18-month-old Francesca Jones plays at home with her father Will and mother Julia Tirabasso in early December.
Melissa Tait
When the wail of a fire alarm broke the night-time quiet of the hospital and her new baby did not stir, Julia Tirabasso knew something was wrong.
“I felt like it was the loudest sound I’d ever heard,” Ms. Tirabasso said, “And she slept through it.”
If her daughter, Francesca, had been born at another time or in a province other than Ontario, Ms. Tirabasso and her husband, William Jones, might never have found out exactly why their daughter could not hear the piercing alarm.
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Instead, within weeks of Francesca’s birth on May 25, 2018, Ms. Tirabasso and Mr. Jones learned that a common viral infection, passed from mother to baby in utero, had made their daughter deaf in both ears.
Francesca’s case was the first to be caught by the pilot phase of a new screening program in Ontario that, as of last July, expanded to become the first in the world to offer all parents the opportunity to have their newborns tested for congenital cytomegalovirus, or cCMV, the most common non-genetic cause of permanent hearing loss in children. The province has already caught 70 cases of congenital CMV infection, 53 of them since the program became universal.
The earlier that children with hearing loss are given hearing aids or cochlear implants, the likelier they are to learn to speak. For a cost of $600,000 a year, Ontario has built a program that should catch most children with cCMV-related hearing loss in time to dramatically improve their lives, raising questions about why other parts of Canada have yet to follow Ontario’s lead.
“People are looking very closely at what’s happening in Ontario,” said Sharon Cushing, an otolaryngologist at Toronto’s Hospital for Sick Children who helped craft Ontario’s cCMV screening program. “I travel all over the world, and they’re amazed at what we’re doing.”
For Francesca, early detection of her cCMV infection helped make it possible for her to become one of the youngest babies in the province to receive cochlear implants, electronic devices that partly restore hearing. She was nearly six months old when the implants were turned on for the first time, on Dec. 10, 2018.
Francesca Jones received cochlear implants when she was just five-months-old, one of the youngest in Ontario. At six months they were “turned on” and the video of baby Francesca reacting to her mother’s voice for the first time went viral. We visit the family one year on to see how Francesca is doing.
In a CBC news clip that has been viewed online nearly four million times, Francesca is quietly chewing on a rubber giraffe when a loud beep played by audiologist Susan Druker catches her attention. Francesca looks up and smiles.
Ms. Tirabasso leans in: “Ciao, Francesca.” Mr. Jones chimes in with, “Hi, Francesca.” The little girl rewards her parents with a wide grin. They both laugh with joy and relief.
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Getting to that moment was a journey that began not long after an outwardly healthy Francesca was born at Toronto’s Mount Sinai hospital.
Her case was caught during a pilot program that drew on two existing, but separate, screening programs for newborns: The Infant Hearing Program, which screens for hearing loss, and Newborn Screening Ontario, which co-ordinates the testing of heel-prick blood samples for more than 25 different diseases.
Until last year, Newborn Screening Ontario did not regularly test for congenital CMV.
Francesca is seen at an appointment with audiologist Susan Druker at Hospital for Sick Children in Toronto.
Melissa Tait
Most of the time, cytomegalovirus is no more dangerous than the common cold. But if a pregnant woman catches the virus through saliva or other bodily fluids and passes it on to her baby in utero, CMV infection can sometimes cause serious health problems. Symptoms range from the obvious – a small head, jaundice or a telltale rash – to the invisible, such as mild hearing loss that worsens over time.
If cCMV infection is identified quickly – ideally within the first four weeks of life – babies can be offered antivirals that work better the earlier they are started. Doctors can also monitor babies for hearing loss, which is especially important in cases where newborns with cCMV appear perfectly healthy.
“These children may, for a variety of reasons, pass their hearing screen at birth, but still be at risk,” said Jessica Dunn, medical lead for the CMV component of the new screening program and an infectious disease doctor at CHEO, a children’s health centre in Ottawa.
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Dr. Dunn said that, with the exception of Ontario’s new universal program, the Canadian health-care system has generally done a poor job of catching cCMV.
