Effect of an educational intervention on nurses' competence in activities of daily living support in end-of-life care using a pretest-posttest repeated measures design.

BACKGROUND: Most patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients' movement and protects nurses' musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the "Advanced Kinaesthetics in Palliative care (AdKinPal) program" on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units. METHODS: A pretest-posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention - the AdKinPal program - is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants' demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints. RESULTS: Fifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses' perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence. CONCLUSIONS: The AdKinPal program can raise nurses' Kinaesthetics competence. Thereby, patients' autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses' self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff's musculoskeletal health can be promoted by enhancing their Kinaesthetics competence. TRIAL REGISTRATION: DRKS00015908. Registration Date 23.11.2018.

[Promoting physical activity in women during breast cancer therapy: A mixed methods evaluation of a nursing counselling intervention]. / Bewegungsförderung bei Frauen während der Brustkrebstherapie.

Promoting physical activity in women during breast cancer therapy: A mixed methods evaluation of a nursing counselling intervention Abstract. Background: Physical activity is associated with improved quality of life in women during breast cancer treatment. However, how physical activity behaviour of patients changes in the first months after the start of the treatment and what role nursing counselling can play has not yet been sufficiently investigated. Aim: To observe differences in physical activity behaviour in women with breast cancer at the time of the initiation of the therapy and six months later, and to explore patients' and health professionals' perspective on a nursing counselling intervention on physical activity. Methods: A mixed-methods evaluation was conducted. In the quantitative part, the physical activity behaviour was assessed at two time points (t0 and t1) with the SQUASH instrument (30-2Wendel-Vos, 2003). In the qualitative part, one focus group interview was conducted with patients and health professionals separately. The quantitative data were analyzed using descriptive and inductive statistics. The qualitative data were analyzed thematically. Results: The sample (N = 47) showed a slight, but not significant increase in the extent of physical activity comparing t1 with t0. A statistically significant increase in the amount of exercise between t0 and t1 was only found in the category "work" (p = 0,002). The central theme of the women was that they felt encouraged by the nursing counselling intervention to "do something for themselves". For the health professionals, in the context of counselling it was important that they themselves were convinced of the importance of physical activity. Conclusions: The integration of physical activity into everyday life is a challenge for women with breast cancer during therapy. A counselling intervention is perceived as supportive but could have a more lasting effect through a longer-term physical activity programme.

Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study.

AIM: The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation. DESIGN: An intervention study was conducted. METHODS: In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation. RESULTS: Forty-six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.

Aggressive incidents in home care services and organizational support: A cross-sectional survey in Switzerland.

AIMS: To explore the available organizational structures addressing aggressive incidents towards home care services staff. BACKGROUND: Organizational structures how professional caregivers deal with care recipients' aggressive incidents. METHODS: An explorative cross-sectional survey using the Violence Experienced by Staff (German version revised) and the Impact of Patient Aggression on Carers Scale was conducted. Data from 852 health care professionals in the German-speaking part of Switzerland were collected between July and October 2019. Multiple logistic regression models were used to investigate associations. The STROBE-Checklist was used as the reporting guideline. RESULTS: Organizational support and management support in home care services were generally rated high and found to cause a significant decrease in negative feelings. Some self-rated skills regarding aggression management were linked to a decrease in perceived burden after aggressive incidents, whereas others increased the perceived burden. CONCLUSION: Organizational structures including official procedures for affected professional caregivers should be established in home care services. This should contain efficient reporting systems and aggression management training for the specific setting. IMPLICATIONS FOR NURSING MANAGEMENT: The study highlights the importance of organizational support regarding aggressive incidents in the home care setting as well as of aggression management training.

Factors associated with aggressive behaviour in persons with cognitive impairments using home care services: A retrospective cross-sectional study.

