Malmö University Publications
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  • Public defence: 2025-02-12 13:15 OR:D138, Malmö
    Howding, Maria
    Malmö University, Faculty of Education and Society (LS), Department of Sports Sciences (IDV).
    Möten i friluftsliv: Lärarutbildare utforskar den egna undervisningspraktiken2025Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The dissertation aims to explore the conditions that fosters change in the teaching approach to friluftsliv in Physical Education Teacher Education (PETE). These conditions pertain to how teaching to teach friluftsliv can be improved to better support students in teaching friluftsliv in their future professional work as physical education (PE) teachers in schools. The study utilizes action research and the Theory of Practice Architectures (TPA) to enhance friluftsliv teaching in PETE. Conducted from 2020 to 2022, the action research project generated empirical data from focus group discussions, a research diary, and notes taken during teaching sessions and workshops, all aimed at fostering conversations about friluftsliv teaching in diverse outdoor settings. The action research process focuses on dialogue and reflection to drive change based on participants' insights.

    The theory of practice architectures offers a framework to understand practices through their sayings, doings, and relatings within social contexts, examining the cultural-discursive, material-economic, and social-political arrangements that shape practices. The concept of ecology of practices places the local improvement project in a broader context.

    Key findings emphasize the importance of time, trust, and ethical considerations in facilitating project engagement and development. The project fostered reflective practices among teacher educators, leading to deeper didactic understanding and revitalizing the integration of local environments into teaching. The study identifies six key arrangements that shape the practice architecture of friluftsliv, with reflective practice and communicative spaces being particularly influential.

    This dissertation concludes that local conditions for friluftsliv should play a more significant role in the educational content of PETE. It emphasizes the need to highlight both general aspects of friluftsliv and local conditions to transform the subject into a heterogeneous school practice. Experiences in, about, and through friluftsliv can support students in making informed didactic choices as future teachers. Creating a supportive learning environment where future teachers can grow personally and professionally is crucial. Teacher educators are pivotal in this process, fostering critical reflection on what it means to teach friluftsliv. The study shows that even if arrangements in friluftsliv practice architecture cannot be changed, itis movable and there are ways to create room for action and drive improvement in teaching. The dissertation contributes to understanding how development work can be implemented in teacher education and highlights the importance of critically examining teaching practices. The study calls for continued efforts in development work and discussions on teaching friluftsliv, especially in the context of urbanization and digitalization, where well-trained teachers are essential for fostering interest in nature-based learning.

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  • Public defence: 2025-02-14 09:15 KL:2370, Malmö
    Oghli, Ibrahim
    Malmö University, Faculty of Odontology (OD). Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Taibah, Saudi Arabia.
    Jaw Function and Oral Health-Related Quality of Life: Relation between Temporomandibular Disorders and other Oral Conditions2025Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The focus of this thesis was two major patient-reported outcomes: quality of life and jaw function. Different study designs were used to examine the prevalence, impact, and predictive factors of orofacial conditions, with a focus on temporomandibular disorders (TMD) and their effects on oral health-related quality of life (OHRQoL). The findings in the different parts of the thesis provide a comprehensive understanding of the burden these conditions reflect on individuals, particularly when they occur in combination. 

    Orofacial conditions such as TMD, burning mouth syndrome (BMS), dry mouth, and bad breath were found to be prevalent in the Swedish adult population, with bad breath being the most commonly self-reported condition. Notably, individuals experiencing multiple conditions, which affected more than a quarter of the population surveyed, demonstrated significantly higher impairments in OHRQoL, illustrating the compounded negative effects of comorbid conditions. TMD and BMS, in particular, were associated with the most substantial impact on quality of life, emphasizing the difference between painful and non-painful conditions. 

    Limitations in jaw function, another key focus, were generally low among the Swedish adult population. However, age and the presence of dental prostheses were identified as significant predictors of increased limitations. This highlights the importance of considering both demographic and dental factors when evaluating jaw function. The study also established normative values for jaw function, offering a benchmark for clinical assessment of orofacial dysfunction. A score of 28 or higher on the Jaw Functional Limitation Scale was found to have clinical significance. 

