[Risk factors for infection among the patrons of an HIV Control Program, Antioquia, Colombia]. / Factores de riesgo de infección en usuarios de un programa de control del VIH, Antioquia, Colombia.

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).

[Comparison of the effect of alprazolam, imipramine and placebo in the treatment of panic disorders in Cali, Colombia]. / Comparación del efecto del alprazolam, la imipramina y placebo en el tratamiento del trastorno de pánico en Cali, Colombia.

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.

Comparación del efecto del alprazolam, la imipramina y placebo en el tratamiento del trastorno de pánico en Cali, Colombia. / [Comparison of the effect of alprazolam, imipramine and placebo in the treatment of panic disorders in Cali, Colombia]

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.

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 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.

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

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries.

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.

[Strategies for extending mental health services to developing countries. I. Description of the project]. / Estrategias para la extensión de los servicios salud mental en países en desarrollo. I. Descripción del proyecto.

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.

Estrategias para la extensión de los servicios salud mental en países en desarrollo. I. Descripción del proyecto. / [Strategies for extending mental health services to developing countries. I. Description of the project]

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.

Estrategias para la extensión de los servicios salud mental en países en desarrollo. I. Descripción del proyecto / [Strategies for extending mental health services to developing countries. I. Description of the project]

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.