Micronutrients and bioactive compounds in oral inflammatory diseases

Oral disorders are a significant public health concern. Oral inflammatory diseases are periodontal infections, oral mucosal lesions, pulpal and periapical lesions. The aetiology is multi-factorial and usually associated with a microbial origin, often driven by the overconsumption of free sugars. However, the role of micronutrients in these processes is now becoming apparent. Most of these studies have emphasised on systemic inflammation, but now the trends have shifted towards the role of micronutrients in oral inflammation. The progression of periodontal disease and healing of the periodontal tissues can be modulated by nutritional status. There are numerous degenerative changes in oral mucosa which have been observed during specific micronutrient deficiencies. Recent studies have advocated the use of dietary supplementation of particular micronutrients to treat the oral inflammatory lesions along with their standard treatment procedures. The micronutrient supplementation can be orally administered or locally delivered. Previously reviewed articles usually lacked compiled information regarding all oral inflammatory diseases. The current review provides an insight into the role of nutrition in oral inflammatory diseases, including periodontal disorders, oral mucosal lesions, pulpal and periapical lesions

Using digital health technologies to monitor pain, medication adherence and physical activity in young people with Juvenile Idiopathic

Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XJuvenile Idiopathic Arthritis can be influenced by pain, medication adherence and physi- 20 cal activity. A new digital health intervention InteractiveClinics, aims to monitor these modifiable 21 risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smart watch to 22 record their pain level and take their medications, using a customized mobile app, synchronized to 23 a secure web-based platform. Daily physical activity levels were automatically recorded by wearing 24 a smart watch. Using a quantitative descriptive research design, feasibility and user adoption was 25 evaluated. Web-based data revealed: pain mean app usage, 68% (SD 30, range 28.6% to 100%), pain 26 score 2.9 out of ten (SD 1.8, range 0.3 to 6.2 out of 10). Medication adherence; mean app usage 20.7% 27 (SD, range 0% to 71.4%), recording 39% (71/182) of the expected daily, and 37.5% (3/8) of the weekly 28 medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), 1 to 6 additional medications 29 (mean 3.5, SD 2.4) for 2-6 days. Physical activity: watch wearing behaviour 69% (435/630), recording 30 low levels of moderate to vigorous physical activity (mean 11.8, SD 13.5 minutes, range 0 – 47 31 minutes). Concluding, remote monitoring of real-time data is feasible. However, further research is 32 needed to increase adoption rates by children.inpressinpres

Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies

Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XPurpose of Review This critical review begins by presenting the history of Juvenile Idiopathic Arthritis (JIA) management. To move the conversation forward in addressing the current shortcomings that exist in the clinical management of children living with JIA, we argue that to date, the advancement of successful treatments for JIA has been historically slow. Factors implicated in this situation include a lack of rigorous research, JIA being considered a rare disease, and JIA’s idiopathic and complex pathophysiology. Recent Findings Despite the well-intended legislative changes to increase paediatric research, and the major advancements seen in molecular medicine over the last 30 years, globally, paediatric rheumatology services are still failing to meet the current benchmarks of best practice. Provoking questions on how the longstanding health care disparities of poor access and delayed treatment for children living with JIA can be improved, to improve healthcare outcomes. Summary Globally, paediatric rheumatology services are failing to meet the current benchmarks of best practice. Raising awareness of the barriers hindering JIA management is the first step in reducing the current health inequalities experienced by children living with JIA. Action must be taken now, to train and well-equip the paediatric rheumatology interdisciplinary workforce. We propose, a resource-efficient way to improve the quality of care provided could be achieved by embedding digital health into clinical practice, to create an integrative care model between the children, general practice and the paediatric rheumatology team. To improve fragmented service delivery and the coordination of interdisciplinary care, across the healthcare system.Open Access funding enabled and organized by CAUL and its Member Institutionshttps://doi.org/10.1007/s11926-024-01145-waheadofprintaheadofprin

Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study

Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XJuvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2–6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0–47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.https://doi.org/10.3390/healthcare1203039212pubpub

Effectiveness of eHealth and mHealth interventions supporting children and young people living with juvenile idiopathic arthritis: Systematic review and meta-analysis

From PubMed via Jisc Publications RouterJuvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good-quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I =79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD -0.14, 95% CI -0.43 to 0.15; I =53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I =74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist-children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.24pubpub

Emerging tools to capture self-reported acute and chronic pain outcome in children and adolescents: A literature review

Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XThe advancement of digital health provides strategic and cost-effective opportunities for the progression of health care in children and adolescents. It is important for clinicians to be aware of the potential of emerging pain outcome measures and employ evidence-based tools capable of reliably tracking acute and chronic pain over time. The main emerging pain outcome measures for children and adolescents were examined. Overall, seven main texts and their corresponding digital health technologies were included in this study. The main findings indicated that the use of emerging digital health is able to reduce recall bias and can improve the real time paediatric data capture of acute and chronic symptoms. This literature review highlights new developments in pain management in children and adolescents and emphasizes the need for further research to be conducted on the use of emerging technologies in pain management. This may include larger scale, multicentre studies to further assess validity and reliability of these tools across various demographics. The privacy and security of mHealth data must also be carefully evaluated when choosing health applications that can be introduced into daily clinical settings.https://doi.org/10.3390/medsci1001000610pubpub

Harnessing interactive technologies to improve health outcomes in juvenile idiopathic arthritis

Background: Children and adolescents with Juvenile Idiopathic Arthritis (JIA) typically have reduced physical activity level and impaired aerobic and anaerobic exercise capacity when compared to their non-JIA counterparts. Low intensity exercise regimens appear to be safe in children with JIA and may results in improvements in overall physical function. Poor adherence to paediatric rheumatology treatment may lead to negative clinical outcomes and possibly increased disease activity. This includes symptoms such as pain, fatigue, quality of life, longer term outcomes including joint damage, as well as increase of healthcare associated costs. Low adherence to medications such as methotrexate and biological-drugs remains a significant issue for paediatric rheumatologists, with alarming reports that less than half of the children with JIA are compliant to drug-therapy. Main body: The recent advances in interactive technology resulting in a variety of wearable user-friendly smart devices may become a key solution to address important questions in JIA clinical management. Fully understanding the impact that arthritis and treatment complications have upon individual children and their families has long been a challenge for clinicians. Modern interactive technologies can be customised and accessed directly in the hands or wrists of children with JIA. These secured networks could be accessible 'live' at anytime and anywhere by the child, parents and clinicians. Multidisciplinary teams in paediatric rheumatology may benefit from adopting these technologies to better understand domains such as patient biological parameters, symptoms progression, adherence to drug-therapy, quality of life, and participation in physical activities. Most importantly the use of smart devices technologies may also facilitate more timely clinical decisions, improve self-management and parents awareness in the progression of their child's disease. Paediatric rheumatology research could also benefit from the use of these smart devices, as they would allow real-time access to meaningful data to thoroughly understand the disease-patterns of JIA, such as pain and physical activity outcomes. Data collection that typically occurs once every 1 or 3 months in the clinical setting could instead be gathered every week, day, minute or virtually live online. Arguably, few limitations in wearing such interactive technologies still exist and require further developments. Conclusion: Finally, by embracing and adapting these new and now highly accessible interactive technologies, clinical management and research in paediatric rheumatology may be greatly advanced.sch_pod1. Australian Institute of Health and Welfare, [AIHW]. What is juvenile arthritis? 2015. http://www.aihw.gov.au/juvenile-arthritis. Accessed 24 May 2016. 2. Bouaddi I, Rostom S, El Badri D, Hassani A, Chkirate B, Amine B, et al. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatr. 2013; doi:10.1186/1471-2431-13-2. 3. Laila K, Haque M, Islam MM, Islam MI, Talukder MK, Rahman SA. Impact of Juvenile Idiopathic Arthritis on School Attendance and Performance. American Journal of Clinical and Experimental Medicine. 2016; doi:10.11648/j.ajcem.20160406.15 4. Schatz BR. National Surveys of population health: big data analytics for mobile health monitors. Big Data. 2015; 1;3(4):219-229. 5. Cingi C, Yorgancioglu A, Cingi CC, Oguzulgen K, Muluk NB, Ulusoy S, et al. The physician on call patient engagement trial- (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients. Forum Allergy Rhinol 2015; doi:10.1002/alr.21468. 6. Stinson JN, Jibb LA, Nguyen C, Nathan PC, Maloney AM, Dupuis LL, et al. Construct validity and reliability of a real-time multidimensional smartphone app to assess pain in children and adolescents with cancer. Pain. 2015; doi:10.1097/j.pain.0000000000000385. 7. Tong A, Jones J, Craig JC, Singh-Grewal D. Children's experiences of living with juvenile idiopathic arthritis: a thematic synthesis of qualitative studies. Arthritis Care Res, 2012; doi:10.1002/acr.21695 8. Nishiguchi S, Ito H, Yamada M, Yoshitomi H, Furu M, Shinohara A, et al. Selfassessment of Rheumatoid Arthritis Disease Activity Using a Smartphone Application. Development and 3-month Feasibility Study. J Rheumatol. 2010; doi:10.3899/jrheum.091327. 9. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012; doi:10.1002/14651858.CD007459. 10. Majeed-Ariss R, Baildam E, Campbell M, Chieng A, Fallon D, Hall A, et al. Apps and Adolescents: A Systematic Review of Adolescents' Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions. J Med Internet Res. 2015; doi:10.2196/jmir.5043. 11. Szer IS, Kimura Y, Malleson PN, Southwood TR. Arthritis in children and adolescents: juvenile idiopathic arthritis. New York: Oxford University Press; 2006. 12. Bugni VM, Ozaki LS, Okamoto KY, Barbosa CM, Hilrio MO, Len CA, et al. Factors associated with adherence to treatment in children and adolescents with chronic rheumatic disease. J Pediatr (Rio J). 2012; doi:10.2223/JPED.2227 13. Pelajo CF, Sgarlat CM, Lopez-Benitez JM, Oliveira SK, Rodrigues MC, Sztajnbok FR, et al. Adherence to methotrexate in juvenile idiopathic arthritis. Rheumatol Int. 2012; doi:10.1007/s00296-010-1774. 14. Nickels A, Dimov V. Innovations in technology: social media and mobile technology in the care of adolescents with asthma. Curr Allergy Asthma Rep. 2012; doi:10.1007/s11882-012-0299-7. 15. Koster ES, Philbert D, de Vries TW, van Dijk L, Bouvy ML. I just forget to take it-: asthma self-management needs and preferences in adolescents. J Asthma. 2015; doi: 10.3109/02770903.2015.1020388. 16. Crosby LE, Barach I, McGrady ME, Kalinyak KA, Eastin AR, Mitchell MJ. Integrating interactive web-based technology to assess adherence and clinical outcomes in pediatric sickle cell disease. Anemia. 2012; doi:10.1155/2012/492428. 17. Lelieveld OT, van Brussel M, Takken T, van Weert E, van Leeuwen MA, Armbrust W. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2007; doi:10.1002/art.22897 18. Singh-Grewal, D, Schneiderman-Walker, J, Wright, V, Bar-Or, O, Beyene, J, Selvadurai, H, et al. (2007). The Effects of Vigorous Exercise Training on Physical Function in Children With Arthritis: A Randomized, Controlled, Single-Blinded Trial. Arthritis Care and Research. 2007; doi:10.1002/art.23008. 19. Raustorp A, Pagels P, Froberg A, Boldemann C. Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect? Acta Paediatr. 2015; doi:10.1111/apa.13027. 20. ACMA, Australia's mobile digital economy - ACMA confirms usage, choice, mobility and intensity on the rise, a.C.A.M: authority editor; 2013. 21. Google. Google Cloud Platform Security [Internet]. Google. 2016. https:// cloud.google.com/security. Accessed 13 Oct 2016. 22. Apple. iOS Security - Report No.: 9.3 or Later. 2016; https://www.apple.com/ business/docs/iOS_Security_Guide.pdf. Accessed 13 Oct 2016.15pub4780pub

