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PubMed2002

Use of sevoflurane during cardiopulmonary bypass decreases incidence of awareness.

BACKGROUND AND OBJECTIVE: The role of sevoflurane has not been studied in relation to awareness during anaesthesia. We observed the effect of sevoflurane on the incidence of awareness during cardiopulmonary bypass for open-heart surgery. METHODS: Fifty-nine patients of age >17 yr undergoing open-heart surgery with cardiopulmonary bypass were randomly assigned to two groups. In both groups, induction was with etomidate, dehydrobenzperidol and fentanyl; anaesthesia was maintained with sevoflurane, fentanyl and N20; vecuronium was used for muscular paralysis. Group 1 (30 patients) received dehydrobenzperidol and fentanyl during cardiopulmonary bypass; Group 2 (29 patients) received sevoflurane and fentanyl. Patients were given different auditory inputs during different phases of surgery. All patients were interviewed with standard questions 8 and 24 h postoperatively for evidence of explicit awareness. RESULTS: Five patients in the dehydrobenzperidol group gave a history of awareness (16.67%) as opposed to none in the sevoflurane group. The difference in the incidences of awareness was significant (P < 0.05), but no differences were found between the interviews conducted at 8 and 24 h. Sevoflurane and opioid combination reduced the incidence of awareness in open-heart surgery.

Adult↗
PubMed1995

Phonological awareness in young second language learners.

English-speaking children (N = 91) who were attending French schools (bilingual group) were given a battery of phonological awareness tests in kindergarten and in grade I. At the time of kindergarten testing the mean age of the children was 5:9. Their performance was compared to age-matched English-speaking children (N = 72) attending English schools (monolingual group). The bilingual children showed heightened levels of phonological awareness skills in kindergarten in the area of onset-rime awareness. By grade I, the pattern of group differences was more complex. The monolingual and bilingual children performed similarly on onset-rime segmentation tasks. The monolingual children had higher phoneme awareness scores than their French-schooled peers; this result is interpreted to reflect the role of literacy instruction on phoneme awareness development. In comparison, the bilingual children had higher syllable segmentation scores than their monolingual peers. This result is interperted to reflect the role of second language input on phonological awareness.

Awareness↗
PubMed2000

Metalinguistic awareness and reading acquisition in the Spanish language.

This research was designed to establish the importance of phonological awareness and print awareness in learning to read Spanish. A sample of 136 preliterate Spanish children (70 boys and 66 girls) whose ages ranged from 5.1 to 6.6 years (average age 5.6 years) participated in the study. The results, using path analysis, from this longitudinal study support the existence of a relationship between phonological awareness and reading. Moreover, the findings of this study reveal the importance of syllabic awareness, at least in Spanish, in the development of other levels of phonological awareness and in its early relation with reading. The results also confirm the existence of a relationship between print awareness and reading comprehension.

Awareness↗
PubMed2006

A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design.

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings.

Activities of Daily Living↗
PubMed2004

[First effects of training phonological awareness in two age cohorts of kindergarten children].

OBJECTIVE: This study investigated to what extent young kindergarten children already benefit from training phonological awareness. METHODS: The training program used here was the German "Würzburg training program of phonological awareness". The control group participated in the regular kindergarten program. A total of 80 children, one and two years before entering school, participated in the study. Tests of phonological awareness were assessed before and after the training as well as after six months. RESULTS: Young kindergarten children (two years before entering school) compared to preschoolers (one year before entering school) had significant lower phonological awareness skills. However both cohorts showed noticeable significant training effects, but preschoolers benefited significantly more from training phonological awareness. Long-term effects were obtained for both cohorts. CONCLUSIONS: Already young kindergarten children do benefit effectively from preschool phonological awareness training. Effects of this training on reading and spelling in school will be investigated further.

Age Factors↗
PubMed2002

Intraoperative awareness: detected by the structured Brice interview?

BACKGROUND: Awareness is a rare complication in general anesthesia, but its consequences are stressful. Efforts must be undertaken to prevent, diagnose, and, if occurring, treat it. The incidence of awareness is higher following anesthesia involving the use of muscle relaxants. As a part of a quality assurance program at our short-stay surgery all patients exposed to general anesthesia are routinely subjected to a Brice interview, which aims to evaluate our standard anesthetic technique regarding awareness. METHODS: The Brice interview was used prospectively in 5216 patients given a propofol/opioid anesthetic for day-case or short-stay surgery. Neuromuscular blocks were used only for surgical needs, not routinely. All patients were interviewed on discharge from the recovery room. A second interview, according to Brice, was undertaken by telephone 3-7 days later in the case of a notable intraoperative event, or otherwise after postoperative patient complaints. All patients were also interviewed by telephone 1-2 days postoperatively. RESULTS: None of the patient interviews indicated awareness. This was also the case in five non-relaxed patients who had an incident of light anesthesia with eye opening and gross motor response without forewarning. Neuromuscular blockade was used in 7% of patients. DISCUSSION: We were unable to detect intraoperative awareness. The anesthetic regimen, including minimal use of muscle relaxants, might be beneficial for awareness prevention. Alternatively, the diagnostic power, the timing of the Brice interview, or the number of interviews performed may be questioned.

Adolescent↗
PubMed1985

Self-awareness and self-confrontation: effects of self-focused attention on members of a clinical population.

Research in the area of self-awareness theory has indicated that self-focused attention consistently produces both an increase in perceived intensity of affect and enhanced accuracy of self-reports. The present studies consider these effects in relation to the technique of self-confrontation as used in psychotherapy. In the first study, members of two different clinical populations (alcoholics and general psychiatric patients) either were or were not made self-aware and then were asked to self-report on their psychiatric problems and their mood states. Results indicated that self-awareness did increase the negative mood states for the psychiatric patients, and it also apparently increased the accuracy with which both patient groups reported on their history of hospitalization. In the second study self-awareness once again exacerbated the reported negative affect of a group of depressed psychiatric patients and enhanced the accuracy with which they reported on their hospitalizations. Additional analyses indicated that although the psychiatric patients generally felt worse when self-aware, they were also more accurate in their self-reports, including descriptions of their problems. The effects of self-awareness on members of clinical population are discussed and related to self-confrontation techniques.

Adult↗
PubMed1997

Orienting attention without awareness.

Previous research has shown that visual attention can be directed to a spatial location in 2 qualitatively different ways. Attention can be allocated endogenously in response to centrally presented precues, or it can be captured exogenously by a visual stimulus with an abrupt onset. It has been suggested that exogenous orienting of attention is an automatic process, whereas endogenous orienting of attention represents a controlled and strategic process. M.I. Posner and C.R.R. Snyder (1975) suggested that an automatic process occurs without intention, does not interfere with other mental processes, and does not necessarily give rise to awareness, whereas a controlled process will likely interfere with other processes and necessarily requires intention and awareness. Three experiments investigated the role of awareness in orienting visual attention. Endogenous and exogenous components of orienting attention were placed in opposition to each other to assess the automaticity of exogenous orienting by examining the potential for brief stimulus events to capture attention in the absence of subjective awareness. Results show that an exogenous cue presented below a subjective threshold of awareness captured attention automatically and without awareness.

Attention↗
PubMed2001

Have rapid socioeconomic changes influenced awareness of blood pressure in Poland?

The aim of our study was to evaluate changes in awareness of blood pressure during transition into a market economy in Poland. Thus, in 1994, we conducted a cross-sectional survey based on a questionnaire interview on a sample of 2080 men (M) and women (F) aged 18 years and over. The subjects were selected from a Polish population by stratified and cluster random sampling with quotas by the Center for Social Research in Sopot. They were asked if they were aware of blood pressure. The results were analysed according to age, sex, education level, income and place of living. In September 1997 we carried out the same investigation on a new group of 1664 adults. In addition to the questionnaire, the blood pressure (three recordings at home) measurements were completed. The interviewers were well-trained medical students. Awareness of blood pressure has declined (P < 0.001) from 71% in 1994 to 65.5% in 1997. The highest decrease in awareness of blood pressure was observed among less educated people, as well as among people living in smaller cities and villages. The overall prevalence of hypertension was 25.9% by 'older' WHO criteria (BP > or =160/95 mm Hg or taking antihypertensive medication) and 44.5% by JNC VI criteria (BP > or =140/90 mm Hg or taking antihypertensive medication). Forty-six percent of hypertensive subjects classified by JNC VI criteria were previously known to be hypertensives and 54% were newly detected (F: 39%, M: 69%). Low awareness of blood pressure in Poland is the crucial factor of insufficient detectability of hypertension. Decline of awareness of blood pressure being the most significant among people representing lower social status, emphasises the need for urgent preventive measures.

Adolescent↗
PubMed2004

Prevalence, awareness, treatment and control of hypertension in employees of factories of Northern Greece: the Naoussa study.

