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Cerebral palsy is a major cause of childhood developmental disability, yet there is no data on the prevalence of cerebral palsy in Hong Kong. In a cross-sectional survey of cerebral palsy rates among children in special and normal primary schools, it was found that the rate of cerebral palsy in Hong Kong is lower than that in overseas populations. This might be caused by a number of reasons. One reason for the �hidden cases� might result from our survey not being able to pick up those children in the private sector or not receiving any service.
Not all children with cerebral palsy in the mainstream schools received extra support. One quarter of such children (26%) were getting no extra educational or therapeutic services to help them cope with their disability. Twelve percent were receiving both educational and therapeutic services. Of the rest, some were receiving either extra educational services or therapy support. Rehabilitation professionals and special educators need to evaluate factors that limit service provision to this subgroup of children. Further studies should determine the best model to facilitate the coordination of educational and therapy services.
The authors strongly recommended the setting up of a Hong Kong cerebral palsy registry to monitor the prevalence and characteristics of this common childhood disability. Information on impairment, disability level, as well as co-morbidities of children with cerebral palsy should also be collected for optimal service planning. Educators, rehabilitation professionals and policy-makers could obtain useful information from the registry to match current and projected needs of children with cerebral palsy in medical, educational, and social services. A registry is different from the current available information systems because data in a registry is usually more accurate and case ascertainment is more complete.
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'Fracture' of the penis is a little-known condition that can be repaired effectively, but men may be too ashamed or embarrassed to seek medical attention when it occurs. Delay getting medical help may leave men with permanent physical and psychological disabilities. In the first published study of penile fracture cases in Hong Kong, it was found that patients often delayed seeking medical help and gave inaccurate accounts of the circumstances of their injury.
While most cases occurred during sexual intercourse, several patients gave different explanations for their injury when they first consulted doctors. One man, who was injured during sexual intercourse, initially said his penis hit against a table corner, while another said he was hit by the ‘falling edge of a door during repair’. A third said he bent the erect penis to pass urine, when his injury actually occurred during sexual intercourse, while a fourth who was found to have suffered a 'fracture' when he rolled on to his erect penis during sleep, was unwilling to say how it happened.
Recognising the injury is usually easy. Characteristically, the patient hears a sharp, snapping sound followed by rapid loss of erection, pain, swelling, purple bruising, and deformation of the penis. There may be a palpable gap or depression in the penile shaft. Typically the penis deviates to the side opposite the injury, producing an ‘eggplant deformity’—the purple ecchymosis and subcutaneous swelling, combined with the deviation, gives the appearance of an eggplant.
With prompt diagnosis and early surgery, the results are excellent—the period of hospitalisation is shorter, complications are minimal, and return to sexual activity happens earlier—but penile 'fracture' may be underreported by patients and clinicians. Emergency physicians and surgeons, as well as family physicians, need to recognise this condition as prompt diagnosis and early surgical repair are essential to ensure a successful outcome with minimal complications.
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