitoring of performance of building structures and heating, ventilation and air conditioning (HVAC) systems, microbial monitoring of indoor air quality (IAQ), and health effects studies of building occupants. The assessment was based on measurable change in the situations before and after remediation. Based on technical monitoring, remediation was successful in three cases, with partial improvement noted in three cases, whereas no remediation was conducted in one case. Based on microbial monitoring, improvement was detected in one, partial improvement in two and no improvement in two cases, whereas no follow-up was conducted in two cases. Health effect studies (mainly self-reported health status) showed improvement in one case, partial improvement in two cases, and no improvement in two cases, whereas no follow-up was conducted in one case, and in one case, follow-up failed due to low response rate. The results illustrate that it is possible to monitor the effects of remediation using various metrics. However, in some cases, no improvement could be observed in IAQ or occupant health, even if the remediation was considered technically successful, i.e. the remediation was fully completed as recommended. This could be due to many reasons, including: 1) all damage may not have been addressed adequately; 2) IAQ or health may not have been perceived improved regardless of remediation; and/or 3) the methods used may not have been sensitive/specific enough to detect such improvement within the 6-12 months follow-up periods after completion of the remediation. There is a need to further develop tools for monitoring and assessment of the success of moisture damage remediation in buildings.

Personal and microenvironmental concentrations of particles and microbial aerosol in relation to health symptoms among teachers

A total of 81 randomly selected elementary school teachers participated in two sampling campaigns conducted 2 weeks apart during the winter. A 24-h sample collection was performed using personal and microenvironmental sampling from homes, and an 8-h sample collection was performed from workplaces of the studied subjects. Filters were analyzed for particle mass, absorption coefficient of the filter, and for both total and viable microorganisms. Comprehensive questionnaire responses were collected from the teachers concerning weekly occurred symptoms during the previous 12-month period, and they filled in symptom diaries immediately after each sampling campaign concerning symptoms during the previous 24-h and 7-day periods. The effect of different recall periods on agreement between questionnaire responses was assessed. Factor analysis was used in order to identify factors explaining the pattern of correlations within the personal, home, and work measurements. Moreover, associations between personal, home, and work measurements of pollutants and symptoms were analyzed using general estimation equations. The recall period of 7 days seemed to provide the most reliable data for the health effect assessment. Information from the factor analysis may allow reduction of variables related to the exposure assessment, and better interpretation of results. Both personal exposure and concentrations of pollutants at home were more frequently associated with health symptoms than concentrations at work. In multipollutant analyses, absorbance coefficient was positively associated with eye symptoms, and total bacteria with both cough and blocked nose.

Effects of moisture damage and renovation on microbial conditions and pupils' health in two schools--a longitudinal analysis of five years

Airborne microbes and pupils' symptoms were monitored in a moisture-damaged (index) school and a reference school for five consecutive years. These surveys were carried out in two separate years before the renovation of the index school, during the renovation, and one and two years after the renovation. Microbial concentrations were higher in the index school than those in the reference school before and during renovation, but afterwards, the levels decreased to the level of the reference school. The effect of remediation was seen as an altered mycobiota in the index school. Year-to-year variation of microbial concentrations, probably due to climatic factors, caused a peak in both schools but their difference remained. Several symptoms were more prevalent in the moisture-damaged school than in the reference school, but the differences disappeared during the renovations. These results emphasize the importance of using a reference building in assessing the microbial conditions of a moisture damaged building. Furthermore, microbial concentrations reflected well the technical condition of the construction, but the reported symptoms of the occupants did not strictly follow the timely fluctuation in microbial conditions.

Does the pill make a difference? Previous maternal use of contraceptive pills and allergic diseases among offspring

BACKGROUND

Maternal use of oral contraceptive pills (OCPs) might increase the prevalence of allergic diseases among offspring. The aim of the study was to clarify if there are differences between OCP types in this association.

METHODS

Primary outcomes were asthma, allergic rhinitis and atopic eczema among 1182 children (618 asthmatic and 564 controls) aged 5-6 years.

