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This study aimed to investigate the self-reported knowledge and coping behaviors for low back pain (LBP) among institutional caregivers for people with intellectual, autistic and associated multiple disabilities and to gather information about factors that affect these coping behaviors in the workplace. A cross-sectional survey was conducted to recruit 1073 caregivers (response rate of 89.5%) from 15 medium to large disability welfare institutions in this study. This study specifically developed a scale to examine objective (10 question items) and subjective knowledge (one question item) of LBP and its coping behaviors (10 question items). The mean score of objective knowledge of LBP was 7.15 (range of 0–10; over 70% correct). A total of 54.2% of respondents expressed that they had a low level of subjective knowledge of LBP, and 45.8% or respondents had a high level. The study also found that many objective knowledge items need to be improved in future health promotion initiatives regarding LBP. Without adjusting for other factors, the study indicated that those caregivers with more subjective LBP knowledge were more likely to adopt higher levels of LBP coping behaviors than their counterparts (OR = 1.536, 95% CI = 1.152–2.046). After adjusting for demographics, working conditions and health status factors, LBP knowledge was not statistically correlated with LBP coping behaviors. Caregivers who worked more days per week (OR = 1.984, 95% CI = 1.408–2.795), had break time on duty (OR = 2.457, 95% CI = 1.5–4.025), exercised regularly (OR = 1.594, 95% CI = 1.115–2.28), had poor health status (OR = 0.497, 95% CI = 0.249–0.995), or had a history of LBP (OR = 1.433, 95% CI = 1.008–2.039) were more likely to adopt higher levels of coping behaviors than their counterparts. This study highlights that institutional managers should pay attention to factors that influence LBP coping behaviors in caregivers, and future studies should examine the effects of the characteristics of care recipients and caregivers’ families on caregivers’ perception of LBP.

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

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 (β=-0.735, p

Low back pain (LBP) is the most common cause of time lost from work and has significant personal impacts and societal burdens. Caregivers for patients with disabilities have a high LBP prevalence that requires attention in the public health system. This study aimed to understand the LBP disability outcomes and determinants of care workers for people with intellectual, autistic and associated multiple disabilities. Study subjects included 678 care workers in 15 disability institutions who reported that they had experienced acute or chronic nonspecific LBP in the previous year. The effects of the LBP outcome were measured by the Roland–Morris Disability Questionnaire (RDQ), which is a self-rated assessment of pain-related disability used in this study. The mean score of the RDQ was 3.97 (range 0–24). Of the respondents, 14% expressed that they were free from pain disability (score = 0), 66.4% subjects expressed they had a little pain disability (score 1–6), 14.7% subjects reported that they were mildly affected by pain disability (score 7–12), 3.8% subjects reported that they were moderately affected by pain disability (score 13–18), and 1% reported they had severe pain disability (score 19–24). A multiple linear regression of the pain disability score revealed that those care workers who expressed that LBP affects their work and living (p

Low back pain is a critical public health problem; this condition significantly affects the quality of life and has a major socioeconomic impact. The present study aimed to investigate the interference of low back pain with everyday functions of life in disability care workers, and to examine the influencing factors of the interference, such as workers’ demographic, lifestyle habits, self-reported health status, working conditions and previous pain experience. The Wong-Baker FACES Pain Rating Scale and Brief Pain Inventory – Short Form were used to identify the pain severity and life interference of 677 participants who had experienced low back pain conditions in the previous year. The results indicated that the mean score of the pain severity was 3.78 ± 1.82, 78.9% subjects experienced mild pain (score 2–4), 13.7% subjects experienced moderate pain, and 5.3% subjects experienced severe pain. More than twenty percent of the respondents reported that low back pain moderately or severely interfered with their daily functions. Many working conditions and pain experienced significantly correlated with the score of pain interference in the care workers after controlling for factors of healthy lifestyle and health status (R2 = 41.7%). These findings may garner attention from health welfare authorities and lead to improvements in health promotion initiatives to prevent low back pain from interfering with the daily activities of care workers for people with intellectual, autistic and associated disabilities.

The aims of the present study were to investigate the prevalence of LBP among institutional caregivers of people with intellectual, autistic or associated multiple disabilities and to examine the risk factors for LBP among this population. A cross-sectional, purposive sampling method was used to recruit into the study 1073 staff who were working in 15 disability welfare institutions. The survey materials included an introduction letter, an informed consent, and a structured questionnaire that queried the participant's demographic and working characteristics, healthy lifestyle, and previous and current LBP experiences. The present study results showed that 63.2% of the participants reported that they had LBP in the previous year. Many factors of the participants’ demographic characteristics (gender, BMI, and marital status), working conditions (years of working experience, weekly work days, labor-oriented work, and direct care staff), and health status (exercise habit, perceived health status, previous and more recent medication experience of musculoskeletal discomfort) associated with LBP occurrence were analyzed in univariate Chi-square analyses. Finally, multiple logistic regression analyses revealed that the factors of female gender (OR = 1.534, p = 0.039), being married (OR = 1.469, p = 0.027), being direct care staff (OR = 1.844, p = 0.025), having fair health status (OR = 1.518, p = 0.012), or previous (OR = 1.996, p

