Prediction of risk for drug use in high school students.

On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent--child relationships. This 53-item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent--child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed.

Prediction of risk for drug use in high school students.

On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent-child relationships. This 53 item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent-child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study.

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.

[The symptoms questionnaire for problem detection in adults]. / El cuestionario de síntomas para la detección de problemas en adultos.

This questionnaire has been designed considering transcultural differences. Its validation includes an approximately 400-patient sample, with their relatives as control sample population. Such populations come from General Health Centers located in Colombia, India, the Philippines, and Sudan. In each area, different cut-off points were used on the calculation of sensitivity and specificity. This instrument is currently used in different parts of the world: It is demonstrating to be valuable and sensitive a tool for identifying mental disorders among individuals seeking treatment at General Health Services. At the same time, it is being used in a training manual for Psychiatry primary care workers. Even though the instrument does not diagnosticate, it nonetheless identifies individuals suffering from psychological disrupting symptoms. Both its simplicity and high sensitivity help in a practical approach to Psychiatry primary care strategies.

El cuestionario de síntomas para la detección de problemas en adultos. / [The symptoms questionnaire for problem detection in adults]

This questionnaire has been designed considering transcultural differences. Its validation includes an approximately 400-patient sample, with their relatives as control sample population. Such populations come from General Health Centers located in Colombia, India, the Philippines, and Sudan. In each area, different cut-off points were used on the calculation of sensitivity and specificity. This instrument is currently used in different parts of the world: It is demonstrating to be valuable and sensitive a tool for identifying mental disorders among individuals seeking treatment at General Health Services. At the same time, it is being used in a training manual for Psychiatry primary care workers. Even though the instrument does not diagnosticate, it nonetheless identifies individuals suffering from psychological disrupting symptoms. Both its simplicity and high sensitivity help in a practical approach to Psychiatry primary care strategies.

The WHO collaborative study on strategies for extending mental health care, II: The development of new research methods.

Teams in seven developing countries under sponsorship of the World Health Organization have been carrying out collaborative operational research on providing mental health care through primary health care services. New techniques of identifying mental disorders in children and adults have been developed and tested. Methods of assessing the skills and attitudes of health workers toward mental health work and of gauging community attitudes toward mental illness have also been developed. Results have been directly applied in planning better mental health care. The authors conclude that cross-cultural collaborative research is effective in improving mental health care for those in greatest need.

The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results.

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.

The burden of mental illness on the family. Results of observations in four developing countries. A report from the WHO Collaborative Study on Strategies for Extending Mental Health Care.

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.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries.

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.

Research screening instruments as tools in training health workers for mental health care.

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.

[Training in psychiatry for health teams in Colombia]. / Capacitación en psiquiatría de grupos de salud en Colombia.

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.

Capacitación en psiquiatría de grupos de salud en Colombia / Training in psychiatry for health teams in Colombia

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)

Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.

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.

[Primary mental health care in Latin America. The Cali program]. / Atención primaria de salud mental en América latina. El programa de Cali.

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.

The classification of psychiatric disorder. A reliability study in the WHO collaborative study on strategies for extending mental health care.

Altogether 26 psychiatrists and other mental health workers, from Colombia, Brazil, Sudan, Egypt, India and the Philippines tried to reach agreement on the classification of 10 case histories, using the International Classification of Diseases (8th revision). The exercise was part of the WHO Collaborative Study on Strategies for Extending Mental Health Care. Conventions, mistakes, differences of opinion and a lack of rules are discussed as causes for disagreement.

Atencion primaria de salud mental en America Latina. El programa de Cali. / Primary mental health care in Latin America. The Cali program

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

Atención primaria de salud mental en América latina. El programa de Cali. / [Primary mental health care in Latin America. The Cali program]

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.

Atencion primaria de salud mental en America Latina. El programa de Cali. / Primary mental health care in Latin America. The Cali program

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