Disparities in the level of COVID-19 health literacy and the associated factors among employees in long-term care facilities in Taiwan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) poses a significant threat to the safety of residents in long-term care facilities, and the staff of long-term care facilities are essential in the care and prevention of major infectious diseases and therefore require good health literacy to ensure the health of residents. The main objective of this study was to examine the health literacy of staff in long-term care facilities and analyze the factors associated with their COVID-19 health literacy in Taiwan to provide a basis for the response mechanism to emerging infectious diseases. METHODS: A cross-sectional survey with a structured questionnaire by a convenience sample method and to assess the COVID-19 health literacy of caregivers working in long-term care facilities in this study. The COVID-19 health literacy scale was a self-administered scale designed to combine the concept of "health literacy" with the 3 levels and 5 stages of preventive medicine. A total of 385 workers from 10 long-term care facilities were surveyed as the study sample, and the validated questionnaires were statistically analyzed using SPSS version 22.0 statistical software. A multivariate logistic regression model was used to establish the associated factors of the COVID-19 health literacy level. RESULTS: Overall, the mean COVID-19 health literacy score was 88.7 ± 10.4 (range: 58-105). Using a quartile scale, 92 (23.9%) of the study participants had low health literacy (health literacy score < 82), 190 (49.3%) had average health literacy (health literacy score 82-98), and the remaining 103 (26.8%) had good health literacy (health literacy score 99-105). Statistical analysis revealed significant differences (p < 0.05) in the COVID-19 health literacy score by demographic variables (education, job category, number of daily service users, and training related to infectious disease prevention and control) of the study population. The logistic regression analysis of the COVID-19 health literacy level (> 82 vs. ≤82) showed a significant difference in the study sample by gender (male vs. female, OR = 2.46, 95% CI = 1.15-5.26), job category (nurse practitioner vs. caregiver, OR = 7.25, 95% CI = 2.46-21.44), monthly service hours (> 160 h vs. 40-79 h, OR = 0.044, 95% CI = 0.07-0.97), experience caring for confirmed COVID-19 patients (yes vs. no, OR = 0.13, 95% CI = 0.02-0.98), and training related to infectious disease prevention and control (yes vs. no, OR = 2.8, 95% CI = 1.52-5.15). CONCLUSIONS: This study recommends that facilities provide immediate updated COVID-19 information to staff, especially frontline caregivers, and specifically enhance COVID-19 infection control education training for all facility staff to eliminate health literacy disparities.

Factors Associated with patient satisfaction towards a prison detention Clinic Care among male drug-using inmates.

This study assessed patient satisfaction and its associated factors among male drug-using inmates utilizing a prison detention clinic in Taiwan. A cross-sectional design and structured questionnaire were employed to recruit 580 drug-using inmates into the study. The Patient Satisfaction Questionnaire Short Form (PSQ-18), developed by the RAND Corporation, was used as the basis for the short scale of patient satisfaction, and the research data were analyzed using the SPSS for Windows 20.0 statistical software package. The results showed that the research subjects had low patient satisfaction in all the factors assessed compared with the scale's general norms. Among the original seven satisfaction subscales in this study, the highest score was for the financial aspects, and the lowest was for the amount of time spent with doctors. This study also investigated satisfaction with medical lab exams and the pharmacy at the prison's clinic, and the satisfaction scores were higher than the original seven subscales. In multiple logistic regression analyses, the final model indicated that the inmates undergoing observed rehabilitation (OR = 13.837, 95% CI = 2.736-69.983) were more likely satisfied with prison detention clinic c than those serving prison sentences. Those inmates with custodial deposits (high vs. low; OR = 1.813, 95% CI = 1.038-3.168), and meet their physical health needs (met vs. unmet; OR = 4.872, 95% CI = 2.054-11.560) had significant correlated with detention clinic care satisfactory level. Although there is only one study setting cannot give a generalizability for people who are incarcerated in Taiwan, this study highlights that the prison authorities should scrutinize factors associated with detention clinic care satisfaction, such as the type of inmate, economic status in the prison, self-reported health status, and their physical health needs, to increase the level of patient satisfaction.

Differences in and Factors Related to Willingness to Provide Care to Patients with Suspected or Confirmed COVID-19 in Long-Term Care Facilities.

