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Background Few studies have examined health related Quality of Life (HR-QoL) during the treatment of head and neck cancer (HNC) with even fewer focusing on the impact of oral mucositis (OM) on HR-QoL. Studies performed during treatment of HNC makes it possible to follow fluctuations in HR-QoL, OM and other treatment related side effects. The aim was to prospectively analyze HR-QoL, changes in clinical variables and the impact of OM on HR-QoL during HNC treatment. Materials and methods Patients were recruited before commencing curative cancer treatment and were given professional oral care weekly during oncologic treatment. HR-QoL was reported before, during (week 2, 4 and 6) and three months after treatment using the EORTC Quality of Life questionnaires C30 and H&N35 and the stimulated whole salivary secretion rate was determined at the same time-points. OM (erythema and ulceration) was registered using the Oral Mucositis Assessment Scale (OMAS), at baseline, weekly during treatment and post treatment. Differences in HR-QoL between different timepoints were analyzed. To analyze the impact of OM on HR-QoL the patients were categorized into two groups: no/mild OM (OMAS ulceration score 0–1) or severe OM (OMAS ulceration score ≥ 2) and HR-QoL was compared between the two OM groups at three timepoints during treatment. Results Fifty-seven patients (43 men, 14 women), with a mean age of 58 years were included. Patients reported progressively impaired HR-QoL, with peak issues noted at weeks 4 and 6, particularly in social eating, senses, appetite loss, sticky saliva, and decreasing salivary secretion rates were determined. Patients with severe OM reported worse HR-QoL compared to those with no/mild OM. Persistent problems 3 months post treatment were appetite loss, dry mouth, senses (smell and taste) and problems with social eating. Conclusion Patients experienced exacerbated symptoms and problems weeks 4 and 6 of oncological treatment, especially among those with severe OM, stressing the importance of clinically monitoring the patients to reduce and alleviate their symptoms. Persistent problems three months post treatment are likely associated with the reduced salivary secretion rate indicating that patients should be monitored also after completed oncological treatment.

ObjectivesThe present retrospective registry-based cohort study aimed to identify parameters associated with the onset of periodontitis in young adults.Material and methodsA total of 345 Swedish subjects were clinically examined at age 19 years (as part of an epidemiological survey) and then followed up to 31 years through the Swedish Quality Registry for Caries and Periodontal diseases (SKaPa). The registry data including periodontal parameters were obtained for the period 2010–2018 (23–31 years). Logistic regression and survival models were used to identify risk factors for periodontitis (PPD ≥6 mm at ≥2 teeth).ResultsThe incidence of periodontitis during the 12-year observation period was 9.8%. Cigarette smoking (modified pack-years; HR 2.35, 95%CI 1.34–4.13) and increased probing pocket depth (number of sites with PPD 4–5 mm; HR 1.04, 95%CI 1.01–1.07) at 19 years were risk factors for periodontitis in subsequent young adulthood. No statistically significant association was identified for gender, snuff use, plaque and marginal bleeding scores.ConclusionCigarette smoking and increased probing pocket depth (≥4 mm) in late adolescence (19 years) were relevant risk factors for periodontitis in young adulthood.Clinical relevanceOur study identified cigarette smoking and increased probing depth in late adolescence as relevant risk factors of periodontitis in young adulthood. Preventive programs should therefore consider both cigarette smoking and probing pocket depths in their risk assessment.

This retrospective registry study aimed to identify psychosocial and behavioral predictors of oral health in young adulthood. A total of 335 Swedish individuals who completed questionnaires pertaining to oral health-related attitudes, perceptions, and behaviors at 19 years, were followed through young adulthood (23-31 years) using registry data. Information on missing, decayed/filled teeth, periodontal status, and self-assessed (SA) oral health scores was retrieved. Predictors of professionally-assessed (PA) and SA oral health were explored using regression analyses. Considering oral health to be very important at 19 years was a predictor for good PA oral health in young adulthood (odds ratio [OR] 3.2, 95% CI 1.1, 9.4). Females (risk ratio [RR] 4.1, 95% CI 1.8, 9.4) and those reporting taking very good care of their teeth (RR 2.5, 95% CI 1.2, 5.3) were more likely to later report very good SA oral health. Smoking increased the risk for poor-very poor SA oral health (RR 5.1, 95% CI 1.9, 13.8). Few participants brushed infrequently at 19 years and they were polarized in their later SA oral health scores. A positive attitude towards oral health at age 19 years was associated with good PA oral health in young adulthood, whereas gender, smoking, toothbrushing frequency, and the perceived quality of own dental care were predictors of subsequent SA oral health.

To explore self-perceived oral health and general self-efficacy and relate this to dental plaque, gingival inflammation, and oral mucositis in head and neck cancer patients in Sweden, before, during, and three months after treatment. Registration of clinical variables (dental plaque, gingival inflammation, and oral mucositis) was performed in 75 patients. The patients completed the self-perceived oral health (SPOH), and general self-efficacy (GSE) questionnaires at baseline, week 6 during treatment, and 3 months after treatment. Changes in clinical variables and answers to questionnaires between time-points were analyzed as well as differences between clinical variables and questionnaire data. The majority had low levels of plaque and gingival inflammation at all time-points, and oral mucositis occurred in 82%. Forty-three percent perceived their oral health as good at baseline, and the proportion decreased to 18% at week 6. At baseline, toothbrushing twice a day was reported by 95%, and daily interdental cleaning by 51%. The majority had high self-efficacy at all time-points. No statistically significant differences between self-perceived oral health and clinical variables were found. Despite major challenges during cancer treatment, most patients had good oral hygiene, perceived their oral health as good, and had high self-efficacy. This study contributes to increased knowledge about HNC patients' self-perceived oral health and ability to maintain good oral hygiene during cancer treatment. Such knowledge can be used in the development of customized oral care protocols, which in turn may have a positive impact on both oral health and quality of life.

