ABSTRACT
A review is presented of the characteristics of 432 users of the Human Immunodeficiency Virus (HIV) Control Program sponsored by the Public Health Departmental Laboratory of Antioquia, Colombia, who were seen between July 1988 and June 1989. The prevalence of seropositivity to HIV was 29.4%, while that of AIDS was 6.7%. Eight of the seropositive subjects were women. The average age on entrance into the Program was 28.7 +/- 7.9, and it was significantly higher among the seropositive subjects. The study sample was divided into four subgroups: women, bisexual men, homosexual men, and heterosexual men. In all the subgroups the prevalence of high-risk sexual practices was high and the percentage of condom utilization was low. Frequency of exposure to different risk factors, such as injections, transfusions of blood or other fluids, surgical interventions, tattoos, consumption of alcohol and other psychoactive substances, acupuncture, and sexual preference and practices, was determined. HIV seropositivity for the group as a whole was associated with sexual relations with infected persons (OR = 3.96), active anal coitus (OR = 3.81), sexual relations with men (OR = 3.69), passive anal coitus (OR = 3.35), and sexual relations abroad (OR = 2.24). In men, HIV seropositivity was associated with anal coitus (OR = 4.0), homosexual relations (OR = 3.96), sexual relations with infected persons (OR = 3.75), and sexual relations abroad (OR = 1.88); in women there was an association with intravenous drug use (chi 2 = 10.72) and with sexual relations abroad (OR = 12.67).
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , HIV Infections/prevention & control , HIV Seroprevalence , Adolescent , Adult , Ambulatory Care Facilities , Child , Colombia/epidemiology , Female , Humans , Male , Middle Aged , Risk Factors , Sexual Behavior , Substance Abuse, Intravenous/complications , Travel , Urban PopulationABSTRACT
A comparison of safety, and efficiency of Alprazolam, Imipramine, and placebo in the treatment of panic disorder shows that both active drugs are significantly superior to placebo as regards therapeutic effectiveness. On a 77 patient sample, 62 completed an 8-week treatment, and 66 were considered as "assessable" for efficiency results after completing a 3-week treatment. Significantly, more placebo-treated patients than either Alprazolam, or Imipramine-treated patients dropped out trial, while the number of panic attacks was significantly reduced in both Alprazolam-, and Imipramine-treated groups. When trial was over, 96% of patients in Alprazolam group, and 95% of patients in Imipramine group were free from panic attacks, if compared to 65% in the placebo group. Generally speaking, drugs were well tolerated, and no serious adverse effects or life-threatening events were observed.
Subject(s)
Alprazolam/therapeutic use , Imipramine/therapeutic use , Panic/drug effects , Adolescent , Adult , Alprazolam/adverse effects , Colombia , Double-Blind Method , Female , Humans , Imipramine/adverse effects , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
A comparison of safety, and efficiency of Alprazolam, Imipramine, and placebo in the treatment of panic disorder shows that both active drugs are significantly superior to placebo as regards therapeutic effectiveness. On a 77 patient sample, 62 completed an 8-week treatment, and 66 were considered as [quot ]assessable[quot ] for efficiency results after completing a 3-week treatment. Significantly, more placebo-treated patients than either Alprazolam, or Imipramine-treated patients dropped out trial, while the number of panic attacks was significantly reduced in both Alprazolam-, and Imipramine-treated groups. When trial was over, 96
of patients in Alprazolam group, and 95
of patients in Imipramine group were free from panic attacks, if compared to 65
in the placebo group. Generally speaking, drugs were well tolerated, and no serious adverse effects or life-threatening events were observed.
ABSTRACT
Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.
Subject(s)
Attitude of Health Personnel , Developing Countries , Health Occupations , Mental Disorders/therapy , Health Occupations/education , Humans , Psychotropic Drugs/therapeutic useABSTRACT
As part of the WHO Collaborative Study on Strategies for Extending Mental Health Care 259 families in four developing countries (Colombia, India, Sudan and the Philippines) were screened with regard to the social burden caused by mental illness of one of its members. Levels of subsistence, previous illness, financial burden, personal relations and social acceptance were studied. The social burden was greatest in the urban areas.
