Autonomy should not be understood as an inherent quality of rural subjects but as fundamentally a political and cultural project. This paper will present an overview of the evolution of the idea, project, and practice of peasant and indigenous autonomy in Latin America from the 1990s to today. It will trace the origins of the process and examine how the different dimensions of the concept of autonomy (economic, political, ideological, and ethnic) came together in the early 1990s to form a coherent although contradictory political project, which attempted to present an alternative to neoliberalism and political paternalism. The paper will assess the extent to which this project addressed the main challenges that the different sectors of the peasantry faced with the neoliberal restructuring of the economy and the deployment of neoliberal multiculturalism in the region. Through the case studies of Brazil, Ecuador, Nicaragua, and Mexico, the paper will argue that the autonomy projects entailed serious contradictions since their inception because by wanting to solve some problems through certain mechanisms, rural

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Objective: Despite significant improvements in diagnosis delay and treatment strategies, the burden of Systemic Lupus Erythematosus (SLE) remains high. The objective of the study was to assess the association between diagnosis delay, disease activity and burden on daily life (BoDL) in a large sample of European patients with SLE. Methods: In May 2020, Lupus Europe, the European umbrella patient association for SLE, conducted a multilingual anonymous online cross-sectional study to individuals with a self-reported physician's diagnosis of SLE living in Europe. The BoDL score was computed using 1 to 5 Likert scales on 5 domains (mobility, anxiety/depression, self-care, daily activities and pain/discomfort) and the sum was rescaled on a 0 (minimum Burden on daily life) to 100 (maximum BoDL) scale. Comparisons between independent groups were made using the Mann-Whitney test for continuous outcomes and the Chi-2 test (or Fisher exact test) for quantitative data. Results: Data of 4,150 SLE patients from 35 European countries were analysed. Those with a diagnosis of SLE within 2 years of first symptoms had significantly lower mean BoDL scores than those diagnosed after 5 years (33.6 versus 44.0, p<0.001). The BoDL score was better in SLE patients feeling that their lupus had been under control during the last 3 months versus the others (34.0% versus 47.6%, p<0.001). Conclusion: This large international study highlights the association between diagnosis delay and self-perceived disease activity with the burden of the disease on the daily life of people living with SLE. Healthcare pathways, which may accelerate diagnosis and optimize therapeutic management, are necessary to improve patients outcomes in SLE.

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