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PubMed2005

Impact of a community pharmacist-directed clinic in improving screening and awareness of osteoporosis.

RATIONALE, AIMS AND OBJECTIVES: There is a need to increase screening and awareness of osteoporosis risk in order to prevent fractures and related morbidity. Although one in two women are at risk of developing the condition, only one in five receives bone mineral density screening. The purpose of the current study was to investigate the effectiveness of an osteoporosis screening and awareness programme directed by a pharmacist in the community setting. METHODS: The study design to test for improved awareness was a prospective, pre-post trial with no control group. The level of awareness of risk was assessed both before the screening and following an educational intervention on osteoporosis provided in the pharmacy. Based on assessed risk level, a recommendation was made for follow-up with a doctor for a dual-energy X-ray absorptiometry (DEXA) scan and/or pharmacotherapy. Patients at medium or high risk were also surveyed as to their intention to follow-up with lifestyle modification recommendations. RESULTS: There was a significant improvement in tested awareness from pre- to post-intervention at 26%; as well in self-rated awareness. There was also a significant correlation between self-rated and tested awareness. Participants indicated satisfaction with the pharmacist interaction and with their role in improving awareness. A large percentage of participants indicated that they intended to follow-up with the pharmacist's recommendation for calcium intake, exercise and/or consulting with their doctor. CONCLUSION: The results indicate that the community pharmacist can successfully screen individuals for risk of osteoporosis and improve their awareness about steps to prevent or delay fractures.

Absorptiometry, Photon↗

PubMed2006

Factors associated with the awareness and practice of evidence-based obstetric care in an African setting.

OBJECTIVE: To identify the factors associated with important (> or =50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions. DESIGN: Cross-sectional analysis of data from our Reproductive Health Interventions Study. SETTING: North-west province, Cameroon, Africa. POPULATION: Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. MAIN OUTCOME MEASURES: Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. METHODS: Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions. RESULTS: A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance. CONCLUSIONS: Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.

Adult↗

PubMed2006

Awareness of illness and nonadherence to antipsychotic medications among persons with schizophrenia.

OBJECTIVE: The purpose of this study was to assess the effects of patients' awareness of their illness on the clinical presentation, management, and course of nonadherence to antipsychotic medications among patients with schizophrenia. METHODS: A national survey was conducted of psychiatrists who were treating patients with schizophrenia. The survey was sent to 771 psychiatrists, of whom 534 responded, for a response rate of 69 percent. The psychiatrists were asked to report on presentation, management, and course for one adult patient with schizophrenia who had been under their care for at least one year and who had been nonadherent to oral antipsychotics at some point in the past year. Patients who were aware that they had a mental illness were compared with those who were not aware. RESULTS: Of the 534 respondent psychiatrists, 310 reported on an eligible patient, and 300 of these patients were classified by illness awareness. Ninety-seven patients, or 32 percent, were not aware that they had a mental illness. These patients who lacked awareness had significantly longer episodes of antipsychotic nonadherence, were more likely to completely cease taking the antipsychotic medication, were more likely to have severe positive symptoms, and were more likely to be psychiatrically hospitalized after nonadherence than those who were aware of their illness. Psychological interventions and several types of family interventions were significantly less effective among patients who lacked awareness. CONCLUSIONS: A lack of awareness of mental illness is common among patients with schizophrenia who are nonadherent to antipsychotics. Such nonadherence tends to be especially disruptive and unresponsive to simple commonly used psychological interventions.

Adult↗

PubMedDate not supplied

Prognostic awareness and the terminally ill.

The authors rated patients who were in advanced stages of cancer and in their final few weeks of life on their level of awareness of their medical prognosis (N = 200, mean age = 71.0 years). The authors measured prognostic awareness with a semistructured interview, dividing patients into those acknowledging No Awareness, Partial Awareness, and Complete Awareness. The authors also administered a semistructured interview for depressive disorders, along with an assessment of various demographic and social support measures. Nineteen patients (9.5%) denied awareness of both their terminal prognosis and foreshortened life expectancy. Thirty-four patients (17%) were placed in the partial awareness category, with the remaining 147 patients (73.5%) reporting complete awareness. Depression was nearly three times greater among patients who did not acknowledge their prognosis, as compared with those who demonstrated partial or complete acknowledgment (chi2 = 7.094), P = 0.029). In addition to depression, male patients, older patients, and those having "intense social contact" were associated with lower ratings of prognostic awareness. Dying patients differ in respect to their capacity to acknowledge their prognosis. Prognostic disavowal is most likely to arise in patients with underlying psychological distress and emotional turmoil.

Adaptation, Psychological↗

PubMed2004

Awareness of husband's impending death from cancer and long-term anxiety in widowhood: a nationwide follow-up.

BACKGROUND: We investigated the predictors and long-term consequences of awareness time - the length of time a woman is aware of her husband's impending death from cancer. METHODS: All women (n = 506) living in Sweden under 80 years of age who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were followed with an anonymous postal questionnaire, 2-4 years after their loss. RESULTS: We received completed questionnaires from 379 of the widows. Of these, 55 (15%) reported an awareness time of 24 hours or less, 56 (15%) of 3-6 months and 95 (26%) of one year or more. The associations between the awareness time and morbidity were of a reverted 'J-shape,' with awareness time of 24 hours or less carrying the highest risk and 3-6/6-12 months the lowest. On comparing the awareness time of 24 hours or less with 3-6 months (preformed response category), the relative risks for anxiety were found to be 1.9. (1.0-3.6) (visual digital scale) and 4.5 (1.0-20.0) for intake of tranquillising drugs. Those not informed of their husband's fatal condition or not provided with psychological support by caregivers during their husband's last months of life had an increased risk of a short awareness time. CONCLUSIONS: During a man's terminal cancer illness, the wife's awareness time varies considerably and is influenced by information and psychological support from caregivers. A short awareness time may result in an additional and avoidable psychological trauma.

Anxiety↗

PubMed2004

The construction of awareness in early-stage Alzheimer's disease: a review of concepts and models.

OBJECTIVES: This review considers the concepts and models that, often implicitly, underlie accounts and studies of variations in awareness of difficulties in people with early-stage Alzheimer's disease (AD). In order to do this, it is necessary to draw on explanations presented within the discourses of different disciplines. The review aims to explore the key tensions and debates that arise in attempting to conceptualize awareness, and attempts to specify what kind of conceptual framework is needed in order to advance our understanding of variations in awareness in AD. METHODS: A range of literature relating to concepts and models of awareness, drawn from different disciplines and published during the past 30 years, is critically reviewed. RESULTS: The literatures of different disciplines present varying constructions of the concept of awareness. Neuropsychological, psychiatric and psychosocial explanations are considered and their relevance to understanding awareness in early-stage AD is discussed. CONCLUSIONS: An understanding of variations in awareness in early-stage AD requires a biopsychosocial model of awareness that incorporates the influence of both neuropsychological impairments and psychosocial responses. Improved understanding of variations in awareness is essential for the development of person-centred approaches to intervention and care in AD.

Alzheimer Disease↗

PubMed2004

Awareness in early-stage Alzheimer's disease: a review of methods and evidence.

PURPOSE: This review has three main aims: (1) To illustrate the strengths and limitations of current approaches to assessing awareness of difficulties and impairments in people with early-stage Alzheimer's disease (AD). (2) To consider the evidence regarding factors associated with level of awareness. (3) To highlight the implications for assessment and intervention. METHODS: A comprehensive range of literature on awareness in AD published in the past 20 years is critically reviewed. RESULTS: Four main approaches to the assessment of awareness can be discerned, each with significant conceptual and methodological limitations. These limitations affect the quality of the available evidence regarding factors associated with level of awareness, which is contradictory, with few clear findings emerging. Awareness does, however, appear to be related to the outcome of rehabilitation, and this has important implications for the selection of appropriate and sensitive interventions. CONCLUSIONS: The review highlights the need for a broad conceptualization of awareness. Greater clarity about theoretical frameworks, and improved assessment methods, are required in order to enhance understanding of variations in awareness in early-stage AD. Awareness is an important variable for clinicians to consider.

