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Damp Indoor Spaces and Health (2004) / Chapter Skim
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1 Background and Methodologic Considerations
Pages 17-28

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From page 17...
... committee responsible for this report to conduct a comprehensive review of the scientific literature regarding the relationship between damp or moldy indoor environments and the manifestation of adverse health effects, particularly respiratory and allergic symptoms. The request came against the backdrop of escalating public and scientific community interest in the question of whether indoor exposure to mold and other agents might have a role in adverse health outcomes experienced by occupants of damp buildings.
From page 18...
... • The experimental data on the nonallergic biologic effects of molds and bacteria, including the bioavailability of mycotoxins and toxic effects seen in in vitro and animal toxicity studies of mycotoxin and bacterial toxin exposure. • The state of the scientific literature regarding health outcomes and indoor exposure to dampness and dampness-related agents.
From page 19...
... The literature of engineering, architecture, and the physical sciences informed the committee's discussions of building characteristics, exposure assessment and characterization, indoor dampness, pollutant transport, and related topics; and public health and behavioral sciences research was consulted for the discussion of public health implications. These disciplines have different practices regarding the publication of research results.
From page 20...
... If an initial examination revealed that the study addressed agents or means of exposure that were not relevant to the indoor environments being evaluated; details regarding the subjects, research methodology, or some other aspect of the study that lead the committee to conclude that it would not inform the review; or that the study replicated information in papers that were already being reviewed, it was not further evaluated. Publication Bias An important aspect of the quality of a review is the extent to which all appropriate information is considered and serious omissions or inappropriate exclusions of evidence are avoided.
From page 21...
... The committee informed its expectations for the literature by the reality of the state of the science -- for example, the lack of valid quantitative exposure assessment methods and a lack of knowledge of which specific microbial agents might primarily account for any presumed health effects. Although the quantitative and qualitative aspects of the process that could be made explicit were important to the overall review, ultimately the conclusions expressed in this report are based on the committee's collective judgment.
From page 22...
... It can be categorized as selection bias, information bias, confounding bias, and reverse causality bias. Selection bias refers to the way that the sample of subjects for a study has been selected (from a source population)
From page 23...
... A simple comparison of the incidence of the health outcome among the exposed and non-exposed may exaggerate an apparent difference because socioeconomic status is also thought to influence the incidence of several health problems. If exposed people were of higher socioeconomic status, the simple comparison would tend to mask any true association between exposure and outcome by spuriously increasing the risk of disease in the non-exposed group.
From page 24...
... Rather, consistency of a positive association means that the results of most studies are positive and that the differences in measured effects are within the range expected on the basis of all types of error, including sampling, selection bias, misclassification, confounding, and differences in exposure.
From page 25...
... However, the committee recognized that research regarding mechanisms is still in its infancy, and it did not predicate decisions on the existence of specific evidence regarding biologic plausibility. The committee did not feel that there was sufficient evidence to support confident quantitative estimates of the risk associated with relevant indoor exposures.
From page 26...
... That is, the evidence fulfills the criteria for "sufficient evidence of an association" and, in addition, satisfies the evaluation criteria discussed above: strength of association, biologic gradient, consistency of association, biologic plausibility and coherence, and temporally correct association. The finding of sufficient evidence of a causal relationship between an exposure and a health outcome does not mean that the exposure would inevitably lead to that outcome.
From page 27...
... 1994. Publication bias and public health policy on envi ronmental tobacco smoke.
From page 28...
... 1964. Assess ing Causes of Adverse Drug Reactions with Special Reference to Standardized Methods.


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