According to the Crohn’s and Colitis Foundation of Canada, there is approximately 1 in every 200 individuals who is living with inflammatory bowel disease (IBD). Many of those living with IBD also need to have an ostomy. The literature on the effects IBD and an ostomy has on adolescents and young adults lacks consensus. Therefore, the purpose of this phenomenological study was to try to understand the lived experiences of adolescents and young adults (N=6) living with IBD and an ostomy. Sociodemographic information was collected, and the participants were interviewed in person using a semi-structured interview guide. The work of van Manen (1990) was used as a guide for data collection, analysis and interpretation of this study. Analysis revealed the essence of the adolescents’ and young adults’ lived experience as being “Concealing and Revealing the Self”. Three themes communicate the essence of their lived experience: (a) Uneasy feelings, (b) “It’s hard…”, and (c) A renewed sense of self. The needs of the adolescents and young adults, along with their recommendations to health care providers, are addressed. The study findings inform nurses in the areas of practice, education and research. Practice recommendations include being cognizant that these individuals need holistic care that addresses their psychological, psychosocial and physical needs. This study forms the basis for future research to explore some of the themes in greater detail, as well as a recommendation for a longitudinal study.

Pastaraisiais dešimtmečiais industrinėse, išsivysčiusiose Vakarų Europos ir Šiaurės Amerikos šalyse ypač išaugo lėtinėmis uždegiminėmis žarnų ligomis (UŽL) sergančių vaikų skaičius. UŽL etiopatogenezė nėra pilnai aiški, tačiau manoma, kad jų išsivystymą sąlygoja pakitęs imuninis atsakas į žarnyno bakterijų antigenų stimuliaciją genetiškai predisponuotiems individams. Genetiniai tyrimai parodė genų polimorfizmo reikšmę atpažįstant bakterijas (NOD2) bei jų įtaką tokiuose ląstelės mechanizmuose, kaip imunoreguliacija (IL23R, IL10) bei autofagija (ATG16L1, IRGM). Naujausių tyrimų, atliktų su UŽL sergančiais individais, duomenimis, pakitusi žarnyno bakterijų sudėtis sukelia imuninės sistemos stimuliaciją, epitelio funkcijos sutrikimą bei gleivinės pralaidumą, dėl ko išsivysto lėtinis žarnyno gleivinės uždegimas. Remiantis klinikinių, radiologinių, endoskopinių bei histologinių tyrimų duomenimis, išskiriamos dvi UŽL: opinis kolitas (OK) ir Krono liga (KRL). OK – lėtinis storosios žarnos uždegimas, kurio metu pažeidžiami paviršiniai, t. y. gleivinės ir pogleivio, žarnos sluoksniai. KRL atveju, uždegiminiai pakitimai apima ne tik paviršinius, bet ir giliuosius žarnos sienelės sluoksnius, kurie gali atsirasti bet kurioje žarnyno dalyje, tačiau dažniausiai stebimi plonosios žarnos galinėje bei storosios žarnos pradinėje dalyse. Neseniai atlikti epidemiologiniai tyrimai parodė, kad vaikų, sergančių UŽL, sergamumas ir paplitimas kito: Krono ligos susirgimų atvejų skaičius laipsniškai... [toliau žr. visą tekstą] / In recent decades the number of children with chronic inflammatory intestinal diseases (IBD) has increased in the industrialized developed countries of Western Europe and North America [Benchimol et al., 2011; Molodecky et al., 2012]. IBD pathogenesis is not completely clear, but it is though it evolves from changes in the immune response to antigen stimulation of intestine bacteria to genetically predisposed individuals [Xavier et al., 2008]. Genetic studies have shown the importance of genetic polymorphism in identifying of bacteria (NOD2) and their influence on cell mechanisms such as immune regulation and autophagy (IRGM, ATG16L1) [Travasso et al., 2009; Cooney et al., 2009]. According to the data of the recent studies with IBD, the changed composition of the intestinal bacteria causes immune stimulation, epithelial dysfunction, and mucosal permeability, as a result, chronic inflammation of the intestinal mucosa develops. Based on the data of clinical, radiological, endoscopic and histological studies, there are two IBD subtypes: ulcerative colitis (UC) and Crohn's disease (CD). UC is a chronic inflammation of the large intestine, when surface layers, i.e. mucosa and submucosa are affected. In CD inflammatory changes include not only the surface but also the deeper layers of the intestinal wall, which can occur in any part of the intestine. These changes are often seen in the end of the small intestine and in the initial part of the large intestine. Recent... [to full text]

