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Table of Contents Abstract .........................................................................4 Preamble .........................................................................5 1. Introduction......................................................................7 1.1 Indoor Air as a Public Health Issue .......................9 1.2 What Is Mold? ..........................................................9 2. Health Effects of Indoor Molds....................................11 2.1 Epidemiological Studies of Respiratory Illness ..................................................13 2.1.1 Cross-sectional studies.................................13 2.1.2 Case-control studies.....................................21 2.1.3 Building investigations ................................26 2.1.4 Cohort studies ..............................................27 2.2 Effects of Molds in Sensitive Groups ...................27 2.2.1 Pulmonary hemorrhage ..............................27 2.2.2 Invasive mycoses .........................................28 2.2.3 Allergic bronchopulmonary mycoses and allergic fungal sinusitis.........................29 2.3 Animal Studies .......................................................29 2.4 Discussion................................................................31 2.4.1 Summary of findings ...................................31 2.4.2 Limitations....................................................31 2.4.2.1 Exposure assessment......................31 2.4.2.2 Outcome assessment .....................32 2.4.2.3 Confounding factors ......................32 2.4.2.4 Bias ..................................................32 2.4.2.5 Study design ...................................33 2.4.3 Conclusion ...................................................33 3. Investigation of Fungal Contamination of the Non-industrial Workplace.............................................35 3.1 Background .............................................................37 3.2 General Principles ..................................................37 3.3 Objectives of a Mold Investigation .....................38 3.4 Methodological Considerations ............................40 3.4.1 Informed inspection ....................................40 3.4.2 Culturable air samples ................................40 3.4.3 Sticky surface samplers ...............................41 3.4.4 Documentation of visually moldy area......................................41 3.4.5 Mycological analysis of bulk samples .......42 3.4.6 Microscopic techniques ..............................42 3.5 Conclusion ..............................................................43 References .......................................................................44 Fungal Contamination in Public Buildings: Health Effects and Investigation Methods 3

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