Asset Booms and Tax Receipts: The case of Spain, 1995-2006

At about 3¾% for more than 10 years in a row, Spain is enjoying the longest period of sustained growth above the euro area since the late sixties. This period is also characterised by a combination of persistently low real interest rates and a dynamic demography, which has been feeding unprecedented growth in asset markets. In parallel, total-tax receipts have grown by about 4¼ percentage points of GDP, thus recording an elasticity with respect to GDP of 1.2. This paper discusses and assesses the extent to which the increase in tax receipts can be associated to changes in the composition of GDP, which would fade out after the current expansion tapers off. Econometric analyses provide evidence that 50 to 75 percent of the increase in tax revenues, observed in Spain between 1995 and 2006, might be of a transitory nature and would disappear with the asset boom. On this basis, in a context of significant composition effects, using standard tax elasticities may lead to an overestimation of structural revenues and to an incorrect assessment of the fiscal stance. This may be relevant in EMU because the likelihood of occurrence of asset booms may be relatively high when the monetary-policy stance is far from consistent with the country's inflation. Furthermore, in the specific case of Spain, the size of transitory composition effects associated to the current asset boom highlights the interest for the policymakers of the country to carefully assess the implementation of unfunded tax cuts and/or expenditure increases, especially those more difficult to revert in bad times.Fiscal policies, tax revenues, deficits, asset prices, composition effects, Spain, Martinez-Mongay, Maza Lasierra, Yaniz Igal

Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations

Purpose This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned. Methods A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system. Results The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19 min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation. Conclusions A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians’ time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system. Highlights This paper reports a realistic experience in the design and evaluation of a telemedicine solution for remote dermatology consultation (tele-dermatology) in Aragón, Spain. ► This study takes a different approach discussing the strengths and limitations of a teledermatology experience in a realistic manner. ► A list of lessons learned is provided for future teledermatology implementations. Many pediatricians are involved in the experience providing in this way a detailed concordance analysis for children dermatological clinics

Association of physical activity levels and prevalence of major degenerative diseases: Evidence from the national health and nutrition examination survey (NHANES) 1999–2018

Objectives: Degenerative diseases are associated with lower healthy life expectancy and higher mortality. Physical activity (PA) has demonstrated a fundamental role in the prevention and control of several pathologies associated to the aging process. The aim of this study was to analyze the association of PA with the prevalence of sarcopenia, osteoporosis and osteoarthritis in non-institutionalized American population. Methods: Cross-sectional study carried out in participants aged ≥50 years from the 1999–2018 National Health and Nutrition Examination Survey (NHANES). Sarcopenia was defined using appendicular lean mass adjusted for body mass index (ALM:BMI; men 1800 MET-min/week was associated with reduced odds for osteoporosis; and performing 150–1800 MET-min/week of PA was associated with reduced odds for osteoarthritis after adjust the results by several confounders. Conclusions: The benefits of PA in sarcopenia, osteoporosis, and osteoarthritis prevention are evident among Americans aged ≥50 years

A cross-sectional analysis of the association between physical activity, depression, and all-cause mortality in Americans over 50 years old

Depression is estimated to be the second leading cause of disability in the United States and is associated with a 52% increased risk of death. Lifestyle components may have an important role in depression pathogenesis. The aims of this study were to analyze the association of meeting the physical activity (PA) recommendation guidelines and depression, and to analyze the all-cause mortality risk of the joint association of PA and depression. This cross-sectional study included 7201 participants from the 2007–2014 National Health and Nutrition Examination Survey aged ≥ 50 years and linked to National Death Index records through December 31, 2015. Depression was defined as a score ≥ 10 using the Patient Health Questionnaire (PHQ-9). PA was self-reported, and total PA was used to classify participants as more active (≥ 600 MET-min/week) or less active (< 600 MET-min/week). The odds ratios for depression were examined according to be more active or less active. The hazard ratios (HR) for the association of PA level and depression status with all-cause mortality were examined. Being more active was associated with reduced odds for depression. Compared with less active participants with depression, those who were more active and having depression had HR 0.45 (95% CI 0.22, 0.91, p = 0.026) for all-cause mortality. Being more active is associated with lower odds for depression and seems to be a protective factor against the increased all-cause mortality risk due to depression

