The changing role of village health volunteers in northeast Thailand: an ethnographic field study.

The system of Primary Health care (PHC) in Thailand is one of the oldest in the world and is known worldwide for its success. Supporting the concept of community involvement, the Village Health Volunteer (VHV) is the backbone of this health care delivery system. In December 1994, an ethnographic field study was conducted in a village in Northeast Thailand to explore the implementation and acceptance of the role of the VHV. The VHVs displayed appropriate knowledge of their role but reported decreased use of their services by residents due to the close proximity of the village to a major urban area where health services were readily available. The majority of the villagers who were interviewed did not know the VHVs in their community and few had used their services. They relied on self-treatment and self-referral for their health care concerns. With increasing urbanization of this once rural village, the VHV no longer serves as the point of entry into the health care system. While still a vital part of the PCH system, the role of the VHV will need to adapt to the changing needs of the community it serves.

PIP: Primary health care (PHC), the major strategy in the effort to reach the goal of "Health for All by the Year 2000," depends upon community participation and engenders community empowerment. Thailand's PHC system, one of the oldest and most successful in the world, grew from a 1966 pilot program to a full-fledged program of universal health care in 1980. Community health workers, known in Thailand as village health volunteers (VHVs), are an essential part of the PHC model as they link the community to the organized health system. The VHVs must fulfill certain criteria and undergo training to fulfill their health promotion and disease prevention functions. An ethnographic field study was undertaken in a rural Thai village in 1994 to determine 1) how VHVs view their role, 2) how villagers view the VHVs' role, and 3) if VHVs and the current PHC model leads to universal access to health care. Data were collected via focus groups, semi-structured interviews with VHVs and villagers, and observations during a 2-week period. It was found that the VHVs believed their role to be vitally important but found it difficult to obtain continuing education. Increasing urbanization, however, led most villagers to bypass the VHVs and seek health care in a neighboring city. Villagers reported minimal use of VHVs, and most could not identify the VHVs, depending instead upon self-treatment and self-referral. While this study is preliminary only, it was concluded that the role of the VHVs has diminished in importance and should be adapted to address evolving social problems resulting from urbanization such as 1) the impact of migration on family structure, 2) intergenerational discord, 3) risk factors associated with old age, 4) increased exposure to sexually transmitted diseases and HIV/AIDS, 5) widening economic disparities, and 6) increasing domestic and social violence.

Mental health review tribunals. A follow-up of reviewed patients.

BACKGROUND: Mental health legislation allows for treatment needs to override civil liberty. Mental health review tribunals act as a counterbalance. This study examines the long-term outcome of patients reviewed by a tribunal, and in particular whether the tribunal, in its concern for civil liberty, might be discharging patients prematurely. METHOD: All non-offender patients from a defined catchment area reviewed by the tribunal between the inception of the 1983 Mental Health Act and 31 December 1991 were followed-up until 31 May 1993. RESULTS: Those discharged by the tribunal did not differ significantly from those refused discharge in subsequent survival period in the community, in readmission rate or in final outcome. CONCLUSIONS: Within the limitations of a non-experimental study, the main hypothesis was not supported. An intensive study of family and personal life in the three months after discharge would cast useful additional light on the soundness of tribunal decisions.

A study of the validity of the scaled version of the General Health Questionnaire in paralysed spinally injured out-patients.

This study validates the GHQ-28 on a sample of paralysed, spinally injured out-patients under the care of the West Midlands Spinal Injuries Unit. The validity of the GHQ-28 was 0.83 (95% confidence interval: 0.70 to 0.93) using the Clinical Interview Schedule (CIS) as the validating criterion. The effectiveness of the GHQ-28 as a screening instrument using CIS 11/12 as case criterion, and thus a prevalence rate of 0.18, was judged by relative operating characteristic (ROC) analysis. The area under the ROC curve was 0.91 +/- 0.03. 'Optimum' discrimination occurred near GHQ 3/4 (0011 scoring scheme) giving a sensitivity of 0.81, a specificity of 0.82 and a misclassification rate of 18%.

