Robust information for effective municipal solid waste policies: Identifying behaviour of waste generation across spatial levels of organization.

Existing studies have studied influencing factors of MSW generation behaviour at different spatial levels of organization, but always one at a time and not simultaneously. Income is a strong influencing factor, affecting MSW generation from the individual to the country level, capable of hiding the effects of the others. This study shows that when MSW generation behaviour is holistically analysed across multiple levels of organization (individuals, households, and communities) hierarchically organized as functional units of MSW generation within a specific study area, it is possible to identify influencing factors in addition to income (education, demographic, health, ethnic, economic activity and financial types) as explanatory variables. Increasing the number of influencing factors of MSW generation makes it possible to create a robust knowledge base for MSW management policies in fast-growing urban areas of developing countries, improving the information used to select proper policies and plans within their MSW management systems and avoiding overlapping policies causing legal gaps. Betania, an urban area of the Panama City district, has been chosen as a case study area. The results show that the household income explains 86% of its members MSW generation and the community indigenous population explains 21% of households MSW generation. It is concluded that MSW generation is not linear across levels, it has as many degrees of freedom as influencing factors shaping the levels of organization where functional units generating waste exist. Influencing factors appearing at each spatial level affects MSW generation in an interdependent manner in variable degrees of magnitude.

Diversidad y usos de las plantas medicinales en Panamá / Diversity and uses of medicinal plants in Panama

Panama has 10,444 species of plants, some with medicinal properties, but there is no inventory to determine the totality of medicinal plants that are used. Our goal is to perform a review of publications and research with a view to presenting an estimated on the diversity of medicinal species and types of uses. Throughout the country are used medicinal plants, but its use is increasing more rural areas, and this is due to the scarcity of health services. The species most sold in pharmacies and public markets are: Equisetum bogotense (cola de caballo), Lippia alba (tilo), Pluchea carolinensis (salvia), Cymbopogon citratus (hierba de limón), Neurolaena lobata (contragavilana), Costus spicatus (caña agria) and Momordica charantia (balsamino). Among some species of medicinal plants that are exported we have: Psychotria ipecacuana (raicilla), Smilax aspera (zarzaparrilla) and Ficus benjamina.

Panamá tiene 10.444 especies de plantas, algunas con propiedades medicinales, pero no existe un inventario para determinar la totalidad de plantas medicinales que se emplean. Nuestro objetivo consistirá en realizar una revisión de las publicaciones e investigaciones con el fin de presentar un estimado sobre la diversidad de especies medicinales y tipos de usos. En todo el país se usan las plantas medicinales, pero su uso se incrementa más áreas rurales, y esto se debe a la escasez de servicios de salud. Las especies que más se comercializan en farmacias y mercados públicos son: Equisetum bogotense (cola de caballo), Lippia alba (tilo), Pluchea carolinensis (salvia), Cymbopogon citratus (hierba de limón), Neurolaena lobata (contragavilana), Costus spicatus (caña agria) y Momordica charantia (balsamino). Entre algunas especies de plantas medicinales que se exportan tenemos: Psychotria ipecacuana (raicilla), Smilax aspera (zarzaparrilla) y Ficus benjamina.

Comparative transcriptome analysis reveals resistance-related genes and pathways in Musa acuminata banana 'Guijiao 9' in response to Fusarium wilt.

Fusarium wilt caused by Fusarium oxysporum f. sp. cubense (Foc), is one of the most devastating diseases in bananas resulting in significant loss of Cavendish bananas production worldwide. Here we show the agronomic traits and the resistance of 'Guijiao 9' in the field trials from 2012 to 2017. And then we dissect and compare the transcriptome response from these two cultivars (cv. 'Guijiao 9' and cv. Williams) in an attempt to understand the molecular basis that contribute to the enhanced Foc tropical race 4 (Foc-TR4) resistance. 'Guijiao 9' is a Cavendish cultivar with strong resistance to Foc-TR4, which was reflected in a lower disease severity and incidence in glasshouse and field trails, when compared to the susceptible cultivar Williams. Gene expression profiles of 'Guijiao 9' and Williams were captured by performing RNA-Seq analysis on 16 biological samples collected over a six day period post inoculation with Foc-TR4. Transcriptional reprogramming in response to Foc-TR4 was detected in both genotypes but the response was more drastic in 'Guijiao 9' than in Williams. Specific genes involved in plant-pathogen interaction and defense signaling including MAPK, calcium, salicylic acid, jasmonic acid and ethylene pathways were analyzed and compared between 'Guijiao 9' and Williams. Genes associated with defense-related metabolites synthesis such as NB-LRR proteins, calmodulin-binding protein and phenylpropanoids biosynthesis genes were significantly up-regulated in 'Guijiao 9' resistant to Foc-TR4 infection. Taken together, this study highlights the important roles of plant hormone regulation and defense gene activation in mediating resistance in 'Guijiao 9'.

