Las propuestas previas de tributación en el País Vasco: posible modelo hacia el cumplimiento cooperativo

The new models in the legal-tax relationship point out to a possible evolution where cooperation between tax administration and the taxpayer is enhanced. It is glimpsed a state of legal security from the tax agreements that might arise. However, this idyllic transformation in the relationship between the tax administration and the taxpayer does not lack negative effects such as taxing on demand, individualistic or not being feasible for the rest of the taxpayers. Because of these circumstances and the search for new mechanisms, still under construction, the previous tax proposals included in the Basque tributary administration can be a convenient model to apply to the rest of the Spanish State in order to fulfill a cooperative compliance.Los nuevos paradigmas en la relación jurídico-tributaria apuntan hacia una posible evolución donde la cooperación entre la Administración tributaria y el contribuyente debe ponerse en valor. En todo ello se vislumbra un entorno de mayor seguridad jurídica propiciado por los acuerdos fiscales que puedan producirse. Si bien, esta idílica transformación en las relaciones entre Administración y contribuyente no está exenta de efectos nocivos como puede ser la aparición de una fiscalidad a la carta, individualista e indisponible para los demás contribuyentes. Ante tales circunstancias, y la búsqueda de nuevos mecanismos que fragüen un proceso aún en construcción, las propuestas previas de tributación que se contemplan en la normativa foral pueden ser un modelo conveniente para su aplicación al resto del Estado en aras de avanzar hacia el cumplimiento cooperativo

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

Background: Age-related multiple comorbidities cause older adults to be prone to the use of potentially inappropriate medicines (PIM) resulting in an increased risk of adverse events. Several strategies have emerged to support PIM prescription, and a huge number of interventions to reduce PIM have been proposed. This work aims to analyze the effectiveness of PIM interventions directed to older adults. Methods: A systematic review was performed searching the literature in the MEDLINE PubMed, EMBASE, and Cochrane scientific databases for interventional studies that assessed the PIM interventions in older adults (≥65 years). Results: Forty-seven articles were included, involving 52 to 124,802 patients. Various types of interventions were analyzed such as medication review, educational strategies, clinical decision support system, and organizational and multifaceted approaches. In the hospital, the most successful intervention was medication review (75.0%), while in primary care, the analysis of all included studies revealed that educational strategies were the most effective. However, the analysis of interventions that have greater evidence by its design was inconclusive. Conclusion: The results obtained in this work suggested that PIM-setting-directed interventions should be developed to promote the wellbeing of the patients through PIM reduction. Although the data obtained suggested that medication review was the most assertive strategy to decrease the number of PIM in the hospital setting, more studies are necessary

Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal

Background: Portugal has among the highest rates of dependency among older adults in Europe. Older adults with aging-related comorbidities are prone to the use of potentially inappropriate medication (PIM). Objective: The aim of this study was to analyze PIM prescriptions in older Portuguese adults, as well as the change rate of PIM prescriptions over time, and assess the geographical variability between the different regions of mainland Portugal. Methods: Using a national database, PIM prescriptions were analyzed for older adults (aged 65 years and older) between 2019 and 2021 from 2 perspectives: PIM-defined daily dose (DDD) frequency (%) and DDD per 1000 inhabitants per day (DID). Results: Overall, mainland Portugal presented a PIM DDD frequency of 9.20%, which was relatively higher in Alentejo and Centro and lower in the North. Alprazolam, fluoxetine, and rivaroxaban were PIM with higher DDD frequency values. Over the years, the DID change rates for these three PIM were -3.80%, -14.86%, and +18.54%, respectively, depending on the geographic region. Alprazolam and fluoxetine were mostly prescribed to older women, whereas rivaroxaban was mostly prescribed to older men. Conclusions: These results emphasize the need to implement initiatives and interventions to decrease PIM prescriptions in older adults

@CpaInnova

Memoria ID-108. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Composition and seasonal variation of epigeic arthropods in field margins of NW Portugal

Field margins act as shelters for different arthropod taxa in agricultural fields. Several factors may promote seasonal changes in arthropod communities, especially in regions with marked seasonality, such as Mediterranean areas. Epigeic arthropods were sampled from the margins of fields located in northwestern Portugal during 2 contrasting seasons, spring and autumn. Organisms were identified to family or order level and seasonal variation in arthropod communities was evaluated. Abundance, group richness, and feeding guild parameters were affected by sampling season, with both abundance and richness being higher in spring. Of the groups captured in both seasons, most evidenced either higher abundance in spring or similar abundance between seasons. Ants constituted one of the most abundant trophic guilds in spring but one of the least captured in autumn, while catches of parasitoids and parasites were not affected by sampling season. Results indicate that the higher taxa approach is useful to distinguish seasonally distinct communities

Uncovering genetic causes of hypophosphatemia

Background Chronic hypophosphatemia can result from a variety of acquired disorders, such as malnutrition, intestinal malabsorption, hyperparathyroidism, vitamin D deficiency, excess alcohol intake, some drugs, or organ transplantation. Genetic disorders can be a cause of persistent hypophosphatemia, although they are less recognized. We aimed to better understand the prevalence of genetic hypophosphatemia in the population. Methods By combining retrospective and prospective strategies, we searched the laboratory database of 815,828 phosphorus analyses and included patients 17?55 years old with low serum phosphorus. We reviewed the charts of 1287 outpatients with at least 1 phosphorus result ?2.2 mg/dL. After ruling out clear secondary causes, 109 patients underwent further clinical and analytical studies. Among them, we confirmed hypophosphatemia in 39 patients. After excluding other evident secondary causes, such as primary hyperparathyroidism and vitamin D deficiency, we performed a molecular analysis in 42 patients by sequencing the exonic and flanking intronic regions of a panel of genes related to rickets or hypophosphatemia (CLCN5, CYP27B1, dentin matrix acidic phosphoprotein 1, ENPP1, FAM20C, FGFR1, FGF23, GNAS, PHEX, SLC34A3, and VDR). Results We identified 14 index patients with hypophosphatemia and variants in genes related to phosphate metabolism. The phenotype of most patients was mild, but two patients with X-linked hypophosphatemia (XLH) due to novel PHEX mutations had marked skeletal abnormalities. Conclusion Genetic causes should be considered in children, but also in adult patients with hypophosphatemia of unknown origin. Our data are consistent with the conception that XLH is the most common cause of genetic hypophosphatemia with an overt musculoskeletal phenotype

The information management in palliative care

According to the patient’s autonomy law (Law 41/2002, of November 14), is the patient who has the right to be informed and the owner of the information it receives. It has developed a structured interview was administered randomly to the relatives of the patients in the care process Palliative Care Unit (PCU) of the Virgen de las Nieves Hospital of Granada, to assess the level of awareness about this law. In addition to assessing the level of knowledge that the patient has about their diagnosis / prognosis. The data obtained in this study contrast with the Act, where less than half of patients, according to their families, know their disease and a lower figure is reported fourth of its forecast. Also, most advanced patient relatives are against the law of patient autonomy. This requires that more professionals we strive to achieve a communicative process that brings the patient to his reality and support in their last phase of life

Cardiomiopatia hipertrófica dilatada com síndrome de Wolff-Parkinson-White

A cardiomiopatia hipertrófica é uma doença genética com apresentaçao, prognóstico e estratégias de tratamento variáveis. A visibilidade ligada à cardiomiopatia hipertrófica refere-se em grande parte a seu reconhecimento como causa comum de taquiarritmias e morte súbita cardíaca. O cardiodesfibrilador implantável é aceito como tratamento definitivo para prevençao de morte súbita, especialmente em pacientes de alto risco. Apesar da baixa prevalência, a via acessória é encontrada em 5% dos pacientes com cardiomiopatia hipertrófica e a ablaçao é o método de escolha, em decorrência do risco de taquiarritmias atriais. Relatamos o caso de um paciente com cardiomiopatia hipertrófica, em fase dilatada, com via acessória