Disability In China Research Articles

The bidirectional relationship between sarcopenia and disability in China: a longitudinal study from CHARLS.

Sarcopenia and disability represent significant concerns impacting the health of older people. This study aimed to explore the bidirectional relationship between sarcopenia and disability in Chinese older people. This study recruited older people ≥60 years old from the China Health and Retirement Longitudinal Study. In phase I, the study analyzed the relation between disability and subsequent sarcopenia using multinomial logistic regression models. Conversely, in phase II, the study assessed whether sarcopenia was associated with future disability using binary logistic regression models. In phase I, 65 (16.80%) new cases of possible sarcopenia, 18 (4.65%) cases of sarcopenia, and 9 (2.33%) cases of severe sarcopenia were observed in the disabled older people and 282 (10.96%) new cases of possible sarcopenia, 97 (3.77%) cases of sarcopenia, 35 (1.36%) cases of severe sarcopenia were observed in the older people without disability. The OR (95% CI) for sarcopenia in older disabled individuals compared to those without disability was 1.61 (1.25-2.07). Adjusting for all covariates in 2011, the OR (95% CI) value for disabled individuals vs. those without disability was 1.35 (1.02-1.79). Subgroup analyses showed that disabled participants aged < 80 years were more likely to have sarcopenia (OR = 1.42, 95% CI: 1.07-1.89), and the risk of sarcopenia did not differ significantly between sex subgroups. In phase II, 114 cases (33.83%) in the possible sarcopenia patients, 85 cases (28.91%) in the sarcopenia patients, 23 cases (35.94%) in the severe sarcopenia patients, and 501 cases (16.10%) in the individuals without sarcopenia showed symptoms of disability. The OR (95% CI) for disability was 2.66 (2.08-3.40) in the possible sarcopenia patients, 2.12 (1.62-2.77) in the sarcopenia patients, and 2.92 (1.74-4.91) in the severe sarcopenia patients compared with the no sarcopenia patients. After adjusting for all covariates in 2011, the OR (95% CI) values were 2.21 (1.70-2.85) in the possible sarcopenia patients, 1.58 (1.14-2.19) in the sarcopenia patients, and 1.99 (1.14-3.49) in the severe sarcopenia patients, as compared to the older people without sarcopenia. Subgroup analyses showed that compared with men, women with possible sarcopenia had a higher risk of disability (OR = 2.80, 95% CI: 1.98-3.97). In addition, participants aged < 80 years with sarcopenia or severe sarcopenia s were more likely to have disability (OR = 2.13, 95% CI: 1.52-2.98; OR = 2.98, 95% CI: 1.60-5.54). The occurrence of disability increase the risk of sarcopenia in the older people, and baseline sarcopenia predicts the future disability in older people.

Implementation and Challenge of Supported Employment for People With Disabilities in China.

The Chinese government initiated a pilot program to implement supported employment for people with disabilities in 2014. Since then, policies have been enacted to promote supported employment. This study explored how practitioners understand and implement supported employment for people with disabilities in China. It was found that non-governmental service organizations have mainly implemented supported employment with financial support provided by local disabled persons' federations; without a governmental guide, the small-scale folk practice presented many difficulties and unstable factors. Results indicated that the Chinese government should actively establish and improve the supported employment system and further expand supported employment practices at the governmental level.

A randomized controlled trial of mindfulness-based intervention on individuals with physical disabilities in China

Individuals with physical disabilities (PD) face many quality of life challenges. In this study, a randomized controlled trial was conducted to investigate the impact of mindfulness-based intervention (MBI) on the psychological morbidity (indexed by depression and anxiety), emotional well-being (indexed by mindfulness and self-compassion), and health-related quality of life (QOL) among individuals with PD in China. A total of 512 participants with PD were randomly allocated to either the MBI group or the control group. Participants in the experimental group received an eight-week MBI in four sequential stages with different mindfulness meditation exercises. Results showed that participants who underwent MBI exhibited significantly fewer symptoms of depression and anxiety, elevated levels of mindfulness and self-compassion, and enhanced health-related QOL compared to those who did not receive the treatment after intervention. The study yielded promising results for using MBI in promoting the well-being of individuals with PD in China. Suggestions for future research are also highlighted.

