Norovirus in children under 2 years of age: an epidemiological study in Panama during the COVID-19 pandemic.

Introduction: Norovirus infection is a common cause of acute gastroenteritis (AGE). Surveillance activities are important to aid investigation into effective norovirus control strategies, including vaccination. Here, we report ancillary findings related to the incidence, prevalence, and etiology of AGE caused by norovirus in Panama after adjustment of study methodology to comply with national coronavirus disease 2019 (COVID-19) mandates. Methods: In January 2020, children aged <2 years began enrolling into an epidemiological study in Panama to estimate the burden of norovirus in preparation for evaluating upcoming prevention strategies. This included an observational, longitudinal, community-based AGE surveillance study and a hospital-based AGE surveillance study. For the longitudinal study, healthy children aged 5-18 months were enrolled from January 6 through March 23, 2020, with a follow-up of approximately 6 months. The last participant was contacted on September 23, 2020. For the hospital-based study, starting on January 21, 2020, children aged <2 years who were admitted to the Hospital del Niño Dr. José Renán Esquivel in Panama City due to AGE were evaluated. The last sample was collected on September 29, 2020. Collected stool samples were tested for norovirus as well as astrovirus, sapovirus, and various enteropathogens. Unfortunately, this study was disrupted by the subsequent implementation of disease transmission control procedures for the COVID-19 pandemic, and the study methodology was revised to comply with COVID-19 mandates. Results: In the longitudinal surveillance cohort [N = 400 (Chiriquí, n = 239; Panama, n = 161)], a total of 185 AGE episodes were documented (Chiriquí, n = 85; Panama, n = 100) resulting in an overall AGE incidence of 11.6 (95% CI: 9.99-13.4) episodes per 100 child-months. The norovirus-related AGE incidence was 0.3 (95% CI: 0.10-0.73) episodes per 100 child-months (5/185 AGE episodes) and the prevalence of norovirus was 4.6% (13/282 stool samples collected). In the hospital-based surveillance cohort, at least one pathogen was detected in 50% of samples (44/88 stool samples collected) and norovirus prevalence was 6.8% (6/88 stool samples collected). Discussion: This report demonstrates how the occurrence of the COVID-19 pandemic hindered the conduct of clinical trials. However, this also created unique research opportunities to investigate the potential impact of pandemic control measures on the etiology of infectious diarrheal disease.

COVID-19 epidemic in Panama.

Objective: It is necessary to establish the evolution that the pandemic has had in Panama by weeks and months and to clearly establish the existence of surges or peaks, according to cases and deaths and the relationship with age groups. Methodology: We conducted a retrospective cohort study of all confirmed COVID-19 cases reported by the Ministry of Health of Panama during the first 3 years of the epidemic (March 9, 2020, March 11, 2023). All cases were obtained from information provided by the Ministry of Health. We obtained daily information of the population at the national level reported as new cases, deaths, admission to hospitals, admission to intensive care units and by age groups. The information is classified by epidemiological week and by month from the diagnosis of the first case until March 2023. Results: During the three years of the study, 1,032,316 cases of COVID-19 were registered in the Republic of Panama, and the number of deaths reported was 8,621, for a fatality rate of 0.83 % throughout that period. The number of deaths decreased over the 3 years of the pandemic; however, similar to the cases, there were periods of surges (peaks) per year in June/July and in December/January. The lethality progressively increased according to the age of the affected patients. During the first year, the lethality in those under 20 years of age was 0.05 %, and in those over 80 years old, it was 17.54 %. This pattern was maintained during the second year; however, there was a large decrease in all age groups. Conclusion: the highest lethality rate in Panama occurred in the first year of the pandemic, with a great decrease in the third year; the impact of lethality is proportional to the age of the individual, with a high possibility of death in those over 80 years of age. During each pandemic year, there are two peaks (surges of new cases and deaths) per year, which are important times to take into account to generate strategies aimed at reducing the impact.

Resilience mediates the effect of the COVID-19 pandemic on mental health in a sample of adults in Panama.

Background: The COVID-19 pandemic was characterized by global increases in depression, anxiety, and stress symptoms. Previous studies have shown that resilience mitigates these symptoms, however there is limited research exploring the link between resilience and mental illness during the COVID-19 pandemic in Central America. Objective: To examine the role of resilience as it relates to the perceived effect of the pandemic on mental health symptoms. Methods: A sample of 480 adults in Panama were recruited from March to May 2021 to complete an online survey. The online survey consisted of sociodemographic questions and scale measures assessing depression, anxiety and stress symptoms, resilience, and social support. Results: Results indicated that resilience mediated the relationship between the perceived effect of the COVID-19 pandemic and mental health symptoms; participants who felt more personally affected by the pandemic reported more depression, anxiety, and stress symptoms via decreased resilience. Further analyses revealed that resilience was moderated by sex and social support, showing that the indirect effect of resilience was greater for women and individuals who perceived low social support. Discussion: These findings contribute to a growing body of research documenting the adverse effects of the COVID-19 pandemic on mental health and reveal potential mechanisms through which pandemic-related distress decreases resilience, thereby increasing symptoms of mental illness.

Mixed-methods evaluation of a group psychosocial intervention for refugee, migrant and host community women in Ecuador and Panamá: Results from the Entre Nosotras cluster randomized feasibility trial.

Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.

