Los paraísos fiscales. Un caso particular: La evolución de Andorra

[Resumen]: Las profundas reformas llevadas a cabo en el ámbito internacional, dirigidas fundamentalmente a la consecución de una mayor transparencia fiscal y cooperación, así como la constante lucha contra el blanqueo de capitales y financiación del terrorismo, han puesto en el punto de mira el fenómeno de los paraísos fiscales. El turbulento contexto normativo ha afectado especialmente a países que se encuentran en el límite terminológico de “paraíso fiscal”, y la efectividad de los compromisos de intercambio de información se está poniendo en entredicho. El presente Trabajo de Fin de Grado tiene por objeto analizar el concepto, características y vías de acceso a las ventajas proporcionadas por los paraísos fiscales, con la finalidad última de proponer una serie de medidas tendentes a paliar y, en la medida de lo posible, terminar con la opacidad y lograr la supresión del secreto bancario. Asimismo, se abordará el fenómeno de Andorra, principado que no sin esfuerzos ha tratado de evitar ser considerado paraíso fiscal como consecuencia de un cuestionable secreto bancario.[Abstract]: The deep reforms carried out in the international area, directed fundamentally to the attainment of a major fiscal transparency and cooperation, as well as the constant fights against money laundering and terrorism financing, have placed tax havens into the spotlight. The unsettled regulatory context has concerned specifically those to be operating within the term of "tax haven", and the efficiency of their commitments for a further exchange of information is being questioned. This final project aims to analyse the concept, characteristics and the ways to access the advantages provided by tax havens, with the overriding aim of proposing a series of measures tending to relieve and, to the extent possible, to end with opaqueness and to achieve the suppression of bank secrecy. We will also address the issues in Andorra, principality that, not without some difficulty, has tried to avoid being considered a tax haven as a consequence of a questionable bank secrecyTraballo fin de grao (UDC.ECO). ADE. Curso 2017/201

Are computerised respiratory sounds in COPD gender dependent?

This study explored gender differences in normal and adventitious respiratory sounds (RS) of patients with COPD. Twenty-six patients were enrolled. RS were recorded simultaneously at posterior right/left chest and airflow standardised (0.4-0.6l/s). Breathing phases were automatically detected using the airflow signals. Normal RS, crackles and wheezes were analysed with developed algorithms. The frequency of maximum intensity and the mean intensity of inspiratory normal RS were slightly higher in females than in males. During expiration, the mean intensity was lower in females, however, a significant difference was only found at posterior left (p=0.01). The mean number of crackles and wheezes seemed to be higher in male patients, although a significant difference was only observed in expiratory crackles at posterior right chest (p=0.04). Findings suggest that minor differences exist between female and male patients with COPD regarding normal and adventitious RS. However, it is still unknown if these differences are clinically relevant.publishe

Pulmonary rehabilitation is successful in mild Chronic Obstructive Pulmonary Disease

Pulmonary rehabilitation (PR) is effective in improving healthrelated quality of life of patients with moderate-to-very-severe COPD. However, the effects of PR in patients with mild COPD have been scarcely explored. The overall findings show that PR improves exercise tolerance, dyspnea, muscle strength, physical activity and health-related quality of life in patients with mild COPD, and that most of these benefits last for at least 6 months. This study is a relevant step towards the integration of PR as part of the first-line management of patients with mild COPDpublishe

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment

Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.info:eu-repo/semantics/publishedVersio

Pulmonary rehabilitation is successful in mild Chronic Obstructive Pulmonary Disease

Pulmonary rehabilitation (PR) is effective in improving healthrelated quality of life of patients with moderate-to-very-severe COPD. However, the effects of PR in patients with mild COPD have been scarcely explored. The overall findings show that PR improves exercise tolerance, dyspnea, muscle strength, physical activity and health-related quality of life in patients with mild COPD, and that most of these benefits last for at least 6 months. This study is a relevant step towards the integration of PR as part of the first-line management of patients with mild COPDpublishe

Are in person and telephone interviews equivalent modes of administrating the CAT, the FACIT-FS and the SGRQ in people with COPD?

