D-fence Against the Canadian Winter: Making Insufficient Vitamin D Levels a Higher Priority for Public Health

With most of the country situated above the latitude of the 42nd parallel north, there is a significant portion of the Canadian population that is not getting enough of the sunshine vitamin during the winter. Vitamin D is naturally produced when skin is exposed to sunlight, however during the winter months in Canada the sun is too low in the sky for this to occur. A full quarter of the Canadian population is estimated to have vitamin D levels so low as to be considered insufficient or deficient by Health Canada guidelines. Increasing vitamin D intake should be considered a public health priority. Vitamin D deficiency is known to be linked to rickets in children and osteomalacia in adults (bone softening and malformation) as well as osteoporosis (loss of bone density, increasing susceptibility to fractures). However a growing body of evidence also suggests that vitamin D may have a role in the prevention of chronic diseases such as heart disease, high blood pressure, diabetes, cancer, cognitive decline, Parkinson’s disease, multiple sclerosis and arthritis. There is, of course, no way to change Canada’s proximity to the equator. But there are ways to help Canadians get more vitamin D through dietary intake. Improving the vitamin D status of the Canadian population through food fortification and dietary supplements represents an inexpensive intervention that can improve the health of the population, but debate remains over how much vitamin D the Canadian population needs and how to ensure the population adheres to whatever recommendations are made. Food fortification has already demonstrated its effectiveness in improving vitamin D levels (as it has for other public health priorities, such as with iodized salt). Decades ago, the prevalence of rickets in Canadian children led health professionals to lobby for, and win, legislation making vitamin D fortification mandatory for milk. Other foods, such as orange juice, milk of plant origin and margarine are sometimes also fortified with vitamin D. However many Canadians do not consume milk or the other fortified foods or do not take dietary supplements at the current recommended levels, increasing their risk of vitamin D insufficiency. It is clear there is a need to gain a better understanding of the benefits and the costs of strategies associated with vitamin D intake in the general population. There have been longstanding concerns about the risk of people consuming too much vitamin D (leading to hypercalcemia). More recently there has emerged great disagreement in the scientific and regulatory communities over what constitutes an excessive dosage of vitamin D, and even what constitutes the optimal blood-serum level for vitamin D. The inability to settle on firm guidelines is paralyzing any movement towards increasing vitamin D intake in the Canadian population. Fortification and public health strategies are needed to ensure current vitamin D targets are met. Health Canada’s proposal to allow greater levels of vitamins and minerals to be added to foods, to meet consumer demand (within maximum limits), has been on the table since 2005. A decade later, the Canadian winters have grown no shorter, and the solar zenith angle has not changed. It is becoming an increasingly urgent matter of public health to reach a consensus on updated guidelines for vitamin D intake levels and limits, to better inform Canadians

Laying the Foundation for Policy: Measuring Local Prevalence for Autism Spectrum Disorder

WHY IS THIS AN IMPORTANT ISSUE?Autism Spectrum Disorder (ASD)1 is the most common neurological condition diagnosed in children in Canada. Estimates of prevalence are reported as national numbers but may not reflect local numbers and consequently local needs. Local and provincial ASD prevalence estimates can be used by policy makers to inform local service delivery, resource allocation and future planning.WHAT DOES THE RESEARCH TELL US?ASD prevalence is on the rise Estimates of ASD prevalence in Canada have risen dramatically over the past several decades.2 The reason for the dramatic rise is uncertain and may be a result of a combination of a true rise in incidence, changing diagnostic criteria and increased awareness.3 It has been speculated that Alberta may have higher numbers of persons with ASD due to family in-migration to utilize higher levels of funding for ASD supports compared to other provinces.4 Prior to this study, there were no prevalence estimates for Alberta to assess this theory. A better understanding of Alberta ASD prevalence is critical as these estimates assist policy-makers, clinicians and educators in planning for school supports, adult day programs, employment programs, housing options and other programs essential to enhancing quality of life for individuals living with ASD and their families

The Value of Caregiver Time: Costs of Support and Care for Individuals Living with Autism Spectrum Disorder

WHY IS THIS AN IMPORTANT ISSUE?An estimated 1 in 86 children are diagnosed with Autism Spectrum Disorder (ASD)1 making it the most commonly diagnosed childhood neurological condition in Canada.2 The true costs of lifelong support for people living with ASD3 are often underestimated and fail to acknowledge the value of caregiver time over the lifespan. Significant gaps in publically provided support systems leave the cost burden to be picked up by families. Relying on continued family supports where community services are fragmented or unavailable is not a sustainable approach. WHAT DOES THE RESEARCH TELL US? A continuum of supports are needed Most people living with ASD need supports that range from occasional assistance with higher level tasks, like organizing appointments or banking, to those who need continuous help with daily living.4 Areas where supportive care may be needed can be categorized broadly to include: self care, home living, service co-ordination, personal organization, health and safety management, adult day opportunities/employment, transportation, advocacy and social skills. These supports are most successful when they address the individual’s uniqueness in terms of communication, social, sensory, behavioural needs and physical and/or mental health conditions. Currently there are a lack of available supports, limiting opportunities for socialization, employment and residential living resulting in reduced independence for adults with ASD

