Suicide trends and self-harm in Panama: results from the National Mortality Registry and hospital-based data.

PURPOSE: We aimed to (1) to investigate mortality trends due to suicide in Panama at the national and regional levels from 2001 to 2016, (2) to describe the sociodemographic and clinical characteristics of admitted patients with non-fatal self-harm from 2009 to 2017 in a regional hospital, and (3) to examine the association between mental health diagnoses and intentional self-harm, lethality, self-harm repetition and all-cause mortality within this population. METHODS: Using the national mortality registry, annual percentage changes (APC) with 95% confidence intervals (CI) were estimated to evaluate suicide trends over time. Self-harm cases were assessed by trained psychiatrists at a referral hospital through interviews. Logistic regression models were used to estimate the association between mental diagnosis with intent-to-die and lethality, expressed as odds ratios (OR) and 95% CI. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% CI for self-harm repetition and all-cause mortality. RESULTS: The trend of suicide in women declined, with an APC of - 4.8, 95% CI - 7.8, - 1.7, while the trend began to decline from 2006 in men; APC - 6.9, 95% CI - 8.9, - 4.9. Self-harm repetition over 12 months was 1.8%. Having a mental health diagnosis was associated with intentional self-harm (OR 1.5; 95% CI 1.0-2.4) and self-harm repetition (HR 2.7, 95% CI 1.3-5.8). Medication overdose was the preferred method for self-harm, while intentional self-harm by hanging was the preferred method for suicide. CONCLUSIONS: Strategies for prevention and early intervention after self-harm deserve attention. Our findings highlight the importance of data to inform action.

Indigenous Ethnicity and Low Maternal Education Are Associated with Delayed Diagnosis and Mortality in Infants with Congenital Heart Defects in Panama.

BACKGROUND: This 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). METHODS: A 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. RESULTS: An 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). CONCLUSION: Inequalities 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.

Trend Analysis of Cancer Mortality and Incidence in Panama, Using Joinpoint Regression Analysis.

Cancer is one of the leading causes of death worldwide and its incidence is expected to increase in the future. In Panama, cancer is also one of the leading causes of death. In 1964, a nationwide cancer registry was started and it was restructured and improved in 2012. The aim of this study is to utilize Joinpoint regression analysis to study the trends of the incidence and mortality of cancer in Panama in the last decade. Cancer mortality was estimated from the Panamanian National Institute of Census and Statistics Registry for the period 2001 to 2011. Cancer incidence was estimated from the Panamanian National Cancer Registry for the period 2000 to 2009. The Joinpoint Regression Analysis program, version 4.0.4, was used to calculate trends by age-adjusted incidence and mortality rates for selected cancers. Overall, the trend of age-adjusted cancer mortality in Panama has declined over the last 10 years (-1.12% per year). The cancers for which there was a significant increase in the trend of mortality were female breast cancer and ovarian cancer; while the highest increases in incidence were shown for breast cancer, liver cancer, and prostate cancer. Significant decrease in the trend of mortality was evidenced for the following: prostate cancer, lung and bronchus cancer, and cervical cancer; with respect to incidence, only oral and pharynx cancer in both sexes had a significant decrease. Some cancers showed no significant trends in incidence or mortality. This study reveals contrasting trends in cancer incidence and mortality in Panama in the last decade. Although Panama is considered an upper middle income nation, this study demonstrates that some cancer mortality trends, like the ones seen in cervical and lung cancer, behave similarly to the ones seen in high income countries. In contrast, other types, like breast cancer, follow a pattern seen in countries undergoing a transition to a developed economy with its associated lifestyle, nutrition, and body weight changes.