Background: The COVID-19 pandemic brought numerous challenges, namely in routine assessment of people with chronic obstructive pulmonary disease (COPD). The COPD Assessment Test (CAT), the Functional Assessment of Chronic Illness-Fatigue-Subscale (FACIT-FS) and the St. George's respiratory questionnaire (SGRQ) are important patient-reported outcome measures used to assess people with COPD, but its face-to-face application has been compromised. The telephone interview offers a simple and effective alternative, yet uncertainty regarding its equivalence remains. This study aimed to establish the reliability and validity of the CAT, the FACIT-FS and the SGRQ administered by telephone interview in people with COPD. Methods: Data from an observational prospective study including people with COPD were analyzed. Participants answered to the CAT, FACIT-FS and SGRQ questionnaires in person and by telephone, with a maximum interval of 48-h. Participants were randomly selected to answer first to the in-person questionnaire followed by telephone or vice versa. Reliability measures included internal consistency with Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC2,1), test-retest measurement error with the standard error of measurement (SEM) and agreement with the Bland and Altman 95% limits of agreement. Validity was assessed with the Spearman correlation (rho). Results: Fifty-five people with COPD (44 men; 68.1 ± 7.9 years; FEV1: 59.1 ± 20.3% predicted) were included. Similar internal consistency was observed between in person vs. telephone interview for the CAT (0.82 vs. 0.84), the FACIT-FS (0.83 vs. 0.84) and the SGRQ (0.92 vs. 0.93). Test-retest reliability was excellent, with an ICC2,1 of 0.77 (95% CI: 0.65; 0.86), 0.86 (95% CI: 0.77; 0.92) and 0.94 (95% CI: 0.90; 0.96) for the CAT, FACIT-FS and SGRQ total scores, respectively. The SEM showed a low level of associated measurement error and the Bland and Altman plots illustrated a good level of agreement between both modes of administration, with no evidence of systematic bias. Robust positive correlations (rho 0.87–0.94, p < 0.001) were found for the CAT, FACIT-FS and SGRQ total scores applied by both methods. Conclusion: The telephonic administration of the CAT, the FACIT-FS and the SGRQ are a valid and reliable alternative approach to in person interviews for monitoring symptoms and health-related quality of life in people with COPD. The telephone might be an important add-on for personalized assessment and management of COPD thru remote monitoring.publishe

A vivência da DPOC em estadio avançado enquadrada no contexto da CIF

A doença pulmonar obstrutiva crónica (DPOC) é uma das principais causas de morbilidade e mortalidade mundiais. A patologia é inicialmente caracterizada pela limitação progressiva do fluxo de ar, mas com o avanço da doença, os pacientes experienciam também uma redução da capacidade funcional. A Organização Mundial de Saúde (OMS) recomenda o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para caracterizar o espectro típico de problemas de funcionalidade em pacientes com DPOC, o que não tem vindo a ocorrer. No entanto, para a implementação de um modelo de cuidados de saúde centrados no paciente, como preconizado também pela OMS, a aplicação da CIF não explora em profundidade a vivência da doença. Assim, este estudo tem como principal objectivo caracterizar de forma integrada a vivência dos pacientes com DPOC em estadio avançado, de acordo com a CIF. Uma amostra de conveniência de 15 pacientes (8 mulheres) com DPOC nos estadios III e IV, com idades compreendidas entre os 45 e os 80 anos, foi recrutada. Os dados foram recolhidos através de uma metodologia mista: aplicação do core set da CIF para as doenças pulmonares obstrutivas e realização de entrevistas individuais semi-estruturadas. A falta de energia, a dificuldade em gerir emoções, a intolerância ao exercício físico e a dispneia foram os principais problemas na componente das Funções do Corpo. Na componente das Actividades e Participação, foi notório o impacto profundo da DPOC na vida pessoal e na vida familiar dos participantes. Na componente dos Factores Ambientais, o clima e a qualidade do ar constituíram barreiras graves à vida dos participantes. Os sistemas de saúde foram considerados facilitadores, embora os participantes referissem necessitar de um apoio mais próximo. Relativamente às características pessoais, os participantes apresentavam muitos receios quanto à evolução da sua condição de saúde e para lidar com a doença tinham uma tendência para seleccionar estratégias de coping de evitamento e centradas nas emoções. O enquadramento da CIF permitiu um levantamento das necessidades dos pacientes com DPOC em estadio avançado nos diferentes domínios da saúde, condição fundamental para a delineação e implementação de intervenções integradas e centradas no paciente

