title: Dampness, bacterial and fungal components in dust in primary schools and respiratory health in schoolchildren across Europe.
abstract: BACKGROUND
  Respiratory health effects of damp housing are well recognised, but less is known about the effect of dampness and water damage in schools. The HITEA study previously reported a higher prevalence of respiratory symptoms in pupils from moisture damaged schools, but the role of specific microbial exposures remained unclear.
  
  
  OBJECTIVE
  To study associations between school dampness, levels of fungal and bacterial markers, respiratory symptoms and lung function in children.
  
  
  METHODS
  Primary schools in Spain, the Netherlands and Finland were selected on the basis of the observed presence (n=15) or absence (n=10) of moisture, dampness and/or mould. Settled dust was repeatedly sampled in 232 classrooms and levels of 14 different microbial markers and groups of microbes were determined. Parental reports of respiratory symptoms were available from 3843 children aged 6-12 years, of whom 2736 provided acceptable forced spirometry testing. Country-specific associations between exposure and respiratory health were evaluated by multilevel mixed-effects logistic and linear regression models and combined using random-effects meta-analysis.
  
  
  RESULTS
  The prevalence of respiratory symptoms was higher in moisture damaged schools, being more pronounced in Finnish pupils. Effects on lung function were not apparent. Levels of microbial markers were generally higher in moisture damaged schools, varied by season and were lower in Finnish schools. Wheeze tended to be inversely associated with microbial levels. All other respiratory symptoms were not consistently associated with microbial marker levels.
  
  
  CONCLUSIONS
  Health effects of moisture and microbial exposures may vary between countries, but this requires further study.
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: José
authors.initials: J
authors.lastname: Jacobs
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Hospital del Mar Research Institute (IMIM), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Borràs-Santos
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Krop
authors.affiliation: Department Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Martin
authors.initials: M
authors.lastname: Täubel
authors.affiliation: Department Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Leppänen
authors.affiliation: Department Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Haverinen-Shaughnessy
authors.affiliation: Department Environmental Health, National Institute for Health and Welfare, Kuopio, Finland Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Pekkanen
authors.affiliation: Department Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Hyvärinen
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Doekes
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Hospital del Mar Research Institute (IMIM), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Jan-Paul
authors.initials: JP
authors.lastname: Zock
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
mesh_terms: D001249:Asthma / Q000503:physiopathology; D002648:Child; D004391:Dust / Q000032:analysis*; D005060:Europe; D005260:Female; D005387:Finland; D006801:Humans; D006813:Humidity; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D012129:Respiratory Function Tests; D012135:Respiratory Sounds; D012137:Respiratory System / Q000382:microbiology; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000382:microbiology; D012574:Schools; D013030:Spain
chemical_list: D004391:Dust
keywords: microbial exposure; moisture/mould; respiratory health; school children