Introduction Care approaches to oral health are shaped by the perspectives of both aged care and dental care professionals. This study provides a new and comprehensive understanding of how these two professional groups conceptualise and address oral care for care-dependent older adults.Material and Methods Researchers conducted 13 focus group discussions with 4-6 participants each in two Danish municipalities within the Lifelong Oral Health research project: nine with aged care staff and four with managers from aged care and dental care. Two semi-structured interviews were conducted with dental care staff. The research was guided by a qualitative methodological framework using inductive thematic analysis to explore participants' experiences and perspectives.Results Aged care and dental care staff held varying perspectives on four distinct care approaches: (1) knowledge of oral health; (2) prioritisation of oral health; (3) care practice in relation to oral health; (4) handling refusal of oral care. In contrast to dental care staff, aged care staff had rudimentary oral health knowledge and prioritised other care tasks over oral care. Aged care staff took a rehabilitative approach to oral care, whereas dental care staff favoured a compensatory approach. Aged care staff stated that the right to self-determination overruled the duty of care presented by dental care staff when patients refused oral care. These differences affected daily oral care practices and collaboration between both staff groups, who both endorsed better collaboration.Conclusion Divergent care approaches to oral care between aged care and dental care staff can hinder good oral health in care-dependent older adults. To enhance oral health in older adults, this article identifies four divergent approaches and explores how they challenge inter-professional collaboration.

BACKGROUND:A large number of older people depend on others for help with their daily personal care, including oral health care. Nursing home and elder-care staff often face challenges identifying older people, who are exposed to or at an increased risk of oral diseases. Thus, the aim of this study was to identify risk factors that non-dental care staff can use to identify older people at risk of oral diseases and poor oral hygiene. METHODS:In this cross-sectional study, the oral health and risk factors for poor oral health were determined for 217 care dependent older people living in two nursing homes and a rehabilitation centre or receiving home care in two Danish municipalities. The outcome variables for oral disease i.e. caries, periodontitis, and gingivitis, and oral hygiene, i.e. plaque and calculus, were assessed using standardised oral examinations. Risk factors for oral diseases and poor oral hygiene were assessed based on a questionnaire concerning (1) background information, (2) health status, (3) social support, (4) oral health behaviours, and (5) self-reported oral health. The associations between oral health and risk factors were investigated using logistic regression analyses. RESULTS:In general, older people with different living arrangements had quite similarly distributed risk factors. The oral examinations showed that 54.5% had oral diseases, and 14.8% had poor oral hygiene. Not seeing a dentist regularly was significantly associated with having oral diseases (Odds Ratio, 2.87; CI, 1.53-5.39) and poor oral hygiene (OR, 4.50; CI, 1.83-11.05). A significant association was found between the presence of an oral disease and adversely affected quality of life (OR, 2.65; CI, 1.42-4.95), especially due to challenges eating (OR, 3.76; CI, 1.64-8.60) and/or smiling and showing teeth (OR, 3.64; CI, 1.27-10.42). A significant association was also found between poor oral hygiene and taking psychotropic drugs (OR, 2.61; CI, 1.08-6.30). CONCLUSION:Questions regarding the use of the dental care system and oral health problems could be used by nondental care staff in conversations with older people to determine their risk of oral diseases and poor oral hygiene.

BACKGROUND:There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.OBJECTIVE:The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.METHODS:We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.RESULTS:We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.CONCLUSION:Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people.PROSPERO ID:CRD42021231721.

Residential biomass combustion is a significant source of aerosol particles on regional and global scales influencing climate and human health. The main objective of the current study was to investigate the properties of cloud condensation nuclei (CCN) emitted from biomass burning of solid fuels in different cookstoves mostly of relevance to sub-Saharan east Africa. The traditional three-stone fire and a rocket stove were used for combustion of wood logs of Sesbania and Casuarina with birch used as a reference. A natural draft and a forced-draft pellet stove were used for combustion of pelletised Sesbania and pelletised Swedish softwood alone or in mixtures with pelletised coffee husk, rice husk or water hyacinth. The CCN activity and the effective density were measured for particles with mobility diameters of ∽65, ∽100 and ∽200 nm, respectively, and occasionally for 350 nm particles. Particle number size distributions were measured online with a fast particle analyser. The chemical composition of the fuel ash was measured by application of standard protocols. The average particle number size distributions were by number typically dominated by an ultrafine mode, and in most cases a soot mode was centred around a mobility diameter of ∽150 nm. The CCN activities decreased with increasing particle size for all experiments and ranged in terms of the hygroscopicity parameter, κ, from ∽0.1 to ∽0.8 for the ultrafine mode and from ∽0.001 to ∽0.15 for the soot mode. The CCN activity (κ) of the ultrafine mode increased (i) with increasing combustion temperature for a given fuel, and (ii) it typically increased with increasing potassium concentration in the investigated fuels. The primary CCN and the estimated particulate matter (PM) emission factors were typically found to increase significantly with increasing potassium concentration in the fuel for a given stove. In order to link CCN emission factors to PM emission factors, knowledge about stove technology, stove operation and the inorganic fuel ash composition is needed. This complicates the use of ambient PM levels alone for estimation of CCN concentrations in regions dominated by biomass combustion aerosol, with the relation turning even more complex when accounting for atmospheric ageing of the aerosol.

Emissions from candles are of concern for indoor air quality. In this work, five different types of pillar candles were burned under steady burn conditions in a new laboratory scale system for repeatable and controlled comparison of candle emissions (temperature ~25°C, relative humidity ~13%, O2 >18%, air exchange rate 1.9 h-1 ). Burn rate, particle number concentrations, mass concentrations, and mode diameters varied between candle types. Based on the results, the burning period was divided in two phases: initial (0-1 h) and stable (1-6 h). Burn rates were in the range 4.4-7.3 and 4.7-7.1 g/h during initial and stable phase, respectively. Relative particle number emissions, mode diameters, and mass concentrations were higher during the initial phase compared to the stable phase for a majority of the candles. We hypothesize that this is due to elevated emissions of wick additives upon ignition of the candle together with a slightly higher burn rate in the initial phase. Experiments at higher relative humidity (~40%) gave similar results with a tendency toward larger particle sizes at the higher relative humidity. Chemical composition with respect to inorganic salts was similar in the emitted particles (dry conditions) compared to the candlewicks, but with variations between different candles.

Burning candles release a variety of pollutants to indoor air, some of which are of concern for human health. We studied emissions of particles and gases from the stressed burning of five types of pillar candles with different wax and wick compositions. The stressed burning was introduced by controlled fluctuating air velocities in a 21.6 m3 laboratory chamber. The aerosol physicochemical properties were measured both in well-mixed chamber air and directly above the candle flame with online and offline techniques. All candles showed different emission profiles over time with high repeatability among replicates. The particle mass emissions from stressed burning for all candle types were dominated by soot (black carbon; BC). The wax and wick composition strongly influenced emissions of BC, PM2.5 , and particle-phase polycyclic aromatic hydrocarbons (PAHs), and to lower degree ultrafine particles, inorganic and organic carbon fraction of PM, but did not influence NOx , formaldehyde, and gas-phase PAHs. Measurements directly above the flame showed empirical evidence of short-lived strong emission peaks of soot particles. The results show the importance of including the entire burn time of candles in exposure assessments, as their emissions can vary strongly over time. Preventing stressed burning of candles can reduce exposure to pollutants in indoor air.

This research was part of the Salutary Umeå Study of Aerosols in Biomass Cookstove Emissions (SUSTAINE) laboratory experiment campaign. We studied ice-nucleating abilities of particulate emissions from solid-fuel-burning cookstoves, using a portable ice nuclei counter, Spectrometer Ice Nuclei (SPIN). These emissions were generated from two traditional cookstove types commonly used for household cooking in sub-Saharan Africa and two advanced gasifier stoves under research to promote sustainable development alternatives. The solid fuels studied included biomass from two different African tree species, Swedish softwood and agricultural residue products relevant to the region. Measurements were performed with a modified version of the standard water boiling test on polydisperse samples from flue gas during burning and size-selected accumulation mode soot particles from a 15 m3 aerosol-storage chamber. The studied soot particle sizes in nanometers were 250, 260, 300, 350, 400, 450 and 500. From this chamber, the particles were introduced to water-supersaturated freezing conditions (−32 to −43 ∘C) in the SPIN. Accumulation mode soot particles generally produced an ice-activated fraction of 10−3 in temperatures 1–1.5 ∘C higher than that required for homogeneous freezing at fixed RHw=115 %. In five special experiments, the combustion performance of one cookstove was intentionally modified. Two of these exhibited a significant increase in the ice-nucleating ability of the particles, resulting in a 10−3 ice activation at temperatures up to 5.9 ∘C higher than homogeneous freezing and the observed increased ice-nucleating ability. We investigated six different physico-chemical properties of the emission particles but found no clear correlation between them and increasing ice-nucleating ability. We conclude that the freshly emitted combustion aerosols form ice via immersion and condensation freezing at temperatures only moderately above homogeneous freezing conditions.

