Search

Statement of problem Oral health–related quality of life (OHRQoL) is a subjective measure that assesses a person's perception of oral health. Patients with Alzheimer disease (AD) suffer from impaired cognitive function and a compromised ability to perform activities of daily living. Further exploration is needed to clarify whether OHRQoL is negatively impacted by cognitive degeneration and oral health conditions among patients with AD. Purpose The purpose of this systematic review was to increase understanding of OHRQoL among patients with AD and explore factors that may affect OHRQoL. Material and methods Searches were conducted in PubMed, the Cochrane Library database, Medline, EBSCO, ProQuest, and EMBASE until August 30, 2018, with no date restrictions. The initial search targeted quantitative observational studies published in English that included the keywords AD, oral, prosthesis, and OHRQoL. Data extraction was independently conducted by 2 reviewers. OHRQoL was investigated as the outcome. Cognitive status and oral health conditions were treated as exposures. Tools used to measure OHRQoL included the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile. The research adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Six studies were included. The sample sizes ranged from 30 to 226 participants, 5 studies used cross-sectional designs, and 1 was a nonrandomized controlled trial. Three studies reported higher OHRQoL scores among participants with AD than those among controls, but only 1 study showed a statistically significant difference. A statistical analysis was conducted with 4 studies that reported GOHAI scores, and no significant differences were found in GOHAI scores between participants with AD and controls (standard mean difference: 0.09; 95% confidence interval: −0.66 to 0.85). All studies that explored factors affecting OHRQoL showed different associations between cognitive impairment, oral health conditions, and OHRQoL. One study showed that cognitive impairment was negatively associated with OHRQoL. Three studies found oral health conditions (including periodontitis, gingival bleeding, probing depth >4 mm, and number of natural teeth) impaired the OHRQoL of participants with AD. Three studies reported that prosthetic type and quality positively affected OHRQoL among participants with AD. Conclusions OHRQoL may not fully represent actual oral health problems of patients with AD. Clinical dentists should evaluate oral problems in this population, preferably by using both subjective and objective examinations, including oral and dental conditions. This will ensure oral problems among patients with AD can be detected early and timely treatment provided.

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection, metabolic disease, vascular disorder and several other less common conditions. Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature. CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient's left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos." CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.

Objective Pu-erh tea was presumed to have anti-hyperglycemic effects via inhibition on alpha-amylase and alpha-glucosidase. However, no integerated literatures were published to substantiate such presumption. Methods Current study adopted systemic review method to validate inhibitory effects on alpha amylase and alpha-glucosidase. Five English databases (PubMed, EBSCO, SCOPUS, Cochrane Library, Web of Science) and three Chinese ones (Airti Library, CNKI Library, and Google Scholar) were searched up to 22 March 2018 for eligible literatures, using keywords of Pu-erh, Pu’er, alpha-amylase or alpha-glucosidase. Results Six studies exploring inhibitory effects on alpha-glucosidase and seven on alpha-amylase were included for systemic review. Though results showed pu-erh tea has significant inhibitory effects on alpha-amylase and alpha-glucosidase, high heterogeneity was detected among studies included. Conclusions High heterogeneity may be due to complex alterations of chemicals under different degrees of fermentation. More future studies are required to further identify principal bioactive component(s) at work.

Background: The traditional home care model entails caring &ldquo, for&rdquo, people with disabilities, not &ldquo, with&rdquo, them. Reablement care has been applied to long-term care, but the evidence for care attendants, home care recipients, and family caregivers simultaneously is limited. Methods: First, a survey was conducted to explore the needs of home care recipients and family caregivers to achieve independence at home to develop the reablement home care model for home care. Then, an intervention with two groups was implemented. The experimental group included a total of 86 people who participated in the reablement home care model. The control group included 100 people and received usual home care. The self-reliance concept, job satisfaction, and sense of achievement for care attendants, quality of life for home care users, and caregiving burden for family caregivers were assessed. Results: The reablement home care model improved the job satisfaction and achievement of home care attendants, improved mutual support and independence in the self-reliance concept and quality of life among the users, and reduced the stress of the users and family caregivers. Conclusion: The reablement home care model improved the outcomes for providers, care recipients, and family caregivers. Reablement home care is suggested in long-term care policies.