Age Factors↗

PubMed2005

Awareness of glaucoma in the rural population of Southern India.

PURPOSE: To explore the awareness of glaucoma amongst the rural population of Andhra Pradesh, India. MATERIALS AND METHODS: A total of 7775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study. The responses of subjects older than 15 years (n=5573) who completed a structured questionnaire regarding awareness (heard of glaucoma) and knowledge (understanding of disease) of glaucoma formed the basis of this study. RESULTS: Awareness of glaucoma (n=18; 0.32%) was very poor in this rural population, and females were significantly less aware (p=0.007). Awareness of glaucoma was also significantly less among illiterate persons (p<0.0001), and socially backward population (p<0.0001). Majority of the respondents who were aware of glaucoma (n=10; 55.6%) did not know if visual loss due to glaucoma was permanent or reversible. The major source of awareness of glaucoma in this population was TV/magazines and other media followed by information from a relative or acquaintance suffering from the disease. CONCLUSION: Awareness of glaucoma is very poor in the rural areas of southern India. The data suggest the need for community-based health education programmes to increase the level of awareness and knowledge about glaucoma.

Adolescent↗

PubMed2003

Functional connectivity of the medial temporal lobe relates to learning and awareness.

Learning with awareness is believed to require the involvement of the medial temporal lobe (MTL). In this study, the hypothesis tested was that this involvement is best appreciated by the pattern of MTL functional connectivity with other brain areas. In a sensory learning paradigm, human subjects were classified as AWARE or UNAWARE, on the basis of whether they noted that one of two tones predicted a visual event. Only AWARE subjects acquired and reversed a differential response to the tones. However, learned facilitation was evident in both groups. MTL activity, indexed by blood flow changes measured with positron emission tomography, was correlated with facilitation in both groups but in opposite directions (greater MTL activity was related to less facilitation in AWARE subjects but more facilitation in UNAWARE subjects). Discrimination and reversal in AWARE subjects involved anterior medial, inferior prefrontal, and lateral occipital cortices. Furthermore, unique regional patterns of MTL functional connectivity were observed: AWARE subjects engaged dorsolateral prefrontal and lateral occipital cortices, whereas UNAWARE subjects showed a more spatially restricted network involving contralateral MTL regions and the thalamus. In the AWARE group, the MTL functional connectivity pattern overlapped with regions associated with facilitation and discrimination, but in UNAWARE subjects, the MTL pattern was related only to facilitation. These results suggest that the MTL and functional connected regions, including dorsolateral and medial prefrontal cortex, acted to link facilitation and discrimination patterns in AWARE subjects. Thus, the contribution of the MTL to learning and awareness is shaped by the pattern of interregional interactions, the neural context.

Acoustic Stimulation↗

PubMed2005

An analysis of intraoperative recall of awareness in Thai Anesthesia Incidents Study (THAI Study).

