Indoor air microbes and respiratory symptoms of children in moisture damaged and reference schools

Determining ventilation strategies to relieve health symptoms among school occupants

Purpose

Poor indoor air quality (IAQ) contributing to occupants’ health symptoms is a universal, typically ventilation-related, problem in schools. In cold climates, low-cost strategies to improve IAQ in a naturally ventilated school are rare since conventional methods, such as window opening, are often inappropriate. This paper aims to present an investigation of strategies to relieve health symptoms among school occupants in naturally ventilated school in Finland.

Design/methodology/approach

A case study approach is adopted to thoroughly investigate the process of generating the alternatives of ventilation redesign in a naturally ventilated school where there have been complaints of health symptoms. First, the potential sources of the occupants’ symptoms are identified. Then, the strategies aiming to reduce the symptoms are compared and evaluated.

Findings

In a naturally ventilated school, health symptoms that are significantly caused by insufficient ventilation can be potentially reduced by implementing a supply and exhaust ventilation system. Alternatively, it is possible to retain the natural ventilation with reduced number of occupants. The selected strategy would depend considerably on the desired number of users, the budget and the possibilities to combine the redesign of ventilation with other refurbishment actions. Furthermore, the risk of poorer indoor air caused by the refurbishment actions must also be addressed and considered.

Practical implications

This study may assist municipal authorities and school directors in decisions concerning improvement of classroom IAQ and elimination of building-related symptoms. This research provides economic aspects of alternative strategies and points out the risks related to major refurbishment actions.

Originality/value

Since this study presents a set of features related to indoor air that contribute to occupants’ health as well as matters to be considered when aiming to decrease occupants’ symptoms, it may be of assistance to municipal authorities and practitioners in providing a healthier indoor environment for pupils and teachers.

Mycobiota and the Contribution of Yeasts in Floor Dust of 50 Elementary Schools Characterized with Sequencing Internal Transcribed Spacer Region of Ribosomal DNA

The assemblage of fungi including unicellular yeasts in schools is understudied. We conducted an environmental study to characterize fungal communities in classroom floor dust. We collected 500 samples from 50 elementary schools in Philadelphia, PA, and evaluated room dampness/mold conditions. Genomic DNA from dust was extracted for internal transcribed spacer 1 Illumina MiSeq sequencing to identify operational taxonomic units (OTUs) organized from DNA sequences. Differential abundance analyses were performed to examine significant differences in abundance among groups. We identified 724 genera from 1490 OTUs. The genus Epicoccum was not diverse but the most abundant (relative abundance = 18.9%). Fungi were less diverse but most dissimilar in composition in the most water-damaged classrooms compared to the least water-damaged, indicating differential effects of individual classroom water-damage on fungal compositions. We identified 62 yeast genera, representing 19.6% of DNA sequences. Cyberlindnera was the most abundant (6.1%), followed by Cryptococcus, Aureobasidium, Rhodotorula, and Candida. The average relative abundance of yeasts tended to increase with increasing dampness and mold score and was significantly (p-value = 0.048) higher in the most water-damaged classrooms (22.4%) than the least water-damaged classrooms (18.2%). Our study suggests the need for further research on the potential health effects associated with exposures to yeasts in schools.

Environmental Factors Shaping the Diversity and Spatial-Temporal Distribution of Indoor and Outdoor Culturable Airborne Fungal Communities in Tianjin University Campus, Tianjin, China

Airborne fungi have significant influence on air quality and may pose adverse effects on human health due to their allergenic and pathogenic effect. We carried out a 1-year survey on the airborne fungal diversity and concentration of indoor and outdoor environments, within the Tianjin University campus. Airborne fungi were sampled using an HAS-100B air sampler. Isolated fungal strains were identified based on morphological and molecular analysis. A total of 641 fungal strains belonging to 173 species and 74 genera were identified in this study. The dominant fungal genera were Cladosporium (29.49%), Alternaria (25.9%), and Epicoccum (6.24%), while the most frequently occurring species were A. alternata (15.44%), C. cladosporioides (11.86%), and E. nigrum (5.77%). The mean fungal concentration at different sites ranged from 0 to 420 CFU/m³, which is lower than the permissive standard level. There was a seasonal variation in the airborne fungal community, while temperature and relative humidity were positively correlated with the fungal concentration and diversity at almost all the sites. Higher fungal diversity was recorded in peak period of human traffic at the two canteens, whereas the two dormitories showed higher fungal diversity in off-peak period. Our study provides the first report on the diversity and concentration of airborne fungal species within different Tianjin University campus environments and clarifies the role played by environmental factors on the analyzed fungal community. Our results may represent valuable information for air quality monitoring and microbial pollution control in densely populated human living environments.

Environmental Factors Affecting Diversity, Structure, and Temporal Variation of Airborne Fungal Communities in a Research and Teaching Building of Tianjin University, China

Airborne fungi are widely distributed in the environment and may have adverse effects on human health. A 12-month survey on the diversity and concentration of culturable airborne fungi was carried out in a research and teaching building of Tianjin University. Indoor and outdoor environments were analyzed using an HAS-100B air sampler. A total of 667 fungal strains, belonging to 160 species and 73 genera were isolated and identified based on morphological and molecular analysis. The most abundant fungal genera were Alternaria (38.57%), Cladosporium (21.49%), and Aspergillus (5.34%), while the most frequently appearing species was A. alternata (21%), followed by A. tenuissima (12.4%), and C. cladosporioides (9.3%). The concentration of fungi in different environments ranged from 0 to 150 CFU/m3 and was significantly higher outdoor than indoor. Temperature and sampling month were significant factors influencing the whole building fungal community, while relative humidity and wind speed were highly correlated with fungal composition outdoor. Variations in the relative abundance of major airborne fungal taxa at different heights above-ground could lead to different community structures at different floors. Our results may provide valuable information for air quality monitoring and microbial pollution control in university building environments.

