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Assessment of hypoglycaemia awareness using continuous glucose monitoring.

AIMS: To investigate the possibility of assessing hypoglycaemia awareness in patients with Type 1 diabetes using continuous glucose monitoring. METHODS: Twenty patients with Type 1 diabetes were investigated. Ten patients with Type 1 diabetes and strongly impaired hypoglycaemia awareness were compared with 10 patients with intact hypoglycaemia awareness regarding quality of hypoglycaemia perception (number of undetected hypoglycaemic episodes per 24 h, glucose level < 3.3 mmol/l). Hypoglycaemia detection was assessed using the event function of the Continuous Glucose Monitoring System (CGMS; Medtronic MiniMed, Northridge, CA, USA). Patients were instructed to enter an event upon suspecting being hypoglycaemic. RESULTS: Satisfactory CGMS performance could be achieved [mean r = 0.893 between calibration measurements and CGMS data, mean absolute difference (MAD) = 20.6%], although artefacts were observable and had to be controlled. Hypoglycaemia unaware patients showed a significantly higher total number of hypoglycaemic episodes (P < 0.05), number of undetected hypoglycaemic episodes (P < 0.01), and mean glucose levels (P < 0.05). Even in aware patients, undetected hypoglycaemia was observable. No significant differences regarding occurrence of nocturnal hypoglycaemia were observable. CONCLUSIONS: The possibility of direct assessment of hypoglycaemia awareness using continuous glucose monitoring was demonstrated. Its application in clinical practice could be of use for assessing hypoglycaemia perception and evaluating the impact of treatment changes on hypoglycaemia awareness.

Adult↗

Emotional awareness and couples' relationship satisfaction.

This study examined the role of emotional awareness in couples' relationships and the effects of a tendency to respond to difficult couples' situations with "soft" emotions (including sadness and fear) versus "hard" emotions (including anger and resentment). Participants were 56 heterosexual couples who completed a measure of relationship satisfaction and two measures of emotional awareness, including one that was developed as part of this study. Results indicated that women were more emotionally aware than men in response to couples' situations, but not in response to general situations outside the relationship. In addition, higher levels of emotional awareness and a higher awareness of "hard" emotions were associated with decreased relationship satisfaction for women, but not for men. Discrepancy between partners' levels of awareness was related to lower satisfaction for both men and women.

Adaptation, Psychological↗

Toxicity awareness and unintended suicide in drug overdoses.

The objective of this paper is to determine patients awareness of the toxicity of the drugs they overdose with, the source of these drugs, and whether they would have taken them had they been fully aware of their toxicity, and to examine the implications for prevention. A prospective review of one hundred consecutive overdoses admitted through an A&E department was carried out. Awareness was scored by a ranking questionnaire and intent by response to a standard question when toxicity was explained. Paracetamol was most the most frequently taken drug (39 cases). Overall awareness of toxicity was low. Twenty-eight patients (30%) said they would not have overdosed if they had been aware of the toxicity of what they had taken. Forty-nine per cent of patients took someone elses tablets. There is a rise in analgesic poisoning from 1976. Higher toxicity awareness may reduce the incidence of drug overdose. Smaller prescriptions and over the counter preparations especially paracetamol and limited access to toxic drugs, especially in high-risk homes, should reduce both the number and severity of overdoses. It is possible that a number of deaths from deliberate drug overdose may be unintentional as 30% of survivors in this study did not intend the toxic effects of the drug taken.

Accident Prevention↗

Factors associated with hypertension awareness, treatment, and control in a representative sample of the chinese population.

We studied factors associated with awareness, treatment, and control of hypertension (systolic/diastolic blood pressure measurements >/=140/90 mm Hg, respectively, and/or current drug treatment for hypertension) in a representative sample of the Chinese population (n=15 838). Awareness, treatment, and control were defined by self-report of a hypertension diagnosis, self-report of current antihypertensive medication use, and a systolic and diastolic blood pressure <140/90 mm Hg, respectively. Higher awareness (OR; 95% CI) was noted for persons who were married (1.43; 1.09, 1.88) and had their blood pressure measured in 1 year (47.4; 31.7, 70.4) or 1 to 5 years (11.4; 7.09, 18.2) preceding their study visit; lower awareness was found among men (0.62; 0.52, 0.74) and current smokers (0.79; 0.63, 0.99). Among those aware of their hypertension, treatment was more common (OR; 95% CI) at higher income (1.24 [0.87, 1.75], 1.46 [1.01, 2.12] and 1.58 [1.06, 2.37] for increasing versus the lowest quartile of income) and for participants who had their blood pressure measured during the preceding year (3.87; 1.89, 7.93) and was less common among men (0.76; 0.59, 0.98). Controlled hypertension was more common (OR; 95% CI) among persons whose blood pressure had been measured 1 year (4.93; 1.51, 16.1) and 1 to 5 years (14.8; 3.63, 60.5) prior to their study visit and, among persons aware of their hypertension diagnosis, those who undertook lifestyle modification (1.59; 1.11, 2.27). These data identify potential methods for improving blood pressure control in China through the identification, follow-up, and lifestyle modification of persons with high blood pressure.

