Search

The prevalence of hyperuricemia in Taiwan is high, and hyperuricemia has been associated with a risk of developing several diseases. Although the traditional risk factors for hyperuricemia are well known, the relationship between heavy metals and hyperuricemia is still undefined. Therefore, the aim of this study was to investigate the relationship between hyperuricemia and heavy metals. A total of 2447 participants (977 males and 1470 females) residing in southern Taiwan were enrolled, and levels of the following heavy metals were measured: lead in blood, and nickel, chromium, manganese, arsenic (As), copper, and cadmium in urine. Hyperuricemia was defined as a serum uric acid level greater than 7.0 mg/dL (416.5 μmol/L) in men and 6.0 mg/dL (357 μmol/L) in women. The participants were divided into two groups: those without hyperuricemia (n = 1821; 74.4%) and those with hyperuricemia (n = 626; 25.6%). Multivariate analysis showed that only high urine As (log per 1 μg/g creatinine; odds ratio, 1.965; 95% confidence interval, 1.449 to 2.664; p < 0.001), young age, male sex, high body mass index, high hemoglobin, high triglycerides, and low estimated glomerular filtration rate were significantly associated with hyperuricemia. In addition, the interactions between Pb × Cd (p = 0.010), Ni × Cu (p = 0.002), and Cr × Cd (p = 0.001) on hyperuricemia were statistically significant. Increasing levels of Pb and Cr yielded an increased prevalence of hyperuricemia, and the effect was progressively greater for increasing Cd. Moreover, increasing levels of Ni yielded an increased prevalence of hyperuricemia, and the effect was progressively greater for increasing Cu. In conclusion, our results show that high urine As is associated with hyperuricemia, and some interactions of heavy metals on hyperuricemia are noted. We also found that young age, male sex, high BMI, high hemoglobin, high triglycerides, and low eGFR were significantly associated with hyperuricemia. [ABSTRACT FROM AUTHOR]

The Cerebral Palsy Quality of Life for Children (CP QOL-Child) is the first health condition-specific questionnaire designed for measuring QOL in children with cerebral palsy (CP). However, its construct validity has not yet been confirmed by confirmatory factor analysis (CFA). Hence, this study assessed the construct validity of the caregiver proxy-report version of the Chinese version of the CP QOL-Child in children with CP using CFA. A total of 312 children with CP (mean age: 8.59 years, SD: 2.52 years) and their caregivers participated in this study. The Chinese version of the CP QOL-Child was completed by the caregivers of children with CP. Then, CFA was applied to evaluate the seven-factor measurement structure of the CP QOL-Child. The seven-factor CFA model had an adequate fit to our data as judged by [chi][squared] statistic and various goodness-of-fit (GOF) indices, including the root mean square error of approximation (RMSEA). This study provided empirical evidence of the construct validity of the CP QOL-Child to support its use with children with CP in the Chinese speaking society. (Contains 3 tables.)

Using data from 31 provinces/municipalities in China from 2003 to 2018, this article examines the impact of international tourism on hotel sales revenue (HSR). Specifically, this study lays a theoretical foundation for investigations of the nonlinear and state-dependent effects of international tourist arrivals (ITAs) on HSR. Results of both traditional and dynamic panel regression test models reveal the following interesting results. First, the positive relationship between ITA and hotel performance is not unique to Taiwan but is also found in Mainland China. Second, based on the theory of economies of agglomeration, the impact of ITA on HSR is found to be inverse U-shaped. Third, the effects of ITA on HSR are economic state-dependent, relying to a great extent on economic conditions. Furthermore, ITA has a stronger impact on HSR during periods of economic expansion. Important policy implications are provided based on the empirical results. [ABSTRACT FROM AUTHOR]

