Jia-Ling Wu

Physical Activity and Its Determinants among Adolescents with Intellectual Disabilities.

Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16-18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregivers educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population.

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.

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.

Rehabilitation service utilization and determinants among people with an intellectual disability: preliminary findings in Taiwan.

Improving rehabilitation services for people with intellectual disabilities (ID) remains an ongoing challenge in the public health system. The purpose of this article was to investigate the types of rehabilitation services used by people with ID and determine what factors predict resource utilization in Taiwan. Samples of 957 people with ID were recruited from the Taiwan National Disability Register in a cross-sectional study in 2001. The findings indicated that 24.5% of individuals with ID had received rehabilitation services in the past 7 months. The main types of services used were speech and communication therapy (50%), psychotherapy (32.1%), occupational therapy (30.3%) and physiotherapy (25.2%). Stepwise logistic regression was carried out for the utilization of rehabilitation services (yes/no). The model revealed that the following factors: (i) Major Illness Card holder, (ii) time spent in medical care, (iii) having a family physician, (iv) having illnesses, (v) age of ID individual, and (vi) gender of the main carer, were all significantly associated with the utilization of rehabilitation services. We should reorient the healthcare system to respond adequately to the health needs of rehabilitation service users and its determinants, and further research should focus on the effectiveness and efficiency of rehabilitation for people with ID in Taiwan.

Institutional Care for People with Disabilities in Taiwan: A National Report between 2002 and 2007.

The purposes of the present study were to describe the institutional care for people with disabilities included service types, service capacity and service utilization from 2002 through 2007 in Taiwan. Data were obtained from four ways of national data: (1) The condition of service institution for the physically and mentally disabled; (2) The physically and mentally disabled population by aged and grade; (3) The physically and mentally disabled population by cause; (4) Taiwan general population by age. We used percentage and overtime trend figures to examine the change in service capacity and the institutional care utilization of people with disabilities. The results revealed that the administrative prevalence of disabilities was increasing from 3.69% to 4.45% from 2002 to 2007 (increase rate 22.8%) in Taiwan. The number of disability institutions was increasing from 223 to 254 and yield an increasing rate 12.2%. The service capacity of institutional care was 16,664 persons in 2002, and it was increasing to 20,707 persons in 2007 (increase rate=24.3%). The cases admitted to institutional care were increasing from 12,611 in 2002 to 17,002 in 2007 (increase rate=34.8%). The male individuals with disabilities were more likely to admit to institutional care than the female cases. The data of the present study provided can be a basis for further discussion on the debate of institutional care or community care for people with disabilities in Taiwan community.

National disability registers report on causes of intellectual disability in Taiwan: 2000–2007

The main purposes of the present analysis were to describe the causes of intellectual disability (ID) and examine its overtime change from 2000 to 2007 in Taiwan. Data of the present study mainly come from the public web-access information which collected by the Department of Statistics, Ministry of the Interiors, Taipei, Taiwan. Data were obtained from two ways of 2000-2007 national data: (1) The physically and mentally disabled population by cause; (2) Taiwan general population by age. The present results found that the congenital disability and the disease were the main causes among the ID population in Taiwan. The overtime trend (2000-2007) of causes among the ID population illustrated that the percentage of congenital-caused ID was decreasing and the disease-caused ID was increasing slightly. However, both of above two causes - congenital- and disease-caused ID prevalence - were increasing slightly in the Taiwan general population in the year 2000-2007. The present analysis suggests that the current disability registers should re-examine the ID-caused categories according to the evidence-based literatures regarding attributive risks for this group of people in Taiwan.

Perception and experience of primary care physicians on Pap smear screening for women with intellectual disabilities: A preliminary finding

This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey by a structured, self-administered questionnaire (12 perceptional issues), and were posted to all primary care settings (N=168) which provided Pap smear tests for women with ID in Taichung and I-Lan counties in Taiwan, Republic of China during the period of 2009. The vital primary care physician of each healthcare setting was the main respondent of the questionnaire. Finally, there were 69 valid questionnaires returned, giving a response rate of 41.7%. The main findings showed that 72.5% medical care settings provide Pap smear services and 51.5% have practical experience on conducting the tests for women with ID. Among the respondents, nearly 90% primary care physicians expressed that women with ID need Pap smear test regularly. With regard to the associated factors in the delivery of Pap smear screening services to women with ID. The study found that experienced healthcare settings in Pap smear tests for women with ID were more likely to be in public healthcare settings, felt confident in providing screening tests, having a rapid screening program and having a reminding follow-up system. Those respondents felt necessity in Pap smear test for women with ID were more likely to express it is needed to set up a special screening clinic for this group of women. The present study suggests that women with ID need thoughtful, well-coordinated care from primary care physicians, to increase access to health care providers may be helpful in improving Pap screening tests for this population.

Extrinsic high-effort and low-reward conditions at work among institutional staff caring for people with intellectual disabilities in Taiwan.

The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N=1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan in 2006. Conditions at work were measured using Siegrists Effort-Reward Imbalance (ERI) model, the questionnaire included 23 Likert scaled items and it divided into three scales: effort, reward and overcommitment. Multiple logistic regression modeling was conducted for extrinsic high-effort/low-reward status in relation to staff and working environmental factors. We found that 15.1% staff were in the low-effort/low-reward group, 35.9% was in the low-effort/high-reward group, 17.9% belonged to the high-effort/high-reward group and 31.1% was included in the high-effort/low-reward group. Controlling for many personal demographic and organizational characteristics, the factors of perceived job support (OR=0.91; 95% CI=0854-0.97), job control (OR=0.954, 95% CI=0.934-0.974), job demand (OR=1.155, 95% CI=1.109-1.203) and job stress (felt sometimes stressful compare to no stress at all, OR=2.305, 95% CI=1.161-4.575) of the staff were significantly correlated to the extrinsic high effort/low reward at work in the multiple logistic regression model. The present study highlights that the service providers need to be aware and understand the experiences that their staff encounters in the organizational, interpersonal and personal level regarding unfair working conditions such as high effort/low reward to improve the positive health of the staff.