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  • Public defence: 2026-04-24 13:00 Niagara Auditorium B2, Malmö
    Gottschalk, Sara
    Malmö University, Faculty of Culture and Society (KS), School of Arts and Communication (K3).
    Controversies of urban transition: Thickening urban sustainable planning processes through design2026Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis investigates how design can contribute to democratic and eco-socially just urban transitions through long-term, place-based, and practice-based interventions. The research is executed as a designerly engagement with a realworld case of planned urban development for sustainability transition, the Sege Park project, in Malmö, Sweden. The development project is a municipally led project that explicitly seeks to experiment with new approaches to sustainability beyond conventional urban planning practices. The research program draws on civic participatory design, design for transition, metadesign, and degrowthoriented perspectives and approaches urban development for transition as a complex, multi-dimensional design process in which sustainability is continually negotiated, contested, and materialised, across actors, institutions, temporalities, and scales.

    The central contribution of the research program is the articulation of the concept of thickening as both a methodological and ontological orientation for design research. The concept initially emerged as a response to the empirical complexity of the case, but through the operalisation of a layered methodological approach, which combined a case study methodology with ethnographic inquiry, design mapping, observant participation, design interventions, and retrospective analysis, the conceptual idea of thickening grew into a broader, ontological approach engaging with the real world as thick – inhabited, relational, and constantly in-the-making.

    Empirically, the thesis contributes with insights into planned urban development for transition by understanding it as a distributed design practice. It shows how municipal civil servants are engaged in designerly practices of urban transition but also in frequent socio-material infrastructuring efforts to align the municipal vision of sustainability transition among a wide range of actors, including municipal departments, developers, NGOs, grassroot groups, and the residents. Together, these practices and infrastructuring efforts aim to make sure that the vision materialises – and ultimately that an institutioning of more ambitious urban transition practice can take place. This distribution of responsibilities for urban transition across sectors and actors both enables and challenges democratic and socially just transitions. Further, the research highlights the strategic role of civic actors as groundbreakers and long-term anchors for transition.

    A further contribution concerns the role of the designer–researcher in planned urban transition. By working through a dual position of doing research into design and research through design, the thesis elaborates how attention to place-based controversies inherent to urban transition processes can provide openings for designerly interventions. In the research work, two forms of intervention were experimented with: the controversy walks and a study circle for homemaking stewardship as seeds for change. The interventions demonstrate how design through small-scale, situated interventions can allow for collective reflection,capacity building, and organisation for longer-term transition processes.

    At a meta level, the thesis argues that design research focused on democratic and eco-socially just transitions requires continued engagement in real-world, complex cases, as well as the continued development of a thickening design research practice.

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  • Public defence: 2026-04-29 09:15 Odontologiska fakulteten, Klerken 2370 Aulan, Malmö
    Göranson, Emma
    Malmö University, Faculty of Odontology (OD).
    Malocclusion in Adolescents: Quality of Life and Equality of Orthodontic Care2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Malocclusions are common and comprise a range of different types, such as crowding and increased overjet. Approximately 70% of children and adolescents present with some degree of malocclusion, often of mild severity. In Sweden, publicly funded orthodontic treatment is provided free of charge to about 30% of children and adolescents. Treatment is prioritised for those with the greatest treatment need, based on the severity of malocclusion.

    Untreated malocclusions may impair oral health-related quality of life (OHRQoL). The magnitude of the impact may differ depending on the type and severity of malocclusion; however, current knowledge is limited and largely based on earlier research in need of updating. Findings may also vary depending on how OHRQoL is measured. The orthodontic-specific instrument Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was developed to assess the impact of malocclusion on OHRQoL; however, a Swedish version was not previously available.

    To determine malocclusion severity and eligibility for orthodontic treatment, various assessment methods are used in both clinical practice and research. Photographs are increasingly used in place of clinical examination or dental study models, although it is not yet established whether photograph-based assessments perform equally well.

    Although dental care for children and adolescents is publicly funded and free of charge in Sweden, disparities in both oral health and access to dental care persist. However, less is known about whether orthodontic treatment uptake differs between population groups.

    This thesis investigated malocclusion in adolescents, its association with OHRQoL, and how orthodontic treatment is distributed within the public dental care system. The work was conducted using several approaches. Previous research was synthesised in a systematic review to examine associations between malocclusion and OHRQoL. Clinical data were collected and analysed to examine how different malocclusion traits relate to adolescents’ OHRQoL. The PIDAQ instrument was translated, culturally adapted, and evaluated for use in Swedish adolescents. In addition, photograph-based assessment of malocclusion was evaluated by comparison with more comprehensive assessment methods. Finally, registry data were used to investigate sociodemographic differences in orthodontic treatment uptake.

    Key conclusions: Malocclusion negatively affects adolescents’ OHRQoL, with poorer OHRQoL reported by females and the most significant impact observed for crowded front teeth. The orthodontic-specific OHRQoL instrument PIDAQ is valid for use in Swedish adolescents. Photographs can be used for reliable malocclusion assessment. Orthodontic treatment uptake within publicly funded care is unevenly distributed across sociodemographic groups, with lower levels observed among males, individuals with a foreign background, and those whose parents have lower educational attainment. The findings may contribute to the development of more effective clinical practices and enhanced strategies for equity within publicly funded orthodontic care.

    List of papers
    1. Malocclusions and quality of life among adolescents: a systematic review and meta-analysis
    Open this publication in new window or tab >>Malocclusions and quality of life among adolescents: a systematic review and meta-analysis
    2023 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 3, p. 295-307, article id cjad009Article, review/survey (Refereed) Published
    Abstract [en]

    BACKGROUND: Malocclusions in adolescents might have a negative impact on oral health-related quality of life (OHRQoL). Potential confounding variables (confounders) such as age, gender, caries, and socioeconomic status may skew the real relationship between malocclusions and OHRQoL.

    OBJECTIVES: To analyse the effect of malocclusions in adolescents on OHRQoL, when controlled for potential confounders.

    SEARCH METHODS: Five databases (PubMed, Cochrane Library, Cinahl, Scopus, and Web of Science) were searched up to 15 June 2022.

    SELECTION CRITERIA: Studies in which OHRQoL in 10-19-year olds with and without malocclusions were compared.

    DATA COLLECTION AND ANALYSIS: Screening, data extraction, and quality assessments were performed by four investigators independently. Risk of bias was assessed according to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) guidelines. To be included, studies had to control for confounders. Certainty of evidence was assessed with GRADE.

    RESULTS: Thirteen cross-sectional studies with low and moderate risk of bias were included in the qualitative synthesis. Four of these were also included in the quantitative synthesis (meta-analysis). The 13 studies in the qualitative synthesis displayed a large variation among the indices used for malocclusion ratings, as well as in instruments measuring OHRQoL. There was moderate quality of evidence that malocclusions have a negative effect on OHRQoL. The four articles included in the quantitative synthesis (meta-analysis) measured malocclusions with DAI and OHRQoL with CPQ 11-14 short form. There was moderate quality of evidence that malocclusions have a negative effect on OHRQoL (RR/PR 1.15, 95% CI 1.12-1.18, 3672 participants).

