Objectives -To determine why, in the London Borough of Hackney before 1990, fewer children than expected were identified with remedial causes of short stature. To construct a practical model for height surveillance of 5 and 11 year old school entrants to improve the quality of child growth surveillance. Setting -City and Hackney Borough, London, United Kingdom. Methods -School nurses were trained by a clinical auxologist to measure children's height at school entry accurately and reproducibly. New procedures for measurement technique, plotting of data, referral, and audit were established. A reference manual was provided and a continuing training programme was started. Results -During the first year the percentage of the target group measured was low. Changes in work practice led to improvements from 77% measured in the first year to 91% in the second year and 87% in the third year for 5 year olds. Improvements for 11 year olds were from 36% to 86% to 87% over the three years. Only 1·2% of 5 year olds and 2·6% of 11 year olds measured had height less than the third centile (compared with Tanner's height standards). Conclusions -School nurses measured height reliably. New audit procedures led to rapid changes in working practice and improvements in the percentage of children measured. The low numbers of short children previously identified with UDrecognised abnormality may indicate an upward trend in height in this inner city population.

Data were collected on the seven day weighed food intakes of 65 schoolchildren, aged 12-13 years, living in an inner city, socially deprived area in east London. Blood samples were collected during the week and analysed for cholesterol, serum ferritin, vitamins A, E, B-12, a carotene, and folic acid.Boys generally fared better than girls with almost a quarter of the girls having intakes of calcium, magnesium, iron, zinc, vitamin A, and riboflavin less than the lower reference nutrient intake, an amount which, by definition, is enough for only the few people in a group who have low needs. Although the mean energy intake was close to the estimated average requirement for both boys and girls, 740/o did not meet the recommended intake for fibre and a high proportion of children consumed more than 11% oftheir energy from saturated fat (85%) and added sugar (88%).Thirty seven per cent ofthe children ate no fresh fruit during the week they kept a diary and only 19% had vegetables (fresh or frozen), other than potatoes, on a daily basis. Their main sources of energy were chips, bread, and confectionery.No association was found between fat intakes and plasma cholesterol concentrations. Girls had significantly lower blood concentrations offolic acid, ferritin, and a carotene.The findings of this study confirm the anxieties often expressed that many schoolchildren, particularly in less affluent areas, are eating diets which are unhealthy according to government recommendations.

To establish the reliability of school nurses given training in height measurement we conducted an intra- and inter-individual reliability study under field conditions. The measurements of 7 school nurses were compared with those of a trained auxologist. The pooled standard deviation of the differences between repeat measurements for the school nurses (0.32 cm) compared favourably with that of the auxologist (0.35 cm). Height measurements made by school nurses were accurate within the range of -0.53 cm to +0.64 cm when compared with the auxologist. We conclude that a single, accurate height measurement made by a school nurse would be sufficiently reliable for use in routine screening for short stature.

The UK 1990 height charts are derived from an up to date dataset and introduce a change in the centile lines, particularly the addition of the 0-4th centile. This study examined the likely impact of these changes. Height data from London school children (1990)(1991)(1992)(1993) were examined using Tanner and Whitehouse (TW) and UK 1990 charts. Numbers of children with height below TW 3rd centile were compared with numbers below the UK 1990 3rd and 0*4th centiles. The TW charts identified only 1% of children below the TW 3rd centile, while the UK 1990 charts identified 3°/0 below the 3rd and 0.40/o below the 0-4th centiles. If the 3rd centile remains as the referral 'cut off' for short stature, the introduction of the UK 1990 charts would increase current workload two-to threefold, while a change to the 0-4th centile would reduce it by 500/O. A significant number of children with abnormalities may be excluded from further assessment as a result of this latter change. In this small scale community study it is not possible to assess the consequences of this change. The heights at diagnosis of children with growth hormone (GH) deficiency (peak GH <20 mU/l during a standard provocation test) were therefore compared to the 0-4th centile (UK 1990 charts). Sixty eight children with heights <2nd centile (UK 1990 charts) currently receiving GH replacement (17 female, 51 male, aged 9 7, SD 3 5, years) were assessed, and of these, 28 (41%) had heights at diagnosis between 0-4th and 2nd centile, with a mean height standard deviation score of -2-32 (SD 0.21 (TW).3 It has been suggested that in these cross sectional data charts, the lowest centile (0-4th), that is, -2-67 SD, should be used as a more practical 'cut off' for growth surveillance programmes than the current TW 3rd centile.2 The purpose of this report is to assess the potential effects of such changes on community height surveillance.This study is based on the examination of a dataset collected by school nurses in the inner city area of the London Borough of Hackney between 1990 and 1993.4 The three questions asked were first, do the UK 1990 charts more accurately represent the current child population of Hackney than the TW charts? Second, if it is appropriate to use the new charts, what would be the effect of the change from TW charts to the new growth charts on the workload of community health workers? Last, what would be the effect on the referral of children with short stature if the cut off for referral were changed from the 3rd to the 0-4th centile? Methods Heights of children were measured by a school nurse at school entry examinations at age 5 years or 11 years.4 A free standing technique using a minimeter was employed.5 6 The name, date of birth, sex, date of measurement, and height of the child were recorded. The accuracy and reproducibility of the nurses' measurements were satisfactory.5 The height data were compared with the TW 3rd centile, UK 1990 3rd centile, and UK 1990 04th centile. Children with height less than these cut off points we...

The effect of clinical experience on the accurate and reliable interpretation of auscultated lung sounds was examined by comparing 16 new graduates (Group A) with 16 experienced cardiopulmonary physiotherapists (Group B). Subjects listened to a tape comprising six different lung sounds, with each sound repeated three times in random order. Group B tended to be more accurate than Group A for five of the six sounds but the difference was significant only for the normal breath sound (χ(2) = 6.72, p = 0.01). Intra-rater reliability was poor; for any individual sound, a maximum of nine subjects recorded the same response on all three occasions. There were no significant inter-group differences in reliability. In conclusion, clinical experience had no significant effect on accuracy and reliability.