Adult↗

Representation of change: separate electrophysiological markers of attention, awareness, and implicit processing.

Awareness of change within a visual scene only occurs in the presence of focused attention. When two versions of a complex scene are presented in alternating sequence separated by a blank mask, unattended changes usually remain undetected, although they may be represented implicitly. To test whether awareness of change and focused attention had the same or separable neurophysiological substrates, and to search for the neural substrates of implicit representation of change, we recorded event-related brain potentials (ERPs) during a change blindness task. Relative to active search, focusing attention in the absence of a change enhanced an ERP component over frontal sites around 100-300 msec after stimulus onset, and in posterior sites at the 150-300 msec window. Focusing attention to the location of a change that subjects were aware of, replicated those attentional effects, but also produced a unique positive deflection in the 350-600 msec window, broadly distributed with its epicenter in mediocentral areas. The unique topography and time course of this latter modulation, together with its dependence on the aware perception of change, distinguishes this "awareness of change" electrophysiological response from the electrophysiological effects of focused attention. Finally, implicit representation of change elicited a distinct electrophysiological event: Unaware changes triggered a positive deflection at the 240-300 msec window, relative to trials with no change. Overall, the present data suggest that attention, awareness of change, and implicit representation of change may be mediated by separate underlying systems.

Adolescent↗

Subjective awareness of abnormal involuntary movements in chronic schizophrenic patients.

The authors examined the effects of verbal and visual feedback on subjective awareness of involuntary movements in 20 chronic schizophrenic patients. At initial evaluation only 25% of the patients were fully aware of their movement disorder. Both verbal and visual feedback resulted in significant immediate enhancement of awareness. However, assessment of awareness 2 weeks later showed a return to prefeedback baseline levels. Lack of awareness of involuntary movements was associated with a lack of awareness of psychiatric disorder, and both were associated with a longer duration of illness.

Adult↗

Relationship of awareness of dyskinesia in schizophrenia to insight into mental illness.

OBJECTIVE: The purpose of this study was to determine whether lack of awareness of motor dysfunction and lack of insight into mental dysfunction are related and to evaluate the longitudinal stability of lack of awareness of abnormal movements in schizophrenia. METHOD: Forty-three patients with schizophrenia and tardive dyskinesia participated in the study. The Scale of Unawareness of Mental Disorder was used to assess insight. All patients still meeting inclusion criteria after 2 years (N = 16) were reevaluated at follow-up. RESULTS: Twenty (46.5%) of the 43 patients had at least moderate unawareness of their tardive dyskinesia. Awareness of tardive dyskinesia was only modestly related to two of the five dimensions of insight into mental disorder assessed. Patients with the deficit syndrome showed significantly less awareness of their tardive dyskinesia than patients without the deficit syndrome. Lack of awareness of tardive dyskinesia was stable over time. CONCLUSIONS: Lack of awareness of tardive dyskinesia is a common feature in schizophrenia and is stable over time. Since patients are often unaware of dyskinesia, direct clinical examination is required to identify early tardive dyskinesia.

Adult↗

Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial.

OBJECTIVE: Schizophrenia is characterized by high suicide risk and low awareness of disorder. Although awareness has benefits for medication compliance and clinical outcome, it is unclear how it may relate to suicide risk in this population. METHOD: This multicenter investigation assessed awareness and suicide-related behavior in 980 patients with schizophrenia or schizoaffective disorder. Patients were followed over 2 years and assessed by blinded raters for suicide-related events. RESULTS: Awareness of psychiatric condition at baseline was associated with increased risk of suicide events over the follow-up. This effect was mediated by depression and hopelessness levels. By contrast, changes in awareness associated with treatment decreased the risk of suicide. CONCLUSIONS: Although some patients may become depressed after acknowledging the clinical handicaps of their disorder, treatment-related changes in awareness are generally associated with a positive outcome relative to suicide risk. The complex interactions and mediation effects of these clinical variables require careful monitoring.

Adult↗

Information and awareness of diagnosis and progression of cancer in adult and elderly cancer patients.

AIMS AND BACKGROUND: The present study examines the effects of physicians' attitudes towards providing information about diagnosis and progression of disease to cancer patients. The aims of the study were to: a) establish how many patients (subdivided into an adult and an elderly group) were informed and how many were aware of the diagnosis and progression of disease; b) identify possible significant differences between the two groups as regards information and awareness of disease; c) determine possible significant differences between information about diagnosis and disease progression and between awareness of diagnosis and progression within each group, and d) identify the patients' real needs. METHODS AND STUDY DESIGN: A total of 311 adults and 92 elderly cancer patients were enrolled in the study. A semi-structured clinical interview was employed to assess the "information" and "awareness" variables and the patients' needs. Statistical analyses were made with the chi squared test. RESULTS: Significant differences were observed between the two groups as regards information and awareness of diagnosis. Within each group, we found significant differences between information about diagnosis and progression and between awareness of diagnosis and progression. The principle needs expressed in both groups were to have clear information and emotional containment. CONCLUSIONS: The results of the study showed that physicians informed a greater number of adult than elderly patients and more often during the early rather than in the more advanced stages of the disease.

Adult↗

Awareness in retrieval medicine.

Awareness is the spontaneous recall of an event(s) that occurred during general anaesthesia and surgery. The incidence of awareness is approximately 0.2% of cases where neuromuscular blockers are used and half that where they are omitted. The majority of data relating to awareness is from anaesthetic practice. We report a case of awareness associated with an out-of-hospital transportation of a critically ill patient requiring a medical escort (retrieval). We discuss the risk factors associated with awareness during retrieval, in particular the trend toward excessive administration of neuromuscular blockers, and the unique challenges for the prevention of awareness within the retrieval environment.

Adult↗

Primary ACL Repair and Reconstruction in Isolated ACL Ruptures: Forgotten Joint Scores and the Association Between Residual Laxity and Joint Awareness.

BACKGROUND: Primary anterior cruciate ligament (ACL) repair has recently reemerged as a treatment option for carefully selected proximal ACL tears. However, evidence regarding patient-reported joint awareness and the relationship between postoperative laxity and joint awareness remains limited. PURPOSE: To compare joint awareness, clinical outcomes, and postoperative laxity between primary ACL repair and hamstring tendon autograft reconstruction in carefully selected patients with isolated ACL rupture, and to explore the association between residual laxity and postoperative joint awareness. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective cohort study included 85 patients with isolated ACL rupture treated with either primary ACL repair (n = 26) or hamstring autograft reconstruction (n = 59), with a minimum follow-up of 24 months. Clinical outcomes, including visual analog scale score, Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner activity scale score, postoperative knee laxity, return to sport, and rerupture rates, were evaluated. The authors also used the Forgotten Joint Score-12 (FJS-12), a measure of joint awareness, to evaluate patients. A higher score reflects lower joint awareness, suggesting function more similar to a native knee. Multivariable regression analyses were performed to evaluate variables associated with postoperative FJS-12 values. RESULTS: No differences were observed between groups in postoperative Lysholm, IKDC, and Tegner activity scale scores; Lachman- and pivot-shift-assessed postoperative laxity; and return-to-sport rates. However, postoperative FJS-12 values were significantly higher in the repair group compared with the reconstruction group (87.0 &#xb1; 15.0 vs 77.5 &#xb1; 14.2; mean difference, 9.5 points [95% CI, 2.8-16.3]; P = .006), corresponding to a moderate effect size (Cohen d = 0.66). Secondary exploratory regression analyses demonstrated that residual postoperative laxity was associated with lower postoperative FJS-12 values in both Lachman- and pivot-shift-based models (R2 = 0.649 and 0.680, respectively; P < .001 for both). CONCLUSION: In carefully selected patients with proximal ACL tears and adequate tissue quality, no significant between-group differences were detected in conventional clinical outcomes, postoperative laxity, return-to-sport rates, or rerupture rates between primary ACL repair and reconstruction. Primary ACL repair was associated with higher postoperative FJS-12 values at short- to midterm follow-up, suggesting function more similar to that of a native knee. Residual postoperative laxity was associated with lower FJS-12 values in secondary exploratory analyses.

Humans↗

Changes in reported awareness of product warning labels and messages in cohorts of California Hispanics and non-Hispanic whites.

A cohort of 777 Hispanics and 234 non-Hispanic Whites were interviewed in San Francisco, California, over the telephone in 1991 and again 1 year later. Overall, both Hispanics and non-Hispanic Whites showed an increase in awareness of a general product warning label for beer and wine containers but a decrease in awareness of a product warning label for cigarettes. High- and low-acculturated Hispanics' awareness of a general product warning label increased for alcoholic beverage containers, although highly acculturated Hispanics were more aware. Both Hispanics and non-Hispanic Whites showed an increase in awareness of specific warning messages. The highly acculturated Hispanics showed more increased awareness of specific message than the less acculturated Hispanics.

Adult↗

The relationship between self-awareness of neurobehavioral symptoms, cognitive functioning, and emotional symptoms in multiple sclerosis.

OBJECTIVE: To examine self-awareness of neurobehavioral symptoms in multiple sclerosis (MS) across three domains of function (apathy, disinhibition, and executive control), and examine the relationship between self-awareness and cognitive functioning. METHODS: Twenty-six individuals with MS completed neuropsychological testing, measures of emotional functioning, and self-ratings of neurobehavioral symptoms using the Frontal Systems Behavior Scale (FrSBe), a 46-item questionnaire with subscales assessing frequency of symptoms in executive dysfunction, disinhibition, and apathy. Informants' ratings of the FrSBe were also obtained. Decreasing differences between patient and informant reports on each subscale of the FrSBe (concordance) indicate higher levels of self-awareness. RESULTS: Results showed significant positive correlations between cognitive abilities and self-awareness of executive dysfunction and disinhibition. In contrast, affect symptomatology (measures of anxiety and depression) were negatively correlated with self-awareness of executive dysfunction. CONCLUSIONS: Level of self-awareness of neurobehavioral symptoms in MS is related to level of cognitive impairment In addition, symptoms of depression and anxiety reduced the accuracy of self-reporting. Thus, a clinician who relies on self-reports in creating an evaluation and treatment plan should consider the patient's cognitive and emotional states.

Adult↗

Mode of functional connectivity in amygdala pathways dissociates level of awareness for signals of fear.

Many of the same regions of the human brain are activated during conscious attention to signals of fear and in the absence of awareness for these signals. The neural mechanisms that dissociate level of awareness from activation in these regions remain unknown. Using functional magnetic resonance imaging with connectivity analysis in healthy human subjects, we demonstrate that level of awareness for signals of fear depends on mode of functional connectivity in amygdala pathways rather than discrete patterns of activation in these pathways. Awareness for fear relied on negative connectivity within both cortical and subcortical pathways to the amygdala, suggesting that reentrant feedback may be necessary to afford such awareness. In contrast, responses to fear in the absence of awareness were supported by positive connections in a direct subcortical pathway to the amygdala, consistent with the view that excitatory feedforward connections along this pathway may be sufficient for automatic responses to "unseen" fear.

Adult↗

Declarative memory, awareness, and transitive inference.

A characteristic usually attributed to declarative memory is that what is learned is accessible to awareness. Recently, the relationship between awareness and declarative (hippocampus-dependent) memory has been questioned on the basis of findings from transitive inference tasks. In transitive inference, participants are first trained on overlapping pairs of items (e.g., A+B-, B+C-, C+D-, and D+E-, where + and - indicate correct and incorrect choices). Later, participants who choose B over D when presented with the novel pair BD are said to demonstrate transitive inference. The ability to exhibit transitive inference is thought to depend on the fact that participants have represented the stimulus elements hierarchically (i.e., A>B>C>D>E). We found that performance on five-item and six-item transitive inference tasks was closely related to awareness of the hierarchical relationship among the elements of the training pairs. Participants who were aware of the hierarchy performed near 100% correct on all tests of transitivity, but participants who were unaware of the hierarchy performed poorly (e.g., on transitive pair BD in the five-item problem; on transitive pairs BD, BE, and CE in the six-item problem). When the five-item task was administered to memory-impaired patients with damage thought to be limited to the hippocampal region, the patients were impaired at learning the training pairs. All patients were unaware of the hierarchy and, like unaware controls, performed poorly on the BD pair. The findings indicate that awareness is critical for robust performance on tests of transitive inference and support the view that awareness of what is learned is a fundamental characteristic of declarative memory.

