Clinical Epidemiology and Decision Making Case Study
Dr. Merle Point-Johnson
Managerial Epidemiology HSA 535
May 27, 2012
1 Formulate a plan on how you would use clinical epidemiology to guide your opinions and actions on dealing with this issue.
A clinical epidemiologist generally works for a health care service with the main goal of finding ways to halt or avoid communicable epidemics. Epidemiologist study a wide range of health care issues. They perform research on areas regarding serious life threatening diseases, diseases that are considered infectious, illnesses that run in families, or medical condition that have occurred as a result of exposure to environmental pollutants. They also do research regarding certain types of physical injuries. Epidemiologists collect and analyze important information about public health and behavior of diseases. An epidemiologist also plans wellness lesson, write explanation about research, and talks to the public about any results from investigations. Epidemiology is the study of the distribution of health-related states or events in specified population and the application of this study to the control of health problems (CDC).
Epidemiology includes (1) the methods of measuring the health of groups and for determining the attributes and exposures that influence health, (2) the study of the occurrence of disease in its natural habitat rather than the controlled environment of the laboratory; and (3) the methods for the quantitative study of the distribution, variation, and determinants of health-related outcomes in specific groups (populations) of individuals, and the application of this study to the diagnosis, treatment, and prevention of these states or events.
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The plan that I would use to guide my opinions and actions on dealing with the flood damage would be to find out the kind of damage we will be looking at from the Pennsylvania Department of Environmental Protection. I would also find out what type of mold that has affected the areas. How many commercial and residential developments were affected by the flood? Also I would need to know how many people where affected by the flood. I also would need to establish how many people that were maybe injured from the flood and that way I would know what kind of medical attention is needed to assist with treatment medically. I would even research the types of molds to see what kind of an affect it would have on the people in the residential and commercial areas that was affected. After I receive all that necessary information I can start putting it in perspective and see what procedures that can be taken to keep everyone from getting sick and recommend ways to prevent the mold from making people sick.
2 Propose three (3) types of molds that could develop from flood damage and the associated health risks with each type of mold.
The three types of molds that could develop from flood damage include allergenic mold, pathogenic mold, and toxic molds. A toxic mold is a type of mold that produces hazardous by products, called mycotoxics. While individuals with asthma and other respiratory problems may have reactions to many types of mold, it’s thought that mycotoxins are more likely to trigger health problems in even healthy individuals. These toxins are believed to be linked to memory loss and to serve lung problems in infants and the elderly. Floating particles of mold are invisible to the naked eye, so it’s impossible to see where they might have landed until they begin to grow. Loose mold particles that accumulate on items with a house are easily inhaled and can be a constant irritation to the people and pets that live there. The toxic mold we hear most about is stachybotrys chartarum, a slimy, greenish-black mold that grows on moisture-laden materials that contain cellulose, such as wood, paper, drywall, and other similar products. Even if the mold in the home is not toxic mold, it still can cause problems because any mold growing on organic materials will in time destroy them, and too much mold of any type smells bad and degrades air quality. Mold thrives in damp, humid conditions:
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* Bathrooms with poor ventilation. Install an exhaust fan if possible.
* Leaky water pipes. Repair them immediately.
* Roof leak. Repair them right away.
* Flood aftermath. Repair as soon as possible.
* Clothes dryers and exhaust fans that vent under the house or back into the room. Vent them to the outside. (Wicket, Janet, 2012).
Pathogenic mold is the type of mold that causes infections. Pathogenic molds can cause serious health effects in persons with suppressed immune systems. Those taking Chemotherapy and those with HIV/AIDS, or autoimmunity disorders. If any pathogenic molds are identified, it is suggested that you seek advice from an Industrial Hygienist or other mold professionals.
Hyphae and hyphal elements are single, unidentifiable fragments of molds. Although they might not be traceable to a specific mold species, these fragments can be responsible for allergic reactions in some people and may indicate previous or current growth. Ascospores and basidiospores are clusters of spores that may not be easily identified as a specific species, but may represent a mold problem in the property (Mold types-Black mold, toxic mold, and mildew).
