Dental health of patients with X-linked hypophosphatemia: A controlled study

ObjectiveThe present study compared the dental health of patients with X-linked hypophosphatemia (XLH) with healthy age- and gender-matched controls to increase our knowledge of the impact of XLH on oral health.Materials and methodsTwenty-two adult patients with XLH in the Stockholm region of Sweden were referred to the Department of Orofacial Medicine at Karolinska Institutet for an extended clinical and radiological examination. Pre-existing radiologic examinations of 44 healthy age- and gender-matched controls were retrieved from the Department of Oral Radiology, at Karolinska Institutet.ResultsThe 22 patients with XLH (15 females, median age 38 years, range 20–71; 7 males, median age 49 years, range 24–67) had a significantly higher number of root-filled teeth compared to healthy controls (p = .001). In the XLH group, females had significantly better oral health than males, especially concerning endodontic and cariological status (p's = .01 and .02, respectively). Periodontal status differed non-significantly between the XLH and control groups.ConclusionPatients with XLH had a significantly lower oral health status compared to a healthy population especially concerning endodontic conditions. Male patients with XLH had a higher risk of poor oral health compared to female patients with XLH

Läroplan i rörelse : det individuella programmet i möte mellan nationell utbildningspolitik och kommunal genomförandepraktik

This thesis examines the activities within the Swedish steering system concerning upper secondary school. Sweden has a long history of shared responsibility between the state level of government and the municipalities, dating back to federal decisions concerning the establishment of a compulsory school system. By the early 1990s two parallel changes were taking place within the Swedish educational sector, one concerning the steering system which evolved towards deregulation and decentralization, and the other an extension of the compulsory school. A consequence of the latter change was that in practice upper secondary education became mandatory. The political aim was to realize the vision of “one school for all”. In this study the political vision and the larger question of how to turn it into reality (the differentiation question) is used to show how activities at national as well as the local level of the steering system are formed.Se även under Uppsala i DiVAportalen.</p

The Interplay between National Educational Policy and Local Practice: : A study of curriculum processes

This thesis examines the activities within the Swedish steering system concerning upper secondary school. Sweden has a long history of shared responsibility between the state level of government and the municipalities, dating back to federal decisions concerning the establishment of a compulsory school system. By the early 1990s two parallel changes were taking place within the Swedish educational sector, one concerning the steering system which evolved towards deregulation and decentralization, and the other an extension of the compulsory school. A consequence of the latter change was that in practice upper secondary education became mandatory. The political aim was to realize the vision of “one school for all”. In this study the political vision and the larger question of how to turn it into reality (the differentiation question) is used to show how activities at national as well as the local level of the steering system are formed

HIV induced humoral immune response with specific relevance to IgA

Human Immunodeficiency Virus (HIV) transmission occurs primarily after hetero- and homosexual contact and across mucosal surfaces. The immune response in mucosal tissues is typified by secretory immunoglobulin A (SIgA), which is the predominant lg class in human external secretions. Since the dimeric lgA molecule is stabilized by the attendant J-chain and the secretory component, it has the unique capacity to maintain its function in an environment rich in proteolytic enzymes (e.g. mucosal compartments). This study was designed to investigate the biological function of local versus systemic humoral response against HIV infection. Furthermore, to define lgA mediated neutralization against both primary and T cell line adapted HIV-1 and HIV-2 isolates. The innate local defense in the oral cavity against HIV transmission was additionally adressed by investigating the presence and biological function of secretory leukocyte proteinase inhibitor (SLPI). The locally produced anti-HIV responses were investigated both with respect to different stages of disease and with respect to the time of follow-up. Using synthetic peptides representing earlier identified antigenic sites of the HIV-1 and HIV-2 proteins for IgG antibodies in serum, we illustrated potential epitopes for salivary and serum derived lgA antibodies. lgA mediated response against HIV-1 was found to be mainly directed against epitopes in the second and fourth variable regions (V2 and V4) of gpl20. In contrast, we found strongest lgA binding activity against a region (aa 615-658) in the central part of gp36 in HIV-2. The neutralizing activity mediated by lgA antibodies could not be correlated to the total amount of lgA in saliva or serum, or to any dominance in neutralizing activity against primary isolates with a specific biological phenotype. The high degree of inter-individual variability in neutralizing capacity indicate that the presence of functional, specific anti-HIV1 lgA antibodies is not a general phenomenon and can not be associated with elevated levels of total lgA but can be observed on an individual basis, even in late stages of disease. A persistent longitudinal SIgA response was also found in salivary samples from four out of eleven HIV-1 infected patients during a follow-up period of three years. These samples contained highly specific anti-HIV-1 SIgA with neutralizing activity against both a T cell adapted strain and four primary isolates. Furthermore, serum derived lgA obtained from two different cohorts, one in Guinea Bissau and one in Portugal demonstrated neutralizing capacity against HIV-2. Among several salivary derived innate factors with antiviral effect, SLPI is the only protein proved to be efficient in physiological concentrations. We have investigated the biological function of SLPI in salivary mediated inhibition of HIV infection and in addition the inhibitory effect of recombinant SLPI on isolates with various virus tropism. No significant difference in salivary concentrations of SLPI could be found between HIV infected individuals and healthy controls. Elevated levels of salivary SLPI could be associated with an increased inhibitory effect of the whole saliva sample against HIV-1 isolates. The inhibitory effect was found to decrease with broad co-receptor usage of the virus. To further elucidate the mechanisms of SLPI in the entry stage of the lifecycle of HIV1, we used a panel of virus isolates with distinct molecular phenotype. The monotropic strains, using either CXCR4 or CCR5 were shown to be most receptive to the inhibitory effect of rSLPI, while multitropic strains displayed a lower sensitivity to the protein