AIM: This study aimed to investigate the frequency of documented aggression, on the part of cognitively impaired individuals, against health professionals in home care services and to highlight related factors. DESIGN: A retrospective cross-sectional study was conducted using data obtained from the nursing documentation of six home care service organizations in Switzerland. METHODS: We analysed the nursing documentation of 1,186 clients in six home care services, between July 2019-September 2019, using the Cohen-Mansfield Agitation Inventory. We conducted a factor analysis as well as a descriptive data analysis and logistic regression using IBM SPSS Statistics. RESULTS: A factor analysis revealed in five factors, of which three represented aggressive behaviour in the sample. These factors were physically aggressive behaviour, verbally aggressive behaviour and importunate behaviour. Aggressive incidents, documented in the nursing records of 14.7% of clients in our sample, tended to be associated with cognitive, communication and mobility difficulties. IMPACT STATEMENT: This retrospective cross-sectional survey gives an overview of the frequency and forms of documented aggressive behaviour on the part of persons with cognitive impairments towards health professionals in home care services. One of the motivating factors for this study was the awareness that aggressive behaviour on the part of clients may stress health professionals in various ways which in turn may have an impact on the quality of care provided. The study revealed that healthcare specialists, rather than more qualified general or psychiatric nurses, were routinely assigned to assisting such clients and therefore specific educational and training interventions for these specific group of staff are indicated.

Experience of aggressive behaviour of health professionals in home care services and the role of persons with dementia.

AIMS: To explore the view of health professionals on the form and frequency of aggressive behaviour of clients against health professionals in home care services. DESIGN: An explorative cross-sectional survey was conducted. METHODS: We conducted a survey using the Survey of Violence Experienced by Staff German version Revised (SOVES-G-R) and the Impact of Patient Aggression on Carers Scale (IMPACS). A convenience sample of 852 healthcare professionals from German-speaking Switzerland participated. Data collection was conducted between July-October 2019. Data were analysed descriptively using IBM SPSS Statistics. RESULTS: Of the health professionals, 78.9% (N = 672) experienced aggressive behaviour since they worked in home care services. The most frequent aggressive behaviour was verbal aggression (75.6%, N = 644), while the most common predisposing factor was restriction in cognitive ability (71.3%, N = 67). Fear, burden and impairment of nursing relationship were common consequences of aggressive behaviour.

Experiences of relatives with outpatient palliative care: a cross-sectional study.

AIM: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN: A cross-sectional survey. METHODS: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

The effect of written information and counselling by an advanced practice nurse on resilience in women with vulvar neoplasia six months after surgical treatment and the influence of social support, recurrence, and age: a secondary analysis of a multicenter randomized controlled trial, WOMAN-PRO II.

BACKGROUND: Women with vulvar neoplasia often complain about physical and psychological distress after surgical treatment. Lack of information and support can influence resilience. Whether an information-related intervention through an advanced practice nurse supports resilience and which other factors affect resilience in women with vulvar neoplasia has never been investigated. METHODS: The aims of this study were (a) to analyse whether counselling based on the WOMAN-PRO II program causes a significant improvement in the resilience scores of women with vulvar neoplasia compared to written information and (b) to identify the potential predictors of resilience. A randomized controlled trial was conducted in women with vulvar neoplasia (n = 49) 6 months after surgical treatment in four Swiss hospitals and one Austrian hospital. Analyses of resilience and its predictors were performed using a linear mixed model. RESULTS: Thirty-six women (intervention I, n = 8; intervention II, n = 28) completed the randomized controlled trial. In total, 13 women (26.5%) dropped out of the trial. The resilience score did not differ significantly between the two interventions three and six months after randomisation (p = 0.759). Age (b = .04, p = 0.001), social support (b = .28, p = 0.009), counselling time (b = .03, p = 0.018) and local recurrence (b = -.56, p = 0.009) were identified as significant predictors of resilience in the linear mixed model analyses. CONCLUSION: The results indicate that the WOMAN-PRO II program as single intervention does not cause a significant change in the resilience scores of women with vulvar neoplasia 6 months after surgery. Predictors that promote or minimise resilience have been identified and should be considered when developing resilience programs for women with vulvar neoplasia. A repetition of the study with a larger sample size is recommended. TRIAL REGISTRATION: The WOMAN-PRO II program was registered in ClinicalTrials.gov NCT01986725 on 18 November 2013.