    CONCLUSIONS: There is moderate quality of evidence that malocclusions in adolescents have a negative impact on OHRQoL, after taking relevant confounders into consideration. Future studies should ideally use standardized measures for malocclusion ratings and OHRQoL.

    REGISTRATION: PROSPERO. CRD42020186152.

    Place, publisher, year, edition, pages
    Oxford University Press, 2023
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-59299 (URN)10.1093/ejo/cjad009 (DOI)000960634800001 ()36995692 (PubMedID)2-s2.0-85160765201 (Scopus ID)
    Available from: 2023-04-20 Created: 2023-04-20 Last updated: 2026-03-17Bibliographically approved
    2. Translation and validation of the Swedish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for adolescents
    Open this publication in new window or tab >>Translation and validation of the Swedish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for adolescents
    2021 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 4, p. 241-247Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument developed for assessment of orthodontic aspects of oral health-related quality of life (OHRQoL). This study aimed to translate and validate the Swedish version of PIDAQ for use in Swedish adolescents 12-19 years of age.

    MATERIAL AND METHODS: The translation was made according to the process described in 'Guidelines for Establishing Cultural Equivalency of Instruments' by Ohrbach et al. Field testing was performed in a group of consecutive patients who were about to start orthodontic treatment (untreated group) and a group of consecutive patients who had recently finished orthodontic treatment (treated group).

    RESULTS:  During the translation procedure, a Swedish version of PIDAQ was formed. In the field testing, a total of 144 questionnaires, 72 from untreated patients (mean age 14.6 years) and 72 from treated patients (mean age 17.3 years) were collected. The exploratory factor analysis detected two factors, which differs from the factor structure in the original questionnaire. The mean total PIDAQ score was significantly higher (p < .001) in the untreated group, 40.6 (20.3), than in the treated group, 9.4 (10.5), implying a high discriminant validity. Reliability was excellent, with internal consistency Cronbach's alpha values varying from 0.94 to 0.97.

    CONCLUSION: The Swedish version of PIDAQ demonstrates good validity and excellent reliability and is suitable for future research on the effect of malocclusion on OHRQoL in Swedish 12- to 19-year-olds.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2021
    Keywords
    Quality of life, adolescent, malocclusion, orthodontics
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-22014 (URN)10.1080/00016357.2020.1823014 (DOI)000576029200001 ()33026890 (PubMedID)2-s2.0-85092382265 (Scopus ID)
    Available from: 2020-10-28 Created: 2020-10-28 Last updated: 2026-03-17Bibliographically approved
    3. The Reliability and Validity of Intraoral Photographs in Assessing Orthodontic Treatment Need
    Open this publication in new window or tab >>The Reliability and Validity of Intraoral Photographs in Assessing Orthodontic Treatment Need
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    2025 (English)In: Orthodontics & craniofacial research, ISSN 1601-6335, E-ISSN 1601-6343, Vol. 28, no 3, p. 474-484Article in journal (Refereed) Published
    Abstract [en]

    Background: Orthodontic treatment need has commonly been assessed using treatment need indices during clinical examinations or using photographs in combination with plaster casts. Recently, the use of intraoral photographs alone to screen malocclusions has increased.

    Objective: This study aimed to validate intraoral photographs for the assessment of orthodontic treatment need.

    Materials and methods: The study sample consisted of case files from 30 pre-orthodontic patients aged 12-19 years. Each case file included intraoral photographs and casts. The cases were consecutively recruited from two orthodontic treatment waiting lists: 15 from the Department of Orthodontics at Folktandvården Eastmaninstitutet, Stockholm, Sweden and 15 from the Center for Orthodontics and Pediatric Dentistry, Norrköping, Public Dental Service Östergötland. Their orthodontic treatment need was assessed by four raters (calibrated orthodontists) using the indices IOTN-AC, IOTN-DHC, ICON, and DAI. The four raters individually assessed the 30 cases on three occasions: (1) photos only, (2) photos and casts, and (3) photos only. Finally, the four raters jointly made a consensus assessment using both photos and casts. For IOTN-AC and IOTN-DHC, interrater agreement was assessed with Fleiss' kappa, and validity with the Wilcoxon signed-rank test. For ICON and DAI, interrater agreement was assessed with Intra Class Correlation (ICC) (1, 2) and validity with a paired t-test.

    Results: Interrater agreement for IOTN-AC was slight (0.14-0.18) and moderate for IOTN-DHC (0.51-0.57), regardless of whether photographs were used alone or combined with casts. ICON demonstrated moderate interrater agreement (0.57-0.72), while DAI showed moderate to excellent (0.70-0.91), similarly unaffected by the use of photographs alone or in combination with casts. The validity analysis, which compared the individual assessments to the consensus one, revealed equivalent differences whether the assessment involved intraoral photographs alone or in combination with casts.

    Conclusion: Intraoral photographs are sufficient for assessing orthodontic treatment need because interrater agreement and validity are similar whether photos are used alone or with casts. However, interrater variability was substantial for both assessment methods.

    Trial registration: ClinicalTrial.gov. identifier: NCT05038865.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2025
    Keywords
    interrater agreement, intraoral photography, orthodontics, reliability, validity
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-73334 (URN)10.1111/ocr.12896 (DOI)001395180000001 ()39803929 (PubMedID)2-s2.0-85214803972 (Scopus ID)
    Available from: 2025-01-27 Created: 2025-01-27 Last updated: 2026-03-17Bibliographically approved
    4. Equality of specialist orthodontic care for adolescents in the Swedish public dental service: a cohort study
    Open this publication in new window or tab >>Equality of specialist orthodontic care for adolescents in the Swedish public dental service: a cohort study
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    2025 (English)In: BMC Oral Health, E-ISSN 1472-6831, Vol. 25, no 1, article id 841Article in journal (Refereed) Published
    Abstract [en]

    Background: In Sweden, dental care for children and adolescents, including specialist orthodontic treatment, is publicly funded. This study aims to analyze the impact of sociodemographic factors on the distribution of publicly funded specialist orthodontic treatment in a mid-sized Swedish region. Methods: A registry-based cohort study was conducted in Region Östergötland, including individuals born between 2000 and 2003. Sociodemographic data were obtained from Statistics Sweden (SCB), while dental health information was sourced from The Swedish Quality Registry for Caries and Periodontal Disease (SKaPa). The primary outcome variable was initiation of specialist orthodontic treatment, extracted from dental records. Statistical analysis was performed using Stata v.18.1. Results: The cohort comprised 16 893 individuals, with 51.5% males and 48.5% females. Specialist orthodontic treatment was initiated for 25.7% of the population (n = 4 342), with most treatments involving fixed appliances. Several sociodemographic factors were significantly associated with the likelihood of receiving orthodontic treatment. Females had 1.74 times higher odds (95% CI: 1.63–1.87) of receiving treatment compared to males. Individuals born in Sweden had 1.42 times greater odds (95% CI: 1.18–1.72) of receiving treatment compared to those born abroad. Similarly, children with Swedish-born parents had 1.16 times increased odds (95% CI: 1.04–1.30) compared to children with foreign-born parents. Children of mothers with university/college education had an OR of 1.29 (95% CI: 1.12–1.48), while those whose fathers had a university/college education had an OR of 1.19 (95% CI: 1.05–1.34), compared to parents with primary/lower secondary education. Conclusions: Males, individuals born outside Sweden, those with foreign born parents, and whose parents had lower educational levels were less likely to receive orthodontic treatment within the publicly funded dental health services in Region Östergötland. These findings suggest that sociodemographic factors influenced the distribution of orthodontic care, though the role of treatment demand requires further investigation.