As life expectancy increases for persons with an intellectual disability, concerns have been raised that there will be an increased demand for health or social services, particularly to address the challenges posed by the problems of dementia. To plan services for people with an intellectual disability who might experience the consequences of aging, an important first step is to obtain epidemiological data on the prevalence of dementia in this vulnerable population. This study aimed to investigate the dementia prevalence rate and its associated demographical factors in adults with an intellectual disability in Taiwan. A national survey was conducted to recruit 460 community residents of at least 45 years of age with an intellectual disability. The Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) was administered to caregivers to determine the symptoms of dementia in adults with an intellectual disability. The results indicated that 16.5% of the adults with an intellectual disability might have dementia conditions (DSQIID score ≧ 20). After controlling for other factors in a multiple logistic regression analysis, the older adults with intellectual disability (≧55 vs. 45–54, OR = 2.594, 95% CI = 1.438–4.679) and those individuals with a comorbid diagnosis of mental illness or neurological disease (with vs. without, OR = 2.826, 95% CI = 1.593–5.012) had a higher risk of dementia than their counterparts. This study suggests that further longitudinal studies are needed to examine the specific aspects of the functions of living and morbidity that might be affected by aging and concomitant conditions in adults with an intellectual disability.

This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged.

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

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, β=4.780, p=0.031; intermediate vs. literate, β=6.642, p=0.030), with comorbid Down's syndrome (β=-7.135, p=0.063), and with a more severe disability condition (severe vs. mild, β=-7.650, p=0.007; profound vs. mild, β=-19.169, p0.001) 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.

The primary healthcare service profile is important and provides valuable information on healthcare policies for patients with autism spectrum disorders (ASD) and co-occurring conditions. The present study analyzed data associated with outpatient care visits and expenditures in patients with ASD and co-occurring intellectual disability (ID) using healthcare setting insurance claims data in Taiwan. A retrospective analysis was conducted by merging database of healthcare setting medical care discharge claims used by the Taiwan Bureau of National Health Insurance and Disability Registration System. There were 5273 children and adolescents with ASD who utilized outpatient services during the year 2005. Taiwan NHI claims (510 cases with co-occurring ID and 4763 cases without ID) were analyzed in the study. The study found that ASD subjects without ID have 1.6-fold the annual outpatient visits of those with ID (13 visits vs. 8 visits). Those ASD cases with ID are more likely to use psychiatric visits and that individuals without ID use more rehabilitation services. The total annual outpatient care expenditure from 5273 children and adolescents with ASD was 137,842,159 New Taiwan Dollars (NTD). Cases without ID have increased medical costs compared with cases with ID in annual outpatient care expenditure (OR = 1.274, 95% CI = 1.173–1.384). A logistic regression analysis of outpatient expenditure (low vs. high) showed that of the cases with ASD and ID, the factors of age (reference: 6–11 years; 0–5 years, OR = 1.383, 95% CI = 1.106–1.730), severe illness (reference: no; OR = 1.838, 95% CI = 1.538–2.196), low income family (reference: no; OR = 1.799, 95% CI = 1.344–2.408), medical care setting (reference: clinic; private hospital: OR = 1.769, 95% CI = 1.199–2.610; corporate hospital, OR = 1.624, 95% CI = 1.139–2.315) and clinical unit (reference: psychiatric; rehabilitation, OR = 1.913, 95% CI = 1.651–2.344; pediatrics, OR = 1.461, 95% CI = 1.014–2.017) had more outpatient costs (on average) than their counterparts. Finally, this study highlights that health authorities should pay much attention to the factors which correlated to medical needs and costs of children and adolescents with ASD and ID to ensure efficacy of medication and continuing support for patients in treatment.

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.

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 314.0 x : 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.

Burnout has been considered important to understand the well-being of people who work with individuals with intellectual disabilities (ID) and developmental disabilities (DD). To identify personal and workplace characteristics associated with burnout, this study aimed to utilize the Chinese version of the Copenhagen Burnout Inventory to provide a burnout profile of caregivers who served individuals with ID/DD and evaluate the potential factors associated with burnout in this group. A purposive sampling method and a self-administered structured questionnaire were employed to recruit 276 caregivers from 4 different disability institutions for study participation. The results revealed that the average personal burnout score (PBS) and work-related burnout score (WBS) were 44.0 (SD = 16.8) and 34.2 (SD = 15.9). These burnout scores were higher compared with general full time employees in Taiwan. The results showed that that 17.8% of the staff were moderately burnt out (PBS score: 50–70), and 7.6% of the staff were in the highest exhausted level (PBS score ≧ 70) of PBS. With regard to the WBS score, 20.7% were moderately burnt out (PBS score: 50–70), and 5.1% of the staff were in the highest exhausted level (WBS score ≧ 70). Finally, a multiple regression analysis reported that the factors of self-report health status and WBS significantly predicted higher respondent PBS ( R 2 = 0.642). The study highlights the need to improve the psychological health and well-being of the caregivers who work with individuals with ID/DD and the need for the institutions to strengthen supportive healthy working environments to decrease staff burnout.

The incidence of single-parent families has increased significantly in Taiwan in recent years. Children born in single-parent families are predisposed to suffering from emotional problems. We aimed to determine if the children of single-parent families are more depressive than children from both-parent families, and to examine the individual and joint effects of various factors on the depression risk. A cross-sectional study was performed to investigate the depression status of elementary school children in MiaoLi County, Taiwan. A total of 881 eligible subjects, including 144 children from single-parent families were recruited from 29 schools. Data for depression-related demographic characteristics, family and school variables were collected. The results show that 27.6% of children from single-father families with depressive symptoms, 15.1% children from single-mother families and 15.3% children from both-parent families with repressive symptoms. This study provides significant evidences that single-father family was one significant predictor for childhood depression and the enhanced effects of socioeconomic status and peer relationship on depression of children from single father families were found up to 4-fold (OR = 4.0, 95% CI = 1.8–8.5) and 5-fold (OR = 5.5, 95% CI = 2.3–13.2) risk respectively. The results provide hints to parents and teachers for improving the mental health of children in single-parent families by reducing the occurrence of depression.

Metabolic syndrome is highly prevalent in society gradually and has important implications for public health in recent years. The present study aims to examine the gender effect on the prevalence of metabolic syndrome among adults with disabilities. A cross-sectional study was conduct to analyze annual health check-up chart of 419 people with disabilities whose age ≥ 20 years in east Taiwan. We used to diagnose the metabolic syndrome was defined by the Taiwan Bureau of Health Promotion as the presence of three or more of the following five components: abdominal obesity, high blood pressure, high fasting glucose level, high triglyceride level, and low high-density lipoprotein cholesterol level. The results showed that the prevalence of metabolic syndrome was 19.3% in the study subjects (16.8% in men and 23.1% in women; p = 0.110). Our study also indicated that the genders were significantly different in the followings (men vs. women): abdominal obesity (33.2% vs. 50.9%; p0.001), high blood pressure (36.4% vs. 23.7%; p = 0.006), high fasting glucose level (18.4 vs. 14.8%; p = 0.334), high triglyceride level (24.0% vs. 14.2%; p = 0.014) and HDL-C (21.6% vs. 35.5%; p = 0.002) among the sample. To prevent the metabolic syndrome occurrence and consequences, the study suggests that the health authorities should put greater efforts to address the metabolic syndrome components, particularly in higher rates of obesity-related health conditions to avoid significant health and health care costs in the future.

Metabolic syndrome (MetS) increases the risk of cardiovascular events. Heart rate variability (HRV) represents autonomic functioning, and reduced HRV significantly increases cardiovascular mortality. The aims of the present paper are to assess the prevalence of MetS in adults with intellectual disabilities (ID), the difference in short-term HRV between the healthy and ID population, and the association of short-term HRV with MetS. In this study, we analyzed 129 ID subjects who participated in routine health check-ups in October 2010. We measured their metabolic components and evaluated the relationships of MetS with short-term HRV indices. The study found that MetS and obesity are common in persons with ID. ID subjects have significantly lower HRV than healthy adults, and persons with ID persons with MetS have significantly lower HRV than ID subjects without MetS. The individual components of MetS are differentially associated with HRV in ID men and women. Metabolic syndrome adversely affects autonomic cardiac control, and reduced autonomic cardiac control could contribute to an increased risk of subsequent cardiovascular events in individuals who exhibit metabolic syndrome. Sex differences in vagal activity and sympathovagal balance may partly explain the greater increase in cardiovascular risk associated with MetS in ID women compared with ID men.

This study aims to analyze the ambulatory visit frequency and medical expenditures of the general elderly population versus the elderly with intellectual disabilities in Taiwan, while examining the effects of age, gender, urbanization and copayment status on ambulatory utilization. A cross-sectional study was conducted to analyze data from 103,183 national health insurance claimants aged 65 or older. A total of 1469 had a principal diagnosis of mental retardation (intellectual disability) and claimed medical outpatient services in 2007. The average number of ambulatory visits was 30.1 ± 23.1, which is much higher than in the United States and other developed countries, and the mean annual visits of the elderly with intellectual disabilities was significantly higher than the general population in Taiwan (35.2 ± 28.7 vs. 30.0 ± 23.1). Age and copayment status affected outpatient visit frequency. The mean medical expenditure per visit and the mean annual outpatient cost were 1146.5 ± 4497.7 NT$ and 34,533.7 ± 115,891.7 NT$, respectively. Male beneficiaries tended to have higher average annual medical expenses and mean medical expenses per visit than female beneficiaries. The three most frequent principal diagnoses at ambulatory visits were circulatory system diseases, musculoskeletal system and connective tissue diseases and digestive system diseases. We conclude that the elderly with intellectual disabilities had higher demand than the general population for healthcare services, and the NHI program lowers the barrier to care for populations with special needs.

This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, “Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan”, which is a cross-sectional survey conducted in 2009. We recruited 502 women aged ≧15 years who were officially registered as having physical and mobility disabilities. The results show that 11.3% of women with physical and mobility disabilities accepted hysterectomy surgery and that hysterectomy prevalence was increasing by age: 7% (45–49 years), 9.7% (50–54 years), 26.3% (55–59 years), 31% (60–64 years) and 17.6% (≧65 years). Multilevel logistic regression analyses revealed that being ≧50 years or older (OR = 4.65, 95% CI = 1.79–12.064), having had cervical cancer (OR = 17.2, 95% CI = 3.5–84.47) and not having a Pap smear test within the last 3 years (OR = 2.79, 95% CI = 1.194–6.561) were more likely to accept a hysterectomy operation than their counterparts. This study suggests that future studies should analyze hospital data and assesses long-term changes to understand an area's hysterectomy profile and correlated factors for these types of vulnerable populations.

The present study aims to characterize the prevalence of autism spectrum disorders (ASDs) in Taiwan while examining the effects of age, gender, and urbanization on ASD occurrence. A cross-sectional study was conducted to analyze data from 895,639 random health insurance claimants who claimed medical services in the year 2007. Autism was defined using the ICD-9-CM Diagnosis Code 299.0 (autism, current or active). The prevalence of autistic cases was found to be 12.3‰ (10,868/884,771) in the general population, with the prevalence among males (19.2‰) significantly higher than that among females (6‰). With regards to age distribution, we found that the autistic group (mean age = 16.0 years) was significantly younger than the general population (mean age = 37.2 years). A logistic regression analysis found that age, gender, residence urbanization level and Bureau of National Health Insurance regional division all constituted influence factors for autistic occurrence. The results demonstrate the importance of taking into account age, gender, and geographical disparities in autistic prevalence in order to implement appropriate public health policies for the ASD population.

The study aims to explore knowledge and attitudes regarding cervical cancer screening and to examine its determinants based on the perspectives of Taiwanese women with physical disabilities living in the community. A cross-sectional survey was employed in the study, and we recruited 498 women aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. A mail-out structured questionnaire designed to collect data concerning the participants' demographics, reported use, health experience and perception (understanding and attitudes) of cervical cancer screening among women with physical disabilities. We used a scoring system (range 0-10) to categorize the study subjects' awareness of screening (low vs. high). The results showed that 77.3% of subjects reported a low level of awareness (score[double bond] 7), whereas 22.7% were in the high awareness level group (score7). The logistic regression model revealed that married women (OR = 3.30, 95%CI = 1.25-8.71), those with a higher educational level (OR = 2.88, 95%CI=1.51-5.53), and those with a high familiarity with Pap smear resources (OR = 5.31, 95%CI = 2.82-9.98) had a significantly higher perception level of cervical cancer screening among women with physical disabilities. This study highlights the necessity of increasing the knowledge and awareness of cervical cancer screening and reducing the barriers to cervical cancer screening experienced by women with 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.

Purposes of the present paper were to describe the overtime change of disability prevalence among the elderly (65 years and older), and to analyze the geographic disparity of the disability prevalence during the year 2000-2010 in Taiwan. Study data mainly come from two public web-access information: (1) The physically and mentally disabled population by age and grade, 2000-2010; (2) Taiwan general population by age, 2000-2010. We used statistical methods include number, percentage and geographical information system (GIS) to describe the disability prevalence among the elderly people by year and administrative area, and a trend test was conducted to examine the overtime change of disability prevalence in the elderly people. The results found that the mean of disability prevalence rate in the elderly population was 14.8% and it was significantly increased during the past 11 years (R(2) = 0.901; p < 0.0001). With regards to the elderly disability prevalence disparity in administrative areas, those areas of higher elderly disability prevalence were more likely to occur in east-mountain areas-Taitung County (24.2%), Yilan County (21.0%), Hualien County (20.3%), and central-agricultural counties such as Yunlin County (21.8%), Nantou County (17.6%) and Chiayi County (17.3%). The most relative change areas of disability prevalence rate in the elderly population during the past 11 years were more likely to occur in central or east areas in Taiwan. The present study highlights the authorities should pay much attention to increasing rate and the geographical disparity of disability prevalence in the elderly population, to allocate appropriate health and welfare resources for this vulnerable population.

The present study analyzes data of the governmental reported general population and population of persons with disabilities from 2002 to 2009, to describe the disability prevalence and to test the overtime change with particular focused on the geographic differences in Taiwan. In average, the disability prevalence was 42.06‰ (range = 31.06‰–80.04‰ in different areas) of the general population during the past 8 years. We found that the disability prevalence in general population (R2 = 0.991; p

The present paper aims to explore awareness and acceptability of human papillomavirus (HPV) vaccination and to identify factors influencing HPV acceptability among women with physical disabilities in Taiwan. The study participants were 438 adult women with physical disabilities, aged 18-69 years. The participants were all officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. The major findings were that 54.5% of the participants had previously heard about the HPV vaccine and that vaccine acceptability was very low (3.2%) if the participants would have had to pay for the vaccine but would increase to 60% if the government were to provide the vaccine for free. We found that those participants who had had a Pap smear test within the past 1 year or 3 years were significantly more likely to be aware of and willing to receive the HPV vaccine than those who had not. To increase the HPV vaccination rate among women with physical disabilities, the study suggests that the current health care system in Taiwan should consider implementing free immunization for this group of women.

There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze medical fee of 397 individuals with ASD based on population-based National Health Insurance (NHI) claims data in Taiwan. The average frequency of hospital admission in the respondents was 3.5 annually, mean of hospital stay was 111.9 days, and the mean medical expenditure was 94,293 NTD in the year of 2005. Those autistic individuals with characteristics of younger age (OR = 31.085, 95% CI = 12.772–75.659), hold a serious illness card (OR = 4.980, 95% CI = 1.690–14.673), more frequent in inpatient care (OR = 7.636, 95% CI = 2.643–22.066), longer days in acute ward (OR = 3.840, 95% CI = 1.989–7.416), and days in acute + chronic wards (OR = 3.804, 95% CI = 1.334–10.846) were more likely to consume more medical expenditure than their counterparts. The present study provides valuable medical care utilization information to health care decision makers to initiate a supportive healing environment for people with ASD.

