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PubMed2004

BIS monitoring: awareness and catastrophic events.

The bispectral index is an electroencephalogram-based monitoring tool to help anesthesiologists determine depth of anesthesia. The bispectral index indicates both the potential for awareness and of relative hypnotic overdose, but it does not predict movement or hemodynamic responses to stimulation, and it cannot predict the exact moment consciousness returns. The bispectral index has been assessed for its relationship to awareness, and bispectral index monitoring appears to be generally associated with a low incidence of awareness. The bispectral index has also has been noted to detect periods of cerebral ischemia. It is also being used in intensive care units to help quantify the level of sedation in patients and as an outcome predictor in patients with brain injuries. Low values of the bispectral index often occur during catastrophic, ischemic, events but the use of this technology for the routine monitoring of such events is unproven.

Anesthesia, General↗
PubMed2001

PAD awareness, risk, and treatment: new resources for survival--the USA PARTNERS program.

Peripheral arterial disease (PAD) is a very common manifestation of atherosclerosis and is associated with a high risk of cardiovascular morbidity and mortality. Despite the magnitude of the problem, PAD is often under-recognized in clinical practice until its limb manifestations are severe or heart attack or stroke supervene. The PAD Awareness, Risk and Treatment: New Resources for Survival (PARTNERS) program, recently completed in the USA, had five aims: (1) creation of a method for detection of PAD in primary care practice; (2) assessment of the awareness of the PAD diagnosis in both patients and physicians; (3) assessment of the magnitude of the atherosclerotic risk factor burden and intensity of treatment of atherosclerotic risk factors in PAD patients; (4) assessment of the disease-specific and general quality of life of PAD patients in their communities; and (5) provision of an educational intervention to foster improved community-prescribed medical interventions for patients with PAD. Lack of public and physician interest in PAD contrasts with the high prevalence and poor medical prognosis of PAD. The intention of PARTNERS was to create a community-based program to measure current rates of PAD awareness, physician recognition and treatment intensity. Data obtained will form the basis of future clinical investigations to improve clinical care for PAD patients in the USA.

Awareness↗
PubMedDate not supplied

Awareness of ageism, motivation, and countertransference in the care of elders with Alzheimer's disease.

This article focuses on the importance of a practitioner's awareness of ageism, motivation, and countertransference in working with elders with dementia. These factors have the capacity to significantly affect a professional's performance. Additionally, they may also affect the type and quality of services a memory-impaired client receives. Ageism is discussed at the micro, mezzo, and macro level, and practitioners are urged to develop an increased awareness of the effects of ageism on client/service options and as well as practitioner's beliefs. Monitoring professional motivation and being aware of countertransference are important considerations in practitioner-client relationships. Professionals are encouraged to incorporate personal introspection and consultation or supervision to ensure that clients receive the most appropriate service available. Case examples are provided to illustrate concepts.

Aged↗
PubMed1999

Crossmodal and sensorimotor integration in tactile awareness.

We investigated tactile awareness in three patients with tactile extinction of stimuli located on contralesional somatotopic space. Contralesional tactile awareness was enhanced when they gazed to the left and when they moved their limbs. We suggest that personal somatotopic and peripersonal space are integrated by polymodal and sensorimotor links, which allow us to be aware of and act effectively on stimuli in space.

Aged↗
PubMed2005

A case of awareness despite an "adequate depth of anesthesia" as indicated by a Bispectral Index monitor.

We report a case of awareness that occurred despite the presence of an "adequate" depth of anesthesia as measured by Bispectral Index. Our patient was at high risk for this complication. Hypotension limited the use of sevoflurane, and neuromuscular, sympathetic, and beta-adrenergic blockade prevented the patient from responding to his awareness. Preoperative use of opioids and gabapentin for chronic pain may have modified his response to anesthesia or affected his Bispectral Index reading. Our attempt to measure depth of anesthesia may have resulted in false reassurance concerning adequacy of anesthesia and contributed to awareness.

Anesthesia↗
PubMed2002

AIDS awareness and sexual behaviour in a high HIV prevalence area in rural northern Kwazulu-Natal, South Africa.

