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PubMed1998

The Awareness Questionnaire: factor structure and internal consistency.

Patients with traumatic brain injuries often show impaired awareness of their impairments. This impaired awareness can decrease motivation for treatment and limit eventual functional outcome. The importance of this phenomenon has led to the development of multiple techniques and scales for measuring impaired awareness. The present paper briefly reviews the various methods of operationalizing impaired awareness and describes a new scale (the Awareness Questionnaire) designed to incorporate all these methods. Findings of previous studies supporting the validity of the Awareness Questionnaire are presented. The present investigation examined the factor structure and internal consistency of the Awareness Questionnaire with samples of 126 traumatic brain injury survivors and 75 family members/significant others. Principal components factor analysis with varimax rotation indicated three factors: cognitive, behavioural/affective, and motor/sensory. Investigation of internal consistency (Cronbach Coefficient Alpha) in both the patient and family sample yielded satisfactory results. These findings are supportive of continued use and investigation of the Awareness Questionnaire.

Activities of Daily Living↗

PubMed2004

Awareness of financial skills in dementia.

The present study examined the relations among levels of cognitive functioning, executive dysfunction, and awareness of financial management capabilities among a sample of 42 community-dwelling persons with dementia. Financial tasks on the Measure of Awareness of Financial Skills (MAFS) were dichotomized as simple or complex based on Piaget's operational levels of childhood cognitive development. Severity of global cognitive impairment and executive dysfunction were significantly related to awareness of financial abilities as measured by informant-participant discrepancy scores on the MAFS. For persons with mild and moderate/severe dementia, and persons with and without executive dysfunction, proportions of awareness within simple and complex financial task categories were tabulated. Significantly less awareness of financial abilities occurred on complex compared with simple tasks. Individuals with mild dementia were significantly less aware of abilities on complex items, whereas persons with moderate/severe dementia were less aware of abilities, regardless of task complexity. Similar patterns of awareness were observed for individuals with and without executive dysfunction. These findings support literature suggesting that deficits associated with dementia first occur for complex cognitive tasks involving inductive reasoning or decision-making in novel situations, and identify where loss of function in the financial domain may first be expected.

Aged↗

PubMed2004

Are parents aware of their schoolchildren's headaches?

BACKGROUND: The objective of this study is to determine parents' awareness of their children's headaches and to evaluate some of the factors that affect this awareness. METHODS: The subjects of the study are 2601 children who were diagnosed with headache. Data on the children and the parents was collected using a detailed data form. The diagnosis of headache in children was made on the basis of the criteria of the International Headache Society (IHS). If the parents of a child diagnosed with headache reported that their child had headache, the parent was evaluated to be aware of his/her child's headache. In the statistical analyses, chi-square and binary logistic regression were used. RESULTS: Almost 74% of parents were aware of their children's headache. It was found that migraine type headache, female gender, being the first child of the family, travel sickness of children, the presence of headache history in one of the family members; the number of family members and mother's age are factors that affect the awareness level of parents. It was also revealed that parents who do not work outside are more aware of their children's headache and that educational and financial status do not have any effect on the degree of awareness. CONCLUSIONS: In a city like Mersin, which is economically well developed when compared with the rest of the country, one quarter of the parents are not aware of their children's headache.

Adult↗

PubMed2002

Awareness and recall in outpatient anesthesia.

UNLABELLED: We studied the incidence of awareness and explicit recall during general anesthesia in outpatients versus inpatients undergoing surgery. During a 14.5-mo period, we structurally interviewed 1500 outpatients and 2343 inpatients. Among outpatients, there were five cases of awareness and recall (one with clear intraoperative recollections and four with doubtful intraoperative recollections). Of the inpatients, six reported awareness and recall (three with clear and three with doubtful intraoperative recollections). The incidence of clear intraoperative recollections was 0.07% in outpatients and 0.13% in inpatients. The difference in the incidence was not significant. Among outpatients, those with awareness and recall were given smaller doses of sevoflurane than those without awareness and recall (P < 0.05). In conclusion, awareness and recall are rare complications of general anesthesia, and outpatients are not at increased risk for this event compared with inpatients undergoing general anesthesia. IMPLICATIONS: Rapid recovery from general anesthesia is a crucial element of outpatient surgery. However, this practice may predispose a patient to receive less anesthetic, with increased risk for awareness and recall. We have shown that outpatients undergoing an operation using general anesthesia are not at increased risk for awareness compared with inpatients.

