Seventy five patients with chronic respiratory disability were randomised to a group visited by a respiratory health worker (42) or control group (33). The first group was visited monthly by a respiratory nurse, who gave education and support. The effect of the intervention was assessed in terms of quality of life (by questionnaires), the number and duration of admissions to hospital, and the number of deaths. The questionnaires on quality oflife showed no changes in either group during the study, but nearly all of the group visited by a respiratory health worker said that they valued the visits and wished them to continue. Their knowledge about their condition also improved compared with that of the controls. The duration of stay in hospital for respiratory reasons in the group visited by a respiratory health worker was longer than that of control patients. This was explained by their being scored as more ill than the controls on

Summarizes the difficulties facing today’s adolescents and data on the prevalence of risk‐taking behaviour which threatens their health. Describes how the school nurse is in a unique position to influence the health of school age children, and is often perceived by them as a caring, listening person whom they can trust. Suggests that school health services are in a rut, straddling the boundary between health and education services and failing to fit neatly into the primary health care team. Outlines how this is having a weakening effect, as providers and purchasers are unwilling to support a service which appears expensive and of questionable value. Deplores the lack of documented evidence on the effectiveness of school health services. Applauds authorities which have replaced routine medical examinations with more appropriate services. Urges the school health service to design services which recognize adolescents as a group with specific health needs. Makes a list of recommendations for achieving this aim.

This paper describes the work of two nurses visiting patients with chronic respiratory disease at home. The outcome measures suggested that there were fewer deaths in the nurses' group but failed to show any changes in quality of life. The nurses chose the nursing model devised by Roper et al. as a framework for their intervention. Initial assessment by the nurses showed the patients had a number of problems which could be grouped into physical health, knowledge, psychosocial and social. The nurses' monthly visits were used to assist the patients to plan strategies for resolving their problems. Advice was directed at helping patients promote and control their own health and measurable goals were set. Most of the patients achieved the goals set, valued the visits and said they wished them to continue. Psychosocial problems proved most difficult to solve. Patients' knowledge was demonstrated to have increased. A nursing audit found the patients had received 'excellent' quality of care. The nursing method used in this study would be appropriate for such work as it focuses attention on the individual patient and his problems. Application of this approach will require education and support for nurses.

2 Simpson LO, Shand BI, Olds RJ. The effects of dietary supplementation with Efamol on the healing rate of intractable leg ulcers: a pilot study. NZ Family Physician 1986;13:68-70. 3 Kury PG, Ramwell PW, McConnell HM. The effects of prostaglandins El and E2 on the human erythrocyte as monitored by spin labels. Biochem Biophys Res Commun 1974;56:478-83. 4 Rasmussen H, Lake W, Allen JE. The effects of catecholamines and prostaglandins upon human and rat erythrocytes. Biochim BiophysActa 1975;411:63-73. 5 Kamada T, Yamashita T, Baba Y, et al. Dietary sardine oil increased erythrocyte membrane fluidity in diabetic patients. Diabetes 1986;35:604-1 1. 6 Cartwright IJ, Pockley AG, Galloway JH, Greaves M, Preston FE. The effects ofdietary omega-3 polyunsaturated fatty acids on erythrocyte membrane phospholipids, erythrocyte deformability and blood viscosity in healthy volunteers. Atherosclerosis 1985;65:39-46. 7 Adair HM. Epidermal repair in chronic venous ulcers. BrJ Surg 1977;64:800-4.

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