Background Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. Methods A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. Results Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well‐being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. Conclusions The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. Patient and Public Contribution The current study involved stakeholders including a service user organization, the public, first‐line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.

Objective To investigate current odontological care routines for patients treated for head and neck cancers in the county councils/regions (C/Rs) of Sweden. Methods An invitation to fill in a web‐based questionnaire was sent to dentists/dental hygienists working in dental clinics in the 12 C/Rs, treating and responsible for the odontological care of patients undergoing treatment for cancer of the head and neck. The questionnaire started with two mandatory and one non‐mandatory questions, followed by questions regarding routines before (n = 28), during (n = 23), and after (n = 9) treatment, plus two additional questions, totalling 65 questions. Results Four dental hygienists and six dentists in 10 of the 12 C/Rs answered the questionnaire. Three C/Rs stated that they measure both the unstimulated and stimulated salivary secretion rate, and another C/R stated that they measure the stimulated secretion rate only. Similar recommendations were given regarding oral hygiene, salivary stimulants and substitutes, and extra fluoride. However, great variations were seen regarding recommendations for preventing and relieving oral mucositis. There were also discrepancies regarding information about the importance of avoiding smoking and alcohol. In seven C/Rs, patients visited the dental hygienist once a week during cancer treatment. Conclusion The results suggests that there are great variations in odontological care given to patients undergoing treatment for cancer of the head and neck region in different county councils/regions in Sweden. There is a need to develop and implement evidence‐based guidelines to decrease the risk of oral complications and increase both the quality of life and the quality of care.

Pathway specificity is poorly understood for mitogen‐activated protein kinase (MAPK) cascades that control different outputs in response to different stimuli. In yeast, it is not known how the same MAPK cascade activates Kss1 MAPK to promote invasive growth (IG) and proliferation, and both Fus3 and Kss1 MAPKs to promote mating. Previous work has suggested that the Kss1 MAPK cascade is activated independently of the mating G protein (Ste4)–scaffold (Ste5) system during IG. Here we demonstrate that Ste4 and Ste5 activate Kss1 during IG and in response to multiple stimuli including butanol. Ste5 activates Kss1 by generating a pool of active MAPKKK (Ste11), whereas additional scaffolding is needed to activate Fus3. Scaffold‐independent activation of Kss1 can occur at multiple steps in the pathway, whereas Fus3 is strictly dependent on the scaffold. Pathway specificity is linked to Kss1 immunity to a MAPK phosphatase that constitutively inhibits basal activation of Fus3 and blocks activation of the mating pathway. These findings reveal the versatility of scaffolds and how a single MAPK cascade mediates different outputs.

Ribonucleotide reductases catalyze the reduction of ribonudeotides to deoxyribonucleotides. Three classes have been identified, ail using free-radical chemistry but based on different cofactors. Classes I and II have been shown to be evolutionarily related, whereas the origin of anaerobic class III has remained elusive. The structure of a class III enzyme suggests a common origin for the three classes but shows differences in the active site that can be understood on the basis of the radical-initiation system and source of reductive electrons, as well as a unique protein glycyl radical site. A possible evolutionary relationship between early deoxyribonudeotide metabolism and primary anaerobic metabolism is suggested.

Alcoholics often develop personality and behavioural changes, social and personal neglect, confabulation, lack of insight, empathy and emotional control. Such symptoms would increase the risk of engagement in and exposure to acts of violence and criminal activities carrying a risk of physical damage including head trauma and violent death. This was the case in at least 4 of the studied cases. A structural basis for such frontal lobe symptoms was looked for in a forensic material of 18 alcoholics, compared with an age-matched control group with regard to liver disease, brain changes of the Wernicke-Korsakoff type and cortical, especially frontal cortical changes. The salient finding was a consistent pattern of synapse loss in the superior laminae of the frontal cortical area 10 of Brodman in heavy drinkers, not related to liver disease or possible previous mental disease. The synapse loss is more likely related to alcohol, possibly mediated through vitamin B deficiency. Brain stem lesions as a source of additional symptoms cannot be dismissed. This pattern of synapse loss in alcoholism has not been described previously. The cortical changes are closely similar to those found in frontotemporal dementia, and seem to be a plausible main cause of the alcoholic frontal symptomatology and alcoholic dementia.

Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice. In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints—measured at 1 year—were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857. 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (difference in change 10·4%, 95% CI −0·3 to 21·2, p=0·06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17·3%, 6·4 to 28·2, p=0·009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37·3%, 18·1 to 56·5, p=0·004), and oily fish (156 [17%] vs 81 [8%]; 8·9%, 0·3 to 17·5, p=0·04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0·005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10·4%, 0·6 to 20·2, p=0·04) and high-risk (586 [58%] vs 407 [41%]; 16·9%, 2·0 to 31·8, p=0·03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not differ between groups, but in high-risk patients the difference in change from baseline to 1 year was 12·7% (2·4 to 23·0, p=0·02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6·0%, −0·5 to 11·5, p=0·04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8·5%, 1·8 to 15·2, p=0·02) and statins (381 [37%] INT vs 232 [22%] UC; 14·6%, 2·5 to 26·7, p=0·03) were more frequently prescribed. To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients. European Society of Cardiology through an unconditional educational grant from AstraZeneca.