Occupant health in buildings: Impact of the COVID-19 pandemic on the opinions of building professionals and implications on research

The objectives of this study are to investigate building professionals' experience, awareness, and interest in occupant health in buildings, and to assess the impact of the COVID-19 pandemic on their opinions, as well as to compare the research on occupant health in buildings to professionals' opinions. To address these objectives, a mixed research methodology, including a thorough review of the literature (N_L = 190) and an online survey (N_S = 274), was utilized. In general, there is an increasing research interest in occupant health and a heightened interest in health-related projects, among professionals, following the COVID-19 pandemic. Specifically, among the nine different building attributes examined, indoor air quality was the most researched building attribute with a focus on occupant health and was also presumed to be the most important by the professionals. Professionals considered fatigue and musculoskeletal pain to be the most important physical well-being issues, and stress, anxiety, and depression to be the most important mental well-being issues that need to be the focus of design, construction, and operation of buildings to support and promote occupant health, while eye-related symptoms and loss of concentration were the most researched physical and mental well-being symptoms in the literature, respectively. Finally, professionals indicated that COVID-19 pandemic had significant effect on their perspectives regarding buildings' impact on occupant health and they believed future building design, construction and operation will focus more on occupant health because of the pandemic experience.

Microbial exposures in moisture-damaged schools and associations with respiratory symptoms in students: A multi-country environmental exposure study

Moisture-damaged buildings are associated with respiratory symptoms and underlying diseases among building occupants, but the causative agent(s) remain a mystery. We first identified specific fungal and bacterial taxa in classrooms with moisture damage in Finnish and Dutch primary schools. We then investigated associations of the identified moisture damage indicators with respiratory symptoms in more than 2700 students. Finally, we explored whether exposure to specific taxa within the indoor microbiota may explain the association between moisture damage and respiratory health. Schools were assessed for moisture damage through detailed inspections, and the microbial composition of settled dust in electrostatic dustfall collectors was determined using marker-gene analysis. In Finland, there were several positive associations between particular microbial indicators (diversity, richness, individual taxa) and a respiratory symptom score, while in the Netherlands, the associations tended to be mostly inverse and statistically non-significant. In Finland, abundance of the Sphingomonas bacterial genus and endotoxin levels partially explained the associations between moisture damage and symptom score. A few microbial taxa explained part of the associations with health, but overall, the observed associations between damage-associated individual taxa and respiratory health were limited.

Impact of a green roof system on indoor fungal aerosol in a primary school in Greece

A primary school was investigated for airborne fungi by a culture-based method, in classrooms underneath a green roof in comparison to conventional concrete roofs. A portable Burkard sampler was used for the collection of air samples onto petri dishes with 2% Malt Extract Agar. The fungal aerosol mean concentration was 71 CFU m^-3 (range 17-176 CFU m^-3, median 51) in the classroom directly under the green roof, significantly lower than 192-228 CFU m^-3 (range 0-1090 CFU m^-3, median 69) under the concrete roofs and 188-412 CFU m^-3 (range 0-2183 CFU m^-3, median 771) in ground floor classrooms. The Indoor/Outdoor ratio was 0.4 for total fungi and 0.2-1.1 for predominant genera underneath the green roof, whereas 1-2.1 and 0.3-3.2 respectively for the rest of classrooms. The Potential Exposure Dose (PED) for fungal particles was calculated to 4.6 CFU kg^-1 and 9.3-35.3 CFU kg^-1 respectively. The genera Penicillium, Cladosporium and Aspergillus prevailed indoors and in ambient air. Aspergillus concentrations indoors correlated significantly with the concentration of the coarse fraction (PM10) of particulate matter. The genus Penicillium increased indoors during late spring and summer, in temperature 20-23 °C and relative humidity 42-53% and also predominated in ambient air, both indicative of multiple anthropogenic sources of amplification. The evidence about the green roof positive effect on microbial indoor air quality (mIAQ) is a matter of concern for further investigation.

Identifying and evaluating school environmental health indicators

Children's health, attendance, and academic performance may be affected by school environmental hazards. While prior studies evaluated home environment and health, few have evaluated indicators of school in-/outdoor environment and health. This study addresses this knowledge gap by systematically reviewing and evaluating outdoor and indoor indicators of school environment and student's health and performance in New York State (NYS). We also evaluate statistical methodologies to address highly correlated indicators and integrate multiple exposures. Multiple school environmental indicators were identified from various existing NYS datasets. We summarized data sources, completeness, geographic and temporal coverage, and data quality for each indicator. Each indicator was evaluated by scientific basis/relevance, analytic soundness/feasibility, and interpretation/utility, and validated using objective NYS data. Finally, advanced variable selection methods were described and discussed. We have identified and evaluated multiple school environmental health indicators. It was found that mold and moisture problems, ventilation problems, ambient ozone, and PM_2.5 levels are among the top priorities of school environmental issues/indicators in NYS, which were also consistent while using NYS data. Choice of best variable selection method should be made based on the research questions and data characteristics. The school environmental health indicators identified, and variable selection methods evaluated, in this study could be used by other researchers to help school officials and policy makers initiate prevention programs.

Municipal challenges in managing a building with noted health symptoms

Purpose

This study aims to present property management challenges that municipalities have encountered regarding a public building with noted building-related symptoms. The study goes on to provide reasons for the failure of attempts to manage the symptoms and discusses the current challenges concerning the process.

Design/methodology/approach

A participatory case study was used as the research methodology to identify the current challenges concerning a municipal approach to managing the building-related symptoms in a case-study building. The researchers scrutinised the history of the health symptom management process and attended the project planning meetings focused on the investigation of the condition of the building.

Findings

Multiple challenges concerning maintenance and omitted or postponed repair actions, as well as vagueness in the management process were found. In addition to this, it was noted that the complexity of the initial design of the building and vandalism have resulted in challenges for the maintenance and moisture performance of the building structures. According to the study, more orderliness and a more systematic process is needed when managing a municipal property.

Practical implications

The identified property management challenges may be of practical value for the facility managers and the property owners, especially when managing the building-related symptoms and a damaged building.

Originality/value

This study highlights the importance of having an in-depth understanding of condition assessments as well as proper maintenance and timely repairs for the successful management of the building-related symptoms in a municipal building. This is a pilot project in a larger project of management of building refurbishment.

Does dampness and mold in schools affect health? Results of a meta-analysis

This paper provides meta-analyses of the published findings relating the respiratory health of occupants of schools with visible dampness, water damage, visible mold, and/or mold odor. Random effects models were used to develop central estimates and confidence limits for the associations of respiratory health effects with school dampness and mold. Eleven studies, all with cross-sectional designs, were included in the meta-analyses; however, analyses for some health outcomes were based on as few as four studies. Analyses were performed using data from adults and children combined, using only data from children, and using data from adults and children after excluding two studies. The central estimates of odds ratios from the meta-analyses were consistently above unity. The evidence of adverse health effects was strongest for cough and wheeze, which had confidence limits excluding unity in some or all analyses. The odds ratios of 1.32 for cough and 1.68 for wheeze suggest moderate increases in health risk. Studies not included in the meta-analyses provide additional evidence that dampness and mold in schools are associated with adverse health outcomes. These meta-analyses and the published literature not included in the meta-analyses suggest that dampness and mold in schools are associated with adverse respiratory health effects.

