Impact Factor:1.137 | Ranking:21/36 in Social Sciences, Biomedical | 81/136 in Public, Environmental & Occupational Health | 5-Year Impact Factor:1.396Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
Sally Nathan s.nathan{at}unsw.edu.au School of Public Health and Community Medicine, UNSW AustraliaNiamh Stephenson School of Public Health and Community Medicine, UNSW AustraliaJeffrey Braithwaite Australian Institute of Health Innovation, UNSW AustraliaEmpirical studies of community participation in health services commonly tie effectiveness to the perceived legitimacy of community representatives among health staff. This article examines the underlying assumption that legitimacy is the major pathway to influence for community representatives. It takes a different vantage point from previous research in its examination of data (primarily through 34 in-depth interviews, observation and recording of 26 meetings and other interactions documented in field notes) from a 3-year study of community representatives’ action in a large health region in Australia. The analysis primarily deploys Michel de Certeau’s ideas of Strategy and Tactic to understand the action and effects of the generally ‘weaker players’ in the spaces and places dominated by powerful institutions. Through this lens, we can see the points where community representatives are active participants following their own agenda, tactically capitalising on cracks in the armour of the health service to seize opportunities that present themselves in time to effect change. Being able to see community representatives as active producers of change, not simply passengers following the path of the health service, challenges how we view the success of community participation in health. © 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC
By Ed Susman, Contributing Writer, MedPage Today Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.This small study of patients with Parkinson's disease and familial controls demonstrated significant deficits in speech and communication among the affected participants.SYDNEY -- A new study demonstrated that subtle changes in speech can impact the ability of Parkinson's patients to communicate and may result in further isolation from the community, researchers said here.
Patients participating in the Factors Affecting the Speech of People with Parkinson's Disease Study scored an average 14.8 percentage points lower in their ability to communicate intended emotions compared with controls (P=0.02), Maxwell Barnish, a PhD candidate at University of East Anglia in Norwich, England, and colleagues found.
In his poster presentation at the International Congress on Parkinson's Disease and Movement Disorders, Barnish noted that the communication and emotional conveyance were both predicted by patients' cognitive status as measured by the Montreal Cognitive Assessment.
"Cognitive impairment significantly affects speech and communication in Parkinson's disease," he said. "This leads to reduced communicative participation."
Parkinson's patients were stratified by the median score on the test, and those who scored lower than or equal to 23 also measured 16.7 percentage points lower, on average, in their ability to convey emotion, he told MedPage Today. Cognitive status predicted 19% of the variance in communicative participation, which was statistically significant (P<0.05), he said.
For the study, the researchers recruited 45 people with Parkinson's disease and 29 people who were friends or relatives of the patients. All were from various areas of the U.K. and all were white. The patients were about 70 years of age, and ranged from 48 to 93 years.
The group was not gender-balanced, with a predominance of men in the patients and a predominance of women among the controls. The difference was controlled for in the analysis, Barnish said.
"The majority of Parkinson's patients in this study had mild speech impairments, but this impairment had a substantial impact on everyday communication tasks," Barnish explained. "The qualitative analysis we performed indicated that patients were anxious about their speech and that voices sounded different."
Barnish suggested that their anxiety and perceived voice change might lead to them become less outgoing.
Previous research had not focused on the relationship between cognitive status and everyday communication, hence Barnish attempted to define these relationships.
"Further research is required to determine how these findings can be applied in speech and language therapy for Parkinson's disease," he added.
Alison Yarnall, MD, of the University of Newcastle in England, told MedPage Today, "This is an interesting area of study. Obviously speech and communication are important aspects of daily living that can be interrupted by Parkinson's disease."
"Drugs in Parkinson's disease are well studied with big randomized clinical trials, but things like speech therapy and physical therapy, which can make a massive difference to patients, are often not well studied," she said. Yarnall said she was interested in seeing how further research in the field could impact treatment decisions and resource implementation.
Barnish and Yarnall had no disclosures.
Primary source: Movement Disorder Society
Source reference:
Barnish M, et al "Relationships between cognitive status, speech characteristics and communicative participation in Parkinson's disease" MDS 2013.