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The maternal perspective of the attachment relationship has been the focus of considerably less research in comparison to the volumes of studies conducted on infant attachment to mothers. A systema...

Objectifs : Offrir une thérapie par videoconference pour soulager la peur de la récidive du cancer (PRC) par l’entremise de la vidéoconférence. Déterminer la faisabilité et l’efficacité de ce traitement dans un contexte clinique. Matériel et méthodes : Thérapie par vidéoconférence cognitivoexistentielle une fois par semaine pour six semaines. Résultats : Diminution progressive de la PRC et de la détresse psychologique reliée au cancer. Satisfaction adequate de la vidéoconférence. Conclusion : L’utilisation de la vidéoconférence permettrait à un plus grand nombre de survivants de cancer d’être traités pour leur PRC.

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.

Cognitive-behavioral therapy (CBT) is effective for treating chronic pain, but little is known about the mechanisms that might facilitate or hinder its utility when delivered by videoconference. In...

In many societies, the iconic image of the family is that of a White, American middle-class, first-marriage nuclear family with two heterosexual parents and biological children. Research, however, ...

In recent years, there has been growing interest in studying coparenting across family structures. However, to date little is known about how women coparent with other women in stepfamilies. To bet...

This work constitutes a systematic review of the empirical literature about emotional facial expressions displayed in the context of family interaction. Searches of electronic databases from Januar...

This study fills an important gap in the motherhood literature by exploring the experience of maternal attachment in women mothering in stepfamilies, and how it relates to their sense of competence as a (step-)parent. Forty-three Canadian women living in stepfamilies completed a series of self-reported measures on their (step)maternal experience. Results enabled us to create a portrait of the maternal experience of women mothering in stepfamilies through measures of coparenting satisfaction, adult attachment style, sense of parenting competence, and the overall quality of the relationship with the children in their care; and to predict the quality of maternal relationship among 3 different mothering contexts (e.g., biological children born in current union, biological children born in a previous union, and stepchildren).

In Canada and in the United States, psychotherapy supervision has been defined as a core professional competency within mental health professions, and more specifically in clinical and counselling psychology (Canadian Psychological Association, 2002; Falender et al., 2004). However, how supervisors develop competencies in psychotherapy supervision remains an understudied area (Barker & Hunsley, 2013; Belleville & Viau-Quesnel, 2014; Watkins, 2012b). Given that (a) psychotherapy supervisors do not spontaneously acquire skills necessary for supervising effectively (Hoffman, 1994), (b) experience alone does not adequately prepare one to become a psychotherapy supervisor (Worthington, 2006), and (c) the development of specific competencies are necessary for the ethical and professional practice of psychotherapy supervision (Watkins, 2012b), it is crucial that we increase our understanding of "what makes for the effective teaching of effective supervision" (Hunsley & Barker, 2011, p. 144). This study aims to provide a critical assessment of the existing literature using a BES methodology to inform future research and the development of Canadian training and practice guidelines in this area.A Proposed Definition of Psychotherapy Supervisor DevelopmentOne of the major challenges in this area of research has been a lack of a clear conceptualisation of what psychotherapy supervisor development is and how it works. A definition is an important starting point for any assessment of the research literature by delineating the construct; that is, what constitutes psychotherapy supervisor development and what does not. Given that a systematic review tries to identify, appraise, select, and synthesize all high quality research evidence on a given research question, a sound definition provides a clear frame of reference to orient and anchor its execution. This is especially necessary in this case, because whereas there have been numerous reviews in the area of clinical/ psychotherapy supervision (at least 32 by the mid-90s) and more since then (Ellis, Ladany, Krengel, & Schult, 1996; Milne & James, 2000; Milne, Sheikh, Pattison, & Wilkinson, 2011), only a few have focused on psychotherapy supervisor development per se (see Barker & Hunsley, 2013). This distinction is crucial, because it is the difference between reporting on what works for delivery of clinical/psychotherapy versus how a supervisor becomes effective at delivering what works.To help us formulate a valid and useful definition for the construct of supervisor development, we are guided by Milne (2007), who noted four criteria necessary for a useful definition: (a) precision (e.g., it has an essential meaning that makes it distinct); (b) specificity (e.g., it defines a concept clearly and completely); (c) operationalization (e.g., it is stated in a form that permits measurement); and (d) corroboration (e.g., it receives adequate support from research). A reasonable starting point for formulating a definition of psychotherapy supervisor development was recently proposed by Watkins (2012a):The process of growth involved in being and becoming a psychotherapy supervisor, its unfolding and evolution over time; the factors (e.g., openness, defensiveness) that facilitate or fracture that growth process; the developmental issues (e.g., independence vs. dependence) that potentially affect and permeate that process; and the tailoring of supervisory interventions to match supervision of supervision needs. (p. 46)This definition represents a synthesis of Watkins' review of 30 years of literature on the subject of psychotherapy supervisor development and incorporates concepts from all four extant developmental models that describe how supervisors develop their skills and professional identities (Hess, 1987; Roenhauser, 1994; Stoltenberg & McNeill, 2009; Watkins, 2012a).However, when Milne's (2007) criteria are applied to Watkins' (2012a) definition of psychotherapy supervisor development, several gaps and limitations become apparent:(a) The process of growth involved in being and becoming a psychotherapy supervisor is not defined precisely in behavioural terms, that is, what is meant by growth and development? …

