Florida State University-Panama

Randomized controlled trials (RCTs) are the foundation of current clinical treatment guidelines. However, they may not reflect real-world populations, due to strict eligibility criteria. We determined the proportion of individuals with major depressive disorder (MDD) receiving maintenance antidepressant treatment in routine care who would be ineligible for RCTs, and compared their outcomes with those who were eligible. Utilizing specialized health care registers in Finland (2004-2018) and Sweden (2006-2021), we identified adults diagnosed with non-psychotic MDD (ICD-10: F32, F33) who were stabilized on maintenance antidepressant monotherapy. Through multidisciplinary expert consensus on latest meta-analytic evidence, we derived a standardized list of RCT inclusion and exclusion criteria. These criteria were systematically applied to classify individuals as RCT-eligible or RCT-ineligible. We then used Cox proportional models to derive hazard ratios (HRs) of a composite primary outcome of hospitalization due to any psychiatric reason or suicide attempt, and all-cause mortality, during a 6-month follow-up. Secondary outcomes were treatment changes (i.e., discontinuation, switch or augmentation) and psychiatric sick leave ≥2 weeks. A total of 73,720 individuals in Finland and 135,092 in Sweden were included. More than one third of patients with MDD (33.5% in Finland and 35.3% in Sweden) were found to be ineligible for RCTs. The most common reasons for ineligibility were comorbidities (serious somatic disease, other psychiatric disorders, or substance use disorder). RCT-ineligible individuals had more than twice the risk of the composite primary outcome compared to eligible individuals (HR=2.44, 95% CI: 2.15-2.76 in Finland; HR=2.61, 95% CI: 2.37-2.87 in Sweden). Approximately one third of the composite primary outcome was attributable to RCT-ineligibility factors (32.5%, 95% CI: 27.9-37.1 for Finland; 36.2%, 95% CI: 32.6-39.8 for Sweden). Risk of treatment change was slightly but significantly higher in ineligible individuals. Findings were consistent in a wide range of sensitivity analyses. We conclude that more inclusive eligibility criteria for RCTs, and their integration with real-world data, are needed to improve the generalizability of antidepressant trial evidence and MDD clinical treatment guidelines.

Binge Eating Disorder (BED) is the most prevalent eating disorder and is associated with psychiatric comorbidities, health impairments, and decreased quality of life. Emerging evidence suggests that psilocybin-assisted therapy may promote cognitive and emotional flexibility and disrupt maladaptive behavioral patterns, making it a promising candidate for BED treatment. This open-label pilot study evaluated the feasibility, safety, and preliminary therapeutic effects of a single 25mg dose of psilocybin administered in the context of Acceptance and Commitment Therapy (ACT)-based psychotherapy in adults with BED (N = 5). Primary outcomes included safety measures, and exploratory outcomes included self-reported binge eating frequency, depression, anxiety, psychological flexibility, anthropometric indices, and neuroimaging biomarkers assessed over a 14-week follow-up. Psilocybin was well tolerated, with no serious adverse events. Reductions in self-reported binge eating frequency were observed across all participants and sustained through week 14. Improvements were also noted in depression, anxiety, and psychological inflexibility. Three participants showed reductions in body mass index and waist circumference. Given the open label design and small sample size, causality cannot be inferred. fMRI analyses generated preliminary signals of change-such as increased functional activation from pre- to post-intervention in the middle frontal gyrus, angular gyrus, and supramarginal gyrus in response to processed versus unprocessed food cues. Psilocybin-assisted therapy was feasible and well-tolerated in individuals with BED. The clinical and neurobiological observations provide directions for future adequately powered trials.

