Table2_Unmet environmental needs and unmet healthcare needs in a population of young adults with cerebral palsy: what the SPARCLE study tells us.docx

IntroductionOptimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling.MethodsYoung adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs.ResultsWe studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment.DiscussionOur results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.</p

Table1_Unmet environmental needs and unmet healthcare needs in a population of young adults with cerebral palsy: what the SPARCLE study tells us.docx

IntroductionOptimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling.MethodsYoung adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs.ResultsWe studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment.DiscussionOur results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.</p

Delivery outcomes following instrumental rotation.

<p>Delivery outcomes following instrumental rotation.</p

Prevalence (and 95% confidence interval) for 1,000 children aged 8 and born from 1995 to 2004, by six indicators based on census unit data.

<p>Census units were divided into tertiles of the 8-year-old population according to the distribution of each indicator in the general population. (A) Prevalence of all ASD (B) Prevalence of ASD without intellectual disability (IQ >70). (C) Prevalence of ASD with Intellectual Disability (IQ <70) (D) Prevalence of Severe Intellectual Disability (IQ <50) without ASD.</p

Prevalence risk ratios (and their 95% CI bars) of ASD and severe ID by the index of deprivation based on census block groups of residence divided into population quintiles (the first quintile being the least deprived and used as a baseline).

<p>Prevalence risk ratios (and their 95% CI bars) of ASD and severe ID by the index of deprivation based on census block groups of residence divided into population quintiles (the first quintile being the least deprived and used as a baseline).</p

Prevalence of ASD (with and without ID) and severe ID without associated ASD for 1,000 children aged 8 living in the surveillance area and born from 1995 to 2004.

<p>Prevalence of ASD (with and without ID) and severe ID without associated ASD for 1,000 children aged 8 living in the surveillance area and born from 1995 to 2004.</p

Cases Included in the Study and Prevalence of ASD (with and without ID) and Severe ID for 1,000 Eight-Year-Old Children Living in the Surveillance Area between 2003 and 2012.

<p>Denominator</p><p>^a = number of 8-year-old children living in the surveillance area between 2003 and 2012 (based on an estimation of the population with 2007 census data carried over to the 10 generations studied).</p><p>^b<i>p</i> = prevalence for 1,000 eight -year-old children living in the surveillance area.</p><p>^c 95% confidence interval.</p><p>Cases Included in the Study and Prevalence of ASD (with and without ID) and Severe ID for 1,000 Eight-Year-Old Children Living in the Surveillance Area between 2003 and 2012.</p

Prevalence Risk Ratio of ASD and Severe ID by Six Indicators based on Census Unit Data.

<p>^a n = number of cases in the census unit group defined by tertile of distribution of each indicator in the general population.</p><p>^b PRR = prevalence risk ratio.</p><p>Census units were divided into tertiles according to the distribution of each indicator, the first tertile being the least deprived and used as a baseline for the computing of risk ratios.</p

Frequency of unobserved items on ADS infant and mother subscales at discharge and 6 months.

<p>Frequency of unobserved items on ADS infant and mother subscales at discharge and 6 months.</p

Neonatal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.

<p>Neonatal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.</p