A. J. Hedley

Management of queues in out-patient departments: the use of computer simulation.

Notes that patients attending public outpatient departments in Hong Kong spend a long time waiting for a short consultation, that clinics are congested and that both staff and patients are dissatisfied. Points out that experimentation of management changes in a busy clinical environment can be both expensive and difficult. Demonstrates computerized simulation modelling as a potential tool for clarifying processes occurring within such systems, improving clinic operation by suggesting possible answers to problems identified and evaluating the solutions, without interfering with the clinic routine. Adds that solutions can be implemented after they had proved to be successful on the model. Demonstrates some ways in which managers in health care facilities can benefit from the use of computerized simulation modelling. Specifically, shows the effect of changing the duration of consultation and the effect of the application of an appointment system on patients waiting time.

Time studies in A&E departments ‐ a useful tool for management

A time and motion study was conducted in an accident and emergency (A&E) department in a Hong Kong Government hospital in order to suggest solutions for severe queuing problems found in A&E. The study provided useful information about the patterns of arrival and service; the throughput; and the factors that influence the length of the queue at the A&E department. Plans for building a computerized simulation model were dropped as new intelligence generated by the study enabled problem solving using simple statistical analysis and common sense. Demonstrates some potential benefits for management in applying operations research methods in busy clinical working environments. The implementation of the recommendations made by this study successfully eliminated queues in A&E.

Smoking, Occupational Exposure and Mortality in Workers in Guangzhou, China

PURPOSEnTo compare the mortality risk of smoking and overall occupational exposure in Guangzhou, China.nnnMETHODSnBaseline data on smoking and occupational exposure of 82159 workers aged 30+ were retrieved from medical records established in 1988-92. Vital status and causes of death were followed through 1998.nnnRESULTSnDuring follow-up 1584 workers had died. Adjusted relative risks (RR) with 95% confidence intervals (95%CI) for ever-smoking in men was 1.23 (1.07-1.41) for total deaths, 1.43 (1.17-1.74) for all cancer, 3.77 (2.31-6.14) for lung cancer and 2.54 (1.09-5.92) for stomach cancer (all showing significant linear trends with amount and duration of smoking). The RR in women of 1.10 (0.59-2.06) for total deaths and 1.60 (0.65-3.92) for all cancer were positive but not significant. No significant excess mortality risk was observed for occupational exposure in each gender. In both genders combined, the RR for total deaths was 1.23 (1.08-1.40) for smoking and 1.07 (0.96-1.19) for occupational exposure. If the relationships were causal, 12% of all deaths could be attributed to smoking but only 3% to occupational exposure.nnnCONCLUSIONnSmoking was more predictive of premature deaths than overall occupational exposures in middle aged workers. Smoking cessation should be a top priority in occupational health practice.

A Smoking Intervention Programme for Primary School Students in Hong Kong

This study was designed to evaluate a smoking prevention programme targeted at primary school children. The objectives were to: 1) assess the feasibility of the programme; 2) increase the children’s awareness of the purposes of tobacco advertising; 3) record any change in attitude towards smoking and 4) measure the effects on the children’s knowledge about the harmful effects of smoking.

Tobacco advertisements were associated with positive attitudes to smoking among children who had never smoked

Many studies have shown that tobacco advertisements and positive attitudes to smoking, as well as other factors such as family smoking and peer influence, are associated with the smoking behaviour of children. In our cross-sectional study on 6304 junior secondary-school students (forms 1–3, aged mainly 12–15 years), we found that the students’ perception of cigarette advertisements as attractive was strongly associated with smoking experience (Lam et al., 1994). Other factors associated with any smoking were knowledge about the hazards of smoking, positive attitudes to smoking and smoking by the family, schoolteachers and peers (Lam et al., 1995). The association was examined in this and other studies by comparing children who smoked with children who did not. All the risk factors, such as attitudes to smoking, were treated as independent variables, whereas smoking (yes versus no) was the dependent variable. Few studies have addressed children who have never smoked and the factors associated with positive attitudes (as the dependent variables). The aim of this study was to examine factors associated with positive attitudes to smoking among children who had never smoked from the above-mentioned data on 6304 students.

Passive smoking and respiratory symptoms in never smoking women in Hong Kong

In 1989, a cross-sectional survey on primary school children in Hong Kong showed that air pollution (outdoor) and ETS had independent adverse effects on respiratory health.1 This study was aimed to study the relationship between passive smoking and respiratory symptoms in never-smoking mothers of the primary school children in the 1989 survey.

Smoking and lung function in Hong Kong Chinese schoolchildren

The association between tobacco smoking and diseases of the respiratory system, such as chronic obstructive lung disease and lung cancer, is well recognized in adults, as is its association with respiratory ill health in children who are exposed to environmental tobacco smoke (Environmental Protection Agency, 1992). The effect of exposure to tobacco smoke on lung function is less clear. Lower values for forced expiratory volume (FEV) have been reported for children living with parents who smoke (Hasselblad et al., 1981; Vedal et al., 1984; O’Connor et al., 1987; Kauffman et al., 1989), but not necessarily with parallel change in functional vital capacity (FVC) (Kauffman et al., 1989). Gold et al. (1996) found larger values for both FVC and FEV in children who smoked than those who did not, but the rates of growth in lung function were reduced in the smokers (Lebowitz et al., 1987; Gold et al., 1996). This paper presents the results of a preliminary examination of lung function in Chinese primary school children according to the children’s exposure to tobacco smoke.

A pilot study on mortality and smoking in Hong Kong

No epidemiological study on the mortality attributable to smoking has been carried out in Hong Kong. Indirect local estimates have been derived from western data, but these figures may be subject to flaws caused by differences between Hong Kong and the West in the stage of the smoking epidemic, background disease rates and exposure to other risk factors. The weakness of these indirect estimates had been challenged by the Tobacco Institute in Hong Kong (Fletcher, 1995). Epidemiological studies are urgently needed to produce more direct evidence on the burden of local deaths attributable to tobacco. The results would provide the first assessment of the tobacco epidemic and provide strong support for tobacco control measures in Hong Kong.

Environmental tobacco smoke, air pollution and respiratory symptoms in non-smoking housewives in Hong Kong

In Hong Kong, environmental tobacco smoke at home is an important source of air pollution because of the crowded conditions in which most families live. Its effects on the respiratory health of children were shown in a four-year study in 1989–92 (Ong et al., 1991; Peters et al., 1996). The aim of the present study was to examine the effects of environmental tobacco smoke and air pollution on the respiratory health of nonsmoking housewives.

Variation in Smoking Behaviour in a 4-Year Cohort Study of Respiratory Health in Hong Kong Children

Official statistics about young children smoking were previously unavailable in Hong Kong as the method used to obtain information on smoking habits through the General Household Survey was unsuitable for this purpose. In a four-year longitudinal study of respiratory health in two districts of Hong Kong, a cohort of students was surveyed each year, from Primary 3 in 1989 to Primary 6 in 1992.1 The smoking habits (together with other health and life style factors) were observed repeatedly. It provided an opportunity to study the uptake of smoking for the young children and examine the contributing factors. However in such studies care must be taken to identify possible reporting errors by very young children. The main objective of this article was to evaluate the reliability of the data obtained.