    Place, publisher, year, edition, pages
    BioMed Central (BMC), 2025
    Keywords
    Cohort study, Healthcare disparities, Orthodontics, Sociodemographic Factors
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-76861 (URN)10.1186/s12903-025-06220-x (DOI)001498578600016 ()40437452 (PubMedID)2-s2.0-105006739680 (Scopus ID)
    Available from: 2025-06-11 Created: 2025-06-11 Last updated: 2026-03-17Bibliographically approved
    5. Malocclusion Traits and Oral Health-Related Quality of Life in Adolescents: A Multicentre Cross-Sectional Study
    Open this publication in new window or tab >>Malocclusion Traits and Oral Health-Related Quality of Life in Adolescents: A Multicentre Cross-Sectional Study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-83153 (URN)
    Available from: 2026-03-17 Created: 2026-03-17 Last updated: 2026-03-17Bibliographically approved
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  • Public defence: 2026-05-07 10:00 Allmänna sjukhuset, HS aula, Malmö
    Mikaelsson Midlöv, Elina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Standing next to but not being part of: Support for relatives in general palliative care at home2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore support for relatives from healthcare professionals, before and after a patient’s death, when general palliative care is provided at home. The thesis comprises four studies, based on the perspectives of relatives and registered nurses, using both quantitative and qualitative methods. Studies I and II were register studies with data from the Swedish Register of Palliative Care. Study I analysed data from 160 relatives involved in general palliative care at home across Sweden, using descriptive statistics to describe support from healthcare professionals. Study II analysed open-ended responses from 83 of these relatives through thematic analysis to describe their suggestions for improving support. Study III analysed data from four focus groups with 18 registered nurses, using content analysis to explore their experiences of supporting relatives when general palliative care is provided at home. Study IV analysed data from 14 interviews with relatives involved in general palliative care at home, applying phenomenological hermeneutical analysis to elucidate their experiences of support from healthcare professionals.

    The findings show that even if relatives receive some support (I–IV), it is often perceived as insufficient (I–II, IV), and that they tend to be more satisfied with support before the patient’s death than after (I–II, IV). The findings also indicate possible differences in whether support is offered, depending on the type of relative (I, III–IV). Overall, relatives need structured support through shared responsibility, continuous and timely information and communication, and access to competent and familiar healthcare professionals (II–IV). They also need to be seen as persons with their own needs beyond those of the patient and to receive tailored support (II, IV), including emotional support to process grief and experiences (III–IV), both before and after the patient’s death. Furthermore, the findings show that relatives and healthcare professionals may share fundamental needs, such as a need for structure and shared responsibility, and a need to know and be in control of the situation (II–IV). Healthcare professionals’ ability to support relatives may therefore partly depend on their own access to support (III).

    This thesis contributes to increased knowledge on support for relatives in general palliative care at home by providing insights from two perspectives: relatives as recipients of support and registered nurses as providers of support, before and after a patient’s death. In conclusion, to meet relatives’ personal and changing support needs, healthcare professionals must adopt a dual focus on both patients and relatives, along with a structured and person-centred approach. Although some support is provided, it is often unstructured, insufficiently personalised, and unequal, both before and after the patient’s death. These shortcomings, resulting from limited knowledge and competence among healthcare professionals and organisational constraints regarding time and resources, risk leaving relatives feeling overwhelmed, unsafe, and alone, standing next to but not being part of palliative care when provided at home.

    List of papers
    1. Support given by health professionals before and after a patient's death to relatives involved in general palliative care at home in Sweden: Findings from the Swedish Register of Palliative Care
    Open this publication in new window or tab >>Support given by health professionals before and after a patient's death to relatives involved in general palliative care at home in Sweden: Findings from the Swedish Register of Palliative Care
    2024 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 22, no 5, p. 1142-1149Article in journal (Refereed) Published
    Abstract [en]

    Objectives: General palliative care (PC) is provided more at home, leading to increased involvement of relatives. Although support for relatives is a fundamental component of PC, there are deficiencies in the support provided to relatives when general PC is provided at home. This study aimed to describe the support provided by health professionals before and after a patient's death to relatives involved in general PC at home.

    Methods: A cross-sectional register study was implemented, with data from the Swedish Register of Palliative care. The sample consisted of 160 completed surveys from relatives who had been involved in general PC at home, with 160 related surveys answered by health professionals. Only the questions about support to relatives were used from the surveys.

    Results: The findings showed that although many relatives appear to receive support in general PC at home, not all relatives receive optimal support before or after a patient's death. The findings also indicated differences in whether relatives received some support before and after a patient's death depending on the type of relative. There were also differences in responses between health professionals and relatives regarding if relatives received counseling from a doctor about whether the patient was dying.

    Significance of results: There is potential for improvements regarding support for relatives, especially after a patient's death, which has been confirmed in previous studies. The differences in whether relatives received support before and after a patient's death depending on the type of relative highlight the need for future research on how to support different types of relatives before and after a patient's death when general PC is provided at home.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2024
    Keywords
    Home care, palliative care, relatives, support
    National Category
    Nursing
    Identifiers
    urn:nbn:se:mau:diva-63090 (URN)10.1017/S1478951523001323 (DOI)001071522700001 ()37746762 (PubMedID)2-s2.0-85173773758 (Scopus ID)
    Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2026-04-02Bibliographically approved
    2. Relative's suggestions for improvements in support from health professionals before and after a patient's death in general palliative care at home: A qualitative register study
    Open this publication in new window or tab >>Relative's suggestions for improvements in support from health professionals before and after a patient's death in general palliative care at home: A qualitative register study
    2024 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 38, no 2, p. 358-367Article in journal (Refereed) Published
    Abstract [en]

    Introduction: The efforts of relatives in providing palliative care (PC) at home are important. Relatives take great responsibility, face many challenges and are at increased risk of poor physical and mental health. Support for these relatives is important, but they often do not receive the support they need. When PC is provided at home, the support for relatives before and after a patient's death must be improved. This study aimed to describe relatives' suggestions to improve the support from health professionals (HPs) before and after a patient's death in general PC at home.

    Methods: This study had a qualitative descriptive design based on the data from open-ended questions in a survey collected from the Swedish Register of Palliative Care. The respondents were adult relatives involved in general PC at home across Sweden. The textual data were analysed using thematic analysis.

    Results: The analysis identified four themes: (1) seeking increased access to HPs, (2) needing enhanced information, (3) desiring improved communication and (4) requesting individual support.

