An exploration of violence, mental health and substance abuse in post-conflict Guatemala

Guatemala’s 36-year civil war officially ended in December 1996 after some 200,000 deaths and one million refugees. Despite the ceasefire, Guatemala continues to be a violent country with one of the highest homicide rates in the world. We investigated potential associations between violence, mental health, and substance abuse in post-conflictGuatemalausing a community-based survey of 86 respondents living in urban and ruralGuatemala. Overall, 17.4% of our respondents had at least one, direct violent experience during the civil war. In the post-conflict period, 90.7% of respondents reported being afraid that they might be hurt by violence, 40.7% screened positive for depression, 50.0% screened positive for PTSD, and 23.3% screened positive for alcohol dependence. Potential associations between prior violent experiences during the war and indicators of PTSD and aspects of alcohol dependence were found in regression-adjusted models (p < 0.05). Certain associations between prior civil war experiences, aspects of PTSD and alcohol dependence in this cohort are remarkable, raising concerns for the health and safety of the largely indigenous populations we studied. Higher than expected rates of depression, PTSD, and substance abuse in our cohort may be related to the ongoing violence, injury and fear that have persisted since the end of the civil war. These, in turn, have implications for the growing medical and surgical resources needed to address the continuing traumatic and post-traumatic complications in the post-conflict era. Limitations of the current study are discussed. These findings are useful in beginning to understand the downstream effects of the Guatemalan civil war, although a much larger, randomly sampled survey is now needed.

Loss to Follow-Up among a Group of Patients with HIV and Severe Mental Illness in South Africa

Background: Persons with HIV and severe mental illness face numerous barriers in antiretroviral treatment adherence. More information is needed on reasons for loss of follow-up in this population. Methods: A retrospective analysis was conducted on adult HIV patients with a history of mental illness enrolled at an urban HIV clinic in Johannesburg, South Africa who discontinued care. Results: 24.8% of adult patients in the clinic discontinued follow-up during the study period. Of those discontinuing follow-up, 48 were successfully traced by home visits. Among this group, 21 (43.8%) were not engaged in care, 12 (25.0%) had transferred care, 9 (18.8%) were deceased, 3 (6.2%) had relocated, and 3 (6.2%) were missing. Transportation costs and distance, conflicts with work/school schedule, and confusion regarding when to return were the most frequently cited reasons for discontinuing follow-up. Conclusions: Although almost 25% of patients were lost to follow up, overall rates of retention in care for these patients were similar to those seen in other HIV-infected populations and higher than those seen among patients with psychiatric disease. Tracing patients through home visits proved to be an effective means to confirm the magnitude of patients lost to follow up, ascertain their outcomes, and elucidate the reasons for discontinuing care.

A pilot study eliminating immunologically-reactive foods from the diet and its effect on symptomatology and quality of life in persons with chronic migraines and headaches

Purpose: Chronic migraines and headaches are significant public health problems, and their symptomatologies have been positively linked to diet. We explored if individuals suffering from chronic migraines/ headaches who required medication treatment had improvement in symptomatology and subjective ratings of QoL when following an immune-reactive food exclusion diet based on the results of the ImmunoBloodprint test, an IgG-mediated food sensitivity assay. Methods: Thirty-seven subjects, aged 18 and over, took part in the study. Subjects had to eliminate all reactive foods from their diet for 90 days. Migraine intensity and frequency were measured using the MTAQ, and QoL was assessed with the SF-36 survey at base- line and 30-, 60-, and 90-day follow-up. Results: Sub- jects who eliminated IgG-mediated reactive foods from their diet had reductions in migraine symptomatology and had improvements in nearly all indicators of QoL, according to the SF-36, from baseline to 90-day follow-up. Conclusions: Subjects were able to improve their migraine symptoms and QoL in response to eliminating IgG reactive foods from the diet. This test may represent a strategy to help mediate chronic migraine symptomatology without the use of medication.