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Although not captured by the covariates or asthma stratification, it is possible that participants who had been inside but had not participated in clean-up were more susceptible to respiratory symptoms than were Mold Damage House others. 

Such susceptible participants may have chosen not to participate in clean-up upon entering a home and experiencing symptoms, Mold Damage House creating an effect similar to the "healthy worker" phenomenon in occupational cohort studies. 

Following the flooding in New Orleans, public health officials were obligated to make recommendations guided by little, if any, Mold Damage House existing data on what activities would pose a health risk. Our results suggest that simply entering a water-damaged home post flood, even without participating in clean-up, poses a greater risk of respiratory symptoms than previously hypothesized. 

These findings should inform future recommendations, Mold Damage House including those on respiratory protection, in the postflood setting.Participants who were still involved in clean-up at the time of the interview more frequently reported exacerbation of respiratory symptoms. This finding was independent of the number of homes cleaned and may reflect recall bias. 

However, it is possible that still participating in clean-up served as a marker for an unmeasured factor. For instance, 6 months after the storms, Mold Damage House the interiors of water-damaged homes may have been drier than earlier in the post flood period, promoting greater aerosolization of respirable particles and thus greater exposure.

Furthermore, individuals who returned to New Orleans later Mold Damage House and were thus still participating in clean-up may have had different susceptibility to respiratory symptoms than did those who returned and participated in clean-up earlier. 

Although we did not address such possible explanations directly, Mold Damage House the association we found suggests that the health risk posed by participating in clean-up of water-damaged homes can persist many months after the inciting flood. 

This point is particularly important for public health officials and health care providers when advising the public Mold Damage House and caring for symptomatic individuals months after a flood.The recommendation to use respirators during clean-up activities was widely heeded. 

Of all persons surveyed, Mold Damage House two thirds had participated in clean-up activities and more than two fifths had used a respirator during cleanup. On the basis of residential population estimates done 1 month before this survey, 

These findings suggest that the recommendation was relevant to approximately 105 000 adults in Orleans Parish alone, Mold Damage House and that of those, approximately 65 000 followed the recommendation. We found that respirator use was negatively associated with exacerbation of respiratory symptoms when inside a water-damaged home, indicating a protective effect. 

For both URSs and LRSs, we saw this effect regardless of respirator category. OR estimates were less than 1 for both mild symptoms and moderate or severe symptoms that got worse when inside, and many reached statistical significance. For mask use, Mold Damage House we did not find a consistent protective effect.

The ability of certified respirators to filter fungal particles has been investigated in previous experimental and field studies. In a pilot project conducted in New Orleans from November 2005 to January 2006, researchers evaluated 2 respirators, Mold Damage House concluding that the reusable respirator provided greater protection against fungal spores than did the disposable N-95 FF respirator.

To our knowledge, our investigation is the first to find that respirator use Mold Damage House (and specifically N-95 FF respirator use) during clean-up of water-damaged homes protects against respiratory symptoms. This finding is particularly notable given that we did not collect detailed information on respirator use. 

The participants categorized as using a respirator during clean-up were likely heterogeneous in the amount of clean-up time they spent without a respirator and in how well they followed manufacturers' guidelines on respirator use Mold Damage House (e.g., maintaining a good seal, replacing dirty filter material). 

This heterogeneity may have led us to underestimate the true protective effect of respirator use on symptom exacerbation. Limitations There are several limitations to our study. Assessments of respiratory health effects and Mold Damage House exposure were limited to participants' reports. 

Validations of questions on respiratory symptoms and diagnoses suggest that they have high specificity but lower sensitivity for conditions confirmed through testing, such as asthma and rhinitis. Thus, Mold Damage House some participants not identified by our questionnaire may have been found to have respiratory pathology with further testing. 

Residents' reports of homes' percentage of mold coverage were validated soon after the hurricanes via independent home inspections, Mold Damage House suggesting such reports are reliable (M. A. R., PhD, MPH, unpublished data, 2005). However, we may have found a stronger correlation between exposure and symptoms by incorporating environmental sampling.

Another limitation is that we considered participants to have asthma only if diagnosed by a physician. The fact that no participant reported a new Mold Damage House diagnosis of asthma since the hurricanes may reflect a lack of new asthma in the population. 

Yet at the time of our survey, the number of physicians practicing in Orleans Parish had fallen to less than half of the pre-Katrina number, Mold Damage House and services at functioning medical facilities were limited. 

Had health care been more accessible following the hurricanes, it is possible that some participants would have been newly diagnosed with asthma, Mold Damage House particularly among the 10% of those without an asthma diagnosis who reported experiencing at least 3 LRSs. 

Finally, Mold Damage House the small numbers in some subgroups likely limited our ability to establish the statistical significance of some results. Conclusions Six months after Hurricanes Katrina and Rita, respiratory symptoms were common in New Orleans. 

Both URSs and LRSs were positively associated with exposure to water-damaged homes, even exposure limited to being inside without participating in clean-up activities. Respirators, Mold Damage House including disposable N-95 FF respirators, had a protective effect against symptom exacerbation when inside a water-damaged home. 

Public health authorities and health care providers should consider advising the public to use respirators when inside water-damaged homes, Mold Damage House regardless of activities undertaken while inside.

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