BackgroundThe early diagnosis of Alzheimer's disease (AD) demands reliable biomarkers and accessible detection methods. Evidence shows that combining brain imaging with cerebrospinal fluid (CSF) biomarkers significantly enhances the sensitivity and specificity of AD diagnosis. As biomarkers are included in diagnostic criteria, disclosing biomarker results to participants becomes crucial. However, in low‐resource settings—where healthcare access, provider training, and patient support are often limited—disclosing AD biomarkers poses distinct ethical, logistical, and psychological challenges.MethodInforming research participants about their individual test results is a critical ethical obligation grounded in the principles of respect for persons, beneficence, and justice. Effective disclosure must also consider culture, individual circumstances, and varying levels of health and research literacy. To date, no studies in Latin America, to our knowledge, have incorporated biomarker disclosure in aging and dementia studies. In Panama, the Panama Aging Research Initiative – Health Disparities (PARI‐HD) program is addressing this gap by conducting a study to evaluate the diagnostic and prognostic value of biomarkers in blood, cerebrospinal fluid, and magnetic resonance imaging (MRI).ResultsThis study includes participants without cognitive impairment, individuals with mild cognitive impairment, AD, and Parkinson's disease. All participants provide informed consent and undergo a clinical evaluation, collection of information regarding health and functional status, cognitive testing, blood sampling to analyze serological and genetic biomarkers, lumbar puncture to obtain CSF, and brain structure evaluation using MRI. We propose to conduct a pilot research study where participants will receive biomarker results from a member of the research team that has previously received training in disclosure. Following disclosure, participants will receive a short questionnaire to assess comprehension of results and questionnaires to assess depression and anxiety symptoms. Psychological counseling will be available if requested and to individuals presenting mental health symptoms. Follow‐up calls will be conducted to assess individuals’ response to disclosure.ConclusionThis study will focus on context‐specific approach to AD biomarker disclosure that prioritizes patient well‐being in low‐resourced environments.

The apolipoprotein E (APOE) gene is a well-established risk factor for Alzheimer's disease. This study aims to investigate the relationship between APOE genotype and cognitive aging in a sample of Hispanics. We also present data from the research protocol of an ongoing clinical study within the PARI-HD program. The main objective is to evaluate the diagnostic and prognostic value of biomarkers in blood, cerebrospinal fluid and magnetic resonance imaging for MCI, AD and PD in Panamanian older adults (≥ 65 years of age). Participants (n=725) were divided into 2 groups, an outpatient cohort (n=269) and a community cohort (n=456) and underwent comprehensive neuropsychological assessments. For the clinical study of biomarkers, we obtained demographic data, functional status and neuropsychological evaluations. Also, CSF, MRI and fasting blood samples were obtained. Participants were divided into: MCI, AD, PD, and without cognitive impairment groups. APOE analysis shows that the ε4 frequency was 32.3% among the outpatient cohort compared to 23.8% among the community cohort. Results showed that ApoEε4 status was a significant predictor of cognitive impairment. In the outpatient cohort, carrying at least one copy of the APOEε4 allele was significantly associated with worse performance on attention. These findings suggest that APOEε4 confers risk for cognitive deterioration in Panamanian population, highlighting the importance of considering genetic and demographic factors in understanding the heterogeneity of cognitive impairment. Our study is the first of its kind in Panama and one of few in the LAC region, setting a milestone in exploring CSF protein analysis and MRI techniques associated with MCI, PD and AD in Hispanic/Latino older adults.

The solution of a nonhomogeneous linear Caputo fractional differential equation of order nq,(n−1)<nq<n with Caputo fractional initial conditions can be expressed using suitable Mittag–Leffler functions. In order to extend this result to such a nonhomogeneous linear Caputo fractional differential equation of order nq,(n−1)<nq<n, that also includes lower order fractional derivative terms, we can reduce such a problem to an n-system of Caputo fractional differential equations of order q,0<q<1, with corresponding initial conditions. In this work, we use an approximation method to solve the resulting system of Caputo fractional differential equations of order q with initial conditions, using the fundamental matrix solutions involving the matrix Mittag–Leffler functions. Furthermore, we compute the fundamental matrix solution using the standard eigenvalue method. This fundamental matrix solution then allows us to express the component-wise solutions of the system using initial conditions, similar to the scalar case. As a consequence, we obtain solutions to linear nonhomogeneous Caputo fractional differential equations of order nq,(n−1)<nq<n, with Caputo fractional initial conditions having lower-order Caputo derivative terms. We illustrate the method with several examples for two and three system, considering cases where the eigenvalues are real and distinct, real and repeated, or complex conjugates.

Aim. This article examines how digital platforms, applications, and artifacts affect opportunity recognition in entrepreneurship education, focusing on self-efficacy among Indonesian undergraduates. The aim is to understand how these digital resources help students recognise entrepreneurial opportunities and develop entrepreneurial competencies. Methods. A cross-sectional survey of 202 undergraduates in Greater Jakarta, Indonesia, assessed their use of digital platforms, applications, and artifacts. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to examine the relationships among digital sources, self-efficacy, and opportunity recognition. Results. The study finds that digital platforms and applications help students identify entrepreneurial opportunities, with self-efficacy partially mediating the effects of digital artifacts. Digital artifacts increased self-efficacy but did not directly influence opportunity recognition. The findings emphasise the need for interactive digital tools in entrepreneurship education and highlight the critical role of self-efficacy in the learning process. Conclusion. Digital platforms and applications significantly contribute to students' opportunity recognition, while digital artifacts support the development of self-efficacy. Enhancing self-efficacy is essential for optimising digital learning outcomes in entrepreneurship education. Research restrictions. The study is limited to undergraduate students in Greater Jakarta, which may limit the generalisability of the findings. Future research should explore broader demographic and cross-cultural contexts.

