Deterioration of fine motor skills and functional disability in patients with moderate-to-advanced Parkinson disease: A longitudinal follow-up study.

INTRODUCTION: Parkinson disease (PD) caused substantially disability. The impairment of fine motor skills (FMSs) is correlated with the severity of functional disability (FD) cross-sectionally in people with PD (PwP). The present study investigated the decline in FMSs and the predictive value of baseline FMSs for the progression of FD. METHODS: People with moderate-to-advanced PD who received two evaluations within 1-5 years were identified from the Taiwan Data Bank of Persons with Disability database. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate FD, and FMSs including pen-holding, buttoning, and knotting were assessed. RESULTS: Our study included 2,271 people with moderate-to-advanced PD. We observed annual progression of FD in each domain of the WHODAS 2.0, with no difference between the sexes. The most significant correlation between FD and FMSs was that of decline in buttoning ability and deterioration of summary WHODAS 2.0 scores. Deterioration in FD across all domains of WHODAS 2.0 was associated with at least one FMS. The extent of disability in all three types of FMS at baseline was also correlated with deterioration of motility. Additionally, baseline disability in buttoning was significantly correlated with cognitive decline, and disability in knotting was significantly associated with the progression of FD. CONCLUSION: FMSs may be reliable markers for further FD, particularly in the areas of cognition, motility, and life activity. Because of the significant FD observed in people with moderate-to-advanced PD, the availability of predictors is essential for applying precautionary measures and providing appropriate treatment.

The use of premixed drugs in commodity packets in the population: prevalence and correlates revealed by the 2018 National Survey of Substance Use in Taiwan.

BACKGROUND: Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug packet users. METHODS: Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs and other psychoactive substances, among others. RESULTS: Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had a lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were similar to those of the exclusive use of other drugs except that there was a lack of gender differences in the use of drugs in commodity packets but not in the exclusive use of other drugs. CONCLUSION: Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug packet use.

Status of resource recycling stations in Taiwan and recycling work-related health effects.

Resource recycling has become an integral part of environmental protection efforts. At present, the development of Taiwan's resource recovery and related works are quite mature. However, laborers or volunteers working in resource recycling stations may be exposed to different types of hazards during the recycling process. These hazards can be divided into biological, chemical, and musculoskeletal problems. These hazards are usually related to the work environment and work habits; therefore, a related control strategy is needed. Tzu Chi's recycling business has been running for over 30 years. In addition to leading the trend of resource recycling in Taiwan, many elderly people have also participated in Tzu Chi recycling stations as volunteers. These older volunteers may be more sensitive to exposure to hazards, and thus the focus of this review is to illustrate the possible hazards and health impacts of resource recovery work and to recommend relevant interventions to improve occupational health during resource recovery work.

Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System.

To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale-Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.

The Feasibility of a Training Program for Peers with Severe Mental Illness to Provide One-to-One Services in Taiwan: A Pilot Study.

BACKGROUND: In Taiwan, services provided by patients' peers in the mental health care system are still lacking. Therefore, this study aimed to develop a community setting model by a training program for severe mental illness (SMI) patients' peers that also have SMI in Taiwan. METHOD: This training program comprised of 13-h lectures, 15-h practice classes, and an eight-week internship. In 2018 and 2019, the trainees provided one-to-one services to service users with SMI during the internship at a halfway house. The satisfaction and outcomes among all participants were measured in this training course. RESULTS: The total mean satisfaction score in the training course for trainees (10 items, n = 13) and internship services for service users (12 items, n = 29) were 4.7 ± 0.4 and 4.6 ± 0.5, respectively. Among the trainees, 11 demonstrated improved Brief Psychiatric Rating Scale-18 (BPRS-18), Chinese Health Questionnaire-12 (CHQ-12), and Global Assessment of Functioning (GAF) scores after the whole training course. Among the 29 service users, their scores in the BPRS-18 and CHQ-12 decreased, whereas their scores in the GAF increased significantly under the internship service. CONCLUSION: In this pilot study, the trainees and service users who received internship services felt satisfied. The service providers and users with SMI both showed better clinical outcomes.