The objective of this study was to examine the prevalence and the levels of awareness, control, and treatment of hypertension in workers, technicians and clerks of factories of the city of Naoussa. A total of 1976 employees in 19 units were examined. From those, 1937 (1045 men and 892 women), 15-73 years of age, were included in the analysis. Every employee was examined twice with 1 week's interval between the two examinations. Analysis was performed using the 140/90 mmHg hypertension threshold. In every visit, three blood pressure (BP) measurements were taken with at least 1-min interval between them. In the analysis only the average BP of the second clinic visit was used. In total, hypertension prevalence was 30.5% (32.1% for men and 28.7% for women respectively, P=0.10). The levels of awareness, treatment, and control of hypertension in hypertensive patients were 18.6%, 11.8%, and 2.2%, respectively. The levels of awareness and treatment differed significantly between men and women (13.4 vs 25.4%, P<0.001 and 9.6 vs 14.8%, P<0.05), but there was no difference in the levels of control (1.5 vs 3.1%, P=0.18). Hypertension prevalence, awareness, and treatment differed also between patients <45 and > or =45 years of age (22.0 vs 53.2%, P<0.001, 9.7 vs 28.4%, P<0.001 and 6.5 vs 17.7%, P<0.001, respectively). In conclusion, the prevalence of hypertension in our study's population is high, while the levels of awareness, treatment, and control are disappointing and should be significantly improved. There is also a difference in awareness and treatment in favour of women compared to men and in favour of patients >/=45 years of age compared to those <45 years of age.

Adolescent↗
PubMed2006

Awareness, treatment and control of hypertension: the 'rule of halves' in an era of risk-based treatment of hypertension.

Detection, treatment and control of high blood pressure in many populations are insufficient. We reported current prevalence, awareness, treatment and control of hypertension in the Netherlands and compared the findings with other studies. Furthermore, we related actual treatment of hypertension to estimated absolute 10-year cardiovascular risk, as according to current guidelines on this subject, initiation of blood pressure-lowering treatment depends on the level of cardiovascular risk. The Utrecht Health Project is a prospective cohort study in a suburb of Utrecht. Information on medical history, life style and measurements of blood pressure, cholesterol and glucose of the first 4950 participants of the study was obtained. Cardiovascular risks were calculated using the Framingham risk function. Prevalence of hypertension was 23.3%. Among those with hypertension, 33.7% was aware of the condition. Of those aware, 59.4% was treated. Of those treated, 41.9% had blood pressure below the recommended level. In half of those aware of their hypertension, and a calculated cardiovascular risk less than 10%, treatment of hypertension was started unnecessary. Of those aware of their hypertension with a calculated cardiovascular 10 years risk exceeding the treatment threshold of 20%, treatment was absent in 33.6%. Awareness and control of hypertension are still inadequate in the Netherlands and comparable with other European countries. Management of hypertension is too often not risk-based despite recommendations in guidelines on prevention of cardiovascular diseases available since 2000.

Adolescent↗
PubMed1998

Sun awareness in school teachers.

School children are important targets for sun awareness education, but the knowledge, attitudes and behaviour of school teachers with respect to sun awareness are poorly understood. A questionnaire-based survey of 76 school teachers was undertaken. Twenty-four per cent of teachers indicated previous experience in teaching sun awareness, but 93% of teachers had no classroom resources for teaching sun awareness. Sun awareness was perceived by respondents as unimportant relative to other health education issues. There was considerable scope for improvement in attitudes and behaviour of teachers with respect to sun awareness. Teachers need more information about environmental factors which affect strength of sunlight, individual risk factors for sunburn and sunscreen strength. Intervention strategies involving school teachers need simple messages, emphasizing the importance of shade, clothing and hats in sun avoidance.

Adolescent↗
PubMed2003

Awareness of illness in patients with bipolar I disorder with or without comorbid anxiety disorders.

BACKGROUND: The present study examined whether specific types of comorbid anxiety disorders, namely panic disorder (PD), social phobia (SP) and obsessive-compulsive disorder (OCD) are differentially associated with course variables and insight into bipolar illness. METHOD: The sample consisted of 151 consecutively hospitalized patients with bipolar I disorder. They were assessed in the week prior to discharge using the Structured Clinical Interview for DSM-III-R (SCID-P), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF) and the Hopkins Symptom Checklist (HSCL-90). Level of insight was assessed with the Scale to assess Unawareness of Mental Disorders (SUMD). RESULTS: Of the 151 bipolar subjects, 92 had no PD, SP and OCD comorbidity, 35 had PD and 24 had SP and/or OCD. The three groups differed significantly on the current awareness of illness and treatment response scores and the retrospective awareness of illness and treatment response scores. Post-hoc analyses revealed that, compared with bipolar patients without PD/SD/OCD and those with comorbid PD, patients with comorbid SP and/or OCD had better insight on current awareness of illness, current awareness of treatment response, retrospective awareness of illness and retrospective awareness of treatment response. The regression analysis showed that the presence of no panic type anxiety comorbidity was a predictor of good insight. CONCLUSIONS: These data indicate the value of identifying comorbid anxiety disorders in patients with bipolar illness. The results could be interpreted as evidence of discrete disorders within the bipolar spectrum, one that is characterized by, among other things, SP and/or OCD with good insight, another characterized by PD with poor insight.

Adult↗
PubMed1997

Event-related brain potential correlates of two states of conscious awareness in memory.

