Impaired Insight Research Articles

‘Never mind the bullocks’: animating the go-along interview through creative nonfiction

ABSTRACT Recent years have seen increasing enthusiasm for the use of go-along interviews to attend to the fleeting, more-than-human relational encounters that co-constitute people’s everyday experiences of health and wellbeing. Go-alongs are an approach to qualitative fieldwork in which research participants literally walk (or drive, swim, wheel, kayak and so forth) the researcher through their place experiences. While such approaches have wide-ranging advantages, there are growing calls to better animate the go-along encounter; to capture and convey go-alongs that are more vivid, sensuous and entangled with the dynamic meanings and materialities that shape everyday life. This methodological paper presents a creative non-fiction, produced as a tentative response to these calls, and designed to invite further reflection on some of the key challenges and opportunities of using such emplaced mobile methods within the social sciences. Situated at the under-researched intersection of critical disability and mobilities research, it draws on the findings of a two-year study that examined how people with sight impairment in the UK negotiate and experience a sense of wellbeing (or otherwise) with and through diverse types of everyday nature.

Risk and Protective Factors Associated with Moderate and Acute Suicidal Ideation among a National Sample of Tribal College and University Students 2015-2016.

We examined the relationship between suicide risk and disability status, as well as risk and protective factors, adjusting for demographic characteristics, among students attending 22 Tribal Colleges and Universities (TCU; 20 rural and 2 urban) across the United States in fall 2015 and 2016. Tribal college students (N = 3,239) participated in a cross-sectional online or paper survey assessing alcohol use patterns and mental health outcomes, yielding a response rate of 31.3%. Of the students surveyed, 8.8% indicated moderate or high suicide risk. Hearing impairment was significantly associated with moderate/high suicide risk (OR = 2.11; 1.24-3.61, P=.006), as was vision impairment (OR= 3.03; 1.92-4.77, P<.001), having a physical/mental/or emotional condition (OR= 2.12; 1.75-2.57, P< .001), experiencing critical appraisal (OR= 1.30; 1.24-1.36, P< .001), and experiencing critical isolation (OR= 1.83; 1.66-2.01, P< .001). Scoring high on resilience (OR= 0.93; 0.92-0.95, P< .001), reporting higher emotional social support (OR= 0.75; 0.70-0.79, P< .001), and reporting higher levels of instrumental social support (OR= 0.69, 0.62-0.76, P< .001) were significantly associated with lower suicide risk. Students attending tribal colleges who experience hearing impairment, sight impairment, or a physical/emotional/mental condition have a greater risk of suicidality. Students experiencing critical appraisal and critical isolation may benefit from behavioral health interventions to reframe these experiences and develop resiliency skills. Developing avenues of emotional and instrumental social support within TCU settings offers key protective factors to buffer the risk of suicidality. Examining additional ways to build resiliency may also offer protection from suicide risk in this population.

Profiling biopsychosocial health of cancer-diagnosed elderly in Italy by Passi d’Argento, 2016-2017

Abstract Background PASSI d'Argento (PdA) is an Italian population-based surveillance system, coordinated by the Istituto Superiore di Sanità (ISS) and carried out by the Local Health Units (LHUs). PdA monitors wide-ranged health related-behaviours in the elderly (65+) living in Italy as per the three pillars of the “Active Healthy Ageing” framework: Health, Participation, Security. Methods The PdA sample is randomly selected from the LHU lists, stratified by sex and age. 22,811 records have been collected in 2016-2017 on a representative sample of residents aged over65, not being hospitalised, in long-term care, in a nursing home or prison. Results 3,019 respondents resulted cancer-diagnosed elderly (CDE) reporting cancer diagnosis or confirmation, leukaemia and lymphomas included (annual average prevalence of 12.8%, Confidence Intervals 95%: 12.1-13.4%; one million and 729 thousand people). CDE refer: poorer health conditions (22%) than Chronic Elderly Patients (CEP; 18%) and Healthy Elderly (HE; 5%), sight impairment (12%), hearing loss (15%) and chewing problems (14%). CDE (10%) and CEP (11%) are more prone to fall than HE do (6%). Disability accounts for 21% in CDE and CEP vs. 12% in HE. A multivariate analysis confirms a compromised psychophysical health profile in CDE vs. HE, and vs. CEP. CDE behave still unhealthily, are insufficiently advised by health professionals, do not comply with the seasonal flu vaccination [Health]. CDE face increased risk for isolation or cognitive decline: they experience lower social connectedness (17%) than CEP (20%) and HE (28%) [Participation], and perceive higher neighbourhood insecurity (19%) than how CEP (17%) and HE (13%) do [Security]. Conclusions PdA data on the poor biopsychosocial health profile of CDE highlight to what extent healthy behaviours and prevention can ameliorate their quality of life PdA calls for global action strategies in Italy, which aim at taking complete charge of CDE and also CEP. Key messages In Italy, elderly cancer survivors show poor biopsychosocial health profile and overall quality of life. By modifying behaviours, elderly suffering from any cancer or chronic disease can age healthily.

Agreement amongst consultant ophthalmologists on levels of visual disability required for eligibility for certificate of sight impairment : Sight impairment registration using binocular composite visual fields.

Registration as sight impaired allows access to services important for patients. The rates of sight impairment due to visual field loss are underestimated. Previous work has shown that evaluation of visual field defects in both eyes produces poor agreement among ophthalmologists for categorisation of patients as eligible for sight impairment registration. To evaluate the impact of binocular summation of both eye glaucomatous visual field defects on agreement for sight impairment registration. Thirty consultant ophthalmologists (Graders), graded 50 glaucomatous visual field sets. Each consisted of both monocular fields and summated binocular plots. Graders classified the visual field sets as sight impaired (SI), severely sight impaired (SSI) or neither. Trichotomous, (SI, SSI or no sight impairment) and dichotomous (any sight impairment versus no sight impairment) concordance values were estimated for the group of graders as a whole and for glaucoma and non-glaucoma experts. For trichotomous analysis the overall kappa agreement rate was 0.29; for dichotomous analysis it was 0.40. There was no material difference between glaucoma experts and non-experts. Overall agreement was modest. Grading for SI showed the poorest levels of agreement. Using binocular fields does not appear to improve concordance for sight impairment registration. Moreover, there is no difference in agreement between glaucoma and non-glaucoma experts. An overall score for visual disability using mean deviation may be a more pragmatic approach.

Study on the Role of Inflammatory Markers and Type D Personality on Symptom Profiles and Severity in Patients with Major Depressive Disorder

The high rates of chronicity and recurrences account for the limited efficacy of current antidepressants, conceived based on the current neurobiological hypotheses, in reaching the full clinical and functional remission of major depressed (MDD) patients. We aimed to analyze the role of pro-inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), respectively, and type D personality (TDP) on the depressive symptoms measured by the 17-item Hamilton Depression Rating Scale (HAM-D). The processed data are part of a prospective 8-weeks follow-up study conducted in 50 subjects with MDD referred to ‘Eduard Pamfil’ Psychiatric Clinic Timisoara. The presence of elevated pro-inflammatory markers in MDD patients with TDP has been significantly associated with higher somatic anxiety (p = 0.005) and somatic symptoms-general (p = 0.016) mean rank scores compared to their counterparts without significant inflammation. The combination of increased CRP and IL-6 levels were significantly correlated with higher impaired insight (p = 0.026) mean rank scores, additionally. The presence of a significant level of IL-6 has shown a significant effect of size (p = 0.023) on the severity of major depression at baseline. On the contrary, type D personality has not influenced the severity of depressive symptoms (p &gt; 0.05). Inflammatory markers significantly impact the clinical profiles and symptoms severity of MDD patients.