The Response of Litter-Associated Myxomycetes to Long-Term Nutrient Addition in a Lowland Tropical Forest.

Myxomycetes (plasmodial slime molds) are abundant protist predators that feed on bacteria and other microorganisms, thereby playing important roles in terrestrial nutrient cycling. Despite their significance, little is known about myxomycete communities and the extent to which they are affected by nutrient availability. We studied the influence of long-term addition of N, P, and K on the myxomycete community in a lowland forest in the Republic of Panama. In a previous study, microbial biomass increased with P but not N or K addition at this site. We hypothesized that myxomycetes would increase in abundance in response to P but that they would not respond to the sole addition of N or K. Moist chamber cultures of leaf litter and small woody debris were used to quantify myxomycete abundance. We generated the largest myxomycete dataset (3,381 records) for any single locality in the tropics comprised by 91 morphospecies. In line with our hypothesis, myxomycete abundance increased in response to P addition but did not respond to N or K. Community composition was unaffected by nutrient treatments. This work represents one of very few large-scale and long-term field studies to include a heterotrophic protist highlighting the feasibility and value in doing so.

Bioactivity Profiling of Plant Biodiversity of Panama by High Throughput Screening.

We report relative bioactivities of extracts prepared from a large collection of plants from three national parks in Panama. Over 181 plants were collected, taxonomically identified and their detannified dichloromethane (DCM)-methanolic extracts were used for profiling selected bioactivities. Assays were performed to evaluate the antioxidant activity of the extracts for Antioxidant Response Element (ARE) induction, total non-enzymatic antioxidant potential, anti-inflammatory and anticancer properties. The high throughput analysis of 280 extracts resulted in identification of 57.5% of the extracts that could induce ARE at one or more concentrations tested, 93.5% that harbored total antioxidant capacity, and 2.1% of the extracts that showed lung cancer cell line-specific cytotoxicity. Data from our profiling experiments indicate that a large number of extracts could be a source for further isolation and chemical identification of compounds that could serve as leads for discovery of antioxidant, anticancer and anti-inflammatory agents to prevent or treat complex diseases like cancer and neurodegenerative disorders.

Ethnomedical uses and pharmacological activities of most prevalent species of genus Piper in Panama: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Piperaceae is the fifth largest family of plants in Panama. This review focuses on the ethnomedical uses of the most prevalent Panamanian species and biological activities of their extracts and/or constituents both in Panama and worldwide. Many species have a plethora of ethnomedical uses such as antibacterial, antifungal, anti-inflammatory, anticancer, antidiabetic, anti-Helicobacter pylori, antiulcer, antiprotozoal, estrogenic, insecticidal, local anesthetic, diuretic, and for women's health conditions. AIM OF THE REVIEW: The aim of this review is to compile all ethnomedical uses of most prevalent species of Piper in Panama, and their extracts or phytoconstituents worldwide, through a complete literature search, so that it may allow selection of potential unexplored Piper species for future research and development of phytotherapeuticals for important ailments. METHODOLOGY: This review conducted a thorough search in books and databases such as Google Scholar, PubMed, Sci-Finder, Scopus, ACS publications, Science Direct, and Reaxys (Elsevier), until October of 2017. The information provided in this review is based on peer-reviewed papers only in English. The key words used to search were: "Piper", "Piperaceae", "Panama", "Pharmacological activity", "Chemistry," "Toxicity," and "Clinical studies". Scientific names of the plants were validated through www.tropicos.org. Potential full-texts of eligible papers, irrespective of database, were identified. Study selection and data extraction were conducted by one author (AIS) and confirmed by others (MPG, ADA). The extracted data were summarized in tabular form and a narrative description was used to provide a summary of updated information. RESULTS: The ethnomedical uses of most prevalent 23 Panamanian species of Piper both in Panama as well in the world are provided. Of these species only Piper arboreum, Piper auritum, Piper cordulatum, Piper hispidum, Piper dariense, Piper multiplinervium and Piper umbellatum have ethnomedical uses in Panama. Some of the uses are by native Amerindians of Panama. These include ailments such as liver pains, common colds, skin infections, insecticidal, as a bath to alleviate colds, snakebites, different types of pains, skin ailments, wound healing, rheumatism, women's health, antipyretic, and anti-inflammatory. Other Panamanian species are widely used in many countries of the world. Of all the Piper species, P. aduncum has the most ethnomedical uses. Panamanian uses are different from the ones in other countries. A total of 61 compounds present in Piper species reported in this review have shown a variety of biological activities in vitro. These compounds belong to different chemical types, such as chromenes, amides, alkaloids, benzopyrans, benzoates, essential oils, pyrrolidines, flavokaines, chalcones, methylenedioxy propiophenones, cinnamates, monoterpenes, sesquiterpenes, phenols, among others. From this review it is evident that extracts and pure compounds isolated from Piper species have shown a wide array of mainly in vitro activity and some ethnomedical uses may be correlated with their activities reported. CONCLUSIONS: Plants of this genus have provided bioactive species, both from crude extracts and pure compounds thus substantiating their efficacy in traditional medicine. In vivo and toxicological studies are still limited, but the results of different activities of Piper reported point out the great potential of these species for obtaining bioactive principles that may be useful in treating diseases. However, a thorough investigation of Piper species relating to chemistry, in vivo pharmacological activities, with emphasis on their mechanism of action, safety and efficacy and toxicity is warranted.