Factores asociados de ingreso a un hospital de referencia de tercer nivel en Panamá durante el primer año de pandemia por COVID-19

Introducción: Panamá ocupa la quinta posición en incidencia acumulada de países latinoamericanos y la cuarta posición de muertes en Centroamérica por COVID-19. Hay pocos datos en la población pediátrica panameña. Se describen las características de esta población, admitidos al Hospital Materno Infantil José Domingo De Obaldía, durante el primer año de pandemia. Objetivos: Describir factores clínicos y epidemiológicos asociados al ingreso hospitalario a salas o Unidad Terapia Intensiva Pediátrica (UCIP). Métodos: Estudio descriptivo, transversal, retrospectivo con componente analítico con edad de 1 mes a 13 años 11 meses, de pacientes hospitalizados entre 01 abril 2020 y 30 abril 2021 y diagnóstico de SARS-CoV2 mediante reacción de polimerasa en cadena, detección de antígeno o serología al ingreso o durante su hospitalización. Los datos fueron analizados con IBM SPSS versión 25.0. Resultados: 84 pacientes fueron evaluados, 71 (85%) cumplieron los criterios de inclusión. Los factores de riesgo asociados a ingreso a UCIP: indígena 1,86 (3,08-1,13), referido de Bocas del Toro 9,33(43,43-2), desnutrición 5,6 (30,53-1,02), enfermedad neurológica 7,46 (36,94-1,5), radiografía de tórax con infiltrado intersticial y consolidación 14,93 (123,9-1,8), shock 1,32 (1,58-1,1), alteración del estado de alerta 22,4 (172-2,91), hipoxia 6,22 (23,13-1,67) y disnea 2,61 (5,7-1,19). La mortalidad fue 4%, asociada a compromiso respiratorio y comorbilidades. Conclusiones: Ser indígena, tener comorbilidades, radiografía de tórax (infiltrados intersticiales y consolidados) predominaron en los ingresos a la UCIP.

Background: Panama occupies the fifth position in cumulative incidence of Latin American countries and the fourth position in deaths in Central America from COVID-19. There are few data in the Panamanian pediatric population. The characteristics of this population, admitted to the José Domingo De Obaldia Maternal and Child Hospital, during the first year of the pandemic, are described. Aim: To describe clinical and epidemiological factors associated with hospital admission to wards or Pediatric Intensive Care Unit (PICU). Methods: Descriptive, cross-sectional, retrospective study with an analytical component with an age range of 1 month to 13 years 11 months, patients hospitalized between April 1,2020 to April 30, 2021 and diagnosis of SARS-CoV2 by polymerase chain reaction, antigen detection, or serology. upon admission or during hospitalization. Data were analyzed with IBM SPSS version 25.0. Results: 84 patients were included, 71 (85%) met the inclusion criteria. Risk factors associated with admission to the PICU: indigenous 1.86 (3.08-1.13), referred from Bocas del Toro 9.33 (43.43-2), malnutrition 5.6 (30.53-1.02), neurological disease 7.46 (36.94-1.5), chest X-ray with interstitial infiltrate and consolidation 14.93 (123.9-1.8), shock 1.32 (1.58-1.1), altered alertness 22.4 (172-2.91), hypoxia 6.22 (23.13-1.67) and dyspnea 2.61 (5.7-1.19). Mortality was 4%, associated with respiratory compromise and comorbidities. Conclusions: Being indigenous, having comorbidities, chest X-ray (interstitial and consolidated infiltrates) predominated in admissions to the PICU.

Hepatitis aguda de origen desconocido. Una serie de casos probables atendidos en un hospital pediátrico de referencia en Panamá

Introducción: Durante el año 2022 se objetivó un aumento de casos de hepatitis de origen desconocido en la población pediátrica. Su etiología a día de hoy todavía no ha sido esclarecida. Este estudio tiene como objetivo presentar la clínica y los resultados de los análisis de laboratorio de los pacientes con hepatitis atendidos en el Hospital del Niño Dr. José Renán Esquivel durante el año 2022.   Material y métodos: Estudio descriptivo de 10 pacientes pediátricos con criterios de hepatitis aguda de origen desconocido atendidos en nuestro centro durante el año 2022. Se ha llevado a cabo un análisis de las principales variables clínicas, analíticas, demográficas, vacunales y serológicas.   Resultados:  Se encontraron 10 pacientes, con una media de edad de 2,8 años. La clínica predominante ha sido la de ictericia, fiebre y clínica gastrointestinal. Analíticamente se ha detectado un aumento de los niveles de transaminasas así como de bilirrubina. Tan sólo un paciente contaba con historia de vacunación para el SARS-CoV-2. El principal agente etiológico identificado ha sido el adenovirus, encontrándose en el 40% de los casos.   Conclusiones: Los pediatras deben tener en cuenta el diagnóstico de hepatitis aguda de origen desconocido en pacientes con clínica de ictericia y fiebre, pudiendo asociar vómitos, diarrea, hepatomegalia, dolor abdominal y coluria, entre otros. La elevación de transaminasas (>500 U/L de AST o ALT) y bilirrubina debe aumentar el índice de sospecha. A pesar de que el principal agente etiológico parece guardar relación con el adenovirus, son necesarios más estudios para confirmar dicha hipótesis. (provisto por Infomedic International)

