Speech intelligibility and marital communication in Motor Neuron Disease

The onset of a progressive, fatal illness such as Motor Neuron Disease (MND) inevitably results in physical and communication disabilities that impinge on the individuals’ ability to remain functionally independent. The loss of speech as a result of dysarthria, a motor speech disorder, is one of the most profound changes that the person with MND will experience. The decline in the individuals’ speech intelligibility, that negatively influences communication effectiveness, implies that in 80% of cases alternative and augmentative communication (AAC) strategies are required to support the daily communication needs of individuals with MND. The dyadic nature of chronic illness implies that multiple aspects of one of the most important adult relationships, marriage, will be affected. Roles and responsibilities performed by each member of the couple will continually change as the disease progresses. The emotional trauma of adjusting to the unavoidable alteration in their relationship elicits strong emotions such as guilt, anger and frustration. Communication is one of the most constructive ways of dealing with these emotions. The ability of spouses to convey their innermost thoughts, feelings and intimacy through communicative interaction is vitally important in marital communication. The aim of this study was to compare how persons with MND and their spouses perceive changes in their marital communication in relation to the deteriorating speech of persons with MND. Fourteen couples divided into two participant groups, persons with MND and spouses, participated in this non-experimental correlational research study. Data was collected during three visits at six-monthly intervals over a 12 month period. At each of these visits both participant groups completed a variety of objective and subjective measures, of which twenty percent were interrated by independent raters. Results confirmed the inevitable decline in speech intelligibility of persons with MND across the disease progression. The persons with MND did not report a change in their perception of marital communication although their spouses indicated a statistically significant decrease between the first and last visits. Interestingly, there was no statistically significant relationship between the deteriorating speech of persons with MND and the couples’ perception of marital communication, confirming that marital communication was not influenced by decreased speech intelligibility.Thesis (PhD)--University of Pretoria, 2010.Centre for Augmentative and Alternative Communication (CAAC)unrestricte

Contributing factors to high prevalence of hearing impairment in the Elias Motsoaledi Local Municipal area, South Africa: A rural perspective

Background: There is evidence that the factors contributing to the prevalence and aetiology of hearing impairment vary widely from one country to another. In South Africa, as in other low-income and middle-income countries, more context-specific information on the estimated prevalence of hearing impairment and the factors that contribute to its onset is required. Aim: The aim of this study was to provide decision-makers and hearing health professionals with local and accurate information on the prevalence of ear and hearing disorders in the Elias Motsoaledi Local Municipal (EMLM) area of the Limpopo province, South Africa. Methods: The World Health Organization (WHO) protocol for population-based surveys of prevalence and causes of deafness, hearing impairment and other ear diseases was utilised. A random multi-stage cluster sampling strategy, two-stage sampling, was utilised to select the seven municipal wards and 357 households through the probability proportional to size method. A total of 850 participants were included in the study. Results: The overall prevalence of hearing impairment was 19.88% (95% confidence interval [CI]: 0.15–0.2) and 8.94 (95% CI: 0.08–0.12) for disabling hearing impairment. The prevalence of ear disease was 13.19% (95% CI: 0.10–0.15), with impacted cerumen and otitis media reported most often. Associations with hearing impairment were established for age, gender and hypertension. Conclusion: The study has shown a higher prevalence of disabling hearing impairment in the rural EMLM area of the Limpopo province compared to global prevalence rates. In addition, known factors associated with hearing impairment were confirmed

Availability of audiological equipment and protocols for paediatric assessment and hearing aid fitting in Gauteng, South Africa

