Social norms that sustain transactional sex and associations with sexual health outcomes: A mixed-methods study in the Comarca Ngäbe-Buglé, a rural-Indigenous region of Panama.

The Comarca Ngäbe-Buglé (CNB), home to >200,000 Indigenous people, is one of the poorest regions in Panama. We describe transactional sex (TS) behaviours, normative beliefs and factors associated with TS among Indigenous adolescents(14-19years) in the CNB. We conducted a mixed-methods study in the CNB between January and November 2018, which included a qualitative study with participant observation and semi-structured interviews that focused on descriptive norms related to TS; and a cross-sectional study among public-school-going adolescents using self-administered questionnaire to report sexual behaviour and injunctive norms related to TS. Participants in the epidemiological study were also asked to submit samples for HIV, syphilis, chlamydia, and gonorrhoea testing. Qualitative thematic analysis was used to organise and analyse field notes and semi-structured interviews. Quantitative analysis included four models: TS experience and acceptance of a TS offer and the associations of these outcome variables with demographic and behavioural variables and HIV/STI infections. In the qualitative study among 20 adolescents, we found that people offering TS were reported to be from within and outside of the community, and included older men and women, and disturbingly, teachers. Participants reported feeling individual and collective agency in the decision to engage in TS and described little social sanctions for participation. In the quantitative study among 700 adolescents(309 girls[45.1%],379 boys[54.9%]), we found that girls(18.8%;58/309) and boys(15.5%;58/379) reported similar levels of having been offered TS, and of acceptance among those offered(girls 81.4% [35/43]; boys 77.8% [35/45]). TS was found to be associated with the reported forced sex and HIV/syphilis seropositivity. Due to widespread acceptance and feelings of agency, interventions would not be effective if they focused on eliminating the transactional component of sexual encounters. Instead, interventions should focus on individual and household economic stability, increasing violence reporting, bringing perpetrators to justice, and adopting condom use during all sexual encounters.

Extensive data engineering to the rescue: building a multi-species katydid detector from unbalanced, atypical training datasets.

Passive acoustic monitoring (PAM) is a powerful tool for studying ecosystems. However, its effective application in tropical environments, particularly for insects, poses distinct challenges. Neotropical katydids produce complex species-specific calls, spanning mere milliseconds to seconds and spread across broad audible and ultrasonic frequencies. However, subtle differences in inter-pulse intervals or central frequencies are often the only discriminatory traits. These extremities, coupled with low source levels and susceptibility to masking by ambient noise, challenge species identification in PAM recordings. This study aimed to develop a deep learning-based solution to automate the recognition of 31 katydid species of interest in a biodiverse Panamanian forest with over 80 katydid species. Besides the innate challenges, our efforts were also encumbered by a limited and imbalanced initial training dataset comprising domain-mismatched recordings. To overcome these, we applied rigorous data engineering, improving input variance through controlled playback re-recordings and by employing physics-based data augmentation techniques, and tuning signal-processing, model and training parameters to produce a custom well-fit solution. Methods developed here are incorporated into Koogu, an open-source Python-based toolbox for developing deep learning-based bioacoustic analysis solutions. The parametric implementations offer a valuable resource, enhancing the capabilities of PAM for studying insects in tropical ecosystems. This article is part of the theme issue 'Towards a toolkit for global insect biodiversity monitoring'.

Improving Retention in Mental Health and Psychosocial Support Interventions: An Analysis of Completion Rates across a Multi-Site Trial with Refugee, Migrant, and Host Communities in Latin America.

Research on mental health and psychosocial support (MHPSS) interventions within refugee and migrant communities has increasingly focused on evaluating implementation, including identifying strategies to promote retention in services. This study examines the relationship between participant characteristics, study setting, and reasons for intervention noncompletion using data from the Entre Nosotras feasibility trial, a community-based MHPSS intervention targeting refugee, migrant, and host community women in Ecuador and Panama that aimed to promote psychosocial wellbeing. Among 225 enrolled women, approximately half completed the intervention, with varying completion rates and reasons for nonattendance across study sites. Participants who were older, had migrated for family reasons, had spent more time in the study community, and were living in Panamá (vs. Ecuador) were more likely to complete the intervention. The findings suggest the need to adapt MHPSS interventions to consider the duration of access to the target population and explore different delivery modalities including the role of technology and cellular devices as reliable or unreliable source for engaging with participants. Engaging younger, newly arrived women is crucial, as they showed lower completion rates. Strategies such as consulting scheduling preferences, providing on-site childcare, and integrating MHPSS interventions with other programs could enhance intervention attendance.

