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Background: Environmental problems are becoming more recurrent nowadays, which is why many countries have acted on the matter, through different forms, laws and taxes that can contribute and reduce the polluting impact of companies at the time of manufacturing their products. One of the reforms has been environmental taxes, which are not only aimed at raising money, but also at taking corrective action on the behavior of companies that damage both the environment and the health of the population. The research is intended to finding out the opinion and interest of managers of different companies in the industrial sector on environmental taxes, also known as green taxes, and whether they consider it necessary to add green taxes to the current tax system. Method: For data collection of the research, 120 managers of small and medium-sized enterprises in the industrial sector were questioned about whether green taxes could have an influence on ecosystem conservation and several other questions. Results: 63.3% of the managers surveyed agree that the application of an environmental tax is necessary. Conclusion: It is concluded that managers are in favor of green taxes and approve that such taxes should be given as part of ecosystem conservation and environmental protection for all businesses, and that they promote businesses that do not generate any side effects or transformations to the environmental balance, thus improving the quality of life of residents.
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Conservación de los Recursos Naturales , Política Ambiental , Impuestos , Cambio Climático , Contaminación Ambiental , Conservación de los Recursos Naturales/economía , Conservación de los Recursos Naturales/legislación & jurisprudencia , PerúRESUMEN
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
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Síndrome Antifosfolípido/tratamiento farmacológico , Enfermedades Hematológicas/tratamiento farmacológico , Enfermedades Renales/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Síndrome Antifosfolípido/etiología , Cardiopatías/tratamiento farmacológico , Cardiopatías/etiología , Enfermedades Hematológicas/etiología , Humanos , Enfermedades Renales/etiología , América Latina , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/etiología , Lupus Eritematoso Sistémico/complicaciones , Nefritis Lúpica/tratamiento farmacológico , Nefritis Lúpica/etiología , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/etiología , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Enfermedades Musculoesqueléticas/etiología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiología , Nivel de AtenciónRESUMEN
This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren's syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management.
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Enfermedades Reumáticas/diagnóstico por imagen , Reumatología/métodos , Ultrasonografía/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , América Latina , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Adulto JovenRESUMEN
Objetivo. Analizar la frecuencia y características de la reducción de dosis de fármacos biológicos en una cohorte de pacientes con artritis crónica, en condiciones de práctica clínica de un hospital de tercer nivel. Material y métodos. Estudio descriptivo y transversal, que incluyó a todos los pacientes visitados consecutivamente durante 6 meses(junio de 2011-noviembre de 2011) por un solo investigador, con pacientes que habían recibido al menos una dosis de fármaco biológico durante el año 2011. Resultados. Se incluyeron 153 pacientes: artritis reumatoide (AR) (n = 82), espondilitis anquilosante (n = 29), artritis psoriásica (n = 20)y grupo miscelánea (n = 22) con una evolución media de 14,9 ± 7,7 años. En el momento del análisis, 70 pacientes (45,7%) estaba con dosis reducida (un 50% en el grupo miscelánea; un 50% en artritis psoriásica; un 48,2% en espondilitis anquilosante, y un 42,6% en AR). El tiempo medio de reducción de dosis fue de 17,4 ± 17,5 meses. Los fármacos biológicos más utilizados a dosis reducidas fueron: etanercept, adalimumab y tocilizumab; el 57,6, el 54,9 y el 40 respectivamente de los pacientes tratados con estos agentes lo hacían a dosis reducidas. Los pacientes con dosis reducidas en comparación con aquellos con dosis normales tenían un mismo tiempo de evolución de la enfermedad, pero recibían menos FAME, glucocorticoides y AINE, con un tiempo similar de uso del agente biológico. Los pacientes con AR y dosis reducidas tenían, en el momento del análisis, mayores índices de remisión que los pacientes con dosis normales (82,9 vs. 34%, p < 0,0001). La decisión terapéutica en el momento del análisis fue mantener la dosis reducida en la práctica totalidad de los pacientes. Conclusión. En nuestra práctica clínica, el 45,7% de los pacientes con artritis crónica reciben terapia biológica a dosis reducidas, tras haber alcanzado la remisión o baja actividad a dosis estándares, manteniendo la mayoría de ellos un buen control de la enfermedad (AU)
