UNASUR: Developments in the Defense Area

The article summarizes the last developments in South America towards a common defense area, referring to the history and origins of the Union of South American Nations (UNASUR).Fil: Gil, Luciana Victoria. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Argentinean Non-Tariff Barriers in MERCOSUR: Regulations and Politics in Trade Conflicts

Este artículo aborda las restricciones no arancelarias como problema constante en la agenda del MERCOSUR. Analiza la propia definición de restricción o barrera a nivel internacional, observando que dificulta su identificación y genera discusiones sobre su legitimidad, dos problemas que enfrentó la normativa del proceso de integración. En este marco, el artículo da cuenta de los principales conflictos surgidos a raíz de restricciones no arancelarias aplicadas por Argentina contra la importación de Brasil durante diez años. Evidencia que si tempranamente la normativa del MERCOSUR definió las restricciones como instrumentos ilegítimos en el proceso de integración, el escaso avance que hubo en el establecimiento de instrumentos regionales para abordarlas hizo que las restricciones se fueran naturalizando como parte del proceso. La insatisfacción tanto con los mecanismos de consultas regionales como con el sistema de solución de controversias hizo que la mayoría de aquellos conflictos fueran negociados de manera bilateral, perpetuándose un círculo vicioso entre la debilidad de aquellos instrumentos normativos regionales y la preferencia de los líderes nacionales por negociar las restricciones a nivel político.This article deals with non-tariff barriers as a permanent problem in MERCOSUR. First, it analyses the international definition of “barriers”, which creates difficulties to identify them and generates discussions on their legitimacy. It shows that MERCOSUR regulations faced also both problems. Second, the article addresses the main conflicts emerged from non-tariff barriers imposed by Argentina against Brazilian imports. It demonstrates that MERCOSUR regulations early defined non-tariff barriers as illegitimate instruments in the integration process, but because of the lack of effective regional mechanisms to deal with them, they became ordinary. The dissatisfaction of different agents with the performance of the consultative mechanisms and the regional court had as a consequence a bilateral approach to trade conflicts, perpetuating the relation among weak regional regulations and preferences of national leaders for political negotiations as a vicious cycle.Fil: Gil, Luciana Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Dimensiones del desarrollo en las Relaciones Internacionales: reflexiones sobre industria y salud en tiempos de pandemia

