Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic

Originally Posted Here: https://www.health.harvard.edu/blog/intimate-partner-violence-and-traumatic-brain-injury-an-invisible-public-health-epidemic-2018121315529

While studying brain injuries in the mid-1990s, I began volunteering in a domestic violence shelter. I noticed that the abuse and problems many women reported were consistent with possibly experiencing concussions. Women reported many acts of violence that could cause trauma to the brain, as well as many post-concussive symptoms. Shockingly, my search for literature on this topic yielded zero results.

When I decided to focus my graduate work on this topic, I was even more shocked by what I learned from women who had experienced intimate partner violence (IPV). Of the 99 women I interviewed, 75% reported at least one traumatic brain injury (TBI) sustained from their partners and about half reported more than one — oftentimes many more than one. Also, as I predicted, the more brain injuries a woman reported, the more poorly she tended to perform on cognitive tasks such as learning and remembering a list of words. Additionally, having more brain injuries was associated with higher levels of psychological distress such as worry, depression, and anxiety.

When I published these results, I was excited about the possibility of bringing much needed awareness and research attention to this topic. Unfortunately, over 20 years later — despite the plethora of concussion-related research in athletics and the military — concussion-related research in the context of intimate partner violence remains scant, representing a barely recognized and highly understudied public health epidemic.

What do we know about intimate partner violence-related traumatic brain injuries?

First, we need to understand that an estimated one in three women experience some type of physical or sexual partner violence in their lifetimes. IPV is not a rare event, and it traverses all socioeconomic boundaries. It is the number one cause of homicide for women and the number one cause of violence to women. For many reasons, including the stigma of being abused, many women hide their IPV — so the chances that we all know personally at least a few people who have sustained IPV are quite high.

Though we lack good epidemiological data on the number of women sustaining brain injuries from their partners, the limited data that we do have suggest that the numbers are in the millions in the US alone. Most of these TBIs are mild and are unacknowledged, untreated, and repetitive. Consequently, many women are at risk for persistent post-concussive syndrome with completely unknown longer-term health risks.

What are the signs and symptoms of IPV-related TBI?

A concussion, by definition, is a traumatic brain injury (TBI). All that is required for someone to sustain a TBI or concussion is an alteration in consciousness after some type of external trauma or force to the brain. For example, either being hit in the head with a hard object (such as a fist), or having a head hit against a hard object (such as a wall or floor), can cause a TBI. If this force results in confusion, memory loss around the event, or loss of consciousness, this is a TBI. Dizziness or seeing stars or spots following such a force can also indicate a TBI. A loss of consciousness is not required, and in fact does not occur in the majority of mild TBIs.

There are often no physical signs that a TBI has occurred. Recognizing that an IPV-related TBI has occurred will typically involve asking the woman about her experience following a blow to the head or violent force to the brain, and then listening for signs of an alteration of consciousness (such as confusion, memory loss, loss of consciousness). Within the next days or week, a range of physical, emotional, behavioral, or cognitive issues may indicate post-concussive symptoms that could include

headaches dizziness feeling depressed or tearful being irritable or easily angered frustration restlessness having poor concentration sleep disturbances forgetfulness taking longer to think.

If a TBI is suspected, a woman should see a doctor if possible. Sustaining additional TBIs while still symptomatic will likely increase the time to recovery, and possibly increase the likelihood of more long-term difficulties.

What can we do?

An important component of addressing IPV-related TBI is to raise awareness and destigmatize intimate partner violence. IPV is unfortunately quite common, and some estimates suggest that millions of women may be sustaining unacknowledged, unaddressed, and often repetitive mild TBIs or concussions from their partners. Talking openly and honestly about this problem, especially in cases were abuse may be suspected, is critical. As we open up this conversation about the commonality of IPV with nonjudgmental acceptance of a woman’s experience, we will be in a better place to hear, understand, and support women who may be unknowing members of this invisible public health epidemic.

Resources

If you or someone you know is experiencing intimate partner violence, The Hotline is a 24/7 support service that has a wealth of resources, including access to service providers and shelters across the US.

Follow me on Twitter @EveValera2‏

The post Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic appeared first on Harvard Health Blog.


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Smell disorders: When your sense of smell goes astray

Originally Posted Here: https://www.health.harvard.edu/blog/smell-disorders-when-your-sense-of-smell-goes-astray-2018121215539

We spend our days interacting with the world around us through our senses of sight, sound, and touch. But anyone who has developed complete nasal obstruction from an infection or severe allergies has experienced what it’s like to be without one of our most basic senses: our sense of smell.

The many functions of smell

In other animals, the sense of smell is absolutely crucial for survival, reproduction, and rearing of young. Although humans can survive without smell, research has shown that losing the sense of smell negatively impacts quality of life, even driving some people toward clinical depression. Just as other animals depend on the sense of smell as an alarm system for danger, we also depend on smell to warn us of the hazards of smoke from a fire, natural gas leaks in the home, and spoiled food.

On a daily basis, smell rounds out our experiences and is often an integral part of our memory of events from years gone by. Memories of a perfume worn by your spouse or the bread being baked at your grandmother’s house when you were a child last for decades, and are often intricately tied in with strong emotions.

The flavor of a meal depends heavily on the ability to smell, and without it, eating is just a bland means to dispel hunger. With so much of our social activity involving congregating at restaurants, bars, and cafes, it is understandable how someone losing the sense of smell can develop a sense of alienation.

