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Fokus på ledarskap har i alla tider varit viktigt för att skapa effektiva organisationer som kan nå längre. I Sverige under 1990-talet växte ett ledarskap fram med fokus på mindre styrning och mer handlingsutrymme, för att främja god arbetsmiljö och organisationers effektivitet. År 2016 tillsattes en delegation av den svenska regeringen, vars syfte var att utbilda offentliga organisationer i Sverige i arbetet om att utveckla en mer tillitsbaserad organisering och ledning i sina verksamheter. Nu, tio år efter att man lämnat styrning genom kontroll och istället tillitsbaserad styrning och ledning tågat in är det viktigt att fundera över om det tillitsbaserade ledarskapet syns till? Studiens syfte är att undersöka hur tillitsbaserat ledarskap uttrycks och syns inom hr-organisationer i offentlig sektor. Denna kvalitativa studie har utförts genom observationer av fyra avdelningsmöten. Det empiriska materialet har analyserats tematiskt med hjälp av teorin om tillitsbaserad styrning och ledning, och presenteras med fokus på kommunikation, kompetens och gemenskap. Det resultat som framkommer i studien är att det tillitsbaserade ledarskapet är synligt i offentlig hr-organisation i Sverige, genom tillmötesgående kommunikation, bekräftad kompetens samt god gemenskap och samhörighet. Studien visar hur chefer använder kommunikationsstrategier och metoder som återkoppling, handlingsutrymme, medbestämmande och gemenskapsaktiviteter för att möjliggöra och upprätthålla ett ledarskap baserat på tillit. Trots kritik i den tidigare forskningen om begreppet tillit och dess eventuella otydlighet, visar studiens resultat att chefers strategier och metoder är återkommande i olika arbetsgrupper, vilket befäster tanken på ett ledarskap med samsyn och gemensam ram. Avslutningsvis presenteras rekommendationer för framtida forskning inom området. Nyckelord: Ledarskap, tillitsbaserad styrning och ledning, offentlig sektor, medbestämmande, handlingsutrymme

Background. Complications of orthognathic surgery are quite rare, but they cause suffering in affected individuals.The range of complications is broad and includes both hard and soft tissue. Case presentation: We here present a case of a fully healthy woman without signs of impaired healing capacity. Thepatient underwent bimaxillary orthognathic surgery and experienced multiple complications both peri- and postoperatively.During the post operative period, the patient also suffered from soft tissue complications after an orthopaedicinjury. Therefore, we referred the patient to her general practitioner for further medical investigation. Wealso present the result after restorative surgery and endodontic and prosthodontic treatment resulting in a successfulrehabilitation. Conclusion: This case report clearly shows the need for a good collaboration between different odontologicaland medical fields to achieve a good and predictable result. In situations where normal healing processesdo not occur, in-depth analysis must be carried out. Highlights: Orthognathic surgery affects soft and hard tissue which can result in adverse healing and complications.It is of great importance to follow up performed surgery to see late complications. Be restrictive with earlyre-operations when there are signs of necrosis. Always use a multidisciplinary approach when handling complicationsafter surgery.

Although three-dimensional (3D) co-culture of gingival keratinocytes and fibroblasts-populated collagen gel can mimic 3D structure of in vivo tissue, the uncontrolled contraction of collagen gel restricts its application in clinical and experimental practices. We here established a stable 3D gingival tissue equivalent (GTE) using hTERT-immortalized gingival fibroblasts (hGFBs)-populated collagen gel directly crosslinked with genipin/cytochalasin D and seeding hTERT-immortalized gingival keratinocytes (TIGKs) on the upper surface for a 2-week air–liquid interface co-culture. MTT assay was used to measure the cell viability of GTEs. GTE size was monitored following culture period, and the contraction was analyzed. Immunohistochemical assay was used to analyze GTE structure. qRT-PCR was conducted to examine the mRNA expression of keratinocyte-specific genes. Fifty µM genipin (G50) or combination (G + C) of G50 and 100 nM cytochalasin D significantly inhibited GTE contraction. Additionally, a higher cell viability appeared in GTEs crosslinked with G50 or G + C. GTEs crosslinked with genipin/cytochalasin D showed a distinct multilayered stratified epithelium that expressed keratinocyte-specific genes similar to native gingiva. Collagen directly crosslinked with G50 or G + C significantly reduced GTE contraction without damaging the epithelium. In summary, the TIGKs and hGFBs can successfully form organotypic multilayered cultures, which can be a valuable tool in the research regarding periodontal disease as well as oral mucosa disease. We conclude that genipin is a promising crosslinker with the ability to reduce collagen contraction while maintaining normal cell function in collagen-based oral tissue engineering.