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

This study employed the International Osteoporosis Foundation&rsquo, s One-Minute Osteoporosis Risk Test to examine factors related to the osteoporosis risk of institutional caregivers. In this cross-sectional study, a self-developed structured questionnaire comprising the One-Minute Osteoporosis Risk Test was used to obtain data on the caregivers&rsquo, demographic data, health habits, working style, and osteoporosis risk. Seven disability welfare institutions were selected as research sites, and 465 copies of questionnaires were distributed to the institutions&rsquo, employees, with 455 valid responses collected for a valid return rate of 98%. SPSS for Windows (Version 20.0) was used to analyze questionnaire data, descriptive-statistical frequency, a &chi, 2 test, and logistic regression were used to determine the correlation between demographic data, health habits, working style, and osteoporosis risk. The results revealed that primary risk factors include &lt, 30 min of daily exercise (38%), lack of dairy product or calcium tablet intake (28%), and &lt, 10 min of daily outdoor activity or not taking vitamin D supplements (29.9%). In total, 395 (86.8%) of the respondents scored less than 5 in the osteoporosis risk test, the remaining 60 (13.2%) scored 5 or higher, revealing a high risk of early osteoporosis. An independent variable analysis revealed that the risk factors of early osteoporosis include age, education level, having undergone bone density tests, prior disease diagnosis, long-term medication use, physical fitness, dietary habits, and average time of exposure to sunlight. In the multivariate analysis, poor physical fitness (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.12&ndash, 4.27, p = 0.023) and average daily time of exposure to sunlight (OR = 0.24, 95% CI: 0.59&ndash, 2.59, p &lt, 0.001) were significantly correlated with osteoporosis risk. In other words, respondents with poor physical fitness were 2.18 times as likely to have osteoporosis as those with good physical fitness, and those exposed to sunlight for 30 min or longer every day were 0.24 times as likely to have osteoporosis as those exposed to sunlight for less than 30 min every day. Accordingly, institutions must encourage employees to spend more time in the sun every day and improve their physical fitness through exercise.

Purpose: This study was to implement and evaluate a successful aging intervention program for middle-aged private insurance beneficiaries. Methods: The participants were recruited from the staff and middle-aged clients for the experimental and control groups of a private insurance company. The two client (experimental and control) groups were matched by comparable age groups, gender, education, and purchased insurance types. The intervention program provided for the staff and the experimental group consisted of a series of educational courses on the topics about successful aging and preparation for 4 months. In total, there were 40 staff members, in addition to the 74 members of the experimental group and 60 members of the control group participating in the study. Results: After the intervention, the rate of physical activity and exercise significantly improved for the staff and for the intervention group. There were significant improvements in behaviors associated with doing exercise and living a less sedentary lifestyle and in the utilization of health examinations, and improvements in fitness and blood pressure. Conclusion: The successful aging intervention program significantly improved awareness of successful aging, exercise behavior and fitness.

BACKGROUND: Previous researches proved that the ST‐segment elevation (STE) in lead aVR had great significance on the prediction of severe left main lesion or serious multivessel lesions. The current research is to summarize the published data and evaluate the overall association of STE in lead aVR and left main coronary artery disease (LMD) in Non‐ST‐elevation acute coronary syndrome. METHODS: Literature searching was performed in the online database, and a systematic review was conducted based on the searched results. Meaningful STE in lead aVR was summarized and analyzed for odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: Twenty‐seven articles were included for final data analysis. Compared with STE