Convolutional neural network for breathing phase detection in lung sounds

We applied deep learning to create an algorithm for breathing phase detection in lung sound recordings, and we compared the breathing phases detected by the algorithm and manually annotated by two experienced lung sound researchers. Our algorithm uses a convolutional neural network with spectrograms as the features, removing the need to specify features explicitly. We trained and evaluated the algorithm using three subsets that are larger than previously seen in the literature. We evaluated the performance of the method using two methods. First, discrete count of agreed breathing phases (using 50% overlap between a pair of boxes), shows a mean agreement with lung sound experts of 97% for inspiration and 87% for expiration. Second, the fraction of time of agreement (in seconds) gives higher pseudo-kappa values for inspiration (0.73-0.88) than expiration (0.63-0.84), showing an average sensitivity of 97% and an average specificity of 84%. With both evaluation methods, the agreement between the annotators and the algorithm shows human level performance for the algorithm. The developed algorithm is valid for detecting breathing phases in lung sound recordings

Determinación de seroprevalencia de brucelosis bovina en la Provincia de Pastaza y posibles factores de riesgo asociados con la enfermedad

La brucelosis bovina es una enfermedad que puede transmitirse de los animales a los humanos (zoonosis); causada por bacterias del género Brucella. Estos microorganismos tienen afinidad por el sistema reproductivo, tanto de machos como de hembras, causando orquitis, aborto en el último tercio de gestación, acompañado con retención placentaria y metritis, pudiendo llegar a causar infertilidad. El objetivo de este estudio fue establecer la prevalencia aparente de brucelosis bovina en la provincia de Pastaza, a través de dos pruebas serológicas: Rosa de Bengala y Suero Aglutinación Lenta en Tubo con EDTA y los factores de riesgo asociados a la aparición y permanencia de esta enfermedad en cada una de las fincas donde se desarrolló el presente estudio. La prevalencia encontrada en la provincia por finca fue de 3,4% y por animal fue de 1,04%. Se identificaron 14 factores de riesgo de los cuales los más importantes fueron el tipo de explotación (p valor = 0,001) y movilización (p valor= 0,22). Con este estudio se demostró que la brucelosis bovina afecta a las ganaderías de la provincia de Pastaza y el único factor de riesgo estadísticamente importante es el tipo de explotación.Bovine brucellosis is a disease that can be transmitted from animals to humans (zoonoses), caused by bacteria of the Brucella gender. These microorganisms have an affinity for the reproductive system of both males and females, causing orchitis, abortion in the last third of gestation, together with retained placenta and metritis, and can even cause infertility. The aim of this study was to establish the apparent prevalence of bovine brucellosis in the province of Pastaza, through two serological tests: Rose Bengal and Slow Serum Agglutination in Tube with EDTA and risk factors associated with the occurrence and continuance of this disease in each of the farms where this study took place. The prevalence found in the province per farm was 3.4% and per animal was 1.04%. We identified 14 risk factors of which the most important were the type of operation (p value = 0.001) and mobilization (p value = 0.22). This study demonstrated that bovine brucellosis affected herds in the province of Pastaza and the only statistically significant risk factor is the type of exploitation

Psychological functioning of patients at earlier grades of COPD

Chronic Obstructive Pulmonary Disease (COPD) has a major impact on patients' psychological function. Anxiety and depression have been reported in approximately 50% of patients with COPD. However, most of the available data is related to patients at advanced grades. The aim of this study was to assess the presence of anxiety and depression in patients at earlier grades of COPD. A cross-sectional study was carried out with 98 outpatients with COPD (GOLD 1 and GOLD 2) in the central region of Portugal. Socio-demographic and functioning data were collected with a questionnaire based on the International Classification of Functioning, Disability and Health. Spirometry was also performed. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics and χ2 tests were applied using PASW Statistics version 18.0. Participants mean age was 64.46±12.68 years old and mean FEV1 % predicted was 75.59±15.88. Approximately half of the sample (n=53; 54.08%) had symptoms of anxiety (HADS-A≥8), 40.82%(n=40) of depression (HADS-D≥8) and 31.63%(n=31) of both. The grade of COPD and gender were not found to be significantly associated with anxiety or depression. However, anxiety was significantly associated with severe dyspnea (p=0.025) and depression with higher difficulties in walking (p=0.001) and higher restrictions in participating in community life (p=0.049). Patients with COPD at earlier grades have high levels of anxiety and depression. Knowledge about the psychological functioning of patients with COPD will inform psycho-education and respiratory physiotherapy interventions, to support patients and improve their adjustment to the disease.publishe