This article presents the results of research on the effect of the coronavirus pandemic on the medical equipment industry in Argentina, focusing on the province of Buenos Aires. It is presented as a case study that contributes to generate reflections about the complex connection between the different dimensions of the concept of development. The concept of development has been widely used in sociology and economics, but the discipline of International Relations ignored it for a long time frame. Therefore, from an international perspective, questions on development remained in the area of international economics and development studies. In Latin America, the first genuinely peripheral approach to development, structuralism, emerged also from the field of economics to discuss modernization theories. It promoted a new approach to development and industrialization to overcome the so-called underdevelopment of the region. Its central conceptual tool, dependency, was considered a fundamental pillar for Latin American International Relations and International Political Economy. The discipline of International Relations expanded its scope, while the concept of development increasingly included other dimensions that were not strictly economic, such as health. The end of the Cold War implied an important challenge for considerations about the concept and the United Nations promoted a human development approach. This had practical effects which, for example, conditioned development cooperation: the percentage of official development aid allocated to the health sector between 1995-2000 and 2007-2011 went from 7 to 13%. This gave greater visibility to health in different reports and international meetings, such as the Commission on Health Research for Development or the Project on Priority Medical Devices of the World Health Organization, which drew attention to the incompatibilities of modern and technologically complex products and the (human, technological and infrastructure) resources available in low-income countries. This was followed by a series of publications on public policies, innovation, regulations, use, priorities and even conditions for the donations of medical equipment. When the pandemic caused by the SARS-CoV-2 virus was declared, the WHO issued its list of priority medical devices for this illness, which served as a reference for the governments of the affected countries. However, the availability of these devices in regions, countries and local communities was highly uneven. At the international level, the demand for medical equipment increased notably, while different countries established export bans on those devices that were in short supply. Access to these resources became an indicator of the relative success or failure of countries in caring for the health of their citizens. The pandemic thus reinforced a certain homogenization in the priority given to medical products as indicators of development. Yet, at the same time, it generated opportunities to discuss their pertinence and relevance. In this context, the supply capacity of these products in Argentina was at the center of concerns and facilitated a multiplication of policies to support the sector, as well as public-private initiatives for the production of medical equipment, both to face the pandemic and to strengthen this industrial sector in the future. The potential capacities of this sector, which until then had not been the target of specific policies, became evident. However, at the same time, a series of limiting factors were identified, linked to the country's position in the global medical equipment industry and to the structural economic difficulties that the country has historically faced. This situation generated interest in more in-depth studies on the sector. Therefore, this article presents the characteristics of this sector in Argentina, and, in particular, the province of Buenos Aires, as well as the effects of the pandemic on it. The main part of the medical equipment industry is housed in this province. Buenos Aires represents 50% of the total manufacturing activity in the country. It is also the most populated province and this population has, at the same time, a wide margin of unsatisfied needs. In this analysis, questions about the convergence between the industrial and health dimensions, the role of public policies dedicated to one or the other, and the relevance of dedicating (material and/or human) public resources to an industrial sector, became evident. The goods produced by this sector may be a way of improving health, but they are neither the only way nor the sufficient means to do it; the social determinants of health have been widely recognized. Therefore, this case study recalls that, although the notion of development exceeds the industrial dimension, the exploration of the link between it and others, such as the health dimension, is complex and necessary. To start this exploration, the research is carried out using a qualitative methodology, through bibliographic and documentary analysis, as well as in-depth interviews and statistical data. The article starts by synthesizing the main dimensions that formed part of the concept of development since the second post-war period, concentrating on the role given to industry and health in its evolution. It identifies the structuralist approach as a tool to understand the place of the Argentine industry in the structure of the global medical equipment market, concentrated in a few companies and countries that generate a large part of the production, sales and technology of the sector. It also identifies the circular way in which human development has conceived the relationship between health and economic development, underlining the role of social debate to define the priority each society gives to one or the other. In a second section, the paper synthesizes the characteristics of the medical equipment industry at a global level to facilitate locating the Argentine industry in this global structure. Finally, it presents the characteristics of the sector in Argentina, with a particular focus on the province of Buenos Aires: a marginal sector in terms of industrial income, which registers historical trade deficit and which, at the same time, shows potential industrial capacities in terms of innovation, technology and human resources. The effects of the pandemic for this sector were limited in terms of its economic indicators and historical industrial structure, but substantial in terms of visibility of the sector on the political agenda, which generated the mentioned opportunity to discuss the relevance and pertinence of dedicating public resources to foster it. In his way, the reflections triggered by the analysis of this specific case aim to enrich the research agenda of International Relations, in particular by encouraging debate on the relationship between health, industry and development.  El objetivo de este artículo es exponer los resultados de un estudio que indagó el efecto de la pandemia de covid-19 en la industria de equipamiento médico en Argentina, en particular, en la provincia de Buenos Aires. Presentará dicho efecto focalizando en la vinculación de aquella industria con el mercado global de equipamiento médico, las características del sector local y la atención política al mismo como efecto de la pandemia. El estudio fue llevado a cabo por medio de una metodología cualitativa, a través del análisis bibliográfico y documental, así como de entrevistas en profundidad y datos estadísticos recogidos en un proyecto vinculado al tema. El artículo se presenta como un análisis de un caso concreto a partir del cual generar reflexiones acerca de la complejidad de la conexión entre las distintas dimensiones que ha adquirido el concepto de desarrollo en las ciencias sociales, en particular, la dimensión de la industria y la de la salud. Para ello, el artículo inicia resumiendo los principales ejes del concepto de desarrollo desde la segunda posguerra, centrándose en los aportes del estructuralismo y del enfoque del desarrollo humano y describiendo, a la par, las iniciativas internacionales abocadas a dar visibilidad a la salud como una de esas dimensiones, reforzadas por la pandemia. En este marco, el artículo presenta sintéticamente las características del mercado global de equipamiento médico, su evolución en Argentina y los efectos de la pandemia en el mismo, con el foco puesto en la provincia de Buenos Aires. Muestra que dichos efectos fueron limitados en cuanto a sus indicadores económicos, pero sustanciales en cuanto a su visibilidad en la agenda política, manifestada en encuentros, anuncios y políticas orientadas al sector. Para concluir, expone las reflexiones disparadas por el análisis de este caso concreto, para las cuales se vale de algunas herramientas identificadas en el estructuralismo y en el enfoque del desarrollo humano. Con estas reflexiones, el artículo apunta a enriquecer la agenda de investigación de las Relaciones Internacionales, en particular, incentivando el debate sobre la relación entre salud, industria y desarrollo

Restricciones no arancelarias en el Mercosur: ¿Un problema para la integración y el desarrollo?

El Mercosur ha sido objeto de innumerables críticas, entre ellas, aquellas que apuntan a las restricciones al comercio intrarregional como responsables de su escasa evolución como mercado común. Pero las restricciones han sido utilizadas en todo el mundo en distintos momentos, con distintos objetivos y con distintos grados de éxito. Tal vez el principal problema en nuestro proceso de integración sea la forma en que estas restricciones se imponen. Desde su fundación formal en 1991, el Mercosur fue concebido como un proyecto de integración que tenía entre sus objetivos principales promover el desarrollo económico de los países que lo conformaban. Desde una visión liberal, el primer instrumento de integración que llevaría a tal objetivo sería la apertura comercial intrarregional, que permitiría la conformación de un mercado regional. En este sentido, si bien al Mercosur se le atribuyó un considerable éxito en términos de aumento del intercambio comercial durante sus primeros años, luego fue señalado como un proceso “estancado”, y se apuntó a las restricciones al comercio intrarregional como causas de aquel “estancamiento”. Según esta concepción, tales restricciones no permiten consolidar ni una zona de libre comercio ni una unión aduanera entre los cuatro socios (Argentina, Brasil, Uruguay y Paraguay) e impiden, así, la evolución hacia un verdadero mercado común y su objetivo de desarrollo económico. Históricamente, sin embargo, han sido herramientas comerciales legítimas utilizadas en distintos países y regiones como instrumentos para orientar ese desarrollo. La “mala imagen” de estas restricciones en el Mercosur, entonces, parece deberse más a la forma en que se deciden y aplican, que a sus causas y efectos económicos. Un estudio sobre el comercio del calzado argentino en el Mercosur dispara reflexiones sobre el poco éxito que ha tenido la forma –aislada de otras políticas de desarrollo, cortoplacista e unilateral– de administrar el comercio, ya que no ha logrado consolidar el sector regionalmente, ni diluir los reclamos de los importadores brasileños, ni –mucho menos– propiciar esfuerzos para alcanzar un consenso regional sobre los mecanismos con los cuales orientar el desarrollo económico.Fil: Gil, Luciana Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Interdisciplinario de Economía Política de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Económicas. Instituto Interdisciplinario de Economía Política de Buenos Aires; Argentin

Restricciones comerciales en el sector calzado: vaivenes de una historia reciente