Inflammatory Bowel Disease (IBD) is a debilitating, life- long disease that affects about 1.4 millions Americans. Little is known about the pathogenesis of IBD and an effective cure still remains to be discovered. While there are numerous T cell targeting therapies for IBD, more research is still needed. Bispecific T Cell Engagers, BiTES, is a modified protein capable of engaging two antigens simultaneously; it is capable of activating T cells by circumventing the MHC protein molecule. This provides an alternative to the current molecular therapies for IBD. In addition to monoclonal therapy research, there has been a plethora of research on immunomodulatory molecules, such as β- glucan. The benefit of β-glucan has been shown with supplements and food sources alike in animal models. In this study, we used BiTES, CMPD-1, with an anti-CD3/ Dectin-1 epitopes capable of engaging T Cells and β-glucan in beads and fungi cell wall. CMPD-1 is capable of engaging Splenic and Lamina Propia T Cells from a C57BL/6 mice. Likewise, CMPD-1 engaged T cells to hyphae of C. albicans and A. fumigatus, which have a higher concentration of β-glucan than in the candida form. The data show a delayed in hyphae growth in yeast with CMPD-1 and a decrease in yeast growth for the first four hours when compared to non- BiTES molecules. Additionally, qualitative analysis of CMPD-1 shows a decrease A. fumigatus growth after a 72-hour incubation period. Splenic T cells from mice lacking Dectin-1 and Wild-type (WT) mouse strains where incubated with BiTES compound and yeast for 23 hours followed by a PrestoBlue killing assay to assess yeast cell viability. The PrestoBlue assay showed that CMPD-1 killed more A. fumigatus in both T cell subsets; although, the difference lacked statistical significance. The applications of this molecule as a therapeutic agent for IBD are promising, although, still in its infancy. An alternative use for this molecule is to train the immune system with the BiTES molecule in conjunction with β-glucan supplements to build immunity against opportunistic pathogens such as A. fumigatus and C. albicans that often cause havoc in IBD patients as a result of the changes in microbiota, and compromised integrity of the GI tract. / 2017-06-16T00:00:00Z

Parents of children with a chronic disease are usually highly involved in their child’s treatment and may be affected by the heavy demands and constant stress. This can increase the risk of developing burnout, which is an individual reaction to long-term stress consisting of symptoms associated with emotional exhaustion, as well as physical and cognitive fatigue. The overall aim was to estimate the prevalence of burnout in parents of children with Type 1 Diabetes Mellitus (T1DM) and inflammatory bowel disease (IBD) (paper I), identify the risk factors associated with parenting a child with T1DM (paper II), explore how mothers suffering from burnout describe their mothering of a child with diabetes, with special focus on their need for control and Performance-based self-esteem (PBSE) (paper IV), and to evaluate the effect of a group intervention aimed at reducing stress-related symptoms (paper III). A total of 251 parents of children with T1DM, 38 parents of children with IBD and 124 parents of healthy children participated in a population-based study (I, II). The validated Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. 16 parents (SMBQ ≥3.75) participated in a group intervention and were evaluated for changes in SMBQ and PBSE (III). A total of 21 mothers of children with T1DM who scored for clinical burnout (SMBQ) participated in a qualitative study. Semi-structured interviews were conducted and Inductive content analysis was used (IV). In the study group 36.0% parents of children with a chronic disease scored for clinical burnout (SMBQ ≥3.75) compared to 20.2% of the reference parents (p=0.001) with a preponderance of mothers compared to fathers, 42% vs. 20.5% (p=0.001), respectively (I). Less support from the social network, sleep disturbances and lack of personal leisure time and recovery seem to be important risk factors for clinical burnout in parents of children with T1DM, especially mothers (II). Mothers’ experiences of mothering a child with T1DM were interpreted as one theme; Mission impossible, illustrating the extremely difficult circumstances under which they bring up the child with diabetes to adulthood (IV). Parents’ subjective evaluation of the intervention group was mainly positive and SMBQ (p=0.01) and PBSE scale (p= 0.04) measurements were significantly reduced 6 months after completion of the intervention (III). It is important to pay attention to how parents and especially mothers experience their daily life in order to support those who are at risk of developing burnout.