The associations of palliative care experts regarding food refusal: A cross-sectional study with an open question evaluated by triangulation analysis.

INTRODUCTION: Health professionals in oncologic and palliative care settings are often faced with the problem that patients stop eating and drinking. While the causes of food refusal are very different, the result is often malnutrition, which is linked to health comorbidities and a high mortality rate. However, the professionals lack the time and knowledge to clarify the cause for each patient. What associations do health professionals have when faced with food refusal? OBJECTIVE: To investigate the associations that health professionals in oncological and palliative settings have about denied eating behavior. METHODS: A cross-sectional study, starting with an open question focusing professionals' associations regarding food refusal. The results were inductively analyzed, whereby generic categories were developed. Subsequently, the categories were transformed into quantitative data to calculate the relationships between the categories. RESULTS: A total of 350 out of 2000 participants completed the survey, resulting in a response rate of 17.5%. Food refusal is primarily associated with physical and ethical aspects and with end-of-life. Half of the participants frequently find that patients refuse to eat. The attitudes show that the autonomy of the patient is the highest good and is to be respected. Even in the case of patients with limited decision-making capacity, the refusal to eat is acceptable. CONCLUSION: Clarifying the cause of food refusal requires a great deal of knowledge and is strongly influenced by the associations of health professionals. While the associations have very negative connotations, information and training is needed to make professionals aware of this and to change their associations. With this knowledge and in an interprofessional cooperation, mis-labelling of patient settings can be avoided and fears can be reduced.

Effects of Written Information and Counseling on Illness-Related Uncertainty in Women With Vulvar Neoplasia.

OBJECTIVES: To determine whether written information and/or counseling decreases illness-related uncertainty in women with vulvar neoplasia. SAMPLE & SETTING: 49 women with vulvar neoplasia from four Swiss hospitals and one Austrian hospital. METHODS & VARIABLES: A longitudinal, multicenter, randomized phase 2 study was performed. The written information group received a set of leaflets. The counseling group received five consultations with an advanced practice nurse (APN) from diagnosis to six months postsurgery that focused on symptom self-management, healthcare services, and decision making. Uncertainty was measured as a secondary outcome five times by the Mishel Uncertainty in Illness Scale. RESULTS: Total uncertainty and the subscales of ambiguity, inconsistency, and unpredictability improved significantly over time within the counseling group but not within the written information group. In addition, counseling improved inconsistency over time, and total uncertainty, inconsistency, and unpredictability at distinct time points more efficiently than written information. IMPLICATIONS FOR NURSING: Counseling can reduce illness-related uncertainty. APNs are valuable healthcare providers who promote women's self-management and may support them in becoming more familiar with illness-related events and common symptoms during this rare disease.

The self-reported and observed competence of nursing staff in mobility care based on Kinaesthetics in nursing homes - A cross-sectional study.

BACKGROUND: The majority of care-dependent persons living in nursing homes have mobility impairment affecting the physical, psychological, and social aspects of the persons' lives. Therefore, nursing staff needs competence to provide good mobility enhancing care. AIM: This study assesses the self-reported and observed competence of nursing home staff in mobility care based on Kinaesthetics in order to increase attention about nursing staff's impact on nursing home residents' mobility. METHODS: A cross-sectional study design involving a survey and an observational study was employed. Survey data were collected using the Kinaesthetics Competence Self-Evaluation (KCSE) scale. For the observational study, data were collected with a video camera and rated using the Kinaesthetics Competence Observation (KCO) instrument. Data were analysed using descriptive statistics, correlation methods and a generalised linear model. RESULTS: The majority of survey participants (n = 180) indicated their competence in mobility care based on Kinaesthetics as very good (mean score 13, SD 1.44, on a scale from 4 to 16). The observed competence of nursing staff (n = 40) was good (mean score 10.8, SD 2.44, out of a possible score from 4 to 16). Positive correlations were found between self-reported or observed competence in mobility care based on Kinaesthetics and employment rate, work experience in nursing home care and Kinaesthetics training. CONCLUSION: A combined assessment of self-evaluation and observation is recommended in order to get a comprehensive picture of knowledge, skills, attitude and dynamic state of nursing staffs' competence in mobility care based on Kinaesthetics.

Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale.

BACKGROUND: Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care. METHODS: The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015. RESULTS: The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted. CONCLUSION: The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.

Effects of a mobility monitoring system on the cost of care in relation to reimbursement at Swiss nursing homes: learnings from a randomized controlled trial.

BACKGROUND/OBJECTIVE: Nursing homes in Switzerland are under pressure to efficiently coordinate staff activities to cover their personnel costs under the care financing system. In this study, the use of a mobility monitoring system accompanied with case conferences was investigated in order to improve sleep quality and estimate the cost benefit of this intervention. METHOD: In an open two-phase randomized controlled trial at three nursing homes, residents with cognitive impairment were randomly assigned to an intervention group and a control group. In the intervention group, a 10-week period of intensive use of the monitoring system and case conferences led by an advanced nurse practitioner (Phase I) was followed by 3 months of reduced use of the monitoring system and case conferences led by an internal registered nurse (Phase II). In the control group, the monitoring system was only used for data acquisition. Nurses reported the activities with a specifically developed tool. Based on the recorded activities, the cost of care was calculated. The correlating reimbursement per patient was calculated from the care levels in the Swiss reimbursement system. Data from 44 residents was included in the analysis with a linear mixed model. RESULTS: Although analysis revealed no statistically significant effects, results indicate that the use of a monitoring system can guide nurses in organizing their tasks to increase effectiveness. Information systems such as the mobility monitor can help to identify single outliers that do not correspond with the overall situation. CONCLUSION: In the health care system, problematic individual cases can account for a disproportionally high cost levels. It was shown that information systems can have a significant economic impact in the long run. TRIAL REGISTRATION: The study is registered at the German Clinical Trials Register under the Nr. DRKS-ID: DRKS00006829 .

The impact of written information and counseling (WOMAN-PRO II Program) on symptom outcomes in women with vulvar neoplasia: A multicenter randomized controlled phase II study.

OBJECTIVE: To determine whether written information and/or counseling based on the WOMAN-PRO II Program decreases symptom prevalence in women with vulvar neoplasia by a clinically relevant degree, and to explore the differences between the 2 interventions in symptom prevalence, symptom distress prevalence, and symptom experience. METHODS: A multicenter randomized controlled parallel-group phase II trial with 2 interventions provided to patients after the initial diagnosis was performed in Austria and Switzerland. Women randomized to written information received a predefined set of leaflets concerning wound care and available healthcare services. Women allocated to counseling were additionally provided with 5 consultations by an Advanced Practice Nurse (APN) between the initial diagnosis and 6months post-surgery that focused on symptom management, utilization of healthcare services, and health-related decision-making. Symptom outcomes were simultaneously measured 5 times to the counseling time points. RESULTS: A total of 49 women with vulvar neoplasia participated in the study. Symptom prevalence decreased in women with counseling by a clinically relevant degree, but not in women with written information. Sporadically, significant differences between the 2 interventions could be observed in individual items, but not in the total scales or subscales of the symptom outcomes. CONCLUSIONS: The results indicate that counseling may reduce symptom prevalence in women with vulvar neoplasia by a clinically relevant extent. The observed group differences between the 2 interventions slightly favor counseling over written information. The results justify testing the benefit of counseling thoroughly in a comparative phase III trial.

Assessing nursing staff's competences in mobility support in nursing-home care: development and psychometric testing of the Kinaesthetics Competence (KC) observation instrument.