    In terms of orofacial pain conditions, including TMD, odontogenic pain, oral mucosal pain, and pain following third molar extractions, were all found to have a moderate impact on the pain dimension of OHRQoL. The highest burden was observed in patients with pain after 3rd molar extraction, although all four pain conditions resulted in a notable reduction in quality of life. This standardized understanding of the pain-related impact on OHRQoL provides critical insight for clinicians managing patients with various orofacial pain syndromes. 

    Longitudinal analysis of TMD patients revealed that the physical component of health-related quality of life (HRQoL) over time is significantly predicted by baseline factors such as age, general health, and jaw function. Older age and poor general health were associated with worse physical HRQoL in painful TMD cases, whereas impaired jaw function was particularly relevant in non-painful TMD cases. Interestingly, no significant predictive factors were identified for the mental component of HRQoL, suggesting the need for further research into the psychological dimensions of TMD and other orofacial conditions. 

    Overall, this thesis provides evidence that orofacial conditions, particularly TMD, have a significant and multidimensional impact on both oral and general quality of life. By integrating cross-sectional and longitudinal data, this work offers valuable insights into the epidemiology, functional consequences, and long-term predictors of quality of life in individuals with orofacial conditions. 

    List of papers
    1. Prevalence and oral health-related quality of life of self-reported orofacial conditions in Sweden
    Open this publication in new window or tab >>Prevalence and oral health-related quality of life of self-reported orofacial conditions in Sweden
    2017 (English)In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 23, no 2, p. 233-240Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To (i) determine the prevalences of self-report in a Swedish adult population, of temporomandibular disorders, burning mouth syndrome, dry mouth, and bad breath and (ii) determine oral health-related quality-of-life impairment in subjects reporting these conditions.

    Subjects and methods: A cross-sectional, randomized sample of the adult Swedish population (response rate: 46%, N = 1309 subjects) self-reported their condition from the preceding month to assess prevalences of self-report for the studied conditions together with comorbidity group of subjects who reported more than one condition. The 49-item Oral Health Impact Profile (OHIP) used to assess oral health-related quality of life.

    Results: The most prevalent condition was bad breath (39%), followed by dry mouth (22%), temporomandibular disorders (18%) and burning mouth syndrome (4%). High comorbidity of conditions occurred in 27% of the population. Quality-of-life impairment increased with the number of comorbid conditions. Among individual conditions, burning mouth syndrome and temporomandibular disorders (57% and 40% OHIP points) presented higher impairment than dry mouth and bad breath (32% and 26% OHIP points).

    Conclusions: Orofacial conditions were common and often coexist. The comorbidity group experienced the highest impact on oral health-related quality of life: the more the comorbid conditions, the greater the negative impact.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2017
    Keywords
    public health, diseases, pain, quality of life, orofacial pain
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-15761 (URN)10.1111/odi.12600 (DOI)000394908900013 ()27770603 (PubMedID)2-s2.0-85007379705 (Scopus ID)23583 (Local ID)23583 (Archive number)23583 (OAI)
    Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2025-01-24Bibliographically approved
    2. Prevalence and normative values for Jaw Functional Limitations in the general population in Sweden
    Open this publication in new window or tab >>Prevalence and normative values for Jaw Functional Limitations in the general population in Sweden
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    2019 (English)In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 25, no 2, p. 580-587Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: For jaw functional limitations measured by the Jaw Functional Limitation Scale (JFLS), (a) determining prevalence in the Swedish general adult population, (b) investigating the influence of demographic factors and self-reported dental status and (c) deriving normative values. METHODS: A random sample of the general adult population in Sweden was approached (response rate: 46%, N = 1,372). Prevalence was determined for the JFLS summary score and individual items. The influence of age, gender and dental status was investigated with regression analyses and normative values presented. RESULTS: The JFLS median score was 0, and all items had prevalences ≤30%. Age and gender did not influence jaw functional limitations but dental status did. Normative JFLS scores were 1, 9 and 28 for the 7th, 8th and 9th deciles, respectively. In dental status-stratified norms, 9th deciles were 20, 43 and 100, for subjects with natural teeth only, removable and complete dentures, respectively. CONCLUSIONS: The Swedish general adult population had excellent jaw function, but dental status was major determinant. In the absence of information linking JFLS scores to important patient concerns, the score distribution can serve as a reference with the 9th decile as threshold for functional limitation.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2019
    Keywords
    dental diseases, epidemiology, jaw function, normative values, pain, public health
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-15495 (URN)10.1111/odi.13004 (DOI)000458899300025 ()30447172 (PubMedID)2-s2.0-85058043486 (Scopus ID)27086 (Local ID)27086 (Archive number)27086 (OAI)
    Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2025-01-22Bibliographically approved
    3. The Impact of Orofacial Pain Conditions on Oral Health Related Quality of Life: A Systematic Review
    Open this publication in new window or tab >>The Impact of Orofacial Pain Conditions on Oral Health Related Quality of Life: A Systematic Review
    2020 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 47, no 8, p. 1052-1064Article in journal (Refereed) Published
    Abstract [en]