This study used longitudinal prospective data from a representative Canada-wide survey to assess the impact of childhood family experience on well-being during adolescence. First, we constructed family composition profiles to capture the number and type of changes in family structure that occurred in our sample over a 12-year period. Then, we examined links between initial family status, family composition profiles, timing of parental separation, and later behavioral outcomes during adolescence. Marital status at birth, as well as 2 different family transition profiles, were linked to externalized problems during adolescence. Timing of the first family transition suppressed the effect of family transition profiles on adolescent behavioral outcomes.

Is family structure a cue for stereotyping? Past reviews on the topic of stereotypes and parenthood are divided. To update the current understanding on this important question, this systematic review summarizes and integrates the body of literature published between 2003 and 2013 on stereotypes associated with married, divorced, single, step, same-sex and adoptive parents. Seventeen articles met all of the inclusion criteria. An analysis of the final sample of studies helps main trends pertaining to these six parental types to be identified. Findings revealed that motherhood and fatherhood continue to be conceptualized differently, with stereotypes associated with different types of fathers appearing more positive than those associated with different types of mothers. Married parents also appear to remain the parental type that is the most positively stereotyped and against which other types are compared. These results are compared to past meta-analytic reviews and implications for future research are pre...

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.

Whereas US-based data have contributed to our understanding of family composition changes over the last decades, data on Canadian families are limited, and previous studies have stressed the need for in depth, longitudinal investigations. This article begins to fill this gap in the literature by providing a current and detailed portrait of family composition changes from 1996 to 2008 (Study 1). Additionally, we performed an analysis of the role of specific child, parent and family characteristics, in interaction with family composition and family transition, in predicting pre-school children’s behavioral outcomes (Study 2). Using nationally-representative Canadian data collected from the National Longitudinal Survey of Children and Youth (NLSCY), we focus our inquiry on a mean sample for 0–5-year-olds of 2,866 children at cycle 8 (2008). Results show increases in non-traditional family households over time, as well as significant relationships between child characteristics, household characteristics, and family processes in predicting three behavioral outcomes: emotional problems, hyperactivity/impulsivity, and physical aggression.

PurposeDifficulties in defining stepfamily roles remain an important issue for its members. A potentially important factor in defining roles in the family is the identification with a particular gender type and how it relates to one's expectations about one's place in the family system. The purpose of this paper is to explore how gender typing processes inform our understanding of the stepmother role construction process, and its link with stepfamily adjustment.Design/methodology/approachSemi‐structured interview data from six androgynous and six feminine stepmothers were selected based on gender type identification.FindingsResults from this analysis were analyzed using a phenomenological approach, and are presented with the intent to explore how gender typing processes inform our understanding of the stepmother role construction process, and its link with stepfamily adjustment.Originality/valueGender typing has not been studied in the context of stepmother families, even though research on stepmothers’ adjustment has highlighted the ambiguous nature of their role in the stepfamily. Additionally, while qualitative inquiry continues to represent the favoured paradigm in the emerging area of stepmother research, studies of this type remain limited in scope.

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

This article presents additional data analyses from an earlier study on risk and resilience factors linked with adjustment in stepfamilies with adolescents. The primary objective addressed how individual and family-level factors impacted adjustment in a sample composed of 3 members (biological father, stepmother, and adolescent) from a subsample of 39 stepmother families. Multiple regression results showed that each stepmother family member's adjustment is affected by both shared and nonshared processes. Results also highlighted the role of triangulations and role ambiguity in the psychosocial adjustment of stepmother family members. This study was approved by the Ethics Bureau of the Faculty of Social Sciences of the Universite de Montreal, and was supported financially by graduate scholarships from the Fonds Quebecois de Recherche sur la Societe et la Culture, and the Conseil de Developpement de la Recherche sur la Famille du Quebec. The author wishes to thank the participants for their interest and col...

Both the Amiel-Tison Neurological Assessment at Term and the Amiel-Tison Neurological Assessment From Birth to 6 Years Old are based on the same conceptual framework and both can be used throughout childhood; however, interobserver reliability must be evaluated before these assessments can be introduced into neurodevelopmental follow-up. The aim of this study was to evaluate the interobserver reliability of both assessments. Infants between 29 and 37 weeks gestation were examined with the Amiel-Tison Neurological Assessment at Term (n = 33) and with the Amiel-Tison Neurological Assessment From Birth to 6 Years Old (n = 26). The infants were assessed by two examiners, one after and in the absence of the other. The kappa coefficient and percentage of agreement were calculated. The majority of items in both assessments showed an excellent reliability. The kappa coefficient for the final synthesis was also excellent in both cases. Future studies on the predictive validity of both assessments are required to determine their utility in predicting long-term neurodevelopmental outcome.

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.

To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life.Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases.Half of the sample waited more than 9.1 months (95% confidence interval: 6.5-16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p.05).Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.

Using data from three members (adolescent, stepparent and biological parent) of eighty (80) stepfamilies, the effects of individual, interpersonal and systemic factors in each member's psychosocial adjustment were examined. Using a risk and resilience framework, the primary objective addressed whether different factors would influence each type of stepfamily members' adjustment in similar or different ways. Multiple regression results showed that each stepfamily member's adjustment is affected by both factors shared by all three members, such as the quality of communication and the length of cohabitation, and factors unique to their position in the family, such as parent-child alliances, age and sex of respondent. Results also highlighted the role of reciprocity, contradiction and bi-directional effects in the psychosocial adjustment of stepfamily members.

Understanding the pattern of maturation of the fetal brain sets the stage for ultrasonographic documentation of neural development or damage. General movements and primary reflexes are the expression of spinal motor activity in the first half of pregnancy, but increasingly complex functions denote the switch over from initial spinal control to a higher control in the second half of the pregnancy. Both the Prechtl Neurologic Assessment and the Amiel-Tison Neurologic Assessment at Term have been used as the basis for proposed three- and four-dimensional ultrasonographic criteria of central nervous system optimality and fetal central nervous system compromise. The predictive value of such imaging is limited by its “hands-off” observation and the immaturity of the fetal brain, but the possibility of employing such advanced imaging holds great promise.

After completing this article, readers should be able to: 1. Explain why the difference between small for gestational age and intrauterine growth restriction is important for determining time of delivery. 2. Describe the potential developmental consequences of placental insufficiency. 3. Delineate the hypotheses underlying the association between prenatal stress and developmental outcome. Deprivation of supplies is the common pathogenic factor for fetuses experiencing placental insufficiency, even if all do not exhibit hypotrophy at birth or accelerated maturation as a response to stress. Nearly one century ago, placental insufficiency was remarkably described by the French obstetrician Pierre Budin: “They are tiny, puny infants with great vitality. Their movements are untiring and their crying lusty, for their organs are quite capable of performing their allotted functions. These infants will live, for although their weight is inferior … their sojourn in the womb was longer.” (1) Since then, normative growth curves and precise determination of gestational age (GA) have permitted consensual categorization of newborns, the last advance being the identification of an intrauterine growth restriction (IUGR) subgroup among the small-for-gestational age (SGA) group (10th percentile). (2) However, this categorization remains unsatisfactory when dealing with the very preterm group for several reasons, including unknown GA in many cases and inadequacy of the current growth curves in the low range of GA. Why is it so important to make a distinction between SGA and IUGR infants? First, the cause is different: genetic factors explain a large proportion of cases in SGA infants and epigenetic factors are involved in IUGR fetuses. This current conception is elegantly summarized by Fowden: “Normal fetal growth depends on an adequate supply of nutrients and on a strict temporal relationship between tissue accretion and differentiation. During early development, the pattern of intrauterine growth is largely determined by the fetal genome but, as size …

The purpose of this study was to evaluate the association between an abnormal aortic isthmus blood flow index and postnatal neurodevelopmental outcome in fetuses with placental circulatory insufficiency. STUDY DESIGN Forty-eight children who were born between 1991 and 1999 were included in this study on the basis of abnormal umbilical artery Doppler velocimetry. Prenatal isthmus blood flow index was obtained by dividing the sum of the systolic and diastolic Doppler blood flow velocity integrals by the systolic blood flow integrals. Neurodevelopmental outcome between 2 and 5 years was classified as optimal, when neurologic assessment and developmental quotient were within normal limits and as nonoptimal when abnormal neurologic findings and/or a nonoptimal developmental quotient was present. Neurodevelopmental outcome was analyzed in relation to isthmus flow index and pulsatility indices in the umbilical artery.The mean gestational age at delivery was 33.0 +/- 2 weeks. Nonoptimal neurodevelopmental outcome was found in 60.4% of the children (29/48). An inverse correlation was found between the isthmus blood flow index and postnatal neurodevelopmental outcome. All 13 children with an isthmus blood flow index of0.5 were in the nonoptimal group. All 19 children with an optimal outcome had an isthmus blood flow index of0.5, but this was also the case for 16 other children with nonoptimal neurodevelopmental outcome. An isthmus blood flow index cut-off value of 0.70 was associated with the highest overall positive and negative predictive values. The pulsatility index in the umbilical artery did not provide any significant contribution in the explanation of the outcome.The isthmic blood flow index can help to identify a subgroup of fetuses with placental circulatory insufficiency that might benefit from early delivery.

The eligibility criteria currently used for neurodevelopmental follow-up are traditionally based on perinatal events and characteristics of the infants at birth. However, they seem unsatisfactory to target efficiently all children who will manifest long-term neurologic sequelae and eventually require rehabilitation services. The updated version of the Amiel-Tison's Neurological Assessment At Term (ATNAAT) is expected to allow a better prediction of the neurodevelopmental outcome in high-risk infants. The main objective of the present study, which was performed on 35 infants, was to analyze the interobserver reliability of the updated version of ATNAAT. The evaluator and the observer coded the items of the test simultaneously. Among the 35 items tested, 16 demonstrated an excellent reliability based on the kappa coefficient, 11 items yielded a fair to good reliability, whereas only two items produced an agreement below 0.40. The final synthesis, which was a global appreciation of the neurologic status based on the different findings, yielded a good reliability with a kappa coefficient of 0.76. Among the infants who had a nonoptimal outcome from the assessment, only 38.5% met the traditional criteria currently used for follow-up. It would be important to conduct further research on predictive validity to demonstrate the capacity of the ATNAAT to forecast the long-term neurologic outcome of infants at risk.

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.

This research presents the findings from an evaluation and organizational development initiative that was requested by a Canadian youth agency working in a large urban setting. A team of four researchers affiliated with the Center for Research on Educational and Community Services (CRECS) at the University of Ottawa conducted the evaluation. The purpose of the evaluation was to identify the supervision needs and challenges of coordinators and front line staff, assess the efficiency of the current supervision practices, and evaluate the supervisors’ and supervisees’ satisfaction with these current practices. A literature review was performed to help provide a clear definition of ‘supervision’ and the different professional roles it encompasses. Additionally, research evidence pertaining both to what contributes to supervision efficacy and supervisor competency was reviewed to distill the most robust findings in the existing literature. The lines of evidence consisted of a document and file review, an online employee survey, group discussions (i.e. focus groups), and interviews with key informants. The results of the evaluation helped the research team formulate recommendations to the agency for the development of enhanced supervision practices across its various service areas.

Objective: To compare ease of recording and reliability of ultrasonographic approaches used to time fetal heart atrial and ventricular contractions. Methods: Seventeen consecutive fetuses seen at our fetal cardiology unit for possible fetal cardiac arrhythmia were included in this study. The same ultrasonographer obtained M-mode tracings of atrial and ventricular free walls, atrial wall and opening of the aortic valves, a peak of the mitral valve, and the opening of the aortic valves; and Doppler signals of flow-velocity waveforms in the outflow tract of the left ventricle and simultaneous flow-velocity waveforms in the aorta and superior vena cava. The outcome measures were rate of successful attempts and intra- and interobserver reliability coefficients. Results: Valid recordings were made for all patients with one M-mode (atrial and ventricular free walls) and two Doppler (intraventricular, superior vena cava, and ascending aorta) approaches. Atrioventricular intervals were significantly longer with M-mode compared with Doppler ultrasonography. Reliability coefficients were excellent (at least 0.89) for all intraobserver measurements. Comparisons of atrioventricular and ventriculoatrial interval measurements made by two observers gave the following intraclass correlation coefficients (95% confidence interval): atrioventricular = M-mode: 0.87 (0.79, 0.91), left ventricular outflow: 0.93 (0.89, 0.96), superior vena cava–aorta: 0.98 (0.97, 0.99); ventriculoatrial = M-mode: 0.79 (0.67, 0.87), left ventricular outflow: 0.97 (0.95, 0.98); superior vena cava–aorta: 0.99 (0.98, 0.99). Conclusion: Fetal atrioventricular intervals measured indirectly from M-mode or Doppler tracings were equally reliable when measured by the same observer; the Doppler approaches had better correlation between measurements made by two different observers.

Les ergothérapeutes évaluent de plus en plus tôt les capacités des nourrissons. La vigilance très variable de ces derniers influence inévitablement l'expression de leurs comportements. Pour contrer l'effet de cette instabilité, Grenier (1985) propose l'état libéré qui permet d'optimiser la qualité d'attention du nourrisson. Le but de l'étude était d'identifier les comportements distinguant cet état libéré de l'état d'alerte (état 4) décrit par Brazelton (1973). Certains paramètres définis dans le modèle de l'organisation synactive du développement de Als (1982) ont été retenus pour répertorier les comportements des nourrissons dans les deux états de vigilance. L'âge moyen au moment de l'observation était de 62 heures. La durée de cette observation des comportements était de 5 minutes. Parmi les 54 nouveau-nés à terme évalués, 21 ont pu être observés dans les 2 états de vigilance à l'étude; 33 ont été évalués dans un seul état. Les résultats confirment la stabilité supérieure de l'état libéré. Les comportements de stress, d'auto-régulation et les besoins de régulation externe sont moins fréquents dans cet état; ces différences sont statistiquement significatives (p

Dans le Modèle ludique (Ferland, 1994a), le jeu est perçu comme la voie privilégiée pour développer la capacité d'agir de l'enfant avec déficience physique, concept qui présente des liens avec celui de la capacité fonctionnelle. Afin d'analyser les relations existant entre le comportement ludique de l'enfant (intérêt, action et attitude de jeu) et sa capacité fonctionnelle, une étude de type exploratoire fut menée auprès de 30 enfants d'âge préscolaire ayant une déficience motrice cérébrale. L'Évaluation du comportement ludique (Ferland, 1994b) et le Pediatric Evaluation of Disability Inventory (Haley, Coster, Ludlow, Haltiwanger & Andrellos, 1992) ont été utilisés. Les résultats indiquent, entre autres, que les relations entre les deux concepts étudiés sont principalement établies par les capacités ludiques. L'intérêt et l'attitude ludiques s'avèrent, pour leur part, des dimensions disctinctes et complémentaires.

BACKGROUND: Although preterm infants born at 29 to 36 gestational weeks (GW) are at risk for developmental delay, they do not always benefit from systematic follow-up. Primary care physicians are then responsible for their developmental surveillance and need effective screening tests. This study aimed to determine whether the Ages and Stages Questionnaires (ASQ) at 12 and 24 months’ corrected age (CA) identify developmental delay in preterm infants. METHODS: With a cross-sectional design involving 2 observations at 12 and 24 months’ CA, 124 and 112 preterm infants were assessed. Infants were born between May 2004 and April 2006 at 29 to 36 GW. The ASQ and the Bayley Scales of Infant Development were used. Concurrent validity was calculated by using κ coefficient, sensitivity, and specificity. RESULTS: At 12 months’ CA, the ASQ did not perform well in identifying infants with mental delay (κ = 0.08–0.19; sensitivity = 0.20–0.60; specificity = 0.68–0.88). Agreement (κ = 0.28–0.44) and specificity (0.90–0.97) were better for the psychomotor scale, but the sensitivity remained insufficient (0.25–0.52). At 24 months, the ASQ had good sensitivity (0.75–0.92) and specificity (0.55–0.78) for detecting mental delays (κ = 0.45). Results remained unsatisfactory for detecting motor delays (sensitivity = 0.31–0.50; specificity = 0.73–0.92). CONCLUSIONS: Preterm infants with developmental delays at 12 months’ CA are not adequately identified with the ASQ. At 24 months’ CA, the ASQ identifies mental delays but not psychomotor delays. Additional measures should be used to increase yield of detecting at-risk preterm infants.