Validity of self-reported height and weight and derived body mass index in middle-aged and elderly individuals in Australia

Background : Body mass index (BMI) is an important measure of adiposity. While BMI derived from self‐reported data generally agrees well with that derived from measured values, evidence from Australia is limited, particularly for the elderly. Methods : We compared self‐reported with measured height and weight in a random sample of 608 individuals aged ≥45 from the 45 and Up Study, an Australian population‐based cohort study. We assessed degree of agreement and correlation between measures, and calculated sensitivity and specificity to quantify BMI category misclassification. Results : On average, in males and females respectively, height was overestimated by 1.24cm (95% CI: 0.75–1.72) and 0.59cm (0.26–0.92); weight was underestimated by 1.68kg (–1.99– ‐1.36) and 1.02kg (–1.24– ‐0.80); and BMI based on self‐reported measures was underestimated by 0.90kg/m2 (–1.09– ‐0.70) and 0.60 kg/m2 (–0.75– ‐0.45). Underestimation increased with increasing measured BMI. There were strong correlations between self‐reported and measured height, weight and BMI (r=0.95, 0.99 and 0.95, respectively, p<0.001). While there was excellent agreement between BMI categories from self‐reported and measured data (kappa=0.80), obesity prevalence was underestimated. Findings did not differ substantially between middle‐aged and elderly participants. Conclusions : Self‐reported data on height and weight quantify body size appropriately in middle‐aged and elderly individuals for relative measures, such as quantiles of BMI. However, caution is necessary when reporting on absolute BMI and standard BMI categories, based on self‐reported data, particularly since use of such data is likely to result in underestimation of the prevalence of obesity.     

The effect of acetylcysteine on the antioxidant system in an experimental toxic lesion of the liver]

The liver damage by CCl4 in albino rats was followed by a drastic activation of lipid peroxidation processes and suppression of most components of the antioxidant system. The administration of acetylcysteine to the affected animals exerted the positive effect which manifested itself in a decrease of lipid peroxidation products content in the blood plasma and liver and in the partial normalization of the antioxidant protection system.     

When to consult the podiatrist

Mechanical, infectious and neurovascular foot complications are common in rheumatic diseases, partly because disabled rheumatic patients are unable to do their own daily foot-care. Proper diagnosis and treatment needs the close cooperation of the rheumatologist, podiatrist, physiotherapist and occupational therapist; the podiatrist is an important member of this multidisciplinary team.     

Hypertension in pregnancy. A study of 142 women presenting before 32 weeks' gestation

This study evaluates the outcome of 142 consecutive pregnancies in women in whom hypertension was diagnosed before 32 weeks' gestation and who were managed by a team comprising obstetricians, physicians and perinatologists. Arterial pressure was lowered to 140/90 mmHg or lower with clonidine hydrochloride or methyldopa therapy to which, in most cases, a vasodilator, hydralazine or diazoxide was added. The outcome of patients who were managed by the multidisciplinary team from the clinical onset of their disease was compared to the outcome of those who were transferred after the onset of hypertension from other centres. A greater perinatal mortality rate was found among the infants of patients with pre-eclampsia and patients with essential hypertension in pregnancy when the mothers were referred late for management. Reasons for the difference in pregnancy outcome are not clear. Possible explanations are discussed which emphasize the need for further study to establish optimal management of this common complication of pregnancy.     

Plasma unconjugated 15alpha-hydroxyoestriol (oestetrol) levels in normal human pregnancy.

Serial measurements were made of the concentration of plasma unconjugated oestetrol in normal human pregnancy. The mean curve and limits of normal variation have been established. Plasma levels rose from just below 2 ng/ml at 20 weeks to approximately 5 ng/ml at term.     

Assessment of placental function in normal and pathological pregnancies by estimation of plasma oestradiol levels after injection of dehydroepiandrosterone sulphate.

A test of placental function was assessed by measurement of plasma oestradiol levels in 32 patients after intravenous injection of 50 mg dehydroepiandrosterone sulphate (DHAS). Every pregnant patient showed a rise in plasma oestradiol after DHAS; two puerperal patients showed no rise. It was not possible to distinguish the variable response in normal pregnancy from that in patients with severe hypertension and proteinuria or with retarded intrauterine fetal growth. The test was of no value in one hypertensive patient as a predictor of fetal death eight days later or, in another, to confirm fetal death of two days duration. Our results do not suggest that this test is a useful addition to currently available tests of placental endocrine function.     

The association of obstructive defecation,lower urinary tract dysfunction and the benign joint hypermobility syndrome: A case–control study

It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.     

Regional musculoskeletal conditions: foot and ankle disorders

Foot pain is very common, especially in women, owing to inappropriate footwear. Overuse, repetitive strain and minor, easily forgettable injuries may result in chronic foot and ankle pain. Rheumatoid arthritis, spondyloarthropathies and gout frequently affect the foot, often as a first presentation. Charcot's joints and foot infections are not rare in diabetes. The rheumatologist should be familiar with foot disorders, either localized or as manifestations of generalized disease. History taking, physical examination, identification of the source of pain by intra-articularly given local anaesthetics and imaging methods should be used to reveal the underlying disorder. Correct diagnosis and efficient therapy-including local steroid injections, physiotherapy, orthoses, surgery-are necessary not only for treatment but also for preventing biomechanical chain reactions.This chapter gives an overview of the epidemiology, diagnosis and treatment of foot pain and foot disorders caused by both local and generalized diseases.