Predictors of Employment Status for Persons with Bipolar Disorder.

Bipolar disorder is characterized by manic and depressive episodes and can be a lifetime condition. Bipolar disorder has been found to be associated with various types of disabilities, including low employment rate and high dependence on public aid. The purpose of this study is to identify factors related to being employed for persons with bipolar disorder. Nine thousand eight hundred and eighty-six subjects with bipolar disorder were collected between July of 2012 and November of 2013 and retrieved from Taiwan national disability database on May of 2014. The mean age of the sample is 45.41 (SD = 10.5), with 64% as female. Logistic regression was used to examine the log odds of the predictive variables on outcome of employment. A Receiver Operating Characteristics analysis was applied to locate the cutoff score of World Health Organization Disability Assessment Schedule 2.0 for being employed. All demographic variables were found to be significantly correlated with employment status among subjects. The Receiver Operating Characteristics results revealed that those subjects whose scores were below 33.57 had about a four-fold higher probability of being in employment than those whose scores were above 33.57. The result provides insights into future research effort and intervention design aimed at helping persons with bipolar disorder to obtain gainful employment.

Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study.

AIM: This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability. METHOD: We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years. RESULTS: These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement. INTERPRETATION: This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects. WHAT THIS PAPER ADDS: Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.

Movilidad y desempeño educativo y social de niños con problemas de aprendizaje en Taiwán: un estudio de seguimiento de 3 años OBJETIVO: Este estudio evaluó el desempeño de los niños con problemas de aprendizaje en Taiwán utilizando el Banco de Datos de Personas con Discapacidad de Taiwán. MÉTODO: Para el análisis incluimos 3854 niños (2343 varones, 1511 mujeres; edad media [DE] 9 años 11 meses [2 años 4 meses]) con trastorno específico del aprendizaje (SLD), trastorno por déficit de atención/hiperactividad (TDAH), autismo, epilepsia, o trastornos intelectuales. Utilizamos la Escala de Funcionamiento del Sistema de Evaluación de la Discapacidad-versión infantil para investigar el desempeño en el seguimiento durante al menos 3 años. RESULTADOS: Estos participantes demostraron una mejora en todos los dominios de la Clasificación Internacional del Funcionamiento, de la Discapacidad, y de la Salud (CIF) incluida la movilidad, el aprendizaje, la participación social y la vida diaria. Los niños con SLD (p = 0,3) y epilepsia (p = 0,442) no demostraron una mejora significativa en el aprendizaje, mientras que aquellos con TDAH (p < 0,001), autismo (p < 0,001) y discapacidad intelectual (p < 0,001) sí lo hicieron. Los niños con epilepsia mostraron el mayor deterioro y la menor mejora. INTERPRETACIÓN: Este estudio de desempeño en niños con distintos diagnósticos indicó que los niños con autismo o TDAH recibieron una educación más estructural. Sin embargo, las estrategias educativas para las personas con SLD o epilepsia requerían mejoras. Finalmente, la SLD posiblemente esta poco diagnosticada en niños, y los niños con epilepsia se ven afectados en múltiples aspectos del desempeño.

