3 research outputs found
Análisis de la evasiĂłn como base para mejorar el sistema de recaudaciones de los impuestos arancelarĂos a las importaciones
El objeto de este trabajo es analizar la problemática de la evasión e implementar una estrategia orientada a mejorar el sistema de recaudación de impuestos arancelarios, que promueva la ejecución de un programa modernizador de la Corporación Aduanera Ecuatoriana.
Primeramente, se establece la problemática y los antecedentes del sistema administrativo-tributario de los impuestos arancelarios, realizando luego un estudio de la evasiĂłn en el Ecuador en el perĂodo 1994-1998. Además, se determina un mecanismo como estrategia general de posicionamiento, para lograr una mejor recaudaciĂłn. Posteriormente, se presentan datos estimativos acerca de la recaudaciĂłn potencial de los ingresos arancelarios comparada con la recaudaciĂłn efectiva en el perĂodo de análisis. Finalmente se evalĂşa los efectos del arancel cero en el año 2005 y la competitividad del paĂs
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Variables econĂłmicas que determinan los flujos de emigraciĂłn internacional del Ecuador entre 1993 y 2003
El presente trabajo, con las adaptaciones pertinentes y tomando como guĂa el trabajo de migraciĂłn internacional desarrollado en PerĂş por De los RĂos y Rueda (2005) , encuentra que los determinantes más importantes que explican la emigraciĂłn ecuatoriana son de carácter econĂłmico, ocupando el primer lugar de importancia el desempleo, seguido de la desigualdad de ingresos, representada por el coeficiente del Gini, entre otras variables. Las de orden no econĂłmico son explicativas en menor grado, siendo la más significativa el requerimiento de visado por los paĂses de destino. En sĂntesis, los resultados obtenidos muestran que los ecuatorianos migran al exterior por el deterioro relativo de la economĂa ecuatoriana con respecto a la de los paĂses de destino