Importance: Early identification of young children at risk of developmental coordination disorder (DCD) can support early intervention and prevent secondary sequelae. Objective: To examine the psychometric properties of a translated and cross-culturally adapted version of the Little Developmental Coordination Disorder Questionnaire–Taiwan (LDCDQ–TW). Design: Prospective study. Setting: Kindergartens and preschools in north, central, and south Taiwan. Participants: In Phase 1 the participants were 1,124 parents of typically developing children ages 36–71 mo. Children with confirmed developmental diagnoses were excluded. Participants in Phase 3 were 162 children who had been recruited in Phase 2. Outcomes and Measures: The LDCDQ–TW, a 15-item parent questionnaire for identifying children at risk for DCD, and the Movement Assessment Battery for Children (2nd ed.; MABC–2), were administered. Results: The findings revealed excellent test–retest reliability (intraclass correlation coefficient [ICC] =.97) and poor interrater reliability (ICC =.47). On the basis of MABC–2 scores, the non-DCD group (≥15th percentile) scored significantly higher than the DCD and suspect-DCD groups on the LDCDQ–TW, but the latter two groups did not differ from one another. Using the 15th percentile as a cutoff for both the MABC–2 and the LDCDQ–TW, sensitivity was.96 and specificity was.68. Conclusions and Relevance: Although standardized performance-based assessments are required to confirm a diagnosis of DCD (typically after age 5 yr), the LDCDQ–TW demonstrated sound reliability and validity and can support the early identification of young children at risk of DCD in Taiwan. What This Article Adds: The LDCDQ–TW can facilitate early intervention for DCD and prevent secondary sequelae, improving outcomes for children with DCD. The LDCDQ–TW demonstrated sound reliability and validity and can support the early identification of young children at risk of developmental coordination disorder in Taiwan. [ABSTRACT FROM AUTHOR]

Enhancing children's daily participation is the optimal goal of early childhood intervention. This study aimed to identify child and family predictors of participation for toddlers with global developmental delay. Fifty-nine toddlers with global developmental delay (aged 24–43 months) and their mothers participated in a 6-month longitudinal study. Predictors for participation were child factors [age, gender, delay severity, mastery motivation (perceived persistence and task persistence), and withdrawal behavior], and family factors (socioeconomic status, family income, maternal education, stress, and maternal teaching behavior). Dependent variables were participation diversity and intensity of four activity types measured 6-month later using the Assessment of Preschool Children's Participation (Chinese version). Correlation and hierarchical regression statistical methods were used. Older children with higher persistence had higher overall participation. Different factors predicted different participation dimensions and different activity types. Older age, higher perceived persistence, and being less withdrawn predicted higher diversity and intensity for play participation. For skill development participation, older age, less severity, higher mastery motivation, and better maternal teaching behaviors predicted higher diversity; and age, mastery motivation and maternal teaching predicted intensity. Different factors predict participation attendance differently. Supporting parents to enhance toddlers' mastery motivation may optimize children's participation in daily activities. Based on the child and their caregiver preferences, applicability and/or engagement for different activity types, interventionists could collaborate further with caregivers to find strategies to increase children's participation attendance in daily life. Interventionists could consult with caregivers: (a) to observe the persistence and positive affect (mastery motivation) of children during different activities, (b) to figure out the possible barriers to participation in those activities, and (c) to demonstrate appropriate caregiver-child interactions. Interventionists are encouraged to support children's mastery motivation and quality of maternal teaching behaviors to enhance participation in daily activities. [ABSTRACT FROM AUTHOR]