Mobilidade e desempenho educacional e social das crianças com dificuldades de aprendizagem em Taiwan: Um estudo de acompanhamento de 3 anos OBJETIVO: Este estudo avaliou o desempenho de crianças com problemas de aprendizagem usando o Banco de Dados de Pessoas com Deficiência em Taiwan. MÉTODO: Foram incluídas 3.854 crianças (2.343 homens, 1.511 mulheres; idade média [SD] de 9 anos e 11 meses [2 anos e 4 meses] com transtorno específico de aprendizagem (TEA), transtorno de déficit de atenção/hiperatividade (TDAH), autismo, epilepsia ou deficiência intelectual para análise. Utilizou-se uma Escala de Funcionamento do Sistema de Avaliação de Incapacidade-Criança para investigar o desempenho no acompanhamento por pelo menos 3 anos. RESULTADOS: Esses participantes demonstraram melhora em todos os domínios do Classificação Internacional de Funcionalidade, Saúde e Incapacidade, incluindo para mobilidade, aprendizagem, participação social e vida diária. As crianças com TEA (p = 0,3) e epilepsia (p = 0,442) não apresentaram melhora significativa no aprendizado, enquanto aquelas com TDAH (p < 0,001), autismo (p < 0,001) e deficiência intelectual (p < 0,001) apresentaram melhora significativa. Crianças com epilepsia apresentaram maior comprometimento e menor melhora. INTERPRETAÇÃO: Este estudo de diagnóstico cruzado de problemas de aprendizagem indicou que as crianças com autismo ou TDAH receberam mais educação estrutural. No entanto, as estratégias de educação para aqueles com TEA ou epilepsia exigia melhora. Finalmente, o TEA é possivelmente subdiagnosticado em crianças, e crianças com epilepsia são afetadas em múltiplos aspectos.

Men's decrease and women's increase in harmful alcohol use from the 2014 to 2018 national surveys in Taiwan: A harbinger for an emerging national trend in East Asia?

BACKGROUND: Gender differences in alcohol use have narrowed in Western societies, but that in Asia has been less investigated. By comparing the 2014 and 2018 waves of the national survey in Taiwan, we aimed to examine the gender differences in population trends in past-month alcohol use, binge drinking, and harmful alcohol use. METHODS: The national survey enrolled 17,837 participants in 2014 and 18,626 participants in 2018. Binge drinking was defined as having ≥5 drinks on one occasion in the past month, and harmful alcohol use as having an Alcohol Use Disorders Identification Test score of ≥8. RESULTS: There were significant decreases from 2014 to 2018 in the population's prevalence of past-month alcohol use, binge drinking, and harmful alcohol use. However, males and females had different trends: males showed significant reductions in all three alcohol use behaviours (a decrease of 3.79%, 1.59%, and 2.60%, respectively), while females exhibited a significant rise in harmful alcohol use (from 1.32% to 1.72%), particularly among those aged 18-29 years. CONCLUSION: There was gender convergence in alcohol use in Taiwan, mainly due to men's decrease and women's increase in harmful alcohol use. Our findings have important implications for the intervention and prevention of the problematic use of alcohol in East Asia.

The Potential Win-win Strategy for Healthy Aging and Environmental Protection: Environmental Volunteering.

PURPOSE: To explore the physical activity level of community environmental volunteering (CEV) participants and the differences in physical functions and daily activity patterns between the older adults who engaged in intensive CEV (≥15 hours/week) and non-intensive CEV (<15 hours/week) groups. DESIGN: Cross-sectional study. SETTING: Three recycling stations in Taiwan. SAMPLE: In total, 113 community-dwelling older adults who regularly participated in CEV. The response rate was 53%. MEASURES: The ActiGraph wGT3x-BT accelerometer for the percentage of sedentary, light, and moderate to vigorous physical activity (MVPA) of CEV time and awaken time; the Jamar hand dynamometer for grip strength; and the MicroFET3 muscle testing dynamometer for knee extension strength. ANALYSIS: Analysis of covariance with the baseline characteristics as covariates. RESULTS: Overall, MVPA, light, and sedentary activities accounted for 53.73%, 41.10%, and 5.23% of CEV time, respectively. The intensive group (n = 61) displayed greater dominant handgrip strength (P = .004) and higher MVPA percentage in daily life (P = .044) than the non-intensive group (n = 52). CONCLUSION: CEV provides sufficient opportunities for older adults to perform physical activity. Intensive CEV is related to greater handgrip strength but not lower limb strength. Further study is needed to establish the causal relationship between CEV and health variates.