We sampled ammonium sulfate particles and indoor particles of outdoor origin through a small chamber covered with polyvinyl chloride flooring. We measured the uptake of semivolatile organic compounds (SVOCs) by the airborne particles in real time. The particles acquired SVOC mass fractions up to 10%. The phthalate ester (di(2-ethylhexyl)phthalate) (DEHP), a known endocrine disruptor, contributed by approximately half of the sorbed SVOC mass. The indoor particles acquired a higher DEHP fraction than laboratory-generated ammonium sulfate aerosol. We attribute this increased uptake to absorption by organic matter present in the indoor particles. Using a thermodenuder to remove volatile components, predominantly organics, reduced the SVOC uptake. Positive matrix factorization applied to the organic mass spectra suggests that hydrocarbon-like organic aerosol (typically fresh traffic exhaust) sorbs DEHP more efficiently than aged organic aerosol. The SVOC uptake is one of the processes that modify outdoor pollution particles after they penetrate buildings, where the majority of exposure occurs. Particles from indoor sources, typically dominated by organic matter, will undergo such processes as well. Aerosol mass spectrometry improves the time resolution of experimental investigations into these processes and enables experiments with lower, relevant particle concentrations. Additionally, particle size-resolved results are readily obtained.

First experimental and theoretical study determining the atmospheric fates of CHF2OH and CHF2O; products from degradation of a chlorofluorocarbon replacement.

Phthalates are ubiquitous in indoor environments, which raises concern about their endocrine-disrupting properties. However, studies of human uptake from airborne exposure are limited. We studied the inhalation uptake and dermal uptake by air-to-skin transfer with clean clothing as a barrier of two deuterium-labeled airborne phthalates: particle-phase D4-DEHP (di(2-ethylhexyl)phthalate) and gas-phase D4-DEP (diethyl phthalate). Sixteen participants, wearing trousers and long-sleeved shirts, were under controlled conditions exposed to airborne phthalates in four exposure scenarios: dermal uptake alone and combined inhalation + dermal uptake of both phthalates. The results showed an average uptake of D4-DEHP by inhalation of 0.0014 ± 0.00088 (μg kg-1 bw)/(μg m-3)/h. No dermal uptake of D4-DEHP was observed during the 3 h exposure with clean clothing. The deposited dose of D4-DEHP accounted for 26% of the total inhaled D4-DEHP mass. For D4-DEP, the average uptake by inhalation + dermal was 0.0067 ± 0.0045 and 0.00073 ± 0.00051 (μg kg-1 bw)/(μg m-3)/h for dermal uptake. Urinary excretion factors of metabolites after inhalation were estimated to 0.69 for D4-DEHP and 0.50 for D4-DEP. Under the described settings, the main uptake of both phthalates was through inhalation. The results demonstrate the differences in uptake of gas and particles and highlight the importance of considering the deposited dose in particle uptake studies.