Introduction: During the year 2022 an increase in cases of hepatitis of unknown origin was observed in the pediatric population. Its etiology has not yet been clarified. This study aims to present the clinical and laboratory results of patients with hepatitis treated at the Hospital del Niño Dr. José Renán Esquivel during the year 2022.   Material and methods: Descriptive study of 10 pediatric patients with criteria of acute hepatitis of unknown origin seen in our center during the year 2022. An analysis of the main clinical, analytical, demographic, vaccination and serological variables was carried out.   Results: The final sample consisted of 10 patients, with a mean age of 2.8 years. The predominant clinical manifestations were jaundice, fever and gastrointestinal symptoms. Laboratory tests showed increased levels of transaminases and bilirubin. Only one patient had a history of vaccination for SARS-CoV-2. The main etiological agent identified was adenovirus, found in 40% of the patients studied.   Conclusions: Pediatricians should consider the diagnosis of acute hepatitis of unknown origin in patients with jaundice and fever, which may be associated with vomiting, diarrhea, hepatomegaly, abdominal pain and choluria, among others. Elevated transaminases (>500 U/L of AST or ALT) and bilirubin should increase the index of suspicion. Although the main etiological agent to date seems to be related to adenovirus, further studies are needed to confirm this hypothesis. (provided by Infomedic International)

Informe de gestión Sociedad Panameña de Pediatría 2021-actualidad

Los retos planteados durante los últimos años a nivel sanitario a raíz del virus que causó la Covid-19, demandó una mayor presencia de toda la comunidad científica a nivel mundial y Panamá no escapó de esa realidad, desde la Sociedad Panameña de Pediatría (SPP) nos sentimos complacidos por todo el trabajo y aporte realizado al país en los últimos años.  Desde que asumimos la presidencia de la SPP en el año 2021 nos hemos enfocado en la formación continua y el fortalecimiento de las capacidades de nuestros asociados a través de la realización de una serie de cursos, jornadas de docencia, seminario y talleres, no solo de forma presencial, sino también virtual.  Por ejemplo, logramos una amplia participación en los cursos virtuales que ofrecimos y que estuvieron enfocados en la vacunación pediátrica, así mismo, brindamos un seminario taller relacionado con la Obesidad Infantil y acompañamos a la Caja del Seguro Social en el curso de reanimación neonatal, entre otros.  Sin embargo, nuestro evento cumbre es sin duda alguna la realización de nuestro congreso anual de pediatría en el que se reúnen una amplia gama de especialistas en pediatría nacionales e internacionales con el objetivo principal de actualizar los conocimientos, mejorar destrezas, analizar los desafíos actuales, conocer nuevos métodos de diagnósticos y atención, así como de plantearnos el futuro de la atención pediátrica.    Durante los últimos dos años cada congreso ha sido acogido con gran éxito por lo más de 500 participantes que ha habido en cada uno y no tenemos la menor duda de que han llenado las expectativas de los asistentes.  Por otro lado, nos hemos esforzado por ser una Sociedad de Pediatría que se involucra de forma directa en el quehacer nacional procurando, como establece nuestro objetivo principal, ser un defensor pleno de los derechos de los niños, niñas y adolescentes en el país.  Hemos sido un ente asesor para las autoridades, proponiendo soluciones concretas relacionadas con la necesidad de fortalecer la red de atención primaria, impulsar la buena alimentación y los estilos de vida saludable, entre otros, que han contribuido en la toma de decisiones en favor de la población infantil.   De hecho, reestructuramos nuestra página web y nos hemos valido de las distintas plataformas digitales que tenemos a nuestro alcance para pronunciarnos de manera contundente respecto a una variedad de temas que afectan directamente a la población para la que servimos.  Así, por ejemplo, hemos instado a las autoridades a tomar acciones que realmente proteja a los infantes de ser víctimas del abuso infantil en todas sus formas (físico, sexual, verbal, etc.), hemos expuesto sobre la necesidad de impulsar programas que prevengan los embarazos en adolescentes y al mismo tiempo que se haga un mayor esfuerzo por educar respecto al tema para que se puedan hacer las denuncias correspondientes y restituir los derechos de las víctimas.  Recuperar las coberturas de vacunación y orientar a los padres de familia referente a los beneficios de completar los esquemas de vacunación de sus hijos también ha sido otra de las campañas en la que hemos invertido nuestros esfuerzos.   Como Sociedad hemos trabajado de forma paralela en la unificación de nuestros asociados, la apertura para que más colegas se sumen a nuestro gremio. Actualmente contamos con 320 socios activos; no obstante, no descansaremos hasta tanto logremos que cada pediatra de nuestro país se sume a nuestra asociación y juntos podamos garantizar la mejor atención a nuestros pacientes.  Aún tenemos muchos desafíos, por ejemplo, nos espera trabajar en la elaboración y armonización de protocolos de manejo de diferentes condiciones médicas para asegurar que los diagnósticos sean lo más precisos posibles y los tratamientos se implementen en tiempo y forma oportunos.   Otro aspecto que nos gustaría mejorar es disponer de los medios técnicos a nuestro alcance para que el proceso de afiliación, admisión o actualización a la Sociedad de Pediatría sea más ágil, sencillo y cómodo.   Somos plenamente conscientes que, sin invertir en mejorar las capacidades y habilidades de nuestros miembros, no seríamos una verdadera asociación dedicada a brindarle lo mejor. Como tal, continuaremos alentando el aprendizaje y la mejora de las habilidades para enfrentar los desafíos que nos ha dejado la pandemia de COVID-19. Finalmente, esperamos seguir tendiendo puentes y trabajando con diversas sociedades, organizaciones, universidades, empresas y gobiernos para lograr nuestro objetivo de cerrar la brecha de desigualdad en la atención integral a la niñez en todo el país, y para ello insistiremos en la participación a través de cada espacio, dejando de ser espectadores y acompañar así en el desarrollo integral de cada infante.

The challenges posed in recent years at the health level as a result of the virus that caused the Covid-19, demanded a greater presence of the entire scientific community worldwide and Panama did not escape that reality, from the Panamanian Society of Pediatrics (SPP) we are pleased for all the work and contribution made to the country in recent years. Since we assumed the presidency of the SPP in the year 2021, we have focused on continuous training and strengthening the capacities of our associates through a series of courses, teaching days, seminars and workshops, not only in person, but also virtually. For example, we achieved a wide participation in the virtual courses we offered, which were focused on pediatric vaccination, we also offered a seminar-workshop related to Childhood Obesity and we accompanied the Social Security Fund in the neonatal resuscitation course, among others. However, our most important event is undoubtedly our annual pediatric congress, which brings together a wide range of national and international specialists in pediatrics with the main objective of updating knowledge, improving skills, analyzing current challenges, learning new methods of diagnosis and care, as well as considering the future of pediatric care. During the last two years each congress has been received with great success by the more than 500 participants that have attended each one and we have no doubt that they have fulfilled the expectations of the attendees. On the other hand, we have strived to be a Pediatric Society that is directly involved in the national activity, trying, as our main objective establishes, to be a full defender of the rights of children and adolescents in the country. We have been an advisory body for the authorities, proposing concrete solutions related to the need to strengthen the primary care network, promote good nutrition and healthy lifestyles, among others, which have contributed to decision-making in favor of the child population. In fact, we restructured our website and have used the various digital platforms available to us to make a strong statement on a variety of issues that directly affect the population we serve. Thus, for example, we have urged the authorities to take actions that really protect children from being victims of child abuse in all its forms (physical, sexual, verbal, etc.), we have exposed the need to promote programs to prevent teenage pregnancies and at the same time to make a greater effort to educate on the subject so that the corresponding complaints can be made and the rights of the victims can be restored. To recover vaccination coverage and orient parents regarding the benefits of completing their children's vaccination schedules has also been another of the campaigns in which we have invested our efforts. As a Society we have worked in parallel in the unification of our associates, the opening for more colleagues to join our guild. We currently have 320 active members; however, we will not rest until we get every pediatrician in our country to join our association and together we can guarantee the best care for our patients. We still have many challenges ahead of us, for example, we have to work on the development and harmonization of protocols for the management of different medical conditions to ensure that diagnoses are as accurate as possible and treatments are implemented in a timely manner. Another aspect that we would like to improve is to have the technical means at our disposal to make the process of affiliation, admission or update to the Pediatric Society more agile, simple and comfortable. We are fully aware that, without investing in improving the skills and abilities of our members, we would not be a true association dedicated to providing you with the best. As such, we will continue to encourage learning and skill enhancement to meet the challenges that the COVID-19 pandemic has left us with. Finally, we hope to continue building bridges and working with diverse societies, organizations, universities, companies and governments to achieve our goal of closing the inequality gap in the comprehensive care of children throughout the country, and for this we will insist on participation through every space, ceasing to be spectators and thus accompanying the integral development of each infant.

Un nouvel agenda pour la santé mentale dans les Amériques : Rapport de la Commission de haut niveau sur la santé mentale et la COVID-19 de l’Organisation panaméricaine de la Santé - Résumé d’orientation

Les besoins non satisfaits en matière de santé mentale dans la Région des Amériques sont l'une des principales sources de morbidité et de mortalité dans la Région, avec pour résultat d'énormes conséquences sanitaires, sociales et économiques. La pandémie de COVID-19 a exacerbé la crise de santé mentale dans la Région, et a nécessité une action urgente aux plus hauts niveaux du gouvernement comme dans tous les secteurs afin de rétablir de meilleurs systèmes et services de santé mentale aujourd'hui et pour l'avenir. Le présent résumé d’orientation présente les points saillants du rapport emblématique de la Commission de haut niveau sur la santé mentale et la COVID-19 de l'OPS. Il fournit une analyse de la situation concernant la santé mentale dans la Région, suivie d'une série de recommandations et d'actions correspondantes pour aider les pays à accorder la priorité à la santé mentale et à la faire progresser en utilisant des approches fondées sur les droits de l'homme et l'équité.

Dietary patterns, social determinants, and emotions during COVID-19 confinement in Panama: An online survey.

Aim: We aimed to evaluate health and nutrition behaviors among the Panamanian population during the confinement period corresponding to the first wave of the COVID-19 pandemic. Methods: We conducted a cross-sectional study using an online survey for data collection with a total of 2475 participants over the age of 18 using an online survey. We also completed 64 face-to-face interviews. After data validation, 1561 surveys were included in the study. Most respondents were women (74.2%) between 18 and 49 years old. Among the respondents, 83.3% had a university education level, and 49.9% reported a monthly family income of fewer than 1000 USD. In addition, more than 50% self-reported as overweight or obese. Results: We identified three dietary patterns: a healthy, a non-healthy, and a mixed dietary pattern. The respondents with healthy and nonhealthy dietary patterns reported better socioeconomic conditions than participants from the mixed dietary pattern. Individuals with mixed dietary patterns had lower incomes, less education, and higher unemployment rates. Regarding emotions, we found that women experienced more negative emotions, such as fear, worry, and anxiety, during the lockdown period. Conclusions: Taken together, these results indicate that the mobility restriction measures imposed during the COVID-19 pandemic could have affected dietary patterns by exacerbating existing inequalities. Directing resources toward promoting healthy nutrition strategies with the most significant positive impacts on public health is a priority, especially in critical situations such as the COVID-19 pandemic.