Importance: In Chinese-speaking societies, a reliable and valid measure is needed to enable early identification of young children's challenges in sensory processing. Objective: To examine the psychometric properties of the Chinese version of the Infant/Toddler Sensory Profile (ITSP--C) when used with Taiwanese children. Design: Prospective study. Setting: Multiple settings. Participants: Participants were 367 typically developing (TD) infants ages 0--6 mo (mean [M] age = 3.44 mo, standard deviation [SD] = 1.82) and 677 toddlers ages 7--36 mo (M age = 22.33 mo, SD = 8.15), along with 42 toddlers with developmental disabilities (DD; M age = 28.4 mo, SD = 6.7). Outcomes and Measures: The ITSP, a caregiver questionnaire that measures how children respond to sensory events in daily life, was translated and cross-culturally adapted into a Chinese version (ITSP--C). Results: Internal consistency was high for the 0--6 mo subscale (a = .80) and the 7--36 mo subscale (a = .82). Test--retest reliability was excellent for the 7--36 mo subscale (intraclass correlation coefficient = .94). Logistic regression analysis demonstrated that the ITSP--C discriminated between children with DD and TD children. Conclusions and Relevance: The ITSP was successfully adapted to Chinese with similar reliability and validity to the original ITSP. The 7--36 mo subscale had a higher level of reliability than the 0--6 mo subscale, and quadrant scores were more reliable than section scores. Moreover, the ITSP--C discriminated children with DD from TD children on the basis of their sensory processing patterns. What This Article Adds: The ITSP--C has sound psychometric properties and support for its use in early identification of sensory processing difficulties in young Chinese-speaking children. [ABSTRACT FROM AUTHOR]

Background Family-centered intervention for preterm infants has shown short- to medium-term developmental benefits; however, the neurological effects of intervention have rarely been explored. Objective The objectives of this study were to examine the effect of a family-centered intervention program (FCIP) on neurophysiological functions in preterm infants with very low birth weight (VLBW; birth weight of < 1500 g) in Taiwan, to compare the effect of the FCIP with that of a usual-care program (UCP), and to explore the FCIP-induced changes in neurobehavioral and neurophysiological functions. Design This was a multicenter, single-blind randomized controlled trial. Setting The study took place in 3 medical centers in northern and southern Taiwan. Participants Two hundred fifty-one preterm infants with VLBW were included. Intervention The FCIP group received a family-centered intervention and the UCP group received standard care during hospitalization. Measurements Infants were assessed in terms of neurobehavioral performance using the Neonatal Neurobehavioral Examination–Chinese version, and their neurophysiological function was assessed using electroencephalography/event-related potentials during sleep and during an auditory oddball task during the neonatal period. Results The FCIP promoted more mature neurophysiological function than the UCP, including greater negative mean amplitudes of mismatch negativities in the left frontal region in the oddball task in all infants, lower intrahemispheric prefrontal-central coherence during sleep in infants who were small for gestational age, and higher interhemispheric frontal coherence during sleep in those who were appropriate for gestational age. Furthermore, interhemispheric coherence was positively associated with the total neurobehavioral score in preterm infants who were appropriate for gestational age (r  = 0.20). Limitations The fact that more parental adherence strategies were used in the FCIP group than in the UCP group might have favored the intervention effect in this study. Conclusions Family-centered intervention facilitates short-term neurophysiological maturation in preterm infants with VLBW in Taiwan. [ABSTRACT FROM AUTHOR]

Background Increasing evidence shows common motor deficits associated with autism spectrum disorder (ASD) that can relate to impaired planning and control processes of the sensorimotor system. Catching is a fundamental motor skill that requires coordination between vision, posture, and arm movements. Although postural control and ball catching have been shown to be impaired in children with ASD, previous studies have not investigated how these components are integrated. Objective The objective of this study was to investigate the sensorimotor control of arm movements and postural adjustments during ball catching in children with and without ASD. Design This study employed a cross-sectional design. Methods Fifteen children with ASD (mean [SD] age = 8.8 [1.2] years; 12 boys) and 15 age- and sex-matched typically developing children participated in this study. Children were asked to catch a ball rolling down a ramp in 6 test conditions in which visual inputs and ramp direction were manipulated to provide different sensory conditions and postural demands. Results Compared with their typically developing peers, children with ASD had increased difficulties catching balls, especially those from lateral directions. They less often used visual information to plan for catching motion, demonstrated fewer and delayed anticipatory postural adjustments, and exhibited increased corrective control. Limitations The sample excluded children with intellectual disability and attention deficit and hyperactivity disorders that might reduce the generalizability to the whole ASD population. Conclusions Our results suggest that motor difficulties present in children with ASD can result from compromised sensorimotor integration in planning and control of movements. [ABSTRACT FROM AUTHOR]

