Pension system for same-sex couples in Colombia

El presente trabajo busca reflejar uno de los cambios progresivos del sistema de seguridad social en Colombia después de la Constitución de 1991; el sistema pensional para parejas del mismo sexo. Como primera medida, se realiza un recuento de la evolución doctrinal, constitucional y legal que ha catalizado el cambio normativo, destacando los hitos más importantes. Posteriormente, se presenta en términos prácticos cómo las parejas del mismo sexo son beneficiados por el sistema de seguridad social en pensiones. Por último, se presenta un estudio de derecho comparado sobre la materia, y un análisis de los efectos económicos del mismo.This essay aims to depict how Colombian Social Security has changed along with social transformations. A new approach towards same sex couples has been introduce progressively in the State’s Social Security System. In order to illustrate so, the text includes a series of regulations, which constitute the basis and framework for the transformation, plus the most important jurisprudence concerning the subject. The system’s extension to same sex couples resulted on benefits, subsequently explained. Following this, a brief study on Comparative Law describes how this same transformation has taken place in other countries and how these have opted to embrace it. Finally, amid the positive consequences arising from the situation, the authors convey an analysis upon negative economic effects that could potentially result from the transition

WTO Law & Environmental policies : consistency of eco-labels, carbon taxes and green subsidies under WTO provisions

La presente monografía propone soluciones legales a la tensión entre el comercio internacional y el medio ambiente en el marco de la OMC. Medidas como impuestos al carbono, etiquetas ambientales y subsidios ambientales son comúnmente implementados con el objetivo de reducir las emisiones de carbono. No obstante, los Miembros deben diseñar cuidadosamente las medidas para evitar inconsistencias con las obligaciones del GATT, el OTC y el Acuerdo sobre Subvenciones y Medidas Compensatorias. Adicionalmente, el Artículo XX del GATT incluye excepciones que buscan un balance entre el acuerdo multilateral y el derecho de cada Miembro a establecer sus propias políticas públicas.This monograph aims to provide legal solutions to the tension between trade and environment within the WTO forum. Policy instruments such as Carbon Taxes, Eco- labels and Green Subsidies are commonly used by WTO Members to tackle climate change’s effects as they incentivize the de-carbonization of national economies. Nonetheless, Members must carefully design these environmental measures to avoid inconsistencies with its commitments under the GATT, the TBT and the SCM Agreements. Moreover, Article XX of the GATT enshrines exceptions that provide a balance between the multilateral agreement and the individual policy space that every Member is entitled to.Abogado (a)Pregrad

Transición energética en colombia: No necesariamente una realidad que se sustenta en el cambio climático

The development of the NCRES seeks to improve society’s well-being and environment preserva­tion through cleaner energy sources and the reduction of greenhouse gas emissions. This document is focused on reviewing the causes of the energy transition in Colombian, along with the public poli­cies about NCRES, and analyzing the economic incentives that have been established. Finally, it will propose some adjustments considering the new challenges and opportunities regarding energy, partic­ularly green hydrogen as a new opportunity to diversify the energy matrix.El desarrollo de las FNCER busca el mejoramiento del bienestar de la sociedad con la preservación del medio ambiente a través de fuentes de generación de energía mucho más limpias y que reducen las emisiones de gases de efecto invernadero. En este escrito se busca revisar las causas de la transición energética, así como las más recientes políticas públicas colombianas en el desarrollo de los FNCER y analizar los incentivos tributarios que se han consagrado. Así mismo, proponer algunas modificaciones de cara a los nuevos retos y oportunidades energéticas, particularmente en relación con la novedad del hidrógeno verde como una oportunidad de diversificar la matriz energética

Design of an algorithm for the diagnostic approach of patients with joint pain

Background Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. Objective To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. Methods Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point “joint pain” as a common symptom for the four diseases. Results Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. Conclusion We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk