METODOLOGÍA PARA EL CÁLCULO DEL IMPACTO AMBIENTAL DE LA LOGÍSTICA FARMACÉUTICA EN CUBA

Introducción: El aumento del impacto ambiental en la logística farmacéutica, ha despertado el interés por el uso de herramientas como el Análisis de Ciclo de Vida (ACV) para lograr operaciones menos agresivas con el medioambiente. A pesar de esto, su uso continua siendo fragmentario y existe poca evidencia de su aplicación en la logística de medicamentos en Cuba. Por lo tanto, es necesario diseñar una herramienta para el apoyo a la toma de decisiones con enfoque en el impacto ambiental de las operaciones logísticas. Objetivo: Diseñar una metodología para el cálculo del impacto ambiental de las operaciones logísticas en la cadena de suministro de medicamentos en Cuba. Materiales y Métodos: A partir de la revisión de la literatura especializada, se diseñó una metodología con enfoque en el ACV y para el cálculo del impacto ambiental de la logística farmacéutica en Cuba. Además, se caracterizó el funcionamiento logístico de la cadena de suministro de medicamentos para contextualizar la aplicación de la metodología y favorecer la toma de decisiones. Resultados y Discusión: Se diseñó una metodología adaptada a las características de la logística farmacéutica en Cuba. Esta constituye una guía para tomar decisiones enfocadas en las operaciones logísticas sostenibles. El diseño se llevó a cabo con enfoque en la mejora continua y la retroalimentación para asegurar la implementación efectiva. Conclusiones: La aplicación de la metodología permitirá el diseño de los procesos logísticos a lo largo de la cadena de suministro de medicamentos para la selección de alternativas más limpias

Desempeño integral de los procesos logísticos en una cadena de suministro

This paper aims to establish a general method to measure the overall performance of logistics processes in the lines of tacking the Graphic Enterprise of Villa Clara, problems affecting its performance in the processes of purchasing, customer service and internal transport. To measure the overall performance of the logistics processes, the indicator Overall Performance Level of the Logistic Processes is built (NDIPL). For this, interviews, expert method, multicriteria methods, statistical techniques, direct observation and records analysis were applied. Once the procedure was applied and determined the level of overall performance of the selected logistics processes, better results were achieved in some of the indicators evaluated in these logistic processes and in the level of overall performance. Also, it was demonstrated the possibility of using this procedure as an instrument for evaluating logistics processes.El trabajo persigue desarrollar un procedimiento general que permita medir el desempeño integral de los procesos logísticos en las líneas de presillado de la Empresa Gráfica de Villa Clara. Se identifican los problemas que afectan su desempeño en los procesos de compras, servicio al cliente y el proceso de transporte interno. Para medir el desempeño integral de los procesos logísticos se utiliza el indicador Nivel de Desempeño Integral de los Procesos Logísticos (NDIPL). Se aplicaron entrevistas, método de expertos, métodos multicriterios, técnicas estadísticas, observación directa y análisis de registros. Una vez aplicado el procedimiento y determinado el nivel de desempeño integral de los procesos logísticos seleccionados, se lograron mejores resultados en algunos de los indicadores evaluados en estos procesos logísticos y en el nivel de desempeño integral. Se demuestra la posibilidad de utilizar dicho procedimiento como instrumento de evaluación de los procesos logísticos

Modelo multicriterio para la gestión integral de residuos sólidos urbanos en Quevedo – Ecuador

The analysis of the urban solid waste supply chain reveals the main problems that affect it. This work presents a multi-criteria model for the optimization of the economic variables, environmental impact and customer satisfaction of the integral management process of urban solid waste, which facilitates the promotion of systematic improvement actions of variables or factors that intervene in the process . The model allows generating information for decision-making by municipal authorities in the canton of Quevedo-Ecuador. To achieve this, a diagnosis was made of the current conditions of the generation, transport, separation, treatment, composting and final disposal process of these wastes, identifying the relevant indicators for the current management of the same and later the multi-criteria model was elaborated including four objective functions whose goal is the optimization of the problem, considering a series of restrictions in each of the processes mentioned above. The result obtained allows minimizing the cost and use of transportation, maximizing savings in environmental impact and customer satisfaction. It is concluded that the application of the multi-criteria model allowed to verify its feasibility and rational use as an effective instrument of the decision-making process.El análisis de la cadena de suministros de residuos sólidos urbanos permite revelar los principales problemas que la afectan. Este trabajo presenta un modelo multicriterio para la optimización de las variables económicas, impacto ambiental y satisfacción al cliente del proceso de gestión integral de los residuos sólidos urbanos, el cual facilita que se promuevan acciones de mejora sistemática de variables o factores que intervienen en el proceso. El modelo permite generar información para la toma de decisiones por parte de autoridades municipales, en el cantón de Quevedo-Ecuador. Para lograrlo, se procedió a hacer un diagnóstico de las condiciones actuales del proceso de generación, transporte, separación, tratamiento, compostaje y disposición final de éstos residuos, identificando los indicadores pertinentes para la gestión actual del mismo y posteriormente se elaboró el modelo multicriterio incluyendo cuatro funciones objetivas cuya meta es la optimización del problema, considerando una serie de restricciones en cada uno de los procesos mencionados anteriormente. El resultado obtenido permite minimizar el costo y uso de transporte, maximizar el ahorro del impacto ambiental y la satisfacción al cliente. Se concluye, que la aplicación del modelo multicriterio permitió constatar su factibilidad y racional utilización como instrumento efectivo del proceso de toma de decisiones

Burden of non-communicable disease studies in Europe : a systematic review of data sources and methodological choices

Background Assessment of disability-adjusted life years (DALYs) resulting from non-communicable diseases (NCDs) requires specific calculation methods and input data. The aims of this study were to (i) identify existing NCD burden of disease (BoD) activities in Europe; (ii) collate information on data sources for mortality and morbidity; and (iii) provide an overview of NCD-specific methods for calculating NCD DALYs. Methods NCD BoD studies were systematically searched in international electronic literature databases and in grey literature. We included all BoD studies that used the DALY metric to quantify the health impact of one or more NCDs in countries belonging to the European Region. Results A total of 163 BoD studies were retained: 96 (59%) were single-country or sub-national studies and 67 (41%) considered more than one country. Of the single-country studies, 29 (30%) consisted of secondary analyses using existing Global Burden of Disease (GBD) results. Mortality data were mainly derived (49%) from vital statistics. Morbidity data were frequently (40%) drawn from routine administrative and survey datasets, including disease registries and hospital discharge databases. The majority (60%) of national BoD studies reported mortality corrections. Multimorbidity adjustments were performed in 18% of national BoD studies. Conclusion The number of national NCD BoD assessments across Europe increased over time, driven by an increase in BoD studies that consisted of secondary data analysis of GBD study findings. Ambiguity in reporting the use of NCD-specific BoD methods underlines the need for reporting guidelines of BoD studies to enhance the transparency of NCD BoD estimates across Europe

CT or Invasive Coronary Angiography in Stable Chest Pain.

Background: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. Methods: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris. Results: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). Conclusions: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.)