Estimation method for distance cost to access medical services: Policy and patient privacy implications in Taiwan.

Introduction: Indicators of healthcare access with high reliability, validity, timeliness, and easy application can aid in an understanding of the supply and demand of a region's medical resources and assist governments in allocating resources more effectively. However, a key concern when developing indicators is the protection of private information, such as patients' residential addresses. Objectives: We develop an estimation method for distance cost using official public information, including a region's disease prevalence rates and population. Materials and methods: The method accounts for patients' privacy and addresses limitations associated with using the National Health Insurance Database. This cross-sectional study conducts a secondary data analysis using SPSS and QGIS. The data were divided into a validation group and an index development group with the medical distance calculated for each group. Data for the validation group were sourced from the medical records of patients with diabetes (n = 108-164) and hypertension (n = 243-348) in Yuli documented by a medical center in 2017-2019, and the data for the novel index development group included diabetes and hypertension prevalence sourced from national official public data. The study compared the consistency of the two groups' medical treatment distances to verify the accuracy of the estimation method. Results: The estimated distances for the index development group showed a high consistency (ICC > 0.9). Further, the index development group had an excellent R-square after adjusting for age (98.1%) and gender (92.7%). Conclusions: The proposed method to estimate healthcare on the basis of disease prevalence and population protects patient privacy and can be implemented by local governments. Trial registration: This study was approved by the Research Ethics Committee of the Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (IRB109-239-B).

The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: a pilot study in Taiwan.

BACKGROUND: Vocational peer support (VPS) services are recovery-oriented interventions in modern psychiatric care for persons with schizophrenia. However, few VPS services are found in Taiwan. Hence, a pilot program of peer co-delivered vocational rehabilitation to support persons with schizophrenia in Taiwan was proposed and evaluated. METHODS: Six peers were trained and were willing to co-lead and assist workplace problem-solving groups and care skills training in an extended vocational rehabilitation program from August 2017 to December 2018. The social support, mental health, psychiatric symptoms, and functioning of service users were assessed before and after peer co-delivered services, and the assessments were based on the following: Social Support Scale (SSS), Chinese Health Questionnaire-12 (CHQ-12), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF), and the Chinese version of the Social Functioning Scale (C-SFS). RESULTS: The recruited 46 service users were mostly middle-aged (49.1 ± 9.8), with 27 being male (58.7%). After interventions, 42 service users who completed the program had a significantly increased SSS score (149.1 ± 31.8 vs. 161.2 ± 35.0, df = 41, t = 2.70, p = 0.01) and subscale of friend-peer dimension (44.4 ± 12.0 vs. 53.2 ± 13.2, df = 41, t = 4.72, p < 0.001). The objective (GAF: 69.8 ± 9.8 vs. 72.6 ± 8.8, df = 41, t = 3.50, p = 0.001) and subjective social functional scores (C-SFS: 75.2 ± 8.8 vs. 78.1 ± 9.5, df = 41, t = 2.59, p = 0.01) both significantly increased. The weekly wage elevated significantly (37.5 ± 35.5 vs. 43.6 ± 38.0, df = 41, t = 2.57, p = 0.01) and the BPRS-18 score decreased significantly, too (31.2 ± 6.7 vs. 29.3 ± 5.0, df = 41, t = - 2.83, p = 0.007). CONCLUSIONS: Peer co-delivered vocational rehabilitation services may enhance the social support received by persons with schizophrenia and improve their occupational outcomes. The pilot program proposed can thus be a model for non-Western countries with limited resources allocated by governments to support persons with schizophrenia. TRIAL REGISTRATION: ClinicalTrials NCT04767204, retrospectively registered on Feb 23, 2021.

Exploring Factors Associated with Functional Change and Predictors of Participation Improvement-A Two Years Follow-Up on People with Depression.

