Transfusion-acquired babesiosis in a nonendemic area

Babesiosis is a tick-borne illness endemic to the coastal areas of southern New England. Despite the enormous safety measures that transfusion and blood bank services perform for each product, transfusion of blood products is not without risk. The majority of transfusion-related reactions and complications are recognized soon after transfusion. We report a case of transfusion-acquired babesiosis in Washington State that presented 4 weeks after transfusion of a blood product from a donor living in a babesiosis-endemic area.     

Cognitive determinants of energy balance-related behaviours: measurement issues

The burden of disease as a result of overweight and obesity calls for in-depth examination of the main causes of behavioural actions responsible for weight gain. Since weight gain is the result of a positive energy balance, these behavioural actions are referred to as 'energy balance-related behaviours' (EBRBs). In the broadest sense, there are only two EBRBs: food intake and physical activity. However, both diet and physical activity are complex behavioural categories that involve a variety of actions. This article discusses the potential problems and opportunities related to the assessment of cognitive determinants of energy intake and energy expenditure behaviours. We argue for the necessity of studying determinants of EBRBs within an energy balance approach, i.e. focusing on energy input as well as output, instead of only studying dietary change or physical activity behaviour. As a result, however, theoretically sound questionnaires assessing determinants of EBRBs are likely to annoy respondents. It is especially the measurement of the behaviours and the use of belief-based constructs that cause questionnaires to be long, which may lead to low response rates and invalid data. In this article, we propose a careful and systematic consideration of the inclusion or exclusion of measures of cognitive determinants. First, if studies show that an EBRB is strongly influenced by environmental factors and is not or only to a minor extent under intentional control, measurement of cognitions is of little use. Second, only when we have proof that attitudes, norms and perceived behavioural control predict intentions, should we aim to assess the underlying beliefs. Third, since assessment of beliefs results in similar or better prediction than using belief-valuation combinations, we should not 'annoy' respondents with valuation items. Finally, we argue that the traditional paper-and-pencil survey is still the most reliable and practical data collection method. However, pilot studies applying computerised adaptive methods to determinants of EBRBs are encouraged.     

Becoming a competent clinician: basic competencies in intervention

This article summarizes the results from the Intervention Work Group of the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The generic charge presented to the Intervention Work Group was "to address issues related to interventions." The Intervention Work Group identified four competency components of knowledge, skills, and abilities: (a). foundational competencies; (b). intervention planning; (c). intervention implementation; and (d). intervention evaluation competencies. A fifth component that included "practice management" was labeled as "others." Each component is discussed, including competencies that were deemed an essential knowledge, skill, and/or value. A discussion of training for intervention competence and assessing that intervention competence is included. Future directions for the science and practice of psychology in the intervention arena are summarized. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Drug-related problem classification systems

OBJECTIVE: To provide an overview of and critically appraise classifications of drug-related problems (DRPs) for use during the pharmaceutical care process and research in pharmacy. DATA SOURCES: A literature search was conducted using MEDLINE and Yahoo (January 2003) and manually. The search terms included DRP, drug-related problem, drug-therapy problem, and medicine-related problem. STUDY SELECTION AND DATA EXTRACTION: English- and German-language articles on pharmaceutical care and DRPs were reviewed. DATA SYNTHESIS: Most classifications of DRPs were identified through searching publications on pharmaceutical care and DRPs. Fourteen classifications with different focuses were found. Some classifications were hierarchical, categorized into main groups and subgroups. Various terminologies and definitions for DRPs were revealed, as well as guidelines for an optimal DRP classification. Classifications were assessed according to a clear definition, published validation method, and results reflecting process and outcomes, usability in pharmaceutical care practice, and a hierarchical structure with main groups and subgroups. CONCLUSIONS: Finding DRP classifications by computerized search of the biomedical literature with the help of PubMed proved to be difficult. No classification could be found that met all of our criteria for an optimal system. Few classifications have been validated. Three have been tested as to their usability in practice and internal consistency. The Pharmaceutical Care Network Europe system Version 4 comes closest to the defined requirements.     

Obesity and colon cancer: Does leptin provide a link?

Obesity, a risk factor for colorectal cancer, is associated with elevated serum levels of leptin, the adipocyte-derived hormone, and insulin. Experimental and epidemiologic studies have indicated a role for insulin in the pathogenesis of colon cancer, and recent experimental studies have suggested a similar role for leptin. In a case-control study nested in the Janus Biobank, Norway, we measured serum levels of leptin and C-peptide (a marker of pancreatic insulin secretion) in cryopreserved prediagnostic sera from men (median age, 45 years) who were diagnosed with cancer of the colon (n = 235) or rectum (n = 143) after blood collection (median time, 17 years), and among 378 controls matched for age and date of blood collection. Conditional logistic regression analyses showed an approximately 3-fold increase in colon cancer risk with increasing concentrations of leptin up to an odds ratio (OR) of 2.72 (95% CI = 1.44-5.12) for top vs. bottom quartile (p(trend) = 0.008). The corresponding OR for C-peptide was 1.81 (95% CI = 0.67-4.86; p(trend) = 0.19). The risk estimates remained unchanged after mutual adjustment. No association of hormone levels with rectal cancer risk was found. Reproducibility of hormone measurements assessed by intraclass coefficients (ICCs) for paired samples taken 1 year apart was high for leptin (ICC = 0.82) but lower for C-peptide (ICC = 0.30). Our results suggest that leptin is a risk factor for colon cancer, and that leptin may provide a link between obesity and colon cancer. Leptin may be directly involved in colon tumorigenesis or it may serve as a sensitive and robust marker of an obesity-induced adverse endocrine environment. Only weak support for an association of insulin with colon cancer was found.     

Serum insulin-like growth factor-1 is an independent predictor of prognosis in patients with renal cell carcinoma

Obesity is associated with an increased risk of certain cancers, including renal cell carcinoma. A possible mediator of this risk is insulin-like growth factor-1 (IGF-1). The authors evaluated the prognostic information of IGF-1, IGFBP-3, leptin, and prealbumin in sera sampled at diagnosis from 256 consecutive patients with renal cell carcinoma. Insulin-like growth factor-1 and leptin were positively correlated to body mass index (BMI). Insulin-like growth factor-1 and IGFBP-3 did not correlate to tumour stage or grade. Leptin and prealbumin were both inversely related to tumour stage and grade. When survival was analysed in patients with levels above a median of IGF-1, leptin, and prealbumin, prognosis was more favourable, compared with those with lower levels (p=0.017; p=0.024, and p<0.0001, respectively). In a multivariate analysis, tumour stage and serum IGF-1 levels were independent prognostic factors. The results indicate that serum IGF-1 at diagnosis is related to prognosis in renal cell carcinoma.