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PubMed2005

Impaired sustained attention and error awareness in traumatic brain injury: implications for insight.

The processes of error awareness and sustained attention were investigated in 18 traumatic brain injury (TBI) individuals and 16 matched control participants. In Experiment 1, we found that: (1) in comparison to controls, TBI participants displayed reduced sustained attention and awareness of error during the Sustained Attention to Response Task; (2) degree of error awareness was strongly correlated with sustained attention capacity, even with severity of injury partialed out; and (3) that error feedback significantly reduced errors. We replicated the finding of a correlation between error awareness and sustained attention capacity in Experiment 2 with a separate sample of 19 TBI participants and 20 controls. We conclude that TBI leads to impaired sustained attention and error awareness. The finding of a significant relationship between these two deficits in TBI suggests there may be a link between these two processes. Feedback on error improves sustained attention performance of control and TBI participants.

Adolescent↗

PubMed2006

A review of awareness interventions in brain injury rehabilitation.

Unawareness related to brain injury has implications for participation in rehabilitation, functional outcomes, and the emotional well-being of clients. Addressing disorders of awareness is an integral component of many rehabilitation programmes, and a review of the literature identified a range of awareness interventions that include holistic milieu-oriented neuropsychological programmes, psychotherapy, compensatory and facilitatory approaches, structured experiences, direct feedback, videotaped feedback, confrontational techniques, cognitive therapy, group therapy, game formats and behavioural intervention. These approaches are examined in terms of their theoretical bases and research evidence. A distinction is made between intervention approaches for unawareness due to neurocognitive factors and approaches for unawareness due to psychological factors. The socio-cultural context of unawareness is a third factor presented in a biopsychosocial framework to guide clinical decisions about awareness interventions. The ethical and methodological concerns associated with research on awareness interventions are discussed. The main considerations relate to the embedded nature of awareness interventions within rehabilitation programmes, the need for individually tailored interventions, differing responses according to the nature of unawareness, and the risk of eliciting emotional distress in some clients.

Awareness↗

PubMed2002

Prevalence of daily breakfast intake, iron deficiency anaemia and awareness of being anaemic among Saudi school students.

Iron deficiency anaemia is one of most prevalent nutritional disorders worldwide. It is known to affect the health and cognitive ability of children and adolescents. Studies in Saudi Arabia concentrate only on the population of young children and pregnant females or girls. Studies on the whole school student population is lacking. The objectives of this study were to identify the nutritional habits and the prevalence of anaemia among school students in Jeddah, as well as to recognize the students' awareness of their anaemic nutritional status. Data were collected from a sample of Saudi school children in Jeddah City from 42 boys' and 42 girls' schools during the month of April 2000. Data collection was done by an in-person interview to collect socio-demographic factors, nutritional habits, weight and height. Haemoglobin was measured in a sample of 800 students selected at random from both genders and different age groups. Anaemia was defined according to the new WHO cut-off levels for haemoglobin as: blood haemoglobin <11.5 g/dl for the 5-11 years boys and girls; <12.0 g/dl for 12-14 years boys and girls; <12.0 g/dl for 15+ girls and <13.0 g/dl for 15+ years boys. Proportion and 95% confidence intervals (CI) were calculated and significance was considered when the 95% CI did not overlap. Anaemia was reported among 20.5% of school students. Anaemia was more prevalent among students of at least 12 years as compared to the younger age group. Also, anaemia was more marked among governmental school attendees and those born to low-educated mothers. Menstruating girls were at around double the risk of being anaemic than non-menstruating girls. Anaemia was associated with negative impact on school performance and was more marked among those who failed their exams as compared to students with excellent results. Skipping breakfast was reported by 14.9% of students and this habit did not differ by age, sex, body mass index or social class. Skipping breakfast was more marked among students with poor school performance as compared to those with very good or excellent results. Only 34.1% of anaemic school students were aware of being anaemic. Awareness was nearly equal in all age groups and social classes but girls were more aware of their anaemic status than boys. Iron deficiency anaemia appears to be prevalent among school students. At age 12 years and over, low social class and menstruating girls constitute the high-risk groups. Screening is recommended for high-risk groups and school health programs are crucial to improve students' nutritional habits, knowledge and awareness.