Background. Family-centered care for preterm infants in Western societies has yielded short- to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies. Objective. The aim of this study was to examine whether a family-centered intervention program (FCIP) could improve the short-term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP). Design. This was a multicenter, single-blind, randomized controlled trial study. Setting. Three medical centers in northern and southern Taiwan were the locations for the study. Participants. The participants were 251 VLBW preterm infants without severe perinatal complications. Intervention. The infants were randomly assigned to receive the FCIP or the UCP during hospitalization. Measurements. Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group. Results. The FCIP promoted earlier full enteral feeding (β = -1.1 weeks; 95% CI = -1.9 to -0.2 weeks) and hospital discharge (β = -0.6 week; 95% CI = -1.1 to -0.1 weeks), greater weight gain (β = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (β = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants' neurobehavioral performance and weight gain (r = .20-.31; all Ps < .05). Limitations. The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions. Conclusions. Family-centered care facilitated short-term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through parental adherence to interventions. The designated strategies may be considered in a future launch of family-centered care in Taiwan. [ABSTRACT FROM AUTHOR]

Purpose:The study aimed to investigate comprehensively the determinants of the quality of life (QOL) of caregivers of children with cerebral palsy (CP) based on the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Methods:A total of 167 children with CP (mean age 9.06 years, SD 2.61 years) and their caregivers (mean age 40.24 years, SD 5.43 years) participated in this study. The QOL of caregivers was measured with the World Health Organization Quality of Life-BREF-Taiwan version (WHOQOL-BREF-TW). The potential determinants of QOL were collected, including child characteristics, caregiver characteristics, and environmental factors from all dimensions of the ICF-CY and analysed using multiple regression models. Results:Four multiple regression models revealed that determinants of the QOL of caregivers of children with CP was multidimensional, encompassing child characteristics (age, type of CP, fine motor impairment, other diseases, behaviour and emotions, visual impairment, hearing impairment), caregiver characteristics (general mental health, parenting stress, marital status, family coping patterns, and socio-economic status), and environmental factors (child’s medication, school setting, and current rehabilitation service, caregiver’s spouse’s age, family life impacts, and domestic helper). Conclusions:Knowledge of the determinants of QOL could serve as a guide in a holistic approach to evaluation and intervention and help plan interventions targeted at these determinants to improve the QOL of caregivers of children with CP.Implications for RehabilitationCaregivers of children with CP had lower QOL, except the environment QOL.The QOL determinants of caregivers of children with CP are multidimensional, including child characteristics, caregiver characteristics, and environmental factors.In addition to child characteristics of severity of fine motor impairments and emotional and behavioural problems, caregiver characteristics of general mental health, parenting stress, and coping patterns, and environmental factors of family life impacts, and school setting demonstrated important relationships with caregiver QOL. [ABSTRACT FROM PUBLISHER]

Objectives Hypertensive crisis is categorised into hypertensive urgency and hypertensive emergency. The present work aimed to determine the effect of different gradings of blood pressure (BP) ratios in predicting the severity of paediatric hypertensive crisis. Methods This was a retrospective case series, based in the paediatric emergency departments of the Changhua Christian Hospital and the Tzu-Chi General Hospital, Taiwan. From 1995 to 2010, the correlation between the severity of hypertension (HTN) and the difference in elevated systolic BP and 99th percentile plus 5 mm Hg (dSBP), the difference in elevated diastolic BP and 99th percentile plus 5 mm Hg (dDBP), dSBP ratio (dSBP/99th percentile plus 5 mm Hg) and dDBP ratio were analysed. A total of 110 children with a first attack of hypertensive crisis were recruited. Results Patients with hypertensive crisis caused by essential HTN had lower dDBP ratios than the other causes (p=0.033), while those with an oncological aetiology had the highest dSBP and dDBP ratios among all the aetiologies. For clinical presentations, patients with nausea/vomiting and visual impairment presented with higher dSBP ratios than those without the symptoms (both p<0.05), but patients with altered consciousness had higher dSBP and dDBP ratios than those who had clear consciousness (p<0.05). Children with hypertensive urgency had lower dSBP and dDBP ratios than those with hypertensive emergency (both p<0.05). Conclusions dDBP and dSBP ratios may serve as BP parameters in predicting the severity of paediatric hypertensive crisis. A dSBP ratio greater than 20% may indicate a critical point for severe hypertensive crisis in children. [ABSTRACT FROM AUTHOR]