Chemical control of medically important arthropods in Panama: A systematic literature review of historical efforts.

Vector-borne diseases are a major source of morbidity in Panama. Herein, we describe historical usage patterns of synthetic insecticides to control arthropod disease vectors in this country. We examine the influence of interventions by vector control programs on the emergence of insecticide resistance. Chemical control has traditionally focused on two mosquito species: Anopheles albimanus, a major regional malaria vector, and Aedes aegypti, a historical vector of yellow fever, and current vector of dengue, chikungunya, and Zika. Countrywide populations of An. albimanus depict hyperirritability to organochlorine insecticides administered by indoor residual spraying, although they appear susceptible to these insecticides in bioassays settings, as well as to organophosphate and carbamate insecticides in field tests. Populations of Ae. aegypti show resistance to pyrethroids, particularly in areas near Panama City, but the spread of resistance remains unknown in Ae. aegypti and Aedes albopictus. A One Health approach is needed in Panama to pinpoint the insecticide resistance mechanisms including the frequency of knockdown mutations and behavioral plasticity in populations of Anopheles and Aedes mosquitoes. This information is necessary to guide the sustainable implementation of chemical control strategies and the use of modern vector control technologies such as genetically modified mosquitoes, and endosymbiont Wolbachia-based biological control.

Updated checklist of treehoppers of Panama (Hemiptera: Membracidae) with plant associations.

An updated checklist of treehoppers (Hemiptera: Membracidae) of Panama is provided with known province distribution data. The world catalogue of Membracoidea, through April, 1997, lists 68 genera, 162 species, and 1 subspecies from Panama (McKamey, 1998). Flynn (2012) listed all known species from Panama, documenting range extensions for 29 genera, 107 species, and 1 subspecies previously unknown from Panama, bringing the treehopper fauna from Panama to 97 genera, 269 species, and 2 subspecies. Inspection of 768 additional specimens since 2012 (new total of 3,595 specimens for the study), in addition to published literature, has added 2 new genera and 40 new species bringing the treehopper fauna to 100 genera (increase of 3 genera), 313 species (increase of 44 species) from 2012, and 2 subspecies. Many new provincial sites were added to each species with an updated provincial map showing numbers of species in each province. Updated species counts per Province (with increase): Bocas del Toro 65 (+10), Chiriqui 162 (+11), Veraguas 26 (+3), San Blas 8 (+1), Herrera 9 (+1), Darien 72 (+13), Los Santos 4 (+1), Cocle 43 (+9), Colon 187 (+79), and Panama 150 (+32). Tables listing published checklists and keys for Nearctic and Neotropical treehoppers are presented.

A Spatial Signal of Niche Differentiation in Tropical Forests.

AbstractExplaining diversity in tropical forests remains a challenge in community ecology. Theory tells us that species differences can stabilize communities by reducing competition, while species similarities can promote diversity by reducing fitness differences and thus prolonging the time to competitive exclusion. Combined, these processes may lead to clustering of species such that species are niche differentiated across clusters and share a niche within each cluster. Here, we characterize this partial niche differentiation in a tropical forest in Panama by measuring spatial clustering of woody plants and relating these clusters to local soil conditions. We find that species were spatially clustered and the clusters were associated with specific concentrations of soil nutrients, reflecting the existence of nutrient niches. Species were almost twice as likely to recruit in their own nutrient niche. A decision tree algorithm showed that local soil conditions correctly predicted the niche of the trees with up to 85% accuracy. Iron, zinc, phosphorus, manganese, and soil pH were among the best predictors of species clusters.

Chlorine Water Taste Threshold and Acceptability among Indigenous and Non-Indigenous Populations in Rural Panama.

