Given the complexities involved in identifying and reporting suspected cases of child abuse and neglect, it's crucial that the Mandated Reporter Guide emphasizes the importance of objective findings as solid evidence.
Objective findings, such as radiological findings in chiropractic clinics, can provide concrete evidence of abuse that may otherwise be missed. Radiological examinations often reveal patterns of injuries that are inconsistent with the explanations provided. For example, multiple fractures at different stages of healing, unusual fractures for the child's developmental stage, or injuries that are rare from accidental trauma.
Therefore, the guide should recommend that:
Chiropractors should consider ordering radiological examinations when physical examination and patient history raise suspicion of abuse, even in the absence of visible injuries.
Findings from these examinations should be thoroughly documented, including the location, nature, and age of injuries.
Any discrepancy between these findings and the provided history of the injury should be noted as it may indicate a potential case of abuse.
While subjective findings such as inconsistencies in injury history or behavioral signs can be crucial, they should not be the sole basis for reporting suspicion of abuse. Children and elderly patients may have difficulty accurately recalling events, leading to inconsistencies that are not necessarily indicative of abuse.
This doesn't mean we should disregard subjective findings. On the contrary, the guide should instruct chiropractors to:
Be attentive to verbal and non-verbal cues that may indicate distress or fear.
Document any observed behavioral changes or emotional responses that seem disproportionate to the situation.
Note any inconsistencies in the history and presentation of injuries.
Limitations of Physical Examination
Given the nature of chiropractic practice, chiropractors may not examine private parts such as breasts and female chest, potentially missing signs of abuse. The guide should acknowledge this limitation and recommend that:
Chiropractors should be trained to identify signs of abuse visible in the areas they typically examine.
If suspicion arises from observed or reported symptoms that fall outside the chiropractor's scope of practice, the chiropractor should refer the patient to a suitable medical professional for a more comprehensive examination.
In conclusion, the Mandated Reporter Guide should emphasize the importance of both objective and subjective findings in identifying potential abuse cases. It should also acknowledge the limitations of physical examinations in chiropractic settings and provide guidance on referring patients for further evaluation when necessary.
我們最近發表在《自然科學報告》上的研究剛剛在上週於澳大利亞黃金海岸舉行的第17 屆世界脊骨神經科聯合會(WFC) 雙年度大會上獲得了國際脊醫國家考試委員會(IBCE)海報獎，這標誌著該研究是最重要的研究之一專業人士：
https://www.nature.com/articles/s41598-023-28520-4。 我們的工作代表了與脊醫手法相關的不良事件的最大研究之一，包括 960,140 次治療。
✔ 我們發現與脊椎矯正相關的嚴重不良事件非常罕見，只有兩起嚴重不良事件（發生率為每 10 萬人中 0.21 例），均為骨質疏鬆症的老年女性發生的肋骨骨折。 沒有危及生命或導致死亡的不良事件。
As the Chairman of the Chiropractic Doctors Association of Hong Kong (CDAHK), I am penning this letter to express our support for the public consultation on the Vibrant, Healthy, and Tobacco-free Hong Kong initiative. We acknowledge the compelling need to address the prevalent issue of tobacco usage in our society.
We concur with your concerns about the health implications of smoking, particularly in light of our aging population and the rising incidence of chronic diseases. The uptrend in female smokers and the vulnerability of secondary school students to smoking pose serious threats that demand immediate attention.
Research has shown that chiropractors cater to a significant proportion of tobacco users (Muramoto ML et al., 2014). Our health and healing philosophies, as well as our practice patterns, are ideally suited to provide brief interventions (Muramoto ML et al., 2014). Studies have illuminated the feasibility of implementing systematic changes in chiropractic settings to identify tobacco users, advise them to quit, and refer them to cessation services (Buettner-Schmidt K et al., 2018). Chiropractors have proven their ability to offer effective smoking cessation counsel (Buettner-Schmidt K et al., 2018).
Given the link between tobacco usage and the health issues often treated by chiropractors, we are uniquely positioned to provide patients with personalized health feedback, which could potentially motivate them to quit smoking. Despite the potential value of chiropractors in conducting tobacco interventions, we are often underutilized and inadequately trained in these techniques (Rose KA, 2017). Thus, including alternative practitioners in tobacco cessation efforts can be beneficial (Eaves ER, 2017).
We are in complete agreement with the government's endorsement of the WHO's recommendations to achieve a smoking prevalence target of 7.8% by 2025 and aim for further reduction in the long term. The strategies outlined in the consultation document are in alignment with these objectives.
However, to fully harness the potential of the chiropractic community in tobacco control, we suggest putting more emphasis on the strategy to 'Enhance Education, Support Cessation.' Chiropractors can contribute by educating patients on the health risks of smoking during consultations and providing referrals to cessation support services as needed. We recommend the introduction of training programs for chiropractors on conducting effective tobacco interventions.
1 疫情的爆發讓我們明白醫療系統的優化不僅需要增加醫護人手，更需要擴大和多元化醫療服務的提供。脊醫可以在減輕傳統醫療系統的壓力，提升城市應對突發公共衛生事件的能力方面發揮作用。因此，我們建議政府考慮在基層醫療系統中加入脊醫服務，以提供更全面的醫療護理。我們之前的建議已經交給基層醫療健康管理局 。並可完善開發病假紙的權力，提升病患的照顧