To Örebro University

Background: Various forms and types of knowledge have enjoyed legitimacy in physical education (PE) since sports techniques became the orienting idea for PE in economically advanced countries in the mid-twentieth century. The forms and types of knowledge granted legitimacy at any one moment are dependent on a range of socio-discursive factors. In this paper, we consider ball games knowledge within the Swedish PE teacher education context in the 2020s.

Purpose: The specific aim of the paper is to generate insights into how ball games experts within PE teacher education define legitimate ball games knowledge. Our proposition is that by examining the ways these experts define ball games knowledge, physical education teacher educators may develop more nuanced understandings of how and why knowledge comes to be seen as legitimate.

Methods: In order to conceptualize experts' knowledge of ball games, Shulman's concepts of content knowledge (CK) and pedagogical content knowledge (PCK) were employed. Semi-structured interviews were conducted with two teacher educators who specialized in ball games education from three different PETE institutions in Sweden (n = 6). The interviews focused on the PETE educators' understandings of ball games and how they prepared preservice teachers to teach ball games.

Findings: The PETE educators defined ball games CK as: (1) understanding of games as a cultural phenomenon, (2) tactical understanding of games, and (3) embodied understanding of how to play ball games. The PETE educators defined ball games PCK as: (1) using ball games to meet different curricular goals, (2) focusing on tactical understanding with a small number of concepts, (3) adapting teaching so that all pupils are included, and (4) managing competition.

Conclusions: Four issues related to the legitimacy of this knowledge are raised. The issues concern the ways in which: (1) a complementary sport discourse is permeated by educational discourse to achieve legitimacy; (2) CK and PCK are designed to achieve legitimacy with different stakeholders; (3) public health discourse is not used to develop legitimacy for ball games knowledge, and (4) historical factors continue to affect experts' understandings of ball games. The central conclusion drawn from the investigation is that ball games experts engage in a complex process of discursive negotiation when defining the knowledge with which they work.

Scholars have long questioned the impact of teacher education programmes. Persistent claims are that pre-service teachers have fixed ideas about pedagogy when they enter training and that they become enculturated once in the profession. Within physical education (PE), similar concerns have been raised with respect to ball games. Research suggests that pre-service PE teachers typically have substantial experience of ball sports and find it difficult to implement non-traditional ball games pedagogies when they enter schools. Against this background, the aim of the study is to explore how pre-service teachers recontextualise ball games as pedagogic discourse in their transitions from university to school placement. Bernstein's pedagogic device and pedagogic discourse are employed as the theoretical framework. The investigation focuses on a Swedish PETE programme and the participants are six pre-service teachers. The empirical material consists of written assessments, observations of the pre-service teachers' lessons during school placements, and individual interviews. Findings suggest that the pedagogic discourse of ball games at the university was aligned with course learning outcomes and included the need to communicate goals, adapt and modify teaching, and combine different approaches. The pedagogic discourse at school placement involved traditional ball games, minimal curriculum references, progression in two or three lessons, and inclusive, enjoyable lessons. Factors that regulated the discourse were: familiarity with the pupils; the conceptualizing of inclusive teaching; norms regarding ball games in PE; expectations of the pre-service teachers; and the framing of ball games education in PETE. Recontextualising rules highlight challenges in transitions related to ball games.

Teaching approaches in ball games in school physical education (PE) have traditionally focused on technical proficiency. Technical approaches have been criticised for being teacher-centred, exclusive, and lacking meaning. Game-based approaches (GBAs) have been presented as an alternative way to teach ball games. Employing GBAs is, however, not without challenges. Scholars have pointed to teachers' limited content knowledge of games, their poor understanding of GBAs, and cultural expectations of ball games as factors that constrain teachers' work with GBAs. The aim of this article is to provide an understanding of how beginning teachers describe ball games as a pedagogic practice in Swedish PE. Semi-structured interviews were conducted with 12 beginning teachers who had graduated from two physical education teacher education (PETE) institutions. Bernstein's concepts of classification and framing were used to analyse the teachers' descriptions of pedagogic practice. The findings illustrate how the classification of ball games knowledge varies. Some of the beginning teachers aimed to develop pupils' understanding of games while others instead used ball games as a means for developing general movement capability or cooperation. Ball games teaching was characterised by a combination of GBAs and technical approaches. The influence of competitive sport outside of school was seen as a challenge, and the beginning teachers used strong framing and different teaching strategies combined with assessment to manage this challenge. The findings raise questions about ball games education in PETE in relation to specific national contexts.