Plantas medicinales de Panamá 2: etnobotánica de la Reserva Forestal La Tronosa, Provincia de Los Santos / Medicinal plants of Panamá 2: ethnobotanics of Forestal Reserve La Tronosa, Province of Los Santos

La Reserva Forestal La Tronosa se localiza en la provincia de Los Santos, distrito de Tonosí con una superficie de 20,579 ha. El objetivo de la investigación era determinar el uso de las plantas medicinales. La metodología incluye, caminatas etnobotánicas y la aplicación encuestas, en las comunidades: La Bijagual, Culebra, Corotúa y la Bonita. Se identificaron 108 especies y se procesaron 1,855 datos de procedencia y parte usada de las plantas, forma de preparación y propiedades curativas. La Bonita fue la comunidad que más usa las Plantas Medicinales en un 38%. La parte más usada de la planta fue la hoja (69 %) y se preparan en lavados (65%) e infusiones (57%). Las plantas más usadas son sábila, mastranto y salvia. Las enfermedades más comunes son: respiratorias (19,7 %), dolor de cuerpo (19%) y problemas estomacales (18%).

The Tronosa Forest Reserve is located in the province of Los Santos, Tonosí district with an area of 20.579 ha. The aim of the research was to determine the use of medicinal plants. The methodology includes surveys ethnobotanical walks and implementation in communities: La Bijagual, Culebra, Corotúa and La Bonita. Species were identified 108 and 1855 data source and used portion of the plants, the preparation form and processed healing properties. La Bonita was the community that uses the medicinal plants by 38%. The part of the plant used was the leaf (69%) and are prepared in wash (65%) and tea (57%). The plants most commonly used are aloe, mastranto and sage. The most common diseases are respiratory (19,7%), body pain (19%) and stomach problems (18%).

Evaluación nutricional de la papa de aire (Dioscorea bulbifera L) cultivada en panamá / Nutritional evaluation of air potato (Dioscorea bulbifera L) grown in panamá

El objetivo del presente estudio fue el de conocer la composición nutricional de los tubérculos de la papa de aire (Dioscorea bulbifera L.) especie subutilizada en la agricultura campesina panameña. Se seleccionaron 18 muestras obtenidas de parcelas de prueba ubicadas en comunidades campesinas del distrito de Donoso, provincia de Colón, en Panamá, durante los años 2012 y 2013. A las muestras seleccionadas se les determinó humedad, proteínas, azúcares, almidón, lípidos, cenizas y contenido energético. En el segundo año se incluyó el análisis de vitamina C, compuestos fenólicos y actividad antioxidante. No se encontraron diferencias significativas de los valores entre comunidades, tipo de parcela y año de cultivo, lo cual evidencia una alta estabilidad de estos valores nutricionales en las condiciones del trópico muy húmedo de Panamá. Los resultados obtenidos presentan un contenido nutricional similar al de otros tubérculos utilizados en la dieta campesina de Panamá. Los valores de actividad antioxidante y contenido de compuestos fenólicos encontrados le confieren características de alimento funcional(AU)

The goal of this study was to determine the nutritional composition of air potato (Dioscorea bulbifera L.) tubers, underutilized specie in the Panamanian peasant agriculture. The samples were obtained from test plots located in rural communities in the district of Donoso, Province of Colon in Panama, during the years 2012 and 2013. Contents of moisture, protein, sugars, starch, lipids, ashes and energetic were determined to the 18 selected samples. In the second year were included analysis of vitamin C, phenolic compounds and antioxidant activity. No significant differences of the values between communities, type of land and crop year were found, which suggest high stability of these nutritional values of air potato, in the very humid tropics conditions of Panama. The results show that the air potato tubers have a nutritional value similar to other tubers used in the peasant diet of Panama. The levels of antioxidant activity and phenolic content found, give D. bulbifera characteristics as a functional food(AU)

Plantas medicinales de Panamá 1: etnobotánica de la reserva forestal el montuoso / Medicinal plants of Panamá: ethnobotanics of the montuoso forestal reserve

Se investigó el uso de las plantas medicinales de las comunidades de la Reserva Forestal El Montuoso (RFM), en el Distrito de Las Minas Panamá, se incluyeron los asentamientos humanos de mayor densidad: Chepo, Caras Pintadas, Tres Puntas, La Loma del Montuoso y La Peña. Se identificaron 142 especies. De estas especies el 52 por ciento provienen de los bosques de esta reserva y 47 por ciento de los huertos familiares, no se ha observado por parte de la población, intenciones de domesticación de las plantas, provenientes del bosque para posteriormente sembrarlas en sus huertos familiares. La parte más usada de las plantas medicinales es la hoja que se consumen generalmente en infusiones; en tanto que las raíces y la corteza se cocinan por 5 a 20 minutos (decocción y reducción). El principal uso de las plantas medicinales en la RFM es para combatir problemas gastrointestinales, enfermedades asociados al resfriado común, dolores en el cuerpo, presión arterial alta y enfermedades dermatológicas. Entre las especies silvestres más usadas tenemos: hierba de pasmo (Siparuna guianensis Aubl, Siparuna pauciflora Perkins, Siparuna tonduziana Perkins) y la hierba de montaña (Piper darienense C.DC.). The cultivated species most used are: mastranto (Lippia alba (Mill.) N.E.Br.), lemongrass (Cymbopogon citratus (DC.) Stapf) y aloe (Aloe vera L.). Estas plantas medicinales representan un gran recurso para esta región de difícil acceso a los servicios de salud.

The use of medicinal plants in the communities of The Montuoso Forest Reserve (MFR), in the district of Las Minas Panama is investigated. Human settlements of higher density were also included: Chepo, Caras PIntadas, Tres Puntas, the Loma del Montuoso and La Peña. 142 species were identified. Of these species, 52 percent are coming from the forests of the reserve and 47 percent of home gardens. It has not been observed by the population, intentions of domestication of plants from the forest, then sow in their home gardens. The most widely used medicinal plants of the MFR are usually consumed in teas; while the roots and bark are cooked for 5-20 minutes (decoction and reduction). The main use of medicinal plants in the MFR is to treat gastrointestinal disorders, diseases associated with the common cold, body aches, high blood pressure and skin diseases. Among the wild species used are: Hierba de Pasmo (Siparuna guianensis Aubl, Siparuna pauciflora Perkins, Siparuna tonduziana Perkins) and mountain herb (Piper darienense C.DC.). The Most used cultivated species are: Mastranto (Lippia alba (Mill) N.E.Br.), Lemongrass (Cymbopogon citratus (DC) Stapf.) and Aloe (Aloe vera L). These medicinal plants are a great resource for this region of difficult access to health services.