The patients' view of life in a psychiatric hospital. A questionnaire study and associated methodological considerations.

In any assessment of hospital life, the patients' view is indispensable, but there is no generally accepted way of seeking it. In this study, the views of 258 patients in four 'traditional' English psychiatric hospitals were obtained by a questionnaire of 45 items supplemented by freehand comments. Their experience of fellow patients, the staff and the material and institutional aspects of hospital care were explored. Some of the benefits and problems of questionnaire use in this realm are discussed.

Pharmacokinetics of lithium in patients treated with controlled release lithium formulations.

There has long been discussion as to the relative merits of the lithium formulations available in the UK. Two of these have been shown to exhibit similar pharmacokinetics in normal volunteers and both are now marketed as controlled release formulations. In this study the serum lithium profiles of these formulations were compared in patients at two centres during the first 4 h after the dose, and at 24 h. We were unable to show any significant difference between the formulations in respect of maximum serum lithium concentrations or the concentration at each time point.

A prospective study of the effects of lithium on thyroid function and on the prevalence of antithyroid antibodies.

Tests of thyroid function and pathology were carried out on 133 patients before they were treated with lithium (Li+). Of the 12 patients who subsequently became hypothyroid during treatment with lithium 9 had, before the commencement of treatment, thyroid autoantibodies and/or an exaggerated thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH), whereas 3 patients had neither of these indicators. Lithium administration was accompanied by a rise in thyroid antibody titre in 20 patients but a fall in only 5, a statistically significant difference. Evidence that it may be an immunostimulant is discussed. Li+-induced thyroid failure cannot be accurately predicted, and may occur suddenly. The best minimum safeguard, therefore, is serial thyroxine (T4) (or free T4) estimation, supplemented if equivocal by a free thyroxine index (FTI), a basal TSH and, if doubt remains, by a TRH test.

The seasonal incidence of mania and its relationship to climatic variables.

Monthly hospital admission rates (HA) for mania were classified by sex, type of admission (first, or re-admission) and by country (England and Wales or Scotland). Of the 8 classes thus created, all but one showed a statistically significant annual cycle with a peak in Summer and trough in Winter. There was no significant difference in phase or amplitude between male and female cycles. A linear increase in yearly re-admission rates was found during the 8 years of the English and the 11 years of the Scottish data. Current month's mean daily temperature (lag0) and last month's (lag1) mean day-length and mean daily hours of sunshine correlated better with admission rate than did the values for other months. In a multiple regression analysis temperature made the other 2 climatic variables redundant in accounting for variation in HA.

Suicide in psychiatric patients.

The study relates to suicides occurring in Shropshire during 1965 to 1973 inclusive. Psychiatric patients who had committed suicide were compared with others, matched by sex and age who had not done so. The suicide group included a higher proportion of members who had behaved violently, experienced a broken marriage (through death, separation or divorce) or earlier had deliberately harmed themselves, often by dangerous means. Of the psychiatric patients who committed suicide 63 per cent had seen a doctor within a month beforehand, yet very few were receiving adequate physical treatment for depressive illness at the time of their death. Immigrants from eastern Europe were found to be particularly prone to suicide.

Right- and left-handed counting of braille dots in subjects unaccustomed to braille.

Previous work has shown that children acquainted with Braille can usually read better with their left than with their right hand. It is also known that, at least in right-handed people, the right cerebral hemisphere is dominant for counting dots. The present paper compares, in right-handed subjects unacquainted with Braille, the comparative skill of right and left middle (M) and index (I) fingers in counting Braille dots. In one experiment with 30 subjects no significant difference was found between LI and RI fingers. Another experiment failed to reveal any R/L differences although it detected a superiority of I over M fingers at P less than 0-025. When the task was split between the two I fingers working simultaneously they performed significantly (P less than 0-001) better than when working alone. This latter finding is thought to have a bearing on the failure to detect R/L differences; other possible explanations of the findings are also discussed.