BACKGROUND: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.

METHODS AND FINDINGS: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79-0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75-0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85-0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20-0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93-0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97-0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29-1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05-1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.

CONCLUSIONS: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.

BACKGROUND: Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse.

OBJECTIVES: To identify possible risk factors for T2D relapse in patients who initially experienced remission.

SETTING: Nationwide, registry-based study.

METHODS: We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m² who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication.

RESULTS: In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates.

CONCLUSION: Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.

BACKGROUND: Symptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability.

METHODS: The study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test-retest methods.

RESULTS: A total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach's alpha coefficient of 0.82, and very good agreement in terms of test-retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88-0.93). The items related to hypoglycemia yielded a good Cronbach's alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85-0.91).

CONCLUSION: The DSS-Swe questionnaire shows good reliability regarding both internal consistency and test-retest performance for use in Swedish populations.

Dumping and post-bariatric hypoglycaemia (PBH) are side effects that occur after bariatric surgery. The aim of this study was to estimate the prevalence of dumping and PBH symptoms before Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) at 6 months, 1 year, 2 years and 5 years after surgery in a Swedish population. A cross-sectional single-centre study was performed at Lindesberg Hospital, Region Örebro County, Sweden, between 2020 and 2023. The Swedish version of the Dumping Severity Scale (DSS-Swe) questionnaire, which includes eight items regarding dumping symptoms and six items regarding hypoglycaemia symptoms, was used. A total of 742 DSS-Swe questionnaires were included. The average age at surgery was 42.0 years (standard deviation [SD] = 11.9), and the average body mass index was 41.8 kg/m2 (SD = 5.9). The surgical methods consisted of RYGB (66.3%) and SG (33.7%). The proportion of RYGB patients with highly suspected dumping increased from 4.9% before surgery to 26.3% (adjusted odds ratio [OR] = 7.35, 95% confidence interval [CI] = 3.08-17.52) at the 5-year follow-up. PBH symptoms increased from 1.4% before surgery to 19.3% at the 5-year follow-up (adjusted OR = 17.88, 95% CI = 4.07-78.54). For SG patients, no significant increase in dumping or PBH symptoms was observed. In patients with persistent type 2 diabetes (T2D), there were no cases of highly suspected hypoglycaemia following RYGB or SG. Symptoms of dumping and PBH were common after RYGB, while no clear increase was observed after SG. Persistent T2D seems to be a protective factor against PBH symptoms.

Biocide resistance poses a significant challenge in industrial processes, with bacteria like Pseudomonas oleovorans exhibiting intrinsic resistance to traditional antimicrobial agents. In this study, the impact of biocide exposure on the metabolome of two P. oleovorans strains, namely, P. oleovorans P4A, isolated from contaminated coating material, and P. oleovorans 1045 reference strain, were investigated. The strains were exposed to 2-Methylisothiazol-3(2H)-one (MI) MIT, 1,2-Benzisothiazol-3(2H)-one (BIT), and 5-chloro-2-methyl-isothiazol-3-one (CMIT) at two different sub-inhibitory concentrations and the lipids and polar and semipolar metabolites were analyzed by ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry UPLC-Q-TOF/MS. Exposure to the BIT biocide induced significant metabolic modifications in P. oleovorans. Notable changes were observed in lipid and metabolite profiles, particularly in phospholipids, amino acid metabolism, and pathways related to stress response and adaptation. The 1045 strain showed more pronounced metabolic alterations than the P4A strain, suggesting potential implications for lipid, amino acid metabolism, energy metabolism, and stress adaptation. Improving our understanding of how different substances interact with bacteria is crucial for making antimicrobial chemicals more effective and addressing the challenges of resistance. We observed that different biocides trigged significantly different metabolic responses in these strains. Our study shows that metabolomics can be used as a tool for the investigation of metabolic mechanisms underlying biocide resistance, and thus in the development of targeted biocides. This in turn can have implications in combating biocide resistance in bacteria such as P. oleovorans.