OBJECTIVES. To study the morbidity patterns of non-urgent patients utilising accident and emergency services and compare these patients with 'true' accident and emergency cases. To analyse the morbidity pattern of non-urgent cases over different time periods, and across different age groups.

DESIGN. A cross-sectional study completed over a 1-year period.

SETTING. Four accident and emergency departments in Hong Kong.

PATIENTS. Two thousand, four hundred and ten patients randomly selected from four accident and emergency departments.

MAIN OUTCOME MEASURES. The morbidity patterns by body system, according to the International Classification of Primary Care, were tabulated and analysed for 'true' accident and emergency cases versus non-urgent cases. The ten most frequent diagnoses for the 'true' accident and emergency and non-urgent cases were also compared. Further analysis of accident and emergency service utilisation was conducted comparing different age groups, and also different time periods.

RESULTS. Significantly more cases presenting to the accident and emergency service with respiratory and digestive problems were found to be non-urgent, rather than appropriate accident and emergency cases. In contrast, significantly more cases presenting with circulatory and neurological problems were appropriate cases for accident and emergency department management. The morbidity pattern for the ten most frequent diagnoses seen in non-urgent cases was noted to be similar to the Hong Kong general practice morbidity pattern for self-limiting conditions. Utilisation of accident and emergency services for acute self-limiting conditions was more marked in the late evening, and also among children and the younger population in general.

CONCLUSION. The utilisation of accident and emergency services by patients requiring a general practice service only, reflects problems in the primary health care delivery system. These may be solved by appropriate interfacing between general practitioners and other service providers, with the aim of providing seamless health care. Without revision of primary health care services, accident and emergency departments will continue to be used inappropriately by patients as an alternative to general practice care.

Key words: Emergency service, hospital/utilization; Health services misuse; Hong Kong; Morbidity

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OBJECTIVES. To determine the incidence of acute primary angle-closure glaucoma in the Hong Kong Chinese population, and to identify risk factors for this condition.

DESIGN. Prospective study.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. Patients with acute primary angle-closure glaucoma presenting between 1 March 1998 and 29 February 2000.

MAIN OUTCOME MEASURES. Demographic data, presenting symptoms and signs, temporal details of the presentation, and precipitating factors. The crude regional incidence was calculated according to the Hong Kong population census of 1991 and the age-specific incidence was calculated.

RESULTS. Seventy-two cases (72 eyes of 72 patients) of acute primary angle-closure glaucoma were recruited. The crude incidence was 10.4 per 100,000 per year in the population aged 30 years and older. Patients at higher risk of attacks were those aged 70 years or older (age-specific incidence, 58.7 per 100,000 per year) and females, who had a relative risk of 3.8 compared with males (95% confidence interval, 1.7-8.4). Only four (5.6%) patients had a positive family history of acute primary angle-closure glaucoma. Seventeen (23.6%) patients were noted to have an upper respiratory tract infection before the attack, and 25 (34.7%) patients had taken antitussive agents. There was a statistically significant inverse correlation between the monthly attack rate and the monthly rate of influenza (Spearman's rank correlation coefficient = -0.388; P=0.031).

CONCLUSION. There is a high incidence of acute primary angle-closure glaucoma among Chinese residents of Hong Kong, with elderly females at highest risk. A significant proportion of patients reported upper respiratory tract infection or the use of antitussive medication prior to attacks.

Key words: Acute angle-closure glaucoma; Epidemiology

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OBJECTIVE. To determine the incidence and clinical characteristics of non-melanoma skin cancer in Hong Kong Chinese patients.

DESIGN. Retrospective study.

SETTING. Social Hygiene Services, Hong Kong.

PATIENTS. Records of 528 Chinese patients with a histological diagnosis of non-melanoma skin cancer from 1990 to 1999 were reviewed.

MAIN OUTCOME MEASURES. Demographic data, site and clinical type of cancer, predisposing factors, history, recurrence, and the development of new skin cancers.