Allergenic mold is not normally dangerous in small quantities, but can be a problem for people who are particularly allergic to mold or who have asthma. In large quantities, it is more likely to be a problem for these individuals. Allergenic mold can be cleaned or removed by people who are not personally mold-sensitive by long ordinary cleaning methods and while wearing appropriate respiratory protection and gloves. People who are particularly mold sensitive should avoid working with or distributing moldy materials which might cause a reaction or increase their sensitivity. Where large areas of this mold are involved, e.g. in excess of 30 sq. ft., professional cleaning is likely to be needed. Some of the common mold-allergic responses include:
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* Allergic Rhinitis- affects 20-30% of the population. Other than molds, dust mites, and mite fecal pellets, pollen or other plant fragments and animal dander such as from pets or mice can cause or contribute to this complaint.
* Asthma- affects about 5% of the U.S. population. Several molds commonly found indoors may be a factor in triggering an asthma attack, including the most common genera.
* Aspergillosis- affects people who have become sensitized to Aspergillus sp. An inflammation of the respiratory airways (Mold Classes &Classes of Mold Related Illness).
3 Outline a plan to communicate key information to health practitioners who will most likely treat the systems of mold. Include a timeline when this outbreak can be expected.
Attention to all Healthcare Practitioners:
After the flood damage in the Northeast, we have an estimate of 5,400 homes and businesses that have suffered some sort of flood damage during that event, and 124 sewage treatment plants were affected by the flood, with 14 of them spilling raw sewage into waterways. With this flood we have mold infestation, which can cause adverse health effects. I have estimated 5,000 to 15,000 people that may have side effects from the flood damage. There are many symptoms that could affect these people which include: headaches, weak immune systems, asthmatic problems, fever, nasal and sinus congestion, vomiting, skin and tissue infection, diarrhea, eye infection, visual loss, lung disease, difficulty breathing, and hearing problems (The Health Risk of Untreated Sewage).
Due to the flood and the raw sewage in the waterways it is possible that people can start having symptoms right away from the time they evaluate their homes and businesses and the time they returned to their homes. Especially if they had some of their tap water they are at higher risk.
4 Compare three (3) methods that could be used to decrease mold or exposure to mold. Include the advantages and disadvantages of each method.
Mold, mildew, and fungi are all term generally used to describe a distinct group of organisms that appear as wooly or powdery growth. Although often used interchangeably, these terms, in fact, are not synonymous. Rather; mold and mildew (along with rust, yeasts, and mushrooms) are different members of the fungus family. Although once considered a part of the plant kingdom, fungi are now regarded as a distinct kingdom of organisms. They absorb nutrients from dead or living organic matter, and they lack photosynthetic pigments. Molds and mildew can grow anywhere- indoors or outdoors- wherever there is enough surface moisture to keep them alive. They can be found in every type of climate and in every social and economic condition. They live where moisture, oxygen, and other chemicals are present. They can be found on the surface of objects within pores, and inside deteriorated materials.
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Indoor, you do not want just to avoid mold; you want ideally, to prevent their growth and to rid your home of them when they are discovered. Controlling the growth of indoor mold, however, is complicated by three factors (1) temperature setting is based on human comfort levels. Temperature that are good for controlling mold may be uncomfortable for human occupants; (2) mold spores are omnipresent inside and outside. As soon as conditions are right, they began to grow and spread; and (3) nutrients for mold growth are always available. They are present in the construction materials and furnishing used in the homes. Of the ingredients necessary for mold growth-a warm temperature, a mold spore, nutrients, and moisture- the last is the single most important and the only one that we can control for. Therefore, to decrease the presence of indoor mold, liquid water and excess humidity must be eliminated through appropriate clean-up, repairs, and installation of ventilation and heating/cooling systems.