The coronavirus disease 2019 (COVID-19) pandemic has exerted tremendous effects on the residents of and caregivers at long-term care facilities (LTCF). The combination of a vulnerable, aged population, staffing shortages, and inadequate resources in LTCF will cause a great negative impact in these sectors. Addressing the caregiver's lack of interest in providing care for patients with COVID-19 is a great challenge for institutional managers. The primary objective of this study was to analyze the factors related to the willingness of personnel at LTCF to provide care to patients with COVID-19. This was a cross-sectional study in which personnel from 10 LTCF were recruited as participants through convenience sampling and completed structured questionnaires. A total of 500 questionnaires were distributed and 385 valid questionnaires were recovered, posting a response rate of 77%. A statistical analysis was performed using SPSS 22.0. The results of the survey revealed that only 30% of the participants were willing to provide care to patients with COVID-19; 23% more of the participants were willing to provide such care if their institutions provided sufficient PPE. Regarding other conditions, 31.5% and 76% of the participants expressed that they would be willing to provide such care if their compensation were increased and working hours were reduced. In the univariate analysis, the willingness of participants with different characteristics (job categories, years of holding a professional certificate, job location type, monthly income, experience with caring for patients with confirmed COVID-19, and completion of training related to communicable disease control) varied significantly (p < 0.05). Furthermore, in the logistic regression analysis, several demographic and professional characteristics (education level, job category, number of patients served daily, and monthly income) were significantly correlated with willingness to provide care to patients with COVID-19 (p < 0.05). On the basis of these findings, the LTCF should securitize the associated factors of care wiliness in personnel to eliminate the difference of the willingness to provide care to patients with suspected or confirmed COVID-19.

Factors Associated with Free Hospital Outpatient Service Use among Middle-Aged and Older Urban Homeless Adults in Taipei.

Homeless individuals have many negative experiences with inequality regarding access to and the use of primary healthcare services, so policies to eliminate the disparities in and barriers to primary care access for these people are needed. The aim of this study was to explore the use and determinants of free hospital outpatient services for homeless people, in order to describe the provision of free healthcare policies for this vulnerable population in Taipei. One cross-sectional survey was conducted to recruit homeless people aged 45 years old and over in Taipei in 2018. A structured questionnaire was used, and face-to-face interviews were conducted by three social workers to collect the data. Finally, 129 participants were recruited in the study. The results show that 81.4% of the homeless people had made free hospital outpatient care visits (mean = 5.9 visits) in the last three months. An unadjusted logistic regression analysis showed that those homeless people who reported having usual healthcare providers, with higher depressive symptom scores, who used medication and had been hospitalized within one year, and had more chronic diseases, were significantly more likely to make free hospital outpatient visits. The adjusted logistic regression model indicates that homeless people with severe depressive symptoms (odds ratio (OR) = 9.32, 95% CI = 1.15-56.07), who had received medication (OR = 3.93; 95% CI = 1.06-14.52), and who had more than five chronic diseases (OR = 1.06, 95% CI = 1.35-13.27), were significantly more likely to make free hospital outpatient visits than their counterparts. The findings highlight that homeless people have higher healthcare requirements than the general population, and the healthcare system should pay more attention to factors associated with higher outpatient service use, such as homelessness, severe depressive symptoms, the receipt of medication and chronic diseases.

Correlates of Depressive Symptoms among Middle-Aged and Older Homeless Adults Using the 9-Item Patient Health Questionnaire.

This study investigates the screening for depressive symptoms among middle-aged and older homeless adults based on Patient Health Questionnaire-9 (PHQ-9) and examines the possible factors associated with their major depressive symptoms. A cross-sectional survey was employed, and research subjects included 129 homeless people aged 45 years old and over in Taipei Wanhua District and Taipei Main Station. We used a structured questionnaire and face-to-face interview conducted by three social workers to collect data in the analyses. The content of the questionnaire included an informed consent form, demographic characteristics, enabling and need factors of healthcare, and PHQ-9 of homeless people. Results revealed that 15.5% respondents were free of depressive symptoms, 16.3% had mild level (score 5-9), 31.8% had moderate level (score 10-14), 26.4% had moderately severe level (score 15-19), and 10.1% had severe level of depressive symptoms (score 20-27). Adopting a PHQ-9 score 10 as a cut-off point for major depressive symptoms, 68.3% of middle-aged and older homeless adults were the cases needing to be referred to healthcare settings for further recheck in the near future. A multiple regression analysis found gender, age, and usage of psychiatric outpatient care were associated with major depressive symptom occurrence. The female participants were less likely to have major depressive symptoms than the male participants (OR = 0.29, 95% CI = 0.09-0.96). The elderly participants were more likely to have major depressive symptoms than the aged 45-54 years (OR = 5.29, 95% CI = 1.44-19.41). Those participants who have ever used psychiatric outpatient care were significantly more correlated with the occurrence of major depressive symptoms than their counterparts (OR = 3.65, 95% CI = 1.46-9.09). The present study suggests that in the future health policy should eliminate the risk factors of depressive symptoms and improve mental healthcare access, to improve the health and wellbeing of the homeless population.

Health Literacy of Osteoporosis Risks among Caregivers Serving in Disability Care Facilities.

Osteoporosis is a global public health issue and its consequent effects are a growing concern worldwide. Caregivers generally experience occupational physical ailments and they have less of a tendency to engage in preventive health behaviors, leading them to be in a higher risk group for osteoporosis. This study aims to present a general profile of health literacy related to osteoporosis risks and identify its associated factors among disability institutional caregivers. A cross-sectional study with a structured questionnaire was used to collect information on 465 caregivers from seven disability care institutions regarding their awareness of the health literacy related to osteoporosis risks. The results indicate that the average literacy score related to osteoporosis risks among the respondents was 60 points (full score is 80 points), with 50-59 being the most common range (51.9%), followed by 60-69 points (43.5%), and 4.4% of cases had more than 70 points. A multivariate logistic regression model revealed that respondents' age (40-49 vs. 18-29; odds ratio (OR) = 2.53, 95% confidence interval (CI) = 1.31-4.87), education level (senior high vs. primary and junior high, OR = 2.00, 95% CI = 1.03-3.89; college and above vs. primary and junior high, OR = 3.66, 95% CI = 1.84-7.31), experience in undergoing a bone density test (OR = 1.94, 95% CI = 1.28-2.93), and poor physical fitness status (OR = 0.64, 95% CI = 0.43-0.95) were the significant predictors of the osteoporosis health literacy level. The osteoporosis health literacy of institutional caregivers is moderate, and there are many items that are worthy of attention in future health promotion programs. This study highlights risk factors related to a lower level of osteoporosis healthy literacy such as older age, less education, no experience of bone density test, and poor physical fitness that highlight the need to raise further awareness in order to improve caregivers' bone health.

Early Osteoporosis Risks and Associated Factors among Caregivers Working in Disability Institutions: IOF One-Minute Osteoporosis Risk Check.

This study employed the International Osteoporosis Foundation's One-Minute Osteoporosis Risk Test to examine factors related to the osteoporosis risk of institutional caregivers. In this cross-sectional study, a self-developed structured questionnaire comprising the One-Minute Osteoporosis Risk Test was used to obtain data on the caregivers' demographic data, health habits, working style, and osteoporosis risk. Seven disability welfare institutions were selected as research sites, and 465 copies of questionnaires were distributed to the institutions' employees, with 455 valid responses collected for a valid return rate of 98%. SPSS for Windows (Version 20.0) was used to analyze questionnaire data; descriptive-statistical frequency, a χ2 test, and logistic regression were used to determine the correlation between demographic data, health habits, working style, and osteoporosis risk. The results revealed that primary risk factors include < 30 min of daily exercise (38%), lack of dairy product or calcium tablet intake (28%), and < 10 min of daily outdoor activity or not taking vitamin D supplements (29.9%). In total, 395 (86.8%) of the respondents scored less than 5 in the osteoporosis risk test; the remaining 60 (13.2%) scored 5 or higher, revealing a high risk of early osteoporosis. An independent variable analysis revealed that the risk factors of early osteoporosis include age, education level, having undergone bone density tests, prior disease diagnosis, long-term medication use, physical fitness, dietary habits, and average time of exposure to sunlight. In the multivariate analysis, poor physical fitness (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.12-4.27, p = 0.023) and average daily time of exposure to sunlight (OR = 0.24, 95% CI: 0.59-2.59, p < 0.001) were significantly correlated with osteoporosis risk. In other words, respondents with poor physical fitness were 2.18 times as likely to have osteoporosis as those with good physical fitness, and those exposed to sunlight for 30 min or longer every day were 0.24 times as likely to have osteoporosis as those exposed to sunlight for less than 30 min every day. Accordingly, institutions must encourage employees to spend more time in the sun every day and improve their physical fitness through exercise.

Open-labelled observations of language dysfunction in old ischemic stroke patients with aphasia when given plant and marine-based nutrient supplements for 12 weeks.

BACKGROUND AND OBJECTIVES: This study aimed to explore the effect of functional foods on aphasia related to a previous ischemic stroke. When stroke-related neurological deficits result in physical dependency and poor selfcare that persists longer than 6 months, full recovery is almost impossible and the patient often requires long-term care. The functional foods, EASE123 and BioBalance#6, include numerous plant and marine-based nutrient supplements that could prove beneficial for such patients. METHODS AND STUDY DESIGN: This open-labelled study included 10 patients diagnosed with prior ischemic stroke and aphasia lasting longer than 6 months. Each patient was administered 6 tablets of EASE123 at 10:30 AM and at 90 minutes before sleeping, and 3 tablets of BioBalance# 6 at 2:30 PM. After a treatment period of 12 weeks, the patients were followed during a 4-week withdrawal period. Functional improvement was assessed by scores and subscores on the Concise Chinese Aphasia Test (CCAT) at weeks 4, 8, 12, and 16. RESULTS: Average total CCAT scores and matching ability improved significantly at weeks 4, 8, 12, and 16 (p<0.05). Simple response scores improved significantly at weeks 8 and 12 (p<0.05). Auditory comprehension improved significantly at weeks 4 and 12 (p<0.05), and reading comprehension, at week 12 (p<0.05). Repetition ability improved significantly at weeks 8, 12, and 16 (p<0.05), and spontaneous writing, at weeks 4, 12, and 16 (p<0.05). CONCLUSIONS: Matching, repetition, and average total CCAT scores improved over the course of the study. Therefore, 6 months after ischemic stroke, EASE123 and BioBalance# 6 administration may improve stroke-related aphasia.

Comparison of job burnout and life satisfaction between native and foreign female direct care workers in disability institutions.

BACKGROUND: There is little information about the burnout and wellbeing of institutional caregivers working for people with intellectual and developmental disabilities; information is particularly limited in the understanding of experiences of direct care workers. OBJECTIVE: The aims of the study were to provide a profile of self-perceived burnout and wellbeing of direct-care caregivers working in disability institutions, and to compare the difference between native- and foreign caregivers. METHODS: A cross-sectional survey was conducted. We recruited 46 female living assistants of people with intellectual and developmental disabilities in two disability institutions in Taiwan. There were 23 subjects who were local residents and 23 subjects who were foreign providers of labor. A self-administered questionnaire which included scale of the Copenhagen Burnout Inventory (CBI), the Subjective Happiness Scale (SHS), and the Satisfaction with Life Scale (SWLS) were employed in the survey. RESULTS: Findings revealed the local caregivers were slightly higher than foreign caregivers in personal burnout score (PBS) and work-related burnout score (WBS), although there were no significant differences. Those caregivers from foreign countries seem to be slightly happier and have higher life satisfaction than native caregivers. CONCLUSIONS: In order to decrease the burnout and improve wellbeing of caregivers of people with intellectual and developmental disabilities, service providers should understand the experiences which caregivers encounter in their workplaces. Caregivers can benefit if they receive appropriate support to improve positive health while working for their service clients.

Risk for osteopenia and osteoporosis in institution-dwelling individuals with intellectual and/or developmental disabilities.

The purpose of this study was to investigate the prevalence of and contributing factors to osteopenia and osteoporosis among people with intellectual disabilities (ID) or/and developmental disabilities (DD) residing in a disability institution in Taiwan. The present study was conducted at one disability institution in Taiwan and recruited 184 institutionalized residents with ID and/or DD (115 men and 69 women aged 18-72 years) for analysis. For all residents with ID and/or DD, information was obtained about their age, gender, level of ID, BMI, and bone mineral density (BMD). BMD is a measurement of calcium levels in bones that can estimate the risk of osteoporosis and bone fractures. Bone tests were divided into three outcome categories based on their calcaneal BMD T-scores: Normal BMD, a T-score≧-1; Osteopenia, -2.5≦T-score<-1; and Osteoporosis, a T-score<-2.5. The results revealed that 46.2% of cases were normal and that 27.7% and 26.1% of cases had osteopenia and osteoporosis, respectively. Multiple logistic regression analyses found that male gender (OR=2.482, 95% CI=1.04-5.93, p<0.05), age≧40 years (OR=3.051, 95% CI=1.07-8.69, p<0.05) and being overweight/obese (OR=0.395, 95% CI=0.17-0.93, p<0.05) were more likely to be associated with osteoporosis. Another model indicated that males (OR=2.169, 95% CI=1.12-4.19, p<0.05) and those aged≧40 years (OR=3.026, 95% CI=1.32-7, p<0.01) tended to have an increased risk for osteopenia and osteoporosis. To improve the bone quality of individuals with ID or/and DD and to decrease the occurrence of osteopenia and osteoporosis, this study highlights that we should pay much attention to the potential risk factors for bone quality in these vulnerable populations.

Are early onset aging conditions correlated to daily activity functions in youth and adults with Down syndrome?

This study aims to answer the research question of "Are early onset aging conditions correlated to daily activity functions in youth and adults with Down syndrome (DS)?" A cross-sectional survey was employed to recruit 216 individuals with DS over 15 years of age in the analyses. A structured questionnaire included demographic data, brief self-reported aging conditions, Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) and activity of daily living (ADL) scales were completed by the primary caregivers who were well-suited for providing information on the functioning conditions of the DS individuals. Results showed that the most five frequent aging conditions (sometimes, usually and always) included frailty (20.2%), vision problem (15.8%), loss of language ability (15.3%), sleep problem (14.9%) and memory impairment (14.5%). Other onset aging conditions included more chronic diseases (13.9%), hearing loss (13%), chewing ability and tooth loss (12.5%), incontinence (11.1%), depressive syndrome (7.7%), falls and gait disorder (7.2%), loss of taste and smell (7.2%). The data also showed scores of DSQIID, onset aging conditions and ADL has significant relationships each other in Pearson's correlation tests. Finally, multiple linear regression analyses indicated onset aging conditions (ß=-0.735, p<0.001) can significantly predicted the variation in ADL scores after adjusting other factors (R2=0.381). This study suggests that the authority should initiate early intervention programs aim to improve healthy aging and ADL functions for people with DS.

Primary caregivers' awareness and perception of early-onset dementia conditions in adolescents and young and middle-aged adults with Down syndrome.

The present study aims to investigate the onset of dementia conditions using the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) scale and to identify the possible factors associated with DSQIID scores in people with Down syndrome (DS). The study population was recruited from the voluntary registry members of the Republic of China Foundation for Persons with Down syndrome; primary caregivers provided DSQIID information on 196 adolescents and adults with DS (aged 15-48 years) who were entered into the database and analyzed using SPSS 20.0 software. The results described the distribution of early-onset dementia conditions in 53 adolescents and adults with DS, and 2.6% of the subjects with DS had possible dementia (DSQIID score ≧ 20). Univariate analyses found that older age (p=0.001) and comorbid conditions (p=0.003) were significantly associated with DSQIID scores. Older subjects were more likely to have higher DSQIID scores than were younger age groups after ANOVA and Scheffe's tests. Lastly, a multiple linear regression analysis revealed that age (p<0.01), severe disability level (p<0.05) and comorbid condition (p<0.01) significantly explained 13% of the variation in DSQIID scores after adjusting for the factors of gender, education level and multiple disabilities in adolescents and adults with DS. The study highlights that future research should focus on the occurrence of dementia in people with DS and on identifying its influencing factors based on sound measurements, to initiate appropriate healthy aging policies for this group of people.

Association of early-onset dementia with activities of daily living (ADL) in middle-aged adults with intellectual disabilities: the caregiver's perspective.

Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the "Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach" project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r=-0.28, p<0.001). The multiple linear regression model reported that factors of male gender (ß=4.187, p<0.05), marital status (ß=4.79, p<0.05), education level (primary: ß=5.544, p<0.05; junior high or more: ß=8.147, p<0.01), Down's syndrome (ß=-9.290, p<0.05), severe or profound disability level (ß=-6.725, p<0.05; ß=-15.773, p<0.001), comorbid condition (ß=-4.853, p<0.05) and dementia conditions (ß=-9.245, p<0.001) were variables that were able to significantly predict the ADL score (R(2)=0.241) after controlling for age. Disability level and comorbidity can explain 10% of the ADL score variation, whereas dementia conditions can only explain 3% of the ADL score variation in the study. The present study highlights that future studies should scrutinize in detail the reasons for the low explanatory power of dementia for ADL, particularly in examining the appropriateness of the measurement scales for dementia and ADL in aging adults with ID.