    Conclusions: It is important to understand and address how the support to relatives may be improved to reduce the unmet needs of relatives. The findings of this study offer some concrete suggestions for improvement on ways to support relatives. Further research should focus on tailored support interventions so that HPs can provide optimal support for relatives before and after a patient's death when PC is provided at home.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2024
    National Category
    Nursing
    Research subject
    Care science
    Identifiers
    urn:nbn:se:mau:diva-65610 (URN)10.1111/scs.13239 (DOI)001147115800001 ()38258965 (PubMedID)2-s2.0-85183052281 (Scopus ID)
    Funder
    Blekinge Institute of Technology
    Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2026-04-02Bibliographically approved
    3. Supporting relatives when general palliative care is provided at home– a focus group study based on nurses’ experiences
    Open this publication in new window or tab >>Supporting relatives when general palliative care is provided at home– a focus group study based on nurses’ experiences
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    2025 (English)In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 24, no 1, article id 108Article in journal (Refereed) Published
    Abstract [en]

    Background: Relative's efforts are essential when palliative care is provided at home and support from healthcare professionals is needed. Despite this, since the support provided varies, relatives may have unmet support needs. Many people receive general palliative care at home rather than specialised care, and nurses play a significant role in supporting relatives. This study aimed to explore registered nurses' experiences of supporting relatives before and after a patient's death when general palliative care is provided at home.

    Methods: This study used a qualitative explorative design. Data were collected through focus group interviews with 18 registered nurses in home care in Sweden and were analysed using content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used for explicit reporting.

    Results: The findings are presented in four categories with subcategories: receiving support to provide support, continuously providing understandable information, balancing different needs and building relationships facilitates safety and identifying needs.

    Conclusions: Even if registered nurses support relatives to some extent, they rarely reflect on the support they provide and lack structure in providing support both before and after the patient's death. The findings showed inadequacies in support after the patient's death, which is also emphasised in previous studies. The findings also showed deficiencies in routines, local guidelines and checklists as well as in training and education on how to support relatives when palliative care is provided at home, thereby risking that relatives' needs remain unmet. This highlights the need for creating routines and developing detailed local guidelines and checklists on providing support to relatives both before and after the patient's death.

    Place, publisher, year, edition, pages
    BioMed Central (BMC), 2025
    Keywords
    Home care, Nurses, Palliative care, Relatives, Support
    National Category
    Nursing
    Research subject
    Care science
    Identifiers
    urn:nbn:se:mau:diva-75570 (URN)10.1186/s12904-025-01744-z (DOI)001472115100003 ()40259273 (PubMedID)2-s2.0-105003140049 (Scopus ID)
    Funder
    Blekinge Institute of Technology
    Available from: 2025-04-24 Created: 2025-04-24 Last updated: 2026-04-02Bibliographically approved
    4. Standing next to but not being part of: relatives' experiences of support from healthcare professionals when general palliative care is provided at home
    Open this publication in new window or tab >>Standing next to but not being part of: relatives' experiences of support from healthcare professionals when general palliative care is provided at home
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    2026 (English)In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 25, no 1, article id 54Article in journal (Refereed) Published
    Abstract [en]

    Background: Relatives play a crucial role when palliative care is provided at home. More advanced care at home places higher demands on relatives, taking great responsibility, facing challenges, and often lacking adequate knowledge and skills to provide care. Therefore, relatives need support from healthcare professionals, yet do not receive the needed support. This study aimed to elucidate relatives' experiences of support from healthcare professionals before and after a patient's death when general palliative care is provided at home.

    Methods: A phenomenological hermeneutical method was used. The inclusion criteria were relatives of people who had died, involved in general palliative care at home. The sample consisted of 14 adult relatives involved in general palliative care at home between one week and 12 months. Data were collected through individual interviews between January and May 2025.

    Results: Relatives needed to be seen as they felt left out; they felt an overwhelming responsibility; they needed to feel safe at home through guidance from and access to healthcare professionals; they felt the need to know what was happening and what to expect; and they needed help in processing the grief both before and after the patient's death. These themes formed the main theme: Standing next to but not being part of.

    Conclusions: The findings of this study showed a lack of support for relatives before and after the patient's death but offer insights into what support relatives need from HCPs when general PC is provided at home. Relatives need to feel seen, informed and prepared, to feel safe when care is provided at home, and not feel overwhelmed by the responsibility of the situation. As research continuously reveals that relatives have unmet support needs, this highlights the need for tailored interventions and the targeting of available support actions for improved support. Since relatives play a crucial role in palliative care at home, continued work with education and training for relatives should be prioritised to support them in feeling prepared, obtaining necessary caregiving knowledge and skills, enabling them to cope with the situation at home.

    Place, publisher, year, edition, pages
    Springer Nature, 2026
    Keywords
    Home care, Palliative care, Relatives, Support, Support needs
    National Category
    Nursing
    Identifiers
    urn:nbn:se:mau:diva-82831 (URN)10.1186/s12904-026-02021-3 (DOI)001698224400001 ()41689015 (PubMedID)2-s2.0-105030870008 (Scopus ID)
    Available from: 2026-02-24 Created: 2026-02-24 Last updated: 2026-04-02Bibliographically approved
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  • Public defence: 2026-05-08 09:00 Odontologiska fakulteten, Klerken, 2370 Aula, Malmö
    Nordström, Marie
    Malmö University, Faculty of Odontology (OD).
    Caries-free Against the Odds—Salutogenic Resources in Young Adults2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Oral health inequalities remain a global public health challenge, especially among low socioeconomic groups. While the association between lower socioeconomic status and worse oral health outcomes is well-established, less attention has been paid to the salutogenic resources or protective factors that can promote good oral health in low socioeconomic groups.

    The aim was to explore salutogenic resources among healthy, caries-free young adults from low socioeconomic backgrounds. This thesis is based on four studies: a systematic review, a case–control study in Sweden using questionnaire and register data, and two qualitative interviews conducted in Sweden and South Africa. Salutogenic resources were identified at the individual, family, community, and societal levels.

    Identified individual resources were coping, health literacy, locus of control, motivation, self-efficacy, self-esteem, and self-regulation. However, some resources were protective only among individuals born in Sweden or those who immigrated during the ages of 0–5 years.

    Family played a central role by positive influence, conveying healthy traditions, and instilling healthy habits during childhood, together with parental guidance and support through adolescence. This enabled young adults to develop and apply resources and assets to take control over their own health, and to maintain oral health when encountering challenges.

    Social and economic support from the community and society were important when encountering hardships. Sport organizations and health professionals served a role in encouraging healthy habits and health education.

    In conclusion, this thesis indicates the importance of salutogenic resources for oral health among young adults from low socioeconomic backgrounds and shows the need to consider the wider context and circumstances in health promotion. A salutogenic framework should be applied when conducting health promotion in different settings. However, further research is needed to evaluate the potential of salutogenic and interdisciplinary interventions as well as the role of social networks and community resources to promote good oral health.