Adolescent↗

[Phonological awareness therapy in the literacy process].

BACKGROUND: Phonological awareness and literacy. AIM: to verify the influence of phonological awareness therapy in the literacy process. METHOD: 46 children were submitted to an assessment involving the reading and writing of words and non-words and of phonological awareness. The experimental group was submitted to therapy. RESULTS: Therapy had a positive influence in the performance of the children in the experimental group (76.47%) regarding tasks of phonological awareness and regarding their performance in reading and writing; only literate children were able to perform tasks involving phonemic awareness. CONCLUSION: Phonological awareness therapy facilitates the acquisition of the alphabetic code.

Awareness↗

Assessing impaired hypoglycemia awareness in type 1 diabetes: agreement of self-report but not of field study data with the autonomic symptom threshold during experimental hypoglycemia.

OBJECTIVE: The aim of our study was to determine the agreement of two noninvasive methods, a self-report and a field study method, for the assessment of impaired hypoglycemia awareness with a gold standard criterion of hypoglycemia awareness, the autonomic symptom threshold during experimental hypoglycemia. RESEARCH DESIGN AND METHODS: A total of 19 type 1 diabetic patients completed a standardized questionnaire to assess impaired hypoglycemia awareness and performed a hand-held computer (HHC) study to assess their recognition of hypoglycemic episodes occurring during 24 weeks. Patients subsequently underwent a stepped hypoglycemic clamp to study responses to standardized hypoglycemia. Diagnoses of impaired hypoglycemia awareness were based on the separate self-report questions, a composite self-report score, and three different cutoff levels for the percentage of accurately recognized hypoglycemic episodes during the field study Agreement of these noninvasive measures with the hypoglycemic clamp measure were tested by calculating kappa values, sensitivity, and specificity. RESULTS: The composite self-report score agreed reasonably well with the hypoglycemic clamp measure (kappa 0.49, sensitivity 66.7%, and specificity 85.7%) and showed a better agreement than the separate self-report questions. The HHC criterion of impaired hypoglycemia awareness did not agree with the hypoglycemic clamp criterion at any of the cutoff levels tested. CONCLUSIONS: The composite self-report tested in this study is a reasonably reliable assessment method for the diagnosis of impaired hypoglycemia awareness, using the physiological definition of an absence of autonomic symptoms at a blood glucose level of 3 mmol/l. In contrast, the recognition of hypoglycemic events in everyday life as measured using the HHC method is not related to the hypoglycemic clamp criterion.

Adult↗

Relationship between phonemic and lingual awareness.

The purpose of this preliminary investigation was to assess the relationship between knowledge of speech sounds (phonemes) and lingual awareness in normal adult speakers of English. The study also examined subjects' descriptions of lingual contact. 36 subjects (M age=19.6, SD=.71) who were enrolled in an undergraduate phonetics class participated. All passed a speech and hearing screening and reported having received no prior speech therapy or classes in articulation, phonetics, or speech science. During the first class meeting, the subjects were given two tests. The measure of phonemic awareness consisted of (a) judging which two (out of three) printed words began (or ended) with the same phoneme, (b) counting, substituting, reversing phonemes in words, and (c) indicating primary stress in two-syllable words. The lingual awareness test consisted of subjects imitating a syllable, then responding to a multiple-choice question regarding (a) tongue position (front to back), (b) tongue height (high to low), (c) contact with the teeth, and (d) contact with other oral cavity structures. Subjects were requested to imitate the syllable prior to answering each question, e.g., "Say tuh. Did you feel your tongue in the front, middle, or back of your mouth?" Seven English phonemes (t, k, s, sh, r, l, and voiceless th) were presented in a consonant-vowel syllable with the central vowel "uh." Subjects were aided by a line drawing of the oral cavity. A significant correlation of .53 was found between the two tests, suggesting that individuals who possess greater awareness of speech sounds tend to exhibit heightened lingual awareness. Sound-symbol knowledge was the best predictor of lingual awareness. Subjects had the most difficulty describing lingual contact for phonemes that are often troublesome for children to articulate (sh, r, l, and s).

Adolescent↗