OBJECTIVE
To determine the accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test (POCT) for detecting periodontitis in adults, through meta-analysis.


MATERIALS AND METHODS
Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP-8 POCT for detecting periodontitis in adults, when compared with clinical examination, were considered eligible. A comprehensive search was performed up to 31 August 2023 through five databases. Quality Assessment of Diagnostic Accuracy Studies 2 was utilized to evaluate the methodological quality of the included articles. Meta-analysis was performed using Bayesian bivariate hierarchical model and subgroup analysis.


RESULTS
From 368 screened studies, 6 studies (4 cross-sectional and 2 longitudinal studies) were included in the meta-analysis. Overall, the pooled sensitivity and specificity of salivary aMMP-8-POCT for detecting periodontitis were 0.63 (95% CI: 0.41-0.82) and 0.84 (95% CI: 0.65-0.95), respectively. Subgroup analyses revealed that the 95% CI for oral fluid types, predefined diagnostic thresholds and the POCT systems largely overlapped, indicating that the differences between them may not be significant.


CONCLUSION
Salivary aMMP-8 POCT shows fair accuracy for detecting periodontitis. The diagnostic accuracy cannot be significantly influenced by the types of oral fluids, predefined diagnostic thresholds or the specific POCT systems used. More research is needed to confirm the clinical utility and implementation of aMMP-8 POCT in the diagnosis of periodontitis.

Diagnostic accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test for detecting periodontitis in adults: A systematic review and meta-analysis.

PURPOSE
To provide a detailed overview of the fundamentals of saliva constituents and production. The review outlines the clinical manifestations as a consequence of salivary gland dysfunction and management strategies for patients with salivary gland dysfunction. Prosthodontic implications of saliva and salivary gland dysfunction are presented.


MATERIALS AND METHODS
English-language literature relating to saliva constituents, physiologic saliva production, clinical manifestations secondary to salivary gland dysfunction, salivary biomarkers, and management strategies were retrieved via electronic search. Relevant articles were summarized for this manuscript with a view toward providing pragmatic information.


RESULTS
Saliva is produced by three pairs of major and minor salivary glands. The major salivary glands, namely the parotid, submandibular, and sublingual glands contribute approximately 90% of the saliva production. Saliva contains serous and mucinous secretions produced by different types of cells within salivary glands. Parasympathetic and sympathetic fibers innervate the major salivary glands, and upon stimulation, the parasympathetic innervation increases serous secretions, while the sympathetic innervation increases protein secretion. Stimulated saliva is mainly derived from the parotid glands which are composed of serous acini, while unstimulated saliva is mainly derived from the submandibular glands which are composed of mixed seromucous acini. As major salivary glands contribute the most to salivary flow, local or systemic factors influencing those glands can disrupt saliva production resulting in clinically significant oral manifestations.


CONCLUSIONS
This review provides a fundamental overview of saliva production. In addition, the review highlights the various clinical manifestations secondary to salivary gland dysfunction, explores salivary biomarkers for screening of systemic diseases, discusses management strategies for patients with salivary gland dysfunction, and outlines the prosthodontic implications of saliva and salivary gland dysfunction. This article is protected by copyright. All rights reserved.

Prosthodontic implications of saliva and salivary gland dysfunction.

Background Microbiomes are essential components of the human body, and their populations are substantial. Under normal circumstances, microbiomes coexist harmoniously with the human body, but disturbances in this equilibrium can lead to various diseases. The oral microbiome is involved in the occurrence and development of many oral and gastrointestinal diseases. This review focuses on the relationship between oral microbiomes and oral and upper gastrointestinal diseases, and therapeutic strategies aiming to provide valuable insights for clinical prevention and treatment. 

The oral microbiome and oral and upper gastrointestinal diseases

Periodontal disease is a prevalent and potentially impactful oral health condition, ranging from gingivitis to severe periodontitis. Early detection and precise management are crucial in modern dentistry due to its prevalence and potential systemic health implications. Traditional clinical assessments and radiographic imaging have been the primary diagnostic tools. However, recent advances in oral diagnostics have introduced the concept of non-invasive, easily accessible salivary biomarkers. This review explores the evolving landscape of salivary biomarkers associated with periodontal disease, offering a comprehensive analysis of recent studies. It delves into the key findings, clinical significance, and potential impact of these biomarkers in revolutionizing periodontal disease diagnostics and treatment monitoring. The study emphasizes their diagnostic and prognostic capabilities, including their ability to assess disease severity, correlate with clinical parameters, aid in early detection, and enhance personalized treatment planning. As the field of oral diagnostics continues to advance, understanding the role of salivary biomarkers in periodontal disease management holds the promise of improving precision and effectiveness in oral healthcare. This review underscores the potential for salivary biomarkers to become integral components of routine periodontal care, offering a minimally invasive and patient-centered approach to oral health management.

Salivary Biomarkers in Periodontitis: A Scoping Review

Healthcare, religion, governance, politics, and economics have historically caused many of the world’s most significant conflicts, and they continue to do so because these issues are often the most fundamental in the structure of a society. To gain a military advantage, parties to armed conflicts have polluted water, burned crops, cut down forests, poisoned soils, and killed animals over the years. A variety of context factors, particularly socioeconomic conditions, governance, and political factors, interact and play a key role in translating climate change into conflict risks. Unrest all over the world risks putting more than half of the countries into a crisis of health, economy, and social safety, which remains the most constant threat to human civilization. The security and safety of healthcare facilities, workers, and supply lines remain of paramount concern, along with access to health services, technology, and innovation. This seminal work correlates the effects of infection pandemics, conflict, healthcare, and climate issues on the world economy. It interconnects them with victims and future public health for sustainable security in the world ecosystem. Healthcare issues, when focused on the highest platform, could compel global leaders to forego conflicts and work together.