Parental worry about indoor air quality and student symptom reporting in primary schools with or without indoor air quality problems

Poor indoor air quality (IAQ) in schools is related to increased symptom reporting in students. We investigated whether parental worry about school IAQ influences this association. Data came from survey collected from five Finnish primary schools with observed IAQ problems and five control schools. Parents (n = 1868) of primary school students reported worry about IAQ in schools and symptoms of their children. Associations between observed IAQ problems, worry, and five symptom scores (ie, respiratory, lower respiratory, eye, skin, and general symptoms) were analyzed using multivariate logistic regression and mediation analysis. Parents were on average more worried in schools with observed IAQ problems. Observed IAQ problems were strongly associated with increased worry and all symptoms under study (unadjusted ORs ranged between 1.48 [95% CI 1.48-2.16] and 2.70 [95% CI 1.52-5.17]). Parental worry was associated with all symptoms (unadjusted ORs ranged between 2.49 [95% CI 1.75-3.60] and 4.92 [95% CI 2.77-9.40]). Mediation analyses suggested that parental worry might partially explain the association between observed IAQ problems and symptom reporting (proportion mediated ranged between 67% and 84% for the different symptoms). However, prospective studies are needed to assess causal relationships between observed IAQ problems, worry, and symptom reporting in schools.

Online Questionnaire as a Tool to Assess Symptoms and Perceived Indoor Air Quality in a School Environment

School environments are a complex entirety where various different exposure factors are related that contribute to the indoor air quality (IAQ) and may affect occupants’ health and well-being. Indoor air questionnaires are useful for collecting information about the occupants’ experiences and perceptions of the indoor air and for evaluating the results of the measures taken. A common way to implement health questionnaires is to ask the respondents to describe symptoms at certain time points, such as weeks or months. The aim of our study was to develop a short and easy online questionnaire to assess symptoms and perceived IAQ. We also aimed to test the usability of the questionnaire in school buildings and assess the differences between the online measurement data (CO2, T, and RH) and the IAQ complaints and symptoms reported by the pupils. A total of 105 teachers and 1268 pupils in 36 classrooms at six schools answered the questionnaires over a two-week period. The participants completed the questionnaire always after the lesson in the studied classroom. We received 719 answers from the teachers and 6322 answers from the pupils. The results demonstrated that the teachers reported more IAQ problems and symptoms than the pupils did. Differences between classrooms were observed in both the IAQ problem and reference schools. The most common significant differences (p-value > 0.05) between the classrooms were among humidity, too cold air, and stuffy air, and among symptoms, dry/sore throat, tiredness, headache, and skin symptoms. Maximum values of CO2 measurements and the highest prevalence of stuffy air were relatively consistent. The testing process demonstrated that such a questionnaire was suitable for adults and children aged at least 12 years. The results of our study suggest that a quick and easy online questionnaire that is completed within a short period may be useful for gathering valuable knowledge about perceived IAQ. It could be used in combination with other indoor environment investigations to produce detailed results and restorative measures.

Assessing associations between indoor environment and health symptoms in Romanian school children: an analysis of data from the SINPHONIE project

School environment may have an impact on children's health, but few studies have focused on indoor comfort factors such as temperature, humidity, and noise in relation with potential effects on children's health. Our cross-sectional study used data from the European Schools Indoor Pollution and Health Observatory Network in Europe (SINPHONIE) project to assess children's allergy, asthma-like symptoms, and flu-like symptoms in relation with classroom comfort and environmental factors. The study used self-reported data from three questionnaires to identify classroom conditions and student health outcomes for 280 students. We used backwards variable selection and unconditional logistic regression to assess the outcome-environment relationship while controlling for demographics, family history of allergy, and home exposures. We found increased risks for allergy and flu-like symptoms associated with hot classrooms in the heating season, increased risks for asthma-like symptoms associated with noisy classrooms, and a protective effect for allergy associated with good outdoor air quality. Romanian classrooms rely on natural ventilation, which may contribute to increased temperature and humidity in the heating season. Further research warrants the use of SINPHONIE's measurement data to validate our findings.

Analyzing symptom data in indoor air questionnaires for primary schools

Questionnaires on symptoms and perceived quality of indoor environment are used to assess indoor environment problems, but mainly among adults. The aim of this article was to explore best ways to analyze and report such symptom data, as part of a project to develop a parent-administered indoor air questionnaire for primary school pupils. Indoor air questionnaire with 25 questions on child's symptoms in the last 4 weeks was sent to parents in five primary schools with indoor air problems and in five control schools. About 83% of parents (N=1470) in case schools and 82% (N=805) in control schools returned the questionnaire. In two schools, 351 (52%) parents answered the questionnaire twice with a 2-week interval. Based on prevalence of symptoms, their test-retest repeatability (ICC), and on principal component analysis (PCA), the number of symptoms was reduced to 17 and six symptoms scores were developed. Six variants of these six symptom scores were then formed and their ability to rank schools compared. Four symptom scores (respiratory, lower respiratory, eye, and general symptoms) analyzed dichotomized maintained sufficiently well the diversity of symptom data and captured the between-school differences in symptom prevalence, when compared to more complex and numerous scores.