Subject(s)
Family , Mental Disorders , Adult , Colombia , Cross-Cultural Comparison , Developing Countries , Female , Humans , India , Male , Mental Disorders/economics , Mental Health Services , Middle Aged , Philippines , Sudan , World Health OrganizationABSTRACT
A semi-structured interview for assessing the knowledge and attitude of health workers concerning mental health problems was applied in seven developing country areas within the context of a World Health Organization coordinated collaborative study. The results indicate a lack of basic mental health training associated with a failure to recognize mental health problems, restricted knowledge concerning psychotropic drug therapy, and an inability to visualize practical forms of mental health care which could be introduced at primary care level. The results were used to design appropriate training programs, and the observations will be repeated to assess the effectiveness of training.
Subject(s)
Attitude of Health Personnel , Developing Countries , Mental Health , Primary Health Care , Humans , Interviews as Topic , Mental Health ServicesABSTRACT
Two simple screening instruments for mental disorders in adults and children respectively were developed in the course of an evaluative study on mental health care in developing countries. Two research teams have attempted to use these same instruments as training tools for primary health care workers. Their experience has shown that the design of the instruments with short, easily understandable questions to which an answer "yes" or "no" can be given is also highly appropriate in the training situation and in daily work. The adaptation and use of these new training tools for primary health care workers in Manila (Philippines) and Cali (Colombia) is described.
Subject(s)
Health Occupations/education , Mental Disorders/diagnosis , Mental Health Services , Adult , Child , Colombia , Developing Countries , Education, Nursing, Continuing , Humans , Philippines , Primary Health Care , Research , Surveys and QuestionnairesABSTRACT
About 90% of the 40 million victims of mental disorders in the developing countries receive no treatment, and little progress is being made in this respect. This article examines the use of new strategies for solving the problem. It is obvious that the traditional methods of mental health care have been ineffective and that new programs should now be undertaken that can ensure proper service within the coming decades for those being neglected. Based on the results of a practical experiment carried out in Colombia, the authors, without making any definitive recommendations, point to the usefulness of training auxiliary staff of urban and rural health centers to work as a team (under the supervision of a physician or a graduate nurse) in the care and management of psychiatric patients. They enumerate the advantages offered by training programs on various aspects of mental health for general practitioners (who usually have little interest in psychiatry), psychiatry residents, nurses, and auxiliaries.
Subject(s)
Patient Care Team , Psychiatry/education , Allied Health Personnel/education , Colombia , Community Mental Health Services , Education, Continuing , Humans , Internship and Residency , Textbooks as Topic , WorkforceABSTRACT
About 90per cent of the 40 million victims of mental disorders in the developing countries receive no treatment, and little progress is being made in this respect. This article examines the use of new strategies for solving the problem. It is obvious that the traditional methods of mental health care have been ineffective and that new programs should now be undertaken that can ensure proper service within the coming decades for those being neglected. Based on the results of a practical experiment carried out in Colombia, the authors, without making any definitive recommendations, point to the usefulness of training auxiliary staff of urban and rural health centers to work as a team (under the supervision of a physician or a graduate nurse) in the care and management of psychiatric patients. They enumerate the advantages offered by training programs on various aspects of mental health for general practitioners (who usually have little interest in psychiatry), psychiatry residents, nurses, and auxiliaries (Au)
Subject(s)
Psychiatry/education , Textbook , ColombiaABSTRACT
To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.