BACKGROUND: Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff's interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff's competences in kinaesthetics. METHODS: The Kinaesthetics Competence (KC) observation instrument was developed between January and June 2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated with two expert panels (n = 5, n = 4) regarding content validity, usability and inter-rater agreement. Content validity was assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional study in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In this study nursing staff (n = 48) was filmed during mobilization situations. Based on this video data two observers independently assessed nursing staff's competences in kinaesthetics with the KC observation instrument. Inter-rater reliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage of agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was evaluated using Cronbach's alpha coefficient and item analysis. RESULTS: The final version of the KC observation instrument comprised of four domains (interaction, movement support of the person, nurses' movement, environment) and 12 items. The final instrument showed an excellent content validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole scale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach's alpha coefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct validity of the instrument was supported by a significant discrimination of the instrument between nursing staff with no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales. CONCLUSIONS: The KC observation instrument showed good preliminary psychometric properties and can be used to assess nursing staff's competences in mobility care based on the principles of kinaesthetics.

[Interrater reliability and agreement of the Swiss MDS version 2.0]. / Interrater-Reliabilität und Übereinstimmung der Schweizer RAI-MDS Version 2.0.

Numerous studies have been performed to assess the validity and reliability of the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI), which was developed and initially implemented in the United States. In general, RAI-MDS 2.0 has been reported to have moderate to high interrater reliability. From the late 1990s onwards the geriatric nursing assessment has been used in nursing homes in Switzerland. The objective of this study was to examine interrater agreement and reliability of the Swiss version of RAI-MDS 2.0 for the first time. For this purpose, 61 nursing home residents were independently assessed by two assessors. The MDS coordinator of the nursing home and an extern expert conducted independent resident assessments by reviewing the chart and asking front line staff about the residents' behaviour. Proportions of exact agreement were calculated and interrater reliability was assessed using kappa and intraclass correlation (ICC) coefficients. For most of the checked items, a high agreement between the two raters was observed. The reliability coefficients for 47 % of the items reached values between 0,81 and 1,0. 29 % of the items achieved values between 0,61 and 0,80. The values of 10 % of the items ranged between 0,41 and 0,60. Two items assessing skin condition obtained a value of 0,25 and 0, respectively. The results of the reliability analysis show that mainly items evaluating pain, mood and behavior, and some items estimating physical function and skin condition are less reliable.

[ Comparison of BESA and RAI: evaluating the outcomes of two assessment instruments for long-term residential care needs]. / Pflegebedarfserfassungsinstrumente BESA und RAI: Vergleich der Outcomes in Minuten.

In Switzerland, the level of nursing care required for residents in nursing homes is either assessed by the BESA Catalogue 2010 or by the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI). Within both instruments the nursing care need is represented in minutes. According to these minutes, the resident is allocated to a tariff level. The aim of the study was to compare the outcomes of the two assessment instruments BESA Catalogue 2010 and MDS. For this purpose data were collected in two nursing homes. At each facility 60 nursing home residents were assessed with the BESA Catalogue 2010 and the MDS. The assessments were independently performed by nurses of the facility (internal assessment) and by system experts (external assessment). Descriptive data analysis and a comparison of the outcome in minutes and with regard to tariff level were carried out. In average, internal assessments were higher than external assessments. In both nursing homes, half or 54 % of residents were allocated into a higher tariff level by means of internal assessment. Comparing the outcomes in total and within tariff level, significant differences were found. Different classifications may occur, especially for residents with high nursing care needs. As a result, higher or lower costs of nursing care may arise.

Influence of polymorphisms in the NOD1/CARD4 and NOD2/CARD15 genes on the clinical outcome of Helicobacter pylori infection.