Objectives: This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group. Methods: Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction. Results: Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p <= 0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC >= 2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=-0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=-0.23, p=0.21). Conclusion: COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia.

Increasing evidence emphasizes the importance of chemokines and chemokine receptors as regulators of bone remodeling. The C–C chemokine receptor 3 (CCR3) is dramatically upregulated during osteoclastogenesis, but the role of CCR3 in osteoclast formation and bone remodeling in adult mice is unknown. Herein, we used bone marrow macrophages derived from adult male CCR3-proficient and CCR3-deficient mice to study the role of CCR3 in osteoclast formation and activity. CCR3 deficiency was associated with formation of giant hypernucleated osteoclasts, enhanced bone resorption when cultured on bone slices, and altered mRNA expression of related chemokine receptors and ligands. In addition, primary mouse calvarial osteoblasts isolated from CCR3-deficient mice showed increased mRNA expression of the osteoclast activator–related gene, receptor activator of nuclear factor kappa-B ligand, and osteoblast differentiation–associated genes. Microcomputed tomography analyses of femurs from CCR3-deficient mice revealed a bone phenotype that entailed less cortical thickness and volume. Consistent with our in vitro studies, the total number of osteoclasts did not differ between the genotypes in vivo. Moreover, an increased endocortical osteoid mineralization rate and higher trabecular and cortical bone formation rate was displayed in CCR3-deficient mice. Collectively, our data show that CCR3 deficiency influences osteoblast and osteoclast differentiation and that it is associated with thinner cortical bone in adult male mice.

Bakgrund: Diabetes är ett växande problem i Sverige liksom i övriga världen. Sjukdomen och dess komplikationer orsakar mycket lidande och stora kostnader för samhället. Inom diabetesvården arbetar personalen för att patienter med diabetes ska leva ett gott liv med så lite lidande och komplikationer som möjligt. För att säkra kvalitén och utveckla vården behöver vårdpersonalen systematiskt och kontinuerligt identifiera förbättringsområden och genomföra små som stora förbättringsarbeten. Syfte: Denna studie syftar till att beskriva diabetessjuksköterskans arbete med förbättringar inom primärvården samt att beskriva faktorer som främjar respektive hindrar arbetet med förbättringar. Metod: Metoden som användes var en enkätbaserad kvantitativ tvärsnittsstudie. Totalt 84 diabetessjuksköterskor inom primärvården i Västra Götalandsregionen besvarade enkäten. Data analyserades statistiskt och redovisades deskriptivt. Öppna frågor analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visade att 92% tyckte att det är mycket viktigt att bedriva förbättringsarbete och 56% angav att de hade ganska stora möjligheter att utföra förbättringsarbete. Av diabetessjuksköterskorna som besvarade enkäten så hade 63% ganska ofta idéer om förbättringsarbete och 73 % hade kunnat bedriva förbättringsarbete. Det som tydligast angavs som viktigt för att bedriva förbättringsarbete var stöd från ledningen, ett fungerande samarbete med övrig personal och tid för reflektion kring förbättringsområde. Slutsats: Diabetessjuksköterskan tycker det är viktigt med förbättringsarbete och har ofta idéer om förbättringsområden. Om försättningar ges vad gäller stöd från ledning, samarbete med övrig personal och tid för att kunna bedriva förbättringsarbete så ökar möjligheterna för att utvecklingen och kvaliteten av diabetesomvårdnaden drivs framåt., Diabetes is a growing problem in Sweden as well as in the rest of the world. The disease and its complications cause a great deal of suffering and great costs to society. In diabetes care, health care personnel work to ensure that patients with diabetes live a good life with as little suffering and complications as possible. To ensure quality and develop care, healthcare personnel need to systematically and continuously identify areas of improvement and carry out small and large improvement work. Objective: The aim of the study was to explore the diabetes specialist nurse's work with improvements in primary care and to describe factors that promote and hinder the improvement work. Method: The method used was a survey-based quantitative cross-sectional study. A total of 84 diabetes specialist nurses in the Västra Götaland region answered the questionnaire. Data were analyzed statistically and presented descriptively. Open-ended questions were analyzed by qualitative content analysis. Results: The results of the study showed that 92% of the participants thought it was very important to do improvement work, 80% felt that they had very large or quite large opportunities to do improvement work and 86% indicated that they very often or quite often had ideas about improvement work. 73% of the participants had the opportunity to participate in improvement work. What was most clearly stated as important for being able to carry out improvement work was that they had support from management and time to be able to carry out improvement work. Conclusion: The diabetes specialist nurse's thinks it is important and often has ideas for improvement work. If the diabetes specialist nurse is given the conditions for conducting improvement work such as support from management, a working collaboration with other staff and time for reflection on improvement areas, it can lead to increased quality in diabetes care and better care for patients with diabetes.