Subject(s)
Community Health Centers , Mental Disorders/epidemiology , Primary Health Care , Adolescent , Child , Child, Preschool , Colombia , Female , Humans , India , Infant , Infant, Newborn , Male , Mental Disorders/diagnosis , Philippines , Sudan , World Health OrganizationABSTRACT
The paper describes the experience acquired during more than 8 years in carrying out primary mental health care in Cali, Colombia. It had already been shown that the use of trained paramedical personnel achieved some advantages to that of traditional approaches. The present programme is carried out in two different geographical areas (rural and urban) which provide care to about 10 per cent of their population. Although final clinical results are still not available, the basic approach entails the use of primary mental health agents (auxiliary nurses and health promotors) as the first step of assistance, ending in the top of the hierarchy, where a doctor and/or a trained nurse are responsible for the diagnoses. A trained psychiatrist acts only as a periodic consultant and as the main source for training. There is evidence to suggest that these primary mental health care agents have more time to talk to the patients and are more able to understand their local psycho-social circumstances. This system enables cheaper and more effective care services. Its advantages, risks and related problems are discussed, and mention is made for the need to maintain regular clinical assessment. The various training techniques are also discussed.
Subject(s)
Mental Disorders/therapy , Mental Health Services/organization & administration , Primary Health Care/organization & administration , Adolescent , Adult , Allied Health Personnel/education , Colombia , Education, Nursing , Female , Humans , Male , Mental Disorders/epidemiology , Middle Aged , National Health Programs/organization & administration , Nurse Clinicians , Pilot Projects , Psychiatry/educationABSTRACT
En este documento se describe la experiencia adquirida durante mas de ocho anos en la realizacion de programas de atencion primaria de salud mental destinados a extender los servicios de la especialidad en Cali, Colombia. A modo de referencia basica se describen las circunstancias anteriores a la iniciacion de esta experiencia, asi como las condiciones, recursos y el sistema de salud. Ademas, se hace un resumen de las ultimas investigaciones mas pertinentes llevadas a cabo por el grupo de Cali en el campo epidemiologico y psicometrico, en la medida en que se relacionan con esta investigacion. Se ha llegado a la conclusion de que los agentes de atencion primaria disponen de mas tiempo para charlar con los pacientes; su contacto clinico es mas directo y lo establece una persona que entiende bien el idioma del paciente, sus problemas y curcunstancias psicosociales
Subject(s)
Primary Health Care , Mental Health , Mental Health ServicesABSTRACT
The paper describes the experience acquired during more than 8 years in carrying out primary mental health care in Cali, Colombia. It had already been shown that the use of trained paramedical personnel achieved some advantages to that of traditional approaches. The present programme is carried out in two different geographical areas (rural and urban) which provide care to about 10 per cent of their population. Although final clinical results are still not available, the basic approach entails the use of primary mental health agents (auxiliary nurses and health promotors) as the first step of assistance, ending in the top of the hierarchy, where a doctor and/or a trained nurse are responsible for the diagnoses. A trained psychiatrist acts only as a periodic consultant and as the main source for training. There is evidence to suggest that these primary mental health care agents have more time to talk to the patients and are more able to understand their local psycho-social circumstances. This system enables cheaper and more effective care services. Its advantages, risks and related problems are discussed, and mention is made for the need to maintain regular clinical assessment. The various training techniques are also discussed.
ABSTRACT
En este documento se describe la experiencia adquirida durante mas de ocho anos en la realizacion de programas de atencion primaria de salud mental destinados a extender los servicios de la especialidad en Cali, Colombia. A modo de referencia basica se describen las circunstancias anteriores a la iniciacion de esta experiencia, asi como las condiciones, recursos y el sistema de salud. Ademas, se hace un resumen de las ultimas investigaciones mas pertinentes llevadas a cabo por el grupo de Cali en el campo epidemiologico y psicometrico, en la medida en que se relacionan con esta investigacion. Se ha llegado a la conclusion de que los agentes de atencion primaria disponen de mas tiempo para charlar con los pacientes; su contacto clinico es mas directo y lo establece una persona que entiende bien el idioma del paciente, sus problemas y curcunstancias psicosociales
Subject(s)
Primary Health Care , Mental Health , Mental Health ServicesABSTRACT
1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13.9%. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.