    Pain in the orofacial region is one of the most common reasons for patients to seek dental treatment. Oral health related quality of life (OHRQoL) can be affected not only by pain, but also by other oral disorders. Four main dimensions, Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact, have been suggested to cover different areas of OHRQoL. The aim of this systematic review was to map the impact of orofacial pain conditions on the Orofacial Pain dimension of OHRQoL (PROSPERO registration: CRD42017064033). Studies were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with odontogenic pain, oral mucosal pain/Burning Mouth Syndrome (BMS), third molar extractions or temporomandibular disorders (TMD). A search in PubMed (Medline), EMBASE, Cochrane, CINAHL, and PsycINFO on June 8, 2017, updated January 14, 2019, combined with a hand search identified 2,104 articles. After screening of abstracts 1,607 articles were reviewed in full text and 36 articles were included that reported OHIP-data for 44 patient populations including 5,849 patients. Typical Orofacial Pain impact for all four conditions (odontogenic pain, oral mucosal pain/BMS, pain after third molar extractions and TMD) was between 2 and 3 on a 0-8 converted OHIP-scale with the highest reported impact for pain after 3rd molar extractions. This review provides standardized information about OHRQoL impact from four orofacial pain conditions as a model for the Orofacial Pain dimension. The results show moderate impact for the pain dimension of OHRQoL in patients with common orofacial pain conditions.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2020
    Keywords
    Burning Mouth Syndrome, Temporomandibular Disorders, facial pain, oral health, patient reported outcomes, quality of life
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-17340 (URN)10.1111/joor.12994 (DOI)000545120000001 ()32415993 (PubMedID)2-s2.0-85087456351 (Scopus ID)
    Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2025-01-22Bibliographically approved
    4. [Paper IV]
    Open this publication in new window or tab >>[Paper IV]
    (English)Manuscript (preprint) (Other academic)
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-73178 (URN)
    Available from: 2025-01-22 Created: 2025-01-22 Last updated: 2025-01-22Bibliographically approved
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  • Public defence: 2025-02-21 09:15 Allmänna sjukhuset, aulan (AS:E002), Malmö
    Dao Nyesiga, Gillian
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Immune tolerance: induction and disruption for therapeutic immune modulation2025Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This study investigated the tolerance induction and disruption of immune tolerance as strategies for immune modulation.

    For induction of immune tolerance, novel monocyte-derived tolerogenic dendritic cells (ItolDCs) were generated, and their ability to modulate the immune system was assessed using in vitro assays in hemophilia A patients who had developed neutralizing antibodies against their factor VIII replacement therapy. The cells were characterized, their functionality was assessed, and their feasibility as a safe cell therapy was further evaluated using both in vitro and in vivo studies for the induction of immune tolerance against factor VIII.