Although gains in access to water services over the past two decades have been large, more than two billion people still lack access to safely managed drinking water. This study examines and compares free chlorine taste and acceptability thresholds of rural Indigenous Ngäbe and rural Latino Panamanians to study if taste aversion may be a limiting factor in chlorination of community systems in Panama using the three-alternative forced choice test methodology. This study is the first to establish a best-estimate taste threshold for a rural Indigenous group and the only study in Latin America to report best-estimate taste thresholds using those methods. Median taste thresholds were 0.87 mg/L Cl2 for Indigenous Ngäbe participants (n = 82) and 1.64 mg/L Cl2 for Latino participants (n = 64), higher than both the minimum concentration for biologically safe water (0.2 mg/L) and the recommended concentration range in Panama (0.3-0.8 mg/L). Median acceptability thresholds were established much higher than taste thresholds at 3.45 mg/L Cl2. The results show that the ability to accurately taste chlorine may not be the limiting factor for adoption of safe water initiatives in remote and Indigenous communities.

Non-Tuberculous Mycobacterial isolates from Panama: A retrospective 5-year analysis (2017-2021).

BACKGROUND: The genus Mycobacterium includes well-known bacteria such as M. tuberculosis causing tuberculosis and M. leprae causing leprosy. Additionally, various species collectively termed non-tuberculous mycobacteria (NTM) can cause infections in humans and animals, affecting individuals across all age groups and health conditions. However, information on NTM infection prevalence in Panama is limited. METHODS: This study conducted a retrospective analysis of clinical records from 2017 to 2021, specifically focusing on patients with NTM isolates. Data were categorized by variables like sex, age, HIV status, and sample source. RESULTS: Among the 4430 clinical records analyzed, 698 were linked to patients with NTM isolates. Of these patients, 397 were male, and 301 were female. Most female patients with NTM isolates (n = 190) were aged >45 to 85 years, while most male patients (n = 334) fell in the >25 to 75 years age group. A noteworthy proportion of male patients (n = 65) were aged 25-35 years. A significant age difference between male (median [min-max] = 53 years [3-90]) and female (median [61 years [6-94]) patients was observed (p < 0.001). Regarding HIV status, 77 positive individuals were male, and 19 were female (p < 0.001). Most samples (n = 566) were sputum samples, with additional pulmonary-associated samples such as broncho-alveolar lavage, tracheal secretions, and pleural fluid samples. Among extrapulmonary isolates (n = 48), sources included catheter secretions, intracellular fluids, peritoneal fluid, blood cultures, cerebrospinal fluid, bone marrow samples, and capillary transplant lesions. Specifically, the analysis identified the pathogenic microorganisms responsible for mycobacteriosis in Panama during the specific period 2017-2021, as M. fortuitum (34.4%), M. intracellulare (20.06%), and M. abscessus (13.75%), respectively. CONCLUSIONS: This study highlights the growing public health concern of NTM infections in Panama. The research provides valuable insights into the prevalence and distribution of NTM species in the country, offering a foundation for the development and implementation of effective prevention and control strategies for NTM infections in Panama.

Attitudes and behaviors of maternal Tdap vaccination in Panama, Peru, and Colombia: An international cross-sectional study.

INTRODUCTION: Despite a recommendation by PAHO for Tdap vaccination in pregnant women since 2019, uptake remains suboptimal across Latin America. This study evaluated the knowledge and attitudes of women towards maternal Tdap vaccination in Colombia, Peru, and Panama to identify the critical behavioral and social drivers of Tdap vaccine uptake during pregnancy. METHODS: A cross-sectional online survey was undertaken between December 8, 2022, and January 11, 2023, targeting women in Colombia, Peru, or Panama with a child 12 months or under. We collected data on respondents' demographics, social and behavioral determinants of vaccine acceptance, determinants of vaccine uptake (using the validated 5As taxonomy), and previous vaccination experience. RESULTS: In the 938 respondents who completed the survey (Panama, n = 325; Peru, n = 305; Colombia, n = 308), 73-80 % had received the influenza vaccine, whereas only 30-39 % had received a Tdap vaccine. Significant correlates of Tdap vaccine uptake common to all three countries included a health professional recommendation, knowledge of the vaccine and location of vaccination, perceived vulnerability to pertussis infection, perceived importance of immunization, and receipt of a reminder. In specific countries, nonvaccinated women were more likely to cite issues with ease of access (Panama, Colombia), affordability (opportunity costs; Peru, Colombia), and understanding the rationale for vaccination in pregnancy (Panama, Colombia). CONCLUSION: To increase maternal Tdap vaccine uptake, health professionals should be encouraged to recommend vaccination consistently, and pregnant women should receive reminders explaining why and where to be vaccinated.

How Racism and "Tropical Medicine" Built the Panama Canal.

