Soutien au réseau des services de garde montréalais dans la prévention et la gestion de la COVID-19 : un service à 3 pôles.

SETTING: From April 2020, in sight of child care reopening, the Direction régionale de santé publique de Montréal (DRSPM) conducted a situational analysis with its child care (CC) partners in order to learn about the challenges they envisioned in their role in preventing and managing COVID-19. The CC partners requested access to preferred public health support. INTERVENTION: The DRSPM established a service consisting of three components: (1) telephone support available 6 to 7 days/week for CC managers facing a COVID-19 situation; (2) a regional committee combining four Montreal representatives of CC associations and one from the Ministère de la Famille; (3) prevention brigades formed by front-line health workers from the Centres intégrés universitaires de santé et de services sociaux (CIUSSS). OUTCOMES: This health promotion intervention (1) enabled CC services to handle the pandemic with better capability and confidence through facilitating access to accurate and positive information; (2) supported the commitment and collaboration of CC services by acting as a mediator between them and decision-makers; and (3) responded to the psychosocial needs of community members. IMPLICATIONS: This service helped to adjust public policy and promote community resilience by raising awareness of the importance of balancing COVID-19 prevention and the collateral impacts of the pandemic.

RéSUMé: LIEU: Dès avril 2020, la Direction régionale de santé publique de Montréal (DRSPM) a réalisé un état de situation avec ses partenaires du réseau des services de garde (SDG) pour prendre connaissance des défis envisagés dans leur rôle de prévention et de gestion de la COVID-19 lors de la réouverture des SDG. Les SDG ont demandé d'avoir accès à un soutien privilégié de la santé publique. INTERVENTION: La DRSPM a mis en place un service reposant sur trois pôles : 1) un soutien téléphonique disponible 6 à 7 jours/semaine aux gestionnaires des SDG devant gérer une situation de COVID-19; 2) un comité régional composé de quatre représentants montréalais des associations de SDG ainsi que du ministère de la Famille; 3) des brigades de prévention composées d'intervenants de première ligne des Centres intégrés universitaires de santé et de services sociaux (CIUSSS). RéSULTATS: L'intervention de santé publique qui a été mise en place a permis de : 1) conférer les moyens aux SDG afin d'accroître leur capacité et leur confiance dans la gestion de la pandémie en facilitant l'accès à une information juste et positive; 2) soutenir l'engagement et la collaboration des SDG en agissant comme médiateur à leur égard; et 3) répondre aux besoins psychosociaux des membres de la communauté. CONSéQUENCES: Ce service a permis d'ajuster les politiques publiques et de promouvoir la résilience communautaire en sensibilisant les acteurs concernés à l'importance de trouver un juste équilibre entre la protection de la population et les impacts collatéraux de la pandémie.

Health promotion innovations scale up: combining insights from framing and actor-network to foster reflexivity.

There are numerous hurdles down the road for successfully scaling up health promotion innovations into formal programmes. The challenges of the scaling-up process have mainly been conceived in terms of available resources and technical or management problems. However, aiming for greater impact and sustainability involves addressing new contexts and often adding actors whose perspectives may challenge established orientations. The social dimension of the scaling-up process is thus critical. Building on existing conceptualizations of interventions as dynamic networks and of evolving framing of health issues, this paper elaborates a social view of scaling up that accounts for the transformations of innovations, using framing analysis and the notion of 'expanding scaling-up networks'. First, we discuss interventions as dynamic networks. Second, we conceptualize scaling-up processes as networks in expansion within which social learning and change occur. Third, we propose combining a 'representational approach' to frame analysis and an 'interactional approach' that illustrates framing processes related to the micro-practices of leading public health actors within expanding networks. Using an example concerning equity in early childhood development, we show that this latter approach allows documenting how frames evolve in the process. Considering the process in continuity with existing conceptualizations of interventions as actor-networks and transformation of meanings enriches our conceptualization of scaling up, improves our capacity to anticipate its outcomes, and promotes reflexivity about health promotion goals and means.