Adolescent↗

PubMed2005

Development and validation of the Subjective Awareness of Neuropsychological Deficits Questionnaire for Children (SAND-C).

Although lowered awareness of abilities has been associated with poorer outcome in adults with neurological compromise, a dearth of research exists examining whether lowered awareness exists in younger populations. Using findings from recent literature and expert opinion, a 47-item Subjective Awareness of Neuropsychological Deficits Questionnaire for Children (SAND-C) was created to assess awareness of cognitive functioning in 6 domains (attention, psychomotor, visual-spatial, language, memory, and executive functioning). Confirmatory factor analysis (CFA) of the SAND-C was conducted on a sample consisting of 365 healthy children and 48 children with epilepsy. The SAND-C was found to have strong reliability. Factor analysis confirmed the a priori 6 factor model, but the 6-factor model was only marginally better than a more parsimonious 1-factor solution. Post-hoc exploratory factor analyses indicate that the SAND-C may measure more constructs for adolescents than for younger children. The difference between younger and older children may reflect developmental changes in metacognitive awareness and abstraction about their own abilities.

Adolescent↗

PubMed1998

Reinforcement without awareness: I. Voice level.

Although some studies have reported that reinforcement can strengthen people's behaviour without their awareness, most studies that have incorporated adequate procedures for assessing awareness have been unsuccessful. Using rigorous procedures, we report two studies designed to provide more scope for learning without awareness by making the reinforcement contingency as unobtrusive as possible. Subjects were told that the experiment was on ESP, and that they were to say which of two words the experimenter was thinking about. In fact, reinforcement was contingent on the loudness of the subject's voice when responding. Even though subjects reported no awareness of a relationship between trial outcomes and their behaviour, the probability of the reinforced responses increased significantly over trials in both experiments. These results support the view that reinforcement can occur without awareness.

Adult↗

PubMed1998

Radiation awareness program for extracorporeal shockwave lithotripsy using Medstone lithotripters.

To determine the effectiveness of a radiation awareness program in reducing the radiation exposure to patients treated by a Medstone lithotripter, the exposure was calculated at the end of each extracorporeal shockwave (SWL) treatment using a table of measurements of the estimated entrance exposure rates 70 cm from the X-ray tube port. The results, related to stone size and patient weight, were distributed every month to each radiologic technologist, and a summary was sent regularly to the treating urologists. The doses before and after the introduction of the radiation awareness program were compared to determine the effectiveness of the program, and the chi-square test was used to determine statistical significance. The average calculated radiation exposure before and after introduction of the radiation awareness program was 16.39 rad and 8.26 rad, respectively, for patients with single renal stones; 17.31 rad and 9.02 rad, respectively, with single ureteral stones; 18.45 rad and 9.39 rad, respectively, with multiple renal stones; and 20.59 rad and 11.28 rad, respectively with multiple ureteral stones. These reductions in calculated radiation exposure were statistically significant only with multiple ureteral stones (P = 0.03). The only statistically significant differences in the stone-free rates, retreatment rates, and post-SWL secondary procedure rates before and after the introduction of the radiation awareness program were seen in the stone-free rates with single renal stones: 70% v 65%, respectively (P = 0.02); in the retreatment rates with single ureteral stones: 10% v 6%, respectively ( P < .01); and in the post-SWL secondary procedure rates with single renal stones: 4% v 2%, respectively (P = 0.01), and single ureteral stones: 7% v 4%, respectively (P = 0.05). The radiation awareness program resulted in a 51% reduction in the estimated radiation exposure to patients during SWL using Medstone lithotripters.

Awareness↗

PubMed2004

Awareness and the EEG power spectrum: analysis of frequencies.

BACKGROUND: Power spectral analysis is a well-established method for the analysis of EEG signals. Spectral parameters can be used to quantify pharmacological effects of anaesthetics on the brain and the level of sedation. This method, in numerous variations, has been applied to depth of anaesthesia monitoring and has been incorporated into several commercially available EEG monitors. Because of the importance of EEG spectral analysis, we evaluated the performance of each frequency in the power spectrum regarding detection of awareness. METHODS: Ninety artefact-free EEG segments of length 8 s were obtained from a database that contains perioperatively recorded EEG data. For the present analysis, EEG data were selected from 39 patients with propofol-remifentanil or sevoflurane-remifentanil anaesthesia with a period of awareness. Half of the EEG segments were recorded during periods of awareness as defined by an adequate response to the command 'squeeze my hand'. The other half were from unresponsive patients. The power spectral density was calculated for each segment. The performance of each frequency bin of the power spectrum as a detector of awareness was assessed with a remapped prediction probability rPK, i.e. the prediction probability PK mapped to a range of 0.5-1. RESULTS: The remapped prediction probability was high (rPK>0.8) for low frequencies (<15 Hz) and for high frequencies (>26 Hz), with a minimum (rPK<0.55) at 21 Hz. Indentations in the 'performance spectrum' occur at the power-line frequency (50 Hz) and its harmonics and at 78 Hz, probably caused by the continuous impedance measurement of another device used in parallel. With the exception of the indentations, the remapped prediction probability of the high frequencies (>35 Hz) was >0.95. CONCLUSIONS: The best performance for the detection of awareness was achieved by EEG power spectral frequencies from >35 Hz up to 127 Hz. This frequency band may be dominated by muscle activity. The frequency band between 15 and 26 Hz may be of limited value, as reflected by lower rPK values.

Anesthetics, Combined↗

PubMed2004

Assessment of the potential effects of population changes in attitudes, awareness and beliefs on self-reporting of occupational ill-health.

BACKGROUND: It is important to take account of the effects of population changes in attitudes, awareness and beliefs when interpreting temporal trends in self-reported occupational ill-health. Aim To assess how changes in population attitudes, awareness and beliefs have influenced trends in the self-reporting of occupational and other types of ill-health. METHOD: A review of relevant literature was carried out. The criterion for inclusion was that papers must be based on empirical evidence; theoretical discussion papers were included only where empirical examples were included. RESULTS: Several examples were identified where raised awareness of a health problem following intended or unintended publicity was followed by an increase in self-reports of this problem. The magnitude of the increase varied widely according to the situation. One example was identified where self-reports decreased following a publicity programme designed to prevent the occurrence and worsening of the problem in the population. Potential mechanisms identified as influencing changes in self-reporting of ill-health following raised awareness included changes in symptom/illness management, perception of symptoms, tolerance of symptoms, recognition and diagnosis of illness, attribution of illness; social desirability and legitimacy and recall. CONCLUSION: The effects of changes in population attitudes, awareness and beliefs on trends in self-reports of occupational and other illness are difficult to predict for any given situation.

Awareness↗

PubMed1997

Awareness and control of hypertension and hypercholesterolaemia in France and Northern Ireland.

We assessed awareness and control of hypertension and hypercholesterolaemia in a cross-sectional study of 586 men from France and 189 from Northern Ireland, aged 35-55, without known coronary artery disease. Prevalence of hypertension was 28% in France and 31% in Northern Ireland (p < 0.42). In France, 70% of hypertensive subjects were aware of their status, vs. 58% in Northern Ireland (p < 0.10). Overall, 40% of subjects with a history of hypertension were untreated, and only 32% of the French and 12% of the Northern Irish subjects treated for hypertension (diet with/without drugs) were normotensive. The prevalence of hypercholesterolaemia was 46% in France and 48% in Northern Ireland (p < 0.62). In France, 59% of hypercholesterolaemic subjects were aware of their status, vs. only 17% in Northern Ireland (p < 0.0001). In both countries, half of those with a history of hypercholesterolaemia were untreated, and only 47% of the French and 43% of the Northern Irish patients treated for hypercholesterolaemia (diet with/without drugs) were controlled. While awareness of hypertension is comparable in France and Northern Ireland, awareness of hypercholesterolaemia is much lower in the latter. Control of hypertension and hypercholesterolaemia in both countries is poor and should be improved.

Adult↗

PubMed1999

Awareness during anesthesia: a closed claims analysis.

BACKGROUND: Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. METHODS: The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. RESULTS: Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P < 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). CONCLUSIONS: Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

Adult↗

PubMed1998

Impaired awareness and employment outcome after traumatic brain injury.

Inaccurate self-awareness is a common finding after traumatic brain injury. Such impaired awareness has been hypothesized to limit patients' eventual functional outcomes by decreasing motivation for treatment and resulting in selection of inappropriate long-term goals. Previous investigations of the association between impaired awareness and employment outcome have produced inconsistent results. The present article reviews these studies and presents the results of our new investigation of this issue. In addition, we studied the comparability of two methods of measuring impaired awareness. Results provided strong support for a positive relationship between accurate self-awareness and favorable employment outcome at follow-up.

Adolescent↗

PubMed1998

Awareness intervention: who needs it?

It is widely accepted that awareness deficits present challenges to recovery and should be addressed as part of rehabilitation programming. Response to awareness intervention is commonly inferred from measurements that rely on reports by subjects and significant others. This article describes the findings from a pilot study that examined the relationship among a variety of awareness indicators in three individuals with brain damage over a 9-month period. Results suggest a dissociation between behavioral and perceptual indices of awareness. Changes in behavioral indicators of awareness selected by caregivers were not related to changes in self- or caregiver ratings. The clinical and research implications of the findings are discussed.

Activities of Daily Living↗

PubMedDate not supplied

Awareness and distress after traumatic brain injury: a relative's perspective.

OBJECTIVE: To examine the relationship between relatives' distress level and their ratings of impaired awareness for persons with traumatic brain injury (TBI). DESIGN AND OUTCOME MEASURES: Participants were 25 patients with TBI, 16 with probably dementia, and 15 with memory complaints but no dementia. Participants completed the Barrow Neurological Institute Screen for Higher Cerebral Functions. Relatives of all patients completed the Patient Competency Rating Scale (Relative Form). Relatives also rated their distress level on a scale from 0 (no distress) to 10 (severe distress) and then rated the patient's level of awareness of their difficulties, also on a scale from 0 (not aware) to 10 (completely aware). SETTING: Clinical neuropsychology outpatient service of a neurological institute and medical center. RESULTS: For relatives of patients with TBI, a significant correlation of -0.52 (P = .006) was found. Correlations for the dementia and memory complaint groups were -0.62 (P = .03) and -0.39 (P = .20), respectively. CONCLUSIONS: The presence of brain dysfunction associated with neuropsychological disturbances appears to influence the magnitude of the relationship between the distress level of family members and their ratings of impaired awareness in persons with TBI.

Adult↗

PubMed1998

A three stage model of awareness: formulation and initial experimental support.

The various components which together make up the complex state of consciousness require neural support involving a connected network of many brain areas at differing levels. At the lowest level is non-aware processing, of which there is not direct awareness. There are also modules involved in processing with awareness but without focussed attention. Finally there must be a set of modules involved in directing attention in a controlled manner. We expect to be able to dissociate the various components of the three-stage network by using different levels of attention. The results of an auditory experiment performed under three different levels of awareness and attention are analysed to show support for the three-stage model of awareness. The relevant auditory areas are delineated.

Acoustic Stimulation↗

PubMed1996

Impaired awareness of deficits in Alzheimer disease.

This study examined the relation between awareness of memory and functional decline and cognitive function in patients with Alzheimer disease (AD). Twenty-six patients with early AD and 16 nondemented elderly controls were studied. Awareness of deficits was determined by using (a) a discrepancy score between subject's and caregiver's ratings on a memory questionnaire, (b) a discrepancy score between subject's and caregiver's ratings on an activities-of-daily-living scale, and (c) a clinical rating of dementia awareness for patients. Whereas self-ratings of memory and activities of daily living were not significantly different between AD patients and controls, these two measures differed significantly when AD patients' ratings were compared with those of their caregivers. Measures of awareness of deficits correlated with one another and were primarily associated with performance on tests of executive and visuospatial functions but not with depression. Early AD is characterized by a failure of self-monitoring. Deficits in self-monitoring have been proposed to occur after damage to the frontal lobes and other cerebral areas. Impaired awareness of memory and functional deficits in AD is related to cognitive impairments, which may involve frontal and right hemisphere connections.

Aged↗

PubMedDate not supplied

Longitudinal study of self-imposed driving restrictions and deficit awareness in patients with Alzheimer disease.

Thirty-five patients with Alzheimer disease (AD), including 19 who were still driving, were evaluated for level of awareness and driving status. There was no significant correlation between driving status and Mini-Mental State Examination (MMSE) scores. Only the attention subscore of the awareness questionnaire yielded a statistically significant difference between drivers and nondrivers. Follow-up of the patients who were still driving was conducted 12-18 months later. All but 4 patients had stopped driving. Caregivers responded to a questionnaire assessing the patient's driving behaviors since the onset of AD. There was no correlation between MMSE and driving status. In 7 of 10 cases, caregivers or patients made the decision that the patient should stop driving. However, caregivers reported long periods between the caregiver's perception that the patient should stop driving and actual cessation (0.5-48 months). Results suggest that AD patients do restrict several areas of their driving voluntarily and that a failure to do so may be associated with an awareness deficit. In particular, a deficit of awareness for attention was significantly associated with an absence of restricted driving behaviors such as avoiding unfamiliar routes. Awareness of a deficit that is related to driving performance may be critical to restricted driving behavior, and this change in behavior may enable the patient to prolong his or her status as a driver.

Adult↗

PubMedDate not supplied

Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease.

Caregiver burden, the stress experienced as a result of caregiving, is determined by many factors. This study examined the contributions of the patient's awareness of memory deficit and behavioral disturbance to caregiver burden in Alzheimer disease. Participants were 41 patients with Alzheimer disease and their caregivers. Dementia severity, functional impairment, awareness of memory deficit, and behavioral disturbance were measured and examined in relation to caregiver burden. Positive correlations were found between caregiver burden and both impaired awareness of memory deficit and behavioral disturbance. Regression analyses demonstrated that both impaired patient awareness of memory deficit and behavioral disturbance contributed to caregiver burden over and above dementia severity and functional impairment. However, when both were entered together into regression equations, only behavioral disturbance contributed to caregiver burden. Of the problem behaviors, measures of disinhibition contributed most to caregiver burden. These data further our understanding of the multiple contributors to caregiver burden. We conclude that both patient awareness of memory deficit and behavioral disturbance impact caregiver burden, with behavioral disturbance making the greater contribution.

Activities of Daily Living↗

PubMed1985

Factors influencing doctors' awareness of the life problems of middle-aged patients.

Because individuals who deal effectively with life events may be healthier, doctors may need to be aware of the important events in their patients' lives. This study was designed to document the actual level of awareness that 20 community family practitioners had of their middle-aged patients' life events. A total of 116 patients completed a life events questionnaire when they visited their family doctors. The physicians completed a similar questionnaire for each patient. A comparison between the patients' and physicians' responses provided the measure of doctors' awareness. Doctors were found to be aware of approximately 25% of all patients' life events. Awareness was inversely associated with patients' self-reliance and directly associated with age of patients and with those events having a negative effect. The observed level of knowledge may be unacceptably low, in which case physicians must find ways to improve their knowledge. Alternatively, this level of knowledge may be realistic, given that some patients may not need to discuss their life events, particularly self-reliant patients or patients experiencing events that did not affect them negatively. If this is the case, family physicians need to find ways of determining the patients and events for which their knowledge would be helpful.

Adult↗