The Infirmary Assessment Clinic was established at the Tuen Mun Hospital to assess the elderly registered on the central waiting list for the infirmary. The main purpose of the clinic was to look for appropriate candidates for infirmary placement and to deliver support to those who could remain in the community. A multidisciplinary approach was adopted for the assessment. Sixty-seven candidates were assessed and 51 were found to be qualified, i.e. 24% required a lower level of institutional care. With this rectification of the list, the clinic could save HK$5.8 million in one year if all assessed candidates were placed in the appropriate level of institutional care for 12 months. Seventy-five per cent of eligible candidates had mental disabilities and 55% had physical disabilities. All mental disabilities could be categorised as dementia requiring support in activities of daily living. A dividing score (Mini Mental State Examination <151,2 and Barthel Index <603,4) was arbitrarily defined as a guiding score for the assessment. Although this was found to be sensitive (84%), it was not specific (62%). The decision was multifactorial and individualised.

Silicosis is the most common occupational disease notified in Hong Kong. Annually, up to 200 cases--mostly from the construction industry--are reported. To elucidate the personal and behavioural risk factors for silicosis, we studied 215 silicosis patients in the construction industry and 173 controls from 1990 to 1992. We investigated occupational exposure to dust, work practice, education, vocational and safety training, work experience and personal habits (cigarette smoking, alcohol intake). No formal education, no vocational and safety training, current and past smoking, and the use of dust masks were found to be significant risk factors. Because of selection bias in the choice of controls in this study, risk factors identified in the logistic regression model have to be interpreted with caution. In addition to dust suppression on construction sites, on-the-job safety, health training and health maintenance programmes should be provided to construction workers. Health education should be aimed at increasing worker awareness of the danger of fibrogenic dusts, encourage the proper use and maintenance of effective personal protective equipment, implement dust supression measures, and discourage smoking.

The Abbreviated Mental Test is a useful screening test for abnormal cognitive function in the elderly patient. It is widely used in UK geriatrics practice. A modified local version of the Abbreviated Mental Test is also commonly used in Hong Kong. In the present study, the local version of the 10-question Abbreviated Mental Test was validated against clinical diagnoses of normal/abnormal cognitive function (by DSM III R criteria). Sixty-nine patients (aged 65 years and older) referred to the Acute Geriatric Assessment Team at the Queen Mary Hospital were assessed. Nine patients (13%) were excluded because of language barrier, deafness, dysphasia and/or severe dysarthria. Sixty patients completed the test and the clinical assessment. An incorrect answer in each of the test items was found to be significantly associated with abnormal cognitive function (P<0.005). For the Abbreviated Mental Test score, the best cut-off point was found to be six (below six was considered abnormal); this yielded a sensitivity of 96% and a specificity of 94%.

From October to December 1985, 78 patients with active pulmonary tuberculosis (mean age, 73.4 years) were given the Mantoux test (1 unit). Non-reactors were rechallenged with 10 units. The results of the test group were compared with those of 108 controls. Fifty-three patients with radiologically inactive tuberculosis (mean age, 71.4 years) were included. Twenty-one had radiologically inactive tuberculosis without prior treatment, 32 had radiologically inactive tuberculosis with a mean interval of 11.9 years from previous treatment, and 55 had no radiological or clinical evidence of tuberculosis (mean age, 72.0 years). The Mantoux test in either strength showed either low sensitivity or specificity for active tuberculosis. Although both showed good positive predictive value of over 80% in indicating an abnormal chest X-ray, further investigations were required to establish disease activity. We concluded that the Mantoux test has limited usefulness, as a screening or diagnostic tool for active tuberculosis, in the elderly population of Hong Kong, where the prevalence of tuberculosis is high.

This study was conducted to evaluate the efficacy of in situ extracorporeal shock wave lithotripsy treatment of ureteric stones using the Dornier MFL 5000 lithotripter. From March 1991 to June 1994, 184 patients received in situ extracorporeal shock wave lithotripsy treatment. The overall success rate was 76% (77% for upper; 69% for middle; and 81% for lower ureteric stones, respectively). The level and size of the stones did not affect the final outcome significantly. An average of 1.23 sessions were required for each patient and the rate of major auxiliary intervention was 21%. We conclude that extracorporeal shock wave lithotripsy is an effective treatment for ureteric stones.