Seroprevalence of anti-SARS-CoV-2 antibodies among school and daycare children and personnel: protocol for a cohort study in Montreal, Canada.

INTRODUCTION: Further evidence is needed to understand the contribution of schools and daycares for the spread of COVID-19 in the context of diverse transmission dynamics and continually evolving public health interventions. The Enfants et COVID-19: Étude de séroprévalence (EnCORE) study will estimate the seroprevalence and seroconversion of SARS-CoV-2 among school and daycare children and personnel. In addition, the study will examine associations between seroprevalence and sociodemographic characteristics and reported COVID-19 symptoms and tests, and investigates changes in health, lifestyle and well-being outcomes. METHODS AND ANALYSIS: This study includes children and personnel from 62 schools and daycares in four neighbourhoods in Montreal, Canada. All children aged 2-17 years attending one of the participating schools or daycares and their parents are invited to participate, as well as a sample of personnel members. Participants respond to brief questionnaires and provide blood samples, collected via dried blood spot, at baseline (October 2020-March 2021) and follow-up (May-June 2021). Questionnaires include sociodemographic and household characteristics, reported COVID-19 symptoms and tests, potential COVID-19 risk factors and prevention efforts and health and lifestyle information. Logistic regression using generalised estimating equations will be used to estimate seroprevalence and seroconversion, accounting for school-level clustering. ETHICS AND DISSEMINATION: This study was approved by the research ethics boards of the Université de Montréal (CERSES) and the Centre Hospitalier Universitaire Sainte-Justine. Results will contribute to our knowledge about SARS-CoV-2 transmission in schools and daycares and will be made available to study participants and their families, school and public health decision-makers and the research community.

Quelle est l'association entre les caractéristiques résidentielles et du quartier et le développement de l'enfant à la maternelle?

OBJECTIVES: Evaluate the association between residential and neighbourhood characteristics of families and children and the latter's development, using data from the Montréal Survey on the Preschool Experiences of Children in Kindergarten (MSPECK). METHOD: A sample of 1101 children was extracted from a survey frame that included Montréal children assessed in the 2012 Québec Survey of Child Development in Kindergarten (2012 QSCDK). Data collected from the children's parents were used to document the following residential and neighbourhood characteristics (independent variables): material deprivation in the neighbourhood, housing health, residential crowding, housing instability, neighbourhood safety, and access to resources. Linking QSCDK data provided a measure of development for children in kindergarten (dependent variable). Logistic regression was used to predict the probability of kindergarten children being vulnerable in at least one domain of development, or in two or more domains. RESULTS: Children living in neighbourhoods perceived to be dangerous are 1.5 times more likely to be vulnerable in at least one domain of development, compared with their peers living in neighbourhoods perceived to be safe (95% CI: 1.02-2.14). A similar result is observed for vulnerability in two or more domains of development (OR 1.67; 95% CI: 1.07-2.61). Children living in families who lack access to resources are also more likely to be vulnerable in two or more domains of development than their peers in families who have easy access to resources (OR 1.56; 95% CI: 1.003-2.44). CONCLUSION: Parents' feelings of insecurity and lack of access to local resources can limit children's opportunities for socialization and their exposure to enriching experiences.

[Not Available]. / La fréquentation d'un service éducatif préscolaire : un facteur de protection pour le développement des enfants de familles à faible revenu?

OBJECTIVES: Describe the preschool education of children in educational services. Study the effects of components of preschool educational service attendance on the development of kindergarten children, based on income. METHOD: A sample of 1,184 children was extracted from a survey frame that included Montréal children assessed in the 2012 Québec Survey of Child Development in Kindergarten (2012 QSCDK). Data collected from the parents of these children allowed us to document the following components of educational service attendance (independent variables): longitudinal profile of the service used; age at entry; duration; average weekly attendance; and cumulative time. Linking QSCDK data provided a measure of development of children in kindergarten (dependent variable). Various logistic regression models using different combinations of components of educational service attendance were tested. Akaike information criterion enabled us to select the model that best explains the data. RESULTS: Children from low-income families are proportionately fewer to attend a preschool educational service than children from better-off families (79.6% vs. 90.5%; chi-square test (1df), p < 0.001). Children from low-income families who attended only an early childhood centre (centre de la petite enfance) are less likely to be vulnerable in two or more domains of development compared to their peers who did not attend educational services (OR 0.23; CI: 0.06 ­0.92). Children who started attending an educational service before the age of 12 months are less likely to be vulnerable in two or more domains of development (OR: 0.38; CI: 0.18­0.81). CONCLUSION: Attending an early childhood centre (centre de la petite enfance) is beneficial to the development of children from low-income families.