We report an event-related potential (ERP) experiment of human recognition memory that explored the relation between conscious awareness and electrophysiological activity of the brain. We recorded ERPs from healthy adults while they made "remember" and "know" recognition judgments about previously seen words. These two kinds of judgments reflect "autonoetic" and "noetic" awareness, respectively. The ERP effects differed between the two kinds of awareness while they were similar for "true" and "false" recognition. Noetic awareness was associated with a temporoparietal positivity in the N400 range (325-600 ms) and a late (600-1,000 ms) frontocentral negativity, whereas autonoetic awareness was associated with a widespread, late, bifrontal and left parietotemporal (600-1000 ms) positivity. In the very late (1,300-1, 900 ms) time window, a right frontal positivity was observed for both remember and know judgments of both true and false targets. These results provide physiological evidence for two types of conscious awareness in episodic memory retrieval.

Adult↗
PubMedDate not supplied

Distributed situation awareness in dynamic systems: theoretical development and application of an ergonomics methodology.

The purpose of this paper is to propose foundations for a theory of situation awareness based on the analysis of interactions between agents (i.e. both human and non-human) in subsystems. This approach may help to promote a better understanding of technology-mediated interaction in systems, as well as helping in the formulation of hypotheses and predictions concerning distributed situation awareness. It is proposed that agents within a system each hold their own situation awareness, which may be very different from (although compatible with) that of other agents. It is argued that we should not always hope for, or indeed want, sharing of this awareness, as different system agents have different purposes. This view marks situation awareness as a dynamic and collaborative process binding agents together on tasks on a moment-by-moment basis. Implications of this viewpoint for the development of a new theory of, and accompanying methodology for, distributed situation awareness are offered.

Awareness↗
PubMedDate not supplied

Measuring team situation awareness in decentralized command and control environments.

Decentralized command and control settings like those found in the military are rife with complexity and change. These settings typically involve dozens, if not hundreds to thousands, of heterogeneous players coordinating in a distributed fashion in a dynamically networked battlefield laden with sensor data, intelligence reports, communications, and plans emanating from many different perspectives. Consider the concept of team situation awareness in this setting. What does it mean for a team to be aware of a situation or, more importantly, of a critical change in a situation? Is it sufficient or necessary for all individuals on the team to be independently aware? Or is there some more holistic awareness that emerges as team members interact? We re-examine the concept of team situation awareness in decentralized systems beyond an individual-oriented knowledge-based construct by considering it as a team interaction-based phenomenon. A theoretical framework for a process-based measure called 'coordinated awareness of situations by teams' is outlined.

Awareness↗
PubMed2002

The development of awareness and the use of compensatory strategies for cognitive deficits.

BACKGROUND: Cognitive rehabilitation often involves teaching individuals with acquired brain injuries (ABI) to use compensatory strategies for cognitive deficits. The use of compensatory strategies is frequently limited by reduced awareness of deficits. The process through which a person with ABI develops awareness and begins to use compensatory strategies is rarely explored from the clients' perspectives. OBJECTIVE: To explore the development of awareness and the use of compensatory strategies by adults with ABI. SETTING: A cognitive rehabilitation day treatment programme. METHOD: A critical incidents, qualitative inquiry was conducted with three clients who had made good recovery. The development of awareness and the use of compensatory strategies is examined from the clients' perspectives. Their perspectives are compared to the perspectives of the therapists with whom they worked during the cognitive rehabilitation process. RESULTS: Clients described the development of deficit awareness as a slow process with occasional 'aha' moments. These moments involved a comparison of current performance to pre-morbid performance on functional tasks. There was agreement among clients and therapists on the cognitive deficits manifested and on the strategies used to compensate for those deficits. The description of the process of developing awareness, however, was different. CONCLUSION: In-depth qualitative exploration of the experiences of clients has the potential to provide guidance for more effective cognitive rehabilitation interventions.

Adolescent↗
PubMed2004

Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries.

PRIMARY OBJECTIVE: To examine the relationship between self-awareness, goal setting ability (i.e. ability to set realistic goals) and performance/outcome in a cognitive task and for rehabilitation. RESEARCH DESIGN: Regression analyses were conducted to compare the predictive power of self-awareness and demographic/neuropsychological variables on goal setting ability and performance/outcome. METHODS AND PROCEDURES: Self-awareness of 63 patients with brain injuries was measured by direct clinicians' rating and the difference between patient and staff ratings in a questionnaire. RESULTS: The awareness measures predicted 32% of the variance for goal setting ability in the rehabilitation context but only 4% of the goal setting variance in the cognitive task. Similarly, self-awareness predicted 33% of the variance for rehabilitation outcome but only 5% of the performance in the cognitive task. CONCLUSIONS: Self-awareness seems to be related to goal setting ability and outcome in a long-term rehabilitation process but less in short-term experimental tasks.

Adult↗