The purpose of this study is to understand the functional status distribution and to explore the factors associated with changes in functional status and social participation in people with depression using two-year follow-up data. Subjects were selected from the Taiwan Databank of Persons with Disabilities (TDPD) if they had an evaluation date between July 2012 and 31 December 2017. We used data for 1138 individuals with multiple evaluation records and who were diagnosed with depression. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was the primary functional status measure. Other factors selected from the TDPD included social demographic data, living situation, employment status, economic status, and educational level. The results show scores in all dimensions of the WHODAS 2.0 declined over two years, especially in the domains of cognition, household activities, social participation, and total WHODAS 2.0 score. Aging groups showed poor recovery in cognition, getting along with others, and household activities. People living in suburban areas showed poorer recovery than people living in rural and urban areas in cognition, self-care, and general function (total score of WHODAS 2.0). Employment was also strongly associated with functional recovery in household activities, social participation, and general function. The original scores for cognition and getting along with others showed a significant negative relationship with social participation improvement. Our results can be used by policy makers to provide resources and conduct investigations, and by clinicians when making rehabilitation plans.

Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study.

BACKGROUND: Stroke is a leading cause of long-term disability and is considered a major global health burden. OBJECTIVES: We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. METHODS: We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. RESULTS: A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. CONCLUSION: Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.

Effects of Hearing Disability on the Employment Status Using WHODAS 2.0 in Taiwan.

The aim of this study was to explore the association between employment status and World Health Organization Disability Assessment Schedule, Second Edition (WHODAS 2.0) scores of working-age subjects with hearing impairment. The data of 18,573 working-age subjects (age ≥ 18 and <65 years) with disabling hearing impairment were obtained from the Taiwan Data Bank of Persons with Disability (TDPD) for the period from 11 July 2012 to 31 October 2018. Demographic data and WHODAS 2.0 scores for each domain were analyzed to identify their relationship with employment status. Unemployed subjects with disabling hearing impairment had higher WHODAS 2.0 scores in all domains compared with the employed subjects. Binary logistic regression revealed that older age, female sex, lower educational level, institutional residence, rural residence, lower family income, and moderate to severe impairment were more strongly associated with unemployment status. The data in this large population-based study offer comprehensive information on important factors associated with the employment status of people with disabling hearing impairment. Early identification of risks of unemployment of patients with hearing impairment can raise awareness for aggressive community and government campaigns regarding public health to improve the self-confidence, social participation, and related psycho-social wellbeing of people.

The Relationship of Urbanization and Performance of Activity and Participation Functioning among Adults with Developmental Disabilities in Taiwan.

Developmental disability is likely to be lifelong in nature and to result in substantial activity and societal participation limitations. The performance of individuals is related to the environment, supports, and urbanization of living cities. Most of the surveys for people with disabilities have not discussed the relationship between the cognitive impairment properties and performance of participation and activities functioning, and most cognitive impairments are regarded as having similar performance. The location of residence in childhood is mainly influenced by parents and main caregivers, but the factors related to the preferences of adults with cognitive impairment in the location of residence are more complicated. OBJECTIVE(S): The aim was to explore and compare the relationships of the urbanization degree of their living cities and the functioning performance of daily living in various domains among adults with intellectual disability (ID), autism, and concomitant communicative impairment (CCI). METHOD: The cross-sectional study was applied, and the data was collected face-to-face by professionals in all authorized hospitals in Taiwan. The participants were 5374 adults with ID (n = 4455), autism (n = 670), CCI (n = 110) and combination disabilities (n = 139) which were according to the International Statistical Classification of Diseases 9th Revision (ICD-9) from a total of 167,069 adults with disabilities from the Disability Eligibility System (DES) in Taiwan between July 2012 and October 2013. The authors used the World Health Organization Disability Assessment Schedule 2.0-36 item version of WHO (WHODAS 2.0-36 items) to measure performance and capability of daily living. RESULTS AND CONCLUSIONS: There were significant differences in age, gender, disabled severity, and the urbanization between all subgroups (p < 0.05). After adjusting the age of all participators, the degree of urbanization just significantly affected the functioning score distribution in domain 1: cognition for an adult with ID, autism, and CCI; in domain 2, mobility for an adult with CCI and combination disability; in domain 3, self-care; domain 4, independent domains for ID (p < 0.05). There were no significant differences between urbanization degree and functioning scores in all domains for adults with autism. All in all, only in groups with combination disability did we find that the worse the degree of impairment was, the lower the degree of urbanization of their place of residence was, and there was no such phenomenon in adults with autism and ID in our study.

Structural Validity of an ICF-Based Measure of Activity and Participation for Children in Taiwan's Disability Eligibility Determination System.

To assess activity and participation for children in Taiwan's Disability Eligibility Determination System (DEDS), we developed a questionnaire, the Functioning Disability Evaluation Scale (FUNDES-Child), based on the Child and Adolescent Scale of Participation (CASP). The study follows a methodology research design to investigate the construct validity of the frequency and independence dimensions of FUNDES-Child 7.0. Two samples were randomly stratified from the databank of 13,835 children and youth with disabilities aged 6.0-17.9 years to examine structural validity by exploratory factor analysis (EFA, n = 4111, mean age of 11.3 ± 3.5) and confirmatory factor analysis (CFA, n = 4823, mean age of 11.4 ± 3.5)). EFA indicated a 4-factor structure for the frequency dimension (51.3% variance explained) and a 2-factor structure for the independence dimension (53.6% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (Goodness fit Index, GFI; Normed Fit Index, NFI; Comparative Fit Index, CFI; and Tucker-Lewis Index, TLI ≥ 0.95, Root Mean Square Error of Approximation, RMSEA < 0.06). Results provide evidence that the participation part of FUNDES-Child 7.0 has acceptable structural validity for use in Taiwan's DEDS. Utility of FUNDES-Child 7.0 in rehabilitation, welfare, and educational services needs further study.

Hand fine motor skill disability correlates with dementia severity.

BACKGROUND: The progression of dementia, which impairs motor skills and cognitive function, is a warning of greater disability. The present study investigated the association between hand fine motor skills, assessed according to the Functioning Disability Evaluation Scale - Adult Version (FUNDES-Adult), and dementia severity. METHODS: People with mild and moderate to severe dementia were identified from the Taiwan Data Bank of Persons with Disability. The FUNDES-Adult was assessed for all enrollees, and the following hand fine motor skills were evaluated: pen-holding, buttoning, and knotting. Statistical analysis was performed using SAS, and P values < 0.05 were considered significant. RESULTS: Disability in all the 3 fin. motor skills was significantly greater in patients with moderate to severe dementia than in those with mild dementia. Disability in any of the skills was sensitive to distinguish mild from moderate to severe dementia (sensitivity: 78.1 %, specificity: 55.2 %, area under the curve: 0.739, 95 % confidence interval [CI]: 0.734-0.745). Those with fine motor skill disability were at a significantly higher risk of moderate to severe dementia (odds ratio: 3.71, 95 % CI: 3.53-3.90, P <  .001). CONCLUSION: Hand fine motor skill disability was more prevalent in patients with moderate to severe dementia than in patients with mild dementia. A straightforward motor skill assessment can serve as a screening tool in the community to detect the progression of dementia.

Potential benefits of environmental volunteering programs of the health of older adults: a pilot study.