Can co-production enhance professional public service provision? evidence from vocational training programme for people with disabilities in China

ABSTRACT Recent research on professional services has sought to pay nuanced attention to the relationship between professionalism and public service performance. At the same time, existing literature has examined the role of co-production in local public service delivery but has primarily remained theoretical and qualitative, calling for more empirical testing. Bridging these two different streams of literature, this article is the first to investigate how co-production affects the performance of China’s vocational training service for disabled persons. Using cross-sectional data from the 2018 national survey conducted by the China Disabled Persons’ Federation, our research shows that training institutions adopting a co-production approach are more likely to achieve higher employment rates (self-reported) among their trainees. Furthermore, multiple measures of professionalism are found to be positively associated with the employment outcomes of vocational training programmes. Implications for future research on professionalism and co-production in public service delivery are also discussed.

The Effect of a Family Member–Assisted Online Early Reading Intervention Program for Students With Intellectual Disability in China

Early reading skills are a prerequisite for children to acquire subsequent reading skills. Many online programs have been reported to be effective in improving students’ reading skills. However, there is limited evidence demonstrating the effectiveness of online early reading programs for students with intellectual disability (ID). Using a single-case multiple-probe across-participant design, the study examined whether a family member–assisted online early reading program could improve the early Chinese reading skills of students with ID. All three participants demonstrated significant treatment effects on early reading skills in response to the program. These acquired effects were generalized across settings and maintained in follow-up conditions for all participants. As such, this study extends the limited literature on the effectiveness of online programs to develop early reading skills in students with ID.

Study of the Construction of Sports and Health Service Platforms for the Disabled in China

With the rapid development of the economy, the living standards of Chinese people have generally improved. Consequently, sports facilities have been improved and the concept of sports has been redefined. The implementation of the national fitness program has stimulated the public’s interest in sports. However, the popularization and development of sports for the disabled still face a series of obstacles. To enhance the quality of disabled sports public services in China, safeguard the rights of individuals with disabilities, and foster societal harmony, this paper adopts a multifaceted approach. Drawing upon literature review and logical analysis, it aims to provide policy guidance, optimize service delivery, enhance supervision mechanisms, facilitate feedback mechanisms, and implement scientific management practices. Drawing from successful cases in the United States, this paper aims to address key challenges in the provision of sports public services for individuals with disabilities in China. By examining the service content offered by relevant platforms in the US, specific solutions are proposed to overcome existing shortcomings in China’s disabled sports public services. Additionally, the paper outlines a construction model for sports health service platforms catering to people with special needs.

How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay.

As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.

Do older adults with disability face home care poverty? Evidence from China

ABSTRACT Home care poverty is the inability of older people to access adequate home care services and their unmet needs for home care. With the increasing number of older adults (60 years old and above) with disability in China, the Chinese government pays more and more attention to home care. In this case, it is of great significance to explore whether older adults with the disability face home care poverty and its influencing factors. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 were utilized. SPSS 22.0 was used as a data analysis tool to conduct descriptive statistics and multiple logistic regression analysis on the sample (n = 1932). The study found that in 2018, 48.0% of older adults with disability faced home care poverty. Multiple logistic regression results showed that degree of disability, age, rural and non-eastern regions, income poverty, family caregiver, and reluctant caregivers were positive factors that increased the risk of home care poverty in disabled older adults (p < .05). But care duration, care expenditure, social pensions insurance, community daily life care and community medical services are the positive factors to eliminate the home care poverty for older adults with disability (p < .05). In order to solve the problem of home care poverty of older adults with disability, based on the research conclusions, the study proposed to establish a long-term care insurance system, formulate supportive policies for family caregivers or their families, and establish a wide variety of community care services.

Making sense of policy development of inclusive education for children with disabilities in China

Inclusion is integral to the education policy in countries across the world. In China, inclusion has been reaffirmed in recent policies as a priority in enhancing educational quality for disabled children. However, the growing scale of special schools and the increasing number of students enrolled seem to convey a conflicting message with inclusion. This paper critically examines the policy development from 1987 to 2023 concerning education for disabled children in China to make clearer sense of China’s inclusion agenda. The analysis highlights a policy vision where special schools are seen as key resources to enhance inclusive provisions and will continue to grow in scale in the short term as they transform to be an integral and inter-connected part within the wider education system rather than segregated settings, while Learning in Regular Classrooms and inclusion remain a primary objective and rationale underpinning the educational development for disabled children. This means a broader understanding of special education/schools in China is needed. The Chinese government has forged and embraced a unique, if not controversial approach that is adapted to suit the local contexts. This may set an example for the global community to explore localised strategies for inclusion to enhance education for all.

Teaching Individuals with Intellectual Disabilities in China: Strategies and Challenges

Teaching Individuals with Intellectual Disabilities in China: Strategies and Challenges

The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study

ObjectiveThe economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. MethodsThe total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. ResultsThe discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18–29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. ConclusionsASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.

An Evaluation of Online Training on Pre-service Special Education Teachers’ Case Application of Visual Schedules for Individuals With Intellectual and Developmental Disability in China

Multiple evidence-based practices (EBPs) were identified in education, but relatively little attention has been paid to implementation. Special education teachers in the Chinese mainland faced great challenges in terms of a lack of knowledge and skills regarding EBPs. Asynchronous online training has been successfully provided for pre-service professionals on instructional methods or strategies. The present study evaluated the effects of self-paced online training on pre-service special education teachers’ case application of visual schedules to support individuals with intellectual and developmental disabilities. A pre/post-test control group design was utilized. Seventy-seven undergraduate students (mean age 20.5 years) who majored in special education participated in this study. Results indicated that the self-paced online training was effective in improving pre-service special education teachers’ case application of the visual schedules strategy. In addition, participants were in agreement on the social acceptability of the online module of visual schedules. The results are discussed from a perspective of effective and socially valid online training, along with limitations and future implications.

Chronic Hepatitis B Virus Infection and Risk of Stroke Types: A Prospective Cohort Study of 500 000 Chinese Adults.

Stroke is a leading cause of mortality and permanent disability in China, with large and unexplained geographic variations in rates of different stroke types. Chronic hepatitis B virus infection is prevalent among Chinese adults and may play a role in stroke cause. The prospective China Kadoorie Biobank included >500 000 adults aged 30 to 79 years who were recruited from 10 (5 urban and 5 rural) geographically diverse areas of China from 2004 to 2008, with determination of hepatitis B surface antigen (HBsAg) positivity at baseline. During 11 years of follow-up, a total of 59 117 incident stroke cases occurred, including 11 318 intracerebral hemorrhage (ICH), 49 971 ischemic stroke, 995 subarachnoid hemorrhage, and 3036 other/unspecified stroke. Cox regression models were used to estimate adjusted hazard ratios (HRs) for risk of stroke types associated with HBsAg positivity. In a subset of 17 833 participants, liver enzymes and lipids levels were measured and compared by HBsAg status. Overall, 3.0% of participants were positive for HBsAg. HBsAg positivity was associated with an increased risk of ICH (adjusted HR, 1.29 [95% CI, 1.16-1.44]), similarly for fatal (n=5982; adjusted HR, 1.36 [95% CI, 1.16-1.59]) and nonfatal (n=5336; adjusted HR, 1.23 [95% CI, 1.06-1.44]) ICH. There were no significant associations of HBsAg positivity with risks of ischemic stroke (adjusted HR, 0.97 [95% CI, 0.92-1.03]), subarachnoid hemorrhage (adjusted HR, 0.87 [95% CI, 0.57-1.33]), or other/unspecified stroke (adjusted HR, 1.12 [95% CI, 0.89-1.42]). Compared with HBsAg-negative counterparts, HBsAg-positive individuals had lower lipid and albumin levels and higher liver enzyme levels. After adjustment for liver enzymes and albumin, the association with ICH from HBsAg positivity attenuated to 1.15 (0.90-1.48), suggesting possible mediation by abnormal liver function. Among Chinese adults, chronic hepatitis B virus infection is associated with an increased risk of ICH but not other stroke types, which may be mediated through liver dysfunction and altered lipid metabolism.

Collaboration of health and education sectors drives equity for children with complex disabilities in China.

Medical professionals often find it challenging to assess children having both complex disabilities and visual impairment, which may lead to excluding such children from educational programs and limiting their full participation in family and community activities. Identification and assessment of these children are essential to close this exclusion gap. A five-year project in Shanxi province, China, provided comprehensive training to eye health providers and educators as they learned to assess, identify, refer and serve children with visual impairments, both with and without complex disabilities. A team of teachers, vision and general healthcare providers worked to assess the vision of these children at schools, residential settings, and in homes throughout Shanxi. The project led to deep collaboration between Shanxi's health and education sectors, and established replicable precedents for policy and system changes toward the inclusion of children with complex disabilities and visual impairment.

Characteristics of hearing loss-associated gene mutations: A multi-center study of 119,606 neonates in Gannan.

HL is the second most common congenital disability in China, and its high incidence brings a serious burden of medical and educational sequelae. HL genetic screening enables the identification of individuals with inherited HL and carriers in a large scale. This study aimed to measure the detection rates of hearing loss (HL)-associated gene mutations in the Gannan population. The molecular etiology and risk factors of hereditary HL were also analyzed. In total, 119,606 newborns from 18 districts of Gannan were enrolled in this multi-center study conducted between April 2019 and April 2021. Otoacoustic Emission (OAE) was used for primary hearing screening 3 days after birth in quiet conditions, and OAE combined with automated auditory brainstem response (AABR) was applied 29-42 days after birth for those who failed or missed the initial screening. Meanwhile, high-throughput sequencing of hotspot HL-associated mutations in GJB2, GJB3, MTRNR1, and SLC26A4 were performed. Among the 119,606 newborns, 7796 (6.52%) failed the hearing screening. Genetic screening revealed that 5092 neonates (4.26%) carried HL-associated mutations. The detection rate of GJB2, SLC26A4, MTRNR1 and GJB3 mutations were 2.09%, 1.51%, 0.42% and 0.24%, respectively. The most prevalent variant was GJB2 c.235delC (1.74%). The second most prevalent variant was SLC26A4 c.919-2A>G (0.93%). The population who failed the hearing screening had a lower proportion (24.64%) of SLC26A4 gene variants compared to the population who passed (37.46%). Genetic screening identified 4612 (3.86%) carriers who were normal in hearing screenings. The concurrent hearing and genetic screening identified 480 (0.40%) neonates at high risk for hereditary HL. The results of this study suggest that the concurrent hearing screening and high-throughput genetic screening would greatly improve the effectiveness of newborn HL programs. This integration also facilitates the management of congenital HL, and aids in the prevention of aminoglycoside antibiotics-induced HL.

Research on the Protection of Rights and Interests of People with Disabilities in the Public Administration Process under the Perspective of Good Governance

As the process of building a harmonious society continues to advance, the problems of disadvantaged groups, including people with disabilities, have been highlighted in the process of public administration in China in recent years. This paper tries to focus on the defects in the current process of protecting the rights and interests of people with disabilities in China from the perspective of good governance and proposes effective ways to protect the rights and interests of people with disabilities from three dimensions: from the rule of man to the rule of law, from the power-based to the service based, and from the government-based to the society-based, in order to promote social and political stability and create a harmonious society with positive interaction.

Gender differences in caregiver attitudes and unmet needs for activities of daily living (ADL) assistance among older adults with disabilities

BackgroundWith a rapidly ageing population and a decline in the availability of family caregivers, the number of older adults with disabilities who have unmet long-term care needs is gradually increasing worldwide. However, whether there are gender differences in the association between primary caregivers or their attitudes and unmet needs for activities of daily living (ADL) assistance remains largely unknown.MethodsThis study used the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), containing the data of 1187 older adults with disabilities aged 65 and older, to identify gender differences in the attitudes of primary caregivers toward the unmet needs for ADL assistance among with disabilities adults in China. Binary logistic regression analysis was conducted to determine the effects of primary caregivers and their caregiving attitudes on the unmet care experiences of older adults with ADLs. In addition, a gender-stratified analysis was conducted to compare the differences based on older adults’ gender.ResultsThe results revealed that the lack of positive attitudes from primary caregivers might create a situation of unmet needs for ADL assistance among older adults. When family members carry the main burden of care, older adults with disabilities, especially older women, have a lower level of unmet needs for ADL assistance. Therefore, it is important to consider gender-specific interventions to improve ADL assistance among older adults.ConclusionsThe findings suggest that the presence of a family member as a caregiver has a significant effect on unmet needs for ADL assistance in women, highlighting the importance of developing an emotional bond with the caregiver. Given that the availability of informal caregivers, such as family members, is declining, it is crucial to provide financial assistance and formal services, such as paid home services and community-based care services, and reduce the burden on family caregivers to address the unmet needs for ADL assistance among older adults with disabilities in China.

The average life expectancy of persons with disabilities in China

The average life expectancy (ALE) of persons with disabilities (PWDs) is much shorter than that of the total population in many countries. However, there have been relatively few empirical studies on the ALE of PWDs in China. This study estimates the ALE and compiles the life tables of PWDs in China using data on 1,359,812 PWDs registered in the Special Surveys of Basic Services and Needs of the Disabled (SSBSND) in K Province in China from 2015 to 2017. The ALE of PWDs at age 20 is 45.2 years (95% CI: 44.7–45.8) for men and 48.1 years (95% CI: 47.6–48.6) for women, which is 15.0 years (men) and 16.5 years (women) lower than that of the entire population. The ALE of those with the most severe disability is only 33.7 years (95% CI: 32.2–45.1) for men and 37.1 years (95% CI: 35.3–38.8) for women. The ALE is relatively short for persons with intellectual and physical disabilities; moderate for those with hearing, speech, and mental disabilities; and relatively long for those with visual and multiple disabilities. Of the PWDs participating in basic old-age insurance (BOI), more than 30% do not live long enough to receive their pensions. As such, because a large proportion of PWDs die before 60 years old, social policies for PWDs should be specially designed.

Individualizing Instruction for Students With Intellectual and Developmental Disabilities in China: Teachers' Perceptions and Practices.

This study investigated Chinese special education teachers' perceptions and practices of individualizing instruction for students with intellectual and developmental disabilities (IDD). Semistructured interviews were conducted with 31 teachers who taught elementary Chinese language arts and math in six public special education schools for students with IDD in Shanghai. In addition, lesson plans written by 19 of the 31 teachers were collected. Thematic analysis revealed that teachers recognized the necessity of adapting instruction. However, practices and beliefs associated with one-size-fits-all approaches to teaching were prevalent. Although all teachers described making efforts to address individual differences, these efforts appeared to be inadequate. Teachers perceived fully addressing the needs of individual students as difficult and described challenges in four areas.

Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model

BackgroundPrevious studies have shown that middle-aged and elderly adults with disabilities are at higher risk for depressive symptoms. However, there are few studies on the long-term trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population. ObjectiveThis study aimed to identify the different development trajectories of depressive symptoms and their influencing factors in middle-aged and elderly people with disabilities in China. MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, a longitudinal cohort was formed for the study. A total of 2053 participants underwent at least two measures of depressive symptoms, assessed using the Center for Epidemiological Studies Depression Scale (CES-D10), a depression symptom assessment scale. We constructed a Group-Based Trajectory Model (GBTM) to identify the development trajectory of depressive symptoms in 2053 middle-aged and elderly disabled individuals, screened the potential predictors using lasso regression, and analyzed the factors affecting the development trajectory of depression through multivariate logistic regression. ResultsWe identified four depression symptom trajectories throughout the follow-up process: “low depressive symptom group”, “worsening depressive symptom group”, “relieved depressive symptom group”, and “high depressive symptom group”. We found that there were differences in basic characteristics among different subgroups of depression trajectory. However, middle-aged and elderly disabled women living in rural areas, with limited ADL or IADL, physical pain, poor self-reported health and self-reported memory, short sleep time, and no relatives and friends to take care of them were the key groups for the prevention and treatment of depressive symptoms. ConclusionThere is heterogeneity in the trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population, it is necessary to focus on the characteristics of the trajectories of different subgroups.