Mind the Gap: Transportation Challenges for Individuals Living with Autism Spectrum Disorder

WHY IS THIS AN IMPORTANT ISSUE?An estimated 1 in 86 children are diagnosed with Autism Spectrum Disorder (ASD)1 making it the most commonly diagnosed childhood neurological condition in Canada.2 Transportation challenges for those with ASD are a growing issue in Canada. People living with ASD3 and others who live with neurodevelopmental disability (NDD)4 rely almost exclusively on public transit and caregivers for transportation. The current transportation options are insufcient in meeting the needs of this population. WHAT DOES THE RESEARCH TELL US?Transportation is essential to promoting quality of life The transit system plays an essential role in improving quality of life for individuals with ASD and for their caregivers. However, problems with cognition, perception and communication are barriers to independence in transportation. Availability of transportation is critical to enable high levels of physical activity among those with intellectual disabilities.5 Safe and reliable transportation improves one’s ability to participate in programs that support quality of life and impacts employment, volunteering, religious participation, exercise, self-advocacy and health care for people with intellectual and developmental disabilities.6 Caregivers for those with ASD emphasize that transportation is critical to enable meaningful opportunity and community engagement in employment, education, healthcare and social pursuits.

How is Funding Medical Research Better for Patients?

With rising health care costs, often health research is viewed as a major cost driver, calling to question the role and value of provincial funding of health research. Most agree that the quality of healthcare provided is directly linked to our ability to conduct quality research; however currently there is little empirical evidence supporting the link between engagement in health research and healthcare performance. In Canada this has resulted in funding for health research that varies over time and between provinces. While medical knowledge is a public good, we hypothesize there are local benefits from health research, such as the attraction of a specialized human capital workforce, which fosters a culture of innovation in clinical practice. To address this question, we look at whether health outcomes are impacted by changes in provincial research funding in Alberta compared to other provinces. Provincial funding for medical research, which varies greatly over time and among provinces, is used as a proxy for medical treatment inputs. Trend rates of reduction in mortality from potentially avoidable causes (MPAC) (comprised of mortality from preventable causes (MPC) and mortality from treatable causes (MTC)), are used as a proxy health outcome measure sensitive to the contributions of technological progress in medical treatment. Our analysis suggests that investment in health research has payback in health outcomes, with greater improvements in the province where the research occurs. The trend declines seen in age standardized MPAC rates in different Canadian provinces may be impacted by shifts in provincial research funding investment, suggesting that knowledge is not transferred without cost between provinces. Up until the mid-1980s, Alberta had the most rapid rate of decline in MPAC compared to the other provinces. This is striking given the large and unique investment in medical research funding in Alberta in the early 1980s through AHFMR, the only provincial health research funding agency at the time. However in recent years, Alberta’s rate of decrease in MPAC has occurred at a rate slower than the other provinces (British Columbia, Ontario or Quebec) with provincial medical research funding. This is striking at a population level, where Alberta’s failure to achieve a reduction in age standardized rates of MTC comparable to British Columbia, Ontario or Quebec after 1985 represents 240 unnecessary deaths in 2011 and 48,250 Potential Life Years Lost worth around $4.8 billion. The findings from our study suggest that some of the divergence in the rates of reduction in MPAC between provinces may be due to beneficial changes in institutional structure and human capital, resulting in differences across provinces in the capacity to adopt new effective healthcare innovations. While health indicators such as MPAC are the result of complex interactions between the patient, treatment and the healthcare system, as well as socioeconomic and demographic factors, this analysis suggests that a different capacity for health research within the provinces impacts health outcomes. The findings from this analysis are limited by the lack of data related to research funding and the health research workforces within provinces. This analysis has important implications for health research policy and funding allocations, suggesting that decision makers should consider the long-term impact provincial funding for health research has on health outcomes. This study also highlights the lack of longitudinal public data available for provincial health research funding. This information is critical to inform future health research policy

It’s Not Just About Baby Teeth: Preventing Early Childhood Caries

Early Childhood Caries (ECC) is a serious disease that is about much more than cavities on baby teeth. In Canada, it is a growing public health problem with adverse long-term effects on children's physical, emotional and intellectual well-being. The failure to invest in preventive care has resulted in reactive, rather than proactive, measures against this disease. These measures are expensive and a needless drain on costs in the public health-care system. Children with severe ECC end up in hospital; in fact, in Canada, this disease is the most common reason children undergo day surgery. From 2010 to 2012, one in 100 children under age five required day surgery for ECC, with approximately 19,000 of these surgeries performed each year on children under age six. Canadian hospital costs for ECC day surgery in children aged one to five ranged from $1,271 to$1,963 per child, totalling $21.2 million between 2010 and 2012. Children from low-income families, along with aboriginal, immigrant and refugee children are disproportionately affected by dental disease, with between 50 per cent and 90 per cent of suffering from some form of ECC. This compares to an average of 57 per cent of children affected in the general population. A recent Alberta study indicates that when municipalities cease fluoridating their water supplies, children suffer increased levels of tooth decay. This has reignited the discussion around whether municipalities should add fluoride to the drinking water, or reinstate it in places where the water used to be fluoridated. While fluoridation can be an effective prevention strategy, this study also shows that fluoride alone is not enough. To reduce the costs and developmental consequences associated with severe ECC and improve well-being, oral health policies focused on disease prevention and health promotion are still necessary. This briefing paper provides background on the etiology, risk factors and prevalence of ECC in Canada to provide scope for the magnitude of this preventable disease in children. To address the avoidable socioeconomic costs, three areas require policy development. First is the need for increased public education and access to ECC prevention services for at-risk populations. Parents need to know they should reduce their children’s intake of sweet drinks, and avoid filling bottles with sugar water, juice or soft drinks, especially at night. They should also clean an infant’s gums with a soft toothbrush or cloth and water starting at birth. When the baby’s first tooth erupts, parents should commence daily brushing with toothpaste and book a first dental visit. Second is the need to empower health-care professionals to integrate ECC prevention in their early visits with parents of young children. Such visits are more common in family medicine, and these primary care providers can play a critical role in educating parents and promoting children’s oral health. Curriculum and continuing education for these health professions should be enhanced to emphasize ECC’s long-term health effects. Third, government should invest in preventive oral health services for children rather than relying on emergency dental care. Children should have access to early preventive dental services to instill in them habits for lifetime oral health. Provinces without universal public funding for children’s preventive dental health should remove the access barriers that children without dental insurance face

What do we Know About Improving Employment Outcomes for Individuals with Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is the most commonly diagnosed neurological disorder in children. Adults with ASD have some of the poorest employment outcomes in comparison to others with disabilities. While data in Canada is limited, roughly 25 per cent of Americans living with ASD are employed and no more than six per cent are competitively employed. Most earn less than the national minimum hourly wage, endure extended periods of joblessness and frequently shuffle between positions, further diminishing their prospects. Poor employment outcomes result in lower quality of life and often lead to steep economic costs. Governments are wise to pay attention to the poor employment outcomes as the high numbers of children now diagnosed with ASD will become adults in the future in need of employment opportunities. Improving employment outcomes for those living with ASD is an important policy objective. Work opportunities improve quality of life, economic independence, social integration, and ultimately benefit all. Adults with ASD can succeed with the right supports. Fortunately, there are many emerging policy and program options that demonstrate success. This paper conducts a review of studies and provides policy recommendations based on the literature, to help governments identify appropriate policy options. Some key factors are both those that are unique to the individual and the external supports available; namely school, work, and family. For example, factors that contribute to successful employment for people living with ASD may include IQ, social skills and self-determination, but for all, even for the less advantaged, external assistance from schools, employers and family can help. Inclusive special education programs in high school that offer work experiences are critical as are knowledgeable employers who can provide the right types of accommodation and leadership. In the work environment the use of vocational and rehabilitative supports, from job coaching to technology-mediated training are a few of the work related factors that enhance success. Information in this paper provides policy makers with a way to move forward and enhance the current employment situation for those living with ASD ultimately improving quality of life and economic independence

Definition of a labelling code for the noise emitted by machines

It has been increasingly realised that traditional parameters, such as A-weighted sound levels, sound power and noise spectra in octaves or third octaves are not enough to describe a sound and that machine labels should show more subjective information about the emitted noise. A new labelling system based on empirical data is proposed. The methodology of the study used as the basis for the proposal is explained, as well as the objective and subjective characteristics to be included in the new label. The uses and applications of the label are discussed briefly

Depth of Field Analysis for Multilayer Automultiscopic Displays

With the re-emergence of stereoscopic displays, through polarized glasses for theatrical presentations and shuttered liquid crystal eyewear in the home, automultiscopic displays have received increased attention. Commercial efforts have predominantly focused on parallax barrier and lenticular architectures applied to LCD panels. Such designs suffer from reduced resolution and brightness. Recently, multilayer LCDs have emerged as an alternative supporting full-resolution imagery with enhanced brightness and depth of field. We present a signal-processing framework for comparing the depth of field for conventional automultiscopic displays and emerging architectures comprising multiple light-attenuating layers. We derive upper bounds for the depths of field, indicating the potential of multilayer configurations to significantly enhance resolution and depth of field, relative to conventional designs.Massachusetts Institute of Technology. Media LaboratoryMIT Camera Culture GroupNational Science Foundation (U.S.) (Grant IIS-1116452)United States. Defense Advanced Research Projects Agency. MOSAIC ProgramUnited States. Defense Advanced Research Projects Agency. SCENICC ProgramAlfred P. Sloan Foundation (Research Fellowship)United States. Defense Advanced Research Projects Agency. (Young Faculty Award

A Moving-Knife Solution to the Four-Person Envy-Free Cake-Division Problem

Envy-freeness