The paper aims to analyze the hospital inpatient care use and medical fee of people with ID co-occurring with schizophrenia in Taiwan. A nationwide data were collected concerning hospital admission and medical expenditure of people with ID (n = 2565) among national health insurance beneficiaries in Taiwan. Multiple regression analyses were undertaken to determine the role of the explanatory variables to hospital psychiatric inpatient care and medical expenditure. We found that there were 2565 individuals with ID used hospital psychiatric inpatient care among people with ID in 2005, and 686 cases (26.7%) co-occurring with schizophrenia according to hospital discharge claims. Those ID patients co-occurring with schizophrenia consumed more annual inpatient fee than those without schizophrenia (251,346 vs. 126,666 NTD) (p < 0.001). We found factors of female cases, longer hospital stay in chronic ward and general ward users among ID patients co-occurring with schizophrenia used more hospital inpatient care (R(2) = 0.417). Annual hospital inpatient days were significantly affected by factors of severe illness card holder, annual inpatient care fee, longer hospital stay in acute or chronic ward (R(2) = 0.746). Those factors of female cases, high inpatient care users, longer hospital stay in acute ward and general ward were consuming more medical care fee than their counterparts (R(2) = 0.620). The study highlights the future study should examine the efficacy of hospital inpatient care for people with ID and schizophrenia.

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of "2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan" were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively.

We collected self reported rate of cervical smear testing and to examine the affecting factors in women with physical disabilities in the study, to define the reproductive health care for this group of people. The study population recruited 521 women with physical disabilities aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan. Those people with physical disabilities include following: upper and low limb, spinal cord injury and other nervous system impairments. Results found that there were 71.5% participants had ever used the Pap smear tests in their life time and mean age of the first screening was 39.21±10.16 years (range=20-85 years). Nearly 41% of participants expressed that they had accepted the screening within 1 year and 28.1% reported they used the Pap smear screening regularly. Our study also found women with physical disabilities have higher use of Pap smear tests than does the general population in Taiwan (74% vs. 64% in aged≥30 years). Logistic regression model for the use of Pap smear test indicated that those married women (OR=12.06, 95% CI=6.85-21.22), with mild level of disability (OR=2.10, 95% CI=1.05-4.21) and high cognitive level toward Pap smear information were factors to affect the use of Pap smear in the study participants. We suggest the further study should conduct to examine the quality perception and follow-up service of Pap smear test for women with physical disabilities, to ensure the health care right for this group of women.

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this population. We used purposive sampling to recruit 54 institutional managers who care for people with intellectual disabilities in Taiwan. The present study employed a cross-sectional design using a self-administrative structured questionnaire that was completed by the respondents in November 2009. The results showed that more than 90% of the respondents agreed with earlier onset aging characteristics of people with ID. However, nearly all of the respondents expressed that the government policies were inadequate and the institution is not capable of caring for aging people with ID, and more than half of them did not satisfy to their provisional care for this group of people. With regard to the service priority of government aging policy for people with ID, the respondent expressed that medical care, financial support, daily living care were the main areas in the future policy development for them. The factors of institutional type, expressed adequacy of government's service, respondent's job position, age, and working years in disability service were variables that can significantly predict the positive perceptions toward future governmental aging services for people with ID (adjusted R(2) = 0.563). We suggest that the future study strategy should underpin the aging characteristics of people with intellectual disabilities and its differences with general population to provide the useful information for the institutional caregivers.

Dependency ratios are useful as general indicators of future economic and social health. The present paper focuses on the description of dependency ratios and over time change in different kind of disability which include autism, intellectual disability, vision, hearing, and limb impairments. We analyzed data mainly from the public web-access information which collected by the Taiwan MOI. We analyzed the national register data in two ways for 2000–2009: the Disabled Population by Aged and Grade and the Taiwan General Population by Age, to examine the dependent ratios in disabilities. The dependency ratio measures the percentage of dependent people (not of working age)/number of people of working age (economically active), and it is decomposed into the child dependency ratio, the aged dependency ratio and index of aging. The results found the aged dependency ratios in general or disabled population were significantly increased in 2000–2009. Vision, hearing and limb disabilities had the higher aging index in all disabilities. Intellectual disability and autistic cases were relatively younger age population than other disabilities. However, the trend test revealed that child dependency ratio in autism decrease significantly as the identified case number increase during the past 10 years. Many reasons were discussed in the context of the trend changes. Finally, the results highlights that the increasing dependency ratio trends revealed that we are facing an aging population, the social security system need to provide for a significantly older and non-working population. The future study should consider the indicators such as the number of people receiving disability benefits or the use of disability-adjusted life years, they would provide more accurate for tracking dependency in the society.