PURPOSE: To study the effects of participating in a 12-week environmental volunteering program on the physical performance of older adults across different age groups MATERIALS AND METHODS: We conducted a pretest-posttest pilot study with a single group. The intervention consisted of twice-weekly recycling activities and once-weekly rehabilitation exercise at community-based care centers. The recycling activities of the environmental volunteering program included sorting and handling paper products, plastics, and metals; disposing electronic products; and sorting clothes. The rehabilitation exercise program comprised a 90-min course for special needs and 30 min of health education. The evaluation tools were the handgrip strength, five-times-sit-to-stand test, sit-and-reach test, Timed Up and Go (TUG) test and usual and fast gait speeds. RESULTS: In total, 45 participants completed the program. After the program, the participants showed significantly great improvements compared to baseline in all outcome measures. We further divided these participants into two age subgroups [65-75 years (n = 31) and >75 years (n = 14)]. The 65-75-year subgroup only showed significant improvements in handgrip strength, TUG and usual gait speed. However, the >75-year subgroup showed significant improvements in all outcome measures. CONCLUSIONS: This innovative environmental volunteering program conducted in a local Taiwanese community can be a sustainable and feasible model to improve physical performance in the participants, the subgroup aged >75 years in particular. It also provides a potential avenue for researchers and policymakers to address environmental and aging-related issues.

Hand Fine Motor Skill Disability Correlates with Cognition in Patients with Moderate-to-Advanced Parkinson's Disease.

In older individuals, hand fine motor skill disability is associated with cognitive levels. Similarly, patients with moderate-to-advanced Parkinson's disease (PD) often have cognitive dysfunction. Here, we investigated the association between hand fine motor skill and cognitive dysfunction in patients with moderate-to-advanced PD. Moderate and advanced PD patients with and without dementia were identified from the Taiwan Data Bank of Persons with Disability. Hand fine motor capacities, namely pen holding, buttoning, and knotting, were assessed with the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were performed on Statistical Analysis System (SAS) and a p value of <0.05 was considered significant. In total, 3440 patients with PD were enrolled, of which 612 had dementia, exhibiting significant disability in all three tasks. After adjustments for age, sex, and PD severity, pen holding and knotting were significantly associated with PD dementia. The presence of any disability in either task was not only sensitive to the presence of dementia but also associated with cognitive disability in moderate and advanced PD patients without dementia. In conclusion, hand fine motor skill disability was associated with cognitive disability in patients with moderate-to-advanced PD. These simple hand fine motor skills may thus be applicable in screening tests for the early identification of cognitive dysfunction in patients with moderate-to-advanced PD.

Validating the ICF core set for cerebral palsy using a national disability sample in Taiwan.

Purpose: To validate the activities and participation (d) codes of two age-specific brief International Classification of Functioning, Disability, and Health (ICF) core sets for school-aged children with cerebral palsy (CP), using national dataset of the child version of the Functioning Scale of the Disability Evaluation System (FUNDES) in Taiwan.Methods: Students with CP aged 6-17.9 years (n = 546) in the national dataset were analyzed. Items of the child version of the FUNDES were linked to the ICF d-codes and matched to two brief ICF core sets for CP. The restriction rate of the linked d-codes were calculated. Random Forest regression was applied to select the important linked d-codes for predicting school participation frequency.Results: The vast majority of the content of the Taiwanese dataset was covered by two core sets. The matched d-codes represent high restriction rates (80%) and most were important for predicting school participation. One important code, d740 (formal relationships, such as relationship with teachers), identified in this study were not included in two ICF core sets.Conclusions: Two brief ICF core sets for CP capture the majority of relevant functional information collected by the child version of the FUNDES. Some additional codes not covered in the international ICF core sets should be considered for inclusion in the revised Taiwanese version.Implications for rehabilitationCerebral palsy (CP) is the most common cause of severe physical disability in childhood. ICF core sets for CP promote a comprehensive assessment and service provision.To ensure applicability, ICF core sets for CP were validated in Taiwan using the child and youth national dataset of the child version of the Functioning Scale of the Disability Evaluation System. This study shows content validity and proposes new ICF codes additions for the Taiwanese version.Among top five ICF-based predictors for school participation frequency, four of them were consistent in both children and youth groups as d310-d350 (basic communication), d750 (informal social relationships), d820 (school education), and d710-d720, d880 and d920 (social play), which could be taken into consideration in clinical application.