Chia-Feng Yen

The Effectiveness of Healthy Physical Fitness Programs on People with Intellectual Disabilities Living in a Disability Institution: Six-Month Short-Term Effect.

Little information is available on the provision of physical fitness and intervention program among people with intellectual disabilities. The aim of this study is to provide information of examining the effectiveness of healthy physical fitness programs on people with intellectual disabilities living in a disability institution. There were 146 participants with intellectual disabilities (age 19-67 years) were recruited in the study. We collected information on disability condition (type and level), height, weight, BMI, and physical fitness status (includes V-shape sit and reach test, sit-up 30s, sit-up 60s, and shuttle run) at the beginning and 6 months later of the program intervention. The results show that there were statistical decreases in individuals weight, BMI score, BMI category, and positive improvement in V-shape sit and reach test, sit-up in 30s and 60s tests after 6-month interventions. However, the shuttle run test did not improve at the post-test among people with intellectual disabilities. The results also showed that the mild disability level group has the highest effectiveness on the healthy fitness program on decreasing body weight. Generally speaking, the preliminary study found the healthy exercise program has positive fitness effects on people with intellectual disabilities. To maximize the benefits of regular physical activity on people with ID, there is a need to evaluate the long-term effect of the intervention program and then to initiate the healthy exercise strategies in institution for this group of people.

Quality of life in caregivers of children and adolescents with intellectual disabilities: use of WHOQOL-BREF survey.

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71+/-2.35, psychological well-being (PW) was 12.21+/-2.55, social relationship (SR) was 12.99+/-2.43 and environment (EN) was 12.32+/-2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities.

Medical care services for people with intellectual disabilities living in the general community: A cross-sectional survey of inpatient care utilization in Taiwan, 2001

Background. The medical care needs and problems of persons with intellectual disabilities (ID) living in the general community have received limited attention in previous studies. The aim of this article is to describe aspects of medical care utilization among people with ID living in the general community, with particular emphasis on examining the type and determinants of inpatient care utilization in Taiwan. Methods. A cross-sectional survey of people with intellectual disabilities was employed. A total of 997 respondents who provided fully completed data concerning inpatient care utilization were recruited into the analysis. Results. A total of 12.4% of individuals with intellectual disabilities had used inpatient care in the 7 months prior to the survey. The average number of inpatient care visits in that time was 1.43, with an average hospital stay of 16.91 days. Surgery, fever, gastrointestinal disorders, psychiatric disorders, and accident were the main causes of inpatient care utilization. A stepwise logistic model showed that the factors of holding a Major Illness Card, regular medicine-taking and self-perceived health status were statistically significant to inpatient care utilization of people with intellectual disabilities. Conclusions. Medical care providers and policy makers need to be aware that many people with intellectual disabilities have increased medical care needs that may require modification of standard medical care practices and service models in society.

Physical and mental health status of staff working for people with intellectual disabilities in Taiwan: Measurement with the 36-Item Short-Form (SF-36) health survey

Little explicit attention has been given to the generic health profile of staff working for people with intellectual disability in institutions. This study aimed to provide a profile of physical and mental health of staff working in disability welfare institutions, and to examine the possible demographic and organizational factors that explain an association with their health. A cross-sectional questionnaire survey was conducted to analyze 1243 staff (76% response rate) working in 24 institutions in Taiwan. The 36-Item Short-Form (SF-36) Taiwan version was used to measure their generic health status. The mean of Physical component scores (PCS) was slightly higher than Mental component scores (MCS) (50.83 vs. 45.12). With regard to each dimension among PCS, the mean score of Physical functioning (PF) was 57.14 (S.D.=5.93), Role limitations-physical (RP) was 49.88 (S.D.=9.69), Bodily pain (BP) was 52.14 (S.D.=8.09) and General medical health (GH) was 51.50 (S.D.=8.28). Among the MCS, Vitality (VT) was 46.19 (S.D.=6.71); Social functioning (SF) was 46.44 (S.D.=7.58); Role limitations-emotional (RE) was 47.30 (S.D.=11.89) and Mental health (MH) was 43.58 (S.D.=8.81). We found the generic health of staff working for people with intellectual disabilities were significantly lower in PCS and MCS than the Taiwan general population. Influences of staffs demographic and organizational characteristics on their health were also analyzed in the content. This study highlights the authorities and service providers need to continue to develop their awareness and understanding of the experiences that their staff encounters in the organizations, so that they can receive resources to support their positive health in working for people with intellectual disabilities.