    For research on disruption of immune tolerance, meningioma, the most common brain tumor, was studied. To map the immune cell composition in meningiomas, a protocol was optimized for shorter enzymatic digestion, which breaks down the tissue into single-cell suspensions of viable immune cells. Since CD8+ T cells are vital in tumor suppression, further studies were conducted to explore their characteristics and identify possible targetable processes for immunotherapy.

    To investigate both induction and disruption of immune tolerance, various techniques were employed, including flow cytometry, immunohistochemistry, and functional-cell-based assays.

    Our investigation demonstrated that ItolDCs are a feasible and safe option for cell therapy aimed at inducing immune tolerance. Thus, factor VIII-loaded ItolDCs are ready for clinical evaluation to reduce inhibitor levels in patients with hemophilia A.

    Several tolerance-associated markers (PD-1, TIM-3, TIGIT, and LAG-3) were identified in CD8+ T cells in meningioma. These findings highlight how tumor cells may evade immune defenses and suggest potential immunotherapeutic targets, including immune checkpoint inhibitors.

    Taken together, various approaches may be employed for immune modulations to either induce or disrupt immune tolerance.

    List of papers
    1. Tolerogenic dendritic cells generated in vitro using a novel protocol mimicking mucosal tolerance mechanisms represent a potential therapeutic cell platform for induction of immune tolerance.
    Open this publication in new window or tab >>Tolerogenic dendritic cells generated in vitro using a novel protocol mimicking mucosal tolerance mechanisms represent a potential therapeutic cell platform for induction of immune tolerance.
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    2023 (English)In: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 14, article id 1045183Article in journal (Refereed) Published
    Abstract [en]

    Dendritic cells (DCs) are mediators between innate and adaptive immunity and vital in initiating and modulating antigen-specific immune responses. The most important site for induction of tolerance is the gut mucosa, where TGF-β, retinoic acid, and aryl hydrocarbon receptors collaborate in DCs to induce a tolerogenic phenotype. To mimic this, a novel combination of compounds – the synthetic aryl hydrocarbon receptor (AhR) agonist IGN-512 together with TGF-β and retinoic acid – was developed to create a platform technology for induction of tolerogenic DCs intended for treatment of several conditions caused by unwanted immune activation. These in vitro-generated cells, designated ItolDCs, are phenotypically characterized by their low expression of co-stimulatory and activating molecules along with high expression of tolerance-associated markers such as ILT3, CD103, and LAP, and a weak pro-inflammatory cytokine profile. When co-cultured with T cells and/or B cells, ItolDC-cultures contain higher frequencies of CD25+Foxp3+ regulatory T cells (Tregs), CD49b+LAG3+ ‘type 1 regulatory (Tr1) T cells, and IL-10-producing B cells and are less T cell stimulatory compared to cultures with matured DCs. Factor VIII (FVIII) and tetanus toxoid (TT) were used as model antigens to study ItolDC antigen-loading. ItolDCs can take up FVIII, process, and present FVIII peptides on HLA-DR. By loading both ItolDCs and mDCs with TT, antigen-specific T cell proliferation was observed. Cryo-preserved ItolDCs showed a stable tolerogenic phenotype that was maintained after stimulation with LPS, CD40L, or a pro-inflammatory cocktail. Moreover, exposure to other immune cells did not negatively impact ItolDCs’ expression of tolerogenic markers. In summary, a novel protocol was developed supporting the generation of a stable population of human DCs in vitro that exhibited a tolerogenic phenotype with an ability to increase proportions of induced regulatory T and B cells in mixed cultures. This protocol has the potential to constitute the base of a tolDC platform for inducing antigen-specific tolerance in disorders caused by undesired antigen-specific immune cell activation.

