Intended for healthcare professionals



BMJ 1997; 315 doi: (Published 11 October 1997) Cite this as: BMJ 1997;315:960

The incidence of coeliac disease in childhood has declined in Britain in the past 20 years, but it has risen in Sweden and stayed constant in Italy. A paper in Archives of Disease in Childhood (1997;77:206-9) claims that these trends reflect changes in infant feeding practices. The risk of an infant developing coeliac disease is reduced if gluten is withheld until at least 5 months. Foods that are free of rice and gluten should be used for initial weaning, the report concludes.

The current issue of Advances in Psychiatric Treatment (1997;3:250-311) deals with the treatment and management of sick doctors. It includes some helpful material on dealing with stress and burnout, defined as “a progressive loss of idealism, energy, purpose, and concern as a result of conditions at work.” The best protection against the harmful effects of stress may be to ensure that the most enjoyable components of a job are not sacrificed to meet clinical or administrative demands.

Despite directly observed therapy, enablers, and incentives, some patients with tuberculosis remain persistently non-adherent—a sentence in current jargon from a paper in JAMA (1997;278:843-6) on a growing problem. New York City and California have enacted measures that permit long term civil commitment of patients who are persistently non-adherent. A study of 67 such patients …

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