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PubMed1996

Self-awareness of deficits in adults with traumatic brain injury: how best to measure?

Some method of assessing self-awareness of deficits in patients with traumatic brain injury (TBI) is required to increase our understanding of the phenomenon, and to then evaluate strategies for clinical intervention with patients who lack such self-awareness. Options for the assessment of self-awareness of deficits following TBI are reviewed. The most commonly used method is comparison of patients' self-ratings on questionnaires of functional abilities with ratings by relatives or staff on the same questionnaires. An additional method of assessment, an interviewer-rated semi-structured interview is proposed (the Self-Awareness of Deficits Interview), and some preliminary inter-rater reliability data are presented. However, quantitative methods of evaluating self-awareness have shortcomings, and qualitative research may be more appropriate in some circumstances. An approach which makes use of multiple measures to evaluate self-awareness of deficits is recommended.

Activities of Daily Living↗

PubMed2006

Awareness of and compliance with air pollution advisories: a comparison of parents of asthmatics with other parents.

OBJECTIVES: To determine parents' awareness of and compliance with air pollution advisories, and to compare the awareness and compliance of parents' of asthmatics to that of other parents. METHODS: Responses of 240 parents surveyed at pediatric clinic visits were compared. RESULTS: A total of 88% of parents were aware of air pollution advisories; 71% reduced pollution and 55% restricted children's play "sometimes" because of advisories. However, only 7% complied with more than one third of the advisories issued. More parents of asthmatics reported awareness of alerts (p = 0.002), reducing pollution (p = 0.005), or restricting play "sometimes" in response to advisories (p = 0.007). CONCLUSIONS: Most parents report awareness of and some compliance with air pollution advisories. Parents of asthmatics are more aware and somewhat more compliant than other parents.

Air Pollutants↗

PubMedDate not supplied

Mortality awareness and risk-taking in late adolescence.

The relationship of mortality awareness to sexual, drug, and athletic risk-taking by male and female college students was measured using two questionnaires. Regression analyses of Study 1 data revealed: (a) significantly greater sexual risk-taking among males (n = 68) than among females (n = 119) beta = -.20, p less than .01; (b) a significant negative relationship of mortality awareness to sexual risk-taking in males, beta = -.36, p less than .01; and (c) no relationship of mortality awareness to reported drug use or athletic risk-taking. Regression analyses of data from Study 2, which included only male subjects (n = 40), revealed that initial mortality awareness was significantly related to sexual risk-taking (beta = -.33, p less than .05), but that manipulated awareness of death did not affect willingness to take sexual risks. It was suggested that mortality awareness may reduce the taking of risks that present nonsalient consequences, and that the consequences of risky sexual behavior may be less salient for males than for females.

Adolescent↗

PubMed2006

Approaches to the assessment of awareness: conceptual issues.

Recent interest in the empirical exploration of patients' awareness in relation to their clinical states has resulted in a range of approaches taken to evaluate such awareness. These approaches vary in terms of the bases on which awareness is determined and rated, the contents of the measures used, the level of detail and complexity of judgements required, etc. The approaches use different definitions and objects of awareness and hence give rise to different (and on occasions divergent) awareness phenomena. Such differences help to explain both the contradictory nature of published results and the difficulties involved in generalising from them. In practical terms, these differences should encourage the development of management and rehabilitation strategies that are individual to specific phenomena of awareness.

Awareness↗

PubMed2006

What do we mean by "conscious" and "aware"?

The concepts of consciousness and awareness are multifaceted, and steeped in cultural and intellectual history. This paper explores their complexities by way of a series of contrasts: (1) states of consciousness, such as wakefulness and sleep are contrasted with awareness, a term that picks out the contents of consciousness: these range across all our psychological capacities; the scientific background of the two concepts is briefly outlined; (2) consciousness is contrasted to self-consciousness, itself a complex term embracing self-detection, self-monitoring, self-recognition, theory of mind and self-knowledge; (3) "narrow" and "broad" senses of consciousness are contrasted, the former requiring mature human awareness capable of guiding action and self-report, the latter involving the much broader capacity to acquire and exploit knowledge; (4) an "inner" conception of consciousness, by which awareness is essentially private and beyond the reach of scientific scrutiny, is contrasted with an "outer" conception which allows that consciousness is intrinsically linked with capacities for intelligent behaviour; (5) finally "easy" and "hard" questions of consciousness are distinguished, the former involving the underlying neurobiology of wakefulness and awareness, the latter the allegedly more mysterious process by which biological processes generate experience: Whether this final distinction is valid is a focus of current debate. Varied interests converge on the study of consciousness from the sciences and the humanities, creating scope for interdisciplinary misunderstandings, but also for a fruitful dialogue. Health professionals treating disorders of consciousness should be aware both of its scientific complexities and of its broad cultural background, which influences the public understanding of these conditions.

Animals↗

PubMedDate not supplied

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND: Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the children's general phonological abilities and lead to gains in their literacy skills. AIMS: To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies. METHODS & PROCEDURES: Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy. OUTCOMES & RESULTS: Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy. CONCLUSIONS: The results show the effectiveness of phonological awareness therapy in benefiting children's general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

Articulation Disorders↗

PubMed2004

The influence of sociodemographic factors on awareness, knowledge and attitude toward andropause among health professionals in Ile-Ife, Nigeria.

A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.

Adult↗

PubMedDate not supplied

Report from the CDC. Awareness of perinatal group B streptococcal infection among women of childbearing age in the United States, 1999 and 2002.

BACKGROUND: The issuance in 2002 of new guidelines recommending universal screening for group B Streptococcus (GBS), a leading cause of neonatal sepsis in the United States, has created a new opportunity to educate women of childbearing age to be active partners in prevention. METHODS: To assess baseline levels of awareness about perinatal GBS, we analyzed responses to a question included in a health communications/social marketing survey in 1999 and 2002. RESULTS: Among the 2917 women under 50 who responded, 47% reported ever having heard of perinatal GBS. Among women pregnant at the time of the survey, awareness was 66%. Women with a high school education or less (OR = 0.60, 95% CI 0.50-0.73), household income <25,000 US dollars (OR 0.65, 95% CI 0.54-0.79), or reporting black, Asian/Pacific Islander, or other race (ORs [95% CI] 0.70 [0.57-0.87], 0.61 [0.41-0.90], 0.41 [0.20-0.85], respectively) had lower awareness of perinatal GBS than other women. Women currently pregnant (OR 2.2, 95% CI 1.5-3.3) had higher awareness. CONCLUSIONS: Awareness of perinatal GBS is high among currently pregnant women, for whom this issue is most important. Efforts to raise awareness should be targeted to women from traditionally underserved populations, such as those who are of nonwhite race or who have lower educational attainment or household income.

Adolescent↗

PubMed2006

Exposure of UK industrial plumbers to asbestos, Part II: Awareness and responses of plumbers to working with asbestos during a survey in parallel with personal sampling.

Throughout the European Union, millions tonnes of asbestos were used in the manufacture of products for building and for industrial installations. Today, in the UK, it is estimated that over half a million non-domestic premises alone have asbestos-containing materials in them and it is recognized that those working in building maintenance trades continue to be at significant risk. In part II, the awareness of UK plumbers to when they are working with asbestos was investigated and compared with the monitored levels reported in part I. The plumbers were issued by post with passive samplers, activity logs to monitor a working week and a questionnaire. The activity logs were used to assess whether maintenance workers were knowingly or unknowingly exposed to airborne asbestos fibres during a course of a working week. The questionnaire was designed to gather information on their: age, employment status, current and past perception of the frequency which they work with asbestos and knowledge of the precautions that should be taken to limit exposure and risk. Approximately 20% of workers reported on the sample log that they had worked with asbestos. There was a high correlation (93%) between the sampling log replies that they were knowingly working with asbestos and measured asbestos on the passive sampler. However, some 60% of the samples had >5 microm long asbestos structures found by transmission electron microscopy (TEM) analysis suggesting that the plumbers were aware of about only one-third of their contacts with asbestos materials throughout the week. This increased to just over one half of the plumbers being aware of their contact based on the results for phase contrast microscopy (PCM) countable asbestos fibres. The results from the questionnaire found that over half of the plumbers replying thought that they disturb asbestos only once a year and 90% of them thought they would work with asbestos for<10 h year-1. Their expectations and awareness of work with asbestos were therefore far lower than found during the period of monitoring. The response to an open question on the precautions to be taken, found that 61% of plumbers would avoid disturbance and 59% would use respiratory protection if they did disturb asbestos. However, their awareness of the methods and the need to reduce their risk by control of emissions at source was very low and suggests that further awareness raising and training is needed. The survey was carried out prior to the introduction of the duty to manage and gives a useful baseline to assess the impact of regulatory initiatives.

Adult↗

PubMed2006

Independence of visual awareness from attention at early processing stages.

According to a widely accepted idea, only the results of attentional selection reach visual awareness. A competing model postulates that awareness is independent of attentional selection: contents of subjective visual experience may also exist without the contribution of attention. We tested these competing models by tracking the independent contributions of selective attention and awareness to electrophysiological brain responses. Our results showed that the earliest effects of visual awareness emerged earlier than the effects of attention and regardless of the presence or absence of attention. The early effects of attention were elicited regardless of the presence or absence of awareness. The results suggest that visual awareness and selective attention are initially independent of each other.