Inter-individual variation in saliva antioxidant status in relation to periodontal disease

Increased salivary antioxidant capacity has the potential to limit oxidative tissue damage and improve the health of the gingival tissues. In this thesis, the antioxidant profile of saliva was assessed in relation to periodontal health status. Salivary protein carbonyl concentration was assessed as a biomarker of oxidative tissue damage.;The major scavenging antioxidants in saliva were urate, ascorbate and albumin. Urate contributed 70% of the total antioxidant activity (TAA). Saliva flow rate followed a diurnal rhythm, peaking at 5.00pm with nadir at 3.00am. TAA followed a similar pattern. Saliva antioxidant flow rate was lower in individuals with severe periodontal disease, who also exhibited greater oxidative injury. In males TAA was significantly higher than in females, but no relationship was noted between sex and periodontal health. Sex differnces in TAA were unexplained although TAA and urate flow rates followed the same monthly cyclical pattern as progesterone and beta-estradiol in women. Nutritional intervention, in the form of antioxidant supplementation was found to have little effect on salivary antioxidant status with only a transient increase in ascorbate evident. Dental hygiene products, in the form of mouthrinses and toothpastes, were found to vary significantly in their antioxidant capacity, with those containing methylsalicylate having the highest antioxidant capacity.;These data suggest that severe periodontal disease is associated with a decreased salivary antioxidant flow rate and increased oxidative injury. In addition, dietary antioxidant supplementation does not appear to increase salivary antioxidant status as it does in plasma. The use of certain dental hygiene products may boost antioxidant capacity within the oral cavity, although in vivo studies are required to investigate this further

