OBJECTIVE. To evaluate universal screening with an opt-out approach of pregnant women for human immunodeficiency virus infection.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All women booked or delivered in Kwong Wah Hospital from 1 January 1999 to 30 November 1999 were recruited.

MAIN OUTCOME MEASURES. Numbers of women who received the human immunodeficiency virus antibody screening test, refused the test (and the reasons why), tested positive, and tested positive with confirmation by immunoblot study.

RESULTS. A total of 5597 women were recruited and 5459 screening tests performed in this study. Of the 16 screened positive cases, three were confirmed by immunoblot study. The overall acceptance rate for the test was 97.5%. The acceptance rate among the 5191 women recruited through the hospital's booking clinic was not significantly different from that among the 406 women who did not go through the hospital's booking clinic (97.6% versus 96.6%).

CONCLUSION. Universal screening of pregnant women for human immunodeficiency virus infection with an opt-out approach is practical, feasible, and clinically acceptable in Hong Kong.

Key words: Disease transmission, vertical; HIV infections/transmission; Hong Kong; Prenatal care

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OBJECTIVE. To determine clinical and baseline polysomnographic data on obstructive sleep apnoea secondary to adenotonsillar hypertrophy in Hong Kong Chinese children.

DESIGN. Prospective study.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. Fifty children (35 boys and 15 girls) suspected to have obstructive sleep apnoea were recruited between January 1999 and December 1999.

MAIN OUTCOME MEASURES. Symptoms questionnaire, electrocardiogram, chest radiograph, and full-night polysomnography.

RESULTS. All patients had symptoms suggestive of obstructive sleep apnoea. None were found to have clinical evidence of cor pulmonale. Forty-five (90%) of 50 children had obstructive sleep apnoea with a respiratory disturbance index of greater than five. Central and mixed apnoeas were rare. Tonsil size did not correlate with the severity of obstructive sleep apnoea.

CONCLUSION. Symptoms and signs suggestive of obstructive sleep apnoea can lead to a high detection rate and confirmation of obstructive sleep apnoea by polysomnography.

Key words: Polysomnography; Sleep apnea; Tonsil

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OBJECTIVES. To determine the clinical attitudes and behaviour of family doctors in Hong Kong towards patient self-management of upper respiratory tract infections, and factors which may influence this practice.

DESIGN. Questionnaire survey conducted between February 1999 and April 1999.

SETTING. Hong Kong College of Family Physicians.

PARTICIPANTS. Members of the Hong Kong College of Family Physicians.

RESULTS. A total of 730 family doctors completed a postal questionnaire on self-management of upper respiratory tract infection, giving an overall response rate of 71.9%. The majority (95.2%) of respondents agreed that patients should be advised on self-management. More than two thirds (69.7%) of respondents also considered patients should be advised on self-medications for upper respiratory tract infection. Nearly two thirds and one third of respondents stated they would advise more than 60% of patients on self-management and self-medication, respectively. A close association was noted between the doctor's view on the usefulness of antibiotics for upper respiratory tract infection and patient advice regarding self-management and self-medication strategies.

CONCLUSION. Doctors with certain characteristics are more likely to advise patients with upper respiratory tract infection on self-management and self-medication for upper respiratory tract infection.

Key words: Family Medicine; General Practice; Management pattern; Respiratory tract infection

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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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