The Mould Show

Can A Questionnaire On Mould Help Explain Health Risks?

January 23, 2020 Dr Cameron Jones Episode 31
The Mould Show
Can A Questionnaire On Mould Help Explain Health Risks?
Show Notes Transcript

Trend detection and identification has important ramifications in public health. With regard to water damage and mould, often the occupants own version of events and 'lived experience' inside the home is lost in the quicksand of data from spore traps, tape lifts, moisture levels and ERMI readings.

We ALL want to know if there is an underlying trend based on the observation of random variables over time? BUT, what are those random variables?

This Livestream focuses on this problem by exploring 2 different self-reporting questionnaires. Interesting questions about the ability for surveys to capture trend direction and discover persistent or anti-persistent (unstable) conditions warranting further fine-grained assessments and inspections are detailed.

Link to the FREE surveys:

1. Mould Risk Assessment: www.drcameronjones.com
2. Housing Mould Hazard: https://www.drcameronjones.com/pl/138413

1:37 News
2:40 Nano sized mould and temperature on earth, ice nucleation and respiratory hazards
9:31 Is my home making me sick?
9:40 Is the asset value of my home being compromised by water damage/mould?
10:15 Context of the problem
14:14 Survey Example #1: Mould Risk Assessment
22:39 Overview of Survey #2
25:14 Survey Example #2: Housing Mould Hazard
31:07 Conclusions

#mould #sickbuilding #waterdamage


Hello, and welcome to 2020. My name is Dr Cameron Jones and I'm an environmental microbiologist, and you've tuned in to The Mould Show, which is a live stream and a podcast which we do every single Thursday, usually around about 11 AM.

In any case, today, we are going to be talking about the subject of whether or not questionnaires are useful in mould and water damage investigations. I think they're useful, and I would want to talk about a lot of the research which uses these qualitative or semi-quantitative surveys to collect information from people to, in a sense, capture a lot of the information that is sometimes lost during a visual inspection or a walk-through of a potentially water-damaged property.

But some of the things that I want to be talking about today is, again, whether or not self-reporting questionnaires are useful during water damage assessments. This is some collaborative work that I'm doing with some other colleagues. But what I want to do immediately is, again for the start of a new year, we're going to be doing a few things a little bit differently. Obviously every single week, lots of really interesting research comes out, and I want to be focusing on a lot of the new research, which is coming out. So we're going to be doing a new segment which is going to be highlighting some of this new research. And so in order to get straight into this, we're going to...

Okay, so what is some of this new research? Well, I'm really covering only two stories that came out this week, which are really fascinating. Anyone who's interested in fungal biology will find these of interest. The first one is a publication which just came out a couple of days ago. I saw this on a Facebook group and basically the paper came out on the 15th of January 2020. Really it's talking about fungal fragments, and I'm going to be explaining why the fungal fragments are important. To do that, I'm just going to zoom you up on here because I need to explain to you really what the micron and the sub-micron size range is.

If you can imagine a meter rule which is subdivided into centimetres and down on through to millimeters, there is something called the micron size scale. Basically, there are a thousand microns in every one millimetre. The bacteria and yeasts and fungi and our red blood cells and white blood cells and so many of our tissues are composed of elements that are formed or composed at the micron size scale. But what about if we go even deeper into structures and then we get into the nano-size range.

To build a visual picture of this, I wanted to highlight how many nanometers are present in some common, everyday objects. And you can see the non-pointy end of a pin, for example, there are one million nanometers present. Now, if we look at this particular publication, they're talking about the fact that in the airspace, in the atmosphere, there are a whole bunch of particles. And often in our spore traps, we see this as sub-particles and with the recent bush fires, there have been these colloidal particles, which are the burnt vegetation, which is in the air.

And a lot of these particles are also added to by the pollen from plants and also the fungal spores, which easily become airborne. And to date, it was considered that these micron size objects are responsible for something called ice nucleation. Ice nucleation is a fancy way of saying that atmospheric water collects around the surface of these particles present in the air and they aggregate together. And these regulate the temperature on land.