Current wheeze, asthma, respiratory infections, and rhinitis among adults in relation to inspection data and indoor measurements in single-family houses in Sweden-The BETSI study

In the Swedish Building Energy, Technical Status and Indoor environment study, a total of 1160 adults from 605 single-family houses answered a questionnaire on respiratory health. Building inspectors investigated the homes and measured temperature, air humidity, air exchange rate, and wood moisture content (in attic and crawl space). Moisture load was calculated as the difference between indoor and outdoor absolute humidity. Totally, 7.3% were smokers, 8.7% had doctor' diagnosed asthma, 11.2% current wheeze, and 9.5% current asthma symptoms. Totally, 50.3% had respiratory infections and 26.0% rhinitis. The mean air exchange rate was 0.36/h, and the mean moisture load 1.70 g/m³ . Damp foundation (OR=1.79, 95% CI 1.16-2.78) was positively associated while floor constructions with crawl space (OR=0.49, 95% CI 0.29-0.84) was negatively associated with wheeze. Concrete slabs with overlying insulation (OR=2.21, 95% CI 1.24-3.92) and brick façade (OR=1.71, 95% CI 1.07-2.73) were associated with rhinitis. Moisture load was associated with respiratory infections (OR=1.21 per 1 g/m³ , 95% CI 1.04-1.40) and rhinitis (OR=1.36 per 1 g/m³ , 95% CI 1.02-1.83). Air exchange rate was associated with current asthma symptoms (OR=0.85 per 0.1/h, 95% CI 0.73-0.99). Living in homes with damp foundation, concrete slabs with overlying insulation, brick façade, low ventilation flow, and high moisture load are risk factors for asthma, rhinitis, and respiratory infections.

A Multidisciplinary Research Framework on Green Schools: Infrastructure, Social Environment, Occupant Health, and Performance

BACKGROUND

Sustainable school buildings hold much promise to reducing operating costs, improve occupant well-being and, ultimately, teacher and student performance. However, there is a scarcity of evidence on the effects of sustainable school buildings on health and performance indicators. We sought to create a framework for a multidisciplinary research agenda that links school facilities, health, and educational outcomes.

METHODS

We conducted a nonsystematic review of peer review publications, government documents, organizational documents, and school climate measurement instruments.

RESULTS

We found that studies on the impact of physical environmental factors (air, lighting, and thermal comfort) on health and occupant performance are largely independent of research on the social climate. The current literature precludes the formation of understanding the causal relation among school facilities, social climate, occupant health, and occupant performance.

CONCLUSIONS

Given the average age of current school facilities in the United States, construction of new school facilities or retrofits of older facilities will be a major infrastructure investment for many municipalities over the next several decades. Multidisciplinary research that seeks to understand the impact of sustainable design on the health and performance of occupants will need to include both an environmental science and social science perspective to inform best practices and quantification of benefits that go beyond general measures of costs savings from energy efficiencies.

Fungal and bacterial growth in floor dust at elevated relative humidity levels

Under sustained, elevated building moisture conditions, bacterial and fungal growth occurs. The goal of this study was to characterize microbial growth in floor dust at variable equilibrium relative humidity (ERH) levels. Floor dust from one home was embedded in coupons cut from a worn medium-pile nylon carpet and incubated at 50%, 80%, 85%, 90%, 95%, and 100% ERH levels. Quantitative PCR and DNA sequencing of ribosomal DNA for bacteria and fungi were used to quantify growth and community shifts. Over a 1-wk period, fungal growth occurred above 80% ERH. Growth rates at 85% and 100% ERH were 1.1 × 10⁴ and 1.5 × 10⁵ spore equivalents d^-1 mg dust^-1 , respectively. Bacterial growth occurred only at 100% ERH after 1 wk (9.0 × 10⁴ genomes d^-1 mg dust^-1 ). Growth resulted in significant changes in fungal (P<.00001) and bacterial community structure (P<.00001) at varying ERH levels. Comparisons between fungal taxa incubated at different ERH levels revealed more than 100 fungal and bacterial species that were attributable to elevated ERH. Resuspension modeling indicated that more than 50% of airborne microbes could originate from the resuspension of fungi grown at ERH levels of 85% and above.

Fungal compositions and diversities on indoor surfaces with visible mold growths in residential buildings in the Seoul Capital Area of South Korea

Indoor visible mold growths are known to be associated with allergies and respiratory illnesses. However, a question remains of their compositions and diversities. Using swab sampling and high-throughput DNA sequencing, this study analyzed taxonomic compositions and diversities of fungi on indoor surfaces laden with visible mold growths in residential apartments in South Korea. The sequencing results showed low species diversities with Shannon indices ranging from 0.14 to 2.29 (mean = 1.11). Several allergy-related genera were detected on the same surface, where the most abundant Cladosporium with a mean relative abundance of 41% co-occurred with less abundant Aspergillus (0.094%), Rhodotorula (6.3%), Cryptococcus (3.7%), Alternaria (4.1%), and Crivellia (17%). β diversity analyses showed significant differences in the fungal communities between enclosed balconies and other indoor areas (P < 0.05, ANOSIM), emphasizing a need to sample at multiple indoor locations when assessments are made for indoor visible mold growths. High-throughput sequencing is powerful in characterizing compositions and diversities of fungal communities. Future studies should examine the relationships between taxonomic compositions and diversities of indoor visible molds and health outcomes of allergies and respiratory illnesses in residential buildings.

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results

BACKGROUND

Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available.

OBJECTIVES

The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization.

METHODS

In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis.

RESULTS

Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a.

CONCLUSIONS

SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.

Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State

Most previous research on indoor environments and health has studied school children or occupants in non-school settings. This investigation assessed building-related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building-related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62-5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72-2.65), paint odors (RR = 1.73; 95% CI: 1.40-2.13), mold (RR = 1.71; 95% CI: 1.39-2.11), and moldy odors (RR = 1.65 95% CI: 1.30-2.10). Stronger associations were found with increasing numbers of reported IAQ-related classroom characteristics. Similar results were found with having any building-related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ.

PRACTICAL IMPLICATIONS

Teachers play an important role in educating children, and teacher well-being is important to this role. Health symptoms among New York teachers while at work are common and appear to be associated with numerous characteristics related to poor classroom IAQ. Improving school Indoor Air Quality may reduce sickness and absenteeism and improve teacher performance.

Indoor fungi: companions and contaminants

This review discusses the role of fungi and fungal products in indoor environments, especially as agents of human exposure. Fungi are present everywhere, and knowledge for indoor environments is extensive on their occurrence and ecology, concentrations, and determinants. Problems of dampness and mold have dominated the discussion on indoor fungi. However, the role of fungi in human health is still not well understood. In this review, we take a look back to integrate what cultivation-based research has taught us alongside more recent work with cultivation-independent techniques. We attempt to summarize what is known today and to point out where more data is needed for risk assessment associated with indoor fungal exposures. New data have demonstrated qualitative and quantitative richness of fungal material inside and outside buildings. Research on mycotoxins shows that just as microbes are everywhere in our indoor environments, so too are their metabolic products. Assessment of fungal exposures is notoriously challenging due to the numerous factors that contribute to the variation of fungal concentrations in indoor environments. We also may have to acknowledge and incorporate into our understanding the complexity of interactions between multiple biological agents in assessing their effects on human health and well-being.

