Understanding Health, Subjective Aging, and Participation in Social Activities in Later Life: A Regional Finnish Survey.

To understand health and well-being in later life, it is vital to consider the meaning of subjective aging. This study aimed to explore how perceived health, self-perceptions of aging, and participation in social activities relate to each other among older persons in the Bothnia region and Åland islands in Finland. Data were analyzed using Spearman's and polychoric correlation and multinomial logistic regression analyses. The perceived good health and the younger physical, psychological, and social dimensions of subjective age were found to be associated with each other and with participation in social activities outside one's home.

Timely support for promoting mental wellbeing among families with young children -an interview study exploring the experiences of multi-professional practitioners in Finland.

BACKGROUND: Childhood is a critical period for promoting mental wellbeing and previous research suggests that various family-focused mental health promotion and early prevention initiatives are effective. The aim of the study was to explore Finnish health and social care practitioners' views and experiences of mental health promotion practice targeting families with young children. METHODS: Individual semi-structured interviews with 14 practitioners representing various municipal services, faith-based and third sector organizations were conducted in 2021 and analysed using thematic analysis. RESULTS: Various challenges and opportunities for supporting mental health related to both structural features of the health and social care landscape and the varying needs of families were identified. The lack of resources as well as the social stigma associated with mental health problems and with public welfare services, hindered proactive work approaches and timely support. However, low-threshold initiatives and adapted information to families as well as further training about mental health for practitioners together with multi-professional collaboration and teamwork were suggested as potential enablers for mental health promotion. CONCLUSIONS: The study highlights the importance of reaching families in a timely manner in order to promote mental wellbeing and prevent mental health problems. The findings, bringing to the fore the practitioners' own experiences and views, suggest how current practice could be developed in order to safeguard mental health and wellbeing for all families with young children. The practitioners' views and experiences are key components when building future sustainable and proactive health and social care services.

A novel non-invasive method allowing for discovery of pathologically relevant proteins from small airways.

BACKGROUND: There is a lack of early and precise biomarkers for personalized respiratory medicine. Breath contains an aerosol of droplet particles, which are formed from the epithelial lining fluid when the small airways close and re-open during inhalation succeeding a full expiration. These particles can be collected by impaction using the PExA® method (Particles in Exhaled Air), and are derived from an area of high clinical interest previously difficult to access, making them a potential source of biomarkers reflecting pathological processes in the small airways. RESEARCH QUESTION: Our aim was to investigate if PExA method is useful for discovery of biomarkers that reflect pathology of small airways. METHODS AND ANALYSIS: Ten healthy controls and 20 subjects with asthma, of whom 10 with small airway involvement as indicated by a high lung clearance index (LCI ≥ 2.9 z-score), were examined in a cross-sectional design, using the PExA instrument. The samples were analysed with the SOMAscan proteomics platform (SomaLogic Inc.). RESULTS: Two hundred-seven proteins were detected in up to 80% of the samples. Nine proteins showed differential abundance in subjects with asthma and high LCI as compared to healthy controls. Two of these were less abundant (ALDOA4, C4), and seven more abundant (FIGF, SERPINA1, CD93, CCL18, F10, IgM, IL1RAP). sRAGE levels were lower in ex-smokers (n = 14) than in never smokers (n = 16). Gene Ontology (GO) annotation database analyses revealed that the PEx proteome is enriched in extracellular proteins associated with extracellular exosome-vesicles and innate immunity. CONCLUSION: The applied analytical method was reproducible and allowed identification of pathologically interesting proteins in PEx samples from asthmatic subjects with high LCI. The results suggest that PEx based proteomics is a novel and promising approach to study respiratory diseases with small airway involvement.

Health Promotion Practice Among Older Persons: A Nordic Multi-Professional Focus Group Study Exploring what It Is and How It Could be Achieved.

The growing ageing population in the Nordic region calls for increased focus on health promotion work. To enhance multi-professional understanding and further develop strategies for promoting healthy ageing, it is vital to consider the perspectives of those working with health promotion. The aim of this study was to explore a wide spectrum of practitioners' experiences of community-level health promotion targeting older adults in Finland and Sweden. Nine focus group interviews (34 informants) were conducted in 2019-2020. "Seeing the person" emerged as the ideal for health promotion targeting older adults, but this ideal was not always realized in current practice. Barriers related to organizational structures and the practitioner role were identified. However, work methods connected to user involvement and technology-based tools were considered key facilitators, enabling tailored health promotion initiatives.

Severe acute respiratory syndrome coronavirus 2 can be detected in exhaled aerosol sampled during a few minutes of breathing or coughing.

BACKGROUND: The knowledge on the concentration of viral particles in exhaled breath is limited. The aim of this study was to explore if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be detected in aerosol from subjects with the coronavirus disease 2019 (COVID-19) during various types of breathing and coughing and how infection with SARS-CoV-2 may influence the number and size of exhaled aerosol particles. METHODS: We counted and collected endogenous particles in exhaled breath in subjects with COVID-19 disease by two different impaction-based methods, during 20 normal breaths, 10 airway opening breaths, and three coughs, respectively. Breath samples were analyzed with reverse transcription real-time polymerase chain reaction (RT-PCR). RESULTS: Detection of RNA in aerosol was possible in 10 out of 25 subjects. Presence of virus RNA in aerosol was mainly found in cough samples (n = 8), but also in airway opening breaths (n = 3) and in normal breaths (n = 4), with no overlap between the methods. No association between viral load in aerosol and number exhaled particles <5 µm was found. Subjects with COVID-19 exhaled less particles than healthy controls during normal breathing and airway opening breaths (all P < 0.05), but not during cough. CONCLUSION: SARS-CoV-2 RNA can be detected in exhaled aerosol, sampled during a limited number of breathing and coughing procedures. Detection in aerosol seemed independent of viral load in the upper airway swab as well as of the exhaled number of particles. The infectious potential of the amount of virus detected in aerosol needs to be further explored.

Exploring a new method for the assessment of metal exposure by analysis of exhaled breath of welders.

PURPOSE: Air monitoring has been the accepted exposure assessment of toxic metals from, e.g., welding, but a method characterizing the actual dose delivered to the lungs would be preferable. Sampling of particles in exhaled breath can be used for the biomonitoring of both endogenous biomarkers and markers of exposure. We have explored a new method for the sampling of metals in exhaled breath from the small airways in a study on welders. METHODS: Our method for particle sampling, Particles in Exhaled Air (PExA®), is based on particle counting and inertial impaction. We applied it on 19 stainless steel welders before and after a workday. In parallel, air monitoring of chromium, manganese and nickel was performed as well as blood sampling after work. RESULTS: Despite substantial exposure to welding fumes, we were unable to show any significant change in the metal content of exhaled particles after, compared with before, exposure. However, the significance might be obscured by a substantial analytical background noise, due to metal background in the sampling media and possible contamination during sampling, as an increase in the median metal contents were indicated. CONCLUSIONS: If efforts to reduce background and contamination are successful, the PExA® method could be an important tool in the investigations of metals in exhaled breath, as the method collects particles from the small airways in contrast to other methods. In this paper, we discuss the discrepancy between our findings and results from studies, using the exhaled breath condensate (EBC) methodology.

Nordic population-based study on internet use and perceived meaningfulness in later life: How they are linked and why it matters.

AIM: The aim was to explore the association between internet use, the use of specific internet-based activities and perceiving life as meaningful, among older adults in two regions in Finland and Sweden. METHODS: The data was collected through a population-based survey (N = 9386) as part of the GERDA project conducted in 2016. In order to analyse the associations between perceiving life as meaningful and internet use and related activities, odds ratios with a 95% confidence interval were calculated using binary logistic regression analysis, where socio-demographic factors and health status were controlled for. RESULTS: Statistically significant associations were found between perceiving life as meaningful and internet use in later life. When looking further at the specific internet-based activities under study, activities related to leisure and entertainment showed a statistically significant connection to perceived meaningfulness in later life, after controlling for socio-demographic factors and health status. CONCLUSIONS: The results indicated that there was a statistically significant positive association between internet use and perceiving life as meaningful in later life. Online activities related to leisure and entertainment seem to be especially associated with perceived meaningfulness. Although causal direction could not be determined, the results suggest that internet use may support the experience of wellbeing in everyday life among older persons, through the unlimited access to interest-driven activities that it provides.

Current smoking alters phospholipid- and surfactant protein A levels in small airway lining fluid: An explorative study on exhaled breath.

Small airways are difficult to access. Exhaled droplets, also referred to as particles, provide a sample of small airway lining fluid and may reflect inflammatory responses. We aimed to explore the effect of smoking on the composition and number of exhaled particles in a smoker-enriched study population. We collected and chemically analyzed exhaled particles from 102 subjects (29 never smokers, 36 former smokers and 37 current smokers) aged 39 to 83 years (median 63). A breathing maneuver maximized the number exhaled particles, which were quantified with a particle counter. The contents of surfactant protein A and albumin in exhaled particles was quantified with immunoassays and the contents of the phospholipids dipalmitoyl- and palmitoyl-oleoyl- phosphatidylcholine with mass spectrometry. Subjects also performed spirometry and nitrogen single breath washout. Associations between smoking status and the distribution of contents in exhaled particles and particle number concentration were tested with quantile regression, after adjusting for potential confounders. Current smokers, compared to never smokers, had higher number exhaled particles and more surfactant protein A in the particles. The magnitude of the effects of current smoking varied along the distribution of each PEx-variable. Among subjects with normal lung function, phospholipid levels were elevated in current smokers, in comparison to no effect of smoking on these lipids at abnormal lung function. Smoking increased exhaled number of particles and the contents of lipids and surfactant protein A in the particles. These findings might reflect early inflammatory responses to smoking in small airway lining fluid, also when lung function is within normal limits.