RESULTS. Non-melanoma skin cancer is uncommon but not rare among the Chinese population in Hong Kong. The incidence of newly diagnosed basal cell carcinoma in 1990 was 16.0 per 10,000 new skin case attendances and, in 1999, the incidence was 31.8 per 10,000 new skin case attendances. The corresponding figures for squamous cell carcinoma in 1990 and 1999 were 6.9 and 11.6 per 10,000 new skin case attendances. The incidence of basal cell carcinoma among the Hong Kong Chinese population in 1990 and 1999 was 0.32 and 0.92 per 100,000, respectively, whereas that of squamous cell carcinoma was 0.16 and 0.34 per 100,000, respectively. Demographic data and the site distribution of non-melanoma skin cancer were comparable to those reported in Caucasians living in North America and Europe, but different from those in Caucasians living in Australia and Hawaii. Pigmented basal cell carcinoma was the most common type of non-melanoma skin cancer (60.1%) in Chinese patients, in contrast with rodent ulceration in Caucasian. Multiple skin cancers, recurrence, and subsequent new skin cancers were less frequently observed than in studies of Caucasians.

CONCLUSION. When compared with reported findings in Caucasians, Chinese patients show differences in the clinical type and multiplicity of lesions, predisposing factors, recurrence and subsequent new skin cancer rates for non-melanoma skin cancer. Pigmented basal cell carcinoma seems to be an important differential diagnosis with regard to pigmented lesions in the Chinese population.

Key words: Carcinoma, basal cell; Carcinoma, squamous cell; Incidence; Risk factors; Skin neoplasms/epidemiology

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OBJECTIVE. To determine the frequency of rearrangement of the myeloid-lymphoid leukaemia gene in acute leukaemia in Hong Kong Chinese children.

DESIGN. Immunophenotyping, cytogenetic, and molecular analysis.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Bone marrow or peripheral blood samples were taken from 27 children aged 16 years or younger with acute leukaemia, from September 1995 through February 1998.

MAIN OUTCOME MEASURES. Gene rearrangement was analysed by Southern blotting of HindIII digestion products of mononuclear cell DNA, followed by hybridisation with the myeloid-lymphoid leukaemia P/S4 probe. Nested reverse transcription-polymerase chain reaction analysis was performed to detect and characterise duplication of the myeloid-lymphoid leukaemia gene.

RESULTS. Only one (4%) of 23 children whose marrow or peripheral blood samples contained adequate material for genetic study showed rearrangement in the myeloid-lymphoid leukaemia gene. No children were positive for partial tandem duplication of the myeloid-lymphoid leukaemia gene.

CONCLUSION. Myeloid-lymphoid leukaemia gene rearrangement is rare in Hong Kong Chinese children with acute leukaemia.

Key words: Child; Chromosomes; Gene rearrangement; Hong Kong; Leukemia, lymphocytic, acute/genetics; Leukemia, myeloid/genetics

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OBJECTIVE. To study the epidemiological, clinical, and microbiological features of Plesiomonas shigelloides infection in Hong Kong.

DESIGN. Retrospective study.

SETTING. Infectious Disease Unit of a district hospital, Hong Kong.

PATIENTS. Patients with laboratory-confirmed cases of Plesiomonas shigelloides infection between 1 January 1995 and 31 December 1998.

MAIN OUTCOME MEASURES. Epidemiological and clinical data, antibiotic sensitivity, and clinical outcome.

RESULTS. There was an increasing trend in the number of isolates of Plesiomonas shigelloides obtained and the prevalence of the bacterium. A total of 197 isolates were obtained from 188 patients, and most isolates (172; 87.3%) were obtained during the summer. Clinical and epidemiological data were available for 167 patients (85 males, 82 females). Patient age ranged from 1 month to 95 years; the mean and median ages of the patients older than 15 years were 51.0 and 40.5 years, respectively (n=132). Only 35 (21.0%) of the 167 patients had a history of travel outside Hong Kong, whereas 21 (12.6%) had a history of consuming seafood or uncooked food; 39 (23.4%) had underlying medical conditions. Most patients (165; 98.8%) had symptoms of Plesiomonas shigelloides infection. Nine (5.4%) patients had had chronic diarrhoea for more than 2 weeks; watery and bloody diarrhoea was discharged by 122 (73.1%) and 42 (25.1%) of the patients, respectively. All 197 Plesiomonas shigelloides isolates were sensitive to ofloxacin, or levofloxacin and ceftriaxone. Resistance or partial resistance was recorded for ampicillin (72%), tetracycline (67%), co-trimoxazole (12%), and chloramphenicol (5%). The majority of patients (142/167; 85.0%) had self-limiting cases of infection, but 25 patients were given antibiotics for more severe symptoms at the time of presentation; there were two deaths.

CONCLUSIONS. The occurrence of Plesiomonas shigelloides infection in Hong Kong is increasing, although most cases of are self-limiting.

Key words: Diarrhea/microbiology; Gastroenteritis; Gram-negative bacterial infections; Plesiomonas/drug effects

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