Tsan Hon Liou

Fully automated large-scale assessment of visceral and subcutaneous abdominal adipose tissue by magnetic resonance imaging

Objective:To describe and evaluate a fully automated method for characterizing abdominal adipose tissue from magnetic resonance (MR) transverse body scans.Methods:Four MR pulse sequences were applied: SE, FLAIR, STIR, and FRFSE. On 39 subjects, each abdomen was traversed by 15 contiguous transaxial images. The total abdominal adipose tissue (TAAT) was calculated from thresholds obtained by slice histogram analysis. The same thresholds were also used in the manual volume calculation of TAAT, subcutaneous abdominal adipose tissue (SAAT) and visceral abdominal adipose tissue (VAAT). Image segmentation methods, including edge detection, mathematical morphology, and knowledge-based curve fitting, were used to automatically separate SAAT from VAAT in various ‘nonstandard’ cases such as those with heterogeneous magnetic fields and movement artefacts.Results:The percentage root mean squared errors of the method for SAAT and VAAT ranged from 1.0 to 2.7% for the four sequences. It took approximately 7 and 15 min to complete the 15-slice volume estimation of the three adipose tissue classes using automated and manual methods, respectively.Conclusion:The results demonstrate that the proposed method is robust and accurate. Although the separation of SAAT and VAAT is not always perfect, this method could be especially helpful in dealing with large amounts of data such as in epidemiological studies.

Implementing disability evaluation and welfare services based on the framework of the international classification of functioning, disability and health: experiences in Taiwan

BackgroundBefore 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person’s eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system.MethodsTo develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III.ResultsThe measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability.ConclusionThis study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.

Prevalence and secular trends in overweight and obese Taiwanese children and adolescents in 1991–2003

Objective: To describe recent trends in overweight and obese schoolchildren in Taiwan using international cut-off points. Design: Three independent cross-sectional surveys were used. Participants: The study enrolled 157 485 students in 1991, 130 770 students in 1997 and 72 789 students in 2003, all aged 6–18 years, from elementary schools, secondary high schools and senior vocational high schools Results: The prevalence of overweight and obese students increased significantly between 1991 and 2003. During this period, the percentage of male overweight and obese students increased from 5.7% to 14.2% and from 7.9% to 17.4%, respectively. The prevalence of female overweight and obese students increased from 11.1% to 13.4% and from 3.1% to 4.1%, respectively. Covariance analysis indicates that both sexes in 2003 had significantly higher percentages of overweight and obese subjects than those in 1991 and 1997 (p<0.001). Additionally, the prevalence of overweight and obese boys was higher than that for girls in each survey (p<0.001). Discussion: Analytical results demonstrate that prevalence and secular trends in overweight and obese Taiwanese children and adolescents increased significantly from 1991 to 2003. Taiwanese boys are more likely to become overweight and obese than their female counterparts.

Effects of elastic-band exercise on lower-extremity function among female patients with osteoarthritis of the knee

Objective: To investigate a new style of resistance exercise using elastic bands and explore its therapeutic effect on the lower-extremity function of female patients with osteoarthritis (OA) of the knee. Design: A randomized, controlled clinical trial. Setting: University-affiliated medical center. Participants: Forty-one women with mild-to-moderate knee OA were randomly assigned to one of two groups, an exercise group (n = 24; age: 65.0 ± 8.4 years), and a control group (n = 17; age: 70.8 ± 8.4 years). Interventions: The exercise group performed supervised exercise with elastic bands in addition to conventional modality treatments two to three times a week for 8 weeks. The control group received only the conventional modality treatments over the same period. Main outcome measures: The distance of the functional forward-reach, 30 s chair stand repetitions, walking function (time of a 10 m walk, timed up-and-go, and going up-and-down 13-stair tests), and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores. Results: Statistically significant improvements in all measures were observed in the exercise group after 8 weeks (p < 0.001). Except for the outcomes on the functional forward-reach (p = 0.108) and going up-and-down 13-stair test (p = 0.278), there were significant differences in the extent of improvement between the two groups. Positive changes in the 30 s chair stand test, 10 m walk test, and timed up-and-go test were 2.5 ± 1.4 repetitions, 1.4 ± 1.2 s, and 1.6 ± 1.1 s in the exercise group, which were significant better than those in the control group (0.6 ± 0.9 repetitions, 0.5 ± 1.1 s, and 0.3 ± 1.1 s, respectively) (p ≤ 0.001). The lower scores of all three subscales of the WOMAC index were significant after 8 weeks (p ≤ 0.05), especially for pain (−2.3 ± 1.3) and physical function (−10.7 ± 5.9) (both p ≤ 0.01), and the improvements were all significant better than those of the control group (p ≤ 0.05). Conclusions: A new style of resistance exercise using elastic bands with four color combinations (yellow-red, red-red, red-green, and green-green) over a period of 8 weeks can significantly improve lower-extremity function among females with mild-to-moderate knee OA. Implications for Rehabilitation Resistance exercise is an effective means of improving the lower extremity function for people with knee osteoarthritis (OA). A new model for using elastic bands combinations based on leg-press exercise and the principles of progressive resistance training leads to improved lower extremity function in female patients with knee OA after an 8-week period.

Validity and reliability of the Functioning Disability Evaluation Scale-Adult Version based on the WHODAS 2.0--36 items.

BACKGROUND/PURPOSE The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individuals activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult). METHODS During 2011-2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1-6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0-36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system. RESULTS The internal consistency was excellent (Cronbachs α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56-0.94 and 0.55-0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1-6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%. CONCLUSION FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities.

Functioning and Disability Analysis of Patients with Traumatic Brain Injury and Spinal Cord Injury by Using the World Health Organization Disability Assessment Schedule 2.0

The purpose of this study is to compare traumatic brain injuries (TBI) and spinal cord injuries (SCI) patients’ function and disability by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); and to clarify the factors that contribute to disability. We analyzed data available between September 2012 and August 2013 from Taiwan’s national disability registry which is based on the International Classification of Functioning, Disability, and Health (ICF) framework. Of the 2664 cases selected for the study, 1316 pertained to TBI and 1348 to SCI. A larger percentage of patients with TBI compared with those with SCI exhibited poor cognition, self-care, relationships, life activities, and participation in society (all p < 0.001). Age, sex, injury type, socioeconomic status, place of residence, and severity of impairment were determined as factors that independently contribute to disability (all p < 0.05). The WHODAS 2.0 is a generic assessment instrument which is appropriate for assessing the complex and multifaceted disability associated with TBI and SCI. Further studies are needed to validate the WHODAS 2.0 for TBI and SCI from a multidisciplinary perspective.

Systematic review of ICF core set from 2001 to 2012

Abstract Purpose: This study systemically reviewed the published literature on the ICF core set. Method: A computer search of the MEDLINE, PubMed and SCOPUS databases was conducted between 2001 and December 2012. Articles reporting on the development of a set or sets of ICF categories for specific disease or health conditions were selected for a systematic review. Results: The analysis included 116 articles from 36 journals, with the majority of papers having been published in 2011 and 2012. In these studies, spinal cord injury was the most frequently reported disease. The majority of the experts involved in the consensus process were physicians and physical therapists. Conclusion: This systematic review of studies on ICF core sets provided background information on the current developmental status of ICF core sets. Our findings also highlight possible directions for future research. Implications for Rehabilitation The aim to develop ICF core sets is to provide a practical way to address a specific patient population in daily practice. This review showed the development of ICF core set in last decade and provide directions for future research. Development of ICF core set is still limited in area outside Europe and incomplete in number of major diseases.

Prevalence and correlates of self-induced vomiting as weight-control strategy among adolescents in Taiwan

AIMS This study was designed to assess the prevalence and correlates of self-induced vomiting to control body weight among adolescents in Taiwan. BACKGROUND Over the past decades, the rate of obesity among children in Taiwan has nearly tripled. Educational authorities have devoted considerable effort to prevent the increase in childhood obesity. DESIGN An observational exploratory design to investigate the problem of using unhealthy weight-reduction strategy. METHODS This study consists of a cross-sectional study aimed at collecting national representative data. We chose 120 representative schools using a three-stage stratified systematic sampling design with probability proportionate to the size of the population in Taiwan. Participants consisted of 8673 girls and 7043 boys, aged 10-18 old. RESULTS Of the participants, 13% reported using self-induced vomiting, the prevalence being highest in participants aged 10-12 (15·9%) and lowest in participants aged 16-18 (7·5%). Several factors were significantly and positively associated with the use of self-induced vomiting as a weight-loss strategy, specifically subjects who (1) watched television, used computer, surfed the Internet or played video games for greater than or equal to two hours/day, (2) consumed fried food every day and (3) ate night-time snacks every day (odds ratio = 1·55, 2·10 and 1·51, respectively; p < 0·05). Eating breakfast every day and sleeping for more than eight hours a day were both protective factors against the use of self-induced vomiting to control body weight (odds ratio = 0·43 and 0·86, respectively; p < 0·05). CONCLUSIONS Self-induced vomiting was prevalent among adolescents who had tried to lose weight; sedentary lifestyle, shorter sleep length and unhealthy eating habits may contribute significantly to this behaviour among these adolescents. RELEVANCE TO CLINICAL PRACTICE School nurses who are helping adolescents lose weight should also pay attention to the possibility they are using self-induced vomiting as a weight-control strategy.

Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan.

Abstract Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p < 0.001), age (1.38–4.81, p < 0.05), and speech impairment (1.94–5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability. Implications for Rehabilitation Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

A pilot study of videoconferencing for an Internet-based weight loss programme for obese adults in Taiwan

We conducted a pilot study of the feasibility of an Internet-based weight loss programme using videoconferencing to emulate face-to-face situations and a Web service to support self-monitoring. A pre–post test design was used to compare changes in bodyweight, metabolic variables and attendance rate. Nine subjects lost on average 5.9 kg (6.0% of body weight, P<0.001) over the course of the 12-week programme. Waist circumference was reduced significantly (10.2 cm, P=0.03). Total cholesterol, aspartate transferase (AST) and alanine transferase (ALT) significantly decreased. Eight participants completed a questionnaire after the intervention. Overall, responders were satisfied with the protocol and considered the Internet weight loss programme to be helpful to them. One technical problem was that Internet congestion could reduce the quality of audio and video. The Internet appears to hold promise as a medium to facilitate communication in weight loss programmes.