• This study developed and tested a moderated mediation model. • Findings show P-O fit is positively related to voice, and perceived nature of the work is a mediator between these two variables. • Findings also show functional quality of the service moderates the direct effect of P-O fit on perceived nature of the work. • Functional quality of the service also moderates the indirect effect of P-O fit on voice via perceived nature of the work. This study developed and tested a moderated mediation model for examining the relationships among person-organization fit (P-O fit), employee voice, employees' perceived nature of the work and employees' perceived functional quality of their services. Using 265 frontline employees from several 3 star hotels in Taiwan, the analytical results show that P-O fit is positively related to employee voice, and that employees' perceived nature of the work mediates the positive relationship between these two variables. The analytical results also show that employees' perceived functional quality of their services moderates the direct effect of P-O fit on employees' perceived nature of the work, as well as the indirect effect of P-O fit on employee voice via employees' perceived nature of the work. Theoretical and practical implications for the hospitality literature and hotel practitioners are discussed herein. [ABSTRACT FROM AUTHOR]

Background: The Mullen Scales of Early Learning (MSEL) is a standardized comprehensive developmental assessment tool for children aged 0-68 months. However, few Asia-based studies have explored cultural and linguistic adaptations of the MSEL or investigated its psychometric properties in populations with autism spectrum disorder (ASD).Aims: This study evaluated the reliability and validity of the MSEL-Taiwan version (MSEL-T) for Taiwanese children with ASD, global developmental delay (GDD), and typical development (TD).Methods and Procedures: The MSEL items were translated and modified according to the language and culture in Taiwan. In total, 191 children (ASD, 69; GDD, 36; and TD, 86) aged 19-68 months were assessed using the MSEL-T and Peabody Developmental Motor Scales 2 (PDMS-2) at enrollment, followed by the assessments of Vineland Adaptive Behavior Scale-Chinese version (VABS-C) at the age of 36 months or later.Outcomes and Results: All subscales were verified to have good interrater reliability and internal consistency, and subscale scores indicated moderate to high correlations with PDMS-2 and VABS-C scores. Significant differences in MSEL-T scores were observed between same-aged pairs of children with TD and GDD and between pairs of children with TD and ASD.Conclusions and Implications: The findings provide evidence of validity and reliability of the MSEL-T. And it is suggested that the culturally and linguistically adapted MSEL-T is a good tool for the clinical assessment of children with and without ASD. [ABSTRACT FROM AUTHOR]

Introduction: Stroke can lead to life-long disability and constitutes a huge financial burden on the family and society. Stroke survivors with cognitive impairment often experience considerable challenges in the process of recovery and returning to society. Interventions that effectively help individuals resume essential daily activities and return to active participation in their communities are lacking. This study examines the efficacy of a newly-developed intervention programme, the Optimising Participation after Stroke through Strategy-training (OPASS) programme, for improving community participation among stroke survivors with cognitive impairment., Methods and Analysis: A single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding will be implemented to assess the efficacy of the OPASS programme. An expected 210 adults with cognitive impairment following stroke will be randomly assigned to either the experimental intervention (OPASS) group or the attention control group. In addition to their usual rehabilitation, both groups will receive 45 min sessions, twice weekly for a total of 12-15 sessions. The primary outcome is change in participation performance, which will be measured using the participation measure-three domains, four dimensions scale. Additional measures include the Activity Measure for Post-Acute Care generic outpatient short forms, Montreal Cognitive Assessment, Stroop Test, Trail Making Test and General Self-Efficacy Scale. These scales will be administered at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Their results will be analysed using multiple linear regression models and mixed-effects regression models. Further assessment of feasibility and acceptability of the intervention will be conducted through structured interviews with participants, caregivers and therapists. These interviews will be transcribed and thematically analysed., Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N201804055). The findings will be disseminated through presentations at scientific conferences and through publication in peer-reviewed journals., Trial Registration Number: NCT03792061; pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) is a two-stage screening scale for determining the risk of autism spectrum disorder (ASD) in toddlers. However, the validity of the M-CHAT-R/F for Asian populations has not yet been established., Aims: This study investigated the psychometric properties of the M-CHAT-R/F, Taiwan version (M-CHAT-R/F-T), among low- and high-risk Taiwanese toddlers aged 16-30 months. The associations among M-CHAT-R/F-T scores, developmental performance at 24 and 30 months, and ASD diagnosis prediction at 36 months were examined., Methods and Procedures: A two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprising 25 toddlers with ASD and 71 atypically developing (ATD) and 221 typically developing (TD) toddlers., Outcomes and Results: The M-CHAT-R/F-T exhibited acceptable internal consistency and test-retest reliability. The M-CHAT-R/F-T scores were significantly correlated with several syndrome scores of the Child Behavior Checklist for Ages 1.5-5 and were significantly higher among toddlers with ASD than among ATD or TD toddlers. Furthermore, M-CHAT-R/F-T scores were negatively correlated with developmental scores in the Mullen Scales of Early Learning at 24 and 30 months. Moreover, the screening exhibited acceptable predictive validity (sensitivity = 0.86; specificity = 0.96) for ASD diagnosis at 36 months., Conclusions and Implications: The findings indicate that the M-CHAT-R/F-T is a valid and reliable tool for the developmental screening of low- and high-risk Taiwanese toddlers in community and clinical settings., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Unlabelled: The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother-to-infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)- and hepatitis B e antigen-positive pregnant women with HBV DNA ≥7.5 log10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log10 IU/mL) from 30-32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log10 IU/mL, P < 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT (P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF-group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines., Conclusions: Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (Hepatology 2015;62:375-386., (© 2015 by the American Association for the Study of Liver Diseases.)

Purpose: Comprehensive description of functioning is important in providing early intervention services for infants with developmental delay/disabilities (DD). A code set of the International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY) could facilitate the practical use of the ICF-CY in team evaluation. The purpose of this study was to derive an ICF-CY code set for infants under three years of age with early delay and disabilities (EDD Code Set) for initial team evaluation., Methods: The EDD Code Set based on the ICF-CY was developed on the basis of a Delphi survey of international professionals experienced in implementing the ICF-CY and professionals in early intervention service system in Taiwan., Results: Twenty-five professionals completed the Delphi survey. A total of 82 ICF-CY second-level categories were identified for the EDD Code Set, including 28 categories from the domain Activities and Participation, 29 from body functions, 10 from body structures and 15 from environmental factors., Conclusions: The EDD Code Set of 82 ICF-CY categories could be useful in multidisciplinary team evaluations to describe functioning of infants younger than three years of age with DD, in a holistic manner. Future validation of the EDD Code Set and examination of its clinical utility are needed., Implications for Rehabilitation: The EDD Code Set with 82 essential ICF-CY categories could be useful in the initial team evaluation as a common language to describe functioning of infants less than three years of age with developmental delay/disabilities, with a more holistic view. The EDD Code Set including essential categories in activities and participation, body functions, body structures and environmental factors could be used to create a functional profile for each infant with special needs and to clarify the interaction of child and environment accounting for the child's functioning.

Objective: To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners., Patients and Methods: In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations., Results: Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU., Conclusion: Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction., (Copyright © 2011 Wiley-Liss, Inc.)