Host immune response influences the clinical outcome of Helicobacter pylori infection leading to ulcer disease, gastric carcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. A genetic risk profile for gastric cancer has been identified, but genetic susceptibility to develop MALT lymphoma is still unclear. We investigated the role of NOD1 and NOD2 as intracellular recognition molecules for pathogen-associated molecules in H. pylori infection in vitro and analysed the influence of single nucleotide polymorphisms on susceptibility to ulcer disease and MALT lymphoma. Expression of NOD1 and NOD2 significantly sensitized HEK293 cells to H. pylori-induced NF-kappaB activation in a cag pathogenicity island (cagPAI)-dependent manner. In cells carrying the Crohn-associated NOD2 variant R702W the NF-kappaB response was significantly diminished. NOD1/NOD2 expression levels were induced in the gastric epithelium in H. pylori-positive patients. No mutations were found to be associated with gastritis or gastric ulcer development. However, the R702W mutation in the NOD2/CARD15 gene was significantly associated with gastric lymphoma. Carrier of the rare allele T had a more than doubled risk to develop lymphoma than controls [odds ratio (OR): 2.4, 95% confidence interval (CI): 1.2-4.6; P < 0.044]. H. pylori-induced upregulation of NOD1 and NOD2 in vivo may play a critical role in the recognition of this common pathogen. A missense mutation in the leucine-rich region of CARD15 is associated with gastric lymphoma.

Genetic variants in matrix metalloproteinase genes are associated with development of gastric ulcer in H. Pylori infection.

BACKGROUND AND AIMS: Matrix metalloproteinases (MMPs) are a family of enzymes that degrade most of the macromolecules making up the extracellular matrix. H. pylori infection increases the secretion of MMPs in the gastric mucosa leading to severe mucosal damage. The aim of this study was to investigate if genetic variants in MMPs involved in the inflammatory response to H. pylori could predispose patients with chronic H. pylori infection to develop gastric ulcer disease. METHODS: A total of 599 H. pylori-infected patients undergoing gastroscopy were genotyped for 20 SNPs covering the MMP-1, -3, -7, and -9 genes by TaqMan technology. Haplotype and single marker analysis was conducted to assess associations with gastric ulcer disease. RESULTS: Carriage of allele G of the functional promoter variant MMP-7-181 was significantly associated with gastric ulcer conferring a 1.6-fold increased risk (95% CI: 1.0-2.6, p = 0.037). In addition, carriage of allele A of a coding SNP in exon 6 of MMP-9 confers a 2.4-fold increased risk (95% CI: 1.0-2.6, p = 0.013) for gastric ulcer. CONCLUSION: The level of association found in this study is in agreement with the nature of a complex genetic disease. Genetic variations in the MMP-7 and -9 gene may be part of a complex genetic risk profile to develop gastric ulcer in chronic H. pylori infection. Further studies are warranted to elucidate the pathophysiological role of these genes in ulcerogenesis.

Regulation of cell growth and the expression of extracellular matrix proteins in colorectal adenocarcinoma: a fibroblast-tumor cell coculture model to study tumor-host interactions in vitro.

The production of abundant connective tissue within malignant tumors, the so-called desmoplastic stromal reaction, is a hallmark of colorectal adenocarcinomas. This stroma is produced to a large extent by myofibroblasts and contains various amounts of collagens (type I, III, and V), chondroitin sulfate proteoglycan, hyaluronic acid, fibronectin, and tenascin-C. In this study we have established a monolayer coculture model between two different colorectal adenocarcinoma cell lines (HRT-18, and CX-2) and colonic fibroblasts (CCD-18) to investigate the mechanisms regulating (i) the production of extracellular matrix (ECM) components, (ii) the induction of myofibroblastic differentiation, and (iii) cellular proliferation. We found that TGFbeta1 and FGF-2 stimulated ECM synthesis of fibroblasts. Myofibroblastic differentiation was stimulated by TGFbeta1 but suppressed by FGF-2. There was a mutual stimulation of proliferation between fibroblasts and carcinoma cells. The analogies with ECM components expressed in cocultures and colorectal adenocarcinoma samples suggest that the coculture model used in this study is useful to study tumor cell-fibroblast interactions.