Can self-reported height and weight be relied upon?

AIMS: To assess whether self-reported height and weight [and body mass index (BMI)] can be used in workplace health promotion campaigns. METHODS: Volunteers were instructed how to measure their weight, height and waist circumference (WC). Self-reported values were compared with direct measurements. Accuracy was assessed using simple (self-report - actual) and percentage difference [(self-report - actual)/(actual measurement)]. The distribution of differences (in weight, height and BMI) across age and BMI classes was calculated plus Pearson (parametric) and Spearman (non-parametric) coefficients of correlation, to assess relation of differences (simple and percentage) with actual values. For percentage differences, classes were created to explore differences in mean values of actual measurements across various difference classes, using analysis of variance. RESULTS: Eight hundred and fifty-seven workers took part; 585 (68%) provided all requested data. 'Statistical analysis showed that men and the whole group underestimated their BMI due to overestimating their height and underestimating body weight'. Similar trends were seen in females, especially the centrally obese ones (WC >80 cm), but women as a group were more accurate than men in anthropometric self-reports. Males >40 years of age underestimated their weight. CONCLUSIONS: This study showed that the differences between actual and self-reported values depend on the actual values and self-reported anthropometric measurements cannot be relied upon, at least in males. Females seem to provide more accurate reports than men and we could consider their measurements reliable, although a further study with a larger number of female participants would be needed.

Surveillance case definitions for work related upper limb pain syndromes.

OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. RESULTS: Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diffuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. CONCLUSIONS: There was enough consensus between several health professionals from different disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management.

Hepatitis B--are surgeons putting patients at risk?

The 1993 Department of Health guidelines permit a surgeon who is hepatitis B surface antigen (HBsAg) positive but e-antigen (HBeAg) negative to perform exposure prone procedures, unless demonstrated to have infected patients. However, there is increasing evidence of transmission of hepatitis B to patients from health care workers in this supposedly low infectivity category. The Occupational Physician must decide whether existing guidelines represent an adequate risk assessment and indeed whether this is an acceptable risk for patients. If an NHS Trust continues to follow these guidelines it may be in breach of its duty of care to patients. Yet refusing to allow such carriers to operate without testing for additional serological markers may be unlawful discrimination. Further research is clearly needed as well as an urgent review of the guidelines.

In-vitro evaluation of antifungal agents in the treatment of yeast peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD).

This study compared the static and kinetic activities of six antifungal agents, in broth and used dialysate, against six yeast strains known to have caused peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). Minimum inhibitory concentrations (MIC) and IC50 results show a trend towards greater activity by amphotericin B, 5-fluorocytosine, tioconazole and itraconazole in comparison to miconazole and ketoconazole although there was some strain variability. Minimum fungicidal concentrations (MFCs) of amphotericin B were less than or equal to 1mg/l, while 5-fluorocytosine and the azoles showed large discrepancies between MIC and MFC values. In kinetic studies amphotericin B was the most potent fungicidal agent. 5-fluorocytosine showed modest activity and failed to achieve total killing. The azoles demonstrated variable degrees of inhibition of C. glabrata and showed minimal activity with C. albicans. Itraconazole showed good activity against C. parapsilosis in broth. All agents, with the exception of 5-fluorocytosine, showed reduced activity in used dialysate in comparison to broth.