We investigate the uptake of the Di(2-ethylhexyl) phthalate (DEHP) by laboratory generated and ambient aerosol particles passing through a 1.2 liter chamber covered with vinyl flooring on its internal surfaces. We found approximately five times more efficient DEHP uptake on a mass basis by organic particles (ambient particles) compared to laboratory generated salt particles. The increased uptake is likely due to increased adsorption by pre-existing organic aerosol, which is abundant in the ambient aerosol particles. This implies that compounds with adverse health outcomes are added to particles in indoor air after infiltration into buildings via gas-to-particle conversion of indoor generated SVOCs. We show that aerosol mass spectrometry is a suitable tool for highly time-resolved investigations of this process. (Less)

Phthalate esters are suspected endocrine disruptors that are found in a wide range of applications. The aim of this study was to determine the excretion of urinary metabolites in 16 individuals after inhalation and/or dermal exposure to 100–300 µg/m3 of deuterium-labelled diethyl phthalate (D4-DEP) and bis(2-ethylhexyl) phthalate (D4-DEHP). Dermal exposure in this study represents a case with clean clothing acting as a barrier. After inhalation, D4-DEP and D4-DEHP metabolites were excreted rapidly, though inter-individual variation was high. D4-DEP excretion peaked 3.3 h (T½ of 2.1 h) after combined inhalation and dermal exposure, with total excreted metabolite levels ranging from 0.055 to 2.351 nmol/nmol/m3 (nmol of urinary metabolites per phthalates air concentration in (nmol/m3)). After dermal exposure to D4-DEP, metabolite excretion peaked 4.6 h (T½ of 2.7 h) after exposure, with excreted metabolite levels in between 0.017 and 0.223 nmol/nmol/m3. After combined inhalation and dermal exposure to D4-DEHP, the excretion of all five analysed metabolites peaked after 4.7 h on average (T½ of 4.8 h), and metabolite levels ranged from 0.072 to 1.105 nmol/nmol/m3 between participants. No dermal uptake of particle phase D4-DEHP was observed. In conclusion, the average excreted levels of metabolites after combined inhalation and dermal exposure to D4-DEP was three times higher than after combined exposure to D4-DEHP; and nine times higher than after dermal exposure of D4-DEP. This study was made possible due to the use of novel approaches, i.e., the use of labelled phthalate esters to avoid the background concentration, and innovative technique of phthalate generation, both in the particle and the gas phase.

We have exposed sixteen test subjects to particle and gas phase phthalates in the controlled chamber exposure study. Deuterium labelled phthalates were used to generate particle D4-DEHP (di(2-ethylhexyl) phthalate) and gas phase D4-DEP (diethyl phthalate) for exposures scenarios allowed studying the dermal only and combined inhalational and dermal uptake. Metabolites were measured in urine samples before and after three hours of exposure. The inhalation was the dominant route of uptake for both DEHP and DEP in this study design and exposure settings. Larger uptake of DEP compared to DEHP both via inhalation and dermal uptake was observed. Dermal uptake of DEHP was not observed in this study. Inhalational urinary excretion factors of the metabolites were found to be 0.73 for DEHP and 0.53 for DEP. This study also highlights the importance of taking into consideration the deposited dose of inhaled particles in studies of uptake of particles. (Less)

Reduced sulphur compounds (RSCs) emitted from pig farms are a major problem for agriculture, due to their health and environmental impacts and foul odour. This study investigates the removal of RSCs, including H2S, and their oxidation product SO2 using Gas Phase Advanced Oxidation (GPAO). GPAO is a novel air cleaning technique which utilises accelerated atmospheric chemistry to oxidise pollutants before removing their oxidation products as particles. Removal efficiencies of 24.5% and 3.9% were found for 461ppb of H2S and 714ppb of SO2 in a laboratory system (volumetric flow Q=75m3/h). A numerical model of the reactor system was developed to explore the basic features of the system; its output was in fair agreement with the experiment. The model verified the role of OH radicals in initiating the oxidation chemistry. All sulphur removed from the gas phase was detected as particulate matter, assuming the observed particles were made of sulphuric acid. In a second set of experiments a range of RSCs at mixing ratios typically found in pig farms were treated using a larger industry-scale system (Q=600–1200m3/h) that included a wet scrubber. Removal efficiencies >90% were found for all compounds. The study demonstrates the ability of GPAO to control RSC emissions with a low energy input relative to many currently available techniques.

1Ergonomics and Aerosol Technology, Lund University, Box 118, SE-22100, Lund, Sweden 2Division of Nuclear Physics, Lund University, Lund, Sweden 3Thermochemical Energy Conversion Laboratory, Umeå University, Umeå, Sweden 4Department of Environmental Science, Aarhus University, Roskilde, Denmark 5Department of Meteorology, Pennsylvania State University, University Park, PA, USA