Inter-individual variation in saliva antioxidant status in relation to periodontal disease

Free radicals have been implicated in the aetiology of many human disease states, including periodontal disease (PD). Saliva contains an array of antioxidants that neutralise the harmful effects of free radical formation within the oral cavity. Increased salivary antioxidant capacity may limit oxidative tissue damage and improve the health of the gingival tissues. In this thesis, the antioxidant profile of saliva was assessed in relation to PD severity. Salivary protein carbonyl concentration was assessed as a biomarker of oxidative tissue damage. Urate, ascorbate and albumin contributed 85% of the total scavenging antioxidant capacity (TAA) which followed a diurnal rhythm (peak 5.OOpm, nadir 3.OOam). Salivary antioxidant flow rate was significantly lower in individuals with severe PD (TAA 0.2 10 ± 0.02 M/ml/min) than those with healthy gingivae (TAA 0.270 ± 0.02 iiM/ml/min) (p<O.O5). Oxidative injury was greater in the group with severe PD (protein carbonyls = 25.43 ± 11.09 fmoles/g protein) compared to the healthy group (7.77 ± 2.38 flnoles/g protein) (p<O.O5). Individuals with low salivary TAA were 4.5 times more likely to suffer severe PD. TAA in males (654 ± 25 iiM/ml/min) was significantly higher than in females (545 ± 23 iiM/ml/min) (p=O.OO2), but no relationship was noted between ex and periodontal health. TAA and urate flow rates followed the same monthly cyclical pattern as progesterone and 13-estradiol in women. Nutritional antioxidant supplementation was found to have little effect on salivary antioxidant status with only a transient increase in ascorbate evident. These data suggest that severe PD is associated with a decreased salivary antioxidant flow rate and increased oxidative injury. In addition, dietary antioxidant supplementation does not appear to increase salivary antioxidant status as it does in plasma. Toothpastes and mouthrinses containing antioxidants may reduce the extent of oxidative injury in vivo, with more research required in this are

Inter-individual variation in saliva antioxidant status in relation to periodontal disease

Free radicals have been implicated in the aetiology of many human disease states, including periodontal disease (PD). Saliva contains an array of antioxidants that neutralise the harmful effects of free radical formation within the oral cavity. Increased salivary antioxidant capacity may limit oxidative tissue damage and improve the health of the gingival tissues. In this thesis, the antioxidant profile of saliva was assessed in relation to PD severity. Salivary protein carbonyl concentration was assessed as a biomarker of oxidative tissue damage. Urate, ascorbate and albumin contributed 85% of the total scavenging antioxidant capacity (TAA) which followed a diurnal rhythm (peak 5.00pm, nadir 3.00am). Salivary antioxidant flow rate was significantly lower in individuals with severe PD (TAA 0.210 f 0.02 μM/ml/min) than those with healthy gingivae (TAA 0.270 ± 0.02 PM/ml/min) (p<0.05). Oxidative injury was greater in the group with severe PD (protein carbonyls = 25.43 ± 11.09 fmoles/g protein) compared to the healthy group (7.77 ± 2.38 fmoles/g protein) (p<0.05). Individuals with low salivary TAA were 4.5 times more likely to suffer severe PD. TAA in males (654 ± 25 gWral/min) was significantly higher than in females (545 ± 23 pWml/min) (p=0.002), but no relationship was noted between sex and periodontal health. TAA and urate flow rates followed the same monthly cyclical pattern as progesterone and ß-estradiol in women. Nutritional antioxidant supplementation was found to have little effect on salivary antioxidant status with only a transient increase in ascorbate evident. These data suggest that severe PD is associated with a decreased salivary antioxidant flow rate and increased oxidative injury. In addition, dietary antioxidant supplementation does not appear to increase salivary antioxidant status as it does in plasma. Toothpastes and mouthrinses containing antioxidants may reduce the extent of oxidative injury in vivo, with more research required in this area.EThOS - Electronic Theses Online ServiceGBUnited Kingdo