Objective: Previous investigations yielded inconsistent results for diagnostic and prognostic predictive values of MicroRNAs (miRNAs) for acute myocardial infarction (AMI). Methods and results: We systematically searched on PubMed and Web of Science for articles explored association of miRNAs and AMI published from January 1989 to March 2019. For diagnostic studies, a summary of sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratio (DOR), which indicated the accuracy of microRNAs in the differentiation of AMI and no AMI, were calculated from the true positive (TP), true negative (TN), false positive (FP), and false negative (FN) of each study. In addition, the summary receive-operating characteristics (SROC) curve was constructed to summarize the TP and FP rates. For follow-up study, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) for individual clinical outcomes. The meta-analysis showed a sensitivity [0.72 (95% CI: 0.61--0.81)] and specificity [0.88 (95% CI: 0.79--0.94)] of miR-1 for AMI. In addition, miR-133 showed a sensitivity [0.73 (95% CI: 0.55--0.85)] and specificity [0.88 (95% CI: 0.74--0.95)] for AMI. Moreover, the present study showed a sensitivity [0.83 (95% CI: 0.74--0.89)] and specificity [0.96 (95% CI: 0.82--0.99)] of miR-208 for AMI. A significant association was found between miR-208 and mortality after AMI (HR 1.09, 95% CI 1.01--1.18). It also indicated a sensitivity [0.84 (95% CI: 0.70--0.92)] and specificity [0.97 (95% CI: 0.87--0.99)] of miR-499 for AMI. Conclusions: Circulating miR-1, miR-133, miR-208, and miR-499 showed diagnostic values in AMI.

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

The purposes of this study were to investigate the level of functional independence of adolescents and adults with Down syndrome (DS) and to examine the influence of their demographic characteristics, level of disability, and comorbidities on their functional independence. The study population was obtained from the voluntary registry members of the Republic of China Foundation for Persons with DS in Taiwan. Two hundred and sixteen adolescents and adults with DS (≧15 years) whose caregivers had completed valid structured questionnaires were recruited for the study. The present study used the Barthel Index (BI) of activities of daily living (ADL) to determine a baseline level of physical functioning in people with DS. The results showed that 1·9% of the cases were severely dependent (BI score 21–60), 20·4% of the cases were moderately dependent (BI score 61–90), 8·3% of the cases were mildly dependent (BI score 91–99), and 69·4% of the cases were totally independent (BI score 100). The multiple logistic reg...

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

Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the "Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach" project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r=-0.28, p

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

The purpose of this study was to collect information on the fasting blood glucose (FBG) profile in individuals with disabilities and to determine associated risk factors in this population. This study was a cross-sectional survey of 833 adults with disabilities who were 30 years of age or older and who voluntarily participated in the 2010 annual health examination provided by a local government in east Taiwan. The results demonstrated that 23% of participants had prediabetes (FBG: 100–125 mm/dl), and 10·7% participants had diabetes (FBG>126 mm/dl). The findings appear to demonstrate that individuals with disabilities experience a higher prevalence of diabetes than the general population, and greater attention must be paid to this population within the healthcare system. In the logistic regression model, older age, and body mass index (BMI) were predictive of diabetes in this population. In addition, elderly individuals (OR = 5·96, 95% CI = 1·67–21·23) or those from 44 to 64 years (OR = 6·67, 95% CI = 1·94...

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.

Background Robots are gradually becoming intelligent tools for surgeons in computer assisted orthopedic surgery. A hands-on robot combining CT-free navigation software and coordinated control has been designed for total knee arthroplasty. Methods The hands-on robot is under bilateral force control so that the robot not only follows the force commands from the operator but also shapes the reflected force back to the operator. The proposed coordinated control also defines three operating modes to fulfill intelligent bone cutting by tuning appropriate scaling to the admittance gains. Results Experimental results demonstrated assistive, resistant and emergent actions to meet various bone cutting conditions by the coordinated controller. Conclusions The proposed coordinated controller enables the robot to perform bone cutting more safely, rapidly and accurately compared with being performed by manual bone saw. The intelligent bone cutting has been successfully verified by a cadaver test. Copyright © 2013 John Wiley & Sons, Ltd.

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.

