Intimate Partner Violence-Related Brain Injury Among Colombian Women.

OBJECTIVE: The aim of this study was to assess the prevalence of brain injury (BI) and its relationship to cognitive and psychological outcomes in women survivors of intimate partner violence (IPV) in Colombia, South America. SETTING: Women's shelters and organizations in Barranquilla, Colombia. PARTICIPANTS: Seventy women from the city of Barranquilla, Colombia, who experienced any form of IPV. DESIGN: Cross-sectional, retrospective. MAIN MEASURES: Participants were administered the computerized EMBRACED neuropsychological battery to assess learning, working and long-term memory, cognitive flexibility, and processing speed. Participants also completed measures of psychological symptoms. Partner violence severity was assessed with a semistructured interview for survivors of domestic violence. Presence and severity of IPV-related BI were assessed using the Brain Injury Severity Assessment (BISA). RESULTS: Thirty-one percent of women sustained at least one BI during an abusive relationship, and 10% sustained repetitive BIs. Furthermore, BI was negatively associated with measures of long-term and working memory, cognitive flexibility, as well as a trending ( P = .05) positive association with depression. With the exception of the relationship between BI and cognitive flexibility, which was substantially reduced and no longer significant, all of these relationships were nearly identical in strength when controlling for abuse severity, socioeconomic status, and educational level. CONCLUSION: These data are the first to specifically examine IPV-related BI in relation to cognitive and psychological functioning in a sample of Colombian women. These data add cross-cultural knowledge to the limited work in this area that has largely focused on women in North America.

Caregiving in Dementia and its Impact on Psychological Functioning and Health-Related Quality of Life: Findings from a Colombian Sample.

Existing published studies about health-related quality of life (HRQOL) in caregivers of dementia patients living in Latin American countries are very limited. However, cultural aspects, personal values, and social structure may affect the way caregivers experience their role in different societies. The current study investigated the relationship between HRQOL and psychological factors using a cross-sectional design. The sample consisted of 102 informal caregivers of patients with dementia from Bogotá, Colombia, South America. Measures included the Patient Health Questionnaire (PHQ-9) for depression, the Satisfaction with Life Scale (SWLS), the Zarit Burden Interview, and the Short Health Questionnaire (SF36) for HRQOL. Canonical correlations revealed that there was a significant relationship between caregivers' mental health and HRQOL, such that caregivers with better satisfaction with life and less symptoms of depression had more vitality and better general health. There is a strong relationship between mental health and health-related quality of life in Colombian caregivers of dementia patients living in their country of origin. Specific aspects of mental health, including satisfaction with life and depression, need to be addressed in order to improve caregivers' quality of life. Given that mental health care resources may be scarce in Latin American countries, culturally appropriate interventions should focus on preventing/treating depression and promote life satisfaction, as a way to improve their quality of life.

A Four-Country Study of Strangulation-Related Alterations in Consciousness in Women Who Have Experienced Intimate Partner Violence: Co-Occurrence with Traumatic Brain Injuries and Measures of Psychological Distress.

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.

Health-related quality of life of individuals with traumatic brain injury in Barranquilla, Colombia.

OBJECTIVE: To assess health-related quality of life (HRQoL) of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. PARTICIPANTS/METHODS: Thirty-one individuals with TBI and 61 healthy controls completed the SF-36, a self-report HRQoL measure composed of eight component areas: physical health problems, pain, role limitations due to physical problems or due to emotional problems, emotional well-being, social functioning, energy/fatigue and general health perceptions. RESULTS: The samples were statistically similar with respect to age, gender and education and statistically different with respect to depression, SES, social support and cognition. Compared to healthy controls, individuals with TBI had significantly lower means on all SF-36 sub-scales. However, after adjusting for depression, SES, social support and cognitive performance, significant differences remained on three of the SF-36 sub-scales. Specifically, individuals with TBI had lower adjusted means on Role-Physical (p-value < 0.005), Role-Emotional (p-value < 0.005) and Bodily Pain (p-value < 0.05). CONCLUSION: Even after controlling for depression, SES, social support and cognitive performance, individuals with TBI living in Barranquilla Colombia report having poorer quality of life across various domains, including Role-Physical, Role-Emotional and Bodily Pain. These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to improve quality of life in Colombian individuals with TBI.

The Coin in Hand-Extended Version: Development and Validation of a Multicultural Performance Validity Test.

The number of computerized and reliable performance validity tests are scarce. This study aims to address this issue by validating a free and computerized performance validity test: the Coin in Hand-Extended Version (CIH-EV). The CIH-EV test was administered in four countries (Colombia, Spain, Portugal, and the United States) and performance was compared with other commonly used validated tests. Results showed that the CIH-EV has at least 95% specificity and 62% sensitivity, and performance was highly correlated with scores on the Test of Memory Malingering, Victoria Symptom Validity Test, and Digit Span of the Wechsler Adult Intelligence Scale. There were no significant differences in scores across countries, suggesting that the CIH-EV performs similarly in a variety of cultures. Our findings suggest that the CIH-EV has the potential to serve as a valid validity test either alone or as a supplement to other commonly used validity tests.

Item analysis of the Spanish version of the Boston Naming Test with a Spanish speaking adult population from Colombia.

OBJECTIVE: The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance. METHODS: Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit. RESULTS: Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable. CONCLUSIONS: Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.

Normative data for the Neuropsychological Assessment Battery of Reading, Writing and Cognitive Functions (ENLEF) / Datos normativos para la batería de evaluación neuropsicológica de lectura, escritura y funciones cognitivas (enlef)

Resumen Las dificultades de aprendizaje constituyen una problemática frecuente en las escuelas. Aunque diversos instrumentos de evaluación neuropsicológica han sido creados, la mayoría se han desarrollado y estandarizado para población no colombiana, o no están diseñados para niños menores de seis años y no permiten relacionar claramente las habilidades académicas y los procesos cognitivos subyacentes a ellas. El objetivo de este estudio es construir los datos normativos de la batería ENLEF en población infantil colombiana a partir de la evaluación de la influencia de las variables sociodemográficas en el desempeño de la prueba. Participaron 516 niños y niñas escolarizados de entre cuatro y siete años, quienes fueron evaluados por psicólogos entrenados con la batería ENLEF. Los resultados mostraron una influencia de la edad y el estrato sobre el desempeño de los participantes en la mayoría de las pruebas. Sin embargo, en algunas pruebas de lenguaje y de lectura se observó solo una influencia del estrato socioeconómico. Los resultados del presente estudio permiten el uso de la ENLEF en la población infantil colombiana como una alternativa culturalmente contextualizada para la evaluación de funciones cognitivas y habilidades de lectoescritura. Además, se confirma la influencia de la edad y el nivel socioeconómico sobre el desarrollo cognitivo.

Abstract Learning disabilities are a frequent problem identified at school. Although there are several neuropsychological tests available, most of them have been developed and standardized for non-Colombian population, haven't been designed for children below six years old, and don't allow to clearly relate academic skills with cognitive process. The aim of this study was to develop normative data for the ENLEF test for Colombian children, by assessing the influence of sociodemographic characteristics on the test performance. Trained psychologists assessed 516 school-children aged from four to seven years using the ENLEF test. Results showed an influence of age and socioeconomic status on the participants' performance in most of the subtest. Nevertheless, in some language and reading subtests, only the influence of socioeconomic status showed an influence on the performance. These results allow the use of the ENLEF test for children in Colombia, as a culturally-contextualized option to assess cognitive functions and reading and writing skills. Furthermore, influence of age and socioeconomic status on cognitive development is also confirmed.

The effect of cognitive impairment on self-generation in Hispanics with TBI.

The objective of this study was to determine the moderating effect of cognitive impairment (CI) on the usefulness of the generation effect to improve learning and memory in Hispanics with traumatic brain injury (TBI). Sixty-one Hispanic individuals with TBI (29 without CI, 22 with mild to moderate CI, and 10 with severe CI) and 44 healthy controls (HC) were required to remember the last word in each of 32 sentences. Target words were presented in a self-generated and provided condition. Recall and recognition were examined immediately, after 30 minutes, and at one week. Individuals remembered and recalled significantly more words in the generated condition than the provided condition, regardless of group or time. The self-generation technique equally benefitted all participants regardless of TBI status or degree of CI. Future cognitive rehabilitation programs designed to improve short-term recall and recognition in Hispanic individuals with TBI should include the self-generation technique. Further research into the longer-term effects of the generation effects is warranted.

