Upregulation of hepatic bile acid synthesis via fibroblast growth factor 19 is defective in gallstone disease but functional in overweight individuals

Background: Fibroblast growth factor 19 (FGF19) is an enteric hormone regulating bile acid de novo synthesis by sensing ileal bile acid flux. However, the role of FGF19 in cholelithiasis has not yet been elucidated and therefore is investigated in the present study. Methods: Total mRNA and protein were isolated from ileal biopsies and used for tissue expression analysis. FGF19, 7α-hydroxycholesterol (7α-OH-Chol), 27-hydroxycholesterol (27-OH-Chol), and different bile acids were determined in the blood samples. Results: FGF19 serum levels did not differ between gallstone carriers and controls but were significantly decreased in the overweight individuals (−32%, p = 0.0002), irrespective of gallstone status (normalweight to overweight controls −29%, p = 0.0017; normalweight to overweight gallstone carriers −44%, p = 0.0338), and correlated inversely with bodyweight (p < 0.0001, ρ = −0.3317). Compared to non-overweight controls, apical sodium-dependent bile acid transporter expression was significantly diminished in the non-overweight gallstone carriers (−42%, PmRNA = 0.0393; −52%, pprotein = 0.0169) as well as in the overweight controls (−24%, PmRNA = 0.0148; −43%, pprotein = 0.0017). FGF19 expression varied widely and was similar in all groups. A significant negative correlation was noted between 7α-OH-Chol, 27-OH-Chol, and FGF19 serum levels (p < 0.01; ρ7α-OH-Chol = −0.2155; ρ27-OH-Chol = −0.2144) in obesity. Conclusion: Upregulation of hepatic bile acid synthesis via FGF 19 is defective in gallstone disease but functional in overweight individuals

Rasch Measurement Analysis of a 25-Item Version of the Mueller/McCloskey Nurse Job Satisfaction Scale in a Sample of Nurses in Lebanon and Qatar

The Mueller/McCloskey Nurse Job Satisfaction Scale (MMSS) is widely used, but its psychometric characteristics have not been sufficiently validated for use in Middle Eastern countries. The objective of our methodological study was to determine the psychometric suitability of a 25-item version of the MMSS (MMSS-25) for use in middle-income and high-income Middle Eastern countries. A total of 1,322 registered nurses, 859 in Lebanon and 463 in Qatar, completed the MMSS-25 as part of a cross-sectional multinational investigation of nursing shortages in the region. We used the Rasch rating scale model to investigate the psychometric performance of the MMSS-25. We identified possible item bias among MMSS-25 items. We conducted confirmatory factor analyses (CFA) to compare the fit to our data of five factor structures reported in the literature. We concluded that irrespective of administration in English or Arabic, the MMSS-25 is not sufficiently productive of measurement for use in the region. A core set of 13 items (MMSS-13, Cronbach’s α = .82) loading on five dimensions eliminates redundant MMSS items and is suitable for initial screening of nurses’ satisfaction. Of the five factor structures we examined, the MMSS-13 was the only close fit to our data (comparative fit index = 0.951; Tucker–Lewis index = 0.931; root mean square error of approximation = 0.051; p value = .401). The MMSS-13 has psychometric characteristics superior to MMSS-25, but additional items are required to meet the research-specific objectives of future studies of nurses’ job satisfaction in Middle Eastern countries