An outbreak of scabies in a school for children with learning disabilities.

An outbreak of scabies was detected in autumn 1992 at a school for children with learning disabilities. Because of the scale of the outbreak all the children at the school, and their contacts, were treated on one 'mass treatment day'. Scabies is still widely misunderstood and carries a social stigma, which makes investigation and control more difficult than it would otherwise be.

Legionnaires' disease in elderly people: the first sign of an outbreak in the community?

Legionella pneumophila is responsible for up to 5% of cases of community-acquired pneumonia and mainly affects people aged over 50 years. The confirmation of legionellosis in two elderly patients living close to each other prompted a search for other cases. A total of eleven subjects with legionnaires' disease was recognized. The clinical findings are described and the diagnosis of legionellosis is discussed. Environmental investigations pointed to a cooling tower in the local town centre as the probable source of infection.

Compliance following referral in the early detection of oral cancer and precancer in Sri Lanka.

An innovative approach for the early detection of oral cancer and precancer within the context of the primary health care system has been field tested in Sri Lanka. The overall compliance in accepting this particular PHC approach for cancer screening, as estimated by arrival at a referral centre manned by consultant staff, was 54.1%. Nearly 80% of those who turned up without needing an additional reminder, did so within the first 2 weeks of case finding. There was a variation in the degree of compliance depending on the primary health care worker who did the screening and referral. Compliance was greater when the screening area was nearer to the referral centre and in subjects who were diagnosed as having a more advanced stage of the disease. Certain practical considerations that contributed to noncompliance were identified. Postal reminders were seen to increase overall compliance by 10.9%.

Utilization of primary health care workers for early detection of oral cancer and precancer cases in Sri Lanka.

Oral cancer presents a serious public health problem in south-east Asian countries. In Sri Lanka and India 35-40% of all cancers are reported to be oral cancers, which are curable if detected in the early stages. The idea that, in developing countries, one of the few practical approaches to early detection of these cases could be through the utilization of primary health care workers was tested in a field study carried out in Sri Lanka. In a control area the subjects with oral lesions were identified by medical/dental officers. In the study, 34 primary health care workers were able, alongside their routine duties, to examine the oral cavity of 28 295 subjects during a period of 52 weeks; 1220 subjects were detected with lesions needing re-examination. The performance of these primary health care workers was very satisfactory in terms of the number of cases detected and the accuracy of their diagnoses, which were verified by re-examination at a specially designated referral centre. The clinical diagnoses of the three categories of lesions detected were as follows: stage 1 lesions for observation (homogeneous or ulcerated leukoplakia), stage 2 lesions for investigation (speckled leukoplakia, erythroplakia, or submucous fibrosis), and stage 3 lesions for treatment (cancer). There was 89% correspondence between the stage 1-3 diagnoses by the health workers and the clinical diagnoses made at the referral centre. However, compliance by patients was low because only 50% of the cases detected in the field attended the referral centre. The cost-effectiveness of this approach to cancer control has been demonstrated.