Background: Accurate diagnosis and management of hearing loss (HL) is based on valid and accurate ear-specific and frequency-specific information. This is especially relevant as non-optimal hearing amplification as part of early hearing detection and intervention programmes may result in further delays in the speech and language development of children with HL. Audiological measures utilised may vary according to the age, cognitive ability and physical ability of the infant or child. It is therefore important to compare and critically evaluate current clinical practice in order to recommend guidelines for paediatric audiology in South Africa. Objectives: To determine the availability of audiological equipment and clinical protocols used by audiologists in Gauteng for paediatric audiological assessment and hearing aid (HA) fitting. Method: A descriptive, cross-sectional survey research design was utilised to describe the availability of clinical audiological equipment and protocols used by audiologists in Gauteng, South Africa for paediatric assessment and HA fitting. Eighteen audiology departments, eleven public hospitals and seven private practices were included in the study. Results: Results revealed the limited availability of departmental protocols within departments for paediatric assessment and HA fitting. Although there appeared to be a wide variety of equipment available to audiologists in public sector hospitals and private practice, a lack of high-frequency tympanometers and equipment for real ear measurements was revealed. Conclusion: These findings highlight the need for the development and use of current, evidence-based practice guidelines for paediatric audiological assessment and HA fitting in South Africa. These guidelines should include a list of essential equipment required for paediatric assessment and HA fitting. Current, evidence-based practice guidelines for paediatric HA fitting are important in ensuring that secondary developmental delays associated with a delay in early intervention for children with HL are reduced

Motor neuron disease : the impact of decreased speech intelligibility on marital communication

BACKGROUND: The onset of motor neuron disease (MND), a neurodegenerative disease, results in physical and communication disabilities that impinge on an individual’s ability to remain functionally independent. Multiple aspects of the marital relationship are affected by the continuously changing roles and responsibilities. Communication is one of the most constructive ways of dealing with emotions that are elicited by these changes. METHOD: This study explored the association between the deteriorating speech of persons with MND and couples’ perception of marital communication. Fourteen couples participated in this non-experimental correlational research study. Data were collected over a 12-month period through the administration of objective and subjective measures. RESULTS: Results showed that despite decreased speech intelligibility, the relationship between the deteriorating speech and the couples’ perception of marital communication was not statistically significant. CONCLUSION: Overall, the results proved that the supposition that communication between couples will invariably deteriorate as a result of progressively reduced speech intelligibility is not necessarily valid. The fundamental importance of effective communication in marriage is highlighted. It is well established that augmentative and alternative communication strategies can preserve the ability to develop and maintain intimate rewarding relationships, even in the face of profound physical disabilities.http://www.safpj.co.zaam201