Percepción del riesgo de desastres en una comunidad vulnerable del Distrito de San Miguelito, Panamá

Introducción: Los desastres causan daños al ambiente y a las personas, impactando en la salud, condición de vida y paz emocional, lo que requiere una comunidad conocedora de las características territoriales, las incidencias de los efectos ambientales, los peligros sanitarios y las competencias intersectoriales ante un desastre. Objetivo: Identificar la percepción del riesgo de desastres en una comunidad vulnerable.Metodología: Estudio descriptivo transversal con un universo estudio de 304 viviendas con jefes de hogar de la comunidad Villa Esperanza del Distrito de San Miguelito. Se consideró la percepción del riesgo ambiental y epidemiológico. Fue elaborado un cuestionario con preguntas abiertas y cerradas para datos cualitativos y cuantitativos. Se aplicaron medidas de tendencia central presentando los datos en frecuencias relativas y absolutas en escala nominal, ordinal y en mapas georeferenciados.Resultados: Aceptaron participar 286 jefes de hogar. El 53.8% no percibe el riesgo ambiental y el 46.2% si lo percibe. El riesgo epidemiológico no es percibido por el 79.0% de los jefes de hogar y el 21.0% sí lo percibe. Considerando las enfermedades prevenibles por vacunas e infecciones por Coronavirus (COVID -19), el 44.4% indicó, que algún miembro del hogar padeció está enfermedad. Conclusión: Se identificó la subestimación del riesgo o negación implícita del riesgo y ausencia de linealidad en la percepción de riesgo de desastre.Se hace necesario la promoción y prevención para conocimiento, control preventivo y preparación en gestión de riesgo de desastres en la comunidad Villa Esperanza. (provisto por Infomedic International)

Introduction: Disasters cause damage to the environment and people, impacting health, living condition and emotional peace, which requires a community knowledgeable about territorial characteristics, incidences of environmental effects, health hazards and intersectoral competencies in the face of a disaster. Objective: To identify the perception of disaster risk in a vulnerable community.Methodology: Cross-sectional descriptive study with a study universe of 304 households with heads of household in the Villa Esperanza community of the District of San Miguelito. The perception of environmental and epidemiological risk was considered. A questionnaire was prepared with open and closed questions for qualitative and quantitative data. Measures of central tendency were applied, presenting the data in relative and absolute frequencies on a nominal and ordinal scale and on geo-referenced maps.Results: 286 heads of household agreed to participate. 53.8% do not perceive environmental risk. A total of 53.8% did not perceive environmental risk and 46.2% did. Epidemiological risk is not perceived by 79.0% of the heads of household and 21.0% do perceive it. Considering vaccine-preventable diseases and Coronavirus infections (COVID-19), 44.4% indicated that a member of the household had suffered from this disease. Conclusion: Underestimation of risk or implicit denial of risk and lack of linearity in the perception of disaster risk were identified, making it necessary to promote and prevent knowledge, preventive control and preparation for disaster risk management in the Villa Esperanza community. (provided by Infomedic International)

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama.

PURPOSE: Dialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination. METHODS: This is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years. RESULTS: A total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020-2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001). CONCLUSION: Ninety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.

Organisation panaméricaine de la Santé: 120 ans de promotion de la santé publique dans la Région des Amériques

[EXTRAIT]. En 2022, l'Organisation panaméricaine de la Santé (OPS) a célébré son 120e anniversaire. En repensant aux années écoulées et à l'histoire de cette Organisation, je suis renvoyé au pouvoir de la solidarité et à son caractère essentiel dans la construction d’un avenir plus sain, plus juste et plus prometteur. Au cours des trois dernières années, la Région des Améri- ques a dû faire face à l’une des crises les plus graves depuis plus d’un siècle. La Région a été particulièrement touchée par la pandémie de COVID-19, qui a profondément affecté tous les domaines de notre vie et a fait reculer les progrès sociaux et économiques de plusieurs années. Cependant, même lorsque les obstacles semblaient insurmontables, notre Région a tra- vaillé sous le signe de la collaboration pour vacciner plus de 700 millions de personnes. Aujourd’hui, les pays et territoires de la Région des Amériques comblent les lacunes existant dans nos systèmes de santé, renforcent la surveillance des maladies et élargissent les capacités de fabrication, afin de mieux se préparer aux défis à venir. Je félicite les contributeurs et les rédacteurs du Pan American Journal of Public Health de faire progresser la santé et le bien-être des peuples de la Région des Amériques et de promouvoir nos valeurs régionales de santé, d’équité, de solidarité et de justice sociale.