    List of papers
    1. Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review
    Open this publication in new window or tab >>Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review
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    2023 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 3, p. 176-185Article, review/survey (Refereed) Published
    Abstract [en]

    Objective: To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

    Materials and methods: The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

    Results: A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

    Conclusions: Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2023
    Keywords
    Dental caries, common risk approach, salutogenesis, resilience, systematic review
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-54102 (URN)10.1080/00016357.2022.2095021 (DOI)000825783700001 ()35811490 (PubMedID)2-s2.0-85133691731 (Scopus ID)
    Available from: 2022-08-02 Created: 2022-08-02 Last updated: 2026-04-01Bibliographically approved
    2. Some young adults can maintain good oral health despite socioeconomic challenges
    Open this publication in new window or tab >>Some young adults can maintain good oral health despite socioeconomic challenges
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    2024 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 132, no 3, article id e12985Article in journal (Refereed) Published
    Abstract [en]

    The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19–23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was ‘Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health’, comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2024
    Keywords
    salutogenesis, health promotion, dental caries, young adults, socioeconomy, resilience, family support, health behaviour, psychology
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-66678 (URN)10.1111/eos.12985 (DOI)001189369500001 ()38520668 (PubMedID)2-s2.0-85189551739 (Scopus ID)
    Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2026-04-01Bibliographically approved
    3. Age at immigration modifies the impact of salutogenic resources on dental caries in young adults facing persistent poverty in Sweden: a case–control study
    Open this publication in new window or tab >>Age at immigration modifies the impact of salutogenic resources on dental caries in young adults facing persistent poverty in Sweden: a case–control study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-83484 (URN)
    Available from: 2026-04-01 Created: 2026-04-01 Last updated: 2026-04-01Bibliographically approved
    4. Healthy family traditions and personal health assets - salutogenic resources for oral health among young adults in vulnerable communities in South Africa: a qualitative study
    Open this publication in new window or tab >>Healthy family traditions and personal health assets - salutogenic resources for oral health among young adults in vulnerable communities in South Africa: a qualitative study
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    2025 (English)In: BMC Oral Health, E-ISSN 1472-6831, Vol. 25, no 1, article id 1418Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Dental caries is a global public health problem with persistent inequalities. Research with a salutogenic perspective, as in, a focus on health factors, can provide important knowledge to be used in health promotion. The aim was to explore salutogenic resources among dental caries-free young adults living in vulnerable communities in South Africa.

    METHODS: A total of 32 participants (28 females, 4 males, mean age 26.2 years) with no previous caries experience were purposively recruited from two under-resourced townships. The qualitative data from interviews were audio-recorded, transcribed, and analyzed via qualitative content analysis.

    RESULTS: The resulting theme, A salutogenic foundation for oral health: preservation of traditions and use of personal health assets as protection against challenges, comprised two categories: (1) Individual health assets and early intergenerational learning, and (2) Ability to apply learned health strategies. Having individual health assets and tools for coping, early learning experiences by positive family influence, being exposed to healthy traditions during hardships, and the ability to apply learned health strategies were important salutogenic resources. Together, these resources formed a salutogenic foundation for oral health which enabled individuals to develop healthy routines, make healthy choices for oral health, and maintain oral health when encountering challenges and hardships.

    CONCLUSIONS: Salutogenic resources for oral health empowered individuals from vulnerable communities to maintain oral health. This suggests that future health promotion interventions should be considered and directed at multiple levels, targeting individual, family, community, and structural factors to promote sustainable oral health.

    Place, publisher, year, edition, pages
    BioMed Central (BMC), 2025
    Keywords
    Humans, South Africa, Female, Oral Health, Male, Adult, Qualitative Research, Vulnerable Populations, Young Adult, Adaptation, Psychological, Dental Caries / prevention & control, Health Behavior, Health Promotion, Family, Salutogenesis, Socioeconomic status
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-79779 (URN)10.1186/s12903-025-06941-z (DOI)001578850400004 ()40988040 (PubMedID)2-s2.0-105017101360 (Scopus ID)
    Available from: 2025-09-27 Created: 2025-09-27 Last updated: 2026-04-01Bibliographically approved
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  • Public defence: 2026-05-08 10:15 Orkanen D138
    Björklund, Sanne
    Malmö University, Faculty of Education and Society (LS), Department of Natural Science, Mathematics and Society (NMS).
    Preschool–Naturing in the Anthropocene: Coordinating Early Childhood Science Education with Swedish Preschool Practice2026Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The aim of this research project is to explore what child–nature relations are made possible through science education in Swedish preschool practice in the time of the Anthropocene. During the last decades, the tasks and purposes for Swedish preschool have made a shift towards an increased focus on teaching and learning. One of the areas that has been further articulated in the curriculum is science education. Previous research shows how early childhood science education (ECSE) has developed into a practice that entails many possibilities for child–nature relations to form, both through various dimensions like embodiment,aesthetic expressions, play and inquiry, and by facilitating child–nature relations that foster care and empathy towards nature. The notion of the Anthropocene brings new questions in relation to education to the fore: questions on natureculture relations and humans’ responsibility for the wellbeing of this planet, in a time when we need new ways to live and educate with nature. Actor-network theory (ANT) is the methodological stance that is evoked in this research project. By noticing the horse chestnut tree and acknowledging it as a sociomaterial actor, it became an actor to follow into ECSE assemblages. The results describe seven enactments of ECSE: facting, fictioning, gathering, visiting, sensing, exploring and caring, that also produce different child–nature relations. The results also describe how these enactments of ECSE are coordinated within preschool practice, and how local rituals make some child–nature relations possible while others struggle in the margins. This shows how power is located in teaching practices in ways that sometimes hide what is possible for children and pedagogues. It also shows how ECSE is a flexible practice that allows for multiple possibilities to develop and coexist, coordinations that allow for other child–nature relations to emerge and be explored, which is important in the Anthropocene. The results are concluded by presenting a new concept to think with: preschool–naturing.

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  • Public defence: 2026-05-13 09:15 Klerken 2370 Aulan, Malmö
    Olsson, Jenny
    Malmö University, Faculty of Odontology (OD).
    Pre-Medical Dental Care – When, Why and How2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In addition to desired therapeutic effects, certain medical treatments cause an increased risk of infectious complications. Patients facing such medical treatments therefore oftentimes undergo what is known as a pre-medical dental evaluation. The purpose thereof is to identify and eliminate oral findings that may compromise the upcoming medical treatment or cause infectious sequelae owing to the effects of the medical treatment. However, scientific evidence is limited regarding the importance of pre-medical dental evaluations and the effect of infection control measures. Guidelines for which oral findings that require treatment prior to various medical interventions are often general and open to interpretation. One specific oral finding whose management is frequently discussed, even in medically healthy patients, is asymptomatic apical periodontitis associated with root-canal–filled teeth. The overall aim of this thesis was therefore, with particular emphasis on root-canal–filled teeth with asymptomatic apical periodontitis, to contribute new knowledge that could support the clinical practice of dentists involved in pre-medical dental care.

    The thesis comprises four studies. In a survey among hospital-affiliated dentists in Sweden, the pre-medical dental management of various oral conditions was examined. In a follow-up interview study, the decision-making process regarding the pre-medical management of root-canal–filled teeth with asymptomatic apical periodontitis was explored. In the third study, a systematic review of the literature was conducted regarding the impact of oral foci of infection and pre-transplant dental treatment on adverse events in adult patients undergoing solid organ transplantation. The fourth and final study investigated whether clinically available factors reflect the degree of inflammation in apical periodontitis associated with root-canal–filled teeth.