Adult↗

PubMed2003

Awareness: Monitoring versus remembering what happened.

BACKGROUND: Awareness during anesthesia is foremost assessed with postoperative interviews, which may underestimate its incidence. On-line monitors such as the Bispectral Index and patient response to verbal command are not necessarily commonly used. This study investigated response to command during deep sedation (Bispectral Index 60-70) and the ability of prevailing monitoring techniques to indicate awareness and predict recall. METHODS: The authors systematically assessed the response to command using the isolated forearm technique while monitoring electroencephalographic and hemodynamic variables. Fifty-six elective surgical patients were repeatedly given verbal instructions to squeeze the observer's hand during target-controlled infusion with propofol and alfentanil. After recovery, conscious recall was assessed with a short structured interview. RESULTS: Overall, 1,082 commands were given. No response was observed to 887 (82%) commands, an equivocal response was observed to 56 (5%) commands, and an unequivocal response was observed to 139 (13%) commands. Of the 37 patients (66%) with an unequivocal response to command ("awareness"), nine (25%) reported conscious recall after recovery. Their reports provided valuable insights as to how awareness may be adequately addressed. Hemodynamic variables poorly predicted awareness, whereas parameters derived from the encephalogram, especially the Bispectral Index, were highly significant predictors (P < 0.0001). Electroencephalographic parameters did not discriminate between patients with or without conscious recall, whereas heart rate and responsiveness to command did. CONCLUSIONS: The incidence of awareness is underestimated when conscious recall is taken as evidence. Awareness can be monitored on-line with behavioral and modern neurophysiologic measures. Providing feedback during intra-anesthetic awareness helps patients to cope with a potentially stressful situation.

Adult↗

PubMed2005

Breast self-examination and breast awareness: a literature review.

AIM: To explore the literature on breast self-examination and breast awareness. OBJECTIVES: To clarify the confusion surrounding breast awareness and breast self-examination. To critique the evidence for breast awareness as a health promotion tool. BACKGROUND: Over 41,000 women are diagnosed with breast cancer each year in the United Kingdom. Compared with other European countries, women in England have poor survival prospects, for breast cancer, due in part to advanced disease at first presentation. In the United Kingdom, women are encouraged to be breast aware from the age of 18. However, the evidence suggests that women do not engage in breast awareness and are frightened and confused about their role in breast health promotion. METHODOLOGY: Four databases were used: Medline, Ebsco including CINAHL and Sociological Abstracts and the Cochrane Database of Systematic Reviews. The search terms 'breast awareness' and 'breast self-examination' were used and combined with 'breast cancer', 'breast screening' and 'health promotion'. CONCLUSION: The evidence on breast self-examination is clear, there is no benefit to breast cancer mortality and results suggest that breast self-examination may do more harm than good. Breast awareness provides women with some acknowledgement of the part they can play in being empowered to fight breast disease, not in terms of statistics used for mortality but on the qualitative effects of reductions in morbidity. RELEVANCE TO CLINICAL PRACTICE: The Royal College of Nursing of The United Kingdom is actively encouraging all nurses to promote breast awareness along with clear guidelines for doing so. The United Kingdom National Health Service Cancer Plan: a plan for investment, a plan for reform, encourages preventive care, information giving, good communication as well as evidence-based practice. In breast care this can reduce confusion for women and encourage empowerment in breast health promotion.

Attitude to Health↗

PubMed1995

AIDS awareness in blood donors in north India.

Prevention of AIDS can only be achieved by a successful public awareness programme. This study was carried out to establish the level of awareness of AIDS and HIV infection through blood transfusion among Indian blood donors of various socioeconomic groups. A questionnaire consisting of 20 questions pertaining to various aspects of AIDS and HIV infection was circulated to 1012 voluntary blood donors. The responses were categorized as good, average and poor knowledge according to the number of correct responses. The majority of the donors were males (93.5%), married (69.7%) and belonged to the Hindu community. Of the donors, 44.4% were educated, 49.9% were highly educated and 5.8% were illiterate. Overall, only 205 (20.3%) showed good awareness of AIDS and the majority of these 168 (16.6%) were highly educated. Approximately 80% of our population did not have sufficient knowledge about AIDS or the danger of contracting as well as disseminating this disease in the community. One hundred and ninety-one (18.9%) donors were in the higher income group and only 13 of them showed good awareness. Most of the donors, 384 (38.0%), were government white collar workers and belonged to the middle income group. In this group 154 had good awareness. The majority of donors with good awareness (176 out of 205) preferred to receive HIV tested banked blood or blood from their own relatives during emergencies. None of the blood donors had any knowledge of autologous blood donations. This study showed that awareness of AIDS was not satisfactory in Indian society. More intensive public awareness campaigns by the Government with the help of Non-Governmental Organizations is required in India to prevent an explosive AIDS situation in the near future.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist.

We interviewed 303 cardiac surgery patients to evaluate the incidence of intraoperative awareness with recall. First, we randomly interviewed 99 patients, of whom four patients (4%) reported awareness and recall. We informed the cardiac anaesthesiologists of the results of these interviews, and we also gave general information regarding means to reduce awareness and recall during general anaesthesia. Thereafter, we interviewed 204 consecutive cardiac surgery patients. Now, three of the patients (1.5%) had intraoperative awareness with recall. The reduction in the incidence from 4% to 1.5% was not significant. However, the doses of principal anaesthetic drugs had increased significantly between the two interview phases, while the dose of pancuronium, the main muscle relaxant used, had decreased significantly. Also, there was a significant increase in the number of anaesthesias where anaesthetic agents had been administered continuously instead of bolus or non-continuous dosing techniques. Between the patients with awareness and recall and those without it, there was no difference in the doses of anaesthetic agents given. The patients with awareness were significantly younger than those not aware. In conclusion, with educational measures and vigilance over the problem, the incidence of intraoperative awareness during cardiac anaesthesia may be reduced. The incidence figure of 1.5% we observed is of the magnitude reported recently by others with modern cardiac anaesthesia techniques.

Adult↗

PubMed1997

Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade.

BACKGROUND: There is no reliable technique for monitoring drug concentrations in total i.v. anaesthesia (TIVA) with muscle relaxation. An increased risk of awareness with TIVA has been stated as a possible drawback. The present study was conducted in order to assess the incidence of conscious awareness in TIVA based on propofol, alfentanil and neuromuscular blockade. METHODS: One thousand patients anaesthetized with TIVA based on propofol, alfentanil, and neuromuscular blockade were subjected postoperatively to a structured interview for conscious awareness on two separate occasions: on discharge from the post-anaesthesia care unit, and the day after anaesthesia. Five hundred of these patients were also interviewed a third time, approximately 1 week later. RESULTS: Two cases of awareness were detected (0.2%). One of these was identified immediately after extubation. The second patient had no memory of intraoperative events or dreams at the first interview, recalled a bad dream on the day after, and had explicit recall of intraoperative events at the interview 8 days later. In both cases, haemodynamic signs of inadequate anaesthesia were present. The incidence of conscious awareness in this study is similar to the lowest previously reported incidence of awareness following general anaesthesia in patients who had been paralyzed and thereafter subjected to a structured postanesthesia interview. CONCLUSIONS: If the true incidence of conscious awareness is to be determined, interviews must be extended beyond the first postoperative day. Our study indicates that if appropriate dosing of propofol and alfentanil are adhered to, and proper action is taken in case of haemodynamic alterations suggestive of inadequate anaesthesia, the incidence of conscious awareness in non-cardiac TIVA with neuromuscular blockade is low.

Adolescent↗

PubMed2006

Patient awareness of complex partial seizures.