Indoor Air Problems and Hoarseness in Children

OBJECTIVES

A well-functioning voice is becoming increasingly important because voice-demanding professions are increasing. The largest proportion of voice disorders is caused by factors in the environment. Moisture damage is common and can initiate microbial growth and/or diffusion of chemicals from building materials. Indoor air problems due to moisture damage are associated with a number of health symptoms, for example, rhinitis, cough, and asthma symptoms. The purpose of this study was to investigate if children attending a day care center, preschool, or school with indoor air problems due to moisture damage were hoarse more often than the children in a control group.

METHODS

Information was collected through electronic and paper questionnaires from the parents of 6- to 9-year-old children (n = 1857) attending 57 different day care centers, preschools, or schools with or without indoor air problems due to moisture damage.

RESULTS

The results showed a significant correlation between the degree of indoor air problem due to moisture damage and the frequency of hoarseness. Significant predictors for the child being hoarse every week or more often were dry cough, phlegm cough, and nasal congestion.

CONCLUSIONS

The results indicate that these symptoms and exposure to indoor air problems due to moisture damage should be included in voice anamnesis. Furthermore, efforts should be made to remediate indoor air problems due to moisture damage and to treat health symptoms.

Current asthma in schoolchildren is related to fungal spores in classrooms

BACKGROUND

The presence of visible mold in households is associated with asthma. However, the role of "classroom fungus" in the development of childhood asthma, as well as the fungal species that may lead to asthma, remains controversial. This nationwide school survey was conducted to investigate the correlation between fungal spores in classrooms and asthma in schoolchildren.

METHODS

From April to May 2011, a cross-sectional survey was conducted to assess allergic/asthmatic conditions in schoolchildren aged 6 to 15 years old in 44 schools across Taiwan. Personal histories and current asthmatic conditions were collected using a modified International Study of Asthma and Allergies in Childhood questionnaire. Fungal spores in classroom were collected using a Burkard Personal Air Sampler and counted under light microscopy. Three-level hierarchical modeling was used to determine the complex correlation between fungal spores in classrooms and childhood asthma.

RESULTS

The survey was completed by 6,346 out of 7,154 parents (88.7%). The prevalences of physician-diagnosed asthma, current asthma, and asthma with symptoms reduced on holidays or weekends (ASROH) were 11.7%, 7.5%, and 3.1%, respectively. The geometric mean spore concentrations of total fungi, Aspergillus/Penicillium, and basidiospores were 2,181, 49, and 318 spores/m3. Aspergillus/Penicillium and basidiospores were significantly correlated with current asthma and ASROH after adjusting for personal and school factors. Of those with current asthma, 41% reported relief of symptoms during weekends.

CONCLUSIONS

Classroom Aspergillus/Penicillium and basidiospores are significantly associated with childhood asthma and ASROH. Government health policy should explore environmental interventions for the elimination of fungal spores in classrooms to reduce the prevalence of childhood asthma.

Infrared camera-proven water-damaged homes are associated with the severity of atopic dermatitis in children

BACKGROUND

Moisture problems in dwellings have been linked to respiratory symptoms, but little is known about their association with symptoms of atopic dermatitis (AD). Moreover, the questionnaire-based survey or visual inspection for water damage does not use a standardized approach for assessing dampness.

OBJECTIVE

To determine water damage in the houses of children with AD by assessing variations in surface temperature with an infrared camera, an interview-led questionnaire, and evaluation of the relation between the presence of water damage and the severity of AD.

METHODS

Fifty-two homes of patients with AD were visited, and air samples were obtained from the living room and a child's bedroom. Water damage was determined by thermal assessments using an infrared camera and by the presence of visible mold or water stains. The effect of water damage on the severity of AD was analyzed by comparing the presence or absence of water damage and other aggravating factors between water-damaged and undamaged homes.

RESULTS

Water damage was observed in 31 of 52 homes (59.6%), and the concentrations of airborne mold were significantly higher in water-damaged homes than in undamaged homes (P = .0013). However, there was no difference in airborne mold levels between homes with and those without visible mold or water stains. Logistic regression analyses showed that water-damaged homes were significantly related to moderate to severe AD (adjusted odds ratio 14.52, 95% confidence interval 1.75-121.13, P = .0025).

CONCLUSION

Water-damaged homes affect the severity of AD in children. Infrared camera-driven assessment is a promising tool for determining moisture problems in buildings.

Hypersensitivity pneumonitis in a cluster of sawmill workers: a 10-year follow-up of exposure, symptoms, and lung function

BACKGROUND

The long-term prognosis of repeated acute episodes of hypersensitivity pneumonitis (HP) is not well described. We report on a 10-year follow-up of a 10-person cluster from a Norwegian sawmill who had all experienced relapsing episodes of HP.

OBJECTIVES

To evaluate the health symptoms, work-related sick-leave, and lung function of 10 workers exposed to mold in a Norwegian sawmill.

METHODS

Participants were evaluated at baseline and 10 years later at follow-up. A structured interview, measurement of serum IgG antibodies to Rhizopus microsporus (R. microsporus) antigens, lung function tests, high resolution computed tomography (HRCT) of the chest, and personal measurements of exposure to mold spores and dust were completed for each participant.

RESULTS

At baseline, nearly all workers reported acute episodes of HP more than twice a month. At follow-up, both the frequency and intensity of symptoms had declined. Sick-leave was reduced and gas diffusing capacity improved - paralleling the gradually reduced air levels of mold spores.

CONCLUSIONS

In spite of an initially high occurrence of symptoms, long-term clinical and physiological outcome was good. With reduced exposure to mold spores, symptoms declined and lung function was restored.

Biochemical and immunological analysis of mould skin prick test solution: current status of standardization

BACKGROUND

Sensitization prevalence to moulds reached from less than 10% in the general population to more than 25% in atopic and/or asthmatic subjects. To diagnose IgE-mediated mould sensitization, skin prick test (SPT) and specific IgE (sIgE) measurement are recommended. However, concordance of SPT and sIgE results is often less than 50% and standardization of the extracts is required to achieve reliable test results.

OBJECTIVE

The aim of our study was to analyse mould SPT solutions (SPTs) with respect to quantity and quality of protein, antigen and human IgE-binding content as a prerequisite for further in vivo studies.