The objective was to assess AIDS awareness and sexual behaviour in a rural South African community with a high HIV prevalence. One hundred clinic attenders underwent a structured interview using a standard questionnaire. Although the 64 female and 36 male patients, mean age 22 (range 13-45), had good knowledge of AIDS-related issues, only 50 perceived HIV/AIDS as a common problem. Of the 75 patients who were sexually active only 30 (40%) used condoms (men 16; 55% vs women 14; 30%, P=0.033) despite being better informed about the protective effect of condoms (active 61; 81% vs abstinent 14; 56%, P=0.011). More men than women admitted to multiple sexual partners (17; 47% vs 7; 11%, P<0.0001). In conclusion, despite a high level of awareness of HIV/AIDS issues, self-perceived risk was low, condom use was infrequent and especially men continued to have multiple sexual partners. Awareness has yet to translate into reduction of risk behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Fish consumption and advisory awareness in the Great Lakes Basin.

More than 61 million adults live in the eight U.S. states bordering the Great Lakes. Between June 2001 and June 2002, a population-based, random-digit-dial telephone survey of adults residing in Great Lakes (GL) states was conducted to assess consumption of commercial and sport-caught fish and awareness of state-issued consumption advisories for GL fish. On the basis of the weighted survey data, approximately 84% of the adults living in these states included fish in their diets. Seven percent (an estimated 4.2 million adults) consumed fish caught from the Great Lakes. The percentage of residents who had consumed sport-caught fish (from any water source) varied regionally and was highest among those who lived in Minnesota (44%) and Wisconsin (39%). Consumption of GL sport fish was highest among residents of Michigan (16%) and Ohio (12%). Among residents who had eaten GL fish, awareness of consumption advisories varied by gender and race and was lowest among women (30%) and black residents (15%). However, 70% of those who consumed GL sport-caught fish twice a month or more (an estimated 509,000 adults across all eight states) were aware of the advisories. Findings from this survey indicate that exposure to persistent contaminants found in GL fish is likely limited to a relatively small subpopulation of avid sport-fish consumers. Results also underscore the public health importance of advisories for commercial fish because an estimated 2.9 million adults living in these states consume more than 104 fish meals per year and may be at risk of exceeding the reference doses for methylmercury, polychlorinated biphenyls, and other bioaccumulative contaminants.

Adolescent↗
PubMedDate not supplied

Managing awareness: negotiating and coping with a terminal prognosis.

This study examined the way in which a terminal cancer prognosis was negotiated by patients and their lay carers, and the complexities involved in managing a context of awareness. Individual semi-structured interviews were undertaken with 16 patients and 14 lay carers. These were transcribed verbatim and analysed using a grounded theory approach. The process started with being given bad news, when the concept of life was no longer open-ended. The need to maintain hope influenced the amount of information sought by patients and their families and was an important strategy in helping patients cope with the knowledge of their disease. Levels of awareness appeared to be influenced less by setting, than by the way the prognosis was managed within individual families. Difficulties facing patients and carers in knowing how to communicate with each other within a context of open awareness suggest that they need help in learning how to do this. Achieving an environment to enable this requires private space and staff skilled in enabling and facilitating the complexities of communication between patients and their carers.

Adaptation, Psychological↗
PubMed1999

Measuring the effects of street pole banners on consumer awareness and preference.

The authors used a relatively new advertising medium to increase public awareness of their children's hospital. They found that street pole banners, a form of outdoor advertising, made a measurable, positive impression on consumer consciousness. Banners effectively supplemented a product awareness campaign that included more traditional media. This study is the first documentation of the use of banners to market health care services. Using a two-phase approach, respondents were surveyed via telephone before and after exposure. Results of the follow-up survey show significant increases in levels of awareness and preference. The authors hope their report on the successful use of street pole banners will spur further research on the use of this innovative media.

Advertising↗
PubMedDate not supplied

Community pharmacists' awareness of and involvement with medications intended for use in primary and secondary schools.

OBJECTIVE: To observe the degree to which community pharmacists are aware of and involved in issues related to the use of medications in primary and secondary schools and to identify the interventions they use to deal with these issues. DESIGN: Cross-sectional survey. SETTING: Illinois. PARTICIPANTS: 569 licensed pharmacists with community pharmacy experience. INTERVENTIONS: A survey comprising questions about the experiences, attitudes, and behaviors of community pharmacists with regard to medication use in schools was mailed in June 2003. MAIN OUTCOME MEASURES: Descriptive and bivariate statistical analysis of survey items. RESULTS: Almost all respondents reported that they had dispensed medications for use in school; two thirds thought that taking medications at school creates the potential for special problems (e.g., missed dose, social stigma). Of nine interventions that could help minimize these problems, the respondents used a mean of 3.34 interventions. Providing additional labeled containers for use at school was the most common intervention reported. Respondents who thought that medication use in schools caused special problems provided significantly more interventions than those that did not share this concern. CONCLUSION: Pharmacists are aware of and involved in the issues and potential problems created by medication use in schools. While they make use of interventions that are available to all community pharmacists, they could do more to help resolve issues. Additional effort to raise pharmacist awareness about medication use in schools is warranted.

Attitude of Health Personnel↗
PubMed2006

Memory impairment and awareness of memory deficits in early-stage Alzheimer's disease.

Recognition memory of auditory verbal learning tests and awareness of memory deficits were examined in 24 individuals with early-stage Alzheimer's disease (AD) using a performance prediction-postdiction paradigm. Individuals with AD displayed impaired recognition memory, and recognition performance correlated positively with regional cerebral blood flow at rest in bilateral prefrontal areas and the left medial temporal area. In addition, underawareness of memory deficits was also marked even at this early stage. Individuals with AD retrospectively overestimated memory performance after actual performance, but appeared to benefit from feedback, and displayed intact online awareness of memory dysfunction, leading to normal prediction of the second session. However, individuals with AD failed to retrospectively incorporate incidents of memory failure into generalized self-belief systems. Brain/ behavior correlational analyses suggest that the prefrontal cortex and posterior dorsomedial regions including the precuneus may be involved in self-awareness.

Aged↗
PubMed2002

Impact of aviation highway-in-the-sky displays on pilot situation awareness.

Thirty-six pilots (31 men, 5 women) were tested in a flight simulator on their ability to intercept a pathway depicted on a highway-in-the-sky (HITS) display. While intercepting and flying the pathway, pilots were required to watch for traffic outside the cockpit. Additionally, pilots were tested on their awareness of speed, altitude, and heading during the flight. Results indicated that the presence of a flight guidance cue significantly improved flight path awareness while intercepting the pathway, but significant practice effects suggest that a guidance cue might be unnecessary if pilots are given proper training. The amount of time spent looking outside the cockpit while using the HITS display was significantly less than when using conventional aircraft instruments. Additionally, awareness of flight information present on the HITS display was poor. Actual or potential applications of this research include guidance for the development of perspective flight display standards and as a basis for flight training requirements.

Adult↗
PubMed2005

Activation in visual cortex correlates with the awareness of stereoscopic depth.

Using event-related functional magnetic resonance imaging, we studied the activation correlating with the awareness of stereoscopic depth using a bistable slanted surface (slant rivalry). Bistability resulted from incongruence between two slant-defining cues: binocular disparity and monocular perspective. The stimulus was perceived as alternating between the perspective-dominated percept (monocular depth) and the disparity-dominated percept (stereopsis), while sensory input remained constant, enabling us to study changes in awareness of depth associated with either cue. Transient activation relating to perceptual alternations was found bilaterally in the caudal part of the intraparietal sulcus, in the right-hemispheric anterior intraparietal sulcus, within visual area V4d-topo, and inferior to area MT+. Transient activation correlating specifically with alternations toward the disparity-dominated percept was found in a number of visual areas, including dorsal visual areas V3A, V7, and V4d-topo and visual areas MT+ and lateral occipital complex. No activation was found for alternations toward the perspective-dominated percept. Our results show that of all visual areas responsive to disparity-defined depth, V4d-topo shows the most robust signal changes correlating with the instigation of stereoscopic depth awareness (stereopsis).

Awareness↗
PubMed2005

Method for evaluating subjective states of awareness that accompany recognition: adaptation for use in Portuguese-speaking patients with schizophrenia.

OBJECTIVE: Memory is composed of several systems and processes, and recognition can be accompanied by two subjective states of consciousness: autonoetic awareness, which characterizes conscious recollection; and noetic (or semantic) awareness, related to feelings of familiarity. The objective of this study was to describe the adaptation to Portuguese of an experiential procedure for investigation of states of awareness that accompany recognition. METHODS: Development of the material (word list and instructions permitting manipulation of the level of information processing); translation/adaptation of the original instructions to Portuguese; and application of the procedure in healthy volunteers and patients with schizophrenia. Manipulation of the level of processing consisted in requiring, during the learning phase, that subjects form a phrase or count the number of letters of the words presented. The level of processing, documented in healthy volunteers, should be expressed by greater conscious recollection of words used to form phrases than of words for which letters were counted. In addition, there should be no change in the proportion of recognition based on feelings of familiarity. RESULTS: The procedure was first applied in six healthy volunteers, in whom the processing level effect was clearly reproducible. Subsequently, it was used in patients with schizophrenia, who understood and followed the instructions perfectly. There was also a clear processing level effect in the patient group. CONCLUSION: The Portuguese version of this method can be used in our milieu, even in patients with schizophrenia, allowing the study of memory alterations accompanying this mental disorder.

Adult↗
PubMed2006

Evaluating characteristics of community riparian awareness program interactions.

As part of its mandate to evaluate and monitor program delivery, the Alberta Riparian Habitat Management Society (Cows and Fish) has commissioned independent evaluations to examine the effectiveness and applicability of the community-based riparian awareness and management program. The society's aim is to improve the understanding of landscape function, to better enable landowners and managers to make management decisions. The staff interaction evaluation examined staff ability to deliver certain valued characteristics, and identified whether the program and staff increased awareness and management action. Respondents rated staff highly on all characteristics. Landowners that participated in riparian health programming as part of community/watershed groups were 19% more likely to have learned new information and 21% more likely to implement management change than those that were not part of a group. Repeat interactions are critical to learning new information and influencing management. All those with frequent interactions had learned new information, compared to only 70% of those with very little interaction. A diverse array of interactions led respondents to alter their management, indicating the need for a wide variety of extension tools and activities. The results strongly support the need for a community-based approach in resource management and awareness activities, which enables repeat, ongoing and diverse interactions with extension staff.

Awareness↗
PubMed2000

The factors related to age awareness among middle-aged and elderly Japanese.

The purpose of this article was to expand past research by examining relationships between age awareness and related factors in Japanese middle-aged and elderly people. The subjects were 1,129 participants (575 men and 554 women, aged 40 to 79 years) of the National Institute for Longevity Sciences--Longitudinal Study of Aging (NILS-LSA). They were examined with a questionnaire and interview. As a result, chronological age, self-rated health, and visual and hearing ability tend to be the related factors for awareness of aging. Comparing the demographic and physiological factors, however, major life events, difficulties and daily life experiences showed a stronger influence on age awareness. These results provide an interesting basis for the future understanding of adult development and the meaning of aging.

Adult↗
PubMed1999

Association between health-related knowledge and the awareness of blood pressure readings. Japan Lifestyle Monitoring Study Group.

This study aims to evaluate the relationships between awareness of blood pressure testing and health-related knowledge. Among 9 blocks in Japan, one or two areas were selected and a questionnaire survey including physical activity, nutrient intake, drinking habits, smoking habits, medical history, annual frequency of blood pressure testing, subjective sense of wellness, and health related knowledge was conducted. Respondents' sex and age were adjusted as potential confounding factors and the association between possession of health-related knowledge and awareness of blood pressure testing were examined by using a multiple logistic regression model. Among the 1,834 effective responses, 263 (14.3%) answered that they could state their blood pressure levels. These individuals tended to have a greater health-related knowledge. Even after adjusting for other potential confounders (smoking habits, medical history, annual frequency of blood pressure testing, and subjective sense of wellness) health-related knowledge were significantly related to blood pressure awareness.

Adult↗
PubMed2001

Awareness of dying: an experience of Chinese patients with terminal cancer.

Despite the effort to provide an alternate way to dying, there seems to be little effort to examine the real situation of hospice care. For example, the patients' desired outcomes are seldom addressed. It is recently that studies began to investigate the features of "good death." However, work in eastern cultures, such as Chinese, remains scarce. The purpose of this study is to gain an understanding of what it means to die a "good death" from the perspective of Chinese patients. Thirty-three Chinese hospice patients with terminal cancer were interviewed. Grounded in the analysis of qualitative data, seven elements that contribute to dying a good death emerged. Awareness of dying was identified as the foremost essential element of a good death. From the findings of this study, most respondents considered receiving a diagnosis of cancer as one of the significant points of psychological distress in the course of their illness. Half of the patients openly talked about their cancers and more than half of them discussed various issues related to death. That means, about one-third of the respondents talked about death and cancer with openness. These preliminary findings may reflect the progress of hospice work in Hong Kong. Meanwhile, 13 respondents did not mention the word "death" and 16 of them did not mention that they had cancer. They talked about their illness and future using the expressions that they preferred. It is important that health care professionals also respect people who show awareness of dying as much as those who do not present clear evidence of this awareness. Both groups of people can have a positive experience when they die.

Adult↗