The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis.

The aim of this study is to provide a more accurate representation of COVID-19's case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

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.

STEM doctorate recipients with disabilities experienced early in life earn lower salaries and are underrepresented among higher academic positions.

There is paucity of data examining disparities in salary and representation for disabled scientists, which is needed to advance inclusion and equity for people with disabilities in STEM. Using data from the 2019 Survey of Doctorate Recipients (United States, N = 1,148,817), we show that doctorate recipients working in Science, Technology, Engineering and Mathematics (STEM) with disabilities experienced early in life (at age <25 yr) earned US$10,580 less per year (95% CI: -$13,661, -$7,499) than non-disabled workers. In the subset of academic workers, doctorate recipients with early disabilities earned $14,360 less (95% CI: -$17,546, -$11,175) than those without disabilities. We observed an underrepresentation of academics with disabilities in higher faculty ranks (χ2: 647.2; P < 0.0001), among Deans/Presidents (χ2: 27.4; P = 0.0004) and among those with tenure (χ2: 525; P < 0.0001). These findings support a need to expand inclusion efforts, provide equal opportunities for career advancement and improve working conditions for people with disabilities in STEM.

Disparities in influenza vaccination for U.S. adults with disabilities living in community settings by race/ethnicity, 2016-2021.

BACKGROUND: There is a paucity of data examining disparities in influenza vaccination at the intersection of disability and race. OBJECTIVE: To compare the prevalence of influenza vaccination between U.S. adults (≥18 years) with and without disabilities living in community settings, and to examine changes in influenza vaccination over time by disability status and race/ethnicity groups. METHODS: We analyzed cross-sectional data from the Behavioral Risk Factor Surveillance System (2016-2021). We calculated the annual age-standardized prevalence of influenza vaccination (last 12 months) in individuals with and without disabilities (2016-2021), and examined percentage changes (2016-2021) by groups of disability status and race/ethnicity. RESULTS: From 2016 to 2021, the annual age-standardized prevalence of influenza vaccination was consistently lower in adults with disabilities as compared to those without disabilities. In 2016, 36.8% (95%CI: 36.1%-37.4%) of adults with disabilities had an influenza vaccine versus 37.3% (95%CI: 36.9%-37.6%) of those without disabilities. In 2021, 40.7% (95%CI: 40.0%-41.4%) and 44.1% (95%CI: 43.7%-44.5%) of adults with and without disabilities had an influenza vaccine. The percentage change in influenza vaccination from 2016 to 2021 was lower among people with disabilities (10.7%, 95%CI: 10.4%-11.0%; vs. no disability: 18.4%, 95%CI: 18.1%-18.7%). Among adults with disabilities, Asian adults reported the largest percentage increase in influenza vaccination (18.0%, 95% CI: 14.2%, 21.8%; p: 0.07), and Black, Non-Hispanics adults reported the lowest (2.1%, 95% CI: 1.9%, 2.2%; p: 0.59). CONCLUSIONS: Strategies to increase influenza vaccination in the U.S. should address barriers faced by people with disabilities, particularly the intersectional barriers faced by people with disabilities from racial and ethnic minority groups.

A Spanish matrix sentence test for assessing speech reception thresholds in noise.

OBJECTIVE: To develop, optimize, and evaluate a new Spanish sentence test in noise. DESIGN: The test comprises a basic matrix of ten names, verbs, numerals, nouns, and adjectives. From this matrix, test lists of ten sentences with an equal syntactical structure can be formed at random, with each list containing the whole speech material. The speech material represents the phoneme distribution of the Spanish language. The test was optimized for measuring speech reception thresholds (SRTs) in noise by adjusting the presentation levels of the individual words. Subsequently, the test was evaluated by independent measurements investigating the training effects, the comparability of test lists, open-set vs. closed-set test format, and performance of listeners of different Spanish varieties. STUDY SAMPLE: In total, 68 normal-hearing native Spanish-speaking listeners. RESULTS: SRTs measured using an adaptive procedure were 6.2 ± 0.8 dB SNR for the open-set and 7.2 ± 0.7 dB SNR for the closed-set test format. The residual training effect was less than 1 dB after using two double-lists before data collection. CONCLUSIONS: No significant differences were found for listeners of different Spanish varieties indicating that the test is applicable to Spanish as well as Latin American listeners. Test lists can be used interchangeably.

Under-5 Mortality in Central America: 1990-2016.