What this paper has discovered is that in fact, there is a much larger concentration of particles present in the air, and these occur in the nanosize scale. And again, this is very, very self-evident from anyone who has an appreciation of chemistry or has a strong chemistry background, would appreciate that whatever occurs at the micron size scale also occurs at the nanosize scale as well. However, from a biologist's point of view, this is a very interesting research because it is discovering that these nano-sized particles of fungal cells are present as well.

And the researchers are making a couple of... or two key points in their paper. That one, there is a correlation between the emission of these nano-size fragments of fungi approximately one and a half days after rainfall. So as the spores become airborne, obviously some of them break down and shear off, and the scientists measured something that most fungi or all fungi have, which is a chemical called chitin. So they were looking for this type of material present in the air space, and they've used really rigorous methods to quantify this.

But the other thing that they have also discovered is that, and they also point this out, and since fungi are closely associated with respiratory disorders and a whole range of inflammatory processes, they are definitely making the point that the presence of this fungal cell material in the nanoscale in the air is also a strong likelihood of impacting people even if you don't measure any spores present in the air.

And so their conclusion, and I'll quote from this, it seems likely that fungal aerosol nanoparticles could be a significant, but underappreciated contributing factor to the negative health impacts of fungal spores. And so that is the key piece of research, which I wanted to highlight on today.

Now, also just in Science Advances published this week, a really interesting paper came out, which was popularized on Vice Magazine. And they've discovered by looking at the fossil record in Congo that the fossil record showing fungi again is much older than has been previously considered. And they have now found fossil evidence of fungal microorganisms that are 715 to 810 million years old. Bear in mind that the development of complex life forms was about 540 million years ago. So again, in the conclusion to their paper, they're saying that the possibility that fungi helped to colonize the land surface almost 300 million years ago before plants is the take-home message from this study.

So fungi are really, really old. The fossil evidence supports this. And not only that, that fragments of fungal spores present in the air are probably contributing to surface temperature changes throughout the world, as well as inducing a whole range of unexpected and unwanted health impacts due to the fact that they're incredibly small.

I now want to move on with the topic of today. Most people want to know an answer to this fundamental question, is my home making me sick? And the next question after that one is, is the asset value of my home being compromised by water damage or mould? And of course, this brings into play whether or not the experience of water damage and/or visible mould is either known whether it's historical, that is did it happen a couple of months ago, weeks ago or years ago, or is it something that's just happened and you might not have seen any mould here?

So these are the two dominant perspectives that most of my clients have and they want answers to these questions. So the context of the problem really is how to determine if a property has a mould problem. The next question is, and the premise of the whole reason for carrying out the indoor air quality and mould inspections is that the occupant or occupants of any particular building, they have the first-person experience and knowledge of the history of what has happened at that particular property, including water events.

Now the first approach to quantifying whether or not any particular property has a mould problem is to obviously carry out a visual inspection followed by the taking of data. And this data collection exercise uses a range of complementary, but overlapping methods like spore traps, ERMI testing, dust testing, tape lifts, viable cultures. So a whole range of different methods, including infrared thermal imaging and moisture mapping and that sort of thing.

However, the issues with this are that onsite inspections are time-consuming, they cost a lot of money and they don't scale. So the ability to service all those people who are potentially exposed to adverse health due to water damage and mould is limited by the ability of assessors with experience to assist people with their water damage claims.

And so the second approach is to obviously move towards some type of qualitative or semi-quantitative questionnaire, which could capture the first person narrative or experience of the occupants. And that is really what we're focusing on today. So we've designed a couple of survey instruments, which are in the process of being developed and tested with some focus groups and some proper testing, which I'm doing with some colleagues. And essentially, the point of this is that we have a preliminary version of what is called a questionnaire or an instrument. And it is based on obviously a revision of all the academic literature out there, which has used semi-quantitative and quantitative metrics and questionnaires and surveys to poll individuals and those associated with water-damaged buildings and that's to capture their perceptions.