Sarcoma alveolar de partes blandas: aportación de un caso

Se presenta el caso de un sarcoma alveolar de partes blandas de 5 años de evolución, localizado en el tercio proximal del muslo izquierdo, en una mujer de 32 años. Tras los estudios radiológicos y complementarios con TAC y RNM, se efectuaron primero una punciónbiopsia y luego una biopsia preoperatoria que fueron informadas como negativas en cuanto a malignidad tumoral. El estudio histopatológico tras resección de la tumoración (5x7x 6 cm.), reveló la existencia de una neoplasia de bajo grado de malignidad de aspecto alveolar, formada por células de amplio citoplasma vacuolado con inclusiones PAS +. El estudio inmunohistoquúnico demostró débil positividad a la actinia, desmina y proteína S-100. Tras la cirugía, la paciente fué tratada con quimioterapia sistémica y radioterapia local. No se ha detectado recidiva local tras un año de evolución postoperatoria. Con este motivo de este caso, se revisa el enfoque diagnóstico y terapéutico de los sarcomas de partes blandas.The case of an alveolar soft tissue sarcoma located at the proximal left thigh of a 32-year-old woman is reported. The tumor had been growing for 5 years. After radiological and complementary studies with CT-scan and MRI, the needle-aspiration biopsy first and then the peroperative biopsy were found to be negative regarding malignancy. The histopathologic analysis of the resected tissue (5x7x 6 cm) revealed a low malignant neoplasia of alveolar pattern formed by cells with a wide vacuolated cytoplasm exhibiting PAS + inclusions. Immunohistochemical studies showed slight positive stain against actin, desmin and S-100 protein. After wide tumor resection, the patient was treated with sistemic chemotherapy and local radiation therapy. One year after surgery, no local recurrence has been detected. Based on this casereport, the diagnostic and therapeutic approach to soft tissue sarcomas is here reviewed

Metalosis por titanio en pseudoartrosis de húmero

Presentamos un caso clínico de pseudoartrosis diafisaria de húmero, en la que se pudo observar un proceso de corrosión por abrasión de los clavos centro-medulares, acompañado de la emisión de una gran cantidad de micropartículas metálicas (titanio) al interior de los tejidos. Se plantea la posibilidad, como otros trabajos han demostrado, que la presencia de titanio en el interior de los tejidos, estimule la liberación de sustancias mediadoras de la reabsorción ósea, favoreciéndose el proceso de su pseudoartrosis.We present a clinical case of humerus non-union. An excesive inestability of the focus caused a corrosion process of the titanium nails. Metal microparticles were delivered. Inmunity reaction versus titanium occasioned osseus reabsortion and it favoured the pseudoarthrosis process

Active video games improve muscular fitness and motor skills in children with overweight or obesity

(1) Background: Childhood obesity is an important public health problem. Children with overweight or obesity often tend to show the pediatric inactivity triad components; these involve exercise deficit disorder, pediatric dynapenia, and physical illiteracy. The aim of the study was to examine the influence of an active video games (AVG) intervention combined with multicomponent exercise on muscular fitness, physical activity (PA), and motor skills in children with overweight or obesity. (2) Methods: A total of 29 (13 girls) children (10.07 ± 0.84 years) with overweight or obesity were randomly allocated in the intervention group (AVG group; n = 21) or in the control group (CG; n = 8). The intervention group performed a 5-month AVG training using the Xbox 360® with the Kinect, the Nintendo Wii®, dance mats, and the BKOOL® interactive cycling simulator, combined with multicomponent exercise, performing three sessions per week. The control group continued their daily activities without modification. Weight, PA using accelerometers, and motor competence using the Test of Gross Motor Development 3rd edition were measured. Muscular fitness was evaluated through the Counter Movement Jump height, maximal isometric strength of knee extension and handgrip strength, and lean mass using Dual-energy X-ray Absorptiometry. Mann–Whitney U and Wilcoxon signed rank tests were performed. The biserial correlation coefficients (r) were calculated. Spearman’s correlation coefficients among PA, muscular fitness, and motor competence variables were also calculated. (3) Results: The AVG group significantly increased their knee extension maximal isometric strength (4.22 kg; p < 0.01), handgrip strength (1.93 kg; p < 0.01), and jump height (1.60 cm; p < 0.01), while the control group only increased the knee extension maximal isometric strength (3.15 kg; p < 0.01). The AVG group improved motor competence and light physical activity (p < 0.05) and decreased sedentary time (p < 0.05). Lean mass improved in both AVG group and CG (p < 0.05). Lastly, the percentage of improvement of motor skills positively correlated with the percentage of improvement in vigorous PA (r = 0.673; p = 0.003) and the percentage of improvement in CMJ (r = 0.466; p = 0.039). (4) Conclusions: A 5-month intervention combining AVG with multicomponent training seems to have positive effects on muscle fitness, motor competence, and PA in children with overweight or obesity