BACKGROUND AND OBJECTIVES: We aimed to calculate the change in under-5 mortality rates (U5MRs) (1990-2016), to assess countries' status regarding Sustainable Development Goal (SDG) 3.2.1 (reducing the U5MR to ≤25 deaths per 1000 live births by 2030), to list the most important causes of death (1990, 2016), and to examine the association between selected SDG indicators and U5MRs using a linear mixed-effects regression. METHODS: Ecological study in which we used estimates from the Global Burden of Disease Study 2016 for Central American countries. Results were expressed as U5MRs (deaths per 1000 live births), cause-specific mortality rates (deaths per 100 000 population <5 years of age), and regression coefficients with 95% confidence intervals. RESULTS: U5MRs decreased 65% (1990-2016), and in 2016, all countries but Guatemala had met SDG 3.2.1. The main causes of death were diarrheal diseases (1990; 311.1 per 100 000) and lower respiratory infections (LRIs) (2016; 78.1 per 100 000). When disaggregated by country (2016), congenital birth defects were the most important cause of death in all countries except for in Honduras (neonatal preterm birth) and Guatemala (LRIs). Nutritional status; availability of water, sanitation, and hygiene services; coverage of vaccines; and coverage of contraception were associated with a reduction in U5MRs. CONCLUSIONS: Central America has achieved a large reduction in U5MRs. Countries must address both the high mortality caused by LRIs and the rising mortality caused by noncommunicable causes of death through an improvement of SDG indicators that guarantees equitable progress in child survival in the region.

Loudness and auditory steady-state responses in normal-hearing subjects.

This study evaluated the use of multiple auditory steady-state responses (ASSRs) to estimate the growth of loudness in listeners with normal hearing. Individual intensity functions were obtained from measures of loudness growth using the contour test and from the electrophysiological amplitude measures of multiple amplitude-modulated (77-105 Hz) tones (500, 1000, 2000, and 4000 Hz) simultaneously presented to both ears and recorded over the scalp. Slope analyses for the behavioural and electrophysiological intensity functions were separately performed. Response amplitudes of the ASSRs and loudness sensation judgements increase as the stimulus intensity increases for the four frequencies studied. A significant relationship was obtained between loudness and the ASSRs. The results of this study suggest that the amplitude of the ASSRs may be used to estimate loudness growth at least for individuals with normal hearing.

[Dichotic digit test. Case]. / Test de dígitos dicóticos. Estudio de un caso.

In this study we present a case of a 71-year-old female patient with sensorineural hearing loss and fitted with bilateral hearing aids. The patient complained of scant benefit from the hearing aid fitting with difficulties in understanding speech with background noise. The otolaryngology examination was normal. Audiological tests revealed bilateral sensorineural hearing loss with threshold values of 51 and 50 dB HL in the right and left ear. The Dichotic Digit Test was administered in a divided attention mode and focalizing the attention to each ear. Results in this test are consistent with a Central Auditory Processing Disorder.

[The effect of cochlear sensorineural hearing loss on binaural integration mechanisms]. / Efecto de la hipoacusia neurosensorial coclear en los mecanismos de integración biauricular.

INTRODUCTION: Binaural integration is the ability to process different messages when presented simultaneously in both ears. Any deficit in this mechanism implies poor auditory discrimination of background noise and difficulties in processing competing auditory signals. METHOD: In the present study, pairs of digits were presented dichotically to both ears in adult subjects with normal hearing and bilaterally symmetrical sensorineural cochlear hearing loss. RESULTS: Hearing sensitivity, the difficulty in hearing the pairs and the effect of aging determine the capacity for correct recognition. In general, subjects with normal hearing score higher than those with hearing loss. Hypoacusic subjects show a deficit in the recognition of digits presented to the left ear and a greater advantage in the right ear. CONCLUSIONS: The study of binaural integration mechanisms may be useful in the audiological evaluation of patients who reject bilateral amplification and in normal- hearing subjects presenting difficulties to understand speech in noisy settings.

Análisis de los Determinantes Socioeconómicos del Gasto de Bolsillo en Medicamentos en Seis Zonas Geográficas de Panamá.

OBJETIVO: Caracterizar el gasto de bolsillo privado en medicamentos en función de los determinantes sociodemográficos y socioeconómicos. MATERIALES Y MéTODOS: La fuente de datos es la Encuesta de Gasto de Bolsillo en Medicamentos de 2014. Se caracterizó el gasto de bolsillo privado mediante variables explicativas sociodemográficas (SOD) y socioeconómicas (SES). Se hizo análisis factorial por componentes principales, regresión logística y lineal simple. RESULTADOS: Los Odds Ratio demuestran que la educación y la zona geográfica son determinantes fundamentales que inciden en el gasto de bolsillo. Los medicamentos son productos necesarios, en adición a que el gasto de bolsillo aumenta a un promedio del 2% por cada año de vida cronológica adicional. CONCLUSIONES: Existe mayor vulnerabilidad en las zonas más pauperizadas respecto del acceso a medicamentos, en especial en las indígenas e implica un mayor riesgo de gasto catastrófico a menor ingreso ante la mayor prevalencia de enfermedades crónicas.