Exploring the Nuanced Links Between Internet Use and Subjective Well-Being Among Older Adults: A Nordic Population-Based Study.

AIM: The aim was to explore the various associations between subjective well-being and internet use among older adults in two regions in Finland and Sweden. METHODS: The data was collected through a population-based survey (N = 9,386) as part of the GERDA project conducted in 2016. The connection between subjective well-being (measured by perceived meaningfulness, happiness and life satisfaction) and internet use (distinguishing between internet users, non-users and users with support, and diverse internet activities) was studied by conducting binary regression analyses, calculating odds ratios with 95% confidence intervals. The analyses also controlled for key subjective well-being covariates. RESULTS: Statistically significant associations were found between perceived life meaningfulness and internet use. When looking into the specific internet-based activities under study, activities related to leisure and entertainment showed statistically significant associations to perceived meaningfulness as well as perceived happiness, also after controlling for potential covariates. However, internet use and the different internet activities failed to show statistical significant associations to life satisfaction in the adjusted regression model. CONCLUSION: The things we do on the internet (the activities) as well as how we conceptualize and measure subjective well-being in this type of research studies seem to matter when it comes to the relationship between subjective well-being and internet use in later life. Internet use and internet activities displayed various connections to the subjective well-being proxies used in this study. Therefore, the complexity and multidimensionality of both subjective well-being and internet use and related links need to be carefully explored in order to deepen our understanding of experienced well-being among older adults in a digitized world.

COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden.

The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.

Particles in exhaled air (PExA): non-invasive phenotyping of small airways disease in adult asthma.

RATIONALE: Asthma is often characterised by inflammation, damage and dysfunction of the small airways, but no standardised biomarkers are available. OBJECTIVES: Using a novel approach-particles in exhaled air (PExA)-we sought to (a) sample and analyse abundant protein biomarkers: surfactant protein A (SPA) and albumin in adult asthmatic and healthy patients and (b) relate protein concentrations with physiological markers using phenotyping. METHODS: 83 adult asthmatics and 21 healthy volunteers were recruited from a discovery cohort in Leicester, UK, and 32 adult asthmatics as replication cohort from Sweden. Markers of airways closure/small airways dysfunction were evaluated using forced vital capacity, impulse oscillometry and multiple breath washout. SPA/albumin from PEx (PExA sample) were analysed using ELISA and corrected for acquired particle mass. Topological data analysis (TDA) was applied to small airway physiology and PExA protein data to identify phenotypes. RESULTS: PExA manoeuvres were feasible, including severe asthmatic subjects. TDA identified a clinically important phenotype of asthmatic patients with multiple physiological markers of peripheral airway dysfunction, and significantly lower levels of both SPA and albumin. CONCLUSION: We report that the PExA method is feasible across the spectrum of asthma severity and could be used to identify small airway disease phenotypes.

Two techniques to sample non-volatiles in breath-exemplified by methadone.

The particles in exhaled breath provide a promising matrix for the monitoring of pathological processes in the airways, and also allow exposure to exogenous compounds to be to assessed. The collection is easy to perform and is non-invasive. The aim of the present study is to assess if an exogenous compound-methadone-is distributed in the lining fluid of small airways, and to compare two methods for collecting methadone in particles in exhaled breath. Exhaled particles were collected from 13 subjects receiving methadone maintenance treatment. Two different sampling methods were applied: one based on electret filtration, potentially collecting exhaled particles of all sizes, and one based on impaction, collecting particles in the size range of 0.5-7 µm, known to reflect the respiratory tract lining fluid from the small airways. The collected samples were analyzed by liquid chromatography mass spectrometry, and the impact of different breathing patterns was also investigated. The potential contribution from the oral cavity was investigated by rinsing the mouth with a codeine solution, followed by codeine analysis of the collected exhaled particles by both sampling methods. The results showed that methadone was present in all samples using both methods, but when using the method based on impaction, the concentration of methadone in exhaled breath was less than 1% of the concentration collected by the method based on filtration. Optimizing the breathing pattern to retrieve particles from small airways did not increase the amount of exhaled methadone collected by the filtration method. The contamination from codeine present in the oral cavity was only detected in samples collected by the impaction method. We conclude that methadone is distributed in the respiratory tract lining fluid of small airways. The samples collected by the filtration method most likely contained a contribution from the upper airways/oral fluid in contrast to the impaction method.