Endoscopic biliary drainage has emerged as the standard treatment for palliative drainage in malignant biliary strictures (MBS). This prospective study aimed to investigate the outcomes of patients diagnosed with MBS who underwent biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP) at Complejo Hospitalario Metropolitano. The primary goals were to evaluate the stent dysfunction (SD) and mortality over a 12-month follow-up period. We evaluated the technical and functional deployment success rates according to the stricture location and type of stent used. Out of 191 patients screened, 147 were eligible for inclusion. Distal strictures exhibited significantly higher technical (96.3%) and functional (75.8%) success deployment rates compared to hilar strictures (32.4% technical, 58.8% functional). The overall incidence of SD reached 46.9%, while mortality was 43.5%. Notably, complications varied by stricture type, with bacteremia predominating in hilar stricture cases. The findings from our prospective study affirm a commendably high rate of successful endoscopic stenting interventions along with a lower incidence of adverse events in patients suffering from MBS. Conversely, it is imperative to acknowledge that the endoscopic management of malignant hilar strictures necessitates a more individualized approach due to the elevated complication rates and increased likelihood of SD observed in our study.

Introduction: The apolipoprotein E (APOE) gene is a well-established risk factor for Alzheimer’s disease, with the APOE ε4 allele being the most strongly associated genetic variant. Research has suggested that the influence of APOE ε4 on cognitive decline may vary across different populations. This study aimed to investigate the relationship between APOE genotype and cognitive aging in Hispanics. Methods: A diverse sample of Hispanic adults was recruited for a study on cognitive aging. Data were analyzed for n = 725 participants from the Panama Aging Research Initiative – Health Disparities (PARI-HD) study. Participants were divided into 2 groups, an outpatient cohort (n = 269) and a community cohort (n = 456) and underwent comprehensive neuropsychological assessments. Results: A greater number of participants in the outpatient cohort were cognitively impaired than the community cohort, and the outpatient cohort had a significantly higher frequency of ε4 (33.8% vs. 25.7%). Results showed that carrying at least one copy of the APOE ε4 allele was a significant predictor of cognitive impairment in the community cohort (OR = 2.06, 95% CI = 1.14–3.72, p = 0.017) but was not significantly associated with performance on cognitive tests for either cohort. Conclusion: These findings suggest that APOE ε4 confers risk for cognitive deterioration in the Panamanian population, highlighting the importance of considering genetic and demographic factors in understanding the heterogeneity of cognitive impairment.

Hantavirus pulmonary syndrome is a zoonotic disease that has been present in the Americas since 1993 and in Panama since the early 2000s. The disease is transmitted to humans through the inhalation of aerosols containing viruses from feces, urine, and saliva from asymptomatic, infected rodents. While various climatic, ecological, social and cultural factors have been associated with hantavirus transmission, research on beliefs and socio-cultural perspectives regarding its care and prevention remains limited. This study addresses this gap by exploring the beliefs, socio-cultural context and care practices related to hantavirus disease in an endemic community. Guided by the One Health approach and Leininger's Theory of Culture Care Diversity and Universality, an ethnonursing approach was used in a hantavirus-endemic community in Panama from September 3, 2021, to August 25, 2022. The study involved 30 participants, including 11 key participants (community members with personal or familial experience of hantavirus) and 19 general participants (community authorities and health professionals). Data were collected through in-depth interviews, participant observation and field notes. Leininger's four phases of ethnonursing analysis were followed using ATLAS.ti. Five themes were identified: (1) hantavirus develops within the context of the community, with its own expressions, meanings and lifestyles; (2) living in and of the land: what we are and what defines us; (3) hantavirus prevention and its challenges: what we do and what we propose; (4) God, the higher power that helps, protects, and gives strength and resilience in daily life and in the face of hantavirus disease; and (5) sharing within the family: joys, longings, celebrations and concerns about hantavirus. Based on the study findings, we propose a model of culture care decision and action modes for hantavirus prevention, emphasizing the importance of implementing relevant, sustainable, and culturally aligned prevention practices in the affected communities.