OBJECTIVES: This study aimed to analyze intraoperative awareness using database of Thai Anesthesia Incidents Study (THAI Study) with regard to frequency, contributing factors, preventive and corrective strategies. MATERIAL AND METHOD: Details of intraoperative recall of awareness were recorded prospectively by attending anesthesiologists or nurse anesthetists in standardized record forms during February 1, 2003 to July 31, 2004. Participating hospitals included 7 university hospitals, 5 tertiary care hospitals, 4 secondary care hospitals, and 4 primary care hospitals. All data were analyzed to identify contributing factors, preventive and corrective strategies. RESULTS: Among 126078 general anesthetized cases, there were 99 cases of intraoperative recall of awareness. Awareness was found in female patients more than male patients (63% versus 37%). The majority of patients had ASA PS 1 and 2. Cardiac, obstetric, and lower abdominal surgery were involved in anesthesia awareness more than other type of surgery. Patients experiencing awareness reported sound (62%), pain (51%), feeling operated without pain (33%), and paralysis (25%). There was slight impact of anesthesia awareness in Thai patients (only 13% had temporary emotional stress and 13% had mild anxiety) despite small percentage of proper management by reassurance and psychiatric consultation (15%). The contributing factors included inadequate knowledge (67%), inadequate medication dosage (44%), and inadequate care from inexperience (11%). Awareness incidents were documented to be preventable in 36% of patients and partially preventable in 38% of patients. The corrective strategies included guideline practice (30%), additional training (28%), quality assurance activity (19%), and improved supervision (16%). CONCLUSION: The incidence of intraoperative recall of awareness in this study was 0.08%. Patients reported sound, pain, feeling operated without pain, and paralysis. Corrective strategies included guideline practice, additional training, quality assurance activity, and improved supervision.

Adolescent↗

PubMed1990

Physician awareness of elevated cholesterol.

Recent studies suggest a heightened awareness of the association between elevated cholesterol and heart disease. Physician awareness of an elevated cholesterol level was investigated at a university-affiliated, 200-bed community hospital. All cholesterol levels greater than 240 mg/dL on a multichemistry profile were evaluated regarding physician awareness. Criteria for awareness included any notation in the patient's chart indicating the physician's recognition of the abnormal cholesterol level or therapeutic intervention (dietary or pharmacologic). During March 1986, an awareness level of 20% was found. A similar review in March 1988 revealed no change despite a redefinition of the normal laboratory range of serum cholesterol from 133 to 298 mg/dL to 130 to 240 mg/dL. On April 12, 1988, a 1-hour lecture sponsored by the Physician Cholesterol Education Program was presented at a hospital general staff meeting. Physician cholesterol awareness rose to 51.6% for the remainder of April through May 1988, and was 48.3% at 6-month post-CME follow-up. Chart reviews showed no heightened physician awareness related to the patient's age, sex, or diseases secondarily associated with increased cholesterol; however, increased physician awareness was associated with the primary diagnosis of atherosclerotic vascular disease and severity of hypercholesterolemia. Physician awareness of an elevated serum cholesterol level was poor during two retrospective prevalence surveys but improved considerably after delivery of an educational program.

Awareness↗

PubMed2006

Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers.

OBJECTIVE: To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon. METHODS: In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions. FINDINGS: Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI)=11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% CI=2.0- 6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice. CONCLUSION: The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed.

Adrenal Cortex Hormones↗

PubMed1996

[Monitoring intraoperative awareness. Vegetative signs, isolated forearm technique, electroencephalogram, and acute evoked potentials].

Several methods have been developed to quantify central anaesthetic effects and monitor awareness during general anaesthesia. The most important of these are the PRST score, calculated from changes in blood pressure, heart rate, sweating, and tear production, the isolated forearm technique, where the patient is allowed to move during surgery, the processed electroencephalogram (EEG) and the derived parameters median frequency (MF) and spectral-edge frequency (SEF), and mid-latency auditory evoked potentials (MLAEP). In clinical practice, the application of individual doses of anaesthetics is generally guided by autonomic vegetative clinical signs such as changes in blood pressure, heart rate, sweating, and tear production, quantified as the PRST score. Unfortunately, these parameters are not very reliable with regard to predicting the suppression of consciousness and awareness, especially when high-dose opioids are used in patients with cardiovascular medications and a variety of accompanying diseases. The PRST score probably indicates mainly the autonomic responses to painful stimuli, and seems to be useful in guiding the individual use of analgesics. The isolated forearm technique is a useful test of the patient's responsiveness during general anaesthesia, and thus an instrument for investigating the incidence of awareness during different anaesthetic regimens and when muscle relaxants are employed. A disadvantage is that it can only be used for 20 to 30 min because of pressure-induced nerve blocks or lesions. It can not be employed when long-term relaxation is necessary and consciousness and awareness are to be monitored continuously. The processed EEG and the derived parameters MF and SEF are important scientific tools to quantify central effects of many anaesthetics and opioid analgesics that allow the development of pharmacodynamic-pharmacokinetic models of anaesthetic action. MF has proven to be useful in monitoring closed-loop feedback of intravenous drug administration. Unfortunately, until now there have been no clinical studies that document the usefulness of MF or SEF with regard to predicting intraoperative arousal or awareness. To the contrary, some experimental data failed to predict imminent arousal and response to surgical incision or verbal commands by MF or SEF. Therefore, the EEG seems to be of limited value for monitoring awareness, consciousness, or memory formation during anaesthesia. MLAEP are suppressed in a dose-dependent fashion by many general anaesthetics and correlate with wakefulness, awareness, and explicit and implicit memory during anaesthesia and seem to be a promising method of monitoring awareness during anaesthesia. Nevertheless, future studies will have to determine threshold values for the different MLAEP parameters for intraoperative awareness and explicit and implicit recall of intraoperatively presented information for the different commonly used anaesthetics. Only then will it be possible to determine the usefulness of the method in clinical practice.

Anesthesia, General↗

PubMed2005

Differential changes in brain glucose metabolism during hypoglycaemia accompany loss of hypoglycaemia awareness in men with type 1 diabetes mellitus. An [11C]-3-O-methyl-D-glucose PET study.

AIMS/HYPOTHESIS: Hypoglycaemia unawareness in type 1 diabetes increases the risk of severe hypoglycaemia and impairs quality of life for people with diabetes. To explore the central mechanisms of hypoglycaemia awareness, we used [11C]-3-O-methyl-D-glucose (CMG) positron emission tomography (PET) to measure changes in global and regional brain glucose metabolism between euglycaemia and hypoglycaemia in aware and unaware diabetic subjects. MATERIALS AND METHODS: Twelve men with type 1 diabetes, of whom six were characterised as aware and six as unaware of hypoglycaemia, underwent two CMG-PET brain scans while plasma glucose was controlled by insulin and glucose infusion either at euglycaemia (5 mmol/l) or at hypoglycaemia (2.6 mmol/l) in random order. RESULTS: With hypoglycaemia, symptoms and sweating occurred only in the aware group. Brain glucose content fell in both groups (p=0.0002; aware, 1.18+/-0.45 to 0.02+/-0.2 mmol/l; unaware, 1.07+/-0.46 to 0.19+/-0.23 mmol/l), with a relative increase in tracer uptake in prefrontal cortical regions, including the anterior cingulate. No detectable differences were found between groups in global brain glucose transport parameters (K1, k2). The cerebral metabolic rate for glucose (CMRglc) showed a relative rise in the aware subjects (11.839+/-2.432 to 13.958+/-2.372) and a fall in the unaware subjects (from 12.457+/-1.938 to 10.16+/-0.801 micromol 100 g(-1) min(-1), p=0.043). CONCLUSIONS/INTERPRETATION: Hypoglycaemia is associated with reduced brain glucose content in aware and unaware subjects, with a relative preservation of metabolism in areas associated with sympathetic activation. The relative rise in global glucose metabolic rate seen in aware subjects during hypoglycaemia contrasted with the relative fall in the unaware subjects and suggests that cortical neuronal activation is a necessary correlate of the state of hypoglycaemia awareness.

3-O-Methylglucose↗

PubMed2000

Radon awareness, testing, and remediation survey among New York State residents.

Between November 1995 and January 1997, a radon awareness, testing, and remediation survey was conducted to measure general awareness and factual knowledge about radon and prevalence of radon testing and remediation among New York State residents. The survey found that 82% of 1,209 respondents had heard of radon, but only 21% were knowledgeably aware of radon. With regard to radon testing, only 15% of respondents who were aware of radon had their homes tested. The percentage of respondents who were aware or knowledgeably aware of radon increased with increasing education level. The findings from the study suggest that the New York State public awareness programs that targeted high radon areas did show some effect both by increasing public awareness and promoting residential testing. The relatively low percentage of respondents who were knowledgeably aware of radon and the low percentage who had tested their homes strongly suggest that renewed efforts by the public health community are needed to increase knowledge about radon and its health effects and to encourage radon testing and remediation.

Adolescent↗

PubMed2007

Can increasing awareness of HIV seropositivity reduce infections by 50% in the United States?

BACKGROUND: In 2003, US Centers for Disease Control and Prevention (CDC) announced an HIV prevention initiative that emphasized increasing the proportion of persons living with HIV who are aware of their positive serostatus. Previously, CDC set a national HIV prevention goal of reducing new infections by 50% by 2005, with increasing serostatus awareness a central goal. The objectives of this article are to examine the national epidemiologic consequences of increasing serostatus awareness and the important question of how far increasing awareness could lead toward achieving CDC's goal of a 50% reduction in incident infections. METHODS: Scenario analysis methods were used to project incident HIV infections over 1- and 10-year time horizons at varying levels of HIV seropositivity awareness. Because HIV transmission rates are several times higher for those who are unaware of their HIV seropositivity than for those who are aware, we modeled the effects of increasing awareness via HIV counseling and testing and moving people from the higher to the lower transmission category. RESULTS: Increasing awareness of HIV seropositivity via HIV counseling and testing in the United States from a baseline 75% to 95% has the potential of reducing new infections by as much as 32% in a single year. Achieving the national goal of 50% reduction seems out of reach, however. CONCLUSIONS: Reduction of new infections by 50% in the United States requires a combination of prevention services to reduce further the already low HIV transmission rate from persons aware of their HIV seropositivity and HIV risk reduction interventions for at-risk persons. Counseling and testing alone seems insufficient to meet the 50% incidence reduction goal.

AIDS Serodiagnosis↗

PubMed1988

The role of contextual factors in the relationship between physical activity and self-awareness.

Previous research has indicated that performing arousing or unusual activities heightens self-awareness, as indexed by the use of first person singular pronouns in a sentence completion task (McDonald, Harris & Maher, 1983; Wegner & Giuliano, 1980; 1983). This type of self-awareness seems to reflect awareness of oneself as an individual. In the study reported here, we examined the impact of contextual factors on both awareness of oneself as an individual and awareness of oneself as a group member. The latter type of self-awareness was indexed by the use of first person plural pronouns. Subjects either ran or walked in place while in one of three contexts: (1) alone; (2) with co-actors present; or (3) in a group which fostered interaction and interdependence among participants. The results indicated that, relative to the other two contexts, the group context lowered self-awareness as indexed by the use of first person singular pronouns, but enhanced self-awareness as indexed by the use of first person plural pronouns. This is discussed in terms of the impact that social context has on different forms of self-awareness.

Arousal↗

PubMed1997

Fertility awareness and natural family planning.

Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the sub-fertility investigations. (2) The information is also useful when helping couples to understand how each method of family planning works--how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective observations of the alterations in cervical mucus and the basal body temperature rise are accurate indicators of the fertile phase. Research on the chances of conception on each day of the menstrual cycle, using hormonal assays to estimate the time of ovulation, was carried out in 1994 by Weinberg and Wilcox. Their results showed that the timing of sexual intercourse, in relation to ovulation, strongly influences the chance of conception. Conception only occurred during a 6-day interval that ended on the estimated day of ovulation. The chances of conception fell to zero 24 hours after ovulation. Several different methods of natural family planning are taught; some methods depend on only using one of the indicators of fertility, others are based on two or more indicators. The main indicators of fertility are: observing the cervical mucus, recording the basal body temperature, palpating the cervix and a calculation based on the cycle length. Research studies performed using a combination of the indicators of fertility show that the failure rate using a combination is less than most of the studies which use a single indicator. In each case the method failure is far lower than the user failure. (ABSTRACT TRUNCATED)

Body Temperature↗