ESTUDIO ETNOBOTÁNICO DE LA PAPA DE AIRE (Dioscorea bulbifera L) EN DONOSO (COLÓN, REPÚBLICA DE PANAMÁ) / ETHNO-BOTANICAL STUDY OF AIR POTATO (Dioscorea bulbifera L) IN DONOSO (COLÓN, REPUBLIC OF PANAMÁ)

Con el objetivo de conocer y rescatar la historia, usos y manejo dado a Dioscorea bulbifera L. por las comunidades campesinas del distrito de Donoso (provincia de Colón, Panamá) se llevó a cabo un estudio etnobotánico en el primer semestre de 2012. El mismo se desarrolló a partir de grupos focales, recorridos de campo y entrevistas semiestructuradas a personajes clave (ancianos, curanderos y personas que cultivan D. bulbifera). Se realizaron cinco grupos focales y 11 entrevistas semiestructuradas, abordando aspectos relativos a historia, nombres, manejo tradicional, usos y formas de consumo de la papa de aire en la región. Como resultados destacados se tiene que D. bulbifera es una especie de muy vieja presencia en las comunidades, teniendo como uso principal la alimentación humana. Igualmente, los agricultores dan cuenta de la importancia de esta especie como alimento altamente nutritivo y con algunos usos medicinales. La información recabada sugiere un conocimiento erosionado respecto de esta especie, lo cual se refleja en el nivel de conocimiento de su manejo y la disminución de su cultivo. No obstante, el conocimiento rescatado resulta de gran utilidad para el establecimiento de ensayos que se orienten a la sistematización de prácticas de cultivo de esta especie.

In order to know and rescue the history, uses and management of Dioscorea bulbifera L. given by peasant communities in the district of Donoso (Colón Province, Panamá) an ethno-botanical study was conducted in the first semester 2012. The study was developed from focus groups, field observations and semi-structured interviews to key figures (elders, healers and people who plant D. bulbifera). Five focus groups and eleven semi-structured interviews were conducted, addressing aspects of history, names, traditional management, uses and forms of consumption of air potatoes in the region. Some outstanding results, demonstrate that Dioscorea bulbifera is a species of very old presence in the communities, used mainly for human consumption. Furthermore, farmers report the importance of this species as a highly nutritious food and having some medicinal uses. The information gathered suggests an eroded knowledge about this species, which is reflected in the level of knowledge of its handling and decreased cultivation. However, the rescued knowledge is useful for establishing essays that aim to systematize practices for cultivation of this species.

Niveles de Ocratoxina A y Aflatoxinas totales en cafés de exportación de Panamá por un método de ELISA

Se realizó un estudio de las condiciones del procesamiento del café de exportación en 15 beneficios, ubicados en Chiriquí, región occidental de Panamá. Además se analizaron 21 muestras de café procesado (grano verde), provenientes de los beneficios. Las muestras fueron analizadas microbiológicamente y se cuantificaron las Aflatoxinas totales (B1, B2, G1 y G2) y Ocratoxina A (OTA), mediante el método de inmunoafinidad ELISA. Se determinó un límite de detección de 0,017 ng/mL, para la Ocratoxina A, lo que equivale a una concentración de 0,829 μg/kg en la muestra, y un límite de detección de 0,027 ng/mL, para las Aflatoxinas totales, lo que equivale a una concentración de 1,350 μg/kg de Aflatoxinas totales. En la muestra, se encontró que cuatro de las 21 (19%) resultaron positivas a la presencia de Ocratoxina A y tres, a la presencia de Aflatoxinas totales (14%). Las muestras presentaron niveles de Ocratoxina A en el rango de 4,90-37,73 μg/kg; sólo tres de ellas superaron el límite máximo permitido por la Unión Europea, para la concentración de Ocratoxina, que es de 5,0 μg/kg. Las Aflatoxinas totales se encontraron en el rango de 1,51- 1,93 μg/kg, por debajo de los 10 μg/kg, que es el límite máximo permitido en el café por la Unión Europea. Los resultados nos indican que el procesamiento de café producido en Panamá cumple satisfactoriamente con los estándares internacionales de manejo poscosecha, lo que conduce a una baja incidencia de hongos productores de micotoxinas y niveles muy bajos de micotoxinas.

Levels of Ochratoxin A and total Aflatoxins in Panamanian exportation coffee by an ELISA Method. A study about processing conditions of exportation coffee in 15 benefits located in Chiriquí, western region of Panama, was conducted. In addition, 21 samples of processed coffee (green beans), from the benefits, were analyzed. The samples were microbiologically tested in order to quantify total aflatoxins (B1, B2, G1 and G2) and Ochratoxin A (OTA), using the immunoaffinity ELISA method. A detection limit of 0.017 ng/mL, was determined for Ochratoxin A, which is equivalent to a concentration of 0.829 μg/kg, and a detection limit of 0.027 ng/mL, for total aflatoxins, which is equivalent to a concentration of 1.350 μg/kg. It was found that four (19%) out of the 21 samples were positive to the presence of Ochratoxin A and three (14%) to the presence of total aflatoxins. Samples showed levels of Ochratoxin A in the range 4.90 - 37.73 μg/kg; only three of them exceeded the maximum limit allowed by the European Union, for the concentration of Ochratoxin, which is of 5.0 μg/kg. Total aflatoxins were found in the range 1.51 - 1.93 μg/kg, below 10μg/kg which is the maximum limit allowed for coffee by the European Union. The results indicate that the processing of coffee produced in Panama successfully meets international standards for postharvest handling, which leads to a low incidence of mycotoxins and very low levels of mycotoxin- producing fungi.

Factors associated to depression in renal transplant recipients in Panama.

AIM: High rates of affective disorders have been reported in kidney transplant recipients treated for end-stage renal disease. Latin America has experienced a significant increase in transplant activity in recent decades, but there is a dearth of data regarding psychosocial issues following kidney transplantation. The aim of this study was to measure the prevalence of depression and the demographic factors associated to depression among renal transplant recipients in Panama. MATERIALS AND METHODS: This cross-sectional study was conducted between March to May 2010 in a hospital setting during routine outpatient evaluations. The study included 119 renal transplant recipients (58 males, 61 females). Depressive symptoms were measured using the self-report Hospital Anxiety and Depression Scale and diagnoses were established by a trained psychiatrist using the Mini-International Neuropsychiatric Interview. Regression models were used to explore the association between depression and sociodemographic variables. RESULTS: The prevalence of depression was 11.8% among transplant recipients. Linear regression indicated that the presence of an anxiety disorder, increasing age, and lower education levels were significantly and independently associated with depressive symptoms. Logistic regression analysis confirmed that anxiety and a perception of negative social support significantly increased the likelihood of depression. CONCLUSIONS: These findings have important clinical implications. Depression after kidney transplantation has been shown to affect health outcomes adversely. Our results underscore the need to assess depressive symptoms as well as other affective disorders as part of the screening and treatment of renal transplant patients in Panama.

National vitamin A survey in Panama.

The prevalence of vitamin A deficiency in a nationally representative sample of children 12-59 months old in Panama was assessed using serum retinol levels and dietary indicators. The median serum retinol level found was 1.27 +/- 0.42 mumol/L (38 micrograms/dL); 6.0% of the study sample providing adequate blood specimens had levels below 0.7 mumol/L (20 micrograms/dL), indicating deficient vitamin A intake. The Panama City Metropolitan Area and the country's western region had the highest prevalences of low serum retinol levels (below 0.7 mumol/L in 9% and 6% of the study children, respectively), as compared to overall prevalences of 5% in the two other regions studied. Low serum retinol levels were significantly more prevalent among Indians in the study group (primarily Guaymí Indians) than among non-Indians (13% versus 5%). Dietary information provided by the study children's mothers showed that high risk of inadequate dietary vitamin A intake closely paralleled low serum retinol levels; specifically, the highest prevalence of dietary inadequacy was found in the western region, especially among the Indians. The Panamanian Government is currently increasing distribution of high-dose vitamin A capsules to Indian preschoolers in Chiriquí and Bocas del Toro Provinces.

[Infant and child mortality in Latin America].

PIP: High mortality rates persist in Latin America, and data collection is made very difficult because of the lack of reliable statistics. A study was initiated in 1976 to measure the probability of mortality from birth to 2 years of age in 12 Latin American countries. The Brass method was used and applied to population censuses. Probability of mortality is extremely heterogeneous and regularly very high, varying between a maximum of 202/1000 in Bolivia, to a minimum of 112/1000 in Uruguay. In comparison, the same probability is 21/1000 in the U.S., and 11/1000 in sweden. Mortality in rural areas is much higher than in urban ones, and varies according to the degree of education of the mother, children being born to mothers who had 10 years of formal education having the lowest risk of death. Children born to the indigenous population, largely illiterate and living in the poorest of conditions, have the highest probability of death, a probability reaching 67% of all deaths under 2 years. National health services in Latin America, although vastly improved and improving, still do not meet the needs of the population, especially rural, and structural and historical conditions hamper a wider application of existing medical knowledge.^ieng