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Caroline Girestam Croonquist,1,2 Jesper Dalum,3 Pia Skott,1,2 Petteri Sjögren,4 Inger Wårdh,2,3 Elisabeth Morén3 1Folktandvården Stockholm AB, Stockholm, Sweden; 2Academic Centre Of Geriatric Dentistry, Stockholm, Sweden; 3Department Of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; 4Oral Care AB, Stockholm, SwedenCorrespondence: Elisabeth Morén Department Of Dental MedicineKarolinska Institutet, Box 4064, Huddinge 141 04, SwedenTel +46 70 165 88 03Email elisabeth.moren@ki.sePurpose: The primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs.Patients and Methods: In this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff’s attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher’s exact test and two-way variance analysis (ANOVA).Results: Improvements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C.Conclusion: Monthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.Keywords: aged, residential facilities, nursing staff, dental care, attitude of health personnel, oral health

Since 2016, Park School in Denmark has consistently used Japanese lesson study as an approach to the professional development of its mathematics teachers. The school has moved beyond the initial adaptation of lesson study, and no longer includes external support. In this article, I investigate how three groups of teachers participated in the maturing lesson-study phases, especially the reflection phase. I apply social practice theory, particularly the concepts of figured worlds and improvisation, to examine the groups' improvisation of artefacts and actions during lesson study, and the mature, valued outcomes. This study explains how and why the mature lesson-study efforts at Park School offer predominantly superficial learning opportunities to students and teachers alike. It concludes that in countries unaccustomed to lesson study, external support (or other external knowledge sources) is also important at the mature stages of its adaptation. This study proposes three activities that offer such support.

This study aims to explore how a research-informed product, a hypothetical learning trajectory (HLT), was implemented by a group of Shanghai teachers in mathematics classrooms and promoted by a researcher through a Chinese lesson study. The instruction informed by the HLT served as a boundary object to promote conversations between the researcher and the teachers. The researcher played an indispensable role as a broker to facilitate the transformation of the boundary object. A fine-grained analysis of the data set showed that the team of teachers and the researcher formed a boundary encounter between teaching and research communities in which the participants negotiated and agreed on HLT-informed instruction. The study identified four turning points that are crucial for transforming HLT-informed instruction from an abstract object to a concrete form. Based on the turning points, we revealed the role played by the researcher as a broker in this lesson study. Finally, the challenges of bringing HLT into the classroom are discussed.

AbstractObjective 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.

Purpose: The purpose of the article is to identify, describe and explain what and how new mathematics teachers learn when participating in a lesson-study induction programme, by networking theories. Design/methodology/approach: To explore this phenomenon, the author combines the two theoretical frameworks, Patterns of Participation and the Knowledge Quartet. In a case study with one teacher, the latter framework is used as a zoom into the parts identified as important by the first framework. Findings: The combination of the two frameworks proved productive as it provides: (1) a more complete insight into what the teacher learned, (2) complementary views on what and how the teacher learned and (3) different insights into the complex situations new teachers find themselves in. These findings contribute to the theorisation of lesson study and to research on new mathematics teachers. Research limitations/implications: As the study includes only one teacher, its results regarding new teachers' learning are not generalisable to the same extent as are the results regarding the benefits of combining the two frameworks. Practical implications: In Denmark and other western countries, it is crucial to provide new mathematics teachers with support that focuses specifically on mathematics education. The article proposes a design of such an induction programme based on lesson study. Originality/value: Outside East Asia, lesson study is rarely used to support the professional development of new mathematics teachers during their first teaching years. The article contributes an exploration of this phenomenon in Denmark.

In this article, we conduct a qualitative systematic review of studies examining the use of digital games to promote students' mathematical reasoning in primary and lower secondary schools. Digital games now have a prominent role in students' leisure time, as has mathematical reasoning in curricula around the world. This study investigates how the affordances of digital game--based learning environments (DGBLEs) are used to support students' mathematical reasoning. Through a thematic analysis, we construct five distinct themes that describe how mathematical reasoning is afforded in the DGBLEs in the reviewed studies: developing (winner) strategies, exploring an immersive environment, experimenting, designing learning games and solving tasks. By analysing the themes in relation to the reasoning and proof cycle, we found that DGBLEs primarily supported exploration, conjecturing and, to a lesser extent, justification. We conclude that students' mathematical reasoning can be achieved through DGBLEs that specifically target exploration, conjecturing and justification, and by carefully structuring students' interactions with and dialogues about the games played.