Objective: To analyze the frequency and characteristics of dose reduction of biological agents in a cohort of patients with chronic arthritis, in clinical practice conditions in a tertiary level hospital. Material and methods: Descriptive, cross-sectional study, which included all patients, followed consecutively during 6 months (June 2011-November 2011), by one investigator, with patients who at least have received one dose of biological agents in 2011. Results: We included 153 patients: Rheumatoid arthritis (RA) (n = 82), ankylosing spondylitis (n = 29), psoriatic arthritis (n = 20), and miscellaneous group (n = 22). Mean disease duration was 14.9 ± 7.7 years. At the time of analysis, 70 patients (45.7%) were receiving low doses of biological therapy (50% in miscellaneous group group, 50% in psoriatic arthritis, 48.2% in ankylosing spondylitis, and 42.6% in RA). Mean time of dosage reduction was 17.4 ± 17.5 months. The most common biological agents used in low dose were: etanercept, adalimumab and tocilizumab; 57.6%, 54.9% and 40% respectively, in patients with a reduced dose of biological therapy. The patients at low dose of biological therapy compared with standard dose, had similar mean disease duration, but received significantly less DMARDs, glucocorticoids and NSAIDs, and similar biological agent duration. RA patients with reduced biological treatment, at the time of analysis, had higher remission rates versus patients receiving a standard dose (82.9% vs 34%, p < 0.0001). The medical decision at the time of analysis was to maintain low-dosage biological treatment in almost all patients. Conclusion: In our clinical practice, 45.7% of our chronic arthritis patients receive low dose of biological therapy, after achieving remission or low activity at standard doses, maintaining a good control of the disease (AU)
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Humanos , Masculino , Femenino , Terapia Biológica/instrumentación , Terapia Biológica/métodos , Terapia Biológica , Enfermedades Reumáticas/terapia , Artropatía Neurógena/terapia , Artritis/terapia , Artritis Reumatoide/terapia , Terapia Biológica/estadística & datos numéricos , Terapia Biológica/tendencias , Estudios de Cohortes , Estudios Transversales/métodos , Estudios Transversales/tendencias , Estudios Transversales , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the frequency and characteristics of dose reduction of biological agents in a cohort of patients with chronic arthritis, in clinical practice conditions in a tertiary level hospital. MATERIAL AND METHODS: Descriptive, cross-sectional study, which included all patients, followed consecutively during 6 months (June 2011-November 2011), by one investigator, with patients who at least have received one dose of biological agents in 2011. RESULTS: We included 153 patients: Rheumatoid arthritis (RA) (n=82), ankylosing spondylitis (n=29), psoriatic arthritis (n=20), and miscellaneous group (n=22). Mean disease duration was 14.9±7.7 years. At the time of analysis, 70 patients (45.7%) were receiving low doses of biological therapy (50% in miscellaneous group group, 50% in psoriatic arthritis, 48.2% in ankylosing spondylitis, and 42.6% in RA). Mean time of dosage reduction was 17.4±17.5 months. The most common biological agents used in low dose were: etanercept, adalimumab and tocilizumab; 57.6%, 54.9% and 40% respectively, in patients with a reduced dose of biological therapy. The patients at low dose of biological therapy compared with standard dose, had similar mean disease duration, but received significantly less DMARDs, glucocorticoids and NSAIDs, and similar biological agent duration. RA patients with reduced biological treatment, at the time of analysis, had higher remission rates versus patients receiving a standard dose (82.9% vs 34%, p<0.0001). The medical decision at the time of analysis was to maintain low-dosage biological treatment in almost all patients. CONCLUSION: In our clinical practice, 45.7% of our chronic arthritis patients receive low dose of biological therapy, after achieving remission or low activity at standard doses, maintaining a good control of the disease.