We received a short paperfrom Dr Williams raising the issue ofmedical confidentiality as encountered by general practitioners in cases of child sexual abuse. Similarly, we received a letterfrom Dr Singh describing a conflict with his local social services department about the confidentiality of information requested by the department for inclusion in a mental handicap register. We asked a general practitioner, a consultant psychiatrist, a consultant paediatrician, an expert in medical ethics, and a solicitor to comment on these two cases.

Many authorities had no named person with responsibility for a child health strategy. Of those that did, most named persons had inadequate experience and few had postgraduate qualifications in child health. Most authorities had no comprehensive planning mechanisms for children's services. In consequence, most commissions were failing to comply with the UN Convention on the Rights of the Child.

This article discusses the ethical considerations involved in population-focused work. Identification and selection of appropriate health promotion interventions are also addressed.

No abstract

on " Unexplained Steatorrhoea in the Syndrome of Hyponatraemia and Carcinoma of Bronchus" (February 3, p. 287). They conclude that inappropriate secretion of antidiuretic hormone was the most likely cause of the hyponatraemia and renal salt wasting in their patient. This seems a reasonable supposition in the light of other published cases. However, no statement is made in the report that the urine was consistently hypertonic to plasma, in the face of plasma hypotonicity. In fact, it is stated that the patient could dilute normally to a specific gravity of 1002. This would seem inconsistent with the thesis that there was increased antidiuretic hormone activity unless, at the time of the test, renal tubular responsiveness to A.D.H. had decreased, perhaps through potassium depletion. The high ammonium output in relation to pH after ammonium chloride loading possibly reflects the urinary tract infection present in this patient; a defect in acidification of tubular origin is unproven. This finding would be equally consistent with an acquired defect due to potassium depletion. The negative response to nicotine stimulation, and the impaired ability to concentrate urine after pitressin, could be explained on a similar basis. The results of these tests suggest either that inappropriate A.D.H. secretion was a transient phenomenon, not operating throughout the patient's illness, or an acquired renal resistance to A.D.H. had developed, perhaps due to potassium depletion, a likely consequence of steatorrhoea. Pyelonephritis would be a less likely alternative explanation.-I am, etc.,