PURPOSE: To assess self-awareness of complex partial seizures (CPSs) in unselected epilepsy patients through a thorough interview. METHODS: The study comprised 134 patients at our epilepsy clinic, whose CPSs had been documented by the patient's family members. We investigated the proportion and characteristics of patients unaware of their CPSs compared to those who were, and we monitored the evolution of unawareness of CPSs during the follow-up. RESULTS: Thirty-one (23%) patients were assigned to the unawareness group (complete, 23; incomplete, 8) and 103 (67%) patients to the awareness group. Patients in the unawareness group were older and had a later age of onset than patients in the awareness group. Interictal epileptiform discharges (IEDs) localized primarily to the temporal region and were more frequently detected in the unawareness group (94%) than the awareness group (55%). Bilateral independent IEDs were found more frequently in the unawareness group than in the awareness group (48% vs. 13%). The bilateral presence of lesions was also more frequent in the unawareness group than the awareness group (16.1% vs. 4.9%). Six (26%) of 23 patients with complete unawareness of their CPSs had experienced awareness of CPSs during the follow-up. Two of these patients even experienced the emergence of de novo aura. CONCLUSIONS: Our results indicate that a significant number of epilepsy patients are not aware of their CPSs. Unawareness of CPSs may be related to bitemporal dysfunction and a rapid and complete loss of consciousness caused by rapid spread of ictal discharges to the contralateral hemisphere in association with bilateral independent IEDs and bilateral presence of lesions.

Adult↗

PubMed1996

Has awareness of the alcohol warning label reached its upper limit?

Has awareness of the alcoholic beverage warning label reached its maximum? This study tracks changes in the level of awareness among a sample of 7334 inner-city African-American gravidas seeking prenatal care between May 1989 and June 1993. Previously, we found that a significant increase in awareness of the warning label occurred in March 1990. In the current analysis over a 50-month period, the level of awareness continued to increase through December 1992 and then leveled off, suggesting a negatively accelerated growth function. The logistic function fitted to the awareness curve predicts that the upper limit of awareness in this population has been reached (the predicted upper limit being 81.5%). In addition a logit regression analysis showed that women who did not know about the warning label were more likely to be over 29 years of age. Heavier drinkers were 1.25 times more likely to be aware of the label. Among those drinkers who were not aware of the label, 30% drank at both conception and antenally, thus putting their fetus at high risk for alcohol-related birth defects.

Adult↗

PubMed2004

Tracking women's awareness of heart disease: an American Heart Association national study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in men and women in the United States, yet prior research has shown a lack of awareness of risk among women. The purpose of this study was to assess the contemporary awareness, knowledge, and perceptions related to CVD risk among American women and to evaluate trends since 1997, when the American Heart Association initiated a national campaign to improve awareness of CVD among women. METHODS AND RESULTS: A telephone survey of a nationally representative random sample of women was conducted in June and July 2003, with an oversampling of black and Hispanic women; results were compared with those of similar surveys in 2000 and 1997. The present survey included 1024 respondents age > or =25 years; 68% were white, 12% black, 12% Hispanic, and 8% other ethnicities. Awareness, knowledge, and perceptions about heart disease were evaluated by use of a standard interviewer-assisted questionnaire. A shift in awareness of heart disease as the leading killer of women has occurred since 1997. In 2003, 46% of respondents spontaneously identified heart disease as the leading cause of death in women, up from 30% in 1997 (P<0.05) and 34% in 2000 (P<0.05). In contrast, the percentage of women citing cancer as leading cause of death has significantly decreased. Black, Hispanic, and younger women (<45 years old) had lower awareness of heart disease as their leading cause of death than did white and older women. Nearly all women reported comfort in discussing prevention with healthcare providers, but only 38% of women reported that their doctors had ever discussed heart disease with them. CONCLUSIONS: Awareness of CVD has increased, although a significant gap between perceived and actual risk of CVD remains. Educational interventions to improve awareness and knowledge are needed, particularly for minority and younger women.

Adult↗

PubMedDate not supplied

Who benefits from training in linguistic awareness in the first grade, and what components show training effects?

Who among first graders benefit from training in linguistic awareness, and what components of the linguistic awareness are most amenable to training effects? At the beginning of Grade 1 prospective at-risk readers (26 out of 117) were identified on the basis of very low phonological awareness. In the autumn term, they received practice in linguistic awareness. When compared to controls individually matched controls on phonological awareness, listening comprehension, and WISC-R scores, the intervention group showed a more rapid building-up of phonological awareness, especially phoneme-blending ability, as well as superiority in word recognition, spelling, and listening comprehension, which were sustained until the end of Grade 1. Reading comprehension could not be compared because 8 of the 26 controls did not read fluently enough to be tested. The half of the control group with cognitive delays, receiving normal special education instruction, performed consistently worse than their matched pairs in the intervention group. The latter group showed development of phonological awareness, decoding, and spelling equal to that of the cognitively nearly average intervention group and their matched pairs in the control group, who received no additional support. These three groups, originally defined as at-risk readers, performed at the level of other preschool nonreaders at the end of Grade 1. In sum, the children with cognitive delays benefitted from training in linguistic awareness. The results underscore the importance of phoneme synthesis skills in beginning reading and spelling, at least with regular languages.

Awareness↗

PubMed2005

Differences in need for antihypertensive drugs among those aware and unaware of their hypertensive status: a cross sectional survey.

BACKGROUND: Lack of antihypertensive use among hypertensive individuals is a major public health problem. It remains unclear as to how much of this lack of treatment is because of failure to diagnose hypertension or failure to initiate drug treatment for those with a diagnosis of hypertension. The primary aim of this study was to determine the proportion of those untreated individuals who would be recommended to start drug therapy for control of blood pressure among those aware or unaware of their diagnosis of hypertension. METHODS: The Canadian Heart Health Surveys (1986-1992), a national, cross-sectional descriptive survey (n = 23,129), was used to determine the proportion of individuals who were untreated, yet satisfied the 2004 Canadian hypertension guidelines for initiating drug therapy. Patients were divided into subgroups of those aware and unaware of having a diagnosis of hypertension according to self reported awareness from the survey. RESULTS: Of those with untreated hypertension (= 140/90 mmHg), only 37% were aware of their diagnosis. 74% of untreated individuals aware of their diagnosis of hypertension would require drug therapy, compared to 57% of those who were unaware. Of those >65 years of age, 52% of aware individuals needed drug therapy whereas only 34% of unaware elderly would need drug treatment. CONCLUSION: In both unaware and aware subgroups, the majority of patients with untreated hypertension would benefit from antihypertensive drug therapy according to the 2004 Canadian Hypertension recommendations. The proportion of untreated patients that still need drug therapy was higher among those who were aware compared to those who were unaware. This finding suggests that the major gap in hypertension control may be in initiating drug therapy rather than in diagnosing hypertension. Further studies are needed to confirm these results to ultimately help strategize public health efforts in controlling hypertension.

Adolescent↗

PubMed2002

Phonemic awareness and reading ability: an investigation with young readers who are deaf.

The study examined the relationship between phonemic awareness and reading ability in students who are deaf. The research questions were: (a) What is the relationship between phonemic awareness and reading ability in students who are deaf? (b) Does phonemic awareness facilitate the reading development of these students? Participants were 29 children of primary school age enrolled in a residential school for students who are deaf. The dependent variable, reading ability, was measured by a retelling task. The independent variables were age, language ability, and phonemic awareness. Language ability was determined through expert analysis of participant interviews. Phonemic awareness was measured with a word-to-word matching task. Descriptive techniques and multiple regression analysis were employed to analyze the data. Results indicated that reading ability was significantly correlated to language ability, but not to phonemic awareness. Phonemic awareness did not contribute to any of the variance in reading ability. The study results call into question the role of phonemic awareness as a prerequisite for reading development.

Adolescent↗

PubMed1995

Situation awareness in anesthesiology.

Situation awareness has primarily been confined to the aviation field. We believe that situation awareness is an equally important characteristic in the complex, dynamic, and risky field of anesthesiology. We describe three aspects of situations of which the decision maker must remain aware: subtle cues, evolving situations, and special knowledge elements. We provide examples of real or simulated anesthesia situations in which situation awareness is clearly involved in the provision of optimal patient care, and we map the elements of situation awareness onto a cognitive process model of the anesthesiologist. Finally, we consider how situation awareness can be further investigated and taught in this medical domain using anesthesia simulators and analyses of real cases. The study of situation awareness in anesthesiology may provide a good example of the wider application of the concept of situation awareness to nonaerospace environments.

Adult↗

PubMed2001

Single-cue delay eyeblink conditioning is unrelated to awareness.

We examined the importance of awareness for eyeblink conditioning by directly comparing single-cue delay eyeblink conditioning and single-cue trace eyeblink conditioning. During single-cue delay conditioning, participants who became aware of the stimulus contingencies early in the conditioning session conditioned no better than those who became aware later in the session or did not become aware. Thus, the level of awareness was unrelated to the overall level of conditioning across the session. In contrast, awareness of the stimulus contingencies early in the session predicted the success of single-cue trace conditioning. These data, together with earlier findings, show that awareness is irrelevant to single-cue delay eyeblink conditioning but is critical for single-cue trace eyeblink conditioning. The findings from the present study are related to previous findings for differential (CS+ and CS-) eyeblink conditioning and awareness.

Aged↗

PubMedDate not supplied

[French validation study of the levels of emotional awareness scale].

According to a thesis based on the idea of an influence of cognitions in the structuring of internal reality, emotional awareness, ie the capacity of representing your own emotional experience and that of others, is a cognitive process that goes into maturation. Defining this concept, Lane and Schwartz present a cognitivo-developmental model in five stages of the processes of symbolization, accounting for the differences in levels of emotional awareness observed in individuals. The organization of these cognitive processes would thus be structured in well differentiated stages, in which the development of the emotions would be inseparable from the development of ego and of the relation to others. These authors focus on the capacity of representing in a conscious way the emotional experience and consider that verbal representations used to describe the contents of what is experience constitute a good reflection of the organization structural of the emotional awareness. Therefore, they worked out an instrument of evaluation: the Levels of Emotional Awareness Scale (LEAS), which measures the capacity to describe your own emotional experience and the one you allow to others, in an emotional situation. The system of quotation of this scale is based on the analysis of the verbal contents of the provided answers, in direct reference to the authors' theory of the levels of differentiation and integration of the emotional experience. It is therefore an empirical measurement which is centered specifically on the structural organization of the emotional experience. The various studies of validation of this instrument show that it presents solid metrological properties. This work presents the validation of the French version of Lane and Schwartz's LEAS. Validity and fidelity were studied in a group of 121 healthy subjects. This setting is part of a larger clinical evaluation, also including a collection of socio-demographic and clinical data, and other instruments of self-evaluation (Beck Depression Inventory, BDI, Hospital Anxiety and Depression Scale, HAD, and Toronto Alexithymia Scale, TAS). The face validity appears correct: the questionnaire was well accepted and seemed easy to complete. A principal components analysis of the correlation matrix of the set of items was used as the method of extraction of the various factors and made it possible to confirm the unidimensionality of the instrument. The number of factors to be retained was given according to Kaiser and Cattell criteria. The internal consistency was evaluated through computation of the Cronbach coefficient, whose value is 0.75 for the scale's global score. The confidence interval of the margin of error of LEAS scores was also measured; for the global score it is IC=[m 6.1]. The measure given by this rating scale may therefore be considered sufficiently accurate, since this interval is weak. A study of the frequency of quotation of each item of the instrument was carried out, in order to check the homogeneity and the uniformity of quotations, as well as a diagram of distribution of the score, showing that it follows a law which is close to a normal law. The concurrent validity could only be studied via the similar concept of alexithymia, measured with the TAS, for there is not other instrument validated in French evaluating the levels of emotional awareness, and these two instruments seem to measure different notions, because none of the correlations between the scores of these two questionnaires are significant. Concerning discriminant validity, the Pearson correlation coefficients between the global score for the LEAS, the BDI score and the HAD sub-scores for depression and anxiety were measured; it is clear that the level of emotional awareness is independent from negative affects. Furthermore, the study of the reliability made it possible to highlight excellent intra-class correlation coefficients (r=0.993). The French version of the Levels of Emotional Awareness Scale thus appears to be valid and accurate and should allow the study of levels of emotional awareness on psychopathology. It is about an easily acceptable and simple questionnaire of use in varied clinical circumstances.

Adolescent↗