Anti-Indigenous racism in Canadian healthcare: A scoping review of the literature.

BACKGROUND: Health inequity between Indigenous (First Nations, Inuit and Métis) peoples and other citizens is an important policy concern in Canada, as in other colonial countries. Racism in healthcare has been identified as contributing to poorer care and to worse outcomes. Despite a large literature regarding racism in other healthcare contexts, the dimensions of the existing literature on anti-Indigenous racism in Canadian healthcare are unclear. METHODS: A scoping review examined the evidence of anti-Indigenous racist experiences in healthcare in the research literature, including the types of racist behaviours identified, settings studied, and Indigenous populations and geographic regions included. We identified English and French language journal articles on anti-Indigenous racism in Canadian healthcare settings in Scopus, PubMed, CINAHL and the Bibliography of Indigenous Peoples in North America (BIPNA), and grey literature reports. RESULTS: 2250 journal articles and 9 grey literature reports published since 2000 were included in screening, and 66 studies were included in the final review. Most used qualitative interviews with patients, but a large proportion included healthcare providers. Most were conducted in urban settings, a majority in Ontario or British Columbia, with mixed Indigenous populations. The largest proportion focussed on patient experiences with healthcare in general, rather than specific clinical contexts.Most racist experiences identified were "covert" racism, including patients feeling treated differently from non-Indigenous patients, being ignored, treated more slowly, or not believed. Stereotyping of Indigenous peoples as substance users, poor patients or poor parents was also commonly reported. "Overt racism", including the use of racist slurs, was not widely found. Some quantitative studies did use standardized or validated instruments to capture racist experiences, but most did not result in generalizable estimates of their prevalence. The few studies linking racism to health outcomes found that experiencing racism was related to reluctance to seek healthcare, potentially leading to higher unmet healthcare needs. Gender was the intersecting dimension most identified as shaping healthcare experiences, with Indigenous women and girls at risk to specific stereotypes. Some papers suggested that socioeconomically disadvantaged Indigenous people were at the highest risk to experiencing racism. CONCLUSIONS: Types of anti-Indigenous racism identified in Canadian healthcare appear similar to those reported in other jurisdictions. Indigenous peoples facing multiple dimensions of disadvantage, especially gender and social class, may be the most likely to experience racism. It is likely that the experience of racism in healthcare has implications for Indigenous peoples' health, mainly by reducing healthcare access.

Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada.

Background: Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada. Methods: Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics. Results: The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative. Conclusions: This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.

Speaking in the presence of noise: Consistency of acoustic properties in clear-Lombard speech over time.

Individual speakers are often able to modify their speech to facilitate communication in challenging conditions, such as speaking in a noisy environment. Such vocal "enrichments" might include reductions in speech rate or increases in acoustic contrasts. However, it is unclear how consistently speakers enrich their speech over time. This study examined inter-speaker variability in the speech enrichment modifications applied by speakers. The study compared a baseline habitual speaking style to a clear-Lombard style and measured changes in acoustic differences between the two styles over sentence trials. Seventy-eight young adult participants read out sentences in the habitual and clear-Lombard speaking styles. Acoustic differences between speaking styles generally increased nonlinearly over trials, suggesting that speakers require practice before realizing their full speech enrichment potential when speaking clearly in noise with reduced auditory feedback. Using a recent objective intelligibility metric based on glimpses, the study also found that predicted intelligibility increased over trials, highlighting that communicative benefits of the clear-Lombard style are not static. These findings underline the dynamic nature of speaking styles.

The time course of adaptation to distorted speech.

When confronted with unfamiliar or novel forms of speech, listeners' word recognition performance is known to improve with exposure, but data are lacking on the fine-grained time course of adaptation. The current study aims to fill this gap by investigating the time course of adaptation to several different types of distorted speech. Keyword scores as a function of sentence position in a block of 30 sentences were measured in response to eight forms of distorted speech. Listeners recognised twice as many words in the final sentence compared to the initial sentence with around half of the gain appearing in the first three sentences, followed by gradual gains over the rest of the block. Rapid adaptation was apparent for most of the eight distortion types tested with differences mainly in the gradual phase. Adaptation to sine-wave speech improved if listeners had heard other types of distortion prior to exposure, but no similar facilitation occurred for the other types of distortion. Rapid adaptation is unlikely to be due to procedural learning since listeners had been familiarised with the task and sentence format through exposure to undistorted speech. The mechanisms that underlie rapid adaptation are currently unclear.

Incidence, Demographic, and Seasonal Risk Factors of Infections Caused by Five Major Enteric Pathogens, Ontario, Canada, 2010-2017.

In Canada, enteric infections cause significant health and economic burden. We evaluated the individual characteristics of laboratory-confirmed cases of Campylobacter spp. (n = 28,728), non-typhoidal Salmonella spp. (n = 22,640), Yersinia spp. (n = 1674), Verotoxin-producing Escherichia coli (VTEC; n = 1340), and Listeria monocytogenes (n = 471), reported between 2010 and 2017 inclusive, in Ontario, Canada (population ∼13,500,000). We calculated overall and pathogen-specific annual and mean incidence rates (IRs) for Ontario. We used multivariable Poisson and negative binomial regression models to estimate incidence rate ratios (IRRs) for years, seasons, age groups, and sexes, and we included two-way age and sex interaction terms in the models. Campylobacter and Salmonella infections had the highest IRs whereas Listeria infections had the lowest IRs. None of the infections showed long-term trends over the 8-year study period; however, rates of all five infections were elevated in the summer. More Salmonella, VTEC, and Listeria infections were linked to disease outbreaks than were Campylobacter and Yersinia infections. Overall, mean IRs of Campylobacter, Salmonella, Yersinia, and VTEC infections were highest in children 0-4 years old, whereas Listeria IRs peaked in adults 60 years and older. Higher mean IRs of Campylobacter were observed in males. No other differences by sex were statistically significant. The same mean rate was observed in both sexes for Listeria. Adjusting for all other factors, significant age- and sex-specific differences in IRs were observed in Campylobacter, Salmonella, and VTEC infection rates. No significant interactions of age and sex were found for Yersinia and Listeria infections. Future research should focus on the pathogen-specific socioeconomic, environmental, or agricultural risk factors that might be responsible for these infections.

How reliable are online speech intelligibility studies with known listener cohorts?

Although the use of nontraditional settings for speech perception experiments is growing, there have been few controlled comparisons of online and laboratory modalities in the context of speech intelligibility. The current study compares outcomes from three web-based replications of recent laboratory studies involving distorted, masked, filtered, and enhanced speech, amounting to 40 separate conditions. Rather than relying on unrestricted crowdsourcing, this study made use of participants from the population that would normally volunteer to take part physically in laboratory experiments. In sentence transcription tasks, the web cohort produced intelligibility scores 3-6 percentage points lower than their laboratory counterparts, and test modality interacted with experimental condition. These disparities and interactions largely disappeared after the exclusion of those web listeners who self-reported the use of low quality headphones, and the remaining listener cohort was also able to replicate key outcomes of each of the three laboratory studies. The laboratory and web modalities produced similar measures of experimental efficiency based on listener variability, response errors, and outlier counts. These findings suggest that the combination of known listener cohorts and moderate headphone quality provides a feasible alternative to traditional laboratory intelligibility studies.

Area-Level Clustering of Shiga Toxin-Producing Escherichia coli Infections and Their Socioeconomic and Demographic Factors in Ontario, Canada: An Ecological Study.

Shiga toxin-producing Escherichia coli (STEC) infections are an important health burden for human populations in Ontario and worldwide. We assessed 452 STEC cases that were reported to Ontario's reportable disease surveillance system between 2015 and 2017. A retrospective scan statistic using a Poisson model was used to detect high-rate STEC clusters at the forward sortation area (FSA; the first three digits of a postal code) level. A significant spatial cluster in the southwest region of Ontario was identified. A case-case logistic regression analysis was applied to compare FSA-level socioeconomic and demographic characteristics among STEC cases included inside the spatial cluster with cases outside of the cluster. Cases included in the spatial cluster had higher odds of living in FSAs with a low median family income, low proportion of lone-parent families, and low proportion of the visible minority population. In addition, STEC cases inside the cluster had higher odds of coming from rural FSAs. Our study demonstrated that STEC cases were spatially clustered in Ontario and their clustering was associated with FSA-level socioeconomic and demographic determinants of cases.

Enhanced amplitude modulations contribute to the Lombard intelligibility benefit: Evidence from the Nijmegen Corpus of Lombard Speech.

Speakers adjust their voice when talking in noise, which is known as Lombard speech. These acoustic adjustments facilitate speech comprehension in noise relative to plain speech (i.e., speech produced in quiet). However, exactly which characteristics of Lombard speech drive this intelligibility benefit in noise remains unclear. This study assessed the contribution of enhanced amplitude modulations to the Lombard speech intelligibility benefit by demonstrating that (1) native speakers of Dutch in the Nijmegen Corpus of Lombard Speech produce more pronounced amplitude modulations in noise vs in quiet; (2) more enhanced amplitude modulations correlate positively with intelligibility in a speech-in-noise perception experiment; (3) transplanting the amplitude modulations from Lombard speech onto plain speech leads to an intelligibility improvement, suggesting that enhanced amplitude modulations in Lombard speech contribute towards intelligibility in noise. Results are discussed in light of recent neurobiological models of speech perception with reference to neural oscillators phase-locking to the amplitude modulations in speech, guiding the processing of speech.

Sculpting speech from noise, music, and other sources.

Intelligible speech can be generated by passing a signal through a time-frequency mask that selects which information to retain, even when the signal is speech-shaped noise, suggesting an important role for the mask pattern itself. The current study examined the relationship between the signal and the mask by varying the availability of target speech cues in the signal while holding the mask constant. Keyword identification rates in everyday sentences varied from near-ceiling to near-floor levels as the signal was varied, indicating that the interaction between the signal and mask, rather than the mask alone, determines intelligibility.

Epilepsy and lifestyle behaviors related to bone health.

OBJECTIVE: Adults aged 50 years and older with epilepsy face an increased risk of fracture associated both with age and with the use of antiepileptic drugs. Lifestyle behaviors, such as physical activity and calcium and vitamin D intake, have been found to be beneficial to bone health. The aim of this study is to investigate these osteoprotective behaviors in people aged 50 years and older with and without epilepsy. METHODS: In 2010, the Canadian Community Health Survey (CCHS), a cross-sectional survey that collects health-related data nationwide, included a subset of questions related to epilepsy along with the standard items on physical activity, nutrition, and sun exposure. Data on osteoprotective behaviors were extracted and analyzed for adults aged 50 years and older. RESULTS: There were no significant findings related to calcium and vitamin D intake as measured by food choices and sun exposure survey items. People with epilepsy participated in physical activity significantly less often and for significantly shorter duration than people without epilepsy. Significantly fewer people with epilepsy reported intending to increase exercise in the next 12 months as compared to those without epilepsy. SIGNIFICANCE: Although adults aged 50 years and older with epilepsy face an increased risk of fracture as compared to those without epilepsy, they do not engage in a higher level of osteoprotective behaviors. In fact, adults with epilepsy are less physically active and report less intention to exercise than adults without epilepsy.

Non-native consonant acquisition in noise: Effects of exposure/test similarity.

When faced with speech in noise, do listeners rely on robust cues or can they make use of joint speech-plus-noise patterns based on prior experience? Recent studies have suggested that listeners are better able to identify words in noise if they experienced the same word-in-noise tokens in an earlier exposure phase. The current study examines the role of token similarity in exposure and test conditions. In three experiments, Spanish learners of English were exposed to intervocalic consonants during an extensive training phase, bracketed by pre- and post-tests. Distinct cohorts experienced tokens that were either matched or mismatched across test and training phases in one or both of two factors: signal-to-noise ratio (SNR) and talker. Cohorts with fully matching test-training exposure were no better at identifying consonants at the post-test phase than those trained in partially or fully mismatched conditions. Indeed, at more adverse test SNRs, training at more favourable SNRs was beneficial. These findings argue against the use of joint speech-plus-noise representations at the segmental level and instead suggest that listeners are able to extract useful acoustic-phonetic information across a range of exposure conditions.

Lexical frequency effects in English and Spanish word misperceptions.

When listeners misperceive words in noise, do they report words that are more common? Lexical frequency differences between misperceived and target words in English and Spanish were examined for five masker types. Misperceptions had a higher lexical frequency in the presence of pure energetic maskers, but frequency effects were reduced or absent for informational maskers. The tendency to report more common words increased with the degree of energetic masking, suggesting that uncertainty about segment identity provides a role for lexical frequency. However, acoustic-phonetic information from an informational masker may additionally constrain lexical choice.

Identification of a xenobiotic as a potential environmental trigger in primary biliary cholangitis.

BACKGROUND & AIMS: Primary biliary cholangitis (PBC) is an autoimmune-associated chronic liver disease triggered by environmental factors, such as exposure to xenobiotics, which leads to a loss of tolerance to the lipoic acid-conjugated regions of the mitochondrial pyruvate dehydrogenase complex, typically to the E2 component. We aimed to identify xenobiotics that might be involved in the environmental triggering of PBC. METHODS: Urban landfill and control soil samples from a region with high PBC incidence were screened for xenobiotic activities using analytical, cell-based xenobiotic receptor activation assays and toxicity screens. RESULTS: A variety of potential xenobiotic classes were ubiquitously present, as identified by their interaction with xenobiotic receptors - aryl hydrocarbon receptor, androgen receptor and peroxisome proliferator activated receptor alpha - in cell-based screens. In contrast, xenoestrogens were present at higher levels in soil extracts from around an urban landfill. Furthermore, two landfill sampling sites contained a chemical(s) that inhibited mitochondrial oxidative phosphorylation and induced the apoptosis of a hepatic progenitor cell. The mitochondrial effect was also demonstrated in human liver cholangiocytes from three separate donors. The chemical was identified as the ionic liquid [3-methyl-1-octyl-1H-imidazol-3-ium]+ (M8OI) and the toxic effects were recapitulated using authentic pure chemical. A carboxylate-containing human hepatocyte metabolite of M8OI, bearing structural similarity to lipoic acid, was also enzymatically incorporated into the E2 component of the pyruvate dehydrogenase complex via the exogenous lipoylation pathway in vitro. CONCLUSIONS: These results identify, for the first time, a xenobiotic in the environment that may be related to and/or be a component of an environmental trigger for PBC. Therefore, further study in experimental animal models is warranted, to determine the risk of exposure to these ionic liquids. LAY SUMMARY: Primary biliary cholangitis is a liver disease in which most patients have antibodies to mitochondrial proteins containing lipoic acid binding site(s). This paper identified a man-made chemical present in soils around a waste site. It was then shown that this chemical was metabolized into a product with structural similarity to lipoic acid, which was capable of replacing lipoic acid in mitochondrial proteins.

The correlates of physical activity among adult Métis.

OBJECTIVES: Métis, with a population of close to 390,000 people, are a culturally distinct and constitutionally recognized Aboriginal group in Canada that suffers from poorer overall health than non-Aboriginal Canadians. One important predictor of good health is physical activity. Guided by frameworks based on social and Aboriginal-specific determinants, we investigated the correlates of leisure-time physical activity (LTPA) and active transportation (walking) among adult Métis, with a particular focus on how culturally specific variables were associated with these two types of activity. We also examined how demographic, geographic, socioeconomic and health-related factors were associated with physical activity. DESIGN: We used data from Statistics Canada's 2006 Aboriginal Peoples Survey and Métis Supplement to analyze the correlates of physical activity among Métis aged 20-64, using a series of logistic regression models. RESULTS: Having attended a Métis cultural event in the past year was positively associated with LTPA, as was a high level of spirituality. Similarly, those who had attended a cultural event in the last year were more likely to report a high level of active transportation. Speaking an Aboriginal language and being a member of a Métis organization were not independently associated with the two types of physical activity. Self-perceived health, being male and household income were other correlates positively associated with LTPA, whereas age, body mass index and smoking were negatively associated with this type of activity. Active transportation was positively associated with self-perceived health and being female, while negatively associated with age and body mass index. CONCLUSIONS: The results of this study suggest that interventions aimed at increasing physical activity among adult Métis might be more successful if they are connected to cultural activities and spirituality. This research also suggests that demographic, socioeconomic and health-related factors are important considerations when designing initiatives to increase physical activity among adult Métis.

Talkers produce more pronounced amplitude modulations when speaking in noise.

Speakers adjust their voice when talking in noise (known as Lombard speech), facilitating speech comprehension. Recent neurobiological models of speech perception emphasize the role of amplitude modulations in speech-in-noise comprehension, helping neural oscillators to "track" the attended speech. This study tested whether talkers produce more pronounced amplitude modulations in noise. Across four different corpora, modulation spectra showed greater power in amplitude modulations below 4 Hz in Lombard speech compared to matching plain speech. This suggests that noise-induced speech contains more pronounced amplitude modulations, potentially helping the listening brain to entrain to the attended talker, aiding comprehension.

Effects of exposure to noise during perceptual training of non-native language sounds.

Listeners manage to acquire the sounds of their native language in spite of experiencing a range of acoustic conditions during acquisition, including the presence of noise. Is the same true for non-native sound acquisition? This study investigates whether the presence of masking noise during consonant training is a barrier to improvement, or, conversely, whether noise can be beneficial. Spanish learners identified English consonants with and without noise, before and after undergoing one of four extensive training regimes in which they were exposed to either consonants or vowels in the presence or absence of speech-shaped noise. The consonant-trained cohorts showed substantially larger gains than the vowel-trained groups, regardless of whether they were trained in noise or quiet. A small matched-condition benefit was evident, with noise-training resulting in larger improvements when testing in noise, and vice versa for training in quiet. No evidence for habituation to noise was observed: the cohort trained on vowels in noise showed no transference to consonants in noise. These findings demonstrate that noise exposure does not impede the acquisition of second language sounds.

Temporal factors in cochlea-scaled entropy and intensity-based intelligibility predictions.

Cochlea-scaled entropy (CSE) was proposed as a signal-based metric for automatic detection of speech regions most important for intelligibility, but its proposed superiority over traditional linguistic and psychoacoustical characterisations was not subsequently confirmed. This paper shows that the CSE concept is closely related to intensity and as such captures similar speech regions. However, a slight but significant advantage of a CSE over an intensity-based characterisation was observed, associated with a time difference between the two metrics, suggesting that the CSE index may capture dynamical properties of the speech signal crucial for intelligibility.

Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study.

BACKGROUND: Canadian youth exhibit a number of risky behaviours, some of which are associated with overweight and obesity. The purpose of this study was to examine the prevalence of 15 modifiable risk behaviours in a large sample of Canadian youth, to identify underlying subgroups based on patterns of health behaviours, and to examine the association between identified subgroups and overweight/obesity. METHODS: Data from 18,587 grades 9-12 students in Year 1 (2012-13) of the COMPASS study and latent class analysis were used to identify patterns and clustering among 15 health behaviours (e.g., physical inactivity, sedentary behaviour, unhealthy eating, substance use). A logistic regression model examined the associations between these clusters and overweight/obesity status. RESULTS: Four distinct classes were identified: traditional school athletes, inactive screenagers, health conscious, and moderately active substance users. Each behavioural cluster demonstrated a distinct pattern of behaviours, some with a greater number of risk factors than others. Traditional school athletes (odds ratio (OR) 1.15, 95% CI 1.03-1.29), inactive screenagers (OR 1.33; 1.19-1.48), and moderately active substance users (OR 1.27; 1.14-1.43) were all significantly more likely to be overweight/obese compared to the health conscious group. CONCLUSIONS: Four distinct subpopulations of youth were identified based on their patterns of health and risk behaviours. The three clusters demonstrating poorer health behaviour were all at an increased risk of being overweight/obese compared to their somewhat healthier peers. Obesity-related public health interventions and health promotion efforts might be more effective if consideration is given to population segments with certain behavioural patterns, targeting subgroups at greatest risk of overweight or obesity.

Incorporating sex, gender and vulnerable populations in a large multisite health research programme: The Ontario Pharmacy Evidence Network as a case study.

BACKGROUND: Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex- and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). METHODS: A mixed method study incorporating (1) team members' critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). RESULTS: Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex- and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. CONCLUSIONS: The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members.

Effects of linear and nonlinear speech rate changes on speech intelligibility in stationary and fluctuating maskers.

Algorithmic modifications to the durational structure of speech designed to avoid intervals of intense masking lead to increases in intelligibility, but the basis for such gains is not clear. The current study addressed the possibility that the reduced information load produced by speech rate slowing might explain some or all of the benefits of durational modifications. The study also investigated the influence of masker stationarity on the effectiveness of durational changes. Listeners identified keywords in sentences that had undergone linear and nonlinear speech rate changes resulting in overall temporal lengthening in the presence of stationary and fluctuating maskers. Relative to unmodified speech, a slower speech rate produced no intelligibility gains for the stationary masker, suggesting that a reduction in information rate does not underlie intelligibility benefits of durationally modified speech. However, both linear and nonlinear modifications led to substantial intelligibility increases in fluctuating noise. One possibility is that overall increases in speech duration provide no new phonetic information in stationary masking conditions, but that temporal fluctuations in the background increase the likelihood of glimpsing additional salient speech cues. Alternatively, listeners may have benefitted from an increase in the difference in speech rates between the target and background.