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.

[Unhealthy homes: possible interventions and their efficacy]. / Risques liés à l'habitat: les interventions possibles et leur efficacité.

Numerous health risks have been identified in dwellings and are a public health priority. Homes most often accumulate several different risks. Intervention programs must take this reality into account. Identification of a source of chemical pollution in the home makes it possible to correct indoor air quality quickly and inexpensively and provides immediate health benefits. Extermination of mites requires implementation of a group of complementary techniques in all contaminated areas, with help, when possible, from an indoor environment counselor. A team of multidisciplinary indoor habitat and health advisors must assess the health risks of the home. This inexpensive strategy reduces risks, although its effectiveness still requires confirmation. When the building has structural defects or abnormalities, more complex methods of renovation, or even moving, are necessary. There again, a complete assessment of their benefits to occupants' health is necessary.

Housing and health counselling: preliminary results of a new medical referral system in France.

STUDY OBJECTIVES: Since 2002, a new unique service is available to physicians in southeast France. They may ask for a housing environmental inspection for their patients when they feel that the indoor environment has a negative influence on health status. This telephone survey was designed to evaluate the efficacy of this service. DESIGN: During this time period, 328 such housing environmental inspections have been performed. The protocol of these inspections included a detailed questionnaire and environmental sampling for mold identification, mite-allergen evaluation and, in selected cases, measurement of volatile organic compounds (VOC). Inspections were performed by trained technicians. From April to September 2005, we performed a telephone interview survey, using a structured questionnaire, to evaluate the reported outcome. RESULTS: Main defects identified in houses were mold infestation (44%), mite contamination (32%), and VOC exposure (9%) from new furniture, repairs performed and hobbies. Substantial repairs, including carpentry, wall floors and ceilings repairs, mold decontamination, and plumbing, had been performed in 59.4% of those houses. Full compliance, partial compliance, and no compliance by the occupant with the recommendations provided by the housing environmental inspectors were 50%, 20%, and 30%, respectively. Reasons for non-compliance included moving, time, and money constraints. When rating the efficacy of the service, total, almost total, and partial effectiveness was reported by the families to be 3%, 31%, and 56%, respectively. CONCLUSION: This type of service holds great promise for patients as well as for physicians and should be investigated further by measuring physician-diagnosed health outcome and using cost-benefit analysis.

Mycotoxin identification in moldy dwellings.

The objective of this study was to assess the level of macrocyclic trichothecenes (MCT), one of the most potent mycotoxins, on wall surfaces, floor dust and air samples from moldy dwellings. The study was based on an index group comprising 15 flooded dwellings contaminated by Stachybotrys chartarum or Chaetomium and a control group comprising nine dwellings without molds on visual inspection and mold sampling. Three samples were collected from each dwelling: a sample from the moldy wall, using a swab, a floor dust sample on a 0.5 m(2) surface with a cloth and an air sample using a pump comprising a 1 microm Teflon filter. The MCT level was measured using a monoclonal, antibody-based ELISA test. Compared with measurements performed in index dwellings, higher MCT values were measured on floor dust samples from moldy dwellings (P = 0.02). Samples from wall surfaces demonstrated nearly significant differences (P = 0.06). No significant differences were observed for air samples (P = 0.15), but some samples showed increased MCT levels. Significant correlations were observed between the levels measured on wall surfaces, floor dust and air samples (P = 0.02 to 0.05). In contrast, no correlation was observed between moldy surface and MCT levels. In conclusion, this paper reports for the first time direct evidence for the presence of MCT in moldy dwellings.

[Wall relative humidity: a simple and reliable index for predicting Stachybotrys chartarum infestation in dwellings]. / Le taux d'hygrométrie murale, indicateur de la présence de la moisissure Stachybotrys chartarum dans les logements.

As the indoor mold Stachybotrys chartarum (SC) has been linked to serious health disorders, its identification in water-damaged dwellings is of utmost importance. The aim of this work was to compare wall relative humidity (RH) measurements with the results of mold identification studied on 458 samples collected from 100 dwellings. Mold identification was based on direct microscopic examination of wall samples collected by the gummed paper technique. Mean (+/- SD) wall RH (%) was much higher (97.0 +/- 6.1) when SC was identified (30 samples) than when other molds were identified (291 samples, 41.8 +/- 36.9) and when no molds were identified (137 samples, 38.9 +/- 34.8). There was a direct relationship between wall and room-air RH but the scatter of results implies that the latter cannot be used as a surrogate for the former. This study suggests that simple wall RH measurement can serve as a reliable indicator of SC infestation of dwellings.