La educación virtual y su impacto en el aprendizaje como modalidad de enseñanza clínica en enfermería durante la pandemia de covid-19, en la universidad de panamá. documento tipo ensayo argumentativo / Virtual education and its impact on learning as a clinical teaching modality in nursing during the covid-19 pandemic, at the university of panama. document type argumentative essay / Educação virtual e seu impacto na aprendizagem como modalidade de ensino clínico em enfermagem durante a pandemia covid-19, na universidade de panamá. documento do tipo ensaio argumentativo

El presente artículo, es un ensayo, que permite hacer una reflexión sobre los elementos que integraron la formación de los estudiantes de enfermería durante la pandemia COVID 19, cuando de un día a otro se tuvo que transformar la educación y asumir cambios radicales, como dejar de ir a las aulas de manera presencial, para recibir la formación que permitiera el logro de las metas del perfil profesional de enfermería, a través de un medio digital remoto, como fue una pantalla de computador, tableta o celular. El año 2020 será sin duda, recordado por el impacto que generó en la metodología de enseñanza procedimental en Enfermería. Como docentes universitarios enfrentamos el reto de la formación de profesionales de enfermería, con la práctica de destrezas, desde la distancia, en modalidad sincrónica. La educación virtual permitió la incorporación de los elementos de aprendizaje de manera activa generando la información para la construcción del conocimiento en el saber, el ser y en el hacer como parte de las competencias que debían adquirir los estudiantes. Se enfrentaron retos como el de abordar el consumo de data, con un impacto económico sobre todo en el periodo de crisis económica.

Abstract This article is an essay that allows a reflection on the elements that made up the training of nursing students during the COVID 19 pandemic, when education had to be transformed, from one day to the next, and radical changes taken: namely, from not having in-person classes to receive the training, that would allow achieving the goals of the professional profile of nursing, to teaching with a remote digital medium, like a computer monitor, tablet or cell phone. The year 2020 will be remembered undoubtedly for the impact it generated on the procedural teaching methodology in Nursing. As university teachers, we face the challenge of training nursing professionals, through the practice of skills, from a distance, in a synchronous mode. Virtual education allowed the incorporation of learning elements in an active way generating information for the construction of knowledge in knowing, being, and doing as part of the skills that students should acquire. Challenges, such as dealing with data consumption with an economic impact, were especially faced during the economic crisis.

Resumo: Este artigo é um ensaio, que nos permite refletir sobre os elementos que integraram a formação dos alunos de enfermagem durante a pandemia COVID 19, quando de um dia para o outro a educação teve que ser transformada e mudanças radicais tiveram que ser assumidas, como parar de ir às salas de aula pessoalmente para receber a formação que permitiria o cumprimento das metas do perfil profissional de enfermagem, através de um meio digital remoto, como um computador, tablet ou celular. O ano de 2020 será, sem dúvida, lembrado pelo impacto que gerou na metodologia do ensino processual em Enfermagem. Como professores universitários enfrentamos o desafio de formar profissionais de enfermagem, com a prática de habilidades, à distância, na modalidade síncrona. A educação virtual permitiu a incorporação de elementos de aprendizagem de forma ativa gerando informações para a construção do conhecimento baseado no ser, no saber e no fazer como parte das habilidades que os alunos tinham que adquirir. Desafios foram enfrentados, como a abordagem do consumo de data, com impacto econômico especialmente no período de crise econômica.

Tratamiento de COVID-19 en Panamá. La historia del inicio, estudio PanaCovid2020

Antecedentes En Panamá, durante los primeros cinco meses de pandemia, se reportaron 65,256 casos y 1,421 fallecimientos por COVID-19. Los tratamientos utilizados en pacientes hospitalizados durante este periodo fueron variando en la medida que surgía evidencia científica. Metodología Presentamos un estudio multicéntrico observacional, descriptivo, de corte transversal y retrospectivo de la terapéutica administrada en pacientes hospitalizados con COVID-19 en siete centros estatales de la República de Panamá, entre el 1 de marzo al 31 de julio de 2020. Se analizó el resultado de recuperado o fallecido en relación al uso de hidroxicloroquina, heparinas y esteroides. Resultados Se revisaron 837 expedientes. 60.7% pacientes eran hombres y la mediana de edad fue 53.6 años. Los tratamientos más utilizados fueron heparinas 84.7%, esteroides sistémicos 76.5%, azitromicina 65.5% e hidroxicloroquina en 41.1%. La frecuencia de uso de oxigenoterapia fue de cánula nasal 73,2%, máscara facial con reservorio 39%, cánula de alto flujo 8.9%, ventilación mecánica no invasiva 11.1% y ventilación invasiva en el 15.3%. Los esteroides mostraron mayor tasa de recuperación (OR 1.72 [1.16-2.54). Conclusiones El reto de abordar una nueva enfermedad, sin tratamiento conocido, con evolución y desenlace variable, llevó a la comunidad médica a utilizar medicamentos empíricos con potencial terapéutico incierto. Destacamos que desde muy temprano se administró esteroides sistémicos, heparinas y tocilizumab; actualmente con beneficios para pacientes con requerimientos de hospitalización. Además, se empleó técnicas de oxigenación, como la cánula de alto flujo y ventilación mecánica no invasiva, con dudosa efectividad; pero que hoy ya tienen un rol estudiado en la falla respiratoria por COVID-19. (provisto por Infomedic International)