At the turn of the 20th century, the physician William Gorgas led work that substantially mitigated mortality from mosquito-borne diseases among workers building the Panama Canal. The waterway launched the United States to political and economic superpower status by eliminating the need for risky maritime travel around the southern tip of South America, expediting exportation of US goods in international markets. Yet, as this article explains, innovations that curbed malaria and yellow fever were deeply rooted in racist foundations of capital and empire.

Molecular screening of tick-borne microorganisms in ticks from rural areas of Panama, with the first record of Ehrlichia minasensis in Rhipicephalus microplus from Central America.

During a molecular screening of rickettsial, borrelial and protozoal agents in ticks from rural areas of Panama, we detected DNA of Rickettsia amblyommatis in four Amblyomma mixtum collected from horses in a locality in Los Santos province. Ehrlichia minasensis and Anaplasma marginale were identified from three and two Rhipicephalus microplus, respectively, collected on cows from Chiriqui province. No DNA from other tick-borne agents was found. These results increase the information of R. amblyommatis and A. marginale in Panama, and also mark the first record of E. minasensis in Central America.

Mixed success for carbon payments and subsidies in support of forest restoration in the neotropics.

Restoration of forests in low- and middle-income countries (LMICs) has the potential to contribute to international carbon mitigation targets. However, high upfront costs and variable cashflows are obstacles for many landholders. Carbon payments have been promoted as a mechanism to incentivize restoration and economists have suggested cost-sharing by third parties to reduce financial burdens of restoration. Yet empirical evidence to support this theory, based on robust, dynamic field sampling is lacking. Here we use large, long-term datasets from Panama to evaluate the financial prospects of three forest restoration methods under different cost-sharing and carbon payment designs where income is generated through timber harvests. We show some, but not all options are economically viable. Further work combining growth and survival data from field trials with more sophisticated financial analyses is essential to understanding barriers and realizing the potential of forest restoration in LMICs to help meet global carbon mitigation commitments.

Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022.

We report a patient from Panama who had lobomycosis caused by Paracoccidioides (Lacazia) loboi. We used combined clinical-epidemiologic and phylogenetic data, including a new gene sequence dataset on this fungus in Panama, for analysis. Findings contribute useful insights to limited knowledge of this fungal infection in the Mesoamerican Biologic Corridor.

Short-term power load forecasting based on the CEEMDAN-TCN-ESN model.

Ensuring an adequate electric power supply while minimizing redundant generation is the main objective of power load forecasting, as this is essential for the power system to operate efficiently. Therefore, accurate power load forecasting is of great significance to save social resources and promote economic development. In the current study, a hybrid CEEMDAN-TCN-ESN forecasting model based on complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN) and higher-frequency and lower-frequency component reconstruction is proposed for short-term load forecasting research. In this paper, we select the historical national electricity load data of Panama as the research subject and make hourly forecasts of its electricity load data. The results show that the RMSE and MAE predicted by the CEEMDAN-TCN-ESN model on this dataset are 15.081 and 10.944, respectively, and R2 is 0.994. Compared to the second-best model (CEEMDAN-TCN), the RMSE is reduced by 9.52%, and the MAE is reduced by 17.39%. The hybrid model proposed in this paper effectively extracts the complex features of short-term power load data and successfully merges subseries according to certain similar features. It learns the complex and varying features of higher-frequency series and the obvious regularity of the lower-frequency-trend series well, which could be applicable to real-world short-term power load forecasting work.

Global Initiative for Childhood Cancer: progress and challenges in Panama / Iniciativa Mundial contra el Cáncer Infantil: avances y desafíos en Panamá / Iniciativa Global para o Câncer Infantil: avanços e desafios no Panamá

[ABSTRACT]. Despite being classified as a high-income country, Panama still faces challenges in providing care for children and adolescents with cancer. Annually, 170 new cases of childhood cancer are diagnosed in Panama, and the survival rate is around 60%. To improve this, the establishment of a Pediatric Cancer Commission comprised of healthcare professionals and nonprofit organizations has been a critical step toward the objectives outlined in the CureAll framework of the World Health Organization Global Initiative for Childhood Cancer (GICC). To improve childhood cancer care in Panama, a workshop for cancer in children and adolescents was conducted with the support of St. Jude Children’s Research Hospital, Children’s Hospital Colorado, the Ministry of Health of Panama, and the Pan American Health Organization. The commissions established were on: Nursing, Palliative Care, Psychosocial, Hospital Registry, Early Diagnosis, and Health Services. Each commission has a specific project to be implemented in the period 2021–2029 to continue the progress toward improving childhood cancer care. Since the start of implementation of the GICC in Panama, important achievements have included the launch in 2021 of the Guide for the Diagnosis of Cancer in Children and Adolescents, and training programs for primary care health personnel. Through these programs, more than 1 000 health professionals have been trained on diagnosis of cancer in childhood and adolescence. Challenges remain, such as access to quality care, and it is essential to continue efforts to improve childhood cancer care.