We're now in the process of doing content validation to assess the relevance of the items or the questions to make sure they're clear, whether or not they are capturing the right aspects of the problem, and then linking this with some measurements. Again, we need your help with this. Hence why we're putting these questionnaires out here into the public domain to get some feedback. And they are very functional because the questions preexisting in many cases, and have been derived from the academic literature. We are now doing what I said as pre-testing. And so we're using a sample of persons and that means you. So we encourage you to do this free test that it takes less than five minutes, especially if you suspect that you are in water-damaged buildings or are being exposed to mould.

So basically you now come through to our website, which I've put up on the screen here. These are just stills at the moment. I've got a live section to this live stream, which is going to show you how we actually run through this. But if you go to the website here, and if you click on, "Take the free survey," it's going to ask you to input your name and an email so that you can get the results. And then it's going to move through and it's going to present you with the mould risk assessment. This is version one of this. We've got a number of different versions at play, but I'm only going to talk about two of them at this point.

So what is going to happen now is that you can see that eventually, you fill in the checkboxes, which is for your experience, or if you're answering this on behalf of your family, this is for you to answer how you believe this is affecting you. And then you're going to get a rating. And the rating is semi-quantitative, but it is essentially aimed at guiding you through the process. So now what we're going to do now is I'm going to play you the video to show you how this actually works for the first version.

Okay. So you can see that I filled in the opt-in form and put in my email details and click through to the mould risk assessment. And you can see that the first question asks whether or not you've noticed any visible mould on floors, walls, or ceilings. So for the purposes of this example, we will say, yes.

Question number two asks whether you have noticed any visible damp staining. Now this is different to visible mould because sometimes there can be an experience of dampness in a property before mould appears, or in some situations, mould does not appear at all, but you just have the presence of damp staining. And again, for this example, we will select yes.

The third question asks whether or not you suspect that there is any hidden moisture or humidity inside floors, walls, or ceilings that may not be visible from within the room. And again, you can choose yes or no, depending on what you think. So we'll select yes for the purposes of this example.

Question number four is really important because condensation issues and moisture buildup inside properties is a significant cause of mould. And certainly, we wanted to capture this phenomenon as opposed to rising damp situations or lateral damp flooding situations, because sometimes buildings are particularly energy-efficient and this energy efficiency often contributes to building tightness. And this building tightness can also be then connected with unwanted condensation.

So I'm asking in question four whether or not there is moisture buildup inside the property and how large this is when you look at your windows on rising. So again, for this example, we'll assume that it's quite significant and about the size of an A4 sheet of paper or a child's ruler.

Now the next question, number five. During the last three months, have you noticed or been bothered by a bad smell? Now, this doesn't have to be mould, but it will be captured within the survey if you do select yes. And so your options are no never, yes sometimes, yes frequently. Again, this bad smell, the aim of this question is to capture those situations where you suspect that the water damage may be affecting perhaps a common area, and you may be getting some diffusion of this odour. Do you do a water damage issue, which may be external to your immediate property, for example, in an apartment? So again, for the purposes of this, we can either choose no, yes sometimes or frequently.

Again, question number six during the last three months, have you noticed or been bothered by a chemical smell? Again, chemicals, this is different to mould or water damage. So if you haven't, just select no.

Question number seven is, during the last three months, have you noticed or been bothered by a mouldy smell? Now, if it's intermittent, definitely put down just sometimes. Even if you notice water damage or staining if you don't smell mould and you've only noted it maybe once, just put down sometimes. Don't artificially inflate the metrics on this survey.

And question number eight, during the last three months, have you noticed or been bothered by an earthy smell? Now, again, this is somewhat different from a direct mould smell. Again, the wording of this is to capture those situations where there may be a decomposition or a bio-deterioration event occurring behind, for example, plasterboard or wall sacking. So if you haven't, put no. If you can smell a decomposition smell similar to say a compost heap, well put down sometimes.

Question number nine is looking at whether or not you're experiencing dry air indoors. And the purpose of this question is to capture those situations where the air might be stagnant indoors, and you potentially experience this as a suffocating type feeling. So if you haven't put no, or yes frequently, or sometimes.

And the 10th question, during the last three months, have you noticed or been bothered by humid or damp air indoors? And again, often this is no or frequently depending on the severity of the problem inside your home or apartment.