Purpose: The aim of this paper is to identify the role of the principal in establishing a whole school approach for health and wellbeing. Two questions are asked: (1) What do successful Swedish principals do when they take on a whole school approach? (2) How do these results relate to previous research on successful school leadership? Design/methodology/approach: This paper focuses on the complexity of organisational processes and considers the role of successful leadership in managing a whole school approach to health promotion. It presents findings from two different but interlinked projects, and draws on document studies and interviews with principals, student health team members and teachers in Sweden. Findings: This paper argues that successful school leaders are crucial in establishing a whole school approach, because of the work they do to synchronise the health-promoting activities in schools. The study identifies four aspects of coordination that need to be enacted simultaneously when leading health-promoting processes. The fifth aspect identified is that a whole school approach is not limited to the school, but the whole local school context, i.e. a synchronisation between different system levels. Originality/value: Although limited in scale, this paper reports key findings that could have practical implications for school leaders. The study suggests that successful school leadership research needs to use a health-promoting lens in order to make leadership practices health-promoting practices. It also proposes extended comparative research from different fields and contexts.

Abstract Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99–1.21 among men and 1.15; 95%CI = 1.00–1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61–0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47–0.76) and intensive care (aRR = 0.43; 95% CI = 0.21–0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.

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.

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.

Hensikten med denne studien er å bidra med mer kunnskap om kommunikasjon mellom lærer og elever under arbeid med matematikkoppgaver som innebærer matematisk resonnering. Datamaterialet er videoopptak av matematikkundervisning i to klasserom på mellomtrinnet. Vi startet analysen med å identifisere episoder der det foregikk resonneringsprosesser. Videre analyserte vi enkeltutsagn i episodene, før vi satte utsagnene sammen til kommunikasjonsmønster. Studien viser at kommunikasjonen mellom lærer og elev følger fire mønstre avhengig av om eleven har kommet fram til riktig svar, feil svar, ikke hadde kommet fram til noe svar, eller har et uferdig svar. Det viser seg at det bare er i de tilfellene hvor eleven har kommet fram til riktig svar, at læreren forsøker å utvide elevens resonnering. I studien identifiserte vi også noen lærergrep som så ut til å kunne stoppe elevens videre resonnering. ENGLISH ABSTRACT Communication patterns in work on mathematical reasoning The purpose of this study is to contribute to more knowledge about communication between teacher and students during work on mathematics tasks that involve mathematical reasoning. The data material is video recordings of mathematics teaching in two classrooms in middle school. We started the analysis by identifying episodes that included reasoning processes. Further on, we analyzed the episodes utterance by utterance, before identifying some communication patterns. The study shows that the communication between teacher and student follows four patterns depending on whether the student suggest the correct answer, the wrong answer, no answer, or an unfinished answer. The study shows that it is only in cases where the student suggests the correct answer that the teacher tries to expand the student’s reasoning. We have also identified some teaching practices that seem to stop the student’s further reasoning.

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.

Abstract Background Patients with schizophrenia spectrum diagnoses have a poor prognostic outlook and rates of recovery. Inpatient care is common, but the decision to initiate such care is not solely up to the patient but also influenced by the healthcare providers. Recent ideas about shared decision-making however challenges this idea. Patient-Controlled Admissions (PCA) refers to a care model where a patient signs a contract that allows the decision for admission into inpatient care to be transferred onto the patient. Methods In Region Stockholm’s public healthcare PCA was introduced to patients with schizophrenia spectrum diagnoses deemed to have the greatest care needs. Outcomes of a 12-month naturalistic within-group follow-up was analyzed using Wilcoxon signed-rank test. Results In total, 56 patients fulfilled the study’s inclusion criteria, with between 20 to 42 patients having complete data and being able to analyze statistically, depending on the variable. Number of admissions, inpatient days, number of involuntary admissions, and involuntary admission days decreased, but only significantly so for inpatient days, p