Onset aging conditions of adults with an intellectual disability associated with primary caregiver depression.

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p<0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR=3.807, p=0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.

Assessment of the 9-item Patient Health Questionnaire (PHQ-9) as a screen tool for symptoms of depression in community caregivers for adults with intellectual disabilities.

The study aim was to determine the extent and determinants of reporting depressive symptoms in caregivers for persons with intellectual disabilities based on assessment of the 9-item Patient Health Questionnaire (PHQ-9). A cross-sectional study was conducted, recruiting 455 caregivers for adults with ID who were providing care in community residences, with complete PHQ-9 data being analyzed. The results indicated that the mean of each item scored on the PHQ-9 varied from 0.3 (Q9) to 1.1 (Q4). For two items (Q3 - "sleeping difficulties" and Q4 - "fatigue"), the respondents reported occurrence during several days in the previous two weeks. However, after scrutinizing the distribution of each item in the PHQ-9, 3.3-14.5% respondents reported that each item happened nearly every day, and 4.0-17.8% expressed that each happened more than half of the days in the previous two weeks. With respect to difficulties examined on the PHQ, 47% of cases expressed that it was somewhat difficult, 8.2% expressed that it was very difficult, and 4.5% felt that it was extremely difficult to work, care for things at home, or get along with others. Finally, a logistic regression model revealed that only one factor of self-perceived health status (fair/poor vs. excellent/very good, OR=7.519, 95% CI=3.03-18.68, p<0.001) exhibited a statistically significant correlation with depressive symptom occurrence (PHQ-9 score ≥ 10) among the caregivers. The study highlights the need to strengthen appropriate health initiatives for monitoring mental health status and to provide necessary services for community caregivers for adults with ID.

Caregivers' reported functional limitations in activities of daily living among middle-aged adults with intellectual disabilities.

This study was conducted to describe the functioning of Activities of Daily Living (ADL) and to examine socio-economic effects on ADL functioning among adults with intellectual disabilities (ID) aged 45 years and older (N=480) in Taiwan. The Barthel Index (BI) was used to determine a baseline level of ADL functioning in the study participants. There are five categories of functional impairment using the following cut-off values in Taiwan: total dependence (BI score 0-20), severe (BI score 21-60), moderate (BI score 61-90), mild (BI score 91-99), and total independence (BI score 100) (Taiwan Department of Health, 2012). The results revealed that 2.3% of adults with ID were in total dependence, 11.9% were in severe dependence, 27.9% were in moderate dependence, 8.1% had a mild dependence, and 49.8% were totally independent. In the multiple linear regression model of the ADL score, we determined that educational level, comorbid Down's syndrome, and disability level are the variables able to significantly predict ADL score (R(2)=0.190) after controlling for the factors of age, marital status, and other comorbidity conditions. Those ID adults with a lower education level (primary vs. literate, ß=4.780, p=0.031; intermediate vs. literate, ß=6.642, p=0.030), with comorbid Down's syndrome (ß=-7.135, p=0.063), and with a more severe disability condition (severe vs. mild, ß=-7.650, p=0.007; profound vs. mild, ß=-19.169, p<0.001) had significantly lower ADL scores. The present study highlights the need to support mobility in older adults with ID as much as possible to optimize independence in this group.

An exploratory study of health behaviors and the risks for triple H (hypertension, hyperlipidemia, and hyperglycemia) in young adults with disabilities between 20 and 39 years of age.

Metabolic syndrome is highly prevalent and has important implications for the health care sector. However, information on the implications of metabolic syndrome for people with disabilities is limited. The purpose of this study was to explore the relationship between health behaviors and the risk for triple H (hypertension, hyperlipidemia, and hyperglycemia) in young adults with disabilities. The present study analyzed the annual health examination charts of 705 young adults with disabilities between ages 20 and 39 in Taiwan. Results found that the prevalence of hyperglycemia, hyperlipidemia, and hypertension in adults with disabilities was 5%, 15% and 17.7%, respectively. These prevalence figures were higher than those for the general population of the same age group in Taiwan. Multivariate logistic regression analyses revealed that almost none of the health behaviors were significantly correlated with the occurrence of triple H disorders among young adults with disabilities. Only one factor, BMI, independently predicted the occurrence of triple H disorders. We suggest that future studies should scrutinize the effects of health behaviors on triple-H disorders in people with disabilities to initiate personalize health promotion programs for this group.