One University of Alberta study published in 2014 found that, between 2005 and 2008, Canadian pediatricians reported only 49 cases of congenital CMV, or 4.5 cases for every 100,000 births – a much lower birth prevalence than would be expected based on previous studies.
“The most likely explanation for the low reporting rate is missed diagnosis,” the study, published in the journal Paediatric Child Health, found.
Hoping to remedy that, Newborn Screening Ontario modified an existing blood test to detect cCMV in the dried blood spot, obtained from the heel prick, that NSO already collected from 99 per cent of the approximately 143,000 babies born in the province every year.
Once developed, the test cost about $2 a sample.
During the pilot phase, beginning in May, 2018, parents were offered the chance to opt-in to cCMV testing only after their children failed a full hearing screening test. Once the program became universal, last July, all parents were able to opt-in to testing for cCMV and three genetic risk factors for hearing loss, even if their children passed the initial hearing screen.
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Once Francesca tested positive for cCMV infection, Toronto’s Hospital for Sick Children immediately set up a day’s worth of appointments for the stunned couple and their one-month-old baby, whisking them from an infectious diseases doctor to an ear, nose and throat specialist and on to the audiology department.
“I was crying all day,” Ms. Tirabasso said. But she also found reason for hope. Dr. Cushing told Ms. Tirabasso and Mr. Jones that the health system had a “toolbox,” full of ways to help Francesca.
With guidance from 11 different types of doctors and health-care workers, including an auditory verbal therapist, an occupational therapist, a family support worker and an in-home teacher, Francesca, now 18 months old, can sing her alphabet, count, make animal sounds and mimic her parents as they read to her.
Ms. Tirabasso reads to her daughter.
Melissa Tait
“Do you want to read?” Ms. Tirabasso asked her daughter on a recent afternoon, holding up a board book titled Little Blue Truck.
“Read!” Francesca replied. As Little Blue Truck drove around his farm, Francesca repeated his signature sound, “Beep beep!” and quacked, neighed and mooed along with the animals. “All done!” Francesca said as she shut the book.
Softly, she called out for “Papa!” then switched to Mr. Jones’s lap. He read the opening of a Dr. Seuss book. “One fish, two fish, red fish, blue fish, black fish, blue fish, old fish …” Francesca interjected, “new fish.”
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“You’ve never said that before,” Mr. Jones said, clearly tickled.
To get Francesca to this point, where she comprehends words and speaks as well as any hearing toddler, has taken an all-encompassing effort by Ms. Tirabasso, a lawyer, and Mr. Jones, a product manager for a medical-device company.
They talk to Francesca constantly, narrating as they serve her tomatoes and cheese for dinner in their apartment north of downtown Toronto. Taped to the walls of the apartment are notes with tips from a language therapist: “6 sounds everyday e, a, ouu, mmm, siii, shh; use word ‘sandwiches’; Don’t feed her with full plate. Empty plate + ask her what she wants.”
When Francesca was younger, they hid around corners and rang bells, banged wooden spoons against pots and softly shook rice inside Tupperware containers, watching to see if Francesca could follow the source of the sounds.
If not for the small gadgets above Francesca’s ears, you might never guess that, when the external portion of the cochlear devices are removed for bath or bedtime, Francesca can’t hear at all.
Marlene Bagatto, an audiology professor and researcher at University of Western Ontario who chairs the Canadian Infant Hearing Task Force, said all Canadian children with hearing loss deserve the kind of early intervention that has helped Francesca to develop language. “The best chance you have for developing spoken language really well is up to age two. Earlier is better,” she says.
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The task force’s 2019 report card on Canadian early hearing detection and intervention programs rated only Alberta, British Columbia, Northwest Territories, Nova Scotia, Ontario and Yukon as having programs “sufficient” to identify hearing loss in babies and intervene to improve their odds of developing language. And only Ontario offers universal screening for cCMV. “It’s not okay for babies in this country,” Dr. Bagatto said.
Francesca Jones at The Hospital for Sick Children in Toronto after an appointment with the audiologist in early December.
Melissa Tait
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Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