Insertion/withdrawal forces of metallic terminals of audio-jack electronic connectors usually decrease significantly with increasing mating/unmating cycles. One of major mechanisms causing such a phenomenon could be due to wear performed on the terminals. In this study, fatigue failure of the terminals is defined as either the insertion force or the withdrawal force going beyond the range of the corresponding specification requirements, and a finite element analysis is carried out to assess the durability of the terminals. Elastic–plastic copper alloys with assumptions of isotropy and isotropic hardening for the terminal materials are adopted in the analysis. The Archard model is used to account for abrasions as a function of contact pressure, sliding distance, and hardness. The user subroutine UMESHMOTION integrated in the commercial package ABAQUS is coded to control the movement of the contact surfaces. Variations of the insertion/withdrawal force over 20,000 mating/unmating cycles are efficiently obtained by introducing multiplication factors into the simulations. Calculation results are further validated by the associated experimental measurements.

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.

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.

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

Background This study provides a perspective on the mental health status and analyses the effectiveness of a stress-relief program for primary caregivers of adolescents with intellectual disability (ID).Method Seventy-seven primary caregivers of people with ID were recruited (intervention group, n = 31; non-intervention group, n = 46) to the study, which involved participation in one stress management workshop (intervention group only) and both groups reading an education booklet on stress management.Results We found that 22.1% of caregivers in the study were at high risk of depressive stress and in need of mental health consultation; this prevalence was nearly six times that of the general population. The effectiveness of mental health initiatives resulted in a significant reduction in depressive stress for the intervention group.Conclusions The study highlights that a “face-to-face” workshop is an effective way to decrease levels of depressive stress.

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.

Aims The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs’ priorities in the delivery of health care services to this group of people in Taiwan. Methods The study employed a cross-sectional design and was conducted by a census method, the aim being to collect information from all GPs in Taiwan. A questionnaire was mailed out, between 10 April 2006 and 16 June 2006, and the responses provided by 331 GPs (response rate = 16) were included in the analysis. Results The results showed that most of the respondents did not have sufficient experience to deal with patients with intellectual disabilities and lacked adequate knowledge about intellectual disabilities. Indeed, respondents expressed the need for on-the-job training in the field of intellectual disabilities and generally agreed that their role in providing health care services for people with intellectual disabilities was important. However, they were generally not satisfied with the achievements of their role on health care issues. The study highlighted that many issues need to be prioritized for people with intellectual disabilities in relation to policy planning at different health care stages (primary, secondary and tertiary health care). The results also revealed that those senior GPs with considerable experience in treating people with intellectual disabilities were more likely satisfied with their role in providing health care for this group of people. Conclusions It is concluded that Taiwanese health and welfare authorities need to focus more carefully on issues concerning deficiencies in the training of GPs, and to employ appropriate strategies to address health care issues raised in the present study so as to improve the quality of care for people with intellectual disabilities.

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.

Objectives. The purpose of this study was to investigate the blood lead levels (BLLs) of primary-school children aged 7 to 12 in Penghu island and to determine the factors affecting their BLLs. Methods. A total of 1,885 participants were recruited and BLLs were measured with a flameless atomic absorption spectrophotometer. A questionnaire was used to collect personal information. Results. The results indicated that the mean BLL of primary-school children in Penghu was 6.0±2.4 µg/dl (1.0~29.3 µg/dl). The mean BLL of schoolboys (n=1,046) was 6.3±2.6 µg/dl, with a maximum of 29.3 µg/dl, while the mean BLL of schoolgirls (n=839) was 5.7±2.2 µg/dl, with a maximum of 23.4 µg/dl. Risk-factor analysis showed that personal characteristics (i.e., gender, frequency of milk consumption, grade levels) and geographic factors (i.e., levels of urbanization) significantly influence the BLLs. However, there was no significant impact on BLLs from drinking water, residential distance from a major road, and living close to lead-emitting sources. Conclusions. Geographical factors were highly associated with BLLs. The BLLs of the primary-school children living in the main Penghu island were lower than those in the other small islands.

