RESUMO
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.
Assuntos
Conservação dos Recursos Naturais , Política Ambiental , Impostos , Mudança Climática , Poluição Ambiental , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/legislação & jurisprudência , PeruRESUMO
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.
Assuntos
Síndrome Antifosfolipídica/tratamento farmacológico , Doenças Hematológicas/tratamento farmacológico , Nefropatias/tratamento farmacológico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Síndrome Antifosfolipídica/etiologia , Cardiopatias/tratamento farmacológico , Cardiopatias/etiologia , Doenças Hematológicas/etiologia , Humanos , Nefropatias/etiologia , América Latina , Pneumopatias/tratamento farmacológico , Pneumopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/etiologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etiologia , Doenças Musculoesqueléticas/tratamento farmacológico , Doenças Musculoesqueléticas/etiologia , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Padrão de CuidadoRESUMO
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.