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ASSIGNMENT 4
CLINICAL EPIDEMIOLOGY AND DECISION MAKING CASE STUDY

Formulate a plan on how you would use clinical epidemiology to guide your opinions and actions on dealing with this issue.
Plan:
Contact Department of Environmental Protection to see what type of mold we are dealing with.
I need to estimate how many people are involved
How many personal house and commercial building.
Assess how many people will need medical attention, so I will know how many medical staff to have available.
Once I have all those things in place; I can give my opinion and what type of action need to be taken to prevent as many people as I can from health injuries pertaining to mold.

Propose three types of molds that could develop from flood damage and the associated health risks with each type of mold.
Different types of mold - black mold, toxic mold, allergenic mold - are present all the time around us

and in the air we breathe. In low levels, molds and mold spores are generally harmless but if their

levels increase they can affect people; especially people with allergies, asthma and respiratory

conditions or suppressed immune system.

Allergenic mold and mold spores are normally not dangerous to humans in low amounts, but they

cause allergic or asthmatic symptoms. Generally, these types of mold can be relatively easy and safely

cleaned and removed. Note that even dead mold spores or mold particles can trigger allergy symptoms

or allergic reactions.

Mycotoxic mold and mold spores are those containing toxins in the cell wall. These types of mold can

cause serious health problems in humans and animals. These molds range from short-term irritation to

immunosuppression, to cancer and even death. If toxic molds are identified, it is suggested that you

seek advice from an Industrial Hygienist or other mold professional for guidance. The average

homeowner should NOT attempt the abatement of these types of mold.

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 professional. The average homeowner should

NOT attempt the abatement of this type of molds.

Hyphae & hyphal elements are single, unidentifiable fragments of mold. 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.(http://www.Americanairandwater.com/mold/mold-types.htm)

What is black mold?

Black mold or toxic mold has been associated with the mold Stachybotrys Chartarum, a type of greenish-black fungus that is found throughout the world and typically wet and slimy to the touch; mold commonly associated with heavy water damage (American Industrial Hygiene Association).

There are somewhere in the neighborhood of 15 different species that grow in surrounding where the humidity exceeds 50% . Stachybotrys Chartarum thrives on materials high in cellulose and low in nitrogen content. Examples include wet leaves, straw, carpet, wallpaper, thermal insulation, fiberboard, dry wall, gypsum board, paper, dust, and hay.

The health effects of Stachybotrys Chartarum are Agricultural and farm workers who handled moist, wet hay experienced symptoms not unlike those that were affecting nearby animals. Individuals who ate grain from the contaminated hay experienced symptoms such as burning sensations in the mouth, nausea, vomiting, diarrhea and abdominal pain.

Stachybotrys Chartarium occurs more frequently in animals than in humans. However, if spores are released into the air, humans certainly can come into contact with them and develop symptoms that include coughing, wheezing, runny nose, irritation to the eyes or throat, skin rash, and diarrhea. Many of these symptoms are commonly associated with allergies. In fact, some theories hold that the symptoms are an allergic reaction to the mold or from toxic byproducts from the mold. There also seems to be an association between trichothecenes (the mycotoxin produced when SC interacts with certain other molds) and certain human diseases.

Http://www.toxic-mold-news.com/toxic mold

3. Outline a plan to communicate key information to health practitioners who will most likely treat the symptoms of mold. Include a timeline when this outbreak can be expected.

MEMO: Health Practitioners

We have an estimate of 5,400 homes and businesses suffered from some sort of flood damage during the event. We had a 124 sewage treatment plants that were affected by the flood, with 14 of them spilling raw sewage into waterways. We have mold infestation, and we need to be prepared to take care of over approximately 10,000 plus people being our highest and 4,000 being our lowest. If anyone come in with the following symptoms:

Respiratory problems such as wheezing, difficult in breathing

Nasal and sinus congestion

Eyes-burning, watery, reddened, blurry vision, light sensitivity

Dry, hacking cough

Sore throat

Nose and throat irritation

Shortness of breath and lung disease

Chronic fatigue

Skin irritation

Central nervous system problems (constant headaches, loss of memory, and mood changes)

Aches and pains

Fever

Headaches

Diarrhea

Immune suppression

Th outbreak of the mold festation can be from the time people left there home til when they return to their home or place of business.

Health practitioners need to take caution and treat these people with great care.

4. Compare three(3) methods that could be used to decrease mold or exposure to mold. Include the advantages and disadvantages of each method.