Development and validation of the schedule for the assessment of insight in eating disorders (SAI-ED)

This study examined the reliability, validity and internal structure of the newly developed, interview-based Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and the relationships of insight with demographic and clinical characteristics in EDs. Ninety-four female patients – 44 with anorexia nervosa (AN) and 50 with bulimia nervosa (BN) – were assessed with SAI-ED. The Brown Assessment of Beliefs Scale was used to evaluate convergent validity of SAI-ED. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. The final 8-item SAI-ED demonstrated good psychometric properties. Inter-rater and test-retest reliabilities were high. Three subscales of SAI-ED were identified which measure major insight components: awareness of illness, awareness of symptoms, and treatment engagement. Patients with AN had significant lower score on SAI-ED than patients with BN. Impaired insight was associated with: (a) lower current and lowest lifetime BMI and more severe dietary restrain in AN, (b) illness duration, severity of overall ED symptoms, body-related concerns and obsessionality in BN. Insight is a multidimensional construct in EDs associated with different clinical aspects in AN and BN. The SAI-ED is a valid and reliable tool for the assessment of insight in EDs patients.

Autonomous Smart White Cane Navigation System for Indoor Usage

According to the statistics provided by the World Health Organization, the number of people suffering from visual impairment is approximately 1.3 billion. The number of blind and visually impaired people is expected to increase over the coming years, and it is estimated to triple by the end of 2050 which is quite alarming. Keeping the needs and problems faced by the visually impaired people in mind, we have come up with a technological solution that is a “Smart Cane device” that can help people having sight impairment to navigate with ease and to avoid the risk factors surrounding them. Currently, the three main options available for blind people are using a white cane, technological tools and guide dogs. The solution that has been proposed in this article is using various technological tools to come up with a smart solution to the problem to facilitate the users’ life. The designed system mainly aims to facilitate indoor navigation using cloud computing and Internet of things (IoT) wireless scanners. The goal of developing the Smart Cane can be achieved by integrating various hardware and software systems. The proposed solution of a Smart Cane device aims to provide smooth displacement for the visually impaired people from one place to another and to provide them with a tool that can help them to communicate with their surrounding environment.

Hygiene promotion might be better than serological screening to deal with Cytomegalovirus infection during pregnancy: a methodological appraisal and decision analysis

BackgroundCytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. In 2016, the French High Council of Public Health was mandated to update recommendations regarding prevention of cytomegalovirus infection in pregnant women. We summarize a critical appraisal of knowledge and deterministic decision analysis comparing the current no-screening situation to serological screening during pregnancy, and to hygiene promotion.MethodsScreening was defined as systematic serological testing, during the first trimester, with repeated tests as needed, to all pregnant women. Outcomes were: 1) severe sequela: intellectual deficiency with IQ ≤ 50 or hearing impairment < 70 dB or sight impairment (≤ 3/10 at best eye); 2) moderate sequela: any level of intellectual, hearing or sight deficiency; and 3) death or termination of pregnancy. We simulated the one-year course of cytomegalovirus infection in a cohort of 800,000 pregnant women. We developed a deterministic decision model, using best and min-max estimates, extracted from systematic reviews or original studies.ResultsRelevant data were scarce or imprecise. We estimated that 4352 maternal primary infections would result in 1741 foetal infections, and an unknown number of maternal reinfections would result in 1699 foetal infections. There would be 788 cytomegalovirus-related consequences, including 316 foetal deaths or terminations of pregnancy, and 424 moderate and 48 severe sequelae. Screening would result in a 1.66-fold increase of poor outcomes, mostly related to a 2.93-fold increase in deaths and terminations of pregnancy, not compensated by the decrease in severe symptomatic newborns. The promotion of hygiene would result in a 0.75-fold decrease of poor outcomes, related to both a decrease in severe sequelae among symptomatic newborns (RR = 0.75; min-max: 1.00–0.68), and in deaths and terminations of pregnancy (RR = 0.75; min-max: 0.97–0.68).ConclusionsPrevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended.