Impact of smell disorders

Smell disorders affect 19% of the population over the age of 20 and 25% of the population over 53. If smell loss from aging alone is considered, one out of eight people between 53 and 91 will be affected over a five-year period. The detrimental effect of smell loss on flavor of food could significantly impact the elderly population, where diet and nutrition are already often a concern.

The sense of smell (olfaction) is dependent on millions of specialized nerve cells that are located in a deep protected recess high in the nasal cavity. Remarkably, these nerve cells normally die and are replaced throughout our lifetime. Therefore, the system has the capacity to repair itself after injury, but this isn’t always possible or complete.

The most common causes of prolonged smell loss occur as a result of upper respiratory infection, head injury, chronic sinus disease, and aging. However, other conditions such as Alzheimer’s disease, Parkinson’s disease, and tumors can be associated with smell loss.

In some cases, the loss of smell is complete (anosmia), while in other cases there is only a partial loss (hyposmia). In many instances where smell loss occurs, remaining smells are distorted. The distortions are either experienced as odors smelling dramatically different from what was remembered (parosmia) or smelling an odor that isn’t present (phantosmia).

Perhaps if they were pleasant, these distortions of smell might not be as distressful. However, in almost all instances, the experienced smells are unpleasant, with “smoke,” “swamp-like,” “musty,” “garbage,” or “chemical-like” among some very common descriptions. The odor is usually hard for people to describe, since it is not like anything they have experienced before.

Treating smell disorders

In cases where smell loss results from sinus disease, we have had some success in treating the condition. Oral and topical steroids often provide relief. Sometimes surgery is required to reduce the obstruction of odors to the sensory nerve cells. Sinus disease usually requires long-term management, and fluctuations in the ability to smell are common.

In contrast to chronic sinus inflammation, success in treating people with loss of smell resulting from head injury, upper respiratory infection, or aging is poor. The natural ability of the olfactory system to repair itself allows for some patients to regain the sense of smell after a respiratory infection-related loss or head injury. This recovery can take over a year, and can be so gradual that people have difficulty recognizing the change. Predicting whether recovery will occur in an individual is usually not possible, but overall any improvement that occurs within a one-year period increases the chances of recovery.

If you experience any persistent change in your sense of smell, visit your doctor for an evaluation. Some rare forms of smell disorders may result from tumors in the brain, neurodegenerative disease, or infection. These conditions should be diagnosed expediently for proper management and treatment. In addition, your doctor should talk to you about risks, such as depression and nutritional concerns that may stem from loss of smell.

Although therapies are currently lacking, there is hope for future breakthroughs. Ongoing scientific work is investigating how stem cells in the nose replace dying olfactory nerve cells. In the future, we will be able to add medication in the nose to trigger these cells to make more neurons, or replace missing stem cells to regenerate the neurons. Or we may be able to electrically stimulate a sensation of smell using an artificial implant. Continued research advances in this field will someday allow us to restore this important sensory system to those unfortunate enough to experience smell disorders, and provide them with the ability to once again fully experience the world around them.

The post Smell disorders: When your sense of smell goes astray appeared first on Harvard Health Blog.


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Holiday toys for kids: “Back to basics” is best

Originally Posted Here: https://www.health.harvard.edu/blog/holiday-toys-for-kids-back-to-basics-is-best-2018121115611

It’s the holiday season, time for buying toys for the children in our lives. As we do, the American Academy of Pediatrics (AAP) encourages us to think about buying toys that can actually help children as they grow and develop.

Play is the work of children. That doesn’t mean it can’t be fun; of course play should be fun. But play is at its best when it encourages learning and development, and when it encourages interaction with other people. So many gifts these days are full of bells and whistles and cool electronic gadgets, but don’t really help children (and are often quickly discarded). The AAP thinks that when buying gifts for children we should think more about getting back to basics, and suggests we think about toys from traditional toy categories:

Symbolic/pretend play. These toys are the building blocks for imaginative play. They are things like dolls, animals, dollhouses, kitchen sets, tool sets, dress-up costumes, or puppets. Children can use them to create their own stories, doing it differently each time. Simple is best: toys don’t need to walk or talk or do anything, really. It’s better to leave that up to children. Fine motor/adaptive/manipulative. These are things like actual building blocks and other building sets, train sets, or puzzles. These are toys that not only encourage children to build and create, but also encourage fine motor skill development and early math (and even engineering) skills. There are apps that allow kids to build things digitally, but using their hands is best; nothing outdoes the three-dimensional approach. Art. Nothing encourages creativity and fine motor skills better than drawing, painting, and building with clay. So buy paper, crayons, markers, paint and paintbrushes — and modeling clay. They are inexpensive gifts that can keep children happy for hours. There is something very powerful for development when children have to start a project from scratch, like a drawing from a blank piece of paper. Language and interaction. This is where books come in — there is nothing better for learning new words, and appreciating words, than books. And when they are read aloud, in someone’s lap, they encourage interaction, which helps children flourish. Games encourage interaction too; traditional board games can be fun for everyone, and bring people together. Gross motor. In general, we are a sedentary nation — and most children do not get the recommended hour of physical activity every day. So make it easier for them. Buy them a bike or a trike, or a basketball and a net, or a soccer ball or a jump rope. Anything you do to get them moving not only builds strength and skills, it builds habits that can keep children healthy for the rest of their lives.

That’s the thing: when we get back to basics with toys, we not only give children hours of fun, but we’re helping them learn skills and strategies to grow into happy, healthy adults.

Follow me on Twitter @drClaire

The post Holiday toys for kids: “Back to basics” is best appeared first on Harvard Health Blog.


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