Ways to decrease mold inside the home or business would be to keep indoor humidity below 60% and, ideally, between 35 to 45%, continuously running the air conditioning or a dehumidifier can lower moisture enough to prevent mold growth- if these are kept clean. Filters on should be scrubbed or changed regularly. The home should be well-ventilated; especially those areas where moisture tends to build up like kitchens, bathrooms, laundry rooms, and basements. The use of air conditioners, dehumidifiers, and fans can reduce indoor moisture. If carpeting or furnishing becomes wet, they must be quickly and thoroughly dried or discarded (Bishop, Chris, Molds).
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The advantage of all the methods is to avoid exposure to mold. This will also help reduce people from getting sick and having health problems. Another advantage is that by hiring a professional to come and remove the mold it will be gone for good. The disadvantage of decreasing mold is that it will be costly to remove carpet, or any areas in the home that has been exposed to mold. Another disadvantage would be that if you are not properly cleaning your home you could have to get rid of everything in order to avoid getting sick and it can also be costly because you have to buy new housing equipment.
5 Formulate three (3) talking points the Pennsylvania Department of Environment Protection can use when addressing the concerns of the community of health risks associated with mold and what preventative measure can be taken to avoid contracting this infection.
The three talking points the Pennsylvania Department of Environment Protection that can be used when addressing the concerns of the community of health risk associates with mold would include (1) the symptoms to look for if you have been exposed to the mold. Molds are the leading cause of outdoor airborne allergies, which can recur year-round. But some of the symptoms that are caused from inside mold are nasal stuffiness, eye irritation, wheezing, headaches, cold-and-flu like symptoms, inability to concentrate, and fatigue. Mold exposure has been associates with asthma onset. Symptoms usually disappear when the mold is removed. Exposure to mold can cause serious health problems. Some people with chronic illness, such as obstructive lung disease, for example, may develop mold infections in their lungs (Bishop, Chris, Molds).
The second point would be who is affected by mold. Some people are more sensitive to mold than others. It doesn’t have to be an extensive amount of mold in an area to affect certain people which include infants, children, immune-compromised patients, pregnant women, people who have respiratory problems, people with allergies or asthma, and the elderly (Mold removal unit, 2003).
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The third point is what should people do if there home or business has mold? People should have professionals come I and inspect their place and see what all needs to be done to correct the mold problem. Along with cleaning tips that people can do in order to make sure they prevent mold from happening. Cleaning includes cleaning your house, not leaving dirty clothes unwashed, if you have damp areas get them dry, and or pull up carpet if it is damp so it won’t have mold. The ways to have preventative measure that can be taken to avoid contracting this infection or mold would be to avoid areas where mold is obvious, use personal protective equipment and keep your hands, skin, and clothing clean and free mold contaminated dust (Mold removal unit, 2003).
6 Suggest the type of study you would use to evaluate the long-term effects of mold exposure and the reasoning behind your selection.
The type of study I would use to evaluate the long-term effects of mold exposure would be case control study. Most epidemiological studies compare one group to another to determine the effects of risk factors such as exposure or treatments on the incidence or course of the disease. The studies can be classified on the basis of (1) the date when the disease is identified, (2) the date of exposure or treatment recognition and the (3) time frame used in conducting the analysis. One of the classic study designs used in epidemiological research is the retrospective or case control study. With this mode of investigation, one identifies a group of subjects with a particular outcome, such as a disease or conditions, and compares them to a group without the disease or condition. The case control study is an inexpensive, relatively efficient approach to measuring the effects of exposure, and it is particularly suited for rare disease with long latency periods or exposures over a long period. I feel that the case control will cover all the basis because people may have mold regardless of if it’s a flood or not in their home and business and they can know the risk factors that are involved with mold altogether.
Fleming, Steven T. (2008).
Managerial Epidemiology Concepts and Cases (2nd Ed.).
Chicago: Health Administration Press.
Wicket, Janet (2012).
Toxic Molds in Homes, Stachybotrys Chartarum.