Lower socioeconomic status and the acceleration of aging: An outcome-wide analysis

Aging involves decline in a range of functional abilities and phenotypes, many of which are also associated with socioeconomic status (SES). Here we assessed whether lower SES is a determinant of the rate of decline over 8 y in six domains-physical capability, sensory function, physiological function, cognitive performance, emotional well-being, and social function-in a sample of 5,018 men and women aged 64.44 (SD 8.49) y on average at baseline. Wealth was used as the marker of SES, and all analyses controlled for age, gender, ethnicity, educational attainment, and long-term health conditions. Lower SES was associated with greater adverse changes in physical capability (grip strength, gait speed, and physical activity), sensory function (sight impairment), physiological function (plasma fibrinogen concentration and lung function), cognitive performance (memory, executive function, and processing speed), emotional well-being (enjoyment of life and depressive symptoms), and social function (organizational membership, number of close friends, volunteering, and cultural engagement). Effects were maintained when controlling statistically for other factors such as smoking, marital/partnership status, and self-rated health and were also present when analyses were limited to participants aged ≤75 y. We conclude that lower SES is related to accelerated aging across a broad range of functional abilities and phenotypes independently of the presence of health conditions and that social circumstances impinge on multiple aspects of aging.

Major depression, sleep, hostility and body mass index are associated with impaired quality of life in schizophrenia. Results from the FACE-SZ cohort.

BackgroundImpaired Quality of life (QoL) in schizophrenia has been mostly associated with psychotic and mood symptomatology, insight and functioning so far. AimsQoL levels remain unsatisfactory due to other factors we aim to explore. MethodWe have explored sleep quality with the Pittsburgh Sleep Quality Index, hostility with the Buss&Perry questionnaire, major depression with the Positive and Negative Syndrome Scale depressive factor, functioning with the Global Assessment of Functioning scale and weight gain with body mass index in addition to other classical QoL-associated factors. Results559 patients (mean age=31 (SD 9) years, 74% male sex) were included in the national FACE-SZ cohort. Impaired QoL has been significantly associated with respectively major depression, impaired sleep quality, increased hostility, impaired functioning and impaired insight independently of age, sex, treatments, tobacco smoking and body mass index.Major depression was associated with impaired psychological and physical well-being, and impaired self-esteem. Impaired sleep quality has been associated with impaired psychological and physical well-being and sentimental life. Hostility has been associated with impaired psychological well-being and self-esteem, impaired friends’ relationships and impaired autonomy. Weight was associated with impaired physical well-being. Tobacco smoking was associated with higher level of friends’ relationships. ConclusionsMajor depression, sleep, hostility, and weight gain have been identified as potential targets to improve QoL in schizophrenia and should be implemented in the recommendations for good practice to optimize schizophrenia care.

T206. ANTIPSYCHOTIC EFFECTIVENESS FOCUSING ON INSIGHT

BackgroundImpaired insight is common among patients with schizophrenia, and a major obstacle for treatment adherence and improvement. Previous studies have investigated the effect of antipsychotics on insight, but findings are indecisive due to small or homogeneous samples, non-randomized design or short follow- up.The aim of this study was to investigate if there were differential effects on insight among different antipsychotic medications, and whether the effect was directly related to improvement in insight or indirectly through reduction of psychosis symptoms.MethodsData was derived from the Bergen-Stavanger-Innsbruck-Trondheim study (BestIntro). This is a randomized, rater-blinded, naturalistic study with a head- to head comparison of three antipsychotic medications: amisulpride, aripiprazole and olanzapine. Inclusion criteria were adults with a F20-F29 ICD-10 diagnosis being actively psychotic defined as a score of ≥4 on items P1, P3, P5, P6, or G9 on the Positive And Negative Syndrome Scale (PANSS). Insight was measured by PANSS item G12. We used a modified version of PANSS to assess psychosis symptoms (PANSS total score minus item G12, mPANSS). Level and change in insight and psychosis symptoms were estimated in latent growth curve models. The pattern of change indicated a piecewise model with the initial phase from baseline to week six and the long-term phase from week six to one year. The study drugs were used as predictors.ResultsA total of 144 participants were included, 35% female and 61% had previously used antipsychotic medication. Mean insight score at baseline was 3.36. Preliminary findings show differential effects on insight among the three medications, where aripiprazole was the least effective drug. The effect on insight was related to improvement in psychosis symptoms for all study drugs. In addition, we found a direct effect on insight in the long-term phase for amisulpride and olanzapine. In the same phase, the aripiprazole group showed a slight increase in impaired insight.DiscussionThis is the first randomized study with a heterogeneous sample to find an effect of antipsychotics on insight that exceeds the contribution of reduction of psychosis symptoms. Although we have not investigated the association between increased insight and medication adherence, our results imply that patients with impaired insight will benefit from antipsychotic treatment. More specifically, treatment with amisulpride or olanzapine may be more helpful in improving insight over time.

A higher degree of insight impairment in stabilized schizophrenia patients is associated with reduced cardiac vagal tone as indexed by resting-state high-frequency heart rate variability.

Varying degrees of impaired clinical insight in schizophrenia differentially impact medication adherence and clinical outcomes, prompting in-depth investigations of the deficits. Research is scarce on the differences in peripheral physiological markers between varying degrees of impaired insight. The aims of this study were to examine the differences in (1) resting-state high-frequency heart rate variability (HF-HRV) and (2) crucial clinical outcomes between schizophrenia patients with varying degrees of insight impairment as measured by the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). The study recruited a sample of 95 stabilized schizophrenia patients with insight impairment. Patients were divided into 2 groups of either minimal insight impairment (n = 25, PANSS G12 = 2-3) or moderate-to-severe insight impairment (n = 70, PANSS G12 ≥ 4). Patients with moderate-to-severe insight impairment displayed lower HF-HRV, clinician-rated psychosocial function, medication adherence, and working memory capacity, and higher self-reported psychosocial function and life quality, but comparable cognitive insight compared to those with minimal insight impairment. A logistic regression model predicted moderate-to-severe insight impairment based on HF-HRV values at the optimal cut-off point of 3.655, with the sensitivity and specificity 84% and 72%, respectively. HF-HRV seems a peripheral marker sensitively reflecting central pathophysiology implicated in insight impairment of schizophrenia.

Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age

The aim of this study was to analyse in particular dependence in instrumental daily life activities (I-ADLs) and its association with physical impairments and functional limitations in the elderly. The study was based on cross-sectional data on 70-year-olds (n = 602) and longitudinal data on subjects followed up to the age of 76 (n = 371). Persons dependent in ADL had lower values in maximum walking speed, grip strength, knee extensor strength, stair climbing capacity and in forward reach, compared with those who were independent in ADL. Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL. Possible critical levels for disability in ADL are discussed, as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL.

Improving Insight in Non-Treatment-Resistant Patients With Schizophrenia With Transcranial Direct Current Stimulation

Impaired insight into illness is a common feature of schizophrenia that is frequently associated with worse clinical and functional outcomes. Transcranial direct current stimulation (tDCS) is a method of brain stimulation that delivers a weak electric current to targeted brain regions. In this pilot randomized-sham controlled study, we aimed to examine the efficacy of adjunctive tDCS on insight in patients with schizophrenia.

Cognitive anosognosia is associated with frontal dysfunction and lower depression in Parkinson's disease.

Anosognosia refers to a deficit of self-awareness or impaired insight for cognitive and behavioral problems. Cognitive anosognosia was explored in de novo patients with Parkinson's disease (PD) and its relationship to cognitive function and neuropsychiatric symptoms was investigated. The cross-sectional study enrolled 340 drug-naïve patients with PD. According to the presence of mild cognitive impairment (MCI) and subjective cognitive complaint, patients were classified as patients with cognitive anosognosia (PD-CA, n=74), with normal cognitive recognition (PD-NR, n=184) or with cognitive underestimation (PD-CU, n=82). After controlling for covariates, cognitive performance and neuropsychiatric symptoms were compared between the PD groups. Cognitive anosognosia was found in 21.8% of patients with de novo PD. The PD-CA group showed poorer performance in all cognitive domains except for attention. Amongst PD patients with MCI, those with cognitive anosognosia showed lower composite z-scores in the Stroop color reading test than those without. The Beck Depression Inventory score in the PD-NR group was lower than that in the PD-CU group and higher than that in the PD-CA group. The Cognitive Complaints Interview score mediated the association between cognitive anosognosia and Beck Depression Inventory score. Cognitive anosognosia in PD was associated with greater frontal dysfunction and lower depression. Since cognitive anosognosia has a harmful impact on PD patients and their caregivers due to overestimation of their abilities in everyday life, early identification of cognitive anosognosia in PD is important in management and prognosis.

Self-awareness of problematic drug use: Preliminary validation of a new fMRI task to assess underlying neurocircuitry

BackgroundMultiple psychopathologies feature impaired clinical insight. Emerging evidence suggests that insight problems may similarly characterize addiction, perhaps due to aberrant functioning of self-referential brain circuitry, including the rostral anterior cingulate and ventromedial prefrontal cortices (rACC/vmPFC). We developed a new fMRI task to probe whether rACC/vmPFC abnormalities in cocaine use disorder (CUD) constitute neural correlates of readiness to change, one facet of insight. MethodsEighteen individuals with current CUD and 15 healthy controls responded about their own need to change their drug use and eating behavior (control condition) and the need for a named acquaintance to do the same (two additional control conditions). Measures of simulated drug-choice behavior, addiction severity, and neuropsychological function were collected outside the scanner. ResultsCUD participants perceived a greater need for behavior change than controls (as expected, given their diagnosis), but fell short of “agreeing” to a need for change; in CUD, lower perceived need correlated with higher simulated drug-choice behavior, a proxy measure of drug-seeking. During drug-related insight judgments, CUD participants had higher activation than controls in an anatomically-defined region of interest (ROI) in the medial orbitofrontal cortex, part of the rACC/vmPFC. Although not showing group differences, activation in an anatomically-defined ACC ROI correlated with insight-related task behavior (in all participants) and memory performance (in CUD). ConclusionsAs a group, individuals with current CUD appear to show mild insight problems and rACC/vmPFC abnormalities vis-à-vis readiness to change behavior. With replication and extension of these results, insight-related circuitry may emerge as a novel therapeutic target.

Perceptions of Flower Farm Workers on the Health Effects of Chemicals Exposures around Bahir Dar Town, Ethiopia

Aims: Explore the perceptions of flower farms workers towards the health effects of chemical exposures. Perception is the views, attitudes and opinions of workers.&#x0D; Study Design: Descriptive survey, using quantitative and qualitative approaches.&#x0D; Place and Duration of the Study: Tana Flora, Bahir Dar Farm and Tal Flowers, between November 2018 and June 2019.&#x0D; Methodology: Statistical analyses were done using 302 sample workers (80 male and 222 female; age ranges 15-65 years) at 95% confidence interval employing stratified random sampling techniques via proportional sample selection, and a response rate of 95.6%. Independent sample t-test with the assumption of equal variance (the Leven’s t-test) was used to analyze the existence of significant perception differences among female and male workers, and workers labour divisions. Qualitative data was obtained through structured interviews from farms managers (3); regional Environmental, Forest and Wildlife Protection Development Authority (EFWPDA) officials (3) and field observations that supplemented the quantitatively analyzed data.&#x0D; Results: Leven’s t-test showed the computed p-values were less than the preset significance level (0.05) for the majority of health impacts of chemical exposures. Significant perception differences were observed among male and female workers and workers of different labour divisions (production vs. protection; pack house vs. protection) towards health impacts: skin rush, appetite loss, stomach cancer, birth defects, reproductive system damage, dizziness and impaired sight. Males perceived in a better way than females since farms gave special focus to male workers in the protection section 27(8.9%) and they engaged using the required health protective gears. Further, in flower farms, most of the proposed health impact mitigation measures were poorly implemented.&#x0D; Conclusion: Workers perception differences were occurred due to a particular attention to male workers in protection labour division; hence the regional EFWPDA should do the proper supervision and follow up for effective implementation of health impact mitigation measures.

Psycho-demographic and clinical predictors of medication adherence in patients with bipolar I disorder in a university hospital in Egypt.

BackgroundPoor adherence to treatment is one of the main challenges to symptom control and preventing recurrence in bipolar disorder (BD). Numerous studies have established an association between patients’ poor adherence and an increased risk of recurrence, relapse of the symptoms and admission to hospital.AimTo study the socio-demographic and clinical factors associated with medication nonadherence in patients with BD who were admitted to the hospital.SettingThe study was conducted at the Institute of Psychiatry, Ain Shams University.MethodsA 1-year longitudinal prospective study of 110 patients, aged 18–60 years, with BD-I. Young Mania Rating Scale, Clinical Global Impression, Global Assessment of Functioning, Sheehan Disability Scale and Insight and Treatment Attitude Questionnaire were applied before and 6 months after discharge. Adherence was measured using the Morisky 8-Item Medication Adherence Scale. Sociodemographic data and level of functioning were studied in relation to adherence.ResultsHigher adherence was noticed in female, married and older patients and those with a higher level of education. However, low adherence was more common in male, non-married and less educated patients. Follow-up after 6 months revealed that the high adherence group scored the lowest in terms of disability. Meanwhile, the low adherence group scored the highest scores in disability.ConclusionSeveral socio-demographic and clinical variables were found to be associated with a low adherence rate to the prescribed medication in patients with BD-I. Age and impaired insight were found to be significant predictive factors for non-adherence.

ASSESSING CONSTRUCTION LABOURS’ SAFETY LEVEL: A FUZZY MCDM APPROACH

Risk decision matrix has widely been favoured by the researchers in the area of construction safety risk assessment. Although it provides the construction safety professionals with the final illustration of the risks magnitude, it suffers from major shortcomings, including inability to considering the importance of probability and severity, impaired analysis resulting from the use of raw numbers for ratings, and the limited range of classifications for assessing the risks. All these shortages give an impaired insight to the concerned parties, deteriorating the involved workers’ safety. As such, this paper aims to develop a novel Risk Assessment Model (RAM) through the integration of the Fuzzy Best Worst Method (FBWM) with the Interval-Valued Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (IVFTOPSIS). Based on the application of RAM to a real-life case study, it was observed that the developed RAM contributes to the body of construction safety risk assessment in five unique ways: (1) computing the importance of the two risk parameters (i.e. probability and severity) using fuzzy-reference-based comparisons, (2) obviating the needs for having statistical data, (3) prioritizing the identified risks using the combination of interval-valued triangular fuzzy numbers with TOPSIS, (4) providing the safety analysts with wider ranges of classifications for conducting risk assessment, and (5) providing the safety professionals with appropriate evaluation strategies for controlling the analysed risks. The developed model in the study can be applied to any projects, giving a conclusive plan to the concerned safety professionals for adopting the further prudent mitigation measurements.

Impact of visual and auditory deprivation on speech perception and production in adults

ABSTRACT Speech perception relies on auditory and visual cues and there are strong links between speech perception and production. We aimed to evaluate the role of auditory and visual modalities on speech perception and production in adults with impaired hearing or sight versus those with normal hearing and sight. We examined speech perception and production of three isolated vowels (/i/, /y/, /u/), which were selected based on their different auditory and visual perceptual saliencies, in 12 deaf adults who used one or two cochlear implants (CIs), 14 congenitally blind adults, and 16 adults with normal sight and hearing. The results showed that the deaf adults who used a CI had worse vowel identification and discrimination perception and they also produced vowels that were less typical or precise than other participants. They had different tongue positions in speech production, which possibly partly explains the poorer quality of their spoken vowels. Blind individuals had larger lip openings and smaller lip protrusions for the rounded vowel and unrounded vowels, compared to the other participants, but they still produced vowels that were similar to those produced by the adults with normal sight and hearing. In summary, the deaf adults, even though they used CIs, had greater difficulty in producing accurate vowel targets than the blind adults, whereas the blind adults were still able to produce accurate vowel targets, even though they used different articulatory strategies.