The severity of autism spectrum disorder was strongly related to the education and service outcome. Without a clear profile of autistic population and its change, efforts to understand its nature and improve the quality of service or education will be impossible. The present study aims to describe the over time reported rate of autism severity based on a nationwide population-based 10 years register data in Taiwan. We obtained the national register data– the Disabled Population by Aged and Grade and the Taiwan General Population by Age to examine the overtime trend change of autism severity from 2000 to 2009. Results showed that the reported prevalence of autistic cases significantly increased from 0.93 to 3.96 per 10,000 population in 2000–2009. The group of mild disability grade was significant increasing from 33.4% to56.2% in percentage of four disability levels in the year of 2000 and 2009, the other groups were decreasing percentage significantly at the same period ( p

The present paper aims to assess the hypertension, hyperglycemia and hyperlipidemia prevalence of adolescents with intellectual disabilities, and to recognize the health disparities between the study participants and the general population. This study conducted a cross-sectional medical chart analysis of 856 students who participated in school enrolment health examinations in three special schools in Taiwan from 2005 to 2007. We found there were 11.7% cases had hypertension. The biochemical analyses results showed that the elevated or abnormal rates of each exam were the following: triglyceride (9.1%), total cholesterol (1.1%), and fasting plasma glucose (0.3%). The study found the prevalence of hypertension and elevated triglyceride were significantly higher than the general population at the same age, and the body mass index had significantly correlated to hypertension and elevated triglyceride tests. Based on the study findings, many potential risks for metabolic syndrome in adolescents with intellectual disabilities were higher than the general population. The present study suggests that it is necessary to monitor and set up a follow-up health policy for students with intellectual disabilities in healthcare system.

There is little information of hepatitis B vaccination coverage for people with intellectual disabilities (ID). The present paper aims to examine the completed hepatitis B vaccination coverage rate and its determinants of children and adolescents with ID in Taiwan. A cross-sectional questionnaire survey, with the entire response participants was composed of 495 primary caregivers of children and adolescents with ID (age 3-24 years) who studying in 3 special education schools in Taiwan. The results showed that coverage rate of completed hepatitis B vaccination was 74.34% in children and adolescents with ID. Although hepatitis B vaccination is a universal health policy in Taiwan, the uncompleted coverage rate of our study subjects was 2 times of the Taiwan general population at the same age. In the logistic regression analysis of hepatitis B vaccination coverage, we found that the factors of household income and ID individual's age were variables that can significantly predict they did not accept a completed vaccination. The present study suggests that parents and providers should routinely review immunizations of children and adolescents with ID.

This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey by a structured, self-administered questionnaire (12 perceptional issues), and were posted to all primary care settings (N = 168) which provided Pap smear tests for women with ID in Taichung and I-Lan counties in Taiwan, Republic of China during the period of 2009. The vital primary care physician of each healthcare setting was the main respondent of the questionnaire. Finally, there were 69 valid questionnaires returned, giving a response rate of 41.7%. The main findings showed that 72.5% medical care settings provide Pap smear services and 51.5% have practical experience on conducting the tests for women with ID. Among the respondents, nearly 90% primary care physicians expressed that women with ID need Pap smear test regularly. With regard to the associated factors in the delivery of Pap smear screening services to women with ID. The study found that experienced healthcare settings in Pap smear tests for women with ID were more likely to be in public healthcare settings, felt confident in providing screening tests, having a rapid screening program and having a reminding follow-up system. Those respondents felt necessity in Pap smear test for women with ID were more likely to express it is needed to set up a special screening clinic for this group of women. The present study suggests that women with ID need thoughtful, well-coordinated care from primary care physicians, to increase access to health care providers may be helpful in improving Pap screening tests for this population.

Although little is known about the incidence of cervical cancer in women with intellectual disabilities (ID), Pap smear screening is an effective public health program to prevent cervical cancer to this group of people. The purposes of this study were to identify and evaluate the factors regarding the utilization of the Pap smears in women with ID seen in the preventive health screening program. We employed a cross-sectional survey "2009 National Survey on Preventive Health Use and Determinants among People with Disabilities", with the study sample 508 women with ID (agedor =15 years) participated in the research in Taiwan. Results showed that there were 22.1% women with ID had ever used Pap smear screening previously and mean age of the first screening was nearly 40 years old. Comparing to the general population in Taiwan, the ID women at age group35 years was less likely to use screening and the age groupor =35 years was more likely to use Pap smears than did the general women. Finally, a logistic regression analysis showed that marital status and had experience of accepted tubal ligation surgery were two factors which predicted Pap smear test use in the study. Those women with ID who had marital status were 8.99 times (95% CI=1.65-49.15) more likely than those had not marital status to use Pap smear test. Women with ID had experience on tubal ligation surgery were 10.48 times (95% CI=1.40-78.26) more likely to use Pap smear test than their counterparts. This study highlights that to acknowledge the rights of women with ID to access Pap smear screening service, health professionals will need to become more flexible and competent in the service that they provide.

Little information is available on the prevalence and risk factors for less-healthy food intake among people with intellectual disabilities (ID). This study aimed to provide the information of healthy or less-healthy food intake among Taiwanese adolescents with ID and to examine the risk factors to their food intake. A cross-sectional data on 1419 adolescents 12-17 years of age were analyzed in the study. There were 1.4% of adolescents with ID who regularly smoke, 0.6% were regular alcohol drinkers and 0.5% currently chewed betel nut. Less than 40% of respondents expressed the ID individuals had regular exercise lifestyle and 41.0% were reported to have less-healthy food intake behaviors. A logistic regression analysis found that the factors of female caregiver's gender, perceived excellent health status and was not accompanied by specific diseases such as asthma or allergic rhinitis which were correlated with healthy food intake behaviors among adolescents with ID. This study suggests improving the ways of healthy food intake toward reducing the potential risks for less-healthy food intake in the lives of adolescents with ID.

