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Background Child development is influenced by the psychosocial environment. As part of developmental surveillance, identifying psychosocial risk factors that could hinder optimal development is therefore important. However, whether parents consider this type of question pertinent and acceptable remains unknown. Objectives To examine parental perception regarding the acceptability of asking questions about psychosocial background as part of a standardized developmental surveillance questionnaire. Design/Methods Using an online questionnaire and a snowball sampling approach, we surveyed parents living with at least one child Results Of 1651 participants, 97% were mothers and 93% declared having a post-secondary degree. Median age was 34 years old (interquartile range 31-38). An overwhelming majority found acceptable the questions about concerns regarding their child development (99%) and family history of developmental problems (95%). Psychosocial indicators were considered acceptable in the following proportions: substance abuse (84%), food insecurity (77%), past maternal history of depression (74%), and education level (65%). Higher rates of acceptability correlated with higher educational levels. Main themes that emerged regarding unacceptability were as follows: questions being offensive or intrusive, questions not relevant to child development, improper physical environment to ask such questions and lack of relationship with the health care professional in charge. Conclusion As part of developmental surveillance, questions on psychosocial risk factors can be disturbing to parents and must be addressed in a trusting environment and with a sensitive manner.

Background: Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. Objective: This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. Methods: A total of 107 infants born at

BACKGROUND Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. OBJECTIVE This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. METHODS A total of 107 infants born at RESULTS The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. CONCLUSIONS Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.

Classrooms have consistently grown larger in the last decade, and moving higher education from an elite model to one of near universal participation has resulted in more diversity in the student body. While several teaching techniques have been developed to address these challenges, other initiatives have centred on the manner in which classroom assessment is conducted, and how it can stimulate student learning and improve real inclusiveness, despite students’ varied backgrounds and special needs. Differentiated evaluation describes the impact of pedagogical differentiation on the evaluation process. It offers all students choices regarding evaluation that are deemed equivalent and fair. While it has most often been used at the primary and secondary school levels, it stands as a valid strategy to be used at the undergraduate level, where we are observing growing diversity within the student body. Maintaining teaching and learning quality in large-sized classes has become a real challenge for university programmes. Classrooms have consistently grown larger, and moving higher education from an elite model to one of near universal participation has resulted in more diversity in the student body. Instruction in large classes has also been linked with a variety of negative effects on student learning. Of note, it has been shown to reduce students’ level of active involvement in the learning process, as well as the frequency and quality of instructor interaction with and feedback to students, and students’ motivation and cognitive skills inside the classroom (Cuseo, 2007; Iaria & Hubball, 2008; Teaching and Educational Development Institute, 2003). These findings have implications for student success, as student engagement has been strongly correlated with academic achievement, critical thinking, and student persistence (Pacarella & Terenzini, 1991; Tinto, 1993). In response to these findings, assessment reform represents a current effort to raise standards and improve the quality of university education here in Canada and abroad. Such initiatives are grounded in the idea that assessment has the potential not only to evaluate but also to promote learning (Hayaman, 1995). In fact, some research suggests that learning tends to consolidate as the information is processed through a growing number of channels (e.g., reading the content, having to explain the content to someone else, applying the content to a specific problem) (Sousa, 2002). Some examples of innovations in this area can be found in the growing number of programmes focusing on experiential learning and/or work-integrated learning (or cooperative education, internships, work placements, and apprenticeships), because they offer the chance for students to apply what they learn in class to real-life situations, and they also enhance the competitiveness of recent graduates (Fisher, Rubenson, Jones, & Shanahan, 2009). The use of these methods, however, varies greatly among disciplines. In Canada, assessment reform represents a particular challenge for a number of fields, because larger classrooms have led to the generalisation of the use of multiple-choice tests as the preferred means of assessment in both first- and upper-year undergraduate courses. Multiple-choice

As early as possible, neonatologists try to identify neonates at risk of unfavorable neurodevelopmental outcomes. They are fairly reliable in predicting very poor outcomes as well as optimal outcomes. However, within these two extremes, the prediction still remains a challenge. Immaturity of the neonatal brain constitutes a limit in itself. During decades with the growing knowledge of brain development, many methods have been developed for neurological assessment of the neonate. Neither of them applied alone was perfect in terms of clinical applicability, sensitivity, reproducibility and specificity. The motor function is the first to provide the clinician with clues. Higher functions, in particular language and other cognitive functions, will develop later. However, recent researchers give credit to the brainstem for controlling exceedingly rudimentary learning-related cognitive-like activity. At present, the anticipation of late emerging developmental disabilities remains difficult even though early motor dysfunction has repeatedly been associated with a higher risk of intellectual or other learning disabilities. Despite our modest recent contribution to the domain of prediction, further studies on welldefined high risk populations with rigorous methodology that aim to demonstrate these links are still needed. Besides neurological observations, research is in process of including behavioral and stress/ reactivity measures; feasibility and benefits have to be demonstrated. At present, fetal neurology is supported by neonatal neurology. Obstetricians are wise enough to take from both methods described above the elements they are able to transpose to fetal life. A comparative table of neonatal and fetal assessment is to be found elsewhere. As for neonatal neurology, the future of fetal neurology will have to rely on short- and long-term follow-up studies to define the predictive value of the chosen items. Obstetricians will have to be as patient as pediatricians, to work, step by step, towards defining optimality and impairment. They will have to be very careful when deciding to interrupt pregnancies; at the time being, such decisions are restricted to cases of very severe impairment. In line with the spectrum described above, they can expect to find more cases with moderate to mild abnormalities than cases with severe ones. However the most pleasant aspect for the echographer is to check fetal optimality. Just as a newborn infant categorized as at risk of brain damage is competent enough to demonstrate CNS integrity from birth, a high risk fetus will soon be competent enough to demonstrate CNS integrity before birth.

Objective During fetal life, the parallel position of the two cardiac ventricles confers a special status to the aortic isthmus. Flow through the isthmus reflects the balance between the performances of the two ventricles and their respective peripheral impedances. This study proposes a fetal aortic isthmus flow velocity index and its reference values defined on the basis of gestational age (GA). Methods Video recordings of 111 normal fetuses from 18 to 39 weeks of gestation were retrospectively reviewed. An isthmus flow velocity index (IFI) was calculated as follows: IFI = (systolic + diastolic)/systolic velocity integrals. GA-specific reference ranges of IFI were constructed. Results An IFI of 1.33 ± 0.03 was found at 18 weeks. This value decreased slightly but steadily with GA to reach 1.23 ± 0.16 at 39 weeks. This change is mainly related to a decrease in diastolic velocity integrals. Conclusion The proposed IFI provides information on the direction and, indirectly, on the volume of blood flow through the fetal aortic isthmus. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives Placental circulatory insufficiency, expressed by the disappearance of the diastolic component of the umbilical artery Doppler velocity waveforms, causes blood flow redistribution that could disturb, to different extents, the systemic venous returns to the heart. The purpose of this study was to investigate the effect of an absence of diastolic blood flow in the umbilical artery on the relationship between the Doppler flow velocities of the venae cavae. Methods Fifteen normal fetuses (normal group) were matched for gestational age with 11 fetuses with absent diastolic flow in the umbilical artery (abnormal group). In the venae cavae, the following Doppler variables were measured and compared between groups: (a) during ventricular systole: maximum (Smax) and minimum velocities (Smin) and velocity integrals (SI); (b) during ventricular diastole: peak velocity of the E-wave and its integral (EI), the A-wave and its integral (AI). A venous velocity index (VVI) was defined as (Smax + Smin)/Smax. Results In the normal group, Smin and VVI were significantly higher in the inferior vena cava (IVC) than in the superior vena cava (SVC). The ratio SVC-VVI/IVCVVI was therefore always less than one. In the abnormal group, Smin, SI, E, EI and VVI were higher in the SVC compared to those of the IVC. The ratio SVC-VVI/IVCVVI was always greater than one. Conclusion In the absence of umbilical artery diastolic flow, a reciprocal shift is observed between the IVC and SVC velocity waveforms characterized by a flow profile in the IVC which resembles that of a normal SVC profile and vice versa. These changes are another manifestationof bloodflowredistributiontowardsthebraininthepresence of placental circulatory insufficiency. They should be taken into account on Doppler assessment of ventricular diastolic function based on venous flow patterns during placental circulatory impairment. Copyright  2002 ISUOG. Published by John Wiley & Sons, Ltd.

Health services research regarding the needs, delivery and utilization of paediatric rehabilitation is an emerging field of interest, given the increase in infant survival and subsequent growing focus on childhood disabilities (Perrin 2002; Halfon et al. 2004; Msall et al. 1998; Majnemer et al. 2002; Limperopoulos et al. 2001). Childhood disability has a substantial impact on the healthcare system, as children who have restrictions in activities are high users of healthcare services, particularly rehabilitation (Newacheck and Halfon 1998). Early identification of children with physical and developmental disabilities is crucial to ensure that appropriate interventions are provided as soon as possible to allow children to develop their full potential, maximize their level of function and prevent further disabilities (L’Office des personnes handicapees du Quebec 1992; Michaud and Committee on Children with Disabilities 2004; Halfon et al. 2004; Majnemer 1998; Majnemer et al. 2002; Feldman et al. 2002; Simpson et al. 2003; American Academy of Pediatrics 1996). Conversely, barriers limiting accessibility to rehabilitation services (e.g., long waiting times) could significantly compromise a child’s functional and health status. In Quebec, services were reformed in the early 1990s to better meet the needs of families of children with disabilities. The intent was to implement comprehensive coordinated services within the community (Office des personnes handicapees du Quebec 1992; Regie regionale de la sante et des services sociaux de Montreal-Centre 1998; Ordre des physiotherapeutes du Quebec 1996). Paediatric outpatient rehabilitation services for children under 6 years of age were no longer provided at acute care paediatric hospitals; children requiring these services were referred to specialized paediatric rehabilitation centres. This situation created accessibility problems (Regie regionale de la sante et des services sociaux de Montreal-Centre 1998; Institut de readaptation en deficience physique de Quebec 2002). Problems with accessibility to paediatric rehabilitation services are not limited to Quebec residents (Fox et al. 1993; Majnemer et al. 2002; Feldman et al. 2002; Simpson et al. 2003). Some of the factors associated with accessibility to these services have been identified. Younger children typically receive rehabilitation services before older children (Majnemer et al. 2002; Bailey et al. 2004; Feldman et al. 2002; CanChild 2000). Very young children referred to rehabilitation are more likely to have an identifiable pathologic condition (e.g., genetic syndrome, seizure disorder) or risk condition such as prematurity. Older children are more likely to be referred for problems related to developmental delay (Bailey et al. 2004). Severity of the disability may be another factor influencing accessibility. For example, children may be denied access to rehabilitation services provided by Health Maintenance Organizations (HMOs) if the child cannot improve significantly over a short period of time, which is often the case for children with severe disabilities (Fox et al. 1993). In other cases, the more severe a physician perceives a child’s disability, the more likely it is that the child will be referred to physical therapy (Campbell et al. 1995). Diagnosis may also influence referral times to rehabilitation. Because paediatricians appear to be reluctant to refer children with developmental delays or less severe disabilities to early intervention services (Bailey et al. 2004), it is unclear whether severity enhances or impedes access to rehabilitation. Socio-economic status (SES) may also influence access to rehabilitation. Parental knowledge of child development has been linked with higher parental educational level (McCune et al. 1984), implying that those who are knowledgeable may recognize problems earlier, perhaps leading to earlier rehabilitation. In addition, it is well established that lower family SES has been associated with higher incidence and severity of disability in children (Simpson et al. 2003; Msall et al. 1998; Perrin 2002). Two studies have explored service delivery (by measuring waiting times or service utilization patterns) for paediatric rehabilitation services in Montreal. These studies used a cross-sectional design and were limited to only one of two paediatric tertiary care hospitals (Feldman et al. 2002; Majnemer et al. 2002). Feldman et al. (2002) included school-aged children using resources allocated by the school system as opposed to rehabilitation centre, while the study by Majnemer et al. (2002) included children with pervasive developmental delay (autistic spectrum disorders) receiving services at centres specialized in treating intellectual disability. Neither study measured disability in a consistent or standardized fashion. The current study was designed to address some of the limitations of previous studies. We followed a prospective cohort of preschool-age children with physical disabilities recruited from both tertiary care paediatric hospitals in Montreal and measured their performance with a well-accepted functional measure. The objectives of this study were to describe waiting time to receive physical therapy (PT) or occupational therapy (OT) services at rehabilitation centres for preschool-aged children with physical disabilities, and to examine the factors associated with waiting time, including the child’s age and the diagnosis and severity of the physical disability. We hypothesized that access time to rehabilitation was longer for younger children within specific diagnostic groups and for those with more severe disabilities.

Objective To describe when and by whom concern is first expressed for children referred to rehabilitation because of neuromotor problems. Study Design and Setting We conducted a survey of parents of 92 children (aged 0-6 years) who were on the waiting list for physical or occupational therapy services at rehabilitation centers in Montreal, Quebec. We compared age of child at initial concern with who first expressed concern for children who were considered at risk due to their perinatal history of prematurity and those who were not born prematurely but were later diagnosed as having neuromotor problems. Intervention Parents were interviewed regarding their child’s medical history and utilization of health care services. Results Parents were concerned later than physicians were regarding their child’s development (mean difference, 8.2 months; 95% confidence interval [CI], 3.7-12.6 months). There was no significant difference in time of recognition of problems between the premature (10.2 months) and full-term (11.9 months) groups. Even after controlling for risk group, parental concern occurred later than physician concern (β coefficient, 7.3; 95% CI, 2.5-12.2). The child’s age at the time of initial concern was associated with the child’s age at referral to rehabilitation (β coefficient, 0.04; 95% CI, 0.01-0.06). Conclusions Early recognition is important if a child is to benefit from early rehabilitation. It may be important to improve primary care screening of children for neuromotor problems and to increase parental awareness regarding normal motor development of their children. Prompt, simultaneous referral to medical evaluation and rehabilitation resources may decrease delays in rehabilitation.

The most dramatic increase in brain volume occurs in the last three months of fetal life and the first two years after birth. Concomitantly, the skull follows the volumetric increase in the cerebral hemispheres mostly by passive adaptation. The relationship between head and brain growth explains why the classical neurological assessment in infancy universally includes measurement of head circumference (HC). However, this crude information derived from HC measurement remains insufficient to qualify brain growth. One way to better document the relation between brain and skull could be to rely on the correlation between HC and body growth parameters, given a general agreement on the definition of proportionate and disproportionate head–body growth. Significant information with respect to the integrity of the underlying cerebral hemispheres can also be provided by systematic palpation of the main cranial sutures. In particular, the distension or overlapping of the squamous sutures which are strategically located at the junction of the cranial vault and the cranial base could be a valid marker of brain growth disorder.

La présente étude vise à témoigner de l’expérience de mères monoparentales québécoises vivant dans un contexte défavorisé en employant la méthode participative Photovoice. Six mères monoparentales ont participé à ce projet de recherche. L’approche phénoménologique sert de cadre théorique et oriente l’analyse des données, effectuée à l’aide de NVivo10. Les résultats permettent d’identifier trois thèmes principaux reflétant le vécu des participantes. Les résultats de cette étude formeront la base d’un outil de psychoéducation et de sensibilisation centré sur les enjeux des foyers monoparentaux matricentriques et destiné aux jeunes et leurs familles., The current study looks at the experience of Quebec single mothers living in a disadvantaged context by using Photovoice, a participatory approach. Six single mothers participated in this research project. The phenomenological approach provides a theoretical framework and orients the data analysis, using NVivo10. The results reveal three main themes that reflect our participants’ maternal experience. Results from this study will help develop a psychoeducational tool as well as an awareness campaign on issues experienced by singles mother households and intended for youth and their families.

Cet article1 présente l’ensemble de la démarche qui a donné lieu à la mise en ligne d’un programme éducatif visant l’enrichissement des relations conjugales et familiales des adultes qui vivent une recomposition familiale. Des recensions des écrits portant à la fois sur les défis vécus par les couples-parents de familles recomposées et les programmes de prévention offerts à cette population ont été réalisées. Les conclusions tirées de ces recensions constituent les fondements du programme d’éducation en ligne La famille recomposée : une équipe à bâtir qui est brièvement décrit dans cet article., This article presents the process that led to the development and implementation of an online education program which aims to help stepfamily couples enrich their relationship as well as the relations in their stepfamily. Reviews of the literature on both the challenges faced by stepfamily couples and parents, and the prevention programs offered to this population, were conducted. The conclusions drawn from these reviews form the basis of the online education program The stepfamily: A team to build which is briefly described in this article.