Minerva

Child growth and coeliac disease . . . and other stories

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5196 (Published 16 November 2017) Cite this as: BMJ 2017;359:j5196

Early growth in children with coeliac disease

A cohort study in Norway measured the growth of nearly 60 000 children on six occasions during the first two years of their lives (Arch Dis Child doi:10.1136/archdischild-2016-31230). This allowed investigators to look back at the early development of the 440 children who were later diagnosed with coeliac disease. They found that differences in growth rates emerged long before any gastrointestinal symptoms became apparent. As a group, the children with coeliac disease had been shorter from 12 months old and lighter from 18 months.

Psychological stress declines rapidly after middle age

Up to the age of 50, nearly half of American adults say yes if asked whether they experienced stress for a lot of the day yesterday. After 50 however, the proportion drops sharply, and, by the age of 75, only 1 in 5 responds positively. The pattern is unaltered by taking account of factors such as employment, social support, marital status, health conditions, health insurance, and church attendance (J Psychosomat Res doi:10.1016/j.jpsychores.2017.09.016). It seems that, regardless of their social situation and whether they are well or ill, Americans report stress much less frequently from middle age onwards.

Chronic widespread pain

Data from UK Biobank, a longitudinal study of half a million adults, show that mortality among people with chronic widespread pain syndromes is double that of people without chronic pain (Ann Rheum Dis doi:10.1136/annrheumdis-2017-211476). Deaths from cancer, cardiovascular, and respiratory diseases were all commoner in people who had reported “pain all over the body.” However, adjustment for low levels of physical activity, high body mass index, poor quality diet, and smoking substantially reduced the excess risk. Doctors often find it hard to help patients with chronic widespread pain but it looks as if encouraging a healthier way of life would be worthwhile.

Best practice after cardiac arrest

National and international guidelines for advanced life support were updated in 2015. A survey of English National Health Service acute hospital trusts finds that the recommendations have been taken up variably and incompletely (Postgrad Med J doi:10.1136/postgradmedj-2016-134732). Waveform capnography and ultrasound were often unavailable and post-resuscitation debriefing occurred at only a few trusts. On the other hand, most hospitals were taking part in quality improvement strategies such as the National Cardiac Arrest Audit.

Reporting of interventions for patellofemoral pain

A recent Cochrane review found strong evidence that exercise therapy was effective for people complaining of patellofemoral pain (Br J Sports Med doi:10.1136/bjsports-2017-097547). It reduced severity of pain in both the short and long term, and improved function. But a review of the quality of reporting discovered that not a single study gave enough detail about their exercise programme to allow full replication. How can anyone implement exercise therapy for patellofemoral pain if they can’t find out what it is?

Progress in acute myocardial infarction

In 1955 the US president Dwight Eisenhower complained of indigestion while playing golf. The next day, an electrocardiogram revealed an anterolateral infarction with ST segment elevation. At that time, no one knew that aspirin inhibited platelet aggregation, defibrillators had still to be invented, and beta blockers and statins weren’t even twinkles in a pharmacologist’s eye. However, it’s probably prompt revascularisation that has made the biggest difference to outcomes after acute coronary events. SWEDEHEART registry data show that mortality almost halved between 1995 and 2014 (Eur Heart J doi:10.1093/eurheartj/ehx569).

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