Les cellules épithéliales produisent des facteurs influençant la réponse inflammatoire intestinale. L'étude de la contribution de ces facteurs à l'homéostasie des tissus est devenue essentielle à la compréhension des maladies inflammatoires chroniques intestinales (MICIs). Vanin-1 est une enzyme épithéliale qui produit des facteurs solubles dans les tissus dont l'intestin en réponse à un stress. Nous avons identifié Vanin-1 comme facteur de susceptibilité et marqueur des MICIs chez l'homme. La création d'une souris mutante nous a permis d'identifier des mécanismes d'action potentiels de Vanin-1 dans les tissus. Vanin-1 pourrait un jour être exploité pour développer une stratégie thérapeutique contre les MICIs. / Intestinal epithelial cells have recently been identified as producing factors influencing grandly the curse of intestinal inflammation. It became of a great importance, therefore, to identify the contribution of epithelial molecules to inflammatory bowel diseases (IBD). Vanin-1 is an epithelial enzymes which release soluble factors in tissues such as gut. This study identifies Vanin-1 as a marker and a susceptibility factor of IBD. By producing a mutant mice, we identified potential mechanisms by which Vanin-1 could act in tissues. It is hoped that Vnn1 can be exploited to develop future therapeutic strategies against IBD.

Introduction: Inflammatory bowel disease is a common, complex relapsing disorder characterised by immune dysregulation, altered intestinal permeability and microbial insult. Limited knowledge is available regarding the metabolic changes observed during progression of the disease, and limited biomarkers of disease available that have been validated and shown to be of sound clinical value. Aim of Study: A two stage metabolomics approach was adopted to determine if metabolic signature profiles, could distinguish inflammatory bowel disease Crohn’s disease (CD) patients from ulcerative colitis (UC) patients and from healthy controls. Methods: A serum metabolomics approach was undertaken to define metabolic changes associated with UC and CD. Serum samples from a discovery study of 30 UC, 30 CD and 29 ethnically, age and gender matched controls were analysed by ultra-performance liquid chromatography mass spectrometry. A subsequent validation study was preformed using 28UC, 31CD, and 29 gender matched controls were also analysed using UPLC-MS.ResultsClasses of metabolites, identified as biologically interesting and at significantly different levels (p<0.05) in comparisons of control and CD and UC cohorts included: steroids and steroid derivatives, phosphocholine, Vitamin D metabolites, fatty acids and conjugates, glycerolipids, isoprenoids, amino acids, and phosphosphingolipids. There were fewer discriminatory metabolites differentiating the CD and UC cohorts. Conclusion: Serum Metabolomic profiling may represent a novel technology which could be used to distinguish individuals with CD from those with UC and healthy controls.

Bakgrund: Ulcerös kolit och Crohns sjukdom är de vanligaste förekommande inflammatoriska tarmsjukdomarna (IBD), vilka är kroniska och går i skov. Sjukdomarna är mest utbredda i västvärlden, drabbar främst yngre människor samt har en ökande incidens. Symtombilden för sjukdomarna är mångfasetterad och består företrädesvis av diarré, buksmärta, trötthet och viktminskning. Syfte: Syftet var att belysa upplevelsen av hur det är att leva med IBD i det dagliga livet. Metod: En systematisk litteraturstudie som baserades på tio kvalitativa vetenskapliga artiklar. Resultat: Fyra huvudkategorier och fem subkategorier uppenbarades; upplevelse av emotionell påverkan (upplevelse av förändrad kroppsbild, en känsla att inte bli betrodd, medicinens emotionella påverkan), upplevelse av social påverkan (påverkan på familj- och arbetsliv och socialt obehag i samband med elimination), upplevelse av fysisk påverkan samt upplevelse av att tvingas förändra livet. Konklusion: IBD visade sig lämna avtryck på det dagliga livet i flera avseenden, då det synliggjordes att hela människan berördes. Det framkom att individen upplevde att sjukdomen förknippades med skam och pinsamhet samt att det rådde en bristande förståelse hos utomstående. / Background: Ulcerative colitis and Crohn´s disease are the most common inflammatory bowel diseases, which are chronic with relapses. The diseases mainly occur in the Westerns world, mostly affect younger people and are increasing. The symptoms are multifaceted and consist of diarrhea, abdominal pain, fatigue and weight loss. Aim: The purpose was to illuminate the experience of living with IBD in daily life. Method: A systematic literature review based on ten qualitative scientific articles. Results: Four main categories and five subcategories arose; experience of emotional impact (experience of changed body image, a feeling of not being trusted, the emotional impact of the medicine), experience of social impact (influence on family and work life, social discomfort in case of elimination), experience of physical impact and experience of being forced to change life. Conclusion: IBD turned out to affect daily life in several aspects, it appeared that the whole human being was concerned. It emerged that the individual experienced that the disease was associated with shame and embarrassment and a lack of understanding among third party was found.

The aim of this study was to establish a bacteria-induced mouse model of human IBD applicable for investigation of the role of commensal versus pathogenic bacteria in the onset and development of chronic intestinal inflammation. The mouse model introduced in the present work focused on chronic inflammatory reaction triggered by S. enterica infection. Furthermore, differences between the acute and chronic phase of infection were analyzed. Additionally, it was investigated, whether antibiotic treatment prior to infection has a significant impact on the course of the systemic or local mucosal immune response against S. enterica. Due to the significant increase of the IL-22 level reported from IBD patients, and the assumed crucial role of this immunoregulatory cytokine for human IBD a special focus of this study was to analyze the role of IL-22 in the established mouse model of bacteria-induced chronic colitis.

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Inflammatoriska tarmsjukdomar (IBD) kan leda till ett brett spektrum av symtom och påverka många områden i de drabbades liv. Många får diagnosen i sin ekonomiskt och socialt mest produktiva ålder. Syftet med studien var att belysa unga människors upplevelser av att leva med IBD. Metoden som användes var en litteraturstudie där sju vetenskapliga artiklar ingick. Artiklarna baserades på kvalitativa studier och materialet var inhämtat genom intervjuer. Vi fann att de ungas upp-levelser kunde relateras till sex huvudsakliga områden nämligen behandling, framtid, mognad, måltider, relationer och symtom. Hur svår sjukdomsupplevelsen var för de unga berodde på om de vid tillfället var i en stabil eller i en instabil fas i sjukdomen. De upplevde att det i båda fallen krävdes mer ansträngning och efter-tanke av dem än av deras friska jämnåriga. Motsatsen till att vara sjuk uttrycktes ofta ”att vara normal”. Flera unga gav förslag på förbättringar riktade till vården till exempel att i god tid förbereda överflyttning från barn- till vuxenvård. / Inflammatory Bowel Diseases (IBD) can lead to a broad spectrum of symptoms and influence many aspects of the affected person’s life. Many get diagnosed during their most economically and socially productive age. The aim of this study was to display how young people experience living with IBD. The method used was a literary review which included seven scientific articles. The articles were based upon qualitative studies and the material was obtained through interviews. We found that the experiences of the young people could be related to six main themes namely future, maturity, meals, relations, symptoms and treatment. How difficult the experience of the disease were depended on if they at the time were in a stable or instable phase of the disease. In both cases they experienced that it demanded more effort and reflection of them than of their healthy peers. The opposite of being sick was often expressed ”to be normal”. Several young people made suggestions of improvements aimed at health services for example that in good time prepare the transition from pediatric to adult care.