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BackgroundThis is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD).MethodsA retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists. Critical CHD was defined according to the defects listed as targets of newborn pulse oximetry screening. Diagnoses were considered delayed when made after the third day of life for the critical CHD and after the twentieth day of life for the non-critical. A logistic regression model was performed to examine the association between socioeconomic variables and delayed diagnosis. A Cox proportional hazards model was used to assess the relationship between socioeconomic features and mortality.ResultsAn increased risk of delayed diagnosis was observed in infants with indigenous ethnicity (AOR, 1.56; 95% CI, 1.03–2.37), low maternal education (AOR, 1.57; 95% CI, 1.09–2.25) and homebirth (AOR, 4.32; 95% CI, 1.63–11.48). Indigenous infants had a higher risk of dying due to CHD (HR, 1.43; 95% CI, 1.03–1.99), as did those with low maternal education (HR, 1.95; 95% CI, 1.45–2.62).ConclusionInequalities in access to health care, conditioned by unfavourable socioeconomic features, may play a key role in delayed diagnosis and mortality of CHD patients. Further studies are required to study the relationship between indigenous ethnicity and these adverse health outcomes.

ObjectiveCardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of this study is to investigate mortality trends due to ischaemic heart disease (IHD) and stroke in Panama from 2001 to 2014, as well as the mortality differences by sex and age groups.MethodsData were obtained from the National Mortality Register. The International Classification of Diseases 10th revision codes (ICD-10) I20–I25 and I60–I69 were used for IHD and stroke, respectively. Age-adjusted mortality rates were calculated using the world population of the WHO as standard. Trends were analysed using Joinpoint Regression Program and annual percentage changes (APC) were estimated.ResultsFrom 2010, the IHD mortality trend began to decline in the whole population of Panama (APC −4.7%, p<0.05). From 2001 to 2014, a decline in the trend for IHD mortality was observed (APC −1.7%, p<0.05) in women, but not in men. Stroke mortality showed a significant annual decline during the study period (APC −3.8%, p<0.05) and it was more pronounced in women (APC −4.5%, p<0.05) than in men (APC −3.3%, p<0.05).ConclusionsIn Panama, the mortality rates from IHD and stroke have declined in recent years. Better access to healthcare, improved treatment of acute IHD and stroke, low tobacco consumption and better control of hypertension probably account for a significant part of this mortality reduction.

Objetivo. Caracterizar la compra ilegal de productos derivados del tabaco y su asociación con variables socio­demográficas y socioeconómicas. Material y métodos. La fuente de datos es la Encuesta Mundial de Tabaco en Adultos de 2013. Se caracterizó la compra ilícita mediante variables sociodemográficas (SOD) y socioeconómicas (SES). Se utilizaron modelos de regresión logística. Resultados. Se encontraron asociaciones de las variables SOD y SES con compra ilegal, particularmente en hombres; grupo etario de 15 a 39 años, educación no formal, empleado de gobierno e inactivos, área urbana, fumador diario y en el primer quintil de ingresos. Conclusiones. Las variables SOD y SES influyen en la compra ilícita. Es importante la vigilancia del comercio ilícito en el segmento minorista y la aplicación efectiva de las normas vigentes.

Introduction: Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds. Methodology: A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates. Conclusions: The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.

Objetivo. Caracterizar el deseo de cesación y disposición al pago por una terapia de abandono de consumo de tabaco. Material y métodos. La fuente de los datos es la Encuesta Mundial de Tabaco en Adultos (EMTA). Se caracterizó la cesación y la disposición al pago mediante variables sociodemográficas (SOD) y socioeconómicas (SES). Se realizaron regresiones logísticas para estimar asociaciones. Resultados. El mayor deseo de cesación se observó en las mujeres, aspecto educativo, empleado no gubernamental e inactivo, zona rural, fumadores ocasionales, ingresos medios y la mayor disposición al pago, en educación, mayores de 60 años, empleado no gubernamental y cuenta propia, zona urbana, fumadores ocasionales e ingreso medio bajo. Conclusiones. Existe una alta relación entre el deseo de abandono y la disposición al pago con las variables SOD y SES. Las terapias de cesación pueden aplicarse en centros de trabajo y exigen un cambio de enfoque en la intervención.

En los años sesenta del siglo pasado, con el advenimiento y uso del transistor en las computadoras, se inició la llamada revolución de la información. Su principal característica ha sido la intensa tasa de cambio en la innovación, la cual ha permitido avances sin precedentes y la convergencia de los sistemas de información dedicados con los sistemas de telecomunicaciones. Este fenómeno se intensificó aún más durante las dos últimas décadas del siglo pasado, cuando la tecnología de Internet abrió la puerta a un nuevo orden mundial, dando paso a un mundo globalizado en el que la transmisión de voz, datos y video se lograron con toda facilidad entre dos puntos cualquiera del globo terráqueo. Tal vez las tecnologías que mayormente han contribuido a estos grandes impactos económicos y sociales han sido los protocolos de comunicaciones. En este trabajo se realiza una revisión de la evolución de los mismos y se propone su evaluación tecnológica relativa con base a sus dimensiones tecnológicas. Finalmente, se discute la propuesta prospectiva de un protocolo digital estándar que seguramente permitirá un sistema de redes en todas partes, generando la interconexión absoluta del mundo en el futuro cercano. Descriptores: protocolos de comunicación, tecnología, evolución y evaluación. A bstract The information revolution started with the transistor invention, and its integration and use in the computers during the sixth decade ofthe last century. Immediately unprecedented advances followed the intense innovation rate of change bringing telecommunication dedicated information Systems convergence. This phenomenon was intensified during the very last decades of last century, when Internet technologies opened the door to a nevo world order bringing a global world in which voice, data and video transmission could be easily done between any two points of the earth. May be the technologies that mainly contributed to these great economical and social impacts have been the communication protocols. In this work we review its evolution and propose a method for its technological evaluation based in its technological dimensions. Finally the prospective proposal of a standard digital protocol is discussed. It will surely permit a "Network Everywhere" System leading absolute world interconnectivity in the near future.