Healthcare utilization and expenditure analysis between individuals with intellectual disabilities and the general population in Taiwan: a population-based nationwide child and adolescent study.

This study examines differences in outpatient-visit frequency and medical expenditures between (1) children and adolescents in Taiwan with intellectual disabilities and (2) children and adolescents in Taiwan's general population. A cross-sectional study was conducted to analyze data from 2007 provided by Taiwan's National Health Insurance program. A total of 236,045 beneficiaries younger than 19 years made use of outpatient services; among them, 35,802 had a principal diagnosis of mental retardation (intellectual disability). The average number of ambulatory visits was 14.9 ± 12.4, which is much higher than in the United States and other developed countries. The mean number of annual visits of the individuals with intellectual disabilities was significantly higher than that of the general population in Taiwan (20.1 ± 20.0 vs. 14.0 ± 12.2); age, gender, urbanization level of residential area, and copayment status affected outpatient visit frequency. The mean annual outpatient costs were NTD6371.3 ± NTD11989.1 for the general population and NTD19724.9 ± NTD40469.9 for those with intellectual disabilities (US $1 equals approximately NTD30). Age, gender, urbanization level of residential area, and copayment status were the determinants that accounted for this difference in cost. Children and adolescents with intellectual disabilities had higher use rates of rehabilitative and psychiatric services than the general population. We conclude that individuals with intellectual disabilities had higher demands than the general population for healthcare services, especially for rehabilitative and psychiatric services.

Outpatient rehabilitation utilization and medical expenses in children aged 0-7 years with ADHD: analyses of population-based national health insurance data.

Medical costs of attention-deficit/hyperactivity disorder (ADHD) are substantial and have a large impact on the public health system. The present study presents information regarding outpatient rehabilitation care usage and medical expenditure for children with ADHD. A cross-sectional study was conducted by analyzing data from the Taiwan National Health Insurance claims database for the year 2009. A total of 6643 children aged 0-7 years with ADHD (ICD-9-CM codes 314.0x: attention deficit disorder, 314.00: attention deficit disorder without hyperactivity, or 314.01: attention-deficit disorder with hyperactivity) who had used outpatient rehabilitation care were included in the analyses. Results showed that the mean annual rehabilitation care was 22.24 visits. Among the care users, 76% of patients were male, and 24% were female. More than half of the children with ADHD had comorbid mental illnesses as well. A logistic regression analysis of outpatient rehabilitation expenditure (low vs. high) showed that of those children with ADHD, those aged 0-2 years tended to incur more medical costs than those aged 6-7 years. Other factors such as frequency of rehabilitation visits, hospital medical setting and ownership, location of medical care setting, and types of rehabilitation were also significantly correlated with medical expenditure. The results from this study suggest that health care systems should ensure accurate diagnosis and measurement of impairment to maintain appropriate and successful management of rehabilitation needs for children with ADHD.

Reported numbers of patients with rare diseases based on ten-year longitudinal national disability registries in Taiwan.

This paper aims to describe a general demographic picture of patients with rare diseases in Taiwan and particularly focuses on the prevalence of rare diseases over time, age and gender distributions. We analyzed data mainly from the national disability registry from 2002 to 2011 in Taiwan, Republic of China. The results showed that the number of rare diseases increased from 93 to 193 between 2002 and 2011 and that the prevalence of rare diseases increased from 0.02 to 0.74 per 10,000 people in this time period. The gender ratio (male/female) was between 1.02 and 1.13 during this time period, with male cases representing a higher percentage than female cases in the rare disease population. The occurrence of rare diseases was significantly increased in children 3-5 years of age and elementary school children 6-14 years of age. The data also revealed that the occurrence of rare diseases in Taiwan was attributed primarily to pathogenic diseases and secondarily to genetic diseases. To obtain precise epidemiological data on rare diseases for future healthcare planning, this study highlights the importance of the cooperation of healthcare authorities with the social welfare department to strengthen the ability of the public healthcare system to regularly monitor and measure the occurrence of rare diseases in the community.