World health organization disability assessment schedule 2.0 as an objective assessment tool for predicting return to work after a stroke

Purpose: To analyze whether World Health Organization Disability Assessment Schedule 2.0 can be used as an objective assessment tool for predicting the return-to-work status of working-age patients with stroke.

Method: We obtained the data on 2963 patients disabled by stroke (age <60 years) from the Taiwan Data Bank of Persons with Disability for the July 2012–January 2014 period. Of these patients, 119 could return to work, whereas 2844 could not. Demographic data and World Health Organization Disability Assessment Schedule 2.0 standardized scores of patients with stroke who could return to work and those who could not (return to work and nonreturn-to-work groups, respectively) were analyzed and compared using the chi-squared and independent Student’s t-tests. Receiver operating characteristic curve analysis was performed to investigate the prediction accuracy for the return-to-work status, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the return-to-work status of patients with stroke.

Results: The World Health Organization Disability Assessment Schedule 2.0 scores in all domains were lower in the return-to-work group than in the nonreturn-to-work group. The receiver operating characteristic curve showed moderate accuracy for all domain-specific scores [area under the curve, 0.6–0.8] and good accuracy for the summary scores of World Health Organization Disability Assessment Schedule 2.0 (area under the curve, >0.8). Binary logistic regression revealed that younger age, less severe stroke and standardized World Health Organization Disability Assessment Schedule 2.0 summary scores below the cutoff points were predictors of the return to work status of working-age patients disabled by stroke.

Conclusions: World Health Organization Disability Assessment Schedule 2.0 can be used as an objective assessment tool for predicting the return-to-work status of working-age patients disabled by stroke. This tool can aid in establishing rehabilitation strategies and goal-setting processes for the return-to-work of patients with stroke.

• Implications for rehabilitation

• World Health Organization Disability Assessment Schedule 2.0 summary scores can predict the return-to-work status of working-age patients with stroke.

• Younger age and less severe stroke are associated with the return-to-work status of patients with stroke.

• Lower disability scores of the World Health Organization Disability Assessment Schedule 2.0 items result in a favorable return-to-work status and help in establishing effective rehabilitation strategies for facilitating the return-to-work of young patients with stroke.

     

Prevalence and associated risk factors of anemia in children and adolescents with intellectual disabilities

Anemia is known to be a significant public health problem in many countries. Most of the available information is incomplete or limited to special groups such as people with intellectual disability. The present study aims to provide the information of anemia prevalence and associated risk factors of children and adolescents with intellectual disability in Taiwan. We analyzed physical examination charts of 937 children and adolescents with intellectual disability at the age of 6–18 years from three special schools. We collected information on their demographic characteristics (age and gender), disability condition (type and level), BMI (weight and height) and measured blood hemoglobin concentration (Hb). There were 11.6% of children and adolescents with intellectual disability with anemia (boy <13 g/dl, girl <12 g/dl), and the factors of gender, age, disability level and BMI are significantly correlated to anemia in bivariant analyses in the study. In the logistic regression analysis, the model revealed that the factors of gender (OR = 0.63, 95% CI = 0.41–0.95), and age (OR = 3.21, 95% CI = 1.77–5.82) were variables that could significantly predict the anemia occurrence of the participants. The study highlights the anemia prevalence in children and adolescents with ID is a mild public health problem among people with intellectual disabilities, but to prevent the problems become worst; the health authority should include providing children and adolescents with adequate nutrition and appropriate health protections during early childhood.     

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

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

Medical care services for people with intellectual disabilities living in the general community: a cross-sectional survey of inpatient care utilization in Taiwan, 2001

Background. The medical care needs and problems of persons with intellectual disabilities (ID) living in the general community have received limited attention in previous studies. The aim of this article is to describe aspects of medical care utilization among people with ID living in the general community, with particular emphasis on examining the type and determinants of inpatient care utilization in Taiwan.

Methods. A cross-sectional survey of people with intellectual disabilities was employed. A total of 997 respondents who provided fully completed data concerning inpatient care utilization were recruited into the analysis.

Results. A total of 12.4% of individuals with intellectual disabilities had used inpatient care in the 7 months prior to the survey. The average number of inpatient care visits in that time was 1.43, with an average hospital stay of 16.91 days. Surgery, fever, gastrointestinal disorders, psychiatric disorders, and accident were the main causes of inpatient care utilization. A stepwise logistic model showed that the factors of holding a Major Illness Card, regular medicine-taking and self-perceived health status were statistically significant to inpatient care utilization of people with intellectual disabilities.

Conclusions. Medical care providers and policy makers need to be aware that many people with intellectual disabilities have increased medical care needs that may require modification of standard medical care practices and service models in society.     

Does the planned long-term care policy in Taiwan meet the needs of people with disabilities?

The long-term care (LTC) insurance policy will be enacted in Taiwan. Under the proposed policy, people with disabilities will have priority in receiving insurance. The aim of this study was to compare the functional statuses of 3 disability groups and to investigate the coverage provided by the planned LTC insurance in Taiwan.     

Comparison between rigid and flexible laser supraglottoplasty in the treatment of severe laryngomalacia in infants

Objective

Traditionally, laser supraglottoplasty for the treatment of severe laryngomalacia (SLM) is via rigid endoscopy (RE). Potassium-titanyl-phosphate (KTP) laser fiber can pass through a flexible endoscopy (FE) and cauterize tissue. This study is designed to evaluate and compare clinical variables between these two techniques in the treatment of SLM in infants.

Methods

A retrospective study includes four-year period of consecutive infants who received laser supraglottoplasty. In the first two years (2006-2007), conventional RE CO₂-laser with general anesthesia and endotracheal intubation were used. In the latter two years (2008-2009), a novel technique of FE KTP-laser with intravenous sedation, nasopharyngeal oxygen and a noninvasive respiratory support (if indicated), without any artificial airway was used immediately after the diagnostic FE. After laser surgery, infants were followed for three months. Clinical variables were analyzed and compared.

Results

A total of 57 infants (27 in RE group, 30 in FE group) were enrolled. Basic variables were similar between both groups. Clinical improvement was comparable with 88.9% and 93.3% in the RE and FE groups, respectively. There are no significant differences in mean number of laser surgery, major complications, duration of post-laser respiratory support and hospitalization days, body weight percentile between the two groups. However, the durations of waiting time, operation, ET intubation and total hospital days were significantly less in the FE group.

Conclusions

FE technique has similar success rate but more convenient and cost-effective than the RE technique. It may to be a practical alternative therapy for infants with SLM.     

The risk of metabolic syndrome among institutionalized adults with intellectual disabilities

People with metabolic syndrome (MS) are at increased risk of coronary heart disease and other health problems, such as diabetes and stroke. However, there is little previous information on the prevalence and determinants of MS among people with intellectual disabilities (IDs). The present study aimed to examine the prevalence of MS risk factors among institutionalized adults with IDs. We analyzed the annual health check data of 164 institutionalized adults with IDs whose age was ≧20 years in 2009. The measure of MS in the study was the presence of three or more of the following five components: central obesity, elevated blood pressure (BP), elevated fasting glucose (FG), elevated triglycerides (TG), and reduced high-density lipoprotein (HDL-C). The prevalence of MS was 11.6% in the study participants (8% in males and 17.2% in females), which is lower than that in the general population of Taiwan. In the logistic regression analysis of the occurrence of MS, we found that gender, TG and HDL-C were variables that could significantly predict MS after controlling for other potential factors. Adults with IDs who were female (OR = 38.354, 95% CI = 1.985-741.029) and who had higher TG levels (OR = 1.043, 95% CI = 1.008-1.079) and reduced HDL-C levels (OR = 0.696, 95% CI = 0.549-0.883) had a statistically higher risk of MS. This study was one of the first to provide information on the prevalence of MS and its risk factors among institutionalized adults with IDs. We suggest that further study should focus on the specifics of MS, such as incidence, age-specific risk factors and further prevention or treatment in people with ID.     

Analysis of seasonal influenza vaccine uptake among children and adolescents with an intellectual disability

The aim of the present study was to describe the seasonal influenza vaccination rate and to examine its determinants for children and adolescents with intellectual disabilities (ID) living in the community. A cross-sectional survey was conducted to analyze the data on seasonal influenza vaccination rate among 1055 ID individuals between the ages of 12-18 years. The results found that 22.9% of the study participants used the vaccine during the past three years, and the vaccination rate among different age groups varied from 18.1 to 26.5%. There was no gender difference of seasonal influenza vaccination rate among age groups. Multilevel logistic regression analysis revealed that ID individuals with moderate (OR = 1.59, 95% CI = 1.08-2.34) or severe (OR = 2.31, 95% CI = 1.20-4.45) disability, with an illness (OR = 1.64, 95% CI = 1.02-2.63), who have general health exams (ever used, OR = 1.57, 95% CI = 1.03-2.40; regularly used, OR = 1.89, 95% CI = 1.05-3.41) were more likely to have seasonal influenza vaccination than their counterparts. The present study highlights that the substantial disparity in receipt of seasonal influenza vaccine in children and adolescents with ID reflects the effects of disability level, disease condition, and general health exam experience and suggests the need for greater attention to factors affecting ID individuals to improve their preventive health care.     

The use of high resolution melting analysis to detect Fabry mutations in heterozygous females via dry bloodspots

BackgroundAs an X-linked genetic disorder, Fabry disease was first thought to affect males only, and females were generally considered to be asymptomatic carriers. However, recent research suggests that female carriers of Fabry disease may still develop vital organ damage causing severe morbidity and mortality. In the previous newborn screening, from 299,007 newborns, we identified a total of 20 different Fabry mutations and 121 newborns with Fabry mutations. However, we found that most female carriers are not detected by enzyme assays.MethodsA streamlined method for high resolution melting (HRM) analysis was designed to screen for GLA gene mutations using a same PCR and melting program. Primer sets were designed to cover the 7 exons and the Chinese common intronic mutation, IVS4+919G>A of GLA gene.ResultsThe HRM analysis was successful in identifying heterozygous and hemizygous patients with the 20 surveyed mutations. We were also successful in using this method to test dry blood spots of newborns afflicted with Fabry mutations without having to determine DNA concentration before PCR amplification.ConclusionThe results of this study show that HRM could be a reliable and sensitive method for use in the rapid screening of females for GLA mutations.