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant

BACKGROUND Guidelines on physical activity or exercise and pregnancy encourage pregnant women to continue or adopt an active lifestyle during and following pregnancy.1-3 Two systematic reviews of pregnancy-related guidelines on physical activity found similarities between recommendations from different countries, but noted that the guidelines differed in focus.4 5 The guidelines provided variable guidance on prenatal exercise, or on how pregnant women might approach continuing or adopting sport activities.6 However, most guidelines did not include important topics such as prevalence and known risk factors for common pregnancy-related diseases and complaints, and the role of exercise in preventing and treating them. Importantly, the focus of most previous guidelines has been on healthy pregnant women in the general population, in whom there is almost always a decline in physical activity during pregnancy.7 8 Indeed, a high proportion of pregnant women follow neither physical activity nor exercise guidelines, 9 putting them at increased risk of obesity, gestational diabetes mellitus (GDM), and other pregnancy-related diseases and complaints.1 On the other hand, there are enthusiastic exercisers and elite athletes who often meet and exceed general exercise recommendations for pregnant women, but there are no exercise guidelines specifically for these women. Important questions for such women are unanswered in current guidelines: Which activities, exercises and sports can they perform, for how long and at what intensity, without risking their own health and the health of the fetus? How soon can they return to highintensity training and competition after childbirth? The IOC and most National Sports Federations encourage women to participate in all Olympic sport disciplines. The IOC promotes high-level performance, and it is also strongly committed to promoting lifelong health among athletes10-not just during their competitive sporting careers. With an increasing number of elite female athletes competing well into their thirties, many may wish to become pregnant, and some also want to continue to compete after childbirth. With this background, the IOC assembled an international expert committee to review the literature on physical activity and exercise (1) during pregnancy and (2) after childbirth, using rigorous systematic review and search criteria.11 For efficiency, where sex is not specified, the reader should assume that this manuscript about pregnancy and childbirth refers to females (ie, \u27the elite athlete who wishes to train at altitude\u27 is used in preference to \u27the elite female athlete...\u27). AIMS The September 2015 IOC meeting of 16 experts in Lausanne had three aims. They were to: 1. Summarise common conditions, illnesses and complaints that may interfere with strenuous exercise and competition, during pregnancy and after childbirth; 2. Provide recommendations for exercise training during pregnancy and after childbirth, for highlevel regular exercisers and elite athletes; and 3. Identify major gaps in the literature that limit the confidence with which recommendations can be made. METHODS For each section of the document, a search strategy was performed using search terms such as \u27pregnancy\u27 OR \u27pregnant\u27 OR \u27postpartum\u27 AND \u27exercise\u27 OR \u27physical activity\u27 OR\u27leisure activity\u27 OR\u27leisure\u27 OR \u27recreation\u27 OR \u27recreational activity\u27 or \u27physical fitness\u27 OR \u27occupational activity\u27 AND terms related to the condition under study (eg, \u27gestational diabetes\u27). Available databases were searched, with an emphasis on PubMed, EMBASE, Cochrane, PEDro, Web of Science and SPORTDiscus. In addition, existing guidelines with reference lists were scanned. The review of each topic followed the general order: prevalence of the condition in the general pregnant or postpartum population, prevalence in high-level exercisers or elite athletes, risk factors in the general population and in relation to exercise and sport, and effect of preventive and treatment interventions. Level of evidence and grade of recommendations are according to the Cochrane handbook (table 1) for prevention and treatment interventions only. Each member of the working group was assigned to be the lead author of one or more topics and 1-3 others were assigned to review each topic. A first full consensus draft was reviewed before and during the 3-day IOC meeting (27-29 September 2015), and a new version of each topic was submitted to the meeting chairs (KB and KMK) shortly after the meeting. Each topic leader made amendments before sending a new version for comments to the working group

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2 - The effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes

Prevalence, Causes and Socio-Economic Determinants of Vision Loss in Cape Town, South Africa

PURPOSE: To estimate the prevalence and causes of blindness and visual impairment in Cape Town, South Africa and to explore socio-economic and demographic predictors of vision loss in this setting. METHODS: A cross sectional population-based survey was conducted in Cape Town. Eighty-two clusters were selected using probability proportionate to size sampling. Within each cluster 35 or 40 people aged 50 years and above were selected using compact segment sampling. Visual acuity of participants was assessed and eyes with a visual acuity less than 6/18 were examined by an ophthalmologist to determine the cause of vision loss. Demographic data (age, gender and education) were collected and a socio-economic status (SES) index was created using principal components analysis. RESULTS: Out of 3100 eligible people, 2750 (89%) were examined. The sample prevalence of bilateral blindness (presenting visual acuity <3/60) was 1.4% (95% CI 0.9-1.8). Posterior segment diseases accounted for 65% of blindness and cataract was responsible for 27%. The prevalence of vision loss was highest among people over 80 years (odds ratio (OR) 6.9 95% CI 4.6-10.6), those in the poorest SES group (OR 3.9 95% CI 2.2-6.7) and people with no formal education (OR 5.4 95% CI 1.7-16.6). Cataract surgical coverage was 68% in the poorest SES tertile (68%) compared to 93% in the medium and 100% in the highest tertile. CONCLUSIONS: The prevalence of blindness among people ≥50 years in Cape Town was lower than expected and the contribution of posterior segment diseases higher than previously reported in South Africa and Sub Saharan Africa. There were clear socio-economic disparities in prevalence of vision loss and cataract surgical coverage in this setting which need to be addressed in blindness prevention programs

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field