Now, next question, do you actually see any visible areas of mould that are formed? And this is very important because the size of the mould generally is indicative of the moisture intrusion or water accumulation impact on your property. So is it one-meter square, about the size of an A4 sheet of paper, less than the size of a sheet of paper, no visible mould at all, or much larger than one square meter or more? So let's have a look at this now. Just say it's one square meter or more.

And now we want to look at what areas in question 12, the last question in this survey, which rooms or areas are affected with visible mould or dampness? And say, for example, it might be your bathroom. Then there may be two or more bathrooms in a property. I just want you to highlight whether or not one or more bathrooms are affected. Sometimes leaks can occur in two disparate rooms. And also if there are any other rooms not listed in here, just put another room here. And if you think that the roof void is affected, especially if there is a top-down roofing leak, for example, when it rains or there's a storm, well definitely put down that you suspect that there might be some visible dampness due to the fact that you've seen water coming through the ceiling. That would be appropriate to highlight the roof void.

And then that's it for this survey. You just click finish, and you end up with a mould risk rating. And for this example, your score was 18, meaning that the thresholds have already been preset depending on the ranking of the questions and the tally that we get. And for that situation, there is a strong risk from mould. In any case, that's what I wanted to show you today. And that's what the mould risk assessment does. So feel free to go to drcameronjones.com and do this free survey and print out your results.

Okay. As I said, we need your help. We're in the process of actively developing these for remote inspections and assessments, and certainly offering this to our clients and to the general public who may not be in a financial position to carry out an onsite inspection, but need some answers to give them some guidance on their problems. So we'll move forward to the second survey instrument that we're designing. This is a housing mould hazard checklist. And again, this is all based on peer-reviewed research on some of the key metrics which need to be captured.

Essentially, this one is a little bit different in that we are focusing on symptoms as well as experiences. Now, just to put a disclaimer here, I'm a PhD, not a medical doctor. So the aim of this is not to replace persons attending their physician to get a diagnosis to specific symptoms, but it is to capture in an information communication manner how one would describe a constellation of symptoms that are affecting one or more persons inside the built environment.

So that is the aim of this mould hazard checklist. It's not to diagnose, but it is to catalogue people's self-reporting or first-person perspective on the nature of their symptoms and potential illnesses that may follow from those feelings or behaviours.

So the aim of the second instrument is to capture both qualitative and quantitative aspects of the building, that is which areas are affected and by how much, and is it visible water condensation, or maybe just the experience or observation of staining, and then to also capture the subjective feelings of illness and beliefs regarding individuals' abilities to perform daily life activities. So that's the point of this.

So again, I'll put the URL for this particular access to the housing mould hazard checklist. Again, it is free. I've put it down there and highlighted it in red. It's off my personal business website, drcameronjones.com. You can see it highlighted down at the bottom. The URLs may change over time, but for the time being, you can access it here. And it'll also be in the show notes to this.

Again, it's similar to the first survey in that there is a series of questions. All of these are designed to be short surveys and to be conducted very quickly. Again, I've got a short video to highlight how the difference between...

This next quick video is going to show you how we fill out the free housing mould hazard checklist, and this is the second iteration of this particular survey. So when you go to the website shown in the PowerPoint presentation or keynote, you're going to see that you have to fill out your name and email.

Now, that will let you into the survey. And it's going to ask you a couple of groups of questions. They've been placed into different groups. And all you need to do is put a tick beside each of the features that apply to your particular housing. And all of these variables have been taken from the housing Respiratory Hazard Index that was published in the Journal Of Environmental Health in 2012. And they have questions such as, does your property feel a little bit damp, or does it feel quite damp? Again, this is applying a numeric scale to what are, in many cases, very subjective, first-person reports about how you feel in your particular property. Does your house smell musty?

So, for example, if my property feels a little bit damp, it sometimes smells musty, I know that there has been a major leak through the roof, although it's quite cold in winter and I know after having perhaps gone up into the roof void that there's no ceiling insulation, then that could be an issue. If it was a major leak in the roof, that would assume that it was quite significant. Might have just been a minor leak in the roof, you might've just seen some water staining on the underside of the ceiling. So anyway, fill out the questionnaire as best you can.