    The results showed that hospital-affiliated dentists in Sweden agreed on the pre-medical management of several oral conditions. Patients are therefore generally likely to receive similar and consistent care regardless of provider. This does however not apply to root-canal–filled teeth with asymptomatic apical periodontitis, where consensus for management was low. The decision-making process for this condition involved multiple aspects, where uncertainty regarding the risk–benefit balance of treatment versus no treatment played an important role. However, factors such as the age and quality of root canal filling and features of the apical radiolucency should be interpreted with prudence when assessing lesion severity, as they do not seem to reliably reflect the degree of inflammation in apical periodontitis in root-canal–filled teeth. Furthermore, oral infectious foci at time of transplantation and pre-medical dental treatment might impact infection-related outcomes but appear to lack impact on the risk of mortality or graft rejection in solid organ transplant patients. In conclusion, this thesis contributes new knowledge on current practices and optimal approaches to when, why, and how pre-medical dental care is provided.

    List of papers
    1. Pre-medical dental evaluation and treatment of oral infection: a survey study among hospital-affiliated dentists in Sweden
    Open this publication in new window or tab >>Pre-medical dental evaluation and treatment of oral infection: a survey study among hospital-affiliated dentists in Sweden
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    2022 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, no 1, p. 29-37Article in journal (Refereed) Published
    Abstract [en]

    Objective To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. Materials and methods A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. Results Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. Conclusion Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2022
    Keywords
    Pre-medical dental evaluation, oral infectious sequelae, assessment of risk
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-43930 (URN)10.1080/00016357.2021.1934535 (DOI)000659333100001 ()34107238 (PubMedID)2-s2.0-85107617693 (Scopus ID)
    Available from: 2021-06-22 Created: 2021-06-22 Last updated: 2026-04-01Bibliographically approved
    2. Pre-medical assessment of root canal-filled teeth with asymptomatic apical periodontitis: a multifaceted balancing act
    Open this publication in new window or tab >>Pre-medical assessment of root canal-filled teeth with asymptomatic apical periodontitis: a multifaceted balancing act
    2023 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no 9, p. 1063-1076Article in journal (Refereed) Published
    Abstract [en]

    AIM: Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding pre-medical management of root canal-filled teeth with asymptomatic apical periodontitis.

    METHODOLOGY: Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root canal-filled teeth with asymptomatic apical periodontitis - one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analyzed using Qualitative Content Analysis with an inductive approach.

    RESULTS: A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four subcategories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference.

    CONCLUSION: The current interview study found pre-medical decision-making regarding root canal-filled teeth with asymptomatic apical periodontitis to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2023
    Keywords
    Decision-making, dentistry, qualitative research, uncertainty
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-61396 (URN)10.1111/iej.13941 (DOI)001004859900001 ()37269098 (PubMedID)2-s2.0-85161820839 (Scopus ID)
    Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2026-04-01Bibliographically approved
    3. Impact of Oral Infection on Organ Transplantation: A Systematic Review
    Open this publication in new window or tab >>Impact of Oral Infection on Organ Transplantation: A Systematic Review
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    2024 (English)In: Journal of Evidence-Based Dental Practice, ISSN 1532-3382, E-ISSN 1532-3390, Vol. 24, no 4, article id 102035Article, review/survey (Refereed) Published
    Abstract [en]

    Objectives: Posttransplant infections may lead to dire consequences in immunocompromised organ recipients. Oral foci of infection are therefore often eliminated prior to solid organ transplantation to reduce posttransplant morbidity. However, despite increasing numbers of organ transplantations the necessity of pretransplant dental treatment and its effect on transplant outcome remains uncertain. The aim of the present systematic review was to evaluate the impact of oral foci of infection and pretransplant dental treatment on adverse events following solid organ transplantation.

    Methods: Studies on adult patients undergoing solid organ transplantation with/without oral infection or with/without pretransplant dental treatment were eligible. An electronic search in PubMed, Scopus, Web of Science, CINAHL and Cochrane was conducted up to June 11, 2024. Screening of eligibility, data extraction and risk-of-bias assessment of the included studies with the Newcastle-Ottawa Scale were done independently by two reviewers. Data were synthesized with a narrative approach.

    Results: In total, 4035 unique publications were identified. After full text assessment of 75 studies nine cohort studies on liver, kidney, heart and/or lung transplantation based on 727 patients were included. Two studies based on 161 patients found a significant increase of infectious complications after liver transplantation when no dental treatment was performed. Presence of oral foci increased the risk of hospitalization after kidney transplantation in one study but was associated with lower infection rate after lung transplantation in another study. No studies found significant impact on mortality or on organ rejection. Overall, the quality of the included studies was good with low or medium risk-of-bias.

    Conclusion: To our knowledge, this is the first systematic review on the impact of oral infection on organ transplantation. The results suggest a possible link between persisting oral infection and posttransplant infectious complications, thus lending support to the elimination of oral infectious foci before solid organ transplantation.

    Place, publisher, year, edition, pages
    Elsevier, 2024
    Keywords
    heart transplantation, liver transplantation, lung transplantation, kidney transplantation, dentistry, dental focal infection
    National Category
    Surgery
    Identifiers
    urn:nbn:se:mau:diva-72193 (URN)10.1016/j.jebdp.2024.102035 (DOI)001351181200001 ()39631966 (PubMedID)2-s2.0-85208075690 (Scopus ID)
    Available from: 2024-11-14 Created: 2024-11-14 Last updated: 2026-04-01Bibliographically approved
    4. A cross-sectional study on apical periodontitis in root-canal–filled teeth—can anamnestic, clinical and radiographic status inform on level of inflammation?
    Open this publication in new window or tab >>A cross-sectional study on apical periodontitis in root-canal–filled teeth—can anamnestic, clinical and radiographic status inform on level of inflammation?
    (English)Manuscript (preprint) (Other academic)
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-83449 (URN)
    Available from: 2026-03-31 Created: 2026-03-31 Last updated: 2026-04-01Bibliographically approved
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  • Public defence: 2026-05-22 09:00 Odontologiska fakulteten, Klerken, 2370 Aula, Malmö
    Henricsson, Sara
    Malmö University, Faculty of Odontology (OD).
    Self-perceived oral health and orofacial appearance in an older population2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Self-perceived oral health (SPOH) and orofacial appearance (OA) are important aspects of health and well-being in older adults, influencing functional ability, self-image, and social participation. The aim of this thesis was to enhance the understanding of how oral health and OA are perceived and experienced by older adults aged 60 years and older within a Swedish context. This thesis is based on data from the Swedish National Study on Aging and Care (SNAC-B) and includes cross-sectional, longitudinal, and qualitative interview studies.

    The findings showed that 60-year-olds, irrespective of birth cohort, generally perceived their oral health and OA as satisfactory, and that these perceptions remained relatively stable over an 18-year follow-up. At the same time, perceptions of OA were characterized by complexity and ambivalence. Older adults expressed a dual perception of their own OA, where societal ideals of youthfulness coexisted with a negative view of striving for a youthful-looking appearance. Dental aspects were primarily emphasized by those with dental problems. Perceptions of others’ OA were similarly nuanced, where qualities such as warmth and charisma could outweigh physical appearance, while societal norms continued to influence what was considered a normal-looking appearance.