Escalation of War and Conflicts Among the Pandemic, Natural Disasters, Food and Economic Crises: A Global Health Concern

Saliva is a useful biomarker for diagnosing oral health conditions, including periodontal disease (PD). Smoking is a risk factor for PD. The aim of this systematic review was to summarize the salivary biomarkers associated with PD based on smoking status. A comprehensive search of the MEDLINE (via PubMed), EMBASE, Cochrane, SCOPUS, and Web of Sciences databases was conducted up to 1 January 2021 using key terms relevant to the topic of our research and Cochrane methodology and improved with searching a gray literature resource. The methodological quality of all included studies was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies-2. Seven studies were included. Smokers had increased levels of malondialdehyde, sialic acid, salivary cortisol, salivary interleukin 1β, albumin, tissue inhibitor of matrix metalloproteinase (TIMP), and the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), as well as decreased levels of superoxide dismutase, activity of lactate dehydrogenase, activity of enzyme activity of β-glucuronidase, uric acid, matrix metalloproteinase-8 (MMP-8)/TIMP-1 ratio, and combinations of MMP-8 and ICTP. However, mixed results were observed some studies in detecting glutathione peroxidase, MMP-8, and MMP-14. The results were interpreted with caution because of limitations in the number of included studies and the study design. Some salivary biomarkers are potentially useful in combination or alone for diagnosing PD. Methodological and systematic studies are needed to develop more effective biomarkers.

https://www.mdpi.com/1660-4601/19/21/14619/pdf?version=1667913242

Evaluation of Salivary Biomarkers of Periodontal Disease Based on Smoking Status: A Systematic Review

/pdf/correction-financial-burden-of-catastrophic-health-untzgk8k.pdf

Correction: Financial burden of catastrophic health expenditure on households with chronic diseases: financial ratio analysis

As extensive as the concept of and the resources required for 'Health for Korean Unification' are, and due to the limited access to information on the state of health and medical care in North Korea, discussion on 'Health for Korean Unification' has tended to be intermittent and lacked concrete action plans. In this article, we specifically distinguished areas of cooperation and selected five executable agenda that meet the goals of international development cooperation: 1) Health security; 2) Easing the burden of major diseases; 3) Resilient healthcare system; 4) R&amp;D cooperation; 5) Sustainable cooperation system. Then we provided corresponding strategic priorities and operative directions, in consideration of future military and political sanctions against North Korea. The strategies we outline are sustainable, preemptive for problems that might affect lives of South and North Korean citizens, and satisfy the unmet needs of the North Korean health system. Throughout the process, we utilized a special platform, the 'Korean Peninsula Healthcare Cooperation Platform,' designed to enable continual communication across sectors engaged in public health and medical care. By doing so, we take the first step to actually carry out the 'Health for Korean Unification,' which tended to have remained on the discussion agenda. 

Mid-Term Strategic Plan for the Public Health and Medical Care Cooperation in the Korean Peninsula

Abstract Background: Many low- and middle-income countries and international organisations have invested resources to strengthen primary health care (PHC). This study aimed to identify the challenges and unmet needs in the current PHC by assessing the experiences and perceptions of healthcare workers in three townships (Htan Ta Pin, Hmawbi, and Taikkyi) in Yangon, Myanmar. Methods: The study was conducted among healthcare professionals and community leaders in three townships. Adopting a mixed-method approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (FGDs) were conducted online for qualitative data. Findings: Enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5 ratings) while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28) and the impact of the intervention (4.7). The FGDs revealed that while specific infrastructures and equipment were reported insufficient and necessary, the need for financial support has been the recurrent theme throughout the discussions. Interpretation: Utilising the World Health Organisation’s six building block frameworks, our findings suggest that a long-term targeted financial investment in the PHC system is critical in Myanmar through increasing healthcare expenditure per capita.

Current status and needs in the primary healthcare system in Yangon, Myanmar: a mixed-method evaluation

Objectives Despite the epidemiological importance of social vulnerabilities in compliance with preventive measures, little is known about the disproportional nature of preventive behaviors in crisis-affected populations. We examined adherence to COVID-19 preventive behaviors, focusing on social distancing measures in the conflict-affected regions in eastern Ukraine. Methods From a multisectoral needs assessment conducted in 2020 using a household interview of a stratified simple random sample, we included 1,617 rural and urban households located in the government-controlled area. We performed multivariable binary logistic regression analysis with latent class analysis (LCA) to identify unmeasured patterns of classification of preventive measures using data from a cross-sectional survey. Results The conflict-affected populations showed difficulty in complying with COVID-19 preventive measures due to losses of housing, partners, and access to food resources due to conflicts. Among the various preventive measures, wearing a face mask (88.1%) and washing hands more regularly (71.4%) were the most frequently reported. Compliance with social distancing was significantly lower in those who experienced the direct impacts of conflicts indicated by damaged accommodation or being widowed. Three different groups who showed distinctive patterns of employing COVID-19 preventive measures were identified via the LCA model, which were “highly complying group”, “moderately complying group”, and “face masks only group”. The group membership was associated with a respondent’s poverty status. Conclusion The findings show the difficulty in compliance with COVID-19 preventive measures among conflict-affected populations indicating secondary impacts of the conflicts on preventive health behaviors. To mitigate the health impacts of conflicts, immediate attention is needed to address barriers to COVID-19 preventive measures among conflict-affected populations in Ukraine. This study suggests the need for public health strategies to improve preventive health behaviors in conflict-affected populations under pandemics or large-scale outbreaks.

https://www.frontiersin.org/articles/10.3389/fpubh.2023.1151452/pdf

Challenges of COVID-19 prevention during protracted conflicts: differential adherence to preventive measures in “contact line” regions in eastern Ukraine

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