Background: In Panama, during the first five months of the pandemic, 65,256 cases and 1,421 deaths due to COVID-19 were reported. The treatments used in hospitalized patients during this period varied as scientific evidence emerged. Methodology: We present a retrospective, descriptive, cross-sectional, observational, descriptive, multicenter study of the therapeutics administered in hospitalized patients with COVID-19 in seven state centers in the Republic of Panama, between March 1 and July 31, 2020. The outcome of recovered or deceased was analyzed in relation to the use of hydroxychloroquine, heparins and steroids. Results: A total of 837 files were reviewed. 60.7% of patients were men and the median age was 53.6 years. The most commonly used treatments were heparins 84.7%, systemic steroids 76.5%, azithromycin 65.5% and hydroxychloroquine in 41.1%. The frequency of oxygen therapy use was nasal cannula 73.2%, face mask with reservoir 39%, high-flow cannula 8.9%, noninvasive mechanical ventilation 11.1% and invasive ventilation in 15.3%. Steroids showed higher recovery rate (OR 1.72 [1.16-2.54). Conclusions: The challenge of dealing with a new disease, without known treatment, with variable evolution and outcome, led the medical community to use empirical drugs with uncertain therapeutic potential. We highlight the early administration of systemic steroids, heparins and tocilizumab; currently with benefits for patients requiring hospitalization. In addition, oxygenation techniques were used, such as high-flow cannula and noninvasive mechanical ventilation, with doubtful effectiveness, but which today have a studied role in respiratory failure due to COVID-19.   (provided by Infomedic International)

Informe anual 2021. Panamá: Respuesta a la COVID-19 y preparación para el futuro

En el 2022 se celebra el 120.º aniversario de la Organización Panamericana de la Salud (OPS). En calidad de organismo independiente especializado en salud del sistema interamericano, la OPS brinda cooperación técnica a sus Estados Miembros para abordar las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, como Oficina Regional de la Organización Mundial de la Salud para la Región de las Américas, participa en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible a nivel de país. A nivel subregional, la OPS trabaja con los mecanismos de integración para que la salud y sus determinantes tengan un lugar en la agenda política. En el informe anual correspondiente al 2021 se presenta la cooperación técnica de la OPS en los países y territorios en este período, con la aplicación de las estrategias de cooperación en los países, la respuesta a sus necesidades y prioridades, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la OPS y los Objetivos de Desarrollo Sostenible. En consonancia con el tema general de "responder a la COVID-19 y prepararse para el futuro", se ponen de relieve las medidas que ha adoptado la OPS con respecto a la pandemia de COVID-19 y sus esfuerzos continuos en áreas prioritarias como las emergencias de salud, los sistemas y servicios de salud, las enfermedades transmisibles, las enfermedades no transmisibles y la salud mental, la salud a lo largo del curso de vida y la equidad en la salud. También se presenta un resumen financiero del bienio 2020-2021.

Rapport quinquennal 2018-2022 du Directeur du Bureau sanitaire panaméricain : Défense de l’équité en santé au service du développement durable. Résumé d’orientation

Voici le résumé du Rapport quinquennal 2018-2022 du Directeur du Bureau sanitaire panaméricain : Défense de l’équité en santé au service du développement durable. Il met en évidence les réalisations du Bureau sanitaire panaméricain au cours des cinq dernières années, contextualise les défis importants, résume les principaux problèmes rencontrés et présente des conclusions. Au cours de cette période, le Bureau sanitaire panaméricain a continué d’appuyer les progrès accomplis par les États Membres sur la voie de la réalisation de la santé universelle, est intervenu suite à diverses situations d’urgence sanitaire, a appuyé le développement de systèmes de santé résilients et s’est associé aux pays pour aborder les déterminants sociaux concernant l’inégalité de l'accès et des résultats en matière de santé. Le résumé se concentre sur deux défis majeurs de cette période, la pandémie de COVID-19 et la crise financière de l’Organisation panaméricaine de la Santé, qui ont tous deux été exacerbés par l'« infodémie » liée à la COVID et les retards sans précédent dans le paiement des contributions fixées. Bien que ces deux défis aient considérablement entravé le travail du Bureau sanitaire panaméricain, la crise financière a menacé l’existence même de l’Organisation. Un thème central des enseignements tirés est la nécessité absolue de placer l’équité au cœur des stratégies visant à atteindre la santé universelle. Parmi les autres enseignements clés, particulièrement mis en évidence pendant la pandémie, il faut citer la nécessité d’investir davantage dans l’autosuffisance régionale en médicaments et produits médicaux essentiels, l’importance vitale de maintenir des programmes nationaux de vaccination solides et de protéger le Fonds renouvelable pour l'accès aux vaccins, ainsi que la fonction cruciale du Bureau sanitaire panaméricain en tant qu’agence technique politiquement neutre qui détient la confiance de tous les États Membres en servant d’intermédiaire honnête pour la santé de tous les peuples des Amériques.

Overcoming obstacles in Panama to starting a renal biopsy program in a rural area during the COVID-19 pandemic.

Due to the many implemented restrictions, the SARS-CoV-2 pandemic has rendered some tasks more difficult, for instance, the evaluation of outpatients. Panama's tertiary care hospital for kidney biopsy referral was transformed into a COVID-only hospital in order to assist the large number of COVID-19 patients. In order to face the impossibility of following patients with nephrotic or nephritic syndrome, a biopsy program was implemented in a southern province in Panama. Thirty kidney biopsies were carried out over a 1-year period. This experience shows that kidney biopsy programs, that are usually run only in large referral centers, can also be implemented in small nephrology centers, allowing to obtain accurate diagnoses and to guide correct treatment.

