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This thesis deals with adverse health effects on teachers in moisture- and moulddamaged
schools before and after building remediation. This was an intervention
study where bronchial reactivity and immunological resposes were measured
clinically and subjects filled in symptom questionnaires. Classification into moistureand
mould-damaged buildings and non-damaged buildings was based on technical
and microbiological measurements of the building before and after remediation
parallel to the health study.
In the first part of the study, the health effects among teachers in a mould-damaged
school before, during and after extensive remediation were assessed by collecting
health data three times with a self-reported symptom questionnaire from the teachers
in that school (n=31) and from a reference group of teachers working in a nondamaged
school. The questionnaire included about 70 questions on general and
respiratory irritation symptoms, respiratory infections, allergic diseases and medical
treatment. At the end of the remediation and two and three years later, spirometry was
measured; and at the end of the remediation and two years later mould-specific
immunoglobulin G antibodies were determined twice from 26 teachers by enzymelinked
immunosorbent assay (ELISA).
In the second part of the study, teachers (n=52) at the different mould-damaged
schools made serial measurements of peak expiratory flow (PEF) three times a day
during a three week-period; the second week was winter holiday (non-exposed) week.
Three out of four moisture- and mould-damaged schools were selected for the followup
study, and teachers (n=56) took part in a self-administered symptom survey before
and one year after remediation of the buildings. The questionnaire was the same as in
the first study.
In the first part of the study, a cluster of asthma was identified, the prevalence of
asthma being 26% and three of the cases diagnosed as occupational disease caused by
exposure to fungi. Among the index group symptoms of bronchitis (p=0.03),
conjunctivitis (p=0.02) and fatigue (p=0.02) decreased after remediation. During the
three-year follow-up, the lung function levels of the index school teachers remained at
the same normal level. Nor was there any significant change in IgG-antibody
concentrations between index and reference groups or during the follow-up study.
However, for ten out of twenty moulds, an association was found between elevated
mould-specific IgG antibodies and sinusitis.
As a result of the second part of the study, in the mornings, afternoons and evenings
the means of the weekly PEF-levels were found to be slightly, but significantly,
reduced between the second holiday week and the third week. In the intervention
study, self-reported fatigue (OR=0.2) and headache (OR=0.4) were reported to
decrease. Female gender was a risk factor for sinusitis, age over 40 years was a risk
for voice problems and more than ten years at the same school was a risk for
conjunctivitis and headache.
In conclusion, mould remediation of the school building had positive effects on
teachers` health. The effect was seen as a decrease in general symptoms and in
respiratory infections. No new cases of asthma were found after remediation.
Exposure-induced symptoms appeared to be reversible. Significant risk factors for
health outcomes were female gender, age and a working history of more than ten
years at the same school. In non-asthmatic teachers, a minor but significant decrease
was found in PEF-levels during the exposure period. Based on the results of this
study, spirometry was not sensitive enough to detect changes in lung function after
mould remediation. Futhermore, IgG-antibodies did not appear to be a useful
biomarker for decrease in exposure due to successful remediation of a work
environment.