The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed

Long term association of hip fractures by questions of physical health in a cohort of men and women

We do not know if fracture predicting factors are constant throughout life, if they can be assessed earlier in life, and for how long. The aim was to study the association between questions about health status and mobility and fragility fractures in a cohort during a 35-year follow-up. A cohort of 16,536 men and women in two age groups, 26–45 and 46–65 years old, who answered five questions of their physical health status in postal surveys in 1969–1970. We obtained data on hip fractures from 1970 to the end of 2016. We found most significant results when restricting the follow-up to age 60–85 years, 35 for the younger age group and 20 years for the older. Men of both age groups considered “at risk” according to their answers had a 2.69 (CI 1.85–3.90)– 3.30 (CI 1.51–7.23) increased risk of having a hip fracture during a follow-up. Women in the younger age group had a 2.69 (CI 1.85–3.90) increased risk, but there was no elevated risk for women in the older age group. This study shows that questions/index of physical health status may be associated with hip fractures that occur many years later in life, and that there is a time span when the predictive value of the questions can be used, before other, age-related, factors dominate. Our interpretation of the results is that we are studying the most vulnerable, who have hip fractures relatively early in life, and that hip fractures are so common among older women that the questions in the survey lose their predictive value

Dental health of patients with X-linked hypophosphatemia : A controlled study

ObjectiveThe present study compared the dental health of patients with X-linked hypophosphatemia (XLH) with healthy age- and gender-matched controls to increase our knowledge of the impact of XLH on oral health.Materials and methodsTwenty-two adult patients with XLH in the Stockholm region of Sweden were referred to the Department of Orofacial Medicine at Karolinska Institutet for an extended clinical and radiological examination. Pre-existing radiologic examinations of 44 healthy age- and gender-matched controls were retrieved from the Department of Oral Radiology, at Karolinska Institutet.ResultsThe 22 patients with XLH (15 females, median age 38 years, range 20-71; 7 males, median age 49 years, range 24-67) had a significantly higher number of root-filled teeth compared to healthy controls (p = .001). In the XLH group, females had significantly better oral health than males, especially concerning endodontic and cariological status (p's = .01 and .02, respectively). Periodontal status differed non-significantly between the XLH and control groups.ConclusionPatients with XLH had a significantly lower oral health status compared to a healthy population especially concerning endodontic conditions. Male patients with XLH had a higher risk of poor oral health compared to female patients with XLH.Peer reviewe

Cognitive changes and neural correlates after oral rehabilitation procedures in older adults: a protocol for an interventional study

Abstract Background Epidemiological studies show an association between masticatory function and cognitive impairment. This has further strengthened the notion that tooth loss and impaired masticatory function may be risk factors for dementia and cognitive decline. Animal experiments have indicated a causal relationship and several possible mechanisms have been discussed. This evidence is, however, lacking in humans. Therefore, in the current interventional study, we aim to investigate the effect of rehabilitation of masticatory function on cognition in older adults. Methods Eighty patients indicated for prosthodontic rehabilitation will be randomly assigned to an experimental or a control group. Participants will conduct neuropsychological assessments, masticatory performance tests, saliva tests, optional magnetic resonance imaging, and answer questionnaires on oral health impact profiles and hospital anxiety and depression scale before, 3 months, and 1 year after oral rehabilitation. The difference between the two groups is that the control group will be tested an additional time, (at an interval of about 3 months) before the onset of the oral rehabilitation procedure. The primary outcome is a change in measures of episodic memory performance. Discussion Although tooth loss and masticatory function are widespread in older people, it is still an underexplored modifiable risk factor potentially contributing to the development of cognitive impairment. If rehabilitation of masticatory function shows positive effects on the neurocognitive function, this will have great implications on future health care for patients with impaired masticatory status. The present project may provide a new avenue for the prevention of cognitive decline in older individuals. Trial registration: The protocol for the study was retrospectively registered in ClinicalTrials.gov Identifier: NCT04458207, dated 02-07-2020

Observational study of selective screening for prediabetes and diabetes in a real-world setting : an interprofessional collaboration method between public dental services and primary health care in Sweden

Objective: Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm. Design: A descriptive observational study. Setting: The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic. Subjects: Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes. Main outcome measures: Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes. Results: DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification. Conclusions: DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden