Exposure to intimate partner violence (IPV) can have long-lasting effects on a child’s socio-emotional and neurological development. Research has focused on the effects of IPV on women or older children, while the developmental consequences of exposure to domestic violence during early childhood are less well documented. However, one would expect significant developmental effects since the infant’s brain and stress-related systems are especially susceptible to environmental stimuli. The goal of this mini-review is to examine how findings on infant exposure to IPV can be related to risk and resilience of development in infancy. We describe the known effects of witnessing violence during the perinatal period on socio-emotional development and the possible pathways by which IPV affects brain and stress-regulating systems. Exposure to IPV during infancy disrupts the infant’s emotional and cognitive development, the development of the Hypothalamus-Pituitary-Adrenal (HPA) axis and brain structures related to witnessing itself (auditory and visual cortex). The findings are embedded in the context of the resource depletion hypothesis. A central problem is the dearth of research on exposure to IPV during infancy, its effect on caregiving, and infant development. Nonetheless, the available evidence makes it clear that policies for prevention of IPV are critically needed.
OBJECTIVEAwake craniotomies have become a feasible tool over time to treat brain tumors located in eloquent regions. Different techniques have been applied in neurooncology centers. Both “asleep-awake-asleep” (asleep) and “conscious sedation” were used subsequently at the authors’ neurosurgical department. Since 2013, the authors have only performed conscious sedation surgeries, predominantly using the α2-receptor agonist dexmedetomidine as the anesthetic drug. The aim of this study was to compare both mentioned techniques and evaluate the clinical use of dexmedetomidine in the setting of awake craniotomies for glioma surgery.METHODSThe authors retrospectively analyzed patients who underwent operations either under the asleep condition using propofol-remifentanil or under conscious sedation conditions using dexmedetomidine infusions. In the asleep group patients were intubated with a laryngeal mask and extubated for the assessment period. Adverse events, as well as applied drugs with doses and frequency of usage, were recorded.RESULTSFrom 224 awake surgeries between 2009 and 2015, 180 were performed for the resection of gliomas and included in the study. In the conscious sedation group (n = 75) significantly fewer opiates (p < 0.001) and vasoactive (p < 0.001) and antihypertensive (p < 0.001) drugs were used in comparison with the asleep group (n = 105). Furthermore, the postoperative length of stay (p < 0.001) and the surgical duration (p < 0.001) were significantly lower in the conscious sedation group.CONCLUSIONSUse of dexmedetomidine creates excellent conditions for awake surgeries. It sedates moderately and acts as an anxiolytic. Thus, after ceasing infusion it enables quick and reliable clinical neurological assessment of patients. This might lead to reducing the amount of administered antihypertensive and vasoactive drugs as well as the length of hospitalization, while likely ensuring more rapid surgery.
Assessing outcomes in multinational studies on traumatic brain injury (TBI) poses major challenges and requires relevant instruments in languages other than English. Of the 19 outcome instruments selected for use in the observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, 17 measures lacked translations in at least one target language. To fill this gap, we aimed to develop well-translated linguistically and psychometrically validated instruments. We performed translations and linguistic validations of patient-reported measures (PROMs), clinician-reported (ClinRO), and performance-based (PerfO) outcome instruments, using forward and backward translations, reconciliations, cognitive debriefings with up to 10 participants, iterative revisions, and international harmonization with input from over 150 international collaborators. In total, 237 translations and 211 linguistic validations were carried out in up to 20 languages. Translations were evaluated at the linguistic and cultural level by coding changes when the original versions are compared with subsequent translation steps, using the output of cognitive debriefings, and using comprehension rates. The average comprehension rate per instrument varied from 88% to 98%, indicating a good quality of the translations. These outcome instruments provide a solid basis for future TBI research and clinical practice and allow the aggregation and analysis of data across different countries and languages.
Early exposure to adversities, such as witnessing intimate partner violence (IPV) can have long‐lasting impact on infants behavioral, emotional, and neurological development. Yet, research so far has focused on how IPV affects the well‐being of women or on the retrospective effects in older children. The first 2 years of life are characterized by rapid development of brain and behavior, making infants even more vulnerable than women or older children to the detrimental effects of exposure to violence. The goal of this review is to summarize the scientific findings on the effects of IPV on infant brain maturation and related socioemotional development. We describe effects of violence on attachment, symptoms of trauma in infants, and possible pathways involved in how IPV exposure may affect maturation of brain regions related to emotional regulation. We relate affected brain structures to development of stress reactivity (amygdala), memory (hippocampus), the processing of witnessed events itself (auditory and visual cortex), and how these consequences relate to potential subsequent psychopathology.
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