RESULTS

Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with ethinyloestradiol (EO), increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs (OR 1.67, 95% CI 1.07-2.59, P < 0.024), and this risk was increased mainly in those children with parental allergy (OR 1.78, 95% CI 1.11-2.86, P < 0.018), especially in boys (OR 2.12, 95% CI 1.17-3.84, P < 0.014). No associations were observed between maternal use of OCPs before pregnancy and asthma or atopic eczema among offspring. The association between the previous use of OCPs and allergic rhinitis was not mediated through maternal sex steroid levels during early pregnancy, but women who had used more androgenic types of progestin formulas had higher serum levels of progesterone during early pregnancy.

CONCLUSION

Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with EO, increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs and this risk was detected mainly in boys and in children with parental allergy.

Moisture damage and childhood asthma: a population-based incident case-control study

Most previous studies on the association between moisture damage and asthma have been cross-sectional and relied on self-reported exposure and health. The present authors studied the association by carrying out careful home inspections among new, clinically determined cases of asthma and controls. New cases of asthma aged 12-84 months (n = 121) were recruited prospectively and matched for year of birth, sex and living area with two randomly selected population controls (n = 241). Trained engineers visited all homes. Both cases and controls had lived >or=75% of their lifetime or the past 2 yrs in their current home. Risk of asthma increased with severity of moisture damage and presence of visible mould in the main living quarters but not in other areas of the house. Cases more often had damage in their bedroom. Associations were comparable for atopic and nonatopic asthma and for children aged >30 months or <or=30 months. The present results, using standardised assessment of exposure and asthma, suggest that moisture damage and mould growth in the main living quarters are associated with the development of asthma in early childhood.

Characterizing microbial exposure with ergosterol, 3-hydroxy fatty acids, and viable microbes in house dust: determinants and association with childhood asthma

The authors assessed determinants of ergosterol, 3-OH fatty acids (FAs), and viable microbes in vacuum cleaner dust, and investigated the association between these microbial markers and childhood asthma. The authors studied the homes of 36 children who were new cases of childhood asthma and the homes of 36 controls. Home characteristics explained 34% to 44% of the variation in levels of different microbial groups. Determinants of 3-OH FAs were a lower level of cleanliness, having a fireplace, having livestock, and moisture damage; determinants of viable bacteria were the level of home repair needed and the material used in the building frame of the home. Ergosterol was associated with the presence of livestock and the practice of cleaning rugs outside; viable fungi was associated with the material used in the building frame, visible mold, and the practice of cleaning rugs outside. Exposure to mesophilic actinomycetes was nonsignificantly associated with risk of asthma. The authors concluded that the variation of microbial levels in dust could be explained relatively well by home characteristics, and suggested that exposure to mesophilic actinomycetes may increase the risk of new asthma.

Children's homes--determinants of moisture damage and asthma in Finnish residences

Certain housing characteristics increase the risk for moisture damage, which has been associated with increased risk for asthma in children. Modeling moisture damage as a function of these characteristics could therefore provide a simple tool to estimate building-related risk for asthma. This study aimed to find out specific associations between asthma case-control status of children and moisture damage and housing characteristics. The data consisted of information on 121 asthmatic children and predominately two age-, gender- and place of residence-matched control children for every case, and information on moisture damage and housing characteristics in the homes of the children. In a previous study, we found a statistically significant association between moisture damage observations in main living areas and asthma in children. Using logistic regression, five models were formulated to predict moisture damage status of the homes and moisture damage status of living areas. The models were able to classify the damage status correctly in 65.0-87.7% of the homes (kappa values 0.10-0.47) as functions of housing characteristics. None of the models qualified as a significant determinant of the case-control status of the children.

PRACTICAL IMPLICATIONS

It can be hypothesized that building-related risk for asthma could be roughly estimated using models predicting moisture damage status of buildings as a function of easily obtainable housing characteristics. The results of this study indicated that, with a moderate certainty, it is possible to model moisture damage status of buildings using housing characteristics. However, the models developed did not associate with asthma in children. In conclusion, it was not possible to estimate the risk for asthma by studying housing characteristics only, but detailed information on moisture damage (e.g. location of damage) was crucial for such estimation.