The aim of mathematics education research is to develop comprehensive understandings of the problems of mathematics teaching and learning, and the ambition is, at least in the long run, to support the development of institutionalised teaching-learning practices. Looking back at the attempts to structure syllabi and other curricular materials and to study student learning in clinical settings in the past, it is disappointing to see the dismal results of the efforts. There is "a complexity" involved in mathematics education that goes beyond the subject itself and beyond individual students' cognition. The papers in the present issue of the Journal of Mathematics Teacher Education (JMTE) in different ways and to different extents reflect this move beyond an interest in mathematics per se and in individual students' learning. It is increasingly acknowledged that the student population in many countries in the West is becoming increasingly diverse, and that mathematics plays a significant societal and political role in and beyond educational contexts. We sometimes tend to write about teachers' knowledge and beliefs, about noticing, and even about equity as if contextual issues do not matter much. But they do matter, also within the countries that dominate our international journals at present. The "full complexity" of mathematics teaching and learning is to a great extent contextual complexity.

Teacher identity has become important in mathematics education research, but mainly in relation to programmes for teacher education (TE) and professional development (PD). Less attention has been paid to understanding the role and development of identities in the majority of cases in which teachers are not involved in long-term TE or PD. This paper presents a study that seeks to develop such understandings. The study defines teacher identities as their shifting experiences of being, becoming and belonging related to the profession. It is a longitudinal case study of a novice teacher, Anna, and it asks how Anna's identities change over the first 4 years of her career at her school, Northgate. To address the question I use a framework called Patterns of Participation (PoP) in combination with a range of methods, including interviews with Anna, her closest colleagues and the leadership at her school, and observations of Anna's classrooms and of team meetings. I argue that this combination invites new understandings of identity development, because it does not prioritise teacher engagement in one particular practice (e.g., as promoted by PD), but allows interpretations of how Anna's engagement with a multitude of different practices play a role for her professional experiences. The results suggest that in general terms, Anna's identity changes from being 'a mathematics teacher at Northgate' to becoming 'a mathematics teacher at Northgate'.

Synbiotic 2000, a pre + probiotic, reduced comorbid autistic traits and emotion dysregulation in attention deficit hyperactivity disorder (ADHD) patients. Immune activity and bacteria-derived short-chain fatty acids (SCFAs) are microbiota–gut–brain axis mediators. The aim was to investigate Synbiotic 2000 effects on plasma levels of immune activity markers and SCFAs in children and adults with ADHD. ADHD patients (n = 182) completed the 9-week intervention with Synbiotic 2000 or placebo and 156 provided blood samples. Healthy adult controls (n = 57) provided baseline samples. At baseline, adults with ADHD had higher pro-inflammatory sICAM-1 and sVCAM-1 and lower SCFA levels than controls. Children with ADHD had higher baseline sICAM-1, sVCAM-1, IL-12/IL-23p40, IL-2Rα, and lower formic, acetic, and propionic acid levels than adults with ADHD. sICAM-1, sVCAM-1, and propionic acid levels were more abnormal in children on medication. Synbiotic 2000, compared to placebo, reduced IL-12/IL-23p40 and sICAM-1 and increased propionic acid levels in children on medication. SCFAs correlated negatively with sICAM-1 and sVCAM-1. Preliminary human aortic smooth-muscle-cell experiments indicated that SCFAs protected against IL-1β-induced ICAM-1 expression. These findings suggest that treatment with Synbiotic 2000 reduces IL12/IL-23p40 and sICAM-1 and increases propionic acid levels in children with ADHD. Propionic acid, together with formic and acetic acid, may contribute to the lowering of the higher-than-normal sICAM-1 levels.

A vision of universalised human freedom, equality, security and democracy emerged in the wake of the Scientific Revolution and the Enlightenment, the British Industrial Revolution, and the French Revolution. This vision, not even approximately practicable at the time, is now well within reach. A viable socialist strategy will not be oriented around an encompassing central plan but rather an agenda of human-centred goals – the creation of preconditions for all individuals to fully realise their personal capacities and to function as free citizens, exercising control individually and collectively, at the workplace and in society. Central to the realisation of such a programme will be a focus on the crucial role played by the first years of life in shaping human development and in the formation of class hierarchies. JEL codes: B51, H40, P16