METHODS

Commercial SPTs of Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum and Penicillium chrysogenum from six manufacturers as well as two in-house extracts from Aspergillus versicolor were investigated. Protein-, antigen- and IgE-binding contents were quantified by Bradford assay, sandwich ELISA and IgE-ImmunoCAP-inhibition tests. Protein composition and IgE and IgG binding were analysed by SDS-PAGE and immunoblotting, respectively.

RESULTS

Median protein concentrations were similar in all mould SPT extracts (90-110 μg/mL). In contrast, antigen contents and IgE-binding capacity showed a high variability with median antigen values from 4 to 118 μg/mL and IgE inhibition results between 30 to 95%. Whereas almost all SPTs of A. alternata and A. versicolor showed complete sIgE inhibition with mean values > 80%, only three extracts for A. fumigatus, two extracts for C. herbarum and none of the tested extracts for P. chrysogenum exceeded 50% sIgE reduction. Quantitative amounts of protein, antigenic and IgE-binding structures were not comparable with the quality of the corresponding protein or immunoblot pattern, with the exception of A. alternata SPTs.

CONCLUSIONS AND CLINICAL RELEVANCE

Commercially available mould SPT extracts showed high variability raising the question of comparability and reliability of SPT results. Possible consequences for diagnostic test outcome will be investigated in the next step.

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.

Effect of moisture-damage intervention on the immunotoxic potential and microbial content of airborne particles and on occupants' upper airway inflammatory responses

This intervention study evaluated the effect of moisture-damage repairs on the exposure and on the upper airway inflammatory responses of the occupants. The airborne microbial exposure was followed by quantitative PCR analyses of 13 microbial species in repeated long-term indoor air samples before (N = 26) and after (N = 28) repairs of the school building. Airborne particulate matter was collected similarly from the same premises (before N = 25, after N = 34) for determination of nitric oxide (NO), tumor necrosis factor α (TNFα), and interleukin-6 (IL-6), measured in the cell culture medium of mouse macrophages. NO, TNFα, IL-6, and IL-4 were also analyzed in the nasal lavage (NAL) samples of the occupants (N = 13) to characterize their upper airway inflammatory responses during the exposure and after its cessation. After the repairs, concentrations of the measured airborne microbes decreased, the difference being significant for six of 13 species. After renovation, airborne particulate matter also caused significantly lower production of IL-6 and TNF-α in mouse macrophages than the material collected before the renovation. The concentration of IL-4 in the NAL samples was significantly lower after the renovation. These results show that the inflammatory potential of the airborne material decreases after intensive repair of the moisture damage.

Dampness and mould in schools and respiratory symptoms in children: the HITEA study

BACKGROUND

The adverse respiratory health effects of dampness and mould in the home have been extensively reported, but few studies have evaluated the health effects of such exposures in schools.

OBJECTIVES

To assess the associations between dampness and mould in school buildings and respiratory symptoms among 6-12-year-old pupils in three European countries with different climates.

METHODS

Based on information from self-reports and observations, we selected 29 primary schools with and 27 without moisture damage in Spain, the Netherlands and Finland. Information on respiratory symptoms and potential determinants was obtained using a parent-administered questionnaire among 6-12-year-old pupils. Country-specific associations between moisture damage and respiratory symptoms were evaluated using multivariable multilevel mixed effects logistic regression analysis.

RESULTS

Data from 9271 children were obtained. Nocturnal dry cough was consistently associated with moisture damage at school in each of the three countries: OR 1.15; 95% CI 1.00 to 1.30 with p for heterogeneity 0.54. Finnish children attending a moisture damaged school more often had wheeze (OR 1.36; CI 1.04 to 1.78), nasal symptoms (OR 1.34; CI 1.05 to 1.71) and respiratory-related school absence (OR 1.50; CI 1.10 to 2.03). No associations with these symptoms were found in the Netherlands or Spain (p for heterogeneity <0.05).

CONCLUSIONS

Moisture damage in schools may have adverse respiratory health effects in pupils. Finnish school children seem to be at higher risk, possibly due to quantitative and/or qualitative differences in exposure.

A new immunoassay to quantify fungal antigens from the indoor mould Aspergillus versicolor

Aspergillus versicolor is among the most commonly found moulds in moisture-damaged buildings and can be associated with adverse health effects in humans. This paper reports the development, validation and application of an enzyme immunoassay to quantify A. versicolor antigens. A sandwich ELISA was developed using polyclonal antibodies that recognize a broad range of A. versicolor proteins present in fungal spores and in mycelia fragments. To validate the new method, A. versicolor antigens were quantified in samples collected from homes with visible mould growth, including dust from vacuumed walls and bulk samples of building materials. Antigen concentrations were compared to the results of a commercial ELISA based on monoclonal antibodies (AveX ELISA, Indoor Biotechnologies, Charlottesville, USA) and correlated with colony forming units (CFU) of A. versicolor. The A. versicolor ELISA was very sensitive with a lower detection limit of 120 pg ml(-1). The assay also showed some reactivity to other moulds with strongest reactions with other Aspergillus species (1-3% reactivity). The new assay detected A. versicolor antigens in a much higher percentage of dust samples (88% vs. 27%) and bulk samples (89% vs. 24%) than the AveX assay. A significant correlation (r = 0.67, and p < 0.0001) was found between antigen concentrations and CFU of A. versicolor. Based on its low detection limit and good correlation with the culture-based method, this new immunoassay seems to be a useful tool for the measurement of A. versicolor exposure levels and a reliable complement to the traditional monitoring techniques, such as mould cultivation or microscopy.

Coarse and fine culturable fungal air concentrations in urban and rural homes in Egypt

The main objective of the present study was to assess culturable airborne fungal concentrations, and types in different seasons. Two-stage viable impactor samplers were used with malt extract agar medium as the collection media. Culturable airborne fungal concentrations were collected indoors and outdoors of 43 homes in urban and rural environments from November 2008 to October 2009 in Egypt. Fungal concentrations were significantly higher in the rural environment than the urban environment. The median indoor and outdoor total fungal concentrations were 608 and 675 CFU/m3 in the urban environment and 1,932 and 1,872 CFU/m3 in the rural environment, respectively. The greatest concentrations were found in the autumn and spring season. Indoor and outdoor concentrations were significantly correlated (P < 0.001). The highest concentrations were observed in the fungal size range of <8 µm (fine fraction). The indoor/outdoor (I/O) ratios were not statistically different between seasons. Alternaria, Aspergillus, Cladosporium, Penicillium and yeasts were the predominant genera indoors and outdoors, and the abundance of genera varied by season and region. This study is of a potential interest as little reported research on the indoor fungal air quality from Egypt.