And now we move on to the symptoms and the symptoms that you might experience. This is related to your indoor air quality and any known suspect or visually confirmed dampness, moisture or mould exposure. Do you suffer from fatigue? Is your concentration affected? Have you had any nose irritation? Do you suffer maybe a cough? Do you suffer anxiety by entering this particular building? Have you had any episodes of headaches or dizziness?

And again, these are just self-reported questionnaires. The survey isn't attempting to replace you attending a medical practitioner or a doctor, but it is a self-reporting questionnaire aimed to try to come to terms with the combination of subjective first-person experiences and building specific features.

Again, have you had any asthma issues in the last 12 months? What about your experience with hay fever, perhaps any congestion or even recurrent infections? Or have you missed any days at work or at school or university due to having respiratory problems that are unusual for you? And similarly, I'm very interested in whether or not individuals are taking any asthma medication, whether they are experiencing recurrent bouts of influenza. And of course smoking status and the use of electronic cigarettes should definitely be included in here because they impact on respiratory health.

And then we go to click finish. And you can see that the score for this particular survey was 17 and the recommendation or the threshold is that there is a likely risk for mould. This is up at the upper end. And so you can see, it's a pretty straightforward instrument, but it's something that you can use to get down on paper some of your experiences in these water-damaged building and there you can then just share these survey results with other persons, at least to have something to refer to and discuss your concerns or claims regarding water damage.

Okay. So what did you think of that? It's pretty easy. You just have to go to a website. You've got to key in your details. You get moved through these process onto the survey page. You fill out the survey, according to your experience and you get some semi-quantitative results. Now it couldn't be easier than that, could it?

Well, I ask you to work with me and so that we can make this a robust screening tool, which is useful to all persons who are experiencing water damage and mould. And I want to move through now to some of the conclusions. Again, this is an example of a digital health application. These are being increasingly used worldwide as tools of medicine and for promoting healthy, positive health messaging, because education is really the key to improving behaviours in society.

And again, we hear this term of Dr Google all the time. Well, whether or not laws have caught up with digital health applications or not, people are always going to refer to, historically, libraries and social networks for opinions and information. And increasingly, people are using, in many cases, these digital platforms to help them form opinions and reach conclusions that relate to their health without resorting to a physician.

It is very important that I mention the fact that this is a very poorly regulated legal space. As I mentioned, I'm a microbiologist. I approach the academic literature from a scientist's perspective. A lot of the literature, which impacts on water damage and mould is coming from the environmental science perspective. And a lot of it again is coming from the medical perspective. We're talking about microorganisms here. And so really, it is very important to recognize who the different stakeholders are. In Canada, for example, there are some papers talking about digital e-health applications and apps, which empower the individual to get some perspective on their situation.

And in Canada, it's a grey area of law. And so it's very important to remember that these don't replace the individual taking responsibility for themselves and attending a doctor to get a definitive direction or pathway. But it is important to note that these applications are informational and may prove extremely valuable. And as we move towards artificial intelligence augmented apps, this will become increasingly so, in my opinion.

It is important to recognize that any set of questions or a survey, it is very possible that the questions are too general or they are vague, or that the questions are linked with vague outcomes. So it's really impossible for a set of questions to capture the complexity of an individual's biology, but they do go some way to augment the options available to people. And an article that appeared in Time Magazine written by... or quoting a doctor in it, stated that if people do use online symptom checkers before seeing a doctor, they may already have a good idea about what might be wrong with them and about the options that might be available to them. And they can then use that information to develop some questions, to ask the doctor. And that can only be a good idea.

So that is the conclusion I want to make to today's show for The Mould Show. I think the questionnaires are an extremely valid approach to capturing first-person, self-reporting symptoms and experiences in water-damaged buildings and offices. And I think a lot of that information does need to end up in reports regarding particular properties and how this impacts on the occupants who go about their daily lives inside these buildings.

In any case, my name's Dr Cameron Jones. We do these shows every single week. Next week, I will be back with another very interesting topic in the arena of indoor air quality and mould. Have a great week, and bye for now.