'Health assessment' at school entry: performance of a system based on school nurse interviews.

OBJECTIVES: To describe the performance of a school entry 'health assessment' based on school nurse interviews. BACKGROUND: Universal medical examination at school entry has largely been replaced by a 'health assessment' led by the school nurse, based on screening tests, a health interview, eliciting parental and professional concern and past history. As a result children with possible problems are selected for school medicals, reviewed in school or referred to a range of health professionals and other agencies. SETTING: Inner city south-east London. SUBJECTS: Children born between 1/3/89 and 31/8/89 who were on the class lists of 21 randomly selected primary schools. DATA COLLECTION: A form for each subject was distributed to the school nurse and completed as children were invited for screening, school health interviews and medical examinations. MAIN OUTCOME MEASURES: Proportion of subjects attending, patterns and proportions of reviews and referrals. RESULTS: 426 children were eligible for inclusion and 419 (98%) forms were returned. 232 children were seen for a health interview and a further 50 were screened for vision, hearing and growth problems only. 124 had no contact with the school nurse or doctor. Following health interview or screening, 180 children were reviewed and/or discussed with other health professionals. 71 external referrals were made. CONCLUSION: Adequate coverage at school entry is difficult to obtain. The objectives of school entry health assessment and the relationship between selection criteria and health needs require clarification.

Tinea capitis in south-east London--a new pattern of infection with public health implications.

Recent observations on tinea capitis cases in London suggest that there has been a change in the pattern of infection with a recent and significant rise in the incidence of infections due to anthropophilic fungi. The purpose of this study was to investigate the prevalence and identity of tinea capitis in schools in south-east London and factors which might affect the spread of infection. This was achieved by carrying out a survey of all children, with parental consent for scalp examination, in 14 nursery, infant or junior schools in Lambeth. In addition, the accuracy of clinical diagnosis was compared with mycological findings. There were 1057 children from 4 to 14 years of age in the study. The infection rate in different schools ranged from 0 to 12% with a mean of 2.5%. A further 4.9% of children were scalp carriers of dermatophytes (range in classes 0-47%). A striking feature was that all infections were caused by anthropophilic fungi, mainly Trichophyton tonsurans or Microsporum rivalieri, and there was a correlation between the presence of two or more carriers within a class and the infection in the other children. There was a poor correlation between ability of trained observers to predict infection on clinical grounds and mycological results. This investigation shows variable but significant levels of scalp ringworm in schools and that the dominant organisms are anthropophilic. It provides support for the observation that there has been a shift in the pattern of tinea capitis in London and, possibly, other U.K. centres, with a trend towards more infections transmissible among children, with T, tonsurans being the commonest organism. The implications for control, which involve screening in schools, where appropriate, and guidance to general practitioners on treatment, are discussed.

Growth screening in schools: an evaluation of the programme in one district.

It has been recommended that all children should have their height and weight measured at school entry, although the disadvantages associated with screening and the benefits, in terms of a change in outcome, have not been fully established. The measuring equipment used in schools, recording of anthropometric data and adherence to local guidelines were assessed across one district. Few schools had the recommended equipment, problems with accuracy were common and screening coverage was low. The achievement of optical outcome will require a reduction in the gap between local practice and recommended policy: guidelines should recognize difficulties encountered in the field.

Takayasu's arteritis as a differential diagnosis of systemic juvenile chronic arthritis.

After a series of throat infections an 8-year-old girl presented with fever and limb pain, initially diagnosed as juvenile chronic arthritis. Persistent symptoms led to further investigations when she was shown to have an arteritis affecting her aorta.