Molds are small organisms found almost everywhere, inside and outside, including on plants, foods, and dry leaves. They can be nearly any color-white, orange, green or black. Molds are beneficial to environment and are needed to break down dead material. Very tiny and lightweight, mold spores travel easily through the air.(North Carolina Department of Public Health0

Most building surfaces can provide nutrients to support the growth of mold. When mold spores land on material that is damp – for example, walls, floors, appliances (such as humidifiers or air conditioners), carpet or furniture – they can begin to multiply. When molds are present in large numbers, they may cause allergic symptoms similar to those caused by plant pollen(North Carolina Department of Public Health)

If the home has been flooded, remove all drywall to at least 12 inches above or around any water mark. Harder, non-porous materials such as glass, plastic, or metal can be kept after they are cleaned. Carpets and rugs that cannot be thoroughly dried and cleaned should be discarded and replaced. If the damaged area is small, you may be able to save the carpet by cleaning the area with a mild detergent. There also are professional home cleaning services that may be able to clean your carpets.(North Carolina Department of Public Health)

The advantage of removing the drywall is because of contamination of mold from the flood, removing it from the house and letting professional do the cleaning with causes you less exposure.

The disadvantage is the cost of the clean-up.

2. Floors and hard surfaces should be cleaned with a bleach and water solution made of no more than one cup of bleach per one gallon of water, or use a household disinfectant. A professional cleaner may be able to clean furniture and drapes.(North Carolina Department of public Health)

The advantage is savaging what you have but the disadvantage is later being subject to mold because of poor cleaning. I would advise people if they could just to get new furniture.

3.Basement-Pump out standing water and remove all debris. Wait to pump until flood waters have receded below basement level. Allow debris to drain before disposal. Strain away all liquids from trash. After straining trash, wrap in newspaper and store in tight-lid garbage cans until pick up. Paneling and wallboard must be immediately cleaned and dried thoroughly. If the damage is severe, they should be removed and replaced.(North Carolina Department of public health)

The advantage of waiting for the water to rececbelow basement level to help you get less exposure as possible to mold. As always the disadvantage is the cost of cleaning especially if you don't have flood insurance.

5. Formulate three(3) talking points the Pennsylvania Department of Environment Protection can use when addressing the concerns of the community on health risks associated with mold and what preventative measure can be taken avoid contracting this infection.

First talking point: The health risk associated with mold

Molds(sometimes referred to as black molds, even though mold can come in a variety of colors) can cause a wide array of adverse responses in humans depending on the type and quantity that is present. However, these are not the lone factors when considering the health affects to mold exposure. Since dose and human response can be highly individualistic, the sensitivity of the person exposed is also an important consideration. For example, infants and young children, the immune compromised, and the elderly are at an increased risk of experiencing adverse health effects related to mold exposure.

There are many routes of exposure to molds including dermal. Ingestion, and inhalation.

The health risks associated with mold exposure include, but are not limited to: allergic reactions, irritation associated with volatile organic compounds(VOCs), invasive disease, mycotoxicosis.

Http://www.toxic-black-mold-info.com

Second Talking point: The symptoms you experience when you come in contact with toxic mold

Respiratory problems such as wheezing, difficult in breathing

Nasal and sinus congestion

Eyes-burning, watery, reddened, blurry vision, light sensitivity

Dry, hacking cough

Sore throat

Nose and throat irritation

Shortness of breath and lung disease

Chronic fatigue

Skin irritation

Central nervous system problems (constant headaches, loss of memory, and mood changes)

Aches and pains

Fever

Headaches

Diarrhea

Immune suppression

Third talking point; What can be done to avoid contracting the infection(or contact of mold)

1). Avoid areas where mold contamination is obvious. 2) Use environmental controls;3) use personal protective equipment and (4) keep hands, skin, and clothing clean and free mold contaminated dust

http://www.cdc.gov/mmwr/prenew/mmwrhtm

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 study that I would use is the cohort study because :

Cohort studies begin with a defined population(cohort), measure baseline information about exposures(personal Characteristics, health status, behavior, and risk factors), may measure interim modifications of these exposures, and measures outcomes of interest(morbidity and mortality(S.T. Fleming, Managerial Epidemiology Concepts and Cases, 2nd edition, 2008, P317).

Although typically the cohort is followed prospectively, the cohort may be defined and the exposures measured retrospectively, with outcomes measured in the present(S.T. Fleming, Managerial Epidemiology Concepts and Cases, 2nd edition, 2008, p317).

Mold exposure would be to a population that not only experience a flood environment but it's people that actually have mold in their personal houses or businesses that they don't know about and it causes a health hazardous; and being in that environment are risk factors. Doing a cohort study on mold would cover all the bases that need to be known.

References:

http://www.toxic-mold-new.com/toxicmold

http://www.Americanairandwater.com/mold/mold-types.htm

http://cdc.gov/mmwr/prenew

S.T. Fleming, Managerial Epidemiology Concepts and Cases, 2nd edition, 2008