Introduction: Self-rated Health (SRH) is a commonly measured concept in gerontological studies. The single item measures people’s subjective rating of their current health status. A great majority of Long-term Care users are physically disabled elders with a poorer rating of SRH. Yet, few studies have examined the associations betweem different combinations of self-care disabilities (e.g. Activity of Daily Living, ADL) and SRH. In this study, combinations of 6 ADL disabilities among a group of disabled elders were identified to correlate with their ratings of subjective global health.

Purpose: Internet use is one indicator of active aging index, which represents the opportunity to social connection social participation, learning, receiving information and service application. The study was to examine the internet use and area difference and related individual factors for the middle-aged and older adults in Taiwan. Methods: The data were from the 2013 Digital Divide Survey (Middle-aged and Elderly Adults), with n=7157 persons. The samples were drawn from the middle-aged and older adults aged 50 years old or more population. The interviews were collected by telephone in 2013. Descriptive analysis, Chi-square test, and generalized linear models with binary logistic response were applied. Results: There were 43.0% of the participants using internet. The participants who lived in the towns with higher digital development and wealthier income cities/counties were more likely to use internet. Sex, age, education, income, and occupations (professions, housewives/unemployed/students, and retiree) were significantly different in internet use. For those internet users, 12.2% used instant communication app, 11.0% used social media, 35.4% used both, and 41.3% did not use any. Only 5.5% of the users expressed their political opinions online. For the internet users, being female, younger, higher educated, and working in service industry were more likely to use social communication or social media apps. Discussion: There were area- and individual socioeconomic inequalities in internet use for the current middle-aged or older cohorts in Taiwan. The structural barriers need to be removed to promote active aging.

Fine particulate matter (PM2.5) is an air pollutant that is receiving intense regulatory attention in Taiwan. In previous studies, the effect of air pollution on bladder cancer has been explored. This study was conducted to elucidate the effect of atmospheric PM2.5 and other local risk factors on bladder cancer mortality based on available 13-year mortality data. Geographically weighted regression (GWR) was applied to estimate and interpret the spatial variability of the relationships between bladder cancer mortality and ambient PM2.5 concentrations, and other variables were covariates used to adjust for the effect of PM2.5. After applying a GWR model, the concentration of ambient PM2.5 showed a positive correlation with bladder cancer mortality in males in northern Taiwan and females in most of the townships in Taiwan. This is the first time PM2.5 has been identified as a risk factor for bladder cancer based on the statistical evidence provided by GWR analysis.

The present study aims to investigate the onset of dementia conditions using the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) scale and to identify the possible factors associated with DSQIID scores in people with Down syndrome (DS). The study population was recruited from the voluntary registry members of the Republic of China Foundation for Persons with Down syndrome; primary caregivers provided DSQIID information on 196 adolescents and adults with DS (aged 15-48 years) who were entered into the database and analyzed using SPSS 20.0 software. The results described the distribution of early-onset dementia conditions in 53 adolescents and adults with DS, and 2.6% of the subjects with DS had possible dementia (DSQIID score ≧ 20). Univariate analyses found that older age (p=0.001) and comorbid conditions (p=0.003) were significantly associated with DSQIID scores. Older subjects were more likely to have higher DSQIID scores than were younger age groups after ANOVA and Scheffe's tests. Lastly, a multiple linear regression analysis revealed that age (p0.01), severe disability level (p0.05) and comorbid condition (p0.01) significantly explained 13% of the variation in DSQIID scores after adjusting for the factors of gender, education level and multiple disabilities in adolescents and adults with DS. The study highlights that future research should focus on the occurrence of dementia in people with DS and on identifying its influencing factors based on sound measurements, to initiate appropriate healthy aging policies for this group of people.

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR=3.807, p=0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.

Robots can provide real-time bone cutting assistance on various operational conditions. A human intent estimation together with a bilateral force control has been designed to assist the surgeon in total knee replacement. Different admittance gains are online adjusted based on estimated human intent, followed by the robot to exert appropriate forces to the cutter, either pushing or pulling forces so that the bone cutting can be carried out in easier, safer and more precise way. Experiments show that the proposed control structure is promising to meet the clinical needs for real-time bone cutting assistance.