En las últimas décadas, la industria argentina del calzado ha estado siempre incluida entre los sectores sensibles de la política comercial del país, tanto en relación a la región como a terceros países. Las restricciones arancelarias a la importación de calzado desde Brasil, vecino y socio del Mercosur, fueron decayendo desde 1999; sin embargo, estuvo entre los principales sectores beneficiados por la protección no arancelaria. A partir de 2003, el crecimiento de la industria en general y del sector en particular, que se sostuvo hasta 2008, no impidió que continuaran las demandas de mayor protección ni que se adoptaran nuevas decisiones comerciales al respecto, inclusive hasta el período posterior a 2015, cuando se eliminó la mayoría de las licencias no automáticas (LNA) argentinas al comercio intra Mercosur. Mientras tanto, en los 27 años que lleva el proceso de integración sudamericano, los socios no han encontrado un mecanismo regional que incentive la integración productiva en el sector ni que evite el conflicto comercial. ¿Por qué? En este artículo se estudia el período 1999-2009 y se propone una respuesta más política que económica, vinculada a la forma en que empresarios y gobiernos han favorecido soluciones cortoplacistas más que proyectos de desarrollo de largo plazo. Para esta lectura, se recurre a una tipología propuesta por Theodore Lowi para analizar dinámicas políticas.Fil: Gil, Luciana Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Interdisciplinario de Economía Política de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Económicas. Instituto Interdisciplinario de Economía Política de Buenos Aires; ArgentinaVII Jornadas de Historia de la Industria y los ServiciosBuenos AiresArgentinaUniversidad de Buenos Aires. Instituto Interdisciplinario de Economía Política de Buenos Aires. Área de Estudios sobre la Industria Argentina y LatinoamericanaUniversidad Nacional de San Martín. Escuela de Economía y Negocio

Procesos políticos e integración regional: herramientas analíticas clásicas para investigaciones nuevas sobre el MERCOSUR

El presente artículo es un ensayo exploratorio acerca de los enfoques sobre políticas públicas que parecen brindar elementos útiles para la interpretación de la principal dimensión del Mercado Común del Sur (Mercosur): su dimensión comercial. Pese al considerable éxito que se le atribuyó a este proceso de integración en términos de intercambio comercial durante sus primeros pasos (1991- 1998), hace años que se lo señala como un proceso ‘estancado’ que enfrenta diversas dificultades para avanzar 1 . Entre ellas, los obstáculos al libre comercio intrarregional y las excepciones al arancel externo común (conocidas, éstas últimas, como ‘perforaciones’) suelen apuntarse como algunas de las más directas expresiones de aquel ‘estancamiento’ 2 , ya que no permitirían consolidar la zona de libre comercio en la región, ni la unión aduanera (hoy imperfecta). Esto, a su vez, impediría la evolución hacia un verdadero mercado común 3 , obstaculizando el proceso de integración y sus objetivos de desarrollo 4.Fil: Gil, Luciana Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto Interdisciplinario de Economía Política de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Económicas. Instituto Interdisciplinario de Economía Política de Buenos Aires; Argentin

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

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.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR

Introducción: el lupus es una enfermedad compleja y varias veces de difícil abordaje. Alcanzar la remisión es uno de los objetivos, incorporando opciones terapéuticas. Objetivos: describir las características generales de los pacientes según el estado de la enfermedad y el uso de belimumab. Materiales y métodos: estudio de corte transversal, registro RELESSAR. Se definió el estado de la enfermedad como: remisión: SLEDAI=0 y sin corticoides; baja actividad de la enfermedad: SLEDAI >0 y ≤4 y sin corticoides; control no óptimo: SLEDAI >4 y cualquier dosis de corticoides. Resultados: se incluyeron 1.277 pacientes, 23,4% en remisión, 12,6% en baja actividad y 63,8% con control no óptimo. En este último grupo eran más jóvenes y con menor duración de la enfermedad; presentaban mayores índices de actividad y cronicidad, y mayor empleo de inmunosupresores. Solo el 22,3% de los pacientes con criterio potencial de uso de belimumab (lupus eritematoso sistémico activo a pesar del tratamiento estándar) lo recibía en ese momento. Las variables asociadas a hospitalizaciones fueron: terapia con corticoides, ciclofosfamida y mayor SLICC. Conclusiones: se refleja la complejidad del manejo de estos pacientes y se visualizan aspectos estructurales como la desigualdad. El uso del belimumab resultaría beneficioso en los pacientes seleccionados

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit