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PubMed2004

Awareness of the use of folic acid to prevent neural tube defects in a Mediterranean area.

OBJECTIVES: The risk of neural tube defects (NTDs) is decreased in women who take folic acid during the periconceptional period. The main objective of our study was to evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects in a Mediterranean area. STUDY DESIGN: A retrospective study was performed from 1 July to 30 November 2000. One thousand consecutive women who delivered in our hospital were interviewed during the immediate postpartum period about their knowledge of neural tube defects and folic acid intake before and during pregnancy. RESULTS: Most women (85.7%) referred not having been specifically informed about the need to take folic acid to prevent neural tube defects although approximately half of the women (50.6%) were in fact, aware of the need for folic acid intake. Eight percent (8.1%) of the women took folic acid before conception but only 6.9% did so during the effective period from 4 weeks before conception to 4 weeks after conception. Logistic regression analysis showed that awareness of the need to take folic acid together with having had preconceptional counselling and knowledge of NTDs were the strongest variables related to the fact of having taken folic acid during the correct period. CONCLUSIONS: Although the population is aware of the need to take folic acid, the real impact of the present recommendations is almost negligible. Information in primary care and preconceptional counselling to specifically inform patients about the need to take folic acid to prevent NTDs seem to be crucial to improve the final intake of folic acid during the protective period.

Adult↗
PubMed2005

The effect of subject awareness and prior slip experience on tribometer-based predictions of slip probability.

Prior knowledge of potentially slippery conditions has been shown to alter normal human gait in slip and fall experiments. We sought to quantify how the empirical relationship between slip probability and available floor friction was affected by subject awareness and prior slip experience. Sixty-eight subjects (40 females, 28 males) walked over three different low-friction surfaces inserted periodically between non-slip control trials. Three increasing levels of prior knowledge were used: deceived (unaware of the slippery surface), aware (20% chance of a slippery surface, but no prior slip experience) and experienced (aware with prior slip experience). Available friction was measured using a drag sled and a variable incidence tribometer. Of 620 low-friction trials, 124 generated slips greater than 27mm. The proportion of slips, the slip distance and the required friction (taken from the control trial immediately before a low-friction trial) generally decreased with increasing levels of prior knowledge. These adaptations were accommodated by logistically regressing slip outcome (yes/no) against the normalized friction (available friction minus required friction) rather than against available friction alone. The regressions showed that subject awareness biased the slip probability curve toward a lower slip risk for a given normalized friction, but that the subsequent addition of slip experience generated a slip risk curve that was not significantly different from that of deceived (and presumably unprepared) subjects. These findings suggest that data to validate a tribometer's ability to predict the risk of slipping (but not falling) can be acquired from subjects with prior slip experience.

Accidental Falls↗
PubMed2005

Adaptations to normal human gait on potentially slippery surfaces: the effects of awareness and prior slip experience.

Prior knowledge of potentially slippery conditions has been shown to alter normal human gait in slip and fall experiments. Here we quantify the effects of two aspects of prior knowledge - awareness of a possible slip and prior slip experience - on normal gait. Sixty-eight subjects (40F, 28M) each walked over 48 high-friction surfaces (control trials) and 12 low-friction surfaces. Within- and between-subject changes in lower limb muscle activation, gait kinematics and ground reaction forces were analyzed in three non-slip control trials: one before and one after the first unexpected slip exposure, and a third after repeated slip exposures. Subjects knew they might slip in the latter two trials but not the first trial. Twenty subjects slipped during their first low-friction exposure (early slip group), 32 in later low-friction exposures (late slip group), and 16 subjects did not slip at all. Simultaneous changes in awareness and experience between the first two analyzed trials of the early slip group altered the muscle activity in both limbs, reduced the foot and knee angles at heel strike in the slip limb and reduced the ground reaction forces, impulses and utilized friction after heel strike in the slip limb. A change in only awareness between the first two analyzed trials of the late slip group produced the same kinematic changes seen in the early slip group, but only small muscle activity change and no kinetic changes. Subsequent slip experience in the late slip group produced the muscle activation and kinetic changes observed in the early slip group, but no further kinematic changes. These results showed that awareness of a potential slip primarily alters how the slip-limb approaches the floor, whereas prior slip experience primarily alters the anticipatory muscle activation and how the foot interacts with the floor. These muscle, kinematic and kinetic changes were consistent with a more cautious "normal" gait, and can reduce the external validity of slip and fall experiments.

Adolescent↗
PubMed2006

Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya.

BACKGROUND: Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community. OBJECTIVE: To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services. SUBJECTS: Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya. MAIN OUTCOME MEASURES: First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities. RESULTS: The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1-2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%). CONCLUSIONS: Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.

Adolescent↗
PubMed2006

Heart rate response after emotional picture presentation is modulated by interoceptive awareness.

The perception of visceral signals plays a crucial role in many theories of emotions. The present study was designed to investigate the relationship between interoceptive awareness, emotional experience and heart rate responses in an emotional stimulation paradigm. Based on their performance in a heartbeat perception task 38 participants (16 males, 22 females) were classified as subjects with either high (n=19; 8 males) or low interoceptive awareness (n=19; 8 males). 120 pictures (40 pleasant, 40 unpleasant, 40 neutral slides) from the International Affective Picture System served as emotional stimuli. Heart rate changes were recorded during baseline and during slide presentation. After each slide, the subjects had to rate emotional valence and arousal on a 9-point self-report scale. Statistical analyses revealed significantly stronger heart rate responses to pleasant and unpleasant stimuli in subjects with high interoceptive awareness. Furthermore, subjects with high interoceptive awareness rated pleasant and unpleasant slides as significantly more arousing; no differences were found in the emotional valence ratings. Heartbeat perception scores correlated significantly positive with both the mean arousal rating and with the mean heart rate changes. Our results demonstrate a strong relationship between the perception of cardiac signals and the peripheral processing of emotional stimuli.

Adult↗
PubMed2007

Private and public self-awareness in social anxiety.

Clark and Wells' [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.

Adult↗
PubMed2005

Phoneme awareness is a key component of alphabetic literacy skills in consistent and inconsistent orthographies: evidence from Czech and English children.

Two studies investigated the importance of phoneme awareness relative to other predictors in the development of reading and spelling among children learning a consistent orthography (Czech) and an inconsistent orthography (English). In Study 1, structural equation models revealed that Czech (n=107) and English (n=71) data were fitted well by the same predictors of reading and spelling. Phoneme awareness was a unique predictor in all models. In Study 2, Czech (n=40) and English (n=27) children with dyslexia showed similar deficits on phoneme awareness relative to their age- and spelling-matched control peers. Phoneme awareness appears to be a core component skill of alphabetic literacy, which is equally important for learners of consistent and inconsistent orthographies.

Age Factors↗
PubMed2006

A contextual analysis of attention to chronic pain: what the patient does with their pain might be more important than their awareness or vigilance alone.

UNLABELLED: It is often believed that to feel greater pain is to experience greater effects of that pain, and that attention and awareness represent the transmission mechanism in this relationship. By implication, it is assumed that if attention and awareness can be lessened, the effects of pain will likewise reduce. Despite conceptual work and data suggesting more complex processes might indeed be in place, these long-standing and intuitively appealing ideas remain, either explicitly or implicitly, in both research and clinical applications. The purpose of this study was to compare the role of attentional processes in chronic pain with a process that is more contextual, functional, and behavior-focused, namely, acceptance. The hypothesis tested is whether it is more important to understand the amount of contact an individual has with pain, in this case awareness and vigilance to pain, or the degree of influence on behavior brought with that contact, in this case acceptance. Data from 227 patients seeking treatment for chronic pain were examined. Results from correlation analyses showed that acceptance scores achieved stronger correlations than scores for the attention variables with measures of cognitive, emotional, social, and physical functioning. When acceptance of pain was taken into account in multiple regression analyses, scores from the attention measures accounted for little or no variance in measures of patient functioning. The value of various mental, mechanical, behavior-focused, and contextual models of attention in chronic pain is discussed. PERSPECTIVE: Attention, awareness, and vigilance appear immediately applicable for understanding chronic pain. These processes, however, might be incomplete in accounting for pain-related suffering and disability. Acceptance is proposed as a process that expands the framework of attention to include varying cognitive, emotional, and social influences exerted by pain on patient behavior.

Adaptation, Psychological↗
PubMed2004

An electrophysiological correlate of human visual awareness.

In order to shed more light on the neural correlates of human visual awareness, event-related potentials (ERPs) were recorded in a perceptual threshold experiment. The masked stimuli (line-drawings of coherent, familiar objects and scrambled, meaningless non-objects) were presented below, near, and above the subjective perceptual threshold. A prominent negative ERP deflection, peaking around 260-270 ms from stimulus onset, was observed only for the stimuli reaching subjective visual awareness. The results indicate a direct relationship between the crossing of the subjective threshold and this negative ERP deflection. A similar ERP response called 'visual awareness negativity' (VAN) has been observed in recent studies, using completely different stimulus manipulations (change blindness, reduced contrast stimuli). Hence, VAN appears to be a general electrophysiological correlate of visual awareness, observed in any experimental design that contrasts consciously perceived vs. unperceived visual stimuli.

Adult↗
PubMedDate not supplied

Separate neural definitions of visual consciousness and visual attention; a case for phenomenal awareness.

What is the relation between visual attention and visual awareness? It is difficult to imagine being aware of something without attending to it, and by some, visual consciousness is simply equated to what is in the focus of attention. However, findings from psychological as well as from neurophysiological experiments argue strongly against equating attention and visual consciousness. From these experiments clearly separate neural definitions of visual attention and visual consciousness emerge. In the model proposed here, visual attention is defined as a convolution of sensori-motor processing with memory. Consciousness, however, is generated by recurrent activity between cortical areas. The extent to which these recurrent interactions involve areas in executive or mnemonic space depends on attention and determines whether a conscious report is possible about the sensory experience, not whether the sensory experience is there. This way, a strong case can be made for a pure non-cognitive form of seeing, independent of attentional selection, called phenomenal awareness. This can be dissociated from the reportable form, depending on attention, called access awareness. The hypothesis explains why attention and consciousness seem so intricately related, even though they are fully separate phenomena.

Attention↗
PubMed2005

Contingency awareness in human aversive conditioning involves the middle frontal gyrus.

In contrast to the wealth of data describing the neural mechanisms underlying classical conditioning, we know remarkably little about the mechanisms involved in acquisition of explicit contingency awareness. Subjects variably acquire contingency awareness in classical conditioning paradigms, in which they are able to describe the temporal relationship between a conditioned cue and its outcome. Previous studies have implicated the hippocampus and prefrontal cortex in the acquisition of explicit knowledge, although their specific roles remain unclear. We used functional magnetic resonance imaging to track the trial-by-trial acquisition of explicit knowledge in a concurrent trace and delay conditioning paradigm. We show that activity in bilateral middle frontal gyrus and parahippocampal gyrus correlates with the accuracy of explicit contingency awareness on each trial. In contrast, amygdala activation correlates with conditioned responses indexed by skin conductance responses (SCRs). These results demonstrate that brain regions known to be involved in other aspects of learning and memory also play a specific role, reflecting on each trial the acquisition and representation of contingency awareness.

Adult↗
PubMed2004

Spatial attention speeds discrimination without awareness in blindsight.

An intimate relationship is often assumed between visual attention and visual awareness. Using a subject, patient GY, with the neurological condition of "blindsight" we show that although attention may be a necessary precursor to visual awareness it is not a sufficient one. Using a Posner endogenous spatial cueing paradigm we showed that the time our subject needed to discriminate the orientation of a stimulus was reduced if he was cued to the location of the stimulus. This reaction-time advantage was obtained without any decrease in discrimination accuracy and cannot therefore be attributed to speed-error trade-off or differences in bias between cued and uncued locations. As a result of his condition GY was not aware of the stimuli to which processing was attentionally facilitated. Attention cannot, therefore be a sufficient condition for awareness.

Adult↗
PubMed2006

Neural correlates of crossmodal visual-tactile extinction and of tactile awareness revealed by fMRI in a right-hemisphere stroke patient.

We used fMRI to study the neural correlates of crossmodal, visual-tactile extinction in a single case (patient GK). GK has chronic extinction after a lesion centred on right inferior parietal cortex, and has previously been investigated extensively in purely visual fMRI studies [e.g. Rees, G., Wojciulik, E., Clarke, K., Husain, M., Frith, C., & Driver, J. (2000). Unconscious activation of visual cortex in the damaged right hemisphere of a parietal patient with extinction. Brain, 123(Pt 8), 1624-1633; Rees, G., Kreiman, G., & Koch, C. (2002). Neural correlates of consciousness in humans. Nature Reviews Neuroscience, 3(4), 261-270]. With concurrent stimulation of the right visual field plus left index finger, GK showed crossmodal extinction of left touch on approximately half of such trials here (reflecting impaired sensitivity, i.e. lowered d-prime), albeit becoming aware of left touch on the other half. fMRI revealed activation of contralateral primary somatosensory cortex on crossmodal trials when touch was extinguished from awareness, suggesting unconscious residual processing there. When GK became aware of the left touch, additional activation was found in surviving right parietal cortex, and in frontal regions; moreover, functional coupling was enhanced with a region of frontal cortex implicated in awareness by previous work. Finally, on trials where crossmodal extinction arose, surviving right parietal cortex showed stronger functional coupling with the left visual and right somatosensory regions driven by the competing stimuli, indicating that crossmodal extinction arises when inputs to separate modalities interact competitively via multimodal cortex.

Aged↗
PubMed2005

The long-term lasting effectiveness on self-efficacy, attribution style, expression of emotions and quality of life of a body awareness program for chronic a-specific psychosomatic symptoms.

OBJECTIVE: A 3-day residential body awareness program (BAP) was developed to teach people with chronic a-specific psychosomatic symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The long-term effects of the program on body awareness, psychological factors, psychosomatic symptoms and quality of life for people with CAPS are presented in this study. METHODS: A pre-post design is used with post-measures 2 and 12 months after the program, without controls (n = 122). Mean age is 42.5 (S.D. = 9.0) and 60% is female. RESULTS: The results showed an increase of body awareness, self-efficacy, expression of emotions and quality of life. Stress-related symptoms decreased and the attribution style was found to be less depressive. Participants achieved significantly higher levels of functioning at 2 months which increased significantly more at 12 months. The majority of the measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants also confirm the found effects. DISCUSSION AND CONCLUSION: Evaluation of the BAP gives evidence to conclude that this program leads to the theoretically expected long-term effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. Two and 12 months after the 3-day program, they are more capable of self-management in coping with stress and psychosomatic symptoms. PRACTICE IMPLICATIONS: This article sheds new light on the difficulties that individuals with psychosomatic symptoms and their professional interventionists encounter when attempting to manage the chronicity of the problems. By paying more attention to learning self-management by increasing body awareness and self-efficacy, patient educators may be able to increase their effectiveness.

Adaptation, Psychological↗
PubMed2007

Second-order motion without awareness: passive adaptation to second-order motion produces a motion aftereffect.

Although second-order motion may be detected by early and automatic mechanisms, some models suggest that perceiving second-order motion requires higher-order processes, such as feature or attentive tracking. These types of attentionally mediated mechanisms could explain the motion aftereffect (MAE) perceived in dynamic displays after adapting to second-order motion. Here we tested whether there is a second-order MAE in the absence of attention or awareness. If awareness of motion, mediated by high-level or top-down mechanisms, is necessary for the second-order MAE, then there should be no measurable MAE if the ability to detect directionality is impaired during adaptation. To eliminate the subject's ability to detect directionality of the adapting stimulus, a second-order drifting Gabor was embedded in a dense array of additional crowding Gabors. We found that a significant MAE was perceived even after adaptation to second-order motion in crowded displays that prevented awareness. The results demonstrate that second-order motion can be passively coded in the absence of awareness and without top-down attentional control.

Adaptation, Physiological↗
PubMed2002

Aware and unaware perception in hemispatial neglect: evidence from a stem completion priming task.

The current study used the process dissociation procedure in conjunction with a stem-completion priming task to disentangle the influences of aware and unaware perception in patients with hemispatial neglect. One lateralized picture prime was presented simultaneously with a filler picture followed by a centrally presented word stem. In the inclusion condition participants were asked to complete the word stem with the previously presented picture name; in the exclusion task they were asked to complete the stem with the name of a picture other than the one previously presented. Findings indicated that neglect patients had reduced unaware perception of pictures presented in the left visual field and an absence of awareness for those same pictures. In addition, patients had reduced awareness for right visual field pictures, but unaware perception remained intact. These findings suggest that observations of preserved information processing in neglect are due to residual unaware perception and not due to residual awareness of information in the neglected hemispace.

Aged↗
PubMed1996

The effects of acute hypoglycemia on relative cerebral blood flow distribution in patients with type I (insulin-dependent) diabetes and impaired hypoglycemia awareness.

To examine the hypothesis that in diabetic patients with impaired hypoglycemia awareness the relative regional distribution of cerebral blood flow (rCBF) would be abnormal in a specific area, namely the frontal lobes, rCBF was examined in 20 type I diabetic patients, of whom 10 had a normal awareness of hypoglycemia and 10 had a history of impaired hypoglycemia awareness. rCBF was determined sequentially using single photon emission computed tomography (SPECT) during (1) normoglycemia (arterialized blood glucose 4.5 mmol. L-1) and (2) hypoglycemia (blood glucose 2.5 mmol.L-1) induced by a hyperinsulinemic glucose clamp technique. Distribution of the isotope, 99mTc-Exametazime, was detected using a single-slice multi-detector head scanner. A split-dose technique was used, with 250 MBq being injected during steady-state normoglycemia and 250 MBq during subsequent hypoglycemia. rCBF was estimated in 30 regions of interest, derived from a standard neuroanatomical atlas on two parallel slices at 40 and 60 mm above the orbitomeatal line (OML). No between-group differences in the pattern of overall rCBF or changes in regional tracer uptake were demonstrated. In comparison to the rCBF during normoglycemia, both patient groups exhibited significant changes in the pattern of rCBF during hypoglycemia, with increments of rCBF to both superior frontal cortices and the right thalamus and reduced rCBF to the right posterior cingulate cortex and the right putamen. This pattern of relative redistribution of rCBF during hypoglycemia was preserved in patients who had impaired hypoglycemia awareness.

Acute Disease↗
PubMed2002

Induced gamma activity is associated with conscious awareness of pattern masked nouns.

The aim of this study was to explore the relationship between electroencephalographic (EEG) activity in the gamma frequency range and conscious awareness of a visual stimulus. EEG was recorded from subjects while they were shown backward-masked words only some of which they were able to discriminate correctly. The results showed that activity in the gamma frequency range increased with reported awareness of a word independently of whether it was correctly discriminated or not. It is concluded that gamma power is associated with awareness-dependent visual processing but not with processing that occurs in the absence of awareness.

Adolescent↗