Factors associated with depression and burden in Spanish speaking caregivers of individuals with traumatic brain injury.

OBJECTIVE: To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. DESIGN: Prospective. PARTICIPANTS: Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. OUTCOME MEASURES: Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). RESULTS: Generalized linear models revealed that patient language problems and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers' perception of patient depression was the only factor associated with both caregiver burden and depression. CONCLUSION: Caregivers' perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed.

Rehabilitación neuropsicológica infantil: de la teoría a la práctica clínica / Child neuropsychological rehabilitation

Alrededor del mundo existe una gran cantidad de niños con dificultades cognitivas producto de daño cerebral o trastornos del neurodesarrollo. Estas dificultades traen consigo dificultades de tipo escolar, social, familiar y conductual, entre otras, disminuyendo así la calidad de vida del niño y su familia. Consecuentemente han aumentado en la literatura los artículos que evalúan la utilidad de diferentes programas de rehabilitación neuropsicológica.El objetivo de esta revisión fue (1) determinar cuáles son las modalidades teóricas de rehabilitación neuropsicológica más utilizadas, (2) establecer si se reportanganancias funcionales posteriores a cada intervención y, (3) establecer si durante la intervención se incluyó a los familiares. Los resultados mostraron que la principal modalidad de rehabilitación utilizada fue la restauración. Además, la mayoría de estudios no reportaban de manera clara ganancias funcionales ni incluían a la familia en el proceso terapéutico. Es necesario la realización de estudios que incluyan en su diseño diferentes modalidades de rehabilitación, apoyo familiar y evaluación de las ganancias funcionales...(AU)

Around the world, there are many children with cognitive difficulties as results of brain injury or neurodevelopmental disorders. These difficulties lead to school, social, family Archivos and behavioral disturbances, among others; and reduce the quality of life of the child and his family. Consequently, more papers are published in scientific literature that evaluate the usefulness of several neuropsychological rehabilitation programs. This review aimed (1) to determine which are the most frequently used theoretical models of neuropsychological rehabilitation, (2) to determine if functional gains were reported and, (3) whether during the intervention caregivers were included. The results showed that function restauration was the more frequently rehabilitation model used. Furthermore, most studies did not clearly report functional gains or caregivers' participation in the rehabilitation. Future studies should include in their design different rehabilitation models, family support and evaluation of functional gains...(AU)

Rehabilitación Cognitiva en pacientes con Enfermedad de Alzheimer / Cognitive Rehabilitation in patients with Alzheimer's Disease

La enfermedad de Alzheimer ( EA) es una enfermedad crónica que se caracteriza por la presencia de síntomas cognitivos, problemas físicos y alteraciones emocionales y/o comportamentales. Actualmente más de 24 millones de personas en el mundo han sido diagnosticadas con EA, y se calcula que para 2040 el número será de 81 millones. El objetivo de este artículo es hacer una revisión detallada de las diferentes técnicas y/o tratamientos cognitivos que se han venido utilizando en la rehabilitación de las alteraciones cognitivas de personas con EA, así como de los estudios existentes que evalúan su eficacia. Los principales resultados de la revisión evidencian la aplicación de tratamientos cognitivos mediante técnicas como estimulación cognitiva, aprendizaje sin error, recuperación espaciada, imaginería visual, desvanecimiento de pistas y ayudas externas. La mayoría de tratamientos revisados utilizaron técnicas de manera combinada, las cuales se implementaron en etapas iniciales de la EA; varios de los estudios revisados demostraron el mantenimiento a largo plazo de las ganancias obtenidas en algunos tratamientos.

Alzheimer's disease ( AD) is a chronic illness characterized by the presence of cognitive and physical impairments and emotional and/or behavioral disturbances. Nowadays, over 24 million people around the world are diagnosed with AD and it is estimated that in 2040 this number will rise to 81 million. The objective of this article was to review in detail the different techniques and/or cognitive treatments that have been developed in the rehabilitation of cognitive impairments of population with AD, and the existing papers that test their efficacy. The main results evidence the use of techniques such as cognitive stimulation, errorless learning, spaced retrieval, visual imagery, vanishing cues and external aids. Most of the reviewed treatments used these techniques combined, with patients in the initial stages of AD; many of the papers reviewed demonstrated long term maintenance of the positive results of some treatments.