Subject(s)
Developing Countries , Mental Disorders/diagnosis , Adult , Humans , Mental Disorders/epidemiology , Neurotic Disorders/diagnosis , Primary Health Care , Psychophysiologic Disorders/diagnosisABSTRACT
Mental Disorders constitute a severe Public Health problem in developing countries due to inadequate resources specially in terms of trained personnel; furthermore, Mental Health care is given out only in specialized Institutions where it has not been possible to provide coverage for more than a small part of the population. In this context the Collaborative Study on Strategies for the Extension of Mental Health Care has been planned, using as its guiding principle the recommendations of the WHO Expert Committee on Organization of Mental Health Services in Developing Countries (W.H.O. 1975). The objectives of the study are to determine the feasibility of introducing Mental Health Care directed toward defined priority conditions into general health services, to develop methods of selection for interventions in Mental Health Care as well as methods for task oriented training for health workers, to evaluate effectiveness of alternative low cost methods and to develop and evaluate ways of simulating community response to problems related to mental disorders. The areas selected are representative of the range of environments in developing countries in terms of overall socioeconomic and health status. In each area, actions will be directed towards making baseline observations and towards provision of care (planning, training, supervision and provision of referral channels). Specific interventions in the Cali area are described in regard to the training of the Health Center personnel in Mental Health, the provision of psychotropic drugs at the peri-urban level and provision of Mental Health Care by Primary Health Workers under the supervision of Health Center physicians and nurses.
Subject(s)
Developing Countries , Health Planning/trends , Mental Disorders/therapy , Mental Health Services/supply & distribution , Allied Health Personnel/education , Colombia , Health Priorities , Humans , Mental Health Services/economics , Mental Health Services/organization & administration , World Health OrganizationABSTRACT
Mental Disorders constitute a severe Public Health problem in developing countries due to inadequate resources specially in terms of trained personnel; furthermore, Mental Health care is given out only in specialized Institutions where it has not been possible to provide coverage for more than a small part of the population. In this context the Collaborative Study on Strategies for the Extension of Mental Health Care has been planned, using as its guiding principle the recommendations of the WHO Expert Committee on Organization of Mental Health Services in Developing Countries (W.H.O. 1975). The objectives of the study are to determine the feasibility of introducing Mental Health Care directed toward defined priority conditions into general health services, to develop methods of selection for interventions in Mental Health Care as well as methods for task oriented training for health workers, to evaluate effectiveness of alternative low cost methods and to develop and evaluate ways of simulating community response to problems related to mental disorders. The areas selected are representative of the range of environments in developing countries in terms of overall socioeconomic and health status. In each area, actions will be directed towards making baseline observations and towards provision of care (planning, training, supervision and provision of referral channels). Specific interventions in the Cali area are described in regard to the training of the Health Center personnel in Mental Health, the provision of psychotropic drugs at the peri-urban level and provision of Mental Health Care by Primary Health Workers under the supervision of Health Center physicians and nurses.
ABSTRACT
Mental Disorders constitute a severe Public Health problem in developing countries due to inadequate resources specially in terms of trained personnel; furthermore, Mental Health care is given out only in specialized Institutions where it has not been possible to provide coverage for more than a small part of the population. In this context the Collaborative Study on Strategies for the Extension of Mental Health Care has been planned, using as its guiding principle the recommendations of the WHO Expert Committee on Organization of Mental Health Services in Developing Countries (W.H.O. 1975). The objectives of the study are to determine the feasibility of introducing Mental Health Care directed toward defined priority conditions into general health services, to develop methods of selection for interventions in Mental Health Care as well as methods for task oriented training for health workers, to evaluate effectiveness of alternative low cost methods and to develop and evaluate ways of simulating community response to problems related to mental disorders. The areas selected are representative of the range of environments in developing countries in terms of overall socioeconomic and health status. In each area, actions will be directed towards making baseline observations and towards provision of care (planning, training, supervision and provision of referral channels). Specific interventions in the Cali area are described in regard to the training of the Health Center personnel in Mental Health, the provision of psychotropic drugs at the peri-urban level and provision of Mental Health Care by Primary Health Workers under the supervision of Health Center physicians and nurses.
