[Housing and health counselling services in the management of allergic respiratory disease]

Structural Home Defects Are the Leading Cause of Mold in Buildings: The Housing and Health Service Experience

The study aimed to evaluate the contribution of building problems to mold proliferation in dwellings. We investigated 503 dwellings of patients suffering from respiratory diseases, whose attending physicians had requested a home inspection if the area of mold was equal to at least one square meter. After careful visual evaluation and basic environmental measurements performed by a trained technician, environmental issues were classified into building defects, accidental water damage, and condensation. Data analysis demonstrated that building defects were the pre-eminent cause of mold proliferation. Among the building defects, water infiltration through leaks in roofs or walls was the leading cause. These results highlight the need for health professionals managing patients with respiratory diseases to be able to request a home inspection, and for city health authorities to commission professionals who can focus on building problems and find ways to address them.

Views of general practitioners on indoor environmental health risks in the perinatal period

BACKGROUND

Home is generally perceived as a safety place, whereas the concentration of pollutants, influenced not only by external pollution but also by human activities, the presence of domestic animals, construction and furniture materials, are sometimes greater than outside.

OBJECTIVES

The aim of this study is to determine the general practitioners' (GPs) views on indoor environmental health risks in the perinatal period.

METHODS

Four semi-structured focus group with 31 GPs were conducted in two French departments in November 2009, February, March, and April 2010. The focus group meetings were analyzed using a general thematic analysis.

RESULTS

Perinatal care is a special health issue and a time of privileged sensitization. The attitude of health risks are well known in the case of "traditionally" toxic substances. In the case of "emerging" environmental exposure, these attitudes depend on the knowledge, beliefs, and experience specific to each practitioner. GPs are acquiring a new role in the field of environmental health, while at the same time coming to grips with its own strengths and limitations. The implementation of prevention depends on factors, which are not only specific to the practitioner but also related to the parents and the organization of the medical practice.

CONCLUSION

The sensitization of GPs to environmental medicine, promotion of eco-citizen education, development of research, and the distribution of information are some of the means which need to be implemented to prevent harmful exposure of the infant.

[Sensitisation profile to airborne allergens of patients followed for asthma in Cotonou, Benin. A cross-sectional study using prick-tests]

RATIONALE

The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control.

RESULTS

Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2.

CONCLUSION

Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites.

[Medical indoor environment counsellor (MIEC) in Burgundy: evaluation by physicians and patients]

Since December 2009, chest physicians and allergologists in Burgundy have been able to call upon a medical indoor environment counsellor (MIEC). The consultations are free for the patient and are undertaken following a medical referal after systematic cutaneous prick tests.

AIMS

To describe the indications, the distribution of prescriptions and to measure the impact of the counsellor's visits on the first 100 patients at 6 months and on the physicians at 18 months.

METHOD

Telephone interviews with the 67 physicians (whether prescribers or not) concerning their motivation and/or expectations, and with the first 100 patients concerning follow up of the recommendations.

RESULTS

Seventy percent of the physicians replied (n=47). The satisfaction of prescribers (n=22) was 8.42/10. The indications were rhinitis and a poorly controlled asthma. The requests concerned the search for dust mite (50%) and moulds (46%). Eighty-four percent of the physicians discussed the MIEC's report with the patients. The patients' symptoms were rhinitis (79%), asthma (57%) and conjunctivitis (33%). The Acarex test(®), performed in cases of positive prick tests to house dust mites (n=72), was strongly positive for 67 patients. Sixteen mould samples out of 21 were above the standard concentrations. Sixty-nine patients had followed the recommendations of the MIEC.

CONCLUSION

The impact of the MIEC visits was perceived as positive by the physicians and the patients. The medico-economic impact warrants further evaluation.

Environmental home inspection services in Western Europe

This review deals with environmental home inspection services in Western Europe provided for patients at the request of attending physicians to improve patient management. Such requests are usually motivated by respiratory or general symptoms which occur or worsen at home. The visit includes a standardised questionnaire as well as environmental sampling such as mite-allergen measurement, mould identification and volatile organic compound (VOC) measurements. Besides, some non-respiratory indoor risks are also taken into account. Following the visit, a report is sent to the family and the attending physician. These services have been developed since the early 1990s, but evaluation of their efficacy is still limited. Some studies have demonstrated a reduction in mite-allergen levels and clinical improvement following the visit and implementation of advice provided to the family. However, more studies are needed to further document efficacy and also perform cost-benefit analysis of these services.