[Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]. / Description d'un projet pilote d'ergothérapie pédiatrique en milieux de garde et communautaires.

Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.

Description. Les interventions ergothérapiques en promotion et prévention de la santé et du bien-être des enfants visent à réduire les inégalités de santé et favoriser les facteurs de protection. But. Cette étude vise à décrire un projet pilote de service d'ergothérapie à base communautaire, pour les enfants d'âge préscolaire, en partenariat avec les organismes communautaires et les milieux de garde. Méthodologie. Une approche de recherche-action participative avec soutien d'un comité aviseur a été mis en place. Une ergothérapeute a offert des services d'ergothérapie communautaire selon un modèle d'organisation par paliers durant un an. Résultats. Les services étaient offerts selon trois paliers : 7 ateliers de sensibilisation pour parents et intervenants (palier 1), 57 visites et 27 consultations dans 8 organismes communautaires (palier 2) et 23 suivis individuels (palier 3). Conséquences. Il est possible d'implanter un service d'ergothérapie s"inspirant de la réadaptation à base communautaire avec les organismes communautaires offrant des services aux enfants de 5 et moins et les milieux de garde.

Patients' perceptions on active surveillance for the treatment of small renal masses.

BACKGROUND: Most patients diagnosed with a small renal mass (SRM) are treated with definitive treatments such as surgery or thermal ablation. Given that some SRMs are benign or have low metastatic potential, active surveillance seeks to reduce the overtreatment and the potential complications. Active surveillance is an alternative that is being increasingly considered. Active surveillance has already been shown to be effective, but there is a current knowledge gap regarding patients' perceptions of active surveillance and factors influencing their decision. OBJECTIVE: To describe patients' perceptions of active surveillance of SRMs and to identify factors influencing those perceptions. DESIGN, SETTING, AND PARTICIPANTS: This multicenter descriptive qualitative study recruited patients diagnosed with a renal mass from three institutions, using purposeful sampling. Data were collected using focus group discussions, which were recorded and transcribed. A mixed thematic analysis was performed. RESULTS: Six focus group discussions were conducted with a total of 24 participants. Participants perceived active surveillance as an option to avoid definitive treatments and their potential risks. Active surveillance was, however, perceived to be a temporary solution that would affect their chance of survival and their quality of life. Seven factors were documented as influencing patients' perceptions of active surveillance, the most important being their physician's recommendation. CONCLUSIONS: Perceptions of patients with SRMs toward active surveillance varies among individuals. The development of more patient-oriented information tools is needed to educate patients, to reduce physician influence on the decision-making process and to ensure that the patients' decision reflects their own values and preferences.

Enriching health-professional programs in global health: Development and implementation of an interdisciplinary and integrated approach.

BACKGROUND: Globalization results in a rapidly diversifying population, increased inequities, and more complex health problems affecting populations. This forces medical schools to integrate global health (GH) into the training of health-care professionals from curriculum development to practical learning activities, here and abroad. APPROACH: The approach aims at enriching existing programs in GH competencies in an interdisciplinary context. The goal is to ensure that all health-science students develop a certain level of GH competency. The main actions are the mobilization of key stakeholders, the development of a competency framework (CF) to perform gap analysis, tool formalization, and monitoring and evaluation activities. Subsequent to scoping review and stakeholder consultations, ten principles are identified and used to guide the enrichment process. RESULTS: Actual outputs cover a broad scope, from key decision-makers' support and endorsement to the formalization of tools and the consolidation and creation of activities such as service-learning activities, rotations among underserved populations, and training for international rotations. CONCLUSION: While this unique approach is proving to be a major challenge, the preliminary results are well worth the effort. The project's tangible impacts on health-sciences teaching, the GH competence of graduates, and care delivery are topics of interest for future investigation.

Hepatitis C in Intravenous Drug Users: Study of Obstacles and Facilitators to Access to Health Care and Services / Hépatite C chez les usagers de drogues par voie veineuse : exploration des barrières et des facilitants pour l'accès aux soins et services.

Objective: The study was designed to document the experiences of people affected by hepatitis C with respect to prevention, screening and treatment to more clearly understand the determinants of health trajectories and access to the health system.Methods: Based on an evaluative research, we conducted a thematic qualitative analysis of four focus group interviews with people affected by hepatitis C. Two interviews (n = 3) consisted of people at risk of contracting hepatitis C, the third interview (n = 6) concerned people diagnosed HCV positive but not treated and the fourth interview (n = 6) targeted people who had access to treatment (n = 6).Results: We identified the drivers, barriers and facilitating factors, trajectories of health and care of people affected by hepatitis C in two periods of life: from the injection to HCV screening and from HCV diagnosis to treatment. Life trajectories in relation to hepatitis C are the product of many influences: the personal life experience, the attitude of healthcare staff, the organization of the health system and contingent factors.Conclusion: Understanding the life experience of people affected by hepatitis C is essential to identify potential levers of change and new ways to organize the health system in order to more effectively reach these people.

Using an evidence-based online module to improve parents' ability to support their child with Developmental Coordination Disorder.

BACKGROUND: Developmental Coordination Disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents' awareness and building capacity but few interventions incorporating these best practices are documented. OBJECTIVE: To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their child's health condition. METHODS: A mixed-methods, before-after design guided by the Theory of Planned Behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate. RESULTS: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p < 0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents' behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parents' ability to implement these behavioral changes included clear recommendations, time, and 'right' attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole. CONCLUSIONS: The online module increased parents' self-reported knowledge and skills in DCD management. Future research should explore its impacts on children's long-term outcomes.

Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec.

BACKGROUND: The evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach. METHOD: Inspired by empowerment evaluation, the transformative-participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation. RESULTS: The knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.

[Contribution of public health to paediatric physical disability rehabilitation units]. / Contribution de la santé publique aux services de réadaptation pédiatriques en déficience physique.

AIMS: Approximately 4% of children in North America and Europe live with a chronic disability. Most countries have developed a range of specialized health services to meet the specific needs of these children. However, an increasing number of authors argue that more public health activities should be offered to children with disabilities in order to promote social participation and to ensure more efficient organization of these services. The objectives of this article are: 1) to describe the needs of children with physical disabilities that can be met bypublic health activities, 2) to present the Quebec health care system and discuss the inclusion of public health principles in paediatric rehabilitation services, and 3) to propose ways to improve integration of these principles. METHODS: The needs of children with disabilities are described according to categories of needs from the Life Needs Model: basic skills; applied skills; needs support, education and information for children, family and community. The patterns of paediatric rehabilitation services and service organization in Quebec were analysed. RESULTS AND CONCLUSION: Services for children with physical disabilities are primarily intended to develop basic and applied skills. The mandate of institutions delivering specialized services and waiting lists could limit the possibilities to provide services able to meet all of the needs of disabled children. Integration of public health activities would ensure greater complementarity and further promote social participation. Some approaches providing interesting avenues to further integrate public health in paediatric rehabilitation services are discussed.