This article explores the complexities of settler relations within the context of an academic conference hosted by Indigenous hosts and inclusive of Indigenous ceremony and content. The authors explore a range of questions related to their settler identities as participants in the conference. How are we as settlers to engage in a conference entitled “CYC in Action”, held at an institution constructed on Indigenous land, and dedicated to the promulgation of Western thought and culture? How are we to encounter the ghosts of those Indigenous peoples destroyed and removed from this very geography? How are we to be positioned in relation to our Indigenous colleagues who are reclaiming fragments of this colonized space through ceremony, buildings, and the introduction of sacred objects and totems? Should we adopt the studied neutrality of scholars, the moral high ground of activists, or the inclusive posture of the “good” settler? Do we find ways to be comfortable in the space? Is it an option to seek to be comfortable? Is our “Whiteness” as settlers our passport to enter Indigenous space and claim a right to be there as “friends”? Under the contested relation of a conference taking place on stolen lands that includes both the thieves and the survivors of the theft, who is the host and who determines the conditions of inclusion?

The study reported in this paper concerns the tensions and conflicts that teachers experience while they enact a new set of reform-oriented curricular materials into their classrooms. Our focus is ?n the interactions developed in two groups of teachers in two schools for a period of a school year. We use Activity Theory to study emerging contradictions and we elaborate on the construct of dialectical opposition to understand the nature of these contradictions and their potential for teacher learning. We provide evidence that discussions about contradictions and their dialectical character in the two groups support teachers to engage differently in mathematics teaching and learning and carry potentials for shifts in the practices that evolve in their classrooms. Our study addresses empirically in the context of mathematics teaching the philosophical claim about the role of contradictions as a driving force for any dynamic system.

This article describes the development of the Swedish curriculum-theory tradition with a focus on different curriculum practices, educational message systems, arenas, and curriculum makers. Attention has been paid to different places, spaces, and times in relation to the selection, ordering, and manifestation of knowledge, norms, and values, as well as the management and organization of education. Curriculum and leadership research and changes in Swedish education are described and we introduce the comparative curriculum code as a codification of the contemporary changes in the education system and their consequences for the selection and ordering of knowledge and students.

Serum, urine and tissue from a rat model of chronic kidney disease (CKD) were analysed using nuclear magnetic resonance (NMR) spectroscopy-based metabolomics methods, and compared with samples from sham operated rats. Both urine and serum were sampled at multiple timepoints, and the results have been reported elsewhere (https://doi.org/10.1007/s11306-019-1569-3 [1]). The data could be useful to researchers working with human CKD or rat models of the disease. In addition, several different types of NMR spectra were recorded, including 1D NOESY, CPMG, and 2D J-resolved spectra, and the data could be useful for method comparison and algorithm development, both in terms of NMR spectroscopy and multivariate analysis.

Historically, ureteral reimplantation (UR) has been the gold standard for treatment of primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent urinary tract infections. In infants, open surgery with reimplantation of a grossly dilated ureter into a small bladder, can be technically challenging with significant morbidity. Therefore, less invasive endoscopic management such as dilatation or incision of the ureter–vesical junction, has emerged as an alternative to reimplantation during the last decades. To systematically evaluate the effectivity, safety, and potential benefits of endoscopic treatment (dilatation with or without balloon or incision) of POM in comparison to UR. A systematic review was conducted. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 20 participants and a mean follow-up more than 12 months were eligible for inclusion. Of 504 articles identified, 8 articles including 338 patients were eligible for inclusion (0 RCTs, 1 NRSs, and 7 case series). Age at time of surgery was minimum 15 days to a maximum of 192 months. Indications for endoscopic treatment (ET) included patients with loss of split renal function (>10%) and worsening of hydroureteronephrosis. The studies analysed reported a success rate ranging from 35% to 97%. Success was defined as stabilization of differential renal function without further procedures. A post-operative complication rate of 23–60% was reported (mostly transient haematuria, urinary tract infections and stent migration or intolerance). In 14% of the cases salvage UR following initial ET, was performed due to relapse of symptomatic POM. Endoscopic treatment for persistent or progressive POM in children is a minimally invasive alternative to UR with a long-term modest success rate. Additionally, it can be performed within a wide age span, with equal success rate and complication rates. [ABSTRACT FROM AUTHOR]