Occupational sensitization to storage mites in the personnel of a water-damaged grocery store

OBJECTIVES

To investigate the occupational exposure and sensitization to storage mites (SM) in sales staff working in a moisture-damaged and three healthy reference buildings.

METHODS

The study population consisted of the entire personnel (n=12) in the moisture-damaged grocery store. They all suffered from persistent upper respiratory tract symptoms. Twelve (in results 11) symptom-free controls working in three healthy reference groceries were matched with age, sex and occupation. Dust samples from each building were examined for mites. The clinical study consisted of otorhinolaryngological examination and determination of IgE reactivity. Specific serum IgE antibodies were measured against three SMs and two house dust mites (HDM). Skin prick tests (SPT) were made to the same five mites and to five common aeroallergens. If sensitization to any of the SMs was detected, a nasal provocation test (NPT) was performed.

RESULTS

SMs were found in all buildings. In all, seven cases and four control subjects showed IgE-mediated reactivity. Sensitization to mites was detected in six cases and in three controls and in 2/12 and 3/11 this was the only IgE antibody response observed. In addition, one case and one control subject were sensitized to common aeroallergens. NPT with SMs was positive in four cases and in one control.

CONCLUSIONS

In grocery stores, the personnel are exposed to SMs. The risk of sensitization to mites is obvious and an IgE response can occur without any reactivity to common aeroallergens. SM allergy may in some cases explain the chronic rhinitis related to moisture-damaged buildings.

Chemical and microbial exposures in a school building: adverse health effects in children

In this cross-sectional study, the authors examined the relationship between an unusual combination of indoor air contaminants in a school and adverse health effects among the attending children. A leaking roof and damp floors, together with gaseous leaks from the sewage system, led to a combined exposure of hydrocarbons, 2-ethylhexanol from plastic floor coverings, and moisture-associated microbes. The health status of 274 children in the school was assessed via repeated symptom questionnaires. Statistical analysis revealed a relationship between the indoor air contaminants and adverse health outcomes such as respiratory irritation, asthmatic symptoms, eye and general symptoms, and increased occurrence of common viral respiratory infections. No association was found between the exposures and doctor-diagnosed asthma, other allergic diseases, or bacterial respiratory infections. Chemical contaminants from the sewer system and damp construction materials were identified as the source of the problem. Remediation of the school building improved the indoor air quality and the health status of the children.

Microbial exposure, symptoms and inflammatory mediators in nasal lavage fluid of kitchen and clerical personnel in schools

OBJECTIVES

The aim of this study was to investigate how the microbial conditions of kitchen facilities differ from those in other school facilities. The health status of the personnel was also studied.

MATERIALS AND METHODS

The microbial investigations were conducted in six moisture-damaged schools and two reference schools. The symptoms of the kitchen personnel were surveyed with questionnaires and inflammatory responses in nasal lavage (NAL) fluid were measured.

RESULTS

The total concentrations of airborne microbes were lower in kitchens than in other facilities of the schools. However, the occurrence of moisture damage increased the airborne microbial concentrations both in kitchens, and in other facilities. Bacterial concentrations were high on surfaces in the damaged kitchens. Gram-negative bacteria predominated, but also thermophilic bacteria and mycobacteria were detected. Respiratory and general symptoms were prevalent both among kitchen workers and clerical personnel in the moisture-damaged environments. Reported allergies and repeated respiratory infections were connected with high IL-4 concentrations in NAL fluid. Median concentrations of studied inflammatory mediators (NO, IL-4, IL-6 and TNF-alpha) were slightly higher in NAL samples of kitchen workers than among the clerical personnel.

CONCLUSIONS

Kitchen facilites differ from other facilities of the school building for their moisture conditions and microbial contamination. Thus, they represent a specific type of environment that may affect the health status of the personnel.