Prevalence and associated risk factors of anemia in children and adolescents with intellectual disabilities

Anemia is known to be a significant public health problem in many countries. Most of the available information is incomplete or limited to special groups such as people with intellectual disability. The present study aims to provide the information of anemia prevalence and associated risk factors of children and adolescents with intellectual disability in Taiwan. We analyzed physical examination charts of 937 children and adolescents with intellectual disability at the age of 6-18 years from three special schools. We collected information on their demographic characteristics (age and gender), disability condition (type and level), BMI (weight and height) and measured blood hemoglobin concentration (Hb). There were 11.6% of children and adolescents with intellectual disability with anemia (boy <13 g/dl, girl <12 g/dl), and the factors of gender, age, disability level and BMI are significantly correlated to anemia in bivariant analyses in the study. In the logistic regression analysis, the model revealed that the factors of gender (OR=0.63, 95% CI=0.41-0.95), and age (OR=3.21, 95% CI=1.77-5.82) were variables that could significantly predict the anemia occurrence of the participants. The study highlights the anemia prevalence in children and adolescents with ID is a mild public health problem among people with intellectual disabilities, but to prevent the problems become worst; the health authority should include providing children and adolescents with adequate nutrition and appropriate health protections during early childhood.

Factors for healthy food or less-healthy food intake among Taiwanese adolescents with intellectual disabilities.

Little information is available on the prevalence and risk factors for less-healthy food intake among people with intellectual disabilities (ID). This study aimed to provide the information of healthy or less-healthy food intake among Taiwanese adolescents with ID and to examine the risk factors to their food intake. A cross-sectional data on 1419 adolescents 12-17 years of age were analyzed in the study. There were 1.4% of adolescents with ID who regularly smoke, 0.6% were regular alcohol drinkers and 0.5% currently chewed betel nut. Less than 40% of respondents expressed the ID individuals had regular exercise lifestyle and 41.0% were reported to have less-healthy food intake behaviors. A logistic regression analysis found that the factors of female caregivers gender, perceived excellent health status and was not accompanied by specific diseases such as asthma or allergic rhinitis which were correlated with healthy food intake behaviors among adolescents with ID. This study suggests improving the ways of healthy food intake toward reducing the potential risks for less-healthy food intake in the lives of adolescents with ID.

Serum uric acid, hyperuricemia and body mass index in children and adolescents with intellectual disabilities.

The aims of the preset study were to describe the profile of serum uric acid, the prevalence of hyperuricemia and its risk factors among children and adolescents with intellectual disabilities. We conducted a cross-sectional study of 941 children and adolescents with intellectual disabilities (aged 4-18 years) who participated in annual health examinations in three special schools in Taiwan. This study indicated 30.6% boys and 17.9% girls with intellectual disabilities were with hyperuricemia in Taiwan. The factors of gender, age and BMI were variables that can significantly predict the hyperuricemia occurrence in this vulnerable population. Those children and adolescents with intellectual disabilities were boys (OR=2.93, 95% CI=2.02-4.26) and older age (OR=6.49, 95% CI=2.19-19.21) were more likely to be hyperuricemia. With regard to BMI to hyperuricemia occurrence, those children and adolescents with intellectual disabilities were overweight (OR=1.16-3.21, 95% CI=1.16-3.21) and being obese (OR=4.95-11.58, 95% CI=4.95-11.58) was more likely to have a hyperuricemia than the normal weight group. This study provides the general profile of serum uric acid, hyperuricemia and its risk factors of children and adolescents with intellectual disabilities. Medical professionals should be highly alert to the possible consequences of hyperuricemia and provide useful information about the clinical manifestation of this condition for caregivers of children and adolescents with intellectual disabilities.