The elevated serum glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transaminase (GPT) rate among people with intellectual disabilities (ID) is unknown and have not been sufficiently studies. The present paper aims to provide the profile of GOT and GPT, and their associated relationship with other biochemical levels of children or adolescents with ID. A cross-sectional design was conducted in three Taiwanese public special schools to analyze annual health examination chart of students with ID. There were 1041 aged 3-21 years children and adolescents with ID participated in the study. The results show elevated rate of GOT and GPT were 3.7% and 7.2%, the study indicates the elevated GPT in children and adolescents with ID is higher than the general school aged children in Taiwan. In multiple linear regression models show that the factors of BMI, HBsAg, TC and UA can significantly explain the GOT value (R(2)=0.275). Those factors of gender, BMI, HBsAg, TC and UA can significantly explain 44.4% variation of GPT value (R(2)=0.444). To prevent the further liver disease burden in people with ID, the study highlights that the health care professionals should assess liver functions of this group of people, and to inform their caregivers the importance of implement regular liver health check-up.

Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16-18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregiver's educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population.

The aims of the preset study were to describe the profile of serum uric acid, the prevalence of hyperuricemia and its risk factors among children and adolescents with intellectual disabilities. We conducted a cross-sectional study of 941 children and adolescents with intellectual disabilities (aged 4–18 years) who participated in annual health examinations in three special schools in Taiwan. This study indicated 30.6% boys and 17.9% girls with intellectual disabilities were with hyperuricemia in Taiwan. The factors of gender, age and BMI were variables that can significantly predict the hyperuricemia occurrence in this vulnerable population. Those children and adolescents with intellectual disabilities were boys (OR = 2.93, 95% CI = 2.02–4.26) and older age (OR = 6.49, 95% CI = 2.19–19.21) were more likely to be hyperuricemia. With regard to BMI to hyperuricemia occurrence, those children and adolescents with intellectual disabilities were overweight (OR = 1.16–3.21, 95% CI = 1.16–3.21) and being obese (OR = 4.95–11.58, 95% CI = 4.95–11.58) was more likely to have a hyperuricemia than the normal weight group. This study provides the general profile of serum uric acid, hyperuricemia and its risk factors of children and adolescents with intellectual disabilities. Medical professionals should be highly alert to the possible consequences of hyperuricemia and provide useful information about the clinical manifestation of this condition for caregivers of children and adolescents with intellectual disabilities.

The objectives of this study were to examine trends related to the staffing of disability welfare institutions caring for people with disabilities in Taiwan. Nationwide data from the 2002 to 2007 “ Service Manpower in Disability Welfare Institutions ” report, which are derived mainly from the Department of Statistics, Ministry of the Interior, Taiwan, were analyzed. The data included number of workers, job type and gender distribution of staff working in welfare institutions catering for the disabled. We also used the disabled population and those who had been admitted to institutional care to analyze the service load per staff member. Based on analyses of current governmental statistics, the results showed that staff numbers in institutions for the disabled increased from 6191 to 7820 (20.8% increase), and the female/male ratio these staff increased from 4.18 to 4.51 from 2002 to 2007. Educator/training personnel (33.3–36.7%) accounted for a higher proportion of staff than other job categories, and each staff member served 5.8–6.3 persons with disabilities on average. The second largest group was living assistant (18.4–20.5%; 9.9–11.8), and the remaining personnel were administrative staff (13.5–14.6%; 13.9–15.9), nursing staff (6.4–8.7%; 24.9–32.0), social workers (6.2–7.5%; 28.8–32.8), and counseling staff (3.8–6.3%; 21.9–57.1). Curve estimation tests showed a significant change over the period of the study in the number of disabled people attended to on average by administrative staff, social workers, nurses and other staff. The results highlight the requirement for further study to explore the needs of the majority service provider – female staff – to provide them with adequate professional or psychological support to enable them to work with people with disabilities in institutions. In addition, further analysis should focus on a review of staff numbers for different types of institutions, to examine their adequacy.

Although many studies have explored emergency services for children, there are few published reports of the utilization of emergency services by children with disabilities. The present study attempts to provide data regarding the utilization of, and factors affecting, emergency department visits by disabled children in Taipei. A general census of 1006 children with disabilities, identified from the Taiwan National Disability Registry System in Taipei, was conducted. The overall response rate was 38%, yielding a sample of 340 disabled children. The results showed that 30.1% of children with disabilities had utilized emergency department services over the past 4 months with an average of 1.4 visits per child. The most common reasons for emergency visits were fever (34.7%), respiratory symptoms (24.2%), abdominal pain (15.8%), injury (7.4%), and epilepsy seizures (7.4%). This study also found, using a logistic regression model, that emergency department utilization may be associated with household economic status and the reported physical health of children with disabilities. The ‘deficit’ and ‘balance’ household economic status groups gave odds ratios of 3.902 (95% CI = 1.469–10.364) and 3.311 (95% CI = 1.249–8.779), relative to the ‘surplus’ group. The model also indicated that those children with disabilities who were reported as being in poor physical health had 11.359 times (95% CI = 2.968–43.469) the likelihood of using emergency care than those whose physical health was in excellent condition. The study suggests that in order to maximize the health of children with disabilities, medical care stakeholders should consider who are the most likely groups to use emergency department services and develop anticipatory guidance or preventive services for this vulnerable population.