    In conclusion, older adults generally perceive their oral health and OA as satisfactory and relatively stable over time; however, perceptions of appearance are complex and shaped by both individual experiences and societal norms. Taking older adults’ perspectives on oral health and OA into account may contribute to a better understanding of these interrelationships and thereby support the development of a more person-centered approach in encounters with older adults within dental care and other healthcare settings.

    List of papers
    1. Self-perceived oral health and orofacial appearance in an adult population, 60 years of age
    Open this publication in new window or tab >>Self-perceived oral health and orofacial appearance in an adult population, 60 years of age
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    2024 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 22, no 3, p. 575-587Article in journal (Refereed) Published
    Abstract [en]

    Objective: The study aimed to compare self-perceived oral health and orofacial appearance in three different cohorts of 60-year-old individuals. Method: A cross-sectional design, based on data obtained from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprised 478 individuals, from baseline, 2001-2003 (n = 191), 2007-2009 (n = 218) and 2014-2015 (n = 69). Comparisons were made within and between the cohorts, with bivariate analysis and Fisher's exact test. Statistical significance was considered at p < 0.05. Results: The result showed that a low number of the participants reported self-perceived problems with oral health. Of the problems reported, a higher proportion in cohort 2014-2015 (39.3%) experienced problems with bleeding gums. The experience of bleeding gums increased between the cohorts 2001-2003 and 2014-2015 (p = 0.040) and between 2007-2009 and 2014-2015 (p = 0.017). The prevalence of discomfort with sensitive teeth was experienced in 7%-32%. Twice as many women compared to men experienced discomfort in all cohorts (no significant differences between the cohorts). Satisfaction with dental appearance was experienced in 75%-84%. Twice as many women compared to men were dissatisfied with their dental appearance in 2001-2003 (p = 0.011) and with discoloured teeth (p = 0.020). No significant differences could be seen between the cohorts regarding discomfort with dental appearance or discoloured teeth. Conclusion: The 60-year-olds irrespective of birth cohort, perceived their oral health and orofacial appearance as satisfactory.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2024
    Keywords
    appearance, older adults, oral health, orofacial, self-perceived
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-61920 (URN)10.1111/idh.12711 (DOI)001020957000001 ()37369990 (PubMedID)2-s2.0-85162987983 (Scopus ID)
    Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2026-04-08Bibliographically approved
    2. Self-perceived oral health and orofacial appearance in older adults - an 18-year follow-up study in Karlskrona, Sweden
    Open this publication in new window or tab >>Self-perceived oral health and orofacial appearance in older adults - an 18-year follow-up study in Karlskrona, Sweden
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    2024 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 255-263Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To analyze whether self-perceived oral health and orofacial appearance change with increasing age. Methods: This longitudinal study is based on data from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprises 160 participants 60 years of age at baseline 2001-2003. The same participants were re-examined at 66-, 72-, and 78 years of age. To analyze whether perceptions of oral health and orofacial appearance changed with increasing age, Cochran's Q test was conducted. Statistical significance was considered at p <= 0.05, and the calculated value Q must be equal to or greater than the critical chi-square value (Q >= 7.82). Significance values have been adjusted for the Bonferroni correction for multiple tests. Results: Self-perceived mouth dryness, both day (Q = 7.94) and night (Q = 23.41), increased over the 18-year follow-up. When divided by gender, significant differences were only seen for mouth dryness at nighttime. A decrease in sensitive teeth was perceived with increasing age, and an increase in self-perceived satisfaction with dental appearance, and a decrease in self-perceived problems with dental gaps between the ages of 60 and 78. These changes were, however, not statistically significant. Men experienced a higher proportion of discomfort with discolored teeth at age 78 than at 60 (Q = 9.09). Conclusions: Self-perceived oral health and orofacial appearance were relatively stable, with few changes over an 18-year follow-up.

    Place, publisher, year, edition, pages
    Medical Journals Sweden, 2024
    Keywords
    Older adults, oral health, orofacial appearance, self-perception
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-69972 (URN)10.2340/aos.v83.40574 (DOI)001267523400009 ()38700368 (PubMedID)2-s2.0-85192044617 (Scopus ID)
    Available from: 2024-07-30 Created: 2024-07-30 Last updated: 2026-04-08Bibliographically approved
    3. A dual perception of an ageing orofacial appearance - an interview study
    Open this publication in new window or tab >>A dual perception of an ageing orofacial appearance - an interview study
    2025 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 20, no 1, article id 2516618Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: This study aimed to explore how people aged 65 years and older experience their orofacial appearance (OA).

    METHOD: Semi-structured interviews were conducted with 20 strategically recruited participants aged 65-79 years from the Swedish National Study on Aging and Care-Blekinge (SNAC-B) in Karlskrona. A semi-structured interview guide was developed, and the interviews were analysed using thematic analysis to identify patterns in the data.

    RESULTS: The older adults' experience of their OA was represented in four themes: (i) you kind of have to like the situation as it is now-to accept orofacial appearance in its current state; (ii) an ageing orofacial appearance-a slow continuous downhill slope; (iii) looking good for others to fit the social norm; and (iv) keeping up orofacial appearance-seemingly without effort.

    CONCLUSION: The older adults in this study had a dual perception in relation to their own OA. Although society often values a younger looking appearance, striving for a youthful appearance is seen negatively, which may potentially reflect the complexities of the perceptions of one's own ageing OA. Only those with dental issues found the impact of teeth on OA perception to be particularly significant.

    Place, publisher, year, edition, pages
    Taylor & Francis Group, 2025
    Keywords
    Humans, Aged, Female, Male, Aging / psychology, Sweden, Interviews as Topic, Face, Body Image / psychology, Qualitative Research, Self Concept, older adults, oral health, orofacial appearance, self-perception
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-76722 (URN)10.1080/17482631.2025.2516618 (DOI)001504004200001 ()40483717 (PubMedID)2-s2.0-105007639486 (Scopus ID)
    Available from: 2025-06-10 Created: 2025-06-10 Last updated: 2026-04-08Bibliographically approved
    4. Peer perceptions of orofacial appearance among older adults - a qualitative study
    Open this publication in new window or tab >>Peer perceptions of orofacial appearance among older adults - a qualitative study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Odontology
    Identifiers
    urn:nbn:se:mau:diva-83610 (URN)
    Available from: 2026-04-08 Created: 2026-04-08 Last updated: 2026-04-08Bibliographically approved
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  • Public defence: 2026-05-22 09:00 HS aula AS: E002, Malmö
    Hemle Jerntorp, Sofia
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Interprofessional Education in Clinical Practice: Exploring healthcare students' interprofessional competencies as well as patients' and family members' involvement in the care process at interprofessional training wards2026Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The purpose of interprofessional collaboration (IPC) is to supply comprehensive, high-quality care to patients. Although healthcare professionals are expected to contribute to IPC, interprofessional skills require training. At interprofessional training wards (ITWs), healthcare students are trained in interprofessional teams where the patients’ needs are presumed to guide the work. However, previous research indicates that students’ personality traits, gender and healthcare education influence how well prepared they are for interprofessional learning (IPL). Little is known about how these factors influence self-efficacy for competence in interprofessional collaborative practice (IPCP). In addition, the link between interprofessional competence and patient and family member involvement in the care process has not been clearly highlighted in empirical interprofessional education (IPE) research before.