[School readiness survey of Montreal children starting school]. / Enquête sur le développement des enfants montréalais à leur entrée à l'école.

The aim of the survey was to provide a picture of the school readiness of 5-year-old Montréal children starting school and to identify disparities between neighbourhoods and the socio-economic factors determining these differences. 10,513 children were assessed using the Early Development Instrument. The results show that in Montréal, one child in three is vulnerable in at least one area of school readiness. Figures range from 22% to 43% in the different territories. A significant association was found between parents' level of education and the vulnerability of children. Differences between languages are found when analyzing school readiness based on groups of children by mother tongue. A comparative analysis between Montréal and two other large Canadian cities shows that the average score of children in Montréal is higher than the average score of Vancouver children in all areas and higher than the average score of Toronto children in two areas. The differences between territories in Montréal raise questions about public policies and inequalities in access to services and resources between affluent and less affluent neighbourhoods. A comparative analysis between Montréal and two Canadian cities provides a nuanced view of the perception of child vulnerability in Montréal when compared to the rest of Canada.

[School readiness and community mobilization: study retrospective in a Montreal area]. / Maturité scolaire et mobilisation communautaire: étude rétrospective dans un quartier Montréalais.

OBJECTIVES: This article presents a modelling of the collective decision-making process by which a community-based population-level intervention transformed the organization of early childhood services in a Montréal community from 2001 to 2006. PARTICIPANTS: Multisectoral players from a childhood/family issue table. LOCATION: The chosen territory is one of the most multi-ethnic and poorest neighbourhoods of Montréal. INTERVENTION: The intervention being examined is Understanding the Early Years (UEY), a Canada-wide initiative aiming to strengthen communities' capacity to use quality information to support the thought process relating to the organization of early childhood services. Twelve Canadian regions took part, including Montréal. RESULTS: The time chart for the collective decision-making process presents the events that significantly influenced the procedure: establishment of an intersectoral working committee, production of a portrait of the neighbourhood, think tank, development and implementation of the Passage maison-école [home-to-school] and Femmes-Relais [relay women] projects, retreats, and inclusion of school readiness as a priority focus area in the neighbourhood's three-year action plan. Also presented are the contextual factors that influenced decision making: the neighbourhood's cooperation and coordination history, the researcher's involvement, financial support and shared leadership. CONCLUSION: The benefits of UEY-Montréal in this territory extended beyond 2006. With respect to current priorities for action in early childhood, this territory is a good example of mobilization for school readiness.

Bridging the poverty gap in dental education: how can people living in poverty help us?

Dental education on specific knowledge and intervention approaches for working with people living on welfare is crucial to the therapeutic success of the relationships dental professionals establish with this clientele. Despite growing attention to the importance of cultural competence and communication skills training in dentistry, very few initiatives have been documented in relation to serving low-income populations. Following discussions at a 2006 Montreal-based colloquium on access to dental care, academics, dental association administrators, and public health agency and antipoverty coalition representatives began collaborating to develop innovative pedagogy designed to increase providers' competence in interacting with their underprivileged patients. The group's first round of workshops (November 2006-October 2007) resulted in the creation of an original video-based tool containing testimonies from six individuals living currently or formerly on welfare. The videotaped interview data represent their perceptions and experiences regarding their oral health, dental care service provision, and poverty in general. This article describes the participative methods, the content of the resulting DVD, and the implications of the "Listening to Each Other" program, a collaborative knowledge translation approach for improving interaction between underprivileged people and dental care providers.