    Place, publisher, year, edition, pages
    Frontiers Media S.A., 2023
    Keywords
    antigen loading, antigen-specific response, cell therapy, immune tolerance, regulatory B cells (Bregs), regulatory T cells (Tregs), tolerogenic dendritic cells (tolDCs)
    National Category
    Immunology in the medical area
    Identifiers
    urn:nbn:se:mau:diva-63661 (URN)10.3389/fimmu.2023.1045183 (DOI)001092545900001 ()37901231 (PubMedID)2-s2.0-85175369630 (Scopus ID)
    Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2025-01-28Bibliographically approved
    2. Pre-Clinical Safety Evaluation of an Autologous Tolerogenic DendriticCell Therapy for Patients with Hemophilia A with Inhibitory Antibodies
    Open this publication in new window or tab >>Pre-Clinical Safety Evaluation of an Autologous Tolerogenic DendriticCell Therapy for Patients with Hemophilia A with Inhibitory Antibodies
    (English)Manuscript (preprint) (Other academic)
    National Category
    Biomedical Laboratory Science/Technology
    Identifiers
    urn:nbn:se:mau:diva-73385 (URN)
    Available from: 2025-01-28 Created: 2025-01-28 Last updated: 2025-01-28Bibliographically approved
    3. Flow Cytometry Analyses of Meningioma Immune Cell Composition Using a Short, Optimized Digestion Protocol
    Open this publication in new window or tab >>Flow Cytometry Analyses of Meningioma Immune Cell Composition Using a Short, Optimized Digestion Protocol
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    2024 (English)In: Cancers, ISSN 2072-6694, Vol. 16, no 23, article id 3942Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Current challenges in meningioma treatment, including post-surgical complications and cognitive impairments, highlight the need for new treatment alternatives. Immunological interventions have shown promise. However, there is a knowledge gap in characterizing infiltrating immune cells in meningioma and their interplay. Further studies on immune cells in single-cell suspensions from digested meningioma tissues could identify targetable mechanisms for non-surgical treatment options with fewer side effects. This study aimed to optimize a protocol for faster digestion of meningioma tissues into viable single-cell suspensions and to identify infiltrating immune cell populations.

    METHODS: We modified a commercial kit intended for whole skin dissociation to digest resected meningioma tissues into viable single-cell suspensions. Tumor-infiltrating immune cell populations were characterized using flow cytometry.

    RESULTS: , with a small proportion co-expressing CD83. Women were more likely to have a lower proportion of immune cells, B cells, and NK cells. Female patients with a high proportion of immune cells had a higher proportion of macrophages.

    CONCLUSION: We successfully optimized a protocol for generating single-cell suspensions with viable immune cells from meningioma tissues, revealing infiltrating antigen-presenting cells with an immunosuppressive phenotype, and lymphocytes. This short protocol allows advanced analyses of tumor-infiltrating cells using techniques such as single-cell RNA sequencing and flow cytometry, which require live, dissociated cells.

    Place, publisher, year, edition, pages
    MDPI, 2024
    Keywords
    T cells, TIM-3, brain tumor, immune cells, lymphocytes, macrophages, meningioma, single-cell suspension, tumor digestion, tumor-infiltrating cells
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:mau:diva-72847 (URN)10.3390/cancers16233942 (DOI)001376117400001 ()39682129 (PubMedID)2-s2.0-85211949815 (Scopus ID)
    Available from: 2024-12-20 Created: 2024-12-20 Last updated: 2025-01-28Bibliographically approved
    4. Evaluating CD8+ T Cell Immune Dynamics in Meningioma: A Comprehensive Study of Inhibitory Molecules, Cytokines, and Proliferation
    Open this publication in new window or tab >>Evaluating CD8+ T Cell Immune Dynamics in Meningioma: A Comprehensive Study of Inhibitory Molecules, Cytokines, and Proliferation
    (English)Manuscript (preprint) (Other academic)
    National Category
    Biomedical Laboratory Science/Technology
    Identifiers
    urn:nbn:se:mau:diva-73387 (URN)
    Available from: 2025-01-28 Created: 2025-01-28 Last updated: 2025-01-29Bibliographically approved
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