Understanding the challenges, opportunities, and drivers to addressing health inequalities within local health systems: the UNFAIR case study qualitative project

\ua9 The Author(s) 2025. Background: Despite policy prominence and frameworks focusing on health inequalities, healthcare leaders do not feel they have the skills and knowledge to reduce health inequalities. This comparative case study explored four areas in England to understand the challenges, opportunities, and drivers of local health systems addressing health inequalities and what ‘good’ practice might look like. Methods: Interviews were held with 46 people working in health care services across the NHS, local authority or voluntary, community, social enterprise sectors. Key documents (n = ~ 10) in each of the four areas relating to reducing health inequalities were analysed using documentary analysis methods. Interviews and documents were coded and analysed independently before being integrated to synthesise findings. Analysis was conducted using a two-stage approach - firstly, an inductive analysis of emergent themes; secondly, to build knowledge on each case studys’ system approach of reduction of health inequalities, principles of the Action Scales Model were used. Results: Nineteen themes were identified across the four case studies; some themes were not apparent in all the case studies, nor in either the documentary analysis or interviews. These themes allowed us to compare between cases to explore what might be contributing to good practice. Themes identified included: understanding the local context; facilitators of how to tackle health inequalities and improve health and wellbeing; and future concerns. The secondary analysis highlighted potential levers for action from each case study; these included optimising retention and recruitment of workforce and allowing time and resources for longer-term planning. Two case study areas which appeared to have system resilience, demonstrated having a shared vision, strong partnerships, understanding of the system, and putting people and communities at the heart of decision making. Conclusion: This comparative case study makes a crucial contribution in the understanding of health systems addressing health inequalities in their local areas. The combined interview and documentary analysis findings provide rich insights of local systems’ documented strategies, plans and what is happening ‘on the ground’

Enhanced Syllable Discrimination Thresholds in Musicians

Speech processing inherently relies on the perception of specific, rapidly changing spectral and temporal acoustic features. Advanced acoustic perception is also integral to musical expertise, and accordingly several studies have demonstrated a significant relationship between musical training and superior processing of various aspects of speech. Speech and music appear to overlap in spectral and temporal features; however, it remains unclear which of these acoustic features, crucial for speech processing, are most closely associated with musical training. The present study examined the perceptual acuity of musicians to the acoustic components of speech necessary for intra-phonemic discrimination of synthetic syllables. We compared musicians and non-musicians on discrimination thresholds of three synthetic speech syllable continua that varied in their spectral and temporal discrimination demands, specifically voice onset time (VOT) and amplitude envelope cues in the temporal domain. Musicians demonstrated superior discrimination only for syllables that required resolution of temporal cues. Furthermore, performance on the temporal syllable continua positively correlated with the length and intensity of musical training. These findings support one potential mechanism by which musical training may selectively enhance speech perception, namely by reinforcing temporal acuity and/or perception of amplitude rise time, and implications for the translation of musical training to long-term linguistic abilities.Grammy FoundationWilliam F. Milton Fun

Beat synchronization across the lifespan: intersection of development and musical experience

Rhythmic entrainment, or beat synchronization, provides an opportunity to understand how multiple systems operate together to integrate sensory-motor information. Also, synchronization is an essential component of musical performance that may be enhanced through musical training. Investigations of rhythmic entrainment have revealed a developmental trajectory across the lifespan, showing synchronization improves with age and musical experience. Here, we explore the development and maintenance of synchronization in childhood through older adulthood in a large cohort of participants (N = 145), and also ask how it may be altered by musical experience. We employed a uniform assessment of beat synchronization for all participants and compared performance developmentally and between individuals with and without musical experience. We show that the ability to consistently tap along to a beat improves with age into adulthood, yet in older adulthood tapping performance becomes more variable. Also, from childhood into young adulthood, individuals are able to tap increasingly close to the beat (i.e., asynchronies decline with age), however, this trend reverses from younger into older adulthood. There is a positive association between proportion of life spent playing music and tapping performance, which suggests a link between musical experience and auditory-motor integration. These results are broadly consistent with previous investigations into the development of beat synchronization across the lifespan, and thus complement existing studies and present new insights offered by a different, large cross-sectional sample

Neural correlates of indicators of sound change in Cantonese: evidence from cortical and subcortical processes

Across time, languages undergo changes in phonetic, syntactic and semantic dimensions. Social, cognitive and cultural factors contribute to sound change, a phenomenon in which the phonetics of a language undergo changes over time. Individuals who misperceive and produce speech in a slightly divergent manner (called innovators) contribute to variability in the society, eventually leading to sound change. However, the cause of variability in these individuals is still unknown. In this study, we examined whether such misperceptions are represented in neural processes of the auditory system. We investigated behavioral, subcortical (via FFR), and cortical (via P300) manifestations of sound change processing in Cantonese, a Chinese language in which several lexical tones are merging. Across the merging categories, we observed a similar gradation of speech perception abilities in both behavior and the brain (subcortical and cortical processes). Further, we also found that behavioral evidence of tone merging correlated with subjects’ encoding at the subcortical and cortical levels. These findings indicate that tone-merger categories, that are indicators of sound change in Cantonese, are represented neurophysiologically with high fidelity. Using our results, we speculate that innovators encode speech in a slightly deviant neurophysiological manner, and thus produce speech divergently that eventually spreads across the community and contributes to sound change

Evidence for Shared Cognitive Processing of Pitch in Music and Language

Language and music epitomize the complex representational and computational capacities of the human mind. Strikingly similar in their structural and expressive features, a longstanding question is whether the perceptual and cognitive mechanisms underlying these abilities are shared or distinct – either from each other or from other mental processes. One prominent feature shared between language and music is signal encoding using pitch, conveying pragmatics and semantics in language and melody in music. We investigated how pitch processing is shared between language and music by measuring consistency in individual differences in pitch perception across language, music, and three control conditions intended to assess basic sensory and domain-general cognitive processes. Individuals’ pitch perception abilities in language and music were most strongly related, even after accounting for performance in all control conditions. These results provide behavioral evidence, based on patterns of individual differences, that is consistent with the hypothesis that cognitive mechanisms for pitch processing may be shared between language and music.National Science Foundation (U.S.). Graduate Research Fellowship ProgramEunice Kennedy Shriver National Institute of Child Health and Human Development (U.S.) (Grant 5K99HD057522

Assessing performance on the Montreal Cognitive Assessment (MoCA) in experienced cochlear implant users: use of alternative scoring guidelines.

Although research suggests a relationship between hearing impairment and cognitive decline in older adults, nuances of this relationship remain unclear. This uncertainty could be attributed to verbal administration of standardized cognitive measures to hearing-impaired (HI) individuals. Various strategies for testing HI populations have been suggested. We tested the efficacy of applying alternative scoring methods that systematically removed auditory-based items on the Montreal Cognitive Assessment (MoCA) in 27 cochlear implant patients. We calculated the original MoCA score and three alternative scores. The first alternative removed items from the Attention and Language sections; the second alternative removed the Delayed Recall task, and the third alternative removed the Attention, Language, and Delayed Recall items. QoL was assessed using the Glasgow Benefit Inventory and Nijmegen Cochlear Implant Questionnaire. Results indicate a significant difference in MoCA scores with two alternative scoring methods. The second alternative MoCA score related to self-reported performance on the GBI

Subcortical neural synchrony and absolute thresholds predict frequency discrimination independently

The neural mechanisms of pitch coding have been debated for more than a century. The two main mechanisms are coding based on the profiles of neural firing rates across auditory nerve fibers with different characteristic frequencies (place-rate coding), and coding based on the phase-locked temporal pattern of neural firing (temporal coding). Phase locking precision can be partly assessed by recording the frequency-following response (FFR), a scalp-recorded electrophysiological response that reflects synchronous activity in subcortical neurons. Although features of the FFR have been widely used as indices of pitch coding acuity, only a handful of studies have directly investigated the relation between the FFR and behavioral pitch judgments. Furthermore, the contribution of degraded neural synchrony (as indexed by the FFR) to the pitch perception impairments of older listeners and those with hearing loss is not well known. Here, the relation between the FFR and pure-tone frequency discrimination was investigated in listeners with a wide range of ages and absolute thresholds, to assess the respective contributions of subcortical neural synchrony and other age-related and hearing loss-related mechanisms to frequency discrimination performance. FFR measures of neural synchrony and absolute thresholds independently contributed to frequency discrimination performance. Age alone, i.e., once the effect of subcortical neural synchrony measures or absolute thresholds had been partialed out, did not contribute to frequency discrimination. Overall, the results suggest that frequency discrimination of pure tones may depend both on phase locking precision and on separate mechanisms affected in hearing loss