    Aim: This thesis aims to investigate healthcare students’ self-efficacy for competence in IPCP before and after clinical placement at ITWs. Additionally, it explores patients’ and family members’ experiences of involvement in the care process at an ITW.

    Method: The four studies (I–IV) included in this thesis were performed at three different ITWs in southern Sweden. In Studies I and II, the study sample comprised healthcare students required to undertake clinical placements at the ITWs across four disciplines: nursing, medicine, occupational therapy and physiotherapy. Study I had a cross-sectional design, including 598 students, and Study II had a pre-post design and included 518 students. The students participated in the studies by providing background information and completing the following questionnaires: the Interprofessional Education Collaborative Competency Self-Efficacy Tool (IPECC-Set 9), the Readiness for Interprofessional Learning Scale (RIPLS) and the Neuroticism, Extraversion, and Openness to Experience Five-Factor Inventory (NEO-FFI). Data were analysed using IBM’s Statistical Package for the Social Sciences and included descriptive statistics, correlations, multiple regression analysis, independent sample t-test, paired sample t-test and analysis of variance. The significance threshold was set at p < 0.05. In Study III, data were collected through individual interviews with patients admitted to an ITW. The study included 22 patients. Data were analysed following the principles of reflexive thematic analysis according to Braun and Clarke. In Study IV, data were collected through individual interviews with 19 family members of patients admitted to an ITW. The interviews were analysed using content analysis as described by Elo and Kyngäs.

    Result: In Study I, no differences were found in self-efficacy for competence in IPCP between the four educational disciplines. However, medical students were less ready for IPL, and so were male students. The personality traits Extraversion and Conscientiousness were identified as positive predictors of self-efficacy for competence in IPCP. In Study II, all students, regardless of educational discipline, gender, personality traits, previous healthcare experience or whether the students reported working in healthcare during their studies, scored significantly higher in self-efficacy for competence in IPCP after attending the ITW. In Study III, the main result was that although most patients at the ITW wanted to be involved in the care process, they described being hindered by their health condition or by not being involved by the student team in care planning and decision-making. In addition, most patients said that they needed their family members’ support to be involved in care planning. In Study IV, family members expressed their wish to be involved in the care process to support the patient and bridge information between the patient and the interprofessional student team. However, family members described how their contributions were seldom recognised by the student teams, and how they had to actively seek information to be involved in the care process.

    Conclusion: The link between interprofessional competencies and patient and family member involvement must be emphasised, as it will enhance the quality of patient care and further develop students’ interprofessional competencies. Educators must refine the IPE activities to enable patients’ and family members’ involvement in care planning and decision-making. Interprofessional competencies are essential skills applying to all healthcare disciplines, which justifies the development of a unified interprofessional collaborative practice curriculum.

    List of papers
    1. Healthcare students’ personality traits, readiness for interprofessional learning and self-efficacy for competence in interprofessional collaborative practice
    Open this publication in new window or tab >>Healthcare students’ personality traits, readiness for interprofessional learning and self-efficacy for competence in interprofessional collaborative practice
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Identifiers
    urn:nbn:se:mau:diva-83719 (URN)
    Available from: 2026-04-15 Created: 2026-04-15 Last updated: 2026-04-15Bibliographically approved
    2. Changes in healthcare students' self-efficacy for competence in interprofessional collaborative practice after clinical placement at an interprofessional training ward
    Open this publication in new window or tab >>Changes in healthcare students' self-efficacy for competence in interprofessional collaborative practice after clinical placement at an interprofessional training ward
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Identifiers
    urn:nbn:se:mau:diva-83720 (URN)
    Available from: 2026-04-15 Created: 2026-04-15 Last updated: 2026-04-15Bibliographically approved
    3. Patients’ experiences of involvement at a clinical training ward: a qualitative interview study
    Open this publication in new window or tab >>Patients’ experiences of involvement at a clinical training ward: a qualitative interview study
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    2024 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 38, no 6, p. 1092-1100Article in journal (Refereed) Published
    Abstract [en]

    Interprofessional education aims to foster healthcare students’ ability to collaborate in interprofessional teams with the patients at the center of care as active participants. However, little is known about how patients experience this collaboration. Therefore, this study aimed to explore patients’ experiences of being involved in the interprofessional team of healthcare students at a clinical training ward in Sweden. A descriptive design with a qualitative approach was used. Data were collected through semi-structured individual interviews with 22 patients. Braun and Clarke’s reflexive thematic analysis was used. The main finding was that patients were only included as passive participants. Although most patients wanted to be involved, they were hindered due to their health condition or excluded from care planning and decision-making. The patients needed family members’ support to be involved. However, this need was not recognised by the interprofessional team of healthcare students. Patient involvement must be highlighted as an important component of interprofessional education initiatives. Further research is needed to explore family members’ perspectives on involvement in interprofessional training ward settings.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2024
    Keywords
    Collaboration, education, interprofessional, patientinvolvement, training ward
    National Category
    Nursing
    Research subject
    Care science
    Identifiers
    urn:nbn:se:mau:diva-71378 (URN)10.1080/13561820.2024.2395971 (DOI)001310415500001 ()39266451 (PubMedID)2-s2.0-85204145426 (Scopus ID)
    Available from: 2024-09-25 Created: 2024-09-25 Last updated: 2026-04-15Bibliographically approved
    4. Family members' experience of involvement in the patient care process on an interprofessional training ward: A qualitative interview study
    Open this publication in new window or tab >>Family members' experience of involvement in the patient care process on an interprofessional training ward: A qualitative interview study
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    2025 (English)In: Journal of Interprofessional Education & Practice, ISSN 2405-4526, Vol. 39, article id 100742Article in journal (Refereed) Published
    Abstract [en]

    Background: Involving family members in the care process leads to higher-quality patient care. However, this requires collaboration among various healthcare professionals. At interprofessional training wards, healthcare students learn to work together across different disciplines. However, there is limited knowledge about family members’ involvement in the patient care process during interprofessional education in clinical settings. Aim: This study aimed to explore family members’ experience of involvement in the patient care process on an interprofessional training ward. Method: An inductive content analysis was applied on data from individual interviews with 19 family members of patients admitted to an interprofessional training ward.Results: Family members experienced that they had to be involved in the patient care process to bridge knowledge between the patient and the interprofessional student team in order to influence healthcare and have control over the situation. Moreover, they wanted to be acknowledged as family members and needed transparency in the patient care process. Family members’ involvement was governed by the patient’s needs and influenced by the degree of trust in the interprofessional student team. Conclusion: Interprofessional education activities should focus more on family members’ involvement in the interprofessional training ward.

    Place, publisher, year, edition, pages
    Elsevier, 2025
    Keywords
    Clinical training ward, Education, Healthcare students, Interprofessional collaboration, Relatives’ participation
    National Category
    Nursing
    Research subject
    Care science
    Identifiers
    urn:nbn:se:mau:diva-74661 (URN)10.1016/j.xjep.2025.100742 (DOI)2-s2.0-86000500790 (Scopus ID)
    Available from: 2025-03-12 Created: 2025-03-12 Last updated: 2026-04-15Bibliographically approved
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