Low Levels of Exhaled Surfactant Protein A Associated With BOS After Lung Transplantation.

BACKGROUND: There is no clinically available marker for early detection or monitoring of chronic rejection in the form of bronchiolitis obliterans syndrome (BOS), the main long-term complication after lung transplantation. Sampling and analysis of particles in exhaled air is a valid, noninvasive method for monitoring surfactant protein A (SP-A) and albumin in the distal airways. METHODS: We asked whether differences in composition of exhaled particles can be detected when comparing stable lung transplant recipients (LTRs) (n = 26) with LTRs who develop BOS (n = 7). A comparison between LTRs and a matching group of healthy controls (n = 33) was also conducted. Using a system developed in-house, particles were collected from exhaled air by the principal of inertial impaction before chemical analysis by immunoassays. RESULTS: Surfactant protein A in exhaled particles and the SP-A/albumin ratio were lower (P = 0.002 and P = 0.0001 respectively) in the BOS group compared to the BOS-free group. LTRs exhaled higher amount of particles (P < 0.0001) and had lower albumin content (P < 0.0001) than healthy controls. CONCLUSIONS: We conclude that low levels of SP-A in exhaled particles are associated with increased risk of BOS in LTRs. The possibility that this noninvasive method can be used to predict BOS onset deserves further study with prospective and longitudinal approaches.

Characterization of exhaled breath particles collected by an electret filter technique.

Aerosol particles that are present in exhaled breath carry nonvolatile components and have gained interest as a specimen for potential biomarkers. Nonvolatile compounds detected in exhaled breath include both endogenous and exogenous compounds. The aim of this study was to study particles collected with a new, simple and convenient filter technique. Samples of breath were collected from healthy volunteers from approximately 30 l of exhaled air. Particles were counted with an optical particle counter and two phosphatidylcholines were measured by liquid chromatography-tandem mass spectrometry. In addition, phosphatidylcholines and methadone was analysed in breath from patients in treatment with methadone and oral fluid was collected with the Quantisal device. The results demonstrated that the majority of particles are <1 µm in size and that the fraction of larger particle contributes most to the total mass. The phosphatidylcholine PC(16 : 0/16 : 0) dominated over PC(16 : 0/18 : 1) and represented a major constituent of the particles. The concentration of the PC(16 : 0/16 : 0) homolog was significantly correlated (p < 0.001) with total mass. From the low concentration of the two phosphatidylcholines and their relative abundance in oral fluid a major contribution from the oral cavity could be ruled out. The concentration of PC(16 : 0/16 : 0) in breath was positively correlated with age (p < 0.01). An attempt to use PC(16 : 0/16 : 0) as a sample size indicator for methadone was not successful, as the large intra-individual variability between samplings even increased after normalization. In conclusion, it was demonstrated that exhaled breath sampled with the filter device represents a specimen corresponding to surfactant. The possible use of PC(16 : 0/16 : 0) as a sample size indicator was supported and deserves further investigations. We propose that the direct and selective collection of the breath aerosol particles is a promising strategy for measurement of nonvolatiles in breath.

Effects of pollen season on central and peripheral nitric oxide production in subjects with pollen asthma.

BACKGROUND: Pollen exposure of allergic subjects with asthma causes increased nitric oxide (NO) in exhaled air (FENO) suggestive of increased airway inflammation. It is, however, unclear to what extent NO production in peripheral airways and alveoli are involved. OBJECTIVES: The aim of the present investigation was to analyze the relationship between central and peripheral components of FENO to clarify the distribution of pollen induced inflammation in asthma. SUBJECTS AND METHODS: 13 pollen allergic non-smoking subjects with mild-intermittent asthma and 12 healthy non-smoking control subjects were examined with spirometry and FENO at flows between 50 and 270 mL/s during and out of pollen season. RESULTS: Spirometry was normal and unaffected by season in subjects with asthma as well as controls. Out of season subjects with asthma had significantly higher FENO, elevated airway production (JáwNO) and preacinar/acinar production (CANO) than controls. Pollen exposure resulted in significantly increased FENO and JáwNO but not CANO. FENO among controls were not affected by season. Individual results showed, however, that CANO increased substantially in a few subjects with asthma. The increased CANO in subjects with asthma may be explained by increased NO production in preacinar/acinar airways and back diffusion towards the alveoli. CONCLUSIONS: The findings may indicate that subjects with allergic asthma have airway inflammation without alveolar involvement outside the pollen season and pollen exposure causes a further increase of airway inflammation and in a few subjects obstruction of intra acinar airways causing impeded back diffusion. Increased NO production in central airways, unassociated with airway obstruction could be an alternative explanation. These effects were not disclosed by spirometry.