BACKGROUND: Innate lymphoid cells (ILCs) are the most recently identified leukocytes of the immune system and these cells are increasingly acknowledged to play important roles in host defence and tissue repair. ILCs are also contributors of inflammatory diseases such as asthma and colitis. We analyzed the presence and relative proportions of the different ILC subsets (ILC1, ILC2 and ILC3) in gingivitis and periodontitis. Further, we investigated if ILCs express receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine crucial for osteoclast differentiation and bone resorption. METHODS: We collected gingivitis and periodontitis soft tissue and characterized ILC subsets including RANKL expression in single-cell suspensions using flow cytometry. RESULTS: ILCs were detected both in gingivitis and periodontitis. The majority of ILCs, in both conditions, were ILC1s. Furthermore, RANKL expression was detected on a fraction of the ILC1s. CONCLUSIONS: Our discovery of the presence of ILCs both in gingivitis and periodontitis and concomitant expression of RANKL on a fraction of the ILC1 population suggest that these cells may be of importance in periodontal disease. In addition, our findings provide a new insight into the field of oral immunology.

The mechanism of how patatin-like phospholipase domain-containing protein 3 (PNPLA3) variant M148 is associated with increased risk of development of hepatic steatosis is still debated. Here, we propose a novel role of PNPLA3 as a key player during autophagosome formation in the process of lipophagy. A human hepatocyte cell line, HepG2 cells, expressing recombinant I148 or 148M, was used to study lipophagy under energy deprived conditions, and lipid droplet morphology was investigated using florescence microscopy, image analysis and biochemical assays. Autophagic flux was studied using the golden-standard of LC3-II turnover in combination with the well characterized GFP-RFP-LC3 vector. To discriminate between, perturbed autophagic initiation and lysosome functionality, lysosomes were characterized by Lysotracker staining and LAMP1 protein levels as well as activity and activation of cathepsin B. For validation, human liver biopsies genotyped for I148 and 148M were analyzed for the presence of LC3-II and PNPLA3 on lipid droplets. We show that the M148-PNPLA3 variant is associated with lipid droplets that are resistant to starvation-mediated degradation. M148 expressing hepatocytes reveal decreased autophagic flux and reduced lipophagy. Both I148-PNPLA3 and M148-PNPLA3 colocalize and interact with LC3-II, but the M148-PNPLA3 variant has lower ability to bind LC3-II. Together, our data indicate that PNPLA3 might play an essential role in lipophagy in hepatocytes and furthermore that the M148-PNPLA3 variant appears to display a loss in this activity, leading to decreased lipophagy., Funding Agencies|Swedish Research Foundation [11284]; Crafoord Foundation; Swedish Diabetes Foundation; Albert Pahlsson Foundation; Dr Per Hakansson Foundation