Job strain and determinants in staff working in institutions for people with intellectual disabilities in Taiwan: a test of the Job Demand-Control-Support model.

Little is known about the job strain of staff working in disability institutions. This study investigated the staffs job strain profile and its determinants which included the worker characteristics and the psychosocial working environments in Taiwan. A cross-sectional study survey was carried out among 1243 workers by means of a self-answered questionnaire. The outcome variable (high-strain job) was evaluated. The explanatory variables were: worker characteristics and the psychosocial working environment evaluated according to Karaseks Job Demand-Control-Support model. The results show that many staff characteristics were correlated with job strain, such as staffs working hours, age, gender, job title, educational level, religion, in-job training, working years in disability institutions and Effort-Reward Imbalance factors. Organization factors, such as geographical, institutional ownership and accreditation performance and size were also correlated with staffs job strain. In multiple a logistic regression model of the job strain, we found that the factors of financial reward (high compare to low, OR=0.95, 95% CI=0.928-0.975), extrinsic effort (high compare to low, OR=1.072, 95% CI=1.072-1.158), perceived job stress (sometimes stressful compare to no stress, OR=2.305, 95% CI=1.161-4.575; very stressful compare to no stress, OR=3.931, 95% CI=1.738-8.893) of the staff were significantly correlated to the high job strain of the staff. An important focus of future research should be extending the findings to consider the factors to affect the high job strain to improve the well-being for staff working for people with intellectual disability.

Development of traditional Chinese version of World Health Organization disability assessment schedule 2.0 36--item (WHODAS 2.0) in Taiwan: validity and reliability analyses.

BACKGROUND World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provided a standardized method for measuring the health and disability and the traditional Chinese version has not been developed. AIMS To describe the process of developing the traditional Chinese version of the WHODAS 2.0 36-item version and to evaluate the concurrent validity and test-retest reliability of this instrument. METHODS The study was conducted in two phases. Phase I was the process of translation of WHODAS 2.0 36-item version. Phase II was a cross-sectional study. The participants were 307 adults who were tested the validity and reliability of draft traditional Chinese version. RESULTS The reliability of Cronbachs α and ICC in the WHODAS 2.0 traditional Chinese version were 0.73-0.99 and 0.8-089, respectively. The content validity was good (r=0.7-0.76), and the concurrent validity was excellent in comparison with the WHOQOL-BREF (p<0.5). The construct validity, the model was explained total variance was 67.26% by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) illustrated the traditional Chinese version was good to assess disability. There was a valid and reliable measurement scales for evaluating functioning and disability status. CONCLUSION For disability eligibility system of Taiwan government to measure the disability, the traditional Chinese version of the WHODAS 2.0 provided valuable evidence to design the assessment instrument.

The risk of metabolic syndrome among institutionalized adults with intellectual disabilities

People with metabolic syndrome (MS) are at increased risk of coronary heart disease and other health problems, such as diabetes and stroke. However, there is little previous information on the prevalence and determinants of MS among people with intellectual disabilities (IDs). The present study aimed to examine the prevalence of MS risk factors among institutionalized adults with IDs. We analyzed the annual health check data of 164 institutionalized adults with IDs whose age was >/= 20 years in 2009. The measure of MS in the study was the presence of three or more of the following five components: central obesity, elevated blood pressure (BP), elevated fasting glucose (FG), elevated triglycerides (TG), and reduced high-density lipoprotein (HDL-C). The prevalence of MS was 11.6% in the study participants (8% in males and 17.2% in females), which is lower than that in the general population of Taiwan. In the logistic regression analysis of the occurrence of MS, we found that gender, TG and HDL-C were variables that could significantly predict MS after controlling for other potential factors. Adults with IDs who were female (OR = 38.354, 95% CI = 1.985-741.029) and who had higher TG levels (OR = 1.043, 95% CI = 1.008-1.079) and reduced HDL-C levels (OR = 0.696, 95% CI = 0.549-0.883) had a statistically higher risk of MS. This study was one of the first to provide information on the prevalence of MS and its risk factors among institutionalized adults with IDs. We suggest that further study should focus on the specifics of MS, such as incidence, age-specific risk factors and further prevention or treatment in people with ID.