[RESUMEN]. Pese a estar clasificado como un país de ingresos altos, Panamá aún debe hacer frente a distintos desafíos relacionados con la atención a la población infantil y adolescente con cáncer. Cada año, en Panamá se diagnostican 170 casos nuevos de cáncer pediátrico, con una tasa de supervivencia en torno al 60%. Para mejorar esta situación, la creación de una Comisión de Cáncer Pediátrico, conformada por profesionales de la salud y organizaciones sin fines de lucro, constituye un paso fundamental para lograr los objetivos planteados en el marco CureAll de la Iniciativa Mundial contra el Cáncer Infantil (GICC, por su sigla en inglés) de la Organización Mundial de la Salud. A fin de mejorar la atención de los pacientes pediátricos con cáncer en Panamá, se realizó un taller sobre el cáncer en la población infantil y adolescente. El evento contó con el apoyo del St. Jude Children's Research Hospital, el Children's Hospital Colorado, el Ministerio de Salud de Panamá y la Organización Panamericana de la Salud. Se crearon comisiones sobre enfermería, cuidados paliativos, aspectos psicosociales, registros hospitalarios, diagnóstico temprano y servicios de salud. Cada comisión está a cargo de un proyecto específico, que deberá ponerse en práctica en el período 2021-2029 para proseguir con los avances encaminados a mejorar la atención oncológica pediátrica. Desde que se inició el proceso de aplicación de la Iniciativa Mundial contra el Cáncer Infantil en Panamá se han obtenido logros importantes, como la publicación de la Guía para la detección temprana y atención oportuna de la sospecha del cáncer en niños y adolescentes 2021 y los programas de capacitación para el personal de atención primaria de salud. Estos programas han permitido capacitar a más de 1 000 profesionales de la salud en materia de diagnóstico del cáncer en la niñez y la adolescencia. Subsisten algunos desafíos, como el acceso a una atención de calidad, y es crucial proseguir con las medidas tendientes a mejorar la atención oncológica de los pacientes pediátricos.

[RESUMO]. Apesar de ser classificado como um país de alta renda, o Panamá enfrenta desafios para oferecer atendi- mento a crianças e adolescentes com câncer. Anualmente, são diagnosticados 170 casos novos de câncer infantil no Panamá, e a taxa de sobrevida gira em torno de 60%. Para melhorar essa situação, a criação de uma Comissão de Câncer Pediátrico, composta por profissionais de saúde e organizações sem fins lucrativos, foi uma etapa fundamental para atingir os objetivos delineados na estratégia CureAll da Iniciativa Global para o Câncer Infantil (GICC) da Organização Mundial da Saúde. Para melhorar o atendimento aos pacientes com câncer infantil no Panamá, realizou-se uma oficina sobre câncer em crianças e adolescentes, com o apoio do St. Jude Children's Research Hospital, do Children's Hospital Colorado, do Ministério da Saúde do Panamá e da Organização Pan-Americana da Saúde. As comissões estabelecidas foram as seguintes: Enfermagem, Cuidados Paliativos, Aspectos Psicossociais, Registro Hospitalar, Diagnóstico Precoce e Serviços de Saúde. Cada comissão tem um projeto específico a ser implementado no período de 2021 a 2029 a fim de continuar avançando na melhoria do atendimento a pacientes com câncer infantil. As realizações mais importantes alcançadas desde o início da implementação da GICC no Panamá incluem o lançamento do Guia para o Diagnóstico de Câncer em Crianças e Adolescentes em 2021 e os programas de capacitação para profissionais de saúde da atenção primária. Por meio desses programas, mais de mil profissionais de saúde receberam capacitação no diagnóstico de câncer na infância e adolescência. Ainda existem desafios, como o acesso a atendimento de qualidade; portanto, é essencial continuar os esforços para melhorar o atendimento de pacientes com câncer infantil.