Adolescent↗

PubMed2005

Enhancing self-awareness in medical students: an overview of teaching approaches.

Self-awareness is an individual's tendency to pay attention to his or her own emotions, attitudes, and behavior in response to specific situations. In the case of physicians, self-awareness is their insight into how their emotional makeup influences patient care. Conceivably, such insight may improve doctors' professional performance. The authors review published approaches aimed at enhancing the self-awareness of medical students and draw attention to some problems in these approaches that call for further research. Published teaching programs of self-awareness may be classified as direct or indirect. The primary objective of direct programs is to promote students' insight into their own feelings and attitudes by classroom instruction or small-group discussions, during which students share with their peers their emotional responses to various clinical experiences. The primary objective of indirect approaches is to teach clinical skills, such as patient interviewing, patient counseling, and self-assessment. It has been claimed that these programs also enhance self-awareness by drawing students' attention to differences between students' assessment of their own performance and the assessments of their instructors and patients. Both types of programs should be given consideration for inclusion into the medical curriculum. However, since presently available evidence does not allow educators to identify an optimal teaching program, more study is needed concerning the effectiveness of the various approaches to teaching self-awareness. Specifically, an effort should be made to ascertain that the benefit of the direct approaches exceeds their cost in terms of time, teacher training, and-possibly-student embarrassment.

Attitude↗

PubMed1986

Awareness and recall.

Awareness and recall under anesthesia is a complication that appears to be related to the use of muscle relaxants. While little is known about unconscious awareness and its physical and psychological consequences, it is well known that recall can result in traumatic psychological sequelae under certain circumstances. The anesthesiologist must be aware of the possibility of awareness before it occurs and either try to avoid it or explain to the patient the possibility of awareness and the circumstances under which it might occur. In the event of unexpected awareness, the anesthesiologist must deal with the patient in an honest and forthright manner. Failure to do so may lead to dire psychological consequences for the patient and legal consequences for the anesthesiologist.

Anesthesia, General↗

PubMed2001

Hypertension guidelines and their limitations--the impact of physicians' compliance as evaluated by guideline awareness.

OBJECTIVE: The initial step of an optimal therapeutic strategy for patients with arterial hypertension is the recognition and acceptance of new recommendations by the physicians themselves. This guideline awareness of the physicians has never been evaluated in detail. DESIGN: The awareness of content of current recommendations in hypertension diagnosis, treatment and treatment control was therefore assessed in primary care physicians using a questionnaire. The guidelines of the German Hypertension Society were used as the reference standard. PARTICIPANTS: A total of 24 899 German physicians, including all internists, all cardiologists and 22% of general practitioners were contacted in a nationwide survey. MAIN OUTCOME MEASURES: The number of answers in agreement with the guideline was used as a measure of guideline awareness. Adequate awareness of content of guideline recommendations was defined as the correct answer to five out of eight questions; the correct answers had to include the appropriate definition of hypertension. RESULTS: The analysis was based on 11 547 returned questionnaires (47.1%). An adequate guideline awareness was found in 23.7% of the total study population, especially in 37.1% of cardiologists, in 25.6% of internists and in 18.8% of general practitioners. While the guideline awareness was significantly influenced by the duration of private practice, regional and municipal factors had only minor influence on the results. CONCLUSION: The impact of hypertension guidelines on actual medical knowledge is modest. Thus, the information strategies about current treatment guidelines must be improved and tailored to the needs of physicians in clinical practice to ultimately improve patient care.

Awareness↗

PubMed1996

Awareness of illness in schizophrenia and outpatient treatment adherence.

We present a brief measure of awareness of illness in schizophrenia and test whether awareness is related to perceived need for and adherence to outpatient psychiatric treatment. A prospective design assessed treatment adherence, awareness of the signs and symptoms of schizophrenia, symptoms, neurocognitive status, and substance abuse at baseline and 6-month follow-up in 89 persons with schizophrenia. Results indicate that persons with greater awareness perceived greater need for outpatient treatment and evidenced better adherence to outpatient treatment when adherence and awareness were measured concurrently. Awareness was not related to adherence at 6-month follow-up. In addition, neurocognitive impairment was associated with lower overall adherence to treatment when reported by collaterals at baseline and 6-month follow-up. Neurocognitive impairment was, however, associated with higher self-reported adherence to medication, which suggests that neurocognitive status may bias adherence reporting in persons with schizophrenia.

Adolescent↗

PubMedDate not supplied

An exploratory study of body awareness in persons with heart failure treated medically or with transplantation.