Psychosocial response to the COVID-19 pandemic in Panama.

Background: The impact of the COVID-19 pandemic and the associated restrictions on mental health is being studied. Objective: To analyze the psychosocial response to the COVID-19 pandemic in adults residing in Panama. Methods: A community sample of 480 adult residents of Panama completed a survey that included sociodemographic questions, COVID-19 related questions (e.g., health concerns regarding the virus, knowledge and behaviors in biosafety) and scales of stress, anxiety, depression, prosocial behavior, resilience, perceived social support, and insomnia. Results: Most of the participants (>60%) reported being negatively affected by the pandemic. Women experienced greater depression, anxiety, and stress symptoms than men, and age was negatively associated with depression, anxiety, and stress symptoms. Self-perceived health status and self-perceived social support were negatively associated with depression, anxiety, and stress symptoms. Self-perceived social isolation was positively associated with depression, anxiety, and stress symptoms. Psychiatric illness and insomnia were positively associated with depression, anxiety, and stress symptoms, whereas psychological resilience was negatively associated with depression, anxiety, and stress symptoms. Discussion: These results corroborate other studies regarding COVID-19 and mental health. This study highlights the need for specific prevention and intervention mechanisms related to the COVID-19 pandemic in different population groups. This is the first report of the psychological impact of COVID-19 in the general Panamanian population and one of the only studies in the Latin American region and, therefore, contributes to research in the Latino population and lower-middle income countries.

Analyzing Spanish-Language Public Sentiment in the Context of a Pandemic and Social Unrest: The Panama Case.

Over the past decade, an increase in global connectivity and social media users has changed the way in which opinions and sentiments are shared. Platforms such as Twitter can act as public forums for expressing opinions on non-personal matters, but often also as an outlet for individuals to share their feelings and personal thoughts. This becomes especially evident during times of crisis, such as a massive civil disorder or a pandemic. This study proposes the estimation and analysis of sentiments expressed by Twitter users of the Republic of Panama during the years 2019 and 2020. The proposed workflow is comprised of the extraction, quantification, processing and analysis of Spanish-language Twitter data based on Sentiment Analysis. This case of study highlights the importance of developing natural language processing resources explicitly devised for supporting opinion mining applications in Latin American countries, where language regionalisms can drastically change the lexicon on each country. A comparative analysis performed between popular machine learning algorithms demonstrated that a version of a distributed gradient boosting algorithm could infer sentiment polarity contained in Spanish text in an accurate and time-effective manner. This algorithm is the tool used to analyze over 20 million tweets produced between the years of 2019 and 2020 by residents of the Republic of Panama, accurately displaying strong sentiment responses to events occurred in the country over the two years that the analysis performed spanned. The obtained results highlight the potential that methodologies such as the one proposed in this study could have for transparent government monitoring of responses to public policies on a population scale.

Presión positiva en vía aérea y cánula de alto flujo en el tratamiento de insuficiencia respiratoria por COVID-19, en unidades de cuidados respiratorios especiales, de dos hospitales de referencia en la República de Panamá

Introducción: En Panamá, así como en otras partes del mundo como España e Italia, se crearon Unidades de Cuidados Respiratorios Especiales para brindar soporte no invasivo a pacientes con insuficiencia respiratoria por neumonía por SARS-COV-2. En este trabajo se describen las características demográfica y clínicas de los pacientes que utilizaron ventilación no invasiva y/o cánula de alto flujo.  Material y métodos: El diseño del estudio fue prospectivo, observacional y descriptivo en dos hospitales de referencia en Panamá. Los pacientes firmaron un consentimiento informado y se procedió a llenar un cuestionario diario sobre las características demográficas y variables clínicas diarias.  Resultados: Se logró recolectar datos de 173 paciente, 60.69% correspondió al sexo masculino y se encontraban en una media de edad de 59 años, la comorbilidad más común fue la hipertensión arterial. El 88.75% de los pacientes tuvieron un NEWS 2 por arriba de 5 que indicaba mayor vigilancia por riesgo medio de paciente crítico, tanto la VMNI como el CAF tuvieron buenos resultados, 60% y 80% respectivamente. Conclusión: Nuestro estudio nos da luces sobre las características de los pacientes con insuficiencia respiratoria que requirieron dispositivos no invasivos y nos permite observar la evolución de estos en un contexto donde los recursos son limitados para terapia en cuidados intensivos. (provisto por Infomedic International)

Introduction: In Panama, as in other parts of the world, Special Respiratory Care Units were created to provide non-invasive support to patients with respiratory failure due to SARS-COV-2 pneumonia. In this work, the demographic and clinical characteristics of the patients who used non-invasive ventilation and/or high-flow cannula are described. Material and method: The study design was prospective, observational and descriptive in two Reference Hospitals in Panama. The patients signed an informed consent and proceeded to fill out a daily questionnaire on demographic characteristics and daily clinical variables. Results: We included 173 patients, 60.69% were male and had a mean age of 59 years, and the most common comorbidity was hypertension. In the evaluation of the risks, the 88.75% had a NEWS 2 above 5 that indicated greater vigilance due to the medium risk of a critical patient, both NIV and HFC had good results in 60% and 80% respectively. Conclusion: Our study sheds light on the characteristics of patients with respiratory failure who required non-invasive devices and allows us to observe their evolution in a context where resources are limited for intensive care therapy. (provided by Infomedic International)