Indoor air quality and sources in schools and related health effects

Good indoor air quality in schools is important to provide a safe, healthy, productive, and comfortable environment for students, teachers, and other school staff. However, existing studies demonstrated that various air pollutants are found in classrooms, sometimes at elevated concentrations. Data also indicated that poor air quality may impact children's health, in particular respiratory health, attendance, and academic performance. Nevertheless, it should be noted that there are other adverse health effects that are less documented. Few data exist for teachers and other adults that work in schools. Allergic individuals seem to be at a higher risk for adverse respiratory health consequences. Air quality improvement represents an important measure for prevention of adverse health consequences in children and adults in schools.

Occurrence of moisture problems in schools in three countries from different climatic regions of Europe based on questionnaires and building inspections - the HITEA study

The aim of this study was to assess occurrence of dampness and mold in school buildings in three European countries (the Netherlands, Spain, and Finland), representing different climatic regions. An assessment was performed utilizing both questionnaires and on-site building investigations, and the agreement between these two methods was evaluated for validation purposes. On the basis of questionnaire data from a representative sample of schools, different types of moisture problems were reported in 24-47% of all school buildings at the time of the study. Most commonly reported was dampness in the Netherlands, moisture/water damage in Spain, and mold odor in Finland. Subsequently, 20-24 schools per country were selected for on-site inspections by trained staff. The overall agreement between the questionnaire and inspection data was good (kappa-value 0.62), however, with large differences (0.39-0.91) between countries. Extrapolating from the inspection data, the minimum estimates for prevalence of moisture problems in school buildings are 20% in the Netherlands, 41% in Spain, and 24% in Finland. In conclusion, moisture problems (such as moisture damage, dampness, and mold) are relatively common in schools. The occurrence and severity may vary across geographical areas, which can be partly explained by building characteristics.

PRACTICAL IMPLICATIONS

On the basis of this study, the prevalence of verified moisture problems in school buildings was highest in Spain, but lower and similar in Finland and the Netherlands. Questionnaire-based surveys can be used to assess moisture problems in school buildings, but because of large variation in agreement with inspection data, the questionnaire needs to be validated by on-site inspections in a subsample of the surveyed buildings.

Evaluation of microbiological air quality and of microclimate in university classrooms

The proliferation of air-diffused microorganisms inside public buildings such as schools, hospitals, and universities, is often indicated as a possible health risk. In this research, we have illustrated the results of an investigation realized to determine the health of the air in some university classrooms, both from a microbiological and a microclimatic viewpoint, during the normal didactic activity of direct lessons. The results obtained have been expressed by means of contamination indices, already used in previous works. Very little contamination was recorded in the different phases of air treatment, which underlines the efficiency of the system and of the maintenance protocols. The Global Index of Microbial Contamination (GIMC per cubic meter) showed a value greater than the mean during the heating period (290), while the highest values (95th percentile 1,138.45) were recorded in the period using air conditioning. The index of mesophilic bacterial contamination, though it did not show any significant differences in the various modes of air treatment, showed a mean value (1.34) and the 95th percentile value (4.14), which was greater in the air-conditioning phase. Finally, the mean value of the amplification index underlined a decrease in the microbial contamination in comparison to the outside, while showing situations of increased microbial amplification during the period of simple ventilation (95th percentile 4.27). The 95th percentile values found for GICM in the three sampling periods, however, permitted us to identify the value of GIMC per cubic meter equal to 1,000 as a guide to provide a means of self-monitoring the quality of the air inside the classrooms. From a microclimatic viewpoint, two periods of the year manifested discomfort situations: during the heating phase (winter) and during the simple ventilation phase (spring). The results obtained indicate, therefore, a need to intervene on the environmental parameters, not being able, in this particular case, to intervene on other aspects that influence the microclimate.

Microbial secondary metabolites in school buildings inspected for moisture damage in Finland, The Netherlands and Spain

Secondary metabolites produced by fungi and bacteria are among the potential agents that contribute to adverse health effects observed in occupants of buildings affected by moisture damage, dampness and associated microbial growth. However, few attempts have been made to assess the occurrence of these compounds in relation to moisture damage and dampness in buildings. This study conducted in the context of the HITEA project (Health Effects of Indoor Pollutants: Integrating microbial, toxicological and epidemiological approaches) aimed at providing systematic information on the prevalence of microbial secondary metabolites in a large number of school buildings in three European countries, considering both buildings with and without moisture damage and/or dampness observations. In order to address the multitude and diversity of secondary metabolites a large number of more than 180 analytes was targeted in settled dust and surface swab samples using liquid chromatography/mass spectrometry (LC/MS) based methodology. While 42%, 58% and 44% of all samples collected in Spanish, Dutch and Finnish schools, respectively, were positive for at least one of the metabolites analyzed, frequency of detection for the individual microbial secondary metabolites - with the exceptions of emodin, certain enniatins and physcion - was low, typically in the range of and below 10% of positive samples. In total, 30 different fungal and bacterial secondary metabolites were found in the samples. Some differences in the metabolite profiles were observed between countries and between index and reference school buildings. A major finding in this study was that settled dust derived from moisture damaged, damp schools contained larger numbers of microbial secondary metabolites at higher levels compared to respective dust samples from schools not affected by moisture damage and dampness. This observation was true for schools in each of the three countries, but became statistically significant only when combining schools from all countries and thus increasing the sample number in the statistical analyses.

Comparing mixing and displacement ventilation in classrooms: pupils' perception and health

Several studies have found that indoor air quality (IAQ) in schools is often poor and may affect the health of the pupils. Building ventilation is a means to reduce pollutants indoors, but different designs should be evaluated for their effectiveness in different environments. In a field experiment performed at four classrooms in one school building, air was supplied either in the mixing or in the displacement mode, and we collected information on exposures, pupils' perception of IAQ and climate, and health symptoms and performed clinical examinations. The room temperature, relative humidity, concentration of CO₂, and cat allergen were measured at the breathing height and were similar during each ventilation mode. The children perceived IAQ were similar in the two ventilation regimes, and there were few differences in symptom reports or clinical parameters. However, the pupils reported more eye symptoms during displacement ventilation.