Heart failure is a chronic disabling problem afflicting a growing number of adults. These individuals experience episodes of exacerbation demonstrated by increasing shortness of breath, fatigue, and fluid retention. The symptoms often develop in a slow and insidious manner making perception of worsening difficult to determine. Theoretically, an increase in body awareness may help individuals recognize symptoms of worsening heart failure earlier, but it is not known whether increased body awareness leads to somatization, an abnormal dwelling on body symptoms. This study was conducted to describe body awareness in 90 persons with heart failure or after transplant. We found that the Body Awareness Quesionnaire was a reliable measure of this concept in this sample. When body awareness was examined for age, gender, and treatment (HF or transplant) group were examined, no significant differences were found. Furthermore, there were no significant relationships between body awarenss and negative moods such as anxiety, depression, or anger. Interventions to enhance body awareness may be a fruitful new direction that will improve symptom recognition without increasing somatization in persons with heart failure.

Affect↗

PubMedDate not supplied

Palpitations and cardiac awareness after heart transplantation.

OBJECTIVE: The aim of this study was to examine the awareness of resting heartbeat in heart transplantation recipients, compare it with that found in other medical populations, and determine whether clinical characteristics are associated with accurate heartbeat awareness. METHODS: Eligible patients underwent a research battery consisting of a heartbeat detection task and self-report questionnaires assessing cardiac symptoms, psychosocial variables, and cognitive function. The accurate awareness of resting heartbeat was determined by presenting the patients with auditory stimuli at each of six different delays following the R wave on the ECG. Patients then selected the tones that they thought coincided with the sensation they had of their heart beating. The patients' physicians rated their cardiac morbidity. The results were contrasted with comparable data obtained in previous work with other ambulatory medical populations. RESULTS: Forty-one consecutive heart transplantation recipients who survived for at least 3 months after surgery were eligible. Thirty-four (82.9%) of them were studied and complete data were obtained on 26 (63.4%). Nine patients (34.6%) were reliably able to detect their resting heartbeat. When compared with the 17 patients who were not accurately aware of their heartbeat, the two groups did not differ significantly in cardiac morbidity, cognitive brain dysfunction, generalized psychiatric distress, depression, somatization, or hypochondriacal attitudes. A significantly higher proportion of heart transplantation recipients were accurately aware of their heartbeat than was found in a sample of general medical outpatients and in asymptomatic, nonpatient volunteers. CONCLUSIONS: One-third of heart transplant recipients are accurately aware of resting heartbeat, despite the absence of cardiac innervation.

Adult↗

PubMedDate not supplied

Cholesterol awareness and treatment in patients with coronary artery disease participating in cardiac rehabilitation.

OBJECTIVES: To survey cholesterol management practices among patients with coronary artery disease enrolled and not enrolled in cardiac rehabilitation. BACKGROUND: The National Cholesterol Education Program (NCEP) initially established guidelines regarding cholesterol awareness and treatment in 1987. Serum cholesterol reduction is most effective for reducing cardiac events in patients with established coronary artery disease, yet surveys of cholesterol awareness and treatment have not included these patients. METHODS: Three hundred seventy-nine men and women with coronary artery disease were surveyed according to cholesterol awareness, serum cholesterol level, frequency of lipid-lowering medication use, and frequency of achievement of a serum total cholesterol < 5.2 mmol/L (200 mg/dL) corresponding the 1987 NCEP guidelines for coronary artery disease patients, which were in place at the time of the study survey. RESULTS: Overall, 72% of the patients were aware of their cholesterol level, with an average serum total cholesterol of 5 5 +/- 1.0 mmol/L (213 +/- 39 mg/dL). Use of lipid-lowering medication was 26%. Forty-three percent had a total cholesterol < 5.2 mmol/L (200 mg/dL). Patients enrolled in a long-term cardiac rehabilitation program demonstrated enhanced cholesterol awareness (78%), lower total cholesterol values (5.2 +/- 0.9 mmol/L [203 +/- 36 mg/dL]), higher use of lipid-lowering the therapy (34%), and more frequent achievement of total serum cholesterol of < 5.2 mmol/L (200 mg/dL) (48%) compared to the other patient groups (all P < .05). CONCLUSIONS: Patients with coronary artery disease demonstrate relatively low rates of cholesterol awareness, lipid-lowering medication use, and achievement of total serum cholesterol < 5.2 mmol/L (200 mg/dL) corresponding to the 1987 NCEP guidelines. Participation in long-term cardiac rehabilitation is associated with enhancement of these rates. Further efforts to educate physicians and develop programs to optimize cholesterol management in patients with coronary artery disease are needed.

Aged↗