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.

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.

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.

Determinants of Employment Outcome for the People with Schizophrenia Using the WHODAS 2.0.

Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78.

[The Policy and Practice of Preventive Care for the Elderly].

Taiwan is projected to become an aged society in 2018. In addition to establishing a comprehensive, long-term care system that is able to deal with the expected impacts of population aging, it is imperative that the government focus on improving the prevention of aging-related conditions. This article introduces the innovative preventive care policy promoted by Taiwan's Ministry of Health and Welfare and its preliminary results. Furthermore, the foundational ideas behind this policy and how it is being executed are explained. Medical and related professional groups participated in the research and development of the associated care plan and in the training of community-based trainers. Local governments integrate local resources in order to establish contracted community service bases and to provide professionally reviewed preventive care plans. A network of 850 contracted communities was established in 2017, and 17,117 participants have received services through this network to date. The Kihon checklist (KCL, the basic assessment tool for frailty used by the Japanese Ministry of Health, Labor and Welfare) was used before and after the intervention. Participants showed noticeably improved scores on the instrumental activities of daily living (IADL) and in the motor function, nutrition, oral function, socialization, dementia, depression, and lifestyle domains, with scores on the emotional happiness index showing especially strong improvement.

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 individual's 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 (Cronbach's 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.

Modified Mininutritional Assessment can effectively assess the nutritional status of patients on hemodialysis.

OBJECTIVE: We sought to determine whether the MNA (Mininutritional Assessment) would be an effective tool for assessing the nutritional status of patients undergoing hemodialysis. DESIGN: Purposive sampling. SETTING: Two hospital-managed hemodialysis centers in central Taiwan. PATIENTS: Subjects were 95 ambulatory patients older than 40 years without acute diseases or infections who had received hemodialysis treatment at the center for longer than 30 days. METHODS: Each subject was interviewed with a structured questionnaire to elicit basic personal data and health- and lifestyle-related information and answered questions on the Council on Nutrition Appetite Questionnaire and MNA. Serum biochemical data were obtained from their routine measurement. The nutritional status of each subject was graded with two modified MNA versions. MNA-TI adopted population-specific anthropometric cut-points, and MNA-TII further had the body mass index question deleted from the scale and question scores adjusted but maintained the same 30 total points. RESULTS: Based on the strength of correlation with the key nutrition-related parameters including appetite status, serum creatinine, percent weight loss, hospital length of stay, number of prescribed drugs, and hemodialysis time, both modified MNA versions reflected the nutritional status of Taiwanese hemodialysis patients better than the Council on Nutrition Appetite Questionnaire. Serum albumin did not reflect nutritional status well in these hemodialysis patients. MNA-TI predicted 26.4% and MNA-TII predicted 29.5% of hemodialysis patients were either malnourished or at risk of malnutrition. CONCLUSIONS: Both versions of the modified MNA are effective in assessing the nutritional status of hemodialysis patients. MNA-TII without body mass index is a significant improvement for hemodialysis patients because body weights fluctuate significantly between dialysis sessions.