PRACTICAL IMPLICATIONS

Both mixing and displacement ventilation may be appropriate in school classrooms as long as the overall design, ventilation rates, and maintenance of systems are satisfactory.

Indoor air quality in elementary schools of Lisbon in spring

Analysis of indoor air quality (IAQ) in schools usually reveals higher levels of pollutants than in outdoor environments. The aims of this study are to measure indoor and outdoor concentrations of NO(2), speciated volatile organic compounds (VOCs) and carbonyls at 14 elementary schools in Lisbon, Portugal. The investigation was carried out in May-June 2009. Three of the schools were selected to also measure comfort parameters, such as temperature and relative humidity, carbon dioxide (CO(2)), carbon monoxide (CO), total VOCs, and bacterial and fungal colony-forming units per cubic metre. Indoor concentrations of CO(2) in the three main schools indicated inadequate classroom air exchange rates. The indoor/outdoor (I/O) NO(2) ratio ranged between 0.36 and 0.95. At the three main schools, the total bacterial and fungal colony-forming units (CFU) in both indoor and outdoor air were above the advised maximum value of 500 CFU/m(3) defined by Portuguese legislation. The aromatic compounds benzene, toluene, ethylbenzene and xylenes, followed by ethers, alcohols and terpenes, were usually the most abundant classes of VOCs. In general, the indoor total VOC concentrations were markedly higher than those observed outdoors. At all locations, indoor aldehyde levels were higher than those observed outdoors, particularly for formaldehyde. The inadequate ventilation observed likely favours accumulation of pollutants with additional indoor sources.

Real and perceived risks for mycotoxin contamination in foods and feeds: challenges for food safety control

Mycotoxins are toxic compounds, produced by the secondary metabolism of toxigenic moulds in the Aspergillus, Alternaria, Claviceps, Fusarium, Penicillium and Stachybotrys genera occurring in food and feed commodities both pre- and post-harvest. Adverse human health effects from the consumption of mycotoxins have occurred for many centuries. When ingested, mycotoxins may cause a mycotoxicosis which can result in an acute or chronic disease episode. Chronic conditions have a much greater impact, numerically, on human health in general, and induce diverse and powerful toxic effects in test systems: some are carcinogenic, mutagenic, teratogenic, estrogenic, hemorrhagic, immunotoxic, nephrotoxic, hepatotoxic, dermotoxic and neurotoxic. Although mycotoxin contamination of agricultural products still occurs in the developed world, the application of modern agricultural practices and the presence of a legislatively regulated food processing and marketing system have greatly reduced mycotoxin exposure in these populations. However, in developing countries, where climatic and crop storage conditions are frequently conducive to fungal growth and mycotoxin production, much of the population relies on subsistence farming or on unregulated local markets. Therefore both producers and governmental control authorities are directing their efforts toward the implementation of a correct and reliable evaluation of the real status of contamination of a lot of food commodity and, consequently, of the impact of mycotoxins on human and animal health.

Distribution characteristics of airborne bacteria and fungi in the feedstuff-manufacturing factories

The objective of the study is to investigate the distribution patterns of airborne bacteria and fungi in three feedstuff-manufacturing factories in Korea. The geometric mean (+/-GSD) levels of airborne bacteria and fungi in the feedstuff-manufacturing factory were 113(+/-18)cfu/m(3) and 89(+/-5)cfu/m(3) for pelleting process and 198(+/-5)cfu/m(3) and 124(+/-12)cfu/m(3) for powdering process, respectively. The percentage of respirable (0.65-4.7 microm) and total (>4.7 microm) concentration of airborne bacteria and fungi in the feedstuff-manufacturing factory ranged from 60% to 90% and were higher in pelleting process than powdering process. The ratio of indoor concentration and concentration in ventilation air from outside for airborne bacteria and fungi exceeded 1.0 regardless of types of feedstuff manufacture process. The predominant airborne microorganisms in the feedstuff-manufacturing factory were Staphylococcus spp., Micrococcus spp., Corynebacterium spp. and Bacillus spp. for airborne bacteria and Cladosporium spp., Penicillium spp. and Aspergillus spp. for airborne fungi, respectively. Based on the result of the study, there would be an association between relative humidity among environmental factors and airborne microorganism's bioactivity.

Indoor allergens in school and day care environments

Most studies that have examined exposure to indoor allergens have focused on home environments. However, allergen exposures can be encountered in environments other than the home. For example, many children spend a large part of their time in schools and day care facilities. Over the past 2 decades, a large number of studies have been conducted in school and day care environments. However, the role of indoor exposures in allergy and asthma development or morbidity in these settings is not well characterized. The purpose of this review is to evaluate the importance of indoor allergen exposures in school and day care settings. We summarize the key findings from recent scientific literature, describe exposure characteristics, discuss the role of these exposures in relation to asthma and allergy symptoms, and provide information on the effectiveness of published interventions.

Aeromycological profile of indoor and outdoor environments

The aim of this work was to determine the differences between indoor and outdoor aeromicological composition. The aerobiological study was performed, from 15 January to 14 April 2008, using two volumetric spore traps, one placed indoors and another positioned outdoors on the roof of the Faculdade de Ciências building. A total of 23 000 spores were sampled outdoors and 15 500 spores were identified indoors. In both environments, the most abundant fungal spores were Cladosporium, Aspergillus/Penicillium, Agaricus, Rusts, Agrocybe and Lepthosphaeria. Moreover, Alternaria, Botrytis, Coprinus, Fusarium and Ganoderma spores were also detected in the outdoor air. The outdoor maximum (858 spores m(-3) day(-1)) was registered on the 9 February whereas the indoor peak (614 spores m(-3) day(-1)) was reached two days later. Qualitative similarities were found between the indoor and outdoor aeromicological content however quantitatively spore concentrations differed, suggesting the existence of airflows between the two environments due to ventilation, inefficient isolation or passive transport of spores. The majority of the selected fungal types were night sporulators, the exceptions were Aspergillus/Penicillium and Cladosporium, with daily maximum values during the morning and the afternoon, respectively. Several of the identified spores have been proved as causal agents of respiratory problems. Therefore, it is important to know the microbial composition of indoor air in order to take measures to improve air quality helping to reduce health problems related to respiratory allergic diseases in sensitized patients.