Chronic Kidney Disease in Panama: Results From the PREFREC Study and National Mortality Trends.

INTRODUCTION: The magnitude of chronic kidney disease (CKD) in Panama has yet to be described. We investigated the association between sociodemographic and cardiovascular exposures with CKD in 2 Panamanian provinces. Further, we analyzed national trends of CKD mortality from 2001 to 2014. METHODS: Data were derived from Prevalencia de Factores de Riesgo de Enfermedad Cardiovascular (PREFREC [Survey on Risk Factors Associated With Cardiovascular Disease]), a cross-sectional study designed to analyze the prevalence of risk factors associated with cardiovascular disease. Biomarkers of kidney function were measured in 3590 participants. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 and/or albuminuria ≥30 mg/g creatinine. Odds ratios (ORs) with 95% confidence intervals (CIs) for CKD were calculated using logistic regression. We calculated age-standardized CKD mortality rates in the country using the National Mortality Register. Annual percentage change and 95% CIs were estimated to evaluate the trends over time. RESULTS: The prevalence of CKD was 12% (reduced eGFR: 3.3%; albuminuria; 9.9%). CKD was associated with hypertension (OR: 1.8; 95% CI: 1.2-2.7), age 60 years or older (OR: 1.9; 95% CI: 1.2-2.9), and previous myocardial infarction (OR: 2.4; 95% CI: 1.0-5.7), whereas monthly family income was inversely associated with CKD (OR: 0.4; 95% CI: 0.1-0.9) (adjusted). A sustained increase in the trend of CKD mortality was observed from 2001 to 2006, followed by a decreasing trend in subsequent years. Coclé province had the highest adjusted mortality rate. DISCUSSION: CKD poses a significant health problem for Panama. Health inequalities and an increase of cardiometabolic risk factors warrant robust epidemiological surveillance, improved diagnosis, and treatment. Further national studies aimed to address geographical disparities are necessary.

Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015: a hospital-based observational study.

OBJECTIVES: Comprehensive epidemiological and economic studies of gastric cancer (GC) in Panama are limited. This study aims to evaluate the association between socioeconomic and clinical variables with survival, describe the survival outcomes according to clinical stage and estimate the direct costs associated to GC care in a Panamanian population with GC. DESIGN AND SETTING: A retrospective observational study was conducted at the leading public institution for cancer treatment in Panama. PARTICIPANTS: Data were obtained from 611 records of patients diagnosed with gastric adenocarcinoma (codes C16.0-C16.9 of the International Classification of Diseases 10th revision), identified between 1 January 2012 and 31 December 2015. METHODS: Cox proportional hazards models were used to calculate HRs with 95% CI to examine associations between the variables and survival. Kaplan-Meier curves were used to assess overall and stage-specific survival. Direct costs (based on 2015 US$) were calculated per patient using standard costs provided by the institution for hospital admission (occupied bed-days), radiotherapy, surgery and chemotherapy, yielding total and overall mean costs (OMC). A comparison of OMC between groups (sex, social security status, clinical stage) was performed applying the bootstrap method with a t-test of unequal variances. RESULTS: An increased risk of dying was observed for patients without social security coverage (HR: 2.02; 95% CI 1.16 to 3.53), overlapping tumours (HR: 1.50; 95% CI 1.02 to 2.22), poorly differentiated tumours (HR: 2.27; 95% CI 1.22 to 4.22) and stage IV disease (HR: 5.54; 95% CI 3.38 to 9.08) (adjusted models). Overall 1-year survival rate was 41%. The estimated OMC of GC care per patient was 4259 US$. No statistically significant differences were found in OMC between groups. CONCLUSIONS: Socioeconomic disparities influence GC outcomes and healthcare utilisation. Policies addressing healthcare disparities related to GC are needed, as well as in-depth studies evaluating barriers of access to GC-related services.

Analysis of mortality trends due to cardiovascular diseases in Panama, 2001-2014.

OBJECTIVE: Cardiovascular 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. METHODS: Data 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. RESULTS: From 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). CONCLUSIONS: In 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.

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.

Test de dígitos dicóticos. Estudio de un caso / Dichotic digit test. Case study

Mujer de 71 años diagnosticada de hipoacusia neurosensorial bilateral. Se llevó a cabo adaptación audioprotésica en ambos oídos. Menciona que a pesar de la amplificación nota dificultades para la comunicación, especialmente en ambientes ruidosos. La exploración otorrinolaringológica está dentro de los límites normales. El estudio audiométrico concuerda con umbrales de 51 y 50 dB HL en los oídos derecho e izquierdo respectivamente. Los resultados en el test de dígitos dicóticos en modalidad de atención dividida y focalizada son compatibles con un trastorno del procesamiento auditivo central (AU)

In this study we present a case of a 71-year-old female patient with sensorineural hearing loss and fitted with bilateral hearing aids. The patient complained of scant benefit from the hearing aid fitting with difficulties in understanding speech with background noise. The otolaryngology examination was normal. Audiological tests revealed bilateral sensorineural hearing loss with threshold values of 51 and 50 dB HL in the right and left ear. The Dichotic Digit Test was administered in a divided attention mode and focalizing the attention to each ear. Results in this test are consistent with a Central Auditory Processing Disorder (AU)

Efecto de la hipoacusia neurosensorial coclear en los mecanismos de integración biauricular / The effect of cochlear sensorineural hearing loss on binaural integration mechanisms

Introducción: La integración biauricular es la habilidad para procesar de forma simultánea por ambos oídos señales acústicas diferentes. El déficit en este mecanismo conlleva una pobre discriminación auditiva en presencia de ruido de fondo y dificultades en el procesamiento de señales acústicas competitivas. Material y método: En esta investigación se han presentado pares de dígitos de forma dicótica con distintos niveles de dificultad. Los sujetos participantes en este estudio eran adultos con audición normal y con pérdidas auditivas neurosensoriales bilaterales simétricas de origen coclear. Resultados: El estado auditivo, la dificultad de los ítems y el efecto del envejecimiento determinaron las capacidades de acierto. En general los sujetos normoyentes obtienen mejores puntuaciones que los sujetos con pérdida auditiva. Los sujetos hipoacúsicos muestran un déficit en el reconocimiento de los dígitos presentados por el oído izquierdo y una mayor ventaja del oído derecho. Conclusiones: El estudio de los mecanismos de integración biauricular puede tener interés en la evaluación audiológica de los pacientes que rechazan la amplificación biauricular y en sujetos que experimentan dificultades en la comprensión del habla en entornos ruidosos con una sensibilidad auditiva normal

Introduction: Binaural integration is the ability to process different messages when presented simultaneously in both ears. Any deficit in this mechanism implies poor auditory discrimination of background noise and difficulties in processing competing auditory signals. Method: In the present study, pairs of digits were presented dichotically to both ears in adult subjects with normal hearing and bilaterally symmetrical sensorineural cochlear hearing loss. Results: Hearing sensitivity, the difficulty in hearing the pairs and the effect of aging determine the capacity for correct recognition. In general, subjects with normal hearing score higher than those with hearing loss. Hypoacusic subjects show a deficit in the recognition of digits presented to the left ear and a greater advantage in the right ear. Conclusions: The study of binaural integration mechanisms may be useful in the audiological evaluation of patients who reject bilateral amplification and in normal- hearing subjects presenting difficulties to understand speech in noisy settings

Estudio psicométrico del acúfeno crónico. Adaptación del cuestionario sobre tinnitus (Tinnitus Questionnaire) a una muestra española / A psycometric study of chronic tinnitus. Spanish revised version of the Tinnitus Questionnaire

El acúfeno crónico es la percepción subjetiva de un ruido continuo en los oídos o en la cabeza en ausencia de un sonido externo que lo justifique. Es una sensación molesta y en algunos casos puede convertirse en un síntoma discapacitante para el que lo padece. Afecta a un 6 por ciento de la población y en la mayoría de los casos está asociado con pérdida auditiva. Los factores psicológicos y las estrategias de afrontamiento han demostrado estar más asociados a la gravedad del acúfeno que los aspectos estrictamente fisiológicos. En un intento de cuantificar estas dimensiones se han desarrollado varios cuestionarios. El Cuestionario de Acúfenos (Tinnitus Questionnaire, TQ; Jakes et al. 1985) es uno de los que más ampliamente se ha empleado ya que describe el impacto del acúfeno en distintas dimensiones tanto psicológicas como audiológicas. En el presente estudio se ha llevado acabo una adaptación a una muestra española del TQ con el objetivo de obtener un instrumento útil y eficaz en la evaluación de estos pacientes (AU)

Cultura política de los periodistas en sucre

La investigación plantea como objetivo caracterizar la cultura política de los periodistas en Sucre, específicamente conocer la autoimagen que tiene el periodista en relaicón a la política, las percepciones que tiene tanto d ela democracia, del sisetma de partidos, de las institucione spolíticas y de lasorganizaciones de la sociedad civil y el conjunto de valores que porta el periodista en su trabajo cotidiano.