Primary prevention of intellectual disability (ID) has long been a goal of public health professionals, without a clear picture of the ID population, efforts to understand its nature and improve the lives for this group of people will be impossible. The purpose of this paper was to describe the over time prevalence of ID from 2000 to 2007 in Taiwan, particular focused on the age and gender distributions. We analyzed data for the present study from the 2000 to 2007 Taiwan national disability registers, mainly were obtained from two ways: (1) the Physically and Mentally Disabled Population by Aged and Level; and (2) Taiwan General Population by Age. The results revealed that the registered number of people with ID drastically increased from 71,012 to 91,004 and the general population was slightly increasing from 22,276,672 to 22,958,360 in the year of 2000 and 2007 in Taiwan. The increase rate of population in ID cases is 13.67 times of the general population (ID = 28.15%, general population = 2.06%) and the ID prevalence was increasing from 0.318% to 0.396% in this period of time. Males occupied more percentage than female in ID population (roughly the male/female ratio was 1.37). The ID population was particularly significant increased during the age periods of the school and young adult. However, in the elderly age groups (≧60 years) showed the percentage of Taiwan general population was 2.9 times of ID population percentage to the age structure in 2007 in the analysis. The present analysis suggests that the prevalence is varied in different time. Therefore, it is needed to conduct the incidence as a choice in the public health system to monitoring and measuring the occurrence of people with ID in the community.

The purposes of the present study are to provide the first data on utilization, understanding and satisfaction of the National Health Insurance (NHI) premium subsidy for families of children with disabilities in Taipei. Data from the 2001 Taipei Early Intervention Utilization and Evaluation Survey for Aged 0-6 Children with Disabilities were analyzed. In the study, a total of 1006 questionnaires were mailed, of which 340 valid questionnaires were returned, giving a response rate of 33.8%. More than one-third of families of children with disabilities did not receive any financial subsidy of National Health Insurance (NHI). Less than half of the respondents (43.8%) understood the NHI premium subsidy policy completely, while 28.7% partial understood and 27.5% still did not know this auxiliary policy. Approximately 38.5% of the respondents were specifically very satisfied or satisfied, with the NHI subsidy program. There were 18.9% respondents who felt dissatisfied or very dissatisfied with the NHI scheme for children with disabilities in Taiwan. Chi-square or t-test analyses were significant for the caregiver's age (p0.05), children's disability onset and disability diagnosed age and disability level (p0.01) on receiving the subsidy assistance. A multiple stepwise logistic regression revealed that the factor of 'onset age of disability' was slightly significant associated with the use of NHI premium subsidy (OR=0.966; 95% CI=0.947-0.986). Health policies should aim to reduce the inequity in NHI premium subsidy utilization and improve their understanding and satisfaction toward this subsidy scheme.

The aim of this paper was to describe the over time prevalence of autism from 2000 to 2007 in Taiwan, with particular focus on the age, gender, prevalence and causes. We analyzed data from the public web-access information collected by the Department of Statistics, Ministry of the Interiors, Taipei, Taiwan. The data included: (1) the physically and mentally disabled population by age and severity level; (2) the physically and mentally disabled population by cause; and (3) the Taiwan general population by age. The registered number of people with autism drastically increased from 2062 to 7207 (increase rate = 249.5%), and the male/female ratio of autism was 6.0–6.6 from 2000 to 2007. The autistic cases increased significantly, particularly in children between 6 and 11 years of age, occupying about 43.9–49.5% of the autistic population. The reported prevalence of each age group, aged 0–5 years was 2.4–7.8/10,000, aged 6–11 was 5.0–17.3/10,000, and aged 12–17 years was 2.1–10.4/10,000 from year 2000 to 2007. The main cause of autism was congenital (48.5–58.0%), followed by disease (9.5–31.1%) or other (20.0–32.7%). An increase in prevalence would suggest the need for more attention and funding of services for children with autism.

Aim: To explore the perceptions of institutional directors on the preventive health strategies for people with intellectual disabilities in institutions. Methods: A structured questionnaire was conducted by a cross-sectional postal survey in all registered institutions in Taiwan in 2002. A total of 157 questionnaires were mailed, of which 121 valid questionnaire were analyzed in this study. Results: The respondents indicated important perception to the preventive health strategies across the 17 criteria, the mean score of importance in preventive health strategies was from 8.4 to 9.7 (score 1–10). But the analysis found that there were many gaps of ‘importance’ compared with ‘satisfactory’ to implementation of preventive health strategies, particularly in the issues of ‘thyroid screening for intellectual disabilities (ID) with Down syndrome’, ‘prevention and treatment of osteoporosis’, and ‘diagnosis and treatment of mental disorders’, these health issues need to be improved in institutions. The present study found that the size and ownership of institutions were not related to the perceptions of importance and satisfaction toward preventive health strategies. Conclusions: The institutions should explore the reasons of why the failure to carry through important health plans into practice to ensure quality of health services for people with ID who living in institutions.