Assessment of GPs' beliefs relating to the care of people with intellectual disabilities: A Taiwan-based,opportunity-guided approach

Purpose. This study was designed to investigate general practitioners' (GPs) beliefs about the perceived importance of their role in, and their satisfaction with, providing healthcare to people with intellectual disabilities. The identification of healthcare issues with potential for improvement was assessed using gap analysis and an opportunity-guided method.

Method. A cross-sectional census survey by a mail-structured questionnaire recruited 331 GPs (response rate = 16%) who provided information on healthcare for people with intellectual disabilities in 2006 in Taiwan.

Results. The results indicated that GPs considered their role in providing healthcare for people with intellectual disabilities to be important (mean score 7.2 – 8.3). However, the respondents generally did not feel satisfied (mean score 4.6 – 5.5) with their achievements in treating patients with intellectual disabilities. We found that the gender and educational level of the respondents were statistically correlated to the perceived importance they considered their work to have, while the factors of age, medical practice setting and training experience in intellectual disability were statistically correlated to GPs' perceived satisfaction in providing healthcare to people with intellectual disabilities (p < 0.05). Those healthcare issues of ‘training and experience in intellectual disability’, ‘multi-disciplinary and multi-sectoral cooperation’, ‘adequate competence in disability diagnosis’, ‘genetic consulting services’, ‘duty of disease prevention and health promotion’, and ‘adequate medical consultation time’ were the five most promising areas to be improved in healthcare for people with intellectual disabilities according to the opportunity-guided analysis.

Conclusions. This study highlights that health professionals need to examine carefully healthcare issues pertaining to people with ID, and that much more effort is required to develop appropriate healthcare policies based on the opportunity-guided health issues identified here.     

Effects of bihemispheric transcranial direct current stimulation on motor recovery in subacute stroke patients: a double-blind,randomized sham-controlled trial

Persons with Parkinson’s disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL), inter alia due to dysfunctional supplementary motor area (SMA). Combined intermittent theta-burst stimulation (iTBS) over the SMA followed by video game-based training (VBT) may therefore improve dexterity related ADL. The VBT may induce high flow levels related to high performance during the training. The aim of this study is to evaluate the feasibility of a combined iTBS-VBT intervention in persons with PD. A total of nine persons with PD (mean age 63.3?±?8.76 years) with self-reported difficulties with dexterity related ADL were included in this pilot iTBS-VBT study. All participants received either iTBS or sham stimulation over the SMA followed by a 45-min VBT, three times a week for a total of three weeks. Feasibility was measured by means of the adherence rate and the system usability (System Usability Scale). Moreover, flow was measured after the last VBT session. Adherence rate was excellent with 100%. High system usability scores (i.e., mean 80%, range 55–97.5) and a significant Spearman’s correlation with the Flow State Scale (r?=?.762, p?=?.017) further point to the high feasibility of the VBT. Neither demographic variables nor difficulties in dexterity related ADL affected the usability of the VBT. This study demonstrates the high feasibility of a combined iTBS-VBT intervention. Moreover, the level of self-reported usability was related to flow experience. Whether this kind of combined iTBS-VBT intervention improves dexterity will be evaluated in a randomized controlled trial. Trial registration clincaltrials.gov NCT04699149, date of registration 1. June 2021     

Quality of life in caregivers of children and adolescents with intellectual disabilities: Use of WHOQOL-BREF survey

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71 ± 2.35, psychological well-being (PW) was 12.21 ± 2.55, social relationship (SR) was 12.99 ± 2.43 and environment (EN) was 12.32 ± 2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities.     

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia

Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012–January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student’s t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework.

• Implications for rehabilitation

• Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients.

• When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed.

• When dementia patients aged 65–75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended.

• With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

     

Studies of intracorneal distribution and cytotoxicity of quantum dots: risk assessment of eye exposure

The cornea is a potential route of exposure and drug administration for nanoparticles. In this work, we use noninvasive two-photon microscopic imaging to study the distribution and permeability pathway of CdSe/ZnS core/shell quantum dots (QDs) capped with three different functional groups through the cornea. With no additional staining, the two-photon image clearly discloses that fluorescent QDs penetrate and reside within the interlamellar space of second harmonic generating collagenous stroma when the corneal epithelium barrier is injured. An in vitro cytotoxicity test using bovine corneal stromal cells incubated individually with all three kinds of QDs indicates that the cell viability decreases significantly as the QD concentration and incubation period increased. The results also show that the specific QDs influence corneal stromal cell viability up to a significant magnitude of 50% under a relatively low concentration (5-20 nM) and short exposure period (24-48 h). Furthermore, two-photon imaging shows that QDs can be retained within the cornea up to 26 days in an in vivo mouse model. On the basis of our in vivo and in vitro data, we conclude that QDs can penetrate and be retained within cornea long enough to cause consequential cytotoxicity, under the circumstance in which the corneal epithelium barrier is injured. Since corneal abrasion is quite a common situation in daily life, our work raises public attention to the potential risk of eye exposure to nanoparticles.     

Three-dimensional reconstruction of cranial defect using active contour model and image registration

In neurosurgery, cranial incisions during craniotomy can be recovered by cranioplasty—a surgical operation using cranial implants to repair skull defects. However, surgeons often encounter difficulties when grafting prefabricated cranial plates into defective areas, since a perfect match to the cranial incision is difficult to achieve. Previous studies using mirroring technique, surface interpolation, or deformed template had limitations in skull reconstruction to match the patient’s original appearance. For this study, we utilized low-resolution and high-resolution computed tomography images from the patient to repair skull defects, whilst preserving the original shape. Since the accuracy of skull reconstruction was associated with the partial volume effects in the low-resolution images and the percentage of the skull defect in the high-resolution images, the low-resolution images with intact skull were resampled and thresholded followed by active contour model to suppress partial volume artifacts. The resulting low-resolution images were registered with the high-resolution ones, which exhibited different percentages of cranial defect, to extract the incised cranial part. Finally, mesh smoothing refined the three-dimensional model of the cranial defect. Simulation results indicate that the reconstruction was 93.94% accurate for a 20% skull material removal, and 97.76% accurate for 40% skull material removal. Experimental results demonstrate that the proposed algorithm effectively creates a customized implant, which can readily be used in cranioplasty.     

High outpatient visits among people with intellectual disabilities caring in a disability institution in Taipei: a 4-year survey

Few studies reported in the literature have addressed the long-term trend of the use of medical care for people with intellectual disabilities (ID) in institutions. The subject cohort in this study was made of 168 individuals with ID in a public residential facility from 1999 to 2002 in Taipei, Taiwan. The average age of participants was 19.3 years, and their average stay in an institution was 6.6 years. The average annual outpatient visit of the study participants was 18.2 in the previous 4 years. It was found that they had more medical visits than the general population. Nearly 20.8-34.5% (average 29.0%) of the participants utilized more than 25 visits annually which was defined as high outpatient visit users. This group of high outpatient users consumed more than half of the total annual outpatient care visits in the past 4 years. In the full model of Generalized Estimating Equations to compare the high and non-high outpatient users, the factor of individuals with ID dwelling in the institution were more likely to be high outpatient care users than individuals who were only accepting institutional day care services (OR=6.29, 95% CI=1.35-29.30). The present study provides general information of high outpatient utilization and its determinants of people with ID and provides evidence for medical care decision makers dealing with policy development for people with ID care in institutions.     

Institutional care for people with disabilities in Taiwan: a national report between 2002 and 2007

The purposes of the present study were to describe the institutional care for people with disabilities included service types, service capacity and service utilization from 2002 through 2007 in Taiwan. Data were obtained from four ways of national data: (1) The condition of service institution for the physically and mentally disabled; (2) The physically and mentally disabled population by aged and grade; (3) The physically and mentally disabled population by cause; (4) Taiwan general population by age. We used percentage and overtime trend figures to examine the change in service capacity and the institutional care utilization of people with disabilities. The results revealed that the administrative prevalence of disabilities was increasing from 3.69% to 4.45% from 2002 to 2007 (increase rate 22.8%) in Taiwan. The number of disability institutions was increasing from 223 to 254 and yield an increasing rate 12.2%. The service capacity of institutional care was 16,664 persons in 2002, and it was increasing to 20,707 persons in 2007 (increase rate=24.3%). The cases admitted to institutional care were increasing from 12,611 in 2002 to 17,002 in 2007 (increase rate=34.8%). The male individuals with disabilities were more likely to admit to institutional care than the female cases. The data of the present study provided can be a basis for further discussion on the debate of institutional care or community care for people with disabilities in Taiwan community.