or placebo (table I); the serum potassium concentration showed a statistically significant decrease during treatment with chlorthalidone and chlorthalidone combined with atenolol as compared with during the atenolol or placebo period (table II); and plasma renin activity rose with chlorthalidone and decreased with atenolol, though this was not statistically significant (table II).These findings have important implications. Beta-blockers alone are ineffective in black hypertensive patients, and thiazides rather than beta-blockers should be the baseline treatment of hypertension. When beta-blockers are used in black hypertensive patients they should initially be combined with a thiazide diuretic. Prevalence of urinary incontinence THELMA M THOMAS, KAY R PLYMAT, JANET BLANNIN, T W MEADE Summary and conclusionsThe prevalence of urinary incontinence was investigated by determining the number of incontinent patients under the care of various health and social service agencies in two London boroughs and by a postal survey of the 22 430 people aged 5 years and over on the practice lists of 12 general practitioners in different parts of the country. The prevalence of incontinence known to the health and social service agencies was 0 2% in women and 0 1% in men aged 15-64 and 2-5% in women and 1 3% in men aged 65 and over. The postal survey, to which 89% of the people whose correct address was known replied, showed a prevalence of urinary incontinence of 8 5% in women and 1-6% in men aged 15-64 and 116% in women and 6 9% in men aged 65 and over. Nulliparous women had a lower prevalence than those who had had one, two, or three babies, but within the parity range of one to three there were no differences in prevalence. The prevalence was appreciably increased in women who had had four or more babies. Incontinence was moderate or severe in a fifth of those who reported it in the postal survey, of whom less than a third were receiving health or social services for the condition. Incontinence is a common symptom, and many unrecognised cases appear to exist. There may be considerable scope for improving its management.

Providing residential aged care is challenging because of the complexity of residents' health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed 'The Tri-focal model of care'. This model was developed based on the concepts of 'partnership-centred care', 'positive work environment' and the need for evidence-based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching-nursing home concept and the quality of residential aged care.

Vision screening of all children at school entry has been a traditional practice for many years. Recently, decisions have been made to discontinue screening and to rely on parent and teacher referral methods instead. A review of the literature suggested that parent and teacher referral methods of screening were less than satisfactory, and that professional screening of all children at school entry age should be continued.

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